Is the Atkins Diet Really Healthy?

Jenny Marsh—05/2004
In recent years, the Atkins diet, based on a dietary plan promoted by the late Dr. Robert Atkins, has become very fashionable. This diet recommends a very low or no-carbohydrate program with high levels of protein and fat. From the Atkins perspective, carbohydrate is the cause of not only excess weight, but also of some of the modern chronic diseases including heart disease. What is the truth behind the Atkins diet and is it really healthy?

THE ATKINS DIET is one method that can be used to lose weight. But this of course does not automatically make it healthy. We can lose weight in many unhealthy ways including total prolonged periods of starvation, eating only gherkins for 2 months and, as a friend of mine recently did, eating only chocolate for weeks on end. They can all lead to weight loss but nobody in their right mind would undertake them as they are all decidedly unhealthy methods. (Yes, I do have friends who aren't in their right minds!)

Why do such diverse fad diets work? They are all actually reduced calorie programs, albeit unhealthy ones. Calories have long been the bane of the dieter and so many of the popular fad diet programmes have tried to play down this aspect of dieting in favour of other, less severe, restrictions (like not eating carbohydrates but as much of everything else as we desire). Everybody on a diet naturally wants an easy ride and so any program that promises fewer restrictions becomes an instant best-seller. The incentive to come up with easy diets is therefore huge. But the bottom line is that ALL diets ultimately work by reducing calorific intake. There are no exceptions, however much Dr. X, who happens to make a tidy sum from the promotion of his or her new fad diet, would have us believe.

My friend who lost weight eating chocolate for a few weeks, for example, was actually (if one added up her total calories) eating far less then her daily calorific requirement and so she lost weight. Eating only chocolate, however, is exceedingly unhealthy because not only is that regime high fat and high sugar, it also supplies the body with hardly any of the other nutrients that it needs - proteins, vitamins, minerals, fatty acids and complex carbohydrates. On the other hand, eating a reduced calorie diet consisting of a balanced combination of fruits and vegetables is a healthy method of weight loss because fruits and vegetables tend not only to have a relatively low calorific density, but also contain much needed vitamins, minerals, fibre and are fairly easy to digest. (Protein sources might include soy, legumes and nuts.)

The Atkins diet works because it is actually a low-calorie diet, despite the claim by its proponents that calorific intake is unimportant: if you add up the total calorific content of a typical Atkins menu, it is significantly less than the average person's daily requirement. If it wasn't, it wouldn't work, period. What is more, there is actually no dietary evidence to suggest that an Atkins diet is in any way more efficient at loosing weight than any other diet with a similar restriction in calories. As the Physicians Committee for Responsible Medicine points out: "Three recent studies (one at Duke University, a second at the University of Pennsylvania and a third at a medical center in Philadelphia) suggest that the average weight loss with high-protein diets during the first six months of use is approximately 20 pounds, or about half a pound per week. This is not demonstrably greater than that which occurs with other weight-loss regimens or with low-fat, vegetarian diets."

The fact that the Atkins diet achieves the necessary calorie reduction with a low carbohydrate and high protein/fat diet is immaterial with regards to weight loss, a fact corroborated by Gerald Reaven M.D. from Stanford University who says that, "There are so many studies showing that if you decrease calories, people lose weight, and it doesn't matter if you do it by cutting fat, protein or carbohydrate." Therefore, to attribute Atkins weight loss specifically to its low carbohydrate and high protein/fat regime is misleading.

Atkins proponents' claim, however, is that the high levels of carbohydrates in the average Western diet is the chief cause of obesity and many chronic diseases such as heart disease, diabetes and even cancer. The mechanism put forward for the dangers of a high and even moderate carbohydrate diet is that it promotes constantly high levels of insulin in the blood which lead to a metabolic imbalance called insulin resistance or Syndrome X, in which the fat storage cells become resistant to this hormone's messenger's request to store the excess broken down carbohydrates (glucose). As a result, insulin production is further increased (the body needs to "shout" louder as excess glucose in the blood is very dangerous). This results in unhealthily high levels of insulin in the blood which then cause a whole host of complications including obesity, Type II diabetes and heart disease. Atkins supporters claim that a high protein/fat, low carbohydrate diet does not stimulate insulin release and so it will not lead to these metabolic imbalances.

The problem with this claim is that, although there is evidence that Syndrome X is a real metabolic problem, attributing it solely to high carbohydrate diets doesn't hold up to scientific scrutiny. A study reported in the American Journal of Clinical Nutrition by Holt, Brand-Miller and Petocz has shown that beef and cheese produce a larger insulin release than pasta, and fish a larger insulin release than popcorn. Insulin resistance may not, therefore, be a cause of obesity but a symptom of obesity (a position held by most doctors). The reason why individuals feel better on the Atkins diet is because they are eating fewer calories, not necessarily because they have cut out carbohydrates. This would make sense when one considers that every clinical study into obesity has shown that individuals or societies who subsist on predominantly carbohydrate diets have lower obesity, lower heart disease, lower diabetes, lower colon cancer and live longer than those who have high protein, meat-based diets.

In fact, the American Journal of Cardiology published a study that showed that three weeks on a high-complex carbohydrate diet, along with exercise, reduced insulin levels for those with Syndrome X by 30 percent, along with a 20 percent reduction in cholesterol and triglycerides. If Atkins was correct that carbohydrates are actually the cause of these problems, then this would be impossible.

However, it must be said that these healthy carbohydrate diets tend to be high in complex carbohydrates or wholefoods and low in simple carbohydrates or processed foods. There is no doubt that diets high in sugar, white flour, white rice and alcohol are positively unhealthy to the body, so any diet that cuts these out will make a person not only feel better (high glycaemic foods like these can zap our energy) but may help a person lose weight as these tend to be the high calorie and addictive foods. However, grouping all carbohydrates as undesirable throws the baby out with the bathwater as complex carbohydrates such as whole grains can be beneficial. Indeed, as we have mentioned, they are the staple diet of those societies in the world that are the most healthy.

Atkins works because it helps to eliminate sugar, alcohol and white flour, of which the average Westerner eats far too much. If the story ended there, then Atkins would be a novel way to achieve these ends and could be recommended. But it actually achieves these ends at a price to health, a price that many people are not aware of because they are being fed misinformation by the Atkins lobby. (It is important to remember that the Atkins diet is an industry in itself, making massive amounts of money for both its founding organisation and the low-carbohydrate food industry it has spawned. This presents a serious conflict in interest for most of those pumping out pro-Atkins information.)

Followers of the Atkins diet are encouraged to substitute carbohydrates with red meat, chicken, eggs, cheese, bacon, cream, butter and fish; Atkins himself erroneously declaring in his book Dr. Atkins' Dietary Revolution that, " One of the biggest reasons this diet works so successfully is because you eat protein and fat. " This, however, introduces an enormous amount of saturated fat and animal protein to the body which research has consistently associated with increased risk of heart disease and other degenerative conditions. Atkins supporters will claim that it is actually carbohydrates that are the cause of problems such as heart disease (not saturated fat), but this claim is not supported by scientific evidence. It is a fact that Western consumers of meat and dairy products have a much higher cholesterol level than those that do not, and it is an indisputable fact that the higher a person's cholesterol level is, the higher their risk of heart disease. As John Robbins points out in The Food Revolution, "A study published in the Journal of the American Dietetic Association found [that] people who followed the Atkins diet for 12 weeks showed significant increases in LDL ('bad' cholesterol) and substantial reductions in HDL ('good' cholesterol), indicating markedly increased risk for heart attacks."

The Atkins diet also pushes the body into a metabolic state called ketosis. In fact, ketosis is one indicator that Atkins himself used to make sure people were following his diet. Ketosis is a metabolic state induced by a low carbohydrate diet (and also by starvation and diabetes) which signals that the body is desperately breaking down proteins and fats to fuel vital functions including energy for the brain. Fats are incompletely (with 30% efficiency) broken down into ketones, which are used as an emergency fuel by our muscles and organs. The brain and nervous system, however, can only use glucose as a fuel, and so the body also can also scavenge its own muscle tissue and organs in order to convert (with 70% efficiency) them into glucose. (As the Atkins diet is so high in protein this tends not occur to a dangerous degree.) The result can be a deterioration of the body, a sluggish mind from a lack of body glucose, and strain on the kidneys to excrete the excess ketones in the blood (which have made it dangerously acidic).

John Robbins writes, ".the consequences of extended ketosis include muscle breakdown, nausea, dehydration, headaches, light-headedness, irritability, bad breath, kidney problems and an increased risk of heart disease." Research has also shown that prolonged ketosis can even be fatal for pregnant women and for diabetics. Of course, none of these studies are mentioned in the pro-Atkins literature. Instead, we see such irresponsible statements touted by the official Atkins organisation on its website as: "Saturated fat remains a valuable part of the [Atkins diet]. There is absolutely no scientific research to support any claims that eating red meat and saturated fat as part of your Atkins program is anything other then beneficial."

Apart from potentially causing kidney damage, high protein diets like Atkins pull calcium from the bones because the diet makes the body highly acidic, leaving the metabolism no choice but to use its own bone calcium to try to neutralize this acidity. (This is why a major study of more than 75,000 nurses in the US found that those who ate the most dairy products, which are high in protein, had the greatest risk of bone fracture.) Atkins proponents are fond of citing the Inuit (Eskimo) diet which is almost 100% animal protein/fat based and yet these indigenous people have very low levels of heart disease. What is not highlighted is the fact that the Inuit have low life-expectancy and one of the highest levels of osteoporosis in the world. Neal Barnard, MD, who is president of the Physicians Commission for Responsible Medicine points out that there was a recently published study in the American Journal of Kidney disease which showed that calcium losses for those on the Atkins diet was 65% above normal, and even on the more moderate maintenance diet, calcium losses were 55% above normal. Considering that osteoporosis is already a serious concern for individuals on a balanced diet, one can see that those on the Atkins diet are running a high risk of eventual bone fracture.

The other aspect of high animal protein diets is that they increase the risk of colon, prostate and breast cancer. William Castelli, M.D., of the National Heart, Lung and Blood Institute in the US has stated that vegetarians "have only 40 percent of our cancer rate." So rather than reducing cancer, the Atkins diet may be the worst thing for it. In fact, many scientific studies have shown that the breast cancer risk for women worldwide who consume high amount of animal products is many times that of women who do not.

The bottom line on the Atkins diet, therefore, is that it is a decidedly unhealthy method of loosing weight, and it is a method that is difficult to stick to long term (because it is the usual low-calorie diet in disguise). In the words of James Anderson, Professor of Medicine and Clinical Nutrition at the University of Kentucky School of Medicine, "People lose weight [on the Atkins diet], at least in the short term. 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."

The Atkins industry, however, will not allow something like independent medical research to stand in the way of their profits, and so they have recently struck back by sponsoring their own "studies" into the comparison of the Atkins diet with standard low fat diets. These were undertaken at Duke University Medical Center in North Carolina and the Veterans Affairs Medical Center in Philadelphia. (Whenever an industry sponsors its own studies, you can be assured that the results are likely to be skewed, intentionally and unintentionally, in favour of the sponsor.) Of course, they chose obese participants (not merely those overweight) because any weight reduction in that group is likely to have such a strong beneficial effect that it is likely to mask health concerns associated with the method of weight-reduction itself. As Atkins substantially reduced their calories, they lost weight, and as they lost weight, their blood fat levels reduced (this is a normal symptom of weight loss, not of a high protein diet). Whilst the Atkins diet had a slight lead in weight reduction after 6 months, 12 months on you could not tell the two apart. (And that was just a standard low-fat diet.) Of course, even though these studies show little actual benefit, they are splashed across the health sections of every newspaper as a major victory to Atkins because fad diets are such a hot media topic. Unfortunately, though, any victory for Atkins supporters is actually a defeat for health, independent scientific enquiry and common sense.

If you want to lose weight effectively and keep that weight off, most independent studies (and there have been many of them) have shown that the healthiest way to do so is to eat a reduced calorie diet high in complex carbohydrates (whole grains) and vegetables, low in animal proteins and fats, low in simple carbohydrates such as sugar, pastry, alcohol and white pasta/rice, and plenty of aerobic exercise. You might also consider taking green foods such as algae, and vitamin/mineral supplements (especially antioxidants and B vitamins) to help the body increase its metabolic efficiency. However, there are unfortunately no shortcuts, unless you are prepared to risk damaging your health.

So is the Atkins diet really healthy? Absolutely not!



Update 22 July 2010

A new study involving 100,000 men and 270,000 women over a five-year period by Imperial College in London has shown that the less meat you eat the less likely you are to be over-weight. The study found that for every additional 250g of meat eaten daily, there is a weight gain of 4.4lb over a five-year period. And those who ate processed meats like sausages and bacon put on 5lbs over the same period. The authors of the study took into consideration factors such as smoking, drinking and inactivity which might have a greater association with meat eaters.