Rooting out more anti-low-carb bias
In an example of more brain damage from the mainstream medical press, a recent online article from heartwire savaged the low-carb diet as a treatment for diabetes along with one of its main academic proponents. This piece, when read critically, provides a blueprint for how to subtly (and not so subtly) disparage an idea that doesn’t meet mainstream approval. And it shows why the low-carb diet – despite the mountains of evidence demonstrating its superiority – continues to have difficulty gaining traction.
Here’s the story. Dr. Eric Westman, from Duke University, gave a talk at the European Association for the Study of Diabetes (EASD) conference last month in Stockholm. Dr. Westman made the point in his talk that since 98 percent of the research presented at diabetes meetings involved a pharmaceutical approach to treatment perhaps it was time to take a look at the benefit of lifestyle changes, specifically diet, to treat the disease. He went on to provide data showing the benefits of low-carbohydrate diets in the care of diabetic patients.
As might be expected, the mainstream – and let me assure you, the EASD meeting was the most mainstream of mainstream meetings – didn’t like what they heard. Neither, apparently, did the writers at heartwire, another mainstream organization.
(Heartwire is an online magazine, available to anyone but requiring free registration, that goes out to physicians – cardiologists, primarily – and provides the latest news of various drugs, procedures and therapies for heart disease. Heartwire is owned and operated by another mainstream medical news agency, Medscape, which is owned by the even more mainstream (if possible) WebMD.)
Let’s take a look at this abysmal excuse for balanced coverage and see how the writer sprinkled seeds of doubt about the efficacy of the low-carb diet throughout the article. As we go through this exercise, bear in mind that most readers of this piece are busy cardiologist who most likely scan these pieces in an effort to get the gist of them without spending the time reading the entire thing.
(In case you don’t want to register for heartwire to read this piece online, I’ve uploaded a pdf for you to read here Kill or cure? Atkins diet debated in diabetes )
The bias starts early: right with the title:
Kill or cure? The Atkins diet debated in diabetes
Most cardiologists (and other physicians) reading this article more than likely already have a bias against the low-carb diet. Imagine for a moment that you are a busy cardiologist and have come across this article as you scan your emails between patients. (Heartwire is delivered to subscribers via email.) You’ve had a few patients who have done well on low-carb diets, and you’ve heard about these diets in the media, but you don’t really know all that much about them. You do have a bias, however, because you are a cardiologist, after all, and therefor you are more than likely to be a believer in the lipid hypothesis, and you know that these diets are high in fat. Reading this title, most will assume the article is anti-low-carb and that it will confirm their own anti-low-carb bias. And even the little picture at the top of the piece (reproduced above left) hints at bias because of the large chunk of red meat the questioning physician is holding. You will then scroll down, skim through and have your eyes caught by the bold quotes set apart from the body of the piece. If you’re in a hurry, these quotes are probably all you’ll read. They tell you everything you need to know: heartwire – and by extension, mainstream cardiology – believes these diets to be bad.
Read these quotes as a stand alone substitute for the meat of the article and see what you think the takeaway message is.
I would never prescribe an Atkins diet to a person with type 1 or type 2 diabetes.
There are no long-term data comparing the different diets in diabetes management.
Low-carb is not defined consistently across all the research studies, it’s very confusing.
If you want your patients to love you, improve their glucose; get them off insulin and injections.
It’s my hunch that it’s both—it’s the weight loss, but how you do it gives you a little extra power.
With these diets there is no suffering, no hunger and there is a feeling of satiety.
Atkins is atherogenic. I’m concerned about . . . its impact on LDL cholesterol.
The ADA does not recommend an Atkins type low-carb diet because of the concerns about the impact of that fat load on heart health.
Based on these quotes, the low-carb diet doesn’t sound like an effective option for diabetes treatment, does it?
But what about the body of the article? Let’s take a look.
The piece starts out presenting the crux of the problem.
The fact that lifestyle interventions can often do better than drugs at controlling type 2 diabetes is recognized by many in the field, but implementation of this approach is hampered by the fact that it is difficult to get busy general physicians to actively encourage lifestyle change or to get affected individuals to alter lifelong habits.
The next paragraph introduces Dr. Westman, who may have a solution for the problem. But let’s take note of how they introduce him.
But one nutrition expert believes he has the answer: the Atkins diet. Dr Eric C Westman (Duke University, Durham, NC) admittedly has vested interests in promoting this approach—he is the coauthor of the latest Atkins book and receives honoraria from Atkins Nutritionals—but argues that he values his reputation above all else and that his aim is to convince people that the science exists to back his claims.
The above is absolutely outrageous! I’ve read many articles about statin drugs in heartwire, Medscape and WebMD (and countless other mainstream publications), and I’ve never seen this kind of introduction. Could you imagine reading the following:
But one expert believes he has the answer: statin drugs. Dr. Joe Blow (Harvard University, Cambridge, MA) admittedly has vested interests in promoting this approach – he is paid tens of thousands of dollars every year as a consultant to several pharmaceutical companies that make statin drugs – but argues that he values his reputation above all else and that his aim is to convince people that the science exists to back his claims.
Believe me, that would never, ever happen despite the fact that in the majority of cases it is true. Most of the people who promote statins in print and in lectures are on the payroll of the statin companies. Annoying as this is, it is even more abhorrent since most of the controlled studies that have been done (and there have been many) demonstrate the efficacy of the low-carbohydrate diet whereas controlled trials showing any benefit from statins are scarce as hen’s teeth.
As you read on through the piece, you’ll find Dr. Westman’s answers to questions being characterized in the following ways:
This way of stating Dr. Westman’s responses imply that he is, well, admitting or conceding to the other point of view. When describing the responses of those chosen to refute Dr. Westman – all lipophobes to their very cores – the writer uses a different characterization.
Eckel [Dr. Robert Eckel] says…
And he [Eckel] is keen to stress…
Eckel begs to differ
Dietitian Stephanie A. Dunbar…says…
Dr. Arne Astrup says…
You can see that all the mainstreamers trotted out to refute the low-carb guy all ‘say’ and ‘believe’ and ‘note’ and ‘add’ and ‘beg to differ’ and are ‘keen to stress.’ They don’t ‘concede,’ ‘admit’ or ‘acknowledge.’ (They actually do in one or two places, but mainly they ‘say’ whereas Dr. Westman ‘concedes’ or ‘admits’.) This is a subtle but effective way of presenting material to the reader in an appallingly biased way. The writer should be ashamed.
I’ll leave it to readers of this blog to peruse the entire heartwire article to notice the rest of the bias that runs throughout. Those who choose to go ahead and register (free) can read the rollicking debate following the article containing comments by Gary Taubes, Richard Feinman and a number of other people most will recognize.
I do want to take a moment to show how easily a mind can be closed. I would like to look at a couple of specific responses from Dr. Robert Eckel, the academic heavy hitter the author used to refute Dr. Westman’s approach. Dr. Eckel is a professor of medicine at the University of Colorado and has held numerous lofty positions in the academic world including the presidencies of the American Heart Association and the North American Association for the Study of Obesity, now the Obesity Society, the organization of academic obesity researchers. (Full disclosure: I am a member of the Obesity Society.) Dr. Eckel has written and lectured extensively on the dangers (as he perceives them) of the low-carb diet, and has attacked numerous specific low-carb diets and their developers, including yours truly.
Throughout the article while Dr. Westman is ‘admitting,’ conceding’ and ‘acknowledging,’ Dr. Eckel is (pompously, in my opinion) is attempting to refute whatever it is Dr. Westman admits, concedes, etc. It quickly becomes clear that Dr. Eckel is so close minded about the subject of low-carb diets that he has lost all objectivity.
Dr. Westman makes the case that a recent study in the Annals of Internal Medicine demonstrated that low-carb diets raised HDL-cholesterol levels. Most of the readers of this blog – at least those who have gone on a low-carb diet – know that HDL-cholesterol goes up on such a diet. We all know that saturated fat raises HDL-cholesterol levels. And we all have seen or at least know of the countless studies showing the benefits of having higher levels of HDL-cholesterol. In fact, a number of studies performed over the past few years have shown that infusing HDL into subjects with coronary plaque brings about a reversal of the plaque. Dr. Eckel has got to be aware of at least some of these studies, but look what he says when Dr. Westman raises the issue:
“This claim that Atkins preserves the HDL level” is irrelevant, he [Eckel] says, since “the science is not advanced enough yet to say whether a rise in HDL is a good thing. To make any conclusions on this is really premature.”
The very model of a modern closed-minded academician.
And it’s obvious that Dr. Eckel wants to remain close minded. He doesn’t even want there to be the possibility that the low-carb diet could be shown to be beneficial.
At the end of this extended attack on him, Westman, disappointingly to me since there is so much data already out there, seeks not to do battle with the large body of existing research showing the benefits of the low-carb diet but instead bolts for the ever-present refuge of all researchers and recommends even more research.
Westman says a long-term outcomes study comparing low-carb and low-fat diets is sorely needed; such data do exist for the Mediterranean diet, he notes.
“Everyone talks about the Mediterranean diet, but the low-carb one looked just as good in the DIRECT study. I’m an advocate for studying this kind of approach within mainstream medical research; it’s been avoided, and that’s too bad. It needs to be given the same attention as other approaches,” he concludes.
Surely, you may think, Eckel would agree with this. Let’s gather some good data and settle this once and for all. But that’s not the case.
But Eckel is vehemently opposed to any such outcomes study with Atkins, telling heartwire: “I feel that would be an irresponsible trial.”
Irresponsible? Why? Because just about every study done so far shows the low-carb diet to stabilize blood sugar, reduce high blood pressure, and improve the lipid levels Dr. Eckel so believes in. It seems unbelievable. But maybe not so unbelievable when you dig a little deeper.
Why, you might ask, is this scientist so obdurate in the face of all the evidence that’s out there? Perhaps because much of the evidence isn’t in accord with his religious beliefs. I try never to mention a person’s religious faith, but when it impacts his scientific thinking it at least needs to be made known. Unless he’s changed his thinking recently, Dr. Eckel apparently is one of the few academic scientists who are literal interpreters of the bible. I assume this because Dr. Eckel serves on the technical advisory board of the Institution for Creation Research, an organization that believes that not only is the earth only a few thousand years old , but that the entire universe in only a few thousand years old. And they believe that man was basically hand formed by God on the sixth day of creation. And Dr. Eckel’s own writings on the subject appear to confirm his beliefs.
I don’t have a problem with people who have such beliefs (or any other beliefs, for that matter) as long as they don’t conflict with my own life and activities. But when my own notions of what constitutes the most healthful diet based upon my education, study and work with thousands of patients is denigrated as hucksterism, as it has been by Dr. Eckel, then I do take exception.
Part of my own coming around to the low-carb diet was driven by my many hours of study in the anthropological and paleopathological literature. Using technology available today, it’s possible to see what early man ate, and it’s very easy to determine his health. As it turns out, when early man made the conversion from a hunter-gatherer diet and lifestyle to an agricultural one, he experienced an enormous decline in health.
In a post I recently wrote, I put up the graphic below showing all the factors confirming the low-carb diet to be the best for the greatest number of people.
Of all the evidence that exists, I think the evolutionary/natural selection data and the anthropological data are the most compelling because they provide the largest amount of evidence over the longest time. To Dr. Eckel, however, these data aren’t applicable because in his worldview prehistoric man didn’t exist and therefore wasn’t available to be molded by the forces of natural selection. I haven’t a clue as to what he thinks the fossil remains of early humans really were or where they came from. Perhaps he believes – as I once had it explained to me by a religious fundamentalist – these fossilized remains of dinosaurs, extinct ancient birds and mammals and prehistoric man were carefully buried by the devil to snare the unwary and the unbeliever. If this is the case, I guess I’ll have to consider myself snared.
In Dr. Eckel’s view, man was created post agriculturally. In fact, in his view, there was never an pre-agricultural era, so how could man have failed to adapt to agriculture?
Whatever the reason, Dr. Eckel seems to have a preternatural hatred for anything low-carb. His mind is made up, and not only does he not want to be confused with the facts, as the old saying goes, he doesn’t even want research to be done to perhaps come up with the facts that might confuse him. It is even more troubling that he sits as an editor and is a reviewer for numerous mainstream medical and nutritional journals. What chance do you think a low-carb paper has to make it through his review? Until he retires, all we can do is understand his biases and try to work around them. I would suggest that whenever you read or hear reported anything Dr. Eckel says or writes about low-carb dieting – including his responses in this piece to Dr. Westman – you should take it with a very large grain of salt.