"A New Concept in the Treatment of Obesity"
JAMA 1963 Oct 5 ,
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(2008 Jan blog post)
INTRODUCTION : Many critics of Dr. Atkins and his lowered-carbs diet seem to think he pulled his diet out of thin air. The critics seem to lack the will to look up the texts that he credits with leading to his diet proposals. Ironically, many of his strongest critics are doctors in the AMA, American Medical Association --- and Atkins got his inspiration from papers published in the JAMA, Journal of the American Medical Association.
Further irony: The 'Atkins diet' (actually, a lifetime-way-of-eating methodology) was not invented by him. Atkins was actually trying to popularize medical study results that he had read about in medical journal articles published back in the early 1960's --- for the benefit of his patients, for the citizens of this country, for the citizens of the world --- and for his own health. In other words, he was trying to communicate important health information that was "locked away" in stuffy old medical journals, in and among pages of mind-numbing verbiage. To quote Atkins in his book "Atkins for Life", 2003, page xii: "The first published documentation [link to PDF file] of the success of a controlled carbohydrate dietary regimen appeared in the 1800s, but we needn't go back that far. It was after reading a scientific study [its text is below] on the effectiveness of several low carbohydrate weight-loss programs in the October 1963 issue of the Journal of the American Medical Association [JAMA] that I decided to put a similar approach into practice. We now have, on our web site www.atkinscenter.com, summaries of close to four hundred [ 400 ! ] scientific studies that support the principles upon which the controlled carbohydrate nutritional approach is based." And in the back of the book "The Atkins Essentials" (2004) that was published after Atkins' death, there is a bibliography of 15 peer-reviewed studies, published in 2001 to 2003, that specifically focused on the outcomes that result from the "Atkins Nutritional Approach". Many of these recent studies come from respected researchers at institutions such as Harvard and Stanford --- again, members of the AMA. I find it amazing that people (many of them doctors and dieticians) who debunk lowered-carbs diets can simply ignore all these studies or pass them off as invalid --- reports and studies from the 1800's to 2003 and beyond. Simplification of the Atkins diet : For many, it would be extremely difficult to follow a dietary regimen as strictly as the strict regimen documented in clinical studies. If you don't like to try to keep track of the ratio of protein-to-fat-to-carbs that you are eating (I sure don't) --- and if you don't like to to count grams or calories (I sure don't), then, as a simpler alternative, just try the 'No Flour, No Sugar Diet' proposed by Dr. Gott M.D. in a book by that name. Dr. Gott realized that it is just too much to expect that people can and will do food data-gathering and calculations --- especially on a day-to-day basis. By the way, Dr. Gott, I would guess, is a member of the AMA --- unless he has been driven out by anti-lowcarb-diet doctors high up in the AMA hierarchy. Dr.Gott's "lowered-carbs"-views, and, especially, the publishing of those views for the world to see, must have made him the target of powerful 'sugar-and-starch carbohydrate interests'. I have to wonder what is driving those anti-lowcarb-diet AMA doctors to 'bad mouth' Atkins so vehemently --- and ignore studies published in their own journal, the JAMA. Monetary ties to soft-drink-AND-candy-AND-processed-foods-AND-drug-AND-insulin industries ??? Medical reports that inspired Atkins : The majority of the text of the October 1963 "scientific study" mentioned in the Atkins quote above is presented below. This is the study that led to Atkins' many years spent in formulating and fine-tuning and promoting a lowered-carbs way of eating, to help many of Atkins' patients --- and ultimately anyone who was in need of help and who would listen. I could no longer find the Oct 1963 article on-line on the internet. The JAMA web site, in 2008, did not have journal articles on-line that the JAMA published before the mid-1960's. So I found the article in a university medical school library --- and I have devoted some hours to keying in the major part of the text, so that the article is preserved on-line.
NOTE: In finding that Oct 1963 JAMA article, I ran across a Dec 1963 JAMA article that Atkins probably saw --- titled "The Treatment of Obesity in an Outpatient Dietetic Unit". The Dec 1963 article takes a more "clinical-data-only" approach, than the "biochemistry-oriented" Oct 1963 article, in pointing out the benefits of a lowered-carbs diet. The results of the Dec 1963 paper come from a "dietetic outpatient clinic" --- and the paper says in the introductory summary that patients "came to eat a low-carbohydrate, high-protein diet". That probably caught Atkins' eye --- along with the term "obesity" in the title. Since that Dec 1963 article probably erased any doubts that Atkins may have had about the likelihood of success in trying a lowered-carbs way of eating, I have keyed in a majority of the text of that Dec 1963 article. The text of the Dec 1963 publication is available via this "hyper-link". Read the Oct and Dec 1963 texts yourself. See if you would have come to the same course of action that Atkins pursued, if you had a medical practice like he had. Note that the Oct 1963 paper (text below) starts the diet with a 48-hour fast --- to break previous patterns of dietary behavior. The Atkins diet starts with a milder form of this --- an "induction" phase. |
Start of the Oct 1963 paper :
"A New Concept in
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Table for protein, fat, and carbohydrate values [grams]
Food | Protein | Total Fat | Unsaturated Fat | Carbohydrate |
---|---|---|---|---|
1. One egg | 6.0 | 6.0 | --- | --- |
2. 11 oz meat : | ||||
6 oz meat group A | 42.0 | 26.4 | 3.9 | --- |
5 oz meat group B | 35.0 | 15.5 | --- | --- |
3. 7 servings fat : | ||||
4 teaspoons corn oil | --- | 20.0 | 10.0 | --- |
3 teaspoons margarine | --- | 12.0 | 3.3 | --- |
4. 2 cups skim milk | 16.0 | --- | --- | 24 |
5. 2 servings fruit | --- | --- | --- | 20 |
6. 1/2-cup B-vegetable -OR- 1/2-slice bread |
2.0 | 6.0 | --- | 7 |
7. 2 to 4 cups A-vegetable |
--- [very low] |
--- [very low] |
--- [very low] |
--- [very low] |
Totals | 101.0 gm | 79.9 gm | 17.2 gm | 51 gm |
Source: Averages of values given in Nutritive Value of Foods,
Home and Garden Bulletin No. 72, U.S. Department of Agriculture
Note: Percent of fat that is polyunsaturated = 100 x 17.2 / 79.9 = 21.5%
Meat List - Group A Chicken, turkey, pork (includes chops, roast, and steak) Meat List - Group B Fish (any kind --- canned fish should be "water packed" instead of "oil packed"), lamb (all cuts), veal (all cuts), beef (all cuts, including liver) Discussion of meats The meats are divided into two groups, A and B, according to their content of polyunsaturated fatty acids and total fat. Six ounces of meat or more should come from group A and 5 oz or less should come from group B. The group A meats contribute small amounts of polyunsaturated fatty acids to the diet. Although it seems more logical to place pork in the B group of meats because of its relatively high total fat content, it was placed in the A group instead, for the following reasons:
There are good reasons for placing fish in either group A or group B. Fish was placed in group B because, in the small amounts usually eaten in the American diet, as compared with meat, it would not contribute markedly to the polyunsaturated fatty acid content of the diet. Possible substitutions are suggested for some of the meat. Any of these substitutions alter the constituents of the diet, but are included to make the diet more realistic to follow. Substitutions suggested are:
The question of possible use of frankfurters and luncheon meats frequently arises. In general, their use is discouraged. Their relative fat content is usually higher than plain cuts of meat and the sodium content is high as well. Cereal "fillers" and dried skim milk powder frequently are added to luncheon meats. Either of these additions would increase the carbohydrate content of the diet. |
Fat List
Fat | Amount in one serving |
---|---|
Corn oil, cottonseed oil, safflower oil [a] | 1 teaspoon |
Mayonnaise (not more than 4 teaspoons should be used per day because of a slightly lower polyunsaturated fatty acid content and a small carbohydrate content not found in the recommended oils.) |
2 teaspoons |
California (English) walnuts (not more than 2 tablespoons or 10 halves should be used per day because of carbohydrate content.) |
1 tablespoon chopped or 4 to 5 halves |
Margarine made with corn oil or safflower oil (not more than 3 teaspoons should be used per day because of lower polyunsaturated fatty acid content than the recommended oils.) |
1 teaspoon |
[a]
The oil should not be heated to high temperatures, such as those
reached in frying, because oxidation occurs. In calculating values
for the fat list in the diet, the seven servings allowed were broken
down into 4 teaspoons of corn oil and 3 teaspoons of margarine.
Fruit List
Fruits may be fresh, dried, cooked, or canned, so long as no sugar is
added to them. One of the two servings of fruit allowed daily
should be a good source of ascorbic acid and are designated by an
asterisk (*).
Fruit | Amount in one serving |
---|---|
Apple (2-in. diameter) | 1 small |
Apple sauce | 1/2 cup |
Apricots, fresh | 2 medium |
Apricots, dried | 4 halves |
Banana | 1/2 small |
Blackberries | 1 cup |
Raspberries | 1 cup |
*Strawberries) | 1 cup |
Blueberries | 2/3 cup |
*Cantaloupe (6-in diameter) | 1/4 |
Cherries | 10 large |
Dates | 2 |
Figs, fresh | 2 large |
Figs, dried | 1 small |
*Grapefruit | 1/2 small |
*Grapefruit juice | 1/2 cup |
Grapes | 12 large |
Grape juice | 1/4 cup |
Honeydew melon, medium | 1/8 |
Mango | 1/2 small |
*Orange | 1 small |
*Orange juice | 1/2 cup |
Papaya | 1/3 medium |
Peach | 1 medium |
Pineapple | 1/2 cup |
Pineapple juice | 1/3 cup |
Plums | 2 medium |
Prunes, dried | 2 medium |
Raisins | 2 tablespoons |
Rhubarb | 1 cup |
*Tangerine | 1 cup |
Watermelon | 1 cup |
Vegetable List
These vegetables are allowed either raw or cooked.
A green or yellow vegetable is recommended daily for its vitamin
A content.
These vegetables, all very low in protein, fat, and
carbohydrate, are considered "free" in calculating their [body-weight
generating] values. However, since they actually do contain small
amounts of carbohydrate, an upper limit of 4 cups daily is made.
Asparagus | Lettuce |
Broccoli | Mushrooms |
Brussel sprouts | Pepper |
Cabbage | Radishes |
Celery | String beans |
Chicory | Summer squash |
Cucumbers | Tomatoes |
Escarole | Tomato juice |
Eggplant | Watercress |
Cauliflower | Greens [see list below] |
Greens
Beet greens
Chard
Collard
Dandelion
Kale
Mustard
Spinach
Turnip greens
Vegetable-B-and-Bread List
(Vegetable-B denotes high-carb vegetables)
Either one-half slice of bread or one-half cup of any of
the vegetables listed below can be eaten, since their protein,
fat, and carbohydrate values are so nearly the same.
Beets | Carrots | Onions |
Peas | Squash | Turnips |
Pumpkin | Rutabaga |
Suggested Daily Meal Plan :
1/2-cup vitamin C fruit or juice
1 cup skim milk
3 oz meat
2 oz meat
3 oz meat
1/2 cup skim milk |
Notes on the meal plan : Ideally, the protein in the diet would be divided equally in each of the six feedings. However, a larger amount is given at the luncheon and dinner meals to more nearly resemble the American meal pattern. The fruit, which could be eaten at any time during the day, was placed at breakfast, which is the usual meal for having a fruit high in ascorbic acid, and at dinner, so that a "dessert" can be eaten when the entire family is usually together. Margarine is allowed at each meal, to be used on toast at breakfast and on cooked vegetables at the other two meals. The remaining fat allowance is used as oil which can be put on salads in combination with vinegar, lemon, and spices and herbs. Other combinations of fats from the fat list also could be made. Some individuals prefer to drink the oil straight, as they would a medication. Skim milk is suggested as the beverage between meals, since coffee or tea usually is available at meal time either at home or in a restaurant. Women who spend their day at home have found the diet quite easy to handle. Those people working away from home must be more ingenious. Cold meat, such as leftover chicken or roast beef, can be wrapped in waxed paper and taken to work. The substitution of cheese or hard-cooked eggs can be made and may be easily slipped into a bag or purse. A meat prepared without fat or carbohydrate can be obtained in the humblest of restaurants [in the 1950's], for if no roasted, boiled, or broiled meats are available, beef patties usually are. Skim milk can be carried in a thermos bottle. Celery sticks, radishes, and raw tomatoes are good for packed lunches and are usually available in restaurants [again, in the 1950's]. {Try to find radishes or celery in restaurants or fast food places nowadays!?! And tomatoes are spoiled or on the verge of spoiling about half the time, in restaurants. Bring your own.] Lettuce, vinegar, and oil are universally available, even if not listed on restaurant menus [again, in the 1950's]. [Mostly salad dressing packs in restaurants nowadays --- full of a wide variety of chemicals. Bring your own.] If skim milk is not available in any way during the day between meals, the following changes may be made in the diet plan:
--- Four eggs should be eaten each week. If a person does not want an egg every day as outlined on the diet, an ounce of meat from either group A or group B may be substituted for the egg. For those people who find the quantity of food too large, the most advisable action to take is proportionate reduction of the amount eaten of all of the food groups. A single food or food group should not be eliminated from the diet and feedings should not be eaten less often than six times a day. The diet, as outlined, meets 1958 recommended daily allowances of the National Research Council for adults. To retain the protein, fat, and carbohydrate values, as well as the National Research Council's recommended allowances, the only suggested change in food selection would be to reduce the fruit to one serving daily and to increase the bread to one slice daily. Other changes in food selection cannot be made which will meet the protein, fat, and carbohydrate values and still meet these recommended allowances. If a patient has known allergies or if a patient, after sincere attempts, finds the food as outlined in the diet impossible to eat, a different diet, retaining the protein, fat, and carbohydrate values, would have to be planned with nutritional supplements given to meet recommended allowances. Comment [summary] Clinical results that have followed the use of this plan of therapy have been remarkably encouraging and surprising. [The reader is referred here to a graph that shows a "typical weight loss curve over a 3-month period during which 45 lb (20.4 kg) were lost. During this period the patient (female) felt no hunger." The graph shows a steady weight loss from about 229 lb to about 184 lb --- from 18 March 1963 to 24 June 1963 --- about 15 lb per month --- more than 3 lb per week.] No patient to date has complained of hunger at any time. Some who have been especially addicted to high-carbohydrate food, particularly rich desserts, have had some "withdrawl unhappiness" for a short time, but it is not attended by hunger. Several patients have returned to normal weight after losses of 50 to 100 lb (22.7 to 45.4 kg) and this circumstance has necessitated changes of management to maintain their improvement. The first modification has been to broaden the use of fruits and vegetables to include some which previously had not been included. These changes are additions [in calories] rather than isocaloric [same calories] substitutions. Patients are asked to do this carefully, allowing at least 2 weeks after each change before proceeding to further additions. They are next allowed increased bread, up to one slice per meal, included as additions rather than substitutions. Throughout all these stepwise increases in food and calorie intake, they are asked to continue to divide their daily food allotment into six feedings and are again admonished that desserts should be the last additions for experimentation. Under these circumstances all patients who have evolved through this prodedure have maintained their weight loss despite increased caloric intake and have manifested no tendency to regain weight over periods of up to 6 months. Much more experience is necessary regarding this transition period before any significant conclusions can be drawn. One of the most surprising features of this therapeutic program has been the autonomous manner in which it has operated. At the time of discharge of patients from the hospital, careful instruction is given concerning all details of treatment and they are asked merely to communicate by mail after 1 month, during which time no physician sees them. In contrast to our previous experience, very few patients thus far have failed to continue the weight loss which began in the hospital. Losses have varied from 9 to 28 lb (4.1 to 12.7 kg) during that month and have continued thereafter until the first progress visit, approximately 2 months after discharge. In surveying this vast spectrum of metabolic changes associated with the obese state, it is mainifestly difficult or impossible to establish which abnormalities are causes and which are the effects of obesity. Likewise, we are unable to throw very much light on the baffling question of the relative importance of genetic and environmental or adaptive factors in the etiology [development] of this [obese] condition, although the former [genetics] influences are being studied [25] [26] and the latter are self-evident. We have an intuitive feeling that fasting is not the correct way to manage obesity, since it provides no opportunity for readjustment and re-education of the patient's dietary and eating habits. One unexpected dividend that has emerged from the institution of this therapeutic program has been the spontaneous evolution of new and more beneficial dietary habits in a great many patients who have commented with great surprise about the apparent loss of old compulsions to eat and modification of cravings for certain high-carbohydrate foods. [NO WONDER the doctors whose funding comes from food industries slam Atkins and his diet so mercilessly.]
Finally, it is pertinent to ask: The striking deviations from normal in most of the metabolic findings that have been described led originally to the impression that these subjects represented a separate clinical entity. With further experience, however, the magnitude of these changes, as they are studied in patient after patient, is now seen to cover a continuous spectrum and we are more inclined to believe that "metabolic obesity" may be a stage of the obese state rather than a separate and distinct form of the condition. It appears to be more closely related to the duration than to the degree of obesity. [I suspect it can be either or both.] Only increased experience can provide the perspective necessary for a final, correct interpretation. [If the question here is whether an abnormality in metabolism can unavoidably cause obesity, I think the concentration camps in Germany during World War II provide the answer. There were no fat prisoners in those camps after some months on their diet --- no matter what their metabolism was like. In other words, it is simple physics --- conservation of matter --- matter (fat in the body) cannot be created unless matter is introduced (to the body). And this study indicates that the kind of matter that it is important to reduce is carbohydrates (sugars and starches, rather than fiber, the 3rd major component, by weight, in carbohydrates). Reduce the amount of matter (especially sugars and starches) going into the body, and the fat is reduced. Thus portion control and well-balanced 'real' food results in proper, healthy weight maintenance. In other words, ingest at least as much protein and healthy fats and fiber as sugars and starches --- and not too much of any of them.] In conclusion, the authors wish to reiterate that the original investigations on which this therapeutic program is based were initiated as an unbiased effort to study the perplexing and controversial problem of energy metabolism in human obesity. It is still a research project and this tentative plan of management is offered for broad trial by physicians with hope that the resulting extensive experience and further modification as new information becomes available will help to establish a final judgment of its validity.
[NOTE: I think that history will show that those villifying doctors have done a great dis-service to humanity --- and those doctors are actually traitors to their profession, which is supposed to promote health in their fellow citizens of the world.] 1300 University Ave., Madison 6, Wis. (Dr. Gordon) This investigation was supported by funds from the National Institutes of Health, from Smith, Kline, and French Laboratories, and from the Wisconsin Heart Association. References
1. Gordon, E.S., et al:
2. Gordon, E.S., and Goldberg, E.M.:
3. Dole, V.P.:
4. Gordon, E.S.:
5. Opie, L.H., and Walfish, P.G.:
6. Goldberg, E.M., and Gordon, E.S.:
7. Berkowitz, D.:
8. Kekwick, A.; Pawan, G.L.S.; and Chalmers, T.M.:
9. Gordon, E.S.:
10. Bansi, H.W. and Olsen, J.M.:
11. Elsback, P. and Schwartz, I.L.:
12. Roth, J. et al:
13. Schteingart, D.E.; Gregerman, R.I.; and Conn, J.W.:
14. Randle, P.J., et al:
15. Hales, C.N., and Randle, P.J.:
16. Grodsky, G.M., et al:
17. Stuchlikova, E., et al:
18. Dickerson, V.C.; Tepperman, J.; and Long, C.N.H.:
19. Tepperman, J., and Tepperman, H.M.:
20. Hollifield, G., and Parson, W.:
21. Cohn, C., and Joseph, D.:
22. Cohn, C., and Joseph, D.:
23. Bedell, G.N.; Wilson, W.R.; and Seebohm, P.M.:
24. Doorenbos, H.; Cost, W.S.; and Nagelsmit, W.F.:
25. Steinberg, A.G.:
26. Astwood, E.B.: |
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This blog content was posted 2008 Jan 29.
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