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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New Study Says Drinking Lots of Coffee Okay for Heart

A new study printed in the upcoming issue of Circulation claims heavy coffee consumption does not harm the heart. Prompting Reuters to encourage people to go ahead and order that second cup of coffee—or third, or fourth! Good thing, because according to Esther Lopez-Garcia coffee is an extremely popular drink worldwide:

"We believe this study clearly shows there is no association between filtered coffee consumption and coronary heart disease," said Esther Lopez-Garcia, an instructor in the School of Medicine at the Universidad Autonoma de Madrid in Spain, who worked on the study.


"This lack of effect is good news, because coffee is one of the most widely consumed beverages in the world."

Don't park yourself at your local coffee house just yet. The study does warn that heavy coffee drinkers also tend to smoke and drink alcohol more often. Two factors that clearly compromise health, but according to Dr. Fuhrman coffee is dangerous enough on its own.

In his book Eat to Live Dr. Fuhrman provides two reasons why lots of coffee shouldn't be included in a healthy diet:

First caffeine is a stimulant that allows you to get by with less sleep and reduces the depth of sleep. Sleep deprivation results in higher levels of the stress hormone cortisol and interferes with glucose metabolism, leading to insulin resistance.1 This insulin resistance, and subsequent higher baseline glucose level, further promotes heart disease and other problems. In other words, caffeine consumption promotes inadequate sleep, and less sleep promotes disease and premature aging. Adequate sleep is also necessary to prevent overeating. There is no substitute for adequate sleep.


The second issue is that eating more frequently and eating more food suppresses caffeine-withdrawal headaches and other withdrawal symptoms. When you are finally finished digesting the meal, the body more effectively cleans house; at this time people experience a drive to eat more to suppress caffeine-withdrawal symptoms. You are prodded to eat again, eating more food than you would if you were not a caffeine addict.

One cup of coffee per day is not likely to cause a significant risk, but drinking more than this one-cup maximum can interfere with your health and your weight-loss goals.

Dr. Fuhrman also refers to coffee as a mind altering substance that prohibits total nutrition excellence. But for heavy coffee drinkers quitting is tough and can leave you feeling lousy. Here's some words of wisdom from Dr. Fuhrman to help you soldier through it:

You could feel better by drinking a cup of coffee every three hours, evenly spaced out, to keep you caffeine blood levels constant. Or you could take medications such as Fioricet, Cafergot, Excedrin, Esgic, Fiorinol, Migrainal, Wigraine, and others whose active ingredients are narcotics, barbiturates, ergotamines, or caffeine; or you can just get some amphetamines or cocaine from the alley behind the liquor store. Either way, I hope you understand that temporarily feeling better does not mean getting well. Putting toxic drugs in your body can only compromise your health and lead to further dependence and suffering. In order to detoxify, you need to feel worse, not better; then after the withdrawal symptoms are completed, you will truly become well.

For more information on the coffee-craze check out these previous posts: Coffee is Not for Everyone, Caffeine Freaks: Get Tested, and Busy Week for Coffee.

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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.

Research: Mediterranean Diet Cuts Alzheimer's Risk

According to the Associated Press a study published in the Annals of Neurology claims the dissipating Mediterranean diet, thought also to ward off heart disease, may reduce risk of Alzheimers. Lead author Dr. Nikolaos Scarmeas explains the research:

The diet he tested includes eating lots of vegetables, legumes, fruits, cereals and fish, while limiting intake of meat and dairy products, drinking moderate amounts of alcohol and emphasizing monounsaturated fats, such as in olive oil, over saturated fats. Previous research has suggested that such an approach can reduce the risk of heart disease.

Prior research has also suggested that certain components of the Mediterranean diet can reduce the risk of developing Alzheimer's, Scarmeas said. But he said the previous work has tended to focus on individual nutrients like vitamin C or foods like fish. By studying a comprehensive diet instead, the new research could take possible interactions between specific foods and nutrients into account, he said.

Spokeswoman for the Alzheimer's Association Dr. Marilyn Albert believes the study's message is clear:

The kinds of things we associate with being bad for our heart turn out to be bad for our brain.

Before you rush off to buy a vat of olive oil, consider Dr. Fuhrman's thoughts on the Mediterranean Diet. From his book Eat to Live:

Even two of the most enthusiastic proponents of the Mediterranean diet, epidemiologist Martin Katan of the Wageningan Agricultural University in the Netherlands and Walter Willett of the Harvard School of Public Health, concede that the Mediterranean diet is viable only for people who are close to their ideal weight.1 That excludes the majority of Americans. How can a diet revolving around a fattening, nutrient-deficient food like oil be healthy?

Ounce for ounce, olive oil is one of the most fattening, calorically dense foods on the plant; it packs even more calories per pound than butter (butter: 3,200 calories; olive oil: 4,200). The bottom line is that oil will add fat to our already plump waistlines, heightening the risk of disease, including diabetes and heart attacks.

A recent edition of Dr. Fuhrman's Healthy Times newsletter (they are archived in the member center) addresses Alzheimer's. This is from the main article:

Alzheimer's dementia is an irreversible brain disorder that typically develops in the elderly. It leads to memory loss, personality changes, and a general decline in cognitive function.

With the high incidence of Alzheimer's disease in our aging population, more and more research is underway to come up with novel treatments for this brain disease. Given the large distortion of brain architecture that occurs in Alzheimer's, it is unlikely that drug treatment will offer a solution to this debilitating problem.

Growing evidence has implicated vascular risk factors, diabetes, hypertension, and high cholesterol in the etiology of Alzheimer's disease. Cerebral ischemia (lack of blood flow secondary to lipid deposits), aided by marginal nutritional deficiencies, promotes the development of the pathology seen in Alzheimer's.2

Recent studies conducted in the United States have revealed that just as in heart disease, strokes, and vascular dementia, Alzheimer's disease is the end result of nutritional inadequacy earlier in life. Patients with Alzheimer's, compared with controls, showed deficiencies of multiple vitamins, especially the antioxidants found in vegetables and fruits.

Green vegetable consumption was low and animal fat consumption was high in the past histories of Alzheimer's patients.3,4 Japanese studies have found the same relationships: individuals with low consumption of vegetables and high consumption of meat were found to be the ones most likely to develop Alzheimer's.5

Just as in the case of heart disease, the world's leading researchers on the subject consider diets high in animal fat to be the major factor in the causation of Alzheimer's. Oxidative stress to our brain tissue from the combination of a diet rich in saturated fat and low in the antioxidants and phytochemicals found in fruits and vegetables lays the groundwork for brain damage later in life. Deficiencies of DHA (a long-chain omega-3 fatty acid) which often are found in Alzheimer's patients, also have been shown to promote dementia.6 Inadequate intake of omega-3 fatty acids found in flax and hemp seeds, walnuts, leafy greens,and certain fish also are implicated in the etiology of Alzheimer's.

Aluminum Connection
The aluminum present in processed foods also may play a role in accelerating the development of Alzheimer's. Recent evidence has shown that high body stores of aluminum can potentiate the damage to brain DNA from a low body load of antioxidants.7,8 Aluminum calcium sulfate is used as an anti-caking agent so dry ingredients flow freely. Aluminum sulfate is used as a bleaching agent in flour and cheese. Aluminum stearate is used as a chewing gum base and as a defoaming component in the processing of sugar. Aluminum chloride and aluminum sulfate are used as leavening agents in baked goods. Cookies, cakes, cold cereals, and pancakes are all high in aluminum.

Fortunately, when you eat a diet low in processed foods and rich in vegetables, beans, fresh fruit, and nuts and seeds, you dramatically decrease your dietary exposure to aluminum and increase the level of antioxidant compounds in your brain.

Isolated nutrients
Taking vitamin E, vitamin C, or other isolated nutrients has been shown to be only slightly useful and cannot be expected to offer you a significant degree of protection against dementia. That is because vitamins are only a small part of the antioxidant story. For example, the vitamin C in an apple accounts for less than one half of one percent of the antioxidant activity in a whole apple. Most of the antioxidant activity in the apple (and in fruits and vegetables in general) is the result of phenols, flavonoids, carotenoids, and other compounds that work additively and synergistically to protect you against disease.

Multifactorial Causes
The development of Alzheimer's follows the same basic pattern seen in almost every disease affecting aging Americans. Diseases are multifactorial and develop as a result of environmental stresses, the most damaging of which are almost always nutritional excesses and deficiencies. Once these stresses have taken their overall toll, you develop one disease and not another, based on your inherited genetic tendencies and your inherent resistance to certain degenerative processes.

Recipe for Protection
The bottom line is that if you follow the Eat To Live dietary recommendations, you need not fear developing dementia later in life. A comprehensive nutritional program throughout life that includes the following important features can assure freedom from both heart disease and dementia as you age:
1. a vegetable-based diet;
2. high intake of greens, both raw
and cooked, and in soups containing
beans;
3. at least four fresh fruits a day;
4. daily consumption of raw nuts and seeds or avocado as your major fat source;
5. dramatic reduction or elimination of processed foods, sugar, white
flour, and animal products;
6. limited consumption of grains, in favor of colorful vegetables;
7. supplementation to assure adequate levels of vitamins D and
B12, iodine, and DHA fatty acids;
8. blood evaluation of homocysteine and, if needed, supplementation
to normalize.

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Cheese, Calories From Fat

Most cheeses get the majority of their calories from fat, and even the lower fat cheeses are rich in artery-clogging saturated fat:

CheesesPercent of Calories from FatPercent of Fat that is Saturated Fat
Cream Cheese89%63%
Gouda Cheese69%65%
Cheddar Cheese74%64%
Mozzarella Cheese69%61%
Mozzarella Cheese, part skim56%64%
Kraft Velveeta Spread65%66%
Kraft Velveeta Light43%67%
Ricotta, whole milk68%64%
Ricotta, part skim51%62%

From the forthcoming revised version of Dr. Fuhrman's book Cholesterol Protection for Life.

Responding to Comments About Dr. Atkins

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).[344] 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).[345] With so many people on these diets, that could mean Atkins is endangering the health of millions of Americans.[346] LDL cholesterol is, after all, the single most important diet related risk factor for heart disease,[527] the number one killer in the United States for both men and women.[347]

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[526]]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."[523]

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.

Continue Reading...

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.

Watch Out for Starch!

For those with heart disease or who are overweight, limit starchy foods to one serving or one-cup daily. That is, one corn on the cob, one baked potato, or one sweet potato. There is no limit on the amount of low-starch, plant foods you can eat. Although there is some flexibility with higher starch vegetables, if you are not overweight, you can eat more starchy vegetables.

Avoid all refined carbohydrates such as white bread and pasta. Oatmeal and steel cut oats are permissible for breakfast, but even whole grains such as 100 percent whole-wheat products should also be limited to one serving per day.

Healthier Starches (one or two daily): Turnips, parsnips, butternut & acorn squash, corn, sweet potato, peas, carrots, wild rice & brown rice, quinoa & millet, and steel cut oats & oatmeal.

Unhealthier Starches (none to one weekly): White bread, pasta, white rice, quick cook hot cereals, tortillas, chapattis, cold breakfast cereals, pancakes, and waffles.

The most important exclusion here is the removal of refined carbohydrates--sugar, white rice, white bread, white flour pasta, but even whole grains such as brown rice and whole wheat bread are limited to one serving per day. Squash, corn, sweet potato, carrots are preferable carbohydrate choices to white potato, and whole grain breads; they are richer in phytochemicals and carotenoids. They are best utilized by adding them to soups, mixed with greens and beans. Whether you use a little more or a little less of the high starch grains or vegetables (dependent on your body weight and activity level), your meals should still have a higher ratio of green-to-starchy vegetables when you are trying to lower cholesterol.

From the forthcoming revised version of Dr. Fuhrman's book Cholesterol Protection for Life.

I'm Not Fat

Dr. Fuhrman begins his book Eat to Live with this observation of America's dietary indiscretions:

Americans have been among the first people worldwide to have the luxury of bombarding themselves with nutrient-deficient, high-calorie food, often called empty-calorie. By "empty-calorie," I mean food that is deficient in nutrients and fiber. More Americans than ever before are eating these rich, high-calorie foods while remaining inactive—a dangerous combination.

Unfortunately millions of people don't acknowledge the consequences of these habits. Notably obesity. According to Dr. Fuhrman the effect of the standard American diet (SAD) is like digging our graves with forks and knives.

To make matters worse the Associated Press reports a new study reveals many obese people don't categorize themselves as such. A dangerous mistake when you consider the increased health risks associated with being obese. Tim Whitmire reports:

"If somebody doesn't perceive themselves to be obese, they are most likely not going to pay attention to any public health information about the consequences of obesity," said Kim Truesdale, a nutrition researcher at the University of North Carolina at Chapel Hill.


Among those consequences are heightened risk of heart disease, diabetes, high blood pressure and arthritis.

The study of 104 adults, ages 45 to 64, showed that only 15 percent of people who fit the body type for obese correctly classified themselves that way.

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 Häagen-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?

Animal vs. Plant Foods and Heart Disease in Pictures--UPDATED

UPDATE: The following charts have been corrected. Germany and Switzerland are no longer listed twice.

We have been discussing Atkins and other high-animal fat diets. Consider these graphs from Dr. Fuhrman, which tell a pretty dramatic story about the difference between eating an animal-fat based diet and a plant-based diet.

Animal Fat vs Heart Disease
Animal Food vs Heart Disease corrected.jpg

Plant Food vs Heart Disease
Plant Food vs Heart Disease corrected.jpg