Friday, May 31, 2013

The New Nutritional Consensus: key opinion leaders


Key opinion leaders, people to follow, central figures
Please contact me if you know people that should be on the list, or if you are unhappy with your listing!


UPDATE: This blog post has morphed into its own website! Please head over to http://ds9a.nl/new-consensus/ for a better version!



The old nutritional consensus can be characterized as:


“Fat is bad, especially saturated fat, of which you should eat very little, otherwise you get high cholesterol which leads to clogged arteries and heart disease. High cholesterol should be lowered with statin pills. Transfats are horrible. If you eat fat, use vegetable oil, margarine and skim dairy products. People get overweight because they don’t move enough and do eat too much, and people who don’t lose weight should eat less and exercise more. If they fail to lose weight, they should try harder!


Also, eat more fruit and vegetables. Carbohydrates are good, especially whole grains. Base your diet on them. Stay away from salt. We are suspicious of meat, especially red & processed meat. Eat fish every once in a while. Otherwise, calories are calories.”


Over the past decades, the wisdom above has been codified by governments and regulators in “food pyramids”, “healthy plates”, “eat well plates” etc. This wisdom has presided over a fourfold increase in diabetes, and an obesity epidemic.
The common response to this is that the wisdom is fine, but that people just don’t listen and persist in not following the message.


It turns out that people did listen. Over the past decades, our intake of fat has actually decreased and the amount of time spent in sports schools has skyrocketed. So if people have listened, it must be the message that is wrong!


While the jury is out, a new consensus is appearing on the leading edge of science and in the ‘blogosphere’. The virtue of this consensus is that it leads to rapid weight loss in many overweight people. In addition, lots of folks with medical issues see their symptoms resolved or lessened if they follow the new consensus. I’ve observed this many many times among close friends and family now.


Here is what most people in the new consensus agree on:


Saturated fat and monounsaturated fat, whether from animal or vegetable origin, is actually fine. Industrial transfats are horrible. Polyunsaturated vegetable oils are dangerously unstable, and should be avoided. Actual butter is to be vastly preferred over margarine, which is a dangerous product. We like most fish too. Eat Real Food, not industrially processed or “lite” variants.


Carbohydrates are not holy, and specifically wheat and gluten are questionable, as they lead to spikes in blood sugar and inflammation. It is this inflammation that leads to heart disease, not “fat clogging arteries”.


Carbohydrates are especially fattening. Fructose, a component of sugar and HFCS is highly suspect and implicated in causing diabetes and heart disease. Cancer cells need loads of sugar and insulin. So, stay away from sugar and reduce carbs drastically. We have a soft spot for very dark chocolate though.


Cholesterol is the stuff of life, don’t fight it with pills. Statins “work”, with a lot of dangerous side effects, because they lower inflammation caused by excess carbs, not because they lower cholesterol.


While exercise has many benefits, you can’t exercise yourself out of a bad diet.


Within the new consensus, here are some interesting groups:
  • The Ketogenic Folks
    These simply drop all carbohydrates, which leads to rapid weight loss for a lot of people. Dropping all carbs generally leads to the body shifting its metabolism to burning fat, which helps a lot. Little attention to quality of food. Observe this community on
    reddit.
  • Paleo
    The guiding philosophy here is that anything we haven’t been eating for a million years is unlikely to work well for us. There is ample evidence that many paleolithic societies were low carb,  and as they did not have organized agriculture, ate little dairy.
  • Primal
    Primal goes beyond paleo, and encompasses how one should exercise, relax, sleep, play and deal with stress. Advocates living the good life. Full disclosure: I’m very much on board with these folks.
  • “Eat real food”
    This includes the paleo and primal spheres. Like to speak about Food with a capital F. “Eat Food not ingredients”. Stress the importance of eating unadulterated real food, and not chemical products.


Below is a list of many relevant opinion leaders in ‘the new consensus’, and some of the historical forebears.  I’ve tried to give a fair description of everyone involved. Because the new consensus is new, it attracts people used to upsetting the applecart. Many of them are highly opinionated and sometimes too sure of themselves, and where this is the case, I will note this. If I’ve done my job correctly, almost everybody will be slightly unhappy with their description. If they are still alive, that is.


I’ve marked medical doctors who’ve actually treated patients in a medical capacity with a . I think such folks, who have been on the frontlines, tend to know a lot more than deskbound scientists or amateurs like me.


Historical:
  • William Banting / William Harvey / Brillat-Savarin
    William Banting was a 19th century English undertaker who was “severely overweight”. A doctor he consulted, William Harvey, had learned in Paris from Brillat-Savarin that to lose weight, one should drop the carbs. This was the first time that Banting managed to lose weight, and he publicized his success in a famous letter, which was translated and shared widely. To this day, in Swedish “Bantar” means “dieting”. The trio Banting / Harvey / Brillat-Savarin are sort of the fathers of the low-carb movement.
  • Ancel Keys (1904 – 2004)
    Originated the theory that dietary fat causes heart disease. Swayed entire nations with his theories. The popular rhetoric is that he handpicked a few countries to make his case that consumption of fat was strongly correlated with heart disease, and that his theories took the world by storm. Denise Minger
    demolished that story, though. However, what is true is that he is “the founding father” of the fat-is-evil theory. We all love to hate him.
  • John Yudkin (1910 – 1995)
    English scientist and author of “Pure, White and Deadly”, a 1970s book exposing sugar as being behind a host of ailments. Widely ridiculed at the time. Turns out he was right.
  • Robert Atkins (1930 – 2003)
    Of the famous Atkins diet. Originally a cardiologist, in the 1960s he struggled to control his own weight. He chanced upon prior low carb research, and decided to try it for himself to great success. In 1972 his book “Dr. Atkins' Diet Revolution” came out and became an instant bestseller.


Currently active:
  • Mark Sisson
    A former Ironman competitor and long-distance runner, with a biology degree. Runs the “Mark’s Daily Apple” blog and is the author of a number of books describing the ‘primal’ lifestyle, which ranges from how to sleep to how to barbecue your food. I admit to being very impressed by Mark. His research is impeccable, and he manages to provide clarity and balanced reviews of even the most controversial issues. Makes a living from what he espouses, sells products and books, so has a commercial stake in what he says. I admire a man that can outrun almost everybody, can cook with the best of them, writes books AND debunks medical literature. Highly recommended.
  • Dr John Briffa / @DrBriffa
    An actual UK family doctor (physician, GP etc) who loves his patients. Fights a brave war with UK institutions on their ‘heart healthy advice’ doled out by organizations beholden to the grain industry. Can be a bit wonky at times with posts on ‘grounding’ to leak electrons into the beach, but still an excellent read. Digs up great research, and he must be a godsend to his patients.
  • J. Stanton
    Author of the Gnoll Credo, a well known paleo book. His story “
    Eat like a predator, not like prey” nicely brings together a lot of the paleo mindset and what it is based on.
  • Dr Thomas Dayspring / @DrLipid
    A specialist lipidologist. An expert on all matters of fat in the blood, perhaps one of the best. Believes that carbohydrates cause many issues with blood lipids, and standard bearer that “high cholesterol” is a nonsense diagnosis. Overweight, which is interesting given that he should know how to deal with that! Unlike some of the hardcore ‘low carbing solves everything’, he provides very detailed case studies on when what kind of medication is needed to treat a patient. Has commercial ties to lipid testing industry, speaker for big pharma. Still, he’s an indispensable authority and a great educator.
  • Dr Aseem Malhothra / @DrAseemMalhotra
    Dr Malhothra is a British cardiologist who thinks our current epidemic of obesity and diabetes (‘Diabesity’) can be prevented. Fights the old consensus with frequent articles in mainstream newspapers. Author of a recent and important paper in the British Medical Journal “
    The dietary advice on added sugar needs emergency surgery
  • Yoni Freedhoff / @YoniFreedhoff
    Canadian doctor, assistant professor at University of Ottawa, director of a weight loss institute. Prolific writer, antagonizes the food industry. Became famous when he got ‘disinvited’ to a food industry event when they found out his opinions. Instead, he put
    his presentation on YouTube where it got a quarter of a million views. Talks a lot about how our environment has become ‘obesogenic’, and how the food industry disingenuously works on keeping us fat. Has a broader view on obesity than many hardcore low-carbers. A force of good.
  • Jimmy Moore / @livinlowcarbman
    Jimmy is a great personal example of what one can achieve through the “new consensus”. Runs the prolific Living La Vida Lowcarb podcast, where he interviews the entire “who’s who” of the new consensus. Was so overweight that it might have killed him, which actually happened to his brother. Although he sometimes overstates his own knowledge, and his personal medical situation may make him a “special case”, one can’t help but admire his boundless energy. He’s a central point in the new consensus community.
  • Petro Dobromylskyj (animals)
    A veterinarian! Peter is driven by the quest for knowledge. Fan of Kwaśniewski’s Optimal Diet, which helped him feel a lot younger and resolve health issues. Peter trawls through large amounts of research, and does a fine job debunking folks trying to tease ‘the old consensus’ out of modern research. Opinionated guy, sometimes overstates the case, but given how much he cares, that is to be understood. Has a gift for seeing non-obvious truths, like for example that “getting fat is good until you stop”. Feuds with Guyenet.
  • Stephan Guyenet
    Neurobiologist, researcher. While almost everybody has now settled on the simple conclusion that carbs raise insulin and that insulin causes fat storage, Stephan begs to differ. A controversial figure within the new consensus since he partially agrees, but partially uses ever weirder mouse models to prove insulin is not responsible. I’ve included Stephan because he is a vital part of the new consensus dialogue, even though is he is not part of the actual consensus.
  • The Fat Nurse” / @FatNurseBlogger
    Much like Mark Sisson, “The Fat Nurse” provides balanced commentary both on the new consensus, and how the old consensus is being taught in medical school. Spends serious time explaining how things work. Is an actual registered nurse studying to be a primary care clinician and lipid researcher in the future. Each of her blog posts is prime reading material.
  • Ben Goldacre / @BenGoldacre
    British physician, academic and science writer. As of 2012 he is Wellcome research fellow in epidemiology at the London School of Hygiene and Tropical Medicine. Ben is somewhat of an outlier in this field in that he’s not a specifically “new consensus” guy.  He most certainly is a “things must change” guy though! He’s fighting the medical and especially the pharmaceutical world for their bad pharma. Rightfully criticizes some of the new consensus people for being too sure of their case.
  • Zoë Harcombe / @ZoeHarcombe
    One of the people criticized by Ben Goldacre. Zoë chanced upon “the truth” of the new consensus via several detours. Used to espouse a vegetarian diet. These days, she advocates a low-carb, low-sugar “real food” diet. Author of a book which describes “The Harcombe Diet”. Even though she could be criticized, she’s doing a world of good. You can’t go wrong advocating “real food” and warning about the dangers of sugar, or the nonsense of lowering cholesterol with statins.
  • Tim Noakes / @ProfTimNoakes
    Fascinating South African professor of sports & performance medicine. Literally wrote the book on it. Then, after developing (pre-)diabetes himself, discovered he’d been parroting the untrue “heart healthy carbohydrate” story. Asked his readers to tear out whole chapters of his previous books. Lives a low-carb life these days, and advocates this.
  • William Davis (“Dr Wheat Belly”) / @WilliamDavisMD
    What can I say. Dr Davis warns us nonstop about the evils of grain, of which it appears there are many. While I tend to agree, Dr Davis sees grain behind every tree and as the root cause of almost everything. However, it can’t be denied that by now it is clear that such a thing as ‘non-celiac grain intolerance’ actually exists, and that many people can benefit from eliminating grains from their diet. Publishes success stories most Fridays on his blog.
  • Peter Attia / @EatLikePete
    Trained as a surgeon, but later opted to work for McKinsey & Company. Found that despite exercising and following ‘the old consensus’, he started to gain weight, which he could not get rid of. Decided to study the science, and started “the war on insulin”. Co-founder of the Nutritional Science Institute. NuSi is founded with $35M, and its stated goal is to clarify loads of things about how our body deals with food. Peter also maintains a blog called
    The Eating Academy, where he’s done a marvelous job on elucidating lipidology, cholesterol, diabetes etc. Worth reading!
  • Robert Lustig
    Robert H. Lustig is an American pediatric endocrinologist at the University of California, San Francisco where he is a Professor of Clinical Pediatrics. Achieved internet fame with his YouTube lecture “Sugar: the bitter truth”, which now tops 3.5 million views. Is the main fructose antagonist. Author of a recent epic paper which argues convincingly that sugar is indeed to blame for the current epidemic of obesity and diabetes.
  • Andreas Eenfeldt, MD / @DietDoctor1
    Swedish medical doctor specialized in family medicine. Wants to find out how to get as healthy as possible using natural methods such as diet, exercise and perhaps a supplement (vitamin D) or two. Sweden is a frontrunner in the world of low-carb. and Andreas is at the forefront of that.
  • Michael R. and Mary Dan Eades ✚ / @DrEades
    Medical doctors and authors of a number of low-carb books of which “Protein Power” is probably the most well known. Maintain an interesting blog where they reflect on recent research. Tweets relevant material almost daily.
  • Richard D. Feinman (‘Richard the Other’)
    Richard David Feinman is a professor of biochemistry and medical researcher who studies nutrition and metabolism. His current area of research is the area of diet composition and energy balance. He is generally credited for doing the first serious scientific research on the
    Atkins Diet. His latest work is on how cancer thrives on sugar and insulin, and the effects of very low carb diets on tumors.
  • Tom Naughton (‘fathead the movie’) / @TomDNaughton
    Comedian, educator, health writer, software developer. What’s not to like! Saw the ‘Supersize me’ movie, and thought it was a load of bologna. To counteract this funny but inaccurate movie, he decided to make a funny but correct one in response. In “Fathead the movie”, he eats a lot of fast food but still manages to lose weight. In other scenes, renowned experts weigh in on the sorry state of the ‘old consensus’. These days, Tom runs a blog full of interesting information and links.
  • Dr Jay Wortman (‘My Big Fat Diet’) / @DrJayWortman
    Dr. Wortman is a physician from Canada. After working in construction for ten years he returned to school to obtain a BSc in Biology and Chemistry and a medical degree. Developed type 2 diabetes himself, dropped all carbs and recovered his health. Canada’s aboriginal populations have been developing rampant diabetes and obesity after following the advice to lay off their arterycloggingsaturatedfats!! of their traditional diets, and to government guidelines. Dr Wortman has made a project of helping these communities return to eating real food that used to work for them. This project was a great success as shown in the
    My Big Fat Diet documentary. In 2003, Dr. Wortman received the National Aboriginal Achievement Award for Medicine. He’s currently reentering active medical service after having been in government for decades. He’s a man to admire!
  • Ray Medina (Syontix)
    A lot of the new consensus is about the importance of carbs and the right kinds of fat. However, it turns out that within our gut, trillions of bacteria form a vital part of our metabolism. The importance of this ‘hidden organ’ is only now becoming clear. Ray was a long time sufferer of a host of digestive ailments, and after seeing lots of doctors and undergoing many treatments that did not work, he decided to educate himself on all matters of the gut and managed to restore his health.

    This led him to found a company that sells pre- and probiotics, and I don’t know if they are good or not. However, I do know that the Syontix blog is a fount of gut-related wisdom. I feel strongly that when we look back a few decades down the road, we’ll be shaking our heads about how we ignored our gut bacteria “and tried to lose weight by eating less hahaha”.




6 comments:

  1. I knew I forgot to add Phinney & Volek (sorry!), will look up Westman (who is new to me) and update the blog. Thanks!

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  2. Added all four to http://ds9a.nl/new-consensus/peoplejs.html - which will be the followup to this page! Thanks.

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  3. Robert Cameron (The Drinking Man's Diet) belongs between Keys and Yudkin. He was advocating a low-carb lifestyle in 1964, and sold 2.4 million copies of his book!

    http://www.forbes.com/2004/04/21/cz_af_0421feat.html

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  4. Wow phillip, that is a great find, ordered up the book _immediately_ ;-) While the story is cool, it does not really improve the power of http://ds9a.nl/new-consensus/ - but I might squeeze it in somewhere ;-)

    ReplyDelete