Low-Carb Diets Take a Punch
By Sally Squires
Washington Post Staff Writer
Tuesday, July 6, 2004; Page HE01
Low-carb diets are in the hot seat.
While the South Beach Diet and the Atkins Diet continue
to tally book sales -- an estimated 30 million to date -- 11 health
organizations have teamed up to dispel what they call popular
misconceptions about the low-carbohydrate approach and to warn about the
risk of its long-term use.
The Partnership for Essential Nutrition, led by former
U.S. Surgeon General C. Everett Koop's Shape Up America! group, cautions
that studies show the low-carb approach can starve the brain of
carbohydrates, produce constipation and other gastrointestinal problems,
reduce energy levels and cause difficulty concentrating.
In the long run, the groups warn, the regimens can
stress the kidneys and increase the risk of liver disorders, gout,
coronary heart disease, diabetes, stroke and several types of cancer.
"Low-carbohydrate diets conflict with decades of solid
scientific research that clearly encourages us to reduce saturated fat and
boost fruit, vegetable and fiber intake," said Barbara Moore, president
and CEO of Shape Up America!
These diets have "promoted the simplistic belief that
individuals can solve their weight and related health problems by
eliminating one nutrient from the diet, or at least drastically reducing
intake of that nutrient: carbohydrates," noted Alison Rein, assistant
director of food and health policy for the National Consumers League, one
of the groups in the partnership. The partnership received a $25,000 grant
from Weight Watchers to produce a public service announcement for TV about
the potential dangers of low-carb diets.
Not only is this "magic bullet" approach wrong, Rein
said, but "it has also likely led to decreased consumption of fresh fruit
and vegetables, whole grains, low-fat dairy foods and fiber."
Colette Heimowitz, director of education and research
for Atkins Nutritionals, dismissed those concerns,
saying that research "continues to support the safety of low-carb diets as
an option for weight loss and maintenance." She said that Atkins
Nutritionals has created a food ladder to help guide consumers to add back
carbohydrates after the induction phase of the Atkins diet, when
carbs are most strictly limited.
The partnership, Heimowitz said, "is funded by big
industry and Weight Watchers. They have millions of dollars behind them. .
These are the companies whose sales are plummeting and
who are also launching their own low-carb products."
Moore said 10 of the 11 health groups in the partnership
have contributed only time, not money. Nine are nonprofit, including one
that is funded by the federal Centers for Disease Control and Prevention.
Two are university affiliated. Shape Up is footing the bill for the
partnership. Moore said the group has received money for other projects
from Tanita (makers of a body fat scale), Gerber Food Products (to sponsor
a one-day meeting in Washington on childhood obesity) and the Florida
Department of Citrus (for a meeting on breakfast nutrition).
The partnership also includes the Alliance for Aging
Research, the American Association of Diabetes Educators, the American
Institute for Cancer Research, the American Obesity Association, the
National Women's Health Resource Center, the Pennington Biomedical
Research Center in Baton Rouge, La., the Society for Women's Health
the University of California-Davis Department of
Nutrition and the Yale-Griffin Prevention Research Center in Derby, Conn.
Some of these groups receive some corporate funding in addition to other
The partnership offers this advice to those considering
a low-carb approach to weight loss:
Beware quick weight loss Studies show that the fast,
initial drop in pounds that occurs with extremely low-carb diets such as
Atkins is mostly due to water loss caused by a metabolic condition called
ketosis. "This form of weight loss is extremely stressful on the body and
forces the brain to alter its metabolism," Moore said. "And it can't be
ameliorated by drinking more water." And as the partnership noted,
"research has shown that this weight loss cannot be sustained over time."
"We agree with that," said cardiologist Arthur Agatston,
author of the South Beach Diet, which doesn't push its adherents into
"Even in advertising, we have asked the publisher not to
make claims about rapid weight loss. We emphasize again and again slow
weight loss, about one to two pounds per week, which is more-permanent
Calories count. "The Atkins Essentials" says poultry,
fish, shellfish, meat and eggs are foods that "you do not need to limit."
It notes that exceptions are processed meats, such as
bacon and hot dogs, that may be cured with sugar or contain fillers that
The partnership noted that "a surprising number" of
Americans are less concerned about the amount they eat than what foods
they consume. "Contributing to this view is the growing belief [among
those polled] that low-carb diets create weight loss without cutting
calories, a view that the overwhelming number of credible scientific
studies refutes." For example, a 2003 review article published in the
Journal of the American Medical Association found that weight loss on low-carb
diets is due to decreased calories. On the first two weeks of South Beach
Diet, adherents are advised to eat specific menus that range from about
1,100 to 1,500 calories per day -- similar to traditional low-calorie
"The monotony of the diets is a major factor in why
people lose weight, because they end up being bored and eating less," the
Representatives for Atkins Nutritionals agree that their
adherents consume fewer calories, but say it's because the combination of
higher fat and protein is more satisfying to dieters.
"We have already demonstrated in studies that people end
up eating fewer calories on Atkins," Heimowitz said. "They're eating about
1,400 to 1,800 calories per day is what studies have demonstrated" --
roughly what people are advised to eat on traditional weight-loss
On South Beach, "calories count, but counting calories
doesn't work," Agatston said -- the reason that the
program advises consuming healthy food in limited portions.
Eat healthy carbs. A national opinion poll conducted for
the partnership in June found a lack of even "a rudimentary understanding
of what carbs are and their role in the diet." The National Academy of
Sciences recommends that Americans eat a minimum of 130 grams of
carbohydrates per day -- roughly six times what is included in the
induction phases of low-carb diets. The academy also noted, however, that
most Americans eat two to three times more than they need. So reducing
processed carbs makes sense for many people seeking to control their
weight as well as for those aiming to choose better
carbs: Highly processed carbohydrates, such as those found in sugary or
white-flour baked goods are more likely to raise blood sugar and boost
production of insulin.
Expect snap-back pounds. Research shows that as
carbohydrates are reintroduced, rapid weight gain often occurs for low-carb
dieters, the partnership noted.
"That's true, if you go into ketosis, " Agatston said.
By eating too few carbohydrates, stores of glycogen are depleted. Eat
carbs again "and you will snap back weight," Agatston said. "We don't find
that [with South Beach] because we don't put people into ketosis."
In "Atkins Essentials," readers are warned that "the
first week on Atkins may not be, punning aside, a piece of cake." At the
end of the second week, the book guides readers toward deciding whether to
stay in this first phase or to move on to one of the other three phases of
the diet, which gradually reintroduces more carbohydrates, such as berries
and whole grains, to guide dieters gradually out of ketosis.
Choose high-protein foods wisely. South Beach emphasizes
fish, poultry and other protein low in saturated fat. But a survey
conducted for the partnership found that half of those on low-carb diets
are increasing consumption of steak and 30 percent are eating more bacon,
which tend to be high in saturated fat. People on low-carb regimens are
"eating more eggs and less cereal, fruit and dairy," Moore noted.
Read ingredients carefully. The average low-carb dieter
spends about $85 a month on any number of the more than 1,000 products
labeled low-carb, carb-smart, carb-aware, carb-wise or reduced-carb, or
otherwise claiming to be carb-restricted. Yet there is no official or
uniform definition of these terms, leaving food and beverage manufacturers
free to apply their own. "While these foods are widely advertised and
promoted, many of these claims are not regulated by the federal
government, leading to confusion over what these labels mean," the
partnership said, noting that consumers need to compare products
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