August 23, 2003
Daily Mail (London)
by David Jones
LAST Wednesday, when Paul and Lisa Huskey switched on the big screen TV in their picturesque lakeside chalet in the sprawling Missouri countryside, they could barely contain their anger and grief.
They had been planning to while away an insufferably hot morning by watching a light-hearted talk show. But, instead, they were confronted by the man they blame for destroying their lives: the late diet guru Dr Robert Atkins.
Mrs Huskey gazed in silence for a few moments at the footage of Dr Atkins smugly explaining how fat-sodden dishes such as lamb chops and salad smothered with blue-cheese dressing can miraculously melt away excess weight.
Then, turning her eyes towards a photograph of her teenage daughter Rachel, positioned above the television cabinet, the middle-aged mother quietly began to weep.
‘Please turn that man off,’ she implored her husband. ‘I can’t even bear to listen to him talking this dangerous rubbish. It killed our little girl.’
Stony faced, Mr Huskey nodded and reached for the remote control …
Like Britain, America is currently obsessed with the Atkins Diet. Barely a day passes without it featuring on TV or in newspapers. And more than 30 years after his first weight-loss bible was published, Dr Atkins, who died last year after slipping on ice, again tops the best-seller list.
Spurred by the personal testimony of stars such as Jennifer Aniston and Catherine Zeta-Jones, who attribute their svelte figures to the controversial Atkins regime, the U.S. is also witnessing an upsurge in ‘low carb’ restaurants, cafes and grocers.
It is a trendy new industry that has gripped millions of women - and men, too - on this side of the Atlantic.
Of course, all this is marvellous news for Atkins Nutritionals, the multimillion pound company which markets the books and videos, plus a range of food lines such as low-carb chocolate bars and pasta, which are due to appear in British supermarkets shortly.
Yet among health experts, who have spent years preaching against a high-fat diet, and urging people to lower their meat and dairy intake in favour of fruit and ‘good’ carbohydrates such as wholegrain bread, the Atkins phenomenon is causing deep concern.
Experts have warned that it could increase cholesterol, clog arteries and, in the long term, induce coronary heart disease.
Last week, in a controversial report, a nutritional expert from the Government-funded Medical Research Council described the diet as a major health risk with potentially disastrous consequences for millions, including kidney damage and bone loss.
However, gauged by the vast number of people experimenting with Atkins, or similar regimes such as the South Beach Diet (a favourite of Bill and Hillary Clinton) these predictions of doom appear to be falling on deaf ears.
At a time when people’s desperation to be thin is matched only by their craving for vast portions of fatty food, a diet which promises drastic weight loss while allowing unlimited amounts of meat and cheese - and even lashings of butter and cream - is apparently well worth the health risk.
Out in the corn-and-Bible belt of Missouri, however, Paul and Lisa Huskey are sickened by the clamour to leap aboard the Atkins bandwagon.
Deeply private Middle American country folk, whose world revolves around their family and the local Pentecostal church, they would not ordinarily court publicity. But this week, they invited me to their isolated home, near the small town of Sturgeon, Missouri, out of a sense of duty.
They want to save other wouldbe slimmers - and particularly image-conscious teenagers - from suffering the same fate as their daughter, who collapsed and died during a school history lesson when she was just 16 years old.
ACCORDING to the local coroner, Jay Dix, Rachel died of arrhythmia, or a sudden irregular heart beat. Yet his autopsy revealed her to have been in good physical order, and neither her heart nor any other of her major organs were in any way abnormal.
In his post-mortem report, Mr Dix noted that Rachel had been following ‘a high protein diet’, later established as the Atkins. But he added, somewhat clumsily, that, ‘the diet as the cause of death cannot been stated with certainty’.
Rachel died in August 2000, and the coroner has since passed away himself.
Among those who knew the bright, personable schoolgirl, however, disquiet over her death has steadily grown.
It has been fuelled by a recent study, published in the respected Southern Medical Journal, in which a team of physicians from University of Missouri Hospital in Columbia argue that Rachel might well have died as a direct result of following the Atkins Diet.
Led by Professor Joseph Tobias, a world-renowned child health specialist, the team investigated Rachel’s death in painstaking detail.
They discovered that the levels of potassium and calcium in her blood had been critically low and argue that the depletion of these essential electrolytes could have caused the ‘ventricular fibrillation’ or sudden irregular heart beat which killed her.
Maintaining the correct amount of electrolytes - and potassium in particular - is crucial to normal bodily function. Potassium has a vital role in the way nerve and muscle cells work and if levels drop, the cells stop working effectively. In the heart - which is almost entirely muscle - this can cause the cells to become ‘disorganised’ so that the pumping action of the heart becomes chaotic or stops altogether.
The Missouri hospital research team suggest that people on the Atkins Diet may be particularly susceptible to an imbalance of potassium and other electrolytes for several complex reasons.
One is that the diet has a diuretic effect and causes frequent urination, and electrolytes such as potassium and calcium are passed through the water.
In addition, the Atkins Diet forces the body into a state known ‘ketosis’ in which fat is broken down for energy in the absence of carbohydrates.
THIS is the metabolic process which is said to make the diet work so quickly and effectively, but one of the potential dangers is that it increases the loss of potassium, calcium and magnesium.
Dr Atkins recognised that this might cause problems and recommended dietary supplements to counteract it.
However, Atkins Nutritionals strongly dispute that Rachel’s fatal metabolic imbalance could have resulted from the diet, venturing that it may have been triggered by any number of factors, including the adrenaline drugs pumped into her body as paramedics battled to restart her heart in the classroom.
If Rachel was secretly bulimic or anorexic this could have been another possible factor, they say.
But the researchers found no evidence of an eating disorder.
Paediatrician Dr Paul Robinson, an adolescent medicine specialist who took part in the investigation, told the Mail that while there was no outright proof that the diet had killed Rachel, he remained ‘very concerned’ that it might have done so.
He said: ‘Our findings are consistent with what we understand is the body’s potential response to the Atkins Diet. Obviously it doesn’t happen very often, and not in everybody. But I am very, very concerned about it.
‘There is certainly lots of evidence that it may have been the diet.’
Although millions now follow the Atkins Diet, Dr Robinson pointed out that its safety had yet to be established by a long-term, largescale clinical trial.
Until this had been done, he urged people not to experiment with it.
‘You wonder whether there are other people dying and we don’t know about it,’ he added. ‘It’s important to know. This is a huge trend now.’ Quite so.
But what do we know of Rachel Huskey? Is she really the world’s first Atkins Diet victim?
Whether or not she is destined to be acknowledged as such, her tragic story ought to be told, if only as an indictment of the agonising pressures society places on young people who weren’t blessed with the looks or figure of Britney Spears, and don’t fit the slender stereotype.
On the surface, Rachel was the last person one might expect to fret over her body image. Raised in a devoutly religious community which even considers blue jeans to be unsuitable attire, she was a strong-willed, independent girl whose social life centred on the church and her family.
Abrilliant scholar, she was also a gifted vocalist and trombone player, and her ambition was to become a music teacher. She liked boy bands Nsync and the Backstreet Boys, but her female role models were mostly gospel singers.
She wasn’t a particularly large baby, weighing 7lb 8oz at birth, but as she grew older she became round-faced and podgy - traits she was said to have inherited from the ‘big-boned’ Huskey women.
UNTIL she reached adolescence, she never seemed bothered by her size. She was active, playing softball and basketball, and although she enjoyed hearty southern dishes such as baby-back ribs, steaks, and barbecued chicken, her appetite was not considered excessive.
According to her best friend, Regina Roberts, ‘she ate like a bird’.
True or not, as she grew older her weight problem persisted, and by the age of 11 she had become the butt of cruel jibes by a small group of classmates. They called her ‘fat girl’ and accused her of gluttony.
Unbeknown to her parents, these taunts continued throughout her adolescence.
‘She would cry sometimes, but usually she just wrote it off,’ says Regina, now a 19-year-old accountancy student, who was also considerably overweight.
‘Rachel was very independent, but if you get teased for many years it gets to you, and you start to think: “If I can just get slim then maybe I’ll be accepted.” At our school, the supposedly cool set were all stick thin. If you weren’t skinny you were nothing.
‘The girls we hung around with were always the outsiders, and I think Rachel thought that if she could lose weight she would be more popular.’ By her 16th birthday, in May 2000, Rachel stood 5ft 9in tall and tipped the scales at about 17 stones. She bought frumpy clothes from outsize stores, and envied her younger sister Lydia, now 15, who was naturally slim and strikingly beautiful, and wore fashionable, figure-hugging outfits.
She finally decided to lose weight later that summer. By slimming down, she hoped to attract the attention of Tyler Sexton, a goodlooking and affable teenage boy who attended her church.
Her parents, who care little for appearances, would never have pressed her to diet. ‘To us, she was perfect just as she was,’ says her father, Paul - but they were naturally supportive.
Lisa Huskey, now 40, had also grown heavier since her days as a trim college athlete. Her weight was causing her knee trouble, and she thought the best way to encourage Rachel was to diet along with her.
Because her sister had suffered eating disorders, Mrs Huskey was wary of crash diets. But she had been impressed by TV commercials for the Atkins Diet, which allowed plenty of protein and didn’t restrict calories, and so she bought the book and accompanying videos.
Rachel, too, was enthused by a regime that even allowed her to eat Big Macs so long as she discarded the bun. And so, like countless mothers and daughters, the pair began their slimming venture together. Today, Mrs Huskey still feels guilty for allowing Rachel to start Atkins without consulting her doctor. Yet she acted responsibly and has no reason to reproach herself.
She escorted her daughter on long walks; ensured she drank plenty of water and ate three square meals a day: bacon and eggs for breakfast, and usually meat or chicken with salad or vegetables for lunch and dinner.
Rachel also snacked on sticks of mozzarella cheese: permitted on Atkins.
The promotional videos emphasised the diet was safe, she adds: ‘They showed a man and his kids losing weight, and a cardiologist saying it was perfectly fine.
‘He said it would actually lower cholesterol and blood pressure, and urged you not to be put off by people who said your breath stank (one of the side-effects of ketosis).
The message was: “Don’t let anybody sabotage your diet.” ‘ She pauses, and adds bitterly: ‘Anyhow, you don’t ever think a diet is going to kill anybody.’ For six weeks, the pair stuck to the eating plan religiously and it worked just as promised. Mrs Heskey lost about 15lb. Although Rachel suffered bouts of nausea, she lost 20lb and suddenly a new, exciting world began to beckon her.
The school bullies fell silent. Tyler Sexton, the boy she had admired from afar in the church congregation, invited her on her first date - a touchingly innocent walk in the local park.
And her sister Lydia still remembers the fun they had the night before she died. ‘Rachel was trying on my shirts in her bedroom, and she was so thrilled that she could fit into them for the first time,’ she says.
‘She was really proud and excited, and she kept running out to show Mum.’
HER sister’s joy was tragically brief. The following day she practised with the school’s new marching band, then went to history class. To gently break the students in after the summer holiday, her teacher staged a quiz.
Rachel had just answered a difficult question correctly, and celebrated by exchanging ‘high-five’ hand slaps with other pupils, when she keeled over at her desk. By the time the paramedics arrived, her heart had stopped.
At first, there was speculation that she might have died of heatstroke, for the temperature outside was 104 degrees. But this was quickly discounted.
No-one could think of any reason why a happy, healthy teenage girl who had never touched alcohol or drugs should die suddenly - but Mrs Huskey was convinced she knew the answer.
‘Rachel had taken a break from the diet for two weeks, but she wanted to lose more weight, and she had been back on it for eight days when she passed away,’ she says.
‘When Dr Tobias came to speak to us at the hospital I said straight away: “Did the diet kill her?” He said he thought it could cause electrolyte imbalances and he would look into it.’ As the investigation got under way, Mr and Mrs Huskey sought legal advice.
For a time they considered suing, but they were eventually advised against it. ‘In America there’s a law for the rich and a law for the poor,’ Mrs Huskey says.
‘The Atkins people have millions, and we were told they would have kept the case going until we ran out of money. Our lawyer suggested we try someone else, but by then we had lost the will. No amount of compensation would have brought Rachel back.’ Yesterday, responding to the Mail’s questions about Rachel’s death, Atkins Nutritional were at pains to avoid a war of words with the Huskey family.
However, the company remains convinced that it offers a healthy solution to the western obesity epidemic.
Company consultant Dr Stuart Trager agreed that the Atkins Diet should continue to be researched. Anyone under the age of 18 should consult their doctor before undertaking it, or any other diet, he added.
BUT HE described the university hospital study as flawed, and warned against ‘ dangerous assumptions’. While electrolyte imbalance could cause arrhythmia, he said there was nothing to suggest that in Rachel’s case it had resulted from her diet.
If it had there would inevitably have been hundreds more reported cases like hers. But so far as was known, there had not been a solitary incident of a similar nature.
‘Everyone is terribly concerned about this, and it’s not a case where anyone wants to accuse or blame,’ he said. ‘This is a clearly a tragedy and I am a parent myself.
‘But it is just as important that we make decisions based on the facts. I think there are a lot of facts here that we don’t actually have.’ Perhaps so, but Rachel’s parents will always believe that the Atkins Diet killed her.
‘I want people to know that this is not something you play around with,’ her mother told me as she tended her daughter’s immaculately-kept grave.
‘It’s not something to be flippant about. I want people to know you can actually die doing something as stupid as this.
‘Rachel was just the cutest child. I used to tell her: “It doesn’t matter what you look like on the outside, it’s what’s on the inside.” But to me she was beautiful anyway.’