Living Low Carb (8 page)

Taller did not recommend a diet devoid of carbohydrates—in fact, a typical day’s menu contained up to three slices of “gluten bread,” something no low-carb advocate today, including myself, would recommend (there are far more healthful starchy carbs to choose from, including sprouted-grain or gluten-free breads). The rest of the day’s food came from meat, poultry, seafood, and plenty of vegetables as well as some oils. There was no counting of calories.

Now here’s where it gets interesting.

In the ’50s and ’60s, when Taller was writing, a scientist named Ancel Keys had begun studying heart disease and diet—research that culminated in what has come to be known as the diet-heart hypothesis. Keys concluded that cholesterol is a cause of heart disease, saturated fat causes a rise in cholesterol, and therefore saturated fat causes heart disease. Keys’s sevencountry study
²⁰
became the basis for dietary policy for more than three decades, indirectly birthed the fat phobia of the ’80s, and directly spawned an entire bureaucracy devoted to lowering cholesterol (the National Cholesterol Education Program) and also to producing some of the most profitable pharmaceutical drugs in history (see
chapter 9
). Note for now that there are serious problems with this theory, and it is finally being reexamined.
²¹

Taller, a product of the time, accepted the demonization of cholesterol and believed that if you could reduce it in the diet, you could significantly lower heart-disease rates. He was very concerned about the saturated fat in the low-carb diets of the past, so he came up with what he thought was a perfect solution: his version of the diet would incorporate tons of polyunsaturated fats. Problem was, he lumped all unsaturated fats together. He was correct in pointing out how healthful marine fats are (the famous omega-3’s from fish and flaxseed), but he was dead wrong in advocating excessive amounts of man-made refined vegetable oils like safflower, sunflower, and corn oils, which we now know are associated with a host of diseases, inflammatory conditions, and cancers.
²²

Taller’s book went through eighteen printings and ultimately had more than a million copies in circulation, but his career came to an unfortunate end when he was convicted of six counts of mail fraud for using the book to promote a particular brand of safflower capsules, which the court called “a worthless scheme foisted on a gullible public.”
²³
Too bad. By all reports, he was a good guy and very sincere in his efforts to bring healthy low-carb living to the masses.

The other low-carb book published in the ’60s—also against a backdrop of the fledgling no-fat madness started by the flawed Keys research—was one that didn’t deserve much attention, though that little detail didn’t stop it from selling 5½ million copies.
The Doctor’s Quick Weight Loss Diet,
²⁴
otherwise known as the Stillman diet, put forth a high-protein solution that attempted, at the same time, to satisfy the low-fat contingent. On the Stillman diet, you ate nothing—and I mean nothing—but protein with every drop of fat trimmed from it. You could eat all you wanted from the following selection: lean meats with all possible fat trimmed; chicken and turkey without skin; all non-fatty fish; eggs made in nonstick pans without butter, margarine, oil, or other fat; cottage cheese and other soft cheeses made only from skim milk; and at least eight glasses of water a day. We know from the Stefansson experiment that this diet, if followed for any length of time, would make you very sick precisely because of the
absence
of fat.

The Stillman diet was a dumb idea and should not be followed for any reason. Although the Stillman all-protein plan was in fact a low-carb diet, it’s important to remember that not all low-carb diets are
high-protein
diets. Even the Atkins diet, which will be discussed at greater length in
chapter 7
, is not necessarily high-protein. In fact, the average protein content of all three major phases of the Atkins diet is only 31% (the average
fat
content is 56%); and during the Atkins maintenance phase, the average protein content is only 5% higher than Weight Watchers (25% versus 20%)!
²⁵
Some of the diets discussed in this book don’t even approach high-protein: for example, Barry Sears’s Zone diet (see
chapter 7
) has often been called a high-protein diet by magazine writers who have either not read his books or not understood them, and by members of the American Dietetic Association, who have frequently done neither. The point is that
low-carb does not necessarily equal high-protein,
and the Stillman diet is Exhibit A in making the case that all low-carb diets are not the same.

Atkins, Yudkin, and the Question of Sugar

By 1970, the Keys research had been published and was being picked up by the media; the low—or no—cholesterol brigade was gearing up for an assault on the consciousness of the American public. In 1972, Robert Atkins published the first edition of the
New Diet Revolution,
the Cadillac of lowcarb diet plans, which became the de facto poster child for the low-carb movement two decades later.

Atkins was the first popular diet-book author to seriously focus on insulin as a determinant in weight gain. He preached the virtues of something he called “the metabolic advantage”: benign dietary ketosis (a process that, because it is so central to the discussion of low-carb diets and so misunderstood, will receive much further attention in
chapter 10
). Because his high-fat, high-protein, low-carb diet went so dramatically against the conventional “wisdom” of the times, Atkins was attacked mercilessly in the press and vilified by the medical mainstream, who turned him into a pariah in the medical community. His voice was drowned out by the low-fat, nocholesterol, calorie-counting establishment, and although he remained active, he didn’t catch on big-time until the early 1990s, when an updated edition of the
New Diet Revolution
was published.

The public, with its rapidly expanding waistlines, was growing weary of the low-fat dogma and beginning to realize that low-fat diets were accomplishing very little in the way of weight loss; people were finally ready to look elsewhere for a solution.

In the same year in which Atkins published the first edition of his book, which firmly took the position that the problem in obesity was carbohydrates, not fat, a brilliant English doctor named John Yudkin was making waves by politely and reasonably suggesting to the medical establishment that perhaps their emperor, while indeed cholesterol-free and low-fat, was nonetheless naked as a jaybird. A professor of nutrition at Queen Elizabeth College, London University, and the Surgeon-Captain of the British Royal Navy, Yudkin was a highly respected scientist and nutritionist and the possessor of both an MD and a PhD, with dozens of published papers in such august peer-reviewed journals as
The Lancet, Cardiovascular Review, British Medical Journal, The Archives of Internal Medicine, The American Journal of Clinical Nutrition,
and
Nature
to his credit.

Yudkin was typically portrayed by his detractors as a wild-eyed fanatic who blamed sugar as the cause of heart disease, but in fact he was nothing of the sort. In his 1972 book,
Sweet and Dangerous,
he was the embodiment of reason when he called for a reexamination of the data—which he considered highly flawed—that had led to the hypothesis that fat causes heart disease. (These data, as you will recall, came originally from a study of six
²⁶
and then seven countries
²⁷
published by Ancel Keys, studies that conveniently omitted a substantial amount of data that did not fit his hypothesis.)
²⁸

Yudkin pointed out that statistics for heart disease and fat consumption existed for many more countries than those referred to by Keys, and that these other figures didn’t fit into the “more fat, more heart disease” relationship that was evident when only the six selected countries were considered. He pointed out that there was a better and truer relationship between
sugar consumption
and heart disease, and he said that “there is a sizable minority—of which I am one—that believes that coronary disease is
not
largely due to fat in the diet.” (Three decades later, Dr. George Mann, an associate director of the Framingham Study, arrived at the same conclusion and assembled a distinguished group of scientists and doctors to study the evidence that fat and cholesterol cause heart disease, a concept he later called “the greatest health scam of the century.”
²⁹
Around the same time, the brilliant Danish scholar Uffe Ravnskov, MD, PhD, reanalyzed the original Keys data and came to the identical conclusion. His exemplary scholarship is supported by hundreds of referenced citations and studies from prestigious, peer-reviewed medical journals and can be found in book form
³⁰
and at the Web site
http://www.ravnskov.nu/cholesterol.htm.
)

While Yudkin did not write a low-carb diet book per se, he was one of the most influential voices of the time to put forth the position that sugar was responsible for far more health problems than fat was. His book called attention to countries in which the correlation between heart disease and sugar intake was far more striking than the correlation between heart disease and
fat
. And he pointed to a number of studies—most dramatically of the Masai in Kenya and Tanzania—where people consumed copious amounts of milk and fat and yet had virtually no heart disease. Interestingly, these people also consumed almost no sugar.
³¹

Yudkin patiently explained that sugar consumption is
one of a number
of indices of wealth. Heart disease is associated with many of these indices, including fat consumption, overweight, cigarette smoking, a sedentary lifestyle, and television viewing. It is
definitely
associated with a high intake of sugar. He never said that sugar
causes
the diseases of modern civilization, just that a case could easily be made that it deserved attention and study—certainly as much as, if not more than, fat consumption. (Yudkin himself performed several interesting studies on sugar consumption and coronary heart disease. In one, he found that the median sugar intake of a group of coronary patients was 147 grams, twice as much as it was in two different groups of control subjects who didn’t have coronary disease; these groups consumed only 67 and 74 grams, respectively.)
³²

As Yudkin put it, “It may turn out that [many factors including sugar] ultimately have the same effect on metabolism and so produce coronary disease by the same mechanism.” What is that mechanism? Fingers are beginning to point suspiciously to an
overload of insulin
as a common culprit at the root of at least some of these metabolic and negative health effects like heart disease; controlling insulin was the main purpose of the original Atkins diet and has become the raison d’être of the low-carb approach to living. (In the next chapter, we will explore some of the connections between high levels of insulin and heart disease, hypertension, obesity, and diabetes.)

Cholesterol Madness

Yudkin’s warnings against sugar and Atkins’s early low-carb approach to weight loss were mere whispers lost in the roar of anti-fat mania. By the mid-1980s, fat had been utterly and completely demonized, and fat phobia was in full bloom, with hundreds of no-cholesterol foods being foisted on a gullible public (despite the findings that dietary cholesterol had little or no effect on serum cholesterol, a fact acknowledged even by Ancel Keys himself, who, in 1991, said that dietary cholesterol only mattered if you happened to be a rabbit!).
³³
In November 1985, the National Heart, Lung, and Blood Institute launched the National Cholesterol Education Program with the stated goal of “reducing illness and death from coronary heart disease in the United States by
reducing the percent of Americans with high blood cholesterol
.”
³⁴
(Emphasis mine.)

Though high cholesterol
doesn’t
cause heart disease and, in fact, has turned out to be a relatively poor predictor of it, the juggernaut was already in full swing, and the cry of “hold the butter” was heard all over America. Fat-free foods were everywhere. Snackwells replaced Oreos as the best-selling cookie in America. In 1976, Nathan Pritikin opened his Pritikin Longevity Center in Santa Barbara, California, and for the next decade he preached the super-low-fat dogma to all who would listen, which included most of the country. Jane Fonda ushered in a new generation of aerobicized exercise fanatics whose motto was “no pain, no gain” and who looked upon fat of any kind as a Tootsie Roll in the punch bowl. (Later, Apex, a supplement company based in California, got a strong foothold in health clubs as nutrition “experts” largely by being the handmaiden of the American Dietetic Association, and Apex’s people taught gullible trainers and their clients the dogma of high-carbohydrate diets for weight loss while they railed against the “dangers” of high protein and ketosis.)
³⁵
It became a point of pride to exorcise any hint of fat from the diet: egg-white omelettes became de rigueur on every urban menu, and waiters across America became accustomed to orders without butter, oil, or fat of any kind.

Pritikin died in 1985, but his mantle was quickly taken up by Dr. Dean Ornish. Ornish’s reputation—and much of the public’s faith in the low-fat diet approach—was fueled by his famous five-year intervention study (the Lifestyle Heart Trial), which demonstrated that intensive lifestyle changes may lead to regression of coronary heart disease.
³⁶
Ornish took 48 middleaged white men with moderate to severe coronary heart disease and assigned them to two groups. One group received “usual care,” and the other group received a special, intensive 5-part lifestyle intervention consisting of (1) aerobic exercise, (2) stress management training, (3) smoking cessation, (4) group psychological support, and (5) a strict vegetarian, high-fiber diet with 10% of the calories coming from fat.