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>>I think the evolution to the standard hunter-gatherer model and the agriculural society is well founded. It is the model of modern society after all and I think we are much healthier then any humankind in the past. In general.

In terms of medicine, yes; however, in terms of diet, absolutely not!

The Egyptians, who had a very close to "perfect" diet in terms of the AMA recommendations of the past 20-30 years, are now found (via autopsy of their mummies) to have had significant atherosclerosis and obesity in their time.

In "Protein Power", Drs. Eades (who are also amateur archaeologists) recount the examination of the remains of hunter/gatherers and agricultural groups who, although separated by time, lived in the same area. Examination of the bones showed that the hunter/gatherers were healthier, having less disease and being better nourished (example: fewer dental caries, taller, significantly less evidence of disease damage). The only significant difference between the 2 groups was diet.

>>As I said, if the Atkins diet works for you, then you all have no reason to listen to me. My diet works for me, that I can say (As you.) that it works fine, so we will just have to agree to disagree with the specifics.

(shrug) each to his or her own. As long as you are healthy, and your bloodwork is normal, then what you are doing IS fine for you.

>>One thing I do not like is the fact that most Atkins people seem to be crusaders.

Low-carbers DO tend to be crusaders. IMO, it's a combination of 2 factors:

1) they've found this wonderful Way of Life (to distinguish it from "diet", which word has been badly abused), and want to share it with everyone; and

2) they've had to suffer the (usually) well-meaning but inaccurate and irritating comments about their "unhealthy" diet, and often develop an equally irritating "knee-jerk" reaction to what seems like criticism from having to defend their own lifestyle choices.

Nor do I think that bodybuilders in general are "knuckleheads", even though I would not choose to go that route myself. Some bodybuilders are very careless with their health, true (stacking and steroids come to mind); others are much more knowledgeable about their bodies than many nutritionists or doctors.

Arioch, you say that you have eliminated refined carbs/processed sugars -- for someone who does not need to lose weight, that is one of the basic premises of most low-carb proponents. Although the weight-loss regime is important for those of us who need it, that is NOT the be-all and end-all of a dietary regime!

Sadly, the book by Dr. Atkins that most clearly states this (SuperEnergy Diet) is out of print and needs updating to reflect more current research; however, the true "Atkins diet" comprises 4 themes, as follows:

1) the weight-loss regime, as expanded in New Diet Revolution;
2) the weight maintenance regime; basically, eliminate refined and processed carbs, and eat enough whole-food carbs to maintain optimal weight (also comprising the maintenance stage of the weight-loss regime);
3) the weight GAIN regime, where the person eats more whole-food carbs than on the maintenance regime; and
4) the regime that I call the "holding pattern", for
-- pregnant women
-- people who are ill
-- people who are about to undergo surgery
-- a few other instances I can't remember :(
where one would essentially eliminate the refined stuff and eat a "balanced" diet heavy in micronutrients and fibre.

Does that sound more reasonable to you?

>>What studies, who promoted them and what epedimiological controls (name the authority monitoring these studies) were in place for these studies?

Good question! and back at you. Since *you* were the one proclaiming that high protein = kidney damage, I would think it would be appropriate for you to also start digging for studies.

Let me know when you've got studies proving your point, complete with assessment of the reliability of data and possible conflicts in funding, and I'll then respond with the information to which I referred (I'll have to search the list, but that's not too big a deal).

>>Studies show that sooner or later, high-protein diets result in renal (kidney) failure.

Show me these studies to which you refer!

I belong to a LISTSERV group (that includes scientists, doctors and nutritionists, BTW) that has examined numerous studies related to low-carb, including many studies concerning high protein/liver and kidney health. NOT ONE has shown that a normal, healthy kidney or liver is damaged by higher protein intake!

The *only* time that one should NOT have a higher protein diet is during end-stage renal failure, essentially when the kidneys are barely functioning. This is usually due to severe illness, genetic disorders or to damage caused by ....(drum roll)....high blood sugars!

>>I choose to believe Joslin, HArvard, MIT, AMA, JAMA, Association of sports medicine, the entire New England Medical community, and just about every credible scientific source in the world.

Just because a medical source is *generally* reliable and credible, does not mean that it is *infallible*. Doctors and scientists are human beings, as prone to mistakes and jumping at the latest fad as anyone else, but can be damnably slow to admit significant errors. This is particularly the case when an entire generation may possibly have been placed at GREATER risk of chronic disease because of misinformation, and an entire generation of health-care providers has been trained on the premise that the low-fat diet is a healthful one. It is also very easy to "read in" results to a study that you wish to see, in spite of the hard facts; sometimes this is in good faith, other times it is intellectual dishonesty.

An example of how terribly wrong doctors can be, in good faith: when a new diabetic drug called troglitazone (Rezulin) was introduced, it did not indicate that regular liver testing was vital. Doctors who, in good faith, prescribed it to their patients were not aware of this; as a result, a number of people suffered severe liver damage, and some died as a result. Rezulin was recalled briefly, then reintroduced *with* the warnings (but, I believe, is no longer available).

Some of the research that has been taking place that debunks the low-fat theory (and it IS a theory) has been taking place at Harvard University, under the auspices of Gerald Reaven and Walter Willett -- a fine institution with an admirable reputation for solid research.

Gary Taubes' article makes it abundantly clear that, for years, it has been extremely difficult for anyone who wished to actually do decent research assessing the effectiveness of the low-carb diet to obtain any US government funding until very recently. It has taken years of overwhelming clinical results and research from other countries to reverse this obdurate position (as well as a rapidly growing number of practitioners -- doctors, nurses and nutritionists -- who are prescribing a low-carb diet because of results they've seen in patients/colleagues or experienced themselves).

Re-read the portion of the article that relates how the low-fat paradigm came into existence -- no such firm evidence was in effect at its introduction; in fact, it is a little frightening at how a few well-placed people imposed their untested OPINIONS and ASSUMPTIONS on an entire populace (despite objections from reputable scientists), essentially making said populace unwitting research subjects.

Here's 1) a pilot study abstract posted at the ADA site, under Scientific Sessions (search under the abstract #), and 2) an abstract from a Kuwaiti study on the ketogenic diet, complete with overall data


A Pilot Study Comparing a Low Carbohydrate and Low Fat Diet on Weight and Glycemic Control in Obese Diabetics. The VA Low Carbohydrate Intervention Diet (VALID) Study

Abstract Number: 256-OR
Abstract Category: Behavioral Medicine, Clinical Nutrition,
Education
Abstract Scheduled: S8-M
Monday - June 17 2002
Authors: PRAKASH SESHADRI
FREDERICK F. SAMAHA
LINDA STERN
MONICA M. WILLIAMS
NAYYAR IQBAL.

There has been a great deal of controversy regarding the use of low carbohydrate diets in the management of type 2 diabetes mellitus. Long-term studies demonstrating the benefits and safety of a low carbohydrate diet in type 2 DM are currently not available.[br]We prospectively randomized 25 obese type 2 diabetic patients to either a low calorie/low fat(n=12)(500 kcal deficit, restricted fat and carbohydrate diet)(LF) or low carbohydrate diet (n=13) ([lte] 30 gm carbohydrate, non-calorie restricted diet)(LC). Patients were given four intense three hour weekly dietitian led sessions followed by monthly support group sessions for a total of 6-months. Data was collected at baseline and after 6 months of diet.[br]At the end of six months, 6 of 12 subjects on the LF diet and 8 of 13 subjects on the LC diet completed the study. The results are summarized in the table below. A 6-month medication review showed 4 of 8 LC subjects had a decrease in diabetic medications. Of 6 LF subjects, 3 had an increase and 1 had a decrease in diabetic medications.[table1]This pilot study demonstrates that at least 6 month use of a LC diet in obese type 2 diabetics patients is associated with a significant reduction in weight and Hba1c. This is achieved without any deleterious affects on serum lipids. There was no statistical significance between the two groups in reduction of BMI and Hba1c. Larger studies of longer duration are needed to demonstrate the benefits and safety of a LC diet in type 2 DM.

****

Effect of Ketogenic Diet in the Reduction of Body Weight in Obese Patients.

Hussein M Dashti, Yousef Y Bo-Abbas, Sami K Asfar, Abdulla I Behbahani, Mousa A Khoursheed, Hilal M Al-Sayer, Nagi S Al-Zaid Dept of Surgery, Fac of Med, Kuwait Univ, Kuwait, Kuwait, Kuwait; Dept of Med, Fac of Med, Kuwait Univ, Kuwait, Kuwait, Kuwait; Dept of Physiology, Fac of Med, Kuwait Univ, Kuwait, Kuwait, Kuwait

To determine the long-term effects of ketogenic diet (consisting of 30 gms carbohydrate, 1gm/kg body weight protein, 20% polysaturated, 80% polyunsaturated and monounsaturated fat) in obese patients following the
administration for a period of twelve weeks. In this study sixty-three obese patients (body mass index > 30kg/m2) with a high glucose and cholesterol level were selected. Female: male ratio was 2:1. The fasting blood sugar, total cholesterol, LDL-cholesterol, HDL-cholesterol, triglycerides, Na+, K+, urea, uric acid and creatinine levels of these patients were determined before and after the administration of the ketogenic diet. Changes in these parameters were monitored at weekly interval for twelve weeks. There was a significant reduction in all the parameters examined (p <0.001), except in the level of Na+, K+, and creatinine, while the level of HDL-cholesterol significantly increased. The level of urea and uric acid increased transiently during the 2nd and the 3rd week and returned to normal level during the 4th week. These levels remained constant from 4th to the 12th week. Interestingly, there was a significant reduction in body weight (99 +/- 2.8 to 80 + 3.0 kg). The level of triglycerides (2.74 +/-1.2 to 1.2 +/- 0.5 mmol/L), cholesterol (5.4 +/- 0.14 to 4.72 +/- 0.28 mmol/L), LDL (4.13 +/- 0.14 to 3.1 + 0.12 mmol/L) and glucose (7.7 +/- 0.5 to 5.2 +/- 0.43 mmol/L) also significantly decreased. The level of HDL showed a
significant increase from 1.08 +/- 1.01 to 1.3 +/- 0.1 mmol/L.

In conclusion: - Ketogenic diet acts as a natural therapy for weight reduction in obese patients. It significantly reduced the level of triglycerides, total cholesterol, LDL-cholesterol and glucose whereas the level of HDL increased in these patients. The side effect of other drugs commonly used for the reduction of body weight in such patients is not observed in patients who were on Ketogenic diet. These results indicate that the administration of ketogenic diet for relatively long period is safe to
follow.

****

For those who are wondering what the numbers mean:

Results:
- significant reductions in body weight, fasting blood sugar, total cholesterol, LDL cholesterol, triglycerides
- significant increase in HDL cholesterol
- transient (temporary) increase in urea and uric acid, which levelled off after 4 weeks (this relates to kidney function, and determining risk for patients with gout; this means that there is no ongoing kidney problems, and patients with gout should be fine)
- sodium (Na), potassium (K) levels and creatinine clearance (which is a measure of kidney function) remained the same


Just as an aside....when my father asked his cardiologist about low-carb dieting, she gave her full approval, and indicated that a colleague of hers at St. Paul's Hospital (Vancouver, B.C., Canada) had done well on one, returning to the body weight he'd had in his 20's.

It's true -- Dr. Atkins had cardiomyopathy, which is infection of the heart muscle (just a note -- recently they've found that infection is a significant cause of heart attacks....)

An interesting discussion; however, something I haven't seen is extended discussion of the problems OTHER than obesity that are addressed by a low carbohydrate diet.

From what I have seen, obesity is a *symptom* of the underlying metabolic disorder (yes, this is a simplification of what does occur -- fat cells are more active biologically than most people know) and an aggravating factor; treating only one aspect of the problem, though, doesn't remedy all the problems....and what of those people who don't have obesity as a symptom/factor? Plenty of people of "normal" weight have unbalanced insulin metabolism!

A high level of insulin in the blood (hyperinsulinemia) is known to indicate an elevated risk of cardiovascular problems. Two examples:

1) a study where 1 group of dogs had insulin injected into their leg veins, and the control group was injected with a saline solution -- the first group of dogs had developed atherosclerotic plaques in their leg veins.

2) a study of policemen in Helsinki showed that those men with higher levels of insulin in their blood had a higher risk of heart disease (naturally, known as the Helsinki policeman study ;) )

As well, high levels of glucose in the blood (hyperglycemia) is extremely damaging to all parts of the body...that's why diabetes has so many associated complications such as blindness, loss of limbs, kidney failure, etc. This is a result of the process called "glycation", where glucose invades tissues such as nerve, blood, or muscle cells, or kidney nephrons, and essentially "caramelizes" it (of course, damaging it).

As well, since insulin is a hormone, if it is out of sync it can throw other hormones out of balance as well, including the sex hormones. I am a prime example of this -- I have an insulin-linked condition called "polycystic ovary syndrome", and one of the characteristics of this is male-pattern hair growth due to the elevated levels of male hormone in the blood, which is definitely NOT a desired characteristic in a woman! (other characteristics are: lack of or infrequent menstruation; impaired fertility; male-pattern baldness; obesity; greater risk of cardiovascular disease; greater risk of Type 2 diabetes; greater risk of uterine cancer -- definitely not something to take lightly.)

Unlike the low-fat diet (which, as previous posts indicated, was NOT based on solid scientific research before its imposition), the low-carb diet deals with the underlying problem of the imbalanced insulin mechanism.

As has been noted elsewhere, the current North American diet is FAR higher in sugars and starches than that of our hunter/gatherer ancestors, from whom we get our genetic inheritance. We simply are not designed to process that much glucose on a regular basis! and therefore it causes systemic damage over a long period of time (which is becoming progessively shorter, as the amount of sugars and starches in the average diet skyrockets). No wonder children are now being diagnosed with what was once called "adult-onset" diabetes!

It's a shame that Dr. Atkins' weight-loss regime and, in particular, the first stage of it, has been misinterpreted or simply not read properly. In another book of his (sadly, out of print) he expands on and explains his *entire* dietary regime. The weight-loss diet espoused in New Diet Revolution begins as a deliberately and carefully unbalanced diet to counter the metabolic disorder and "kick-start" weight loss; as the diet progresses, it becomes more balanced (but still much lower in carbs than the norm).

For those who are interested in the bodybuilding applications, do a Google search for "cyclical ketogenic diet".

As to the concern about kidney health, there is NO research that indicates that high protein damages normal, healthy kidneys. The only time that low protein is indicated, is when someone is in end-stage renal failure, basically where they're limping along on dialysis waiting for a transplant.

All glucose that is needed for body functioning (and a little bit IS needed) can be provided by protein and fat. The body can convert up to 58% of protein to glucose, and approximately 10% of fat (the glyceride portion) to glucose. The benefit of carbohydrate foods is not the carbs, but the micronutrients (such as the lycopene in tomatoes).

For someone who doesn't need to lose a significant amount of weight, the basic formula is to eliminate sources of refined sugars and starches, and keep the intake of high-glycemic foods such as baked potatoes to a minimum. High-fibre veggies are fine at any time! and low-carb substitutes such as almond meal instead of bread crumbs for dredging, or pork rinds instead of potato chips, are a good idea for anyone (surprise! pork rinds have less fat gram for gram than regular potato chips -- check the USDA database -- and they don't have the trans-fatty acids that are the truly bad fats as do potato chips).

Lots of other things I'd like to say, but I'll save it for later :)