UK doctors cannot cope with Diet & Lifestyle

• NICE cannot cope with Diet & Lifestyle

• This is significant, as NICE advises Ministers and UK doctors
how to treat patients and spend the NHS money
• This is not a conspiracy – it is lack of knowledge
• I met a doctor who told me:
“I know nothing about Nutrition”
This is both sad and dangerous
• I don’t know how to take this further

rufus@greenbaum.com 1
Public Health – Diet & Lifestyle

Rufus Greenbaum
•A private individual - interested in preventive health
• Correspondence with UK government about Vitamin D
- DoH, SACN, NICE & others
- since December 2008
• Involved with 5 hospitals in NW London, since July 2010
• Organised 4 conferences about Vitamin D, in 2010 & 2011
• Now Director www.GreenVits.eu

rufus@greenbaum.com 2
UK Health – National Guidance
• Department of Health
Secretary of State for Health
Minister of State for Health
Minister of State for Care Services
Under Secretary of State for Public Health
Under Secretary of State for Quality
• Chief Medical Officer ( CMO )
• National Institute for Health & Clinical Excellence ( NICE )
• Scientific Advisory Committee on Nutrition ( SACN )
• Medicines & Health Regulation Agency ( MHRA )
• British National Formulary ( BNF )

Timescales ?
Government & researchers will take years before they recommend changes
Health Professionals and patients can take action in days !

rufus@greenbaum.com 3
Public Health – My Timelines
2006 Retired from career in Electronics
Studied Preventative Health
2008-2016 Focus on SACN & Vitamin D
Attended quarterly meetings
Made formal written submissions
2010-2011 Organised 4 scientific conferences on Vitamin D
www.vitamindassociation.org/events
2011- 2015 Consulted to 3 vitamin manufacturers
2014-present NICE Registered Stakeholder
Invited to submit comments on draft Guidelines
Invited to Scoping Workshops
2015-present Established www.GreenVits.eu
Selling high quality Vitamins, Minerals & Supplements
rufus@greenbaum.com 4
 My submission to SACN - 1
• Evidence from biomarkers that deficiency = 25(OH)D < 100 nmol/L
• Circulating 25-Hydroxyvitamin D levels indicative of Vitamin D sufficiency
( Dr Bruce Hollis, 2005, American Society for Nutritional Sciences )
• Vitamin D in preventive medicine – are we ignoring the evidence ?
( Dr Armin Zittermann, 2003, British Journal of Nutrition )
• 3 Biomarkers:
• Parathyroid Hormone ( PTH )
• Calcium Absorption
• Bone Mineral Density ( BMD )
• My reading of these 2 papers is that below 100 nmol/L:
•The body uses up stores of Vitamin D – required by many genes
•Muscle strength is reduced
•BMD is reduced by withdrawal of Calcium from the bones
* Copy of full submission available on request
rufus@greenbaum.com 5
My submission to SACN - 2
Estimation of optimal serum concentrations of
25-hydroxyvitamin D for multiple health outcomes
( Dr Heike Bischoff-Ferrari, 2006, American Society for Nutrition )
• Lower Extremity Functions – for older people:
“8-foot walk time” showed major improvements above 60 nmol/L
“Sit-to-stand time” showed major improvements above 40 nmol/L,
( with continued minor improvements up to 120 nmol/L )
• Periodontal Disease
Improvements were seen as 25(OH)D increased from 71-112 nmol/L
Dental “Attachment Loss” reduced when 25(OH)D was 90-100 nmol/L
• Colorectal Cancer
Inverse relationship between 25(OH)D and colorectal cancer
* Copy of full submission available on request
rufus@greenbaum.com 6
My submission to SACN - 3
The amount of colecalciferol required to raise the 25(OH)D levels
of the average UK person to the lower limit of 100 nmol/L:
Season Dose ( micrograms ) Dose ( IU )
Winter 100 micrograms/day 4,000 IU/day
Summer 50 micrograms/day 2,000 IU/day
• Compliance may be better with a weekly supplement of 20,000 IU
• Obese people should increase the dose ( maybe double required )
• People who cover their bodies should take the full winter dose all year long
• Without a “Loading Dose”, it takes 90-120 days for 25(OH)D to stabilise
• The dose / response varies for about 10% of the population
• Study of 3,500 people taking large doses at: www.grassrootshealth.net
• Supplementation required for life ( not a 1-off top-up like iron )
• Whole family should be tested or supplemented
* Copy of full submission available on request
rufus@greenbaum.com 7
Vitamin D - UK Local Action
• Monitor and supplement Vitamin D levels to > 100 nmol/L
* Cost / Benefit is massive for the people at risk
* This is an “Easy / Hard” challenge
* Each step is easy - making it happen everywhere is hard !
• Local Action ?
* Public Health Directors & Doctors
* Paediatric Endocrinology
* Community Paediatrics & Dietetics
* Health Visitors & Midwives
* Doctors & Nurses in General Practice
* Pharmacists
* Nutritional Therapists
• Health Insurance Companies ?
* BUPA / PPP / WPA would benefit from wide supplementation

rufus@greenbaum.com 8
NICE cannot cope with Diet & Lifestyle

NICE cannot cope with Diet & Lifestyle

Anything that affects your health has to be a licensed medicine !

I made submissions on illnesses where Diet & Lifestyle may make a difference:
• Rheumatoid Arthritis
• Macular Degeneration
• Early Stage Breast Cancer
• Thyroid Disease
• Endometriosis
• Urinary Incontinence
• PTSD
• Diabetes
• Atrial Fibrillation
• +++
rufus@greenbaum.com 9
NICE – Submission on Rheumatoid Arthritis - 1
Submission:
There is very good evidence that diet contributes to the Inflammation
that presents as Rheumatoid Arthritis
GP to refer patient at first presentation to a Dietitian or Nutritional Therapist
who can review the current diet and suggest changes
Dietitians https://www.bda.uk.com/
Nutritional Therapists http://bant.org.uk/
Sources:
http://www.ncbi.nlm.nih.gov/pubmed/16194694
http://rheumatology.oxfordjournals.org/content/38/11/1039.full
http://www.semarthritisrheumatism.com/article/S0049-0172(05)00087-9/abstract
Response:
Thank you for your comment. CG79 includes recommendations on dietary modifications.
The surveillance review did not identify any new evidence in this area
that would change these recommendations and therefore this area will not be updated
but the existing recommendations will still stand.

rufus@greenbaum.com 10
NICE – Submission on Rheumatoid Arthritis - 2

Submission:
There is very good evidence that increasing Vitamin D to 100-150 nmol/L
helps to prevent and treat Rheumatoid Arthritis - in the early stages
GP to prescribe Vitamin D to adjust level and review after 3 months

Source:
http://www.vitamindwiki.com/Overview+Rheumatoid+Arthritis+and+vitamin+D
http://www.ncbi.nlm.nih.gov/pubmed/24907153

Response:
Thank you for your comment. CG79 includes recommendations on dietary modifications.
The surveillance review did not identify any new evidence in this area
that would change these recommendations and therefore this area will not be updated
but the existing recommendations will still stand.

rufus@greenbaum.com 11
NICE – Submission on Rheumatoid Arthritis - 3
Submission:
There is very good evidence that adjusting Omega-3 and Omega-6 levels
helps to prevent and treat Rheumatoid Arthritis - in the early stages
Key Indicators Target Comments
Omega-3 Index >8% Is the Omega-3 level high enough ?
Omega-6/3 Ratio <3:1 Is the Inflammation low enough ?
Increasing Omega-3 may need 2-5 grams of Omega-3 per day.
Reducing Omega-6 needs advice about diet and lifestyle from a Dietitian or Nutritional Therapist
Source:
http://www.expertomega3.com/omega-3-studies/inflammatory-diseases
http://www.ncbi.nlm.nih.gov/pubmed/12442909
http://www.ncbi.nlm.nih.gov/pubmed/22765297
http://www.greenvits.eu/pages/omega-3
Response:
Thank you for your comment. CG79 includes recommendations on dietary modifications.
The surveillance review did not identify any new evidence in this area
that would change these recommendations and therefore this area will not be updated
but the existing recommendations will still stand.

rufus@greenbaum.com 12
NICE - Macular Degeneration

There is good evidence that lack of Omega-3 and Vitamin D

contributes to Macular Degeneration and that
boosting them helps to prevent and treat it

In a NICE Scoping Workshop I asked everyone

if they advised their patients about “Diet and Lifestyle”
• Response from eye surgeon #1 – “No”
• Response from eye surgeon #2 – “No”
• Response from eye surgeon #3:
“Certainly not – vitamins are dangerous”

rufus@greenbaum.com 13
NICE – Early stage Breast Cancer - 1
Submission:
Refer patient at first presentation to a Dietitian or Nutritional Therapist
who can review existing diet and advise changes

Dietitians https://www.bda.uk.com/
Nutritional Therapists http://bant.org.uk/

Comments:
Thank you for your comment.
We will systematically search and review evidence
according to the NICE guidelines manual and make
any recommendations based upon this evidence.

rufus@greenbaum.com 14
NICE – Early stage Breast Cancer - 2
Submission:
There is very good evidence that adjusting Vitamin D levels of 25(OH)D to 100-150 nmol/L
helps to prevent and treat breast cancer
Some doctors recommend aiming for 200 nmol/L during the treatment phase
Vitamin D has a half-life in the body of 30-60 days, so dosage is required at least every 7-30 days.
Vitamin D is fat soluble, so the dosage needs to be adjusted according to weight of the patient.
Source:
http://www.vitamindwiki.com/Cancer+-+After+diagnosis
http://www.vitamindcouncil.org/health-conditions/breast-cancer/
http://grassrootshealth.net/
http://ar.iiarjournals.org/content/34/3/1163.full
http://www.tandfonline.com/doi/pdf/10.4161/derm.1.1.7388
http://www.greenvits.eu/blogs/news/31767747-how-much-vitamin-d-do-i-need

Comments:
Thank you for your comment.
We are not covering vitamin D in the scope of this guideline.

rufus@greenbaum.com 15
NICE – Early stage Breast Cancer - 3
Submission:
There is very good evidence that adjusting Omega-3 and Omega-6 levels helps to prevent and treat breast cancer

Key Indicators Target Comments

Omega-3 Index >8% Is the Omega-3 level high enough ?
Omega-6/3 Ratio <3:1 Is the Inflammation low enough ?
Increasing Omega-3 may need 2-5 grams of Omega-3 per day.
Reducing Omega-6 needs advice about diet and lifestyle from a Dietitian or Nutritional Therapist
Source:
http://www.expertomega3.com/omega-3-studies/oncology
http://analysis.hqt-diagnostics.com/Products/HQT-Analysis
http://www.greenvits.eu/collections/omega-3
http://preventcancer.aicr.org/site/News2?page=NewsArticle&id=7629&news_iv_ctrl=0&abbr=pub_
http://www.ncbi.nlm.nih.gov/pubmed/26714774

Comments:
Thank you for your comment.
We are not covering Omega-3 and Omega-6 in the scope of this guideline.

rufus@greenbaum.com 16
NICE – Early stage Breast Cancer - 4
Submission:
Review the effect of Vitamin C on prevention and treatment of breast cancer.
This can be Intravenous ( Riordan Protocol ) or Liposomal or normal capsules, powder and tablets.

Sources:
http://vitamincfoundation.org/vitcancer.php
http://www.cancer.gov/about-cancer/treatment/cam/patient/vitamin-c-pdq
Book: Vitamin C: The Real Story, by Steve Hickey & Andrew Saul

Comments:
Thank you for your comment.
We are not covering vitamin C in the scope of this guideline.

rufus@greenbaum.com 17
NICE – Early stage Breast Cancer - 5
Submission:
Is cancer a nuclear genetic disease or a mitochondrial metabolic disease?

Books:
Cancer as a Metabolic Disease, by Professor Thomas Seyfried
Tripping over the Truth, by Travis Christofferson
Talk: https://www.youtube.com/watch?v=SEE-oU8_NSU

Comments:
Thank you for your comment.
We will not be reviewing causes of cancer in this guideline.

rufus@greenbaum.com 18
UK doctors - Diet & Lifestyle - Summary
• Most UK doctors cannot cope with Diet & Lifestyle
• SACN cannot cope with Diet & Lifestyle
• NICE cannot cope with Diet & Lifestyle
• Top down does not work
• Government will take 10 years to do nothing

• Need Bottom-Up Grass-Roots action

• Journalists and Health Writers can help
• Health Professionals and Patients
can take action in days

rufus@greenbaum.com 19