Criticism of Virta's good results, coming from PCRM

virtahealth
vegan
pcrm

(Jack Bennett) #1

I just ran across this letter from Dr. Neal Barnard from PCRM, effectively attacking Virta for their positive results in reversing symptoms of Type II diabetes. Barnard provides a number of citations but the tone of the letter seems defensive and “sour grapes”.

They seem to be saying: Yeah, they may be getting good results now, but just you wait… Apparently they blame “fat-induced insulin resistance” (lipotoxicity) for Type II diabetes, though it’s not clear how keto can cause this when it also reduces excess body fat (weight loss).

If you’re not familiar with the “Physicians Committee for Responsible Medicine”, it’s a vegan lobby group led by Dr. Barnard, who promotes his own program (a very low fat vegan diet) as a panacea for curing heart disease, cancer, diabetes, and everything else. Presumably good publicity and good outcomes for Virta represents a threat and a challenge to PCRM’s model of the world, and their vegan outlook.

My question is, how do they sustain their worldview? (The same question could be asked of Ornish, Esselstyn, Campbell, MacDougall, Greger, and all the other popular doctors who promote ultra-low-fat veg-n or semi-veg-n diets as the ultimate path to health.)

My best guess is that they are true believers who think they have found the answer(s): the USDA guidelines are essentially correct but don’t go far enough (30% fat in the diet? Try 10%!), dietary cholesterol and saturated fat are truly the enemy, plant-based everything is the answer, heart-healthy whole grains are the best foods, total cholesterol should be below 150 and LDL should be as low as possible, carbs should be 70+% of the diet, more fiber is better, etc, etc.

I believe that we can strengthen our own understanding of keto, our own approach, by trying to understand the “opponents”. We can better understand what we do by contrasting it with the ways of those who do things very differently. Why do they believe what they believe? What evidence do they use in supporting their case? How do they push back against the things that we believe?


#2

2 possibilities:
1- B12 deficiency
2- I do believe it was H.L. Mencken who said something to the effect that it was difficult to for a man to understand something something when his salary depended upon not understanding it.


(Michael - When reality fails to meet expectations, the problem is not reality.) #3

@barefootbob Upton Sinclair, not Mencken.

Due to our primate herbivore ancestry, we retain the relic metabolic ability to digest some carbs. This is not in dispute. On the other hand, there are no essential carbs. That means we have no need to eat them and derive no nutritive benefit doing so. Gluconeogenesis synthesizes all the sugar we still require as glucose. Claiming otherwise is religion not science.


(Justin Jordan) #4

Aside from anything else, they do have the advantage that the Standard American Diet is so bad that almost anything is going to look good in comparison. The diets that Ornish/McDougall/Barnard actually recommend (which next to no one will do) ARE a massive important over normal crap, so it makes it easy to look at patients and think you’ve found The Way.

This can apply to keto, too. There’s a lot of stuff that people believe that is motivated thinking around here, even.

But more generally, there’s a specific kind of thinking that goes with these kinds of things I first noticed in exercise, where you wrap around into circular thinking. “This exercise program is the best, so if I am getting poor results, I am doing it wrong, or I am at my genetic limit. I know it is my genetic limit, because these are the results I get from doing the best exercise program.”


(charlie3) #5

Possibly they get more strident because they’re losing the argument.


(PJ) #6

I have observed online the following:

  1. No matter what ‘dietary plan’ you choose, changing from the ‘see-food’ ‘standard diet’ will lead to improvements in fat loss, how they feel, etc. This leads nearly everybody to believe their eating plan is The Answer™ initially.

  2. After some time, the initial results, which are the “differential” between the nearly-worst-possible diet and whatever diet plan is in question, usually mostly in ‘water and inflammation’ changes, have reached equilibrium. This is usually a few months in. By this time, everyone is sure their diet will save the world just like it’s saving them.

  3. Now is when the actual test of the dietary plan and how that person is implementing it, compared to everything else in their life (from their genetics to their age, sex, activity level, environment, socioeconomic options, job/family limitations, etc.) kicks in. This isn’t just testing ‘whether’ ‘it’ ‘works’ but how well it’s being implemented for that person.

“I’m losing weight, and all my hair fell out” is a somewhat imperfect implementation, although if you began obese, any healthy diet will cause such rapid weight loss that some of that will be a result.

“I’m losing weight but I’m getting gout” (sometimes in lower carb diets) is an imperfect implementation, and a few things including supplementation and NOT drinking diet soda should probably be added.

“I’m losing weight but my teeth are rotting out or falling out” or “but I’m an emotional wreck” or “but I have major constant adult acne now” or “but I have these unexplained rashes” (all sometimes in lower fat diets) is an imperfect implementation (and don’t get me started) – I think you get the idea.

But the most likely complaint for people who began and are still fat at this point, is that they are no longer losing weight. Now I don’t just mean, not for a month or two while they get smaller despite the scale. I mean they just aren’t losing. Sometimes are even slightly gaining. Sometimes they’re to the point of eating insanely low numbers of calories and they still cannot seem to lose fat, despite that they have a whole lot of it to lose.

I think this represents a problem with whatever the person is doing, though that may not be their eating plan. It might be they have, by this point in life, genuine hormonal imbalances that might requires supplements, or even medications.

It can also be their choice of foods. This is harder for people who cook for families I suspect. But sometimes I see people’s diet journals (not here, but on another forum I frequent) and they’re like, a bit of this and that – all ‘foods’ which in even a small serving would be way too carby, but they just ate one cherry, one Triscuit, etc. and processed meats. At the end of the day yes, they made their carb goals, but for godssakes it looks like their diet was based on stealing Hors D’oeurves from a wedding they weren’t invited to.

Of course: Maybe the degree of metabolic damage means they can eat 20 carbs but not 50, at least for some more time. Maybe their primary fat is mayonnaise from soybean oil, or cream cheese, and their body has an inflammatory reaction to it no matter how few carbs it has.

Or for vegans, maybe they are nearly living on grains now, and their body is inflamed from that. Or maybe they are nearly living on fruit and starch now, and there’s so much sugar in their diet they’re heading for diabetic very quickly.

  1. So Person-X goes to their “dietary community” and they say, “I feel like crap, and I’m not losing weight.” And their community says, “Tell us what you are eating.” And they spell it out.

Various things can come from this:

a/ Their implementation is not ideal, or not ideal “for them,” and they’re able to get corrective advice, that with trial and error, works for them.

b/ Their diet is not ideal, or not ideal “for them,” and even when they have become the absolute Poster Child™ for DietX, they still feel crappy and aren’t losing weight.

c/ It might be that (a) is the case, but they cannot let go of food addictions and they can’t fully commit, so they don’t do the trial and error, they just decide it didn’t work for them and they tell anyone who asks, “Yeah, I did Atkins, that didn’t work for me.”

Usually, every community from keto to vegan, will then suggest, directly or indirectly, that they are probably just not doing it well enough. And sometimes they are correct… and sometimes they aren’t. Every community is filled with people who believe it’s working for THEM – after all, they wouldn’t be doing it otherwise.

But I notice a difference when it comes to low-carb versus vegan diet forums and their conversations and tendencies. Obviously these are generalities, and not “every” person, yada yada. But:

Lowcarb tends to be filled with people who are “objective biometric” freaks. They track every body measure known to man that they can afford. The fact that so many people begin eating keto or lowcarb because they are either fat or diabetic or both, adds to this, since both fat and blood sugar can be measured. Many others are very serious about their athletics, so they track because of or related to that.

On the whole, if keto or lowcarb (or how it is being implemented in context) does not work for someone, it is REALLY OBVIOUS. There is no way to generalize about it if you’re measuring your ability to squat or your blood glucose or whether your pants are looser. Either it’s working, to whatever degree, or it’s not.

Vegan tends to be filled with people who are “subjectively earnest” about it all. The fact that vegan is political-philosophical at base, diet being a secondary follow on to those, is probably a lot of the reason for that. It seems to have a much higher percentage of very young people; and of women. And of lean people who loved running and yoga and living on pasta and fruit smoothies long before they went vegan.

In the keto and low carb worlds, if you tell these groups that the diet is just not working for you, they will try to help, they may suggest you see a doctor for more insight, but most the time they figure it’s up to you and if it really isn’t working, well, you know, people are different, so maybe it’s just not for you. That’s because for many of these people, it’s just an eating plan not a religion, and they are basing results on actual measurable results, so it’s just data. Good or bad, it is what it is.

In the vegan world though, because this is a politic and philosophy – that is to say, it may as well be a religion – if you tell them it is not working for you, after initial “fix it” assistance, you are now the enemy. You are lying. And if you are fat and you say that this is not causing weight loss and is even causing weight gain, well it must be that you are lying about what you eat, you know, “like fat people do.” Any questioning of whether this “works” is a form of heresy. Are you being paid by the beef industry?

(You know what would change the mind of a lot of young women who want to be vegan because of their misleading propaganda about it making you skinny? Seeing how many women I have met over the years in low-carb areas who weigh 300++ pounds who “used to be” vegetarian or vegan. If it had worked for them, would they have ended up weighing that??)

As a result of the “social circling” in the low-fat and vegan worlds, it becomes a “self-selected community.” Every community is of course, but I mean, there is a social shunning and negative ostracization in the vegan community that is so extreme, it’s kind of impressive. It’s like the internet food version of Lord of the Flies.

This leaves the “leaders” of the communities with what? With a community that, as an absolutely amazing coincidence, only seems to be filled with people who proactively promote how well veganism works for them. Everybody else is either terrified to say otherwise or leaves the community entirely.

Contrast this with low carb and keto, where people argue over all kinds of things including eating carbs in cycles, or on weekends, or before working out, or more if you’re menopausal, or just eating meat, or eating much more fiber, or – really, aside from the “generally low in carbs most the time” bit, there’s a whole variety of opinions and approaches and constant experimentation in it.

Because it’s an eating plan, not a religion. And people differ.

But I think the nature of the low-fat and vegan communities – which greatly overlap – creates a false-positive for its “leaders,” who look out into the community and only see conformity. Oh look, all these young people, all these lean people, all these runners and yoga folks, and they all want to save the world, and this is a Higher Calling, and any other perspective on reality is an existential threat which must be stamped out like the heresy it is.

Hence, PCRM, cannot abide the fact that keto makes diabetics healthier.

PJ


(bulkbiker) #7

Its simply sour grapes as Barnard had such a resounding “success” over time with his vegan study and T2…


#8

Vegans are our friends. They do the same things we do. It’s a false dichotomy to set up vegan vs Virta.

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(Doing a Mediterranean Keto) #9

Really? Vegans eat pasta and bread.


(Jack Bennett) #10

I don’t think keto or carnivore people have a genuine quarrel with vegan eaters.

I think there’s a certain defensiveness against vegan activists.

Sometimes they are the same people.


#11

Yep, really. The vegans are trying to improve their nutritional health as one of their aims.


(Doing a Mediterranean Keto) #12

So, according to you, all diets that try to improve their nutritional health, can be assimilated to keto? Really?

For me, veganism is quite similar to SAD. In fact, the only difference with SAD is they do not eat animal protein. But they eat wheat, bread, pasta, sugar and vegetable oils.

Some people may do very well with veganism, but I would say that for most people here, veganism would be as bad as SAD for them (for sure for me!).

In fact, some people in keto are carnivores, which is the DIAMETRICAL OPPOSITE of veganism.

So, no, in no way veganism can be assimilated to keto, IMHO.


(bulkbiker) #13

They really aren’t… maybe Plant only eaters are (incorrectly IMO)… but most “vegans” are anti animal exploitation and will admit to not be interested in health when pressed.
Most would say they’d rather die than eat beef even if beef were deemed essential for their health.


(Jack Bennett) #14

I ate “WFPB” for a couple years. I personally tried to avoid the V-word when talking to non-veg people because I knew it tended to trigger people. I was doing it for health, not ideology, so I wanted to steer away from all the activism and drama.

The funny thing is, at that time I already saw the common ground between the health-oriented vegan and Paleo/low-carb diet communities. Both groups were into plant foods, single-ingredient foods, locally-grown, know-your-farmer kind of stuff. The paleo people just added in pastured animals and animal foods, which was good for reducing cruelty and suffering (though not quite enough for the vegans, of course).


(Jack Bennett) #15

I found a rebuttal of the original PCRM letter.


(Karen) #16

My goodness this is extremely well put.


(Jack Bennett) #17

Your whole post is awesome but this made me laugh out loud. Talk about missing the keto forest for the trees … :joy::laughing:


(Bunny) #18

Has nothing to do with eating more or less fat, bottom line your still getting fat no matter what you eat.

Both diets are correct (they cut out the highly refined sugars and processed foods) if you don’t get involved in the cry baby emotional politics?

Vegan/Vegetarian, Meat Only Diets, High Fat/Low Fat, Low Carb/Moderate Complex Carbohydrate intake are all ketogenic; any one who says it isn’t has some serious comprehension issues?

Metabolically fit people go into ketosis naturally with out restricting anything in there diet.

Purposely putting your body into ketosis long-term is another story and probably why the diet quits working for weight loss (actual body fat) as the main goal.

Getting fatty deposits out of the skeletal muscle tissue would probably resolve the entire issue of weight gain, diabetes, cancer and the ability to oxidize carbohydrates without gaining weight and without the need of dieting or ketogenic diets but I’m probably so ahead of my time with what I’m saying here that it will probably take them 40 more years to figure it out!


(Karen) #19

Are you suggesting carb cycling here?
Dipping in and out of ketosis?
You may have something here


(Bunny) #20

No, maybe the better question is; are you metabolically fit enough to eat more complex carbohydrates and are you artificially forcing the body into ketosis rather then hormetically training the body to burn (oxidize) more complex carbohydrates rather than store them as lipid droplets in the adipocytes?

The Virta Health clinical treatment pattern clearly demonstrates this?