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 | look at the latest in low-carb marketing and research and some
very persuasive last words from the mouth of Dr. Atkins. |
(If you want to understand why the Atkins diet works, read the section 'Dr. Atkins, in his own words' at the end of this article.) |
In the past months, it's been hard to open a magazine or newspaper without being confronted with an Atkins related article. The post mortem Atkins seems to be bigger than he was in life, almost literally and metaphorically. Fahrenheit 2004 is the temperature at which truth burns and with so much money at stake and so many special interests and spin-doctors at work, the controversy has been hot and truth has been hard to pin down.
I suspect we'll never be sure of the answers to some of the following questions. Did Dr. Atkins slip and fall on the ice and hit his head, leading to a coma and death, or did he have another heart attack, which caused the fall? (He was known to have suffered a cardiac arrest in 2002). Was his cardiac condition the result of a viral infection, as the Atkins group asserts, or could it have been partly a result of his diet and lifestyle? Did the good doctor actually gain over 60 lbs. during the 8 days he was admitted to hospital and his death, thus elevating his weight classification from merely overweight to obese? We'll probably never know the answers to these questions because, somewhat surprisingly, no autopsy was performed.
Of course, none of this would matter were it not for the fact that there is a potential 25 billion dollar business in low carb living, and the untimely death of its figurehead from cardio-vascular complications would not be what the spin doctor ordered.
These are not mean-spirited and petty observations but rather they are illustrations of how hard it is to find the simple truth where big bucks are involved and how easy it is to become cynical.
Diets and their followers
Diets can be like cults, and cults often rise and fall with the publicity about the life and death of their leader or guru. The anti-cancer diets of Nathan Pritikin and Adelle Davis lost some credibility when Ms. Davis died of cancer and Dr. Pritikin committed suicide after being diagnosed with cancer. The low carb/high protein diet of Dr. Irwin Stillman 'The Doctor's Quick Weight Loss Diet' went out of fashion when Dr. Stillman died of a heart attack. This book was actually ghost written by Samm Sinclair Baker, who also co-wrote 'The Scarsdale Diet' with Dr. Herman Tarnover, who was shot to death by his headmistress mistress. (Although we can't blame this on the diet). Sales of Suzanne Somers ThighMaster and diet books were not helped when she was pictured leaving a liposuction clinic. So it's understandable that the low-carb industry does not want us associating Dr. Atkin's death with a heart condition.
I've noted previously in 'Well' that most people really haven't read the 500 plus pictureless pages of 'Dr. Atkins New Diet Revolution', so that much of what is talked and written about Atkins does not come from a clear understanding of his diet. To prove my point, I created an informal Atkins quiz, which I gave to 10 people who had either been on the diet or who felt they were familiar with it.
Quiz
- "If you're not eating vegetables, you're not on the Atkins diet' True or False?
Answer: True
Responses: 4 T 6 F
- Dr. Atkins said that if you followed his diet you didn't need vitamin supplements and he did not recommend them.
Answer: False
Responses: 5 T 5 F
- How many phases in the complete Atkins Diet?
Answer: 4
Responses: 1 Don't know 3 Two stages 2 Three stages 4 Four stages
- Name as many phases (or levels) as you can in the Atkins Diet.
Answer: 1. Induction
2. OWL (Ongoing Weight Loss)
3. Pre-maintenance
4. Lifetime Maintenance
Responses: Only one person could name the 4 correctly.
- Are you likely to go into ketosis if you follow the Atkins diet?
Answer: Yes, particularly in the induction phase.
Responses: 7 Yes 2 Don't know 1 No
- Dr. Atkins says, "If you are not exercising you are not on the Atkins Diet." True or False
Answer: True
Responses: 4 True 6 False
- What artificial sweetener does Dr. Atkins recommend?
Answer: Sucralose marketed as Splenda
Responses: 1 Splenda 7 incorrect or "don't know' 2 "He doesn't believe in artificial sweeteners".
- What is the "metabolic advantage" that Atkins claims for his diet?
Answer: Atkins simple answer is that burning fat takes more calories than burning carbohydrates and that the 'calorie is a calorie' thinking is wrong.
Responses: 6/7 people were on the right track in answering this one.
Overall, as I suspected, half the people didn't really know what they were talking about.
The 'Metabolic Advantage" Question
When you set aside all the do's and don'ts and packaging and presentation, the 25 billion dollar question remains, 'Does the Atkins Diet, or ones just like it, confer a 'metabolic advantage' over the many low fat diets?' Atkins has always maintained that this is the case, basing his original thinking on two modest studies by Kekwick and Pawan reported in the Lancet July 28, 1956. (I reviewed those studies in detail in the Fall 2002 edition of 'Well' in 'The Great Diet Debate') However, much to the discomfort of many of the nutrition establishment, most recent research seems to suggest that Dr. Atkins has a strong case. Last year, a Harvard School of Public Health study was released in which the scientists worked with the chefs at the Ristorante Marino in Cambridge, Mass. to provide some meticulously crafted menus, which included dinner, a snack, breakfast and lunch. Reporting on the study Ann Brocklehurst writes,
"The 21 participants were divided into a low-fat group, whose members lost 17 lb. on average, a low-carb group that ate the same number of calories and lost 23 lb., and a third group on a low-carb plan that got 300 more calories than everyone else and lost 20 lb. The counterintuitive results contradict the idea that the best way to lose pounds is to eat fewer calories, and support Atkins' metabolic-advantage theory and the idea that it takes more energy to digest certain foods.
Matching Caloric Intake |
|
|
Extra 300 Calories |
|
Low Fat | Low Carb | Low Carb |
Weight Loss | 17 lbs. | 23 lbs. | 20 lbs. |
The Harvard study, designed as a pilot for a much larger study still to come, was too small to be statistically conclusive. It was led by the new guard in the diet wars, researchers with reputations to make, and was attacked, using familiar criticisms, by the old guard, who not only have reputations to lose, but an entire belief system. First off, the critics accused the poorer-performing dieters of cheating, a standard charge that's easy to make since diet studies rely on the honour system, and it's impossible to prove that some dieters aren't secretly scoffing down Snickers bars. The critics also accused the Harvard participants of violating the first law of thermodynamics, which states that energy -- in this case calories -- can neither be created nor destroyed. But the obvious alternative explanation is simply that the conventional wisdom about nutrition is wrong.
Although a very small minority of nutritionists concede that the calorie theory needs refining, the majority can't give up their faith in low fat. They point to numerous peer-reviewed scientific studies that demonstrate people who follow low-fat diets lose weight. But what remains to be proven is whether low-fat diets work better or worse than low-carb alternatives. With definitive diet studies still to come, however, the public has chosen not to wait around and get fatter. It's ignoring the dire warnings of nutritionists and opting for low carb."
Two studies were published last year in the New England Journal of Medicine and both showed that participants lost more weight on the Atkins Diet than a matched group on a low fat diet. Not only did the Atkins followers lose more weight but, to the surprise of the researchers, improved key factors associated with coronary artery disease. As previously reported in the Spring 'Well' 2003 (Walking Thoughts - sub-section Dr. Atkins), Dr. Gary Foster, who is clinical director of the Weight and Eating Disorders Program at the University of Pennsylvania, and his co-researchers compared an Atkins diet group to a group on a low-fat/high complex-carb diet. After 3 months the Atkins group lost twice as much weight and some of their major coronary risk factors improved.
| Atkins group | Low Fat Group |
LDL
(Bad cholesterol) | 7 points higher | 2 points lower |
HDL
(Good cholesterol) | 12 points higher | unchanged |
Triglycerides | 22 points lower | unchanged |
It would have been better to see the LDL's go down, but the increase in HDL's and big decrease in triglycerides is impressive. Dr. Foster said, "It was very surprising, I went into this skeptical about the claims that the Atkins Diet was safe and now I'm much more open-minded." He has now embarked on a major 5-year low carb study.
In the second study, at the Philadelphia Veterans Affairs Medical Center, subjects started weighing an average of 288 pounds. One group was told to limit carbohydrates to 30 grams a day. The other was told to eat 500 calories a day less than the quantity necessary to maintain their starting weights and to limit fat to 30 percent of calories.
After six months, the low-carbohydrate dieters lost an average of 13 pounds. The low-fat dieters lost four. Fifty-three of the 132 people quit before the six-month period.
These results are not definitive and not statistically significant, but they are not what the experts expected to find and go a long way to explaining why the New York Times best sellers list looks the way it does, with the low carb South Beach Diet leading the way in hard cover sales (over 5 million) and Dr. Atkins New Diet Revolution still leading paperback sales after nearly 7 years, and the Atkins Essentials not far behind.
Many physicians who've long preached low fat diets to their overweight patients are now turning to Atkins to deal with their own weight problems. Two leading cardiologists in my home town could both be poster boys for sustained weight loss on Atkins.
High Profits from Low Carbs.
Big business is not waiting for the definitive research study, if indeed such a thing will ever exist. They have jumped on the low carb gravy train (or perhaps non-gravy train) as a way of boosting sales to weight conscious North Americans. Writing in the New York Times, Kate Zernike and Marian Burros reported.
"Last month, representatives of 450 companies, including Kraft, Con-Agra and WalMart, gathered at a two day Low-Carb Summit in Denver to discuss how to take advantage of what analysts predict will be a $25 billion market for everything from low-carb pasta to low-carb European barge cruises and low carb marshmallows to hotel "get a-weighs."
In Southern California, two entrepreneurs (and Atkins dieters) last month opened the first two in a chain of low-carb supermarkets called 'Pure Foods', and individual low-carb markets are opening nationwide, while in Canada the 'Low Carb Centers' are doing brisk business. In January, a new magazine called 'LowCarb Living' hit newsstands."
The "Atkins approved" symbol is ubiquitous and is showing up at places we don't always associate with weight loss. Here's a few of the companies I've seen in recent days who are proffering low-carb choices:
McDonalds
Morning Start
Burger King
TGI Fridays
Pure Foods
Kraft
Nestle
Heinz
Weston Bakeries
Panago Pizza
*For a delightful article on low carb communion wafers see the Grins section of this issue.
Even the breweries are involved with Molson's selling low-carb Molson Ultra, while Sleeman's offers Clear Beer and Labatt's, Sterling Beer, all to help us lose weight and drink ourselves thin.
Health Canada is already moving to try and bring some consistency and meaning to low carb labeling. One term that's starting to show up is 'net carbs'. Net carbs exclude carbohydrates that come from fiber and sugar alcohols, with the lower tally supposedly reflecting only those carbohydrates that elevate blood sugar. Meanwhile, names like 'Carb Wise', 'Carb Conscious', 'Carb Smart', 'Carbolite' and 'Atkins Friendly' are everywhere on your grocery store shelves.
The old conventional wisdom was that low carb dieters couldn't eat bread, pasta, cake, cookies or candy. But the new improved decarbonated wisdom is that low carb dieters can eat almost any food, as long as they buy higher priced, low carb versions.
Dr. Atkins was astute in designing a diet that is psychologically appealing. The Induction phase of the diet really jump-starts weight loss, reinforcing people's immediate desires. Our taste buds respond to fat and Atkins dieters can indulge in a variety of fatty treats. By cutting out most carbohydrates, he eliminates the food group, which accounts for the largest proportion of our caloric intake.
The Atkins spokespeople such as seminar leader Colette Heimonitz have been quietly preaching moderation and a little revisionism to Atkins followers.
The diet remains high fat but the new word is that more of that fat should be unsaturated, the kind that comes from fish and selected vegetable oils rather than just bacon, cheese, steaks and butter. In the words of Dr. Atkins in 'Atkins for Life', "You should always eat a balance of different types of natural fat."
It's interesting that despite all the low carb publicity and the possibility of a 'metabolic advantage' and the sales of millions of books, the huge majority of people on the National Weight Control Registry lose weight the old fashioned way. The National Weight Control Registry, which follows over 3000 people who have lost at least 30 lbs (average over 71 lbs) and have kept it off for 6 years, has found some commonalities among people who successfully lose weight, and, more importantly, keep it off.
- Breakfast in the morning. (Don't leave home without it.)
- Regular exercise
- Plenty of fruits and vegetables. (complex carbs)
- Regular weigh-ins. (Don't kid yourself)
For people in search of a nutritional loophole, things like breakfast, regular exercise and fruit and vegetables have very little appeal despite the fact that they can be the foundation of long-term weight control and healthy living.
Meanwhile, the dueling diet doctors pronounce their new theories and denounce opposing points of view and the public gets ever more confused. The recent American College of Preventative Medicine conference is typical. Lisa Sanders, M.D. from the Yale Preventative Medicine Research Center said, "I think Atkins has got something" and went on to say physicians should not summarily dismiss low carb diets. At the same conference, a colleague from the same Research Center at Yale, David Katz, M.D., said that low carb diets such as Atkins are "so utterly wrong as to be insane."
The real insanity of course is people who don't exercise, eat huge quantities of processed food, smoke, live stress-filled lives, and then look for a pharmacological or medical solution for their unsustainable lifestyle.
"There's only one guru can help you win
And she's walking around inside your skin.
You are the trainer, the dietician is you
You're the psychologist, you're the guru."
I enjoyed the following article by Richard Cohen, which brought a little humor into the serious business of losing weight. As Monty Python and Don Ardell never tire of reminding us, "Always look on the bright side of life."
When Faith is Toast.
by Richard Cohen
Near where I live is a marvelous bakery. Sometimes I stand outside the window, like some forlorn figure from Dickens, and watch people eat their bread, lathering it with butter or jelly or -- someone stop me! -- cream cheese on a toasted anything. I love bread more than almost anything in the world, but I will not have it, cannot have it, have not had it -- all on account of Robert Atkins, who died last year at the age of 72, weighing 258 pounds. For years, I've been on his diet.
 
My story is that I've been on something like the Atkins diet for years. I say "something like" since I never actually read his diet book or consulted a doctor of any kind. I simply listened to what my friends were saying and cut out bread and pasta and started eating meat. It worked. I lost weight.
[Martin's comment. "This is typical of the way in which many people approach the Atkins diet."]
Sure, I missed my bread. Sure, I missed my bagel in the morning. And sure, I missed my pasta, which I enjoyed at least once a day. It was tough to give all that up. But in exchange, I got to eat meat, which meant steak, which is what I was not supposed to eat until Dr. Atkins, blessed be he, came along and repealed all sorts of laws of nature or physics. I loved the guy.
I could have bacon. This was Atkins's greatest gift. Not only was bacon suddenly okay and not, as it had been before, the precursor of almost-instant death, but it was actually good for you. Every morning, I had three slices of delicious bacon. What a diet! On weekends, I sometimes had more than three slices, figuring that if three slices were good for me, six were even better, a virtual fountain of youth from which I could drink each morning of a very, very long life.
Now, all of that is being brought into question. A group of anti-Atkins guerrilla fighters, the Physicians Committee for Responsible Medicine, which advocates vegetarian diets, got hold of the New York City medical examiner's report on Atkins's death and went to town with it. They raised all sorts of questions: Why the heart condition? Why was he so obese? Did his diet contribute to his heart problems? In other words, could you really eat fat and lose weight at the same time -- and stay healthy? After all, 72 is not that old.
For me -- and countless others -- much depends on the answer to that question, and I'm not talking about diet and health. I'm talking instead about gullibility, about wanting to believe something so badly that common sense got shoved aside. (Bacon, indeed!) The Atkins diet made me into a believer. Here I was, all these years, the sort of person who laughed when some homophobe turned out to be gay or some cultural conservative was found in the hay with a 16-year-old. I scoffed at people who were always discovering that college sports were corrupt or that "fan" was just another word for sucker. Me? I floated above it all. I believed fully and without reservation in cynicism. Cynicism will never let you down.
And yet every morning, I did my little religious number from the church of Dr. Atkins. I had my bacon. It made no sense -- not to me, anyway -- but it gave me something I wanted, which happened to be the bacon. Later in the day, I could have my steak -- the fattier, the better -- and take solace from the sacrifice I was making by forswearing bread and pasta.
Now, I am experiencing a crisis of faith. Atkins is dead and his secret is out. He was fat and sick. I want to move on to a new diet, something with bread and pasta that also satisfies my newly reinforced cynicism.
All I need is someone to tell me it works. |
One of the goals of 'Well' is to help you look at wellness through 'new eyes' and to sometimes see familiar things in a different light. 'Well' also can bring you some depth, which is not always available in the speed-reading world of computers and popular magazines. Dr. Atkins can no longer respond to his critics, so we have given him the last word and some space to describe his diet and why it works.
Dr. Atkins in his own words
The following is a verbatim transcript of Dr. Atkins' presentation to the Millennium Lecture Series Symposium, "The Great Nutrition Debate", sponsored by the US Department of Agriculture in the year 2000. The presentation was accompanied by slides, most of which are unavailable to me, but I have included the ones I could find. Other presenters included John McDougall and Dean Ornish, who gave some insightful and often humorous responses to Dr. Atkins presentation. Dr. Ornish spoke last and opened with the comment that the "order of presentation was from the most unhealthful (Dr. Atkins) to the most healthful diet (the Ornish Diet)." But as the wheels of science and research grind away, it seems that there are some reasons behind the success of Dr. Atkins' diet.
Okay. I've got a lot to say and not a lot of time to say it, so I'm not going to be very sociable.
After analyzing virtually every scientific paper written on the low carbohydrate diet over the last 80 years, beginning with when it was first offered as a treatment for epilepsy, I am convinced that a diet low enough in carbohydrate to automatically convert our stored fat into the body's primary energy fuel is qualified at present to be considered the treatment of choice for obesity and related conditions such as diabetes, hypertension and atherosclerosis.
I know that to gain mainstream acceptance of this proposal I must first demonstrate that the nutritional program, which I believe can put an end to the lion's share of obesity right now, is both safe and effective over both the short and the long term, so in the brief time allotted let me do just that.
Stored fat is, after carbohydrate, the body's backup fuel system. The human body cannot store more than a two-day supply of carbohydrate. In the absence of dietary carbohydrate, fat becomes the primary fuel. It's next on the pecking order.
This metabolic changeover is supported by biochemical catalysts, which facilitate the steady burning of fat, producing more energy, increased well-being and a dramatic loss of appetite.
What are ketones? They are simply the energy fuels derived from our fat stores. Fat delivers energy via ketones, just as carbohydrate delivers energy by way of glucose. Enzymes are present within all our cells, including our brain cells, to convert ketones into useable fuel.
When ketones are used as fuel, the most consistent finding is a decrease in appetite. Insulin is not involved in ketone production. Thus, the consequences of elevated insulin, which are many - there are increases in triglycerides, in blood pressure, in adrenaline, in cortisol; all of these are avoided.
Obese individuals and people who are overweight are keto resistant. Pay attention to this term. What it means is that there will be no accumulation of ketones in the blood.
The best documentation of keto resistance was brought to us by two very important researchers, the department heads of London's Middlesex Hospital, Alan Keckwick and Gaston Pawan.
In their documentation they showed that obese subjects given the ketogenic diet that I'll tell you about momentarily produced a flat level of ketones rising from two milligrams to an average of four milligrams, never more than six, whereas the non-obese subjects had their ketones escalate rapidly.
This is one reason why overweight people will never have problems with ketosis, but ketosis is a negative catchword for many people. The only reason can possibly be that they're confusing it with diabetic ketoacidosis.
Look how diametrically opposed they are. Ketoacidosis occurs in Type I diabetes, meaning it occurs because of an insulin absence or an insulin deficiency. Benign ketosis is achieved in overweight subjects whose metabolism is characterized by the fact that they put out too much insulin.
Ketoacidosis is caused by an increased intake of carbohydrate, benign ketosis by a decreased intake of carbohydrate. There is, of course, acidosis in ketoacidosis, but in benign dietary ketosis the pH is normal. There is no acidosis. In ketoacidosis, patients are extremely symptomatic, and in ketosis the subjects describe an improvement in well-being. Now, that's pretty different. Don't let anybody confuse it ever again.
Much of the success of the low carbohydrate diet is that it is extremely effective for people with large appetites who enjoy eating, and these are the two main reasons why. First, hunger is eliminated. Hunger is not even allowed. Hunger is eliminated because the biochemical changes I will outline momentarily reduce the appetite.
Secondly, and this is something that bears emphasis. More weight is lost on low carbohydrate diets than on balanced diets identical in calories. This benefit is called "metabolic advantage". We're going to look at these two phenomena right now. First we'll look at the hunger aspect.
The guru of fasting as a weight loss system, Dr. Garfield Duncan, back in the 1960s when fasting was in vogue, he described a dramatic decrease in hunger after the second day of a fast. He attributed this to high levels of ketones. In his words, "In every case, there was a relationship between hyperketonemia and loss of appetite."
In 1963, Walter Lyons Bloom and Gordon Azar in Atlanta discovered that the same degree of ketosis could be achieved simply by eating protein and fat containing foods and eliminating carbohydrate. There was no need to fast. Instead of a fast, a meat and salad diet would do the trick. Therefore, carbohydrate restriction will suppress the appetite.
Bloom and Azar's paper convinced me to go on the only diet I've ever been on. That was 36 years ago, and I'm still counting, and I'm still on it, but here's the second point.
Is a calorie is a calorie is a calorie really true? This axiom that everyone repeats, is it really true? The truly significant breakthrough came from Keckwick and Pawan. After a series of animal experiments, including the discovery that rats on a low carbohydrate diet put out a fat mobilizing substance which, when injected into other animals, caused an automatic weight loss, they directed their attention to obese humans.
Two groundbreaking studies were published in 1956.
First, they studied 1,000 calorie diets, but it was a research study that they had done on rats, and this is what they did. There were diets 90 percent fat, 90 percent protein, 90 percent carbohydrate. They wanted to see the effect.
One thousand calories of 90 percent carbohydrate produced no weight loss. As a matter of fact, there was a slight weight gain. The 90 percent protein diet produced a weight loss between three and a half and four pounds in the week that people followed it. The 90 percent fat diet did even better. Between five and six pounds of weight were lost. That is a dramatic portrayal of how different foods can lead to different amounts of weight loss.
But, of course, there were all 1,000 calorie diets, and they wanted to look at diets with sufficient calories not to provide guaranteed weight loss.
So look at this one. Look at this one. For an average of eight days, six subjects were alternated between a 2,000 calorie balanced diet and a 2,600 low carbohydrate diet.
The 2,000 calorie balanced diet led to a one pound weight gain, as you see on this slide, whereas the 2,600 calorie low carbohydrate diet given to the very same subject -- it was a cross over study -- produced a three pound weight loss in the same amount of time. Keckwick and Pawan did water balanced studies, and it wasn't water.
The mathematics. A half a pound a day more weight loss is 1,750 calories of advantage plus the 600 in the extra food. This provided an edge totaling 2,350 calories per day. That means they demonstrated for the first time a phenomenon called metabolic advantage, a refutation of the calorie theory where diets of different compositions lead to disproportionate weight loss.
Keckwick and Pawan, despite their important academic position, were met with skepticism, but nine years later Dr. Fred Benwa and his colleagues at Oakland Naval Hospital furthered the concept. Their technology allowed them to measure body fat, and this is what they found.
They compared a total fast, which certainly was in vogue in those days, with a 1,000 calorie, ten grams -- very low -- carbohydrate diet for ten days. They found that the fasting took off 21 pounds, but only seven and a half of those pounds were fat. The other 14 were lean body mass.
The low carbohydrate diet, despite the extra 1,000 calories, took over 14 pounds, all but one-half pound of which was fat. Virtually none was lean body mass. Again it met with skepticism, but it was quite logical. In starvation, you will start to use your protein for fuel, but when ample fat and protein are included in the diet there will be no need to do so.
More skepticism and more studies. This time the professor of medical nutrition at Cornell, Dr. Charlotte Young, studied eight obese 23-year-old men, undergraduates at Cornell and graduate students at Cornell. They were all overweight, and she used an 1,800 calorie diet.
An 1,800 calorie diet of differing amounts of carbohydrate. One was 104, moderate low; one was 60, even lower; and the other was 30 grams of carbohydrate a day. She also did body fat estimations.
This is how much body fat they lost. Two pounds a week for the nine weeks on the 104 gram diet, two and a half pounds a week on the 60 gram diet, and 3.6 pounds per week on the 30 gram diet. This means that cutting down from 60 to 30 grams, from low to even lower, without cutting calories led to an increase ten and a half pounds of fat being lost in the nine weeks of the study.
I hope I've proven that the diet is effective, so now let's turn our attention to the safety. Over the years, I've heard myriad concerns, but very little in the way of observed complaints. In fact, in 1973 the AMA requested that its members be on the lookout for adverse effects from my diet and report them to AMA headquarters.
Three years later when we checked, despite the fact that millions had been on my diet, no examples of adverse reactions were in their files. None. Some complaints, by the way, that organs such as the kidneys or the liver are damaged by the diet must be dismissed immediately as being total inventions. Not a single case of kidney or liver damage was ever reported, even as an isolated case history.
The major issue then seems to be the speculation that it would be bad for the heart. I hope you agree that it's not the cholesterol and fat in the diet that leads to heart disease, but rather the cholesterol and fat in the blood. If so, we can review the changes in the lipid profile on low carbohydrate diets. They fall into a common pattern.
The total cholesterol usually drops a bit, and there is usually a tendency for the HDL to rise and the LDL to fall, much as a recent study out of Wilmington, Delaware on a modified low carbohydrate diet shows.
In this particular study, all the lipid variables moved in the right direction. You will notice that these people lost a lot of weight, and the first group that I'm about to show you the changes were fairly dramatic.
Another group was done with more people who lost very little weight, but they had a major effect on their blood sugar. They were diabetics. However, again every single one of the parameters, the cholesterol, the triglycerides and the LDL, all went down, and the HDL went up.
Okay. Now, most of the other studies throughout the years, and I've reviewed the literature, and it goes back to the 1950s and 1960s -- there are about ten of them -- report a striking improvement in triglycerides particularly.
I want to talk about triglycerides because this is much more important than you might imagine. It's logical, by the way, that it should be beneficial in controlling triglycerides because body fat biochemically is triglyceride, and we know that the diet causes a loss of body fat.
The first demonstration of this was done at Harvard by P.K. Ressel and his colleagues. The subjects had very high triglycerides in Ressel's study. Their triglycerides ranged from 500 and up, and a typical fall was from 1,300 down to 300.
There were many, many other studies, which I don't have time to show, but you can be sure that high triglycerides are corrected by a low carbohydrate diet.
The impact of high triglycerides cannot be underestimated. Let's look at another Harvard study, this one very recent, published in Circulation, October, 1997. Gaziano was the senior author.
He took 340 patients who survived a myocardial infarction and got out of the hospital. They were compared with age and sex matched controls. Of all the lipids studied, and they studied every lipid there was, they were most fascinated by the elevation of triglycerides combined with a low level of the good cholesterol, the HDL.
This is what the study showed. They divided them into quartiles of this ratio, triglyceride to HDL. The lowest quartile or the most ideal number, so to speak, was given a factor of one. They were assigned that number. Then 4.1 times more of that group in the second quartile were in the heart attack group, 5.8 times in the third quartile, but in the fourth quartile, the upper 25 percent, there was 16 times more likelihood of being in the heart attack group if you had triglycerides combined with low HDL. This is the most powerful risk factor for heart disease ever described.
If you look at what cholesterol does, it's maybe two to one. If you look at what homocystine does maybe five to one, but 16 to one? This is what you must be looking for if you want to reverse heart disease.
The importance of high triglycerides then is that they are perhaps the most important cardio risk factor at all, but they are a known surrogate marker for hyperinsulinism. Now, we haven't talked about hyperinsulinism, but a lot of people have. High triglycerides and low HDL are surrogates for this phenomenon.
You do see, by the way, the same incidence of high heart attack rates when you study insulin levels as well. Even more important is that triglycerides are a known responder to carbohydrate restriction.
We've done a retrospective study on 319 subjects at the Atkins Center we're going to really skip most of. We don't have time. I just want to point out that in the group of 85 people who had triglycerides of over 150, the value one year later was less than 50 percent of what it was at the beginning of the study.
To dismiss the complaint that the Atkins diet skimps on fruits and vegetables, I would like to point out that it is nutritionally naive to lump fruits and vegetables together. There is a wide variance in their phytochemical content.
In my latest book, Age Defying, I deal with this issue. Carbohydrates per se are not nutritionally essential, only the phytochemicals that they contain. Future dieters will be instructed to select foods with a high antioxidant to carbohydrate ratio. The best phytochemicals act as antioxidants.
There is a very good study. By the way, it was done out of Tufts, and I wonder if it was done from the USDA. I hope it was because this work is very, very valuable.
These are the fruits and vegetables that have the highest ratio of antioxidants, done by the Tufts study, per gram of carbohydrate.
You see that at the top of the list are foods like garlic, kale, onions, leafy greens, spinach.
These are the foods with the highest ratios. The only fruits on the list were berries.
If we now turn to the next list, you're going to see the bottom of the list.
You're going see that things like apples and pears and bananas have a reading of 0.2, and yet kale a reading of 6.5, so that if you pick the right green vegetables you will do 30 times better than if you pick the wrong fruits.
One leaf of lettuce has double the antioxidant power as an entire banana, so let's no longer lump fruits and vegetables together. Let's learn to be selective and pick the vegetables that work.
Now we have to deal with the accusation that the Atkins diet is low in vitamin and
mineral content. Here's an example of a 2,000 calorie version of my strictest diet from the standpoint of carbohydrate. It only has 20 grams. It starts with a three egg omelette of avocado and cheese and tomato and two strips of bacon and so on. You can read the rest. I hope you can. I can't from here, but maybe you can.
All right. I want to show you it measures up to the RDI, which stands for the recommended daily intake, of 12 different vitamins.
Do you see that black line? That's 100 percent. These are 12 vitamins. Nine of the vitamins go way over that line, two of them are virtually at the line, and only one, pantothenic acid, is at the 50 percent mark, and it's a question of whether we can do better.
 
Now, I personally believe in nutritional supplements for everyone. I believe that people on the food pyramid diet need nutritional supplements a lot more than people on the Atkins diet, and so if I tell people to take nutritional supplements it's not because my diet is inadequate. It's because they were on an inadequate diet before they started my diet.
Okay. Now the main question about the long-term studies. No one has one. There are no long-term studies showing that any diet for weight reduction is both effective and safe. Mostly it's not hard to show that they're safe, by the way, but none have been shown to be effective. To be effective, they must be followed. They must be easy and pleasant enough to follow.
The recidivism rate of most diets falls into the 95 percent range, which indicates that very few people want to follow them. I predict that my diet will be the first diet to achieve the long-term effectiveness award, and the reason is that it is easy to follow. It's easy to comply with. You're never hungry. You have a metabolic advantage. You can take in more calories than you can on other diets and still lose weight. You can go to restaurants, order from the best of the main courses. You can eat in luxuriously, and you will correct an awful lot of other health problems.
 It will correct diabetes, hypertension, most of the risk factors for heart disease, gastritis, esophageal reflux disorder, headaches and a variety of other problems, and for all of these reasons I hope -- the reason I'm here, by the way, is to help the people of our nation and of other nations, and I hope to correct the misinformation that people have to deal with saying that a low carbohydrate diet is scientifically unsupported
I hope that some government official will decide okay, it's pretty clear that long-term studies are going to have to be studied by the government and that they will do that. When they do, they will begin to get some of the exiting results.
Thank you.
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