PETER JOHANSKY/ENVISION FOR TIME DISH WISH: Dinner out comes with tough choices

Low Fat vs. Low Carb
	The doctors present their dueling diet theories: Robert Atkins, M.D.   Dean Ornish, M.D.

Posted Sunday, Aug. 25, 2002; 4:00 p.m. EST

The Case for Low Carbs
by Robert Atkins, M.D.

For the past 20 years, anything other than a low-fat diet—which usually includes a lot of carbohydrates—has been considered unscientific and dangerous. So it is quite ironic that as researchers are finally studying the benefits of the Atkins Nutritional Approach (ANA), which controls carbohydrates, the scientific underpinnings for the low-fat approach are being challenged.

Research on controlled-carbohydrate programs demonstrates that subjects find them easy to follow and effective in helping them lose weight. In addition, controlling carbohydrates lowers glucose and insulin levels in the blood—risk factors associated with heart disease, diabetes and other metabolic syndromes.

Here are the facts regarding the three phases of my program. During induction, the amount of carbohydrates allowed is limited to 20 grams a day—the equivalent of three cups of broccoli, spinach or salad greens. Mine is not and has never been a no-carb diet. During the next phase of the program, ongoing weight loss, you add five grams of carbs a week until you find what we call your CCLL, or critical carbohydrate level for losing, which is usually between 40 to 60 grams a day. Once you've achieved your desired weight, you continue to add healthy carbs, seeking a level that does not cause you to regain weight.

The ANA recommends that the carbs you add consist of more green vegetables, followed by seeds and nuts, fruit that won't spike your insulin levels (such as berries, cherries and green apples), whole grains and even some starchy vegetables. How many carbs you can include in your daily diet will depend on your age, gender, level of activity and genetics. Followed properly, the Atkins program (www.atkinscenter.com) can last a lifetime, without your having to count calories or feel hungry all the time.

Low-fat diets require strict calorie counting, do not allow for individual metabolisms and often require putting up with hunger due to a low-calorie and minimal-fat intake.

As far as safety is concerned, look to the science for your answer, not high-profile critics. My program preserves lean body mass, sparing muscle loss. In my experience, it is not harmful to bones or kidneys.

For over 30 years, I've been a lone voice in the wilderness. I am grateful that the National Institutes of Health is now examining controlled-carbohydrate and low-fat nutrition. These studies may end up showing that excessive carbohydrates are the true culprits, not fat. At what point am I allowed to say, "I told you so"?

—Dr. Atkins is chairman of the Dr. Robert C. Atkins Foundation and author of Dr. Atkins' New Diet Revolution

The Case for Low Fat
by Dean Ornish, M.D.

Here's how you lose weight: burn more calories. Eat fewer calories. That's it.

You can burn more calories by exercising. You can eat fewer calories by consuming less food. You can lose weight on any diet, but it is hard to keep the pounds off because you feel hungry and deprived. An easier way to consume fewer calories is to eat less fat, because there are nine calories in each gram of fat, whereas protein and carbohydrates have only four. So eating less fat allows you to consume fewer calories without eating less food.

I agree with the high-protein advocates that it is wise to eat fewer simple carbohydrates, like sugar, white flour and white rice. They are also low in fiber, so you get a lot of calories that don't fill you up. On top of that, simple carbohydrates get absorbed quickly, causing your blood sugar to zoom up. Your body responds by making more insulin, but too much insulin accelerates conversion of calories into body fat.

The goal, however, is not to go from simple carbohydrates to bacon and brie. Instead you should opt for whole foods with complex carbohydrates such as unrefined whole-wheat bread, brown rice, fruits, vegetables and beans. These are packed with thousands of protective substances. In addition, they are rich in fiber, which slows their absorption, thus preventing a spike in your blood sugar and an excessive insulin response.

On a high-protein diet, you may lose some weight because you are eating fewer simple carbohydrates. But you can lose even more weight by eating fewer simple carbohydrates and less fat. And you enhance your health instead of mortgaging it. Indeed, there is now evidence that a high-protein diet can actually decrease the flow of blood to the heart in patients with heart disease (www.ornish.com).

The more closely and the longer people follow a low-fat, whole-foods diet, the more their heart disease improves. In our research, angina (chest pain) decreased 91%, and cholesterol levels fell 40%, without medications. Most patients eligible for bypass surgery or angioplasty were able to avoid it safely. These findings have been published in the leading peer-reviewed journals. Medicare now covers 1,800 patients in our lifestyle program.

I eat high-fat foods sometimes, but I don't delude myself into believing they are good for me. To get the full benefits of the good fats, you need to consume just three grams of fish oil or flaxseed oil a day.

You have a spectrum of dietary choices. But to the degree that you reduce simple carbohydrates and fat, you will lose weight and gain health.

—Dr. Ornish is the founder and president of the Preventive Medicine Research Institute and the author of Eat More, Weigh Less