Atkins - fluid gain, coronary artery disease, hard vs. surrogate outcomes.

[Guest guest]

> He didnt gain that much weight in the hospital. If he did, there

would have been medical intervention.

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That's not the way I read it. When you have patients, especially

comatose patients, admitted to the ICU, physicians normally give

them IV fluids. Usually about 2-3 L/day. Patients also receive

fluids with their medications. Almost every medication to such

patients is given mixed with salt or salt plus water. These

patients often retain salt and water, because they have enormously

high levels of cortisol and other stress hormones, their kidney

function often goes down, etc. etc.

This is from the website:

http://www.snopes.com/medical/doctor/atkins.asp

" Thanks to his death certificate (as displayed at The Smoking Gun),

we know Atkins was 258 pounds at the time of his death. Yet

according to a copy of his medical records, as turned over to USA

Today by the diet guru's widow, Atkins weighed 195 pounds upon

admission to the hospital 8 April 2003 following his fall. He died

on 17 April 2003 after having been in a coma for more than a week. "

This sounds very believable to me. People who saw Atkins prior to

his death note that he did not look obese. A 260 lb. weight in a

person under 6 feet tall would be very noticeably obese.

With regard to his heart condition, as far as I read, Atkins never

had coronary artery disease, but a form of cardiomyopathy - this is

a disease that affect cardiac muscle directly and is not due to

insufficient blood supply due to coronary atherosclerosis. He had a

cardiac arrest due to this myopathy. This is described in the lay

press as a " heart attack " , which is confusing, since usually, " heart

attack " means myocardial infarction, due to coronary artery disease.

Without looking at the autopsy report, one can't be sure - but I

haven't seen any information that Atkins ever had coronary artery

disease. The causes of cardiomyopathy are many. Few are diet

related and those that are usually are due to severe vitamin

deficiency. Most are due to virus infections. So it is doubtful

that Atkins' heart problems were due to his diet. (I do read,

however, that some people doing Atkins and eating a lot of saturated

fat do have increases in their lipids, and there is one lawsuit

underway where a person contends that Atkins cause his heart attack -

to prove or disprove this would require a large randomized,

controlled trial - so we'll never know).

See:

http://archives.cnn.com/2002/HEALTH/diet.fitness/04/25/atkins.diet/

and also:

http://www.cnn.com/2004/HEALTH/02/16/atkins.widow/

It's easy to think simplistically. There are many thinks other than

atherosclerosis that incapacitate and kill people. This also is

relevant in choosing the best diet.

Just because a given diet improves insulin sensitivity or lowers

certain markers of atherosclerosis, or increases HDL cholesterol, by

no means assures that that particular diet will have an overall

beneficial effect on health.

This is why the final measure of any diet is in terms of so-

called " hard outcomes " . Will this diet

a) Make you live longer?

Result in fewer hospitalizations?

c) Improve quality of life?

Right now people are focusing on so-called " surrogate outcomes " -

primarily weight loss and inflammatory and lipid markers in the

blood, etc., or for high blood pressure - lowering of the blood

pressure.

This is OK, but each one of these diets may conceivably be doing

something bad to the body in some other area that might counteract

the apparently good effect on these surrogate outcomes.

Just a few examples:

1) You have no muscle mass. You lose protection of " sitzfleisch "

and prolonged sitting causes damage to your pudendal and other

nerves - a form of " bicycle seat neuropathy " . You develop bladder

and bowel problems, leading to a markedly diminished quality of life.

2) You have no tissue reserves. You develop some serious medical

condition and are hospitalized. You can't eat for several weeks

because of your condition. Because you have no reserves, you

rapidly become malnourished, infected, and die.

3) You develop osteoporosis. At age 85 you fall on the sidewalk and

break your hip. You die in the hospital due to complications of hip

surgery.

4) Your spouse gets tired of your obsessive eating habits. He or

she feels unloved because you don't eat the food they prepare. Your

spouse divorces you. Divorced people have a much lower life

expectancy than married people.

5) You and your fat friend are on a sailing trip in the Caribbean.

Your boat capsizes and you are in the water for 18 hours until being

rescued. After 18 hours your fat friend is plucked out of the water

by the Coast Guard. You die of hypothermia after the initial 6

hours of being in the water (I think this is a paraphrase of a story

that actually happened).

I'm just speaking generally here - philosophizing, and not talking

about any one diet in particular. So we need to take a broad look

at these diets in general.

Unfortunately, no hard outcome studies have been done yet in humans

using a prospective, randomized design, that I know of. I believe

some such studies now are underway. The problem is, that such

studies usually require thousands of patients to show a difference

in death rate.

Anyway, not that I'm pro or against Atkins, but the facts appear to

be that (1) he had cardiomyopathy, and not atherosclerosis, (2) he

was never obese, as his admission hospital record showed a weight of

197 lbs which for his height was quite appropriate, and (3) these

massive weight gains in hospital ICU patients happen all the time -

they are " iatrogenic " - due to IV fluid administration, and have

nothing to do with metabolism or diet or carbs.