Overweight, he was “as aware as any man of the gigantic gaps in our knowledge—and of the likelihood that many of our present concepts may be erroneous.” He also noted, in his discussion of hormonal influences on obesity, that insulin “favors fat synthesis” and that someone who over-secretes insulin could “tend to become hungry as a result.” But when a physician suggested publicly, as Atkins did, that carbohydrates raised insulin levels, that insulin favors fat synthesis, and that a diet lacking carbohydrates might reverse this process, these nutritionists would denounce it, as Mayer himself did in 1973, as “biochemical mumbo-jumbo.”
With the publication of Dr. Atkins’ Diet Revolution and its subsequent censure by the American Medical Association, the nature of the professional discussions on carbohydrate-restricted diets turned from their clinical utility to the reasons to avoid them. The actual science suddenly mattered less than ever.
Atkins was a Cornell-trained cardiologist. Between 1959 and 1963, coinciding with the early years of his practice in Manhattan, he gained fifty pounds. He eventually decided to try carbohydrate restriction, he said, “because that’s what was being taught at the time.” His attempt coincided with the 1963 publication in JAMA of a lengthy article by the University of Wisconsin endocrinologist Edgar Gordon, entitled “A New Concept in the Treatment of Obesity.” Gordon was one of the few clinicians of that era who studied fat metabolism and then designed a diet based specifically on that science. Gordon’s diet, as described in JAMA, began with a forty-eight-hour fast—“not to produce a spectacular loss of weight, but rather to break a metabolic pattern of augmented lipogenesis”*123 —and then allowed protein and fat as desired but limited carbohydrates to minimal fruits, green vegetables, and a half-slice of bread every day. “The total caloric value is quite high in terms of reducing diets,” wrote Gordon. Atkins later said his attention was caught by Gordon’s observation that his subjects lost weight without ever complaining of hunger.
In his diet, Atkins replaced the two-day initiatory fast with a week or more of complete carbohydrate restriction, under the assumption, as the Atlanta physician Walter Bloom had noted, that the two states were physiologically identical. Atkins said he lost twenty-eight pounds in a month and felt energized in the process. In 1964, while Atkins was personally reaping the benefits of his diet, he was also working part-time as a company physician with AT&T. The junior executives noticed his weight loss, so he told them about the diet. Sixty-five of them eventually tried it, as Atkins told it, and all but one reduced to their desired weight. The sole exception wanted to lose eighty pounds but lost only fifty.
Atkins then started treating obese patients out of his cardiology clinic and developed the diet as he came to prescribe it in his book. He instructed his patients to start off with an initiation period, eating no carbohydrates other than a small green salad twice a day. Once they were losing weight at a suitably rapid rate, they could begin adding small amounts of carbohydrates back into their diet until they reached what he called the critical carbohydrate level, when their weight loss either leveled off or could no longer be maintained. Then they would have to back off again on the carbohydrates to experience further benefit from the diet. He also had them check their urine for ketone bodies—with the same ketosticks used commonly by diabetics—to ensure that they remained in ketosis and were still burning body fat. The reliance on ketosis to initiate and maintain weight loss, and the progressive addition of carbohydrates to the diet, are what Atkins considered his contributions to the clinical science of carbohydrate restriction.*124 His career as a diet doctor grew slowly until 1966, when the women’s fashion magazines began recommending his diet, and his business boomed. After Vogue popularized the diet in 1970, Atkins set out to write Diet Revolution, which was then advertised as “the famous Vogue superdiet explained in full.”
The gist of Dr. Atkins’ Diet Revolution can be distilled down to three assertions. The first is that weight could be lost on his diet without hunger, and perhaps without even restricting calories. Atkins said that his patients regularly lost weight eating three thousand calories a day, and that he had one three- hundred-pounder who reduced significantly while eating five thousand. His only explanation was that obesity is caused by the kind of calories we consume and not the quantity, and so if we avoid carbohydrates our bodies function correctly and shed any excess weight. He attributed the absence of hunger to the copious calories, the ketosis (which is probably not the case), the effect of insulin on blood sugar—all overweight people “produce too much insulin,” he wrote, and that lowers blood sugar and makes people hungry—and the secretion of what the British clinicians Alan Kekwick and Gaston Pawan had called fat-mobilizing substance. (Virtually all hormones, with the exception of insulin, will mobilize fat from adipose tissue, but none of them will do so effectively when insulin is elevated.)
Atkins’s second claim was that his diet was inherently healthy, much more so than a low-fat diet, because refined carbohydrates and starches, not saturated fat, caused heart disease and diabetes. Atkins later said that Peter Cleave’s Saccharine Disease had been a revelation to him. In Diet Revolution he discussed the research from Yudkin, Margaret Albrink, Robert Stout, and Peter Kuo implicating triglycerides as a more significant risk factor for heart disease than cholesterol. He also claimed, on the basis of his experience with “ten thousand” overweight patients, that cholesterol “usually goes down” on his diet, despite the high saturated-fat content, and that triglycerides invariably decrease.
His third claim was what he called the “cruel hoax” of calorie-restricted diets: “The balanced low-calorie diet has been the medical fashion for so long that to suggest any alternative invites professional excommunication,” Atkins wrote. “Yet even most doctors admit (at least privately!) the ineffectiveness of low-calorie diets—balanced or unbalanced.” Atkins supported his accusation by invoking Albert Stunkard’s 1959 “comprehensive review of the thirty years of medical literature,” and offering three reasons why calorie-restricted diets inevitably fail. First, they “don’t touch the primary cause of most overweight,” which is a “disturbed carbohydrate metabolism.” They also fail because they reduce energy expenditure. “Dr. George Bray,” he wrote, “has demonstrated that people on low- calorie diets actually develop lower total body energy requirements and thus burn fewer calories.” (Although Atkins didn’t say so, this research had led Bray himself to publish an article entitled “The Myth of Diet in the Management of Obesity.”) And, finally, Atkins wrote, “The main reason low-calorie diets fail in the long run is because you go hungry on them…. And while you may tolerate hunger for a short time, you can’t tolerate hunger all your life.”
Had Atkins wanted to avoid professional excommunication, he might have published something other than a polemic couched as a diet book. But he was feeling “resentment,” he wrote, “that [he] had been duped so long by misinformation given me in the medical literature.” The Diet Revolution was not just advocating a way to lose weight, which Atkins credited, in any case, to Banting, Pennington, Kekwick, and Pawan, but overthrowing the current nutritional wisdom entirely. Unlike Irwin Stillman, whose 1967 mega–best-seller The Doctor’s Quick Weight Loss Diet was also based on carbohydrate restriction, Atkins wanted “a revolution, not just a diet.” “Martin Luther King had a dream,” Atkins wrote. “I, too, have one. I dream of a world where no one has to diet. A world where the fattening refined carbohydrates have been excluded from the diet.” Atkins deliberately portrayed his diet as diametrically opposed to the growing orthodoxy on the nature of a healthy diet. Whereas Keys had insisted that the solution to obesity was to convince fat people that overeating was a sin and overeating fat would kill them, Atkins said his patients lost “thirty, forty, 100 pounds” eating “lobster with butter sauce, steak with Bearnaise sauce…bacon cheeseburgers….” “As long as you don’t take in carbohydrates,” Atkins wrote, “you can eat any amount of this ‘fattening’ food and it won’t put a single ounce of fat on you.”
Diet Revolution may have been, as its publisher claimed, the fastest-selling book in history. Nonetheless, its “chief consequence,” as John Yudkin noted in 1974, may have been “to antagonize the medical and nutritional establishment.” In fact, Atkins had to antagonize only a very small and select group of men to have a profound and lasting effect on how we think about obesity and weight regulation. In obesity research, particularly in the United States in the 1970s, the established wisdom was determined not by any testing of
