Atkins Nutritional Approach

(Redirected from Atkins Diet) Dr. Atkins' New Diet Revolution book

The Atkins Nutritional Approach, popularly known as the Atkins Diet or just Atkins, is a popular but controversial high-protein, high-fat, low-carbohydrate diet. It was popularized by Dr. Robert Atkins (1930-2003) in a series of books, starting with Dr. Atkins' Diet Revolution in 1972. It has been astonishingly popular in recent times because of his revised book, Dr. Atkins' New Diet Revolution, in which he updated some of his ideas but remained faithful to the original concepts.

Dr. Atkins argued that many eating disorders are the result of hyperinsulinism, or excessive secretion of insulin which comes through eating too many carbohydrates. According to Atkins, this causes food cravings and unstable blood sugar levels, which can cause mood swings, depression, and sleeping problems. Atkins claimed that his diet stabilizes insulin and blood sugar levels, eliminating cravings and often reducing appetite.

Atkins represents a radical departure from prevailing theories. He claimed there are two main unrecognised factors about Western eating habits, arguing firstly that the main cause of obesity is eating refined carbohydrates particularly sugar, flour, and high-fructose corn syrups; and secondly that saturated fat is overrated as a nutritional problem, only trans fats from sources such as hydrogenated oils need to be avoided. Consequently, Dr Atkins rejects the advice of the food pyramid, instead telling us the tremendous increase in refined carbohydrates is responsible for the rise in metabolic disorders of the 20th century, and the focus on the detrimental effects of dietary fat has actually contributed to the obesity problem by increasing the proportion of insulin inducing foods in the diet.

The Atkins Nutritional Approach seems to provoke extreme reactions, to the point where even just discussing it can be a problem. Dr. Samuel Klein, of the North American Association for the Study of Obesity, has reported encountering anger from academicians simply for daring to present data on the Atkins diet.

Nature of the diet

While most of the emphasis in Atkins is on the diet, nutritional supplements and exercise are considered equally important elements.

Atkins involves restriction of the intake of carbohydrates in order to switch the body's metabolism from burning glucose to burning fat (chiefly stored fat). This process (called lipolysis) begins when the body enters the state of ketosis as a consequence of running out of carbohydrates to burn. Although Atkins claimed that ketosis helped the body burn fat more easily, nutritionalists are quick to point out that the body will burn stored fat for energy whenever the calories taken in are less than those burned.

Atkins restricts "net carbs", or carbs that have an effect on blood sugar. Net carbohydrates can be calculated from a food source by subtracting sugar alcohols and fiber (which are shown to have no effect on blood sugar level) from total carbohydrates. Sugar alcohols need to be treated with caution, while they may be slower to convert to glucose they can be a significant source of glycemic load and can stall weight loss.

Preferred foods in all categories are whole, unprocessed foods with a low glycemic load.

There are four phases of the Atkins diet:

Induction

The Induction phase is the first, and most restrictive phase of the Atkins Nutritional Approach. It is intended to cause the body to quickly enter a state of ketosis. Carbohydrate intake is limited to 20 net grams per day. The allowed foods include a liberal amount of most meats, a good bit of cheese and cream, two cups of salad, and one cup of other vegetables. Caffeine and alcoholic beverages are not allowed.

The Induction Phase is usually when many see the most significant weight loss - reports of losses up to six or eight pounds (3 or 4 kg) per week are not uncommon.

Atkins suggests the use of KetoStix, small chemically reactive strips used by diabetics. These let the dieter monitor when they enter the ketosis, or fat burning, phase.

Ongoing Weight Loss

The Ongoing Weight Loss (OWL) phase of Atkins consists of an increase in carbohydrate intake, but remaining at levels where weight loss occurs. Carb intake increases by 5 grams of carbs per day each week. A goal in OWL is to find the "Critical Carbohydrate Level for Losing". The OWL phase lasts until weight is within 10 pounds (4.5 kg) of the target weight.

Pre-maintenance

Carbohydrate intake is increased again, and the key of goal in this phase is to find the "Critical Carbohydrate Level for Maintenance", this the maximum number of carbohydrates you can eat each day without gaining weight.

Lifetime maintenance

This phase is intended to carry on the habits acquired in the previous phases, and avoid the common end-of-diet mindset that can return people to their previous habits and previous weight. Whole, unprocessed food choices are emphasised, with the option to drop back to an earlier phase if you begin to gain weight.

Views in favor of the diet

When the Atkins diet was introduced in the 1970s, it was immediately attacked by existing experts, who claimed it was unhealthy and would fail. Those claims persist today, even though there are now studies indicating the contrary:

  • "The low-carbohydrate diet produced a greater weight loss...and greater improvement in some risk factors for coronary heart disease" --New England Journal Of Medicine, Volume 348:2082-2090, 22 May 2003, Number 21
  • "better participant retention and greater weight loss...greater decreases in serum triglyceride levels" --Annals Of Internal Medicine, 18 May 2004 | Volume 140 Issue 10 | Pages 769-777
  • "Diets high in fat do not appear to cause excess body fat, and reductions in fat will not be a solution." --American Journal Of Medicine, Volume 113, Issue 9, Supplement 2, 30 December 2002, Pages 47-59
  • "sustained weight loss" --American Journal of Medicine, Volume 113, Issue 1, July 2002, Pages 30-36
  • "When carbohydrates were restricted, study subjects spontaneously reduced their caloric intake to a level appropriate for their height, did not compensate by eating more protein or fat, and lost weight. We concluded that excessive overeating had been fueled by carbohydrates." "In addition to the calorie reduction and weight loss, subjects experienced markedly improved glucose levels and insulin sensitivity, as well as lower triglycerides and cholesterol." This is not a controlled study in that there was no control group; it merely observed the effect of putting ten obese diabetics on the Atkins diet; this is "the only study of the Atkins diet to have been conducted in the strictly controlled environment of a clinical research center where every calorie eaten and spent was measured." --Annals of Internal Medicine, 15 March 2005

It's important to note that many of these represent scientifically controlled studies, published in peer-reviewed journals. Proponents of the Atkins diet feel much of the criticism leveled at the diet comes from statements and opinions of individuals and associations, rather than from controlled and reviewed studies. Advocates of the diet dispute criticisms based on the fact that a low-carb diet is likely to be high-fat and allegations that fat, especially saturated fat, is harmful. Atkins backers maintain that, aside from trans fat, saturated fat is not harmful and is actually necessary in diet. Proponents cite Gary Taubes who, in a 2001 article in Science, 291 (5513): 2536, claims that the oft-cited "consensus" opinion against saturated fats derives from political rather than scientific motives.

The original recommendations for low-fat diets were based on the idea that, yes, the studies had not been done to prove fat harmful, but maybe it was harmful (for example, saturated fat in diet was associated in some studies with high cholesterol levels which was associated in some studies with heart disease), and allegedly there was no harm in reducing fat, therefore it should be reduced; millions of lives might be lost if we waited for scientific proof.

However, when fat is reduced in a diet, the practical consequence is that people will substitute carbohydrates. Carbohydrates, especially highly-processed, quickly-digested carbohydrates, cause a blood sugar spike, stimulating insulin production and all the consequences of that, quite possibly resulting in weight gain, which is itself a major cardiac risk factor. As was pointed out at the time the original low-fat recommendations were being worked out, shifting dietary composition toward carbohydrates and away from fat affects many different metabolic systems in the body; making such a shift without strong scientific evidence effectively subjected a whole population to an uncontrolled experiment; only now are the results of this experiment starting to be widely examined, and many are concluding that recommending low-fat diets was a very bad idea. It's not just the cardiologist, Dr. Atkins, but also renowned cardiologist Dr. Agatston ("South Beach Diet") and many others.

Critics of low-carb dieting may also fail to consider a simple fact of life: people are built differently. As with any diet, the Atkins may not be effective for some people. For some people, a low-fat diet may work as well as a low-carb diet, perhaps better. But for many people, it seems, a low-carb diet may be more effective, and there is accumulating research confirming this.

Opponents of the Atkins diet tend to claim that weight is regained when dieting stops. However, this is true of all diets, not just low-carb diets. It is unfair to single out the Atkins or any low-carb diet for this factor. The crucial issue is the sustainability of the diet in its Maintenance phase. In the context of widespread propaganda against fat, many people, even those who try the Atkins diet or other low-carb diet, try to make it low-fat, which apparently does not work. The fat is a crucial part of Atkins, for fat is satisfying, it sates.

For years, opponents of the Atkins diet claimed that (1) it would not work, it was preposterous, eating all that fat would make people fat, and (2) it would seriously increase cardiac risk. Yet, when studies are finally done to see what low-carb/high-fat diets actually do, they are at worst as effective as the recommended low-fat diets, and they do not, in fact, increase cardiac risk factors; indeed, overall, they lower them. So then the critics defend their low-fat position by noting, correctly, that the new studies were small. Yet the studies on which the low-fat gospel was based were also small, and less definitive. In the end, no study has shown that cardiac disease has been reduced by promoting low-fat diets, and there is evidence to the contrary.

Criticism of the diet often focuses on the safety of inducing ketosis, which is one of the body's natural processes for the metabolism of body fat often during sleep. It is biologically natural to burn fat - that's why we store it. Ketosis should not be confused with ketoacidosis, a serious medical condition seen in diabetics and alcoholics.

Low-fat diets are not automatically healthy ones. Traditional, high-fat French cooking has led to a much lower incidence of obesity, morbid obesity and chronic heart disease than in the high-sugar American diet, despite overall energy intake and exercise levels being the same.

The 22 May 2003, issue of the New England Journal of Medicine published two scientific, randomized studies comparing standard low-fat diets to low-carbohydrate diets such as the Atkins Diet. In both studies, subjects lost more weight on the low-carbohydrate plans.

A research study carried out by the Weight and Eating Disorders Program at the University of Pennsylvania, reported in May 2003 that the Atkins diet raised levels of HDL (or "good") cholesterol by an average of 11% and reduced the amount of triglycerides in the bloodstream by 17%. This counters one of the chief criticisms of Atkins' approach, which is that cholesterol is raised by eating fatty foods and meat.

In the study, conventional dieters' HDL cholesterol raised by only 1.6% while their triglyceride levels did not improve significantly. Weight loss was also statistically greater in the Atkins dieters after three and six months compared with the conventional dieters (although this did not remain statistically significant after a year). The study followed the diets of 63 obese men and women. (See New Scientist, 21 May 2003.)

Views critical of the diet

Low-carbohydrate diets have been the subject of heated debate in medical circles for three decades [1] (http://www.lowcarb.ca/). They are still controversial and only recently has any serious research supported some aspects of Atkins' claims, especially for short-term weight-loss (6 months or less).

But many in the scientific community also raise serious concerns:

  • The National Weight Control Registry, funded by the National Institutes of Health (NIH) tracked the habits of successful dieters over a longer term, 10 years. Despite this diet's overwhelming popularity compared to other diets, of the 5,000 Americans confirmed to have lost an average of 70 pounds (32 kg) and able to prove they have kept it off for at least 6 years of the decade of NIH’s data-keeping, less than 1% were confirmed to be Atkins adherents.
  • Even in studies only one year long, this diet can fail to produce the greater weight-loss which is claimed to come from factors other than calorie-reduction such as ketosis: It was compared to dieters on Dean Ornish’s diet, Weight Watchers, and The Zone Diet for 1 year. The Atkins Diet came last in terms of weight lost at the end of the year. (Dansinger, M.L., Gleason, J. L., Griffith, J.L., et al., "One Year Effectiveness of the Atkins, Ornish, Weight Watchers, and Zone Diets in Decreasing Body Weight and Heart Disease Risk", Presented at the American Heart Association Scientific Sessions 12 November 2003 in Orlando, Florida.)
  • The May 2004 Annals of Internal Medicine study showed that Atkins Dieters had significantly more diarrhea, general weakness, rashes and muscle cramps. Atkins.com now suggests a fiber supplement.
  • Also, acidity from the typically high protein intake can cause osteoporosis (Feskanich D, Willett WC, Stampfer MJ, Colditz GA. Milk, dietary calcium, and bone fractures in women: a 12-year prospective study. Amer Jrnl Public Health 1997;87:992-7. See also follow-up in February, 2003 issue of the American Journal of Clinical Nutrition (Vol. 77, No. 2, 504-511); this includes 72,000+ people and 18 years of data. Cumming RG, Klineberg RJ. Case-control study of risk factors for hip fractures in the elderly. Amer Jrnl Epidemiology 1994;139:493-503.

With its emphasis on fatty foods, the Atkins diet has generally been considered by most medical and nutritional experts to be unsound. It also violates the food pyramid, which states that amounts of carbohydrates, protein and fats (in that order) must be regularly consumed to stay healthy. Some experts have even suggested Atkins' plan is quackery. Among those criticizing the healthiness of his diet, if not also skeptical of the claims of greater weight-loss than other, safer diets, are such reputable organizations as:

a. “...the Atkins diet, as recommended, poses a serious threat to health.” --Chair of the American Medical Association's Council on Food and Nutrition, testimony to Congress

b. "unhealthy and can be dangerous." --C. Everett Koop (Shape Up America! news release, 29 December 2003)

c. "a nightmare of a diet." --Journal of the American Dietetic Association 102 (2002): p.260

d. Also condemned by National Institutes of Health in NIH Publ. No. 94-3700, 1993.

e. Condemned by ACS in American Cancer Society; Weighing In on Low Carb Diets, 2004.

f. Condemned by the American Kidney Fund in American Kidney Fund news release, 25 April 2002.

g. Condemned by American Heart Association in Circulation 104 (2001): p.1869.

h. Condemned by Johns Hopkins in Diabetes 2004. Johns Hopkins University White Paper, 2004

i. Condemned by the American College of Sports Medicine in Medicine and Science in Sports and Exercise 33 (2001): p.2145.

j. Expressing a general sentiment was the conclusion: “runs counter to all the current evidence-based dietary recommendations.” --Journal of the American College of Cardiology 43 (2004): p.725

Opponents of the diet also point out that the initial weight loss upon starting the diet is a phenomenon common with most diets, and is due to reduction in stored glycogen and related water in muscles, not fat loss. They claim that no evidence has surfaced that any diet will cause weight loss unless it reduces food energy below the maintenance level, and reports have indicated that successful weight loss due to the Atkins diet may be the result of less food energy being consumed by the dieter, rather than the lack of carbohydrates. [2] (http://news.bbc.co.uk/1/hi/health/3416637.stm) They further point out that weight loss on fad diets, which typically restrict or prohibit certain foods, is often due to the fact that the dieter has less food choices available. Also, a diet of low-carb foods may quickly become dull to many people, meaning that their appetite is somewhat naturally suppressed as they become hungry for carbs, but the dieter either has none handy or resists this hunger.

There is also bad breath and fatigue, it is claimed: [3] (http://content.health.msn.com/content/article/87/99349.htm?GT1=3391), [4] (http://www.ext.colostate.edu/pubs/columnnn/nn000905.html), and Cleveland Clinic Journal of Medicine 68(2001): p.761

On May 27, 2004, Jody Gorran, a 53-year-old Florida businessman with a family history of heart disease, filed a lawsuit against Atkins Nutritionals, Inc. and the estate of Dr. Robert Atkins, claiming that the Atkins diet regimen caused severe heart disease, making it necessary for him to undergo angioplasty. As of 28 May, he has been seeking a court injunction banning Atkins Nutritionals from marketing its products without a warning of potential health risks, and asking for compensatory damages.

Dr. Robert Eckel of the American Heart Association says that high-protein, low-carbohydrate diets put people at risk for heart disease. [5] (http://www.lowcarb.ca/articlesb/article332.html)

Misconceptions about the diet

Many people incorrectly believe that the Atkins Diet promotes eating unlimited amounts of fatty meats and cheeses. In fact, while certain foods are allowed in unlimited quantities (i.e., are limited only by appetite), the Atkins Diet is very specific in recommending lean meats, such as seafood and poultry. This is a key point of clarification that Dr. Atkins addressed in the more recent revisions of his book.

Some criticism of the diet seems to be based on a confusion between ketosis and ketoacidosis. Ketosis is short for Benign Dietary Ketosis, which is a normal metabolic process that results when glucose is not available as a source of energy. The body then burns mostly fat, both directly and through conversion to ketones which make the energy of fat available in water soluble form. Ketoacidosis is a metabolic crisis due to the inability to utilize glucose because of a lack of insulin and in which there is an abnormal accumulation of ketones exacerbated by severe dehydration as the kidneys spill the useless glucose, losing water in the process. This occurs in diabetics and in a related form in alcoholics.

Another common misconception arises from confusion between the Induction Phase and rest of the diet. The first two weeks of the Atkins Diet are strict, with only 20g of carbohydrates permitted per day. The plan is clear that dieters should not ordinarily continue past the 2-week Induction Phase without slowly raising their daily carbohydrate count. Once the weight-loss goal is reached, carbohydrate levels are raised even further, though still significantly below USDA norms, and still within the definition of ketosis.

Reference

  • New England Journal of Medicine: (vol 348, p 2082) (http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=12761365)

Related topics

  • Diet
  • Dieting

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published 1999. There are 24 Indiana state parks, nine man-made reservoirs and hundreds of lakes in the state. Once the weight-loss goal is reached, carbohydrate levels are raised even further, though still significantly below USDA norms, and still within the definition of ketosis. Many other astronauts, including Neil Armstrong and Gene Cernan, were graduates of Purdue University in West Lafayette ([1] (http://www2.indystar.com/library/factfiles/history/space_program/hoosier_astronauts.html)). Neil Armstrong's Purdue class ring may be the only such object that has ever traveled to the moon and back. The plan is clear that dieters should not ordinarily continue past the 2-week Induction Phase without slowly raising their daily carbohydrate count. Indiana is the home state of a disproportionately large number of Astronauts, including such notables as "Gus" Grissom, and Frank Borman. The first two weeks of the Atkins Diet are strict, with only 20g of carbohydrates permitted per day. Counties would remain under their current time zones, but the bill also asks the federal Department of Transportation, which has jurisdiction over time zones, to reconsider whether more counties should switch to the Central zone.

Another common misconception arises from confusion between the Induction Phase and rest of the diet. On April 28, 2005, the state legislature voted 51-46 for the entire state to observe daylight saving time starting April, 2006. This occurs in diabetics and in a related form in alcoholics. More recently, support has begun to grow for returning Indiana to the Central time zone with Central time zone DST, but this has not been popular enough to implement. Ketoacidosis is a metabolic crisis due to the inability to utilize glucose because of a lack of insulin and in which there is an abnormal accumulation of ketones exacerbated by severe dehydration as the kidneys spill the useless glucose, losing water in the process. In the past several years, there have been attempts to place the entirety of Indiana in the Eastern time zone, with Eastern DST, but these have proved impossible to implement. Ketosis is short for Benign Dietary Ketosis, which is a normal metabolic process that results when glucose is not available as a source of energy. The body then burns mostly fat, both directly and through conversion to ketones which make the energy of fat available in water soluble form. Eventually, a long-fought battle in the Indiana state legislature led to the current compromise.

Some criticism of the diet seems to be based on a confusion between ketosis and ketoacidosis. However, many parts of the state stayed on Central DST the entire year. Atkins addressed in the more recent revisions of his book. When DST was formally adopted, Indiana was in the Central time zone. This is a key point of clarification that Dr. The history of this unique arrangement is fairly convoluted. In fact, while certain foods are allowed in unlimited quantities (i.e., are limited only by appetite), the Atkins Diet is very specific in recommending lean meats, such as seafood and poultry. Several counties in the northwestern corner of Indiana, near Chicago, and several counties in the southwestern corner of Indiana are in the Central time zone and remain subject to daylight saving time.

Many people incorrectly believe that the Atkins Diet promotes eating unlimited amounts of fatty meats and cheeses. The area that is within the Eastern time zone is legally exempt from daylight saving time; some counties within this area, particularly Floyd, Clark, and Harrison counties near Louisville, Kentucky, and Ohio and Dearborn counties near Cincinnati, Ohio, observe daylight saving time unofficially and illegally by local custom. [5] (http://www.lowcarb.ca/articlesb/article332.html). Most of Indiana has historically exempted itself from the observation of daylight saving time (DST). Robert Eckel of the American Heart Association says that high-protein, low-carbohydrate diets put people at risk for heart disease. The three largest Protestant denominations in Indiana are: Baptist (17% of the total state population), Methodist (10%), Lutheran (5%). Dr. Indiana's percentage composition by religious affiliation is as follows:.

As of 28 May, he has been seeking a court injunction banning Atkins Nutritionals from marketing its products without a warning of potential health risks, and asking for compensatory damages. Indiana is home to a significant proportion of Mennonite and Amish Christians. Robert Atkins, claiming that the Atkins diet regimen caused severe heart disease, making it necessary for him to undergo angioplasty. The Catholic presence is perhaps better known than its size would imply due to the existence of the University of Notre Dame in the state. and the estate of Dr. Religiously, Indiana is predominantly Protestant, although there is also a moderate-sized Roman Catholic population. On May 27, 2004, Jody Gorran, a 53-year-old Florida businessman with a family history of heart disease, filed a lawsuit against Atkins Nutritionals, Inc. The five largest ancestries in the state are: German (22.7%), American (12%), Irish (10.8%), English (8.9%), African American (8.4%).

There is also bad breath and fatigue, it is claimed: [3] (http://content.health.msn.com/content/article/87/99349.htm?GT1=3391), [4] (http://www.ext.colostate.edu/pubs/columnnn/nn000905.html), and Cleveland Clinic Journal of Medicine 68(2001): p.761. Racially, the state is:. Also, a diet of low-carb foods may quickly become dull to many people, meaning that their appetite is somewhat naturally suppressed as they become hungry for carbs, but the dieter either has none handy or resists this hunger. Its largest city and capital is Indianapolis, where the nation's most famous auto race, the Indianapolis 500, is held each year. [2] (http://news.bbc.co.uk/1/hi/health/3416637.stm) They further point out that weight loss on fad diets, which typically restrict or prohibit certain foods, is often due to the fact that the dieter has less food choices available. Indiana is a state of mostly small towns and midsize cities. They claim that no evidence has surfaced that any diet will cause weight loss unless it reduces food energy below the maintenance level, and reports have indicated that successful weight loss due to the Atkins diet may be the result of less food energy being consumed by the dieter, rather than the lack of carbohydrates. As of 2003, the population of Indiana was 6,195,643.

Opponents of the diet also point out that the initial weight loss upon starting the diet is a phenomenon common with most diets, and is due to reduction in stored glycogen and related water in muscles, not fat loss. Like most Great Lakes states Indiana has small to medium operating petroleum fields; the principal location of these today is in extreme southwest Indiana in an area somewhat confusingly called the " Illinois Field"". Expressing a general sentiment was the conclusion: “runs counter to all the current evidence-based dietary recommendations.” --Journal of the American College of Cardiology 43 (2004): p.725. One of the many public buildings faced with this stone is The Pentagon, and after the attack of September 11, 2001, a special effort was made by the mining industry of Indiana to replace those damaged walls with as nearly identical type and cut of material as the original facing. There are also large coal mines in the southern portion of the state. j. In mining Indiana is probably best known for its decorative limestone fron the southern, hilly portion of the state. Condemned by the American College of Sports Medicine in Medicine and Science in Sports and Exercise 33 (2001): p.2145. ( Source for basic manufacturing facts in the above two paragraphs is generally McCoy and McNamara, "Manufacturers in Indiana", Purdue University Center for Rural Development, Research Paper 19, July 1998 ).

i. In other words, firms often see in Indiana a chance to obtain higher than average skills at lower than average wages for those skills, which often makes location in the state desirable. Johns Hopkins University White Paper, 2004. This makes it possible for firms to offer, and labor accept, somewhat lower wages for these skills than would normally be paid. Condemned by Johns Hopkins in Diabetes 2004. Second, Indiana's labor force is located primarily in medium-sized and smaller cities rather than in very large and expensive metropolises. h. First, much of the heavy manufacturing, such as industrial machinery and steel, requires highly skilled labor, and firms are often willing to locate where hard-to-train skills already exist.

Condemned by American Heart Association in Circulation 104 (2001): p.1869. The explanation appears to be certain factors in the labor market. g. However, Indiana has been much less hit by declines in traditional Rust Belt manufactures than many of its neighbors. Condemned by the American Kidney Fund in American Kidney Fund news release, 25 April 2002. Like most interior states, Indiana is poorly located with respect to emerging coastal markets and new overseas sources of raw materials for manufacturing. f. Surprisingly, in view of the large agricultural sector, comparatively little food processing occurs in the state.

Condemned by ACS in American Cancer Society; Weighing In on Low Carb Diets, 2004. In addition, Indiana has the international headquarters of the Eli Lilly and the US headquarters of the Roche pharmaceutical companies. e. Indiana's other manufactures include electrical equipment, transportation equipment, chemical products, rubber, petroleum and coal products, and factory machinery. 94-3700, 1993. The Calumet region of northwest Indiana is the largest steel producing area in the USA, and this activity also requires that very large amounts of electric power be generated. No. In the state industry tends to be concentrated in its northern half.

Also condemned by National Institutes of Health in NIH Publ. A high percentage of Indiana's GDP comes from manufacturing, and much of this activity is heavy manufacturing. d. Many isolated parcels of woodland remain, and much of the southern, hilly portion is heavily forested ( a condition which supports a local furniture-making sector in that part of the state). "a nightmare of a diet." --Journal of the American Dietetic Association 102 (2002): p.260. It should be remembered that while the state is in the Corn Belt, the original land was not prairie and had to be cleared of deciduous trees. c. Specialty crops include melons ( southern Wabash Valley), tomatoes (concentrated in central Indiana), grapes, and mint ( Source: USDA crop profiles).

Everett Koop (Shape Up America! news release, 29 December 2003). The state's nearness to large urban centers, such as Chicago also assures that much dairying, egg production, and specialty horticulture occur. "unhealthy and can be dangerous." --C. Soybeans are also a major cash crop. b. Indiana is located well within the Corn Belt, and the state's agricultural methods and principal farm outputs reflect this: a feedlot-style system raising corn, to fatten hogs and cattle. “...the Atkins diet, as recommended, poses a serious threat to health.” --Chair of the American Medical Association's Council on Food and Nutrition, testimony to Congress. Indiana's Per Capita Income was $28,783 as of 2003.

a. The total gross state product in 2003 was $214 billion. Among those criticizing the healthiness of his diet, if not also skeptical of the claims of greater weight-loss than other, safer diets, are such reputable organizations as:. See also: List of Indiana counties, Watersheds of Indiana. Some experts have even suggested Atkins' plan is quackery. The 475 mile long Wabash River bisects the state from northeast to southwest and has given Indiana two themesongs, the state song On the Banks of the Wabash as well as The Wabash Cannonball. It also violates the food pyramid, which states that amounts of carbohydrates, protein and fats (in that order) must be regularly consumed to stay healthy. Indiana is one of the Great Lakes states.

With its emphasis on fatty foods, the Atkins diet has generally been considered by most medical and nutritional experts to be unsound. Indiana is bounded on the north by Lake Michigan and the state of Michigan, on the east by Ohio, on the south by Kentucky with which it shares the Ohio River as a border, and on the west by Illinois. But many in the scientific community also raise serious concerns:. See: List of Indiana Governors, Indiana General Assembly. They are still controversial and only recently has any serious research supported some aspects of Atkins' claims, especially for short-term weight-loss (6 months or less). Lugar (Republican). Low-carbohydrate diets have been the subject of heated debate in medical circles for three decades [1] (http://www.lowcarb.ca/). Evans "Evan" Bayh III (Democrat) and Richard G.

(See New Scientist, 21 May 2003.). senators are B. The study followed the diets of 63 obese men and women. The state's U.S. Weight loss was also statistically greater in the Atkins dieters after three and six months compared with the conventional dieters (although this did not remain statistically significant after a year). The current governor of Indiana is Mitch Daniels, whose campaign slogan was "My Man Mitch," elected on November 2, 2004. In the study, conventional dieters' HDL cholesterol raised by only 1.6% while their triglyceride levels did not improve significantly. The area was claimed for New France in the 17th century, handed over to the Kingdom of Great Britain as part of the settlement at the end of the French and Indian War, given to the United States after the American Revolution, soon after which it became part of the Northwest Territory, then the Indiana Territory, and joined the Union in 1816 as the 19th state.

This counters one of the chief criticisms of Atkins' approach, which is that cholesterol is raised by eating fatty foods and meat. The specific Native American tribes that inhabited this territory at that time were primarily the Miami and the Shawnee. A research study carried out by the Weight and Eating Disorders Program at the University of Pennsylvania, reported in May 2003 that the Atkins diet raised levels of HDL (or "good") cholesterol by an average of 11% and reduced the amount of triglycerides in the bloodstream by 17%. 100-400CE). It was part of the Mississippian culture from roughly 1000CE up to the conventional end of Mississippian dating ("contact with Europeans"). In both studies, subjects lost more weight on the low-carbohydrate plans. The area of Indiana has been settled since before the development of the Hopewell culture (ca. The 22 May 2003, issue of the New England Journal of Medicine published two scientific, randomized studies comparing standard low-fat diets to low-carbohydrate diets such as the Atkins Diet. USS Indiana was named in honor of this state.

Traditional, high-fat French cooking has led to a much lower incidence of obesity, morbid obesity and chronic heart disease than in the high-sugar American diet, despite overall energy intake and exercise levels being the same. A resident of Indiana is called a Hoosier and it is also the mascot for Indiana University, located in Bloomington, in southern Indiana. Low-fat diets are not automatically healthy ones. postal abbreviation for the state is IN. Ketosis should not be confused with ketoacidosis, a serious medical condition seen in diabetics and alcoholics. The U.S. It is biologically natural to burn fat - that's why we store it. Its capital is Indianapolis.

Criticism of the diet often focuses on the safety of inducing ketosis, which is one of the body's natural processes for the metabolism of body fat often during sleep. Indiana, meaning the "Land of the Indians", is a state of the United States. In the end, no study has shown that cardiac disease has been reduced by promoting low-fat diets, and there is evidence to the contrary. State tree: Tulip tree. Yet the studies on which the low-fat gospel was based were also small, and less definitive. State stone: Salem limestone. So then the critics defend their low-fat position by noting, correctly, that the new studies were small. State river: Wabash.

Yet, when studies are finally done to see what low-carb/high-fat diets actually do, they are at worst as effective as the recommended low-fat diets, and they do not, in fact, increase cardiac risk factors; indeed, overall, they lower them. State poem: Indiana (http://www.in.gov/sic/about/emblems/state_poem.html), by Arthur Franklin Mapes. For years, opponents of the Atkins diet claimed that (1) it would not work, it was preposterous, eating all that fat would make people fat, and (2) it would seriously increase cardiac risk. State motto: "The Crossroads of America". The fat is a crucial part of Atkins, for fat is satisfying, it sates. State flower: Peony. In the context of widespread propaganda against fat, many people, even those who try the Atkins diet or other low-carb diet, try to make it low-fat, which apparently does not work. State bird: Cardinal.

The crucial issue is the sustainability of the diet in its Maintenance phase. Non-Religious – 8%. It is unfair to single out the Atkins or any low-carb diet for this factor. Other Religions – 1%. However, this is true of all diets, not just low-carb diets. Other Christian – 1%. Opponents of the Atkins diet tend to claim that weight is regained when dieting stops. Roman Catholic – 20%.

But for many people, it seems, a low-carb diet may be more effective, and there is accumulating research confirming this. Protestant – 67%. For some people, a low-fat diet may work as well as a low-carb diet, perhaps better. 1.2% Mixed race. As with any diet, the Atkins may not be effective for some people. 0.3% American Indian. Critics of low-carb dieting may also fail to consider a simple fact of life: people are built differently. 1% Asian.

Agatston ("South Beach Diet") and many others. 3.5% Hispanic. Atkins, but also renowned cardiologist Dr. 8.4% Black. It's not just the cardiologist, Dr. 85.8% White. As was pointed out at the time the original low-fat recommendations were being worked out, shifting dietary composition toward carbohydrates and away from fat affects many different metabolic systems in the body; making such a shift without strong scientific evidence effectively subjected a whole population to an uncontrolled experiment; only now are the results of this experiment starting to be widely examined, and many are concluding that recommending low-fat diets was a very bad idea.

Carbohydrates, especially highly-processed, quickly-digested carbohydrates, cause a blood sugar spike, stimulating insulin production and all the consequences of that, quite possibly resulting in weight gain, which is itself a major cardiac risk factor. However, when fat is reduced in a diet, the practical consequence is that people will substitute carbohydrates. The original recommendations for low-fat diets were based on the idea that, yes, the studies had not been done to prove fat harmful, but maybe it was harmful (for example, saturated fat in diet was associated in some studies with high cholesterol levels which was associated in some studies with heart disease), and allegedly there was no harm in reducing fat, therefore it should be reduced; millions of lives might be lost if we waited for scientific proof. Proponents cite Gary Taubes who, in a 2001 article in Science, 291 (5513): 2536, claims that the oft-cited "consensus" opinion against saturated fats derives from political rather than scientific motives.

Atkins backers maintain that, aside from trans fat, saturated fat is not harmful and is actually necessary in diet. Advocates of the diet dispute criticisms based on the fact that a low-carb diet is likely to be high-fat and allegations that fat, especially saturated fat, is harmful. It's important to note that many of these represent scientifically controlled studies, published in peer-reviewed journals. Proponents of the Atkins diet feel much of the criticism leveled at the diet comes from statements and opinions of individuals and associations, rather than from controlled and reviewed studies. Those claims persist today, even though there are now studies indicating the contrary:.

When the Atkins diet was introduced in the 1970s, it was immediately attacked by existing experts, who claimed it was unhealthy and would fail. Whole, unprocessed food choices are emphasised, with the option to drop back to an earlier phase if you begin to gain weight. This phase is intended to carry on the habits acquired in the previous phases, and avoid the common end-of-diet mindset that can return people to their previous habits and previous weight. Carbohydrate intake is increased again, and the key of goal in this phase is to find the "Critical Carbohydrate Level for Maintenance", this the maximum number of carbohydrates you can eat each day without gaining weight.

The OWL phase lasts until weight is within 10 pounds (4.5 kg) of the target weight. A goal in OWL is to find the "Critical Carbohydrate Level for Losing". Carb intake increases by 5 grams of carbs per day each week. The Ongoing Weight Loss (OWL) phase of Atkins consists of an increase in carbohydrate intake, but remaining at levels where weight loss occurs.

These let the dieter monitor when they enter the ketosis, or fat burning, phase. Atkins suggests the use of KetoStix, small chemically reactive strips used by diabetics. The Induction Phase is usually when many see the most significant weight loss - reports of losses up to six or eight pounds (3 or 4 kg) per week are not uncommon. Caffeine and alcoholic beverages are not allowed.

The allowed foods include a liberal amount of most meats, a good bit of cheese and cream, two cups of salad, and one cup of other vegetables. Carbohydrate intake is limited to 20 net grams per day. It is intended to cause the body to quickly enter a state of ketosis. The Induction phase is the first, and most restrictive phase of the Atkins Nutritional Approach.

There are four phases of the Atkins diet:. Preferred foods in all categories are whole, unprocessed foods with a low glycemic load. Sugar alcohols need to be treated with caution, while they may be slower to convert to glucose they can be a significant source of glycemic load and can stall weight loss. Atkins restricts "net carbs", or carbs that have an effect on blood sugar. Net carbohydrates can be calculated from a food source by subtracting sugar alcohols and fiber (which are shown to have no effect on blood sugar level) from total carbohydrates.

Although Atkins claimed that ketosis helped the body burn fat more easily, nutritionalists are quick to point out that the body will burn stored fat for energy whenever the calories taken in are less than those burned. This process (called lipolysis) begins when the body enters the state of ketosis as a consequence of running out of carbohydrates to burn. Atkins involves restriction of the intake of carbohydrates in order to switch the body's metabolism from burning glucose to burning fat (chiefly stored fat). While most of the emphasis in Atkins is on the diet, nutritional supplements and exercise are considered equally important elements.

Samuel Klein, of the North American Association for the Study of Obesity, has reported encountering anger from academicians simply for daring to present data on the Atkins diet. Dr. The Atkins Nutritional Approach seems to provoke extreme reactions, to the point where even just discussing it can be a problem. Consequently, Dr Atkins rejects the advice of the food pyramid, instead telling us the tremendous increase in refined carbohydrates is responsible for the rise in metabolic disorders of the 20th century, and the focus on the detrimental effects of dietary fat has actually contributed to the obesity problem by increasing the proportion of insulin inducing foods in the diet.

He claimed there are two main unrecognised factors about Western eating habits, arguing firstly that the main cause of obesity is eating refined carbohydrates particularly sugar, flour, and high-fructose corn syrups; and secondly that saturated fat is overrated as a nutritional problem, only trans fats from sources such as hydrogenated oils need to be avoided. Atkins represents a radical departure from prevailing theories. Atkins claimed that his diet stabilizes insulin and blood sugar levels, eliminating cravings and often reducing appetite. According to Atkins, this causes food cravings and unstable blood sugar levels, which can cause mood swings, depression, and sleeping problems.

Atkins argued that many eating disorders are the result of hyperinsulinism, or excessive secretion of insulin which comes through eating too many carbohydrates. Dr. Atkins' New Diet Revolution, in which he updated some of his ideas but remained faithful to the original concepts. It has been astonishingly popular in recent times because of his revised book, Dr.

Atkins' Diet Revolution in 1972. Robert Atkins (1930-2003) in a series of books, starting with Dr. It was popularized by Dr. The Atkins Nutritional Approach, popularly known as the Atkins Diet or just Atkins, is a popular but controversial high-protein, high-fat, low-carbohydrate diet.

Dieting. Diet. New England Journal of Medicine: (vol 348, p 2082) (http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=12761365). Amer Jrnl Epidemiology 1994;139:493-503.

Case-control study of risk factors for hip fractures in the elderly. Cumming RG, Klineberg RJ. 2, 504-511); this includes 72,000+ people and 18 years of data. 77, No.

See also follow-up in February, 2003 issue of the American Journal of Clinical Nutrition (Vol. Amer Jrnl Public Health 1997;87:992-7. Milk, dietary calcium, and bone fractures in women: a 12-year prospective study. Also, acidity from the typically high protein intake can cause osteoporosis (Feskanich D, Willett WC, Stampfer MJ, Colditz GA.

Atkins.com now suggests a fiber supplement. The May 2004 Annals of Internal Medicine study showed that Atkins Dieters had significantly more diarrhea, general weakness, rashes and muscle cramps. L., Griffith, J.L., et al., "One Year Effectiveness of the Atkins, Ornish, Weight Watchers, and Zone Diets in Decreasing Body Weight and Heart Disease Risk", Presented at the American Heart Association Scientific Sessions 12 November 2003 in Orlando, Florida.). (Dansinger, M.L., Gleason, J.

The Atkins Diet came last in terms of weight lost at the end of the year. Even in studies only one year long, this diet can fail to produce the greater weight-loss which is claimed to come from factors other than calorie-reduction such as ketosis: It was compared to dieters on Dean Ornish’s diet, Weight Watchers, and The Zone Diet for 1 year. Despite this diet's overwhelming popularity compared to other diets, of the 5,000 Americans confirmed to have lost an average of 70 pounds (32 kg) and able to prove they have kept it off for at least 6 years of the decade of NIH’s data-keeping, less than 1% were confirmed to be Atkins adherents. The National Weight Control Registry, funded by the National Institutes of Health (NIH) tracked the habits of successful dieters over a longer term, 10 years.

We concluded that excessive overeating had been fueled by carbohydrates." "In addition to the calorie reduction and weight loss, subjects experienced markedly improved glucose levels and insulin sensitivity, as well as lower triglycerides and cholesterol." This is not a controlled study in that there was no control group; it merely observed the effect of putting ten obese diabetics on the Atkins diet; this is "the only study of the Atkins diet to have been conducted in the strictly controlled environment of a clinical research center where every calorie eaten and spent was measured." --Annals of Internal Medicine, 15 March 2005. "When carbohydrates were restricted, study subjects spontaneously reduced their caloric intake to a level appropriate for their height, did not compensate by eating more protein or fat, and lost weight. "sustained weight loss" --American Journal of Medicine, Volume 113, Issue 1, July 2002, Pages 30-36. "Diets high in fat do not appear to cause excess body fat, and reductions in fat will not be a solution." --American Journal Of Medicine, Volume 113, Issue 9, Supplement 2, 30 December 2002, Pages 47-59.

"better participant retention and greater weight loss...greater decreases in serum triglyceride levels" --Annals Of Internal Medicine, 18 May 2004 | Volume 140 Issue 10 | Pages 769-777. "The low-carbohydrate diet produced a greater weight loss...and greater improvement in some risk factors for coronary heart disease" --New England Journal Of Medicine, Volume 348:2082-2090, 22 May 2003, Number 21.

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