End of Atkins?

Dr. Robert Atkins, creator of the high-protein, low-carbohydrate Atkins Diet, died April 17, 2003, after an accidental fall left him comatose. We are supposed to speak well of the dead but the sad truth is Dr. Atkins probably did more in his lifetime to confuse

Americans about nutrition than anyone else. Since the 1970s, Dr. Atkins claimed diets very high in saturated fat and cholesterol and practically devoid of fruits, whole grains and beans are the only way most people can successfully lose weight, keep it off and regain their health. The truth is the only way people lose weight and keep it off is by eating fewer calories and it really does not matter much what is the source of those calories. Atkins claimed that the key to weight loss success was the restriction of dietary carbohydrates to such a low level that ketosis resulted.1 A recent comprehensive review of the scientific literature found that ?weight loss while using low-carbohydrate diets was principally associated with decreased calorie intake and increased diet duration but not with reduced carbohydrate intake.?2 Simply put it really does not matter much what the ratio of fat to carbohydrate to protein is in a weight-loss diet. What matters in the short-run is whether or not calorie intake is reduced.

Review backs Atkins? claim that saturated fats don?t raise cholesterol levels

This same comprehensive review did state, ?low-carbohydrate diets had no significant adverse effect on serum lipids, fasting serum glucose, and fasting serum insulin levels, or blood pressure.?2 However, the studies examined were short term and did not report the amount of saturated fat and cholesterol consumed on the low-carbohydrate diets. In the short term, blood lipids and other cardiovascular disease risk factors may not deteriorate on an Atkins-style diet. However, in the long term, at a stable weight the amount of saturated fat and cholesterol in the Atkins diet would surely have adverse effects on many CVD risk factors. Indeed, many CVD risk factors were far worse on an Atkins-style diet than on a very-low-fat, near-vegetarian diet in the longest study included in this review.3 Some children are kept on ketogenic diets for years because this type of diet can markedly reduce epileptic seizures. One common problem these children frequently have is a high serum cholesterol level. The truth is a diet high in meat, cheese, eggs and butter will always elevate serum cholesterol levels and promote CVD compared to a diet high in fiber and carbohydrate and very low in saturated fat and cholesterol.

Where are all the Atkins? diet successes?

Given the many adverse effects of obesity, it is arguable that at least some people would be better off on an Atkins-style diet if it helped them keep the weight off. The National Weight Control Registry (NWCR) has been systematically gathering information and documenting individuals who have had success at losing a lot of weight and keeping it off. Today more than 4,500 cases of individuals who have had long-term weight control success are in the NWCR. The vast majority of those long-term weight control success cases consumed a high-carbohydrate, high-fiber diet. Despite more than 10 million books sold, less than 1% of these successes have used the Atkins diet. Since Atkins started promoting his diet more than 30 years ago the percentage of obese Americans has grown from around 15% to nearly 1 in 3 adults. An examination of popular diets found that ?The BMIs were significantly lower for men and women on the high-carbohydrate diet; the highest BMIs were noted for those on a low-carbohydrate diet.?4

By James J. Kenney, PhD, RD, FACN

References

1. Dr. Atkins? New Diet Revolution: New York, NY: Avon Books; 1998

2. JAMA 2003;289: 1837-50

3. Prev Cardiol. 2002;5:110-8

4. J Am Diet Assoc. 2001;101:411-20