Dr. Bill Wilson who formulated CARB Syndrome and Sugar-Brain after testing his theories on 18,000 patients
This is an important question. If you have spent any time on this site learning about sugar-brain or CARB syndrome and then tried to discuss these concepts with your healthcare provider, you were likely met with a blank stare. Most healthcare professional don’t know about these concepts because they are relatively new and yet to be supported by controlled medical studies.
More importantly, is it ethical for me to promote these concepts to the public when they have yet to be accepted by the medical establishment? This is a complex issue. In science and medicine there is no such thing as a concept or theory that is 100% proven. We must be satisfied with relative degrees of support. On the other hand it is much easier to perform studies that suggest that a theory lacks substance. It is much easier to disprove than to prove.
This blog post was stimulated by correspondence with Gary Taubes, the author of “Good Calories, Bad Calories” and “Why We Get Fat”. I have sent some of my blog posts to Gary for his comments and he has been kind enough to give me valuable feedback. Gary recently suggested that I be a little more humble when promoting the sugar-brain and CARB syndrome concepts. He suggested that I should own the ideas because they have yet to be widely accepted. I respect Gary’s opinions and I agree with his assessment.
The sugar-brain and CARB syndrome evolved over decades as I was treating thousands of patients with complex medical and brain problems. At the same time I was spending a lot of time paying attention to the relevant medical literature. Over time I found that using these concepts seemed to give my patients consistently better outcomes. As a practicing physician improved outcomes drive everything.
Another issue when it comes to diet and health is the lack of consensus among the experts. Vegan, Ornish, Paleo, low fat, high protein, low carb—they all have their passionate supporters who can cite studies supporting their positions. What is a confused general public to do when even the experts can’t agree?
My suggestion is to start with issues where there does seem to be a general consensus. I advise my patients to break down risks to their health into three general groups: tigers, rats and mosquitoes. Tigers will quickly kill you if you ignore the threat. Rats will chew on your ankles and make you miserable but they won’t kill you—at least not in the short term. Mosquitoes tend to be a minor nuisance. What we really need to look for are the tigers in our diet. If you look at all the various dietary recommendations when it comes to health, three bad boys stand out: sugar, high fructose corn syrup and high glycemic carbohydrates like white flour. Virtually all popular diets exclude these three tigers for good reason. I exclude them because I believe they are the primary triggers of sugar-brain and CARB syndrome. Others exclude them because of their well-documented adverse metabolic affects.
Today I spent some time in a Barnes and Noble store perusing the diet book section. There were books promoting the benefits of “healthy” carbohydrates, books promoting low-carb diets, books promoting pre-agricultural Paleo diets, and books promoting vegan diets, yet I failed to find any books promoting the health benefits of sugar, HFCS or high glycemic carbohydrates. Thus I feel pretty safe recommending that people avoid these toxic substances. Nobody seems to be demonizing vegetables so it seems they should be placed in “the more the better” category. In general fruits get a pass except from those who primarily focus on the adverse affects of excessive fructose. Artificial fats, partially hydrogenated fats and so forth—I don’t see much support for them even if they aren’t tigers so let’s throw them under the bus.
What about natural fats, grains, dairy, legumes, meat, fish, seafood and so forth? Here the consensus seems to fall away. We know that people can lose weight following many different types of diets and each particular diet seems to have its own special metabolic footprint in humans. We also know that weight loss alone is not necessarily and ideal goal. It is clear that you can be thin and sick—just look at someone with anorexia. I do have my own opinions on many of these issues but others will strongly disagree with me. Should I give up and say nothing?
I respond by going back to the tigers, rats and mosquitoes. I will definitely give you my opinion about the tigers in our diet—sugar, HFCS and high glycemic carbohydrates. Whether the sugar-brain and CARB syndrome concepts stand the test of time or not is irrelevant because of the large volume of data that already exists showing us these dietary items are toxic.
In my opinion the issue of proteins, fat and vegan start to drift into the territory of rats and mosquitoes. If some day science convinces us that eating meat is bad for us, I suspect that it won’t be a strong negative affect. The same is true for natural fats. We have yet to see a strong consensus that eating such fats is bad for us although this could certainly change in the future. People following a vegan diet seem to do OK as long as they stay away from the tigers. The Paleo folks aren’t too happy about this but we need more high quality studies to sort this issue out in the future. At the present time I tend to lean in the Paleo direction but I am keeping an open mind about it. Combining any type of fat with carbohydrates, especially high glycemic carbohydrates seems to be a bad idea. The insulin response from the carbohydrates shifts the balance towards more fat storage and the fat provides the substrate to store even more fat. Of course I’m describing the typical American diet.
Now let’s go back to the issue of sugar-brain and CARB syndrome. I do have one advantage over people like Gary—I am in the business of actually treating patients. If my concepts don’t consistently result in improved outcomes, then that suggests that I must be a lousy or incompetent physician and I do take my job seriously. The sugar-brain and CARB syndrome concepts didn’t just pop into my head one day in a light-bulb moment. They slowly evolved over decades as I was working hard to help my patients improve their health and wellbeing. Because these concepts are a rather radical departure from accepted dogma, it took a long time for me to believe that they might have some merit.
As a matter of fact it was my patients who convinced me that they do. Whenever I drifted away from using these concepts my patients would insist that I get back on track. One thing that I have learned over the years is that patients know when they are healthier. They can feel it. It goes well beyond blood tests or numbers on a scale. Humans evolved to be very attuned to the their health status. When patients follow the treatment protocols based on the sugar-brain and CARB syndrome concepts, they virtually always move in the direction of better health. I only make this rather bold statement because I have seen it thousands of times.
Despite the fact that I strongly believe that these concepts have merit, I would never introduce them to the public if doing so entailed any significant risks because to do so would be highly unethical. All of the treatment modalities used for treating sugar-brain or CARB syndrome involve low or no risk treatments that are readily available for treating other conditions. Perhaps I use these tools in a different manner than others because I am using a different theoretical model to guide me. People sail their ships differently in a round world model than they do in a flat world model even when the ships and crews are identical.
So yes, the sugar-brain and CARB syndrome concepts are unproven. They are my concepts although I borrowed ideas from many brilliant people over the years. I do hope that some day high quality medical studies will support the concepts. Until that day comes, keep your mind open and do your own research. If you decide to follow these protocols, pay attention to your health. If you don’t notice any improvement in your health over time, feel free to follow another path. As I tell my patients, I am not your mother. My job is to give you the highest quality information at my disposal and your job is to decide whether you want to follow it. The one thing I can assure you is that I take my job very seriously
