http://www.thewest.com.au/20040329/...-sto122237.html

Fat loss fads: the facts and fallacies

By Dr Geoff Taylor


AS A medical practitioner who has watched for 30 years the changing "fads" of medical dietary advice, the current media campaign highlighted in The West Australian against low-carbohydrate diets strikes me as the height of hypocrisy and intellectual bigotry.

In this modern age, we as practitioners try to practise evidence-based medicine. In other words, no treatment should be recommended unless it has been thoroughly trialled and shown to be of benefit. Conversely, no treatment should be rejected unless it has failed to be shown of benefit.

Here in Australia we are still recommending low-fat diets as the cure for all ills - obesity, heart disease and diabetes.

It may come as a surprise to many that all attempts to show that they prevent heart disease have failed to show any significant benefit. An extensive review of dietary trials in the European Heart Journal (1997) failed to show any benefit from diets low in saturated fat. Indeed, one big study showed a considerably higher mortality in the patients treated for five years with a low-fat diet, and the increased mortality continued for the following 10 years.

The only dietary advice that has been shown through proper trials (DART trial and Lyon study) to be worth while is that we should eat more foods containing particular polyunsaturated fatty acids - we should supplement our diet with fish and fish oils and eat nuts.

The benefits of obese people losing weight are immediately obvious to most of us. The reason the public is adopting low-carbohydrate diets is that they work, whereas countless low-fat diets that have been recommended for the past two decades have failed.

There is nothing new about the Atkins diet promoted since 1972, except it almost encourages participants to eat fat. The Scarsdale diet introduced in 1978 is perhaps much more sensible. It is not hard to create a low-carbohydrate diet that is also low in saturated fats.

Low-carbohydrate diets have been around since Victorian times when William Banting published a small pamphlet in 1863, after losing 21kg in a year. The diet had been suggested by the famous French physician Claude Bernard.

Many of us take issue with the Atkins diet because of its allowance of fat consumption. Yes, we would like to think that this would be harmful. Should we not sit up and take notice when the trials done on the Atkins diet show an improvement in cholesterol and lipid profiles rather than the opposite. Also, patients lost weight more effectively than on a low-fat diet. Are the British really more open-minded than we Aussies? The British Medical journal ran an editorial article last year entitled The Atkins Diet is Vindicated after the American trials were published.

One criticism levelled at low-carbohydrate diets is that they induce a state of dangerous ketosis, the ketosis being caused by the burning of fats. Funny really, that the whole human race is in a state of ketosis every morning when we rise from our slumbers, before we eat breakfast. Must be very dangerous. Surely the whole point of weight loss diets is to burn the fat we have accumulated. It can be argued that any diet that does not cause a state of ketosis is a total failure.

We currently face a worldwide epidemic of obesity and diabetes, a disease of carbohydrate metabolism. Traditionally diabetes was treated with low-carbohydrate diets, but 20 years ago physicians did a mental knight's move, arguing that, as diabetics frequently died of heart disease, we should recommend a low-fat diet.

Trials have failed to demonstrate any benefit for heart disease from this advice, yet the advice for diabetics remains unchanged. Indeed, the dietary advice of Diabetes Australia is that 50 per cent of a diabetic's diet should be carbohydrate. Is it any wonder that our diabetic patients continue to get fatter and their diabetic state deteriorates.

Modern physicians seem to have forgotten the work of Professor Kerin O'Dea, who in 1984 took 10 Aboriginal diabetics out into the desert to live on a traditional hunter-gatherer diet. There was a huge reduction in the carbohydrate in their diets. In just seven weeks, the average weight loss was 8kg, and their diabetes had improved to such a degree that in 50 per cent of them blood sugar levels had fallen to normal levels. What she demonstrated was that diabetes was potentially curable, yet this sentinel paper is largely forgotten.

Nowhere in the world is the answer to our problems more immediately obvious than here in Australia. The human race evolved as hunter-gatherers like the Aboriginals. It is only in the past few centuries, a mere blip in evolutionary time, that we have had access to foods such as refined flour and sugar.

Man has been surviving for many thousands of years on a low-carbohydrate diet. There can be little doubt that before white settlement there was no such thing as obesity in Australia.

The low-fat dietary advice of the past 20 years should be viewed as a social experiment that failed. We face an epidemic of obesity and diabetes, yet the so-called experts are rejecting the most useful dietary management out of hand without considering the facts. Are they throwing the baby out with the bath water?


Geoff Taylor is a Busselton doctor
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I sent this article to the politician over here who is talking about
spending money on anti-lc programmes.

Val