The International Network of Cholesterol Skeptics

Homepage                                                                                                     Discussions


Discussions July 2002

About Taubes, Atkins, Pritikin and Ornish


Stephen Byrnes
Eric Freedland

Malcolm Kendrick

Eric Freedland

Bogdan Sikorski
Tom Clayton
Eric Freedland

Tom Clayton

Stephen Byrnes

Barry Groves
Tom Clayton
Dag Viljen Poleszynski

Bogdan Sikorski


 7. July
Stephen Byrnes

Everyone: Well, I may not have made it into the New York Times (yet!), but you all may
want to read my recent "round-up" article on low-carb diets on my website at I originally wrote it for an
Australian magazine, but have since also sold it to a UK magazine. It is
also under consideration in the USA with three alternative health
Frankly, I find it amazing that Gary Taubes even got an article like this
into print, let alone in an ultra-conservative publication like the New York

16. july

Thursday July 11, 2002    Press Release SOURCE: Pritikin Longevity Center & Spa

Pritikin Doctors and Dietitians Challenge Gary Taubes' Fat-Promoting
Article, 'What If It's All Been a Big Fat Lie?' published July 7, 2002, In
New York Times

Article Fails To Recognize Significance Of Difference Between Refined Vs.
Unrefined Carbs

AVENTURA, Fla., July 11 /PRNewswire/ -- The physicians and dietitians with
the nonprofit Nathan Pritikin Research Foundation and the pioneering
Pritikin Longevity Center, one of the first American programs to promote a
low-fat, fiber-rich carbohydrate diet, are in an excellent position to
comment on major nutrition and medical topics, including the issues raised
by Gary Taubes' article published July 7, 2002, in the New York Times
Magazine entitled "What If It's All Been a Big Fat Lie?"

The article proposes that Atkins and other proponents of high-fat diets may
be correct that carbohydrates are the cause of America's obesity, diabetes,
and heart disease epidemics. The take-away from the article by the public
and many news sources, though not expressly written, is that the "low- fat,
high-carb diets" don't work and that the answer to our health and weight
problems may be an Atkins-like high-fat, very low-carb, low-nutrient diet.

Mr. Taubes is correct that the typical American diet is a disaster and his
article, much more than any other recent article, has brought to the
forefront the controversy of high-fat vs. high-carb diets. Mr. Taubes points
out that sugars and other refined carbs like white bread and white rice
cause spikes in blood sugar and surges in insulin, which, in turn, stimulate
appetite, worsen cholesterol profiles, and decrease fat-burning,
contributing to the fattening of America. Though the author mentions that
there are different types of carbs, he seemingly pronounces all high-carb
diets the same, infers that they are all ineffectual, and then makes the
leap to high-fat diets as the answer.

There is, however, another far healthier alternative: a low-fat diet that is
rich, not in sugary, REFINED carbs, but in carbs of a different color --
fiber-filled, nutrient-packed, straight-from-the-earth carbs like fruits,
vegetables, beans, and whole grains such as oats, brown rice, and corn.
These high-fiber carbs, known as unrefined carbs, cause no insulin
overreaction. Unlike the low-fat, high-carb diets generically referred to by
Mr. Taubes as causing an increase in triglyceride levels and other ills,
low-fat, high-carb diets full of UNREFINED carbs have the most proven
healthy effects of all diets.

The dramatic health results of people who have followed this kind of diet at
the Pritikin Longevity Center (over 70,000) demonstrate the remarkable
effectiveness of a low-fat, high-unrefined carb diet. A sampling of the
results from the more than 65 Pritikin studies include a 33% drop in
Triglycerides and a 23% drop in average and LDL cholesterol (4,587
subjects), 30% reduction in fasting insulin by subjects studied with
Syndrome X, and of 652 type 2 diabetics, 39% of those on insulin left the
program insulin-free and 70% of those on oral medications left

These results have been published in peer-reviewed medical journals such as
the "New England Journal of Medicine" and the "Archives of Internal
Medicine." Regular exercise and a low-fat diet full of fruits, vegetables,
and whole grains have also been proven to reverse coronary artery disease
and prevent heart attacks. And in the largest study ever published on weight
loss, the National Weight Control Registry, most of the nearly 3,000
subjects credit two factors for their success: a low-fat, high-carb diet and
regular physical activity. They lost, on average, 64 pounds, and,
impressively, kept it off for five years and more. Only 1% followed a
high-fat, high-protein diet.

No such data exist on the high-fat diets. Without data to show that a
high-fat, low-nutrient diet is safe or effective in the long term, it seems
irresponsible to promote such a diet. We agree with Mr. Taubes that research
comparing an Atkins'-type diet with a low-fat diet is badly needed, but it
is imperative that the low-fat diet used is one that is full of high-fiber,
unrefined carbs. We are ready, willing, and able to be the comparator.

In conclusion, we wish to assure Mr. Taubes and readers of the New York
Times that low-fat, high-carb diets have NOT been "a big fat lie."
Certainly, if we trade fat for sugars in the form of refined carbs, we ARE
living a lie. "Fat free" carbs can make us fat. But, just as there are
"healthy" and "unhealthy" carbs, there are "healthy" and "unhealthy" fats --
a distinction the Atkins' diet does not appear to recognize. A huge body of
research has confirmed that saturated fats, cholesterol, and trans fatty
acids block arteries. They're the primary culprits of our country's #1
killer: heart disease. Foods sizzling with saturated fat do clog arteries.
Mr. Taubes was right to wince over his breakfast of sausage and eggs.

SOURCE: Pritikin Longevity Center & Spa


Eric Freedland

Colleagues,   At the risk of preaching to the choir... Talk about misleading... Until Knopp et al (JAMA 1997), the Pritikin diet was not studied alone and without exercise, stress reduction, and other components of a comprehensive approach such as Pritikin's and Ornish's. Knopp et al clearly demonstrated that despite the assistance of spousal education and support the lowest fat group could not tolerate such a low fat diet. They found that as percentage of fat was lowered below 30%, traditional lipid profile risk factors clearly worsened in direct relation
to the degree of  lowering of percentage of dietary fat. The weight loss registry is not really a trial, and it shows that, yes, a very small percentage of folks can keep weight off with a low fat diet if they also exercise vigorously for about 90 minutes per day. What kinds of folks do you think sign up for a weight registry? I'm guessing not predominantly the dismal failures. Is this supposed to be scientific evidence?   Perhaps it is along the same lines as the dogma that brought us the widespread use of HRT, until someone finally conducted a large controlled trial. (JAMA 2002)  Why do the Pritikin folks not cite the numerous studies suggesting  glycemic load's association with elevated CRP and other risk factors for diabetes and CHD. The jury is still out re insoluble fiber's usefulness and it would seem that soluble fiber's general usefulness is likely due to its slowing of carbohydrate absorption and glycemic index of meals. This is probably not as important in a diet that is low-carb to begin with. 

So,  according to the Pritikin folks who are unbiased and in the best position to comment,  I am to conclude that large amounts of insulin are bad, that highly refined carbs elicit large spikes, but large amounts of less refined carbs, which also yield a net large amount of insulin, are OK. Could someone please explain how that works?

Saturated fat has been villified in part because of the many studies that do not control for the background diet. The recent study in Diabetes Care by Willett's group while showing a relationship between hot dog (and other processed meat) consumption and diabetes, showed no such association with saturated fat. The nitrites and other factors, perhaps contaminants, as well as trans fats, and perhaps low fiber along with a high carb/ high caloric diet, are likely contributors to disease. By the way, contrary to the Pritikin folks who are in the best position to know,  Atkins clearly advises against trans fats and one will not find any such ingredients in his products.
If one is going to follow a high carb, low fat diet, it certainly makes sense for it to be low GI with truly whole grains and lots of high antioxidant and phytonutrient laden fruits and vegetables. For some individuals this may work Ok, especially those with the good fortune to have been born with some genetic protection from developing insulin resistance and who exercise quite a bit. (It could also work Ok only for a while in others.) But it is documented clearly (see multiple refs by LC Hudgins et al) that if we do not consume enough fat our bodies will manufacture SATURATED fat. Again, look at the fatty, marbled steak. Where did the fat come from if the cow ate only low fat grain?   


Malcolm Kendrick
Dear sceptics (as we spell it in the UK)
All ideas start as heresay and end up as superstition. The high fat diet God
cannot be attacked using logic and facts, we need to make effigies of
International opinion leaders and stick pins in them. This is my new
approach - I will let you know if it works or not. If any of you feel a
sharp pain between the shoulder blades then you will know it's working, but
not accurate.

Moving on. I have become intruiged by the condition called HIV
lipodystrophy. It may be caused by the virus itself, or it may be triggered
by protease inhibitors. Or it may be a combination of both - this is not
clear. However, HIV lipodystrophy would appear to have another name
(syndrome X) the metabolic and fat re-distribution is identical.

I read an article that suggested that HIV-lipodystophy was caused by
increased senstivity to cortisol at the post-receptor level. But, I can't
for the life of me find it again. Do any of you have any information/papers
etc. on HIV-lipodystrophy that support the 'cortisol sensitivity'


Eric Freedland
Malcolm, The expert on this area is Stephen Grinspoon, MD at Mass General Hospital
(Neuroendocrine unit). He recently gave medical grand rounds there on this
topic. If you can't find his contact info maybe I can help.


 Bogdan Sikorski
Dear Sckeptics (maybe that spelling can solve the Anglo-American split)
No, It does not look right but Scheptics does!

This discussion re: which dietary approach is better is indeed interesting,
but pointless. As Eric eloquently points out the facts are laid out for
every one to see! But the "blind" will never acknowledge them. Clearly, the
collective amnesia about the work done by Kekwick et al. is also endemic in
some dietary circles. Must be the combined effect of statins and low-fat
I would like to point your attention to the attached article.
If such crappy work is produced to support the high-fat camp, then we have
no hope of convincing anyone who would care to listen.
This must be the work of the "fifth column" (speaking in military terms).
Please make sure that you read the appendix.

(The crab: Eric C. Westman, MD, MHS, William S. Yancy, MD, Joel S. Edman, DSc, Keith F. Tomlin, Christine E. Perkins, MSW Effect of 6-Month Adherence to a Very Low Carbohydrate Diet Program Am J Med. 2002;113:30 –36.


Tom Clayton
Bogdan:  Pardon me for being dense. Please summarize why the article is crappy.  

Eric Freedland
Some thoughts....
Ornish never studied his diet alone. It was always part of a comprehensive
lifestyle intervention program. Knopp did study the diet alone and found it
worsened risk factors. Ron Krauss also suggests the LDLs get smaller while
HDL goes down and TGs go up. As far as Ornish showing objective evidence of
improved disease--that's BS. He used angiography and showed questionable
changes. Many of his first study's treatment group dropped out, and the one
death was in the intervention group. This he attributes to over-exercising.
The numbers were also small. It didn't hurt that he had mentors and
co-authors like Gotto a former pres of the AHA.  It is interesting that in a
letter to Lancet, Lance Gould, one of his co-authors, renounced the Ornish
diet as potentially harmful in that it appeared to worsen some risk factors.
As far as Ornish using PET scans and flow what. According to
Libby and others like Braunwald (see two months ago cover article in
Scientific American), only 15% of MIs are related to disturbed flow and
significant plaque size. The overwhelming majority are due to the types of
plaque which are vulnerable to becoming inflamed and rupturing. This can
result in breaking off a piece or bleeding and clotting off a vessel. A July
4 NEJM study and accompanying editorial (Button et al 2002) suggest that "to
the extent that inflammation is a marker of plaque vulnerability, the work
of Button et al suggests that persons with an increasd risk of acute
coronary events are likely to have many vulnerable lesions throughout the
coronary tree" and may not benefit from focal therapies such as angioplasty
and bypass. I've heard cardiologists lament that they might angioplasty a
large stenotic lesion but it might be the small ones that are truly
life-threatening. I would venture, as I believe would Krauss, that the
increased number of small LDL particles along with high TGs and low HDL
indicate insulin resistance and a pro-inflammatory state that could likely
result in a greater risk for MI.

Why does Ornish get away with saying that his studies "show actual
documented reversal of heart disease...We did not look at traditional risk
factors but actual disease?" Meanwhile, in interviews he states as though it
was established fact that  " eating meat causes heart disease" and other
outrageous statements without backing them up. Shouldn't there be a level
playing field where everyone should be held to the same standard? 

I agree that studies to support points must be pristine. But, Tom is quite
right that there is certainly a strong, biased mindset that can be difficult
to break through. A few months ago there was an epidemiological study by
Willett's group in Diabetes Care that showed a "Western" diet (especially
hot dogs) increases risk for diabetes. The article specifically mentioned
that the study did not show a correlation with saturated fat intake and
diabetes (it did suggest an association with diabetes and processed meats
such as hot dogs). Yet, the accompanying editorial states something to the
effect of how another study demonstrates that the risks of diabetes
increases with consumption of saturated fat. These guys are not
intellectually honest. The day before the study was released I heard Willett
say that they did not show a relationship with saturated fat and diabetes
but that may have been a wash because of the effect of the gycemic load.
Huh? I think Willett is struggling with the notion that saturated fat might
not be a culprit or villain. Perhaps he'll come around


Tom Clayton
Eric wrote: Shouldn't there be a level playing field where everyone should be held to the same standard? You mean like lawyers?   Politicians? You are exactly right to question this, but this would have to be IN YOUR DREAMS. Sad but true.


Stephen Byrnes
Malcolm:  It would appear that protease inhibitors are at the root of lipodystrophy as
the condition seemed to only appear after these drugs were introduced. Work
on cortisol and its relationship to AIDS was done by Alfred Hassig and his
Study Group on Nutrition & Immunity in Switzerland. They had a number of
papers published and they can all be read at Go to
"FIND" and then look up Hassig's name.


18. july
Barry Groves
Hi Bogdan  I see what you mean. What the h*ll could all that supplementation possibly
be for? I have lived low-carb for 40 years without a need to take pills.
With real food, who needs them? 
And I don't see any advice or indication that the lack of carbs was made up
with increased fat. I wonder if the people who ran this study really knew
what a low-carb diet in the real world should be.
But then Atkins sells pills and diet supplements. They are a big part of his
income. Perhaps the scientists were led to believe that they were necessary.
But I believe they send entirely the wrong message: "if you eat a low-carb
diet it is so unbalanced that supplements are needed" is not what I would
want people to believe.


Tom Clayton
I remember talking to John McDougall years ago about the problems with making a living just promoting "prevention."  So, I do not view it as a contradiction. Eating the right foods (that we were designed to run on) AND taking supplementation in case the supplements were not there, or in sufficient amounts, or to counter the often decreased absorption as one ages simply means that you cover more bases. I am now experimenting with a nocturnal growth hormone releaser and I haven't had as much energy in years (I am 50)  so, we don't know everything we need to know yet. 
Please pass the pills.


Dag Viljen Poleszynski

I agree with Tom - there is no contradiction between eating well and taking supplements. Thousands of studies show the benefits of supplements, and the theoretical justification is clear to me:
1) Nutrient density of foods were much higher when we evolved as humans,
2) traditional foods have much higher nutrient densitity than present-day industrial foods,
3) pollution is much higher today, requiering more cofactors for detoxification and elimiation of free radicals,
4) we eat less because we move around much less, hence ingest less nutrients than before,
5) nutrients are not toxic
6) we are biochemically so diverse that some people require 100+ times more of a given nutrient than the average to achieve maximum health benefits
7) nutrients have been shown to be able cure or ameliorate more that 100 somatic and possibly 20-30 mental illnesses including schizophrenia (which also may be ameliorated by eating the right foods)...etc
 Bruce Ames recently wrote an excellent paper showing the usefullness of supplements to treat 50 genetic diseases, also giving creadit to the pioneering work of Linus Pauling and Roger J. Williams. This is only the tip of the iceberg. Walter Willett and JAMA concurs with this, recommending supplements. It is totally unrealistic to believe that everybody will eat perfect diets, that agriculture suddenly will produce high-quality, unpolluted foods, and that the food industry will not further deplete it.
The key should be eating the best foods we can and take supplements adapted to each person's individual needs! I take quite a few myself (going on 56 and feeling great!)....


 25. July
Bogdan Sikorski
 Dear Dag Viljen and others
I would choose to disagree with the line of your argument about
supplements, and align with Barry on that subject.
However, I certainly recognize that supplements may be needed in cases,
including pathologies, when dietary supply of proper nutrients is, or has
been, chronically poor or simply wrong. But which ones?

A good example is Vit B1 which is almost exclusively needed for carbate
catabolism, but virtually obsolete when running on fat!
Animal product/fat-based diets require no supplements if implemented
correctly, as shown by JK.

Over the years I have taken kilograms of various supplements with minimal
benefits to my health, but since I changed my diet over 5 years ago - I
have taken no supplements (except for CoQ10 for few weeks last year to see
if it did anything to me - I  could see no clear benefit - as yet?) and my
health has never been better.
Fat is it!!! and JK - rules!!! - and so say all of us (millions in Poland
and few lost souls outside).

Dear Tom and others
It will be my pleasure, but firstly - sorry for a delay, caused initially
by ISP server problems, and next (last Saturday) by an injury to my left
palm caused by a chisel slip. I managed not to cut any tendons, but the
collateral damage done by the 8 cm cut appears to be slow in healing.
Clearly, my typing is presently rather inefficient so I will be brief.

1. As Barry has already indicated - what the hell were they doing including
all this supplementation. According to the title - the effects of
low-carbate diet were supposed to be studied, but were not!!!
2. Experimental design was simply tragic! -
         a. self-reporting
         b. no structured diet plan (virtually free-hand except for
supposedly controlled carbate intake)
         c. "... Food intake before the program was not assessed, but..."
         d. curious switch from <25 g/d to "about 50 g/day" of carbate -
why - no reason given (to reduce ketosis? - why - is it bad? -  clearly not
in most circumstances.
         e. Program Adherence - assessment - ''Based on an average of 8
days of food records....'' - commmmmmooooon!!! - in the  words of a certain
tennis player - for 6 month study?
         f. few other dubious decisions including exclusion criteria

3. As pointed out by the authors - ''Limitations of this study include
uncontrolled design, self-report of several variables..." (the most crucial
ones for gods sake!!!

I am very surprised that the Atkins Center paid for that study - its is not worth a cent!!!
On the other hand - it might correctly mirror an approach of a typical person to any dietary challenge, when no strict criteria or external controls are put in place.