"Jim Marnott" wrote in message
. ..
The burning question

October 23, 2003

*Yet another study has shown that the Atkins diet works. But even
the
scientist in charge is baffled about why the low-carb regime reduces
fat
more effectively than conventional low-calorie, low-fat eating
plans,
Robert Matthews reports.*

An academic nutritionist at the University of Cincinnati, Dr Bonnie
Brehm, is at the cutting edge of research into the biggest question
to
hit her field in decades: does the Atkins diet work?

Most nutritionists faced with the torrent of anecdotal evidence for
its
effectiveness have simply parroted the mantra that more research is
needed, while muttering darkly about possible long-term health
effects.

Brehm and her colleagues, in contrast, have spent the past few years
actually doing the research and will unveil their findings at the
American Dietetic Association's annual meeting next week.

They have been studying the effectiveness of the Atkins diet in
trials
involving people classed as clinically obese, implying a weight of
more
than 92 kilograms (14 stone) in a person 175 centimetres (5 foot, 9
inches) tall. The latest results are in - and they appear to
vindicate
the late Dr Robert Atkins, whose diet books have sold 15 million
copies
over 30 years.

According to Brehm, those following Atkins's low-carbohydrate diet
for
four months achieved twice the weight loss of those on a
conventional
calorie-controlled, low-fat diet. Furthermore, the team found no
evidence of harmful effects from following the diet - at least
during
the study.

These results are in line with those found in similar small studies
now
starting to emerge. As well as backing the claims made for the
Atkins
diet, these latest results seem to further undermine standard
nutritional advice about the need to focus on cutting fat and
calories.

They are something of an embarrassment to Brehm, whose research is
funded by the American Heart Association, which has long advocated
calorie-controlled, low-fat diets.

As a scientist, Brehm puts unearthing the truth above pleasing her
paymasters - but it is this that causes most concern. She is having
problems explaining her findings - and in the increasingly
vociferous
debate over the Atkins diet, that may well land her in trouble at
next
week's meeting.

The scientific world is becoming increasingly polarised over the
diet,
with researchers such as Brehm being given a tough time over their
apparent support for what some scientists regard as the nutritional
equivalent of crystal therapy. At the heart of the controversy is
the
science behind the Atkins diet - first published 30 years ago - and
whether it is really anything more than a collection of buzzwords.

Conventional wisdom dictates that calories are the key to weight
loss,
and so those who lose weight must simply be consuming fewer calories
than they burn up. Yet, according to Brehm, the obese people who
lost
weight on the Atkins diet ate and burned up essentially the same
number
of calories as those on the standard diet. What was very different
was
the proportion of body fat shed by each group, which mirrored their
percentage weight loss. On the face of it, this backs the central
claim
of the Atkins diet: that a low-carb diet turns the body into a
fat-burning machine.

To trigger this effect, Atkins dieters are instructed to begin by
eliminating all carbohydrates from their diet, forcing their bodies
to
get energy by burning up fat reserves instead. The result is
supposed to
be weight loss, plus the production of compounds known as ketones;
the
higher the level of "ketosis", the more fat is being burnt.

BZZZZT. The part about "higher ketosis" is flat out wrong. Sigh.

That's the theory. Yet studies of the patients in Brehm's trial
failed
to reveal a connection between ketosis and fat loss. "We didn't see
any
correlation - all of our expectations were confounded," she says.
"I'm
hoping someone in the audience might have some answers."

Yeah, because ketosis is merely a confirmation that you are burning
fat for fuel, not a magic bullet.

Brehm is confident that there is a reasonable, if not simple,
explanation for her findings: "In the end, the energy in has got to
match the energy out."

Even more baffling is why there are still such enormous gaps in
knowledge about how humans respond to diet. The past 20 years have
seen
obesity reach record levels in the developed world. This has led
scientists to concede that the standard advice on nutrition and
healthy
eating has been an abject failure - yet the Atkins diet is still
dismissed as a "fad" by the British Dietetic Association, with
leading
nutritionists insisting that there is insufficient scientific
evidence
to give it more credence. This lack of evidence has not deterred
many in
the medical profession from condemning the diet out of hand. Last
week a
poll of British doctors revealed that one in four would advise their
patients to stay fat rather than try the Atkins diet - despite the
proven life-threatening effects of obesity.

Such attitudes might suggest that the scientific world is in the
grip of
cognitive dissonance over the Atkins Diet, preferring to ignore
whatever
evidence it does not like.

I find it kind of funny, in a way. Knowing the way the scientific
process works, and the peer-review raking-over-the-coals that happens
behind the closed ranks the communities face the public with, I know
that this is business as usual, only right out in the
non-understanding public's view-- who are going to look on this as a
mark against the establishments' reputation and respect and not see
that this is standard operating procedure. The scientific/medical
communities are shooting themeselves in the foot and they don't even
know it.


Professor Eric Westman, a clinical trials
expert at Duke University in North Carolina, and author of a study
of
the evidence for and against the diet, says, "It is making people
re-examine dogma - and it's not always appreciated."

According to his review, which is due to appear in Current
Atherosclerosis Reports, studies show that the Atkins diet does
produce
weight loss over six months, and without obvious health effects.
Contrary to the claims of many nutritionists, there is even evidence
that it may be healthier than the standard diet: despite its
promotion
of fat and eggs, studies suggest that the diet may boost levels of
the
healthy forms of cholesterol.

Westman thinks that this unexpected effect may explain a
long-standing
mystery surrounding heart disease. In the late 1980s, researchers
began
investigating the unusually low rates of heart attacks and stroke
among
Eskimo communities in Greenland. Until now, the explanation was
thought
to lie in their diet of oily fish. Yet attempts to reduce heart
disease
using supplements of fish oil extracts proved disappointing. Westman
says the studies of the Atkins diet point to another explanation:
that
the lo-carb diet forced on the Inuit by their environment gives them
higher levels of healthy forms of cholesterol, which are proven to
lower
heart disease risk.

Despite this, Westman cautions anyone with a medical condition
against
rushing onto a low-carb diet. "The problem is that it works too
well,"
he explains. "The diet can cause insulin levels to drop by 50 per
cent
in one day, so diabetics could find themselves over-medicated. It's
the
same for those with high blood pressure."

Even so, Westman believes that the results are impressive enough to
warrant an intensive research effort on the Atkins diet: "We're in a
period when we will learn a lot."

It is not a prospect that thrills the entire nutritional science
community. Westman has been vilified for conducting research with
financial support from the Atkins Foundation - despite the fact that
some vocal critics of the diet, such as Dr Susan Jebb, the head of
nutrition at the UK Medical Research Council, have, in turn,
received
funding from bodies such as the Flour Advisory Bureau.

Brehm has also run into resistance even over her research funded by
the
American Heart Association.

"We had a tough time getting our results published - it took 18
months
altogether," she says. "The big journals really couldn't handle it.
But
we're not endorsing the diet: it's just our results."

What both sides do agree on is the paucity of scientific evidence on
the
long-term benefits and health effects of the Atkins diet. With the
world-wide obesity problem now claiming an estimated 2 million adult
lives a year, Brehm believes that the time has come to commit
serious
resources to studies of low-carb diets.

As she says: "We need much more doing - and doing quickly." This is
a
sentiment endorsed by Professor Tom Sanders, the director of the
Nutrition, Food and Health Research Centre at King's College,
London -
and a sceptic regarding the Atkins diet.

"The evidence is that it's the calorie intake that counts," Sanders
says. "But in the end, diets don't work because people don't follow
them. We need large-scale, randomised and controlled trials of
treatments of obesity running for one to two years."

Those already embarked on such research suspect that it will take a
great deal to overcome the visceral response the mere mention of
Atkins
provokes among academics. Says Brehm: "A lot of people just want to
hold
on to what they learned in college."

Other than that one error, this is a fantastic article,. It doesn't
cover just the highlights (and get half of them wrong). I'm sure the
good doctor would have considered it an excellent piece. I just wish
he was still alive to see it.

revek


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