PERSONAL HEALTH --- NEW YORK TIMES, WEDNESDAY, DECEMBER 25, 1996

by Jane E. Brody

"A Recipe for woe: high-fat, high-protein diets can undermine health as
they take away pounds."

(Second of two columns on dietary fat and weight loss.)

Americans, having failed to lose weight in the dat-free food era, are
flocking back to a century-old regimen that has failed them repeatedly in
the past: the high-protein, high-fat low-carbohydrate diet currently
advocated by Robert Atkins, Barry Sears and others who assert that it is
carbohydrates, not fats, that are making people in this country fat.

This scheme was first promulgated in 1863 by a London undertaker named
William Banting. It seems to resurface periodically under different
rubrics, each time capturing the diet-book dollars of gullible Americans.
Indeed, you might forget buying lottery tickets: writing a diet book with
a gimmick is a surer route to riches

Of Course It Works

Of course the low-carbohydrate diet works. If you cannot eat cookies,
candy, cake, doughnuts, bagels, french fries, pie, ice cream and a host
of other high-carbohydrate, high-calorie, high-fat favorites that people
typically overeat, you are likely to consume fewer calories than you were
eating before and you will undoubtedly lose weight.

At first, the loss will be mainly water, because carbohydrates are the
nutrients that hold water in your body.

A friend who had been on one of the low-carbohydrate diets for three
months lapsed one day and ate a baked potato, which, she said, caused her
to gain three pounds overnight. Now, the potato weighed only about half a
pound, so even if she digested and assimilated every bit, it would not
have been possible to gain three real pounds. What her dehydrated body
gained was water, drawn in by the carbohydrates in the potato.

Furthermore, if you follow the Atkins regimen to the letter, substances
called ketones will accumulate in your bloodstream and can make you
slightly nauseated and light-headed and cause bad breath. This state is
not exactly conducive to a hearty appetite, so chances are you will eat
less than you might otherwise have of the high-protein, highfat foods
permitted on the diet. A ketogenic diet also has risks: excreting
potassium and sodium along with the ketones can disrupt heart rhythms} an
increase in uric acid can cause kidney stones, and a loss of calcium in
urine raises the risk of osteoporosis.

The questions to ask yourself are not whether you can lose weight on this
or any other diet, but whether you can stay on the diet indefinitely and
keep the weight off permanently and whether you can do so without
incurring other health risks. Where are the long-term follow-up studies
to show that this is a once-and-for-all, safe and effective weight-loss
program?

Where are the people who have been on this diet for the 20-plus years
since Dr. Atkins first published his "diet revolution?" Did they lose the
desired amount of weight and keep it off? And are there any long-term ill
effects?

No scientifically solid study has been published to support this diet
scheme.

And with the rapidly emerging evidence that a diet rich in plant foods
--- grains, beans, fruits and vegetables --- is one of the best
preventatives of heart disease and cancer, a weight-loss scheme that
greatly limits such foods is not exactly conducive to a long and healthy
life.

The Body's Arithmetic

There is also no evidence that the human body violates the first law of
thermodynamics, said Dr. Jules Hirsch, an obesity specialist at the
Rockefeller University in New York.  No diet that allows you to eat "all
you want" of anything results in weight loss unless calories expended
exceeds calories consumed.

Nor does it matter where the calories come from, Dr. Hirsch said. If
anything, carbohydrates are preferable to fats as a calorie source for
someone trying to lose weight because the body expends slightly more
energy to metabolize them and because you can eat a larger volume of
carbohydrates than you can can of fats before exceeding your caloric
needs.

So why, with the big push for grains, fruits and vegetables in recent
years, have Americans become fatter than ever, with half the population
now significantly overweight?  Dr. Kelly Brownell, a psychologist who
specializes in nutrition and eating disorders at Yale University blames
what he calls "the toxic food environment we now live in: the ready
availability of high-fat, goodtasting, heavily promoted, deceptively
advertised foods." Americans are hard put to escape caloric overload when
faced with mini-marts at service stations, drive-in windows at fast food
establishments, packaged fast food meals and "super-size" servings of
high-fat, high-calorie foods.

"The super-size fries and soft drink at McDonald's adds up to 800
calories and you haven't yet touched the burger," Dr. Brownell said. He
[noted that if laboratory animals were given free access to high-fat
foods, they would eat them in preference to low-fat foods and they would
get fat and sick.

Some Solutions

Dr. Brownell recommends a societal effort to "buffer people against toxic
food messages, just the way we teach children not to smoke" and to
prohibit misleading advertising that, for example, calls a cereal that is
80 percent sugar "part of a good breakfast."

"People are not inevitably overweight, nor is their weight totally under
personal control," Dr. Brownell said. "There's an environment at work
making a lot of this happen. It's not high-carbohydrate diets that are
causing the increase in obesity.  It's the ready availability of
high-sugar, high-fat foods and the decline in physical activity."

Although the average American today eats fewer calories than one did a
century ago, Dr. Brownell pointed out that since 1900 the prevalence of
obesity had more than doubled because physical activity had declined so
substantially. Despite the exercise boom, relatively few Americans do
anything to make up for the lack of activity in their workaday lives.

Dr. Brownell maintains that much of the success of a weight-loss program
is determined by "what goes on in your head." For most people, starting
with an "unrealistic esthetic ideal or the height-weight tables as the
goal is likely to result in frustration, disappointment and giving up."
Instead, he recommends setting a more achievable goal of losing about 10
percent of one's weight. After achieving that loss and doing everything
possible to make sure it is permanent, then you can decide whether you
want to and can try to lose more.

Biology seems to work against an obese person who loses a significant
amount of weight, Dr. Hirsch noted. The body becomes more efficient,
using fewer calories to perform a given task. The only way to counter
that fundamental fact is through regular physical activity that increases
muscle mass at the expense of body fat, which will raise the number of
calories the body burns at all times, at rest or at work.

Bob Avery