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Danger! Atkins Dieters Beware!

Spencer Patton

September 24th, 2007

 

 

 

 

Introduction

 

If you have ever heard anything about the Atkins diet, chances are statements such as “Enjoy all the steak, cheese, and wine that you can eat and lose weight!” and “You don’t have to avoid eating all those fatty foods to lose fat anymore!”  The Akins diet was invented in the late 1990’s by Dr. Robert C. Atkins.  It is an amazing sounding diet that is supposed to allow one to eat all the protein that they would ever want, as long as one does not eat sugars or carbohydrates. The impacts of this diet are so negatively profound on both the body as well as, believe it or not, the economy, that its own popularity fueled the fire.  Dr. Atkins sold more than 6 million copies of his book “The Amazing No-Hunger Wight-loss plan that has helped millions lose weight and keep it off.”

 

A Brief Word on Obesity and Weight-Loss Programs

 

“Obesity is a major public health risk in the United States, where 65 percent of adults are overweight (i.e., they have a body mass index [BMI] of 25 kg per m2 or greater). The prevalence of obesity in the United States was 14.5 percent from 1976 to 1980 and has since risen to 30.5 percent. The percentage of children who are overweight (i.e., BMI in the 95th percentile or greater for age and sex) is at an all-time high: 10.4 percent of two- to five-year-olds, 15.3 percent of six- to 11-year-olds, and 15.5 percent of 12- to 19-year-olds, based on growth charts from 1979. Black and Hispanic children are more likely to be overweight than white children (21.5, 21.8, and 12.3 percent, respectively)” (1). Americans spend $33 billion annually on weight loss products and services, and a large portion of this money was spent on low-carbohydrate diets in 2006.

 

So are the specifications of the Atkins Diet?

 

The first important aspect of the Atkins diet is that there is a firm restriction on sugars and carbohydrates.  The following is an excellent table from a peer-reviewed study in the journal “American Family Physician” (2):

 

Table 1: Nutritional and Calories Assessment of Various Diets

Diet

Tot. Cal / Day

Carb grams / Day (% of calories)

Protein grams / Day (% of calories)

Fat grams / Day (% of calories)

Typical American Diet

2,200

275 (50)

82.5 (15)

85 (35)

(Atkins Diet Phases)

 

 

 

 

Introduction

1,152

13 (5)

102 (35)

75 (59)

Ongoing

1,627

35 (9)

134 (33)

105 (58)

Maintenance

1,990

95 (19)

125 (25)

114 (52)

 

What this table ought to illustrate is the significant rise in protein and fat grams from both a material level (grams) as well as a percentage of caloric intake level.  These sharp increases (in some cases even double) and decreases in diet percentage intakes have drawn tremendous speculation as to the effects from a variety of different fields of medicine.  Those implications will be discussed further into this examination of the diet.

            The second important aspect of the Atkins Diet is the emphasis on the elimination of sugar from the diet.  “Dr. Atkins claims that the eating of foods high in carbohydrates causes the secretion of increased levels of insulin in the blood. The increased levels of insulin cause any excess food intake to be turned into body fat, in the form of triglycerides. Thus, if lower amounts of carbohydrates are consumed, the body naturally produces less insulin and looks to other sources for fuel, namely fat! For this reason, the Atkins diet restricts processed and refined carbohydrates and limits intake to 15-60 grams per day, encouraging protein and fat consumption” (3). The following graph below is an excellent illustration of the blood-sugar levels (and resulting insulin) after the consumption of sugary foods as well as carbohydrates:

(2)

 

 

Specific Atkins Diet Claim Evaluation

 

It is now important to examine some of the specific implications of the Atkins diet in both a long-run and short-term perspective. The first claim that individuals frequently hear is the promise of immediate results:

 

(1) Atkins claims that it is normal and even desirable that in the Induction phase of the diet the individual loses 5 pounds or more the first week.

 

“The American Dietetic Association, however, maintains that in order to avoid potential health hazards one should only lose 1-2 pounds per week. Pounds lost quickly on diets like Atkins are often regained because faulty habits have not been changed. Another area where the American Dietetic Association disagrees with Atkins is with fat intake. Low carbohydrate ketogenic diets (such as the Atkins' diet) are often high in fat which may increase cholesterol and lead to many other health risks” (3).

 

One of the main problems with almost any diet is that the initial weight-loss can frequently be water-weight or a non-sustainable change in desire / exercise work ethic, both of which do not point to real long-term results from a dietary change.

 

(2) Skeptics of the Atkins diet claim that it can lead to severe dehydration.

 

            “The primary health risk of the Atkins' Diet is dehydration. After carbohydrates are significantly reduced, ketosis begins and the dieter initially looses liver glycogen. This storage of carbohydrates is lost because the body does not have enough glucose to maintain blood sugar so it turns to the liver glycogen. Glycogen consists of a large number of water molecules and when the body converts glycogen to glucose, the water is lost from the body. This explains much of the initial weight loss on the Atkins' Diet, rather than Atkins' claim that the initial weight loss is fat. The large amount of water loss poses the risk of dehydration, but is not the most potentially severe consequence of the Atkins' Diet. The high fat content may put the dieter at risk for coronary heart disease, hyperlipidemia (high blood fat), and hypercholesterolemia (high blood cholesterol). The high protein content may put extra strain the kidneys which can lead to electrolyte imbalance or decrease the kidneys' ability to absorb calcium, either of which could lead to the early stages of osteoporosis” (4).

 

(3) The Atkins Diet increases all the bad fats and cholesterol, even if weight loss is present.

James Anderson, the head researcher at the UK College of Medicine, led a critical review and computer modeled analysis of the Atkins Diet, amongst others.  His conclusions began with the following statement: “Of course, weight loss contributes to the lowering of cholesterol, but high-fat diets such as the Atkins diet increase the risk for heart attacks and strokes by raising LDL cholesterol – the bad stuff – and increasing the tendency for blood to form clots, which are the forerunners of most heart attacks and strokes” (5).  Not surprisingly, Anderson points out in the study that the doubling of protein intake leads to direct increases in coronary heart disease.  He further draws the high protein levels to leading to kidney stones, kidney damage, and higher blood pressure.

Research Findings

Without question, the most significant problem with the research on the Atkins diet is that it has not had long to take place.  With the Atkins diet only really coming into existence in 1999 and entering mainstream society in the 2000’s, medical studies have not had very long to be designed and implemented with documented results readily available.  The best studies are short-term and largely patient-opinion based rather than tested medical results.  With that said, there are far more studies on low-carbohydrate diets than Atkins specifically.  Some of those studies will be examined below.

 

(1)  The first study is from the New England Journal of Medicine.  Performed at the Pennsylvania School of Medicine, it was one of the few ground-breaking studies on the Atkins diet that revealed perhaps the tip of the iceberg of a number of problems. “Despite the popularity of the low-carbohydrate, high-protein, high-fat (Atkins) diet, no randomized, controlled trials have evaluated its efficacy. METHODS: We conducted a one-year, multicenter, controlled trial involving 63 obese men and women who were randomly assigned to either a low-carbohydrate, high-protein, high-fat diet or a low-calorie, high-carbohydrate, low-fat (conventional) diet. Professional contact was minimal to replicate the approach used by most dieters. RESULTS: Subjects on the low-carbohydrate diet had lost more weight than subjects on the conventional diet at 3 months (mean [+/-SD], -6.8+/-5.0 vs. -2.7+/-3.7 percent of body weight; P=0.001) and 6 months (-7.0+/-6.5 vs. -3.2+/-5.6 percent of body weight, P=0.02), but the difference at 12 months was not significant (-4.4+/-6.7 vs. -2.5+/-6.3 percent of body weight, P=0.26). After three months, no significant differences were found between the groups in total or low-density lipoprotein cholesterol concentrations. The increase in high-density lipoprotein cholesterol concentrations and the decrease in triglyceride concentrations were greater among subjects on the low-carbohydrate diet than among those on the conventional diet throughout most of the study. Both diets significantly decreased diastolic blood pressure and the insulin response to an oral glucose load. CONCLUSIONS: The low-carbohydrate diet produced a greater weight loss (absolute difference, approximately 4 percent) than did the conventional diet for the first six months, but the differences were not significant at one year. The low-carbohydrate diet was associated with a greater improvement in some risk factors for coronary heart disease. Adherence was poor and attrition was high in both groups. Longer and larger studies are required to determine the long-term safety and efficacy of low-carbohydrate, high-protein, high-fat diets” (5).

(2)  Another study was done by researchers at the Bassett Research Institute in Cooperstown, New York, who followed 18 Atkins dieters for a month. During the 2-week induction period, the dieters consumed 1,419 calories a day, compared with 2,481 calories a day before starting the diet, and lost an average of about 8 pounds. In the next phase, dieters averaged 1,500 calories a day and lost an additional 3 pounds in two weeks. Dieters in both phases cut back on carbohydrates by more than 90%, but the actual amounts of fat and protein they ate changed little. Some patients felt tired, and some were nauseated on the plan. Most indicated that they were eager to go back to their regular diet (6).  Unfortunately with this study, there is little document-worthy medical results.  Regardless, the worst case is that some personal opinions of the participants inspire future researchers to investigate the fatigue and nausea experienced.

(3)  In yet another study, researchers who compile the National Weight Control Registry analyzed the diets of 2,681 members who had maintained at least a 30-pound weight loss for a year or more. Because the Atkins diet has been used for more than 30 years, the researchers reasoned that, if it worked, its followers would be well represented. However, they found that only 25 (1%) of these successful people had followed a diet with less than 24% of their daily calories in the form of carbohydrates. The mean duration of successful weight maintenance in this low-carbohydrate group was 19 months, whereas the mean duration of dieters who consumed more than 24% of their daily calories as carbohydrates was 36 months. Because so few Atkins dieters were found in the Registry, the researchers concluded that the Atkins diet may not create the favorable "metabolic advantage" claimed for it (7).

 

So What’s the Bottom Line?

Without question, society’s addiction to weight-loss solutions has really fed the likelihood to accept any hype that they hear.  Society, growing more obese every day, is increasingly desperate to find a no-effort solution to their weight problem.  It is no surprise that we see diets such as Atkins, as well as many more extreme ones, going through boom-and-bust cycles of popularity in mainstream media.  Perhaps Barrett sums it up best when he comments: “Although short-range studies have found that low-carbohydrate diets can produce weight loss, no study has demonstrated that such diets are safe or effective for long-term use. Atkins advocated his diet for more than 30 years and stated that more than 60,000 patients treated at his center had used his diet as their primary protocol. However, he never published any study in which people who used his program were monitored over a period of several years. The recent popularity of low-carbohydrate diets has encouraged food companies to market low-carbohydrate foods for people who want to "watch their carbs." Most of these foods are much higher in fat than the foods they are designed to replace. I believe that "low-carb" advertising is encouraging both dieters and non-dieters to eat high-fat foods, which is exactly the opposite of what medical and nutrition authorities have been urging for decades. Following a low-carbohydrate diet under medical supervision may make sense for some people, but a population-wide increase in fat consumption is a recipe for disaster” (4).

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

REFERENCES

(1)  Strauss RS, Pollack HA. Epidemic increase in childhood overweight, 1986-1998. JAMA 2001;286:2845-8.

(2)  Last, Allen, Wilson, Stephen. “Low-Carbohydrate Diets.” American Family Physician. Vol. 73 No. 11. (http://www.aafp.org/afp/20060601/1942.html).

(3)  Norwood, David. “The Dangers of the Atkins Diet.” (http://www.inch-aweigh.com/dangeratkins.html).

(4)  Barrett, Stephen. “Low-Carbohydrate Diets.” (http://www.quackwatch.org/01QuackeryRelatedTopics/lcd.html).

(5)  Anderson, James and others. “Fad Diets Do More Harm than Good.” Journal of the American College of Nutrition. 2000.

(6)  Foster GD and others. “A multicenter, randomized, controlled trial of a low-carbohydrate diet for obesity”. New England Journal of Medicine 348:2082-2090, 2003.

(7)  Miller, BV and others. “Effects of a low carbohydrate, high protein diet on renal function.” Obesity Research 8(supplement 1):82S, 2000.

(8)  Wyatt HR and others. Long term weight loss and very low carbohydrate diets in the National Weight Control Registry. Obesity Research 8(suppl 1):87S., 2000.

 

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