Archive for March, 2009

Calories Count; not Carbs

Sunday, March 15th, 2009

The low carbohydrate diet, basically a high fat diet which has been around since the 1860’s,  enjoyed an astounding re-awakening in the 1970’s thanks to Dr. Atkins, and again in recent years. But if one looks at the history of weight loss diets, other magic methods have recurrently captured the public imagination. So we have had low fat, high protein, low protein, high carb, high fat and other “miraculous” diets. Rarely mentioned is the low calorie diet. Moreover, every month brings an avalanche of outrageous fad diets-3.9 million sites on Google: the South Beach diet,the Cheater’s diet, the Ornish diet, the Dr. Phil diet, the Shangri-La diet, the banana diet, the Raw Foods diet, etc., etc. Where does this leave Low Carbs and Atkins?

One false theory is that only carbohydrate in the diet will stimulate insulin production. The truth is that all ingested foods stimulate insulin production. The second false theory is that insulin stores fat only when high carb foods are eaten. See Kathy Goodwin’s excellent article The bottom line with regard to the body’s biochemistry is that fat will only be stored if too much food (from any source) is eaten.” My emphasis.

The Danish investigator, Professor Astrup analyzed the Atkins diet and assorted claims that low carbohydrate diets are effective for weight loss. In Astrup’s exhaustively researched article, in The Lancet 2004; 364:897, he and his colleagues examined 2,609 articles on low carbohydrate diets, and found out of only 107 articles which could be reviewed. Only five studies evaluated participants for more than 90 days, but were not randomized and had no control group.”There was insufficient evidence to make recommendations for or against these types of diets.” Is the Atkins or low carb diet safe? Here is what Astrup had to say: “…restricted intake of whole grain bread and cereals, fruits and vegetables does not equal a healthy diet, and absence of these food groups may increase the risk of cancer and cardiovascular disease.” Moreover, the low carbohydrate contents of the diet is “below the minimum needed to supply the brain and muscles with sugar.” Atkins dieters more often report muscle cramps, diarrhea, halitosis, general weakness, and rashes than those on a recommended low fat diet.

Finally, a recent lead article in the New England Journal of Medicine (360;9, Feb.26, 2009) Comparison of Weight-Loss Diets with Different Compositions of Fat, Protein, and Carbohydrates” compared 811 overweight adults to one of four low calorie diets of different composition. This is one of the most thorough and longest-term study (two years!) reported on the subject. Conclusion: “Reduced-calorie diets result in clinically meaningful weight loss regardless of which macronutrients they emphasize.”

In other words, for weight loss Calories Count, not the percentage of fat, protein, or carbohydrates in your diet.

Medical Schools, Healthcare, and Big Pharma

Wednesday, March 4th, 2009

Who would have believed that Harvard Medical School could be contaminated by Big Pharma? The New York Times recently reported on the front of their business page that a Professor of Pharmacology  displayed suspicious bias by belittling one of his students who asked about the possible side effects of a cholesterol lowering drug. This led to an online search by one of the students who discovered that the professor, a full-time member of the Harvard medical faculty, was also a paid consultant to 10 drug companies.

According to the Times article,  this episode grew into a “full-blown student and faculty movement investigating and exposing the drug industry’s influence at Harvard and 17 affiliated institutions.” The students and allied faculty members claim that Harvard should be embarrassed by the American Medical Student Association who gave the renowned institution an F grade for their poor management in monitoring the receipt of money received from drug companies.  It should be added that other top notch medical schools received much higher grades, for example, the University of  Pennsylvania received an A, Stanford, Columbia and New York University, B’s, and Yale a C.

The teaching hospitals of Harvard are privately owned, but not the medical school. Moreover, the previous dean served on a pharmaceutical company board. Dr. Jeffrey S. Slier, the new dean who wants to clean up the mess has recently announced the formation of a 19 member committee to reassess the school’s conflict of interest policies.

In the meantime the State of Massachusetts has passed a law effective July 1 requiring licensed physicians to disclose corporate gifts over $50, and the U.S. Senate is now investigating several prominent medical professors for ties to the pharmaceutical industry.

I have previously written on the politics of drug promotion in my newsletter, Second Opinions in the “Ties that Bind”   The monied tentacles of the pharmaceutical industry reach out to the entire health care archipelago. This includes some of our most prestigious medical journals, researchers, medical experts setting nationwide medical guidelines, professional associations, hospitals, and, of course practitioners.  It’s not at all surprising that medical schools are being influenced by drug industry money.

Equally shocking is the fact that the United States and New Zealand are the only countries in the world that permit the promotion and advertising of drugs to the general public via TV and the other media.