Dear Steven Bartlett...

It is so much harder to debunk misinformation than it is to create it...

Dr Georgia Ede is a Harvard trained psychiatrist specialising in nutritional and metabolic psychiatry. She has a new book out, and she was recently chatting to Steven Bartlett on the Diary of a CEO Podcast.

Her credentials sound very impressive, and if you know me, you will also know it is not my style to ‘call out’ other health care professionals. I prefer to create positive, uplifting informational content. It would be so much easier for me to grow a following from nutritional outrage than from nuance, but I really just dislike the energy of it. I dislike how it makes me feel. And honestly, I dislike the idea of creating an online atmosphere that attempts to shame other health care professionals who have worked for years to help people.

There is another important reason I don’t like doing this. Have you heard of Brandolini's Law? It states that it takes significantly more effort to refute false information than it does to create it. Debunking a false claim often requires providing detailed evidence, explanations, and context, while creating the misinformation can be done quickly with simple, catchy statements. False claims can also spread rapidly with minimal effort, while accurate responses might not reach the same audience.

This means that one must chose one’s battles wisely. And so, here we are. Some platforms are just too big, and some statements uttered with authority are just so egregiously false, that I feel I have to say my piece. There is no way I have the time to go over every statement she made (as per Brandolini’s law…!) , and I’ll spare you having to listen to it (please don’t) but in summary, this psychiatrist is a staunch proponent of the keto diet and the carnivore diet (despite claiming to be ‘nutritionally agnostic’) and she proferred some real corkers on her episode of a podcast that has now amassed a billion listeners across platforms.

In the image above she is enthusiastically describing how the human body doesn’t need fibre, and that it is not an essential nutrient. So bizarre was this claim that the podcast fact checkers basically debunked her themselves (this is visible only on the YouTube video and not when listening to the podcast).

You may be aware of the recent BBC investigation that concluded that allowing comments to go unchallenged creates a distrust of conventional medicine, and in an analysis of 15 health-related episodes of The Diary of a CEO, BBC World Service found each episode contained an average of 14 harmful health claims that went against extensive scientific evidence. Since this report came out, Steven Bartlett has listened, and he has responded with fact check labels on his YouTube videos at moments where statements made by guests could be contentious. At one stage in this conversation he made a valiant attempt at a rebuttal, by saying 'but you need fibre, right?’ and ‘isn’t it important for digestion or the microbiome?’ She claims the biggest myth about fibre is that it is good for digestion. ‘It is by definition, undigestible by humans.’ She suggests that by being in ketosis, we do not need to have short chain fatty acids (from the breakdown of fibre in the gut) but instead, we can rely on fat burning to produce butyrate instead.

So to be clear; fibre is indeed important. The reason it is not officially an ‘essential nutrient’ is because it contains a range of compounds, including inulin, beta-glucans, polydextrose, psyllium, and resistant starch, and the potential benefits range from increased stool weight and frequency to improved blood chemistry (eg, lipid and glucose levels). Fibre comes from carbohydrate in plant foods, such as whole grains, vegetables, fruit, and legumes, which have been dominant in human diets for millions of years. Carnivore (and paleo proponents) love to get misty eyed about ancestral diets, and despite doing this whilst typing ‘bacon, tho’ on their iPhones, they may be unaware that hunter-gatherers mainly ate fruit and wild grains, then into the agricultural era, the ancients consumed more than 100 grams of various digestible and indigestible dietary fibre sources from plants per day. During these million years, the human gut microbiota has provided vital nutritional services through digesting fibre from lactose and cellulose, degrading toxins, and biosynthesizing vitamins, signalling molecules, and other essential substances.

When Dr Ede was questioned about some anecdotes she shared and the evidence for carnivore diets, she claimed our knowledge of nutrition comes from ‘questionnaire based guesswork; untested theories about what we should eat. Untested theories, wild guesses and wishful thinking.’ She goes on to explain that when people worry about the carnivore diet, ‘we really don’t have any long term data on any kind of diet pattern’ and a ‘vegan diet is incompatible with human life’ whereas any concerns people have about carnivore diets are merely ‘theoretical’.

There is so much to unpack here. But the first thing to say is that it is wild to me that a healthcare professional should denigrate an entire field of medicine and research. Epidemiologists study the health of populations, and a typical example of a question they study is how air pollution affects human health. Or the impact of toxins in waterways on human health. Or the effects of exercise on human health. Nobody tries to cast doubt on the findings of an epidemiologist until their specialist subject is nutrition. Then all hell breaks loose.

Modern epidemiology usually involves big data, specialised knowledge and deep mathematics. It's hard for mere mortals - and even doctors - to understand. It's a bit like radiology; I’d seek help from a working radiologist to interpret your latest MRI. It takes years of study to understand what body part you’re looking at in sagittal cross section. I'm not aware of any major influencers who seek help from epidemiologists to interpret the very papers they dismiss. And those epidemiologists have almost no presence on the internet. They are too busy actually doing epidemiology.

Epidemiologists can look for faint signals in huge amounts of data and follow up huge populations for many decades in order to be able to infer causality. It’s not just simple associations folks. The food frequency questionnaires used in these studies are designed to pick up dietary patterns. Nobody expects you to remember what you ate for lunch three weeks ago. But you do know if you regularly buy and consume apples. You do remember if you tend to eat fish and lentils. You know how often you grab a takeaway. It’s these kinds of dietary patterns over the course of a lifetime that give us very real data when it comes to disease risks. Put simply, when huge populations are followed for many decades with statistical accuracy, the data trumps intuition. Studies such as the Adventist Health Study, the Nurses' Health Study, the Health Professionals Follow up study and the Framingham Heart Study to name a few, these have all contributed significantly to our understanding of the relationship between diet and disease. What do they tend to show? Many things. But one thing Dr Ede left out? Processed meat consumption is significantly associated with a 6% greater breast cancer risk, an 18% greater colorectal cancer risk, a 21% greater colon cancer risk, a 22% greater rectal cancer risk, and a 12% greater lung cancer risk. Meanwhile higher dietary fibre intake is associated with a reduced risk of death from all causes.

Dr Ede goes on to claim that you ‘really cannot burn fat unless you are in ketosis’ and ‘if you are not in ketosis you are not burning fat.’ This is again untrue. This should be obvious, but in case it is not, your body naturally uses fat for energy even when it is not in a state of ketosis, and achieving a calorie deficit through diet and exercise is the primary way to burn fat regardless of ketone levels.

Don’t get me wrong; ketogenic diets can be useful. Originally they were used to treat refractory epilepsy in children who were unresponsive to medication. These children have to remain in physiological ketosis. Sadly despite the therapeutic benefits, children have died from complications of the ketogenic diet while being treated for epilepsy. These complications include cardiac arrest, acute pancreatitis, and cardiomyopathy. These are not theoretical risks, and they have occurred despite strict medical supervision in people who were adhering to true ketosis. People find keto diets helpful for rapid weight loss too. How does it work? Put simply, when you eat less than 50 grams of carbs a day, your body eventually runs out of fuel (blood sugar) it can use quickly. This typically takes 3 to 4 days. Then you’ll start to break down protein and fat for energy, which can make you lose weight. This is called ketosis. However, the idea that high-carbohydrate diets lead to excess insulin secretion, thereby promoting fat accumulation and increasing energy intake has been disproven by rigorous testing, and metabolic ward studies by Kevin Hall’s research team have shown that this is demonstrably false. You can lose weight on ANY dietary pattern, provided you are consuming less energy than you expend. That is not always easy. But plant-based diets full of fibre have been shown to be highly satiating, and ad libitum consumption of minimally processed whole foods (ie eating as much as you want until you’ve had enough) has been shown to cause weight loss for participants in many randomised controlled studies, with added benefits of reducing lipid markers and HBA1c as well.

I am acutely aware of my own bias as I write this tome. I have the same passion for sharing information that I think is going to help people that Dr Ede does. However, my conclusions are drawn from more than personal anecdote. That I have benefited personally from a plant based diet is a plus. But of course why wouldn’t I eat a dietary pattern that is both evidence-based and that minimises harm to the natural world? Vegan diets are not inherently healthy, and yes B12 supplementation and planning are both important. But I would support my patients in trying whatever type of minimally-processed high-plant diet that suits them personally, be that Mediterranean, Japanese, Korean, African, Chinese, Middle Eastern, Indian, Persian, eco-Atkins, intermittent fasting, veggie, pescatarian, MIND diet, PORTFOLIO diet, whole foods plant based, vegan or any other iteration that supported their long term health. Because we DO have the data for that.

I think the Diary of a CEO is an amazing phenomenon - Steven Bartlett works exceptionally hard to produce a piece of podcasting that is both engaging and informative, keeping the listeners coming back for more. I have also loved some of his guests over the years, most notably Shahroo Izadi, Dr Tara Swart, Dr Stacey Simms, Dr Neal Barnard, Dr Will Bulsiewicz and most recently Dr Sarah Berry. Keep up the good work and maybe one day you’ll decide to have l’il old me on to chew the fat (or glug the seed oils….!) with you. Mmmm, seed oils…material for my next newsletter maybe?

Message me if you have any questions. If you found this essay useful, forward it to a friend who has been considering a carnivore diet. You may just save them from having a myocardial infarction on the running machine at the gym.

A must watch video:

References:

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• https://www.jandonline.org/article/S2212-2672(15)01743-8/fulltext

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