Atkins and other low-carbohydrate diets: hoax or an effective tool for weight loss?

doi:10.1016/S0140-6736(04)16986-9

The Lancet

Volume 364, Issue 9437, 4–10 September 2004, Pages 897-899

https://doi.org/10.1016/S0140-6736(04)16986-9 Get rights and content

Summary

Context

The Atkins diet books have sold more than 45 million copies over 40 years, and in the obesity epidemic this diet and accompanying Atkins food products are popular. The diet claims to be effective at producing weight loss despite ad-libitum consumption of fatty meat, butter, and other high-fat dairy products, restricting only the intake of carbohydrates to under 30 g a day. Low-carbohydrate diets have been regarded as fad diets, but recent research questions this view.

Starting point

A systematic review of low-carbohydrate diets found that the weight loss achieved is associated with the duration of the diet and restriction of energy intake, but not with restriction of carbohydrates. Two groups have reported longer-term randomised studies that compared instruction in the low-carbohydrate diet with a low-fat calorie-reduced diet in obese patients (N Engl J Med 2003; 348: 2082–90; Ann Intern Med 2004; 140: 778–85). Both trials showed better weight loss on the low-carbohydrate diet after 6 months, but no difference after 12 months.

Where next?

The apparent paradox that ad-libitum intake of high-fat foods produces weight loss might be due to severe restriction of carbohydrate depleting glycogen stores, leading to excretion of bound water, the ketogenic nature of the diet being appetite suppressing, the high protein-content being highly satiating and reducing spontaneous food intake, or limited food choices leading to decreased energy intake. Long-term studies are needed to measure changes in nutritional status and body composition during the low-carbohydrate diet, and to assess fasting and postprandial cardiovascular risk factors and adverse effects. Without that information, low-carbohydrate diets cannot be recommended.

Section snippets

Weight loss on low-carbohydrate diets

Several studies claim that low-carbohydrate diets are effective for weight loss. A systematic review of low-carbohydrate diets reported that the weight loss is associated with only the duration of the diet and the restriction of energy intake, not with carbohydrate restriction itself.⁵ Only 107 articles out of the 2609 identified could be reviewed; only five studies evaluated participants for more than 90 days, but were not randomised and had no control group. There was insufficient evidence to

Putative mechanisms behind the weight loss

During severe carbohydrate restriction, glycogen stores and associated bound water are depleted, hence weight loss could predominantly be fluid rather than fat loss. Two studies that measured body composition by dual-energy X-ray absorptiometry both failed, however, to find any indication of excessive reduction in lean body-mass.11, 13 So, the greater weight loss over 6 months seems to be attributable to fat loss, which is supported by beneficial changes in cardiovascular risk factors.

The

Safety of low-carbohydrate diets

Somewhat surprisingly, greater improvements in some cardiovascular risk factors were seen in people on the low-carbohydrate diet. Triglyceride concentrations were significantly more reduced,9, 12 HDL-cholesterol improved more,11, 12 and indices of fasting insulin-sensitivity were greater,8, 11 although improvements in other blood lipids and blood pressure were the same for both diets. These findings agree with other studies, which have also shown improvements in LDL-cholesterol particle size

Future research

The mechanisms responsible for producing weight loss with the low-carbohydrate diet require clarification. Is increased 24-h energy expenditure responsible for the weight loss as claimed by Atkins? If weight loss is rather due to reduction in spontaneous energy intake, can it be achieved by increasing the protein in a low-fat diet?

Although there is no solid evidence to support advising against the short-term use of low-carbohydrate diets, as long as the individual loses weight, future research

Recommendations to the public and patients

There is no clear evidence that Atkins-style diets are better than any others for helping people stay slim, and despite the popularity and apparent success of the Atkins diet, evidence in support of its use lags behind. Although the diet appears, as claimed, to promote weight loss without hunger, at least in the short term, the long-term effects on health and disease prevention are unknown.

Patients who want to try these diets should be told that, although safety cannot be guaranteed, they seem

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This review critically reviews the potential role of diet - gut microbiota -brain axis and network interactions in migraine alleviation. Further, various possibilities of dietary and microbiome-based treatment strategies for migraine are assessed based on epigenetics. A holistic epigenetic network analysis and scoping necessary diet – gut microbiota – brain axis in migraine mitigation is critically summarized.
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Rapid ReviewAtkins and other low-carbohydrate diets: hoax or an effective tool for weight loss?

Summary

Context

Starting point

Where next?

Section snippets

Weight loss on low-carbohydrate diets

Putative mechanisms behind the weight loss

Safety of low-carbohydrate diets

Future research

Recommendations to the public and patients

J Pediatr

Am J Clin Nutr

Physiol Behav

J Nutr

J Pediatr

Am J Med

Lancet

Letter of corpulence

Dr. Atkins' new diet revolution

Introducing Atkins at home

Popular diets: a scientific review

Obes Res

Rapid Review
Atkins and other low-carbohydrate diets: hoax or an effective tool for weight loss?