Dr. Zoë Harcombe - 'What about fiber?'

thank you for that lovely introduction what the fiber that's what I'm going to be talking about today actually that's a ripoff of Karen's in sins Booker what the fat but there we go right let's get the boring bits out of the way I have no financial ties to any industry if you've been following the UK media over the past week you will particularly appreciate I have no conflicts with the statins industry I'm the author of a number of books and for my income I write and receive royalties and subscriptions I have a subscription site that a number of you support and thank you very much for doing that now if you've watched me before you may also know that I don't clutter up the slides with references so just make a note of the slide number on the bottom right hand corner and the references are on my site /l cd19 okay ster let's go by the end of this presentation if you don't know already you will know what fiber is how much do we need the origins of the idea that it is good for us what are the guidelines what is the totality of the evidence all of the claimed mechanisms by which fiber could be of benefit what's really going on and of course the bottom line and I think the presentation may lend itself to just a little bit of toilet humor so let's go for that so fiber what is it carbohydrates 101 there are three monosaccharides they are better known as single sugars because I would like it to be known that every time we talk about carbohydrate we should be mindful of the fact that we're talking about sugar so we know these single sugars as glucose fructose and galactose there are then three disaccharides which are two sugars and you can see what we know is ship rose is glucose and fructose what we know is lactose is glucose and galactose and what we know is maltose is two units of glucose so we can immediately see that no matter what carbohydrate we eat we immediately put glucose into the bloodstream we then have polysaccharides many sugars and we have digestible polysaccharides and they are known as glycogen in animals including humans and they're known as starch in plants and we are asked to eat starchy foods which then replenishes our glycogen that's the many sugars of the digestible form and we then have in digestible many sugars and they come in a soluble version which would be things like beans or oats and that means they dissolve or swell in water and then there is an insoluble version which would be more like bran now actually I should have put the toilet next to both of those because both the soluble and the insoluble fiber this is what fiber is that's the circle of fiber both of them end up down the toilet now it doesn't immediately make you think perhaps fiber isn't quite so good for us after all now some of you will be familiar with this famous quote from the panel on macronutrients 2005 the lower limit of dietary carbohydrate compatible with life apparently is zero we don't need carbohydrate it is not an essential nutrient provided that enough fat and protein are consumed so we've just immediately seen that fiber is a subset of carbohydrates so we have no need for carbohydrate we have therefore no need for fiber and very kindly the most recent American doctor guidelines 2015 to 2020 reinforced this for us so first of all they just defined what an essential nutrient is something that we must consume we can't synthesize it in the body and then they very kindly added dietary fiber well not essential so we have the situation that dietary fiber is not essential now we could end things there and I I might suggest you if you're in a row with a conventional dietitian or health practitioner you might want to end it there because they cannot come back on that point we have no need for this thing that ends up in the toilet pan but I've come a long way from Wales we've won the rugby this morning so I'm very happy so I'm gonna carry on and talk to you a little bit more about fibre so what is the origin of the belief that this is good for us so we're going to introduce some characters here and boy are they characters so we're going to start off with Sylvester Graham he of graham crackers Fame and Graham Sylvester Graham believed that we should be eating a plant-based diet he was very much in favor of a vegan diet because he thought that it cured impure thoughts and lust and impure thoughts and lust Drive masturbation and masturbation of course as we all know drives blindness decay and early death so that was mr. Graham a very influential person lmg white came just a little bit after mr. Graham she was one of the founders of the Seventh day Adventist movement as Nina said this morning we now have one of these on the Dietary Guidelines committee she was one of the founders and arguably the most influential seventh-day adventists and she also believed that we should have a plant-based diet she believed that animal flesh and milk and butter were responsible for impure thoughts in men and for their general wickedness so they should not be having the flesh of those animals and then we have Kellogg John Harvey Kellogg and yes we're talking here Kellogg's Corn Flakes all bran the massive conglomerate cereal company that's still here today and Kellogg bless him at the age of 12 he was asked to typeset LNG White's first book and of course he then read all about these dire warnings about masturbation and lust and the other sins and so on so Kellogg came to believe three things number one meat is a sin number two masturbation is a sin number three fiber purges the body well he was right on one of those because fiber does indeed purge the body and if you ever haven't it is quite a nice sensation as well actually do you ever have what we Brits call a number two you do feel quite good afterwards cuz you are literally no longer full of crap we then move on to Denis Burkitt who is positively sane compared to the three that we've just looked at Denis Burkitt was an Irish surgeon who did a lot of work in Africa and came to observe an association between people who had a lot of fiber in their diets and who suffered less from the non communicable diseases diabetes obesity heart disease and so on so he became known as fiber man and he was famously quoted as saying America is a constipated nation and if you have small stools you need large hospitals so that's that then and we have one person to thank for piecing together all of this energy sort and that is the wonderful Belinda FET key who started investigating this wondering why her husband surgeon Gary FET key had been hauled over the coals let's hear it for both of those and again if you check the references for this slide I've put some of Linda's best posts on there but the connection that she has made between the dieticians Dietetic organization sponsored by the cereal conglomerates the cereal companies themselves the seventh-day adventists vegans what has become known now as the Garden of Eden diet and of course we saw it in George's presentation yesterday the eat Blansett diet and she's pieced all of that together quite wonderfully so when did all of this start well if we go back to the famous pamphlet that came out of the Senator McGovern committee in 1977 there was no mention of the word fiber what that pamphlet said was just simply increase your consumption of fruits and vegetables and whole grains by the 2000 Dietary Guidelines for Americans there were a number of mentions of fiber in the document but no fiber targets wasn't until 2005 that fiber was declared a nutrient of concern and some targets were set and they were set at 14 grams per day per thousand calories and this is from the most recent Dietary Guidelines for the Americans it is the table by gender by age of what that 14 grams per day amounts to and you can see that it Peaks for men at about 34 grams in the 19 to 30 age group presumably the most wicked ones who need the most fiber the unfortunate thing however is that there is no evidence base for these targets and as I try to argue with public health England evidence base means that the evidence came first so as you would have seen from Rob Wolf's presentation yesterday the recent Reynolds paper from January 2019 tried to put up a curve that said 30 grams of fiber is just the perfect amount that we should be having while I'm sorry but you can't post rationalising 2019 something that you introduced in 2005 the evidence has to come first there is no evidence base for that 14 grams there is no RCT no trials had been done this is just plucked out of the air so how exactly would we get 30 grams of fiber well very helpfully The Guardian newspaper who is having a bit of a pop at low carb diets in January they published an article saying this is the kind of food that you would need to eat to get 30 grams of fiber and you can see there's a portion of bran flakes medium banana medium baked potato baked beans etc but have a look at just how many calories how many grams of carbohydrate and how many grams of sugar you end up eating trying to get those 30 grams of fiber almost half the daily allowance for a female and the World Health Organization says we should have no more than 5 to 10 teaspoons of sugar a day we're at 44 grams which is 10 times the foreground teaspoon now of course the World Health Organisation says we're talking about free sugars fruit sugar and milk sugar doesn't count yeah because the body can work out the difference can they be so dull another interesting observation is that to get the most fiber the biggest bang for your buck the most fiber for your calories you are looking at processed food Kellogg's have got it right you'll be choosing all brown or fruit and fiber or bran flakes or baked beans that's how you get the big bang for the buck but you also get a lot of sugar because you've got to disguise the disgusting taste of the brown now you may not be aware that those were the input guidelines you may not be aware that there are actually output guidelines now I live quite near Bristol in southeast Wales and a team in Bristol in 1997 came up with what was known as the Bristol stool chart and if you've ever looked at your number twos you need to be coming up with type 3 or type 4 for your number twos if you're not coming up with those then your output targets are not being met so what's the evidence now ideally we would want to stop start at the pyramid at the top of the pyramid for the best available evidence which of course would be systematic reviews meta-analysis of randomized control trials that have examined fiber we simply can't do that because there is one study that is large enough and long enough that is examined fiber and it's the diet and Riaan function trial published in 1989 also from South Wales very close to where I live it's studied 2033 men these studies never studied women for two years there were fad interventions fish interventions and fiber interventions and you can see the numbers there all deaths in the fibre arm 123 versus a hundred and one in the control it was meant to examine heart deaths we had 109 in the intervention group and 85 in the control I know they didn't meet statistical significance but I imagine it was quite significant personally for the 22 extra deaths in the control group the fiber groups sorry who who didn't make it to the end of the study so that is not compelling evidence at the RCT level that fiber is good for so next best evidence might be to look at what Cochrane have done and Cochrane have done one paper specifically on dietary fiber looking at cardiovascular disease they've done one then looking at whole-grain cereals as a representation of dietary fiber and looking at cardiovascular disease and then again they've done one for whole grains looking at type two diabetes and the references aver the conclusion of all those three studies was that we need properly designed long term randomized control trials to be able to get to the bottom of this topic so of course what did academic institutions do of course they rushed out to do those properly designed long term randomized control trials unfortunately they didn't and what we ended up with instead was a diarrhea of epidemiology that's my new favorite collective now and by the way I do like that one specifically for Nina and Gary we have so much epidemiology we have what is called an umbrella review and an umbrella review is a meta-analysis of meta analyses and we got one of those last year 2018 Baroness and and the team looked at 18 different meta analyses there were 21 different outcomes and they concluded that three provided compelling evidence so that immediately means that 18 out of 21 did not provide compelling evidence now to be fair of the three they did get a couple of the biggies so they did get all cause mortality and they did to get cardiovascular disease mortality and the third just for interest was pancreatic cancer so they did have some interesting stuff in there but we then have to look at the usual classic issues with epidemiology and of course we start off with the fact that we are looking at Association and not causation so that reynolds paper from this year that I mentioned came up with the 15% relative risk for all cause mortality and that was when they compared people consume in 30 grams of fiber a day with those compare those consuming approximately 5 grams that is extreme now Bradford Hill would say if don't get double on your relative risk there's almost no point even going through the other eight criteria because the chances of you establishing causation are extremely low and 15 percent is nowhere near double the second issue with epidemiology is of course that they look at relative risk and not absolute risk now we can't use the numbers in the Reynolds study because at the meta-analysis level you've lost the raw data so I went back to one of the biggest studies from the Umbrella review it was yang from 2015 they also interestingly came up with a 16% relative risk for all cause mortality but they did at least have the raw data so you can established at the incident rate is 0.6 8% and that is in a 10-year study so divide that by 10 for the instant rate in any one year now when you apply the 16% difference to that you're looking at the difference of 0.63 to 0.73 even if this were causal would any of us be worried and the third issue is of course the healthy person confounder now I've gone to zoo in for this analysis which was one of the key papers in that Reynolds study had a beautiful characteristics table which shows what we see in almost all of these epidemiological studies when you look at people in the top category of fiber versus those in the bottom category of fiber the people in the bottom category of fiber are consuming double the alcohol they are one and a half times more likely to be obese one and a half times more likely to be in the lowest activity category a one and a half times more likely to have the lowest education so you then have to start asking the question is fiber a marker or a maker of a healthy person and The Lancet paper that Reynolds paper and the assassination attempt by The Guardian newspaper in the UK that somehow this paper was a blow to low carb diets got me thinking why do these studies even come up with the difference between those in the highest group and those in the lowest group who exactly are they compare him so I put together this little matrix which was in your goodie bag and it introduces what I define as nine food groups because you will notice in the plates and pyramids of the public health bodies they seem to have absolutely no idea what a food group is they think protein is the food group as opposed to it being a macronutrient in virtually every food so I put the food groups on this chance so and bottom left-hand corner you've got foods that are both low in fiber and low in carbohydrates in box a you've got high fiber low carbohydrate in Box B you've got where they want us to be eating high carbohydrate high fiber and then in Box Steve you've got high carbohydrate but low fiber so meat fish eggs and dairy are in box see you've got vegetables fruits but non starchy and low sugar in box a and of course not some seeds over in Box B you've got the starchy of vegetables or higher sugar fruits legumes beans and pulses and whole grains and then down in the bottom right hand corner the only real it's not even a real food but the only thing that would even get a mention in the food group is something in the grains category and of course it will be the refined grains so who exactly is in each of these boxes well in Box B I thought it might be good to put Gwyneth Paltrow who has been so macrobiotic in her past she has even named her children Apple and muesli now I jest she's she knits sorry she names her children Apple and Moses not Apple and muesli but probably could have named the Matalin muesli so in the bottom left hand corner is she comparing apples and muesli with the people that we know in the bottom left hand corner well I only know two people I've just discovered Georgia is in there as well but I only know two people in that bottom left-hand box and that's Shaun Baker and Michaela Peterson and they do look a bit don't know let's say but are they being compared with the people in Box B of course they're not not nice because when you go back to look at the studies that have been used in these meta analyses they date back to 1968 these guys weren't even here people were not eating the way that we ate in 1968 which is exactly the point that Rob Wolfe made yesterday and many thanks to Michaela and Sean for being such good sports and sending their before photos I look forward to the after ones so know what what we are actually comparing apples and all brown with is somebody who eats a complete junk food diet I I do this all the time because Jess so she mustn't be political but loving or hating you got to admit his diet is not great but when we transfer this and and maybe take a little bit of the joking out this is what we compare in we're comparing the high fiber people which is the affluent family they never eat refined grains they're always eating whole grains they eat the fruits and vegetables they're more educated they don't smoke you cannot adjust for a whole lifestyle it's an advantaged privileged person in that box B and unfortunately in box D are the people that we're most trying to help the most disadvantaged the people who weren't as educated and who don't have access to grass-fed beef and kale and some of the other things so that is what is being compared and when you realize that that is the difference that's being compared and yet we still only come up with a 16% relative risk difference when we're comparing those types of people it just supposed to show how weak the epidemiology is and we can ask them make a remark a question in a different way but it's the question we need to keep asking describe and make people healthy order healthy people eat fiber what are the claimed mechanisms now normally you wouldn't go on to mechanisms because we haven't established at least double to start going through the Bradford Hill criteria but I do think this is important because this is the kind of stuff that we're being hit with by colleagues who haven't become enlightened into our way of eating so one of the first arguments that they present is that fiber might slow glucose absorption and improve insulin sensitivity well relative to refined grains yes it does but not relative to meat fish eggs and dairy and that argument comes up again and again so don't let them bash you over the head with that one the second argument is that it might inhibit cholesterol synthesis and reduce blood cholesterol levels yes it might well do we know that fibrous foods often contain plant sterols plant cholesterol which replaces human cholesterol in the gut to an extent and will lower our blood cholesterol but one of the references on this slide is from a paper that I wrote examining the impact of lowering cholesterol with plant sterols on the endpoints the things that count heart disease and cancer and it is not a good thing to do third argument is they say it might promote weight loss by regulating energy intake this came from the Umbrella review can you believe there was one reference which had been put together by a fiber body representing those fake food companies who push fibrinous in their products and that study showed that apples were better than apple juice yeah we're back to whole grains are better than refined grains whole foods are better than we thought we won't fight you on that one but meat fish eggs and dairy are better still the consumption of fibers particularly from vegetables is associated with higher micronutrient intakes and micro nutrient intakes might be good for us no they're definitely good for us but that doesn't mean the fiber is good for us it's not a case for fiber in itself it's the case for foods that contain fiber another argument this came from the owner study it's pronounced but it's actually a une 2016 I've seen this one quite a few times fibre decreases transit time and then yeah rushes through the body fairly quickly reducing the impact of the carcinogens and the lining of the claritin well we don't eat carcinogenic foods we eat healthy whole real foods that should be the first thing if you're worried about the transit time because you're eating things that will cause cancer then don't eat things that will cause cancer second thing nutrient absorption I'd be a little bit worried if I thought all my nutrients were being accelerated out at the end of my body so maybe meat stays in the body longer than melon because it's more nutritious maybe we shouldn't be trying to fight how long food needs to stay in the body and if an empty bowel is so good then why are they not telling us to fast because we do that and the final one and this is becoming bigger and bigger is about the gut microbiome the microbiota in our gut and they say that that is the important thing fiber feed on that and that's why it's so important so I'm just going to do one slide on that one what creates optimal microbiota you know there's certain things that we should do and certain things that we shouldn't do first of all choose healthy parents these do look pretty good especially mom makes your mum's looking super healthy makes your mum then gives you birth properly because that's how she gives you all of her healthy gut flora make sure she then breastfeed you don't take antibiotics unless your life depends on it especially as a child but also as an adults antacids are really not good either do eat good real stuff and don't eat junk we do know from studies that eating junk is really not good for your microbiome and then there are foods that don't contain fiber but they are also fabulous for our gut flora so we've got things like caffeine natural life yogurts unpasteurized milk and cheese beans on toast may I suggest that if you've got a fabulous gut microbiome beans on toast it's not going to make much difference and if you've got a dreadful microbiome again beans on toast it's not going to make much difference now while we're on beans there was a fabulous study in 1991 when they got 10 volunteers and they actually try to measure the outputs in the form of flatulence from human beings so obviously they didn't give those human beings meat and that stuff they gave them 200 grams of beans a day and measured the emissions and the emissions included methane which I find hysterical because the vegans are blaming the cows and they're the ones eating the beans I kind of think that's like blaming the dog when you've just farted uh tonight ever doing that right so what do I think is really going on well go back to a pie chart that I did present in Parliament last week protein tends to form about 15% of any natural diet sure it can get to 20% if you're eating a good amount of meat fish eggs and dairy but it tends to be in that range so the minute you set a dietary fat restriction of 30% you have set a carbohydrate minimum of 55 percent and in case we didn't spot that that's a sentence from the 1977 senator McGovern Committee increase your carbohydrate consumption to account for 55 to 60 percent of calorie intake but carbohydrate is non-essential we don't need it so in a world where it has become better known that we don't need carbohydrate what on earth these public health bodies supposed to be doing because they want us in that box be on the matrix they want to start there having the high carbohydrate in the high fiber we've sussed out high carbohydrate so they are promoting the high-fiber aspect of box B like there is no tomorrow and at the same time they are attacking those foods in box C like there's no tomorrow meat fish eggs and dairy that's a dual strategy but of course what they have completely missed in all of this is box a and we inhabit box a so I repeated that Guardian exercise only I did it for the low carb world this time I only needed seven foods flax seeds alfalfa well-chosen vegetables artichokes blackberries and look at what has happened to the calories the carbohydrates so we have a third of the calories we have a quarter of the grams of carbohydrate we have a fifth of the grams of sugar now I went for a carb intake of about between 30 to 50 grams if any of you were on a strict two intake of 30 grams you just simply drop the blackberries and perhaps have a few more nuts and seeds and they ends up being pretty fabulous meals so you've got cream blackberries and C's for breakfast you might have salmon with asparagus on a bed of alfalfa for lunch and that should have been on cauliflower rice but you try find a picture with Chinese cabbage Jerusalem artichokes on a bed of cauliflower rice with as much meat with the fat on as you could possibly want but that's what we're gonna have for dinner with maybe some cheese for dessert so we're back to that's how we get our fiber now when we was doing this research I came across a Harvard scale and Harvard would like us to aim for a gram of fiber for every 10 grams of carbohydrates we'll look at what we're doing we're getting 31 grams of fiber for 43 grams of carbohydrate we will always win on that half of scale because we are low carbohydrate we will always win box a will always beat box B so we can beat them at their own game if you get this far along in the argument with the dietician or the health professional who's not enlightened we'll beat them at their own game we're on the last slide and I need a little bit of audience participation here because I just want to check you look like you've been listening fabulously I just want to check how you've been doing so is fine but essential is 14 grams per day per thousand calories evidence-based is there any RCT or Cochrane evidence is there a robust mechanism for benefit is a low carb diet necessarily a low fiber diet ok last one's a bit tricky concentrate I did give you a clue earlier beans beans good for the heart the more you eat the more you you've been fabulous thank you very much for listening [Applause]

Channel: Low Carb Down Under

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Keywords: Low Carb Down Under, LCDU, www.lowcarbdownunder.com.au, Low Carb Denver 2019, #LowCarbDenver, fibre, fiber, Dr Zoë Harcombe, Harcombe Diet, Cambridge University, The Obesity Epidemic, Public Health Nutrition, Low Carbohydrate Diet, LCHF, Ketogenic Diet, Low Carb High Fat

Id: 4KrmpK_Lckg

Length: 29min 57sec (1797 seconds)

Published: Sat Apr 06 2019