October 10

The low-fat diet cascade


Finally the New York Times comes up with a halfway decent review of Gary Taubes’ book Good Calories, Bad Calories. In yesterday’s Science section John Tierney (obviously not a member of the Kolata/Brody/Burros coven) takes a serious look at Gary’s book and what it has to say about the mainstream medical/nutritional establishment’s recommendation to follow a low-fat diet.
Gary Taubes spends many pages in detailed analysis of how the mainstream went wrong in promulgating these incorrect recommendations for so many years despite the mountains of contradictory evidence. John Tierney brilliantly sums up the same situation in just a few paragraphs using a TV show most of us are familiar with as an example:

We like to think that people improve their judgment by putting their minds together, and sometimes they do. The studio audience at “Who Wants to Be a Millionaire” usually votes for the right answer. But suppose, instead of the audience members voting silently in unison, they voted out loud one after another. And suppose the first person gets it wrong.
If the second person isn’t sure of the answer, he’s liable to go along with the first person’s guess. By then, even if the third person suspects another answer is right, she’s more liable to go along just because she assumes the first two together know more than she does. Thus begins an “informational cascade” as one person after another assumes that the rest can’t all be wrong.
Because of this effect, groups are surprisingly prone to reach mistaken conclusions even when most of the people started out knowing better…
Cascades are especially common in medicine as doctors take their cues from others, leading them to overdiagnose some faddish ailments (called bandwagon diseases) and overprescribe certain treatments (like the tonsillectomies once popular for children). Unable to keep up with the volume of research, doctors look for guidance from an expert — or at least someone who sounds confident.
In the case of fatty foods, that confident voice belonged to Ancel Keys, a prominent diet researcher a half-century ago (the K-rations in World War II were said to be named after him). He became convinced in the 1950s that Americans were suffering from a new epidemic of heart disease because they were eating more fat than their ancestors.

As Taubes points out in his book Keys was strong of personality and didn’t shy away from vociferously attacking anyone with whom he disagreed. And he didn’t just point out in a civil way that he though opposing opinions were incorrect and give the reasons why, he attacked vituperatively in medical journals and in person during conferences. He was the Anthony Colpo of his day resorting to personal attacks and innuendo with the difference being that Keys was widely respected by the mainstream and was on the cover of Time magazine(see above); he was like E.F. Hutton: when he spoke people listened (by the millions) despite the fact that what he said was balderdash. Other academicians feared his wrath so they more or less published their findings but didn’t publicly promote them. As a consequence the cascade started with Keys and he made sure that it kept going until it took on a life of its own that still breathes today. If you don’t think so, take a look at some of the reviews of Good Calories, Bad Calories.
(To see an example of what a swine Keys could be, take a look at this exchange. In 1973 a well-respected scientist named Raymond Reiser wrote a paper questioning the idea that saturated fat might be the danger Keys thought it was. (click here for full text) Keys lost no time in responding, accusing Reiser of being a liar and distorting the facts. (click here for full text) Reiser responded (click here), but others got the message: don’t fool with Keys unless you want the same treatment. You can see the same kind of invective today on the part of anyone who questions the lipid hypothesis in the medical literature.)
Tierney has a follow up piece today in the online version of the Times that delves a little deeper into the phenomenon of informational cascades:

The belief that low-fat diets prolong your life is one example of a cascade. The crusade against global warming is another — which is not to say that global warming isn’t real. Cascades can be based on correct beliefs as well as mistaken ones. The point is that large groups of people can reach a “consensus” without most of them really understanding the issue: Once a critical mass of people starts a trend, the rest make the rational decision to go along because they figure the trend-setters can’t all be wrong. The danger is that you end up with the blind leading the blind…

He goes on to quote from a prominent researcher in the field as to why the group consensus over time doesn’t lead to a correct result. In short, it’s because the choice is posed in binary or yes/no form.

It all comes down to the fact that many choices are primarily binary. Endorsing a diet or not endorsing it. Buying a gizmo or not buying it. Going to the restaurant here or not. Running from the lion or not. Chasing the blond girl at the bar or not.
See, prior to our work, researchers thought that the following corrective force would be at work: If I see one agency adopt the 100% low-fat diet, and I think it is a bad idea, I should endorse it only halfway–say, I would suggest a 60% low-fat diet. The next person could figure out from my half-hearted adoption that I wasn’t so favorable, either. If he has negative private views, his choice would become even less favorable (say, 10% low-fat diet). Pretty rapidly, the truth will win out as more and more people act and their actions tell everyone how strongly they believe the diet. They communicate their private views through their action.
What cascades have done is to show that as long as the main choice is binary, this logic won’t hold. There is no strong corrective force any longer. I don’t really have the choice of going 50% low-fat diet. I have the choice of endorsing it or not endorsing it. No one cares about the details of how I am endorsing it. They can only easily observe whether I am for it or against it. If I follow, then those coming after me can no longer learn anything (easily at least) from what I have been choosing as my recommendation.

This analysis confirms one of the suspicions I’ve held for a long time, namely that the most vociferous popularizer of the low-carb diet – Robert Atkins – was its worst enemy in terms of its gaining wide acceptance. Atkins was so personally cantankerous and made such hubristic pronouncements that most mainstream researchers couldn’t stand him and couldn’t bring themselves to admit that he was right about what he said. As a consequence they thought in binary terms: either the low-carb diet is good or it’s bad. And since Atkins is its main proponent and we hate Atkins, it’s bad. Even low-carb proponents didn’t particularly like Dr. Atkins. As I mentioned in a previous post, John Yudkin, a low-carb proponent if there ever was one, said of the Atkins book that its

chief consequence [may have been] to antagonize the medical and nutritional establishment.

Had Dr. Atkins been charismatic, friendly, approachable, in full command of the medical literature, and had he not made the bizarre and hubristic comments about repealing the laws of thermodynamics, I think low-carb would probably be the diet of choice right now, recommended by mainstream nutritionists instead of being viewed as a fad diet that is dangerous. The obesity and diabetes epidemics might have been avoided. I’ve learned from many conversations with various scientists that they just can’t bring themselves to say publicly that Atkins was right because they loathed him so much.
Read these two pieces by John Tierney and you’ll see why people jumped on the low-fat bandwagon; read Good Calories, Bad Calories to see all the information they had to ignore to do so.
To end this post I want to relate an instance where I was almost publicly embarrassed by the cascade effect. In 1989 I was on my first book tour for my first book. It was early in the tour and I was in Minneapolis in the middle of January and going on my very first live TV show that had a studio audience. The book I was promoting told people how to concoct a protein shake and use it as part of a protein-sparing fast regimen. It’s hard to realize now with the plethora of tasty protein shake drinks available that in the late 1980s these products didn’t exist. I came up with a way to use powdered milk, some commercially available protein powders (there were a couple available, but they were used to add to a whole lot of carbs to make body building products – without the sweetening, they were undrinkable) and a few other ingredients to make a pretty good low-carb protein meal replacement. On this TV show I was to make up one of the drinks in front of the audience and have several people try it live.
Needless to say I was a little nervous. I liked the stuff, MD liked the stuff, all the people who loved me told me they liked the stuff, but here I was going to give it to total strangers on live TV and get their opinions. I was in a sweat.  I was in the Green Room feverishly making sure I had all the ingredients so that I could put it together without leaving something out. I wasn’t paying attention to the monitor showing what was going on on the show I was moments away from being on.
Unbeknownst to me there was a solar eclipse in process that the hosts of the show kept cutting to on an onstage monitor. As the eclipse progressed the monitor was showing the advancement of the moon across the sun. Of course the moon passing in front of the sun threw the moon’s shadow across the surface of the earth in places where the eclipse was visible.
The host had asked members of the audience what causes an eclipse. The first person asked responded that an eclipse was the shadow of the sun on the earth, which is, of course, idiocy because the sun is the source of light so it can’t be a shadow. As other people were asked the same question, they all fell into step and gave the same answer. This was the setup.
As my turn came and I (filled with angst about the protein shake I was going to make and unaware of the eclipse situation) walked out onto the set, the first thing I was asked after my introduction was something along the following lines:
Now we can get an answer to our question from a real scientist. Dr. Eades there is an eclipse going on right now and we’re all debating about what a solar eclipse really is. We all think it is the shadow of the sun moving across the moon, is that right?
I was caught totally off guard, and my first impulse was to agree with the consensus, but fortunately, I took a moment to think it through and said that No it was the moon moving across the sun. But I realized after how easily I could have gone with the consensus. And if I had thought that going against the consensus would have branded me as a fraud and an idiot, I might have gone along. Or if there had been a Harvard astronomer on the set and the announcer had said Dr. Eades, Dr. X here from the Harvard astronomy department has just told us that the eclipse is caused by the shadow of the sun on the earth, what do you think? I may well have agreed. Cascades can be powerful persuaders.
Oh, and just in case you’re wondering, once we got into the diet part of my appearance it went great. All the people really liked the shake I made, or at least had the decency to say they did on live TV.

Leave a Reply

Your email address will not be published. Required fields are marked

  1. That herd mentality is hard to resist.
    I keep telling my kids…”let’s not be so open minded that our brains fall out”
    Well written article Doc!
    who is gonna have more than a slice of avocado for dinner!!
    Thanks. I’m glad you enjoyed it.

  2. Thanks Dr. Eades: Great article. As a scientist myself, I believe much of global warming is real, but I believe you’ve hit on the real dilemna. So many people despise Al Gore, that they take a binary approach and refuse to believe. And as a result, the global warming issue is not taken seriously. Fortunately, I refused to let the personality of Dr. Atkins dissuade me from believing he was on to something.
    Thanks again,
    Dave Futoma
    Al Gore is pretty easy to despise, but I haven’t let him stand in the way of my skepticism of global warming.

  3. Ugh, poisonous idiocy in some of the reviews on Taubes’s book. “Read Dean Ornish,” indeed. I was obliged to comment to that one (albeit not to say “no thanks!” although, really, I should have.)

  4. Well, Keys did live to be 100, so whatever he was eating certainly wasn’t killing him. Also, how do you explain the low incidence of heart disease in japan and china, where the main staple of the diet is white rice? And you claim that dietary protein and fat require more complex metabolic processing than carbohydrates (leading to increased energy expenditure and body heat) – doesn’t increased metabolic processing imply increased metabolic stress? And isn’t low body temperature predictive of a longer life span in animal models?
    Hi David–
    The uncle of a good friend of mine lived to be 103 and drank like a fish and smoked until he was in his late 80s. Does that mean we should emulate him?
    Your comment has so many implied premises included that I can’t answer it without dissecting all the premises, which I don’t have time to do. Read Taubes’ book to find the answer to the Japan/China situation. Birds have run at a higher temperature and have much higher metabolic rates than similar sized animals…and outlive them by a factor of 5-10 times. So temp and metabolic rate doesn’t really have a lot to do with longevity.

  5. Hi Dr. Eades,
    Correct me if I’m mistaken but I get the impression that you consider the low-carb approach the best path to health for all of humanity. I pointed out in a previous comment that the biochemical individuality phenomenon may mean that some humans, perhaps a substantial proportion, are biochemically equipped to thrive on a vegetarian diet. Your Response:
    “I have read Roger Williams’ book. But I’m not sure it applies to the omnivore/vegetarian debate.”
    You further remarked, “I don’t believe that people are dissimilar enough that one group responds wonderfully to a vegetarian diet while another responds better to an omnivorous or a carnivorous diet. I believe that humans were evolved to perform optimally on a particular diet. The search for this diet occupies much of my time. At this point in my quest I’m pretty certain that that diet is a meat-based, low-carbohydrate diet. I realize that there will be a variation of response to this diet just as there was a variation of response to my ‘identical’ showers, but I don’t think anyone will necessarily do better on a vegetarian diet. I think there are people who seem to tolerate a vegetarian diet better than others, but that doesn’t mean a vegetarian diet is optimal even for them.”
    The above was from your February 25, 2007 A Fat Vegetarian Post.
    For all I know, you may be correct. But I can’t help but wonder (because there are so many vegetarians out there who seem to be healthy) whether we omnivores ought to insist that our approach is superior until we know for certain. Some vegetarian activists and animal rights folks are, to be sure, guilty of binary thinking. But aren’t you doing the same thing when you say, I don’t think anyone will necessarily do better on a vegetarian diet. Perhaps we could dispel some confusion if we acknowledged the fact that not everybody needs to take the omnivore route to sound health. After all, the important thing is food quality. Food from whatever source must contain adequate supportive nutrients in order for proper nourishment to take place. As Michael Pollan points out, “You are what you eat eats.” Humanity needs food derived from good quality soil.
    Thanks for supplying a link to the Raymond Reiser paper. I printed it out to read after I finish Gary Taubes’ new book.
    David Brown
    Nutrition Education Project
    Hi David–
    I agree that some people appear to be pretty healthy on vegetarian diets. The reason I think the meat-based, low-carb approach is better even for these people is that in my experience these people who have come to me as patients did even better on the higher-protein, low-carb diet than they were doing on their vegetarian approach. You may ask why anyone who was in perfect health and a vegetarian would come to me in the first place? The answer is that one of the people who ended up working for me was a runner and, although not a vegetarian, she improved her times so much with a change in diet that she sent several vegetarian runner friends of hers to me. Once these folks improved, I started getting vegetarians who weren’t runners.
    But I found that many vegetarians who thought they were healthy really weren’t. Take a look at this post about Nina Planck and her experiences with a long-term vegetarian diet. I found her experience to be pretty typical.
    The difference in digestive anatomy and physiology between us and herbivores explains it all. I plan a long post on that subject in due course.

  6. What if ?
    What if What ?
    What if both are equally good and necessary – low-fat and low-carb ?
    What if one eats low-carb on Day 1 and then eats low-fat on Day 2 ?
    In this example – the fat ranges between 5% – 25% – which is from moderately-low to extremely-low in fat.
    This should satisfy the low fater’s – ?
    On the low-carb Day 1 – the fat is 25% – protein is 55%-70% and carbs are 5%-20%.
    This would satisfy some low-carber’s except those who insist on a high fat level.
    On Day 2 – the low-fat day – fat is 5% – carbs are 75%-95% and protein is 5%-20% and the largest source of energy comes from beans/lentils/peas.
    In essence – the fat in the diet is cycled between moderately-low and extremely-low.
    Protein is cycled from very low to extremely high.
    Carbs are cycled from low to very high.
    On Day 2 – the low-carb day – protein ranges from 320 grams to 660 grams – ? There is a reason for this. The protein intake promotes the turn-over of protein – allowing the body to get rid of old protein and make new proteins.
    Also when large mass of protein reaches the large intestine – it better serves to manufacture Vitamin K2.
    On Day 1 – the low fat day – the beans and some grains and other carbs in the diet help increases the bacteria in the large intestine that actually manufacture the Vitamin K2.
    So much protein is eaten on Day 2 that when Day 1 comes around – the person is simply not very hungry – so the intake of the high carbs is actually reduced to something like 800 calories.
    Day 2’s – calorie intake from high protein is around 1600 calories.
    So the average calorie intake – becomes 1200 calories.
    This is even slightly lower than those supporting the life extension reduced calorie system.
    This diet is my invention by the way.
    The Ideal Calorie Setpoint Diet or Jet Burn Diet.
    The average protein intake is 160-200+ grams – but on the high protein day is 320-660 grams and on the low protein day is 20-60 grams.
    The diet supports the maximum cell renewal and turn-over.
    It supports the renewal of fats by burning excess fats with-in the body.
    It supports the maximum use of Vitamin K2.
    And supports an ideal body composition by way of high protein – and by keeping the bodies metabolism at normal levels – even on the very low caloric intake.
    And it does this via – low-carb and low-fat and by cycling both of them.
    Hi Jeff–
    I’ll post this and leave others to comment on it.

  7. How does one go ‘great’? Does he perform super well? If it were up to my father and I, we’d say that hopefully it went great and that good English is our fort’ay’. I hope that you make less mistakes with your facts.
    Were I your father I might disown you.

  8. I am generally pretty good at avoiding the cascade effect; for what reason, I don’t know. I gotta tell ya though, not going along with the herd killed any chance I ever had at being one of the “cool kids” either at school or in life. Perhaps it’s the gift to see what’s really there.
    Sometimes coolness has to be sacrificed on the alter of not acting or thinking like an idiot. It’s a lesson I had to learn over and over and over.

  9. Dear Dr Eades,
    Excellent analysis; again. Where you mention Anthony Colpo, I would have taken Prof Dr Martijn Katan (‘The Katanic Verses’) as an example of agressive and uncivilized behaviour. Katan recently made some slanderous attacks on Dr Uffe Ravnskov in a Dutch TV show and all the sheep in Dutch academia applauded, totally unaware of the naked facts. Contrary to Keys and Katan, Colpo is spreading sound information and I’m sure he even saved people.
    But I do see your point.
    Gary Taubes has done a tremendous job and the fall out will be huge, although it may take some time. Not even Katan can put him aside as a crank, although he certainly will try, as he has done in the past.
    The big problem are the journalists (I’m one myself) and especially their gatekeepers. Most of them are completely brainwashed. The few journalists who have studied the subject in depth, and start to deviate form the mainstream dogma, are simply not allowed to report what they see. That’s why websites like yours are so extremly vital.
    Melchior Meijer
    The Netherlands
    Hi Melchior–
    I took Katan to task in an earlier post. He is a nasty piece of work who apparently hates Ravnskov with a passion. Colpo is much the same way in that he launches vituperative personal attacks against anyone whose opinions he happens to disagree with whether they be friend or foe.

  10. From my experience I’ve seen that people who as you put it “resorting to personal attacks and innuendo” instead of arguing the point have no footing. When I see that I can quickly discern who has the strongest argument and is usually right. I call these pseudo-scientists. Scientists (should) make decisions based on data irrespective of their personal feelings toward another investigator. Have you found this to be true in your professional experience?
    Yep. Personal invective has no place in science. Science should be based on its merits, not on the personalities of its individual researchers. Sadly, this isn’t always the case.

  11. Dr. Mike, you wrote… “Had Dr. Atkins been charismatic, friendly, approachable, in full command of the medical literature, and had he not made the bizarre and hubristic comments about repealing the laws of thermodynamics, I think low-carb would probably be the diet of choice right now, recommended by mainstream nutritionists instead of being viewed as a fad diet that is dangerous.”
    Aren’t you that “charismatic, friendly, approachable, in full command of the medical literature” kind of guy? Why aren’t you still out there on Good Morning America and Oprah promoting this life style? C’mon, get out there and promote! Now would be as good a time as any with Good Calories, Bad Calories out there supporting you.
    Hey Dave–
    Get me the gigs, and I’ll show up and be charismatic.

  12. Another well done post Dr. Mike. I saw the Tierney review in the NYTimes and was going to draw it to your attention, but you beat me to it. Also wanted to mention that my spouse has some acquaintances in NYC and is hearing that Gary Taubes’ book is generating a lot of positive buzz there (nothwithstanding the dyspeptic duo of you-know-who…ok, I ‘ll say it: Brody/Kolata).
    And you are right about the cascade stuff which I previously have experienced (who hasn’t?), but never thought much about it…..until now. Sometimes human nature (especially the ego thing) seems to be our own worst enemy.

  13. Right now, I’m laughing my butt off. I just got back from the grocery store. As I walked into the store, there was a lady doing cholesterol screenings, and since I hadn’t had a lipid profile done in a few years, I had her test me.
    The last time I was tested was less than a year after I stopped eating so many carbs, lost weight, and started weight training. My total cholesterol was 208, but the HDL was excellent and the LDL was only a little higher than desirable. Triglycerides were 55. In the years since that last test, I’ve almost completely purged my diet of polyunsaturated vegetable oil. Most of the fat in my diet is from meat, butter, virgin coconut oil, and a little olive oil. As I’ve put on muscle over those years, my meat intake has gone up, including red meat. So, according to current dietary dogmas, my meaty diet and all that saturated fat should translate into a terrible lipid profile. The numbers:
    Total cholesterol: 169
    HDL: 40 (desired is above 35)
    LDL: too low to measure
    Triglycerides: less than 50
    I had originally gone to the store to buy some sirloin. I bought a ribeye, instead.
    Good for you.

  14. Several years ago while in a faculty meeting of the English department where I taught, we were all lamenting the paucity of anything remotely resembling genuine thought or conviction in our students’ essays. One of the instructors observed that students don’t think, they merely “assimilate commonplaces.” His phrase has stayed with me because it captures exactly what so many people do in forming their opinions and beliefs. They do not think for themselves, they do not read on a subject, they do not query all the people they can find who might know something, examining all angles, weighing all the evidence they can find before arriving at a conclusion that then becomes their belief. No, most of the time they merely catch scent of whatever happens to be blowing in the societal wind, inhale deeply without much critical examination and then exhale the same as if it were their very own original idea. And we are all guilty of this to some degree. But it can be a very useful exercise to take something one believes and ask, Why do I believe this? And we can exercise great rigor in knowing why we believe what we do in certain aspects of our lives and be completely uncritical in some other because our passion just isn’t there to do the examination necessary.
    This assimilation of commonplaces certainly applies to the low-fat dogma so many accept as fact, but it affects everything we believe, about what is right or wrong, how to solve grave social ills, how to parent our children, who to vote for, what is true about the supernatural, etc. We all have our beliefs about evolution, abortion, embryonic stem-cell research, global warming, illegal immigration, the war in Iraq, what have you, but how knowledgeable are we, really, when we open our mouths to pontificate on these things as if we know what we are talking about? How knowledgeable are the politicians who tell us they have the answers to all these issues and more? Most of the time we are merely passing off commonplaces we have assimilated as if they are the Very Truth. We are not very rigorous in analyzing why we believe what we do and whom we decide to trust. And we are definitely prone to allowing our judgment to be clouded by any personal stake in an issue, whether it’s financial gain, getting elected, keeping a job, having to change the way we do something, or just enduring the embarrassment of having been wrong.
    Ideas have consequences, and if one is in a position of authority, such as a doctor or a Supreme Court justice, making decisions coming from assimilated commonplaces can have far-reaching, even deadly, consequences. It can be crucial for correcting a wrong idea to trace how a commonplace belief has arisen as a consequence of someone’s mistake. Taubes’ book is valuable for helping us to understand the cascade of steps that culminated in the low-fat gospel so deeply entrenched today as an assimilated commonplace. Ancel Keys made a terrible mistake, and lots of people are suffering as a result of it.
    Hi ethyl–
    You are correct in every word you wrote. Most of us all ‘assimilate commonplaces’ because we somehow think that there is wisdom in what the crowd thinks. And there is wisdom in what the crowd thinks if – as in Who Wants to be a Millionaire – they are allowed to think independently and have their votes tallied. But more often than not the opinion or ‘wisdom’ of the crowd comes as a result of a cascade that springs from the wrong original thought.

  15. I’d love to know what Loren Cordain thinks of the Taubes book, particularly the saturated fat stuff (hint hint). By and large I think Loren is an excellent scientist, and so if anyone could put together a scientifically sound counter-case, it should be him.
    I haven’t talked or corresponded with Loren since the book’s publication. I’ll let you know when I find out.

  16. Thanks Dr. Eades: I ran across another review of Taubes’ book in the Wall Street Journal.
    Got to love this guy.
    “Even if it sounds plausible that a diet laden with highly processed carbs is, at least in part, a cause of obesity, and perhaps diabetes, it remains just a theory, one still resisted by many mainstream diet researchers.”
    Nice application of the cascade theory. It is the carbs, Scott!!
    Dave Futoma
    I read the review. Sounds like the reviewer missed the point, doesn’t it. Of course many mainstream diet researchers resist it – the whole book is a treatise on why.

  17. There is an article in the Thursday NY Times about dental care in the U.S. As well as saying that there are many people who cannot afford dental care, it talks about an increase in dental caries during the last 20 years. Is this possibly a result of the increase in dietary carbs (i.e., sugar in the bloodstream)? Seems like more than a coincidence…….
    Since there is no controversy over the fact that sugar causes dental caries, then the fact that people are getting more is no surprise since the intake of sugar has gone up markedly over the last few decades.

  18. The “informational cascade” is a very interesting theory. I can see how these researchers could get caught up in it. Too bad they didn’t get caught up in the correct theory, low carb!
    Yep, cascades can be correct as well as incorrect. It is too bad it didn’t go in the right way.

  19. You say Atkins was an abrasive jerk and hurt his cause. Yet the main point of your article is how much of a jerk Keys was and how that helped his cause.
    What’s the difference? Is it just because Keys was first and his ilk are now entrenched?
    Hi seyont–
    There is a big difference. Keys was in a position of great power so his opinion counted within the scientific community. If he made you look bad, it could hurt your career and make you look bad in the eyes of your colleagues, all of which made it difficult for people to buck him even though he was wrong. Atkins, on the other hand, was not an academician. He was considered a charlatan trying to hawk a diet book. (Not by the public, but by the people in power.) As such it made it difficult for him and his ideas to get an honest evaluation by the scientific community. And he made it even more difficult by his own personality. Other doctors who came before him and had bestselling books promoting low-carb diets – Herman Taller and Dr. Stillman come to mind – didn’t receive the same abuse that Dr. Atkins did because they didn’t bring it on themselves.

  20. And the cascade keeps on flowing downhill to the most innocent and helpless. Scholastic, the school publishers,are now offering a nutrition game full of misinformation and low fat, lowcal propoganda. It is being distributed to schools along with lesson plans. Kiddies are to be graded on how their families eat.
    I can only be glad my children are grown. 0therwise I might have to homeschool them.
    God help us all. When dogooders start doing good with something about which they haven’t a clue, trouble can’t be far behind.

  21. You said, “Had Dr. Atkins been charismatic, friendly, approachable, in full command of the medical literature, and had he not made the bizarre and hubristic comments about repealing the laws of thermodynamics, I think low-carb would probably be the diet of choice right now, recommended by mainstream nutritionists instead of being viewed as a fad diet that is dangerous.”
    Thanks for that! I began doing Atkins right after Dr. A died. The diet enabled me to lose 75 pounds and keep it off. I never could understand why, if the diet works as advertised, people hated Dr. A so much. Your comment helps to explain it.

  22. So, a lot of the folks at a low carb message forum are a little up in arms that you called Dr. Atkins hubristic and cantankerous, especially since he seemed so charming on TV being interviewed by Larry King. Frankly, I’ve worked with a lot of people that fit that description so I can imagine that Dr. Atkins, as much as I appreciate him for leading me to low-carb, could have had those attributes, but I am curious as to what earned him that reputation with you.
    Hi Nancy–
    You saw him after he had been prepped by a squadron of media consultants after he had sold his name to Atkins Nutritionals for many millions of dollars. And at a time – brief though it was – that the low-carb diet seemed to be at its pinnacle so he wasn’t having to defend himself: he was being vindicated. I’ve seen him many times in person and on other TV shows where he wasn’t so charming. He had a real chip on his shoulder and didn’t mind letting people see it. Whenever he was questioned about specific aspects of how the diet worked from a metabolic perspective, he launched into a tirade about how many patients he had treated with the diet and how no one should question him because he was the only one who had the experience to comment on instead of calmly laying out the science, which I suspect he didn’t really know. (Let me hasten to say that I don’t know that he didn’t know it, but I suspect that he didn’t based on conversations at medical meetings) He had the idea that he had invented the low-carb diet despite the fact that many came before him promoting the same diet: Taller, Stillman, Pennington, Donaldson and a number of others. And he was quite proprietorial about it. Read Gary Taubes’ book to learn how Dr. Atkins learned about the low-carb diet from another doctor who used it in his practice. He didn’t invent the low-carb diet, he was merely another guy who came along and rediscovered it because it worked. He thought that anyone who came up with a different version of a low-carb diet was trying to rip him off. As a friend of mine, famous in nutritional circles, said of Dr. Atkins: He went around being mad because the cave man used his diet and didn’t give him credit for it.
    If you really want to get a picture of what he was like, ask some of the people involved in the early days of Atkins Nutritionals who worked with him directly. They will know much better than I.

  23. Jeff, do you really eat this way? What a lot of calculating and scheduling it appears to be. Can’t imagine how to incorporate that into life, let alone leave enough time to enjoy cooking and eating the food.

  24. the hilarity about the Ephron ‘i told you so i knew it’ is that within the past 12 months i saw a post by her and she was raving about eating carbs..which doesn’t negate what she says in this piece but it certainly intimates that this is not how she eats..contrary to the thing i read!

  25. A recent study from MIT: http://www.sciencedaily.com/releases/2007/10/071011125341.htm
    A cursory search couldn’t track down, for me, the publication (I work for an academic institution and have access to many journals) to see what references they included to support their assertion that cholesterol has damaging effects and is a culprit in the aging process and aging related diseases.
    I recently stumbled onto your blog when my boyfriend showed me your post regarding IF, which is something that we do pretty naturally. We were both pleased to read it. As such when I have time I’ve read through some of your former posts.
    I understand that it is difficult to sway the medical science community and pharma; so often studies that might support or refute common “wisdom” are buried or publicized depending on this very thing.
    Recently, I was delighted to find a study conducted regarding Intercessory Prayer as a modality for recovering patients. Prior studies had espoused the benefits and shown positive correlation between those who received prayer and their prognosis and recovery. However, most of these studies did not have rigorous controls. A rather large group of collaborators, who stated in their hypothesis that they believed they could show under their conditions of rigor that a positive correlation existed, in fact found a negative correlation. I know these types of studies generally don’t get much press and have no real benefit for the pharm industry but I enjoyed it because it took a very logical approach and employed good controls and experimental groups, something a scientific study should absolutely have.
    I thought the study you posted recently on the topic of thermodynamics and the ketogenic diet in mice was well planned and their discussion was excellent because it did not gloss over the fact that the ketogenic diet had an unexpected result.
    Would you point me to some studies similar to this? I’m curious to see the source of their funding, the hypothesis presented and the thrust of the discussion, also the impact factor of the journal that accepted their publication. I would love also to see some studies that initially support the ketogenic diet and have rigorous controls, whether the outcome is positive or negative.
    Anna D
    Hi Anna–
    Here is the PubMed citation for the paper you referenced from ScienceDaily. You can find all the references listed.
    From time to time I post on various articles on ketosis and the ketogenic diet and list specific articles in those posts. A long list of such articles, however, is beyond the scope of the comments section.

  26. Al Gore is pretty easy to despise, but I haven’t let him stand in the way of my skepticism of global warming.
    Hi Dr. Eades. There’s a popular Canadian blog that has been doing a running series called “The Sound of Settled Science” that you might find interesting:
    The global warming people have much in common with the low-fat people.
    Thanks for the link. Quite interesting.

  27. Excellent post by ethyl d. Combine what ethyl d wrote with the ‘groupthink’ concept and you have a pretty powerful vehicle in which dissent from the mainstream is steamrollered

  28. Dr. Mike – Thanks for turning me on to Taubes’ book. I’m halfway through it and find it extremely informative, much like your blog.
    I just read Kolata’s review that you linked. To me, the most verifiable criticism of Taubes’ analysis is that he ignored the calorie-is-a-calorie-is-a-calorie rsearch of some researchers names Hirsch and Leibel. What is your take on their studies, as reporter by Kolata, and whether Taubes should have addressed it?
    Taubes absolutely addressed it, but I’m going to post on the very study she quoted as soon as my travel schedule permits.

  29. Hi Dr. Eades,
    I just noticed on Amazon that Gary Taubes has a new book to be released in Jan ’08 called
    “The Diet Delusion”. Do you have the skinny this one as I don’t recall you mentioning anything about it in previous posts?
    Hi Ned–
    I don’t know for sure, but I suspect it is alternative title that the publisher provided to Amazon early on. If it were a new and different book, I’m sure Gary would have told me about it.
    If you look up my name on Amazon, you’ll find the same thing: multiple books that don’t exist.

  30. Great article Dr. Mike.
    It works well with the conclusion I’ve come to over the years: “The more widely held a given belief is, the greater the probability that belief is categorically false”. I’ve seen it happen enough times to formulate the opinion, but I’d never been able to figure what the mechanism might be until now. Thanks!

  31. How can LDL be too low to measure, especially when they aren’t measuring it? Does the formula break down when triglycerides are too low as well as when it’s too high?
    Back in ’05 I had one test where my triglycerides were 37, total cholesterol 111, and HDL was 52, the lab report said my LDL was 52. This lab does not measure LDL directly so 111-52-(37/5)=51.6 This is the only test I have a record of where my triglycerides were under 50.
    Alex’s LDL would have to be between 119 and 129, wouldn’t it?
    Probably. Typically LDL is calculated, not measured. And you’re right LDL can’t really be too low to measure.

  32. In Dr. Atkins’ defense, I have to say his books are completely convincing and charming. I do not find a single “discouraging” word in them. I believe Dr. A devised the common-sense explanation of why low-carb works, and that is his greatest legacy – the misunderstood role of insulin and the eventual exhaustion of the pancreas. I haven’t heard anyone else explain this theory but him, or those who have written after reading him.
    He did make statements deeply critical of the AMA and AHA, and this I assumed is why he was reviled. However, these statements were factually correct on his part, these institutions were fatally misguided and he did have the simple solution to the global health crisis. In response, these groups did not merely reject his opinion, they attacked it and questioned his credibility even though his theory was clearly evident and demonstrable. This system-wide revulsion cannot merely be the result of a “difficult” personality on his part, but must rather be from the entrenched corruption of the entire system which remains proudly and willfully uncomprehending, dooming generations to early death. His professional and moral frustration was understandable and justified. He may have not approached those in power in the most sensitive way, but neither did Jesus. There are times when being nice just doesn’t get your message across to a morally deaf audience. I doubt very much that Dr. A would have been listened to regardless of how nice he was about it. It merely would have been easier to ignore him.
    Which leaves us with the deep mystery of why is the medical community so willfully and persistently blind on this medically straightforward theory? Regarding the theory of “cascading”, your analysis is too generous to say that the third person is persuaded that the first two must be right, rather the third person finds themself outnumbered, and does not want to be rejected by the social group – in other words, he is not convinced, he is afraid. In this light, see the studies on “Groupthink” which were popular in the 70’s, and which perhaps you remember. It is a very real dynamic, as anyone who has ever been part of any group consensus can attest, and certainly still valid today.
    Since there is no logical explanation as to why this cascade was accepted, a deeper explanation might be economic and psychological, that is, because it plays much better to human (and particularly American) greed and weakness. Sugar has been a huge industry since colonial times, including having deep roots and complicity in the slave trade. Today, the sugar lobby is a huge contributor to Congressional campaigns. The sugar, corn and grain growers benefit from enormous congressional subsidies. The doctors benefit from payoffs from pharmacy companies, who benefit from needing more new drugs for ever-sicker patients. And the patients certainly prefer the message that they do not have to give up candy and pastry. Beef growers force feed corn and grain to fatten cows. Everyone in the medical-industrial-agricultural complex benefits by the support of sugar and keeping patients sick. This whole system is cheaper and easier and more profitable than the healthy alternative. But this system is starting to crumble due to increasingly overpriced and unaffordable medical care and drugs, and a population who only get sicker.
    And finally, yes, the system of free scientific inquiry and review usually gets it right eventually, even if we have to live with a very mistaken theory for a time. Sometimes living with the mistake for a few decades or centuries is precisely what is needed to bring the truth to light. The low-carb nutritional theory is particularly frustrating because we have been suffering from it for millenia, and the greatest science community in history still is deeply blind to the obvious error. I only hope that our current systemic error is the precursor to a global revelation of the truth.
    Sorry for the verbosity.
    Hi Kevin–
    You wrote:
    “I believe Dr. A devised the common-sense explanation of why low-carb works, and that is his greatest legacy – the misunderstood role of insulin and the eventual exhaustion of the pancreas.”
    Actually in his first and most influential book Dr. Atkins proposed the existence of some mysterious hormone that he called Fat Mobilizing Substance (FMS) as the driving force for the weight loss seen with low-carb diets.
    And his books were accessible and charming, mainly because he didn’t write them. He had ghost writers for each one.
    I disagree that even if he had been more friendly that he would still have been snubbed. Friendliness never hurts – it only helps.
    I agree that the sugar industry and the carb industry in general are a major force in maintaining the high-carb status quo. Let’s hope their power wanes some in the near future as more and more info continues to pile up showing the damage that sugar and carbs cause.

  33. The problem with information cascades is that once initiated they can become self-sustaining. Even in the face of mounting compelling evidence that the information propagated by the cascade is fundamentally wrong the acquired momentum acts to oppose change.
    The low fat, anti-saturated fat cascade has acquired so much momentum that it’s influence is likely to continue to increase long after the publication of Taubes’s ‘Good Calories, Bad Calories’. The following web link to Hannaford Guiding Stars, a ‘health’ rating system for foods that gives high rankings to low fat foods and foods low in saturated fat, is an example of the increasing sphere and dissemination of the effect of the low fat cascade.
    God help us. All this effort expended to come up with a system that flies in the face of science.

  34. Thoughts on dear Jeff’s Jet Set Point Diet Plan….
    #1 why try to satisfy all people. You don’t find scientific truth through appealing to all comers. That’s how you sell stuff to masses, but not how you find objective, scientific proof.
    #2 Given what we understand about the role of insulin in metabolizing fat (or rather, in storing it and preventing the withdrawal and oxidization of it), why would you bother with a high carb day, that will surely set your fat loss efforts back by increasing fat stores.
    #3 Given what else we know about insulin, fat storage, and hunger, the high carb day would seem to provoke over eating and increased hunger. Perhaps, depending on the type of carbs (complex, slow digestion carbs vs. sugar), this might make the low carb day very difficult indeed.
    #4 Given personal experience, a day of carbs at the high carb level (800 kcal, not sure if this is of carb and therefore 200g of carbs or total with 75% of it being carbs, and therefore 150g, but either way), I would be riding the rollercoaster of withdrawl. It would be like quitting an alcohol habit every first day, then drinking two bottles of champagne on every second day. That might be down from a couple bottles of vodka, but it’s not exactly what I would call a good cure for alcoholism.
    #5 I dunno that I need to bury this plan anymore, but based on the best research available, we don’t really believe in set points, thrifty genes or really anything other than insulin moves food into fat storage (and prevents it’s removal by any other hormone) and that every other hormone pretty much (to a greater or lesser degree) takes energy out of fat storage. That’s the state of the art of our knowledge, and the plan, as sketched by Jeff doesn’t really address this problem, even though it claims that it “supports the maximum cell renewal and turn-over… (and) supports the renewal of fats by burning excess fats with-in the body.” It doesn’t sound grounded in the best that science has to offer us, so why bother.
    Last thought there: Protein Power works to optimally move fat out of fat storage (again, low insulin levels, all the time) while protecting the lean body mass (positive nitrogen balance due to adequate protein levels, customizable to high protein levels based on activity levels, allowing you to not just maintain but grow from fat-skinny to skinny-muscular). Why reinvent the wheel, especially by breaking it’s main rules.
    Last though in this post: After reading GCBC, I am understanding why Dr. Eades is into intermittent fasting. I dunno if it’s for me, but if I stall, I might look into some version.

  35. The Diet Delusion is the title for the UK edition of Good Calories, Bad Calories.
    I wasn’t bother by the GC, BC title until I had the book and was out and about reading it , especially while waiting in Urgent Care and my husband’s hospital room when he had appendicitis and diverticulosis 10 days ago. People ask what I am reading and when they see the front cover, they roll their eyes and dismiss it as a “diet” book, and don’t even seem to hear my explanation that it is a review of the science supporting diet/nutritional roles in modern chronic disease.
    Hi Anna–
    Typical response from people about diet books. It’s one of the reasons I hate book signings.

  36. Did it REALLY start with Keys? I mean, where did HE get the idea that dietary cholesterol or saturated fat was bad?
    Read Gary Taubes’ book and you’ll learn exactly where and how Keys came up with his theories.

  37. There was a reference in Aubrey de Gray’s book, Ending Aging, about a recent study that showed higher levels of methylglyoxal, 2x normal, with a ketogenic diet
    Since methylglyoxal is highly reactive, much more so than glucose, de Gray suggests that ketogenic diets may be more damaging on a long-term basis than glucose-based metabolism. Do you have any comment on this? (I am eating a restricted carbohydrate diet, but keeping carbs at 400-500/day to stay out of ketosis.)
    Hi Tim–
    I read de Gray’s book in a prepublication version and found it to be quite stimulating. In fact, I’ve got the actual print version on order (it should be home when I arrive there in a couple of days) and I plan to review it on this site. Many of the SENS (Strategies for Negligible Senescence) that he writes about are in some way promoted by a carb-restricted diet. For example, a low-carb diet is typically a high-fat diet, and high-fat diets have been shown to increase the biosynthesis of mitochondria. The more mitochondria one has, the longer it will take de Gray’s idea of the survival of the slowest to totally corrupt the cell.
    I was surprised, however, with his one page attack on ketogenic diets as causing an increase in methylglycoxal as being a driving force in protein cross linking. I though Aubrey was smarter than that. He first states that high blood sugar is a potent AGE-producing force (as are increased levels of blood fats) then says that if you follow a ketogenic diet to reduce blood sugar and triglycerides you will be increasing the levels of methylglycoxal, which is a more potent AGE promoter. He bases this supposition on the paper you link to above. Altough methylglcoxal is a more potent AGE promoter, its concentration – even when elevated – is so abysmally low compared to that of the less potent blood sugar that it makes very little difference. A reduction in blood sugar (even if accompanied by an increase in methylglycoxal) brings about a reduction of AGE formation that is orders of magnitude greater than the increase engendered by even a doubling of methylglycoxal levels (which is about what most papers report). In addition, most other papers demonstrate that methylglycoxal levels track WITH blood sugar levels and not in the opposite direction.
    I think de Gray’s mentioning of this one paper and making the issue of it that he does makes for a flaw in an otherwise great book. (Great, that is, after you get into part II)

  38. It is tough to change people’s thinking about low fat. Even my wife, after seeing for the past 7 months how I have lost 35 lbs of fat, normalized my blood glucose levels, became more trim and muscular, with increased energy, still falls once in a while for the low fat/high carb crap. We are having this on going struggle over how to feed our 1 yr old daughter, she wants to feed her cereals and I adamantly refuse. I am in favor of feeding her free range eggs (which she loves) and fruit for breakfast. at dinner she eats meat, veggies/fruit. Our baby is remarkably healthy and I attribute that the PP lifestyle.
    Hey Carlos–
    Keep up the good fight. Your daughter will ultimately thank you for it.
    Good luck.

  39. Finally the truth about the “scientific community”. Science majors are taught in school to rigorously test theories in the light of the scientific method, not to employ the popularity contest method of theory approval/disapproval. But in the course of adult life, anybody who has been involved in a science-based education process or career knows that it is all basically about getting the job, the grant, the chair, the contract, the endorsement, in short, the good deal, not “Truth”.
    What nobody seems to consider is that if medical professionals, journalists or commentators endorsed Dr. Atkins ideas, everybody at Archer Daniels Midland and Conagra and all the other grain producing leviathons would be going around with sour pouts on their faces til the theories were bashed and erased from the public discourse. The low carb diet proponent doesn’t help the sales of corn chips, spongey white bread and chocolate chip cookies AT ALL. Low carb just fails all ’round to grease the skids of Big Business. Look how fast low carb products disappeared once the fad was bashed. Meat producers can grow leaner animals to please the low fat crowd (cuts of pork have become so lean as to be nearly inedible when cooked til done) and still maintain a market.
    Cascade, binary thinking, oh i know. we used to call that being pig-headed, and it was a negative thing to be accused of…
    robyn cardy

  40. Dr Eades,
    I’ve been doing some research (and that can be dangerous, ha) regarding muscle building and low-carb. The article may not pertain specifically to the muscle aspect, but it sure does the low-carb question. Time and again I read from lifters and bodybuilders that you NEED at least some carbs in order for the protein you consume to convert to muscle (some kind of necessary synergistic effect, apparently).
    Additionally, one article that “allows” for very low carbs much of the time insists on going high-carb at least every few days. Rather than inaccurately regurgitate the man’s arguments, I’ll link and cite in particular the area where he reflects on the “Cons of Low-Carb.”
    Any advice would certainly be appreciated–sorry to hear about your spam problem.
    Bert Hancock
    Hi Bert–
    In quickly scanning through the link you provided, I can tell you that the guy is wrong almost across the board in terms of what he calls the Cons of Low Carbing, except maybe for the part about not getting much fiber. But it’s been pretty well demonstrated that fiber doesn’t do anyone much good anyway, so who cares.
    Here is a full-text article from a peer-reviewed journal that deals with your concerns.

  41. I seem to see methylglyoxal references everywhere. http://www.ncbi.nlm.nih.gov/sites/entrez?cmd=retrieve&db=pubmed&dopt=AbstractPlus&list_uids=17929190
    suggests that methylgiyoxal production is a primary contributor to aging:
    The predominant molecular symptom of ageing is the accumulation of altered gene products. Nutritional studies show that ageing in animals can be significantly influenced by dietary restriction. Genetics has revealed that ageing may be controlled by changes in intracellular NAD/NADH ratio regulating sirtuin activity. Physiological and other approaches indicate that mitochondria may also regulate ageing. A mechanism is proposed which links diet, exercise and mitochondria-dependent changes in NAD/NADH ratio to intracellular generation of altered proteins. It is suggested that ad libitum feeding conditions decrease NAD availability which also decreases metabolism of the triose phosphate glycolytic intermediates, glyceraldehyde-3-phosphate and dihydroxyacetone-phosphate, which can spontaneously decompose into methylglyoxal (MG). MG is a highly toxic glycating agent and a major source of protein advanced-glycosylation end-products (AGEs). MG and AGEs can induce mitochondrial dysfunction and formation of reactive oxygen species (ROS), as well as affect gene expression and intracellular signalling. In dietary restriction-induced fasting, NADH would be oxidised and NAD regenerated via mitochondrial action. This would not only activate sirtuins and extend lifespan but also suppress MG formation. This proposal can also explain the apparent paradox whereby increased aerobic activity suppresses formation of glycoxidized proteins and extends lifespan. Variation in mitochondrial DNA composition and consequent mutation rate, arising from dietary-controlled differences in DNA precursor ratios, could also contribute to tissue differences in age-related mitochondrial dysfunction.
    Hi Tim–
    This paper indicates that fasting, which promotes ketosis and the other metabolic changes found in carb-restriction, suppresses methylglycoxal formation, which would be the opposite of what Aubrey de Gray wrote about. Hipkiss is a long-time researcher on AGEs and protein-linking damage. I would trust him on this issue much more than I would Aubrey.

  42. “I took a moment to think it through and said that No it was the shadow of the moon moving across the sun.”
    My first impulse was to agree with you Dr Eades, but fortunately, I took a moment to think it through and said that No it was the shadow of the moon moving across the earth.
    But that is probably what you meant to write.
    Thank you for your excellent books and articles
    Hi Doug–
    I went back and reread what I wrote, and you’re right, it is confusing. I said what I meant to say, which was that the eclipse “was the shadow of the moon moving across the sun.” It would have been clearer had I written that the eclipse was the shadow thrown on the earth of the moon moving across the face of the sun.
    Thanks for letting me clear this up.

  43. Thanks for the responses! I’ve also been puzzled by the fact that you are in ketosis while fasting, and that this seems to be fine (or at least OK if you fast every-other-day).
    I have a lot of respect for de Gray too, so I paid for a copy of “Ketosis Leads to Increased Methylglyoxal Production on the Atkins Diet” so I could see exactly what they did and what they found.
    The increase in methylglyoxal in ketosis was not overnight — it took 2 to 3 weeks to reach a peak. So it looks like every-other-day fasting (per studies showing this equivalent to calorie restriction) is fine, but long-term fasting could increase methylglyoxal in the same way fed ketosis appears to. Or it could be that long-term fasting and fed ketosis have some metabolic differences where fasting does not increase methylglyoxal.
    Have you considered getting your methyglyoxal levels checked, assuming you have been in long-term ketosis? If your levels were high, then that would be a real concern and you should change your diet; if normal, then that would really be a strong counter-point to the results from this paper.
    And it certainly would be nice to have the experiment done re long-term fasting and check methyglyoxal levels that result.
    Thanks for the site — a great resource!
    Hi Tim–
    I read this same study. Virtually every other study shows that ongoing glycolysis is the source of most of the methyglyoxal found in the circulation. People with higher blood sugar levels tend to have the most methylgloxal while fasting (which generates ketones) appears to decrease the levels, which makes sense because glycolysis isn’t taking place during fasting.

  44. I’m sorry, but I’m still puzzled by your response. You say this is “just one study”. But it is an actual study that measured methlyglyoxal in people who were in ketosis, and in *all* cases they had significantly higher methylglyoxal than when they were not in ketosis. How do you explain this?
    They also suggest a path whereby ketosis could increase methylgloxal through acetone, which is at elevated levels during ketosis:
    “Another pathway that could be very significant to Atkins dieters
    is MG production through ketone bodies. On a low-carbohydrate diet such as the At-
    kins diet, patients become ketotic, with elevated levels of aceto-acetate and β-hy-
    droxybutyrate. Acetoacetate breaks down into acetone, which studies have shown
    oxidizes into acetol,7,8 a possible precursor of methylglyoxal.”
    Don’t you have any concern about this at all? You seem to be just ignoring it, not responding to either the actual data or the theory about why it might be happening.
    No, I don’t really have much concern for this at all. It is just one study, which means nothing scientifically. Studies need to be verified by other studies in other labs before they can be truly meaningful. Plus this study wasn’t even peer reviewed. The NY Academy puts on numerous meetings throughout the year on specific subjects. Scientists speak at these meetings, them publish the text of their talks as papers in the Annals of the NY Academy of Science. This is much different than the rigid peer-review process most journals go through.
    I would be a little more concerned if this paper – peer-reviewed or not – had burst on the scene with no opposing papers out there. But it didn’t. Virtually every paper out there shows data indicating that methlyglyoxal (MG) is produced in higher quantities in diabetics and those with higher blood glucose levels. Other studies (multiple) have demonstrated that the intermediate products in glycolysis drive the production of MG and show that when the total time subjects are in the glycolytic state is lessened, so is the production of MG. All these papers state that fasting or intermittent fasting (both of which decrease the amount of time spent in glycolysis) markedly reduces the levels of MG. And fasting and intermittent fasting produce large amounts of ketones. So how can the production of ketones cause an increase in MG if dietary strategies that increase ketosis end up reducing the levels of MG?
    The authors of the paper you’re so taken with seem to have an anti-low-carb bias, which is easily discernible from the language they use.
    For all the above reasons I tend to look at the NY Acad paper as a curiosity, not as something to be concerned about.

  45. I agree with everything you say here, except for the level of concern.
    Everything else I’ve read agrees with you, that ketones improve mitochondrial efficiency and lower MG levels. What I haven’t seen anywhere else, though, are studies that address a longer-term timeframe. This study shows MG increasing to a peak 2 to 3 weeks into ketosis. (Even if they are biased against low-carb diets, I presume they are not lying about the actual experiments and measurements.) Everything else I’ve read applies to shorter timeframes. Do you have links to other papers that address the same longer timeframe as this study?
    If I was you, I would be curious about my MG levels and get them checked 🙂
    As always, thanks for your thoughtful comments!
    Hi Tim–
    I doubt that MG levels can be easily checked. It’s not something your doctor could order or that any of the commercial reference labs could test. I’m sure it has to be looked for with special tests not available outside the research lab.
    A line out of Aubrey’s book pretty much sums up my feelings about the study you’re fixated on. In referring to scientists, he says “…they know that when a result is reported that contradicts established conventional thinking, the new evidence is often found later on to have been the result of experimental error.”
    The odds are higher of that in this case since it wasn’t even a peer-reviewed report. Sooner or later other groups with look at this, and when they do, I suspect that the data will be different. If other groups confirm this finding, then I will give it a little more consideration.

  46. These area few excerpts from an article titled and by –
    Lean Eatin’ – Part I
    Choosing the right foods to get lean and mean
    By Dr. John M Berardi, Ph.D.
    First published at http://www.t-mag.com, May 17 2002.
    ‘ my comment – the article suggests fat and carb’s have an equal Thermic Effect of Feeding (TEF) and that protein alone had double the thermogenic power vs. fat or carbs alone! ‘
    The TEF, as I’ve said many times before, represents the additional caloric expenditure (above resting metabolism) that it takes to digest, absorb, and process the food you eat. Studies on the thermic effect of different foods have been important in describing the different effects of the macronutrients on metabolism.
    The TEF lasts from between one to four hours after eating a meal. When adding up the thermic effects from each of your meals, this extra metabolism represents between 5% and 15% of your total daily energy expenditure. Therefore, if your daily energy expenditure is 3,000kcal, about 150 to 450kcal of that comes from the TEF. Interestingly, different macronutrients tend to have different effects on metabolism.
    Welle et al. (1981) and Robinson et al (1990) demonstrated that during a normal six hour period of rest and fasting (basal metabolism), subjects burn about 270kcal. When eating a single 400kcal meal of carbs alone (100g) or fat alone (44g), the energy burned during this six hour period reached 290kcal (an additional 20kcal). Interestingly, when eating 400kcal of protein alone (100g) the subjects burned 310kcal during this six hour period (an additional 40kcal). Therefore, protein alone had double the thermogenic power vs. fat or carbs alone!
    ‘ my comment – it would have interesting to see what would happen if the fasting state had been longer putting the subjects in deep ketosis before eating – but I suspect probably little difference. ‘
    Swaminathan et al (1985) demonstrated that during a normal fasted 90-minute period, both lean and obese subjects burned about 110 calories. When consuming a 400kcal, fat only meal (44g), the lean subjects burned 125kcal (+15kcal) while the obese subjects only burned 110kcal (+0Kcal).
    This indicates that while the lean can up-regulate metabolism when eating fat, the obese may, in fact, have a defect in their thermogenic response mechanisms for fat. When fed a 400kcal mixed meal (P+C+F), the lean subjects burned 130kcal (+20kcal) during the 90-minutes while the obese burned 125kcal (+25kcal) during the 90-minutes. These data demonstrate that mixed meals are more thermogenic than fat only meals and that lean people have a better TEF response than the obese.
    So now that you understand that different macronutrients (at the same energy intake) can alter calorie balance within a single meal, here’s another interesting argument for the fact that all calories were not created equal. In a study by Campbell et al (1991), 6,500 rural and urban Chinese were compared to the US population norms for energy intake, macronutrient breakdown, and health. This is an important comparison due to the fact that obesity and cardiovascular diseases have reached epidemic proportions in North America while the prevalence is much lower in China. Check out this data on average nutrient intake:
    Energy – 30.6kcal/kg
    Carbohydrate – 42% (224g)
    Fat Intake – 36% (85.86g)
    Alcohol – 7%
    Fiber – 11g/day
    Protein – 15% (80g)
    % Protein from Animal – 70% (56g)
    BMI (wt/ht*ht) – 25.8
    Energy – 40.6kcal/kg
    Carbohydrate – 71% (504g)
    Fat Intake – 14% (44g)
    Alcohol – 5%
    Fiber – 33g/day
    Protein – 10% (71g)
    % Protein from Animal – 11% (7g)
    BMI (wt/ht*ht) – 20.5
    It’s interesting to note that while the Chinese have a much lower body mass index (as represented by weight in kg/height squared in meters) and a much lower prevalence of obesity and cardiovascular disease, they eat about 25 to 35% more food than we do! Now, the Chinese tend to be more active than we are, but when the numbers were corrected for activity levels, the differences remain!
    Looking at the macronutrient breakdowns, the Chinese are on a high-carb diet, no doubt. But they’re not fat. And while their protein intake, by percentage, is lower, they do get nearly as much total protein, by gram amount, as we do. Perhaps we could take a lesson from the Chinese. Clearly not all calories are created equal because if they were, the Chinese would be fatter than we are! But instead, the average 100kg Chinese person gets to enjoy a 4060kcal diet while keeping his lean physique.
    I know, I know, that study is only epidemiological and therefore lacks some explanatory power, but stay tuned as I present two final studies to demonstrate that all calories were not created equal.
    This article also has some other interesting conclusions regarding macronutrient amounts and ratio’s
    The above shows clearly no benefit from fat or carb’s – from a TEF standpoint – although coconut and olive oil are slightly better at it – I doubt that much –
    So exactly what benefit does the Atkins diet at 60% fat provide ? Aside from 40% protein.
    On a 1000 calorie diet the Atkins dieter doesn’t get enough protein by amount – and just the borderline amount needed if the diet is 1500 calories –
    Reduce the fat to 10 percent and a 1000 calorie Atkins dieter would about the needed protein by amount – 225 grams –
    So – just what is all that fat good for ?
    Hi Jeff–
    The fat is a macronutrient that can be burned for energy without creating an insulin spike. If you keep carbs up and fat low, then you run insulin levels up, which tend to drive fat into the fat cells instead of out where they can be burned. You’ve got to eat something, and that something has to be composed of some combination of fat, protein and carbohydrate. Each of those macronutrients in addition to simply acting as calories to be burned also engenders a metabolic response. And although fat doesn’t do much in terms of TEF it also doesn’t do much metabolically, i.e., no real insulin response to speak of. Carbs, which also don’t contribute much in the way of TEF, do stimulate a considerable metabolic response. It’s the metabolic response that those of us advocating the low-carb diet worry about, not the TEF.

  47. ‘ You’ve got to eat something, and that something has to be composed of some combination of fat, protein and carbohydrate. ‘
    I’d like to comment on the above – using myself as a current example –
    I ate 530 grams protein Monday(3 cans tuna – 100 gr and 430 gr whey protein – and a little cheese – butter – cottage cheese and yogurt with that and a small amount of peanut butter – olive oil – coconut)
    and Tuesday had 80 grams protein from plain sugar/fructose free yogurt and cottage cheese and almost nothing else except a few lettuce leaves –
    I didn’t eat that way Tuesday because I had to – I simply didn’t want any carbs – from plants at least and all I really wanted was the 80 grams of protein and some carbs I guess from the yogurt and cottage cheese –
    I eat this way because I want my daily ‘average’ intake of protein to be about 250 grams a day –
    And do this by cycling protein from very high – to adequate or moderate(80 to 130 grams) or so -three high protein days and two days moderate – per week
    As you cab see – I simply don’t believe the recommend protein amounts – recommended by the main-stream nutritional scientists –
    And this pertains to the Atkins dieter and everyone else –
    A fear of protein ? In my meat eating days – I remember my Grandma cooking up a big pan of Deer or Elk liver – no one else in the family could stand it – so I got to eat the whole pan – I could have and would have – ate a big pan of liver every day – then – if I’d had the chance –
    I am no longer shackled by what my family eats and can choose what I eat – which is 250-300 grams protein averaged per day day – from fish and whey protein – mostly
    Regardless of anyones opinion’s to the contrary –
    So – although I consider 12% fat close too ideal in terms of needed fat – up-too 25% is fine if it serves a purpose – an extra 300 calories of coconut – beans – peanut butter or olive oil – each one of these would provide an extra boost of value to a low-calorie diet and if the fat% reached 25% – it would be fine –
    Cheese – I think this one food is an exception – I wouldn’t hesitate to eat a pound of it a day – regardless of it’s 80% fat content – and eat little of anything else on those days – however – this doesn’t serve my purposes in getting enough protein generally – so I eat only small amounts most days –
    So – I may be a nut of sorts – I guess – but in the end my views are flexible somewhat – simply because nature provides that flexibility –
    Metabolically – I suppose on those days I eat 530 grams protein – I certainly have enough glucose if needed – and extra protein for protein turn-over –
    I also might be burning some ketone’s as my carbs tend to be very low on those high protein days – and a few days after
    Metabolically – I’m not sure what this means – if anything – although I think it’s generally accepted that high protein drives or forces insulin evels down also – where-as low carb – and fat do not spike it in the first place –
    Eating plant carbs whole and raw and at least eating cooked plants whole – also tend to limit insulin response –
    Beans – even in relatively small amounts – also slow the break-down of any other food eaten with them – so they too are capable of improving insulin response –
    But of all of these methods – high protein is the only one that forces insulin levels down – and beans by actively slowing food break-down – limit it that way – the other methods (low carb and fat) work by not forcing insulin up in the first place
    My calories on high protein days(530 grams) are 2300 or so – so at least theoretically – there are ‘no’ extra calories to turn into or add to fat deposits –
    All the civilized diets on earth – guarantee only one thing – that your young for a while – then get massive cellulite and thunder thighs – then diet away all your muscle – then eat yourself fat again -then at some point in older age you rather suddenly turn into a shrunken – wrinkled up old prune –
    At least with my own diet – I’m going to chew my neighbor’s leg off or his dog up – hair – skin and all – before I give up to this sad scenario – metaphorically speaking – of course –
    Hi Jeff–
    Thanks for the description of your diet. Many body builders consume as much or more protein than you without problems, so you’re not all that unusual.

  48. I bought your 30 day book; my wife and I have started the plan, her to lose weight and me to regain health. During research due to a bout with statins I have subcribed to many websites and just received this report:
    Would you please comment? Can low carb be abused or can it work too well?
    Thank you in advance.
    See this post I wrote on a similar situation a couple of years ago.

  49. I am currently beginning a Low-Carb diet, again….
    I followed the Protein Power Plan before I got married and it worked like a charm, Thank You!
    I have a couple of questions…
    1. I have heard that doing Low Carb does not work as well when you try it again. The body becomes used to the metabolic pathway and does not react by losing bodyfat?
    2. Should Diet Soda be avoided…What about Sucralose?
    3. I am concerned about the recent Methylglyoxal research…I did read your responses above but need some reassurance that this diet will not lead to pre-mature aging.
    Keith – Louisville, KY
    I’ve seen no evidence that a low-carb diet is less effective the second time around. As long as it is followed as it should be and not halfway, weight loss should be the same.
    There are scientific papers on both sides of this issues. Some say there is no difference others report that diet sodas actually increase the overweight process. But, I’ve never seen a randomized control trial, which is the gold standard, so really can’t say for sure. If you’re going to use an artificial sweetener, I think sucralose is the one.
    You’ll have to make your own call on the methyglyoxal. I wouldn’t worry about it for a second, but that’s just me. But it’s an opinion I’ve come to after doing a lot of reading on the subject. If you haven’t read it already, here is a more recent post on the subject, including a comment from Dr. Aubrey de Gray’s assistant who wrote his book.

  50. Thank You Dr….
    One final question.
    Do you recommend any vitamins or minerals that can help stave off Carbohydrate cravings?
    Thanks again.
    Keith – Louisville, KY.
    Take plenty of magnesium. That seems to help the most.

  51. Hi Dr. Mike.
    I read your debate with Tim Lundeen and it seems to me that there is only this single paper by Beisswenger that address the issue of levels of MG during ketosis or dieting. If you have any data/ publications which suggest that levels of MG are not elevated during ketosis I would be very happy to get a reference. If not we will have to refee to his paper in comming publications on the subject, since we have no data avalibale to disapprove his results.
    Thanks for an interesting blog.
    Rasmus Rasmussen

  52. Hi Dr. Eades,
    You rock. I just discovered your writings, and you are so consistently thoughtful, clear and respectful. Thanks for being you.
    I started a low-carb diet a few weeks ago and I am definitely in ketosis–I know this because I stink! My urine and breath and body odor are pretty darn intense.
    1) Does this ever go away?
    2) Can the stench alone be intuitive evidence that ketosis is not a preferable homeostatic state?

    1. The deep ketosis should get less over a couple of weeks as you adapt to the state. By this I mean that your body begins to use ketones more easily so that they don’t spill into the urine and breath so much.
      It may not be that your ketosis is much different than anyone else’s but instead that your sense of ketone smell is much more acute.

  53. I just got back from visiting the doctor because I have high blood pressure. He told me that I need to pay better attention to my diet so I have decided to learn more about my diet. I purchased your 30 minute low calorie diet book.

{"email":"Email address invalid","url":"Website address invalid","required":"Required field missing"}

Be The First To Know When New Content Is Premiered!

Sign up to be notified about new blog posts, podcast interviews, tasty recipes, scheduled appearances or live talks, or interesting special offers. And especially sign up to learn when and where you can begin to pre-order our next book, Protein Power 2.0!