Critics May Have Told Big Fat Lies About the Atkins Diet
Wednesday, February 15th 2006
There is a growing number of people in the American medical establishment who believe that Dr Robert Atkins and his high-protein, low-carbohydrate diet may have been wrongly condemned without proper trial. These people are also saying that the high-carbohydrate, low-fat diet recommended all around the world by governments and most of the medical establishment in the past 20 years may be what is responsible for both the rampaging obesity epidemic and the spike in adult-onset diabetes.
At the lead, and lending considerable credibility to the questions being raised, is Dr Walter Willet, chairman of the department of nutrition at the Harvard School of Public Health.
At issue is the U.S. Government's carbohydrate-friendly food pyramid, which recommends six to 11 servings of grains a day. Translate "grains" to pasta, rice, bread and cereal. Doctors such as Willet also challenge the restriction of all fats, which lumps the "good fats" such as olive oil and canola oil in with highly saturated butter and fat in meats.
Willet says research at the longest-running, most comprehensive diet study clearly contradicts "the idea that all fat is bad for you."
In fact, the exclusive focus on the adverse effects of fat may have contributed to the obesity epidemic, he says. Those grain-based carbohydrates, as well as sugar-based products, are largely prohibited on low-carbohydrate diets that also encourage consumption of "good fats" - and even some more controversial choices as butter.
Mainstream researchers are now committed to studies of the benefits and risks of variations of the popular low-carb diets. A six-month study at North Carolina's Duke University released recently shows a low-carb diet can lead to significant and sustained weight loss. Dieters in the programme rigidly limited carbohydrates consumption to 25g a day, and despite the higher fat diet, blood lipid profiles improved.
According to a New York Times article, five recent studies showed that subjects on some form of the Atkins diet lost twice the weight as the subjects on the low-fat, low-calorie diet.
But controversy remains. A study of low-carbohydrate, high protein diets at the University of Texas Southwestern Medical Center concluded that while the diets do work for weight loss, they also raise the risk of kidney stones and possibly bone loss.
The U.S. Government's National Institutes for Health had funded a $US2.5 million study of 360 obese people for five years to see how they do on a low-carbohydrate diet.
Here is a very condensed version of the New York Time's article of July 7, 2002 re-examining the 30-year-old but still controversial diet. The excerpts appear here thanks to the author and copyright holder Gary Taubes.
New York Times' Revelations
When Atkins first published his Diet Revolution in 1972, Americans were just coming to terms with the proposition that fat - particularly the saturated fat of meat and dairy products - was the primary nutritional evil in the American diet.
Atkins managed to sell millions of copies of a book promising that we would lose weight eating steak, eggs and butter to our heart's desire, because it was the carbohydrates, the pasta, rice, bagels and sugar, that caused obesity and even heart disease. Fat, he said, was harmless.
Atkins allowed his readers to eat "truly luxurious foods without limit", as he put it, "lobster with butter sauce, steak with béarnaise sauce? bacon cheeseburgers", but allowed no starches or refined carbohydrates - which means no sugars or anything made from flour. Atkins banned even fruit juices, and permitted only a modicum of vegetables, although the latter negotiable as the diet progressed.
Research at the longest-running, most comprehensive diet study clearly contradicts "the idea that all fat is bad for you." Five recent studies showed that subjects on some form of the Atkins diet lost twice the weight as the subjects on the low-fat, low-calorie diet.
Atkins was by no means the first to get rich pushing a high fat diet that restricted carbohydrates, but he popularized it to an extent that the American Medical Association (AMA) considered it a potential threat to health. The AMA attacked Atkins' diet as a "bizarre regimen" that advocated and "unlimited intake of saturated fats and cholesterol-rich foods", and Atkins even had to defend his diet in Congressional hearings.
Thirty years later America has become weirdly polarized on the subject of weight. On the one hand Americans have been told with almost religious certainty by everyone from the Surgeon General on down (and have come to believe with almost religious certainty) that obesity is caused by the excessive consumption of fat, and that if they eat less fat, they will lose weight and live longer.
On the other, there is the ever-resilient message of Atkins and decades' worth of best-selling diet books pushing some variation of what scientists would call the alternative hypothesis: it's not the fat that makes us fat, but the carbohydrates, and if we eat less carbohydrates we will lose weight and live longer.
The perversity of this alternative hypothesis is that it identifies the cause of obesity as precisely those refined carbohydrates at the base of the famous Food Guide Pyramid - pasta, rice and bread - that we are told should be the staple of our healthy low-fat diet. It also identifies the sugar or corn syrup in the soft drinks (and fruit juices and sports drinks that we have taken to consuming in quantity if for no other reason than that they are fat-free and so appear intrinsically healthy) as a cause of obesity.
This alternative hypothesis is that the cause of obesity is precisely those refined carbohydrates at the base of the famous Food Guide Pyramid - pasta, rice and bread...
While the low-fat is good-health dogma represents reality as we have come to know it, and the U.S Government has spent hundreds of millions of dollars in research trying to prove its worth, the low-carbohydrate message has been relegated to the realm of unscientific fantasy.
However, over the past five years there has been a subtle shift in the scientific consensus. It used to be that even considering the possibility of the alternative hypothesis, let alone researching it, was tantamount to quackery by association. Now a small but growing minority of establishment researchers have come to take seriously what the low-carb-diet doctors have been saying all along.
Walter Willett, chairman of the department of nutrition at the Harvard School of Public Health, may be the most visible proponent of testing this heretic hypothesis.
Willett is the de facto spokesmen of the longest-running, most comprehensive diet and health studies ever performed, which have already cost upward of $US100 million and include data on nearly 300,00 individuals. That data says Willett, clearly contradict the low-fat-is-good-health message "and the idea that all fat is bad for you; the exclusive focus on adverse effects of fat may have contributed to the obesity epidemic."
These researchers point out that there are plenty of reasons to suggest that the low-fat-is-good-health hypothesis has now effectively failed the test of time. In particular, they say we are in the midst of an obesity epidemic that started around the early 1980s and that this was coincident with the rise of the low-fat dogma. (Type 2 diabetes, the most common form of the disease, also rose significantly through this period.)
The researchers also say low-fat weight-loss diets have proved in clinical trails and real life to be dismal failures, and that on top of it all, the percentage of fat in the American diet has been decreasing for two decades. Cholesterol levels have been declining, smoking has declined and yet the incidence of heart disease has not declined as would be expected.
"That is very disconcerting," Willett says. "It suggests that something else bad is happening."
The science behind the alternative hypothesis can be called Endocrinology 101, which is how it is referred to by David Ludwig, a researcher at Harvard Medical School. Ludwig runs the paediatric obesity clinic at children's Hospital Boston and prescribes his own version of a carbohydrate-restricted diet to his patients.
Endocrinology 101 requires an understanding of how carbohydrates affect insulin and blood sugar and in turn fat metabolism and appetite. This is basic endocrinology, Ludwig says, which is the study of hormones, and it is still considered radical because the low-fat dietary wisdom emerged in the 1960s from researchers almost exclusively concerned with the effect of fat on cholesterol and heart disease. At the time, Endocrinology 101 was still under-developed and so was ignored. Now that this science is becoming clear it has to fight a quarter century of anti-fat prejudice.
The alternative hypothesis also comes with an implication that is worth considering for a moment because it is a whopper and it may indeed be an obstacle to its acceptance. It the alternative hypothesis is right - still a big "if" - then it strongly suggests that the on-going epidemic of obesity in America and elsewhere is not, as we are constantly told, due simply to a collective lack of will power and a failure to exercise. Rather it occurred, as Atkins has been sating (along with Barry Sears, author of The Zone), because the public health authorities told us unwittingly, but with the best of intentions, to eat precisely those foods that would make us fat. And we did.
We ate more fat-free carbohydrates, which, in turn, made us hungrier and then heavier. Put simply, if the alternative hypotheses is right, then a low-fat diet is not by definition a healthy diet. In practice, such a diet cannot help being high in carbohydrates and that can lead to obesity, and perhaps even heart disease.
"For a large percentage of the population, perhaps 30 to 40%, low-fat diets are counterproductive," says Eleftheria Maratos-Flier, director of obesity research at Harvard's prestigious Joslin Diabetes Center. "They have the paradoxical effect of making people gain weight."
Scientists are still arguing about fat, despite a century of research, because the regulation of appetite and weight in the human boy happens to be almost inconceivably complex, and the experimental tools we have to study it are still remarkably inadequate. This combination leaves researchers in an awkward position.
To study the entire physiological system involves feeding real food to real human subjects for months or years on end, which is prohibitively expensive, ethically questionable (if you are trying to measure the effects of foods that might cause heart disease) and virtually impossible to do in any kind of rigorously controlled scientific manner.
But if researchers seek to study something less costly and more controllable they end up studying experimental situations so oversimplified that their results may have nothing to do with reality. This then leads to a research literature so vast that it is possible to find at least some published research to support virtually any theory. The result is a balkanized community - "splintered, very opinionated and in many instance, intransigent," says Kurt Isselbacher, a former chairman of the Food and Nutrition Board of the National Academy of Science. It is a community in which researchers seem easily convinced that their preconceived notions are correct and thoroughly uninterested in testing any other hypotheses but their own.
What is more, the number of misconceptions propagated about the most basic research can be staggering. Researchers will be suitably scientific describing the limitations of their own experiments, and then will cite something as gospel truth because they read it in a magazine.
The classic example is the statement heard repeatedly that 95% of all dieters never lose weight, and 95% of those who do will not keep if off. This will be correctly attributed to the University of Pennsylvania psychiatrist Albert Stunkard, but it will go unmentioned that this statement is based on 100 patients who passed through Stunkard's obesity clinic during the early 1950s.
"For a large percentage of the population...low-fat diets are counterproductive. They have the paradoxical effect of making people gain weight."
Few experts now deny that the low-fat message is radically oversimplified. If nothing else, it effectively ignores the fact that unsaturated fats, like olive oil, are relatively good for you: they tend to elevate your good cholesterol, high-density lipoprotein (HDL), and lower your bad cholesterol, low-density lipoprotein (LDL), at least in comparison to the effect of carbohydrates. While higher LDL raises your heart-disease risk, higher HDL reduces it.
What this means is that even saturated fats (the bad fats) are not nearly as deleterious as you would think. True, they will elevate your bad cholesterol, but they will also elevate your good cholesterol. In other words, it is a virtual washing. As Willett explained, you will gain little to no health benefit by giving up milk, butter and cheese and eating bagels instead.
But it gets even weirder than that. Foods considered more or less deadly under the low-fat dogma turn out to be comparatively benign if you actually look at their fat content. More than two-thirds of the fat in a porterhouse steak, for instance, will definitively improve you cholesterol profile (at least in comparison with the baked potato next to it): it is true that the remainder will raise your LDL, the bad stuff, but it will also boost you HDL. The same is true for lard. If you work out the numbers, you come to the surreal conclusion that you can eat lard straight from the can and conceivably reduce your risk of heart disease.
Researchers will be suitably scientific describing the limitations of their own experiments, and then will cite something as gospel truth because they read it in a magazine.
The crucial example of how the low-fat recommendations were oversimplified is shown by the impact - potentially lethal, in fact - of low-fat diets on triglycerides, which are the component molecules of fat. By the late 1960's researchers had shown that high triglyceride levels were at least as common in heart-disease patients as high LDL cholesterol, and that eating a low-fat, high-carbohydrate diet would, for many people, raise their triglyceride levels and lower their HDL levels.
After 20 years steeped in a low-fat paradigm, it is hard to see that fat could be harmless, let alone beneficial. I have learned that low-fat diets fail in clinical trails and in real life, and they certainly have failed in my life. I have read the papers suggesting that 20 years of low-fat recommendations have not managed to lower the incidence of heart disease in this country, and may have led instead to the steep increase in obesity and Type 2 diabetes.
I have interviewed researchers whose computer models have calculated that cutting back on the saturated fats in my diet to the levels recommended by the American Heart Association would not add more than a few months to my life, if that.
I have even lost considerable weight with relative ease by giving up carbohydrates in my test diet and yet I can look down at my eggs and sausage and still imagine the imminent onset of heart disease and obesity, the latter assuredly to be caused by some bizarre rebound phenomena the likes of which science had not yet begun to describe.
This is the state of mind I imagine that mainstream nutritionists, researchers and physicians must inevitably take to the fat-versus-carbohydrate controversy. They may come around, but the evidence will have to be exceptionally compelling.
Source; The New Zealand Charter Journal, Spring 2002
Footnote from Ideal Health:
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Chitosan, the fat & cholesterol binder that helps to promote weight loss and control blood pressure
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Good nutrition for positive weight control
Levels of protein, carbohydrate and fat in Food
Looking for a sugar alternative? Try Stevia
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Disclaimer: The health information presented here has been written for the New Zealand health consumer. It is of a general nature and is only intended to provide a summary of the subjects covered. The information is not intended to be comprehensive or to provide medical advice to you. While all care has been taken to ensure the accuracy of the information, no responsibility or liability is accepted, and no person should act in reliance on any statement contained in the information provided. All health ailments should be treated by a qualified health professional.
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