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Sept. 21, 1999

High-protein diets gaining support

By Nanci Hellmich, USA TODAY

One day last week, dieter Jerry Voss of Winfield, Kan., had two eggs and eight strips of bacon for breakfast, smoked ribs and pork rinds for lunch and two quarter-pound cheeseburgers (no buns) and pork rinds for dinner.

On his diet, he's not allowed many fruits, vegetables, breads and sweets. But steak, ham and prime rib are just fine.

In a year, Voss lost 100 pounds on this diet, the wildly popular but highly controversial Atkins diet that drastically cuts back on carbohydrates and stresses protein and fat. And he has maintained that loss for a second year. Voss, 36, dropped from 315 pounds to 215 on his 6-foot-2 frame.

For a while, low-fat diets and high-carbohydrate diets were all the rage. But the latest hot trend is low-carbohydrate, high-protein diets - despite vehement opposition from nutrition experts who say they aren't healthful.

Several of the most recent best-selling diet books slash carbohydrates (candy, cake, cookies, bread, grains, pasta, potatoes, corn and some fruits and vegetables) and beef up protein (meat, poultry, fish, eggs, cheese and nuts), including Dr. Atkins' New Diet Revolution; Protein Power; The Zone; and Sugar Busters.

Some new ones also peddle protein: NeanderThin, to be released in January, and Charles Hunt's Diet Evolution, which has just been released.

The diets sound similar but vary significantly in specific details, including recommended amounts of protein, fat, fruits and vegetables.

At a few clinics across the country, severely obese children who have failed at dieting are being put on low-carbohydrate, high-protein plans to jump-start their weight loss. Some doctors are encouraging patients to follow these diets, and the physicians themselves are on them too.

Americans, after all, love their steaks and their bacon and eggs. It feels more like real food than carrot sticks and broccoli. Men especially find the diets palatable and are willing to try them.

"The success of all these books should be giving people a message: This works," says Robert Atkins, a cardiologist and author of Dr. Atkins' New Diet Revolution. He first published his diet in 1972. His current book is No. 5 on USA TODAY's Best-Selling Books list and was the second-hottest-selling book of last year.

Atkins says his diet is easier to follow than typical low-fat diets "because people feel better, are never hungry and can go to nice restaurants and order the best foods on the menus - lobster and rack of lamb."

Early humans ate this diet for years, says family doctor Michael Eades, co-author with his wife, Mary Dan, of Protein Power, No. 27 on USA TODAY's best-selling books list. "It's easy to follow, it works, and it doesn't cause any problems that we've been able to find in at least 15,000 patients."

But many leading obesity researchers and nutritionists are appalled by these diets.

They say some of these low-carbohydrate diets run contrary to the nutrition advice of most major health organizations, which advocate a diet relatively low in saturated fat (animal fat) and high in complex carbohydrates (grains and vegetables). Those recommendations are based on reams of scientific evidence that these foods lower the risk of cardiovascular disease and some types of cancer, they say.

People may lose weight because the protein diets cut out a huge number of foods and are usually low in calories, nutrition experts say. That makes them difficult to stick with, because people may have to forego foods they love and will end up craving them. And sometimes the diets cause weakness, nausea and fatigue.

Physician Kevin Vigilante tried the Atkins diet for about two weeks and said he felt "awful. I was tired and weak." He got bored with "all the brown food on the diet."

He lost 3 or 4 pounds on the plan, but it wasn't worth it, says Vigilante, co-author of Low-Fat Lies, High-Fat Frauds and the Healthiest Diet in the World. "Not having any pasta and potatoes is not a life worth living."

'Seductive' programs

The protein trend is not abating because "the diets are very seductive," says John Foreyt, an obesity researcher with Baylor College of Medicine in Houston.

"High protein usually equates with high fat, which many people love. Most people don't like vegetables anyway, and so they are easy to cut out of a diet." He says some authors of high-protein diet books give dieters "some pseudoscientific rationale why they ought to be eating bacon and meat, and people flock to these unproven, untested diets."

In several of the best-selling diet books, including Protein Power, Sugar Busters and The Zone, the authors write about a hotly debated theory that says people gain weight from eating too much sugar and some other carbohydrates, causing the body's insulin level to rise and prompting fat storage.

Critics counter that there is no scientific basis for the insulin weight-loss theory, and that in fact weight is a function of caloric input and output: Eat more calories of any type of food than your body needs and you gain weight. Eat fewer calories than your body needs and you lose weight.

Unlike some of the other diets, Atkins' weight-loss plan allows dieters to eat protein and fat foods until they're not hungry but puts severe restrictions on carbohydrates, including bread, pasta, cereals, many fruits and some vegetables.

Those restrictions cause the body to partially break down body fat, producing organic compounds called ketones as fuel. "The loss of appetite is quite dramatic and consistent when somebody is living off their stored fat," he says.

Potential drawbacks

Experts have medical concerns about some high-protein plans, including:

Uncomfortable side effects. People who are on a high-protein diet sometimes report having bad breath, constipation, fatigue, nausea, dizziness, irritability or lightheadedness, so medical monitoring is essential, says George Blackburn, director of the Center for the Study of Nutrition and Medicine at Beth Israel Deaconess Medical Center in Boston, who has studied high-protein diets.

Atkins acknowledges that constipation and bad breath could result, but he says other problems are rare.

Fatigue can be avoided, Eades says, if people take a potassium supplement and a multivitamin/mineral supplement with magnesium but not iron.

Potential bone loss. Protein diets can cause leaching of calcium from bones, so a calcium supplement is needed, Blackburn says.

Atkins says the calcium concern is still an open question. "More studies need to be done, but so far many studies show it's only a short-term problem."

Potential stress on kidneys. Blackburn says too much protein can overwork the kidneys, but Atkins and Eades say no one has seen any such harm from these programs. "Based on our experience, the amount of protein we recommend is well within the safe boundary," Eades says.

Blackburn does believe these diets can be used for extremely overweight people (50 pounds or more) for up to three months under medical supervision and with vitamin and calcium supplements. For all practical purposes, he says, weight loss usually occurs in the first three months of dieting, and the rest of the time is spent keeping it off.

So, the trick will be figuring a new, healthy way to eat to keep the weight off forever, he says.

Eades advises people on the Protein Power program to splurge occasionally, then go right back on the program. "We encourage people to eat the birthday cake. I don't mean have a little piece. I don't care if they put their face down in it.

"But once they've had their fun they get back on the more restricted version of the program, lose the weight and then stay on the maintenance phase until their next dietary splurge.

"We're not saying it's going to be easy. It takes a certain amount of discipline."

Anatomy of eating

Some experts say such diets are unrealistic in a country saturated with cinnamon buns and pizza. They fear that once people go off them, they'll regain the weight and then some.

"We eat for reasons other than weight loss," says Barbara Rolls, a professor of nutrition at Penn State. "We eat for pleasure and to live healthier, to prevent cancer and cardiovascular disease.

"Because these diets tend to be high in saturated fat and low in fiber, they're not optimal for healthy living."

Voss says he couldn't adhere to a low-fat diet "because I didn't like a lot of the foods. I don't like vegetables. I couldn't have my bacon, pork chops."

On the Atkins plan, he can eat the foods he really loves, although he does miss homemade chicken and noodles, mashed potatoes and Snickers and Butterfinger candy bars.

Voss says he has felt fine and become healthier on the diet. He no longer needs medication for high cholesterol.

He says he'll stick with this plan for the rest of his life. "There are days when I don't feel hungry at all. I don't have the cravings for foods like chocolate, ice cream, doughnuts and cinnamon rolls anymore."

Blackburn knows these high-protein diets are attractive to people who have tried and failed at losing weight by watching fat and eating plenty of fruits and vegetables.

"I'm not denying that it's embarrassing that we can't make it fun and attractive to do it the old-fashioned way: Cut back on the calories and increase your physical activity. I know it's a lot of hard work. I do it myself every day."

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