Low carb tribalism — human nature, not malicious propaganda

What starts as a seemingly innocuous article on tribalism has sparked a firestorm of reaction from the low-carb community.
Dr. Ethan Weiss (a cardiologist and follower and financial investor in low-carb lifestyles) and Nicola Guess, RD, PhD (who uses LCHF nutrition with her patients) published the article in STAT on May 9, 2019. The overall premise is easy to agree with. We are all subject to a degree of tribalism that, if we aren’t careful, could undermine our objectivity.
STAT: Is tribalism undermining objectivity about low-carb, high-fat diets?
They correctly point out how this is the case for “guns, climate change, abortion, politics, and the like.” Suffice it to say, no topic is beyond reproach when it comes to believing so strongly in something that you can lose sight of objectivity. Nutrition is a prime example as many defend their “beliefs” so strongly that they refuse to even consider alternatives. While this clearly does not apply to everyone, it is rampant in the vegan community and has infiltrated the LCHF community. We should be thankful for Dr. Weiss and Guess for bringing the topic to the forefront and helping us look in the mirror to make sure we maintain an element of objectivity.
The authors rightly acknowledge the numerous health benefits of a low-carb diet, and write that it is an immensely valuable tool for helping patients transform their lives. However, they go on to question the safety of LCHF based on elevated blood cholesterol levels and heart disease risk, and note that they are “disturbed by the discourse surrounding these diets, which often feels less like science and more like cheerleading.”
I applaud them for bringing us back to the science, but I would contend the science of cholesterol as it applies to LCHF lifestyles is less settled then they imply.
For starters, rising cholesterol, specifically LDL cholesterol, is only an issue for the minority of individuals following a LCHF diet. Published studies for weight loss and diabetes management show that few subjects experience a significant rise in LDL. Other studies, such as those in highly trained athletes, and numerous anecdotal reports (and personal clinical experience) show that increased LDL is a real occurrence, although the exact percentage is unknown and is estimated at 15-25%. This is a paradigm I constantly fight in my practice. Eating LCHF does not, by definition, mean an increase in LDL cholesterol. Instead, it usually means an increase in HDL and decrease in triglycerides, and may or may not raise LDL significantly.
Questioning the magnitude of the role of cholesterol in the presence of metabolic health is a nuance without a definitive conclusion. However, it is a question built on a strong scientific base.
So, where do we draw the line? While we need to acknowledge we can overstate the position that “elevated cholesterol is harmless,” we also need to acknowledge the value in an open scientific debate. The authors fear we have gone too far and are at the point of
reductionism and the creation of false dichotomies. We believe that scientists, health care professionals, and journalists must avoid intentionally confusing or alarming the public in an attempt to discredit legitimate science, ultimately in the name of advocating for an agenda.
That is different than saying the question is answered and all debate needs to stop. Rather, as long as the debate is based on scientific principles, then healthcare professionals, journalists and scientists should continue to search for answers as they apply to the unique physiology of LCHF lifestyles.
In fact, Dr. Weiss mentioned that options exist, such as “seeking testing to better define cardiovascular risk.” This is a key statement for me as we have to acknowledge the weak association between LDL and all-cause mortality, especially in the subset of people who are metabolically healthy and have naturally low triglycerides and high HDL levels (as Dave Feldman of choletserolcode.com has been promoting for years). It is exactly this population who would benefit from additional testing rather than assuming all LDL is dangerous. I have a feeling Dr. Weiss would see the value in this although he didn’t specifically say it in his article.
The conclusion of the article unfortunately takes a different tone and pulls out the “anti-vaccine” card.
In addition to being dangerous, such ostensible advocacy appears to be an intentional attempt to degrade the public’s trust in science. One need look no further than the tragedy of the false story linking vaccines to autism as an example of what can and will result.
If we question the risk of LDL when combined with optimal metabolic health, are we intentionally attempting to “degrade the public’s trust in science?” Far from it. Rather, for the most part, we are trying to better understand the existing science and how it applies to us as individuals, rather than being grouped in with entire populations metabolically deranged individuals who eat a low-fat or standard American diet. We should encourage this type of nuanced investigation rather than shut it down as part of blinded tribalism. Comparing this to the anti-vaccine movement is way off base and I wonder if, given the opportunity, the authors would take back that comparison.
I think we can all agree that being blinded by one’s own beliefs is part of human nature, and something we need to actively try to avoid. That’s a far cry, however, from intentionally misleading or falsifying science. That is why we should applaud the authors for stimulating the discussion about tribalism and objectivity.
At Diet Doctor, we are committed to being transparent about the quality of evidence that supports our claims as well as the evidence that goes against our claims. We hope to continually maintain objectivity and avoid the sort of blinded tribalism that can part of human nature.
Thank you for reading, and please let us know how we are doing in our quest for objectivity.
Thanks for reading,
Bret Scher, MD FACC
Earlier
Eggs are bad – then good – then bad again? What gives?
American Diabetes Association endorses low-carb diet as option
The anti-vaxxer line discredited a lot of the good in that article unfortunately. Why not throw in some flat-earth, 9/11 hoax, moon landing as well. Sure its not public health, but it does erode the public's trust in establishment.
I think perhaps this is among top most civilized, reasonable, objective responses that could have ever been written in response to some of the negative suggestions from this article. This shows true class and talent on your part and I commend you.
Dr. C
In recent times I have read very worrying health articles. Some have popped up on Facebook, and I am left wondering who is funding these. This article https://www.stuff.co.nz/life-style/well-good/112543201/feel-free-to-t... is so audacious striking fear into the hearts of those who are less informed. This is a woman who doesn't quite know where she wants to focus - as a heart surgeon or a TV presenter.
Thanks you for a restrained, polite redress of your article.
In the low carb community, like any other diet and health community, there is still quite a lot of judgement and criticism according to personal bias. I note even here, there is a comment about “excesses” like bulletproof coffee and carnivore … both of which I’m guilty of. I currently do a version of low carb that fits into my lifestyle which is simple and stress free for me, and that’s 90% OMAD combined with 90% carnivore, I try to be flexible when it’s appropriate, but I realise to others it may still seem extreme. Even I thought it was extreme before I tried it and I’m still self-conscious about it, but it makes my life so simple right now.
To Carrie, I think it's worth mentioning that if you go from low fat to high fat, a disrupted digestive track is not that unusual as your body needs to relearn how to process fats, especially if you have fatty liver or a sluggish gallbladder and are low in stomach acid or bile. I also had a lot of digestive issues transitioning to high fat but now I cope quite well. Technically for keto or low carb, it isn't 100% necessary if you have body fat to burn for you to eat lots of fat, even though it helps with fat adaption initially, so if you are feeling good on lower fat low carb high veggie moderate protein diet, and have sufficient energy, that's your choice.
Personally, I'm particular about eating fat as it keeps the bile moving through the gallbladder, and I have a family history of people having gallbladders removed after doing weight watchers, which I'd like to avoid, and keto helped me clean the sludge out of there. So for me, high fat is a workable solution, you know, as long as I don't stress about LDL, which some people still want me to do. I'd much rather have higher LDL than have edema, sleep apnoea, fatty liver, amenorrhea (from PCOS), terrible inflammation and pain etc etc, which is what I was experiencing previously, and I choose to believe my LDL is a good natural consequence of my current lifestyle.
Thanks
Much better results than from years of medicines.
Can good science help us here?
thanks
SB
For my part I remain committed to the principles of LCHF and intermittent fasting as “weight/health management tools” in a modern society where we are constantly challenged by the food available and marketed to us. I’m going to keep using these tools. When my weight/body composition/fitness regime is balanced properly and is not a health issue, I am more flexible in my choices - expanding to include more food choices but using portion control and moderation as my guide. This has worked very well now that I’m close to my health and fitness goals.. If I notice I’m slipping, then straight back to these tools to reset that deviation. I have never been happier or felt healthier in my adult years than since adopting this approach. It’s no where near the “faith” component of the antivax movement. I go by what’s happening day by day. Well done with this article.
These attacks and false information circulating against us have been foreseen by many people leading our lifestyle. These attacks are following the usual style of misleading propaganda , by putting some doubt causing infomation into an article that we generally accept as truthfully and informative. We should all be aware of this.
It also reminds us that even the most studied phenomena, the link between low-density lipoprotein in the blood and plaque deposition in the arteries doesn't provide a satisfactory explanation of the mechanism, but only a link.
As for an analogy: Everyone notices the change between night and day and the sun moving around in the sky.
One explanation is the model of the sun rotating around the earth, one is the model of the earth rotating around the sun.
Noticing the link between LDL and heart disease is like being able to see the movement of the sun in the sky.
Looking at different models and explanations is then the step that follows.
To my regret the attitude of not even questioning a preferred model I only notice from the people that rave against the low carb, high fat diet.
When I first started looking into this diet my wife send me a link to the website of a well established Italian cancer research foundation, in which they stated that low carb is bad and that everyone should read their recipe books written and published together with Italian pasta and rice producers.
For me the reassurance of less bias and more science in the low carb, high fat community is that many would probably love to indulge in food that we consider and have experienced to be unhealthy.
But yes, more good science and research overall is a good idea.
My cholesterol had been off the chart in 2017. So bad I was feeling terrible. My doctor said I did not do this to myself overnight. In fact my husband had Cancer and I took care of him while I ballooned in weight from worry. In less than three months of Keto it was normalized.
In nine months I dropped 65 pounds, from a US size 22 to a 14. I have Lupus and had been out of work for five years. I am working at a fast paced warehouse today. I weight 60 pounds more today than when I was only one size smaller. That’s a lot of muscle I have built!
I could not have reclaimed my life today without having changed my eating habits.
Exactly!!! Of course the community is irked that the science they follow is being discredited, with sophistry rather than science I might add. Why wouldn't people be up in arms about blatant and unscientific attempts to undermine the public consciousness on this issue?
Good riddance to those who seek control.