From Richard N. Fogoros, M.D.,
Your Guide to Heart Disease.
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Dateline: May 26, 2003

Two studies appearing in this week's New England Journal of Medicine have offered additional evidence that the sort of low-carbohydrate diet popularized by Dr. Robert Atkins may be more effective at producing weight loss, and may produce more beneficial metabolic changes, than the low-fat and calorie restricted diets favored by most doctors and their professional organizations.

In the first study, 64 subjects with marked obesity and a history of severe overeating - most of whom had either diabetes or metabolic syndrome - were randomized to a low-carbohydrate diet or to a low-fat, calorie-restricted diet. While neither group had impressive weight loss, those on the low-carb diet lost significantly more weight than those on the low-fat diet. Further, the low-carb diet produced lower triglyceride levels and a greater improvement in insulin sensitivity. In the second study, 63 obese patients received either the Atkins diet or a conventional low-calorie diet. Those on the Atkins diet lost significantly more weight at the 6 month follow-up period, but by one year the difference in weight loss between the two groups were similar. In this study, however, patients on the Atkins diet had a significant increase in their HDL cholesterol levels (i.e., the "good" cholesterol,) and a significant decrease in triglyceride levels, throughout the entire duration of the study.

Lead investigators for both studies expressed surprise at the success of the carbohydrate-restricting diets - not so much in their achieving weight loss (which was not spectacular in either study), but instead in the metabolic and lipid improvements achieved with the low-carbohydrate diet. That a failure to restrict fat intake could result in anything other than a marked worsening in lipid levels remains amazing and barely believable to much of the medical community.

Lest Atkins proponents get carried away by the positive results, two editorials accompanying these articles appeared in the same issue of the Journal. Both demanded caution in interpreting these results. To really know whether the low-carbohydrate diets are successful, the editorialists concluded, much larger, better-conducted studies will have to be done showing not just an improvement in blood tests, but also an improvement in the things that really matter - like the incidence of heart attack, stroke, and death. (Click here for a recent review of the low-fat vs. low-carbohydrate controversy.)

What do these studies mean?

These two studies were part of the strategy that DrRich refers to as the "low-carb diet quick-kill" gambit. This is the strategy whereby a few, small, rapidly conducted studies (launched primarily to shut up the low-carb faddists) were supposed to quickly demonstrate that these diets don't work, and that they're dangerous. Now that results from such studies are being reported, it is plain that they are not yielding the expected results. Indeed, based on the two studies published this week, it is safe to say that the "quick-kill" strategy has now officially failed.

So: we're at the point where the larger, more expensive, much more time-consuming studies, of the sort called for by the New England Journal editorialists, will have to be planned and funded. Now that their opening gambit has failed - and now that the "latest" information on low-carb diets is disturbingly positive, and thus cannot be allowed to stand - denigrators of the Atkins-style diet will have little choice but to embrace these new studies.

Such larger, better-designed studies will take at least 5 - 7 years to conduct. Those who favor low-carbohydrate diets will have to wait at least that long for a less tepid endorsement of low-carb diets to be squeezed out of the medical and food-processing establishments. This, of course, is how the system works. Whether we're talking about health care, government, or religion, changing any longstanding policy or procedure or dogma (under which sundry vested interests are doing quite well, thank you,) is supposed to take forever. So there's no need for the followers of Atkins to feel particularly persecuted; it's SOP. Nothing personal; only business.