Slouching toward Low-Carb. “We Thought of This First.”

Posted: January 3, 2012 in American Diabetes Association, low-carbohydrate diet, Research Integrity, The Nutrition Story
Tags: , , , ,

The joke in academic circles is that there are three responses to a new idea. First, “This is wrong,” second, “There’s nothing new in this,” and third, the sub-title of this post. Priority in a scientific discovery is fundamental in science, however, and “we thought of this first” is not always that funny.  Getting “scooped” can have serous practical consequences like jeopardizing your grant renewal and, if nothing else, most of us are motivated by a desire to solve the problem and don’t like the feeling that, by analogy, somebody came along and filled in our crossword puzzle.  In dietary carbohydrate, all three of the responses co-exist.  While an army of dietitians is still claiming that people with diabetes need ever more carbohydrate, in the background the low-fat paradigm crumbles and, somewhat along the lines of the predictions in A Future History of Diabetes , the old guard are coming forward to tell us that they have been recommending low-carb all along.

The latest discoverer of the need to reduce dietary carbohydrate is David Jenkins whose recent paper is entitled “Nuts as a Replacement for Carbohydrates in the Diabetic Diet.” [1] The title is crazy enough, following the tradition of getting away from nutrients, that is, well-defined variables, and replacing it with “food,” that is, mixtures of everything. It is, in fact, not really a low carbohydrate study but the experimental design is not the problem.  It is the background and rationale for the study which recognizes the disintegration of the low-fat diet paradigm but, at the same time, fails to cite any of the low-carbohydrate studies that have been instrumental in showing the need to replace carbohydrates in the diabetic diet. Given forty years of studies showing the benefits of low carbohydrate diets and forty years of unrestrained attacks on the method, it will be interesting to see how Jenkins shows that it is actually the nutritional establishment that invented carbohydrate restriction.

Disputes over priority are well known in the history of science. Newton’s frequently quoted statement that he had seen farther than others because he had “stood on the shoulders of giants” has been interpreted by some historians as a sarcastic comment aimed at Robert Hooke  with whom he had, among other things, a dispute over the priority for the inverse square law (force of gravity varies as the inverse of the square of the distance: F = GmM/g2). Hooke was short and suffered from kyphosis and is assumed not to have shoulders you would profitably stand on.

Even Einstein had trouble.  His dispute with the mathematician David Hilbert about priority for the field equations of general relativity (also about gravity) is still going on, a dispute that I prefer to stay out of. Cited by his biographer, Abraham Pais, Einstein had apparently made up the  verb to nostracize (nostrazieren) which he accused Hilbert of doing. (He meant that Hilbert had made Einstein’s idea community knowledge.  Googling the word gives you only “ostracize” and “Cosa Nostra.”)

It is not the priority dispute, per se — the original low carbohydrate diet is usually attributed to William Banting who published the Letter on Corpulence in 1863, although Brillat-Savarin’s 1825 Physiologie du goût  understood the principle. He said that some people were carbophores and admitted to being one himself.  It is not just priority but that the people who are now embracing carbohydrate restriction were previously unrestrained in their attacks on the dietary approach and were adamant in denying the strategy to their patients.

David Jenkins: “Nuts.”

In trying to find an appropriate answer to the recent bit of balderdash by the redoubtable Hope Warshaw, Tom Naughton recounted the story of the Battle of the Bulge of WWII.  Towards the end of the war, Hitler launched a massive winter attack around the city of Bastogne where, at one point, American Forces were surrounded. When the Germans demanded surrender, the American General, Anthony McAuliffe, sent the one-word reply: “Nuts!”  I always thought it was a euphemism and that he actually went “Vice-presidential” as it was called in the last administration, but it turns to have been a common expression with him and he really did write “nuts” which, of course, had to be explained to the German couriers. (There is a “Nuts” Museum in Bastogne commemorating the battle which the Americans won somewhat as described in the movie Patton).

For installation in the Nutritional Nuts Museum and as an example of the current attempts to co-opt carbohydrate restriction, one can hardly beat Jenkins’s recent paper [1].

Richard:…Who knows not that the gentle duke is dead? ….

King Edward: Who knows not he is dead! Who knows he is?

Queen Elizabeth: All-seeing heaven, what a world is this!

– William Shakespeare, Richard III

The trick is to act as if the point you are making is already established. The Abstract of Jenkins study: “Fat intake, especially monounsaturated fatty acid (MUFA), has been liberalized in diabetic diets to preserve HDL cholesterol and improve glycemic control….” It has? Liberalized by whom?  Although the American Diabetes Association guidelines are traditionally all over the place, few would consider that there is any sense of substantial liberalization on replacing carbohydrate with fat from them or any health agency.

“Replacement of carbohydrate by healthy fat … has been increasingly recognized as a possible therapeutic strategy in the treatment of diabetes [2] as concerns emerge over the impact of refined carbohydrate foods in increasing postprandial glycemia and reducing HDL cholesterol.”  Reference [2] ((1) in the original) actually “emerged” in 2002 and is ambiguous at best: “Carbohydrate and monounsaturated fat together should provide 60–70% of energy intake.” (It is not my style of humor, but the behavioral therapists call this “shoulding on people.”) The paper admits that the evidence “is based on expert consensus”  and contains what might be called the theme song of the American Diabetes Association:

 “Sucrose and sucrose-containing food do not need to be restricted by people with diabetes based on a concern about aggravating hyperglycemia. However, if sucrose is included in the food/meal plan, it should be substituted for other carbohydrate sources or, if added, be adequately covered with insulin or other glucose-lowering medication.” (my italics)

In fact, one emerging piece of evidence is Jenkins 2008 study comparing a diet high in cereal with a low glycemic index diet [3].  The glycemic index is a measure of the actual effect of dietary glucose on blood glucose.  Pioneered by Jenkins and coworkers, a low-GI diet is based on the same rationale as a low-carbohydrate diet, that glycemic and insulin fluctuations pose a metabolic risk but it emphasizes “the type of carbohydrate,” that is, it is a politically correct form of low-carbohydrate diet and as stated in the 2008 study: “We selected a high–cereal fiber diet treatment for its suggested health benefits for the comparison so that the potential value of carbohydrate foods could be emphasized equally for both high–cereal fiber and low–glycemic index interventions.” (my emphasis) The Conclusion of the 24-week study was: “In patients with type 2 diabetes, 6-month treatment with a low–glycemic index diet resulted in moderately lower HbA1c levels compared with a high–cereal fiber diet.”  The figure below shows the results for HbA1c and weight loss and just looking at the figures, the results are certainly modest enough.

By coincidence, on almost the same day, Eric Westman’s group published a study that compared a low glycemic index diet with a true low carbohydrate diet [4].  The studies were comparable in duration and number of subjects and a direct comparison shows the potential of low carbohydrate diets:

We thought of this first.

Oddly, neither of these papers are cited in the current study by Jenkins, et al.  In fact, according to the paper, the precedents go way back:

“Recently, there has been renewed interest in reducing carbohydrate content in the diet of diabetic patients. In 1994, on the basis of emerging evidence, the American Diabetes Association first suggested the possibility of exchanging dietary carbohydrate for MUFA in dietary recommendations for type 2 diabetes). Although not all studies have shown beneficial effects of MUFAs in diabetes, general interest has persisted, especially in the context of the Mediterranean diet.”

The ADA discovered low carbohydrate diets ? Did my blogpost see it coming, or what? But wait…

 “low carbohydrate intakes have also been achieved on the Atkins diet by increasing animal fats and proteins. This influential dietary pattern is reflectedin the relatively lower pre-study carbohydrate intakes of ~ 45% in the current study rather than the 50–60% once recommended.

The researchers in this area might not feel that 45 % carbohydrate has much to do with the Atkins diet but, in any case, it appears not to have been “influential” enough to actually get the studies supporting it cited.

Again: “Fat intake, especially monounsaturated fatty acid (MUFA), has been liberalized…” but “… the exact sources have not been clearly defined. Therefore, we assessed the effect of mixed nut consumption as a source of vegetable fat on serum lipids and HbA1c in type 2 diabetes.”  Therefore? Nuts?  That’s going to clearly define the type of MUFA?  Nuts have all kinds of nutrients.  How do we know that it is the MUFA in the nuts?  In fact, the real question is whether any benefit would not be due to the reduction in carbohydrate regardless of what it were replaced with. So what was the benefit? The figure above shows the effect on hemoglobin A1C. As described by the authors:

 “The full-nut dose reduced HbA1c by two-thirds of the reduction recognized as clinically meaningful by the U.S. Food and Drug Administration (.0.3% absolute HbA1c units) in the development of antihyperglycemic drugs…”

 In other words, almost meaningful, and

 “the number of participants who achieved an HbA1c concentration of <7% (19 pre-study participants, down to 13 post-study participants) was significantly greater on the nut treatment than on the muffin treatment (20 pre-study participants, remaining at 20 post-study participants…).”

This is some kind of accomplishment but the figure above shows that, in fact, the results were pretty poor.  The statistics do show that the “full nut dose” was significantly different from the half-nut dose or the muffin.  But is this what you want to know?  After all, nobody has an average change in HbA1c.  What most of us want to know is the betting odds. If I down all those nuts, what’s the chance that I’ll get better.  How many of the people in the full-nut study did better than those in the half-nut study (did the authors not know that this would sound funny?).  You can’t tell for sure because this information is buried in the statistics but the overlap of the error bars, highlighted in pink, suggests that not everybody gained anything — in fact, some may have gotten worse.

What kind of benefit is possible in a dietary intervention for people with diabetes?  Well, the studies discussed above from Jenkins himself and from Westman show that, with a low-GI diet, it is possible to obtain an average reduction of about 4 %, more than ten times greater than with nuts and with a real low-carbohydrate diet much greater.  I have added an inset to the Figure from Jenkins with data from a 2005 study by Yancy, et al. [5].  The red line shows the progress of the mean in Yancy’s studied.  If you had diabetes, would you opt for this approach or go for the full-nut dose?

Bibliography

1. Jenkins DJ, Kendall CW, Banach MS, Srichaikul K, Vidgen E, Mitchell S, Parker T, Nishi S, Bashyam B, de Souza R et al: Nuts as a replacement for carbohydrates in the diabetic diet. Diabetes Care 2011, 34(8):1706-1711.

2. Franz MJ, Bantle JP, Beebe CA, Brunzell JD, Chiasson JL, Garg A, Holzmeister LA, Hoogwerf B, Mayer-Davis E, Mooradian AD et al: Evidence-based nutrition principles and recommendations for the treatment and prevention of diabetes and related complications. Diabetes Care 2002, 25(1):148-198.

3. Jenkins DJ, Kendall CW, McKeown-Eyssen G, Josse RG, Silverberg J, Booth GL, Vidgen E, Josse AR, Nguyen TH, Corrigan S et al: Effect of a low-glycemic index or a high-cereal fiber diet on type 2 diabetes: a randomized trial. JAMA 2008, 300(23):2742-2753.

4. Westman EC, Yancy WS, Mavropoulos JC, Marquart M, McDuffie JR: The Effect of a Low-Carbohydrate, Ketogenic Diet Versus a Low-Glycemic Index Diet on Glycemic Control in Type 2 Diabetes Mellitus. Nutr Metab (Lond) 2008, 5(36).

5. Yancy WS, Jr., Foy M, Chalecki AM, Vernon MC, Westman EC: A low-carbohydrate, ketogenic diet to treat type 2 diabetes. Nutr Metab (Lond) 2005, 2:34.

Comments
  1. Joe Lindley says:

    I love this!
    We’re seeing the same thing on TV. The guest “nutritional experts” are starting to say things like, “substitute a high protein breakfast”, and “cut down on your pasta”. The low carb mantra is starting to appear more and more minus the admission (so far) that it’s actually low carb.

    • rdfeinman says:

      It would be good if this really signified some progress but the threat is that studies like Jenkins’s are not low carbohydrate and the “high protein,” “replace carbohydrate” will produce another generation of bad nutritional advice, some of it in the name of restricting carbohydrates. The Office of Research Integrity Conference originally scheduled for August is rescheduled for the Ides of March and I will raise these issues in the Session on the Crisis in Nutrition.

      • Mie says:

        You wrote:

        “The title is crazy enough, following the tradition of getting away from nutrients, that is, well-defined variables, and replacing it with “food,” that is, mixtures of everything”

        Since people do eat food as food, not as individual nutrients (or which one do you consume, milk or saturated fat, calcium etc.?) and since the attempt to reduce the benefits of a food down its individual constituents – e.g. citrus fruits down to antioxidants – has proven quite pointless, what is your basis for arguing the this? Food synergy, anyone?

  2. Marilyn says:

    Wasn’t it also Shakespeare who wrote “Much ado about nothing”? I’d say that phrase pretty much sums up the Jenkins thing.

  3. Gretchen says:

    In the Jenkins paper, shouldn’t >7 be <7? This is a common error.

    • rdfeinman says:

      Yes. It should. Fixed. I read this several times and decided from the convoluted way it was described that it was meant as written but you are right. It must have been a typo. I changed the text to suit.

  4. Leaf Eating Carnivore says:

    BwaaaHaHaHaHa!!!

    *sigh*

    Dr. (?) Jenkins, your glasses are on your head.

    And really – didn’t your mother teach you anything about basic literature searches and attributions? Surely you can do better. Real people are getting hurt out here.

    There’s just so freaking much of this. I feel sad for Science – and for us chill’ns.

  5. Fantastic post, thanks! In case some readers are not fully aware, nuts are a good source arginine, polyphenols, alfa-linoleic acid (PUFA) and vitamin E (gamma-tokoferol), apart from MUFA. The ongoing poor and ignoring referencing, as you describe it, is really disturbing. It will be very interesting to read these posts of yours after some 3-5 years, if and when low carb diets gain more acceptance among the policy makers.

  6. Well, we’ll know when they have completely emerged from their wanderings when they come out with, “Bacon as a Substitute for Carbohydrates in a Diabetic Diet”.

  7. “Given forty years of studies showing the benefits of low carbohydrate diets and forty years of unrestrained attacks on the method, it will be interesting to see how Jenkins shows that it is actually the nutritional establishment that invented them.”
    I’m going to read the Yancy study today, but would like maybe at least one more study showing the benefits of a low carb diet, either in terms of weight loss or diabetes treatment. I could start googling on my own, but I’m so new to reading research papers that I’m not really great at discerning the crappy studies from the more well-conducted ones.

  8. George Henderson says:

    Diabetes research in my hometown of Dunedin focusses on Hazlenuts. Here is the researcher’s public take on lipids and nuts: http://www.diabetes.org.nz/food_and_nutrition/healthy_food_choices__and__tips/food/nuts

    and the relevant pubmed entry: http://www.ncbi.nlm.nih.gov/pubmed/21272401

  9. George Henderson says:

    Interestingly, the diabetes website is well out of date; here’s the clinical nut study
    http://www.ncbi.nlm.nih.gov/pubmed/20877394

    SUBJECTS/METHODS: In a randomized crossover study with three phases, 48 mildly hypercholesterolemic participants were asked to consume 30 g of ground, sliced or whole hazelnuts for 4 weeks. Body weight, plasma total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), triacylglycerol (TAG), apolipoprotein (apo) A1, apo B100 and α-tocopherol were measured at baseline and at the end of each dietary phase.

    RESULTS: There were no significant differences in any outcome variable between the different forms of nuts (all P ≥ 0.159). However, compared with baseline, mean values at the end of each hazelnut intervention were significantly higher for HDL-C (P = 0.023) and α-tocopherol (P = 0.005), and significantly lower for TC (P < 0.001), LDL-C (P < 0.001), TC:HDL-C ratio (P <0 .001), apo B100 (P = 0.002) and apo B100:apo A1 ratio (P < 0.001), with no significant difference in body weight (P = 0.813).

    CONCLUSIONS: The ingestion of three different forms of hazelnuts equally improved the lipoprotein profile and α-tocopherol concentrations in mildly hypercholesterolemic individuals. Hazelnuts can therefore be incorporated into the usual diet as a means of reducing cardiovascular disease risk.

    • rdfeinman says:

      The difference between statistically significant and clinically significant, or anything that you can use at all, is at the heart of the problem in the medical literature.

      • Mie says:

        Yes, one should bear this in mind also when advocating carb restriction as the “one cure that fits all” …

      • rdfeinman says:

        The answer to this will be the subject of my next post tonight.

      • rdfeinman says:

        In the end, I decided the answer to Mie’s comment didn’t make a very interesting post but here is the reply:

        I don’t know what “this” is that we should bear in mind and I assume that the phrase “one cure that fits all” is in exclamatory quotation marks rather than something anybody said. Most people in this field feel that dietary carbohydrate restriction derives from the fundamental biochemistry of the glucose-insulin axis and, on that basis, should be “a candidate to be the preferred dietary strategy for cardiovascular health beyond weight regulation (1),” and “the ‘default’ diet, the one to try first, in diseases of carbohydrate intolerance or insulin resistance.” If it doesn’t work, or if you don’t like it, or if you prefer to take drugs, you can try the next thing. It has always been offered as an alternative. The important fact, though, is that no experimental result has indicated anything better than low-carb. Low-carbohydrate diets out-perform anything that they are compared to, for however long that the are tried. And for the standard diet, the USDA diet, the ADA diet (they say they don’t have one but practicing endocrinologist think that they are using the ADA diet) it has never been tested, never. The long-term trials, like the Women’s Health Initiative fail miserably. But…
        …the difference between researchers in carbohydrate restriction and the lipophobes is that we have a null hypothesis. Show us that low-carb isn’t as good as something else will try to push for more research on that thing. All we ask for is that “Based on metabolic principles and the experimental evidence to date, we believe there is a strong case for conducting major prospective trial of carbohydrate restriction, compared to a fat restriction control group, on cardiovascular endpoints (1)” but that means a test in which we get together with Pennington, for example, and agree on what the test is, what the outcome is and what it would mean. I have suggested this to several critics of low-carbohydrate diets and they politely refuse to answer. They prefer, like Harvard School of Public Health, to define what they want to call “low-carbohydrate” and then proceed to shoot it down. And…

        Ravnskov is one of my friends. What I told Ravnskov is that “when I read your book [Cholesterol Myths], I thought ‘it can’t be this bad. I will have to go back and read all the original studies.’ Well, I did and it is this bad. I couldn’t believe it.” The real point is not that some of this is open to interpretation but, rather, given the absolute condemnations of fat or saturated fat, or whatever — the American Heart Association quietly removed proscription against total fat in 2001 without telling anybody (“Who knows not he is dead! Who knows he is?”) — Given this absolute condemnation there should not have been even a single failure, not one. We should not have had a scandal like the Framingham study (the results showing no effect of dietary fat, saturated fat or cholesterol on heart disease were quietly buried until a statistician got them released 8 years later, a phenomenon that probably contributed to the establishment of the need to register a clinical trial so that you couldn’t bury negative results). We should not have had the failure of the Oslo study or MR FIT. We should not have even one of these. And having them, we should not have funded the $ 400 million dollar failure of the Women’s Health Initiative. No cure fits all, but maybe we need to investigate an alternative.

      • Marilyn says:

        Your reply to Mie’s post was most interesting! Thank you.

  10. [...] taking place in front of our eyes and I have to thank Dr. Richard Feinman for giving it a name, Slouching Toward Low-Carb.  What he’s referring to is the current reaction to the success of the low carb diets being [...]

  11. @Michael Libbie: Dr. Andreas Eenfeldt lists the studies showing better weight loss with low-carb eating: http://www.dietdoctor.com/weight-loss-time-to-stop-denying-the-science

    My sense about David Jenkins lately is that he’s a vegetarian diet proponent.

    -Steve

    • rdfeinman says:

      I tried to make my comments directed at the study, which has enough flaws, rather than Dr. Jenkins although I did discuss Westman’s study with him on a “meet the author” program following his paper on cereal and GI so he is at least aware of what’s out there.

  12. Marilyn says:

    “Now is the discount of our winter tents.”

    Love it!

  13. Wait until they “discover” it also cures cardio-vascular disease!
    Regards,
    Stan (Heretic)

  14. Marilyn says:

    @Mike Ellwood: Your pa-in law was a clever man! I just learned a second meaning of the word scoff.

    From the Free Online Dictionary:
    scoff2 Informal chiefly Brit
    vb – to eat (food) fast and greedily; devour

    Great play on words.

  15. George Henderson says:

    Interesting pseudo-post in reply. The cool thing about diet studies is you’re not comparing them with placebo; you’re going toe-to-toe with the competition.
    The use of placebos, while possibly the only meaningful alternative for most trials, carries unfortunate connotations of “psychological effects”. For psychological, read “inexplicable” or “magical”.
    Placebos ought to control for clinical factors present in both arms like personal attention, advice, trepedation, the walk to the clinic, the pheremones in the nurse’s sweat or the allergens in their deodorant, even the motivating effect of the fee paid to subjects.
    Might be science’s way of paying tribute to magic.

  16. majkinetor says:

    On semi-related note, I wonder, Mr Feinman, what do you really think about nuts ? Lots of studies showed benefit for various maladies and they are very rich in minerals, especially in Mg which is very important for insulin resistance (maybe even a reason why diabetics did better on this study)

    Thanks for the post, and everybody for great links in the comments.

    • rdfeinman says:

      Nuts are a food, that is, they have numerous factors related to taste, effects on appetite, macro- and micronutrient composition and therefore I don’t think anything about nuts unless you can have a specific context. The emphasis on “food rather than nutrients,” in my view, is a way for the nutritional establishment, having seen the low-fat paradigm collapse, to muddy the waters and say that no macronutrient is important and thereby send us back to the pre-scientific state of nutrition that gives the field such a bad name. Mineral deficiency is not the major problem for Americans. Without questioning the points you have made on this which I can’t comment on, our major problem is that we are over-nourished. For me, nuts are very habit-forming, more so since they are usually roasted and salted, and I personally tend to over-consume them and they are quite calorific and not truly low in carbohydrate. For people like Walter Willett who are of higher moral character, they may be a way to satisfy hunger with a “handful.”

      On the other hand, the Paleo people are the other group who emphasize food but, oddly, it doesn’t have the same moralistic, Luddite overtone that it does for the lipophobes, and getting away from food based on agriculture and the food that is hunted and gathered leads to an interest in micro- and macronutrients but the biochemistry still has to come first. So, nuts are food and are not a truly part of nutritional biochemistry.

      On a constructive note, whereas, I don’t normally like nuts in food (besides deserts), I discovered that roasted walnuts (and probably other nuts as well) are a very good addition to spaghetti squash. (Cut squash in half long-way, microwave both halves ro 25-28 min depending on size, add butter and walnuts and depending on how much salt on the nuts, additional salt).

    • rdfeinman says:

      @ majkinetor
      I think I was a bit too crabby. From a scientific standpoint, if studies on nuts lead you to ask about minerals, then that’s valuable but in the original post, it was clear that Jenkins’s intent was specifically to not face the value in real carbohydrate restriction. Using a mixture of nuts, in fact, guarantees that the results are uninterpretable even as he says that he thought of carbohydrate restriction first.

  17. majkinetor says:

    The point is, magnesium deficiency is actually epidemic. You can easily find that out but here is one review:

    From all we know, diabetics improved because of Mg in nuts.

    The book New Perspectives in Magnesium Research {2006}, http://goo.gl/5iBxJ

    For many years magnesium loss in diabetes patients was well known. Type 2 diabetes patients are 25% to 38% hypomagnesemic,84 and have associated with low serum magnesium and low magnesium intake. A low magnesium concentration in nondiabetic subjects was associated with relative insulin resistance, glucose intolerance, and hyperinsulinemia. A magne-sium-supplemented diet did not reverse diabetes once already established in rats. An increased dietary magnesium intake in male obese Zucker diabetic fatty rats prevents deterioration of glucose tolerance, thus delaying the devel-opment of spontaneous NIDDM.

    • Dana says:

      I have heard that excess carbohydrate consumption causes magnesium dumping. It could be these diabetics will see even greater benefit eating the nuts but totally dumping grains and other starches, limiting their carb intake to much less starchy fare and ditching sugar entirely. Sound familiar? :)

  18. majkinetor says:

    Here is the review I accidently omitted:

    The multifaceted and widespread pathology of magnesium deficiency

    Few others:
    http://www.amjmed.com/article/0002-9343(87)90129-X/abstract
    http://www.clinchem.org/content/33/4/518.abstract

    And from the chapter “Experimental Data on Chronic Magnesium Deficiency” from the book mentioned above:
    “According to data published to date, the amounts of Mg. consumed are below 80% of the recommended intake in approximately 20% of the population.2–4 In addition, hypomagnesemia (Mg < 0.75 mmol/L) has been found in substantial proportions of the adult population in Europe: 12.6% in Switzerland,5 21% in Austria,6 and 14.5% in Germany."

    This info is for healthy people. Specific diseases further diminish Mg as seen with diabetics.

    So given that nuts are among highest sources of Mg, this study may very well reflect that fact, or at least we have to acknowledge very important confounding variable.

    • rdfeinman says:

      Thanks. I am afraid that I don’t know the story on magnesium although many discuss it. If you say that you want to eat nuts as a way of increasing magnesium that’s fine as long as you remember that it has other things. This is different than Jenkins where, as you say, Mg might be a confounder.

  19. bsc says:

    I thought you might be interested, the Feb Issue of Diabetes Care contains an article “Macronutrients, Food Groups, and Eating Patterns in the Management of Diabetes
    A systematic review of the literature, 2010.” It appears to be reasonably objective on low carb, giving low carb high marks for glycemic control and lipids and finding almost nothing beneficial in high carb low fat. Although it still contains a number of issues in their review that you have noted before, like confusion definitions of low carb, it does appear to be another crack in the facade.

    I hope in my heart that Hope Warshaw will read it, understand it and stand with us facing a bright, bright future (but then again, I have always been an optimist).

    • rdfeinman says:

      You are an optimist. “Reasonably objective” is, of course, the half-full glass. The article is reasonably biased (whatever that might mean). Hope Warshaw is nobody notwithstanding the harm she probably does to her patients. The granting agencies may read it, understand it, and I’m afraid they will simply continue to fund the authors of this paper and their friends and we will slouch toward a future of uncertain brightness.

  20. Leona M Peterson says:

    Now tell me, “Will the dietitians catch up?”
    “Will they please create a big enough splash with their catch-up that we can point to it when we go to a dietitian who says ‘you must have 50% carbs’?

  21. Ketogenesis, Chapter 16, Verse 9:
    “Rejoice, for the tent of low-carb is with mankind, and normoglycemia resides with them. Anyone conquering carbohydrate will inherit these things. Outside are the carb-ridden dogs and those who are disgusting in their starchy filth, and all those who are liking and carrying on a carb-fuelled lie.”

    Monty Beantipper

  22. I’m a dietitian and have been recommending a lower carb intake for over 10 years to people with IR/MetSyn. Some years ago I was reported to my employer as not following ‘best practice’ and underwent a review process of my methods, which determined that my dietary advice was evidence based and I could continue. Even though GPs are supportive because of the results they see, clients are happy to be able to get results they want etc, the issue is coming up again and it’s possible my contract won’t be renewed as a result. Maybe there are other dietitians who understand the need for change but feel they can’t speak out because their jobs could be in jeopardy.

    • rdfeinman says:

      I wish this were the first time I’ve seen such a thing. There are certainly other dietitians who feel as you do but are afraid to speak out. We don’t as yet have a viable political group that can do something beyond bringing out the stories. Can I quote you on this?

  23. […] Slouching toward Low-Carb. “We Thought of This First.” | Richard … […]

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