Living Low Carb (27 page)

Atkins explained that insulin causes the body to store fat, that some people are metabolically primed to put out more insulin than others in response to the same foods, that sugar and carbohydrates were the prime offenders when it came to raising insulin, and that elevated levels of this hormone invariably resulted in increased body fat. He argued that it is not
fat
in the diet per se that makes you fat, but rather
sugar
—even more precisely, fat
in combination
with high sugar—and the resulting insulin that leads to weight gain. Atkins took serious issue with the idea that fat causes heart disease and claimed that his diet would actually
improve
blood-lipid profiles, measurements that show up in blood tests as risk factors for heart disease.

What is the actual diet that stirred such passionate controversy? Well, the Atkins diet is, and always has been, a four-stage affair, but most people think of it as synonymous with the first stage, “induction.” During induction, you eat all the fat and protein you want, but you limit carbohydrates to 20 grams per day—an extremely low level of carbohydrate consumption equal to about 2 cups of loosely packed salad and 1 cup of a vegetable like spinach, broccoli, Brussels sprouts, or zucchini. At stage one, there is absolutely
no
rice, potatoes, cereal, starch, pasta, bread, fruit, or dairy products other than cheese, cream, and butter.

To anyone who has read a diet book in the last ten years that wasn’t written by low-fat guru Dean Ornish or his followers, this list of prohibited foods sounds pretty familiar. But you have to realize that in 1972, banning these foods for even two weeks was the nutritional equivalent of suggesting that every school and office in the country burn the American flag. These foods were the holy grail of the low-fat religion. Bagels were the breakfast of choice for health-conscious Americans. Oils, fats, butter, cheese, cream, steak, and the like were considered heart attacks on a plate, and here Atkins was making them the centerpiece of his eating plan.

The establishment thought him quite mad.

If this weren’t enough, Atkins spoke in downright loving terms of something called ketosis, which he termed “the metabolic advantage” and compared to sunshine and sex. For Atkins, being in ketosis was the secret to unlocking your fat stores and burning fat for fuel. Ketosis was the desired goal of the induction phase. Being in ketosis was a virtual guarantee that you were accessing your stubborn fat stores and throwing them on the metabolic flame, using your fat, instead of your sugar, for energy. A big part of the program involved checking your urine for ketones, which are the by-product of this kind of fat breakdown.

The problem was that mainstream medicine considered ketosis to be not only undesirable but dangerous, a metabolic state to be avoided at all costs. For the most part, they still do—see
chapter 6
for a full explanation of why the common belief that ketosis is dangerous is wholly without merit. The emphasis on ketosis, coupled with the recommendation to eat unlimited amounts of fat, was enough to make Atkins a complete pariah in the medical establishment, and it is only now, more than thirty-five years after the publication of the original book and six years after his death, that we are beginning to see a slow turnaround in that evaluation.

Briefly, ketosis works this way: when there is not enough carbohydrate (sugar) coming into the body and when sugar stores (glycogen) have been essentially used up, the body is forced to go to its fat stores for fuel. Furthermore, because there isn’t enough sugar to get fat into the usual slow-burning energy production cycles of the body (known as the Krebs cycle), the fat has to be broken down in another pathway, with the result that
ketones
—byproducts of this incomplete fat-burning—are made and used freely for energy by most of the tissues, including the brain and the heart. Forced to run on a fuel of fat, the body drops weight as the fat is burned off.

The advantages of this plan are twofold. First, the severe restriction of carbohydrates and sugar in the diet immediately brings down your level of insulin, the hormone that is released in response to carbohydrates (and to some extent protein). By dialing down insulin production, you are forced to burn your own fat, a situation Atkins referred to as biologic utopia. Since insulin is a “storage” hormone, less
insulin
means less
fat storage
. Dietary fat has no effect on insulin, so, Atkins reasoned, even if there
is
a lot of fat coming into the diet, there’s not enough insulin to drive the “fat-storing” machinery.

Second, going into ketosis was a way of “tripping the metabolic switch” from a sugar-burning metabolism to a fat-burning one. Excess calories cause weight gain only when you’re eating a lot of carbohydrates, said Atkins. Dump the carbohydrates, and the fat in your diet is not a problem. He also claimed, to the sputtering frustration of his detractors, that you could consume
more
calories on his program and
still
lose weight, precisely because the fat-storing hormone, insulin, remained at low levels.

Atkins argued that obesity exists when the metabolism is not functioning correctly, but that metabolic disturbances have little to do with the fat we eat; rather, they are caused by eating too many carbohydrates. According to Atkins, if you’ve been overweight for a long time, it’s a virtual certainty that your body has problems processing sugar.

Atkins also believed that the biggest reason people gain back weight lost on a diet is hunger, and that hunger is just about inevitable on a reducedcalorie, high-carbohydrate, low-fat diet. On his program, hunger was virtually eliminated, as were cravings and blood-sugar instabilities. There are good physiological reasons that the appetite is suppressed on a low-carbohydrate diet rich in protein and fat—for example, the release of the hormone CCK (which tells your brain you are full) and the possible suppression of a substance in the brain called neuropeptide Y, which stimulates appetite.

The rules of his induction phase are straightforward and simple. You do not count calories. You do not count protein. You do not count fat. You
do
count grams of carbohydrate, and you can have up to 20 grams a day in the form of
either
2 cups of loosely packed salad and 1 cup of uncooked vegetables chosen from a specific list
or
3 cups of salad. Period. As mentioned earlier, you can’t have starches, grains, sugar, fruit, or alcohol. You cannot eat nuts, seeds, or “mixed” foods (combinations of protein and carbohydrate) like beans, chick-peas, or legumes. It is also suggested that you avoid the artificial sweetener aspartame (Equal) and caffeine, the latter because it can lead to low blood sugar and stimulate cravings.

Weight loss in the induction phase is fairly quick and dramatic. Much, but not all, of the weight loss is water and bloat, largely because insulin’s message to the kidneys to stockpile salt (and therefore water) is no longer being sent. But the induction phase is only meant as a jump-start. Though Atkins felt it was perfectly safe to stay in the induction phase for a month or so, he encouraged dieters to progress to stage two, which he calls ongoing weight loss, or OWL.

The key to the success of OWL is finding what Atkins calls your
Critical Carbohydrate Level for Losing
, or CCLL. (Some version of this has been adapted by virtually every low-carbohydrate diet that uses the concept of “stages.”) Here’s how it works. After completing the initial induction phase, you slowly add back carbohydrates at a very specific rate of 5 grams
per week
(the amount of carbs in another cup of salad, half an avocado, or six to eight stalks of asparagus, for example). This would put you at 25 grams of carbs per week. If you continue losing, in the next week you go up to 30 grams. You continue this progression upward until your weight loss stalls, and then you cut back to the previous level. That level is what Atkins calls your CCLL.

The rules for OWL are simple: you still eat as much protein and fat as you want (stopping when you’re satisfied, of course); you increase carbs by no more than 5 grams per week; you add one new food group at a time to see if it has any negative impact on cravings or symptoms (such as headaches, bloating, and so on); and you continue this way until you are close to your goal weight.

When you are 5 to 10 pounds from your goal, you move to stage three, “premaintenance.” During premaintenance, you up your carbs by another 10 grams per week (typical 10-gram portions are ½ cup of almonds, filberts, or macadamia nuts; ¼ cup of yams or beans; and 1 cup of strawberries or watermelon). Again, you’re looking for the level of carbohydrate consumption that will let you keep losing, albeit at a much slower rate. If you overshoot that level and stop losing completely or even start gaining, you drop back down a level. Simple.

Atkins stresses the importance of the premaintenance stage, but I imagine it’s the one people resist the most. Here’s why: when you’re within spitting distance of your goal, you are naturally tempted to keep doing what you’re doing until you get there. Atkins wants you to actually
slow the weight loss down
during premaintenance to less than a pound a week for 2 to 3 months. Premaintenance is seen as a kind of driver’s ed for lifetime maintenance. You’re using this time to learn and master new habits of eating that will last the rest of your life. You need to do a great deal of experimenting and tweaking, as the difference between your Critical Carb Level for
Losing
and your Critical Carb Level for
Maintaining
is likely to be very small. Finally, when you do arrive at your goal, you increase the carbohydrate level—again in measured increments and very gradually and carefully—until you find the level that allows you to stay exactly at that weight. Now you’re in stage four, “maintenance”; the number of grams of carbohydrate you’re consuming is your Critical Carb Level for Maintaining, and that’s what you continue eating to stay at your goal weight.

Atkins spends a lot of time discussing metabolic resistance to weight loss, which he defines as the inability to burn fat or lose weight. He identifies four major causes of metabolic resistance, which are discussed at length in chapter 20 of his
New Diet Revolution
. Obviously, excessive insulin and insulin resistance is one of the causes (see
chapter 2
for a full discussion on insulin resistance). Prescription drugs or hormones are another, and an underactive or malfunctioning thyroid is another. The last is yeast.

Atkins’s discussion of yeast is useful reading for everyone who has had trouble losing weight. I believe yeast is a far more common factor in weightloss problems than was previously thought. Atkins explains that yeast overgrowth is commonly found in conjunction with a sensitivity to mold, and that the combination may easily suppress metabolism. Dr. Alan Schwartz, medical director of the Holistic Resource Center in Agoura Hills, California, has said that yeast creates its own food source by literally demanding sugar to feed on (i.e., cravings), a theory that would dovetail nicely with Atkins’s. Yeast, a living organism, also produces waste products and toxins, which can weaken the immune system and lead to food intolerances, another obstacle to weight loss. While the mechanisms are not completely understood, it’s a good bet that Atkins was right about the yeast connection. Fortunately, the Atkins diet—at least the induction phase—virtually eliminates all of yeast’s favorite foods, and the classic antiyeast diet looks a lot like Atkins’s induction.

Atkins identifies what he calls three levels of metabolic resistance: high, average, and low. How easily your body responds to carbohydrate restriction defines your level of metabolic resistance. He suspected that most people with a high level of metabolic resistance would wind up with a maintenance level of somewhere around 25 to 40 grams of carbs a day. Those with a low level of resistance would be in the 60-to-90-gram range, and regular exercisers would be at 90-plus grams of carbohydrate per day.

Atkins has been one of the most misunderstood diet authors and has been the target of more attacks than any other low-carb proponent, probably because his was the first and the most commercially successful of the plans and also, to the constant chagrin of the establishment, because he simply wouldn’t go away. While some of the larger criticisms of the Atkins diet are applicable to all low-carb diets and has been dealt with in depth in
chapter 6
, some are specific to Atkins and are briefly addressed here.

One of the sources of misinformation about Atkins came because many people confused the
induction
phase with the whole program. Atkins was very clear that induction was for a limited time only. A common criticism of Atkins is that he doesn’t allow you to eat vegetables and fruits. Actually, he said no such thing. Atkins was a nutritionist, and a very good one at that—he did not want you to miss the incredible nutritional benefits of the phytochemicals found in vegetables and fruits, which you add back to the program in the subsequent stages of his plan. He never said you couldn’t eat vegetables and fruits. He
did
say you couldn’t eat junk carbohydrates.

Another problem with the public’s (and the medical establishment’s) perception of Atkins’s program is that it was based solely on the first (1972) edition of his book. In that edition, where Atkins first put forth the radical proposition that cutting carbohydrates was the key to controlling insulin, he didn’t pay as much attention to what you were
allowed
to eat, concentrating instead on the foods you were
not
allowed. Atkins in 1972 was like the doorman at an exclusive club who is given the order “
don’t let in anyone wearing sneakers!
” and, as a result, is so focused on the ground that he doesn’t realize he is letting in all kinds of other riffraff that just happen to be wearing shoes. Atkins revised the book twice (in 1992 and 2002), and with each edition he became more outspoken about the need to emphasize omega-3 fats, eliminate trans-fats, and include plenty of vegetables and fiber in the diet. But he could never shake the 1972 image as the diet doc who lets you eat pork rinds and lard.