The Low Carbohydrate Diet
This article is dedicated to Robert C Atkins MD who died in April, 2003. Dr Atkins was at the forefront of the nutritional medicine movement, writing his first book on this subject, Dr Atkins’ Nutrition Breakthrough, over 20 years ago. However, he is best known by the public for his controversial low carbohydrate diet.
His diet is very much in the alternative medicine tradition in that it works well but is ignored and openly derided by conventional medicine because it lies outside their paradigm of thinking.
Ironically, few complementary therapists would welcome it either, because it is low in the kind of foods considered best for health and very high in protein. Certainly, most therapists dealing with weight loss would prefer an approach which concentrated on educating people to eat whole grains, fruits and vegetables with adequate exercise.
However, only one person in a hundred is able to lose weight and keep it off permanently. Bearing in mind obesity is a major health problem, any approach which allows people to eat luxuriously without hunger, should be investigated seriously and without prejudice.
The Banting Diet
Low carbohydrate diets are not new. William Banting wrote his Letter on Corpulence in 1864. Banting was a prosperous London coffin-maker, less than 5½ feet in height and weighing 15 stone. He couldn’t tie his shoelaces and could only walk downstairs backwards. Over the years he tried every imaginable way to lose weight without success.
In his sixties he developed an earache and was losing his hearing in one ear. For this reason only, he consulted William Harvey, a noted ear, nose and throat surgeon. As it happened, Harvey had a particular interest in diabetes and how the body handled the food elements. He theorised that sugar and starches caused weight gain, although medical thinking at the time was that weight loss could only be achieved by cutting back on food intake, with the emphasis on dietary fat. In other words, the same as today.
Since there was nothing organically wrong with Banting’s ear, he wondered if excess fat within the ear might be the cause.
He put Banting on an experimental diet. For each meal, including breakfast, he could eat up to 5 ounces of meat, fish or fowl. Vegetables were permitted but not potatoes, and just a little fruit. Sweets, flour and starch were not allowed. He could drink tea without milk or sugar and was allowed claret and sherry but not beer, champagne or port.
His calorie intake was thought to be high at 2,800 a day (estimated average requirement 2,350). Yet in 4 months he lost 20 pounds and after one year was 50 pounds lighter. His hearing was restored and he felt fitter, better and had greater mobility than he’d done in years.
Although the public were impressed, the medical profession was outraged at the suggestion you could eat fat to lose fat by a presumptuous layman with no scientific qualifications (even though he gave full credit to Harvey). The whole idea was considered ridiculous and dangerous. He was denounced as a charlatan. Harvey also suffered at the hands of his colleagues. After some years he recanted so he could continue his career in peace and quiet.
Many people followed his diet and lost weight. This success led one notable doctor to look into it seriously. However, he assumed meat to be lean. Allowed foods were considered low in carbohydrate and fat, thus missing the whole point of the diet. This modified Banting diet met with some approval from doctors interested in obesity, but Banting himself felt this was far inferior to his own.
The anthropologist and explorer Vilhjalmur Stefansson set out on an expedition to the Arctic in 1906. He missed a planned rendezvous and had to spend the winter months among the native Inuit of Tuktoyyaktut living on meat, fish and water. At first he tried to make the diet more palatable by broiling it, but this made him weak, dizzy and showing signs of malnutrition. Eating it the Eskimo way, he remained in good health.
In a later expedition he and Dr Karsten Anderson, although well equipped with food, chose to live on a primitive diet for 4 years. They only got ill when a key component was unavailable. For instance, when seal oil was missing and only lean protein was accessible. As soon as fat/oil was restored, so did their health. Stefansson wrote about their experiences in The Friendly Arctic in 1921.
As his ideas regarding nutrition were met with scepticism, he and Anderson took part in a strictly controlled experiment at Bellevue Hospital in 1928 under the supervision of the great biochemist, Eugene F. Du Bois. They spent one year on an all meat diet deriving 80% of calories from fat and 20% from protein. They were tested for signs of scurvy and other deficiency diseases; mineral deficiencies; effects on the heart, blood vessels and kidneys; and whether harmful bacteria grew in the gut. Their daily calorie intake varied between 2000 and 3100.
Stefansson started out a little overweight. This was quickly lost and then his weight remained stable. During the weight loss his metabolic rate rose by 8.9%. The research team reported no signs of deficiencies, reduced energy or damaged organs. His blood cholesterol was lower after a year than at the start. Bowel movements were normal. They remained mentally alert and physically active. The results were published, but scepticism remained. How could a diet unlimited in fat and high in calories, lower weight and maintain health?
Lose Weight & Gain Health on Meat, Fat & Water
In 1944 Blake F Donaldson, a cardiologist, frustrated by failed attempts to get his patients to lose weight, adopted the low carbohydrate approach in a famous and highly successful experiment with obese patients at New York Hospital. He went on to write Strong Medicine in 1961 in which he explains how he treats obesity and a wide range of health disorders such as heart disease, arthritis, diabetes and high blood pressure, with meat, fat and water.
“The ability to live well on meat and water is the common inheritance of mankind. It is only in the last eight thousand years since man turned to agriculture for a stable food supply that we have had trouble with eating.”
Du Pont Dieters Lose 22 Pounds
A few years after Donaldson’s experiments, Dr Alfred Pennington was asked to supervise the slimming of 20 overweight executives at the Du Pont Corporation. Carbohydrates were restricted but fat, protein and calories were not.
The results were spectacular with each obese dieter losing an average of 22 pounds (range 9-54) in 3½ months. They reported feeling well, enjoying their meals, and not going hungry (hardly surprising on 3000 calories a day). Many reported feeling more energetic, none complained of fatigue, those with high blood pressure saw it drop in parallel with their weight.
After sifting through the scientific literature and the findings of this study, Pennington concluded that Harvey and Banting were right. Overweight is the result of the body’s inefficient handling of carbohydrates.
After this experience there was renewed interest in this form of dieting, being called The Holiday Diet.
A Calorie Is Not A Calorie
In the 1950’s two acclaimed scientists, Kekwick and Pawan provided irrefutable experimental evidence that a diet low in carbohydrates held a significant metabolic advantage over other diets. They demonstrated weight loss can vary on identical numbers of ingested calories. For instance one subject lost nothing on a 2000 calorie balanced diet, but lost over 9 pounds on a low carbohydrate diet of 2,800 calories.
Critics of low carbohydrate diets maintain that most of the weight loss comes from water, but Kekwick and Pawan showed this to be only a small part of the weight loss. They also identified a fat-mobilising substance from the urine of low carbohydrate dieters. This demonstrated that fat stores were being used as body fuel.
Another criticism is that on few carbohydrates the body goes into ketosis and this is dangerous. During the oxidation of fat, ketones (chemicals related to acetone) are produced. These occur in untreated diabetics since they are unable to handle sugar. They can accumulate until they become toxic. Kekwick and Pawan found that when the body is burning fat for fuel, ketones are only produced at 10% of the level of untreated diabetics. This is mild and not a complication of the diet.
Dr Atkins’ Diet Revolution
In 1958 Dr Mackarness wrote Eat Fat & Grow Slim and in the 1960’s the low carbohydrate diet reappeared under the name The Air Force Diet.
Then in 1972 Dr Atkins’ book appeared, claiming that the overweight have a metabolic defect involving insulin. This can be circumvented by restricting carbohydrates. He wrote it after solving his own weight problems and treating ten thousand patients.
But the following year Dr Atkins got a rude awakening when the American Medical Association (AMA) attacked the diet.
“It said, in essence, that what I had been observing and documenting for nine years could not have happened. They denied that my patients lost weight, claiming that people only lose water on such a diet. They denied their improved state of health and laboratory findings by announcing that people would surely get worse.”
Once the gods at the AMA had spoken, no further research on the metabolic advantage of such a diet were carried out in the USA.
But the shocking rise in levels of obesity together with the failure of the approved low fat, high carbohydrate position has led to renewed interest.
Low Carbohydrate Diet Is Vindicated
In the May 22nd edition of the New England Journal of Medicine two studies were published. These were commented on in the British Medical Journal of May 31st under the heading Low Carbohydrate Diet Is Vindicated.
“The studies found that a high protein, low carbohydrate diet led to greater weight loss and improved blood lipid concentrations than the recommended high carbohydrate, low fat diet in healthy obese people as well as in obese patients with complicating conditions.”
In one of the studies, decreases in serum triglyceride concentrations and increases in HDL cholesterol were greater in the Atkins diet group.
In the other study serum triglyceride concentrations decreased by 20% in the low carbohydrate group, whether or not the patients were taking lipid lowering drugs, compared with 4% in the low fat group.
Professor Gary Foster of the University of Pennsylvania, who worked on one of the studies, said: “...our initial findings suggest that such diets may not have the adverse effects that were anticipated.”
"You would expect an increase in (bad) LDL cholesterol, but we didn’t see it. We didn’t expect the improvement in (good) HDL cholesterol and triglycerides to the degree we saw," he said.
If Banting and other people’s experiences were accepted as reality. If the findings and research of notable clinicians and scientists were taken seriously, we would not have wasted almost a century and a half in pursuing dogma.
No diet is right for everyone. And the low carbohydrate diet will neither appeal to everyone or be a good diet to follow for all people. Some people’s biochemistry will not be suited to it. It should however have been taken a lot more seriously by the medical profession.
Dr Atkins may no longer be with us, but thanks to his dogged determination, the low carbohydrate diet is now taken seriously and is here to stay.
This article was first published in Enzyme Digest No. 61, Summer 2003
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