May 21, 2003 -- Controversial diet maven Robert Atkins may no longer be around, but a tug-of-war still lingers over his belief the road to weight loss is paved with bacon cheeseburgers — hold the buns.
Now, two new studies may help resolve the dispute over the effectiveness of the so-called Atkins diet, which advocates low carbohydrate and high fat intake.
Popular among dieters but disputed by their doctors, the Atkins diet has remained a huge question mark in the quest for reliable weight loss. Many experts have remained critical of the approach, but with little evidence to back up their critique.
That is, until today, with the results of the first two studies to specifically examine the low-carb, high-fat diet. The new research, published in the New England Journal of Medicine, compares the weight loss of severely obese individuals eating according to Atkins with those eating according to a conventional low-fat, low-calorie nutrition plan.
The results? While the Atkins dieters slimmed down significantly more than the traditional dieters, there was no weight difference between the groups after one year. The researchers also reported no differences in side effects during the year-long study.
And while the authors caution that additional research is needed, they also discovered an increase in high-density lipoprotein (HDL), or "good" cholesterol and a decrease in serum triglycerides among dieters in the Atkins group. Those results are positive because low HDL and high triglyceride levels increase an individual's risk of developing heart disease.
So, while dieters might be pleased with the early results of the Atkins plan, the success may be short-lived, with the scale tipping right back to where it started. In part, say the studies' authors, that's evidence the diet plan is just not that easy for most people to stick to long-term.
"Any approach to calorie restriction that is not compatible with daily lifestyle patterns is difficult to maintain over the long term," explains an accompanying editorial on the studies, written by Dr. Robert O. Bonow from the Northwestern University Feinberg School of Medicine in Chicago, Ill., and Dr. Robert H. Eckel from the University of Colorado Health Sciences University in Denver, Colo.
Argues Dr. Patrick McBride, the director of Preventive Cardiology at the University of Wisconsin, "The low-carb, high protein Atkins diet "is not a diet that is nutritionally appropriate or palatable over a long period of time because it essentially cuts out major food groups including fruits, vegetables, and complex grains."
Diet Experts Remain Divided
At any time, about 45 percent of women and 30 percent of men in America are actively seeking to lose weight. Unfortunately for them, these studies do not answer the million-dollar question: What is the best way to keep weight off?
Diet experts remain divided. While many feel a diet's long-term success is what is most valuable, others believe there is always a benefit to weight loss, even if it is followed by an inevitable pound rebound.
And there are growing signs some of the country's leading medical institutions are not only devoting increased research to low carbohydrate diets, but are beginning to offer them to their patients.
For example, Harvard University is currently finishing up a study comparing an ultra-low carb diet with the American Heart Association's low-fat diet. And, at Joslin Diabetes Center in Boston, obesity expert Dr. Terry Maratos-Flier says she has been recommending a "modified Atkins" that focuses on fish and chicken instead of beef and pork.
Even though the study found low-carbohydrate, high-protein eaters regain the weight at one year, "the low-carb group still weighs about five pounds less than the conventional diet group, suggesting that some people in that group may be maintaining weight better," Maratos-Flier said.
And other experts seem to agree. "These two randomized, controlled studies add to the recently gathering evidence that low-carb diets may be an important weight control option for many obese, or severely obese patients," explains Dr. Howard Eisenson, the director of the Duke University Diet and Fitness Center.
The Duke Center has been using low-fat diets since 1969. But, says Eisenson, "What we have been doing, for so long, does not provide enough lasting improvement, for enough of our patients, for us to be satisfied." So, because he believes it is "time to open our minds to the possible benefits of a low carbohydrate diet," Eisenson says Duke plans to introduce a new carbohydrate diet option to patients this summer.
There's More to Weight Loss than Diet
On the flip side, argue critics like Dr. James W. Anderson, professor of medicine and clinical nutrition at the University of Kentucky, "The high fat diet does promote weight loss but reinforces unhealthy but popular eating styles."
These unhealthy eating styles, experts say, could cause potential health problems if maintained beyond a year. Research has shown consuming high levels of saturated fat, as many Atkins dieters do, may have adverse health consequences.
Adds Anderson, who discourages his patients from the Atkins diet, "Using the Atkins guidelines long-term will raise cholesterol by 28 percent, whereas a low-fat diet will lower cholesterol by 20 percent."
Ultimately, add Bonow and Eckel: "The recipe for effective weight loss is a combination of motivation, physical activity, and calorie restriction. Until further evidence is available, physicians should continue to recommend a healthy lifestyle that includes regular physical activity and a balanced diet."