Fiona Godlee: Discussion on low carb high fat diets

Fiona Godlee, Editor in Chief, The BMJ, moderated the panel discussion on "Low carb high fat diets: Public controversies and opportunities" at the Swiss Re Institute's "Food for thought: The science and politics of nutrition" conference on 14 - 15 June 2018 in Rüschlikon.

Panelists of this discussion:
Sarah Hallberg, Medical Director and Founder, Indiana University Health Arnett Medical Weight Loss Program, Indiana University Health
Michael Lean, Chair of Human Nutrition, University of Glasgow, and Consultant Physician Adjunct Professor of Human Nutrition, University of Otago, New Zealand
Matthias Schulze, Professor and Head of the Department of Molecular Epidemiology, German Institute of Human Nutrition
Jennie Brand-Miller, Professor of Human Nutrition, The University of Sydney
Roy Taylor, Professor of Medicine and Metabolism, Director of the Newcastle Magnetic Resonance Centre, Newcastle University

[pepper]

Sarah, you were gold. You saved so many people from type2. R.I.P.

[mkvira]

Sarah Halberg at 39:05; most brilliant comment and significant insight from her. She talks about continuum of food/nutrition. However, utilizing processed food and sugar compromises metabolic health. Choices are then limited and low carb becomes the primary option.

[Vannie]

From reading "Diabetes Unpacked", it seems that people's metabolism 'avoids' getting type 2 diabetes by storing the excess glucose as fat, but some people are more successful than others at this. So some may get diabetes without putting on much weight whereas others put on weight until such a point that the body can no longer store the excess glucose and only then develop diabetes. So it seems obvious that it isn't being 'fat' per se that is the risk factor in type 2 diabetes, it's individual response to excess blood glucose. The bottom line is that type 2 diabetes is an intolerance of carbohydrates - and, as they are saying, limiting that is often the best way of preventing or reversing it.

[asarcadyn]

The elephant in the room is that we have been eating animals and plants 4 million years and it is only in the last 50 that we have seen an exponential rise in metabolic diseases. What happened? The USDA guidelines happened.

[asarcadyn]

What a start studded audience asking the questions!

[GardengirlkpBlogspot]

Excellent panel, great moderation . I was formerly obese or yo-yo dieting for 40+ years, (ages 6-46) now in weight maintenance for 6+ years (70 pounds lost). I need multiple tools: calorie restriction and Low Carb diets and intermittent fasting to maintain. I stopped just short of surgery. I NEED to have choices as options at my doctor, so I appreciate Dr. Hallberg's point of needing choices. I've found sustainability with combining 3 methods.

Thank you Swiss Re, Fiona Godlee, and Dr. Hallberg.and for the panel members' rational discussion. Bravo!

[insanelyinsensitive]

Drop people in the wild and log the ones that survive and are healthy and see what they eat....well it won't be tons of carbs.

[ekondigg]

Interesting that there didn't seem to be too much of a controversy on this controversial subject.
Note the question (and response) to the public at 13:10-13:50 "How many people in the audience would consider themselves to be, currently, on a reduced carbohydrate increased fat diet?... Is there anyone in the audience who would consider themselves to be on a high carbohydrate reduced fat diet?"

[kaycee]

I wonder how many of those panel members have changed their tune since 2018.

[ScienceUnbiased]

@33:56 Sarah is incorrect. BHB increases when free fatty acids are converted into usable energy. There are multiple studies showing increases in ketones in all caloric restricted diets (whether low fat, low carb or Mediterranean) which is to be expected, if you're losing weight from fat you're increasing ketones. (fasting, very low carb or low carb high fat increases levels significantly more)

[grahamedwards]

The fourth choice is intermittent feasting followed by fasting. ..
Cf Dr Jason Fung.
Graham Edwards

[lalman]

walter kempner treated all metabolic syndrom with table sugar and white rice with 100% succsess

[RollingBluesBoy]

very stressfull, speeded, frantic setting and a dragon of moderator ... Sadly shorted time for these people to argue important things ...

[henrybird]

I hear closed minded physicians, and not willing to even enertian low carb diets.

[akshayalawani]

My issues with the talk
1. Visceral fat is considered as a whole and sole contributor to increasing blood sugar levels. Or at least it is being potrayed as one by the guests. That is not true. We still do not know root of diabetes.
2. There is no evidence of cellular repair anywhere in literature. So rather than saying diabetes reversal blood sugar management seems better word.
3. The first speaker says adherence is important and also claim nutrition is very individualised. And still proposes common cliche solutions like low carb TO ALL OF THEM.
4. She also says adherence is amazing and it is not an issue. In all the literature, it never is a problem for mostly initial year when accompanied with counselling. However, eventually people fail in 5 years approx.
5. What about rebound.



My conclusion :
Everyone wants to propose theories and solutions too fast. No one actually is focusing at real problem.
Till then, individualistic approach with proper counselling is the only solution.

Eventually a line of approach can be formed, but low carb is not a solution nor a bariatric surgery. They may have 'proven' themselves to be efficient in balancing blood sugar levels, however story doesn't and shouldn't end here. We need better line of treatment that can lead to 'cure' of obesity epidemic. Temporary treatment is not a solution, most of the times it is just pulling an arrow back which will eventually bounce back with greater intensity.

At this stage, the way people are being treated and trained with complete avoidance to how severe the rebound can be, any person who is deciding to start a diet just to lose few kgs, is at a risk of getting fat in long term.