Atkins diet 1

Atkins diet
The Atkins diet, officially called the Atkins Nutritional Approach, is a low-carbohydrate diet created by Robert
Atkins from a research paper he read in the Journal of the American Medical Association published by Gordon Azar
and Walter Lyons Bloom. Atkins stated that he used the study to resolve his own overweight condition. He later
popularized it in a series of books, starting with Dr. Atkins' Diet Revolution in 1972. In his second book, Dr. Atkins'
New Diet Revolution, he modified parts of the diet but did not alter the original concepts.

Nature of the diet

The Atkins Diet involves restriction of carbohydrates to more frequently switch
the body's metabolism from burning glucose as fuel to burning stored body fat.
This process, called ketosis, begins when insulin levels are low; in normal
humans, insulin is lowest when blood glucose levels are low (mostly before
eating). Ketosis lipolysis occurs when some of the lipid stores in fat cells are
transferred to the blood and are thereby used for energy. On the other hand,
caloric carbohydrates (for example, glucose or starch, the latter made of chains of
glucose) impact the body by increasing blood sugar after consumption. (In the
treatment of diabetes, blood sugar levels are used to determine a patient's daily
insulin requirements.)[1] Lastly, because of fiber's low digestibility, it provides
little or no food energy and does not significantly impact glucose and insulin
levels. Dr Atkins' New Diet Revolution
book
In his book Dr Atkins' New Diet Revolution, Atkins made the controversial
argument that the low-carbohydrate diet produces a metabolic advantage because
"burning fat takes more calories so you expend more calories."[2] He cited one study where he estimated this
advantage to be 950 Calories (4.0 MJ) per day. A review study published in the Lancet[3] concluded that there was
no such metabolic advantage and dieters were simply eating fewer calories because of boredom. Professor Astrup
stated, "The monotony and simplicity of the diet could inhibit appetite and food intake".

The Atkins Diet restricts "net carbs" (digestible carbohydrates that impact blood sugar). One effect is a tendency to
decrease the onset of hunger, perhaps because of longer duration of digestion (fats and proteins take longer to digest
than carbohydrates). Atkins states in his book "New Diet Revolution" (2002) that hunger is the number one reason
why low-fat diets fail and that the Atkins diet is easier because you are allowed to eat as much as you want.[2]
Net carbohydrates can be calculated from a food source by subtracting fiber and sugar alcohols (which are shown to
have a smaller effect on blood sugar levels) from total carbohydrates. Sugar alcohols contain about two calories per
gram, and the American Diabetes Association recommends that diabetics count each gram as half a gram of
carbohydrate.[4] Fructose (for example, as found in many industrial sweeteners) has four calories per gram but has a
very low glycemic index[5] and does not cause insulin production, probably because ß cells have low levels of
GLUT5.[6] [7]
Preferred foods in all categories are whole, unprocessed foods with a low glycemic index, although restrictions for
low glycemic carbohydrates (black rice, vegetables, etc.) are the same as those for high glycemic carbohydrates
(sugar, white bread). Atkins Nutritionals, the company formed to market foods which work with the Atkins Diet,
recommends that no more than 20% of calories eaten while on the diet come from saturated fat.[8]
Atkin's book, Atkins Diabetes Revolution, states that, for people whose blood sugar is abnormally high or who have
Type 2 diabetes mellitus, the Atkins diet decreases or eliminates the need for drugs to treat these conditions. The
Atkins Blood Sugar Control Program (ABSCP) is an individualized approach to weight control and permanent
Atkins diet 2

management of the risk factors for diabetes and cardiovascular disease.[9] Nevertheless, the causes of Type 2
diabetes remain obscure, and the Atkins Diet is not accepted in conventional therapy for diabetes.

Ketogenic diet
The induction phase of the Atkins diet is a ketogenic diet. In ketogenic diets there is production of ketones that
contribute to the energy production in the Krebs cycle.[10] Ketogenic diets rely on the insulin response to blood
glucose. Because ketogenic dieters eat few carbohydrates, there is no glucose that can trigger the insulin response.
When there is no glucose-insulin response there are some hormonal changes that cause the stored fat to be used for
energy. Blood glucose levels have to decrease to less than 3.58 mmol/L for growth hormone, epinephrine, and
glucagon to be released to maintain energy metabolism.[10] In the adipose cells, growth hormone and epinephrine
initiate the triacylglycerol to be broken down to fatty acids. These fatty acids go to the liver and muscle where they
should be oxidized and give acetyl-CoA that enters the Krebs cycle directly.[10] However, the excess acetyl-CoA in
the liver is converted to ketones (ketone bodies), that are transported to other tissues. In these tissues they are
converted back into acetyl-CoA in order to enter the Krebs cycle. Glucagon is produced when blood glucose is too
low, and it causes the liver to start breaking glycogen into glucose. Since the dieter does not eat any more
carbohydrates, there is no glycogen in the liver to be broken down, so the liver converts fats into free fatty acids and
ketone bodies, and this process is called ketosis. Because of this, the body is forced to use fats as a primary fuel
source.[10]

Main effects
The effects of the Atkins diet remain a subject of much debate. Some studies conclude that the Atkins diet helps
prevent cardiovascular disease, lowers the low density lipoprotein (LDL) cholesterol, and increases the amount of
HDL cholesterol. Other studies concluded that the diet contributes to cardiovascular disease, coronary heart disease,
arrhythmia, osteoporosis, and kidney stones.[11] [12]

Cholesterol
According to Harper (2004) in a year-long study, the concentration of HDL cholesterol increased, and insulin
resistance improved much more in dieters following the Atkins diet than in those following a low fat, calorie
restricted diet. Harper also mentions that there had not been enough prior research to allow him to confidently say
that Atkins is safe to be recommended to patients.[13] However, as Barnett et al. reported in 2009, some later studies
have yielded opposite results: cholesterol levels have increased in almost one third of dieters using low-carbohydrate
diets, like Atkins, and since then two cardiac deaths have been reported, one due to coronary heart disease, and the
other due to arrhythmia.[14]

Methylglyoxal
A 2005 study by Beisswenger and colleagues compared levels of the glycotoxin methylglyoxal (MG) before and
after starting the Atkins diet. MG is associated with blood vessel and tissue damage, and is higher in people with
poorly controlled diabetes. The study found that MG levels doubled shortly after the diet was started, noting that the
MG rise was related to the presence of ketosis. A rise in acetol and acetone was found, indicating that MG was
produced by oxidation. MG also arose as a by-product of triglyceride breakdown and from lipoxidation (ketosis
related to fat intake).[15]
Whether or not increased methylglyoxal is harmful to human beings has been questioned by the Indian Association
for the Cultivation of Science who, in a 2008 critical overview of various studies, (including Beisswenger's study),
state, "The authors present a brief critical overview of studies indicating both toxic and beneficial effects of
methylglyoxal and suggest that the beneficial effects of methylglyoxal outweigh its toxic effects." While not drawing
Atkins diet 3

any definite conclusions the Indian Association for the Cultivation of Science recommends further study especially
in the area of using methylglyoxal to cure or treat cancer.[16]

The four phases

There are four phases of the Atkins diet: induction, ongoing weight loss, pre-maintenance and lifetime maintenance.

Induction
The most restrictive phase of the Atkins Nutritional Approach. Two weeks are recommended for this phase. It is
intended to cause the body to quickly enter a state of ketosis. Carbohydrate intake is limited to no more or less than
20 net grams per day (grams of carbohydrates minus grams of fiber, sugar alcohols, or glycerin), 12 to 15 net grams
of which must come in the form of salad greens and other fruits and vegetables such as broccoli, spinach, pumpkin,
cauliflower, turnips, tomatoes, and asparagus, to name a few of the 54 allowed by Atkins (but not legumes, since
they are too starchy for the induction phase). The allowed foods include a liberal amount of all meats, poultry, fish,
shellfish, fowl, and eggs; up to 4 ounces (113 g) of soft or semi-soft cheese such as cheddar cheese; most salad
vegetables; other low carbohydrate vegetables; and butter, olive oil and vegetable oils. Drinking eight glasses of
water per day is a requirement during this phase. Alcoholic beverages are not allowed during this phase.[17] Caffeine
is allowed in moderation so long as it does not cause cravings or low blood sugar. If a caffeine addiction is evident, it
is best to not allow it until later phases of the diet.[17] A daily multivitamin with minerals, except iron, is also
recommended. A normal amount of food, on Induction, is around 20 grams of sugar (or net carb), at least 100 grams
of fat.
The Induction Phase is usually when many see the most significant weight loss — reports of losses of 5 to 10 pounds
per week are not uncommon when Induction is combined with daily exercise. Many Atkins followers make use of
Ketostix, small chemically reactive strips used by diabetics. These let the dieter monitor when they enter the ketosis,
or fat burning, phase, but are not always accurate for non-diabetic users. Other indicators of ketosis include a
metallic taste in the mouth, or a sweet smell on breath (the smell of Ketones).[2]

Ongoing weight loss

The Ongoing Weight Loss (OWL) phase of Atkins consists of an increase in carbohydrate intake, but remaining at
levels where weight loss occurs. The target daily carbohydrate intake increases each week by 5 net grams per day. A
goal in OWL is to find the "Critical Carbohydrate Level for Losing" and to learn in a controlled manner how food
groups in increasing glycemic levels and foods within that group affect your craving control. The OWL phase lasts
until weight is within 10 pounds (4.5 kg) of the target weight.
During the first week, one should add more of the induction acceptable vegetables to one's daily products. For
example, 6-8 stalks of asparagus, salad, one cup of cauliflower or one half of avocado. The next week, one should
follow the carbohydrate ladder that Dr Atkins created for this phase and add fresh dairy. The ladder has 9 rungs and
should be added in order given. One can skip a rung if one does not intend to include that food group in one's
permanent way of eating, such as the alcohol rung.
The runs are as follows:
• Induction acceptable vegetables in larger quantities
• Fresh cheese
• Nuts and seeds
• Berries
• Alcohol
• Legumes
• Other fruits
Atkins diet 4

• Starchy vegetables
• Whole grains

Pre-maintenance
Daily net carbohydrates intake is increased again this time by 10 grams each week from the latter groupings, and the
key goal in this phase is to find the "Critical Carbohydrate Level for Maintenance", this is the maximum number of
carbohydrates you can eat each day without gaining weight. This may well be above the level of carbohydrates
inducing ketosis on a testing stick. As a result, it is not necessary to maintain a positive ketosis test long term.

Lifetime maintenance
This phase is intended to carry on the habits acquired in the previous phases, and avoid the common end-of-diet
mindset that can return people to their previous habits and previous weight. Whole, unprocessed food choices are
emphasized, with the option to drop back to an earlier phase if you begin to gain weight.

Popularity
The Atkins Nutritional Approach gained widespread popularity in 2003 and 2004. At the height of its popularity one
in eleven North American adults were on the diet.[18] This large following was blamed for large declines in the sales
of carbohydrate-heavy foods like pasta and rice: sales were down 8.2 and 4.6 percent, respectively, in 2003. The
diet's success was even blamed for a decline in Krispy Kreme sales.[19] Trying to capitalize on the "low-carb craze,"
many companies released special product lines that were low in carbohydrates. Coca-Cola released C2 and
Pepsi-Cola created Pepsi Edge, which was scheduled to be discontinued later in 2005. Unlike the sugar-free soft
drinks Diet Coke and Diet Pepsi, which had been available for decades, these new drinks used a blend of sugar and
artificial sweeteners to offset the flavor of artificial sweetener. These "half-and-half" drinks declined in popularity as
soft drink makers learned to use newer sweeteners to mask the flavour of aspartame (or completely replace it) in
reformulated diet drinks such as Coca-Cola Zero and Pepsi ONE.
Low-carbohydrate diets and the societal changes they have caused have been a subject of interest in the news and
popular media. For example, on 25 April 2004, Canada's Food Network aired a one-hour television documentary
entitled The Low Carb Revolution.
In 2003, Atkins died from a fatal head injury sustained in a fall on ice.[20] His death came after a battle with a heart
condition, cardiomyopathy, reportedly caused by a viral infection, which had caused noticeable weight fluctuation in
his final years. This combination of circumstances led to rumors and allegations that Atkins had died from
complications arising from his namesake nutritional plan; however, contemporary accounts from his physicians did
not substantiate these claims.[21] [22] [23] [24]
On July 31, 2005, the Atkins Nutritional company filed for Chapter 11 bankruptcy protection after the percentage of
adults on the diet declined to two percent and sales of Atkins brand product fell steeply in the second half of 2004.
The company continues to operate and the diet plan remains popular, although it has never regained its former
popularity.

Scientific studies
Because of substantial controversy regarding the Atkins Diet and even disagreements in interpreting the results of
specific studies it is difficult to objectively summarize the research in a way that reflects scientific consensus.[25] [26]
Although there has been some research done throughout the twentieth century,[27] [28] most directly relevant
scientific studies, both those that directly analyze the Atkins Diet and those that analyze similar diets, have occurred
in the 1990s and early 2000s and, as such, are relatively new. Researchers and other experts have published articles
and studies that run the gamut from promoting the safety and efficacy of the diet[29] [30] to questioning its long-term
Atkins diet 5

validity[31] [32] to outright condemning it as dangerous.[33] [34] Until recently a significant criticism of the Atkins
Diet was that there were no studies that evaluated the effects of Atkins beyond a few months. However, studies are
emerging which evaluate low-carbohydrate diets over much longer periods, controlled studies as long as two years
and survey studies as long as two decades.[29] [35] [36] [37]
A Swedish prospective study with a follow-up of approximately 10 years came to the conclusion that elderly
Swedish men on a carbohydrate-restricted diet (however 40% carbohydrates compared to the Atkins recommended
4%) had a hazard ratio of 1.2 for all-cause mortality compared to controls, and a hazard ratio of 1.4 for
cardiovascular mortality.[38]
In addition to research on the efficacy of Atkins and other low-carbohydrate diets, some research has directly
addressed other areas of health affected by low-carbohydrate diets. For example, contrary to popular belief that
low-carbohydrate diets damage the heart, one study found that women eating low-carbohydrate, high-fat/protein
diets had the same or slightly less risk of coronary heart disease, compared to women eating high-carbohydrate,
low-fat diets.[39] Other studies have found possible benefits to individuals with diabetes,[40] cancer,[41] [42] and
epilepsy.[43] [44] Nevertheless some studies demonstrate potentially harmful effects of certain types of
low-carbohydrate diets including various metabolic and emotional side-effects.[45]

Controversies
An analysis conducted by Forbes magazine found that the sample menu from the Atkins Nutritional Approach is one
of the top five in the expense category of ten plans Forbes analyzed. This was due to the inclusion of recipes with
some high cost ingredients such as lobster tails which were put in the book to demonstrate the variety of foods which
could be consumed on the diet. The analysis showed the median average of the ten diets was approximately 50%
higher, and Atkins 80% higher, than the American national average. The Atkins diet was less expensive than the
Jenny Craig diet and more expensive than Weight Watchers.[46]
Low-carbohydrate diets have been the subject of heated debate in medical circles for three decades. They are still
controversial and only recently has any serious research supported some aspects of Atkins' claims, especially for
short-term weight-loss (6 months or less). In a comparison study by Dansinger and colleagues (2005), the goal was
to compare popular diets like Atkins, Ornish, Weight Watchers, and Zone for the amount of weight lost and a heart
disease risk reduction. In the study there were 247 individuals and it lasted for 1 year. All the subjects were
overweight at baseline, and had an increased risk for cardiac diseases. One of the diets was assigned to each
person.[47] The Atkins diet group ate 20g of CHO a day, with a gradual increase toward 50 g daily. The Zone group
ate a 40-30-30 % diet of carbohydrates, fats and proteins respectively. The Weight Watchers group was to keep the
“points” of their food in a determined range, based on their weight. The Ornish group ate a vegetarian diet with 10%
of calories coming from fats. The weight, waist size, blood pressure, and a blood sample were taken, at the
beginning, after 2 months, 6 months and 12 months. All four diets resulted in weight loss with no significant
difference between the diets.[47]
But many in the scientific community also raise serious concerns:
• Dr. Robert Eckel of the American Heart Association says that high-protein, low-carbohydrate diets put people at
risk of heart disease.[48] A long term study published in the New England Journal of Medicine in 2006 found that
while women on low-carb diets were generally healthier than those on high-carbohydrate diets, women eating
more protein and fat from vegetable sources, rather than from animal sources, had a lower risk of heart
disease.[49]
• A 2001 scientific review conducted by Freedman et al. and published in the peer reviewed scientific journal
Obesity Research concluded that low-carb dieters' initial advantage in weight loss was a result of increased water
loss, and that after the initial period, low-carbohydrate diets produce similar fat loss to other diets with similar
caloric intake.[50]
Atkins diet 6

• The May 2004 Annals of Internal Medicine study showed that "minor adverse effects" of diarrhea, general
weakness, rashes and muscle cramps "were more frequent in the low-carbohydrate diet group".
• Concerns have been raised regarding consumption of high levels of protein in individuals with medical conditions
such as kidney disease or gout.
Opponents of the diet also state that the initial weight loss upon starting the diet is a phenomenon common with most
diets, and is due to reduction in stored glycogen and related water in muscles, not fat loss. They say that no evidence
has surfaced that any diet will cause weight loss unless it reduces food energy (calories) below the maintenance level
and that weight loss from the Atkins diet may be the result of less food energy being consumed by the dieter, rather
than the lack of carbohydrates.[51] They further point out that weight loss on fad diets, which typically restrict or
prohibit certain foods, is often because the dieter has fewer food choices available.

Misconceptions about the diet

Many people believe that the Atkins Diet promotes eating unlimited amounts of fatty meats and cheeses.[52] [53] This
is a key point of clarification that Atkins addressed in the more recent revisions of his book. Although the Atkins
Diet does not impose caloric restriction, or definite limits on proteins, Atkins points out in his book that this plan is
"not a license to gorge." The director of research and education for Atkins Nutritionals, Collette Heimowitz, has said,
"The media and opponents of Atkins often sensationalise and simplify the diet as the all-the-steak-you-can-eat diet.
This has never been true."[8]
Another common misconception arises from confusion between the Induction Phase and rest of the diet.[53] The first
two weeks of the Atkins Diet are strict, with only 20g of 'net' carbohydrates permitted per day. Net Carbs are the
total carbohydrate content minus the fiber content. The Net Carbs number reflects the grams of carbohydrate that are
said to significantly impact blood sugar level and therefore are the only carbs needed to count when doing Atkins.
Atkins states that a dieter can safely stay at the Induction Phase for several months if the person has a lot of weight to
lose.[54] Induction, however, is merely a stage to get the body used to fat, and cure cravings for unacceptable foods.
Gradually, carbohydrate levels are raised to slow weight loss and add more acceptable foods (berries, more dairy,
nuts, etc.), though carbs are still significantly below USDA norms. Once the weight-loss goal is reached,
carbohydrate levels are raised again to a state of equilibrium where no weight is lost or gained, which may or may
not be below USDA norms, depending on the individual's metabolism, age, and their exercise level.

Atkins Nutritionals
Atkins Nutritionals, Inc. (ANI) was founded in 1989 by Atkins to promote the diet and sell Atkins-branded products.
Following his death, waning popularity of the diet and a reduction in demand for Atkins products, Atkins
Nutritionals, Inc. filed for Chapter 11 bankruptcy protection on July 31, 2005 citing losses of $340 million.[55] The
company emerged from bankruptcy on January 10, 2006, introducing "a new business strategy that focuses on
providing great-tasting portable foods with a unique nutrition advantage to healthy, active men and women."[56]
Although the marketing focus has changed, the products are still low-carb. It is also stated on the packages the stage
of the Atkins Nutritional Approach where they may be used.
Atkins diet 7

Books
• Robert C. Atkins (2004) Atkins for Life: The Complete Controlled Carb Program for Permanent Weight Loss and
Good Health, 370pp, St. Martin's Press, ISBN 0-641-67892-4
• Robert C. Atkins (2001) Dr. Atkins' New Diet Revolution book, 560 pp, Avon Books; Revised ed., ISBN
0-06-001203-X, ISBN 0-09-188948-0
• Robert C. Atkins (2000) Dr. Atkins' Age-Defying Diet Revolution: A Powerful New Dietary Defense Against
Aging, Saint Martin's Press, LLC, ISBN 9780312251895
• Robert C. Atkins (1999) Dr. Atkins' Vita-Nutrient Solution: Nature's Answer to Drugs, 416 pp, Fireside Books
(Simon & Schuster), ISBN 0-684-84488-5.

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Atkins diet 9

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External links
• Official Atkins Corporate Site (http://www.atkins.com)
• Atkins diet (http://www.dmoz.org/Health/Nutrition/Dietary_Options/Low_Carbohydrate/Atkins_Diet/) at
the Open Directory Project
• New England Journal of Medicine: (vol 348, p 2082) (http://www.ncbi.nlm.nih.gov/entrez/query.
fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=12761365) A randomized trial of a
low-carbohydrate diet for obesity.
• New England Journal of Medicine: (vol 359, p 229) (http://content.nejm.org/cgi/content/full/359/3/229)
Weight Loss with a Low-Carbohydrate, Mediterranean, or Low-Fat Diet (July 17, 2008)
Article Sources and Contributors 10

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Image Sources, Licenses and Contributors

Image:AtkinsDietBook.jpg  Source: http://en.wikipedia.org/w/index.php?title=File:AtkinsDietBook.jpg  License: unknown  Contributors: King of the North East, Solipsist, Stan Shebs

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