I’m always amazed at the number of comments this blog gets from readers who are worried about discussing health issues with their doctors.  Most are a variant of this composite of many comments I’ve read:

I’ve been on a low-carb diet, and I’m afraid my cholesterol is going to be up a little and my doctor will want to put me on a statin.  How can I show him/her that I’m really on the right track?

Another common variant:

I want to go on a low-carb diet, but I’m sure my doctor will be against it.  What should I tell him/her?

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Dr. Dean Ornish never misses an opportunity to worm his way into print. You’ve got to give him credit: he is a self promoter par excellence. When John Tierney posted twice on his New York Times blog about the Israeli study that I posted on previously, Ornish couldn’t resist. He asked if he could post another take on the study. Full post here.

Here is a point he made that readers of this blog (mine) should find amusing. And unbelievable.

What I’d like to focus on here is an encouraging phenomenon that I’ve been predicting for some time: the convergence of dietary recommendations. While people who promote different diets like to accentuate the differences between them, there is actually an evolving consensus of what constitutes a healthy way of eating for most people. While some significant differences remain, a greater agreement is emerging among nutrition experts than most people realize.

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The May 2008 issue of Obesity Reviews, the journal of the International Association for the Study of Obesity, contained a review written by George Bray, M.D. of Gary Taubes’ book Good Calories, Bad Calories (GCBC). Gary Taubes has written a rebuttal that will appear in this same journal. Before we get to Gary’s response, I would like to spend a little time on Bray’s review, which I found interesting and troubling on a number of fronts.

Most reviews of books in academic journals are of academic books and are, at most, a page and a half, maybe two pages, long. The Bray review of GCBC was 13 pages long, including two plus pages of citations. And this for what is basically a popular book written for a general audience, not an academic tome. In all the reading I do of the medical literature, I’ve never seen a book review come even close to this in terms of length and comprehensiveness. Obviously Taubes’ work struck a chord.

George Bray, M.D. is probably the most renowned figure in the field of obesity research today. He is the Boyd Professor at the Pennington Biomedical Research Center (and former executive director) in Baton Rouge, LA; he holds numerous other professorships at various academic institutions; he has held leadership positions in virtually every academic obesity organization in existence; he has authored or co-authored more than 500 scientific papers; he has written at least a dozen books and authored chapters in many more; and he figures prominently in the recent history of how the academic ideas of the causes and cures of obesity are what they are today. It speaks volumes that someone of Dr. Bray’s academic stature would be tapped to write a review (a review, in fact, that is longer than most scientific papers) of a popular book. GCBC has gotten the attention of the academic community.

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The day before yesterday a group of doctors from the nutrition committee of the American Academy of Pediatrics came out with a couple of the most absurd recommendations imaginable. Not only were these recommendations silly beyond belief, one was downright dangerous to boot. I’m talking, of course, about the recommendations that children as young as 8 years old who have LDL concentrations ≥ 190 mg/dL be prescribed statins. (The other one marinated in idiocy is the recommendation that low-fat dairy products be be used in overweight children between the ages of 12 months and 2 years. These two are among 7 recommendations published in the July issue of the journal Pediatrics. All 7 recommendations are listed below*)

Drs. Stephen R. Daniels, Frank R. Greer and the rest of those on the nutrition committee are nominees for the Reckless Award. In fact, their recommendations are so egregious that had they come before the eponymous Dr. John Reckless’s suggestion that statins be put in the drinking water the award would be named after them instead.

Why is the recommendation to give statins to children aged 8 and greater so dangerous? Because no drug therapy is without risk. When as a physician you give drugs to patients, you know there are risks involved, but you balance these risks with the rewards to the patient from taking the drug. In the case of statins, there is absolutely no evidence whatsoever that statins will reduce the incidence of early heart disease and/or death in these children as they reach adulthood. And there is no evidence whatsoever that years of statin therapy in these kids as they age won’t cause disastrous problems later on.

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