Ann Fernholm

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New Study: Low Carbohydrate Diet is an Effective Treatment for Fatty Liver Disease

Approximately one quarter of all adults have fatty liver disease, increasing the risk of cirrhosis, liver cancer, type 2 diabetes and coronary heart disease. Today, there is no medical therapy available for fatty liver disease, and it is considered a chronic disorder. However, a new Swedish study shows that a strict low carbohydrate way of eating can eliminate the fat from the liver within two weeks. This is a major breakthrough.

Fatty liver disease was previously something primarily associated with alcoholism, but the condition has seen a significant increase as part of the obesity epidemic. Studies from the United States and from Europe show that one in ten teenagers has a fatty liver, and that the condition has increased the need for liver transplantations in both adolescents and adults.

Some fat in the liver is normal. But in the long run, too much fat can cause inflammation, an increased risk of cirrhosis, liver cancer, type 2 diabetes and cardiovascular disease. Removing the fat from the liver will drastically reduce the risk of these diseases.

Current recommendations are to avoid sweetened drinks, control portion sizes and exercise, but few people manage to get rid of their liver fat. A Swedish study, carried out at the Sahlgrenska University Hospital in Gothenburg, now shows that a strict low carbohydrate approach can be of great help for sufferers. In the study, the participants continued to eat as many calories as before, while decreasing the amount of carbohydrates consumed and instead increasing the amount of protein. And participants losing weight were encouraged to consume more food, in order to maintain the weight. Despite this, fat was eliminated from the liver. The researchers saw a positive trend already on the first day.

A Surprising Discovery: the Gut Bacteria Started to Produce Folic Acid

The study, newly published in Cell Metabolism, was small – only 10 participants. However, it is very detailed and shows exactly what happens in the body when someone cuts back on starches and sugar. The metabolic functions of the liver changed immediately and the liver fat was rapidly reduced.

The scientists also detected a drastic change in gut flora. A surprising discovery was that the gut bacteria increased the production of folic acid, a vitamin necessary for normal liver metabolism. And previous studies have shown a connection between folate deficiency and fatty liver disease.

Is Sugar Worse Than Starch?

According to some researchers, eating too much sugar increases the risk of fatty liver disease. Sugar contains fructose, which is metabolized by the liver. A high intake of for example candy and soda can lead to a buildup of fat in the liver.

The hypothesis has been tested by a group of scientists at UCSF in San Francisco. They examined the effects of a diet reduced in fructose, and found that a diet that cut out fructose significantly reversed the buildup of liver fat in children and adolescents. In the experiment, the calories from fructose were replaced by glucose-rich, starchy foods. In both the UCSF study and the Gothenburg study, the calorie intake was designed to equal pre-study levels so that the participants wouldn’t lose weight. In only nine days, the participants’ liver fat had been reduced by almost 50%.

Dietary Science Foundation Supports New Study on Treatment for Fatty Liver Disease

Can we draw any conclusions? First and foremost: stop counting calories. Different types of calories have different effects on your health. Carbohydrates do more harm than good for people suffering from fatty liver disease, and we have reason to believe that sugar is the biggest culprit.

BUT. Both the Gothenburg study and the UCSF study are small and lacked a control group. In order for studies to provide results that are as objective as possible, we need large, long-term and well-controlled studies. The Dietary Science Foundation recently informed that we will support a study which will examine the effects of low carbohydrate eating and intermittent fasting (5:2) on fatty liver disease. The study will incorporate a control group, more participants and will carry on for a longer period of time. Thus, it will complete the study from Sahlgrenska in Gothenburg. Over a billion people suffer from fatty liver disease. What if there is a treatment available that could help millions of people achieve better lifelong health in only a few weeks? Think about how these results could affect healthcare costs. Simply put, a new treatment of fatty liver disease would be an amazing development.

Science journalist and writer Ann Fernholm runs the blog Now and then, she writes here at Food Pharmacy.



Ann Fernholm

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New Vital Projects for the Dietary Science Foundation

Boy oh boy, dear readers, what a week! Seems almost unreal. The Dietary Science Foundation has set up some new goals! We will be raising funds to finance a whole bunch of scientific studies connected to diet and health. When we first started the foundation, our goal was to be able to support open-minded scientists who conduct high quality scientific research. And now, our wish has come true!

We would like to say a huge thank you to everyone who has contributed to the 1.3 million SEK (approximately 160.000 US dollars) that we have donated towards various studies on diet and health. THANK YOU! Your donations may help prolong lives.

No treatment for fatty liver disease

One of the projects supported by the Dietary Science Foundation is an evaluation of strict low-carb diet and 5:2 diet for people with fatty liver disease. Today, there’s no treatment for those who suffer (25% of all adults in the world). They are told to lose weight: drink less soda and count calories. Few succeed and way too many die from irreversible liver damage due to inflammation. Others will get liver cancer, type 2 diabetes or cardiovascular disease.

If you can reduce or remove the fat from their livers, it will drastically reduce the risk of these diseases. That’s definitely something worth fighting for. What diet should these patients follow?

Carbohydrates and its role in obesity

The second project is to evaluate diet programs for people suffering from obesity. Questions asked are: What is the role of butter, cream and crème fraîche? And what about the importance of carb quality and quantity?

These questions have been around for a long time. And this study is really good. The Dietary Science Foundation’s mission is to support ambitious scientists who dare to aim high. One of them is Simon Dankel at the University of Bergen who studies carbohydrates and its role in obesity.

Future goal: Large Nordic study of type 2 diabetes

The real good news is that Simon Dankel will also coordinate a Nordic study of low-carb diet for people with diabetes type 2. Scientists at Karolinska Institutet, Lund University and University of Copenhagen will perform the study together. They will meet this spring to discuss the framework. Then, we will start raising funds to finance the study.

We need knowledge – not opinions

We’re tired of ideas, opinions and discussions. When the research aims to tackle some of our most severe and widespread diseases from which people die, we need facts. In all future reports, we would like to read this: The dietary advice for people suffering from type 2 diabetes is based on scientific evidence provided by well-conducted and controlled trials. People who follow the advice can expect to live a symptom free life with little or no medicine. 

Is this your goal too? Your support can change people’s lives. Please help us make this happen.

Science journalist and writer Ann Fernholm runs the blog Now and then, she writes here at Food Pharmacy.



Ann Fernholm, Debate

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Unreliable Dietary Guidelines For Babies Have Done More Harm Than Good

Since the 1980s, the recommendations for when to introduce gluten to children have changed four times – and scientists still disagree on how to prevent gluten intolerance among small children. The unreliable dietary advice for babies appear to be the result of scientific carelessness. Scientists have neglected to test the hypothesis using well-conducted and controlled studies.

The Swedish newspaper SvD recently published a number of articles about dietary guidelines, written by medical journalist Gunilla Eldh and myself. Last Friday, they printed our articles about dietary guidelines for small children. The first one was about Celiac disease, and the advice to introduce gluten to babies before six months. For some children, if worst comes to worst, this may actually have triggered the development of Celiac disease. The second article was about the advice to delay the introduction of allergenic foods to children at high risk of allergy. Current advice is moving away from delaying the introduction of potential allergens, but it is still possible that previous advice contributed to the development of allergies in children.

All dietary guidelines must be scientifically valid

In one of the first articles published by Swedish Svd, some scientists claimed it is difficult to assess the effects of dietary advice using so called randomized controlled trials (RCTs), the form of study that evaluate results and side-effects. According to many scientists, the participants don’t follow the advice they are given, they quit, also, randomized controlled trials are expensive to conduct. This is how they justify the fact that so many dietary guidelines lack scientific credibility.

When it comes to dietary advice for small children, none of these excuses will work. Already back in the 1990s, when these guidelines were introduced, it would have been fairly easy to test the hypothesis that early exposure to gluten may help babies avoid Celiac disease. Scientists could have divided a couple of hundred babies into two groups, and introduced only one of them to gluten. Instead, we had to wait almost 20 years before some other scientists proved the guidelines wrong. If worst comes to worst, the advice to introduce gluten to babies before six months may have triggered the development of Celiac disease.

The same goes for food allergies. In the beginning of the 1990s, specialists issued warnings about allergenic foods, saying that parents should delay the introduction of allergenic foods to children at high risk of allergy. Today – 20 years later – well-conducted scientific studies show that

early introduction to allergenic foods like peanuts, fish and egg, might actually be key to preventing kids’ allergies. Previous advice has probably contributed to the development of allergies in children.

Scientific carelessness can lead to mistakes

Unfortunately, the Swedish National Food Administration won’t learn from mistakes. Once again, we have new recommendations on gluten introduction to prevent Celiac disease. According to the new guidelines, parents should introduce gluten slowly and step-by-step. However, once again, they fail to inform us about the scientific evidence for this advice.

Yet another example of scientific carelessness. Scientists claim they know what they are talking about, even when they have no clue.

In our bodies, there’s a machinery of molecules, developed by millions of years of evolution. Step-by-step, we begin to grasp how this enormous machine works, but there is still so much more to learn. I think it’s time to be a bit more humble and admit that we don’t know everything. Nevertheless, we have invented an incredibly powerful instrument to help us learn more about the world around us: the scientific method. When scientists follow the rules of the scientific method they tend to discover extraordinary things; when they fail to follow the rules, they make mistakes.

When it comes to dietary guidelines for babies, it’s incredibly important that the scientists do their job. Both Celiac disease and food allergy will affect the wellbeing of the child. No one should suffer because of someone else’s carelessness.

Science journalist and writer Ann Fernholm runs the blog Now and then, she writes here at Food Pharmacy.




Ann Fernholm, Debate

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The sugar industry stopped research showing that sugar can cause cardiovascular disease

Just like the tobacco industry, the sugar industry has influenced the research around it. In 1971, they halted a study that showed how sugar negatively affects intestinal flora and upsets blood-fat levels in lab rats. For half a century, the sugar industry has managed to prevent this important knowledge from being publicized.

In 1965, researchers at Harvard were paid by the Sugar Research Foundation, an American organization sponsored by the sugar industry, to write an article claiming that sugar is harmless for the heart. This cover-up was finally revealed just last year by Cristin Kearns, researcher at UCSF in San Francisco..

Now, Cristin Kearns has been digging deeper into the archives, and has discovered that the Sugar Research Foundation, in the years of 1967-1971, funded animal-tested research at Birmingham University, in which scientists investigated whether or not sugar affects the risks of developing cardiovascular disease. The study in fact showed that sugar upsets blood-fat levels, and that intestinal flora are involved in the process: Sugar industry sponsorship of germ-free rodent studies linking sucrose to hyperlipidemia and cancer: An historical analysis of internal documents. In addition, sugar-levels were increased by a protein that is associated with bladder cancer.

These negative results caused the sugar industry to hurriedly withdraw their money from the research project.

The sugar industry therefore, has done exactly what the tobacco industry did. They have directly impeded any research that could affect their sales.

It’s making me so upset just thinking about it, and there are things I want to write that I probably shouldn’t, so let’s just move on.

Sugar, intestinal flora and blood fats

The interesting thing, which the unfinished study shows, is the connection between sugar, a compromised intestinal flora, and an unhealthy level of blood-fat. In my book My Sweet HeartI talk about how fat increases in the liver whenever we eat a large amount of the sugar known as fructose (found in white sugar). The build-up of fat in the liver upsets blood-fat levels, and may in the end cause fatty-liver. In one chapter of the book, you can read the following (for those who haven’t read my books, metabolic syndrome is the disrupted metabolism that people with abdominal obesity and type 2 diabetes experience):

Bowel incontinence and bacterial toxicity seems to contribute to a fatty liver.

As you’ve probably read before, people with metabolic syndrome are more likely to have a depleted intestinal flora, with a high number of inflammatory bacteria. This condition is also associated with a bowel incontinence. The bacteria have special molecules, called endotoxins (shorthand for internal toxins), located in a membrane that surrounds the bacteria. The levels of these toxins found in the blood are increased in those suffering from metabolic syndrome and type 2 diabetes. Some researchers believe that this is a contributing factor to the fatty-liver condition that I describe in chapter 3. For instance, if mice are fed with fructose, they soon develop bowel-incontinence, more bacterial infections in the blood, and, in the long run, fatty-liver. But if the mice are given antibiotics at the same time, it seems to protect them from fatty liver. Antibiotics can cause unbalance among healthy intestinal flora, but at the same time, it is also true that antibiotics help get rid of unhealthy bacteria. In the case of the mice, the antibiotic counteracted the poison-producing bacteria. The experiment suggests that an upset intestinal flora may accelerate the development of fatty liver and metabolic syndrome.

With that said, it should be known that the research I refer to was published in 2008 and 2009. But the sugar industry knew about the link between sugar, intestinal flora and upset blood fats already, in the early 1970s.

Further animal experiments in May this year showed that fructose causes leaky intestines in mice. In September, researchers also published a new article about fructose, intestinal flora and the risk of fatty liver.

It’s tempting to think that this is all exciting new knowledge, but the truth is that the sugar industry knew about it 50 years ago. For half a century, they’ve managed to prevent this knowledge from spreading, and as a result are complicit in decades of disease and needless suffering. Is there anyone else out there who finds all of this a little depressing?

Science journalist and writer Ann Fernholm runs the blog Now and then, she writes here at Food Pharmacy.