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Atkins Research Update; Clinical Research on Controlled-Carbohydrate Nutrition From Around the World

Posted on: Tuesday, 16 November 2004, 09:00 CST

NEW YORK, Nov. 16 /PRNewswire/ -- As an ongoing service from Atkins Health & Medical Information Services to practicing physicians and medical and lifestyle journalists, our communications department provides the latest developments in clinical research on controlled-carbohydrate nutritional practices and the Atkins Nutritional Approach(TM)(ANA(TM)) as they occur and are reported.

Currently, 38 articles, including 33 separate studies, have appeared in major medical journals, confirming the safety and efficacy of the Atkins Nutritional Approach(TM). If you would like any further information or access to our complete library of published controlled-carbohydrate research, please contact Anthony Giordano at (212) 457-9247 or agiordano@atkins.com. You can also find the complete library of published studies in the Science Behind Atkins section at http://www.atkins.com/ .

In this issue:

-- A Calorie is a Calorie Violates the Second Law of Thermodynamics

- Nutrition Journal

-- Long-term Effects of Ketogenic Diet in Obese Patients

- Exploratory and Clinical Cardiology

-- The National Cholesterol Education Program Diet vs. a Diet Lower in

Carbohydrates and Higher in Protein and Monosaturated Fat

- Archives of Internal Medicine

-- Randomized Study Comparing the Effects of a Low-Carbohydrate Diet and

a Conventional Diet on Lippoprotein Subfractions and Reactive Protein

Levels in Patients with Severe Obesity

- American Journal of Medicine

-- Saturated Fats: What Dietary Intake?

- American Journal of Clinical Nutrition

-- High-Protein Weight Loss Diets and Purported Adverse Effects: Where

is the Evidence

- Sports Nutrition Review Journal

-- Effect of a High-Protein, Low-Carbohydrate Diet on Blood Glucose

Control in People with Type 2 Diabetes

- Diabetes

-- Study Presented by Dr. Mary Vernon and Dr. Eric Westman Demonstrates

the Atkins Nutritional Approach Can Help Diabetics Without Use of

Medication

- Study presented at SMA and NAASO in November 2004

-- Sugar-Sweetened Beverages, Weight Gain, and Incidence of Type 2

Diabetes in Young and Middle-Aged Women

- Journal of the American Medical Association

-- Carbohydrates and the Risk of Breast Cancer among Mexican Women

- Cancer Epidemiology, Biomarkers and Prevention

-- Diet Therapy for Narcolepsy

- Neurology

DESPITE THE POPULAR MYTH, ALL CALORIES

ARE NOT CREATED EQUAL

Researchers Say Low-Carbohydrate Diets Have Metabolic Edge

In a recent paper published in the Nutrition Journal, researchers from SUNY Downstate Medical Center show that calorie for calorie, low-carbohydrate, high-protein diets are generally more effective for weight loss than low-fat diets. Their data goes against a longstanding belief in the nutrition community, which for years has held that only calories count in the battle to lose weight.

"There are numerous examples of low-carbohydrate diets being more effective than low-fat diets with the same number of calories. It doesn't always happen but it can happen," said Dr. Richard Feinman of the Department of Biochemistry, SUNY. "The nutritional establishment has been reluctant to accept this, because they say it violates the laws of thermodynamics. However, they have not really looked seriously at thermodynamics. If they had, they would see that these results are possible, and according to the second law of thermodynamics, are also to be expected."

Feinman and Fine reviewed the existing literature on studies that compared low-carbohydrate and low-fat nutritional approaches. In doing so, they found a sufficient number of reports in the literature to establish the existence of a metabolic advantage. Clinical studies from such well-established research facilities as Duke and Harvard(1-2), among others, were reviewed and analyzed. The researchers tabulated results from 10 studies, demonstrating that low- carbohydrate diets can lead to greater weight loss than isocaloric low-fat diets.

To explain this metabolic advantage, Dr. Feinman and Dr. Eugene J. Fine suggest that carbohydrates are more quickly used as fuel for the body, whereas protein "burns" much more slowly. "Your body can make glucose from protein and, to a much lesser degree, from fat," stated Dr. Feinman. "The process of making glucose from protein is slow, and to get the extra energy needed, your body will burn the fat that it has already stored. I think that's the bottom line."

The researchers stress that the human body is not a storage locker. They compare it to a machine, and the efficiency of the machine is controlled by hormones and enzymes, which are impacted by nutrients. Carbohydrate consumption increases insulin and other hormones that regulate enzymes which can lead to storing fat rather than burning it.

Feinman, R.D., Fine, E.J., "A Calorie is a Calorie Violates the Second Law of Thermodynamics," Nutrition Journal, 2004, 3(1): p. 9.

FIRST LONG-TERM LOOK AT ATKINS INDUCTION PHASE-LIKE DIET

SHOWS SUSTAINED SAFETY AND EFFICACY

In an article in the November Journal of Experimental and Clinical Cardiology, H.M. Dashti and a team of medical experts look at the long-term effects of a sustained ketogenic diet in obese patients. Dr. Dashti's two-year long study builds on findings from more than 33 separate studies that identify the effectiveness and health benefits of a diet low in carbohydrates and high in protein and saturated fats similar to the Atkins Nutritional Approach(TM) (ANA(TM)). This research is significant in answering criticism regarding the safety and effectiveness of Atkins, especially the Induction phase, during which lipolysis/ketosis is most pronounced. Dashti and his team validated that the ketogenic, or low-carb, diet significantly reduces body weight and body mass index. Furthermore, Dashti and his team found that a controlled- carbohydrate nutritional approach decreases the level of tryglycerides, LDL (bad) cholesterol and blood glucose and increases the HDL (good) cholesterol. In addition to long term validation of these health benefits, Dashti found no significant negative health implications whatsoever from a low-carb lifestyle.

For years, Dr. Robert Atkins witnessed first hand the benefits of a ketogenic (low-carbohydrate) diet. He prescribed the Atkins Nutritional Approach as laid out in numerous books, including the best-selling Dr. Atkins' New Diet Revolution, as a means for an individual to incorporate a ketogenic diet into his or her life in a way that was satisfying, healthy and easy to understand. In recent years, scientific research has reproduced his clinical experience through prospective controlled research and research protocols. To date, there have been multiple studies that evaluate the ANA from 30 days up to one year. This is the first study that evaluates an Atkins -- like very low -- carb diet for longer than one year.

The study examined the effects of a ketogenic diet on 83 subjects (39 males and 44 females), obese individuals with a body mass index greater than 35kg, high blood glucose and high cholesterol levels. Lipid tests and weight were measured before and after the administration of the Atkins-like diet, which consisted of 30 grams of carbohydrates, 1 gram per kg of body weight in protein and 20 percent polysaturated, 80 percent polyunsaturated and monosaturated fats. The Atkins Induction phase recommends approximately 20 grams of carbohydrates per day. Following Induction, as individuals progress through the next three phases of the ANA, they increase their carbohydrate intake until they find their individual level, below which weight loss is achieved and above which weight gain occurs.

Dashti, H.M., Thazhumpal, C.M., Hussein, T., "Long Term Effects of Ketogenic Diet in Obese Patients," Experimental and Clinical Cardiology, 2004, Vol 9, No. 2.

SOUTH BEACH DIET DOC CONDUCTS RESEARCH THAT VALIDATES THE ATKINS NUTRITIONAL

APPROACH(TM)

Recent research conducted by Dr. Aurthur Agatston affirms the effectiveness and safety of the Atkins Nutritional Approach(TM). The research, just published in the October 25, 2004 issue of the Archives of Internal Medicine, confirms that a low-carbohydrate, high-fat nutritional approach offers distinct advantages and is more effective for weight loss than the National Cholesterol Education Program Diet. Additionally, the study demonstrates superior lipid outcomes resulting from a low-carbohydrate diet similar to Lifetime Maintenance, phase 4 of the Atkins Nutritional Approach(TM) (ANA(TM)).

The research presented by the author of The South Beach Diet adds to the growing body of research that validates the ANA. This research leads to the implication that intermediate outcomes, including lipid profiles, especially an individual's HDL levels are, at best, consistent with findings from research conducted on the ANA. Dr. Agatston's own research has now demonstrated that his modified version of the ANA, using what he defines as "heart healthy" fats, produces no distinct advantage over Dr. Atkins' tried and true nutritional approach.

The authors claim this study shows that a "stepped approach" to controlled-carbohydrate nutrition produces beneficial results in a three-month trial with the gradual introduction of increasing amounts of carbohydrates, and significant reduction in saturated fats. The stepped approach is remarkably similar to recommendations provided in the four phases of the Atkins Nutritional Approach. Even though the researcher's aim was to suggest the safety of a moderate approach to "popular high fat low carb diets," this study demonstrates the remarkable similarities of the approaches, and fails to show demonstrable benefits in comparison to the ANA. Any stated difference is fundamentally insignificant.

After three decades of fighting low-fat bias, Atkins is now supported by 33 separate scientific studies. Dr. Agatston has continually tried to represent the South Beach Diet as healthier than the ANA, yet his own research now clearly demonstrates that there is no such advantage to South Beach over Atkins and that the two diets are remarkably similar. The only exception is that results using South Beach are achieved, at least in part, through caloric restriction.

Aude, Y.W., Agatston, A.S., "The National Cholesterol Education Program Diet vs. a Diet Lower in Carbohydrates and Higher in Protein and Monounsaturated Fat," Archives of Internal Medicine, 2004; 164: 2141-2146.

LOW-CARB APPROACH PROVIDES POTENTIAL DEFENSE AGAINST CORONARY ARTERY DISEASE

(CAD)

33rd Study to Demonstrate the Effectiveness and Added Health Benefits of an Atkins-Like Nutritional Approach Also Suggests Preventative Benefits for Heart

Disease

The 33rd study to validate the science behind the Atkins Nutritional Approach(TM) was published in the recent issue of the American Journal of Medicine. The study by P. Seshadri and I. Stern compared the effects of a low- carbohydrate diet to a conventional (fat- and calorie-restricted) diet on lipoprotein subfractions and inflammation in severely obese subjects. Once again the science demonstrated added health benefits, notably improved lipoprotein subfractions, for those individuals following a low-carb, high- protein approach. The implication is that improved lipoprotein subfractions can decrease an individual's chance of developing coronary artery disease (CAD).

In this six-month study involving severely obese subjects, researchers found an overall favorable effect of a low-carbohydrate diet on lipoprotein subfractions, and on inflammation in high-risk subjects. This is the 33rd separate study to identify specific health benefits to a low-carbohydrate nutritional approach.

Severely obese individuals instructed to consume either a low-carbohydrate diet (less than 30 g cho/day) or a hypocaloric conventional diet (less than 30 percent calories from fat) had similar favorable effects on LDL and HDL cholesterol after six months. However, individuals on the low-carb diet experienced a greater reduction in large VLDL particles than on the conventional diet. Additionally, the low-carb diet produced greater weight loss, a greater decrease in triglycerides and a greater increase in insulin sensitivity. C-reactive protein reductions were significant only in the highest risk individuals, suggesting for those at greatest risk, this approach yields the greatest benefit. Moreover the study suggests that severely obese individuals, especially those with other conditions associated with obesity, who follow a low-carbohydrate diet may have beneficial effects on insulin resistance, blood lipids and markers of inflammation.

Seshadri, P., Iqbal, N., Stern, D.J., Samaha, F.F. "A Randomized Study Comparing the Effects of a Low-Carbohydrate Diet and a Conventional Diet on Lipoprotein Subfractions and C-Reactive Protein Levels in Patients with Severe Obesity," American Journal of Medicine, 2004, 117(5): p. 398-405.

BROAD REVIEW EXAMINES DATA LINKING HIGH-CARB, LOW-FAT DIET TO RISING RISK

FACTORS FOR HEART DISEASE, RE-EXAMINING ROLE OF SATURATED FATS

Analysis conducted by Drs. Bruce German and Cora Dillar of a broad body of research, published in the recent issue of the American Journal of Clinical Nutrition, tells the alarming story of the link between recommendations laid out in 1977 and the rise in risk factors for heart disease. The study examines data over 20 years and illustrates a direct link between the recommendation of a low-fat, high-carbohydrate nutritional approach and an increase in obesity and risk factors for heart disease such as contribution to the lipoprotein pattern that characterizes atherogenic dyslipidemia (high cholesterol) and hypertriacylglycerolemia (high triglycerides).

The researchers suggest that recommendations made 20 years ago amount to a death sentence for millions of obese and at risk Americans today. Based on government guidelines presented in 1977, the food industry inundated the American diet with complex carbohydrates and low-fat foods. Americans began increasing their intake of these foods under the impression that they were following a healthier nutritional approach.

Looking at research of the time on the potential effect of saturated fats in a high-carb diet, led to the conclusion that saturated fat was the enemy. However, since then, a dramatic rise in heart disease and obesity has made the public health recommendations of 1977 seem dangerous and irresponsible. The German and Dillard review summarizes research findings and observations on the disparate functions of saturated fatty acids and seeks to bring a more quantitative balance to the debate on dietary saturated fat. The study takes a good look at the science published since the recommendations and draws a clear link between the low-fat, high-carbohydrate dietary recommendations made in 1977 and the current public health danger facing Americans. This research calls into question the very premise that generated the recommendation: that saturated fat is bad. The review further raises questions about potential positive health effects of saturated fats and fatty acids on reducing risk factors for heart disease and achieving a metabolic advantage for weight loss.

The net summary is that there is not enough information to make sweeping recommendations about the positive or negative health implications of fatty acids in the diet. Independent of that conclusion is the warning that as recommendations shifted to cut saturated fats out of the diet, replacing them with complex carbohydrates, Americans' risk for heart disease increased dramatically as well.

German, J.B., Dillard, C.J., "Saturated Fats: What Dietary Intake?" American Journal of Clinical Nutrition, 2004, 80(3): p.550-559.

DEBUNKING THE MYTHS OF HIGH-PROTEIN DIETS

Researchers Demonstrate that Claims of Purported "Risks" Attached to High-

Protein Intake Are Inaccurate

Often, critics of the Atkins Nutritional Approach(TM) (ANA(TM)), such as the American Heart Association (AHA), have had concerns about the possible health risks of following such an approach. A recent review, published in the Sports Nutrition Review Journal, was done in response to claims to the AHA Nutrition Committee's statement that individuals who follow a high-protein diet are at potential risk for cardiac, renal, bone and liver abnormalities. This review took into consideration 40 studies, all of which examined individuals with normal kidney function. Researcher Anssi H. Manninen concludes that there is no scientific evidence that can support any of the misleading claims made by the AHA.

In the body of studies that was reviewed, no studies were found that suggested that increased protein intake correlated with reduced cardiac function. On the contrary, some studies support a lowered risk of heart disease and more favorable blood lipid concentrations when protein replaces some carbohydrate in the diet. Several studies also show a negative correlation between protein intake and blood pressure. Additionally, the review finds no evidence that high-protein intake produces any damage to healthy kidneys. It is also clear that as the long-term effect of high-protein intake (especially when carbohydrates are controlled) on kidney function in diabetics has not yet been determined. This coupled with other current studies lead to the possibility that there may be need to reassess the traditional recommendations that protein be restricted in order to delay the progression of chronic renal failure.

In terms of bone health, investigators suggest that there is at least some evidence that identifies a correlation existing between high-protein intake and a lowered risk of osteoporosis. Finally, the review finds no scientific evidence of negative effects on liver function while following a high-protein diet. This review, as a whole, suggests a revision of views of high-protein diets that are mostly based on unsubstantiated fears and misrepresentations.

Manninen, A.H., "High-Protein Weight Loss Diets and Purported Adverse Effects: Where is the Evidence?" Sports Nutrition Review Journal, 2004, 1(1): p. 45-51.

LOW-CARB DIETS CAN EFFECTIVELY CONTROL BLOOD GLUCOSE

For Some Type 2 Diabetics, Low-Carb Diets Can Be an Alternative to Drugs

Research and the increased popularity of low-carb diets, like the Atkins Nutritional Approach(TM), have generated interest in the effect of various types and amounts of dietary carbohydrates and proteins on blood glucose. A study published in the medical journal Diabetes, entitled "Effect of a High- Protein, Low-Carbohydrate Diet on Blood Glucose Control in People with Type 2 Diabetes," comes to the conclusion that low-carbohydrate diets can dramatically "reduce the circulating glucose concentration in people with untreated Type 2 diabetes." The implication the study draws is that "potentially, this could be a patient-empowering way to ameliorate hyperglycemia without pharmacological intervention."

Men with Type 2 diabetes were instructed to follow two different diets for five weeks each. The control diet consisted of 55 percent carbohydrate, with emphasis on starch-containing foods; 15 percent protein; and 30 percent fat (10 percent each of mono, poly and saturated fat). The low-biologically- available-glucose (LoBAG) diet consisted of 20 percent carbs, 30 percent protein, and 50 percent fat (10 percent sat fat). Both diets were designed so that lipolysis/ketosis would not occur. Participants picked up their standardized meals and met with a dietitian every two or three days at a research center, where blood and urine samples were taken to measure diet compliance and observe changes in lab values. Blood sugar control improved significantly only when they were consuming the LoBAG diet. There were no changes in the serum lipid lab values that are associated with heart disease on either diet. This suggests that short term consumption of a LoBAG diet, or low-carbohydrate nutritional approach, can improve blood glucose control in diabetics without undesirable changes in serum lipids.

Gannon, M.C., Nuttall, F.Q., "Effect of a High-Protein, Low-Carbohydrate Diet on Blood Glucose Control in People with Type 2 Diabetes," Diabetes, 2004, 53(9): p. 2375-2382.

KANSAS DIABETICS WEANED FROM DRUGS

USING ATKINS NUTRITIONAL APPROACH

An ongoing study presented in November at the Southern Medical Association Conference in New Orleans and at the North American Association for the Study of Obesity conference in Las Vegas demonstrates the effectiveness of treating Type 2 diabetes using the Atkins Nutritional Approach(TM) (ANA(TM)).

This new research by one of the authors of Atkins Diabetes Revolution, Dr. Mary Vernon, and Dr. Eric Westman, a professor at Duke University, adds to the growing body of scientific evidence that the ANA can help Type 2 diabetics avoid the use of blood glucose medication.

The objective of this study was to assess the effect of a carbohydrate- restricted dietary approach on diabetes mellitus (DM) in a clinical practice setting. The rationale for using a carbohydrate-restricted diet for DM derives from the effect of dietary carbohydrate on insulin secretion and serum glucose excursions. The eight-month study concluded that diabetics have normal blood values for glucose and lipids without medication so long as they restrict carbohydrate consumption, specifically using the method of Dr. Robert Atkins, as laid out in the bestselling books Dr. Atkins' New Diet Revolution, Atkins for Life and Atkins Diabetes Revolution.

Study presented by Dr. Eric Westman and Dr. Mary Vernon at two conferences in November 2004. The Southern Medical Association Conference (New Orleans, LA. November 11-12, 2004) and North American Association for the Study of Obesity (Las Vegas, NV. November 15-16, 2004).

SUGAR-LADEN BEVERAGES CAUSE DIABETES IN WOMEN

Harvard Study Links Sugar in Sodas and Other Sweetened Beverages Directly to

the Onset of Type 2 Diabetes in Young and Middle-Aged Women

Everyone knows that sugar-sweetened beverages like soft drinks and fruit punches are less than healthy. Now, science and common sense has proven that most products that contain large amounts of readily absorbable sugars may contribute to weight gain and an increased risk of Type 2 diabetes. Recent research from Harvard University builds on the conventional knowledge regarding the association between consumption of sugar-sweetened beverages and weight change and risk of Type 2 diabetes in women, revealing an overwhelming direct link.

The study, published in the Journal of the American Medical Association, included analysis from 91,249 women free of diabetes and other major chronic diseases in 1991. At the completion of a four-year period, the study found significant weight gain and incidence of Type 2 diabetes. The researchers discovered that women with stable consumption patterns had no difference in weight gain, but weight gain over the four-year period was highest among women who increased their sugar-sweetened soft drink consumption from one or fewer drinks per week to one or more drinks per day, after adjusting for lifestyle and dietary confounders. Increased consumption of fruit punch was also associated with greater weight gain, compared with decreased consumption. Similarly, consumption of fruit punch was associated with increased risk of Type 2 diabetes.

The conclusion validates conventional wisdom regarding the consumption of sugar-sweetened beverages and highlights a problem that can be tied to the rising trend of obesity nationally and the ever increasing risk individuals face of developing Type 2 diabetes.

Schulze, M.B., Manson, J.E., Ludwig, D.S., et al., "Sugar-Sweetened Beverages, Weight Gain, and Incidence of Type 2 Diabetes in Young and Middle- Aged Women," Journal of the American Medical Association, 2004, 292(8): p. 927-934.

HARVARD RESEARCH SUGGESTS LOWER RISK OF BREAST CANCER BY CONTROLLING CARB

INTAKE

Recent research published in the August 2004 edition of Cancer Epidemiology, Biomarkers and Prevention shows that a diet consisting of a high percentage of calories from carbohydrates has a direct correlation to an increase in breast cancer risk in women.

A research team led by Dr. Walter Willett of the Harvard School of Public Health compared 475 women in Mexico City who had breast cancer with 1,391 female residents who had not been diagnosed with cancer. Patients in the study had their diets analyzed at average levels of 57 percent of their total calories coming from carbohydrates, 28 percent from fat and 15 percent from protein.

Final results showed a troubling relationship, that carbohydrate intake was positively associated with breast cancer risk in the population. Women who had controlled their carbohydrates cut their odds ratio of suffering from breast cancer by more than half compared to those who did not control their carbohydrate intake. More importantly, simple sugars such as sucrose and fructose were shown to have the strongest association to an increased risk of breast cancer.

Researchers suggest these findings are related to the effect of carbohydrate consumption on the body's insulin pathway, though it is clear that additional research is necessary to further explore this relationship. The research suggests a potential role for controlled-carbohydrate nutrition with regard to decreasing the risk of breast cancer, especially for women most susceptible to insulin resistance.

Atkins Nutritionals, Inc., has long known there are serious health risks beyond just that of obesity that go along with a very high-carbohydrate diet, particularly one high in refined carbohydrates such as simple sugars. The study from Harvard and Mexico City is the latest addition to a growing body of research that shows disturbing associations between high-carbohydrate diets, most notably high in refined carbohydrates such as white flour and sugar, and cancer risk factors. Science continues to show that by controlling carbohydrate intake and choosing whole grain and complex carbs can greatly aid in the prevention of serious health risks as demonstrated in this study.

Romieu, I., Lazcano-Ponce, E., Sanchez-Zamorano, L.M., et al., "Carbohydrates and the Risk of Breast Cancer Among Mexican Women," Cancer Epidemiology, Biomarkers and Prevention, 2004, 13(8): p. 1283-1289.

ATKINS PROVES BENEFICIAL TO NARCOLEPTICS

Researchers Demonstrate Atkins Nutritional Approach(TM) Can Improve Daytime

Sleepiness in Narcoleptics

There have often been accusations against the Atkins Nutritional Approach(TM) (ANA(TM)), claiming that it can cause fatigue and weakness due to the decreased intake of carbohydrates. However a recent study, published in the June 2004 edition of Neurology, concludes that narcoleptic patients who were following the Induction phase of the ANA, experienced modest improvements in daytime sleepiness. Furthermore, in addition to losing weight, their visits to the narcolepsy clinic were less frequent as they continued to follow the low-carbohydrate protocol. This suggests that the ANA could be beneficial therapy for those suffering from narcolepsy.

Nine patients from the narcolepsy clinic at the Veterans Medical Health Center in North Carolina were recruited for this study. For this study, narcoleptic patients were considered to be individuals who continued to suffer from excessive daytime sleepiness, despite treatment. Subjects also needed to have a particular body mass index. Dietary instructions, taken from Dr. Atkins' New Diet Revolution, included restricting carbohydrate intake to less than 20 grams per day, taking a multivitamin and drinking a good amount of water. The degree of sleepiness of the nine subjects was monitored using three validated scales; adherence to the dietary intervention was self-monitored, through the measurement of ketones in the urine.

As a result of the dietary intervention, patients with narcolepsy who followed Induction for eight weeks not only experienced significant weight loss, but also decreased their symptoms of daytime sleepiness. It was determined that the longer they followed the low-carbohydrate dietary protocol, the less frequent their visits to the narcolepsy clinic became. No unfavorable events or serious side effects were reported. These results suggest that the Atkins Nutritional Approach could be a beneficial therapy for narcoleptics in order to improve symptoms of daytime sleepiness.

Husain, A.M., Yancy, W.S., Jr., Carwile, S.T., et al., "Diet Therapy for Narcolepsy," Neurology, 2004, 62(12): p. 2300-2302.

Atkins Health & Medical Information Services

CONTACT: Atkins Corporate Communications, +1-212-457-9240

Web site: http://www.atkins.com/

Source: PRNewswire

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