Source: LA Times
Date: 22 March 2004

A change of diet

With millions of Americans going low-carb,
health experts now are endorsing the move.

By Valerie Reitman, Times Staff Writer

Veteran dieter Louise "Cookie" Witham never considered trying the Dr. Atkins' diet that promises followers they can eat plenty of steak, cheese, bacon and eggs and still lose weight — provided they give up almost all carbohydrates.

Not only would she have had to cut out bread, pasta and potatoes, but also fruit and most vegetables. "It just never appealed to me, eating all that red meat and high fat," Witham said.

But last Thanksgiving, Witham's 29-year-old daughter, Erica, a physical trainer who has always been the thin one in the upstate New York family, brought home a copy of "The South Beach Diet" and urged her parents and two siblings to try it. They're now believers.

Word-of-mouth success stories such as the Withams' have quickly propelled "The South Beach Diet" to the top of the bestseller list — with more than 5.5 million hardcover copies flying off shelves since its April release. Its popularity — along with several other new diet book titles such as "The Good Carbohydrate Revolution," "Living the Low Carb Life" and a less-restrictive version of the Atkins diet that allows more of the so-called "good carbs" — has helped push the low-carb craze mainstream.

More than three decades after Dr. Robert Atkins introduced his controversial, but intermittently popular, no-carb diet, Americans are changing how, and what, they eat.

Essentially a modified version of the high-protein Atkins diet, the eating plan developed by Miami cardiologist Arthur Agatston seems healthier and more palatable for the long term, its supporters say, with unlimited quantities of nonstarchy vegetables and salad. Although it allows no fruit or whole grains in the first two weeks of the plan, small amounts are allowed afterward. The diet also allows reasonable portions of protein and fats, though it urges leaner meat cuts, reduced-fat cheeses and monounsaturated olive and other oils.

Since the Withams went on the diet Jan. 2, Cookie Witham, 53, has dropped 20 pounds; husband Steve, 60, has shed 18; daughter Christie, 32, has lost 26; and son Steve, 26, has sloughed off 45 pounds. Much to their surprise, the diet hasn't been hard and they no longer crave the foods they gave up.

"Everybody's happy," said Cookie Witham, who still intends to drop several dozen more pounds, as do her two children. "Though the weight is no longer falling off as fast, that's fine. We're learning to eat better."

Whether such diets are truly healthier and more effective than traditional diets remains to be seen. There has been little long-term research on them so far.

But the South Beach diet, in particular, is a step in the right direction, health experts say. It builds on Atkins' principles, and even with its limitations, is seemingly more health conscious and easier to follow for long periods.

"For the first time in a long time, one of the most popular weight-loss books is recommending a healthy diet," the Center for Science in the Public Interest wrote in its January-February Nutrition Action newsletter.

Dr. Frank M. Sacks, a prominent professor at Harvard University's nutrition department, says he recommends the South Beach diet to people who ask him about it. "It's a lot better than Atkins for the low-carb approach, in that it doesn't emphasize such a continuing intake of meat and has many interesting, healthy recipes."

Whereas fats were seen as the primary enemy in America's battle of the bulge for the past two decades, carbs are now being branded as the main villain. White foods — such as flour, rice, pasta and potatoes (which just a few years ago touted their "zero-fat" benefits) — are now verboten.

Many nutritionists and health experts have been saying for years that Americans have been consuming far too many carbohydrates, particularly "high-glycemic" processed products containing an abundance of refined sugars, corn syrup and flours that cause an insulin rush and trigger hunger. But now a number of forces have joined the low-carb movement, pushing the low-fat emphasis aside. Many experts think it's more than just a fad. By endorsing the South Beach diet, the Center for Science in the Public Interest itself seems to be shifting direction, after long advocating that low-fat diets were the way to go.

"It's a cumulative effect," Sacks says. "I've had a lot of colleagues who strongly supported the standard, low-fat, high-carbohydrate diets that now are gradually coming around to thinking that if people are not going to eat standard low-fat diets, then maybe a Mediterranean diet — which, like South Beach, includes fish, poultry, lean meats, monounsaturated oils, lots of vegetables, fruits and whole grains — is the way to go."

In the last few months, food manufacturers have introduced hundreds of low-carb products and are flaunting them in new ad campaigns, with no slowdown in sight. After all, more than 17% of the 10,000 U.S. households surveyed recently by marketing research giant ACNielsen reported that someone in their residence is currently on a low-carbohydrate diet.

"We're seeing a convergence of food companies, consumers and the government all coming to the conclusion that the way America eats isn't good," concludes Phil Lempert, a Nielsen analyst.

Dollar sales of fresh potatoes, instant rice, orange juice, white bread and cereal have dropped, Nielsen says, while sales of eggs, nuts, bacon and meat snacks have surged.

To be sure, not everyone is buying in. Dr. Tomas Silber, a specialist in teen obesity and eating disorders at the Children's National Medical Center, says he's seen "at least 50 famous diets arise and die" in the past 30 years. Although restricting kids' carbohydrates can help because it makes them less hungry, they need counseling and support to stick with any diet.

He notes that the first thing the teens have to do is give up the "empty calories" they down by the hundreds in soda, juice and junk food.

The American Heart Assn. also does not endorse low-carb diets, advocating that individuals should consume about 250 grams of carbohydrates, or a bit more than 10% of their daily calories, with an emphasis on whole grains, fruits and vegetables because they are "chock-full of protective nutrients, such as vitamins, minerals and fiber," with the fiber enhancing the sensation of fullness. It says long-term studies have found a strong association between diets rich in complex carbs and a lower risk of heart disease.

It's not only perennial dieters who are cutting back on carbs. Many people who aren't overweight have been incorporating low-carb principals into their eating habits, forgoing bread, pasta and potatoes and eating more protein, olive oils, beans and nuts.

Undoubtedly, public opinion has changed from when carbohydrates such as pasta, pretzels and potatoes — along with the notable low-fat Snackwell cookies — were perceived by many to be "nonfattening." The U.S. Department of Agriculture's food pyramid helped promote that perception — calling for six to 11 servings of carbohydrates daily. (The USDA says its recommendations were widely misinterpreted: Only very physically active people should be eating anywhere near 11 servings, while the sedentary types should be eating six.)

The dietary shift is being stoked by increasingly alarmed pronouncements about the looming perils of the U.S.' epidemic of obesity: Two-thirds of Americans are overweight, a substantial number of them obese. As the numbers on the scale have risen, so too has Type 2 diabetes and heart disease.

"Far too many Americans are literally eating themselves to death," Health and Human Services Secretary Tommy G. Thompson declared earlier this month, in announcing that the Food and Drug Administration would crack down on labeling that tries to make foods seem less fattening than they are. The regulatory agency also plans to establish guidelines for exactly what qualifies as "low carb" — because many products are taking great liberties with the lack of guidelines.

Many consumers are likely to make the same mistakes that they did with low-fat concoctions — paying too much attention to the carbohydrate content and not enough to the calorie count. For example, Low Carb Enchantments chocolate chip cookies boast only 2.3 grams of net carbs per cookie — a controversial figure that subtracts the amount of fiber (3 grams in this case) and sugar alcohols (6 grams) from the amount of carbs (11 grams), to come up with net carbs. Yet, each cookie is far-from low-calorie, containing 130 calories, 80 of them from fat.

Most health experts, including South Beach's Agatston, still agree that one must burn more calories than one consumes in order to lose weight. But Atkins didn't think it was quite so simple. He maintained that by keeping carbs to a bare minimum, one could maintain a "metabolic advantage."

"When you control carbohydrate consumption sufficiently, your body will switch from burning glucose derived from carbohydrates to burning primarily fat for energy," he wrote in "Dr. Atkins' New Diet Revolution 2002 edition. Some people can lose weight on the diet only if they keep to as few as 15 grams of carbs a day — little more than one glass of skim milk — and he recommends no more than 60 grams of carbs for anyone, even in the maintenance phase.

So if Atkins was right, anyone eating more carbs than that in a day may well gain weight.

Many health experts have attacked the Atkins diet over the years as unhealthy, suggesting that it can cause kidney problems, bad breath, elevated cholesterol levels and other maladies. Atkins, who died recently, always contended this was untrue, and that its adherents' lipids improved on the diet — which was borne out in some studies.

Angela Allen, 31, of Dallas agrees with the Atkins philosophy. She tried everything to lose the 60 pounds she gained while pregnant with her son seven years ago, but couldn't, and always felt hungry.

She switched to Atkins and ate far more calories than on any of the low-fat diets, consuming "tons of steak and hamburger and bacon and eggs and really fatty stuff" like pork rinds. The weight fell off.

Agatston credits Atkins with having the right idea — that high-glycemic carbohydrates, particularly refined sugar and flour — cause big swings in blood sugar that lead people to crave more carbohydrates, and lead them to eat more. In contrast, proteins and fats tend to keep diners more satisfied.

But Agatston just couldn't conscience urging his at-risk patients to indulge in artery-clogging saturated fats such as butter, fatty steaks and Brie. (Of course, Atkins dieters can eat lean meats or fish and avoid the butter and Brie; but in some cases, the lower-fat versions have less fat but more carbs, so on Atkins, the dieter may opt for heavy cream but can't have skim milk.)

Rather than referring to his South Beach diet as "low-carb" — even though it is — Agatston prefers to refer to "good carbs" (such as the ones that come from nonstarchy vegetables, some fruits and beans) and "bad carbs" (those that come from flour, sugar and non whole grains).

He views his diet as being easier to stick to for life because one doesn't need to count calories, or measure portions, like other diets require.

The South Beach diet has its flaws, and not everyone loses weight on it.

Women who are pear-shaped, with the weight on their hips, will have a harder time losing it than those with weight in their bellies, Agatston acknowledges. (The good news for them, says Agatston, is that the pear-shaped are less at risk of heart disease, although they will need to exercise more to lose weight.) Millions of Americans taking anti-depressants may also have difficulty losing weight on it, Agatston says, as they also do with Atkins, for reasons that aren't clear.

In addition, South Beach doesn't quantify what it terms as reasonable portions of protein and polyunsaturated fats such as oils. It recommends that followers eat until they are no longer hungry.

And it could become boring.

Fruit — with the exception of berries, citrus and melons — continues to be highly restricted, even in the maintenance phase of the diet, and can't be eaten for breakfast.

Pasta must be whole grain even in the maintenance phase, and foods such as bananas and baked potatoes — which can be as low as 100 calories and contain potassium — are off limits, because they have natural sugars or starches that Agatston contends cause hunger. Sacks, of Harvard, contends that these restrictions may be taking it a bit too far.

"Pineapple is very healthy, with loads of fiber and potassium. And I wouldn't run down bananas," which have been shown in studies to lower blood pressure and are high in potassium and fiber.

Some competitors are predicting that low-carb diets will be too hard to stick to for those who crave variety. Weight Watchers is running "Welcome Back" ads for those who want to try to get the weight off with a more inclusive diet that allows almost any food, provided it is compensated for by limiting other calories during the day.

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Comparing the diets

The Atkins, South Beach and Weight Watchers diets allow — and limit — a variety of foods. Here are some of the key differences.


What you can eat

Seafood, poultry, red meat, ham, pork, bacon, eggs, cheese, sour cream, butter, oils and nonstarchy vegetables. After first phase, limited amounts of nuts, fruits, alcohol (red and white wine), beans and whole-grain pastas and breads.

What you should avoid

Sweets, white bread, pasta, cereal, milk, yogurt, starchy vegetables, such as potatoes.


South Beach

What you can eat

Seafood, eggs, poultry, lean meat, low-fat cheese, skim milk, most vegetables, small quantities of nuts and oils. After first phase, citrus, melon and berries, yogurt and beans, whole grains including whole wheat pasta and rice.

What you should avoid

Fatty meats, full-fat cheese, white bread, pasta, nonwhole grain cereals, sweets, beer, juice, bananas, pineapple, watermelon and starchy vegetables such as carrots, corn, beets and potatoes.


Weight Watchers

What you can eat

All foods are assigned point value. Generally, the higher the fat or calories, the more points assigned. Low-point foods include fruits, vegetables, low-fat dairy, poultry, seafood, lean meats and grains.

What you should avoid

Lots of high-calorie or high-fat foods, too large of a serving.


Sources:, and

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Low-fat blues
Vitamins and mood
Docosahexaenoic acid
Catecholamine depletion
Mood, food and cognition
Nutmeg seeds and anxiety
Bad moods and sick hearts
Dieting and cognitive deficits
PUFA deficiency and allergies
Fasting/euphoria/ketone bodies/GABA(B) receptors

Go To Good Drug Guide
BLTC Research
The Good Drug Guide
Nootropics/smart drugs
The Hedonistic Imperative
MDMA: Utopian Pharmacology