Low fat blinkers keep low carbs in the cold. Time for a coalition.

If the low carb diet was a political party, it should be now be close to forming a government. Its story mirrors that of actual parties – founded decades ago, it was small for a long time, languishing on the fringes of respectability; its policies were dismissed as untested and possibly dangerous by the low-fat ruling party which had close links to big business.

But gradually support grew, partly due to the clear failure of the ruling party to achieve its stated goals, partly the result of an impressive demolition of its core claims about weight loss and the causes of heart disease by several dedicated academics and partly due to various organisations implementing some of its policies with considerable success, such as the diabetic community.

Now new research strengthens the case for making low carb not only the go-to diet option for reversing diabetes but also an obvious shoe-in for improving the safety and effectiveness of cancer treatment. This is despite the remarkable ability of the old regime to continue pretending that there is no evidence that it has any benefit at all.

A shocking example of this strategy was revealed in painstaking detail by American science journalist Nina Teicholz in the BMJ a couple of years ago. She showed how the evidence used to support the standard US dietary guidelines had ruthlessly excluded evidence of low-carb benefits to maintain its position.

Drastic fast reverses diabetes

Last month, however, it looked, as if the low fat group had staged an impressive comeback with a randomised trial published in the Lancet which demonstrated that diabetes could be reversed and blood sugar levels returned to normal by restricting calorie intake to about 40% of normal – a mere 800 a day for several months delivered in sachets of a 50% carb liquid with added nutrients. Those on the diet lost an average of 10 kilos; the ones who lost the most had the best chance of having a normal blood sugar level meaning they were no longer diabetic.

Now this is clearly not the standard low-fat high-carb diet of a hundred weight-loss regimes. But calorie restriction has always been a part of the low-fat approach (but not so much for low carb) and it has been known since the 1930’s that putting animals on this sort of very restricted fasting regime keeps them healthy with, among other improved markers, low insulin and glucose. The problem for humans is that it makes life pretty grim and few can stand it for long,

But on closer examination – see Dr Zoe Harcombe’s detailed analysis – this randomised controlled trial with over 300 diabetics turns out to be an own goal for the established regime. To begin with it demonstrates clearly something that the low-fat party has been denying for years – that diabetes is reversible with diet. The low carb party has been claiming it is for nearly as long, and there’s evidence that low-carb is an effective and palatable way to do it.

Secondly by continuing to wear the low-fat blinkers the researchers have ended up in a cul-de-sac. The Lancet paper claims that this was the first time a randomised trial had shown that diet could put diabetes into remission. Dr Harcombe, however, points out that there was a low-carb controlled study from 2008 which lead to greater improvements in both blood glucose levels than the low glycaemic control group, allowing participants to reduce medication or come off it entirely.

Life on 1200 calories a day

The trial had been cited 226 times, so it was hardly invisible. She also referenced a randomised trial of high protein for people with pre-diabetes in 2016. All of those on this diet were no long pre-diabetic after six months compared with only 33% of those on the high carbohydrate diet.

So now the low-fat group are in a bit of a bind. Although they have evidence that diet can reverse diabetes, the downside is that patients would have to be on around 1200 calories a day for life, something other studies had long since shown to be almost impossible in the long term.

So what about the official low fat diet as an option? Well that turned out to be a disaster. Just 4% of those getting it in the Lancet trial achieved remission of diabetes compared with 46% of those on the very low-calorie shakes. Dr Harcombe described continuing to recommend the current dietary guidelines for diabetes as ‘medical malpractice’.

As she writes: ‘What would you choose? A very low calorie (which is also in practice low carb) diet, which comes with hunger, nutritional deficiency, inability to socialise (during the liquid phase at least) and a lifelong demand on your willpower? Or would you like to eat low carbohydrate, which avoids hunger, is nutritionally rich, is catered for in any restaurant from McDonalds (no bun) to The Ivy and can be sustained without monk-like discipline?

Unique benefits of low carb diets

Some of the unique benefits of the LCHF (low carb high fat) diet have been set out in a recent paper by the South African nutritionist Professor Tim Noakes. These include: reducing bodyweight, lowering raised blood glucose and insulin, and lowering HbA1c (the marker for long term raised glucose). The diet also reduces levels of triglyceride (fats in the blood), blood pressure and reverses non-alcoholic fatty liver disease (NAFLD). In short, the diet might almost have been tailor-made to deal with the damaging changes in metabolism that come with diabetes. Yet still attempts are made to keep it out of sight.

Much more controversial is the claim that a more extreme version of the low carb diet (the ketogenic) could be a valuable support treatment for cancer. Professor Noakes’ paper sets out the different carbohydrate content of low carbs and ketogenic diets.

In the officially recommended diet, carbohydrates provide at least 55% of your daily calorie intake. In a LCHF diet for diabetes, carbohydrates make up less than 26% of daily calories (about 130 grams) and in a very LCHF (ketogenic) diet for cancer, carbs provide less than 10% of your daily calorie intake or between 20 and 50 grams.

So, what can be the connection between diabetes and the changes in insulin and glucose levels in the blood that a low carb diet can reverse and cancer which, so we are told, is essentially a genetic disease normally triggered by mutations in a gene or two in a single cell?

A diabetes drug to treat cancer

There are lots of clues, some going back nearly a hundred years, but the most recent set comes from an article in an accessible and authoritative magazine called Cancer World aimed at intelligent non-experts interested in the disease. The article is a roundup of the ongoing research into the possibility that the diabetes drug metformin could be a useful treatment for cancer.

This, it explains, is because the drug is effective against many of the symptoms of metabolic syndrome such as weight gain especially around the middle, high levels of glucose and insulin resistance raised blood pressure and increased amounts of fats (triglycerides) in the blood and lowered levels of high density lipoprotein the so called ‘good cholesterol’.

Doesn’t that almost perfectly map onto the list of symptoms that Professor Noakes identified as being improved by a low carb diet? The article goes on to point out that ‘rising levels of obesity and metabolic syndrome are thought to be a factor in the current global cancer epidemic.’

So running trials to see just how effective a low carbohydrate diet could be against cancer would make a lot of sense, wouldn’t it? After all the low carb diet doesn’t have the nasty side-effects of nausea and diarrhoea that come with metformin and cause about a third of diabetes patients to stop taking it.

Diet mimics cancer drugs benefits

But just as the Lancet article ignored the benefits of low carb on diabetes, so Cancer World made no mention of the ways the ketogenic diet can mimic the effect of metformin on cancer cells. In fact, organisations such as Cancer Research UK have specifically rejected claims that there is any benefit to reducing intake of carbohydrates such as sugar that push up levels of blood glucose in cancer patients.

But despite the PR attempt to keep the low carb party firmly on the fringes of mainstream medicine, it’s very clear that metformin looks promising as a cancer treatment because of the effect it has on metabolism and that the ketogenic diet comes with similar benefits. But is it really plausible that treatment of two of our most costly and distressing chronic disorders could be improved by something as simple as eating fewer carbohydrates?

For a very readable account of the secret history of the theory that cancer is a metabolic disease see Travis Christofferson’s ground-breaking book ‘Tripping Over the Truth; How the Metabolic Theory of Cancer is Overturning One of Medicine’s Most Entrenched Paradigms’. Travis has also written about why reducing glucose in the blood is a vital part of fighting cancer here.

Diet cuts cancer treatment side effects

The Cancer World article goes into some detail as to why metformin can benefit patients with prostate cancer, which, although the article doesn’t mention it, also responds well to the ketogenic diet.

The drug brings down insulin which helps because insulin increases the amount of testosterone in prostate cells, a hormone which drives the cancer. High levels of insulin also produce more of a related hormone called IGF (insulin growth factor) which also makes cancers grow. Some of the ways insulin can stimulate cancer growth are set out here.

The drug also can act as an antidote to the damaging effect of reducing testosterone levels in the prostate, the main treatments. Unfortunately this effectively induces metabolic syndrome: the patient puts on weight, becomes less responsive to insulin so blood sugar levels rise along with cholesterol. All damaging changes that a ketogenic diet can also help to reduce.

The article also describes how metformin can help to improve the effectiveness of radiation therapy which routinely damages healthy cells. But the ketogenic diet can also do the same thing according to an article just published in the International Journal of Radiation Biology last October (behind a paywall).

Ketogenic diet protects against radiation damage

One of this paper’s most striking claims is that ‘when glucose and growth factors (such as IGF) are reduced and ketone bodies are elevated (by following a ketogenic diet),’ a change happens in normal but not (crucially) in tumour cells, protecting them from radiation damage. As the article puts it: the metabolism of the healthy cells changes from ‘proliferation (growth) toward maintenance and stress resistance.’

The research into the ways that metformin could become a new cancer treatment have been going on for nearly twenty years and involve cell and animal work and randomised controlled trials.

The Medical Research Council (MRC) is considering running a metformin trial and there are also metformin related projects underway, according to Cancer World, at Miami University, the Swiss Group for Clinical Cancer Research and at the Koritzinsky Lab in Toronto. Meanwhile funding to firmly establish the benefits of a ketogenic diet, which looks as if it can provide as much if not more support than metformin with fewer side-effects, is almost impossible to obtain. Makes commercial sense but is hardly in the best interests of patients.

The parallel with political parties that threaten the status quo is all too plain. One solution would be a coalition. For those fighting for the low carb option for diabetes to join forces with those doing the same for cancer. Signing up patients might then create and unstoppable momentum.