Good Calories, Bad Calories

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 hypotheses or even establishing of consensus but by the judgment of fewer than a dozen men who dominated the field: Jean Mayer, Fred Stare, Jules Hirsch, George Bray, Theodore Van Itallie, Albert Stunkard, George Cahill, Philip White, and perhaps a few others. (And when these men began to retire from the scene in the 1980s, their younger colleagues—Johanna Dwyer, who received her Ph.D. with Mayer; Francis Xavier Pi-Sunyer, who collaborated with Van Itallie; Kelly Brownell, who worked and studied with Stunkard—assumed the leadership and perpetuated their beliefs.)