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Chapter 7 When cultural differences matter

Although the debate between “high fat, low carb” and “low fat, high carb” has been going on for a long time in academia, ordinary people may still not pay attention to the principles involved which are supposed to be discussed by experts. As ordinary people, we only care about three conclusions:

1. I don’t want diabetes.

2. I don’t want to be fat.

3. I want to know how I can eat to stay healthy.

In fact, there is little difference between the first point and the second point in ordinary people’s minds, because there is a correlation, in popular understanding, between being overweight and having diabetes. Of course, people who are overweight are at greater risk of developing diabetes. However, people who are fit and healthy can also be at risk of the disease.

I am such an example. My weight has remained at a similar level since I was a teenager. For children who have grown up at the foot of Prince Mountain, roaming among the mountains and swimming in the reservoirs are natural pursuits. At college, regular exercise and team sports were an important part of our schedule.

If we weren’t currently in the middle of a pandemic, I would be swimming four or five times a week, but even with this healthy lifestyle, I was diagnosed with diabetes.

Fit as I am, I’m still only an amateur. But there are others fitter than me who are dealing with similar health setbacks.

Sami Inkinen, a legend in Silicon Valley and one of the founders of the American real estate search engine Trulia, became a bona fide billionaire when he sold Trulia for $3.5 billion. But wealth is not the only impressive thing about him. He is also an amateur triathlete, and winner of the Ironman world championships! The Ironman is an endurance race involving a 1.5km swim, 40km cycle, and 10km run. It’s not for the faint hearted.

Inkinen is a fit man, that is clear. When you look at his body fat percentage (which is normally 15-18% in a healthy man), it is less than 8%! Looking at this information, it would be hard to believe that someone like Inkinen has diabetes. But he was diagnosed with the disease around the same time as me, in 2014.

Inkinen approached his problem in a similar way to how I had done. He delved into the research. As a Stanford alumnus it isn’t surprising that he used his impressive education to address this new conundrum. Just as I, a Tsinghua alumnus, had done.

Before his illness, His diet had been “optimized” by sports nutrition experts, in order to give him the best performance possible in his races. It was almost 70% carbohydrates, including fruit smoothies and 5 bowls of oatmeal every day. It was this diet that led to his diabetes diagnosis.

As a top student, Inkinen is not only capable of searching for valuable information in the information ocean and making his own judgments, but he also has the spirit to challenge his fate. He didn’t want to spend the rest of his life taking medicine, and so managed his condition with a low-carb, high-fat diet, under the guidance of experts. According to his results, he reversed his diabetes in a year.

During that year, many experts mentored him, and his work with the renowned Dr. Stephen Phinney and Dr. Sarah Hallberg led the three of them to co-founding Virta Health, a business dealing with the reversal of Type 2 diabetes now worth more than $2 billion.

I do take a little pride in the fact that I managed to reverse my own condition in only 3 months, without the help of expensive experts, and only my own research as a resource.

Inkinen used his profile as a Silicon Valley billionaire and Ironman Champion to promote the benefits of a low-carb, high-fat diet. He told his story publicly and frequently, and he set out to prove his theories with a bang! He and his wife rowed 4,000km from California to Hawaii, eating only a low-carb high-fat ketogenic diet consisting of 9% carbohydrates on the rough sea route.

What is particularly amazing is that it took the couple 45 days and three hours to go across the strait, breaking the previous record of 60 days.

Whether this proves that a low-carb high-fat diet can increase exercise endurance remains to be seen, but it was definitely a successful challenge to conventional knowledge.

The fact that it has taken me longer to tell the world about my experiences can be chalked up to the cultural differences between myself and Inkinen. The Chinese people are generally conservative, always making sure then have enough evidence for their views in case they are questioned. In contrast, Westerners are more likely to strive to be first, to be the fastest, and to get the most applause, whether for themselves or others.

For example, having made such a discovery, I certainly hoped to let more people know about it. By 2016 or so, I had come to decide that sharing this cure with the world would be my way of showing how grateful I was for my recovery. But I worried what would happen if people trusted me and then it all turned out to be just a coincidence, proved wrong by medical science. How would I face my friends who I had promised to help?

I kept the list of those who I shared with small, stressing that this was just my personal experience, and that they should do what they thought best. I couldn’t explain why, among all the mainstream media, the medical profession, and those regarded as specialists, this diet wasn’t considered a treatment for diabetes.

I always felt as if I needed more information, more knowledge. So, at the end of 2019 I won a scholarship to train as a health coach with Dr Berg, a low-carb expert. Now certified, I felt as if I had expertise to be able to make the case for the low-carb, high-fat diet. It was time to speak loudly about what I had found, and to join the debates going on in this field.

While Inkinen is to be admired for his work in this area, his business model won’t work everywhere. Virta Health offers its patients the opportunity to reverse their diabetes, but this involves an annual consultation fee of $4000 or so. Even if it would benefit you over your lifetime and save you 100 times that in medical bills, Chinese people are unwilling to pay a fee to find out how to eat. Also, the vast majority of people around the world simply cannot afford $4000 for just consultation!

Business can be an important and effective tool for promoting people’s well being, but it works best when combined with the administrative power of government. Let's look first at Inkinen’s business solution, and then consider what’s missing.

The goal of Inkinen’s company, Virta Health, is to promote personalized solutions for a low-carb high-fat diet.

Currently Virta Health has raised more than $200 million, and after five years of large-scale clinical trials and practices, the results are impressive. In just one clinical trial conducted in collaboration with the Indiana University Health Medical Center, researchers have confirmed that 56% of the nearly 240 participants on the Virta platform had lowered their blood sugar below diabetic levels by the end of the 10-weeks, and 87% of the participants never had to use insulin again.

Five years since its founding, Virta Health not only helps many people get rid of diabetes but also has established a set of effective diagnostic and medical procedures and standards, providing a reference for other successors who are interested in promoting this lifestyle.

Virta’s service process starts with an in-depth video conference with the company’s doctors. In order to formulate a diet strategy, the doctors will carefully review the medical history and lifestyle of each patient. They will mail instruments and equipment for customers to record blood sugar, blood ketone and blood pressure levels.

The patient enters the data into the app, and a wirelessly connected weight scale can automatically send the weight data to Virta. Then, each patient signs a contract with a health coach who is responsible for monitoring the data and giving guidance at any time.

Users can communicate with their coaches through the app every day, or through phone calls or video chats. The coaches’ suggestions are very detailed. If a patient plans to attend a birthday party, her health coach will help formulate a diet ahead of time.

As with my own initial exploration, many patients were still taking medication when participating in Virta’s program. This shows that although Inkinen started very quickly, he still holds a very traditional attitude. Dr. Sarah Hallberg, the medical director of Virta, says that the goal of the program is to let patients gradually taper off their medication, with dietary recommendations and medications constantly being adjusted based on factors that have a positive effect on blood sugar levels.

However, objectively speaking, many problems await to be solved in Inkinen‘s cause. As a large number of qualified people are needed for the above-mentioned work, the cost for human resources is very high, which determines that Virta will provide expensive service. At present, the standard fee is $400 per month, nearly five thousand US dollars a year, but you know, 34% of Americans have no savings at all and 60% of Americans have a deposit of less than 1000 US dollars. How can they afford such a fee?

Inkinen’s vision is to unite with the top 100 American companies, the Veterans Association, insurance companies and other organizations to use the medical insurance fund to pay for the service. This seems to be a feasible solution, but what about people who cannot get enough insurance? Many people in the United States do not have such comprehensive medical insurance, let alone people outside the United States.

The proportion of people with diabetes in the United States is less than one-tenth that of the world. And as in China, the vast majority of people do not have the habit of paying high consultation fees for medical and health care, not to mention the change from paying for injections and medicines to consulting fees. This seems just a shift in economic burden rather than saving.

My concern is what will happen with Virta’s model if Inkinen doesn’t get the support of the industries he needs. Then Virta will just become a rich person’s diabetes solution. As you reach out across the world, without government backing and investment, there would be no way for diabetics in developing countries to have access to this kind of treatment.

My mission is to prevent my fellow diabetics from having to wade aimlessly through meaningless and even dangerous “treatments” as I did. I want to find a way to take my knowledge of the low-carb, high-fat diet and popularize it all over the world. There is much to admire about the high-achieving American student and his Virta Health, but is it impossible to catch up with them?

While this may seem arrogant, I truly believe that there is a better way to promote the low-carb diet, which is not only suitable for a Western environment, but also for China’s national conditions.

That way is the low-carb catering model.

Everyone needs to eat, so it is better to start directly at the level of catering supply. The low-carb diet is lifelong, but a consultation service is only temporary! In addition, China’s efficient social system, which has been tested and proven in the control of COVID-19, is among the best in the world.

As a result, China can fully leverage its institutional and cultural advantages to lead the world in promoting low-carb diets. It can play a strong role in policy, propaganda and mobilization to launch three revolutions to solve the problem:

  • the agricultural revolution, to provide low-carb ingredients,

  • the diet revolution, to encourage people to adopt healthy eating habits, and

  • the health revolution, to implement large-scale non-pharmaceutical interventions.

These revolutions cannot be left to business alone, nor be imagined without government support and change in policy, especially in the face of obstacles from vested interests. Because of the powerful place capital holds in Western political systems, new ideas move slowly. The low-carb diet originated in the West. As early as 2005, Dr Jay Waterman called for a radical shift in the treatment of diabetes from conventional medicine to non-drug interventions based on a low-carb diet. Yet, 16 years have passed, and nothing has been done at a government level!

Although the Diabetes Association has publicly recommended the low-carb diet, there has been no policy support from the government and no systematic shift in the healthcare system. It is up to doctors to decide whether to recommend it to their patients or not. As a result, the vast majority of doctors do not know about it and do not recommend it. Pharmaceutical manufacturers, who make huge profits from diabetes, raise the prices of their medicines every year and are naturally opposed to any alternative solutions.

Dr. Jay Waterman had carried out a year-long study of a low-carb diet on the aboriginal people with satisfying results and the Canadian broadcasting company CBC had followed his study, filmed and broadcasted the related video program. However, the video has been inexplicably removed and cannot be founded anymore. No reason has been given for doing so. It is entirely plausible that vested interests are blocking the public’s access to the relevant information.

Vested interests can influence not only governments but also the professionals since they sponsor many professional conferences and the advertising in many professional journals. For example, at the annual conference of the Dietitian Association of Canada, those who have dared to support a low-carb diet and speak with facts didn’t get an impartial and fair academic discussion. In fact, they were met with personal attacks and gag orders and even had their membership revoked. Doesn’t that expose the problem?

In the western political system, money rules and money talks. Without the support of capital, those who were democratically elected will not have funds, and will even be suppressed by the media, which is controlled by business. Statistics show that the vast majority of campaign money comes from the rich people. These individuals are the top 1% of the population but decide who can get support.

On the surface, one person has one vote, but in fact, it is this 1% who dominate the election. It is a choice of capital rather than a democratic election. In this regard, medical groups with strong financial resources naturally have a strong influence. They can block the new methods like the low-carb diets that threaten their commercial income from receiving government support. Moreover, they can also use their influence in the professions and the media to suppress, stigmatize and block non-drug treatments.

The unsustainable burden of health care in various countries has made it imperative to promote non-drug treatments, including low-carb diets. Therefore, as long as the government supports, I tend to believe the potential and speed of development of low-carb diets in China because it is more likely that the government will overcome the vested interests there. Furthermore, it is entirely possible to form a health revolution, diet revolution and agricultural revolution promoted as is driven by the low-carb diets, which will also generate huge opportunities for business development.

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