Atkins / Low Carb Article, Final Segment

LOW CARBS? AT FIRST YOU'LL DO FINE . . . BUT . . .

Atkins asks you to minimize carbs. At first you're doing just fine because you have glycogen stored. After a day or two, you're using up your stored glycogen and you're not replacing it. Your body shortly thereafter begins producing ketone bodies. I mentioned Atkins' praise of a ketotic state already. Let's look a bit further into this condition.

Ketones are intermediaries in the process of metabolizing fat that are found in abnormal amounts in the blood and urine during periods of metabolic impairment. Give up all of your stored glycogen without replacing it and you're likely going to be in such a state (Note: if you take in too many protein calories, it is possible to avoid carbs and never enter a state of ketosis rendering his low-carb ketosis theories useless). Atkins leads you to believe that the presence of these ketone bodies indicates ongoing fat release. He also assures you that they feed the brain. That is partially true. Here are just a few of the issues he neglects to address:

1. Extended periods of ketosis may affect the chemical composition of the blood in such a way that you increase risk of cardiac incident (blood ketoacidosis).

2. In a state of ketoacidosis, carbon dioxide accumulates in the tissues. Oxygen delivery to the cells is impaired. This can lead to a wide range of disastrous consequences ranging from respiratory ailments to metabolic illness.

3. Toxic ammonia buildup resulting from severe cases of ketoacidosis can be lethal.

I don't want to create any false alarms here. I'm not saying everyone who enters a state of ketosis is going to be at risk of death. I'm just pointing out that there is potential danger in what many people misinterpret to be an ideal physiological state to maintain. At the very least, the risk, just as risks of medications, should be addressed and made public. If Atkins does share that information with readers, I couldn't find it. He also neglects to tell you that the liver is called into play to "filter" the abnormal chemicals building up in the blood. This leads to a residual buildup of uric acid. Interestingly, this uric acid accumulation can lead to . . . formation of kidney stones!

Kidney stones may be common among low-carb dieters, but don't mistake that for an indication that they're normal! If all is working optimally, uric acid levels stay quite manageable, the kidneys continue to function normally, and you will likely never have stones accumulating in your urinary tract. (Ouch again! It hurts just thinking about it!)

BUT DON'T YOU LOSE WEIGHT?

It used to boggle my mind to watch people suffer as they attempt to lose weight. By depriving themselves of carbs and/or calories, they wind up lightheaded, spaced out, uncomfortable, irritable, and all around miserable . . .but when they get on the scale, there's a moment of emotional ecstasy! They're losing weight! Notice I said it "used to" boggle my mind. It doesn't any longer because suffering through fraudulent and potentially harmful weight loss alternatives has almost become more the rule than the exception, and I don't blame those who are victims. I blame an industry that thrives on fraud and deception. Most of the "victims" don't realize there is an alternative, one that truly works, and in the absence of that realization, they're primed to be suckered in by the "Diet Du Jour."

It's important to understand why you lose weight on the Atkins diet, and why the initial weight loss can be substantial. When I had the opportunity to confront Atkins, I asked if he agrees that calorie deprivation leads to metabolic slowdown. "Absolutely." I then expressed my concern that his diet book encourages people to judge their progress by their pounds on the scale rather than body composition. If muscle is lost, metabolism slows, yet the scale would indicate weight reduction. Isn't this the major problem with the conventional calorie deprivation diets? Isn't his diet simply another outgrowth of a metabolism destroying plague of non-solutions categorized as "Diets?" If "Diets Don't Work," why is Dr. Atkins selling you a Diet?

I then asked the question, "isn't it true that the initial weight lost on your diet will be primarily water loss, temporary and meaningless in hope of long term weight reduction?"

Atkins started to deny it. I continued, "Well, I'm not a doctor, so I hope you'll correct me if I'm wrong. I was led to believe that one gram of glycogen attracts 2.4 grams of water, thus if you hold less glycogen in muscle due to carb restriction, it's a given there will be substantial water loss." Again I asked, "So isn't the initial weight loss primarily water loss?"

He started to grow irritated and mumbled a bit, but I heard the words come out, "well, yeah, maybe the initial weight loss."

Right there I hope listeners were able to read between the lines, as early in the interview he was referencing how much weight individuals were losing in just the first few days. Rapid water loss is a trick leading people to believe they're losing weight permanently when in reality it's anything but permanent weight loss.

I want to take a moment to clarify my point here. I am by no means suggesting weight lost on a carb restrictive plan is ALL water weight. It will in all likelihood be a combination of water, fat, and muscle (which I'll get to shortly). I'm simply saying that in the first week, many are overly enthusiastic as they believe the 5 or 6 pounds lost is permanent.

I asked Dr. Atkins if he has ever attempted to have people eat a balance of proteins, carbs, and fats, while eliminating simple sugars and refined flours, in conjunction with a structured exercise program. He said he hadn't and indicated that there wasn't any need for this since his diet is so revolutionary. But, he added, he does encourage people to exercise in his new book. Sure he does. In fact, out of the entire book, one paragraph . . . ONE FRIGGIN PARAGRAPH(!) . . . mentions that people should do resistance training. And . . .that's his new book! The old book . . . the best-seller . . . the diet book that so many Americans are following, makes virtually no mention of exercise! He offers exercise in his "new" book only as a vehicle to resisting the diseases of aging. He makes no mention of lean body mass and its link to metabolism.

My next question, one I never got to ask, is, how can he condemn something if he's never tried it? How can he claim that there isn't any need for a supportive program of nutrition (including supportive carbs) and exercise if he has no history in applying this technology?

Remember for a moment the fact that in his new book he encourages everyone to exercise. He told me that. On the air. OK. I left it at that for a moment and then told him what I've seen with Atkins dieters in their post diet conditions. Residual Weight Gain greater than the weight lost during the diet. INCREASED (not decreased as he claims) LDL (bad cholesterol) levels. I could've kept going but he cut me off telling me he's personally had over 25,000 people through his clinic and they all lost weight!

25,000! I've heard him make claims of 65,000! Here's my question! Where are they? If he has armies of people who have achieved better metabolisms, better health, long term weight loss, and lowered cholesterol levels, why can't I find even a single reference in any peer reviewed medical literature. I'm not asking for an overwhelming abundance of evidence. I'm asking for one case study, not funded by Atkins! Just one! I couldn't find it!

I brought up exercise again but by now he was in a bit of a huff, throwing defensive jabs at me. He blurted out . . ."The people that I work with can't exercise! They're too sick!" Hmmm. So in his new book he says everyone should exercise . . . but out of 25,000 (or was it 65,000), not a single one was able to embark on an exercise program? I'm not a doctor, yet I've personally worked with and facilitated improvement in individuals with eating disorders, chronic fatigue syndrome, fibromyalgia, recurring incidence of stroke, diabetes, heart disease, total hip replacements, MS, and the list goes on, and in every case, without exception, I had these people eating . . . including carbs . . . and exercising. It's amazing to me that this medical doctor claims that he couldn't get a single person involved in exercise . . . a single person out of over 25,000! The comment was especially striking after he made the comment that he encourages everyone to exercise!

He continually contradicts himself, yet the lure of "quick weight loss" continues to suck people into Atkins double-talk nonsensical promotion of a diet that will leave people in a great many cases far worse off than they were when they first purchased his book. Worse yet, and this is by no means the fault of Dr. Atkins, while the "Induction Phase," suggests limiting carbs to 20 grams per day, many who begin the "word of mouth" Atkins Diet never read the book! They just heard from a friend who heard from a friend that carbs are bad. There's just so much misinformation circulating that rumors and conjecture abound where true science appears to be elusive. Those who fail to read the book may also fail to recognize the need for consuming ample quantities of water, and in a glycogen depleted state, that can further add to risk of kidney stones and other disorders.

EAT ANYTHING?

Let's take a look at another of Atkin's premises, one that OK's the consistent ingestion of red meat, of bacon, of butter, and other saturated fats. I can do a complete article on this topic alone, but I'm going to bypass it since saturated fat has been so conclusively linked to coronary artery disease, it doesn't even merit discussion here.

I have, as I mentioned, met with great numbers of Atkins dieters, and I've found some very consistent data in understanding their adherence to the diet. They all cut out simple sugars and refined and processed flours. That's good! I encourage people to do that as it will help stabilize blood sugar and facilitate fat release . . . providing that some other aspects of nutrition are in place (not extended ketosis) and providing that they are involved in a supportive exercise program. Another interesting thing I found, when analyzing their food intake, is although they are told by Atkins they don't have to cut calories, in each and every case, I mean without exception . . . they are eating fewer calories than they were before the diet!

Here's why. Firstly, while butter and cream cheese and sour cream are permitted, you're not allowed to eat potatoes or bread. What in the world will you put the butter, cream cheese, and sour cream on? Most people on Atkins' plan have bacon and eggs for breakfast, but they stop eating the cereal. For lunch they have a cheeseburger sans the bun. Bread, cakes, pastries, and other carb foods are very calorie dense. Most Americans are filling their mouths with high carb foods, thus if you eliminate carbs, you're eliminating MOST of their caloric intake. A steak, although it is higher in fat than many carb foods, is also more water dense, thus, when you take out the carb foods, it becomes quite challenging to keep caloric intake high! It's also meaningful to note that a diet composed primarily of protein and fat will decrease appetite by two separate mechanisms. By eliminating erratic sugar intake you stabilize blood sugar minimizing sugar-induced food cravings, and by stimulating certain amino-acids to cross the blood-brain barrier in greater amounts, you develop a greater sense of satiety. That means that not only are you taking in fewer calories, but your desire for food is decreasing leading to a continual drop of caloric consumption. That is precisely the type of calorie restrictive diet Atkins claims has failed America!

Dr. Atkins openly agreed with me that calorie deprivation slows metabolism, yet . . . he has almost everyone embarking on a calorie restrictive diet cleverly disguised as something else. Will people lose weight? Of course! But is that healthful and permanent?

Let's look at what happens after the water loss. Remember, glucose (stored as glycogen) is the preferred source of fuel for muscle contraction. In a state of calorie deprivation combined with the absence of that preferred fuel source the body finds a way of creating its own glucose, the blood sugar that it's lacking. It can manufacture blood sugar from amino acids. Amino acids are the building blocks of proteins, and there are three of them, known as the Branched Chain Amino Acids, leucine, valine, and isoleucine, that can be simply converted into glucose. You can get these amino acids by breaking apart complete proteins and simply metabolizing the other amino acids or dismissing them from your body as waste.

If I've confused you, I want to un-confuse you. I want you to understand this. Let me make it a bit simpler. Carb intake is severely reduced. Your body wants for glucose beyond that being supplied so it makes its own. It uses amino acids as the raw material. To get those amino acids, it must break down either dietary protein . . . or muscle tissue!

If you are taking in enough protein for muscle synthesis, enough protein that would normally allow you to build new healthy cells, in a state of carb depletion you'll likely sacrifice some of those proteins to manufacture glucose. That gives you intake of protein below that which you need to maintain lean body mass so muscle breaks down and is not repaired. Once you've exhausted your dietary protein supply, your body goes somewhere else to find amino acids. It breaks down more muscle tissue! Since muscle is the site where fat is burned, that cripples your fat burning ability. Since muscle, as opposed to fat, is tissue that actually burns calories, this process slows metabolism. This combination of factors guarantees that when you go off of the low-carb diet, and you will . . . you must . . . your body craves carbs for survival, you'll wind up gaining back all of the weight you lost plus additional fat.

BUT . . . WE'RE ALL CARB SENSITIVE?!?!?

Atkins throws the term "carb sensitivity" around and claims that all Americans due to their unsupportive eating habits, have developed a case of this mysterious ailment. He therefore recommends that you indict carbs. Interestingly, when your body is in a state of glycogen depletion, it begins creating little enzymes, literally hunting for carbs. Some chemical and metabolic changes take place leading to greater carb sensitivity than ever! A friend and associate, one of the individuals I most respect in this field, Keith Klein, a nutritionist based out of Houston, Texas, has found, as I have, an unquestionable increase in carb sensitivity among "Atkins victims."

In working with individuals who do have some challenges with even moderate carb intake, I've found it far better to gradually shift carb intake from unsupportive simple sugars and refined flours to the more supportive carbs in meals complete with proteins, vitamins, minerals, and essential fatty acids. It is then possible to slowly get a carb sensitive individual to gradually tolerate and optimize ingestion of potatoes, whole grains, and vegetables. It takes time, but in a great majority of cases I've used this method to bring about consistent improvement in metabolism and body composition (fat loss). Healthfully. Cutting way back on carbs only appears to add to the problem.

It appears, based on clinical research, that 10-25% of Americans do have some level of insulin resistance (carb sensitivity). Conclusive research has clearly shown that improvements in body composition (lean body mass vs. fat) and regular exercise are far more important in offsetting the challenges of insulin resistance than cutting back carbs.

Atkins lumps all carbs together as "the enemy." There's no question that a gradual American shift to pretzels, Snackwell cookies, and processed bagel breakfasts has led to impaired carbohydrate metabolism in some individuals, but there's no reason to throw the baby out with the bath water. Carbohydrates are a nutrient, and nutrient, by definition, means "something your body needs to ingest to sustain life." There's obviously a flaw with any program that asks people on a massive scale to eliminate intake of a vital nutrient. With a true understanding of the differences between complex carbs and simple sugars, it becomes possible to eliminate the true culprits (simple and refined sugars) and reacquaint carb sensitive individuals with supportive metabolism of high qualify valuable complex carbs (along with protein, fats, vitamins, minerals, and an optimal supply of water).

BUT . . . WON'T THIS LOW CARB PLAN HELP MY METABOLISM?

I'm amazed that so many people buy into the claim that these low-carb diets will stimulate metabolism when I can't find a shred of evidence that lends itself toward that direction. In fact, in the absence of carbs and necessary calories, not only do you run the risk of slowing metabolism through muscle loss, but the thyroid gland also performs a neat little trick. It alters its production of the hormones T3 and T4, hormones instrumental in regulating body heat, to "protect" the body from starvation. This results in a further slowdown of metabolism and can lead to long term thyroid challenges.

I believe, since there isn't any disagreement that exercise is going to be a definite positive factor in fat reduction, fitness, health, and alleviation of disease risks, and since glycogen is fuel for muscle contraction, it's more than obvious that exercisers benefit from ample supplies of glycogen, that fuel obtained from carbohydrates. It's important to protect metabolism so the body learns to efficiently utilize carbs as fuel, proteins for cell repair and maintenance, and essential fats for their inherent biological value as components of cells.

I can keep going. I won't. I believe by now you should have some clarity on the truth behind the Protein Diets. More than ever, people need to be educated, and I'll continue to commit my programs to delivering the fitness truth. I want to emphasize that I do not have a personal vendetta against Dr. Atkins as a person. As I mentioned earlier, I believe his intentions are good. Are there people who will lose weight and be satisfied with the "Atkins Way of Eating?" Sure, but that doesn't make this a sound weight loss solution for the masses. Every diet being aggressively promoted, most of which fail most people, has some sort of driving testimonial behind it. Usually those testimonials refer to pounds lost, not to improvements in body composition.

If Dr. Atkins truly is a professional, I would simply encourage him to recognize the risks, open his eyes to those who are experiencing health issues resulting from his diet, and attempt to refine his approach into one better founded in science.

I will also continue to endorse those who share in delivering truth and I will continually strive to unite the ground army of unrecognized fitness professionals that can be so powerful in finally helping America get fit once and for all.

I welcome your responses and feedback to this article.

Phil Kaplan

A Final Note: Dr. Atkins has an open invitation to visit with me on my radio show to dispute any of the information I've offered. The door is always open.

Another Final note: Since this article was written there has been some Atkins funded research. I address it in a follow up article. Click here to access it.

A Final, Final note:

If you are concerned that the information I've provided is based solely on my opinion, I assure you I've spent years researching this. Here are some references. Throughout those years I've continued to search for legitimate research backing up anything the low-carb Protein sellers profess and I haven't been able to find it. The only legitimate medical references I've found to carb restricted dieting were in cases of using a Ketogenic Diet to reduce seizures in cases of brain malformations or epilepsy, and I should note that in those cases there was often fat accumulation and a concern for elevating blood cholesterol levels:

1. Entering a high Protein twilight zone. Tufts University Diet & Nutrition Letter 1996; 14(3):4-6

2. Coyle, EP, Fat metabolism during exercise. Sports Sci Exch 1995; 8(6):1-6

3. Coyle, EP, Coggan, AR, Hemmert WK, et al: Muscle glycogen utililization during prolonged strenuous exercise when fed carbohydrate. J Appl Physiol 1986; 61(1): 165-172

4. Is pasta now on the 'out' list too? Tufts University Diet & Nutrition Letter 1995; 13(3):4-6

5. Coleman, Ellen, RD, MA, MPH, Carbohydrate Unloading, The Physician and Sports Medicine. 1997, 25(2):97-98

6. Low Carbohydrate, high-protein diet: the way to lose weight? University of California at Berkeley Wellness Letter, December 1992

7. Centers for Disease Control and Prevention, National Center for Health Statistics, Division of Health Examination Statistics. 1996.

8. Golay A; Allis AF; Morel Y; de tonic N; Tankova S; Reaven G. Similar weight loss with low or hig-carbohydrate diets. Am J Clin Nutr, 1996; 63(2):174-178

9. Position Statement of the American Dietetic Association: Weight Management

10. Weintraub M, Long term weight control study: conclusions. Clin Pharm Ther. 1992; 51:642-646

That's only a tiny sampling of the research material I've amassed on the topic. I have also studied hundreds of relevant articles published in the American Journal of Clinical Nutrition, International Journal of Obesity, Journal of the American Medical Association, Journal of the American Dietetic Association, etc. I've still yet to find a single article that supports Atkins.

I've also referenced materials from and/or conversations with many health and fitness professionals ranging from educators to nutritionists. Here's a sampling of individuals I've learned from recently in relation to the topic of Low-Carb dieting:

Megan McCrory, Ph.D., Energy Metabolism Lab researcher, Tufts University

Dr. James J. Kenny, Ph.D., RD, Nutritionist at the Pritikin Longevity Center in Santa Monica, California and Vice-President of the National Council Against Health Fraud.

Ellen Coleman, RD

Tim Patton, RD, Florida International University

Keith Klein, nutritionist, researcher, consumer activitist, Klein's Eating Management Clinic, Houston Texas

Dr. Nancy Wellman, Florida International University

Jim Wright, PhD, Science Editor, Weider Publications

Jeff Feliciano, researcher, Weider Nutrition

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