March 2017 - Macro Four

Yoghurt: Saving Money and Carbs

Low Carb Yoghurt: Tips & Tricks

For a change of pace after a lot of heavy posts, I thought I would share some money saving tips about yoghurt- inspired by Joseph Finau who is helping people do low carb on a budget.

Some people don’t eat dairy at all on a low carb diet, and many following a paleo lifestyle also do not regard it as paleo. Coconut yoghurt may be an option, but that is a different beast to the milk based yoghurts that I will discuss and it often has gelatine or other thickeners. Unlike dairy milk, coconut milk is also already low carb and sugar is sometimes added to ferment it.

Low carb yoghurt — Yoghurt can be much lower carb than you think

This post is about getting the sugar (lactose) and cost out of dairy yoghurt. Some people are lactose intolerant but can tolerate yoghurt which has reduced lactose. Many others have a high regard for fermented foods like yoghurt in their diet. Yoghurt (and especially Greek yoghurt) can be very expensive. If you do eat dairy, but are put off by its carbs or price, then this post is for you.

Carbs and Cost of Bought Yoghurt

Many commercial yoghurts are high in added sugar and carbs. They may have additives like gelatine or other thickeners. Most of all they are expensive. A one-kilo tub of premium yoghurt can cost $7 to $8. Making your own can make it more carb friendly, even lower in lactose and a lot cheaper. Would you believe $1 a litre or maybe less? It is pretty easy once you get the hang of it. We never buy made yoghurt, and you will probably not do that either once you learn some tricks. So how do we do it?

Do You Need Yoghurt Maker?

You can make yoghurt in a warm place in a bowl, but a yoghurt maker takes the guesswork out of it. A 1-litre electric yoghurt maker can be picked up on eBay for around $12. I recommend getting a bigger one (1.5 to 2 litre in capacity) if possible.

If you don’t use a yoghurt maker, then an insulating the container like a wide mouthed vacuum flask or wrapping the bowl in a tea towel might be useful. Having somewhere warm to keep it while it ferments (like a warmed oven) is useful. Using a light bulb for heating (as it a chicken incubator) may also be an option. Whatever you do, it is important to keep it below 45C or 113F or the culture may be killed. If the temperature is lower than 40C or 103F then it may take much longer to ferment.

Do You Need a Starter Culture?

You need milk and some starter, and that is all. You can use some store bought yoghurt (if it has live cultures) as a starter or you can purchase the culture from a cheese supply store some of these stores sell online and ship the live culture in a cool pack. Here is a google search that you can add your country’s name onto to find a possible online source. Although more expensive (about $13), once you are a committed yoghurt maker I recommend purchasing the starter because:

It gives consistent results. Most cultures are a mix of two or more bacteria. Re-using yoghurt batch after batch may deteriorate the ratio.
It is small and stores in the freezer
Commercial strains may be chosen for sweetness. You want a high acid/ low lactose variety
I only use a tiny amount (about 1/8 teaspoon)
You can search for a more acid tolerant starter culture which should give you lower carbs.
My last small jar of culture went for more about eight years of yoghurt making! So divide the cost by 300 to 400!

Which starter? There is some technical info here. You can always email the vendor and ask for their most acid tolerant starter or ask for one leaving the lowest lactose.

Instructions

Heat the milk until it is nearly boiling.
While hot, pour into the container you will make the yoghurt.
Allow it to cool to be lukewarm. Use about 1/8 a teaspoon of yoghurt culture or a tablespoon of yoghurt from a commercial yoghurt. If the milk is too hot (>45C / 113F), you will kill the culture and the milk will not ferment.
Allow the milk to ferment for 12 hours (or longer) in a warm place (40 to 45C/ 103 to 113F ). That is what your yoghurt maker does.
If there is a clear liquid on top, don’t worry, that is normal. It is whey.
For Greek yoghurt, allow it to strain through a sieve until it is the right consistency.
Store in a container in the fridge adding in low carb sweetener when you use it.

Making Lower Carb Yoghurt

As the lactose is fermented by the bacteria in the culture, it is converted to lactic acid which makes it sour. Commercial yoghurts may shorten the fermentation time to save money or to make a sweeter product. Only 20 to 25% of the sugars are converted. Once they are chilled, further fermentation is very slow. By making your own and fermenting it for longer, you can make sure it is much a lower carb yoghurt. It is suggested to ferment it until the whey (clear liquid) separates which can be as long as 20 hours. The fermentation slows as the acidity rises stopping at about 4 to 5 grams of carbs. This is where a high acid culture can help to reduce carbs further.

Now you have basic yoghurt. If you paid $1 a litre for your milk, you now have a litre of low carb yoghurt for $1. The next trick to go even lower carb is straining.

Straining

Greek yoghurt is yoghurt with some of the whey strained out usually for about 4 to 8 hours. Labneh is a yoghurt cheese that has substantially all of the whey removed, often using a weight or pressure. It may have salt, sweetener or herbs and spices added. By straining yoghurt for longer (1 to 2 days), you get labneh.

You can buy a commercial greek yoghurt strainer, but a colander with filter paper or muslin cloth over a bowl or the sink does an excellent job. If you use a bowl, you can use the whey in other cooking. It is possible to just use a very fine sieve (metal or plastic) if you very carefully spoon the set yoghurt into it using a large spoon and taking care not to disturb the ‘curd’. I prefer this as I don’t like buying filter paper to throw away or washing muslin cloth. If your yoghurt runs through your sieve then your sieve is too big, you didn’t ladle it carefully, or it wasn’t fermented for long enough.

Advantages and Disadvantages of Straining

The benefits of straining are:

You lose more of the lactose and other sugars that were not digested by the bacteria as they are soluble and in the whey, so it becomes lower carb even still.
You lose the whey which is a protein that some people with diabetes regard as being insulinogenic (stimulates insulin to rise).
The yoghurt becomes thicker naturally without adding anything, and this makes it more versatile for use as a dip or cream cheese.
The acids are also soluble and disappear with the whey so the yoghurt can be less tart.

The disadvantages of straining are:

You lose about a third of the volume of the yoghurt (hence why I recommend a large yoghurt maker).
The lower acid may mean it will keep for less time.

On the shorter shelf life, it usually isn’t a problem as you are making it at home you don’t need to factor in time for it to sit in the supermarket waiting to be purchased. Salt is often added to labneh, and this probably extends its shelf life a little. You and your family may find it so yummy that it may also be irrelevant.

What is the Carb Count?

Here are a few commercial yoghurt carb facts. Standard unsweetened commercial yoghurt may have 8g of carbs however this can halve to about 4g when more fully fermented which is where commercial greek yoghurts and labneh also sit. You should do even better than that. I expect that my home-made Greek yoghurt and labneh approaches 2g. This article has a good overview.

Squeezing Out the Cents

Having squeezed out the carbs, let’s squeeze out the cents. I often make yoghurt with the milk that the supermarket is selling cheap because it is close to the ‘use by’ date. It is fine for that because you pasteurise it and the yoghurt bacteria do an excellent job of acidifying and creating other antibacterial agents that stop other mould and fungi anyway. Making yoghurt is a biological ‘reboot’.

If you don’t want to invest approximately $40 capital in your yoghurt factory, by now you can see that you could get your yoghurt factory to pay for itself. Make your first few batches without a yoghurt maker and using some leftover yoghurt. Make it with reduced price milk from the supermarket to save even more. By putting your savings into a piggy bank, a few batches of that pays for your yoghurt maker. The next few batches pay for some starter which you can even share with a friend if you wish to get going sooner.

After that, you are miles ahead. It isn’t difficult or time-consuming to make, but you do need to plan ahead. I often make it overnight, and it is nice to think of billions of bacteria working for you for free while you sleep. It is kind of therapeutic like counting sheep.

Time to Rethink Yoghurt?

If you are like me, you may have dropped yoghurt when you stopped eating horse food (aka cereal). It could be a chance to rethink this naturally fermented food. Make your own to keep it low carb and real. As for uses, there are plenty of yoghurt recipes that you might have been avoiding due to the carbs. How about for dressings, sauces or as a (frozen) dessert? How about a refreshing lassi made with your own low carb yoghurt- great on a hot day. It sure beats coca cola or franken-soft drinks full of chemicals.

Joseph Finau: A Kiwi Tongan Being Like Daphnis

Australia’s Indigenous Health Woes

The official statistics I have quoted on indigenous health related to diabesity are appalling. Anecdotally too, there are horrific case examples.

We looked at the nonsensical state of innovation in diabetes and diet. In a situation analogous to the slowness to accept the cure for scurvy, we have seen forces that appear to be holding back effective dietary solutions for indigenous health. Those solutions, based on a traditional diet, were demonstrated back in the 1980s.

The situation looks bleak, but the low-carbohydrate movement has always focussed on grassroots solutions. That is a good strategy. You see the stakeholders who have the most to gain are people whose health is improved. The problem with low carb is that almost everyone else has something to lose. That is particularly the case for the food and pharmaceutical industries who benefit from the status quo. If you are in government and reading this, I have a message. It is incredibly short-sighted not to openly understand whether there are the disempowered stakeholders you should put first. This is an ancient problem for bureaucracy. You need to be counter-intuitive and anthropological. But we are getting deep. The efficient management of innovation by the government is a topic for another post.

Be Like Daphnis

The good news is that change is happening at the grassroots. I came across this Internet meme about Daphnis. It is one of the smaller moons of Saturn and the small ripples it makes in the rings of its much larger neighbour, and it seems appropriate to represent the change we can individually make. I think it is also very apt for this post.

We examined the success of Joy Aghogho in Nigeria. Dr Jay Wortman has done fantastic work with the First Nations peoples of Canada (see his comment in a previous post). Island nations like Vanuatu are going back to traditional foods although one wonders if they have the science completely right.

Joseph Finau: A Kiwi Tongan

I want to focus on the efforts of one individual in New Zealand who is making a difference. Joseph Finau commented on one of my posts, and I think it is worth considering his recent journey.

Joseph is a single dad from Auckland, New Zealand who has a remarkable story of battling diabesity and weathering personal tragedy. Losing 100KG (220 lb) is something entirely amazing but moving beyond that I want to celebrate his success in innovating within his community.

According to the 2013 NZ census, about 60,000 people of Tongan descent live in New Zealand. Most live in the North Island in and around Auckland. Like many Pacific peoples, and in common with the Aboriginal and Torres Strait Islanders, Tongans have suffered from diabesity in the transition from a hunter-gatherer diet and lifestyle to a Western diet and lifestyle. For their diet, diabesity is commonly blamed on the eating of turkey tails, lamb flaps and corned beef. Joseph has a different point of view- one born from the perspective of his success.

I believe that going back to the way our ancestors ate is the only way to cure ourselves from this western disease (Diabetes). for the last 3 years I’ve been eating Island foods mixed in with Western foods. example: Taro leaves & coconut cream & corned beef. Tongans loves corned beef but told it’s no good. the thing is? CORNBEEF has NO CARBOHYDRATES or SUGAR which means it’s low carb.

Joseph has adapted the Western foods Tongan’s love with some traditional food (less the starchy staples) to make Tongan and Pacific island dishes the low-carb way. That is also what the Nigerians have done and it is also what Western low-carbers have done. Corned beef cooked with cabbage in coconut cream and raw fish (AKA ceviche or kokoda) are but two dishes. Joseph has addressed one of the complaints, that low carb is too expensive, by also thinking about the economics for large families who need to be fed on a budget.

Is Low Carb Too Expensive?

The economics of low carb are an interesting topic perhaps for a future post. Let us just say here that the current criticism that low carb is expensive has some validity. It is also true that economies of scale have not yet kicked into the food supply. For sure there will be winners and losers. We only need to look at what has happened to the cost of solar power as economies of scale kicked in. A technology that was always a great idea but was uneconomic is now economic.

Data from the Solar Energy Industries Association and GTM Research show the inverse relationship between scale and cost. CREDIT: SEIA.org

However, for the moment Joseph does have solutions that work for him and his community on a budget. As he shows, it doesn’t have to be about grass fed steak, tinned corned beef (which Tongans already eat) is fine.

LOW CARBZ 4 STARTERS & BIG FAMILIES. (Food is medicine)

Joseph has a Facebook group to reach out to people in his community and around the world. He runs cooking workshops, and his group has a procession of recipes from the one thousand or so members.

Kiwi Tongan Cooking — Joseph Finau shows how to cook LCHF Tongan style

Now one thousand members may be small compared to the 340,000 now in the Ketogenic Lifestyle (Nigerian) group, but with 190,000,000 Nigerians and only 170,000 Tongans and Kiwi Tongans, it is actually quite significant.

What are the lessons for Australia?

Many people have long regarded Tongan diabesity as an intractable problem. Joseph is proving them wrong.

It seems that low-carb can be adapted to almost any cuisine and budget. By analysis of the Nyungar diet and by looking at the work of Prof. O’Dea and (most importantly) consulting with the communities, we should be able to adapt Western food to be closer to the macronutrients that Aboriginal and Torres Strait Islanders became metabolically used to for 30,000 to 50,000 years. It should be possible to make it affordable, available, and it should be more culturally appropriate than the food choices available today.

I am not saying it would be easy. I hesitate to suggest solutions for a people who have had plenty of ‘advice’ from my kind in the past. Social issues are always complex. Any solution must come from their grassroots. We need some champions like Joseph to lead the way to say eating needs to be different. Staple ‘modern’ bush tucker needs to be redefined and delineated from a preference for McDonalds or KFC. Awareness needs to be built about traditional diet and the reasons that fats and sugars are sought after, but need not be consumed in excess. That needs to be internalised. If it is hard for urban dwellers to avoid fast food, then the other side of the coin is poor access to healthy food in remote communities.

In the end, it will be a personal choice. However, if people and communities don’t have knowledge of this option, how can they choose a traditionally oriented diet for optimum health?

‘Blind Freddy’ can see that the existing approach is not working. It doesn’t work for the indigenous people of the world, and it isn’t working for us. We need different thinking.

Is a ‘Sugar Tax’ a Solution?

A sugar tax might provide revenue for some change while food supply economics normalise. If we are to have a sugar tax, why not apply it to tax the majority of unhealthy eating Australians to subsidise the food supply of those who may struggle to afford healthy food because of their socioeconomic or geographic disadvantage? Focus the funds on innovation to change ingrained food habits. This would be likely to normalise when the economics of the food supply and demand and supply settle down anyway.

No-one is arguing any more against sugar being unhealthy (apart from the food lobby). Before taxing other ‘unhealthy’ foods, the science needs to be settled.

It is in the nature of researchers to always call for more research funding. Frankly, when you see misguided research that appears to be being undertaken into diabesity, there are much better uses for the money. I am neither anti-research nor anti-academic, but funding should be judicious and focussed on settling the science for starters.

What are the lessons for NZ?

My Anzac cousins, you chose not to federate with us, and I get that. The last thing you need is some Aussie blogger telling you what to do! Joseph is doing fine, and you have other fantastic people in the low-carb community, but I have to question:

Why on Earth do your bureaucrats and food policy people follow Australia when we think that our dietary guidelines and institutions are dumb and broken?

It perhaps says a lot about the power of trans-Tasman economics over trans-Tasman rivalry, and there is probably a PhD thesis somewhere in that.

I think it is time to assert some of that famous independent Kiwi thinking. Otherwise, pretty soon the change will be over in Australia, and we will claim that Prof. Grant (Schofield) was really an Aussie researcher- just like Split Enz was an Aussie rock band.

Keep Going Joseph

My message to Joseph is simple. You may not have 340,000 group members on facebook but you are like Daphnis, and you are making waves at the grass-roots and leading by example.

You are not half the man you used to be, but twice the man most of us will ever be.

“Kai mate”, my Kiwi Tongan friend, and may that eating be low carb for a long and healthy life.

Prof. Andrikopoulos: The Sir John Pringle of Australian Diabetes?

A Paleo Solution?

In our last post, we saw that Paleo dietary solutions were researched and shown useful for diabetes in Aboriginals in the 1980s. Diabetes and other chronic disease were obviously caused by a western diet and lifestyle, and yet the recommendation to Aboriginal and Torres Strait Islanders was to eat the very same Western diet that was making those chronic diseases prevalent in Western people like me.

Here are the healthy eating charts for Aboriginal and Torres Strait Islanders and the one for all Australians.

Indigenous Healthy Eating Chart not Paleo — Healthy Eating for Indigenous Australians

Australians Healthy Eating not Paleo — Healthy Eating for Australians

Prof. O’Dea’s work showed some forty years ago that we are metabolically different yet these nutrition charts treat us as metabolically equivalent. Prof. O’Dea also revealed that the traditional diet reversed chronic diseases for the First Australians however but for token changes, neither chart reflects a traditional diet. A traditional diet would be around two-thirds meat with few carbohydrates and seasonal fats. It would not have taken too much effort to look at the macro-nutrients of the Nyungar diet or Prof O’Dea’s data and devise a better-suited eating chart. Instead, I am sorry to say; this is like someone drew in a token lizard and kangaroo and substituted and moved some other pictures around. The emergency of diabetes and chronic disease among Aboriginal and Torres Strait Islanders deserves better than this. In fact, as Prof. O’Dea alluded to, we all might be better eating from the same chart reflecting an Australian ‘Paleo’ diet.

A Deeper Mess

When we examine what people diagnosed with diabetes should eat, the recommendation is that they still eat the same as in these charts. All Australians with diabetes should ask themselves something at this point.

If we have used those dietary guidelines as a nation and we have ended up getting fatter and sicker, why will continuing with that advice solve the situation?

The question is profound, but the answer is obvious. Of course, it won’t. Like this country’s obesity and diabetes statistics, your personal statistics will continue to get worse trying to follow that advice. Australia is chronically sick as a nation trying to eat that way, and you are also chronically sick trying to eat that way. Aboriginal and Torres Strait Islanders are even more unwell, and they point the way for all of us.

I must emphasize the word “trying”. You see some people try to explain away the problem by saying that people do not follow the guidelines. They imply that their technical perfection is the only effort needed as if their job was done. Population health demands actual outcomes not theoretically perfect guidelines that people cannot or will not follow.

Where is Innovation?

What has held Prof. O’Dea’s revelations of forty years from a possible practical application? It would be scandalous if this was deliberate as it really would by tantamount to a systematised dietary genocide of the First Australians. We can probably rule that conspiracy theory out though as it is killing us all. How could we arrive at this point where we are all getting sicker trying to follow this advice? This is not a problem of nutrition, and it is not an issue of the science. It is a problem of innovation.

We have already seen in past posts that dietetic organisations like the DAA appear preoccupied with things other than our health (including whole-grain breakfast cereals) and what seems to be dietary dogma. This contributes to the innovation problem.

What about the diabetes research community? While the problems are systemic, innovation can sometimes be held back by an individual at the top who holds views of the status quo. Usually, it is that the existing paradigm and way of thinking is a source of their power. Sometimes there are other reasons. It is instructive to look at the views of those who rule the roost on diabetes advice.

The Australian Diabetes Society

Prof. Sofianos Andrikopoulos is arguably the foremost Australian diabetes researcher being the current CEO and past president of the Australian Diabetes Society (ADS). The ADS vision is: “To be the leading society for research, medical practice and education in diabetes”. They work with Diabetes Australia and the Australian Diabetes Educators Association (among others) who are on the front line to deliver diabetes management in practice. The ADS lists ‘innovation’ as a value.

Organisational Innovation

It takes a certain mindset for organisations and individuals to embrace innovation. In my analysis of companies, the innovative ones have CEO’s that can think differently and embrace with an open mind and build that capability in their organisation. Those organisations have the capability to think of the things that delight the ‘end user’ including things that even the end user never even thought of. They also have the understanding to look for user trends. Users often ‘hack’ a product to make it work better. When they see that ‘hack’ they pick up on that and research it thoroughly to find out why their product or service is being hacked for insight. They don’t discount anecdote or exclaim “N=1!” because that is frequently how invention starts.

Innovation is often mistaken for invention. These are different words with different meanings. Invention is discovery, while the act of innovation is the process of introducing something new. One need not invent to innovate and ego, expertise and the need to be seen as infallible are often the enemies of innovation.

Innovating to Solve Scurvy

I am reminded of the health innovation to use citrus in the British Navy to cure scurvy. There is ample literature on this subject and I don’t propose to redo that work. Here is one reasonable account. My summary:

In the 1700s, the British Navy was facing a battle with a chronic disease called scurvy. In some ‘battles’ it lost most sailors to scurvy than to the troublesome French with whom they were fighting. No matter what they seemed to try, the health of sailors degenerated until they died.
Scurvy is of course due to vitamin C deficiency but this was unknown at the time. Scurvy was seen as a complex problem that was multifactorial and even James Lind (who eventually solved it) “saw scurvy as having many causes, including poor hygiene and discipline“. Most believed that diet was a factor.
Lind undertook ‘medical trials’ to determine the root cause and pioneered the use of citrus juice to prevent scurvy as early as 1753, however authorities did not endorse it.
In the meantime, while citrus juice was still not official policy, “some naval surgeons, however, looked on it as a medicament that they might occasionally provide from their own purse“. No doubt their lack of scurvy was just an anecdote.
Historians attribute a big part of the delay to accept Lind’s work to the personal beliefs of the very eminent Sir John Pringle, who held a differing theory on the cure for scurvy.
It took Pringle’s retirement and death (in 1782) and the appointment of Gilbert Blane as the commissioner of the Sick and Hurt Board, for this simple treatment protocol to be agreed by the Admiralty. That was not until 1795.

The Analogy

What does this have to do with diet and diabetes?

We are facing an epic battle with diabetes as a chronic disease- just like scurvy.
Diabetes is seen to be a complex and multifactorial problem with diet being a major factor- just like scurvy.
O’Dea’s work in the 1980s showed that a Paleo diet, high protein but lower in carbohydrate and fat was a solution for the most sensitive people to this problem (Australian Aboriginals)- just like Lind.
Many of us who have effectively cured our diabetes with that kind of diet are like those lemon juice drinking ship’s surgeons. Some of us are indeed doctors.
So what are the ‘beliefs’ of Prof. Andrikopoulos about the paleo (low carbohydrate) diets and are they holding up acceptance? We can point to two major pieces of work.

The Paleo Mouse Study

In early 2016, Prof. Andrikopoulos published a study of the effect of a paleo diet on mice. His own university wrote a summary of it here. A perusal of his publications shows an extensive list of endocrine-related papers but, unless I am mistaken, no more mainstream diet and nutrition studies until this one.

This study really hit the headlines and caused a media frenzy. I lost count of the news and blog articles that it caused and I spied articles in China, India, Canada and the United Kingdom.

I am not going to analyse this paper in any detail however, many others have found issues with it.

Primarily those issues are:

Mice are not representative of people for dietary research (although they may make good models for endocrine research).
There are plenty of RCTs in humans that show the opposite effect to this study.
This was not a human Paleo diet anyway. Neither by type of food nor by macro composition.
It was not the ancestral (Paleo) diet for a mouse so no wonder it caused health issues.

Mouse Study Fallout

Many critics in the paleo and low-carb high fat (LCHF) community were annoyed by what they saw as a biased attempt to discredit their way of eating and some disparagingly tagged the professor with the nickname “Dr Mouse”.

It certainly left other academics scratching their heads. Prof. Aaron Blaisdell wrote:

Why would the lead author, a scientist of reputable standing in the Australian academe, have been so misled?

Cambridge scholar, Nathan Cofnas, wrote back to the journal the paper was published in to say (among other things):

Mice in the experimental condition were fed something loosely based on a version of the human Paleo diet, which for mice is not Paleo.

An academic peer from New Zealand, Prof. Grant Schofield, seemed annoyed when he wrote:

We think that the way Prof Andrikopoulos presented his results in the media was disgraceful. He can’t be unaware of the human research into LCHF for diabetes and the problems with mouse models. He could easily learn, if he wanted to, about relevant research into the Paleo diet too. Absolutely none of this research supports the claims that he’s making on the basis of his 9 mice.

His claims, despite being based on minimal evidence having very limited relevance. seem designed to disrupt the efforts of those of his colleagues who are using LCHF diets to benefit people suffering from obesity or diabetes.

He and three peers G Henderson, C Crofts, and S Thornley also wrote in their letter to the Journal of Nutrition and Diabetes:

The unfounded conclusions of Lamont et al., and the widespread publicity given to their criticisms of LCHF diets, amount to ‘an unjustifiable interference with a method that is working well’.

It is unclear how this research fits into a systematic endocrinal research program as may be seen in Prof. Andrikopoluos’ other work. Instead, this sudden foray into dietetic research appears to support assertions of interference and a disruptive agenda. I note that at the time that this research was being contemplated and undertaken, Chef Pete Evans and the Paleo diet was very topical. It is possible that Pete Evan’s popular message had somehow upset the Prof. Andrikopoulos and motivated this study to be undertaken. While I applaud academics who involve themselves in topics of controversy (we need more of it), I question the use of these research resources when diabetes is in crisis if that was the motivation. That is, unless the NHMRC is counting media articles instead of citations these days as a KPI.

The MJA Paleo Article

Prof. Andrikopoulos doubled down with a second foray into nutrition when he wrote a journal article for the Medical Journal of Australia that was also not supportive of Paleo diets (low carb) for diabetes in August 2016.

It was also reported widely in the medical media and it was also criticised again– although not as resoundingly as the mouse study. I think it should have been due more criticism.

In the Shadow of CSIRO

It is surprising to realise that when the journal article was written, the CSIRO had already done considerable work on its low carb diet with 93 participants for 24 weeks for diabetes and published in mid-2014 yet that is mentioned nowhere. With his profile in the ADS, that work must have been known to him. About six months after that ‘warning’ that went to doctors through the journal, the CSIRO has published a popular book on the subject on sale to the public. Imagine when patients begin talking about the CSIRO diet and their doctors lack information.

It is all the more surprising when you realise that the mouse study itself was undertaken in the shadow of the CSIRO work. While the diet composition was different (58% vs 80% fat for example) they are similar enough to question why the mouse trial was done at all.

Diabetes Research Leadership?

Prof. Andrikopoulos concluded in his mouse study:

The potential effect of popular weight loss diets needs to be carefully considered with the help of sound evidence before they are recommended for type 2 diabetes.

… and his journal letter:

…. clearly more randomised controlled studies with more patients and for a longer period of time are required to determine whether it has any beneficial effect over other dietary advice.

Prof. Andrikopoulos, as a diabetes research leader through the ADS should be and should have been the driving force to solve these questions. Leadership is not owned, it is given. Unless he has been very busy in the last months solving these important questions of potential dietary diabetes therapies, his leadership position looks diminished.

If indeed, it is as it seems (that these research questions have already been answered) then it would instead appear that his beliefs have been killing the innovation efforts of others.

Back to Our Historical Analogy

What I curiously discovered in writing this blog is that Prof. Andrikopoulos refers to one of Prof. O’Dea’s papers from the 1980s when writing his journal article. Was that reference by Prof. Andrikopoulos to Prof. O’Dea similar to how Pringle may have referred to Lind’s work?

History is indeed repeated by those who do not heed its lessons. If O’Dea is Lind, and Andrikopoulos is Pringle. One speculates who will be the Gilbert Blane who now shows the leadership to bring change and when?

Whether a low-carb paleo diet is 80% fat as in the mouse study or low-fat high protein as in O’Dea’s work, the ADS cannot ignore the low-carb issue any longer. People are getting sicker and dying waiting for innovation. Chronic disease in Aboriginal health is a national shame. It is time for change.

In my next post, I will examine how other indigenous people and groups are tackling their diabesity challenge at the grass roots.