Andrew Howie

APD MBA Android Apps Android Access to data from AusNut. 'No laughing allowed'(oz humour)
How do u know if you are doing a good job? Do u track ur outcomes data

[Andrew Howie @howiepask]

@WeDietitians @FionaWiller The #PRO is impressive and by def is a "n=1" eg https://t.co/C0ssZLruhN

[Vinnie Tortorich @VinnieTortorich]

An anonymous dietitian got an Australian surgeon banned from talking about food.

Dr. Gary Fettke. Senior orthopedic surgeon. Launceston, Tasmania. He amputates the consequences of type 2 diabetes for a living. Feet. Toes. Legs.

He spent years watching the same patients come back. The official high-carb diabetic diet was feeding the disease. So he started telling them: cut sugar. Cut refined carbs. Eat real food.

An anonymous dietitian reported him to AHPRA, Australia's medical regulator. The charge: giving nutritional advice outside his scope of practice.
AHPRA's exact words to him: "There is nothing associated with your medical training or education that makes you an expert or authority in the field of nutrition, diabetes or cancer."

The investigation ran two and a half years. Zero patient harm. Zero patient complaints.

November 2016. They cautioned him anyway. He was forbidden from giving any nutritional advice. To anyone. Even patients about to lose a limb.

He refused to back down. The science was on his side. So was every patient he had ever treated. #isupportgary built into a movement.

October 3, 2018. AHPRA dropped every allegation. Apologized in writing. Four and a half years after the original complaint.

They didn't beat him with science. They tried to beat him with bureaucracy. He outlasted it.

The body listens to what you feed it. The medical board listens to dietitians.

Choose carefully who you listen to.

#NoSugarNoGrains #VinnieTortorich #GaryFettke #isupportgary #AHPRA #LowCarb #Type2Diabetes #DiabetesReversal #SugarLies #FoodIsMedicine #MedicalFreedom

[Andrew Howie @howiepask]

"Bezos has a saying: when the data and the anecdotes disagree, the anecdotes are usually right."

[A Paradise for Parents @HalCranmer]

When someone asks me how do you get people in their 30s, 40s, and 50s to take their health seriously before dementia strikes, I tell them:

"Visit an assisted living home near you—not as a resident, as motivation. Everyone who comes to my home says I don't want to be here, I want to live at home."

Here's why:

"Something that's very important to know is dementia starts in your 30s 40s and 50s. You don't see the signs and symptoms of it until your 60s 70s 80s 90s, but what you do in your 30s 40s and 50s can very much affect what happens to you in your older life especially with dementia and Alzheimer's."

This is how to get started with reversing dementia now:

"Cut out one thing at a time—concentrate on that candy bar after lunch, get rid of that first, then cut out your breakfast cereal, then eat your burgers without a bun...Even if you don't go to the gym and work out, go walking, get out in the sunshine... just move."

[Andrew Howie @howiepask]

https://t.co/BojphZbkjJ

[Sama Hoole @SamaHoole]

1950s: Dr. Cleave (British physician) publishes "The Saccharine Disease."

His argument: All modern disease can be traced to refined carbohydrates.

He examines populations across the British Empire:
- British soldiers in India
- Colonial populations
- Naval personnel
- Metropolitan British population

His finding: Disease follows refined sugar and flour consumption with 20-year lag.

Introduce white flour and sugar to a population. Twenty years later:
- Diabetes appears
- Obesity appears
- Heart disease appears
- Dental decay appears
- Hemorrhoids appear

He documents this pattern in dozens of populations. The timing is consistent. 20 years from refined carb introduction to disease epidemic.

His conclusion: Remove refined carbohydrates, disease disappears.

His prescription: Whole foods, unrefined carbohydrates if carbs at all, emphasis on protein and fat.

The medical establishment's response: Dismissive.

His work is published but ignored. Medical schools don't teach it. The "Saccharine Disease" concept doesn't enter mainstream medicine.

Why? Because in the 1950s, refined carbohydrates are the future of food production.

White flour is cheaper to produce and store than whole grain.

Sugar is profitable.

Processed foods are being developed rapidly.

Cleave's hypothesis threatens the entire food industry's direction.

By 1970s: The low-fat dietary guidelines emerge. Refined carbohydrates are recommended as "heart healthy" because they're low in fat.

Everything Cleave warned about is officially endorsed.

His book goes out of print. His work is forgotten.

Modern result: The diseases Cleave documented now affect 60%+ of the population in developed nations.

Diabetes, obesity, heart disease, dental decay - all following the exact 20-year timeline he documented.

We introduced refined carbs to developing nations. Twenty years later, they have diabetes epidemics.

Every population follows the same pattern Cleave proved in 1956.

But we're still calling these "diseases of civilization" as if they're inevitable byproducts of progress rather than predictable consequences of dietary changes.

Cleave gave us the diagnosis and the cure 70 years ago.

We buried his work and created the largest epidemic of preventable disease in human history.

[Dr David Unwin @lowcarbGP]

13 YEARS of drug free T2D remission!! So proud of our ‘expert patient’ Chris who has proved low carb is sustainable and helped many others in our group consultations with his advice 👏👏 Most recent HbA1c 40mmol/mol or 5.8%. Now we have 151 similar cases. We wrote his case up in 2015 https://t.co/n8bPLSmFLV

[Andrew Howie @howiepask]

Beautiful.

[Dr David Unwin @lowcarbGP]

1/3 What if going Keto, carnivore or very low carb could help save the planet via actually breathing out less carbon dioxide? Turns out burning fat instead of carbs you breathe out 30% less CO2 This is calculated via the Respiratory Quotient So a carnivore breathes out 120kg less CO2 over a year !!! I asked AI about it

[Joy Y. Erdile, MSc, RD @jyerdile]

H/t to Shauna Prouten, a fellow Dietitian.

[Paul Mason MD @DrPaulMason]

Here is a summary on 'Blood Pressure, longevity and drugs' I have composed for my patients. My conclusions might surprise you.

'Blood Pressure, Longevity and Drugs'
High blood pressure (hypertension) is a well-known risk factor for early death. The belief that lowering blood pressure can lead to an increase in life expectancy has driven Australians to spend over $1.2 billion annually on blood pressure medications. However, while these drugs lower blood pressure, they don’t address the most common root cause of hypertension, which is insulin resistance. As a result, the expected longevity associated with a particular blood pressure may well be different in unmedicated and medicated individuals.

What’s the Ideal Blood Pressure for longevity?
Studies assessing the association between blood pressure and mortality often has significant limitations. These studies are often conducted in developed countries on high-risk populations. This means that many study subjects are likely to be taking blood pressure medications, limiting the generalisability of findings to unmedicated populations. Additionally, the number of very elderly participants in these studies is typically limited, restricting the ability of these studies to inform us about blood pressure and optimal longevity.

One study, published in BMJ in 2018, addresses these limitations and is the most methodologically sound study I have found on this topic. This was a prospective longitudinal study of 4,658 elderly Chinese individuals with an average age of 92 years (including 825 centenarians). Given the impressive age of the subjects, this study has the potential to inform us of optimal blood pressure for longevity.

There are two numbers in a standard blood pressure reading. The top number refers to systolic blood pressure (SBP) and indicates pressure when the heart pumps. The bottom number refers to diastolic blood pressure (DBP), which is the pressure when the heart relaxes between beats.

Systolic blood pressure (the top number reflecting peak pressure when the heart pumps) was shown by this study to predict longevity, with an optimal reading being 129 mmHg. Systolic blood pressures both below and above this level were found to represent an increased mortality risk, though this was not significant between about 120 mmHg and 140 mmHg. Importantly, the risk of premature mortality was greater for lower blood pressures than for higher blood pressures.

Diastolic blood pressure (bottom number, reflection pressure when the heart is relaxed), was shown to be all but worthless when it comes to predicting longevitiy. All-cause mortality was bascially identical across a wide range of diastolic blood pressure (40 mmHg to 130 mmHg).# In essence, it is reasonable to only consider systolic blood pressure (the top number) when predicting longevity based on blood pressure**.

These findings have been replicated in other populations too. A UK-based study of females over the age of 80 had broadly similar findings, identifying the lowest risk of mortality when systolic blood pressure was between 120 to 139 mmHg.## Another study of 68,901 Korean adults over the age of 65 found that the optimal systolic blood pressure in terms of mortality was 130-139 mmHg. In summary, the optimal systolic blood pressure for longevity in an unmedicated population is likely to be around 130 mmHg, with diastolic blood pressure being all but irrelevant.*

Does Treating High Blood Pressure with Drugs Increase Life Expectancy?

Perhaps the most influential clinical guidelines on the management of blood pressure in Australia were published by the Australian Heart Foundation in 2016. Angiotensin-converting enzyme (ACE) inhibitors, angiotensin II receptor blockers (ARBs), calcium channel blockers, and thiazide-type diuretics are all recommended as first-line management for hypertension. Despite the strong recommendation to use these drugs for hypertension, on balance, there is no compelling evidence that taking blood pressure medications for hypertension increases life expectancy.

This was demonstrated by a 2017 meta-analysis of 74 individual trials involving over 300,000 patients, which found no evidence that treating hypertension, even when systolic pressures were over 160 mmHg, offered any mortality benefit. Of course, it may be argued that some classes of medication may be superior to others, offering benefits through mechanisms independent of their blood-lowering effect. There is little compelling evidence, however, that any of the four classes of medication commonly initiated for hypertension offer mortality benefit.

A Closer Look at Specific Drug Classes:
ACE Inhibitors
A 2014 meta-analysis published in JAMA examined these drug classes in patients with diabetes. Nine out of 11 studies on ACE inhibitors (e.g., Ramipril, Perindopril) found no benefit. The two outliers were industry-funded, with significant methodological limitations. One of these outliers was not in fact a new study, but rather a 're-analysis' of existing trial data from a previous study which just so happened to come to a different conclusion. The other outlier was the ADVANCE trial which also had major methodolgical limitations. One of these was the use of a run in period (commonly seen in statin trials). Before the study officially started, every eligible subject received the active medications for 6 weeks. If they had any side effects to the drugs, they were removed from eligiblity before the study even started (~14% of subjects who registered for the trial ultimately did not take part in the study). Of course, subjects removed during the run-in period were not included in adverse event data. Consequently, practices such as this load the deck in favour of the drug intervention, leading to an overestimation of the net benefits. Further, these studies were on diabetics, and thus not applicable to the general population. Without these two industry funded outlier studies, the marginal benefit found by this meta-analysis for ACE inhibitors in terms of all cause mortality all but evaporates.

ARBs
A 2014 meta-analysis published in JAMA examined these drug classes in patients with diabetes. Seven individual studies assessed Angiotensin II Receptor Blockers (e.g., Candesartan, Irbesartan, Losartan, Olmesartan, Telmisartan, Valsartan), with none finding a mortality benefit.

Calcium Channel Blockers
Calcium channel blockers are another class of medication often used for the management of hypertension. One of the earliest drugs in this class was nifedipine, which was introduced into the Australian market in the 1980's. The immediate-release formulation of nifedipine was discontinued in Australia in October 2020 after it was found to significantly increase the risk of death in patients with heart disease by 2-3 times. Slow release nifedipine remains available, and is often prescribed to lower blood pressure.

Despite this, I could not locate any research finding nifedipine to offer benefit when compared to 'no treatment at all' in terms of mortality. Most randomised controlled trials compared nifedipine against other blood pressure drugs rather than placebo, meaning can't tell us whether nifedipine is superior to 'no treatment at all'. The only randomised controlled trial that I could find comparing nifedipine against a placebo in the treatment of hypertension, the 'Systolic Hypertension in Europe trial' found there to be no mortality benefit. & Similarly, there is no evidence of mortality benefit compared to placebo for other calcium channel blockers, including amlodipine, felodipine and lercanidpine.

Thiazide diuretics
As with other blood pressure lowering medications, there is little if any evidence that thiazide type diuretics (eg. hydro-chlorothiazide) and thiazide 'like' diuretics (eg. indapamide) improve longevity when used to treat hypertension. This was demonstrated by a 2015 meta-analysis and systematic review of 21 studies which failed to find any mortality benefit of either thiazide-type or thiazide-like diuretics when compared to placebo.

Conclusion
In summary, the use of blood pressure medications appears to offer no compelling mortality benefit. Most studies compare drugs against each other rather than placebo, creating an illusion of benefit. Additionally, non-inferiority trials—where a new drug is compared against an older drug—often perpetuate the recommendation of multiple drugs without clear evidence of efficacy.

Medications are simply no substitute for addressing the underlying causes of hypertension. Focusing on improving diet, exercise, and overall metabolic health offers a more effective and sustainable path to longevity and well-being.

******************************************************
*It's worth noting that the systolic blood pressure found to be optimal for longevity, 129 mmHg, is a level the American Heart Association considers to represent elevated blood pressure. Indeed, it is just shy of the 130 mmHg threshold which is considered stage 1 hypertension. That the optimal blood pressure for longevity as identified by this study is considered to represent elevated blood pressure ought to have us rethinking our blood pressure goals.

**Importantly, this study also looked at whether or not study participants were taking medications for blood pressure and found these findings to be independent of medication status.

#There is another measure called 'pulse pressure,' which is the difference between SBP and DBP (SBP - DBP = pulse pressure). Being derived from both systolic blood pressure and diastolic blood pressure, the predictive value of pulse pressure was found to be midway between the two (inferior to the simpler systolic blood pressure).

##This study also found that blood pressures below 120 mmHg were more common in the last three months of life (despite the absence of any medication changes), with blood pressures below 110 mmHg being associated with the highest risk of all.

*******************************************************
If you have read this far, thank you. Grok AI suggested some changes which fairly decimated this post. While clearer, it removed a lot of nuance which I feel is important when communicating science. Please feel free to let me know whether you prefer long form summaries as I provide them to my patients, or if I should 'GROKIFY' my posts.

[Andrew Howie @howiepask]

@thelowcarb_rd Track and objectively review own clinical #outcomes data.

[Defeat Diabetes Au @DefeatDiabetes_]

Our mate Dr David Unwin in the UK recently celebrated his 150th patient in remission from type 2 diabetes. He prescribes a low carb diet instead of drugs. You can watch our exclusive interview with him to hear how he does this.

https://t.co/lOxTF1cb6C

[Andrew Howie @howiepask]

Outcomes matter. This post and comments fantastic 👏 👌.

[Dr Shawn Baker 🥩 @SBakerMD]

Has a ketogenic or carnivore diet helped you or a loved one with an autoimmune condition?

Comment down below!

[Andrew Howie @howiepask]

@psvbluemts Thanks Peter. Great work.

[David It Up! @Dave_it_up]

When the Mind Shuts the Door: How Cognitive Dissonance Keeps Doctors from Seeing Long COVID

In the field of psychology, cognitive dissonance refers to the mental discomfort experienced when someone holds two or more conflicting beliefs, values, or attitudes. In medicine, this phenomenon often arises when new evidence challenges long-standing practices. Instead of adapting, some doctors experience discomfort, leading them to downplay or reject new information to maintain their sense of consistency. As psychologist Leon Festinger, who developed the theory of cognitive dissonance, once said: “A man with a conviction is a hard man to change. Tell him you disagree and he turns away. Show him facts or figures and he questions your sources.”

This resistance to change has occurred throughout the history of medicine, from dismissing the importance of handwashing to ignoring the dangers of smoking. Today, we see the same dissonance with Long COVID. Many doctors are reluctant to fully recognize the long-term impacts of COVID-19, despite overwhelming evidence and patient reports. As cognitive dissonance prevents doctors from accepting new realities, millions of patients are left without the care they desperately need.

Historical Resistance in Medicine

One of the earliest examples of cognitive dissonance in the medical community was the resistance to hand hygiene in the mid-nineteenth century. Ignaz Semmelweis, a Hungarian physician, discovered that requiring doctors to wash their hands between patients dramatically reduced infections and deaths in hospitals. Yet, the medical community at large rejected his findings because it implied that doctors were responsible for spreading disease—a concept that clashed with their perception of themselves as healers. It wasn’t until decades later, with the widespread acceptance of germ theory, that handwashing became standard practice in hospitals.

Similarly, when Louis Pasteur and Robert Koch developed germ theory, it met with significant skepticism. At the time, the dominant belief was that diseases were caused by “miasma” or bad air. Doctors resisted abandoning this familiar theory, even as new evidence showed that microorganisms were responsible for illnesses.

In the 1980s, cognitive dissonance surfaced again during the early stages of the HIV/AIDS epidemic. Initially, the medical community viewed the disease as limited to certain marginalized populations, and many were slow to recognize the growing evidence that it was a much broader public health issue. The bias of previous experience and reluctance to confront new evidence delayed effective treatment and public health responses, just as it had in the past.

Modern Examples of Cognitive Dissonance

Even within the past 40 years, cognitive dissonance has continued to shape medical responses. One striking example is the slow acceptance of the bacterial cause of stomach ulcers. For decades, stress and spicy food were blamed for ulcers, even as mounting evidence suggested otherwise. When Australian scientist Barry Marshall demonstrated that Helicobacter pylori bacteria were the real cause, his findings were initially ignored. Marshall even resorted to infecting himself with the bacteria and developing ulcers to prove his point. Still, it took years for the medical community to shift its thinking and change treatment protocols.

The opioid crisis is another clear example. For years, pharmaceutical companies promoted opioids as safe and non-addictive, despite early warning signs of widespread addiction. Cognitive dissonance prevented many doctors from altering their prescribing habits, even as evidence mounted that overprescription was contributing to the crisis. The delay in adapting to new realities contributed to the devastating public health consequences we’re still dealing with today.

A more recent example is the shift in understanding the role of dietary fat and sugar in heart disease. For decades, the medical community emphasized low-fat diets, even as research increasingly showed that refined carbohydrates and sugar were the real culprits. The persistence of the low-fat narrative illustrates how hard it is to shake entrenched ideas, especially when they have shaped public health guidelines for years.

Long COVID: The New Frontier of Cognitive Dissonance

Now, we see cognitive dissonance at work again with Long COVID. Despite increasing evidence that COVID-19 can cause long-term symptoms—ranging from chronic fatigue and brain damage to cardiovascular and neurological issues—many doctors are reluctant to fully acknowledge its existence or scale. This dissonance arises from several factors.

First, doctors are trained to view viral infections as acute illnesses with clear beginnings and endings. The idea that a virus can trigger long-term, debilitating symptoms does not fit this framework, creating discomfort for many clinicians. It’s easier to dismiss or downplay Long COVID than to confront the possibility that SARS-CoV-2 may behave differently than other viruses.

Additionally, cognitive dissonance stems from previous experience with viruses. Many doctors didn’t observe long-term complications from previous viral outbreaks, such as SARS or MERS, leading them to assume that COVID-19 would follow a similar course. This bias towards established beliefs makes it difficult for some to accept the growing evidence that COVID-19 may have lasting effects on a significant number of patients.

There’s also a systemic element. Recognizing the scale of Long COVID would require healthcare systems to make significant changes, from allocating more resources to chronic care to investing in long-term research. Admitting the severity of Long COVID would necessitate a major overhaul of healthcare practices, which many find daunting. Instead of pushing for these changes, many doctors are minimizing the issue to avoid confronting the discomfort that comes with acknowledging such a widespread problem.

Overcoming Cognitive Dissonance in Medicine

Breaking the cycle of cognitive dissonance in the medical community is crucial for progress. Overcoming this resistance requires education, empathy, and systemic reform.

First, doctors must be willing to adapt their understanding as new evidence emerges. Continuing medical education programs should emphasize the importance of flexibility and adaptability in the face of evolving scientific knowledge. Training that teaches clinicians to challenge their own assumptions is key to overcoming cognitive dissonance.

Empathy also plays a critical role. Doctors need to listen to patients’ experiences and recognize that symptoms like those reported by Long COVID sufferers may not fit into traditional diagnostic frameworks. Patient-reported outcomes can offer valuable insights, even if they aren’t fully captured by clinical tests. Listening to patients with an open mind can help bridge the gap between new realities and outdated practices.

Finally, the healthcare system needs to be more agile. We need systems that respond more quickly to emerging evidence, update guidelines in real time, and ensure that resources are available for long-term research. Without these changes, cognitive dissonance will continue to hold back progress, and patients will suffer the consequences.

Cognitive dissonance has long been a barrier to progress in medicine. From rejecting handwashing in the nineteenth century to delaying responses to the opioid crisis in the twenty-first, this resistance to change has caused harm. Today, Long COVID is the latest frontier where cognitive dissonance is holding doctors back. By understanding the roots of this resistance and addressing it head-on through education, empathy, and systemic reform, we can begin to make progress in treating the millions of patients suffering from this complex condition. As we’ve seen throughout history, overcoming cognitive dissonance is the first step toward true medical progress.

[Mike - Low Carb Dietitian @thelowcarb_rd]

@mimikmorgan The average dietitian doesn't track outcomes. So large chunks of the profession don't even know that what they preach isn't working. Might be the same for other healthcare professionals I'm not sure.

[Prof Brendan Crabb @CrabbBrendan]

“There never has been a building that we could not turn into a healthy building with just a little bit of attention” - just as relevant to Oz

Kids Are Headed Back to School. Are They Breathing Clean Air? | Scientific American https://t.co/0L7B1pMwHy

[Dr David Unwin @lowcarbGP]

A whole BBC Radio 4 programme on food addiction this morning 11 am, the work of @drjenunwin is paying off !!

[Dr Dan Goyal @danielgoyal]

@ShaunLintern Patient-related outcome targets versus performance/operational targets. This will affect an immediate change in NHS management culture. @wesstreeting

[Andrew Howie @howiepask]

@psvbluemts Thanks for this post Peter.

[Bob Brown Foundation @BobBrownFndn]

🔊 An update from Bob Brown outside the courthouse today after he was found guilty for peacefully defending Swift Parrot habitat. #EndNativeForestLogging #politas

[Julian Cribb @JulianCribb]

@sciam https://t.co/qVJWc6g7T3