Atkins diet

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The Atkins diet, officially called the Atkins Nutritional Approach, is a low-carbohydrate diet created by Dr Robert Atkins from a diet he read in the Journal of the American Medical Association and used to resolve his own overweight condition. He later popularized the Atkins diet in a series of books, starting with Dr. Atkins' Diet Revolution in 1972. In his revised book, Dr. Atkins' New Diet Revolution, he modified or changed some of his ideas, but remained faithful to the original concepts.

Atkins franchise, a business formed to provide products to those individuals on the diet, was highly successful due to the popularity of the diet, and is considered the driving entity of the larger "low-carb craze" [2] during the early millennium. However its success dwindled and Atkins Nutritionals of Ronkonkoma, New York, the company founded by Dr Atkins in 1989, filed for Chapter 11 bankruptcy in January 2005, two years after his death. The company re-emerged in January 2006, and the Atkins logo is still highly visible through licensed-proprietary branding for food products and related merchandise.
Dr Atkins' New Diet Revolution book

Contents

[edit] Nature of the diet

The Atkins Diet is a departure from the previously prevailing metabolic theories. Atkins said that there are important unrecognized factors in Western eating habits leading to obesity. Primarily, he believed that the main cause of obesity is eating refined carbohydrates, particularly sugar, flour, and high-fructose corn syrups.

The Atkins Diet involves restriction of carbohydrates to more frequently switch the body's metabolism from burning glucose as fuel to burning stored body fat. This process (called ketosis) begins when insulin levels are low; in normal humans, insulin is lowest when blood glucose levels are low (mostly before eating). Caloric carbohydrates (e.g., glucose or starch (itself made of chains of glucose)) produce most of the blood sugar after meals and can be calculated to even determine the insulin needs of diabetics.[1] Because of its low digestibility, fiber provides little or no food energy and does not significantly impact glucose and insulin levels. Ketosis involves lipolysis in which some of the lipid stores in fat cells are transferred to the blood.

In his book Dr Atkins' New Diet Revolution, Dr. Atkins made the controversial argument that the low-carbohydrate diet produces a metabolic advantage in which the body burns more calories, overall, than on normal diets, and also expels some unused calories. He cited one study where he estimated this advantage to be 950 calories (4.0 MJ) a day. However, a review study published in the Lancet concluded that there was no such metabolic advantage and dieters were simply eating fewer calories due to boredom. Professor Astrup stated, "The monotony and simplicity of the diet could inhibit appetite and food intake" The Atkins Diet restricts "net carbs" (digestible carbohydrates that impact blood sugar). One effect is a tendency to decrease the onset of hunger, perhaps due to longer duration of digestion (fats and proteins take longer to digest than carbohydrates). Dr. Atkins says in Dr. Atkins' New Diet Revolution (2002) that hunger is the number one reason why low-fat diets fail. Although studies show the efficacy of the Atkins approach after one year is the same as some low-fat diets, it was easier, according to Atkins, to stay on the diet because dieters did not feel as hungry or "deprived".[citation needed]

Net carbohydrates can be calculated from a food source by subtracting fiber and sugar alcohols (which are shown to have a smaller effect on blood sugar levels) from total carbohydrates. Sugar alcohols contain about two calories per gram, and the American Diabetes Association recommends that diabetics count each gram as half a gram of carbohydrate.[2] Fructose (e.g., as found in many industrial sweeteners) has four calories per gram, although it has a very low glycemic index[3] and does not cause insulin production, probably because ß cells have low levels of GLUT5.[4][5]

Preferred foods in all categories are whole, unprocessed foods with a low glycemic index, although restrictions for low glycemic carbohydrates (blackrice, vegetables, etc.) are the same as those for high glycemic carbohydrates (sugar, white bread). Atkins Nutritionals, the company formed to market foods which work with the Atkins Diet, recommends that no more than 20% of calories eaten while on the diet come from saturated fat.[6]

According to the book Atkins Diabetes Revolution, for people whose blood sugar is abnormally high or who have Type 2 diabetes mellitus, this diet decreases or eliminates the need for drugs to treat these conditions. The Atkins Blood Sugar Control Program (ABSCP) is an individualized approach to weight control and permanent management of the risk factors for diabetes and cardiovascular disease.[7] Nevertheless, the causes of Type 2 diabetes remain obscure, and the Atkins Diet is not accepted in conventional therapy for diabetes.

[edit] The Four Phases

There are four phases of the Atkins diet: induction, ongoing weight loss, pre-maintenance and lifetime maintenance.

[edit] Induction

The Induction phase is the first, and most restrictive, phase of the Atkins Nutritional Approach. Two weeks are recommended for this phase. It is intended to cause the body to quickly enter a state of ketosis. Carbohydrate intake is limited to no more or less than 20 net grams per day (grams of carbohydrates minus grams of fiber, sugar alcohols, or glycerin), 12 to 15 net grams of which must come in the form of salad greens and other vegetables (broccoli, spinach, pumpkin, cauliflower, turnips, tomatoes, and asparagus, to name a few of the 54 allowable vegetables [but not legumes, such as green beans, since they are too starchy for the induction phase]). The allowed foods include a liberal amount of all meats, poultry, fish, shellfish, fowl, and eggs; up to 4 ounces (113 g) of soft or semi-soft cheese such as cheddar cheese; salad vegetables; other low carbohydrate vegetables; and butter, olive oil and vegetable oils. Drinking eight glasses of water per day is a requirement during this phase. Alcoholic beverages are not allowed during this phase.[8] Caffeine is allowed in moderation so long as it does not cause cravings or low blood sugar. If a caffeine addiction is evident, it is best to not allow it until later phases of the diet.[8] A daily multivitamin with minerals, except iron, is also recommended.

The Induction Phase is usually when many see the most significant weight loss — reports of losses of 5 to 10 pounds per week are not uncommon when Induction is combined with daily exercise. Many Atkins followers make use of Ketostix, small chemically reactive strips used by diabetics. These let the dieter monitor when they enter the ketosis, or fat burning, phase, but are not always accurate for non-diabetic users. Other indicators of ketosis include a metallic taste in the mouth, or bad breath.

[edit] 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. The target daily carbohydrate intake increases each week by 5 net grams. A goal in OWL is to find the "Critical Carbohydrate Level for Losing" and to learn in a controlled manner how food groups in increasing glycemic levels and foods within that group affect your craving control. The OWL phase lasts until weight is within 10 pounds (4.5 kg) of the target weight. During the first week, one should add more of the induction acceptable vegetables to one's daily products. For example, 6-8 stalks of asparagus, salad, one cup of cauliflower or one half of avocado. The next week, one should follow the carbohydrate ladder that Dr Atkins created for this phase and add fresh dairy. The ladder has 9 rungs and should be added in order given. One can skip a rung if one does not intend to include that food group in one's permanent way of eating, such as the alcohol rung. The rungs are as follows:

  • Induction acceptable vegetables in larger quantities
  • Fresh cheese
  • Nuts and seeds
  • Berries
  • Alcohol
  • Legumes
  • Other fruits
  • Starchy vegetables
  • Whole grains

[edit] Pre-maintenance

Carbohydrates intake is increased again this time by 10 net carbs a week from the ladder groupings, and the key goal in this phase is to find the "Critical Carbohydrate Level for Maintenance", this is the maximum number of carbohydrates you can eat each day without gaining weight. This may well be above the level of carbohydrates inducing ketosis on a testing stick. As a result, it is not necessary to maintain a positive ketosis test long term.

[edit] 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 emphasized, with the option to drop back to an earlier phase if you begin to gain weight.

[edit] Popularity

The Atkins Nutritional Approach gained widespread popularity in 2003 and 2004. At the height of its popularity one in eleven North-American adults were on the diet.[9] This large following was blamed for large declines in the sales of carbohydrate-heavy foods like pasta and rice (sales were down 8.2 and 4.6 percent, respectively, in 2003[10]). The diet's success was even blamed for a decline in Krispy Kreme sales [3]. Trying to capitalize on the "low-carb craze," many companies released special product lines that were low in carbohydrates. Coca-Cola released C2 and Pepsi-Cola created Pepsi Edge, which was scheduled to be discontinued later in 2005. Unlike the sugar-free soft drinks Diet Coke and Diet Pepsi, which had been available for decades, these new drinks used a blend of sugar and artificial sweeteners to offset the flavour of artificial sweetener. These "half-and-half" drinks declined in popularity as soft drink makers learned to use newer sweeteners to mask the flavour of aspartame (or completely replace it) in reformulated diet drinks such as Coca-Cola Zero and Pepsi ONE.

Low-carbohydrate diets and the societal changes they have caused have been a subject of interest in the news and popular media. Coverage has included among other things a one-hour documentary television special called The Low Carb Revolution on Food Network Canada, on April 25, 2004.

In 2003, Robert Atkins died from a fatal head injury sustained in a fall on ice.[11] His untimely death came after a battle with a heart condition, cardiomyopathy, supposedly caused by a viral infection, which had caused noticeable weight fluctuation in his final years. This combination of circumstances led to rumors and allegations that Dr. Atkins had died from complications arising from his namesake nutritional plan. However contemporary accounts from his physicians did not substantiate these rumours.[12][13][14] Nevertheless the reputation of the nutritional plan, and the low-carbohydrate concept in general, suffered.

On July 31, 2005, the Atkins Nutritional company filed for Chapter 11 bankruptcy protection after the percentage of adults on the diet declined to two percent and sales of Atkins brand product fell steeply in the second half of 2004. The company continues to operate and the diet plan remains popular although it has never regained its former popularity.

[edit] Scientific studies

Main article: Medical research related to low-carbohydrate diets

Because of the substantial controversy regarding the Atkins Diet and even disagreements in interpreting the results of specific studies it is difficult to objectively summarize the research in a way that reflects scientific consensus.[15][16] Although there has been some research done throughout the twentieth century,[17][18] most directly relevant scientific studies, both those that directly analyze the Atkins Diet and those that analyze similar diets, have occurred in the 1990s and early 2000s and, as such, are relatively new. Researchers and other experts have published articles and studies that run the gamut from promoting the safety and efficacy of the diet[19][20] to questioning its long-term validity[21][22] to outright condemning it as dangerous.[23][24] Until recently a significant criticism of the Atkins Diet was that there were no studies that evaluated the effects of Atkins beyond a few months. However, studies are emerging which evaluate low-carbohydrate diets over much longer periods, controlled studies as long as two years and survey studies as long as two decades.[19][25][26][27]

In addition to research on the efficacy of Atkins and other low-carbohydrate diets some research has directly addressed other areas of health affected by low-carbohydrate diets. For example, contrary to popular belief that low-carbohydrate diets damage the heart, one study found that women eating low-carbohydrate, high-fat/protein diets had the same or slightly less risk of coronary heart disease, compared to women eating high-carbohydrate, low-fat diets.[28] Other studies have found possible benefits to individuals with diabetes,[29] cancer,[30][31] and epilepsy.[32][33] Nevertheless some studies demonstrate potentially harmful effects of certain types of low-carbohydrate diets including various metabolic and emotional side-effects.[34]

In 2009 a multi-center prospective randomized trial of 811 overweight adults compared four diets emphasizing varying ratios of fat, protein and carbohydrate.[35] All diets were designed to create a 750 kcal deficit. Participants who completed the study lost an average of 4 kg regardless of diet composition. Most of the weight loss occurred in the first six months with some regain by 2 years. Blood pressure changes and waist circumference were also similar between groups, though the low fat diet yielded greater reduction in LDL ("bad cholesterol").

[edit] Controversies

An analysis conducted by Forbes magazine found that the sample menu from the Atkins Nutritional Approach is one of the top five in the expense category of ten plans Forbes analyzed. This was due to the inclusion of recipes with some high cost ingredients such as lobster tails which were put in the book to demonstrate the variety of foods which could be consumed on the diet. The analysis showed the median average of the ten diets was approximately 50% higher, and Atkins 80% higher, than the American national average. Atkins was less expensive than Jenny Craig and more expensive than Weight Watchers.[36]

Low-carbohydrate diets have been the subject of heated debate in medical circles for three decades. 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:

  • Dr. Robert Eckel of the American Heart Association says that high-protein, low-carbohydrate diets put people at risk of heart disease [4]; A long term study published in the New England Journal of Medicine in 2006 found that women reduced heart disease risk by eating more protein and fat from vegetable sources.[37]
  • A 2001 scientific review conducted by Freedman et al. and published in the peer reviewed scientific journal Obesity Research concluded that low-carb dieters' initial advantage in weight loss was a result of increased water loss, and that after the initial period, low-carbohydrate diets produce similar fat loss to other diets with similar caloric intake.[38]
  • The May 2004 Annals of Internal Medicine study showed that "minor adverse effects" of diarrhea, general weakness, rashes and muscle cramps "were more frequent in the low-carbohydrate diet group".
  • Concerns have been raised regarding consumption of high levels of protein in individuals with medical conditions such as kidney disease or gout.

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 (calories) below the maintenance level and that weight loss from the Atkins diet may be the result of less food energy being consumed by the dieter, rather than the lack of carbohydrates.[39] They further point out that weight loss on fad diets, which typically restrict or prohibit certain foods, is often because the dieter has fewer food choices available.

[edit] Misconceptions about the diet

Many people incorrectly believe that the Atkins Diet promotes eating unlimited amounts of fatty meats and cheeses. This is a key point of clarification that Dr. Atkins addressed in the more recent revisions of his book. Although the Atkins Diet does not impose caloric restriction, or definite limits on proteins, Dr. Atkins points out in his book that this plan is "not a license to gorge." The director of research and education for Atkins Nutritionals, Collette Heimowitz, has said, "The media and opponents of Atkins often sensationalise and simplify the diet as the all-the-steak-you-can-eat diet. This has never been true."[6]

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. Atkins states that a dieter can safely stay at the Induction Phase for several months if the person has a lot of weight to lose.[40] Induction, however, is merely a stage to get the body used to fat, and cure cravings for unacceptable foods. Gradually, carbohydrate levels are raised to slow weight loss and add more acceptable foods (berries, more dairy, nuts, etc.), though carbs are still significantly below USDA norms. Once the weight-loss goal is reached, carbohydrate levels are raised again to a state of equilibrium where no weight is lost or gained, which may or may not be below USDA norms, depending on the individual's metabolism, age, and their exercise level.

[edit] Atkins Nutritionals

Main article: Atkins Nutritionals

Atkins Nutritionals, Inc. (ANI) was founded in 1989 by Dr. Robert Atkins to promote the diet and sell Atkins-branded products. Following his death, waning popularity of the diet and a reduction in demand for Atkins products, Atkins Nutritionals, Inc. filed for Chapter 11 bankruptcy protection on July 31 2005 citing losses of $340 million.[41] The company emerged from bankruptcy on January 10, 2006, introducing "a new business strategy that focuses on providing great-tasting portable foods with a unique nutrition advantage to healthy, active men and women."[42] Although the marketing focus has changed, the products are still low-carb. It is also stated on the packages the stage of the Atkins Nutritional Approach where they may be used.

[edit] Books

  • Robert C. Atkins (2004) Atkins for Life: The Complete Controlled Carb Program for Permanent Weight Loss and Good Health, 370pp, St. Martin's Press, ISBN 0-641-67892-4
  • Robert C. Atkins (2001) Dr. Atkins' New Diet Revolution book, 560 pp, Avon Books; Revised ed., ISBN 0-06-001203-X, ISBN 0-09-188948-0
  • Robert C. Atkins (2000) Dr. Atkins' Age-Defying Diet Revolution: A Powerful New Dietary Defense Against Aging, Saint Martin's Press, LLC, ISBN 9780312251895
  • Robert C. Atkins (1999) Dr. Atkins' Vita-Nutrient Solution: Nature's Answer to Drugs, 416 pp, Fireside Books (Simon & Schuster), ISBN 0-684-84488-5.

[edit] See also

[edit] References

  1. ^ Carbohydrate Counting.
  2. ^ Sugar Alcohols - Reduced Calorie Sweeteners.
  3. ^ Kaye Foster-Powell, Susanna H. A. Holt, and Janette C. Brand-Miller. July 2002. International Table of Glycemic Index and Glycemic Load Values: 2002. American Journal of Clinical Nutrition 76(1):5-56
  4. ^ D. L. Curry (1989). "Effects of Mannose and Fructose on the Synthesis and Secretion of Insulin". Pancreas 4 (1): 2–9. doi:10.1097/00006676-198902000-00002. PMID 2654926. 
  5. ^ Y. Sato, T. Ito, N. Udaka, et al. (December 1996). "Immunohistochemical Localization of Facilitated-Diffusion Glucose Transporters in Rat Pancreatic Islets". Tissue Cell 28 (6): 637–643. doi:10.1016/S0040-8166(96)80067-X. PMID 9004533. 
  6. ^ a b BBC (January 19, 2004) Atkins diet boss: 'Eat less fat'. BBC News. Retrieved on September 12, 2007.
  7. ^ Atkins Diabetes Revolution Robert C. Atkins
  8. ^ a b Atkins.com. Acceptable Foods. Atkins Nutritionals, Inc. Retrieved on September 12, 2007.
  9. ^ Atkins Bankruptcy a Boon for Pasta Makers : NPR
  10. ^ [1]
  11. ^ Statements on Atkins' death, USA Today, 2 Oct. 2004
  12. ^ Atkins diet author home after cardiac arrest, CNN, 25 April 2002
  13. ^ Weight-loss doctor dies at 72 from head injuries, USA Today, 18 April 2003
  14. ^ Dolson, Laura: How Did Atkins Die?: The Truth About Atkins' Death, About.com: Low Carb Diets, 2 October 2007
  15. ^ Taubes, Gary: What if It's All Been a Big Fat Lie?, New York Times, Sunday, July 7, 2002
  16. ^ Warner, Jennifer: Jury Still Out on Low-Carbohydrate Diets, MedicalNet.com, April 8, 2003
  17. ^ Lieb, Clarence W. (1926). The Effects of an Exclusive Long-Continued Meat Diet. http://www.bodybuilding.com/fun/md66.htm. 
  18. ^ Kekwick, A., Pawan, G.L.S. (1956). Calorie Intake in Relation to Body-Weight Changes in the Obese. pp. 155–161. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=13347103&dopt=Abstract. 
  19. ^ a b Iris Shai, R.D., Ph.D. (July 2008). "Weight Loss with a Low-Carbohydrate, Mediterranean, or Low-Fat Diet.". New England Journal of Medicine 359:229-241. http://content.nejm.org/cgi/content/short/359/3/229. 
  20. ^ Linda Stern, MD; Nayyar Iqbal, MD; Prakash Seshadri, MD; Kathryn L. Chicano, CRNP; Denise A. Daily, RD; Joyce McGrory, CRNP; Monica Williams, BS; Edward J. Gracely, PhD; and Frederick F. Samaha, MD (2004). "The Effects of Low-Carbohydrate versus Conventional Weight Loss Diets in Severely Obese Adults: One-Year Follow-up of a Randomized Trial". Annals of Internal Medicine 140 (10): 778–785. PMID 15148064. http://www.annals.org/cgi/content/abstract/140/10/778?etoc. 
  21. ^ Drs Arne Astrup, Thomas Meinert Larsen, Angela Harper (2004). "Atkins and other low-carbohydrate diets: hoax or an effective tool for weight loss?". Lancet 364(2004):589. http://www.theheart.org/article/157035.do. 
  22. ^ Carol S Johnston, Sherrie L Tjonn, Pamela D Swan, Andrea White, Heather Hutchins and Barry Sears (May 2006). "Ketogenic low-carbohydrate diets have no metabolic advantage over nonketogenic low-carbohydrate diets". American Journal of Clinical Nutrition 83. http://www.ajcn.org/cgi/content/abstract/83/5/1055. 
  23. ^ C. Tissa Kappagoda, MBBS, PhD, FACC*,*, Dianne A. Hyson, RD, MS, PhD{dagger} and Ezra A. Amsterdam, MD, FACC (2004). "Low-carbohydrate–high-protein diets: Is there a place for them in clinical cardiology? .". Journal of the American Medical Association 43: 725-730. http://content.onlinejacc.org/cgi/content/abstract/43/5/725?ijkey=403c54c990542393cf53bf14242831bd3400e289&keytype2=tf_ipsecsha. 
  24. ^ Charlotte E. Grayson, M.D., Loss: High Protein, Low Carbohydrate Diets, Web MD, retrieved 17 July, 2008
  25. ^ Thomas L. Halton, Sc. D., Walter C. Willett, M.D., Dr. P.H., Simin Liu, M.D., Sc. D., JoAnn E. Manson, M.D., Dr. P.H., Christine M. Albert, M.D., M.P.H., Kathryn Rexrode, M.D., and Frank B. Hu, M.D., Ph. D. (2006). "Low-Carbohydrate-Diet Score and the Risk of Coronary Heart Disease in Women". New England Journal of Medicine 355:1991-2002: 1991. doi:10.1056/NEJMoa055317. PMID 17093250. http://content.nejm.org/cgi/content/abstract/355/19/1991. 
  26. ^ Christopher D. Gardner, PhD (March 2007). "Comparison of the Atkins, Zone, Ornish, and LEARN Diets for Change in Weight and Related Risk Factors Among Overweight Premenopausal Women.". Journal of the American Medical Association 297 No. 9: 969. doi:10.1001/jama.297.9.969. PMID 17341711. http://jama.ama-assn.org/cgi/content/abstract/297/9/969. 
  27. ^ Jørgen Vesti Nielsen and Eva Joensson (June 2006). "Low-carbohydrate diet in type 2 diabetes. Stable improvement of bodyweight and glycemic control during 22 months follow-up". Nutrition and Metabolism 3:22. doi:10.1186/1743-7075-3-22. http://www.nutritionandmetabolism.com/content/3/1/22. 
  28. ^ Thomas L. Halton, Sc. D., Walter C. Willett, M.D., Dr. P.H., Simin Liu, M.D., Sc. D., JoAnn E. Manson, M.D., Dr. P.H., Christine M. Albert, M.D., M.P.H., Kathryn Rexrode, M.D., and Frank B. Hu, M.D., Ph. D. (2006). "Low-carbohydrate diet score and the risk of coronary heart disease in women". New England Journal of Medicine 355:1991-2002. PMID 17093250. 
  29. ^ Yancy, W.S.; Foy M, Chalecki AM, Vernon MC, Westman EC. (2005). "A low-carbohydrate, ketogenic diet to treat type 2 diabetes". Nutrition & Metabolism 1 (2): 34. doi:10.1186/1743-7075-2-34. PMID 16318637. http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1325029. 
  30. ^ Bravi, F.; Bosetti C, Scotti L, Talamini R, Montella M, Ramazzotti V, Negri E, Franceschi S, & La Vecchia C (2007). "Food groups and renal cell carcinoma: A case-control study from Italy". International Journal of Cancer 120 (3): 681–5. PMID 17058282. 
  31. ^ Sun Ha Jee, PhD, MHS; Heechoul Ohrr, MD, PhD; Jae Woong Sull, PhD, MHS; Ji Eun Yun, MPH; Min Ji, MPH; Jonathan M. Samet, MD, MS: Fasting Serum Glucose Level and Cancer Risk in Korean Men and Women, Journal of the American Medical Association, Vol. 293 No. 2, Jan. 12, 2005.
  32. ^ Johns Hopkins Epilepsy Center. "The Ketogenic Diet"
  33. ^ Freeman, John M.; Kossoff, Eric H.; Hartman, Adam L.: The Ketogenic Diet: One Decade Later, PEDIATRICS, Vol. 119 No. 3 March 2007, pp. 535-543
  34. ^ Carol S Johnston, Sherrie L Tjonn, Pamela D Swan, Andrea White, Heather Hutchins and Barry Sears (May 2006). "Ketogenic low-carbohydrate diets have no metabolic advantage over nonketogenic low-carbohydrate diets". American Journal of Clinical Nutrition 83. PMID 16685046. http://www.ajcn.org/cgi/content/abstract/83/5/1055. 
  35. ^ Sacks, F.; Bray G, Carey V, Williamson D. New England Journal of Medicine. PMID 19246357. http://content.nejm.org/cgi/content/short/360/9/859. 
  36. ^ Costly Calories Forbes.com
  37. ^ msnbc.msn.com (November 8, 2006), Carbs may be worse for heart than fatty foods: Long-term study eases concerns about risk of Atkins, other low-carb diets.
  38. ^ Freedman MR, King J, and Kennedy E (2001), Popular Diets: a Scientific Review Obesity Research, Volume 9, Supplement 1, Pages 5S-17S. Retrieved on September 12, 2007.
  39. ^ BBC (January 21, 2004), Uncovering the Atkins diet secret. BBC News. Retrieved on September 12, 2007.
  40. ^ Atkins, Robert (2003-09-25). Dr. Atkins' New Diet Revolution, Revised Edition. .Evans. pp. 119–120. ISBN 978-1590770023. 
  41. ^ Atkins Nutritionals files for bankruptcy - AP 1 August 2005.
  42. ^ ATKINS NUTRITIONALS, INC. EMERGES FROM BANKRUPTCY - Company press release

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