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Living with Diabetes

The Atkins Diet

What is the Atkins diet?

CartoonThe ‘Atkins diet’ is a low carbohydrate diet, which was suggested by Dr Atkins as a means of promoting weight loss. He suggested that weight loss through dieting can be optimised not only by decreasing caloric intake, but also by manipulating the body’s metabolism.

What is the basis for this diet?

The basis of low carbohydrate diets stems from the idea that foods which contain carbohydrates, (e.g. rice, bread, pasta, sugar) promote insulin secretion and hence energy storage and the storage of fat. Conversely, low carbohydrate diets avoid high insulin levels and encourage the body to burn fat stores.

What does the diet involve?

The Atkins diet is divided into three phases.

Phase I – Carbohydrate is restricted to less than 20 g per day (about one banana). They are allowed to eat fats, meats, eggs and small amounts of salad. All carbohydrate containing food including fruit and milk, should be avoided. Vitamin supplements are encouraged.

Phase II – Slightly more carbohydrate is permitted to encourage a gradual ongoing weight loss.

Phase III – When the ideal weight is achieved, carbohydrate intake can be increased until the weight stabilises. Ideally, this should not exceed 90 g per day.

Does it work?

Many people claim to have dramatic weight loss on the Atkins diet. Formal studies comparing it to more traditional diets are limited. Two research papers published in the New England Journal of Medicine (2003) suggested that very obese people on the Atkins diet did indeed lose more weight over a six month period than those on a conventional diet. However, the differences were only a matter of several pounds and we do not know whether these benefits were sustained.

Are there any concerns about the Atkins diet?

The Atkins diet is very controversial. It flies in the face of established views, which consider that a healthy diet should consist of about one third fruit and vegetables (five portions a day), one third carbohydrates (bread, cereals, rice, pasta, potatoes), one sixth meats and fish and one sixth milk and dairy products.

Many dieticians are concerned that low carbohydrate diets are too restrictive and that these diets place people at risk of vitamin deficiencies as well as heart disease due to the high content of fat.

Recently there have been multiple health scares about the Atkins diet with reports of dangerously low blood minerals and irregular heart rhythms occurring in those on the diet. Again, these reports are anecdotal only – there are plenty of people on the Atkins diet who have not had these problems. Until there is more formal research, it would be impossible to know if such health problems are made more common by the diet, or if the case reports are just coincidental.

People on low carbohydrate diets have to breakdown protein and fat in order to supply the body’s requirements of glucose. Productions of ketones occurs as a result.

The Atkins diet and diabetes

There are two types of diabetes. People who have type 1 diabetes produce no insulin themselves. They depend on regular injections to provide their bodies with insulin. A low carbohydrate diet would influence the amount of insulin required and make control of blood sugar levels more difficult.

Individuals with Type 2 diabetes produce some insulin themselves. However they make inadequate amounts or are resistant to it’s action. There is good evidence that weight loss can increase this group of patients’ sensitivity to insulin and help to improve control of their blood sugars. Some suggest that the Atkins diet may also help to increase this sensitivity more that other traditional diets.

Irrespective of the type of diet used, achieving ideal body weight is likely to help people with diabetes to achieve good control.

So, should I go on the Atkins diet?

This ultimately comes down to a matter of your own choice. There is no good evidence either way for the long- term effects of the Atkins diet.

It is probably not advisable for diabetic patients on insulin therapy to try the Atkins diet. The low carbohydrate content would make their blood sugars harder to control and predispose to hypoglycaemia. Reducing insulin doses as a result may lead to diabetic ketoacidosis.

It is true that weight loss can help type 2 patients control their blood sugars with diet or tablet therapy. It may be argued that the Atkins diet has a role here.

Very little research has been done on the long term effects of the Atkins diet and until this is available it is impossible to predict the occurrence of long term side effects. It is also not know whether this diet has any advantage over conventional diets.  Many would argue that there is good evidence for the currently recommended ‘healthy diet and that this is what should be recommended while we are waiting for further evidence.

 

Dr Stephen Wallis
West Suffolk Diabetes Service
September 2003