I have been recently following the controversy surrounding Steve Cooksey and his website Diabetes-Warrior.net with great interest. If you do not know, Steve Cooksey is being investigated by the North Carolina Board of Dieticians for giving nutritional information on his website without a license.
This is obviously a complex issue, but the more I look into it, it is also not simply a legal issue either, where a person is accused of allegedly giving advice he shouldn’t have been giving. In my opinion, it is a political one which invokes several important topics regarding the popularity and success of low-carb dieting and the abject failure of conventional dietary guidelines that are promulgated by government bodies.
Specifically, as I see it, the ‘Cooksey Affair’ is a referendum in regards to the conventional wisdom of bodies like the American Diabetes Association and other dietary boards which have suggested and recommended over and over again that a diet that is based on a large amount of complex carb and a large amount of whole grains is healthy for diabetics. It is not.
As a physician and as a father of two type I diabetics, I have personally looked into the effectiveness and the validity of these recommendations, and I think they are simply wrong. Certainly, I have never been an ‘enemy’ of most grains or carbohydrates, but to base the majority your diet on them doesn’t make sense on many levels, diabetic or not. Why feed sugar and starch to a person who has trouble managing the metabolism of sugar and starch? Even if you disguise them as’ healthy’ complex carbs, your body isn’t fooled.
Also, as a father of diabetics, I know from direct personal experience how difficult blood sugars are to manage if you base a diet on grains and carbohydrates. And from my perspective, what Steve Cooksey has done should totally be investigated for the right reason–to see why and how it worked so well.
But ultimately, the issue is much deeper than this: Does the government have the right to intrude into every aspect of our lives, including as something so basic as to what we decide to eat? And more importantly, as it regards Steve Cooksey, does the government have the right to control the sharing of information of this type between free and consenting individuals?
My answer is a resounding NO. But unfortunately, we already have a government that says YES.
I have said this before in my blog, and I will say it again. I am totally disgusted by school lunches and school food choices. Even where I live, where people are relatively well-educated and wealthy, I am appalled at what is being served. Kids get things like cereal bars, low-fat milk, chocolate milk, waffles with corn syrup sauce that has a maple flavor, pizza, chicken fingers, etc. All of these things are things my daughters simply can not eat. And luckily, we can and we do opt out by sending lunch to school with them. But the fact is, you don’t have to be a doctor to realize that if it’s a bad for a diabetic, it is bad for you. And what’s worse, all of these foods that are provided to our children are sanctioned by the government, folks.
And if you think it’s just kids, folks, let me ask you a question: When was the last time you were in a hospital or another similar place, and you saw a vending machine? Does anyone see a disconnect here?
Frankly, when you see hospitals with vending machines, it’s time to have a serious discussion folks and perhaps a reality check. I hope, if nothing else, the ‘Cooksey Affair’ brings these issues to the forefront.
The second important point that I want to make in regards to the ‘Cooksey Affair’: what is the role of certification? From my perspective, there are two important issues that need to be discussed.
First of all, certification, in theory, provides a metric for quality and safety. Often it does. That is true. As a physician, I had to train for seven years in residency after medical school, and still to this day, the cases I do are under intense scrutiny in terms of things like their outcomes, safety, lack of complications, and patient satisfaction. I am constantly judged on many levels as a physician, and the metric that is ultimately used is my success and failure, not the fact that I am board certified by the American Society of Plastic Surgeons. But above all, the only true metric is from a doctor’s perspective is: Did I help my patient?
And so, in reality, certification can be a meaningless metric, especially if you are the recipient of bad and inept services. In my particular field, there are plenty of examples of botched liposuction and breast surgery that result in deformity and even death by so-called ‘certified’ practitioners who are not plastic surgeons, and perhaps have only taken a weekend course to obtain certification. These is an extreme example, but it is relevant here because in the case of a surgical complication resulting in death by an inexperienced but ‘certified’ practitioner, we know who is to blame.
But let’s say the effects of bad advice or bad actions are not so shocking or proximal as death and deformity. And let’s say these recommendations still eventually result in in heart attacks, neuropathy, limb amputation, blindness, kidney failure and death in 10-15 years. Who then is to blame? In most cases it is the patient, because they couldn’t follow the advice, or perhaps they did follow the advice, and it was just bad luck, anyway.
I think this a big flaw in the system, and it needs to be addressed and rectified. In order to do this, we need to develop the proper metrics for evaluating success. That is, we need to listen to the many people who have gone against ADA recommendations and have succeed in treating their diabetes, like Steve Cooksey. Likewise, we need to listen to the ones who have failed, find out why, and help them succeed, if we can.
This is where certification can fail miserably because it does not always provide a proper metric for success, safety, or competence. And in the worse case scenario, it often used as a bullying tactic that eliminates legitimate competition and protects the interests and hierarchy of the ‘certifiers’. Unfortunately, I can’t help but feel this is what is happening to Steve Cooksey.
The second issue as it regards certification is the issue that goes a bit like this: Well, that’s all fine and dandy, but really, you have to have a world with certifications, or else people would be harmed or die.
This is an example of what is known as the logical fallacy of the false dilemma, or what is also known as black or white thinking. I am not suggesting that certification is not important, I am simply questioning whether all certifications are necessary, and whether they do what people want and expect them to do. By arguing, that we have to resort to anarchy to achieve a better system implies a false dilemma. And ultimately, it is the root of what propagandists use to spread their message or defend their viewpoints. It is important to identify it when it occurs, because the false dilemma seems exceptionally powerful tool at quieting those stubborn things we otherwise know as facts.
For example, if we go back to the issue of school lunches, the false dilemma is invoked when people say something like this: Well, by saying that you think school lunches are horrible, then you want kids to go hungry. This gets twisted in a variety of ways, that usually preys on emotions, and not facts. For instance, someone might say: Poor people simply can not afford high-quality food, and at least they are getting calories, even though they may not be healthy. So, you must not like poor people that much, then.
But if you are effective to any degree in staving off the false dilemma, there is always the fall back tool of ad hominem attacks that marginalize the issues that you have to protect yourself against, as well. Of course, I must be just another whack-job Libertarian (or they might say Losertarian) who thinks Dr. Demento, Ron Paul, has an actual chance to be president. (By the way, I like Ron Paul very much, but I don’t think he will be the next president, either…)
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Now, I have looked at Steve Cooksey’s site and it is my personal opinion that it is not only a good site for information but also an excellent site that I would recommend to anybody who reads my blog and who has diabetes for additional information. Mr. Cooksey also has a disclaimer which clearly says he is not a medical professional in anyway shape or form, so I do not see why that there is a problem in a free society, especially in regards to food.
Seeing what Steve done makes me curious to see if I can help him get the message out because even if he is not ‘certified’ he appears to be a certified success story. Like I have noted, there are a lot of very official certifications out there with very official people holding them who know some official things, but are by all accounts completely incompetent. You see this everywhere. If you do not believe me, do you remember 2008’s subprime mortgage crisis? Did that affect you? There were a lot of very official men with official titles running that thing. How’d that work out for you?
There is a also issue that Mr. Cooksey has been selling his dietary advice on his website, which I could not personally find, but if that is the case, I still find no problem with it because essentially that is equivalent to any diet book. I personal have many diet books and I have a million cook books. I have several cook books which basically promote a healthy lifestyle, maybe to lose weight or treat diabetes or what not, and they may or may not have approval or stamps of approval, but they basically make those claims. I do not see how that is different in that regard, but I guess in a lawyer’s mind anything is possible.
I also think Mr. Cooksey has got a leg to stand (which many diabetics don’t who follow a high carb diet) here because we know that the scientific studies suggest that a low-carb, paleo type of diet is good for diabetics. We have Karen O’Dea’s classic study of the Australian aborigines going back into the bush which has been documented many times and is a kind of standard-bearer study in this regard. Many other studies that have shown that it is good for diabetics.
Even vegetarian diets have been shown to be decent for diabetics when they basically cut out grains and high carbs and processed foods and so-called diabetic friendly foods which are not so friendly at all for diabetics!
Rather than getting the ACLU invloved, which Jimmy and Steve mentioned, I think now is the time that I would call all the low-carb movers and shakers, doctors like Dr. William Davis, Dr. Andreas Eenfeldt, Dr. Ron Rosedale, Dr. Jack Kruse, Dr. Mike Eades, Dr. Jeff Volek, Dr. Phinney and many others that I have not mentioned, to get together and create a consensus for low-carb dieting.
Together, these guys together have millions of readers on their blogs and have written and sold tons of books and published countless scientific journals and they know the safety and efficacy of low-carb dieting. And I think the time has come to involve all these guys to get together in a room and come out with the consensus statement that low-carb dieting is safe, discuss some of the strategies that are available, how they can be appropriately instituted and discussion of things such as what are safe carbohydrates and how much carbohydrate should I have in my diet and how that can be individualized.
There might be some boxing going on behind closed door between these big hitters in order to get a consensus statement but believe me, if there is a consensus statement that is made, we will all be the much better for it, and so will people like Steve Cooksey and all the bloggers out their who are doing good work in terms of informing the public in terms of a healthy and nutritious lifestyle while standing up to special interests.
Now is the time.
Consider it.
Absolutely brilliant commentary Dr.O. I have been following your posts regarding Steve Cooksey and he and the individuals following his plan have had great results. We seem to believe that the government has our best interests at heart but clearly that’s not the case even if it is unintentional. The few minutes of TV I watch are filled with commercials about “healthy” whole wheat products. The bottom line is that we have to educate ourselves about the science of nutrition and silencing people like Steve is a true disservice because he is clearly on the right track.
Thanks,
Mary
Thanks Mary. I appreciate the readership. I want Steve and people like Steve to succeed. I also believe that doctors like me should parter with people like Steve so we can learn as much as we can from them, and ultimately, help our patients. The greatest teacher you have as a doctor is your patient. If we lose this ethic as doctor, then medicine is irrelevant and useless. Unfortunately, a lot of people feel it already is.
“And if you think it’s just kids folks, let me ask you a question: When was the last time you were in a hospital or another similar place, and you saw a vending machine? Does anyone see a disconnect here?”
Forget the vending machines! To me, an even bigger disconnect is seen if you look at the trays of hospital food served to diabetic and cardiac patients–diets prescribed by registered dieticians. A typical breakfast is high fiber, whole grain cereal with skim milk, fruit juice, fruit cup, and toast with low sugar(!) jam, maybe some oil based low fat spread if you’re lucky. No fat, low protein, high glycemic load. Now that’s a disconnect!!!!
Unfortunately for Steve, they are not attacking the content of his blog, only the act of advising others on dietary matters. I’d like to see the wider community rally around him, because it’s not just a low carb/paleo issue (although we all know that’s the heart of the matter, it’s not the legal issue), it’s whether anybody who is not a licensed dietician in the state of North Carolina can give ANY dietary advice–this should touch personal trainers, Weight Watcher’s and Jenny Craig advisors, chiropractors, naturopaths, physicians, etc.
If they were attacking content, this would be a great opportunity to bring low carb to the forefront, much like the case in Sweden (I think it was) when dieticians attempted to have a physician’s license revoked because she advised her patients to follow a low carb diet. In that case, low carb was on trial, and it WON!
Great point. Hospital food has always been considered lousy, but really (and more appropriately) its toxic.
Purely by accident, I discovered (basically) what Steve Cooksey was doing when I was DX’d in 2006. I immediately went low carb and seriously reduced all symptoms and had a fasting reading of 75 within 2 weeks. I lost about 60 lbs. and put back on 10 in muscle tone. When I meet Steve, I dropped grains. The annoying pot-belly and a raft of other medical problems vanished. What we have here is a case of Big Money not wanting common sense to get out to the masses. There is too much money to be made by Big Medicine, so that when a valid and simple treatment (that makes them lose $$$) comes along, they move to squash it. It’s a pity, really. It’s not about helping people. It’s about murder for money, plain and simple. Well, then, riddle me this, Batman – how DID the ancients and some modern tribes survive for so long – take the Native Alaskans for example – without a grain-based, agrarian diet and system? Why is this? How did we evolve over the last few million years, then, without Big Brother to “protect” us?! As far as I’m concerned, the ADA and all these other Fascists can kiss my not-so-fat-anymore-butt!
That’s really awesome, Brian. I am so glad to hear success stories like yours, and I think it is important for people to know that the ADA recommendations are wrong and that there is another, way more effective way. We can continue along this path as a country. The health care system will collapse the American economy at this rate, not to mention fail to cure disease. I commend you for your passion, and congratulations on your great example. Thanks for sharing your story with me.
Thank you for pointing out grain-free, low-carb vegetarianism can work for diabetics! I am one, and enjoying what I eat more than ever.
Professional control of nutrition information shared with the public MUST end. (Don’t look behind the curtain! HAH!).
Linda, thanks for your comment. I believe that many different types of diets can be healthy. Humans are omnivores, after all. Basing a diet on an array of fresh vegetables is not a bad idea, but basing a diet on grains is.
What a wonderful article. I’ve posted it to FB and commented how few people are able to capture all the elements of the conflict as well and as empathetic and readable and you have. Thank you so much for not only “getting it” but actually espousing it too, even in the face of such handcuffing–biased–practice guidelines. You are a credit to the profession! Many thx… – lc
Laurence, thank you for the kind words. Steve Cooksey is doing the good work, though. I am just supporting him, and I wish more doctors who believe in the safety and utility of low-carbohydrate diets that eliminate grains for the treatment of obesity and metabolic disorders would make their voices heard. Ultimately, as a doctor, I am a patient advocate first and foremost. If a patient like Steve comes to me, and has the success he has had, I want to know why and see if I can share that with as many patients as possible.
Great post. After I was diagnosed with Type 2 diabetes, I immediately began educating myself about what to do. I settled on going low carb immediately. End result? “Normal” fasting blood sugars, improved blood profiles, lower blood pressure, and an end to the cycle of always being hungry even when stuffed. I finally understood why I could never get enough to eat when eating “low fat” and “high carbs.” I was keeping my system flooded with insulin. I have never had an Hb1ac above 6% and I’ve lost 45 pounds.
I was appalled when I went to a class on diabetes management given by an “ADA certified diabetes educator,” who was also a Type 2 diabetic from a long line of diabetics. Besides the usual advice to eat carbs with every meal, the most insane thing I heard was “You can still eat Oreos. A carb is a carb is a carb. If you’re going to eat 25 grams of carbs it doesn’t matter if it is from an Oreo or some other carb.” What the heck?! That’s like telling a room full of heroin addicts that a little bit of heroin now and again is just fine.
All I know is that so long as I watch the carbs and not the fat or protein, the better all my health markers get. I’d love to know just how big my LDL particles really are.
Sometimes the enemy of good is not evil, but ignorance.
As Steve knows, I had a theory, which I feel is now fact, that a carb is NOT a carb is NOT a carb unless it’s a different carb, OK?! What I mean is that 20 grams of carbs of Oreos are not the same carbs as 20 grams of carb from a tomato or some carrots. And you get a lot more tomato or carrot for you carb count! Different foods/carbs do different things to BG, short and long term. I was actually told to leave a “Christian” diabetes group online because of this theory, in that I was giving out dangerous advice that was going to kill people, and that such rapid weight loss was not good and that I really needed to see some professionals. I did consult some, and they recommended drugs and more carbs and less fat. I ignored them. I have never a full blood panel done, as I do not have health care ins. and cannot afford it. However, I am about 60 lbs. lighter, kept it off for 5.5 years, and my last A1C was 5.4. However, as blood cells in a healthy person are prone to living longer, I am not sold on the validity of the A1C test. Anyway, I have to agree with Steve. I think my reactions to such a meeting would have been less than serene. Low carb works, period, end of story. I take no meds. My AM reading was 89 this morning.
Well said!!!!
I like this write-up, it is the most succinct I have seen yet. Knowing you are a physician with 2 kids with T1D is an inspiration.
I took a bit of an opposite stance on the Steve Cooksey issue – if you haven’ t seen in other blogs – and yes, I got crucified for it. LOL
I notice when you are speaking about licensing, you are not speaking about basically scrapping the works all together. It is this is stance that I agree with the most.
I am not for the scrapping of every guideline or licensing for one very special reason. When it comes to dealing with someone’s disease and the interactions and contraindications of medicines, food, etc – it is an area that I think you can agree needs to be navigated with a bit of experienced hand.
The issue that I took with Steven Cooksey giving specific advice doesn’t come from an “eat less carbs,” or a “here are my diabetic nutrition charts.” What my objection comes from is when a person has other special needs – like a fresh diagnosis, undiagnosed T1D LADA, or other concerns that Steven has no experience on.
For me, I advocate for the low carb approach, but only when the numbers are normalized. (That is the single most imporant variable that Dr. Bernstein calls for before his protocol.) Issues with exercising with large amounts of ketones are a problem as well – something a newbie diabetic will not understand.
As a physician, you are probably aware at the complexity and scope in treatment of T1D. People assume it is something simple – just keep the numbers down, and all will be great. Anyone who has read Dr. Bernstiens masterpiece will know different. It is a complex beast, even for a T2D – and that is where I thought the problems with Mr Cooksey began.
With that said, I wish Mr. Cooksey all the best, and I want to see him succeed in making changes that need to be changed. I wish it was done in a more positive way – but perhaps we need a bit of adversity to actually make a change.
I applaud you – you are right, we absolutely need to have everyone band together. Don’t forget one of the most important group of people though, and that is the DOC. (Diabetic Online Community.) If we could get a movement of people involved at that grassroots level – and leave behind the obvious disdain on T2D and how they are “completely responsible” for their predicament, then we could see some amazing change.
Sorry for the novel – but I just wanted to let you know tht I appreciate this post, and the thinking behind it.
Jason Sandeman
I think you make excellent points, Jason. One of the main problems is that certification is often not a metric for quality, and in many cases, works against that goal, and the second main problem is that a low-carb approach is mostly criticized for the treatment of diabetes. Why? I think the main reason is that doctors are afraid that people will become hypoglycemia, which can be dangerous. But once again, this is not an either-or approach. People get quite low with high carb diets as well because they dose with a lot of insulin–I know this for a fact.
Like I have said, some grains can be helpful in maintaining blood sugar numbers, in my case, undercooked oatmeal (overcooking will cause a blood sugar spike), but flour and bread and wheat products are a disaster–no matter how healthy the whole grains are. And ultimately, my point is that basing your diet on grains is not a good idea for diabetics, and for most people. But this is the conventional wisdom at this time, and to get to a point where we are having a discussion in depth about your points (which are excellent) about managing diabetes will still take some hard work. Steve rattled some chains and that’s a good thing because this is, as I see it, purely political and not about ideas or helping patients. Otherwise, he would have gotten a warning and a small fine, and not be facing a 120 day jail sentence and shutting down his website.
Oh wow! I didn’t realize the extent of the trouble Steve was in! 120 day jail sentance, a fine? I didn’t see anything about that – where did you hear that?
That changes everything in my perspective. I contend he shouldn’t give “Personalized” advice, but he sure as heck doesn’t need to go to jail for it.
This needs another post…
That’s what I read, and that’s what Steve said.