After spending a lot of time in the world of low carb and Paleo, I can’t imagine how I missed her. The “her” is an anonymous blogger who calls herself CarbSane. The other day I was preparing to write an Amazon review on Jimmy Moore’s excellent new book “Cholesterol Clarity—What the HDL is Wrong With My Numbers?” The review is still in the works but trust me, I will give the book five stars. I was perusing some of the other reviews when I came across the review written by CarbSane. She not only trashed the book, but also she managed to literally chew Jimmy up and spit him out! She then went on to trash many people who contributed to the book including Gary Taubes, Mark Sisson, Dr. Fred Pescatore, Dr. William Davis and a long list of other people who I respect. She rated the book 2 stars but then went on to say it really deserved a 1 star. Out of 36 reviews there were only three that weren’t 4 or 5 stars so CarbSane’s review really stuck out like a sore thumb.
CarbSane Seems a Little Insane
I decided to do a little research on CarbSane. I visited her web site and read through some of her ranting and rambling blog posts. The pattern was the same—if someone from the low carb or Paleo world pokes their head out of a foxhole, she blasts them with both barrels. The purpose of this blog post isn’t to challenge CarbSane’s positions on diet and health because a long list of people smarter than me has already done so. What caught my attention was CarbSane herself.
I became fascinated with her because I immediately recognized that she fits the pattern of someone with a treatable disease and as a practicing physician with over 35 years of experience, this is what I do. I try to figure out what is wrong with people—in other words I diagnose them and then give them advice on how to fix the problem.
In her blog posts she often refers to the fact that she has an eating disorder and has struggled with her weight. Years ago she had some success with low carb eating but it was only temporary. In the end she became disillusioned by low carb eating and decided to challenge those who still promote this approach. Her opposition to a low carb approach doesn’t bother me in the least, because I actually like to be around people who disagree with me. Science advances when theories and concepts are challenged, not when everyone is in agreement. I even agree with some of her views. What I sense from CarbSane is her passion for attacking others is a reflection of her own ongoing health problems.
Forget About Your Weight and Focus on Your Brain
Like just about everyone else, CarbSane seems to focus on issues like her weight or her eating disorder, yet what I see is a brain that isn’t working as intended. I think she has a classic case of untreated CARB syndrome. Carbohydrate Associated Reversible Brain syndrome or CARB syndrome is a form of reversible brain dysfunction that can gradually occur in people who eat a diet of processed foods. The concept evolved over several decades in an attempt to explain the connection between metabolic problems like insulin resistance, obesity and type II diabetes and common brain disorders. The concept was recently described in a peer-reviewed journal and presented at a conference at Harvard, so it seems to be catching some wind.
As with any other disease, CARB syndrome has typical symptoms that gradually emerge over time in a more or less predictable manner. To date we have identified 22 such brain dysfunction symptoms. After spending a lot of time reading her blog posts and her interactions with others, it is clear to me that CarbSane has some mood issues and at times she even seems a little hypomanic. She also tends to drift into being somewhat obsessive-compulsive, especially when attacking others. She also seems to have poor impulse control, a poor self-image (the eating disorder) and low self-esteem. At times there isn’t a clear transition from one thought to the next, suggesting some focus and concentration issues.
If you read through her comments directed at others, it’s pretty clear she comes up short in the empathy department. She seems to spend a lot of time attacking those who disagree with her. On her web site she states: “I was fatigued from time to time from sleep deprivation as I had raging insomnia”. There go two more off the list—excessive fatigue and insomnia. She also comments: “By restricting carbohydrates you will discover your previously unknown addiction to carbohydrates and start craving them. The longer you do Atkins the fewer carbohydrates you will eventually be able to eat. Eventually even protein will lose it’s physiologically satiating properties and trigger hunger and cravings because a skinless chicken breast might as well be at Little Debbie cake.” I’m not a big fan of Atkins but it sure sounds like CarbSane is familiar with cravings for sweet and starchy foods, the hallmark symptom of CARB syndrome. If you have such cravings your disease is out of control and your brain will push you to store extra fat even as you lose lean body mass from under-eating. If you read through the 22 symptoms of CARB syndrome, it becomes apparent that CarbSane already has most of them.
You might wonder how can I possibly diagnose someone with a disease who I have never personally met? Yes, to some extent I am speculating, but in medicine we often speculate about possible diseases in patients we have never seen when discussing cases with our colleagues in “curb side” consults. CarbSane even does this herself when she speculates that Jimmy Moore has Klinefelter’s syndrome and she doesn’t even have an MD behind her name. Over the years I have successfully treated thousands of patients who fit the CARB syndrome pattern and in my opinion CarbSane clearly falls into this category. After 35 years of clinical experience, my diagnostic skills are very sharp.
Wasted Talent, A Wasted Life
In a sense it’s very sad. She is obviously an intelligent person but she wastes her time obsessing about the weight status of other people like Jimmy Moore. I don’t care about Jimmy’s weight. If his metabolic parameters and brain function are good (no CARB syndrome), then he’s good to go. There is really no such thing as a “weight problem”. Excess body fat itself does not significantly increase morbidity and mortality unless it is coupled with inflammation and bad metabolic markers. Although virtually everyone with CARB syndrome has excessive body fat when you measure body composition, there is no correlation between the amount of excessive fat and the severity of the accompanying brain dysfunction. You can be a thin person with a little extra body fat and severe brain dysfunction—think anorexia, or you could be a large person with a lot of extra fat and only mild brain dysfunction symptoms. In a sense body fat and brain dysfunction move together but don’t correlate in severity.
Thus a large person with a lot of extra fat needs to focus a little more on losing that extra fat to reduce their morbidity and mortality. If their brain dysfunction is only mild, that too will improve as an extra bonus. A thin person with severe brain dysfunction needs to concentrate on fixing their brain in order to improve their quality of life. The good news is that if you focus on improving brain function, excessive body fat will also gradually disappear regardless of your size, weight or BMI.
CarbSane spends a lot of time talking about people who haven’t done well after following low carb or Paelo diets. They continue to have brain dysfunction symptoms or regain weight. In my opinion the reason they fail is because they focus on weight rather than on their underlying disease. CarbSane also believes that when it comes to weight, calories call the shots. I think CarbSane needs to review her science. Obesity is defined as excessive body fat. The most accurate way to access body fat is to measure body composition. I have measured over 18,000 body composition readings on my patients over the years and there are many people with “normal” body weight and BMI who have excessive body fat. Even some thin people have excessive body fat. The majority of these people with excessive body fat also have brain dysfunction symptoms indicating that they have CARB syndrome. So forget about you weight and focus on your symptoms.
Fix Your Brain, No More Insane
The CARB syndrome concept focuses on your brain. If you have CARB syndrome your brain isn’t working properly so your quality of life suffers. You can live to be a hundred years old and you will likely end up spending 100 years making yourself and those around your miserable. Because CARB syndrome is reversible and treatable, it’s tragic when someone like CarbSane lives her life with severe brain dysfunction. I don’t know a thing about her body composition and I really don’t care. If she addresses her brain dysfunction her body composition will automatically improve. CarbSane needs to stop obsessing about her own and other people’s weight and focus on fixing her brain. Her only chance of doing so is for her to understand the nature of her disease.
People with advanced CARB syndrome often lose insight and fail to understand that their brain isn’t working so well. If you read some of CarbSane’s blog posts you will see what I mean. She has several posts that go on and on about Jimmy Moore’s weight and body to an obsessive degree. From what I can tell Jimmy’s metabolic markers are just fine and his brain function seems excellent. CarbSane needs to forget about Jimmy and the other low carbers and focus on her own brain function.
It appears that the three dietary triggers of CARB syndrome are excessive fructose mainly from sugar and HFCS, high glycemic carbohydrates mainly from grains and excessive omega 6 fatty acids from vegetable oils. Any diet that reduces or eliminates this toxic triad will help to reverse CARB syndrome. Low carb, Paleo, ketogenic—take your pick. The reason that these diets have had some success is because they reduce or eliminate processed food. With advanced CARB syndrome dietary changes are often not enough to turn the disease around. People often need targeted supplements like L-glutamine to suppress cravings for sweet and starchy foods, Cinsulin to improve insulin sensitivity and precursor products like CARB-22 to restore neurotransmitters levels. Some patients with advanced CARB syndrome benefit from low dose medications but using them effectively can be tricky.
An Offer You Can’t Refuse
CarbSane, the good news is that there is hope for you. You have a treatable disease and I have a great deal of experience managing complex patients like yourself. In the past you tried various diets in an attempt to lose weight and things stalled out and you didn’t feel good or lose more weight. That’s because you don’t understand the disease that is destroying your health and quality of life. Contact me and I will guide your treatment protocol at no cost. I’ll even throw in a free bottle of CARB-22. I’ll be waiting for your call.
Get ready for some online poo to be flung your way, Dr. Wilson.
Sam:
Poo I can do. Thanks for the heads up.
Dr. Bill Wilson
A typical ploy of those who get panty-bunched about carbsane (who actually has actually revealed her real name some 3 years ago – get with the times, “doc”)
I get it, Doc, slander and ad hominem are easy substitute for thinking. But why not humour us where others of your ilk have failed and actually produce evidence against anything carbsane has argued scientifically?
I look forward to it : )
Mike:
As I stated in my post, it is not my intention to argue the fine point of nutrition with CarbSane. I actually agree with many of her positions. I simply made some observations about her style and approach to interacting with others. As I told CarbSane, she if certainly free to discount my observations. I fail to see any slander in my comments. Perhaps you could enlighten me.
Dr. Bill Wilson
Do you always diagnose anonymous people without personally examining them or forming a proper patient-doctor relationship? Seems a bit unethical or illegal to me… but what do I know? I’m just a therapist with a few thousand patients under my belt.
Anon:
Good point. I made a tentative diagnosis based on the information available to me. I told CarbSane that if she wanted to confirm her diagnosis she would need to have a face-to-face with a health care provider and I offered to provide this service for free. She has yet to take me up on my offer. I do know the legal ins and outs of medicine.
Dr. Bill Wilson
I have been aware of CarbSane for sometime but never really read much of her rantings until I read her reviews of Jimmy’s book. This is an interesting explanation of her “syndrome.” Have you heard of another anti-carb zealot who goes by Durianrider? I recently posted some comments about my success with a ketogenic diet and he reared his ugly head and made some many bizarre accusations that I truly had to ask “what’s up with this guy?” I was accused of being a “sock puppet” and “anonymous” and his principal accusation was that I don’t really exist and that all I of my claims were undocumented lies because it would be impossible to have done the things I claim I do (bike 20 to 60 miles a day on a very low carb diet at age 60). I’d be interested to see if you suspect CARB syndrome in this guy.
Peggy:
I don’t know this dude but I think you need to stick with what works for you. There will always be some folks who try to tear you down when you are having success. You know yourself so trust your own judgment.
Dr. Bill Wilson
If Evelyn has Carb Syndrome, then what disorder does Jimmy Moore have?
Jimmy might have a touch of CARB syndrome but he is dealing with it. The best I can tell CarbSane still has her head in the sand.
Dr. Bill Wilson
Hello Dr. William L. Wilson,
I cannot tell you how relieved I am that you have finally diagnosed me! I plan to stay up all night and read every last word on this website to educate myself about CARBSyndrome.
I am also thrilled to discover that you practice in MA these days, so while it will be a distance to travel, it will be worth it if you can cure me! I will be researching your facility tonight as well. I hope to find a lot of information on the treatment programs available. Gosh this is so exciting I can hardly contain myself, but I promise I won’t eat any carbs until I can see you.
So I shall be calling your office some time tomorrow in the hopes of setting up the earliest available appointment during which you can analyze my brain with your Futrex.
This is very exciting and I think the media relations office at your hospital will be thrilled at the publicity this will generate for them when the CARB-22 actually cures me!
I can’t wait!!
Sincerely,
CarbSane (who is no longer anonymous)
CarbSane:
It’s nice to know that we do have one thing in common–a bit of sarcasm. I don’t have a private practice at this time but I thinking about opening one. I’ll keep you posted. If you contact the public relations office at the Hospital where I work you will find out that they have asked me to be on their local TV show to discuss the CARB syndrome model. You are welcome to tune in. If you want to take me up on my offer, then let me know. We can set up a time and place for our first appointment.
By the way, if you are no longer anonymous then how come nobody knows your name? I gave you my name straight up. If you can’t admit who you are, perhaps you have more problems than I can deal with.
Dr. Bill Wilson
You are my hero.
Joseph:
Thanks. I do try to help people.
Dr. Bill Wilson
After such a comprehensive diagnosis why don’t you now tackle her theories on diet and nutrition?
Bootleg:
I agree with her on certain points. I like the fact that she challenges others. CarbSane seems to have her own opinions about nutrition that at times seem impervious to a meaningful dialogue. If I an wrong, I am more than willing to discuss these issues with her.
Dr. Bill Wilson
Bill,
your email imprint f this post arrived while I was contributing a comment to Amazon, if about another book. ithink your post is an excellent analysis, and for me it is enlightening to see CARB syndrome theory in application.
The modern classical analysis has it that weight gain aarises simply beciase we eat too much, ingest too many calories, and have too many calories come from fats present in the diet. The modern classic and largely consensual nalysis is wrong of course. It is wrong on several counts.
The sequestration of body fat arises, in the main, under the influence of the hormone insulin which is predominant in converting surplus glucose to glycogen, and when glycogen reserves are replete (full) then glucose or glycogen are projected along the pathway that has them converted to body fats. Under the correct conditioons this process is ‘adaptive’ in the sense it wards of starvation if food becomes scarce. When food is less plentiful, and when the food sources (or choices) conatin less carbohydrate then bllod sugars will fall, insulin levels will fall,and any body fats can be fats can be released and used for energy via the pathways of lypolysis and ketosis (as Rober Atkins described it). it is a reversal, a systemic reversal in metabolic management, governed by hormones, but which is noit possible if levels of insulin remian high. Insulin is a pivotal metabolic gatekeeper permitting glucosis (cells running upon glucose) and hyper-glucosis (cells running on glucose and excess glucose stemming from excess in the supply chain being converted [sequestered] to body fats).
Obesity doesn’t result from a wilful capacity to overeat. weight gain and obesity results from a decline in the capacity of an individual to cease eating when they needen’t. Consciuosness and consceince isn’t the driver in this. Nature hasn’t assigned the task of self regulating how much we eat to the conscious or the conscience. It is the hormones that are tasked with signalling to and from the brain when we have had our fill and should cease eating. When hormones cease to do this in the way(s) that they should, then we face asteady decline in teh capacity to self-regulate our appetite and our sense of satiety (being full and satisfied).
It is indicated, I detect, if not yet firmly established, that the signals that transmit senses of satiety, and that are therefore involved in the self-regulation of appetite, are typically fat centric. Signals may be conveyed by molecules that are derived from certain fats or lipophiles, or they may be initiated by the presence of fats in the guts.
Something that grips my curiosity, BIll, but which I haven’t had time to explore in depth is if there is a feedback circuit of some kind that can attenuate the business of digestion. The food we ingest becomes chime, and chime is amash of various carbohydrates, fiber, fats, and proteins, and too my mind fats may well form some resiatnt barrier to the business of digestion. Cholesterol is supplied to the guts as a constituent of bile acids, and cholesterol then beomes a nucleic component in a chylomicron whose job it is to convey fats and lipids, along with fat soluble vuatmins, over the gastrointestinal divide and into the body proper ready for distribution. Cholesterol seems central to the cycle, and we’d have to wonder if chylomicrons (or any other lipoprotein) could form at all in the complete absense of choilesterol. Does bile and cholesterol within bile equate to a detergent that helps break down fats, but in so doing does it then permit digestion of cabrs and proteins present in chime? This begs a further curiosity. Is the supply of bile attenuated in any way? If so, by what and for what reason?
To a point, and largely from the standpoint of sytems analysis, I can see that attenuation of digestion could be an adaptive development in biology and in human evolution in particular. Firstly, chylomicrons and the route they take suggets to me they can buffer energy (in fats) without having to lay it down as body fat. Secondly, if the body has an adequate supply of energy to fuel metabolism why send it over from the guts and across the GI divide to the body proper, when in effect, attenaution of digestion could leave it resting in the guts? Bulk in the guts is potential cause of discomfort, but fats are not bulky, anbd a certain amount of fats could rest a while in the guts prior to need without causing discomfort.
So it is from a striking sytemic perspective, albeit a limited and mixed evidential one, that I think satiety can be signalled from a fat centric basis and that such signals mat attenuate digestion and prescribe the limits of how much we ingest at a meal or between meals. As I say, the evidential basis I am in possession of is not strong,m but I did trump oleoethanolamide as a derivative of oleic acid that could be sequetially significant in the chain of communication that assists the self-regulation of appetite. As yet I simply do not know.
I agree, CarbSane does not come across as unintelligent, but she does come accross as channelling her evident energies along destrcutive, as opposed to constructive, trajectories. I hope she makes contact with you for there is potential within her that she is not acessing.
And where I empathise with you most is that for all I dislike Amazon for the trend to monopoly and lack of diversity in supply, the reviews that arise beneath books, along with the deabte that can establish itself in the comments beneath a review can be as instructive as the book itself was intended to be, and sometimes more so. Reviews and comments are an expedient contribution to crowd-sourcing a solution to many a signifcant question.
Obesity doen’t arise becuase we ingest too many calories. Obesity arises because of a decline in the ability to cease or refrain from eating when we have no need of food. Willpower doen’t enter into it. The entirely fictional lipid hypothesis (as the dominat explanation for the cause of heart disease), and the ease with marketing encourages people to believe eating fats will make us fat, has evything to do with the hormonal canges and imbalances that lead to weak signals we ought to be able to follow without any involvement of our conscious self. Having seen CARB syndrome theory channeleed to such illuminating eefect in application I have developed a notable advance in my understanding of, and respect for, it.
God bless you Bill, and my God bless CarbSane and prevent her from continuing to bark up the wrong tre entirely.
Here’s a deabte arising beneath a book on Amazon, It was John Briffa who marked the book for my attentyion after a comment I placed benath his blog on sleep shortage. The link may be of interest to you.
http://www.amazon.co.uk/review/REGX4PASKMVON/ref=cm_cr_rev_detup_redir?_encoding=UTF8&asin=0671038680&cdForum=Fx1SPH4LZ3W42XF&cdPage=1&cdThread=TxEGY1AY7IBQIP&newContentID=Mx2RJJ0TDTA8QXN&store=books#Mx2RJJ0TDTA8QXN
Christopher:
Thank you for your well though out response. I really like your perspective. I also agree that CarbSane has some good points but she needs redirect herself in a positive direction as you have done. I agree with you that the issue of obesity is much more complex than usually presented. We need good minds to work on these issues so thank you for giving us the benefit of yours.
Dr. Bill Wilson
If CarbSane accepts your offer I hope you will be telling her that the dietary causes of CARB syndrome are not fructose or high glycemic carbs or n-6 fats, but nutritional deficiencies caused by refining of carbs. When they make white flour/rice/sugar they remove most of the vitamins and minerals, you know. Actually they remove all of them from sugar. They also add extra iron to white flour and (in the US) to white rice. You may not be aware that iron overload has been found in many diseases, and has recently been shown to cause diabetes in mice by preventing access of manganese to mitochondria. The diabetes could be prevented with extra manganese.
http://www.ncbi.nlm.nih.gov/pubmed/23372018
White flour has had up to 80% of its manganese removed. Most of its magnesium has been removed too, and much of its copper. More than 75 similarities have been found between animals deficient in copper and people with ischemic heart disease.
http://ajcn.nutrition.org/content/71/5/1213.full
And it’s not just diabetes and heart disease, it’s brain disease too. Alzheimer brains have iron overload in the damaged parts, and copper is needed to get the iron out. Alzheimer ‘tangles’ are due to low activity of an enzyme called PP2A, which is a manganese enzyme. It also requires methylation, which is dependent not just on B vitamins but on copper as well.
Jane:
I think you make some very good points. Our processed foods is poisoned in ways that we can’t even imagine so we need to be very aggressive about the solutions.
Dr. Bill Wilson
Is this a parody site? I truly hope Jimmy Kimmel is behind this.
Ura:
No parody here. It’s the real deal.
Dr. Bill Wilson
I have read several of Carbsane’s rantings, and while I agree with your basic premise, there is more going on that signals a personality disorder or mental illness of some type, especially her need for attention at any cost. If most people disagree with something, they don’t tend to be obsessive about attacking those who favor said position. She is sick, perhaps a Messiah complex. A few less hours at the computer would be a start towards improvement.
Digby:
Very astute observations. I sometimes spend too much time in front of a computer (ask my wife) but I do so in an effort to help people. There is already enough negativity in the world. Wake up in the morning, thank God you are here and do something positive for the world. It isn’t that difficult to do.
Dr. Bill Wilson
A stunning and brave post Dr.Wilson. If you can get CarbSane to a safe weight, you will become world famous. I hope she takes up your kind offer and finds salvation. I believe a low carb lifestyle will improve Evelyn’s long term health no-end.
Eddie–Thanks for your comments. Yes indeed I have been attacked by some of her supporters but I don’t mind it when people disagree with me. Sometimes (but not always) that can lead to a meaningful conversation. I agree with many of her positions but think she could be much more effective if she didn’t spend all her time attacking those who don’t agree with her. I am certainly open to having meaningful conversations with CarbSane if she is willing to do so. As I mention in the post I am more concerned about people’s metabolic health and brain function than their weight.
Digby, you might see CarbSane in a different light if you were a scientist. Her science is very good. I have been examining it for a long time, curious to know why she gets such a lot of criticism. I thought she must be posting nasty comments on other people’s blogs that I didn’t see. However I have now seen a collection of these comments, on Carole Sampson’s now-defunct blog CarbSaneR, and I am more puzzled than ever.
Digby and Jane:
I didn’t write my post to criticize her views. I have spent enough time on CarbSane’s site to recognize that I often agree with her. What caught my eye is that she seems to spend so much time attacking others who disagree with her in a way that does not lead to a learning experience for anyone. She seems to be very intelligent and has a lot to offer. Before I posted the blog I was warned by many not to do it because I would face the wrath of CarbSane and her followers. There has been some of that but many of the conversations have been productive.
I often work seven 12 hour days in a row in an intense acute care setting. I often pick up extra shifts on my week off so I have very little free time. I give away information that I think might be helpful to people and I do so at my own expense. My wife thinks I am a little crazy to do so, and perhaps she’s right but I get my kicks from helping people. If people don’t find my information helpful or useful they are free to ignore it and if they do, I certainly won’t be offended. Life is too short for that.
Dr. Bill Wilson
Hi Bill
Actually I think your post on CarbSane was very helpful. Something like that was needed, to get things out in the open. You may not be aware that her detractors have been far more obsessive and vitriolic about her than she has been about anyone. I have been watching this for a long time and have been profoundly shocked. CarbSane does not retaliate because she knows she will be punished with something even nastier. I have been the target of this kind of thing myself. My crime was to try and draw attention to the role of mineral deficiencies in modern disease. CarbSane’s detractors either make fun of what I say or concoct elaborate explanations for their ill health which ignore it.
Jane:
Thank you so much for your comments. If we try to maintain an open mind I think we can learn a lot from each other and that includes CarbSane. From what I can tell we share some views.
Dr. Bill Wilson