#MSCOVID19: Fighting diet dogma

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I did a video consultation yesterday with a patient with MS who in the event of getting COVID-19 is at very high risk of severe COVID-19. This patient has type 2 diabetes with poor glucose control, is hypertensive and is also obese (BMI of 32). I asked what their GP had done to help them lose weight. The GP had recommended exercise and believe it or not hadn’t discussed diet with them. 

The idea that exercise is a primary treatment for obesity is a myth. Obesity and metabolic syndrome is an endocrine disorder due to hyperinsulinaemia (high insulin levels). The idea that can you treat obesity with exercise, and not address the hyperinsulinaemia, is a dogma that has been disproven years ago. I actually take the contrary view that you first have to start losing weight to exercise properly. If you have a BMI of 32 and you start doing unsupervised exercise you are likely to get an injury and then become less active. 

The other dogma is that obesity is too many calories in and too few out; i.e. obesity is a simple imbalance of what you eat with what you expend. This dogma has also been disproven. Not all calories are made equal. Carbohydrates, in particular, processed carbohydrates with a high glycemic index are much more obesogenic compared to fats, proteins and complex carbohydrates (low glycaemic index). 

I briefly explained this to this patient and referred her to Dr David Unwin’s or ‘the diet doctor’s’ website. David Unwin is one of the NHS’ heroes and deserves to be knighted to his contribution to the health of the nation. David Unwin has been treating metabolic syndrome with a low carbohydrate diet and getting over 50% of his patients with type 2 diabetics off medication; he is putting their diabetes into remission. The science behind low carbohydrate diets as a treatment for obesity, hypertension and type 2 diabetes is well-grounded; in my opinion, it’s irrefutable. 

The other positive spin-off of a low carbohydrate diet, beyond weight loss, is that it is also ketogenic. Ketosis may have other health benefits for pwMS. There is very compelling data from animal models that ketosis is neuroprotective and may promote remyelination (please see my blog post ‘COULD DIET BE THE NEW ADD-ON DMT?’ from 21-Feb-2020). 

So if you consider yourself of being at-risk of severe COVID-19 and you are obese and/or diabetic and/or hypertensive maybe it is the right time to try a low carbohydrate diet.

I am not saying in this post that you shouldn’t exercise. However, exercise is a powerful appetite stimulant and what happens is that if you exercise without addressing your diet you will simply end up eating more calories than you expend. You need to get your diet right first. A correct diet allows you to maximise the benefits of exercise.

If you are interested in reading more about my thoughts on diet, I would recommend reading my Medium posts ‘Diet as a Philosophy’ and ‘Evolutionary Medicine: why low-fat diets are bad for you’. 

Dare I suggest that you owe it to yourself, your family and friends and the NHS to de-risk yourself from getting severe COVID-19?

CoI: multiple

About the author

Prof G

Professor of Neurology, Barts & The London. MS & Preventive Neurology thinker, blogger, runner, vegetable gardener, husband, father, cook and wine & food lover.

17 comments

  • I am hoping that by now nutrition plays a far greater role in medicine training so that those emerging from their studies and going into a health profession realise the importance of good nutrition. Coupled with that, people should take responsibility for their own health and nutrition should be part of the school curriculum.

  • I agree that a diet high in refined carbs is obesogenic, but what about a diet high in whole carbohydrates?

    I think the issue with a low carb diet is adherence – exactly why the celebrities in your blog post failed on the diet. And it’s the same issue with exercise stimulating diet as you point out above. Either way people need to be disciplined enough to stick to their chosen diet.

    For myself I find it easier to eat a whole food plant based diet just because it’s quite difficult to overeat on it – though again you still have to stick to it and cut right down on refined carbs. I’ve gained weight during lockdown because I’m moving a lot less so can’t get away with cheating on my diet any more.

    I’ve heard experts say that the diet that works is the one you can stick to – I have to say I agree with that above all!

    • But if you have metabolic syndrome (as the patient has that I am referring to above) and you want to treat your disease with a diet you have to choose a diet that keeps the area under the insulin curve as low as possible. It is difficult to do that with a pure plant-based (vegan) diet.

  • Whilst the motivation and rational for this post is correct and sincere I think it is likely to add to worry, anxiety and guilt at this time in an already struggling anxious group. Many vulnerable people are struggling to get through lockdown without the added guilt of not being able to go full ‘low carb’. Low Carb is not the only method to reverse obesity or T2. Other diets will achieve this. The key is finding a balance that is nutritious, works for the individual and most importantly, is sustainable.
    Dr Unwin does great work but not everyone has this resource. Please only take dietary advice from a Registered Dietician, especially if you have specialist medical needs.

    • Unfortunately dietitians are part of the problem and most still promote outdated dietary guidelines that have be shown to be heavily influenced by the food industry and are not evidence-based.

  • As you know I have been your patient for more than 10ys and listen very carefully to what you have to say…. but I can not get over my addiction to bread!
    I bake my own sourdough (50/50 wholemeal and white) and have it daily…. any advice on how to get over this?

    “David Unwin is one of the NHS’ heroes and deserves to be knighted to his contribution to the health of the nation.”
    Joel Fuhrman is the unquestionable populiser of this approach. Several European doctors like Unwin (I can think of 2 in France and 1 in Sweden of the top of my head) have since followed suit. Now knighthood has been granted for lesser achievements, but in my view Dr. K and his work on cladribine is more knighthood worthy than emulating what was being done in the US….

    • I know you well and if I recall correctly you don’t have metabolic syndrome so there is no need to give up your sourdough. I love it as well. If you are going to eat bread eat sourdough; it is fermented the way flour is meant to be fermented. There is evidence that sourdough has a ‘relatively low glycaemic index’, which makes it different to other breads.

      I think the honour should go to William Banting in relation to his ‘Letter of Corpulence‘ that dates back to 1864 😉

      • Out of curiosity, what does the UK professorial class (medicine) value more in your view: a nobel prize or British Empire knighthood?

        I have always thought that the former is more priced, since it is usually followed by the latter (lead-lag effect) but am starting to have doubts…

  • Perhaps the first step for most of us would be to get added sugar out of the diet. In my GP days I used to give simple advice about this to patients and it worked. I was amazed to find out how many people with diabetes had not been asked how many sugars they have in hot drinks. The answer frequently came as a shock!

    Then the disaster of soft drinks, the sugar foods and confectionary. I was staggered by how much sugar patients were taking. The record was 600 spoons a week! In a busy surgery this advice could be condensed into a few minutes and the results were great. 7% weight loss on average for 240 patients.

    I did advise to reduce the main carb culprits too, rice, pasta potatoes and bread, but added refined sugar is surely the lowest hanging fruit.

  • Dear Gavin,
    I love your “Covid De-Risk recommendations”. I think it should be taken forward, considering the lack of straightforward mid-term efficient solution, scepticism on the mid/longer-term solutions, and we are probably still far of heird immunity.
    Your approach to build on the already previously aknowledged (other) health benefits for people with well known and highly prevalent chronic conditions make it even more useful.
    And to your last question, yes of course!
    Take care and be safe,
    Sagit

    • Thanks. But everybody still thinks that by self-isolating and shielding they are not going to get COVID-19. What they are doing is flattening the curve. The majority of us will still get the infection before the vaccine emerges, which is why it is critical to make sure you are as healthy as possible or not so healthy. I would not be surprised if people on immunosuppressive therapies have a lower risk of getting severe COVID-19.

      People also have to realise that to show the vaccine works will require people getting infected with SARS-CoV-2. The trials will be placebo-controlled and hence a proportion of the study population won’t get an ‘active’ vaccine.

      • Considering the circoumstances, to my humble opinion, the aim should be to have the “How to de-risk yourself” paragraph, next to the confinement / social distancing and shielding measures and advice, on the NHS / government websites. Involve journalists, influencers.

  • The one diet I was able to stick to – and still live by (more or less) – was the 8-week Blood Sugar Diet Recipe Book, written by Michael Mosley’s wife. First off: read the intro very, very carefully. Then, just cook the recipes! I lost 1.5 stone in 6 weeks with the minimum of effort and have not put it back in 3 years. The only caveat – I don’t think good weight loss is possible if you’re not willing to cook properly. Ready meals won’t do. Then, when the weight’s gone, you’ve got to stick with the low-carb ideas – i.e. finding substitutes for potatoes, eating far more veg, no white sugar, sourdough as the only (and occasional) bit of bread. There are far more things you can have than the ones you can’t and it’s way easier to live with than feeling out of control of your body.

  • Published a couple of hours ago. It seems that EID Natal is the go to drug these days…

    “Turning to the numbers, BIIB reported a revenue beat of $120 million due to ex-US Tysabri and ex-US Tecfidera. Meanwhile Q1 Non-GAAP EPS of $9.14 beat the consensus estimate by $1.45; and GAAP EPS of $8.08 beat by $0.50. The press release also states that BIIB revenue benefited from “$100 million attributed to accelerated sales due to the COVID-19 pandemic, primarily in Europe.”

  • This is good to read. I have had highly active RRMS for 20+ years, and have done well in recent years with a low(ish) carb, high fat approach, concentrating on real food. Dr Food and Dr Tysabri work together on my team. Real food is key: you free up such headroom for nutrient-dense food like meat and eggs and full fat dairy and leafy greens, once you eradicate the nutrient-poor sugar and cereals.

    It would be great if more doctors paid attention to nutrition. Perhaps they could start by helping to shift the processed food industry’s baleful influence on the professional and government advisory bodies, which have told us for 50 years or more to limit real foods like butter, red meat and eggs and instead get nice and fat and diabetic on bread, marge and industrial seed oils.

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