Physicians examine fad diets, fiber intake, and social media nutrition topics

In a discussion broadcast by The Curbsiders, primary care physicians Dr. Matthew Frank Watto and Dr. Paul Nelson Williams examined the clinical realities of popular fad diets, evaluated patient fiber intake, and reviewed nutrition topics discussed on social media alongside guest Dr. Joan Blake.

Dr. Williams noted that the ketogenic diet is very high in fats and very low in carbohydrates, having been initially developed for refractory epilepsy before being repurposed for weight loss. While it provides quick initial weight loss, glycemic control, and blood pressure control, Dr. Watto raised concerns regarding lean mass hyper-responders with very high LDL cholesterol levels. Dr. Watto stated that he tries not to recommend the diet due to a lack of long-term cardiovascular safety data and negative health outcomes associated with eating animal fat over time. Dr. Williams remarked to Dr. Watto that he knows he has been hot on the topic of lean mass hyper-responders for years now, observing cases where cholesterols reach the 400s and 500s and low-density lipoprotein (LDL) cholesterols reach the 200s and 300s. Dr. Williams joked that he would innovate his way into a heart attack by 55.

The DASH diet is high in plants, vegetables, and fruits, and low in salt to help with high blood pressure. Meanwhile, Dr. Williams characterized the paleo diet as meat-forward while excluding grains, dairy, and processed foods. Dr.

Addressing various dietary interventions, dietitian Cathy A. Nonas noted that the perfect short-term diet is anything that the patient is willing to adhere to that won’t hurt the patient. She added that all diets work as long as you can adhere to them, though long-term weight maintenance remains a difficult issue. Ms. Atkins refused to refer to her by name.

Psychologist Dr. Gary D. Foster reported that low-carbohydrate diets produce greater weight loss at 6 months compared to low-calorie, low-fat diets, but noted that weight loss at 1 year is equivalent between the approaches. Dr. Foster noted that so far, no effect has been seen on total cholesterol at the meeting, which was cosponsored by the American Diabetes Association. Dr. Holly R. Wyatt cautioned clinicians against telling patients that fad diets do not work, warning that if you tell them that, and they just lost 10 pounds on the Atkins diet, they are going.