Robert Atkins, MD

Dr. Robert Atkins was the cre­ator of the “Atkins Diet,” which was yet anoth­er rein­car­na­tion of the low-car­bo­hy­drate diet first advo­cat­ed by Vic­to­ri­an under­tak­er William Bant­i­ng. Atkins tried the diet him­self in the ear­ly 1960s, after hav­ing read about it in a med­ical jour­nal. He then con­vert­ed his fledg­ling car­di­ol­o­gy prac­tice into an obe­si­ty prac­tice on the Upper East Side of Man­hat­tan. The Atkins diet was first launched as “The Vogue Diet” in an arti­cle in Vogue mag­a­zine. Dr. Atkins fol­lowed this up with his 1972 best-sell­er, Dr. Atkins’ Diet Rev­o­lu­tion, which became a best-sell­er. Since then, the Atkins diet and its imi­ta­tors have peri­od­i­cal­ly come back into vogue.

The basic prin­ci­ple of the Atkins diet is very sim­ple, although its phys­i­o­log­ic effects are com­pli­cat­ed and con­fus­ing. The dieter sim­ply avoids eat­ing foods that con­tain car­bo­hy­drates (sug­ars and starch­es). It’s one thing to tell peo­ple to give up foods that con­tain refined sug­ar, such as can­dy and dough­nuts and sug­ary soft drinks. How­ev­er, many peo­ple in the nutri­tion field became alarmed when Atkins told peo­ple to avoid bread, rice, pas­ta, pota­toes, and beans, as well as fruit. They became even more dis­turbed when they real­ized that a car­di­ol­o­gist was encour­ag­ing peo­ple to eat ani­mal-based foods, such as meat, eggs, cheese, and fish, which con­tain cho­les­terol and sat­u­rat­ed fat. By going on an Atkins-type diet, the dieter is basi­cal­ly trad­ing starch­es and sug­ars for more fat, includ­ing sat­u­rat­ed fat. How could a car­di­ol­o­gist, of all peo­ple, make such a rec­om­men­da­tion?

Many of the ear­ly fears about the Atkins pro­gram were great­ly exag­ger­at­ed. Any anthro­pol­o­gist could have explained that of course peo­ple could sur­vive on an Atkins-type diet for an extend­ed peri­od of time with­out too many dra­mat­ic ill effects. The Atkins diet basi­cal­ly mim­icks the tra­di­tion­al diet of the Inu­it (Eski­moes), except that it includes low-calo­rie veg­eta­bles, such as sal­ads. The Inu­it sur­vived on their tra­di­tion­al diet for extend­ed peri­ods for thou­sands of years. They were nev­er the health­i­est peo­ple on earth, but they man­aged to sur­vive in an extreme­ly chal­leng­ing envi­ron­ment. Yet they have poor health sta­tis­tics, includ­ing high rates of osteo­poro­sis and a short life expectan­cy. No ratio­nal per­son would want to fol­low that kind of a diet unless there were no alter­na­tive, as there gen­er­al­ly wasn’t dur­ing the win­ter in the high Arc­tic.

For some­one fol­low­ing the Atkins diet, the objec­tive is to enter a state called “keto­sis.” When the body runs low on blood sug­ar, the liv­er starts to make new blood sug­ar from its stores of a car­bo­hy­drate called glyco­gen and from the amino acids made from break­ing down pro­tein. It also starts to depend more heav­i­ly on fat for a fuel. When the body burns a lot of fat but lit­tle car­bo­hy­drate, it pro­duces a lot of acidic break­down prod­ucts, includ­ing ace­tone, that are col­lec­tive­ly called “ketone bod­ies.” They give the breath the fruity odor of some­one with untreat­ed juve­nile dia­betes. When these build up high enough in the blood­stream, the con­di­tion is called keto­sis.

After the glyco­gen reserves are gone, the body then has to use amino acids as a source of sug­ar. How­ev­er, burn­ing pro­tein for ener­gy puts a strain on the liv­er and kid­neys, which then have to deal with the waste prod­ucts. Car­bo­hy­drates, in con­trast, pro­duce less in the way of tox­ic waste prod­ucts.

When peo­ple stop eat­ing car­bo­hy­drates, the body first starts to deplete the blood sug­ar (glu­cose). When the blood glu­cose lev­el dips, the liv­er con­verts some of its glyco­gen back to glu­cose. Using up the body’s glyco­gen stores frees up sev­er­al pounds of water, which is then excret­ed through the kid­neys, giv­ing the illu­sion that the dieter is rapid­ly los­ing weight. When the body enters the state of “keto­sis,” the ketone bod­ies have a diuret­ic effect on the body, thus caus­ing more water weight to be lost. As a result, much of the weight lost dur­ing the first phase of the Atkins diet is water, not fat, and will come right back as soon as the per­son starts eat­ing nor­mal­ly again and the liver’s nor­mal glyco­gen reserves are restored.

Dur­ing World War II, the Cana­di­an army acci­den­tal­ly ran a tri­al of an Atkins-type diet, when they fed sol­diers noth­ing but their emer­gency rations of pem­mi­can, which was basi­cal­ly dried beef with added fat. The sol­diers were inca­pac­i­tat­ed with­in three days, but recov­ered quick­ly when they resumed eat­ing car­bo­hy­drate. If the sol­diers had had sev­er­al weeks, they could have adapt­ed to the pem­mi­can diet. This means that they would have been able to per­form ordi­nary activ­i­ties and endurance exer­cise, but they wouldn’t have been at the top of their form in terms of weight-lift­ing or sprint­ing. This is hard­ly the ide­al con­di­tion for infantry­men to be in.

The only way to lose weight is to eat few­er calo­ries than you burn up. The Atkins diet achieves this by sup­press­ing the appetite, by mim­ic­k­ing a state that occurs in star­va­tion or severe ill­ness. If the per­son man­ages to lose body fat as a result, then some of the bad effects of obe­si­ty, such as type 2 dia­betes, will start to dimin­ish. How­ev­er, it is far more effec­tive and safer to achieve these health ben­e­fits by a tru­ly healthy diet, which is a low-fat, high-fiber, plant-based diet.

The Atkins diet is a par­tic­u­lar­ly bad idea for peo­ple who already have type 2 dia­betes, for two rea­sons. First, peo­ple with dia­betes are already at risk for kid­ney dam­age. Their kid­neys don’t need the extra stress from a high-fat, high-pro­tein diet. Sec­ond, a high-fat diet has been known since the 1930s to cause insulin resis­tance, even in healthy peo­ple. It would be far bet­ter to switch to a starchy, high-fiber diet that is low in fat and pro­tein. That kind of diet has been proven to reverse type 2 dia­betes and is good for the kid­neys.

Robert Atkins was a bit of a self-pro­mot­er. He had once even con­sid­ered a career as a night­club enter­tain­er before he became a doc­tor. He start­ed pro­mot­ing his diet long before he had done any­thing resem­bling real clin­i­cal research to sup­port it. In lat­er years, his clin­ic on the Upper East Side of Man­hat­tan tried to branch out into oth­er kinds of unre­li­able “alter­na­tive” ther­a­pies, such as the use of ozone to treat can­cer. His real mon­ey­mak­er, how­ev­er, was his line of diet foods.

In the 1970s, Atkins appear on tele­vi­sion to debate Nathan Pri­tikin, an inven­tor who had a low-fat, high-fiber, plant-based approach to con­trol­ling weight and revers­ing heart dis­ease. Pri­tikin had cured his own coro­nary artery dis­ease by this approach. When Pri­tikin died at age 69 in 1985, because of com­pli­ca­tions of radi­a­tion-induced leukemia, the autop­sy report in the New Eng­land Jour­nal of Med­i­cine showed that Pri­tikin had no signs of heart dis­ease, and his arter­ies were as soft and pli­able as a teenager’s. “In a man 69 years old, the near absence of ath­er­o­scle­ro­sis and the com­plete absence of its effects are remark­able.” In con­trast, Atkins devel­oped car­diomy­opa­thy in 2000. Car­diomy­opa­thy is dam­age to the heart mus­cle. The most com­mon cause is coro­nary artery dis­ease; how­ev­er, Atkins claimed that his case was due to a rare viral infec­tion. No autop­sy results for Atkins were pub­lished, which is prob­a­bly because Atkins’ image remained alive and well in adver­tise­ments for Atkins Nutri­tion­als, Inc., and the truth about his health prob­lems might have been bad for the brand.