New York City had a freak snowstorm on April 7, and as a result of an equally freak accident, Dr. Robert C. Atkins slipped on the sidewalk outside his office, fell, and hit his head. One week later, Dr. Atkins, trained as a cardiologist, world-renowned author of a diet named for him, died from injuries suffered in that fall.
Dr. Atkins took an old idea the high-fat, low-carbohydrate diet and turned it into a nutritional empire. Such diets have been used for many decades to treat type 1 diabetics (the ones who can't make their own insulin) on the theory that adding carbohydrate to a system that couldn't handle it would be counterproductive.
In 1972, after having lost weight on such a diet himself, Dr. Atkins compiled and published it as Dr. Atkins' Diet Revolution, which has become one of the best-selling American diet books of all time over 15 million copies to date.
How His Diet Works
The basis of the diet is avoidance of dietary carbohydrate. During the first two weeks of the diet, a person is in the so-called induction phase, only allowed 20 grams of carbs per day (a typical recommendation for a nondieter might be as many as 300 grams per day). There are multiple metabolic results of a severe carb restriction.
First, the body uses up its stored carbohydrate (glycogen in liver and muscle), during which process the water that is stored with the glycogen is also excreted. Once the glycogen is gone, the body will mainly use protein to generate the blood glucose that the nervous system and a few other tissues require for fuel. After a couple of days of carb deprivation, the body starts breaking down fat into compounds called ketones that the brain and other nervous tissue can also use for fuel.
Once the ketones are produced in large enough quantities, some are excreted in the urine, where they can be easily measured. When ketones are thus excreted, a person is said to be "in ketosis" or "ketotic." As ketones are lost from the body, they also "pull" water out of the body.
Thus, a dieter who adheres to this regime will lose weight quickly, though a large proportion of the initial weight loss will be water, not excess body fat. After the two-week induction period, carbohydrate restrictions are gradually loosened, until the dieter may be allowed to eat as many as 100 grams of carbs per day.
Does the Diet Work, and in What Sense?
Does the diet work? Sure but that may be simply because, in addition to restricting carbs, the diet also lowers calories, which is the basis of any weight loss regimen. The loss of ketones in the urine will also contribute a bit to the negative energy balance, since ketones themselves provide some calories.
Dr. Atkins' diet was received enthusiastically by dieters; its high-fat protocol allowed, indeed encouraged, the consumption of foods often forbidden on other weight loss diets. Foods like eggs, butter, avocados, nuts, steak, heavy cream, and other full fat dairy products were given a thumbs up, while sugars and starchy foods like potatoes, corn, bread, pasta, and rice were verboten.
Over the thirty years since the Atkins diet has been available, the core diet has remained essentially the same. Though the book has been updated (1992 saw Dr. Atkins' New Diet Revolution), the changes were primarily in supporting materials. This year, Atkins published his Atkins for Life tome, which is primarily a compendium of menus and recipes that fit with his plan. In addition, some of the background information, such as an admonition to avoid trans fats, is more in line with current mainstream advice.
To say that mainstream nutritional scientists did not receive Dr. Atkins' diet with enthusiasm is one of the great understatements of the year. There was concern that consumption of large proportions of fats, especially saturated fats, would cause increases in blood cholesterol levels and increase the risk of heart disease. In addition, nutritional evaluations of the diet suggested that it provided lower than recommended intakes of a number of nutrients such as vitamins E, A, thiamin, folate, calcium magnesium, and fiber.
The American Medical Association, back in 1973 stated that "No scientific evidence exists to suggest that the low-carbohydrate ketogenic diet has a metabolic advantage over more conventional diets for weight reduction." Atkins himself took great issue with this statement, averring that his review of the medical literature substantiated his claims. In 2001, the American Heart Association published a position statement noting concerns about the restrictions and nutritional adequacy of such diets. This year, a review of the scientific literature failed to find any advantage to high fat versus high carb diet regimes. It found that the success of weight loss was more closely tied to caloric content and duration of diet than it was to diet composition (for a review of this study, see: http://www.healthfactsandfears.com/featured_articles/apr2003/atkins041003.html). But as this review states, there is a paucity of solid data on this topic.
Continued Appeal and Controversy
Atkins himself, while claiming nearly miraculous results with his dietary regime, never actually published those results in a peer-reviewed scientific journal, but that hasn't discouraged his many supporters. Last summer, a lengthy article in the New York Times Magazine by science writer Gary Taubes declared that dietary fat is not the enemy, and that nutritional authorities who support a low fat approach to weight loss don't know what they're talking about (not surprisingly, Mr. Taubes is reported to be an Atkins diet practitioner).
Recently, some short-term studies have indicated that the diet is effective, but no studies have lasted longer than a few months, so long-term safety and efficacy cannot be evaluated. The National Institutes of Health has initiated such a study: we shall see what the long-term effects and safety of the diet are.
In the meantime, popular writers have been describing the short studies as "vindicating" Dr. Atkins and implying that mainstream nutritionists are coming around to his point of view as have many of the obituaries written about him. But such an interpretation is surely premature: without solid, long-term data, it is unlikely we will see the AMA, the AHA, or the NIH supporting a high fat weight loss diet.
Many consumers have tried the diet and, according to Atkins, achieved and maintained weight loss. But some anecdotal evidence suggests that, while this diet can result in weight loss, people find it hard to adhere to this diet over the long-term. A recent article in the New York Times quotes one man who lost twenty-five pounds in ten weeks: "It was easy to do, though I've put a lot of it back on."
Undoubtedly, although Dr. Atkins is no longer with us, his diet will linger on. Will his legacy be that of a maverick who was eventually proved right the man who instigated a "paradigm shift" in weight loss? Or will it be that of a clever entrepreneur who adroitly convinced people that what they liked to eat would help them lose weight? That remains to be seen. Only time and substantial scientific evidence will tell.