Case Histories: The Atkins Diet

Dr. Fuhrman's colleague Dr. Steven Acocella, MS, D.C., DACBN, Board Certified Clinical Nutritionist, American College of Lifestyle Physicians, and a Diplomat of the American Clinical Board of Nutrition, discusses the Atkins low-carb high-fat diet-style:

The following case histories are presented to explicate some of the many risks associated with a high fat, high animal protein, low carbohydrate Atkins diet style. I have added background and ancillary information as well as an editorial discussion to aid in the understanding of these cases.

Atkins Case History: Kathy Barnett
Kathy was a healthy 16 year old teenage girl. She had no medical problems and was active and thriving. Like many teens, especially girls, she struggled with excess weight and body image. She decided to peruse the Atkins diet to lose weight. She stood 5 feet 8 inches tall was nearly 200 pounds when she began dieting. Based upon the low-carbohydrate strategy, her diet correctly consisted primarily of meat and cheese. She ate with regularity and did not fast.

A few weeks after beginning the diet, this otherwise healthy girl suddenly and unexpectedly collapsed [1]. Paramedics were dispatched to her high school to render care. Upon their arrival Kathy had no pulse and was not breathing. The electrical activity of her heart evaluated by paramedics revealed that she was in ventricular fibrillation, an exceedingly unusual finding in such a young patient. Inexplicitly, Kathy was in cardiac arrest at 16 years of age. Despite their best efforts, including CPR and defibrillation, paramedics were unable to revive her.

Discussion
At autopsy examiners could not find any underlying condition that could contribute to or explain her sudden and tragic death. No genetic or anatomic abnormalities of her heart or other organs were found. Kathy had no history of any heart or respiratory related problems. She had no prior complaints or symptoms that could be attributed to nutritional disturbances such as electrolyte or nutrient imbalances. Kathy was not only a medical tragedy but a medical mystery as well. But that was until Dr. Joseph Tobias and his colleagues at University of Missouri, Department of Child Health studied her case.

In an article appearing in the Southern Medical Journal, Dr. Tobias and his team reported on this case and proffer a cause and effect connection between Kathy's untimely death and her lethal diet. The article, titled Sudden Cardiac Death of an Adolescent During Atkins Dieting, focuses on the potential development of a fatal physiological disturbance inherent in this type of diet [1].

Information provided by Kathy's mother confirmed that her daughter was compliantly on the carbohydrate restricted diet long enough to be in ketosis, the metabolic result of relying on dietary fat to meet the body's energy needs. This is likely where this young girl's fatal medical problem began (Atkins refers to this as the 'induction phase').

Russell and Taegtmeyer demonstrated that active heart muscle relying on ketones for energy lost 50% of contractile function in a matter of hours [2]. Other studies have revealed the development of serious and fatal cardiac arrhythmias resulting from high dietary fat consumption [3, 4].

The most compelling finding in this case may provide the medical smoking gun that clearly implicates the Atkins diet as the cause of Kathy's sudden cardiac death. Electrolytes are micronutrients that are essential for many bodily functions. Critical to normal heart rhythm is the electrolyte potassium. But ketones also use potassium to enter the kidney for excretion. The more profound the state of ketosis the greater the depletion of potassium stores [5]. If there is a concomitant deficit of caloric intake, which leads to further depletion, a serious condition called hypokalemia (critically low levels of potassium) can result. Hypokalemia is directly associated with sudden cardiac death. During resuscitation efforts, when corrected for pH shift, Kathy's serum potassium was 3.8 mEq/L, a critically low level reflective of profound hypokalemia.

While is it difficult to establish an absolute nexus between Kathy's diet regimen and her untimely death a preponderance of all the aspects of the case raises an alarming index of suspicion. This is further supported by literature that reported an increased incidence of sudden cardiac death in patients on high protein diets [6]. The likelihood that the mortality in this case is directly related to this diet style was compelling enough for Dr. Tobias and his collaborators to warn against it in the conclusion of their presentation.

Atkins Case History: Jody Gorran
Jody was an active 50 year old when he decided to do something about his mid-life weight gain.7 He diet shopped and decided on the well advertised Atkins Diet. He liked that it was touted as the "no depravation diet" that excluded hunger, set not limit on the amount of food and included foods so rich that they are not included on any other diet [8]. At the time he had no other health problems other than being moderately overweight. In fact, Jody was compliant at having regular check-ups and screenings. In late December 2000, during a routine colonoscopy Jody also consented to a preventive cardiac CT scan (he had no history, symptoms or complaints of coronary artery or cardiovascular diseases). The results were excellent. Jody's plaque score was 0, no blockage of the coronary arteries. The reports reads, "Normal scan, no identifiable atherosclerosis with very low coronary vascular disease risk." Good news. Furthermore, his cholesterol levels were all well within the safe range at that time, these being - Total Cholesterol 153 mg/dl, HDLc 62 mg/dl, LDLc 81 mg/dl and triglycerides 42 mg/dl. Jody was in great cardiovascular shape with an excellent lipid profile and the CT scan to prove it. But this was all about to dramatically change.

Not long after beginning the Atkins Diet Jody had a repeat blood test. The results showed that he was in ketosis, a metabolic hallmark of one carefully abiding by the Atkins Diet. The lipid profile at that time was reported as: total cholesterol: 230 mg/dl, HDLc 65 mg/dl, LDLc 154 mg/dl and triglycerides 56 mg/dl. Jody had gone from maintaining a safe, low risk lipid profile to a dangerous, elevated risk profile [9]. Concerned about these results he consulted the Atkins Diet book and Atkins Website which addressed and allayed his fears. The Atkins literature reported that a few "fat sensitive" persons may develop a less favorable cholesterol level on a high fat [Atkins] diet. Jody read that, "less than one person in three falls into this [elevated cholesterol] category" And, although Atkins suggests eating leaner cuts of meat and "farmers cheese" as the solution, he states, "But if you're not happy [with these foods] don't bother with it; go back to the regular Atkins diet that you enjoyed more". [8] This is the Atkins advice rendered specifically to those who develop unhealthy cholesterol levels while on his diet. Relived by the supportive information from his nutritional guru, and pleased with the weight loss results thus far, Jody continued following the "stages" of the Atkins diet for another two years. In fact, a large quantity of his diet consisted of food products directly manufactured and marketed by Atkins, Inc.

In early October 2003, Mr. Gorran was not feeling well. For the first time in his life he began experiencing chest pain that was becoming increasingly severe. Jody consulted noted cardiologist Bruce Martin, M.D. in October of 2003. During his examination Jody's stress test was consistent coronary ischemia. The blood supply to his heart had become compromised. Dr. Martin scheduled an emergent cardiac catherization. The results were shocking. In less than three years Jody had gone from excellent cardiac health (zero blockages of the coronary arteries) to a critical 99% stenotic occlusion of the major coronary arteries. About two years after beginning the Atkins diet, according to Dr. Martin, Jody was on the brink of suffering a life threatening cardiac event. Mr. Gorran underwent immediate surgical repair to remove blockages, stent implantation and was prescribed several medications.

Noted in Dr. Martin's medical records is the recommendation to immediately and completely discontinue the Atkins diet. It specifies that, "Mr. Gorran has been advised to stop the Atkins diet because of the dangers of saturated fat allowed on this diet."[8] A few months following Jody's cessation of the Atkins diet his lipid profile returned to normal levels that were; total cholesterol 146 mg/dl, HDLc 53 mg/dl, LDLc 81 mg/dl and triglycerides 65 mg/dl.

Discussion
There is abundant, consistent scientific evidence that links excessive total dietary fat, cholesterol and saturated fat to dyslipidemia and the development of heart disease. The preponderance of an overwhelming amount of irrefutable data confirms that dietary saturated fat is especially atherogenic [9-14]. Because the Atkins Diet derives the majority of it's calories from animal sources the saturated fat content is extraordinary high.

Blood flow studies using myocardial perfusion imaging and echocardiograpy were preformed on subjects before and after starting the Atkins Diet. The study showed that blood flow to the heart diminished by an average of 40% after one year on an Atkins high fat diet. Serial blood studies also showed marked increased of inflammatory markers that predict heart attacks [15]. Another study did an intensive review of the Atkins Diet and concluded that the high fat content resulted in the progression of atherosclerosis [16]. Both studies are clearly consistent with the Atkins Diet and heart disease nexus reported in this case.

Dietary fat content of a typical menu by Robert Atkins, M.D. taken from Dr. Atkins' New Diet Revolution and a menu presented by Joel Fuhrman, M.D. in Eat to Live, The Revolutionary Formula for Fast and Sustained Weight Loss - an exemplary diet consistent with the consensus recommendations of the rational evidence-based scientific community [17-18], are in sharp contrast:

Per DayAtkin's MenuEat to Live Menu
Total Calories25501600
Grams of Total Fat16719
Grams of Saturated602
Total Fat Calories1530171
Saturated Fat Calories54018
% of Calories from Total Fat6010
% of Calories from Saturated Fat211


Clearly the total fat and saturated fat contained in the Atkins diet far exceed the daily intake recommendations cited by every reputable source. It is interesting to note that the fat calories alone for the Atkins Diet are about equal to the total calories for the Eat to Live Diet.

An extensive body of scientific literature supports the conclusion that the quantity of dietary fat consumption encouraged by Dr. Atkins is clearly atherogenic and that his diet is disease promoting. Additional long term prospective and retrospective studies will further evidence the significant dangers of the Atkins Diet.

Author's Comments
This well cited article is about more than the science behind it. These people trusted the promises and guarantees held out to them by a member of the medical nutrition community who continued to ignore the wealth of evidence-based dietary science. The books Kathy and Jody read and the infomercials they watched literally instructed them to disregard the warnings of hundreds of credible health professionals citing the dangers of the Atkins Diet. And these cases are neither anecdotal nor isolated, they're representative. The only conclusion that can be drawn regarding the motivation to promote a diet that thousands of pages of data consistently expose as disease promoting is that it's a pursuit that places profits over people. If a prescription drug is administered to a million patients and it results in the death of a just a few, physicians stop prescribing it and manufacturers stop making it. How many case histories about fatal heart attacks, cancer, kidney failure, stroke and other diseases directly attributable to high fat diets are published before Dr. Atkins' New Diet Revolution is finally pulled off the shelf? If their camp were smart they would place a black box warning right on the covers of Atkins' books to attenuate the torrent of litigation that they're undoubtedly headed for; but what ever defensive steps they take, my expert opinion will prevail. If I could write directly to Dr. Atkins I would send him at note that simply read: Kathy Barnett: 1985 - 2001.

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Ashland, Massachusetts Cancer Cluster

Dr. Fuhrman consistently implores his patients to avoid mercury, pesticides, and other cancer-causing compounds. In Massachusetts, there's news of an especially extreme example of such toxins causing serious damage. Mark Jewell of the Associated Press:

A disturbingly high number of cancer cases outside Boston are linked to a former textile dye-making plant with waste ponds that some children swam in, state health officials concluded Tuesday.

People who grew up in Ashland and swam in contaminated ponds were two to three times more likely to develop cancer than those who had no contact with the water, a seven-year study found.

The cancer rate was nearly four times greater among people with a family history of cancer and who also swam or waded in waste lagoons and contaminated wetlands near the Nyanza Inc. dye plant, the Department of Public Health said.

Dr. Fuhrman has discussed this topic several times both in Disease Proof Your Child and in the "Toxins" category on DiseaseProof.

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The Misinformation of Barry Groves and Weston Price

I am glad Barry Groves (an electronic engineer, and honorary board member of the Weston Price Foundation) returned and chimed in again. (This is a continuation of an earlier conversation--if you haven't already please read the whole thing.) Now that his name has been mentioned many times here at DiseaseProof.com when people search for it on the web, hopefully they will be able to read his comments and my responses and see that his nutritional viewpoints are illogical and dangerous. Hopefully this will have some effect from anyone dying needlessly from his writings elsewhere and some book publisher will have second thoughts about publishing anything he puts together.

Barry Groves doesn't get the idea that I am not defending the American diet or the almost worthless recommendations of the American Heart Association. However, I am claiming that my dietary and nutritional recommendations are dramatically protective and can enable people to heart-attack-proof their bodies.

Barry Groves obviously did not read Disease-Proof Your Child or Eat To Live, but maybe others too, are not clear that I clearly explain that processed foods, sugar, white flour, and other low-fat, low-nutrient foods promote heart disease. Saturated fat is only one causative factor; but one I do not ignore.

Dangerous Advice
I realize the web allows a forum for people with potentially dangerous advice, but I think most intelligent people can see through his straw arguments, so I welcome the opportunity to comment again to his skewed nutritional viewpoints and unsubstantiated claims. Each time Barry Groves reports on a medical study he gave a different conclusion to the data than the researchers do, and the studies are usually some poorly done old study. It is typical stuff for the Atkins crowd and the Weston Price Foundation to find one research paper they can claim makes their argument legitimate, but even when they hand pick one study, they typically don't report the research accurately.

Fortunately we have a comprehensive body of knowledge today with over 15,000 articles written since the 1950's documenting the link between a diet high in saturated fat and low in fresh fruits, nuts, seeds, vegetable and beans and the increase risk of cancer and heart disease. Thousands of research scientists don't agree with Barry Groves' meat-centered diet recommendations and the platform of the Weston Price Foundation.

Respected Research Agrees
Let's look at what the most respected modern researchers say after a lifetime of collecting data from all over the world, and I will let the data speak for itself without my interpretation. I could have easily put a hundred decent studies on this list, but a few will illustrate the point. The following indented lines are cut and pasted from medical abstracts; the comments are from the abstracts not mine.

Huxley R ; Lewington S ; Clarke R. Cholesterol, coronary heart disease and stroke: a review of published evidence from observational studies and randomized controlled trials. Semin Vasc Med. 2002; 2(3):315-23
In observational epidemiologic studies, lower blood cholesterol is associated with a reduced risk from coronary heart disease (CHD) throughout the normal range of cholesterol values observed in most Western populations. There is a continuous positive relationship between CHD risk and blood cholesterol down to at least 3 to 4 mmol/l, with no threshold below which a lower cholesterol is not associated with a lower risk. Observational studies suggest that a prolonged difference in total cholesterol of about 1 mmol/l is associated with one-third less CHD deaths in middle age. Dietary saturated fat is the chief determinant of total and LDL cholesterol levels.

Tucker KL ; Hallfrisch J ; Qiao N ; et al. The combination of high fruit and vegetable and low saturated fat intakes is more protective against mortality in aging men than is either alone: the Baltimore Longitudinal Study of Aging. J Nutr. 2005; 135(3):556-61.
Saturated fat (SF) intake contributes to the risk of coronary heart disease (CHD) mortality. Recently, the protective effects of fruit and vegetable (FV) intake on both CHD and all-cause mortality were documented. However, individuals consuming more FV may be displacing higher-fat foods. Therefore, we investigated the individual and combined effects of FV and SF consumption on total and CHD mortality among 501 initially healthy men in the Baltimore Longitudinal Study of Aging (BLSA). Over a mean 18 y of follow-up, 7-d diet records were taken at 1-7 visits. Cause of death was ascertained from death certificates, hospital records, and autopsy data. After adjustment for age, total energy intake, BMI, smoking, alcohol use, dietary supplements, and physical activity score, FV and SF intakes were individually associated with lower all-cause and CHD mortality (P < 0.05). When both FV and SF were included in the same model, associations of each were attenuated with CHD mortality, and no longer significant for all-cause mortality. Men consuming the combination of > or =5 servings of FV/d and < or =12% energy from SF were 31% less likely to die of any cause (P < 0.05), and 76% less likely to die from CHD (P < 0.001), relative to those consuming < 5 FV and >12% SF. Men consuming either low SF or high FV, but not both, did not have a significantly lower risk of total mortality; but did have 64-67% lower risk of CHD mortality (P < 0.05) relative to those doing neither. These results confirm the protective effects of low SF and high FV intake against CHD mortality. In addition, they extend these findings by demonstrating that the combination of both behaviors is more protective than either alone, suggesting that their beneficial effects are mediated by different mechanisms.

Dwyer T ; Emmanuel SC ; Janus ED ; et al. The emergence of coronary heart disease in populations of Chinese descent. Atherosclerosis. 2003; 167(2):303-10.
Most countries in oriental Asia have not yet experienced the 'western' coronary heart disease (CHD) epidemic despite substantial economic development. An exception has been Singapore. We compared mortality and CHD risk factors in Singapore with two Oriental locations, Hong Kong and mainland China, which have not experienced the CHD epidemic. Mortality data from World Health Statistics Annuals age standardized for each location and were supplemented by local data. Risk factor data was obtained from population-based surveys using similar protocols in each location. Measures included diet, blood lipids, blood pressure, height and weight. CHD mortality in the year chosen for comparison, 1994, was significantly higher for Singapore Chinese males [108 (95.2-119.1)] than Chinese males in Hong Kong [44.3 (40.2-48.2)] or China [45.5 (44.2-46.8)]. Female CHD mortality was also relatively higher in Singapore Chinese. The only CHD risk factor markedly higher in Singapore Chinese was serum cholesterol; Singapore males [5.65 (5.55-5.75)], females [5.60 (5.50-5.70)], Hong Kong males [5.21 (5.11-5.31)], females [5.20 (5.10-5.29)] and China males [4.54 (4.46-4.62)], females [4.49 (4.42-4.55)]. Dietary differences in saturated fat consumption were consistent with this. Although there was little difference in total fat intake, a higher consumption of dietary saturated fat and lower consumption of polyunsaturated fat, accompanied by higher serum cholesterol, appear to explain the relatively high CHD mortality in Singapore compared with Hong Kong and mainland China. Differences in body mass index, blood pressure and smoking between locations did not explain the differences in CHD mortality.

Hu FB ; Manson JE ; Willett WC Types of dietary fat and risk of coronary heart disease: a critical review. J Am Coll Nutr. 2001; 20(1):5-19.
During the past several decades, reduction in fat intake has been the main focus of national dietary recommendations to decrease risk of coronary heart disease (CHD). Several lines of evidence. however, have indicated that types of fat have a more important role in determining risk of CHD than total amount of fat in the diet. Metabolic studies have long established that the type of fat, but not total amount of fat, predicts serum cholesterol levels. In addition, results from epidemiologic studies and controlled clinical trials have indicated that replacing saturated fat with unsaturated fat is more effective in lowering risk of CHD than simply reducing total fat consumption. In this article, we review evidence from epidemiologic studies and dietary intervention trials addressing the relationship between dietary fat intake and risk of CHD, with a particular emphasis on different major types of fat, n-3 fatty acids and the optimal balance between n-3 and n-6 fatty acids. We also discuss the implications of the available evidence in the context of current dietary recommendations.

But this is not just about heart disease. And again, with 1,500 references in my book, Eat To Live documenting my dietary recommendations for healthy weight loss, I am only placing a few representative studies here. For example, a recent study showed that after following almost 200,000 Americans for seven years, those who regularly consumed red meat had a double the occurrence of pancreatic cancer. (Nothlings U Wilkins, LR, Murphy, SP Hankins JH et al. Meat and fat intake as risk factors for pancreatic cancer the multiethnic short study J Natl Cancer Inst. 2005 97:1458-65.)

Profits vs. Sense
I realize that quoting one study after another or using clear science and logic will not change the mind of those selling and profiting from the appeal of the meat-based diet like Barry Groves and the Weston Price Foundation recommend. It is still important to address them so that an uninformed individual is not taken in by their dangerous form of quackery, like so many did with Atkins.

Poor Health of Indigenous Meat-Eaters
The dangerous habits of Americans or Europeans who eat only about 5 percent of their caloric intake from fresh produce and the majority of calories from processed foods, does not in anyway make a diet centered on meat health supporting. The whole purpose of this website is to offer information that can offer people control over their health destiny, without dependency on medications and without a premature death due to nutritional ignorance. With the knowledge we have available today and the access to high quality foods all year round we have a unique opportunity to live well and longer than ever before in human history.

When Barry Groves and the Weston Price Foundation people listed above rest their laurels on the health of high meat eating tribes, we have to counter that with real research, not phony claims. The research on the life expectancy of these people is clear. The Inuit Greenlanders have the worst longevity statistics in North America. A careful literature search reveals multiple studies documenting an earlier death in these people as a result of their low consumption of fresh produce and their high consumption of meat.

Legitimate research on the health of these people at present and in the past, show that they die on the average about 10 years younger and have a higher rate of cancer than the general population of Canada. Again, we don't want to mimic the population of Canada and certainly not a population with even a shorter life expectancy. But this research can not be ignore: Iburg KM ; Br�nnum-Hansen H ; Bjerregaard P. Health expectancy in Greenland.
Scand J Public Health. 2001; 29(1):5-12. Choini�re R. Mortality among the Baffin Inuit in the mid-80s.Arctic Med Res. 1992; 51(2):87-93.

Similar statistics are available about the Maasai in Kenya. The Maasai are best distinguished by their jewelry and ornamentation in their "self-deformation" of the body: elongated or torn ear lobes and stretched out lips. They do eat a diet rich in wild hunted meats and have the worst life expectancy in the modern world today. Maasai women have a life expectancy of 45 years, and men only live 42 years. I know these red-meat loving nuts will claim that those statistics are of the modern Maasai, not those of years gone by, but the data is also damaging even if you bring up statistics from 20 or more years ago, when good data was collected. Real African researchers, not Weston Price who just briefly visited them, or the list of Groves' Weston Price Foundation compatriots, documented that a Maasai rarely lived past the age of 60 and when they did, they were considered a very old man. If you want to mimic that dietary style, I guess that is your right, but certainly we know a little more about nutrition than the typical Maasai warrior. (Consider these sources: http://www.kenya.za.net/maasai-cycles-of-life.html and www.who.int/countries/Ken/en/)

Adult mortality figures on the Kenyan Maasai, show that they have a fifty percent chance of dying before the age of 59.

Choosing Between Two Bad Diets vs. Choosing an Optimal One
Weston Price and the Weston Price Foundation's claims about achieving good health on a diet rich in saturated fat are entirely without substance or merit. Weston Price himself did not painstakingly document the lifespan of these people; he was a dentist who just made a quick visit and jumped to simplistic conclusions claiming people were healthy by looking at their teeth. He ignored life expectancy, infant mortality, high rate of infection and many other confounding variables. Weston Price did not grasp the complexity of multi-factorial causation and this tradition is continued by his followers today. This in no way dismisses or makes less of the importance of Price's criticism of the dangers of sugar and other processed foods modern societies eat.

And maybe eating lots of wild meats and natural vegetation, without exposure to modern processed foods may offer a better health outcome than a modern American eating even less produce, and more processed foods, (which may be even worse) but we don't purchase a car by comparing it to a junkyard wreck, we want to know what is best. Fortunately, we actually know that eating a higher percentage of vegetables, legumes, fruit, and raw nuts and seeds in a diet (and much less animal products) can offer a profound longevity advantage due to a broad symphony of life-extending phytochemical nutrients. We have a unique opportunity in human history, we can devise a lifestyle and diet-style to dramatically increase our productive years and live well into the nineties or later without dementia or medical tragedies. We must offer recommendations based on a broad overview of all the evidence. The evidence here is overwhelming; and for those who want maximum control of their health destiny one's dietary choices should not be based on politics, ego, or a belief system.

Prostate Cancer: A Growing Disease In Men

Adapted from Dr. Fuhrman's book Disease Proof Your Child:

The studies examining the link between obesity, body size, and prostate cancer have focused on adult Body Mass Index (BMI). The results of these studies have not been conclusive; some studies have found a direct relationship and others have not.1 When looking carefully at tallness versus obesity, there is an apparent link between prostate cancer and height, but not with obesity. This is probably because extra fat on the body results in a higher estrogen/progesterone ratio, and it is the higher testosterone/estrogen ration that promotes prostate cancer. Therefore, the earlier attainment of adult height is more closely related to prostate cancer risk, not merely being overweight. Men over seventy-one inches tall were observed to have a 32 percent increased risk of prostate cancer. The conclusion is that the dietary style that is most growth promoting also promotes a higher level of testosterone in childhood that is linked to later-life prostate cancer.2

It takes at least one generation for men in immigrant families coming to America to assume the cancer risks of their host country, suggesting the importance of early-life factors.3 Similar to early puberty in females, earlier attainment of adult height and early onset of beard growth in males is a marker of increased risk of prostate cancer.4 Men's diets as toddlers and children most powerfully affect the age when they mature and develop facial hair. The prostate gland is essentially a dormant organ until puberty (much like the female breast), when heightened testosterone levels stimulate its development.

The data on prostate cancer causation points to higher testosterone levels beginning at an earlier age in childhood and throughout puberty as having a strong effect on later occurrence of aggressiveness of prostate cancer.5 Furthermore, studies demonstrate that prostate intraepithelial neoplasia, a cancer precursor to lesion, is already common in men in their twenties and thirties, suggesting that the process of carcinogenesis begins early.6

Prostate cancer is the male version of breast cancer. The genetic predisposition is illustrated by the fact that families with a strong history of breast cancer have an increased risk of prostate cancer in their male offspring and vice versa. So the early nutritional environment we grow our children in creates the favorable soil to fuel the breast cancer and prostate epidemics. The same dietary factors that heighten estrogen levels in females raise testosterone levels in males.

When the death rates for prostate cancer and testicular cancer were examined in forty-two countries and correlated with dietary practices in a carefully designed study, they found that cheese consumption was most closely linked with the incidence of testicular cancer for ages twenty to thirty-nine, and milk was the most closely associated with prostate cancer of all foods.7 Meat, coffee, and animal fats also showed a positive correlation.

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The Haggis and Butter Diet?

The Scotsman reports fad diets like Atkins and processed convenience foods are taking Scotland by storm. With more and more Scottish citizens adopting these diet-styles, health correspondent Lyndsay Moss says Scottish bones could be at risk.

A balanced diet including calcium, vitamin D and other minerals is vital for healthy bones, which are less at risk of fracture.


But the National Osteoporosis Society (NOS) warned that many Scots could be putting their bones at risk due to food fads and because they are eating more processed foods than before.

The charity said regimes such as the low-carbohydrate Atkins diet and the cabbage soup diet could mean people are not getting a nutritional balance.

Bone health is one of the less-discussed aspects of low-carbohydrate diets. A great place to find out more about it is at AtkinsExposed.org, which addresses bone health several times. Here are some highlights:

  • "Some high-protein, very-low-carbohydrate, weight-loss diets are designed to induce ketosis. When carbohydrate intake or utilization is insufficient to provide glucose to the cells that rely on it as an energy source, ketone bodies are formed from fatty acids. An increase in circulating ketones can disturb the body's acid-base balance, causing metabolic acidosis. Evidence suggests that even mild acidosis can have potentially deleterious consequences over the long run, including low blood phosphate levels, resorption of calcium from bone, increased risk of osteoporosis, and an increased propensity to form kidney stones." Read more.
  • "Urinary excretions of calcium and acids are correlated positively with intakes of animal and nondairy animal protein but are correlated negatively with plant-protein intake." Read more.
  • "The concern with bone health arises from the fact that muscle protein has a high sulphur content. When people eat too much of this meat protein, sulfuric acid forms within our bodies which must somehow be neutralized to maintain proper internal pH balance. One way our bodies can buffer the sulphuric acid load caused by meat is with calcium borrowed from our bones." Read more.
  • "Despite having some of the highest calcium intakes in the world, the Inuit also have some of the worst rates of osteoporosis." Read more.

When Restaurant Critics Talk Nutrition

In this morning's Week in Review section of The New York Times, restaurant critic Frank Bruni expounds on the relative merits of being careful about what you eat. He's a man who has essentially dedicated his life to eating richly, so his conclusions are hardly surprising. For instance:

It's also hard to see the point of it. If living to 99 means forever cutting the porterhouse into eighths, swearing off the baked potato and putting the martini shaker into storage, then 85 sounds a whole lot better, and I'd ratchet that down to 79 to hold onto the Hagen-Dazs, along with a few shreds of spontaneity. It's a matter of priorities.

Personally, I'm happy to live in a world where Mr. Bruni has the right to eat whatever he likes. But in this article he veers wide of his core mission--to be an expert on food--and fumbles his temporary role as interpreter of scientific research.

His core failing is familiar to readers of this blog: he assumes that the Women's Health Initiative proved that a low fat does, essentially, nothing:

An eight-year, $415 million federal study of nearly 49,000 women found that those who maintained low-fat diets had the same rates of breast cancer, colon cancer and heart attacks as those who ate what they wanted.

As has been explained in much greater detail previously, that study compared two groups of post-menopausal women, and neither group ate what Dr. Fuhrman and lots of other doctors would consider to be healthy, or even low-fat, diets. Both groups, in fact, ate similarly unhealthy diets, so it's no wonder that the results were inconclusive. (Even in that setting, however, the women in the "low fat" group experienced 9% less breast cancer, contrary to what Mr. Bruni would tell you.)

The article also makes clear a sad and common assumption: that a life of healthy eating doesn't value happiness. Rich as Mr. Bruni's life of restaurant hopping must be, is he really correct to assume that Martina Navratilova's days of fruit, vegetables, basketball, hockey, and decades of championship tennis are really somehow less fun? I know, everyone has different priorities, but I wish he would acknowledge a real world example of someone eating healthily, rather than paint a lazy hypothetical about how terrible it must be not to have ice cream at will.

Bruni's idea that he'd rather die at 79 with ice cream that at 99 without--I'd be interested to get a reaction to that theory from people in hospices. I suspect most of them would not be so cavalier.

And even if we accept that there is nothing more important than moment to moment quality of life--what about the minor and major disabilities that come with aging without concern for your health? The smoker might love the feeling of smoking, but is a life with cigarettes really of higher quality in the waning years, when ailing lungs keep you from playing with grandchildren, or joining the family on the beach for a picnic? I'm not a doctor, and I can't even cite research to prove this particular point, but anecdotally I can tell you that those people I know who are aging with broccoli, salads, and exercise in the routine are by and large having more fun than those who are stuck on the couch with this or that obesity-related health complaint.

Finally, Bruni throws up his hands at all the conflicting medical news, jokingly referring to the Journal of the American Medical Association as "the Journal of Utterly Mixed Signals." I sympathize in theory, but in practice, this is coming from the paper whose pages are filled with Utterly Mixed Signals.

One minute the Times calls T. Colin Campbell's China Study the "Grand Prix of epidemiology" and the "most comprehensive large study ever undertaken of the relationship between diet and the risk of developing disease." Then, when discussing the relationship between diet and disease in subsequent articles, they abandon the lessons of the study entirely without even a passing mention.

Similarly, the Times prints a convincing 2003 Michael Pollan book review explaining, essentially, that our national obesity epidemic is attributable in large part to a deliberate, sustained, and successful effort on the part of food companies to drive profits by getting us to eat more. There is talk of eating less and exercising in hundreds of Times articles. Yet (echoing his colleague Gina Kolata) Mr. Bruni follows up with the conclusion that "given the contradictory medical advice, it may be better to enjoy life."

Who's sending mixed signals now?

Soy's Anti-Cancer Effects

A new study published in the Journal of the National Cancer Institute suggests soy consumption may be linked to a reduced risk of breast cancer. Amanda Gardner of The Healthday News reports:

Asian women have lower breast cancer rates (39 per 100,000) than Western women (133 per 100,000) and, when Asian women migrate to the United States, their breast cancer rates tend to go up. This suggests that an environmental factor, perhaps related to diet, is at play.


Attention has zeroed in on soy products (consumed more in Asia) as they contain high quantities of isoflavones, molecules that affect pathways that could change breast cancer risk. Indeed, more and more women are taking high-dose soy or isoflavone supplements because of their perceived benefits, which include lowering LDL ("bad") cholesterol.

The questionnaire style of data collection makes some researchers leery. Nevertheless, the results are certainly interesting:

When the data was pooled, researchers found a 14 percent relative reduction in the risk of breast cancer among women who had a high soy intake. The association was somewhat higher in premenopausal women.

The scientists quoted didn't endorse soy supplements or refined soy products, but suggested foods like soy nuts and tofu may offer cancer protection.

You can read a lot about Dr. Fuhrman's thoughts on soy in these posts: