Whew! That's me taking a deep breath for two reasons. First, breathing is good for you (it certainly beats the alternative). Secondly, I'm about to tackle a topic that might very well be the most controversial issue in the fitness and weight loss markets today.
I've written several articles over the past few years sharing my position on the low-carb diets and have received my share of praise and condemnation. In writing this piece, which promises to be lengthy, I anticipate there will be an outpouring of agreement and criticism and I welcome both. Before I explain what I see as potential flaws in some of the low-carb offerings, I want to extend my sympathies to Dr. Atkins' friends and family and assure every reader this is by no means an anti-Atkins article. In fact, I admire much of what Dr. Atkins accomplished. I believe it was courageous and important for Dr. Atkins to openly challenge the FDA and the USDA on some of their rulings and theories that had infiltrated the medical community as fact when they were merely opinions open for debate. I fully agree with his position on simple sugars and refined carbs and greatly appreciate that he brought the connection between insulin and fat storage to the forefront. I think the more material the public has available, the more qualified the individuals who make up that public are to embark on a sensible nutritional course.
Periodically an article of mine that confronts some low-carb issues gets posted on a low-carb board and the venomous e-mails pour in. I can almost hear the crafters of the e-mails screaming at my through their computer screens. Many of them disregard much of what I say and erroneously categorize me as an Atkins hater. I'll urge you to read this in its entirety before you form an opinion on whether or not the information I share is sound. If, after reading this piece, you decide to pursue the Atkins diet, or any other reduced carb program, I applaud you for reviewing both sides of the coin and making an educated decision.
Atkins, although he may be the most well known low carb advocate, was not alone in his pursuance of a low-carb lifestyle, and while there are many who are in his corner, there are many who represent what might best be described as the opposition. I've been in touch with the heads of the American Dietetic Association, of Pritikin Longevity Centers, and with nutritional experts at Tufts and Berkeley Universities, and they express concerns and aversions regarding the "cut carbs" mentality that's sweeping the weight loss wanting nation.
The battle continues to rage and recent inconclusive studies and reports such as those published in the Journal of the American Medical Association just add fuel to the fire.
I don't categorize either side as "wrong," but I do believe the truth can be found somewhere in between their respective conclusions. Consumers and dieters are entangled in a battle between "low carb" and "low fat" and the "experts" tend to eliminate the middle ground where I believe the most sensible approach for the masses lies.
A part of the reality that must be considered when confronting the impact of the low-carb diet approach is, while many of the low carb books do provide accurate information, most of the low carb dieters I've met NEVER READ A COMPLETE DIET BOOK! A friend, or a friend of a friend, shares the questionable advice, "just stop eating carbs and you can eat all the protein and fat you want." That is absolutely not "the Atkins diet," although those half educated dieters will be the first to tell you they're "on Atkins." The misinformation passed along from person to person takes one aspect of a low carb protocol completely out of context, but we can't blame the misinformed.
In today's society, people are being pulled in various directions believing there's a quick easy magical fix thanks in great part to the efforts of slick marketers of fraudulent and potentially dangerous diets. The hype is so powerful Americans are getting sucked in by the millions.
There's an oft-aired infomercial that's cleverly disguised as a talk show on which a low carb diet is aggressively "sold." The "guests" discuss feasts of bacon and eggs, cheeseburgers, and lobster dripping with melted butter. They explain that "fat doesn't make you fat, carbs make you fat." They've all somehow done the impossible . . . they've "melted fat." Butter may melt in a heated pan, but bodyfat doesn't melt. Fat loss is a two-step process. First adipose material has to be released from an adipose cell, and then the fatty acids have to be shuttled into the mitochondria of a muscle cell where they can be burned as fuel.
It's fair to suspect that the majority of viewers of that "show" do not purchase the product being marketed, but many follow marketing hype as fat-melting gospel. No mention is made of water. No mention is made of caloric consumption. No mention is made of the thermic effect of food. No mention is made of exercise. The illusion is, "just cut carbs and you'll love life and have the body of your dreams."
My criticism is not one of the passionate and well-informed professionals who inhabit the low-carb camp, but rather one of a reduced carbohydrate diet being aggressively promoted as a solution for the masses.
But It "Worked" For Someone I Know!
While any diet with millions of followers will have its fair share of success stories, those "successes" might not be representative of what most followers will experience. Being in the fitness industry and having amassed a long chain of weight loss success stories, I often meet the less successful dieters seeking yet a new "solution." I've met far too many who have suffered everything from minor discomforts to chronic ailments after following a path of deprivation. Many of these unfortunate diet victims had their bouts with a low-carb approach, and after coming in contact with hundreds of such cases, I personally can not find comfort in aligning with the low-carb advocates, although I certainly welcome them into any forum for open discussion. I've frequently seen Atkins dieters in their post diet conditions complaining of a residual weight gain greater than the weight lost during the diet. I've met many who reported significantly increased LDL (bad cholesterol) levels only weeks after diet abandonment. I am an advocate primarily of education and my study has raised some questions and conclusions that I believe might make the low-carb diet a contraindication for many seeking long term healthful weight loss. I don't pretend to be the all-knowing authority, but believe my questions and concerns merit consideration.
Regardless of the stories anyone provides for public consumption, as long as a band of people hold tightly to the extreme "carbs are the enemy" dictum, criticism by clinicians and conventionally trained and educated experts is inevitable. Along with medical experts raising an eyebrow will come highly qualified fitness professionals. Exercise experts with a background in mainstream nutrition are certain to indict the popular diet books as an impotent piece of the puzzle if those books do not address the importance of exercise.
I'm going to do the best I can to explain some of the realities the infomercials and low-carb marketers may not share. Much of the information that follows is excerpted or re-written from previous articles I've released. I am hoping, with this compilation, to create a single informational piece raising all of the significant questions and providing all of the necessary information to counter or support the readings of someone considering a low-carb lifestyle.
Glycogen = Fuel
When you consume a healthful and supportive diet complete with proteins, carbs, and fats, the carbohydrates are broken down into glucose. Glucose is actually blood sugar. Some of that glucose is transported and stored in muscle tissue as "glycogen." This is sort of the fuel in your fuel tank. That's important to understand. Glycogen = Fuel.
Glycogen is used to produce energy that fuels muscle contraction. ALL muscle contraction! Don't think of muscle contraction only as exercise. Any movement requires the contraction of muscle, from blinking your eye to rising from bed in the morning. As long as you're consuming carbohydrates you access and burn up stored glycogen, but quickly replace it with new muscle fuel. An understanding of that simple fact -- that carbohydrates are the source of muscle fuel -- should raise an immediate red flag toward anything that suggests seriously limiting carbs for any extended period of time.
Once you understand the basic premise behind muscle glycogen, you should understand that the liver also plays a role in fuel storage. Some of the carbs that you eat ultimately wind up stored as liver glycogen. Think of the liver as sort of a "pump" for blood sugar. The brain burns more calories than any other organ in your body, and guess what it uses as its primary source of fuel. Glucose! Carbohydrates! As brain activity results in the "burning" of blood glucose, the liver accesses its glycogen stores to keep blood glucose in adequate supply. Again, as you expend glycogen, the carbs that you ingest replete your supply.
LOW CARBS? AT FIRST YOU'LL DO FINE . . . BUT . . .
On a low carb regimen, at first you'll do just fine because you have a limited glycogen reserve. After a day or two, you're using up your stored glycogen and you're not replacing it. Your body shortly thereafter begins amplifying its production of ketone bodies. Ketones are intermediaries in the process of metabolizing fat that are found in abnormal amounts in the blood and urine during periods of metabolic impairment. Give up all of your stored glycogen without replacing it and you're likely going to be in such a state (Note: if you take in too many protein calories, it is possible to avoid carbs and never enter a state of ketosis rendering the low-carb ketosis theories useless). Atkins leads you to believe that the presence of these ketone bodies indicates ongoing fat release. He also assures you that they feed the brain. That is partially true. Here are just a few of the issues he neglects to address:
- Extended periods of ketosis may affect the chemical composition of the blood in such a way that you increase risk of cardiac incident (blood ketoacidosis).
- In a state of ketoacidosis, carbon dioxide accumulates in the tissues. Oxygen delivery to the cells is impaired. This can lead to a wide range of disastrous consequences ranging from respiratory ailments to metabolic illness.
- Toxic ammonia buildup resulting from severe cases of ketoacidosis can be lethal.
I don't want to sound any false alarms here. I'm not saying everyone who enters a state of ketosis is going to be at risk of death. I'm just pointing out that there is potential danger in what many people misinterpret to be an ideal physiological state to maintain. For clarity I'd like to repeat, ketosis is not fatal, but ketoacidosis can be. Ketosis and ketoacidosis are different states, but there is a link. Ketone levels in the blood are elevated during times of carb depletion. If blood glucose rises in conjunction with blood acidity, the pH of the blood, the actual chemistry of the blood is altered. Someone with normal pancreatic function and efficient use of insulin would not likely shift from ketosis to ketoacidosis, but so many Americans have undiagnosed blood sugar irregularities and that's where the risks come in. It is also possible for stress to alter levels of cortisol and the "stress hormones" which directly antagonize insulin so the possibility does exist that someone who normally has controlled blood sugar can enter a state of ketoacidosis when placed under undue stress with elevated ketone levels. Ketoacidosis can lead to a reduced heart rate, breathing difficulties, and a loss of body fluids, all which put the heart at greater risk.
At the very least, the risk, just as risks of medications, should be addressed and made public. If Atkins does share that information with readers, I couldn't find it. He also neglects to tell you that the liver is called into play to "filter" the abnormal chemicals building up in the blood. This leads to a residual buildup of uric acid. This uric acid accumulation can lead to formation of kidney stones.
Kidney stones may be common among low-carb dieters, but don't mistake that for an indication that they're normal! If all is working optimally, uric acid levels stay quite manageable, the kidneys continue to function normally, and you will likely never have stones accumulating in your urinary tract.
BUT DON'T YOU LOSE WEIGHT?
By depriving themselves of carbs and/or cutting caloric intake down below basal metabolic needs, dieters may wind up lightheaded, spaced out, uncomfortable, irritable, and all around miserable . . .but when they get on the scale, there's a moment of emotional ecstasy! They're losing weight! Suffering through fraudulent and potentially harmful weight loss alternatives has almost become more the rule than the exception, and I can't point a finger at those who are victims. I blame an industry that thrives on fraud and deception.
While the public searches desperately to find a solution, the Cabbage Soup Diet, the 2-day miracle diets, the Papaya Diet, and the Ice Cream Diet add to the confusion. In order to combat the marketing power of these "quick easy" diets, marketers of more legitimate nutritional regimens are almost forced to promote using over-the-top hype if they're even going to compete in the same arena. Of course, the low-carb diets being thrown into the mix serve to further confuse as there is little unity among the diet camps. While marketers do battle, most of the "victims" don't realize there is an "eat right and exercise" alternative, one that truly works, and in the absence of that realization, they're primed to be suckered in by the "Diet Du Jour."
At this point pro-Atkins readers of this article may be on the verge of crafting one of those "you don't know what you're talking about" e-mails. They will insist that I am off base because I mentioned that dieters may feel out of sorts and they in fact feel wonderful. If you feel wonderful on the Atkins Diet, or any other diet, far be it from me to discourage you. This was not written for those who may be thrilled with a low-carb lifestyle, but rather for balanced information among those who are considering carb reduction or are less than satisfied with a carb restricting diet. Many people who begin a low carb diet might feel that uncomfortable lightheadedness I described, but after a matter of days the discomfort subsides. This may be the result of ketones feeding the brain, or it may be the result of the body converting amino acids into glucose. In order to scavenge the branched chain amino acids that can be converted into brain fuel, the "I feel OK now" might be accompanied by muscle tissue breakdown.
Before evaluating whether or not a low carb diet works, It's important to understand why the initial weight loss can be substantial. When I had the opportunity to discuss weight loss attempts with Dr. Atkins during an interview on WZTA in Miami, I asked if he agreed that calorie deprivation leads to metabolic slowdown. His response was, "Absolutely." I then expressed my concern that his diet book encourages people to judge their progress by their pounds on the scale rather than body composition. If muscle is lost, metabolism slows, yet the scale would indicate weight reduction. Isn't this the major problem with the conventional calorie deprivation diets? Isn't a reduced carb diet that results in muscle catabolism simply another outgrowth of a metabolism destroying plague of non-solutions categorized as "Diets?" If "Diets Don't Work," why are the low carb gurus selling you a Diet?
I'm not a doctor, and I certainly defer to someone medically trained, but that deference is not at the exclusion of my right to question. I was educated to believe that one gram of glycogen attracts 2.4 grams of water, thus if you hold less glycogen in muscle due to carb restriction, it's a given there will be substantial water loss. Dr Atkins agreed that much of the initial weight loss may in fact be water.
Of course this issue of rapid weight loss leaves plenty of room for debate, but it's pretty clear that when dieters on any restrictive program lose "10 pounds in 10 days," or "30 pounds in 30 days," it is combined loss of water, fat, and muscle. I believe, based on the continuous marketing of "quick weight loss," many diet sellers are using rapid water loss as a trick leading people to believe they're losing weight permanently when in reality the "result" is short term.
I am by no means suggesting weight lost on a carb restrictive plan is ALL water weight. I already mentioned it may be a combination of water, fat, and muscle (which I'll get further into shortly). I'm simply saying that in the first week, many are overly enthusiastic as they believe the 5 or 6 pounds lost is permanent.
WHERE'S THE RESISTANCE EXERCISE ELEMENT?
In Dr. Atkins' book, "The Age Defying Diet Revolution," he does encourage people to exercise with resistance, but that encouragement is limited to one paragraph. In his previous work, Dr. Atkins Diet Revolution, there is virtually no mention of resistance exercise! He offers resistance exercise in his "new" book only as a vehicle to resisting the diseases of aging. He makes no mention of lean body mass and its link to metabolism. This omission allows for a host of variables that may or may not lead to unpredictable metabolic changes. Any diet or weight loss program that fails to consider body composition (fat vs. lean body mass) in measuring its effectiveness is going to generate random conclusions at best.
WHERE'S THE PROOF?
I guess the most relevant question asked by critics of Atkins' theories is, "where is the proof?" Scientists have been trained to seek out published peer-reviewed research as evidence and then to seek out an overwhelming abundance of evidence as proof. Personally, I'd like to see one case study, carried on over the long term (3-5 years), not funded by Atkins that can stand as a foundation upon which proof can be built.
I'm aware of the recent studies and reports the low carb dieters cling to as "proof," but do they honestly serve as clear evidence that the diets are a valuable long-term weight loss solution? I don't believe they do. One of the oft-referenced studies was conducted at Duke University. (Westman EC, Yancy WS, Edman JS, Tomlin KF, Perkins CE. Effect of 6-month adherence to a very low carbohydrate diet program. Am J Med 2002 Jul;113(1):30-6).
It should be noted that the Duke study was funded by a grant from Atkins. While that doesn't dismiss its validity, it does add question marks to the "conclusion." Had the conclusion proved otherwise, would the study have ever been publicized? The abstract of that study included the following:
"While we're impressed with the weight loss of this diet, we still are not sure about the safety of it," Westman said. "More studies need to be done in order to be confident about the long-term safety of this type of diet."
For example, all participants developed ketonuria, the presence of measurable ketones in urine. The level seen in this study translates to roughly that of a non-dieting person if they didn't eat for a couple of days, said Westman. "This is a finding that we need to learn more about. The level of ketones present was not terribly high, but we don't know if this is safe or harmful to one's health over a long period of time."
A part of the challenge with using these types of studies to indicate that a diet is "safe and effective" goes right back to the strict measure of "pounds lost" rather than reductions in bodyfat. If muscle is lost, that would show up as positive, yet in the long run it would be detrimental to metabolism. Another challenge in interpreting the study's value is it's short term. All diets have the potential to stimulate short-term weight loss, but to date the long term success statistics are abysmal.
Another work that is held up in defense of low carb strategies is, The Harvard Medical School Guide to Healthy Eating, A HARVARD MEDICAL SCHOOL BOOK By Walter C. Willett, M.D. In his book, "Eat, Drink, and Be Healthy," Willett clearly challenges the food pyramid established by the FDA and I'm right in his corner on that one. He also talks about the importance of EFA's, essential fats, the Omega 3's and Omega 6's. That's a bit different than consuming saturated fats in bacon, cheeseburgers, etc. While there are similarities in Willett's findings and Atkin's teachings, there are also enough discrepancies to disregard it as an endorsement of the Atkins Diet.
On July 7, 2002, the New York Times published an article by Gary Taubes titled, "What If It's All a Big Fat Lie." I've written an entire article in response to that Taubes feature.
Supplementing the science we can find an abundance of opinion among those who have pursued the Atkins Diet at one time or another. These opinions, otherwise referred to as anecdotal "evidence," range across the board. Is anecdotal evidence important? Scientists say it's to be dismissed. I believe it should be considered if it is directly linked to the strict adherence to a given protocol. The question then becomes, "did these opinion forming dieters actually follow a prescribed course of action?" As I mentioned earlier, many have never read a complete diet book which leads to great discrepancy among the manner in which they attempted to go "low carb." Typically, these diet bandwagon jumpers heard from a friend who heard from a friend that carbs are bad and are to be avoided at all costs. While Dr. Atkins, in the "Induction Phase," suggests 20 grams of carbs per day, and gradually increases carb intake over time, a passed-along "just cut carbs" mentality is not fully representative of the advice disseminated in "The Diet Revolution." There's just so much misinformation circulating that rumors and conjecture abound where true science appears to be elusive. As an example of a single risk that is enhanced with the omission of a prescribed piece of the dietary puzzle, those who fail to read a book before beginning carb manipulation may fail to recognize the need for consuming ample quantities of water, and in a glycogen depleted state, that can further add to risk of kidney stones and other disorders. As a result, while we can look at and begin to sift through the opinions, there is a long way to go before science can actually "prove" this diet concept's value.
Let's take a look at another low-carb premise, one that OK's the consistent ingestion of red meat, of bacon, of butter, and other saturated fats. I can do a complete article on this topic alone, but I'm going to bypass it since saturated fat has been so conclusively linked to coronary artery disease, it doesn't even merit discussion here.
I have, as I mentioned, met with great numbers of Atkins dieters, and I've found some very consistent data in understanding their adherence to the diet. They all cut out simple sugars and refined and processed flours. That's good! I encourage people to do that as it will help stabilize blood sugar and facilitate fat release . . . providing that some other aspects of nutrition are in place (not extended ketosis) and providing that they are involved in a supportive exercise program. Another interesting thing I found, when analyzing their food intake, is although they are told by Atkins they don't have to cut calories, in every case they wound up eating fewer calories than they were before the diet!
Here's why I believe that's true in many cases. Firstly, while butter and cream cheese and sour cream are permitted, you're not allowed to eat potatoes or bread. By eliminating most foods people tend to flavor with fats, dieters have offered themselves fewer opportunities to consume those fats, fats that very well may have been in their scope of daily food intake prior to the diet. Most people I've met on Atkins' plan or a facsimile thereof have bacon and eggs for breakfast, but they stop eating the cereal. For lunch they have a cheeseburger sans the bun. Bread, cakes, pastries, and other carb foods are very calorie dense. Most Americans are filling their mouths with high carb foods, thus if you eliminate carbs, you're eliminating MOST of their caloric intake and a significant portion of their pre-diet fat intake. A steak, although it is higher in fat than many carb foods, is also more water dense, thus, when you take out the carb foods, it becomes quite challenging to keep caloric intake high!
It's also meaningful to note that a diet composed primarily of protein and fat will decrease appetite by two separate mechanisms. By eliminating erratic sugar intake you stabilize blood sugar minimizing sugar-induced food cravings, and by stimulating certain amino-acids to cross the blood-brain barrier in greater amounts, you develop a greater sense of satiety. That means that not only are you taking in fewer calories, but your desire for food is decreasing leading to a continual drop of caloric consumption. That is precisely the type of calorie restrictive diet Atkins claims has failed America!
Will people lose weight on any diet of reduced calories? Of course! But is that healthful and permanent? Another question up for serious debate. Let's go back and look at some of what might happen after the water loss. Remember, glucose (stored as glycogen) is the preferred source of fuel for muscle contraction. In a state of calorie deprivation combined with the absence of that preferred fuel source the body finds a way of creating its own glucose, the blood sugar that it's lacking. It can manufacture blood sugar from amino acids. Amino acids are the building blocks of proteins, and there are three of them, known as the Branched Chain Amino Acids, leucine, valine, and isoleucine, that can be simply converted into glucose. You can get these amino acids by breaking apart complete proteins and simply metabolizing the other amino acids or dismissing them from your body as waste.
If I've confused you, I want to un-confuse you. I want you to understand this. Let me make it a bit simpler. Carb intake is severely reduced. Your body wants for glucose beyond that being supplied so it makes its own. It uses amino acids as the raw material. To get those amino acids, it must break down either dietary protein . . . or muscle tissue! Since muscle, as opposed to fat, is tissue that actually burns calories, this process slows metabolism and increases the likelihood that when you go off of the low-carb diet, you'll wind up gaining back all of the weight you lost plus additional fat.
BUT . . . WE'RE ALL CARB SENSITIVE?!?!?
The low carb proponents throw the term "carb sensitivity" around and often claim that all Americans, due to their unsupportive eating habits, have developed a case of this mysterious ailment.
It appears, based on clinical research, that 10-25% of Americans do have some level of insulin resistance (carb sensitivity). Conclusive research has clearly shown that improvements in body composition (lean body mass vs. fat) and regular exercise are far more important in offsetting the challenges of insulin resistance than cutting back carbs.
IS A CARB A CARB?
There's no question that a gradual American shift to pretzels, Snackwell cookies, and processed bagel breakfasts has led to impaired carbohydrate metabolism in some individuals, but there's no reason to throw the baby out with the bath water. Carbohydrates are a nutrient, and nutrient, by definition, means "something your body needs to ingest to sustain life." There's obviously a flaw with any program that asks people on a massive scale to eliminate intake of a vital nutrient. With a true understanding of the differences between complex carbs and simple sugars, it becomes possible to eliminate the true culprits (simple and refined sugars) and reacquaint carb sensitive individuals with supportive metabolism of high quality valuable complex carbs (along with protein, fats, vitamins, minerals, and an optimal supply of water).
WON'T THIS LOW CARB PLAN HELP MY METABOLISM?
I'm amazed that so many people buy into the claim that these low-carb diets will stimulate metabolism when I can't find a shred of evidence that lends itself toward that direction. In fact, in the absence of carbs and necessary calories, not only do you run the risk of slowing metabolism through muscle loss, but the thyroid gland also performs a neat little trick. It alters its production of the hormones T3 and T4, hormones instrumental in regulating body heat, to "protect" the body from starvation. This results in a further slowdown of metabolism and can lead to long term thyroid challenges.
I believe, since there isn't any disagreement that exercise is going to be a definite positive factor in fat reduction, fitness, health, and alleviation of disease risks, and since glycogen is fuel for muscle contraction, it's more than obvious that exercisers benefit from ample supplies of glycogen, that fuel obtained from carbohydrates. It's important to protect metabolism so the body learns to efficiently utilize carbs as fuel, proteins for cell repair and maintenance, and essential fats for their inherent biological value as components of cells.
More than ever, people need to be educated, and until enough evidence leads to indisputable proof of a regimen's value and validity, there will be disagreement over "the best way" to find health and well being.
I want to emphasize that I do not hold any personal vendetta against Dr. Atkins as a person and I'm truly sorry to hear of his passing. I believe his stand and his presence inspired the medical community to question, and as science is always nothing more than a "best guess," questions are the path to obtaining a higher level of clarity. Are there people who will lose weight and be satisfied with the "Atkins Way of Eating?" Sure, but I don't believe that makes this a sound weight loss solution for the masses. Every diet being aggressively promoted, most of which fail most people, has some sort of driving testimonial behind it. Usually those testimonials refer to pounds lost, not to improvements in body composition.
As a lifetime learner myself, I encourage you to continue to seek out additional information, to read Dr. Atkins books, and, if you are considering a low-carb diet, to do so with professional supervision and direction. I welcome your responses and feedback related to this article. E-mail email@example.com.
A Final Note:
If you are concerned that the information I've provided is based solely on my opinion, I assure you I've spent years researching this.
- Entering a high Protein twilight zone. Tufts University Diet & Nutrition Letter 1996; 14(3):4-6
- Coyle, EP, Fat metabolism during exercise. Sports Sci Exch 1995; 8(6):1-6
- Coyle, EP, Coggan, AR, Hemmert WK, et al: Muscle glycogen utililization during prolonged strenuous exercise when fed carbohydrate. J Appl Physiol 1986; 61(1): 165-172
- Is pasta now on the 'out' list too? Tufts University Diet & Nutrition Letter 1995; 13(3):4-6
- Coleman, Ellen, RD, MA, MPH, Carbohydrate Unloading, The Physician and Sports Medicine. 1997, 25(2):97-98
- Low Carbohydrate, high-protein diet: the way to lose weight? University of California at Berkeley Wellness Letter, December 1992
- Centers for Disease Control and Prevention, National Center for Health Statistics, Division of Health Examination Statistics. 1996.
- Golay A; Allis AF; Morel Y; de tonic N; Tankova S; Reaven G. Similar weight loss with low or hig-carbohydrate diets. Am J Clin Nutr, 1996; 63(2):174-178
- Position Statement of the American Dietetic Association: Weight Management
- Weintraub M, Long term weight control study: conclusions. Clin Pharm Ther. 1992; 51:642-646
- Bravata DM, Sanders L, Huang J, Krumholz HM, Olkin I, Gardner CD, Bravata DM. Efficacy and safety of low-carbohydrate diets: a systematic review. Center for Primary Care and Outcomes Research, Stanford University School of Medicine. JAMA 2003 Apr 9;289(14):1837-50
- Westman, E.C., et al. 2002. Effect of a low carbohydrate ketogenic diet program on fasting lipid subfractions. American Heart Association Scientific Sessions. Nov. 17. Chicago.
- Eric D. Westman, M.D., Duke University, et al., American Journal of Medicine, July 2002
- Eat, Drink, and Be Healthy: The Harvard Medical School Guide to Healthy Eating by Walter Willett
- Heshka S, et al. Weight Loss With Self-help Compared With a Structured Commercial Program: A Randomized Trial. JAMA 2003 Apr 9;289(14):1792-8
That's only a tiny sampling of the research material I've amassed on the topic. I have also studied hundreds of additional relevant articles published in the American Journal of Clinical Nutrition, International Journal of Obesity, Journal of the American Medical Association, Journal of the American Dietetic Association which could all be held up as evidence to support the value of maintaining a reasonable carbohydrate intake. I've also referenced materials from and/or conversations with many health and fitness professionals ranging from educators to nutritionists.