KCP004 - The Atkins Low Carbohydrate Diet

The Keto Confidential Podcast

Show Notes: KCP004 The Atkins Diet

Terms & Definitions (1:06)

Critical Carbohydrate Level (CCL) – Is the maximum number of net carbohydrates that you can eat each day and still stay in ketosis. You can determine your individual CCL by either testing your urine with ketone test strips or with a blood ketone monitor. When using ketone urine test strips, once the strip doesn’t change color you have exceeded your CCL. If you are using a blood glucose monitor then when the reading is < 0.3 mMol, then you have exceeded your CCL. If you cannot afford to purchase ketone strips or a blood ketone monitor, most research indicates that on average eating less than 50 grams of carbohydrates a day you will enter a state of ketosis.

Critical Carbohydrate Level For Losing (CCLL) – Is the maximum number of net carbohydrates that you can eat each day and still lose weight. The CCLL is not monitoring whether you are in a state of ketosis, rather it is the level of carbohydrates you can eat and still lose weight.

Critical Carbohydrate Level For Maintenance (CCLM) – This is the maximum number of net carbohydrates you can eat on a daily basis and not gain any weight. Again, this is not a measurement of ketosis, but of measurement of body weight.

Who Was Robert Atkins (03:35)

Robert Atkins was an American cardiologist. During his medical internship, Atkins wrote “I had developed the reputation of being the biggest chow-hound in the hospital”. Because of his voracious appetite Atkins began to gain weight. How much he weighed is unknown, but in his book 'Dr. Atkins Diet Revolution', he wrote “It wasn't until 1963, another ten years of gaining, that I suddenly realized, seeing myself in a photograph, that I had three chins”. It was at this point that Atkins stated in his own words that he was “fat”, and that he had to do something about his obesity. The problem was, he loved to eat. Regarding his eating problem he wrote “I have a big appetite, but very little willpower, and even the thought of hunger scared me”. Dr. Atkins had read about Dr. Alfred Pennington's clinical trials and theory. Dr. Pennington believed that obesity was caused not by overeating, but by a metabolic defect in which the body was unable to utilize extra carbohydrates for anything except for making fat.

The Pennington Studies – In the late 1940's, Dr. Pennington placed twenty volunteers on a 3,000 calorie a day diet for three and a half months. During this time, they were allowed to eat anything they wanted except foods that contained sugar and starches which were replaced with fat and protein. At the end of his study, all of his volunteers stated that they did not have any hunger, they had more energy, and they never felt any fatigue while on this diet. On average, the participants lost 22 pounds, while lowering their blood pressure.

Dr. Bloom and Dr. Azar Studies – Bloom and Dr. Azar discovered that when carbohydrates were restricted or eliminated from the diet, the body burned all of it's stored glucose (sugar) for energy. Once the bodies glucose reserves were depleted, the body shifted gears and the liver began to breakdown and process fat stores to produce ketones to fuel the brain and provide the body with an alternative energy source. The extra ketones that the body did not need as energy were then flushed out by the kidneys in the urine. It was the measurable presence of the ketone bodies in the urine that allowed Dr's. Bloom and Azar to monitor the effectiveness of their experiments.

Atkins 1972 (7:28)

Atkins proposed that his patients eat all of the meat, fish, and fowl that they wanted, including all the fat. Eggs, butter, cheese, and heavy cream they wanted. They could drink unlimited amounts of coffee, tea, and diet drinks as long as they did not contain sugar. During their first week, vegetables were limited to a small green salad twice a day. Foods not allowed included: any foods containing sugar or starches such as bread, rice pasta, milk, fruit, fruit juices, and soft drinks, but diet soft drinks were allowed. Like Banting, Atkins allowed small amounts of liquor or wine, but no sugary mixers and no beer.

Atkins advised his patients to not be afraid of eating fat, and that fat did not make them fat. Fat he told his patients was actually a source of healthy energy that helped them to not feel hungry. He also advised his patients to not count calories, but to eat only when they were hungry, then stop eating. The original diet as proposed by Dr. Atkins in 1972, was pretty basic compared to the plethora of low carbohydrate diets that have come onto the scene in the last 40 years. You simply eliminated all carbohydrates from your diet and once you were in a state of ketosis, you began to add small amounts of carbohydrates back into your diet until you were no longer making ketones. This was how you determined your set point or as Atkins called it your 'critical carbohydrate level'. Once you knew your CCL, then you knew how many carbohydrates you could eat each day to maintain a state of metabolic ketosis.

So essentially, Dr. Atkins original diet was a five week trial and error diet. You eliminate all carbohydrates from your diet for one week, and then each week for the next four weeks you would add a few grams of carbohydrates (about 5 grams a week) back into your diet. If at the end of each week your urine is still testing positive for ketones, then you advance to the next week.

Key points of the Atkins original diet plan. 1) Dr. Atkins was a cardiologist, and his primary goal for promoting this way of eating was to help his patients lose weight thereby reducing their risk for cardiovascular disease. 2) His goal was never blood sugar regulation, although some of his patients may have also been diabetics. 3) His original dietary plan as promoted in his book was pretty basic. This was the diet he used with his patients, and they had direct access to him and his clinic so they received all of the individualized support they needed. Dr. Atkins and his staff helped their patients to make individual dietary adjustments as needed. I do not think he ever envisioned the effect that his original book would have on the American diet scene. And 4) Atkins promoted a low carbohydrate diet that allowed his patients and readers to eat all the meats, and fats they wanted. He did not however, promote a high fat diet. In fact, this book never lists any percentages of recommended protein, or fat intake.

Atkins Original Diet Revolution Rules (p.138):

1. Don't count calories.

2. Eat as much of the allowed foods as you need to avoid hunger.

3. Don't eat when you are not hungry.

4. Don't feel that you must finish everything on your plate just because it is there.

5. Drink as much water or calorie-free beverages as thirst requires. Don't restrict fluids...but it is not necessary to force them either.

6. Frequent small meals are preferable*

7. If weakness results from rapid weight loss you may need salt.

8. Everyday take a high-strength multivitamin pill.

9. Read the labels on “low calorie” drinks, syrups, and desserts. Only those with no carbohydrates are allowed.

* Current research indicates that frequent small meals keeps insulin levels elevated for longer periods of time throughout the day and this is recommended for diabetics or anyone who is insulin sensitive.

Atkins 1992 (14:40)

In 1992, Dr. Atkins completed the first major revision of the Atkins diet. His new book 'Dr. Atkins New Diet Revolution' almost doubled in size, growing to 540 pages. In this updated version, Dr. Atkins provided his readers with a more detailed plan for losing and maintaining their weight loss based on his experiences of treating patients in his clinic over the last twenty years. This revision also included quite a bit more reference material that supported his claims regarding the benefits of eating a low carbohydrate diet. The biggest changes however were the amount of net carbohydrates you were allowed to eat when first starting the diet and his adoption of eating phases.

While the previous version of the Atkins diet focused primarily on getting you into a metabolic state of ketosis as fast as possible, the focus of this revision was to ease you into a state of metabolic ketosis. Instead of having his readers go “cold turkey” by eliminating all carbohydrates at once, his new diet started the reader out at 20 grams of net carbohydrates. You would then add small amounts of net carbohydrates (5 to 8 each week) back into your eating plan during the latter phases until you no longer lost or gained weight. This new diet plan was comprised of the following four phases: 1) The induction phase, 2) Ongoing weight loss (OWL) phase, 3) Pre-maintenance phase, and 4) Lifetime maintenance phase.

Key points regarding the 'Dr. Atkins The New Diet Revolution' diet. 1) This revision was written for mass consumption and it contains a lot of additional information not found in his original book. Information such as tips, strategies, and ways to troubleshoot your experiences during each phase of the 'Atkins New Diet Revolution' as well as a number of low-carb recipes. 2) This diet, like his original 1972 diet is only ketogenic in the early phases. In my opinion, this revision focuses more on a low-carbohydrate lifestyle than one of metabolic ketosis, while the original 'Atkins Diet Revolution' published in 1972 was full on keto, but not necessarily high fat.

Atkins 2010 (24:00)

In 2010, Eric Westman, Stephen Phinney, and Jeff Volek collaborated to update and revise the Atkins' diet now titled 'The New Atkins For a New You'. Westman. Phinney, and Volek are considered some of the leading authorities on low carbohydrate and ketogenic diets. So what changed with the new Atkins Diet?

'The New Atkins For a New You' is basically the same as 'Dr. Atkins New Diet Revolution'. The names of the phases have been changed, and the starting point is divided into two separate categories based on the number of net carbohydrates you can eat each day. So if you need to lose more than 40lbs a day, then you follow the 'Atkins 20' guidelines. If you have less than 40 pounds to lose then you follow the 'Atkins 40' guidelines. The only difference between 'Atkins 20' and 'Atkins 40' is the starting number of carbohydrates you are allowed to eat each day. On the 'Atkins 20' program you start by eating only 20 grams of net carbohydrates a day. On the 'Atkins 40' program, you guessed it, you start out by eating 40 grams of net carbohydrates a day.

Their website at www.Atkins.com calls the 'Atkins 20' the original Atkins diet. What they mean by this is that the 'Atkins 20' is the same diet as the 'Dr. Atkins New Diet Revolution', published from 1992 through 2002, not the 'Atkins Diet Revolution' published in 1972. As I mentioned they simplified the name of the phases and list the carbohydrate range of each phase on their website. In Phase 1, you eat 20 – 25 grams of net carbs, Phase 2: 26 – 50 grams of net carbs, Phase 3: 51 – 80 grams of net carbs, and Phase 4: 81 – 100 grams of net carbs each day. Other than that, 'The New Atkins For a New You' is for all intents and purposes the same as 'Atkins New Diet Revolution'. The new book does contain a lot of new and helpful information as well as scientific findings and research that validate the concepts and benefits of a ketogenic diet that have surfaced since the diet was updated in 2002.

You've Got Mail (28:25)

This week I have two different questions regarding net carbohydrates. While each is slightly different, they are both interrelated. Our first question comes from Roger W. who wrote “I hear the term net carbs and total carbs mentioned when it comes to keto. Should I be counting the total carbs or net carbs that I eat each day?”

Great question Roger, so here's the short and simple answer to your question. When you are on a ketogenic diet, you are only counting net carbohydrates, not total carbohydrates. The theory behind counting only net carbohydrates is that our bodies gastrointestional system cannot absorb dietary. Since dietary fiber is passed through your body in the form of stool, you need to be able to figure out the amount of net carbohydrates there are in a product or recipe. Figuring out the amount of net carbohydrates is simple. When you are looking at the label of a product, subtract the amount of dietary fiber from the total carbohydrates, and what you have left is the amount of net carbohydrates per serving.

Martha E. writes in her e-mail “The package of a snack bars that I bought states that each bar has a total of 3 grams of net carbs, but when I subtract the fiber from the total carbs I get 11 net carbs, not 3. What am I doing wrong?

Well, Martha, you are not doing anything wrong, but you are being deceived by the makers of that product, and I will show you why. Many of the so-called diabetic friendly treats, snack bars, and “sugar-free” products get there sweetness from sugar alcohols instead of sugar. Sugar alcohols like dietary fiber are in theory not absorbed by the gastrointestinal system. This is why the snack bars that you are eating claim to only have 3 grams of net carbohydrates.

The only problem with this formula is that while sugar alcohols are in theory not absorbed by the gut, they can still raise your blood sugars. Because your blood sugar increases, you get an increased insulin response which causes you to store more fat. The other problem with sugar alcohols is that in some people they cause gastrointestional distress. The University Of Southern California, San Francisco states on their website “sugar alcohols are hard for the body to digest, the effect on blood sugar levels is less than standard sugar. When counting carbohydrates for products made with sugar alcohols, subtract half of the grams of sugar alcohol listed on the food label from the total grams of carbohydrate. Remember that because sugar alcohols are harder for your body to digest, eating too many sugar alcohols may cause digestive complaints like gas, cramping and diarrhea”.

Because we are talking about the Atkins diet in this podcast, let's examine the nutritional label of their 'Triple Chocolate Bar'. The box that this snack bar comes in states in bold letters on the front of the box 'Only 4 Net Carbs' per bar. The nutritional label lists total carbohydrates as 17 grams, dietary fiber as 5 grams and sugar alcohols as 8 grams. So in order to get the 4 net grams, Atkins subtracts the 5 grams of fiber plus the 8 grams of sugar alcohols from the 17 grams of total carbohydrates to get 4 net carbohydrates.

While the Atkins 'Triple Chocolate Bar' box claims it only contains 4 net carbs, the actual “effect” on your blood sugar levels is actually equivalent to 8 net carbs, not 4 net carbs. That's because we have to account for half of the sugar alcohols. So Martha, to answer your question, I believe the nutritional label on the snack bars you mentioned effectively contains 8 grams of sugar alcohols just like the Atkins 'Triple Chocolate Bar' in my example.

While I personally believe that the formula used by manufacturers of subtracting all sugar alcohols from the total amount of carbohydrates to get a lower amount of net carbohydrates is a deceptive practice, it is not illegal. Unfortunately many people unknowingly eat twice the amount of carbohydrates than they thought they were eating because they believe what they read on the front of the package.

The reality is there are two separate formulas for determining the net carbohydrate count of a product or recipe. If the product or recipe contains no sugar alcohols, then you simply subtract the amount of dietary fiber from the total carbohydrates to get the amount of net carbohydrates. If a recipe contains sugar alcohols then you subtract the fiber, and only half of the sugar alcohols to get the correct amount of net carbohydrates.

If you have any questions or feedback regarding anything you have heard on this podcast, feel free to send me a e-mail at [e-mail]. Don't forget to include your name and e-mail address in message. Keep in mind, that if you do not want me to use your name in a future episode of this podcast, then let please include that in your message

Recipe Of The Episode (33:40)

One of the best ways in which you can reduce the amount of carbohydrates in your salad is to make your own salad dressings. Dressings such as Ranch, Blue Cheese, Thousand Island, Creamy Italian, Creamy French and Catalina all have one common ingredient, and that is mayonnaise. Now you could use a commercial mayo in your dressings, but a better keto option would be to make your own, and that is the recipe featured in this episode.

The ingredients needed to make your own mayonnaise are pretty straight forward egg yolk, oil, lemon juice, vinegar, and seasonings of your choice. When making mayonnaise by hand you need to be able to use a whisk with your dominant hand while slowly adding or pouring the oil with your non-dominant hand. So if you have both hands busy, you need a way to keep the bowl from spinning all over the counter and landing on the floor. I use a plastic bowl that has a silicone coating on the bottom that works great and the bowl never moves when making mayonnaise this way.

In the restaurant, we had stainless steel prep counters and metal bowls and they would not stay in one place. The trick is to take a hand towel and soak it in water, squeeze out the excess, and fold it into a small square and place your bowl on top of the damp towel. This keeps the bowl from sliding around on your counter. We also placed damp towels under all of our cutting boards to keep them from sliding around on the counters.

While I still make mayonnaise by hand occasionally, my preferred method is to use my immersion (stick) blender. You can find complete instructions on how to make mayonnaise using your immersion blender by clicking on the link in the show notes at at www.ketoconfidential.net/KCP004/Atkins.

Here is a lost of the following ingredients that you will need:

1 egg yolk

1 cup olive or canola oil

2 teaspoons fresh lemon juice 2 teaspoons white vinegar

1 teaspoon water ½ teaspoon iodized salt ½ teaspoon dry mustard or ¼ teaspoon prepared yellow mustard ¼ teaspoon sugar ¼ teaspoon white pepper

Remove the egg from the fridge and separate the egg yolk and place in a small bowl and allow to come to room temperature. Once the egg yolk has come to room temperature add the remaining ingredients to the bowl and whisk together for about 1 minute, or until the mixture is completely combined and slightly frothy.

Now is the time to start adding the oil. Initially you need to do this very slowly, a few drops at a time or a slow steady steam while continuously whisking until the mixture begins to form an emulsion. Once the egg and oil begin to come together, you can slowly increase the rate of the oil to a slow steady stream as you continuously whisk the contents. If the emulsion begins to separate stop adding the oil and continue to whisk the contents until the emulsion forms again.

Once your emulsion has fully formed and your mayonnaise appears complete, taste and adjust your seasonings to suit your personal preference, cover with a lid and put it in the refrigerator to chill. Because there are no stabilizers or preservatives, homemade mayonnaise has a refrigerated shelf life of 7 to 10 days.

Some Safety Notes To Consider

There is a slight risk when making homemade mayonnaise that you will not find in commercially prepared mayonnaise, and that is the risk of salmonella poisoning. The eggs we use come from our free range chickens so there is almost no risk. However, if you use raw unpasteurized eggs from your local supermarket, there is a still the very small risk of salmonella. You can of course buy pasteurized eggs thus avoiding the risk, but they do cost more.

While it is not recommended that women who are pregnant and or kids be on a ketogenic diet, I wanted to add this one safety disclaimer regarding raw eggs. Women who are pregnant, infants or those with compromised immune systems should avoid eating mayonnaise made with raw eggs unless they are pasteurized. While the risk is minimal, according to the CDC about 1 egg in 20,000 in the 1990's was contaminated with salmonella. If someone in your family is pregnant, or you have infants or small children under the age of 5 then buy pasteurized eggs. While the risk is poisoning is minimal, and the topic is controversial, the ultimate choice is yours to make.

For complete detailed instructions regarding this recipe and how to make mayonnaise, you can check out my article on my keto food blog 'CulinaryyoU' at www.culinaryyou.blogspot.com, or by visiting my website www.ketoconfidential.net and clicking on the limk on the main page. Or you can simply follow the link that is included in this episodes show notes at www.ketoconfidential.net/kcp004/atkins.

Ending (38:53)

If you enjoyed this episode of the Keto Confidential podcast and have found this content useful, then please subscribe, take a few seconds to rate this episode, and write a quick review about it so that others may benefit from this information. If you know someone that is struggling with obesity. type 2 diabetes, or both please share this podcast with them so that together we can help them overcome their struggles. Once again, I would like to thank you for listening. So until next time, be safe, and stay keto strong my friends.

Links:

CulinaryYou 'Home made Mayo' Recipe

Atkins: Low Carb Diet Program And Weight Loss Plan

References:

Atkins, Robert, M.D. (1972). Dr. Atkins' Diet Revolution: The High Calorie Way To Stay Thin Forever. New York, NY: David McKay Company Inc.

Atkins, Robert, M.D. (2002). Dr. Atkins' New Diet Revolution: The Low-Carb Approach That Has Helped Millions Lose Weight And Keep It Off. New York, NY: Harper.

Banting, William. (1863). Letter On Corpulence. London: Haerison.

Bloom, Walter L. M.D., Gordon J. Azar, M.D. Similarities Of Carbohydrate Deficiency And Fasting I: Weight Loss, Electrolyte Excretion, and Fatigue, Internal Medicine, 1963 (PP 333-337).

Counting Sugar Alcohols, Diabetes Education Online, University Of California, San Francisco. Accessed March 17, 2018.

Moody, Elizabeth, (1950) An Eat-All-You-Want Reducing Diet, Holiday Magazine, New York, NY

Pennington, Alfred W. “Obesity in Industry: The Problem and its Solution”, Industrial Medicine & Surgery, June, 1949, (pp 259 and 260).

Phinney, Stephen M.D., Volek, Jeff, Ph.D. (2011). The Art And Science Of Low Carbohydrate Living. Beyond Obesity LLC.

Phinney, Stephen M.D., Volek, Jeff, Ph.D. (2011). The Art And Science Of Low Carbohydrate Performance. Beyond Obesity LLC.

Westman, Eric, M.D., Phinney, Stephen M.D., Volek, Jeff, Ph.D. (2010). The New Atkins For A New You: The Ultimate Diet For Shedding Weight and Feeling Great. New York, NY: Fireside.