The Medical Letter

The Atkins Diet
The Medical Letter on Drugs and Therapeutics 42(2000):52
The Medical Letter on Drugs and Therapeutics 42(2000):52

The Medical Letter on Drugs and Therapeutics started publication in 1959. The Medical Letter is an independent, peer-reviewed, nonprofit publication that offers unbiased critical evaluations of drugs, with special emphasis on new drugs, to physicians and other members of the health professions. It is published in five languages and has a circulation of more than 120,000.

Nearly 30 years after the first publication of Dr. Atkins’ Diet Revolution promoting a high-protein, extremely low-carbohydrate diet, patients once again are asking their physicians about the Atkins diet. More recent publications. Dr. Atkins’ Age-Defying Diet Revolution and Dr. Atkins’ New Diet Revolution, offer the old message plus new recommendations for taking mineral and vitamin supplements.

THE DIET - The Atkins diet permits the patient to eat unlimited amounts of meat, fish, eggs and some cheeses, but no more than 20 grams of carbohydrate daily for at least the first two weeks.

EFFECTIVENESS - The claim that the Atkins diet can lead to rapid weight loss is correct. An extremely low-carbohydrate diet induces ketosis. In the first week to 10 days of such a diet, ketosis increases water loss, which can cause rapid weight loss. With rehydration, the initial rapid weight loss tends to disappear. No controlled clinical trials evaluating the long- term effectiveness of the Atkins diet are available. The claim that ketosis or limiting food choices mainly to protein suppresses appetite has not been proven. In one study, a minimum-carbohydrate, hypocaloric ketogenic diet did not reduce appetite any more than a diet that did not promote ketosis (JC Rosen et al. Am J Clin Nutr, 42:371, 1985). The claim that the Atkins diet “burns fat” has also not been established. In a well-designed older study, an extremely low-carbohydrate diet did not lead to more fat loss than an equicaloric mixed diet (M-U Yang and TB Van Itallie, J Clin Invest, 58:722, 1976).

ADVERSE EFFECTS - Physiologic and epidemiologic studies suggest that a high-protein diet may increase calcium loss from bone (EM Lau and J Woo, Curr Opin Rheumatol, 10:368, 1998). The dehydrating effect of ketosis can lead to fatigue, constipation, orthostatic hypoten¬ sion and urinary tract stones. Substituting saturated fats for carbohydrates could increase the risk of stroke and myocardial infarction.

CONCLUSION - The long-term effectiveness and safety of the Atkins diet have not been established