Great Britain’s MRC vs. Atkins…

So I read this disturbing article today from Googling for "Atkins nutritionally incomplete". I picked up on that phrase from Medical Research Council’s Dr. Susan Jebb.

Although I realize that people are allowed to have differing opinions on Atkins-type diets, such as the South Beach Diet, Somersizing, Cave Man, etc., it really bugs me when articles completely distort the truth. I feel the need to refute a few glaring misconceptions. I believe the misconceptions are on the part of the reporter writing the article, not on the part of Dr. Jebb who was very selectively quoted. It’s natural for the medical establishment to go slowly when entering new territory; it’s the nature of the Hippocratic oath to “first, do no harm”. So I don’t blame her, but it seems like these misconceptions are endemic to the misconceptions of people who have not read the available literature and many long-term (thirty years so far, in some cases!) studies thoroughly.

1. “The Atkins diet cuts out carbohydrates and boosts consumption of protein without having to avoid fatty foods.”

   This is a totally misleading statement. I’ve now read two of Dr. Atkins’ books, and nowhere do they say to "cut out carbohydrates". It’s true that, for the first two weeks of the diet, he encourages those who are significantly overweight (more than 10-20 lbs for women, or 20-30 lbs for men) to go into “induction”, which involves reducing total carbohydrates to below 20 grams per day. Those 20 grams must come from green leafy vegetables, certain low-carbohydrate but highly nutritive vegetables such as broccoli, and cheeses or other foods in great moderation. "Cut out" carbs? I think not. Sensible low-carb plans obviously reduce carbs, but carbohydrates are a vital part of one’s body chemistry. We low-carbers simply become more selective about which carbohydrates we’ll allow to pass our lips, and in what quantity.

2. “On the other hand, large-scale studies looking at the general effects of eating different kinds of food had yielded a wealth of data.
   They showed that people who ate the most carbohydrates had the lowest rates of heart disease.”

   The unfortunate fact is that, in combination with a way of eating high in refined carbohydrates, saturated fat kills. On the other hand, in combination with low-carbohydrate eating habits, all the classic warning signs of heart disease tend to drop dramatically. Atkins developed his original plan for heart patients, and it was enormously successful in that capacity, often allowing patients to get off cardiac medication.

   On the third hand, Dr. Atkins went into cardiac arrest in a restaurant at the age of 72, roughly one year before his death from a fall. However, it wasn’t due to the traditional clogged pipes; instead, his heart had been damaged by an infection for which he’d been in treatment for two years, which was the cause of his arrest. All the pipes leading to his ticker, and the muscle that had not been damaged by the infection, were in perfect working order.

   Low-carb eating patterns improve cardiovascular health, lower triglycerides, improved HDL concentrations, and tend to lower LDL. We’re all going to die from something, but the chances are good if you begin low-carbing early enough in life, that it won’t be from clogged arteries.

   One important exception: idiots that attempt to go low-carb/low-fat kill themselves. Now that has been well-documented. In addition, as more people hop on the low-carb bandwagon, people will focus on their diet rather than thinking of these deaths as a tragic accident. It’s kind of like when a Catholic priest molests a child, it’s front-page news, whereas when Joe Schmoe molests a child, it ends up on the court report page. When someone who has done Atkins dies of heart problems, it’s a big deal. When someone who isn’t on Atkins dies of a heart problem, it’s not. I have to find myself wondering, as well, if these “Atkins-related deaths” that are fashionable in the news lately were from people that really were going about it in a safe, sensible way and had read the book, or if they’d tried to concoct their own diet regimen that resulted in heart damage. An interesting thought that needs more study to find out, I think.

3. “Fibre, found in carbohydrate food, helped the body eliminate toxins and was associated with reduced levels of cholesterol.”

   The reporter here seems to assume that those on Atkins don’t get enough fiber. I beg to differ; I’m eating more fiber today than I ever did on any other “diet”. And I’m eating significantly more healthy dietary fiber as a result of following Dr. Atkins plan, even though I’m on induction, than I did in my usual standard American diet (SAD).

   Atkins does, however, recommend fiber supplements for those people who get clogged up. I’d recommend the same to anybody on any diet — if you’re getting backed up, start taking some stuff to flush it out rather than crapping a brick once every two weeks. As for me, my intestinal problems tend to err on the other side of that scale, and all the bloating, cramps, and other symptoms of irritable bowel seem to have largely disappeared for me. Except when I got too excited about some imitation sweets… even a few of those seem to cause pretty severe gastro troubles for me, as well as a bunch of other people.

4. “Carbohydrates were also the source of essential vitamins and plant nutrients, which anyone on the Atkins diet would have to consume as supplements.”

   Another totally off-base statement. Dr. Atkins recommends supplements to fend off dietary insufficiencies due to many vegetables and fruits found in supermarkets today lacking the nutrients they would possess if grown more organically, rather than mass-produced in soil that is long-since depleted and living on fertilizer. You could choose to address those deficiencies by using organically-grown fruits and vegetables with the diet.

   The supplements Dr. Atkins recommends are the same that most Americans should probably be taking anyway. Cover your bases, be sure you have sufficient vitamins, minerals, and essential fatty acids. The dude went from being a cardiologist to a specialist in nutrition therapy; it’s natural that he suggests supplementation or behavioral changes in certain areas to correct problems without traditional medications. The problem is not a low-carbohydrate diet; it is that man evolved for millions of years living off the land. Only in the last six thousand years have we learned agriculture, and with that monoculture, we introduce some dietary deficiencies that today we can alleviate using supplements. People who supplement B vitamins, even on the best of diets, tend to have fewer mood swings. People who supplement potassium, or make sure that their diet includes potassium-rich foods, avoid muscle cramps from the lack of it. Supplementation on Atkins is just that — a supplement, not a replacement for proper nutrition from one’s diet. I personally have mega-dosed vitamin C for a long time to avoid colds, and it seems to work like a charm. Although I can get sufficient from my diet, why not use a tool if it’s available?

5. “There was also good evidence that eating excess protein can cause kidney damage, and may lead the body to lose calcium.”

   This is simply untrue, an urban legend, and a twisting of evidence to fit opinion. There has never been a single case where someone with healthy kidneys damaged them by doing Atkins. In the case of individuals with advanced kidney disease, a diet high in protein or in water can further damage already sensitive kidneys. But in most cases, the kidney damage was caused by excessive glucose in the bloodstream in the first place, which is directly attributable to a high-carbohydrate diet! In some cases I’ve read about, going to low-carb diets allows the kidneys to repair some of the damage caused by the high-carb diets.

   Additionally, Atkins need not be considered “high-protein”. It’s only “high fat” or “high protein” compared to low-fat diets and the horribly imbalanced “food pyramid” idea, really. Induction isn’t nearly the entire eating plan, and the other phases of Atkins feature a pretty darn significant percentage of calories from carbs as well as proteins and fats.

   But people in advanced stages of kidney failure shouldn’t be making drastic changes in their diet without the supervision of a knowledgeable physician, anyway.

6. “A study published in the Lancet last month also shows that eating too much fat can double a woman’s risk of breast cancer.”

   Once again, this is only in the case of a high-fat, high-carbohydrate diet. High-fat, low-carbohydrate diets, with adequate fiber (which the Atkins plan provides for easily) appear to reduce cancer risk across the board.

   One must wonder, though, if they reduce the cancer risk just because people are finally really watching what they eat 🙂 Similar cancer risks happen in healthy, non-overweight vegetarians, so one has to wonder if perhaps reduction in cancer risk is simply the result of following any eating plan that covers all the nutritional bases, like Atkins does.

7. “It was psychologically easier to follow than harsher low-fat regimes, but worked the same way as any diet – by reducing calorie intake.”

   While I must agree this diet is much, much easier to follow than the “eat less” plan I’ve always followed in the past to drop a few pounds, I have to disagree on the “reducing the calorie intake” bit. I’m averaging 2400-2900 calories per day at six feet tall, thirty years old, and 230 lbs (woot, go me! 10 lbs lost in two weeks!). The results are all out of proportion to the calorie intake.

   And people who say “it’s all water” are just lying. I know people who have lost over 100 lbs in a year in the OWL phase (Ongoing Weight Loss — much less strict than Induction) of Atkins. That’s a heck of a lot of water.

   There’s a well-documented "metabolic advantage" to a low-carb regimen. The body shifts from primarily carbohydrate-burning mode into fat-burning mode. The switch is automatic, and seems to be rooted in our hunter/gatherer evolutionary heritage. There would be lean times, where the only food one had was that mammoth carcass sitting out in the snow. And the tribe would eat it for weeks. Ketosis/lipolysis begins in the liver, where it converts fats and proteins into glucose for use by the body. Blood sugar remains amazingly constant when one is in this mode, which tends to prevent hunger, reduce cravings, and generally keep one’s spirits up. This, too, seems to be an evolutionary advantage for our species.

   What’s the “metabolic advantage”, calorie-wise, to low-carb eating habits? The chemical reactions required to sustain ketosis/lipolysis occur at far less than 100% efficiency. The most common statistic bandied about is “58%”. So the reality is, eating exactly the same amount of calories as one normally would to maintain weight, but doing so on a low-carb regimen, results in weight loss due to his inefficiency. The ketones that are “left over” after the chemical reactions are all done show up in one’s urine. This is a perfectly safe reaction, far different than “ketoacidosis”, the diabetic condition that also results in ketones, but in the presence of wildly out-of-control blood sugar being dumped into the urine in the body’s desperate attempt to overcome high-carbohydrate ingestion without insulin production.

   Anyway, here’s the fact: you can eat the exact same number of calories you were eating in high-carb, on a low-carb plan, and lose weight doing so. Of course, calorie reduction accelerates the process. And if you’re significantly overweight, you’ll reach a point where you need to crank back the calories in order to continue losing. But that point is far more calories per day than the same individual could sustain in a high-carb diet without gaining weight.

   A calorie is a calorie is a calorie. Until you are talking about the human body when it switches from carb-burning mode to ketosis/lipolysis. And then the rules change. A lot.

8. “Dr Ogden said with any diet, about 60% of people succeed in losing weight at the start. But over the next three to 10 years, 95% to 99% of dieters regained the weight they lost.

   She said: “Some gain even more weight than they had in the first place.””

   Sad but true. The advantage of the Atkins way of eating is that it is much easier to maintain than a lifelong “eat less” regimen. I don’t have any statistics on retention rates, but the amazing thing about people who remain low-carb for life (and I intend to be one of them — no diabetes for me, thanks, I’d be stupid to eat like I’ve been eating with my massive family history of diabetes) is that they can continue to eat satisfying, filling, wholesome foods, as long as their carbohydrates are only consumed in moderation while avoiding all refined carbohydrates. From the people I know who have stuck to it for years, it’s the easiest way of eating to maintain known to man.

End of my rant. I just hate it when people automatically assume that because I’m doing Atkins that I’m gorging on red meat and avoiding all fruits and vegetables. I’m eating far more veggies on my Atkins regimen than I ever did on my standard American diet. Eventually, I’ll get into more fruits, but that’s several weeks away at least. It’s simply a healthier way of eating, for me, and for many other people who have pretty bad reactions to refined carbs.

Of course, there are people blessed with different metabolisms that thrive on high-carb diets. And I wish them well. But I think I’ve definitely found a way of eating, in avoiding the refined carbs that are the plague of the 20th and 21st centuries, that suits my body chemistry and have already helped me keep much more even energy levels and avoid unpleasant side-effects of a refined carbohydrate diet.

All in all, this piece sounds like a PCRM (Physician’s Committee for Responsible Medicine) publicity piece. PCRM is a front for People for the Ethical Treatment of Animals, a militantly anti-meat group. More information available about PCRM available here.