The diet debate: fat vs protein vs carbs in type 2 diabetes - ESA Seminar
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The diet debate: fat vs protein vs carbs in type 2 diabetes Role of a Low carbohydrate, high protein, high unsaturated fat diet ESA Seminar 2018 Diabetes, diet and exercise: Symposium in Honour of Dennis Wilson Professor Grant Brinkworth, PhD, MBA | Principal Research Scientist 4th May 2018
Lifestyle Strategies for Type 2 Diabetes Management
First Line Treatment: Lifestyle Modification (diet and exercise) to:
- reduce body weight
- improve blood glucose control
Weight loss reduces hyperglycemia & metabolic risk factors in Type 2 Diabetes 1
1. How is this best achieved?
2. Which diet approach maximise the benefits of lifestyle modification?
2 | Long-term Health Effects of Very Low- and High Carbohydrate Diets | Grant Brinkworth
1. Lee et al. Am. J. Cardiol. 2007
2| The Diet Debate – fats vs protein vs carbs for type 2 diabetes | Grant Brinkworth, PhD, MBA
Nutritional Management of Diabetes: The Dilemma
• Public guidelines (most countries) advise a High unrefined carbohydrate, low fat
(HC) diet
- Carbohydrate (45-75% of total E) – emphasis on low glycemic index
- Protein (10-20% of total E)
- Fat (15-30% total E;
Nutritional Management of Diabetes - The Evidence
• Blood Glucose Control remains primary target
- associated with reduced development and progression of microvascular complications 1
• Assessments:
- Glycated Hemoglobin (HbA1c)
• average blood glucose levels over 3 months
• standard clinical assessment of blood glucose control
- Post-prandial glucose (PPG) peaks, hyperglycemic excursion & diurnal glycemic variability
• independent risk factor for micro- and macrovascular complications and CVD events 2,3
• Targeting treatment options that both:
1. lowering HbA1c
2. minimizing PPG and daily glucose variability Tay et al. Ann Rev Nutr 2015
provides comprehensive approach to reduce diabetes related CVD risk & complications
1. Colagiuri et al. National evidence based guidelines for blood glucose control in type 2 diabetes 2009, 2. Bonora et al. Int. J. Clin. Prac. 2002, 3. Cavalot et al. J. Clin. Endocrinol. Metab. 2006.
4 | The Diet Debate – fats vs protein vs carbs for type 2 diabetes | Grant Brinkworth, PhD, MBA
Nutritional Management of Diabetes – Carbs
• Carbohydrate (CHO) restriction for glucose control:
• Glycaemic load (GL) greatest influence on PPG and insulin response
• both type (GI%) and quantity (g) influence blood glucose levels/glycaemic control,
but …. Quantity impacts glycaemia the most 1
• Gannon et al. 2 - 4 week energy balance study: CHO restriction reduced HbA1c by
1.25% (absolute units)
• 2016 Meta analysis3 of randomised controlled feeding studies
• replacing CHO with MUFA or PUFA, but not SFA significantly lowered HbA1c
∴ reducing total CHO intake may offer strong option to reduce GL and improve
glycaemic control Low vs High Carbohydrate Diet for patients with type 2 diabetes | Grant
5 |
Brinkworth
1. Sheard et al. Diab. Care, 2004, 2. Gannon et al. Diabetes 2004, 3. Imamura et al. 2016
5 | The Diet Debate – fats vs protein vs carbs for type 2 diabetes | Grant Brinkworth, PhD, MBA
Nutritional Management of Diabetes – Protein and Fat
• Protein and Fat for glucose control:
- attenuate postprandial glucose rises by delaying gastric emptying of CHO 1,2
- via alternating gastrointestinal function caused by an incretin response1,2
• reducing glucose insulinotrphic polypeptide (GIP)
• increasing glucogon-like peptide-1 (GLP-1)
∴ increasing dietary protein and fat levels may reduce PPG response &
improve glycaemic control
Dietary pattern low in carbohydrate and high in fat and protein may be beneficial for
improving glycaemic control for type 2 diabetes management
6 |
1. Gentilcore et al. J. Clin. Endocrinol. Metab. 2006, 2. Ma et al. Diab. Care 2009
6 | The Diet Debate – fats vs protein vs carbs for type 2 diabetes | Grant Brinkworth, PhD, MBA
Low carbohydrate, high fat (LC) diets and glycaemic control in T2DM
Study Team n Duration Results : HbA1c Absolute Difference
Westman et al. (2008) 1 84 24 weeks LC - 1.5% vs. HC -0.5% 1%
Stern et al. (2004) 2 54 52 weeks LC- 0.7% vs. HC – 0.1% 0.6 %
Mayer et al. (2013) 3 46 48 weeks LC- 0.7% vs. HC 0.2% 0.8 %
• 2017 meta-analysis of 10 RCTs showed greater HbA1c lowering with LC vs HC in T2D8
• Dose response effect: greater carbohydrate restriction the greater glucose-lowering effect8
Limitations of previous studies:
• No formalised exercise program or control of physical activity
• Glycaemic control assessment limited to HbA1c and FBG
- GV and PPG - emerging independent risk factors for diabetes complications including CVD 4-7
• Comprehensive approach to reduce diabetes related CVD risk & complications target both:
- lowering HbA1c (chronic)
- minimising daily fluctuations (acute) 7 |
1. Westman et al. Nutr & Metb. 2008; 2. Stern et al. Ann Intern Med. 2004; 3. Mayer et al. Diabs Obes Metab. 2013; 4. Nalysnyk et al. Diabs Obes Metab. 2010; 5. Di Flaviani et al. Diabetes Care. 2011; 6. Monnier et al.
JAMA. 2006; 7. Buscemi et al. Diabet Med. 2010. 8. Snorgaard et al. BMJ Open Diabetes Research & Care 2017
7 | The Diet Debate – fats vs protein vs carbs for type 2 diabetes | Grant Brinkworth, PhD, MBA
Low carbohydrate, high fat diets & CVD risk
- Evidence in obese, non-diabetes populations
• Several RCT’s show up to 1 year, cf. HC diet, an LC diet achieve:
• comparable or greater weight loss 1—3
• greater ä in triglyceride
• greater ã in HDL-C
• similar reductions in blood pressure, insulin resistance, glucose homeostasis, and inflammatory
marker status 1-3
• Detrimental effects of LC diets on blood lipids and CVD risk concern remains
• Studies often show LC diet promote higher LDL-C 1-4
• Flow Mediated Dilatation (FMD - vascular function) impaired 5
7 | Long-term Health Effects of Very Low- and High Carbohydrate Diets | Grant Brinkworth
1. Stern et al. Ann. Intern. Med. 2004, 2. Foster et al. NEJM 2003, 3. Gardner et al. JAMA 2004, 4. Nordmann et al. Arch. Intern. Med. 2006, 5. Wycherley et al. J. Inter. Med. 2010
8 | The Diet Debate – fats vs protein vs carbs for type 2 diabetes | Grant Brinkworth, PhD, MBA
Low carbohydrate, high fat diets & CVD risk
- Evidence in non-diabetes populations
• but …… LC diet studies, concomitantly increase total fat and promote high saturated fat
intakes
• Fat quality/type rather than quantity per se is more important:
Mono- and Polyunsaturated fat:
Saturated Fat:
- promotes insulin sensitivity
- promotes insulin resistance1
- improves lipids profile (reduce total, LDL-C and triglycerides,
- elevates LDL-C2
increases HDL-C) 4
- adversely affects FMD3
- improve FMD 5,6
• \ high saturated fat content of LC diets maybe promote detrimental effects on LDL-C
and FMD
• higher dietary fat intakes, provided saturated fat content remains low maybe
advantageous for reducing CVD risk
8 | Long-term Health Effects of Very Low- and High Carbohydrate Diets | Grant Brinkworth
1. Riccardi et al. Clin. Nutr. 2004, 2. Clarke, BMJ 1997, 3. Keogh et al. Arterioscler. Thromb. Vas. Biol. 2005, 4. Mensink etal. Am. J. Clin. Nutr. 2003, 5. Fuebtes eral. Ann. Inter. Med. 2001, 6. Rallidis et al. Am. J. Clinic, Nutr. 2009
9 | The Diet Debate – fats vs protein vs carbs for type 2 diabetes | Grant Brinkworth, PhD, MBA
2012-15 Australian 2-year study
Devised novel eating pattern:
- markedly limits carbohydrates
- increases protein and unsaturated fat
- and is nutritionally replete
- Adequate vitamins, minerals, trace elements and fibre
Hypothesis:
A low carbohydrate diet, high in protein and unsaturated fat and low
in saturated fat offer:
- greatest improvements in glucose control
- without detrimental effects on CVD risk
9 | Long-term Health Effects of Very Low- and High Carbohydrate Diets | Grant Brinkworth
10 | The Diet Debate – fats vs protein vs carbs for type 2 diabetes | Grant Brinkworth, PhD, MBA2012 Study - Safety Effects of low carb, high fat
• Diet effects not systematically examined
• Evaluate chronic effects of an LC diet vs HC diet on:
Cognitive Function Mood & Psychological Renal Function & Bone Health
Wellbeing
T2D increased risk of cognitive T2D increased risk of depression T2D increased risk of renal
decline and lower quality of life impairment / failure
10 | Long-term Health Effects of Very Low- and High Carbohydrate Diets | Grant Brinkworth
11 | The Diet Debate – fats vs protein vs carbs for type 2 diabetes | Grant Brinkworth, PhD, MBA2012 Study: Multi Aims with diverse health outcomes
Compare the long-term effects (24 months):
1. energy-reduced, low carbohydrate, high fat, low saturated fat (LCLSF) diet
2. energy-matched, conventional high carbohydrate (low-GI), low fat (HC) diet
in overweight/obese individuals with T2DM on multiple health outcomes:
*
* Blood glucose control – HbA1c, FBG, Glycemic Variability (PPG), changes in diabetes meds
11 |
12 | The Diet Debate – fats vs protein vs carbs for type 2 diabetes | Grant Brinkworth, PhD, MBAStudy Design – 2 Year RCT Lifestyle Intervention
• 115 overweight and obese men and women with type 2 diabetes
• Diets: isocalorically matched, with moderate energy restriction
Low Carbohydrate, low saturated fat High Unrefined Carbohydrate, low fat (HC)
(LCLSF)
• 53% carbohydrate (low-GI: 46)
• 14% carbohydrate (< 50g CHO/day)
• 17% protein
• 28% protein
• 30% fat
• 58% fat
-Results
12 month outcome results
- Blood glucose control
- metabolic health & CVD risk
- renal function Received: 13 August 2017
DOI: 10.1111/dom.13164
ORIGINAL ARTICLE
Revised: 24 October 2017 Accepted: 14 November 2017
- mood and quality of life
Effects of an energy-restricted low-carbohydrate, high
unsaturated fat/low saturated fat diet versus a high-
carbohydrate, low-fat diet in type 2 diabetes: A 2-year
randomized clinical trial
Jeannie Tay PhD1,2,6 | Campbell H. Thompson MD2 | Natalie D. Luscombe-Marsh PhD1 |
Thomas P. Wycherley PhD3 | Manny Noakes PhD1 | Jonathan D. Buckley PhD3 |
- cognitive function
Gary A. Wittert MD2 | William S. Yancy Jr MD4,5 | Grant D. Brinkworth PhD1
1
Commonwealth Scientific and Industrial
Research Organisation (CSIRO) – Health and Aim: To examine whether a low-carbohydrate, high-unsaturated/low-saturated fat diet
Biosecurity, Adelaide, Australia (LC) improves glycaemic control and cardiovascular disease (CVD) risk factors in overweight
2
Discipline of Medicine, University of and obese patients with type 2 diabetes (T2D).
Adelaide, Adelaide, Australia
Methods: A total of 115 adults with T2D (mean [SD]; BMI, 34.6 [4.3] kg/m2; age, 58 [7] years;
3
Alliance for Research in Exercise, Nutrition
HbA1c, 7.3 [1.1]%) were randomized to 1 of 2 planned energy-matched, hypocaloric diets com-
and Activity (ARENA), Sansom Institute for
Health Research, University of South bined with aerobic/resistance exercise (1 hour, 3 days/week) for 2 years: LC: 14% energy as
Australia, Adelaide, Australia carbohydrate, 28% as protein, 58% as fat (Weight loss
LCLSF: -9.8 1.0 kg - 10.1 % vs. HC: -10.1 1.0 kg - 11.0 %
No difference in weight loss between diets (P=0.18)
105
LSLSF Diet
103
HC Diet
101
99
Body Composition
Weight (kg)
97
95 No difference between diets
93 for change in FFM:FM ratio
91 with weight loss (P=0.15)
89
87
85
0 4 8 12 16 20 24 28 32 36 40 44 48 52
15 | Long-term Health Effects of Very Low- and High Carbohydrate Diets | Grant Brinkworth Tay et al. ACJN, 2015
Weeks
Values are estimated marginal means SEM FM: Fat mass FFM: Fat free mass
15 | The Diet Debate – fats vs protein vs carbs for type 2 diabetes | Grant Brinkworth, PhD, MBAGlycemic Control: HbA1c
NS: time x diet interaction (p=0.65)
-1% -1%
Long-term Health Effects of Very Low- and High Carbohydrate Diets | Grant Brinkworth
Tay et al. ACJN, 2015
Values are estimated marginal means SEM
16 | The Diet Debate – fats vs protein vs carbs for type 2 diabetes | Grant Brinkworth, PhD, MBADiabetes Medication Use Antiglycemic Medication Effect Score (MES)
* Significant time x diet interaction (p=0.007)
- 0.2
*
- 0.6
Long-term Health Effects of Very Low- and High Carbohydrate Diets | Grant Brinkworth
Tay et al. ACJN, 2015
Values are estimated marginal means SEM
17 | The Diet Debate – fats vs protein vs carbs for type 2 diabetes | Grant Brinkworth, PhD, MBAGlycaemic Variability: MAGE, CONGA, SD
P= 0.09
P= 0.07
- 0.8 mmol/L
- 0.4 mmol/L
- 1.7mmol/L - 0.7 mmol/L
P= 0.003 P= 0.02
- 0.05 mmol/L
- 0.5 mmol/L
*
- 0.5 mmol/L
* Tay et al. ACJN, 2015
- 1.1 mmol/L
MAGE: Mean amplitude of glucose excursions; CONGA: Continuous overall net glycemic action; SD: Standard Deviation
18 | The Diet Debate – fats vs protein vs carbs for type 2 diabetes | Grant Brinkworth, PhD, MBACVD risk markers: Blood pressure, Insulin, HOMA2-IR, CRP
• Significant reduction on both diets
• No diet effect (P≥ 0.38)
CVD Risk LCLSF Diet HC Diet
Markers week 0 Week 52 Change week 0 week 52 Change
Systolic Blood
Pressure (mmHg)
130 123 -7 133 127 -6
Diastolic Blood
Pressure (mmHg)
80 74 -6 81 74 -6
Insulin (mmol/ L)
16.1 10.3 - 5.8 16.0 11.1 - 4.9
HOMA2- IR
2.0 1.2 - 0.7 2.0 1.3 - 0.6
CRP (mg/ L)
2.8 2.0 - 0.9 2.8 1.6 - 1.2
Tay et al. ACJN, 2015
Data are estimated marginal means
19 | The Diet Debate – fats vs protein vs carbs for type 2 diabetes | Grant Brinkworth, PhD, MBATriglycerides
* Significant time x diet interaction (p=0.001)
- 0.01 mmol/ L
*
- 0.5 mmol/ L
Tay et al. ACJN, 2015
Values are estimated marginal means SEM
20 | The Diet Debate – fats vs protein vs carbs for type 2 diabetes | Grant Brinkworth, PhD, MBAHDL cholesterol
* Significant time x diet interaction (p=0.002)
0.1 mmol/ L
*
0.06 mmol/ L
Tay et al. ACJN, 2015
Values are estimated marginal means SEM
21 | The Diet Debate – fats vs protein vs carbs for type 2 diabetes | Grant Brinkworth, PhD, MBALDL cholesterol
No time x diet interaction (p=0.81)
Tay et al. ACJN, 2015
Values are estimated marginal means SEM
22
22 | The Diet Debate – fats vs protein vs carbs for type 2 diabetes | Grant Brinkworth, PhD, MBA
|Flow Mediated Dilatation (Endothelial Function)
No time x diet interaction (p=0.41)
LCLSF Diet
Wycherley et al. Atherosclerosis 2016
Values are estimated marginal means SEM
23 | The Diet Debate – fats vs protein vs carbs for type 2 diabetes | Grant Brinkworth, PhD, MBAMood
• Significant improvements (reduction in scores) over time for BDI and POMS (TMDS and
subscales – Anger, Confusion, Depression, Fatigue, Tension)
- Magnitude of change across domains: 14-43%
• No difference in time-course response between diets (NS, P ≥ 0.22 time x diet)
10
LC 20 LC
POMS - Total Mood Disturbance Score
HC HC
Beck Depression Inventory Score
8 16
12
6
8
4
4
0
2
-4
-8
0
0 4 8 12 16 20 24 28 32 36 40 44 48 52 0 4 8 12 16 20 24 28 32 36 40 44 48 52
Week Week
Brinkworth et al. J Intern Med, 2015
Values are estimated marginal means SEM
24 | The Diet Debate – fats vs protein vs carbs for type 2 diabetes | Grant Brinkworth, PhD, MBACognitive Function – 9 domains
• No differences in response between diet groups for any cognitive function outcome
(P≥ 0.24 time x diet).
• DSST (perceptual speed), OMO (Reasoning Speed), Mscan (Speed of Memory
Scanning) improved overtime (PRenal Function
• Markers: AER, Scr, eGFR and CrCl no differential response between groups, P³0.25 (time x
diet effect)
eGFR (CKD-EPI) CrCL (Cockroft-Gault)
120 100
LC Diet HC Diet LC Diet HC Diet
100
80
eGFR-CKD-EPI (ml/min/1.73m2)
CrCl- Cockroft-Gault (ml/min)
80
60
60
40
40
20
20
0 0
week 0 week 52 week 0 week 52
• Albuminuria:
• Baseline: 7 participants (LC=4, HC=3) with pathological albuminuria
• Week 52: 4 participants (LC=2, HC=2) became normoalbuminuric
• Participants with norm albuminuria at baseline remained constant after 52 weeks
Tay et al. Medicine, 2015
26 | The Diet Debate – fats vs protein vs carbs for type 2 diabetes | Grant Brinkworth, PhD, MBA2-year metabolic outcomes
Outcome LCLSF HC P Value
Completed Study 33/58 28/57
Weight (kg) -6.8 -6.6
Body fat (kg) -4.5 -4.8
Blood Pressure (mmHg) -2.0 -3.2 ≥0.09
HbA1c (%) -0.6 -0.9
Fasting Blood Glucose -0.3 -0.4
Anti-glycemic Medication Effect Score -0.5 -0.02 0.03
Glycemic Variability Indices
- CONGA -1.4 -0.3 0.09
- MAGE -0.4 -0.1 0.001
Triglycerides (mmol/L) -0.1 0.01 0.001
HDL-C (mmol/L) 0.02 -0.1 0.004
LDL-C (mmol/L) 0.2 0.1 0.85
FMD response No Difference between groups
Renal Function No negative effect
CONGA – Continuous Overall Net Glycaemic Action 1; MAGE – Mean Amplitude of Glucose Excursion
Tay et al. DOM 2018
27 | The Diet Debate – fats vs protein vs carbs for type 2 diabetes | Grant Brinkworth, PhD, MBAResults Summary & Conclusion
Low carbohydrate, high protein, high unsaturated, low saturated Current Standard Practice – High unrefined carbohydrate (low GI), low
fat diet protein, low fat
Anthropometric Anthropometric
- Weight loss - Weight loss
- Body composition - Body composition
Glycemic Control Glycemic Control
- ↓ HbA1c - ↓ HbA1c
- ↓ Diabetes Medication reduction (2x) - ↓ Diabetes Medication reduction
- ↓ Diurnal glycemic variability (3x) - ↓ Diurnal glycemic variability
CVD risk CVD risk
- ↓ Total and LDL-Cholesterol - ↓ Total and LDL-Cholesterol
- ↑ HDL-Cholesterol (2x) - ↑ HDL-Cholesterol
- ↓ Triglycerides (40x) - ↓ Triglycerides
- Flow meditated dilatation ❁ - Flow meditated dilatation ❁
Psychological Wellbeing Psychological Wellbeing
- ↑ Mood - ↑ Mood
- ↑ Quality of Life, Diabetes self-management - ↑ Quality of Life, Diabetes self-management
- ↑ Cognitive Function - ↑ Cognitive Function
Renal Function Renal Function
- eGFR, albuminuria ❁ - eGFR, albuminuria ❁
28 | The Diet Debate – fats vs protein vs carbs for type 2 diabetes | Grant Brinkworth, PhD, MBAConclusions
• Both LCLSF and HC diets produced similar weight loss, body composition changes,
improvements in CVD risk markers, mood, quality of life and cognitive function
• LCLSF diet had more favorable effects on:
– lipid profile
– glycaemic control
– attenuating glucose fluctuations
• Incorporation of a low carb, healthy fat eating plan (50-70g CHO/day) within a
comprehensive lifestyle modification program magnifies therapeutic benefits for:
- improving both acute and chronic glycaemic control
- reducing glycemic variability
- enhancing CVD health
29 | The Diet Debate – fats vs protein vs carbs for type 2 diabetes | Grant Brinkworth, PhD, MBAConclusion
• All Low carb diets may not be equal
• All energy reduced diets (including Low Carb and High Carb diets) produce weight
loss and improve glycemic control and CVD risk markers
• A low carb diet (high unsaturated / low saturated fat) may:
- magnify metabolic benefits of weight loss
- more effective for people with Type 2 Diabetes and Metabolic Syndrome
• One size (diet) may not fit all individuals
• Variety of diet approaches for weight and diabetes control is required to
individualise management based on personal preferences:
- tradition, culture, religion, economics, and metabolic and health beliefs and goals
30 | The Diet Debate – fats vs protein vs carbs for type 2 diabetes | Grant Brinkworth, PhD, MBAThe CSIRO Low-Carb Diet
• Step-by-step guide to translate low carb diet plan
into easy practice
• Daily food allowance units tailored for individual
energy requirements
• 12 weekly meal plans and shopping lists
• 80 recipes, including breakfasts, lunch, dinner
(including vegetarian), snacks & desserts
• A comprehensive exercise plan
1 2 3 5
Bread, cereals, Healthy Fats
4 Lean meat, fish,
Low-moderate Dairy poultry, eggs,
legumes and carb vegetables High healthy
starchy Adequate dairy tofu
fats / low
vegetables Unlimited Low saturated fat
Low-fat milk / High lean
Carb Veg Nuts, seeds, oils, protein
Limited Carb yoghurt, cheese
avocados, olives,
31 | fishStudy and Funding Collaborators
External Funding
• NH&MRC Project Grant (App1030415, 2012-2014)
Collaborators
• University of South Australia
• University of Adelaide
• Flinders University
• Duke University
Community Service Providers
• Fit for Success
• SA Aquatic Centre & Leisure Centre
• Boot Camp Plus
32 | Long-term Health Effects of Very Low- and High Carbohydrate Diets | Grant Brinkworth
32 | The Diet Debate – fats vs protein vs carbs for type 2 diabetes | Grant Brinkworth, PhD, MBAAcknowledgements – Team Members Chief Investigators - Grant Brinkworth, PhD; Manny Noakes, PhD; Jonathan Buckley, PhD; Campbell Thompson, PhD; Natalie Luscombe- Marsh, PhD; Carlene Wilson, PhD; Gary Wittert, MD Co-Investigators and Research Associates - Tom Wycherley, PhD; Will Yancy,PhD, Jeannie Tay (PhD); Vanessa Danthiir, PhD; Ian Zajac, PhD Clinical Research Team and Data Management - Anne McGuffin; Lindy Lawson; Julie Syrette; Julia Weaver; Vanessa Courage; Peter Royle Dietetics Research Team - Pennie Taylor; Janna Lutze; Fiona Barr; Paul Foster; Hannah Gilbert; Gemma Williams Laboratory Research Team - Vanessa Russell; Cathryn Pape; Candita Dang; Sylvia Usher; Andre Nikelic Research Exercise Leaders - Fit for Success: Luke Johnston, Annie Hastwell - SA Aquatic Centre & Leisure Centre: Kelly French, Jason Delfos, Kristi Lacey-Powell, Marilyn Woods, John Perrin, Simon Pane, Annette Beckette - Boot Camp Plus: Angie Mondello, Josh Gniadek 33 | The Diet Debate – fats vs protein vs carbs for type 2 diabetes | Grant Brinkworth, PhD, MBA
The diet debate: fat vs protein vs carbs in type 2 diabetes Role of a Low carbohydrate, high protein, high unsaturated fat diet ESA Seminar 2018 Diabetes, diet and exercise: Symposium in Honour of Dennis Wilson Professor Grant Brinkworth, PhD, MBA | Principal Research Scientist 4th May 2018
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