Sep 2010 09
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My articles sometimes upset people, because I write things they don’t want to hear. I’m talking specifically about people who’ve come to cherish a certain dietary paradigm, and don’t like hearing information – no matter how scientifically valid – that conflicts with their glowing opinion of that paradigm. In my experience, the worst such culprits are unquestionably those of the low-carb persuasion.

Too bad for them. My concern when writing about nutrition, health, and training is to accurately relay the plain facts. If these facts are unsettling and discomforting to certain readers then that’s their problem, not mine. I refuse to evade or bend the truth just to appease those who’ve come to cherish certain beliefs – the onus is on them to adopt a more impartial and rational outlook towards health science.

I’m also not in the business of de-programming dietary fundamentalists, for I’ve got far better things to do with my time. As such, I refuse to get into ongoing arguments with email correspondents, as past experience has shown when most people are committed to a certain viewpoint there’s no way they’ll admit they are wrong, even when presented with conclusive scientific evidence proving as much. If you write to me to protest at something I’ve written but cannot provide anything in the way of valid scientific data to back your assertions, I’m going to promptly request you either provide such data or stop wasting my time. And that’s if you’ve caught in me in an especially charitable mood; there’s also a good chance I’ll scan your email, roll my eyes, hit the delete button and get right back to more productive endeavours.

Sorry folks, but my life doesn’t revolve around sitting at my computer and arguing with dogmatic trolls all day. For you folks that don’t have friends/family/girlfriends/hobbies/training/etc to keep you occupied in your (apparently abundant) spare time, hey, that’s cool (actually, it’s sad, but anyway…), just show some consideration for those of us who actually do have worthwhile things to do.

Anyway, this week’s mail includes correspondence from a couple of readers who took exception to my recent post about the poor health and longevity displayed by famous diet gurus. One low-carbing reader appears upset I didn’t deliberately omit the late Dr. Robert Atkins from the discussion, while the other reader…well, I’m not sure what the heck the other reader’s point is; her irrational and incoherent rambling leads me to assume she is just another irrational, incoherent, and rambling low-carbohydrate shill.

Of course, every now and then I come across that rare breed – the person who is fond of a certain viewpoint but also open to acknowledging and examining the opposite side of the story. I’ve had to discard many cherished beliefs and theories over the years when the science and empirical evidence dictated, and it’s always a breath of fresh air to meet others prepared to do the same. True science after all, is an endeavour dedicated to the continued expansion of human knowledge, not the stagnant and dogged defence of what we have become comfortable believing.

“D” is a scientist with research currently in press, who recently wrote applauding my debunking of a certain duplicitous low-carb diet ‘guru’. While we share a dislike of dubious diet ‘doctors’, we don’t necessarily agree on everything. But D, as you will see, is open-minded enough to at least consider new evidence – as any good scientist should. I’ve reprinted the latter portion of the correspondence below; the initial correspondence has been deliberately omitted as it contains details about D’s research, and he may not wish to have his identity plastered all over the Internet whilst in the process of having a paper published.

Low-Carb Diets: Long Term Effects on Compliance, Weight Loss & Mood

Hi Anthony,

You stated somewhere that rodents are different in some important ways metabolically from people. What’s the evidence for that? Does that difference negate relating diet study findings in rodents to people?

The attached paper from ’64 suggests that fat is metabolized differently from carbs in relation to caloric availability in mice. If carbs are metabolized differently than fat, there may be consequences as to the differential effects of high carbs vs low carbs even in isocaloric diets on fat storage. Still, the effect is probably small and perhaps not worth pursuing.

This brings me to another point – I don’t think research on isocaloric diets is of much value.

In real life people feed at the trough of calorie dense cheap foods, such as provided by McDonald’s, and they gulp down massive calories from carbs, high fructose corn syrup and hydrogenated fats even before they’ve had their first burp. Further, the typical high carb diet leaves one ready to return to the trough only a few hours later to fill one’s belly again with excessive carb and fat calories. So while I see your point about how people who exercise intensely can burn 1000’s of carb calories and not gain weight, the average couch potato guy is not the one in those studies who will burn off massive calories.

My point is that even if a metabolic difference is small or nonexistent between diets, a real life  advantage of a high fat/low carb diet is the prolonged sense of satiety one feels, which ultimately can result in overall reduced caloric input/day, which is why low carb diets are good for wt loss in free-feeding folks who are willing to adhere to the diet (see attached papers). Of course it’s tough to adhere to a low carb diet because carbs taste so damn good. Still, when you can eat all of the meat you want it makes it easier to turn down the fries. I also don’t like any of the studies that relate low carb diets to depression or low energy. They’re all flawed and just lab artifacts.

[Email also included commentary critical of statins, which has been omitted so as not to identify author].



Anthony replies:

Hi D,

there are numerous important differences between rodents and humans, including:

  1. Their lifespans are much shorter, meaning the time frame for development of physiological changes will be shortened and intensified.
  2. Rodents have a glucose-to-fat conversion rate up to ten times greater than that seen in humans, see:Di Girolamo M, D Rudman D. Species differences in glucose metabolism and insulin responsiveness of adipose tissue. American Journal of Physiology, 1966; 210: 721-727.Jules Hirsch J, Goldrick RB. Serial Studies on the Metabolism of Human Adipose Tissue. I. Lipogenesis and Free Fatty Acid Uptake and Release in Small Aspirated Samples of Subcutaneous Fat. Journal of Clinical Investigation, 1964; 43 (9): 1776-1792.).
  3. Rodents did not evolve on the same omnivorous diet as humans. Feeding animals diets they were not designed to eat, or macronutrient ratios seldom consumed in the wild, will often produce results starkly divergent to those seen in animals who did evolve to eat that diet.

The undeniable reality is that rodent studies do return results that are simply never seen in humans.

The increase in metabolic rate in the Kennedy et al mice that MAD devotees are so find of citing is a perfect example. This increase is never seen in humans, nor is the greater weight loss (in fact, it’s often not even seen in other strains of mice!). Is this study relevant to humans? Hardly.

Another shining example of the often total irrelevance of rodent studies is the work with conjugated linoleic acid (CLA). When researchers began giving CLA to rodents years ago, the little critters got buffed and shredded – I’ve seen the photos of the dissected carcasses of CLA and control animals and the difference is like night and day. Based upon these early rodent studies, CLA sales took off as supplement companies promised similar results for humans.

And guess what? No human has ever gotten steroid-like effects from popping CLA. In fact, half the human trials with CLA show no difference in fat loss or muscle gain, the others show miniscule differences that hardly justify the cost – you’d probably burn more fat walking down to the health food store to buy the stuff than from actually taking it.

“You ain’t nothin’ but a pussy!” When rodents are given CLA, they lose fat, gain muscle and strength, and start taunting sharp-clawed animals 100 times their size. This never happens in humans.

The value of rodent studies is that they offer a quick and cost effective way for researchers to make preliminary explorations of a hypothesis. But at the end of the day, rodents are not humans, they are rodents, and to deny the stark differences between the two species is absurd. Before a finding can be extrapolated to humans, it must be confirmed in studies with…humans. Again, I find it somewhat disconcerting that I have to keep pointing out that results obtained in a furry four legged rodent weighing 40 grams may not be very relevant to what occurs in a 75 kilogram, long lived, two-legged creature known as Homo sapiens.

“This brings me to another point – I don’t think research on isocaloric diets is of much value.”

C’mon D, you’re too smart to be rehashing the same kind of disingenuous arguments used by evasive low-carbers.

How on Earth are we to know whether the effects of a dietary intervention purported to cause greater weight loss are due to a “metabolic advantage” or to other factors such as satiety, palatability, availability, etc?

Unless we remove all the confounding factors, we can’t know.

Ward studies involving isocaloric feeding are the only way to determine this. Thanks to ward studies, we know there is no “metabolic advantage” and that any greater weight loss is caused by lowered caloric intake, be it intentional or unintentional.

As for your comments about overfed Western slobs inhaling sugar- and fat-laden slop to burping point, I’m afraid you’re preaching to the (long ago) converted. I’m well aware that the refined Western garbage diet typically leads to overconsumption…crikey, I’ve written about this more times than I care to remember. And how do we know it leads to overconsumption and that it’s not a “metabolic disadvantage” at work? Because isocaloric studies show no difference in weight loss at different macro ratios.

And while low-carbers are fond of spitting back with the retort that if low-carb diets cause greater satiety, and hence greater weight loss, then who cares what ward studies show? If everyone loses weight on a low-carb diet, everyone’s happy, right?


The undeniable reality is that a lot of people do not lose weight on low-carb diets, as both real life and clinical trials show. Low-carb diets are no more a panacea for weight loss than any other overblown diet fad. Heck, even Atkins, Eades, Agatston et al have grudgingly admitted that there are people who have failed to lose weight on their diets. Why? Because people believe this MAD bollocks that you can eat all you want but still lose weight so long as you keep your carbs low. It’s the equally moronic corollary of the old low-fat belief that you could eat all you want so long as you ate low-fat foods.

You know, there’s a reason the low-carb fad is dying out…

So what does one say to all the folks who fail to lose weight on a low-carb diet? “Screw you, you don’t fit our hypothesis, so you can just bugger off and we’ll pretend you don’t exist”? Don’t these people deserve to know the truth? Don’t they deserve to know that calories are the final arbiter of weight loss, instead of being fed this fantasy-based MAD nonsense that leads them to frustration and failure? Don’t they deserve to know that the only reason anyone has ever lost weight on a low-carb diet is because they were able to maintain a calorie deficit long enough for weight loss to occur? And that this calorie deficit came about because these diets caused greater satiety. Which means they can follow whatever diet they prefer so long as they maintain a calorie deficit!

And what about the fact that the longest running free-living trials show no difference in weight loss between low-carb and higher carb diets over the longer term? Why is this? Again, because people on the low-carb diets failed to maintain their calorie deficit over the long term, and hence any weight loss advantage disappeared. Again, thanks to ward studies, we know the true mechanism at work.

Do you really want to go back to the dietary Dark Ages where low-carb hucksters were able to run amok claiming a metabolic advantage that did not exist, and perversely profit from doing so, while masses of people were misled into following ineffective strategies?

You applaud my disrobing of Eades and my destruction of his unscientific nonsense – well, it is ward studies using isocaloric feeding that allowed me to do this, which of course is why the disingenuous one has gone to such extreme lengths to try and discredit ward studies, and when that failed, to creatively reinterpret the ones he believed could be made to look supportive.

As for the connection between ketogenic low-carb diets and depression, I’m sorry, but you can’t just dismiss these results with a throwaway line about the results being “lab artifacts”. You could use that line with any laboratory research you don’t agree with! The fact remains that randomized clinical studies with real live humans – not rodents – using standardized psychological tests have shown poorer outcomes in the ketogenic diet groups. And one can’t claim this is the skewed work of researchers with an anti-low-carb bias, because no such link has been established with non-ketogenic low-carb diets.

Given what we know about ketogenic diets and serotonin and brain glucose metabolism, not to mention hypoglycemia and mood state, that there would be marked differences between the two groups is hardly a radical proposition. And crikey, if you’d ever dealt with low-carbers to the extent that I have, you’d certainly have no problem believing these diets can have negative effects on one’s mood and cognitive state! To say that the low-carb arena is populated by a disproportionately high number of misguided fanatics who act a little strange is something of an understatement…

Of course, I agree totally with your anti-statin stance – they are indeed a garbage drug whose effects have been way overblown. Their “miracle” status comes not from what they do to prevent heart disease and increase longevity, as these effects are modest at best and often non-existent. Their ability to become the number one-selling drug class in the world and rake in tens of billions of dollars each year for their manufacturers despite limited benefits and a plethora of toxic side effects truly is a miracle.

Some more recent statin papers you may be interested in are attached, just in case you’ve not seen them, also my 2005 JPANDS paper LDL Cholesterol: “Bad” Cholesterol or Bad Science? and reply.



D replies:

Anthony – Thanks for the papers and comments. Good reminder to keep in mind rodent – human differences. Especially thanks for the statin meta-analysis. I’ve been lecturing lately on cholesterol, statins, etc., to the public and docs, with very receptive audiences, so these papers will help a lot. Unfortunately the FDA has approved statins for treatment of children with elevated cholesterol and as a result of JUPITER, for adults with normal cholesterol – bummer.

Great response to the cholesterol sheep docs that responded to your LDL/Bad science paper.

As to your crikey stuff:

Your comments, as always, are a rigorous assessment of the science. However, my feeling is that isocaloric science is good to test hypotheses, and that’s fine. But science sometimes doesn’t mimic real life, which is why I don’t like any study that imposes calorie restriction on its subjects, because it’s an artificial world the science creates. So it doesn’t relate to real world food consumption.

I like the studies I sent to you that involved obese adults and adolescents who were allowed to free-feed on a low carb diet, and those who chose to remain in the study lost weight and their blood lipids improved. That to me is a better study to relate to real life diets than the isocaloric work.

In general, diets fail because it’s unnatural to maintain a calorie deficit. There are powerful evolutionary forces demanding that we not restrict our caloric intake. I believe the primary reason why the low carb diet is easier to maintain is because of the satiety factor. Still, it requires a lot of self-control and motivation, two factors that the majority of people don’t have.

I guess some low carb advocates say you can engorge yourself with meat and lose weight, but that’s just not good science. So those folks aren’t scientists and their opinion isn’t of much value.

Finally, I’m not impressed with the supposed adverse mood and energy deficit in people on keto diets. A real test of the adverse mood/energy effect of a keto diet would have 3 components:

1 – No caloric restriction

2 – People are free to choose to be on a low carb diet, rather than have it imposed on them.

3 – After a sufficient period of adaptation and adherence to the diet (at least 6 months), I would expect that the low carb group should have lost weight, especially if they started out obese.

I’d be amazed to find a study with a group following 1-3 criteria above demonstrating a strong adverse mood effect and energy deficit.

As I said before, I’d be miserable if calorie restriction would be imposed on me, but I’m choosing to have a calorie deficit (which is damn hard) and a low carb (not ketogenic) diet to lose weight. I also feel no adverse mood effects and my energy is better than ever.  The great enthusiasm I see from other low carb folks suggests to me that when one has control over one’s diet, and weight loss occurs, mood and energy are elevated rather than depressed.


Anthony replies:

Hi D,

“Unfortunately the FDA has approved statins for treatment of children with elevated cholesterol and as a result of JUPITER, for adults with normal cholesterol – bummer.”

In a sane world, this would be considered criminal.

“However, my feeling is that isocaloric science is good to test hypotheses, and that’s fine. But science sometimes doesn’t mimic real life, which is why I don’t like any study that imposes calorie restriction on its subjects, because it’s an artificial world the science creates. So it doesn’t relate to real world food consumption.”

D, you’ve completely ignored my comments from the previous email. No-one’s saying that everyone lives in a metabolic ward where they are fed isocaloric diets. Once again, the value of ward studies involving isocaloric diets is that they conclusively show NO difference in weight loss as a result of macronutrient manipulation. So when people adopt a low-carb or any other “sure-fire” diet in “real life” and don’t lose weight, we know why. Instead of feeling like weight loss failures, we can say to them, “look, it’s not that you’re a ‘failure’ destined to remain forever fat, it’s just that you were suckered in by this MAD hogwash. Tightly controlled ward studies show no difference in weight loss among different diets of equal calorie content. These studies show the real key to losing weight is establishing a calorie deficit. You need to find a diet and exercise regimen that you can live with that will allow you to maintain a deficit and reach your weight loss and body composition goals”.

And when people do lose weight on a particular diet regimen, we also know why – because they lowered their caloric intake and not because of some fanciful and utterly false “metabolic advantage”. You need to decide whether you are happy for the MAD crowd to spout their nonsense and deceive people with impunity, or whether you prefer to see them called out on their BS. Once again, it is primarily ward trials (and the vast research on dietary under-reporting) that allows us to do this.

“I believe the primary reason why the low carb diet is easier to maintain is because of the satiety factor.”

There is a cherished assumption in the low-carb world that it’s easier to stick to a low-carb diet. Like most assumptions made by this crowd, it is false. Regardless of its short-term effect on satiety, the overwhelming evidence indicates that, over the longer term, low-carb dieting – or more specifically, weight loss on a low-carb diet – is not easier to maintain:

  • 1 year study showing greater weight loss at 3 and 6 months, but no significant difference in weight loss at 12 months, similar attrition rates:Foster GD, et al. A Randomized Trial of a Low-Carbohydrate Diet for Obesity. New England Journal of Medicine, 2003; 348 (21): 2082-2090.
  • 1 year study showing no weight loss advantage in T2D subjects, similar attrition rates:Davis NJ, et al. Comparative Study of the Effects of a 1-Year Dietary Intervention of a Low-Carbohydrate Diet Versus a Low-Fat Diet on Weight and Glycemic Control in Type 2 Diabetes. Diabetes Care, 2009; 32: 1147–1152.
  • 1 year study showing no significant difference in weight loss, similar attrition rates:Stern L, et al. The Effects of Low-Carbohydrate versus Conventional Weight Loss Diets in Severely Obese Adults: One-Year Follow-up of a Randomized Trial. Annals of Internal Medicine, 2004; 140: 778-785.
  • Comparison of Ornish, Weight Watchers, Zone, and Atkins diets shows similar weight loss and attrition rates (weight loss higher in Ornish and Zone, but not statistically significant; attrition higher in Ornish and Atkins, not statistically significant – high correlation between degree of weight loss and compliance to diet regardless of assigned regimen):Dansinger ML, et al. Comparison of the Atkins, Ornish, Weight Watchers, and Zone Diets for Weight Loss and Heart Disease Risk Reduction. JAMA, 2005; 293: 43-53.
  • Similar weight loss in low-carb and low-fat groups at 12 months, but worse mood outcomes and concerns about poorer vascular plasticity in former:Brinkworth GD, et al. Long-term effects of a very low-carbohydrate diet and a low-fat diet on mood and cognitive function. Archives of Internal Medicine, 2009 Nov 9; 169 (20): 1873-1880.Wycherley TP, et al. Long-term effects of weight loss with a very low carbohydrate and low fat diet on vascular function in overweight and obese patients. Journal of Internal Medicine, 2010 May; 267 (5): 452-461.
  • Greater compliance at 6-months in low-carb group, but worse dropout rate at 2 years. Compliance at 24 months was 90% in low-fat, 85% in Mediterranean, and 78% in low-carbohydrate diet (p = .042 between groups).Greenberg I, et al. Adherence and success in long-term weight loss diets: the dietary intervention randomized controlled trial (DIRECT). Journal of the American College of Nutrition, 2009; 28: 159-168.
  • No differences in reported weight regain in low-carb dieters vs other National Weight Control Registry members:Phelan S, et al. Three-Year Weight Change in Successful Weight Losers Who Lost Weight on a Low-Carbohydrate Diet. Obesity, 2007; 15: 2470–2477.
  • Vetter et al found greater weight loss at 6-months in low-carb group, but difference at 3 years had disappeared; At 36 months, persons in the low-carbohydrate group weighed a mean 2.2 kg less than at baseline compared with 4.3 kg less in the low-fat group, difference not statistically significant.Vetter ML, et al. Long-term effects of low-carbohydrate versus low-fat diets in obese persons. Annals of Internal Medicine, 2010 Mar 2; 152 (5): 334-335.
  • The most recent report, by Foster et al, comparing the Atkins diet with a 15% protein, 30% fat, 55% carbohydrate diet found no significant differences in weight loss or body composition at 6, 12 and 24 months. Final weight loss and dropout rates in the low-fat and low-carb groups was 7.37 kg and 32% versus 6.34 kg and 42%, respectively.Foster GD, et al. Weight and Metabolic Outcomes After 2 Years on a Low-Carbohydrate Versus Low-Fat Diet. A Randomized Trial. Annals of Internal Medicine, 2010; 153: 147-157.

BTW, I was recently forwarded a newsletter article in which a certain low-carb commentator gushed on about the wonderful cholesterol, triglyceride and blood pressure changes seen in the low-carb group of this study. The low-carb mob are happy to dump on the farcical cholesterol theory when it suits them, but embrace it when it supports their cherished low-carb paradigm (furthermore, the difference in VLDL had disappeared at 24 months).According to this commentator, the health benefits were “enormous”. Hmmm, let’s see:

  • No difference in weight loss, body composition, or dropout rates.
  • Greater reduction in diastolic BP? Yes, but we’re talking a whopping <3 points at 24 months in diastolic – and no difference in systolic.
  • An earth shattering 14 mg/dl difference in triglycerides at 12 months, no difference at 24 months.

Excuse me for being distinctly unexcited.

In regards to the commentator’s claim about the 25 percent increase in HDL on the LC diet – “There’s not a drug on earth that’s been able to do that”; actually, there’s a drug that can raise HDL levels much higher than this. It’s called torcetrapib, and Pfizer had to shelve it after spending squillions of dollars on development because in their clinical trials it was killing rather than saving people.

As always, don’t believe the hype. Especially when it comes from someone committed to a certain sectarian dietary paradigm. Intentional or not, these folks tend to overblow the benefits and downplay or ignore the negatives of their favoured dietary regimen.

The only study I could find showing greater weight loss and lower attrition in a low-carb diet at 1-year was in the A to Z study, but as you can see other trials have repeatedly failed to confirm this result. Avoid falling into the same trap as a certain reality-evading low-carb guru who makes much ado about the A to Z study while completely ignoring the far greater number of non-supportive studies.

Furthermore, even the A to Z study showed high correlation between degree of weight loss and compliance to diet regardless of assigned regimen:

Alhassan S, et al. Dietary adherence and weight loss success among overweight women: results from the A TO Z weight loss study. International Journal of Obesity, 2008; 32: 985–991.

The claim that low-carb diets are marked by higher compliance and greater weight loss is a myth. It seen in some short term studies (and as I point out in the FLB, it is not seen in an almost equal number of short term studies) but is almost never seen in studies lasting a year or more.

Again, I will reiterate what I stated in my earlier email: low-carb diets are no more a panacea for weight loss than any other over-hyped fad. They enjoyed such strong albeit short-lived popularity, not because of their effectiveness, but due to clever PR and due to the fact that people are often hyper-reactive in nature and will swing from one extreme to another. Low-carb shills capitalized on the widely publicized failure of the low-fat campaign by promoting a polar opposite strategy: instead of a moronic and simplistic phobia of fat, they successfully instilled a moronic and simplistic phobia of carbs. Thankfully, carb-phobia appears to be much more short-lived than fat-phobia. Carbs aren’t going anywhere, and I think we will see a trend back towards healthier carbohydrate choices and away from simple-minded anti-carbohydrate paranoia.

The real killer is [caloric] over-consumption, and this is caused by calorie-dense processed foods that readily lend themselves to excess consumption, not carbohydrates per se. I cite in the Fat Loss Bible a study that involved increasing dietary volume, i.e. increasing the total amount of food consumed (in grams) while simultaneously decreasing calorie intake. In other words, people felt fuller despite eating less calories. The weight loss result was dramatic – and it was a high carbohydrate, low-fat diet.

And this gets us back to evolutionary correct eating. The low-carb movement has tried desperately to hijack the Paleolithic nutrition concept, making it appear that “Stone Age” and hunter-gatherer diets were universally low-carb. But we know this simply wasn’t the case. In prehistoric societies, carbohydrate consumption increased the closer you got to the equator (and keep in mind that humans originated in Africa, not the Arctic), with significant amounts of tubers and/or fruits consumed depending on location. But regardless of latitude, the common denominator was fresh whole foods and an absence of the nutrient-depleted, heavily refined and calorie-dense pap that dominates modern diets.

“Finally, I’m not impressed with the supposed adverse mood and energy deficit in people on keto diets. A real test of the adverse mood/energy effect of a keto diet would have 3 components:

1 – No caloric restriction

2 – People are free to choose to be on a low carb diet, rather than have it imposed on them.

3 – After a sufficient period of adaptation and adherence to the diet (at least 6 months), I would expect that the low carb group should have lost weight, especially if they started out obese.

I’d be amazed to find a study with a group following 1-3 criteria above demonstrating a strong adverse mood effect and energy deficit.

As I said before, I’d be miserable if calorie restriction would be imposed on me, but I’m choosing to have a calorie deficit (which is damn hard) and a low carb (not ketogenic) diet to lose weight. I also feel no adverse mood effects and my energy is better than ever.  The great enthusiasm I see from other low carb folks suggests to me that when one has control over one’s diet, and weight loss occurs, mood and energy are elevated rather than depressed.”

First of all, there is no “imposing” Nazi-like squad in jack boots forcing people to eat low-carb diets in free-living studies. People enter these studies entirely of their own volition knowing that they will be randomized to one of 2 or more diets; this is all clearly explained before they commence the study.

Secondly, your comments assume that, left to their own devices, people will magically choose the diet that is best for them, and that this will result in starkly different outcomes than having the diet “imposed” on them. Real life experience has repeatedly shown that people regularly choose dietary patterns that are completely wrong for them and even dangerous. People will stick to a diet even despite significant adverse effects because they have been so swayed by propaganda in favour of that diet.

The truth is, few people have grown up on an evolutionary correct diet and so would have little idea of what constitutes such a diet and what it feels like to be on such a diet.

Once again – studies in which people were randomly assigned (meaning there are just as likely to be an equal number of people in both groups who do and don’t want to be on that diet) to low-carb or higher carb diets have shown poorer mood and cognitive outcomes in the former group. This included a 12-month study showing greater tendencies towards anger, dejection, hostility, depression in the low-carb group (if you find these results unbelievable, then try joining a low-carb forum and calmly and rationally conveying the evidence showing MAD to be false. Please do this before writing back to me insisting that low-carb diets cause no increase in hostility…)

Answer me honestly – knowing that low-carb diets have shown negative outcomes in controlled clinical studies, would you honestly recommend them instead of a more balanced dietary regimen (ie one featuring more moderate levels of protein, fat, and carbohydrate) to someone with a history or susceptibility to depression, mood, or behavioural disorders?

I’m not interested in clever side-stepping, please just give me a yes or no answer.

Would you honestly tell the lady that suffered severe panic attacks on the Atkins Diet (discussed in my article), and enjoyed complete cessation of these attacks as soon as she dumped the diet, that her attacks were just “lab artifacts”?

Again, no clever qualifications, just yes or no.

Hey, some people might do fine on low-carb diets with no discernible negative impact on their mood or cognitive function. But the evidence indicates that some people don’t do so well on these diets at all and to dismiss these findings just because you personally “feel no adverse mood effects” is to be blinded by your own experiences and to assume what you experience is automatically what everyone else must experience on these diets.

And again, you’ve ignored an important point I made both in my article and previous email. You’ve just admitted your diet is a non-ketogenic low-carb diet…and I explicitly stated in the last email and in my article that the negative mood and cognitive findings apply only to ketogenic diets. Try going keto for a year, then tell us how you feel. If you really want to draw out the wonderful cognitive and mood effects of a ketogenic low-carb diet, start doing some serious and regular glycogen-depleting exercise. Then write back and tell me that keto diets don’t adversely affect mood and cognitive function…

As for your requirement that the diets involve no calorie restriction, that’s a convenient way to eliminate all the uncomfortable evidence with a single pen stroke. Given that most adults in countries like Australia and the US are overweight, it’s also an entirely unrealistic one. Furthermore, low-carb diets have been incessantly promoted for weight loss – that has been their indisputable primary selling point.

If there’s no calorie restriction, exactly how are overweight people supposed to lose weight…?

Sure, they could greatly increase their activity levels to the point where calorie restriction becomes unnecessary, but this will likely exacerbate the negative mood effects as you will be introducing a new mood-altering factor: glycogen depletion, see:

Keith RE, et al. Alterations in dietary carbohydrate, protein, and fat intake and mood state in trained female cyclists. Medicine and Science in Sports and Exercise, 1991 Feb; 23 (2): 212-216.

“The great enthusiasm I see from other low carb folks suggests to me that when one has control over one’s diet, and weight loss occurs, mood and energy are elevated rather than depressed.

Yes, control over one’s diet, in fact increased control in any area of life, often brings with it an uplifting sense of empowerment. But whether that feeling is an enduring one is an entirely different story.

I’ve lost count of the times I’ve witnessed people become enthusiastic, often to the point of evangelism, after beginning a new diet or training routine. It happens all the time – someone begins a “wonderful/amazing/awesome” new diet or workout scheme, and they just have to tell everyone who will listen how this sensational new regimen helped them drop 3 kilos or put 1/4″ on their biceps. What you don’t hear exclaimed with such glee is how that 3 kilos eventually came back or how that 1/4″ gain on their biceps completely stalled and never progressed to the 1″ that was promised in the hyperbolic article they got it from. And people certainly aren’t going to brag about how they seem to be more likely to snap at their partners or blow their fuse over what was once a relatively inconsequential event.

Once again, see the above studies showing long-term compliance and success on a low-carb diet is no greater than with other regimens.

And just because your limited circle of low-carb acquaintances (ketogenic status unknown) is yet to report or manifest any overt mood or cognitive symptoms doesn’t negate the fact that far more controlled investigations have uncovered such effects. To ignore these effects when making recommendations for these diets, especially in individuals susceptible to mood or cognitive disorders, is irresponsible.



D replies:

Hmmm –

(calorie deficit + time) = weight loss

What a concept!

I’ll have to chew on this



Anthony, You are too Partial to Impartiality

Hi Anthony,

Very interesting couple of articles ( I was unfortunately influenced by Michio Kushi, Nathan Pritikin and Jim Fixx for a few years, but I survived that and now embrace a nutrient-dense whole foods diet rich in meat and fat, and eat fewer and fewer grains, because that seems to work best for me.

I only question why you would include Robert Atkins, since he died of complications from a fall, not even from the congenital heart disease that plagued him (and if I remember correctly was partly why he became a cardiologist). I think all of the other gurus you and the other author mentioned died of cancer, stroke or heart attack, not from accidents. So Atkins hardly illustrates your point. No, I’m not a “follower” of Atkins or anyone else on your list. Hmmm, come to think of it, Viljhalmur Stephansson dying at age 82 doesn’t sound so terrible either.

There’s also a big difference between living better and living longer. People can be kept alive with drugs and heroic medical measures but have a horrible quality of life, and someone may die at an average age, but have lived in health and vitality, and that sounds preferable to me. And the genetic and environmental factors are unquantifiable. As you point out, stress is important but hard to pin down.

In short, I don’t think longevity is a sensible goal or something that anyone should promise. Good health here and now is a better goal.



Anthony replies:

Hi Jeanmarie,

glad you enjoyed the article.

“I only question why you would include Robert Atkins, since he died of complications from a fall, not even from the congenital heart disease that plagued him (and if I remember correctly was partly why he became a cardiologist).”

Why wouldn’t I? He was, after all, one of the most famous diet gurus of all time – and he made some extremely lavish claims for his diet, including both anti-aging and cardio-protective benefits. Regardless of whether or not he died from complications of a fall, the fact remains that he had heart disease.

Remember, most of these authors, including Atkins, made fortunes by claiming their regimens could not only prevent chronic diseases, but also reverse them.

Nathan Pritikin had pre-existing heart disease, as did Paavo Airola, but I don’t see you questioning their inclusion. Pritikin, in fact, did appear to have successfully reversed his heart disease but then died after slashing his wrists whilst hospitalized for leukemia. Pritikin’s wife believes his leukemia was caused by radiation treatments he received as a child – and she may well be right. It could also be argued that Pritikin’s extreme low fat regimen left him with deficiencies of essential fatty acids and fat soluble nutrients that made his immune system less resistant to leukemia. Or it could be that his diet and lifestyle made little difference and, after being subject to radiation in his childhood, he was destined to die from leukemia no matter what he did.

It could similarly be argued that Atkins was doomed to die of heart disease from the outset, or that his heart condition was not helped and even aggravated by his dietary pattern; ketogenic diets are often associated with poor intakes of crucial heart-healthy minerals like magnesium, potassium, and selenium. That’s assuming he actually followed his own diet; I remember reading a post at the Dragon Door forum by Dr Greg Ellis, who says he went out to dinner with Atkins after being interviewed on his radio show in New York. Ellis, a committed low-carber, left the large potato that accompanied his steak untouched on the plate. He claims Atkins finished his own potato, eyed down the spud on Ellis’ plate, then asked the Ultimate Diet Secrets author if he could have it. After Ellis replied in the affirmative, Atkins allegedly devoured the tater in short order.

I’ve noticed a hypocritical tendency among the respective dietary camps when commenting on the deaths of Atkins and Pritikin. Pritkin’s death is readily cited by low-carbers as an indictment against low-fat eating, but Atkins’ premature demise is glossed over and rationalized away. And vice versa; low-fat advocates made a big song and dance about Atkins’ passing, but seem to have little to say about Pritikin’s premature death. What’s good for the goose is good for the gander; if you’re going to claim that a certain dietary guru’s death was caused by his diet, even when the evidence is hardly conclusive of such a claim, then you have to consider that it played a role in the death of your favorite guru also.

The truth is, we will never know for sure what role diet and lifestyle played in the deaths of Pritkin, Atkins and Airola.

What we do know is that Pritikin, Airola, and Atkins sold millions of books and all made vast sums of money by telling people how they could allegedly extend their lives, avoid and reverse disease, and enjoy sparkling good health – and all died prior to reaching the national average life expectancy for males. I think that is cause for some serious reflection on just how tenable their dietary claims were. If the creators of these programs can’t harness them in a manner that extends life, prevents disease, or reverses pre-existing maladies as claimed, then why should the average Joe hope to fare any better by following their commandments?

If you read the post carefully, you will note that while both MacGregor and I offer some possible explanations, we refrain from reaching any unverified conclusions about the exact reason/s for the premature mortality that seems to plague diet “gurus”. But the fact remains, no matter how hard one tries to rationalize away the deaths of specific diet and health authors, as a group they do not enjoy above average health or longevity – just the opposite.

As for Stephansson, neither MacGregor nor myself claim his passing at 82 is “terrible”. I do find his inclusion by MacGregor relevant because Stephansson, along with the Eskimos he lived amongst during his expeditions, are often cited in support of low-carb diets. One of the alleged benefits enjoyed by the high-protein-eating Eskimos is freedom from cardiovascular disease. Stephansson died of a stroke. At 82, he at least fared a lot better than the Eskimos; what is not so often mentioned about this population is their low rates of CHD were countered by high rates of other ailments, including infection, reduced bone mineral density, bleeding disorders and reduced life expectancy.

In short, I don’t think longevity is a sensible goal or something that anyone should promise.”

I think it is a perfectly sensible goal and am glad that the average life expectancy has steadily risen over the years. I hope that science proceeds to make even greater leaps in this area; I’d like to stick around as long as possible. But whether diet “gurus”, most of whom seem to be hopelessly myopic and terribly biased, often to the point of intellectually dishonesty, should be regarded as worthy commentators on the issue is an entirely different story.



Jeanmarie replies:

Hi Anthony,

Thanks for your thoughtful reply.

I asked why you included Atkins because he didn’t die from a diet-related disease, he died from complications related to an accident. You wrote about the poor longevity track record of famous health “experts,” and presumably if someone was, say, run down by a bus or murdered or fell off a boat and drowned or had some other freak accident, that wouldn’t be blamed on their diet, either. That’s why Atkins’s inclusion doesn’t make sense to me.

Also, so what if Atkins ate a few baked potatoes? It’s a common misconception that he advocated extreme carbohydrate restriction for life. People confuse the induction phase of his diet with the whole thing. (I have read more than one of his books, unlike many people who have written about Atkins, and almost everybody gets this wrong.) If his metabolism and activity level allowed him to eat potatoes now and then, so what? I also know of people who benefited greatly from following his diet. He also advocated eating vegetables, it wasn’t all meat. I don’t know how one could argue that Atkins was doomed to die from heart disease at the outset, because he was reported to be in good health prior to the accident. Of course, I’m not privy to his medical records, only what has been reported, some of which has been shown to be blatantly untrue (such as that he was obese when he entered the hospital; after days in a coma, he did suffer from edema). Now, if the evidence were to show that he was actually a big, fat, hypocrite, that would be disappointing, but I’d somehow cope with that and move on. So far, I haven’t been persuaded that’s the case.

I wasn’t aware (or had long since forgotten) that Pritikin and Airola had heart disease, but their deaths were not from accidents, so they do illustrate your thesis, which I’m not questioning. While Pritikin took his own life, it would seem his cancer diagnosis (and maybe the pain he may have been experiencing) may have had something to do with the decision to do so, and he was only 69. If he hadn’t committed suicide, would the leukemia have killed him? It seems plausible, to say the least. That seems to be what you implied by the phrasing “as leukemia overtook him,” and the prognosis back in 1985 presumably wasn’t too optimistic. Personally, news of Pritikin’s suicide had little to no effect on my dietary choices, as I don’t remember learning of it until much later. Unfortunately it took me many more years to completely get over my flirtation with vegetarianism and low-fat diets.

You can parse the facts any way you like, it’s your article, but by the criteria your article set up, Atkins and Stephansson don’t seem to fit. Death from complications following an accident, and death at eighty-two, don’t fit the theme as I read it of ” the very poor longevity track record of famous health ‘experts’ and diet ‘gurus’.” Yes I know you didn’t use the word “terrible,” that was mine, but using Stephansson as an example of a health guru who died at a younger-than-average age doesn’t make sense, when he died at a much older-than-average age. It just doesn’t logically follow. That’s all I’m saying.



Anthony replies:

Hi Jeanmarie,

I’m not sure why you are going to such great lengths to rationalize away Atkin’s death. The indisputable fact, whether you like it or not, is that Atkins had heart disease. Period. Do you, or do you not, acknowledge that Atkins suffered heart disease?

You claim not to be a follower of Atkins, but your previous email would indicate a preference for low-carb diets as opposed to low-fat, and you do seem very eager to ignore his very real cardiovascular illness. Once again: there seems to be a hypocritical tendency among the respective dietary camps when commenting on the deaths of Atkins and Pritikin. Each camp is quick to cite the ‘opposing’ guru’s death and link it to his nutritional habits, but even quicker to brush off the death of their ‘home team’ guru as an unlucky event unrelated to their diet. This an out-and-out double-standard: if you’re going to claim a certain dietary guru’s health problems and early death was caused by his diet, despite a lack of conclusive evidence, then impartiality and objectivity dictates you should also consider it a possible factor in the morbidity and mortality of your favourite guru.

As for murder, falling off boats, getting bowled over by buses, etc, etc, there actually has been a plausible connection made between low-fat diets, low-cholesterol levels and accidental and violent death (in fact, the association between low-cholesterol and accidental/violent death is quite strong and consistent, as I discuss in The Great Cholesterol Con). Researchers have postulated that low-fat intakes and low cholesterol levels may alter serotonergic expression. Guess what else affects serotonin? Yep, carbohydrate intake. Short term studies show that high-protein/low-carbohydrate meals increase feelings of tension and hostility, and we now have long term studies (up to 12 months) showing that ketogenic low-carbohydrate diets negatively affect cognition, speed of processing, and increase feelings of anger, confusion and dejection:

How do we know that diet-induced changes in reflexes or mental state did not contribute to Atkins’ fall in 2003? When one’s cognitive function and mood state are impaired, even subtly, then they may not make optimal decisions and reactions in response to the surrounding environmental conditions.

“Also, so what if Atkins ate a few baked potatoes?”

Jeanmarie, to be quite honest, I couldn’t give a flying act of fornication whether or not Atkins ate “a few baked potatoes”. But given that he espoused the benefits of low GI foods in his book and cited potatoes (p 79 and 83, Dr. Atkins New Diet Revolution, 2002), and specifically baked potatoes (p 83), as one of the worst foods for causing blood sugar spikes, one has to question just how seriously he took his own recommendations.

“I don’t know how one could argue that Atkins was doomed to die from heart disease at the outset, because he was reported to be in good health prior to the accident.”

For the umpteenth time, Atkins suffered cardiomyopathy and had actually suffered a cardiac arrest a year prior to his fall on the pavement. Damage-control press releases from Atkins Nutritionals notwithstanding, I’m not sure how cardiomyopathy and a history of heart disease constitute “good health”. Again, are you simply going to continue to ignore the fact that he suffered heart disease?

“I wasn’t aware (or had long since forgotten) that Pritikin and Airola had heart disease, but their deaths were not from accidents”

Pritikin did not die of leukemia, he died from blood loss due to severing the arteries in his wrist. Like Atkins, he did not die of the disease he suffered. Why is it OK to exempt Atkins by this criteria, but not Pritikin?

“You can parse the facts any way you like, it’s your article…”

Excuse me?

Do me a favour and refrain from accusing me of customizing the facts to suit myself – especially when you unashamedly harbour such a tendency yourself. I have been careful in both my post and my reply to you to not come to any conclusions, to simply relay the plain facts and put the poor health and longevity records of famous diet ‘gurus’ out there for public consumption. The author of the original article, John MacGregor, was careful to do the same thing.

I have been careful to point out that, in both instances, their (Atkins’ and Pritkin’s) deaths may or may not have been due to the dietary and lifestyle choices they espoused. The purpose of my post was not to make any concrete allegations, but to remind people that these gurus are not infallible and that, if their own health and longevity track records are anything to go by, their recommendations are worthy of far more critical scrutiny by their often unquestioning followers.

Let the record show you are the one bending over backwards to make excuses for Atkins, to ignore the fact that he suffered heart disease, whilst simultaneously failing to award the same concessions to Pritikin.

“…but by the criteria your article set up, Atkins and Stephansson don’t seem to fit.”

I think I’ve said enough on Atkins, if you don’t get it by now, you never will. As for Stephansson, his fatal stroke in 1962 at age 82 was not his first. He suffered a minor stroke in 1952 and more serious one in 1958 that forced him to drastically cut back his teaching activities.

In an article that appeared in Harper’s Bazaar in 1936 ( Stephansson wrote:

“More than twenty-five years have passed since the completion of my first twelve months on meat and more than six years since the completion in New York of my sixth full meat year. All the rest of my life I have been a heavy meat eater, and I am now fifty-six.”

He added, ironically: “That should be long enough to bring out the effects.”

Maybe not.

Dr. Robert Atkins

Nathan Pritikin

Vilhjalmur Stephansson

My Point is…Actually, I Have No Point

Note: the spelling of the next correspondent’s emails has been left unedited. Please keep in mind the documented negative cognitive effects of ketogenic diets as you read through her second email.

I read your articles regularly and recently saw the one about the deaths of “diet gurus”. Disregarding the causes of death, most of the people you cite were at least the average age of death weren’t they? so they didn’t do so badly. How much worse might the picture have been for them if they had followed your strategies? I myself have T2 diabetes and follow the principles of Richard Bernstein[ has he not survived complication free much longer than most type 1 diabetics of his age and duration?]

Whilst about half of T2 diabetics are forced into using insulin within 5 years of diagnosis, I am still managing my blood glucose at Non-diabetic levels![ Hb A1c in the 5%s regularly] with the aid of minimal Metformin only plus a controlled carb way of eating,  into my 8th year. In fact at the clinic which I attend, I am the only patient who regularly records non-diabetic A1cs. I don’t think I could do this by the recommended method of high carb diet and high dose medication.

In addition, I am spared hypos, I have lost 45 pounds in weight and I can walk any distance. Which I do regularly. I can’t run, following a stroke many years ago and am now in my mid 60s

You have fallen into your own trap, of being too prescriptive. There is No such thing as a scientifically proven “Healthy Balanced diet” and no evidence that carbs are essential or that restricting them does any harm. I know you claim to have evidence, I read the article, but I didn’t see the real science behind it.

Hana Rous

Anthony replies:

“Disregarding the causes of death, most of the people you cite were at least the average age of death weren’t they?”

Perhaps you should re-read the article. As it clearly states, most did not reach the national average:

And they certainly didn’t achieve the wonderfully long life and sparkling health that their books promised.

“How much worse might the picture have been for them if they had followed your strategies?”

Which strategies, exactly? The ones I briefly mentioned in the article? Like eating to match your calorie needs instead of carelessly eating like an undisciplined pig and becoming overweight, obese and even diabetic, as people routinely do in the West? Like eating minimally processed, fresh, whole foods instead of refined processed crap? Like getting to bed as soon as possible after dark and rising soon after sunrise, in accordance with our natural circadian rhythm? Like avoiding as much as possible the harmful effects of chronic stress? Like establishing a circle of supportive friends and family? Like getting regular exercise, instead of embracing a sedentary lifestyle and allowing the process of gradual physical decay to proceed unimpeded?

How much better [“worse”?!] off would these folks have been if they embraced all these strategies instead of becoming myopically obsessed with their pet theories, many of which were of dubious scientific validity?

Is this a trick question?

“You have fallen into your own trap, of being too prescriptive.”

Can you show me exactly where I prescribe a specific diet, exercise, and/or lifestyle pattern for everyone? Please provide me with the link, I’d love to see it.

If it is the general guidelines I outlined in the article that have raised your ire, then do you or do you not agree that “a diet and lifestyle that encompasses predominantly nutrient-rich whole foods, avoidance of both caloric overconsumption and underconsumption (the former leads to obesity and chronic disease, the latter results in malnutrition), and a lifestyle marked by temperance, regular physical activity, sufficient sound sleep, a supportive social circle, low stress and/or superior stress coping mechanisms” is a good thing?

If you believe these factors are in some way harmful, please provide me with the scientific evidence to back your bizarre assertion.

“no evidence that carbs are essential…”

You may not have noticed, but this is a website aimed at active and athletic individuals. If you participate in glycogen-depleting exercise/sport, carbohydrates sure as hell are essential! I suggest you consult the abundant literature showing that low-carbohydrate diets decimate exercise performance at high levels of V02max.

Yes, you could always avoid strenuous exercise, but believe it or not, some of us do aspire to be fit and athletic. Struggling along in a state of exhaustion with muscles that are suffering both from glycogen depletion and impaired glucose utilization is hardly amenable to these goals.

“or that restricting them does any harm.”

As I wrote here:

“very low-carb ketogenic diets have been shown to increase markers of lean tissue loss, reduce levels of the thyroid hormone triiodothyronine (T3), and typically lead to substandard intakes of phytonutrient-rich plant foods. Magnesium and potassium intakes are often inadequate on these diets, and anecdotal reports of cramping, lethargy, shakiness and heart rhythm disturbances are common on these diets. There has been at least one case report of fatal ventricular fibrillation after commencement of a very low carbohydrate diet; upon autopsy, toxicological findings were normal but the victim exhbited very low levels of serum potassium and calcium (commencement of a ketogenic diet is well known to cause potassium losses)[4]. In another clinical trial comparing ketogenic and non-ketogenic diets, a participant in the ketogenic group had to be removed a week into the study after suffering cardiac arrhythmias[5]. To add insult to injury, ketogenic diets often cause the breath and body odor of their followers to smell like unwashed feet. Thanks, but no thanks!”

“I read the article, but I didn’t see the real science behind it.”

Again, I suggest you re-read the article. It was not written in anticipation of being published in a peer-reviewed journal – the original author had written it for his local newspaper. The purpose of the article, and my purpose in reprinting it, was to make people think. Yes, I know, thinking is a distinctly unfashionable activity these days, but there’s a lot to be said for using your noggin instead of blindly soaking up every bit of health propaganda that comes your way. The point of the article is that diet and health gurus routinely promise wonderful health and outstanding longevity for those who follow their recommendations, yet rarely experience these benefits themselves. The fact that these so-called “experts” actually tend to live shorter lives than average is a rather sobering thought.

Hana Rous replies:

The records of VLCKD treatment in epileptic children, show they tolerate the diet well. and what about richard Bernstein, David Mendosa and many other diabetics worlwide, who keep fit and well on 30 -50 grams of carb per day for many years?

Incidentally the enlihtened among us now believe that obesitty is more likely to be a symptom of TRype 2 diabetes than a cause. Otherwise what about the morbidly obese people who NEVER develop it, which they would if it were a causal facttor qand trhe slim people who do and they account for up to 20% of new diagnoses.

In my own case, I was certailnly not morbidly obese when diagnosed type 2, but I was at least 4th in a direct line in my family.  And I wrote before that I walk many miles regularly. Uphill about half the time. I also attend the gym at least 4 to 5 times per week and work with a sports htherapist,who says I’m pretty fit. I have controlled my T2 with lowered carbsNOT NO CARBS for about 3 yeqaarsss. Before I found this strategy, I was struggling with the Diabetes UK recommended diet and medication which was causing me to gain weight, which is what sulphonylureas do as I’m sure you know.

I’m sure tyou also know that the human digestive system has no mechanism to break dowwn uncooked starch. This makes me think it’s not a natural part of human diet. Even if we have been cooking it for a few thousand yeas. We still haven’t evolved enzymes to digest raw starch I base my dietary plans on: ” eat that which could be eaten raw and unprocessed, even if I choose, like meat, to cook it”

Anthony replies:

“The records of VLCKD treatment in epileptic children, show they tolerate the diet well”

Have you actually seen these records? And I mean ALL of them – not just the ones that reinforce your personal dietary bias? Like most of those who are enamoured by a particular dietary paradigm, you are utterly incapable of viewing these diets in an impartial light. The reality is that complications are common among epileptic children treated with the ketogenic diet – which is why the popularity of the diet fell by the wayside when suitable drugs became available.

Among this population, adverse affects of ketogenic diets have been widely reported and include cardiomyopathy, dehydration, nausea/vomiting, bruising, diarrhea, constipation, gastritis, hyperuricemia, various infectious diseases, hypoglycemia (low blood sugar), hyponatremia, hepatitis, acute pancreatitis, persistent metabolic acidosis, osteopenia, kidney stones, and severe vitamin and mineral deficiencies. In some instances these adverse effects have proven fatal. As one doctor commented in a 2005 journal article on ketogenic diets, “tolerability and complication-related issues are the rule, not the exception … medical surveillance must be maintained throughout the entire period of dietary treatment.”

Hoyt CS, Billson F. Optic neuropathy in ketogenic diet. British Journal of Ophthalmology, 1979; 63: 191-194.

Kang HC, et al.  Early- and late-onset complications of the ketogenic diet for intractable epilepsy. Epilepsia, 2004; 45 (9): 1116-1123.

Best TH, et al. Cardiac complications in pediatric patients on the ketogenic diet. Neurology, 2000; 54: 2328-2330.

Ballaban-Gil K, et al. Complications of the ketogenic diet. Epilepsia, July 1998; 39 (7): 744-748.

Berry-Kravis E, et al. Bruising and the ketogenic diet: Evidence for diet-induced changes in platelet function. Annals of Neurology, 2001; 49: 98–103.

Duchowny MS. Food for thought: The Ketogenic Diet and Adverse Effects in Children. Epilepsy Currents, July 2005; 5 (4): 152–154.

Hahn TJ, et al. Disordered mineral metabolism produced by ketogenic diet therapy. Calcified Tissue International, Dec, 1979; 28 (1):  1432-0827.

Kelb SA, et al. Nephrolithiasis associated with the ketogenic diet. Journal of Urology, Aug, 2000; 164 (2): 464-466.

You also completely ignore the adverse effects I mentioned in my previous email. I provided citations for you to check them out, but you simply ignored them. Which is just as I would expect – in my dealings with dietary sectarians of all stripes over the years, low-carbers are without question the most evasive, duplicitous and dishonest cherry-pickers in the entire nutrition arena. This pathetic trait extends from the lowliest forum trolls right up to their best-selling authors.

“what about richard Bernstein, David Mendosa and many other diabetics worlwide, who keep fit and well on 30 -50 grams of carb per day for many years?”

What about the people who do poorly on these diets, and suffer constipation, bad breath, heart rhythm irregularities, lethargy, psychological disturbances, and fatal heart conditions? I’m sure they’d find great consolation in the fact that Richard Bernstein and David Mendosa apparently do OK on these diets.

As for the “many diabetics worldwide”…can you please provide me with the detailed case histories of these “many” people? I’m not interested in unreliable and unverifiable forum gossip or the claims of book authors, but real data – from both people who succeeded and failed on these diets.

BTW, what about the short and long term studies showing mood and cognitive impairment among people assigned to ketogenic diets?

I guess you never bothered to read this article and consult the references cited. Hell no, you’ve already made up your mind that ketogenic diets are wonderful and flawless.

Like most low-carb shills, you focus only on the examples that support your beliefs, and ignore the uncomfortable contradictions.

You accuse me of being “too prescriptive”, but I never actually made any specific prescriptions. You, however, are now writing telling me that ketogenic diets are the greatest thing going and you are completely ignoring the abundant evidence to the contrary. So who’s the dogmatist here?

I’m glad Richard Bernstein and David Mendosa appear to be doing just fine on carbohydrate intakes of 30-50 grams per day, but you seem to have missed the fact that my website is aimed primarily at athletic individuals [note: this is not a medical website for diabetics, and at no point have I intimated otherwise]. Can you please provide me with evidence that Bernstein and Mendosa successfully and regularly engage in activities of a glycogen depleting nature? I don’t mean a leisurely run a few nights a week, but a high volume regimen that produces well above average levels of aerobic and anaerobic fitness? In fact, can you please provide evidence of a successful athlete in a glycogen depleting sport (ie boxing, cycling, running, etc) that follows a ketogenic diet? You remained totally silent on my previous comment that controlled scientific studies repeatedly show low-carbohydrate diets (ketogenic and non-ketogenic) decimate athletic performance.

I’m really not sure what the purpose of your disjointed email communication is. First you write to me whining that you didn’t see any “science” behind the health “experts” article, but it was an article about the early deaths of famous diet and health gurus. Exactly what “science” do you need to verify their deaths?! Heck, I even provided hyperlinks to articles about each of these figures that contained their dates of birth and death. Is it really too much of an effort for you to click on a link to find out more about these people?

Then you accuse me of being “too prescriptive”, despite the fact that I’m probably one of the most non-dogmatic commentators around. Unlike yourself, I can see the value in both low-carb and high-carb regimens (although I do believe the complication rate of ketogenic diets is unacceptably high and they are simply unnecessary for most people). As I recently wrote:

“If you are a highly active individual, there’s a good chance I’m going to tell you to eat more carbs, because there are way too many serious exercisers out there who’ve been swayed by nonsensical low-carb dogma, trying to fuel an athlete’s lifestyle on diets more suitable for sedentary housewives. These diets were never designed to fuel high level physical activity. On the other hand, if you are a sedentary person with low or essentially non-existent activity levels, than there’s a good chance I’ll recommend reducing your carbohydrate intake (albeit never to ketogenic levels).”

“I’m sure tyou also know that the human digestive system has no mechanism to break dowwn uncooked starch.”

Um…there’s this thing called “cooking”, which – believe it or not – humans have been using with remarkable success for hundreds of thousands of years. Wherever starch was available, healthy robust hunter-gatherers in every corner of the world ate it regularly, as do today’s longest living societies (another indisputable fact on which you remain strangely silent). All available evidence indicates that humans, and their primate ancestors, have consumed carbohydrate foods throughout their entire history. Meat consumption actually followed later (first, it would seem, as opportunistic scavenging and then later as active hunting). I know this doesn’t sit too well with your ketogenic mind conditioning, but anyone with even a basic knowledge of primate evolution knows that what I have said is correct.

I also note your double standard – cooking makes meat much more palatable (a fact which some scientists believe made a huge impact on our physical and cognitive evolution) and safer from microbial contamination, so you eat cooked meat. But cooked starch, which cooking makes much easier to digest than its raw form, is somehow a big evolutionary no-no.


You might be rapt with your ketogenic diet, but something tells me it’s not doing a whole lot for your cognitive functioning.

Your purpose seems to be to pick a fight, to make inane and irrational criticisms, and to defend your pre-existing biases whilst actively ignoring contradictory evidence. So I will ask the same courtesy I ask of all other time-wasters: if you have no new science to share with me (in the form of helpful citations), if you are not able to point out any typos or factual errors, then please stop wasting both my time and yours. I suggest you go find a low-carb forum where you can co-exist in blissful ignorance with your fellow low-carb dogmatists. In fact, if ignorance is bliss, you must be orgasmic.

Anthony Colpo is an independent researcher, physical conditioning specialist, and author of the groundbreaking books The Fat Loss Bible and The Great Cholesterol Con. For more information, visit or

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