Talk:Protein-sparing modified fast (diet)

Untitled

Initial edit complete, sources needed at various places, and probably some style/grammar changes. Kylefurlong (talk) 20:55, 14 June 2008 (UTC)

Incorrect language link

The French language link points to "Régime Dukan" which is incorrect since there is already a "Dukan diet" page in English. Dukan is high-protein, the reverse of PSMF… Sorry I haven't figured out how to modify or remove the link. 06:12, 16 April 2019 (UTC) — Preceding unsigned comment added by Belbernard (talk • contribs)

Error regarding amount of protein during PSMF

The wiki page says that PSMF recommends 1 - 1.5 grams of protein per kilogram. I don't know the source of this but, it should be 1 - 1.5 grams per lean body mass in pounds, not kilograms according to Lyle Mcdonald's rapid fatloss book. So in order to know how much proteïne an individual should take, he should know his lean body mass at front. Then multiply this with 2.2 in order to know this in pounds. — Preceding unsigned comment added by 83.83.31.17 (talk) 13:05, 2 December 2012 (UTC)

Lyle McDonald may be right, but none of the medical protocols I've seen for PSMFs use this much protein. Most of the peer reviewed studies I've seen use 1-1.5 grams protein per kilo of body weight. For example, the protocol used by the Cleveland Clinic uses 1.5 grams protein per kilo of *ideal* body weight. Here is the protocol they use as published in the Cleveland Clinic Journal of Medicine. The protocol is laid out in table 1. "http://www.ccjm.org/index.php?id=107937&tx_ttnews[tt_news]=370057&cHash=7b0fe1cb51a055a37083723445dd1b0b". (For some reason Wikipedia doesn't like this link, and only recognizes the first bit of it as the actual link. I've tried a few things to make it work to no avail. To view the link, just copy and past both parts and then paste into your browser.) — Preceding unsigned comment added by 24.136.172.22 (talk) 10:52, 17 March 2016 (UTC)

Also in a clinical study done at The University La Sapienza in Rome, female patients were given 50 grams of protein per day, and men were given 65 grams of protein per day via a nasogastric tube. That's a far cry from 1.5 grams per pound. The study is here: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3703161/ — Preceding unsigned comment added by 24.136.172.22 (talk) 11:35, 17 March 2016 (UTC)

Sourcing, infobox, etc.

@Alexbrn: Hi! Although I disagree with you on some of the individual changes you've made, I still think that overall you've made the article better; and, for that, I thank you.

A) Could you please let me know when you're done editing, so that I can make some more of my own edits?

B) What don't you like about the book infobox?

Cheers, --TealHill (talk) 17:26, 4 November 2018 (UTC)

Why do we need a socking great infobox for a minor fringey book inserted in the middle of this article? Alexbrn (talk) 17:32, 4 November 2018 (UTC)

@Alexbrn: The book is fringey and contains bad advice which nobody should ever follow. And, the book's advice killed people. Still, the book sold 2.5 million copies.[1] In fact, it's the best-selling PSMF book ever published.

Is there any way for me to make the infobox narrower?

By the way, I've requested an informal hold on the article for now using an {{in use}} tag. I want to make a few small changes (but not yet put back any infobox).

TealHill (talk) 17:39, 4 November 2018 (UTC)

No need for an infobox. The article _really_ lacks decent sourcing. Alexbrn (talk) 17:44, 4 November 2018 (UTC)

@TealHill: Why are you adding junk sources? Have you read WP:MEDRS? Alexbrn (talk) 18:13, 4 November 2018 (UTC)

@Alexbrn: I think the NEJM source I found is an okay source. It's far from an ideal source; but WP:MEDRS does admit that "a lightweight source may sometimes be acceptable for a lightweight claim". Still, if you don't like it, we can leave it out.

I'm busy, and I dislike doing merges after edit conflicts. The merging takes up time that I would rather spend on other things. For the future, I wonder if you could please try to hold off on your reversions until after I've removed the {{in use}} tag? TealHill (talk) 18:28, 4 November 2018 (UTC)

What kills people is not a "lighweight claim"!! So using case reports - the lowest form of source - is very bad. I shall ping WT:MED as this seems highly problematic. Alexbrn (talk) 18:33, 4 November 2018 (UTC)

Wikipedia:Identifying_reliable_sources_(medicine)should be used therefore agree w/ Alexbrn--Ozzie10aaaa (talk) 19:03, 4 November 2018 (UTC)

Alex and Ozzie, I see that you're not talking about the NEJM source. Instead, you're objecting to the source written by Isner and colleagues.

Isner et al. state that at least 60 dieters died. They analyze 17 of the deaths and make hypotheses about why those 17 dieters might have died. OK, fine. We know that they died unexpectedly; everyone agrees on that. So you're saying our article should give no hint such as "they died due to cardiac arrest", and our article should instead say "we have no clue whatsoever as to why they might have died"?

Cheers, TealHill (talk) 19:25, 4 November 2018 (UTC)

What would be your source for "we have no clue whatsoever"? We should only be dealing in accepted knowledge, not speculative obscurity. Alexbrn (talk) 19:43, 4 November 2018 (UTC)

@Alexbrn:

• The Cleveland Clinic Journal paper says, "Major concerns about the safety of the PSMF stem from experiences with the first very-low-calorie diets in the 1970s, which were associated with fatal cardiac arrhythmias and sudden death."

• Dr. Brody writes that it's not exactly clear why these people died, but that it might have been cardiac arrest caused by hypokalemia.

• Drs. Surawicz and Waller state that liquid-protein diets are associated with an increased risk of sudden cardiac death [cardiac arrest], but that we're not sure why the sudden cardiac deaths happen.

It seems to me that everyone agrees, and nobody disagrees, that many or most deaths among PSMF dieters seem to be due to heart-related reasons. Since there's consensus among doctors, this is not a case of "speculative obscurity".

That said, for now, I'm tired of spending valuable time debating when I could be doing more-important things. It's not crucial that we tell readers _why_ liquid-protein diets are dangerous, as long as we simply state the fact that they're dangerous. So I encourage you to feel free to make whatever edits you want to the article. I might just leave your edits in place.

By the way, I'm just curious:

• What made you interested in reading and/or writing about PSMF diets?

• Do you remember?: How did you first discover that our PSMF article exists?

Kind regards, TealHill (talk) 10:58, 5 November 2018 (UTC)

Also, let me quote a possibly-relevant comment which User:WhatamIdoing wrote elsewhere. "Primary sources are sometimes the best possible sources for standard information about rare diseases. Secondary is not the definition of a good source. It's important to balance multiple considerations around the reliability of sources. A recent primary source from an expert in a respected journal in a relevant area is often better than a review article written by a grad student in a third-tier journal. When we're writing about a common or well-researched condition, we can pick the best of the best of the best (and that's what we wrote MEDRS around), but when we're working on articles about rare diseases, we need to think about sources holistically, and not just through a simplistic primary-bad/secondary-good lens." PSMF isn't a rare disease, but perhaps we can consider it a rare technique. Finally, on an unrelated note: Wikipedia:Biomedical information#What is not biomedical information? seems to suggest that WP:MEDRS doesn't always apply to historical information. TealHill (talk) 19:13, 9 November 2018 (UTC)

I took a quick look, and – wow. So: The deaths blamed on this approach prompted calls for bans on the selling the liquid.[2] There was some fascinating shenanigans about trademarks caused by the author "accidentally" recommending only one brand, which happened to be the brand name that he owned.[3] Even Smith v. Linn, 563 A.2d 123, 125 (Pa. Super. Ct. 1989), a lawsuit brought by the family of a woman who died as a result of Linn's dietary advice, might be WP:Notable,[4] as it is commonly cited as an example of US courts affirming a free-speech right to provide dangerous information to people.[5][6][7] The result of that lawsuit is basically that publishers of dangerous dietary advice and instructions have zero strict liability under US laws.

The likely cause of death has been reported as potassium deficiency[8] and atrophied hearts,[9] probably caused by the fasting rather than the protein drinks.[10]

So the way I see these sources is that this information belongs in Wikipedia, and the only real question is whether we put it all in one page, or if we go for the Least publishable unit approach and write a separate article about the diet, the book, the author, and/or the lawsuit. I'm a m:mergeist myself, but I can go along with any of the options.

Also, it's a classic fad diet,[11][12][13][14] and it ought to be described that way at the start of the article. WhatamIdoing (talk) 07:10, 12 November 2018 (UTC)

@WhatamIdoing: Hi! I'm no doctor, but I assume that fasting is probably fairly safe, if done in moderation.[15] I assume that the fatal mistake of some liquid-protein dieters was that their fasting was not done in moderation.

Feel free to add your information to Wikipedia if you wish. I lean towards the mergeist approach too. All the information can be added to Protein-sparing modified fast § The Last Chance Diet, as long as it doesn't overwhelm the rest of the article. If it does overwhelm the rest of the article, perhaps we can move it into a brand-new article. Maybe we can call the new article "Liquid-protein diet" or "Liquid protein diet" or "The Last Chance Diet".

It's true that journalist Gina Kolata writes the Last Chance deaths happened due to potassium deficiency (hypokalemia). I'm not sure what her source is. I haven't looked through the entire "notes" chapter at the end of her book. Isner et al. claim that the deaths were not due to hypokalemia. Unfortunately, Isner et al. looked at serum potassium levels. I suspect that serum potassium tests are sometimes not a reliable indicator of total body potassium levels.

A few individuals, including computer-science researcher Josh Yelon, suggest that the heart problems may have been caused by copper deficiency [perhaps due to fasting]. I have no idea.

Although the liquid protein diet was a fad diet, modern PSMF diets are probably reasonably effective for weight loss. (The scientific explanation follows. Dr. Jason Fung states that the problem with a high-carb reduced-calorie diet is the following: Carbohydrates raise insulin levels, and insulin inhibits lipolysis. So, high-carb reduced-calorie diets cause the dieter's metabolism to slow down until they stop losing weight. Because modern PSMF diets are very low in carbohydrates, they don't cause the dieter's metabolism to slow down.)

Basically, if the article describes liquid-protein diets as fad diets, I won't object; but, if the article describes modern PSMF diets as fad diets, I may object strongly.

Kind regards, --TealHill (talk) 05:41, 13 November 2018 (UTC)

A "fad diet", no matter what our inadequate article happens to say about it these days, isn't synonymous with an ineffective diet. A fad diet is one that is (or was) an actual fad: something with temporary popularity, and that usually produced equally temporary results, typically involving food restrictions just as peculiar as any fad in the fashion world. The Cabbage soup diet was a fad diet; the "balanced healthy diet" promoted for years by various governments is not a fad diet (even though there's pretty good evidence that "just eat a healthy balanced diet" is an ineffective long-term weight-loss plan for obese people). The gluten-free diet is both a fad diet (a diet that is temporary fashionable) and a non-fad diet (for people with relevant medical conditions, which is maybe about 10% of people on a gluten-free diet this decade).

If "modern" PSMF diets are fashionable at the moment, then even the modern ones are "fad diets". WhatamIdoing (talk) 19:43, 13 November 2018 (UTC)

@WhatamIdoing: Nowadays, the "keto diet" is tremendously popular among healthy individuals who want to lose weight. One proof is that the /r/keto sub-Reddit has about 875,000 subscribers. (Source.) PSMF is much less popular; the /r/PSMF sub-Reddit has only about 6,000 subscribers. (Source.) Even by your definition, I'm not sure that we can call modern PSMF a "fad diet".

In your 12 November comment (quite a bit earlier in this conversation), you mentioned a whole bunch of information about liquid-protein diets. Although the information isn't crucial in order for our readers to get a basic understanding of PSMF history, it still can give them a slightly-deeper understanding of the subject. And so I again encourage you to feel free to edit it into our article — as long as you don't call modern PSMF a "fad diet". :)

Kind regards, TealHill (talk) 00:18, 22 November 2018 (UTC)

Current popularity isn't required for something to be called a fad. WhatamIdoing (talk) 06:42, 26 November 2018 (UTC)

WAiD is correct. This ia a fad diet with a medicalized aspect too like other fad diets (e.g. Atkins). I'm not seeing any source dispute the fad label. Alexbrn (talk) 07:10, 17 December 2018 (UTC)