Friday, 25 July 2014

A spoon-full of sugar helps each mouthful go down!

The latest from Robert Lustig on the fight against dietary sugar.

Read more here:

There is whole lot of money being spent on persuading us that sugar is harmless. It is incredible to think that some people are employed solely to write reports to make sugar look respectable.

"It is difficult to get a man to understand something when his salary depends on his not understanding it"

Things are little different in this country, every manufacturer of food with added sugar (that includes just about all processed food) argues that their food has it's place in a "healthy balanced diet" - even Coca Cola!. When you combine this with the ubiquitous phrase "everything in moderation", you will get a big pile of sugar on our places every day.

They can't all be right, can they? Not when the World Health Organisation are recommending a maximum of 6 teaspoons of sugar per day.

However Action on Sugar is gaining ground (they want to persuade industry to gradually lower the unnecessary sugar content in processed foods), and the new guidelines for school food and drink are also good to see  (

But I wait to see whether our local school will actually remove any more of the wide array of sugary drinks from the counter and start promoting water as the drink of choice. After a minor improvement 2 months back they have stopped replying to my emails since this change was announced; they have until January to change or I will be after them.

So things are starting to change. The biggest danger I see ahead is with the attitudes of parents. So many people argue that they should be allowed to choose for themselves if they want to drink a 2 liter bottle of cheap cola every day; they don't want to be nannied by me or the state.

The trouble is the nation is getting fatter and the Nanny Health Service is getting poorer; and these same people appear to expect nanny to be there to tuck them in and cure them when they need drugs or a gastric band. They cant have it both ways!

Carbohydrate restriction - the first approach in diabetes management

Lots of critics are still arguing about LCHF being some kind of fad with no solid science behind it. Observation shows that the public is getting fatter, but they are sticking to their guns. Many others are backing into the subject in order to try to preserve their reputations and their pensions.

My advice to them today is to go and jump out of a plane!

Here is another serious review of the options for treatment of diabetes and obesity.So long as you don't mind a little science then it provides a very powerful argument for why carbohydrate restriction should be the first port of call for medics treating these diseases. And in case you are wondering, no, it is not proof, just a long list of rather big observations. Anyone interested in public health should read this:

For those wanting a slightly easier summary look here: 

Apart from finding the report fascinating I love the reference to the blinkered approach taken by many who say that in the absence of conclusive scientific proof the diet should not be regarded as safe. . 

There is no rigorous scientific study that proves that using a parachute is a justifiable intervention to stop death by falling out of a plane. But hey, when you look at the options available it seems to work OK, so in general we do it, unless we are looking for some divine intervention.

The same is true for dietary restriction of carbohydrates. 

Monday, 21 July 2014

LCHF Diets - Who do you trust?

In the pub the other evening I was struck by an interesting dilemma.

A good friend of mine who has worked in the NHS all of his life contested the value of the LCHF diet that I have been advocating for all of the last 6 months.

He is convinced that the knowledge of the dieticians that advise him at work is stronger than my flimsy base of knowledge supporting low carbohydrate diets as a cure for obesity or diabetes.

He quoted the years of research behind their advice; and he referred to their dedication and career-long commitment to public health.  I care about the same issues, but who am I (a computer science graduate with a perhaps faddish interest in public health) to suggest that they might be so badly wrong? I knew that my friend was unaware of the time that I have spent researching the latest science on this subject, and there were more interesting things for the boys and I to chat about.

It would have been just plain rude of me to suggest in the local pub that my friend and his advisors might be wrong. So obviously I shut up about the diet thing and got my round in.

This situation reminded me of a video of a presentation by Jeff Volek that I watched he other night.

This was a fascinating talk from the man who really got the whole LCHF movement rolling with solid research and wrote (with Stephen Phinney) The Art and Science of Low Carbohydrate Living, this is perhaps the holy bible of the LCHF movement.

The presentation was quite simply the best introduction to the subject that I have ever seen; I would encourage all parents, teachers, dieticians, doctors and ministers to watch this video.

A great observation near the start of the presentation was this:

New theories have 4 stages of acceptance:
1: This is worthless nonsense.
2) This is an interesting, but perverse point of view.
3) This is true, but quit unimportant.
4) I always said so.

The greatest challenge is not to convince one person that they could change their live with a change of diet; this has been done thousands of times and Jane is doing this with her clients regularly. No, the big challenge is to find a way of helping trusted clinicians, advisors and even governments to change the beliefs that they have held though their careers. It is a much greater dilemma than mine for a GP to change the advice that she gives to her patients , even when she suspects that the new advice is right.

This is referred to by Volek and Phinney as the Warren and Marshall Syndrome (after two Australian scientists who proved that ulcers were created by bacterial infection rather than too much stomach acid. Despite the glaring truth doctors continued to prescribe antacid drugs for several years. They were later given a Nobel prize).  Faced with undeniable proof that a better cause of treatment exists, doctors (just like anyone else) will be very slow to ditch the habits of a lifetime, to in effect admit that they and the medical establishment were wrong.

Now multiply my dilemma to the huge responsibility faced by governments and their advisors when it comes to advising us as to as what we should eat.
  • We know that the current advice is not working.
  • We are only in power for the next 4 years
  • We have heard that there is a much better and safer course to steer.
  • No one likes to be told that they are wrong.
  • Who do we trust?
 Here is my advice. Trust what works. Ignore the lack of full double-blind randomised controlled trials; only the drug companies sponsor this kind of research nowadays and they are simply not interested in proving that they are wrong, it would probably lead to costly law suits. There is no good science either to justify the current nutritional advice that has led to the obesity epidemic.

Trust the diabetics who are no longer reliant on drugs. Trust the obese patients who have their lives back. Eat Real Food, not synthetic crap made of sugar. Trust Tim Noakes! And then when we are older and this is all in the past, make sure that he is given a Nobel prize.

Sunday, 13 July 2014

LCHF and distance running.

As I have mentioned previously one of the reasons I got interested in the LCHF diet is the possibility that it could be beneficial to distance running; this is what gets me interested as I am getting older and the possibility that I could carry on for a few more years at a decent level is exciting.

So I ran my first LCHF marathon back in March and it was all easy enough. I like the food and as you may have read previously I was able to train just as long and as hard as I have done before. The London Marathon and the South Downs Way Relay were to follow and I was hoping to take a close look at fuelling and energy levels when running for more than a couple of hours. But then I picked up a minor injury and have had a couple more since then ( I should add that these were related to skiing and mountain biking, not running). As a result I have not really been able to study this subject in great depth yet.

But it is an interesting subject nonetheless and so here is post number 1 on this subject.

How long can we keep going for?

Mention the word Marathon to a novice runner and a few ideas will come to mind; such as ‘why?’, or ‘26.2 miles!’, or ‘Hitting the wall’. The last of these is the one that strikes fear into the hearts of most runners.

Hitting the wall is simply another description for running out of fuel. Most of us only have the capacity to store enough glycogen to run for about 2 hours.  This is why we generally carb-load before a marathon, to fill the glycogen tank up to the top. Refuelling in good time ensures that we don’t hit the wall and so long as we have done the training we should complete our big run. We learned this back in the eighties and Lucozade and Gatorade have made a heck of a lot of money ever since. Clearly finishing a marathon depends on refuelling, or to put it another way, on consuming sugar.

So how did marathon runners manage to train for and run marathons (often very quickly) before the advent of Gatorade?  Simple, their bodies had adapted to burn fat as well as glycogen. They trained hard and in the absence of carb-gels and carb-drinks their bodies became rather good at switching from carb-burning to fat-burning when the need arose. Most mere-mortals do not train this hard, and if we are on a traditional (and NHS recommended) high-carb diet, we will need to take on fuel on our long training runs and we will rely on fresh fuel (carbs) on Marathon day.

LCHF runners train our bodies to burn mostly fat, with a small proportion of carbs. So, given suitable training we ought to be able to keep running for longer; much longer, without the need to refuel in the same way.

So how far can we go? And how fast can we go?

Dr Peter Attia is an elite athlete who has been testing these questions for some years, recording his performance on both low-carb and high carb diets.

 As you can see Peter is pretty serious. He has determined that a suitably trained athlete (himself) can keep going all day long so long as he doesn’t run out of carbs. Clearly the smaller the percentage of carbs being burned the longer we should be able to run for. A key point is that most of us can regard our fat stores as effectively limitless for these purposes.

We all burn fat as well as glycogen. The point at which we switch to burning more glycogen than fat has a profound effect upon how long we can run for before hitting the wall; the earlier the switch the sooner we run out. Dr Attia found that on a high-carb diet this switch occurred at a heart rate of 104, or 33% of his maximum output (or VO2 Max). When in ketosis (on a LCHF diet) the switch came at a heart rate of 162, this being 84% of his VO2 Max. Don’t forget that he is an elite athlete!

The diet brought about more than this simple change (note that his maximum output had lowered), but even though his VO2 Max had decreased by 12% with the change of diet he was now able to use his glycogen stores very much more efficiently.

After tests both cycling and running Dr Attia has figured that when he is working at his ‘all day’ rate he is working at about 60% of his VO2 Max. On a high-carb diet this required 95% of energy to come from carbs. On a LCHF diet with his body in ketosis this required just 22% of energy from carbs (or strictly from glycogen). So buy lowering the requirement for carbs he is able to go for much longer before running out.

Another aspect of high-carb fuelling is that when exercising for more then 1-2 hours our livers simply can’t process enough carbs per hour to keep the tank topped up. The normal limit is about 50 - 60 grams (or 200-250 calories) per jour.  There are 4 calories per gram of carbs; hence the need to take on carbs early in a run, and keep topping up the tank regularly.  If you leave your refuelling until you feel tired and you are running at a rate that requires about 800-1000 calories per hour then it will quickly be too late for consuming more carbs to be of any help. Here I must give credit to Sarah Rowell. Not only is she the author if the great book “Off Road Running”, where I first learned about trail and fell running and nutrition; but she was also the record holder for the Beachy Head Marathon for 5 years after trouncing all the men in 1986.

How many of us have wondered “what might have been” as we tread that painful last 8 miles towards the finish line with no carbs left but a reserve tank full of fat gagging to be burned? When we decide to run long on carbs, we are all treading an unavoidable path towards that same wall.

Now consider what those last miles might feel like if we were only consuming 25% of our calories (250 grams per hour) from glycogen. We could keep the glycogen tank full as long as we like if we re-fuel appropriately.

Is it any wonder that so many ultra distance runners are using a LCHF diet?

My attempts to replicate this investigation have so far been thwarted by a dumb show-off-dad injury and some bad luck. However I can attest to the fact that running the Hassocks Sport Relief Charity Marathon on LCHF did not leave me feeling even slightly drained or hungry. I ate eggs and bacon before the run and just a couple of cups of soup during the run. But I was not going particularly quickly (I averaged about 6.2 mph on a heart rate of about 130) - nowhere near 60% of my VO2 max.

So I thought I’d call upon the experience of Marina Bullivant. Marina is becoming a bit of a legend around here, having run all 5 Brighton Marathons. After the 4th run she switched to a LCHF diet, lost a stone and a half and then proceeded to beat her PB from 3 years earlier. She has run 3 Marathons so far this year on LCHF, each harder than the last. I asked Marina a few questions about the way she eats and runs:

Q: How long have you been on the LCHF diet?
A: Since June 2013.

Q: Can you estimate how many grams of carbs you eat per day on average?
A: Malcolm, I haven't ever calculated what this might be, or even thought about it!

Q: When you run for over an hour do you use any kind of food for fuel? –
A: I only really fuel for races, and then only half marathon and above.  SDW Relay - sausages, breakfast muffins (eggs, cheese, veg, bacon), cheese, nuts - deviation is Janna's homemade barrabrith (fruit teabread with loads of butter!).  Brighton Marathon I took a couple of the gels they were handing out and wished I hadn't - got stomach pain - stupid thing to do as I never take them normally!  And still got cramp in my calves!  I now take  salt/electrolyte capsules with water on runs over 1.5 hours, no calf cramps so far!

 Q: What is your average mileage per week? Has this increased on the Diet?  
A: I'd have to have a look at my records - it has probably increased since June 2013, as have been running longer races, so training further.  but, as you will see in answer to question below - definitely faster.

A detailed conversation revealed that the average has risen from about 40 to about 50 miles per week.

 Q: What is the longest that you have run for using this regime? –
A: Three Forts Marathon - 27+ miles (May 2014 - my longest ever run). 

Q: After a long run how long does it take to recover before you would run again?  
A: 24 hours!  

Q: Is this recovery rate a change from your recovery rate prior to the diet? 
A: And thinking about it, this was probably not the case before, would say that previously 2-3 days.

Q: What are your 5K and marathon PBs? (here I am looking at the difference between the two paces – what is achievable on LCHF).    
A: 5K  22.32 (June 2014).  Marathon 3:46:36 (April 2014).

I particularly liked Marina’s answer to the second question - she is not counting carbs at all. Not very scientific though, so I quizzed here a bit further and I reckon that she eats about 60  grams of carbs per day, apart from a bit of a blow-out with a roast potato or two with dinner on Sundays which puts her up to about 120 for that one day.

Assuming that Marina is running at close to her VO2 max for a 5K at 8.4 mph, and she runs a marathon at 6.9 mph then her marathon pace is 82% of her VO2 Max.

There is a big difference between Marina and Peter’s all-day rate VO2 Max 80% and 60%. This is likely to be because Peter is an elite athlete with a very high VO2 Max in the first place, whereas Marina just trains for and runs long distances. I think I should have mentioned that this is not rocket science but we can see that Marina is achieving something rather special here; she has lost weight and she is getting more efficient at distance running. Her recovery rate in particular is amazing; she trains the day after running a marathon. Now I never managed to do that!

There is a suggestion that LCHF leads to less inflammation in the body. This is critical in the case of atherosclerosis (inflammation of the arteries) as it means that we are less likely to develop heart disease on a low carb diet than on a high carbs one. You may recognise this as the subject of my earlier posts ( ). But this also has a bearing on the inflammation on our bodies caused during training; if there is less soreness from training then we should recover quicker and can train more. This is what Marina seems to be finding.

This experience is mirrored with another correspondent Simon, a GP on the LCHF diet, who states that
Since going low-carb I seem to get less muscular aches in my legs the day after a run; but possibly this is just due to the passage of time rather than my diet.

Simon has seen improvements across the board, not just for endurance running:
I had thought that my fastest times were behind me. I started reducing carbs 18 months ago and within a matter of 2-3 months was running faster. I have lived the LCHF lifestyle for over a year now and have never run as fast.

Last month I set a lifetime best over 5K and have improved my time over 10K by nearly 2 minutes. My passion is fell running and have seen my times tumble compared with races a year or two before and not by small amounts - 11 mins off a 14 miler in Pendle and 32 mins off the Three Peaks Mountain Marathon. These are races I have done several times before so I have a good idea of what I am capable of running.

This all suggests that LCHF may indeed assist recovery and perhaps even improve performance. My own memories of the Three Peaks Fell Race centre largely around climbing Ingleborough splattered with sticky pink energy drink.

I was also hoping to write about the South Downs Way Relay on LCHF. This 6-person team event covers the 98 miles of the SDW in somewhere between 11 and 14 hours with each team member running 3 legs at close to threshold speed.
                                                                         (The Arena 80 Vets team from 2008)

This race presents particular challenges with regard to fuel – you have to get plenty of fuel down in order to keep going all day, but not so much that you might get a stich from running too soon after eating. Many runners find it hard to get food down at all after a hard run and that compounds the problem.

I have run the event three times for my club Arena 80 and we have come third, second and first in the fiercely contested vets category. On each occasion I have gulped down a pasta, tuna and veg salad the moment I finished each of the first two legs and drunk energy fuel liberally. Luckily I can eat just about anything anywhere (the cook ran out of popcorn and bacon when I was climbing Kilimanjaro), but I still felt worried about energy all day long. Other runners were clearly having bigger problems and the changeover stations were strewn with messy corpses and discarded energy gel packets.

I missed out on the relay due to injury this year, but Marina was invited to join a ladies team from Hurstpierpoint. And so she was able to road-test the LCHF diet. In short it was a doddle. While several of her team-mates suffered from stomach cramps and lack of energy Marina ate some egg&cheese muffins, cheese, nuts and some fruit tea-bread washed down with a good amount of water & salt tablets. That’s all. She reports feeling satiated and strong all day long.

Now as I said earlier Marina is superbly adapted to distance running, but as a first-timer in this gruelling event she did appear to shine.

The key lesson here for LCHF runners is that if we want to run all day long then we can do, but we still need to eat a few carbs to keep the tank full. Marina had some bread. I might eat some flapjack or drink a malco-pop; but we do not need to worry about hitting the wall if we are fuelled by fat.

P.S - If you'd like to read more, including the answers to the question "How fast can I go?" then have a read of my later posts describing fuelling, pacing and finally a PB in one of the hardest marathons in the UK.

Some further reading and inspiration:

2 times Triathlon world champion Jonas Colting is on LCHF

Tim Olsen, the winner of the 2012 and 2013 Western States 100 is on LCHF

Sami Inkinen, a persistent winner of Ironman races is on LCHF. He also writes about his performance here He is currently rowing from San Fransisco to Hawaii to raise awareness of the dangers of sugar.