LETTER TO THE EDITOR
Reply
Sylvan L. Weinberg, MD
Director of Medical Education, The Dayton Heart Hospital, 4555 Southern Boulevard, Dayton, OH 45429
(Email: slwjal{at}aol.com).
In his discussion of my commentary on the diet–heart hypothesis (1), Dr. Baschetti suggests that the low-fat, high-carbohydrate diet is the diet "for which human beings are in essence genetically programmed, because their metabolic physiology has been evolutionarily molded by a nutritional environment in which, for millions of years, that diet was practically the sole one available to our ancestors." However, the references he cites for documentation are merely similar letters to editors in which he previously expressed the same opinions, a practice he has pursued beyond those cited here (2). I would point out to Dr. Baschetti that my conclusions about the role of the low-fat, high-carbohydrate diet in the current epidemics of obesity, type II diabetes, and metabolic syndrome are based on what has actually occurred in the U. S. and elsewhere over the last three or more decades. In my critique, I also cited several recent randomized trials in which low-carbohydrate, high-protein diets showed improvement in lipid patterns, insulin sensitivity, and weight loss, compared with low-fat, high-carbohydrate diets. Although Dr. Baschetti dismisses these studies as "misleading" they are well-controlled trials at highly regarded institutions, and they were performed by scientists who were highly circumspect in self-appraisal of their work.
Dr. Baschetti also argues, as he did in his cited letter to Dr. M. B. Katan (3), that rural Chinese on low-fat, high-carbohydrate regimens have less coronary disease than occurs in the U. S., although it is rising as fat intake increases. Dr. Baschetti cites this as further evidence favoring the low-fat, high-carbohydrate diet. I respond as did Dr. Katan (3), that there are many other factors which make comparison of rural Chinese with American populations difficult, including rising use of cigarettes in China, different levels of physical activity, and of sanitation, health care, and the types of fats available to the low-income Chinese, such as tropical oils, high in saturated fat.
Further, to advocate a low-fat, high-carbohydrate diet because that was the diet primitive peoples ate millions of years ago and to claim that we, therefore, are genetically endowed for that to be the ideal diet, and beyond that to disregard the negative experience with the low-fat, high-carbohydrate diet on the U.S. and other populations and to reject as "misleading" positive randomized research data favoring the low-carbohydrate, high-protein diet, seems fanciful indeed.
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References
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1. Weinberg SL. The diet–heart hypothesis: a critique J Am Coll Cardiol 2004;43:731-733.[Abstract/Free Full Text]
2. Baschetti R. Evolution, cholesterol and low-fat diets Circulation 1999;99:164-167.[Free Full Text]
3. Baschetti R. Low-fat diets and HDL cholesterol Am J Clin Nutr 1998;68:1143-1144.[Medline]
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