Saturday, September 22, 2007

The Low Fat side of the Kimkins Diet: Rabbit Starvation, Sudden Death and Resting Metabolism.

Low Fat Side of Kimkins parts 1 and 2

As discussed in the previous article, very low calorie diets like kimkins can cause gall stones due to rapid weight loss as well as the lack of fat that is commonly seen on this diet. This, may also be a danger for low calorie diets like Tony Ferguson which also commonly results in rapid weight loss, very low fat and can easily slip into the VLCD category for some as well.

Liquid Protein diets and Sudden Death

A concern is the sudden deaths associated with the liquid protein shake VLCD diets in the 70s and 80s. Now yes, there was a major issue with the type of protein used but it wasn't the only issue. Of course there have been improvements in the quality and thus safety of these liquid meal replacement diets over the short term (though they still carry lots of risks) BUT they do not show any safety for unsupervised diets, let alone ones that are simply a stab in the dark and offer no real nutritional guidelines and minimums, to avoid risks associated with VLCD dieting and fasting.

I should add to this that a little while back in the space of a little over a week I had heard of two incidents by people whom had allegedly run into heart trouble whilst following Kimkins. The last person apparently had dangerously low levels of potassium, that is not something to be messed with. The fitday in which allegedly belonged to this person appeared to be kimmers experiment with fat under 30g but mostly under 20g. Protein choices were mostly protein shakes, chicken, egg, fish and turkey and went back to early June so this person would appear to have been on this diet for over 2 months when they ended up in hospital. I haven't heard any more of these two incidences since.

"IN 1976 a book entitled The Last Chance Diet was published and almost immediately, several liquid-protein-modified-fast (LPMF) diets became very popular and fashionable as means of rapid weight reduction. These diets were intended to serve as the dieter's only source of calories. Between January 1, 1977 and December 31, 1977, it was estimated that more than 100,000 persons had used one or more of the LPMF diets as their sole source of nourishment for at least 1 month. By August 1977, however, sudden death in several young LPMF diet users was reported to either the Food and Drug Administration (FDA) or the Center for Disease Control (CDC), and between July 1977 and January 1978 at least 60 deaths among avid users of the LPMF diet were reported to the FDA and CDC. " [16]

One study discussing the dieters that died from sudden death in the late 70's and cardiac dysfunction, speculated that "Although little is known about the pathogenesis of the acquired QT syndrome exhibited by certain persons during and for a variable periods of time after prolonged caloric restriction, it is likely that severely obese individuals who have lost 30% or more of their body weight rapidly, either by fasting or by means of VLC diet, are at substantial risk of developing this dangerous cardiac disorder. Less obese persons who reduce their weight rapidly on similar regimens may develop a prolonged QTc interval after losing as little as 10 to 15% of body weight, In such individuals, death from ventricular arrhythmia could occur within 2 months of dieting." [17]

Some other studies regarding these PSMF shake diets and sudden deaths [18, 19]

This is why I have a problem with the kimkins diet for ANYONE. Who is to say, that a or a future member or two (or three) of kimkins does not have the potential for sudden death through following her diet plans and advice? How do we know that her plan as vague and nutritionally unsound as it appears to be, is any better then the old liquid protein diets of the past that were associated with sudden deaths?

Don't forget she also has a shake plan, a shake plan I might add that even allows for home made shakes that have no proper nutritional guidelines other then protein and carb limits and thus are pretty much left up to the dieter to formulate. Dieters that will have no experience or knowledge in formulating such a thing in order to ensure adequate safety. This is why I believe her shake plan has the potential to be one of the worst plans of hers though eating 4 bites of lean chicken and a coffee is certainly not any better!

But to make things worse, not only does she have an 800 calorie shake plan (4 x 200 calorie protein shakes) amongst her official plans, she has also advised on her forum her recommendation to do, a 450 calorie version of her shake plan, consisting of 3 x 150 calorie protein shakes and that's it... for fastest results. This 450 calorie version, she claims is her fastest plan.

Rabbit Starvation

But there's more , there is also concern regarding diets consisting of mostly lean protein, a concern that was commonly shared by arctic explorers.

The term "Rabbit Starvation" is well known amongst explorers. I have seen this term mentioned in a lot of discussions regarding lean protein and low carb including low carb research papers. If you have been keeping up with this whole kimkins controversy then you have probably seen the term mentioned many times amongst kimkins related discussions as well. The one they usually refer to is, Vilhjalmur Stefansson whom spent many years with the Eskimos, which included eating their diet. I found some of his writings which I will share:

Quoted by Vilhjalmur Stefansson in an article on the weston A Price web site [20]:

"The groups that depend on the blubber animals are the most fortunate in the hunting way of life," wrote Stefansson, "for they never suffer from fat-hunger. This trouble is worst, so far as North America is concerned, among those forest Indians who depend at times on rabbits, the leanest animal in the North, and who develop the extreme fat-hunger known as rabbit-starvation. Rabbit eaters, if they have no fat from another source-beaver, moose, fish-will develop diarrhea in about a week, with headache, lassitude, a vague discomfort. If there are enough rabbits, the people eat till their stomachs are distended; but no matter how much they eat they feel unsatisfied."

He and other explorers termed this diet 'Rabbit Starvation' or 'Rabbit Malaise'.

I was reading his book titled, My life With The Eskimo on google book search [21] and I found this on page 27 and 28:

"In certain places and in certain years rabbits are an important article of diet, but even when there is an abundance of this animal, the Indians consider themselves starving if they get nothing else, ~~ and fairly enough, as my own party can testify, for any one who is compelled in winter to live for a period of several weeks on lean meat will actually starve, in this sense : that there are lacking in his diet certain elements, notably fat, and it makes no difference how much he eats, he will be hungry at the end of each meal and eventually he will lose strength or becomes actually ill."

Then page 140:

"Of our entire seven I was now the only one not actually sick, and I felt by no means well. Doing hard work in cold weather on a diet nearly devoid of fat is a most interesting and uncommon experiment in dietetics, and may therefore be worth describing in some detail. The symptoms that result from a diet of lean meat are practically those of starvation. The caribou on which we had to live had marrow in their bones that was as blood, and in most of them no fat was discernible even behind the eyes or in the tongue. When we had been on a diet of oil straight, a few weeks before, we had found that with a teacupful of oil a day there were no symptoms of hunger; we grew each day sleepier and more slovenly, and no doubt lost strength gradually, but at the end of our meals of long haired caribou skin and oil we felt satisfied and at ease. Now with a diet of lean meat everything was different. We had an abundance of it as yet and we would boil up huge quantities and stuff ourselves with it. We ate so much that out stomachs were actually distended much beyond their usual size ~~ so much that it was distinctly noticeable even outside of one's clothes. But with all this gorging we felt constantly hungry. Simultaneously we felt like unto bursting and also as if we had not had enough to eat. One by one the six Eskimos of the party were taken with diarrhea.

By the 10th of January things were getting to look serious indeed. It was apparent not only that we could not go on indefinitely without fat, but it was also clear that even our lean meat would only last a few days longer. We had on December 11th estimated that we had two months' supplies of meat, and now in a month they were gone. Our estimate had not been really wrong, for if we had had a little fat to go with the meat, it would no doubt have lasted at least sixty days, but without the fat we ate such incredible quantities that it threw all our reckoning out of gear. "

[I can't access the next page so I have no idea how much more he goes into it, if anyone does please share :)]

I found another book by Stefansson on google books titled, Unsolved Mysteries of the Arctic [22], here's an excerpt from page 248-249 which whilst discussing rabbit starvation also discussed something that is so relevant today, lets see if you can pick it:

"It is widely accepted, and probably correct, that the chief difficulty in shifting from a mixed to a meat diet is psychological~~a digestive revulsion based upon the idea that meat is dangerous. For, until recently, it has been a common belief that you cannot be healthy unless you have a varied diet, that meat is injurious if taken in large quantities, and that you become "tired of a monotonous diet". The Andree party do not seem to have had any such inhibitions. This may have been because they were familiar with the history of human diet and knew that nations and races have lived for centuries and millenniums on a diet mainly or exclusively meat. More likely they expected the desirability and palatability of a meat diet through the recent experience of Nansen and Johansen who, as we have noticed more then once, spent a whole winter (a little farther north than the Andree party would be spending theirs) on an exclusive meat diet, coming out in the spring with the best of health.

It is a nearly universal experience, when a shift is being made from a mixed to a meat diet under such conditions as those of the Andree party, that there is little or no prejudice against the lean of the Arctic animals but considerable against the fat. This fat is called blubber, is supposed to be a reprehensible, and the very thought of it commonly nauseates the inexperienced.

But it has been found in various parts of the world that a diet of lean meat exclusively will cause diarrhea in from three days to a week. If no fat can be added to the lean, the diarrhea becomes serious and will lead to death. A well known field where such deaths occur is the northern edge of the forest in Canada where Indians are sometimes unable to find any food except rabbits. The expression "rabbit starvation," frequently heard among the Athapsc Indians north-west of Great Bear Lake, means not that people are starving because there are no rabbits but that they are going through the experience of starvation with plenty of rabbit meat. For this animal is so lean that illness and death result from being confined to its flesh.

When a party like Andree's are making a gradual shift from a mixed to a meat diet, no diarrhea will appear in the early stages; for there is still a considerable percentage of sugars, starches and the accustomed fats such as butter and bacon. When these elements are materially lowered, and meat begins to play a larger and larger part, you approach the diarrhea stage. The trouble, once begun, will continue until the party overcomes its prejudice against "blubber" and begins to use fat enough to make up for the things (like potatoes, bread and sugar) which are normally eaten by a man fond of beefsteak who, when he eats steak, trims the fat away."

They also did a study a few years later where both Stefansson and Anderson lived for one year on an exclusive meat diet [23]. Also if you are interested in reading more there is an old article by Stefansson available called Adventures in Diet [24].

I find these excerpts above very interesting... Here's a quote from a study on hunter gatherer diets [25]

"Many historical and ethnographic accounts have documented the deleterious health effects that have occurred when humans were forced to rely solely on the fat-depleted lean meat of wild animals. Excess consumption of dietary protein from the lean meats of wild animals leads to a condition referred to by early American explorers as "rabbit starvation," which initially results in nausea, then diarrhea, and then death. Clinical documentation of this syndrome is virtually nonexistent, except for a single case study."

"Muscle tissue of wild ungulates typically contains 2.0–3.0% fat by weight. Lean muscle meat of ungulates (2.5% fat by wt) is composed of 79.8% of energy as protein and 20.2% as fat. Consequently, consumption of lean ungulate meat as the sole daily energy intake would rapidly exceed the ability of the liver to eliminate nitrogen as urea and, hence, produce symptoms of rabbit starvation."

According to the nutrition data web site, stewed chicken breast without the skin and bone contains only 18% fat as energy whilst, roasted turkey breast meat 5% fat, light canned tuna in water (drained) 6% fat, egg whites are a mere 3% and protein shakes most likely even less. Keep in mind that the lean meat they are referring to in the quote above is 20% fat. Then we have a quote by Loren Cordain [26]:

"The human physiologic protein ceiling is, in short, the upper limit of dietary protein that humans can digest. Small animals have less fat and more protein for their size than large animals do. The total protein content of a rabbit may be as high as 75%, with 25% fat, while a large animal may be only 35% protein and 65% fat. The maximum amount of protein humans can process at one time is about 35% to 40%. Therefore, using rabbits as a food source will rapidly exceed our protein ceiling, causing a syndrome referred to by early arctic explorers and frontiersmen as "rabbit starvation." Despite eating huge amounts of lean meat, men afflicted with rabbit starvation quickly became lethargic and developed diarrhea; death eventually followed."

So if you think this couldn't possibly happen to you or someone close, think again...

I know of quite a few that have tried kimmers experiment (KE) where they eat lean meat and egg only and after a few days they go nuts and start binging through no fault of their own. I wonder, if there was nothing else available-so that all they could binge on was the lean meat, if they would then get diarrhea and so on as described by Stefansson?

Of course, granted there are tons of people doing kimkins that have the opposite problem, so I am not sure what that means. I have read in the ask kimmer thread of others having unexplainable diarrhea, and I recall Kimmer in her reply to one of the ladies who had diarrhea saying that her sister suffers the same thing and she doesn't know why. Makes me wonder if this was the same?

Muscle and Metabolism

Stefansson speaks of this unsatisfying hunger, I feel it certainly fits with the thought that excess protein converts to glucose, doesn't it? [27] it would also explain some of the incidences where people go right off the rails despite doing every thing right... of course I do think this protein theory as in how much you convert to glucose and how often and how it effects you is individual, but I have seen it myself where some people seem to do this very easily.

The worst bit about the possibly in that environment, is that if your protein is being converted into glucose so much as to invoke such hunger, then would that also keep your glucose metabolism dominant and thus more likely to burn muscle when calories are low?

Burning muscle is something you really want to minimise when trying to lose weight. Other then the more obvious benefits of having muscles, it also uses up more energy then fat just to maintain thus the higher your muscle mass the higher your energy needs. The more muscle we lose the more we lower our energy output which for obvious reasons impedes weight loss. Granted, some muscle is going to be lost during weight loss anyway, but if we lose too much particularly in comparison to our fat loss, we pretty much shoot ourselves in the foot.

There is a good article I found a while back that explains it really well [28]

Being a fertile woman I found this paragraph towards the end of the article scary:


As we saw, if the energy intake is permanently reduced, body weight also reduces until it produces en energy expenditure equal to the intake, and the size of the reduction is inversely proportional to the consumption of the weight loss, which in turn depends on its composition that is determined by the starting weight. As already mentioned, a drastic diet, either in absolute terms (less than 1,200 Cal/day) or in relative (more than 500 Calories less than the starting TEE), causes the loss of a weight containing a percentage of lean body mass greater than what would be physiological for that definite starting weight. This phenomenon, which was proved in fertile women, while the clinical experience and the results of our studies suggest that it does not occur in postmenopausal women or in men, has two types of negative consequences. On one side, starting from the same body weight, since the weight loss consumes more, for a definite cumulative reduction of energy intake less weight is lost, even if in shorter time, than what would be if the weight loss composition was the physiological one. On the other side, with the weight attained being the same, since more lean than due was lost, body weight contains less lean and more fat, and then it consumes less. This means that to maintain any weight after a drastic diet one has to eat less than another person who has lost the same weight with the physiological composition, or a person with equal body weight who never lost weight. But the worst aspect of this phenomenon is that the alteration of body composition that it causes is permanent. In fact, in the case of weight regain after a drastic diet, the composition of the weight regain is the one physiological for the starting weight. Thus, less lean and more fat are regained in comparison with what was lost, and consequently also the maintenance of a weight equal to that prior to the diet entails an energy intake smaller than that before dieting. And, since the alternative is to go back to the previous energy intake stabilizing at a higher weight than that before dieting, it is easily understood how a series of such ups and downs (which is defined as "weight cycling") may lead to a progressive weight gain progressively more difficult to control. Many young women with no genetic predisposition to obesity, misled by mass media and not protected by specialized surveillance, vainly pursue unrealistic beauty ideals and eventually condemn themselves to become obese or to stay on a diet all their life."

I will have to see if I can find anything that backs this up, but its not just about muscle mass as there is also an impact on our thyroid which regulates our metabolism amongst having an effect on other important things such as our cardiovascular system, central nervous system (e.g.: mental state), growth and development and our reproductive system [29].

An interesting study I found explores the effect of a high protein VLCD on resting metabolism, thyroid hormones and energy expenditure of obese middle-aged women. [30]. Whilst they found that RMR dropped due to muscle loss they also found that the extended dieting itself had an effect on T3 levels which did not return to normal within 5 weeks of refeeding. RMR dropped significantly during the diet and upon refeeding returned to near baseline but still lower then baseline.

They note that changes in thyroid metabolism may be a factor in decreased BMR which occurs as a result of prolonged severe caloric restriction. They mention that fasting or semi-starvation leads to decreases in serum T3, increases in rT3 and little change in T4. Whilst rT3 initially increased, they found by 10 weeks it had returned to baseline and kept on dropping until significantly below baseline which they feel may indicate an adaption to prolonged caloric restriction. During the 5 weeks of refeeding that followed the VLCD they found that rT3 and T4 did return to baseline but serum T3 whilst increased, it did not reach baseline levels. They state that declined serum T3 resulting from severe caloric restriction has been linked to diet induced decline in BMR. They mention a study by Moore et al that found that those whom had the slowest weight loss during a 320 cal liquid diet had the lowest RMR and serum T3 levels. They also mention supplementing T3 to counter this was not effective and if I am reading this right suggested that such supplementation promotes protein wasting in luei of fat loss. I should note for those interested that they mention a link between carbohydrate restriction and decreased plasma T3 levels during caloric restriction, click on the link above and scroll down to thyroid hormone changes. I thought I would mention that tidbit as some members on LCF (Low Carb Friends) have been recommending that those with thyroid problems shouldn't go below 30g to 40g per day.

Another study [31] found that RMR was still depressed 2 months after the completion of a PSMF (protein sparing modified fast) and that reductions in fat free mass again did not account for all of the reductions in RMR. Here's an interesting quote I found in this paper in regards to RMR changes in lean and obese individuals:

"Refeeding experiments with lean individuals suggested that the RMR decrement associated with severe caloric limitation reverses within days of resuming maintenance caloric consumption. However, the RMR of our obese subjects remained depressed after massive weight loss despite increased caloric consumption to a level that allowed body weight stabilization."

Leibel and Hirsch [32] found that during weight maintenance some reduced-obese or even partially reduced patients must restrict their food intake to approximately 25% less than that anticipated on the basis of metabolic body size.

This study [33] found a significant reduction in serum T3:

"Serum T3 decreased by as much as 66 percent in VLCD (Very Low Calorie Diet) patients during consumption of the 400 kcal/day diet, whereas rT3 increased by as much as 27 percent. T3 increased when patients were realimented with a 1000 kcal/day balanced diet but remained a significant 22 percent below baseline."

Plus another study on the metabolic adaption in women during a very low calorie diet found that after 21 days the decrease in RMR-LBM ratio was near to that of those suffering chronic under nutrition[ 34 ].

Carol Bardelli also discusses the issue of lean body mass and VLCD dieting which you might find interesting [35]

If anyone comes across any more research on this topic please feel free to share so I can add it to my VLCD Research page and possibly this page as well. The list of references for this article as well as the previous article on gallstones is available here: Low Fat and Very Low Calorie Diets: References if needed but I have provided the links to the references through the article, just click on the relevant number to go there.

Other Kimkins articles by me:

Nov 16: Kimkins Diet Scam
Sept 11: Gallstones
Aug 17: My reply to Deni
Aug 13: The low fat side of the Kimkins Diet
July 18: Is Kimkins okay because its simply low carb?
July 15: Kimkins and Kimmer
June 13: Okay Some Kimkins Stuff...

Tuesday, September 11, 2007

The low fat side of the Kimkins Diet: Gallstones

Low Fat Side of Kimkins parts 1 and 3

Hey guys sorry its taking me a while but I've been very busy and keeping up with this whole kimkins controversy isn't helping LOL

Anyway the article is still very long so I am breaking it up more, I am still touching it up but the next part on gallstones is good to go:

When I began researching the risks of very low calorie and low fat diets I was surprised at just how common gall stones really are, because of this I thought this should be discussed first.

It has been well documented that weight loss, in particular, rapid weight loss increases your chances of developing new gallstones. It has been shown in more then one study that new gallstones have formed in as little as only 4 weeks into a VLCD [1]. One study claims 25-35% of people who experience rapid weight loss form gallstones after their VLCD diet [2] and then another one that is higher again with 54.5% developing gallstones [3], not very good odds!

The reason this is thought to happen is because, during rapid weight loss, cholesterol concentrations in the bladder increases (keep in mind this is said to have nothing to do with dietary cholesterol). To top this off, when you eat very low fat and/or skip meals you do not stimulate your gall bladder to empty itself as often, which worsens the situation, allowing gallstones to form [4]. In fact, one study found a doubling of incidence of hospitalization for gallstones amongst women who fasted overnight for more than 14 hours compared with women who fasted for 8 or fewer hours [5].

But, this isn't just associated with VLC diets. A study was done to see if this also happens on a LCD (low calorie diet). Calories were approximately 925 calories a day spread across 4 liquid meals and one solid meal. By 17 weeks into the study, Six of the 47 patients (12.8%) displayed gallstones with 5 being asymptomatic (no symptoms). The sixth however had severe pain and required a cholecystectomy at 30 weeks from the beginning of the study. [6].

Another study showed an increase risk of symptomatic gallstones with weight cycling, weight cycling is where people intentionally lose weight through diet but then later regain some or all of it back, rinse and repeat, this is otherwise known as yo-yo dieting. They found that weight cycling of more than 10 lb of weight loss and regain led to a 31% to 68% increase in the risk for cholecystectomy [7].

To add to all this, obesity itself is a pretty big risk factor for gallstones [8] with many already having silent gallstones (unsymptomatic), in which symptoms may be triggered when doing a VLCD [9]. Other risk factors are diabetes, metabolic syndrome, some medications including oral contraceptives or postmenopausal hormone replacement therapy (estrogen) [10] as well as females having a higher risk for gall stones which is thought to be due to estrogen increasing cholesterol concentrations in the gall bladder [11]

I was just reading a book called Gallbladder and Biliary Tract Diseases by Nezam H. Afdhal in Google book search [12]. On page 370 under the heading Lowering of the rate of weight reduction, it said this:

"Several Prospective studies have examined the relationship between weight loss and gallstone formation in the placebo arm of randomized controlled trials designed to prevent gallstone formation during rapid weight loss. In the study by Yang et al, patients who lost more then 25% of their baseline bodyweight during a 16 week very low calorie rapid weight loss diet had an incidence of new gallstone formation more then twice that observed for patients with a lower rate of weight loss. In two other studies, the rate of new gallstone formation increased stepwise with the rate of weight loss. Gallstones developed in only 8% of patients who lost less then 10 lb per month. This increased to 31% in patients who lost 10 to 15 lb per month and 49% in patients who lost 15-20 lb per month. The relationship between rate of weight loss and gallstone formation appeared to be stronger in women then men. These data suggests that the risk of weight loss is limited to only 1 to 2 lb per week."

One study that I was reading suggested a minimum of 10g of fat with every meal to reduce risks [13] (Keep in mind when I mention that minimum, it is in the context of trying to prevent gallstones only, personally I do believe we need more fat then that for other nutritional reasons). I have also read another study that claims physical activity helps in the prevention of gallstones [14] and another stating that 34% of cases of symptomatic gallstone disease in men could be prevented by increasing exercise to 30 minutes of endurance-type training five times per week [15].

Now if you think "well this won't happen to me" think again. There is a low carb, low fat diet in Australia that is very popular. Over here diets like Atkins aren't very popular at all ever since the Atkins craze slowed down a few years ago. But then you have the Tony Ferguson Diet which is advertised very heavily on TV and is available through a chain of chemists, their forum is very busy. This diet is not as bad as kimkins calorie wise (unless it was abused) but it can still fall into the VLCD category simply by limiting the veggies and fruit. It consists of a meal replacement for breakfast and lunch along with a fist sized portion of lean protein for dinner plus veggies/salad and fruit for snacks. The meal replacements are protein shakes or soups full of MSG. The shakes if memory serves me correct only contain around 2g of fat so as you can imagine gallstones seems to happen a lot or at least that's what I have been told by regulars on their forum. I was poking around on their forum the other day after a member bought up an issue with gallstones happening a lot there on a thread we have going, The Tony Ferguson Diet.

Now go to their forum, the url is:

(replace the "DOT" with a ".")

Do a search on gallstones and see how common they are. But check this out, this is a comment by one of their staff members on this issue which I found on their forum:

"If you are prone to gall stones, then any form of weight loss can bring them on. There really is no reason why you can't remain on the program with gall stones. Due to the fact is has such little fat content, then it should not trigger a gall stone attack."

Now if you looked at just some of the links on gallstones I have just provided, you would see just how crappy this response is. Kimmer isn't the only one whom appears to be dishing out misleading and inaccurate advice and unlike Kimmer this person I would assume is a trained professional.

As you can see, the odds are not great, seriously it seems pretty essential that you participate in regular exercise, make sure to eat enough fat regularly to encourage gall bladder emptying and avoid rapid weight loss unless medically necessary and under medical supervision.

Other Kimkins articles by me:
Sept 22: The Low Fat side of the Kimkins Diet: Rabbit Starvation, Sudden Death and Resting Metabolism.
Aug 17: My reply to Deni
Aug 13: The low fat side of the Kimkins Diet
July 18: Is Kimkins okay because its simply low carb?
July 15: Kimkins and Kimmer
June 13: Okay Some Kimkins Stuff...