Wednesday, November 27, 2013

The Low-Carb Fraud: A Review

T. Colin Campbell, author of The China Study, has written a new book (more of a report at 57 pages) called The Low-Carb Fraud. Let's start with what Dr. Campbell gets right:

  • There are different kinds of carbohydrates.
  • Most carbohydrates are broken down into glucose in the intestine.
  • Refined carbohydrates are bad. 
  • Low carb diets are fun! (I swear I'm not making this up)
  • Calories don't matter unless you're going to extremes.
  • People lose weight on low carbohydrate diets.
  • People lower their insulin levels on low carbohydrate diets.

That's about it. Mostly, he slanders low-carb proponents and he lies, lies again, and lies some more. He lies when he doesn't need to lie. To wit:

  •  "Dr. Atkins' Diet Revolution...had not been especially successful in the marketplace." According to Dr. Atkins' obituary in The New York Times, "its various editions sold more than 15 million copies, making it one of the best selling books ever." 
  • Dr. Campbell also repeats the rumor that Dr. Atkins was obese when he died. According to snopes.com, Dr. Atkins was taken to the hospital for a head injury.  The snopes article adds that hospital records, as turned over to USA Today by his widow, show the six-foot tall doctor weighed 195 pounds upon admission. His widow says that due to organ failure and fluid retention (and glucose drip? -ed.) he weighed 258 pounds at his death.
  • "We're making no significant inroads in reducing rates of...heart disease..." Heart disease deaths have been going down for years. Why lie about this? If anything, you could attribute this to declining fat in our collective diet. (Or less smoking, or better care for heart attack victims.)

At the end, Dr. Campbell discusses studies that are beyond most people medically ignorant enough to believe the rest of the book. (I didn't read the studies to ascertain their quality or whether Dr. Campbell's interpretation of them was correct. I'll leave that to study wonks.) But before that, he attacks Gary Taubes, author of Good Calories, Bad Calories and Why We Get Fat.


Gary Taubes, says Dr. Campbell, is a journalist, not a scientist, doesn't understand studies and doesn't know what a carbohydrate is. He makes Taubes sound like a lifestyle writer at a suburban newpaper. Dr. Campbell doesn't mention that Taubes has a BS in applied physics from Harvard, earned an MS in engineering at Stanford and an MS in journalism at Columbia University, and was a reporter for Discover magazine. He concedes that Taubes is correct in saying that calories don't have much to do with weight (unless you go to extremes) and that most carbohydrate breaks down into glucose and causes a surge of insulin. Taubes understands all this and more without knowing what a carbohydrate is. But Dr. Campbell asserts that it's only refined carbohydrates that are bad, that Taubes is deliberately confusing refined sugar with all foods that contain carbohydrate. Apparently, your intestine knows whether a molecule of glucose came from a kumquat or a Klondike Bar.

Maybe Dr. Campbell should work on himself before casting stones. He all but admits he's not a scientist:

When a reductionist finding contradicts the big picture, it doesn't make sense to tear down that big picture. Rather we look for exceptions, nuances, and deeper understandings--ways of reconciling an outlier data point with the demonstrated reality. (Kindle location 407)

What real scientists reconcile in the face of data is their picture of reality. Real scientists should also know basic logic--for instance, if A=B, then B=A. "...[A] diet truly low in fat (e.g., 10 percent of calories) is by definition a diet high in good quality whole (not processed) plant-based foods and low in animal based products," Campbell says. Likewise, unless your whole-food, plant-based diet includes a lot of coconuts, olives or avocados (no oils extracted from them), which he doesn't recommend, your diet will be low in in fat. Whole, plant-based diet equals "truly" low fat. Yet on the next page, he chides Gary Taubes for focusing his arguments on low fat diets, albeit "incorrectly labeled" ones, instead of plant v. animal based diets. Dr. Campbell also dismisses several studies comparing low-fat and low-carb diets because, among other things, the low-fat diets were too high in fat. Is he trying to be difficult? Why yes, he is, maybe because Good Calories, Bad Calories isn't about vegan diets.

Dr. Campbell fires away at other authors of low-carb books and diets, including Michael and Mary Dan Eades, Loren Cordain, and Eric Westman, saying they have "no experience in scientific research, and a vast fortune generated by the sales of their shakes, powders, extracts, oils, bars, and even chocolates." The popularity of low-carb diets is mostly marketing.

Was Google down the day Dr. Campbell wrote this book? Some of these authors are professional researchers at respected universities, and the Drs. Eades have a qualification Dr. Campbell doesn't: treating patients--thousands of them. Dr. Cordain of Colorado State University has written over 100 peer-reviewed articles and abstracts. (Dr. Cordain discusses vegetarian diets in The Paleo Answer without using smear tactics, saying he respects people's dietary choices.)  Dr. Westman is a faculty member of the Duke Clinical Research Training Program. The Low-Carb Fraud doesn't mention Dr. Stephen Phinney, a physician-scientist who has written more than 70 peer reviewed papers and book chapters, or Dr. Jeff Volek, a professor and author who leads a research team at the University of Connecticut and co-wrote, with Dr. Phinney, The Art and Science of Low Carbohydrate Living, and, with Drs. Westman and Phinney, The New Atkins for a New You, a book that ought to have popped up on Dr. Campbell's radar. Dr. Richard Feinman, another proponent not mentioned, is a researcher and professor of cell biology at the State University of New York. (Granted, he hasn't written any diet books, just a bunch of peer-reviewed studies and papers.) Physician-researcher Dr. Richard K. Bernstein, a type 1 diabetic since 1946 (how many people can say that?), low carb proponent, and one of the foremost experts on diabetes, doesn't get a mention, either.

Has Dr. Campbell actually read anything that Drs. Eades, Cordain, Phinney, Volek, Westman or Bernstein have written? He keeps calling low-carb diets "high-protein diets." Pretty much any diet is higher in protein than his whole food plant based diet, but most modern low-carb diets call for high fat and moderate protein. He also says low-carb diets eliminate most vegetables, but even Atkins induction calls for two small salads a day. It's just starchy vegetables like potatoes that are off the menu. Almost anything at a salad bar is encouraged. In fact, during a year-long study of 100 people on a low-carb diet (aka My Big Fat Diet), the grocery store on the little island where the participants lived had a run on cauliflower when someone shared a recipe for fried "rice."

Has he heard that low-carb diets are for more than just weight loss? "Charitably, we could say that low-carb advocates are using weight loss as a Trojan Horse to get people to improve their diets and overall health--although there's little evidence for this generous interpretation." Maybe Dr. Campbell hasn't heard that the sweet, starchy foods he recommends can lead to tooth decay or that some of us cured our GERD by giving them up.  Diabetes control is possibly the second most common reason people adopt a low-carb diet; some epileptics are managing their condition with very low carb diets; and there's research in using the diet to fight cancer and prevent Alzheimer's disease. Dr. William Davis has been reducing his patients' coronary plaque and treating other health problems including diabetes with a low-carb, wheat free diet, among other therapies. Many of us with wonky blood sugar and GI problems like FODMAPS simply cannot eat a high-carb diet and feel well.

Dr. Campbell ought to dust off his endocrinology books, too--or read a new one, since it's been a spell since he went to medical school. "Whenever we encounter diversity in nature, we should be slow to dismiss it as unnecessary or unfortunate. A broad spectrum of carbohydrate digestibility and function is very important: it allows the body to adapt to different conditions, ranging from the need for a quick burst of energy to the facilitation of digestion and absorption of other nutrients in the gut." From an evolutionary standpoint, adapting to different conditions is  important.  However, the need for carbohydrate in the human diet is zero. Ever heard of an essential carbohydrate? There aren't any for humans. Ever heard of phytic acid? It's a substance "occurring in plants, especially grains, capable of forming insoluble complexes with calcium, zinc, iron and other nutrients and other nutrients and interfering with their absorption by the body." And as most vegans know, you need supplements such as B12 on a vegan diet because of the lack or absence of certain nutrients in plant foods.

The Low-Carb Fraud includes an appendix on paleo diets. Here, unlike at the beginning of the book, he says that Dr. Loren Cordain is a researcher. The way Dr. Campbell describes paleo diets and the study of paleoanthropology sounds about right to me, as far as it goes, but he does what he accuses Gary Taubes of doing: cherry picking details and weaving a story out of them.

"Cordain, in fact, presented a very similar estimate for the amount of meat in prehistoric humans' diets--3 to 5 percent--in a 2004 symposium in Denver, Colorado," says Dr. Campbell. If Cordain said that, he'd have been referring to very ancient human ancestors such as australopithecus, who lived four million years ago and, were they alive today, would be around four feet tall, covered in hair and, yes, eating a lot of fruits, vegetables and tubers at a preserve. Given their tiny brain size, they wouldn't have a job and an apartment. The book mentions none of this. No, Dr. Campbell compares humans to chimpanzees, a species we split off from six million years ago, rather than Homo erectus, a long, lean, fairly big-brained, meat-eating, tool making ancestor from roughly 150,000 to two million years ago, or even neanderthals, whose genes some of us carry.

There's also no mention of the expensive tissue hypothesis, the idea that human ancestors needed a steady source of rich nutrients (like fat and protein) to build a big brain, an organ that sucks up an inordinate amount of energy. Nor is there any mention of stone tools, butcher marks on animal bones, isotope analysis, the hypothesis that early (and later) human ancestors could have scavenged animal carcasses instead of hunting, humans' decreasing gut size, or--hello--the fact that the need for carbohydrate in the human diet is zero. There's no mention of Dr. Richard Leakey or his colleagues Pat Shipman, Alan Walker, Richard Wrangham, or Brian Fagan, all paleoanthropologists whose view, based on the evidence, is that meat was an important part of the human diet. These scientists have written a gazillion books and papers, none of them promoting any diet, shakes, powders, extracts, oils, bars, and even chocolates.

There's much that, if we're being charitable, Dr. Campbell hasn't read. He ought to do so.

12 comments:

Lowcarb team member said...

I am going to be a man of few words.

Excellent post.

Kind regards

Eddie

Lori Miller said...

Thank you.

Ernie Blenkinsop said...

Sorry Lori, but this review drips with condescending bias.

Lori Miller said...

Sorry, Ernie, but I don't have any patience with someone who writes a book with more lies than pages.

sharmin monee said...

This is great! i have always wanted to know where all the yummy Vegan places were and now i can easily eat out at these place or order in! thanks so much!
Low carb diets



Lori Miller said...

It's interesting to see how the brain works on a vegan diet.

TiGRe812 said...

Great critique!

Lori Miller said...

Thank you.

Max said...

Second that! Great critique.

Lori Miller said...

Thanks.

fitteratfortyish said...

Excellent article!
and LOL to Ernie above.

Love your blog!
Wendy

Lori Miller said...

Thanks, Wendy.