What fuel were you made

to run on?
​Julian King
​Director, Julian King & Associates – a member of the Kinnect Group
​www.julianking.co.nz | www.kinnect.co.nz

2015
2
What’s this all about?
​I am not a dietitian,
nutritionist, epidemiologist or
doctor. I am just a member of
the public who is interested in
being healthy.
​I am also an evaluator with a
science degree. Evidence is
my business. In my day job I
help people use evidence to
make good decisions in the
public interest.
​One of the best evidence-
based decisions anybody can
make is to eat real, whole
foods and avoid processed
foods.
​This is the proverbial ‘low-
hanging fruit’ of the nutrition
world. This one lifestyle
change could do more for
population health than all the
high tech medical
interventions for treating
​obesity-related problems after
they have already occurred.
​From time to time friends have
asked me to recommend “just
one thing” they could read to
get quickly up to speed on this
issue. That’s hard, because
there are lots of good sources
out there.
​This e-book is my attempt to
distill what I have learned in a
few easy sound bites.
3
Spoiler: Processed food is making us
sick
​Why are we humans becoming
worse and worse at
maintaining our weight and
metabolic health?
​Why are our bodies'
homeostatic (self-regulating)
mechanisms failing us?
​The published evidence is
complex. But when we stand
back, some pretty clear
patterns emerge.
​Our industrial diet of
processed food is a major
contributor to our pandemic of
obesity, type 2 diabetes and
related illnesses.
​Sugar and its friends may not
be toxic in small doses, but
they are ubiquitous in our food
supply and we’re overdosing
without knowing it. They are
reducing our quality of life,
driving up our health care
costs, and killing us.
4
Diabesity is a mind-bogglingly big
problem
​The Centers for Disease
Control (CDC) estimate that
one-third of Americans will
develop Type 2 Diabetes at
some point in their lives.
​Cardiovascular disease (CVD)
is the leading cause of death
for people with diabetes in
developed countries.
​Diabetes, CVD and related
metabolic illnesses are
threatening the sustainability
of health care resourcing
(Attia, 2012).
​For example, CVD costs the
U.S. health care system $300
billion a year and growing.
​There is good evidence that
80% of chronic disease and
90% of CVD are avoidable
through lifestyle change
(smoking cessation, dietary
change, and exercise) (Katz,
2013; Kresser, 2014).
5
We all ‘know’ what makes us fat, right?

Gluttony ​We’re all familiar with this

everyday explanation for why
Calories)in)) we get fat.

You)get)fat) ​As the inimitable Robert Lustig

says (tongue-in-cheek),
Calories)out)
​“You’re a glutton and a sloth.”
Sloth

​www.uctv.tv/skinny-on-obesity/ 6
And we’ve been told enough times

Standard advice for the last

few decades has been to eat
Eat$less!$
the food pyramid, reduce
Exercise$more!$$ Low$fat$foods!$
consumption of calories, and
do more exercise. Lots$of$grains!$
And available data suggests
many of us have followed that
advice reasonably well.

7
So how come it’s not working?

​Unfortunately, we’re getting

fatter and sicker.

​The prevalence of diabetes

has nearly doubled over the
last 30 years and now affects
around 9% of women and 11%
of men.

​And obesity continues to

climb.

Menke A, Rust K, Fradkin J, Cheng Y, Cowie C.

2014. Associations between trends in race/
ethnicity, aging, and body mass index with
diabetes prevalence in the United States: A
series of cross-sectional studies. Ann Internal
Med. 2014;161(5):328-35.
8
We missed the bigger picture
Poor)quality)food)
dysfunc1on*
​The idea of ‘calories in,
calories out’ isn’t exactly
wrong. The first law of
thermodynamics tells us
energy can’t be created or
destroyed. Use it or store it.
However, this misses the
Appetite
Calories)in))
Metabolic*
Calories)out)
Activity
​important point that our
bodies are complex systems.
Context matters. Different
nutrients are metabolised
through different pathways.
And have synergistic effects.
You)get)fat)
and$sick$
​If we eat poor quality food all the
time, it can mess with our
metabolic thermostats. Eating
too much, and exercising too
little, can be a consequence of
eating poor quality food.
9
Something’s wrong with our food
Appetite
Calories)in))
Poor)quality)food) Metabolic*dysfunc1on* You)get)fat)
Calories)out) and$sick$
Activity

​What is this poor quality food

• High)in)sugar) of which we speak?

• High)in)refined)starch) Packets* ​It is 80% of the food on our

********(&*low*in*fibre)* Tins* supermarket shelves. It is
Convenience* recognizable by the fact that it
• High)in)seed)oils) Long*shelf*life* comes in a box, packet or tin,
Manufactured*
has an ingredient list, and a
• Low)fat) long shelf life.
Standard)Western)Diet)
• Low)in)micronutrients) High*in*processed*foods*

10
Three recurring ingredients
​Processed foods come in a
variety of forms, from
breakfast cereals to sauces to
snack foods and more.
​But chemically they have a
surprising amount in common.
In particular, three ingredients
seem to have notably
detrimental effects in the
doses they are delivered
​across a wide variety of
processed packaged foods:
Sugar, refined carbohydrates,
and seed oils.
​Consequently, when it comes
to processed foods,
“everything in moderation” is
pretty near impossible.
11
Omega-6 seed oils (or 'vegetable oils’)
are not your friend

​Highly processed polyunsaturated

fats are bad for us (pro-
inflammatory and oxidative).

​Advice to use oils like canola,

sunflower, margarine, etc, is
contributing to harm.

​For example, see nofructose.com; authoritynutrition.com; davidgillespie.org. 12

Carbohydrates make us fat

​I am not on a low carb diet.

You are on an excessively high
carb diet.

​Refined carbohydrates raise

insulin levels, promoting fat
storage and eventually leading
to insulin resistance and type
2 diabetes. The food pyramid
advice to eat lots of grains has
been disastrous.

​For example, see Cereal Killers (movie); Why We Get Fat (Taubes, 2011); eatingacademy.com. 13
Sugar is a “chronic toxin”
(Robert Lustig)

​Sugar (a combination of
fructose and glucose) has
multiple adverse effects on
health. For one, it promotes
the creation and storage of fat
around the vital organs and
belly. It also messes with
hormones that regulate
appetite. Alcohol has similar
effects, by the way.

​For example, see Sugar – The Bitter Truth (Robert Lustig, on YouTube); Pure, White & Deadly
(Yudkin, 1972); Sugar consumption at a crossroads (Credit Suisse, 2013); nofructose.com. 14
“The dose makes the poison”
Paraclesus (1493-1541)

​Sugar, carbohydrates and

omega-6 oils are not harmful
in the mixes found in real food
– but are delivered at toxic
levels in our processed food
supply. We are overdosing
without knowing it.

15
Processed foods also crowd out more
nutritious options

​Processed foods are lower in

essential vitamins and
minerals than real food – and
lower in fibre, which is
important for gut functioning.

16
We’re getting sicker and fatter as a
result
Tolerance*
Reward*centre*
Withdrawal*
Lep1n*resistance*
​Poor quality food is Appetite
Calories)in))
reducing our quantity and Poor)quality)food) Metabolic*dysfunc1on* You)get)fat)
quality of life. Calories)out) and$sick$
Activity
Fructose*
Conserve*energy*
​Sorry, but that includes High)in)sugar) Gout)
Visceral)fat))
Uric*acid**
fruit juice, most breakfast Glucose* Hypertension) deposiBon/NAFLD)

cereals, and all sorts of High)in)refined)starch)

Dyslipidaemia)
Heart)disease)
Fat)deposiBon)
other things that have been
marketed to us as healthy. High)in)seed)oils) Inflamma1on*
Insulin*>>*
Insulin*resistance* Type)II)Diabetes)
& Oxidative stress
Alzheimers)
IGF71*>>*
​This diagram isn’t
Low)in)fat)
comprehensive, but it does Poor*sa1ety* Cancer)
&*
illustrate some of what Nutrient*deficiencies*
Low)in)micronutrients) Rheumatoid+arthri-s+
goes on.

17
This isn’t just a disease of fat people
​Skinny people can still have 240$million$adults$in$U.S.$ 168$million$
metabolic problems (high (70%)$not$obese$
blood sugar, high blood 72$million$
pressure, non-alcoholic fatty (30%)$obese$
liver disease, low HDL
cholesterol, high small dense
LDL particle count, etc). 67$million$
58$million$ Not$obese$$
Obese$and$sick$ and$metabolic$
​In fact, over half the people (80%$of$30%)$ dysfuncCon$$
with metabolic syndrome are (40%$of$70%)$
not obese.

Total:$125$million$sick$
Source:$Robert$LusCg$

18
Evidence is imperfect
​There are no perfect studies.

​It’s hard to decipher the truth in a

field like nutrition where there are
so many studies that seem to
contradict each other, often based
on observational data, as well as
multiple factors, small effect sizes,
and biases of various different
types.

​Why most published research findings are false (Ioannadis, 2005). http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1182327/.
19
Reductionist thinking distracts us from
the big picture
​Human beings eat food, not
individual nutrients.
​Combinations of nutrients can
act synergistically. On top of
that, our bodies are complex
systems. There are lots of
inter-related mechanisms at
work trying to keep us running
smoothly.
Unfortunately, it often seems
as if nutrition studies forget
that nutrients don’t act in
isolation.
When we make sense of the
evidence we need to be
mindful of this complexity and
not focus too myopically on
individual pieces of the puzzle.
We also need to stand back to
evaluate the totality of
evidence rather than the
results of individual studies.
As David Katz says, “the
weight of evidence slowly and
inexorably tilts toward truth;
that is not true of any single
source or study.”
20
We already know what the problem is
​The evidence might not be
perfect, but it is easily good
enough to urge immediate
lifestyle change.
​The weight of evidence is
consistent with the
interpretation that our
industrial diet of processed
foods is the major contributor
to our
pandemic of obesity, type 2
diabetes and related illnesses.
Sugar and its friends may not
be toxic in small doses but
they are ubiquitous in our food
supply and we’re overdosing
without knowing it. They are
reducing our quality of life,
driving up our health care
costs, and killing us.
21
And we know what we need to do

​We already know enough to
prevent 90% of CVD and 80%
of chronic disease, without
medication (Katz, 2013;
Kresser, 2014).
​The top three lifestyle changes
are:
• Quit smoking
• Quit processed food
​A balanced lifestyle with
enough sleep, sunlight, social
connections and managing
chronic stress are also very
important.

• Be active.

22
Eat. Real. Food.
​David Katz and Stephanie
Meller of Yale University’s
Prevention Research Centre
are incredibly well qualified to
draw big picture conclusions
from the pool of nutrition
literature. And they have no
shareholding in one dietary
regime or another.
​In their 2014 paper, Can we
say which diet is best for
health?, they conclude that
​http://www.annualreviews.org/doi/pdf/10.1146/annurev-publhealth-032013-182351
there is no ‘best’ evidence- ​Real food: good. Processed
based diet, but that the most food: bad.
successful eating patterns all:
​It all boils down to one
• Limit processed foods common-sense question. As
Steve Gurney says in his book,
• Are rich in plant-based
Lucky Legs, What fuel were
food, and
you made to run on?
• Favour animal products
from animals that ate real
plants (i.e., the animals
weren't fed industrial
foods either).
23
Low fat isn’t the answer
​Fat doesn't make you fat. And
it doesn't clog arteries.
​In fact, modern evidence
points to fat being good for us
in the context of a real food
diet.
​Our species has been eating
naturally occurring fats for
thousands of years, but the
​epidemic of metabolic There is no need to focus on
syndrome, Type 2 Diabetes the fat content of real food.
and CVD has only sprung up in
recent decades. ​“If we get the foods right, the
nutrients take care of
​Advice to avoid fat has themselves”.
inadvertently contributed to (David Katz, 2014)
harm because it has led to
other, much more harmful
ingredients being eaten
instead.
24
What about saturated fat?
​The first law of nutritionists: for
every nutritionist there is an
equal and opposite nutritionist.
The second law: they are both
wrong. (apologies to David
Wildasin).
While the experts are battling it
out, we each need to consider
the available evidence and
make our own decisions.
​I am no expert. But I have read
obsessively and have not been
able to locate any evidence to
convince me that we have
anything to fear from saturated
fat in the context of a whole
foods lifestyle.
​In fact, there are many different
types of saturated fatty acid,
and recent evidence suggests
the kinds found in real food are
harmless or beneficial while
the worst varieties are those
​that our bodies manufacture
and store when we eat too
many carbs.
​I agree with Kris Gunnars: It
just doesn't make sense to
blame a new problem
(diabesity) on an old food.
​But if you’re not sure, sticking
with foods high in
monounsaturated fats like olive
oil is a safe bet. Everybody
seems to agree on that.

​For example, see http://profgrant.com/2014/11/05/big-fat-debate-in-nz-22-what-does-the-evidence-say/; authoritynutrition.com;

Mozaffarian, D. 2014. Saturated fatty acids and type 2 diabetes: more evidence to re-invent dietary guidelines. Lancet. Diabetes-
Endocrinology. Vol 2, Oct 2014; and DiNicolantonio J. 2014 The cardiometabolic consequences of replacing saturated fats with
carbohydrates or omega-6 polyunsaturated fats: Do the dietary guidelines have it wrong? Open Heart BMJ, March 2014.
25
A few notes on switching diet
​You can do this! - by yourself
or together with family and
friends. If you want some extra
structure or recipe ideas,
check out websites like
Authority Nutrition and I Quit
Sugar.
​If you're diabetic the dietary
changes may affect your
insulin dose. Involve your
doctor.
​A real food lifestyle is much
more likely to be sustainable if
you are eating enough fat.
​Fat in real food is your friend
(think avocado, nuts, meat,
salmon, cheese, etc).
​Keeping carbs low can help
with weight loss.
​You may feel a bit crappy for
the first few days. This is
called low-carb flu and it
passes. Making sure you get
enough fat, salt and water
helps.
26
Don’t make the perfect the enemy of
the good
​If it feels easier, you can
implement your new lifestyle
in stages. Start by making
sure you're getting enough
protein. Then cut out the
added sugar. Once you're
feeling ok with that, cut out
other processed food,
especially refined carbs (e.g,
bread) and processed
polyunsaturated oils.
​See authoritynutrition.com
​You don't have to be perfect.
Don't beat yourself up if you
have the occasional dessert.
But you do need to be serious
about making a real change in
your lifestyle, forever.
Personally I find it easiest to
aim for nearly 100% real food.
But some others thrive on
80/20.
​What about dairy, gluten,
FODMAPS, and so on? Are
they in or out? We're all
different. You know what
works for you. Or if you don't,
experiment and find out.
27
A few notes on exercise

​You can't out-exercise a bad
diet. One sweet drink = an
8km run. Fix the food intake
first.
​Better diet drives better
activity levels. Once you've
been eating properly for a few
weeks you will be surprised at
how much you feel like moving
more.
​The greatest positive ​Best of all is a mix of cardio
difference from exercise and weight bearing exercise.
comes from doing some But this doesn't mean you
rather than none. It does not have to join a gym and get
have to be a lot, e.g., going for sweaty and miserable (unless
a short walk, working a few you want to).
hours a day at a standing
desk, weeding the garden. ​Find the type, quantity, and
intensity of exercise that
works for you.

​Malhotra, Noakes & Phinney (2015), It is time to bust the myth of physical inactivity and obesity: you cannot outrun a bad diet.
http://bjsm.bmj.com/content/early/2015/05/07/bjsports-2015-094911.full 28
Don’t take my word for it. Get some
knowledge and decide for yourself.

​Sugar: The Bitter Truth
(YouTube). Robert Lustig’s
famous lecture. This was the
starting point that ultimately
sent me on a voracious trawl
through countless published
studies. I am responsible for
at least 6 of its 4.4 million
views.
​Nofructose.com (Website &
blog). Gary Fettke,
Orthopaedic Surgeon and
Senior Lecturer at the
University of Tasmania, makes
the case that fructose,
polyunsaturated oils and
refined carbohydrates are the
major contributors to most
modern conditions.
​Disease Proof (Book). David
Katz, Professor and Director of
the Yale University Prevention
Research Center, wrote this
evidence-based guide to
healthy lifestyle change that
can reduce our risk of any
chronic disease by 80%.

29
These rockstars have already reviewed
the evidence so you don’t have to.

​Katz D, Meller S. 2014. Can ​AuthorityNutrition.com ​Death by Food Pyramid

we way what diet is best for
health? Ann Rev Public Health
35:83-103.
​Pick a diet: Paleo,
Mediterranean, Low Carb, Low
Fat, Vegetarian, Vegan… none
stand out as best, but all
stand out as good, because
they all focus on eating real
food.
(Website). A case study in
clear communication. Kris
Gunnars has a talent for
explaining complex science in
short sentences, without
oversimplifying. Well
supported by references to
published studies.
(Book). Denise Minger (2014)
takes us for a ruthlessly
critical walk through the major
sources of nutritional
evidence to unpack what it all
means.
​The most effective diets all
avoid processed food.

30
But wait, there’s more.
​EatingAcademy.com (Website
& blog). Peter Attia, M.D. is on
a mission to challenge what
we think we know about
nutrition and how it impacts
our health and performance.
Equal parts obsessive,
knowledgeable and
entertaining.
​GaryTaubes.com (Website).
Leading science journalist
Gary Taubes is author of Why
We Get Fat and Good Calories,
Bad Calories.
​Together, Gary Taubes and
Peter Attia founded the
Nutrition Science Initiative
(nusi.org).
​Profgrant.com (Blog). Grant
Schofield, Professor of Public
Health at Auckland University
of Technology.
​A good source of Low Carb
High Fat (LCHF) information
and inspiration.
31
And more.
​ChrisKresser.com (Website).
Practical, evidence-based
advice for eating and living
well, and a suite of free e-
books.
​Also Google: Richard Johnson, Robert Lustig, Jeff Volek, Stephen
Phinney, Tim Noakes, Cereal Killers (movie), David Gillespie, I Quit
Sugar, Diet Doctor, Carb Loaded (movie), Mark’s Daily Apple, Zoe
Harcombe, Dr John Briffa, Dr Richard Feinman, Dr Jay Wortman,
Caryn Zinn, Mikki Williden, and hopefulgeranium.blogspot.co.nz/
​Stop press! Two new books recently released:
​Eat Real Food by David Gillespie (2015)
​What the Fat? By Professor Grant Schofield, Dr Caryn Zinn, and
Craig Rodger (2015)
32
 © Julian King, 2015
Director, Julian King & Associates Limited – a
member of the Kinnect Group

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