#FastFixDiabetes - Sounds too good to be true, almost!

Three prime time TV programs in two weeks on my favorite subject of dietary intervention for managing diabetes! 

How exciting that this subject is finally getting the recognition and air-time that it deserves. Interestingly there were several claims that this was new science, and yet I was writing about it four years ago and I feel that I am new to the subject! There were also many bold claims that the diets to be described on these shows could save the NHS billions of pounds; this is also a subject close to my heart.

• The first program was The Big Crash Diet Experiment on BBC1, presented by Dr Javid Abdelmoneim and Dr Susan Jebb
• The second was The Truth About Carbs on BBC1, hosted by Xand van Tulleken.
• And the last was The Fast Fix: Diabetes on ITV, hosted by Anita Rani, Professor Jason Gill and Dr Zoe Williams.

Programs 1 and 3 took almost the same approach, which rather puts a dampener on their claims to be new. They both put a number of pre-diabetic people on a crash diet limited to 600-800 calories a day from nutritionally balanced shakes and soups. They followed the groups for some time and then measured their HbA1c level. Following the diet was difficult with Professor Gill accepting that it is a really hard diet to stick to and most patients stating how difficult it was, using words like “Brutal” and describing “the pain of being hungry”.  

In #fastfixdiabetes this was done at a beautiful retreat in the hills a mile from my house; it certainly won the prize for the best photography.

At the end of the two shows the patients were given their results; predictably they all did very well, which is great. This should have been the cue for how the diet was to be continued, how the patients could then go on to lead healthy lives free of diabetes and save the NHS a fortune. Unfortunately this did not happen. The Big Crash Diet program ended with a minute or two of bemused faces as Susan Jebb (the chief advisor on obesity to the government) showed the patients how to cook a few “healthy balanced meals”. The program's website does point you to a page of healthy low calorie recipes but there was no description of how well or badly the patients might have got on with this when they got home and so their prognosis could only be described as being “better than it was before”; hardly cause for jubilation in the NHS accounts department.

#fastfixdiabetes was worse; there was no discussion about long term diet at all with the patients, just a quick statement at the end that read “After the experiment the patients were  reintroduced to a healthy diet, under supervision”. As well as contemplating the cost of this supervision I was left thinking what does “a healthy diet” mean? A question I and millions of others have been wondering about for many years.  And I have come to the conclusion that the answer to this question is 

“Trust me, I’m a dietitian.”

I feel I need to call out one of the amazing claims made in #fastfixdiabetes. At one point Professor Jason tells Doctor Zoe “What we are hoping to achieve is something that we simply do not see in routine diabetes care; we do not see people getting diabetes into remission, and we are trying to do it without any drugs.” This statement amazed me as I have been writing blog posts on the subject for a long time now. Surely the professor would be aware that there are several successful dietary intervention programs in the UK already, both inside and outside the NHS including a huge program hosted by diabetes.co.uk.  Dr Zoe would also be well aware of this; since like me she recently attended a conference where several speakers gave detailed descriptions of doing exactly this. This bold claim certainly made the TV program sound very impressive but it was not true.

Both of these programs were based upon the results of a trial by Dr Roy Taylor at Newcastle University and Professor Mike Lean at the University of Glasgow. A description of their trial on www.diabetes.org.uk explains how it works and it is truly impressive, in the short term. It also explains that:

       “This is no quick fix, and we’re not recommending you try it alone. Some of the people in the study are finding the diet incredibly challenging and this programme is about more than just the low-calorie diet. After this phase, people may need to work hard to keep to a healthy weight and stay in remission.” 

And that's the thing; we all have to work hard to keep to a healthy weight; this ever-present fact and the poor quality of dietary advice from the NHS is very likely to be why we have such a huge problem in the first place .

There was another howler from the professor, who after giving the great results to Dan said; “Just keep your weight the same and make sure it doesn’t go up” with no indication as to how Dan might do this. This is just like reiterating the tired “Eat less and move more” advice that doctors with very little training in or knowledge of nutrition have been giving the population for the last 30 years. 

Perhaps Dan will manage this as he now appears to be launching a company to provide the #fastfixdiabetes plan with its intensive retreats to “professional people”, so his motivation to achieve this goal will presumably be higher than most. I hope he succeeds on both of these aims but I fail to see how this will help the NHS in any great way.

The name of the program suggested that the patients “fixed” their diabetes, and this suggestion was repeated several times. To be clear the patients did not fix their disease, they significantly but temporarily lowered the risk of developing type 2 diabetes. This is a great thing but it is not a fix. A fixed pipe does not need constant monitoring to ensure that it does not burst again. 

 

Job Done?

To claim that you might save the NHS a fortune you clearly have to provide a solution that describes the long term treatment of patients, not just for a few weeks. If your plan requires expert help in the short term and referral to a dietician in the longer term then I fail to see where these millions will be saved. I certainly don’t see Jeremy Hunt forking out for all pre-diabetics to spend a couple of weeks at a retreat in the Sussex countryside, no matter how lovely the views or what longer term savings might come of it.

Luckily there is a long term solution, and it was described in The Truth About Carbs. This program introduced a number of subjects relating to carbohydrates but the main one was a similar two-week dietary intervention performed on a group of eight patients with pre-diabetes. They were placed on a low carb higher fat (LCHF) diet, essentially this involved cutting down on refined carbohydrates and foods containing sugar; this was described not as a short term fix but a long term lifestyle change.

The patients all agreed that the diet was relatively easy to adopt (although it should be said that the motivation related to being on a TV show must play some part here – don’t these TV trials always succeed?); they attended weekly group sessions but did not require constant motivation to keep going. They all lost weight and improved their diabetes markers in a very similar way to the patients on the other two programs. But this is where the similarities end; because all these patients had to do at the end of the show and for the rest of their lives was continue using a diet that they enjoyed; they reported that the food tasted great and they didn’t report being hungry all the time.  Continuation of the diet requires little in the way of further costs and intervention as the patients already know how the diet works.

To be fair the LCHF diet is not suited to everyone but the results show positive outcomes for most people. This TV show was based on the successful dietary intervention trial performed by Dr David Unwin and his team at the Southport Surgery on Merseyside. David has recently published the results from four years of offering this intervention as a choice to diabetes patients; there has been great success and there has been a clear saving of about £30,000 per year in costs to the NHS. Extrapolate this to every surgery in the country and we are talking about the possibility of saving many millions of pounds.

It is great that this subject is getting more air time. More and more doctors and health professional are taking a serious look at the possibilities for controlling obesity and diabetes with diet rather than drugs. It is up to these people to educate the public as to the choices available to them and the louder the debate the more likely that people will start to realise just how much of their health depends upon what they chose to put in their mouths.

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!

 

Runner's World - A Spoonful of Sugar Keeps the Advertisers Happy

 I have been a subscriber to Runner’s World for about 12 years now. Over the years it has provided much-needed advice and motivation, a little monthly run-envy and the occasional journalistic howler.  Lately the howlers have started to become louder and a little more grating, to the point where my wife, a successful fitness business owner, now regularly asks why we bother with our subscription.  My answer is that I care what the running world looks like, even if I don't always agree with it.

So many promises

This month’s edition includes a six-page blockbuster about the role of sugar in a runner’s diet by the respected coach and nutritional expert Matt Fitzgerald entitled “Sweet Truth”,  and it has really got my goat!

The devil is in the detail!

After a first scan of the article, which reads a lot like like a sales piece for Gatorade, I thought “I wonder who pays his wages”;  but then I saw that actually the article was really just being all things to all people. It rambled around the usual sugar debates and concluded by saying “Don’t worry about sugar, you need it, but you are a runner and you will burn it off”.  Typical stuff, but 6 pages, really?

Unsurprisingly Matt’s article promised to “cut through the hype with a set of Science-Backed Sugar Rules”. I am always intrigued by the term science-backed, particularly in Runners World where the studies quoted are often ridiculously out of tune with the conclusions drawn by scatterbrain journalists. But Matt is chock-full of experience, surely we can expect some hard truths from a top guy like him. Sadly not.

There was a hollow criticism of Gary Taubes (the author of The Case Against Sugar) for "not being a scientist". It would be childish in the extreme of anyone to read this article and simply conclude that Mr Taubes is not qualified to speak on the matter. Character assassination is an ugly thing and Matt seems to have joined the happy brigade who attempt to gain kudos for slagging off other people. 

Then suddenly the RW article was tempered with recognition that overeating sugar can actually lead to insulin sensitivity and type 2 diabetes - the precise point that Taubes et al. are trying to make.  There was  criticism of certain diets but a recognition that we need to watch what we eat – most people call that dieting.  Mostly though there was the ever present implication that what is good for elite runners should be good for the rest of us.

The readers of Runners World are not elite athletes. If a bunch of elite Kenyans eat 20% of their energy from sugar this should not be used to justify the mass-marketing and magazine articles like this that tell the average runner that they should power every training effort and race with gels, PowerAde and carb-loaded snacks. The article did not mention the effect of this marketing on children, who most certainly do not need to consume sugar to power their sport and yet our schools and leisure centres are subsidised by selling energy drinks to kids.

Recognise this?

Matt then asks “If the best runners in on earth are amongst the heaviest sugar consumers then can it be so bad?”  The simple answer is Yes. The best runners in the world will be burning off this sugar on their morning run. The rest of us will not. This ‘Kenyan  paradox’ is hardly surprising, but Fitzgarald’s conclusion “They ate fewer calories than they burned” is simplistic. Maybe they ate less than they burned because there was a very real chance that by doing so they might become rich. Did the researchers ask how much time they spent feeling hungry? This is not a reasonable guideline for normal runners or the public in general.  The best way to eat less than you burn is to control your hunger. Traditional diets fail at this point; eating carbohydrate based diets does not allow you to control hunger unless you are very highly motivated – an elite runner perhaps. Eating a fat-based diet is crucially different here. People who eat a lower percentage of carbohydrates and a higher percentage of natural fats feel hungry less often and hence consume less. This is why LCHF diets consistently out-perform high carb diets in randomised controlled trials. And this is how intermittent fasting works, your body gets used to fuelling on fat and you do not feel hungry so often.

It should also be mentioned that type 2 diabetes does not normally develop quickly. Insulin resistance grows over decades and the more insulin you have to make the more resistance you are likely to develop. Has anyone measured the incidence of type 2 diabetes in retired Kenyan runners? I doubt it, as we are only interested in how they run so fast. Steve Redgrave may have developed hereditary type 2 diabetes, or it may be the result of consuming very high amounts of carbohydrates over a long and illustrious sporting career.

"Don’t worry about fructose says" Matt. The Harvard study he refers to concludes that eating certain whole fruits can be better for preventing weight gain than some vegetables; he doesn’t mention which fruits. The answer is blueberries and apples, but the implication and matts Rule #1 (Don’t worry about natural sugars) is that fructose is therefore good for you. The study does not say this.  Bad use of science Matt!   Most people don’t know the difference between fructose and sucrose and they don’t know the difference between whole fruit and fruit juice; they gorge on orange juice or smoothies thinking that they are healthy.

Lovely fattening smoothies!

Matt says “eat refined sugar in moderation”. Again this statement is problematic because most people do not know what it means; they don’t know what the recommended amounts are, and so what exactly is moderation? For a Runner's World audience fixated by timeings, measurements, performance improvement and measurability, what does “moderation” mean?  Meanwhile every petrol station, office or shop we go to is bombarding us with sugary temptations and saying ”let me be the one to supply your moderate amount of sugar today”.   If we want people to understand how low the World health organisation recommendation on daily sugar intake is, then we need show them. Give them a glossy picture of one large apple; and make it clear that sugar in general is bad for you.

When you consider that it is not very difficult for runners to switch to burning fat instead of sugar it is a wonder that Runners World covers the subject so little – there is a lot of mileage in the subject! 

Matt is not right when he says that you will not perform at your very best if you skip sugar; some people will and some won’t. But I would suggest that most runners would be somewhat richer, a lot healthier, rather happier, and would enjoy their running a whole lot more if they were to exchange those few extra seconds from  their marathon PB for life of running without sugar.  I simply don’t have to think about refuelling when I run a marathon and I finish happier and stronger than anyone I know (well there might be the odd sub-3 exception here!). I am also a little faster at 51 than I was at 45 having recently knocked 6 minutes off my off-road marathon PB.

Matt also provides an anecdote about Julie Benson and her difficulties with the No Sugar No Grain diet which left her feeling drained of energy during her training. This sounds to me like a typical simple case of not having enough energy; in other circumstances this is known as starving. I could be wrong here, but I don’t see references to replacing your energy intake with healthy fats on NSNG diet web sites. Yes it is true that some people do not adapt to fat burning as well as others but these people are certainly a minority of the readers of Runners World.

He introduces stress as a performance inhibitor and suggests that the worry associated with strictly following a formula diet is a common thing. This can be true. But there is nothing particularly stressful about a Real Food diet and no reason to worry if you accidentally fall off the waggon and eat slice of cake. The LCHF waggon is much easier to jump back onto than most for the simple reason that the food is very tasty! Contrast that with the constant warnings from sports nutritionists like Matt whose “Rules” say we MUST replace energy as we run and we MUST follow every run with the right amount of a mixture of carbs and protein. What if we forget, or get the mixture wrong? Will all our effort be wasted? Worry, worry, worry! 

In fact the “science” behind this post-run recovery advice does not support this widely held conclusion; it is based on runners performing in a fasted state, so of course their bodies needed energy and protein after a run. Most people do not run in a fasted state, do they?  And following this advice is precisely why so many runners put on weight during their marathon training. Personally I never feel hungry after a 3-hour run (although a creamy coffee is nice) and I generally recover fast enough to spend the afternoon gardening and run again the next day should I wish to. No stress there then.

Fitzgerald's declaration that runners fear an insulin spike after consuming sugar while running is interesting. I have never heard of this idea before. As far as I am aware most runners have never experienced an insulin spike and wouldn’t recognise one if it hit them in the head; people who fear consuming sugar during exercise are generally referring to the sugar that they will consume in their life and the possibility that it might lead to long-term weight gain or insulin sensitivity.  Yes, consuming sugar delays fatigue, but teaching your body to burn fat will delay it a lot longer.

Finally the article admits that eating sugar can become addictive, and that effort is required to overcome the affliction of having a “sweet tooth” is non-trivial, and may require the assistance of a qualified nutritionist.  Try to square this with the general advice of “eat less and move more” and you will be left with a head-ache.

Eat less more more?

So much of the advice we read neglects the simple fact that we are all habit-based creatures. Matt presumably finds it easier than most people to train hard and eat well because it has become a habit, part of his lifestyle and there are clear incentives for him to retain these habits.  For most people their lifestyle is far more sedentary and revolves around a constant stream of temptations to eat badly. Cakes in the kitchen, sweets in the jar by the door, coffee (and cake) with friends etc.  These habits are hard to break and nutritionists are bonkers if they think that it is a simple thing to adopt a philosophy of "all things in moderation" as Matt and so many others suggest. If it were that easy we would not have an obesity epidemic. 

I would prefer to call a spade a spade; use simple statements. Smoking is bad for you, so avoid it. Drinking alcohol is bad for you so avoid it. Sugar is bad for you, so avoid it. Un-refined food is good for you, eat it.   I am not saying that that this is easy to do, but having commonly agreed guidelines would be a good start. 

For many it takes a compelling event (such as the doctor telling them they have heart disease or type 2 diabetes) to force them to confront the truth and alter their life-long habits.  These days we all seem to want the moon on a stick, but life is harder than that. People should see LCHF as a way  of life, not a dietary fad. 

I do not have diabetes or heart disease. My compelling event came when I read that I could run faster for longer if I changed my diet. That was three years ago and it worked; my improved health (weight stable and all blood markers improved) is a rather nice side-effect of my competitiveness!

I have only ever read one article on running on fat in Runners World. A journalist took up the diet for a few months to see what effect it would have on her marathon time. She found it hard, but lost weight and did rather well; she then gave it up because she missed beer and pizza !  Desperate to get a sub-four-hour time she introduced carbs back into her diet for the last 3 weeks of training, just as she was reducing her weekly milage she confused her body with un-needed carbs. This was a big mistake and as a result she hit some kind of wall at 16 miles, and despite getting a big PB she was disapointed at missing her target. It's OK to race on carbs, although I have never needed to; but you mustn't undo all that good work by carb-loading.

The benefits of LCHF on running do not come as cheaply as this; over time we adapt to oxidise a steadily higher volume of fat per minute, and our performance improves.Runner's World feeds us with a deluge of expert advice like Matt’s telling us that we will not run like a champion unless we eat like a champion.  The science here is desperately poor and generally financed by sports nutrition companies. I know that a lot of RWs advertising income is from big sugar producers like SIS and Lucozade but I would like to see RW place a stronger emphasis on public health, after all most of its readers seem to have taken up running to become more healthy, not to run a sub-2:30 marathon.


PS - 22nd November 2017.
I thought that this article in The Times today was interesting. If you've read this far then so might you.