Richard David Feinman

The headline read “Vascular effects of a low-carbohydrate high-protein diet.”   The article, as anticipated, was trying to trash low carb diets. This is not uncommon. Those of us who work in the field are used to it.  Low carbohydrate diets are the thing that doctors and nutritionists love to hate.  Every junior faculty in a medicine department feels obligated to write a review showing how bad such diets are, frequently by saying that they don’t conform to the recommendations of the USDA, an example of what was the original meaning of “begging the question”, namely assuming the question in deducing the answer, that is: The USDA guidelines defines healthy diets. The Atkins diet says that the USDA guidelines are bad.  The Atkins diet does not conform to the USDA guidelines. The Atkins diet is unhealthy. QED.

The paper in question, however, turned out to be especially infuriating, claiming that a low-carbohydrate  diet will cause the build-up of plaque that is characterized as atherosclerosis but the experiment was absurd.   It reminded me of the kind of articles that William F. Buckley, Jr. used to write, the kind that made you wonder: does he really not see how illogical this stuff is.  By coincidence the low carb-atherosclerosis paper appeared about the same time as Gary Wills’s portrait of Buckley appeared in the Atlantic.  It was a very sympathetic review although Wills was not blind to Buckley’s faults.  I saw in Buckley’s personality this same kind of thing that was in the atherosclerosis paper. I understood pleasure in being infuriating but you can always do that while trying to get it right. I suddenly had some perspective on it all. I could see a mindset where the truth was not the main reinforcer as we say in behavioral psychology.  Buckley was simply motivated by something else. So first, I’ll tell you about the low carbohydrate diet paper.

The thing that drives the nutritional establishment crazy is not that low carbohydrate are effective for weight loss. Everybody knows that. The earliest writers on food, Brillat-Savarin for example, made the observation that the principles of fattening your pig for market by feeding her grains applied to humans as well. What gets people nuts is that the cardiovascular risk that was supposed to follow from the increase in fat did not materialize.  In fact, when actually studied, low carbohydrate diets reduced cardiovascular risk, dramatically lowering triglycerides (fat in the blood), increasing HDL (the so-called “good cholesterol”)  and improving other risk factors.  In fact, the paper by Foo, et al. in PNAS admitted “randomized trials suggest low-carbohydrate diets may accelerate weight loss with surprisingly little negative effect on serum markers of cardiac risk such as cholesterol,” but that didn’t stop the authors who were able to come up with new warnings about atherosclerosis from low-carbohydrate diets.

It wasn’t people, that developed atherosclerosis. It turns out that the low-carbohydrate diet was administered to mice.  Now this could be news since mice are not particularly susceptible to atherosclerosis possibly because they have high HDL (again, the “good cholesterol”). But this was not your ordinary mouse.  This was a mouse that was genetically engineered to be susceptible to cardiovascular disease.  This was an apoE-knockout mouse, a mouse  from which the genes for apolipoprotein E had been deleted ((ApoE-/-).  Apolipoprotein E (apoE) is one of the protein components of the cholesterol and fat-carrying particles known as lipoproteins (LP) that circulate in the blood. It is required for efficient clearance of some of these particles. One wit on the internet suggested that giving an apoE knock-out mouse atherosclerosis was the behavioral equivalent of teaching a cat to go to sleep.  Did the authors not know this was nonsense?  Did they really believe that a low carbohydrate diet had more biological importance than a difference in species and a mutation that predisposed to atherosclerosis? What were they thinking? At stake is the corruption of science and the the corruption of medicine. The coincidental appearance of Wills’s picture of Buckley was helpful:

“Bill was considered an elitist because he loved to use big words. But he did it not from hauteur but from impishness. This was part of his playfulness. He liked to play games in general, and word games were especially appealing to him. He used the big words for their own sake, even when he was not secure in their meaning. One of his most famous usages poisoned the general currency, especially among young conservatives trying to imitate him. They took oxymoron in the sense he gave it, though that was the opposite of its true meaning. He thought it was a fancier word for “contradiction,” so young imitators would say that “an intelligent liberal” was an oxymoron. But the Greek word means “something that is surprisingly true, a paradox,” as in a shrewd dumbness.”

That was it.  The Beth Israel doctors were just having fun.  But cardiology is a serious business and this couldn’t be a pattern but this was a context where getting it right counted.  Atkins was a threat and the truth wasn’t really part of the game.  Wills said that  Buckley “never considered himself an intellectual” as he was always a risk taker.  His debate-team style was not really about the truth.  He certainly gave the impression that he thought he was an intellectual but it turns out that, in the end, he was just screwing around.

So what do Dr. Foo and Dr. Rosenzweig actually believe?  The press release from Beth Israel said that Rosenzweig went off his Atkins diet because his resident Dr. Foo kvetched at him in the hospital cafeteria.  You have to wonder why he went on the diet in the first place.  A recent survey showed that physicians were more likely to recommend low fat diets to their patients while using low carbohydrate diets themselves, although maybe it is easy to talk them out of it. A survey of physicians’ knowledge was also informative. In fact most physicians did not know that low-fat diets increased triglycerides or that carbohydrates are most likely to increase them.  The exception was cardiologists who were aware of these facts.  So maybe it wasn’t surprising that Rosenzweig would have been on the low carbohydrate diet.  That he went off it does suggest that he is as cavalier with his own health as with that of his patients and the readers of PNAS.  In the end, though, this does real harm.  At least for people with diabetes, control of carbohydrates can be life-saving. Buckley at least functioned in the area of journalistic politics whose standards are ambiguous at best.  In the comparison to the Beth Israel doctors, William F. Buckley comes off as rather likable, surely an oxymoron.