The Power of the Diary..

The Power of the Diary.
Nowadays it appears that only a Randomised Control Trial can decide anything.
While RCTs are brilliant and a tremendous scientific tool, they are not the only tool. Having them as the only tool is like having a computer-controlled lathe and having nothing to pick your teeth with.

Recently I saw an elderly American Professor, Nobel Prize winner, discussing his dicovery that we make decisions in two ways. The fast intuitive way and the slow thoughtful way. He did some fab research on this in his day.
Now, I'd never heard of him, but I'd read Malcolm Glanwells book "Blink" which discussed the rapid way, but I can also say that in my 33 years as a histopathologist, I'd long ago worked out that these two methods existed and used to teach my students that. I used to say, "When you've seen enough of something and had enough microscope experience, the diagnosis will usually hit you instantly. When it does, argue against it. If you can't, it's it. On the other hand if it doesn't hit you, but you slowly come to the diagnosis, be careful, because that may be wrong. Show it around." Nobody ever told me that. It was my observation. I've asked several other experienced pathologists and radiologists about this and they mostly had come to identical conclusions, themselves. This is not really RCT territory, but it's nonetheless a fact.

I'd cycled when I was young, cycling to school at the age of ten and so on. I'm from a family that puts on weight and when around 30 I'd got fat and unfit. I started cycling again but found it very difficult to shake off the weight which was inclined to settle at 100kg (BMI 28 ish). I also started running and by strict dieting (low fat high carb diet) managed to become really slim around the age of 36 with a BMI of 22.6 and I kept this weight for about 3 years, doing high mileage cycling and running. I was however, perpetually hungry. Then, I developed chronic Achilles Tendonitis for a year and this stopped me from running walking much or cycling so I swam (I'm a poor swimmer) for a year. I put all the weight back on.
After I resumed cycling I never got the weight back down below BMI 25 and then it crept up to the old level. I was always hungry.
At one stage I tried the Atkins diet for two weeks and I found it very boring (it was the way I tried it, with no imagination or advice). I dropped weight effortlessly but put it back on afterwards.
I continued cycling a lot and when I say a lot, I'm talking about 7000 miles a year, big tours abroad and all that.
Now, at that time, cyclists were told to eat carbs when they cycled. As part of my training for a hard tour (Alps, Pyrenees) I would do 6 weeks with a 100 mile cycle on the Saturday. This would make me very fit and I would temporarily drop 6kg or more before my tour. During these runs I experimented with what I ate. I worked out that a cheese sandwich was much superior to just carbs for such long spins, lasting much longer in effect and found that the traditional carbs stuff was rubbish. I'd never gone the final step of ditching the bread of course. This was not a RCT but it was on the button and later, experts began to recommend cyclists to take protein as well. I'd worked this out from observation.

After the tour I'd put the weight back on, remorselessly. I'd always come back from a tour weighing exactly the same as when I went, with four notable exceptions. (I've been on 76 tours - all my holidays for yonks). Once was in a tour of Galicia where I only ate fish. The fish there and its preparation, is fantastic and they're not big into meat. I lost a couple of pounds there in a week, but the one outstanding one was a hard tour in Germany and Austria with a friend when I lost 12 pounds in twelve days. This was while cycling really hard. This was not dehydration. The fat was gone.
It had been a hard cycle but I'd done as hard in France and Italy and had lost nothing.
I thought this for a while and then it hit me. Bread. In France the breakfast is just starch and you get endlessly replaced plates of bread in restaurants there when eating. Being cyclists we just ate it all. In Germany you never got bread with meals and you always got a salad, even if you never orderered one. As well the German breakfast consists of ham, cheese, fish etc with bread but is nothing  like as starchy.
I noted this and realised it was important. Now, why aren't all the French fat? Answer, they don't eat loads of bread at home. Their restaurants give you bread because it's cheap and will fill you. And, their bread is not full of sugar as it is elsewhere.
The other two exceptions were where I got carried away and gluttonised myself and put on a few pounds.

About two years ago, I belatedly read John Yudkin's famous book, Pure White and Deadly about sugar. I'd always assumed it would be a load of quackery as it was derided when I was a young doctor, but when I read it I was unbelieveably impressed by its rigour and its conclusions. I stopped eating sweet things then, desserts, cake, chocolate etc and was quite hungry but managed to lose 20lb in 20 weeks. I kept this off, more or less until recently, but was quite peckish and snacking a lot. I then began to read extensively on the internet.
I decided, having read material by Tim Noakes, Gary Taubes etc etc to have another bash at Atkins, but Tim Noakes Book which I bought electronically gave me the right approach to the Low Carb diet. You have to put a bit of effort into it and it's completely different to doing what I'd done before. The food is really nice, the vegetables done with butter etc are brilliant and I feel terrific. My mood is very stable, something it could never have been accused of being in the past.
What's happened to me? Well, in 15 weeks I've lost 15 lb with no hunger at all. I'm cycling a lot but always have done. I'm now below 25 in BMI for the first time for maybe 15 years.
This is a series of one, but there's a long history in it and I can speak from considerable experience on the awfulness of the low fat diet (which science now shows to have no cardiac benefit and to be associated with depression etc), I can speak on the value of fat/protein in exercise and I can denounce from the heights, the evils of bread and similar starch.

If you look at modern sport and how middle distance and long distance training is done, you will find that there is a big common ground. It involves a large amount of slow distance training, some anaerobic threshold and some final speed or interval training. This did not evolve from any theory, nor was it the child of a RCT. It was based on the training diaries of Arthur Lydiard. He tried all kinds of training patterns until he came up with this.
RCTs have to be supplemented by the evidence of extraordinary cases, by history, by knowledge of evolution, and by ways of coming to firm conclusions which are outside their remit. Most of all they have to be tempered by that fairly uncommon faculty, common sense.

Update:
Almost seven months on diet.
Now 28lb down and happy with that. Weight 13.00 (182lb) BMI 23.
Weight has been stable for the six weeks that have elapsed when I returned from cycling Lejog (Land's End to John O'Groates). Was exhausted after this, 1100 miles, 70,000 ft climbing. Lost 8lb during it and weight has stabilised.

I look very thin...
I'm 46lb lighter than my max ever weight and 40 lb lighter than the weight I was for very many years.
I eat as much as I like but keep my carbs to about 50g per day.

Update: 21 months on diet. Weight stable at 182lb goes up and down plus or minus two pounds. Feel well.

Update: 34 months on diet. Weight as before, up and down around 182lb.

Interesting stuff continues to ooze from the mud of medical nutrition. The most salient observation is that try as they might, they have nothing against the LCHF diet. N=1 is the usual putdown, but there are a lot of N's out there, and few of the lowfat ones. I met one in New Zealand who'd kept 5st off for six years. She had massive willpower. She told me that she craved food most of the day. I'd been like that on it.