The Worst...and That's Atkins!

The Atkins Diet, it’s an over-hyped and dangerous fad, but we knew that already. What we didn’t know, is how had it is for blood vessels, but we found that out last week. Remember this Reuters report, “High-fat Atkins diet damages blood vessels?” Here’s a refresher:

The high-fat Atkins diet can cause long-term damage to blood vessels, as well as some of the inflammation linked with heart and artery disease, U.S. researchers reported on Tuesday.

In contrast, low-fat regimens such as the South Beach and Ornish diets lowered cholesterol and appeared to benefit artery function, they said.

"It really is the Atkins diet that is the worst," Dr. Michael Miller, director of preventive cardiology at the University of Maryland Medical Center in Baltimore, said in a telephone interview.

"The Atkins diet caused the LDL levels to go up by about 7 percent, whereas in the Ornish and South Beach diets ... they went down 7 to 10 percent."

Now, this enflamed the low-carb consortium—they practically passed out torches and pitchforks—and this outrage went straight to the top. In fact, the Grand Pubahs of nutritional misinformation Atkins Nutritional, Inc. decreed their “official” rebuttal. Here it is:

A presentation at the recent meeting of the American Heart Association in Orlando, Florida, comparing the maintenance stages of three diet regimens, Atkins, South Beach and Ornish, has relied on faulty research and a misunderstanding of Atkins protocols to suggest the Atkins diet may not be heart healthy.

Dr. Michael Miller, who made the presentation, apparently ignored more than 30 years of clinical experience and independent research on low carbohydrate diets, and now four years of trials looking specifically at the Atkins protocols, which have consistently demonstrated the effectiveness and safety of the Atkins diet.

Colette Heimowitz, M.Sc., Vice President of Nutrition & Education at Atkins Nutritionals, commenting on Dr. Miller’s presentation, referenced several peer reviewed studies which report opposite findings. Among the most prominent was a year-long weight loss and health study conducted by Stanford University researchers and published in the Journal of the American Medical Association which showed no increased risk of cardiovascular markers in more than 300 overweight subjects.

In summarizing his study, Dr. Miller acknowledged that researchers considering the effects of low carbohydrate diets have reached very different conclusions depending on sample size, research protocol and any number of other uncontrolled variables. Unfortunately, Dr. Miller's research cannot be fully evaluated since his study has not been peer reviewed or published. But, given the short duration of his study, the very small sample size, and the weak correlations, drawing conclusions about possible long term health risks tied to fat consumption in the maintenance phase of any weight control program is not good science.

According to media reports, the subjects in Dr. Miller’s study were put on what’s described as the maintenance phase of Atkins with 50% of their calories coming from fat. However, this is not the Atkins maintenance phase protocol, nor is it part of the Atkins diet protocols. The lipid response Dr. Miller reported is what one might expect from a combination of rich carbohydrates and fat, but it’s not Atkins.

When it comes to nutrition and weight control, the public deserves science based conclusions. Time and again independent research has shown the benefits of a low-carbohydrate nutritional approach to safe and healthy weight loss and weight maintenance. And that's Atkins!

After reading this I am reminded of old German news reels from the fifties—not sure why. So, as a follow up to last week’s post Atkins...The Worst, I decided to track down some expert opinions on all this Atkins nonsense. First up, Linda Popescu, MS, RD:

The Stanford University study that Atkins Nutritionals references studied 4 different diets over a 12 month period (Atkins, Zone, Ornish and Learn). The amount of weight loss was modest at 12 months for all of the diets, ranging from 2% to 5% of body weight. Participants following the Atkins diet lost an average of 10 pounds over the 12 months. The women participating in the study attended 1 hour classes once per week for 8 weeks; they received email and telephone reminders plus cash incentives for completing data collection materials. With this type of support, a ten pound weight loss for women who averaged 190 pounds is not exactly a success story. If you assume that they would need to lose at least 50 pounds to achieve ideal body weight, they would have to faithfully follow the Atkins Diet for 5 years.

A low fiber, low phytonutrient, high saturated fat is not a recommendation that any responsible health care professional should make. Diets high in saturated fat promote both heart disease and cancer. Vegetables and fruit are carbohydrates. Low carbohydrate diets restrict these rich sources of cancer fighting phytonutrients and fiber.

Now here’s Dr. Fuhrman’s colleague Steven Acocella, D.C., MS, DACBN. Check out what he had to say:

The inherent strength of the pro-Atkins camp is that a high carbohydrate diet is a major culprit in the development of Coronary Artery Disease (CAD), and they could not be more RIGHT! A diet high in refined carbohydrates is a scientifically proven, potent risk factor in the development in CAD. But the leap of error is that they argue by default that must mean that a low carbohydrate diet replaced by a high fat diet reduces, or even remove this increased disease risk. This is an inane argument as both processed carbohydrate intake and high fat/high protein dietary intake raise the risk of developing CAD. Atkin’s made a major contribution to humanity by scientifically exposing the dangers of a high carbohydrate diet. But claiming that a high fat/high protein diet is less dangerous is like comparing arsenic to cyanide. Clearly, both are dramatically dangerous and promote disease. Compare studies done with whole, unprocessed plant food and natural carbohydrate intake and diets whose calories are derived primarily from protein or fat and you will see a stark contrast, namely cardio protective v. cardiopathic results (Chen et al., 2006; Stanton and Crow, 2006; Steffen and Nettleton, 2006; Samaha et al., 2003). Simply put, diets high in refined carbohydrates are as disease promoting, and on par with, a diet high in protein and or fat.

Many claim that my position of the disease promoting nature of a diet high in animal fat and protein is unsupported by the literature because if it were true then millions of people world wide who eat such a diets would be dying from cancer, cardiovascular disease and stroke. Exactly, I agree. They are. The closer you get to the Atkins dietary recommendations the more likely you will suffer an untimely and avoidable death, and this position is supported by the vast majority of the scientific literature (Rosenstock et al., 2006; Foster et al., 2003; Kelemen et al., 2005; McCullough et al., 2002). But the exact same thing can be said about a high carbohydrate diet, no exceptions. We all agree that the SAD diet is a major contributing factor in placing our nation high on the list of diseases of nutritional excess, such as obesity and its co-morbidities, and the 3 leading causes of death.

Atkins and low-carb/high-protein diets (LC/HP) in general simply raise the levels of some of the worst offenders of the SAD diet. A simple law of biology is that if something is detrimental at some exposure level then increasing the exposure level is likely to make it more detrimental, and it doesn’t matter if the offender is carbohydrate or protein or fat.

In the European Journal of Clinical Nutrition, May 2007, a massive 10 year dietary assessment study of 22,944 subjects was published. The investigation was part of the EPIC Project (European Prospective Investigation into Cancer and Nutrition). Titled, Low- carbohydrate-high-protein diet and long-term survival in a general population cohort, Dr. Hsieh of the Harvard School of Public Health and his colleagues’ asses the relationship between high protein, high carbohydrate and low carbohydrate-high protein intake with cancer and cardiovascular mortality. The results were significant.

After proportional hazard regression analysis of 113,230 person years, Dr. Hsieh states, “higher intake of carbohydrates was associated with significant reduction of total mortality”. But perhaps most striking are the authors’ results that state, “…even more predictive of both cardiovascular and cancer mortality were the additive effects of low carbohydrate-high protein scores.” [P=0.001]. The article makes a clear and compelling case for the dangers of a LC/HP diet. The conclusion reads, “Prolonged consumption of diets low in carbohydrates and high in protein (LC/HP) is associated with an increase in total mortality”.

I reviewed the raw statistical data and the mortality gradient is considerable and linearly proportional to LC/HP score. This correlation between macronutrient profile and mortality and morbidity from cancer and cardiovascular disease is not unexpected and consistent with the vast majority of credible studies that all point in the same direction (McCullough, et al., 2002; Trichopoulou et al., 2003).

Addiction is the only reason that anyone would continue to maintain that a pro-Atkin’s, low-carbohydrate diet is health promoting. One would have to literally ignore thousands of studies that irrefutably support these findings. For every research article that dispels the direct relationship between a low-carb, high protein/high fat diet style and disease promotion there’s about 500 studies that refute it.

This is one of my favorite anti-Atkins raps. You can find it over at Here’s an excerpt:

When the chief health officer for the State of Maryland,1 was asked "What's wrong with the Atkins Diet?" He replied "What's wrong with... taking an overdose of sleeping pills? You are placing your body in jeopardy." He continued "Although you can lose weight on these nutritionally unsound diets, you do so at the risk of your health and even your life."2

The Chair of Harvard's nutrition department went on record before a 1973 U.S. Senate Select Committee investigating fad diets: "The Atkins Diet is nonsense... Any book that recommends unlimited amounts of meat, butter, and eggs, as this one does, in my opinion is dangerous. The author who makes the suggestion is guilty of malpractice."3

The Chair of the American Medical Association's Council on Food and Nutrition testified before the Senate Subcommittee as to why the AMA felt they had to formally publish an official condemnation of the Atkins Diet: "A careful scientific appraisal was carried out by several council and staff members, aided by outside consultants. It became apparent that the [Atkins] diet as recommended poses a serious threat to health."4

UPDATE: The Atkins beat down continues. Dr. Fuhrman’s colleague Jennifer Petrillo, MD was eager to throw a few jabs at Atkins over this study. She’s a toughie:

It is no surprise that this new study, which controlled patients for weight loss while they followed each prescribed diet, finds that Atkins is the unhealthiest in the long run. With up to sixty percent f calories coming from fat, what could be expected? It is clear that diets low in fat and high in fruits, vegetables and fiber are protective against heart disease and cancer, yet Atkins recommends only one more serving per day of fruits and vegetables than the Standard American Diet (SAD) guidelines do (six servings over five) and has a fiber content of only twelve grams per 1,000 calories, far below any other commercially-marketed diet plan. The huge amount of animal protein recommended by Atkins serves as the trigger for a cascade of increased T cells, B cells and macrophages that ultimately leads to the release of cytokines that cause inflammation in the body. Add to this the fact that long-term weight loss on Atkins is just average and it is clear that following the Atkins diet is a recipe for disease and early death. The only hopeful thing about the Atkins diet is that adherence to this plan is so poor that hopefully most people discontinue it before they cause major physical damage to themselves. Plant-based nutrient-dense eating, not high fat, high animal protein and low fiber, is the simplest, easiest and best way to achieve great health and longevity.

And to round out the mini-panel, I offer up this great quote from Dr. Fuhrman. It kind of says it all. Take a look:

Any diet high in animal products and low in fiber, fruit, beans, and yellow vegetables is going to shorten life span significantly. If Robert Atkins follows his own dietary advice, he is a perfect example of what you would expect from such unhealthful dietary recommendations. He was overweight and developed heart disease.

But sadly, I’m sure millions of people will continue to fall for the low-carb lies. I guess some emotional attachments to food are just too hard to kick. To quote one low-carber, “At this point I hardly care about the weight! I am so healthy and happy! Why would I not love bacon? Bwa ha ha ha ha ha ha ha ha.” Sigh…

1. The New York Weekly 26 March 1973.

2. Maryland State Medical Journal 1974:70.

3. Obesity and Fad Diets. U.S. Senate Select Committee on Nutrition and Human Needs. 12 April 1973 CIS S581-13.

4. Obesity and Fad Diets. U.S. Senate Select Committee on Nutrition and Human Needs. 12 April 1973 CIS S581-13.

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Comments (1) Read through and enter the discussion with the form at the end
Brad Carpenter - January 24, 2008 12:02 PM

I have read as many reports as I can get my hands on and am most convinced - regarding HP/LC - by short to mid term studies that show lowered overall cholesterol and increased HDL as surprising responses as first order to the apparent key input, "weight loss."

As a disclaimer, I am 6' 1", 44, in a high stress international sales position, and am active (jogging, weight lifting, spin class cycling). At age 38, my weight topped 230 pounds, due to frequent eating out, lifting weights more than cardio exercises (although those occurred - mostly in summer), and generally thermodynamically negative influences (more energy potential consumed than energy used over time). I subsequently left my high stress job in late 2002, went to work for myself, and took control of my health through 5 days/week workouts whenever possible.

Importantly, twice per year for three years, I went on the Atkins diet for 8 weeks. During those periods, I lost on average of 10 pounds each, gaining perhaps 3 back in the intermediate periods. In those intermediate periods, I consumed perhaps 4000 calories per week in alcohol (mostly red wine - that's admittedly about a bottle an evening), plus ate indiscriminantly. My typical peak heart rate was ~ 175-180 bpm, resting ~ 60, and total cholesterol at the beginning of this 3-year period was 210, with a too-small fraction of HDL.

Over a 3.5 year period, I reduced my weight from 235 to 185, with sole loss periods occurring during the 6 or so Atkins cycles (notably including 2 pounds worth of weight loss per cycle due to alcohol avoidance for two weeks - the alcohol consumption issue is a different story :) ).

At the beginning of the 4th year, I resumed the high stress job previously held, at a baseline weight of 193 pounds. As established throughout the previous 3 1/2 year period, I committed to two 8 weeks sessions of Atkins per hyear with more or less unrestrained conduct in intervening periods, but did add restrictions to dining out when possible. Workouts are maintained at 3-4 per week versus the five (5) previously. Average calories per workout are roughly 750, they were perhaps nearer 1000 at the end of the 3 1/2 year "sabbatical" period.

The result of my recent physical (12 months ago, or 1 year after resuming the international sales position) showed total choloesterol of 190, with improvement in HDL/LDL. In my view, key to this was the reduction in weight, supportive of the numerous studies siting this phenomenon.

Importantly, in my view, I do not really change much in the way of eating habits during the Atkins cycles, making it plannable and executable. I take Omega-3 oils as a supplement during this phase (as well as vitamins B and C and glucosamine), and frankly eat more green leafy vegetables (dipped in a total of perhaps 200 calories of cheese sauce) than otherwise. I have no urges to overeat with respect to red meats, fish, shellfish, or poultry, and focus on poultry as my primary meat source. This is all simple to administer.

Eggs and bacon are a treat on Sunday's only, as are steaks 1-2 nights per week.

I do not feel that the opposite diet would be as easy to maintain for 8 weeks. It is far more difficult for myself to completely change eating habits, and thereby eliminate fatty foods (including nuts), than to eliminate sugars, including candy bars, sugared cereals, ice cream, popcorn, mashed potatoes, noodles, various soups, and deserts.

Chicken breast versus a stack of noodles - that decision's all too easy for me. I'm going for the larger protein, no carb choice - instinctively.

I am currently at 193 pounds and in week 3 of an 8 week process, whereby I expect to approach the 185 longer term minimum weight I established while not holding the international travel job.

So, I may be an addict - for 16 weeks a year, but it truly appears to be a healthy addiction. Once someone can show me incontrovertable statistical proof that over short periods Atkins is harmful, I will change my approach, but this seems manageable. As a last comment, and this is likely a result of improved sleep patterns in the absence of alcohol, my resting heart rate will venture down toward the low 50's and occassionally touch the high 40's during the initial 2-week Atkins period. This is the biggest bilogical change I can report, other than weight loss. Additionally, I guess, my peak heart rate also lowers, hypothetically due to difficulty attaining and performing in an anaerobic regime due to limited glucose availability (?)

Just my experience,

Brad C.

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