I'm almost certain that you are reading this book because you know of someone who has lost weight—and likely overcome other health problems—by following the individualized nutritional approach you've been reading about here. And you've decided you want to feel good, look good and be revitalized, too.

But you may be wondering why not everyone acknowledges the fact (and it is a fact) that controlling carbohydrates the Atkins way is the ideal eating strategy for losing weight and promoting good health. One reason the Atkins Nutritional Approach has not been a part of mainstream teaching (although the fide is beginning to change, as well it should) has been misinformation.

If you've encountered these critical articles suggesting that Atkins is dangerous, not to mention ineffective, you may have mixed feelings about starting a lifetime of controlled carbohydrate eating. Let me ease your misgivings: It is clear to'mo—and to every doctor I've met who las had adequate experience with Atkins——that this program should be the "treatment of choice" not only for obesity tut for dishem and several other diet-related disorders. The misinformarion saddens me, because it has prevented so many people in need from using and benefiting from the best treatment available. In effect, these iii-informed n.-views are propagating epidemic, life-threatening conditions.

That is why I am taking the time here, before we start "Part Two: How to Do Atkins—-Today and for Life" to address these criticisms. I don't want you to have any lingering questions or doubts as you read through the remaining sections of the book. Too much is at stake: namely, your health and well-being.

Modem medical history contains few examples of such vast discrepancies between what is said in print and the truth. You may find that the explanations in this chapter sound a bit scientific, This was done on purpose. I want you to have the full complement of information at your disposal to counter any challenge you get. Armed with information gleaned from my forty years of clinical experience, and with the support of specific scientific studies, you will be able to hold your own and likely to sway opinion—in any debate that comes your way.

Fact vs. Fallacy

Fallocy # 1: Ketosis is dangerous and causes a variety of medical problems.

Fact: Our bodies have only two fuel delivery systems to provide us with energy. Our primary fuel is based on carbohydrate and is delivered as F, lucose. Pcople who eat three socalled "balanced" meals every day get ritually all their energy from glucose. But the alternate, back-up fuel is stored fat, and this fuel system delivers energy by way of ketones whenever our small supplyof glucose is used up (in a maximum of two days).

When a person doing Atkim releases ketones, he or she is in ketosis. Ketosis occurs when you are taking in a very low level of carbohydrate from the food you eat, as you will durins much of the weight loss phases of Atkins. Ketones are secreted in the urine (and at times in one's breath), a prefectly normal and natural function of the body. The more ketones you release, the more fat you have dissolved.

Part of this fallacy is the claim that ketones can build up to dangerous levels in the body. Studies show that ketone bodies are very tightly regulated in the body and will not increase beyond the normal range in healthy individuals. (Uncontrolled diabetics, alcoholics, and people who have been on prolonged fasts might see an increase in ketones beyond the normal range.) The body regulates ketone levels the same way it regulates blood-glucose or pH levels. And in the clinical setting of my practice, it has been repeatedly demonstrated that overweight patients produce just enough ketones to meet their immediate needs for fuel—and no more. A person will have no more ketones after three months of controlling carbohydrates than they do after three days. it is highly unlikely that people, other than insulindependent diabetics, will build up ketones.

Confusion about ketosis often comes from people mistaking it for ketoacidosis, a condition found in Type I diabetics; this occurs when a person's blood sugar is out of control and he or she cannot produce insulin. No doctor should have trouble differentiating physiologic ketosis, which you will experience doing Atkins, from kctoacidosis. Further, since people are often overweight specifically because of an overabundance of insulin, it is essentially impossible for them to he in ketoacidosis.

Some individuals at the ketogcnic level of controlled carhohydrate eating may experience mild symptoms such as unusual breath odgr and constipation (see Fallacies #12 and #14). However, the vast majority of individuals do not develop problems. One study of a severely ketogenic diet showed dmt ketosis was benign, with no complications or side effects when studied in metabolic ward conditions. The month-long study documented heart, kidney, liver and bloodcell functions in the patients and found no adverse effects?

In other studies, it has been shown that bone health was not compromised and that renal (kidney) function was found to be stable on controlled carbohydrate diets. Supporting what we know from years of clinical, practice, there is even scientific literature on hyperlipidemia (elevated blood fats—i.e., cholesterol and triglycerides), showing improved values on controlled carbohydrate diets.

So the next time you read that the ketosis produced by the Atkins Nutritional Approach is dangerous, challenge the writer (in a letter to the editor, if necessary) and ask:"What is so dangerous about using up your stored fat?"

Fallacy #2: The Atkins Nutritional Approach is only effective for weight loss because calories are restricted.

Fact: While some people who follow the Atkins Nutritional Approach may eat fewer calories than before, it certainly is not because the program limits calorie intake. People doing Atkins may end up eating fewer calories because they are generally less hungry and no longer obsessed with food.

This occurs for two reasons:

1.Stable blood sugar throughout the day ensures that you will have fewer food cravings and false hunger pains.

2.The food eaten by a person doing Atkins (Mt, fish, cheese, nuts, eggs, and low-sugar/low-starch vegetables and frei0 is less processed and more nutritious than that on the typical pre-Atkins menu. Give a body fewer empty calories, provide it with more nutrientdense alternatives and it will logicnHy be satisfied sooner and require less food.

Let's look at the results of the study mentioned in Chapter 7 that supports these conclusions. Researchers at New York's Schneider Children's Hospital studied forty obese patients, ages 12 to 18; who were split into two groups. We already mentioned that the low-fat group lost half as much weight on 1,100 calories per day as did the controlled carbohydrate group, which was allowed unlimited calories and, on average,ate 1,830 calories per day.

What's even more exciting is that the controlled carIx)hydrate group enjoyed further health benefits—far from suffering the dangers some warn of with the controlled carbohydrate nutritional approach. Lipid profiles (cholesterol and triglycerides) improved more than those on the low-fat program.

Also, those on the controlled carbohydrate diet showed better long-term compliance than those on the low-fat diet. A year later, seven out of eight of those following the controlled carbohydrate approach were still involved with the program as opposed to none on the Low-fat diet.TM

Fallacy #3: The weight lost on the Atkins Nutritional Ap. proach is mostly water, not fat.

Fact: It is typical of any weight loss plan, including the Induction phase of Atkins, that during the first few days, or even the first week, some of the weight loss will be water loss. However, when you follow a controlled carbohydrate eating plan, your body switches from burning carbohydrate to burning stored fat for energy, resulting in the loss of stored fat. In fact, research shows that even when water is lost during the first few days on a controlled carbohydrate nutritional approach, the water balance soon returns to normai, and the weight loss comes from burning body fat for energy? The most dramatic sign of this loss is seeing the inches drop off your measurements.

Fallaty #4: The Atkins Nutritional Approach is unbalanced and defwient in basic nutrition.

Fact: At, ns Nutritional approach actually provides more nutrients than the typical American diet. It deliberately. rebalances your way of eating. It is probable that the eating pattern that led to your weight gain Was improperly balanced in the first place. The evidence showing that overproduction of insulin is responsible for most weight gain is quite irapressive, and the best way to correct an insulin disorder is to avoid foods that stimulate insulin activity—that is, foods high in carbohydrates.

However, the Atkins Nutritional Approach does not exclude these foods (fruits, vegetables and grains). The Induction phase of Atkins, which people often mistake for the entire pwgram, is the most strict, permitting only 20 grams of carbohydrates each day. Those 20 grams come in the form of green, leafy vegetables and also can include nutrientdense, high-fiber, low-carbohydrate vegetables such as broccoli, asparagus, eggplant and spinach. Hardly foods lacking in nutrients!

A sample Induction menu containing 2,000 calories and 20 grams of carbohydrate was analyzed using the highly regarded "Nutritionist V" program (the computer program used by nutritionists worldwide). Results of the analysis found the menu to meet or exceed Recommended Daily Intake (RI)l) requiremeats of nineteen of the twenty-four vitamins, minerals and trace elements, and the remaining few (panic acid, sodium, magnesium, copper, chromium and molybdenum) can easily be replaced with a supplement (see page 134). Once they complete Induction and begin the next phase of the program, individuals can raise their carbohydrate gram count. This phase prescribes even more nutrient-dense, green, leafy vegetables and fruits such as strawberries. With these additions, the plan far exceeds requirements for fiber.

The second part of this criticism is more thought. provoking. I, for one, am deeply committed to finding a vitanutrient solution for most health problems. This means that I believe no eating pattern contains optimal nutrition, and that all of us can improve our health by taking vitanutrients that are targeted to our individual health problems, disease risks and nutrient deficiencies.

That said, let's look at the esscntial-nutrient contributions made by the foods people cat on Low-fat diets. These foods are low in the fat-soluble vitamins A, D, E and K and the essential fatty acids, our number-one deficiency in this country. They also may be low in nutrients we get from meat, such as vitamin Bt2 and carnitine. And if people overeat foods made from white flour—which is often the case on low-fat diets—-they will be Low in half the B complex nutrients (the half that isn't included in the mandatory enrichment) and most of the essential minerals. People on a low-fat diet need supplementation desperately.

Fallacy #5: People doing Atkins may feel tired, weak and lacking in energy.

Fact: Fatigue may occur during the first few days of doing Atkins, while the body adapts to the switch in metabolic pathways. It typically takes about three to four days for the body to convert from a sugar metabolism to a primarily fat metabolism. Your body can store carbohydrates for only up to fortyeight hours, so you can be confident that your metabolic switch will occur, as long as you are doing Atkins properly.

After the transition, those people who were tired at first usually report high energy and clear thinking throughout the day. The explanation is simple: They have rebalanced their nutrition so that their blood sugar is stabilized. They avoid blood-sugar peaks and valleys throughout the day, putting an end to mood swings and periods of lethargy. And those people who consume a full vitanutrient program are much less likely to feel weak or tired even at the start of Atkins.

Fallacy #6: You eat too much protein when doing Atkins, which is bad for the kidneys.

Fact: Too many people believe this untruth simply because it has been repeated so often that even intelligent health professionals assume it must have been reported somewhere. But the fact is that it has never been reported anywhere. I have yet to see someone produce a study for me to review, or even cite a specific case in which a protein-containing diet causes any form of kidney disorder.

The only remotely related phenomenon is the fact that when someone is already suffering from far-advanced kidney disease, it is difficult for that person'sbody to handle protein. But protein has nothing to do with the cause of fife kidney problem.

Fallacy #7: Atkins is high in fat, and we all know that fats cause gallbladder disease.

Fact: There is now overwhelming scientific evidence that gallstones (responsible for over ninety percent of gallbladder disease) are formed when fat intake is low. In a study mat examined the effects of a diet that provided 27 grams of fat per day, gallstones developed in thirteen percent of the participants? The reason is that the gallbladder will not contract unless fat is taken in, and if it doesn't contract, a condition called biliary stasis develops add the bile salts crystallize into stones. Our gallbladders need to he kept active to prevent stone formation.

It is not uncommon to find gallstones in people who are obese, although the gallstones may not be causing discomfort. People with existing stones may, however, have trouble with high-fat meals. If you are one of these people you may have to slowly increase the level of fat you eat according to your own tolerance—-meaning, how you feel. Remember, gallstones are notformed overnight. SO anyone who tells you they started doing Atkins and two weeks later developed gallstones doesn't fully understand the medical situation.

Fallacy #8: The Atkins Nutritional Approach is deficient in bone-building calcium and has a negative impact on cal.

Fact: While you're doing Atkins you will get one hundred percent of the RDI of calcium from foods such as cheese, and kale. (Milk is only one source of calcium, so even if you're not drinking it, you can still meet your needs.) In addition, in a study published in the American Journal of Nutrition, researchers followed four male adults and studied the shortterm and long-term effects of a high-meat diet on calcium metabolism. The study found no significant changes in calcium balance, nor was there any significant change in the intestinal absorption of calcium during the high-meat diet?

Fallacy #9: A nutritional approach that promotes a liberal intake of high-fat meats and dairy products will raise cholesterol levels, ultimately leading to heart disease.

Fact: I certainly do not deny that every major health organization, as well as the United States government, endorses a low-fat diet in the unquestioned belief that fat causes heart disease. But are they fight? A good deal of compelling evideuce points in the opposite direction.

A growing body of scientific literature demonstrates that a controlled carbohydrate eating plan, if followed correctly, promotes heart health and improves clinical health markers. One study, conducted by Jeff S. Volek, MS, RD, PhD, while st Ball State University, showed the positive effects of a controlled carbohydrate nutritional approach on triglyceride levels. The study consisted of twelve healthy men, ages 20 to 55, who followed a controlled carbohydrate program adhering to the Atkins protocols for eight weeks. Upon completion of the study, each participant lowered his triglyceride levels by an avenge of fifty-five percent?

Furthermore,this study showed that a higher-cadbohydrate diet results in increased levels of triglycerides and decreased levels of HDL cholesterol (the good kind). These factors have been associated with higher risks of myocardial infarction, ischemic heart disease and coronary heart disease events.In addition, various researchers have demonstrated that high lriglycerides and low HDL alone—as opposed to the total cholesterol number most of us focus on—may be the most important factors in heart disease and stroke?

We also can look at the research that's come ont of Framingham, Massachusetts—the community studied for fifty years by Harvard researchers to glean meaningful informarion about the cause of heart disease. This research showed that the risk of heart disease increased both with high cholesterol levels and obesity, but their data showed that weight gain and cholesterol levels were inversely cormlated with dietary fat and cholesterol intake! In other words, consuming less fat and cholesterol resulted in more weight gain and higher blood cholesterol.

More recently, the Framingham researchers reported on a study in which the young, healthy, male population of the community was followed for several decades to see which dietary patterns might lead to having a stroke. To their amazement, they found that those with the highest intake of saturated fats had the fewest ischemic strokes (the most common kinds), a whopping seventy-six percent less than those with the lowest intake of saturated fat?

Fallacy #1O: The Atkins Nutritional Approach is the "most severe" of the controlled carbohydrate plans and is most likely to have immediate adverse effects.

Fact: Since there's nothing harmful about a controlled carbohydrate nutritional approach, the concept of severity isn't especially meaningful. The idea of severity surely comes from the low level of carbohydrate consumed during the Induction phase. Induction's purpose is to jump-start the body chemistry into fat mobilization. Throughout the other phases of Atkins, each individual seeks the most permissive level of carbohydrate intake that still resultsin weight loss or weight maintenance.

Fallacy #11: The bad thing about Atkins is that it makes you crave sweets!

Fact: Craving is a symptom of addiction, and the surefire cure for addiction is abstinence. Atkins, with the help of chromium and glutamine supplements, allows yon to get on with the project of dealing with your addiction. For almost everyone with sugar addiction, A tkins is the most effective treatment.

I have treated thousands of patients whose cravings come back as a result of a few unfortunate deviations from the plan. These cravings can he reined in simply by adhering to Atkins. Incidentally, in my experience, the controlled carbohydrate approach can be an extremely effective adjunct to the processes of breaking other addictions, including alcohol and cigarette dependencies.

Fallacy #12: Atkins causes bad breath.

Fact:Well, actually, it causes ketone breath. Ketones, which impart a sweetish smell, do not cause what I would call bad breath. It's a different breath smell to he sure, but not an of. fensive one. I have not noticed it among my patients for years; perhaps i simply consider it normal. In any case, this condition, if it exists at all, is likely to last only as long as yon are doing the Induction phase of Atkins. Try drinking more water, or every now and then chew a little fresh parsley. And, on the positive side, it is proof that your body has switched to the alternative metabolic pathway of burning fat for fuel.

Fallacy #13: People on Atkins learn to eat fatty foods tike bacon and eggs, so if they stop doing the program they are worse off than before.

Fact:For an overweight person, Atkins provides the single best opportunity to find a nutritional approach he or she can live with, without developing the dele to abandon it. The fact that it includes some high-fat, rich foods is exactly what enables people to follow this nutritional plan, eat things that feel satisfying and enjoy the good overall health the plan promotes.

Fallacy #14: The Atkins Nutritional Approach causes constipation because it lacks fiber.

Fact: The Atkins Nutritional Approach includes fiber-rich foods such as spinach, eggplant, broccoli, asparagus and leafy greens. It also includes fruits such as berries. In addition, if more fiber is needed during the Induction phase, I recommend a fiber supplement. This is unnecessary in the Ongoing Weight Loss phase and beyond because more fruits and vegetables are introduced into the eating plan.

Fallacy #15: It is impossible to keep. off the weight lost on the Atkins Nutritional Approach for the long term.

Fact: That statement applies better to Low-fat or low-calorie diets. After all, nothing is more difficult to endure for a lifetime than being constantly hungry. Atkins, from the start, allows you to cat until you feel satisfied. Furtlm'more, the variety of foods allowed on Atkins provides a diverse menu that is neither complicated nor boring and helps people stay motivated to change their eating patterm forever.

Don't just take my word for it turn to the "Food and Recipes" section beginning on page 367 and see for yourself. Additionally, in the time since the last edition of this book was published, numerous companieshave introduced controlled carbohydrate versions of bars, shakes, syrups, candy, chips, desserts, bread, ice cream and mote, including my own company. It has never been easier to stay with an eating plan that offers you the full spectrum of delicious foods in quantifies that leave you satisfied.