THE SKINNY ON ATKINS
By Michael Greger, M.D.*
(Part I)
Reprinted from the June 2004 issue of Dr. Greger�s
Nutrition Newsletter. To subscribe, send a blank e-mail to
[email protected]
WHAT THE EXPERTS THINK OF ATKINS
Atkins "Nightmare" Diet
When Dr. Atkins Diet Revolution was first published, the
President of the American College of Nutrition said, "Of all the bizarre
diets that have been proposed in the last 50 years, this is the most
dangerous to the public if followed for any length of time.�1
When the chief health officer for the State of
Maryland,2 was asked "What�s wrong with the Atkins Diet?" He replied
"What�s wrong with� taking an overdose of sleeping pills? You are placing
your body in jeopardy.� He continued "Although you can lose weight on
these nutritionally unsound diets, you do so at the risk of your health
and even your life."3
The Chair of Harvard�s nutrition department went on
record before a 1973 U.S. Senate Select Committee investigating fad diets:
�The Atkins Diet is nonsense� Any book that recommends unlimited amounts
of meat, butter, and eggs, as this one does, in my opinion is dangerous.
The author who makes the suggestion is guilty of malpractice.�4
The Chair of the American Medical Association�s Council
on Food and Nutrition testified before the Senate Subcommittee why the AMA
felt they had to formally publish an official condemnation of the Atkins
Diet: "A careful scientific appraisal was carried out by several council
and staff members, aided by outside consultants. It became apparent that
the [Atkins] diet as recommended poses a serious threat to health."5
The warnings from medical authorities continue to this
day. "People need to wake up to the reality," former U.S. Surgeon General
C. Everett Koop writes, that the Atkins Diet is "unhealthy and can be
dangerous."6
The world�s largest organization of food and nutrition
professionals,7 calls the Atkins Diet "a nightmare of a diet."8 The
official spokesperson of the American Dietetic Association elaborated:
"The Atkins Diet and its ilk�any eating regimen that encourages gorging on
bacon, cream and butter while shunning apples, all in the name of weight
loss�are a dietitian's nightmare."9 The ADA has been warning Americans
about the potential hazards of the Atkins Diet for almost 30 years now.10
Atkins dismissed such criticism as "dietitian talk".11 "My English
sheepdog," Atkins once said, "will figure out nutrition before the
dieticians do."12
The problem for Atkins (and his sheepdog), though, is
that the National Academy of Sciences, the most prestigious scientific
body in the United States, agrees with the AMA and the ADA in opposing the
Atkins Diet.13 So does the American Cancer Society;14 and the American
Heart Association;15 and the Cleveland Clinic;16 and Johns Hopkins�17and
the American Kidney Fund;18 and the American College of Sports Medicine;19
and the National Institutes of Health.20
In fact there does not seem to be a single major
governmental or nonprofit medical, nutrition, or science-based
organization in the world that supports the Atkins Diet.21 As a 2004
medical journal review concluded, the Atkins Diet "runs counter to all the
current evidence-based dietary recommendations."22
A 2003 review of Atkins "theories" in the Journal of the
American College of Nutrition concluded: "When properly evaluated, the
theories and arguments of popular low carbohydrate diet books� rely on
poorly controlled, non-peer-reviewed studies, anecdotes and non-science
rhetoric. This review illustrates the complexity of nutrition
misinformation perpetrated by some popular press diet books. A closer look
at the science behind the claims made for [these books] reveals nothing
more than a modern twist on an antique food fad."23
Dr. Atkins Had a Dream
There is nothing new or revolutionary about Dr. Atkins
New Diet Revolution. Various high-fat diet fads like Atkins have been
masquerading under different names for over a hundred years, starting in
1864 when an English undertaker and coffin maker by the name of William
Banting wrote a book called Letter on Corpulence.24 Based on what we know
now about these diets, Banting�s book may very well have added to
Banting�s business.
After failing to produce the promised sustained weight
loss, the high-fat fad melted away only to re-emerged in the 1920�s with a
doctor advocating a minimum of three porterhouse steaks a day and stating
that the only two perfect foods were probably "fresh fat meat and
water."25 It then disappeared until the 1940�s with a book extolling the
virtues of eating whale blubber. Then it was recycled again in the 1960�s
with Dr. Herman Taller's bestseller "Calories Don't Count" that
discouraged people from exercising. "By whatever name," one nutrition
textbook reads, "the diet is to be avoided."26
Taller�s "Calories Don't Count" diet empire collapsed
when he was found guilty of six counts of mail fraud for using the book to
promote a particular brand of safflower capsules, which the court called a
"worthless scheme foisted on a gullible public."27
That same year, Dr. Irwin Stillman wrote the "Doctor's
Quick Weight Loss Diet," allowing his patients to eat only meat, eggs, and
cheese. Stillman himself died of a heart attack, but not before misleading
20 million people onto his diet.28
One might wonder why, if this kind of diet was such a
"foolproof"29 "ultimate"30 path to "permanent joyful weight loss� that
�WORKS 100% OF THE TIME!� (emphasis in original),31 they seemed to always
quickly fade into obscurity, only to be resurrected shortly after by
publishers guaranteed a new bestseller by America�s short attention span.
This brings us to 1972, and the publication of Dr. Atkins Diet
Revolution.32
Atkins� diet was centered on fried pork rinds, heavy
cream, cheese, and meat. For Atkins, bacon and butter were health foods
and bread and bananas were what he called "poison."33
Drawing on his experience as a salesman and resort
entertainer, Atkins proved a natural at self-promotion. He was featured in
Vogue magazine (and hence the Atkins Diet was actually first known as the
"Vogue Diet") and soon after appeared on the Tonight Show34 and Merv
Griffen.35 In 1973, the publisher boasted that it became the �fastest
selling book in publishing history.�36
The final chapter of Dr. Atkins Diet Revolution was
entitled "Why We Need a Revolution�." It detailed his proposal to have
some carbs literally banned. "Our laws must be changed to provide a proper
way of eating for everyone." He urged everyone to start lobbying their
legislators. "Political action and protest on your part," he wrote, "can
help revolutionize the food industry, by forcing it to decarbohydratize
many foods � with a federal law to back this change!"37
"Martin Luther King had a dream," Dr. Atkins wrote, "I,
too, have one."38
"The Diet Fad of the 21st Century"
Allowing a good 20 years for dieters to forget Dr.
Atkins past failure, the book was reissued as Dr. Atkins New Diet
Revolution (though there was not much new about it) in 1992.39 Along with
other retro 70�s fashions, and this time backed by an aggressive marketing
campaign, it became the best-selling fad-diet book in history.40
What may have truly made it "The Diet Fad of the 21st
Century" (as an editor of the Journal of the American Dietetics
Association coined it)41 came a decade later with the publication of the
infamous pro-Atkins New York Times Magazine article "What If It's All Been
a Big Fat Lie."42 Atkins quickly wrote an editorial for his Web site
claiming the article "validated" his work. Gushingly favorable follow-up
stories appeared on NBC's Dateline, CBS' 48 Hours, and ABC'S 20/20. The
Atkins corporation claimed literally billions of media hits.43 By the time
the article�s many flaws were exposed weeks later, the book had already
catapulted to #1 on a New York Times bestseller list and Atkins� net worth
zoomed to $100 million.44
The piece was written by freelance writer and Atkins
advocate45 Gary Taubes (who reportedly scored a book deal from it�and a
$700,000 advance).46 The Washington Post investigated his pro-Atkins
article and found that Taubes simply ignored all the research that didn't
agree with his conclusions.
Taubes evidently interviewed a number of prominent
obesity researchers and then twisted their words. "What frightens me,"
said one, "is that he picks and chooses his facts�. If the facts don't fit
in with his yarn, he ignores them."47
The article seemed to claim that experts recommended the
diet. "I was greatly offended at how Gary Taubes tricked us all into
coming across as supporters of the Atkins Diet," said John Farquhar, a
Professor Emeritus of Medicine at Stanford,. The Director of the Center
for Human Nutrition at the Washington University School of Medicine was
asked to comment of one of Taubes� claims. He replied, "It�s
preposterous."48
"He took this weird little idea and blew it up," said
Farquhar, "What a disaster."49
"The article was written in bad faith," said another
quoted expert. "It was irresponsible."50 "I think he's a dangerous man.
I'm sorry I ever talked to him." Referring to the book deal, "Taubes sold
out."51
What the researchers stressed was how dangerous
saturated fat and meat consumption could be, but Taubes seemed to have
conveniently left it all out. "The article was incredibly misleading,"
said the pioneering Stanford University endocrinologist Gerald Reaven who
actually coined the term Syndrome X. "I tried to be helpful and a good
citizen," Reaven said, agreeing to do the interview, "and I ended up being
embarrassed as hell. He sort of set me up� I was horrified."52
The South Beach Diet
The majority of the best-selling diet titles in history
have been sold during just the last 5 years.53 One of the latest steak oil
salesmen is Dr. Agatston, whose South Beach Diet appeared a year after
Atkins� latest and sold its first million copies in just 2 months.54
Currently, subscriptions to his website alone bring in a million dollars a
week.55
The Tufts University Health and Nutrition Letter weighed
in on the South Beach Diet in their May 2004 issue: "Disappointingly, the
South Beach Diet is simply yet another version of a fad wrapped within a
gimmick." They concluded that it was "based on fallacies� replete with
faulty science, glaring nutritional inaccuracies, contradictions, and
claims of scientific evidence minus the actual evidence."56
The article notes, "The faulty and confusing science is
compounded by The South Beach Diet�s own internal inconsistencies."57 Up
front, for example, the author says that his diet doesn�t depend on
exercise, but then goes on to tell people to get 20 minutes a day.58 He
tells readers to avoid bananas in "phase 2"; then goes on to recommend:
bananas dipped in chocolate sauce. He says up front that the diet is
"distinguished by the absence of calorie counting or even rules about
portion size" and that one shouldn�t "even think about limiting the amount
you eat." He then, of course, proceeds to count calories and measure out
servings every step of the way, even to the point of specifying "I
recommend counting out 15 almonds or cashews."59 That sounded like a rule
about portion size to the reviewers.
Tufts lists a few of the "out-and-out food and nutrition
inaccuracies" in The South Beach Diet.60 Agatston says that whole-wheat
bread is not whole grain, but cous cous is (actually the reverse is true).
He claims watermelon is full of sugar but cantaloupe is not (they have the
same amount). For a cardiologist who claims, "I feel nearly as comfortable
in the world of nutrition as I do among cardiologists,"61 Dr. Agatston
"sprinkled an awful lot of nutrition gaffes throughout his book."62 He
claims eggs have minimal saturated fat�wrong. Each egg can have as much as
2 grams,63 giving some of his recipes over third of one�s daily limit.64
To be fair, though, he does frown on lard, although the
Atkins corporation is quick to point out that the South Beach menus do not
have significantly less saturated fat than Atkins.65 Just as Atkins
himself claimed he followed his diet for decades yet, according to his own
cardiologist, was overweight,66 Agatston revealed that he needs to take
medication to lower his cholesterol.67 Agatston, at least, doesn�t call
fruit "poison."68
FAULTY SCIENCE
Phony Baloney
One of Dr. Atkins� dreams probably came true�he likely
became a billionaire before he died. The Atkins corporation is now
estimated to be worth billions of dollars.69 In Family Practice News, one
doctor writes, "Unfortunately, Dr. Robert C. Atkins, who made a lot of
money playing on the ignorance of Americans, knew about as much about
nutrition as an Arkansas hog knows about astronomy."70
Of course, pigs�in Arkansas and elsewhere�have
presumably little use for astronomy. It doesn�t seem like too much to ask,
however, that cardiologists like Dr. Atkins know something about
nutrition.
The entire theoretical framework of low carb diets, like
Atkins and The Zone, hang upon the notion that insulin is the root of all
evil and so to limit insulin release one needs to limit carbohydrate
intake. Dr. Atkins, for example, has a chapter entitled "Insulin�the
Hormone That Makes You Fat,"71 Protein Power calls it the �monster
hormone,�72 and the author of the Zone Diet calls insulin "the single most
significant determinant of your weight."73
What they overlook is that "protein- and fat-rich foods
may induce substantial insulin secretion" as well.74 For example, a
quarter pound of beef raises insulin levels in diabetics as much as a
quarter pound of straight sugar.75
Atkins featured foods like cheese and beef elevated
insulin levels higher than "dreaded� high-carbohydrate foods like pasta. A
single burger�s worth of beef, or three slices of cheddar, boosts insulin
levels more than almost 2 cups of cooked pasta.76 In fact a study in the
American Journal of Clinical Nutrition found that meat, compared to the
amount of blood sugar it releases, seems to cause the most insulin
secretion of any food tested.77
Low carb advocates like Atkins seem to completely ignore
these facts. Recent medical reviews have called Atkins� feel-good theories
"factually flawed"78 and "at best half-truths."79 "In the scientific
world, books like the Zone Diet are generally regarded as fiction,� one
reviewer wrote in the Journal of the American College of Nutrition. �The
scientific literature is in opposition�"80 In a medical journal article
entitled "Food Fads and Fallacies," the Atkins Diet is referred to as a
"�New wives� tale" with a "sprinkling of fallacies."81
According to a 2003 article in the Journal of the
American Medical Association, "Dr. Atkins and his colleagues selectively
recite the literature" to support their claims.82 When researchers take
the time to actually measure insulin levels, for instance, instead of just
talking about them like Atkins does, they often find the opposite of what
Atkins asserted.
A study done at Tufts, for example, presented at the
2003 American Heart Association convention, compared four popular diets
for a year. They compared Weight Watchers, The Zone Diet, the Atkins Diet
(almost no carbs), and the Ornish Diet (almost all carbs) for a year. The
insulin levels of those instructed to go on the Ornish diet dropped 27%.
Out of the four diets that were compared that year, Ornish�s vegetarian
diet was the only one to significantly lower the �Monster� �Hormone That
Makes You Fat," even though that�s supposedly what Atkins and The Zone
diets were designed to do.83
In another study researchers took over a hundred pairs
of identical twins and found that the more fat they ate, the higher their
resting insulin levels were. Even with the same genes, the study "showed a
consistent pattern of higher fasting insulin levels with intake of
high-fat, low carbohydrate diets."84
Other studies show that a high (70-85%) carbohydrate
diet (combined with walking an average of 15-30 minutes a day) not only
can result in significant reductions in body weight, blood pressure,
cholesterol and triglycerides, but significant drops in baseline insulin
levels as well, exactly opposite of what low carb pushers would predict.
In just three weeks on a high (unrefined) carb vegetarian diet and a few
minutes of daily walking, diabetics reduced the amount of insulin they
needed and most of the pre-diabetics seemed cured of their insulin
resistance.85 In general vegetarians may have half the insulin levels of
nonvegetarians even at the same weight.86
In an article entitled "Americans Love Hogwash," Edward
H. Rynearson, Emeritus Professor of Medicine at the Mayo Clinic, singled
out Dr. Atkins for dispensing hogwash he defines as "worthless, false or
ridiculous speech or writings" and praised the AMA for "condemning this
diet for its dangers."87 The "evidence" cited by Atkins has been called
"nearly all anecdotal and misleading."88 "Carbophobia is a form of
nutritional misinformation," a 2003 review in the Journal of the American
College of Medicine noted, "infused into the American psyche through�
advertising� infomercials� and best-selling diet books."89
We know that the Atkins Diet is successful�at making
money. What about for weight loss? We know that cutting down on carbs will
help people lose variety and nutrition in their diet,90 and if they buy
his supplements, their wallet may get slimmer, but what about their
waistline?
Who cares if the American Medical Association calls
Atkins�s theory "naive," "biochemically incorrect," "inaccurate," and
"without scientific merit?" Who cares if it "doesn't make physiological
sense?"91 The question is, does it work?
Losing (Water) Weight
Carbohydrates burn cleanly. In fact the name carbo-
hydrate basically means "carbon (dioxide) and water," which is what plants
make carbs out of, and which is all the waste product one is left with
when one�s body uses them as fuel. During the first few weeks of the
Atkins Diet, the so-called "induction" phase, a person is forced to live
off so much grease that, lacking the preferred fuel�carbohydrates�their
body goes into starvation mode.
In biochemistry class, doctors learn that fat "burns in
the flame of carbohydrate." When one is eating enough carbohydrates, fat
can be completely broken down as well. But when one�s body runs out of
carb fuel to burn, its only choice is to burn fat inefficiently using a
pathway that produces toxic byproducts like acetone and other so-called �ketones.�
The acetone escapes through the lungs�giving Atkins followers what one
weight-loss expert calls "rotten-apple breath"92�and the other ketones
have to be excreted by the kidneys. We burn fat all the time; it�s only
when we are carbohydrate deficient and have to burn fat ineffectively that
we go into what�s called a state of ketosis, defined as having so much
acetone in our blood it noticeably spills out into our lungs or so many
other ketones they spill out into our urine.
To wash these toxic waste products out of our system our
body uses a lot of water. The diuretic effect of low carb diets can result
in people losing a gallon of water in pounds the first week.93 This
precipitous early weight loss encourages dieters to continue the diet even
though they have lost mostly water weight94 and the state of ketosis may
be making them nauseous or worse.95 If one wanted to try to lose water
weight, sweating it away in a sauna may be a more healthful way.
The Director of Yale University's Center for Eating and
Weight Disorders explains the miracle formula used by diet books to become
bestsellers for over a century now: "easy, rapid weight loss; the
opportunity to eat your favorite foods and some scientific 'breakthrough'
that usually doesn't exist."96 The rapid loss of initial water weight seen
particularly on low carb diets has an additional sales benefit. By the
time people gain back the weight, they may have already told all their
friends to buy the book, and the cycle continues. This has been used to
explain why low carb diets have been such "cash cows" for publishers over
the last 140 years.97 As one weight loss expert notes, "Rapid water loss
is the $33-billion diet gimmick."98
Calories Count
When people do lose weight on the Atkins Diet after the
first few weeks, it�s almost certainly because they are eating fewer
calories.99 People lose weight on the Atkins Diet the same way they lost
weight on the 1941 Grapefruit Diet, the 1963 Hot Dog Diet, the 2002 Ice
Cream diet and every other fad diet promising a quick fix�by restricting
calories.
In 2001, the medical journal Obesity Research published
"Popular Diets: A Scientific Review." Claiming to have reviewed every
study ever done on low carb diets, they concluded, "In all cases,
individuals on high-fat, low carbohydrate diets lose weight because they
consume fewer calories."100 Calories count�every time, all the time. "No
magic ingredients, strange food combinations or pseudoscientific formulas
will alter this metabolic fact."101
Dr. Atkins disagreed. In fact, he accused his critics of
having "subnormal intellects" for even holding such a view.102 For three
decades he peddled his claim that people could eat more calories and still
lose weight. Decrying what he called the "calorie hoax," Atkins had a
chapter entitled "How to Stay Fat�Keep Counting Calories." Atkins even
subtitled his book "The High Calorie Way to Stay Thin Forever." The Zone
Diet made a similar claim on its back cover: "You can burn more fat by
watching TV than by exercising."103 (As one commentator exclaimed,
"Goodness, what channel does he watch!")104
Atkins claimed people could lose 85 pounds, without
exercising, eating an incredible 5,500 calories a day.105 The only
problem, critics claimed, was that this ran counter to the First Law of
Thermodynamics, considered to be the most fundamental law in the universe.
No wonder the AMA scolded Atkins publishers for promoting "bizarre
concepts of nutrition and dieting."106
"Metabolic Advantage" Advantageous Only In Selling
Books
Atkins claimed that the key to the so-called "calorie
fallacy" was that the missing calories were explained by the excretion of
ketones. Dieters in ketosis, he argued, urinate and breathe out so many
calories in the form of ketones that "weight will be lost even when the
calories taken in far exceed the calories expended.� He claimed dieters
could "sneak" calories out of the body unused.107
The "Atkins Physician Council" also claims that one�s
body expends more energy burning fat and thus "You wouldn't have to
increase your exercise at all because your body would be working harder,
so that you could literally sit in your armchair and lose weight."108 As
the Secretary of the AMA�s Council on Food and Nutrition tried to make
clear, �The whole [Atkins] diet is so replete with errors woven together
that it makes the regimen sound mysterious and magical.�109
These claims sounded so far fetched that as part of an
investigative documentary, the BBC paid obesity researchers to design an
experiment to test it. So researchers took two identical twins and put one
on the Atkins Diet for a while, the other on a high carbohydrate diet and
locked them both in sealed chambers to measure exactly where the calories
were going. Did the twin on the Atkins Diet have any sort of metabolic
"advantage" by burning fat and protein as his source of fuel? Was he
literally flushing more calories down the toilet? Of course not. "We found
no difference whatsoever," the researcher said.110
As the evidently "subnormal intellects" at the AMA
concluded, "No scientific evidence exists to suggest that the low
carbohydrate ketogenic diet has a metabolic advantage over more
conventional diets for weight reduction."111 The only comprehensive
systematic review ever done of low carb diets found that the carbohydrate
content of the diet seemed in no way correlated with weight loss.112 The
truth seems to be that nothing matters more than calories when it comes to
weight loss.113
But what about all the scientific studies Dr. Atkins
cited in his book to back up his claims? Although his first book had
essentially no citations, by the final edition he listed over 300.114
Reviewing all of the studies on low carb diets, researchers concluded,
"The studies by Atkins to support his contentions were of limited
duration, conducted on a small number of people, lacked adequate controls
and used ill-defined diets."115 Most importantly, though, some of the very
studies he cites actually refute exactly what he�s claiming. And he
accused the AMA of being �intellectually dishonest.�116
Of the few studies that did back up his claims, some had
seriously questionable validity117 and researchers could not replicate the
findings of the rest. 118,
119, 120, 121,
122, 123, 124,
125, 126, 127,
128, 129, 130,
131, 132, 133,
134, 135. One
review of studies that have defended Atkins claims concluded, "It turns
out that when these data are critically analyzed they are often found to
be in error, and it�s therefore impossible to accept the validity of the
conclusions derived by the authors from such erroneous data."136
People lost weight on low carb diets the way everybody
loses weight on any diet�by eating fewer calories.137
Low Calorie Diet in Disguise
The Atkins Diet restricts calories by restricting
choices. If all one did was eat Twinkies, one could lose weight (unless
one were able to consistently force oneself to eat more than a dozen a
day). But would one�s overall health be better or worse for it? In
essence, the Atkins Diet is not much different than the Twinkie Diet.
Americans get half of their energy from
carbohydrates,138 so if people cut out half the food they eat, what they
are left with is calorie restriction. Yes, one can eat unlimited amounts
of fat on the Atkins Diet, but people typically can�t stomach an extra two
sticks of butter�s worth a day to make up for the calorie deficit. Since
so many foods are taboo, people end up eating less out of sheer boredom
and lack of variety. As one obesity researcher put it, "If you're only
allowed to shop in two aisles of the grocery store, does it matter which
two they are?"139
Yes, all the butter one can eat but no bread to put it
on. All the cream cheese, but no bagels. Sour cream, but no baked potato.
Sandwich lunchmeat, but, of course, no sandwiches. All the pepperoni one
can eat, but no pizza crust. Cheese, but no mac.
In later phases of the diet, with less carb restriction,
Atkins throws in a thin wedge of cantaloupe�wrapped in ham, of course.140
Having all the mayonnaise one can eat only goes so far.
On the Atkins Diet one can eat steak, but no
potatoes�and watch the gravy (it may have corn starch in it). All the
shortening one can eat, just no making cookies with it. Eat all the
burgers one wants; you just can�t put them on buns, no fries�and "beware
of ketchup."141
Atkins described how to make cheeseburgers without the
bun: "I put all the meat on the outside� put the cheese on the inside� The
cheese melts on the inside and never gets out."142
Although his recipe for "hamburger fondue,"143 combining
burger meat, blue cheese, and butter, might top the cheeseburger recipe
for heart disease risk, the prize would probably go his recipe for "Swiss
Snack,"144 which consists of wrapping bacon strips around cubes of Swiss
cheese and deep frying them in hot oil. The recipe, which supposedly
serves one, calls for four strips of bacon and a quarter-pound of cheese.
Atkins rivals the creativity of the raw-food chefs of
today in his uses for pork rinds. Pork rinds are chunks of pigs� skin that
are deep-fried, salted and artificially flavored. He recommends people use
them to dip caviar. Or, perhaps if for those who can�t afford caviar, one
can use fried pork rinds as a "substitute for toast, dinner rolls�You can
use them as a pie crust� or even matzo ball soup (see our recipe on p.
190)."145 Matzo balls made out of pork rinds?�now that is a diet
revolution!
The Real Big Fat Lie
In Taubes� article in the New York Times Magazine, he
reiterated a myth common among Atkins and other greasy diet proponents.146
"At the very moment that the government started telling Americans to eat
less fat, we got fatter," wrote Taubes.147 He argues that since the
percentage of calories from fat in the American diet has been decreasing,
and the percentage from carbohydrates increasing, carbs are to blame for
the obesity epidemic.148
Of course a quick trot across the globe shows that some
of the thinnest populations in the world, like those in rural Asia, center
their entire diets on carbs. They eat 50% more carbs than we do, yet have
a fraction of our obesity rates.149 Taubes also left out that the amount
of added fat and total fat Americans eat has also been increasing�we�re
eating more of everything now, fat and carbohydrates. Grease and protein
peddlers blame our obesity epidemic on a low-fat diet that our nation
never ate.
Thirty years ago, the average woman ate about 1500
calories per day, now it�s closer to 2000.150 Men also significantly
bumped up their calorie consumption. With that many extra calories, we�d
have to walk about two extra hours a day to keep from gaining weight. As
analyzed in the May 2004 USDA report on obesity, with more calories, yet
the same sedentary lifestyle, of course we gained weight.151
The reason we�re fat is not because of bread and fruit.
Much of the obesity crisis has been blamed on eating out more (Americans
spend almost twice as much time per week eating out as exercising),152
soft drinks, snacking, bigger portion sizes and "the enormous amount of
very clever and very effective advertising of junk food/fast food."153 Our
children, for example, are subjected to 10,000 ads for processed food
every year.154 There�s no way parents can compete. As one medical journal
pointed out, our children "will never see a slick high-budget (or even
low-budget) ad for apples or broccoli."
Twenty years ago, a typical US bagel was 3 inches; now
it�s twice that and contains a whopping 350 calories.155 Outback
Steakhouse now has an appetizer of cheese fries, which breaks the scale at
over 3000 calories, an appetizer containing more calories than most people
eat all day. One would have to walk about 35 miles to burn that kind of
thing off.156
The standard coke bottle used to be around 6 ounces.
Then came the 12 ounce can. Now we have the 20 ounce bottles, or, of
course, the 64-ounce "Double Gulp," containing about 50 spoonfuls of
sugar. In fact, the Double Gulp is selling so well that 7-Eleven
considered an even larger size, which a company spokesperson described
only as a "wading-pool-sized drink."157
The National Soft Drink Association boasts on their
website that "Soft drinks have emerged as America's favorite refreshment.
Indeed, one of every four beverages consumed in America today is a
carbonated soft drink, averaging out to about 53 gallons of soft drinks
per year for every man, woman and child."158 Interestingly, the
introduction of high fructose corn syrup around 1970 seems to exactly
parallel the sudden rapid rise in obesity in this country.159 Thanks in
part to the American food corporations, becoming overweight, as one
prominent obesity researcher pointed out, "is now the normal response to
the American environment."160
There is no mystery why we are the fattest country on
Earth. "We're overfed, over-advertised, and under-exercised," says
Stanford obesity expert John Farquhar. "It's the enormous portion sizes
and sitting in front of the TV and computer all day" that are to blame.
"It's so gol'darn obvious�how can anyone ignore it?"161
SHORT-TERM SIDE EFFECTS
"Extraordinarily Irresponsible"�Atkins and Pregnancy
So fine, maybe calories, not carbohydrates, are to blame
for our obesity epidemic, and maybe Atkins� claims, as described by one of
the world�s leading obesity researchers, are "the most unutterable
nonsense I ever saw in my life.�162 So what if it�s just a low calorie
diet in disguise? It�s still a low calorie diet where one can eat all the
(albeit bunless) bacon cheeseburgers you want. So what�s the problem?
The immediate concern centers on the state of ketosis.
Pregnant women are the most at risk. Based on detailed data from 55,000
pregnancies,163 acetone and other ketones may cause brain damage in the
fetus, which may result in the baby being born mentally retarded.164 The
fact that ketones seemed to cause "significant neurological impairment"
and an average loss of about 10 IQ points was well known and aroused
"considerable concern" years before Atkins published his first book.165
Atkins nonetheless wrote. "I recommend this diet to all my pregnant
patients."166
After enough pressure from the AMA, Atkins finally
relented. "There�s one other point I�m very sorry about," Atkins finally
admitted, "I now understand that ketosis during pregnancy could result in
fetal damage. My pregnant patients have never had this problem, but I
realize I didn�t study enough cases to validate my recommendation. If
anyone wants a retraction, I�ll be glad to give one."167
Subsequently at the congressional hearing on fad diets,
however, when asked by Senator George McGovern if he had made a public
retraction of his reckless recommendation, Atkins replied, "No; I will
stand by the statement I made in the book� I have recommended it for use
by the pregnant woman with the observation of the managing obstetrician or
physician�"168 After the Senate Select Committee hearings, the publisher
added a small print disclaimer on the copyright page in the front of the
book.169
Highlighting Atkins� recommendation of his diet even
during pregnancy, one nutrition textbook reads "Proponents of the low
carbohydrate diet have been extraordinarily irresponsible in ignoring
these hazards."170 �The woman who goes on a ketogenic diet [like Atkins]
for six months of pregnancy,� noted one fetal specialist, �is playing
Russian roulette.�171
More to Lose Than Weight
Although pregnant and breastfeeding women may be at most
risk, �The [Atkins] diet is potentially dangerous to everyone,� warned the
Chair of the Medical Society of New York County�s Public Health
Committee.172 In all of the editions of his Diet Revolution, Atkins cited
the �pioneering� work of �brilliant� researcher Gaston Pawan.173 When
Atkins was brought before the Senate investigation on fad diets, the Chair
of the Senate Subcommittee read a statement submitted by Dr. Pawan himself
who supported the AMA�s condemnation of the Atkins diet and explained that
he used very high fat diets only for �specific experimental purposes�
(emphasis in original.) in hospital settings and would never �recommend a
very high fat diet indiscriminately to obese subjects for obvious
reasons.�174
The symptoms of ketosis include general tiredness,
abrupt or gradually increasing weakness, dizziness, headaches, confusion,
abdominal pain, irritability, nausea and vomiting, sleep problems and bad
breath.175 One study found that all those subjected to carb-free diets
complained of fatigue after just two days. "[T]his complaint was
characterized by a feeling of physical lack of energy� The subjects all
felt that they did not have sufficient energy to continue normal activity
after the third day. This fatigue promptly disappeared after the addition
of carbohydrates to the diet."176 From a review published in a German
medical journal, "[lightheadedness], fatigue, and nausea are frequent,
despite what Dr. Atkins claims."177
In World War II, the Canadian Army had an illuminating
experience with ketogenic diets. For emergency rations, infantry troops
had pemmican, which is basically a carbohydrate-free mixture of beef jerky
and suet (animal fat). The performance of the infantrymen forced to live
off pemmican deteriorated so rapidly that they were incapacitated in a
matter of days. As reported in the journal War Medicine in 1945, "On the
morning of the fourth day of the diet, physical examination revealed a
group of listless, dehydrated men with drawn faces and sunken eyeballs,
whose breath smelled strongly of acetone."178 A ketogenic diet, concluded
one medical review, "can be associated with significant toxicity."179
In a study funded by Atkins himself, most of the people
who could stick with the diet reported headaches and halitosis (bad
breath). Ten percent suffered hair loss. While most people lost weight�at
least in the short-term�70% of the patients in the study also lost the
ability to have a normal bowel movement.
Constipation
Authorities recommend Americans start roughing it with
"at least 30-35 grams"180 of fiber a day "from foods, not from
supplements."181 The initial phase of the Atkins Diet, which dieters may
have to repeatedly return to, has about 2 grams of fiber per day.182
Atkins can�t help but concede the health benefits
associated with fiber found in, as he describes, "vegetables, nuts and
seeds, fruits, beans and whole unrefined grains;" but then asks "How can
you get the benefits of fiber without the carbs contained in these foods?
The answer is supplementation." He then goes on to basically recommend
that all his followers start taking sugar-free Metamucil. What must Mother
Nature have been thinking, putting all the fiber into such "poison" foods?
The May 2004 Annals of Internal Medicine study which was
misleadingly183 much lauded in the press with headlines like "Scientists
Give Thumbs Up to Atkins Diet," showed once again that most of the Atkins
Dieters suffered from headaches and constipation. They also had
significantly more diarrhea, general weakness, rashes and muscle
cramps�despite taking the 65 supplements prescribed by Atkins. One subject
was so constipated he had to seek medical attention. Another developed
chest pain on the diet and was subsequently diagnosed with coronary heart
disease.184 No wonder Consumer Guide gave the Atkins Diet zero out of four
stars for being �outright dangerous�185 and the editor of the Healthy
Weight Journal gave Atkins the dubious Slim Chance Award for "Worst
Diet."186
"Disease of Kings"
Because of the Henry VIII-style meat load, essentially
every single study on low carb diets that measured uric acid levels showed
that uric acid levels rose.187 In virtually every instance it�s been
studied over the last 50 years, uric acid itself has been tied to
cardiovascular disease risk, and may be an independent risk factor by
increasing free radical damage or making the blood more susceptible to
clotting.188
There is also concern that uric acid levels on a
meat-centered diet might be forced so high that it could start
crystallizing in one�s joints, triggering gout, an excruciating arthritic
condition. A March 2004 article published in the New England Journal of
Medicine documented the effect of meat intake on gout risk.
Harvard researchers followed almost 50,000 men for 12
years and found that "each additional daily serving of meat was associated
with a 21 percent increase in the risk of gout."189 In fact, the Atkins
Diet has been blamed directly for the rising incidence of this so-called
"disease of kings."190 Well, Atkins did claim his diet is "fit for a
prince or princess."191
Prescription for Muscle Cramps
The presence of muscle cramps, Atkins explained, "means
you are losing too many electrolytes." Along with the ketones, one�s
kidneys may also flush out critical electrolytes like calcium, magnesium
and potassium, which may result in muscle cramps or worse.192
Atkins realized this potential danger and recommended
his followers take potassium supplements In fact, some people lose so much
potassium they may need professional help. According to Atkins himself,
sales of potassium supplements "of anywhere near the proper amount of
potassium you may need are illegal over the counter; therefore you may
need a doctor to write you the proper prescription."193 Even Barry Sears,
the author of the flawed194 Zone Diet, recognizes the danger the Atkins
Diet might present: "Any meal that you have to take potassium supplements,
there's something wrong with that."195
Cognitive Impairment
Experts have voiced a longstanding concern that ketosis
might fog up people�s thinking, but wasn�t formally tested until 1995. As
reported in the International Journal of Obesity article "Cognitive
Effects of Ketogenic Weight-Reducing Diets," researchers randomized people
to either a ketogenic or a nonketogenic weight loss diet. Although both
groups lost the same amount of weight, those on the ketogenic diet
suffered a significant drop in cognitive performance.196
After one week in ketosis, higher order mental
processing and mental flexibility significantly worsened into what the
researcher called a "modest neuropsychological impairment."197
"Emotional Zombie"
Not only may the Atkins� Diet impair mental functioning,
it may impair emotional functioning as well. Researchers at MIT are afraid
the Atkins Diet is likely to make many people�especially women�irritable
and depressed.198
The Director of MIT�s distinguished Clinical Research
Center measured the serotonin levels in the brains of 100 volunteers
eating different diets.199 Serotonin is a chemical messenger in the human
brain that regulates mood. In fact, the way antidepressants like Prozac
are purported to work is by increasing brain levels of this
neurotransmitter.
The MIT researchers found that the brain only made
serotonin after a person ate carbohydrates. Carbohydrates seemed to
naturally stimulate serotonin.200 By starving the brain of this essential
mood elevator, the researchers fear that the Atkins Diet may make people
restless, irritable or depressed. They noted that women, people under
stress, and those taking anti-depressants might be most at risk.201
When one follower of low carb guru Herman Tarnower�s
1978 "Scarsdale Diet," wrote to him, "When I diet, I get cranky, and my
husband says, �I like you better fat than cranky�; have you any
suggestions?" Dr. Tarnower responded, "You should be able to diet without
getting cranky. Your husband, I am sure, would like to have you
attractive, lean, and pleasant." His paternalistic prescription may make
one sympathize, as one journalist wrote, "with his lover Jean Harris, the
former school headmistress who later did prison time for his murder."202
Based on the MIT serotonin research, Judith Wurtman,
Director of the Women's Health Program at the MIT Research Center, warns
that filling up on fatty foods like bacon or cheese may make people tired,
lethargic and apathetic. Eating a lot of fat, she stated, may "make you an
emotional zombie."203
"Sunshine and Sex"
Atkins� remedy to counteract or cover-up the toxic
effects of his diet is a list of prescriptions. Constipation? No problem,
he says, take a laxative.204
Leg cramps? They are "probably due to a calcium
deficiency," Atkins explained, "I treat it with calcium supplements and
Vitamins E and C. Sometimes magnesium and potassium have to be added."205
What if uric acid goes up? Not an obstacle for Atkins,
who wrote: "this rarely poses a problem because I routinely prescribe a
drug to prevent uric acid formation� if it goes above the normal range
after being on the diet."206 He fails to mention, however, that this drug
can cause irreversible liver damage, life-threatening anemia, and, in rare
cases, even death.207
Bad breath? Great�that means it�s "working at full
efficiency."208 Just "carry around� one of those purse-sized aerosol mouth
fresheners, and you can have sweet breath�"209
Despite the side effects of ketosis, Atkins� books
encourage people to repeatedly test their urine for ketones to ensure they
remain in this unhealthy state. Atkins almost fetishized ketosis,
describing it being "as delightful as sunshine and sex."210 Atkins did,
after all, start his career off as a stand-up comic.211 One dieter
replied, "I don�t think Dr Atkins had much sex if he thinks that ketosis
is better than sex. It�s certainly not."212
In fact, thanks to its side effects, those who go on the
Atkins Diet in an attempt to attract others may find it counterproductive
when a potential mate gets too close and finds a constipated, cognitively
impaired "zombie" with bad breath.
ALL LONG-TERM STUDIES ON ATKINS A WASH
Atkins Comes In Last For Long-Term Weight Maintenance
Even if people can handle the side effects of the diet,
there are no data to show that the initial rapid weight loss on the Atkins
Diet can be maintained long term. Many of the studies on the Atkins Diet
have lasted only a few days;213 the longest the Atkins Diet has ever been
formally studied is one year.
There have been 3 such yearlong studies and not a single
one showed significantly more weight lost at the end of the year on the
Atkins Diet than on the control diets.214,215,216 In the yearlong
comparison of the Atkins Diet to Ornish�s diet, Weight Watchers, and The
Zone Diet, the Atkins Diet came in dead last in terms of weight lost at
the end of the year. Ornish�s vegetarian diet seemed to show the most
weight loss.217 The Atkins website has no comment.218
Noting that by the end of the year, half of the Atkins
group had dropped out, and those who remained ended up an unimpressive 4%
lighter, Fat of The Land author Michael Fumento commented, "do you really
think any of them could sell a single book copy, much less as many as 15
million (for Atkins), by admitting to a 50 percent drop-out rate in one
year with a mere five percent of weight loss among those left?"219
Ornish�s vegetarian (near-vegan) diet has been formally
tested for years.220 Even though the diet was not even designed for weight
loss, after five years most of the Ornish adherents were able to maintain
much of the 24 pounds they lost during the first year "even though they
were eating more food, more frequently, than before without hunger or
deprivation."221 This is consistent with what research we have on vegans
themselves. Vegans are vegetarians that also exclude dairy and eggs from
their diet.
The biggest study on vegans to date compared over a
thousand vegans in Europe to tens of thousands of meateaters and
vegetarians. The meateaters, on average, were significantly heavier than
the vegetarians, who were significantly heavier than the vegans. Even
after controlling for exercise and smoking and other nondietary factors,
vegans came out slimmest in every age group. Less than 2% of vegans were
obese.222
In a snapshot of the diets of 10,000 Americans, those
eating vegetarian had the slimmest BMI's whereas those eating the fewest
carbs in the sample weighed the most. Those eating less carbs were on
average overweight; those eating vegetarian were not.223
Vegetarians may have a higher resting metabolic rate,
which researchers chalk up to them eating more carbs than meateaters (or
possibly due to enhanced adrenal function).224 At the same weight, one
study showed that vegetarians seem to burn more calories per minute just
by sitting around or sleeping than meateaters�almost 200 extra calories a
day. Although earlier studies didn�t find such an effect,225 if confirmed,
that amounts to the equivalent to an extra pound of fat a month burned off
by choosing to eat vegetarian.226
The only other two formal yearlong studies found that
although the initial drop in weight on Atkins was more rapid, weight loss
on the Atkins diet reversed or stalled after 6 months. The longer people
stay on the Atkins Diet, the worse they seemed to do.227,228 None of the
three longest studies on the Atkins Diet showed a significant advantage
over just the type of high carbohydrate diets Atkins blamed for making
American fat.
Anyone can lose weight on a diet; the critical question
is whether the weight loss can be maintained and at what cost. If low carb
diets really did cure obesity, the original in 1864 would have eliminated
the problem and no more diet revolutions would be necessary. Short-term
weight loss is not the same thing as lifelong weight maintenance.
Long-Term Weight Loss Secrets
Permanent weight control is difficult to achieve. Up to
around 95% of repeat dieters fail, regaining the weight that they
initially lost. What about those 5%, though? Has anyone studied them and
found out their secret? In her book Eating Thin for Life, award winning229
journalist and dietician Anne Fletcher delved into the habits of a few
hundred folks who had not only lost an average of 64 pounds but also
maintained that loss for an average of 11 years. What did she find?
"[B]asically, they're eating the opposite of a
high-protein, low carbohydrate diet," Fletcher reported. When she asked
them to describe their eating habits, the top responses were "low-fat"
followed by "eating less meat."
These dieters with long-term success also told her they
ate "more fruits and vegetables." Research seems to support this notion.
One research study showed, for example, that significant weight loss could
be triggered in people just feeding them extra fruit�3 added apples or
pears a day.230 Harvard studied 75,000 women for a decade and the results
suggest that the more fruits and vegetables women eat the less likely they
will become obese.231 A 2004 review of the available research suggests
that in general "increasing fruit and vegetable intake may be an important
strategy for weight loss."232
Researchers at the National Cancer Institute followed
over 75,000 people for ten years to find out which behaviors were most
associated with weight loss and which with weight gain. They wrapped tape
measures around people�s waists for a decade and found that the one
dietary behavior most associated with an expanding waistline was high meat
consumption and the dietary behavior most strongly associated with a loss
of abdominal fat was high vegetable consumption.233
Even after controlling for other factors, men and women
who ate over a serving of meat a day seemed to be 50% more likely to
suffer an increase in abdominal obesity than those who ate meat just a few
times a week. The researchers conclude: "Our analysis has identified
several easily described behaviors [such as reducing meat intake to less
than three servings per week and jogging a few hours every week] that, if
widely adopted, might help reverse recent increases in adult overweight�
Increases in vegetable consumption might reduce abdominal obesity even
further."234
The sad thing, according to the Director of Nutrition
for the Center for Science in the Public Interest, is that "people keep
believing that the magic bullet is just around the corner . . . if they
only eliminate food 'x' or combine foods 'a' and 'b,' or twirl around
three times before each meal."235 The reality is that most ordinary people
lose weight without the gimmicks Americans spend $30 billion236 a year
on.237
In the largest survey ever undertaken on the long-term
maintenance of weight loss, Consumer Reports found that the vast majority
of the most successful dieters said they lost weight entirely on their
own, without enrolling in some expensive program, or buying special foods
or supplements or following the regimen of some diet guru.238 The most
popular fad diet right now may be Atkins, but it�s not the most popular
diet, and not the one that seems to work the best.
Atkins Missing in Action
The most formal study of lasting weight loss, though, is
the highly respected National Weight Control Registry, funded by the
National Institutes of Health. For over 10 years, the Registry has tracked
the habits of thousands of successful dieters. They now have 5000
Americans confirmed to have lost an average of 70 pounds and were able to
prove they have kept it off for an average of 6 years.239 After a decade
of rigorously tracking those who most successfully lost weight�and kept it
off�one of the chief investigators revealed what they found: "Almost
nobody's on a low carbohydrate diet."240
These researchers, led by a team at Brown and the
University of Colorado, found that the people most successful in losing
and maintaining their weight were eating high carbohydrate diets�five
times as many carbs as Atkins proscribed in the "weight loss" phase of his
diet.241 Out of the thousands of people in the National Weight Control
Registry, less than 1 percent follow a diet similar to the Atkins program.
"We can't find more than a handful of people who follow the Atkins program
in the registry," said one chief investigator, "and, believe me, we've
tried."242
Fifteen million Atkins books sold; and investigators can
only find a "handful" of followers who could qualify for the Registry? To
qualify, all dieters have to do is prove they lost just 30 pounds and kept
it off for at least one year. Twenty-six million Americans243 supposedly
on "hard-core" low carb diets and "almost nobody" on Atkins has even
qualified?
Maybe for some reason only dieters eating lots of
carbohydrates hear about the Registry? No, the National Weight Control
Registry has been plugged in Dr. Atkins� own book for years and is
promoted on the official Atkins website.244 The reason why anecdotes of
Atkins Dieters maintaining their weight loss crop up in Atkins books and
websites but seemingly nowhere else, may be because there isn�t much
oversight when posting information to the web, whereas the Registry
demands proof.245
* Michael Greger, MD, is a graduate of the Cornell
University School of Agriculture and the Tufts University School of
Medicine. Dr. Greger has been publicly speaking about mad cow disease
since 1993. In 1997 he was invited as an expert witness to defend Oprah
Winfrey in the infamous meat defamation trial. He has contributed to many
books and articles on the subject and continues to lecture extensively.
Dr. Greger can be contacted at 857-928-2778, or
[email protected]
.
Part II will continue in next month's, July 2004,
McDougall Newsletter.
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