Interesting info.debate on Atkins Diet

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BMJ 2003;327:414 (23 August), doi:10.1136/bmj.327.7412.414-e

Competing interests / conflicts of interest News extra Researcher criticised for

comments on the Atkins diet London Sue Mayor

A leading UK researcher in nutrition has been criticised by newspapers alleging

that she had a conflict of interest, after she said that the high protein Atkins

diet was based on " pseudo-science " at a recent press briefing, even though a

report from the apparently competing funding source was also discussed at the

briefing.

Dr Jebb, head of nutrition and health research at the Medical Research

Council's Resource Centre for Human Nutrition Research, Cambridge, said at a

press briefing on " faddy diets " organised by the Science Media Centre that the

Atkins diet could pose a major health risk and lacked scientific evidence. The

story gained widespread media coverage last week.

Stories appeared this week, however, in Scotland on Sunday and the Daily

Telegraph noting that she is working on a report funded by the Flour Advisory

Board, for which her research institute will be paid £10 000. The Daily

Telegraph (18 August) said: " Dr Jebb's association with an organisation devoted

to promoting the staple ingredient of one of the world's most popular

carbohydrates has raised eyebrows. "

However, Carolan ge, chief press office for the Medical Research Council,

said that the report from the Flour Advisory Board was raised at the press

briefing, although Dr Jebb could not discuss results as these are embargoed

until 23 September. Dr Jebb's authorship of the report has been posted for some

time on the website of the Flour Advisory Board, she pointed out.

The Resource Centre for Human Nutrition Research receives funding from a range

of sources-with £2.8m ($4.5m; EUR4m) each year being provided by the Medical

Research Council, of which the institute is expected to raise 30% by working for

organisations, including industry.

Ms ge said: " Dr Jebb is not receiving £10 000 herself for working on the

Flour Advisory Bureau report. The research unit is being paid as part of its

overall funding arrangements. "

She considered that funding of £10 000 would not influence Dr Jebb's scientific

judgment. She acknowledged, however, that scientists have to deal carefully with

any apparent conflicts of interest-even though she considered that these had

been openly disclosed in this case.

" It is something that the scientific community has to give thought to.

Scientists have to satisfy the need to be being seen to be independent. It is

important that scientists consider how to meet this need, " she said.

Listing all sources of research funding every time a scientists speaks may not

be the most practical way forward, she suggested. " But it is important that the

scientific community thinks how best to meet this need. "

Dr Jebb is on holiday so was unable to comment on this issue.

PMID: 12933723 [PubMed - indexed for MEDLINE]

Rapid Responses:

Read all Rapid Responses

Pseudo Argument

Owen T. Lynch

bmj.com, 21 Aug 2003 [Full text]

Dr. Jebb's detractors have used a fallacious argument in response to her

assertion that the Atkins diet is based on " pseudo science " . Rather than respond

to her assertion they have attempted to impugn her character. This is called the

ad hominem fallacy and it is a fallacy of relevance.

This type of " pseudo-logic " is the first step down the slippery slope of

" pseudo-science " .

Owen T. Lynch,

Clinc Director, West Burnside Chiropractic Clinic Portland, OR 97209 Send

response to journal:

Re: Pseudo Argument

Competing interests: None declared

Re: Pseudo Argument

How ironic to complain that Dr. Jebb has had her character impugned as Dr.

Atkins, even after his tragic death, continues to endure baseless criticism and

has for over 30 years.

Dr. Atkins was maligned because there was no research to support his nutritional

plan despite the widespread success his patients enjoyed (myself included: 50

pounds lost, cholesterol 151, BP 110/70). Then when The Atkins Center funded

research at prestigious university medical centers, he was openly degraded for

that as well.

Slippery slope indeed. " Pseudo-science " has been dictating the diets of

industrialized nations for decades.

Considering current literature, it can more rightly be said that the faddish low

fat diet, which has been shoved down our throats by those duped by corporate

interests for nearly 30 years, might well indeed be dangerous (as the current

epidemic of obesity, diabetes and cardiovascular disease indicates) and is based

simply on bad science and the wishful thinking of benefactors the ilk of which

are now paying Dr. Jebb to " research " further.

Competing interests: None declared

R. Berry

bmj.com, 22 Aug 2003 [Full text]

Don't knock it: research it!

L. Newell

bmj.com, 23 Aug 2003 [Full text]

Rather than knocking it, surely it would have been more appropriate for Dr. Jebb

to have invited researchers (herself included perhaps) to start an independent

trial of the Atkins versus any other popular " fad " diet from the bookshop versus

simple dietary advice and check what the short and long-term results were, both

in terms of maintaining weight loss and in overall health. It should be funded

by the MRC as funding from the pharmaceutical industry would be problematic

(less obesity = less ill health = fewer pills sold), and the benefits of

reducing the nation's weight are obviously in favour of the NHS budget and the

taxpayer.

I look forward with keen anticipation to the publication of the results. Not to

research it might just suggest to the cynical that Dr. Jebb has a vested

interest in retaining control over all things nutritional in the UK, which I am

certain is not the case.

Competing interests: I have skim-read the book, am not particularly

overweight, do not work in a " weight clinic " , but am an ardent proponent of the

individual's right to informed free choice.

The traditional African eats an Atkins diet.

G Fiddian-Green

bmj.com, 25 Aug 2003 [Full text]

If glycogen stores, built up by a high carbohydrate diet, are the first call for

endogenous nutrient fat stores will not be mobilised and metabolised even during

moderate degrees of anaerobic activity. If, on the other hand, glycogen stores

are depleted by a low carbohydrate diet fat stores will be mobilsed and

metabolised especially with the onset of anaerobic metbolism. In these

circumstances some 18 times more endogenous nutrient is required to replenish

each mole ATP used relative to that required to do so by glycolysis and

oxidative phosphorylation.

Whilst a low carbohydrate might compromise athletic performance it would seem,

from a stoichiometic perspective, to be very likely to cause weight loss in

individuals subjecting themselves to moderate degrees of regular anaerobic

activity. In the absence of anaerobic activity a low carbohydrate diet should

still favour the catabolism of fat, as Dr Alkins suggests, but the likelihood of

weight loss would be less than that in an individual who subjected him/herself

to regular anaerobic exercise.

There is no biochemical reason I can think of for believing that a low

carbohydrate diet or even an Atkins should increase the risk of organ

dysfunction and failure relative to a high carbohydrate or low fat diet. Fatty

acids and cholesterol must rise if it is to be catabolised. Ketosis should only

occur if oxidative phosphorylation is compromised sytemically, ketone bodies

being generated by muscle being readily used as substrate by adequately

oxygenated heart, brain and liver. So the acidosis that may occur in ketosis is

primarily if not exclusively the product of unreversed ATP hydrolysis secondary

to a systemic indequacy in tissue oxygnation rather than the ketosis per se.

The President of the Royal College of Physicians has chosen to make an issue of

hospital diet. Why should she have used her prestigious position to make an

issue of such an inconsequential matter, in terms of outcome in hospitalised

patients? Might it have something to do with the African American??UN initiative

to solve Zimbabwe's land and financial problems by making it it the " bread

basket " of Africa? This would require taking the land, used by generations of

whites to grow lucrative tobacco crops or for more recently wildlife tourism, to

give to Africans to grow ?GM crops. Many Africans would welcome this not only

because it would be a free handout of land but also because some are strongly

opposed to tourism and game conservation because of its impact upon their

culture. They would far prefer to keep the land for themselves and continue with

their traditional but very destructive land management practices, as they have

done in with devastating effect in what used to be c alled the Transkei in

South Africa. Discrediting a high carbohydrate diet has the potential to subvert

this initiative by undermining the market for carbohydrates and promoting a

market for animal fats and proteins i.e the Atkins diet.

Wildlife conservation requires regular culling and that generates large amounts

of protein which could be used by impoverished Africans. At present all the

meat, ivory, heads and skins are burned in accordance with intrnational

directives and the potential revenues are lost. Hunting and photographic

safaris, and the sale of the ivory, heads and skins obtained from culled animals

can be a very lucrative business. Rather than depleting the game it promotes and

funds conservation as clearly demonstrated with deer hunting in the US. More

importantly it creates jobs that bring in dollars, pounds, euros and yen.

Promoting a high carbohydrate diet may be viewed in the same context as the

antismoking lobby's undermining of the tobacco industry, tobacco having been for

decades the major source of income for many Zimbabweans. This researcher's

mis-informed attack against the Atkins diet may be viewed in the same context.

If this researcher, and the MRC which supports her work, has a conflict of

interest it is a political one, not a commerical one (1). The Zulus and most

African tribes including the Masai, are by tradition low carbohyrate, high

protein high fat eaters. Their increasing exposure to refined carbohydrates has

changed that with dubious effect. It may be better if they were to return to

their traditonal Atkins diet.

1. Sue Mayor Researcher criticised for comments on the Atkins diet BMJ 2003;

327: 414-e-0-e

Competing interests: None declared