The SUB expert committee consisted of ten physicians, and several of them were skeptics to low-carbohydrate diets at the beginning of the investigation.
One of the committee members was Prof. Fredrik Nyström, from Linköping, Sweden – a long-time critic of the low-fat diet and a proponent of the benefits of saturated fat, from sources such as butter, full fat cream, and bacon. Here are some quotes from Prof. Nyström translated into English from Dr. Eenfeldt:
“I've been working with this for so long. It feels great to have this scientific report, and that the skepticism towards low-carb diets among my colleagues has disappeared during the course of the work. When all recent scientific studies are lined up the result is indisputable: our deep-seated fear of fat is completely unfounded. You don't get fat from fatty foods, just as you don't get atherosclerosis from calcium or turn green from green vegetables.”
Nyström has long advocated a greatly reduced intake of carbohydrate-rich foods high in sugar and starch, in order to achieve healthy levels of insulin, blood lipids and the good cholesterol. This means doing away with sugar, potatoes, pasta, rice, wheat flour, bread, and embracing olive oil, nuts, butter, full fat cream, oily fish and fattier meat cuts. “If you eat potatoes you might as well eat candy. Potatoes contain glucose units in a chain, which is converted to sugar in the GI tract. Such a diet causes blood sugar, and then the hormone insulin, to skyrocket.”
There are many mantras we have been taught to accept as truths:
“Calories are calories, no matter where they come from.”
“It’s all about the balance between calories in and calories out.”
“People are fat because they don't move enough.”
“Breakfast is the most important meal of the day.”
“Of course these are not true. This kind of nonsense has people with weight problems feeling bad about themselves. As if it were all about their inferior character. For many people a greater intake of fat means that you'll feel satiated, stay so longer, and have less of a need to eat every five minutes. On the other hand, you won't feel satiated after drinking a Coke, or after eating almost fat free, low-fat fruit yogurt loaded with sugar. Sure, exercise is great in many ways, but what really affects weight is diet.”
Fredrik Nyström has also recently shown that fruit does not increase the metabolic rate as much as nuts do in a randomized trial (Agebratt et al. PLOS ONE 2015). Nyström has also specifically studied if exposure to cold for about one hour a day increases metabolism and volume of the "heat organ" brown-adipose tissue. In collaboration with CMIV and colleagues in Gothenburg, it was indeed found that subjects who followed the "cool-protocol" displayed enlargement of supraclavicular brown adipose tissue volumes as measured with magnetic resonance imaging (in press, Metabolism). Also, subjects who had been randomized to avoid coldness, lowered their metabolic rate.
Prof. Fredrik Nyström - Endocrinology Research
Approval for a Low Carbohydrate and High Fat Diet
In 2008, SBU, the Swedish Council on Health Technology Assessment, dropped a bombshell. After a two-year long inquiry, reviewing 16,000 studies, the report “Dietary Treatment for Obesity” upends the conventional dietary guidelines for obese or diabetic people.
For a long time, the health care system has given the public advice to avoid fat, saturated fat in particular, and calories. A low-carb diet (LCHF – Low Carb High Fat, is actually a Swedish “invention”) has been dismissed as harmful, a humbug and as being a fad diet lacking any scientific basis.
The SUB report turns the current concepts upside down and advocates a low-carbohydrate, high-fat diet, as the most effective weapon against obesity.
Super Size Me
You may be aware of Morgan Spurlock's 2004 documentary Super Size Me, in which the American film-maker ate nothing but McDonald's food for a month. Lots of people are disgusted to see what happens to the 33-year-old's body as he accepts Super Size shake, after Super Size shake, and limits himself to 5,000 steps a day and are shocked as his liver becomes toxic, his cholesterol skyrockets and his libido sags.
At the University of Linköping, the Spurlock experience has being replicated under clinical conditions. In February 2011, seven healthy medical students in their early 20s spent weeks stuffing themselves with hamburgers, pizzas, milk shakes and 200g bacon breakfasts - all on the university's tab. A second group of subjects a year later repeated the experiment. Physical exercise was avoided. The study was the brainchild of Fredrik Nyström, doctor and associate professor at the university's department of internal medicine.
This kind of study would probably be out of the question for ethical reason in many countries. Everyone would get sued if the subjects afterwards didn't manage to get rid of their extra kilos. But in laidback Sweden, there were no problems clearing the experiment with the national ethical board. The one proviso Nyström added was that he would pull anyone out of the experiment if they increased their bodyweight by more than 15% - even if he or she was prepared to go on.
Most students struggled to eat the required number of calories a day. They were not confined to McDonalds food, they could choose their diet, so long as they meet the calorie target. To do so they had to resort to emergency tactics like drinking cream, or spoonfuls of olive oil, or coconut oil. Or eating fried chicken or double helpings of bacon and eggs or eating a lot of cheese. They had to find sources of calorie dense fat. That much food was expensive, but the University was paying.
The students complained about the lack of exercise. And they didn't like feeling full all the time.
Spurlock's doctor recommended that he stop the diet because of elevated liver enzymes. Nyström is puzzled about why Spurlock had such an extreme reaction, musing that he could perhaps have had an undiagnosed problem with his liver. Spurlock gained 11.1kg, a 13% increase in his body weight. Perhaps because the Swedish students could eat a high fat diet, without the carbohydrates that are served at McDonalds, their livers were able to cope with this extreme diet. None of the Swedish students had severe changes in their liver enzymes.
Interestingly, in the Swedish experiment, while the liver readings got steadily worse until the third week, they then took a turn for the better. The liver, it would seem, adapts. Cholesterol, meanwhile, was hardly affected.
Nyström found that people respond differently to this feeding routine. One student gained only 4.6kg and his cholesterol was lower at the end of the trial than at the beginning. That demonstrates how difficult it is to change your cholesterol by changing your diet.
Students also showed a desirable pattern of lower blood triglycerides and higher HDL cholesterol. Many students added far less weight that calorie counting would predict. They seem to be "calorie resistant." On the other hand some students Added weight very quickly. One student was withdrawn after only two weeks having already gained 15% of his body weight.
A female student gained 9.1kg, close to 15% of her body weight. "I don't like what I see in the mirror, I look like I'm pregnant."
A male said the walking had become difficult. "I can't keep up with the guys, he complained. I walk 20 steps and I start to sweat. I've found that although I'm still interested in sex, i don't have the stamina to be as active as I'd like."
And this is the most fascinating thing: if Nyström's small group are representative, then it would seem that our bodies are more adaptable than we give them credit for. In other words, metabolism may play a much more important role in the problem of obesity than many people think. Indeed, Nyström claims that for some people, eating 10% more will lead to their metabolism increasing at the same level. The extra energy will be burned off as body heat during sleep. He also wonders if the cold Swedish climate encourages a metabolism that id good at converting excess calories into body heat.