Mr. Wanjek Responds

I recently wrote an email to Chris Wanjek for his article on Live Science titled "The Atkins Paradox?" A few days ago, I received a response to my email. This is a copy/paste, so all typos are his.

Greg,

Thanks for your message. You make many good points. I don't write the titles. I hate paradox. But I don't think I was promoting the impossible-to-follow Ornish diet. I just recapped what the study said, almost to the word, that long-term weight management on Atkins is questionable.

My (tainted) experience goes back to the early 1990s at Harvard, where as a student my department was among the first to study the Med diet of fish but little other meat. So that's what got me going on this. Back then, Dr. Atkins posed regularly for teh camera in front of bacon, pork chops and, yes, lunchmeat. There was much talk about "eat the kind of foods you love..." We thought is was kind of funny back then and never dreamed his diet would be so popular.

I'm in Japan this week, where the Atkins diet sounds very funny to the folks here. Obesity is lower than 5%, and the diet is largely (white) rice and vegetables with some fish. Heavy people here confess to eating to much pork and beef.

From a public health view, Argentina has the highest beef consumption and the highest rate of colon cancer. Japan has high salt intake and high rates of stomach cancer. The U.S. has a high rate of fat consumption and the highest obesity rates by far in the world. When you step back to see the whole world as one big study, these kinds of things are revealed.

Again, thanks for your message.

-chris

I'd like to first make note that he addressed me as Greg, rather than Scott. Also, he didn't really address many of my points and still doesn't back anything up with facts. But I would like to address the few statements he does make. I'm not returning them to him via email because I'm not sure he read the first one.

Dr. Atkins advises avoiding processed meats. If he truly did pose with lunch meats (and I have no reason to doubt that he did), it is a shameful marketing ploy. It's the same marketing ploy used by Nutri-System and their "I can eat chocolate every day." Every diet has to pass itself off as "eat all the foods you love" even though eating all the foods you love is probably why you need Nutri-System/Atkins/Ornish/etc in the first place. It is an unfortunate fact of our dietary world. However, if he attracted just a few people to read his book and see that processed meats are taboo, perhaps it was worth it. So many people think any low-carb diet is Atkins. My low-carb diet would not be described as Atkins. It probably fits within the macronutrient ratios, but many foods that Dr. Atkins would allow are rarities for my hunter-gatherer diet.

I always question those studies that show fat to be responsible for a society's ills. For instance, citing that Americans eat more fat and are more overweight seems very short-sighted. The American diet isn't characterized only by more fat. It's also characterized by more sugar, more processed carbs, fewer fruits and vegetables (and therefore, fewer vitamins and minerals), more highly processed packaged food, and more fast food. These studies never tell whether the meat that was eaten was grass-fed or grain-fed, fresh or in the form of a salami. Did the people eat alot of pepperoni and the authors just classified it all as "meat"? What types of fat were eaten? Trans fats are killers and polyunsaturated fats (which we're told to eat in abundance) are known for their ability to suppress the immune system and their propensity for attack by free radicals.

The heavy people in Japan confess to eating more pork and beef. But what else do they confess to eating? How is the pork and beef cooked? Is it breaded, fried, and thrown into a sugary sauce? Have they adopted a standard Western diet, rife with fast food, fried junk, sugar, and processed carbs? If so, it is irresponsible science to blame pork and beef. And then there are the cultural confounders. Americans move little and sleep little, both of which are known factors in obesity. Can we attribute the low obesity rate in Japan solely to diet? Okinawans live long healthy lives - is that solely attributable to diet? No; it is also attributed to their low stress, family-oriented life. Americans are nomadic. We leave our families and live a fast-paced, stress-filled life, cranking out loads of cortisol in the process. It's not black and white. I see too many studies that have numerous variables, yet they only make a decision about one of them and it's always conveniently the one that supports their hypothesis. Remember that correlation doesn't equal causation.

As for Argentinians and "the highest rate of colon cancer," I'm not sure that's true. According to The Weston A. Price Foundation, the US has a higher rate of colon cancer and lower consumption of red meat. According to colon this site, the "main factors that initiate colorectal cancer are consumption of cooked red meat (due to heterocyclic amines) (Gerhardsson de V et al 1991; Reddy S et al 1987), high intake of refined carbohydrates (Franceschi S et al 2001), poor vitamin and mineral intake, alcohol consumption, smoking, bile acids, fecal mutagens (DNA-damaging agents), fecal pH, and compromised detoxification enzymes (Winawer SJ et al 1992)." S o it's not necessarily red meat, but cooked red meat or, more appropriately, overcooked red meat. Meat should be cooked slowly and not well-done. (Why would you want it well-done anyway? All of the flavor cooks out.) Also note "high intake of refined carbohydrates" and "poor vitamin and mineral intake," two factors which most surely affect the US. A 1975 article in Cancer Research mentions Finland, a country with a high-fat intake and a low colon cancer rate. And then there are the meat-eating Mormons with similar or lower colon cancer rates compared to the vegetarian Seventh Day Adventists. It isn't as cut and dry as so many nutritionists would have us believe. Humans have eaten red meat, and lots of it, for hundreds of millenia, yet they weren't dropping dead from colon cancer until relatively recently. Again, a look to our genetic roots points us in the right direction - sugar and refined carbohydrates are not part of the diet that shaped our genome.

When you step back to see the world as one big study, what is revealed is that there are so many confounding factors across groups to destroy most any hypothesis. That doesn't stop people from arriving at the conclusions that they want to see though. "Oh look at those Americans eating all of that fat and look at how big their waistlines are. Let's disregard the baked potato and bread they had with their steak and focus on the butter and animal fat. And then there's the fat in the cake they ate." So keep that in mind when you read reports that fat (or any other single nutrient) is responsible for all of society's ills.

Eat like a caveman and you won't experience the debillitating diseases of our modern culture. Eat meat, vegetables, nuts, healthful oils (like olive, palm, and coconut), fruits, tubers, and squashes. Earn your carbs by exercising intensely. Avoid processed foods, grains, sugar, polyunsaturated oils, and fast food. It's really rather simple.

The Atkins Paradox?

I found this lovely article by Chris Wanjek today. As you can imagine, that article made me shake my head in disgust. He is so far off-base, repeating the standard party line that I had to send him the following email:

Chris,
I have to disagree with you regarding your column on "The Atkins Paradox". First, I have to make it known that I find it hilarious that whenever a high fat diet shows weight loss, it's a paradox. We have The Atkins Paradox, The French Paradox, and The Inuit Paradox. There's always something to explain it away. Genetics (ha!), red wine (HA!), or some other ad hoc hypothesis. One day people will realize that the paradox is that our so-called nutritionists ignored reality for so long and advocated a low-fat diet. Second, you mention some cad eating a package of bologna and washing it down with a Diet Coke as being on the Atkins Diet. He may be following the letter of the law, but he's certainly not following the spirit. Dr. Atkins focused on meat and vegetables, not pork rinds and artificial sweeteners. I bet Dr. Ornish wouldn't agree that fat-free Twinkies are a good food choice, even though they fall into the macronutrient guidelines of his diet. Of course, he won't stop that from letting him attack Dr. Atkins. In fact, I bet someone following a proper Atkins diet eats far more vegetables than someone following the standard American diet. Perhaps you should better acquaint yourself with what Dr. Atkins really preached. Have you even read The Atkins Diet? And then there's the ad hominem attack on Dr. Atkins about his fall on ice. When you can't attack the science, attack the person - is that how it works? You can surely do better than that.

You mention the "mountains of data" supporting the saturated fat/heart disease myth. I urge you to read The Great Cholesterol Con by Anthony Colpo. You'll see just how much selective science has been used to create the government guidelines. It goes against everything you've been taught. Perhaps it'll open your eyes to the facts: saturated fat isn't a killer and cholesterol isn't a killer. Do you know why it's hard to get to 10% fat on the Ornish Diet? It's unnatural! The human body is designed to run on fat for a majority of the time. Fat stimulates the hormones that suppress appetite as does protein. Carbohydrates, on the other hand, do not. There is a reason people associate a low fat diet with starvation; they are always hungry due to the lack of fat and protein.

You mention that humans have been eating a carbohydrate-based diet for the last few millenia, but what about the hundreds of thousands of years before the advent of agriculture? What did hunter-gatherer humans eat up until about 10,000 years ago? I'll give you a hint: it wasn't a plant-based diet. Grains weren't available in any quantity and the caloric cost of processing them to be edible ( i.e., to reduce their antinutrient content) was higher than the calories garnered from them. It wasn't until we figured out how to grow large quantities of grains that we were able to turn to a carbohydrate-based diet. Think about it logically: plant matter is seasonal; animal food is not. Humans EVOLVED on a diet based on animal products - meat, organs, fat, and bone marrow - and somehow they weren't keeling over from heart disease and cancer. The one year-round staple food before the global distribution network that we enjoy today was meat. Meat of all kinds. And I guarantee you that hunter-gatherers weren't picking up the nearest sharp rock to trim the fat. In fact, they relished the organs and fat more than anything. Check out The Weston A. Price Foundation and Dr. Loren Cordain's The Paleo Diet for a good look into the diet that humans evolved on.

I would absolutely love to see you support this statement with some facts: "Country by country, populations become obese when they adopt an American diet high in animal fat and simple sugars." Quite frankly, it is bunk. First, check the archeological records and see that human health began to suffer when we adopted a (drum roll) grain-based diet. Height suffered, dental health suffered, and population boomed. A high carbohydrate, grain-based diet is good for population growth, but not for human health. Second, I would argue that the obesity epidemic began after the USDA Food Pyramid which focuses on grains, grains, and grains to the exclusion of meat and fat. In fact, the paradox here is that we're told by the goverment that we should eat more grains, a food which MUST be processed, over fruits and vegetables, which can be picked fresh off a tree or from the ground and eaten right on the spot. Our biggest problem isn't meat consumption; it's food product consumption. Too many people focus on food products rather than on food. If it comes in a colorful box, it's a food product. If it can be killed with a stick or dug from the ground, it's food.

Chris, please stop repeating the standard party line of "eat less fat," "animal foods are bad for you," and "Dr. Ornish knows all". Open your mind and do some research beyond what the media reports. This week they love low-carb because it's a story that sells. Next week they'll hate it because it'll be a story that sells. It's unfortunate that Live Science is buying into that, pushing a vegetarian diet and vilifying that which has never been given a fair shake anyway. Note that Ancel Keys' cholesterol hypothesis, on which the saturated fat tripe is based, was flawed from the beginning. He selected only the data that proved what he wanted to prove, discarding the other two-thirds of the data that proved his hypothesis to be nothing but a cloud of smoke.

The biggest problem with The Atkins Diet isn't the diet itself, but the way that most people implement it with using low-carb this and low-carb that, rather than going for the foods on the original low-carb diet: meat, vegetables, nuts, fruit, and tubers. And here's the irony: if people would simply eat foods that don't come with a Nutrition Facts label and a list of health claims, they would likely be eating the right things. Macronutrient content matters little if you're eating meat, vegetables, nuts, fruit, and tubers. The body will naturally regulate intake with nutrient-dense, satiating foods. Eat from the above five groups of whole, natural foods and Atkins, Ornish, Sears, et al will be out of business. Of course, so will all of the nutritionists...keeping us confused about what to eat is good for business, even if it's not good for our waistlines.

I could continue debunking the nutrition information on Live Science's site, but I think I have continued long enough.

Respectfully,

I am awaiting his response and will let you know if I get one.

Media Rejects Atkins Editorial

I came across this on Jimmy Moore's site and then again on Regina Wilshire's site. It appears that the media outlets are determining what gets reported as healthful nutrition advice. Time, Newsweek, JAMA, and others rejected this response to Dr. Dean Ornish's complaints about the A to Z Study that showed his diet to be less effective than the Atkins Diet.

Here it is in its entirety from Dr. Vernon's blog:

As always, Dean Ornish and the media put aside science in favor of headlines and self-interest. The following editorial was rejected by NEWSWEEK, TIME, the Journal of the American Medical Association and others. However, Ornish was allowed exclusivity on the playing field. And who pays the price yet again? The American consumer and the millions suffering from obesity, diabetes and heart disease. Dear reader: write to your local media, the national media, phone, email and demand that Dr. Vernon and other experts who follow the trail of science be given a voice.

More Science and Less Zealotry, Please.

The controversy over which diet is best for all has again made headlines with the Dr_atkins_sitting publication of the Stanford University study in the Journal of the America Medical Association March 7, 2007. Since the results are favorable to the low-carbohydrate Atkins diet, the usual criticism can be expected to follow.

Predictably, Dean Ornish has launched a tirade in which he manipulates the study findings to find fault with the low-carb approach and to deflect criticism away from his ultra low-fat diet which did not perform well in the study. Unfortunately, this is an argument based on dogma and not on science. The science speaks for itself.

As scientists and clinicians, we believe that no one dietary approach is going to be ideal for everyone. There is no doubt that, for some, an ultra-low-fat approach may be appropriate. Unlike Dr. Ornish, we recognize that there is no one-size-fits-all approach to the enormously complex problem of obesity and related conditions. Unfortunately, other authoritative sources like the US dietary guidelines also recommend a single lowered fat high-carbohydrate diet approach and have been doing so over the decades that this epidemic has grown.

Gratuitous attacks on the Atkins diet that imply it involves abandonment of wholesome vegetables and fruit for “bacon and brie” are simply wrong. Even in the most restrictive phase it meets the recommended daily guidelines for vegetables and fruits. As one advances through the phases, low-glycemic fruits, more vegetables, legumes and even whole grains are introduced based on an individual’s metabolic tolerance for these foods. One survey found that people who follow the Atkins plan over the long term eat more vegetables than they did before. Another study found that rather than increase the intake of fat and protein to compensate when carbohydrates were reduced, people simply ate less.

The unfortunate reality of today is that too many Americans are eating potato chips and fries and drinking sugar-sweetened beverages. We support the idea that wholesome foods such as meat, fish, cheese and eggs along with vegetables and low glycemic fruits constitute a healthier diet than chips and fries and sodas.

While this study examined four popular dietary approaches, what is clear is that whatever approach one takes to healthy eating, success will depend on how well you can stick to it. In this case, and in many earlier studies, it is clear that the Atkins diet is the one most people can maintain. On the other hand, the extremely low-fat diet advocated by Dr. Ornish is very difficult to follow. In this study, the subjects who were supposed to reduce their fat intake to his recommended intake of 10% could not reach that target.

Another important aspect of this and earlier studies is the beneficial effect that reducing carbohydrates has on metabolic markers. In his criticism, Dr. Ornish states that the LDL-cholesterol level fell in response to his diet, but does not mention that none of the differences in LDL-C in this study were statistically significant. This is therefore not a scientifically valid criticism. On the other hand, it is widely recognized that elevating the HDL-C, the good cholesterol, is an important factor in reducing cardiovascular risk. In this study there was a highly significant 10% rise in HDL-C in the Atkins group but no such change among those who followed the very high-carbohydrate Ornish diet.

In the same vein, the Atkins group demonstrated a significant (both statistically and clinically) greater reduction in systolic and diastolic blood pressure than the other three diets. A difference in mean arterial pressure of 5 mm Hg is about the response we would expect to see with a first-line pharmaceutical in the clinical setting. Any objective observer would acknowledge this as a major beneficial effect of the Atkins diet.

Dr. Ornish suggests that the positive findings of research such as this that supports the Atkins diet will cause problems, and that “many people may go on a diet that harms them based on inaccurate information.” This is a wildly irresponsible statement, given the consistency with which a reduction in important metabolic and cardiovascular risks are achieved by lowering carbohydrate consumption. It is simply preposterous to suggest that an approach that leads to significant risk factor reduction is unhealthy.

The seriousness of the accelerating epidemic compels us to think outside the box to The_atkins_lifestyle_food_guide_pyr find new solutions where the status quo has failed. The only approach that will be successful is one that people can actually follow. This study adds to the mounting evidence that the Atkins diet is a healthy choice which should be supported as a viable way to lose weight and improve metabolic and cardiovascular risk factors.

The Real Atkins Lifestyle

Before there was research on the Atkins diet it was commonly criticized in the belief that it would elevate cholesterol, ruin one’s kidneys and bones and cause heart disease. None of this has been borne out by the research.

What is clear from this JAMA study, and others like it, is that cardiovascular risk factors actually improve when controlling carbs. The scientific studies of this approach have shown numerous times that a pattern of rising HDL-C and falling triglycerides is the hallmark of carb restriction and that this benefit occurs even in the absence of weight loss.

Research also shows that rising HDL-C (good cholesterol) and falling triglycerides is correlated with larger LDL-C particles which are less likely to cause heart disease. Even the much touted statin drugs do not deliver this kind of improvement in LDL-C particle size. On the other hand, the research shows that eating a high-carb diet and cutting fat intake results in small dense LDL-C particles that are linked to an increased risk of heart disease.

Importance of Fat

There are other problems associated with extremely low fat diets, as well. Cutting fat intake can lead to deficiencies in fat soluble vitamins, depletion of essential fats such as EPA and DHA, and decreases in the absorption of nutrients. Studies also show that people with cholesterol levels that are too low become prone to depression, suicide and cancer and have higher overall death rates than those who have higher cholesterol levels.

When all is said and done, it behooves us to remember that the diet debate is not a horse race where there is only one winner. We know there is a great variability in metabolic and genetic factors that will determine what dietary approach is best for each individual person. Although, in this and many other studies the Atkins diet worked better for more people, it is also evident that other dietary approaches will work for some people as well. The most important thing we have learned from dietary research is that people need to find the approach that will deliver healthy outcomes for them individually. And, just as the proof of the pudding is in the eating, the proof of a diet's effectiveness is whether it can sustain those benefits over the long haul. Hopefully, the weight of the evidence will now allow the Atkins diet to be recognized and supported as a legitimate option for people who want to improve their health through better nutrition.

On a final note, Dr. Ornish’s repugnant attempt to undermine Dr. Atkins’ credibility by perpetuating the myth that he had heart disease is unconscionable. It is unbecoming of any honorable person to make ad hominem attacks on those who are departed. Enough is enough. Dr. Atkins died of a head injury. He is no longer with us, but the line of scientific inquiry that he started continues to vindicate his dietary approach. And no amount of unfounded criticism will alter the fact that this study, and the 60 others before it, clearly demonstrate that what Dr. Atkins had been telling us all along was right.

* Jacqueline A. Eberstein, R.N. Co-author, Atkins Diabetes Revolution, President, Controlled Carbohydrate Nutrition
* Stephen D. Phinney, M.D. Ph.D Emeritus Professor, Department of Medicine, UC Davis, Elk Grove, Cal
* Mary C. Vernon, M.D., CMD, Co-author, Atkins Diabetes Revolution, President, American Society of Bariatric Physicians
* Eric C. Westman, M.D. M.H.S, Associate Professor of Medicine, Duke University Medical Center
* Jay Wortman, M.D, Department of Health Care & Epidemiology, Faculty of Medicine, University of British Columbia