Accusation 14: Objectionably Asserts Diet is Bad for Heart

A number of objectionable statements appear on the website regarding Atkins…

Lipid Profile. You assert that page 23 that the ANA adversely affects the lipid profile thereby increasing risk of cardiovascular disease. However, in the studies referenced by Atkins, the majority of subjects following a low-carbohydrate diet experience favorable responses (e.g. a decrease in serum triglycerides or LDL and an increase in serum HDL) (Westman 2002).

Atkins Ignores Proof that the Atkins Diet Clogs Arteries

Based on one analysis of your diet published in the American Journal of Clinical Nutrition, long-term use of the Atkins Diet is expected to raise coronary heart disease risk by over 50%.[982] But before one even addresses the question of risk factors, as documented in The Proof is in the SPECT Scan, there was a study published in the peer-reviewed medical literature that actually measured what was happening to people’s arteries on the Atkins Diet.[983] The results, posted online, validate that the Atkins Diet, according to the American Dietetic Association, is “a heart attack waiting to happen.”[984]

Atkins Exaggerates the Benefit of Lowering Triglycerides

You claim that triglycerides are as big a threat–or an even bigger threat–to heart health than cholesterol.[985] This is demonstrably false.[986]

Every leading authority–the American Dietetic, Diabetes, Heart, Hospital, Nurses, Public Health and Medical Associations, the American Colleges of Cardiology, Nutrition and Preventive Medicine–all agree that LDL cholesterol is the single most important target for preventing heart disease.[987]

The National Heart, Lung, and Blood Institute coordinates a coalition of more than 40 major medical and health associations, community programs, and governmental agencies whose 27 member Expert Panel took nearly 2 years to develop the latest guidelines for the prevention of heart disease.[988] “For all persons with borderline high or high triglycerides,” the guidelines state, “the primary aim of therapy is to achieve the target goal for LDL cholesterol.”[989]

Elevated triglycerides may not even be an independent risk factor for heart disease.[990] “There are little data,” concludes one review, “that triglyceride reduction improves cardiovascular event rate.”[991] This is why the Expert Panel concentrates on lowering LDL cholesterol levels, an intervention proven to extend life and lower the risk of heart attacks. Yes, the Atkins Diet can consistently reduce triglyceride levels, but even according to your own researchers, the same cannot be said for the most important risk factor, LDL cholesterol.[992] This may be why after just months on your diet, people’s arteries have been shown to clog so rapidly.[993]

Atkins Distorts the Record on Cholesterol

A rise in serum LDL levels is not an inevitable response to low-carbohydrate dietary regimens. Some studies report no statistically significant changes in LDL levels (Stern, 2004; Yancy, 2004) or a statistically significant reduction (Westman, 2002) in LDL levels.

As documented in the section of our website Atkins Distorted His Record on Cholesterol, the Atkins Diet has failed to consistently improve the single most important risk factor for heart disease, LDL, or bad cholesterol. Your website, however, claims “Almost every Atkins follower sees a drop in LDL (“bad”) cholesterol.”[995] Even Atkins-funded researchers concede that this is incorrect.[994]

Atkins Argues that Size Matters

_Furthermore, some studies reveal that in subjects who experienced an increase in serum LDL levels, the increase is due to a greater number of large LDL particles (pattern A) and not an increase of atherogenic small LDL particles (pattern B) (Sharman 2004, Hays 2003, Sharman 2002). In addition, in some instances, the opposite trend may occur in low fat diets: “Paradoxically, a low-fat/high-carbohydrate diet exacerbates atherogenic dyslipidemia if the patient does not lose a significant amount of weight or increase his or her level of physical activity.” (Volek 2002)_

You admit that bad cholesterol may rise on your diet, but argue that the rise may be mostly in large bad cholesterol (pattern “A”) not the “atherogenic small” bad cholesterol (pattern “B”). While earlier research done on rabbits indeed showed that small LDL particles seemed more likely to infiltrate rabbit arteries,[996] studies since then on the arteries of actual human beings found that size doesn’t matter.[997]

Frank M. Sacks, M.D., Professor of Cardiovascular Disease Prevention at Harvard, with over a hundred publications to his name,[998] reviewed all of the evidence surrounding LDL size in 2003.[999] He found that some studies showed that larger LDL (the type that the Atkins Diet elevates) seemed more dangerous. “Thus,” he wrote, “large and small LDL are atherogenic, and it is not possible to judge which if any is more harmful, overall.”[1000] Cleveland Clinic Medical Director (and Vice President of the American College of Cardiology) Steven Nissen, M.D., agrees that LDL particle size simply isn’t clinically useful.[1001]

“In summary,” Dr. Sacks wrote, “the picture is emerging… that small LDL does not have a special relationship to coronary heart disease beyond its contribution to LDL concentration.” He concludes “all LDL types should be viewed as harmful.”[1002] In other words, large or small, bad cholesterol is bad cholesterol.

True, if one switches to a low fat diet centered around refined sugars and starches one can suffer a relative increase in small LDL particle and triglycerides,[1003] but low fat diets based on whole foods not only can also reduce the number of small LDL cholesterol particles (and triglyceride levels),[1004] but routinely drastically improve LDL cholesterol levels overall.[1005] Your diet does not allow for this,[1006] which may be why the arterial blockages in the hearts of your followers have been shown to so dramatically worsen.[1007]

Atkins Offers No Viable Alternative to Drugs

Dr. Atkins warned about the dangers associated with the cholesterol-lowering “statin” drugs,[1008] but then didn’t offer a diet that could lower one’s cholesterol enough to avoid a lifetime of these costly drugs.[1009] On the contrary, the Atkins Diet has in fact been shown to seriously worsen heart disease.[1010]

Atkins claims that the National Heart, Lung, and Blood Institute Expert Panel that sets heart disease prevention guidelines advocates drugs as the “first line of defense.”[1011] This is incorrect. They advocate “lifestyle changes as first-line therapy” as the “the foundation” of prevention[1012] and drugs typically only if lifestyle changes fail. The primary lifestyle change they recommend is “reduced intakes of saturated fat and cholesterol,”[1013] exactly the opposite of what happens when people go on your diet.[1014]

When it comes to diet, LDL cholesterol is the single most important risk factor for heart disease,[1015] the number one killer in the United States for both men and women.[1016] The immediate goal is to get one’s LDL down to double digits,[1017] like most of the people in the world.[1018]. An LDL level below 100 mg/dl “is now considered optimal for all individuals.”[1019]

According to the distinguished editor-in-chief of the American Journal of Cardiology,[1020] the only two groups in America that seem to consistently reach that goal are those on cholesterol-lowering medications and those on a “pure vegetarian” diet.[1021] The only diet that seems to routinely bring one’s bad cholesterol down into the target zone is one devoid of all saturated animal fat and cholesterol.[1022]

Based on the best current published data, the average LDL cholesterol level of Americans is estimated at 130 mg/dl.[1023] Bill Clinton was at 134 at the end of his presidency.[1024] Studies show that the average LDL of healthy meateaters (typically well-educated lean non-smokers with high exercise levels–so healthy in fact that they have half the mortality rates of the general population) is 121, for those who just eat fish 114, vegetarians almost make the mark at 106. and vegans seem the only dietary group that achieves the target LDL at 90 mg/dl.[1022]

While almost every single study of low carb diets showed no reduction–or even an elevation–in LDL levels,[1025-1038] that one single uncontrolled Atkins-funded study you cite that showed a significant drop in LDL levels took 6 months to bring LDL levels from 136 to 126, still very much in the danger zone.[1039]

For Americans to drop from 130 to under 100, they need at least a 23% drop in LDL. That’s exactly how much a low fat primarily vegetarian diet can decrease LDL in 3 weeks based on a study of 4587 adults.[1040] Compare that to the best that your dieters have been shown to do–a 7% drop in 6 months.

Cholesterol-lowering diets don’t have to be low fat, though. A full-fat phytonutrient-rich vegan diet has been shown to drop LDL 30% in 2 weeks–which is as much as one gets with cholesterol-lowering medications.[1041]

This may be the reason then why, when researchers are able to directly measure the arterial blockages in the heart, vegetarian diets have been shown to reverse heart disease, increasing blood flow up to 40%, whereas those on your diet suffered a worsening of their blockages, decreasing blood flow 40%.[1042]

Atkins Exaggerates the Benefit of Raising HDL Cholesterol

Saturated fat can raise HDL (Hickey 2003, Westman 2002). High HDL levels have shown to be protective against coronary heart disease. Therefore, even if LDL is slightly increased, the LDL/HDL ratio and total cholesterol/HDL ratio are still improved after following a low-carbohydrate, high saturated fat diet (Volek 2003).

This claim is similar to the one on your website that low HDL is a more important risk factor than elevated LDL.[1044]

The Expert Panel that writes the federal U.S. heart disease prevention guidelines, representing a coalition of over 30 major medical organizations,[1045] could not even find “sufficient evidence to make HDL a target of treatment.”[1046] They felt the centerpiece of the guidelines, aggressive lowering of the “bad cholesterol” LDL, should negate any increased risk associated with low “good cholesterol” HDL levels. “Thus, ATPIII [the Expert Panel] recommends that the first step in treating patients who are found to have a low HDL level is to lower the LDL level to goal,”[1047] something the Atkins Diet can’t do.[1048]

“Whether raising HDL per se will reduce risk for coronary heart disease,” the panel concludes, “has not been resolved.”[1049] “In all persons with low HDL cholesterol, the primary therapy is [to lower] LDL cholesterol.”[1050]

The available evidence shows that the most important number is not HDL, not total cholesterol, not triglycerides and not the size of the LDL, but the amount of LDL you have in your blood, the amount of this “bad” cholesterol you have circulating in your arteries. The Expert Panel recognized that high triglycerides, small LDL particles, and low HDL cholesterol are a “secondary target of risk-reduction therapy,” but only “after the primary target–LDL cholesterol.”[1051]

You claim that the Atkins Diet significantly raises the level of HDL, or “good” cholesterol, on a consistent basis,[1052] but this does not seem to be true. The majority of controlled studies on Atkins-like diets do not show such an effect.[1053-1066] It is also important to note that even in the minority of studies that do show increases in HDL, this elevation is not necessarily healthful.[1067]

HDL transports cholesterol out of one’s arteries to the liver for disposal or recycling. When one eats more garbage (saturated fat and cholesterol) one may need more metabolic garbage trucks (like HDL) to get rid of it. Eating a stick of butter may raise one’s HDL, but that doesn’t mean this is good for one’s heart.[1068]

In any case, significantly lowering one’s LDL is more important than significantly raising one’s HDL,[1069] though the studies done on low-carb diets typically show neither. It should come as no surprise, then, that in the only study to directly measure the effects of the Atkins Diet on the heart, the Atkins Diet was shown to seriously weaken coronary artery blood flow to the heart.[1070]

Atkins Ignores “More Important” Risk Factors Which Worsen on Atkins

According to your website, “Dr. Atkins does not believe that cholesterol elevations are as important a risk factor as… homocysteine and C-reactive protein.”[1071] It is interesting to note, then, that even research he funded shows that both these risk factors worsen on the Atkins Diet.

“A byproduct of defective protein metabolism,” one can read on your website, “elevated homocysteine levels are a powerful marker of heart disease and stroke risk.”[1072] Homocysteine has also linked to birth defects,[1073] fatal blood clots,[1074] depression[1075] osteoporosis,[1076] and Alzheimer’s Disease.[1077]

One can also read on your website that “The Atkins Nutritional Approach™, in fact, is ideal for moderating homocysteine levels…”[1078] However, of the 34 studies you cite as “supporting” the Atkins Diet, only one study measured homocysteine levels, and in that study Atkins followers suffered a highly significant worsening of their homocysteine levels.[1079]

The American Heart Association has recommended a homocysteine level under 10 (mcmol/L).[1080] The Atkins website agrees: “Above 10 mcmol/L indicates an increasing risk of cardiovascular disease…”[1081] Atkins notes high homocysteine may also be related to cancer.[1082]

So what happened to people put on your diet? In just 6 weeks, their homocysteine levels rose from 9.5 to 10.6. In their conclusion, the researchers deemed this elevation “concerning.”[1083]

In the year-long study that compared your diet to a low fat vegetarian (vegan) diet, homocysteine levels again tended to rise on the Atkins Diet,[1084] yet fall on the vegan diet.[1085] In an article entitled “Vegan Diet-Based Lifestyle Program Rapidly Lowers Homocysteine Levels,” after just one week on a vegan diet, those with elevated homocysteine levels had their levels drop from an average of 11.3 down to 9.2, a highly significant drop of 19% in just a single week.[1086]

Homocysteine, a neurotoxic and vasculotoxic compound linked to dementia, miscarriages and stroke, and which Atkins himself deemed a more important risk factor than cholesterol, became further elevated in both of the two studies which measured homocysteine levels on the Atkins Diet.[1087,1088]

C-Reactive Protein
Atkins also felt that C-reactive protein (CRP) was a more important risk factor than elevated cholesterol levels.[1089] “Chronically inflamed blood vessels are widely regarded as part of the atherosclerotic disease process,” reads your website. “Research has found that high levels of… C-reactive protein, a marker of inflammation, increased the risk of heart disease by four and one-half times.”[1090] C-Reactive protein has also been associated with stroke risk as well.[1091]

Like LDL cholesterol, simply losing weight should lower your CRP levels. How much CRP you have circulating in your blood has been found to be “strictly related to body fatness.”[1092] Yet, every single published study “supporting” Atkins showed that the Atkins Diet was ineffective in lowering CRP.[1093,1094,1095] In fact, one of them showed that after just 6 weeks on the Atkins Diet CRP levels tended to more than double despite a loss of body fat.[1096]

One unpublished meeting abstract on your website did show a decrease in CRP levels on the Atkins Diet,[1097] but two others did not.[1098,1099]. The year-long study that compared your diet to the Ornish Diet, Weight Watchers and The Zone Diet found that C-reactive protein levels were significantly lowered by the Ornish Diet and by Weight Watchers, but not by the Atkins Diet.[1100]

Just two weeks on a low fat primarily vegetarian diet, however, with exercise, can lower CRP levels 45%.[1101] Two weeks on a phytonutrient rich full-fat vegan diet with no additional exercise dropped CRP levels an average of 30%, as much as one sees with the use of statin drugs.[1102] Meanwhile, your diet evidently causes so much inflammation within the body that CRP levels don’t seem to drop at all despite significant weight loss.

Fibrinogen, another inflammatory risk factor associated with heart attack and stroke risk,[1103] tends to rise on the Atkins Diet[1104] and drop on control low-fat diets.[1105] The same thing happens with Lp(a).

If LDL is to be considered bad cholesterol, Lp(a) is really bad cholesterol.[1106] The Atkins website agrees that Lp(a) is a “strong risk factor for heart disease and stroke.”[1107] It also tends to rise on the Atkins Diet[1108] and fall on the control vegetarian (vegan) diet.[1109]

Even taking into account some of the cardiac risk factors deemed most important by Atkins, the available evidence clearly demonstrates that the Atkins Diet may dramatically increases one’s risk for heart disease.