Today I’ve been inundated with comments, emails and even a phone call or two about the ‘study’ that hit the news this morning allegedly showing that the Atkins diet causes blood vessel damage, and increase in ‘bad’ cholesterol and increased levels of inflammation. I figured I would take this opportunity to describe how this kind of information gets out there and discuss this ‘study’ in particular.
To begin with, this isn’t really a scientific study published in a peer-reviewed journal. It was a brief presentation (about 15 minutes including questions) made at the annual scientific meeting of the American Heart Association in Orlando, Florida a couple of days ago. To better understand where presentations like this one fit in the hierarchy of the scientific world, let’s take a look at how these huge meetings are organized.
The annual Scientific Sessions of the American Heart Association is an enormous meeting with thousands and thousands of attendees. This year’s meeting, which is still going on, is being held at the giant convention center in Orlando, Florida. When the organizers of these kinds of meetings start working on putting them together – which they do years in advance – they begin to contact all the big guns for the major lectures. These lectures are presented during the prime times of the conference when nothing else is going on and they can be attended by all attendees. These lectures held in the huge auditorium are usually by well-known, established researchers who present the data from many years of their work on specific inquiries.
Scheduled in around these giant lectures are concurrent meetings, which are held in small conference rooms holding 50-60 or so people. (The photo at the top of this post shows the typical size of one of these sessions) These smaller lectures compete with other lectures taking place at the same time. Usually there are four or five sessions going on at once, which is a major pain if you’re an attendee because invariable two lectures you want to see are going at the same time. (Fortunately, in our case, MD can go to one and I go to the other, so it’s not so bad.) These lesser presentations are often, but not always, made by graduate students or newly minted Ph.Ds or physicians doing postdoctorate work.
At the bottom of the food chain in terms of importance are the poster presentations. These are usually held in a large room and involve a bunch of people with posters describing work that they have done or research in progress.
In between the poster presentations and the concurrent lectures are oral poster presentations. These are lectures about work in progress or small or preliminary studies that have been done but haven’t been published. The ‘study’ in question is an oral poster presentation.
When the organizers of these meetings are in the preparation stage they send out a call for abstracts. They get inundated with abstracts and arrange them sort of in terms of significance with the most interesting or scientifically significant ending up being presented as a concurrent lecture. The next down the list are the oral poster presentations, then finally the posters.
The important thing to understand about these presentations is that they are not peer reviewed as they are if and when they show up in a scientific journal. They are sort of peer reviewed on the spot in the sense that other researchers familiar with the specific field ask questions of the presenters or of the people with the posters. But that’s it. There is no scientific review of the data as there is when it is published in a journal. So people can present all kinds of data with no one looking it over other than the folks who ask questions. And sometimes the exchanges at these meetings can become spirited to say the least, which means that those lecturing are often present data much at odds with what other scientists have found doing the same kind of studies. That’s why it’s always good to take anything that comes from a meeting like this one with a huge grain of salt.
If you take a look at the monster program for the 2007 Scientific Sessions of the American Heart Association (click here) you can find the presentation in question on page 407. It is session #3610. You should roam through this program a little just to get a feel for the scope of a meeting of this size and to see just how much is going on at once, which puts perspective on any given oral poster presentation.
These giant meetings are open to the press, members of which get these huge programs just as do the scientific attendees. The folks with press passes go through these programs looking for lectures that they think will give them a headline. They don’t care how insignificant the talk is, who is giving it, whether it’s a poster or an oral poster presentation – they are looking for headlines. And what better headline than that there is a problem with low-carb diets or even better, the Atkins diet itself.
So the stage is set. I would imagine that of the 30 or 40 people (if that many) who attended this talk a large number had press passes. These media types stay after and talk to the speaker to get a few quotes, then head off to the press room, dash off a few hundred words, send it to their service, and head back off for another headline-grabbing talk (or the bar).
Now that you know the genesis of the news report about this oral poster that many of you have read and maybe worried about, let’s take a look at the study itself.
I emailed the publicist for the University of Maryland Medical Center for an abstract of this talk, and he kindly sent it to me within minutes. (I’ve converted it to PDF for you: miller-2007-aha-abstract-diet.pdf.) Remember, this is all there is. Just an abstract, not a real paper. We can tell only a little about what really went on in this study. But let’s take a look.
The people doing this study were obviously tired of hearing about the supremacy of the low-carb diet as a weight-loss tool, and they probably didn’t want to do yet another study comparing the low-carb diet to the low-fat diet for weight loss or lipid improvement or blood sugar normalization or blood pressure lowering because they knew what that outcome would be. Those studies have been done again and again and the low-carb diet always comes out on top. So, these researchers decided to take a different tack.
They wanted to see what happened when subjects stayed on the diet after reaching maintenance, so they took 18 subjects (they started with 26, but only 18 made it through the entire study) and put them on one of three diets: the Atkins diet, the Southbeach diet or the Ornish diet. The subjects stayed on one of these diets for 4 weeks, then followed their normal diets for 4 weeks, then went on another of the three diets for 4 more weeks, then off for 4 weeks, then on to the last of the three diets for 4 more weeks. But the researchers didn’t put the subjects on the weight-loss versions of these diets, they put them on maintenance versions. They did this by weighing the subjects at the end of each week and adjusting their caloric intake so that they neither gained nor lost weight.
By keeping the weight of the subjects stable, any changes wrought by the various diets could be attributed to the diet and not to the lost weight. Many people believe the changes brought about by low-carb diets occur not because of the diet but because of the weight loss the diet induces. And since in most studies subjects on the low-carb arm lose more weight than those following low-cal diets, it seems reasonable to suppose that it is the lower weight and not the diet composition that results in the better lipids, normalized blood sugars and lowered blood pressure commonly seen in the low-carb group.
In this case the weights stayed the same for all the subjects during the various diets, and as you can see from the abstract, the LDL levels went up (although not significantly) in the Atkins group while LDL levels dropped in the other two groups. The abstract says that the researchers drew blood at the end of each 4 week phase on the different diets, and I assume that they also drew blood at the start of each 4 week dietary trial, but the abstract doesn’t say. For all I know, they could have drawn blood for baseline values at the very start of the study and compared the lab values at the end of each 4 weeks to this baseline number, which would make the later numbers suspect. This is one of the problems with ‘studies’ like this one. These questions would all have to be answered before such a study could be published in a peer-reviewed journal. But in a conference, pretty much anything goes. It would be left up to an attendee to ask such a question.
Along with the LDL levels, the researchers also looked at a number of fairly arcane measures of inflammation: ICAM2, SELL and SOD1. As far as I know, these are not lab studies that the average doctor can order, but are ones that are done in research facilities for research purposes. In any case these indicators went up on the Atkins diet and stayed the same on the Southbeach and Ornish diets.
Finally, the researchers performed a brachial artery reactivity test (BART), which is a somewhat controversial but nevertheless commonly used test to measure endothelial function. (About halfway this old post is a description of how BART works. If you want a more detailed explanation with a discussion the controversial nature of the test, read this full text article.) As to the outcome of BART, the abstract simply reports the following:

BART testing revealed a significant inverse correlation between flow-mediated vasodilation and intake of total fat, saturated fat and monounsaturated fat.

We’re not told if this correlation holds irrespective of which diet the subjects were following or if these were the numbers while they were following the Atkins diet. From the wording of the abstract one would have to think that these values were reported for all the diets. If so, then the researchers have extrapolated from these numbers that the Atkins diet causes more endothelial dysfunction simply because it contains more fat and certainly more saturated fat than the other two diets.
Based on the abstract we find that

In the absence of weight loss, the high fat Atkins diet is associated with increased LDL-C, reduced endothelial vasoreactivity and increased expression of biomarkers of atherothrombosis. As such, these data suggest that isocaloric conversion to the Atkins diet may negatively impact cardiovascular health as compared to the South Beach or Ornish Diet.

Now, let’s probe a little deeper. And we don’t have to get very deep to see a major flaw in this study.
Before we get to the major flaw, though, let’s look at the LDL changes. As far as I’m concerned, they are a big Ho Hum. I mean, who really cares? How many studies do we have to look at to know that when you cut fat from the diet LDL levels decline? We already have dozens showing us this same finding. Dozens of other studies show us that when fat, particularly saturated fat, is increased in the diet that not only do LDL levels rise a little but HDL levels rise a lot. (I posted about this in the past.) So what little risk we might seem to accrue because of increased LDL levels is more than offset by the greater increase in HDL levels. It even gets better. The majority of studies have shown that when LDL levels increase due to high-saturated-fat, low-carb diets, the LDL particle size increases, making the LDL non-atherogenic. And while LDL levels fall with low-fat, high-carbohydrate diets, the LDL particle size decreases and becomes the small, dense type, which is highly associated with cardiovascular disease.
So, this study tells us that when the subjects went on the Atkins diet their lipid profiles actually improved as compared to the other two diets. Why didn’t the researchers just say that? One wonders. One also wonders why – if they went to the trouble and expense to check ICAM2 and the other markers of inflammation – they didn’t bother to check HDL levels or LDL particle size, especially since LDL particle size is lipid parameter that has the strongest correlation to the development of cardiovascular disease.
Back to the major flaw. The abstract doesn’t say how much these subjects weighed. So we can only assume. Let’s assume that they were average weight and required 24oo kcal per day to maintain their average weight. While these subjects were on the Atkins diet part of the study the abstract tells us that they were consuming 50 percent of their calories as fat. Let’s think about this for a minute and do a few back of the envelope calculations. Fifty percent of 2400 calories is 1200 calories. So 1200 calories were fat and 1200 calories were other than fat. Since other than fat means carbs and protein, that means that the other 1200 calories were divided between these two macronutrients. If we assume that 20 percent of calories were protein that calculates out to about 120 grams of protein per day, which is a fair amount and probably more than they actually got. But let’s assume 20 percent. That leaves 30 percent of calories as carbohydrate. Thirty percent of 2400 kcal comes out to 720 calories as carb. And since a gram of carb is 4 calories, dividing it out gives us 720/4 or 180 grams of carb per day. Does that sound like the Atkins diet to you?
Let’s give the researchers the benefit of the doubt and say that they had the subjects on 30 percent protein (180 grams), which I doubt because they would have been scared to death to give someone 180 grams of protein. But let’s assume they bucked up and did it. Running the same calculations on 20 percent of carbs gives us 120 grams of carbs per day – that’s a full 24 teaspoons of sugar’s worth of carbohydrates per day. Or two potatoes and a serving of pasta. Is that the Atkins diet?
See what I mean. It was a flawed study. I already linked to this post above, but it discusses the same issues, i.e., blaming a lab finding on saturated fat when the diet is full of carbs.
What do we care that a low-carb diet showed an increase in inflammation and worsening endothelial function when what was tested wasn’t really a low-carb diet?
In summary: no complete study, no peer review and no Atkins diet. Yet it made the news big time.
Now that you know the story, go back and read the press report of this oral report of a poster. See if your take home message is any different now.
Oh, and one other thing. According to the abstract the study started out with 26 subjects, but only 18 completed it. That’s a dropout rate of over 30 percent. One wonders why these subjects dropped out? And from which dietary protocol? It would be interesting to know, but I can make a pretty good guess.


  1. Hi Dr Mike,
    OK, session 3610 was a load of crap. But in all the vastness of the rest, what good stuff escaped the notice of the vultures of the press? There must have been SOME good stuff!
    And now, just packing up at work and toddling off again to the Sydney Opera House for an all-Rachmaninov program conducted by Vladimir Ashkenazy! If Atkins is going to kill me, at least I’ll be in heaven!
    All the Best,
    Michael Richards
    Hi Michael–
    Didn’t have time to go through all the rest because I was busy writing the post. I’m insanely jealous about the concert.
    Have fun.

  2. Wow. The original news article that you cited (Yahoo news) is scary indeed. That’s amazing. I can imagine what people who are “afraid” of low-carb would think upon reading that. It’s written as very definitive and with scathing accusations.
    I am continually amazed at how much things (in the USA anyway) are just not what they seem. In health, politics, religion, you name it. It’s almost like when some authority figure says do such and such, do the opposite. It seems to revolve around the dollar. I’m a songwriter and there have been songs written about follow-the-money and as I age, it is more apparent each year. Is that called wisdom?
    I really enjoy your posts and read every one. In the medical world, there are very few docs I trust implicitly; I trust you. You seem to be one who honestly seeks truth. Haha, “honestly seeks truth” seems a strange choice of words.
    You hack out these incredible posts and it seems you would have to spend significant time to do that. I appreciate your continued dedication to the cause. It took me years to get there but I’m convinced low-carb is the best. It just… makes… sense.
    Thanks, Dr. Mike!
    Hi Bill–
    Thanks for the kind words and the support.
    I’m glad you enjoyed the post.

  3. Jeff Volek et al. have tested the exact same measures of vascular function using ultrasound and showed highly significant improvement in subjects on 12 weeks of an Atkins type diet. They have also shown consistent improvement in measures of vascular inflammation.
    My first thought was that given the typical initial water weight loss with Atkins (and with South Beach if they were actually doing it right), how could they have adjusted calorie intake to keep them from losing weight? We all know that many lose 5-10 pounds the first week. They would have then had to “chase” this weight loss, which means they were overfeeding them. (Of course, this wouldn’t be the case if you’re right and they were eating 180 g of carb a day anyway–but then as you say, that wouldn’t be low-carb in the first place.)
    Thanks for reviewing the tiny information we were provided with.
    Hey Adam–
    I contemplated mentioning Jeff’s studies, but the post was going on forever, and the abstract and press report were so easy to debunk that I left Jeff’s work out. Thanks for mentioning it here.

  4. Hubby just called and told me he heard this on the radio – I just knew that you would have something to say about it, and immediately went to your blog. Thanks for passing on the correct information and pointing out how flawed that “study” really was.
    There are only two things that really scare me as I grow older….the government and the medical establishment.
    I Agree.

  5. Thanks for posting this! I was sure it was BS science.
    Apparently there was some discussion about IF at the event, did you have a chance to look into that? It was actually positive news but for all I know it could have the same flaws as the Atkins thing.
    No I didn’t look at the IF stuff because there were no abstracts in the program. Later the AHA should publish all the abstracts for the talks and the posters at this meeting, so I’ll take a look at them then.

  6. The question is now, has there been a real long term study of people on a low carb diet, who were not in a weight loss mode and how it affected their lipids? Maybe kids with seizures on a ketogenic diet?
    There have been no actual studies that I know of, but several case reports, which indicate that there aren’t any problems.

  7. LC is the best thing that ever happened to me. I really appreciate your dedication and your blog is one of the highlights of my day. Did you happen to see the huge ads in the Wall Street Journal yesterday for Lipitor? The only that Lipitor really does is to cut down on inflammation which LC does naturally. Our society is killing itself both literally and figuratively by believing everything in the mainstream press. Thank God for the internet.
    On a different note, how many calories a day should a 61 year old woman consume? I seem to be at a plateau on my weight loss and wonder if I am eating too much fat. Thanks. jj
    Hi jj–
    I have no idea how many calories you should be consuming since I know nothing about you, i.e., size, activity level, body composition, etc. But I can tell you that if you have been on LC for a while (and are following it properly) and have plateaued while you still have a fair amount of weight to lose, you probably are consuming too many calories.

  8. I just saw this article at ABC news and popped over here to write you an email but of course you already on like white on, ahem, sorry, rice.
    Anyway–you addressed my big concern with the study (the report of 50% fat which doesn’t really mean it was truly low carb) but what I also wanted to know is about the indices of inflammation that were cited–are these indicies of inflammation (I assume they were c-reactive protein or some such thing?) definitively associated with heart disease?
    Or is this again another case of building castles on sand?
    Hi BN–
    No, they weren’t anything as common as C-reactive protein, but a handful of arcane parameters. Jeff Volek’s work has shown these same parameters to improve on real low-carb diets.

  9. If fat strengthens the immune system, aren’t certain markers of inflammation going to go up pretty much by definition? Less “markers of inflammation” aren’t necessarily better, if those “markers of inflammation” had a job to do. Am I making any sense?
    Not necessarily the ones mentioned in this abstract. But these same parameters have been shown to improve in studies using real low-carb diets.

  10. Another great post! I’m not sure how or where you find the time to do this sort of work but I also greatly appreciate your continued dedication and excellence. You continue to renew my faith in humanity and the existence of intelligent life on earth which for many years was in doubt in my mind.
    Like Paul Simon’s song Kodachrome, I am pretty good at “reading the writing on the wall”. And my read of the way this program was structured is that there was premeditated intent to present the Atkins diet as dangerous by intentionally choosing the weight maintenance aspect. As you pointed out, the diet in this study would be anything but low carb by low carb protocols. What you did not point out is that most people start on some sort very low carb induction phase, usually for the specific purpose of shedding weight. This induction phase initiates important physiological changes that, among other things, shifts the body into fat burning mode. This was clearly not part of the subject research.
    As I have previously pointed out, for reasons unclear to me, Atkins and others like him recommended that carbs be increased incrementally after an initial very low carb phase until one found their carb tolerance. In my opinion this silly advice was probably the biggest factor leading to people falling off the low carb diet and regaining weight. In the present situation Atkins’ recommendations opened the door for the authors of the subject study to present any carb load less than the food pyramid as low(er) carb. This at least gave them the opportunity to argue that the subjects were on an Atkins diet.
    Webster’s Dictionary seems to afford the best explanation for the design of the subject study under the definition of SOPHISM:
    “A piece of plausible but false reasoning intended to either deceive or display intellectual virtuosity.”
    This certainly seems to fit doesn’t it?
    Hi David–
    I suspect that there was a little premeditation going on here. But there is in a whole lot of studies. That’s why they all have to be taken with a grain of salt and read hypercritically. Often we (and I’m as guilty as anyone else) have a tendency to read studies with results that conform to our bias much less critically. Every study should be read as critically as I read this one.

  11. “If we assume that 20 percent of calories were protein that calculates out to about 120 grams of protein per day, which is a fair amount and probably more than they actually got.”
    Yea, I seriously doubt they would even feed them 100 grams or protein a day!! Evil protein….almost as bad as fat! Especially if it’s animal fat!! Another question I’d have about this “study” is what foods, in general, were fed these people….processed foods or natural foods? I’d bet money on processed!
    Thanks for posting on this. I’ve had several people ask me about it. I’d seen it in Yahoo and was quite upset that there was no link provided! Now I know why….although that seems to be the norm lately….write an article about a study, but don’t give enough info for us to find the study!!
    Hi Cindy–
    You are right about the protein. I was actually going to make that point but the post was getting longer and longer so I left it out. I’m glad you brought it up. No mainstream researcher would give subjects that amount of protein. Heaven forbid! It could damage their kidneys. Ha!
    You’re probably right, too, about the processed foods. I’m sure they did everything in their capacity to ensure the results they wanted.

  12. Hi Dr Mike,
    Thanks for this post. I was being beat up by some co-workers yesterday when this came out. This is the kind of reporting that reinforces their misconceptions about fat in the diet. When I pointed out it looked suspicious when the Ornish diet was included and that no one in the study lost weight, they just thought I was in denial. Sometimes it’s annoying having the opposite views of everyone around me but most of the time it’s very satisfying. I do the research to make sure I’m on the right track and they don’t bother to check out the facts and they feel comfortable with their collective (lack of) knowledge. Once again you step up to the plate and knock out a home run with this post.
    Keep up the good fight.
    Hey Dan–
    Now you can rub their noses in it. Have fun.

  13. Go Atkins! Why do they always try to slant against the Atkins Diet when it is obviously so good for loosing weight and for getting your health back on tract …
    Some people just want to observe the surface without investigating the body of information available. Their loss. But it’s a shame when they slant away the truth.
    I suspect that it’s not that they don’t want to investigate the information; I suspect that they’re afraid of the truth.

  14. Thank you so much for posting this. I am still having problems trying to understand the mental contortions required to slam a low-carb way of eating. Why? Just….WHY?!?!?
    Too many reasons to go into hear.
    Glad you enjoyed the post.

  15. thanks Sir. I don’t have one iota of the knowledge yee have but the way it was presented made me wonder
    All good things
    Glad you enjoyed the post.

  16. Hi Dr. Mike –
    Again, thanks for taking the time to respond to yesterday’s article. It appears that the major point in your analysis is that we have to assume that what the researchers are referring to as an Atkins diet in this “study” was not really Atkins at all. That’s scary stuff. We, the public, generally assume when we read these things that the labels used to describe something are accurate.
    Is this type of thing common out there in the research world? I loved your back of the envelope calculations and assume you have exposed this type of inconsistency before. How can people just use whatever “version” they choose of a diet, label it as something it isn’t, and then just throw results out there? Well, I guess you actually answered that question in describing these Session presentations. At any rate, it’s good to have someone like you wading through all of this and letting us in on the truth of the matter. As an average Jane consuming whatever information is out there, it’s all a bit confusing. And now, infuriating.
    Hi Nancy–
    Yep, it is indeed infuriating. But on the other hand, if it hadn’t been published what would I have done with all that spare time on my hands yesterday?

  17. So. They are scaring us to death based on a study of 18 subjects that lasted several weeks. It’s almost like they were *looking* for something to scare us with . . .
    I’m not so sure they weren’t.

  18. Now that I’ve been reading up on nutrition for a while, I pretty much just ignore all those newspaper, magazine, and internet stories reporting study results on the merits or dangers of eating this, that, or the other. It’s so clear from reading analyses of these such as you provide that there are too many things left unsaid in the final media report to take the report seriously. One could drive oneself slowly mad relying on these articles in an effort to choose foods to prevent disease, lose weight, or maintain health. And they all contradict each other: “Study shows coffee conveys health benefits”; “Study shows coffee drinkers at increased risk for (insert disease here).” To look at how what we eat is treated in science and the media, you would think food was only discovered in the last fifty or so years, and we are not quite sure what it is for, so we need to keep running tests on it.
    I didn’t see this particle article, but I’m fairly sure that if I had, I might not have read it at all, or if I did, it would be to laugh at how stupid it is. I eat on daily average about 60% fat, 30% protein, and 10% carbs (30-40g) from mainly vegetables, and I like being 40 lbs lighter, mostly ache and pain-free, clear-headed, generally cheerful and calm, (compared to how I used to be on a low-fat, high-carb effort), and without disease, so I rather suspect that this eating pattern is not wreaking all manner of havoc in my body, despite what any studies to the contrary may claim.
    In other words, let your body be your guide and not a news brief in Yahoo. Right?

  19. Dear Dr. Eades,
    Here’s another article, this one from the Telegraph newspaper in England. It relates to obesity “causing” cancer. Maybe the cancer is caused by how they got obese, and not the obesity itself.
    I’ve visited the U.K. several times and have noticed a definite trend towards vegetarianism and obesity. The first time I went in 1984 I hardly saw any obese individuals. Lately there are so many that you’d think you were in the U.S. It’s very hard to stay on a low-carb diet there (as a tourist that is). Everywhere there are baked potatoes (jacket potatoes) and pastries on offer. If you order a meat sandwich there is a tiny amount of meat and a whole lot of bread. Chips (fries) come with darn near everything.
    Luckily, when I’m there I walk so much (all day) that the excess carbs are burned off. It’s impossible to see the best bits of London from a car!
    Hi Laurel–
    I was in the UK a couple of months ago and noticed the same thing about the increase in obesity.
    Thanks for the link. I can put that article next to the one published in JAMA yesterday showing that overweight people live longer. They will act as constant reminders as to why observational studies are pretty much worthless.

  20. Well that’s quite a through analysis MRE, and timely too.
    OK. lets see some of their sample “low carbohydrate” menus? Was there any checking for cheating? I think back to the old biosphere experiment.
    The AHA has already stated in 2002 that LC diets give better results than low-fat, but need “more study.” My LDL (total) has increased, but the other numbers are much better. I hope subsequent diet comparison studies are better than this!
    Its no wonder some people in the conference room are laughing.
    Indeed. Although that isn’t a photo of the very conference room where this talk was presented. But it is a room of similar size.

  21. Wonderful and oh-so-timely post, Dr. Mike. I was shaking my head the whole way through the brief article I saw yesterday in the press on this subject. I loved your detailed analysis. Of course, your demonstration of the likely non-Atkins nature of the diet used dooms the whole exercise from the start, even without all the other problems. I especially enjoyed this gem in your post:
    The people doing this study were obviously tired of hearing about the supremacy of the low-carb diet as a weight-loss tool, and they probably didn’t want to do yet another study comparing the low-carb diet to the low-fat diet for weight loss or lipid improvement or blood sugar normalization or blood pressure lowering because they knew what that outcome would be.
    The timing of this press on the heels of my reading Good Calories, Bad Calories brought to mind the old saw about 500 Atta Boys getting wiped out. Thanks for keeping up the good fight. Some day . . . .
    Hi Steve–
    I suspect that the ‘gem’ is right on the money. Glad you enjoyed it.

  22. Dr. Mike, you’re very good at debunking this kind of thing, and we are grateful as always. Thanks again. I just wish there were a lot more medical professionals that would wake up, actually read studies in their entirety after first looking at who the financial sponsor was, speak out and maybe also ban all drug reps from their offices. Rhetorical question: Doesn’t that guy at U Maryland have a brain with at least a couple of skeptic cells in there……, or at least a conscience…..oh, I forgot, he’s a cardio doc and I very much regret to say that suggests an economic conflict of interest. (I sincerely hope I’m wrong and that it’s just ….whatever.)
    BTW, it seems to me that the buzz on Gary Taubes’ new book has tapered off, but I’m still hoping to see it on the NYTimes best seller list soon.
    I’m still hoping to see GCBC on the NY Times list, too. And so is Gary. He is out there continuing to promote.

  23. What this study did was establish a new upper boundary for daily carb consumption before blood vessel damage occurs. That number is now roughly 120-180g/day.
    Hi Beth–
    I guess that’s one way to look at it.

  24. You can find all the abstracts for the conference here:
    (There’s a “search this issue” function at the BOTTOM of the page which will let you use key words.)
    For anyone that’s interested, Jeff found that a low carbohydrate diet reduced CRP levels by 55% and interleukin-6 by 51% in men. In a soon to be published study, his group found that a number of pro-inflammatory markers were reduced including tumor-necrosis factor-a (-32%) interleukin-8 (-33%) MCP-1 (-24%), E-selectin (-34%) and I-CAM (-17%). The subjects weren’t maintaining their weight, though–but they weren’t restricting calories either.
    Hey Adam–
    Thanks for the heads up on this – I didn’t realize the abstracts were available yet.
    And thanks for the info from Jeff’s studies. I sent you an email about them a bit ago so keep an eye out for it.

  25. For what its worth, after only 3 months after starting on a reduced carbohydrate diet (<120 gm of carbs per day), my blood work showed my CRP as .6 mg/L on a range of 0 – 6.0 mg/L. Meantime, my triglycerides went from 3.18 mmol/L at the start of my diet to .71 mmol/L. LDl went from 4.0 mmol/L to 2.9 mmol/L. HDL went from 1.0 to 1.2 mmol/L. Of course, this had nothing to do with reducing carbs. It was pure coincidence. Right?
    Hi Dave–
    Good job!
    A lot of people might think it is a coincidence. Especially those espousing low-fat diets. Or they will think the changes came about because you lost weight.

  26. Thanks Dr. Eades. I heard about this “study” yesterday and was wondering where I could find some info on it. So I came to you. I’ve been doing LC for a few weeks now and feel great, and I never seem to get hungry. Thanks for keeping us in the know. Kyle
    Glad I could ease your mind.

  27. I wouldn’t have made it through the Ornish part of the diet. Pass me some bacon and eggs, please!
    If this study is ever submitted for peer review, it will pass the muster and be accepted purely on political grounds: it does not rock the boat.
    If I calculated correctly, 120 g of protein is only 17.1 oz, which is probably about what I eat in a day, on average. It’s good to know that my kidneys are safe.
    One other thing about the study that was not specifically spelled out what what order the diets were eaten in. Was everyone one the diets in the same order, or were people split into groups? The order that the diets were tried could confound the results. I really enjoyed your analysis of the abstract, thanks!
    Do you have any comments on how accurate those body composition scales are? I’ve started doing the Slow Burn workout, and I’m curious as to how much muscle I can gain. My body seems to like to gain muscle, is that normal for a woman?
    Hi Kate–
    The body composition scales can be pretty accurate as long as you follow the instructions. And I don’t mean just the instructions on how to make the things work. The instructions as to when to measure after drinking a certain amount are extremely important in allowing the machines to give accurate readings.
    Good luck.

  28. MRE –
    A post came up recently on a differnet blog I read (A branding blog, if you can believe that!) about Good Calories Bad Calories.
    You can find it here:
    I was interested in your response to Glenn A. Gaesser’s assertions?
    For the record I read your books years ago and have also read the Paleo diet and other things. I’m wondering if Glenn Gaesser is using valid studies.
    Hi Matt–
    I asked Gary about the Gaesser studies. He said that one of the reasons he wrote GCBC was to counter invalid epidemiological studies such as these.

  29. I agree. But if the same results happened on a low fat diet there would be no doubt that the diet was responsible.
    Meantime, in another part of the world a second shot has been fired citing low carb diets as dangerous.
    Low-Carb Diets May Hurt Heart Health
    “By eating a low-carbohydrate diet, you are selecting out those foods that may be rich in healthy carbohydrates,” said Jeannie Moloo, a Roseville, Calif., dietitian and a spokeswoman for the American Dietetic Association. She said these nutrient-packed foods “lower LDL, the bad cholesterol, and blood insulin levels. They may also reduce blood clots.
    “Daily servings of good carbohydrates are crucial to maintaining a healthy cardiovascular system, Tallmadge said, but separating the good from the bad at the supermarket isn’t always so easy.”
    Wow, eating good carbs actually results in lower insulin levels! If a carb is good, it’s healthy. But if it’s bad, it’s unhealthy. What a concept! I wonder how the body deals with the inrush of glucose from good carbs if they result in lower insulin levels?
    Has Taubes’s book started a global war against low carbs eating? Maybe.
    Hi David–
    Yes, the depth of this lady’s dumbth is extreme. So carbs lower insulin levels. Yeesh.

  30. I would really like to see someone get ahold of Dr. Miller and ask him directly about the specific caloric and macronutrient ratios used, and how they were controlled.
    Like you Dr. Mike, when I read of this report, I wondered just how much did they have to feed people when they were supposedly on the low carb diet so that they did not lose weight? It either would have to be an awful lot more total calories than anyone would reasonably eat, or it simply was not low carb. Besides, you can’t just take one phase of a program, and claim that you compared one program to another. If you didn’t start with induction, and move through the phases up to maintenance, then you did not do Atkins.
    I noticed this in the abstract you posted: “caloric adjustments made if weight change exceeded 1 kg”. So, what? They just kept cranking up the quantities until weight loss stopped? Then I saw this;”There were no changes in weight at the conclusion of each phase”. That means when people did lose weight, they adjusted the diets until they gained the weight back. Yikes!
    I also wonder if the 8 participants who “did not finish the study” were merely taken out of the data because their results didn’t fit the conclusion they were looking for.
    Hi Bryan–
    There is a lot to wonder about in this study.

  31. A little off subject, but I started to think about those “metabolic ward studies” that A Colpo has looked at to summon up that Low-Carb does not render more weight-loss per calorie than other diets. Is it possible that those studies also were of people eating 80-150 g carbs? I know I don’t lose any weight if my carb count exceedes 25 g. I know you have some opinions of Colpo and he of you, but the studies were done by others (scientists), right?
    Hi Theresa–
    Unfortunately Anthony misquotes (or maybe misunderstands) a lot of studies to support his untenable positions. While the papers were written by scientists, in Colpo’s case they weren’t read by a scientist, so I would be careful of any interpretations he might give.
    Many studies show that low-carb diets bring about more weight loss per calorie than do low-fat diets. And many studies show that they don’t. I suspect the truth is that there is as I’ve said many times before a small metabolic advantage associated with a low-carb diet. But, as I’ve said before, not enough of one to allow someone to eat everything in site as long as it is low-carb and still lose weight.

  32. Mike interesting post.
    The researchers claim that the inflammatory markers DID get worse from the ‘Atkins’ diet. As you said, the way the thing is worded we don’t really know if it this finding was caused directly by the Atkins diet or by the other diets OR due to changing the diets around messing with a person’s intestinal fortitude.
    But let’s assume it WAS.
    We know that grain is highly acidic and causes inflammation. I can tell you first hand if I watch a baseball game with friends and drnk a few cans of beer (or more) and eat pizza my skin bursts out in red patches – everytime.
    Placed on a higher protein diet coupled with albeit less grain consumption yet still more than likely mainly grain as the carbs, it is possible that the diet was simply too acidic – which has not a thing to do with the higher fat content but rather, the combo of more protein and grain tipping the scale in the direction of making the blood too acidic than either the Ornish or SB diet.
    A possibility.
    Of course these researchers are probably entirely clueless to this as a possibility. After all, a bowl of oatmeal is a bowl of health, right? Little do they realize they might as well drink battery acid (OK that’s a bit of a stretch but you get the idea…)
    Hi Fred–
    I suspect that these researchers are clueless about a lot of things.

  33. These days universities have their own PR machines and do most of the reporters’ jobs for them. Faculty members can hype themselves before going to conferences (I’d never do it but know people who do so routinely) or be recommended for hyping by dept heads or deans who are pestered every few months to supply names to contact They always comply because we do want the public to know more about science and research. My name gets submitted every year or so because I am in an unconventional field for female scientists. PR staff do a short interview on the phone or in person and then write up the science in a pablum format that reporters and the public can absorb, with an innovative headline. Within about 3 minutes of talking in a preliminary interview, they will freely admit how “hot” your research is and whether they must get the full interview in the next day, week or month or whether they’ll “call you” if they have a slow news week. That’s why local newspapers seem to have a new cure for cancer or some major breakthrough coming from the local university at least once a month – the university plants the seeds (mine plants 20-30 per month) and the newpaper decides which to follow up on. Now that most local papers are owned by media giants, cancer cures from all affiliates can be easily compared and the best one will go national.
    Hey deirdra–
    Thanks for an insiders perspective.

  34. In summary, although the study was not high-fat, Atkins, a diet, long-term, nor was there damage, it proves that “High-fat Atkins diet causes long-term damage.”
    I wonder if they were using those sham ‘protein bars’. That would be an easy way to keep the weight on, inflammation steady, and pretend to reduce carbs.
    PS – What a great service you provide. How the heck do you find enough time to write so much, so well, so quickly, and with such good analysis? You have a remarkable knack.
    Hey seyont–
    We don’t know what they were using because we don’t have the data. And neither do the reporters that reported it all as fact.
    Where do I get the time…? I’ve cut back severely on my reading.

  35. My heart sank when I saw this article in the news! For three years my husband and I have been having dinner with 2 other couples, alternating houses. When we started, one person was vegetarian. No big deal, easy enough to include something for her. As of this month’s dinner, all four of the other members are on low-fat vegetarian diets!! After this Saturday it’s my turn. Good thing they all still eat seafood!! It’s this kind of press that makes it almost impossible to convince anyone that the way I eat is really healthy though.
    Spouse and I are eating a nice fatty steak before we go…..
    Hi Lisa–
    Enjoy every saturated bite.

  36. This bias and distortion in the media driven by the medical establishment that can’t accept that the basis for the food pyramid was wrong …. when will this end? How much more diabetes and obesity do we want?
    I am a type-2 diabetic, I have posted on ths site before. Low carb is the only way that I can hold my sugar level, have lipids and chosterol under control. I have dutifully recorded what I have eaten for the past 9 months and my blood sugar readings and weight … for me this is proof that this stuff works. Yet, my doctor only says now ‘keep doing whatever you are doing’ .. his earlier advice based on the ADA 50% carb diet actually as Atkins says was actually malpractice.
    Things are probably not going to change quickly enough to save our nation, Protein Power and Good Calories/ Bad Calories not withstanding, until we get a low carber in the White House and someone like you gets to be Surgeons’ General? Do you know if we have any running?
    Hi Guru–
    I loathe politicians of all stripes, so I don’t read much about them or their dietary habits. I do know that Hillary was a big Dean Ornish fan while in the White House, but I don’t know about now. And I know that Al Gore used Protein Power to lose his weight for the election in 2000, but he obviously hasn’t been following it lately.
    I doubt that we’ll see a low-carber as Surgeon General because people who get chosen for that post typically come from the middle of the mainstream.

  37. Of course the Atkins diet can damage blood vessels. Take a cross-rib roast out of the freezer and drop it on your foot. That will surely damage some blood vessels. You certainly wouldn’t damage blood vessels dropping a whole-grain loaf of bread on your foot. 🙂
    Hmmm. I hadn’t thought of it that way. Better not let the lipophobes get hold of that information or they’ll start writing papers on it.

  38. Dr. Eades,
    I’m a relatively new reader of your blog, and have been reading and learning more about low-carb and its health implications (quite fascinating!) I had a question on your analysis of the poster. According to the abstract, “expression of atherothrombotic biomarkers was not
    increased after the South Beach or Ornish phase.” While I would agree that more than likely the diet was not truly a low carb as you or Atkins would advocate, it still showed an effect, whereas even the (presumably) higher carb diets didn’t? Shouldn’t there have been some sort of dose-dependent relationship, where a greater effect was found on the higher carb diets if it was, as you seem to be implying, the carbs rather than the fat?
    Hi Becca–
    We don’t know because we haven’t seen the data. Remember, this isn’t a peer-reviewed study, so we don’t even know other than in the broadest strokes how the study was even done. It’s dangerous to make sweeping judgments on such paltry information. Other carefully-controlled studies that have made it through the peer-review process show that low-carb diets improve inflammatory markers, so I’m not too worried about it.

  39. Dear Dr. Mike,
    I am living proof that Atkins and Protein Power work. After years of eating just like the ADA recommends, I GOT the Type II diabetes. Even though I didn’t even eat sugar. It was all the whole grains that did me in – that, and not enough fats!
    I’ve been lowcarbing for 8 months now and lost 30 pounds. At 49 I feel great. My insulin levels dropped by 50 %. I also managed to bring my blood glucose down from 310 to around 120. That’s still not it, but it’s close, and I used no medications so far.
    But I seem to have a problem with inflammation: I have another 50 pounds to lose yet my weight won’t budge. I would also like to get rid of my BP medicine, but to my dismay, after 13 years of perfect control, my BP is on the rise. There are days when I don’t feel so good. I suspected inflammation and had my CRP checked – it was 300 % the normal level. That’s when I found your blog, read about the inflammation and started IF. After 3 weeks , I feel fine (I eat just one meal on workdays and 2 meals per day during the weekend). BUT: I gained 4 pounds and my CRP got worse (it’s 500% the normal level now). What could be the reasons? I eat a lot of saturated fat (raw butter and coconut oil) but it’s all organic. Also, my one meal per day is no binging, and I still stay LC all the time.
    I read about the Anti-Inflammation diet by Dr. Monica Reinagel and she seems to think that saturated fats and some other foods are inflammatory. It’s quite confusing. I believe in LC and that fats are good. What could be the reason that LC eating – which suits me so well -and IF – which I easily adopted from day one – does not seem to be working for me and is not diminishing my weight, my inflammation, my blood pressure and my blood sugar?
    Thanks for your valuable thoughts and best regards from Europe, Xenia
    Hi Xenia–
    I couldn’t begin to tell you what’s going on from the history you gave me. You could have an inflammatory process taking place that has nothing to do with your diet. But I don’t know because I haven’t examined you. I would suggest that you see your physician and discuss the situation with him/her. There are a number of tests you can have done that will uncover an inflammatory process at work that you may not be aware of.
    Keep me posted.

  40. The problem with the mainstream media is that they do not seem to feel the need to check the facts. Rather, they look for ways to sensationalize any claim in their headlines and then amplify it to fit their own biases by then getting pseudoscientists to comment on it and reinforce the message.

  41. Here’s the latest attack on low carb.
    Protein diets not so good
    Tuesday November 13, 2007 (2108 PST)
    A few excerpts.
    “There are no long-term studies of these high-protein diets,” she says. However, scientific evidence suggests that the diets carry “great potential” risk of heart disease as well as problems for the kidneys, bones, and liver, she says (Alice Lichtenstein, DSc, a professor of nutrition at Tufts University).”
    “A popular premise of high-protein diets is that excess carbohydrates cause elevated insulin levels, which in turn, promotes storage of body fat, according to the study.
    Supporters of high protein diets say that the high amount of protein and fat relative to carbohydrates helps reduce insulin levels. The researchers counter, however, that protein stimulates insulin secretion, and changes in calorie intake do not influence insulin action.”
    Inference: Protein is the same as carbohydrate.
    If the preceding quoted statements are not deceitful then nothing is. No one is going to convince me that the authors don’t know the true facts of the matter.
    Either they’re stupid or they have an agenda. Who knows which?

  42. Thank you for your reply. I am aware you cannot diagnose me from overseas … I wish you could. But talking to doctors following official doctrine is so useless. I went to see my personal physician yesterday – she’s such a nice lady, but she knows less than I do. When I mentioned inflammation she thought I could try a rheumatologist …
    She also thought my high CRP was nothing special.
    When I mention my high protein diet to any doctor, they go: Aha! But I am sure meat and natural fats are not inflammatory. For the first time in my life my food feels so right. I have no cravings even though I eat only once per day now and that one meal is not excessively big. Most days I hardly eat any carbs. I eat an apple maybe twice a month and if I do eat any carbs, they come from raw vegetables and partly from dairy.
    Well, the only thing I can do is muster on and see what happens. My insulin has come down beautifully, so my weight has to as well, doesn’t it? And when the weight comes down, so will blood sugar (I still have some 20 % to go) and my BP.
    Hi Xenia–
    As the weight comes down so should the blood sugar. It doesn’t always, but it usually does. I’ll keep my fingers crossed that it does in your case.
    There is a new study that will be published in a couple of weeks in a prestigious journal showing that low-carb diets containing meat and saturated fat reduce inflammation more than do low-fat diets. I’ll post on it when it’s no longer embargoed.

  43. Sorry, I just forgot to add one thing:
    Maybe toxins from the fat that I lost so far (30 lb) are now circulating in my blood and causing or furthering my inflammation?
    I read that in many of the studies where scientists found meat and animal fats “pro-inflammatory” did not distinguish between industrially raised meat and truly organic, pastured meat. This could account for some negative reports on meat since not only is corn-fed beef actually second-generation sugar but it also contains pesticides, hormones and other harmful stuff. Plus, it contains arachidonic acid which indeed IS inflammatory.
    I would have suggested the toxin release from the fat loss, but I didn’t know your actual history, so it would have been speculation on my part.
    Actually, the new study I mentioned in the answer to your last comment demonstrates strong evidence that arachidonic acid is not necessarily inflammatory, an idea that will have to change my thinking. But it’s pretty difficult to argue with the data in this paper.

  44. R Tamesis, sensationalism is why Atkins was alway invited onto national talk shows to debate and the Eades almost never. Atkins had a tendency to get confrontational on occasion, which fed right into the controversy that TV producers know gets bigger ratings. The Drs E on the other hand always remain informational instead of confrontational so they’re rarely invited on.

  45. Once I mustered up the courage to do low carb, I began learning more and more about the truth. I know of cultures that have lived traditionally low carb lives that were, by far, the most extreme low carb lifestyle one can imagine. Yet, they had remarkable health. I learned about insulin stability, cancer prevention,glucagon, the mechanics of our precious organs. It is a good thing that I grew in my knowledge about low carb as a whole. I say this because of the way the “experts” want to dumb us down.
    I have been a happy and healthy low carber for 5 years this Thanksgiving and I have not looked back despite the “sky is falling” warnings. I have medical training as a medical assistant and IV technician so I trust my brain’s ability to sort things out.Dr. Mike thanks for not dumbing me down.
    It’s my mission to not dumb anyone down.

  46. This is very late in coming, but I had to relay what I just heard Dr. Dean Edell say during his daily one minute radio segment this morning.
    He quoted from this study without any qualification as proof that Atkins was an unhealthy diet!
    He has always been strongly anti-Atkins, but the way he used this study makes me seriously question his motives and qualifications for reporting science.
    It’s pretty apparent that he has a substantial bias against low-carb. It’s sad, though, that he would parrot that idiotic study without a little more looking into it.

  47. In your opinion do statins have the capacity to alter the distribution of LDL particle size toward the large, fluffy type, like low carbing does? I’ve done some digging around on PubMed and found a handful of studies that seem to indicate they don’t.
    My 48 yo husband started on Crestor about 4 years ago, and I’ve been fighting with him about it ever since. He has no family history of heart disease, no health problems, etc, but his dr. thought his cholesterol was a little too high. I think it’s criminal a guy this young, with no preexisting health problems, would be put on a statin.
    He realized a week ago that he’s developed some hearing loss, and I’m worried it’s because of the Crestor, so am back in full attack mode again.
    I hope to show him a number of studies linking small LDL particle size to heart disease, plus studies showing that statins (esp rosuvastatin) have no effect on particle size. He only believes what he reads in the media, so this whole ordeal has been incredibly frustrating.
    Hi Amanda–
    The literature (at least that which I’ve read) is inconclusive as to whether or not statins reduce LDL particle size. I’ve read a few papers presenting opposite viewpoints. If I were to make a bet as to how it will ultimately shake out, I would bet that there wouldn’t be a reduction in particle size with statins. But I could be wrong.
    See if you can get your husband to read Lipitor: Thief of Memory. That might make him take a different view.
    Good luck.

  48. Hi Dr Eades
    This is a very late reply, but I just found this post from Adam C’s blog.
    First thank you very much for posting about this. I haven’t had time to dig into it like you have, but I’ve been meaning to because it is of important to my current research.
    I’m Cassandra Forsythe, one of the et al’s in Jeff’s lab. I was the team leader for this study that Adam has mentioned, and know that the responses are real.
    However, I must point out that although our study did show reduced inflammatory markers, and it was truly low-carb versus a healthy low-fat, it was a weight loss study, whereas this abstract is weight-maintaining. So, some of our responses may have been a result of the great weight loss that our low-carb subjects had.
    Now, I’m not saying that the same things wouldn’t be seen if it was weight-maintenance and true low-carb, but this is a point to keep in mind.
    Currently, I am working on my dissertation to answer this question. I’m conducting a low-carb weight-maintaining feeding study (i.e. I cook and prepare all the food within the exact guidelines of a low-carb ketogenic diet) with a comparison between high SFA vs, high MUFA plus n-3 PUFA. The end points are the same inflammatory markers measured in our previous work, plus insulin sensitivity and blood fatty acid composition. It would have been nice to do BART again (we’ve done it before), but there just wasn’t any room (or money). The overall purpose is to determine if there is an ideal fat composition of a ketogenic low carb diet, or if it doesn’t matter due to the restricted nature of insulin-provoking carbs. The results will be very exciting and hopefully will be available in the next few months. Currently, I still have no idea what to expect, but know that this study will stimulate a lot more work and interest in low-carb research.
    Thank you again. Happy Holidays. Best, Cassandra
    Hi Cassandra–
    Good point about the possibility of the anti-inflammatory results being due to the weight loss and not necessarily the low-carbs. My own bias is showing a little.
    I’m really excited to see the outcome of your low-carb weight-maintenance study. I think you guys are doing the best low-carb science around. Keep up the good work. And keep me posted. I don’t want to have to wait until it’s published to find out what happened.
    Happy Holidays!

  49. Every time I’m sent to this site, as I was today, I am amazed that anyone would take you seriously. I don’t pay much attention to doctor blogs which are covered with ads for unproven methods and products, anymore than I do to the study you have deconstructed for us.
    Thanks for stopping by. Your comment confirms everything this book explains.

  50. Dear Dr. Eades,
    I hope I’m not asking you a question that was covered elsewhere. I apologize if I am.
    Are you aware of any evidence, be it published or otherwise, that shows a regression of arterial plaque due to low carb dietary influence?
    It’s something that I often wonder about, personally, and it often comes up when I tell people that I think a lower-carbohydrate diet can be heart healthy.
    I’d appreciate it greatly if you could direct me to such data or share some of your experiences from “the field”.
    Thanks for your wonderful blog and your time and consideration.
    Kind regards,
    John Paul
    As far as I know, John Paul, there has not been a human study showing this. There is some work with dogs that I’ve read showing that increasing insulin increases arteriosclerosis, and then reducing the insulin makes the plaque go away. But nothing like that in humans. Dean Ornish was involved in a couple of studies a decade or so ago that purported to show that his extremely low-fat diet ‘reversed’ heart disease, but the studies were kind of bogus. And the two groups studied didn’t just differ in diet, but in a whole host of things. I would love to do such a study, and am working on getting involved with a facility where I can. I’ll keep everyone posted.

  51. Dr. Eades,
    April 2009: The study is back:
    Seems to be almost the same as the one you posted about 2 years ago. Probably dismissible for the same reasons… It does make me wonder about flow-mediated vasodilation since it does seem that high fat meals do temporarily decrease it. My biases make me think that’s not a big deal, but I haven’t been able to find a reason for that.
    If high saturated fat meals do lower flow mediated vasodilation, do you know of a reason why that’s not worth worrying about?
    Thanks, Dan
    I actually haven’t had the time to give this paper a critical read. I’ve got it pulled and printed, but I just haven’t delved into it yet. I suspect that it is similar to the other, but can’t tell until I’ve read it. If it is of interest, I’ll post on it.

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