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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Eat Right for Your Metabolic Type: Just Say No!

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 celebrity doctor, Dr. Mercola:

I went to Mercola.com and took the nutrition quiz. Bison meat, Dr. Mercola recommends that I get more bison meat in my diet. I can show you the print out if you want to see it. In fact, he states that if you're like me and have a test score consistent with a ‘mixed metabolic type’ and eat more bison and other ‘dark meats’ (those meats he lists as ‘most beneficial’ for us mixer-types) we will “dramatically reduce the need for emergency care such as visits to the doctor or hospital, pharmaceuticals and over-the-counter medicine” and “permanently free yourself from the health programs, supplements, foods…that won't have any positive effect on your health”. And, best of all, “you will reach your ideal weight by maintaining the principles”. Bison meat, who knew?

But sadly bison meat is just one piece of a much larger picture in this ‘Mercola Madness’. Dr. Mercola’s approach to improving our health is largely centered on knowing our metabolic type. According to Dr. Mercola we’ll be free of disease and attain proper weight and enjoy all his other promises of greater youthfulness, improved health and vigor if we simply know if we’re a protein, carbohydrate or mixed metabolic type and eat the corresponding foods and follow other recommendations. Wow, such a deal! So how do we find out what type we are? We answer a hundred or so questions and his software spits it out, that’s how. For only 59 bucks this is a great deal too, right? Wrong! The determinate test is junk and the pseudo-science attempting to support metabolic typing is even worse.

Firstly, let's look at the all important questionnaire. It is a subjective test in which you respond based upon how you feel relative to specific food consumption, timing of meals, digestion, cravings etc. The problem is that after years of eating the standard American fare most of the foods that makes us comfortable and feel good (which we base our answers on) are the very foods that got us into trouble in the first place. In fact, it's listening to our bodies that make many of us fatter and sicker. After a while we’re just trying to feed the addictions of toxic hunger and quell cravings in an effort to stay comfortable. It may be subtle but it’s what drives many of us. Taking this subjective test is like asking a cigarette smoker when they crave a cigarette if smoking makes them feel better, and after they say yes we recommend that they smoke because they’re the “smoking-type”. The Mercola questionnaire bases our responses on similar cravings and withdrawal symptoms but from processed foods, sugar and salt intoxication, fat addiction, esophageal spasms and other morbid conditions and cravings. Nice.

I answered the on-line questionnaire as a “carbohydrate-comfortable” person obviously would and it sent me results telling me I was a carbohydrate metabolic type; then I took the test again answering as a meat lover would and low-and-behold it sent me results telling me I was a protein metabolic type. And then I answered as I really felt, and I did this at 5 different times throughout the day. Yes, I guess it is possible to be all 3 metabolic types at once. It looks like I’m a Protein Type at around 8:00 am, a Carbohydrate Type around noon and really mixed up at dinner time.

So, now let’s say you took the big test and the computer based decision spits back your metabolic type; looking at the list of foods he recommends there are some sound choices for each type but this has nothing to do with a factitious metabolic type; good food is good for everyone and bad food is bad for everyone regardless of a test score, blood type, eye color or your mother’s maiden name spelled backwards. But unfortunately it gets worse. In addition to some healthy foods (which may be off limits to you based on your type, sorry) Dr. Mercola recommends some seriously dangerous foods in all categories (just check out QuackWatch.com). But back to this metabolic type nonsense; for this premise to be credible the laws of thermodynamics and biochemistry would have to no longer exist. Furthermore, our species simply does not exhibit a wide enough variation or biodiversity of our 20 or so metabolic pathways for any of this to matter. This is addiction based dieting, plain and simple. Unless, perhaps, some of us really have been abducted by aliens and had our insides altered. It’s that darn anal probe they use isn’t it? Perhaps Dr. Mercola does know something that we don’t! Come on, good nutrition is based upon the right ratio of calories and nutrients relative to age, sex and activity level and a few other basic variables. To alter a diet by doubling the fat content for one person verses another based upon some questionnaire is sheer lunacy (and he actually advocates saturated fat, that’s the malpractice of nutritional medicine in my opinion).

To think that a diet which includes excessive amounts of foods that are clearly well established risk factors for diet related cancers and heart disease is somehow less risky because you scored 82 points instead of a 63 on the Mercola questionnaire is scary, really scary. A healthy and well balanced diet with a high nutrient per calorie ratio is health promoting across our entire population. Conversely, a diet too high in fat or excessive in protein can be very damaging to the health of each one of us, even if you scored 100.

I’m sure he means well but at best Dr. Mercola’s methods are a waste of time and money, at worst a Mercola madness meal could be your last, and I mean your last. But what do I know? After all, there’s still not enough bison in my diet.

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.

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.

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What Happens When You Tell The Truth About Atkins

This is part of a weeklong review of the popular Dr. Atkins high-protein low-carbohydrate diet-style. See Monday's post for an overview.

Michael Greger, M.D., is a physician, international speaker, and author of the book Carbophobia: The Scary Truth Behind America's Low Carb Craze. Dr. Greger is also one of the many medical professionals opposing the Atkins Diet Revolution. In 2004 Dr. Gerger received this threatening letter from Atkins Nutritionals, Inc. for comments made on his website AtkinsExposed.org, formerly AtkinsFacts.org.

Dr. Greger is exceptionally knowledgeable of the risks associated with the Atkins diet-style. So he wasn't deterred by this corporate intimidation. Instead he mailed this comprehensive rebuttal of the accusations levied upon him to the Atkins Corporation. His retort is supported by a tremendous amount of scientific data.

The corporate letter makes seventeen claims against Dr. Greger. He and his staff handle each one with methodical precision.

The first accusation insists Dr. Greger is overlooking the overwhelming amount of evidence claiming the Atkins Diet presents no serious health risks. The Atkins Corporation cites no fewer than thirty-four studies demonstrating weight loss and other health benefits and that these studies show an absence of adverse health effects of a low-carbohydrate diet. Dr. Greger's response:

Thirty-four studies is your "overwhelming weight of evidence"? There are literally hundreds of published reports on low-carbohydrate diets,[545] and you can only find 34 that support your position?


There are also, for example, "no fewer than thirty-four studies demonstrating weight-loss and other health benefits" of cigarette smoking.[546-579] There are also 34 studies showing benefits from thalidomide.[580-613]

Just because the Philip Morris Corporation can wave around more than a hundred[614] studies showing health benefits from smoking, this doesn't mean that smoking is good for you. What it means is that one can cherry-pick data to argue almost any position. This is a classic tobacco corporation tactic.[615]

On your website one can indeed find a list of 34 studies downplaying the risks of the Atkins Diet. But if you go to the website of the Asbestos Institute you can find 34 studies downplaying the risks of asbestos.[616]

Dr. Greger also criticizes references to studies appearing in journals founded by an Atkins spokesman and studies funded by Atkins-Funded researchers. Dr. Greger implies this is a foolish strategy for illustrating unbiased research support.

Atkins Nutritionals, Inc. claims that the Atkins Diet can prevent colon and breast cancer. Dr. Greger points out that the American Cancer Society condemns both the products of tobacco industry and the Atkins Corporation for their potential to cause cancer. They write, "A low-carb diet can be a high-risk option when it comes to health." [873] Here is Dr. Greger's response to both claims of cancer prevention:

You seem to disagree with the American Cancer Society's assessment. Dr. Atkins was asked, for example, if "a lot of red meat could cause colon cancer." He replied that there was "very little evidence to support the viewpoint." [878] On your official website, an Atkins co-author even states that "a controlled carbohydrate eating plan could be a valuable way to help prevent colorectal cancer."[879]


Why then does the American Cancer Society say that "consumption of meat--especially red meats--has been linked to cancers at several sites, most notably colon and prostate"?[880] Is the American Cancer Society merely omitting studies that "contradict" their conclusion?

Your website also claims that "doing Atkins is the ideal way"[888] to control breast cancer risk. "A controlled carb way of eating almost automatically lowers your risk of breast cancer."[889] Eating over a half cup of lard's worth of saturated fat[890,891] every day is an "ideal way" to prevent breast cancer?

Your website claims "Saturated fat, the kind found in meat, butter, cheese and other animal foods as well as tropical oils, hasn't been shown to have any effect on your risk of breast cancer--whether positive or negative."[892] To support this surprising claim the Atkins website cites an article published in 1997 which, upon review, doesn't address the topic at all.[893]

Considering the subtlety of the data in their favor and weight of evidence opposing the Atkins diet-style, it is ponderous why Atkins Nutritionals, Inc would make such claims. Although in many corporate structures information flows from the top down. Therefore this next excerpt should explain the Atkins Corporation's foolishness:

Dr. Atkins was asked "Isn't the consumption of fat related to cancer?" He replied "According to the multitude of studies published, fat per se was not linked to cancer, with the exception of trans fats, which are not included in the Atkins Nutritional Approach."[902] This is incorrect on two counts. First of all, trans fats are not the only exception; saturated animal fat has been linked to cancers of the breast,[903] prostate,[904] endometrium,[905] lung,[906] and pancreas.[907] And second, trans fats are included throughout the Atkins Diet.

It seems logical that Dr. Atkins' employees would be left misinformed if he himself wasn't reviewing the necessary scientific data. This is the sustained theme of Dr. Greger's critique; a painstaking approach that refutes each of the Atkins Corporation's claims with real-world unbiased scientific data.

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Short and Long-Term Dangers of High-Fat Diets

This is part of a weeklong review of the popular Dr. Atkins high-protein low-carbohydrate diet-style. See Monday's post for an overview. The following is from Dr. Fuhrman's book Eat to Live:

An argument can be made for the usefulness of diets like the one advocated by Atkins because they often do result in weight loss. Being overweight is such a health risk that there are some real health benefits one receives from losing weight, even if the mode of weight loss places the person at increased cancer risk. Losing weight--even by a high-protein, high-fat, low-fiber diet--will lower triglycerides, decrease insulin resistance, and lower blood pressure.

These high-proteins strongly forbid refined carbohydrates, junk food, and the nutritionally depleted white pasta, white rice, and bread that most Americans consume in large quantities. That is the good part. They also frequently recommend that the dieter consume hundreds of dollars of nutritional supplements each month, Sure, the supplements are better than nothing on such an unbalanced diet, but they do not make it safe.

The conventional American diet is so unhealthy and fattening that an obese individual following the Atkins diet may derive some marginal benefit if he or she can use it successfully to keep his or her weight down, because of all the various adverse medical complications associated with obesity and because the added supplements add some missing micronutrients. However, the reality is that no matter how many supplements add some missing micronutrients. However, the reality is that no matter how many supplements are taken and how much psyllium fiber is prescribed, it is simply impossible to make up for so many important substances that are lacking in the diet. There are too essential nutrients that have never met the inside of a vitamin jar, and no supplemental gymnastics can ever offset the destructive effects of so much animal food and so little fibrous produce. Plus, on his plan, consuming even a moderate amount of the healthy carbohydrate foods such as fruits and starchy vegetables stops ketosis and you regain your weight.

High-fat diets are unquestionably associated with obesity, and eating meat actually correlates with weight gain, not weight loss, unless you radically cut carbs from your diet to maintain chronic ketosis.1 Researchers from the American Cancer Society followed 79,236 individuals over ten years and found that those ate meat more than three times per week were much more likely to gain weight as the years went by than those who tended to avoid meat.2 The more vegetables the participants ate, the more resistant they were to weight gain.

The Atkins diet, along with other similar plans, is virtually the opposite of the one dictated by our heritage. I has almost no fiber, utilizing instead the precise foods that science has established as the primary cause of cancer and heart attacks, and specifically excludes the foods that have been shown to have a powerful anti-cancer effect. Then you are told to take hundreds of dollars of supplements each month to make up for the deficiencies. Does this make sense to you?

 
Atkins
(from his book)
Eat To Live
(Typical menu)
Total Calories
2550
1600
Protein
188 gm
60 gm
Fat
167 gm
19 gm
Carbohydrate
67 gm
314 gm
Saturated fat
60 gm
2 gm
Sodium
5920 mg
592 mg
B carotene
212 mcg
8260 mcg
Vitamin C
30 mg
625 mg
Calcium
543 mg
877 mg
Magnesium
187 mg
593 mg
Iron
18 mg
22 mg
Manganese
1.5 mg
8.1 mg
Vitamin E
10 IU
22 IU
Fiber
5.4 gm
77 gm
Chromium
0.034 mg
0.168 mg

The Atkins menu above, like most of his meal plans, averages 60 percent of calories from fat. Obviously, the Eat to Live menu has fewer calories and almost no saturated fat and is much higher in fiber and other (anti-cancer) plant-derived nutrients.

Remember, the grams of fiber consumed, when acquired from natural foods, mark the level other phytochemicals--which may make a difference between a long life and a premature death.

Its is difficult to imagine a physician, practicing as a nutritional expert, selling millions of book while recommending 60 grams of disease-promoting saturated fat a day.3

Telling people what they want to hear sell books, products, and services. Atkins continues to make irresponsible statement in support of his dangerous advice. Take, for example, statements from his winter 2001 Health Revelations Special Report (an advertisement brochure for his newsletter):

  • Reverse heart disease with filet mignon!
  • Stop strokes with cheese!
  • Prevent breast cancer with butter!

The worst part is the most people do not have comprehensive knowledge of the world's nutritional literature and research and therefore are not in position to evaluate his fraudulent claims. As a result unfortunate things like this can happen, click here.

Tomorrow we'll take a look at what happens when you tell the truth about Atkins.

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Increased Risk of Cancer Associated with The Atkins Diet

This is part of a weeklong review of the popular Dr. Atkins high-protein low-carbohydrate diet-style. See Monday's post for an overview. The following is from Dr. Fuhrman's book Eat to Live:

Robert Atkins's books, as well as other authors advocating high-protein weight-loss plans, recommend diets for health and weight loss with significantly more animal protein than is typically consumed by the average American. Americans already eat approximately 40 percent of their calories from animal products; we have seen a tragic skyrocketing in cancer and heart-disease rates in the past fifty years as a result of such nutritional extravagance.1 You can lose some weight on the Atkins Diet, but you run the risk of losing your health at the same time.

Atkins recommends that you eat primarily high-fat, high-protein, fiberless animal foods and attempt to eliminate carbohydrates from your diet. Atkins's menus average 60-75 percent of calories from fat and contain no whole grains and nor fruit. Analyses of the proposed menus show animal products make up more than 90 percent of the calories in the diet.

Hundreds of scientific studies have documented the link between animal products and various cancers. Though it would be wrong to say that animal foods are the sole cause of cancer it is now clear that increased consumption of animal products combined with the decreased consumption of fresh produce has the most powerful effect on increasing one's risk for various kinds of cancer. Atkins convinces his followers that he knows better than leading nutritional research scientists who proclaim that "meat consumption is an important factor in the etiology of human cancer."2

Atkins devotees adopt a dietary pattern completely opposite of what is recommended by the leading research scientists studying the link between diet and cancer.3 Specifically, fruit exclusion alone is a significant cancer marker. Stomach and esophageal cancer are linked to populations that do not consume a sufficient amount of fruit.4 Scientific studies show a clear and strong dose-response relationship between cancers of the digestive tract, bladder, and prostate with low fruit consumption.5 To the surprise of many investigators, fruit consumption shows a powerful dose-response association with a reduction in heart disease, cancer, and all-cause mortality.6 There is also a striking consistency in many scientific investigations that show a reduction in incidence of colorectal and stomach cancer with the intake of whole grains.7 Colon cancer is strongly associated with the consumption of animal products.8 And these researchers have concluded that the varying level of colon cancer in the low-incidence population compared with the high-incidence population could not be explained by "protective" factors such as fiber, vitamins, and minerals; rather, it was influenced almost totally by the consumption of animal products and fat.

More saturated fat & less fruit = Higher cancer risk

Less saturated fat & more fruit = Lower cancer risk

There are numerous ways to lose weight. However "effective" they may be, some are just not safe. We wouldn't advocate smoking cigarettes or snorting cocaine simply because doing so would be effective in promoting weight loss. Advocating a weight-loss program based on severe carbohydrate restriction is irresponsible. You may pay a substantial price--your life! As was the case with Dr. Atkins's own death, most likely a heart attack that resulted in the slip and fall.

Check back tomorrow for a review of the short and long-term dangers of high-fat diets.

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How a High-Protein Diet Works

This is part of a weeklong review of the popular Dr. Atkins high-protein low-carbohydrate diet-style. See Monday's post for an overview. The following is from Dr. Fuhrman's book Eat to Live:

How can you eat all the fat and grease that you want and still lose weight? Humans are primates; genetically and structurally, we closely resemble the gorilla. We are designed, just like the other large primates, to survive predominantly on plant foods rich in carbohydrates. When the human body finds that it does not have enough carbohydrates to run its "machinery" properly, it produces ketones, an emergency fuel that can be utilized in times of crisis.

At rest, the brain consumes about 80 percent of our energy needs. Under normal conditions, the brain can utilize only glucose as fuel. However, the human organism has evolved a remarkable adaptation that enables it to survive for long periods of time without food.

In the first few days of no carbohydrate fuel (food), the body's glucose reserves dwindle and the only way we can produce enough fuel for our hungry brain is by breaking down muscle tissue to manufacture glucose. Glucose cannot be manufactured from fat. Fortunately, our body has a built-in mechanism that allows us to conserve our muscle tissue by metabolizing a more efficient energy source--our fat supply.

After a day or two of not eating, the body dips into its fats reserves to produce ketones as an emergency fuel. As the level of ketones rise in our bloodstream, the brain accepts ketones as an alternative fuel. In this manner, we conserve muscle and increase survival during periods of food deprivation.

Atkins' dietary recommendations prey on his survival mechanism. When we restrict carbohydrates so markedly, the body thinks we care calorically deprived and ketosis results. The body begins to lose fat, even if we are consuming plenty of high-fat foods, as Atkins recommends. Once you start consuming carbohydrate-containing fruits, vegetables, or beans, the ketosis ends and the meat and fat become fattening again. Meat consumption leads to weigh gain, unless you have caused a carbohydrate-deficiency ketosis.

To make matters even worse, you pay an extra penalty from a diet so high in fat and protein to generate a chronic ketosis. Besides the increased cancer risk, your kidneys are placed under greater stress and will age more rapidly. It can take many, many years for such damage to be detected by blood tests. By the time the blood reflects the abnormality, irreversible damage may have already occurred. Blood tests that monitor kidney function typically do not begin to detect problems until more than 90 percent of the kidneys have been destroyed.

Protein is metabolized in the liver, and the nitrogenous wastes generated are broken down and then excreted by the kidney. These wastes must be eliminated for the body to maintain normal purity and a stable state of equilibrium. Most doctors are taught in medial school that a high-protein diet ages the kidney.1 What has been accepted as the normal age-related loss in renal function may really be a cumulative injury secondary to the heavy pressure imposed on the kidney by our high-protein eating habits.2

By the eighth decade of life, Americans lost about 30 percent of their kidney function.3 Many people develop kidney problems at young ages under the high-protein stress. Low-protein diets are routinely used to treat patients with liver and kidney failure.4 A recent multitrial analysis showed that reducing protein intake for patients with kidney disease decreased kidney-related death by about 40 percent.5

Diabetics, who are at increased risk of kidney disease, are extremely sensitive to the stresses a high-protein diet place on the kidney.6 In a large, multicentered study involving 1,521 patients, most of the diabetics who ate too much animal protein had lost over half their kidney function, and almost all the damage was irreversible.7 In my practice, I have seen numerous patients who have experienced significant worsening of their kidney function after attempting weight loss and diabetic control with high protein diets. Coincidence? I think not. Damage from such lopsided nutritional advice can be very serious.

Ketogenic diets, like Atkins, have been used to treat children with seizure disorders when medication alone is unresponsive. Medical studies reveal that these diets can result in serious health consequences. Investigators report a greater potential for adverse events than had ever been anticipated. The dangers of these high-protein diets include hemolytic anemia, abnormal liver function, renal tubular acidosis, and spontaneous bone fractures (despite calcium supplementation).8 Kidney stones are another risk of high protein diets.9 These studies point out that there are many subtle adverse outcomes not being attributed to this dangerous way of eating. One outcome is the Atkins Diet's relative inability to lower cholesterol when compared to my vegetable-based, nutrient-dense diet-style.

Tomorrow we will look at the increased risk of cancer associated with the Atkins' diet.

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The Physician and The Student

Following is written by 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:

A young university pre-med student was called from class one day. It seems that unexpectedly and without warning, or even prior symptoms his dad had collapsed on their kitchen floor and was rushed to the emergency room; his dad had had a major heart attack.


At the hospital several hours later, with his father fortunately in stable condition, the son and his mother spoke about what to do "if dad makes it though this". Anxiously, his mom suggested that the son place a call to her doctor, whom she had been seeing for many years and trusted implicitly. And, this doctor was a cardiologist, so what could be better?

Calling directly from the hospital the son was able to get the doctor on the phone. They spoke at length about his dad's sudden and near fatal heart attack. What the son sought most from this kind hearted and concerned physician was advice and guidance. The son wanted to make sure his dad would recover and would never have to endure such suffering again.

The supportive doctor spoke of all the right medications, tests and about lowering his father's stress level at work. The son remembers learning the word "prognosis" that day. When the son specifically asked about diet (he told him dad had always loved barbeque and bacon) the cardiologist assured him that any connection between heart disease and food is a complete myth and that his dad's diet was fine. The doctor went on to tell the son that even if there was a connection between diet and heart disease it wouldn't help to change anything this late in his father's life. At that time his father was 53 years old. The son appreciatively took the advice from this very successful M.D. and dutifully passed it along to his parents.

Twenty-five years later the dad is still alive. He's 79 years old. In the past 20 years he has remarkably survived 5 subsequent heart attacks and a triple open-heart by-pass surgery! The mom is still alive too. She's 72 years young, but severe obesity has left her totally wheelchair bound. Both his mom and dad remain loyal to and follow the advice of their beloved doctor, even today. Their loyalty is a bit surprising considering each of their own maladies.

Well, at least they're both still alive and the family remains close. And as for the son, he knows a lot more now than he did that day in the emergency room. After completing his Master of Science degree in Human Nutrition he went on to become a doctor. In fact, the son has dedicated his professional career to the prevention and recovery of heart disease and other killers like diabetes and cancer through nutrition. Although he has become vehemently opposed to the brand of advice the kind cardiologist gave him so long ago he still does his best to help his parents with their unfortunate health problems. But sadly, despite the son's successes with his own patients, his parents remain set in their ways; they still recite their beloved doctor's rhetoric every time the concerned son tries to help.

The nice cardiologist on the phone that day in the emergency room was Dr. Robert Atkins, and that concerned son was me.

This is part of a weeklong review of the popular Dr. Atkins high-protein low-carbohydrate diet-style. Throughout the week DiseaseProof will examine: