www.bestlowcarbs.com

At one of those wonderful "electronic text sessions" run by Auckland professor of general practice Bruce Arroll at the recent Rotorua NZMA GP CME conference, one of the delegates asked Bruce if he was familiar with the "anti-CAM" (anti-Complementary and Alternative Medicine) site called Quackwatch.

Quackwatch is a great resource for that sceptical clinician just a few years out of medical school or perhaps for that somewhat inflexible and equally sceptical consultant.

But, as we mature, we tend to mellow and shrug our shoulders - and maybe advise our patients benevolently that they may do what pleases them but, to simply watch their wallet and to hopefully follow our more evidence-based traditional medical advice in parallel.

And, of course, to "check out the website". Which website  to guide them towards is always a challenge.
Which is part of the reason why this month we are not in fact looking at Quackwatch - we may have a proper look at a later date - but there have been a number of critics of Quackwatch who claim the science of the founder, retired psychiatrist Dr Stephen Barrett - as well intentioned, committed and highly energised as he is - may not always be comprehensive, up to date, truly evidence based or always fair.

On my Google search I was drawn to one of the Quackwatch articles criticising low-carb diets. And, as we all know, for some people reduced carbohydrate portions can have a rapid and significant effect on weight, insulin resistance and also pre-diabetic markers such as HbA1c.

So, feeling somewhat sympathetic for the "low-carb" movement (and despite its voluminous global advocates all seeming to be in the "Get-Rich-As-Fast-As-Possible-by-Writing-Yet-Another-Atkins-Book" camp), I thought maybe we should look at one of the sites that got all the criticism.

The site at Best Low Carbs is advertised as "Evidence-Based Low Carbohydrate Dieting" and was established by a non-clinician health advocate Dr Tanya Zilberter.

It is promoted as an unbiased approach to low-carb practices. She asks, quite reasonably in my opinion, "Why is Dr Atkins' Book listed on Quackwatch's quackery list", and rightly points out the anti-low-carb approach is outdated (and I believe has also been further supported in more recent authoritative research once again), and that the diet is indeed efficient and safe. And, of interest, the ketogenic diet is said to exist as a conventional medical programme in more than 35 states in the US and also in some 10 other countries.

As a PhD qualified health educator, researcher, exercise physiologist and writer with more than 20 years in health sciences, Dr Zilberter is certainly not unqualified.

She also apparently runs an additional diet-focused website dietandbody.com and of course also sells "the book"- as most Americans would do if they had just half a chance and a functioning word-processor.

Her eBook Low Carbohy-drate Dieting for Beginners is claimed to be, and appears to be, a reasonably well researched guide to low carbohydrate diets.

The basic premise for low carbohydrate diets is the body will always burn carbohydrate first since it is the body's preferred fuel, and will burn fats secondarily via ketosis. Therefore, a high carbohydrate diet will tend to limit fat burning and a low carbohydrate diet will tend to enhance fat burning.

The site is reasonably simple and consists of a large number of links to articles written largely by the one-and-only Dr Zilberter.

There is no visible editorial board, just Tanya. And, I am not sure whether her "evidence-based" framework would stand up to Bruce Arroll's scrutiny.

A selection from the site includes a plethora of articles and abstracts, direct linked references to texts at Amazon.com facts about low carb diets, the top 10 ebooks (downloadable electronic books), low-carb recipes for enhanced fat burning, the mystery of ketosis, other health benefits of low-carb diets, low-carb diets and mood, Atkins diet statistics, low-carb and exercise, low-carb and potassium, the Zone diet, the South Beach diet, how to cheat on a low-carb diet, low-carb and the kidneys, the Glycaemic Index - and of course recipes, recipes, recipes.

So, all in all maybe it is a good reference to pass on to your patients - and, importantly, it does have a nice simple title to remember.

Back to Quackwatch

And, further to my comments on Quackwatch (www.quackwatch.org) just in case I don't get a chance to have a look at it - it does have a scientific and technical advisory board - 152 members in fact, of which 67 are medical and even a legal support team of 28. It is closely affiliated with the National Council Against Health Fraud. It is promoted as "Your Guide to Quackery, Health Fraud, and Intelligent Decisions".

Quackwatch was established in 1969 by the then 35-year-old Dr Barrett. It provides a range of activities which encompass investigating questionable claims, advising quackery victims, distributing reliable publications, debunking pseudoscientific claims, reporting illegal marketing, improving the quality of health information on the internet, and attacking misleading advertising on the internet.

Dr Barrett retired from his psychiatric practice in 1993 to devote himself full time to "quack-busting". Evolving his communication and "marketing" skills he had become more of a Nader-like investigative journalist who was able to harness the power of the internet.

On retirement Barrett devoted himself full time to quack-busting and managed to attract a highly supportive article in Time magazine in 2001.

Quackwatch also has a number of sibling sites for example Acupuncture Watch, Chelation Watch, Chiro Base, Dental Watch, Diet Scam Watch, Homeopathy Watch, Nutriwatch and Pharmwatch to mention a few.

Quackwatch had clocked up its 8 millionth site visitor on 8 January 2007 and it claims to regularly update key pages several times each week.

Some of the links have over time and, perhaps, not unexpectedly, quietly deceased and there is a little bit of tidying up needed. The style and layout could sure do with a bit of modernising.

While reports have been added up until 2006 and 2007 the layout certainly gives the impression of a potential for "web-rot", which is a shame.

It is difficult to know what would happen to the huge wealth of information that is Quackwatch if Dr Barrett now 73 years was to suddenly disengage. I suspect this will only happen once he has taken his last gasp.

If the saying is true "if you don't use it (your brain) you lose it", then his brain, should be around for a while.