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New Studies in 2002 Left Us Asking If High-Fat Diet Is Safe After All

It's bad for you. No, it's good for you. It works. No, it doesn't work any better than any other diet. We're talking about the Atkins diet, of course, possibly the most controversial diet in America and one of the best-selling diet books in history. Until recently, medical opinion outside the Atkins fold was almost universal: Any diet that high in fat is dangerous -- particularly bad for your heart and likely to send cholesterol levels skyrocketing, for starters.

But recent studies have raised new questions: Could Atkins be safe and effective after all? At the American Heart Association meeting earlier this year, Duke researcher Eric Westman, MD, presented the results of a study comparing Atkins dieters to those who used an AHA "Step 1" diet: The Atkins dieters lost an average of 31 pounds compared with 20 pounds for the other group -- and they did it while improving their cholesterol levels. So should you pile your plate high with bacon, cheese, and steak?

Not so fast, say many experts. Even if early assumptions that Atkins must be bad for you were premature, the recent stampede of "maybe Atkins is good for you" headlines is just as much of a rush to judgment. In fact, even some of the authors of studies touted as supporting Atkins are nervous about the sudden public turnaround from skepticism to enthusiasm. Westman, whose research was funded by Atkins, was among the first to point out that it was a small, preliminary study that shouldn't change anyone's eating habits just yet.

"My concern is that anything that we've read recently about the Atkins diet is based on presentations at scientific meetings," says Gary Foster, MD, clinical director of the Weight and Eating Disorders Program at the University of Pennsylvania. "The few actual published studies are simple pre- and post-tests of the Atkins diet. Nobody's compared a conventional diet to Atkins in a randomized, controlled way."

That may soon change. Foster's own year-long study, the longest yet of the Atkins diet, is expected to be published next year, and he's already obtained a five-year grant from the National Institutes of Health to do an even larger, three-center study comparing Atkins to a conventional diet based on the USDA food guide pyramid. "The main outcomes we'll be following, besides weight loss, are lipid levels, bone density, kidney and [blood vessel] function, and exercise tolerance," Foster says.

So in five years, we'll probably know a lot more about Atkins -- but what do we know now? "Early unpublished data from several groups suggest that maybe Atkins isn't as harmful as we thought," Foster says. "However, all of these are small studies, and we need much larger studies with much broader, comprehensive assessments before we should change the dietary recommendations."

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