Online Encyclopedia
Atkins Nutritional Approach
The Atkins Nutritional Approach, popularly known as the Atkins Diet or just Atkins, is a fashionable but controversial high-protein, high-fat, low-carbohydrate diet. It was popularized by Dr. Robert Atkins (1930-2003) in a series of books, starting with Dr. Atkins' Diet Revolution in 1972. It has been astonishingly popular in recent times because of his revised book, Dr. Atkins' New Diet Revolution, in which he revised some of his ideas but remained largely faithful to the original concepts.
Dr. Atkins argued that many eating disorders are the result of hyperinsulinism, or excessive secretion of insulin which comes through eating too many carbohydrates. According to Atkins, this causes food cravings and unstable blood sugar levels, which can cause mood swings, depression, and sleeping problems. Atkins claimed that his diet stabilizes insulin and blood sugar levels, eliminating cravings and often reducing appetite.
The Atkins Nutritional Approach seems to provoke extreme reactions, to the point where even just discussing it can be a problem. Dr. Samuel Klein, of the North American Association for the Study of Obesity, has reported encountering anger from academicians simply for daring to present data on the Atkins diet.
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Nature of the diet
Aktins represents a radical departure from prevailing theories. He claimed there are two main unrecognised factors about Western eating habits, arguing firstly that the main cause of obesity is eating concentrated carbohydrates particularly sugar and refined flour. Secondly, that fat is overrated as a nutritional problem. Consequently, Dr Atkins explicitly rejects the advice of the food pyramid, instead telling us that bread and pasta are not healthy staples, and that the exclusive focus on the detrimental effects of dietary fat have actually contributed to the obesity problem.
While most of the emphasis in Atkins is on the diet, nutritional supplements and exercise are considered equally important elements.
Atkins involves restriction of the intake of carbohydrates in order to switch the body's metabolism from burning glucose to burning fat (chiefly stored fat). This process (called lipolysis) begins when the body enters the state of ketosis as a consequence of running out of carbohydrates to burn. Although Atkins claimed that ketosis helped the body burn fat more easily, nutritionalists are quick to point out that the body will burn stored fat for energy whenever the calories taken in are less than those burned.
Atkins restricts "net carbs", or carbs that have an effect on blood sugar. Net carbohydrates can be calculated from a food source by subtracting sugar alcohols and fiber (which are shown to have no effect on blood sugar level) from total carbohydrates.
There are four phases of the Atkins diet:
Induction
The Induction phase is the first, and most restrictive phase of the Atkins Nutritional Approach. It is intended to cause the body to quickly enter a state of ketosis. Carbohydrate intake is limited to 20 net grams per day. The allowed foods include an unlimited amount of most meats, a good bit of cheese and cream, two cups of salad, and one cup of other vegetables. Caffeine and alcoholic beverages are not allowed.
The Induction Phase is usually when many see the most significant weight loss - reports of losses up to six or eight pounds per week are not uncommon.
Atkins suggests the use of KetoStix , small chemically reactive strips used by diabetics. These let the dieter monitor when they enter the ketosis, or fat burning, phase.
Ongoing Weight Loss
The Ongoing Weight Loss (OWL) phase of Atkins consists of an increase in carbohydrate intake, but remaining at levels where weight loss occurs. Carb intake increases by 5 grams of carbs per day each week. A goal in OWL is to find the "Critical Carbohydrate Level for Losing". The OWL phase lasts until weight is within 10 pounds of the target weight.
Pre-maintenance
Lifetime maintenance
Views in favor of the diet
It is almost an understatement to say Atkins has attracted criticism. This is an entirely normal reception to a radically different theory. Atkins does not strictly speaking constitute a paradigm shift, but many of the same social factors are at work. It is to be expected that established experts in an old way of thinking will reject a radically different new one, frequently out of hand. During a period of paradigm shift it is important to examine the pronouncements by the different organisations and distinguish between them. Look for evidence-based studies (e.g. "We have studied 200 individuals ..."), and avoid opinion-based ones ("We experts believe that ..."). History demonstrates that opinion-based studies are unreliable under these emotionally-charged conditions.
Atkins was originally rejected out of hand by the existing experts, claiming it was unhealthy and would not produce weight-loss. Even looking too closely was almost tantamount to quackery by association, so for two decades it went unstudied. Evidence-based studies eventually began in the face of massive anecdotal evidence that weight-loss did occur, and evidence-based studies have gradually undermined the establishment experts, firstly demonstrating that short-term weight loss did occur, then that it could be maintained, also showing that cholesterol did not rise as predicted. The final unrefuted claim is that Atkins is not healthy for long-term use.
The May 22, 2003, issue of the New England Journal of Medicine published two scientific, randomized studies comparing standard low-fat diets to low-carbohydrate diets such as the Atkins Diet. In both studies, subjects lost more weight on the low-carbohydrate plans.
Supporters claim the exclusive focus on reducing fat is oversimplified, and that low-fat diets are not automatically healthy ones. Traditional, high-fat French cooking has led to a much lower incidence of obesity, morbid obesity and chronic heart disease than in the high-sugar American diet, despite overall energy intake and exercise levels being the same.
A research study carried out by the Weight and Eating Disorders Program at the University of Pennsylvania, reported in May 2003 that the Atkins diet raised levels of HDL (or "good") cholesterol by an average of 11% and reduced the amount of triglycerides in the bloodstream by 17%. This counters one of the chief criticisms of Atkins' approach, which is that cholesterol is raised by eating fatty foods and meat.
In the study, conventional dieters' HDL cholesterol raised by only 1.6% while their triglyceride levels did not improve significantly. Weight loss was also statistically greater in the Atkins dieters after three and six months compared with the conventional dieters (although this did not remain statistically significant after a year). The study followed the diets of 63 obese men and women. (See New Scientist, May 21, 2003.)
Views critical of the diet
Low-carbohydrate diets have been the subject of heated debate in medical circles for three decades [1] http://www.lowcarb.ca/ . They are still controversial and only recently has any serious research supported some aspects of Atkins' claims, especially for short-term weight-loss (6 months or less).
But the broader consensus of the scientific community also raises serious concerns:
- The National Weight Control Registry, funded by the National Institutes of Health (NIH) tracked the habits of successful dieters over a longer term, 10 years. Despite this diet's overwhelming popularity compared to other diets, of the 5,000 Americans confirmed to have lost an average of 70 pounds and able to prove they have kept it off for at least 6 years of the decade of NIH’s data-keeping, less than 1% were confirmed to be Atkins adherents.
- Even in studies only one year long, this diet can fail to produce the greater weight-loss which is claimed to come from factors other than calorie-reduction such as ketosis: It was compared to dieters on Dean Ornish ’s diet, Weight Watchers, and The Zone Diet for 1 year. The Atkins Diet came last in terms of weight lost at the end of the year. (Dansinger, M.L., Gleason, J. L., Griffith, J.L., et al., "One Year Effectiveness of the Atkins, Ornish, Weight Watchers, and Zone Diets in Decreasing Body Weight and Heart Disease Risk", Presented at the American Heart Association Scientific Sessions November 12, 2003 in Orlando, Florida.)
- Although a study cited in the previous section (favorable to this diet) showed a rise in 'good cholesterol,' the lowest incidence of heart disease in the world is amongst people who have the lowest overall cholesterol levels -- including HDL ('good') cholesterol. (Lancet 2:367, 1981) i.e., ‘Good’ cholesterol is good when counter-balancing ‘bad’ cholesterol, but low levels of both, such as what Dean Ornish’s diet promotes, are better.
- In a study funded by Dr. Atkins himself, 70% of the people that could stick with the diet lost the ability to have a normal bowel movement. The May 2004 Annals of Internal Medicine study showed that most of the Atkins Dieters had significantly more diarrhea, general weakness, rashes and muscle cramps. Atkins.com now suggests a fiber supplement.
- The Atkins website and many proponents claim that there is no link between the Atkins Diet and kidney damage; however, the following peer-reviewed studies and other reputable sources contradict this claim:
c. People in affluent societies commonly lose about 30 percent of their kidney function by their 80’s (J Gerentol 31:155, 1976). And the amount of protein typically consumed in the American diet, 12% to 15% protein, is probably a partial cause. (New Eng Jrnl Med 307:652, 1982) Atkins Dieters, as illustrated in the research referred to in letter (b), often get even more protein than that.
- Also, acidity from the typically high protein intake can cause osteoporosis (Feskanich D, Willett WC, Stampfer MJ, Colditz GA. Milk, dietary calcium, and bone fractures in women: a 12-year prospective study. Amer Jrnl Public Health 1997;87:992-7. See also follow-up in February, 2003 issue of the American Journal of Clinical Nutrition (Vol. 77, No. 2, 504-511); this includes 72,000+ people and 18 years of data. Cumming RG, Klineberg RJ. Case-control study of risk factors for hip fractures in the elderly. Amer Jrnl Epidemiology 1994;139:493-503.
With its emphasis on fatty foods, the Atkins diet has generally been considered by most medical and nutritional experts to be unsound. It also violates the food pyramid, which states that amounts of carbohydrates, protein and fats (in that order) must be regularly consumed to stay healthy. Some experts have even suggested Atkins' plan is quackery. Among those criticizing the healthiness of his diet, if not also skeptical of the claims of greater weight-loss than other, safer diets, are such reputable organizations as:
a. “...the [Atkins] diet, as recommended, poses a serious threat to health.” --Chair of the American Medical Association's Council on Food and Nutrition, testimony to Congress
b. "unhealthy and can be dangerous." --C. Everett Koop (Shape Up America! news release, 29 December 2003)
c. "a nightmare of a diet." --Journal of the American Dietetic Association 102 (2002): p.260
d. Also condemned by National Institutes of Health in NIH Publ. No. 94-3700, 1993.
e. Condemned by ACS in American Cancer Society; Weighing In on Low Carb Diets, 2004.
f. Condemned by the American Kidney Fund in American Kidney Fund news release, 25 April 2002.
g. Condemned by American Heart Association in Circulation 104 (2001): p.1869.
h. Condemned by Johns Hopkins in Diabetes 2004. Johns Hopkins University White Paper, 2004
i. Condemned by the American College of Sports Medicine in Medicine and Science in Sports and Exercise 33 (2001): p.2145.
j. Expressing a general sentiment was the conclusion: “runs counter to all the current evidence-based dietary recommendations.” --Journal of the American College of Cardiology 43 (2004): p.725
Opponents of the diet also point out that the initial weight loss upon starting the diet is a phenomenon common with most diets, and is due to reduction in stored glycogen and related water in muscles, not fat loss. They claim that no evidence has surfaced that any diet will cause weight loss unless it reduces calories below the maintenance level, and reports have indicated that successful weight loss due to the Atkins diet may be the result of fewer calories being consumed by the dieter, rather than the lack of carbohydrates. [2] http://news.bbc.co.uk/1/hi/health/3416637.stm They further point out that weight loss on fad diets, which typically restrict or prohibit certain foods, is often due to the fact that the dieter has less food choices available. Also, a diet of low-carb foods may quickly become dull to many people, meaning that their appetite is somewhat naturally suppressed as they become hungry for carbs, but the dieter either has none handy or resists this hunger.
There is also bad breath and fatigue, which are only the milder symptoms of the purposefully-induced ketosis, yet Atkins accuses other diets of causing fatigue: [3] http://content.health.msn.com/content/article/87/99349.htm?GT1=3391 , [4] http://www.ext.colostate.edu/pubs/columnnn/nn000905.html , and Cleveland Clinic Journal of Medicine 68(2001): p.761
In addition, Atkins' claims that high carbohydrate diets cause obesity are contracticted by the fact that societies which treat carbohydrates as a staple, in particular countries in East Asia such as Japan, China and Thailand, where rice is often consumed at each meal and drinks and snacks are also made from the grain, often have remarkably low rates of obesity. However, given other factors, such as an increase in sedentary recreational and work activities over these decades, there is only correlation between this higher-calorie diet and the rise in obesity, but no conclusive, causal relationship between any diet and America's obesity; one can even turn Dr. Atkins' spurious (not supported by the data) correlative argument against the Atkins Diet itself, by pointing out that this obesity rose in concert not with higher carbs and lower fat, but it HAS risen as low-carb diets were created, and got worse as they got more popular.
On May 27, 2004, Jody Gorran, a 53-year-old Florida businessman, filed a lawsuit against Atkins Nutritionals , Inc. and the estate of Dr. Robert Atkins, claiming that the Atkins diet regimen caused severe heart disease, making it necessary for him to undergo angioplasty. As of May 28, he has been seeking a court injunction banning Atkins Nutritionals from marketing its products without a warning of potential health risks, and asking for compensatory damages.
Dr. Robert Eckel of the American Heart Association says that high-protein, low-carbohydrate diets put people at risk for heart disease. [5] http://www.lowcarb.ca/articlesb/article332.html
Dr. Atkins, himself, died of a seizure that was likely caused by atherosclerosis and consequent ischemia of the brain. This led to him falling, fracturing his skull and dying as a result.
Users of the diet must exercise significant caution when manipulating their body's natural metabolic state.
It should also be noted that for individules who participate in sports, this diet is not good. Athletes require carbohydrates as they are easiest for the body to utilize for energy (ATP). Fats must be beta-oxidized , but this requires extra oxygen, reducing the advantage of a high VO2 Max. Less oxygen is going into making energy, some is going into a conversion instead. Protein nucleiotides can also be used to directly synthesize ATP, but at this stage, the free fats and carbohydrates stored within muscles have been depleted. This can result in an athlete "bonking" and suffering from very low performance.
Misconceptions about the diet
Many people incorrectly believe that the Atkins Diet promotes eating unlimited amounts of fatty meats and cheeses. In fact, while certain foods are allowed in unlimited quantities, the Atkins Diet is very specific in recommending lean meats, such as seafood and poultry. This is a key point of clarification that Dr. Atkins addressed in the more recent revisions of his book.
Another common misconception arises from the confusion between the Induction Phase and rest of the diet. The first two weeks of the Atkins Diet are extremely strict, with only 20g of carbohydrates permitted per day. The plan is very clear that dieters absolutely should not continue past the 2-week Induction Phase without slowly raising their daily carbohydrate count. Once the weight-loss goal is reached, carbohydrate levels are raised even further, though still significantly below USDA norms, and still within the definition of "ketosis".
Atkins claims that ketosis produces a "metabolic advantage", although this view is controversial. According to the theory, in order to lose weight on the Atkins Diet, the body must enter ketosis. This is achieved in the induction period, during which the dieter consumes less than twenty grams of carbohydrates per diem; when the body is suddenly cut off from carbohydrates, it enters ketosis and begins burning body fat. This is the basis of the Atkins Diet, and, according to advocates, the reason why it works. Conventional dietary wisdom holds that your body will burn fat for energy any time the calories you consume are less than those you burn.
Thus, consuming low-carbohydrate products every now and then will probably not affect body weight, since simply limiting carbohydrates will not do anything unless:
- The dieter has entered ketosis by going through a full induction period (assuming Atkin's theory is correct) or
- The food in question is low in calories and fat as well
Eating low-carbohydrate foods will not cause significant weight loss unless the above criteria are followed. Also, cutting carbohydrates is not equivalent to following the diet's guidelines.
This is in contrast to the South Beach Diet, which reduces carbohydrate intake but deliberately avoids inducing ketosis.
Reference
- New England Journal of Medicine: (vol 348, p 2082) http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstra
ct&list_uids=12761365
Related topics
published 1999
External links
- New FAQs http://atkins.com/helpatkins/newfaq/index.html of the Atkins Center http://atkinscenter.com/index.html
- Weight loss methods and classification of common diet plans http://www.thedoctorslounge.net/centers/nutrition/weight_loss/diet/index.htm
- New York Times Magazine article What if It's All Been a Big Fat Lie? http://www.diabetes-normalsugars.com/articles/fatlie.shtml
- 'More questions than answers on Atkins diet' in recent news http://www.cleveland.com/living/plaindealer/index.ssf?/base/living/1083241803645
70.xml - Active Low-Carber Forum http://forum.lowcarber.org
- Atkins All the Way: A Support Forum for those on Atkins http://www.atkinsalltheway.com
- Atkins-Diät: News in German http://www.medizin.de/gesundheit/deutsch/486.htm
- Atkins Diet Alert http://www.atkinsdietalert.org/
- Atkins Diet debate http://www.healthyweightforum.org/eng/diets/atkins_diet/
- Atkins Diet Information http://www.thecolumn.org/atkins-diet.asp
- Atkins Diet Information http://www.atkins-diet-information.com
- Atkins Diet overview http://www.low-carb-foods.biz/low-carb-diets/atkins-diet/
- Atkins Diet Support http://www.lowcarb.ca
- AtkinsExposed.org: Exposing the truth behind low carb http://www.atkinsexposed.org/
- Carbohydrate Counter http://www.carbohydrate-counter.org/
- Low Carb Forum http://www.lowcarbforum.de/ (in German)
- The Low Carb User Site http://icarbohydrate.com/
- Low Carb Recipes and Restaurant Guide http://www.locarbrecipes.com/
- Profiling Food Consumption in America http:://www.usda.gov/factbook/chapter2.htm