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Diet Confusion and Controversies with Dr Robert Buist

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Diet Confusion and Controversies with Dr Bob Buist

Faced with the plethora of available dietary dictums, how do we decide which diet is right for which patient?

Today we are joined by leading nutritional biochemist, Dr Robert Buist to navigate these muddy waters. Dr Buist takes us through the health consequences that food modernisation and processing techniques has had on historical and cultural diets. Drawing on his three decades in clinical practice, Dr Buist shares his methods in cultivating new, positive dietary behaviours with patients. 

Covered in this episode

[00:47] Welcoming back Dr Robert Buist
[02:17] Defining the right diet?
[04:07] Historical/ cultural diets
[05:54] Falling victim to convenience
[07:07] Focus on whole, seasonal foods 
[09:53] Finding a balance of good vs. bad
[11:44] Defining carbs
[12:29] Fibre is crucial
[15:58] Modern food is different to predecessors
[19:32] Fermentation: microbial diversity
[22:24] Mediterranean diets
[27:42] Cultural influences to diet
[30:34] Sugar, fat and cholesterol
[42:08] Adapting new diet behaviours
[49:16] Food addiction and weight management
[52:08] Thanking Dr Buist for joining us

Andrew: This is FX Medicine and I'm Andrew Whitfield-Cook. Joining me in the studio today is Dr Robert Buist. Robert has an Honors Degree in Biochemistry, and a PhD in Medicinal Chemistry and Pharmacology, as well as Degrees in Chiropractic and Naturopathic Medicine. 
After eight years in asthma and cardiovascular drug research at Macquarie Uni, and later as a Postdoc Research Fellow at New York State Health Department, he switched his research focus to the newly emerging, at that time, field of nutritional biochemistry and complementary medicine. And is presently acknowledged as one of the founders of Nutritional Medicine in Australia. 
He's also been in high demand as a nutritional educator for pharmacists, doctors, chiropractors, naturopaths, and other health professionals the world over. This has included the delivery of professional seminars, and consulting services. And he's presently on BioCeuticals Scientific Advisory Board and is a formulator of nutrition products and functional foods. 
Bob was also the nutritional guest on the ABC's Margaret Throsby Show for three years. Has presented numerous radio and TV nutritional segments, and for the last 11 years, has been a Quest Nutrition Expert on Australia's national shopping channel, TVSN. 
For the past 22 years, Bob has also been Editor-in-Chief of the international quarterly journal "Clinical Nutrition Review" and is bestselling author of three books on contemporary nutrition. 

And I warmly welcome Bob back to FX Medicine. How are you? 
Bob: Thanks, Andrew. 
Andrew: Now, Bob, we're going to be talking today about something quite dear to your heart and has been for many years, and that's this… the practicalities about the confusion that we experience with the ‘right diet’. And we're getting so many confusing messages these days. 

What I think is interesting is from a population level, you talk about a healthy diet. But that can be very different from a personal perspective. But there's got to be some broad messages here, right? 
Bob: Well, there's so many factors involved with what you call ‘the right diet’ for each individual. And if we look at their genetics, we look at the environment that they're living in, we look at the population, we look at the country that they're living in... 
Andrew: Culture. 
Bob: ...we look at culture, we look at everything needs to come into this, and yet in recent times...when I say recent times, in my whole life, we seem to have gone through various fads. I mean, I remember when I was young, I was into the macrobiotic diet, and we had virtually no protein. You know, we had all the right vegetables and everything, and virtually nothing that we really needed for, you know, building our immune system, and enzymes and the rest of it. 

And that sort of migrated right through to various… we had the Israeli diet, we had the mono-diets of one thing and another. We had juice diets, we had, you know, grape diets, we had vegan diets. Recently, we've had the Paleo diet where obviously, there's a lot of meat, and other times... 
Andrew: Well, is there? 
Bob: Well, it is changing, in the same way that Atkins diet changed. Because Atkins started off with a lot of meat and fat and so on, but that's now changing. And I think the Paleo diet is changing, too. And this is good it's getting back toward, I think, more of a balance. 

And can I just say that one of the things that always used to stand out to me when we're talking about, "What is the right balance? And is there a universal diet? How should we put together various foods?"  
But when you look at say the Inuit, they eat whale and seal. Now, they don't have... 
Andrew: And that's it. 
Bob: ...fresh fruit and vegetables and... 
Andrew: Penguin if you’re lucky. 
Bob: Exactly. So, you know, and they don't have heart disease, that used to stand out. 

Then you'd go through to Africa and you'd have the Bantu and they mainly lived on, you know, corn, beans, some sort of sweet potato, and they were mainly vegans. They didn't have heart disease. Then you had the Maasai which were also from Africa and they lived on blood, milk, and meat, basically. They didn't have heart disease. 
Andrew: And I'm sorry, I'm infamous for saying this, the Hadza tribe. 
Bob: The Hadza tribe? 
Andrew: In Africa as well, the last of the first. They're also famed for having something like 30% of their calories from honey, and they have naff-all diabetes. 
Bob: Right. Exactly. That sounds like Jeff Leech's stuff? 
Andrew: That is. 
Bob: Okay, yeah. He's a very interesting character, some good websites. Look, so I guess what I'm getting at is, how can all these disparate groups worldwide have such fundamentally different diets, and yet they're all healthy? They don't have heart disease, they don't have cancer. And they have… I can remember Burkitt and Trowell talking about a foot or two-foot-long stools. 
Andrew: What? 
Bob: Because of the… Burkitt and Trowell did the original work on fibre in Africa. 
Andrew: So, we're not talking about sitting on stools, we're talking fecal matter? 

Bob: We’re not talking sitting stools.

Andrew: Two foot long? 
Bob: Yeah, and they ate a lot of fiber obviously. 
Andrew: Hell of a lot. 

Bob: Hell of a lot of fibre. You know, I guess what I'm really trying to get to is that, there are many, many different ways of having a diet that can lead to wellness and abundant health. 

Andrew: Can I put in a point? Propose something? 
Bob: Yes. 
Andrew: Each of these culture populations that you've mentioned disparate in their geography didn't have mechanization or convenience. 
Bob: Exactly. Not only they didn't have mechanization and convenience, but if you extend from that they didn't have tins, they didn't have refrigerators, they didn't have processed foods. They didn't actually take their food and try and remove all the fat, and they also didn't add excess sugar. And for that reason, they were eating whole foods, they were eating foods that came straight out of the ground, they were eating fruits straight off the tree, they were getting seals or whales straight out of the ocean.  
And I think there's a very, very interesting point here. And the point is if you're not modifying the food by processing it, putting it in tins, overcooking it, and doing things to it. You've got to be a long way ahead in trying to find the right diet.  
So a long time ago I said to myself, "No matter what the balance is, we must come back to whole foods. They must be seasonal, and if they're seasonal it means that you're in an ecosystem that is supplying foods that are relevant for your particular metabolism. Now, in the summer for example, here in Australia, we have heat waves. You wake up in the morning what do you feel like for breakfast? Do you feel like a hot plate of oats? No, you feel like having some watermelon or feel like having some fruits and so on. Whereas in the winter when it's freezing cold, if it's minus 10 outside. You're going to have something that's hot, you're going to have an entirely different breakfast than something that you've had, you know, when it was hot. 
So, we've got to be more... 
Andrew: Polish breakfast, stodgy food and... 
Bob: Yeah, so we got to be more in tune. And also the nutrients that we're getting from something like fruit. If we're having a fruit breakfast high in potassium and magnesium. If we're sweating all day, we're actually losing a lot of the things that we might be getting in the local foods. So the other things is when I was, you know, thinking about what is the sort of diet that we should have? 
Firstly, yes it must be unrefined, it must be whole, and it must seasonal for this reason. We're going to get the right sort of nutrition that we need for our ecosystem. So if possible if it's in the middle of winter, don't eat pineapples. I mean, even though we can get them from overseas. You know, quite apart from the energy, we know that it's an enormous amount of energy to get something from South America and bring it over here and eat it for lunch. 
Andrew: And so from an ecological perspective you're actually damaging the planet? 
Bob: Exactly. So they were the first things that came into, you know, what is the right sort of diet that, you know, we should be on? 
Andrew: Just backtracking a little bit. If you're talking from a scientific perspective, what's really nice to have in a study is something like a control group, or at least a comparator group, and going back to these cultural populations with their dietary intake. There's a very famous study called the Pima Indians Study. Do you remember that one? 
Bob: Yes, yeah. 
Andrew: And they compared the Pima Indians that lived in Northern Mexico and Southern California. And so the Southern California had the mechanization, the processed foods, a lot more convenience. I wouldn't say they're highly affluent there. But over the border in Mexico, they were extremely low socioeconomic, hard workers, physical labor, but a very high carbohydrate diet of unprocessed foods. And if you look at the health effects of that, north of the border, almost 100% diabetes, south of the border naff-all.  
Bob: Interesting isn't it? 
Andrew: Yeah. So it gets back to that seasonal variation and raw food diet. 

Now, what I got to ask you though is; that's lovely, and I have friends who really concentrate on our raw food or whole food diet I should say. But what about you go out? What about the 50th birthday? What about, "Oh gee, that champagne's lovely?" How do you practically manage this stuff by being ‘a little bad’ without having deleterious health effects? 
Bob: Well you're talking to a flawed human being. So I mean... 
Andrew: Me too, sorry you too? 
Bob: I have always said to my patients, "We have 21 meals a week, 3 of them go for it." So that means that, if you do go out into a restaurant, hopefully, you know what foods are really bad for you and what foods aren't. You can say, "Can I have the sauce on the side, can I have my mayonnaise on the side, can you not put this on, can we just, you know, have them on the side?" So there are ways of getting around that depending on whether you want a high protein, high meat, high fish, or whatever it is, or you want lots of vegetables in that. I mean you can just ask for it, if you go to the right sort of restaurants. There's nothing wrong…  
And also these days, I mean, there's some restaurants springing up that are all organic foods, that are coming from the local area, coming from the farmers' markets that are around at the moment. There's an enormous change happening in Australia, I think, in the restaurant scene, that means we can now go into a restaurant, we're not eating junk food. We're not eating a lot of the foods that are absolutely saturated in sugars, and also the wrong sort of meats that have got fats and things added, and sausages and nitrites and all of the things that we're trying to avoid. So I think we now can have the choice.  
One of the things that I think is very important, and this is another pet of mine. If you actually look at all of the scientific studies that are done that mention carbohydrates, we always mention carbohydrates like we know what we're talking about. 

Everyone says, "We got to go on a low carb diet. We’ve got to go on high fat, high protein, it's got to be low carb." But if you have a look at the clinical studies, often they don't define what a carbohydrate is? So a lot of the carbohydrate, you say 30% carbohydrates, 50% carbohydrates. 
Andrew: It's not as easy as that. Which carb? Which fat? 
Bob: Exactly. 
Andrew: Which protein? 
Bob: And that is the thing that I would like to see all scientific studies in the future, defining exactly what we mean by carbs. For example, we now know that a fibre that's associated with carbs is the food for our microbiome. And depending on which particular type of fibrous plant, the different types of fibre are going to give rise to different types of microorganisms in our microbiome.  
Now a complexity in the microbiome is very much associated with wellness. It's associated with a reduced incidence of cancer, heart disease, all of the autoimmune diseases that we have in the world are going to go down when we get the microbiome right and we get the food for the microbiome right. 

So with all these studies that say, "Let's get rid of the carbs, and let's get into the fat and protein," we now know that the right sort of carbs or the right sort of fibre are contributing to good health. And this is something that's been lacking, I think, in a lot of the scientific studies worldwide over the last 50 or 60 years. 
Andrew: Not looking at diversity because that's just like, there's so much of a pot there. But one microbe in particular which to me is extremely interesting and the researcher that sticks out from this is Clara Belzer. B-E-L-Z-E-R initial C. And the microorganism that she's been studying with regards to hunger is Akkermansia muciniphila.  
Bob: Yeah. 
Andrew: I always stumble on that. 
Bob: No, no. 
Together: Municiphilia. Muciniphilia. 
Andrew: Muciniphilia. 
Bob: It's muciniphila. 
Andrew: Muciniphila. It's the musin and liking, yeah, forgive me. 
Bob: No that's fine. 
Andrew: So Akkermansia muciniphila. And what I'd like to see is which types of foods helped to bloom this organism? There are others I know, and I know it's very simplistic to say that one is the hero, I don't subscribe to that. But it certainly does seem to be let's say a marker that we could perhaps use as a weigh point. And I'd love to see some further works looking at which types of foods, which types of fibers helped to grow this organism in human guts? 
Bob: Well it's interesting you should say that, because the last two conferences I went to, one in Budapest and just a couple of months ago in Vancouver. Guess what the organism was that they were talking about as so important? 
Oh Really? 
Bob: Yeah, that Akkermansia is really important. And what they were talking about is once again having the right foods. So the prebiotics that we haven't heard a heck of a lot about over the last, you know, 10, 20 years... 
Andrew: It sort of waned. 
Bob: It has, but really if we... 
Andrew: Everybody was scared of wind… 
Bob: ...if we eat fibrous foods like, onions, leeks, garlic, asparagus, broccoli, we can go through, spinach, cauliflower. All of the things that we know have a fibrous nature to it, which are carbs. We're not talking about flour that's been refined. We're not talking about sugar that's been added. We're talking about carbs. 

So when you see the big clinical studies that are talking about carbs, are they talking about these foods? I don't think so. I think we're talking about toast for breakfast, and perhaps white toast. And I think we're talking about some sort of biscuits and cakes that they’re allowed to have. We're talking about, you know, all sorts of things that have been refined carbs. And I think there's an entire difference in the outcome of these studies if we're using the sort of highly fibrous, seasonal, whole vegetables, compared to some of the carbs that they're obviously using in these studies.  
Andrew: So obviously, the issue here is what we define as a certain food, i.e., what's bread now versus what's bread a hundred years ago? What's milk now versus, even 20 years ago? You know, you can go into any foodstuff. Jam.. anything that's in a packet now, is different from what it was 20 years ago. 
Bob: Absolutely. I mean, we’ve made big headway. If you go to the supermarket now, you'll see that you've got the A1 and A2 milk, which is the ‘normal milk’. 
Andrew: And yet my dad who was an old farmer from England, used to say, "Oh, no, you always have the Jersey cow," you know. 
Bob: Exactly. 
Andrew: Speaking in a Somersetian accent, but anyway. 
Bob: But just to get on to that, I mean, the A1 milk, is entirely different to the A2 milk. And now, I notice that some of the supermarkets, some of the home brands, are saying, "Contains A1." Of course, it contains A1, every cow contains A1.  
Andrew: Some. 
Bob: Except for the Bos Indicus, which is a special strain of cow, and I think they're mainly Jersey as you pointed out. And the A2 milk actually does not have casomorphin, and a lot of these peptides have been responsible perhaps, or contributing towards diabetes and ischemic heart disease. And that's why a lot of people are now drinking A2 milk. Remember when it first came out, they were on the shelves, reaching expiry date, came from New Zealand, I think, the original A2 corporation. But the whole thing, it went down, there was no sales at all simply because nobody knew what it was. I remember giving lectures around Australia on A2.  
Now, you can buy it at just about any supermarket in Australia. So getting back to what you said, yes, there's been a fundamental, radical change in the way supermarkets are now keeping up with science. Before, you couldn't buy A2 milk, now, you can. And the same happens with breads, you mentioned breads. Can you remember when you were a kid? You’d walked down the aisles of the supermarket, it was all white bread. And in fact, they were spraying with fresh bread spray. 
Oh Really? 
Bob: Yeah, they had a spray that smelled like fresh bread. So you walk along you go, "Mm, I'll have some of that thank you." It was all white bread, had no fibre or anything. Only now, you can buy enormous variety of different high-fibre breads that's got quinoa, that's got spelt it’s got all the different seeds and grains, and it's just quite amazing what's happening. 
Andrew: But Alessio Fasano painted this picture for me, and it really rang true. And that is that, the pressure of providing for the masses is making us ferment, even the good breads in a far quicker time. So the yeasts have to work with, I think they rise it in two hours now, whereas before, it used to be six, eight hours. 

So 20, 30 years ago, it took 8 hours, 12 hours to make a loaf bread, now, it's only taking two. And what that does is decrease the time that the yeast have to act on the proteins of wheat. And so this is where potentially this, use the word ‘allergenic’, let's say sensitivity to wheat is increasing. It may not be the wheat, per se, it may be, again, how we're stuffing up the manufacture of food to provide for everybody who wants that food. 
Where, you know, tomatoes are tasteless. Try and find a strawberry that has that full flavor. You know, I think we've got to get back to, and I'm not saying have a farm. But I think part of this issue and it's got to do with immunological tolerance, is at least have some part of your garden, part of your porch if you live in a unit, that has herbs, veggies, some veggies.  
Bob: And I think you put your finger on it when it comes to fermentation, too. If you come into our household, everything’s fermenting. I mean, the whole kitchen is bubbling. You'd think that witches were running it, you know, because we love fermenting. 

Sandor Katz is the guy that came out here a little while back into Australia. He came to Sydney and he was talking about fermentation, and how since we've had tins and refrigerators and things, we've stopped fermenting. But fermentation is where all these microorganisms are just so important. 
So when you're… getting back to Fasano's work, I mean, really it's a combination of maybe the gliadin which is one of the components of gluten together with the microbiome. I mean, you've got to have the right microbiome. 

So if you got fermented foods that's coming from all the local produce, and you're fermenting it through the winter rather than, I mean, I'm not saying we don’t use refrigerators, but we can still ferment things. That way, we're getting the biodiversity or the diversity of the microbiome, which is already together if you're not having gluten and you're not having gliadin. The gliadin as we know now is very...it's a bad thing for most people, but some people handle it better than others and it depends on your... 
Andrew: Genetic make-up. 
Bob: ...genetic make-up as to which way it goes. But the combination of having the right sort of probiotics, and the right sort of fibre to feed the microorganisms in your bowel, and keeping certain things out, like gluten. You're going to have an entire different bowel. That lower bowel is going to be acidic. And if you have an acidic bowel you're producing acetate, propionate, butyrate and that way the leaky gut is not going to happen. And unfortunately, by not doing that, by having gliadin, and by having the dysbiosis which is the wrong sort of bugs in the gut, we are over-expressing zonulin, and with an over-expression of zonulin, of course, we open up the floodgates and these large macro-molecules get in, trigger the immune system. 

And of course, this is where Fasano has done such amazing work. Because the whole autoimmunity is now open that we now understand a lot about diabetes type one. We understand rheumatoid arthritis, we understand MS, Sjogren's. I mean you can just go on and on. Because we now have the means, I think, at our hand to actually control the dietary intake, the food for the microbiome, and the type of bugs we’re eating and we already mentioned the fermentation. All of these things I think should be considered when we're considering what sort of food, what sort of diet we should be having, no matter where we are in the world, we should be considering these things because of some of this new research which we can now put into action. 
Andrew: Barring the Inuit which really do not have the facility to grow green foods on that bare, frozen landscape. Every other culture on earth, at least the ones that I know, have a base in vegetables. Indeed, if you wanted to talk about the picture child of health for a healthy diet it would have to be the proper, and I use that in bold, the proper Mediterranean diet which does not include a lot of pasta. 
Bob: No. Or meat. 
Andrew: Or meat, thank you. But it does include a basis of a wide variety of vegetables. But importantly, this social interaction. A reducing of stress hormones, a time to chew, you know, allowing your body time to chew, and digest, and imbibe, and intake these foods, and drinks to nourish our body. 

So, I guess where do you go with something like a Mediterranean diet for a population, you know, it's said that the Mediterranean diet is really the healthy diet that we should be adhering to. But you know, then we've got these things about, "Well okay how do you answer the Hadza? How do you answer these other..." 
Bob: You know what I do? I mean, having been in practice for 30 years one of the first things I ask my patient is, "What sort of diet do you have?" I mean if I was to say to you, "Look you can have a steak with some eggs, and some bacon, or you can have some fruit salad, or you can have a salad? 
Andrew: What do you like? 
Bob: What do you like, it's just… try and find out. I mean, we don't have their genome, we haven't got it in front of us. But by what they tell you, I mean some people would not think of having anything that is highly fatty for breakfast like bacon, eggs, and some chops or something like that. And other people they couldn't start the day without it. So I mean, all these things I think, are really important to get some grasp of each individual, and what they're likely to have. 

So when it comes to the Mediterranean diet we can mix and match, because if you have a look at the Mediterranean diet depending on where in the Mediterranean, depends on the balance. Every diet, whether it's in Crete, or it's in France, or Spain, or wherever it is, it's different. Entirely different even though it's a Mediterranean diet. 

I was looking at a show the other night where they were telling us how fantastic chickpeas were, you know, in Crete. And they were cooking them up with capsicum and tomatoes that were stuffed, you know, and they were getting grape leaves, you know. I mean, there's an entire different possible diet but they all have one thing in common, and that is like you said, they're relaxed, they often have a siesta, they often have a glass of wine with their meal. In Crete they have it almost with every meal. 
Andrew: But they also do things like, I was reading this book called The Blue Zones great read, by the way, anybody who's interested in longevity should read that book, The Blue Zones I can't remember the author. But what they were talking about in Crete, they move. They don't exercise, but they move, naturally. They just, I'm doing this. 
Bob: They’re doing things. 
Andrew: I might be sitting down, you know, shelling the peas… taking the ends off the peas, or beans and then I'll get up and do a thing. And then I'll sit down and do this, but then I'll get up and do that. I'll do some cleaning, I'll do that. They're always moving, regularly, every 20 minutes. And that influences the microbiome we now find.  
So there's this whole interaction of, it's not just what we eat, it's what we do, it's what we think, it's what we...how we eat, how fast we eat? 
Bob: Yes, and to what extent does a siesta have an influence? 
Andrew: How we rest, thank you. 
Bob: You know resting, I mean all very important. No, I agree with that and I think that's why when people say we should all do 10,000 steps a day. Now in a city, like Sydney for example, where we are, it's very difficult. You know, if you're working hard to try and do the movement that you're talking about. But we can still every...I mean maybe we put our alarm on, every hour to get up and move around. But the idea of sitting there for four or five hours, you know, and just getting into it, you know, soldier on. No, don't do that. 
Andrew: That's why we should get up and get a coffee Bob. 
Bob: Exactly. And incidentally, 10,000 steps is four kilometers, so to walk four kilometers a day is not that difficult and I mean I've tried it on myself. I mean, you don't have to just do the full four kilometers all at once. But you can move around, and if you can, you know, do some other activity, it's good. 
Andrew: And I think that's critical, it's not just walking. Walking is this sort of one plain, two plain movement. Whereas there's some very interesting research coming out now with regards to cancer, with regards...or even sarcopenia. And better than doing resistant exercise was something like dancing. Because you're moving joints and body parts throughout full ranges of movements, certainly when I dance. 
Bob: That’s what’s behind yoga too, I mean all the different... 
Andrew: Tai Chi, exactly. 
Bob: ...postures that you put into. I mean, what we're doing is toning every muscle group in the body. So, I mean, anyone that is into Tai Chi or yoga, you know, please keep it up. 
Andrew: Bending. 

Bob: Yes: 

Andrew: I think this is one of those key things that we start to lose, bending. Flexing different parts of the body not just the knees. 
Bob: They say, "Use it or you lose it" it's pretty true. 
Andrew: Yeah that's right. So I've got to ask, what about these historically, dare I say the word healthy, they're certainly historical, they're certainly cultural, what about a German diet? You had a more colder environment, colder winters certainly, more milder summers and yet they used to use things which today even, you know, the World Health Organization has lambasted them as a class 1 carcinogen. And that is these preserved meats. 
Bob: Yeah, what they were preserving, there're entirely different preservatives that are in the meats that we do, compared to what traditionally they used to use. 
Andrew: Now this is interesting to me because, again, it's how we're stuffing up a food. Whereas I remember looking back, you know, we'd like to think about E. coli Nissle 1917. A fantastic probiotic, some nice research on it. Where did we get it? Oh, we got it from a human. We got it from a World War I soldier who survived a dysentery outbreak. Now hang on guys, that's a little bit arrogant. We actually can get it from pigs. And what do German soldiers eat a lot of? 
Bob: Yeah, exactly. 
Andrew: Sausage. So I just think we gotta stop this ownership of these organisms. But I just think it was very interesting that it came from the food, you know. 
Bob: But don't you think it's important to have a look at ethnic diets that have gone back. We have clinical trials and they're, you know, well controlled, randomized controlled clinical trials, and they're good. I like randomized controlled clinical trials, I like looking at them. 

But you have a group of people that have lived in an ecosystem for 5,000 years, and they haven't moved around much. Firstly, their genome has been accustomed to the sort of foods that are there. And talking about epigenetics, all of the things that they're eating on a daily basis defines the expression of those genes. It's appropriate for that particular group of people, in that particular place. 

Andrew: Yes.
Bob: So I love ethnic diets and if you can look back and you can see, and the person particularly if they're living in the same country. That's the way to go and that means much more to me than every clinical trial in the world where they're pulling everything to pieces and they're trying to find out what's going on. 
The problem genomically speaking, is we have now moved around the globe, we're intermarrying, we have different races coming together which is heterogeneity of the gene pool, which is good, making us more intelligent, making us more attractive, and so on. But when it comes to actually trying to define what the right sort of diet is, whereas we knew before, if we went back 3,000 years. We don't really know now, what the genes are that are responding to what, in our environment and that's where a lot of the confusion. So not only are we preserving foods, we're modifying foods, and we have, "Oh, we better get rid of the fat in our foods." So what do we do? We have high sugar foods. 
So all the low-fat foods in the supermarket that you get out there are packed with sugar. 
Andrew: And it says no cholesterol. 
Bob: Exactly, no cholesterol but it's now got sugar. And, I mean, this has brought us into an entirely different realm because we've talked before on lipoproteins and how that they are now being modified by the foods we're eating. So the fats and the sugars that we're eating on a daily basis in the modern Western diet are changing the lipoproteins. Now, a good way of looking at this is, LDL is a risk factor for heart disease. 
Andrew: Total LDL? 
Bob: Total LDL. I like to look at LDL as a rich plum on a tree versus a prune. Now, they're both LDL, right, the whole plum and the prune. The shrunken little prune is equivalent to small dense LDL. This is the risk factor. The lovely, fluffy big plum is the good LDL. This is not such a risk factor. This is okay. Now, what happens is when that plum is associated with a high sugar level that we've all had in our diets for I don't know how many years, together with some of the highly oxidizable vegetable oils, seed oils, for example, that oxidize really readily. You've got the ApoB which is around the LDL, which is actually binding it and is able to recognize the actual cells in the blood vessel and it takes the fats in. That is oxidized and it's usually the lysine residues and the sugar glycates it. 
Now, as we have the HbA1c which is a good indication of your sugar level over long period, say, three months, we also glycate our LDL. And when we glycate the LDL and the fats are also oxidizing, we end up with the prune. Now, that prune... 
Andrew: Is the one that migrates. 
Bob: ...when you get your pathology tests, unless you know whether your LDLs are prunes or plums, you know nothing, absolutely nothing. 
Andrew: And this is the fight...this would be interesting for me to talk to a really, really, really old GP, past retirement age. When they didn't have LDL, HDL, trigs. They had total cholesterol, that's it. And then they found, "Oh, no, there's sub-fractions," but now, there's this huge resistance to look at the sub-fractions of the sub-fractions. And I go, "Guys, come on, you can see. You know there's this functional difference." 
There's a study that sort of looked at this regression analysis, and they basically negated the effect of the small, dense LDLs. Which, to me, is just like a way of regression upon regression upon regression until you end up with nothing. To me, it's a trollop of a study. It's like, "Come on, guys, you know there's a difference there. You know what the pathology is. You know that it's oxidized LDL that migrates under the tunica intima of the artery. Why are you not grasping this?.” I don't get this. 
Bob: But, you know, the interesting thing, too, is when we say, "What can we do about it?" Now, we've just defined two areas that people listening to this program can do something about. Firstly, get rid of the seed oils. The polyunsaturated oils we do not need a lot of. We can get it in avocados, we can get it in seeds, nuts...  
Andrew: Beans. 
Bob: ...particularly, beans. We've got a lot of oil. I mean, if you're eating corn on the cob, you're getting corn oil. But it's corn on the cob. So forget this idea we need... 
Andrew: I think the message is we should be eating the plants. 
Bob: We should be eating the whole plant and it's the same with fruit. If you want to get some sugar, eat a whole piece of fruit. You're not getting anything like the 16 teaspoons of sugar in 600mls of a soda. So what we can do is, yes, get rid of the sugar, eat whole foods, this is what we've been saying, and you're going to immediately get your LDLs going towards plums rather than prunes.  

Andrew: Yeah.
Bob: Now, this important. But, you know, one of the things with oxidation is antioxidants, anti-inflammatory agents that naturally exist in fresh fruit and vegetables. Now, if you have a look at LDL that's healthy, and I'm talking about the plum, not the prune. The plum has tocotrienols, tocopherols. It has Coenzyme Q10. 
Andrew: Ubiquinol. 
Bob: It has beta-carotene, ubiquinol. These are all antioxidants, anti-inflammatory agents. They protect those fats that are in the LDL from oxidation. So we need to have some whole fruits, some whole vegetables, seasonal, in our diet. I believe even if we have a high meat, high-fat diet, sure have a high meat, high-fat diet, but make sure we've also got the highly fibrous foods that we mentioned for the microbiome, and we've also got foods that are rich, that are highly colored, for example, you know, the purple, and the red, and the yellow, these are all rich in the carotenoids, and the polyphenolics, and some of the things that we're talking about. That is going to protect the LDL, i.e., the plums and stop the plums going into prunes. Because it's the prunes, these little tiny, small dense LDLs that are taking up professionally...no, not professionally... 
Andrew: Preferentially. 
Bob: Preferentially, sorry, into the endothelium and we're going to then take them up into microphages to form foam cells, and this, of course, is the beginning of atherosclerotic plaque and so on. 

So let's get rid of the sugar, let's get rid of the polyunsaturated oils, and let's take lots of these anti-inflammatory agents and antioxidants. Then we've got a chance of changing the LDL fractions that you mentioned. It's about seven of the LDL fractions. More of the LDL 1 and 2 which we'll find in the plum, and less of the LDL 3 to 7 which are the small dense LDLs which have been modified. This is the modified LDL taken up by scavenger receptors that is taken into the foam cells. 
So this is something that we can do, we can do this right today even though you haven't had any pathology tests, you can actually change the diet in this respect. And you can modify no matter what your preference is for fats and proteins, and carbs. Just make sure the carbs are whole carbs, seasonal, high fibre, and hopefully that the meat that you're eating is largely fish. Like the Mediterranean diet, they have a minimum of two or three meals of fish a week, and I think the fish has got the omega 3 oils and so on. 
Andrew: Absolutely. For any of our listeners that want to catch up on the uselessness of the benefits of seed oils in the diet look at the Sydney Heart Diet Study. I think that's right? Or Sydney Diet Heart Study. That was the one that only recently I think it was, one or two years ago, you know, basically called into question this dietary advice, dietary guidelines which we've been given for, what? Two, two and a half decades? Which has not helped us with heart disease at all. It's other fats that we should be concentrating on. 
Bob: Well even the latest U.S. Dietary Guidelines. 
Andrew: Dietary Guidelines, that's where I was going next. 
Bob: Well they're saying, you know, we need to get our fat down to 10%, and our sugar down to 10%. I don't believe that that's right. I believe we need to control the type of fat that we're taking in, like we said avocados, and seeds, and nuts, and grains and get them… and even if we're having fat from meat, a lot of people are not aware of the fact that the saturated fat, which we think is the stuff around chops, and bacon, and it's the intramuscular marbling in a steak. This is not saturated fat. This is 48% oleic acid which is what we have in olive oil, which we know is okay. 
Andrew: Particularly, well in grass-fed meat. 
Bob: Yes, definitely in grass fed. 
Andrew: It changes in... 
Bob: It changes if you're having grain fed, so go for the grass-fed beef, and you're going to get the right sort of oil. And this is really important because, if we got the right sort of oils, we can take that up a little bit more. And the same with the sugars at 10%. I think we should be aiming at getting the sweet tooth, and I've got a sweet tooth, I know all about it, to try and get away from that. Because if we can just eat the whole fruit, like for example, berries are particularly good, and we're going for low glycemic index, we're going for low glycemic load, but we're still getting the sweetness. When you have a carrot and you haven't been eating a lot of sugar, the carrot is sweet. When you're having pumpkin, or squash you've got a low glycemic load but you've got this sweetness. 

So we've got to move ourselves away, so it's all very well saying, "Yeah, we'll have lots of stevia, and erythritol, and lots of xylitol," they are good. They are good sugar alternatives. But I think ultimately, if we can just train ourselves not to go into the sweet area, then with what I’ve just said, particularly for lipoproteins and that actually can extend through to cancer and a whole lot of different disorders. We are doing ourselves a great favor as far as wellness goes. 
Andrew: It was a very powerful movie, the movie called That Sugar Film
Bob: Yes, yes. 
Andrew: Extremely powerful. But one of the interesting points that I got from the movie was the incredible research that went into that guy who developed the "bliss point." We are basically programmed to like sweetness. And he found...and it was much more than what I thought it would be. You know, so forgive my memory, but let's take it for this analogy. Instead of being one teaspoon of sugar in a cup of coffee, it was more like three teaspoons of sugar in a cup of coffee. And the researchers found that this was evident in infants. So we humans are programmed, call it a survival thing if you like, from when we were primates, hunting for food in the treetops or... And it was incredibly sweet food to survive on, but that's primed. What we've fallen into though is feeding that to ourselves every single day... 
Bob: Well there's too much... 
...without any outlet, without any exercise, without any burning off of that energy. 
Bob: Exactly...and there's too much sugar around, there's too much fat around that are the wrong kind. But I mean, if we could just go through the supermarkets and get rid of all of the oils. 

I mean, in Crete they eat olives, I mean olives, and olive oil and you haven't got the same problems. And the Mediterranean diet is full of olives, and olive oil. It's not full of safflower, sunflower, corn, soybean oil, and that's the stuff that can oxidize very easily. It's about 60% of alpha, sorry not alpha, of cis-Linoleic acid. And that stuff oxidises, it forms linoleic acid and hydroperoxide, and it is a risk factor. And it wasn't around before the Second World War. It's only after the Second World War, we've started to use those oils in the diet. 
Andrew: And that was an economic thing wasn't it? 
Bob: It was an economic thing... 
Andrew: It was under USDA. 
Bob: Yes USDA. 
Andrew: U.S. Department of Agriculture.  
Bob: So and they didn't do any studies on that. So it's really interesting to think we should perhaps go back and if you want intramuscular marbling on your piece of meat, if you're into the Paleo diet, eat the right sort of vegetables, have intramuscular marbling. It's not going to hurt you because you've got the stearic acid, you've got palmitic acid, you've got oleic acid. Now palmitic acid might be in there, I'm not sure what is it, 15%, 16%? But when do we ever eat just pure palmitic acid?

Andrew: No

Bob: We don't do that, and a lot of the studies that are being carried out are being carried out on one single fatty acid that's taken away from its cousins, and its brothers that are in the fat we're eating in our diet. This is a fundamental problem when it comes to clinical research. We do not give someone palmitic acid. We give them whatever the food is that they're going to normally eat. 
Andrew: Yeah, that's right. So, I've got to ask then, somebody's already in that high sugar, bad fat diet. How do you take patients with this slow, call it an evolution, of getting back to what we should be eating, when they've got these extremely powerful satiety and hunger signals governing their lifestyle? What tips can you give our listeners with getting them back onto the right track? 
Bob: Well one of the ways that I was doing it, was using the 5:2 diet. Because what happens is, if you actually limit… this is intermittent fasting. And two days a week, on say Monday and Thursday. If you're a man you just have 600 calories, if you're a woman you have 500 calories. And you knock down the amount of food that you're eating on those days to the 500 or 600 calories, and over the week you've knocked the total calorie load down. But you haven't signaled your body that, "Hang on we're going to a drought, we better hang on to our fat tissue."  
So what happens is, firstly, insulin derived growth factor goes down, the moment it hits 28 and it comes down to 15 and so on. So you are going to lose body fat, and you are going to go into the direction of weight loss. So there's such obesity in the world at the moment, this is one way of getting your...a different way of controlling the diet. Now instead of just eating anything you want which is in the 5:2 diet, I wouldn't do that. I would actually eat good food that we've been talking about on this program. 

So on the five days that you're eating anything in as much as you want, eat good foods. But the other days still cut the calories down. Because we do know most people are addicted to something, and particularly foods. You're addicted to sugar, you're addicted to fat, you can be addicted to bread, you're can be addicted to something, and I think people can relate to that. So to get out of that addictive, firstly you got to want to do these changes, you’ve got to want to perhaps lose weight round the middle. And then by cutting the calories down, you change the way in which some of these hormones like ghrelin and leptin are acting. 
So ghrelin is making you hungry all the time. Now if the ghrelin level drops and you're not as hungry, this is good. So as you're changing the hormone levels. And on this particular diet, you will have your blood sugar come down. You will have your triglycerides come down. You will have a lot of the parameters that you want to start lowering. And this means that your natural homeostatic mechanisms are readjusting.  
So to answer your question we'll need to slowly get there, but we will see a change. But you can't change overnight because I really believe this is an addiction. I think people have food addictions, and this has come out recently in a lot of papers, and at conferences I've been to. People are addicted, I mean, as you know, I mean you can say, "Cut sugar out of your diet," how many people can do that? How many people can cold-turkey cut the sugar out of their diet? I just don't think there's many that can do it. 
Andrew: I remember, forgive me, I think it was Rosemary Stanton? Talking about these addictions if you like, these bad habits can last up to a year. That it really does take quite a long time to cement a new habit into place. What interested me was, somebody, it was two journalists. TV journalists. Were talking about the rationale for the 5:2 diet, and the guy had been doing the 5:2 diet. The female journalist was asking him about it, and he said, "You know what? I just decided to do it, and I knew what I was doing. I still felt hungry, but not starving. And I just got past it. I just went I’m doing it. So I just felt hungry for the day knowing that I wouldn't tomorrow." So that's willpower. 
Bob: Yes, it is. 
Andrew: What interested me was when you look at, we spoke of Jeff Leech, I can't forget this guy. But one of the most important points I took out of his thing was that he was never totally full. When he lived with the Hadza tribe for a year, not at any stage was he totally full. There was always that slight, not starvation, but just like, "Oh I could do with a little bit more," and that in itself is a powerful mechanism for call it healing, for normalization of hunger hormones, blood sugar, of receptors, you know, of how we maintain a homeostatic mechanism with regards to our diet. 
Bob: And that's exactly right. If you can get up from the table feeling like you could just probably eat a little bit more, you know that your hormones are starting to do the right thing. And it's, you've just got to get used to that feeling, just being slightly not stuffed. 
Andrew: But it's the willpower to say that. 
Bob: That's exactly right. 
Andrew: To choose that. 
Bob: But keeping that in mind, remember I said your blood parameters are going to change, and as they change in the right direction, particularly if you're eating foods with low glycemic index, and you're eating all the right fats, you're eating the right oils, and so on. All of that is going to mean that your cells are now going to be contended. 
Now, the mitochondria when they’re overloaded, it doesn't matter you overload them with. It could be any of the macronutrients, it could be protein, carbohydrates, or fat. When the mitochondria's overloaded, like putting two loads of washing in a washing machine, you know, you don't get them clean. What happens is we get reactive oxygen species, we get free electrons buzzing off, and all of that is going to create havoc, it's going to create havoc. And that's where we’ve got to cut the amount that we're eating down. Because if you start thinking in your mind, "How am I going to cut down what I'm eating," and then think, all the little powerhouses in our cell that are generating energy, are releasing reactive oxygen species, free radicals and electrons that are damaging our body. They are oxidizing macro-molecules. They are causing the problem we talked about with the lipoproteins. They are cross-linking because the advanced glycation end products are cross-linking collagen in the blood vessels.  
All of these things happen when we’re overeating. Now, if we can stop the overeating with 5:2 diet, that is, I think, the best handle on it. If you say to a patient, "No, no, you're eating too much, you’ve got to cut down," it doesn't work. From my experience, it doesn't. But they will go on a 5... 
Andrew: You're eating too much Domino's, eat less Domino's. 
Bob: Exactly. But the 5:2 does work and that's why I've been using that to try and change things. 
Andrew: So what about the 5:2 Mediterranean? Because, I mean, the 5:2 diet is kind of like similar to the Israeli diet, isn't it? That sort of starve, what did you call it, feast, famine? 
Bob: Well, the main thing is, like you said, if you're cutting your calories down to 500 or 600 cals, you know the next day, you're going to be eating again. And that is the willpower that you talked about, makes it so much easier if you know, "Well, tomorrow, I'm going to be okay and that will get you through the day. But if you're saying, "For a couple of weeks, I'm just going to go on, you know, two-thirds of what I normally eat.” It won't work because people are addicted to certain things. 
Andrew: Can I ask you in a future podcast if we go into these hunger signals and really explore the biochemistry of that? Because maybe we might have some answers for the...I mean, in some people, you know, the super-obese, and the morbidly obese. These people have extremely powerful hunger signals and they can fit a loaf of bread into an extended stomach. I mean, their stomach can hang down to their left iliac fossa. It is bloated, it is expanded, stretched. So there's that physical stretch receptor signal as well, rather than just the biochemistry. Would you mind if we explore that in another podcast? 
Bob: No, I mean, a lot of the things that you're talking about, I mean, I can remember I've had patients that would eat a kilo of cheese a day, or they would eat a whole loaf of bread. And they have, we call it allergic reactions, but now, what we know about the lower bowel and zonulin. I mean, obviously, there was something going on with the microbiome. There's something going on in the case of bread. It was probably was gluten or gliadin. And some of these things that they are addicted to, are causing a sort of stress response. They’re releasing adrenalin, and they’re releasing endorphins and things because with stress, a lot of people crave a certain stress response, particularly adrenalin. Because adrenalin mobilizes fatty acids, it mobilizes sugar. It gives you a real buzz. 

So that real buzz is why people are gravitating towards certain foods and overeating them even though they are bad for them, causing a problem. They just must have a little bit more of this or that food.  
Andrew: Another topic that I'll ask you to delve into is the resistant weight management, or weight gain if you like. When people plateau and they can't get over it, and what part inflammation plays, and managing inflammation, and how you manage that inflammation from various parts. Whether it be the gut, or just giving some fish oil, some turmeric, whatever. Would you be happy to do that in another podcast? 
Bob: Yeah, I mean, talking about inflammation, I mean, as you know, the visceral mass around the middle when you're overweight is a highly inflamed mass full of macrophages and so on. And the polyunsaturated oils, when we eat polyunsaturated oils, yes, they do oxidize but also when they are taken into the adipocyte, the mitochondria are not going to allow those to be metabolized the same way as saturated fats. 

So the insulin signaling still occurs and it goes in. So we end up with these calories going into the adipose tissue and accumulating there, so we're hungry. So we're hungry while we accumulate polyunsaturated oils like safflower oil, corn oil, and also the glucose is going in, too. So this is a bad situation. 
Andrew: Energy that you can't use. 
Bob: Yeah, so we've got to change that by changing the composition of our diet. 
Andrew: Bob, I've always loved how you can tie in the biochemistry with the patient in front of you and it's always answered. 
Bob: Well, I don't mention biochemistry to the patient, I can tell you. 
Andrew: No, but you do, I mean, I've learnt from you, for so long, and you've always done that. You've always made me question things that I thought was right and changed and looked into why things were happening. 

But today, thank you for taking us into why these dietary choices are so bad for us, and indeed, what can we do to change them in ourselves as well as our patients. 
So I thank you so much for joining us on FX Medicine today. 
Bob: It's a pleasure and the best diet is an individual diet. 

Andrew: This is FX Medicine and I'm Andrew Whitfield-Cook.

Additional Resources

Dr Robert Buist
Dr Robert Atkins: The Atkins Diet
Researcher: Clara Belzer
Sandor Katz
Book: The Blue Zones
That Sugar Film 

Research explored in this podcast

Schulz L, Bennett P, Ravissin E et al. Effects of traditional and western environments on prevalence of type 2 diabetes in Pima Indians in Mexico and the U.S. Diabetes Care 2006 Aug;29(8):1866-71

Ramsden C, Zamora D, Faurot K et al. The Sydney Diet Heart Study: a randomised controlled trial of linoleic acid for secondary prevention of coronary heart disease and death. FASEB J 2013 April; 27(Suppl 127.4)

Other podcasts with Bob include:


The information provided on FX Medicine is for educational and informational purposes only. The information provided on this site is not, nor is it intended to be, a substitute for professional advice or care. Please seek the advice of a qualified health care professional in the event something you have read here raises questions or concerns regarding your health.

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