Atkins Diet: Hope or Hype?

By Janet Ford, DietPower Senior Editor

A strange thing has happened over the past ten years: the whole world seems to think carbohydrates are bad. Restaurants, from fast-food to haute-cuisine, are offering low-carb alternatives on menus. Airlines are handing out low-carb candies to passengers. Hotels feature low-carb programs for guests. In the supermarket, low-carb products are elbowing regular products off the shelves. A California compnay has introduced the nation's first low-carb vending machines. People on the street and in the media—even network news anchors—talk of carbohydrates in the same tones once reserved for PCBs and mercury. What on earth is going on?

Revolutionary or Quack?

Robert C. Atkins, M.D., couldn't have known what a dramatic effect he'd have on the nation's eating habits when he introduced his diet back in September 1972. With the publication of his 300-page Dr. Atkins' Diet Revolution, he mounted a startling challenge to the medical establishment: When everyone else was saying that a low-fat, high-carbohydrate approach was the proper way to lose weight, Atkins railed against carbohydrates, insisting that you could lose weight by eating all the fat you wanted. What's more, with Atkins' plan you could lose weight quickly. Never mind waiting more than a month to drop 10 pounds; follow Atkins and you could lose that much the first week. Helped in part by excerpts that ran in Woman's Day, and Cosmopolitan, the book sold 900,000 copies in the first seven months.

A study published the following year in the Journal of the American Medical Association dismissed the diet as junk. Atkins had also been accused at various times of quackery, including treating cancer patients with ozone and other alternative therapies. The doctor dropped out of the spotlight, and his diet joined a heap of others dismissed as fads.

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In 1992 he roared back, however, with the publication of Dr. Atkins' New Diet Revolution. Again, the scientific and medical establishment greeted the book either by wagging its finger or ignoring it, hoping it would fade into oblivion.

It didn't. Atkins and his book persevered, and the updated version has sold more than 10 million copies. By some accounts, 30 million Americans have tried the diet.

Meanwhile, the diet has outlived its creator: Robert Atkins died on April 17, 2003, at age 72, days after slipping on an icy Manhattan sidewalk and hitting his head. News articles, citing death records, claimed that Atkins was obese at the time of death. His defenders were quick to claim that the drugs used to keep him alive in his final days swelled him up like a water balloon.

The controversy surrounding the man—and the diet—continues. Professional groups such as the American Heart Association, the American Medical Association, the American Dietetic Association, and the American Council on Preventive Medicine continue to attack Atkins' theory, but no longer dismiss him as a fad. "This has become almost a trend," concedes Dr. Bob Eckel, a spokesman for the Heart Association. Even the National Institutes of Health (NIH) has begun some studies looking at the diet's long-term safety and effectiveness.

Help from the Press

Why are Atkins and other low-carb diets now at the center of attention? "A lot of things have come together," says Dr. Holly Wyatt, an assistant professor of medicine at the University of Colorado's Center for Human Nutrition, who is studying the Atkins diet for NIH. One thing that stands out is the average citizen's girth. "We're now in an obesity epidemic," she says. "America is gaining weight. Obesity wasn't on the radar screen twenty years ago."

According to the Centers for Disease Control and Prevention (CDC), nearly three times as many Americans are obese than when Atkins' first book came out. The most recent figures available, from 2007-2008, show that 34 percent of Americans are obese and 68 percent are overweight. Soon, obesity may overtake smoking as the top preventable cause of death, says the CDC. The stats defy the oft-repeated call for Americans to exercise more, adopt a low-fat diet, and eat more fruits and vegetables.

Also working in Atkins' favor were the publication of both scientific and lay articles that cast favorable light on the diet. Atkins dieters indeed lost weight, and in some cases they didn't raise their dangerous cholesterol levels as the alarmist heart doctors had warned—at least in the short haul. "There are no terrible things that we know of," says Dr. Eric C. Westman, lead author of one such study that appeared in the July 2002 American Journal of Medicine. In the same month, a cover article in the New York Times Magazine argued that Atkins may have been right all along. That a highly respected mainstream publication would run such an article "had some impact," says Eckel, a professor of medicine at the University of Colorado Health Sciences Center.

Positive word of mouth doesn't hurt, either, observes Eckel. "When your neighbor has lost ten pounds in seven days, you say, 'Isn't that amazing?'"

The Four Phases of Atkins

Okay, what's so "amazing" about the Atkins diet? And is the diet safe and effective? According to Atkins—and the company he founded, Atkins Nutritionals—this four- phase eating plan will help you lose weight, keep it off, be healthy, and prevent disease. Here's how it works:

Phase 1: Induction

For a minimum of 14 days, Atkins dieters are instructed to eat only what can be found on Atkins' "Acceptable Foods" list. This includes liberal amounts of protein and fat, specifically red meat, poultry, fish, shellfish, eggs, butter, mayonnaise, olive oil, safflower, sunflower, and other vegetable oils. Carbohydrate consumption is restricted to 20 grams per day, and must be obtained mostly from salad and other non-starchy vegetables. Absolutely no fruit, bread, pasta, grains, starchy vegetables, or dairy products (other than cheese, cream, and butter) may be consumed. Nuts and seeds are also banned the first two weeks, as are foods that combine protein and carbohydrates, such as chickpeas, kidney beans, and other legumes. Any drinks containing caffeine must be avoided.

According to Atkins, your body's chemistry changes during this stage, from a carbohydrate-burning metabolism to a fat-burning one. Blood sugar stabilizes, and as a result you will feel less fatigued and moody. You will curb your food cravings and break any addictions to sugar, wheat, caffeine, and any other food.

Phase 2: Ongoing Weight Loss (OWL)

During the second phase, you increase your carbohydrate intake to 25 grams daily the first week, 30 grams daily the next week, etc., until you stop losing weight. Atkins suggests that during the first week of OWL you add either a leafy salad, half an avocado, a cup of cauliflower, six to eight stalks of asparagus, or another vegetable each day. The following week you can try more greens and other vegetables, half a cup of cottage cheese, one ounce of sunflower seeds, or a dozen macadamia nuts. You can also eat blueberries, strawberries, raspberries, blackberries, and other fruits, depending on whether they trigger cravings. When you stop losing weight, you subtract five grams of carbohydrate from your daily allotment, so that slow weight loss continues. You stay in this phase until you're within five to ten pounds of your goal.

Phase 3: Pre-Maintenance

Now you increase daily carbohydrate intake by 10-gram increments each week to maintain weight loss of less than a pound a week. This phase typically lasts two to three months until you reach your goal.

Phase 4: Lifetime Maintenance

In the final phase, you can select from a wider variety of foods while still controlling your carb intake. According to the plan, each person can eat a certain amount of carbs, called the "Atkins Carbohydrate Equilibrium," before he or she begins putting on weight. If you stay at this level, you will not gain weight. If you go over it, your weight will inch upward and you'll need to return to an earlier weight-loss phase.

What the Critics Say

It's important to remember that Dr. Atkins was a physician, not a scientist. He based his diet on years of clinical observation, not on experiments constructed to rule out any bias. This doesn't mean that his diet is hogwash. A few scientific studies performed after the diet became popular have given it a modicum of support. Still, it flies in the face of decades of mainstream nutrition research, and this makes it vulnerable to criticism from the scientific community.

For many professional groups, the problems with the Atkins diet are obvious. The Mayo Clinic, in its online analysis, states that a high-protein diet may involve foods high in saturated fat, which raises your cholesterol and increases your heart risk. Mayo cautions people to avoid any weight-loss program that lists "good" and "bad" foods, reminding them that in weight loss, it's the calories that count.

Atkins claims that "bad" carbohydrates—especially refined carbs found in white bread and pasta, jams, desserts, other sugary stuff, and potato chips—create a rush in insulin, "which tells your body to store fat," says Dr. Mary Vernon, a family practitioner in Lawrence, Kansas, and a staunch advocate of the Atkins diet. Other supporters say that the human body burns calories from protein-laden foods, which have been around for thousands of years, more efficiently than those from refined carbohydrates.

Over the past generation, however, these carb-rich foods have become a staple of the American diet. If you follow the medical establishment's mantra and try to eat a low-fat diet, staying away from meats and junk food, "the rest of the food is kind of boring," says Christopher D. Gardner, an assistant professor at the Stanford University School of Medicine who is taking part in one of the new NIH studies.

Gardner says that food marketers helped spur the obesity epidemic by relaying the wrong message about consuming less fat. Promoting the consumption of more whole grains was "way too complicated," he says, so they went ahead with a simpler approach. "They replaced it not with good things, but with low-fat crap," he says. "Low-fat, but not low-calorie."

Calories appear to be the key to the success of the Atkins diet. "Something suppresses appetite," Westman says. While you may be allowed to eat as much fat and protein as you like, chances are that you won't because you can't. "There's no magic," he says.

Jury's Still Out

Despite the claims of both sides, there have been no long-term studies to show the benefits and risks of the Atkins diet. Most research has looked at the effects of the diet over the course of months, not years. Even Westman and Wyatt, who have published favorable studies on the outcomes, say they're not yet ready to give the diet a ringing endorsement over the long haul.

Wyatt co-authored an important study published in the New England Journal of Medicine. It found that people on Atkins lost weight faster in the first six months, but there was no difference after a year. However, Atkins dieters fared better in controlling their cholesterol. That "doesn't necessarily mean we know how Atkins works three or four years down the road," she says.

"There's no data showing that Atkins produces more weight loss, or that it's safe," Westman adds. "There's really not enough information."

"Telling people what they want to believe is part of the reason Atkins has become so popular," writes Dr. Dean Ornish, whose own diet restricts fat consumption. The Atkins dieters' initial weight loss and cholesterol improvement are counterintuitive, he says, like watching a dog walking on its hind legs. "It doesn't do it well, but it's amazing that it can do it at all," he writes in the Journal of the American Dietetic Association. Like most authorities, Ornish believes people should cut fat, which is twice as rich in calories as carbs and protein are.

"Calories are the villain," Eckel continues. Carbohydrates, in his opinion, are "an innocent victim" of the craze.

Heart Attacks and Bad Breath

Eckel warns that, over the years, the Atkins diet could cause more heart attacks because of increased fat intake. He says it can also create calcium losses that may lead to a decrease in bone mass. In addition, chemical compounds called ketones that it releases into the bloodstream may harm people with diabetes and underlying kidney disease.

Ketones can also cause bad breath. "You may lose weight and start to attract people to you, but when they get too close, it may be counterproductive," Ornish writes with tongue in cheek. Vernon, the Atkins supporter, retorts, "Are you willing to brush your teeth more often instead of being obese?"

Vernon doesn't see the health risks. "If 30 million Americans are on Atkins, it should be causing an epidemic of problems. Where are those?" she wonders. She is on an Atkins maintenance diet, "which for me would be a chicken, a pretty salad, squash with butter, fresh strawberries for dessert. Does that sound like an unhealthy diet?"

Gardner, who for the NIH is looking at the effects of the diet over the course of a year, calls his work in progress "a stupid study. A year isn't long enough. But at least it's longer than others." One reason for the lack of government interest, he says, is that "people look at these things and say, 'They're fad diets. By the time you're done, the diet will be gone.'"

Eckel, the Heart Association spokesman, agrees that looking at the diet for an extended period is crucial. ' "We still have no evidence that it's better long-term than at three to six months," he says. "A quick fix for obesity is not the answer."

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