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Atkins Diet Works; Safety Unknown

Low-Carb Dieters Lose Weight, but for How Long?

By Salynn Boyles
WebMD Medical News Reviewed By Michael Smith, MD


July 18, 2002 -- After three decades of ridicule, the much-maligned Atkins diet is finally getting a little respect within medical circles. A newly published study by Duke University researchers show that the high-fat, low-carbohydrate approach to weight loss does work.


Study participants lost an average of 20 pounds during six months on the Atkins diet, but they were not followed to see if they kept the weight off. Most patients also had improved cholesterol levels at the end of the study, even though the eating plan permits unlimited quantities of fat and cholesterol-rich foods such as eggs and meat.


The study, published in the July issue of the American Journal of Medicine, was funded by a grant from diet guru Robert Atkins' Center for Complementary Medicine. Duke researcher Eric Westman, MD, says he became interested in studying the Atkins diet after several of his patients lost large amounts of weight on it.


"They were on the diet against my advice," he tells WebMD. "But it worked for them, so I became curious about it."


The study included 51 overweight or obese volunteers who were otherwise healthy and were on no prescription medications. All were placed on a very low carbohydrate diet (less than 25 grams per day), but neither calories nor portions were restricted. Dieters also took nutritional supplements a day and received exercise recommendations. After 40% of the weight-loss goal was reached, the daily amount of carbohydrates was increased to 50 grams.


Westman says a typical daily menu might include bacon and eggs for breakfast, a chef's salad for lunch, and steak or hamburger for dinner with one or two cupfuls of low-carbohydrate vegetables. The diet bans high carbohydrate foods such as bread, cereal, rice, pasta, and potatoes.


At the end of six months, 80% of the participants were still on the diet, and they had lost an average of 10% of their original body weight. LDL, or bad cholesterol, decreased in all but one of the dieters, while HDL, or good cholesterol, improved.


Westman says there is no mystery to why participants lost weight on the low-carbohydrate diet. Even though calories were not restricted, the dieters ate an average of 1,450 calories per day. Without carbohydrates the body goes into a state called ketosis, which tends to lower appetite.


But though researchers were impressed by the weight loss, they say more study is needed to pronounce the carbohydrate-restricting diet safe.


"If this diet were a new drug, it would not meet the criteria for safety yet," Westman says. "We know that it works, we just don't know that it is safe. So it is important for people with medical conditions and for those taking prescription drugs to get medical supervision before going on this or any low-carbohydrate diet."


Harvard University weight loss expert George L. Blackburn, MD, PhD, is a critic of the Atkins diet but praised the Duke researchers who conducted this study.


"I would agree with their cautions about safety," he tells WebMD. "And I think everybody agrees that the only weight loss that is of any value is that which you can keep off. There is still no evidence that people lose weight and keep it off with these low-carbohydrate diets. Researchers have looked, but they can't find it."


Blackburn rejects the idea that a single type of food, be it fats or carbohydrates, is the villain that makes people gain weight. And he says the one thing the experts have learned in recent years is that a one-size-fits-all approach to weight loss and nutrition does not work.


"A healthy diet is one that is portion controlled and does not contain an excess of calories," he says. "And a prudent diet includes all food groups."

INTERESTING HUH? STILL NOT WILLING TO GIVE IN...

Wasn't Dr. Blackburn the inventor of the "Protein Sparing Modified Fast"?

Here is the blurb from "The Woman Doctor's Diet For Women" c. 1977 by Dr. Barbara Edelstein.

" I met Dr. Blackburn at a conference on Nutrition and Adolescence. As usual, the major speakers were men, all well-known and full of the traditional pap and platitudes. It was a ho-hum meeting that offered nothing new until Dr. Blackburn appeared and told us about a revolutionary and exciting new concept call the Protein Sparing Diet, or starvation with the addition of protein.

Dr. Blackburn and his colleagues at the Center for Nutritional Reseach at M.I.T. had done extensive work in the field of human obesity, and had observed that obese people make poor dieters but good fasters. Fasting has many advantages; primarily, of course, it accomplishes quick weight loss. However, Dr. Blackburn, a short, decisive man with a staccato voice, said that even though fasters lose weight quickly, they lose too much body protein in the process. Fat can supply total body energy just as effectively as sugar, but it will neither protect nor replace body protein (as found in muscle and organs). Even the brain, which has been thought to utilize only sugar, does very well using fat. Therefore, the Center had been working on a plan for giving people betweem 1 and 1.5 grams of protein per kilogram of body weight daily, or just enough protein to maintain lean body mass (which is the approximate weight of your bones, muscles, organs and essential fat). The Center recommended as the source of protein lean meat and fish. This diet must be supplemented with vitamins, calcium, and potassium. After the first few days of dieting, the high levels of ketones acts as an appetite depressant (as supposedly also happened with Dr. Atkin's Diet).

No one actually attacked Dr. Blackburn after his presentation, although you could see the disapproving glances and feel the shock at one who had dared to upset the apple cart of the traditionalists. But Dr. Blackburn remained impervious; his credentials were spotless and his data were impressive.

Several weeks later I went to Boston to meet Dr. Blackburn and to study his PSMF Diet (Protein Sparing Modified Fast). In person, on a one-to-one basis, he was a typical, no-nonsense type of surgeon who had a remarkable understanding of the physical and psychological character of obesity. He made acceptance into the Center's diet program seem like a conversion to a new religion; first you had to make a formal application for admission. (One of Dr. Blackburn's co-workers told me, "George makes it seem as if you have to walk on water to get into the program--but it's really not that hard to be admitted.") Then you were asked to give an exhaustive psychological, medical, and dietary history from the day you were born, and finally you took a psychological test, the MMPI (Minnesota Multi-Phasic Personality Inventory), to explore your anxiety levels--the Center felt (and I agree) that no one undergoing great psychological stress could be a successful dieter. If you were suffering from a major illness, divorce, or a nervous breakdown, this was not the program for you.

The food allotment--I won't call it a meal-- was 9-12 ounces of meat or fish daily, not to be eaten all at one feeding, as well as a vitamin pill, four calcium pill, and a dose of potassium. If you felt the necessity for more solid food, you could have one eighth of a head of lettace, 4 radishes, half a cucumber, or pickle and clam juice. What about the gnawing pains in your midsection? "Ignore them," said Dr. Blackburn helpfully, "they go away eventually."

Most of Dr. Blackburn's practice was middle-aged (I am using an obesity-based criterion of "middle-age" as ranging between 25 and 50 years old), upper-middle-class and overwhelmingly female. All had the absolute dedication he instilled in them; Dr. Blackburn was unquestionably a superstar. He preached total commitment to the cause, and would allow no failures in his program. "If you eat at parties, don't go to parties," he would say. "If you overeat of vacations, don't go on vacations," "Don't entertain, don't be preoccupied with food, and move your body.:

Dr. Blackburn understood more about female metabolism than any male doctor I have ever known. He realized that overweight women simply cannot eat all they want to of anything except maybe raw vegetables, and the sooner they accept this fact, the better. Since his treatment of men and women was exactly the same (except that men got more food), I can't even call him a sexist!

I saw Dr. Blackburn make only one error while I was in Boston. He was working on an alternative diet plan called MiniMeals. These were chocolate-covered bars consisting of a balanced meal of 225 calories each. You could eat 4 bars a day and have a balanced reducing diet. Along with MiniMeals, Dr. Blackburn conducted a total program, including weekly group therapy. But the program turned out not to be as successful as he had hoped; one day I found him somewhat disgusted. "Barbara," he said, "how can people eat too many MiniMeals?"

"Dr. Blackburn," I replied, "you don't understand. If you are overweight you will eat too much of anything covered in chocolate, even ants!"

The Boston program was successful because success was built into the system. Motivation, modification of behavior, money, movement, and a great male authority figure all made it a tremendous success. Dr. Blackburn's cures are upwards of 60 percent, where the national average is between 5 and 10 percent. The Center did not consider you a successful dieter until you had lost your weight and kept it off of 18 weeks--"touchdown" was not counted.

At the same time as the Boston program, a Cleveland clinic was working on a protein-sparing supplement using Casec (a powdered-protein supplement) and small amounts of sugar. It used the same protein modification fasting principle, but you didn't even get to chew any meat. This diet has since become popular, but I prefer Dr. Blackburn's methods--at least he gave you something to chew on.

Dr. Blackburn wanted me to carry his teachings down to Hartford, telling me, "One good, well-motivated patient on protein sparing is better than ten patients failing on regular diets." I found it too rigorous for most of my patients; however, to this day, when I hear the Protein Sparing Modified Fast called a "fad diet," I get furious. There has never been so much good, intelligent, practical research done on any diet. If I had any criticism of the Center for Nutritional Research, it would be that it is a very male-oriented show with, as usual, a female supporting cast. Be that as it may, I bless Dr. Blackburn for really understanding. If he had only been a woman, it would have been perfect!"


Hope this makes some interesting reading, if this is indeed the same Dr. Blackburn.

Elihnig

Summeryet,

Great find!!! Thanks.

Elihnig,

Yes, it's the same Blackburn. I wonder why it says he is against the Atkin's diet when Gary Taubes NY Times article seemingly used him as a proponent. Blackburn even described his diet as an Atkins type diet.

Quote from NY Times article:
"The bottom line is that for the better part of 30 years Atkins insisted his diet worked and was safe, Americans apparently tried it by the tens of millions, while nutritionists, physicians, public- health authorities and anyone concerned with heart disease insisted it could kill them, and expressed little or no desire to find out who was right. During that period, only two groups of U.S. researchers tested the diet, or at least published their results. In the early 70's, J.P. Flatt and Harvard's George Blackburn pioneered the ''protein-sparing modified fast'' to treat postsurgical patients, and they tested it on obese volunteers. Blackburn, who later became president of the American Society of Clinical Nutrition, describes his regime as ''an Atkins diet without excess fat'' and says he had to give it a fancy name or nobody would take him seriously. The diet was ''lean meat, fish and fowl'' supplemented by vitamins and minerals. ''People loved it,'' Blackburn recalls. ''Great weight loss. We couldn't run them off with a baseball bat.'' Blackburn successfully treated hundreds of obese patients over the next decade and published a series of papers that were ignored."

I am glad you enjoyed it. I get WebMD's newsletter and I couldn't believe the timing as I was getting ready to start the plan!
~Michelle