An introduction to Atkins - get slim the fat way

Dr. Atkins turned all that was accepted in the diet world upside down when he claimed that it is actually carbohydrates that make you fat. He claimed that you should instead eat protein and fat to lose weight. We know that it works, the question is how.

Overweight and obesity is an increasing problem in many western countries and has resulted in an avalanche of various dietary directions, diets, and diet prophets.

Even though other people before Atkins have been advocates for low consumption of carbohydrates, only very few - if any - have created such a stir and become as popular as Dr. Atkins' diet programme - a programme that he, himself, has named a diet revolution. In Britain alone, more than 3 million people follow the Atkins diet today.

The cardiologist Robert C. Atkins, who lent his name to one of the most provokative diet programs in recent times, died on March 17th. 2003 at the age of 72 as a result of having fallen on an icy pavement. He died at a time when his controversial diet method, which was more than 30 years old, had finally achieved some degree of support from the scientific community.

Dr. Atkins loved food. Forty years before his death, he had been overweight and always on the lookout for the diet which would help him get rid of his excess weight in a feasible way. He found the basic principle behind the method that was later to become known as the Atkins diet (Atkins himself preferred to call it a diet program) in a medical journal. The method caught his interest because it was so radically different from any other diet he had encountered. It was based on avoiding most carbohydrates - including certain fruits and vegetables - and avoiding sugar completely . However, proteins and fats were not limited at all .

Dr. Atkins very quickly lost weight on this diet. He was so at ease while doing it that he found it natural to test the method on some of his overweight patients. When the patients also lost weight quickly and unproblematically, he realized that this diet method was special. The new and revolutionary thing to him was the possibility of losing weight and being satisfied at the same time.

Anyone can lose weight
The fact is that no matter which food you choose to eat and no matter which blood type or metabolic type you have, you will inevitably lose weight if your intake of calories is sufficiently low. The process of losing weight, however, can become quite a protracted curse if you are not capable of mobilizing the necessary will-power; particularly if you want to be able to function through pangs of hunger. Usually, the lost weight returns once the diet is completed because the body reacts to large weight loss by increasing appetite and lowering the metabolism. Sometimes you return to your old pattern of life which caused you to be overweight in the first place.

Your body gets its energy from the proteins (e.g. meat, fish, eggs, beans, lentils), carbohydrates (e.g. bread, potatoes, rice, pasta, fruits, sugar), and fats (e.g. fat, butter, margarine, cream, oils, cheese) in your diet. In the intestines, these nutrients are broken down into amino acids, various saccharides including glucose and glycerol, and fatty acids. The satisfying effect of these nutrients is very different. In general,

  • Protein is a very satisfying nutrient.
  • Carbohydrates are satisfying nutrients of medium quality.
  • Fat is a poorly satisfying nutrient.

From this, it is obvious that the high protein content of the Atkins programme has a high satisfying effect, but the book might give the impression that Atkins regarded fat to be more of a satisfying nutrient than it really is.

In conventional diets, low-fat, and carbohydrate-rich food is supposed to promote a weight loss. The focus is on proteins and carbohydrates only containing 4 calories (17 kJ) per gram and fats containing as much as 9 calories (38 kJ) per gram. It would seem, therefore, that calorie-wise, the most drastic effects should be obtained from cutting down on fat. This also applies for alcohol which also contains many calories per gram.

Ketosis
Atkins had several explanations why his diet program works. One of them is ketosis. This is a condition that occurs when the body has been supplied with so few carbohydrates that it is forced into burning fat - including the body's fat deposits. Normally, if there is not enough protein in the diet either, the body will start breaking down the muscles. However, this is not what happens in the Atkins diet. When fats are burned, a biproduct called ketones are made. Some of these ketones are excreted through sweat and breath and can be recognized by their acetone smell. Other ketones are excreted through the urine and a simple test will be able to confirm their appearance here, e.g. by means of a so-called dipstick.

In his book, Atkins emphasizes that this ketosis is a harmless condition that should not be confused with diabetic ketoacidosis. For the same reason, in the latest edition of his book, he preferred to refer to ketosis as lipolysis (fat dissolution). Diabetic ketoacidosis, however, is a serious condition in which a diabetic person has consumed too many carbohydrates and therefore has a very high blood sugar level because of the lack of insulin to transport the sugar into the cells. The lack of insulin results in an accumulation of ketones in the blood.

Food is differently broken down
There is another explanation of the efficiency of the diet. This is based on the fact that the ways in which the body breaks down these basic elements into energy are different. The transformation of protein and fat into energy is a complicated chemical process while the transformation of carbohydrates into energy can be carried out in a few simple chemical reactions. In other words, according to Atkins, burning fat requires more calories than burning carbohydrates.

The glycemic index
The glycemic index is a number reflecting how fast glucose enters the blood after eating a particular food item - i.e. it reflects how rapidly the blood sugar level increases. However, the index does not say anything about how many calories a particular food item contains. Glucose has an index of 100 and therefore belongs to the top of high glycemic food items. Atkins also includes baked potatoes and breakfast cereals in the high glycemic food group. High glycemic food makes the blood sugar rapidly increase with the risk of creating a blood sugar that fluctuates too much during the day, resulting in biochemical chaos - an initial stage of many health problems. On the other hand, e.g. lentils and beans make the blood sugar increase very slowly after consumtion and also enable it decrease slowly. They have an index below 30 and are therefore called low glycemic food items. Atkins recommends that people eat low glycemic food with high content of antioxidants.

The importance of insulin to our health
Insulin is a hormone that transports glucose into the body's cells where it is used to create energy. Once the energy demands are met, the liver transforms the excess glucose into glycogen (stored sugar). When the glycogen deposits have been filled, the liver transforms the rest of the glucose into body fat. Consuming many carbohydrates can over-stimulate the production of insulin. If this persists for many years, the result can be so-called hyperinsulinism; which causes losing weight to become difficult and which also predisposes to cardiovascular diseases, cholesterol imbalances, and increased risk of breast cancer and polycystic ovaries.
Four phases
The Atkins programme is divided into four phases. The first phase - the most restrictive one - is called "Induction" and should last for at least 14 days. Here, you are only allowed to eat 20 g. of carbohydrates a day in order to make your body get into ketosis. An instructive carbohydrate table is included in the book to make this easier.

The second phase, which is less restrictive, is called "Ongoing Weight Loss". Here, you can eat more carbohydrates and the selection of allowed food items naturally increases. For every week, you increase your consumption of carbohydrates with 5 grams a day until you reach a point where you stop losing weight. In this way, you will find your own so-called "Critical Carbohydrate Level for Maintenance".

The third phase is called "Pre-maintenance" and is designed to further reduce your weight loss as you get accustomed to a more sustained diet plan so that you do not gain your lost weight again. This is also the period in which you find out how many carbohydrates you are allowed to eat while still maintaining your weight. The method is the same as in phase two but now you increase your daily carbohydrate consumption by 10 grams a week.

The fourth and last phase is - not surprisingly - called "Lifetime Maintenance". When moving onto this phase you will have reached your ideal weight and begun to tune into a lifestyle and make food choices that will maintain your weight at the present level.

Critique of Atkins
Two of Dr. Atkins' greatest achievements are that he removed many peoples extreme fear of fat and that he emphasized how important it is to limit the consumption of simple carbohydrates for being able to control your blood sugar and the health problems - e.g. overweight - that might result. With his diet program, Dr. Atkins helped many overweight people to get rid of their constant craving for sugar and simple carbohydrates, and he helped them to achieve success and self-confidence through finally reaching their ideal weight after years of failed diets.

In spite of this, his programme has been and still is massively criticized. The criticism is targeted, for example, at the difficulties implied in carrying out the programme in everyday life. Perhaps it is easier in the US where companies have actually specialized in a large selection of food with a low content of carbohydrates. Particularly, vegetarians have a hard time following the Atkins diet because they find the programme boring and, at worst, impracticable. Moreover, critics have presented a number of points which have primarily questioned sustained use of the Atkins diet being beneficial to your health - this is for example based upon:

  • The Atkins diet not containing any vegetables.
  • Large amounts of fat resulting in cholesterol problems and increased triglycerid levels.
  • Large amounts of protein acidifying the body causing osteoporosis and kidney problems.
  • Ketosis causing headache, myasthenia, and myospasms.
  • A lack of dietary fibres resulting in constipation.

Atkins replies to these and other points of criticism in his book. However, his views on a number of issues are outlined below.

Atkins on fruit and vegetables
Vegetables primarily belong to the carbohydrate group of foods. However, the Atkins diet neither renounces fruits nor vegetables. According to which phase you are in, you should just choose the low glycemic fruits and vegetables; i.e. the ones with the most complex carbohydrates.

Atkins on fatty food
Atkins advises against making a low-fat version of his programme. He argues that this will inhibit the conbustion of fat, but he also advises against using poor fats such as transfat. Studies show that cholesterol numbers and triglycerid levels are actually improved on the Atkins diet.

Atkins on meat
Meat is full of (animal) proteins and consumption of large amounts of meat has been linked with the development of osteoporosis. However, a study from 2002 that was published in the American Journal of Clinical Nutrition showed that elderly people who got sufficient amounts of calcium and vitamin D did not suffer from osteoporosis despite consuming large amounts of protein.
Atkins rejects the link between kidney problems and a high protein intake as being unsubstantiated unless there is already an advanced progression of kidney disease. As an addition to this can be mentioned that kidney problems are primarily linked to a lack of magnesium and vitamin B6.

Atkins on exercise
Daily exercise is part of the Atkins programme. There are good exercise tips in the book.

Atkins on dietary supplements
Dr. Atkins realized that dietary supplements are beneficial to modern man and advised people to take a dietary supplement when following his diet. This need is not solely based on farm land lacking vital minerals or by the fact that we are all exposed to a varying degree of pollution and environmental toxins. Even though we are healthy and eat a varied diet, the right dietary supplements provide us with a number of important antioxidants which can prolong our lives by protecting the body against the damaging effect of free radicals. In a state of ketosis, the body needs extra minerals - just as the need for the amino acids cysteine and taurine is increased. To resist acute cravings for sugar, Atkins recommends 500 mg. of the amino acid L-Glutamine before every meal.

Basic 3
Atkins' book proposes a daily supplement of vitamins, minerals, and herbal preparations of high quality and mentions the supplement Basic 3 made by his own company. 3 tablets of Basic 3 contain 11,500 I.U. of vitamin A and betacarotene, 360 mg vitamin C, 200 I.U. of vitamin D, 150 I.U. of vitamin E, 5 µg vitamin K, 25 mg vitamin B1, 25 mg vitamin B2, 20 mg. vitamin B3, 20 mg 60 mg vitamin B5, 25 mg vitamin B6, 600 µg folic acid, 50 mg PABA, 200 µg vitamin B12, 150 µg biotin, 250 mg calcium, 125 mg magnesium, 10 mg zinc, 50 µg selenium, 1 mg copper, 5 mg manganese, 200 µg boron, 300 µg chromium, 30 µg molybdenum, 10 mg potassium, 60 mg NAC, 50 mg Inositol, 50 mg citrus bioflavonoids, and 40 mg green tea.

VitaMax
Alternatively, you can take 4 tablets of VitaMax from Vitaviva and optionally supplement them with 200 µg chromium a day. 4 tablets contain 10,000 I.U. of vitamin A and betacarotene, 700 mg vitamin C, 250  I.U. of vitamin D, 200 I.U. of vitamin E, 35 µg vitamin K, 50 mg vitamin B1, 25 mg vitamin B2, 80 mg vitamin B3, 250 mg vitamin B5, 25 mg vitamin B6, 400 µg folic acid, 25 mg PABA, 50 µg vitamin B12, 150 µg biotin, 250 mg calcium, 250 mg magnesium, 15 mg zinc, 100 µg selenium, 1 mg copper, 7,5 mg manganese, 1000 µg boron, 100 µg chromium, 50 µg molybdenum, 49.5 mg potassium, 100 mg L-Cysteine/NAC, 50 mg Inositol, 50 mg citrus bioflavonoids, and 25 mg green tea extract.

We use different ways of losing weight
If we assume that the people who have not benefited from the Atkins diet have not used it incorrectly, then it is an obvious conclusion that not everyone should eat quite the same combination of food. Actually, this is also the theory that is reflected in the theories of the metabolic type and the blood type in which people are divided into different types based on the way they metabolize the various nutrients in food.

Comparing diet theories:

  • The protein type - thrives best on a distribution of 40% protein, and only few (30%) carbohydrates, and 30% fat. This type resembles type 0 in the blood type theory and should respond well to the Atkins diet programme.
  • The carbohydrate type - thrives best on a diet rich in carbohydrates (60%), a medium amount of proteins (25%), and only a little fat (15%). This type resembles type A in the blood type theory and probably responds poorly to the Atkins diet programme.
  • The mixed type - thrives best on an equal distribution of carbohydrates (50%) and proteins and fats combined, i.e. 30% and 20%, respectively. This type resembles type B in the blood type theory and should also be able to achieve good results with the Atkins diet.

Conclusions
Actually, the Atkins diet is very instructively explained and more complex than you might assume if you have not read the book. You do not have to count calories - instead, you count carbohydrates. It is not impossible for a diet programme to be effective just because the explanation of its mode of operation has still to be elucidated, and the Atkins diet has proved to be effective on numerous occasions. There are quite a number of pitfalls to avoid in the programme, and in his book, Atkins points out that certain knowledge of the long-term health consequences are lacking. Besides, experience shows that the Atkins diet is not suited for everyone.


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References
Dr. Atkins' New Diet Revolution, Harpercollins 2002, ISBN 0060081597.

Dawson-Hughes B, Harris SS. American Journal of Clinical Nutrition, Calcium intake influences the association of protein intake with rates of bone loss in elderly men and women. Am J Clin Nutr 2002 75: 773-779.

Peter D´Adamo Eat right for your type. GP Putnam's Sons 1996. ISBN: 039914255X.

William Wolcott, Trish Fahey. The Metabolic Typing Diet. Broadway Books 2000. ISBN 0-7679-0564-4.