Diet Wars

Datum objave: 01. 01. 2005.

Most people living in Western countries have an obsession with weight loss at some point in their life. Most of them will try any diet that comes advertised in a book, magazine, newspaper, TV, etc. no matter how ridiculous it may sound. There are even a “Grapefruit Diet” and a “Cabagge Soup Diet”..
Not long time ago in a galaxy not so far away…

The Atkins Diet, The Zone, Ketogenic Diet, Sugar Busters, etc…just to mention a few of them. There are numerous diets out there: some of them popular, some of them not; some of them effective, some of them not; some of them safe, some of them not. Doctors against Industry, Nutritionists against Patients, Doctors against Doctors, Nutritionists against Nutritionists, Patients against Patients…even grandmothers are involved…

Don´t be mistaken: It is WAR out there. The Diet Wars.

Most people living in Western countries have an obsession with weight loss at some point in their life. Most of them will try any diet that comes advertised in a book, magazine, newspaper, TV, etc. no matter how ridiculous it may sound. There are even a “Grapefruit Diet” and a “Cabagge Soup Diet”…

Whatever it takes… as long as there is a chance to get rid of a few kilos before that upcoming wedding, birthday, or Saturday night out where the only thing you can imagine is wearing a set of clothes that hasn´t fit since University or two sizes smaller. Most people prefer to buy a ticket on the “weight roller coaster” rather than adopt a sensible, nutritionally balanced and professionally supervised eating plan which would stabilize weight and help achieving fat loss once and for all.

The Atkins Diet is the father of all the low-carbohydrate diets and today remains as the most popular. The basic premise of these diets is to cut WAY DOWN on carbohydrate foods and eat more protein and fat. Doctor Robert C. Atkins, an American cardiologist, was the author of a number of books that promote controlled carbohydrate nutrition and complementary medical techniques. His original Dr. Atkins' Diet Revolution, published in 1972, and Dr. Atkins' New Diet Revolution (1992, 1999) has sold 10 million copies worldwide, being one of the top 50 best-selling books of all time and has remained on The New York Times bestseller list for five years. Although millions of people around the world have tried the Atkins Diet in an attempt to drop some weight in a fast manner, the popular high-protein, low-carbohydrate, unlimited-fat Atkins diet has been maligned and debated by organized medicine, nutritionists, and the general public for decades.

Despite such enthusiasm, few scientific studies have evaluated the long-term effects of these diets on weight and lipid levels. In only five published investigations were subjects following these diets studied for longer than 90 days, and none of the studies were randomized or included a comparison group. As a matter of fact there are ONLY TWO serious studies in the whole medical literature that have assessed, in a controlled and randomised trial, the effect of such diets on human beings. Both of them were published in the most recognized medical journal on Earth and few months ago (New England Journal of Medicine, 2003).
This lack of scientific evidence raises the following question: How come that 31 years have passed since the birth of the Atkins Diet and millions of people have tried it since, and there are only two serious studies out there ?

What this means is that people, both professionals and public in general (Dr. Atkins included as well) have NO IDEA whatsoever if low-carbohydrate diets are either good or bad, either safe or dangerous. On any given day, you can read entire articles in the New York Times or Cosmopolitan or to see a bunch of people arguing about it in Larry King Live, some of them supporting the diet and some of them (the majority) against it. But it doesn´t really matter, what matters is that no one has any real evidence to make a statement.
And if we don´t have any strong evidence about the most popular “fast-dropping-weight-diet” in the whole world, you can imagine the amount of evidence that exists for diets such as the “Grapefruit Diet”.

In the first study published in NJEM, researchers conducted a one-year, multicenter, controlled trial involving 63 obese men and women who were randomly assigned to either a low-carbohydrate, high-protein, high-fat diet (Atkins) or a low-calorie, high-carbohydrate, low-fat (conventional) diet. Subjects on the low-carbohydrate diet had lost more weight than subjects on the conventional diet at 3 months and 6 months but the difference at 12 months was not significant. After three months, no significant differences were found between the groups in total or low-density lipoprotein cholesterol concentrations. The increase in high-density lipoprotein cholesterol concentrations and the decrease in triglyceride concentrations were greater among subjects on the low-carbohydrate diet than among those on the conventional diet throughout most of the study.

Authors reached the following conclusions:

1) The low-carbohydrate diet produced a greater weight loss (absolute difference, approximately 4 percent) than did the conventional diet for the first six months, but the differences were not significant at one year.

2) The low-carbohydrate diet was associated with a greater improvement in some risk factors for coronary heart disease.
3) Adherence was poor and disappointment was high in both groups.
4) Longer and larger studies are required to determine the long-term safety and efficacy of low-carbohydrate, high-protein, high-fat diets.

The second study randomly assigned 132 severely obese subjects (mean body-mass index of 43) with a high prevalence of diabetes (39 percent) or with metabolic syndrome (43 percent) to either a low-carbohydrate diet or a calorie- and fat-restricted (low-fat) diet. Authors found out that severely obese subjects with a high prevalence of diabetes or metabolic syndrome lost more weight during six months on a carbohydrate-restricted diet than on a calorie- and fat-restricted diet, with a relative improvement in insulin sensitivity and triglyceride levels, but these findings should be interpreted with caution, given the small number of subjects and the short duration of the study.

And that´s all folks !

It took doctors 31 years to tell the general public: “We don´t know. All we know for sure is that we need to start doing more research”. Great.

Dr. Atkins had a heart attack in April 2002 and died in April 2003 at the age of 72, after falling on the ice outside his office and hitting his head, which caused bleeding into his brain and, eventually, his death. He had been on the diet for close to 40 years. It would be interesting to know whether the arteries of the founder and promoter of the diet were clogged with the fat that he had been eating for the last 40 years. Dr. Atkins’ death raised multiple questions but no one gave any answers. An autopsy was never performed.

The Atkins diet is a way of life for increasing numbers of successful dieters; and his diet books, which are bought by hundreds of thousands of people, are best sellers. But even Dr. Atkins’ most ardent fans worry about the long-term effects of his diet on them. Careful scientific studies are only now being initiated about the risks and benefits of the diet over the long term.

More recently, during the past few days, Atkins Diet has been constantly appearing in American newspapers. Apparently Atkins Corporation suggested to "make that steak a bit smaller," saying that people should limit their intake of saturated fat by cutting back on Atkins staples such as meat, cheese and butter. Responding to criticism from scientists that Atkins “could lead to heart disease and other health problems”, the director of research and education for Atkins Nutritionals, Colette Heimowitz, told health professionals that only 20 percent of a dieter's calories should come from saturated fat.

This statement was published in the January 18th edition of The New York Times and contradicted entirely the philosophy they maintained for many years. However, the following day Atkins Corporation denied this and said that this was “yet another dramatically inappropriate example of the media reporting and perpetuating a false report on Atkins”… make your own conclusions.

I recently visited the website of Atkins Corporation and there was this link in the front page reading “The Science Behind Atkins”…So I entered. I looked not only behind, but also in front, in both sides, up and down and I couldn´t find where that Science was. I just found a bunch of anecdotes and reviews of unknown people published in second-class Journals.
You want a real scientific fact about Atkins Diet ? Well, one month ago a group of researchers provided preliminary evidence that the Atkins Diet may have a role as therapy for patients with medically resistant epilepsy. 3 out of 6 patients had seizure reduction and were able to reduce antiepileptic medications. So, there might be a role for some of these diets in certain special conditions, but still more and more research is needed. Amazingly, you cannot read this sort of evidence on the Atkins Corporation website.

Somehow, I can understand these companies, because at the end of the day for them is just a matter of selling books and dietary products to make money. Personally, what troubles me the most is that people (once again, both professionals and public in general) seem to believe that having an “ideal” weight is being healthy and not having an “ideal” weight is unhealthy. The truth is: Nutritional status has to do with much more than simply weight. You can have few kilos less or few kilos more but eating what is recommended in the Food Pyramid (which is for me the “most solid structure ever built in the kingdom of Nutrition”) and practicing exercise in regular basis and I can guarantee you that you will be much healthier than someone who is constantly gaining and losing few kilos along the year using whatever diet (Atkins or not).

My point of view as a specialist in Clinical Nutrition is that there is enough evidence to support the "heart-healthiness" of a balanced diet consisting of a wide variety of foods, including fruits and vegetables, whole grains, legumes, lean meat, poultry, and fish, with the total intake of fat accounting for less than 30 percent of the total number of calories and the total intake of saturated fat accounting for less than 10 percent of the total calories.

I believe that the recipe for effective weight loss is a combination of motivation, increased physical activity, and mild caloric restriction and that maintenance of such weight loss on a long term basis is a balance between caloric intake and physical activity, with lifelong adherence. A wealth of epidemiologic and nutritional data collected over the past several decades indicates that the consumption of high levels of saturated fat has adverse consequences on health. Low-carbohydrate diets may also lack important vitamins and fiber. Until further evidence is available regarding the long-term benefits of a low-carbohydrate approach, physicians should continue to recommend a healthy lifestyle that includes regular physical activity and a balanced diet.

In other words: if you want to live longer and healthier, just forget about any sort of diet designed to sell books or pills which will make you lose weight really fast and just surrender to “the power of the almighty pyramid”.

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Let´s put an end to the Diet Wars and may all live finally in nutritional peace.

May the force be with you.

Daniel Fuentes
January 20, 2004
Madrid, Espana

1. Foster GD, Wyatt HR, Hill JO, et al. A randomized trial of a low-carbohydrate diet for obesity. N Engl J Med. 2003 May 22; 348(21): 2082-90.
2. Samaha FF, Iqbal N, Seshadri P, et al. A low-carbohydrate as compared with a low-fat diet in severe obesity. N Engl J Med. 2003 May 22; 348(21): 2074-81.
3. Kossoff EH, Krauss GL, McGrogan JR, Freeman JM Efficacy of the Atkins diet as therapy for intractable epilepsy.Neurology. 2003 Dec 23; 61(12): 1789-91.

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