Dr Peter Brukner is an Australian sports medicine physician and has been doctor to high-profile sports teams such as the Australian cricket team and Liverpool Football Club. Dr Brukner is dedicated to improving public health and is the co-founder of the Australian SugarByHalf campaign. This talk was given at the Public Health Collaboration conference 2018 at the Royal College of General Practitioners in London.

In his wonderfully conversational manner, Dr Brukner opens his talk with a few jokes. But there is a serious edge to his points. He flicks through several news articles, each reporting on some fairly dire statistics. One report shows the UK to be the fattest nation in Western Europe, with 63% of adults being overweight or obese. Another states that the UK eats almost four times as much packaged food as it does fresh food. In addition, the Office of National Statistics states that, after 110 years of steady increase, predicted life expectancy has fallen in Britain. Dr Brukner also highlights a few other issues including high consumption of sugar, doubling rates of diabetes in 20 years and high rates of tooth decay in the UK.

Dr Brukner moves from news articles to newly published scientific papers that have contributed massively to our knowledge and understanding of nutrition. Recent analyses of data from the PURE study (A large epidemiological study looking at a cohort of 135,000 people from 18 countries) resulted in two recent papers with findings that contradict current mainstream dietary recommendations: Firstly, replacing saturated fat with carbohydrate had an adverse effect on blood lipids, and secondly, higher intake of carbohydrate was associated with higher risk of total mortality while saturated fat was inversely correlated with stroke risk.

Dr Brukner opines that it’s helpful for findings from papers that are perhaps common knowledge for some but not for others, such as obesity being associated with cardiovascular mortality, to be published in reputable journals. He also mentions developments in a couple of areas that are often subject to industry bias, such as the effectiveness of statins and the role of sugar-sweetened beverages in obesity.

Low carbohydrate diets are proving to be very effective in treating obesity, type 2 diabetes and other associated conditions in what is a growing body of research. Perhaps most notably over the past couple of years, Virta Health have released three papers so far (with more on the way), showing huge improvements in diabetes biomarkers and cardiovascular risk, using a ketogenic diet approach. In addition, other new publications, including randomised controlled trials and a systematic review and meta-analysis, has shown low carbohydrate approaches to be more effective than standard approaches for diabetes control.

Looking beyond obesity and diabetes, poor metabolic health is associated with other chronic diseases, including a range of cancers and infertility. Dietary interventions including carbohydrate restriction are beginning to be proven effective in treating these diseases, and more besides, including Alzheimer’s disease and autism spectrum disorder. These sorts of problems were around decades ago, but have irrefutably increased massively since the introduction of dietary guidelines in the late 1970s / early 1980s. Interestingly, it is not just people with type 2 diabetes that stand to benefit from carbohydrate restriction; this approach has shown huge improvements to glycaemic control in type 1 diabetics (both children and adults) as well.

Dr Brukner states that although things are gradually changing, there is still a lot of opposition to low carbohydrate science, and many parties still focus on calorie-counting and reducing dietary fat as the main health strategies. This could be partly due to industry bias from food and beverage companies tainting the literature, as was done by big tobacco before the new millennium. For example, the British Nutrition Foundation has a long list of member organisations that bring conflicts of interest. Furthermore, most food and beverage companies are controlled by one of ~10 umbrella companies. It has been highlighted that overcoming vested interests will be a key part of tackling the obesity and type 2 diabetes crises.

There are a number of happenings that are continually marking a changing of the tide in terms of thinking around nutrition and health. For instance, in addition to the Public Health Collaboration’s annual conference where this talk was held, other conferences are being held internationally, such as the ‘Low Carb Breckenridge’ conference, with many critically acclaimed speakers being involved. In addition, there has been an explosion in the publication of books, podcasts, TV documentaries and websites (including yours truly diabetes.co.uk) challenging the current mainstream dietary advice. Dr Brukner finishes by thanking his peers, including the likes of Drs David and Jen Unwin and Professor Tim Noakes, who have been instrumental in working to change mainstream opinio, often in the face of great adversity.

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