Central  South  Dakota  Medical News
The Clinical View
by Phillip Hoffsten
13 OCTOBER 2004

THE DIET MAZE:  THE ATKIN’S DIET

     Last week’s column addressed some generalizations about the many, many diets that are available.  This week’s column will address the history, the effectiveness, and the safety of  the Atkin’s diet plan.  The information contained below is based upon objective, available medical evidence.  It must be realized that the Atkin’s diet plan is a commercial fee for service program with advertisements and claims not at all based upon objective evidence.

     Proponents of the Atkin’s diet plan may take exceptions to the above statement.  A note of clarification is in order.  The claims made for diet plans vary.  Some are directed at rapid weight loss.  Others are directed as control of blood pressure or control of high blood cholesterol.  If a diet user is asked what they would like their diet to achieve, I don’t think very many would answer that they would like a three month or a six month bandaide applied to the problem.  The concept of dietary interventions is to achieve a long term (even lifetime) solution to their high blood pressure, high cholesterol or weight problem.  The discussion that follows has the perspective of long term results, not a three month or a six month treatment plan.

     Question #1:  Where did the idea for the Atkin’s diet plan come from?
     About 1960 Dr. Yudkin published a paper analyzing the dietary habits of the European-American population.  He noted that as more and more refined carbohydrates (breads, cakes, pasta, candy, pastries) came into the European-American diet, the rate of heart disease, high blood pressure and stroke also increased.  Dr. Yudkin looked back at what our ancestors 10,000 years ago ate.  He noted that there were no bakeries, no granulated sugar, no carbonated beverages, no spaghetti factories, and no Mars bars.  Instead our ancestors ate meat and those naturally occurring fruits and vegetables available.  Our ancestor’s diets were relatively higher in protein and fat and relatively lower in carbohydrates.  Not really mentioned but certainly true was the fact that 10,000 years ago there was not the plethora of food in grocery stores such as we have now.  Our ancestors had to chase down, hunt, or gather food rather than stroll down the isle of a well-lit air-conditioned grocery store.   Dr. Robert Atkins picked up on Dr. Yudkin’s observation and by 1970, he wrote a book describing the Atkin’s diet plan.  In that book, he stated that the low fat diet idea was completely wrong.  Instead what he said  we should have is a low carbohydrate diet.  From there, Dr. Atkin’s diet plan has evolved over the past 35 years through multiple modifications (improvements) to its present commercial level with web sites and books on how to use the Aktin’s diet plan.

     Question #2:  Does the Atkin’s diet plan lead to effective weight loss?
     The answer is a very clear yes if the diet plan is followed.  In medical scientific studies involving several hundred individuals, patients who followed the Atkin’s diet plan lost more weight than those who followed a low fat diet plan.  The medical studies upon which this conclusion was based ran only for six months.  There are no long term (several years) studies demonstrating prolonged weight loss or maintenance of the weight that is lost.

     Questions #3:  What is the “gimmick” that makes the Atkin’s diet plan work?
     When a person burns carbohydrates, the waste products are carbon dioxide which is breathed out and water which is excreted in either the urine or sweat.  When a person burns fat, there is a waste product called ketone bodies.  Ketone bodies can be thought of as a stub of a fat molecule.  Ketone bodies cannot be used for energy and instead are excreted in the urine or from the lungs.  Patients that have significant ketone bodies in their blood will have a slight tuity-fruity odor to their breath that smells like s solvent called acetone, which is one of the components of fingernail polish remover.  The Atkin’s diet plan gimmick is the appetite suppression that occurs when a person has a significant amount of ketones in their blood.  With a suppression of appetite, the person is more satisfied and doesn’t get the nibblies that so often lead to weight gain.

     Question #4:  What is the problem with Atkin’s diet plan?
     One problem with the Atkin’s diet plan is the same one present for all diet plans.  Specifically, people stop following the diet.  There is an easy way to see if someone is following the Atkin’s diet plan.  If the person is truly on a low carbohydrate high fat/protein diet, their urine will have ketone bodies easily detected with a simple urine test.  When a large group of individuals stating that they were following the Atkin’s diet plan were monitored for ketone bodies in the urine, most patients had undetectable levels by the end of the third month.  They think that they are still following the diet plan but that is not really happening. The reason for this is the same problem that all diet plans have.  Individuals crave variety in their meal.  Also, the Atkin’s diet plan is more expensive than meals with refined carbohydrates included.

     Question #5:  Is the Atkin’s diet plan safe?
     There are no data indicating a problem with up to six months of use with the Atkin diet plan but there isn’t any information or data addressing what happens to individuals who might follow this diet plan over 3 or 5 or 10 years time.  At least one possible problem with the Atkin’s diet plan is the extra acid that is generated by burning fat.  Those ketone bodies that were mentioned above are all acids.  To neutralize the acid the person needs to have adequate calcium and alkali in their diet.  If these two components are not provided, a person will use bone mineral to neutralize the excess acid.  The detrimental effects from this are the development of osteoporosis and the possible development of kidney stones as the bone mineral calcium is excreted in the urine.  Both of these problems have been seen in patients on high fat, high protein diets.  To this time, there is no objective group information documenting the likelihood of these problems.

     Question #6:  Is there any information showing that the Atkin’s diet plan prevents heart attacks or strokes?
     To this time, there is no published objective medical information indicating that the Atkin’s diet plan decreases stroke or heart attack.  Note this was the original problem that the Atkin’s diet plan was directed to address.  Instead the Atkin’s diet has evolved into a weight loss program which has short term effectiveness but no demonstrated long term prevention of stroke, heart attack, or weight control.

     Question #7:  For whom would the Atkin’s diet plan be an appropriate recommendation?
     At this point, the only objective benefit from the Atkin’s diet plan is for a person who wants to lose 12 pounds in the next 6 months.  The person will have to be disciplined enough to follow the plan and affluent enough to afford it.  There is no objective medical evidence for benefits after six months.

     Question #8:  What about other high fat, low carbohydrate diets?
     The South Beach Diet is merely a spin off from the Atkin’s diet plan.  There is no substantive medical difference between the two. The basis for all high fat diets including the South Beach Diet is the production of ketone bodies as mentioned above.  The Atkin’s diet is the most studied of all the low carbohydrate diets.