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Atkins Diet Debate - Meat And Fat 'Okay'

The Atkins diet follows a "eat fat, lose fat" principle. In other words, it encourages the intake of foods off limits in other diets such as meat, butter and dairy products. It also restricts carbohydrates like rice, bread and potatoes and greatly limits fruit and vegetables. The diet's premise is that a carbohydrate starved body will start to burn up stored fat cells, a process called ketosis.

However, over prolonged periods, ketosis can have harmful effects in some people. The high-protein, low-carb Atkins diet is unsafe and should not be recommended for weight loss, US medical researchers have said in leading medical journal The Lancet. They cited the case of a woman who developed life-threatening complications as a result of following the diet.

The Atkins diet follows a "eat fat, lose fat" principle by encouraging the intake of foods that are normally off-limits in other diets such as meat, butter and dairy products and restricting carbohydrates like rice, bread and potatoes. It also greatly limits fruit and vegetables. The diet's premise is that a carbohydrate-starved body will start to burn up stored fat cells, a process called ketosis.

However, over prolonged periods, ketosis can have harmful effects in some people. Dr Chen Tsuh-Yin and his team in Lenox Hill Hospital in New York described the case of a 40-year-old obese woman who had strictly followed the Atkins diet for a month before it landed her in hospital. She said she had lost 9kg by eating only meat, cheese and salads.

She had also followed other Atkins recommendations, taking multivitamins, omega-3 fatty acids, electrolytes and a "thermogenic" formula. However, she started to have mild gastric pains, her appetite decreased, nausea and vomiting set in and she became increasingly short of breath. Urine and blood analysis showed she had severe ketoacidosis, a condition in which dangerously high levels of ketone acids build up in the liver as a result of a depletion of the hormone insulin.

Insulin is needed to convert glucose into energy that the body can use. Ketoacidosis is usually seen only in diabetics and victims of starvation and can lead to a coma. The woman recovered after three days in intensive care. Doctors advise that to achieve weight loss on a long-term basis, low-carbohydrate diets are no more effective than standard low-fat ones.

In a commentary accompanying the Lancet report, two doctors at the University of Minnesota's School of Public Health said the Atkins diet is nutritionally unsound. "Low-carbohydrate diets for weight management are far from healthy, given their association with ketosis, constipation or diarrhoea, halitosis, headache and general fatigue to name a few," wrote Dr Lyn Steffen and Dr Jennifer Nettleton.

They warned that the diet increases protein load on the kidneys and alters the acid balance of the body. This also results in loss of minerals from bone stores and affects bone strength. "Our most important criterion should be indisputable safety and low-carbohydrate diets currently fall short of this benchmark," the doctors said. The Atkins diet - promoted by the late Dr Robert C. Atkins -was very popular in the late 1990s, reaching almost cult status in 2002.

Dr Atkins died in 2003 after he was alleged to have slipped on an icy road and hurt his head badly. His medical report stated that he had a history of heart attack, hypertension and congestive heart failure. Rumours about the Atkins diet's effects on the heart were soon to spur a decline in its popularity, driving the company to file for bankruptcy last year.

Dr Atkins originally pushed the diet in the 1960s and relaunched it in the 1990s with his book The New Atkins Diet Revolution. At the height of its popularity in the late 1990s, the Atkins craze changed eating habits to the extent that some US bakeries and Italian restaurants were put out of business because they were perceived to be purveyors of harmful Garbs.

People lost weight on Atkins and they lost it quite dramatically. Mr Sumanto Chattopadhyay, a 36-year-old creative director based in Mumbai, said he has been on the diet on and off for about four or five years. He is not obese, he just wanted to lose some fat and look "leaner", he said. "When I was trying to lose weight, none of the other diets helped. But Atkins worked for me and after just six weeks, people were noticing the change and asking me what I had done."

The long-term effects of restricting carbohydrates are not yet known but most nutritionists and doctors believe the Atkins diet would eventually lead to mineral and vitamin deficiencies. Several studies have investigated the health effect of the Atkins diet. A 2003 study published in the New England Journal Of Medicine found that a group of subjects on the Atkins diet lost weight much faster in the first six months than a low-fat group.

However, at the end of one year, the Atkins dieters ~ had regained much of the weight they had lost and there was no difference in the amount of weight lost by the two y groups of dieters. The study also found that at the three-month stage, Atkins dieters tended to have increased levels of LDL or "bad" cholesterol while those on the low-fat diet had decreased levels.

However, the level of "good" cholesterol or HDL increased for Atkins dieters and decreased in low-fat eaters. Triglyceride levels also decreased in Atkins dieters and went up in the other group. Higher levels of good cholesterol are said to protect the heart while high triglyceride levels are a risk factor for heart disease and diabetes.

And at the end of one year, the increased bad cholesterol levels normalised and there was not much difference between the two groups. Many took this to mean that the Atkins diet did not lead to dramatic increases in cholesterol levels as would be expected when eating lots of meat and fat. 

However, the study concluded that there was not enough information to determine whether the beneficial effects of the Atkins diet outweighed its potential adverse effects, like the risk of coronary heart disease, especially in obese people. There is also the fact that each person's cholesterol levels may respond differently to the diet.

Mr Chattopadhyay, for instance, says his bad cholesterol level went up at least 40 points on the diet. And an American businessman, Mr Jody Gorran, has sued Atkins Nutritionals because he developed a clogged artery after being on the diet for two years. A heart scan six months before he started the diet had shown a healthy heart with no signs of plaque.

The 53-year-olds pre-diet cholesterol level of 146 shot up to 230 after the diet. Mr Gorran had to have an angioplasty to unblock the artery and have a stmt put in to keep it open. In an e-mail interview with MYB, Mr Gorran said his case is still before the courts. He sued the company in 2003 for less than US$15,000 and asked for a warning to be placed on their books and food products that "the Atkins diet may be dangerous to your health".

"In terms of legal cases, the $15,000 is a very minimal amount because I wanted the public to realise that I was not doing this for money but to warn them that while the Atkins diet might be okay for the majority of followers, Atkins knew that for one-third of patients, eating as much saturated fat as you desired could cause a dangerous rise in cholesterol which could lead to heart disease and death. This diet almost killed me," Mr Gorran said.

The American Heart Association has also long advised people of the risks of high-protein diets such as the Atkins diet. "People who stay on these diets very long may not get enough vitamins and minerals and face other potential health risks," it warned in 2001. These health problems range from constipation to kidney stones and cancer.

The American Kidney Fund has warned that high-protein diets place a significant strain on the kidneys. The American Academy of Family Physicians also notes that high animal protein intake is largely responsible for the high prevalence of kidney stones in the United States. And especially for people with mildly impaired kidney function, a diet high in meat protein can accelerate the decline of kidney function, the Harvard Nurse's Health Study showed.

Even the studies that compared weight loss on Atkins and low-fat diets admitted there was not much information on the diet's long-term effects on renal function or bone health. Why then does the Atkins diet still inspire followers? Mr Chattopadhyay says the diet made him more aware of all the simple carbohydrates and refined sugar he was eating.

"It cut my sugar cravings and I make healthier choices now, even when I'm not on the diet." He added that it is possible to follow the diet intelligently, by cutting out too many Garbs and choosing leaner meats, egg whites and fish instead of saturated fat. "Also, I never stopped eating fruit and vegetables. I think people who go crazy and follow it strictly to the T may have problems."

In conversations with other Atkins dieters, this is the point that comes across: The Atkins diet jump starts weight loss and awareness of food choices. So, people who follow it even for short periods become more attuned to eating healthier carbohydrates, even as they tone down their meat and dairy intake. And acknowledgement of these Atkins' principles comes from surprising corners.

Dr Dean Ornish, a leading cardiologist and author of Reversing Heart Disease, recommends a diet that is possibly the opposite of Atkins with its emphasis on whole grains and very low levels of saturated fat. Yet, he told the Los Angeles Times in an interview last year, that the good that Dr Atkins did is that he made people more aware of the harmful effects of refined carbohydrates such as sugar and white flour.

"The bad is that he taught people that in the short run, you can sell a lot of books and make a lot of money telling them what they want to hear." According to Dr Ornish, a healthy diet is low in animal fat and rich in fruit, vegetables, legumes and whole grains. Unlike Dr Atkins, Dr Ornish has published studies in major medical journals showing that his diet can help people reverse artery blockages and avoid repeated surgery.

But even as nutritionists and doctors repeat the mantra of a balanced diet, there will always be a market for diets that promise dramatic results. Ultimately, as one researcher put it, all studies about diet and health bring us to the same conclusion: Eat less, move more, avoid junk food, and get those fruit and vegetables.

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