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Could Dr. Atkins Be Right After All?
Q: Have you seen the article "What if Itís All Been a Big Fat Lie?" by science writer Gary Taubes? It was published July 7, 2002, in The New York Times Magazine. It purports to present new data in the ongoing controversy over Atkins-type, low-carb diets. The article says the government and the medical community, in collaboration with low-fat food manufacturers, may have led dieters down the wrong path by ignoring Dr. Atkins and recommending a high-carb, low-fat diet. According to Mr. Taubes, the government-backed recommendation to eat less fat -- and more carbs Ė may actually be responsible for the steep rise in obesity starting in the early Ď70s.
What are your thoughts?
A: Yes, a number of people have asked about the article. Clearly, thereís a lot of interest. The article was reprinted in The Wall Street Journal, The London Times and several regional newspapers. It was also covered on CNN, Nightline, Larry King and 20/20.
I watched the coverage on 20/20 and found it very confusing, a jumbled message. The segment begins with a happy female dieter shopping for butter, cream, sausage and steak, and talking enthusiastically about losing weight while eating as much fat as you want. Mr. Taubes calls the high-carb, low-fat diet a product of "mass delusion" and "classic bad science." Yet, the segment ends with program-regular Dr. Tim Johnson talking about a "good fat, good carb diet." Taubes parting remarks are, "Iíll probably stick to a low-carb diet" until we see how this all works out. (More about Mr. Taubesí diet later.)
According to Mr. Taubesí article, there has been a "a subtle shift in the scientific consensus" on whether it might be carbohydrates, not fat, that make us fat. He says "a small but growing minority of establishment researchers" are now willing to listen to Dr. Atkins and other proponents of the alternative hypothesis: "If we eat less carbohydrates we will lose weight and live longer."
That may be true Ė if we are talking about foods made with refined carbohydrates (think white flour), where the fat and fiber has been removed and sugar or corn syrup added. Itís another story, however, if we are talking about whole grains, fruit and vegetables. There are good carbs and bad carbs, just as there are good and bad fats. The article acknowledges as much, but still insists on framing the issue as high carbs versus high fat. What ever happened to moderate?
Iíve written about the views of many of the people quoted in the article, including Harvard professor Walter C. Willett, M.D. (See article No. 82, "The New and Improved Food Pyramid"), and Gerald Reaven, M.D., (See article No. 46, "Syndrome X, The New Heart Disease Risk"). My take is different than whatís suggested in the article.
Most Visible Proponent?
The article calls Dr. Willett "the most visible proponent of testing [the alternative hypothesis]." Itís true that Dr. Willett has criticized the USDA food pyramid for suggesting that all fats are bad and for failing to distinguish between refined and unrefined carbohydrates. But that hardly implies support for the low-carb, high-saturated fat Atkins-type diet.
In fact, whole grains form the base of Dr. Willettís alternative pyramid, and vegetables and fruit form the second tier of the Willett pyramid. Carbohydrates "should" be the cornerstone of a healthy diet, according to Dr. Willett, but they should come from whole grains, fruit and vegetables, or from beans. "Your body takes longer to digest these carbohydrate packages, especially when they are coarsely ground or intact," Willett writes in his book, Eat Drink and Be Healthy.
Dr. Willett does not condone unrestrained consumption of foods high in saturated fat, such as steak, eggs and cheese, as does Dr. Atkins. Willett puts red meat and butter in the "use sparingly" category at the top of his pyramid, while "plant oils, including olive, canola, soy, corn, sunflower, peanut, and other vegetable oils," the good fats, form the base of his food pyramid, along with whole grain foods.
Dr. Willett agrees that high-protein, low-carbohydrate diets work in the short-term, but he does not recommend them for long-term use. "High-protein diets," Willett writes, "can pull calcium out of the bones. Equally worrisome, these diet are high in saturated fat and cholesterol and so may set the stage for heart disease even as weight decreases." He also warns that such diets "could cause kidney damage in some people."
Lard Reduces Risk?
Citing the work of Gerald Reaven, M.D., and others, the article says the low-fat message is "radically over simplified." "If nothing else," says the article, "it effectively ignores the fact that unsaturated fats, like olive oil, are relatively good for you."
Itís true that some advocates of low-fat eating are reluctant to admit that anything good can come from eating more fat. I can testify firsthand that adding good fat to oneís diet can be beneficial. As related in article No.18, I drastically reduced my triglycerides by adding a little olive oil to my diet. I now consume about 20 percent of my calories as fat.
But the article doesnít stop there. It goes on to say that even saturated fats are not so bad. "True, they will elevate your bad cholesterol," says the article, "but they will also elevate your good cholesterol... itís a virtual wash." Porterhouse steak and lard, says the article, could "conceivably reduce your risk of heart disease."
Itís okay to exaggerate a little to make a point, but thatís going too far. My guess is that the author would be hard put to find an expert willing to say much of anything good about lard.
"The crucial example of how the low-fat recommendations were oversimplified is shown by the impact of low-fat diet on triglycerides," says the article. Thatís where Dr. Reaven is brought into the picture.
Dr. Reaven and his colleagues at Stanford University published the first studies on the concept of insulin resistance and discovered a condition called Syndrome X: a cluster of metabolic disorders that represent a major risk of coronary heart disease. People who have Syndrome X do not respond well to insulin; they are insulin resistant. (See article No. 46 for more details.)
Itís true that Dr. Reaven recommends that people with Syndrome X cut back to 45 percent carbohydrates, "because you have to secrete more insulin to handle the carbs if you are insulin resistant." Dr. Reaven also suggests upping fat intake to 40 percent, because insulin levels do not increase when you eat fat. "Fat has no effect on insulin levels," says Reaven.
He does not recommend consuming foods high in saturated fat, however. "Not any fat will do," says Dr. Reaven. He recommends restricting saturated fat to under 10 percent, saying that it would lower your insulin level, but raise your "bad" LDL cholesterol. In other words, you would simply be trading the "new" kind of heart disease caused by Syndrome X for the "old" kind associated with high LDL cholesterol. He suggests 30 to 35 percent mono and polyunsaturated fat. "These good fats keep insulin and LDL under control," says Reaven. They protect against both the old and new heart disease.
Dr. Reaven does not recommend a diet even remotely similar to the Atkins-type diet. To the contrary, he suggests a moderate carbohydrate intake Ė not low carbs Ė and slightly more fat (good fat) than recommended by the American Heart Association. He certainly does not recommend eating lard or porterhouse steak.
In the closing paragraphs of the article, Mr. Taubes expresses some personal reluctance to adopt the Atkins-type diet. "In the course of my research," he writes, "I have ... stared down at a plate of scrambled eggs and sausage, convinced that somehow, some way, they must be working to clog my arteries and do me in." Acknowledging that there is no peer-reviewed studies showing that low-carb, high-fat diets work or that they are safe, Taubes admits: "Itís a justifiable fear."
Be afraid, Mr. Taubes.
(My friend Jeff Novick, MS, RD, LD/N, Director of Nutrition at the Pritikin Longevity Center, Aventura, Florida, has provided me with a copy of a press release issued by the physicians and dietitians at the nonprofit Nathan Pritikin Research Foundation and the Pritikin Longevity Center in response to Mr. Taubesí article. The press release includes the following paragraphs:
"There is, however, another far healthier alternative: a low-fat diet that is rich, not in sugary, REFINED carbs, but in carbs of a different color -- fiber-filled, nutrient-packed, straight-from-the-earth carbs like fruits, vegetables, beans, and whole grains such as oats, brown rice, and corn. These high-fiber carbs, known as unrefined carbs, cause no insulin overreaction. Unlike the low-fat, high-carb diets generically referred to by Mr. Taubes as causing an increase in triglyceride levels and other ills, low-fat, high-carb diets full of UNREFINED carbs have the most proven healthy effects of all diets.
"The dramatic health results of people who have followed this kind of diet at the Pritikin Longevity Center (over 70,000) demonstrate the remarkable effectiveness of a low-fat, high-unrefined carb diet. A sampling of the results from the more than 65 Pritikin studies include a 33% drop in triglycerides and a 23% drop in average and LDL cholesterol (4,587 subjects), 30% reduction in fasting insulin by subjects studied with Syndrome X, and of 652 type 2 diabetics, 39% of those on insulin left the program insulin free and 70% of those on oral medications left medication free.
"These results have been published in peer-reviewed medical journals such as the New England Journal of Medicine and the Archives of Internal Medicine. Regular exercise and a low-fat diet full of fruits, vegetables, and whole grains have also been proven to reverse coronary artery disease and prevent heart attacks. And in the largest study ever published on weight loss, the National Weight Control Registry, most of the nearly 3,000 subjects credit two factors for their success: a low-fat, high-carb diet and regular physical activity. They lost, on average, 64 pounds, and, impressively, kept it off for five years and more. Only 1% followed a high-fat, high-protein diet."
A "letter to the editor" containing the same paragraphs was submitted to The New York Times, The London Times and several other newspapers. As of this writing, I donít know if the letter has been published, but I assume that it will be.)
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