The Atkins Diet
The Atkins Nutritional Approach, popularly known as the Atkins Diet or just Atkins, is the most marketed and well-known of the low-carbohydrate diets. It was adopted by Dr. Robert Atkins (1930-2003) in the 1960s from a diet he read in the Journal of the American Medical Association and utilized to resolve his own overweight condition following medical school and graduate medical training. After successfully treating over ten thousand patients, he popularized the Atkins diet in a series of books, starting with Dr. Atkins' Diet Revolution in 1972. In his revised book, Dr. Atkins' New Diet Revolution, Atkins updated some of his ideas, but remained faithful to the original concepts.
The Atkins franchise (i.e., the business formed to provide products serving people "doing Atkins") had been highly successful due to the popularity of the diet, and is considered the iconic and driving entity of the larger "low-carb craze". However, various factors have led to its dwindling in success, and the company Atkins Nutritionals of Ronkonkoma, New York, founded by Dr. Atkins in 1989, filed for bankruptcy in July of 2005. The Atkins logo is still highly visible through licensed-proprietary branding for food products and related merchandise.
Atkins Diet Menu:
Nature of the diet
The Atkins Diet - represents a radical departure from prevailing
theories. Atkins claimed there are two main unrecognized factors
about Western eating habits, arguing firstly that the main cause of
obesity is eating refined carbohydrates, particularly sugar, flour,
and high-fructose corn syrups; and secondly, that saturated fat is
overrated as a nutritional problem, and that only trans fats from
sources such as hydrogenated oils need to be avoided. Consequently,
Dr. Atkins rejects the advice of the food pyramid, instead asserting
that the tremendous increase in refined carbohydrates is responsible
for the rise in metabolic disorders of the 20th century, and that
the focus on the detrimental effects of dietary fat has actually
contributed to the obesity problem by increasing the proportion of
insulin-inducing foods in the diet.
Dr. Atkins argued that many eating disorders are the result of
hyperinsulinism, or excessive secretion of insulin which comes
through eating too many carbohydrates. According to Dr. Atkins, this
causes food cravings and unstable blood sugar levels, which can
cause mood swings, depression, and sleeping problems. He claimed
that his diet stabilizes insulin and blood sugar levels, eliminating
cravings and often reducing appetite, which ultimately changes
metabolic process causing a more active burning of stored fat.
Still, the most recent research suggests deeper roots in such
alterations of metabolism functions, arguing that the ultimate
effect of an increase in protein consumption prolongs the feeling of
being sedated, and by doing so reduces the desire to eat.
The question remained though: Why is the feeling of fullness largely
caused by high protein consumption? According to their research
published at Cell Metabolism, Rachel Batterham with her colleague
from University College, London suggest that the connection between
protein intake and weight loss is a small protein molecule, called
peptide YY - a hormone released into the bloodstream from the gut
that acts in the arcuate nucleus of the hypothalamus (the part of
the brain that controls appetite). In effect, the dietary protein
proves to be more effective stimulating release of Peptide YY than
dietary carbohydrate, decreasing craving for food.
While most of the emphasis in Atkins is on the diet, nutritional
supplements and exercise are considered equally important elements.
Atkins involves the restriction of carbohydrates in order to lower
the intake of unnecessary carbohydrates albeit not to cut out
comprehensively, in order to switch the body's metabolism from
burning glucose to burning fat (chiefly, stored fat). This process
(called lipolysis) begins when the body enters the state of ketosis
as a consequence of running out of excess carbohydrates to burn.
Atkins restricts "net carbs", or carbs that have an effect on blood
sugar. Net carbohydrates can be calculated from a food source by
subtracting sugar alcohols and fiber (which are shown to have a
negligible effect on blood sugar levels) from total carbohydrates.
Sugar alcohols need to be treated with caution, because while they
may be slower to convert to glucose, they can be a significant
source of glycemic load and can stall weight loss. Fructose (eg, as
found in many industrial sweeteners) also contributes to caloric
intake, though outside of the glucose -- insulin control loop.
Preferred foods in all categories are whole, unprocessed foods with
a low glycemic load.
Phases
There are four phases of the Atkins diet.
Induction
The Induction phase is the first, and most restrictive, phase of the
Atkins Nutritional Approach. It is intended to cause the body to
quickly enter a state of ketosis. Carbohydrate intake is limited to
20 net grams per day. The allowed foods include a liberal amount of
most meats, up to 4 ounces of aged, hard or soft cheeses, three
tablespoons of heavy cream, two cups of salad vegetables, one cup of
other low glycemic low carb vegetables. Caffeine and alcoholic
beverages are not allowed.
The Induction Phase is usually when many see the most significant
weight loss - reports of losses up to six or eight pounds (3 or 4
kg) per week are not uncommon.
Atkins suggests the use of Ketostix, small chemically reactive
strips used by diabetics. These let the dieter monitor when they
enter the ketosis, or fat burning, phase.
However, simply watching your weight will work. Losing 1-2 pounds a
day means you are in ketosis.
Ongoing weight loss
The Ongoing Weight Loss (OWL) phase of Atkins consists of an
increase in carbohydrate intake, but remaining at levels where
weight loss occurs. The target daily carbohydrate intake increases
each week by 5 net grams. A goal in OWL is to find the "Critical
Carbohydrate Level for Losing" and to learn in a controlled manner
how food groups in increasing glycemic levels and foods with in that
group effect your craving control. The OWL phase lasts until weight
is within 10 pounds (4.5 kg) of the target weight. At first weeks
you should add more of the induction acceptable vegetables to your
daily products. For example, 6-8 stalks of asparagus, salad, one cup
of califlower or one half of avocado. The next week you should
follow the carbohydrate ladder Dr Atkins created for this phase and
add fresh dairy. the ladder has 9 rungs and should be added in order
given. One can skip a rung if one does not intend to include that
food group in one's permanent way of eating such as the alcohol
rung. the rungs are as follows: induction acceptable vegetables,
fresh dairy, nuts, berries, alcohol, legumes, other fruits, starchy
veggies, grains.
Pre-maintenance
Carbohydrate intake is increased again this time by 10 net carbs a
week from the ladder groupings, and the key goal in this phase is to
find the "Critical Carbohydrate Level for Maintenance", this is the
maximum number of carbohydrates you can eat each day without gaining
weight. This may well be above the level of carbohydrates inducing
ketosis on a testing stix. So it is not necessary to maintain
positive stix testing ketosis forever.
Lifetime maintenance
This phase is intended to carry on the habits acquired in the
previous phases, and avoid the common end-of-diet mindset that can
return people to their previous habits and previous weight. Whole,
unprocessed food choices are emphasized, with the option to drop
back to an earlier phase if you begin to gain weight.
Popularity
The Atkins Nutritional Approach gained widespread popularity in 2003
and 2004. At the height of its popularity one in eleven adults were
on the diet. This large following was blamed for large declines in
the sales of carb-heavy foods like pasta and rice (sales were down
8.2 and 4.6 percent respectively in 2003). The diet's success were
even blamed for a decline in Krispy Kreme sales. Trying to
capitalize on the "low-carb craze" many companies released special
product lines which were low in carbohydrates. Coca-Cola released C2
and Pepsi-Cola created Pepsi Edge, which was scheduled to be
discontinued later in 2005. Unlike the sugar-free soft drinks Diet
Coke and Diet Pepsi, which had been available for decades, these new
drinks used a blend of traditional sweetener with the diet drinks'
artificial sweeteners to offset some of the allegedly inferior
flavor of artificial sweeteners. These "half and half" drinks
declined in popularity as soft drink makers learned to use newer
sweeteners to mask the flavor of aspartame (or completely replace
it) in reformulated diet drinks such as Coca-Cola Zero and Pepsi
ONE.
Robert Atkins died from a fatal head injury sustained in a fall on
ice in 2003. The nutritional plan suffered from rumors and
allegations that he was obese at the time and had died from a heart
condition as a result. On July 31, 2005, the Atkins Nutritional
company filed for Chapter 11 bankruptcy protection after the
percentage of adults on the diet declined to two percent and sales
of Atkins brand product fell steeply in the second half of 2004 .
Criticism
An analysis conducted by Forbes magazine found that the Atkins
Nutritional Approach (the boxed retail food product created by
Atkins to facilitate the Atkins diet) is one of the five most
expensive diet plans of the ten plans Forbes analyzed. Although
Forbes found that Atkins diet was significantly less expensive than
Jenny Craig and only slightly more expensive than Weight Watchers,
the Atkins diet nevertheless involved more than an 80% premium over
average American food expenses.
Low-carbohydrate diets have been the subject of heated debate in
medical circles for three decades. They are still controversial and
only recently has any serious research supported some aspects of
Atkins' claims, especially for short-term weight-loss (6 months or
less).
But many in the scientific community also raise serious concerns:
* A 2001 scientific review by Obesity Research magazine concluded
that low-carb dieters' initial advantage in weight loss was a result
of increased water loss, and that after the initial period, low-carb
diets produce similar fat loss to other diets with similar caloric
intake. [8]
* Even in studies only one year long, this diet can fail to produce
the greater weight-loss which is claimed to come from factors other
than calorie-reduction such as ketosis: It was compared to dieters
on the Ornish Diet, Weight Watchers, and The Zone diet for 1 year.
The Atkins Diet came last in terms of weight lost at the end of the
year.
* The May 2004 Annals of Internal Medicine study showed that Atkins
Dieters had significantly more diarrhea, general weakness, rashes
and muscle cramps. Atkins.com now suggests a fiber supplement.
* Also, acidity from the typically high protein intake can cause
Osteoporosis.
Opponents of the diet also point out that the initial weight loss
upon starting the diet is a phenomenon common with most diets, and
is due to reduction in stored glycogen and related water in muscles,
not fat loss. They claim that no evidence has surfaced that any diet
will cause weight loss unless it reduces food energy below the
maintenance level, and reports have indicated that successful weight
loss due to the Atkins diet may be the result of less food energy
being consumed by the dieter, rather than the lack of carbohydrates.
They further point out that weight loss on fad diets, which
typically restrict or prohibit certain foods, is often due to the
fact that the dieter has fewer food choices available. Also, a diet
of low-carb foods may quickly become dull to many people, meaning
that their appetite is somewhat naturally suppressed as they become
hungry for carbs, but the dieter either has none handy or resists
this hunger.
On May 27, 2004, Jody Gorran, a 53-year-old Florida businessman with
a family history of heart disease, filed a lawsuit against Atkins
Nutritionals, Inc. and the estate of Dr. Robert Atkins, claiming
that the Atkins diet regimen caused severe heart disease, making it
necessary for him to undergo angioplasty. As of 28 May, he has been
seeking a court injunction banning Atkins Nutritionals from
marketing its products without a warning of potential health risks,
and asking for compensatory damages.
Dr. Robert Eckel of the American Heart Association says that
high-protein, low-carbohydrate diets put people at risk for heart
disease.
The Physicians Committee for Responsible Medicine, a PETA-connected
organization which is opposed to the Atkins diet, has noted that in
East Asian countries such as Thailand or Japan, the average person's
diet consists of mainly carbohydrates such as rice and noodles, yet
these groups have very low rates of obesity. The average Asian
person is also thinner and slimmer than the average Westerner. This
example seems to contradict the Atkin's claim that low-carbohydrate
diets help to lose weight. However, they do show similar rates of
heart disease and most cannot afford to eat meat.
Views in favor of the diet
When the Atkins diet was introduced in the 1970s, it was immediately
attacked by existing experts, who claimed it was unhealthy and would
fail. Some short-term studies indicate the contrary or indicate that
the long-term safety needs more research:
* "The low-carbohydrate diet produced a greater weight loss for the
first six months, but the differences were not significant at one
year. The low-carbohydrate diet was associated with a greater
improvement in some risk factors for coronary heart disease.
Adherence was poor and attrition was high in both groups. Longer and
larger studies are required to determine the long-term safety and
efficacy of low-carbohydrate, high-protein, high-fat diets." --New
England Journal Of Medicine, Volume 348:2082-2090, 22 May 2003,
Number 21
* "better participant retention and greater weight loss...greater
decreases in serum triglyceride levels" --Annals Of Internal
Medicine, 18 May 2004 | Volume 140 Issue 10 | Pages 769-777(Journal
Editor's note: 'While the study suggests the efficacy and relative
safety of the low-cholesterol diet, the high dropout rate,
self-directed adherence to the diet, and relatively short
observation period challenge the generalizability of the findings.'
* "sustained weight loss [at 6 months]" --Atkins funded,
non-randomized, non-control intervention trial, American Journal of
Medicine, Volume 113, Issue 1, July 2002, Pages 30-36
* "When carbohydrates were restricted [during a 2-week study on 10
obese Patients with Type 2 Diabetes], study subjects spontaneously
reduced their caloric intake to a level appropriate for their
height, did not compensate by eating more protein or fat, and lost
weight. We concluded that excessive overeating had been fueled by
carbohydrates." "In addition to the calorie reduction and weight
loss, subjects experienced markedly improved glucose levels and
insulin sensitivity, as well as lower triglycerides and
cholesterol." This is not a controlled study in that there was no
control group; it merely observed the effect of putting ten obese
diabetics on the Atkins diet; this is "the only study of the Atkins
diet to have been conducted in the strictly controlled environment
of a clinical research center where every calorie eaten and spent
was measured." --Annals of Internal Medicine, 15 March 2005
Two of these represent scientifically controlled studies, published
in peer-reviewed journals. It should be noted, however, that the
number of participants was tiny with less than 100 people completing
each study. They were also short at 6 months and 1 year
respectively. To date no long term study on Atkins has taken place.
Proponents of the Atkins diet feel much of the criticism leveled at
the diet comes from statements and opinions of individuals and
associations, rather than from controlled and reviewed studies.
Advocates of the diet dispute criticisms based on the fact that a
low-carb diet is likely to be high-fat and allegations that fat,
especially saturated fat, is harmful. Atkins backers maintain that,
aside from trans fat, saturated fat is not harmful. Proponents cite
Gary Taubes who, in a 2001 article in Science, 291 (5513): 2536,
claims that the oft-cited "consensus" opinion against saturated fats
derives from political rather than scientific motives.
Critics of the Atkins diet may focus particularly on Atkins, or on
low-carb dieting in general. Proponents claim that critics fail to
consider that people are built differently, and as with any diet,
the Atkins may not be effective for some people.
Continuing research supports the idea that saturated fat may be
cardio-protective in some populations, see
http://www.ajcn.org/cgi/content/abstract/80/5/1175, "Dietary fats,
carbohydrate, and progression of coronary atherosclerosis in
postmenopausal women" and
http://www.ajcn.org/cgi/content/full/80/5/1102 , "Saturated fat
prevents coronary artery disease? An American paradox."
The 22 May 2003, issue of the New England Journal of Medicine
published two scientific, randomized studies comparing standard
low-fat diets to low-carbohydrate diets such as the Atkins Diet. In
both studies, subjects lost more weight on the low-carbohydrate
plans at 6-months but not at 1-year. The editors noted that
"Adherence was poor and attrition was high in both groups. Longer
and larger studies are required to determine the long-term safety
and efficacy of low-carbohydrate, high-protein, high-fat diets."
A research study carried out by the Weight and Eating Disorders
Program at the University of Pennsylvania, reported in May 2003 that
the Atkins diet raised levels of HDL (or "good") cholesterol by an
average of 11% and reduced the amount of triglycerides in the
bloodstream by 17%. This counters one of the chief criticisms of
Atkins' approach, which is that cholesterol is raised by eating
fatty foods and meat.
In another study, conventional dieters' HDL cholesterol raised by
1.6% while their triglyceride levels improved. Weight loss was also
statistically greater in the Atkins dieters after three and six
months compared with the conventional dieters (although this did not
remain statistically significant after a year). The study followed
the diets of 63 obese men and women. (See New Scientist, 21 May
2003.)
In conclusion, although a small number of short-term studies have
been carried out, that indicate that Atkins-style diet may help
dieters achieve comparable weight loss with other dieting methods,
no long term study has yet to be carried out. Thus the long-term
effects of Atkins on health remains unknown, and the results of
these studies indicates the effectiveness of the diet for losing
weight is no better.
Misconceptions about the diet
Many people incorrectly believe that the Atkins Diet promotes eating
unlimited amounts of fatty meats and cheeses. This is a key point of
clarification that Dr. Atkins addressed in the more recent revisions
of his book. Although the Atkins Diet does not impose limits on
certain foods, or caloric restriction in general, Dr. Atkins points
out in his book that this plan is "not a license to gorge."
Some criticism of the diet seems to be based on a confusion between
ketosis and ketoacidosis. Ketosis is short for Benign Dietary
Ketosis, which is a normal metabolic process that results when
glucose is not available as a source of energy. The body then burns
mostly fat, both directly and through conversion to ketones which
make the energy of fat available in water soluble form. Ketoacidosis
is a metabolic crisis due to the inability to utilize glucose
because of a lack of insulin and in which there is an abnormal
accumulation of ketones exacerbated by severe dehydration as the
kidneys spill the useless glucose, losing water in the process. This
occurs in diabetics, in a related form in alcoholics, and also in
starvation.
Another common misconception arises from confusion between the
Induction Phase and rest of the diet. The first two weeks of the
Atkins Diet are strict, with only 20g of carbohydrates permitted per
day. Atkins claims that a dieter can safely stay at the Induction
Phase for several months if the person has a lot of weight to lose.
Once the weight-loss goal is reached, carbohydrate levels are raised
gradually, though still significantly below USDA norms, and still
within or slightly above the definition of ketosis.
The Induction Phase is also known for its comparatively lower intake
of dietary fiber, and this is often misconstrued as characteristic
of the diet as a whole. In fact fibre supplements, such as psyllium
husks, are recommended for the early stages. It is often misstated
that those on the diet do not consume enough vegetables and fruits.
However those who follow it properly should not face this problem as
even the Induction Phase allows for adequate amounts of dark green
leafy vegetables, for example. Many people who try Atkins have
reported eating more vegetables while on the plan than they ever did
before, for example on an informal online low-carb blog survey.