Atkins Diet’s long term effects. Does it cause stroke or heart disease

Atkins Diet’s long term effects. Does it cause stroke or heart disease ?

Introduction
A household name, Atkinson Diet for weight loss, needs no introduction. What needs to be known about it is, how it works, as this research is about if Atkins Diet causes heart disease and stroke in the long run. There can not be a more pertinent question as that is what the controversy over Atkins Diet is all about in that it defies the traditional belief and logic that fat is responsible for triggering heart attacks.

Yes, late Dr Atkins, not a layman nor a naturopath but a medical scholar, introduced the concept in 1972, which raised many eyebrows of his own fraternity, of replacing Carbohydrate by Fat, Protein for producing weight loss. Controversy over it has been razing ever since till this moment as to how a known heart-disease-causing substance called fat cannot cause heart disease or stroke in a diet plan. This seems to have sidelined even the concerns about its weight loss remedy.

One need not be surprised to find there are equal numbers of studies on its side effects as there are for its weight loss claims. To be able to answer to this, one needs to dissect the concept on all sides before reviewing the literature of medical field on the goodness or otherwise of the Atkins diet and finally arriving at a conclusion through the knowledge gained.

Atkins found that carbohydrate was the culprit in causing weight problems in the human body and devised a radical plan of drastically reducing carbohydrate content  in the daily menu but at the same time introducing fatty substances of meat, eggs, cheese, butter, and even bacon which are anathema to traditional  weigh-loss advocates.

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While dieters all over are enthused with the results of Atkins’ radical plan, medical fraternity is not happy and rather worried over the whole plan.

How the concept works
Carbohydrates rich in rice, bread, pasta, cereals, fruits and vegetables provide our body what is called Glucose as a basic fuel which if given as plain glucose separately will get absorbed into the body cells through the blood stream very fast at the rate of thirty calories per minute. Glucose contains carbon and water and hence a carbohydrate. This simplest carbohydrate is called blood sugar and dextrose. The complex carbohydrate known as starch which plants use  to store glucose produced can be found in wheat, rice, corn, oats and vegetables like potatoes and plantains. And it takes glucose in starch to reach the blood stream a longer time at the rate of only two calories per minute. Carbohydrates apart, body also is used to fats and proteins for fuel. These are found in meat, poultry, fish, cheese, butter, cream, and oils.

The four-stage eating plan of Atkins diet consists of only 20 grams of carbohydrate per day in the first stage, fed in the form of salads and non-starchy vegetables and similar dosage and administration of 25 gms Carbohydrates for the second stage increased by 5 gms every week until the body reaches maximum weight loss. The third stage which is pre-maitenance stage gives the extra 10 gms per week as long as weight does not increase. In the fourth stage the individual for whom it will be a life maintenance dose allows him to chose from a wide variety of  foods restricted in carbohydrate content. The individual keeps the weight in check and also is able  eat more than in the three stages. Atkins diet also challenges the USDA Food Pyramid which recommends diet rich in carbohydrate diet of six to eleven servings per day discouraging use of fats, oils and sweets. As Atkins diet  in contrast gives freedom to dieters to consume what have been otherwise discouraged by other plans, it has been popular ever since 1970s. “According to the Atkins website, Atkins plan helps people less hungry and less deprived than many other diets”(Klein)

The mechanism of action
Atkins diet makes body logically to look for alternative sources of fuel when carbohydrate is denied to it. The fat therefore becomes handy for the body to switch over to. Bear in mind diet plan is resorted to by only obese persons rich with fat deposits in their body. A function of Insulin in the body is to convert sugar into energy ( fuel). And it helps body cells to absorb glucose from the carbohydrates by controlling the amount of sugar in the blood. The secreting insulin acts as a blood sugar regulator in the body. This hormone  takes unabsorbed glucose to the fat deposits as fat. It also prevents body to burn the stored fat.  This process known as insulin response is what aids body to accumulate fats.  This function becomes crucial when body finds the food scarce when carbohydrates are deliberately denied in a diet  plan.  It therefore follows  sugar rich and high carbohydrate foods will lead to accumulation of body fats.  With this theory in background, a low carbohydrate diet of Atkins plan, makes the theory work in the reverse direction by enabling body to release less insulin so that when insulin levels are normal, the body will begin to burn the fat as fuel which results in weight loss to the body of the individual. Insulin maintains a stable sugar level, and lets body burn the fat with minimum hunger and cravings. It will be therefore clear now that Atkins diet helps  control insulin levels by restricting  the amount of carbohydrate intake by an individual .

Literary Review
Atkins Diet has been the subject of controversy for over 33 years now and under attack from the medical fraternity for its supposedly dubious claims.  In the early period (1978) Forster H has said that the Atkins diet is similar to the banting diet brought by English Physician Harvey about 100 years ago relying exclusively on animal fats which are ketogenic. This revolutionary diet of Atkins though free of carobohydrate , has high content of fat, cholesterol and purines. It  casuses hyperlipidemia and ketosis which are notorious  health risks. Also hypercholesterolemia is to be found  in most  of the takers of this  diet.  Hypercholesterolemia develops rapidly even in children under this ketonic diet.. There was a Sippy diet with high fat content for peptic ulcer treatment  found to be responsible for increased incidence of coronary heart disease. Hence the above known facts of similar diets of early period seem to suggest potentially hazardous risks of Atkins diet and controlled study should be performed to rule out such risks but the study itself would be problematic because of feared risks.

Study of Davies ( 1994) says that Atkins diet is rich in high protein and fat but low in carbohydrate. As the diet free of carobohydrate, fat is mobilized resulting in ketogenisis in the body. After one week of Atkins diet, carbohydrate is introduced gradually and urine is tested for ketones and to ascertain the level of  carbohydrate. This level is known as CCL (critical carbohydrate level). Ketones will not be more than this CCL.

“CCL is an indicator for each individual of the amount of carbohydrates that can be consumed while allowing the person to lose weight”. (Atkins R.C. 1974).

Davies concludes, yet “there is. some doubt about the safety of this diet and it should only be followed under medical supervision” (Dickerson J. W.T. and Booth E.M. 1985)

Wood RJ, Volek JS, Davis SR, Dell’ova, Fernandez ML in their paper very relevant to this paper  concede that carbohydrate restricted diets (CRD) have  weight loss properties and also improvement in traditional markers for cardiovascular disease (CVD). Yet emerging CVD risk factors could not be ignored.. (Nutr Metab (Lond) 2006,May 4).

Fraser J.F, Long Den P (2003 Sept 5) have found Atkins is likely to cause acute porphyrias, a condition enzymes deficiency. The Atkins diet is supposedly lacking in enzymes, which are  essential for haem biosyntheis, their conclusion supports their fear of possible triggering of ICU admissions because of  potential conditions for developing Porphyrias.

“A case of relapse of panic and anxiety symptoms, after initiation of High protein, a very low carbohydrate diet” (Ehrenreich April 2006). This report is about a woman with  anxiety disorder history.  Though her panic-disorder was under control, she developed relapse of those panic symptoms after she started on Atkins diet.,apparently because of the low-carbo hydrate content.  Her medical history showed that she had relapse of the panic disorder symptoms on starting on Atkins diet and receding of those condition on withdrawl of the diet.  The report adds that it will be prudent to enquire about dieting style and changes of patients admitted for panic disorder.  An estimated  25 millions of Americans were on Atkins diet and one third of Ameican adult population kept  off too much of carbohydrates in their diet.(Gloede W: Dec 2003)

In the treatment of intractable pediatric epilepsy, Atkins diet was tested for its effectiveness as a modified diet and if it would promote ketosis with liberal dose of calories. The plan was to judge the modified Atkins diet would be efficacious and well tolerated in the treatment. The study conluded “A modified Atkins diet is an effective and well-tolerated therapy for intractable pediatric epilepsy.” .( Kossoff EH et al 2006 Feb).

Astrup et al (Lancet 2004 Sept) in their report titled “Atkins and other low carbohydrate diets: hoax or an effective tool for weight loss?” agree that the Atkins diet book which has been sold in 45 million copies in the last more than 30 years that its  effectiveness in reducing body weight in spite of self directed consumption of  fatty substances with reduction of carbohydrate alone to less than 30 grams per day is paradoxical but it may be due to literally absent carbohydrate causing depletion of glucose stock, excretion of bound water. And that the ketogenisis suppresses appetite with the highproetin, which not only satiates but also, is instantly decreasing food consumption.  However the study insists on a long-term study to observe fluctuations in  nutritional status and body composition while under  the low-carbohydrate diet, “and to assess fasting and postprandial cardiovascular risk factors and adverse effects. Without that information, low-carbohydrate diets cannot be recommended.” (Astrup et al 2004)

While commenting that about 66% of adults in America has BMI>25, 30% >30, 8% are diabetic and 24% are having metabolism disorders, Gou GT (2004) says he has compared several diet plans prevailing in the country. In his conclusions

on review of books and scientific reports on diets available for weight reduction and reduction of heart disease risk.,  he agrees that Atkins diet results in weight loss with some degree of risk and that it is not useful in the long run. But it seems to stand out amongst other diets studied by him.  According to him ‘Ultra low fat ones have no tolerence, NCEP Step I is not effective, NCEP Step II Diet, low fat with Mediterranean features is effective, Common Sense Diet with restriction in calories and carbohydrates (no comment on end result), South Beach Diet as carbohydrate restricted ( no comments on end result) and Mediterranean Diet heart protective with increased longevity ( no comment on weight loss).However no diet is effective without physical exercises.

Bravata et al(2003) on “Efficacy and Safety of low-carbohydrate Diets”( A systemic Review) have concluded that because of lack of evidence, they are unable  to make recommendations for or against the use of low-carbohydrate diets for use longer than 90 days or for diets of 20g/d or less of carbohydrates for people  older than 50 took part in the  study. It has been observed by them that weight reduction in participants by use of low carbohydrate diet is well established by low caloric consumption in long duration.  . Even after 30 years of Atkins type of diet, the above recent researchers still say and claim that in spite of plenty of literature their study is the first one based on synthesis of evidence collected and published. They add that their findings declare that there is no harmony among the information from medical literature to guide dietary choices. They urge immediate  studies  that will enquire into the long-term results and effects   of low carbohydrate diets among all the age groups  both  with and without diabetes, hyperkalemia.

Kossoff Eric H proposes that if a modified Atkins diet is developed, it will greatly replace use of drugs like Phenytoin and anti-convulsants for intractable child hood epilepsy. because a  modified Atkins diet holds assurance  as an effective  therapy for both children and adults with intractable epilepsy depending on the traditional ketogenic diet.. Though this treatment has many benefits, without the active role of neurologists and dieticians, its use can only be restricted. Three studies are nearing completion at   Johns Hopkins Hospital (Baltimore, MD, USA), while future trial plans are also underway.            Chen et al ( Lancet . 2006) in their paper titled “ A life-threatening complication of Atkins diet”  have concluded that Atkins diet which is a low carbohydrate diet will result in ketonic production as rightly suggested by Atkins to monitor the level of ketonuria. in their book.  Ketoacidosis occurs during the treatment of refractory child hood epilepsy.  Stress due to Atkins dietary therapy will aggravate starvation-induced metabolic acidosis. However they have not come across any report on such life threatening metabolic acidosis in healthy people on Atkins diet. Their patient’s condition which prompted this study might have been due to glycogen bound water depletion and vomiting caused due to dehydration.  Generally this type of dehydration leads to metabolic alkalosis without renal failure. The patient infact  had been on Atkins diet which must have caused ketosis and her development of ketoacidosis took place when  her oral intake was reduced on pancreatitis or gastroenteritis. They have to say that this type of disorders are likely to become widely prevalent as the Atkins diet is becoming popular allover the world.

 B.Frank and C.Walter ( JAMA 2002) on “optimal diets for prevention of Coronary Heart Disease” say that they have concluded on three dietary strategies as effective from the strong results coming from their metabolic studies, epediomologic investigations and clinical trials. The three dietary plans suggested by them to tackle CDH (coronary heart disease) are 1) to replace saturated and trans-fats by unsaturated fats, 2) to enhance consumption of Omega –3 fatty acids derived from fish oils and plant sources and 3) promote consumption of fruits, vegetables, nuts and whole grains.

A randomized trial by Dansigner et al compares the diet plans Atkins, Omish, Weight watchers and Zone diets  and in their assessment for effectiveness in weight reduction and heart disease, they have found that all the popular diets did reduce body weight and also reduce cardiac risk factors for only one year duration. Generally dietary adherence are aborted in the middle of the therapy though accelerated compliance resulted in enhanced weight reduction and mitigation of cardiac risks.(Jama 2005. 293.43-53)

None of these studies have involved long term research without which the objective of this paper is difficult to achieve except on theoretical considerations and certain premises. Rather no such adverse conditions have surfaced to prompt  long-term studies. It is not as simple as that unless volunteers come forward to subject themselves for the study. This goes to show,  the studies so far conducted suggest they are either prompted by advocates of pro-conventional diet promoters, pro-vegetarian groups or those who are really concerned among the medical fraternity without the support of long-term study participants. This also leads us to wonder if Atkins Dieters are going through or able to sustain a long term therapy for their life time without which data for the long-term side-effects are difficult to obtain. That the Atkins Diet has sold in so many million copies does not mean as many people are following the diet or Atkins Diet’s efficacy cannot be measured in terms of sales. The obesity problem in U.S. or in any parts of the world are still in  pandemic proportions which go to prove the Atkins diet has not been effective in tackling the problem in spite of its existence for more than there decades. Conversely it should be that Atkins Diet has not been able to prevail over the obese person to follow the plan in spite of its promising features as it happens to so many good  virtues which are not necessarily followed. All these, for want of long term data for conclusion for long-term results.

CONCLUSION

It is the claim of the Atkins that the plan does cause weight loss when one cuts down on carbohydrates as explained above in the introduction. Besides, body weight is regulated and results in better health with a feeling of well-being to those on Atkins diet as they are forced to chose nutritional food. Diabetes is also kept at bay as intake of carbohydrate is controlled and insulin production also regulated.

The  literature review seen above makes an impressive record of medical field’s observations which however is divided in opinion tilting against the diet. Aim of this paper is to arrive at  a conclusion whether Atkins Diet causes heart disease or stroke in the long run. The studies seen above suggest that Atkins diet can lead to various side effects like kidney dysfunction besides possibility of complications such as ketosis, dehydration, loss of enzymes, panic disorders, etc.  It seems to really help in the treatment of intractable epilepsy. Overweight individuals with medical problems such as heart disease, hypertension, kidney disease, and diabetes are more prone to unexpected complications than  overweight people with no health problems.  But in a weight loss plan, Atkins diet screens such potentially risky people and therefore fears are misplaced including heart diseases with which we are immediately concerned. That this diet plan was introduced 33 years ago and it is still popular with some setbacks on the financials due to the demise of its inventor, itself is a testimony that Atkins Diet has not caused widespread heart disease epidemiology.

Though there are genuine concerns about its long term sides effect to heart’s health, no scientific evidence has been established so far to disown Atkins Diet for any potential risks to the  heart. The U.S  news & World Report  has reported on 6/2/2003 that obese persons did report weight loss without side effects. The blood cholesterol level also did not shoot up. It is important to note that bad cholesterol level increased a little but with corresponding increase in the good cholesterol level and triglycerides. Specifically, the diet did not cause the expected deterioration in blood cholesterol levels. (Healy).

           A report in Grocer (March 2004) states that more than 3 million Britons and 30 million Americans are on Atkins Diet which only shows that there can be no long term effect on heart in the absence of scientific evidence of healthy individuals developing heart attacks after taking on to Atkins Diet, though the report is skeptical of the Diet as an unethical plan exploiting the consumers (John)

             Another report shows that due to restrictions on carbohydrate consumption, phytochemicals that go with it and that are responsible for preventing  heart disease, cancer, and other disorders, are also restricted and hence this aggravates  possibility of  contracting the said ailments.  It however  reconfirms that no adverse reports  have come in so far, for over intake of fat containing substances. ( Alan 2003)

Although we have come across an instance of a 53 year old man Gorran forced on heart surgery allegedly due to the problems ( cholestrol increased from 146 to 230) caused by the Atkins intake,  who claimed $15,000 from Atkins in a law suit does not appear to have succeeded as Atkins has fought back saying “Atkins  stands by the science that has repeatedly reaffirmed the safety of the diet. The company believes that Gorran had been helped by the Physicians Committee for Responsible Medicine, which promotes a vegan diet banning meat, fish, dairy and egg products and had questioned the Atkins diet’s approach to health in the past.”(Snack food & Wholesale bakery)

After the death of Dr Atkins, it has come to light that Atkins Diet has not been a product of speculation but a due to the stimulus he received from the series of study of Dr H.J.Roberts, M.D. FACP, FCCP from 1962 to 1967 at Palm Beach Institute for Medical Research, FL, which Dr Atkins admittted to Dr Roberts , as disclosed in his requiem honouring Dr Atkins.  Of particular interest to Dr Atkins was Dr Roberts’ researches relating to his findings  of carbohydrate vis-a-vis weight gain. In fact Dr Robert’s recommendations from the research finding was to  add fat and protein in the diet for management of obese patients while trying to reduce carbohydrate.

Like in court findings, when the jury decides in the absence of conclusive evidence, resorts to circumstantial evidence, we are forced to take a view that Atkins Diet has not caused heart disease or stroke in the long run as during the last 33 years of its use there has been no report of heart attack or stroke if one had followed strictly the screening procedures of Dr Atkins Diet plan. Most of the adverse reports that have come in must have been either due to use of Atkins Diet by potentially–at-risk persons or stage managed by vested commercial interests. However we are not going to be complacent over the issue though on going research on Dr Atkins Diet plan may one day finally conclude in its favor.

References
Alan R Gaby, 8/1/2003 Townsend Letter for Doctors and Patients
Astrup A, Meinert Larsen T, Harper A, Lancet. 2004 Sep 4-10;364(9437):897-9. Review.  PMID: 15351198 [PubMed – indexed for MEDLINE

            Atkins, R.C., Dr Atkins’ Diet Revolution, Bantam Books, New York, NY, 1974.

Bravata M.Dena et al, JAMA, April 9, 2003

Davies Jill (1974) Nutrition and Food Science, no 5 September October 1994

Dansinger et al, Jama, 2005: Vol 293: 43-53.

Dickerson, J.W.T. and Booth, E.M., Clinical Nutrition for Nurses, Dietitians and Other

Ehrenreich Mark J, M.D., Dept. of Psychiatry Univ. of Maryland School of Medicine Baltimore, MD Psychosomatics 47:178-179, April 2006 doi: 10.1176/appi.psy.47.2.178 © 2006 Academy of Psychosomatic Medicine

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           Gou GT (2004) Asia Pac J Clin Nutr 2004; 13(suppl):S4

Healy, Berandine P. 6/2/2003 U.S. News & World Report

John white, March 13, 2004 , Grocer  www.highbeam.com accessed on 26 May 2006

Klein Allison, How the diet plan works, http://www.howstuffworks.com/atkins.htm<accessed on 25 May 2006

          Kossoff EH, McGrogan JR, Bluml RM, Pillas DJ, Rubenstein JE, Vining EP., : Epilepsia. 2006 Feb;47(2):421-4. . John M Freeman Pediatric epilepsy Center and John Hopkins Hospital, Baltimore, on “use of a Modified Atkins Diet for epilepsy”

            Snack Food & Wholesale  Bakery  May 1,  2004

Wood RJ, Volek JS, Davis SR, Dell’ova C, Fernandez ML 2006 May 4, Nutr Metab(Lond) >