The Atkins diet, also known as the Atkins Nutritional Approach, is a high-protein, high-fat, very lowcarbohydrate regimen. It emphasizes meat, cheese, eggs, and oils while severely limiting foods such as bread, pasta, fruit, and sugar . It is a form of ketogenic diet.
Robert C. Atkins, a cardiologist and internist, developed the Atkins diet in the early 1970s. The original premise for developing the diet came about because of Atkins' frustration with the increasing rates of American obesity and chronic diseases such as type 2 diabetes. The diet first came to public attention in 1972 with the publication of Dr. Atkins' Diet Revolution. It quickly became a bestseller, but unlike most other fad diets , it remained very popular until about 2004.
Before his death in 2003, Atkins authored many books, including cookbooks and many books promoting variations on his diet. After his death, the popularity of the diet declined substantially. In 2005, Atkins' company, Atkins Nutritionals, filed for Chapter 11 bankruptcy. Until 2005, the company had concentrated on providing diet information through the sale of its books. When the company emerged from bankruptcy in 2006, it had a new business strategy that focused on providing low-carbohydrate foods (mostly Page 91 | Top of Articleshakes and bars) that conform to the Atkins diet. In 2011, Atkins Nutritionals began a refocused advertising campaign aimed at individuals who wanted quick weight loss of up to 15 pounds (6.8 kg) in two weeks. This quick weight-loss continued to be the focus of the Atkins Nutritionals website as of 2012.
The Atkins diet has been one of the most popular fad diets in the United States. It started a “low-carb revolution,” leading to the development of low-carbohydrate choices in grocery stores and restaurants. The regimen is a very-low-carbohydrate, or ketogenic diet, characterized by initial rapid weight loss, usually due to water loss. Drastically reducing carbohydrate intake causes liver and muscle glycogen loss, which has a strong but temporary diuretic effect. Longterm weight loss is said to occur because a very low carbohydrate intake causes the body to burn stored fat for energy.
The Atkins diet consists of four phases that participants are expected to progress through to achieve and maintain weight loss. Throughout these phases, the dieter is encouraged to drink at least eight 8-ounce glasses of water daily to avoid dehydration and constipation , to take a good multivitamin supplement, and to exercise to speed weight loss.
The four-phase diet starts with a two-week induction program designed to rebalance an individual's metabolism . This is by far the most restrictive of the four phases. Unlimited amounts of fat and protein are allowed but carbohydrate intake is restricted to 15–20 grams per day. Foods allowed include butter, oil, mayonnaise, sour cream, guacamole, meat, poultry, fish, eggs, cheese, and cream. The Atkins theory is that high-fat foods enhance the flavor of meals, making the Atkins diet easier to maintain. The daily amount of carbohydrates allowed equals about three cups of salad vegetables, such as lettuce, cucumbers, and celery. Dieters are said to feel hungry for the first 48 hours as their bodies adjust to the abrupt reduction in carbohydrates.
Atkins Nutritionals claims that the induction phase can make people feel revitalized, since carbohydrates can cause blood sugar spikes that lead to fatigue and other symptoms. The diet also claims that the induction phase will help dieters see the benefits of fat burning and strengthen their immune systems. Weight loss during this phase often is often substantial and quick, which can motivate the dieter to continue.
Ongoing weight loss
The second phase of the Atkins diet moves into ongoing weight loss. It involves the slow introduction of foods containing carbohydrates that are also considered nutrient dense and allows 15–40 grams of carbohydrates per day. Most of the carbohydrates come from vegetables. Atkins dieters still eat a high proportion of proteins and fat, but they gradually add more carbohydrates into the diet. The purpose of the phase is to continue to burn fat while controlling appetite and cravings . This phase also introduces the dieter to a broader range of foods and helps determine the dieter's threshold level of carbohydrate consumption (the maximum amount that still promotes weight loss). It is the intention of this phase to deliberately slow weight loss.
If weight loss continues, carbohydrate intake is gradually increased each week. In week one, the dieter can increase carbohydrate intake to 25 grams per day. In week two, if weight loss continues, 30 grams of carbohydrates are allowed. This process of allowing an additional 5 grams of carbohydrates per day Page 92 | Top of Articlecontinues on a weekly basis until weight loss stalls, then the dieter drops back to the previous gram level.
Typical tolerance levels range anywhere from 30 grams to 90 grams of carbohydrates per day. The more a dieter exercises, the more carbohydrates he or she can consume and still lose weight. The Atkins diet recommends choosing first from vegetables that are low in carbohydrates, then from other sources that are fresh foods high in nutrients and fiber . Examples of low-carbohydrate vegetables are lettuce, raw celery, and cucumbers. Nutrient-rich carbohydrates include green beans, Brazil nuts, avocados, berries, and whole grains .
The Atkins diet considers the third phase as practice for lifetime maintenance of the individual's goal weight and “healthy eating habits.” When the dieter is within 5–10 lb. (2.3–4.5 kg) of the goal weight, carbohydrate intake gradually is increased by 10 grams per day each week until weight is gained. Then the dieter drops back to the previous carbohydrate gram level. The purpose is to level weight loss to less than one pound per week. The dieter should continue at this rate until the goal weight is reached and for one month past that time. The goal is to achieve a level at which weight is neither gained nor lost and to internalize habits that become part of a permanent lifestyle.
Examples of vegetables that contain about 10 grams of carbohydrates are 3/4 cup of carrots, 1/2 c. of acorn squash, 1 c. of beets, and 1/4 c. of white potatoes. Legumes and fruit are the next preferred food groups for adding 10 grams daily. One-half apple contains 10 grams of carbohydrates, as does 1/3 c. of kidney beans.
This final phase of the Atkins diet occurs when the dieter's goal weight is reached. Although an adult may be able to consume 90–120 grams of carbohydrates daily, depending on age, gender, and activity level, maintaining the goal weight is more likely if carbohydrate intake remains at the level discovered in pre-maintenance, generally in the range of 40–60 grams of carbohydrates per day. The key, according to Atkins, is never letting weight vary by more than three to five pounds before making corrections.
Though Atkins himself did not believe his highcarbohydrate diet was suitable for vegetarians or vegans, a vegan alternative, dubbed “Eco-Atkins,” has been developed for dieters who do not eat meat or animal products. The protein in the diet comes primarily from soy , gluten (a protein found in wheat), and nuts. Smallscale studies saw slight reductions in dieters' LDL (low density lipoprotein, or “bad”) cholesterol levels, as well as weight loss. The Atkins website warns that vegan dieters will have trouble with the induction phase of the Atkins program and should start in one of the other three phases. The studies were done on dieters who skipped right to the lifetime maintenance part of the plan, without ever following phases one, two, or three.
Atkins and his followers believe that the traditional approach to weight loss of counting calories and cutting fat does not work. They believe that carbohydrates contribute to rising rates of obesity and obesity-related diseases. Through several updates of the Atkins diet, the same basic premise has held with minor revisions. The function of the diet is to enjoy eating while severely limiting carbohydrates. The Atkins diet makes some distinctions between trans fats and other fats. A more clear distinction is also made between carbohydrates in general and sugar in particular. The Atkins diet emphasizes that protein builds energy, repairs muscles and bones, and boosts the metabolism.
The primary benefit of the diet is initial rapid and substantial weight loss. When carbohydrate intake is severely restricted, the body burns more fat stored in the body. There are no limits on the amount of calories or quantities of foods allowed while on the diet, so there is little hunger between meals. According to Atkins, the diet can alleviate symptoms of conditions such as fatigue, irritability, headaches, depression, and some types of joint and muscle pain.
Research also suggests that a high-fat, low-carbohydrate diet similar to the Atkins diet may help certain individuals with epilepsy avoid seizures. Research regarding the effects of diet on epilepsy is ongoing. Clinical trials are underway to determine the safety and effectiveness of a modified Atkins diet on epilepsy. A list of current clinical trials recruiting patients can be found at http://www.clinicaltrials.gov . There is no fee to participate in a clinical trial.
The average carbohydrate intake recommended by the Atkins diet is well below the average level generally recommended by other experts and federal dietary guidelines . Page 93 | Top of ArticleThe U.S. Department of Agriculture suggests eating six (1 oz.) servings each day (on average), and the Institute of Medicine, which determines the recommended daily intake values of vitamins and minerals , advises obtaining 45%–65% of daily calories from carbs. Studies have shown that even though people lose weight on the Atkins plan, they do not necessarily keep the weight off in the long term because the diet does not teach sustainable lifestyle changes.
Like many fad diets, the Atkins plan produces and promotes many food products associated with its diet plan. As of 2012, these products included bars, shakes, candy, pasta, and a baking mix. So although the plan argues against processed foods and snacking, the company heavily promotes the use of its nutritional products to support weight loss or maintenance.
Due to the diet's restrictive nature, adherence to the Atkins diet can result in vitamin and mineral deficiencies. In his books, Atkins recommends a wide range of nutritional supplements, including a multivitamin. Among his recommendations, Atkins suggests the following daily dosages: 300–600 micrograms (mcg) of chromium picolinate, 100–400 milligrams (mg) of pantetheine, 200 mcg of selenium , and 450–675 mcg of biotin .
According to Atkins, this diet causes no adverse side effects. Many health care professionals disagree. Some of the complications reported as resulting from the diet include ketosis, dehydration, electrolyte loss, calcium depletion, weakness, nausea, headaches, and kidney problems. There is also significant concern that since the diet is high in animal fats it could lead to increased levels of cholesterol and an increased risk of heart disease.
People with diabetes who are taking insulin are at risk of becoming hypoglycemic if they do not eat appropriate quantities of carbohydrates. Also, individuals who exercise regularly may experience low energy levels and muscle fatigue from low carbohydrate intake.
Followers of the Atkins diet have reported muscle cramps, diarrhea, general weakness, and rashes more frequently than people on low-fat diets. Others have reported bad breath, headache, and fatigue. Constipation is also a risk due to the limited intake of fruits and vegetables, which contain dietary fiber. The Academy of Nutrition and Dietetics warns that any diet that severely limits one food group should viewed very cautiously by dieters.
High-protein diets may have adverse effects on bone health. A high protein intake causes increased calcium excretion in urine, and low calcium can lead to decreased bone health and risk of fractures. However, recent studies have found that while more calcium is lost, high protein intake may increase calcium absorption, helping to counteract the effects. In addition, although studies comparing low-fat diets with lowcarb diets have not found differences in kidney function in obese patients, physicians have warned that high-protein diets may cause permanent loss of kidney function in anyone with kidney dysfunction.
Research & general acceptance
The Atkins diet has been hotly debated by lay people and the medical community alike. Although many studies have been carried out, the results often seem to be contradictory. In general, research has supported the idea that although short-term weight loss is often successfully achieved using the Atkins diet, long-term health may be put at risk. A study published in the March 2007 volume of the Journal of the American Medical Association found that weight loss achieved by women on the Atkins diet was higher Page 94 | Top of Articlethan that achieved by women on the Zone, Ornish, or LEARN diets. This would seem to indicate that the Atkins diet might be an effective approach to weight loss that is likely to lead to improved health in the longer term. However, a study published in the April 2007 volume of the Journal of Internal Medicine followed a group of more than 40,000 Swedish women for 12 years. The study found that those who followed a low-carbohydrate, high-fat diet were much more likely to have cardiovascular problems, and were at a higher risk of mortality. This type of back-and-forth between evidence supporting the Atkins diet and evidence warning of its risks makes it very controversial.
Although opinion from the general medical community remains mixed on the Atkins diet, it is not generally recommended. A number of leading medical and health organizations, including the American Medical Association, Academy of Nutrition and Dietetics, American Heart Association, and the American Cancer Association advise against the diet in most cases. The Atkins diet calls for eating a mix of foods drastically different than the dietary intakes recommended by the U.S. Department of Agriculture and the National Institutes of Health.
Controversy even surrounded Atkins' death in 2003. Although he died when he slipped on the ice outside his office in February 2003, he spent eight days in a coma before dying, and a copy of the medical examiner's report showed that his weight upon death was 258 pounds. Critics of Atkins' diet said that this was considered obese for a man who was six feet tall. His allies said that most of the pounds were gained in Atkins' time in a coma because of fluid retention. Even while Atkins was alive, he had reported problems with his heart, though these purportedly stemmed from an enlarged heart caused by a viral infection, not from his diet.
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Academy of Nutrition and Dietetics, 120 South Riverside Plz., Ste. 2000, Chicago, IL 60606-6995, (312) 899-0040, (800) 877-1600, firstname.lastname@example.org, http://www.eatright.org .
Tish Davidson, AM