OPINIONS

Dr."F-ATkins"
and Low-Carb Diets

By Prof. Talaat I. Farag

 

Controversy Arises Over Dr. Atkins' Diet Empire

Dr. Robert Atkins (1931-2003), who is best known for an immensely popular diet named after him, encouraged dieters to cut down on their intake of carbohydrates in favor of proteins. Atkins weighed 117kgs (258 lbs) before his death from head injuries caused by a slip and fall on an icy New York pavement in April 2003. The Wall Street Journal ran an article about his condition and cited that Atkins was obese since his height was 183cm and had a body mass index over 31. However, an autopsy was not done and his body was cremated. The pioneer physician of the controversial diet that bears his name since 1972 was clinically overweight at the time of his death though he followed his own diet for 39 years. Dr. Atkins became a best-selling author when he published “Dr. Atkins’ New Diet Revolution,” which advocated meat, eggs and cheese and discouraged bread, rice and fruit. His books sold 15 million copies and attracted 20 million followers who have tried his low-carb regimen within the past year alone. His Atkins' food-related products are worth US$1 billion per year.

If Dr. Robert Atkins, founder and medical director of the Atkins Center for Complementary Medicine in New York and the creator of the high-protein, low-carb "Atkins Diet," may have had obesity, hypertension, and congestive heart failure when he died, debate will flare over his famous diet although conflicting hospital reports showed that his weight was registered at 88.5kgs when he was hospitalized in April.


Viral Cardiomyopathy vs Hypertensive Congestive Heart Failure?

The medical examiner’s report also noted that Atkins had a history of heart trouble, including congestive heart failure and high blood pressure. Dr. Trager explained that Dr. Atkins’s heart troubles had been previously known publicly, and the council asserted that they were a result of cardiomyopathy, or an enlarged heart, which it said stemmed from a viral infection, not the diet. Trager said Atkins weighed 195 pounds when he was admitted after slipping on an icy street and hitting his head. Physicians for Responsible Medicine, the group that released the report and promote a vegetarian diet, acknowledged that fluid retention may have been responsible for some of Atkins’ weight gain, but probably not all of it. The group maintains that the Atkins diet poses weight and health risks to the millions who follow it. In April 2002, a year before he died, Atkins issued a statement saying he was recovering from cardiac arrest related to a heart infection he had suffered from “for a few years.” He said it was “in no way related to diet.”

For years nutrition experts and doctors have debated the Atkins diet, which allows up to two-thirds of all calories from fat, or more than double the usual recommendation. Atkins argued that carbohydrates generate too much insulin, which makes people hungrier and encourages them to put on fat. When Atkins’ book was first published in 1972, the medical mainstream was promoting a low-fat, high-carbohydrate diet. The American Medical Association labeled the Atkins’ diet “potentially dangerous” and Congress summoned him to Capitol Hill to defend the plan. The Atkins diet recently gained renewed popularity after studies showed that people lost weight without compromising their health. The studies showed that Atkins dieters’ cardiovascular risk factors and overall cholesterol readings changed for the better.


Conspiracy Theorists and Dr."F-ATkins"!

Conspiracy theorists want to attribute his condition to his fat-skewed diet, and speculated that his heart, not his feet, caused the fall to the ice. However, upon revelations of the late guru's health, those who opposed Atkins' diet, rushed to refer to him as "Dr. F-ATkins". On discussions of his physical state before death, some chose to claim that Dr. Atkins was overweight and not obese. His widow, Mrs. Veronica, became furious that this data surfaced in the Wall Street Journal. She said that, “I have been assured by my husband’s physicians that his health problems late in life were completely unrelated to his diet or any diet.” 

Dr. Stuart Trager, chairman of the Atkins’s Physicians Council, a New York group affiliated with the Atkins’s diet empire, maintained that the carbohydrate shunning doctor gained more than 60 lbs due to fluid retention in the 8 days he spent in a coma before his death. Other doctors acknowledged that fluid retention might have been responsible for some of his weight gain, but not all of it. “Critically ill patients, when sustained on fluids in the hospital, gain weight,” said the Atkins Physicians Council. “He was grossly swollen, so much so that his family and associates barely recognized him.” On the other hand, Dr. Daniel Fisher, a distinguished cardiologist, confirmed that Atkins' heart failure could have been caused by a virus, but said it would be difficult to rule out diet as a factor until more information is revealed about his death.

What is a Healthy Diet?

We have to sort facts from fiction when we are looking for healthy diets for ourselves and family members. Some believe that by eating less fat and salt and more fiber, they can stay healthy and trim but nutrition is an evolving science. Today we speak of trans-fats, omega-3 fats, soluble and insoluble fibers, phytochemicals, low and high glycemic-index carbohydrates, etc.  Interestingly a new survey showed that one in every nine adults in North America is currently on a low-carb regimen like the Atkins' or South Beach diets, with the potential for that number to double in the next two years. The South Beach Diet, which was developed by Dr. Arthur Agatston is based on avoiding the bad carbs, like white flour, white sugar, baked potatoes, carrots, bananas and pineapples while allowing more fruits, vegetables and dairy products. This diet has produced consistently dramatic results (8 to 13 pounds lost in the first 2 weeks) and has become a media sensation in South Florida.

In the anti-carbohydrate era, there is a need to know that not all carbs are bad for us say today's scientists and nutritionists. Carbohydrates are not the monolithic evil they are made out to be: there are good carbs (breakdown slowly in the body and produce a steady source of energy) and bad carbs. Australia today has become the first country in the world to routinely label food products based on their glycemic-index. Foods are labeled as "low-GI" and "high-GI". The index is a measure of the speed at which food is digested and converted into glucose. The lower the GI of a food, the better the carbohydrate food is, especially if it is also low in fat or added sugar, high in fiber and low in salt. Based on this measure, people are advised to cut down on their consumption of white breads and replace them with whole grains. Based on this diet, some of the other food carbohydrates to eat are pasta, beans, lentils, chick peas, oats, and fresh fruits. For more information about this type of diet visit www.GItesting.com and www.GIsymbol.com. The glycemic-index is the underlying rationale for limiting carbs in popular diets like Atkins', South Beach, The Zone, and Sugar Busters. No one claims that the GI is the magic formula for overturning the obesity epidemic in North America around, but it is helpful to understand why many weight control methods have failed. 

Low-Carb vs. Low-Fat

Today there is a growing debate on whether low-carb diets like Atkins' and South Beach result in greater weight loss than traditional low-fat diets, but by one year results the outcomes are about the same for each regimen. Dr. Walter Willett, Chairman of the department of nutrition at Harvard University and author of Eat, Drink and Be Healthy, is a proponent of a Mediterranean style diet, rich in fresh fruits, vegetables, fish and nuts. He believed people should consume healthy fats and healthy carbs, and avoid refined sugars, flours, and other processed foods. Some have tried the three low-fat diets: grapefruit diet, oat bran diet, and the slim-fast plan.

Low-Carbohydrate Diets and Birth Defects

In Canada, all white flour, white pasta, and corn meal have been fortified with folic acid since 1998 leading to a drop in the number of babies with neural tube defects. People following low-carbohydrate regimens like Atkins' Diet, could trigger a sharp recurrence in these birth defects since they avoid white bread, pasta, breakfast cereals and orange juice - key sources of the folic acid vitamin, needed for the healthy neurological development of fetuses. Many Canadians get their folic acid from white bread, breakfast cereals, pasta made with fortified flour and from orange juice.

Despite the debates surrounding Dr. Atkins' final days and diet, he will always be remembered as a pioneer physician who was interested in promoting dietetic counseling, health education and preventive medicine.

Some of Dr. Atkins's Books

Further Reading

A most recent book dealing with weight loss and its recipes was released in May 2004 entitled The Ultimate Weight Solution Cookbook : Recipes for Weight Loss Freedom written by Phil McGraw and published by Free Press.

Prof. Talaat I. Farag, MD,FRCP,FACP,FACMG is a community geneticist and syndromologist. He is the founder of The Ambassadors Research Foundation in 1998. Email: drfarag@ambassadors.net


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