Sloucho's Full Review: Robert C. Atkins M.D. - Dr. Atkins New Diet Revolu...
I would never have considered reading Dr. Atkins’ New Diet Revolution if not for the fact that my wife’s father and grandfather were both put on the Atkins Diet by their doctors within two weeks of each other. I would not have considered Atkins’ book—or any other diet book—because only two or three of my 175 pounds look out of place on my 6’ frame. When I look at myself in the mirror, I like to tell myself that I am only a few hundred sit-ups away from the body that I would like (and then promptly concoct an excuse for doing the sit-ups tomorrow).
However, because diabetes is a concern in my wife’s family—and because her father and grandfather are now relying on Atkins’ low-carbohydrate strategy to manage their blood sugar levels, I was willing to listen to Mrs. Sloucho when she mentioned the possibility of buying the latest text by this particular diet guru. I was even willing to listen to her when she said that the only way she could possibly succeed with the Atkins diet would be to transform our kitchen into a sugar-free, flour-free zone. In other words, she was convinced that she could not possibly stick to the diet unless I joined her.
“Whatever you think is best,” I said. Food has never been nearly as important to me as it is to Mrs. Sloucho, so I figured that I could easily forgo anything that she was willing to do without.
It turned out that eliminating bread, pasta, rice and potatoes from my diet was not at all easy, and I was fairly grumpy about the deprivation for the first couple of weeks, but now that Mrs. Sloucho and I have entered our second month of what Atkins calls “the induction phase,” I would like to share my own impressions of what detractors call a “fad diet” and what Atkins defiantly labels “a nutritional approach.”
Since Gary Taubes’ article (“What If It’s All Been a Big Fat Lie”) appeared in the New York Times Magazine in July of 2002, the Atkins diet has been receiving more and more press about the possibility that it is a health-conscious diet (and not simply a tool for rapid weight loss). Although Taubes himself does not make this claim outright in the article, he dances around it suggestively enough to have opened the floodgates for a great deal of pro-Atkins propaganda when he says, “I have read the papers suggesting that 20 years of low-fat recommendations have not managed to lower the incidence of heart disease in this country, and may have led instead to the steep increase in obesity and Type 2 diabetes.”
Those who have read Atkins’ New Diet Revolution know that where Taubes uses “may,” Atkins himself uses “did.” For Atkins and his followers, the low-fat, high-carbohydrate diet advocated by the United States Department of Agriculture and endorsed by the American Medical Association did lead to the slow poisoning of a generation of Americans—those of us who have been educated, since the 1980s, to exclude fats as much as possible from our diets in favor of carbohydrates. In Atkins’ opinion, the popularity of the carbohydrate-rich diet is the result of a confusing web of ignorance, shame, greed, and good intentions. America’s farmers (who produce staggering amounts of corn, wheat, and other grains) clearly have a stake in convincing the population that such foods are good for them. And American consumers tend to prefer carbohydrate-based foods because they cost less and keep longer than fat-based foods. Then too, fat has nine calories per gram, whereas carbohydrate comes in at only four calories per gram, so nutritionists have long assumed that those who want to eat more without suffering the consequences of weight gain should opt for carbohydrates over fats. In other words, market conditions and ignorance of endocrinology combined to lead people to the conclusion that fat-reduction was the key to a healthy diet.
In New Diet Revolution, Atkins cries, “Balderdash!” over and over again in response to this prevailing view. He cites studies (without always explaining their methodologies) and provides anecdotal evidence in his attempt to persuade the reader that carbohydrates—not fats—are the cause of what he calls America’s “twin epidemics” of obesity and diabetes. To the best of my understanding, his argument can be summarized as follows:
1) The human body must burn either carbohydrates or fats for energy.
2) Given the choice, the body will always opt to burn carbohydrates over fats.
3) Because we tend to eat too much, our bodies store the excess fuel that we consume as body fat.
4) Whether this excess fuel enters the digestive system as carbohydrate or as fat, it ends up as body fat.
5) Body fat is stored energy, and the body has no incentive to break into this “reserved” energy supply unless its preferred source of energy (eating) is calorically insufficient for the body’s purposes.
6) Caloric insufficiency may be induced by using more fuel (exercising) or by reducing/eliminating fuel intake.
7) The reason the body opts to burn carbohydrates over fats is that carbohydrates can be burned more efficiently.
8) Because fats are an inefficient fuel source, it actually takes more energy to run the human body on fat than on carbohydrate, which means that you can consume more calories on a fat-diet than you have traditionally consumed on carbohydrate-diets and still lose weight.
9) Because it takes more energy to burn fats than to burn carbohydrates, Atkins asserts that there is a “metabolic advantage” to high-fat diets.
I am not a nutritionist, but I have been reading widely about nutrition in the time that Mrs. Sloucho and I have been following the Atkins diet. My motive has been to find a study or an article that will convince Mrs. Sloucho of the error of our ways and allow me to get back to my regular diet of pizza and French fries. What I have learned in my reading is that there appears to be a general consensus about the first six points listed above. In other words, no one seems to dispute the foundation of Atkins’ theory.
However, there does not appear to be much evidence to support points 7 through 9. Critics of Atkins suggest that those who lose weight on the Atkins diet do so merely because they are consuming fewer calories, not because of any “metabolic advantage.” According to researchers such as Randy Seeley of the Obesity Research Center at the University of Cincinnati, the Atkins diet may very well work, but not in the way that Atkins himself thinks. As Seeley observes, “If you’re only allowed to eat in two aisles of the grocery store, does it really matter which two they are?”
It was this quotation from Seeley that prompted me to start putting my own thoughts about Atkins’ regimen down on paper. In my opinion, Seeley’s formulation more accurately characterizes the Atkins program than the positions adopted by Atkins’ proponents or his detractors, though I don’t think the Seeley quip adequately accounts for the distinction between shopping from the meat and produce aisles and shopping from the ice cream and soda aisles. It is true that any restrictive diet is likely to result in weight loss because humans quickly become bored with eating the same thing incessantly (be it fish sticks or Funyuns). But while all restrictive diets may leave us feeling disinclined to eat yet another helping of what we are allowed, it is clear to me that some restrictive diets leave us feeling more or less satisfied (read hungry) than others.
Atkins began generating controversy when his first book appeared in the 1970s, and so many pro- and anti-Atkins diatribes have been written since then that it is virtually impossible for the lay reader to make sense of the information. Worse still, most of what has been written has been transparently inflected by the interests of the parties involved. Atkins himself, after all, pioneered a whole line of low-carbohydrate foods, and his heirs would like nothing better than to market those products to as large a demographic as possible. It is clearly in their interest to overstate the health benefits (and to overlook the health consequences) of an Atkins approach because that is the only way they will manage to market their products to people who are not looking for a crash diet. It is also clearly in the interest of the USDA and the AMA to produce any evidence they can to support the low-fat position that they have maintained for decades. As Taubes puts it, discovering that Atkins’ low-carbohydrate approach is actually healthier than the low-fat approach they have been advocating would be “a collective find-yourself-standing-naked-in-Times-Square-type nightmare” for “the members of the American medical establishment.”
Sadly, the loudest participants in the low-fat vs. low-carbohydrate dietary camps tend to be too invested in their own positions to listen fairly to what those on the other side have to say. As a result, this debate does not occur in the spirit of free scientific inquiry that would be in the interest of those who simply wish to eat healthily. Rather, we tend to get one mean-spirited polemic after another from parties who are more interested in staking their reputations on preserving their reputations than in getting to the bottom of the question about what really is best for our metabolisms. The most challenging thing about the debate is that the combatants simply invoke the results of studies without telling the reader how those results were obtained or how reliable the researchers were.
Consider, for example, Dr. James J. Kenney’s "10 Top Reasons Atkins Is Wrong” (available here: http://www.foodandhealth.com/jan00.pdf). For all I know, Dr. Kenney may be capable of clear thinking, but he does not seem to believe that his readers are. Kenney begins with the assumption that fiber intake plummets when one follows the Atkins plan and says to avoid such diets because “the National Institute of Cancer Research currently recommends, based on the bulk of scientific research, that you get most of your food from plant sources that are high-fiber and low-fat.” Considering that Atkins takes great pains to present himself as a loose cannon in the medical community, telling those who are leaning towards the Atkins plan that it is inconsistent with “current” recommendations of the medical establishment is not terribly persuasive. But more importantly, the critics of Atkins who equate limiting carbohydrates with reducing the intake of vegetables do not appear to have a very accurate notion of the average American diet. Even the most restrictive phase of the Atkins diet (“Induction”) calls for more vegetables than many of us are used to consuming. Mrs. Sloucho and I used to have salads twice a week. Now we are having them twice a day. Once the starchy potato is eliminated from the diet, it tends to be replaced by cauliflower, mushrooms, spinach, broccoli, celery and turnips (foods I ate either sporadically or not at all before adopting a low-carbohydrate strategy).
Kenney goes on to say that the Atkins diet reduces athletic performance. “Since the 1930s,” he writes, “it has been known that a high-carbohydrate diet can enhance endurance during strenuous athletic events.” His passive construction here is maddening. Known by whom? Known with what degree of certainty? Proven how? He goes on to point out that “mountain-climbers and skiers should be warned that a ketogenic diet greatly increases the risk of mountain-sickness.” Setting aside the fact that Kenney considers the rather specific population of marathon-runners and mountaineers significant enough to address reason number 4 to them, the real problem here is that we are expected to accept both of these claims because he asserts that there is evidence out there somewhere to support them. Kenney’s argument reaches its most absurd pitch when he counsels against low-carbohydrate diets because they “do not restrict salt intake[, which] is the main reason blood pressure rises with age.” This kind of claim only plays into the hands of the Atkins proponents, who are quick to point out that there is nothing to prevent one from lowering salt intake on a low-carbohydrate diet. In fact, Atkins goes out of his way to recommend the use of low-sodium (or salt-free) products whenever possible in the recipe section of his book. And even though Mrs. Sloucho and I have not followed Atkins’ recommendation to use low-sodium soy sauce, Dr. Kenney would have a very difficult time convincing me that I consume more salt now than I did on my former diet of Cheese-Nips and Doritos.
The chief problem with Kenney’s rhetorical approach, in other words, is that he is only attempting to preach to the converted. If you are looking for a reason not to employ the Atkins strategy, there are plenty of people who will tell you that it is dangerous, that it flies in the face of conventional wisdom, or that there is “substantial evidence” that it does not work. In New Diet Revolution, Atkins himself does a very good job of anticipating and countering these arguments. If there were a face-to-face debate between Atkins and Kenney, I have to suppose that Atkins would demolish his opponent. But it would be absurd to conclude that the Atkins diet is safe and effective simply because Kenney is an inept rhetorician.
And inept rhetoric is only one of the pitfalls that await those who desire to reach a sound conclusion on the basis of existing nutritional data. In fact, it is Atkins’ very rhetorical efficacy that is the most distressing thing about his book. The claims he makes in the beginning of the book are so powerfully and persuasively presented that he lulls the reader into merely accepting his word for it when he makes more tenuous and arbitrary claims later on.
He does a fantastic job of demystifying the metabolic process for the lay reader and explaining why cutting carbohydrates is the simplest step that one can take toward burning fat. But he is less thorough when it comes to explaining why he insists on the elimination of caffeine. He tosses in a simple caveat that caffeine creates cravings for carbohydrates and points out that caffeine is not generally very good for people, but he does not address the fact that some people might find the caffeine cravings to be a greater obstacle to staying on the diet than the cravings that caffeine might or might not produce in them. Later on, he urges readers to incorporate multivitamins into their “nutritional approach,” but flatly forbids the use of any vitamins including iron. He says not one word (in New Diet Revolution) about what makes iron undesirable. We are simply to take his word for it that we should avoid iron in our multivitamins. The problem with taking his word for it, however, is that the most readily available A-Z vitamins in grocery stores and pharmacies do include iron. Suspiciously, the easiest way for most readers to acquire iron-free daily supplements is to order them from Atkins’ own company.
That, unfortunately, is only the beginning of a very strange series of fuzzy claims that all seem to get back to the Atkins line of products. For instance, Atkins never misses an opportunity to caution readers against consuming foods that contain hydrogenated or partially hydrogenated oils. He does not claim that such oils cause us to gain weight—merely that there is abundant evidence for concluding that they are bad for us. And then he reminds us that all Atkins products are free of such oils. Considering that many of Atkins’ competitors in the growing low-carbohydrate industry use hydrogenated and partially hydrogenated oils, one cannot help wondering about Atkins’ motives for pointing out the dangers of these substances that, in Atkins words, “do not occur in nature” and “baffle our caveman bodies.”
Of course, the Atkins products do include other substances that do not occur in nature, such as maltitol, a sugar substitute that is produced through the hydrogenation of corn starch. Atkins explicitly endorses maltitol as a sweetener because it has “minimal impact on blood sugars,” but he fails to explain why hydrogenated starches do not baffle our caveman bodies in the same way as hydrogenated oils.
Sometimes Atkins gets so caught up in his own argument that simple addition appears to fly out the window. On page 123 of New Diet Revolution, he stipulates that the third rule of induction is to consume “no more than 20 grams per day of carbohydrate, most of which must come in the form of salad greens and other vegetables. You can eat approximately three cups—loosely packed—of salad, or two cups of salad plus one cup of other vegetables.” Considering that there are only 1.3 grams of carbohydrate in a cup of romaine lettuce, it is extremely challenging to make this formula work. Three cups of romaine lettuce yield only 3.9 grams of carbohydrate, and there is no way to construe 3.9 as ‘most’ of 20. However, when one realizes that Atkins is trying to silence those of his critics who contend that the Atkins diet is vegetable-poor, his motives for this mathematically misleading construction are obvious.
But perhaps the most maddening thing about the Atkins system for counting carbohydrates is the distinction that Atkins sometimes draws and sometimes fails to draw between which substances are merely categorized by the FDA as carbohydrates and which substances actually “count” as carbohydrates when trying to follow the Atkins plan. For instance, according to the nifty pocket carbohydrate-counter that is included in the front of New Diet Revolution, there are 3.8 grams of carbohydrate in 6 asparagus spears. But according to the more extensive carbohydrate-counter in the back of the book, only 2.4 of those grams are actually digestible. The other 1.4 are indigestible dietary fiber, which means they do not count under the Atkins system. That calculation seems reasonable enough, but we have to wonder why the pocket carbohydrate-counter that we are provided with does not simply list the carbohydrates that count. Broccoli, being very fibrous, is listed as having 3.9 grams of carbohydrate on the card that I am supposed to take to the store. But when I get back to my house, the back of the book tells me that only 1.7 of those grams actually count. This pointless discrepancy is likely to exasperate many Atkins followers into purchasing Atkins products simply because they are clearly labeled as having ___ grams of what Atkins calls “net carbs” (or “carbohydrates that count when doing Atkins”).
When Atkins first appeared on the scene thirty years ago, medical practitioners such as Albert Stunkard thought that he was just trying to make a quick buck, but now Stunkard has revised his stance to the point of testing the success of the Atkins approach. When I see the hucksterish use of exclamation points in the opening lines of Atkins’ book (“Lose weight! Increase energy! Look great!”), I cannot help thinking that Stunkard’s initial response to Atkins was on-target. What Atkins calls his “nutritional approach” is very likely just another for-profit venture. But then again, Stunkard is right to be interested in testing the Atkins approach. Even if the diet guru is just another snake-oil salesman, his snake-oil might actually work.
And this is the main point that I, a disinterested ordinary guy entering his second-month on the Atkins diet, would like to convey to those of you who are considering the Atkins approach. I have no studies, no flow-charts, nothing but the experience of myself and my wife to go on, but I have formulated a few hypotheses about the Atkins diet.
The first is that Atkins’ “metabolic advantage,” if it exists at all, does not exist to a very pronounced degree in some people. My wife is losing weight on the Atkins program, but I suspect it is because she is eating less, not because it takes more energy to burn fat than it does to burn carbohydrates.
The second is that she is eating less because the Atkins plan has had an appetite-suppressant effect on her. Atkins indicates that this is a fairly standard reaction to his diet, but he doesn’t make as much of this as his critics, who say that Atkins is simply a reduced-calorie diet in disguise.
Thirdly, although I think that the Atkins diet is, in fact, a reduced-calorie diet in disguise, I think it may be the ‘right’ (or perhaps the ‘best’) reduced-calorie diet for most of us. My wife has struggled with her weight for her entire life, and she has been on more fad diets than she can remember. Although she does occasionally crave bread and pasta, she has not been hungry since she started the Atkins program. She cannot remember ever having been on another diet that did not leave her feeling hungry.
In other words, it is my opinion that the Atkins nutritional approach routinely produces the results (in terms of weight loss) that Atkins promises, but I am not persuaded that it produces these results for the reasons that he asserts. Speaking from my own experience, I can say that the Atkins program may not be the right program for people who do not have much weight to lose, as I have been following the rules of induction rigorously for over a month without dropping a single pound. Atkins made it very clear to me that I could force my body to burn fats for fuel rather than carbohydrates, but I believe that I am burning only the fats that I eat and not putting much of a dent in my body fat.
To put it another way, although I continue to appreciate the wit behind Seeley’s question (“If you’re only allowed to eat in two aisles of the grocery store, does it really matter which two they are?”), I have to respond that as far as sating one’s appetite goes, it really does matter. Speaking only for myself and my metabolism, I can say that I never felt anything like the rush of energy that Atkins and his followers talk about as happening after one kicks the addiction to carbohydrates, but I can also say that my cravings for flour and sugar are easily manageable and that I am not the least bit hungry. Atkins says he only talks about counting carbohydrates, never about counting calories, but if counting carbohydrates is what it takes to enable people to control their caloric intake, then the Atkins plan may very well be the most viable solution to our national inclination to overeat.
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