~ A Critical Appraisal of the Atkins Diet

From Dr. Michael T. Murray's Natural Facts Newsletter. Reprinted with permission.


The "Atkins Diet" is now perhaps the most famous diet of all time. Developed by Robert Atkins, M.D. during the 1960s, it is a high-protein, high fat, low-carbohydrate diet that emphasizes the consumption of all meats, poultry, fish, eggs, and most cheeses while limiting the intake of carbohydrates. In the early 1990s, Dr. Atkins brought his diet back into the nutrition spotlight with the publication of his best-selling book Dr. Atkins� New Diet Revolution. It is now estimated that more than 100 million people worldwide have tried the Atkins Diet.

One of the big reason why the Atkins Diet is so attractive to dieters who have tried unsuccessfully to lose weight on low-fat, low-calorie diets is that while on the Atkins program dieters can eat as many calories as desired from protein and fat, as long as carbohydrate consumption is restricted. As a result, many Atkins dieters are spared the feelings of hunger and deprivation that accompany other weight loss regimens.

A Preface to the Critique

While I disagreed with Dr. Atkins on many fundamental dietary issues, he was a man I deeply admired and respected. Just after his New Diet Revolution was published, we were set up as adversaries on a debate on diet and health at a natural foods retailer conference. He called me prior to the conference and suggested that we meet beforehand for breakfast. We had met a couple of times previously and I had been a guest on his radio program. He seemed quite friendly, but I was a little worried because we had such different views on diet. At breakfast, he loaded up on a full plate of bacon and eggs at the buffet table while I chose to have some mixed fruit, yogurt, and bran flakes. Anyway, we talked a little about the format of our debate, but mainly we talked about larger issues such as the oppression of effective natural medicines within the conventional medical community and kindled a cordial professional friendship. Our debate reflected an awareness that we were ultimately on the same side.

Over the next 10 or so years, we spoke on numerous occasions on the phone and at trade shows. He also had me as a guest on his radio show periodically. During this time, his star had risen considerably coinciding with the success of his book and the whole �low-carb� phenomena. I have seen success change people, mainly for the worse. With Dr. Atkins, the more successful he became, from what I saw the more grace, respect, and humility he displayed. I was genuinely happy for his success, because he deserved it and because he was so genuine himself. Dr. Robert Atkins� passion about his diet was based upon his personal and clinical experiences with it. He had seen it transform people�s lives. I honestly believe that it was those experiences that fueled his passion. Though he became known for his diet, he was knowledgeable and experienced in other natural and alternative therapies as well. It has been over 2 years since his death and with his death the low�carb craze seems to be dying as well as noted by the recent bankruptcy filing for Atkins Nutritionals, Inc.

I wanted to preface my appraisal of the Atkins Diet with this personal tribute to demonstrate to Dr. Atkins the same respect he always gave me.

Description of the Atkins Diet

The Atkins Diet is divided into four phases: Induction, Ongoing Weight Loss, Pre-maintenance, and Maintenance. During the Induction phase (the first 14 days of the diet), carbohydrate intake is limited to no more than 20 grams per day. No fruit, bread, grains, starchy vegetables, or dairy products, except cheese, cream and butter, are allowed during this phase. During the Ongoing Weight Loss phase, dieters experiment with various levels of carbohydrate consumption until they determine the most liberal level of carbohydrate intake that allows them to continue to lose weight. Dieters are encouraged to maintain this level of carbohydrate intake until their weight loss goals are met. Then, during the Premaintenance and Maintenance phases, dieters determine the level of carbohydrate consumption that allows them to maintain their weight. To prevent regaining weight, dieters must stick to this level of carbohydrate consumption, perhaps for the rest of their lives.

While I agree with the underlying principle of the Atkins Diet, that diets high in sugar and refined carbohydrates cause weight gain, and ultimately lead to obesity, I do not agree with the solution. I just do not think the Atkins Diet promotes health or is reflective of what humans were designed to eat (see Human Nutrition - An Evolutionary Perspective).

Clinical Evaluation of the Atkins Diet

Despite its enormous popularity, the Atkins program was not evaluated in a proper clinical trial until 2003. In this initial study, while people following the Atkins Diet did experience initial weight loss, though likely as a result of water loss rather than true fat loss, in the long run they gained it all back plus more. In the study, 63 obese men and women were randomly assigned to the Atkins Diet or a low-calorie, high-carbohydrate, low-fat diet. Professional contact was minimal to replicate the approach used by most dieters. While subjects on the Atkins Diet had lost more weight than subjects on the conventional diet at 6 months, the difference at 12 months was not significant. Adherence was poor and attrition was high in both groups.1

Since this initial clinical evaluation other studies have shown similar results. For example, in one study of 34 adults with impaired glucose tolerance 12 weeks of a low fat (18% of total calories), high-complex carbohydrate (62+% of total calories) diet alone (High-CHO) or paired with an aerobic exercise training program (High-CHO+Ex) was compared with the effects of an Atkin�s style diet (41% fat, 14% protein, 45% carbohydrate of total calories). Fiber intake averaged 58�61 g/day in the two high-carbohydrate groups versus 18.5 g/day in the control group. Aerobic exercise was engaged in for 45 minutes per day, four days per week, at 80% of peak oxygen consumption in the High-CHO+Ex group.

All participants were instructed to consume food as they wished. While caloric intake was similar in all three groups, both High-CHO groups (with and without exercise) lost more weight (mean loss 10.5 pounds with exercise and 7 pounds without exercise than the control group (mean loss: a fraction of one pound). Similarly, a higher percentage of body fat was lost by High-CHO+Ex (3.5%) and by High-CHO without exercise (2.2%) than controls (0.2% increase in body fat). Thigh fat area also decreased significantly in both High-CHO groups but not in the control group. Resting metabolic rate and rate of fat oxidation were not decreased in the Hi-CHO (or control) groups.2

In another study, 132 obese adults (BMI >35) of whom 83% had type 2 diabetes or metabolic syndrome were counseled to consume either an Atkins-like diet limited to <30 g of carbohydrate (CHO) per day or to a diet restricted by 500 Kcal per day with <30% of Kcal coming from fat. While initially the Atkins diet did promote weight loss during the first six-month period, but this effect began to disappear during the second six-month period. At 12 months, the difference between average weight loss in the groups was no longer statistically significant (11 pounds in the Atkins group versus 7 pounds in the low fat group) though changes in triglyceride levels favored the Atkins diet (-57 mg vs. +4 mg/dl) as did HgA1c reductions (-0.7 vs. -0.1%) in the patients with type 2 diabetes.3

Another study worth commenting on was funded by the Atkins Foundation. In this study, 120 overweight but otherwise healthy adult subjects with elevated lipid levels followed either the Atkins diet or a diet containing <30% calories from fat, 10% or fewer calories from saturated fat, <300 mg cholesterol, and a deficit of 500-1000 calories. At 24 weeks, the Atkins group had lost a mean of 26 pounds versus a mean loss of 14 pounds in the reduced-fat group. Triglyceride levels fell more in the Atkins group (-74 mg/dl) than in the restricted-fat group (+28 mg/dL) as well and HDL levels increased in the Atkins group (5.5 mg/dl) while they decreased in the low-fat group (-1.6 mg/dl). The main criticism of this dietary study was that the so-called "low-fat" group received almost 30% of their caloric intake from fat and the dieticians administering the dietary recommendations made no clear attempt to significantly restrict sugar and refined carbohydrate sources. Thus, the control diet to which the Atkins diet was compared to was significantly less than ideal.4

The findings from these clinical trials indicate that while adhering strictly to the Atkins diet (dramatically reducing carbohydrate intake while allowing free access to high-fat and high-protein foods) can lead to more weight loss in the first six months, eating a more healthful diet is associated with equal efficacy in the long run and is considerably more health promoting. The long-term health effects of over consumption of high fat and protein include an increased risk for cancer, gout, osteoporosis, and many other chronic diseases. It just seems that it makes more sense to achieve weight loss through more healthful measures.

The Slimstyles Program: An Alternative to the Atkins Diet

The dietary program that I recommend for weight loss is the SlimStyles weight loss program from Natural Factors. While most popular diets will promote short term weight loss if followed closely, they are often so regimented or involve such deprivation of health-promoting foods that very few people have the motivation to stay with these programs over the long term. So, for the long term the overwhelming majority of people fail to achieve and maintain their weight loss goals on these sorts of programs. The SlimStyles program offers a more rationale approach to achieving weight loss. It provides is a new and effective approach that does not fail.

The SlimStyles program is based upon breakthroughs in the understanding of human appetite regulation and methods to improve sensitivity to the hormone insulin. SlimStyles program works because it is based upon achieving five key goals:
  • Effectively decreasing appetite leading to a reduction of calories consumed.
  • Improvement in the sensitivity of body cells to the hormone insulin.
  • Increasing metabolism and the burning of fat without the use of harsh stimulants.
  • Resetting the mechanisms that control fat cell size and body weight.
The secret to the success of the SlimStyles program is a revolutionary dietary fiber supplement known as PGX� (PolyGlycopleX) - a unique blend of selected, highly viscous soluble fibers that act synergistically to develop a higher level of viscosity and expansion with water than with the same quantity of any other fiber alone. Taking PGX� with or before each meal every day in conjunction with healthy eating habits and moderate exercise leads to effective and permanent weight loss.

The development of PGX� began as the result of intense scientific research at the University of Toronto led by Vladimir Vuksan Ph.D., one of the most respected and recognized experts on the role of diet in the risk of diabetes, heart disease, and obesity. Hundreds of different fiber combinations were tested in laboratory, animal and human studies before the formulation was initially established.

Beginning in 2002, Dr. Lyon and researchers at Natural Factors began working cooperatively with the University of Toronto researchers, modifying their formulation for better stability through the digestive tract and improving upon its characteristics as a food ingredient. Through Dr. Lyon�s work significant improvements were made. For example, PGX� was improved so that it has a modest viscosity when first mixed in a weight loss shake, but the viscosity increases greatly once it reaches the stomach and intestine as it forms a very large gelatinous mass that produces the following benefits:
  • Reduces postprandial (after-meal) blood glucose levels
  • Reduces appetite and promotes effective weight loss
  • Increases insulin sensitivity
  • Improves diabetes control
  • Lowers blood cholesterol
PGX� is included in several products from Natural Factors, not only in the SlimStyles label, but also in the WellBetX line of products for glucose management.

Clinical trials are now under way with the SlimStyles program. We hope that the results from these more formal trials produce the same sort of fantastic results that our pilot study and clinical evaluations have.

Key References
  1. Foster GD, Wyatt HR, Hill JO, et al. A randomized trial of a low-carbohydrate diet for obesity. N Engl J Med 2003;348:2082-90.
  2. Hays NP, Starling RD, Liu X, et al. Effects of an ad libitum low-fat, high-carbohydrate diet on body weight, body composition, and fat distribution in older men and women. Arch Intern Med 2004;164:210�7.
  3. Stern L, Iqbal N, Seshadri P, et al. The effects of low-carbohydrate versus conventional weight loss diets in severely obese adults: one-year follow-up of a randomized trial. Ann Intern Med 2004;140:769-77.
  4. Yancy WS, Olsen MK, Guyton JR, et al. A low-carbohydrate, ketogenic diet versus a low-fat diet to treat obesity and hyperlipidemia. Ann Intern Med 2004;140:769-77.

Michael T. Murray, N.D., is a graduate of Bastyr University in Seattle, Washington, and the author of over 20 books including his latest How to Prevent and Treat Diabetes with Natural Medicine. Dr. Murray is Director of Product Development for Natural Factors Nutritional Products.

� 2005 www.doctormurray.com. Reprinted with permission.

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