In Memoriam   The Trailblazing Work of Dr. Robert C. Atkins April 17, 2008 marks five years since Dr. Atkins’ untimely death from a severe head injury sustained in a fall. On April 9, while on his way to work at The Atkins Center for Complementary Medicine he slipped on an icy sidewalk just half a block from his office.  Dr. Atkins loved seeing patients and at the age of 72 had no intention of retiring. In fact, he was working on his next book Atkins Diabetes Revolution when he died. He wanted to write this book for many years. He was convinced that controlling carbs could prevent type 2 diabetes and knew it as a safe and effective therapy for the condition. Since his death the results he saw during years of clinical practice have been borne out in the research done on Atkins-type diets. Over the years, Dr. Atkins was called many things by his critics, but I knew him as a funny, shy, immensely intelligent, curious, innovative and courageous man who believed he was on a crusade to heal people. He is primarily known for his best-selling diet books but his real mission in life was to help people utilizing complementary medicine techniques. He read medical journals and attended conferences, often outside of the U.S., because he found a refreshing open-mindedness there without the focus on throwing drugs at everything. He often said that in emergencies the care Americans receive for acute situations was second to none. Where his thinking deviated was when addressing the chronic health complaints many are likely to face at some point in their lives. His belief in first “do no harm” led him to explore his interest in diet and nutrients for both the prevention and treatment of chronic conditions, rather than drugs and surgery as the first and only treatment strategy. This approach requires that the patient be a very active participant by partnering with their healthcare provider in maintaining or restoring their health. The patient must share the responsibility for their health and well-being not just pop pills. Regardless of the criticisms that were leveled at him for many years, as time goes by it has become apparent that he was spot on about many things. He was ahead of his time and it is my hope at some point he will be acknowledged for his contributions. Dr. Atkins was ahead of his time when: He recommended eating whole eggs. For years and even now, some people are afraid to eat whole eggs thinking they cause heart disease. They wind up with tasteless, nutritionally poor egg whites. The truth is that when dietary intake of cholesterol increases the body will make less to compensate. Dr. Atkins referred to eggs as nature’s most perfect food. They come in their own container, provide essential nutrients, are relatively low cost for high quality protein and make a great snack. They do not cause heart disease: they actually improve your cholesterol/HDL ratio. They contain B vitamins, D, E, calcium, zinc, iron, potassium and magnesium. It is the egg yolk that contains carotenoids lutein and zeaxanthin, helpful in preventing macular degeneration. He was convinced that hormone replacement therapy (HRT) was over-prescribed and dangerous for many women. Drug companies market drugs by turning a normal stage of life into an illness and making billions of dollars. In Dr. Atkins practice it was not unusual to hear time and again about women forced to take HRT by their doctors. Many were placed on it simply because their periods ceased even when they did not have symptoms or were reluctant to take it. They were told it would protect them from heart disease and keep them looking younger. What it really did for many women, especially for those who already had weight issues or stressed blood sugars, was push them into diabetes increasing their risk of heart disease and other complications. Until the findings of the Women’s Health Initiative study, hormones were one of the top prescribed drugs making billions for the drug industry often at the cost of women’s health. The study reported an increase in breast cancer, stroke, heart attack and blood clots while providing a small benefit for hip fracture and colon cancer. Now HRT is recommended only if absolutely necessary when other methods have failed to relieve severe symptoms. It is used for the shortest possible time and can no longer be prescribed for the prevention of heart disease. For many women safer and effective natural alternatives work and should be considered first. He understood that the prevention of heart disease is about much more than cholesterol. Way back in 1974 Dr. Atkins evaluated his patients by measuring cholesterol, HDL, LDL and triglycerides. He understood then that triglycerides are an important risk factor for heart disease and that the total cholesterol is of minor significance. He observed in thousands of patients how his low carb plan improved HDL and drastically and quickly normalized triglycerides. To this day there are still no good drugs that do this. Yet we are spending billions of dollars and millions of people are taking statins who won’t get benefit from them even when they lower LDL. Low HDL and high triglycerides are 2 of the 5 signs of metabolic syndrome affecting tens of millions of people in the U.S. Standard advice still falls short in addressing these conditions that low carb is so good are fixing. The research done on Atkins has always demonstrated improvement in both HDL and triglycerides as compared to low fat which often makes these important values worse. Because the U.S. is a drug prescribing culture for everything, millions think they are at lower risk for heart disease simply because they take statins and have a lower LDL. If they haven’t made the lifestyle changes needed to really protect themselves the incidence of heart disease will remain high. Statins have been around about 20 years and have not yet lowered the incidence of heart disease as they were predicted to do. He taught us how to rebalance insulin and blood sugar simply by the foods we choose to eat. Because he understood the importance of identifying those at risk for blood sugar problems early, he intensively evaluated his patients. He did a 5 hour glucose tolerance test with insulin levels. He began measuring insulin levels in the mid-1970’s when the test first became available. To this day most doctors don’t routinely measure insulin even in their patients at risk. While watching the progression of insulin and blood sugar stress over time he came to better understand the relationship with triglycerides and HDL and how people progress from insulin resistance to hypoglycemia to diabetes. Since the publication of his first book in1972, he sensitized people to the importance of carbs that are bad for blood sugar (high glycemic) and those that are healthy to eat (low glycemic). Now almost everyday you see articles about the dangers of eating high glycemic carbs contributing to obesity, diabetes, cancer and other health problems. He taught us about the bad fat in our foods- manufactured trans fat. Natural saturated fats have been eaten by man since the beginning of the human race. Fat is an essential macronutrient. It has been demonized by poorly done research, wrong interpretations of research, the adoption of a hypothesis without rigorous study and the influence of special interests making billions on the low fat theory. The results of research that implicates saturated fat and heart disease has been compromised by diets high in carbs and trans fats. Yet even now you will still hear the saturated fat dogma repeated even when a study points to carbs as the problem. There is still much work to be done for people to understand the real truth about saturated fat. We can thank Dr. Atkins for being one of the first to bring the spotlight on dangerous, unnatural trans fats that benefit no one but the food industry. He was in the forefront of controlling both the quality and quantity of carbs to have a positive impact on a number of medical conditions. Back in the late 1970’s Dr. Atkins became interested in nutrition as a treatment for chronic medical conditions. One of his goals was to minimize the use of prescription drugs. He felt that in many cases drugs simply addressed a symptom not the underlying cause of the symptom. When someone experienced a side effect from the drug they were often given another drug to deal with the side effect. As people developed more symptoms they were placed on more drugs. Over the years it was common to see patients get better using low carb for seizures, migraines, diabetes, lipid disorders, joint pain, asthma, GERD, depression, insomnia, colitis, PCOS, skin disorders and many other conditions. Recent research is supporting the use of low carb for a number of these conditions including exciting research on Alzheimer’s and cancer risk. He cautioned about difficulty losing weight as a side effect of drugs. Just another reason why drugs should not always be the first line treatment for chronic conditions especially for people who are already overweight, obese or at risk for diabetes. The widespread use of HRT is the perfect example. Many other drugs such as psychotropic meds, birth control meds, insulin and drugs that stimulate insulin, steroids, non-steroidal anti-inflammatory (NSAIDs), beta-blockers and diuretics are the most common offenders. Recently there has been more discussion about the side effects of medications as a barrier to weight loss and even increasing risks for diabetes. The more meds an obese diabetic needs the more difficult weight loss becomes. This becomes a catch 22 since losing weight is an essential goal to improve blood sugar management. All the more reason to use a low carb diet approach for diabetes increasing the chances of avoiding or minimizing meds while allowing for weight loss. He challenged the concept that eating a “balanced diet” gives us all of the nutrients we need. This concept is quite outdated. Who even knows what a balanced diet is, certainly not one that contains 60% carbs-mostly highly refined? Foods we eat are no longer fresh, they are exposed to numerous chemicals, soil is depleted, and storage and cooking can significantly lower nutrient levels. According to the USDA the amounts of nutrients in fresh vegetables has dropped in the last 20 years or so. Further, numerous prescription medications negatively effect vitamin and mineral levels. The amount of nutrients we need is not just to prevent deficiency disease, rather Dr. Atkins and other practitioners of complementary medicine use supplements to maintain or restore optimal health for a variety of medical conditions with great success. Dr. Atkins provided his protocols in Dr. Atkins’ Vita-Nutrient Solution. Keep in mind that money for research for supplements is limited. Much of the research money now available is from the drug industry. Unfortunately, we are not likely to see much research on a natural substance that can’t be patented or will compete with drugs. That does not mean that supplements are not useful and important. Some of the more recent supplement recommendations now commonly accepted: folic acid to lower risk of birth defects and homocysteine (a cardiovascular risk factor), omega 3 fatty acids for numerous conditions, and a daily multivitamin for every adult. Recent information is confirming that finally some supplements are being given a closer look. A good example is Vitamin D. Almost daily you read evidence that we need far more vitamin D than was originally thought and the upper limits of safe are far higher than once thought. We are familiar with the need for Vitamin D for healthy bones. Research is pointing to other very important uses for the “sunshine vitamin”. Vitamin D helps support the immune system, decreases the risk of cancers, may protect us from type 1 and type 2 diabetes, important in auto-immune diseases and decreases the risk for heart disease. There are many other examples of Dr. Atkins’ innovative methods of practicing medicine I could have discussed but these are the high points. He inspired and influenced researchers and practitioners to take an open-minded look at his work. As a result more and more research is being done on low carbohydrate nutrition. In the future, it is likely to be more and more accepted as a safe and effective lifestyle for prevention and treatment. Unfortunately, I am sure there will still be some who will never acknowledge Dr. Atkins contributions to health and nutritional thinking. Knowing him, Dr. Atkins would likely be content to know that many tens of thousands of people all over the world have been helped because he had the courage of his convictions to speak out against the status quo. He will be remembered and appreciated by them. After all he was a physician who wanted to help people and that is certainly what he did.