Whither Low-Carb?

 by: Philip J. Goscienski, M.D.

Fads fade for a reason. Like pet rocks, low-carb diets will disappear because they just don’t do anything worthwhile. The dropout rate is high – about 50 percent – because the diets are boring and are unpalatable to most people. More than 90 percent of dieters return to their previous weight within 5 years, most of them even sooner. Minor side effects such as headache, fuzzy thinking, irritability, halitosis and constipation are almost universal among Atkins adherents. Severe side effects are, fortunately, rare.

Physicians are concerned that long-term adherence to a high-fat, high-protein, low-carbohydrate diet may lead to kidney stones, osteoporosis and heart abnormalities. Kidney stones and disturbances of heart rhythm are well-documented complications of the decades-old ketogenic diet (high fat, low protein, low carbohydrate) that pediatricians have used to lower the seizure frequency in children with neurological disorders.

A reputable journal reported in May 2004 that low-carb diets helped people lose weight without causing adverse effects on cholesterol levels. There was joy among food manufacturers, who had already rushed to market low-carb products that covered the spectrum from beer to bonbons. Lost in all this was the cool scientific observation that overweight persons experienced only a moderate weight loss, and that severely overweight individuals lost, on average, only one pound per month during the study year. The cholesterol profiles did, indeed favor the low-carb dieters, but those levels remained high – because that’s where they started out. Finally, few journalists revealed that the Atkins Foundation funded one of these studies

Those who can successfully navigate the inconvenience and side effects of the low-carb diet and then maintain a significant loss of fat will gain much benefit. The early weight loss, however, is mostly water. Much of the later weight loss consists of lean body mass, mostly muscle. Long-term success depends not only on careful attention to diet, but also to regular exercise. Those who do not incorporate an exercise routine into their life are destined to gain all the weight back, and then some.

In what direction is the low-carb phenomenon going? First, proponents are already backing away from saturated fat. The South Beach diet recognizes that polyunsaturated (from fish) and monounsaturated (from olive oil) fats are not only acceptable, they are essential to good health. Second, the distinction between refined carbohydrates (white flour, sugar) and whole grains is one that needs to be widely disseminated. Third, the low-fat establishment cannot – and must not – ignore the overwhelming benefits of fruits and vegetables in the prevention of cancer and heart disease.

The low-carb craze has probably reached its peak, but remnants will persist for a generation or more, and permutations of it will rise episodically like phoenixes among those who are looking for effortless weight loss. Like the phoenix, that is a myth.