Philip J. Goscienski, M.D.
August 2005
If we needed more evidence that low-carb diets had lost their sizzle it came on August 1, 2005 when Atkins Nutritionals Inc. filed for Chapter 11 bankruptcy.
Fads fade for a reason. The dropout rate is high - about 50 percent - because the diets are boring and are unpalatable to most people. Side effects such as headache, fuzzy thinking, irritability, halitosis and constipation are almost universal among low-carb dieters.
Long-term adherence to a high-fat, high-protein, low-carbohydrate diet worries physicians because it may lead to kidney stones, osteoporosis and heart abnormalities. Kidney stones and disturbances of heart rhythm are well-documented complications of the ketogenic diet (high fat, low protein, low carbohydrate) that pediatricians have used for about 80 years to lower the seizure frequency in children with neurological disorders.
Reputable medical journals have reported that low-carb diets helped people lose weight without causing adverse effects on cholesterol levels. That brought joy to food manufacturers, who had already rushed to market low-carb products that covered the spectrum from bonbons to beer. Lost in all this was the cool scientific observation that overweight persons experienced only a moderate weight loss and that severely overweight individuals in the longest trial lost, on average, only one pound per month during the study year. The cholesterol profiles did indeed favor the low-carb dieters but those levels remained higher than normal because that's where they started out. Finally, few journalists revealed that the Atkins Foundation funded one of these studies.
The real goal of any honest weight loss program is to reduce body fat, not body weight but that's not what happens in the induction phase of these diets. A sharp reduction in carbohydrates forces the body to use its 1- to 1 1/2-pound storehouse of starch-like glycogen for energy before it starts to burn fat. That results in a loss of 3 to 5 pounds of water as the glycogen is used up. The immediate 4- or 5-pound weight loss is dramatic but meaningless.
Those who can successfully navigate the inconvenience and side effects of the low-carb diet and then maintain a significant loss of fat will certainly benefit. Long-term success depends not only on careful attention to diet but also to regular exercise. Persons who do not incorporate an exercise routine into their life are destined to gain all the weight back and then some. Much of the weight loss in calorie-restricting diets consists of lean body mass, mostly muscle. Regular exercise helps to limit that loss of muscle.
In what direction is the low-carb phenomenon going? First, proponents are already backing away from saturated fat. The South Beach diet promotes polyunsaturated (from fish) and monounsaturated (from olive oil) fats because they are essential to good health. Second, we now know that whole-grain products have health benefits that refined carbohydrates (white flour, sugar) do not, especially in slowing the development of type 2 diabetes. Third, the low-fat establishment cannot and must not ignore the overwhelming benefits of fruits and vegetables in the prevention of cancer and heart disease.
The low-carb craze has passed its peak but remnants will persist for a generation or more. New versions of it will rise episodically like phoenixes among those who are looking for effortless weight loss. Like the phoenix, that is a myth.
Philip J. Goscienski, M.D. is the author of Health Secrets of the Stone Age, Better Life Publishers 2005. Contact him at drphil@stoneagedoc.com.