Miracle Cure? Fat Chance
Lean Plate Club, by Sally Squires
Washington Post Tuesday, May 27, 2003; Page HE03
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Findings published last week in the New England Journal of Medicine showed pounds drop more quickly in the short term on the Atkins diet than on low-fat regimens -- and without any apparent heart effects. If this prompts you to reconsider your eating strategies, you may be interested in this advice from the researchers who conducted the studies.
Don't expect a magic cure. Consumers "need to understand that there is no quick, easy, miracle cure for obesity," says Bonnie J. Brehm, associate professor of nursing at the University of Cincinnati and lead author of a recent six-month trial of the Atkins diet vs. the low-fat approach. "It is still going to require an adjustment in what you eat and what you do. You still need to fuel your body with healthy food and you need to be active. There's nothing that will take the place of that."
In Brehm's study, women were randomly assigned to either the Atkins diet or to a low-fat diet. For the first three months, participants met weekly with either a registered dietitian or with other women in their diet group. For the second three months, they were on their own. During the second three-month phase, those in the low-fat group maintained their nutrient intake, while the low-carb group began to add back carbohydrates -- suggesting, Brehm says, that the Atkins group found it more difficult to stay with their regimen when flying solo than the low-fat dieters did.
Losing weight takes commitment. About 40 percent of participants in both groups quit the studies before they ended, a fact that some scientists said could bias the results. What the findings meant to Gary Foster, clinical director of the University of Pennsylvania's Weight and Eating Disorders Program and lead author of one of the studies, is this: "No matter what diet you're on, doing it alone is tough work."
Calories count. The Atkins philosophy is that total calories consumed don't matter, provided carbohydrates are severely restricted. But in one of the studies published last week, participants in the Atkins group ate fewer calories than those in the low-fat group, although the differences were not statistically significant. "The law of thermodynamics still holds here," says Frederick Samaha, chief of cardiology at the Philadelphia Veterans Administration Hospital and lead author of the study. "Weight loss is still entirely an effect of total calories in and total calories out."
Make smart choices. That means choosing healthy foods in all categories. For example, salmon, shrimp, chicken without the skin, lean meat, olive or canola oil and margarine have less saturated fat than porterhouse steak, butter and cream. Research is very clear that saturated fat and trans fats raise blood cholesterol levels and increase risk of heart disease. Good carb choices, Brehm says, are fruit, vegetables and whole grains rather than processed foods.
Lower carbohydrates safely. The Atkins diet recommends consuming only about 20 grams of carbohydrates per day during the early phase and gradually increasing to about 90 grams daily. Eating 20 grams a day puts the body into a state called ketosis. Deprived of sugar from food, the body begins breaking down its own tissue, including fat, for energy. But the National Academy of Sciences sets 130 grams of carbohydrates per day as the minimum intake for proper brain function. Many Americans consume nearly twice the minimum, so there's a lot of room to trim carbs safely.
The final chapter is still being written. The low-fat approach has been studied extensively, while the Atkins diet has been systematically examined in only a couple hundred individuals. Most have followed the diet for six months or less. A new five-year trial of the Atkins diet, funded by the National Institutes of Health, is about to begin and may provide more answers.
-- Sally Squires
"Miracle Cure? Fat Chance"
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