Posted Feb. 15, 2004
Low-carb craze raises health questions



By Shawn Rhea
Post-Crescent staff reporter

Jeff Badger, 47, is waging a battle against middle-age bulge.

Like a growing number of people, the Appleton resident believes he’s found the perfect weapon for peeling pounds from his 6-feet-1-inch frame: A low-carbohydrate, high-fat, high-protein diet.

His typical daily menu: a ham and cheese omelet for breakfast, a bunless double cheeseburger from Hardee’s with a side salad for lunch, and cheese sauce-covered chicken with vegetables and a salad topped with full-fat dressing for dinner.

“In the first three weeks, I lost 16 pounds,” said Badger, who dropped another 11 pounds within three months after starting the Atkins diet in November 2002. His weight settled at 195 pounds and his cholesterol level dropped 30 points.

“For me, it was easy because I was eating the foods I like to eat.”

Badger is among a burgeoning population of dieters turning to low-carb, high-fat eating because they believe it helps them lose greater amounts of weight faster than conventional diets. The trend, driven by the popular Atkins diet, has served up a growing debate over the health implications of such diets, which have turned traditional thinking about nutrition on its head.

In making up their minds, dieters are wading through health research, advice from their doctors and a blitz of marketing by makers of everything from candy to beer who claim to have cut carbs from their products. Also, the U.S. Food and Drug Administration is considering strict low-carb food labeling rules.

“If you ask me, … would I go on a low-carb diet? Absolutely not,” said Dr. Hayan Yacoub, an internal medicine specialist with Affinity Health System based in the Fox Valley.

Yacoub and other local health experts warn that little, if anything, is known about these diets’ long-term effects.

Medical research has yet to point to a definitive answer.

Two short-term studies published in the New England Journal of Medicine in May indicated that low-carb diets initially may offer dramatic results. The studies followed the weight-loss outcomes of 195 obese men and women randomly placed on either the Atkins diet or a more conventional low-fat, high-carb diet. After six months, the Atkins dieters had lost more weight.

But in the second study, which tracked dieters for a year, weight loss was comparable for those following either Atkins or the high-carb diet.

In both studies, however, low-carb dieters experienced greater drops in cholesterol, which is measured as a risk factor for heart disease.

“Studies of these diets don’t track them long term,” said Lisa Behrens, a dietitian at Affinity. “I’m definitely seeing people coming in with higher cholesterol. Sure, if you lose weight you’ll see a modest decrease in cholesterol. But if they stay on (low-carb diets), it goes back up.”

Behrens and other experts point out many possible ill effects, such as osteoporosis, gout, increased risk for certain cancers, severe electrolyte depletion, increased risk for heart disease, and kidney and liver problems. There simply is not enough known to take the risk, Yacoub said.

“It’s like we used to think that hormone therapy helped women. Now we know that it’s bad for the heart.”

Atkins revolution

The now-deceased cardiologist Dr. Robert Atkins and his 1992 guide “Dr. Atkins’ New Diet Revolution” is behind the most popular of the low-carb, high-fat diets.

Atkins advised dieters to “eat liberally of combinations of fat and protein in the form of poultry, fish, shellfish, eggs and red meat, as well as … butter, mayonnaise, olive oil, safflower, sunflower and other vegetable oils.”

And he easily won over dieters ecstatic to hear they could choose these highly flavorful comfort foods.

Michelle Medvecz, 33, of Greenville was among the converts.

Medvecz was on the Atkins diet for nearly a year before ending it last week. She now believes it hurt her health. “My cholesterol had gone up significantly,” she said.

Initially, Medvecz said, she saw an improvement in her cholesterol, which stood at 244 before beginning the diet. Within three months, she had lost nearly 20 pounds and her overall cholesterol dropped to 217 — close to the ideal target of 200 or less.

But a recent test showed that while she had continued to lose weight, dropping a total of 45 pounds, her cholesterol level, at 249, was even higher than when she began the diet.

Medvecz, a nurse with a family history of high cholesterol, said she was so impressed by the rapid weight loss that she ignored the likelihood of a high-fat diet causing problems.

“In the (Atkins) book, it does mention that if you need a cholesterol reduction you should eat lower-fat meats like chicken and turkey, but I didn’t,” she admitted. “Having lost 20 pounds and (initially) seeing my cholesterol go down, I didn’t think that it would (go up again).”

Making a low-carb case

Atkins diet spokeswoman Colette Heimowitz insists that the low-carb, high-fat, high-protein approach to dieting is safe.

Despite claims by some dieters that Atkins has led to heart disease, she said in fact it can produce the exact opposite.

“The evidence in the literature is consistent that people who follow low-carb diets for six months to one year lose more weight and have better improvement in the risk factors for heart disease,” Heimowitz said. “In clinical practice, Dr. Atkins followed patients long term and found similar results.”

She did advise that heart disease patients on the diet should have their doctors monitor progress.

Many health experts say Heimowitz’s argument is refuted by reports last week that Dr. Atkins, 72, was obese and suffering from heart disease upon his death. He was an avid follower of his own diet when he died last April from a head injury following a fall.

The findings came from a leaked medical examiner’s report. Atkins’ supporters insist, however, the diet doctor’s recorded weight upon death was caused by bloating that occurred during his comatose state, and that his heart disease was the result of a viral infection.

The bottom line, said Heimowitz, is Atkins supporters believe that the only bad fats are man-made fats, such as trans fats — the kind found in margarine and nearly every form of processed food. She said it is the mix of fats with carbohydrates that causes obesity and weight-related illnesses.

“The saturated fat issue in my field is much more controversial than you’d imagine,” said Jonny Bowden, author of the book “Living the Low Carb Life” and a board certified nutritionist. “There is a small but vocal group that is questioning the demonization of saturated fats.”

In his book, Bowden — who calls himself a diet agnostic — explains the low-carb philosophy and reviews 14 diets, including Atkins, South Beach and The Zone. He believes that the philosophy behind low-carb dieting needs to be given a fair review, and that much of it will bear out scientifically.

Beyond heart disease

Even if it turns out that consuming more saturated fats doesn’t cause heart disease, many health care professionals argue there is still a plethora of potential problems attached to long-term low-carb dieting.

To begin with, said Gail Underbakke, a registered dietitian with the University of Wisconsin Preventative Cardiology program in Madison, excessive protein consumption — which can occur when replacing carbs with greater quantities of meat — puts people at risk for gout, liver and kidney problems. “I’ve had patients who’ve been on these diets and developed kidney stones,” she said.

Reducing carb intake to as few as 25 grams a day, which Atkins suggested might be appropriate for some dieters long term, would mean consuming less than a fifth of the government’s recommended daily allowance of 130 grams.

As a result, Underbakke said, people following strict, long-term low-carb diets rarely get enough fruits and vegetables. Inadequate consumption of these vital foods can lead to fiber, antioxidant and vitamin deficiencies that open the door to cancer, diverticulitis and other illnesses. “There is a good body of research that shows fruits and vegetables protect us against cancer … and they can’t be replaced by a (vitamin) pill,” she said.

Pop culture vs. science

The general public may have quite a wait before there’s a definitive answer on the best solution to safe, effective weight loss and control. Recent studies don’t appear close to unlocking the secret.

Last April, Stanford University researchers reviewed 107 studies on low-carb diets conducted between 1966 and 2003 and determined that to date all of the controlled studies were too small and too short in duration (none more than 90 days) to judge long-term effects.

They also noted that participants have tended to be young, providing little knowledge about the effects on dieters 53 and older.

And, even some supporters of the low-carb philosophy are expressing concern over the sudden development of pre-packaged snacks and fast-food menus claiming to be low-carb.

Author Bowden said all the hype is failing to focus on one critical fact: Americans need to end their love affair with highly processed foods.

“The very first intervention for anyone should be to eliminate or seriously reduce the number of processed foods in their diets,” he said.

This point may be one of the few things upon which health care professionals on either side of the low-carb debate can agree.

“I do think that things like white bread, pasta, sodas and sweets are causing problems,” said dietitian Behrens.

Like low-carb advocates, she, too, believes Americans could benefit greatly by reducing their intake of processed carbs. But she argues that they should be replaced by smaller portions of highly complex carbs, like dried legumes, fresh fruits and vegetables, and whole-grain breads.

“Do we really want our kids to think that fruit is bad for us?” Behrens said.

“We need to say, OK, maybe people do overdo the carbs. Maybe we eat too much pasta, but more fat is not the answer.”

Shawn Rhea can be reached at 920-993-1000, ext. 526, or by e-mail at srhea~postcrescent.com.

What is a Carb?
A carbohydrate, or carb, is a sugar or a starch contained in foods that supply calories to the body. They come from a wide array of foods such as bread, rice, beans, milk, popcorn, potatoes, cookies, spaghetti, corn and cherry pie.

They also come in a variety of forms. Some kinds promote health while others, when eaten often and in large quantities, may increase the risk for diabetes and coronary heart disease.

The government’s recommended daily allowance is 130 grams. Some low-carb diets, such as Atkins, suggest cutting carbs to as few as 25 a day.

Sources: Harvard School of Public Health, “Dr. Atkins’ New Diet Revolution”

Low-carb 101
For years, conventional dietary wisdom advised people to eat vegetables, fruits and whole grains — all high in carbohydrates — and go light on fat from certain meats, dairy products and processed foods.

But with the 1992 rewrite of his low-carb dietary tome, “Dr. Atkins’ New Diet Revolution,” the now-deceased cardiologist Dr. Robert Atkins turned that advice on its head.

He told dieters they could take off the weight while eating many of the high-fat foods that had long been ruled off limits.

The key, advised Atkins, is to drastically reduce the intake of carbs from food such as bread, pasta, rice, potatoes, sugary snacks, and a number of fruits and vegetables with relatively high sugar contents.

He reasoned that because the body prefers to burn carbs first and fats second, filling up on too many carbs means the body is never depleted of its favorite source and is never able to go into fat-burning mode.

As a result, stored fat isn’t burned and the pounds pile on.

‘Net carbs’
In the midst of the burgeoning low-carb craze, an understanding of what kinds of foods can be legitimately labeled “low carb” is growing more elusive.

Gail Underbakke, a registered dietitian with the University of Wisconsin Medical School’s Preventative Cardiology program, said makers of convenience foods are using the term “net carbs” to make products appear as if they have fewer carbohydrates.

In tallying carbohydrate grams, the “net carb” equation excludes the percentage of carbs that come from fiber, because a certain amount of fiber is insoluble and not absorbed by the body, according to Underbakke.

The problem, she said, is that the equation excludes the entire fiber content, some of which actually is absorbed.

Some of that confusion may soon be cleared up by the Food and Drug Administration, which is considering stricter low-carb labeling requirements.