Knives drawn over Atkins diet study
Experts doubt benefit of high-fat, low-carb

Kim Severson, Chronicle Staff Writer Tuesday, November 19, 2002

In the ongoing battle over America's bulge, all it takes is one little study about the nation's most popular fad diet for the gloves to come off.

Research released Monday at the annual scientific meeting of the American Heart Association showed that in a pound-for-pound contest, people on the Atkins low-carb diet lost more weight and had better cholesterol and triglyceride counts than people on a traditional Heart Association-approved low-fat diet.

But them's fighting words to many of the Bay Area's top heart, nutrition and weight-loss experts. They say the study is flawed and can only mislead an already-fat, confused public.

"When I saw this come out, I just cringed," said UC Berkeley's Joanne Ikeda,

one of the nation's leading nutrition experts. "I think this stuff makes money for Dr. Atkins and not much more than that. If he was right, the Italians who have twice as much carbohydrates in their diet would be worse off than we are. But they have half the obesity compared to us. The epidemiological evidence is just not there."

At issue is the small number of people in the study and the fact that neither the participants' diets nor their exercise levels were monitored according to accepted nutrition study standards. Critics also point out that the study was funded by the Dr. Robert C. Atkins Foundation, a private nonprofit organization that funds research on carbohydrates and was founded by the author of the Atkins diet.

But study or no study, health professionals say Atkins is simply an unhealthy approach that can't work in the long run.

The Atkins diet, which requires limiting carbs in favor of meals based on big portions of protein and fat, and small amounts of vegetables and other carbohydrate-rich foods, was pioneered in the 1970s by Dr. Robert Atkins. It later fell out of favor but has had a resurgence in popularity, and Atkins' books are back at the top of the best-seller list.

From four-star San Francisco restaurants to In-N-Out Burger drive-throughs, cooks have been creating menus that forgo potatoes, pasta and hamburger buns. Most people know at least one smug neighbor or co-worker who has gotten thin scarfing T-bones and dodging bread.

HEALTH EXPERTS IRKED

The Atkins high-fat approach goes against traditional nutritional research. And this latest study -- one of at least three presented at medical conferences over the past year, with the same promising results -- has served only to irritate mainstream health experts.

"Hepatitis C is effective at helping people lose weight, too, but that's no more healthy than suggesting people should not eat a basic balanced diet with lots of fruits and vegetables and grains," said Gail Woodward-Lopez, associate director of the Center for Weight and Health at UC Berkeley.

Noting that the study was only six months in duration, she said, "Americans are really good at losing weight. The problem is they can't keep the weight off, and there certainly is no proof they can keep it off with the Atkins approach."

Judith Levine, a San Francisco registered dietitian with the American Heart Association, said the study will simply serve to further confuse an already- confused public. "It's such a scam," she said.

The study was conducted by Dr. Eric Westman, an internist at Duke's diet and fitness center, who was concerned about the increasing numbers of patients and friends taking up the Atkins diet on their own. He approached the Robert C.

Atkins Foundation in New York City to finance the research.

The study featured 120 overweight volunteers, who were randomly assigned to the Atkins diet or the heart association's Step 1 diet, a widely used low-fat approach. On the Atkins diet, participants limited their carbohydrates to less than 20 grams a day -- a fraction of what's generally recommended -- while 60 percent of their calories came from fat. Most nutritionists recommend a diet with around 30 percent calories from fat.

After six months, the people on the Atkins diet had lost an average of 31 pounds, compared with 20 pounds on the heart association diet. More people stuck with the Atkins regimen.

IMPROVED CHOLESTEROL

Atkins' critics always have argued that the high-fat approach could lead to heart disease. But in this study, total cholesterol fell slightly in both groups. However, those on the Atkins diet had an 11 percent increase in HDL -- the good cholesterol -- and a 49 percent drop in triglycerides, another indicator for heart disease. On the heart association diet, HDL levels were unchanged, and triglycerides dropped 22 percent. The volunteers' total amounts of LDL -- the bad cholesterol -- did not change much on either diet.

The study adds more fuel on the growing debate over whether fat is really all that bad, and it heightens the anticipation over the results of an extensive National Institute of Health study. The results of that yearlong study of 360 patients are expected sometime next year.

The heart association's president, Dr. Robert Bonow of Northwestern University, said the organization will reconsider the Atkins diet as more research results become available.

"Having our top academic centers look at this is wonderful," he said. "We are still dealing with small numbers of patients. We just need more data."

The best advice might come from Dr. Stanley Rockson, chief of consultative cardiology at Stanford University School of Medicine. He says Atkins has some appeal in that the weight loss is quick and eating a high-fat diet naturally curbs appetite. But it can restrict blood vessels in a way that won't show up by simply reading cholesterol levels.

In the same way, an extremely low-fat diet means that extra carbohydrates replace the calories normally supplied by fat. That can lead to insulin resistance, which is part of what causes diabetes and other diseases. A low- fat diet can also be extremely hard to follow.

"The low, low-fat high-carb diet that's been trendy for 15 years is the pendulum swinging too far in one direction," he said. "Atkins is too far a swing in the other direction."

Despite America's desire for a quick solution to obesity, the solution is much simpler, he said.

"It gets back to what grandmothers said. Do everything in moderation. If you eat a balanced diet with fat drawn from the highest possible caliber, meaning limiting animal fat, and you keep fat calories at or under 30 percent of the total diet, that is the very healthy way to lose weight."

The Associated Press contributed to this report.

©2002 San Francisco Chronicle.

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