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.