The Atkins Nutritional Approach

1
The Atkins Nutritional Approach(ANA)

• Colette Heimowitz, MS
• VP, Education, Research
• Atkins Health and Medical Information Services

2
What is the ANA?
The Atkins Nutritional ApproachTM (ANA) is an
easy-to-follow four-phase controlled carbohydrate
program. Initially, you cut back significantly
on carbohydrates to lose weight then you
gradually add back into your diet a variety of
good carbohydrates as you get closer to your
goal weight. The ANA brings your nutritional
intake into balance, helping you to re-energize,
lose weight and lay the foundation for a healthy
life.
3
How Does the ANA Work?

• Carbohydrates and fat provide fuel for the body.
• When carbohydrates are available, the body
  transforms them into energy first.
• Any excess carbohydrates are stored as fat.
• When carbs are sufficiently restricted, the body
  burns fat for fuel, including already stored own
  body fat, which allows people to lose weight or
  maintain their goal weight.
• Studies show that certain risk factors for heart
  disease improve when individuals follow a
  controlled carbohydrate programme (e.g.
  triglyceride levels can decrease by up to 55).

4
What Controlling Carbs Means

• Finding each individuals tolerance level for Net
  Carbs (carbohydrates that impact blood sugar
  levels), first to lose weight and then maintain a
  healthy weight for life.
• Cutting out processed foods full of sugar and
  white flour, as well as restricting other
  high-carb foods.
• Eating a wide variety of delicious foods,
  including protein, healthy fats and
  nutrient-dense carbs.
• It does NOT mean eating no carbs, eating only
  steak, bacon and eggs, or eliminating fruit and
  vegetables.
• It DOES mean retaining good carbs full of
  nutrients, found in foods like dark green leafy
  vegetables, nuts and berries.

5
Atkins Carbohydrate Equilibrium(ACE)
The amount of carbohydrate an individual can eat
each day while neither gaining nor losing weight.
6
What are Net Carbs?

• Carbohydrates can have different metabolic
  effects on the body. Net Carbs are the
  carbohydrates that significantly impact the
  blood-sugar level and are the only carbs that
  count when following Atkins.
• Certain ingredients, such as glycerine and sugar
  alcohols, have a minimal impact on blood sugar,
  and therefore, are not included in a Net Carb
  count.
• Note In the US, fibre is reported as a
  carbohydrate. In the UK, fibre is
• reported separately and is not part of
  the carb count.

7
Benefits of the ANA

• Weight loss and weight maintenance
• Improved health indicators (e.g. triglycerides,
  cholesterol HDL / LDL)
• Better mood regulation
• Increased energy levels
• Increase in concentration and alertness
• Increased ability to cope with stress
• Decrease in gastrointestinal symptoms
• Decreased fatigue
• Decreased preoccupation with food and the need to
  snack
• Decreased need for caffeine
• Decreased reliance on medications in certain
  individuals

8
The Atkins Nutritional Principles

• Four principles
• Weight loss
• Weight maintenance
• Good health and well-being
• Disease prevention

9
The Atkins Nutritional Principles

• Weight Loss
• Both carbohydrate and fat provide fuel for the
  bodys energy needs. Carbohydrate is the first
  fuel to be metabolized. However, when the intake
  of digestible carbohydrate is sufficiently
  restricted (without caloric restriction), the
  body converts from the primary metabolic pathway
  of burning carbohydrate to burning fat as its
  main energy source. This results in weight loss.

10
The Atkins Nutritional Principles

• Weight Maintenance
• For each individual there is a tightly regulated
  carbohydrate threshold below which fat burning
  and weight loss occurs. However, if the
  individuals carbohydrate intake exceeds this
  threshold, carbohydrate burning predominates,
  allowing fat to be accumulated, resulting in
  weight gain. Therefore, each individual has a
  level of carbohydrate intake at which weight is
  maintained.

11
The Atkins Nutritional Principles

• Good Health
• By adhering to a controlled carbohydrate
  nutritional approach, an individual who chooses
  to eat nutrient-dense foods (including adequate
  fiber, healthy fats and supplementation as
  needed) is more likely to meet his nutritional
  needs and promote good health than he would by
  following a calorie-restricted, fat-deficient
  diet. Exercise is also essential for controlling
  weight, enhancing energy and maintaining a sense
  of well-being.

12
The Atkins Nutritional Principles

• Disease Prevention
• By following an individualized controlled
  carbohydrate nutritional approach that lowers
  carbohydrate intake resulting in lower insulin
  production, people at high risk for or diagnosed
  with certain chronic illnesses, including
  cardiovascular disease, diabetes and
  hypertension, can see improvement in clinical
  parameters.

13
The Atkins Nutritional Approach

• The Atkins Nutritional Principles form the core
  of The Atkins Nutritional Approach
• Four Phases
• Induction
• Ongoing Weight Loss
• Pre-Maintenance
• Lifetime Maintenance

14
Phase 1 Induction

• Limit carbohydrate consumption to 20 grams of Net
  Carbs per day for a minimum of 2 weeks.
• For those with a significant amount of weight to
  lose, Induction can be followed for longer
  periods of time.
• Satisfy appetite with foods that combine protein
  and fat, such as fish, poultry, eggs, lamb, pork
  and beef.
• Consume a balance of healthy natural fats such
  as monounsaturated, polyunsaturated, and
  saturated.
• Avoid trans fats (e.g. hydrogenated or partially
  hydrogenated oils)
• Consume carbohydrates in the form of
  nutrient-dense foods such as leafy green
  vegetables.
• Drink at least eight 250 ml glasses of water
  daily.
• Exercise regularly.
• Dont forget to take nutritional supplements.

15
Example of Induction Menu
Breakfast Three-Egg Omelette with
Avocado Mozzarella Cheese and Tomato Decaffeinated
Coffee with Cream Lunch Sirloin Steak ( 8
oz.) Spinach and Mixed Lettuce Salad with
Mushrooms, Onions, Celery and Parmesan
Cheese Dinner Poached Salmon ( 9 oz.) Kale or
Broccoli with Garlic, Lemon and Sesame Seeds
16
Phase 2 Ongoing Weight Loss

• Slow down weight loss by gradually increasing
  daily Net Carb intake in weekly increments of 5
  grams.
• Go from 20 grams/day of Net Carbs one week to
• 25 grams/day the next week.
• Increase carbs by 5 each week until weight loss
  stops.
• Choose additional carbs wisely, adding back
  nutrient-dense foods
• More non-starchy veggies (e.g., asparagus,
  broccoli)
• Berries (e.g. raspberries and strawberries)
• Nuts and seeds (e.g., hazel nuts, almonds)
• Soft cheeses (e.g., cottage cheese, Stilton,
  brie)
• Once weight loss stops, drop daily intake of Net
  Carbs by 5 grams to continue losing weight
  slowly.
• Average grams of Net Carbs are 40-60 for this
  phase.
• Phase 2 lasts until you are within 5-10 lbs of
  goal.

17
Phase 3 Pre-Maintenance

• Goal is in sight 5 to 10 pounds from goal
  weight.
• Lose the last few pounds very slowly to ease into
  a permanently changed way of eating.
• Each week add more grams of Net Carbs (as much as
  10) to the daily allotment.
• As long as weight loss continues, gradually
  introduce foods such as lentils, melon, starchy
  vegetables (turnips, swedes and carrots) and
  whole grains.
• When goal weight is achieved and maintained
  for at least a month, you have found your ACE.

18
The Carbohydrate Ladder

• As the programme progresses, moving from one
  phase to another, add more carbohydrate foods
  back in this order
• Salads and leafy Vegetables
• Hard and Soft Cheese
• Seeds and Nuts
• Soft Fruits such as Berries
• Beans and Pulses
• Other Fruits such as Melon and Pineapple
• Higher carbohydrate Vegetables
• Whole Grains

19
The Power of Five
These portions contain roughly 5 grams of
Net Carbohydrate each

• Vegetables
• 180g or 6.4oz cooked Spinach
• 98g or 3.5oz Red Peppers
• 1 medium Tomato (62g or 2.2oz)
• 156g or 5.5oz cooked Broccoli
• 12 Medium Asparagus spears (180g)
• 180g or 6.4oz cooked Cauliflower
• ½ medium Avocado (86g or 3oz)
• 2/3 cup Courgettes
• Fruits
• 48g or 1.7oz Blueberries
• 92g or 3.3oz Raspberries
• 125g or 4.4oz Strawberries
• 44g or 1.6oz honeydew Melon

• Dairy
• 142g or 5oz Hard Cheese
• 142g or 5 oz Mozzarella Cheese
• 158g or 5.6oz Cottage/Ricotta Cheese
• ¾ cup Double Cream
• Nuts and Seeds (1 ounce)
• Macadamia (10-12 nuts)
• Walnuts (14 halves)
• Whole Almonds (14 nuts)
• Hazelnuts (14 nuts)
• Pecans (14 halves)
• Sunflower Seeds (3 tablespoons)
• Pumpkin Seeds (3 tablespoons)

20
Phase 4 Lifetime Maintenance

• To maintain goal weight, stay at your ACE.
• Average grams of Net Carbs is 40 to 120 per day,
  depending on metabolism, age, gender, activity
  level, or other factors.
• Engage in regular exercise those who exercise
  usually have a higher ACE.
• Changes in activity level, hormonal status or
  other factors may raise or lower your ACE.

21
(No Transcript)
22
Conditions That Need Guidance While Following the
ANA

• Kidney disease
• Protein intake must be monitored in renal
  patients.
• Diabetes
• Monitoring blood sugar levels is an essential
  component to following the ANA for diabetics,
  especially those individuals who may need
  adjustments in medication levels due to improved
  glucose regulation.
• Gout
• Those with a pre-existing gout condition need to
  be monitored by their doctors

23
Conditions That Need Guidance While Following the
ANA

• Pregnant breast-feeding women
• Regardless of the programme, dieting and weight
  loss is not recommended during pregnancy or
  breastfeeding.
• However, pregnant and breast-feeding women can
  safely follow the Lifetime Maintenance phase of
  Atkins.
• Dieters Advantage and Accel nutritional
  supplements should not be taken during pregnancy
  or breast-feeding.

24
Top 10 Myths - and the FACTS
25
Myth No. 1 The ANA Is Unbalanced and Deficient
in Basic Nutrition

• FACT
• People frequently mistake the 20 gram Net Carbs
  per day Induction phase for the whole programme!
• Even during the Induction phase, the ANA calls
  for 5 daily servings of veggies such as 2 cups of
  salad (leafy greens like spinach and watercress),
  1 cup (two ½-cup servings) of broccoli, and half
  an avocado.
• After this phase, individuals raise their carb
  count gradually until they reach their ACE.
• A persons ACE could be up to 120 grams or more
  daily of nutrient-dense carbohydrates, including
  fruit, occasional potatoes, brown rice and whole
  grain bread!

26
Example of 20 Gram CHO Daily Menu
Breakfast
Three Egg Omelet with Avocado,
Mozzarella Cheese and Tomato
Decaffeinated Coffee with Cream
Lunch
Beef Round Steak (8 oz.)
Spinach and Mixed Lettuce Salad
with Mushrooms, Onions, Celery
and Parmesan Cheese
Dinner
Broiled Salmon (9 oz.)
Kale topped with Garlic, Lemon and Sesame Seeds
27
Nutrient Analysis of 20 Gram CHO Sample Menu
Based on Daily Values /RDI
2000 Calorie Diet
Percent of Daily Values
28
Nutrient Analysis of 20 Gram CHO Sample Menu
Based on Daily Values/RDI
2000 Calorie Diet
Percent of Daily Values
29
Myth No. 2 You Lose Mostly Water Weight on the
ANA

• FACT
• A portion of initial weight loss on any diet is
  water weight.
• When one follows a controlled carbohydrate eating
  plan the body switches from burning carbohydrate
  to primarily burning stored fat for energy,
  resulting in the loss of stored fat.
• This is evident through the loss of inches!
• Research results have consistently demonstrated
  that weight lost after the first few days on a
  restricted carbohydrate programme is primarily
  fat and not water or lean body mass.

30
Myth No. 3 The ANA Is Only Effective Because
Calories Are Restricted

• FACT
• Calories are not restricted when doing Atkins
• Individuals may end up eating fewer calories
  because they are generally less hungry and no
  longer obsessed with food.
• Stable blood sugar throughout the day ensures
  fewer food cravings.
• The food on this program is less processed and
  more nutritious than on the typical pre-Atkins
  menu.

31
Myth No. 4 The High-Protein Content of the
ANA Causes Kidney Problems

• FACT
• No one has as yet produced a study for review, or
  even cited a specific case in which the protein
  content of ANA causes any form of kidney
  disorder.
• When someone is already diagnosed with kidney
  disease, they need to modify their total protein
  intake and consult closely with their doctor.

32
Myth No. 5 Fat Intake is Detrimental and Will
Lead to Heart Disease

• FACT
• A growing body of scientific literature
  demonstrates that a controlled carbohydrate
  eating plan, if followed correctly, reduces risk
  factors for heart disease and improves clinical
  health markers.
• The body needs fats to survive and fats provide
  many health benefits.
• Natural fats make individuals feel full sooner
  and keep dieters feeling less hungry for longer.
• Low carb v low fat followed correctly, studies
  show that a low carb eating plan can be more
  effective than a low fat plan in improving risk
  factors for heart disease

33
Quintiles of Dietary Glycemic Load (Women)
Quintile 1 2 3 4 5
Quintile mean glycemic load 117 145 161 177 206
CHO gm/day 144 20 171 11 186 11 200 11 226 20
CHD Cases 139 128 148 160 186
10 YEAR Prospective Study n75,521 Women TEST
FOR INTERACTION, Plt.0001
Liu et al. A Prospective Study of Dietary
Glycemic Load, Carbohydrate Intake, and Risk of
Coronary Heart Disease in US Women. AM J Clin
Nutr. 711455-61, 2000.
34
Myth No. 6 Ketosis Is Dangerous and Causes a
Variety of Medical Problems

• FACT
• The primary fuel in the body is glucose,
  generated from carbohydrate consumption.
• When sufficient carbohydrates are not available
  the body turns to its secondary fuel source fat.
• Fat is burned as energy (lipolysis), producing
  byproducts called ketones. The process is called
  ketosis.
• Ketosis should not be confused with the abnormal
  metabolic state, ketoacidosis.
• Ketoacidosis is only a concern for diabetics
  whose blood sugar is out of control, or for
  alcoholics.

35

• Doctors are scared of ketosis says Richard
  Veech, an NIH researcher who studied medicine at
  Harvard . .. . But ketosis is a normal
  physiologic state. I would argue it is the normal
  state of man. Rather than being poison, which is
  how the press often refers to ketones, they make
  the body run more efficiently and provide a
  back-up fuel source for the brain. Veech calls
  ketones magic and has shown that both the heart
  and brain run 25 more efficiently on ketones
  than on blood sugar.
• Taubes G. NYT Magazine Section, July 7, 2002.

36
(No Transcript)
37
The Human Metabolic Response to Chronic Ketosis
Without Caloric Restriction Physical and
Biochemical Adaptation

• Summary
• In view of the tests done to screen for ill
  effects of the EKD, the remarkably benign nature
  of a diet providing 85 of calories as fat is
  notable. After 4 weeks there was no measurable
  impairment of hepatic, renal, cardiac, or
  hematopoietic function. The serum uric acid
  level, elevated by competition from ketone bodies
  for excretion, was almost back to normal by that
  time.
• Phinney SD, Bistrian BR, Wolfe RR and Blackburn
  GL. Metabolism 198332(8)757-768.

38
Myth No. 7 The ANA Causes Constipation
Because It Lacks Fibre

• FACT
• Doing Atkins means including fibre-rich foods
  such as spinach, aubergines, broccoli, asparagus
  and leafy greens. After the initial phase, it
  also includes soft fruits such as berries.
• If the Induction phase is followed properly and
  all 5 servings of vegetables are included, the
  majority of individuals do not suffer from
  constipation. If more fibre is needed during
  the Induction phase, a fibre supplement is
  recommended.
• Supplementing with fibre is unnecessary in the
  Ongoing Weight Loss (OWL) phase and beyond
  because fruits and more vegetables are introduced
  into the eating plan.
• Drinking plenty (2 litres) of water each day is
  very important.

39
Myth No. 8 The ANA Increases the Risk of
Osteoporosis

• FACT
• During the first week of any weight loss
  programme, one loses water weight. When water is
  lost, so are calcium, potassium and magnesium.
  Thats why taking a multivitamin is so important.
  Calcium is not being leached from the bones.
• Actual studies have shown urinary calcium loss
  lasted a few days. The body then re-adjusts
  itself to a regular state of homeostasis and the
  calcium loss in the urine stops.
• In several studies published in peer review
  journals researchers followed adults and studied
  the short-term and long-term effects of a
  high-meat diet on calcium metabolism. The studies
  found no significant changes in calcium balance,
  nor was there any significant change in the
  intestinal absorption of calcium during the
  high-meat diet.

40
Myth No. 9 Lipolysis / Ketosis Causes Loss of
Muscle Mass

• FACT
• Typically, individuals on very low calorie diets
  can lose muscle mass because they have inadequate
  intake of protein.
• Atkins is not calorie restricted and the high
  protein intake offsets any possible loss of lean
  body mass.

41
STUDIES EXAMINING THE EFFECTS OF A KETOGENIC
DIET ON BODY COMPOSITION
42
Myth No. 10 Atkins Will Cause Weakness, Fatigue
and a Lack of Energy

• FACT
• During the first few days on Atkins, people may
  experience a mild fatigue as the body switches
  metabolic pathways.
• After 3-4 days, the body has switched from a
  glucose metabolism to a fat metabolism.
• Reducing caffeine and sugar intake can lead to
  short-term withdrawal symptoms, but they
  typically pass within the first week.
• After the transition, individuals consistently
  report high energy levels.

43
The Science Behind Atkins
44
Science Supports the ANA

• Perhaps the biggest myth of all is that there is
  no science supporting the ANA
• There are more than 400 peer-reviewed and
  published studies supporting the concepts of
  Atkins Nutritional Principles.
• In the last three years, there have been 16
  studies focusing on the ANA, all supporting the
  safety and efficacy of controlled carbohydrate
  eating.
• Information on all of these studies and more
  supporting scientific information is available
  for review at www.atkins.com

45
Weight Loss in Teenagers
What this graph tells us Teenagers who followed
a low carbohydrate diet lost more weight than
teenagers who followed a low fat diet. The low
carbohydrate group was able to lose more weight
even while consuming more calories - an average
of 730kcal more a day than those following the
low fat diet.
1830 kcal
n30 12 Week Study
8 Carbohydrate
1100 kcal
LBS
56 Carbohydrate
Sondike, S.B., Copperman, N., Jacobson, M.S.,
"Effects of a Low-Carbohydrate Diet on Weight
Loss and Cardiovascular Risk Factor in Overweight
Adolescents," The Journal of Pediatrics, 142(3),
2003, pages 253-258.
46
Weight Loss in Adults
What this table tells us - Adults who followed a
low carbohydrate diet lost more weight than
adults who followed a low fat diet. The low
carbohydrate group was able to lose more weight
both while consuming the same or more calories -
an average of 300kcal more a day than those
following the low fat diet.
Decrease in Low Fat 1 (1500/1800kcal) Low Carbohydrate 1 (1500/1800kcal) Low Carbohydrate 2 (1800/2100kcal)
Weight (pounds) 17 ( 2.4) 8 23 ( 4.6) 11 20 ( 3.4) 10
Waist (inches) 2.6 ( 0.54) 7 4.3 ( 0.73) 11 3.8 ( 0.68) 10
Hip (inches) 1.9 ( 0.71) 4 2.6 ( 0.68) 6 2.9 ( 0.71) 7
Calories Women/Men, respectively
Greene PJ, Willett W, et al. Pilot 12-Week
Feeding Weight-Loss Comparison Low-Fat vs.
Low-Carbohydrate (Ketogenic) Diets, NAASO
meeting Oct. 13, 2003 Obesity Research, Sept.
2003, Oral Abstract 95.
47
Harvard Nurses Health Study Summary
Our findings suggest that a high intake of
rapidly digested and absorbed carbohydrate
increases the risk of CHD independent of
conventional coronary disease risk factors. These
data add to the concern that the current low-fat,
high carbohydrate diet recommended in the United
States may not be optimal for the prevention of
CHD and could actually increase the risk in
individuals with high degrees of insulin
resistance and glucose intolerance.
Liu et al. A Prospective Study of Dietary
Glycemic Load, Carbohydrate Intake, and Risk of
Coronary Heart Disease in US Women. AM J Clin
Nutr.711455-61, 2000.
48
Triglycerides are Important

• Perhaps the most important cardiac risk factor
  of all, especially when combined with low HDL
• (Tanne D. et al Circulation. 2001)
• High triglycerides are a known substitute marker
  for abnormally high insulin
  levels
• Triglycerides are known to decrease with
  carbohydrate restriction

49
The Effect That High Carbohydrate Diets Have on
Triglycerides
What this graph tells us Carbohydrates raise
blood triglyceride(TG) levels. In this study one
group consumed a 40 carbohydrate diet while the
other group consumed a 60 carbohydrate diet.
Notice the high carbohydrate group had higher TG
levels before and after meals. The more
carbohydrates consumed the higher the blood
triglyceride levels.
8am
4pm
CHO Carbohydrate TG Triglycerides
Triglycerides were measured every 2 hours from
8AM-4PM (Breakfast at 8am and Lunch at 12pm)
Abbasi et al. High Carbohydrate Diets,
Triglyceride Rich Lipoproteins,and Coronary Heart
Disease Risk. Am J Cardiol. 8545-48, 2000.
50
The Copenhagen Study An 8 Year Study of 2906 Men
Without Heart Disease
What this graph tells us - Fasting triglycerides
is a stronger indicator of Ischemic Heart
Disease than HDL (which is part of your total
cholesterol)
I N C I D E N C E
141-400
97-141
TG, mg/dl
39-96
11-45
57-133
46-56
HDL-C, mg/dl
Jeppesen et al. Triglyceride Concentration and
Ischemic Heart Disease An Eight-Year Follow-up in
the Copenhagen Male Study. Circulation. 97
1029-36, 1998.
51
The relationship between Triglycerides and
Relative Risk of CHD in Males and Females
CHD Relative Risk
Miller M. Is Hypertriglycerideaemia an
Independent Risk Factor for Coronary Heart
Disease? The Epidemiological Evidence. Eur Heart
J. 19 (suppl H18-22), 1998.
52
Triglyceride Levels in Teens
What this graph tells us Even though the low
carbohydrate group ate on average 730 more
calories each day than the low fat group, the low
carbohydrate group had a much greater reduction
in blood triglyceride levels.
n30 12 Week Study
Mean Change
Sondike, S.B., Copperman, N., Jacobson, M.S.,
"Effects of a Low-Carbohydrate Diet on Weight
Loss and Cardiovasculaisk Risk Factor in
Overweight Adolescents," The Journal of
Pediatrics, 142(3), 2003, pages 253-258
53
Changes in Cardiovascular Risk Factors While
Following Either A Very Low-Carbohydrate Diet
With Nutritional Supplements or A
Low-Fat/Low-Calorie Diet
What this table tells us The low carbohydrate
group experienced greater than 50 reduction in
blood triglyceride levels

Chol TG
HDL-C LDL-C Chol./HDL Low Fat
mg/dl mg/dl
mg/dl mg/dl
ratio (n18) Baseline 217.8 (29.7) 196.0
(114.6) 48.8 (9.6) 133.2 (28.4) 4.5
(0.8) Week 24 204.3 (35.5) 135.8 (82.3)
49.1 (9.7) 127.7 (28.6) 4.2
(0.8) Change -13.5 (22.5) -60.2 (100.2)
0.3 (6.4) -4.0 (17.6) -0.3
(0.7) Low Carb (n22) Baseline 251.4
(29.4) 181.5 (86.7) 56.4 (18.6) 158.2
(25.6) 4.7 (1.3) Week 24 237.9 (45.5) 89.3
(56.2) 61.6 (18.6) 158.0 (39.1)
4.0 (1.1) Change -13.5 (35.6) -92.2 (85.5)
5.2 (10.6) -0.2 (34.2) -0.7 (1.1)
plt0.05, for within-group change from baseline to
Week 24
No significant differences existed between diet
groups
Yancy WS, Bakst R, Bryson W et.al. Obesity
Research (abstract) 9184S, 2001
54
Evaluating the Atkins Nutritional Approach A 12
Month Study
What this table tells us - After one year on
either a low carbohydrate or low-fat diet,
subjects lost weight. The low carbohydrate diet
was associated with greater improvement in risk
factors for coronary artery disease (better
cholesterol profile and triglyceride levels)
Conventional Diet (n20) Atkins Diet (n17) P
change change
Weight -4.5 ? 7.9 -7.3 ? 7.3 0.27
Total Chol -5.5 ? 10.4 0.2? 12.7 0.23
LDL-C -5.8 ? 16.1 0.5? 21.2 0.47
HDL-C 3.1? 15.2 18.2 ? 22.4 0.04
TG 1.4? 52.5 -28.1? 23.6 0.04
Foster G, Wyatt H, Hill J, et al. NEJM
3482082-90, 2003
55
Weight Loss and Cardiovascular Risk Factors in
Women Following Either A Low Carbohydrate Diet or
A Low Fat Diet
What this table tells us Women following a low
carbohydrate program lost more weight at 3 months
and kept the weight off even after 6 months. In
contrast the low fat group lost less weight at
three months and at 6 months gained back 25 of
the original weight lost. Once again,
triglyceride levels decreased much more in the
low carbohydrate group.
3 Months
6 Months
Low CHO Wt Loss, kg 8.0 ?1.0 7.9 ? 1.4, plt0.02
Body fat, ? 1.7 ?0.46 2.2 ? 0.58
TG ? 65.3 ?17.2
Low Fat Wt Loss, kg 4.4 ? 1.1 3.2 ? 1.3
Body fat, ? 1.3 ?0 .48 0.74 ?0.49
TG ? 15.2 ? 8.2
Brehm BJ, Seeley RJ, DAlessio DA, et al. A
Randomized Trial Comparing a Very Low Cabohydrate
Diet and a Calorie- Restricted Low Fat Diet on
Body Weight and Cardiovascular Risk Factors in
Healthy Women, The Journal of Clinical
Endocrinology and Metabolism, 88(4),2003.
56
Low Carbohydrate 6 - Month Study
What this table tells you - Adults who followed a
low carbohydrate diet lost more weight than
adults who followed a low fat diet. In addition,
the low carbohydrate group had a greater
improvement in cardiovascular risk factors
(greater reduction in triglycerides).
Low-CHO, n28
Low-Fat, n30
6 months
P Value
Baseline wt, lbs 293.2 295.1 ns
Wt change, lbs -20.4 -6.5 0.002
Chol. Change, mg/dl -1.3 4.7 ns
HDL change, mg/dl -0.6 -1.4 ns
LDL change, mg/dl -1.8 -6.4 ns
TG change, mg (non-DM) -65 -8.0 0.02
Insulin change, ?U/ml (non-DM) -8.9 -1.1 ns
Samaha, F.F., Iqbal, N., Seshadri, P., et al., A
Low-Carbohydrate as Compared with a Low-Fat Diet
in Severe Obesity, N Engl J Med, 348(21), 2003,
pages 2074-81.
57
Dietary Fat Intake and Risk of Stroke1
The team concluded, "Our findings from this large
cohort of middle-aged US male healthcare
professionals, without a history of
cardiovascular disease or diabetes, indicate that
intakes of total fat, specific types of fat, or
dietary cholesterol do not seem to be related to
the development of stroke."

• Relative Risk (95 CI) P value
• total fat 0.91 (0.65 to 1.28)
  0.77
• animal fat 1.20 (0.84 - 1.70) 0.47
• vegetable fat 1.07 (0.77 - 1.47) 0.66
• saturated fat 1.16 (0.81 - 1.65) 0.59
• monounsaturated fat 0.91 (0.65 - 1.28) 0.83
• polyunsaturated fat 0.88 (0.64 - 1.21) 0.25
• trans unsaturated fat 0.87 (0.62 -
  1.22) 0.42
• dietary cholesterol 1.02 (0.75 - 1.39) 0.99
• 1Comparing the highest fifth of intake with the
  lowest fifth, the multivariate relative risk of
  ischaemic stroke was (95 confidence interval P
  for trend) From the Health professional follow up
  study of 43,732men aged 40-75 years, during 14
  years of follow up.

He,K.,Merchant, A.,Rimm, E.B., et al., "Dietary
fat intake and risk of stroke in male US
healthcare professionals 14 year prospective
cohort study," British Medical Journal, 327,
2003, pages 777-782.
58
One Year Effectiveness of the Atkins, Ornish,
Weight Watchers, and Zone Diets Decreasing Body
Weight and Heart Disease Risk

• All Subjects(40/arm) 12 mo. completers
• Wt loss FRS Wt loss FRS
• Atkins 2.1 6.4 3.9(n21) 12.3 (52)
• Ornish 3.1 3.3 6.2(n20) 6.6 (50)
• Wt Watch 3.0 9.6 4.5(n26) 14.7 (65)
• Zone 3.0 6.9 4.6(n26) 10.5 (65)
• Conc All diets showed significant in FRS, and
  promoted wt loss especially in adherent subjects
  indicating that various strategies can be
  effective
• FRS Framingham Risk Score, a measure for
  reducing 10 yr. heart disease risk.
• Dansinger ML, Gleason JL, Griffith JL et al. AHA
  Scientific Sessions, Orlando, FL 2003

59
Comparison of Inflammatory Markers between
low-fat and low-carb diets

• Conclusion C-reactive protein and serum
  amyloid A levels did not change with a low fat
  diet, but both levels decreased with a low carb
  diet. This suggests that for short periods of
  time, a low carb diet is more efficacious, both
  in causing weight loss and in reducing serum
  inflammatory markers, than is a
  calorically-matched low fat diet.

O'Brien, K.D., Brehm, B.J., Seeley, R.J.,
"Greater Reduction in Inflammatory Markers With a
Low Carbohydrate Diet than with a Calorically
Matched Low Fat Diet," American Heart
Association's Scientific Sessions 2002, Nov 19,
2002, Abstract ID 117597.
60
Exploding Nutrition Myths

• The relationship of fat intake to health is one
  of the areas that we have examined in detail over
  the last 20 years in our two large cohort
  studies
• the Nurses Health Study and the Health
  Professionals Follow-up Study.
• We have found virtually no relationship between
  the percentage of calories from fat and any
  important health outcome.
• But what does seem important is the type of fat
  and the form of carbohydrate.
• Willett W. World Health News, Boston. March 29,
  2000

61
Discrepancies between Published Reports and
Prevailing Assumptions of Low Carb Diets

• When fat is converted from its energy storage
  role to the primary energy fuel ketosis occurs
• Most studies measuring the effects of dietary fat
  on lipids use protocols containing considerable
  amounts of dietary carbohydrate.
• Most published observations on high fat ultra-low
  carbohydrate diets (below 20 of total calories)
  show beneficial results.

62
How the Atkins Lifestyle Works for You

• Healthy convenient foods that taste great!
• Atkins products contain
• No added Sugar
• No Aspartame
• No Hydrogenated or partially Hydrogenated Fat