Dr. Fuhrman responds to the comments made by Barry Groves on How a High-Protein Diet Works and The Physician and The Student.
Barry Groves is correct. One negative story regarding Atkins followers does not a conclusive study make, it only makes one important point. That is--because of the immense popularity of the Atkins' "lots of meat-is-not heart-disease-or-cancer-promoting" message, thousands of individuals have been supported to adopt a diet that all health authorities have declared dangerous. Even more importantly, many people have suffered and died needlessly because of this. Some people will enthusiastically jump on a bandwagon of pseudo-scientific claims that makes statements supporting the continuation of their preferred food habits and addictions. Dr. Acocella's personal story was not written to be a broad overview of the scientific research showing the dangers of the Atkins' meat-based diet; rather it was to show the personal side of the tragedy of bad advice. His parents were so misinformed that he was frustratingly not able to convince them to follow a truly protective lifestyle.
There are other important issues here, too. Watching people die needlessly from dangerous nutritional advice is just one of them. Atkins made many fraudulent claims over the years and he got away with it. He stated, "Reverse heart disease with filet mignon!" and "Prevent Breast Cancer with Cheese" in his newsletters. While at the same time thousands of studies in the scientific literature showed increased heart attack risk and higher cancer risks associated with diets rich in meat and cheese. Consider the position of the nutrition committee of the American Heart Association posted on AtkinsExposed.org:
The May 2004 Annals of Internal Medicine study showed that a third of Atkins dieters suffered a significant increase in LDL cholesterol. The goal is to have a double digit LDL--an LDL under 100 (mg/dl). In the study, one person's LDL shot from an unhealthy 184 to a positively frightening 283 (which means their total cholesterol was probably somewhere over 350). With so many people on these diets, that could mean Atkins is endangering the health of millions of Americans. LDL cholesterol is, after all, the single most important diet related risk factor for heart disease, the number one killer in the United States for both men and women.
In another clinical trial, despite statistically significant weight loss reported in the Atkins group, every single cardiac risk factor measured had worsened after a year on the Atkins Diet. The investigator concludes "Those following high fat [Atkins]diets may have lost weight, but at the price of increased cardiovascular risk factors, including increased LDL cholesterol, increased triglycerides, increased total cholesterol, decreased HDL cholesterol, increased total/HDL cholesterol ratios, and increased homocysteine, Lp(a), and fibrinogen levels. These increased risk factors not only increase the risk of heart disease, but also the risk of strokes, peripheral vascular disease, and blood clots."
If this was not enough, a landmark study published in 2000, actually measured what was happening to peoples' arteries on this kind of diet. Utilizing SPECT scans to actually directly measure the blood flow within the coronary arteries the development of heart disease was directly measured for 16 people on a vegetarian diet that was high in fruits and vegetables and 10 people following a low carb, high protein diet and the results were shocking. Those sticking to the whole-foods vegetarian diet showed a reversal of their heart disease as expected. Their partially-clogged arteries literally got cleaned out, and blood flow to their hearts through their coronary arteries increased 40%. Those on the Atkins Diet had rapid advancement of their heart disease with a decease in blood flow in the heart's blood vessels of 40%.1 Thus, the only study on the Atkins Diet to actually measure arterial blood flow showed this style of eating is exceedingly dangerous. Fortunately more and more doctors are informing their patients regarding the real dangers here and the Atkins diet has lost its luster as a result of these many studies.
Emerging evidence also suggests that ketogenic diets may "create metabolic derangement conducive to cardiac conduction abnormalities and/or myocardial dysfunction"--in other words cause other potentially life-threatening heart problems as well. Ketogenic diets have also been shown in the medical literature to cause a pathological enlargement of the heart called cardiomyopathy, which is reversible, but only if the diet is stopped in time.2 The Atkins Corporation denies that Dr. Atkins' own cardiomyopathy-induced heart attack, hypertension, and blocked arteries had anything to do with his diet. But it is important to counter these ridiculous claims with reality. Atkins had not only cardiomyopathy but high blood pressure and aththerosclerosis according to his medical record. These diseases are not caused by viruses. In fact, even viral-induced cardiomyopathy is thought to be caused by low levels of fruit and vegetables in the diet.3 You can't escape from biological laws of cause and effect; all people eventually pay a price if you eat dangerously.
We already know the low amount of fruits vegetable and beans in the American diet and the high consumption of animal products is dangerous. But the comments by Atkins' devotees like Barry Groves are worse than misleading; Atkins promoters encourage a dietary pattern that puts themselves and their followers at serious, life-threatening risk. That is where the death of people following the Atkins diet (including Atkins) is relevant news. This is no light matter, because lives can potentially be saved by addressing the false assumptions, claims and denial of the known dangers.
Take the repeated assertion by the Atkins camp that a high protein diet does not damage the kidney. If increasing ones risk of heart attack and cancer wasn't enough of an argument. Groves is right, the Harvard data shows that a high protein diet causes kidney damage unless a person has a perfectly normally functioning kidney to start with. But almost 25 percent of people over 45, especially those with diabetes or high blood pressure, have a degree of kidney impairment, and the Atkins' people never warned these people to avoid the diet. The study also did not conclude the high protein diet was safe for those with a normal kidney, it just said that the long-term impact in these people would take longer to detect and was unknown at present time.4 The short-term studies Barry Groves reports offer no reassurance the high intake of animal products will not induce kidney damage or kidney stones. In fact Dr. Knight, the lead researcher in this study concluded, "The potential impact of protein consumption on renal function has important public health implications given the prevalence of high protein diets and use of protein supplements." It is also well established that lots of meat equals lots of gout and kidney stones.5
In a press release entitled American Kidney Fund Warns About Impact of High-Protein Diets on Kidney Health, Chair of Medical Affairs, Paul W. Crawford, M.D., wrote, "We have long suspected that high-protein weight loss diets could have a negative impact on the kidneys, and now we have research to support our suspicions." Dr. Crawford is worried that the strain put on the kidneys could result in irreversible "scarring in the kidneys." Dr. Crawford also discussed the risk that bodybuilders take in eating high-protein diets while building muscle. He noted, "Bodybuilders could be predisposing themselves to chronic kidney disease because hyperfilteration (the strain on the kidneys) can produce scarring in the kidneys, reducing kidney function." "Chronic kidney disease is not to be taken lightly, and there is no cure for kidney failure. The only treatments are kidney dialysis and kidney transplantation. This research shows that even in healthy athletes, kidney function was impacted and that ought to send a message to anyone who is on a high-protein weight loss diet," concluded Dr. Crawford. The American Kidney Fund is the leading national voluntary health organization providing direct financial assistance for the benefit of kidney patients supported by comprehensive educational programs, clinical research and community service projects.
Dr. Grove's reasoning is also illogical and pointing to very short-lived tribes eating lots of meat as offering some value. Yes, the American diet is already too rich in animal products (and refined carbs too) even without the help of Atkins, and this already does lead to many sensitive individuals to develop kidney disease. Taking it a step further up the ladder from 40 percent of animal products in the typical American diet, (which is too high for disease prevention) to 80 percent, encouraged on the Atkins diet, is much more dangerous and foolish. The science supporting what constitutes excellent nutrition is vast. In Eat To Live, I reference about 1500 studies, but that is only the tip of the iceberg. I have reviewed over 60,000 studies that indicate that what we put in our mouth does matter and that we can prevent disease with a high nutrient diet. You have to bury your head in the sand, to deny not just the danger to one's kidneys, from a diet-style rich in meat, but many other dangers as well.
My initial discussion of Atkins' death, here on my blog, was brought up in response to Dr. Mercola's incorrect comments about this issue on his website. The facts are that we do not know for sure if Atkins had a heart attack and then fell and hit his head or just happened to take a really unusual bad fall that killed him. We do know for a fact that he was overweight and weighed about 200 pounds before this incident (he ballooned further up in the hospital), but I never commented on that. Furthermore we know that his heart problems were not limited to cardiomyopathy, his medical record showed he had other heart problems that he covered up for years.
Earlier I discussed a patient of mine, who had an insider's account of Dr. Atkins death from their mutual cardiologist. My patient is in the public eye, and does not want the hassle of being demonized for telling this story. He asks that we refer to him simply as "Mr. Drury." This is his tale:
I have been a patient of Joel Fuhrman, M.D. since September of 2005. I am 67 years of age and I am being treated for severe coronary artery disease. My goal is to melt away the calcification in my arteries by using a plant based diet prescribed by Dr. Fuhrman. From April 2001 to July 2004, I had five non-invasive C T Angiograms, my coronary artery calcification scores varied between 2900 to 3100, normal is about 100 or less.
In November 2001, I was referred to Patrick Fratellone, M.D. who was the cardiologist at The Atkins Center. He was also Dr. Atkin's cardiologist, I would occasionally see Dr. Atkins in passing while I had appointments at the Center. At that time, I was accepted by Dr. Fratellone as a candidate for a test trial to treat the calcification as an bacterial infection (Nanobacterium Sanguinen). The therapy was not successful.
Early May 2002, I elect to have an invasive coronary artery angiogram to see how much blockage I have in my coronary arteries. It was bad, another time I will tell you how bad. On May 29, 2002, I had double by-pass heart surgery. In July, Dr. Fratellone leaves The Atkins Center to set up his own office, since Atkins wanted to downsize his practice. He remained as Dr. Atkins' cardiologist. I continued to use Dr Fratellone for several other alternative therapies which were also unsuccessful. In October of 2002, while under his care as well as several other well known cardiologists, I recall seeing Dr. Atkins on the NBC Today Show. He and Katie Couric were in a heated discussion. She was saying that he had a heart attack and Atkins replied, "I didn't have a heart attack, I had a incident. What I have is an infection." With that it struck me that he must have a condition similar to my case, he must be loaded with the calcification in his arteries. I have to assume that he was using the same therapy, since we both had the same cardiologist, Dr. Fratellone.
Fast forward to April 2003 and Dr. Atkins dies, slips on ice? I see Dr. Fratellone about a month later and during the visit, I express my sorrow for the death of Dr. Atkins. I said that was some accident, slipping on the ice and hitting his head and dying. He looked at me with a questionable stare and pointed to his heart. I said, "He had a heart attack?" He said no more after that.
Since I continued treatment with Dr. Fratellone over the next few month with IV therapy, I would get feed back from some of the staff. It appears that upon Atkins death, his wife, had him admitted to a hospital where his cardiologist, Dr. Fratellone, did not have attending physician's privileges. Therefore, he was not able to care for Dr. Atkins as his cardiologist. Heresay has it that Dr. Fratellone would have been able to save him.
His story of developing heart disease on the Atkins diet, as a friend of Dr. Atkins, and his insider view of Atkins health and death are relevant too. The claims by the Atkins devotees that I have fabricated this story does not merely insult me, but speak to the futility of their argument. As I post many more cases of my patients who developed heart problems on the Atkins diet I guess their only response will be that I am lying. I am hoping that instead, a few of them will re-think their long-held views and maybe reduce the amount of animal products in their diets and start eating more vegetables, beans and fruit. I am not the enemy you guys!
And yes, humans are primates and all primates eat a diet of predominantly natural vegetation. If they eat animal products, it is a very small percentage of their total caloric intake. Luckily we have modern science that shows that most common ailment in today's world are the result of nutritional ignorance and that we can eat a diet-style rich in phytochemicals from a variety of natural plant foods that can afford us the ability to live a long healthy life, not easily obtained by our ancestors. With the many millions of Atkins followers around the world grasping at straws to justify eating a diet rich in animal products, I hope my blog serves to counter health claims by these people and in doing so maybe saves a few lives or reduces someone's suffering.
But the main point here that I always want to emphasize is to describe the benefits of nutritional excellence. In describing the bad science utilized to promote dangerous diets like Atkins, let's always frame it with what a healthy diet should look like. When one eats a truly health supporting diet, you can not only expect a predicted drop in blood pressure, drop in cholesterol and reversal of heart disease, but your headaches, constipation, indigestion and bad breath should all resolve. Eating for nutritional excellence should enable people to reverse diabetes and to gradually lose dependence on drugs. You should not only achieve a normal weight without counting calories and dieting, but to achieve robust health and live a long life free of the fear of heart attacks and strokes. Nutritional excellence, which involves the eating of lots of vegetables, fruits and beans (forbidden on the Atkins diet) does not have to exclude all animal products, but it has to very rich in high nutrient plant foods which should comprise well over eighty percent of caloric intake.
Enough is enough, I think the dangers of the Atkins approach have already been well publicized and addressed by every major nutritional organization and medical group in the country. Let's let it die an uneventful death with as little people suffering from such bad advice as possible.
If an individual well-versed in the body of scientific literature wants to discuss the nutritional merits of a diet with a higher amount or a lower amount of animal products in the range of 0-20 percent, that might be educational and productive, but to pursue this discussion with individuals protecting their desire to eat a diet with 75-85 percent of calories from animal products (like in Atkins menus) is really a waste of time. This debate could never occur in a true scientific venue; Groves opinions are like arguing the earth is flat.
My Eat To Live dietary approach has already been tested and been shown to be the most effective diet-style at lowering cholesterol as reported in the medical journal metabolism.6 A recent study awaiting publication also showed that participants followed for two years lost more weight and kept it off better than any other diet study on record.
In my practice, I have hundreds of patients who had reversed their heart disease that they developed while on the American diet or on the Atkins diet, dropped their cholesterol over a hundred points, without drugs, and are living proof that nutritional excellence, not drugs is the therapy of choice. My book, Eat To Live has enabled thousands or overweight individuals to lose dramatic amount of weight and recover their health without incurring the risks of an unbalanced nutrition. Understanding the differences is critical for the health seeker. Longevity and disease protection are the ultimate goals of dietary advice; you can lose weight snorting cocaine and smoking cigarettes. But, when you settle for second-class nutritional advice you doom yourself not only to a shorter life, but to a poor quality life in your later years, and suffer with medical problems that could have been avoided.
For more data debunking every false assertion of the Atkins proponents over the years visit Atkinsexposed.org.