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Old Thu, Apr-08-04, 11:15
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Default "Controlled-carbohydrate research from around the world"

Controlled-carbohydrate research from around the world

Volume 3, Issue I

April 2004

NEW YORK, April 8 /PRNewswire/ -- As an ongoing service from Atkins Health & Medical Information Services to practicing physicians and medical and lifestyle journalists, our communications department provides the latest developments in clinical research on controlled-carbohydrate nutritional practices and the Atkins Nutritional Approach(TM) (ANA) as they occur and are reported. If you would like any further information or access to our complete library of published controlled-carbohydrate research, please contact Gina Mangiaracina at 212-457-9243, 212-457-9240 or You can also find the complete library of published studies in The Science Behind Atkins section at


"Low-Carb science can no longer be ignored ... "

In a recent article published in the Journal of the American College of Cardiology, Dr. Sylvan Weinberg, MD, MACC, calls for medical professionals to recognize the validity of low-carbohydrate/high-protein diets like Atkins in the fight against heart disease. Additionally, he asserts that it is no longer reasonable to accept or endorse on faith alone the superiority of the low-fat, high-carbohydrate approach to coronary health.

Dr. Weinberg's call to action came in response to an article from the same publication by Kappagoda and others, which challenged the value of a low-carbohydrate/high-protein diet (LCarb-HP), despite an abundance of research showing its favorable impact on obesity, lipid patterns, type 2 diabetes and the metabolic syndrome.

Dr. Weinberg's critique follows the history of the diet-heart hypothesis for the last hundred years. He describes how the promotion of low-fat diets began in earnest following the National Institute of Health (NIH)-sponsored Lipid Research Clinics Coronary Primary Prevention Trial in 1984, which produced evidence that lowering serum cholesterol was essential in the prevention and management of coronary artery disease (CAD).

Dr. Weinberg suggests that the current crises of obesity, type 2 diabetes and the metabolic syndrome reached epidemic proportions due, in part, to the inevitable result of a low-fat/high-carbohydrate diet (LF-HCarb) that led to the over consumption of low-fat products deemed healthy by respected organizations like the American Heart Association, the NIH and the USDA. To make matters worse for the consumer, this dietary approach was promoted aggressively by medical professionals, the media and the government.

Dr. Weinberg goes on to point out that Kappagoda, et al, challenges the role of the LCarb-HP and its role in clinical cardiology, citing theoretical, yet unproven, dangers of this nutritional approach. Also, he mentions that the article's authors tended to dismiss recent, promising studies on LCarb-HP diets, including those from Westman, Yancy and Guyton, and a published peer-reviewed study in the New England Journal of Medicine.

In conclusion, Dr. Weinberg calls for a balanced re-evaluation of the diet-heart hypothesis, which has historically suggested that diets high in fat intake increase the prevalence of coronary artery disease, as well as the role that the LF-HCarb diet may well have played in the current epidemic of obesity, abnormal lipid patterns, type 2 diabetes and the metabolic syndrome. He believes it is no longer tenable to defend the LF-HCarb diet simply because it conforms to current traditional dietary recommendations. Additionally, Dr. Weinberg believes that there is no justification for the ongoing categorical rejection of experience and increasingly favorable medical literature, suggesting that the much-maligned LCarb-HP diet may have a favorable impact on type 2 diabetes, obesity, metabolic syndrome and lipid patterns.

Journal of the American College of Cardiology

Vol. 43, No. 5. 2004 - Sylvan Lee Weinberg, MD, MACC


In a paper presented at the 44th Annual Conference on Cardiovascular Disease Epidemiology and Prevention, Dr. Tobias Pischon and his colleagues examine the correlation between a recently discovered compound, the peptide adiponectin, and blockage of the arteries (atherosclerosis). Adiponectin is a peptide involved in the regulation of blood sugar and fat burning. Now it is also suggested to be a managing factor in the development of atherosclerosis.

Results from laboratory studies and animal models suggest that adiponectin may improve insulin sensitivity and may have anti-inflammatory and anti-atherogenic effects.

Preliminary data suggests high levels of this peptide are associated with lower risk of coronary heart disease and type 2 diabetes in humans. The aim of the study was to examine the association between dietary factors and plasma adiponectin levels among 532 men. The subjects were selected as controls to investigate predictors of coronary heart disease. Information about diet, lifestyle and body measurement data was assessed by questionnaires.

The study indicated that adiponectin was positively associated with total fat intake (or higher amounts of fat resulted in higher levels of adiponectin). In further analyses researchers found a significant inverse association between blood-sugar levels and adiponectin levels. The data suggests that a carbohydrate-rich diet with a high-glycemic load (raising blood sugar) is associated with lower adiponectin levels, and therefore by association, a greater risk of coronary heart disease (CHD). Dr. Pischon's observations raise the hypothesis that adiponectin may be a mediator between dietary factors and CHD.

Obesity Research

11:1055-1064 (2003) - Tobias Pischon, Cynthia J. Girman, Mader Rifai, Gokhan S. Hotamisligil, Eric B. Rimm


A recent study, published in the Journal of the National Cancer Institute, suggests that consistent high-glucose levels in women may be a factor in the development of colorectal cancer. Since there has been much speculation regarding the risk factors for this disease, this study supports a growing recognition that diet -- including high blood glucose levels and an elevated insulin response -- may contribute to a metabolic environment conducive to tumor growth.

Researchers followed 38,451 women for an average of 7.9 years and identified 174 with colorectal cancer. Using food-frequency questionnaires to establish baseline dietary data, these examiners explored the associations of dietary glycemic index, total carbohydrate, fiber, nonfiber carbohydrate, sucrose and fructose with subsequent development of colorectal cancer.

Data indicated that a diet with a high impact on blood sugar (high dietary glycemic load) may increase the risk of colorectal cancer in women.

Dietary and lifestyle risk factors for developing insulin resistance, such as physical inactivity and obesity also increase the risk of developing colorectal cancer and other cancers. Insulin stimulates pathways that increase levels of insulin-like growth factor to promote mitosis and cell proliferation but inhibit the occurrence of cell death in normal and cancer cells in the walls of the colon.

Through this study, researchers observed statistically significant positive associations of both dietary glycemic load and overall glycemic index with colorectal cancer.

Journal of the National Cancer Institute

Vol. 96, No. 3, February 4, 2004 - Susan Higginbotham, Zuo-Feng Zhang, I-Min Lee, Nancy R. Cook, Edward Giovannucci, Julie E. Buring, Simin Liu


In addition to commentaries and tributes to Dr. Atkins, eight studies on the beneficial impact of the Atkins Nutritional Approach(TM) were published. Below are summaries of the abstracts, taken from this peer-reviewed medical journal.


The authors of a recent study question the wisdom of replacing saturated fat in the diet with carbohydrates, suggesting that a low-carbohydrate nutritional approach was a valid tool in the fight against heart disease. The study, published in the Fall 2003 issue of the Metabolic Syndrome and Related Disorders Journal, looked at numerous factors related to coronary heart disease (CHD) and warned against replacing saturated fats, especially beneficial monounsaturated fat, with high-glycemic foods.

The study examines the central relationship of inflammation to CHD, diabetes and obesity and shows the relationship of carbohydrate intake, particularly the glycemic load, to all three. The protective effect of higher beneficial cholesterol (HDL) and lower triglycerides were noted.

They conclude:

"Dr. Atkins foresaw the potential ill effects of carbohydrates in terms of atherogenesis and heart disease decades earlier."

Metabolic Syndrome and Related Disorders

Vol. 1, No. 3, Fall 2003 - Ahmad Aljada; Priya Mohanty; Paresh Dandona


Professors in the Department of Biochemistry, State University of New York in Brooklyn, are using the Atkins Nutritional Approach(TM) to teach nutrition to students. This curriculum was designed, in part, due to the vast adoption, by the public, of low-carbohydrate/ketogenic diets.

This group of educators has begun using the Atkins Nutritional Approach(TM) as a focal point for teaching nutrition and metabolism in the first-year medical school curriculum. Specifically, they present a summary of the metabolic basis of the Atkins Atkins Nutritional Approach(TM) as a real- life example of the process by which energy is stored and used in the body. In their work, they have additionally proposed a mechanism to explain the "metabolic advantage," observed by others including Sondike et al (more than 700 calories in adolescents), and Greene et al (300 calories) that allows individuals consuming limited carbohydrates to consume more total calories and lose greater amounts of weight than those on low-fat programs.

Topics developed include: role of insulin and hormones affecting glucose levels in the metabolizing of fat for fuel, the pathways by which glucose is stored and used (gluconeogenesis) and how protein can be broken down and converted for use as an alternate energy source. Additionally, they developed study programs to examine carbohydrate-protein interactions and ketosis. Their work provides a functional explanation for the "metabolic advantage" with well-defined explanation for the mechanism by which this takes place without violating the laws of thermodynamics.

Metabolic Syndrome and Related Disorders

Vol. 1, No. 3, Fall 2003 - Richard D. Feinman PhD; Mary Makowske PhD


The originator of the Zone Diet, Barry Sears, PhD, proposed a low- carbohydrate nutritional strategy that favors foods with a lower impact on blood sugar (low glycemic) to combat America's growing obesity epidemic. Like the Atkins Nutritional Approach(TM), the Zone Diet recognizes that Americans need a dietary regimen that is satiating and easy to follow.

In making the case for this nutritional approach, he reviews clinical studies that demonstrate how low-glycemic load (GL) diets produced less hunger, promoted more weight loss and improved markers of blood sugar control and coronary heart disease (CHD) risk compared to the usual high-GL diet under conditions of equal calories.

In this work, Dr. Sears suggests: "High-GL diets set individuals up for failure -- they will be constantly hungry and expend fewer calories at rest so weight loss is almost impossible to achieve." He also points out that muscle tissue is broken down for energy on a high-glycemic diet to a greater degree than on a low-GL diet, and fat is oxidized to a lesser degree as an energy source. In contrast, offering significant reinforcement for the health benefits of a controlled-carbohydrate lifestyle type approach, he suggests, "Low-GL diets have been shown to reduce hunger, promote weight loss and reduce risk factors associated with chronic disease such as type 2 diabetes and heart disease..."

Metabolic Syndrome and Related Disorders

Vol. 1, No. 3, Fall 2003 - Stacey J. Bell D.Sc., R.D.; Barry Sears PhD


Though medical experts have historically suggested that a calorie is a calorie, a recent study explored the "metabolic advantage" of the Atkins Nutritional Approach(TM) and the way that different foods are burned as fuel.

By explaining, examining and exploring the laws of thermodynamics as they apply to energy balance within the human body, biochemists Feinman and Fine suggest that the key to understanding the "metabolic advantage" observed with controlled-carbohydrate nutritional strategies involves an appreciation of the efficiencies of different chemical pathways as they apply to the utilization of different macronutrients for energy production. They suggest that ignoring published reports demonstrating greater weight loss per calorie consumed with low-carbohydrate programs compared to isocaloric high-carbohydrate diets, is no longer reasonable based upon claims that this would represent a violation of the laws of thermodynamics ("a calorie is a calorie").

In this review, researchers show that there is no such violation of thermodynamic laws. Energy utilization of different diets depends on the specific chemical pathway taken since metabolic analysis of the efficiency of different pathways reveals large differences. Likewise, thermogenesis produced by diets of different macronutrient composition varies widely. The study presents a plausible mechanism that depends on the inefficiency of metabolic cycles and, in particular, protein turnover.

A low-carbohydrate diet makes demands on protein turnover for gluconeogenesis. From a theoretical point of view, energy balance between two diets is to be expected only if the subjects have the same final physiologic state, and only if all of the changes contributing to the energy, heat, work and chemical effects are known. Most diet experiments do not conform to this ideal.

In essence, they conclude that as there is no contradiction to the laws of thermodynamics, there should no longer be the type of theoretical barrier to accepting reports describing this effect.

Metabolic Syndrome and Related Disorders

Vol. 1, No. 3, Fall 2003 - Richard D. Feinman PhD; Eugene J. Fine MD


With childhood obesity being the new epidemic in developed countries, researchers at the Department of Pediatrics, Marshall University formed a study to examine the affects of different nutritional approaches on children. In this study, investigators examined the efficacy of a low-carbohydrate diet without caloric restriction verses a standard low-calorie program upon obese children.

Children and their parents were allowed to choose one of two dietary protocols: (1) carbohydrate-restricted diet (less than 30 grams per day) with unlimited calories, protein and fat (High-protein, Low-CHO Diet), and (2) calorie restricted diet (Low Cal Diet). In this two-month study, body measurement data were taken at baseline and at the two-month follow-up appointment.

Of the 37 children that completed the study, 27 chose the high-protein/low-carbohydrate program, while 10 chose a low-calorie approach. The only restriction on the low-carbohydrate regime was limiting carbohydrate consumption to less than 30 grams daily; the low-calorie diet was computed by using energy needs based on ideal weight for height and then decreased by 20 percent. Multivitamin and calcium supplement was given to all subjects.

The conclusion: Over this short-term period, the high-protein, low-carb, unrestricted calorie diet demonstrated superior performance with regard to reducing weight and body mass index (BMI) values in these school-aged children. Of note, in addition to more children actually choosing the low- carbohydrate protocol, compliance was observed to be greater in this group as well, once again demonstrating that counting carbohydrates is more palatable than controlling calories. Additionally, compliance was greater in the low- carbohydrate group.

Metabolic Syndrome and Related Disorders

Vol. 1, No. 3, Fall 2003 - James R. Bailes Jr. MD; Misty T. Strow MD; Joseph Werthammer MD; Richard A. McGinnis MS; Yoram Elitsur MD


With increasing awareness of the health risks associated with metabolic syndrome, effective management of this condition is of great importance. To explore the effects of a carbohydrate-restrictive diet on patients with harmful blood fat (lipid) changes, conducive to artery clogging, researchers looked at the effects of a carbohydrate-restricted diet (less than 20 grams per day) on patients with this condition. Patients who were already on statins were included, providing there was no dosage change in their medications (65 percent of the patients).

The rationale for utilizing this nutritional strategy for the management of metabolic syndrome is related to the changes observed in previous studies that have routinely demonstrated reductions of triglycerides (TG) levels, as well as elevation of HDL and weight loss -- addressing three of the major components of this syndrome. As suspected, carbohydrate restriction led to 13 percent reduction in total cholesterol, 16 percent reduction in bad cholesterol (LDL), 38 percent reduction in triglycerides, 13 percent increase in good cholesterol (HDL) and an 82 percent reduction in small dense LDL, suggesting this may be an ideal treatment for this serious condition.

Metabolic Syndrome and Related Disorders

Vol. 1, No. 3, Fall 2003 - Joseph T. Hickey MD; Lisa Hickey BA; William S. Yancy Jr. MD, MHS; Juanita Hepburn BA; Eric C. Westman MD, MHS

Though many Americans have used low-carbohydrate diets to shed pounds, a new study shows that they may also be beneficial for adults suffering from diabetes. In this retrospective study looking at patients who had previously been through an outpatient weight and metabolism management program with a carbohydrate-restricted diet specific effects on diabetes were analyzed. All patients were adults, and all patients were managed in a "free-living" setting. They were given dietary instruction in a carbohydrate- restricted diet, using the Atkins Nutritional Approach(TM) (ANA). Initially, all patients were dropped to the "Induction" level of 20 grams of carbohydrates per 24-hour period. Carbohydrates were reintroduced in 5 gram per day increments until subjects were no longer in ketosis.

The patient population was comprised of 13 type 2 diabetics and 1 type 1 diabetic.

In diabetics taking less than 10 units of insulin, insulin was discontinued. In those taking more than 10 units of insulin per day, dose was reduced by 50 percent at the beginning of the program unless blood glucose was above 350mg/dL.

Of the 14 individuals who were compliant with the diet and had at least baseline and 2-month follow-up measurements, there was a significant reduction in average blood sugar over a 3-month period (Hemoglobin A1c), with seven of the 14 subjects having normalized to non-diabetic levels. In several individual patients this occurred even with only minimal or no weight loss. Additionally, statistically significant reductions in total cholesterol and serum triglycerides were found. There were also significant reductions in the triglyceride/HDL ratio and total-to-HDL Cholesterol ratio. There were non-significant mean changes in LDL and HDL.

Conclusion: Diabetic patients improved glucose control: half of participants to non-diabetic levels and 85 percent to recommended levels with controlled-carbohydrate diet alone. Lipid profiles demonstrated findings consistent with other low-carbohydrate protocols with a decrease in triglycerides and increase in HDL.

Metabolic Syndrome and Related Disorders

Vol. 1, No. 3, Fall 2003 - Mary C. Vernon MD; John Mavropoulos MPH; Melissa Transue RN, BSN; William S. Yancy Jr MD, MHS; Eric C. Westman MD, MHS


A low-carbohydrate nutritional approach, like Atkins, may help patients with type 2 diabetes reduce their dependence on medication.

In this pilot report, seven type 2 diabetics were followed in an outpatient setting. After instruction in a low-carbohydrate diet, they were followed for 16 weeks. The purpose of this study was to evaluate efficacy, safety and metabolic effects of a low-carbohydrate/ketogenic diet in overweight type 2 diabetics, following the standard Atkins protocols. Initially, all patients were dropped to the "Induction" level of 20 grams of carbohydrates per 24-hour period. Carbohydrates were reintroduced in 5 gram per day increments until subjects were no longer in ketosis. Hemoglobin A1C, waist circumference and diastolic blood pressure - all measures of the metabolic syndrome - all improved significantly.

Body weight, BMI, waist circumference, body-fat percentage and diastolic blood pressure significantly decreased on all seven subjects who completed the 16-week study. Decreases in relevant body measures were all favorable, with body weight and BMI decreasing 10 percent. Blood pressure and heart rate also decreased. Of the 7 patients, 4 were off of all hypoglycemic medication. The remaining 3 had marked decreases in their medication numbers and dosages. All subjects experienced a significant drop in triglyceride levels; an average of 62 percent was noted.

Medications (oral hypoglycemic agents [OHA] and insulin) were reduced in most subjects. Only four subjects had detectable urinary ketones, and of these, only one had ketones at more than half of the visits.

Further studies of long-term effects and optimal medication adjustments for the control of blood pressure and blood-sugar levels that occur on the low-carbohydrate ketogenic diet were suggested.

Metabolic Syndrome and Related Disorders

Vol. 1, No. 3, Fall 2003 - William S. Yancy Jr. MD, MHS; Mary C. Vernon MD; Eric C. Westman MD, MHS

SOURCE Atkins Health & Medical Information Services

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