Metabolical Chapter 3 Doctors Need to Unlearn Nutrition

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Metabolical Chapter 3. Doctors Need to “Unlearn” Nutrition

Author: Robert H. Lustig Publisher: New York, NY: HarperCollins Publishers Publish Date: 2021-5-4 Review Date: Status:💥

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I had to relearn everything I know about nutrition and NCDs on my own, through my own research and experience, even though I had a whole lot of people telling me that I was shooting myself in the foot. In one ignominious episode in 2009, I was even thrown out of the UCSF Pediatric Diabetes Clinic, which focused on kids with type 1 diabetes. And this ouster was led by, of all people, the clinic dietitian.

What about type 1 diabetes, due to insulin deficiency? They get diabetic complications in part due to their overinsulinization over time. Both forms of diabetes (type 1 and type 2) are extreme carbohydrate intolerance, so I thought, what if we tried to reduce the insulin requirements of type 1 diabetic kids by getting the refined carbohydrates and sugar out of their diets? Would their blood glucose swings be easier to control?

Even ten years later, in 2019, this concept was still considered alternative, yet is becoming slowly accepted practice and with lots of data supporting it. But in 2009 cutting back on insulin dosage was heresy. For decades the American Diabetes Association said that both type 1 and type 2 diabetics could “eat all the carbs you want, just take enough insulin to cover it” (to their credit, the 2019 ADA guidelines for the first time mentioned carbohydrate restriction).

This offhand comment made by German physicist Max Planck at the turn of the twentieth century was based on his observation that scientists are like mafiosi—they exert a stranglehold on their fields, preventing new ideas from percolating to the surface and, like Don Corleone, you had to wait for them to die in order for science to move forward.

The National Bureau of Economic Research put it to the test. They assembled the names and papers of all the members of the National Academy of Sciences for twenty years, and then assembled the names and papers of all of their coauthors. They looked to see who passed away in that twenty-year interval and assessed the coauthors’ research productivity after their leader died. Not surprisingly, the collaborators fell off the academic cliff without their Godfather. Then they used medical subject heading (MeSH) terms to see who was publishing in that area afterward. Turns out it was an entirely new crop of scientists with completely new ideas. Indeed, the big bosses squelched any dissent in order to maintain their influence.

Academic Arrogance

The octopus-like grip academic gurus maintain on their respective fields involves many tentacles. One big motivation is grant funding—after all, if an authority is proven wrong, the funding will dry up. Second, and even more pernicious, is the ephemeral currency of academia. In Washington, it’s power. On Wall Street, it’s money. In the ivory tower, it’s credit. Credit—really? It’s true; credit is the green-eyed monster of academia. It’s all about how many papers you’ve published in what journal and whether your name is listed first or last (if neither, your contribution is seen as second-rate). The motto really should be “publish and perish.” Academic medicine is the worst, because never has so much been fought over for so little.

And then, finally, there’s the most ridiculous monster of all: skepticism. Now, it’s good for academicians to be skeptical—after all, they’re supposed to apply the scientific method to their deliberations, and keep their own personal biases separate. But what if that skepticism is misplaced? What if it’s being driven by personal hubris rather than good scientific suspicion?

Here is my own very recent example of how this kind of skepticism works to everyone’s detriment, except the academician. I first aired the “sugar is toxic” message in public in 2009. In 2011, Gary Taubes wrote his New York Times article “Is Sugar Toxic?,” followed by my 2012 Nature comment (written with UCSF colleagues Laura Schmidt and Claire Brindis), “The Toxic Truth about Sugar.” We then published our landmark fructose restriction study (see Chapter 20) in the journal Obesity in 2016, which demonstrated causation between sugar consumption and metabolic syndrome. Despite all the information and science gleaned by myself and others, an incredulous WebMD video appeared online asking Joslin Diabetes Center CEO Ron Kahn the question, “Can eating a lot of sugar cause my diabetes?” Kahn responded (and I quote): “Eating a lot of sugar definitely does not cause diabetes if you don’t eat so much sugar that you gain weight. And in fact, sugar to a certain extent is OK because it stimulates the pancreas to make more insulin, which actually helps to control the blood sugar …”

This is the head of the Joslin Diabetes Center, saying in 2015, “a calorie is a calorie,” “it’s about obesity,” and “insulin is good.” With all we knew at that point, to be that unabashed about one’s stance on a seminal point that has such important clinical implications—think about that.

To Kahn’s credit, he has finally come around—in part, because he senior-authored a 2019 article in Cell Metabolism showing in mice that fructose decreases mitochondrial function, while glucose stimulates it. He issued this statement to Science Daily about his paper: “The most important takeaway of this study is that high-fructose in the diet is bad. It’s not bad because it’s more calories, but because it has effects on liver metabolism to make it worse at burning fat. As a result, adding fructose to the diet makes the liver store more fat, and this is bad for the liver and bad for whole body metabolism.”

OK, Kahn finally accepts that a calorie is not a calorie, and that sugar is toxic. Hooray. But why? And why now? The answer is simple: he had to do it himself. That way, he looks like the consummate critical investigator, being appropriately cautious. But it also gives him the opportunity to ignore what came before, dissing other scientists, and allows him to take credit for a new paradigm shift. And remember, in academia, it’s all about the credit.

There are some scientists who aren’t just cautious or contrary—they’re plain calcified. They won’t ever flip—not even when presented with new data or hypotheses. Sure, everyone has a belief system; that’s how we make sense of the world. Some people will allow for rational challenge of their beliefs when they are debunked—we call them moderates—while others defend against it to maintain their worldview at any costs and are called zealots.

But then there’s another class of thinkers who are intransigent because they make money to keep it that way. And in the nutrition field, this seems to be the case more often than not. Credit is the end game of most medical academicians, and clinicians are taught to respect the medical literature. But many docs also rely on the lay press, which often gets it wrong, depending on who is funding the message. They still follow the advice of their big-name colleagues, but are often unaware of who is paying them.

A recent example of zealotry became evident during the 2019 skirmish over whether red meat is good for you or not. A nonprofit scientific group calling itself NutriRECS, headed by Gordon Guyatt (originator of the GRADE system of evidence-based medicine), published a meta-analysis in the Annals of Internal Medicine that couldn’t conclude that red meat was bad for health. They didn’t conclude it was good for health either, just not bad.

This article set off a firestorm in the nutrition community—and most worrisome, before it was even published. A nonprofit nutritional education organization called True Health Initiative (THI), headed by self-proclaimed nutritional entrepreneur and anti-meat advocate David Katz, upon reading the embargoed press release, launched an all-out attack on the Annals office in Philadelphia. This included an email bot campaign on the editor, spamming, and an unheard of request for formal pre-publication retraction. Katz, in conjunction with Neal Barnard of the Physicians Committee for Responsible Medicine (PCRM, another anti-meat advocacy group), petitioned the Philadelphia district attorney to open a case against Annals “to investigate potential reckless endangerment,” and a separate petition to the Federal Trade Commission. All this about a paper that hadn’t even been published yet. Katz himself called Annals a vehicle for “information terrorism.”

Katz and THI don’t dispute the science in this meta-analysis; rather, they call into question the first author, Bradley Johnston, who three years prior had taken money from the International Life Sciences Institute (ILSI; see Chapter 23), a front group for the food industry. They accused another coauthor, Patrick Stover, of having an undisclosed conflict of interest because he is vice chancellor and dean of Texas A&M College of Agriculture and Life Sciences, which had received an endowment to support the International Beef Cattle Academy.

What THI leaves out is that they’re equally if not more conflicted, with a web of cash receipts or endorsements from the likes of # NoBeef, the Olive Wellness Institute, the Plantrician Project, Wholesome Goodness, Quorn, and the California Walnut Commission. Other THI board members, including former U.S. Surgeon General Richard Carmona, served on the board of Herbalife Nutrition Foundation; and David Jenkins, who penned an article about resisting corporate interests, takes money from Pulse Research Network, the Almond Board of California, the International Nut and Dried Fruit Council, Soyfoods Association of North America, the Peanut Institute, Kellogg’s Canada, and Quaker Oats Canada. Calling the kettle black.

Katz for his part stated, “I think there’s a big difference between conflict of interest … versus a confluence of interest. The work you do is what you care about… . No one’s ever paid me to say anything I don’t believe… . There’s nothing fundamentally wrong [with] industry funding.” Is he right?

Academic Societies Have Their Own Agendas

The US has many academic medical societies. Many of them overlap, and all are political. For instance, who is in charge of diabetes? Those organizations laying claim include the Endocrine Society, Pediatric Endocrine Society, Juvenile Diabetes Research Foundation, American Association of Clinical Endocrinology, Diabetes Technology Society, and the omnipresent and ubiquitous two-thousand-pound gorilla in the room, American Diabetes Association (ADA). Many of these societies say that they issue clinical guidelines for clinicians, in order to promulgate and maintain “standards of care” within the profession. But is it more to promulgate and maintain a choke hold over thought and discourse?

The ADA has been particularly egregious in its ignorance of the science involved in the issuance of its guidelines. Full disclosure—I don’t belong and have never belonged to the ADA, in part because of their head in the sand approach to diabetes care.

I got into the obesity field in 1995, and went to my first ADA meeting in 2002. I was dumbfounded. First, there was not one talk on prevention of type 2 diabetes, only on treatment. Second, here is the society that presumably knows the most about the role of insulin in disease—and they’re promoting the message that obese people are at fault for eating too damn much. Then, they tell people with diabetes to eat whatever they want, just so long as they count their carbs and take enough insulin to cover it. Given what we know about glucose and insulin excursions causing chronic metabolic disease, why would they advocate for that? Nonetheless, the ADA guidelines advised this through 2018.

I saw plenty of kids with type 1 diabetes over the years, and the best way to get their hemoglobin A1c down was to get their carbohydrate consumption down, although not every study has been able to get kids to do this effectively. I never understood the ADA’s stance against carbohydrate restriction, and I’ve spoken out against it on many occasions.

The lightbulb of just how conflicted the ADA is went off for me on April 28, 2017, when Stephen Dubner, host of the podcast Freakonomics and a personal hero, released his report: “There’s a War on Sugar: Is It Justified?” Three people were interviewed: Dr. Margaret Hamburg (an MD and former head of the FDA), Dr. Richard Kahn (a PhD and former chief science officer of the ADA until 2009; no relation to C. Ronald Kahn), and myself.

Richard Kahn is a true case study. In 2014, he coauthored an editorial in Diabetes Care exonerating sugar as a cause of obesity and diabetes. In this Freakonomics episode, when Dubner asked Kahn about the cause of obesity, he said, “There’s been some evidence, that with the increased use of psychotropic drugs, anti-depressive drugs, drugs for schizophrenia and other mental disorders, those drugs tend to promote weight gain … and when people stop smoking, that’s usually been associated with weight gain … many people do believe that sugar consumption has been the cause … of our obesity epidemic, and subsequently diabetes. But I believe the evidence for this is pretty weak.” In 2017, San Francisco was debating adding warning labels to cans of soda akin to packs of cigarettes, a campaign in which I was the scientific expert and reviewer of promotional materials. Richard Kahn, in opposition, coauthored an expert report on behalf of the American Beverage Association. In that report he wrote, “There is no scientific consensus that added sugar, including added sugar in beverages, plays a unique role in the development of obesity and diabetes.” Could it be because Kahn, during his tenure at the ADA, signed a three-year $1.5 million sponsorship deal with Cadbury-Schweppes, the world’s largest confectioner? In the end, bowing to political pressure from Big Food, California put the kibosh on the campaign before implementation.

Interestingly, my UCSF colleague Dean Schillinger looked at the same datasets Kahn did (sixty studies in all; see Chapter 23) and when taken in toto, Kahn is correct—there’s no clear consensus. But Schillinger added one variable—food company sponsorship. Lo and behold, of the twenty-six studies sponsored by food companies, all twenty-six showed no effect. Of the thirty-four studies that were independently funded, thirty-three showed a clear relationship between sugar consumption, obesity, and diabetes—meaning the food industry has polluted the data (see Chapter 23), and Kahn toes the same line, polluting it further. He ultimately was replaced by a true National Institutes of Health (NIH)-trained MD diabetes researcher, William Cefalu, and for the first time, the 2019 ADA guidelines mention that carbohydrate restriction could be a viable option for some diabetics. Yet they still haven’t acknowledged sugar as a cause of diabetes. And they’re not the only ones. On its website, Diabetes UK says, “With type 2 diabetes, we know sugar doesn’t directly cause it, but you are more likely to get type 2 diabetes if you are overweight.” Maybe this assertion has something to do with the fact that Diabetes UK received a 500,000 pound contribution from Britvic, the company that is licensed to sell PepsiCo in the UK. This, at the exact same time that the International Diabetes Federation (IDF; which represents 198 countries, just not the US, UK, and Australia) told the Group of Twenty (G20; an international forum of central banks) that taxing sugar could save lives and money.

Why does the ADA and Diabetes UK say sugar doesn’t cause diabetes, while the IDF says taxing sugar could prevent type 2 diabetes? Because many of the IDF’s member countries are poor—they can’t afford the refrigerators to store the insulin, never mind the insulin itself. As a result, they have to prevent disease—and that means changing the food. But to implement the same changes, the US, UK, and Australian diabetes societies would have to admit that they were wrong, and have continued to be wrong for decades now. When given the choice, it’s easier to throw meds at the problem and throw shade at the critics.

Academic societies often blur the facts. What would happen to the ADA if people knew they could prevent diabetes without medicine? What would happen to all the Big Pharma money coming in to support the ADA budget? In the “bad old days,” many academic organizations sold their name to corporations; for instance, the American Medical Association to Sunbeam, and the ADA to SnackWell’s. But that practice is now frowned upon. The ADA is #100 in profitable charities, with $182 million in annual revenues, of which 40 percent come from pharmaceutical corporate donations. In the decade 2002– 2013, while the ADA declared diabetes a treatable disease with meds, thereby increasing the market, the cost of insulin tripled.

After all, why would a private nonprofit society dedicated to eradicating a disease want the disease eradicated? Most medical/professional societies eschew nutritional information and policy because appropriate nutrition can both treat and prevent disease—while most organizations are in the business of only treating disease with medications. For example, we know that sugar consumption drives the development of type 2 diabetes, but the US, UK, and Australian diabetes associations refuse to acknowledge that we could prevent and treat type 2 diabetes through sugar restriction. They much prefer issuing prescriptions. Why? The answer is simple: because if we prevented diabetes, they’d go out of business.

And after all, medical societies are run by people, who’ve got their own skins, or wallets, in the game. There’s more money at stake than you might think. A recent analysis of the ten US societies with the costliest disease expenditures shows that 72 percent of board members have extensive ties with industry, receiving a median honorarium of $32, 000, w i t han u pp err an g eo f o v er$ 500,000 for the oncologists. No wonder drugs rule medicine (see Chapter 6).

The Clinician’s Conundrum

Ivory tower academicians are supposed to advance scientific discourse, but they frequently hold it back, especially when they’re subordinated by their guru, organization or university, or academic society. But what is holding clinicians back from doing right by their patients when they know the truth?

The first thing we’ve learned over the last forty years is that doctors are parochial. We only get information from other doctors, in the form of journal articles, clinical meetings, and webinars. Most of these venues are sponsored by Big Pharma to push their products—you can check for yourself who funds the satellite events at the ADA, for example.

The second thing we’ve learned is that doctors are sheep, meaning doctors follow the herd of other doctors. And there’s good reason. If you don’t follow the medical guidelines, you get a lousy evaluation on Healthgrades—the online company that evaluates physicians and gives them a number score—and the hospital medical board will then investigate you and can revoke your privileges.

The third thing we’ve learned is that most of us doctors don’t listen to our patients. We talk. In part, because insurance companies tightened the screws, so we only have ten minutes with you. Once we have your set of symptoms and arrive at a provisional diagnosis, we’re on to the quickest and easiest form of treatment, whether it’s the most efficacious or not, and our hand is on the doorknob. Next time you go to the doctor, time your visit. Talking about lifestyle changes takes time that we don’t have—because that’s how we’ve been trained and how we get paid.

Nutritional “Know-Nothings”

Nowhere in medicine are the principles more challenged than in the field of nutrition. Nothing is more important than nutrition for correct and optimal bodily and mental functioning, yet nothing in medicine generates more heat and less light.

Only 28 percent of medical schools have a formal nutrition curriculum; even fewer than in 1977 when Congress passed the law that created the Dietary Guidelines and called for more nutrition science in the medical classroom. Now, medical students receive on average 19.6 contact hours of nutrition instruction during their four-year medical school careers, about 0.27 percent of the time spent in class. How is your doctor supposed to provide nutrition advice if they never learned it in the first place?

Apart from rare specialized symposia (e.g., the University of Arizona’s Integrative Nutrition annual symposium, or Tulane University’s Health Meets Food symposium), there are virtually no continuing medical education programs on nutrition that aren’t corrupted by industry influence. This includes nutraceutical companies peddling dietary supplements, as they’re trying to insert themselves between food and medicine. Even more concerning is that this isn’t an exclusively American problem; nutrition is poorly taught around the globe.

Predictably, the focus of medical school education is on treatment—drugs, devices, and digging (surgery)—because they make money for the physician, Big Pharma, and Med-Tech. This is why medical school operating costs are underwritten by pharma companies (see Chapter 6). After all, why would your doctor recommend a $0.10/ d a y d i e t a rys u ppl e m e n t or a$ 0.50 vegetable/day that doesn’t need a prescription, over a $10.00/day pharmaceutical that needs their signature and continued follow-ups?

Nutritional epidemiology is fraught with controversy. Recently, there have been calls to curtail nutritional research because it is hard to do properly. For most nutrients, patient recall is the only method for estimating consumption, and people forget, especially about items that they think aren’t good for them. Furthermore, analysis of data is always suspect since correlation is not causation. In order to determine causation in research, you need one of two kinds of studies. The first is called randomized controlled trials (RCTs; this is the gold standard for drug evaluation), but nutritional studies can’t be controlled very easily, because with prospective (following patients over time) studies it’s hard to alter people’s diets for any length of time. When one nutrient goes up (e.g., carbohydrate), another goes down (e.g., fat). The other kind of study is known as econometric analysis, in which natural history studies of changes in disease rates over time are analyzed, taking into account all other co-occurring factors. This is how we determined that tobacco causes lung cancer—because doing an RCT would get you thrown in jail. Econometric analysis is more conducive to nutritional research, and is how we proved that sugar is causative for type 2 diabetes.

Of course both kinds of studies are complicated to perform, require appropriate statistical analysis, and drive the cost of such projects up. Another reason, as discussed above, is that the food industry has put the thumb on the scale of many nutritional studies, polluting the literature. Last, you have to measure the correct metric, which is difficult, expensive, and time-consuming. For example, biomarkers (e.g., LDL-C) are not the same as events (e.g., heart attacks) (see Chapter 2). Doctors figure, why bother to try?

Patients are notorious for ignoring medical advice, even as it relates to their own longevity. Most can’t or won’t change their diets, or miraculously start exercising just because their doctor tells them to. Stanford nutritionist Christopher Gardner showed in his A to Z study that all dietary interventions regress to the mean—meaning by two months on any specific diet, the subject will return to eating the same way they were before the intervention. Dieting is hard, and rarely works in the long term. You can alter your health, but you have to know why; your doctor does, too. They need to be able to explain the “why” back to you. One thing I’ve learned after forty years in medicine is that if you don’t understand and tell people why something will work, they won’t do it.

You really can’t blame the public for their nutritional whiplash. We are exposed to a daily barrage of contradictory statements and straw man arguments about basic science (one day “fat is bad,” the next day “fat is good”) coming from physicians and dietitians, while nutritional biochemistry is ignored (i.e., how metabolism works versus calorie counting and body weight). The physicians don’t understand it themselves. If there’s no science or understanding, there’s no imperative to change.

Another reason that patients can’t or won’t alter their diets is that they’re abusing sugar—the food additive that’s most addictive, induces metabolic disease, and reduces longevity. These patients need help from their doctors more than ever, but doctors understand addiction about as well as they understand nutrition—witness the doctors’ response to our current opioid crisis where we have two million addicted people and only 5,500 physicians trained in addiction medicine.

Since there’s been perennially so little money for nutrition research, Big Food has stepped in to fill the void. They conduct their own studies, which are 7.36 times more likely to support their own product than not. They pollute the professional journals with biased research, so they can point to their own studies and say that a nutritional principle is not “settled science.” And they use their money to buy the loyalty of dietitians (see Chapter 4), and to co-opt and pay off scientists and critics alike.

Who’s on the Hot Seat?

Doctors are kept honest by their medical organizations, who propose and codify state-of-the-art clinical guidelines. But doctors are also kept honest by their patients, as many of them won’t improve by following those same guidelines. Astute clinicians are pattern recognizers; they know when they’re seeing the same thing time and again—they know something’s up; they might not know what it is exactly, but they know they need to change something. One such pattern recognizer was Robert Atkins, who rethought human nutrition and metabolism, realized refined carbohydrates were hurting himself and his patients, and wrote a book to explain his change in practice. Some called him a huckster and charlatan, some called him dangerous; but he was listening to what his patients were telling him, and ultimately he was proved right.

A most unseemly aspect of medicine is when professionals in the community turn such pattern recognizers into criminals, for daring to think outside the box. Three physicians—Dr. Tim Noakes in South Africa; Dr. Evelyne Bourdua-Roy in Quebec; and Dr. Gary Fettke in Australia—have been formally investigated by their countries’ respective medical boards for promoting low-carbohydrate lifestyle advice. They’re charged with giving “medical advice” on the radio or in lectures that could “mislead the public on low-carb, high-fat (LCHF)/ketogenic diets.” In each case, the charges were brought to the medical board by the dietetics board of each country, without evidence in support of the claims, and without any alleged “victim” of that “dangerous” medical “advice” coming forward.

Noakes was referred to his medical governing board by Johannesburg dietitian Claire Julsing Strydom, president of the Association for Dietetics in South Africa, due to a single tweet he made to a breastfeeding mother. In it, he said that good first foods for infant weaning are LCHF. Thus, for infants, he was suggesting meat, fish, chicken, eggs, dairy, and vegetables. The ADSA views LCHF diets as fashionable and instead supports orthodox low-fat, high-carb diets (e.g., rice cereal, strained fruits). Noakes went on trial twice to have his medical license revoked, and despite being exonerated with testimony from international experts on metabolism and nutrition, has suffered through waves of negative publicity and censure.

Bourdua-Roy’s investigation by Quebec’s medical board is ongoing. The charges against her advocating a LCHF diet were levied by prominent dietitians who wrote an opinion piece in the Le Soleil newspaper. The letter’s first signatory is Caroline Dubeau, regional director of the Dietitians of Canada (DoC) for Quebec; although Dubeau is careful to stress that neither she nor the DoC lodged the complaints against Bourdua-Roy, she wouldn’t say whether the nutritionists who complained are DoC members. The DoC website says that dietitian and nutritionist are protected titles in Quebec. Just as with other sister dietitian associations globally, DoC is heavily conflicted. Like some medical societies, they accept sponsorship money from Big Food, Big Sugar, Big Soft Drinks (with Coca-Cola driving from the front), and Big Pharma. Many of their members have industry links. Last year, over seven hundred doctors, dietitians, and nutritionists signed a letter to their government in support of Bourdua-Roy, calling for radical reform of nutrition guidelines to include low-carb, healthy-natural-fat diets. Bourdua-Roy herself posted a hard-hitting response to Dubeau’s letter, in an article in the HuffPost that eighty other Canadian doctors signed. The headline: “Low-Carb, High-Fat Is What We Physicians Eat. You Should, Too.” Dr. Bourdua-Roy has not yet been exonerated.

Fettke, an orthopedic surgeon by training, developed an aggressive pituitary tumor requiring surgery, chemotherapy, and radiotherapy, and through his own research, has been able to stave off its progression by adopting an extremely low-carbohydrate, high-fat diet, known universally as the ketogenic diet (see Chapter 12). This diet is now in trial around the world (at notable research institutions such as Memorial Sloan Kettering in New York and MD Anderson Cancer Center in Houston) to “starve” the tumor, and reverse its growth. Fettke, as a caregiver, prefers not to have to amputate limbs from diabetic patients as a consequence of their condition, so he tells his patients that a simple dietary change can save both life and limb. For informing his diabetic patients to reduce their sugar intake, Fettke was stripped of his ability to provide nutritional counseling or medical management of his patients. Fettke still doesn’t know the names of the persons who reported him to the Australian Health Practitioner Regulation Agency (AHPRA), but he does know that the complainants are members of the Dietitians Association of Australia (DAA). They accused him of “inappropriately reversing a patient’s diabetes.” Really? The DAA has made its opposition to LCHF and ketogenic diets well known. And AHPRA slapped a lifetime ban on Fettke for his attempts to try to save diabetic patients’ limbs from being sawed off and their lives from being snuffed out. The good news is that Dr. Fettke, with help from the international medical community, finally won his appeal in 2018.

It’s clear that sugar and processed food drive obesity, heart disease, stroke, diabetes, and fatty liver disease (see Chapter 2), and there’s emerging data that processed food is responsible for cancer and dementia as well. It’s also clear that low-carbohydrate diets haven’t worsened this trend, and in some cases have reversed these diseases. Yet the medical establishment refuses to be reeducated, and instead prosecutes the reeducators.

🔮 The Cosmos

Metabolical Chapter 3. Doctors Need to “Unlearn” Nutrition

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