It’s The Carbs. It’s Always Been The Carbs.

Health Tips / It’s The Carbs. It’s Always Been The Carbs.

Somewhere in my library is a copy of Gary Taubes’ 2008 Good Calories, Bad Calories, one of several books that appeared in the wake of the really vicious controversy that surrounded Robert C. Atkins, MD’s Dr Atkins’ Diet Revolution, which first appeared in 1972, has been published in 13 revisions and editions, and continues to sell around the world.

It’s challenging to convey the extent of the controversy regarding Atkins’ suggested way of eating and the animosity that followed. He was flat-out going against what every physician had learned in medical school from the 1940s onward about a healthful diet, weight control, and disease prevention.

Even though Americans were getting fatter by the minute and their cholesterol levels were rising, the treatment Atkins promoted was not eating less fat, but rather eating fewer carbohydrates, especially simple carbs like sugar, starches, and refined flour.

Eat all the meat you want. Eggs and bacon for breakfast? It’s the best breakfast! Eat as much fat as you like. Worst breakfast? Cereal with fruit or a fruit smoothie (most of which are loaded with sugar).

The seriously overweight US public, dropping like flies from heart attacks, loved what Dr. Atkins was recommending. Millions went low-carb, bought his line of packaged foods and supplements, and supported him to the end. Pasta sales plummeted.

Atkins’ bitterest opponent was Dean Ornish, MD, whose Reversing Heart Disease touted extra-low-fat eating, skinless breast of chicken, egg-white omelets, and lots of fruit and veggies. He was, and remains, the quintessence of everything a conventional doctor knows (or thinks she knows) about healthful eating.

Ornish virtually accused Atkins of being a mass murderer with his diet advice. The writing style of this Atkins Wikipedia entry makes me wonder if Ornish got his way with the editorial content. Want to see a bunch of conventional docs trying to rip Atkins? Check out this video from 2000. These guys are mean.

Follow the money

Gary Taubes is an excruciatingly well credentialled science writer with no products except his books to sell anyone. I can picture him sitting in some medical library with a couple of laptops, poring over centuries (yes, centuries) of evidence. Not just clinical studies, but medical anthropology stuff as well. Why do Innuits with a 100% fatty meat/fish diet and virtually no grains or veggies have zero heart disease? Why did the Atkins program actually seem to work? Why the degree of hostility?

I have to thank a patient who suggested I read Taubes’ 2011 book Why We Get Fat and What To Do About It. Honestly, I wasn’t sure I   was up for yet another diet book. But Taubes’ tome was definitely not a diet book. He wanted to explain the physiology without unrealistic claims. It’s not that complicated if you read with a pencil in hand.

The key point is this: After nearly 50 years since the Atkins book, there’s little doubt that all along Atkins was correct and Ornish, along with the vast conventional medicine community, has been wrong.

Why did this conflict occur? Maybe it’s just the Chicagoan in me, but, folks, the rule in this town is follow the money.

Until the 1940s or so, doctors did believe the obesity and heart disease villain was sugar. If you wanted to drop weight and/or limit your risk of heart disease and other chronic illnesses, just cut back on sugar.

This meant avoiding simple carbs and complex carbs. Not only sugar, but all breads, rice, and the like. In other words, avoiding what we now call high-glycemic foods (foods that quickly raise blood sugar).

Then in the 1950s, with heart disease and obesity on the rise, researchers identified the two potential villains as sugars and fats. But the sugar industry funded research with a manipulated outcome that shifted the blame onto fats. Here’s the history. Read it for a surge of anger.

You can’t be too surprised at a revelation like this. After all, the AMA received millions from the tobacco industry before commenting on the damaging health effects of tobacco. This was ten years after the health problems attributed to cigarettes were published in the 1964 Surgeon General’s Report. You’ll love this link in which JAMA editor Morris Fishbein, MD, tells a reporter he keeps nothing but Kent cigarettes on his desk. Here’s still more on how Fishbein used his influence to defend the tobacco industry.

Although you can order Taubes’ 2011 book, my suggestion is to wait a few weeks for his newest title The Case for Keto: Rethinking Weight Control and the Science and Practice of Low-Carb/High-Fat Eating, which I suspect will include more info on the intermittent fasting he’s alluded to in previous books.

To learn right now about low-carb/high-fat eating, click here for the Diet Doctor website, whose beginners page is filled with helpful information. They cover the science on intermittent fasting nicely too.

Take-home nuggets on carbs

There are several take-aways from Taubes, Diet Doctor, and this Health Tip:

  • The scoundrel is the hormone insulin, pumped out by  your pancreas in response to all forms of sugar. If you have too much insulin, you’ll drive fat into your fat cells and gain weight. Rising insulin triggers weight gain, which triggers more insulin because you develop insulin resistance, which in turn leads to metabolic syndrome, which increases your risk for heart disease and diabetes.
  • Insulin levels are driven upward by carbs and by your declining sex hormones. Women often gain weight during menopause because their estrogen levels drop and their bodies store more fat. Many women patients have told me, “I’m eating just the same or even less, and exercising, and I’m still gaining weight.” Repeat after me: It’s the carbs.
  • Cutting calories, starvation diets, trimming away fat, and eating low-fat products are all useless. They’ll just make you feel miserable and hangry.
  • Exercise for weight loss is less than useless. Exercise is extraordinarily healthful for many reasons, but as a weight loss aid it will only make you hungry.  In the memorable words of UK cardiologist Aseem Malhotra, MD: You can’t outrun a bad diet.
  • Low-carb/high-fat eating includes meat, poultry, fish, shellfish, and eggs. Eat plenty of greens and other vegetables that grow above ground (broccoli, cauliflower, click here for more). Enjoy healthful fats (butter, olive oil, and coconut oil) and cheeses, avocado, and olives. Here’s a helpful list of fats and sauces and their carb contents.
  • Avoid sugar and sugar-containing, starchy foods like beans, potatoes, rice, bread, pasta,  carrots, parsnips, corn, peas, French fries, and potato chips.
  • Click here for another useful visual guide to carbs from Diet Doctor.
  • As a bonus, I’ve had more than a few patients tell me eating low-carb/high-fat vastly improved their IBS, skin conditions, and other ailments.

Where do the majority of US physicians stand on all this? A typical primary care physician, if she sees you’re overweight and your cholesterol is high, will start you on statins and have a nutritionist teach you a low-fat diet.

She likely hasn’t read this article from Scientific American telling the world that Ornish was wrong all along.

Be well,
David Edelberg, MD