The Diet Quandary
The Atkins diet endures - and so does medical skepticism. What’s a dieter to do?
The Diet Quandary
Dec 31, 2002
By Ridgely Ochs, Personal Health
You know a weight loss diet is pervasive when the wife of a French chef is on it. Maria Reuge, co-owner of the haute restaurant Mirabelle in St. James, started the Atkins diet, a high-fat, low-carbohydrate diet, before Thanksgiving.
So far, she said a few days before Christmas, she has lost about 10 pounds - but the weight is "not peeling away." She admits she misses fruits and vegetables - strictly limited, especially in the diet's early weeks. And she worries about eating too much red meat - which the diet in no way limits.
Nevertheless, she said she's sticking to it, finding it convenient just to eliminate foods like pastas and breads. Perhaps more important, she's not hungry.
"I'm less obsessed with food," she said. "I don't eat between meals."
It's almost the New Year, a time when dieting is on just about everyone's mind. And unless you've been on Planet X, no doubt you've heard the latest buzz about Robert Atkins and his diet - a plan that essentially turns the government's food pyramid on its head and tells people to limit fruits, vegetables and grains and instead eat meats, butter, eggs and cheese to their hearts' content. Barbara Walters recently named Atkins one of the 10 most fascinating people of the year. And gossip columns and glossy magazines routinely report the litany that everybody who is anybody is on his diet.
There seems no good indication of how many people nationwide are eating the Atkins way, but 15 million copies of various versions of "The New Diet Revolution" have been sold since 1972, said Melissa Skabich, a spokeswoman for Atkins Health and Medical Information Services. The book has been on The New York Times bestseller list for 285 weeks, and it is the No. 1 best-selling Avon Books paperback of all time, she said. USA Today reported it was the No. 4 bestseller this year.
Why so much staying power for a diet that for 30 years has met with so much skepticism from the medical establishment? It doesn't hurt that several studies have found the diet does indeed produce weight loss - often more than seen on a conventional low-fat diet - and, surprisingly, it doesn't appear to be damaging to health, at least in the short-term. In three as-yet unpublished studies, researchers found:
Fifty-three obese women, ages 29-59, at the University of Cincinnati were put on either a conventional diet (30 percent of calories from fat) or the Atkins diet (60 percent of calories from fat) for six months. Both groups consumed the same number of calories. Those on the Atkins diet lost an average of 18.5 pounds; the conventional dieters lost 8.5 pounds. Both groups had normal cholesterol levels and experienced similar improvements in triglycerides, according to the abstract presented at the American Dietetic Association meeting in October. However, the Atkins group did have a major complaint: constipation.
In a study at Duke University Medical Center, sponsored by the Robert C. Atkins Foundation, 120 people went on either an Atkins diet or an American Heart Association low-fat diet. After six months the Atkins dieters lost an average of 31 pounds; the low-fat dieters lost 20. People in the Atkins group were also more likely to adhere to the diet.
Triglycerides fell 49 percent in the Atkins group and only 22 percent among low-fat dieters; HDL, the so-called good cholesterol, rose 11 percent for Atkins dieters and was unchanged in the low-fat group, according to the findings presented last month at an American Heart Association scientific session. The researchers did not report on any side effects. (Another study by the same researchers, published in July in The American Journal of Medicine, followed 41 Atkins dieters over six months and found that 68 percent reported constipation and 63 percent reported bad breath.)
A study led by Dr. Stephen Sondike at Schneider Children's Hospital in New Hyde Park followed 19 overweight adolescents on the Atkins diet and 20 on a low-fat diet for 12 weeks. Those on Atkins lost an average of 22 pounds; the low-fat group averaged 9 pounds. Cholesterol levels improved in both groups, though the LDL (the so-called bad cholesterol) level remained the same in the Atkins group, said one of the researchers, Dr. Marc Jacobson, head of Schneider's center for atherosclerosis prevention. No side effects were reported.
These results don't mean the Manhattan-based cardiologist is suddenly being embraced by mainstream nutrition experts. In fact, the attention being paid to the diet clearly frustrates those interviewed in recent days. They're unwavering in their belief that American obesity - close to two-thirds of adults are overweight or obese - is a result of eating too much and exercising too little.
They point to decades of data supporting the importance of fruits, vegetables and whole grains in preventing heart disease and cancer, as well as the role of cholesterol and fats, especially saturated fats, in promoting those diseases.
"The [Atkins] diet is not consistent with the dietary guidelines of any professional organization. And I honestly don't care if you lose more on one diet than another. The issue is: Is it any better in the long term and is it safe?" said Dr. Robert Eckel, chairman of the council of nutrition and physical activity for the American Heart Association.
"The research is very incomplete. We don't know a heck of a lot more than we did before," said Dr. Keith Ayoob, a spokesman for the American Dietetic Association, who said the diet is getting "undeserved publicity."
"Half the world lives on a diet of rice and vegetables but they don't eat a lot. That's the key," said Ayoob, an associate professor of pediatrics at the Albert Einstein College of Medicine in the Bronx.
"There's no magic bullet. You can't just eat an unhealthy diet. You need to eat lots of fruits and vegetables and whole grains," said Wahida Karmally, director of nutrition at The Irving Center for Clinical Research at Columbia University.
The Atkins team sees it very differently.
"It should be the way of life for every American," said Colette Heimowitz, director of Atkins' education and research. "It has been villainized for 30 years, but when you look at the scientific data, it [the criticism] does not pan out."
And, she said, except for the first two weeks of the diet, in which carbohydrates are severely restricted, the Atkins diet does call for eating healthy fruits, vegetables and grains. "People do not understand the program has plenty of vegetables - that's one of the misconceptions."
In the induction phase, which lasts at least 14 days, the dieter can eat three cups of vegetables a day, including two cups of loosely packed lettuce and one cup of another vegetable, such as broccoli.
"That's more than most Americans get now," she said. "After that, you add more vegetables ... seeds and nuts and eventually whole grains if your body can tolerate them. It depends on how far you have traveled on the disease path."
To understand what is meant by the "disease path," you have to understand the thinking behind the diet. Atkins' premise is that being overweight is caused by a "metabolic disturbance" that occurs when you eat a diet high in carbohydrates - the sugars and starches found in grains, fruits and vegetables. Proteins, found in meat, fish, eggs, nuts and beans, have a lower level of carbohydrates. Fat has none. Eating carbohydrates raises levels of blood sugar, or glucose. This leads the pancreas to secrete the hormone insulin, whose job is to help absorption of glucose in muscles and the liver.
Even as nutritionists have begged Americans to cut fat, one result has been increased consumption of carbohydrates, especially junk carbs like soda or sweets. Atkins contends that it's the consumption of too many carbohydrates - not too many calories - that sends the pancreas into high gear, causing it to secrete more insulin, which at such levels becomes ineffective in taking care of the glucose - a condition called insulin resistance. He terms the condition "hyperinsulism," and says it contributes to fat gain.
In other words, he insists, cutting carbs is the only way to lose weight. Doing so sends the body into ketosis, a state that burns fat, not carbohydrates.
But mainstream nutrition experts say nonsense: Eating too much of any food is what makes you fat and causes insulin levels to rise dangerously.
"I'll tell you the whole truth about carbohydrates and blood sugar swings: If people are consuming less, this is a non-issue. If they are overconsuming calories, then blood sugar will rise. But that doesn't make it [carbohydrates] a 'bad' food," said Ayoob.
Katherine Tallmadge, a nutritionist in Washington, D.C., and spokeswoman for the American Dietetic Association, said that when a person goes on any diet, high insulin levels will drop and cholesterol levels will improve. But, she warned, a long-term Atkins dieter who doesn't lose weight may risk consequences.
"We have decades and decades of research showing that a diet high in fats and animal meats damages the heart and is correlated with cancer," she said.
She also warns that bad breath (from ketosis) and constipation from the diet can be severe. One patient on the Atkins diet was so constipated when Tallmadge first saw her that "she was on the verge of being hospitalized."
The death two years ago of a teenager who had been on the Atkins diet was reported last month in the Southern Medical Journal. "This is anecdotal and one case report never tells very much," said the author, Dr. Paul Robinson, an assistant professor of child health at the University of Missouri. "But I wrote the report to ask the medical community to pay attention."
Robinson said the girl had been on the Atkins diet, along with her mother, for a few months, losing 15-16 pounds. They went off the diet for three weeks, and the girl decided to resume.
"On day 9 of being on the diet, she was in school in class, answered a question from the teacher, walked to the garbage can and collapsed," Robinson said. She died, he said, of ventricular fibrillation, rapid and chaotic rhythm in the main pumping chambers of the heart, a condition Robinson said is rare in young people but can be caused by an extreme electrolyte imbalance, the lack of certain salts and minerals in the blood. He said her calcium and potassium levels were found to be extremely low.
The Atkins company called the report "erroneous" and pointed out that "the resuscitative drugs used in an attempt to save this girl's life are also known to cause the chemical imbalances noted during her post mortem." Robinson said it was "possible but not likely" that the imbalance was due to the drugs. He said there was no sign that she was bulimic or anorexic, which had also been suggested.
"My general stance is that certainly children and adolescents on a diet should be followed by doctors," Robinson said. In a press release, the chief executive of Atkins Nutritional Inc., Paul Wolff, said people should consult their doctors before going on any diet.
The Atkins diet does seem to work in the short term for some and, from his research, does not appear to be unhealthy, said Jacobson from Schneider Children's Hospital.
"I think there are very different types of people and you need to try different things to see what works," he said. "Maybe what works is a matter of metabolism or maybe just individual tastes. Nobody really knows what this is all about."
Wayne Stark of Elmont is one of Jacobson's success stories. Three years ago the 17-year-old senior weighed 280 pounds and was borderline diabetic. He went on the Atkins diet for a year and now weighs 185 pounds, and his insulin levels are normal. He maintains his weight, he said, by exercise and returning to the diet when the pounds begin to add up.
But he also concedes he no longer adheres to an Atkins approach. On the day he was interviewed, he was asked what he had eaten since waking up: A bowl of Lucky Charms for breakfast, he said, and three slices of pizza for lunch.
Copyright © 2002, Newsday, Inc.
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The Diet Quandary: The Atkins diet endures - and so does medical skepticism.
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