The last of these symptoms may be the most telling. The diets induced significant weight loss without hunger even when the patients ate only a few hundred calories a day, as Russell Wilder’s did at the Mayo Clinic in the early 1930s, or 650–800 calories per day, as was the case with the patients treated by George Blackburn and Bruce Bistrian of MIT’s department of nutrition and food science and the Harvard Medical School in the 1970s. Wilder was treating his obese patients with the very low-calorie diet developed by Frank Evans, principally meat, fish, and egg white, with 80–100 calories’ worth of green vegetables. “The absence of complaints of hunger has been remarkable,” Wilder wrote. Bistrian and Blackburn reported in 1985 that they had prescribed their diet of lean meat, fish, and fowl—almost 50 percent protein calories and 50 percent fat—to seven hundred patients. On average, the patients lost forty-seven pounds over a period of four months; nearly three pounds a week. “People loved it,” said Blackburn.†102

Significant weight loss without hunger was also reported when the diet was prescribed at 1,000 calories, as the University of Würzburg clinicians Heinrich Kasper and Udo Rabast did in a series of trials through the 1970s; at 1,200 calories, as the University of Iowa nutritionist Willard Krehl reported in 1967; at 1,320 calories, as Edgar Gordon of the University of Wisconsin reported in JAMA in 1963; at 1,400 or 1,800 calories, as Young and Ohlson did; at 2,200 calories, as the Swedish clinician Bertil Sjövall reported in 1957, and even when the diet provided more than 2,700 calories a day, as reported also in 1957 by Weldon Walker, who would later become chief of cardiology at the Walter Reed Army Medical Center in Washington. The same has invariably been the case even when patients are simply “encouraged to eat as much as [is] necessary to avoid feeling hungry,” but to avoid carbohydrates in doing so, as John LaRosa, now president of the State University of New York Downstate Medical Center, reported in 1980.

Every investigator who compared these carbohydrate-restricted diets with more balanced low-calorie diets also reported that the carbohydrate-restricted diet performed at least as well, and usually better, even when the caloric content of the carbohydrate-restricted diet was significantly greater—say, 1,850 calories versus 950 calories, as Per Hanssen reported in 1936; or 2,200 calories versus 1,200 calories, as Bertil Sjövall reported in 1957; or even an “eat as much as you like” diet compared with a 1,000-calorie diet, as Trevor Silverstone of St. Bartholomew’s Hospital in London reported in 1963 in a study of obese diabetics. The same held true for children, too. In 1979, L. Peña and his colleagues from the Higher Institute of Medical Sciences in Havana reported that they had randomized 104 obese children to either an “eat as much as you like” high-fat, high-protein diet with only 80 calories of carbohydrates, or an 1,100-calorie diet of which half the calories came from carbohydrates. The children on the carbohydrate-restricted diet lost almost twice as much weight as those who were semi-starved on the balanced diet.