The David Gillespie Blog

One in every 250 Australians suffer from a severely debilitating disease but no-one (especially those who have it) dare to speak its name. The annual rate of new diagnoses has at least tripled since 1990 and hospitilisations caused by it have doubled in the last decade alone. This is a disease which is clearly out of control but the worst news is that it is likely to be just the proverbial canary in the coal-mine for much worse epidemics lurking in the background.

IBD (Inflammatory Bowel Disease) is chronic inflammation of the bowel and lumps together two main diseases, Ulcerative Colitis and Crohn’s Disease. IBD is a life-long condition that is generally first diagnosed between the ages of 15 and 40. The chronic inflammation results in recurrent bouts of abdominal pain, diarrhoea, vomiting, fever, weight loss and rectal bleeding.

Doctors are careful to distinguish IBD from IBS (irritable bowel syndrome). IBS is characterized by chronic abdominal pain, discomfort, bloating, and alteration of bowel habits but no bowel abnormalities are detectable using routine clinical testing. Evidence is however beginning to emerge that suggests that IBS may in fact be a low-level pre-cursor to IBD.

Needless to say, IBD has a significant impact on a sufferer’s emotional well-being and it’s something they generally like to keep very much to themselves. Most will suffer enormous discomfort for most of their lives and just try to soldier on. But a person experiencing a ‘flare’ of the symptoms requires near-continuous care. And hospitilisation and surgery is often required. In 2010, over 27,000 hospilitizations occurred for IBD treatment in Australia. A decade earlier there had been just 13,000.

IBD is caused by the body’s immune system attacking the bowel. The standard treatment is to prescribe anti-inflammatory (immune suppressing) drugs. Beyond that, the official position is that IBD is idiopathic (meaning we don’t know what causes it or therefore how to cure it other than by chopping out bits of inflamed bowel).

Our intestine is a glorious piece of machinery. Its job is to extract every bit of stuff we can use from whatever we shove in our gob and avoid any nasty bacteria while doing it. In order to perform this magic trick we have specialist filtering cells that extract the good stuff and drop it into our lymphatic system (fats) or our blood stream (everything else). To do this we need an enormous surface area in contact with potential food. If we uncrinkled it all, our intestine would have the surface area of a football field. With all that space to cover, our immune system naturally concentrates a lot of its resources on defending the parts of our gut responsible for absorbing stuff from the outside world.

We know that IBD is not an auto-immune disease. It is not the body attacking itself. It is our immune system reacting to a foreign body. That reaction, the inflammation response, is our body’s way of defending itself against agents of harm from the outside world.

One of the key shortcuts our immune system uses is to react viciously to something called endotoxins. An endotoxin is a key part of the cell membrane of some of the nastiest critters in the bacterial world. Cholera, Salmonella, Helicobacter (responsible for stomach ulcers and cancers), Legionella, Gonorrhea and Meningococcus are among the very long list of bacteria who carry endotoxins. So it won’t come as a surprise that our immune system goes on high alert when it spots an endotoxin in our bloodstream.

The correct number of endotoxins in our blood is zero. If the number in the blood stream is any higher than that then we know there is a problem with our gut. The gut is usually impermeable to endotoxins, but it can become ‘leaky’, that is, it can become more permeable to endotoxins and they can start to leak through into our bloodstream.

We know that three very common substances will cause our gut to become more permeable, fish oil, alcohol and fructose. Animal studies have convincingly shown fish oil to increase endotoxin leakage into the bloodstream. And animal and human studies have also shown that both acute bingeing and long term exposure to both alcohol and fructose will increase (up to 20-fold) the amount of endotoxin in our blood. Unfortunately both alcohol and fructose also appear to increase the populations of bacteria which produce endotoxins in our intestines (something charmingly termed bacterial overgrowth). So we get the double whammy of more endotoxins in our gut and doors left ajar (gut permeability) to let them into our bloodstream.

These endotoxins of course send our immune system into a killing frenzy which we experience as inflammation of the intestinal tract. We also know that just like any other inflammation response it is made worse if we are consuming too much omega-6 fats found in seed oils (vegetable oils).

Much more disturbingly, the inflammation response does not end at the intestine. First stop for portal blood after the intestine is the liver and there is convincing research which tells us that our inflammation response to endotoxins is what converts a ‘mere’ fatty liver (caused by overconsumption of fructose) to an inflamed fatty liver (steatohepatitis).  Worse than that, it is looking increasingly likely that our immune response to endotoxins is implicated in a raft of diseases associated with inflammation in other organs (such as the heart, pancreas and kidneys).

Alcoholic Fatty Liver Disease now affects 6,203 people but Non-Alcoholic Fatty Liver Disease afflicts a massive 5,538,677 Australians. Even more worryingly, up to 13% of Australian children now have this chronic liver disease. If those numbers are anything to go by, we’re bingeing an awful lot more on fructose (or fish oil) than we are on alcohol. So when we go hunting for the cause of the massive rise in IBD in Australia, I’d be looking in the breakfast cereal, health food and soft drink aisles a long time before I’d be checking out the bottle shop.

When we suffer the symptoms of IBS and quite possibly, eventually, IBD. It is our gut sending us a message. It is saying you are consuming too much fructose (or in rarer cases, alcohol or fish oil). It is the visible warning that far more scary things are going on in organs that don’t throw off symptoms (until it is way too late). So if you are getting those messages from your gut – listen.

IBD is a life sentence of debilitation. It won’t kill you but it will make every part of your life awful from your mid-teens onwards. The science suggests the fastest, bestest, way to avoid it is to not binge on fructose (or booze or fish oil). The only problem with that is that the processed food industry is lacing everything we eat with fructose and just for good measure chucking in a pile of seed oils (vegetable oils) loaded with omega-6 fats to ramp up our inflammation response. Pay attention to what you eat, or preferably construct it yourself from basic ingredients and you will be a long way towards not suffering the horror story which is IBD.

Image courtesy of Ambro / FreeDigitalPhotos.net

Three years ago a Professor from Sydney University published a paper which she claimed exonerated sugar as a cause of obesity in Australia. It has been widely promoted by the processed food industry.  But from the very beginning it was obvious that there were serious problems with both the evidence relied upon and the conclusions reached. So far the University has failed to remove the paper and continues to drag its feet. Why?

In May 2010, the DAA (Dietitians Association of Australia) announced that Dr Alan Barclay, Head of Research at the Australian Diabetes Council had discovered that sugar could not be blamed for Australia’s obesity crisis.

‘Much to everyone’s surprise, it looks as if, unlike in the US, sugar is not the culprit here – or in the UK or Japan,’ said Dr Barclay while commenting on the study he had just completed with co-researcher Alicia Sims. He based this conclusion on his discovery that consumption of sugar had declined by ‘nearly 20 per cent’ since the early 1970s.

After this, the research was frequently wheeled out to rebut anyone who dared to suggest that sugar may indeed be the culprit. One example appeared in the Sydney Morning Herald in July 2010 when one of my books about the dangers of sugar was critiqued by Jennie Brand-Miller a professor of human nutrition at the University of Sydney.

Brand-Miller argued that Australia’s consumption of sugar has ‘actually decreased by about 23 per cent over the past 30 years. That to me blows David Gillespie’s hypothesis out of the window,’ she said.

Brand-Miller was apparently so impressed by Barclay’s findings on sugar consumption that she became the lead author of the paper by the time it was eventually published in 2011.

The paper on Australia’s paradoxical decline in sugar consumption (paradoxical because elsewhere in the world sugar and obesity rise together but here apparently they don’t) finally saw the light of day in a little known online-only journal called nutrients. Brand-Miller was the guest editor for the issue in which the paper appeared.

As you might expect, those with a buck to make from flogging sugar have leapt upon the (now published) paper with glee.

When the AFGC (Australia’s peak processed food lobby group) argued against a change to the Healthy eating guidelines which would restrict sugar consumption, they relied on the paper. When Kellogg’s wants to convince us that the sugar content of Breakfast cereal is not a problem, they rely on the paper. When Pepsico, Coca-cola or the Australian Beverages Council want to convince us that sugar doesn’t cause diabetes or obesity they rely on the paper. And of course the US, Canadian and Australian sugar associations cite it regularly.

Perhaps a little more surprisingly both the DAA and the National Heart Foundation have, in the past, also relied heavily on the paper’s findings to combat any suggestion that sugar consumption is a serious cause for concern.

Very early on, the constant assertion of the existence of an Australian Sugar Paradox happened to catch the eye of a former Reserve Bank economist, Rory Robertson. He had spent most of his life studying economic data and charts – including on commodity consumption and production – and the statement that Australia is eating less sugar now than it did in the 1970s just didn’t ring true. He made a few calls and quickly discovered that some of the data used by the paper was, to put it bluntly, made up (by the FAO – the United Nations Food and Agriculture organisation). It seemed that was necessary because the Australian Bureau of Statistics no longer collected information about sugar consumption, but the FAO still needed to produce a sugar consumption report.

Alerted to the possibility that there were serious problems with the paper, Robertson dug further and began to discover glaring errors and other concerns. For example a graph which showed a 30% increase in sugary drink consumption was described by the authors as showing a 10% decline. And both Brand-Miller and Barclay had failed to mention that the ‘not for profit food endorsement program’ (disclosed in the paper), with which they are both involved, receives payments from CSR (a large retail sugar vendor) and other companies selling foods high in sugar.  I’m sure those payments didn’t influence Brand-Miller and Barclay’s research at all but the potential for conflict should have been disclosed.

Robertson raised his concerns with the authors and the journal to no avail. Frustrated by the refusal to acknowledge obvious errors, in March 2012, he contacted Sydney University’s Deputy Vice Chancellor, Research, Dr Jill Trewhella.  He was swiftly told that his complaints were ‘potentially defamatory’ and that the best avenue of redress was to publish a paper of his own.

Robertson decided instead to campaign to have the paper removed from the public record. His logic was simple. The paper may be error riddled and published in an obscure online-only journal but it punches way above its weight. It is used extensively to undermine any suggestion that sugar consumption is dangerous and it lends the hard won credibility of Sydney University (and the Diabetes Council of Australia) to its clearly inappropriate claims. He felt that simply rebutting it in a journal would not stop it doing harm. It needed to be expunged from the academic record.

Rory is nothing if not persistent. And it appears that Dr Trewhella is finally acting on his concerns. In November 2013, she announced that she had appointed an investigator to ‘conduct an initial inquiry’ the aim of which is to determine if ‘a prima facie case has been established’ in relation to Rory’s complaints.

But now more than 10 weeks have passed and there is still no word from Sydney University as to the outcome of its investigation. It shouldn’t be that hard. The Paradox paper contains obvious errors (such as the 10% increase debacle discussed above) which go to the core of its claim of decreasing sugar consumption. And at least one of those errors has been acknowledged as recently as last Sunday by Brand-Miller in response to questioning by ABC Background Briefing reporter Wendy Carlisle.

But something else makes the investigator’s task even easier. A peer reviewed paper has been published by the University of Western Australia which explicitly states that having analysed the paper and its conclusions, there is no Australian Paradox (because Australian sugar consumption is ‘substantially increasing’). It couldn’t be more black and white if it were a Zebra.

The Australian Paradox paper is, at best, incompetent. There is no justification for its continued existence. Every day that it remains on the public record, it is being used as ammunition by the processed food industry, Sydney University’s reputation as a premier university is being tarnished and the science of human nutrition is being ridiculed.

It’s time for the University to stop pussy-footing around and do what needs to be done. Retract the paper. Prolonging the embarrassment does not make it less embarrassing.

The 2014 Low Fructose Guide to Australian Breads lists the 10 best and 10 worst breads on sale in Australia today (from a sugar content perspective). It also contains a separate section for gluten and wheat free offerings and a comprehensive listing of the sugar content of over 220 supermarket breads and larger bakeries (such as Baker’s Delight).

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