The Atkins Diet actually demands that carbohydrates are kept below 25 grams per day (less than 10% of the U.S. recommended daily allowance) during the first few weeks of the diet (known as the induction period), while fats and proteins can be eaten without limits. The whole idea is that your body will enter ketosis - a state where your body will start to burn off fat as opposed to any stored sugars. This makes most people ornery and gives them bad breath, but also promotes rapid weight loss when paired with exercise.

After you have reached about 10 lbs over what your ideal weight is, Atkins recommends that you gradually up your level of carbohydrates to suit your body's ability to use them efficiently. He would prescribe that a structured diet and exercise regimen would work best at this point, to slowly melt away those last few pounds - in theory this makes you less likely to gain them back.

The Atkins Diet, also known as the ketogenic diet, is a four-stage low-carbohydrate diet which uses the bodily state of ketosis in order to provide weight loss and weight management. Though controversial, Dr. Robert Atkins' diet plan has helped many people lose weight and if his words are to be believed, very well might be the diet we evolved to consume.

See also: What to Eat on the Atkins Diet

"They lose the weight, they feel fine, then they get to their goal weight and they still have 60 more years to live, and are they going to go hungry for all 60 years?"
Dr. Robert Atkins (1931-2003) to CNN on diets which restrict caloric intake

This diet (and variations thereof) is frequently used to treat seizures as it reduces blood glycogen levels, making the brain somewhat immune to seizure triggers. While on this diet, one depends on fats for energy rather than carbohydrates. As a result, you find yourself eating salad without croutons, but with a ton of blue cheese dressing. Like most diets, one must take care to drink a sufficient quantity of water, in this case to avoid damage to the liver and kidneys due to secondary results of ketosis.

KETOSIS

While avoiding supersession of such other writeups as ketosis, no description of the Atkins Diet is complete without at least briefly covering the highest and lowest points of ketosis, at least as it relates to this diet. Firstly, ketosis is a desirable state because it causes your body not to store fat when consumed, and also reduces your body's tendency to consume muscle as fuel. Since ketosis is induced by consuming a minimum of carbohydrates, your body has nowhere to turn for energy beyond the fats you take in, and the fats stored in your body.

On the down side, the reduced levels of insulin can make you tired, though for most this passes in the first couple of weeks. It also increases stress on your liver and kidneys, which is the reason that maintaining a healthy water intake is so important. And it increases calcium loss, necessitating a greater calcium intake.

Dieticians (and others) frequently confuse ketosis with ketoacidosis, a dangerous state which can be deadly in those with diabetes. Put simply, the pH of the blood becomes lower than normal because of increasing acidity due to ketones. If your body is not processing its waste properly, this state can come about. Thus the use of this diet is not recommended to those who require dialysis.

STAGES

The four steps of the Atkins diet are:

  1. Induction: During this phase one consumes 20g (or less) of carbohydrates per day. This is exceptionally difficult due mostly to unnecessary addition of sugar to nearly everything one eats, especially in the USA. Even ostensible meat products like beef jerky or lunch meats tend to be loaded with sugar; most hot dogs are additionally filled with carbohydrate-based fillers. One continues with this step until one has nearly reached their target weight.

    During the onset of this stage, in the first week or so, most people will lose a fair amount of weight due to simple water loss. This should not be mistaken for actual weight loss, as it will be regained immediately if one returns to "normal" dietary process. It is unlikely that anyone will lose more than twenty pounds this way; using the atkins diet to lose twenty pounds is closely akin to using a backhoe to dig a post hole -- in other words, overkill.

  2. Ongoing Weight Loss: During this phase one adds 5g of carbohydrates to their diet each week until weight loss is slowed. One adds these carbs from vegetables, seeds, nuts, and berries. Slowly adding carbs to your diet (Rather than simply jumping to a "normal" eating pattern) allows your body to continue to burn fat stores for energy. One can tell if one is still in ketosis via the use of test strips, a simple litmus test for the presence of ketones in the urine.

  3. Pre-Maintenance: This phase begins once you're within 5-10 pounds of your target weight. At this time you can add starchy foods back to your diet to the tune of 10g carbs per week, dialing back your fat intake to match the new food coming in. The idea here is to move back to a minimal weight loss per day and a balanced diet. If you start gaining back weight, then you simply dial back the amount of carbs you're taking in.

  4. Lifetime Maintenance: This phase begins when you have reached your target weight through pre-maintenance. You can occasionally eat junk food (like candy bars, cookies, and cakes) but this may raise your weight again, sending you back to pre-maintenance.

Some people are on this diet all their lives in order to control seizures, while others stay on it to control their weight. This final stage of the diet can be carried on indefinitely because this final stage is simply a healthy diet little different from the advice of other dieticians; Avoid processed sugar and white flour when possible, watch what you eat, don't binge, eat on a regular schedule.

ADVANTAGES

The major advantage of the atkins diet is that it works all the time, regardless of exercise. This makes it an ideal solution for persons with uncontrolled asthma or some other health conditions which limit their ability to achieve weight loss through exercise. In addition, while in ketosis one's body consumes less protein (in our case, muscle) for energy; during the course of ordinary dieting, one part muscle is consumed for every three parts fat. Putting it back on becomes a time-consuming affair, and is difficult to do if you are on a vegetable-heavy diet, as protein is far more readily available from meat.

When coupled with an exercise regimen, the atkins/ketogenic diet becomes almost brutally effective. Fat is far more energy-rich than carbohydrates but does not break down as easily. Thus, you get plenty of energy, and it is released more slowly. You generally take in a great deal of protein (this diet is all but impossible without meat) and so it is actually easier to build muscle while on this diet.

Dr. Atkins claimed that the diet is a treatment for diabetes, hypertension, gastritis, esophageal reflux disorder, some headaches, and a 'variety of other problems'. He also claimed that it eliminates most of the risk factors for heart disease; note that the high fat intake is not intended to last a lifetime, but it is necessary when your carbohydrate intake is low as it provides energy. The diet is known to reduce the risk of seizures. It is also known to reduce triglyceride levels. High trigylceride levels are known to accompany heart disease and are currently thought to be the primary factor in causing it.

DISADVANTAGES

The first and most obvious disadvantage is that this diet makes it much more difficult to assemble a variety of attractive meals at home. Unless you are flush with cash you will find yourself eating quite monotonously. The second drawback is the "dragon breath" that comes with increased ketone production. This tendency is most pronounced when you begin the diet, and the sour chemical taste in your mouth will be quite annoying until you become accustomed to it. You can keep this from happening by drinking enough water to flush the excess ketones out of your system.

Next, this diet can quite possibly cause kidney failure if you do not take in the recommended eight glasses of water a day. Those who are paying attention will no doubt have noticed that it has been previously (though perhaps erroneously) suggested to drink this much water no matter what one's diet is like, but it is especially important when one is on a high-fat diet such as Atkins. The Atkins Center claims that there are no studies which indicate liver or kidney failure, which does seem to be borne out, but it is a repeatedly-stated concern of most dieticians.

If one does not consume sufficient quantities of fiber, the result can be constipation or loose stool, depending on fat and water intake. It can also cause one's excrement to become more malodorous than such a substance normally is, because of increased quantities of meat in the lower digestive tract. It would be a mistake to eat only meat.

The diet's increased water intake means one has to make sure they get plenty of vitamins. It can also sap you of various oils; to combat this, one can consume macadamia nuts and avocado. Various companies (including, of course, Atkins) sell vitamin and oil complexes intended to offset leaching due to dietary change and water consumption.

ALCOHOL

One of the common questions about the Atkins Diet is whether or not one can safely consume alcohol which is after all converted sugar. The answer is yes, though naturally with certain reservations. First, many alcoholic beverages contain a large amount of unconverted sugar or other carbohydrates. For instance, one beer (A beer is considered 12 ounces for the purposes of this example) is approximately 15 grams of carbs in one shot. The average person will drink more than one beer; the carbs derived thereof add up quickly. Sweet hard alcohols such as rum are far worse. One can however safely drink those in which all of the sugar is converted, such as vodka, scotch whiskey, or gin. Of course, one must avoid mixers which contain sugar. Some no-carb mixers are available, such as sugar free tonic water, which tends to be made with saccharin.

The other caveat is that your body attempts to burn alcohol for fuel before anything else, so while alcohol is in your system, you are not losing weight. Habitual drinking is thus contraindicated while on this diet -- Or, sadly, at any other time.

CONTRAINDICATIONS

There are some states from which one should not essay the Atkins diet; people with severe kidney disease are of course cautioned to avoid it; pregnant women and nursing mothers as well. People with gallstones are also warned to be cautious, and cut out the majority of the fat, though I doubt that you could successfully follow the diet without it.

The diet is significantly more expensive than eating a full range of foods. Many of the cheapest common food items are verboten; breads, starchy vegetables like potatoes, and other starchy foods such as noodles -- that includes ramen of course, students beware. The least expensive foodstuffs you can eat tend to be chicken thighs and hot dogs, though one must be careful to read the packages of the latter because many brands have as much as seven grams of carbohydrates from sugar and filler per frank. Oscar Meyer turkey-based franks have 0g of carbs. Salad can actually end up costing you significant amounts of money if you use the high-fat dressings which will give you energy, as most salad dressings (especially inexpensive ones) are loaded with sugar. Avoid dressings from Kraft and Best Foods; check the produce section for Marie's and Bob's brands, which have far less sugar.

EVIDENCE

A lot of so-called scientists like to pooh-pooh anecdotal evidence because it is not subject to the controls of a formal experiment, but when the numbers become too overwhelming, notice must be taken. Albert Stunkard, to whom can be attributed the saying that "95 percent of all dieters never lose weight, and 95 percent of those who do will not keep it off" (this quote was based on one study of only 100 people) discovered that his chief of radiology had lost 60 pounds on Atkins' diet. "Well, apparently all the young guys in the hospital are doing it," he said. "So we decided to do a study."

I also write from my personal experience; I lost 90 lbs in nine months without doing much exercising, and rapidly decreased my waist size and increased my weight lifting capacity over the course of a semester of lifting for an hour a day twice a week. I chose the diet because I have activity-induced asthma which makes it difficult to do any exercise at all; even walking rapidly leaves me winded. On this diet, I am rarely hungry. It is extremely difficult to locate food when one is on the go, however, as meat tends to be somewhat more expensive than a 'balanced' meal.

But there now have been studies, though none of them have been financed by the NIH. Five studies at Schneider Children's Hospital on Long Island, Duke University, the University of Cincinnati, the Philadelphia V.A. Hospital, and Stunkard's study (led by Gary Foster at the University of Pennsylvania, Sam Klein, director of the Center for Human Nutrition at Washington University in St. Louis, and Jim Hill, who runs the University of Colorado Center for Human Nutrition in Denver. All five studies showed a reduction in cholesterol in both the "normal" and low-carb diets, but triglyceride levels were notably lower on Atkins. While the jury is still out, it seems that putting fat back into your diet can actually reduce the risk of heart disease.

Perhaps based on the weight of these studies, the NIH is finally spending some money to further explore the possibilities. Foster, Klein and Hill (see above paragraph) have received from them US$2.5 Million to do a five year study of 360 obese persons. Dr. Atkins himself has been putting off a long-term study for supposed want of money (in spite of the great deal of profit he's made on selling books, diet supplements, and low-carb foods) and now Willett, Blackburn and Penelope Greene at Harvard have received a grant from Atkins' nonprofit to do a study as well. The irony of this is that doubtless many of those who have insisted for years that Atkins do a study will decry the results when they come back.

There's no need to wait for such a study to prove that the diet works, however -- at least as a means to weight loss. George Blackburn, president of the American Society of Clinical Nutrition, pioneered the "protein-sparing modified fast" to treat postsurgical patients for obesity. "People loved it," Blackburn recalled. "Great weight loss. We couldn't run them off with a baseball bat." He published a number of papers on the subject which were summarily ignored, perhaps as a result of the low-fat dogma becoming prevalent at the time.

HEAVY OPPOSITION

While sitting on the throne one morning I looked in the trash to find the Spring/Summer 2002 edition of "Weight Watchers Walking", which is apparently "A Supplement to Weight Watchers Magazine". Flipping through it, what do I see?

Memo: To Madonna, Jennifer, and other low-carb diet divas
Re: High-protein diets
FLASH Women whose diets are animal-protein heavy have almost four times as many bone fractures as women who eat more vegetable protein.
FLASH Low-carb diets have a poor record when it comes to long-term weight loss, often resulting in higher intakes of fat and cholesterol and a limited offering of nutrients.
FLASH There's no evidence to support that extra dietary protein builds extra muscle.

Well, well. So Weight Watchers considers the low-carbohydrate diets to be a threat, does it? Remember that this magazine is read generally by Weight Watchers members, who they have a vested interest in keeping inside the program. Consider that they cite no sources for any of these arguments.

The first point, about bone fractures, is a quite real issue. A study begun in 1980 and carried out via questionnaire over the following twelve year period indicated a 22% higher risk of forearm fracture in women "who consumed more than 95 g per day compared with those who consumed less than 68 g per day". This is for overall protein, however, and the abstract does not give the exact numbers for animal protein, which were similar. This may serve to illustrate the importance of taking in vitamin supplements while taking part in the diet, but should do little to dissuade one from utilizing it as a means of regulating obesity.

The second point is amusing simply because all diets have a poor record when it comes to long-term weight loss. The most commonly cited statistic is that 95% of people who lose weight gain it back -- see above for the fallacy in quoting that particular study. The question of course is "does this have anything to do with the Atkins Diet in particular, or simply with a general lack of discipline?" It is true that the penalties for going off the Atkins diet are stronger than most, but the idea with this diet is the same as any other; there are procedures for lifetime maintenance, which is actually the literal name of the final phase of the Atkins diet. If you return to eating the way you did before you dieted, of course you're going to gain the weight back. Furthermore, your system is no longer acclimated to the intake of excessive quantities of carbohydrates common in the western diet, which leads to gaining it back even more rapidly after going off of Atkins than what you will experience from other diets. As the American Heart Association is only too happy to tell anyone who will listen, the trick to keeping the weight off is to not go back to your old behavior.

As for the allegations that the diet results in higher intakes of fat and cholesterol, they are absolutely correct. However, they mean nothing in and of themselves. Even studies which decry the Atkins diet are forced to admit that it raises HDL or high density lipoprotein levels, the so-called "good fat". Of course, as we know, consuming fat does not make you fat, and consuming cholesterol does not raise your cholesterol. That is a talent reserved by carbohydrates.

Finally, while there may not be any evidence that shows that consuming more protein helps you build muscle, ketosis is known to slow the rate of lean muscle loss. It is a little known fact that in general, for every three pounds of fat one burns, one loses one pound of muscle. This is not true while one is in the state of ketosis. In other words, you might not be building more muscle, but you are certainly losing less. This only shows that statistics is an exact science, but marketing is an art.

Since I developed this writeup, some content has gone away and some new stuff has come around. A writeup by skongshoj, for example, whose opening paragraph calls the atkins diet "stupid", makes some significant incorrect statements. For example, one oft-repeated argument repeated there states that no one has ever stayed on the Atkins diet for long periods of time - which is patently false. Besides Dr. Atkins himself who had a congenital heart condition and died at the age of 72 because he hit his head after slipping on ice, the diet is used to control seizures because most seizures require glucose. The writeup also says that the body "reacts as if famine is at hand" and "...starts breaking down its stored fat, glycogen and protein to use as emergency fuel." This is partly true, but ignores the fact that the rate of lean muscle loss is actually slowed during ketosis. In ordinary weight loss, you lose one pound of muscle for every three pounds of fat. You lose less muscle on the Atkins diet, unless you fail to consume enough fat to fill your energy requirements.

In addition, the idea that what you consume minus what you burn becomes fat is not a "basic rule of physiology" - it's not even true. Besides failing to account for waste, it completely ignores ketosis. Much of what we hold to be true is based on limited observation, and we are loath to give up our beliefs even in the face of new evidence, forgetting that science does not necessarily describe how things work, but only how they can repeatably be made to work, based on a given and limited set of observations, because no one is omniscient.

Note: If you have atkins experiences or any other information you would like to share, please put them in your scratchpad and message me. It would be good to avoid filling this shell with GTKY writeups. I am quite responsive when it comes to corrections or requests for additional information.

References:

  1. Website: Atkins Center. (http://atkinscenter.com/)
  2. Taubes, Gary. What if It's All Been a Big Fat Lie?. New York Times online, July 7, 2002.
  3. alex.tan, ketoacidosis. Everything2, Wed Apr 12 2000
  • Feskanich D, Willett WC, Stampfer MJ, Colditz GA. Protein consumption and bone fractures in women. Am J Epidemiol. 1996 Mar 1;143(5):472-9. (Abstract http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=8610662&dopt=Abstract)
  • Website: Hold It! The American Heart Association (http://www.deliciousdecisions.org/ff/wyo_hold_main.html)
  • Thanks to RPGeek and Ichiro2k3 for editing assistance.

    Does the idea of losing weight by gorging on pork rinds, lard, red meat and cheese sound stupid? That's because it is. As much as I hate reply nodes, someone has to speak out about this madness, and I guess it might as well be me, although be warned, I'm no professional nutritionist. Are you seriously considering taking medical or nutritional advice from E2?

    Humans are tough survivors conditioned by millions of years of harsh evolution, and among our accomplishments as a species, not the least impressive is the fact that we managed to survive even the Ice Age. This may be hard to imagine in a place and age where there's a McDonald's at every street corner and the most compelling reason for physical exertion is to look good naked, but that never was the world evolution built us for. In the Good Old Days, we couldn't count on getting a full meal every day. The paleolithic hunting parties almost certainly didn't bring home a catch every day, and there would be times where even the gatherers were hard-pressed to bring home enough food to keep the tribe fed (it is likely, however, that the gatherers played a larger role in this than the hunters -- while humans are omnivores, we adapt much better to meat-free diets than to all-meat diets, and it is unlikely that this is completely without reason). Fortunately, one of the things nature has designed us to be able to survive well is hunger. The human body stores glycogen and fat in order to allow it to survive hard times, and through a series of remarkable biological processes, it can resort to all sorts of emergency responses to keep going. First it will burn the stored fat and glycogen depots off and introduce them into the metabolism. When even these run out, the body can even start eating itself, metabolizing protein from its own muscles and organs in a last-ditch attempt to stay alive until food is available and it can regenerate.

    This brings me to the Atkins Diet and similar low-carbohydrate lose weight fast schemes. The basic premise of this particular diet form is to cut out as much carbohydrate intake as at all possible and subsist on fat and protein alone. The body registers that it is being deprived of the energy source it was built to primarily subsist on, reacts as if famine is at hand, and after a few days, it starts breaking down its stored fat, glycogen and protein to use as emergency fuel. Dieters sometimes incorrectly describe the tiredness and possible nausea as "withdrawal", although it has nothing to do with the processes an addict undergoes when deprived of his poison of choice, it is quite simply the beginning state of the body preparing for prolonged hunger (and the brain receiving its emergency signals). The lack of carbohydrates induces the state called ketosis, in which fatty acids from the body fat are incompletely metabolized, releasing ketone bodies (which are, in effect, particles of unmetabolized, rancid fat). One of the results of this is that the body sheds large amounts of stored water and lean tissue while preparing for the coming ordeal. Another is that it gives out a quite unpleasant smell (which, however, is not detectable to all humans). Both the monotony of the diet and the state of ketosis itself tends to reduce the dieter's appetite, which usually results in much lower overall calorie intake and eliminates overeating. These are the reasons the Atkins diet is effective: The body dehydrates, burns off its stored glycogen and fat, and the dieter is unlikely to intake anywhere near as many calories as before. Basically, the Atkins diet works through (more or less) controlled malnutrition.

    Here's the kicker: Humans may be able to withstand incredible amounts of abuse (the fact that a guy like Ozzy Osbourne is still alive and technically well in 2003 is evidence of this), but we aren't designed to withstand hunger for years and years. Quite simply, ketosis is an emergency reaction not meant to be deliberately maintained for a long time. While the body is in the state of ketosis, rancid fat is literally floating around in the bloodstream of the dieter, releasing free radicals and doing all sorts of interesting damage to the body. A prolonged state of ketosis is likely to cause cancer of the colon, bladder, stomach, intestines and lungs (as well as the prostate, if you have one), all sorts of cardiovascular complications as well as kidney and liver failure. It has been proven to speed the progression of diabetic kidney disease. The Atkins diet's lack of fruit will over time demolish the dieter's immune system and hamper the bowel functioning (if eating fruit is bad for us, why do you suppose humans come equipped with quite the sweet tooth?), and the lack of vegetables deprives the dieter of a host of essential nutrients -- some of which, ironically, are needed to properly metabolize fat. This is why Atkins dieters usually regain their former body weight, often even more, when they switch back to a balanced, sustainable diet -- which they will have to at some point, lifelong ketosis would be a death sentence. Dr. Atkins recommends that after a period of time, carbohydrate is slowly reintroduced into the diet, although nobody really knows if the body will have taken serious damage by then.

    You see, there are no conclusive studies about the long-term effects of the Atkins diet or of ketosis in general, because nobody has ever maintained it long-term. The drop-out rate is enormous even compared to other fad diets, making statistical study of the diet's effect difficult at best (studies paid by the Atkins Center exist, but since they typically include less than 100 test subjects monitored for less than a year and with a dropout rate of over 60%, they are close to useless for any scientific work). Even though Dr. Robert Atkins, the inventor of the diet, has recommended it since 1972 (despite public warning advisories against the diet by the American Heart Association and others), he never made any examinations of its long-term effects! While he stated that over 60.000 patients at his weight loss center used the diet as their primary weight loss protocol, he has never monitored people who used his program over a period of several years. Guess why not?

    The public success of the Atkins diet is a huge testament to laziness; people are searching for some alchemy to defeat the basic rule of physiology that body fat is calorie input minus calories burnt. The only proven way of sustainably losing weight, while taking effort and patience (not exactly the cardinal virtues of modern society), is to decrease calorie intake and increase exercise. By going on the Atkins diet, a dieter is going against all medical advice, and trusting his or her very life to a method that has never been proven in the long term even by its own inventor -- and which is regarded as effectively a death sentence by many health professionals.

    References:

    • http://www.fumento.com/fat/lard.html
    • http://www.quackwatch.org/01QuackeryRelatedTopics/lcd.html
    • http://www.supplecity.com/articles/diets/atkinsdiet.htm
    Conflicting reports exist on the Atkins diet, with supporters claiming massive losses from a religiously-followed low-carb regimen, opponents warning of dire consequences from ketosis, and many ordinary people claiming modest effects. The truth is that few people actually follow the Atkins diet, making the debate confusing. While discussion of ketosis may be confusing enough, the effects on most people are more subtle and more complicated than mere biochemistry.

    Facts that any real analysis of Atkins must address include:

    • It's a diet
    • People "follow" diets to different extents
    • Some but not all weight loss is fat.
    • Ketosis is difficult to achieve.
    • the Western Diet is strange to begin with.
    Thus, there are a variety of reasons a person might lose weight on a diet; I will present the most likely reasons a person would lose weight on the Atkins diet.

    It's a diet. Not only that, it's a diet that appeals to people who have never dieted before, including more men than most previous diets as well as women who would hate to give up fat. The fact is that any diet will cause weight loss. Merely being aware of what one is eating and perhaps exercising a bit more will cause some weight loss in many naive dieters (ie new to dieting). Indeed, previous studies have shown that a diet consisting of the dieter's previously-recorded food intake generally causes weight loss - though some think this reflects more an error in people's ability to recall what they eat. Either way, any awareness of food and portion control (Atkins foods do have the benefit of coming in small portions) is clearly shown to work.

    It requires thought The Atkins diet involves removing some staple foods from the dieter's repertoire of foods. This means that a bunch of foods a traditional dieter might have called "perfectly healthy" despite an unhealthy portion size must be re-evaluated.

    Less snacking The typical Western snack food must be eliminated in an Atkins diet. This includes bedtime snacks and worktime snacks - excellent opportunities for weight gain. If a muffin or cupcake is given up, 300-1000 calories may be eliminated from the diet.

    It's boring If fewer food choices are available, less will be eaten. Ever gotten full from a meal then eaten dessert? Variety in tastes improves appetite; Atkins (by restricting this variety) will reduce appetite.

    The above factors can produce weight loss without truly restricting carbohydrate intake much. Below here are ways the Atkins diet can reduce weight that involve a real reduction in carbohydrates. Each way involves a progressively more strict Atkins Diet. Note that true ketosis is quite hard to achieve, since typical Atkins foods such as cheese and meat do contain some carbohydrates.

    Fat is filling In the Western diet, carbohydrates are generally from white rice, white flour, potatos, corn syrup, etc. They are quickly digested and are therefore eaten in large quantities. The best solution is to eat more complex carbohydrates, which are more nutritious, more filling per calorie, and reduce the risk of cancers and heart disease. Fat is filling like complex carbohydrates, although without these other benefits. By switching away from simple carbohydrates to fat, a dieter can lose weight without becoming hungry as mere portion control would do.

    Water weight: Without enough carbohydrates, the body cannot replace stored carbohydrates. The liver stores carbohydrates as glycogen, along with water due to oncotic pressure. Thus, about 10 pounds of water can be lost from the average liver by losing this glycogen. Of course, the glycogen is highly useful in aerobic exercise, since it's used for gluconeogenesis to send glucose to the exercising muscles.

    Ketosis causes nausea. If a dieter is particularly strict about reducing carbohydrates, ketosis can be achieved. The body must have a certain amount of glucose or ketone bodies around, since these are the only possible foods for the brain. If there are not enough carbohydrates to provide glucose, ketone bodies will be produced from proteins (and to a lesser degree fats, since during fat degradation as pairs of carbons are removed these cannot be used; only the odd 3-carbon leftover can be used.) These can feed the brain, but cause acidosis and ketosis of the blood; this causes nausea and reduces appetite.

    Degradation of the body could be required. If a person were truly insane about carbohydrate reduction, they would have to give up standard low-carb fare such as cheeseburgers sans bun in favor of, say, pure olive oil. Such a person would break down existing proteins in their muscle in order to produce ketone bodies to keep the brain alive. This is not the typical reason for weight loss in a normal dieter.

    Summary: People claiming weight loss from the Atkins diet could probably lose the weight from a healthier diet involving more vegetables and complex carbohydrates. Nevertheless, the typical dieter does not follow Atkins or any other diet well, and if the question is whether the average Western diet would be slightly improved by eliminating hamburger buns, the answer would be yes.

    Please note that my observations regarding the frequency with which dieters actually follow their diets is based on experience with St Louis city hospitals. In other cities and settings, it is possible that dieters are more motivated than this.

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