Stone-walling low-carb: DAA, AHPRA, and the Diet of Worms.

Our 2015 paper, Low-carbohydrate diets as the first approach in the treatment of diabetes. Review and evidence-base, summarized the clinical encounter and the study results of the 26 authors. Meant to be a kind of manifesto on practice and theory, the first version of the manuscript was submitted to a couple of major journals under the title”The 15 Theses on…” harking back to Martin Luther’s 95 Theses. A critique of Church practices, especially indulgences — for a few bucks, we get you or your loved ones out of purgatory — the Theses were supposed to have been nailed by Luther to the doorway of a church at Wittenberg. Our MS was rejected by BMJ and New England Journal although, like the first 95, it didn’t seem especially radical — The American Diabetes Association (ADA) acknowledges that dietary carbohydrate is the major source of high blood glucose and the majority of our points of evidence were based on pretty solid fact.  Anyway, somebody suggested that we were, in effect, trying to nail our low-carbohydrate paper to the door of the ADA and, in the long run, we changed the name to”evidence base” and it was finally published.

Until recently, I hadn’t noticed the extensive parallels of the present low-carbohydrate revolution with the Protestant Reformation. The recent imperious and rather savage actions of professional associations, especially two in Australia, the DAA (Dietitian’s Association of Australia) and AHPRA (Australian Health Practitioner Regulation Agency) in clamping down on their own members for deviation from orthodoxy brought out the similarities. Unlike Luther, who felt that the church really needed his help in getting abuses straightened out, Jennifer Elliott, a dietitian with an established practice of 30 years and Gary Fettke an orthopedic surgeon, believed that they were just doing their job and that, however, non-standard, the low-carbohydrate diets which they advocated for people with diabetes, was far from heresy. Due to the ties between government health agencies, Jennifer finally lost her job and Gary is beneath the bizarre order not to recommend diets to his patients because, as an orthopedic surgeon, there is”nothing associated with your medical training or schooling that makes you an expert or authority in the area of nutrition, diabetes or cancer.” (Those of us who are actively attempting to upgrade the medical curriculum would question which part of the medical profession has such experience or authority). Dr. Fettke’s training does, however, allow him to perform amputations which have diabetes as its best cause, second only to accidents. Whatever the case, offering low-fat diets to patients has long been perceived as a threat by institution medication.  While their claims that they, and they alone, can control the epidemics of obesity and diabetes has been in the level of offering reduction of time in purgatory.   The medical establishment has been intolerant of criticism but has largely responded by delaying or preventing publication and by refusing to fund research that might get the “incorrect ” answer. The direct attacks on practitioners is new. There are lots of instances but the Australian cases clearly signify desperation.

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History of religion is still one of the gaps in my undergraduate liberal education and I was unfamiliar with all the dramatic events surrounding Luther’s assignment. The sixteenth century was a brutish time and that I should have figured how violent and oppressive could have been the response of the Catholic Church to Luther’s suggestions for improvement. After all, if you insisted on the word of the Bible instead of the term of priests, indeed, if you wanted direct access to a Bible in your own language rather than in Latin, then everyone could be their own savior. Getting burnt at the stake was standard punishment for such heresy. We all know about Galileo’s brutal treatment and his being forced to recant his heliocentric theories, although at some stage, he allegedly muttered, under his breath,”eppur se muove.” (It (the ground ) does move anyhow ). That was nearly a century after Luther’s protest and the threat was greater in 1521. Finally, he faced a trial in the Diet of Worms. (Contrary to popular belief,”Diet” is an English word and means meeting; the German is Reichstag; Worms is in Germany, about 60 kilometres from Frankfurt-am-Main, and is pronounced”Vorms,” to rhyme with”norms,” but the joke is widely made, even by Shakespeare: see end of this article ). In The Diet, Luther got off as a unanimous vote was required for conviction. He had an inside man, Frederick the Wise, the elector (as local political leaders were known) in his state.  Frederick appears to have thought that Luther was great for tourism (and probably helped get the Church off his own back). Of course,”not guilty,” does not mean innocent and, as for sex-offenders in our day, you might get killed in the street anyway and the police would understand. To protect him, Frederick had Luther”kidnapped,” disguised as an aristocrat with the alias Junker Jörg and he went to the mattresses in a Castle in Wartburg for a year until it all blew over. Lucas Cranach the Elder painted a portrait of Jörg, possibly to allow followers understand that Luther was still alive.

Heresy down beneath

What had the Australian health professionals done to excite the anger of the”Church”? Not much. Jennifer Elliott has over 30 years of experience and is the author of the excellent book, Baby Boomers, Bellies & Blood Sugars  that’s distinguished by its straight-forward practical approach and does not appear to tweak anybody’s beard. In fact, she was not really accused of any specific thing even though the message was clear: low-carbohydrate high fat (LCHF) diets are forbidden. Trying to help out, I sent an email message to Claire Hewat, head of DAA. I attached the twelve-points of evidence paper and I explained our position. I pointed out that”Ms. Elliott seems quite upset and genuinely puzzled since carbohydrate restriction has been a treatment for diabetes more or less forever, certainly going back to Elliott Joslin (early twentieth century physician and authority on diabetes).”

hewat_claire11474634995-300x224        Claire Hewat, head of DAA.

I said a meeting with a reporter from the New York Times that could not understand the resistance to an established, effective and ultimately obvious therapy — you do not give carbohydrates to individuals with a disorder of carbohydrate intolerance — and I made the case that the burden of proof should be on anyone who did not approve.  I suggested a discussion,”perhaps an internet webinar, where all sides present their case. I and/or my coworkers would be pleased to participate.” Claire’s answer was that I was”clearly not in possession of all of the facts in this matter, nor can I apprise you of them as this is part of a confidential complaints process…nor is DAA fearful of debate but this isn’t the place for this.”

Not to digress too much, I loved the thought that I didn’t have the facts right but the facts were not accessible because they were confidential.  It reminded me of watching a scene in one of those old Basil Rathbone Sherlock Holmes films. Holmes is playing the violin and his arch-enemy, Professor Moriarity suddenly appears in the doorway:

Moriarity:”Holmes, I’ve come to….Well, I am sure that you could deduce why I’ve come.”

And I’m positive you can deduce my answer.”

Moriarity:”So that’s final?”

Holmes:”I am afraid so.”

Most distressing remains that DAA constitutes an expert dietitians’ organization that should, as in Macbeth,”against his murderer shut the door, / Not bear the knife myself.” (Is this a DAAger I see before me?)

The details of Jennifer’s case are buried in evasive legal double-talk but the majority of events make it clear that censure derives from her recommending low-carbohydrate diets for her patients with diabetes. In fact, it could have been worse than the Diet in that there were no formal charges and even Luther had been afforded legal representation. There would certainly be no defenders, as Luther had in Frederick, the Wise. Most important, recanting wasn’t an option — if it wasn’t about anything real, there was nothing to recant. (Like Luther, she likely wouldn’t have felt able to recant anyway). Jennifer declined to attend telling Claire that it appeared to be”an invitation to a beheading.” The net effect is that she lost her job and also legal recourse would probably be exorbitant.

From the reformation, heresy may have meant only owning a Bible in your native language, or actually owning any Bible at all. The Church held onto the Latin versions which you did not have to see directly. Somewhat like political nutrient guidelines in our tme, it was not in your native language, and required an “expert” priest to tell you what’s what. The first English translation was accomplished by John Wycliffe and throughout the English Reformation, several people were actually executed for owning a Wycliffe Bible. I found it somewhat akin to the persistent hatred of Dr. Atkins so long after his death, that, at some point, the Church in England had Wycliffe’s body exhumed and burnt at the stake.

Ultimately, Luther succeeded because of Gutenberg and the invention of movable type. Now you did not need to make copies by hand. Today Luther could get the word out. And he wrote the word. During his period of lying low in Wartburg, he translated the Bible into German.   And he printed it. It was a major hit although the German population recognized that they were swindled — financially as well as theologically — and history records a Peasant’s Revolt that was put down with great brutality. We recognize in this parallels to what is really happening in the establishment’s determination to repress LCHF diets. And everyone recognizes the analog of Gutenberg’s press.

Unser Gutenberg  and the Fettke case

Our Gutenberg is, of course, the net where scientific and technical writings, once the province of specialists, can now be seen by many and where they may be discussed widely. Publishers of many journals try to maintain pay-walls in keeping with somebody’s observation that publishers’ function used to be to make new information available while now they work to create information unavailable.  (Many concurrently cash in on open access which fees the writers outrageous fees). Whether the availability of scientific facts is out-weighed by proliferation of other facts is open to question but, on balance, we’ve got a view, not only of the science, but of the internal workings of the health agencies which may otherwise be visible to only a few. And that is the way we have extensive access to this Fettke situation and an associated Diet convened by the Australian Senate.

According to Marika Sboros, Fettke”can’t tell patients not to eat sugar. Why not? Because the nation’s medical regulatory body, Australian Health Practitioners Regulatory Authority (AHPRA), says so….It has been exploring Fettke for more than two years now. That was after the first anonymous complaint from a DAA dietitian in 2014. Earlier this season,  AHPRA told Fettke to stop talking about nutrition until it had determined on a suitable sanction.” And — I am not making this up –“informed Fettke it was investigating him ‘inappropriately reversing (a patient’s) type 2 diabetes…”’

Dr. Gary Fettke testified in an Australian Senate Inquiry on November 1. And only”by coincidence,” a few hours after , AHPRA’s 2 1/2 year investigation came to an end and Fettke was advised that he would be restricted from providing nutritional advice.  In the long run, this didn’t sit well with the Senate which undertook additional hearing interrogating Martin Fletcher, the CEO of APHRA.

“Haven’t you got better things to do?”

You can see Martin Fletcher trying to shield AHPRA’s actions.  on Youtube. At 31:25, one of the Senators asked”…if a health practitionerr is advising a patient to go on a … sensible, medically-accepted diet plan, why would you risk-assess that and have all guns blazing?

One of life’s great disappointments is that when you finally corner the poor guys, they turn out to be pathetic like Saddam Hussein. They don’t break down on the stand as in the old Perry Mason episodes. It’s sad but it is also tough to feel much sympathy.

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Martin Fletcher, CEO of AHPRA trying to juggle the truth at the Senate hearing.

“Bread thou art…”

It was a trip to Rome, intended to deepen his faith, that ultimately led to Luther’s transformation. He saw corruption on a grand scale but what really freaked him out was that corruption and vice were coupled with a cynical disregard for spiritual practice. A priest going through the motions of giving the elements in the sacrament  muttered to himself “Bread thou art, and bread thou shalt stay; wine thou art, and wine thou shalt remain. ”

That becomes the most distressing aspect of this analogy. The quotation above,”There is nothing related to your medical training or education that makes you an expert or authority in the area of nutrition, diabetes or cancer,” comes from a letter to Dr. Fettke that continued”Even if, in the future, your views on the advantages of the LCHF lifestyle become the accepted best medical practice, this does not alter the fundamental fact that you are not suitably trained or educated as a medical practitioner to be providing advice or recommendations on this subject as a medical practitioner.”

This statement that treating disease is less important than loyalty to political power stands as the best exposition of the need for Reformation in Medicine.

Appendix.

Hamlet was charged by his father’s Ghost with avenging the dad ’s murder by Claudius, the current king. Hamlet has set on an”antic disposition” to conceal his motives. At one point, mistaking him for the King, Hamlet kills Polonius, a pompous court officer, who’s hiding behind a wall-hanging. The king hears about it and is pissed and wants to know where the body is (Act 4,Scene 3):

CLAUDIUS: Where is Polonius?

HAMLET: At dinner.

CLAUDIUS: At dinner where?

HAMLET: Not where he eats, but where he is eaten. A certain convocation of politic worms are e’en [now] at him. We fat all creatures else to fat us, and we fat ourselves for maggots. Your fat king and your lean beggar is but variable service–two dishes, but to one table. That is the end.

CLAUDIUS: Alas, alas!

CLAUDIUS: What dost thou mean by this?

HAMLET: Nothing but to show you how a king may go a progress through the guts of a beggar.

CLAUDIUS: Where’s Polonius?

HAMLET: In paradise. But if indeed you find him not within this month, you shall nose him as you go up the stairs into the lobby.

CLAUDIUS (to attendants) Go seek him there.

(Exeunt some attendants)

HAMLET: He will stay till ye come.

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