Quantity's no issue on Atkins diet; quality is
By Megan Murphy April 21, 2003
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Megan Murphy is a Tennessee-licensed registered dietitian and assistant professor of nutrition at Southwest Tennessee Community College. Her column Recipe for Health appears weekly in Health & Fitness.

Last week at my daughter's basketball practice, I asked a small group of parents if they knew someone who was following the Atkins diet. Several of them reported they were either currently following it, had followed it in the past or had plans to do so soon.

Janine James, a nurse and mother of three active girls from Jonesboro, spends a lot of time commuting to Memphis for work and her children's activities. She says her life is too hectic to follow a diet with a certain amount of calories, or fat grams or point totals. James likes the Atkins diet because she can eat all the meat, eggs and cheese she wants. She can get full and satisfied. Besides, she said, "I can have pork skins, so I don't miss the chips so much."

Even while friends and family mourn the passing of Dr. Robert Atkins, the diet doctor whose books have sold more than 15 million copies, the controversy continues over the low-carbohydrate diet he made famous. Atkins encouraged his followers to eat all the bacon, eggs, meat and cheese they wanted, but to significantly limit carbohydrates in their diet. His diet was successful, he said, "because it's the only one where you don't have to cut quantities to lose weight."

Certainly, Americans have a hard time reducing the quantities of the food they eat, so it's no wonder that not having to cut back on certain foods is appealing. Our portions are distorted, as we have become accustomed to mega amounts of food in restaurants and at home. This all-around supersizing has left us with supersized waistlines as well. It's estimated that more than 60 percent of Americans are overweight or obese.

It is difficult to know how many people are following a low-carbohydrate plan, but restaurants have noticed trends that indicate a significant number of people are.

Christian Georgi, president of the Memphis Restaurant Association and owner of the East End Grill restaurants in Memphis, says a lot of people are ordering sandwiches and hamburgers without the bread or buns. And Michelob Ultra, a low-carbohydrate beer, has "taken off like wildfire" at Georgi's establishments. "It's a great marketing ploy," says Georgi, especially since the Ultra beer is only slightly lower in carbohydrate than some other light beers.

Does the Atkins diet have a place in the treatment of obesity in this country? Some health care professionals think so. Dr. George Woodman, a general and bariatric surgeon at Mid-South Bariatrics in Memphis, said the low-carbohydrate regimen may work for those who aren't severely obese.

Woodman observes that many of the obese patients he sees for laparoscopic band surgery to reduce the size of their stomach have followed the Atkins diet, often more than once. Most have never been able to stick to it, or any other diet, long enough to produce the results they need. If the diet worked by itself, notes Woodman, the bariatric surgery he performs wouldn't be in such high demand.

One of the criticisms Atkins received throughout the years was that he did not have scientific data to prove that his diet worked. During the last few years, Atkins and other medical professionals did studies comparing his low-carbohydrate method to other weight-loss methods.

In a study published this month in the Journal of Clinical Endocrinology and Metabolism, 53 women were followed for six months to determine the effects of a very low carbohydrate diet on body composition and risk factors for cardiovascular disease. Forty-two women completed the trial in which half followed a very low carbohydrate diet such as Atkins's and the other half followed a calorie-restricted, moderate-fat diet. The women following the low-carbohydrate diet lost more weight and more body fat than the women on the more moderate diet. Both groups saw healthy changes in their levels of blood lipids, fasting glucose and blood pressure.

Dietitians long have prescribed balance and moderation in the eating plans to their overweight clients. This includes plenty of carbohydrates, good quality protein and a moderate amount of fat.

Clearly, however, traditional dieting has not worked. Adults and children alike in America increasingly battle the bulge. It's tempting to follow a plan that promises less restriction but good weight-loss results.

Some of the women I talked to at my daughter's basketball practice said avoiding carbohydrates altogether was easier for them than trying to include them moderately in their diet. But most people find they can't leave them off forever. Leigh Stone, a Grahamwood Elementary School kindergarten teacher with two busy kids and a hectic lifestyle, says that life without many carbohydrates is no problem - until you take that first bite of french fries, or taste the smoothness of a chocolate bar. Then it's all over and it's difficult to get back to restricting the carbohydrates again.

Barbara Scobey, clinical dietitian and diabetes educator at the outpatient center at Baptist Hospital of Memphis, recognizes some positive aspects of the Atkins diet. Scobey says the diet's emphasis on increasing water intake and including green vegetables, along with encouraging regular exercise, is helpful for anyone wanting to lose weight or just maintain good health. But she is concerned about the limits on high fiber foods such as some fruits, whole grains and starchy vegetables.

Other popular diets also leave off whole food groups. While Dr. Atkins's plan limits carbohydrates, Dean Ornish, another doctor with a well-known diet plan, recommends extremely low amounts of fat, and restricts meats.

The problem is diets that are so lopsided get old. The foods themselves become repetitive, and the restriction gets cumbersome. It's not surprising that most people just don't stay on these diets for very long.

And that's just the problem, isn't it - sticking with a diet?

Atkins came out with the first edition of Dr. Atkins' Diet Revolution in 1972, more than 30 years ago. If it works so well, wouldn't there be a number of long-term followers who have lost weight, kept it off, and had good health because of it? Where are they? I suspect their voices are quiet because there aren't very many of them.

Even if the diet enables people to lose weight, the question has to be asked: Is it a livable, long-term way to eat? And is it truly healthful in the long run?

When I am asked my opinion of the Atkins diet, I always bring up this point: Populations in the world that have less heart disease, less cancer and less obesity than Americans do not consume a low carbohydrate, high protein, high fat diet.

Consider the Japanese, who have one of the lowest rates of obesity, diabetes, cancer and heart disease in the industrial world. The traditional Japanese diet is high in carbohydrates, with rice, grains and vegetables making up the bulk of their food choices. Their intake of high protein, high fat foods, is minimal. If carbohydrates are the culprit in corpulence, the Japanese people should have higher rates of obesity than Americans.


The problem of obesity, the main focus of Dr. Atkins, is complex and encompassing. It is not just about management of diet, but lifestyle and emotional obstacles as well. People who lost weight and kept it off over time eat lower calorie, lower fat diets and have incorporated exercise and stress management into their lifestyle.

Maybe the Atkins diet plan is partly right. Americans would do well to eat less refined carbohydrates, such as cookies, chips, sugary sodas and candy. But they could benefit from adding more complex carbohydrates, such as whole grain breads and cereals, fresh fruits and a wide assortment of vegetables, including the starchy, higher carbohydrate veggies such as sweet potatoes and corn.

Perhaps Atkins did revolutionize the diet industry in a way. His works have fostered more obesity research, and certainly much debate over how to best help people who are overweight. It's an ongoing problem with no single or easy answer.

I see the same point missed. In Asian culture for example - they eat little meat but a lot of rice. That is a way to keep your weight down. The problem is when you eat a lot of rice and a lot of meat. The rice does not make you fat as much as the rice keeps the fat from metabolizing and your body stores it. An old chinese chemist told me you can not eat suger and fat at the same time. So go low fat and eat sugar or go low carb and eat fat. Do not eat high carb and high fat. So yeah Asian cultures eat a lot of rice and little meat - that does not negate what LC eating means for the average american who eats high carb and high meat.

Another point also missed was that the Japaneese, and presumably other Orientals do not eat much refined Sugar. In fact, Stevia (0g Carbs) is more widely used than even sugar in Japan.Also, the Japaneese eat lots of fish, which are rich in Omega-3.

Yes, they eat lots of grain and rice...but, those are about the only carbs they used to eat. Now, McDonald's has shown up, and Obesity rates are on the rise.

Personally, I believe that carbs alone (if too high) can hurt you. You don't need any fat, to get fat. But, regardless...the reason Atkins works so well is because it was designed and meant to be maintaned. The Low-Fat/Low-Cal diets weren't designed to be maintained for a lifetime. The closest thing to a Maintnance plan for the low-fat/low-cal diets is the Food Pyramid, which is extremelly lacking.

Atkins was designed to be and is easily maintained as long as you follow it correctly. There are alot of people out there who think Atkins is 20g of carbs a day, no fruit, no whole grains, etc... for life.

In addition, many people may have abandoned Atkins before the current wave of low-carb products. Nature's Own now makes a reduced carb bread (I found it at Albertsons), Albertsons also has reduced-carb peanut butter (half the carbs of normal PB). There is even low-carb pasta now (Atkins). You can eat low-carb and still get those foods you love. I have every intention of picking up some Nature's Own Reduced Carb and trying it out. At 5g, it isn't likely to derail me. But, if it does...I won't eat it anymore.

No matter what diet you are on, if you go back to your old way of eating...you will gain the weight back. My mother was telling em about a woman who she worked with. The woman had lipsuction and quickly put the weight back on. So, even life-threatening surgery won't keep the weight off if you continue to eat hi-carb.

Do I even need to respond to this? Someone didn't do their research!

The most relevant and telling discrete populations to examine regarding low carbohydrate are the Eskimos and the Native Americans prior to European invasion.

How do you suppose that those Eskimo hunters were able to work for days on end, in the most severe conditions on the planet, without a carb boost to keep their energy up?

And the Native American population increased the levels of obesity and diabetes ONLY after adopting the white man's flour and sugar diet.

And it is also true that one of the most effective examples of the benefits of low carb is being seen in the Native American communities where low carbing is being reintroduced. Back much closer to their diet of pre-white man days.

Eskimos and Indians lived according to the guidelines laid down by their USDA. To get 55-70% intake of carbs they would forage for 10-25lbs of vegetables and blueberries a day along with one (1) low-fat squirrel. They would migrate to Chile in the winter to take advantage of the reversal of seasons. Animals, being animals, would not touch the growing and ripening produce while our ancestors were on their way back from Chile.

Reading this whole post really has made me wonder what it is about Americans and obesity. Specifically, it can't really just be high carbs, as lots of Europeans eat high carbs & we are certainly bigger than they are - and not in a good way! Anyone have any theories? Do we just eat too much? Have studies been done - is it really just Big Gulps and McDonalds, and Atkins is a way of weaning ourselves from overeating in a ketosistic way (I know that's not a word)?

I live in NYC, where people are a bit slimmer than in other parts of the country. My husband lives in Ohio, and when we go there to visit and go out for meals, the portions sizes are unbelievable. We went to a chain Italian restaurant there - I think it was called Macaroni's or Spaghetti's (or something similar), and the portion they put in front of me could have fed a family of six! And a lot of these midwestern cities aren't exactly walking towns. Whenever we visit his midwestern relatives, in Ohio and Illinois, we basically go from the car to the restaurant to home. Anyway, my personal theory is that this country is so huge that we use cars because we have to - the distances are too far to bike or walk. And those dang chain restaurants, giant elephant size popcorn at the movies, and Big Gulps! 'All-you-can-eat' buffets seem to be an American phenomenon, too. My parents take that challenge very seriously! Well, that's my completely unresearched theory. LOL!

The sugar industry should be a lot more worried about low-carbing then 10%. How about 0%.

Orzabelle's comment about New Yorkers not being as fat is interesting, Canadians are also not as fat as Americans (I don't know about New Yorkers), but we are working on it. Canada also doesn't have much in the way of big portion resturants. We always have big tales to tell about how huge the resturant meals are after a trip to the USA. Feed a family of six is right.

orza, only problem is that men are in fact eating 200 less calories (and fat for that matter) than we were in 1965. Women are only eating 80 calories more than they were in 1965. But, we are more obese. What has changed, we traded in the veggies for sodas and candy bars. Carb consumption has risen 70g in men and 50g in women since 1965.

You can't just look at the primary dish. We aren't getting our carbs from our primary dishes...we are getting them from all the sides: Super Sized Fries, Big Gulps, Slushees, Candy Bars, etc...

I believe the Glycemic Index plays some role also. Spaghetti and Unrefined Rice are moderate on the Glycemic Index. But, Potatoes can be as High as 158, which is 1.58x worse than Pure Dextrose. HFCS (Pepsi Sweetener) is high-moderate.

http://members.lycos.co.uk/rmendosa/gilists.htm

It is also interesting to note that while Maltitol, which causes many people to stall, has a moderate to high Glycemic Index, Xylitol and Lactitol which cause less stalls have very low Glycemic Indexes.

For one, they DON'T eat as much rice as we think. Maybe a cup or so per meal. TOPS. Comparable to our bread or potatoes side dishes. It is NOT the biggest part of the meal

Second. They eat LOTS of fish. Often three times a day. That means a LOT of protein. Maybe even more than we do. Pretty high protein, actually.

Third. They suffer a LOT more strokes than we do. Maybe more strokes than we have heart attacks. They have traded heart attacks for strokes.

Fourth. For many, many years (long before they adbandoned traditional diets in favor of MacDonald's) they have had FIVE times as much stomach cancer as we do. It is a TOP cause of death.

Bottom line, they have simply traded causes of death. Their life expectancy isn't much different from that in so-called 'high-fat' cultures such as Switzerland, Austria, Greece.

It the Japanese diet were so perfect, they should be living to 120. But they're not.

They're not living such a long time, but their quality of life is probably better because they have less to cart around.

http://www.cnn.com/2003/HEALTH/diet...reut/index.html

Asian bellies add to obesity woes
Sunday, March 16, 2003 Posted: 10:30 PM EST (0330 GMT)
LONDON, England (Reuters) -- Medical experts have called for a new assessment of how weight-related health risks in Asians are measured which could push up the number of overweight and obese people worldwide to 1.7 billion.

The new figure, which would be 50 percent higher than the current estimate -- is based on recommendations to lower the threshold for Asians because of their special vulnerability to weight-related disorders.

Professor Philip James, the chairman of the London-based International Obesity TaskForce (IOTF), said the global standard for measuring overweight/obesity, the Body Mass Index (BMI), is based on western criteria and needs to be adjusted for Asians.

"The point of reducing the values is that it will be an altering point which you give to both the public and doctors," James said in an interview.

BMI is calculated by dividing weight in kilograms by height in meters squared. In the west a BMI of 23-24 is normal.

Health experts have suggested a lower BMI scale for Asians because of evidence showing their risk of obesity-related diseases such as high blood pressure, abnormal cholesterol and developing diabetes rises if their BMI is more than 23.

By lowering the threshold doctors will become aware of potential risks and will be more likely to advise patients to take measures to reduce their weight.

"There is a wide spectrum of risk factors related to obesity, which when viewed as a whole, have a tremendous impact on health," said James.

Pot Bellies

Obesity is caused by the body's inability to balance energy intake and energy expenditure. People eat too much and do not exercise enough.

A BMI of more than 30 indicates obesity but where the excess fat is accumulating is also important. Abdominal obesity, the accumulation of fat in the stomach area, is a problem in Asia and poses more health risks than fat in the thighs and legs.

So an individual can be quite compact but still suffer the weight-related health risks if all of the fat is centered on the abdomen, the classic pot belly.

"The problem of abdominal obesity seems to be particularly marked in Asia. In other words you can be relatively, modestly plump but you selectively accumulate the fat in the abdomen," James explained. "When it is there it amplifies the risk."

James and members of a World Health Organization expert group are calling for the WHO to do a formal assessment of how the criteria work in different societies. Lowering the benchmark would add another half billion to current estimates of the world's overweight population.

James warned that the impact on health of the escalating obesity epidemic could overtake that of tobacco. Obesity is linked to an increased risk of suffering heart disease, diabetes, certain cancers and psychological problems.

"It is clear that extreme forms of obesity are rising even faster than the overall epidemic and we are witnessing a real health tragedy unfolding," he said.

A friend of mine just came back from Tokyo. She's 145 lbs. at 5'5, and she told me she felt totally scrutinized (even pointed at!) by the Japanese over her hips/tummy/rear end. A few that she came into contact with were kind enough to inform her of how 'fat' they thought she was. She also noted lots of them had tummies themselves, though obesity is certainly a relative term, isn't it? Obesity vs. morbid obesity...