Reprinted from the June 2004 issue of Dr. Greger’s
Nutrition Newsletter. To subscribe, send a blank email to
[email protected]
WHAT THE EXPERTS THINK OF ATKINS
Bringing Home the Bacon
Atkins conceded that the "WORST [emphasis his]" feature
about his diet is the "rapidity with which you gain [weight] if you
abandon it." "But the BEST feature," he claims, "is that you don’t HAVE to
go off this diet…"246
The reason people fall of the wagon, Atkins claimed, is
because of "carbohydrate addiction." What he calls "addiction," though,
others might call our natural urge to eat the fuel our bodies evolved to
live on—carbohydrates. Patients inevitably cheat and then tragically blame
themselves instead of the diet for this failure.
Low carb diets, like all fad diets, tend to fail.247
Even Atkins admitted that there is "no formal documentation" of long-term
weight loss on his diet. He’d been supposedly seeing patients for decades
on his diet; why didn’t he do a study?
When challenged on just that point Atkins replied, "Why
should I support a study? It's all in my book." When it was pointed out
that the book was "all anecdotal," Atkins said mainstream medicine's
demand for proof simply functioned to "maintain it at its current level of
ineptitude."248
In February 2000, the USDA brought Atkins in to discuss
his diet. When asked why he doesn’t conduct his own study, he pleaded
poverty: "But I haven't been able to fund a study." To which the Director
of Nutrition Sciences at Albert Einstein College of Medicine, replied,
"Ten million books in print and you can't fund a study?"
The Director continued: "You market the vitamins. You
sell the vitamins. You market this. This is not for the public good. This
is a money-making proposition."249 The Chair of the Board of Atkins’ own
New York County Medical Society made a similar charge when Atkins’ book
was first published, alleging it was "clearly… unethical” and
“self-aggrandizing."250 The New York Board of Health later tried,
unsuccessfully, to revoke his medical license.251
Why has the U.S. government been lax in testing the
Atkins Diet at any point in the last 30 years? One reason may have been
that it might be difficult to get approval from an ethical review
committee to put people on the diet long term, given what is known about
the dangers of a meat-laden diet. As one medical review concluded, "There
is no evidence that low carbohydrate diets are effective for long-term
weight management, and their long-term safety is questionable and
unproven."252
The current Director of Nutrition at Harvard advises
that all physicians should produce a handout warning about all of the
adverse effects of the Atkins Diet. Not only should the handout explain
explicitly that the diet may increase one’s risk of heart disease, cancer,
and stroke, but also that "Other health risks include… dizziness,
headaches, confusion, nausea, fatigue, sleep problems, irritability, bad
breath, and worsening of gout and kidney problems; osteoporosis, since a
high ratio of animal to vegetable protein intake may increase bone loss
and the risk of hip fracture in elderly women; a rise in blood pressure
with age…and rapid falling blood pressure upon standing up (orthostatic
hypotension), which can… put older patients at higher risk for falls."253
After running through the adverse effects associated with ketosis, the
American institute for Cancer Research wrote, "Those are the short-term
effects. The long-term effects are even more dire."254
LONG-TERM SIDE EFFECTS
"Massive Health Risk"
The Atkins’ Diet downfall is also its one saving
grace—people may not be able to tolerate it for long enough to suffer the
long-term consequences. The American Heart Association states:
"Individuals who follow these diets are therefore at risk for compromised
vitamin and mineral intake, as well as potential cardiac, renal [kidney],
bone, and liver abnormalities overall."255
In Europe, hospitals have already started banning the
Atkins Diet256,257 after the British government’s Medical Research
Council, backed up by the British Nutrition Foundation and the British
Dietetic Association,258 condemned the Atkins Diet as "negligent"259
"nonsense and pseudo-science"260 posing a "massive health risk."261
An article out of the Cleveland Clinic Journal of
Medicine entitled "Physician’s Guide to Popular Low Carbohydrate
Weight-Loss Diets" noted that the Atkins Diet "can jeopardize health in a
variety of ways."262 Let us count the ways.
Malnutrition
Atkins followers risk a number of serious nutrient
deficiencies.263 In fact some people have become so deficient on low carb
ketogenic diets that they almost went blind because their optic nerves
started to degenerate.264,265
When cutting calories, it’s especially important to eat
nutrient-dense diets, but the Atkins Diet presents a double whammy; it
restricts the healthiest foods, like fruit, and unrestricts some of the
unhealthiest, like meat. Shortly after Atkins’ original book was
published, the highly prestigious Medical Letter on Drugs and Therapeutics
concluded that the Atkins Diet was "unbalanced, unsound and unsafe."266 As
noted in a Medical Times review, Atkins has created a "ridiculously
unbalanced and unsound" "hazardous" diet.267 Twenty-seven years later the
Medical Letter offered an update noting that the safety of the Atkins Diet
had still “not been established.”268
A diet like Atkins maximizes the consumption of
disease-promoting substances like the cholesterol, saturated fat, and
industrial pollutants in meat, yet restricts one’s intake of fiber and the
literal thousands of antioxidants and phytochemicals found exclusively in
the plant kingdom (like the carotenoids, lycopenes, bioflavenoids, phytic
acid, indoles, isothiocyanates, etc.) that have "anti-aging, anti-cancer
and anti-heart disease properties."269 As a 2004 medical review concluded,
the Atkins Diet is so "seriously deficient" in nutrition that "there is
real danger of malnutrition in the long term."270
Where might then one get one’s vitamins on the Atkins
Diet? From the Atkins website, of course, on sale now for just over $640 a
year.271 Add some antioxidants and the tab is up to $1000.272 That is of
course in addition to the estimated $400273-$1400274 the pricey Atkins
food—meat and cheese—costs every month (unless one chooses to live off hot
dogs).
Realizing his diet is so deficient in nutrients, Atkins
prescribed no less than 65 nutritional supplements in part to help fill
the nutritional gaps created by his diet.275 A "proper Atkins Dieter"
Atkins wrote, "follows the entire program, including the supplements."276
In his last edition Atkins even had a chapter entitled "Nutritional
Supplements: Don’t Even Think of Getting Along Without Them."277 Perhaps
this is because his corporation sells them.
"Who needs orange juice," Atkins wrote, "when a Vitamin
C tablet is so handy?"278 Oranges, of course, contain much more than
vitamin C. As Sue Radd, a world leader on phytonutrient research, put it
"There's not one vitamin pill in the world that can give you everything
you need."279 A review in the Cleveland Clinic Journal of Medicine agreed
that the Atkins Diet is "deficient in nutrients that cannot be replaced by
supplements and are excessive in nutrients that may increase the risk of
mortality and chronic disease."280
Responding to the criticism that the Atkins Diet was
deficient in fruits and vegetables, Atkins-funded researchers responded
that people in Atkins could include a limited quantity of some vegetables
"and even small amounts of fruit." Even during later, more liberal phases
of the diet, though, Atkins warned readers that eating fruit will "always
be somewhat risky." The Atkins researchers continued, "It would be prudent
to take a multivitamin/mineral supplement."281 A low carb diet is a low
nutrition diet.
Cancer
Atkins followers also risk cancer. Studies at Harvard
and elsewhere involving tens of thousands of women and men have shown
that, for example, regular meat consumption increases colon cancer risk as
much as 300 percent.282,283 As one Harvard School of Public health
researcher noted, because of the meat content, two years on the Atkins
Diet "could initiate a cancer. It could show up as a polyp in 7 years and
as colon cancer in ten."284
It’s tragically ironic that after McDonald’s CEO
apparently dropped dead of a heart attack in 2004, their new CEO was in
the operating room with colo-rectal cancer only 16 days later.285
Women with the highest intake of animal fat seem to have
over a 75% greater risk of developing breast cancer.286 The American
Cancer Society has officially condemned diets high in animal grease,
concluding "a low carb diet can be a high-risk option when it comes to
health."287
Kidney "Scarring"
Atkins followers also risk kidney damage.288 Like his
advice for pregnant women, Atkins once wrote "The diet is safe for people
even if there is a mild kidney malfunction."289 We now know this to be
false.
In a press release entitled "American Kidney Fund Warns
About Impact of High-Protein Diets on Kidney Health," Chair of Medical
Affairs, Paul W. Crawford, M.D., wrote, "We have long suspected that
high-protein weight loss diets could have a negative impact on the
kidneys, and now we have research to support our suspicions." Dr. Crawford
is worried that the strain put on the kidneys could result in irreversible
"scarring in the kidneys."290
Three months later, the newest edition of the New Diet
Revolution was released in which Dr. Atkins stated: "Too many people
believe this untruth [that too much protein is bad for your kidneys]
simply because it is repeated so often that even intelligent health
professionals assume it must have been reported somewhere. But the fact is
that it has never been reported anywhere. I have yet to see someone
produce a study for me to review…"291
Although evidence that such diets could be risky for
one’s kidneys existed years before he made that statement,292 the
definitive study showing just how dangerous his diet could be to a
dieter’s kidneys was published a month before Atkins died. The Harvard
Nurse’s Study proved that high meat protein intake was associated with an
accelerated decline in kidney function in women with mild kidney
insufficiency.293 The problem is that millions of Americans—as many as one
in four adults in the United States—seem to already have reduced kidney
function, but may not know it, and would potentially be harmed by high
meat diets like Atkins.294 And the "excessive" amount of protein which
furthered kidney damage in the women in the Nurses Study is only about
half of what one might expect to get on the Atkins Diet.295
The American Academy of Family Physicians notes that
high animal protein intake is also largely responsible for the high
prevalence of kidney stones in the United States. Kidney stones can cause
severe pain, urinary obstruction, and kidney damage. Plant protein did not
seem to have a harmful effect.296
American Kidney Fund’s Dr. Crawford concluded, "Chronic
kidney disease is not to be taken lightly, and there is no cure for kidney
failure. The only treatments are kidney dialysis and kidney
transplantation. This research shows that even in healthy athletes, kidney
function was impacted and that ought to send a message to anyone who is on
a high-protein weight loss diet."297
Peeing Your Bones Down the Toilet
A 2003 review of the safety of low carbohydrate diets
reeled off an alarming list of potential problems: "Complications such as
heart arrhythmias, cardiac contractile function impairment, sudden death,
osteoporosis, kidney damage, increased cancer risk, impairment of physical
activity and lipid [cholesterol] abnormalities can all be linked to
long-term restriction of carbohydrates in the diet."298
There is a particular concern that children who go on
the Atkins Diet might suffer permanent physical and mental damage as a
result of starving their bodies of critical nutrients. As one U.S. child
nutrition specialist explained, "The effect can be to dull the mind, stunt
growth, and soften bones…I wouldn't want to risk it by putting my child on
a low carbohydrate diet."299
The concern with bone health arises from the fact that
muscle protein has a high sulphur content. When people eat too much of
this meat protein, the sulphur forms acid within our bodies which must
somehow be neutralized to maintain proper internal pH balance. One way our
bodies can buffer the sulphuric acid load caused by meat is with calcium
borrowed from our bones. People on high meat diets can lose so much
calcium in the urine that it can actually solidify into kidney stones.300
Over time, high animal protein intakes may leach enough calcium from the
bones to increase one’s risk of osteoporosis. People may be peeing their
bones into the toilet along with the ketones.
The Harvard Nurse’s study, which followed over 85,000
nurses for a dozen years, found that those who ate more animal protein had
a significantly increased risk of forearm fracture. While plant-based
proteins did not show a deleterious effect, women eating just a serving of
red meat a day seemed to have significantly increased fracture risk.301
Other studies have linked meat consumption to hip fracture risk as
well.302
Although Atkins conceded, "kidney stones are a
conceivable complication,"303 Atkins dismissed any assertion that his diet
might endanger bone health. Researchers decided to test his claim
directly.
In 2002, researchers from the Universities of Chicago
and Texas published a study that put people on the Atkins Diet and
measured 1) how acidic their urine got and 2) just how much calcium they
were losing in their urine. They reported that the Atkins Diet resulted in
a "striking increase in net acid excretion." After just two weeks on the
Atkins Diet, the subjects were already losing 258mg of calcium in their
urine every day. They concluded that the Atkins Diet "provides an
exaggerated acid load, increasing risks for renal calculi [kidney stone]
formation and bone loss."304 In addition, the Atkins Diet is actually
deficient in calcium in the first place—even if one includes his 65
supplements.305 Luckily there’s a 66th, available on his website.306
"Eaters of Raw Flesh"
We don’t have any long-term published data on the bone
health of Atkins followers (or any other health parameter for that
matter). One might look to the Inuit peoples—the so-called "Eskimos"—for
hints, though. (The word Eskimo comes from the word Eskimaux—"eaters of
raw flesh.")307 They seem to be the only population on Earth approximating
the Atkins Diet, living largely off Atkins dream foods like blubber.
Despite having some of the highest calcium intakes in
the world, the Inuit also have some of the worst rates of osteoporosis.308
Although calcium intakes vary widely, people in some villages get over
2500mg a day, almost 5 times what most Americans get, due to their eating
many of their fish whole, bones and all.309 So for example, in one of
their recipes for “Ice Cream," although the "2 cups moose grease" the
recipe calls for is not high in calcium, the "1 dressed pike" added to the
recipe gives the Atkins-friendly dessert a respectable 130mg of calcium
per serving.310 The "unusually rapid bone loss" found in every study ever
published on Inuit bone health is blamed on the "acidic effect of a meat
diet."311,312,313,314,315
While the near-Akins level of animal protein intake
seems to be dissolving their bones, due to the near-Atkins level of animal
fat intake, the Inuit women have some of the highest levels in the world
of PCBs in their breast milk. Their blood is swimming with mercury and
other toxic heavy metals. "They're at the top of the food chain," says Dr.
Russel Shearer, an environmental physical scientist with the Canadian
Department of Indian Affairs and Northern Development, and therefore
"accumulate the highest levels of these contaminants."316 In the last
edition of his book, Atkins did finally acknowledge the threat posed by
the industrial pollutants in animal foods and urged his followers to
choose organic free-range meat.317
Atkins Distorted His Record on Cholesterol
Although ketogenic diets have caused a number of
"serious potentially-life-threatening complications,"318 perhaps the
greatest danger of the Atkins Diet, according to the American Medical
Association, lies in the heart.
Atkins claimed a worsening of cholesterol levels
typically only occurs "when carbohydrates are a large part of the
diet."319 We’ve known this to be false since 1929 when the Institute of
American Meatpackers paid to see what would happen if people lived on an
all-meat diet. The blood plasma of the unfortunate subjects was so filled
with fat it "showed a milkiness" and one of the subject’s cholesterol shot
up to 800!320
Atkins revelations like "Reverse heart disease with
filet mignon!"321 notwithstanding, in the head-to-head comparisons of the
four popular weight-loss diets, Ornish’s vegetarian diet was the only one
that showed a significant decrease in LDL levels—the so-called "bad"
cholesterol. Even researchers paid by Atkins concede that high saturated
fat diets like Atkins tend to increase LDL cholesterol.322 They have to
concede the truth, though, since they publish their work in peer-reviewed
scientific journals. Dr. Atkins, though, died without ever publishing a
single paper in any scientific journal about anything, and thus had more
freedom to bend the truth.
"The truth," Atkins wrote, "is that every one of a score
of studies on [very low carb diets] showed a significant improvement in
cholesterol." He accused those who say otherwise of simply not doing their
homework. Any claim that cholesterol doesn’t significantly improve in
"every one of scores of studies" is, he wrote in the last edition, "one of
the many examples of untruths being perpetrated because the accusers don’t
bother to read the scientific literature."323 Of course he then goes on to
recommend no less than 17 supplements for the "prevention of cholesterol
elevations" on his diet.324
But what about his claim that "every one of a score of
studies showed a significant improvement in cholesterol." When the AMA and
the American Heart Association question this "fact," is it just because
they "don’t bother to read the scientific literature?" That statement of
his, in the latest edition of his book, presents a clear opportunity to
test the veracity of his claims. And the actual truth is almost the exact
opposite.
Unfortunately, Dr. Atkins didn’t include citations to
back up his "score of studies" statement. In fact, when pressed for a list
of citations in general, Dr. Atkins told an interviewer that “It and the
papers I quoted were in a briefcase I lost some time ago.”325 Researchers
have located about a dozen studies, though, that measured the effects of
low carb diets on cholesterol levels. Did they all "show a significant
improvement in cholesterol?" No. In fact, seemingly with only one
exception, every single controlled study showed just the opposite—LDL
cholesterol either stagnated or was elevated by a low carb diet, even in
those that showed weight
loss.326,327,328,329,330,331,332,333,334,335,336,337,338,339
During active weight loss—any kind of weight loss
(whether from chemotherapy, cocaine use, tuberculosis or the Atkins Diet)
cholesterol synthesis temporarily decreases340 and LDL cholesterol levels
should go down.341 Yet, with all the saturated animal fat in the Atkins
Diet tending to instead push levels up, in most studies the bad
cholesterol doesn’t fall like it should have. The saturated fat in effect
cancelled the benefit one would expect while losing weight. And what
happens when people on the Atkins Diet stop losing weight? People can’t
lose weight forever (Stephen King novels aside). The fear is that their
LDL cholesterol level might then shoot through the roof.342,343
Sometimes even during the active weight loss, however,
LDL cholesterol levels became elevated on the Atkins Diet. One study on
women, for example, showed that just two weeks on the Atkins Diet
significantly elevated average LDL levels over 15%.344 In a trial of men
on the Atkins Diet, even though they lost an average of 17 pounds after 3
months, their LDL cholesterol jumped almost 20%.
The May 2004 Annals of Internal Medicine study showed
that a third of Atkins Dieters suffered a significant increase in LDL
cholesterol. The goal is to have a double digit LDL—an LDL under 100
(mg/dl).345 In the study one person’s LDL shot from an unhealthy 184 to a
positively frightening 283 (which means their total cholesterol was
probably somewhere over 350).346 With so many people on these diets, that
could mean Atkins is endangering the health of millions of Americans.347
LDL cholesterol is, after all, one of the most important risk factors for
heart disease, the number one killer in the United States for both men and
women.348
In another clinical trial, despite statistically
significant weight loss reported in the Atkins group, every single cardiac
risk factor measured worsened after a year on the Atkins Diet (measures
included LDL, triglycerides, total cholesterol, HDL, total-to-HDL
cholesterol ratio, homocysteine, Lp(a), and fibrinogen). While the LDL in
the Atkins group increased 6%, the LDL cholesterol levels in the
whole-foods vegetarian group was cut in half—dropping 52%. When the
pro-Atkins journalist who wrote the misleading New York Times Magazine
piece was confronted as to why he didn’t include the results of this
landmark study, which directly contradicted what he wrote in the article,
all he could do was to accuse the researchers of just making the data
up.349
It’s interesting to note that the one exception of a
published study of the Atkins Diet showing a significant LDL lowering had
no control group, put subjects on cholesterol-lowering supplements and was
funded by the Atkins corporation itself. Even in that study though, the
drop was modest—only a 7% drop (compared, for example, to the 52% drop on
the vegetarian diet)—and didn’t include two subjects who quit because
their cholesterol levels went out of control.350
Yet studies like this have been heralded as a
vindication of the Atkins Diet by the mainstream media.351 As journalist
Michael Fumento, co-author of Fat of the Land, pointed out, "How peculiar
when the most you can say for the best-selling fad-diet book of all time
is that it probably doesn't kill people."352 To which I might add, "in the
short-term." Based on an analysis of the Atkins Diet, long-term use of the
Atkins Diet is expected to raise coronary heart disease risk by over
50%.353 "The late Dr. A," Fumento quips, "still gets an F."354
Less often reported in the media is the fact that one of
the research subjects placed on the Atkins Diet in the 2003 "vindication"
study was hospitalized with chest pain and another died.355 Similarly, in
the widely publicized May 2004 study, less widely publicized was the fact
that two people in the low carb-diet arm of the study couldn’t complete
the study because they died. One slipped into a coma; the other dropped
dead from heart disease.356 As the Director of Nutrition at the Harvard
School of Medicine has written, "there is still much danger in the
widespread fad enthusiasm for these diets."357
The Atkins corporation boasts of the supposed ability of
the Atkins Diet to significantly raise the level of HDL, or "good"
cholesterol in a consistent manner.358 HDL transports cholesterol out of
one’s arteries to the liver for disposal or recycling. Only a minority of
controlled studies on Atkins-like diets, however, have shown such an
effect,359,360,361,362,363,364,365,366,367,368,369,370,371,372 but more
importantly, the type of HDL increase seen sometimes on the Atkins Diet
isn’t necessarily healthful.373 When one eats more garbage (saturated fat
and cholesterol) one may need more metabolic garbage trucks (like HDL) to
get rid of it. Eating a stick of butter may raise one’s HDL, but that
doesn’t mean chewing one down is good for one’s heart. In any case,
significantly lowering one’s LDL seems more important than significantly
raising one’s HDL,374 though the studies done on low carb diets typically
show neither.
Because of these “well-known hazards,” the Chair of the
Nutrition Department at Harvard when Atkins’ book was originally published
warned physicians that recommending the Atkins diet “borders on
malpractice.”375
The Proof is in the SPECT Scan
Until the year 2000, all anyone had to evaluate the
impact of the Atkins Diet on the heart was changes in cardiac risk factors
like cholesterol. But then a landmark study was published which, for the
first and only time, actually measured what was happening to peoples’
arteries on this kind of diet. The results were shocking.
Richard Fleming, MD, an accomplished nuclear
cardiologist, enrolled 26 people into a comprehensive study of the effects
of diet on cardiac function. Using echocardiograms, he could visualize the
pumping motion of the heart, and with the latest in nuclear imaging
technology—so-called SPECT scans—he was able to actually directly measure
the blood flow within the coronary arteries, the blood vessels that bring
blood to the heart muscle and allow it to pump. It is when one of these
coronary arteries gets blocked that people have a heart attack.
Fleming then put them all on a low saturated fat, high
carbohydrate diet—the kind that has been proven to not just stop heart
disease, but to in some cases actually reverse it, to open up the
arteries.376 A year later the echocardiograms and SPECT scans were
repeated. By that time, though, 10 of his patients had, unbeknownst to
him, jumped on the low carb bandwagon. All of a sudden, Dr. Fleming had an
unparalleled research opportunity dropped in his lap. Here he had
extensive imaging of 10 people following a low carb diet and 16 following
a high carb diet. What would their hearts look like at the end of the
year? We can talk about risk factors all we want, but compared to the high
carb group, did the coronary heart disease of the patients following the
Atkins Diet improve, worsen, or stay the same?
Those sticking to the whole-foods vegetarian diet showed
a reversal of their heart disease as expected. Their partially clogged
arteries literally got cleaned out, and blood flow to their hearts through
their coronary arteries increased 40%. What happened to those who
abandoned the high carb diet, though, and switched over to the Atkins Diet
and started chowing down on bunless cheeseburgers? Their condition
significantly worsened. All that saturated fat and cholesterol in their
diet clogged their arteries further—the blood flow to their hearts was cut
40%. The only study on the Atkins Diet to actually measure arterial blood
flow showed widespread acceptance of a high saturated fat diet like Atkins
could be heralding a future epidemic of fatal heart attacks. Validation
that "If you were trying to damage your heart," wrote the Center for
Science in the Public Interest, "you couldn’t do much better than to eat a
cheeseburger."377 Maybe filet mignon doesn’t work after all.
The blood flow scans have been posted online so people
can see the evidence for themselves: http://my.webmd.com/content/pages/1/3075_903
"We worry about this," explains Dr. James W. Anderson,
Professor of Medicine and Clinical Nutrition at the University of Kentucky
School of Medicine, "because many of the people who love these diets are
men aged 40 to 50, who like their meat. They may be 5 years from their
first heart attack. This couldn't be worse for them. Did you know that for
50% of men who die from heart attacks, the fatal attack is their first
symptom? They will never know what this diet is doing to them."378
Emerging evidence also suggests that ketogenic diets may
"create metabolic derangement conducive to cardiac conduction
abnormalities and/or myocardial dysfunction"—in other words cause other
potentially life-threatening heart problems as well. Ketogenic diets may
cause a pathological enlargement of the heart called cardiomyopathy, which
is reversible, if the diet is stopped in time.379 The Atkins corporation
denies that Dr. Atkins’ own cardiomyopathy induced-heart attack,
hypertension, and blocked arteries had anything to do with his diet.380
Saturated Fat and Cholesterol Are Bad for You
The Atkins Diet restricts foods that prevent disease and
promotes foods that promote disease.381 No matter what Atkins or other
diet books tell people, the balance of evidence clearly shows that the
intake of saturated animal fat is associated with increased risk of
cancer,382,383 diabetes, and heart disease.384 For over 40 years medical
reviews have also shown the detrimental impact of dietary cholesterol
consumption.385 Even independent of the effects on obesity, meat
consumption itself has been related to an increased risk of coronary heart
disease386
The best dietary strategy to reduce one’s risk of dying
from the number 1 killer in the U.S. is to reduce one’s consumption of
saturated fat and cholesterol. The evidence backing this, according to the
American Heart Association, is "overwhelming."387
Decreasing America’s intake of saturated animal fat is
the primary reason why Johns Hopkins, supported by 28 other public health
schools, launched the Meatless Mondays campaign trying to get Americans to
cut meat out of their diet at least one day out of the week.388 Dr. Jean
Mayer, one of the most noted nutrition figures in history— author of over
750 scientific articles, President of Tufts University, recipient of 16
honorary degrees—warned those going on “this faddish high-saturated-fat
high-cholesterol [Atkins] diet” that they may be “playing Russian roulette
with your heart and with your blood vessels.”389 "The Council," wrote the
American Medical Association in their official critique of the Atkins
Diet, "is deeply concerned about any diet that advocates an ‘unlimited’
intake of saturated fats and cholesterol-rich foods."390
In return, Atkins accused the American Medical
Association of being in the pockets of carbohydrate manufacturers. “If you
look at the financial records of the AMA and the Harvard School of
Nutrition,” said Atkins in an interview, “and see the list of their
benefactors, advertisers, and endowers you'll see why they insist on our
eating carbohydrates." 391
Interestingly, the Atkins corporation seems like it’s
already backpedaling. A front page article in the New York Times revealed
that the Atkins corporation was quietly telling people to restrict their
bacon and butter intake, urging people to keep saturated fat intake under
20% of calories,392 Of course it seems every major health organization on
the planet recommends less than half that, but it does show at least that
Atkins Inc. may be recognizing the dangers of their diet.393
The Atkins corporation claimed that their saturated fat
guideline was nothing new and that Atkins never said people could eat as
much meat as they wanted. They blamed the media for just misconstruing the
Atkins Diet as an eat-as-much-meat-as-you-want diet.394 Really? Atkins
wrote, "There is no limit to the amount of… [any kind of meat in any
quantity] you can eat… You eat as much as you want, as often as you want”
(emphasis in original.)395 In fact he specifically boasts that his diet
"Sets no limit on the amount of food you can eat."396 Maybe the media got
it right.
The Director of Research and Education at Atkins
Nutritionals claims that "Saturated fat isn't as much of an issue when
carbohydrates are controlled; it's only dangerous in excess when carbs are
high." Dr. Frank M. Sacks, a professor of cardiovascular disease
prevention at the Harvard School of Public Health, scoffed at such a
claim. "What they are saying is ridiculous," he said. The revision to 20%
saturated fat, he added, "has nothing to do with science; it has to do
with public relations and politics."397
Closing Off His Heart to the Atkins Diet
One can still go to the Atkins website, though, and read
how innocuous saturated fat is. One reader asks, "Is it OK for me to
consume more than 20% of my calories in the form of saturated fat?" The
answer given is "Absolutely."398
With this kind of advice, 53-year-old businessman Jody
Gorran stayed on the Atkins Diet, and continued to recommend it to his
friends even though his cholesterol had shot up 50%. Before starting the
Atkins Diet, his cholesterol was excellent, he had no history of heart
disease, and an unrelated CT scan showed that his coronary arteries were
clean.399
For Jody Gorran it took two years on the Atkins Diet
before the crushing chest pain started. By then one of his coronary
arteries was 99% blocked and his heart function was suffering for it. An
immediate cardiac catheterization and stent placement may well have saved
his life. In the opinion of his cardiologist, Gorran might well have
otherwise had a massive heart attack and died within a short period of
time. Mr. Gorran is now suing the Atkins corporation, alleging that they
"knew, or should have known," that what they were saying about their diet
and heart disease risk were false. He is trying to get the corporation to
include warning labels on its books, website, and products that a low
carbohydrate diet “may be hazardous to your health—check with your
physician.”400
This is not the first time Atkins was sued. When the
book first came out, a million dollar class action suit was brought
against Atkins and his publisher to recover medical expenses incurred by
the diet’s side effects.401 A Brooklyn Assemblyman on Atkins who nearly
died after a heart attack sued Atkins and the publisher for publishing the
book “without regard to the safety, truth or accuracy if the statements
contained in the book.”402 As revealed in the book Nutrition Cultism, on
three separate occasions Atkins was sued and the cases were settled out of
court in favor of the plaintiffs.403
"The point is," Gorran said in an NBC News interview,
"Dr. Atkins lied to the public. He didn't care. For his ego or for
corporate greed, that's what this thing's about."404 "A successful diet
has to be more than simply losing weight" Gorran said on Good Morning
America, "A successful diet should not kill you."405
Rachel
Most people aren’t able to remain on the Atkins Diet
long enough to develop osteoporosis, kidney damage or hardening of the
arteries. Sixteen year-old high school student Rachel Elizabeth Huskey
only lasted seven weeks.
Rachel had a crush on a boy in her church. So she
started the Atkins Diet to lose weight. In part because she was so
nauseated on the diet, she lost 16 pounds. She was hoping being thinner
would make her more popular at school. After a brief carbohydrate relapse,
she restarted it again "very strictly"406 but could only stick with it
this time for 9 days
In history class, amidst cheering fellow students for
acing a tough question, she collapsed without warning. And then she died.
Frenzied attempts to resuscitate her failed.407 Her doctors blame the
Atkins Diet.
The kidney uses minerals like potassium and calcium to
help rid one’s body of toxins like ketones. People on the Atkins Diet are
urinating these minerals away. And critically low levels in the blood of
these electrolytes can lead to fatal cardiac arrhythmias—lethal heart
rhythms. Rachel was on the Atkins Diet and was found on autopsy to have
critically low blood levels of both potassium and calcium and she died of
a cardiac arrhythmia. Rachel was previously in good health and had no
history of any medical problems.
After ruling out other potential causes, the medical
team of child health specialists that investigated her death couldn’t help
but conclude in their published report, "Sudden Cardiac Death of an
Adolescent During Dieting," that the Atkins Diet was the most likely cause
of her death.
The chief executive of the Atkins corporation denied
there was a link between the diet and Rachel's death, but implied she
should have consulted her doctor before starting the diet.408 In fact,
concern over just such an event led the Director of the Nutrition
Department at the esteemed Cleveland Clinic to declare that for people on
the Atkins Diet, "Careful monitoring of electrolytes is absolutely
essential…" Those who aren’t professionally monitored on this kind of diet
"are at the greatest risk for dangerous complications."409
Dr. Paul Robinson, the Director of Adolescent Medicine
at the University of Missouri involved in the investigation of Rachel’s
death, is afraid that "we're having lots of near misses that we don't know
about."410 "You wonder," he said, "whether there are other people dying
and we don't know about it."411
One would think a teenager collapsing and dying after
just 9 days on the diet might have ruined people’s appetite for Atkins,
but her death was hardly reported in the American press. When her parents
held a press conference to tell their story for the first time and warn
others that Atkins "killed our little girl,"412 it was reported in London,
Scotland, New Zealand, Australia and South Africa. But out of the 34
reports that made it into the papers around the world about this Missouri
teen, only 3 appeared in the U.S.413 Despite repeated warnings from the
American Heart Association, enthusiasm for the Atkins Diet did not seem to
wane.
While tending her daughter's immaculately-kept grave,
Rachel’s mom told a reporter her thoughts on the diet: "I want people to
know you can actually die doing something as stupid as this."414
Down on Atkins Down Under
Australia seems to be the only nation in which action is
actually being taken at a State level. The Victorian Health Minister,
supported by the Australian Heart Foundation and the Australian Medical
Association, issued a warning to alert people to the dangers of the Atkins
Diet and other high-fat fad diets.415 The government is warning the public
about the potential short-term effects—constipation, dehydration, bad
breath, low energy and poor concentration—and potential long-term effects
such as the increased likelihood of cancer, heart disease, depression, and
osteoporosis. "When we know something is bad for people, like smoking,"
the health minister explained, "then we let people know what the health
risks are."416
Initially, the government will distribute educational
materials in doctors’ waiting rooms, gyms and universities, probably
followed by advertising in bus shelters and in the media.417 Australia’s
chief physician urged all governments to follow suit.418
The Atkins empire said that this was the first
government to launch a public health campaign against them. The British
government did issue a warning against low carbohydrate diets, saying they
were "bad for your health" though it didn’t specifically name Atkins.419
The "US Federal Government officials," Atkins corporate representatives
said, "had a much more positive response…"420 Perhaps "low carb" foods
aren’t a $30 billion dollar business down under.
Only Under Monthly Clinical Supervision
In a medical journal article entitled "Bizarre and
Unusual Diets" the authors warn that the Atkins Diet had such questionable
safety that it should "only be followed under medical supervision."421 But
what do doctors know about nutrition? Even though the United States
Congress mandated that nutrition become an integrated component of medical
education,422 as of 2004, less than half of all U.S. medical schools have
a single mandatory course in nutrition.423 That explains the results of a
study published in the American Journal of Clinical Nutrition that pitted
doctors against patients head-to-head in a test of basic nutrition
knowledge. The patients won.424 People off the street seem to know more
about nutrition than their doctors.
Doctors can monitor for adverse effects, though. "The
Atkins program falls short in insufficiently warning dieters," another
review of popular weight loss diets warns, so that they "need to be
monitored by a physician to ensure his or her safety."425 According to the
Chair of the Nutrition Department at Harvard Medical School, people on
Atkins "should be monitored for orthostatic hypotension… dizziness,
headaches, fatigue, irritability, gout and kidney failure." And laboratory
work should include "blood tests (glucose, blood urea nitrogen, sodium,
potassium, chloride, and bicarbonate), urinalysis (specific gravity, pH,
protein, and acetone) and a lipid profile. Vital signs… should be
monitored at least monthly during a low carbohydrate weight-loss
program."426
I suppose the expense of monthly visits would be in
addition to the $10,000-$20,000 the food and supplements are estimated to
cost every year.427,428,429,430
THE SAFER ALTERNATIVE
Where Atkins Deserved Credit
Once, when Dr. Ornish was being interviewed on Dateline
NBC, his interviewer swore that he had lost 50 pounds on an Atkins Diet,
ate a steak every day and felt great. He asked Ornish "How bad could it
be?" When Ornish turned the tables and questioned the host, it came out
that, before going on Atkins, the guy seemed to be living off french
fries, fried onion rings, cheesecake, and at least five soft drinks per
day, everyday. He had since cut all those out and started exercising
religiously. Ornish pointed out that the reason he’s now feeling better
was probably in spite of the steak, not because of it.431
While Atkins used to tell people to eat unlimited
quantities of hydrogenated shortening like Crisco,432 thankfully he
flip-flopped and now warns about the "dangers of trans fats." Just cutting
out deep fried foods (most often fried in 100% vegetable—and 100%
hydrogenated—oil) from one’s diet should alone improve one’s cholesterol
profile. Atkins also encouraged everyone to cut out caffeine, eat more
heart-healthy nuts and omega-3 fatty acids and does consider daily
exercise a critical "non-negotiable" component to his plan.433
Anyone completely cutting out sugary soda, pastries, ice
cream, cookies, cake, candy, kids’ cereals, and Snackwells is probably
going to feel better. But does one need a 300-page diet book to tell us
that? Anything that can give Krispy Kreme’s corporate profits that glazed
look434 is a good thing for America’s health.
For those who don’t remember, Snackwells were Nabisco's
line of low-fat and fat-free junk food that went from zero to a billion
dollars in revenues in four short years, in effect becoming America's most
popular cookie. When Snackwells’ fat-free Devil's Food Cookie Cakes first
appeared, demand was so high that Nabisco had to ration them out to stores
and fights broke out, forcing store managers to keep boxes of the cookie
under lock and key.435
People were mistaking low-fat for low-calorie. The
intention of the government’s recommendation to cut down on fat was to get
people to cut down on items like meat and switch to foods that are
naturally low in fat—like beans, whole grains, fruits and vegetables.
These don’t have much of a profit margin, though, so the food industry
took advantage of the new guidelines to market low-fat junk food like
Snackwells cookies, swapping fat for sugar. Each cookie was basically just
white flour, no fiber and two spoonfuls of sugar. Even bags of jellybeans
started boasting "fat-free." A similar phenomenon is now happening with
low carb junk food. A new Atkins-friendly ice cream, for example, has
almost twice the calories of regular ice cream (and of course twice the
fat).436 “It's Snackwells all over again,” noted one WebMD Medical News
article.437 Junk food—low fat or low carb—is still junk food
People also may feel better on the Atkins Diet because
he tells people to stop drinking cow’s milk. Even the National Dairy
Council admits438 that literally most people on the planet are lactose
intolerant (and may not even know it).439 That change alone should make a
segment of the people trying Atkins feel better. Other easy born-again
Atkins converts might be those with an actual dairy allergy or the one out
of every few hundred Americans who is allergic to wheat.440
Even at his strictest, Atkins "allowed" two small salads
a day. Although they can only be a cup of "loosely" packed greens each,
that’s sadly more salad than many non-Atkins Americans may get. Then
again, of course, Atkins’ "spinach salad" recipe calls for an entire pound
of bacon and 5 eggs. No croutons, of course—"use crumbled fried pork rinds
instead."441
Atkins even recommended eating one’s greens organic,
dark, and leafy,442 although the word "kale" does not seem to frequent the
book sleeve. Unfortunately people may ignore the few reasonable
suggestions that Atkins made, and just use his low carb phenomenon as an
excuse to eat whatever they want.
The Answers are No and No
There seem to be two Atkins Diets: one that he describes
in his books (particularly in later editions), and the one the public
thinks he describes in his books. How many Atkins Dieters, for example,
only eat free-range organic bacon? This may be one of the reasons why we
haven’t seen even higher rates of serious side effects—so few people may
be actually following the diet.
A recent study of 11,000 people found that only one in
four of those claiming to be on a low carb diet were actually
significantly cutting carbs at all.443 Another survey, commissioned by
former Surgeon General C. Everett Koop’s organization Shape Up America!,
found that most people claiming to be on Atkins, or another of the low
carb fad diets, didn’t seem to even know where carbs were found.444 Most
didn’t know, for example, that tomatoes were high in carbs. Thankfully,
about half of them didn’t know apples had a lot of carbs, and 1 in 6 even
thought steak was a carbohydrate.445 Thankfully most people on Atkins are
actually not on Atkins.
Despite the softening of his stance on whole grains and
many vegetables, Atkins still made saturated fat-laden meat and dairy the
centerpiece of his diet. The Atkins Diet therefore remains dangerous even
when "used as directed."
Isn’t it possible to do the Atkins Diet healthfully,
though? Isn’t there some way to modify it to make if safer? Those exact
questions were asked of the editors at the Tufts University Health and
Nutrition Letter by one of the University’s Vice Presidents.
After trying their best, the editorial staff at the
Tufts Letter couldn’t help but conclude, "So, as to whether it’s possible
to follow the Atkins Diet healthfully or tweak it to make it safe and
healthful, the answers are no and no"(emphasis in original).446
Too Good to Be True
What kind of diet can cause birth defects? Or blindness?
Or requires 65 supplements? Or monthly medical checkups, where the
monitoring of electrolytes is considered "absolutely essential?" Is it too
much to ask that one’s diet facilitate instead of debilitate physical
activity? (Here in Boston there has yet to be a night of pork-rind loading
before the Marathon.) What kind of diet may require prescriptions to deal
with the side effects? What kind of diet has side effects at all?
Rational people go on irrational diets because "they're
desperate," says Kelly Brownell, Director of Yale University's Center for
Eating and Weight Disorders. "If you're a person with an overweight body
living in a thin-obsessed world… something that offers a miracle is highly
attractive."447
The Director of Nutrition at the Center for Science in
the Public Interest is dumbfounded that the high-fat regimes have caught
on. "With all the evidence that saturated fat promotes heart disease, it's
almost unbelievable to me that people could successfully tell people to
eat bacon, eggs, ground beef, cheese and cream," she says. "It really
shows that people care more about how they look than how healthy they
are."448
Obesity shouldn’t be a cosmetic or moral issue, but it
does remain a health issue. Obesity, as defined by the Institute of
Medicine, is "an important chronic degenerative disease that debilitates
individuals and kills prematurely."449 Obesity continues to contribute to
hundreds of thousands of deaths in the U.S. every year.450,451,452,453
Losing weight is important, but the goal should be to lose weight in a way
that enhances health rather than in ways that may harm it. People also use
cocaine, amphetamines and tobacco to control their weight—not health
promoting solutions to the problem.
The Consumer Guide concluded that the Atkins Diet “owes
its appeal, like pornography, to the naughtiness of the approach, to the
titillation we all feel in doing something which we think is not
right.”454 Diet gurus like Atkins—the "bad boy of diets"455—gave "his
readers what they wanted to hear," says James Hill, Director of the
University of Colorado Center for Human Nutrition. Asks one Atkins
disciple: "Who wouldn't like a diet that allows fried eggs and bacon and
all the steak you can eat?"456 "But what people want to hear," Dr. Hill
adds, "is killing them."457
Atkins is Based on a Half-Truth
Despite U.S. attempts to stall458 and sabotage459 the
World Health Organization’s report on diet (as they tried to do with
tobacco),460 in May 2004 the WHO Global Strategy on Diet, Physical
Activity and Health was unanimously endorsed by all 192 Member States of
the United Nations. The report blames the growing pandemic of global
chronic disease in part on "greater saturated fat intake (mostly from
animal sources), reduced intakes of complex carbohydrates and dietary
fiber, and reduced fruit and vegetable intakes," in other words, they
blame the global epidemic of obesity, cancer, heart disease and diabetes
on exactly the kind of diet Atkins’ books recommend. As the Harvard Health
Letter put simply, the Atkins Diet "is not a healthy way to eat."461 The
World Health Organization is calling for limiting the consumption of
saturated animal fats462 and "increasing the consumption of fruits,
vegetables, legumes [beans, peas and lentils], whole grains and nuts."463
The evidence to support their position is
"overwhelming."464 After 11 years following 11,000 people, for example,
researchers found that eating whole grains may help people live longer.
That did not seem to be the case for refined grains, though.465 And the
Atkins Diet is based on that half-truth.
Atkins was right in going "against the grain" in the
case of refined carbohydrates like white flour and sugar. But he was wrong
to restrict good carbs—the carbs found in whole unrefined foods—like the
WHO’s "fruits, vegetables, legumes, whole grains and nuts." A bunless
burger is not the answer to a fat-free doughnut.
Just because jellybeans and Wonder Bread are not
health-promoting foods does not mean one has to switch to pork rinds and
bacon. Let’s not throw the wheat germ out with the wheat.
You Can Have Your Carbs and Eat Them Too
What evidence do we have that "good" carbs are good?
Every single long-term prospective cohort study ever performed on the
foods that the Atkins Diet restricts—fruits, vegetables, nuts and whole
grains—show that they protect people from the nations’ biggest killer:
heart disease.466 Harvard studied 75,000 women for a decade and the
results suggest that the more whole grains people eat—like brown rice and
whole wheat bread—the lower their risk of having a heart attack.467
Harvard studied 40,000 men for a decade and suggested that eating whole
grains may cut one’s risk of developing diabetes by more than half.468 The
only thing wrong with whole grains, perhaps, is that they may not sell as
many books.
Atkins seemed to think that fruit was the worst thing
since sliced bread. Fruit consumption alone, however, has been linked to
lower rates of numerous cancers469 and may reduce heart disease mortality,
cancer and even total mortality.470 The World Health Organization blames
low fruit and vegetable consumption on literally millions of deaths
worldwide.471 Everyone should eat more fruits and vegetables as if their
lives depended on it.
The National Cancer Institute’s recommendation is now up
to nine servings of fruits and vegetables every day. While Atkins preached
to restrict fruit and vegetable intake, what Americans really need is more
fruits and veggies, not less.472
Lose Weight without Losing Your Health—or Your Life
Life-long weight control is a marathon; fad diets are
sold on the 100-yard dash. The UC Berkeley School of Public Health’s #1
rated473 newsletter’s "Bottom Line" on Atkins: "Bottom Line: If you follow
the Atkins Diet, you will lose weight—but it could be dangerous beyond a
few weeks. All fad diets get you to cut down on calories, usually by
limiting the kinds of food you can eat, so of course you lose weight.
Most, like the Atkins Diet, deny that ‘calories count,’ but nonetheless
trick you into cutting way down on calories by distracting you with
strange rules and psychological/biochemical babble. As with all crash
diets, keeping the weight off is the hard part. Virtually all crash
dieters eventually gain the weight back, unless they learn the basics of
healthy eating, which crash diets do not teach."474 Diets are not
something to be followed for days, weeks, or months. They should form the
basis of everyday food choices for the rest of one’s life.
So what are the "basics of healthy eating?" According to
the American Dietetics Association, "The overwhelming majority of studies
reported to date including both epidemiological and laboratory approaches,
suggest that eating carbohydrate-rich foods such as vegetables, fruits,
legumes and whole grains, and limiting saturated fat intake, over a
lifetime, is associated with substantially reduced risk for vascular
disease and some cancers."475 It may be no coincidence that the
longest-living people in the world, even by some accounts outlasting the
Okinawa Japanese,476 are the California Seventh Day Adventist
vegetarians.477
Every study over six months in duration of the Atkins
Diet found that the Atkins Diet failed to significantly outperform the
exact diet Atkins blamed our entire obesity epidemic on.478 Why not, then,
choose a healthier diet?
Fewer than 20% of Americans trying to lose weight follow
what’s considered the optimal diet plan for weight control, the one most
proven to be safe and effective for losing weight, keeping the weight off
and promoting health—a diet low in saturated animal fats, and high in
fruits, vegetables and high-fiber-containing carbohydrates like beans and
whole grains.479 How convenient that the most healthful diet also seems to
be the one most successful in controlling one’s weight.480
To lose weight, one can cut down on calorie intake by
restricting the amount of food one eats, or one can transition away from
eating junk food—foodstuffs long on calories but short on nutrition—toward
eating food that is nutrient-dense, but relatively calorie-dilute: foods
like fruits, vegetables, beans and whole grains. One can add nuts to the
list as well, since despite their caloric density, a 2003 review concluded
eating nuts every day might actually help one maintain or even lose
weight.481 People placed on nutrient-dense, calorie-dilute plant-based
diets tend not to complain of hunger, but of having "too much
food."482,483,484
The healthy alternative to the Atkins Diet is not a
fat-free diet, but a fad-free diet. The optimal diet is one centered
around good carbohydrates (unrefined), good fats (like nuts) and the best
sources of protein, which, according to the Harvard School of Medicine,
are "beans, nuts, grains and other vegetable sources of protein…"485 in
other words, by eating a whole-food plant-based diet one can control one’s
weight without risking one’s health—or one’s life. We don’t have to
mortgage our health in order to lose weight.
Conclusion
"Nobody wants to hear this," groaned Dr. James W.
Anderson in an interview. Anderson is a Professor of Medicine and Clinical
Nutrition at the University of Kentucky School of Medicine. "People lose
weight, at least in the short term. I am not arguing with that. But this
is absolutely the worst diet you could imagine for long-term obesity,
heart disease, and some forms of cancer. If you wanted to find one diet to
ruin your health, you couldn't find one worse than Atkins'."486
Thankfully, the low carb mania may have peaked.
According to the June 14, 2004 issue of Fortune magazine, data show that
the number of Americans on a low carb diet has fallen 25% since January.
As one Wall Street analyst explained, "Have you ever tried low carb
bread?"487
* Michael Greger, MD, is a graduate of the Cornell
University School of Agriculture and the Tufts University School of
Medicine. Dr. Greger has been publicly speaking about mad cow disease
since 1993. In 1997 he was invited as an expert witness to defend Oprah
Winfrey in the infamous meat defamation trial. He has contributed to many
books and articles on the subject and continues to lecture extensively.
Dr. Greger can be contacted at 857-928-2778, or
[email protected]
.
References:
245 American Journal of Clinical Nutrition 99(1997):239.
246 Atkins, RC. Dr. Atkins Diet Revolution. David McKay Company, Inc.,
1972.
247 Cleveland Clinic Journal of Medicine 68(2001):761.
248 British Medical Journal 326(2003):1090.
249 Milling & Baking News 7 March 2000.
250 Modern Medicine 28 May 1973:132.
251 The Washington Post 18 April 2003.
252 Cleveland Clinic Journal of Medicine 68(2001):761.
253 Cleveland Clinic Journal of Medicine 68(2001):776.
254 American Institute for Cancer Research Newsletter 67(2000):11.
255 Circulation 104(2001):1869.
256 Caterer and Hotelkeeper 28 August 2003.
257 Daily Record 25 August 2003.
258 The Times (London) 27 September 2003.
259 The Sunday Telegraph (Sydney, Australia) 14 September 2003.
260 The Independent 13 August 2003.
261 The Evening Standard (London) 12 August 2003.
262 Cleveland Clinic Journal of Medicine 68(2001):761.
263 Journal of the American Dietetics Association 86(1985):460.
264 Medical Journal of Australia 1(1977):65.
265 British Journal of Ophthalmology 63(1979):191.
266 Medical Letter on Drugs and Therapeutics 15(1973):1.
267 Medical Times 107(1979):31.
268 The Medical Letter 42(2000):52.
269 Obesity Research 9(2001):1S.
270 Journal of the American College of Cardiology 43(2004):725.
271 "Diet-Pak."
http://atkins.com/shop/get-started.html/pg=2
272 "Anti-Oxidant"
http://atkins.com/shop/products/AntiOxidant.html
273 USA Today 3 May 2004.
274 CBS News. The Early Show. 25 May 2004.
275 Journal of the American College of Cardiology 43(2004):725.
276 Atkins, RC. Dr. Atkins New Diet Revolution. Avon Books, 1999.
277 Dr. Atkins New Diet Revolution 3rd edition. M. Evans and Company,
Inc. 2002.
278 Atkins, RC. Dr. Atkins Diet Revolution. David McKay Company, Inc.,
1972.
279 The Sunday Telegraph (Sydney, Australia) 14 September 2003.
280 Cleveland Clinic Journal of Medicine 68(2001):761.
281 Cleveland Clinic Journal of Medicine 69(2002):855.
282 New England Journal of Medicine 323(1990):1664.
283 Cancer Research 54(1994):2390.
284 Nutrition Action Healthletter, January/February 2004:1.
285 Nation's Restaurant News 17 May 2004.
286 Journal of the National Cancer Institute 95(2003):1079.
287 American Cancer Society. Weighing In on Low Carb Diets. 2004.
http://www.cancer.org/docroot/SPC/content/SPC_1_A_Low_Carb_Diet_to_Prevent_Cancer.asp
288 New England Journal of Medicine 307(1982):652.
289 Atkins, RC. Dr. Atkins Diet Revolution. David McKay Company, Inc.,
1972.
290 American Kidney Fund news release 25 April 2002.
291 Dr. Atkins New Diet Revolution 3rd edition. M. Evans and Company,
Inc. 2002.
292 New England Journal of Medicine 307(1982):652.
293 Annals of Internal Medicine 138(2003):460.
294 American Journal of Kidney Diseases 41(2003):1.
295 Journal of the American College of Cardiology 43(2004):725.
296 American Family Physician 60(1999):2269.
297 American Kidney Fund News release 25 April 2002.
298 Asia Pacific Journal Clinical Nutrition. 12(2003)396.
299 Sunday Mail (Queensland, Australia) 22 February 2004.
300 Journal of Pediatrics 117(1990):743.
301 American Journal Epidemiology 143(1996):472.
302 American Journal of Clinical Nutrition 73(2001):118.
303 The New York Weekly 26 March 1973.
304 American Journal of Kidney Diseases 40(2002):265.
305 American Journal of Kidney Diseases 40(2002):265.
306 “Osteo #10” http://atkins.com/shop/products/Osteo_10.html
307 Abram’s Plains: A Poem. Editorial Emendations.
http://www.uwo.ca/english/canadianpoetry/longpoems/abrams/editorial.htm
308 American Journal of Kidney Diseases 40(2002):265.
309 Calcium intake levels in the United States: issues and
considerations.
http://www.fao.org/docrep/W7336T/w7336t06.htm
310 American Journal of Clinical Nutrition 11(1963):31.
311 American Journal of Clinical Nutrition 27(1974):916.
312 Human Biology 46(1974):369.
313 Human Biology 56(1984):63.
314 Human Biology 47(1975):45.
315 Alaska Medicine 43(2001):1.
316 Canadian Medical Association Journal 152(1995):1237.
317 CNN. Larry King Live. 11 July 2003.
318 Epilepsia 39(1998):744.
319 Atkins, RC. Dr. Atkins New Diet Revolution. Avon Books, 1999.
320 Journal of Biological Chemistry 83(1929):753.
321 Atkins Health Revelations Special Report, Winter 2001.
322 Cleveland Clinic Journal of Medicine 69(2002):855.
323 Dr. Atkins New Diet Revolution 3rd edition. M. Evans and Company,
Inc. 2002.
324 Atkins, RC. Dr. Atkins New Diet Revolution. Avon Books, 1999.
325 Berland, T and L Frohman. CONSUMER GUIDE Rating the Diets.
Publications International, Ltd., 1974.
326 Journal of the American Dietetics Association 77(1980):264.
327 American Journal of Clinical Nutrition 30(1977):160.
328 Nutrition and Metabolism 17(1974):360.
329 Obesity Research 9(2001):1s.
330 Journal of Nutrition. 132(2002):1879.
331 Journal of Pediatrics 142(2003):253.
332 Journal of Pediatrics 142(2003):352.
333 New England Journal of Medicine 348(2003):2074.
334 Annals of Internal Medicine 140(2004):778.
335 New England Journal of Medicine 348(2003):2082.
336 Journal of Clinical Endocrinology and Metabolism 88(2003):1617.
337 Annals of Internal Medicine 140(2004):769.
338 Journal of Nutrition 134(2004):880.
339 Journal of Nutrition 133(2003):2756.
340 Journal of Nutrition 129(1999):1545.
341 American Journal of Clinical Nutrition 56(1992):320.
342 Journal of the American Medical Association 290(2003):912.
343 Journal of the American Dietetics Association 100(2000):1301.
344 Journal of Nutrition 133(2003):2756.
345 Expert Panel on Detection, Evaluation, and Treatment of High Blood
Cholesterol in Adults, National Cholesterol Education Program. Second
report of the Expert Panel on Detection, Evaluation, and Treatment of High
Blood Cholesterol in Adults (Adult Treatment Panel II). Circulation.
1994;89:1329-1445.
346 Annals of Internal Medicine 140(2004):769.
347 Reuters 26 May 2004.
348 Circulation 89(1994):1329.
349 The Washington Post 27 August 2002.
350 American Journal of Medicine 113(2002):30.
351 "Pair of Studies Vindicate Atkins Diet." Associated Press 21 May
2003.
352 National Review Online 6 June 2003.
353 Journal of the American College of nutrition 19(2000):578.
354 http://www.fumento.com/fat/media.html
355 New England Journal of Medicine 348(2003):2074.
356 Annals of Internal Medicine 140(2004):778.
357 Cleveland Clinic Journal of Medicine 69(2002):864.
358 Federal Document Clearing House Congressional Testimony 3 June
2004.
359 Journal of Nutrition. 132(2002):1879.
360 Journal of Pediatrics 142(2003):253.
361 Journal of Pediatrics 142(2003):352.
362 New England Journal of Medicine 348(2003):2074.
363 Annals of Internal Medicine 140(2004):778.
364 New England Journal of Medicine 348(2003):2082.
365 Journal of Clinical Endocrinology and Metabolism 88(2003):1617.
366 Annals of Internal Medicine 140(2004):769.
367 Journal of Nutrition 134(2004):880.
368 Journal of the American College of Nutrition 23(2004):177.
369 Journal of Nutrition 2003 Sep;133(9):2756-61.
370 American Journal of Clinical Nutrition 63(1996):174.
371 Journal of the American Dietetics Association 77(1980):264.
372 American Journal of Clinical Nutrition 30(1977):160.
373 Journal of Clinical Investigation 85(1990):144.
374 Harrison's Advances in Cardiology. McGraw Hill, 2002.
375 Medical Opinion 1(1972):13.
376 Journal of the American Medical Association 280(1998):2001.
377 Nutrition Action Newsletter January-February 2001:1.
378 CBS Healthwatch December 1999.
http://cbshealthwatch.medscape.com/medscape/p/G_Library/article.asp?RecID=203132&ContentType=Library&DietImg=1
379 Neurology 254(2000):2328.
380
http://atkins.com/about/recentnews/wsjresponse.html
381 American Institute for Cancer Research Newsletter 67(2000)11.
382 World Cancer Research Fund/American Institute for Cancer Research.
Food, Nutrition, and the Prevention of Cancer: a global perspective. World
Cancer Research Fund/American Institute for Cancer Research, 1997.
383 Journal of the National Cancer Institute 95(2003):1079.
384 Report of a Joint WHO/FAO Expert Consultation. Diet, Nutrition and
the Prevention of Chronic Diseases. WHO Technical Report Series 916, 2003.
385 Geriatrics (1961):407.
386 Preventive Medicine 13(1984):490.
387 Circulation 98(1998):935.
388
http://meatlessmondays.org/about.html
389 Washington Post 14 April 1973.
390 Journal of the American Medical Association 224(1973):1418.
391 Berland, T and L Frohman. CONSUMER GUIDE Rating the Diets.
Publications International, Ltd., 1974.
392 The New York Times 18 January 2004.
393 Circulation 89(1994):1329.
394 The New York Times 18 January 2004.
395 Atkins, RC. Dr. Atkins Diet Revolution. David McKay Company, Inc.,
1972.
396 Atkins, RC. Dr. Atkins New Diet Revolution. Avon Books, 1999.
397 The New York Times 18 January 2004.
398
http://atkins.com/Archive/2004/2/3-915798.html
399 JODY GORRAN, Plaintiff, v. ATKINS NUTRITIONALS, INC. and PAUL D.
WOLFF, Solely in his Representative Capacity as Co-Executor of the Estate
of Robert C. Atkins, M.D., Defendants.
400 JODY GORRAN, Plaintiff, v. ATKINS NUTRITIONALS, INC. and PAUL D.
WOLFF, Solely in his Representative Capacity as Co-Executor of the Estate
of Robert C. Atkins, M.D., Defendants.
401 The Chronicle (Houston, TX) 9 March 1973.
402 New York Times 23 March 1973.
403 Herbert, V. Nutrition Cultism. George F. Stickley Co., 1980.
404 NBC News Transcripts. Today Show. 28 May 2004.
405 ABC. Good Morning America 28 May 2004.
406 MSNBC. DONAHUE 13 November 2002.
407 Daily Mail (London) 23 August 2003.
408 PR Newswire 11 November 2002.
409 Cleveland Clinic Journal of Medicine 68(2001):777.
410 Newhouse News Service 5 February 2004.
411 The Sunday Telegraph (Sydney, Australia) 24 August 2003.
412 Daily Mail (London) 23 August 2003.
413 Using Lexis-Nexis, searching all English language news, no date
restriction: "Rachel Huskey" and "Atkins Diet" on 17 May 2004.
414 Daily Mail (London) 23 August 2003.
415 Herald Sun (Melbourne, Australia) 13 April 2004.
416 Herald Sun (Melbourne, Australia) 15 March 2004.
417 Herald Sun (Melbourne, Australia) 15 March 2004.
418 The Mercury (Australia) March 16, 2004.
419 The Express 22 September 2003.
420 Herald Sun (Melbourne, Australia) 16 March 2004.
421 The Practitioner 222(1979):643.
422 American Journal of Clinical Nutrition 72(2000):868S.
423 Today’s Dietician February 2004:21.
424 American Journal of Clinical Nutrition 58(1997):319.
425 Clinics in Sports Medicine 18(1999):691.
426 Cleveland Clinic Journal of Medicine 68(2001):761.
427 "Diet-Pak"
http://atkins.com/shop/get-started.html/pg=2
428 "Anti-Oxidant"
http://atkins.com/shop/products/AntiOxidant.html
429 USA Today 3 May 2004.
430 CBS News. The Early Show 25 May 2004.
431 The Diet War: Low-Fat vs. High-Protein with Dean Ornish. 16 July
2002.
http://my.webmd.com/content/article/53/60634.htm?lastselectedguid={5FE84E90-BC77-4056-A91C-9531713CA348}
432 Atkins, RC. Dr. Atkins Diet Revolution. David McKay Company, Inc.,
1972.
433 Dr. Atkins New Diet Revolution 3rd edition. M. Evans and Company,
Inc. 2002.
434 The Evening Standard (London) 28 May 2004.
435 Fumento, M and JE Manson. The Fat of the Land: Our Health Crisis
and How Overweight Americans Can Help Themselves. Penguin, 1998.
436 Consumer Reports 69(2004):12.
437 WebMD Medical News 10 May 2004.
438 National Dairy Council.
Lactose Intolerance and Minorities: The Real Story.
http://www.nationaldairycouncil.org/nutrition/lactose/lactoseIntolerance.asp?page=4
439 Journal of the American Dietetic Association 96(1996):243.
440 Gastroenterology 110(1996):A1.
441 Atkins, RC. Dr. Atkins Diet Revolution. David McKay Company, Inc.,
1972.
442 Dr. Atkins New Diet Revolution 3rd edition. M. Evans and Company,
Inc. 2002.
443 The NPD Group Reports on Low Carb's Impact on America's Diet 5
April 2004.
http://www.npd.com/press/releases/press_040405.htm
444 Shape Up America news release 29 December 2003.
445 Newhouse News Service 5 February 2004.
446 Tufts University Health and Nutrition Letter 21(2003):1.
447 The Washington Post 23 November 1999.
448 The Washington Post 23 November 1999.
449 Institute of Medicine. Weighing the Options. National Academy
Press, 1995.
450 American Heart Journal 147(2004):841.
451 New England Journal of Medicine 338(1998):1.
452 Annals of Internal Medicine 138(2003):24.
453 Journal of the American Medical Association 289(2003):187.
454 Berland, T and L Frohman. CONSUMER GUIDE Rating the Diets.
Publications International, Ltd., 1974.
455 Harvard Health Letter 28(2003):1.
456 Tampa Tribune (Florida) 19 October 1999.
457 Reason March 2003.
458 Developing Countries Attack U.N. Strategy On Obesity. UN Wire.
http://www.unwire.org/UNWire/20040210/449_12957.asp
459 U.S. Opposes WHO's Anti-Obesity Campaign. UN Wire.
http://www.unwire.org/UNWire/20040116/449_12157.asp
460 Centre for Science in the Public Interest letter to Mr. Ed Aiston,
Director General International Affairs Directorate.
http://cspinet.org/canada/who_glstrat.html
461 Harvard Health Letter 28(2003):1.
462 World Health Organization. World Health Assembly Raises Global
Public Health to New Level.
http://www.who.int/mediacentre/releases/2004/wha4/en/
463 World Health Organization. Frequently Asked Questions About the WHO
Global Strategy on Diet, Physical Activity and Health.
http://www.who.int/dietphysicalactivity/faq/en/
464 Circulation 98(1998):935.
465 Journal of the American College of Nutrition 19(2000)326S.
466 Journal of the American Medical Association 288(2002):2569.
467 American Journal of Clinical Nutrition 70(1999)412.
468 American Journal of Clinical Nutrition 76(2002):535.
469 Cancer Causes and Control 7(1996):178.
470 British Medical Journal 313(1996):775.
471 World Health Organization. Fruit, Vegetables and NCD Prevention.
http://www.who.int/dietphysicalactivity/publications/facts/fruit/en/
472 National Cancer Institute. www.9aday.cancer.gov/
473
http://www.berkeleywellness.com/html/wl/wlAbout
474 University of California at Berkeley Wellness .April 2000.
475 Journal of the American Dietetics Association 100(2000):1300.
476 Harvard Health Letter January 2002.
477 Archives of Internal Medicine 161(2001):1645.
478 CNN. Larry King Live. 11 July 2003.
479 US Department of Health and Human Services. Office of the Surgeon
General. The Surgeon General’s Call to Action to Prevent and Decrease
Overweight and Obesity. 2001.
480 Obesity Research 9(2001):1S.
481 American Journal of Clinical Nutrition 78(2003):647s.
482 Journal of the American Medical Association 274(1995):1450.
483 Obesity Research 4(1996):347.
484 Archives of Internal Medicine 164(2004):210.
485 Willett, WC, Skerrett, PJ, and Edward L. Giovannucci. Eat, Drink,
and Be Healthy: The Harvard Medical School Guide to Healthy Eating. Simon
& Schuster, August 2001.
486 CBS Healthwatch December 1999.
http://cbshealthwatch.medscape.com/medscape/p/G_Library/article.asp?RecID=203132&ContentType=Library&DietImg=1
487 Fortune 14 June 2004:152.
Fair Use Notice: This document may contain copyrighted material whose
use has not been specifically authorized by the copyright owners.
We believe that this not-for-profit, educational
use on the Web constitutes a fair use of the copyrighted material (as
provided for in section 107 of the US Copyright Law). If you wish to use
this copyrighted material for purposes of your own that go beyond fair
use, you must obtain permission from the copyright owner.
