“Doctor, how do I lose weight? Should I try Atkins?”
Recently one of my patients asked me this question. Let’s just call him David. He avoided looking into my eyes, almost as he had said something shameful. He had been gaining weight for some time, his height was 180 cm, his weight was 110 kg (242 lbs), BMI was 34 kg/m2. His blood pressure was to high and his blood tests showed elevated blood sugar, indicating mild type 2 diabetes. I do not blame him for almost not daring to mention Atkins, many health professionals even avoid the word.
“As a matter of fact think you should try Atkins” I told him. He seemed a bit surprised. “Can I eat all that fat doctor? Don´t you think it will kill me? I took some time explaining to him why I actually thought Atkins or some other “low carb – high fat” diet might help him improve his health. Today there is a lot of scientific evidence behind such diets and studies show they can be very helpful, especially if you have to lose weight.
Low carbohydrate diets have enjoyed increasing popularity in recent years, particularly to fight obesity. In the Scandinavian countries these diets are commonly referred to as LCHF (Low Carb High Fat). As the name suggests, they contain small amounts of carbohydrates. Usually carbohydrates are our main source of energy. That’s actually what the authorities recommend, more than half of our energy should come from carbohydrates. Therefore, when we cut down on carbohydrates we have to get energy from something else. The most common solution is to increase fat consumption.
Public health authorities and professional associations usually underline the importance of right balance among our daily sources of energy. Thus, about 60% should come from carbohydrates, 25% from fat (no more than 10% from saturated fat) and 15% from proteins. Low carbohydrate diets severely contradict these recommendations, carbohydrate consumption is much lower, and usually considerably more fat is consumed.
Many supporters of low carbohydrate diets have argued that excessive carbohydrate consumption is the main cause of the obesity epidemic in the US and many other western countries. Recent evidence actually suggests they might have a case. Most agree that carbohydrates and sugars are an easy source of energy. Carbohydrates that the body does not use as immediate fuel are stored in the form of glycogen, mainly in the liver. However, this storage capacity is limited and when the glycogen storage pathway is fully used, the body starts to store excess energy as fat. This promotes overweight and obesity. With the extra weight it becomes difficult for us to exercise, we get easily tired, muscle and joint pain becomes more common, our blood cholesterol levels worsen, blood pressure becomes higher and the risk of type 2 diabetes increases.
For individuals who are overweight or obese an LCHF diet is usually very effective to lose weight. This has been confirmed in many scientific studies. I have seen many people lose weight quickly and gain a better life with the help of LCHF diets. Many physicians, especially cardiologists, however, have been concerned that LCHF can adversely affect blood lipids because in most cases fat consumption is increased significantly. We have to get energy for the body’s cells from somewhere when carbohydrates are not around. If we don’t, the body has to retrieve protein from muscle, break them down to amino acids which are used as fuel. This leads to muscle wasting and reduced muscle mass, which is of course undesirable. It is not advisable to increase the consumption of dietary protein to much for different reasons, apart from the fact that proteins are not a particularly powerful source of energy. Fat, however, is a good source of energy.
But what does the Atkins diet and other low carb diets do to our cholesterol and other blood lipids? This actually may vary a lot between individuals. Many have concluded that if we increase the consumption of saturated fat and cholesterol it may significantly worsen our blood lipids and raise cholesterol. However, this is not really the case if you cut down on carbohydrates at the same time as you increase the fats. Studies even suggest that such a diet may have positive effects on blood lipids. Blood levels of HDL-cholesterol (the good cholesterol) generally increase and triglyceride levels decrease. LDL-cholesterol (the bad cholesterol) may increase a bit in some cases. The effect on blood sugar, however, is generally very positive especially if you have diabetes.
If carbohydrate intake is negligible, the body is forced to burn fat. Muscles and most organs can use fatty acids for fuel but the same does not apply for the brain because it does not have an easy access to fatty acids. The brain however can use ketones for fuel. Ketones are compounds formed by the breakdown of fatty acids. With increased ketone production the body goes into a state which is called ketosis. In this way fuel for important organs such as the brain and the heart is provided. This situation should not be confused with ketoacidosis, sometimes seen in individuals with diabetes which can be a dangerous situation. Atkins saw ketosis as a desirable phenomenon and simply an evidence that the body was burning fat. Many professionals, however have considered ketosis to be undesirable although there does not appear to be much scientific rationale behind this opinion.
The Atkins diet has for a long time been considered to be the flagship among the low carbohydrate diets. Atkins, who himself was a cardiologists, gave a strong theoretical argument for why it could be desirable to reduce carbohydrate intake and increase consumption of fat, even saturated fat. Despite this, his concepts have long been considered a taboo among many health professionals. In part, I think this is based on a misconception because most of the criticism has focused on the first stage of the Atkins diet, which usually only lasts for two weeks. In this stage very little carbohydrates are allowed, but fat consumption is promoted. Another criticism has been directed at the amount of saturated fat promoted in the Atkins diet. Atkins believed that saturated fats would not harm you if you at the same time cut down on carbohydrates. In addition, the association between the consumption of saturated fats and the risk of cardiovascular disease is still unclear. The South Beach diet differs from Atkins in this regard, as South Beach encourages the intake of polyunsaturated fatty acids rather than saturated fats. Many cardiologists have, for this reason recommended the South Beach Diet rather than Atkins.
My opinion is that the Atkins diet and other LCHF can often be very useful. If you suffer from obesity, have a lot of abdominal fat or need to lose weight because of diabetes, hypertension or other reasons, it is very likely that the Atkins diets or other LCHF diets will help you gain a better health. However, consult a physician before you start an LCHF diet as there may be some things that need to be addressed before such major changes are made to your diet and lifestyle. The Atkins diet has evolved significantly since Robert Atkins wrote his first book in 1972. It is today considered by many experts to be more sensible than before. It is based on fairly sound and strong scientific arguments.
I saw my patient David recently. He was feeling much better. He had lost 8 kilos (17.6 lbs) in ten weeks. He had not taken the Atkins diet stage by stage, but he had changed his diet according to the LCHF concepts. He had cut out bread, potatoes, rice, pasta and sodas. He was eating a lot of eggs, cheese, meat, fish and vegetables and was slowly starting to introduce fruits again as well as whole corn bread. He had never felt hungry. He was now going for sixty minutes walks six days a week. His quality of life had improved. What’s most important is that he had realized that his own actions could improve his health. I congratulated him. This time he was looking into my eyes and there was a faint smile on his lips.