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The Low-Carb Community Is Its Own Worst Enemy

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The Low-Carb Community Is Its Own Worst Enemy

Yoni Freedhoff, MD

Physicians have been recommending low-carb diets to patients since at least the 1860s, when Dr William Harvey encouraged the British royal family's undertaker, Mr William Banting, to adopt one. He in turn penned the world's first known blockbuster diet book — the not particularly excitingly named Letter on Corpulence, Addressed to The Public.

And yet today, one of the loudest laments of low-carb-promoting physicians is that the medical community, as a whole, purposefully eschews their favored diet. Perhaps one of the reasons for this is the low-carb community itself.

Self-righteous, Indignant Vitriol

Unfortunately for physicians who appropriately see low-carb diets as one of many reasonable options for their patients, the larger medical community may struggle to take them seriously. For instance, it took until 2019 for the American Diabetes Association to include low-carbohydrate diets as a therapeutic option in its nutrition therapy consensus report, and JAMA recently published an opinion piece designed to pour cold water over a diet that has and is helping many people manage weight and various diet-responsive comorbidities.

I would argue that at least part of the blame here lies with the ways in which low-carb diets' loudest champions promote them. In virtually every other area of medicine, physicians are comfortable with the existence of multiple treatment options and modalities, and they also recognize that each patient responds differently to different treatments. When it comes to diets, however, for many vocal low-carb MDs, there can suddenly be only one.

And it's not just the overzealous promotion of one diet at the exclusion of all others that the low-carb community bizarrely champions. Their self-righteous and often indignant vitriol is frequently on display, whether it's trotting out the tired trope of medical organizations and dietary guideline committees purposefully manipulating or ignoring evidence (see the extensive corrections and clarifications for this piece), described by a prominent low-carb physician as being representative of a "conspiracy by a 'matrix of agendas' to promote a plant-based diet"; or asserting that the overwhelmingly unfollowed low-fat dietary guidelines are responsible for the obesity epidemic (refutation available here); or stating that older dietary guidelines posters will one day appear in "museums recording history of human genocide"; or publicly fat-shaming dietitians and researchers with obesity; or even food-shaming a chemo-receiving cancer patient who posted online that she enjoyed (gasp) an ice cream cone.

And it's not just random, angry public trolls pushing these narratives. Some of the low-carb community's most visible and vocal physicians drive these very messages, along with others that may be dangerous and/or incredibly misleading. From stating that fruit should be treated like a poison, to publishing op-eds promoting statin denialism (a thoughtful discussion on this topic can be read here), to coauthoring books with marginalized medical conspiracy theorists with large platforms (more on Dr Mercola here), to stating that sugar is eight times more addictive than cocaine, to producing and selling tea purported to improve weight loss outcomes, to even amplifying anti-vaccination messaging in order to imply that low-carb, high-fat diets treat "vaccine-damaged" autistic children, the low-carb medical community makes it exceedingly easy to not take them — and by extension, their chosen diet — seriously.

That's a shame, of course, as low-carb diets are just as good as other diets when it comes to weight management, whereby those who enjoy them enough to adhere to them can maintain large, clinically meaningful losses and may also see benefits beyond those attributable to simple weight loss, including improved glycemic control in patients with type 2 diabetes.

Less Hyperbole, More Collaborations

If the low-carb community wants to make inroads into the medical community as a whole, I have two recommendations for them. First, the community must do more to call out its own bad actors. As it stands now, at least online, the low-carb community is a self-congratulatory, reinforcing, at times vicious echo chamber. Doing more to police its own members' hyperbole and ugliness would allow for thoughtful discussions and collaborations.

Second, the community should be expressly championing low-carb diets as just one of many options for those seeking weight loss or other diet-related health benefits, not the sole option. Physicians, generally speaking, are quite comfortable with multiple treatment modalities, and diet should be no different — especially because one person's best diet can be another person's worst.

https://www.medscape.com/viewarticle/916329

This is not what i would call a thoughtful article. It is more like a rant filled with gross over generalizations about low carb doctors. Certainly there is plenty of room for criticism of those in the low carb community that overstate their claims but that can be said about any group of advocates about almost any issue you can think of. There are many thoughtful low carb doctors who back up their advocacy of low carb diets with scientific evidence and experiential knowledge. There is no mention of these people. This is a rant not a thoughtful critique and it makes no mention of the long history of crazed low carb demonization, starting in relatively recent times, with what Dr Atkins endured and still, even after his death, continues to endure. We need careful consideration of issues not rants that paint everyone with the same brush.

A tired claim that could be rewritten to substitute "vegan" or "vegetarian" or "plant-based follower" for "low carb." It's obvious where Freedhoff stands in all this. I choose to ignore many of his juvenile, inaccurate claims in this article. Guess I'm one of the self-righteous, indignant low carbers spouting vitriol.

We don't like your diet because you aren't nice!?!??!?!?!?!?!

Yeah. Right.

It couldn't possibly have been our own vested interests.

It's all because Dr. Atkins wasn't nice about it.

The upside of the existence of such an article is that it seems like someone is feeling the heat for stubbornly refusing to consider the benefits of a low carb diet. I guess we're making some progress.

"Dr. Yoni" is the Dr. Oz of Canadian TV. He doesn't have his own show (yet), but he appears on everyone else's shows. As an associate professor of family medicine at University of Ottawa, he is close to the federal government and involved in setting nutrition guidelines. I fast-forward whenever I see him.

A thoughtful piece about this article posted today by Dr Barbara Berkeley on her blog, Refuse to Regain:

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August 13, 2019

Are You a Dietary Fundamentalist?

by Barbara Berkeley, MD

I was struck today by an opinion piece by Dr. Yoni Freedhoff on Medscape, an educational physician website. Dr. Freedhoff, a thoughtful commentator on the diet and obesity scene, contends that the stridency of the Low Carb Community is turning people off. Many Low Carb advocates have gone over the top, he says. They are unable to see any other viewpoint. In fact, they often appear to arrogantly assert that there is no other viewpoint.

Perhaps Freedhoff's article hit home for me because it was a painful reminder of the many times my husband has scolded me for dietary arrogance. He gets particularly annoyed when I start preaching my Low Carb gospel to people when we are out to dinner with them. Granted, I only do this when someone at the table has asked me for advice about eating. But while it is a friend who opens the door, I am the one who barges through it with my soapbox.

https://www.refusetoregain.com/2019...amentalist.html

I assumed from the tea comment he had it out for fellow Canadian Dr Jason Fung with a much bigger following than he has. But quick skimming of his Twitter feed, he has it out for numerous low carb doctors. Mainly ones who also post often on Twitter..it is a cesspool. My solution all doctors off Twitter.

I don't get the impression that statin denialism is the usual stance. More like statin realism--I see most saying that the benefits have been shown in a subpopulation of people with confirmed heart disease, and asking why statins are broadly advocated beyond the group that they've actually been shown to have some benefit to. That is a fair question.

As far as championing a diet at the expense of others--so what? I wouldn't criticize Eric Clapton for going on and on about the blues. What about Classical, or Hip-Hop? People are free to go learn about some other diet.

Compliance is key, everybody says that. What brings compliance? It's not a Vulcan, non-emotional style of thinking. Which wouldn't be useful anyways, because without feelings there's no reason to prefer one outcome over another, anyways. I want somebody who's enthusiastic about a plan to help sell me on it. We have to guard against cognitive bias--but hey, without that bias, why would we prefer our parents or our children? It's not all bad, it can go too far.

As far as fruit being poison--I remember early in my low carb eating, reading Art DeVaney's blog back when it was free and something that people actually read. A lot of talk about fruit in paleo etc. I ended up eating way more fruit than DeVaney advocated, along with low carb food. Atkins plus lots and lots of fruit--blood pressure that had gone from slightly above normal to optimal with low carb eating went back up and beyond, to the highest readings I've had in my life. In my 30s then, 51 now. Aches and pains, weight regain. There might be a fruit-filled diet that I could thrive on, I'm open minded about that. Maybe if I moved to Hawaii and ate their traditional pre-American diet. But there is at least one diet that yes, I'd call adding fruit to it basically toxic.

I might go farther than many people here in thinking that a type I diabetic might sometimes do better on a low fat, high carbohydrate diet than the SAD. Improved insulin sensitivity might greatly improve the numbers of somebody with compromised beta cell function, bringing their insulin requirements down to something that their pancreas can handle. But adding sugary fruit to a diet high in fat, including an otherwise ketogenic-type diet--no. That's unapologetically toxic. Just is.

As far as 'most visible and vocal' goes--I don't know that judging a community by its loudmouths is the way to go. :lol:

I suppose the response from one who is threatened by the success of a particular WOE is consistent with Freedhoff's views. I know the excitement of those experiencing significant health improvements due to a particular WOE often comes across as strident and enthusiastic for those wanting to share, but arrogant and indignant? Those are subjective terms one can never truly confirm.

It's not paranoia if they really are out to get you. :rolleyes:

This thread and one in the LC Reseach/Media subforum ("The War on Meat has begun...") strike me as both being related to the topic of nutritional zealotry versus nutritional enthusiasm.

When does enthusiasm cross the line into zealotry? My first approximation answer is: An enthusiast SHARES information and thereby attempts to convince others to voluntarily convert to his/her way of thinking. A zealot attempts to cut off the exchange of any information contrary to his/her way of thinking and to FORCE others to act according to his/her way of thinking regardless of whether they think/feel differently.

Under my definition, 99.99% of the members of this forum are nutritional enthusiasts, not zealots...and I've met/interacted online with very very few low-carb zealots...despite what Dr. Yoni Freedhof writes. OTOH, the University Warden (President? Dean?) discussed an article linked to a post by Demi in the "The War on Meat thread definitely qualifies as a nutritional zealot. And, unfortunately, I've met/interacted online with a good many Vegans who are nutritional zealots.

What do y'all think? How would you draw the line between zealotry and enthusiasm?

Honestly to me it feels like watching this team of bullies harass and belittle and marginalize and exclude and propagandize against and get funding pulled from and prevent publishing of another tiny group of a few people, who eventually have a few more people join them.

Until one day, someone on behalf of the bully group basically says that the only reason the message of the tiny group isn't accepted better is because they are just too strident about what they believe.

Having failed to completely silence them, despite attempts on every level to do so for a century -- despite being quite successful at reducing dramatically their funding, scope and message -- now any issue is still the fault of the tiny group being attacked all these decades.

Talk about "crybully" on the science level.

PJ

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Originally Posted by bevangel

I think your definitions are consistent with my experiences. Enthusiasts vs zealots is a good way to categorize the approach. Anyone following a different WOE than I deserves respectful consideration. When some attempt to impose that WOE on all in the name of health, saving the planet, or any other agenda not directly related to one's nutritional health, that's when I strongly object. Vision of the Anointed, by Thomas Sowell defines and describes this behavior pattern very well.

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Originally Posted by bevangel

It's not paranoia if they really are out to get you. :rolleyes:

Especially if they're wearing masks and carrying bats! :agree:

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Originally Posted by NewRuth

We don't like your diet because you aren't nice!?!??!?!?!?!?!

Yeah. Right.

It couldn't possibly have been our own vested interests.

It's all because Dr. Atkins wasn't nice about it.

My bold because this is a favorite excuse of those who essentially take a bullying stance. "It's your tone" is a good reason to offer a teen who is learning manners (hopefully!) while it is deceitful to use this excuse to ignore important facts.

From what I have gleaned, mostly from reading between the lines, it was his nemesis, Dr. Ancel Keys, who wasn't "nice." It is my understanding he was a ruthless careerist.