One cheer for Atkins
It has been hailed as a "diet revolution," but in fact it's been more like a 30-year food fight. The issue is the safety and effectiveness of the high-protein, low-carbohydrate diet widely known as Atkins after its popularizer, the late physician Robert Atkins. This fast and painless way to weight loss has incited equal measures of public enthusiasm and medical scorn.
The dietary skirmish is not going to be settled anytime soon, certainly not by the two new reports in last week's New England Journal of Medicine comparing this no-pain diet with standard medical fare. The studies are important but small victories for Atkins aficionados. They indeed showed that extremely overweight people could modestly melt pounds away with no evident harm. Specifically, the diet did not cause the expected deterioration in blood cholesterol levels. Though bad cholesterol rose a bit, there was an offsetting improvement in good cholesterol and triglycerides. But--and this is a huge but--the same studies revealed a high dropout rate, and, as with other diets, many of the lost pounds were back within a year. This is important, because Atkins claimed that the speed and gustatory pleasure of mouthwatering steaks and lobster dripping in melted butter would inspire the lifelong changes that the ascetic get-used-to-hunger, low-calorie approach has never been able to do. For a nation woefully overweight and eternally in search of an easy fix, it's worth knowing what will bring closure to this feisty debate.
In addition to celebrating eggs and ribs and sour cream, Atkins demonizes carbohydrates and scorns calorie counting as a fool's pastime. In the other corner is the medically correct crowd, the legions of doctors and nutritionists upholding the conventional medical wisdom of the "healthy diet." Healthy makes no claims to being fun: Its balanced regimen of fruits, vegetables, pastas, and grain has long been the catechism of weight loss. But such puritanical slimming has lost its sway as America has grown more and more obese and science has failed to prove Atkins wrong. Let's face it: Eating all those luscious forbidden morsels as the fat melts off is devilishly seductive.
Cream or sugar? The Atkins diet is also seductive because it makes physiological sense. The usual energy source for our body is sugar. Carbs are made of sugars, and when they run short, the body automatically shifts into a new energy gear, a kind of backup generating system--called ketosis--in which fat, not sugar, becomes the primary fuel. Ketosis (so named for ketones, the byproducts of burning fat) is an abnormal metabolic state also seen in starvation and uncontrolled diabetes. In fact, ketones can kill, but the healthy body gets rid of them promptly--through the kidneys and the lungs (an unpleasant effect of the Atkins diet is called acetone breath). Ketones have a diuretic effect and thus explain the immediate and gratifying loss of pounds. The Atkins mantra that calories don't matter is still open to debate. People are actually taking in fewer calories on very low carb diets, and ketones may be curbing hunger for more.