The date of the first publication: October 24, 2020.
The date of the last review and update: August 23, 2023.
A short summary.
Dr. Paul Mason, a frequent guest at different low carb conferences and low carb podcasts, makes gross errors during each of his public appearances. His errors go beyond “gross” and are, sometimes, just catastrophic. Despite this, low carb conference organizers and podcast hosts keep inviting Paul Mason and seek his opinion and advice on different topics.
People are strange. Many get confused even about the very basics of their trade or of whatever they are actively studying.
Grassroots health evolved towards a form of irresponsible primitivism: a group of confused individuals tours podcasts and health conferences and repeats the same absurdities at each appearance.
A side note:
If there is need, we can help you with identifying a competent medical practitioner. We can also review your past laboratory tests, suggest additional laboratory tests, and provide recommendations on self-monitoring, diet, and physical activity.
Paul Mason’s presentation “Ketogenic nutrition in athletes: A review of current evidence”.
There is a recent striking example of how much absurdity doctor Paul Mason can pack in his presentations and talks. On February 12, 2020, the Youtube channel of “Low Carb Down Under”, a low carb conference in Australia, published a video presentation by Paul Mason. The presentation was packed with absurd statements and gross errors. Many of the sentences were directly contradicting the information on the slides that Paul Mason was showing.
In the presentation, doctor Paul Mason notably stated that “on high carbohydrate diets, the energy stored as fat is largely inaccessible” and “athletes literally have to eat themselves” in longer events. Here is a quote and a screenshot of the transcript of Paul Mason’s presentation:
Unfortunately, on high carbohydrate diets, the energy stored in fat is largely inaccessible. This means that in longer events, when glycogen stores are depleted, high carbohydrate athletes literally have to eat themselves to the finish.
Immediately after making this statement, Paul Mason showed a slide from a study by Burke et al., 2017 (1), where one could see that athletes on high carb diets were burning between 0.25 grams of fat per minute and 0.76 grams of fat per minute during a race. The high-carb athletes from that study obviously CAN access their fat storage. Thus, Paul Mason was showing a slide that was directly contradicting what he was saying. Strange.
The slide from the study by Burke et al., 2017 (1), is inserted below. The open bars represent fat oxidation by the athletes on their usual (high carb) diets, and the filled bars represent fat oxidation after a dietary intervention. “HCHO” and “PCHO” diets were high carb diets with about 550g of carbohydrates a day. “LCHF” stands for “low-carb high-fat diet”.
More details on fat burning and diets can be found on the slides below clipped directly from the study by Burke et al. (1). For fat burning, see “Figure 5 (D)”.
So, the strange doctor Paul Mason says “fat is largely inaccessible” and shows a slide where we can see that fat is very accessible. 0.75 grams of fat burned every minute means that fat is very accessible.
In his following sentences, Paul Mason says something which is in contradiction with what he said a moment before. Mason says:
“the rate of fat oxidation in the high and periodic carbohydrate groups during a 25 kilometer time trial did not improve.”
The rate of fat oxydation did not improve but the rate was not zero. They can access their fat storage.
How does the brain of doctor Paul Mason function?
So, why does Paul Mason makes a statement that fat is largely inaccessible and then displays slides that contradict his statement? How does his brain function?
Another absurd statement: “just because fat is oxidized, it doesn’t mean that it’s used effectively for energy”.
A moment later, Paul Mason makes another absurd statement:
Here is the problem though, just because fat is oxidized, it doesn’t mean that it’s used effectively for energy.
Paul Mason continues:
So, these athletes were breaking down fat but they weren’t able to efficiently use the resulting products. To understand why let’s have a look at the production and use of ketones in the liver. First of all, free fatty acids enter the liver where they can be converted into ketones…
It appears that doctor Paul Mason somehow drifted towards believing that human muscles can’t use fat unless it is first converted to ketones. Is this true?
Felig et al., 1975 (3):
Carbohydrate and Fatty Acid Utilization
Although uptake of blood glucose by exercising muscle was recognized almost 90 years ago, the role of glucose in muscle energy metabolism was overshadowed by the identification of circulating free fatty acids as energy-yielding substrates.
It is now clear that in addition to free fatty acids , stored carbohydrate (muscle glycogen) and bloodborne glucose contribute substantially to the energy needs induced by exercise. The relative contributions of each of these fuels at any given time is largely determined by the duration and intensity of exercise.
Fatty-acid utilization continues to increase during prolonged exercise (Fig. 2). Between one and four hours, the uptake of free fatty acids by muscle increases by 70 per cent. Thus, after four hours of continuous mild exercise, the relative contribution of fatty acids to total oxygen use is twice that of carbohydrate. The increase in uptake of free fatty acids is in direct proportion to their inflow — a relation that has been observed during brief as well as prolonged exercise and during prolonged starvation.
These findings indicate that, under normal circumstances, uptake of free fatty acids by exercising muscle is not primarily regulated by the muscle itself, but by external factors such as the rate at which fatty acids are mobilized from adipose tissue.
As you can see from the citation from Felig et al., 1975 (3), above, free fatty acids are one of the main substraits used by exercising muscles. There is no need to convert free fatty acids to ketones.
How come doctor Paul Mason, who is a “Specialist Sports Medicine and Exercise Physician”, does NOT know the basics of muscle fuel utilization?
So, how come doctor Paul Mason, who is a “Specialist Sports Medicine and Exercise Physician” and who obtained his medical degree with honours from the University of Sydney, does NOT know the basics of muscle fuel utilization?
Fat is an accessible fuel for athletes on a high carbohydrate diet.
The correct statement: Fat is an accessible fuel for athletes on a high carbohydrate diet, but when athletes go on a low carb ketogenic diet, they can burn a lot more fat per minute than when they are on a high carb diet.
Paul Mason continues his presentation and displays another slide, a slide based on a 2016 study by Jeff Volek and colleagues (2) were the authors showed percentages of energy derived from fat and from carbohydrates during a 180-minute experimental run. We can clearly see that right from the start, the athletes on a high carbohydrate diet derive 40% of their energy from fat. By the end of the race, they derive more than 60% of their energy from fat.
The data from study by Volek et al., 2016 (2), confirm almost exactly the graph on fuel utilization from Felig et al., 1975 (3).
Paul Mason does not know the basics facts that he should have learned during his years in the medical school. And he remains blind to the same basic facts when they show up in the studies that he reads. Strange.
A serious error in the way Volek et al., 2016 (2), designed their study.
Below, there is a figure from the study by Volek et al. (2). We can see again that the athletes on a high carb diet burn fat right from the start.
The low-carb athletes consumed a low carb meal before the run and their insulin levels were not affected to the same degree as that of the athletes on a high carb diet.
There is a serious error in the study (2) design. Indeed, Volek and colleagues (2) gave a high carb meal to the athletes on a high carb diet 90 minutes before the race started. The insulin levels in the high carb group spiked and made fat less available at the beginning of the run. The low-carb athletes consumed a low carb meal before the run and their insulin levels were not affected to the same degree as those of the athletes in the high-carb group. Hence, higher fat oxidation in the low-carb athletes right from the start.
If both high-carb and low-carb groups had started the run fasted or had had an identical low-carb meal, the fuel utilization in the two groups could have been almost the same.
If we look at another graph from the study by Volek et al., 2016 (2), we can see that there was a drop in free fatty acids in high-carb athletes right before the treadmill run started. If both groups had consumed an identical low-carb meal, or, if both high-carb and low-carb groups had started the run fasted, the fuel utilization in the two groups could have been almost the same.
Is keto-adaptation in athletes a myth?
Keto-adaptation in athletes is not necessarily a myth. The difference in serum fatty acids between the high-carb and the low-carb groups was statistically significant only at the time point “0 minutes”, that is, at the start of the run. Yet, fat oxydation was significantly higher in low-carb athletes at all time points. However, a high-fat meal for the low-carb group before the start of the run remains a confounding factor.
Conclusions.
Anthropology of online health educators.
People are strange. Many get confused even about the very basics of their trade or of whatever they are actively studying.
Grassroots health evolved towards a form of irresponsible primitivism.
Grassroots health evolved towards a form of irresponsible primitivism: a group of confused individuals tours podcasts and health conferences and repeats the same absurdities at each appearance. There is often an extreme naivté in interpretation and treatment of subjects.
Confused, irresponsible, unsophisticated individuals gain huge popularity and flowing with the mass audience.
Identifying a competent medical practitioner, interpreting laboratory test results, self-monitoring, diet and exercise.
We can help you to identify a competent medical practitioner. We can also review your past laboratory tests, suggest additional laboratory tests, and provide recommendations on self-monitoring, diet, and physical activity.
If you need help, do not hesitate to get in contact with us.
Selected references:
1. Burke LM, Ross ML, Garvican-Lewis LA, et al. Low carbohydrate, high fat diet impairs exercise economy and negates the performance benefit from intensified training in elite race walkers. J Physiol. 2017;595(9):2785–2807.
2. Volek JS, Freidenreich DJ, Saenz C, et al. Metabolic characteristics of keto-adapted ultra-endurance runners. Metabolism. 2016;65(3):100–110.
3. Felig et al., N Engl J Med. 1975 Nov 20;293(21):1078-84.
I’ll stick to the man. I have been on low carb keto for 2 years I have lost 20kg. All my vital signs are now good. Pressure 130/70, low excellent sugar, my joints have improved by taking Bone broth, (I no longer need surgery for a damage knee), my cholesterol is great, in fact I feel healthier than when I was 40. I am now 78. If he is wrong then the medical profession are also unforgivingly grossly in error. To expound any benefit in seed oil is in my opinion libelous. Bread, I have been suffering this for years, yet not one doctor successfully diagnosed my acid reflux other than prescribing pills and going vegetarian. On a vegetarian diet my weight became uncontrolled and I almost felt as though I was starving all day. Ate like a sheep not a lion. If any arrows need to be flown it has to be in the direction of poor biased research, often sponsored by vested interest the greed of big pharma, and vested interest in the likes of GMO and grain farmers
Thank you for your comment, Graham.
You may want to improve your blood pressure.
You may also want to monitor your SHBG-Testosterone-Estradiol for the prevention of osteoporosis and for other reasons. Your urinary electrolytes, in particular calcium, may need monitoring. On a “too low carb diet”, if ketones are too high, there is metabolic acidosis. The latter needs to be addressed, managed, corrected.
For your other vitals, you may also want to take a look at your albumin. It is a very informative biomarker in terms of healthy longevity.
Regarding Paul Mason:
A health educator has to be factually correct. The fact that “low carb”, which needs to be defined, works in many cases has little to do with what Paul Mason tells in his presentations.
I completely agree with you Graham. Perhaps the author of this article may be better served studying more of what Dr Mason teaches and having a proper understanding of what he is saying rather than twisting his words out of context ?
GPs are catastrophically wrong in relation to diet and their knowledge of nutrition. I spent years being ‘drugged’ by them and became sicker and sicker – fatty liver, insulin resistance and metabolic disease and associated weight gain. After 12 months of a ketogenic diet and intermittent fasting I am in perfect shape, no medication, BP 110/60, 10kgs lighter, healthy cholesterol, sleeping well with loads of energy and a clear mind, not to mention complete health after 45 years of chronic asthma – the total opposite to how I felt under the ‘care’ of a GP. I’m 47 and have never felt healthier, happier or more alive. I am a living shining example of what Dr Mason teaches.
Dr Paul Mason, Dr Jason Fung, Prof Tim Noakes and many others need to be applauded for changing the status quo of the medical profession (I use the term ‘profession’ very loosely). The are teaching HEALTH which seems to be the main thing missing in the Health Care System.
(Author – FYI the correct spelling is ‘scientific’).
Liz, thank you for your comment and for pointing out a mistype.
Your blood pressure looks good, but you need to watch your pulse pressure in the future, since it appears to be a bit high.
It is good that you feel good and biomarkers have improved. It is not clear what you call “a ketogenic diet”. You need to make sure that you eat enough. Chronic caloric restriction is detrimental. In the years to come, you also need to watch your SHBG and estrogen.
Liz, you identify a diet with some personalities that search engines pushed on your screen. It is a mistake.
Doctors are trained to memorize and to apply dubious guidances. But there is a minority of medical practitioners who are actually good. If you make no effort to identify good medical practitioners, your chances to get a good treatment or a good general advice on how to stay healthy are very low.
“Doctors” are “bad” because there is no demand for quality health care, for competent doctors.
There is so much contradictory nutrition information available, how does a non- medical person figure out what to believe? I have a very high Agatstan score and have been working over the last 18 months to figure out how I should be eating (I’m 5’10” and 146 lbs.). My cardiologist believes saturated fat has been unfairly demonized and has no problem with red meat, butter, and full fat dairy. The only thing most experts seem to agree on is sweets are bad and veggies are good.
Dwight, thank you for your comment.
Agatston units measure coronary artery calcium score, or CAC score.
CAC score is arguably the most reliable marker of atherosclerosis that we have today.
It is of note, however, that CAC score differs in different ethnicities. Asians and Africans have lower CAC scores than Europeans of the same age group. In all ethnicities, women have lower CAC scores than men of the same age group.
Mr. Agatston, who came up with the “units” to measure CAC is a currently practicing physician in the US. Mr. Agatston is, however, confused on the ways to treat people with high CAC score. For example, Agatston prescribes statins to his patients with high CAC score. Statins, however, accelerate arterial calcification instead of slowing it.
What needs to be addressed to keep atherosclerosis and arterial calcification under control:
– Inflammation (atherosclerosis is a chronic inflammatory disease);
– Blood pressure, including pulse pressure (difference between systolic and diastolic blood pressure). Blood pressure is a major factor associated with atherosclerosis and arterial calcification;
– Calcium and phosphorus metabolism (high levels of both may result in calcium phosphate precipitation in soft tissues, including arteries);
– Mineral intakes and mineral metabolism in general;
– Acid-base balance;
– Kidney health;
– Vitamin K metabolism;
Also, many other aspects of metabolism and physiology may play a role in accelerated atherosclerosis and arterial calcification.
You can check our posts and consulting programs on arterial calcification (marked with the tag “CAC score”). If you need help, we can work with you and your medical practitioner. Blood pressure is one actionable item that can be improved relatively rapidly and make a difference.
Regarding the types of fat.
Fat intakes should be moderate, reasonable. If antioxidants naturally present in seeds are preserved in oils, and if there is no heat treatment in the extraction process, the resulting seed oil may be ok for human consumption.
Animal fat contains both saturated and polyunsaturated fats. High intakes of animal fat will, therefore, results in considerable intakes of polyunsaturated fat. Heat treatment, even boiling in water, will inevitably denature polyunsaturated fatty acids. Some polyunsaturated fat will be converted into “trans” fat. Trans fat is not good, but inevitable, since we only consume cooked animal fat.
A diet should provide all necessary minerals and vitamins. Food, including fat, should be of good quality. Fat intakes should not be excessive.
I trust Paul Mason. He is a field practitioner. Besides, in further clarifications on the study in focus, there was no periodization and should have been considered. These are discussed in other interview analysis by Paul, Dr. Tim Noakes, etc.
A person named Liz commented above on the “field doctors” who treated her for years and whom she probably trusted. Here is a citation:
“GPs are catastrophically wrong in relation to diet and their knowledge of nutrition. I spent years being ‘drugged’ by them and became sicker and sicker – fatty liver, insulin resistance and metabolic disease and associated weight gain.”
https://medical-en.nneandersphysiologicalliteracy.com/another-load-of-absurdities-from-the-strange-doctor-paul-mason/#comment-559
This article is written by some sore looser jealous and perhaps being paid by big pharma and food magnets to disprove what is obvious: the food we are forced to buy and eat is making people sick and killing them. Nothing new however. Tobacco companies used to fight to death proving tobacco is innocent. Shame on those who wrote this review and support some dirty agendas.
Nat reacts irrationally to a critique of an online health educator. From the anthropological view, such reactions are of interest.
Note that nobody is forced to buy bad supermarket food. Also, many dietary guidelines and textbooks recommend dietary intakes that are consistent with “low carb diets”.
An example in the following article:
https://medical-en.nneandersphysiologicalliteracy.com/debunking-nina-teicholz-the-dietary-guidelines-tell-to-eat-low-carb-100g-d-nina-has-not-read-them/
My son in law suggested looking into Paul Mason’s diet for my Hashimotos disease and my extraordinarily high thyroid antibodies. Being a nurse, I like to do a bit of research before I commit to something. I am wondering how healthy a high fat, low carb diet is in the long term. (me being”old school”) Paul Mason seems to have really good reviews and people appear to be healthier and have lost a lot of weight on the keto diet. I have only just started looking into all this. I actually stumbled onto your website and would like to know your qualifications as well. Good to look into both sides, interesting. Rather mind boggling, though.
Author, who are you? What is your name? What are your credentials? Why isn’t your name alongside your opinion piece?
Charles Luke, thank you for your comment.
Articles on our site may have multiple authors. The intent is to publish as a group rather than promoting individual authors.
Luke, one of our lines of work is to verify if the person behind “credentials” is competent and able to think and act coherently.
For example, Paul Mason obtained his medical degree with honours from the University of Sydney. Mason is a “Specialist Sports Medicine and Exercise Physician”. Yet, Mason does NOT know the basics of muscle fuel utilization. How come? Are the credentials of Paul Mason valid? Are all the physicians graduating from the University of Sydney with and without honours can be as catastrophically confused as Paul Mason can be on the very basics of their specialty? Did Paul Mason know the basics of muscle fuel utilization at the time he was passing his exams at the University? Did Paul Mason forget the basics of muscle fuel utilization since then?
If Paul Mason can forget or get confused some time after graduation, then other medical doctors, and specialists in other areas, also can. In this case, “credentials”, that is, medical degrees with and without honours, should be valid only for a limited period of time. For instance, for 180 days, as the COVID-19 “vaccine passports” in Europe. And medical practitioners and specialists in other areas should undergo (“intelligence”) tests at regular intervals to confirm their diplomas and “credentials”.
Paul Mason is an enthusiastic reader of published literature and he has a drive to educate. Unfortunately, Paul Mason gets catastrophically confused. But since Paul Mason is never corrected or challenged at the many conferences, podcasts, and other venues where he appears as a speaker, the “credentials” of those who invite Paul Mason do not mean much.
This is practical anthropology. Before you “trust” a specialist with “credentials”, before you outsource all thinking to him or her, ask that person to pass some tests.
An extract from our correspondance with consulting clients:
“Practical anthropology of medical doctors.
A single medical practitioner is unlikely to have a comprehensive high level understanding in too many areas. The majority of medical practitioners work in high throughput public or private institutions where deep understanding of physiology and continuous learning are not sufficiently encouraged.
One should, therefore, have realistic expectations of what an average, even good, medical practitioner can deliver. A better result can be expected if several credible medical practitioners and researchers work as a group, as a task force. This type of work is our preferred approach. We use it whenever possible.”
Another extract from our correspondance with consulting clients on the possible goals:
“In the first half of life, a good goal is to fully develop one’s potential in terms of health, physical fitness, and well-being. In the second half of life, the goal is to preserve life quality, namely, confidence, ambitions, physical form and other aspects related to the quality of life. In advanced age, age-related cognitive decline and loss of mobility are among the main threats. Indeed, according to some estimates, between 30 and 50 per cent of people develop dementia by the age of 85. Loss of mobility is associated with depression, loss of interest in life.
Keeping one’s biomarkers in optimal ranges, understanding what the optimal ranges are, intelligent self-monitoring, are among the effective approaches.
It is very important to avoid serious errors. When health enthusiasts start experimenting with diets, exercise, different biohacks, there is a high risk of errors.”
Some commentators, who appear to be irrational supporters of the often confused Internet health educator Dr. Paul Mason, pollute the discussion with spammy messages of support.
On one hand, everybody should be able to exercise the right to “Freedom of Speech”. On the other hand, when “groupies” flood the thread with their messages of support to their “idol”, the informative part of the discussion gets lost.
We, therefore, created a special page for the comments that do not contribute to the discussion productively.
In this way, Freedom of Speech is preserved, while the discussion here remains interesting and informative.
The “Freedom of Speech” page for this article is at the following address:
https://medical-en.nneandersphysiologicalliteracy.com/a-freedom-of-speech-page-for-the-article-another-load-of-absurdities-from-the-strange-doctor-paul-mason/
Sorry, I don’t follow your argument here at all:
“If both high-carb and low-carb groups had started the run fasted or had had an identical low-carb meal, the fuel utilization in the two groups may have been almost the same.”
as well as here:
“A serious error in the way Volek et al., 2016 (2) designed their study: If both groups consumed that same meal, or, better, if both high-carb and low-carb group started the run fasted, the fuel utilization in the two groups may have been almost the same.”
If the High-carb group would have eaten a low-carb meal, it would have turned them into the low carb group. If they had fasted, yes, the results would have been better.
But that’s exactly in alignment with what the study says?
They ate a low-carb meal, which resulted in a different result than for the ones who eat a different meal, hence the result for the low-carb meal (aka low-carb group) vs. the result for the group not eating low-carb.
sorry, but that’s not a very convincing argument on your end.