Status of the Atkins Diet - 2008
The low-carb vs. low-fat controversy has raged for several years now. In order to improve the health of Americans, the medical and public health establishments fully embraced low-fat diets a couple of decades ago in a very deliberate and coordinated way, based on reasoning that seemed pretty obvious. Namely, since fat in the bloodstream is bad for you, fat in the diet (which has a way of getting into the bloodstream) must also be bad for you. Therefore: avoid fat.
Dr. Atkins and a few other small voices had always tried to counter this message, but until a few years ago their efforts were considered by the mainstream as decidedly "fringe," if not outright crazy. The Atkins message was that it's not the fats, it's the carbohydrates that cause the problem. Carbs do this by stimulating the release of insulin, a hormone that is quite efficient at taking excess dietary calories and storing them as fat. So: by avoiding carbs you can avoid the "spikes" in insulin levels that cause people to gain weight.
Until the present decade, very little scientific evidence existed to compare the effects of low-fat and low-carb diets, or even to prove that low-fat diets did what they were supposed to do (i.e., to produce weight loss and improve blood lipid levels), a fact that Atkins proponents trumpeted loudly. Indeed, it was mainly to stifle the voice of the pro-Atkins camp once and for all (which was annoyingly persistent and which was steadily gaining adherents) that caused the scientific community to finally launch comparative clinical trials.
In general, those comparative studies have been much more kind to the Atkins low-carb approach than most had suspected. Indeed, studies have shown that weight loss is at least as great with low-carb as with low-fat diets. The one remaining question has been whether blood lipids (and therefore cardiac risk) is unfavorably affected by low-carb diets.
In the past year, at least two studies have made inroads in allaying such fears. The first, the A-to-Z trial, compared four popular diets, from the ultra low-carb Atkins diet to the ultra-low fat Ornish diet, in 311 overweight or obese premenopausal women. The study concluded that after 12 months, women assigned to the Atkins diet lost more weight - and showed more favorable metabolic changes - than women assigned to the other three diets.
The second study, just published in the January 1 issue of the Journal of the American College of Cardiology, compared low-carb and low-fat diets in 88 individuals with abdominal obesity and at least one other marker for metabolic syndrome. They found that all the diets tested resulted in equivalent weight loss. However, while the more "traditional" low-fat diets were somewhat better at reducing LDL cholesterol, the low-carb diets were significantly better at increasing HDL cholesterol and reducing triglyceride levels.
The bottom line:
The low-carb Atkins approach to weight loss now ought to be considered an entirely acceptable alternative, even by the medical and public health establishments. But the low-fat vs low-carb camps are not really as far apart as most people think. Here are four principles for a heart healthy diet that everyone can agree to.
Please note that none of the studies looking at either low-carb or low-fat diets have shown remarkable, astounding levels of weight loss, no matter which diet is used. Most subjects remained overweight even after a year of dieting - they're just less overweight (often just a bit less) than they were before. So neither the low-carb nor low-fat approach by itself is usually sufficient to restore optimal body weight. To lose weight you've got to consistently burn more calories than you consume. In almost every case, that requires a disciplined and aggressive exercise program in addition to diet, whatever that diet may be.
References:
Gardner CD, Kiazand A, Alhassan S, et al. Comparison of the Atkins, Zone, Ornish, and LEARN diets for change in weight and related risk factors among overweight premenopausal women: the A TO Z Weight Loss Study: a randomized trial. JAMA 2007; 297: 969-977.
Tay J, Brinkworth GD, Noakes M, et al. Metabolic effects of weight loss on a very-low-carbohydrate diet compared with an isocaloric high-carbohydrate diet in abdominally obese subjects. J Am Coll Cardiol 2008; 51: 59-67.
Comments
I read a few Atkin’s follower’s posts about what they were eating, and many seemed to be on a big meat/fat festival. I only saw a few mentions of vegetables.
I also recall reading about some people following Atkins having severe medical problems because of ketosis. Does ketosis always cause the body to become very acidic?
I’ve been reading about vegetables helping to alkalize the body, while meats, fats, and sugar (including quick carbs I believe) cause the body to become acidic.
So finally my question: Could the people that had severe health problems from following the Atkins diet prevented problems by eating more vegetables, to offset the acidifying effects of all those meats and fats?
Thanks,
S
To the last poster, there is really no need for vegetables in a our diet. And there is no such thing as an essential carbohydrate. It is our early ancestors’ consumption of meat and the much needed saturated fat that developed our brain and made us the rulers of this planet.
To the last poster…when you give out such severe misinformation, doubtlessly not based on education, you may well mislead others to their detriment. Eat as you wish. The Adkin’s diet, as Dr. Adkins set it up, is a terrible diet that includes far too much animal fat. Animal fat is inflammatory in excess, and can lead to increased incidence of heart disease and cancer. A diet limiting carbs to some extent especially limiting high-glycemic index carbs, and substituing good fats
for animal fats, to some extent, is most prudent. Americans should be consuming much higher levels of omega 3 fatty acids. Exercise is also critical because even thin, nonsmoking individuals that are inactive have greater incidences of heart disease than those who get regular exercise.
I assure you that it is prudent to try to eat, on a daily basis, a fair quantity of a wide variety of vegetables, some of which should be raw
but washed. We as Americans need to plant less Bermuda grass to water, and leave room in our yards for gardens to grow our own lettuce, spinach, broccoli, etc., where we can control pesticide use ourselves.
A diet of fruit, vegetables and a small amount of protein, ideally from soy products, or best quality fish is the correct way to go.
No competent scientist would support the nonsensical Atkins diet. You might be unaware that Dr.Atkins was quite unhealthy at the time of his death and that his next of kin went to great lengths to prevent an autopsy being carried out. Why was this, if his diet was so great??
I spent many years practising in Third World countries where meat was rarely eaten because of its scarcity. The “primitive savages” had good physiques on their high carb diet (taro, sweet potato mainly)
Remember also, that the animals that you eat for food are all vegetarians. How do you explain that they derive their muscle from grain and grass?
Americans are the world’s most obese people because of your intake of fast food garbage and your lack of REAL exercise.
Graham, medical and sports scientist, Gold Coast, Australia
To the comments by Sterling H and Graham Sayer,
Gary Taubes says that there are ways to spot incompentent scientists. One is when they deny that there’s any evidence on the other side, and dismiss their intellectual opponents as incompetent.
It’s certainly true that there are (or at least were) many tribal groups that subsisted on high levels of carbs and low levels of fats and proteins, and had wonderful cardiac health. And contemporary Seventh Day Adventists eat vegetarian high-carb diets and have low rates of cardiac disease.
But you also have to look at groups like the Masai, who lived almost entirely on meat and animal products, and had great cardiac health, and the Eskimos and Inuit people who had almost no access to grain or vegetables and subsisted on near-completely carnivorous diets and had great cardio health. You have to account for the Mormons, who some of the highest consumption of beef in the US and still have much lower rates of cardiac problems.
And you have to account for Vilhjalmur Stefansson, who as a science experiment, lived on a (rigorously monitored) all meat diet for a year and saw his health improve.
How do you explain such evidence?
Dr Rich,
According to the Tay et al study:
“a high degree of individual variability for the LDL response in the VLCHF diet was observed, with 24% of individuals reporting an increase of at least 10%.”
It’s not clear to me if this was accommodated by an increase in HDL and/or decrease in triglycerides, yet the authors conclude:
“This suggests that the potential long-term effects of the VLCHF diet for CVD risk remain a concern and that blood lipid levels should be monitored. ”
Also, if the high-carb diet was proscribed as high-fiber/low-GI, then I suspect we would see a much superior lipid comparison in favor of high carb — and such a diet would provide the energy substrates required to more efficiently fuel a vigorous exercise program.
Kind regards, Paul Rogers
Compliance with the Atkins diet in the AtoZ study was seriously compromised, therefore it is fallacious to attribute the results to the Atkins diet.
Don’t take my word for it, read the original paper in its entirety and the authors’ replies to criticism in JAMA, in which they said it was not a goal of their study to ensure adherence with the tested popular diets.
To quote this paper as supportive of health benefits of the Atkins Program is intellectually slothful and misleading.