Friday, 25 May 2018

The Public Health Collaboration Annual Conference

I spent last weekend at the annual conference of the Public HealthCollaboration, a charity I’ve been a patron of along with my wife Jane for the last 3 years. The conference was at the Royal College of General Practitioners in Euston Square and was attended by over 300 doctors, scientists, health professionals, journalists and professors. There was even at least one IT consultant, and I have to say that he was feeling somewhat out of place on Saturday morning surrounded by such eminent and dedicated people.

There was a packed schedule of 8 talks on each of the 2 days with subjects ranging from the history of fueling for endurance sports to curing epilepsy with a LCHF diet. 

The whole weekend was televised and will be available shortly on the PHC website. I’d like to highlight a small sample of the content that had the most impact on me.

Tom Williams and Simon Tobin gave a great talk on parkrun. Tom is the COO of parkrun which now has weekly 5k runs in over 530 locations worldwide. We had dinner with Tom on Friday night and it turns out that he is a low-carb advocate as well as a passionate believer in sport for all; there are even parkruns in prisons now and Tom likes to ensure that the focus of each event is not on the first finishers (we don’t call them winners!) but on the slower runners; the ones for whom 5k is a huge achievement. One of the things that Tom is most proud of is that the average parkrun time is getting slower!

Tom is pictured on the right here with Dr Ian Lake, a type 1 diabetic and marathon runner enjoying a very tasty LCHF dinner at Caffe Caldesi

Simon Tobin is a doctor from Southport and a previous correspondent of mine on this blog; he and the other doctors in his practice have been offering the LCHF diet as an intervention for patients with type 2 diabetes for several years now; the results are amazing with most patients managing to reduce or remove their dependence on drugs for managing the disease.  Remember that the best that a patient can hope for on drugs is that their condition might not get worse.

Simon often prescribes parkrun to his patients as a lifestyle intervention! This makes a lot of sense when you consider that over half of the diseases we suffer from are the result of lifestyle choices. Drugs are not the only answer and in many cases they are clearly the wrong answer.

Over the last 6 years Aseem Malhotra has become the poster-boy of the UK Real Food movement. He is regularly seen on TV debating with the likes of Susan Jebb the UK Government's advisor on obesity who is part if the team that advice the government on advice for healthy eating, or Professor Roy Collins who advises the NHS that just about everyone should be taking statins, although his own research suggests quite the opposite to anyone who doesn’t have a vested interest in the sales of Statins!  

When I first met Aseem 5 years ago he offered to share this slide with me but I forgot to follow up on his promise. 

One of his first major causes was to try to stop the sale of unhealthy and sugary foods in hospitals. When he had a heart attack patient wake up after an operation to be fed a burger and chips in bed he knew that something had to be done. His local hospital has now become the first in Britain to ban the sale of junk foods on site.

Aseem has published a number of contentious papers in the British Medical Journal, and he has developed a particularly tough skin having made a number of high profile enemies along the way. He is highly critical of the role of the food and drugs industry in influencing research and advice on matters of health; and equally critical of the eminent scientists who profit from this support whilst ignoring the latest scientific data on issues such as what causes heart disease.  

The best example of this is how the NHS still tells us that saturated fat and it's co-conspirator cholesterol are bad for us and will increase our risk of CVD despite the overwhelming evidence that they will not. There is so much at stake here in terms of NHS money and people’s lives, but it appears that what matters most is the imminence and incomes of those learned men and women who, by working so closely with the food and drugs lords have found themselves in the position of advising Her Majesty’s Government on what is best for her subjects. 

The phrase “eminence trumps evidence” is true at the highest level but it is good to see that increasingly, doctors are refusing to allow transparency and objectivity to be trumped by eminence and vested interests. A survey in Pulse, a publication for GPs, in October revealed that two-thirds of GPs were rejecting the Nice advice to offer statins to those at low risk.

Aseem received a well-deserved standing ovation at the end of his presentation. Interestingly this was attacked on twitter as evidence of cultist behaviour in the PHC movement. Anyone who was there would assure you that it was nothing of the kind. Just a spontaneous outpouring of gratitude for someone who has given so much. Exactly the same could be said of the next speaker.

Aseem and Tim
Tim Noakes – was just marvelous. He gave a self-deprecating account of his career, explaining how as a result of his research into nutrition for endurance sports he became the first producer of energy gels and the author of the bible of distance running (Lore of Running). He then tore this illustrious career apart by describing the faults in his methods and how they had been avoiding the importance of fat all along “because we didn’t understand the pathways by which the body uses fat for energy”.  Years later after reading the work of others he was not too proud or eminent to admit that his interpretation of his clinical data was wrong.

His favorite anecdote seems to be the one where back in the 80's the great Zimbabwean triathlete Paula Newby-Fraser accidentally miss-heard his advice and adopted a low-carb rather than a low-fat diet.  She then proceeded to win more Ironman races than anyone else in the history of the sport.

Tim has been involved in a high-profile court case for the last few years in which the Health Professionals Council of South Africa (HFCSA) have clearly tried to ruin his career because they take his recent research and publications on LCHF as a direct attack on their profession. Four years ago Tim gave some generic advice to a woman asking a simple question on Twitter and they have accused him of bringing their profession into disrepute.

You can find out all the details online if you wish but suffice it to say that I have never heard a sadder tale of the lengths that an eminent group of learned people will go to in order to protect their power and influence; ignoring simple evidence and attacking a kind and caring man in such a profound and prolonged manner. They are a disgrace to their profession and prove John Cleese (and more recently Assem Malhotra) correct when they said that 
One should never forget the first principle of the old KGB. Always accuse your enemy of exactly what you are doing.”

The abuse that Tim has received as been awful, but the support he has gained is incredible and the whole fiasco has brought so much attention to the diet that he now feels that perhaps the human cost was worth paying.

And in many ways this story reflects the problem that we at the PHC were all gathered to discuss; the way that government advice is dictated by a small group of eminent men and women who seem intent on protecting their own dated research and opinions and incapable of changing their minds in the face of new evidence.

Professor Tim Noakes amazed the scientific world by tearing up the chapter on nutrition in his famous book and declaring that he got it wrong. Perhaps it’s now time for UK government health advisors like Professor Rory Collins and Doctor Susan Jebb to do the same thing.

Tim also mentioned the work of Virta Health, an American company providing structured programs for dietary intervention for the treatment of type 2 diabetes. There were not many plugs to commercial enterprises during the conference but this one deserved it’s airtime.

There is not much data on the longer-term impact of the diet on important health markers such as blood pressure, cholesterol and blood sugar, and this is what allows many of the diet’s detractors to state that the diet may work well in the short term but they have concerns about its longer-term efficacy and adherence. Well the data from Virta and Southport  (see below) is filling that void with overwhelmingly good news. Virta already have a very large study group and the papers that they are producing make fantastic reading. All of the important health markers being measured on their patients continue to improve in the two years that the data has been collected for. Comparing this data to the alternative of a life on Metformin and the likelihood of a painful early death I know what I would recommend to my loved ones.

When you consider that the huge majority of health issues relate to lifestyle choices it is a wonder that so little NHS time and investment is put into dietary interventions like this.

Which brings us on neatly to my final hero of the PHC conference Dr David Unwin. Four years ago a GP friend send me a link to a report written by Dr David Unwin and his wife Dr Jen Unwin from the Norwood surgery in Southport. The report described the early results of a trial that they had been performing with their diabetic patient in which they provided dietary advice as an option to patients. Patients who opted into the trial were given regular advice and assistance with adopting the LCHF diet. The results were very impressive and I wrote about them in this blog post

David's talk provided a fascinating insight into the subject of fatty-liver disease, a precursor to diabetes and something that is entirely influenced by lifestyle factors such as diet and exercise.

For me the best bit of the talk was the way he dealt a huge blow to the detractors of the LCHF diet. If you research “LCHF diet” you will find lots of influential dietitians and health advisors whose principle criticism reads like this:

The diet may have positive benefits in the short term but we have concerns about its long term use”.

These concerns arises from the lack of long term studies of the diet. This is despite the fact that of all the studies comparing the health effects of low-fat verses low carb diets there is an overwhelming majority in favour of low-carb. 

Much like the work by Virta Health but clearly in the impartial, public NHS domain, the Northwood trial has now been running for several years and they have been meticulously collecting data from all of the participants; they have now published data that shows the following:

And that’s not all that was achieved in the Northwood group. The risk of heart disease has dropped significantly according to the JBS3 score used to judge this risk

And so now we have the data. Of course it is open to scrutiny but I for one will be passing these last to graphics to anyone who continues to suggest that they have concerns about the long term use of the diet.

There were lots of other great talks at the conference; Peter Brukner (the Doctor on the Australia Ashes winning team) provided a very humorous introduction and update on the latest worldwide news. Zoe Harcombe was on fire as usual, destroying the ridiculous notion that “calories in = calories out” with a perfect explanation of the laws of thermodynamics and how they do not apply to weight or food. 

Zoe Williams (of Trust Me I’m A Doctor fame) gave an interesting talk about the importance of physical activity; her rather famous co-presenter Micheal Mosely was in the audience. Jen Unwin and Charlotte Summers made us think hard about whether we are addicted to sugar. Trudy Deakin, David Cavan and Professor Ian Broom gave us loads of fascinating insights into the practicalities of reversing type 2 diabetes for large patient groups. And Dr Scott Murray gave a great talk on factors influencing heart disease.   There were more talks but I had to take a few walks to stretch my limbs and give my brain time to digest everything!

Lastly, thanks to Sam Feltham the Director of the PHC charity. 

Jane and I have known Sam for several years and he is a great leader and motivator. He has the greatest respect of the many partners, patrons and members of the organization and he did a brilliant job of organizing a fascinating weekend. Sam puts his heart and soul (and his career) into everything he does.  Commitment like this is contagious, and the impact of the PHC is growing as a direct result of his work. 
 Well done Sam!