Tuesday, January 25, 2005

I Hate Atkins.

The "low carb revolution" aggravates the crap out of me. It is rare that one person has an insight that turns all of established science on its head, and I don't believe that Atkin's work nearly approaches the compelling nature necessary to make one alter both one's perception of a fairly vast body of medical science, but also traditional diets. There are also class implications to Atkin's, but let me go through what I understand of the science first.

The first key thing to note is that the Atkins diet isn't new: people tried it in the '70s. Perhaps this time it'll stay around longer. We are facing even more of an obesity crisis than we were in the '70s, and it may be easier to stay with it now that the food industry has attempted to appeal to low carb fanatics.

However, the ultimate response to Atkins advocates is this: The measure of a diet is not whether or not someone can lose weight on it, but whether or not one can healthily and comfortably maintain it. One can lose quite a bit of weight by fasting under a tree for a month, but doing it for much longer is a sure way to die. This brings up two immediate questions: First, can you continue to cut the carbs; second, are there other issues with the diet aside from the weight loss? The first question is fairly simple. Even Atkins concedes, and it's obvious to see, that if one steps back onto the carb bandwagon, one will regain the weight one lost (perhaps balloon up even faster as someone retains the habits of eating too much meat). If you can comfortably not drink milk or smoothies and eat pasta, bread, cereal, bananas, berries, fruits of all types, candy, ice cream, cake, pie, desserts of most types, etc., then yes, you may be able to stay low weight on a low carb diet.

There's another, marginally more nuanced observation that studies of the low carb diets have made. Most of the time, low carb diets are in fact low calorie diets in disguise. A lot of the things you attack on a low carb diet are heavy in calories, and thus you reduce your net calorie consumption. It's a simple biological fact about calories: if you consume more than you use (i.e. have more biological energy than you need), then those calories are metabolized as fat for long-term storage.

Another fairly obvious observation is that someone can be low weight and unhealthy. Weighing in at 130 pounds doesn't help if you're eating arsenic. One can be consuming high degrees of fat, say, that clog arteries and raise the risk of various cardiovascular problems as well as cancer. This is where the social issues start to come in. We don't see obesity problems as drastic as the US' even in other industrialized and rich societies. There are some diet differences, of course, but those countries do have fast food joints and meat. The Belgians and the French developed french fries, and the Japanese bred the king of beef. A major problem is food additives, running the gamut from preservatives to artificial sweeteners and coloring agents.

It gets worse. (For citation purposes, I'm using Dr. Gregory Ellis, a purveyor of an alternative low carb diet; Keith Klein, a TaeBo nutritionist who is focused on body building and exercise; and Kathy Goodwin, a nutritionist for The Diet Channel). Klein says that low carb diets may alter T3 levels, thereby playing havoc with someone's metabolic rate; most of the weight loss is actually water, also an unhealthy fact; those who return to a carb diet after losing the pounds with Atkin's will find that their body equilibrium has changed to horde carbohydrates rather than burn them off; can cause a situation called gluconeogenesis, which is caused by the low carb's diet assault on the protein balance, thereby harming muscle and long-term protein storage; threaten diabetes and diabetes-like symptoms by reducing the regularity of insulin flow; and, in essence, let one "look good in [one's] coffin." He also notes that the bodybuilders of the late 80s and 90s, by eating nutritionally dense (high protein, moderate carbs, low fat), had definition and tone and in general superior muscles to the bodybuilders of the 70s and 80s who relied heavily on low carb diets. Let me quote some of the best articles I've found on the topic, from Goodwin.

"Low carb plans arouse an irrational fear about the hormone insulin. Insulin, like other hormones in the body, has many vital functions. One function is to enable our cells to take up glucose from the bloodstream and use it for energy. This gives us the ability to do everything from lifting a finger to recalling memories to running a marathon. Insulin has become unpopular (in obese countries) due to the fact that it helps the body store fat. Because of this fat storing function, low carb plans have condemned insulin to eternal damnation. Unfortunately, it's a very undeserved reputation based on false and twisted truths. One false theory is that only carbohydrate in the diet will stimulate insulin production. The truth is that all ingested foods stimulate insulin production. The second false theory is that insulin stores fat only when high carb foods are eaten. The bottom line with regard to the body's biochemistry is that fat will only be stored if too much food (from any source) is eaten. If the body takes in less calories than it uses in a day, all those calories will be "burned" or used for energy. It does not matter what percentage of those calories came from fat, protein or carbohydrate. On the other hand, if the body takes in more calories than it burns, insulin will help to store those extra calories as fat. Again, it does not matter where the extra calories come from. In fact, if the extra calories are from carbohydrate, the body actually burns some calories in order to turn carbohydrate into fat for storage. In contrast, extra fat calories can be immediately stored as fat. To blame insulin as the sole contributor to obesity is not only ludicrous, it's irresponsible thinking. What about all those days when we got into our cars, sat at the office all day, got the supersize meal from the drive-through, "remote-controlled" the TV all night while devouring ice cream to comfort our stress and emotions? Might this be a better explanation for rampant obesity in America? Obesity is an extremely complex issue. It has to do not only with excess calories and lack of exercise, but also genetics, psychological issues, social issues, medical problems and so many other things. The fact that normal portion sizes at restaurants are growing ever more outrageous, and that high calorie, high fat foods are cheaper and more accessible than ever doesn't help either. Obesity is not a simple issue and insulin is not the cause.

The idea that a high carb diet is responsible for obesity and illness (a concept supported by low carb plans) is completely contradicted by many population-based studies. For instance, in Japan, carbohydrates compose the overwhelming majority of daily caloric intake. High carb foods like grains, rice, and vegetables are daily staples of Japanese life, and intake of high protein, high fat animal products is minimal. In contrast to the reported "evils" of carbohydrates touted by low carb plans, Japan has some of the lowest rates of obesity, heart disease, cancer and diabetes in the world. Enough said.

The Atkins diet places no limit on the amount of saturated-fat-laden products one can have each day. Large portions of foods like butter, red meat and bacon are advocated and encouraged. The Atkins plan contradicts numerous studies which have demonstrated the significant correlation between diets high in saturated fat and increased heart disease risk. Dean Ornish, M.D., a renowned cardiologist and author of the book Dr. Dean Ornish's Program For Reversing Heart Disease, showed an actual reversal of the heart disease process through a diet limited to only 10% of daily calories from fat. Prior to Ornish's findings, significant reversal of heart disease was only thought possible through surgery. Ornish's study participants followed a diet abundant in fruits, vegetables, and whole grains, with the overwhelming majority of calories coming from carbohydrates. Dr. Atkins has not published a single study showing the long term effects of his diet on heart health. Considering his diet has been around since the 70's he's certainly had ample time to do so. Bottom line - heart disease is America's number one killer - if you have heart disease or a family history, stay away from low carb, high saturated fat diets."

I must be fair here: The low carb revolution is not simply Atkins. There are a number of low carb plans that are more sensible. There are some shows hosted on the Food Network, for example, such as George Stella's Low Carb and Loving It, which say some interesting and I think very promising things. 1) Low carb can let you lose some weight temporarily, but the way to truly reach your target goal and stay healthy is also to try to cut calories and fat. 2) Not all carbs are identical. Stella does not count carbs coming from fiber, for example, because fiber is essential. 3) With proper cooking, one can have a lot of taste without a lot of fat, calories or carbohydrates. This is what I can agree with, and I think this is the perfect segue to the broader social issues.

Why do we have obesity in this country in particular? Well, let's look at other countries. First of all, the US has a particular type of opulence that allows even poor individuals (ESPECIALLY poor individuals) to have dirt cheap meals at McDonalds and Carl's Jr. These meals are filled with meat, cheese, and low quality vegetables. Now, this opulence wouldn't be a problem if it was gained legitimately, but it takes a fairly cursory look at the history of the country to see the way that this wealth was obtained. Second, other countries have effective regulatory regimes. Due to the incredible corporatist nature of this country, regulatory capture is the rule, not the exception. In fact, corporations often annotate the cost of breaking the law as part of their budgets because the fines are so infinitesimal. (For this and a wealth of other great information, see Take the Rich Off Welfare). We have an incredibly polluted food and drink supply, filled with low quality products with massive amounts of additives. After all, elementary market assumptions tell us that if corporations can sell low cost products, they will. To say that people "want" this type of food is ridiculous: People "want" good food as much as anything else. If you were to offer someone fresh fruit and vegetables and good quality meat, who would turn you down? The problem is that, for many, the price of living is going up, wages are going down, and further, even if they are conscientious consumers with some money, they often don't have the time to cook good meals or to learn how to cook good meals, and they also don't have the individual wherewithal to sort through the thousands of products at a grocery store and find the ingredients with the least problems. The organic food industry's successes really raise my hopes in this regard. And remember, one can believe in markets and nonetheless see a necessary government task in establishing regulations as to what type of food can be produced, from a public health standpoint and for a market sustainability standpoint. Regulations can be good for business, and I think this is a concrete case of such a situation.

The fact is that the low carb diet is a suburban, opulent way out of the simple way to lose weight: Exercise more, eat less. In particular, one should be eating high quality calories that contain fiber, vitamins, minerals, and protein. One has to ingest a certain number of calories to be full, so those calories had better as dense as possible. Archaeologists have noted something strange about old corpses: Their teeth are not much worse than modern teeth, mainly because the amount of sugar in the food supply was far less, so they didn't have as much of a need for toothpaste, floss and Listerine. Our ancestors ate diets heavy in high-quality cereals and fresh ingredients, and this tradition carries on in the healthier industrialized countries. So why do we seek the easy way out despite all evidence to the contrary?

That's America, my friends.


Blogger Sophie said...

This blog is a load of rubbish. Do you even know what ketosis is? Or how it works? In fact, do you even know how the human body works? I am guessing not.

4:55 PM  

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