The Truth About The Atkins Diet

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2.50H E A LT Hy: se ySo mi lito a 8—ePr . R g eavs — pNOVEMBER 2002VOLUME 29 / NUMBER 9CENTER FOR SCIENCE IN THE PUBLIC INTERESTL E T T E RTMT h e Tr u t hAbout theAtkins DietBy Bonnie Liebman“What If It’s All Been a Big Fat Lie?”asked the cover story of the July 7thNew York Times Magazine. The article, by freelance writer Gary Taubes,argues that loading our plates withfatty meats, cheeses, cream, and butter is the key not just to weight loss,but to a long, healthy life.“Influential researchers are beginning to embrace the medical heresythat maybe Dr. Atkins was right,”writes Taubes.Taubes claims that it’s not fattyfoods that make us fat and raise ourrisk of disease. It’s carbohydrates.And to most readers his argumentssound perfectly plausible.Here are the facts—and the fictions—in Taubes’s article, whichhas led to a book contract with areported 700,000 advance. Andhere’s what the scientists he quoted—or neglected to quote—have tosay about his reporting.(Continued on page 3)

C O V E RPerhaps the most telling statement in Gary Taubes’s NewYork Times Magazine articlecomes as he explains how difficult it is to study diet andhealth. “This then leads to a research literature so vast that it’s possible to find atleast some published research to supportvirtually any theory.”He got that right. It helps explain whyTaubes’s article sounds so credible.“He knows how to spin a yarn,” saysBarbara Rolls, an obesity expert atPennsylvania State University. “Whatfrightens me is that he picks and chooseshis facts.”She ought to know. Taubes interviewed her for some six hours, and shesent him “a huge bundle of papers,” buthe didn’t quote a word of it. “If the factsdon’t fit in with his yarn, he ignoresthem,” she says.Instead, Taubes put together whatsounds like convincing evidence thatcarbohydrates cause obesity.“He took this weird little idea and blewit up, and people believed him,” says JohnFarquhar, a professor emeritus ofmedicine at Stanford University’s Centerfor Research in Disease Prevention.Taubes quoted Farquhar, but misrepresented his views. “What a disaster,” saysFarquhar.Others agree. “It’s silly to say that carbohydrates cause obesity,” says GeorgeBlackburn of Harvard Medical School andthe Beth Israel Deaconess Medical Centerin Boston. “We’re overweight becausewe overeat calories.”It’s not clear how Taubes thought hecould ignore—or distort—whatresearchers told him. “The article waswritten in bad faith,” says F. Xavier PiSunyer, director of the Obesity ResearchCenter at St. Luke’s-Roosevelt HospitalCenter in New York. “It was irresponsible.”Here’s a point-by-point response toTaubes’s major claims.S TTheTr u t hAbouttheAtkinsDietCLAIM #1: The experts recommend an Atkins diet.TRUTH: They don’t.An Atkins diet is loaded with meat,butter, and other foods high in saturated fat. Taubes implies that many ofthe experts he quotes recommend it.Here’s what they say: “The article was incredibly mislead-ing,” says Gerald Reaven, the pioneering Stanford University researcher,now emeritus, who coined the term“Syndrome X.” “My quote was correct, but the context suggested that Isupport eating saturated fat. I washorrified.”“Gary Taubestricked us allinto comingacross assupportersof theAtkins diet.”— John FarquharStanford University According to Taubes, HarvardUniversity’s Walter Willett is one of the“small but growing minority of establishment researchers [who] have cometo take seriously what the low-carb-dietdoctors have been saying all along.”True, Willett is concerned about theharm that may be caused by highcarbohydrate diets (see “What to Eat,”page 7). But the Atkins diet? “I certainly don’t recommend it,” he says.His reasons: heart disease and cancer.“There’s a clear benefit for reducingcardiovascular risk from replacingunhealthy fats—saturated and trans—with healthy fats,” explains Willett,who chairs Harvard’s nutrition department. “And I told Taubes several timesthat red meat is associated with a higherrisk of colon and possibly prostate cancer, but he left that out.” “I was greatly offended at how GaryTaubes tricked us all into coming acrossas supporters of the Atkins diet,” saysStanford’s John Farquhar.Taubes’s article ends with a quotefrom Farquhar, asking: “Can we get thelow-fat proponents to apologize?” Butthat quote was taken out of context.“What I was referring to wasn’t thatlow-fat diets would make a person gain››››NUTRITION ACTION HEALTHLETTER N O V E M B E R 2 0 0 23

C O V E Rweight and become obese,” explainsFarquhar. Like Willett and Reaven, he’sworried that too much carbohydratecan raise the risk of heart disease.“I meant that in susceptible individuals, a very-low-fat [high-carb] diet canraise triglycerides, lower HDL [‘good’]cholesterol, and make harmful, small,dense LDL,” says Farquhar.Carbohydrates are not what hasmade us a nation of butterballs, however. “We’re overfed, over-advertised,and under-exercised,” he says. “It’s theenormous portion sizes and sitting infront of the TV and computer all day”that are to blame. “It’s so gol’darnobvious—how can anyone ignore it?”“The Times editor called and tried toget me to say that low-fat diets werethe cause of obesity, but I wouldn’t,”adds Farquhar.CLAIM #2: Saturated fatdoesn’t promote heart disease.TRUTH: It does.If there’s any advice that experts agreeon, it’s that people should cut back onsaturated fat. They’ve looked not justat its effect on cholesterol levels, but onits tendency to promote blood clots, raiseinsulin levels, and damage blood vessels.They’ve issued that advice after examining animal studies, population studies, and clinical studies.1-3 Taubes dismisses them with one narrow argument.Saturated fats, he writes, “will elevateyour bad cholesterol, but they will alsoelevate your good cholesterol. In otherwords, it’s a virtual wash.”Experts disagree. “Fifty years ofresearch shows that saturated fat andcholesterol raise LDL [‘bad’] cholesterol, and the higher your LDL, thehigher your risk of coronary heart disease,” says Farquhar. Yet Taubes has noqualms about encouraging people toeat foods that raise their LDL.He’s willing to bet that higher HDL(“good”) cholesterol will protect them.No experts—at the American HeartAssociation; National Heart, Lung, andBlood Institute; or elsewhere—wouldtake that risk.“The evidence that raising HDL isprotective is less solid than the evidence that raising LDL is bad,” saysDavid Gordon, a researcher at theNational Heart, Lung, and BloodInstitute.4S T O R Y“My quote wascorrect, butthe contextsuggestedthat I supporteating saturated fat. I washorrified.”— Gerald ReavenStanford UniversityCLAIM #3: Health authoritiesrecommended a low-fat diet asthe key to weight loss.TRUTH: They didn’t.“We’ve been told with almost religiouscertainty by everyone from the SurgeonGeneral on down, and we have cometo believe with almost religious certainty, that obesity is caused by theexcessive consumption of fat, and thatif we eat less fat we will lose weight andlive longer,” writes Taubes.It’s true that some diet books, notablyDean Ornish’s Eat More, Weigh Less,have encouraged people to eat as muchfat-free food as they want. (Of course,Ornish is talking about fruits, vegetables, and whole grains, not fat-freecakes, cookies, and ice cream.) But“everyone from the Surgeon Generalon down” is baloney.“The Surgeon General’s report doesn’tsay that fat causes obesity,” saysMarion Nestle, who was managing editor of the report and is now chair of thenutrition and food studies depart-mentat New York University. “Fat has twicethe calories of either protein or carbohydrate. That’s why fat is fatteningunless people limit calories from everything else.”And health authorities like theAmerican Heart Association; NationalHeart, Lung, and Blood Institute; andU.S. Department of Agriculture neverurged people to cut way back on fat.Their advice: “Get no more than 30percent of calories from fat.” At thetime that advice was issued, the averageperson was eating 35 percent fat.NUTRITION ACTION HEALTHLETTER N O V E M B E R 2 0 0 2CLAIM #4: We’re fat because weate a low-fat diet.TRUTH: We never ate a low-fatdiet.“At the very moment that the government started telling Americans to eatless fat, we got fatter,” says Taubes.“We ate more fat-free carbohydrates,which, in turn, made us hungrier andthen heavier.”It’s hard to believe this claim passedthe laugh test at The Times. If youbelieve Taubes, it’s not the 670-calorieCinnabons, the 900-calorie slices ofSbarro’s sausage-and-pepperoni-stuffedpizza, the 1,000-calorie shakes orDouble Whoppers with Cheese, the1,600-calorie buckets of movie theaterpopcorn, or the 3,000-calorie orders ofcheese fries that have padded our backsides. It’s only the low-fat Snackwells,pasta (with fat-free sauce), and bagels(with no cream cheese).“It’s preposterous,” says SamuelKlein, director of the Center for HumanNutrition at the Washington UniversitySchool of Medicine in St. Louis.“There’s no real evidence that low-fatdiets have caused the obesity epidemic.”Taubes argues that in the late 1970s,health authorities started tellingAmericans to cut back on fat, and thatwe did. Wrong.According to the U.S. Department ofAgriculture, added fats (oils, shortening,lard, and beef tallow) have gone upsteadily since the late 1970s (see“Hardly a Low-Fat Diet”). Total fats(which include the fat in meats, cheese,and other foods) have also gone up,though not as steadily.So how can Taubes write that “themajor trends in American diets, according to USDA agricultural economistJudith Putnam, have been a decrease inthe percentage of fat calories and a‘greatly increased consumption of carbohydrates’”?The key is the word “percentage.”The percentage of fat calories in ourdiets declined because, while we atemore fat calories, we ate even morecarbohydrate calories.“We’re eating roughly 500 caloriesa day more than we did in 1980,”Putnam told us. “More than a third ofthe increase comes from refined grains,a fifth comes from added sugars, and athird comes from added fats.”

C O V E RGovernment surveys show nochange—or a slight decrease—in fatconsumption since the late 1970s. Butthey don’t look at how much fat is produced, how much is sold, and howmuch is wasted. The surveys simplyask consumers what they eat. And it’spossible that once people were told toeat less fat, they (consciously or unconsciously) started under-reporting howmuch they ate.Says Putnam: “People don’t adequately report added fats, added sugars,and refined grains.”The bottom line: Taubes blames theobesity epidemic on a low-fat diet thatthe nation never ate.CLAIM #5: Carbs, not fats, causeobesity.TRUTH: The evidence blamingobesity on carbs is flimsy.The evidence that carbohydrates makeyou fat can be called “Endocrinology101,” says Taubes, implying that it’swell-established fact. In a nutshell,Endocrinology 101 says that “we’re hungrier than we were in the ‘70s” becausewe’re eating more carbohydrates.“Sugar and starches like potatoes andrice, or anything made from flour, likea slice of white bread,” are “known inthe jargon as high-glycemic-index carbohydrates, which means they areabsorbed quickly into the blood,”explains Taubes.“As a result they cause a spike ofblood sugar and a surge of insulinwithin minutes. The resulting rush ofinsulin stores the blood sugar awayand a few hours later, your blood sugaris lower than it was before you ate.“It’s preposterous.There’s no realevidence thatlow-fat dietshave causedthe obesityepidemic.”—Samuel KleinWashington UniversitySchool of MedicineS T O R YHardly a Low-Fat DietThe result isAdded Fats & Oils in the Food Supplyhunger and acraving for morecarbohydrates.”It sounds convincing, butthere’s a problem:“It’s not provenat all,” says PennState’s BarbaraRolls. “We haveno firm data thatglycemic indexaffects bodyweight or howfull people feelafter eating.”Harvard’sDavid Ludwig hasdone a few studies on glycemicindex and weight.In the largest, heAccording to Taubes, a low-fat diet has made us fat. Yet our confound that 64sumption of all added fats combined (red line) is higher than everoverweight adobefore. Estimates of total fat (not shown), which includes the fatslescents who werein meats, dairy, etc., also show a rise since the late 1970s. The bottold to eat lowertom line: Americans never went on a low-fat diet.glycemic-indexSource: USDA/Economic Research Service.foods lost anaverage of fourpounds, while 43overweight adolescents who were toldthere is no good evidence that insulinto make modest cuts in calories and fattriggers weight gain. “Insulin crosses thegained three pounds.4blood-brain barrier and turns off food“It’s hard to tease apart what led tointake,” says Pi-Sunyer. “That makesthe weight loss in that study,” explainssense. You’ve just eaten, so you don’tRolls, “because calorie density, fiber,need to eat for a while. If anything,and glycemic index all go hand ininsulin should lower food intake.”hand.”In other words, foods with a lowCLAIM #6: The Atkins diet isglycemic index—most vegetables,the best way to lose weight.fruits, and whole grains—are also highTRUTH: We don’t know the bestin fiber and low in calorie density.way to lose weight.What’s more, Ludwig’s study didn’t“Until we have more research, no onerandomly assign children to one diet orhas the solution to the safest and mostanother, so the two groups weren’teffective weight loss,” says Washingtoncomparable. “The low-glycemic-indexUniversity’s Samuel had fewer minorities,” says“Preliminary data from several studColumbia’s Pi-Sunyer. Whites in bothies suggest that, at least over the shortgroups were more likely to lose weight.term, the Atkins diet is superior to aAnd he and others question thelow-fat diet in a free-living environ5whole glycemic index theory. Amongment,” he says. “But it’s too early tohis criticisms: “People eat meals, wheresay that the Atkins diet is better.”low-glycemic foods balance out highEven if ongoing studies show thatglycemic foods.”theAtkins diet promotes weight loss,For example, “people don’t eat pastawewon’tknow if other diets—onesalone,” he explains. “They eat it withhigh in unsaturated fat or protein orolive oil, clams, tomatoes, or othervegetables and whole grains, for examfoods, and that dampens the differple—would work as well or better.ences in their effects on insulin.”And, contrary to Taubes’s claims,››››NUTRITION ACTION HEALTHLETTER N O V E M B E R 2 0 0 25

C O V E R“We need lots more randomizedcontrolled trials to evaluate the different permutations,” says Walter Willett.(He and Blackburn are embarking on astudy testing a high-unsaturated-fatMediterranean diet, not the highsaturated-fat Atkins diet, as Taubesimplies.)“What’s important is not theories,but evidence.”CLAIM #7: The Atkins dietworks because it cuts carbohydrates.TRUTH: If the Atkins dietworks, it’s not clear why.If the Atkins diet does work, it mayhave nothing to do with the glycemicindex or Atkins’s promises. “It’sunlikely to be related to the explanation in Atkins’s book,” says Klein,“because that doesn’t make physiological sense.”Other possibilities: In one study, thepeople on a low-carb diet were told tofollow Dr. Atkins’ New Diet Revolution,which could have been more persuasive than what the people on a lowerfat diet got—a manual designed byacademics.Or, says Klein, “it may simply be easier to cut carbs.” Everyone knows whatthey are: bread, pasta, rice, potatoes,sweets, etc.Or, the monotony of a low-carb dietcould have curbed the dieters’ appetites.“You lose a lot of foods when you cutout carbs,” says Klein. And with lessvariety, says Blackburn, “people eatless, so they lose more weight.”“It’s also possible that a chemical isreleased by a high-fat diet that suppresses the appetite,” adds Klein. “Wejust don’t know.”S T O R Ythe other if it can hurt your bones?”The problem: All the protein thatAtkins recommends leads to acidicurine.6 “And there’s no dispute that anacid urine leaches calcium out ofbones,” says Blackburn.“You can buffer the diet by taking acouple of Tums a day, but now we’reinto medical supervision of people onthe diet,” he adds.Blackburn and others also want toknow whether an Atkins diet makes theblood vessels less elastic. “Studies suggest that a diet high in animal fats maycause blood vessels to constrict,” hesays. “That’s a root cause of atherosclerosis.”In preliminary studies, the LDL(“bad”) cholesterol of people on theAtkins diet didn’t go up. That’s comforting. (Of course, LDL didn’t go downeither, as it usually does with weightloss.)“The harm caused by saturated fatcould be overcome by weight loss,”Klein explains. But what happens oncepeople stop losing weight and start trying to maintain the loss? Will theirLDL climb? “We don’t know.”“It’s silly to saythat carbohydrates causeobesity. We’reoverweightbecause weovereat calories.—George BlackburnHarvard University”CLAIM #8: The Atkins diet is safe.TRUTH: It isn’t.Taubes not only neglects to mentionthat the meat in an Atkins diet maypromote cancer. He ignores someresearchers’ concerns about otheradverse effects.“The Atkins diet may produce moreweight loss in the first three weeks, butit’s not spectacular,” says Harvard’sGeorge Blackburn. “Who cares if onegroup loses a few more pounds than6CLAIM #9: Low-fat diets don’thelp people lose weight.TRUTH: Low-fat diets work ifdieters cut calories.“Low-fat weight-loss diets have provedin clinical trials and real life to be dismal failures,” writes Taubes.It’s not clear which clinical trials he’sNUTRITION ACTION HEALTHLETTER N O V E M B E R 2 0 0 2referring to. In 1998, the NationalHeart, Lung, and Blood Institute issuedguidelines to help doctors treat obesity.7Its conclusion: People who are toldto cut fat (but not calories) lose someweight because they inadvertently eatfewer calories. But people who cut fatand watch calories lose more.“A low-fat diet helps people eat fewercalories,” says Rena Wing, a professorof psychiatry and human behavior atthe Brown University Medical Schoolin Providence, Rhode Island. “Maybepeople want to hear that if they eat alower-fat diet they don’t have to eatfewer calories, but that’s not true.”What about Taubes’s claim that lowfat diets are a failure “in real life”?Wing’s National Weight LossRegistry keeps track of people—so far,about 3,000—who report having lost atleast 30 pounds and having kept theweight off for at least six years.8 Theregistry can’t “prove” which diet is bestbecause it’s not a controlled experiment. But it does offer evidence ofwhat works in the long run.“People on low-carbohydrate dietslike Atkins’s are very rare in the registry,” says Wing.“The people in our registry consistently report eating around 24 percentof calories from fat,” she adds. They alsoexpend roughly 2,800 calories a week—that’s like walking four miles a day.Furthermore, a low-fat diet aidedweight loss in a six-year study of 3,200people called the Diabetes PreventionProgram.9“Patients were put on a low-fat dietwith about 25 percent of calories fromfat and they participated in 150 minutesof physical activity a week,” says Wing.“They lost about seven percent oftheir body weight and kept most of it offfor four years. And they reduced theirrisk of diabetes by 58 percent.”Of course, it was both diet and exercise that led to their success. But if alow-fat diet promotes weight gain, asTaubes argues, the exercise—onlyabout 20 minutes a day—would havehad to not only counter the fatteningeffects of the low-fat diet, but actuallylead to weight loss. Unlikely.

“I told Taubesseveral timesthat red meatis associatedwith a higherrisk of colon andpossibly prostatecancer, but heleft that out.”—Walter WillettHarvard UniversityCLAIM #10: Taubes examinedthe evidence objectively.TRUTH: He let his biases rule.The New York Times Magazine isn’t theNational Enquirer. Readers expect TheTimes to run articles that are honestlyreported and written. Yet in August,The Washington Post revealed thatTaubes simply ignored research thatdidn’t agree with his conclusions.For example,

It’s hard to believe this claim passed the laugh test at The Times. If you believe Taubes, it’s not the 670-calorie Cinnabons, the 900-calorie slices of Sbarro’s sausage-and-pepperoni-stuffed pizza, the 1,000-calorie shakes or Double Whoppers with Cheese, the 1,600-calorie buckets of movie theater popcorn, or the 3,000-calorie orders of

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