How can we lose weight? Protect our hearts? Control blood pressure? Docs are divided

excerpt from Newsweek Dec. 8 issue - http://msnbc.msn.com/id/3606238/

Science is the foundation of good medicine, but it rarely offers complete or perfect answers. Doctors examining the same evidence may differ sharply on how best to promote health or treat illness. In this forum, Harvard experts stake out opposing positions on three open questions.

DOES ATKINS MAKE SENSE?

Yes: I have long doubted that cutting carbs is the key to losing weight, as proponents of the Atkins diet claim. But recent evidence has forced me to reconsider. I'm still not convinced that the Atkins approach is more effective or more healthful than others, but I now believe it can help overweight people shed pounds.

What changed my mind was a spate of new studies comparing the Atkins diet with low-fat or low-calorie regimens. In the first study, involving 79 overweight people, those on Atkins lost 13 pounds over six months, while those on the American Heart Association diet lost only four. In the second study, obese women shed 15.4 pounds by counting carbs for six months but only seven by counting calories and fat. The third study compared Atkins with three other popular diets (Ornish, Weight Watchers and the Zone), and found that all four brought significant weight loss over a year's time. Atkins worked no better than the other diets-but it worked.

These studies tell us nothing about long-term weight management. We know only that Atkins can work as a short-term strategy. But the findings support a central tenet of the low-carb faith: that a relatively fatty diet may help you lose weight because it makes food more satisfying and filling.

-Anthony L. Komaroff, M.D.

No: I agree that the Atkins diet can produce short-term weight loss, but a diet should promote long-term weight loss and better overall health. A high-fat regimen is unlikely to help you achieve either of those goals.

Suppose you went on an 800-calorie per day diet, in which all 800 calories were in the form of hot-fudge sundaes. You would lose weight on that diet, but would it be healthy? The original Atkins diet was not that different from a hot-fudge sundae diet. It sanctioned steak, bacon, cheese and butter, while banning not only sweets but also bread, pasta, grains, many fruits and some starchy vegetables. This advice flies in the face of overwhelming evidence that diets high in fruits, vegetables and whole grains are healthy.

The latest version of the Atkins diet is more sensible. Even some healthy (whole- grain) carbohydrates are allowed, though in moderation. But it still goes wrong in sanctioning unlimited saturated fat. Unless larger studies show that it helps people keep weight off for a long time, and that this weight loss brings the expected health benefits, then studies showing short-term weight loss just don't mean very much. If you're determined to try the Atkins diet, swap the steak and bacon for fish or chicken with a fresh vegetable sauteed in olive oil. And add some fruit and some whole-grain, high-fiber foods. That's a healthier low-carb diet.

-Frank M. Sacks, M.D.

© 2003 Newsweek, Inc.