Hear hear!

Hi Phillipa, I think you’ve answered your own question. As I pointed out in my article, many people paint all carbohydrates with the same brush and equate refined sugar (fizzy drinks and candies) with the good stuff like oats and wholemeal products. Good quality carbohydrates like the ones you’re eating will leave your stomach a lot slower and give you an ongoing and stable blood sugar level as opposed to refined junk which will be digested quickly and leave you feeling hungrier sooner. Remember that fruit has lots of nutrient density including fibre, so they can fit into a healthy and varied diet. If you only eat a half an orange at night and no other food, you’ll be hungry in the morning not because you at an orange but because you had such little food. If you eat an orange with other foods, then it will be digested differently than if eaten alone. For specifics, I would suggest working with a qualified dietitian who can help you tailor your approach. Check out Dietitians NZ here: https://dietitians.org.nz/find-a-dietitian/. Kind regards

Hi Andrew,
I think we could go back and forth all day and I’m sure neither of us has the time nor patience to do so. But I’m sure we can agree that:
1) Yes, people do need to eat less refined rubbish. There is no debate over that.
2) People need to increase both exercise time and incidental movement (inactivity physiology research supports this).
3) Food companies do have an ethical duty to provide healthy foods and sadly many of them fail, including many companies jumping on the “healthy” bandwagon selling sugar-laden “organic” or “paleo” foods. Here’s another article I wrote along these lines on this topic: https://drbillsukala.com/fibbing-food-labels-fattening/
4) Regarding low carb, I have supported its use where warranted, but have not seen any compelling evidence that this is the end-all-be-all for everyone on Earth. In the many years I have followed this debate, I have seen a lot of cherry picking data to serve agendas (on both sides, unfortunately). If you only look at pro-LCHF information sources, they do not provide a clear and balanced view on both sides of the debate. I see at lot of emotional talk of conspiracies etc. While there are many people who would say low carb is THE gospel and only solution, I can also show papers that will show short-term weight loss for lower carb/higher protein is slightly greater at 6 months, but by 12 months, there is a convergence of results where a higher carbohydrate diet resulted in the same amount of weight loss as a lower carbohydrate diet. The biggest factor in weight loss and long-term weight loss maintenance is actually adherence. If you have a person who was eating rubbish food, not exercising, and doing no incidental movement and then put them on any diet that is nutrient-dense and moderate in energy intake they will lose weight (and keep it off if it’s sustained).

Bottom line from my perspective, whilst everyone is splitting hairs and fighting a pointless emotional battle over whose diet is best, I step back and say get the right eating pattern (I hate the word “diet”) for the job. There is no one size fits all approach that is right for everyone. Lower carbohydrate diets DO have merit and can be therapeutically useful in certain clinical situations. But to play devil’s advocate against myself, even if everyone at a little less carbohydrate, so what? We have gluconeogenesis to fix that. But I think it is useful to point out that by making protein and fat intake too high at the expense of carbohydrate, this does reduce the intake of important fibres and phytonutrients which have valuable health properties for the body independent of weight loss (i.e., think gut microbiome and its role in health).

As I said, dietitians do not arbitrarily oppose the use of lower carbohydrate regimens, but they are a useful tool to be applied when relevant.

In response to your final line regarding not understanding why the low-carb diets generate such opposition, in my view, it’s not necessarily the diet alone that is garnering flack, but also the militant nature of it’s promoters. In my 27 years working in the health industry, I’ve watched the evolution of nutrition the science and its slow perversion into a religion. The debate (if we even want to call it that) has become so emotional for some promoters (and their followers) that there will not be any meeting of the minds. Moreover, I see many people just parroting back what their guru wrote in a book.

Regarding it’s classification as a fad, I think it’s important to note that a lower carb regimen is not a single diet. It has been hijacked by many self-styled nutritionist who put their own spin on it and pervert it into a cult. THAT is where it’s gone wrong. Many “gurus” will push extreme regimens and make up all kinds of bat-shite crazy theories that have no merit, cite a bunch of “case studies” of their satisfied users (who would have lost weight anyway by simply giving up Maccas and KFC every day).

But as I said up front, it’s an emotional debate that, in this post-truth Trump era of “alternative facts,” is really just a waste of time unless people are open to a civil debate and are willing to acknowledge that there are pros and cons for every eating pattern and there is evidence which can be cherry picked in either direction. I believe it’s best to look at the preponderance of evidence that is neither 100% in favour of either side of the fence and say, “hey, these are our tools. Let’s apply them when the situation merits this diet or that diet.” And aside from all that, as I said above, it’s also about adherence. High carb diets are shit for adherence, some people calling them cardboard diets. People eating lots of protein and fat sometimes get constipated. Point is, if someone can’t stick with a diet, no matter what it is, then perhaps it’s time to try something else.

Balance in views and judicious application of evidence where warranted (and no to everyone and their agendas, on either side of the table).

The rubbish food you mention is usually extremely high in sugar, including fructose and there is good evidence of fructose causing fatty liver, which has become epidemic and precedes diabetes. I don’t think clinicians would be as obsessive as to not call something Metabolic syndrome just because it did not precisely fit some criteria. Some diabetics do not get obese, that is well known, but they still get all the other features.

The recent evidence does strongly support Low carbohydrate diets as better for weight loss and better for diabetes and fatty liver. To label it is as a FAD diet is simply unscientific as it has good evidence of superior effectiveness in people with insulin resistance and in reality the Dietary Guidelines are the modern FAD diet, introduced without solid evidence and they have failed to acquire positive evidence. The eyeball test and the data says they are a failure with a %600 increase in diabetes and huge rates of obesity. Trying something like a Low Carb diet, which has scientific evidence of superior results for obesity is not something that should be opposed by dieticians. I do not understand why it generates such opposition.

Hi Andrew,
Thanks for your comment.
1) On the first point, I would politely disagree that the excess sugar intake is a direct result of following dietary guidelines. I trained as a dietitian nearly 25 years ago (before moving into exercise physiology) and even then, the recommendations encouraged people to eat real food, not too little and not too much, not supplements, not meal replacements (i.e., brown rice, quinoa, lots of fruits and veggies, lean cuts of meat, fish, poultry, and good quality fats). When we talk about sugar intake in particular, the argument is not a simple dichotomous line down the middle of good guys vs bad guys. I have no kindling love affair with any government health agency or any particular dietitian’s groups, but I will call bullshit where I see it. And the argument that “dietitians are making people fat” is unfair and unfounded. During my research for my PhD in diabetes, I dug really deep into the scientific literature on this topic. The truth is, there are many factors and meta-factors that are attributed to excess refined food intake (not just sugar, but also excess fat and the corresponding calories). You must account for socioeconomic demographics like level of education, income, geographic location, quality food availability/accessibility, information sources on nutrition, not to mention institutionalised racism in impoverished minority sections of the country (Australia, NZ, US, Canada, UK, etc). All of these things are real and they can and do influence what people put into their mouths. So while superficial social media conversations might sound intuitively logical on the surface, the actual causative factors of why people eat too much refined rubbish food is more intricate.

2) I would agree that for individuals with insulin resistance, if they simply cut out all of the rubbish food they were eating that caused their obesity (and resultant insulin resistance/diabetes), then they would fare much better (that much I have seen first hand in clinical practice and it’s supported by evidence). There is evidence that for some patients, they can benefit from having fewer carbohydrates and more protein, but again this is something that must be taken on a case by case basis by the endocrinologist/clinical dietitian.

2a) On a side note, regarding metabolic syndrome, I would encourage you to check out Khan’s work on this topic: http://care.diabetesjournals.org/content/28/9/2289 This idea of metabolic syndrome as a clinical entity is a bit misguided. The criteria that the patient must tick 3 of 5 boxes can be misleading. What if someone has high blood pressure and elevated plasma glucose, but nothing else. They tick 2 out of 5 boxes. That means they don’t have “metabolic syndrome” per se, and they might leave the doc’s office thinking, “whew, dodged a bullet there!” But in reality, both elevated BP and BG are still clinically meaningful and are cause for alarm. Do we not treat the person? Are they not at increased risk for cardiovascular disease? So we do have to use clinical judgment when evaluating patients on an individual basis instead of using a carpet bombing approach to classifying people with/without metabolic syndrome. But that’s a separate story (don’t get me started!).

3) Fructose. It’s true that fructose can have adverse effects on the liver, but those who would demonise fructose as a molecule and who buy into Lustig’s alarmist self-promotion often neglect the fact that for someone who is eating very healthy, if they have the occasional piece of candy against a backdrop of a healthy lifestyle (exercise, healthy eating, etc), it is not realistic to think that would cause any lasting damage. The devil is in the dose. Do I think society as a whole needs to reduce fructose intake? Of course, but not for the reasons that the alarmist camp would have everyone believe. It’s because eating too much refined junk in general crowds out good quality nutrient-dense foods and provides a LARGE number of excess calories. Partner this up with excessively high levels of INACTIVITY and you have a perfect metabolic storm. Again, as I mentioned in point 1 above, the great sugar debate is, in actual fact, far more complex than a naive fructose = fat/unhealthy = insulin resistance. Here are two other articles on my site which discuss this topic: https://drbillsukala.com/is-sugar-bad-for-you/ and https://drbillsukala.com/is-fruit-sugar-bad/

4) One thing we can agree on is that, yes, advice should be evidence-based and tailored to the individual.

The carbohydrates are everywhere, in the forms of lerp, honeydew/ nectar, & manna. Australian native plants are carbohydrate factories, because of our combined high sunshine levels & poor soils. The high light levels encourage rapid photosynthesis. However, the plants can’t convert all the sugars they produce into physical structures (wood, seeds, leaves), because there are insufficient essential minerals in the old soils. The plants have to get rid of the excess carbs somehow, so they “sweat it out” in the form of nectar/ honeydew, or in some cases manna. They are also assisted by psyllid larvae which suck carbohydrates from the plants, & themselves excrete it to form lerp.

I get this information from an excellent book called Where Song Began: Australia’s Birds & How They Changed the World by Tim Low (Penguin Group (Australia), 2014). I was most surprised to learn that Australian native peoples traditionally ate diets very high in refined carbohydrates. I had assumed the opposite was the case, & was the reason for the high levels of diabetes found in Indigenous Australian populations today.

Also, Indigenous Australians in southern regions obtained carbs from eating the roots of Microseris lanceolata (also known as murnong & native daisy). However, obviously, gathering this destroys the plant.

Hope this information is useful & interesting to your readers Bill!

Thanks Jon. All very interesting questions. Unfortunately, I don’t have time to dig into researching your thesis topic but would be interested to read your report and recommendations when finished. I’d suggest contacting full-time academics who are working in the area and get their take on these questions. Kind regards