WEIGHT MANAGEMENT: ATKINS DIET

The Atkins diet is essentially a low-carbohydrate, high-fat, high-protein diet. Dr Robert Atkins caused controversy, made headlines and aroused public interest up until his tragic death from a head injury in April 2003 aged 70. His revolutionary views caused feelings to run high among nutritionists, clinicians and most of all obese and overweight people the world over. His suggestion that carbohydrates should be reduced as part of dietary treatment for overweight and obesity is as old as the hills. In 1864, William Banting, in his Letter on Corpulence, told his followers to 'reduce farinaceous foods'. Foods such as bread, pasta, potatoes, cereals, sugars and fruits, and usually alcohol, are restricted in favour of protein and fat. The concept is that reduced carbohydrate lessens the burden on the body's insulin supplies, thus reducing insulin resistance. But the thought of having a deliberately high-fat diet, with lashings of butter, fried food and fatty meats, has set alarm bells ringing among the established medical hierarchy. The American Heart Association issued a position statement saying that high-fat diets would cause disruption of normal lipid metabolism, high triglycerides and LDL;

High-protein, low-carbohydrate diets put people at risk for heart disease. The saturated fat and cholesterol content of the diet will raise the bad cholesterol and increase the risk for cardiovascular disease, particularly heart attacks.

It pointed the finger particularly at people who stopped losing weight on the diet but continued the high-fat intake. But Dr Atkins disagreed, issuing a reply based on several recent studies indicating that high triglycerides and low HDL were linked to high carbohydrate diet and that because of the increased bodily fat metabolism in his diet, the HDL: LDL ratio can improve significantly. His critics responded by saying that there is generally an improvement in lipid profile with weight loss but that it is still unhealthy to eat large quantities of saturated fat. The nutritionists for the Atkins diet do, however, recommend 'healthy fats' and encourage such foods as oily fish, as well as vitamin supplementation.

The American Dietetic Association publicly stated its concern about high levels of protein affecting the kidneys and liver; studies have also shown a link with renal colic, but once again Dr Atkins denied the link.

Various experts have expressed their worries about the diet, saying that no long-term studies have been undertaken, primarily because of the recent rise to popularity of the system. The diet has been said to be physiologically unsustainable because the body becomes ketotic as a result of fat metabolism leading to acetone as the end product, which leads to raised pulse and respiration, as well as bad breath. But, once again, long-term evidence of these effects is lacking.

Another major criticism of the diet is that it is becoming increasingly clear that fruit and vegetables are protective of good health (and hence they are being promoted in schools and supermarkets), which leads to concern about the massive reduction of these foods in low-carbohydrate diets.

The main resistance to the Atkins diet, however, is the likelihood that weight loss will turn out to be only temporary. Carbohydrate, stored as glycogen in the liver, is bound with fluid. When this store is depleted, much of the weight lost is water, which is rapidly regained when a person finishes the Atkins plan and eats carbohydrate again. Weight maintenance after weight loss is therefore a potential problem for low carbohydrate devotees, although this is addressed in the plan.

Currently, it seems that there is no definitive answer as to whether or not low-carbohydrate diets are safe or effective; there appears to be evidence on both sides. However, it is certainly true that some patients do rapidly lose significant amounts of weight on the Atkins diet, and some appear to be able to maintain considerable weight loss. There is considerable scepticism and suspicion surrounding low-carbohydrate diets, and certainly no consensus as to their value in long-term weight management. They are undeniably popular but should be approached with caution.

Apart the reservations that many clinicians have about the diet, there are problems from the patient's perspective in sticking to the regime. It seems that the range of foods, and therefore tastes and flavours, is somewhat limited, leaving the dieter bored and unsatisfied, although never hungry. A unremitting, unlimited intake of steak after steak, bacon, sausage, egg, cheese, and so on can become monotonous without the variety introduced by carbohydrate, and does result in patients abandoning the regime for the sake of a piece of forbidden fruit! The diet lacks calcium and fibre, causes constipation and can be expensive.

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WEIGHT LOSS/BODY-BUILDING