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Atkin's diet

Indications: - popular diet for weight reduction a) average weight reduction 10% (9 kg) over 6 months b) 6% fat loss (37% to 31% body fat) - decreased total cholesterol (214 to 203 mg/dL)* - decreased LDL cholesterol (136 to 126 mg/dL)* - increase HDL cholesterol (52 to 62 mg/dL)* - may improve fasting glucose [2] * mean values from study [1] Procedure: - high protein, low carbohydrate diet - diet limits carbohydrate intake to 25 g/day initially, then 50 g/day after 40% of the weight loss has been achieved - calorie intake is not limited Mechanism of action: - may work, in part, by reducing calories - protein & fat can reduce hunger thus Atkin's dieters may eat less - ketonuria develops as a sign of reduced carbohydrate intake Adverse effects: 1) constipation (68%) 2) hallitosis (63%) 3) headache [5] 4) myalgias [5] 5) diarrhea 6) muscle weakness 7) rash 8) concerns for long-term effects [2] a) heart disease (high fat) b) low carbohydrate, high protein diet linked to increased risk for cardiovascular disease in women [8] c) renal failure (high protein) d) osteoporosis (high protein) 9) meat-based low-carbohydrate diet associated with increased long-term mortality [7] Clinical trials: Data from 6 month study funded by - Atkin's Center for Complementary Medicine - mean age 44, men & women, mean body mass index (BMI) 31.4 Mean calorie intake [1] 1447 kcal/day - 23 g of carbohydrate - 115 g of protein - 98 g of fat Data for another 6 month study [3] - 132 obese subjects, mean body mass index (BMI) 43 - most patients had diabetes mellitus or metabolic syndrome X - low carbohydrate vs low fat diet Results: 1) only 60% of participants completed study 2) mean weight loss greater in low carbohydrate than in low fat diet (6 kg vs 2 kg) 3) non significant trend toward lower caloric intake in low carbohydrate diet group 4) insulin-sensitivity in non-diabetics, fasting glucose in diabetics & triglycerides improved significantly more in the low carbohydrate diet group Data from a 12 months study [3] - 63 obese subjects, mean body mass index (BMI) 34 - 59% completed study - low carbohydrate vs low fat diet Results: 1) at 6 months weight loss greater in low carbohydrate diet group 2) at 12 months, both groups had regained weight, no significant difference in overall weight loss (4.4% vs 2.5%) 3) at 6 months weight loss greater in low carbohydrate diet group, but at 1 year no difference because low fat diet group continued to lose weight [5] Data from Eco-Atkin's diet study [6] Data from 12 month study [10] - 150 obese subjects - low carbohydrate diet (<40 g/day of digestible carbohydrates) vs low fat diet (<30% fat) - caloric intakes similar Results: - at 12 months. low carbohydrate group lost 3.5 kg more than low fat group [10] - low carbohydrate group with greater improvement in body composition, serum CRP, HDL cholesterol, & serum triglycerides

General

low carbohydrate diet; ketogenic diet (Atkin's diet, Eco-Atkin's diet)

References

  1. Journal Watch 22(17):131, 2002 - Westman EC et al, Effect of 6-month adherence to a very low carbohydrate diet program. J Med 113:30, 2002 PMID: 12106620
  2. Prescriber's Letter 10(6):32 2003
  3. Journal Watch 23(13):103, 2003 Samaha FF et al, A low-carbohydrate as compared with a low-fat diet in severe obesity. NEJM 348(21):2074, 2003 PMID: 12761364 - Foster GD et al, A randomized trial of a low-carbohydrate diet for obesity. NEJM 348(21):2082, 2003 PMID: 12761365
  4. Journal Watch 24(1):5, 2004
  5. Journal Watch 24(14):114, 2004 Yancy WS Jr, Olsen MK, Guyton JR, Bakst RP, Westman EC. A low-carbohydrate, ketogenic diet versus a low-fat diet to treat obesity and hyperlipidemia: a randomized, controlled trial. Ann Intern Med. 2004 May 18;140(10):769-77. PMID: 15148063 - Stern L, Iqbal N, Seshadri P, Chicano KL, Daily DA, McGrory J, Williams M, Gracely EJ, Samaha FF. The effects of low-carbohydrate versus conventional weight loss diets in severely obese adults: one-year follow-up of a randomized trial. Ann Intern Med. 2004 May 18;140(10):778-85. PMID: 15148064 - Willett WC. Reduced-carbohydrate diets: no roll in weight management? Ann Intern Med. 2004 May 18;140(10):836-7. No abstract available. PMID: 15148073
  6. Jenkins DJA et al The effect of a plant-based low-carbohydrate ('Eco-Atkins') diet on body weight and blood lipid concentrations in hyperlipidemic subjects. Arch Intern Med 2009 Jun 8; 169:1046. PMID: 19506174 - Tuttle KR and Milton JE The 'Eco-Atkins' diet: New twist on an old tale. Arch Intern Med 2009 Jun 8; 169:1027. PMID: 19506171
  7. Fung TT et al, Low-Carbohydrate Diets and All-Cause and Cause-Specific Mortality Two Cohort Studies Annals of Internal Medicine 2010, 153:289-298 PMID: 20820038 http://www.annals.org/content/153/5/289.abstract - Yancy WS Jr et al. Animal, vegetable, or . . . clinical trial? Ann Intern Med 2010 Sep 7; 153:337 PMID: 20820043
  8. Lagiou P et al Low carbohydrate-high protein diet and incidence of cardiovascular diseases in Swedish women: prospective cohort study BMJ 2012;344:e4026 PMID: 22735105 http://www.bmj.com/content/344/bmj.e4026 - Floegel A Low carbohydrate-high protein diets BMJ 2012;344:e3801 PMID: 22718914 http://www.bmj.com/content/344/bmj.e3801
  9. Ebbeling CB et al. Effects of dietary composition on energy expenditure during weight-loss maintenance. JAMA 2012 Jun 27; 307:2627 PMID: 22735432
  10. Bazzano LA et al Effects of Low-Carbohydrate and Low-Fat Diets: A Randomized Trial. Ann Intern Med. 2014;161(5):309-318 PMID: 25178568 http://annals.org/article.aspx?articleid=1900694