Chewing the fat on a keto cure for diabetes
Israeli endocrinologist Dr Mariela Glandt is on a mission. She has begun a “revolution” against orthodox medicine for type-2 diabetes (T2D) in Israel.
Glandt, a graduate of Harvard and Columbia universities in the US, hopes to spread the revolution globally wherever T2D is epidemic. That includes SA. “Doctors can no longer ignore the evidence that drug treatment for T2D does not work,” she says.
“It just makes patients fatter, sicker and coming back for more [drugs].”
That’s a provocative opinion among some doctors worldwide. They say there is an alternative to drugs for T2D that’s more effective, safer and cheaper. It is dietary change.
In other words, the “right” foods that don’t cause blood sugar (glucose) spikes and excessive insulin release that are T2D hallmarks.
That alternative powered Glandt’s first revolutionary salvo
Metabolix 2019, Bringing You the Science of Keto, in Tel Aviv in November. It was Israel’s first international conference showcasing the evidence for low-carbohydrate, highhealthy-fat (LCHF) and ketogenic (very LCHF) diets.
The focus was on the best foods to treat, control or prevent T2D without drugs; foods to turn back the tide of common T2D co-morbidities (presence of more than one disease or disorder in the same person), particularly heart disease, kidney disease, blindness and cancer that make it such a devastating, life-threatening condition. Not forgetting dementia and significant risk of limb amputation.
Animal foods topped the best-food list, and speakers showed why plant foods don’t match animal foods for nutrient density. That did not make the conference anti-plants or LCHF echo chambers. There were dissenting voices. Speakers showed it’s possible (not easy) to be vegetarian on LCHF and keto, and even vegan only if you really know what you’re doing and preferably only under medical supervision.
The conference showed that low-carb is already becoming medical mainstream. One sign was conference support from the Israeli Diabetes Association and Kupat Holim Meuhedet, Israel’s third-largest health-care insurer network.
Speakers gave other signs: in the UK, doctors prescribe lowcarb for T2D patients under the country’s NHS (National Health Service). British GP David Unwin showed how his practice saves the NHS £50,000 annually in unprescribed insulin for T2D patients.
Earlier in 2019, the American Diabetes Association consensus statement included low-carb diets as diabetes options. Other countries are making similar changes but SA isn’t.
Speaker after speaker dispatched any vestige of lowcarb controversy.
Glandt said she changed her medical practice four years ago after it dawned on her that there was something wrong with the logic of giving more insulin to T2D patients who already had excessively high insulin levels.
“Why not just tell patients to stop eating foods that raise insulin levels in the first place?” she said.
Why not indeed. Especially since speakers said it’s well known that carbs cause maximum insulin release and most high-fat, protein foods cause minimal release.
Speakers said many dietitians (including in SA) still tell diabetics to “eat carbs moderately”. That elicited Unwin to comment: “Telling diabetics to eat carbs moderately just leaves them moderately poisoned.”
Many dietitians still see carbs as optimum brain fuel. Conference speakers showed that the real brain food and fuel is fat.
They probed the soft underbelly of the aforementioned “real meat” of controversy: not just high-fat but saturated-fat content of LCHF and keto diets.
Speakers showed why saturated fat still strikes fear into hearts and minds of doctors globally. It’s a legacy of the decades-old “diet-heart hypothesis” that saturated fat causes heart disease.
The conference neatly and unequally divided into dietheart hypothesis detractors and supporters. On one side were detractors, the majority, who say the diet hypothesis is unproven, terminally ill, deserves a decent burial but lives on, zombie-like, in its spawn: low-fat, high-carb diets.
On the other side were supporters who say the hypothesis is alive and well and low-fat diets are “heart-healthy” because, unlike LCHF and keto, they don’t increase cardio vascular disease risk by raising “bad” LDL-cholesterol.
Both sides say they have data for their positions.
And it’s true that LCHF and keto diets often do raise LDL levels. Dr Stephen Phinney, US emeritus professor of internal medicine and a specialist in clinical nutrition, explained why that’s nothing to worry about.
Phinney is co-founder and head of Virta Health, a US research-based programme assessing how doctors can reverse “millions of cases of T2D”. a transient He said raised”LDL effect , the is result mostly of “mobilisation” of pre-existing cholesterol in the circulation system from fat cells after weight loss.
In those for whom LDL levels remain high long term, he’d have “no inhibition” in adding a statin (cholesterollowering drug).
Israeli endocrinologist Dr Roy Eldor was adamant that doctors must worry about raised LDL.
Eldor is an internist, a researcher and director of the Tel Aviv Sourasky Medical Centre Diabetes Unit Institute of Endocrinology, Metabolism and Hypertension.
He said doctors can’t know for sure that raised LDL isn’t doing harm by causing atherosclerosis (arterial plaque build-up that can rupture, causing heart attack and stroke) because “the data isn’t there”.
Few cardio vascular disease biomarkers have “more merit than LDL-cholesterol”, Eldor said.
Statins for elevated LDL are one of modern medicine’s “most evidence-based” life-saving interventions in terms of “hard outcomes” (lives saved).
Paediatric endocrinologist Ram Weiss, professor at the Technion School of Medicine and head of paediatrics at Ruth Children’s Hospital, Rambam Medical Centre, Haifa, was more muted but strong on data primacy.
Evidence for LDL risk may not be “as strong as everyone thinks it is”, but it is significant, Weiss said.
“You can’t argue with the data. The truth, even when it’s painful, is still the truth.”
Glandt saw another truth from her side of the scientific fence: the decades-long demonisation of saturated fat on the basis of the diet-heart hypothesis caused “fat phobia” that doctors passed on to patients.
“It paralysed us,” she said. “It made us scared to use powerful, natural, safe, cheaper weapons we have LCHF and keto.”
Take-home messages from the conference were hopeful: T2D is not necessarily the lifethreatening disease doctors once thought it was.
Dietary change can reverse all T2D symptoms and prevent lifelong drug dependency.
TELLING DIABETICS TO EAT CARBS MODERATELY JUST LEAVES THEM MODERATELY POISONED