Week in Review

Special investigation: the laxative in the sausage rolls

Food researcher George Henderson assesses the best-selling New Zealand low-carb cookbook What The Fat, and asks: How did it become so popular, is there any such thing as ‘healthy’ fat, and why is a laxative included in the sausage roll recipe?

AUT Professor Grant Schofield was overweight and inflamed, yet doing everything right according to received opinion, when he travelled to the South Pacific in 2012 to do volunteer medical work for the World Health Organisation [WHO]. He was sent to remote islands. He noticed people were fit and healthy – with none of the Western diseases like type 2 diabetes which are prevalent in Westernised Pasifika communities - despite eating a variety of foods, including fatty meats and coconuts. It totally contradicted the WHO diet handouts he was supposed to be using to educate the natives about their diets.

A seed of doubt was sown. That same year, influential South African sports physician Tim Noakes admitted he – and the Public Health Establishment – had been wrong about diet and health. Schofield and some of his colleagues, including the at-first-sceptical dietitian Dr Caryn Zinn, began testing the effects of low carb, high fat [LCHF] diets in the well-equipped AUT exercise science laboratories and their home kitchens. Their research confirmed the importance of what Noakes was saying – and Grant’s weight gain and inflammation resolved pretty much immediately.

When Schofield and Zinn started talking publicly about the LCHF diet (and to be fair he sometimes did this in a provocative and undiplomatic way, as you tend to do when you first learn that you’ve been lied to all your life), the dietary Establishment was aghast. Even though its members eventually had to accept the scientific evidence, they’ve done so grudgingly and always supplied a plethora of spurious caveats. ‘Even if the high fat diet works,’ critics argued, ‘if you promote it publicly people will get the wrong end of the stick (as South Park reminded us, people would be eating dirt and chairs if there were no Dietary Guidelines) and just eat more greasy chips and pies and drop dead.’

Schofield and Zinn took this on as a challenge, and said to themselves: ‘Okay, let’s write a book that explains the diet and provides recipes and hopefully it’ll be so popular that no-one in NZ will be left in any doubt about the correct way to approach the LCHF diet.’

So they did just that in 2015, bringing Michelin-starred chef Craig Rodgers on board for the recipes, first with a self-published version of What The Fat? which was such a runaway success that the wait-list to reserve it at local libraries went round the block, then with a series of further books– Sports Nutrition, What The Fast!, and the latest book, What The Fat Recipes, all the titles but the niche Sports Nutrition being picked up by publishers and translated into languages the authors hadn’t even heard of, with the result that their critics are now able to sneer about “people who have diet books to sell”. You just can’t win, at least not from the top down, on science alone; the dietary Establishment stays Established for a reason. But you can win from the bottom up, as grateful readers share the secrets and the books with the people they care about, as GPs, pharmacists, and others at the coal face of health realise that they finally have a tool to promote metabolic health, reverse chronic diseases, and reduce their patients’ dependence on drugs.

It hasn’t all been plain sailing. Zinn faced down an attempted complaint from the Dietitians Association of Australia, which the New Zealand body she is actually a member of was wise enough to reject, and in 2016 flew to South Africa as a defence witness in the trial of Tim Noakes on charges of dietary heresy. Other low-carb proponents have faced disciplinary action over the years; the first was Dr Anna Dalquist in Sweden in 2004. The Swedish public health authorities, like those in New Zealand, feared that if people ate more fat, cholesterol would go up and therefore heart disease would increase.

Graph showing rate of deaths attributable to heart attacks (AMI, acute myocardial infarction) in Sweden, adjusted for age.

Luckily Sweden is the sort of state that keeps state-of-the-art records of food consumption and disease rates (unlike NZ); Swedish butter and oil consumption went up after 2004, margarine slumped, cholesterol rose a bit – and heart attack deaths kept dropping, and continue to drop, so that they’re almost half as common as they were in 2004. Success has a hundred fathers and no-one’s saying that the increasing popularity of LCHF in Sweden after the Dalquist trial was the cause of this improvement, but it’s very hard to make the case any longer that it has done, or will do, any harm.

In the past year or so we’ve seen the growing acceptance of LCHF, especially for the treatment of diabetes, in the UK and the US, and even the NSW Parliament has recommended the diet be offered to patients. The previous treatment of diabetes with high-carbohydrate diets and ever-increasing insulin doses was a scandalous mismanagement that has cost people their lives and health unnecessarily. In very-low carb diet programmes, the reversal of type 2 diabetes is becoming an accepted phenomenon – many more people can come off insulin and have normal blood glucose without carbs. Dr Glen Davies, a Taupo GP, has used the LCHF diet in this way – a grateful patient donated hundreds of copies of What The Fat? to his surgery – and has recorded 38 cases of type 2 diabetes reversal in the past year.

What is healthy fat? Healthy fat was the term chosen by Zinn, in place of the ‘high fat’ usual in LCHF, to remind us that fat quality is important. For a start, the recipes don’t use deep-frying, and the fats in them are going to fuel your body, they’re not disposable industrial lubricants to be scorched then dumped into drains to contribute to the construction of fatbergs. Therefore, we want to use only the best fats; those we find existing naturally in fatty foods as diverse as lamb, cheese, salmon, and sesame seeds, plus those cooking oils extractable with minimal chemistry and eaten historically by healthy populations – mainly olive oil, butter and ghee, and coconut oil. Yes, these are a bit more expensive than the budget seed oils (about 4x the price at Pak’nSave), but we’re not going to waste them, and anyway, wasn’t a saturated fat tax supposed to be good for us?

‘A goddamn laxative!’, ReadingRoom literary editor Steve Braunias fulminated, when he noticed that a recipe for low-carb sausage rolls included psyllium husk, a fibre best known as a laxative. He ought to bring his outrage under control. There’s no wheat in any of the recipes in What The Fat, and it’s good to have a substitute that can bind the other ingredients as well as gluten and starch can for baking; the absorbent type of fibre in psyllium makes it perfect for this. Also, fibre has become a shibboleth, the dietary Establishment’s last-ditch weapon in their battle to convince us that everyone needs to eat grain. Although fibre is technically a class of carbohydrates, it’s indigestible to those of us who aren’t bacteria, so LCHF [low-carb, high-fat] diets don’t have to be low (or high) in fibre to work.

That said, not everyone tolerates a high-fibre diet; there’s no point making your bowel irritable just because someone told you that the microbiome is ‘hip’ or ‘cool’ or ‘where it’s at, daddy-o’. Adjust intake to suit your needs. Is psyllium a laxative when cooked into dry food, without the large dose of water that you’re supposed to mix Metamucil with? That’s your business.

But two criticisms of What The Fat have merit. First, Grant admits he was wrong to stress, in the early books, the need to limit protein because ‘excess protein turns to glucose’. Classic ketogenic diets limited protein, but the modern evidence for this mattering to the average person just isn’t there, and protein has satiating and strength benefits; this advice is off the table.

Secondly, the ingredients for some What The Fat recipes can be expensive, especially those using nuts as grain substitutes. The LCHF diet works just as well using cheaper ingredients – fatty mince, frozen veges, seeds instead of nuts, and so on - and I’d really like to see a budget version of What The Fat come out sometime.

Grant and co have always had a medical focus. They know that with up-to-date diet and lifestyle advice, we can reverse chronic diseases that are currently treated as if they are progressive (progressive means a disease will get worse and require more meds and operations as you age). Last year, they assembled a larger team of medical professionals to form PreKure, an online health coach training service that teaches students how to apply diet and lifestyle interventions successfully within the medical system, with a more advanced low carb/ketogenic diet module available to medical professionals and graduates.

At the same time, the platform is used to supply a regular free online course, the PreKureME 21-day challenge, to the general public; about a thousand people took part in the June course (the next PreKureME challenge starts in September - although the LCHF version of the challenge is always the most popular, Mediterranean and Vegan/vegetarian/flexitarian versions are also available).

The hope is that with a bit of New Zealand initiative PreKure can show the world how to use effective, evidence-based diet and lifestyle advice at the scale needed to reverse disease epidemics and not just individual cases, and do this in a way that supports our currently over-worked health system which, when all is said and done, is still one of the world’s best.

As a teenager, I always wanted to be part of a revolution, but soon became too old to want to revolutionise everything for no good reason the way young people, and old people who should know better, do. It’s been a dream come true to be able to play a small supporting role in a diet-and-lifestyle based health revolution for which LCHF, for all its intercessionary power, is really just the proof of concept. My proudest moment so far was contributing, to What The Fast!, a section listing medical contraindications for fasting and the keto diet, and explaining them.

This made What The Fast!, as far as I know, the first low-carb book anywhere in the world to include due diligence at this level. Driven as much by curiosity as by conscientiousness, we’ve scouted out potential problems even our critics weren’t aware of, and warned about them up front before anyone else even mentioned them.

And that, I think, is how revolutions can stay won.

What the Fat? by Grant Schofield, Caryn Zinn and Craig Rodger (Blackwell and Ruth, $49.99)

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