New York:
A recent study of low-fat versus low-carbohydrate diets confirmed what followers of the Atkins diet have long believed: a low-carb diet can be good for your heart.
The study, reported in
The Annals of Internal Medicine, showed that no matter what plan dieters followed, they saw improvements in heart disease risk factors, and low-carb dieters had a greater increase in HDL, the "good" cholesterol.
Recently I spoke with Dr Eric C Westman, associate professor of medicine at Duke University Health System and one of three co-authors of the book
The New Atkins for a New You, the latest update of the Atkins low-carb diet. We spoke about how the diet has changed and what many people don't know about low-carb eating plans. Here's our conversation.
Q. What's different in this version compared with earlier Atkins books?
A. In my practice, most people don't know what the Atkins plan really is. That was the purpose of the book. The new Atkins tells people about the scientific background. What's new is that you can do it in many different ways. It's much more versatile and flexible than the popular perception. Did you know you can do a vegetarian Atkins, for example?
Q. I'm sure many people don't know that. So what's the general view of Atkins, and why are people getting it wrong?
A. Atkins is a way of eating that promotes good, healthy whole foods. Period. The science of it is that these are foods that don't raise the blood sugar much. Atkins has always been about eating the good sources of carbs, protein and fat. What I want to get out there is that Atkins is healthy eating.
I think the public perception is that it's beef and bacon. That has been perpetuated by two sources: the media, which want controversy, and the vegetarian element, who don't want you to eat animal products. You can eat seafood and fish. You can have lots of different protein sources -- chicken, eggs, cream and cheese.
The second wrong perception is that there are no vegetables on Atkins, that it's a no-carb diet. We talk about it right up front. You have to have vegetables. The foundation of the diet is vegetables.
Q. Has that aspect changed since "Dr Atkins' Diet Revolution" was published in 1972?
A. Vegetables have always been there. The carb restriction was at the minimum of 20 grams per day. The new Atkins incorporates the new science of the glycemic index and the ability to subtract fiber grams, which is not something Dr. Atkins talked about. We've updated that element so you can eat more vegetables by subtracting fiber grams.
Q.The book talks about "foundation" vegetables. I don't remember that from the first book. What are they?
A. In the original book, these didn't have a name, and people thought it was a diet without vegetables. The foundation vegetables are any of the nonstarchy vegetables, which could be asparagus, broccoli, string beans, okra, tomatoes, onions, peppers, for example. Corn and potatoes are the things people miss. You can have five measuring cups of leafy greens. I have men who come in and say, "It's more vegetables than I've eaten in my life."
Q. I remember the diet from years ago required such restricted carbs that your body went into a process called ketosis. Is that still part of it?
A. Ketosis for the first phase is still the same, but it's limited. Dr. Atkins taught how to reincorporate the carbs. It was focused on as a weight-loss diet rather than a healthy lifestyle forever. I think the problem was that back in 2003, during the Atkins renaissance, a lot of people went on Atkins and did the Atkins induction. I have a lot of these people in my clinic, and they tell me they didn't eat veggies and didn't know what to do next. That's why the new Atkins is coming out, to teach you how to gradually reincorporate the carbs based on your own body's metabolism. Some people can tolerate a lot of carbs; others are intolerant or sensitive to them.
Q. How do you know if you are intolerant or sensitive to carbs?
A. The simplest tool to know is your weight. Your weight is a reflection of water weight, fat weight and muscle weight. Some people know because of cravings that occur when they eat the carbs. If you're eating a candy bar, and you can't stop and you have to eat more and you're still hungry, that means you're sensitive to the carbs. A doctor can measure glucose and insulin in a medical clinic as a more formal way to make a medical determination. But you can figure it out by your own body weight and the cravings you have.
Q. Why do you think so much controversy remains about low-carb diets?
(Read: Low-carb dieters, high fat food)A. It's complicated. The Atkins diet was labeled as a high-fat diet. We've been told over the past 40 years that fat in the diet is bad. Now we know that fat is not bad. What's happened is that there is a paradigm shift in thinking about carbohydrates, fat and protein and health. These are things that are slow to change.
In the new Atkins we say, "Meet your new friend: fat." We're really trying to do the P.R. for the macronutrient that no one wants to talk about. Fat in the diet does not mean fat in your arteries and fat on your hips, which is what everyone thinks. It's an American view. If you go to Europe, they're not so allergic to the idea of fat. It's a very parochial kind of view. My colleagues outside the U.S. are not so afraid of cholesterol in the blood. They don't prescribe statins so much.
Q. How has the science evolved since Dr. Atkins's death several years ago?
A. The science wasn't there when he was alive. It's evolved where we now have randomized controlled trials, the highest level of evidence we have, that now show that dietary fat has no real relationship to bad events in human health. We're not promoting any particular way to go. One size does not fit all. If there is anything we've learned over the last four years, it's just that the low-carb or Atkins approach should be a viable option. People should be able to eat this way if they want to, but they've been on the defensive for so long.
Q. Do you think it's possible for someone to be addicted to carbs?
A. The science is just starting to look at foods being addictive. Most people don't know anyone addicted to rib-eye steak, who can't stop eating it. But most people know someone who can't stop eating carbs. I think there may be some truth to that. In the popular way people talk about carbohydrate foods, people come in and say, "I'm addicted to them." The science is in its infancy there.
Q. How did the three authors of this book get together?
A. Over the last 10 years or so we found ourselves at meetings presenting similar science and similar findings. We all became Atkins advocates. We were asked by the company, Atkins Nutritionals, to write the book and update it.
Q. Did you know Dr Atkins?
A. I met him on several occasions. I went to visit his clinic. I wrote him a letter, and he called back. After a brief discussion, I was saying, "Where's the science? I read your book, but that's not science, it's anecdote." He said: "Come to my clinic. Why would I do the study when I know what the results will be?" We went up and took a look at the clinic, and it certainly was working. I had no idea the controversy I was getting into. I was naïve.