Dr. Atkins and High-Fat Diets
Consumer Guide: Rating the Diets 53(1974):242.
by Theodore Berland and Lawrence Frohman, M.D.,
Theodore Berland is the award-winning, nationally acclaimed author of more than 200 magazine articles and eight books in the fields of science and medicine. A graduate of the School of Journalism of the University of Illinois, with an advanced degree in sociology from the University of Chicago, he has been a visiting lecturer in the School of Journalism of Northwestern University. He has received awards from the American Medical Association, the American Dental Association, and the American Optometric Association. His books include The Fight for Quiet, The Scientific Life, Living with your Bronchitis and Emphysema, Living with your Ulcer, and Noise - the Third Pollution.
Lawrence Frohman, M.D., medical consultant on RATING THE DIETS, is Director of the Division of Endocrinology and Metabolism, Michael Reese Medical Center, Chicago. A graduate of the Medical School of the University of Michigan, Dr. Frohman has herd posts as visiting professor at the University of Milan (Italy), and Hebrew University in Jerusalem (Israel), as well as associate professor of medicine. State University of New York, in Buffalo. He is the author of numerous articles in the fields of heredity, diet, endocrinology, and metabolism.
High-fat diets are exciting because they are so contrary. After all, you go on a diet to remove fat from your body; and you have been taught that fats in your food pack the greatest amount of Calories per ounce or gram, about twice as much as protein or carbohydrates. Suddenly you are told to eat as many fats as you wish.
You're also told to cut down or cut out carbohydrates. But the ban on carbohydrates seems to lose some of its punch - the punch that Stillman gave it with his sweeping declaration of meat, fish and eggs and nothing else - by combining with tantalizing visions of mayonnaise, whipped cream, butter sauce, pastrami, and cheesecake. It does sound revolutionary and daring: a dieter's paradise.
In fact, high-fad diets are not new or revolutionary; they ve been around for more than a century. Called by one name or another, they have all claimed amazing results. Dr. Atkms' "revolution" — latest of these — follows in many footsteps. We'll travel back through time for a brief look at the forefathers of high-fat dieting, but we'll spend most of our time on Dr. Atkins, since his "revolution" is the best known at the moment.
(A word on kinds of diets. CONSUMER GUIDE labels low- or no-carbohydrate diets that leave protein and fat proportions about equal as Low Carbohydrate Diets. They differ from Atkins', Taller's and other diets in this chapter in the amount of fat they allow; they differ from Stillman's in the proportions of protein and fat they call for. Low Carbohydrate diets will be analyzed in a chapter of their own.)
The first popular high-fat reducing diet was that of one William Banting, coffin-maker to the Duke of Wellington in Great Britain. Banting's Letter on Corpulence was published in London in 1864. The pamphlet became a best seller as thousands of Britishers read and followed the principles which had helped this 5-by-5 man reduce to 156 pounds from 202 pounds in a year. Banting, however, was following a trail already marked by an ear surgeon named William Harvey. 1 And Harvey's advice was based on the ideas of a French doctor.
Banting came to the surgeon with an earache. Harvey had just returned from Paris where he had attended lectures by Claude Bernard, a famous physiologist. What had fascinated Harvey was Bernard's detailing of the evils of sugars and of the control of diabetes by no-sugar diets. He was so impressed that his treatment of patients changed.
Back in London, Harvey examined the 60-year-old coffin- maker and concluded that his pain resulted from the pressure of fat on the eustachian tube (a narrow tunnel connecting the middle ear to the back of the throat; the tube equalizes air pressure on both sides of the eardrum).
Convinced that the only way his patient would get relief from the pain was to get rid of body fat, Harvey placed him on a unique diet: meat, mutton, bacon, and fish; and a bare minimum of sugar, bread, -beer, and potatoes. With dramatic success, Banting lost weight and, like all converts, felt an overwhelming urge to share his discovery with-the world. His pamphlet followed.
The Harvey-Banting diet was rediscovered in the late 1800's by physicians to the Earl of Salisbury. To get the obese Earl's weight and girth down, they prescribed a diet of meat. The Earl and his menu are still with us in a name we give a form of ground beef: Salisbury steak.2
In the first part of this century, weight-reducing diets began to concentrate on counting Calories and limiting foods within a balanced diet. In mid-century, the high-fat theory resurged, thanks to Alfred W. Pennington, M.D., then head of the medical division at E. I. duPont de Nemours and Co., Wilmington, Delaware. In the 1940's Pennington studied fat duPont employees and their health and by 1951 he had formulated a diet by which, he said, they would eat fat and get thin-.3
When Pennington found that the diet really worked, he publicized his theory that people with a tendency to be fat have a defect in their metabolism. In other words, people get fat not because of eating too much but because of what their bodies do with food — turning too much of whatever they eat into fat.4 He felt that putting fat people on low-Calorie diets only served to starve them, without removing their fat. This he said, was because fat people's bodies break down carbohydrate incompletely (stopping before the final breakdown into acids and molecules required by the cells). As a result, much of the carbohydrates they eat is converted directly to fat.
The solution was obvious to Pennington: severely restrict the amount of carbohydrates fat people eat. He also accepted the findings of experiments which had been conducted at the Russell Sage Institute in 1928: that each meal should consist of 2-to-3 ounces of fat and 6-to-9 ounces of meat — in other words, fat meat. Pennington's theory became popularly known as The duPont Diet, and was published by Holiday Magazine in June 1 950 and subsequently offered in 1 0-cent booklet form.5
Pennington's diet worked well enough to lead others to try it. One confirmation came from Dr. George L. Thorpe of Wichita. Kansas. He found that patients who followed it could lose 6-to-8 pounds a month without strain. "I have yet to find a patient on this diet who complained of not having enough to eat, of tiredness, weakness, or constipation." He added that to maintain the required ratio of three parts of lean meat to one of fat, fried suet was often necessary.6 The main advantage of the diet besides lack of hunger, he reported, was that just the fatty areas of the body were lost, sparing a gaunt appearance and loss of energy.
Drastic diets rise and fall in popularity. The high-fat theory quieted for awhile, then was popularized anew by Herman Taller with the publication of his book Calories Don't Count in 1961. Taller, a Brooklyn obstetrician-gynecologist,-had fought his own fatness for years. In 1955, after a regular medical examination, his doctor told him his cholesterol count was too high. Since high blood cholesterol recently had been linked with premature heart disease, change in diet was recommended. Taller's doctor prescribed a supplement to his daily diet of oils which were polyunsaturated fats (cholesterol is a saturated fat). To his doctor's satisfaction, Taller's blood cholesterol dropped to normal. To Taller's own surprise, he was losing weight, even though consuming 5000 calories a day. It was then that he began doubting low-Calorie theories of weight loss.
Taller delved into history and medical journals and found the Banting pamphlet and the Pennington reports. They made sense to him and he combined their conclusions with his own experience to come up with his "new nutrition principles." Low-Calorie diets, he wrote in a sweeping indictment, are not effective, are only temporary in their results, are based on incorrect ideas, may be harmful in upsetting delicate body mechanisms, do not affect the cause of obesity,
"To lose fat," Dr. Taller wrote, "you must make your body consume its stored fat, a process my new nutrition principle achieves." By eating lots of the right fats, he proposed, "you set in motion a process which stimulates the pituitary gland and gets this fat-burning going at a higher rate . . . The obese person not only burns the fat he eats; his system gets so fired up that it burns the fat he has accumulated over the years."
The key element in Taller's diet was "lipo-equilibrium," meaning fats in balance — a balance absent in fat people. His idea was to restore it, and to get the liver to convert body fat to energy for the body to spend. He saw the way to do this as eating lots of soft polyunsaturated fats. Eating such fats, wrote Dr. Taller, "you set in motion a happy cycle. You stimulate body production of certain hormones which work to release fats stored around the body." The best of these polyunsaturated fat-containing oils, in his opinion, was saf- flower oil; corn oil was next best. He recommended taking two tablespoons of oil before each meal.
Dr. Taller cited case after case in which his oil worked to melt away fat. He withstood the heavy barrage of criticism from the American Medical Association and other medical organizations, but when he promoted the sale of safflower oil along with his book, the Federal government stepped in and put an end to both.
On May 10, 1967, he was found guilty in U. S. District Court, Brooklyn, on six counts of mail fraud and one of violation of the Federal drug laws; the next month he was fined $7,000 and given probation on a two-year sentence. The government prosecutors had called the sales tie-in of his book (which sold 2-million copies) and CDC brand (for "Calories Don't Count") safflower capsules made by Cove Vitamin and Pharmaceuticals, Inc., a "worthless scheme foisted on a gullible public."7
Still, Dr. Taller had interested a fat-conscious public in high- fat diets, and provoked reports such as that of Dr. Broda 0. Barnes of Colorado State University. 8 That physiologist had kept his patients on saturated-fat diets for 25 years and they had lost weight. High on his diet list was eggnog made with whipped cream, bacon, and eggs. After all, he noted, since Eskimos live on blubber and stay trim and have a low incidence of heart disease, why not other North Americans?
Today's popular high-fat diet is the creation of Robert C. Atkins, M.D.9 Like Taller's, the Atkins book has provoked a barrage of criticism and controversy, including blasts from the AMA, leading nutritionists, and an inquiry by a Congressional committee.
Dr. Atkins is at this moment the nation's leading diet doctor. A parade of fat people, mostly women, come to his swanky and modern mid-Manhattan offices, plush with stuffed soft-vinyl sofas and walls resplendent with original art. At 42 years and a bachelor, he is six feet tall and a bit plump at 170 pounds. ("I'd be in great shape if I didn't have this stupid job to do sitting behind this desk 1 2 hours a day. The only chance I have to get in shape is when I go on vacation and play volleyball," he explained.) He wears well-tailored clothes and his silver-streaked hair hangs stylishly over his ears and is brushed across his high brow.
In an exclusive interview with CONSUMER GUIDE Dr Atkins was careful to explain that he "did not start out'with the idea of writing a book. But it helped solve problems which /existed. It properly explains to the public obesity, nutrition and metabolism." He admitted to CONSUMER GUIDE that "in a sense I adapted Taller's approach," but went on to state that, "This is 13 years later. A lot of scientific evidence has linked insulin and heart disease and hammered down the case against carbohydrates. I believe the evidence overwhelmingly implicates sugar as a major epidemiological culprit."
Brown-eyed and left-handed Doctor Atkins has been in practice in New York since 1959, about the time that Irwin Stillman retired from practice (see the chapter on high-protein diets). Born in Columbus, Ohio, Dr. Atkins was educated at the University of Michigan and Cornell Medical College. After his internship in Rochester, N.Y., he came to New York City for a residency in cardiology. In fact, it was as a heart specialist that he began his practice. Ho became interested in dieting four years later, he claims, when he became a-medical consultant for AT&T. He posed for a portrait for a company identification badge; his photograph took him by surprise. "Do I really have three chins?" he asked his nurse. When she nodded, he realized that he was no longer the skinny 135- pound kid of high school days, but a plump practitioner of 175 pounds of flab.
He felt that it was clearly time to do something about his fat. But what? The idea of hunger scared him; he felt he had no will power. "I was looking for 'The Hungry Man's Diet/ " he said. He started searching through medical journals and textbooks and came upon Pennington's report from duPont. It fascinated him. Even more intriguing was a report by British researchers who had found in the urine of people who were fasting a substance which mobilized fat (moved it out of adipose - fatty — tissue to be burned.10 Following this new finding, the researchers from Middlesex Hospital, London, analyzed the mobilizing substance and found that it was not growth hormone, which is known to do this (see Chapter 5) but a new substance.11 Dr. Atkins also read the reports of Walter Lyon Bloom, M.D., of the Ferst Research Center, Piedmont Hospital, Atlanta, who wrote that people on a no-carbohydrate diet have the same metabolic changes as people who were totally fasting. 12 Dr. Bloom's diet fascinated Dr. Atkins: bacon and eggs, and plenty of meat.
He put himself on that kind of diet and carefully checked the ketones in his own urine, as Dr. Bloom had done.13 (Ketones are the "ash" left when fats are burned; their presence in the urine, then, indicates that the body is- burning fat. For a more detailed description, see Chapter 5.) As a physician, he knew this was easy to do: merely buy urine test sticks or tablets in a drugstore; if his urine turned the stick or tablet purple, ketones were present. His book notes, in his enthusiastic style, "I soon discovered that even if I added 1 0 to 15 grams of carbohydrate, after a zero carbohydrate start, the tablet still turned purple. This meant that my body was continuing to burn my fat. I could snack on cheese, cold cuts, cold shrimp, cottage cheese, and have a filling salad with each meal. For dessert I discovered creamy ricotta cheese, which I enhanced with artificial sweeteners and flavored many ways."
He ate a lot. Because he was eating so much, he was surprised when, after six weeks, he found he had lost 28 pounds. And, he wrote, the more he ate, the more he lost. While he was happy to be thinner, he was also resentful "that I had been duped so long by the misinformation given me in the medical literature . . . that there is only one way to lose weight — a low-Calorie diet."
He next tried the eat-a-lot diet on 65 employees at AT&T. "Most averaged a loss of 18 pounds in the first month," he wrote. The weight-losers said they were "rejuvenated" and "like new." So heady was his success that he put his private patients on the same diet, and before long he was no longer a cardiologist but a diet doctor. That was in 1 964.
His name started getting around in show business circles as he treated comedians, actors, and columnists; his fame zoomed. A description of his diet appeared in Harper's Bazaar in 1966 and in 1970 Vogue ran a 1 6-day version called Vogue's Super Diet. His practice grew with his fame. Soon his 23-room office complex was handling 350 desperately fat patients a week.14
It was then that Ruth West, who had authored diet books of her own, became excited by the magazine accounts of the high-fat diet and asked Dr. Atkins if he'd like to collaborate on a diet book. Dr. Atkins was delighted, ready, and willing. He was upset about the ban on cyclamates as artificial sweeteners from the market and wanted a platform to express his concern. Also, he was thinking of expanding his business interests by opening a West Coast office and perhaps a string of health spas. "I was well known in New York but I felt I needed national exposure if I decided to expand my business interests. I thought that a book would be the answer," Dr. Atkins later told two reporters for The New York Weekly.
The book - Dr. Atkins' Diet Revolution - was copyrighted in the names of Atkins and West, and she is thanked under Acknowledgements "for her inestimable help in the preparation of this book," although she is not listed as co-author.
The book is written in first-person, from Dr. Atkins to the reader. The writing style is never conservative or modest For instance on Page 28, the authors say. "This diet works 100 percent of the time!" Full-page advertisements for the book boasted, "You can now command your body to melt away fat."
In the book. Dr. Atkins claims his diet was proven effective in eight years of practice with 10,000 patients. Their menus included bacon and eggs, heavy cream in their coffee, mayonnaise in their salads, butter sauce for lobster and cheesecake - all foods loaded with fats, and especially with the saturated fats, including cholesterol.
Quoting eminent scientists who have studied obesity and diets (but never giving book titles or other references), Atkins and West state that fat people have something wrong with the way their bodies handle sugar and other carbohydrates- in effect, they are "carbohydrate intolerant." The obese 'are victims of "carbohydrate poisoning." Ergo, cut down or cut out carbohydrates, not Calories. The authors also quote 248 CONSUMER GUIDE Duncan's Diseases of Metabolism (as CONSUMER GUIDE does in Chapter 5) as stating that no carbohydrate is required in the diet.
Specifically, the Atkins diet calls for an initial week of zero-carbohydrate menus. The menus include an abundance of fats; recommended are such dishes as chicken salad with mayonnaise and celery, seafood with lemon butter sauce, cheese omelet with bacon, and eggs Benedict with Holland daise sauce, among others. No fruits, vegetables, sugars, starches, breads, sweet pickles, chewing gum, ice cream, catsup, and so on. "At the end of the first week," says Atkins in his book, "following this basic zero-carbohydrate diet most men will have lost seven or eight pounds, most women five or six pounds."
When this weight loss occurs, the author says, you may go on to "Level Two" of the diet, which allows you to add foods with carbohydrates — about five grams more each day for the week. You yourself will discover when you must level off, for as soon as your urine test sticks stop turning purple, it means you are not releasing ketones any more which, in turn, means your body is not burning fat. As long as the test sticks are turning purple, you may move step by step up to "Level Five," adding to your diet such foods, in moderation, as grapefruit, cantaloupe, cottage cheese, pea pods, wine and alcohol, cheesecake, tomato and other similar foods. All these you may consume as long as your body remains in a state of ketosis — burning fat and eliminating ketones from the body, To Dr. Atkins, the state of ketosis is a divine one. (Ketosis,as we explained earlier and in Chapter 5, is a condition of the body in which fragments of fat, called ketones, are abundant in the blood and excreted in the kidney. Dr. Stillman calls it the ash left after the body burns fat. When diabetics get out of control, they also develop ketosis.) Ketosis, says Atkins and West, "is a signal for rejoicing. It is a sign that unwanted fat is being burned up as a fuel." Of course, they warn, if you are a diabetic, ketosis may develop into acidosis, and that is a danger signal. (Ketosis may also be dangerous for unborn babies, as revealed below.)
Doctors who become alarmed when nondiabetic dieters have ketosis, wrote Atkins and West, "have had no experience with the ketosis induced by a carbohydrate-free diet. I have, since this is my specialty." They add, "I have observed no ill effects and have never seen a state of acidosis as a result. On the contrary, I have arrived at the conclusion that ketosis is a state devoutly to be desired."
They advise their readers to keep checking their urine for ketone bodies daily — keep turning the test sticks purple, they say, and you keep losing weight. Also, the ketones in your urine and in your breath "are sneaking Calories out of the body as a negative sort of bonus." (Yes, Calories, even though they aren't supposed to count.) When the test sticks start turning lighter purple, you have reached your Critical Carbohydrate Level. It should not exceed 40 grams a day, they say.
On this diet, write the authors, your body will have no carbohydrates to burn as fuel, and so will mobilize fat from the soft, hanging, unsightly adipose tissue under your skin. Cutting out carbohydrates triggers secretion of fat-mobilizing hormone or FMH to keep the body's metabolic fires fueled with fat. You convert your body "from being a carbohydrate- burning engine into being a fat-burning engine," they claim. "This is the diet revolution."
And, say Atkins and West, their diet is for the rest of your life: "as personal to you as a pair of contact lenses." You'll lose weight and never be hungry. And you will be an expert on carbohydrate content of foods.
Atkins and West do have some cautions. While they acknowledge that they are placing a diet in your hands, they advise you to have a good physical by. a physician and tell him you are going on a diet. They also want you to take supplementary vitamins, especially A, B-complex, C, and D, in heavy dosages.
While they spend many pages attacking sugar and other carbohydrates, Atkins and West give little rationale for wanting you to eat so much fat. (The real reason seems to be that fats make you feel full and keep hunger away. That's the basis for jokes about Chinese meals leaving you hungry so soon; they are low-fat.) Also, say the authors, fat "helps sneak off Calories by the excretion of ketone bodies." Some 98 pages of the book are devoted to meal plans and recipes.15
Once you're at the weight and figure you desire, Atkins and West have a maintenance program for you. The idea is to find your Critical Carbohydrate Level with the Ketostix: you gradually add carbohydrates to your diet until the test sticks are no longer turned purple by your urine. Then you back off and eat just that many grams of carbohydrate every day. They suggest slowly returning to starches, but never to pure sugar.
Like Dr. Taller, Dr. Atkins' popular propounding of a high-fat. low-carbohydrate diet was heavily criticized by organized medicine and nutrition. Here is a sampling:
—Fredrick J. Stare, M.D., professor and chairman of nutrition at the Harvard School of Public Health, said it bordered on malpractice to recommend such large proportions of saturated fats and cholesterol when the hazards to the heart are so well known.16
—The Council on Foods and Nutrition of the American Medical Association called it "a bizarre regimen" that is "without scientific merit."17
—The chairman of the board of the New York County Medical Society said Atkins' book was unethical and self-aggrandizing.18
—The highly-respected 7776 Medical Letter called it "unbalanced, unsound, and unsafe."19
CONSUMER GUIDE has analyzed the criticism fired at the Atkins high-fat, low-carbohydrate diet and here presents the -arguments in an organized manner, free of the strong rhetoric with which they were originally presented. Among medical journals and magazines which carried attacks on Dr. Atkins were The Medical Letter, Medical Opinion, Modem Medicine, and American Medical News and its sister publication, the Journal of the American Medical Association. McCall's magazine also criticized Atkins, and newspapers around the country, including The New York Times, Washington Post, and Los Angeles Times carried the remarks of his critics. And on Thursday, April 12, 1973, Sen. George McGovern (D- S.D.) and his Select Committee on Nutrition and Human Needs held a hearing at the Dirksen Senate Office Building in Washington on the Atkins book and diet. The findings of the hearing, together with the findings of other Congressional Committees studying nutrition in the United States may ultimately be used in food and drug legislation. (If you want to look up the article from which these criticisms are gleaned, find the citation in this chapter and consult a medical library. You should be able to obtain a copy of the McGovern Committee hearings either from your own Senator or Congressman or from the U.S. Government Printing Office, Washington, D.C. 20402 for $ 1.50.)
A summary of the criticisms, including those of CONSUMER GUIDE, follows. The section following carries the rebuttal of Dr. Atkins and his supporters.
1. The Atkins diet is not based on scientific or nutritional principles. Its premise, neither new nor revolutionary, is more than a century old. Like other low-carbohydrate diets, it ignores the fact that the human being is an omnivore and not a carnivore — people need to have all four elements of food in their diet (dairy, grain, meat, and fresh fruits and vegetables). The Atkins diet is essentially the diet of a hunter. Man stopped being a hunter many thousands of years ago.
Dr. Atkins makes casual references to respected researchers and cites significant studies, but uses them for his own purpose. In our interview, CONSUMER GUIDE asked'Dr. Atkins for specific citations to specific statements in his book which he had attributed to other doctors and scientists. He replied that the book was written for the public and so no specific references were cited. When pressed for his own private reference list used in the preparation of the manuscript, Dr. Atkins said, "It and the papers I quoted were in a briefcase I lost some time ago."
A frequent criticism leveled at Dr. Atkins is that if, indeed, he did come upon a new nutritional principle, the proper place to announce and explain it would be in a medical journal or at a medical meeting. Dr. Atkins did neither. Nor did he deal with the medical aspects of water in weight control. Most of the weight lost on such a low-carbohydrate diet is water. Studies have shown, said the AMA,20 that carbohydrate in the diet, among other actions inhibits excretion of sodium and water. Other studies have shown that if only 600 Calories of carbohydrate are given to people after they've fasted, they regain all their weight mostly as water.
With the help of IIT Library Services and the Florsheim Medical Library at Michael Reese Medical Center, CONSUMER GUIDE was able to track down the textbooks and journal articles which Dr. Atkins alludes to in his book. A shocking finding is that in some instances he took statements out of context to "support" his theory.
The Senate hearing also revealed this reprehensible tactic. In several places in his book. Dr. Atkins quotes John Yudkin, M.D., emeritus professor of nutrition at the University of London, who has long warned of the health dangers of sugar. But Dr. Yudkin favors a diet low in sugar and other carbohydrates and not high in fat (see the chapter on Low- Carbohydrate Diets). In fact, he tried a diet high in fats on some of his patients. He concluded that since so many fats and carbohydrates go together (as in bread-and-butter and in ice cream), the chief benefit of a low-carbohydrate diet had to do with lowering Calories rather than with increasing fafs. He stated: "The term 'high-fat diet' is a misnomer; the correct term is 'low-carbohydrate diet.' We now also understand why this diet can lead to loss of weight in the obese. It is low in Calories, and it is this which causes loss of weight, and not some peculiarity in carbohydrate metabolism."21 CONSUMER GUIDE does not see this as supporting Dr. Atkins' theory.
Dr. Atkins also refers to the work of another British scientist, Gaston L. S. Pawan, research biochemist who is head of the Metabolic Division at Middlesex Hospital Medical School, London, suggesting he supported the high-fat diet. In response to a request from Senator McGovern's committee, Dr. Pawan wrote, "I have used very high fat diets in obese subjects only for specific experimental purposes on volunteer subjects in hospital. I would not recommend a very high fat diet indiscriminately to obese subjects."22
Again. CONSUMER GUIDE does not find this supportive of Atkins, or of any other high-fat diet, for losing weight.
2. Dr. Atkins (or anyone else) cannot revoke the first law of thermodynamics that the energy in any isolated system has to be in balance. The Calories eaten have to equal the Calories burned if the system (body) is to remain the same. If the body burns more Calories than it eats, it burns off its fat reserves to maintain that balance. If it eats more than it burns, it stores fat to maintain the balance. Therefore, no person in any sedentary occupation can consume 5000 Calories, as Dr. Atkins claims, and also lose weight. Even allowing for the difference in the ways the body handles fats, carbohydrates, and proteins, such heavy intake is against the law of physics.
So is the Atkins concept that Calories leave as ketones in urine and breath. At most, these lost ketones account for but 100 Calories per day. 23
3. Diets high in saturated fats and cholesterol are hazardous to health. CONSUMER GUIDE must point out that Atkins' and the other high-fat diets go directly against the strong current which medical researchers have built up against such diets in the Jast 18 years. Research in the laboratory with chickens and chimpanzees, and studies in communities and clinics, have firmly nailed atherosclerosis - which is the main cause of the Big Killer, heart attacks - to fats in the diet.
Since the beginning of the century, when the living standards of Americans and others in Western society began to rise sharply, we have consumed more and more fats in the form of butter, cream, ice cream, cheeses, and marbled meats. In recent years, doctors-and the American Heart Association have urged us to eat less of these, to rely on skim milk, lean cuts of beef, poultry, and fish in order to reduce fats, especially saturated fats and cholesterol. Dr. Taller, then Dr. Atkins, urged people to reverse the trend and in effect gorge themselves with such fats.
The Atkins diet also may seriously disturb the rhythm of the heartbeat. The Medical Letter quoted an English report which showed that "the starvation-like state induced by a low- carbohydrate, ketogenic diet stimulates release of free fatty acids into the plasma; in patients with cardiovascular disorders such as cerebrovascular and coronary artery disease, increased free fatty acids may induce cardiac arrhythmias."24
In fact, in March 1973 a law suit was brought against Dr. Atkins charging that his diet led to a heart attack. 25 New York actor and lawyer Joseph Kottler, 62, charged that Doctor Atkins, of whom he had been a patient, had treated him "recklessly and carelessly" and that the diet had led to Kottler's having a heart attack. One of Dr. Atkins' attorneys said the suit was without merit and that the plaintiff was "jumping on the publicity trolley car."26 The N. Y. Times account of the suit noted that a week earlier the AMA's Council on Foods and Nutrition had warned that persons whose blood fats rise in response to unlimited eating of foods high in saturated "fats and cholesterol assume increased risk of heart disease. 27 The case was still pending at the time this book went to press.
Diets heavy in fats can also bring on diarrhea, which certainly can cause loss of water and weight, but also causes loss of vitamins, minerals, and enzymes. 28
4. The state of ketosis (in which ketones are abundant in blood and urine) is not paradise; actually it is an unhealthy state. As CONSUMER GUIDE reveals in the chapter on High- Protein diets, these partly-burned fats can irritate the kidneys. Aware of this. Dr. Stillman insists his dieters drink at least eight glasses of water a day. Dr. Atkins, however, advises patients to-"drink as much water ... as thirst requires. Don't restrict fluids . . . but it is not necessary to force them either."29 He would have done his readers a favor had he passed on his Brooklyn colleague's advice and spared his readers' kidneys. Even with heavy intake of water, however, the AMA has warned that, "Ketogenic diets may also cause a significant increase in blood uric acid concentration" which could cause gout to flare up in susceptible dieters.30
During the Senate committee hearings, evidence was presented which also indicted the ketogenic diet as being dangerous to unborn children. Dr. Karlis Adamsons, professor of obstetrics and gynecology at Mt. Sinai Hospital School of Medicine, New York, said, "If I were a fetus I would forbid my mother to become ketogenic." When the pregnant woman's body becomes ketogenic, the amount of glucose in her blood drops. As we said in Chapter 4, glucose is the major form of energy used by the brain and nervous system. If the mother's blood sugar is lowered, so is the unborn infant's; the result may be brain damage. Dr. Adamsons cited a study made in the late 1960's of 55,000 pregnancies. Analysis of the immense amount of data showed, among other findings, that children born of mothers who had a form of ketosis known as acetonuria had lower IQ scores than children born of mothers who didn't.31
5. The existence of a fat-mobilizing hormone has never been confirmed or unequivocally identified, says the AMA and The Medical Letter.
6. Dr. Atkins' and other high-fat diets may cause other health problems. The lack of carbohydrates brings on fatigue after two days on the diet, says the AMA. CONSUMER GUIDE notes that experience with other diets low in carbohydrates indicates this is so (see the chapters on High-Protein and Low-Carbohydrate diets). Such diets may also cause hypotension, or low blood pressure, says the AMA. This is a threat not only to adults, but also to unborn children.
The New York County Medical Society said, further, that the Atkins diet may also cause weakness, apathy, dehydration, calcium depletion, lack of stamina, nausea, and fainting.32
Dr. Atkins has two general reactions to the AMA, his County Medical Society, and other critics. One is to invite them to review the records of the 10,000 patients he claims he has successfully treated for obesity. "The data are here and I invite all serious investigators to review and analyze them," he told CONSUMER GUIDE during an interview. "I've made the offer time and again, but no one has yet taken me up on it." He contends that the data of his patients are unique; that other physicians who have prescribed high-fat diets have never cut out carbohydrates completely, as he has. The results are bound to be different, he says.
The other reply to his critics is to criticize them for closed minds and vested interests. He explained to CONSUMER GUIDE, "In the history of medicine, there have been many controversies. When there were two opinions involved in the controversy, the result was further study by disinterested people. This is no controversy because the other parties haven't studied my program and its basis. They are not even entitled to participate in the discussion. What we have here is a new frontier of medicine and the same people are giving their old opinions. If you look at the financial records of the AMA and the Harvard School of Nutrition and see the list of their benefactors, advertisers, and endowers you'll see why they insist on our eating carbohydrates."
Dr. Atkins quotes reports that Dr. Stare and his department receive hundreds of thousands of dollars from food companies as well as from the food industry-financed Nutrition Foundation."
Here are specific rebuttals to specific criticisms.
1.When CONSUMER GUIDE asked Dr. Atkins why he hadn't published the data from his 10,000 patients, he explained that it was frightfully expensive to pull that much data together and analyze it. Still, CONSUMER GUIDE suggests it would have been far cheaper than the thousands of dollars of legal fees he has had to pay to defend his book and theory. (In fact. Dr. Atkins says alt of the money he has made on the book has gone into attorneys' fees.)
2. Dr. Atkins maintains that his Calorie counting critics have never studied the amount of Calories in ketones washed out by the urine or blown away in the breath, but have only guessed at them. Furthermore, said Dr. Atkins, "No one has done a scientific study of the energy balance of people who lose weight yet eat lots of Calories. There are people who are not on my diet who eat 2000, 3000, 4000, and 5000 Calories a day, lead sedentary lives, and yet still maintain or lose weight. Calorie excretion through ketones is the only explanation, the only way those Calories can leave the body without burning. Let's have some good studies to find out."
CONSUMER GUIDE agrees that more studies need to be also finds the AMA and Harvard critics somewhat calcified in their opinion that all food Calories are alike. These critics choose to ignore some of the significant additions to scientific knowledge of carbohydrates and fatty- acid metabolism which have come in recent years. For instance, George E. Schauf, M.D., has successfully treated more than 900 obese people by putting them on diets of lean animal meat and poultry, a carbohydrate intake limited to 50- to-80 grams a day, and corn and safftower oil in salads. Also revealing were studies at Oak Knoll Navy Hospital, Oakland, Calif., which showed that obese sailors lost more fat when on a fat-and-protein diet with few carbohydrates than they did when fasting. Dr. Schauf believes such findings strongly support the theory that how much fat is lost depends a great deal on how much the fat cells can be driven to work. A diet built around low Calories alone, he says, won't make them work hard enough.34
3. In his testimony before the special Senate committee, Dr. Atkins attempted to refute Dr. Stare's criticism of the dangers of the high-cholesterol content of his diet. "He knows as I do that a high-fat diet, when given in conjunction with any significant amount of carbohydrates, is capable of raising the serum cholesterol level, and usually does. But what he has not stated, despite this body of evidence, is the effect of a high-fat or moderately high-fat diet in the absence of a significant quantity of carbohydrates. This is a different metabolic situation and the results are different, and I think this is the important distinction we must make before this committee, that there is a difference between a diet of restricted carbohydrates and high fat as compared to a diet of high fat and no restriction of carbohydrates.
"Until there is a body of evidence showing that the cholesterol levels go up or serum fat levels go up when there is this kind of carbohydrate restriction recommended in my book, then we must assume that data has (sic) not been accumulated. The only data which has (sic) been accumulated are those I personally have accumulated." 35
During his interview with CONSUMER GUIDE, Dr. Atkins said he has measured the blood cholesterol of "4000 or 5000 of my patients. We are now tabulating the data from a group of 500 patients for median cholesterol level drops on a regimen of my diet with supplemental B-complex and C vitamins. Our early results seem to confirm the findings of others that vitamins play a role in fat mobilization and usage. In hundreds of my patients, blood cholesterol has dropped 100 points or more; 96 percent of all my patients showed a drop in triglycerides. 75 percent of my patients showed a drop in both blood cholesterol and triglycerides."
Dr. Atkins also was critical of his critics whose attacks were based on the results of laboratory studies. "The studies are not relevant," he told CONSUMER GUIDE, "because they are in animals, not people; and, because the animals haven't been living on an antecedent lifetime diet of sugar and refined flour. There have been no studies in animals living on diets comparable to the diet people have lived on before going on my diet. It-is intellectually dishonest for doctors to get up and criticize and try to discredit this program with their statements based on no information."
4. Speaking of the charges that a ketogenic diet is dangerous during pregnancy, Dr. Atkins told the Senate committee that he recommends his diet to his pregnant obese patients because, "I believe it is safe when followed by a physician. I have stated that I do not recommend to an obese pregnant patient that she turn around and start eating carbohydrates because I am well aware that in obesity there is a high predilection to diabetes, and diabetes frequently has its onset during pregnancy and a diabetic pregnancy may be full of complications."36 In other words, Dr. Atkins sees no reason why one of his patients, on becoming pregnant, should drop his diet and begin eating carbohydrates again.
CONSUMER GUIDE believes no woman of child-bearing age should go on Dr. Atkins' or any other special diet without first consulting her family physician or gynecologist. Since the thalidomide disaster of a decade ago, researchers have come to realize that the fetus is extremely sensitive to the slightest alterations in the chemical environment of the dark uterine sea in which it lives. 35. Nutrition and Diseases - 1 973, op. cit. p. 1 9 36. Ibid. p. 20 5. The argument over the existence of a Fat Mobilizing Hormone (FMH) pivots on the word "hormone." CONSUMER GUIDE finds this an incredible bit of nitpicking on the part of Dr. Atkins' critics; at the same time, we must add the fact that the existence of FMH. is not crucial to Dr. Atkins' theory. Why is it in the book at all? In any case, the AMA states "no such hormone has been unequivocally identified in man" although it acknowledges that growth hormone and adrenalin-like chemicals can mobilize fat. 37
In his letter to the Senate committee, Professor Pawan said that evidence is growing that some Fat Mobilizing Substance exists in the body besides growth hormone and chemicals. And, he said, "There is suggestive evidence that FMS may be a hormone. At present it would be premature to designate the substance - FMS - a 'hormone,' since it has not yet satisfied the stringent scientific criteria for such a definition." 38
Such a substance has also been found in urine by Dr. Eli Seifter of Albert Einstein College of Medicine.39 Furthermore, Maurice V. L'Heureux of Loyola University Stritch School of Medicine, near Chicago, reported in June, 1973, to a meeting of the American Chemical Society, that he was able to isolate FMS from the urine of fasting rats. The FMS acts to stimulate the production of cyclic-AMP, which in turn boosts the action of a fat-destroying enzyme named lipase. ^o FMS is far from being available at your local pharmacy, although in medical experiments where it has been injected in obese subjects, it has stimulated loss of weight.41
6. In their book (p. 131), Atkins and West wrote, "This diet is not a fad diet, nor is it designed for a quick weight loss, but it's going to be the way you eat for the rest of your life."
CONSUMER GUIDE adds that if you are going to make this your lifetime diet, you should be aware that it can cause fatigue and depression. You may have to resort to an occasional glass of orange juice (as Stillman suggests in his diet) for some carbohydrate to pull you out. More importantly, you must have a thorough physical examination and laboratory testing to be sure you are up to the Atkins Diet. In fairness, we must quote that same advice from Page 1 30 of his book: "Before any patient starts with me, I take a comprehensive series of blood tests, which I recommend you have your own physician give you, particularly if you have more than 20 pounds to lose. Get a routine series of blood tests as a base line so that .if anything changes, you will know where you stand. The blood count, sugar level, cholesterol, and triglycer- ides should improve, but the uric acid level may go up. For my patients, this rarely poses a problem because I routinely prescribe a-drug to prevent uric acid formation for my patients if the uric acid level is high to begin with, or if it goes above the normal range after being on the diet."
CONSUMER GUIDE'S EVALUATION
If you've been on a low-Calorie diet and then put yourself on the Atkins diet, you are liable to think you are not dieting at all. In a sense that may be true. If you gorge yourself with as many fats as Dr. Atkins wants you to, you'll be eating lots of high-Calorie foods. Yet, the point has to be emphasized that by restricting your carbohydrate intake, you will also limit some fats — without bread, you will be cutting down on butter, for instance, and therefore Calories.
The main weakness of the Atkins diet is the absence of scientific reasons for its high-fat content. The ability of the body to make its own sugars from protein for immediate and stored fuel is well known (see Chapters 4 and 5). Fat in the adipose (fatty) tissue under the skin, and around certain internal organs, has to be released and sent on its way, or mobilized; so certainly the body has some Fat Mobilizing Substances to do the job. But despite Taller and Atkins, it remains unclear in logic, and undemonstrated in experiments with animals or trials in people, just how eating lots of fat will stimulate the body to release fat it has stored away weeks or months before. More likely, your body will continue to store the extra fats you eat and do not burn.
Likewise, CONSUMER GUIDE feels that the danger of high- fat diets to the heart and arteries is reason enough to stay away from it. Ketosis adds another reason. Women who will not have children, and men who are healthy (especially with no kidney or gout problems), can live through months of ketosis quite well. However, if you are pregnant (or liable to be), have any kidney problem, gout, or heart disease, stay away from the Atkins diet. And while Atkins doesn't insist on it, CONSUMER GUIDE recommends you follow Stillman's advice and consume at least eight glasses of water on any ketogenic diet.
CONSUMER GUIDE finds the Atkins diet potentially dangerous, not well-thought out, and not firmly based on scientific principles. Dr. Atkins has evidently taken up the fallen high-fat banner from Taller, who took it up from Pennington and other predecessors, and added some colors of his own. (Taller, at least, emphasized unsaturated fats.) But it is still the shocking high-fat approach of Banting and Harvey and probably owes its appeal, like pornography, to the naughtiness of its approach, to the titillation we all feel in doing something which we think is not right. In that sense, the Atkins diet is self indulgent and unscientific and should be avoided, especially when there are other, safer and effective diets. Its only value is that fat keeps hunger away and thus stems your compulsion to nibble.
CONSUMER GUIDE rates the Atkins and similar high-fat diets as Not Recommended.
1. Herman Taller, Calories Don't Count. New York, Simon and Schuster, 1961. p. 28
2. Carlton Fredericks, Dr. Car/ton Fredericks' Low-Carbohydrate Diet. New York: Award Books, 1965. p. 29
3. A. W. Pennington, "The Use of Fat in a Weight-Reducing Diet." Del. St. M. J. 23: 79-86 (Apr.) 1951
4. A. W. Pennington, "Obesity: Overnutrition or Disease of Metabolism?" Amer. J. Dig. D/s. 268-274 (Sep.) 1953
5. Diet Guide. Philadelphia: Holiday, 1950
6. "MD Gives Simple Diet for Fast Weight Loss." Sci. News Letter. (30 Nov) 1957.
7. N. Y. Times, (2 May) 1967. p. 51; (24 June) 1967. p. 31
8. "Diet on Whipped Cream." Sci. News Letter. 87: 259 (24 Apr) 1965
9. Robert C. Atkins, Dr. Atkins' Diet Revolution. New York: David McKay 1 972. (Also New.York: Bantam Books 1973)10. T. M. Chalmers, A. Kechwick, G.L.S. Pawan, and I. Smith,Lancet, 1 958, i., p. 866 11. T. M. Chalmers, G.L.S. Pawan, and A. Kechwick, Lancet, 1960. pp. 6-9 CONSUMER GUIDE 12. W. L. Bloom, "Fasting as an Introduction to the Treatment of Obesity," Metabolism, 8: 214. 1959
13 W L. Bloom, "Fasting Ketosis in Obese Men and Women,"' J. Lab & Clin'. Med., 59: 605-61 2 (April) 1962
14. Pamela Howard and Sandy Treadwell, "Dr. Atkins Says He' Sorry." The New York Weekly, 26 March 1973. (Reprinted in Nutrition and Diseases - 1973, Hearing Before the Select Committee on Nutrition and Human Needs of the U.S Senate 93rd Congress, 12 April, 1973. Washington: USGPO Stack No. 5270-01835. 1973)
15. Howard and Treadwell, ibid.
16. Fredrick J. Stare and Jelia Witschi, "Diet Books: Facts, Fads and Frauds." Med. Opinion, 1: 13-18 (Dec) 1 972
17. "A Critique of Low-Carbohydrate Ketogenic Weight Reduction Regimens — A Review of Dr. Atkins' Diet Revolution." JAMA 224: 1415-1419 (4 June) 1973
18. "When a Best Seller on Dieting Runs Into Medical Critics." Modern Med., (28 May) 1 973, pp. 1 32-33
19. "Dr. Atkins' Diet Revolution" Med. Letter, 15: 41-42 (May 11)
20. JAMA, 1973,op. aft.
21. John Yudkin and Margaret Carey, "The Treatment of Obesity by the 'High-Fat' Diet - The Inevitability of Calories." Lancet,(29 Oct) 1960, pp. 939-941
22. Nutrition and Diseases - 1973, op. cit., p. 59 (Under Pamela Howard and Sandy Treadwell)
23. JAMA, 1973, op. cit., p. 1416; and Med. Letter, op. cit., p.42
24. M. F. Oliver, V. A. Kurien, and T. W. Greenwood, "Relation Between Serum-Free-Fatty Acids and Arrhythmias and Death after Acute Myocardial Infarction." Lancet, (6 April) 1968, pp. 710-714
25. "Diet Revolution Author Is -Sued for $7 Million on Heart Attack." N.Y. Times, (23 March) 1973. (Reprinted in Nutrition and Diseases — 1973, op. cit. p. 66)
26. "Suit Ties Dr. Atkins' Diet to Heart Attack." Amer. Med. News,[2 April) 1973, p. 13
27. "AMA Panel Denounces 'Dr. Atkins' Diet Revolution.' " Amer. Med. News, (19 March) 1973
28. Dr. Neil Solomon with Sally Sheppard, The Truth About Weight Control. New York: Dell, 1973. p. 122
29. Atkins, op. cit. p. 138
30. JAMA, 1973, op. cit. p. 1417
31. Nutrition and Diseases - 1 973, op. c/'t. pp. 36-38
32. Mod. Med., op. c/'t. p. 132
33. Beatrice Trum Hunter, Consumer Beware! N. Y.: Simon and Schuster, 1971. Chapt.
34. George E. Schauf, M.D., "All Calories Don't Count. . .Perhaps." Nutr. Today, Sep-Oct 1 97 1, pp. 1 6-24
37 .JAMA, op. cit., p. 1417
38. Nutrition and D/'s eases - 1 973, op. cit. p. 59
39. Solomon, op. cit., p. 262
40. Roderic P. Kwok and Maurice \J. L'Heureux, "Fat-Mobilizing Substance and Cyclic AMP." Great Lakes Regional Meeting of the American Chemical Society, June 1973. Paper No. 93. Also, reported in Medical World News, (13 July) 1973, p. 15; and Science News, (1 6 June) 1 973
41. Solomon, op. cit., p. 262