The diet debate

Portland study weighs controversial Atkins diet against the traditional low-fat approach

BY MARY BELLOTTI Issue date: 12/31/2002
The Tribune

Ursa Ficker lost 45 pounds in four months by following the controversial high-protein, low-carbohydrate Atkins diet. Though she sometimes craved popcorn and even carrot sticks, she says the diet was easy to follow — as long as she was losing weight.

Susan Downs extols the virtues of a high-carbohydrate, low-fat diet that allows a variety of foods in controlled portions. She lost about 10 pounds on such a diet and says it’s helped her learn healthier eating habits.

Both women are participating in a Portland study involving 25 volunteers who are comparing the protein-heavy Atkins diet with a more traditional regimen called DASH, an acronym for Dietary Approach to Stop Hypertension. (The DASH diet was designed for people with high blood pressure but was adapted for the study as a weight-loss plan because of the variety of foods it allows.)

Thirteen people — five men and eight women, including Ficker — followed the Atkins diet; 12 volunteers — four men and eight women, including Downs — followed the DASH regimen.

The study is a collaboration between Kaiser Permanente’s Center for Health Research and Oregon Health & Science University’s General Clinical Research Center. Researchers are trying to determine if the high-in-fat Atkins diet is safe to follow over long periods of time.

“People were going on these low-carbohydrate diets in large numbers, and they were reporting feeling good and losing weight,” said Kaiser researcher Njeri (pronounced “Jeri”) Karanja, the study’s lead investigator.

“When we looked at the food composition (of the Atkins diet), it was contrary to what we generally recommend.”

Karanja’s collaborator on the project is registered dietitian Diane Stadler, an assistant professor in OHSU’s medical school. The two researchers are compiling the study’s findings, which should be available in March.

Though their results aren’t finalized, Karanja and Stadler, along with dieters Ficker and Downs, had some advice for people who intend to start a weight-loss diet after the holidays and might be considering Atkins.

All four recommended consulting a doctor or other health care provider before embarking on any diet.

Unlike more conventional low-fat diets, which have been scientifically tested, the Atkins diet is not nutritionally complete and should be “significantly supplemented with vitamins and minerals,” Stadler noted.

Finally, Atkins dieters in particular should ask for blood tests before starting the Atkins diet and at least once during the diet to monitor levels of cholesterol, triglycerides and other health markers.

Is it safe?
The National Institutes of Health provided $400,000 for Karanja and Stadler’s small-scale study. It is one of several around the country comparing the Atkins and high-carbohydrate diets.

The Atkins diet has been around since 1972, when Dr. Robert Atkins first developed a high-protein approach to weight loss.

Atkins reintroduced the diet in 1992, and it has been hugely popular since then. Its popularity attracted the attention of researchers, including Karanja and Stadler, who now are directly comparing the two approaches.

The Atkins diet received a boost last month when Duke University released a report showing that the high-protein regimen helped dieters lose weight quickly and even lowered their cholesterol and triglycerides.

But because Atkins is high in saturated fat, allows few high-fiber foods and eliminates most dairy products, researchers worry that it might lead to other health problems.

“That kind of diet, from past studies, may not be healthy for bones over the long term,” Karanja said. “Sometimes (too much) protein injures the kidneys. Maybe it doesn’t. We don’t know. Those are the things we need to look at.”

Volunteers in the Portland study followed their respective diets for 18 weeks. The researchers told them not to add exercise to their daily routine but to maintain their normal level of activity. They could drink as much or as little water as they wanted, Stadler said.

Every day, Ficker and others in the Atkins group ate as much as they wanted of such foods as eggs, cheese, meat, poultry and fats. They dined on quiche, bacon and even steak for breakfast, cheeseburgers and chicken with alfredo sauce for lunch, burgers and fish with butter sauce for dinner. Snacks included cheese sticks or pork rinds or celery sticks with cream cheese.

The dieters were following the first phase of the Atkins regimen, which largely excludes fruits, grains, sweets and other high-carbohydrate foods. Vegetables such as lettuce and cucumbers are allowed in limited amounts.

In three subsequent phases, carbohydrates are gradually added back as dieters reach their goals, but the bulk of the diet is protein.

In the DASH group, Downs and her fellow dieters ate the same number of calories as those in the Atkins group, but their meals were carefully portioned. Their menus included legumes, fruits, vegetables, grains and very few fats.

They ate cereal, toast and milk for breakfast; bean soup, garden burgers and tuna salad for lunch; pizza, spaghetti, beans and rice for dinner. Snacks included fruits, nuts and vegetables.

During the study, dieters had at least three blood tests to monitor levels of insulin, cholesterol, sugars and fats and to measure kidney function.

How did it go?

“I wasn’t worried at all (about health) because I knew I was being monitored,” said Ficker, who was on the Atkins diet. “That was part of the reason I agreed to do this diet.”

The diet worked well for a while. But after the study ended, Ficker stopped losing weight, and she’s not sure why. It was enough, though, to prompt her to quit the diet.

Ficker has since regained about 18 pounds but acknowledges that she “went back to eating the same way I had been” and did not start an exercise program.

Anyone considering the Atkins should know “it’s an all-or-nothing diet,” Ficker said. “It’s hard to start but easy to maintain. I was never hungry because protein is very filling, and fat is what makes you satisfied.”

Downs wanted to lose some weight while learning healthier eating habits. She was randomly chosen to follow the DASH diet, for which she is grateful.

“Carbs are the love of my life,” she said. “I have a bagel every morning, and I’m not a big meat eater.”

The hard part of following DASH was limiting portion sizes. At first, she felt hungry.

“After a while on the DASH diet, I didn’t eat as much, and now my portion sizes are what I got on the diet. For me, the diet was about a lifestyle change.”

Here are some other recommendations from the researchers:
• Find out as much as you can about Atkins or any other diets you want to start.
• No matter which diet you choose, be prepared to change your habits. “When you go on a diet for a short period of time, your chance of regaining weight is high unless you modify your lifestyle in a way you can continue for the rest of your life,” Stadler said. “Make changes not only in your diet but in your level of activity as well.”
Information about the Atkins diet is available online at www.atkinscenter.com. DASH diet details are at www.nhlbi.nih.gov/health/public/heart/hbp/dash/.

Contact Mary Bellotti at mbellotti~portlandtribune.com.

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