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The Atkins Nutritional Approach™ (ANA) Colette Heimowitz, MS VP, Education, Research Atkins Health and Medical Information Services.

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Presentation on theme: "The Atkins Nutritional Approach™ (ANA) Colette Heimowitz, MS VP, Education, Research Atkins Health and Medical Information Services."— Presentation transcript:

1 The Atkins Nutritional Approach™ (ANA) Colette Heimowitz, MS VP, Education, Research Atkins Health and Medical Information Services

2 The Atkins Nutritional Approach TM (ANA) is an easy- to-follow four-phase controlled carbohydrate program. Initially, you cut back significantly on carbohydrates to lose weight; then you gradually add back into your diet a variety of “good” carbohydrates as you get closer to your goal weight. The ANA brings your nutritional intake into balance, helping you to re-energize, lose weight and lay the foundation for a healthy life. What is the ANA?

3 How Does the ANA Work?  Carbohydrates and fat provide fuel for the body.  When carbohydrates are available, the body transforms them into energy first.  Any excess carbohydrates are stored as fat.  When carbs are sufficiently restricted, the body burns fat for fuel, including already stored own body fat, which allows people to lose weight or maintain their goal weight.  Studies show that certain risk factors for heart disease improve when individuals follow a controlled carbohydrate programme (e.g. triglyceride levels can decrease by up to 55%).

4 What Controlling Carbs Means  Finding each individual’s tolerance level for Net Carbs (carbohydrates that impact blood sugar levels), first to lose weight and then maintain a healthy weight for life.  Cutting out processed foods full of sugar and white flour, as well as restricting other high-carb foods.  Eating a wide variety of delicious foods, including protein, “healthy” fats and nutrient-dense carbs.  It does NOT mean eating no carbs, eating only steak, bacon and eggs, or eliminating fruit and vegetables.  It DOES mean retaining “good” carbs full of nutrients, found in foods like dark green leafy vegetables, nuts and berries.

5 Atkins Carbohydrate Equilibrium (ACE) The amount of carbohydrate an individual can eat each day while neither gaining nor losing weight.

6 What are Net Carbs?  Carbohydrates can have different metabolic effects on the body. Net Carbs are the carbohydrates that significantly impact the blood- sugar level and are the only carbs that count when following Atkins.  Certain ingredients, such as glycerine and sugar alcohols, have a minimal impact on blood sugar, and therefore, are not included in a Net Carb count. Note: In the US, fibre is reported as a carbohydrate. In the UK, fibre is reported separately and is not part of the carb count.

7 Benefits of the ANA  Weight loss and weight maintenance  Improved health indicators (e.g. triglycerides, cholesterol HDL / LDL)  Better mood regulation  Increased energy levels  Increase in concentration and alertness  Increased ability to cope with stress  Decrease in gastrointestinal symptoms  Decreased fatigue  Decreased preoccupation with food and the need to snack  Decreased need for caffeine  Decreased reliance on medications in certain individuals

8 The Atkins Nutritional Principles Four principles:  Weight loss  Weight maintenance  Good health and well-being  Disease prevention

9 The Atkins Nutritional Principles  Weight Loss oBoth carbohydrate and fat provide fuel for the body’s energy needs. Carbohydrate is the first fuel to be metabolized. However, when the intake of digestible carbohydrate is sufficiently restricted (without caloric restriction), the body converts from the primary metabolic pathway of burning carbohydrate to burning fat as its main energy source. This results in weight loss.

10 The Atkins Nutritional Principles  Weight Maintenance oFor each individual there is a tightly regulated carbohydrate threshold below which fat burning and weight loss occurs. However, if the individual’s carbohydrate intake exceeds this threshold, carbohydrate burning predominates, allowing fat to be accumulated, resulting in weight gain. Therefore, each individual has a level of carbohydrate intake at which weight is maintained.

11 The Atkins Nutritional Principles  Good Health oBy adhering to a controlled carbohydrate nutritional approach, an individual who chooses to eat nutrient-dense foods (including adequate fiber, healthy fats and supplementation as needed) is more likely to meet his nutritional needs and promote good health than he would by following a calorie- restricted, fat-deficient diet. Exercise is also essential for controlling weight, enhancing energy and maintaining a sense of well-being.

12 The Atkins Nutritional Principles  Disease Prevention oBy following an individualized controlled carbohydrate nutritional approach that lowers carbohydrate intake resulting in lower insulin production, people at high risk for or diagnosed with certain chronic illnesses, including cardiovascular disease, diabetes and hypertension, can see improvement in clinical parameters.

13 The Atkins Nutritional Approach  The Atkins Nutritional Principles form the core of The Atkins Nutritional Approach  Four Phases: oInduction oOngoing Weight Loss oPre-Maintenance oLifetime Maintenance

14 Phase 1: Induction  Limit carbohydrate consumption to 20 grams of Net Carbs per day for a minimum of 2 weeks.  For those with a significant amount of weight to lose, Induction can be followed for longer periods of time.  Satisfy appetite with foods that combine protein and fat, such as fish, poultry, eggs, lamb, pork and beef.  Consume a balance of healthy natural fats such as monounsaturated, polyunsaturated, and saturated.  Avoid trans fats (e.g. hydrogenated or partially hydrogenated oils)  Consume carbohydrates in the form of nutrient- dense foods such as leafy green vegetables.  Drink at least eight 250 ml glasses of water daily.  Exercise regularly.  Don’t forget to take nutritional supplements.

15 Example of Induction Menu Breakfast Three-Egg Omelette with Avocado Mozzarella Cheese and Tomato Decaffeinated Coffee with Cream Lunch Sirloin Steak ( 8 oz.) Spinach and Mixed Lettuce Salad with Mushrooms, Onions, Celery and Parmesan Cheese Dinner Poached Salmon ( 9 oz.) Kale or Broccoli with Garlic, Lemon and Sesame Seeds

16 Phase 2: Ongoing Weight Loss  Slow down weight loss by gradually increasing daily Net Carb intake in weekly increments of 5 grams.  Go from 20 grams/day of Net Carbs one week to 25 grams/day the next week.  Increase carbs by 5 each week until weight loss stops.  Choose additional carbs wisely, adding back nutrient- dense foods:  More non-starchy veggies (e.g., asparagus, broccoli)  Berries (e.g. raspberries and strawberries)  Nuts and seeds (e.g., hazel nuts, almonds)  Soft cheeses (e.g., cottage cheese, Stilton, brie)  Once weight loss stops, drop daily intake of Net Carbs by 5 grams to continue losing weight slowly.  Average grams of Net Carbs are 40-60 for this phase.  Phase 2 lasts until you are within 5-10 lbs of goal.

17 Phase 3: Pre-Maintenance  Goal is in sight – 5 to 10 pounds from goal weight.  Lose the last few pounds very slowly to ease into a permanently changed way of eating.  Each week add more grams of Net Carbs (as much as 10) to the daily allotment.  As long as weight loss continues, gradually introduce foods such as lentils, melon, starchy vegetables (turnips, swedes and carrots) and whole grains.  When goal weight is achieved and maintained for at least a month, you have found your ACE.

18 The Carbohydrate Ladder  As the programme progresses, moving from one phase to another, add more carbohydrate foods back – in this order:  Salads and leafy Vegetables  Hard and Soft Cheese  Seeds and Nuts  Soft Fruits such as Berries  Beans and Pulses  Other Fruits such as Melon and Pineapple  Higher carbohydrate Vegetables  Whole Grains

19 The Power of Five  Vegetables: o180g or 6.4oz cooked Spinach o98g or 3.5oz Red Peppers o1 medium Tomato (62g or 2.2oz) o156g or 5.5oz cooked Broccoli o12 Medium Asparagus spears (180g) o180g or 6.4oz cooked Cauliflower o½ medium Avocado (86g or 3oz) o2/3 cup Courgettes  Fruits: o48g or 1.7oz Blueberries o92g or 3.3oz Raspberries o125g or 4.4oz Strawberries o44g or 1.6oz honeydew Melon  Dairy: o142g or 5oz Hard Cheese o142g or 5 oz Mozzarella Cheese o158g or 5.6oz Cottage/Ricotta Cheese o¾ cup Double Cream  Nuts and Seeds: (1 ounce) oMacadamia (10-12 nuts) oWalnuts (14 halves) oWhole Almonds (14 nuts) oHazelnuts (14 nuts) oPecans (14 halves) oSunflower Seeds (3 tablespoons) oPumpkin Seeds (3 tablespoons) These portions contain roughly 5 grams of Net Carbohydrate each:

20 Phase 4: Lifetime Maintenance  To maintain goal weight, stay at your ACE.  Average grams of Net Carbs is 40 to 120 per day, depending on metabolism, age, gender, activity level, or other factors.  Engage in regular exercise; those who exercise usually have a higher ACE.  Changes in activity level, hormonal status or other factors may raise or lower your ACE.

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22 Conditions That Need Guidance While Following the ANA Kidney disease  Protein intake must be monitored in renal patients. Diabetes  Monitoring blood sugar levels is an essential component to following the ANA for diabetics, especially those individuals who may need adjustments in medication levels due to improved glucose regulation. Gout  Those with a pre-existing gout condition need to be monitored by their doctors

23 Conditions That Need Guidance While Following the ANA Pregnant & breast-feeding women  Regardless of the programme, dieting and weight loss is not recommended during pregnancy or breastfeeding.  However, pregnant and breast-feeding women can safely follow the Lifetime Maintenance phase of Atkins.  Dieter’s Advantage and Accel nutritional supplements should not be taken during pregnancy or breast- feeding.

24 Top 10 Myths - and the FACTS

25 Myth No. 1: The ANA Is Unbalanced and Deficient in Basic Nutrition FACT:  People frequently mistake the 20 gram Net Carbs per day Induction phase for the whole programme!  Even during the Induction phase, the ANA calls for 5 daily servings of veggies such as 2 cups of salad (leafy greens like spinach and watercress), 1 cup (two ½-cup servings) of broccoli, and half an avocado.  After this phase, individuals raise their carb count gradually until they reach their ACE.  A person’s ACE could be up to 120 grams or more daily of nutrient-dense carbohydrates, including fruit, occasional potatoes, brown rice and whole grain bread!

26 Example of 20 Gram CHO Daily Menu Breakfast Three Egg Omelet with Avocado, Mozzarella Cheese and Tomato Decaffeinated Coffee with Cream Lunch Beef Round Steak (8 oz.) Spinach and Mixed Lettuce Salad with Mushrooms, Onions, Celery and Parmesan Cheese Dinner Broiled Salmon (9 oz.) Kale topped with Garlic, Lemon and Sesame Seeds

27 Nutrient Analysis of 20 Gram CHO Sample Menu Based on Daily Values /RDI Percent of Daily Values 2000 Calorie Diet

28 Nutrient Analysis of 20 Gram CHO Sample Menu Based on Daily Values/RDI Percent of Daily Values 2000 Calorie Diet

29 Myth No. 2: You Lose Mostly Water Weight on the ANA FACT:  A portion of initial weight loss on any diet is water weight.  When one follows a controlled carbohydrate eating plan the body switches from burning carbohydrate to primarily burning stored fat for energy, resulting in the loss of stored fat.  This is evident through the loss of inches!  Research results have consistently demonstrated that weight lost after the first few days on a restricted carbohydrate programme is primarily fat and not water or lean body mass.

30 Myth No. 3: The ANA Is Only Effective Because Calories Are Restricted FACT:  Calories are not restricted when doing Atkins  Individuals may end up eating fewer calories because they are generally less hungry and no longer obsessed with food.  Stable blood sugar throughout the day ensures fewer food cravings.  The food on this program is less processed and more nutritious than on the typical pre-Atkins menu.

31 Myth No. 4: The High-Protein Content of the ANA Causes Kidney Problems FACT:  No one has as yet produced a study for review, or even cited a specific case in which the protein content of ANA causes any form of kidney disorder.  When someone is already diagnosed with kidney disease, they need to modify their total protein intake and consult closely with their doctor.

32 Myth No. 5: Fat Intake is Detrimental and Will Lead to Heart Disease FACT:  A growing body of scientific literature demonstrates that a controlled carbohydrate eating plan, if followed correctly, reduces risk factors for heart disease and improves clinical health markers.  The body needs fats to survive and fats provide many health benefits.  Natural fats make individuals feel full sooner and keep dieters feeling less hungry for longer.  Low carb v low fat – followed correctly, studies show that a low carb eating plan can be more effective than a low fat plan in improving risk factors for heart disease

33 Quintiles of Dietary Glycemic Load (Women) Quintile12345 Quintile mean glycemic load 117145161177206 CHO gm/day144 + 20171 + 11186 + 11200 + 11226 + 20 #CHD Cases139128148160186 Liu et al. A Prospective Study of Dietary Glycemic Load, Carbohydrate Intake, and Risk of Coronary Heart Disease in US Women. AM J Clin Nutr. 71:1455-61, 2000. 10 YEAR Prospective Study: n=75,521 Women TEST FOR INTERACTION, P<.0001

34 Myth No. 6: Ketosis Is Dangerous and Causes a Variety of Medical Problems FACT:  The primary fuel in the body is glucose, generated from carbohydrate consumption.  When sufficient carbohydrates are not available the body turns to its secondary fuel source: fat.  Fat is burned as energy (lipolysis), producing byproducts called ketones. The process is called ketosis.  Ketosis should not be confused with the abnormal metabolic state, ketoacidosis.  Ketoacidosis is only a concern for diabetics whose blood sugar is out of control, or for alcoholics.

35 ““ Doctors are scared of ketosis” says Richard Veech, an NIH researcher who studied medicine at Harvard.... “But ketosis is a normal physiologic state. I would argue it is the normal state of man. Rather than being poison, which is how the press often refers to ketones, they make the body run more efficiently and provide a back-up fuel source for the brain.” Veech calls ketones “magic” and has shown that both the heart and brain run 25% more efficiently on ketones than on blood sugar.” Taubes G. NYT Magazine Section, July 7, 2002.

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37 The Human Metabolic Response to Chronic Ketosis Without Caloric Restriction: Physical and Biochemical Adaptation Summary: In view of the tests done to screen for ill effects of the EKD, the remarkably benign nature of a diet providing 85% of calories as fat is notable. After 4 weeks there was no measurable impairment of hepatic, renal, cardiac, or hematopoietic function. The serum uric acid level, elevated by competition from ketone bodies for excretion, was almost back to normal by that time. Phinney SD, Bistrian BR, Wolfe RR and Blackburn GL. Metabolism 1983;32(8):757-768.

38 Myth No. 7: The ANA Causes Constipation Because It Lacks Fibre FACT:  Doing Atkins means including fibre-rich foods such as spinach, aubergines, broccoli, asparagus and leafy greens. After the initial phase, it also includes soft fruits such as berries.  If the Induction phase is followed properly and all 5 servings of vegetables are included, the majority of individuals do not suffer from constipation. If more fibre is needed during the Induction phase, a fibre supplement is recommended.  Supplementing with fibre is unnecessary in the Ongoing Weight Loss (OWL) phase and beyond because fruits and more vegetables are introduced into the eating plan.  Drinking plenty (2 litres) of water each day is very important.

39 Myth No. 8: The ANA Increases the Risk of Osteoporosis FACT:  During the first week of any weight loss programme, one loses water weight. When water is lost, so are calcium, potassium and magnesium. That’s why taking a multivitamin is so important. Calcium is not being leached from the bones.  Actual studies have shown urinary calcium loss lasted a few days. The body then re-adjusts itself to a regular state of homeostasis and the calcium loss in the urine stops.  In several studies published in peer review journals researchers followed adults and studied the short- term and long-term effects of a high-meat diet on calcium metabolism. The studies found no significant changes in calcium balance, nor was there any significant change in the intestinal absorption of calcium during the high-meat diet.

40 Myth No. 9: Lipolysis / Ketosis Causes Loss of Muscle Mass FACT:  Typically, individuals on very low calorie diets can lose muscle mass because they have inadequate intake of protein.  Atkins is not calorie restricted and the high protein intake offsets any possible loss of lean body mass.

41 STUDIES EXAMINING THE EFFECTS OF A KETOGENIC DIET ON BODY COMPOSITION

42 Myth No. 10: Atkins Will Cause Weakness, Fatigue and a Lack of Energy FACT:  During the first few days on Atkins, people may experience a mild fatigue as the body switches metabolic pathways.  After 3-4 days, the body has switched from a glucose metabolism to a fat metabolism.  Reducing caffeine and sugar intake can lead to short- term withdrawal symptoms, but they typically pass within the first week.  After the transition, individuals consistently report high energy levels.

43 The Science Behind Atkins

44 Science Supports the ANA Perhaps the biggest myth of all is that there is no science supporting the ANA:  There are more than 400 peer-reviewed and published studies supporting the concepts of Atkins Nutritional Principles.  In the last three years, there have been 16 studies focusing on the ANA, all supporting the safety and efficacy of controlled carbohydrate eating.  Information on all of these studies and more supporting scientific information is available for review at www.atkins.com

45 Weight Loss in Teenagers LBS n=30 12 Week Study Sondike, S.B., Copperman, N., Jacobson, M.S., "Effects of a Low-Carbohydrate Diet on Weight Loss and Cardiovascular Risk Factor in Overweight Adolescents," The Journal of Pediatrics, 142(3), 2003, pages 253-258. 56% Carbohydrate 8% Carbohydrate 1830 kcal 1100 kcal What this graph tells us – Teenagers who followed a low carbohydrate diet lost more weight than teenagers who followed a low fat diet. The low carbohydrate group was able to lose more weight even while consuming more calories - an average of 730kcal more a day than those following the low fat diet.

46 Weight Loss in Adults Greene PJ, Willett W, et al. “Pilot 12-Week Feeding Weight-Loss Comparison: Low-Fat vs. Low-Carbohydrate (Ketogenic) Diets,” NAASO meeting Oct. 13, 2003 Obesity Research, Sept. 2003, Oral Abstract #95. Decrease in:Low Fat 1* (1500/1800kcal) Low Carbohydrate 1* (1500/1800kcal) Low Carbohydrate 2* (1800/2100kcal) Weight (pounds)17 (± 2.4); 8%23 (± 4.6); 11% 20 (± 3.4); 10% Waist (inches) 2.6 (± 0.54); 7%4.3 (± 0.73); 11%3.8 (± 0.68); 10% Hip (inches)1.9 (± 0.71); 4%2.6 (± 0.68); 6%2.9 (± 0.71); 7% * Calories: Women/Men, respectively What this table tells us - Adults who followed a low carbohydrate diet lost more weight than adults who followed a low fat diet. The low carbohydrate group was able to lose more weight both while consuming the same or more calories - an average of 300kcal more a day than those following the low fat diet.

47 Harvard Nurses Health Study: Summary Liu et al. A Prospective Study of Dietary Glycemic Load, Carbohydrate Intake, and Risk of Coronary Heart Disease in US Women. AM J Clin Nutr.71:1455-61, 2000. “Our findings suggest that a high intake of rapidly digested and absorbed carbohydrate increases the risk of CHD independent of conventional coronary disease risk factors. These data add to the concern that the current low-fat, high carbohydrate diet recommended in the United States may not be optimal for the prevention of CHD and could actually increase the risk in individuals with high degrees of insulin resistance and glucose intolerance.”

48 Triglycerides are Important  Perhaps the most important cardiac risk factor of all, especially when combined with low HDL (Tanne D. et al Circulation. 2001)  High triglycerides are a known substitute marker for abnormally high insulin levels  Triglycerides are known to decrease with carbohydrate restriction

49 The Effect That High Carbohydrate Diets Have on Triglycerides Abbasi et al. High Carbohydrate Diets, Triglyceride Rich Lipoproteins,and Coronary Heart Disease Risk. Am J Cardiol. 85:45-48, 2000. CHO = Carbohydrate TG = Triglycerides Triglycerides were measured every 2 hours from 8AM-4PM (Breakfast at 8am and Lunch at 12pm) 8am 4pm What this graph tells us – Carbohydrates raise blood triglyceride(TG) levels. In this study one group consumed a 40% carbohydrate diet while the other group consumed a 60% carbohydrate diet. Notice the high carbohydrate group had higher TG levels before and after meals. The more carbohydrates consumed the higher the blood triglyceride levels.

50 The Copenhagen Study: An 8 Year Study of 2906 Men Without Heart Disease Jeppesen et al. Triglyceride Concentration and Ischemic Heart Disease An Eight-Year Follow- up in the Copenhagen Male Study. Circulation. 97: 1029-36, 1998. HDL-C, mg/dl TG, mg/dl What this graph tells us - Fasting triglycerides is a stronger indicator of Ischemic Heart Disease than HDL (which is part of your total cholesterol) 11-4557-13346-56 39-96 97-141 141-400 INCIDENCEINCIDENCE

51 Miller M. Is Hypertriglycerideaemia an Independent Risk Factor for Coronary Heart Disease? The Epidemiological Evidence. Eur Heart J. 19 (suppl H18-22), 1998. The relationship between Triglycerides and Relative Risk of CHD in Males and Females CHD Relative Risk

52 Triglyceride Levels in Teens Mean % Change n=30 12 Week Study Sondike, S.B., Copperman, N., Jacobson, M.S., "Effects of a Low-Carbohydrate Diet on Weight Loss and Cardiovasculaisk Risk Factor in Overweight Adolescents," The Journal of Pediatrics, 142(3), 2003, pages 253-258 What this graph tells us – Even though the low carbohydrate group ate on average 730 more calories each day than the low fat group, the low carbohydrate group had a much greater reduction in blood triglyceride levels.

53 Changes in Cardiovascular Risk Factors While Following Either A Very Low-Carbohydrate Diet With Nutritional Supplements or A Low-Fat/Low- Calorie Diet Chol TG HDL-C LDL-C Chol./HDL Low Fat mg/dl mg/dl mg/dl mg/dl ratio (n=18)Baseline217.8 (29.7)196.0 (114.6) 48.8 (9.6) 133.2 (28.4) 4.5 (0.8) Week 24204.3 (35.5)135.8 (82.3) 49.1 (9.7) 127.7 (28.6) 4.2 (0.8) Change-13.5 (22.5)*-60.2 (100.2)* +0.3 (6.4) -4.0 (17.6) -0.3 (0.7) Low Carb (n=22)Baseline251.4 (29.4)181.5 (86.7) 56.4 (18.6) 158.2 (25.6) 4.7 (1.3) Week 24237.9 (45.5)89.3 (56.2) 61.6 (18.6) 158.0 (39.1) 4.0 (1.1) Change-13.5 (35.6)-92.2 (85.5)* +5.2 (10.6)* -0.2 (34.2) -0.7 (1.1)* Yancy WS, Bakst R, Bryson W et.al. Obesity Research (abstract) 9:184S, 2001 *p<0.05, for within-group change from baseline to Week 24 No significant differences existed between diet groups What this table tells us –The low carbohydrate group experienced greater than 50% reduction in blood triglyceride levels

54 Evaluating the Atkins Nutritional Approach: A 12 Month Study Conventional Diet (n=20) Atkins Diet (n=17) P % change Weight -4.5  7.9 -7.3  7.3 0.27 Total Chol -5.5  10.4 0.2  12.7 0.23 LDL-C -5.8  16.1 0.5  21.2 0.47 HDL-C 3.1  15.2 18.2  22.4 0.04 TG 1.4  52.5 -28.1  23.6 0.04 Foster G, Wyatt H, Hill J, et al. NEJM 348:2082-90, 2003 What this table tells us - After one year on either a low carbohydrate or low-fat diet, subjects lost weight. The low carbohydrate diet was associated with greater improvement in risk factors for coronary artery disease (better cholesterol profile and triglyceride levels)

55 Weight Loss and Cardiovascular Risk Factors in Women Following Either A Low Carbohydrate Diet or A Low Fat Diet Low CHOWt Loss, kg 8.0  1.07.9  1.4, p=<0.02 Body fat, %  1.7  0.462.2  0.58 TG  65.3  17.2 Low FatWt Loss, kg 4.4  1.13.2  1.3 Body fat, %  1.3  0.480.74  0.49 TG  15.2  8.2 3 Months6 Months Brehm BJ, Seeley RJ, D’Alessio DA, et al. “A Randomized Trial Comparing a Very Low Cabohydrate Diet and a Calorie- Restricted Low Fat Diet on Body Weight and Cardiovascular Risk Factors in Healthy Women,” The Journal of Clinical Endocrinology and Metabolism, 88(4),2003. What this table tells us – Women following a low carbohydrate program lost more weight at 3 months and kept the weight off even after 6 months. In contrast the low fat group lost less weight at three months and at 6 months gained back 25% of the original weight lost. Once again, triglyceride levels decreased much more in the low carbohydrate group.

56 Low Carbohydrate 6 - Month Study Baseline wt, lbs293.2295.1ns Wt change, lbs-20.4-6.50.002 Chol. Change, mg/dl-1.3+4.7ns HDL change, mg/dl-0.6-1.4ns LDL change, mg/dl-1.8-6.4ns TG change, mg (non-DM)-65-8.00.02 Insulin change,  U/ml (non-DM) -8.9-1.1ns 6 months Low-CHO, n=28 Low-Fat, n=30 P Value Samaha, F.F., Iqbal, N., Seshadri, P., et al., “A Low-Carbohydrate as Compared with a Low-Fat Diet in Severe Obesity,” N Engl J Med, 348(21), 2003, pages 2074-81. What this table tells you - Adults who followed a low carbohydrate diet lost more weight than adults who followed a low fat diet. In addition, the low carbohydrate group had a greater improvement in cardiovascular risk factors (greater reduction in triglycerides).

57 Dietary Fat Intake and Risk of Stroke 1 Relative Risk (95% CI) P value total fat 0.91 (0.65 to 1.28) 0.77 animal fat1.20 (0.84 - 1.70) 0.47 vegetable fat1.07 (0.77 - 1.47) 0.66 saturated fat1.16 (0.81 - 1.65) 0.59 monounsaturated fat0.91 (0.65 - 1.28) 0.83 polyunsaturated fat0.88 (0.64 - 1.21) 0.25 trans unsaturated fat 0.87 (0.62 - 1.22) 0.42 dietary cholesterol1.02 (0.75 - 1.39) 0.99 1 Comparing the highest fifth of intake with the lowest fifth, the multivariate relative risk of ischaemic stroke was (95% confidence interval; P for trend) From the Health professional follow up study of 43,732men aged 40-75 years, during 14 years of follow up. He,K.,Merchant, A.,Rimm, E.B., et al., "Dietary fat intake and risk of stroke in male US healthcare professionals: 14 year prospective cohort study," British Medical Journal, 327, 2003, pages 777-782. The team concluded, "Our findings from this large cohort of middle-aged US male healthcare professionals, without a history of cardiovascular disease or diabetes, indicate that intakes of total fat, specific types of fat, or dietary cholesterol do not seem to be related to the development of stroke."

58 One Year Effectiveness of the Atkins, Ornish, Weight Watchers, and Zone Diets Decreasing Body Weight and Heart Disease Risk All Subjects(40/arm)12 mo. completers %Wt loss %FRS*%Wt loss % FRS* Atkins2.1 6.4 3.9(n=21) 12.3 (52%) Ornish3.13.36.2(n=20) 6.6 (50%) Wt Watch3.09.64.5(n=26)14.7 (65%) Zone3.06.94.6(n=26)10.5 (65%) Conc: All diets showed significant in FRS, and promoted wt loss especially in adherent subjects indicating that various strategies can be effective * FRS= Framingham Risk Score, a measure for reducing 10 yr. heart disease risk. Dansinger ML, Gleason JL, Griffith JL et al. AHA Scientific Sessions, Orlando, FL 2003

59 Comparison of Inflammatory Markers between low-fat and low-carb diets Conclusion: C-reactive protein and serum amyloid A levels did not change with a low fat diet, but both levels decreased with a low carb diet. This suggests that for short periods of time, a low carb diet is more efficacious, both in causing weight loss and in reducing serum inflammatory markers, than is a calorically-matched low fat diet. O'Brien, K.D., Brehm, B.J., Seeley, R.J., "Greater Reduction in Inflammatory Markers With a Low Carbohydrate Diet than with a Calorically Matched Low Fat Diet," American Heart Association's Scientific Sessions 2002, Nov 19, 2002, Abstract ID: 117597.

60 Exploding Nutrition Myths “The relationship of fat intake to health is one of the areas that we have examined in detail over the last 20 years in our two large cohort studies: the Nurses Health Study and the Health Professionals Follow-up Study. We have found virtually no relationship between the percentage of calories from fat and any important health outcome We have found virtually no relationship between the percentage of calories from fat and any important health outcome. But what does seem important is the type of fat and the form of carbohydrate.” Willett W. World Health News, Boston. March 29, 2000

61 Discrepancies between Published Reports and Prevailing Assumptions of Low Carb Diets  When fat is converted from its energy storage role to the primary energy fuel ketosis occurs  Most studies measuring the effects of dietary fat on lipids use protocols containing considerable amounts of dietary carbohydrate.  Most published observations on high fat ultra-low carbohydrate diets (below 20% of total calories) show beneficial results.

62 How the Atkins Lifestyle Works for You Healthy convenient foods that taste great!  Atkins™ products contain oNo added Sugar oNo Aspartame oNo Hydrogenated or partially Hydrogenated Fat


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