Review Time

Back in 2007, I did a series on the "rules" of Atkins. Here I present the links to that series and will follow-up in the coming weeks with lessons learned and a view of the long-term.

• Handing you the Keys to Success
• Establishing Good Eating Habits: Rule One
• Rule Two: Back to Basics
• Rule Three: Vegetables & Fruits are Heart of Controlled-Carb
• Rule Four: Starches, Sweets: No Longer Staples
• Rule Five: Break Free from Contradictions
• Rule Six: Empower Yourself
• Rule Seven: Use Your Smarts!
• Rule Eight: Keep it Real
• Rules to Drink it Up!
• Rules to Maintain a Balance

Quick Clicks to Low-Carb Rules Articles

• Handing you the Keys to Success
• Establishing Good Eating Habits: Rule One
• Rule Two: Back to Basics
• Rule Three: Vegetables & Fruits are Heart of Controlled-Carb
• Rule Four: Starches, Sweets: No Longer Staples
• Rule Five: Break Free from Contradictions
• Rule Six: Empower Yourself
• Rule Seven: Use Your Smarts!
• Rule Eight: Keep it Real
• Rules to Drink it Up!
• Rules to Maintain a Balance

Rules to Maintain a Balance

Sometimes when we first start a low-carb diet, our bodies react in ways that might seem off, so the next rule addresses the "potty problems" that some find when they're starting on a new low-carb diet.

Rule 12:

• If you are constipated, mix a tablespoon or more of psyllium husks in a cup or more of water and drink daily. Or mix ground flaxseed into a shake or sprinkle wheat bran on a salad or vegetables.

This rule compliments rule 11 - that is it helps with strategies to avoid and counteract constipation. Water and high-fiber supplements are recommended to help maintain regularity. With any changes to your daily diet your body may experience short-term bouts of constipation and the above rule helps get you through this. It also reinforces for the long-term what works for constipation naturally rather than chemically processed products or sugar-laden fiber mixes that are commercially available.

The secret of this rule is that it is providing you with natural ways to alleviate constipation, not only in beginning, but in the long-term as you look to maintain your goal weight if you still have occasional issues.Important in this rule is to understand what it is to be constipated.

Constipation is not just not having a bowel movement for a couple of days - it is having the urge to have a bowel movement and being unable to go to the bathroom! When you do finally go, the feces are dry and hard. While not going for a day or two may be alarming, if you are not uncomfortable, you are probably not constipated. When you are constipated it is important to be sure you are getting plenty of water and increasing your fiber so that you are able to go without straining. Drinking water as instructed in the previous rule along with this one give you the tools to regulate yourself naturally.

The last rule we'll look at speaks directly to the recommendation to take, at minimum a good multivitamin with minerals. It's pretty much a universal given no matter what type of diet you eat that you should include a vitamin each day, and the same is true for those starting a low-carb diet.

Rule 13:

• At a minimum, take a good daily multivitamin with minerals, including potassium, magnesium and calcium, but without iron.

Many people starting out on a low-carb diet with both feet and take a large number of supplements.

In this rule, Dr. Atkins makes it clear that at minimum you need a good multivitamin each day. Also specifically mentioned are minerals, which are important to maintain electrolyte balance, especially when you're starting a low-carb diet and will experience a metabolic shift to burn fat primarily instead of glucose, which releases a lot of water from stored glycogen.

Much like the rule on water (fluid) intake is universally agreed as a "good rule", so too is this rule. While some people will benefit from additional supplements to their daily multi-vitamin, it is not necessary to start with more than a good multi-vitamin with minerals.

In the long-term, maintaining this habit of taking a good multivitamin is also a good idea no matter what diet you follow.

It is important to note with this rule that the multi-vitamin must have potassium, magnesium and calcium - these control and keep in balance your electrolytes (your body salts), so chooing one with a good balance and ratio of these minerals is important. Important too is to use a multi-vitamin not packed with iron (unless you have a medical reason to take additional iron) since your diet will now contain enough iron (if you follow it correctly) each day without additional supplementation of iron. Too much iron is as deterimental to your health as too little. Unless you have a reason to take more iron, find a good multi-vitamin without iron!

The secret within this rule is to learn to keep a balance - insure you're getting all the nutrients you can with real food and have a multivitamin each day to be sure if you missed somewhere along the way, you had it in your vitamin.

This rule and the one before it aren't about extremes - it is about balance.

By taking care of potential "potty problems" and including a good multivitamin each day, you're developing a habit that will enhance your ability to get all of your nutrients each day - even on those days you may not eat "well".

Rules to Drink it Up!

Three rules specify the importance of adequate hydration and choosing beverages wisely.

Rule 9:

• Avoid foods or drinks sweetened with aspartame. Instead, use sucralose or saccharin. Be sure to count each packet of any of these as 1 gram of carbs.

Rule 10:

• Avoid coffee, tea and soft drinks that contain caffeine. Excessive caffeine has been shown to cause low blood sugar, which can make you crave sugar.

Rule 11:

• Drink at least eight 8-ounce glasses of water each day to hydrate your body, avoid constipation and flush out the by-products of burning fat.

Starting with the last one, drinking eight 8-ounce glasses of water, provides direction to make sure we consume enough fluids each day.

It's universally accepted that water is important; with disagreement as to whether fluid intake must be water itself or any beverage that helps provide hydration. I tend toward the belief that all fluids count toward water intake - if someone wants to drink water, great!; if someone wants to consume iced tea with lemon or a diet beverage, great! It's all good as long as we also are mindful of the other rules which have important considerations when choosing what to drink.

Rule nine limits consumption of artificial sweeteners and specifically suggests that we avoid aspartame (NutraSweet, Equal) because evidence suggests it stimulates insulin and may cause lowering of blood sugars. This in turn would trigger hunger and leave one open to eating more than desired. Else where in Atkins book he provides an allowance of three packets of articifical sweetener each day of the two he recommends. This limit isn't to say you can't have something sweet, but rather forces selection and limitation as you're starting a low-carb diet.

That one must count each packet of any artificial sweetener as 1g of carbs - this alone places a limit on how much you can have in a day, without stating it, if you're following rule three and getting the majority of your carbs from vegetables and salads. Long-term, into maintenance, this is an excellent rule - it limits your exposure to chemical sweeteners and lessens the chance you'll use them in excess if you continue to follow this rule for the rest of your life.

The potential of caffeine to affect insulin and blood sugars is also included in the rules. Each time you have caffeine, your body has an insulin response and the potential for cravings to be triggered. In addition to the potential for cravings being induced by caffeine, there is also the risk of feeling more hungry and eating more than you would had you not had the caffeine. While initially caffeine may supress the appetite, later after its effects are waning, you may actually feel more hungry than you would have had you not had the caffeine.

It is especially important in the first two weeks to do all you can to limit your cravings; as you can see from the above rules that are in place, many of them aid in limiting the cravings to keep you on track. It is also important to begin to fully understand "hunger" and how much sates your appetite rather than leaving you stuffed. By avoiding caffeine, limiting artificial sweeteners and keeping yourself hydrated you're accomplishing this goal.

Dehydration when following a low-carb diet, due to ketosis, is to be avoided. It will increase the concentration of ketones in your body and the result is less efficient buring of fat for energy. You'll also run a greater risk of getting constipated, as well as, a greater risk of painful headaches. Proper hydration while you're in ketosis will help to eliminate the ketones from your body in your sweat, urine and respiration - you need the water intake to accomplish this each day.

As an aside, I've found caffeine has little effect on me. Over the years I've noted that it's a "your mileage may vary" type thing and usually recommend an individual see how they feel with and without caffeine in their daily menu.

Rule Eight: Keep it Real

A low-carb dietary approach is easy to maintain almost anywhere you can eat - at home, on the road or in a restaurant. The key is to carefully consider your options available and understand where carbs are most likely to be found in things "allowed" when they're prepared by others. When you're cooking at home, you know what ingredients you're using; on the road or in a restaurant, odds are high that the chef is using ingredients you won't be including in a controlled-carb diet.

Rule 8:

• Eat out as often as you wish but be on guard for hidden carbs in gravies, sauces and dressings. Gravy is often made with flour or cornstarch, and sugar is sometimes an ingredient in salad dressing.

In an effort to keep it real, rule eight establishes that it's perfectly reasonable to eat out, with a caution to be aware of ingredients used in food preparation. As one more rule, it again repeats an underlying theme within all the rules - take responsibility for what you do eat.

Simply put, do not assume anything in a restaurant is acceptable unless you ask or ingredients are clearly stated on the menu! Where ingredients are not disclosed on a menu, learning how to ask and actually taking the time to ask about ingredients and food preparation is something you'll become accustomed to over time - and in the long-term will be an invaluable asset in your tool-box of strategies to insure you're eating controlled-carb for life!

When you eat out, in addition to the food you get, you're paying for a service - to have your food prepared - so be fully prepared to expect to be served acceptable food for your diet. Start by asking that things be prepared in a way that is acceptable for you or ask for guidance as to what else is acceptable if the chef cannot prepare something without particular ingredients. The basic ingredients, at minimum, you must insist are not included in your meal because of carbohydrate content are sugar, corn starch, arrowroot, potato starch and flour. The standard food ingredients to not be included are bread crumbs, breading, rice, pasta and potatoes, sugar based marinades, high carbohydrate salad dressings, etc.

In addition, you also want to be careful to avoid dishes prepared with shortening, margarine and other fats high in trans-fats. This isn't explicit to the rule above, but given our current knowledge, it's something to avoid when eating out.

If a restaurant is having a difficult time accomodating you, choose a simple salad wth oil and vinegar for your dressing, have a basic protein grilled (no marinade) baked or broiled, and some steamed vegetables.

In all the years I've restricted carbohydrate in my diet, I've never been unable to find something on a menu that's acceptable. Sometimes it means being a bit creative, but as long as a restaurant has basic foods, you can find something to eat as a meal while you're there.

Rule Seven: Use Your Smarts!

It's almost impossible to miss the recommendation to read labels on food packages these days. It's good advice no matter what dietary approach you decide to follow, and is front and center in the Rule of Induction (Atkins) too, found in rule number seven.

Rule 7:

• Don't assume any food is low in carbohydrate - instead, read labels. Check the carb count (it's on every package) or use a carbohydrate gram counter.

This rule establishs a lifelong habit that, as you continue along with a controlled-carb diet, will be invaluable to you. You're expected to make it a habit to read labels and take responsibility for your food choices at the start of a low-carb diet and as you continue along and lose weight.

Once firmly rooted as a part of your food selection process, reading labels makes you a smart and savvy shopper - with an ability to quickly identify packaged foods that are not your best bets nutritionally.

While the first couple weeks has an underlying encouragement to limit foods to those which are fresh, it is possible to include a wide variety of prepared and/or packaged foods, thus the potential to derail success if you're not careful with your choices. So, in the first couple of weeks this rule is invaluable anytime you're including packaged processed foods in your menus.

The reality is that most people will include some packaged foods, whether salad dressings or prepared foods, from the start; so making it a habit to read labels reinforces the requirement that one take responsibility for what they eat.

Over time, reading labels helps to develop a keen eye while enabling one to make good choices among the packaged foods they include in their day-to-day menus. As more and more variety is added to a low-carb diet, it is critically important to be in the habit of reading nutrition labels - not only for carbohydrate content, but to understand ingredients used since differing brands of same-type items varying greatly not only in carbohydrate content, but ingredients used in the preparation of the packaged or prepared food.

Rule Six: Empower Yourself

You may recall that in rule one of the Rules of Induction (Atkins), those starting the first phase of the diet are reminded to eat regularly and develop a pattern of eating each day that they're comfortable with, be it three meals a day or four or five. Also within that rule was the caution not to go more than six waking hours without eating something. I bring rule one up again today because it complements rule six, which says:

Rule 6:

• Adjust the quantity you eat to suit your appetite, especially as it decreases. When you're hungry, eat the amount that makes you feel satisfied, but not stuffed. When you're not hungry, eat a small controlled carbohydrate snack to accompany your nutritional supplements.

Where rule one speaks to our need to establish good eating patterns to take with us as we lose weight and then maintain our weight, this rule helps us understand that over time, as our weight declines, our food intake will decline and we still need to be aware that even with a diminished appetite, it's important to nourish our bodies for good health.

So many diets play on our fears - and one of the biggest is our fear that we lack enough willpower to actually stick with a diet long enough to lose the weight; forget about keeping it off!

One of the draws of a low-carb diet is the natural appetite suppression that comes within a few days of carbohydrate restriction. A large number of studies have noted that even when allowed ad libitum access to any and all of the foods allowed on a low-carb diet, those who stick with the allowed foods experience a "spontaneous" reduction on caloric intake while consuming an adequate level of protein and dietary fats to sate appetite and lose weight.

Sometimes the appetite suppression is so good that it's easy to miss a meal or go without eating too long. This rule reminds us that adjusting our food intake as we lose weight is expected, but we do not need to limit our intake to a point where we're potentially doing more harm than good, nor to we have to rely solely on willpower to lose weight or live with hunger pangs as we lose - we need nutrients from food, we need energy from food (even while losing weight) and we need to establish good eating habits.

That means eating for both to nourish the body and to sate appetite; adjust how much you eat to satisfy your appetite, allow yourself - give yourself permission - to eat and feel satisfied. Satisfaction with your meals keeps you motivated as you lose weight.

This rule does have a caution and that is to be aware not to overeat and stuff yourself, not to gorge or binge. For some who are new to low-carb this may be something that could become problematic - eating too little and then binging - so the caution is there to listen to your body, pay attention to your appetite and learn when you're hungry and when you're satisfied. Over time, if you're paying attention to this you'll find your body really does trigger hunger when you're hungry and if you're eating well, establishing an eating pattern happens!

The last part, to include a small carbohydrate controlled snack with your supplements, reminds us that including nutritional supplements is considered a benefit on the diet and eating something small with them can help you with rule one to establish good eating habits!

Over time as you lose weight, your appetite is going to naturally diminish and your energy requirements will adjust too. This is something to be aware of for the long-term - what you eat when you start - whether it's 3000-calories or 2000-calories - is going to slowly decline in time as your body weight is reduced. Someone who weighs 300-pounds needs more calories each day to maintain their weight than someone who weighs 150-pounds. So, in the long term, this rule is establishing this in your mind to remember later, as you reach a lower weight - you won't eat the same as you do at the start of the diet!

Overall this rule fosters a sense of empowerment - the understanding that you can, perhaps for the first time in your life, listen to your body and learn how to eat well over the period of losing weight and then as you maintain your weight!

Rule Five: Break Free from Contradictions

Thus far we've looked at four of the Rules of Induction for the Atkins diet. I've used the Atkins diet rules because no matter which low-carb diet one chooses, these rules have little "gems" that can broadly apply to any controlled-carb diet based on its design, carbohydrate restriction and/or phases.

Today, we'll look at rule five. At first glance, it appears to be in a rather harsh tone toward the reader:

Rule 5:

• Eat nothing that isn't on the Acceptable Food List. And that means absolutely nothing. Your "just this one taste won't hurt" rationalization is the kiss of failure during this phase of Atkins.

Simply put, this rule is reinforcing the importance of being able and ready to begin something new and different while letting go of the "diet baggage" we all had/have that will not serve us well throughout weight loss on a low-carb diet, and certainly not when we maintain our weight later. The only way to say it is straight-out and without sugar-coating it - if you start the diet with bad habits and do not address them, they'll be your undoing on this diet (or any diet) you want to utilize as your means to lose weight.

This rule makes clear that everything on the 'acceptable foods list' is allowed, go and enjoy these foods; those not on the list are not allowed right now - not even one bite, not even if you can manage to include them within your carbohydrate allowance for this period. The time frame here is two weeks and you will not die without the foods that are excluded during this period.

You may crave them, want them, think you need them - but what you 'want' is not always what you 'need' and for now, there are plenty of nutrient-dense foods you are allowed to eat, so take this period to eat those and only those foods; more variety will come in time.

Many wonder why this rule is so harsh. In part it is helping to break habits of the past, in part wiping clean years of eating foods that were not the best choices for health and well-being, in part imploring you to ignore many current dietary contradictions, and in part to help you naturally supress cravings for carbohydrate-rich foods.

Did you catch that last item?

It is true for the vast majority of those starting a low-carb diet; if you can simply stick with the 'acceptable foods list' for your first two weeks, you'll find that cravings for carbohydrate-rich foods diminish quickly and by the end of two-weeks, they're supressed so you no longer think much about having bread or pasta or potatoes or sweets.

Now granted, these foods will always be around you; but you will now have a powerful way to make them less tempting in the future if you can avoid them completely for a couple of weeks.

In the process you'll be rewarded for your efforts and discipline too - you'll lose weight in the first two weeks, find you have more energy at the end of the two weeks, and also realize that the foods you used to reach for in times of stress or to celebrate can be replaced by foods that are better for you and your health.

What this two week period is teaching for the long-term is that you ultimately control what you choose to eat. It is a period that is allowing you time to step back from everything you think you know, retreat from all the contradictions we hear from the "experts," step back from all the habits you've developed over the years, and start again - at the basics.

This particular rule goes against everything we hear and read so often; on the one hand we're repeatedly told part of the underlying reasons for obesity is lack of willpower and discipline; on the other hand we hear often this insistence that if you want something eat it, if you're on a diet and craving whatever it's better to eat it than to not because it's not good to deprive yourself of something you want.

How in the world is one supposed to develop this necessary discipline if they're never challenged and expected to discipline themselves?

As I said, this rule sets a standard for you to hold yourself to, that for a short period of time - two weeks - you will avoid any food that is not on the accepted food list so you can prove to yourself some big things:

• What you think you want to eat isn't always what you need to eat
• Food is not the enemy, nor do you lack willpower; given adequate time and nourishment, your body will help you re-learn how to eat well
• You really don't have to punish yourself to lose weight with feelings of hunger, eat what's allowed and you'll be sated
• You really are empowered to make good decisions and eat delicious food while you lose weight
• You'll really get to experiment and play more with your eating later, as you move forward and continue to lose weight

These first two weeks extend to the longer term as you are empowered to listen to what your body is telling you; you'll initially get over the idea you need starchy or sweet foods all the time, and then understand as you continue, when and where these foods will fit into your long-term menus. Once again, you'll also begin to appreciate just how good real food tastes, and take the foods from these first two weeks into your long-term eating, so they serve as your foundation for the future.

Life Gets in the Way

Just a quick post to let readers know that life has gotten a wee-bit hectic here and this week time is short for writing the continuation of the series in progress. I'll be back on Friday morning with the next installement - hope you'll come back then as we continue looking at the rules of induction (Atkins) and how they provide us with insights for long-term success!

Rule Four: Starches, Sweets: No Longer Staples

Rule 4:

• Eat absolutely no fruit, bread, pasta, grains, starchy vegetables or dairy products other than cheese, cream or butter. Do not eat nuts or seeds in the first two weeks. Foods that combine protein and carbohydrates, such as chickpeas, kidney beans and other legumes, are not permitted at this time.

For many the thought of not having a piece of bread, a side of pasta or rice, a bowl of cereal, etc. seems way too restrictive. With the low-carb products on the market, like low-carb bread, low-carb pasta, this rule seems silly - one that can be dismissed as long as they maintain rule 3 and keep carbohydrate at or below 20g net each day.

From this rule, we learn by implication - all carbohydrates are not created equal, and thus are not to be treated in a similar manner as you continue along to the long-term and maintain your weight. In baby steps, you'll be given opportunity to re-introduce many, many carbohydrate-rich foods, but for now, you're at square one and starting to learn how to eat well.

It is in this minimum two weeks period you eat those foods which are nutrient powerhouses - meats, poultry, eggs, fish, non-starchy vegetables, non-traditional fruits, good fats/oils and some dairy.

While critics focus on the limitations imposed on low-carbers - no sweets or starches in the first two weeks - often insinuating this is all one is allowed for the long-term, that's not the case.

This is a two-week period to "eat clean" from a limited selection of foods, designed to break you from the habits of old, establish good eating patterns, get back to basics that provide essential nutrients and lay the foundation of what your base diet will be later, when you are allowed to include more carbohydrate from a wide variety of foods.

By excluding bread, pasta, grains, starchy vegetables, most dairy products, nuts, seeds and legumes, this rule takes the focus off what many people consider highlights of their meals - starch; it resets emphasis on those things - protein, fat, nutrient-dense non-starchy vegetables and low-GL fruits - that in the long-term that will now be the foundation of your meal-planning well into maintenance.

Once you have a firm grip on this basic rule, and are eating in a pattern that no longer requires some sort of bread, potatoes, rice, pasta, etc. as a staple of your meals, you're on your way to understanding how these items may be re-introduced later as a complement in your habitual diet if you choose to include one or more of them.

Where before a meal may have been centered around your big bowl of pasta with maybe a small meatball or sausage, a crusty loaf of italian bread and perhaps croutons on your salad, over the long-term, as you mainatin your weight, your meals - if you learn from the rules of induction - are bulit upong your solid foundation of healthful eating - non-starchy vegeteables, quality protein, good fats and, by then, any additional foods you like and can tolerate well as a complement to your meal instead of the focus of the meal.

This rule fosters breaking the mindset that you need carbohydrate-rich foods to provide the majority of calories in each meal and at the end of each day - you don't - and by following this rule and waiting until the time is right to increase carbohydrate, you will be better able to assess what carbs you can and cannot tolerate in your meals as you progress - you'll better appreciate also how to portion your meals with these items "on your plate" in later in maintenance.

These foods, we often believe are staples will no longer be the main attractions in your meals when you're maintaining, but can still be a part of your diet in the long-term.

Trust the good doctor on this one and just don't eat anything that resembles bread, pasta, grains, etc. - no matter how low-carb they're promoted as.

During the first two weeks (minimum) avoid any and all processed products if you can.

Eat clean.

Keep it simple.

Learn.

Appreciate how good real food tastes.

Take your time.

Plan along the way.

Try new foods that are allowed.

Focus on the delicious food that is allowed.

Enjoy your meals!

Enjoy eating!

It's worth it in the long-term!

Rule Three: Vegetables & Fruits are Heart of Controlled-Carb

We hear much of a healthy diet is from eating fruits and vegetables. Research suggests there is a strong correlation between "good" health and "bad" health over the long-term when comparing the dietary habits of those eating a diet rich with fruits and vegetables to those consuming less than recommended levels.

Diets that strategically restrict carbohydrate are often criticized for lack of fruits and vegetables in the dietary approach. Much like the second rule getting lost in translation, from an allowance of a large variety of meats, poultry, fish, shellfish and game to a requirement to eat "fatty steaks, bacon, brie and cheeseburgers," by those unconvinced a low-carb diet is scientifically supported, rule three is often either ignored in the media and/or used to show how unsustainable carbohydrate restriction is in the long-term for someone to do forever.

How about we take a look, and see what the third rule actually says, and what it "pearls" it contains in both the short and long-term, and where vagueness may lead to misinterpretation:

Rule 3:

• Eat no more than 20 grams a day of carbohydrate, most of which must come in the form of salad greens and other vegetables. You can eat approximately three loosely packed cups of salad, or two cups of salad plus one cup of other vegetables.

First, we know from the published books, that the Induction period is a minimum of two weeks; while one can, and many do, stay within the 20g of carbohydrate beyond two weeks, the above rule is in place for at least the first two weeks.

During this time, the person starting the low-carb diet is tasked with two things in this rule:

1. limiting carbohydrate to just 20g a day and
2. ensuring that most of those 20g carbs are from salad greens and other (allowed) vegetables.

As an example, the rule says this is "approximately" three loosely packed cups of "salad" (note not simply salad greens), or two cups of "salad" (again not simply salad greens) plus one cup of other (allowed) vegetables (without mention of raw or cooked state).

We also know that the plan includes a deduction of fiber, so the amount of non-starchy vegetables (and fruits which I'll get to in an upcoming post) - in cups - that one is expected to consume depends highly on which allowed vegetables are selected in a day. Regardless of which are included, a minimum 10g net (deducting fiber) must come from non-starchy vegetables!

We also plainly see that it is not *mandatory* to deduct fiber per the rule above; however, I strongly suggest folks do deduct fiber as it allows a greater intake of non-starchy vegetables, which are not only low in calories, but nutrient powerhouses. When you deduct the fiber, you're able to consume more essential nutrients than if you don't.

I've previously offered examples of how different selections of non-starchy vegetables may look in a day of eating on a plan allowing 20g net in a day. Once again, I am providing examples to emphasize, even at 20g net carbohydrate, where 10g net is the minimum, a low-carb plan - done properly - meets or exceeds intake recommendation of at least five servings per day in the Dietary Recommendations for Americans for fruits and vegetables.

Example 1

• 1-cup green beans (cooked measure)
• 2-cups Shredded Cos/Romaine Lettuce (raw)
• 4-pieces Crimini Mushrooms (raw)
• 1/4-cup Shredded Red Cabbage (raw)
• 4 Cherry Tomatoes (raw)
• 1-cup Spinach (raw)
• Total Carbohydrate = 18g
• Fiber = 8g
• Net Carbohydrate = 10g
• USDA Servings of fruits/vegetables = 5

Example 2

• 1/2 Avocado (raw)
• 3-cups Cos/Romaine Lettuce (raw)
• 4 Cherry Tomatoes (raw)
• 1/4 cup Shredded Red Cabbage (raw)
• 1-cup Spinach (cooked measure)
• 1/2-cup Broccoli Florets (raw)
• 1/2-cup Sliced Cucumber (raw)
• Total Carbohydrate = 24g
• Fiber = 14g
• Net Carbs = 10g
• USDA Servings of fruits/vegetables = 6

Example 3

• 2-cups Shredded Cos/Romaine Lettuce (raw)
• 1/2-cup Cherry Tomatoes (raw)
• 1-cup Spinach (cooked measure)
• 1/2-cup Asparagus (cooked measure)
• 1/2 cup Sweet Green Peppers (cooked measure)
• Total Carbohydrate = 21g
• Fiber = 9g
• Net Carbs = 12g
• USDA Servings of fruits/vegetables = 6

One can see from the examples above, depending on selections made from those fruits and vegetables allowed in the first two weeks, it is not difficult to meet the recommended intake of 5-or-more servings of fruits and vegatables.

The aim to include a minimum of 10g (of the 20g allowed) from non-starchy vegetables is a "must" in the rule above.

It is also clearly stated as a "minimum," and therefore understood that if you would like to include 12g, 15g or more from non-starchy vegetables in lieu of other foods that have carbohydrate, that is also allowed.

So, if one is cognizant of and desiring more than the minimum intake of fruits and vegetables, they are completely allowed to consume more - with the only restriction being not to exceed 20g net (deducting fiber) during the first two weeks.

Must you aim to consume half your allowed carbohydrate from fruits/vegetables? YES

Can you eat more fruits/vegetables (allowed ones), say 12g, 15g, 18g? YES

Can you deduct fiber? YES

Do you have to? NO (but doing so allows a greater intake of fruits/vegetables and associated essential nutrients)

With all that said, and focus on what all the rules mean for the long-term, I contend that one is expected to continue eating this level (as minimum each day) as they progress toward the long-term eating. I believe that this is one more "foundational" part of carbohydrate restricted diets in the long-term and something intended to be continued as one increases carbohydrate and includes a wider selection of foods, including more vegetables, fruits, nuts, seeds, legumes, and if desired, even whole grains.

Many folks say a low/controlled-carb diet is a way of life, yet find it difficult to take what they start with - 20g net (deducting fiber), of which most must be provided by non-starchy vegetables, a 10g minimum each day - and maintain that aspect as one solid foundation to build upon as they continue to lose weight and then maintain their weight.

Old eating habits start to creep back with more carbs; habits such as preferrentially selecting sweeter foods or grains (even if whole grain) with consumption of non-starchy vegetables waning as one re-introduces more carbohydrate.

If one takes this rule, and continues to extend it --- fully --- until they reach 40g net carbohydrate each day (deducting fiber), they will be consuming incredibly healthful levels of fruits and vegetables, and will be able to eat a very wide variety of them too. That is, until 40g carbohydrate is achieved in the diet during weight loss, one must always include half those carbohydrates from fruits and vegetables with each incremental increase in carbohydrate. (Beyond that, it is increasingly difficult to continue adding more non-starchy vegetables and fruits due to their bulk; you can, of course - it's just not as easy to do).

Now that isn't exactly stated explicitly in the rule, but it is from my experience and those I've given assistance, one significant contributor to maintenance of weight in the long-term. That's because if you're aware of and including a lot of fruits and vegetables (specifically non-starchy vegetables and low-glycemic load fruits) it is difficult to consume excess calories each day over the long-term.

It becomes much easier to consume excess calories when you "play" the carb game (like many play the "points" game with Weight Watchers) and make choices to stay within a number, rather than focus on quality of choice.

But if you're committed to making sure that, no matter what intake of carbohydrate you reach (60g, 90, 120g or more), that you always are sure you include at least 10g net minimum at the start and then 20g minimum (net) from non-starchy vegetables/low glycemic-load fruits as you continue along, you'll have a favorable calorie intake that helps maintaining weight easier.

As you add back carbs, this rule must remain in your eating habits, even if you only stick with 10g net as minimum (which I don't suggest you do) as you're learning in the beginning - you cannot add back carbs and eliminate or reduce how many vegetables and salads you eat each day and expect to maintain your weight using grains, nuts, fruits, etc. as your primary source of carbohydrate later....you must always maintain a level of carbs from your vegetables and salad greens - even in maintenace.

This rule, like rule two, is taking you "back to basics" - helping you learn, step-by-step, how to nourish your body with high quality nutrients from real foods; over time you're encouraged to include a wider variety of non-starchy vegetables, low glycemic-load fruits, nuts, seeds, legumes and more, and the starting basics for the diet should be extended out for the long-term; that is, establish now, at the start, that as part of your long-term habitual diet, non-starchy vegetables and low-GL fruits will be a large part of your overall diet - your body will thank you!

Rule Two: Back to Basics

Over the last few decades, the population at large, has slowly been indoctrinated to fear dietary fat; to limit intake of dietary cholesterol; and to limit consumption of foods rich with saturated fat like meat, whole dairy, butter and eggs. This happened despite little evidence that such an approach to eating provided a long-term health benefit, or ability to maintain weight. But, with decades of reinforcement in the popular thinking, it's understandable how the second rule in the Rules of Induction is the most misunderstood and maligned of them all.

Let's take a look:

Rule 2:

• Eat liberally of combinations of fat and protein in the form of poultry, fish, shellfish, eggs and red meat, as well as pure, natural fat in the form of butter, mayonnaise, olive oil, safflower, sunflower and other vegetable oils (preferably expeller-pressed or cold-pressed).

Is it any wonder that, when a diet comes along and allows these foods, in complete contradiction to decades of fat phobia propoganda, it is vehemently opposed by the leading health organizations and government agencies? That we're innundated with dire warnings of consequence to health, heaped upon us in a concerted effort to discredit and dismiss anyone who says differently; despite scientific evidence and data supporting not only the inclusion of these foods in the human diet, but their inportant contributions to the human diet!

Ignore the man behind the curtain Dorothy....ignore that in the noble attempts to improve the health of our population, researchers and clinicians were lead astray by what we now know was half-truth data, published in the fifties and sixties.

They know it, we know it, but still it's difficult to come to grips with that fact and reverse direction after decades of building the foundation of a "truth" only to find it terribly flawed. It's often easier to continue on in the lie than face the fact you're wrong; moreso when the entire group and community you exist within endorses the continuation of the established dogma, despite the evidence to the contrary.

It's easier to "kill the messenger" than kill the flawed paradigm that hold these foods are to be limited, heck, even avoided at all cost.

To admit such is akin to killing thyself and the core set of beliefs one holds to be true.

Dramatic license here?

Sure, but it does speak of something critically important one must do for their long-term health when they begin to, perhaps for the first time in their life, establish good eating habits for the rest of their life.

Simply put, the second rule of induction grants us permission to dismiss everything we've been told and taught to hold as truth about eating, macronutrients (carbohydrate, protein, fat) and a "balanced, healthy" diet; allows us to re-learn what it means to be human and eat food; and encourages us to enjoy the experience of truly eating a healthy diet while losing weight and then continue to do so along the way to finally, once and for all, maintain that weight well into the future.

I'm quite the optimist aren't I?

Seriously, don't studies tell us again and again that dieting to lose weight fails, that all we really ever do is get good at losing weight, but we're never quite able to master maintaining our weight in the long-term?

Let's start by examining the very base reason most folks even begin a diet to lose weight - they're overweight or obese and have decided it's time to do something about it.

So they begin, they are off to a good start, they're motivated and continue to be motivated with each incremental decline they see on the scale.

Problem?

Absolutely - the focus is on the scale; the number on the scale matters most and damn the torpedos, no matter how inconvenient, stressful or annoying it is to weigh, measure and count every calorie, the individual is in a battle against their bathroom scale to reach a desired number in the shortest period of time possible.

Millions have mastered this task, only to have to repeat it again and again throughout their life. I apolgize now if this sounds crass, but anyone can lose weight with even just a small level of effort; it doesn't take an Einstein to eat less for weeks or months to reach a number on the scale; most will put up with high levels of discomfort to reach that goal - hunger, moodiness, irritability, stress and counting, measuring and weighing anything they consider putting in their mouth.

In the short-term, such measures do work; in the long-term they fail because the person has been mistakenly led to believe "if only..." they do this, measure that, control this and avoid that over the short-term, somehow that alone will enable them to maintain their new lower weight without much more than keeping on keeping on; except the keeping on part is next to impossible!

That's because the very dogmatic recommendations we're repeatedly told are balanced and healthy to lose weight are scaring people away from the very foods that we need to eat to thrive as humans; this forces an unnatural eating patten across the population due to a deeply flawed fear of dietary fat and cholesterol and leads to failure in the long-term because it is not only unsustainable, it's incompatible with true health in the longer term.

The heart and soul of our metabolism is the endocrine system - when it dysfunctions, a cascade of health problems follow - insulin resistance, high blood pressure, dyslipidemia, diabetes, and other chronic and debhilitating diseases.

Why then are we specifically told to avoid the very foods that fuel the proper function of this system?

The current recommendations not only scare us from healthy food, they make simply eating way too stressful for an average person - measure this, weigh that, watch this, avoid that, don't eat this, that's better, blah, blah, blah - who wants to deal with that much stress each day? Sure, a motivated person, desiring weight loss will submit to such stress to reach a goal - but then what happens? They do what is natural and human - they do what they need to do to relieve the stress and relax, are then an easy target to point to as someone lacking willpower, someone just not commited to sticking with it; someone who simply doesn't care and is lazy!

Anyone who has attempted to lose weight only to regain it can relate - no matter how hard you try to stick with a diet that is, for lack of a better phrase, "high maintenance" to follow each day for the rest of your life - sooner or later you find the "benefit" (weight on scale) isn't worth the time and "stress" (weighing, measuring, going hungry, chastising yourself for wanting to eat, etc.).

As I said in my last post, what if the problem isn't you or your "willpower," but a deep flaw within the recommendations that lead not to success, but failure in the long-term?

Here's the rule again:

Rule 2:

• Eat liberally of combinations of fat and protein in the form of poultry, fish, shellfish, eggs and red meat, as well as pure, natural fat in the form of butter, mayonnaise, olive oil, safflower, sunflower and other vegetable oils (preferably expeller-pressed or cold-pressed).

The short and long-term secrets within this rule include:

1. Eating "liberally" is not the same as eating until you are stuffed and goes hand-in-hand with rule 6, which we'll look at later this week. This rule is also a natural extention to rule 1 to eat regular sized portions.

2. You're allowed to eat animal foods such as meats, poultry, fish and eggs provides you with combinations of both fats and protein - necessary for health, losing and maintaining weight on a carbohydrate restricted diet.

Note that in the rule, no one is told they must eat "fatty meats" or must consume "bacon, brie and oodles of t-bone steaks." No, instead they're to eat foods that provide both fat and protein; they can choose whatever cuts they like, whatever combinations suit their tastes; whatever they prefer.

Want boneless skinless chicken breast? Allowed.

Want a filet mignon? Allowed.

Want some eggs? Allowed.

Want some dark turkey meat? Allowed

Want some salmon? Allowed.

This "allowance" of all things that provide a good fat-protein combination reinforces our mindfullness not to fear food, food is not the enemy!

Adding to this is that using fats and/or oils as part of your meals is allowed - from sources of natural, good fats and oils; with those natual oils being preferentially from expeller-pressed or cold-pressed sources.

Why are the animal products with combinations of fat and protein and the use of natural fats & oils so important?

By integrating both into your meals you are also beginning the process of balancing your essential fatty acid ratios in your eating from the fats found in these sources, and perhaps for the first time, consuming adequate protein, thus adequate essential amino acids.

Important too is to choose quality, eat well and enjoy your food and meals. Don't worry each day about how much fat is in a particular food or meal at this stage, over time you'll be able to "tweak" as you go and learn better how to nourish your body and eat what really is a well-balanced, healthy diet.

With fat and protein providing the vast majority of "essential" nutrients, this liberal approach at the start of your weight loss diet takes you "back to basics" and with time, provides you the opportunity to not only learn how to eat well for the long-term, but to actually enjoy your meals again - without fear that you're killing yourself with every bite!

Establishing Good Eating Habits: Rule One

Odds are, overweight or not, by the time a girl reaches adulthood, she's tried one or more diets to lose weight or not gain weight; with boys, the incidence of dieting in the teenage years is less prevalent. In early adulthood this often continues, with many women and men developing what is termed "disordered" eating habits; skipping breakfast or other meals, relying on meal replacement products, like ready-to-drink shakes, rather than eat food for all meals, eating lots of small things on the run, or going long hours without eating anything, then taking one large meal at the end of the day, in the belief that will keep thier calorie intake lower over the day.

These types of habits aren't necessarily "eating disorders," though they may be part of one; more often than not, they are habits that one develops over time that are counter-productive to developing and maintaining a healthy relationship with food, and can stand in the way of long-term success when one loses weight and tries to maintain that loss over the long-term.

Food, while an easy target of blame in the weight loss game, is not an enemy to be avoided or held in disdain; it is essential to our health and well-being and, in the long-term, it's not simply learning what to eat that helps one maintain weight, but how to eat that sets the stage for long-term success.

With this understanding, it is easier to see why I believe the first rule in the Rules of Induction (for the Atkins diet) is the most important:

Rule 1:

• Eat either three regular-size meals a day or four or five smaller meals. Do not skip meals or go more than six waking hours without eating.

The first rule is straight forward and critically important not only in the first two weeks, but throughout the entire weight loss period, and then for maintaining weight in the long-term.

The reason is simple - it establishes that one doesn't need to eat in a typical three-meal-a-day pattern, but highlights the importance that eating regularly - even simple smaller meals multiple times each day - is a habit to continue with if you're already doing so, or establish now as you begin and continue to learn how to eat properly for the rest of your life.

Without establishing this as habit, you'll leave yourself open to disordered eating habits and continue to view food and eating as something bad or to be avoided. Now is the time to set aside all that disdain for food, eating, portions, and all that and dismiss that thinking so you can begin to learn to love food again!

This is the first step to "get back to basics" - a means to develop a healthy relationship with food and avoid continuing in a disordered eating pattern that is counter-productive in the long-term. In anything you do in life, be it your job, your hobbies, or anything else that requires skill, one thing that clearly sets apart those who succeed from those that fail is the feeling of confidence in ones ability. Few are "born naturals" in a given situation - most take the time and put in an effort to learn and do along the way, to build their confidence and master whatever it is they enjoy.

This is no different; by taking the time to work on this as you start a diet to lose weight, you will develop not only a sense of confidence that food is really not an enemy (since you will be losing weight while you establish good eating habits), you will also learn to listen to your body and take cues based on hunger to learn when to eat in a pattern that is in synch with your body. This is because eating regularly keeps your metabolism functioning and enables your metabolism to hum along nicely.

If you read the rule, you'll notice it says " three regular-size meals a day or four or five smaller meals" which hints at learning how much is enough; stated another way, portion size is important. If you're inclined to eat three meals a day, these meals will be larger than if you are inclined to eat four or five smaller meals.

We know from the various publications written by Dr. Atkins, that Induction is not a license to overeat or stuff ourselves. In my view, this Induction period is an opportunity to learn what a "portion size" means to you as an individual.

So many weight loss diets prescribe specfic weights and measures, claiming such portions are more than adequate for anyone attempting to lose weight.

But let's be honest - how many are truly satisfied after eating a tiny 2-to-3 ounce portion of bonless, skinless chicken breast? If you're one of the few who find this intake adequate for you and you're satisfied and not hungry, great!

If not, maybe the problem isn't you, or as you are often told, your lack of willpower, but instead that you have not eaten enough to adequately provide for your needs.

Listen to that - have some more - and as you begin to feel that sense of "satisfied," not stuffed, but satisfied and confident you've eaten well, without worry that you're going to be hungry again way too soon, then stop eating.

In this period, you are allowed to portion your meals as "regular-size" meals, keeping in mind that you won't eat larger portions just because you can. If three "regular-size" meals isn't your style, you simply adjust to more "smaller sized" meals in a regular pattern throughout the day.

The key here is to develop good eating habits and then maintain them as you move along.

Long-term this rule is the "golden rule" of maintenance. It is the most important rule of all the rules if you ask me!

By the time you reach maintenance, if you have been following this rule all the time - not just in induction - you're not only eating an adequate level of calories, no longer in ketosis and at your goal weight - you're also in the habit of eating portions that are "normal" for you and eating regularly to keep your metabolism working at a steady pace.

You've also learned that skipping meals may lead to eating more when you do eat and that it is best to keep your appetite sated by eating regularly for your particular needs - whether it is three regular meals each day or four or five smaller meals each day; and you may also have learned you're less likely to snack as often because your appetite is sated with regular meals!

This rule firmly establishes that you are tasked with setting the frequency of your eating pattern, sticking with an eating pattern that is regular, and develop a sense of what your needs are, learn what your "portion size" is in meals, and learn how to eat regularly instead of fearing food or your appetite!

Over the long-term you'll set the stage for success with this rule because you're allowing yourself to establish a healthy relationship with food and come to know that food is not your enemy, eating well is not a bad thing, and that enjoying your meals is truly a wonderful thing!

There is Something Perverse About the Atkins Diet...

I've been crazy busy the last few weeks, but absolutely had to stop what I was doing to write about an article today - The Atkins Paradox: What Diet Studies Don't Reveal - by Christopher Wanjek, the "Bad Medicine" columnist over at LiveScience.com.

My headline above was taken directly from the column, "So why not go with Atkins if you can loose weight and eat bacon? The reason, most doctors say, is because there is something perverse about the Atkins diet."

I haven't laughed so hard in, well, a few days. And, what followed was even funnier...Consider the breakfast of a gentleman on the Atkins diet whom I encounter each morning on a commuter train eating an entire block of baloney right out of the package with one hand and washing it down with a diet Coke in his other hand. Between the salt, fat and artificial additives in the lunchmeat and soda, this simply can't be healthy.

Good golly Miss Molly!

I don't know about you, but when I read these stories about someone "on the Atkins diet" - or any carbohydrate restricted approach - doing it completely wrong, well all I can do is laugh. I'm not laughing because the poor fellow eating the bologna and diet coke breakfast is going about Atkins wrong, but because this columnist really, truly believes this guy is a good example to show how "perverse" the Atkins diet is.

For anyone who has not read Dr. Atkins' New Diet Revolution, he was pretty clear to avoid, or at least limit, processed meats - "Processed meats such as ham, bacon, pepperoni, salami, hot dogs, and other luncheon meats - and some fish - may be cured with added sugars and will contribute carbs. Try to avoid meat and fish products cured with nitrates, which are known carcinogens." (page 124, paperback, 1992, 1999, 2002 edition)

In fact, he specifically recommended "Always aim for unprocessed natural foods and select the freshest produce you can find. If possible, purchase organic meats and dairy products." (page 130, paperback, 1992, 1999, 2002 edition)

Not exactly a ringing endorsement of bologna for breakfast each day, huh? Then again, let's not let inconvenient facts get in the way of an article promoting low-fat diets are supreme!

And this presentation of bologna & diet coke for breakfast for an Atkins dieter really isn't the biggest problem with this article.

No, the biggest problem really is the deceptive assessment of the study published in JAMA that I previously wrote about. This is how Mr. Wanjek portrayed the results:

The Atkins and Ornish data have overlapping confidence intervals. This is a measure of statistical strength given sample size and other factors. The study implies that, with 95-percent confidence, the true weight loss could be as low as 6.8 pounds for the Atkins group and as high as 8.2 pounds for the Ornish group.

In fact, the Ornish dieters were closing the gap at 12 months as the Atkins dieters were gaining weight. This supports earlier studies suggesting that a low-fat lifestyle is better at keeping off weight in the long run.

Closing the gap? Who is he kidding? Here is the graph of each group at each measurement interval:





















Note that I've highlighted the Ornish group. I've done that because the contention that they "were closing the gap" and losing weight at 12-months is utter and complete hogwash. As a group, they were gaining weight since the two-month point in the study!

Then the suggestion that the overlapping confidence interval was masking some secret weight loss potential for the Ornish group - more utter and complete hogwash.

What Wanjek didn't say is important and it's that the range of weight loss in those following Ornish and Atkins. Here is the data:

Atkins 4.7kg [95% CI, -6.3 to -3.1kg]

Ornish 2.2kg [95% CI, -3.6 to -0.8kg]

Oh, there was an over-lap all right, but no matter how you slice it, those trying to follow the Atkins diet lost as little as 6.8-pounds (3.1kg) and as much as 13.9-pounds (6.3kg), with an average weight loss of 10.3-pounds for the group. Compare that to those trying to follow the Ornish diet - weight loss was a little as1.8-pounds (0.8kg) and as much as 7.9-pounds (3.6kg) with an average weight loss of 4.8-pounds for the group.

Put another way - the least weight loss in the Atkins group was about the best in the Ornish group. Have a look for yourself:

We're supposed to be convinced that those following Ornish were doing as well as those following (or trying to) Atkins? Oh yeah, that graphic above shows just how close the two dietary approaches were...not.

Pass the nitrite-free bacon and double cream brie, thank you very much.

Atkins Editorial Rejected

Five heathcare professionals - Dr. Stephen D. Phinney, MD; Dr. Mary C. Vernon, MD; Dr. Eric C. Westman, MD; Dr. Jay Wortman, MD; and Jacqueline A. Eberstein, RN - recently penned and submitted an editorial response to the recent media attention concerning the A to Z study published in JAMA. It was rejected by JAMA, Newsweek, Time and others. Here it is, in its entirety:

More Science and Less Zealotry, Please.

The controversy over which diet is best for all has again made headlines with the publication of the Stanford University study in the Journal of the America Medical Association March 7, 2007. Since the results are favorable to the low-carbohydrate Atkins diet, the usual criticism can be expected to follow.

Predictably, Dean Ornish has launched a tirade in which he manipulates the study findings to find fault with the low-carb approach and to deflect criticism away from his ultra low-fat diet which did not perform well in the study. Unfortunately, this is an argument based on dogma and not on science. The science speaks for itself.

As scientists and clinicians, we believe that no one dietary approach is going to be ideal for everyone. There is no doubt that, for some, an ultra-low-fat approach may be appropriate. Unlike Dr. Ornish, we recognize that there is no one-size-fits-all approach to the enormously complex problem of obesity and related conditions. Unfortunately, other authoritative sources like the US dietary guidelines also recommend a single lowered fat high-carbohydrate diet approach and have been doing so over the decades that this epidemic has grown.

Gratuitous attacks on the Atkins diet that imply it involves abandonment of wholesome vegetables and fruit for “bacon and brie” are simply wrong. Even in the most restrictive phase it meets the recommended daily guidelines for vegetables and fruits. As one advances through the phases, low-glycemic fruits, more vegetables, legumes and even whole grains are introduced based on an individual’s metabolic tolerance for these foods. One survey found that people who follow the Atkins plan over the long term eat more vegetables than they did before. Another study found that rather than increase the intake of fat and protein to compensate when carbohydrates were reduced, people simply ate less.

The unfortunate reality of today is that too many Americans are eating potato chips and fries and drinking sugar-sweetened beverages. We support the idea that wholesome foods such as meat, fish, cheese and eggs along with vegetables and low glycemic fruits constitute a healthier diet than chips and fries and sodas.

While this study examined four popular dietary approaches, what is clear is that whatever approach one takes to healthy eating, success will depend on how well you can stick to it. In this case, and in many earlier studies, it is clear that the Atkins diet is the one most people can maintain. On the other hand, the extremely low-fat diet advocated by Dr. Ornish is very difficult to follow. In this study, the subjects who were supposed to reduce their fat intake to his recommended intake of 10% could not reach that target.

Another important aspect of this and earlier studies is the beneficial effect that reducing carbohydrates has on metabolic markers. In his criticism, Dr. Ornish states that the LDL-cholesterol level fell in response to his diet, but does not mention that none of the differences in LDL-C in this study were statistically significant. This is therefore not a scientifically valid criticism. On the other hand, it is widely recognized that elevating the HDL-C, the good cholesterol, is an important factor in reducing cardiovascular risk. In this study there was a highly significant 10% rise in HDL-C in the Atkins group but no such change among those who followed the very high-carbohydrate Ornish diet.

In the same vein, the Atkins group demonstrated a significant (both statistically and clinically) greater reduction in systolic and diastolic blood pressure than the other three diets. A difference in mean arterial pressure of 5 mm Hg is about the response we would expect to see with a first-line pharmaceutical in the clinical setting. Any objective observer would acknowledge this as a major beneficial effect of the Atkins diet.

Dr. Ornish suggests that the positive findings of research such as this that supports the Atkins diet will cause problems, and that “many people may go on a diet that harms them based on inaccurate information.” This is a wildly irresponsible statement, given the consistency with which a reduction in important metabolic and cardiovascular risks are achieved by lowering carbohydrate consumption. It is simply preposterous to suggest that an approach that leads to significant risk factor reduction is unhealthy.

The seriousness of the accelerating epidemic compels us to think outside the box to find new solutions where the status quo has failed. The only approach that will be successful is one that people can actually follow. This study adds to the mounting evidence that the Atkins diet is a healthy choice which should be supported as a viable way to lose weight and improve metabolic and cardiovascular risk factors.

The Real Atkins Lifestyle

Before there was research on the Atkins diet it was commonly criticized in the belief that it would elevate cholesterol, ruin one’s kidneys and bones and cause heart disease. None of this has been borne out by the research.

What is clear from this JAMA study, and others like it, is that cardiovascular risk factors actually improve when controlling carbs. The scientific studies of this approach have shown numerous times that a pattern of rising HDL-C and falling triglycerides is the hallmark of carb restriction and that this benefit occurs even in the absence of weight loss.

Research also shows that rising HDL-C (good cholesterol) and falling triglycerides is correlated with larger LDL-C particles which are less likely to cause heart disease. Even the much touted statin drugs do not deliver this kind of improvement in LDL-C particle size. On the other hand, the research shows that eating a high-carb diet and cutting fat intake results in small dense LDL-C particles that are linked to an increased risk of heart disease.

Importance of Fat

There are other problems associated with extremely low fat diets, as well. Cutting fat intake can lead to deficiencies in fat soluble vitamins, depletion of essential fats such as EPA and DHA, and decreases in the absorption of nutrients. Studies also show that people with cholesterol levels that are too low become prone to depression, suicide and cancer and have higher overall death rates than those who have higher cholesterol levels.

When all is said and done, it behooves us to remember that the diet debate is not a horse race where there is only one winner. We know there is a great variability in metabolic and genetic factors that will determine what dietary approach is best for each individual person. Although, in this and many other studies the Atkins diet worked better for more people, it is also evident that other dietary approaches will work for some people as well. The most important thing we have learned from dietary research is that people need to find the approach that will deliver healthy outcomes for them individually. And, just as the proof of the pudding is in the eating, the proof of a diet's effectiveness is whether it can sustain those benefits over the long haul. Hopefully, the weight of the evidence will now allow the Atkins diet to be recognized and supported as a legitimate option for people who want to improve their health through better nutrition.

On a final note, Dr. Ornish’s repugnant attempt to undermine Dr. Atkins’ credibility by perpetuating the myth that he had heart disease is unconscionable. It is unbecoming of any honorable person to make ad hominem attacks on those who are departed. Enough is enough. Dr. Atkins died of a head injury. He is no longer with us, but the line of scientific inquiry that he started continues to vindicate his dietary approach. And no amount of unfounded criticism will alter the fact that this study, and the 60 others before it, clearly demonstrate that what Dr. Atkins had been telling us all along was right.

• Jacqueline A. Eberstein, R.N. Co-author, Atkins Diabetes Revolution, President, Controlled Carbohydrate Nutrition
• Stephen D. Phinney, M.D. Ph.D Emeritus Professor, Department of Medicine, UC Davis, Elk Grove, Cal
• Mary C. Vernon, M.D., CMD, Co-author, Atkins Diabetes Revolution, President, American Society of Bariatric Physicians
• Eric C. Westman, M.D. M.H.S, Associate Professor of Medicine, Duke University Medical Center
• Jay Wortman, M.D, Department of Health Care & Epidemiology, Faculty of Medicine, University of British Columbia