The Atkins Diet - A Comprehensive Analysis

by Kathy Goodwin, RD

Low Carb Craze

It has been 10 years since Dr. Robert Atkins re-introduced his 1970's low carb diet program (known in the 70's as Dr. Atkins Diet Revolution). The book, now known as Dr. Atkins New Diet Revolution has flooded the market, producing what can only be termed "low carb mania" in the United States and abroad. Millions have tried his diet, and his books have been on the bestseller lists for a decade. It has been estimated that nearly 25 million Americans are on a low carb diet during any given period. Dozens of "low carb" products continue to flood the market, reminiscent of the 80's and early 90's "fat free" everything era. Just what is the Atkins diet, and what's the bottom line behind its safety and long term effectiveness?

How the Atkins Diet Works

The first two weeks of the Atkins diet is termed the "induction" period. During this time, dieters are permitted to eat no more than 20 grams of carbohydrates per day. This translates into a diet consisting of nearly unlimited meats, poultry, seafood, eggs, cheeses, oils, butter, margarine, bacon, and sausages. The 20 gram carb limit is generally derived from trace amounts of carbs in sauces, dressings, cheeses and a couple cups of lettuce greens or vegetables daily. During these two weeks, participants are not allowed to have any milk, fruits, grains, cereals, breads or "high glycemic index" vegetables such as potatoes, peas, corn and carrots. After the first two weeks, dieters can begin adding about 5 more grams of carbohydrates to their diet weekly. Generally, a diet consisting of no more than 40 to 90 grams of carbohydrates is what dieters must stick to long term, in the "maintenance" phase. Even this is a scant amount of carbohydrate compared to what health experts and major health organizations recommend.

Is the Atkins Diet good for Cancer Prevention?

Not until the inception of "low carb mania" would anyone have thought it wise to limit their intake of healthy fruits, vegetables and whole grain breads and cereals. But, since these are "high carb" foods, you will be limited to small amounts of these nutritious staples on the Atkins plan. Let's compare the Atkins diet plan to the diet recommendations from the American Cancer Society for optimal cancer prevention:

1. Eat five or more (optimally nine) servings of fruits and vegetables daily; include fruits and vegetables at every meal and for snacks.
   

   If one were to consume a fruit and vegetable at each meal and snack this would tabulate to upwards of 85 grams of carbohydrate, the upper end of the "maintenance phase" limit on the Atkins plan. Forget about having any healthy whole grains, legumes or milk products for the rest of the day. This recommendation would be extremely difficult to adhere to even on the maintenance phase of the Atkins plan.

2. Choose whole grains in preference to processed grains and sugars

   Will you have anything left in your daily carb ration to have healthy whole grain products like bran, whole wheat bread, brown rice, oats, and whole grain cereals? Considering each serving of these healthy foods contains a whopping 15 grams of carbohydrate, probably not. Forget about beans and legumes too, despite the fact that they are a nutrition powerhouse, they simply have too many carbs.....

3. Limit consumption of red meats, especially those high in fat and processed

   There is no limit on the Atkins plan to the amount of protein, fats and red meats one can consume. There is little else to eat other than these foods with such a significant carbohydrate restriction.

Current estimates are that nearly 33-50% of cancers can be prevented through a healthy diet. The recommendations above come from hundreds of research studies which show a link between cancer prevention and a high intake of fruits, vegetables, whole grains and legumes. Hundreds of studies also support the link between a high fat diet, high intake of red meats and increased incidence of cancer. The Atkins plan defies all this research and translates into a diet that may put you at increased cancer risk. Don't think that adding supplements to your diet - which you must do on the Atkins plan - equals the same nutrition you get from eating real foods. Fruits, vegetables and whole grains are loaded with thousands of substances, called phytochemicals, which are showing significant promise in chronic disease prevention. How these substances work to prevent illness, cancer, and disease is not completely understood. To be effective, these chemicals interact with each other and the complex combinations can only be obtained from eating whole foods. You simply can't get all these phytochemicals in a pill.

Healthy Populations Eat Carbs

The idea that significant amounts of carbohydrates in the diet lead to obesity and illness (a concept supported by low carb plans) is completely contradicted in many global epidemiological studies. For example, Japan, which has some of the world's lowest rates of obesity, heart disease, cancer and diabetes, has a diet which is very rich in carbohydrate content. The Japanese enjoy rice, vegetables, beans and legumes, and fruits at most meals. They have a diet that is very low in saturated fat and red meats; however it is high in fish which contain protective omega-3 fatty acids. The healthy, yet high carb, traditional Japanese style diet would be contraindicated under the Atkins plan. What a shame considering how much more healthy this population is than America.

What About the Studies that Say the Atkins Diet is OK?

In the past year, two studies have been published on the effectiveness of the Atkins diet versus a standard low-fat, low-calorie diet in two reputable medical journals, The New England Journal of Medicine, and Annals of Internal Medicine. The findings were indeed surprising, in that several heart disease indicators actually improved in the participants following the Atkins diet. They saw a much larger decrease in serum triglyceride levels as compared to the low fat group, and a greater increase in serum HDL (which is "good" or beneficial cholesterol to the heart) than the low-fat group. Both groups saw similar reductions in LDL cholesterol (the "bad" cholesterol for the heart) and total cholesterol levels. In addition, at the end of one year, both groups had achieved similar levels of weight loss.

There are, however, a few important facts that surfaced in these studies that seem to have been overlooked in media reports. First of all, about 40% of the participants in each diet group dropped out of the study before its completion due to inability to adhere to either diet. That indicates about a 3 out of 5 chance that you will be able to stick to either diet for a year. In addition, while the Atkins group lost on average 15.4 pounds after six months, by the end of the year, their total weight loss averaged only 9.7 pounds. The study shows that by the end of the year, the Atkins dieters had regained 1/3 of their weight. This is in keeping with what we have known about diets all along - diets, especially those with severe restrictions in foods we enjoy, are extremely difficult to stick to long term. Additionally, most people end up regaining lost weight on severely restricted diets because of difficulty adhering to the restrictions long-term. Don't hold your breath on the long term weight loss effectiveness of severely restricted diets. Bottom Line: Restricting Calories is what Causes Weight Loss

A recent research study conducted by the North American Association for the Study of Obesity showed that Atkins dieters cut their normal daily caloric intake by 1,000 calories while following the Atkins plan. Additional research has shown that during the ongoing weight loss phase, Atkins dieters consumed only 1500 calories a day on average, much less than their previous caloric intake. Furthermore, in the research study presented in The Annals of Internal Medicine above, scientists found that in both the low-fat diet group and in the Atkins diet group, calorie consumption was reduced as compared to the participant's previous diets. This only goes to show what we've known all along as the bottom line in weight loss: calories eaten must be less than calories burned for weight loss to occur. With so little food choices on the Atkins diet, it's easy to see why people eat fewer calories and therefore lose weight. There's nothing magical behind the hype about low carb plans.

Rates of Obesity Climbing Still

Since the inception of his first low carb diet book in the 1970's, Atkins' books have sold over 15 million copies. Since the 2nd takeoff of his revised book in 1994, several other best-selling books advocating a low carb plan flew off the shelves too. Millions were made in sales of low-carb copycats like "Protein Power", "The Carbohydrate Addict's Lifespan Program" and "The Zone", which further propelled the low-carb movement. With millions upon millions having tried a low carb plan as a weight loss solution since the early 90's and before, surely we would see a significant decline in obesity rates, right? On the contrary, from 1991-2001 obesity rates in America have jumped from 12% to 20.9%, and we continue to see a rise today. Paradoxically, as more and more diet books appear, the weight loss industry gets richer and America grows fatter. Diets alone, especially very restrictive diets, are not the answer to long term weight loss.

Health Risks on Atkins

While many following the Atkins plan will never suffer any serious or major side effects, probably due to inability to adhere to the diet long term, a great many have suffered serious consequences. For one thing, we know that extremely high protein diets, like Atkins, can lead to acidic urine. Acidic urine leaches calcium from the body which significantly increases one's risk for osteoporosis and kidney stones. On the website atkinsdietalert.org, we learn about a man from Florida whose cholesterol shot up from 146 to 230 after two months following the Atkins plan; Rachel Huskey, just 16 years old, who collapsed and died due to electrolyte imbalances probably attributed to the Atkins plan; and a woman from California who experienced gall bladder disease and kidney stones (which is a common occurrence due to calcium loss) after just six months on the Atkins diet.

Why is Our Country Obese?

If you were to take Atkins and many other low-carb advocates at their word, many would solely blame the "low fat" diet as America's obesity problem. What Atkins and other low-fat bashers will not tell you, however, is that America has never really followed a low-fat diet, despite health expert's recommendations. The National Center for Health Statistics shows little to no change in America's total daily fat gram consumption since the early 70's. In addition, our consumption of added fats and oils in the diet has significantly increased since that time. Another fact that low carb proponents fail to tell us is that as a nation, we eat on average 500 more calories a day than we did in 1980. Remember that old basic weight loss equation - calories in must be less than calories out - that's still the bottom line. Many other events have triggered skyrocketing obesity rates including less exercise, the advent of super-sized portions and more frequent dining out. Let's get a typical day in the life of the American to explain our obesity problem: Get in the car, sit at the desk at work, grab lunch from the vending machine or fast food, indulge in a high calorie snack mid-day, "grab" something else for dinner from the drive through because it's a pain to make dinner at home, sit in front of the TV, eat chips and ice cream unconsciously, go to bed. Sounds like a pretty food toxic and sedentary lifestyle, huh? America needs to get moving and begin to reduce portion sizes and make healthier food choices.

Long Term Weight Loss: How Do We Achieve It?

Dieting alone seems to have a pretty dismal outlook for long term weight control. But, we have much to learn from the thousands of people enrolled in the "National Weight Control Registry". The average registrant in this program has lost 60 pounds and kept it off for five years. Not surprisingly, very few of the participants report following a low-carb or Atkins style diet as their method of achieving long-term weight loss. Actually, the vast majority report the following as their keys to living a healthy lifestyle, and maintaining lost weight: they eat on average 24% of their calories from fat, they expend about 2800 calories weekly in exercise, they don't skip breakfast, and most continuously monitor their eating behavior, often through using a food diary. Most of the methods the participants followed have been well established for decades as the best ways to lose weight and keep it off. But, in America's constant search for an easy, magic bullet, we continue to defy common sense and research and get lured right into the next weight loss craze.

What's Left to Eat?

Big distinctions need to be made between healthy and unhealthy foods. No one will argue with Dr. Atkins' advice to limit sugary processed foods, like cakes, cookies, ice cream, candies, doughnuts, chips, crackers, French fries, and processed breads and flours. There is little in these foods that will serve your chances at optimal health and weight control. However - when a plan starts telling you to limit foods that have been proven to be healthy, (like fruits, vegetables, legumes and whole grains) buyer beware. Just like there is a distinction between "good carbs" and "bad carbs", fats in the diet can be "good" or "bad" as well. Some fats have been proven again and again to be detrimental to your health - these include butter, cream, animal fats, high fat dairy products, margarines that contain "hydrogenated" oils, and fatty red meats. On the other hand, some fats, like olive oil, canola oil, oils in fish, and nuts and seeds, can be very good for you. America's mindset needs to switch from following restrictive fads to beginning to follow a diet that is best for health. Often when we see a switch of mindset to choosing foods for health, rather than thinness, weight loss generally follows. This is especially true when regular exercise, an individualized eating plan, and behavior modification strategies are thrown into the mix. Common sense strategies, yes, but they are the only ones proven to work long-term. For more advice on how to choose methods that will help your chances at long-term weight control, see our article, Successful Weight Loss Tips.