BERNARD V. MILLER III, M.D.,1 JOSEPH S. BERTINO Jr., Pharm.D.,1,2,3,4. ROBERTA G. REED, Ph.D.,4 CHRISTINE M. BURRINGTON, B.S.,4. LESLIE K.
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An Evaluation of the Atkins’ Diet BERNARD V. MILLER III, M.D.,1 JOSEPH S. BERTINO Jr., Pharm.D.,1,2,3,4 ROBERTA G. REED, Ph.D.,4 CHRISTINE M. BURRINGTON, B.S.,4 LESLIE K. DAVIDSON, B.A.,4 ALLAN GREEN, Ph.D.,4 ANNE M. GARTUNG, R.N., M.S., F.N.P.,2,4 and ANNE N. NAFZIGER, M.D., M.H.S.1,2,4
ABSTRACT Low-carbohydrate (LC) weight-reducing diets are popular choices for self-dieters. Eighteen adults (BMI 25 kg/m2) were enrolled in this short-term longitudinal study to evaluate dietary intake and weight on their “usual” diets and LC diet. Subjects were instructed to follow the first two phases of the diet described in Dr. Atkins’ New Diet Revolution (2 weeks each). Total daily intake of calories and nutrients were calculated from 3-day food diaries. Body weight was measured at the end of each 2-week diet session. All enrolled subjects completed the study (age = 39.8 ± 8.1 years, BMI = 36.6 ± 6.6 kg/m2). Mean caloric intakes were 1400 ± 472 kcal/day (Induction diet) and 1558 ± 490 kcal/day (Ongoing Weight Loss diet) both p 0.001 compared to “usual” (Baseline diet) 2481 ± 723 kcal/day. Body weights were 107.4 ± 24.2 kg, 103.6 ± 23.0 kg and 102.1 ± 22.6 kg at the conclusion of the Baseline, Induction, and Ongoing Weight Loss diets, respectively (both p 0.001). Decreases in daily caloric intake correlated with weight loss. Pearson correlation coefficients were, r = 0.64 (p 0.001) and r = 0.40 (p 0.001) for Induction and Ongoing Weight Loss diets versus “usual” diet. Caloric intake is decreased when otherwise healthy overweight and obese adults self-implement Atkins’ Induction and Ongoing Weight Loss diets and significantly altered their dietary micronutrient intake. Weight loss can be explained by the self-selected lower caloric intake on The Atkins’ Diet.
INTRODUCTION
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ATKINS’ DIET and other low carbohydrate (LC) diets are currently popular in American culture1 as the prevalence of obesity continues to increase making it a true epidemic and public health crisis.2 The effectiveness of LC diet has been a topic of debate for over 40 years.3,4 HE
Cardiovascular risk continues to be an important concern due to the restriction of multiple foods that are low fat and high fiber and inclusion of high fat, high cholesterol foods.5,6 LC diet studies in the obese have indicated more favorable metabolic benefit with regard to serum lipoproteins and insulin sensitivity than hypocaloric diets without carbohydrate
The 1Department of Internal Medicine, 2Clinical Pharmacology Research Center, 3Department of Pharmacy Services, and 4The Bassett Research Institute, Bassett Healthcare, Cooperstown, New York.
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restriction.7–10 Other evidence refutes a “metabolic advantage” and suggests that the LC diet temporarily shifts water and electrolyte balance,11–15 potentially affecting both lean body mass and fat mass blood flow. The Atkins’ Diet proposes weight reduction without conscious caloric restriction. The LC diet has been shown in randomized controlled trials (RCT) to produce greater weight loss than conventional weight reducing diet with minimal professional contact.7 It has been shown in other RCTs with dietary counseling that caloric intake is restricted following a LC diet.8,9 No studies have shown that caloric intake is decreased with minimal professional assistance (i.e., handing a subject the book). The aim of this short-term study was to evaluate the dietary intake and body weight of overweight or obese adults while on their “usual” diet compared with the first two stages of The Atkins’ Diet.
MATERIALS AND METHODS This study consisted of three consecutive diets lasting 2 weeks each. The “usual” or Baseline diet had no carbohydrate restriction and participants were asked to follow their usual eating patterns for 2 weeks after screening and return with completed 3-day diet records. Subjects were then supplied with a copy of Dr. Atkins’ New Diet Revolution18 and asked to read the book and follow the diets as described by Dr. Atkins. All subjects provided written informed consent prior to study participation. Subjects 18 years of age and body mass index (BMI) 25 kg/m2 were recruited from the local area for study. Medical history, physical examination and laboratory screening were performed to assure that participants were healthy and without history of cardiovascular disease. Screening sessions also included instruction for completion of 3-day diet records if subjects met inclusion and exclusion criteria. Additional exclusion criteria included the chronic use of any medication and any history of clinically significant chronic illness including coronary artery disease, hypertension, diabetes mellitus, hyperlipidemia, gout,
nephrolithiasis, renal impairment, elevated liver function tests, and thyroid disorders. The Institutional Review Board of the Mary Imogene Bassett Hospital approved this study. The Atkins’ Diet instructs individuals to begin their weight loss diet with a 2-week period of severely reduced intake of dietary carbohydrates (
