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
About low carb
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- 1 comment removed
- GeneVery well written. Thank you
- CarrieI am over weight and so far the only diet that has helped me in any way is low carb with lots of vegetables and moderate meat, but I can’t say that the high fat helps at all honestly. I did at one time try KETO and it messed up my whole digestive track for days but eating mostly vegetables has had almost no side affects. People want to be able to eat high fat diets while remaining healthy and that just doesn’t seem to be a workable solution.
- Susan K HuntAwesome article.
Thanks - ChrisIt seems you suggest the science behind cholesterol is probably correct except when talking about LCHF diets. If this is true, how did you come to this conclusion?
- EldensteinExactly!
- sudhir borgaonkarIt is very confusing indeed. At one end- LCHF diet and other end- Dr Esselstyn's diet- whole food plant based, which has angiographically reduced CAD, unlike LCHF diet, as I understand. Whom do we believe? Both are not RCTs. Long term effects of LCHF diet known? How to know which diet is suitable for whom?
Can good science help us here?thanks
SB
- 1 comment removed
- Sharon HeenanPara 5: (less settled "then" they imply) should be ( less settled "than" they imply). Hope this helps...
- CelticIt’s quite obvious there are agendas to fill. There is money to be lost by people becoming healthy and not in need of statins. I work in the aged care sector and every client between the ages of 65 - 85 that come through my office is on cholesterol and/or blood pressure meds. I have 90 year old clients who are healthier than the younger clients because they eat the old way and do not need to take meds. I’m sure that cholesterol meds are causing the magnitude of dementia and Alzheimer’s that is rife in aged care today. This spurs me on in my personal journey to continue to research with an open mind the LCHF and carnivore diet that I am currently undertaking with IF. If anything I can use this as an elimination diet to see how and what my body reacts to. I stay away from GP’s as I find them typical and close minded especially here in Australia. They try and force BP and Cholesterol drugs onto you at every visit as they have vested interests in the companies. I am an advocate of Keto and carnivore as the proof is in the pudding with so many success stories.
- Joseph TursiI have been on the LCHF diet for three years now. While never obese (5'10" and 178 lbs) I have lost about 25 lbs and backed off my A1C to 5.5 from 6. I have always had very high cholesterol total with high LDL and triglycerides. After my first year my total cholesterol dropped almost 70 points and my tryes dropped to amazing lows! At first my doctor was very impressed and began reading about the LCHF diet. However, in my second and third year my cholesterol total has risen to 328 and my HDL component is high. Now he is not so impressed but I push on because I am convinced the key to health is keeping my A1C low and preventing diabetes which is the cause of a multitude of health problems. My doctor believes that with such high LDL I am headed for a "cardiac event." I don't want to be sticking my head in the sand but I am staying with the LCHF diet since my overall sense of wellbeing and health is strong. But now I see the concerns some experts have about the amount of saturated fat in this diet.
- Mary WhiteI've been on LCHF for over 15 years. I'm immensely healthier than I was before I began the low-carb regimen. I was very ill and didn't know it. I don't want to bore with detail but a large bleeding polyp in my bowel. Since that was removed I've had no more dangerous health issues, I feel good every day, and as far as I can tell I'm actually certifiably healthy. I'm nearing my 75th b.d. and will continue with my LCHF lifestyle, not only because it suits my metabolism but because it's my right to do so without interference from people who want to run you, me, and everyone else because they have some warped ideas about what science is.
Good riddance to those who seek control.
- 1 comment removed
- DavidBefore deciding one way or another wrt the efficacy of vaccines, one must do one's own research. That can be tricky with most channels censoring certain information, but give it a try anyway. Always look out for the science.
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 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.