The Nutrition Debate #44: Joslin Clinic Fights Back

The Joslin Diabetes Center in Boston is “the world’s largest diabetes research center, diabetes clinic, and provider of diabetes education,” according to Wikipedia. It came as no surprise, therefore, when on February 8th Joslin shot back at comments made by Richard Kahn, Ph.D., former Chief Scientific and Medical Officer of the American Diabetes Association. This Dr. Kahn is not to be confused (I think) with Richard Kahn, Ph.D., “anarchist educator” and core faculty member of Antioch University in Los Angeles, although their Ph.D.’s in my view are equally worthless.

Dr. Kahn the former ADA executive had said “even though weight loss can prevent or delay the onset of diabetes, the failure of patients to maintain weight loss beyond an average of four years makes diabetes prevention programs a ‘waste of resources,’ and the health system should focus instead on reducing the likelihood of complications once patients have been diagnosed with diabetes.” He made these remarks at a briefing for public health advocates and diabetes researchers entitled “Confronting the Growing Diabetes Crisis” on February 7th by the journal Health Affairs.

Joslin’s rebuttal was that their extensive “experience with innovative weight management programs…is showing that patients can maintain healthy weight levels well past four years.” Edward S. Horton, M. D., Professor of Medicine at Harvard Medical School (with which Joslin is affiliated), and past President of the American Diabetes Association said, “There is a legacy for the initial weight loss even if people cannot maintain it. The 10-year follow up of the patients who completed the diabetes prevention program showed that people who initially lost weight continued to develop diabetes at a lower rate over 10 years than those who did not lose weight, even if they gained part of that weight back.”

This internecine battle demonstrates clearly that overweight and obesity is the problem, as well as the surest predictor of incipient Type 2 diabetes, and that losing weight is the first line of defense against it. Type 2 diabetes is also associated with a host of associated Diseases of Civilization (CVD, CHD, stroke, Alzheimer’s and some cancers). A recent NY Times story reported, “Researchers found diabetes was associated with a higher overall risk for colon, rectal and liver cancers among both men and women. In women, diabetes was most strongly associated with a higher risk of stomach, anal and endometrial cancers. In men, diabetes was most likely to raise risk for pancreatic and bladder cancers.

The battle also illustrates the difficulty of losing weight and keeping it off. Even the Harvard Medical School defenders of Joslin’s programs, in remarks posted in Public Health and Policy (issue 612) one day after Dr. Kahn’s controversial statement, appear to disagree. Enrique Caballero, M. D., said, “Not having a full answer on what to do in the long term does not mean that efforts to identify these strategies and translate them to clinical practice model should be abandoned.” On the other hand, Martin Abrahamson, M. D., Chief Medical Officer at Joslin Diabetes Center and an Associate Professor of Medicine at Harvard Medical School, said, “Since we know which weight management programs will work in the fight against obesity, the challenge is to find ways to implement them in communities, which we at Joslin are working hard to do” (emphasis added in both quotes).

The problem is that Joslin’s “innovative” weight management programs, referring to the Horton quote above, are not innovative enough. Joslin and Harvard both still cling to the Diet-Heart or Lipid Hypothesis promulgated first by Ancel Keys in the early 1960’s and later the American Heart Association: Saturated fat and dietary cholesterol are bad for you. Although increasingly recognized as unproven, this hypothesis still dominates in the medical establishment and suffuses public health policy. Government intervention began with the ill-conceived McGovern Commission in 1977; this resulted in the HHS/USDA's Dietary Guidelines for Americans produced in 1980 and updated every 5 years to the present day.

This misguided prescription for public health is promulgated and abetted by a corrupt consortium of big pharma, big agribusiness and big processed food manufacturers. The effects of this cartel on our health have been devastating, both in the last 50 years in the United States and increasingly worldwide as the Western Diet proliferates. My stock in McDonalds just passed 100 dollars a share, doubling in the last 5 years, in large part due to their success overseas.

Until this “corrupt bargain” is broken, our health will continue to decline as rates of obesity and diseases of civilization such as diabetes rise. The Way of Eating advocated in this column, The Nutrition Debate, is a solution. My views, although personal, reflect a growing movement of individuals including many “new age” health professionals, both Ph.D.’s and M. D.’s, from whom I take hope and glean edification. If I sound angry, it is only at leaders like Joslin, and patients like Paula Deen (see last week’s column,) who do not see the damage that high carb diets can do. Or who are fatalistic about the rising prevalence of obesity and diabetes – who think there’s nothing to be done but pop a pill. Perhaps, like “the other Dr. Richard Kahn,” I too am an “anarchist educator” (sans Ph.D.).

© Dan Brown 3/11/12