Low carb diets, the glycemic-index, Dr. Atkins and ketones
From: "Saul Pressman"
Date: Mon Jun 16, 2003 11:03 pm
Subject: Re: [oxyplus] Dr. Atkins and ketones
Thanks for the post.
Here is the part I found most interesting:
"The glycemic-index concept and the idea that starches can be absorbed into
the blood even faster than sugar emerged in the late 70's, but again had no
influence on public health recommendations, because of the attendant
controversies. To wit: if you bought the glycemic-index concept, then you
had to accept that the starches we were supposed to be eating 6 to 11 times
a day were, once swallowed, physiologically indistinguishable from sugars.
The gist of the glycemic-index idea is that the longer it takes the
carbohydrates to be digested, the lesser the impact on blood sugar and
insulin and the healthier the food. Those foods with the highest rating on
the glycemic index are some simple sugars [as in fruit], starches and
anything made from flour. Green vegetables, beans and whole grains cause a
much slower rise in blood sugar because they have fiber, a nondigestible
carbohydrate, which slows down digestion and lowers the glycemic index.
Protein and fat serve the same purpose, which implies that eating fat can be
beneficial, a notion that is still unacceptable. And the glycemic-index
concept implies that a primary cause of Syndrome X, heart disease, Type 2
diabetes and obesity is the long-term damage caused by the repeated surges
of insulin that come from eating starches and refined carbohydrates. ...
The 71-year-old Atkins, a graduate of Cornell medical school, says he first
tried a very low carbohydrate diet in 1963 after reading about one in the
Journal of the American Medical Association. He lost weight effortlessly,
had his epiphany and turned a fledgling Manhattan cardiology practice into a
thriving obesity clinic. He then alienated the entire medical community by
telling his readers to eat as much fat and protein as they wanted, as long
as they ate little to no carbohydrates. They would lose weight, he said,
because they would keep their insulin down; they wouldn't be hungry; and
they would have less resistance to burning their own fat. Atkins also noted
that starches and sugar were harmful in any event because they raised
triglyceride levels and that this was a greater risk factor for heart
disease than cholesterol.
Atkins's diet is ... the battleground on which the fat-versus-carbohydrates
controversy is likely to be fought scientifically over the next few years.
After insisting Atkins was a quack for three decades, obesity experts are
now finding it difficult to ignore the copious anecdotal evidence that his
diet does just what he has claimed. Take Albert Stunkard, for instance.
Stunkard has been trying to treat obesity for half a century, but he told me
he had his epiphany about Atkins and maybe about obesity as well just
recently when he discovered that the chief of radiology in his hospital had
lost 60 pounds on Atkins's diet. ''Well, apparently all the young guys in
the hospital are doing it,'' he said. ''So we decided to do a study.'' When
I asked Stunkard if he or any of his colleagues considered testing Atkins's
diet 30 years ago, he said they hadn't because they thought Atkins was ''a
jerk'' who was just out to make money: this ''turned people off, and so
nobody took him seriously enough to do what we're finally doing.''
In fact, when the American Medical Association released its scathing
critique of Atkins's diet in March 1973, it acknowledged that the diet
probably worked, but expressed little interest in why. Through the 60's,
this had been a subject of considerable research, with the conclusion that
Atkins-like diets were low-calorie diets in disguise; that when you cut out
pasta, bread and potatoes, you'll have a hard time eating enough meat,
vegetables and cheese to replace the calories.
That, however, raised the question of why such a low-calorie regimen would
also suppress hunger, which Atkins insisted was the signature characteristic
of the diet. One possibility was ... that fat and protein make you sated
and, lacking carbohydrates and the ensuing swings of blood sugar and
insulin, you stay sated. The other possibility arose from the fact that
Atkins's diet is ''ketogenic.'' This means that insulin falls so low that
you enter a state called ketosis, which is what happens during fasting and
starvation. Your muscles and tissues burn body fat for energy, as does your
brain in the form of fat molecules produced by the liver called ketones.
Atkins saw ketosis as the obvious way to kick-start weight loss. An
inevitable criticism of Atkins's diet has been that ketosis is dangerous and
to be avoided at all costs.
When I interviewed ketosis experts, however, they universally sided with
Atkins, and suggested that maybe the medical community and the media confuse
ketosis with ketoacidosis, a variant of ketosis that occurs in untreated
diabetics and can be fatal. ''Doctors are scared of ketosis,'' says Richard
Veech, an N.I.H. researcher who studied medicine at Harvard and then got his
doctorate at Oxford University with the Nobel Laureate Hans Krebs. ''They're
always worried about diabetic ketoacidosis. But ketosis is a normal
physiologic state. I would argue it is the normal state of man. It's not
normal to have McDonald's and a delicatessen around every corner. It's
normal to starve.''
Simply put, ketosis is evolution's answer to the thrifty gene. We may have
evolved to efficiently store fat for times of famine, says Veech, but we
also evolved ketosis to efficiently live off that fat when necessary. Rather
than being poison, which is how the press often refers to ketones, they make
the body run more efficiently and provide a backup fuel source for the
brain. Veech calls ketones ''magic'' and has shown that both the heart and
brain run 25 percent more efficiently on ketones than on blood sugar.
The bottom line is that for the better part of 30 years Atkins insisted his
diet worked and was safe, Americans apparently tried it by the tens of
millions, while nutritionists, physicians, public-health authorities and
anyone concerned with heart disease insisted it could kill them, and
expressed little or no desire to find out who was right. During that period,
only two groups of U.S. researchers tested the diet, or at least published
their results. In the early 70's, J.P. Flatt and Harvard's George Blackburn
pioneered the ''protein-sparing modified fast'' to treat postsurgical
patients, and they tested it on obese volunteers. Blackburn, who later
became president of the American Society of Clinical Nutrition, describes
his regime as ''an Atkins diet without excess fat'' and says he had to give
it a fancy name or nobody would take him seriously. The diet was ''lean
meat, fish and fowl'' supplemented by vitamins and minerals. ''People loved
it,'' Blackburn recalls. ''Great weight loss. We couldn't run them off with
a baseball bat.'' Blackburn successfully treated hundreds of obese patients
over the next decade and published a series of papers that were ignored.
The second trial, published in September 1980, was done at the George
Washington University Medical Center. Two dozen obese volunteers agreed to
follow Atkins's diet for eight weeks and lost an average of 17 pounds each,
with no apparent ill effects, although their L.D.L. cholesterol did go up.
The researchers, led by John LaRosa, now president of the State University
of New York Downstate Medical Center in Brooklyn, concluded that the
17-pound weight loss in eight weeks would likely have happened with any diet
under ''the novelty of trying something under experimental conditions'' and
never pursued it further.
Now researchers have finally decided that Atkins's diet and other low-carb
diets have to be tested, and are doing so against traditional
low-calorie-low-fat diets as recommended by the American Heart Association.
To explain their motivation, they inevitably tell one of two stories: some,
like Stunkard, told me that someone they knew-a patient, a friend, a fellow
physician-lost considerable weight on Atkins's diet and, despite all their
preconceptions to the contrary, kept it off. Others say they were frustrated
with their inability to help their obese patients, looked into the low-carb
diets and decided it was compelling. ''As a trained physician, I was trained
to mock anything like the Atkins diet,'' says Linda Stern, an internist at
the Philadelphia Veterans Administration Hospital, ''but I put myself on the
diet. I did great. And I thought maybe this is something I can offer my
None of these studies have been financed by the N.I.H., and none have yet
been published. But the results have been reported at conferences-by
researchers at Schneider Children's Hospital on Long Island, Duke University
and the University of Cincinnati, and by Stern's group at the Philadelphia
V.A. Hospital. And then there's the study Stunkard had mentioned, led by
Gary Foster at the University of Pennsylvania, Sam Klein, director of the
Center for Human Nutrition at Washington University in St. Louis, and Jim
Hill, who runs the University of Colorado Center for Human Nutrition in
Denver. The results of all five of these studies are remarkably consistent.
Subjects on some form of the Atkins diet-whether overweight adolescents on
the diet for 12 weeks as at Schneider, or obese adults averaging 295 pounds
on the diet for six months, as at the Philadelphia V.A.-lost twice the
weight as the subjects on the low-fat, low-calorie diets.
In all five studies, cholesterol levels improved similarly with both diets,
but triglyceride levels were considerably lower with the Atkins diet. Though
researchers are hesitant to agree with this, it does suggest that
heart-disease risk could actually be reduced when fat is added back into the
diet and starches and refined carbohydrates are removed. ''I think when this
stuff gets to be recognized,'' Stunkard says, ''it's going to really shake
up a lot of thinking about obesity and metabolism.''
Edited and posted by
Dr. Saul Pressman
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