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Thursday 30 April 2015

Effects of a long-term lifestyle intervention program with Mediterranean diet and exercise for the management of patients with metabolic syndrome



The impact of a lifestyle intervention (LSI) program for the long-term management of subjects with metabolic syndrome in a primary care setting is not known.


This 3-year prospective controlled trial randomized adult subjects with metabolic syndrome to receive intensive LSI or to usual care in a community health centre in Malaga, Spain. LSI subjects received instruction on Mediterranean diet and a regular aerobic exercise program by their primary care professionals. Primary outcome included changes from baseline on different components of metabolic syndrome (abdominal circumference, blood pressure, HDL-cholesterol, fasting plasma glucose and triglycerides).


Among the 2,492 subjects screened, 601 subjects with metabolic syndrome (24.1%) were randomized to LSI (n = 298) or to usual care (n = 303); of them, a 77% and a 58%, respectively, completed the study. At the end of the study period, LSI resulted in significant differences vs. usual care in abdominal circumference (−0.4 ± 6 cm vs. +2.1 ± 6.7 cm, p < 0.001), systolic blood pressure (−5.5 ± 15 mmHg vs. -0.6 ± 19 mmHg, p = 0.004), diastolic blood pressure (−4.6 ± 10 mmHg vs. -0.2 ± 13 mmHg, p < 0.001) and HDL-cholesterol (+4 ± 12 mg/dL vs. +2 ± 12 mg/dL, p = 0.05); however, there were no differences in fasting plasma glucose and triglyceride concentration (−4 ± 35 mg/dl vs. -1 ± 32 mg/dl, p = 0.43 and −0.4 ± 83 mg/dl vs. +6 ± 113 mg/dl, p = 0.28).


Intensive LSI counseling provided by primary care professionals resulted in significant improvements in abdominal circumference, blood pressure and HDL-cholesterol but had limited effects on glucose and triglyceride levels in patients with metabolic syndrome.

They should have trialed low carb instead of the Med diet then they would have seen big improvements on glucose and triglyceride levels


Seven years to the day I buried my Father, he died riddled with diabetic complications.

Seven years to the day I buried my Father, he died riddled with type two diabetic complications. Like many of his generation he followed the advise of his medical professionals to the letter. He followed a high carb low fat regime. On insulin and ten type two related medications, his last years were blighted and painful. In his younger days he was a Royal Marine, he taught me about boxing and was a fighter to the end.  

A tune he loved from the best military band in the world, well he certainly believed it. He also believed the Marines the best armed force in the world. No doubt other men and women from other armed forces would disagree with that. It's amazing the life long loyalty serving in the military so often brings about. Eddie

Quote of the day Tim Noakes talking about LCHF

The Low Carb Diabetic read by people all over the World.

The screen shot is from our audience stats for the last month. Please note, we only get the stats from the top ten countries. I ask myself, do so many people speak English, or is it the fact we have a language translation feature on this blog. Thank you to all the people that take the time to read our blog, and the very best of luck and good health to you and yours. Eddie

Northern Ireland midwives stage strike action.

"Midwives in Northern Ireland are staging a four-hour strike action on Thursday in a dispute over pay.

They are calling for a 1% pay increase, as was given to their colleagues in Wales, Scotland and England.

The industrial action is being held between 08:00 BST and 12:00 BST.

It is the first time members of the Royal College of Midwives have staged a strike in their 134-year history.

The Department of Health said officials were working to ensure a safe service was provided during the stoppage."

While NHS fat cats draw eye watering high salaries and pensions, the people at the coal face have to fight for a very modest pay rise. PM Cameron said he would not meddle with the NHS, he lied.

Full story to above here.


"He promised "no more pointless and disruptive reorganisations". Instead, change would be "driven by the wishes and needs of NHS professionals and patients".  Link to the promise here.

Diabetes UK will they ever see the light ?

Courgettes / Zucchini - Some Helpful Hints

Courgettes / Zucchini are becoming ever more popular and with good reason, they have a deliciously sweet, nutty taste. They’re often used to bulk out sauces and dishes like a bolognaise or lasagne, but why not also enjoy courgettes in their own right.

Many of us enjoy growing our own Courgettes, but if left too long in the soil, they will grow huge and bloated with water. While these green monsters might look magnificent, the best tasting courgettes are the shorter, slim ones.

If you’re already living the LCHF lifestyle, you will know that courgettes are low in carbs, just 2g. carb per 100g, and they are probably high up on your must buy shopping (or growing) list. They may not pack the nutritional punch of other green vegetables (broccoli, kale etc.) but they do contain significant levels of potassium to control blood pressure and vitamin C to boost your immune system.

The courgette’s thin dark skin is high in soluble fibre, which slows digestion and stabilises blood sugar levels – potentially getting rid of those pesky mid-afternoon sweet cravings. Soluble fibre can also prevent constipation and help with those horrible IBS symptoms so many of us endure.

You can buy courgettes from most big supermarkets as well as small farmers markets (when in season). Many prefer to buy locally sourced courgettes as supermarkets can of course ship vegetables thousands of miles despite them being in season a few minutes down the road, but how and where you buy is always a personal choice.

Now – how to prepare courgettes? Try not to cook courgettes with too much water as they can go quite soggy. The best way to cook them is to get a good crunch. Slice them in thin chip shapes, place them on foil and drizzle with extra virgin olive oil and a sprinkling of salt, spices and herbs, then place under the grill until golden. You can eat these as a snack, or with a salad. Alternatively, you can roast courgettes up with a selection of other vegetables to enjoy with classic meat and buttery mashed swede. Or you can make Greek style fritters on the BBQ with lots of chopped dill.

Courgettes keep well in the fridge, but don’t leave them too long or they’ll develop a slightly bitter taste.

More information here, with a lovely Courgette / Zucchini Fries recipe here.
Some text taken from this resource here

All the best Jan

Wednesday 29 April 2015

Is Tim Noakes REALLY SA’s new ‘Dr Death’? Here’s a big fat surprise!

UPDATED with new info:  
The nutrition gloves have come off again. This time it looks suspiciously like Big Food squaring up through its dietitian proxies against emeritus University of Cape Town professor Tim Noakes and low-carb, high-fat (LCHF). I’ve been watching with amusement, and more than a little mystification, the flurry of recent “news” reports announcing that the Health Professions Council of SA is investigating Noakes for ‘unprofessional conduct’. After all, Association for Dietetics in SA president Claire Julsing Strydom laid the charge against Noakes more than a year ago, in February 2014. The hearing will take place early June. Clearly, no one can accuse the HPCSA of doing anything in a hurry.
Precisely what ‘unprofessional conduct’ Noakes, a medical doctor, nutrition and sports scientist (rated A-1 by the National Research Foundation), is alleged to have committed is a revelation. Spoiler alert: it’s about as mundane as you get, although it puts Noakes in the same category of offenders as apartheid cardiologist ‘Dr Death’ – Wouter Basson.  Noakes has been demonised since he did the unthinkable (to many doctors and scientists) in 2009: admitted he’d got things wrong, apologised profusely and headed off in a completely new direction. Read on to find out what Noakes has done now.
(Claire Julsing Strydom, president of the Association for Dietetics in SA (ADSA) initially declined to comment for this blog, but replied through Twitter, directing me to the association’s Guidelines on Infant Nutrition. These guidelines appear to suggest that ADSA and its members no longer routinely advise cereal as a first food for infant weaning. It also appears that they advise meat and veg, as well as dairy foods. I have asked her to confirm that to me in writing. Watch this space.) – MS
By Marika Sboros

So, the Health Professions Council of South Africa (HPCSA) is investigating Prof Tim Noakes for “unprofessional conduct”. You could be forgiven for thinking Noakes has gone nuts and done something really, really bad.

After all, the HPCSA has so far reserved that charge for doctors who’ve done something really, really bad to patients – such as sexually abused them, exploited them financially, caused physical or mental harm, disfigured or maimed them for life, or in a worst case scenario, killed them.

Patricia Sidley, a Johannesburg health writer with an MA in bioethics and health law from Wits University, is no fan of Noakes. However, she finds it strange that the HPCSA has let the charge laid by Association for Dietetics in SA (ADSA) president Claire Julsing Strydom in February 2014, get this far – given that its most recent, high-profile case of unprofessional conduct is against “Dr Death”, Wouter Basson.

Basson is the apartheid-era cardiologist who ran the government’s chemical and biological warfare programme. His “duties” included poisoning people with lethal cocktails of muscle relaxant and other drugs, on the whim of the ruling Nationalist Party. (The HPCSA is yet to decide on a suitable sanction against Basson. He got off all murder and attempted murder charges, many of which took place in Namibia, formerly South West Africa, thus outside the HPCSA’s jurisdiction.)

The HPCSA in effect puts Noakes and Basson in the same category of offenders. Sidley describes that as “idiotic” – in slightly more profane words.

But back to Noakes’ alleged “unprofessional conduct”. It can seem somewhat anticlimactic to say he tweeted his opinion in response to a mother’s question on best foods to wean her infant.

Did Noakes advise the mother to give the infant poison – drip-feed unrefined sugar (that spikes the hormone insulin), or undiluted fresh fruit juice (that’s high in liver-straining fructose) straight into the baby’s veins? No. He advised low-carb, high-fat (LCHF) foods that include meat, full-fat dairy and veg – and not to give cereal.


Sea bass with sizzled ginger, chilli & spring onions

Sea bass with sizzled ginger, chilli & spring onions

I think when you are cooking it is a combination of the smell and look of the dish that wakens your taste-buds. Now this recipe will set your taste buds tingling. The aromas released while cooking this dish will have everyone licking their lips in anticipation ...

Serves 6 (2 grams car per serving)
6 x sea bass fillets, about 140g/5oz each, skin on and scaled
about 3 tbsp oil
large knob of ginger, peeled and shredded into matchsticks
3 garlic cloves, thinly sliced
3 fat, fresh red chillies deseeded and thinly shredded
bunch spring onion, shredded long-ways
1 tbsp soy sauce

1. Season the fish with salt and pepper, then slash the skin 3 times. Heat a heavy-based frying pan and add 1 tbsp oil. Once hot, fry the fish, skin-side down, for 5 mins or until the skin is very crisp and golden. The fish will be almost cooked through. Turn over, cook for another 30 secs-1 min, then transfer to a serving plate and keep warm. You’ll need to fry the fish in 2 batches.
2. Heat the remaining oil, then fry the ginger, garlic and chillies for about 2 mins until golden. Take off the heat and toss in the spring onions. Splash the fish with a little soy sauce and spoon over the contents of the pan.

Why not serve this great tasting dish with some low carb cauliflower rice ... and here is a nice recipe.

Cauliflower rice 3 |

Serves 6
½ cauliflower cut into pieces small enough to fit into your blender chute
1 cup coconut cream
¼ cup desiccated coconut
dried or fresh coriander/cilantro
salt to taste

Grate all the cauliflower using the blender.
Place in a large saucepan and add the coconut cream, coconut, coriander and salt.
Cook on a medium/high heat until softened, stirring occasionally to stop the coconut cream from burning.
Garnish with more coriander and desiccated coconut.

Now all you have to do is prepare, cook, eat and enjoy this great tasting low carb food.

Sea Bass original recipe here
Cauliflower Rice original recipe here

All the best Jan

Tuesday 28 April 2015

Cardiologist says sugar and carbs are the main cause of rising obesity rates (Video)

Sugar and carbohydrates are the main culprits in rising obesity rates, and exercise doesn't actually help you lose much weight. That's according to a provocative article in a leading medical journal by three health experts. British cardiologist Dr Aseem Malhotra is one of the co-authors and he spoke to Lateline's Emma Alberici.

Follow the link to watch the video or  read the transcript.

Check out the original BMJ article by Malhotra, Noakes and Phinney here


Indonesian President Widodo has a big pair of bollocks !

No, don't get me wrong, drug trafficking is a serious crime and those caught deserve a stiff prison sentence. I read with horror but no surprise, "Indonesia 'executes eight prisoners' for drugs offences". Will this stop drug trafficking? no way. Will executing eight people, some had spent ten years in prison, make a difference? I very much doubt it. So, what's the point, it proves the Indonesian President Widodo has a big pair of bollocks. To appease the voters, the big man has shown he can be tough, and maybe he has earned some brownie points. 

My opinion, he is a gutless little rat, and one day Karma will catch up with him. Don't start me off re. the US, the situation is infinity worse. I have some great friends in the US, and in many respects the US represents all things good. The downside, many US citizens are complete morons, lead by complete idiots. That being said, the UK has more than it's share of what I call "the great un-washed"


Can You Low Carb and Run? Yes says Dr David Unwin!

Dr Unwin

You may have already read this, or a similar article, about Dr David Unwin, (pictured above). Some readers may know David under the Forum Name 'Southport Doctor'. it is a very interesting read.

"Hello, I am David Unwin, another GP interested in the low-carb approach to helping my patients with type two diabetes.

My work formed the basis of an article published in the March 2014 edition of Practical Diabetes. ‘Low carbohydrate diet to achieve weight loss and improve HbA1c in type 2 diabetes and pre-diabetes: experience from one general practice’.

I am not a diabetic, but have been on the diet for about two years now. I started it as a gesture of support for my patients but find I am more alert and need less sleep on it. Surprisingly it seems to help me run faster too! I recently finished a 10 K road run in less than 46 minutes, my best time for years.

Since writing the article in March, my practice has been given a small grant which means we have now helped 37 people with type two diabetes. Interestingly, the results are very similar to our original cohort including improvements to cholesterol, despite a diet higher in fat which makes one wonder…


Diabetics have long been exhorted to give up sugar and encouraged to take in complex carbohydrate in the form of the starch found in bread and pasta (especially if ‘wholemeal’). In fact, bread should be seen as concentrated sugar which explains why it has a higher glycaemic index than table sugar itself.

As there are no essential nutrients in starchy foods and diabetics struggle to deal with the glycaemic load they bring, we question why they need form a major part of their diet at all.

The recent increase in screening in general practice along with epidemic of ‘central obesity’ is revealing large numbers of pre-diabetics and diabetics (diabesity). At a time when there are questions about drug safety, which diet is best is of particular importance.

Many patients are already experimenting with the ‘low carb’ approach as it is so widely advocated on the internet. We wanted to see how effective and well tolerated it was.

A series of 19 type 2 diabetics and pre-diabetics volunteered to go on a low carbohydrate diet backed up with ten-minute one to one sessions with a GP or practice nurse, and regular group education.

After seven months only one had dropped out, of the rest all had significant weight loss (average 8.63 Kg) and the average HbA1c was down from 50.68 to 39.9 mmol/mol (6.7% to 5.7%).

Despite the higher fat intake on this diet the cholesterol dropped and liver function improved for nearly all participants.

We conclude this approach is easy to implement, brings rapid weight loss and improvement in HbA1c using a diet that the great majority of patients find easy to live with.

You can find the full article at Practical Diabetes.

These words and picture taken from 'The Diabetes Diet Blog' here 

All the best Jan

Intarcia gets $225M for trial to revolutionize type 2 diabetes care !

Intarcia Therapeutics has announced a $225 million investment which will go largely to pay for a planned trial of its once-a-year ITCA 650 pump and drug combination device aimed at revolutionizing the market for type 2 diabetes, establishing it as the standard of care.
The undisclosed investors in the Boston-based company will get 1.5 percent of future global net sales of the device, with the option to convert that royalty into Intarcia common stock at a $5.5 billion company valuation during an agreed-upon conversion period. Morgan Stanley acted as the agent for the deal.
Including this investment, the company has now raised more than $1 billion in financing in the last five years, with more expected in coming years in milestone payments.
“This large and innovative financing announced today is another first-of-its-kind in our industry, and it shows investor confidence in our pivotal data, our partnerships and our overall approach to a huge unmet need and opportunity in type 2 diabetes,” said Intarcia CEO Kurt Graves in a statement.
More on this story here.

The health benefits of... ginger


Ginger, a culinary spice and medicinal marvel - here is a little more information on this versatile seasoning.

The Zingiberaceae botanical family to which ginger belongs includes three spices: turmeric, cardamom and ginger. From ancient India and China to Greece and Rome, the rhizome (root) of ginger has been revered as a culinary and medicinal spice. Gingerbread, ginger beer and preserved ginger are all familiar products. But ginger is more than a seasoning - its medicinal properties have been valued and used throughout the ages.

Identifying ginger...

The ginger plant is a creeping perennial with thick, tuberous underground stems and an ability to grow up to one metre in height. Cultivated mainly in tropical countries, Jamaican ginger (which is paler) is regarded as the best variety for culinary use. According to Chinese tradition, dried ginger tends to be hotter than fresh.


Native to southeastern Asia, India and China, ginger has been an integral component of the diet and valued for its aromatic, culinary and medicinal properties for thousands of years. The Romans first imported ginger from China and by the middle of the 16th century, Europe was receiving more than 2000 tonnes per year from the East Indies. The top commercial producers of ginger now include Jamaica, India, Fiji, Indonesia and Australia.

Ginger is available in various forms:

1. Whole fresh roots. These provide the freshest taste.
2. Dried roots.
3. Powdered ginger. This is ground made from the dried root- Preserved or 'stem' ginger. Fresh young roots are peeled, sliced and cooked in heavy sugar syrup.
4. Crystallised ginger. This is also cooked in sugar syrup, air dried and rolled in sugar
5. Pickled ginger. The root is sliced paper thin and pickled in vinegar. This pickle, known in Japan as gari, often accompanies sushi to refresh the palate between courses.

4.6 calories0.2g protein0.1g fat0.9g carbohydrate0.0g fibre
A 10g serving of fresh ginger

The benefits of ginger tea:

Ginger tea is great to drink when you feel a cold coming on. It is a diaphoretic tea, meaning that it will warm you from the inside and promote perspiration. It is also good when you don't have a cold and just want to warm up!

To make ginger tea (for nausea)...
Steep 20-40g of fresh, sliced ginger in a cup of hot water. Add a slice of lemon or a drop of honey if you fancy.

The origin of ginger ale...

In English pubs and taverns in the 19th century, bartenders put out small containers of ground ginger for people to sprinkle into their beer. And it was the ancient Greeks who prized ginger so highly that they mixed it into their bread, creating the first gingerbread.


The many curative properties of ginger are widely researched. Used on the skin it can stimulate the circulation and soothe burns. As a diaphoretic it encourages perspiration, so it can be used in feverish conditions such as influenza or colds. The root, which is the part of the plant most widely used in alternative forms of medicine, is rich in volatile oils. It is these oils that contain the active component gingerol.

Soothes digestive system...

Historically, ginger has a long tradition of being very effective in alleviating discomfort and pain in the stomach. Ginger is regarded as an excellent carminative, a substance that promotes the elimination of excessive gas from the digestive system and soothes the intestinal tract. Colic and dyspepsia, respond particularly well to ginger.


Ginger-root appears to reduce the symptoms associated with motion sickness including dizziness, nausea, vomiting and cold sweating. Ginger has also been used to treat the nausea and vomiting associated with mild symptoms of pregnancy sickness.


Ginger also contains very potent anti-inflammatory compounds called gingerols. These substances are believed to explain why so many people with osteoarthritis or rheumatoid arthritis experience reductions in their pain levels and improvements in their mobility when they consume ginger regularly. Gingerols inhibit the formation of inflammatory cytokines; chemical messengers of the immune system.

How to select and store:

Fresh ginger can be purchased in most supermarkets. Mature ginger has a tough skin that requires peeling. Fresh ginger can be stored in the fridge for up to three weeks if it is left unpeeled. Whenever possible, choose fresh ginger over dried since it is superior in flavour and contains higher levels of the active component gingerol. The root should be fresh looking, firm, smooth and free of mould with no signs of decay or wrinkled skin. If choosing dry ginger, keep it in a tightly sealed container in a cool, dark dry place for no more than six months.


Ginger is very safe for a broad range of complaints, whether it is taken in a concentrated capsule form, eaten fresh or sipped as a tea or ginger ale. Ginger contains moderate amounts of oxalate. Individuals with a history of oxalate-containing kidney stones should avoid over-consuming ginger. If you're unsure or concerned whether it is safe for you to consume ginger always consult your doctor.

Words from original article here

Many recipes do use ginger, it may well be worth adding it to your shopping list!

All the best Jan

Monday 27 April 2015

How Knowledge is Power in Nutrition | Dr. Wendy Pogozelski Type 1 diabetic | TEDxSUNYGeneseo

When Wendy Pogozelski began studying the primary literature in the field of nutrition, she was shocked to find enormous differences between the nutrition advice she’d found in the mainstream vs. the research and clinical results she was reading about. She connected with other researchers, doctors, biochemists and professors who had similar concerns and has become part of an international effort to help students, consumers and patients understand the science behind nutrition.

Dr. Wendy Pogozelski received her B.S. in Chemistry from Chatham University and her PhD from The John Hopkins University. She was an Office of Naval Research post-doctoral fellow at the Naval Research Lab in Washington, D.C. In 1996, she came to Geneseo where she now holds the rank of Distinguished Teaching Professor and serves as Chair of the Chemistry Department. In her laboratory work, Dr. Pogozelski and her students investigate the effects of radiation on mitochondria. Since developing an interest in the biochemistry of nutrition, Dr. Pogozelski has been working with an international group of scientists and clinicians who are trying to bridge the gulf between scientific research and nutrition education.


Well done Graham for posting this must watch masterpiece. As you will see this Woman is very bright and extremely knowledgeable. Diagnosed type one at forty years of age. On a low carb diet quickly obtained non diabetic BG numbers. Yet again we see her dietitian said she must have 130 carbs per day for brain function (completely wrong). I suspect the dietitian's brain function is way below that of Dr Pogozelski. Eddie

British Dietetic Association living in a dream world !

In my opinion the dietary information for diabetics presented on BBC radio 4 'Food Program' here was extremely poor. The program gave a very clear indication why the epidemics of obesity and the often linked type two diabetes continue unabated. It is also my and many high profile medical professionals opinion, no improvements will occur, until the likes of the BDA make substantial changes in their dietary recommendations for diabetics.

Is it any wonder the NHS audited statistics for diabetics make gruesome reading year after year. Diet plays a huge part in diabetes control. Until the BDA change their dietary recommendations, the carnage will go on. So bad has the reputation become for dietitians in the US, a breakaway group called 'Dietitians for Professional Integrity' has been formed. They state.

"Our efforts are guided by professional integrity. We believe the American public deserves nutrition information that is not tainted by food industry interests. Those of us who co-founded Dietitians for Professional Integrity are nutrition experts first and foremost; we went to school to help people achieve better health through food, not to help multinational food companies sell more unhealthy products." Link to Dietitians for Professional Integrity here.

Could it be a matter of time before we see the same in the UK? BDA dietitians have informed me in the past, they are not allowed to sell any products, but only a cursory check on Google, reveals many well known BDA dietitians with links to what many consider junk food companies.


Results for England. The National Diabetes Audit 2010-2011

Percentage of registered Type 1 patients in England

HbA1c > 6.5% (48 mmol/mol) = 92.6%
HbA1c > 7.5% (58 mmol/mol) = 71.3%
HbA1c > 10.0% (86 mmol/mol) = 18.1%

Percentage of registered Type 2 patients in England

HbA1c > 6.5% (48 mmol/mol = 72.5%
HbA1c > 7.5% (58 mmol/mol) = 32.6%
HbA1c >10.0% (86 mmol/mol) = 6.8%

These results are very similar to those obtained in previous NHS audits over the past 5 - 6 years. Link to information here.

Monday ... Monday !

" I was happy this morning, as I woke up in bed, 

Then realized it was Monday and I faced the day with dread, 
For somehow, whatever comes my way, my temper is displayed, 
Just mentioning 'it's Monday', my nerves, they become frayed.

The day will be just a ' write off', it's no good me trying to do
Any sort of reasonable job, things won't go right. It's true! 
It's like a 'cloud' which hangs around and never let's you be, 
Whatever I attempt to do, disaster follows me.

If I could sleep through Mondays, then that would be just bliss! 
Then Mondays wouldn't have happened, I'd have given them a miss! "

I was reading the above poem by Ernestine Northover and it prompted these thoughts ...

Is Monday your least favourite day of the week? Many people do not seem too keen on Mondays, They go to bed Sunday night with a sinking feeling ... they have to get up for work, for school ... Oh Yuck! 

When I was growing up Monday was traditionally the big wash day, and it would seem my dear mum spent most of the day washing sheets, towels - you name it and it was washed. The washing lines in the garden were full and if it wasn't sunny, or at least dry weather, the washing went on lines and 'clothes horses' around the house. Growing up we did have routine in our house and Monday was always wash day. Shopping was done almost every day, for the fresh foods that were used in my mums good home cooking and baking. I don't think she ever complained about the Monday wash, Of course life is different now with the many electrical devices available to assist with the weekly chores.  
I can remember we very often had a cottage or shepherds pie on Mondays, the left over meat from the Sunday Roast would be minced up, onions and carrots, some gravy added plus mashed potato on top. My mum always used to add milk and butter to her mashed potato and it did taste good. Nowadays, whenever I make a Cottage or Shepherds Pie instead of potato I use mashed swede always with butter added ... if she were here I think mum would have loved it.

Here below is what my LCHF recipe idea for Shepherds Pie looks like. You just use the standard recipe but substitute the mashed potato with mashed swede, or grated cauliflower. You can also see Pauls's reduced carb Shepherd's Pie here and more Low Carb recipe ideas here

Hope your Monday is a good one - thanks for reading.

All the best Jan 

Sunday 26 April 2015

Reporting Bias: No Love for Real Low-Carb Research

Why are diet studies designed and interpreted so badly?

by Richard Feinman PhD

Richard Feinman, PhD, is a professor of cell biology at SUNY Downstate Medical Center.

Articles in the lay press that put a positive spin on carbohydrate restriction are the persistent nemesis of the nutritional establishment.

Such was the case with a recent study on low carb diets by Bazzano et al., which was funded by the National Institutes of Health. Those of us working in dietary carbohydrate-restriction are continually frustrated at the NIH's unwillingness to fund low-carb studies and the media's reluctance to give its experimental successes appropriate coverage

The research community was eager to understand what the Bazzano paper did that the hundred or so previous studies had not done.

Like so many others, it clearly demonstrated the value of carbohydrate-restriction. This was not a revolutionary finding, since there had been vast amounts of earlier work, some of which had more impressive outcomes.

So, as several people pointed out, the story is in the story. The story is that somebody finally paid attention.

Paradoxically, the Bazzano paper may have perpetuated some questionable ideas and practices that, in my view, impede progress in the field.

First, in the way of precedents, important previous studies were dismissed on the grounds that they were shorter term.

The principle that a long study is inherently better than a short study is an opinion. Science usually judges studies on their quality of the work and the ability to answer the question at hand. Short trials have better control of variables and, in diet studies, better interaction with the participants.

Adherence to a diet in an experimental study, as in a clinical or real-world setting, may be dependent on how successful the diet is, but it is also understood that the encouragement and monitoring of the healthcare provider is the major factor and is likely to have less effect as the duration of the trial increases.

If effectiveness and adherence are not completely independent, the second is under substantial control by the experimenter. This is common sense and has been demonstrated numerous times, but the idea persists that we have to wait for the long-term study.

Also, it is incorrect to interpret a 6-month study as being only a 6-month study. One has to ask whether there is anything in the results that suggests any limitation for the future.

It is good that the effectiveness of dietary carbohydrate restriction is getting attention from the media and the granting agencies, but what is missing in this latest paper is the scientific foundation.
While clear on the practical benefits, the Bazzano paper suffers from a purely phenomenological bent, as if we should just try this diet and compare it to that diet. But "diet" in the sense of what people are told to eat is not a biological parameter.

The content of what they actually consume is the controlling variable. Not all macronutrients are the same, and the principle of removing carbohydrates derives from the fundamental biochemistry.

Dietary carbohydrate -- directly or indirectly, via insulin and other hormones -- is catalytic, controlling the disposition of fat and whether it is stored, incorporated into TAG-rich lipoproteins, or oxidized.

Fat, in this sense, has a passive role. The failure to understand this fundamental principle of metabolism accounts for the continued progression of papers critical of high-fat diets.

A high-fat diet in the presence of low carbohydrates is very different from a high-fat diet in the presence of high carbohydrates. Lack of appreciation of this idea is one barrier to progress in this field.

The Bazzano study made a valuable contribution in showing that low-carbohydrate diets "may be an option for persons who are seeking to lose weight and reduce cardiovascular risk factors and should be studied further."

However, further study will only be profitable if we focus on fundamental biochemical mechanisms and if we cite and critically evaluate the work that has already been done.


British Dietetic Association Chairperson Catherine Collins doesn't like a straight question !

A couple of days ago I logged into Twitter to be greeted with this. "Is nutrition the only health subject where accountants, amateur photographers & gym bunnies feel obliged to correct the knowledge of experts?" A tweet from British Dietetic Association Chairperson Catherine Collins no less. I am a professional photographer, my first thought was does she mean me. Over the years I have given the BDA some heavy duty criticism, and was certainly happy to bite the low carb biscuit on that tweet. I replied to her tweet. "Why have dietitians failed totally to stem the tide of the obesity epidemic? Catherine was not amused and replied. "because we don't personally guide every mouthful of food & drink an individual chooses to swallow. But we do in ICU EN pts" So that was me put straight. At that stage another dietitian waded in with lots of waffle on the lines of we don't make the recommendations, so don't blame us.

Now at this stage I started to worry, I had been giving the BDA a tough time for years, had I got it all very wrong. For years I had been told the BDA were experts in dietary information for all sorts of medical conditions regarding diet. Yet two dietitians had said otherwise, certainly as far as diabetics were concerned. I decided to check out the BDA site re. diet for type two diabetics, and found some woeful information. Yet again I saw the 'eatwell plate' loaded with starchy carbs, fruit and even a can of cola on display. But it got worse. The BDA page linked below stated and I quote "The ideal HbA1c is between 48–58mmol/mol" that equates to 6.5 to 7.5 in old money, numbers that no well controlled type two diabetic would be happy with for sure, and over time could well lead to diabetic complications for many.

Well I went back to Catherine and said I felt the BDA dietery information for diabetics was very poor, and that the blood glucose numbers were far from "Ideal" As you can see below, Catherine stated "Eddie. Pur-lease. Check yr facts before tweeting,otherwise undermines yr intelligence. BDA diabetes factsheet? Same as DMUK" Catherine was not the only dietitian that day who stated the BDA did not write the dietary recommendations for diabetics, the BDA recommendations come from Diabetes UK the charity.

So, we have the BDA the organisation of experts on diet, but with no recommendations of their own, passing the buck to DUK. It's my opinion this is a very sad state of affairs, when the one professional organisation that should be leading the fight against type two diabetes and it's often linked obesity, has no dietary information to offer type two diabetics, and relies on a charity whose members are mostly volunteer amateurs. BTW after my tweets to Catherine re. the eat-well plate and "ideal" BG numbers, she blocked me from her twitter account. That seems to be the standard modus operandi from a BDA dietitian when you ask a straight question. I suspect it will ever be thus.

From the BDA website April 2015.

Link to the BDA information for type two diabetics here.


Some of the tweets. 

  1. Is nutrition the only health subject where accountants, amateur photographers& gym bunnies feel obliged to correct the knowledge of experts?
  2. Why have dietitians failed totally to stem the tide of the obesity epidemic?
  3. They reckon it's everyone's fault but the dietitians. They take no responsibility. Following orders evidently.
  4. Eddie. Pur-lease. Check yr facts before tweeting,otherwise undermines yr intelligence. BDA diabetes factsheet? Same as DMUK
  5. The facts are obesity is an epidemic as is type two diabetes. Meanwhile the BDA pushes the totally failed eat well plate.
  6. From the BDA "The ideal HbA1c is between 48–58mmol/mol" Very wrong.