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 dessert 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.
Editor's Note: At the author's request, the phrase "dessert should be treated like a poison" above was changed from the original text, "fruit should be treated like a poison."
Follow Yoni Freedhoff on Twitter: @YoniFreedhoff
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Any views expressed above are the author's own and do not necessarily reflect the views of WebMD or Medscape.
Cite this: The Low-Carb Community Is Its Own Worst Enemy - Medscape - Aug 08, 2019.