Introduction
Dr. Eric Westman: Today, I have Sam Feltham. Sam, thanks for being with me.
Sam Feltham: Absolute pleasure, Eric.
Dr. Eric Westman: Please introduce yourself to us.
Sam Feltham: My name is Sam Feltham. I’m the director of the Public Health Collaboration, which is a charity in the UK dedicated to helping cultivate a society where everyone enjoys good metabolic health.
We do that in a myriad of ways through several different projects. Our three major ambitions are to help reverse the type two diabetes and pre-diabetes epidemics, get food addiction recognized as an official diagnosis, and also undo the childhood obesity crisis. All at the same time, hopefully, because they kind of all intertwine a little bit.
We’ve got projects all lined up with those, the prominent ones being The Lifestyle Club, which is our type two diabetes remission coaching service, Liberate, our food addiction coaching service, and the Real Food Rebellion, which is our schools-based project that helps children and young people better understand the environment they’re growing up in and how to make healthier choices.
I got into this space 15 years ago, in 2010. I had a small career as a snowboard instructor, instructing around the world. I started in New Zealand, then went over to Vermont, back to New Zealand, then Colorado, then New Zealand again, then the Alps, and finally Banff, which was my final season.
During that season I decided I was a bit sick and tired of moving every six months and having to make a new group of friends. It’s great in your mid-20s, very exciting, but reality hits eventually, or at least it did for me. So I was wondering, what should I do for the rest of my life?
There was a program in Canada called The Last 10 Pounds, the host of which was a former CFL player. He was really inspiring, actually. He turned himself into a personal trainer after his football career, and I thought that was really inspiring. So I decided to apply to become a master personal trainer with the European Institute of Fitness. I got in and qualified in summer 2010.
Then I moved to London with my brother and set up a personal training business there. Over the next five years, I managed to build that fitness business and started to focus on fitness boot camps across 10 locations around the country. It was really exciting, and one of the things that gave me a bit of notoriety in this space were my overfeeding experiments on myself.
That got me in touch with a lot of people like yourself, Eric, and many other nutritional legends throughout the world. I always had in the back of my head, how can I affect more change in the world?
By the end of 2015, I found myself in a bit of a philosophical quandary. I could focus on my private business and try to affect change that way, because we were helping hundreds, if not thousands, of people every month improve their lifestyles, but I always felt like it was an uphill battle. You needed systemic change. I thought the other option would be to create a nonprofit organization that would focus on improving dietary guidelines and ultimately population outcomes as well.
I pitched this idea of creating a charity called the Public Health Collaboration to the likes of David and Jen Unwin, Joan McCormack, Trudy Deacon, Ian Lake, and several others. They said, “Great idea, but where’s the money going to come from?” Which is essentially always the bottom line.
I said, “Right, what we’ll do is have an online crowdfunding campaign and see if there’s an appetite for this.” We launched that crowdfunding campaign in February 2016, and within that month we managed to double our target. That really just gave us the seed money to start the PHC going.
Over the past almost 10 years – it’s our 10-year anniversary next year – we’ve grown to a fairly sizable organization, with a couple hundred volunteers across the country, a fair few employees, and also a scientific advisory committee that’s fairly big and a board of trustees, and just lots and lots of support. And to my amazement, we have actually created some change.
When we first came out in the world, Public Health England issued a press release saying that we were irresponsible for saying what we were saying, which was just to eat real food, avoid fake food, and be active every day. Earlier this year, we actually co-authored an open letter to NICE, the organization responsible for medical guidelines in the UK, with the British Dietetics Association. That’s the equivalent of the Academy of Nutrition and Dietetics in the US. The letter was saying that we need to update the dietary guidelines within NICE for type two diabetes remission, and that low-carb should be one of the options presented to patients. So there have definitely been some mainstream changes, which is absolutely fantastic.
But we’ve been in touch for a fair while now, haven’t we, Eric? Over a decade.
Dr. Eric Westman: Years ago, it was actually Andreas Eenfeldt, who started Diet Doctor out of Sweden, who started showing this graphic of the score of low-carb versus low-fat. And there was this little name underneath: Public Health Collaboration of the UK. This website popped up that had this great graphic of, if you had a score like a football game, it was like 20 to nothing. The studies showed low-carb beat low-fat. I’ve always enjoyed the practical figures and infographics that have come out of the Public Health Collaboration UK. That got into my slide deck.
I’ve been careful to say low-carb wins, because low-fat can work, too – there are always other ways to go about it. But then there was a curious web presence of this young man, Sam Feltham, who did a self-experiment with different diets, and it caught my eye, I have to say. Then you were still in the game enough to write a paper, and it was published in the medical literature.
Sam’s 5000 Calorie A Day Diet
Dr. Eric Westman: Why did you do this n-of-one experiment that basically blows out of the water “calories in, calories out,” even in just one person? What was on your mind for that study?
Sam Feltham: Thank you so much, Eric. I must express my gratitude to you for enabling that publication; you made it get into the peer-reviewed literature. So that’s mind-blowing. Thank you for that.
The original thought process for that – so it was 2013, and I was dealing with clients on a daily basis. Before becoming a personal trainer, I generally believed in the calorie formula. But when I became a personal trainer and started actually advising people, it just didn’t seem to work.
It wasn’t until I read Why We Get Fat by Gary Taubes that I started to actually advise my clients on low-carb diets. From that point on, it just became easier. Like you said: eat until you’re not hungry anymore, and then go for it from there. Just avoid the starchy refined carbohydrates.
Dr. Eric Westman: You don’t have to count calories.
Sam Feltham: Precisely. You don’t have to count calories at all.
Some people really did flourish with that, but some people really struggled with the idea that it wasn’t all about calories. So I thought, how can I demonstrate this to my clients?
I’ve always been a naturally lean individual. That got me thinking: if somebody can superficially eat around calorie maintenance and, over the years, continually put on weight eating low-fat fake food, then surely the opposite is true. Me being naturally lean, I could eat superficially at a calorie surplus but not put on weight.
So what I decided to do was overeat – not just a little bit, but twice as much. I ate twice as much as I usually would. I wanted to demonstrate the different types of diets out there. I started off with my usual low-carb, real food diet. Instead of my 3,000 calories, I was eating almost 6,000 calories a day. When you calculate it over those three weeks, the net calorie surplus – after the protein thermogenic effect, exercise, and loss from fiber – was 47,000 calories.
According to the calorie formula, I should have put on 6.1 kilograms. But in actual fact, I only put on 1.3 kg, just under 3 lb. That was mind-blowing. At the same time, I actually lost about an inch from my waist. That was the first one, and it really sparked things off on social media. This was 2013, so you still didn’t have the connectivity you have now, but it was being talked about everywhere, which was awesome to see.
I waited three months to “biochemically reset.” Then, the second one, I decided to do the opposite: low-fat fake food. I ate cereals and skim milk for breakfast, skinless chicken sandwiches for lunch with low-fat mayonnaise, and then a low-fat lasagna for dinner, finishing it off with some chocolate.
Dr. Eric Westman: Again, 5,800 calories a day?
Sam Feltham: Exactly. I managed to get the net calorie surplus within 53 calories of the first experiment, so it was as close as you could get given the variables. Again, 47,000 calorie surplus, exactly the same as the first one. I should have put on 6.1 kg, but I actually put on 7.1 kg, about 16 lb. For someone naturally slim all his life, that was damning. Just feeling flab for the first time.
Dr. Eric Westman: I remember you wrote some comments about what it was like on the different diets. It was hard to consume all the low-carb food because you were full, but you felt terrible on the high-carb one because of all the bloating, that sort of thing.
The point is, you developed two totally different dietary patterns, same calorie level, and gained different amounts of weight over the three-week period.
Sam Feltham: Exactly. And the exercise was the same as well, just so people know.
Dr. Eric Westman: What I also liked about what you did is that you took pictures. There’s actually a company that validates your weight by having you take a selfie with your hand and side view, with dates. I liked that as part of the methodology.
If someone wants to recreate this, it’s great to have the numbers, but also the pictures. You can see your belly was bigger.
Sam Feltham: And also my chin.
Dr. Eric Westman: So you were exercising, right? Biking?
Sam Feltham: Yes.
Dr. Eric Westman: The other interesting thing is this: it struck me, coming back from the meetings in June in Europe, that now there’s a new cohort of people like you. You’re younger. But you’re not coming to this because you’ve been sick and trying to fix something. You’re asking the question: what’s the healthiest way to be?
So now you have the overfeeding of low-carb – 5,800 calories, you gained a kilo. For three weeks. Now you have the 5,800 high-carb, low-fat, and you gained seven kilos.
What was your thought process for the third dietary pattern?
Sam Feltham: I wanted to land somewhere in between, and that was real food, very low-fat, high-carb, vegan. I thought I’d throw that into the mix because I thought it was an interesting aspect.
Dr. Eric Westman: The other thing about being able to choose these groups is that, albeit it’s just one human, there are social factors, ethical factors, and popularity. A generic study of just carb levels doesn’t take into account fiber, veganism, and so on. So I love that the third group was high calorie vegan.
What happened?
Sam Feltham: Yes. I managed to get the same gross calorie surplus, but the net calorie surplus ended up being 40,000 calories. The discrepancy was because of the amount of fiber I was eating. Pretty close, but not as close as I wanted. I was able to eat the same gross volume of calories, but I wasn’t able to get the net calorie surplus because of the amount of fiber.
As you know, the recommended daily intake in the UK is 30 grams of fiber. I was eating 175, which was a lot. My wife still hasn’t forgiven me for that time, because to say I was regular is another thing.
That 40,000 should have converted into 5.2 kg weight gain, but I actually only put on 4.7. You get pretty close, but still a little less than the calorie formula said I should. However, even then it was 7,000 calories less than the first one, yet I put on three times the amount of weight. The whole discrepancy or misconnect between the calorie formula and the actual outcomes with three different diets was quite demonstrable, I thought. It really helps a lot of my clients understand – wow, this really might not be just about calories.
Dr. Eric Westman: While it seems predictable for the people who understand calories and glucose and insulin, the hormonal hypothesis of weight gain, it makes sense that this would happen. But I wouldn’t have predicted that much of a difference necessarily.
Continuations of the Study
Dr. Eric Westman: Since that time, has anyone approached you? Has it been replicated? That’s really what’s needed here.
Sam Feltham: Yeah. So this is it. Nobody’s really tried to replicate it. I was particularly hoping that a real calorie advocate would try to replicate it. I called people out at the time. During the experiments and right afterwards I was saying to people like Layne Norton and others, “Well, if you think I’m lying, do it yourself. Demonstrate it and see what happens.”
Dr. Eric Westman: This paper was published in October 2021 in Current Opinion in Endocrinology, Diabetes and Obesity. The title is A case study of overfeeding 3 different diets. It’s been four years now and I’ve only heard one comment – that was from Ben Bikman.
Ben, being a biology scientist at BYU in the US, mentioned it at a meeting. It drew his attention because it wasn’t just on the internet. It had been formalized and put into a research paper like this. It’s been fascinating that that’s often what’s required. Everyone will ignore it until there’s a paper. Even though it was real without the paper, there is a formality in getting into a paper like this, and I think that’s still important.
Limitations to the Study
Dr. Eric Westman: Regarding the limitations, your weight changed, but you really didn’t measure the body composition, did you? Like the water weight, fat weight?
Sam Feltham: I did. I had a bit of that data.
Dr. Eric Westman: One might argue that the difference is just water, right?
Sam Feltham: Yeah, for sure. I did do bod pods. I did a bod pod at the end of the first experiment. Now, I didn’t do it at the start. However, I did do a bod pod at the beginning of the second experiment, which is obviously like my normal body composition at the start of the low-fat fake food trial. And yeah, that was the same as at the end of the first one. So logically, it didn’t change much over the first experiment.
Now, on the second one, yes, my body fat went from, I think it was 12 up to maybe 25 or something like that on the bod pod. It was quite clear there was fat involved, not just water.
Dr. Eric Westman: What I really loved about what you did is that it throws out, like you said to Layne Norton, the strawman of “prove me wrong.” You did the due diligence to validate, I think sufficiently – with the weight, the bod pod body composition, and then the pictures. This is like throwing down the gauntlet which I think is a challenge for those who are holding on to the old paradigm that “calories in, calories out” is all there is.
In fact, a medical student could do this for their class. They could make people do it to show just how different the reality is from what the teaching is.
This study is a challenge to anyone who debates or thinks you faked it. Will you do it again?
Sam Feltham: Not sure I could handle it now with two young kids and also being 40-plus. It’s probably a bit of a spanner in the works. Any young gun calorie advocate out there looking to make a name for themselves – please take up the challenge. Prove it.
Dr. Eric Westman: There’s also a young physician, Nick Norwitz, who stealth-experimented with Oreo cookies and did something similar. He overfed himself calories but was also measuring his body temperature, and it went up. I think this is one of the explanations of why some people stay lean and some people gain weight. You can actually burn off the calories you eat as heat. You called it very correctly there – the thermogenic effect of food. But this really needs to be redone to put the nail in the coffin, or to say maybe it isn’t true that calories are just about calories. There’s so much other experiential, clinical evidence that that’s not the case.
Anyway, thank you for recapitulating that. Even now, four years later, no one has debunked or thought what you did was wrong, in terms of trying to replicate it and failing to replicate it. That’s really important. The hallmark of science is replication.
Sam Feltham: The one thing I wanted to mention is that there are studies similar to this, like the Claude Bouchard ones in Canada. He took twins and put them in metabolic wards, overfeeding them by 1,000 calories. Off the top of my head, it was 10 sets of twins, and the weight gain ranged from 2.5 kg to 10 – even though it was the same extra calories. And even within the twins, there was variation. That’s proof in itself that it isn’t all about the calories.
Dr. Eric Westman: In today’s world, we need an in-your-face kind of study. That was the appeal of Nick Norwitz eating Oreos and dropping his LDL – he knew that was going to happen. Anyway, great work.
New Research
Dr. Eric Westman: Last month the Public Health Collaboration of the UK had a wonderful meeting, and you’re the driving force behind those meetings. All the lectures were stellar. Of course, clinically, David Unwin and Jen Unwin are just changing the UK environment, and part of it is their connection to the government. I hear stories that they think they’re all optimistic and then the government decides not to act. It’s still grassroots.
One of the studies – you may have seen it before – was Isabella Cooper’s study of 10 women who were otherwise healthy. This is shifting the question: is a low-carb diet therapeutic, can it reverse diabetes? That’s established. But what about people who don’t have disease? Maybe being ketogenic is a better metabolism. That’s the theory, right? To see this now being studied is really pioneering. It’s taking the idea that this is bizarre and you don’t want to do it to, “What if this is actually the better diet to do even when you’re healthy?”
What was your impression of Dr. Cooper’s work?
Sam Feltham: Every time I speak to Isabella, I feel like my brain is insignificant compared to hers. She’s just incredible – the depth of knowledge she has is mind-blowing.
The main outcome is that everything gets better essentially for those women. And Isabella will go into more detail at next year’s 10th anniversary conference. Tickets have just gone on sale if people want to check that out and be up to date with Isabella’s research as well as lots of others. Go to phcukconference.org.
My impression of Isabella’s research is that, as you say, not only is ketogenic therapeutic but it can quite possibly be one of the healthiest approaches for longevity. You’ll need long-term data to properly prove that hypothesis but the immediate biomarkers she’s measuring show everything is improving.
Dr. Eric Westman: We’ve come a long way from 20 years ago, when IRBs (institutional review boards) asked, “Can you feed people all that fat?” Now, here, people have voluntarily done that. What was neat about this study is that she recruited people who had already been doing keto for about four years, average age 35. These were young, healthy women, and almost everything looked great. Lots of things were checked.
Some of the women even had keto babies, which I first heard about in Indonesia pre-pandemic. Doctors there were saying that these children who don’t eat carbs are even developing faster. And I’m like, well, where are the publications? They went, well, they don’t have them. But that word of mouth, for me to hear that, gave me some confidence that it’s okay for children not to eat so many carbs.
Of course, children are born in ketosis, and probably when they’re breastfeeding from a keto mother they’re still in ketosis. This is all wide open, and I’m so glad that you’re focusing now on pediatrics and children. I mean, when I go to an obesity meeting I look around and I say, where are the pediatricians? They need to be in on this. Now, of course, the US is inundated with all the shots and the medications, and that’ll probably drive pediatric treatment, too. But food matters.
Childhood Nutrition and Obesity
Dr. Eric Westman: What have you come up with at the PHC UK to address childhood nutrition and obesity?
Sam Feltham: We’ve been working on our schools program for the past couple of years, called Real Food Rebellion. The idea is for the kids to really rebel against the environment that’s been put against them because we really do need a bit of a rebellion from the kids.
From my perspective in particular, as the father of two young kids, kids’ brains are getting hijacked by ultra-processed food and by screens. We really need to change that if we want the next generation to continue to improve humanity and civilization. Otherwise, we’re just going to get kids that are sicker and fatter every single generation, and then civilization is literally going to deteriorate because we’re unhealthy.
Dr. Eric Westman: I always hope for a technological fix, but that’s only part of it. How do you bring in the Real Food Rebellion? How is the teaching there?
Sam Feltham: Over the past couple of years, we’ve been piloting it in different schools. Just this Easter, we had it at several schools for 700 high school-aged students and then 700 elementary school kids as well. In the UK, high schools are called secondary schools and elementary schools are called primary schools.
We’ve got the secondary school project and the primary school project, because the two approaches are a little bit different. Primary school kids want cartoons and things like that. Secondary school kids want it in an app or something more teenage-friendly.
We’ve been learning over the past couple of years. We’ve been very fortunate in that we’ve been given this opportunity for some funding from an organization to really take Real Food Rebellion to the next level. We’re in the process of updating the materials, which is incredible. Over the next year, we’re going to be improving that.
The way it works at the moment is that it’s a six-week program that the teacher teaches in school. When you’ve got schools involved, you have to think about the funding from their perspective – how is it going to fit into the curriculum already being taught? It’s actually 30-minute lessons that fit into what’s in the UK called PSHE lessons. It’s using that PHSE funding to make it happen.
We give them all of the resources to teach it, and also the materials for the kids to actually learn about better nutrition and better choices for when they’re out in the wild – at the supermarket or anywhere like that. In essence, the teacher teaches it with our materials and our support at the moment. We’re looking to expand those materials, whether it be some sort of funky AI chatbot that the teenagers can speak to – because they’re all over speaking to ChatGPT for everything. But we want to try and have an AI bot that would be particularly cultivated to certain responses and things like that. We’re still working all of that out. It’s early days, but we’ve got promising feedback from both the teachers and the students on what we’ve done already. Fingers crossed that will continue.
As that develops, parent engagement is a big part too, because they’re the ones cooking the meals for the kids and teaching behaviors. Helping parents make their own changes will be helpful as well.
Dr. Eric Westman: Is the food environment like in the US, where candy is everywhere and children can have it all the time?
Sam Feltham: Oh yeah, very much so.
Dr. Eric Westman: In some countries, schools limit sugar and candy to one day a week. Role modeling in schools would be so important. Is that part of the program, or is it really just educating the children, not changing the loop at the school?
Sam Feltham: For the time being, we’re treading lightly because it’s a very sensitive subject, particularly when dealing with a large, broad population of people. Food is so emotional for people. So at this stage, it’s really about informing teachers, students, and parents about the dangers of ultra-processed food and sugar.
As time goes by, they’ll become more aware, like, “Oh my gosh, we’re actually giving kids candy every single week. What are we doing?” Or, “We’re giving sugary desserts every single day.” That really grinds my gears – the school meals delivering sugary desserts every single day. Why? You don’t need that. You can just have a bowl of fruit and that’s it.
It’s even less money because you don’t have to prepare it or anything. You just put some fruit out for them to pick. If they don’t want it, fine. If they do, great. You just don’t need to give them sugary dessert. It contains no nutritional value.
Dr. Eric Westman: It’s interesting you frame it as a rebellion in the language, because it is like teaching kids to protect themselves. And yet the sugar – you want it, and you want more of it. Which gets us into the other major theme of the PHC UK, and it’s been very helpful worldwide is the idea of sugar addiction.
We’re basically teaching our children, like I was taught, that it’s okay to have this addictive substance, even though the long-term health consequences are not great.
Raising Awareness About Sugar Addiction
Dr. Eric Westman: Do you incorporate a sugar addiction in this? What else are you doing PHC-wise for sugar addiction?
Sam Feltham: Yeah, definitely. I mean we don’t mention it at the primary school project, and it gets a cursory mention in the secondary school project. But without the ability to actually open up that conversation – particularly to a teenage audience – you really need a clinical experience. All you could do is signpost. Even then, our Liberate food addiction coaching service doesn’t necessarily cater for teenagers either. Eating disorders is quite another sensitive subject that needs one-to-one time with people, and Real Food Rebellion doesn’t quite have that infrastructure just yet. Maybe one day, but we’ll take it step by step.
Liberate
Sam Feltham: On that note, Liberate has been going a couple of years, and we piloted it last year. That paper should hopefully be coming out in the next couple of months in Frontiers, which would be absolutely magic, because the preliminary data suggests that even though we’re suggesting to people to reduce their carbohydrates and tying that in with a 12-step program, we’ve reduced binge eating symptoms by 44% as a result of that.
Traditionally, in the eating disorders world, they say not to demonize any food. That everything is on the table. Everything should be on the table. Everything should be available. But, it’s an addiction. And so, the people who have those addictions can’t control themselves. They can’t moderate themselves. It’s exactly the same as telling an alcoholic, “Just moderate your drinking, just have one.” That’s not going to happen. It’s insane. When it comes to food addiction, abstinence really is unfortunately your only option.
Slanting towards a low-carb diet could be helpful in that. Not everybody in the Liberate program follows a low-carb diet, but they’ll certainly shift towards real food, if not slightly higher protein. That’s helpful in itself to lower food noise in terms of that background voice in your head saying, “Yes, I’m going to eat some candy or a donut,” that sort of thing.
Liberate currently runs 8-week courses about every two or three months. The most recent round has just started, and the next one will probably be in October or November. Excitingly, we’re about to launch a pre-recorded version of the course, which is going to be a lot more cost-effective for people as well. It means you can watch it in your own time, but it also gives you the opportunity to sign up to weekly support sessions. You can still get that live session support that people really enjoy, because it’s great to have things on hand and do it in your own time, but equally you do want to speak with other people that are having similar experiences so that you can learn from each other and also be understood as well. Food addiction can be a really lonely journey.
If people want to find out more about that, they can go to liberatetoday.org and just get in touch if you’ve got any questions.
Shifting the Paradigm Around Sugar
Dr. Eric Westman: Great. That brings to mind the binge eating treatment, and that’s totally different from the traditional view and traditional treatment.
I remember early on, 20 years ago here at Duke University, talking to other behavioral binge eating therapists. They thought that me studying the Atkins diet, or a very high-fat diet that didn’t allow carbs, was the worst thing to do for binge eating disorder. 25 years ago, they also thought that high-fat diets were the worst thing you could do for heart disease. That paradigm shift – flipping it upside down for cardiovascular disease and here for binge eating disorders – starts from that addiction model: if you can’t moderate, you have to stay away.
The 12-step program for alcohol being applied to other areas, including food, makes sense. But you have to change your viewpoint. It doesn’t make sense from the old way. The proof is in the studies being positive. Shebani Sethi at Stanford published papers looking at binge eating as an addictive disorder.
I credit your group, and Jen Unwin and David Unwin, for pushing this theme, even trying to get it into the medical world. It’s a decades-long process.
Sam Feltham: Oh, it really is. And the change will come over the coming decades.
Dr. Eric Westman: We need it faster!
Sam Feltham: We do need it faster. We absolutely do need it faster, and I wish it was. But these things take decades to change. I do honestly feel like we’re starting to get to the early majority with all of this.
As I said at our conference this year, Eric, shout out to you because you were awarded the Lifetime Achievement Award this year. In my eyes you absolutely are a legend and pioneer in the field. A lot of this wouldn’t have come about without your work, because you really stepped out from the mass of scientists that were out there. You were genuinely curious, and you started a pilot study that turned into quite a few randomized control trials. Without that basis, none of this probably would have come about. So it’s all credit to you.
Dr. Eric Westman: Well, to be fair, I just studied it. Dr. Yancy and I had studied it and put it in the literature. Dr. Atkins and Dr. Eades, Dr. Rosedale, and it goes back to Banting in London, were the real pioneers.
The recurring theme here with the N=1 trial being on the internet – nobody in the medical world will take notice. You get it into PubMed, you formalize it, do the due diligence of a paper, and that’s what we did – got this information into a format that is more credible. I had no idea the paradigm view against this would be so strong.
Seeing the results in people day to day, someone quoted me years ago, 10 years ago, saying, “Why don’t other doctors do this? It’s so clear. It’s so obvious.” That’s a topic for another discussion of why the rest of the world hasn’t caught on.
Sam Feltham: That’s the Semmelweis effect. For those that don’t know, Ignaz Semmelweis was a Hungarian obstetrician based in Austria. He was in charge of a maternity hospital that had medical students attached to it. This was, I think, in the mid or late 1800s. He came up essentially with the germ theory. He did a test where he tracked the mortality rate from the medical students, who were often coming from a theater where they were dealing with cadavers in the morgue. Exactly. They were trying their surgical skills on cadavers and then going straight to deliver a baby. Then you had midwives who were just on the ward delivering babies. There was a discrepancy – the mortality rate was lower for the midwives compared to the medical students. So he instituted a policy of washing hands for the midwives. Mortality decreased even more.
It was so obvious. The blanket policy became: everybody wash their hands in between every single patient. But when he presented this to the medical community, they thought it was absolute rubbish. “How dare you say that I, a gentleman doctor, have dirty hands.” That was the attitude.
Dr. Eric Westman: It’s so important in many ways, not only that no one believed him, but also that he didn’t have to know why. He didn’t have to know that there was a germ. It was just the mere fact of the effect of washing hands. In retrospect, it was so obvious.
And then, of course, the tragedy was that he died in an insane asylum.
Sam Feltham: Of an infection. He got beaten at the hospital. His mental health must have been terrible, because of the frustration of the medical community not listening to him. Then 10 years later, more evidence comes out, and everybody says, “Oh yeah, probably Semmelweis was right.”
Dr. Eric Westman: The lesson here is: don’t go crazy on me, fans.
Sam Feltham: Yes, don’t take it personally. Definitely not.
Dr. Eric Westman: The world may not be ready for that in various ways.
Looping back to today – having sugar around is just so common. I wonder if 10 or 15 years from now, people will look back and say, “Oh my gosh, you had candy on a plane?” Just like how smoking was finally banned on planes. Or, “Oh my gosh, there’s candy at the checkout in the grocery store?” It will seem like lunacy.
Conclusion
Dr. Eric Westman: It was so great to see you in person in London. Thank you, and thanks to the Public Health Collaboration for all the work you do. I do think there is change happening for the good, for the health of people. But we fight so many different things. The fights seem very similar in the UK and in the US.
Sam Feltham: Very much so. There are multiple forces at work preventing this from getting better. But as you say, there is absolutely improvement, and change is coming, slowly but surely. We just have to stay the course.
Dr. Eric Westman: I didn’t have a chance to check the grocery store much. Do you have keto bread and keto ice cream? I tell people: don’t have those things. But it’s hit the shelves here.
Sam Feltham: Not in a main supermarket. There are certainly low-calorie ice creams and protein bars, but not really keto snacks or keto bread. You might get it in health shops, but not in mainstream supermarkets.
Dr. Eric Westman: Here, big food has changed to include keto things, but they’re not low enough in carbs for a true keto diet. But then, of course, my typical straw poll survey of cab drivers in London: two of the three had done Banting, low-carb, keto at some point. That means we have one more cabby to convince!
Watch the full video here.
Speaker Bios
Eric Westman, MD, MHS, is an Associate Professor of Medicine at Duke University, the Medical Director of Adapt Your Life Academy and the founder of the Duke Keto Medicine Clinic in Durham, North Carolina. He is board-certified in Internal Medicine and Obesity Medicine and has a master’s degree in clinical research. As a past President of the Obesity Medicine Association and a Fellow of the Obesity Society, Dr. Westman was named “Bariatrician of the Year” for his work in advancing the field of obesity medicine. He is a best-selling author of several books relating to ketogenic diets as well as co-author on over 100 peer-reviewed publications related to ketogenic diets, type 2 diabetes, obesity, smoking cessation, and more. He is an internationally recognized expert on the therapeutic use of dietary carbohydrate restriction and has helped thousands of people in his clinic and far beyond, by way of his famous “Page 4” food list.
Sam Feltham has been in the health and fitness industry for over a decade. Starting out as a party coordinator at a sports center, he worked his way up to study at the European Institute of Fitness and qualified as a Master Personal Trainer. After 5 years of running a fitness boot camp business and a successful podcast, Sam shifted his focus on to improving public health by setting up and directing the Public Health Collaboration of the UK.
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