To Your Health

Q. I'm a distance runner, not too much overweight but I would still like to lose about 10 more pounds. Some of my friends are losing weight on the Atkins Diet, but it takes away some very good foods. Is it still worth doing?

A. The Atkins Diet was first popularized by Dr. Robert Atkins around 1972, but he is certainly not the first in line. Very low carbohydrate diets under various names have been extolled since the mid-1800s. These diets are still popular partly because they place no limits on total calorie intake, only on carbohydrate intake. For instance the Atkins Diet recommends 20-40 grams of carbohydrate per day in the initial phase of the diet (60 to 90 grams per day at maintenance) compared to the 100 grams per day of carbohydrate often recommended to prevent the breakdown of lean body mass. The fast weight loss from these diets is primarily the result of a loss of water and lean body mass because the body breaks down lean body mass in an effort to provide glucose to the brain.

To Dr. Atkins' credit, his newest book puts more emphasis on exercise and includes recommendations for certain food supplements. His diet does tend to be very low in folic acid and deficiency of folic acid can lead to increased serum homocysteine, increasing the risk in heart disease. The Fulani people of northern Nigeria are semi-nomadic herdsmen who eat a diet that resembles the Atkins Diet, high in fat with animal protein contributing about 20% of total calories. It supplies only about one-third of the recommended dietary allowance for folate, and the average serum homocysteine concentration in that population is above the acceptable range.

Although exercise is an essential part of a safe weight loss program, the American Kidney Fund raises a red flag about the risk of dehydration in those who are exercising vigorously while on the Atkins-style diet. The diet places a strain on the kidneys, known as hyperfilteration, related to the excessive amount of protein. The waste products of protein metabolism, such as urea, force the kidneys to work harder and the increased urination may cause dehydration. Kidney function could be impacted to the extent that chronic kidney disease would develop, which is incurable at present and treatable only by dialysis or kidney transplant.

The healthiest populations do not eat low-carbohydrate diets. Judging from the Japanese experience, a better diet would be generous in whole grains, vegetables, and fruits. Japan has one of the lowest rates of obesity among the "developed" countries, and high-carbohydrate foods, such as rice, grains, and vegetables, are the staples in their menu. Their risk of diabetes, heart disease, and cancer are also lower than for Europeans and Americans. Animal protein is more of a condiment in Japan than a central food to build a meal around.

Although men are not at risk, women who eat a very high-meat, low-carbohydrate diet during pregnancy increase the incidence of elevated blood pressure in their children's adult years. The medical journal Hypertension reported last December that regardless of the mother's blood pressure, body size, or smoking habits during pregnancy, consumption of a pound of red meat per day while avoiding carbohydrates resulted in higher blood pressure when their children reached their late 30s. The authors assume that these observations reflect the metabolic stress imposed on the mother's kidneys by an unbalanced diet.

If the Atkins Diet really worked well, the long-term weight loss success of its adherents would have become evident over the past 25 years. Paradoxically, the weight loss industry seems to get richer while America continues to grow fatter.