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Nonsense About Doctors Who May Be Sued
As the low-fat brigade and British Dietetic Association find their cosy world disintegrating under the weight of evidence against them, one dietitian tries to hit back.
Beware of misinformation such as this article that realslimmers.com has at http://www.realslimmers.com/Content.go?id=6275. It is written or, at least, condoned by a well-known dietitian, Lyndel Costain. This gives it an air of authority. It shouldn't as it is nonsense. My reply follows it.
DOCTORS are being warned that they could face legal action if they fail to advise their patients against high protein, low-carbohydrate diets.
Medical experts in Britain say that the country's obsession with weight means many people are becoming 'carbophobes', rejecting healthy low fat diets in favour of dangerous 'celebrity' diets such as the Atkins diet.
An advertising campaign is being launched warning that high protein and other faddish weight loss programmes are potentially dangerous. Experts are concerned over the growing consumer belief that obesity is caused by carbohydrates and not fat, a theory pushed by Dr Atkins. He argues that insulin makes you store fat, and that avoiding carbohydrates such as bread, potato and pasta will stop the over-stimulation of insulin.
But studies have shown that the foods consumed on these high protein diets are linked to heart disease, colon cancer, kidney disease, osteoporosis and diabetes.
Diets such as Atkins are designed to induce ketosis, an abnormal state that occurs in uncontrolled diabetes mellitus and starvation. Over time, ketosis can cause a host of physical problems, including calcium loss, brittle bones and kidney stones.
The British Dietetic Association's annual conference saw Realslimmer.com dietitian Lyndel Costain slamming fad diets as 'hogwash'.
'Eating plans like the low-carb plan mislead people,' she said. 'Insulin can only make you store fat if you are taking in excess calories, and this diet works by restricting the overall calories consumed,
'The diet works in the short term because it is low in calories - not because of their theories about insulin.
'The only way to lose weight safely and keep it off is on a low fat, low calorie diet, similar to those we recommend on Realslimmers.'
August 13 2002
Barry Groves replies:
I am concerned by the number of inaccuracies and misinformation contained in
your article about doctors being warned that they could face legal action if
they fail to advise their patients against low-carbohydrate diets.
". . . warning that high protein and other faddish weight loss programmes are potentially dangerous." This is true. But the low-carb diet, properly constituted, is NOT a high protein diet, it is a normal protein, high-FAT diet.
"rejecting healthy low fat diets" There is no such thing as a 'healthy low-fat diet'. It is precisely such diets that are the cause of the dramatic rise in obesity and diabetes we see today. This has been known for 140 years (Banting W. Letter on Corpulence Addressed to the Public , London, 1863)
"Diets such as Atkins are designed to induce ketosis, an abnormal state that occurs in uncontrolled diabetes mellitus and starvation." While it is true that ketosis does occur in starvation, ketosis is not 'an abnormal state that occurs in uncontrolled diabetes'. That is 'ketoacidosis', which is quite different. And ketosis is not a feature of all low-carb diets -- only the first two weeks of Atkins'. I, for example, avoid ketosis by reducing carbs to no less than 60 grams per day.
"But studies have shown that the foods consumed on these high protein diets are linked to heart disease, colon cancer, kidney disease, osteoporosis and diabetes." Do they? I can't find one (please send references). On the contrary:
Heart disease
This whole cholesterol thing is a nonsense. But if you do believe that cholesterol levels predict the risk of a heart attack, you should know that total cholesterol is lowered by low-carb, high-fat diets (Hays J. Paper presented to the 81st Annual Meeting of the Endocrine Society, 15 June 1999). Hays also found that:
- LDL (the 'bad' cholesterol) fell from 133 to 105 mg/dl,
- HDL (the 'good' cholesterol) increased from 44 to 47 mg/dl.
- Triglycerides declined from 229 to 182 mg/dl.
- Patients lost an average 40 lbs in weight
Although animal fats are talked of as causing heart disease, this has never been proven -- and it's not for want of trying. The only fats implicated in heart disease are the 'healthy' polyunsaturated vegetable oils. "Thus hyperlipidaemia can be controlled by a diet which is low in unsaturated fat . . ." (Editorial. Prevention of coronary heart disease. Br Med J 1968; 2: 689-90.)
"It is thus clear that attempts to keep cholesterol low by changing to margarines containing vegetable oil has been shown to be of little value, and indeed would be damaging in certain circumstances." (McMichael J. Diets, lipids and heart disease. Acta Medica Scanda 1980; 207: 151-2.)
"Only the percentage of calories from polyunsaturated fats is significantly and directly related to the 10-yr incidence of angina pectoris or coronary insuffiency." (McGee DL et al. Ten year incidence of coronary heart disease in Honolulu Heart Programme - Relationship to nutrient intake. Am J Epidem 1984; 119 (5): 667-676.)
And we have known since 1936 that cholesterol levels are unrelated to athersclerosis (the 'furring up' of arteries) and have no relationship with heart disease anyway (Landé KE, Sperry WM. Human atherosclerosis in relation to the cholesterol content of the blood serum. Arch Path 1936; 22: 301-12) .
Colon Cancer
Colon cancer is more likely to be caused by 'healthy' cereal fibre (D Kritchevsky. Fibre and cancer. In Dietary Fibre: Basic and Clinical Aspects. (G V Vahouny and D Kritchevsky eds.) p427. Plenum, NY. 1986.- Dietary studies of cancer of the large bowel in the animal model . Ibid p469. Wasan H S, Goodlad R A. Fiber-supplemented foods may damage your health. Lancet 1996; 348: 319-20. Fuchs C S, et al. Dietary Fiber and the Risk of Colorectal Cancer and Adenoma in Women. N Eng J Med 1999; 340: 169.)
Kidney disease
Although protein restricted diets are helpful for people who have kidney disease, eating meat does not cause kidney problems. (J. Dwyer et al. Diet, indicators of kidney disease, and late mortality among older persons in the NHANES I Epidemiologic Follow-up Study. Amer J of Pub Health 1994, 84: 1299-1303.)
Osteoporosis
1. When studies were done with people eating meat with its fat, no calcium loss was detected, even over a long period of time. (Spencer H, Kramer L. Factors contributing to osteoporosis. J of Nutr , 1986, 116:316-319. and: Further studies of the effect of a high protein diet as meat on calcium metabolism. Amer J Clin Nutr ., 1983, 37: 924-9) .
2. Other studies confirmed that meat eating did not adversely affect calcium balance (Hunt J, et al. High- versus low-meat diets: Effects on zinc absorption, iron status, and calcium, copper, iron, magnesium, manganese, nitrogen, phosphorus, and zinc balance in postmenopausal women. Amer J Clin Nutr, 1995, 62:621-32; Spencer, Osis, and Kramer, Do protein and phosphorus cause calcium loss? J Nutr 1988 Jun;118(6):657-60. )
3. And that protein actually promotes stronger bones. (C. Cooper, et al. Dietary protein and bone mass in women. Calcif Tiss. Int ., 1996, 58:320-5.)
Diabetes
And we have known since 1935 that diabetes is caused solely by excessive carb intake (Given H D C. A New Angle on Health . John Bale, Sons & Danielsson Ltd. 1935) . This has been confirmed many times since and is now in no doubt.
And on weight loss
"The only way to lose weight safely and keep it off is on a low fat, low calorie diet, similar to those we recommend on Realslimmers." My wife and I struggled to lose weight on such a diet in the 1950s. In 1962 we started a low-carb diet. We haven't been overweight since. Can you produce anyone who has stayed slim for 40 years after being overweight? But that is anecdotal. Clinical studies have also shown that the best way to lose weight is on a low-carb, high-fat diet: For example:
In 1933, a clinical study carried out at the Royal Infirmary, Edinburgh studied the effects of low- and high-calorie diets, of up to 2,700 kcals per day but with varying constituents.
When they compared four diets with different ratios of fat, protein and carb, but with exactly the same energy at 1,000 kcals, average daily losses were:
- high carb/low fat diet - 49g [like a modern slimming diet]
- high carb/low protein - 122g
- low carb/high protein - 183g
- low carbohydrate/high fat - 205g [like the diet I recommend]
Note that although all the diets had exactly the same number of calories, those on the low-carb diet lost over four times as much weight as the ones on the low-fat diet.
Drs Lyon and Dunlop pointed out that: "The most striking feature of the table
is that the losses appear to be inversely proportionate to the carbohydrate
content of the food. Where the carbohydrate intake is low the rate of loss in
weight is greater and conversely."
(Lyon DM, Dunlop DM. The treatment of obesity: a comparison of the effects of
diet and of thyroid extract.
Quarterly Journal of Medicine
1932; 1: 331-52.)
And this is still found today. In a clinical dietary trial in Durham, North
Carolina, published in 2000, after 6 months, patients on low carbohydrate,
high-protein / fat diet had an ?average weight loss more than 10%, and ?total
cholesterol fell 10.5 mg/dl (0.27 mmol/l). lAfter twelve months their mean
weight loss was 10.9% and total cholesterol fallen by 14.1 mg/dl (0.37 mmol/l).
(William S. Yancy. New research examines effectiveness and weight loss
maintenance of the low carbohydrate diet. NAASO 2000 - Annual Scientific
Meeting, Long Beach, California. 30 October 2000)
I can understand people like Lindel Costain trying to defend their increasingly
precarious position. She must know that she is the one who is more likely to be
sued as the truth gets out. Costain would be better employed addressing the
real problems of her patients that have been caused by 'healthy eating'. And to
paraphrase what Dr James Hays said about the low-carb, high-fat diet at Endo
99,
It's going to come whether you at realslimmers.com like it or not.
Incidentally, the idea of doctors being sued is, of course, a nonsense as, not
only are those who have been helped by a low-carb diet unlikely to sue those
who have helped them, such a case would never come to a court of law. All
doctors of medicine have the defences that 1.) they are not trained in
nutrition and 2.) latest research published in the medical journals over the
last few years indicates that a low-carb, high-fat diet is far healthier than
the current dietary regime currently recommended by the British Dietetic
Association.
Barry Groves, PhD
http://www.second-opinions.co.uk
Last updated 14 August 2002
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