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J Am Coll Cardiol, 2004; 44:1526-1527, doi:10.1016/j.jacc.2004.07.013
© 2004 by the American College of Cardiology Foundation
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LETTER TO THE EDITOR

Reply

C. Tissa Kappagoda, MBBS, PhD, FACC

Department of Internal Medicine (Cardiovascular Medicine), One Shields Avenue, TB 172, Bioletti Way, University of California, Davis, CA 95616

Ezra A. Amsterdam, MD, FACC and Dianne A. Hyson, MS, PhD, RD

(Email: ctkappagoda{at}ucdavis.edu).

We appreciate Dr. Manninen's interest in our paper (1). In the process of highlighting the issue of protein intake we believe he has raised the telescope to the Nelsonian blind eye and ignored the main thrust of our position. Our focus was high-protein–low-carbohydrate (Atkins type) diets in the context of clinical cardiology. These diets invariably include significant quantities of saturated fats, cholesterol, and sodium, and they are consistently low in fiber. These are the areas of concern to those who are responsible for caring for patients with cardiovascular disease. Bodybuilders are probably estimable people, but they do not usually constitute a large sector of our practice.

The issue of the actual amount of protein to be consumed daily is a difficult one to resolve. Problems associated with identifying upper limits for protein intake have been covered fully in the report issued by the Food and Nutrition Board of the Institute of Medicine, which is a component of the National Academy of Sciences in the U.S. A detailed reading of this report will provide some insights into difficulties in identifying these limits, and the Board has, quite properly in our view, advocated prudence. The American Heart Association (AHA) Nutrition Committee has also adopted a similar cautious approach. We are uncertain whether the members of these bodies consulted the distaff sides of their families in preparing their respective reports, but we are persuaded that they have indeed reviewed the best available evidence in making their recommendations.


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  1. Kappagoda CT, Hyson DA, Amsterdam EA. Low-carbohydrate–high-protein diets: is there a place for them in clinical cardiology? J Am Coll Cardiol 2004;43:725-730.[Abstract/Free Full Text]




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