Atkins and the High Meat / Low or No Carbohydrate Diets:
Science Weighs In
by Katherine Tallmadge
Description
The no - to - low carbohydrate diet has been around for almost a century. One of the most celebrated proponents of using this diet for weight loss has been Dr. Robert Atkins.. His diet first became popular in the 1970s, fell into decline for a time, and has come back full circle - along with bell-bottoms!
Atkins says the essence of the diet is to eat all the meat, animal fat and fat you want, but keep your carbohydrate intake to a minimum - about 20 grams per day (virtually zero carb-containing foods) - in order to produce a condition in your body called “ketosis.” Ketosis is an unnatural physiological state your body goes into when you are ill or starving - and causes weight loss, if you think being ill is the best way to lose weight! Atkins and other proponents of a no-carbohydrate diet believe being in ketosis is desirable - as it leads to lowering of the appetite. One Atkins proponent said ketosis is normal, because “it’s normal to starve,” referring to man’s evolutionary periods of starvation being something we‘re missing in today’s society. (found in: The New York Times, July 7, 2002, quotes by Richard Veech and Robert Atkins also Robert Atkins quoted in The United States Department of Agriculture proceedings of “The Great Nutrition Debate,” February 24, 2000, Washington, D.C.).
The quick and dramatic weight loss is what persuades people to follow low carbohydrate regimens. I don’t blame them for being tempted to go for it. Unfortunately, when carbohydrates are cut to such low levels and you get into a state of semi-starvation, that quick weight loss has high health costs. It’s also mainly from water loss and protein loss, which is potentially dangerous because water keeps you alive and functioning more than any other nutrient. That’s not the only thing you could lose when following this diet. Common side effects reported have been severe constipation, muscle loss, hair loss, and energy loss.
Ketosis
Your body’s primary fuel is glucose, supplied largely by carbohydrates, such as fruits, vegetables and grains. Glucose is the primary fuel for most cells in the body and the most efficient and effective fuel for the brain, red blood cells, nervous system, fetus, and placenta. Even when fat is burned for energy, a small amount of glucose is needed to metabolize fat completely.
When there isn’t enough carbohydrate in your diet to produce glucose for fuel - usually after a period of starvation or an extremely low carbohydrate diet - the body uses its imperfect back-up system of proteins and fat for energy instead. This produces what are called “ketone bodies” in the blood. When ketone bodies build up in the blood, this leads to a condition called “ketosis.“ Ketosis disrupts acid/base balance, causing the blood to become too acidic, leaching calcium from the bones and causing dehydration, bad breath (from the ketone bodies) and poor appetite, among other symptoms.
When your body is in ketosis with unavailable carbohydrates in your diet and unavailable glucose in your blood, your brain, red blood cells and the rest of the body begin using ketone bodies for part of its energy needs. The rest of its energy needs comes from the breakdown of protein, which when glucose is not present, must be broken down to supply glucose to the brain - an important organ, most would agree. Carbohydrates spare body proteins from being broken down and used to make glucose. So, during starvation or a very low carbohydrate diet, since the body’s first and most important need is for energy, you have no choice but to break down protein. In the end, much to your dismay, you may end up becoming thinner, but an unmuscular and flabby thin person!
*(The above three paragraphs are from: Nutrition by Paul Insel, R. Elaine Turner and Don Ross, Jones and Bartlett Publishers 2002 and Advanced Nutrition: Macronutrients by CD Berdanier, CRC Press 1995 and Biochemistry, 4th Edition by L. Stryer, WH Freeman 1995)
The Atkins supporters believe starving or semi-starving is normal. Others in the scientific community believe it’s dangerous. Just spend some time in a hospital ward observing people with anorexia nervosa to see what extreme dieting, starving, semi-starving and experiencing ketosis can do to a person's physical and mental health and life When people starve or just semi-starve, it’s very well documented that they experience a multitude of dangerous health problems and symptoms: Low metabolic rate, low body temperature, cold sensitivity, sleep disturbance, abnormally low blood pressure and heart rate, constipation, depression, social isolation, irritability, preoccupation with food, easy fatigue, low energy, inability to concentrate
Ketones are particularly dangerous for a developing fetus which is dependent on glucose for growth and energy. Studies show, in the absence of glucose, the fetus is forced to use ketone bodies for the growth and development of its organs, including the brain. This has been shown to cause mental retardation.
Dr. Atkins advocates going into ketosis by eating large amounts of animal meats and fats while eating no fruits and grains and very little vegetables. One recipe goes as far as advising you to wrap cheese in bacon, then deep fry it. On the Atkins Diet, you would go to a McDonald’s, order a quarter pounder with cheese and eat everything but the bun - oh, and forget the pickles and tomato, too!
Carbohydrates, Insulin and Diabetes
Atkins and other no-carb diet gurus advocate eating a no-to-low carbohydrate diet to reduce insulin in the blood. Studies show insulin rises whether you eat protein, carbohydrates or fat and it is not the absence of insulin that burns fat, but exercise and / or a reduction in calories. Exercise also clears glucose (and triglyceride) from the blood, increasing insulin sensitivity and reducing the amount of circulating blood insulin. Exercise also increases the good cholesterol or HDL.. This exercise effect will continue 24 to 48 hours after exercise.
(found in: Heath, et al.Single 45-min session of vigorous running or cycling lowers blood insulin level, J. Appl Physiol. 55:512, 1983 and Kristiansen et al.Glucose uptake into skeletal muscle is directly related to GLUT4 protein concentration in maximally exercising human skeletal muscle, J Appl. Physiol. 89:1151, 2000 and Low CV fitness doubles type 2 diabetes prevalence in overweight/obese and triples prevalence in normal weight, Wei et al. Ann Int. Med. 130:89, 1999 and Improved fat tolerance is lost in trained humans after only 2.5 days of no exercise, Hardman et al. J Appl Physiol 84:1895, 1998))
The no-carb diet gurus also have people believing that carbohydrates and high insulin levels cause diabetes. But the fact is that what causes diabetes and insulin resistance is being overweight and/or sedentary. And weight gain is caused by an imbalance in the calories you take in versus the calories you burn.
While I have never believed that there are “good” and “bad” foods, I am convinced that certain foods should be emphasized and be more prevalent in a person’s diet while other foods should be used only sparingly. One of my chief concerns about the Atkins diet is that it emphasizes foods that I think should be consumed with great caution while downplaying foods that I believe should be emphasized. Specifically, the Atkins diet’s emphasis on high meat and animal fat can have wide ranging consequences that are not positive.
High Meat and Animal Fat
What is all that excess meat and animal fat doing to your body?
* The Kidneys excrete the products of protein breakdown, so a high protein diet can strain kidney function causing dehydration, with especially harmful consequences for people with kidney disease or diabetes. (from: Nutrition by Paul Insel, R. Elaine Turner and Don Ross, Jones and Bartlett Publishers 2002)
* Calcium Loss can be caused by an excessively high protein intake, especially animal proteins, as they create an acidic blood and this leaches calcium from the bones. (from: Itoh R, et al. Dietary protein intake and urinary excretion of calcium: a cross-sectional study in a healthy Japanese population. Am J Clin Nutr. 1998;67:438-444)
* Promotes Obesity and Its Related Diseases. A diet high in meat is usually also high in fat, a very concentrated calorie source - and this promotes obesity when eaten in large quantities. This is exacerbated because when you eat more meat, it displaces foods like fruits, vegetables and whole grains, all of which are bulkier and lower in calories than meat and fat. *The National Weight Control Registry, the longest-term and most important study of people who have successfully lost at least 30 pounds and kept it off for at least five years, found 80% of their successful weight maintainers ate a diet containing less than 30% of their daily calories as fat and 35% reported consuming less than 20%. (*found in: Siao Mei Shick, Rena Wing, et al Persons Sucessful at Long-Term Weight Loss and Maintenance Continue to Consume a Low Energy, Low Fat Diet, Journal of The American Dietetic Association 98(4) 408-413).
In “The Truth About Diets” Consumer Reports June 2002, said “In the largest survey ever undertaken on the long-term maintenance of weight loss,” people who successfully maintained at least 10% of their weight for at least one year chose lean protein such as reduced fat dairy products, egg whites, fish, chicken, and lean cuts of beef and pork. And they only included small quantities of healthful fats such as olive oil, avocados, nuts, olives and fatty fish (like salmon).
When cultures who traditionally eat a plant-based diet (predominantly carbohydrate), such as Asians, Mexicans and Africans, move to the United States and switch to our high meat and saturated fat diet, their rates of obesity, diabetes, heart disease, breast and prostate cancer (among other things) soar.
* Increases Cancer Risk. Studies show that diets containing substantial amounts of red meat may increase the risk of cancers of the colon and rectum, pancreas, breast, prostate and kidney. Diets high in animal fat additionally may increase the risk of cancers of the lung, colon and rectum, breast, endometrium and prostate. Diets containing substantial amounts of grilled, broiled, barbecued or fried meat may increase the risk of cancer of the stomach, colon and rectum. Based on this research the American Institute for Cancer Research recommends a diet of no more than 3 ounces of red meat daily. (found in: Food, Nutrition and the Prevention of Cancer: A Global Perspective, pub: the World Cancer Research Fund and the American Institute for Cancer research 1997)
* Increases Heart Disease Risk: Research has strongly linked a diet high in animal fats to high triglycerides, high cholesterol levels and heart disease. Science has proven that cutting saturated fat intake lowers total and bad cholesterol (LDL’s) in susceptible individuals, and high saturated fat in the diet raises it.
(Found in: Fleming RM. The Effect of High, Moderate and Low Fat Diets on Weigt Loss and Cardiovascular Disease Risk Factors. Preventive Cardiology (Fall 2002) and National Cholesterol Education Program. Third report of the expert panel on detection, evaluation, and treatment of high blood cholesterol in adults. NIH publication 01-3305, May 2001)
Dr. Atkins says that his patients’ LDL and triglyceride levels actually decrease (modestly) on his diet. While that may be true for some people, I’ve found that it is only a temporary result. I believe this improvement is not caused by the diet, but a result of weight loss. I believe this because I, other doctors and researchers have observed that following the Atkins regimen over time reverses these positive numbers.
Once the weight loss has stopped, the bad cholesterol and triglycerides which temporarily reduced during weight loss return to previously high and dangerous levels. They often go higher than ever before (see personal stories). Even Atkins, who has recently developed heart problems of his own, acknowledges that the positive results he claims have not been demonstrated in a scientific study beyond 6 months.
* Increases Risk for Alzheimer’s and Dementia: New evidence suggests that a diet which causes high levels of blood cholesterol and high blood pressure may increase the risk for Alzheimer’s and dementia. The studies show that diet may be even more influential than carrying the “Alzheimer’s gene,” ApoE-e4. (Found in: Kivepelto, M. et al, Hypertension and hypercholesterolemia as risk factors for Alzheimer’s disease: potential for pharmacological intervention. CNS Drugs 2002; 16(7): 435-44 and Petot, GJ et al, Use of surrogate respondents in a case control study of dietary risk factors for Alzheimer’s disease. J Am Diet Assoc 2002 Jun;102(6):848-50)
Reduced Fruits, Vegetables, Grains
One of the most troubling aspects of the Atkins diet, in my view, is its clear de-emphasis of plant foods: fruits, vegetables and whole grains. A massive amount of scientific data and research confirms that a diet high in fruits, vegetables, whole grains, and fiber is essential to health and longevity in many different ways. Cultures which eat in this way are clearly the longest living and healthiest on the planet - ie, Mediterraneans, Asians. When cultures who traditionally eat a plant-based diet (predominantly carbohydrate), such as Asians, Mexicans and Africans, move to the United States and switch to our high meat and saturated fat diet, their rates of obesity, diabetes, heart disease, breast and prostate cancer (among other things) soar.
But there is an important distinction here which I would like to make. Notice my definition of carbohydrate is fruits, vegetables and whole grains. I do not advocate consumption of large quantities of sugars or refined flour or so-called “fat-free” high-sugar, highly processed food products and snack foods (and neither do any other nutrition professionals I know). A high intake of these refined carbohydrates can increase insulin levels, weight, and triglycerides in susceptible people (actually an abnormally high intake of anything will !). But, certainly, in moderation, even these less nourishing and more fattening foods can be enjoyed as part of a healthy diet.
Effects of Low Fruits, Vegetables, Whole Grains
* Obesity. People who eat little or no fruits and vegetables have a harder time maintaining a healthier weight. Fruits, vegetables and whole grains are bulky, low calorie foods and eating more of them means you feel full while eating fewer calories. Numerous studies show eating a higher fiber diet leads to fullness and results in naturally eating fewer calories overall. In “The Truth About Diets” Consumer Reports June 2002, said “In the largest survey ever undertaken on the long-term maintenance of weight loss,” people who successfully maintained at least 10% of their weight for at least one year ate generous portions of watery foods such as fruits and vegetables and high-fiber grains and legumes such as oatmeal, brown rice, whole wheat bread, lentils, and chickpeas.
* Cancer. More than 200 studies of various research designs have revealed a strong association between diets high in vegetables and fruits ( five to nine four-ounce servings -- or about four cups -- daily) and a significantly lower risk for cancer. This is why the National Cancer Institute and other health organizations recommends a minimum of five servings of fruits and vegetables daily(found in: Food, Nutrition and the Prevention of Cancer: A Global Perspective, pub: the World Cancer Research Fund and the American Institute for Cancer research 1997)
* Heart Disease. The American Heart Association recommends eating at least 5 servings of fruits and vegetables daily as this has been shown to lower blood pressure and the risk of stroke, which has been shown in study after study. Whole grains have been found to prevent heart disease as well, which is why the AHA recommends at least 6 servings of grains, preferably whole grains. (found in: Jacobs, D. et al. Whole-grain intake may reduce the risk of eschemic heart disease death in postmenopausal women: the Iowa Women’s Health Study. Am J Clin Nutr 1998; 68: 248-57 and DASH [Dietary Approaches to Stop Hypertension] diet is effective treatment for stage 1 isolated systolic hypertension. Hypertension 2001 Aug;38(2): 155-8)
A new study shows whole grains reduce blood glucose and insulin, improving the risk for diabetes and heart disease. (found in: Nicola M McKeown, James B Meigs, Simin Liu, Peter WF Wilson and Paul F Jacques Whole-grain intake is favorably associated with metabolic risk factors for type 2 diabetes and cardiovascular disease in the Framingham Offspring Study.. American Journal of Clinical Nutrition 2002;76:390-398)
While I’ve tried to keep an open mind about the Atkins Diet, I have had substantial experiences with clients who have been on it and this has only deepened my concerns about the fundamental elements of the plan.
Personal Story 1
Elsa called me about her husband, Robert. She was worried because he was at high risk for heart disease and wanted to see if changing his diet would have a positive effect. When Robert came to see me, he was also concerned. He’d been on Pravachol, a cholesterol-lowering drug, for about three years and his doctor recently told him he would need to take a second pill unless he could lower his cholesterol from a high of 230.
Robert told me he had been a follower of the Atkins diet for the past 4 years (coincidence?). When I reviewed what he had been eating, I found he was following the Atkins diet pretty closely - lots of cheese, eggs, bacon, ham, and fried foods (so it isn‘t coincidental that his cholesterol got to such a high level that he began having to take Pravachol to begin with). He stayed religiously away from rice, bread, cereals, and fruit. At 5’11”, he weighed 205 pounds. He was slightly overweight and wanted to get down to a lean 180. But my hunch was that his weight was not a major factor contributing to his high cholesterol levels - his diet was.
So, we quickly reversed his way of eating. He began enjoying a more normal eating pattern of fruit, nuts, oats, and whole grain cereals for breakfast. Salads and sandwiches made with lean meats for lunch. He and his wife continued their regular routine of restaurant eating, but Robert opted for seafood and vegetables whenever possible. Within two months, Robert received a very positive letter from his doctor saying that his total cholesterol had fallen to a healthy 173. On top of that, his good cholesterol - or HDL - had stayed as high as it was before - at 51. He was spared from the prevacol!
Personal Story 2
33-year-old Barbara’s cholesterol had gone up 100 points to near 300 a year after starting the Atkins regimen. Her doctor was threatening her with cholesterol-lowering meds. Can you imagine being so young and already dependent on drugs to prevent heart disease by the time you’re 40 or 50? Luckily, she was able to bring her cholesterol back down to a normal healthy range in no time and avoid the drugs. Coincidence? I don’t think so.
Personal Story 3
Another nasty side-effect of the Atkins regimen reared its ugly head when Ellen came through my doors. A successful official at the United States Department of Agriculture, she had been on the Atkins regimen for a couple of months. She was distressed over hearing the news from her doctor that she would probably have to be hospitalized to clear her colon. She had already taken many sick days from work because her intestines were so constipated - and impacted - she was miserable. Even enemas administered by her doctor were having minimal effect.
So, again, we had to make a dramatic and immediate switch from the Atkins diet to the opposite: a healthy, high fiber diet. Ellen got results within a couple of days (I‘ll spare you the details) - and her weight stayed at a fit and trim level. The sad news is she had to eat double - and even triple - the amount of fiber the average person needs to eat, just to be regular. I believe the Atkins diet was probably responsible for permanently effecting her ability to be regular as she said her bowels were completely normal before she started the diet.
Personal Story 4
Peter is an athlete and thought the Atkins Diet would help him lose weight and gain muscle. Instead, very soon after he started the regimen, he felt exhausted and listless, he couldn‘t perform any of the exercises he was used to. The carbohydrates his body needed for energy were not being provided by the diet and he not only couldn’t exercise as usual, but could hardly get through each day.
Rating The Atkins Diet
With
Katherine’s Diet Primer
1. Is the diet individualized?
No. It gives the same recommendations to everyone - a low carb, high meat and animal fat diet.
2. Does the diet advocate a balance and variety of foods?
No, it forbids whole categories of healthy, nourishing and delicious foods
3. Is the diet based on good science? Is it a diet which will improve your health?
No. By all scientific accounts, it is a diet which will damage your health
4. Does the diet promote a positive attitude toward food and eating?
No. The diet advocates semi-starvation through ketosis.
5. Does the diet promise quick results?
Yes.
6. Does the diet require exercise or physical activity?
No. This is one of the most “popular” aspects of this diet. Although Atkins admits exercise is good for you, he says you can lose weight without it and most people doing the Atkins Diet are not exercising.
7. Does the diet require special packaged foods, liquid or herbal supplements or megadoses of vitamins and minerals?
Yes. The diet advocates supplements as it is deficient in so many essential nutrients. Dr. Atkins even sells supplements, always a red flag when a health professional sells supplements he or she also recommends.
8. Does the diet have a scientifically established track record of success that has persisted over time?
No. Even though the Atkins diet has been around for 40 + years, the longest study to date was conducted over a paltry 6 months (see summary of study below). Coincidence?
9. Does the diet have unacceptable side affects? Yes (see study results below). High animal fats and low intake of fruits, vegetables, whole grains and fiber increase your risk for severe constipation, heart disease and cancer. Low energy levels. Bad Breath. Loss of body protein, muscle, water, hair.
Summary
The side effects of the Atkins Diet which I and many of my colleagues have observed range from increasing risk from heart disease, constipation, exhaustion and listlessness, inability to be physically active. Other side effects of the diet have been hair loss, muscle loss, dehydration, bad breath, you name it; it’s not pretty.
The good news is, most of these clients were able to reverse the negative consequences caused by the Atkins regimen. Soon after switching to a healthy diet, they knocked their heart-disease risk factors dramatically and were able to resume a normal and healthy life. They were even able to keep losing weight and maintain a healthy weight. In summary, the Atkins Diet may help you lose weight - temporarily, but at a substantial cost to your health and well-being. There are, I believe, better ways to lose weight and to live.
Atkins Study Results*
Researchers did a study of 6 months funded by the Atkins Center for Complementary Medicine. While subjects lost weight and experienced minor improvements in their lipids, the following observations were made:
1) urinary calcium excretion and uric acid excretion significantly increased - showing the increased acidity of the blood and leaching of calcium from bones.
2) The researchers calculated fat loss using calipers - very inaccurate accounting of fat versus muscle loss. Though they estimated the loss as 66% fat mass, which means 44% of the loss was water and muscle.
3) Significant adverse effects were reported. With these kinds of side-effects, how long could someone stand to be on the diet?
* 68% experienced constipation,
* 63% bad breath,
* 51% reported headaches,
* 10% noted hair loss.
4) The food intakes and exercise were self-reported. Most diet studies of this type provide food and exercise programs for their subject to insure better control. Were the minor positive effects due to exercise? Who knows? It wasn't controlled for in this study.
5) The study only lasted for 6 months. We already know people who lose weight using any method will respond positively on many parameters. But are those positive effects due to the diet or the weight loss? With the no-carb diet, my experience has been the positive effects come from the weight loss. Because when healthy people switch to these diets, they feel terrible and their blood lipids go up dramatically. It seems they only experience the negative side effects.
(* Found in: Westman, Eric, Yancy, William, et al Effect of 6-Month Adherence to a Very Low Carbohydrate Diet Program The American Journal of Medicine July 2002 Vol 113 pages 30 - 36.)
I believe there are healthier, more positive and fun ways to lose weight!
Diet Simple makes weight loss individualized and painless. I know this may sound surprising. Most people believe that in order to achieve big results, you have to do something radical. But the truth is, study after study shows it’s the small, easy changes you make in eating that have the most dramatic and lasting results. And, I believe, the radical diets actually backfire and don’t produce results. If they produce anything, it’s eating disorders, feelings of deprivation and depression, and demoralizing yo-yo’ing weight.
During the past twenty years as a weight loss counselor, I’ve witnessed the joy, surprise and relief of my clients as they learned that losing weight my way is an easy and positive experience. My clients and I have discovered that losing weight doesn’t have to be a frustrating, angst-ridden chore, like the dozens - even hundreds - of diet plans touted on television and in magazines. But nearly every one of those "diets" results in yo-yo gains and losses, slowing your metabolism and making you heavier than ever before. They’re depressing, depriving and they leave you lifeless, denied of vital energy.
My clients also experience dramatic improvements in their health - and that's without a depressing radical diet! They achieve improvements in Diabetes (meds cut in half within one month), 50 - 100 - point drops in bad cholesterol (LDL) within two months, dramatic drops in triglycerides with a corresponding increase of good cholesterols (HDL), disappearing constipation, heartburn and other gastrointestinal complaints, profound increases in energy and well-being.
Regularly, I hear, "This is easier and more positive than I ever imagined weight loss could be!" And that's music to my ears.
Copyright by Katherine Tallmadge 2002
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