Posted on Sun, Aug. 01, 2004

Advocate for Atkins

The official champion of the popular diet is a Philadelphia surgeon who says it worked wonders for him.

By Marian Uhlman

Inquirer Staff Writer


Stuart Trager knew exactly what he wanted for lunch and made a beeline for the salad bar. He piled on lettuce, sprinkled cheddar cheese, tossed in cucumbers, carrots and bell peppers, and crowned his one-pound salad with roast turkey.

It seemed like an unusual choice for a man who is the new face of the popular Atkins diet. But the Philadelphia doctor was making a point.

"We don't sit around and just eat meat and cheese," said Trager, 42, who typically eats a salad at lunch. Atkins is about choosing whole foods and skipping highly refined and processed carbohydrates loaded with sugar. "It's that simple," he said.

Trager, medical director and primary spokesman for Atkins Nutritionals, is making it his mission to get that message out, from Capitol Hill to the talk-show circuit. He's intent on telling others why they, too, should consider the Atkins approach. And whenever possible, he's trying to set the record straight about the diet, as he recently illustrated with his ample portion of vegetables.

Trager, a highly regarded hand surgeon at Pennsylvania Hospital, didn't plan to be a diet doctor. He became a believer in the low-carb approach only after it helped him shed more than 20 pounds and get into the best shape of his life.

The Atkins approach "is truly something that I feel incredibly passionate about," Trager said.

Since its founder died unexpectedly more than a year ago, Trager has become the medical conscience for the company. But he winces at any suggestion that he's the new Dr. Robert Atkins. He's trying to carry on the message, not embody it.

The Atkins approach requires dieters to watch the amount and type of carbohydrates they eat and to choose - especially at the beginning of the diet - mostly proteins and fats. Dieters may gradually add a wide variety of carbs to their plates.

For years widely ridiculed, the diet - along with other low-carb approaches - has such a widespread appeal that food companies have created a new menu of low-carb options, from bagels to candy.

Sales of Atkins Nutritionals' food products have more than tripled in the last year to $224 million, according to Information Resources Inc., which tracks food trends.

But the diet's emphasis on protein and fat still generates plenty of criticism. The American Heart Association says hundreds of studies show that diets high in saturated fats are associated with an increased risk of heart disease. And many experts question whether the diet works in the long run.

"My experience is: People who have been on it can lose a tremendous amount of weight, and gain most of it back, just like any other diet," said Marion Nestle, a New York University nutrition professor and author of Food Politics: How the Food Industry Influences Nutrition and Health. "As soon as they start to eat a balanced diet... the weight comes right back."

Trager, who speaks in subdued tones, is always ready with a retort for naysayers. In the last few months, he's rebutted research suggesting low-carb diets cause bad moods, and handled more than 30 major interview requests - including Larry King Live and Good Morning America - emphatically denying news reports that Atkins was overweight when he died at age 72.

On Friday, a news crew for Germany's largest TV station came to his tidy Center City office for an interview. Dressed in a black suit, Trager was surefooted answering the questions.

When asked about new research suggesting that a high-protein diet lowered fertility in mice, Trager said it would be wrong to apply the findings to women.

"This is a bigger problem for mice who want to get pregnant," he quipped.

Trager became a staunch Atkins defender for a simple reason. It worked for him.

He discovered the diet five summers ago while sailing on Chesapeake Bay with a friend, Philadelphia reproductive endocrinologist Ben Gocial. Trager noticed "in wide-eyed amazement" that Gocial had lost quite a bit of weight, but was eating plenty of tasty-looking food - spareribs, fish, omelettes and crabs.

Trager was counting calories and running as much as 40 miles a week, but was making little progress toward losing more than 20 pounds.

Still, he wanted to slim down from about 180 pounds, believing it would help him run faster and qualify for the Boston Marathon. It was an ambitious athletic goal for him. Trager never had starred in sports. As a high school swimmer in Allentown, he was technically good, but never particularly fast.

Shortly after his weekend with Gocial, Trager switched to Atkins. Almost immediately, he saw the pounds peel off. He started feeling more energetic and enjoyed running more.

He made the Boston qualifying time in March 2000 and soon entered the grueling Ironman competition - a one-day event that includes a 2.4-mile ocean swim, a 112-mile bicycle ride, and a marathon. He has competed in seven such events since then - twice in the Ironman World Championship. He now carries about 150 pounds on his 5-foot-7 frame.

He credits Atkins and training.

"This helped me get in control of my body and life," said Trager, who lives in Villanova with his wife and two young children.

As he toned up, he wanted to find out more about the science behind the diet. He drove to New York City to meet with Atkins and members of his staff in the summer of 2000.

"I was going up there as skeptically as possible," said Trager, a graduate of the Medical College of Pennsylvania. "I was truly shocked. I remember driving back thinking that these people were truly determined to help people and to change the way the world was eating."

He became a consultant.

In December 2001, Trager invited Atkins to speak at the opening of his new wellness program.

It was the first time Trager had seen Atkins in a professorial role. He was patient and passionate. He explained to the audience how his approach could make a difference in the soaring rates of diabetes and obesity. As Trager listened, Atkins' message resonated.

He knew then that he wanted to do more to help Atkins with his mission.

Trager soon began to take on a more public role, even joining Atkins on the Phil Donahue Show. He spoke at the annual meeting of the American College of Cardiology in 2003. And in the spring, he became the company's medical director.

Trager spends much of his time talking. He has met with government officials, from Health and Human Services Secretary Tommy Thompson on down, trying to demystify the diet. Trager helped develop an Atkins version of the Food Guide Pyramid as a tool to explain the diet and promote it.

His dedication comes as no surprise to several high-profile doctors who know him.

"Stuart is a very smart guy, trained in the basic tenets of research," said Warren Breidenbach, Trager's mentor at the University of Louisville School of Medicine and the first American surgeon to perform a hand transplant. The fact that "he doesn't have a formal education in nutrition really doesn't have anything to do with it."

Robert Booth, chief of orthopedics at Pennsylvania Hospital, said he had never met an orthopedist like Trager.

"He is much more holistic," said Booth, who helped recruit Trager 18 months ago from Graduate Hospital.

Trager's vision goes beyond repairing injured bones to promoting wellness, Booth said. He wants to help people become "healthier, lighter and physiologically functional," to avoid medical problems later.

Trager remains active in his orthopedic practice, while devoting a chunk of each workweek to Atkins.

His focus is on the emerging science behind Atkins and helping people understand it. He has an advisory role in the company's in-house research, he said, but is not involved in a separate foundation set up by Atkins. The Dr. Robert C. Atkins Foundation funds outside research, and recently received $40 million from the Atkins estate.

Already, Trager said, 31 recent small studies indicate that people can lose weight using the approach without increasing risks for cardiovascular or metabolic problems.

The recent studies "have been so much more positive than the mainstream thinking was," he said.

They help clear up misconceptions, he said, and drive the diet - and the company - forward.

"Everybody said this didn't work. Now it is clear we must be taken seriously."


http://www.philly.com/mld/inquirer/9264270.htm

"As soon as they start to eat a balanced diet..."? What a ridiculous statement! Maybe, "as soon as they started eating like they did before" would be accurate, but how can eating a truly healthy, balanced diet make you gain all that weight back? I guess it must depend on how you define "balanced."

No, It's real. It's old but from a real test. You just have to order the results you want when you finance the research.
The research in question was conducted over a 3 (three) day period. After 3 days (when most of the weight lost was water) almost all the weight was regained. Once published it will remain forever.

If you want the diet to raise cholestrol, then you run the test for 2 weeks. Dr. Atkins mentions this in DANDR. 2 weeks after not ingesting carbs (this includes fasting/starvation) your cholestrol spikes.

danny

"We don't sit around and just eat meat and cheese," said Trager, 42, who typically eats a salad at lunch. Atkins is about choosing whole foods and skipping highly refined and processed carbohydrates loaded with sugar. "It's that simple," he said."


I am so grateful for this person!

When followed properly, Atkins is basically the exact same thing as a healthy whole-foods low fat diet. The only difference is instead of getting our energy from saccharides in starches & sweet fruits (which mostly contain very little else other than raw energy), we get our energy from fatty acids in things like dairy, meats, oils, and nuts. We are better off for it, as fat is more satiating & keeps blood sugar stable, unlike the high-sugar diet.

And what, I wonder, is her "experience"? Let's see those case studies.

As far as I am concerned, Atkins is the most balanced I have ever eaten in my life.

I guess she's talking about those people who view Atkins as a weight loss tool, but they intend on eating "normally" (that is the perception of what is "healthy" i.e. more rice less fat) when they hit goal weight.

Soon as they trade the nuts for the refined grains, even if they intended to be moderate, they find themselves eating more and more because they are hungrier. Than before you know it, bam, they're back at their original weights.

They key to avoiding this slippery slope, of course, is to resist falling pray to the erroneous belief that Atkins is "abnormal" and "unhealthy" and that one should attempt to "eat normally and healthfully" at goal weight. As someone in maintenance I can tell you the pressure is overwhelming to eat more grain and less fat. All the time people are telling you "hey you're thin now! Why are you still "dieting"! Eat like a normal person! Some pasta won't kill you!"
I often find myself giving in not to temptation of foods (I have very good control), but to societal pressure. If you give in, even if you intend to be very "moderate", you run the risk of starting on a downward spiral which leads to insatiable cravings, appetite, eating, and weight gain.

So I can definitely see how it can happen to people even if they never intended to "go off". Once you're in the grips of carbs (and they can get you even if you never intended to saddle up a plate of cookies & cake), it's like being in the grips of addiction... it's very hard to pull yourself form that. Like with addiction, it usually takes hitting "rock bottom" to get you to overcome it. Unfortunately, rock bottom for most people winds up being surpassing their old high weight. Relatively few people can prevent falling off the wagon once they are at goal weight, without it having rolled over them first. In order to prevent it you have to be aware of the cumulative nature of addiction. You have to consciously be aware of the fact that addiction overwhelms your conscious mind and your ability to trust your perceptions of reality. Even if you just have 1 now, eventually you will want 2, and without even realizing it you one day wake up to discover you've totally lost all control and are heavier than you were before.

One thing that took me completely by surprise is how GOOD everything tastes now that I'm eating this way. I thought I enjoyed my food before...now I will actually look up from an ordinary meal I cooked myself to exclaim, "I love eating this way!"

I am stunned to find that bread actually masks the taste of sandwich ingredients, and what I liked about pasta was the sauce. I would never have believed it, yet you could not get me to go back to my "old" way of eating.

That, I think, is the biggest problem with this kind of change...people cannot image a "life without bread." Yet I've found I can't imagine a life WITH bread. You just have to trust the changes.

Me too! When I had my first bunless burger at Carl's Jr., I was amazed at how good it tasted. It was so fresh-tasting. And I could taste all the ingredients. I already knew I like my own cooking above restaurant cooking, but this was such a revelation. I could never go back to burying the taste of food in starches.

Woo:

I think you are mistating the facts here.

"Atkins is basically the exact same thing as a healthy whole-foods low fat diet."

At best, even on maintenance, Atkins is medium to high fat. There is simply nowhere to get the necessary calories once you cut out the carbs. You can add a little protein, but not that much.

Any successful, healthy low carb diet for a strong and active person is high fat, at least by the standards set by the US government and the health industry.

You have to have the fat to have the energy to run at full speed and carry out athletic activities. Just ask those Eskimos of old.

But, I love your posts, and your thoughtful observations. Just don't try to push Atkins as being "low fat". IMHO, of course.

I didn't say Atkins was low fat, that's the opposite of what I said. I said the only difference between Atkins and a low fat diet is that the low fat diet you get energy from raw sugar (high carb), but on Atkins you get energy from raw fat (high fat).

My point was that both the proper LF diet and proper Atkins contain very high amounts of healthy veggies & fruit... the only difference is where the bulk raw energy is coming from. Higher energy containing foods tend to be, as a rule, lower in nutrition. This is because if a food has a lot of energy you have to eat less of it, which means per calorie it will have less nutrition than lower energy foods.
High calorie low fat foods like breads and pasta and rice - which contain very little nutrients - make up the LF diet's energy. High calorie high fat foods like cream and butter and oils - which likewise contain very little nutrients - make up our energy.

Both diets should contain lots of low-energy high-nutrition foods. The only difference is where the energy is coming from. That's what I was trying to say.

I think a lot of the carbs we ate were packaging really! I never heard of anyone eating pasta because they like the taste of pasta, its because they like the sauce! You don't eat a hamburger because you want the bun, its just to keep your fingers clean.

I've had burritos wrapped in lettuce leaves and wow! They were sensational. So much more of the complexity of the guacamole and carne asada came through, it didn't have to vye for your tongues attention through a relatively tasteless tortilla.

You don't eat a hamburger because you want the bun, its just to keep your fingers clean.

Actually, I enjoyed the very sweet, spongey white bun on fast food burgers. I even used to eat plain spaghetti. I also enjoyed the taste and sensation of smoking. I quit them all, though, because the pleasure isn't worth it.

Fortunately, I really like food in general, and adore so many of the LC menu items, I don't feel deprived. I do feel deprived of my camel lights, but my partner says I just have to deal.

I think a lot of the carbs we ate were packaging really!

When you think about it, it's the combination of carbs and fat that is so easy to overeat. Try to eat 500 calories of pure, fat-free starch, say boiled elbow macaroni, no sauce or nothing, and you'd probably gag before you got to 500 calories.

Or, try to eat 500 calories of olive oil. Or Lard. Or Butter. That's like three quarters of a stick. It would be hard to do.

But, dip those noodles in butter. . . fry those potatoes in oil. . . drop that donut dough into hot fat. . . you can eat 500 calories without blinking an eye. I once ate 1800 calories of Dunkin Donuts as a SNACK.

For me, true, wholesome LC foods are much harder to overeat.

I have to disagree about the nutrition in fats. Some nutrients are only obtained from fats. Fats are essential for good health. Carbohydrates are totally unessential and all necessary nutrients can be obtained from other sources.