1. Understand in broad outline the benefits of carbohydrate restriction for diabetes and metabolic syndrome.
2. Have awareness of the literature studies on low-carbohydrate diets for the treatment of diabetes.
3. Discuss with patients the resources and information available for diets stressing carbohydrate restriction.
The authors have disclosed that they have no significant relationships with or financial interests in any commercial organizations pertaining to this educational activity.
Diabetes is fundamentally a disease of carbohydrate intolerance. Reduction in dietary carbohydrate, alone or as an adjunct to pharmacology, is thus an intuitive approach to treatment. The major therapy before the discovery of insulin, low carbohydrate diets are perceived as part of diabetes therapy by many physicians and laymen alike. Since the discovery of insulin, however, the standard diet has emphasized fat reduction and health agencies have specifically discouraged the use of low carbohydrate diets although the American Diabetes Association (ADA) (1) has recently given limited acceptance, at least for weight loss.
It has also been argued that carbohydrate restriction improves all the features of metabolic syndrome and, as such, provides an operational definition (2) as well as a treatment modality, an idea supported by prospective studies(3).
For the practitioner contemplating the use low-carbohydrate diets, there is a need to understand the basic rationale for a course of action different from standard recommendations. Guidance on implementation is also required, especially for patients already on medication where one has to avoid the risk of hypoglycemia due to the combined effects of drug and diet.
DN, a 56 y/o Caucasian male presented with a 3 year history of type 2 diabetes, coronary artery disease, hyperlipidemia, hypertension, gastroesophageal reflux disease, sleep apnea, and depression. His weight was 131.1 kg, BMI 41.4 kg/m 2. Blood glucose varied from 130 to 390 mg/dL and hemoglobin A1c was 8.2%.
Medications included Lantus insulin 46 units daily, Byetta 5 mcg twice daily, glipizide 10 mg twice daily, Nexium 40 mg daily, Toprol 100 mg daily, Enalapril 20 mg daily, Cymbalta 40 mg twice daily, Lyrica twice daily.
DN was started on a carbohydrate-restricted diet (< 20 grams/day) and followed at 1-2 weeks intervals to monitor adherence and medications. Because reductions in dietary carbohydrate allow return to more normal glycemic control and reduced insulin fluctuations, insulin and other glucose-lowering drugs must be reduced in advance. Upon program initiation, DN's Byetta was discontinued, insulin was reduced to 30 units but glipizide was continued. After two weeks, blood glucose was 94 to 172 with several readings below 100 mg/dL and insulin was discontinued. By the fourth month DN had only been able to reduce his weight by 8 % to 120.6 kg (BMI 38.1 kg/m2), but blood glucose was 111 to 156, (HbA1c =5.7%) and he was able to discontinue all medication.
Several reports in the scientific literature, consistent with the case study, provide support for low-carbohydrate diets as an attractive alternative if not the preferred treatment in diabetic and pre-diabetic states (4) A recent small study has been followed to 44 months (5).
1. Carbohydrate restriction improves glycemic control, the primary target of nutritional therapy and reduces insulin fluctuations.
2. Carbohydrate-restricted diets are at least as effective for weight loss as low-fat diets.
3. Substitution of fat for carbohydrate is generally beneficial for markers for and incidence of CVD. Whereas low-fat diets are generally more effective for reducing LDL, dietary carbohydrate is the strongly correlated with small dense LDL which are considered more atherogenic and carbohydrate restriction is the most effective method of lowering triglycerides and raising HDL.
4. Carbohydrate restriction improves the features of metabolic syndrome.
5. Beneficial effects of carbohydrate restriction do not require weight loss.
Points 2 and 5 are of particular importance in that the 2008 ADA Recommendations and Interventions (7) received some attention for admitting, for the first time, that "for weight loss, either low-carbohydrate or low-fat calorie-restricted diets may be effective in the short term (up to 1 year)." The emphasis on weight loss rather than glycemic control seems odd to many but given how difficult it is to lose weight by any method, patients and physicians should be encouraged by the fact that benefits accrue to low-carbohydrate diets even if weight reduction is not attained . Experiments in the literature have demonstrated dramatic improvements in triglycerides and HDL-C in patients with type 2 diabetes under conditions where reduction in body mass were minimal(8).
One of the ironies in this recommendation is that insulin therapy is established to pre-dispose to weight gain(10). Patient apprehension of the possibility of insulin-related weight gain has been cited as a barrier to insulin use(11).
Reduction in medication is sensibly taken as improvement in a medical condition. The case study above is characteristic of the carbohydrate-restriction interventions and remains one of their strongest benefits(12). At the Duke Lifestyle Clinic, using diets of 20 grams carbohydrate maximum per day (VLCKD; Table 1) it has been possible to have patients taper off as much as 280 units of insulin in 3 weeks. Because there is immediate improvement in glycemic control, patients already on glucose-lowering drugs must have medication reduced or eliminated before a change in diet. Blood pressure also improves, so patients taking antihypertensive medication require monitoring as well.
The concept of a metabolic syndrome (MetS; insulin resistance syndrome) has had great intellectual impact in medicine because it suggests that a broad and seemingly disparate set of conditions of overweight, hypertension, atherogenic dyslipidemia (high triglycerides and small dense-LDL-C and low HDL-C) have a common origin. The underlying factor is likely insulin resistance, simultaneously a feature of the diabetic or pre-diabetic state. Recent papers in this journal and others have raised the question as to whether the concept is really useful for the clinician (13). That is, would characterization of multiple markers as a syndrome lead to any different treatment than the sum of the treatments for each individual risk indicator?
The observation that traditional and emerging markers of MetS are precisely those that are targeted by carbohydrate restriction provides evidence for the appropriateness of the designation syndrome and suggests, as well, a unique method of treatment (14). Thus, there are many ways to treat obesity but none are as effective as carbohydrate restriction at improving triglycerides. Known since the fifties (15) this is probably the most robust response to any dietary intervention, Similarly, there are several pharmacologic approaches to raising HDL-C or improving hypertension but few target the other markers. In addition, low-fat diets tend to lower HDL-C and, in any case, seem to require weight loss for beneficial effects whereas carbohydrate restriction does not. Carbohydrate restriction is also of obvious value in improvement of glycemic and insulin responses which are frequently exacerbated by low-fat diets.
That the collection of markers is improved by a single type of intervention argues for the existence of a common (carbohydrate-sensitive) mechanism and suggests for the physician that treating any one marker by reducing carbohydrate has the potential to prevent the onset of others which may not be evident at the moment. This hypothesis was tested in a prospective study in which forty overweight subjects with atherogenic dyslipidemia were randomly assigned to dietary interventions restricted in fat (low fat diet, LFD) or carbohydrate (carbohydrate-restricted diet, CRD). Subjects consuming the CRD had improved glycemic control and insulin sensitivity, greater reductions in weight and adiposity and improvements in several inflammatory markers(16).
Implementation of low carbohydrate diets is complicated by the lack of clear definitions. Many studies show benefits proportional to the reduction in carbohydrate but there also appears to be a threshold effect reflected in the recommendation for very low carbohydrate diets, the so-called induction period of popular diets such as the Atkins Diet. Table 1 lists definitions which would probably be accepted by most workers in low carbohydrate diets.
Carbohydrate-restricted diets do not generally specify what the carbohydrate is to be replaced with leading critics to characterize them as high-fat or high-protein. LaRosa was the first of several researchers to show that in practice, many dieters simply reduce calories by removing carbohydrates without replacement (17). Protein in the diet generally tends to be relatively stable and the key question is the relative amounts of fat and carbohydrate. According to the rationale for carbohydrate restriction, where glucose and insulin are control elements, fat is expected to play a relatively passive role and specific recommendations to reduce fat are unnecessary. Undesirable effects of high fat are seen only under conditions where carbohydrate is moderate to high and, in any case, substitution of carbohydrate for fat is almost always deleterious (18).
A survey of an online support group, the Active-Low Carber Forums showed, perhaps surprisingly, that the major change for dieters was increase in the consumption of non-starchy vegetables (19). Low-carbohydrate diets may in some sense be characterized as high-vegetable diets. Finally, although critics of low carbohydrate diets point to limited choices, there are now thousands of recipes and strategies on the Internet, the most comprehensive is probably the site at About.com (http://lowcarbdiets.about.com/).
Exercise clearly enhances the proportion of fat loss, especially if the exercise involves resistance training. The combination of resistance training and diet has been investigated in two studies which both showed that men and women who consumed a low carbohydrate diet while performing resistance training 3 times per week had the greatest decreases in percent body fat (20).
Side effects and, conversely, the ability to realize therapeutic goals strongly affect adherence to any intervention but compliance with a diet is largely separate from the efficacy of the diet itself and depends on the motivation, external support and the overall features of the patient-physician interaction. Low-carbohydrate diets attain at least as high a degree of compliance as low fat diets in experimental trials but such experiments may not offer the full potential for patient support.
The internet provides opportunity for support of people attempting to follow a low carbohydrate diet. The Active-Low Carber Forums (http://forum.lowcarber.org/ ) as of September, 2008 had more than 110, 000 members. The forums and similar support groups specifically targeting people with diabetes offer support and suggestions for implementing dietary plans. The widespread use of glucometers suggests that people with diabetes my have a unique opportunity to participate in their own medical nutrition therapy. Education and support from physicians will be most successful in patients who are able to discover for themselves which foods or combinations of food will allow good glycemic control.
In treating patients already receiving medication, physicians may need training in the use of low-carbohydrate diets but the literature and case studies are consistent with the intuitive value of such diets.
Dr Feinman congrats for your blog. I consider you a major contributor in the nutritional treatment of the Metabolic Syndrome. I would like to ask a question that puzzles me. In terms of the general public and the medical community involved with this, especially dietitians and nutritionists, is there any awareness that carbohydrates are not an essential nutrient?
This is a good question. With respect to the medical community, I work in a medical center and there is a wide range of understanding of metabolism but a substantial appreciation by many physicians of the benefits of carbohydrate restriction. Most physicians are interested in helping the patient, are not particularly doctrinaire but many clinicians are overworked as it is and are unlikely to want to fight with the nutritional board of the American Diabetes Association who are part of and speak for the most narrow-minded, political segment of the organization. I suspect there is even more confusion among dietitians who are even more constrained by limitations on their licensing although many understand the physiology. And, of course, the general public has a still wider range of views and more confusion.
On the specific question of there being no requirement for dietary carbohydrate, some take this as an objectionable recommendation for a zero carbohydrate diet which, if it were even possible (even red meat has glycogen), is not recommended by anybody. My current research activity involves collecting and tabulating patient responses to carbohydrate restriction in diabetes because the stories are so compelling. So why is there so much resistance? Why, don't people understand the benefit of carbohydrate-restriction? Some have not the capacity to ask. Some simply don't get it. A few are genuinely evil: consider political benefit beyond anything that happens to the patient. In the end, a large number of people do understand but it has not been possible, despite the blogs, despite the forums, to get people together. I had tried do this with Nutrition & Metabolism society and still am trying (http://www.nmsociety.org and our face book page). If you are volunteering to organize a meet-up or some kind of group in the UK, I'm at feinman@mac.com.
Thank you for the reply Dr Feinman. I suspect this antithesis of some people is partly to the "fad-diet" stereotype of restricting carbohydrates, and a slippery slope of the fact that carbohydrate is not essential. Another explanation is that restricting carbohydrates is too simple for some people to go under the label of "science based" , I find this in practice too. Whenever I inform clients that carbohydrates are not an essential nutrient the almost immediate response (or thought) is that they think I am suggesting they ban all carbohydrates forever.
My advice (and my own behavior) is to get all or most of your carbohydrate from vegetables. People do have to recognize, as explicitly said in the new Atkins book, that "a fruit is not a vegetable." Along those lines, one of the popular experts that I like is Suzanne Sommers because she understands the problem (after all, what does Walter Willett know about having a weight problem): she lost a part in Starsky and Hutch because they told her she was "too chunky." She recommends eating fruit in pieces in the course of the day (reduces insulin surges) and eating that way helps.
Can you please make the article PDF accessible? Thank you.
It's because you're a lucky guy. Dietary carbohydrate restriction is primarily therapeutic. Although many people stay on low-carbohydrate diets because they feel better, the dietary approach is primarily for people who don't react to carbohydrate the way you do. You're a lucky guy.
So Ken you have 2000 to 2800 calories JUST FROM CARBS (!!!) everyday and still manage to stay at 12% bodyfat , at 40 years of age. Dr Feinman, I think you should do a case study here. If we assume that you get some protein and fat in your diet you could be eating 4000 calories easily. I can give some explanations to that: a) you don't know how to count carbohydrates. You may count the weight of foods rich in carbs but not the actual energy/carbohydrate content. b) Your count is right and you do 3-5 hours of hard exercise every day which I personally think is highly unlikely. c) A combination of bad counting and 2-3 hours of exercise d) Your home and everything in it is made of DNP and e) You are lying, which doesn't happen very often in the internet.
I take this as an offer to fund a case study, is that right? Until we are underway on that, we have to assume that Ken is roughly describing his experience. In early phases of low carb diets people describe rather remarkable intake of protein and fat that Ken would not believe. The principle "one size does not fit all" is almost always disingenuous but it is a good principle until you do get hard data from the case study. The check can be made out to the Research Foundation of the State University of New York and mailed to me.
I'd like to see this guy's complete thyroid panel. I'd guess he has very good T3 conversion.
Nevertheless, your work is excellent, and should receive more funding. Keep it up!
Thanks. You know how to make out the check, right?
I enjoy reading your posts. This one in particular I am spreading far and wide in the hope that people will learn how to 'get well' and loose weight and generally feel better!
My question is – are you an advocate that if you 'do this diet' and get better, you can go back to living life, just like you did before? I certainly am not of this opinion. I do not believe for example Type 2 DM can be cured. I do however believe it can be put into remission – and stay that way, so long as you don't regress to your old lifestyle….. YES lifestyle – not diet.
Thank you. I think that very few people can go back to carbs. In fact, from what I see and what I read — I am not a health care provider — there can be many variations and problems. What we know is less than what we don't know and type 2 DM can be difficult but we do know the big principles. On the other hand, for many people a lifestyle change can be so beneficial as to put the question of a cure into the realm of semantics. In some sense, I definitely feel that my nearsightedness has been cured…if I wear my glasses.


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Toby Stephens and Claire Skinner to star in West End revival of A Day in the Death of Joe Egg
Musicians' counselling service established to tackle stress and anxiety of profession
Susie McKenna and Taio Lawson join Kiln Theatre as associate directors
Ken Stott: 'Actors can't make a living from theatre anymore. It's chilling'
Ken Stott in The Dresser. Photo: Tristram Kenton
by Mark Shenton - Oct 20, 2016
When I go to meet Ken Stott at London's Duke of York's Theatre, he's like a touring actor arriving at the stage door for his latest visit to a familiar place.
He is starring there in a new production of Ronald Harwood's The Dresser, and it's the first time he's been back since he last appeared at the venue in a revival of Arthur Miller's A View from the Bridge in 2009.
We enter the Number One dressing room, just inside the stage door entrance. He sniffs around the room that he's going to call home for the next 16 weeks, checking out the fridge (empty, except for a pint of fresh milk), the kettle (same make, but different model to the last time he was here), and the furnishings.
For the next hour, he barely settles, and talks to me mostly standing up. There's a restlessness to him, and there are times when his mind seems elsewhere. He's not good at recalling facts – he can't remember which West End venue he performed God of Carnage in, for instance (it was the Gielgud Theatre) – but he's unfailingly polite and chuckles frequently. He is both warm and brutally honest in his replies to my questions, even when he is extremely critical about aspects of the business of being an actor. This ranges from how Margaret Thatcher changed the business forever by abolishing the closed shop, to how film auditions are conducted, to bad behaviour in the stalls.
Ralph Fiennes, Janet McTeer and Ken Stott in God of Carnage at the Gielgud Theatre, London, in 2008. Photo: Tristram Kenton
"I do think it's very bleak at the moment," he says at one point, towards the end of our conversation. "For so long we've lived in this awful society created by Thatcher's deregulation of everything. We can't even make a living anymore from the theatre or television. The first thing an aspiring actor must do is become an Equity member and support anything that gives more power to the actor. We relinquished so much in one fell swoop with Thatcher and in the ensuing years with the belief that anyone can do this. I seem to find myself working with people who have not been to drama school; we're losing the language that used to unify us about how to rehearse and approach a script. I find it very chilling."
It's not the only thing he's down on. He's been performing in more films recently, including a recurring role in The Hobbit feature film series, and also a surprise appearance (to him as well as us) in Woody Allen's recently released Cafe Society. How did the job come about? "I have no idea. They sent me a piece of dialogue, and I put myself on a tape for him, and he liked it. That's all I know. It was pretty daunting – you have to remember I'm being asked to play a Jewish man from the Bronx, by a man from the Bronx. It's quite far from myself, but too close to him for comfort. But I got away with it."
Q&A: Ken Stott
What was your first job? Appearing in Saint Joan at the Lyric Theatre in Belfast. I earned £18.50 a week.
What do you wish someone had told you when you were starting out? That you can't see good acting. I've always known what bad acting was – I would be carrying a spear and watch someone thinking: 'I can fucking do that a lot better' – but I wish I'd known what good acting was.
What's your best advice for auditions? Wear something that makes you feel comfortable – you are yourself, so don't try to be someone else until you open your mouth.
If you hadn't been an actor, what would you have been? A singer.
Do you have any theatrical superstitions or rituals? I used to love them, thinking they were part of the fabric and rich tapestry of theatre, but I have none now. I do not observe them anymore at all. I don't have any God that I believe in, so how could I possibly have superstitions?
The Hobbit came about in similar circumstances, following an audition tape he sent in. "It's become the norm for the way films are now cast, which, if you think about it carefully, is wrong in so many ways. There was a time when you only met the director, if you were up for a job. Now, we never meet them; we do a piece of dialogue in front of a camera, and the director chooses from that accordingly. We don't have a clue about each other. What they don't realise – or maybe they do and there's nothing they can do about it because the production company won't pay for them to come across and meet the actor and talk to them – is that if they don't like what they see, they can't change it. If the actor and the director were in the same room, we might have the opportunity to turn it into something that they do want. But with a tape, what you see is what you get. The art of acting is insulted, and the art of directing also gets a swipe."
They're fighting words, yet they're spoken with a measured kind of resigned calm. That's not always been the case. When he was last on the same stage in A View from the Bridge, there was an incident with a rowdy school party and he stopped the show to admonish their bad behaviour. "Choose a show – any show – and they'll tell you stories of wretched mobile phones going off, or in this case teachers who were not controlling their children properly."
Stott and Laura Carmichael in Uncle Vanya at the Vaudeville Theatre, London, in 2012. Photo: Tristram Kenton
Today, he seeks to make amends for it and to put it into context. "I do have some regrets around that. The spotlight was suddenly on these two kids who were making the performance hell for everybody, but it's the teacher who should be blamed. What I should have done at the time, and I didn't – and it's something that wakes me up in the middle of the night – is that I didn't take the steps to identify the school, the teacher and the children and invite them back to see the show again. That is what I should have done – not the teacher, but the kids. For goodness sake, my father was a teacher, and I should have known better than to blame the kids. It was, I suppose, a fit of pique. The red mist came down and I took it out on them. In retrospect, I wish I'd apologised to the kids for being so angry."
A few years earlier he had starred in Heroes opposite Richard Griffiths at Wyndham's Theatre just up the road, and remembers Griffiths stopping the show when a phone went off. "He launched into a tirade, lambasting the person for ruining the play for everyone. It went on too long, quite frankly, and I thought: 'Enough.' Also, it was just one page from the end of the play, so by the time we got back to it, we'd kind of forgotten what we'd done and then the audience was asked to applaud. Sometimes it is better to say nothing."
Richard Griffiths, John Hurt and Stott in Heroes at Wyndham's Theatre, London, in 2005. Photo: Tristram Kenton
But then he chuckles as he remembers how he stopped a show himself at this very theatre: "I do remember a phone went off here, and I said, 'Is it off now?' There was no reply. So I said, 'Switch your phone off and tell me when you have done so.' This small voice finally mumbled, 'I've switched it off.' "
There was also the sad event of his previous West End first night, when he starred in the title role of Uncle Vanya at the Vaudeville Theatre in 2012. The last minutes of the performance were disrupted by an audience member crying out that it wasn't good enough. It turned out to be the great former director of the National Theatre, Peter Hall. "That was rather unfortunate," Stott says today. "None of us are sure why he was invited, as it was well-known that he was not in sound mind [Hall was diagnosed with dementia in 2011], but they did their level best to pretend he was and it didn't work." He is, however, proud of the work: "I think our production was rather good, and it grew. All productions do."
Theatre, of course, was for a long time his main home as an actor. He had a particularly golden age during Richard Eyre's tenure at the National, appearing in the world premiere of Miller's Broken Glass (for which he won an Olivier in 1995 for best actor in a supporting role, and which transferred to the Duke of York's Theatre), Three Men on a Horse (which transferred to the Vaudeville Theatre, London), The Recruiting Officer, The Sea, Jacobowsky and the Colonel and The Prince's Play, the last of which he gently recalls as "a thing of beauty". He also says he'd love to go back: "I'd be very happy to work there again – I would welcome it."
Stott with Reece Shearsmith in The Dresser. Photo: Tristram Kenton
He subsequently earned his stripes in the commercial theatre when he was part of the original triumvirate of stars in Yasmina Reza's Art at Wyndham's Theatre. When I ask how it feels today to know that it is coming back to London's Old Vic in December, he says: "It's a play that never occurred to me would be done again. It's nice to know that, when people get a copy of it, my name is on the front, and I was very proud to be on stage alongside Tom [Courtenay] and Albert [Finney]. I used to pinch myself – 'I can't believe this, I'm on stage with them.' "
I didn't want to do The Dresser. I thought it was dated… [but] it is so much better than I remembered
His co-stars in that show provide a nice symmetry with his return to the stage now in The Dresser, since Courtenay was in the original West End production (playing the title role opposite Freddie Jones as Sir), and Finney appeared in the 1983 film version as Sir, opposite Courtenay reprising his stage role.
But Stott initially resisted approaches to do it himself. "Funnily enough, there was talk of doing it a few years ago, and I didn't want to. I'm not sure why. I think I thought it was dated, but this time around when I was asked to do it by [producer] Mark Goucher, I read it again and I thought: 'What on earth had made me think it was dated?', because it isn't – it's bright and it's funny and it's tragic. It is so much better than I remembered. And people outside our business are fascinated by the theatre, they absolutely love it, and any opportunity to have a glimpse backstage is gleefully accepted."
Playwright Harwood was himself a dresser to the veteran actor-manager Donald Wolfit, but Stott notes that Harwood "is adamant that it is not about them". In his long and varied career, however, Stott notes that he's known actors like Sir and dressers like Norman.
"They abound. Or maybe I should put that in the past tense, as they seem to be a dying breed. But there are dressers I have known who are very much like Norman, and cantankerous Sirs." Does he have a dresser himself on the show? "There's a very nice girl in the wardrobe department looking after me."
He's relishing being back on stage: "But I'm an old man now," he says [in fact he's just turned 62 this week], "and I rue the fact that I can't run around the stage as I once did. There's a helluva lot of energy required in this production. I wouldn't want it any other way, but the body does retaliate, though, and I have to pull and drag myself through it. But it does always feel worthwhile."
Eileen Nicholas and Stott in Through the Leaves at the Bush Theatre, London, in 1985. Photo: Conrad Blakemore
Prior to the West End, it played a few touring dates outside London – in Cheltenham, Brighton and Richmond – but he says: "It feels like we've done three months, but it has only been 21 performances." And honest again to the last, he also admits frankly: "I don't love touring. I have no fondness for the touring life, I think I can say categorically. I worked all over the country in rep when I was younger, and that experience was enough."
So was his experience of being a salesman of double glazing, early on in his career, fresh out of training at Mountview Academy of Theatre Arts. "I had no work as an actor and no money and an overdraft and a desperate need to pay it off. And there seemed to be no prospect of doing it as an actor. A pal of mine, who was also an out-of-work actor, said to try his double-glazing business – he said to tell them I was an absolute shit and all I cared about was making loads of cash and they would love me. I had a couple of lucky breaks with people buying it, but the moment I paid off my overdraft, I kissed it goodbye."
Another career sideline he gave up a little more reluctantly was performing in a band. "I joined a very good band called Still Life after I left drama school and they were excellent musicians, but I had to leave because I got a job as an actor. I would have loved to have gone on, but I knew I wanted to be an actor and needed to do that. I sometimes wish I'd stayed a little longer just to enjoy it."
Ken Stott's top tip for an aspiring actor
• Forget drama school – just go to the gym and get fit. We only need superheroes now, nothing else.
But if he misses that particular calling, he found a ready audience in television, with starring roles in a number of successful TV series – Takin' Over the Asylum, The Vice, the title character in Rebus, Messiah and, most recently, The Missing.
"I sort of put an end to The Vice and Rebus because I didn't want to get to a place where all anyone can think about is you and that character. But afterwards, I've thought, hold on, Helen Mirren has done how many Prime Suspects? Why was I so worried? An actor doesn't want to get typecast, but I don't think anyone needs to worry about it at all. And they're very artistically useful – it is from them that I get the confidence for film."
He's also proud of his Scottish origins and still speaks in a gentle Scots burr. He came to London to train, he says, because "Scottish actors were still seen as people who wore kilts – they suffered from the Gordon Jackson syndrome".
"But something we never really got out of is the Lord [John] Reith rubbish that there should be a standard English spoken and that the BBC should lead the way," he adds. "Reith did more damage to our society than I think anyone gives him the credit for. It reinforced, if not invented, the idea that if you speak with an accent, you cannot play leading roles. But RP is the one voice I cannot stand, because of its slipperiness: it hides where you've come from and who you are. And there is something about it that is part of an English culture of a feeling of superiority and entitlement."
Stott shoots from the hip, and it's certainly refreshing to hear. He's also proof of the upward mobility of an actor who has retained a connection to his own roots while being able to play absolutely anyone, from a touring actor-manager, as he is now, to Eddie Carbone (the New York longshoreman from A View from the Bridge) or Uncle Vanya.
CV: Ken Stott
Born: 1954, Edinburgh
Training: Mountview Academy of Theatre Arts
Landmark productions: The Recruiting Officer, National Theatre (1992), Broken Glass, National Theatre (1994), Duke of York's Theatre, London (1995), Art, Wyndham's Theatre, London (1997), God of Carnage, Gielgud Theatre, London (2008), A View from the Bridge, Duke of York's Theatre, London (2010), Uncle Vanya, Vaudeville Theatre, London (2012)
Awards: Olivier award for Broken Glass (1995), BAFTA TV award Scotland for The Missing (2015)
Agent: Roger Charteris, the Artists Partnership
The Dresser runs at the Duke of York's Theatre, London, until January 14
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Mid-scale touring 'near-unaffordable', claims major Arts Council theatre report
Mark Shenton is a theatre critic and journalist who has written for The Stage since 2002
The Dresser review at the Duke of York's Theatre, London – 'Ken Stott...

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text:
March 5 2011 - January 21 2022
0Neils40yarder
Big Stall
Showing content with the highest reputation on 06/11/2021 in all areas
Take him a square go maybe
Only if we get Jocky Scott (and his jetpack) in as well.
Former Motherwell Fc Players Thread
What's Connor Sammon got to do with Danny Johnson?
unfortunate choice of words here.
A fit and healthy Griffiths with his head screwed on would be a fantastic signing.
Whilst I don't know enough to argue against your assertion about his time in England I'm not convinced your point about the Premiership/Scotland is correct. He wasn't a kick off double figures by the turn of the year having scored against both halves of the Old Firm and Aberdeen in a Motherwell team that was far from fluent. He simply wasn't given an opportunity thereafter when the formation changed post-Ross County Cup loss. He also scored 7 goals in 20 appearances for Dundee which isn't the worst record either.
A goal every two games at every club he's played at, including Motherwell and Dundee. That's exceptional. He's one of those players that makes me think I must know fuck all about football if he's not been able to impress with those stats.
It's all gone very quiet on the squad rebuild only 1 confirmed signing so far, and alleged interest in Lafferty, the season starts in just over 4 weeks with the league cup, time we had some new players in to discuss.
New strip
As much as i love that 94/95 away top, i still think the Canterbury away which is similar is a better looker. IMO
I'd just like to think there are better out there. There must be a striker somewhere who could emulate Moult and we could get a payday at the end of his time. Issue is finding him. Can't help but feel I've seen this adoration of a player numerous times before. Cup final in 2017, Bigi plays OK compared to the rest, many on here see his regular inclusion as the key to success. Hastie, purple patch, a few wise heads were suggesting the hype should be tempered and that, with hindsight was astute. Lafferty has a number of things not going for him, attitude, age and a run of good games after a significant drought. Adding penalties to his tally has to be tempered too, what's important here if he was instrumental in them being won rather than slotting them away. In his favour, he seemingly single handedly kept a rank team their top flight status a possibility until the last round of fixtures. But context is required, I didn't watch all of both legs of the playoff, maybe that's a better indicator. His arrival would result in a shoulder shrug rather than genuine anticipation for me.
Interesting statement by Killie. If he's after that money he's onto plums. Going in asking that after being relegated and their annual revenue in mind boggling. I bet Flow would like to unleash the dragon with a statement like that on a few agents or players. Would be a glorious thing to read.
Loved him as a lad but some of Colin O'Neil's pish and behaviour is worthy of that mantle of late. Andy Walker and Tom Boyd who were infected with COVID-OF-1690 worthy of a shout. Wasn't there some unwarranted bitching at the time of administration (Greg Strong) or was it legimate? Add Goram itching, waiting to get to a PA at an Orange Lodge to belt out the classics. Let's not overlook a recent departure: https://www.pressandjournal.co.uk/fp/sport/football/ross-county/3199291/ex-caley-jag-liam-polworth-on-being-made-to-train-with-kids-at-motherwell-as-he-confirms-ross-county-link/
Almost as predictable as you coming on here to play your broken record on this subject. Why you insist that what transpired is fully legit and all parties are without reproach without written affidavits from all sides and an Mi5 surveillance sting operation is the other side of the coin. What would you need to change these from baseless to believable? The subject has been covered at length in other threads. He agreed on a deal, got a wage increase, changed his mind, tried to engineer a move, renegotiated and contract end date changed. A 10 year old playing Cluedo could put all the clues together for a plausible timeline of events. Essentially his actions meant we lost out on a decent potential transfer fee (however would he have been pursued if it was attached to his signature?). I accept the alternative was having a petulant wean playing centre half till next summer. When it quacks like a duck, floats like a duck, looks like a duck and is called Daffy ...... it's probably a fucking duck.


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The History of New Hampshire's Weirs Beach on Lake Winnipesaukee
Weirs Beach Has Been Inhabited For Thousands of Years
Today, Weirs beach is one of the fun hotspots on Lake Winnipesaukee with great food, a boardwalk full of fun activities for the whole family, and the home of the M/S Mount Washington every summer. But did you know that this valuable piece of real estate has a history stretching back thousands of years?
The Original Summer "Resort"
Recent archaeological expeditions at the beach have found that Native Americans used the area as a summer camp for hunting and fishing dating back to 8000 BC. The native Abenaqui of the Penacook tribe called their village Aquedoctan, meaning "place of good fishing."
In fact, this popular summer resort actually got its name from the particular type of basket the Native Americans used to trap the shad that migrated through the channel on their way from Lake Winnipesaukee to the Merrimac River, to the sea. These fish traps were called "WEIRS" and went into the channel to prevent the shad from moving through the channel to the river.
Then, in 1652, an expedition sent by Governor Endicott of the Massachusetts Bay Colony followed the Merrimac from its mouth, located in what is now Newburyport. Arriving at Lake Winnipesaukee at Weirs channel, they carved their initials into a rock, Endicott Rock, to mark the northern boundary of the colony. The stone is still there today, protected by a monument erected in 1892. The first white settlers arrived in 1736, with the construction of a fort. This was the end of the Native American habitation of Weirs.
The Arrival of The Tourists
By 1848, the Boston, Concord and Montreal railroad arrived in Weirs and with it, New England tourists. Within a few years, Weirs had become one of the most popular tourist destinations in the United States.
In 1849, seeing the increase in passengers visiting Weirs, the Boston, Concord & Maine railroad purchased the steamship "The Lady of the Lake". From her homeport in Weirs, The Lady of the Lake offered regular steamship service to the ports of Wolfeboro, Center Harbor, and Alton Bay, until her last service in 1893. In 1872, the competing B&M railroad began service on the lake, launching the Mount Washington. It was the longer, faster, and more luxurious ship, and soon dominated passenger service serving 60,000 passengers each year.
By the turn of the 20thcentury, four express trains each day left Boston bound for Weirs. Train travel reached its peak in 1915. As the age of the automobile began in earnest, train service from Boston started a long, slow decline, finally stopping in 1960.
By the 1920s Weirs was THE vacation destination for New Englanders with its busy railroad station, a beautiful grand hotel on the beach, a boardwalk, and a large dance pavilion. Then two fires would change everything.
In 1924, a devastating fire destroyed the Grand Hotel Weirs. Then, in 1939 a second fire would end steam travel on Lake Winnipesaukee. On a cold December night, a fire at the railway station quickly spread down the ramp to the winter berth of the Mount Washington. There were attempts to free her, but the water level was low, and she was grounded in the mud. The ship, boardwalk and railway station all were destroyed entirely, marking the end of an era.
Captain Leander Lavallee set out to rebuild the vessel. Unfortunately, it was wartime, and raw materials were being used for the war effort, making it impossible to save the ship. However, after a diligent search throughout New England, he found a vessel on Lake Champlain, The Chateauguay, a 203-foot long vessel that was built in 1888.
In April of 1940, four months after the devastating fire, he had found his vessel, cut it into 20 pieces, transported it by railcar to Lakeport and rebuilt her with a new steel superstructure and twin 750 horsepower diesel engines. Christened the SS Mount Washington II, she was relaunched into service, where she still takes visitors on sightseeing cruises around Lake Winnipesaukee departing from Weirs Beach every day from May thru October.
In the 1940s, an effort had begun to rebuild after the devastating fire, and a new hotel was constructed. Before the 1950s, the beach as we know it today did not exist. Visitors would enter the water from the rocky shoreline at Endicott Park and swim to one of two diving rafts anchored offshore. It was around this time that local businessmen, led by Ed Hoagland, owner of the Lakeview House began to petition to construct the beach that is there today, and in November 1955 the Weirs city council change the name to Weirs Beach. And a resort was reborn!
Weirs Beach Today
Today, Weirs Beach is once again a dominant vacation destination drawing visitors from throughout the Northeast and around the world! With fine dining, luxury accommodations, charming bed and breakfasts, the boardwalk, arcades, nightlife, great shopping and of course, the beach, Weirs Beach is a great place to bring the entire family for a true New England summer vacation!
If you're planning a vacation on Lake Winnipesaukee, make sure to visit the M/S Mount Washington ticket office to experience a unique view of New Hampshire's crown jewel! Cruises depart from the town dock in Weirs Beach several times each day from May to October. Don't miss our spectacular Sunday Brunch cruise leaving Alton Bay.
If you're planning an event, wedding, company outing, or would like to arrange a private charter, give us a call at (603) 366-5531 and let us help you plan a memorable event you'll be talking about for years to come!
Rich Aug 29, 2019
Man, oh, man!!! So many great memories. My parents started going up to the Weirs in the 60s with my older brothers and sister. My earliest memories were in 79 or 80. I was 6 or 7. I would save my quarters all year, just to play the arcade games at the end of the boardwalk. We stayed at a quad which was part of the Lakeside Hotel. We would spend hours at the private beach at the bottom of the hill. Every year, the same families would stay in July and we became friends that looked forward to seeing each other and when the week was over, there was a pit in your stomach because you just did not want to leave. The nostalgia! The smells in the air… to this day if I smell fried dough it takes me right there. Pac man, donkey kong, usa vs ussr hockey….all the games…. the gypsy in the glass case. Put a quarter and she will read your fortune. I remember the funspot and the keller house. I remember the tamarac. The polar caves. I remember as a kid when the mount Washington went out the wake sent big waves to the beach and we ate it up! The weirs beach water slide then the surf coaster and wave pool. I must say, the one thing missing is just that. The weirs needs a water park again! As the years have gone by I have made my way ip there. When I met my wife, I could not wait to show her this place. Unless you grew up going there folks just dont get it. Now that we have kids a 7 year old and 3 year old we have been wanting to go. We have found ourselves in North Conway at the red jacket. It has a huge pool and indoor water park. The kids love it. My heart wants to go back to the weirs but the kids love the water park..lol. We go as a family, 10 of us, 4 kids, really 6 if you count me and my brotheri law. My heart and my gut want to go back to the weirs, especially to bring my mom. She is 82 and healthy. I know she would like to go again, one more time….. so we shall see, I will try and rally the troops and get there for July of 2020. I hear things have improved over the past couple of years with a new company taking over the boardwalk. Here's to all the memories and to making new one's at the Weirs!!!
Lorraine Cardosi Aug 29, 2019
Always loved the Weirs! Started going there in late "40s". It's a great place.
Bonnie Aug 05, 2019
Back in the 80's and 90's Weir's beach was the place to be it has died down way down There used to be 2 slides The weirs beach water slide and serve coaster They had Go kart. Fun spot mini golf Jade island JB scoops And lots more shops in the weirs. What has happened to all that Amusement where has it gone the water slides people love doing that stuff now you'd think with some of that land that they have up there at the weir's beach water slide used to be or somewhere up there maybe even at gunstock somebody would build an amusement park for kids and adults alike That's what they're missing here in the LAKES REGION OF NEW HAMPSHIRE just look at Canopy Lake park, Storyland, santa's village, And whales tails are always filled every day. I think GUNSTOCK WOULD BE THE PERFECT PLACE 🙂
Ms. Dale Bowden Aug 05, 2019
My parents were married in 1948, and each year they would go to lake Winnipesaukee on their anniversary. They always had a wonderful time and brought us back souvenirs. I live in Florida now but hope someday to visit the lake. Thank you for this wonderful history!
Robert t Beauchemin Aug 05, 2019
I witnessed the reincarnation from 1956 thru 1980… I was Blessed


here and to the ends of the earth.
Emmanuel bases its beliefs on the Bible, God's Word, and agrees with the expression of Biblical truth found in The Baptist Faith and Message.
In the beginning man was innocent of sin and was endowed by his Creator with freedom of choice. By his free choice man sinned against God and brought sin into the human race.
In Spring of 1958 home Bible studies began with several families. Glenwood Busbee came as Mission Pastor in July, 1958, and remained until June of 1959. Under his leadership the first Sunday School and worship services were held in the old Assembly of God Building at Third Ave. and Fourth St. SE. In 1959 a house was purchased as a parsonage and worship services were held there led by Southtown Baptist Church (Minneapolis) laymen.
In December, 1959, Bill Williamson was called as pastor. He served until July, 1964, when he resigned to enter full-time chaplaincy at the Mayo Clinic. While he was pastor the church was officially constituted, services were moved to North Hall, Mayo Civic Auditorium, and in 1960 the church purchased 2.5 acres at 2911 18th Ave. NW. Ground breaking for a building was in 1961, and it was occupied in June, 1962.
Over the years we have had nine other pastors. In 1975 a larger sanctuary was built and the first service held there was in 1976. A 10,000 sq. ft. education building was built in 1991, with an additional education building added in 2000, and the sanctuary was remodeled at that time. Special 'Together We Build' programs were held to raise money for the constructions. The parsonage was remodeled in 2005 and opened as the Baptist Hospitality House, currently managed by the Serenity House Network.
Emmanuel has provided English as a Second Language (ESL) classes for over 30 years. Hundreds of IBM, Mayo, and other employees and their spouses have improved their English skills while socializing with other ESLers from around the world.
Several mission congregations have been sponsored by Emmanuel. They include Island Park Baptist Church, La Crosse, WI, congregations in Austin and Byron, and Hmong, Lao, and Hispanic groups which currently meet in our building.
Emmanuel Baptist Church associated from its beginnings with the Southern Baptist Convention. We also associate with the Minnesota-Wisconsin Baptist Convention, and the Pioneer-Western Baptist association.


We fully understand how frustrating and exhausting it can be to deal with infertility. The added stress to a relationship, the financial concerns, and often times it is a matter of "where do we begin" or if medical treatment has begun it can be "what else can we do?"
If you or a loved one is in this position, we have answers. Fertility acupuncture is an area of major focus in our clinic. We have developed specific treatments and have worked with thousands of fertility patients, often in conjunction with fertility specialists in Sioux Falls. This is not something we rarely or once in a while do as an 'add on' to our chiropractic practice, this is an area where we have extensive experience and are proficient and effective, achieving high rates of success.
We utilize fertility acupuncture to help our patients conceive naturally OR if you plan to undergo assisted fertility treatments, such as IUI or IVF. Some very good studies as well as our internal statistics prove that our therapies are mutually beneficial with medical reproductive treatments in leading to a live birth.
Research has shown that fertility acupuncture can increase blood flow to the uterus, which provides a thick, rich uterine wall lining. This nourishing environment increases the chances of conception. There are also ideas centering around the effect of acupuncture on the ovarian cycle.
In addition to the these powerful effects, our therapies are excellent at helping with many of the common issues that people deal with while treating for infertility; stress, ill feelings due to medications, lack of sleep, and anxiety. As anyone who is going through or has gone through fertility issues before, reducing stress is an extremely important factor when dealing with such an emotionally charged issue as trying to conceive a child without success.
We welcome you to read through the research links below as well as a sampling of patient testimonials to see what others have had to say about their experience here doing fertility acupuncture in Sioux Falls.
In addition to helping with fertility problems, we also provide a significant amount of pregnancy related care. We can help with pregnancy related issues that are very common, such as the typical first term myriad of; morning sickness, dry-retching, vomiting, extreme fatigue, and dizziness. We will typically use acupuncture to assist with these aforementioned issues and if you're dealing with spinal pain, we can use chiropractic therapy as well.
We can also help with later stage problems such as breech baby. We typically use moxibustion for this and have witnessed excellent results.
Her best friend encouraged her to see Dr. Tricia for acupuncture.
She couldn't find a reason not to go. "I had nothing to lose," Lee says. "Either way I wouldn't come out of the situation with a baby; who not try something natural?"
"We decided to try a more natural approach."
I dealt with infertility for years due to endometriosis. I started going to Natural Arts Chiropractic & Acupuncture and seeing Dr. Tricia for acupuncture. It allows blood to flow where it is needed to optimize your chances of getting pregnant and allows you to completely relax. Dr. Tricia is a very caring and understanding woman. She wants nothing more than a positive outcome. I am so fortunate to have her and acupuncture as part of my fertility journey. I am now a mother of twins and feel that acupuncture played a key role in the success of becoming pregnant and carrying my children.
Drs. Tracy & Tricia were with us every step of the way through our pregnancy journey, from understanding where we were at in our medical treatment cycle and planning each acupuncture session accordingly, to listening each month when we felt defeated, and rejoicing right along with us when we found out we were having a baby!
WE HAVE HUNDREDS OF POST CARDS JUST LIKE THESE!
"Thank you all so much for your help last year! We struggled for 2 years and lost hope of having our own child. You helped make our dream come true and we feel very blessed. [Name hidden for anonymity] is an awesome baby with a big personality already. He is very loved!
"Dr. Tracy, just wanted to send you a thank you note for your encouragement, caring, and wonderful acupuncture. We are expecting a baby on Valentine's Day! Everything is going great, we are almost at 11 weeks! Thank you for taking the time to do acupuncture on a holiday weekend during our IVF!"
"A HUGE thank you to the entire staff at Natural Arts Chiropractic and Acupuncture for helping to make our dreams come true! Your support, expertise and compassion has made our family complete. We can't thank you enough."
"Dr. Tracy, wanted to send a BIG thanks to you. [Name hidden for anonymity] and I are expecting in February! We are almost 12 weeks. We are really thankful for you being so flexible and kind! Thanks again!"
"Just wanted to write a note to say THANK YOU for helping us complete our family with a precious little girl. We are so happy and can not tell you how thankful we are for the blessings we have received with your help. Many thanks"
"Dr. Tricia, I just wanted to write and say Thank You from the bottom of my heart for helping me and preparing my body for a baby. We are now in week 23 and we are looking forward to our new addition at the end of February. Thank you so much!"


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