Dr. Atkins has left the building. We have lost our high fat guru, so available as a foil for those tofu munching, arugula crunching, low-fat health fanatics. Who will champion the cause for the all-you-can-eat lard smorgasbord now? Fear not, his legacy lives on, and you can still consume an entire chocolate cheesecake in front of your friends while mumbling something about doing Atkins.
While many will seek to wrap Dr. Atkins into a neat little package, medical research does not fully vindicate him or fully condemn him. As the different eulogies roll out, I have seen several already that misconstrue his diet and then half-heartedly defend it. Sympathy for his passing does not make Dr. Atkins right, just as his dying does not prove him wrong (slipping on the ice while getting exercise gives him credibility. He lived his recommendations). I am not an Atkins’ follower, but I am both a Naturopathic Doctor and a medical researcher, with a solid grounding in nutrition and biochemistry. My comments are based chiefly on the New Diet book, (Dr.Atkins’ New Diet Revolution, 2002) with a few comments on Atkins For Life.
Let me be clear about who might benefit from Atkins’ Diet. Anyone who has given him or herself over to apathy and morbid obesity. Actively involving yourself in your food choices and making conscious choices is always better than despair. The newest information we have is that being really large affects your quantity of life as well as your quality of life. Any readers who think this describes them should stop reading this and go pick up whatever health book looks the least bit interesting.
The hype surrounding Atkins diet far exceeds the reality, but the hype was of Dr. Atkins own doing. In the ads for New Diet, Dr. Atkins promises that you can eat all the delicious meals you love, never count calories, and reduce your risk factors for chronic fatigue, diabetes, and high blood pressure. Its not just weight loss, it is total wellness, and you too can be one of the lucky Atkins flock!
Dr. Atkins ability to sell a high protein/high fat diet has made him a cult figure, and he encourages this by referring to his diet as “doing Atkins.” Atkins didn’t “invent” his diet. A Banting diet from 1863 pushed high fat and protein. In the 1920’s uncontrolled epileptics were put on a ketogenic (60% fat) diet, a practice that is once again popular in medical circles. More recently, a horde of high protein diets have poured onto the bookstore shelves. Atkins was the beginning of this horde, having tried a low carbohydrate diet himself in 1963. His New Diet book dates from 1992, but he has been peddling the same ideas since 1972 (the first 1972 “revolution” sold 10 million copies).
While it is true that Dr. Atkins’ diet does not require calorie counting, Dr. Atkins does not mention in his introduction that instead of counting calories with a calorie counter you now must count carbohydrates with a carbohydrate counter. And these arent normal carbohydrates, they are an Atkins creation called net carbs, where you take total carbohydrates and subtract out the fiber, so be prepared with a calculator.
Supposedly people can eat as much fat as they want, but at the beginning of the diet part of New Diet Dr. Atkins encourages people to: “feel satisfied but not stuffed.” (p. 123). It is clear that Dr. Atkins is aiming for a ketogenic fat burning state, which he tries to call lipolysis instead of ketosis, and to pretend that it is a separate state from that of advanced diabetics (who enter ketosis because their body cells can no longer use glucose). In fact, it is the same ketosis (no fair inventing new body processes) but people are much less likely to go into ketoacidosis (out of control ketosis) than diabetics.
So the Atkins Diet is all hype? Not at all. The Atkins weight loss plan is an effective way to lose weight. Under the Atkins diet, you will immediately lose ten to fifteen pounds of water weight as the liver loses all its stored glucose. Then you will switch to ketotic fat burning, with protein providing some glucose inefficiently. When protein is burned for fuel by the body, only 55% converts to energy, the rest converts to heat. Add to that the two hormones that slow down your urge to eat whenever high quantities of fat are present, and you have a recipe for rapid weight loss. The trouble is that when you go off Atkins you’ll gain it back. He is quite clear about that, which is why it is so important for Atkins to defend his diet plan as a plan for life, not short term weight loss.
But to defend his diet for life, Atkins makes some claims he can’t back up. Dr. Atkins says that: “low-fat fanatics have claimed that a high-protein diet would impair kidney function. Yet, I have never seen or heard a single accuser provide a single example of a single case in which that happened.” (New Diet, p.xiii). This is where he really loses me. As a medical researcher, it should be impossible to miss the evidence to the contrary. Consider the following U.S. study result: “Consumption of an LCHP (Low-carbohydrate high-protein) diet for 6 weeks delivers a marked acid load to the kidney, increases the risk for stone formation, decreases estimated calcium balance, and may increase the risk for bone loss. Copyright 2002 by the National Kidney Foundation, Inc.” (Am J Kidney Dis 2002 Aug;40(2):265-74) In a group of Argentinian epileptic children placed on a ketogenic (60% fat) diet:
“The side effects and complications during admission were delay in onset of the ketotic state (10.5%), intolerance of the rapid onset of ketosis (21%), hypoglycemia (47.37%), refusal to drink fluids (15.79%), lack of appetite (15.79%), and nausea and vomiting (26.31%). During treatment the serum cholesterol rose in 64.7% of the children, 40.91% were constipated, 31.82% had periods of anorexia, symptomatic metabolic acidosis occurred during intercurrent infections in 9.09%, renal calculi in 9.09%, carnitine insufficiency in 9.09% and severe complications which led to hospital admission in 21.05%.” (Rev Neurol 2001 Nov 16-30;33(10):909-15)
While these children represent the far end of the spectrum for side effects, the high-fat/ high protein approach to diet is far from risk free.
At this point, if the Atkins aficionados are still reading, they are prepared to cite chapter and verse, study after study to support Atkins. While the studies in the back of Atkins’ books are valid studies, he has cherry picked the supporting studies from among others less supportive. Atkins has, for example, a study that says: “Phosphorus and protein intakes do not contribute to the wide variability in calcium absorption efficiency. (Am J Clin Nutr 2000 Sep;72(3):758-61) The study does say that, but the author was doing a metabolic analysis of nuns over a twenty year period. A much more specific study that Atkins ignores actually measured calcium urine after protein and phosphorus ingestion in young men and found that: “Simultaneous increases in protein and phosphorus intakes caused a 28% increase in urinary calcium (excretion) whereas the increase in protein intake alone caused a 115% increase (in calcium excretion).” (J Nutr 1981 Mar;111(3): 553-62) When studies conflict, selecting the ones that just support our point of view is not good science.
In some cases, Atkins is a viable option despite the risks. Cherry picked or not, Atkins does have studies that support his diet plan. In particular, diabetics and pre-diabetics with sugar imbalances do better on Atkins than on carbohydrates. Morbidly obese and obese people who have not been successful on low-fat diets will lose weight on Atkins total diet regime (diet and exercise). Losing a significant amount of weight will, as a recent Duke University study shows, lower cholesterol and other lipid markers despite high fat intake. And six month studies of people on Atkins show that, while the kidney changes with high quantities of protein, it was not as severe as the critics had thought. Atkins puts in the beginning of his book that people with severe kidney disease should not do Atkins, so on some level he realized the risks.
Despite Dr. Atkins protestations to the contrary, it is also possible to lose weight on high carbohydrate, restricted calorie diets, particularly if those diets are full of complex carbohydrates instead of simple ones (think whole wheat and brown rice instead of takeout and white bread). Nowhere in Dr. Atkins’ book was there any mention of the dietary habits of the rest of the world, where high carbohydrates are often a necessity, and obesity is not rampant. Given a choice, low fat may be safer, and long term studies have shown that consistent replacement of high fat snacks with low fat snacks (day-glow chips with air popped popcorn) gives the most consistent long-term weight loss.
For the vast majority of people, those who do not yet require a full two airplane seats but who still cringe at the sight of a scale or a BMI index, Atkins provides some interesting insights, but is not the best route to a magazine cover figure (better invest in a good airbrush and some digital retouching).
But while I may not admire the diet, I admire the man. Dr. Atkins withstood an amazing barrage of criticism over the years, and continued to change his dietary recommendations to take into account new information.
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