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Chapter 3. Atkins Goes To South Beach

“Self-conceit may lead to self-destruction.”
Aesop (620 BC - 560 BC)

“Oh what a tangled web we weave, When first we practice to deceive!”
Walter Scott (1771 - 1832)

This chapter explains for the first time the mechanisms of  precipitous weight loss during the induction stage (first two weeks), describes the causes of the most common  diet-related side effects, and  deciphers the weight loss plateau phenomenon associated with the Atkins Diet.

If you benefited from the Atkins Diet, and can't stand any criticism of its late author, let me say this before you start calling me names —  you are in the lucky minority! This information, however, is intended for people who had failed the Atkins Diet, and would like to learn why. In all other respects, I am a die-hard advocate of low-carb dieting, and living proof of its prowess.

The number of overweight and obese Americans is mind-shattering — by the turn of the 21st century, 137 million adults out of 210 million adults were overweight. In this context, it isn’t surprising that in the United States alone over 35 million people have read Dr. Atkins’ books with the intent to lose weight.

And the facts are: when the original Diet Revolution was published in 1972, only 14% of Americans were overweight. When New Diet Revolution was released, in 1992, 56% of Americans were. In 2003, when Dr. Atkins passed away, the figure rose to an incredible 65% — a staggering 464% jump in just one generation. Some revolution!

True, some of Dr. Atkins’ readers lost weight. Fewer kept it off permanently. The majority failed completely. Some of these dieters ended up with more health problems after the diet than what they had started with, including Dr. Atkins himself.

After Dr. Atkins’ cardiac arrest, unquestionably from obesity-related complications, and his mysterious death one year later, ever-hopeful dieters jumped onto the South Beach bandwagon. Still, permanent weight loss remained as elusive as ever for most do-it-yourselfers, and the shortcomings of this new fad diet were just about the same as the shortcomings of the Atkins diet.

Both the Atkins and South Beach diets share a common denominator — a low intake of carbs. Though Dr. Agatston, the author of the South Beach Diet, denies that his diet is low-carb, it absolutely is: around 100 grams (3.6 oz) of carbs are allowed on South Beach, which is still 300% to 500% less than what most Americans consume daily.

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Food from plants — grains, legumes, fruits and vegetables — are the major source of dietary carbohydrates and fiber. Whenever the amount of carbohydrates in any diet goes down four to five times, so does the corresponding amount of fiber. Thus, someone who was getting 25 to 50 grams (0.9–1.8 oz) of fiber on a regular diet is now getting only 5 to 10 grams (0.17–0.35 oz) on a low-carb one.

Not surprisingly, an instant and dramatic reduction of fiber in the diet causes constipation among dieters, who depend on a high intake of fiber to move their bowels — a condition this book defines as latent constipation. Here are the reasons behind this grief-causing dilemma of constipation":

These cumulative problems are even more acute for someone who already has a prior history of constipation and anorectal disorders, such as hemorrhoidal and diverticular diseases, which are present in over half of the adults over, respectively, the ages of fifty and sixty.

When constipation becomes unbearable, most people just drop the diet and resume a high-carb, high-fiber lifestyle. Others may do so only after belatedly following Dr. Atkins advice to add fiber laxatives. Supplemental fiber forces out hardened stools with considerable pressure, often strong enough to cause hemorrhoidal prolapse and/or laceration of the anal canal. That’s enough pain and suffering to stop any diet dead in its tracks.

We know, of course, that other people (including my family and many readers of my early books) embraced a low-carb lifestyle, lost weight, and weren’t perturbed by constipation a tiny bit. These people belong to three distinct groups:

Keep in mind that taking supplemental fiber isn’t a question of having your cake and eating it, too. It is a man-made laxative medicine, and just as with all drugs, it comes with a price, which is amply described throughout this book. Still, a lot of people would gladly tolerate constipation for the fleeting chance of getting back into their prom gowns and tuxedos. But even that wasn’t happening — they weren’t losing weight or they couldn’t keep it off beyond the first few weeks. Here are the reasons why.

A diet empire built on crap, literally

If a diet doesn’t work, the blame is always passed onto the dieter: you aren’t strong-willed, you aren’t committed, you aren’t this, you aren’t that. That’s — forgive my bluntness — certified bull! The reasons diets don’t work have little to do with will power, commitment, and other personal characteristics. All it really means, is that:

If The Diet Isn’t Working For You,
It’s A Bad Diet!

If one lacks the know-how necessary to develop an effective diet, or the integrity to tell the hard truth that losing weight is very hard, all that’s needed is a gimmick that shows at least some weight loss. The induction stage of the Atkins diet and phase one of the South Beach diet, both lasting the same 14 days, became these faultless gimmicks for their respective promoters, a three-card Monte of sorts, that suckers people in even if they sense a con.

The deception is right there, on the back cover of The South Beach Diet, stated in no uncertain terms:

Dr. Agathston’s diet has produced consistently dramatic results (8 to 13 pounds lost (sic) in the first 2 weeks!) [...] Now you, too, can join the ranks of the fit and fabulous with The South Beach Diet. (Hardcover edition, 2003).

And right on the front cover of Dr. Atkins’ New Diet Revolution:

Experience in 14 days the unique metabolic edge the Atkins Diet provides. (Hardcover edition, 1992)

Inside, Dr. Atkins provides specifics: depending on gender, current weight, and metabolic resistance, one can expect to lose between 2 and 16 lbs in 14 days (p. 172, Chart 17.2).

Indeed, who can resist an easy loss of 5–10–15 lbs in just two unforgettable weeks, when fat is melting like butter, pounds are dripping off, and the waistline is shrinking!

Actually, it wasn’t fat that was melting, but “crap.” It wasn’t pounds that were dripping off, but body water. And it wasn’t the waistline that was shrinking, but bloated intestines. And none of these are just “figures of speech” to grab your attention, but actual physiological occurrences behind phantom weight lossa phenomenon, I believe, that is defined, described, deciphered, and debunked for the first time in this book.

To fathom what I’m talking about, let’s begin with a simplified overview of energy metabolism, so you can perceive the difference between real and phantom losses, as well as understand and appreciate the dynamics that drive the processes of weight loss and gain.

The body needs a continuous supply of glucose to fuel energy metabolism. To maintain tight glucose homeostasis — stability within a corridor of about 70 to 90 mg/dL — the body converts digested nutrients into cellular energy from carbohydrates or synthesizes glucose in the liver from fatty and amino acids by means of gluconeogenesis. These processes complement and back each other up in case any one raw nutrient — carbohydrates, fats, or protein — is temporarily unavailable.

While fasting and at relative rest, a 155 lbs (70 kg) individual requires approximately 200 g (7 oz) of glucose during a 24-hour period. The formula to calculate the demand for your particular weight is 2 mg of glucose per kg of body weight for each minute (2 mg/kg/min). [1]

These 200 g, are, of course, approximate. The actual number changes depending on the body and outside temperature, levels of additional physical and intellectual activity, and some other factors. “Additional” means above and beyond the body’s regular functionality, such as heart function, breathing, walking, vision, hearing, thoughts, etc. Obviously, the additional activities increase energy needs, and that’s why exercise, physical as well as intellectual, will accelerate commensurate weight loss.

Beyond the glucose for energy metabolism, the body needs a continuous supply of fatty and amino acids to build new cells, synthesize hormones, enzymes, vitamins, and other critical substances. These needs are called plastic, organic, or replacement, meaning to rebuild or to replace dead cells and the substances lost with feces, urine, perspiration, and exhaled air.

The amount of replacement fatty and amino acids isn’t as simple to determine, because, unlike glucose, the body stores considerable amounts of fat (adipose tissue) and protein (muscle tissue), and can synthesize what it needs on demand. However, according to the U.S. RDA [DRI as of recent — Ed.], the rule of thumb is:

Also keep in mind that, relative to an individual’s age and weight, fat and protein requirements are higher for growing children, for the elderly to compensate for diminishing digestion, for women during pregnancy and lactation, for body builders and physical laborers, for people recovering from disease, or who are under stress, and similar circumstances.

The rest is really, really simple. Just note one key distinction — I am using the terms “losing fat” or “fat loss” rather than “losing weight” or “weight loss,” because that’s what you are after — real fat loss rather than phantom weight loss.

Of course, these processes are much more elaborate and complex, the numbers are approximate, and you can easily pick up the specifics from any decent medical biochemistry textbook. But that’s enough for us to figure out and conclude that to consistently lose fat, you need to take the following steps:

And, conversely:

The South Beach diet performs somewhat better than Atkins, because, much to his credit, Dr. Agatston urges moderation in everything — carbs, fat, and protein. But this is still not enough for the sustained and permanent weight loss that readers desire. As long as excess carbs, fat, and protein are still present in the diet, the loss of body fat is a physiological impossibility, period.

To summarize: in order to consistently lose fat on a low-carb diet, you must keep your body in a perpetual state of lipolysis. To accomplish this feat you must consume: (a) ZERO carbs; (b) under 60 grams of protein to prevent muscle wasting, and (c) under 70–80 grams of fat to enjoy some level of satiety, enhance the digestion of proteins, maintain the integrity of intestinal mucosa, and prevent the formation of gallstones. (Please adjust these figures to your own weight and levels of activity!)

Alas, nothing even remotely close is recommended by either the Atkins or South Beach diets. Why, then, do so many people report losing between 5 to 15 lbs (2.2- 6.8 kg) during the induction stage? Are they all lying? What, then, explains the weight loss during the induction stage (phase one) anyway?

They’re not lying. As I said before, they’re simply observing phantom weight loss, meaning the loss of (1) fat, (2) body water, (3) foods in transit, and  (4) accumulated stools.

A moderate loss of fat (1) is possible, but not likely. Here is why:

Thus, a realistically attainable loss of fat during the induction stage (phase one) is under 1.4 kg (3 lbs); (14 days * 100 g). Obviously, even this minor fat loss won’t happen if you follow Atkins’ advice and consume unlimited amounts of fat and protein. And you will lose only half that much fat on the South Beach diet, if you follow Dr. Agatston’s menu and consume around 100 g (3.5 oz) of carbohydrates.

For comparison’s sake, the total daily weight loss during complete starvation ranges — depending on starting weight and activity level — from 200 to 400 g (7–10.4 oz), which is the physiological weight loss ceiling. This, of course, includes the loss of fat and protein used for the body’s plastic needs.

Here’s a real-life example: David Blaine, who spent 44 days without food, emerged from his glass cage 55 lbs (25 kg) lighter[5]. Assuming 20 of those pounds were phantom weight loss (he’d been stuffing himself with loads of food just before going in), the magician was losing 0.79 lb (358 g) per day. And that was definitely at the high-end of the scale — hanging in a transparent box in the center of London under the 24/7 scrutiny of gawking crowds requires a great deal more energy than a simple, straightforward fast.

Now the water loss (2). Since 45 to 65% of an adult’s body weight is composed of water, a person may drop 5% of that volume before dehydration sets in. For a 176 lbs (80 kg) person, a 5% loss represents between 5.7 and 6.2 lbs (2.6–2.8 kg). And here is what’s happening during the induction (phase one) stage of either diet:

To summarize: If water loss is all you want, drink less, keep to your regular diet, reduce potassium-rich products, consume at least 1 g of protein per kg of body weight, and visit the sauna often.

Now, moving on to the melting “crap” part. First, there are foods in transit (3):

To summarize: The actual difference of consumed food before and during the induction phase varies greatly from person to person, so I’ll assume this weight reduction at a modest 3 lbs (1.4 kg), less than the weight of a single dinner for most adult Americans.

Finally, there are accumulated stools (4):

To summarize: At the rate of 300 to 500 g per day (average weight of stool on a high-fiber diet), elimination accounts for the loss of 5 to 7 lbs (2 — 3 kg) in the first week alone. After adding up all these losses — improbable loss of fat, minor loss of water, tiny reduction of food still transiting through the intestines, and reasonable elimination of stools — here is what you end up with:

 The components of weight loss during
the induction stage of the Atkins or South Beach diets

Weight loss from Daily
weight loss
of loss
1. Loss of fat 100 g (3.5 oz) 14 days 3 lbs (1.4 kg)
2. Intestinal content in transit Varies 2–3 days 3 lbs (1.4 kg)
3. Endogenous (body) water Varies 3–5 days 5.7 lbs (2.6 kg)
4. Accumulated stools Varies 4–6 days 5.0 lbs (2.2 kg)
Total weight loss     16.7 lbs (7.6 kg)

As you can see, the total estimated weight loss comes to a substantial 16.7 lbs (7.6 kg) while using the most conservative estimates. From this, 13.7 lbs [darker cells — Ed] is a phantom weight loss made of water, foods that are still being digested, and stools.

Even then, this considerable weight loss can be accomplished only by someone who follows a very strict, literal form of induction: zero carbs and under 80 grams of fat and protein each for 14 days; almost a starvation protocol for most people. That’s why both Dr. Atkins and Dr. Agatston hedged their claims of 14-day weight loss at, respectively, 2 to 16 lbs and 8 to 13 lbs, knowing well that very few people can diet exactly “by the book.” To hedge even more, Dr. Atkins invented the fictional term metabolic resistance, so he could disown failing dieters:

— Blame yourself, lady. You aren’t losing weight because your metabolic resistance is to-o-o high!

It gets even worse if you continue to the next stage — the ongoing weight loss (OWL) on Atkins, or phase two on South Beach. The fat loss stops on both diets for all but the most physically active and dedicated dieters. And those on Atkins would begin gaining back real fat even faster, because now they are permitted unrestricted fat and protein consumption along with carbohydrates. In other words, three-card Monte is over.

Luckily, there’s still a consolation prize: relieving one’s body of excess water and “crap” is actually a great deed. Not exactly what was set out to be accomplished in the first place, but still good for the health, body, and mind. That said, as soon as the induction stage is over, so is the loss of weight. There simply isn’t any more food, water, and “crap” left inside, and in most cases, that’s the moment when constipation sets in. The “honeymoon” is over for good. People reach the dreaded plateau of the Atkins or South Beach diets.

The loss of “foods in transit,” water, and stools also explains the precipitous reduction of the waistline (clothing size) during induction. The reduction happens because the four conditions typically related to a high-fiber diet are now gone: edema, intestinal bloating, flatulence, and impacted stools. Serendipitously, the “shrinking” intestines happen to be right under the waistline.

You can easily accomplish a similar feat by taking a massive dose of laxatives and spending several hours in a hot sauna. That’s what some jockeys do before races to reduce their weight, or some women to squeeze into tight-fitting gowns. Not really much fun and bad for the health, but it may easily bring a size 12 body down to an 8 — good enough to crash a party. Just don’t crash yourself from severe dehydration.

Was Dr. Atkins aware of all this? At some point he probably was. But it must be hard to admit that one’s empire was built, literally, on crap, and that all this time one’s readers and patients had been “dumping” water and stools, not fat. And if Dr. Atkins didn’t know it, all things considered, he’s darn lucky not to have lived long enough to get embarrassed by the “revelations” in this book.

Does Dr. Agatston, the author of the South Beach Diet, know this? It’s hard to say. If he did, his book should have described the phantom weight loss phenomenon, and it wouldn’t mislead people into believing that they are losing real fat, as opposed to just phantom weight. Well, his book doesn’t even have an index entry for constipation, so what do you expect?

It’s also worth noting that the “fit and fabulous” inhabitants of South Beach, Florida represent a cross-section of overweight Americans in the same way that Victoria Secret’s catalogue represents the average American woman. And I can also assure you that the carefree diets of the young jocks and beach bunnies who populate South Beach are as close to Dr. Agatston’s diet as New York is to Miami.

— So would you say the Atkins and South Beach diets are frauds?

Well, I wouldn’t go that far, but there’s an incredible amount of naiveté and ineptness associated with them, that’s for sure. You expect this kind of crudeness from quack “dieticians,” but not from bona-fide medical doctors. At the very least, both deserve credit for turning back the onslaught of the high-carb menace.

Misfortune loves company

Besides indigestible fiber, other factors, conditions, and considerations may contribute to diet-related constipation or cause it directly. The majority of them are amply described in this book, but here’s a brief reprise:

If you aren’t up to the task, by all means heed Dr. Atkins’ advice and take fiber laxatives. It’s always better to replace one evil with another to save yourself from an even greater evil — namely, severe constipation and irreversible damage of the anorectal organs. Since by now you already know the perils of too much indigestible fiber, you can’t say I didn’t warn you.

And, by the way, keep in mind that dietary fiber in any form — either from laxatives or food — is a major stimulant of a ravenous appetite. What else do you expect from a substance called INDIGESTIBLE? The fact is, the body can’t differentiate between the things you swallow, so it dutifully keeps trying to digest whatever is inside. And it keeps trying, and trying, and trying...

And while it keeps trying, the stomach and intestines keep o-o-o-ozing digestive juices and enzymes to complete this senseless task. And the more these juices and enzymes are splashing around inside you, the more they stimulate the appetite, especially a few hours after the last meal. And if you don’t “feed the burner” with foods that neutralize these potent acidic juices and flesh-eating proteolysis enzymes, they eventually cause all kinds of problems, from ubiquitous heartburn to deadly ulcerative colitis, and everything in between.

Well, you get the picture. Besides a torn anus, increased appetite is the last thing you want to deal with, right?

Don’t be sorry, be ready!

Should you decide to attempt a low-carb diet again, these key points should help you to prevent constipation from ruining an already meager meal plan:

For desert, nurture this thought — just by following the suggestions in this chapter and this book, you may easily drop 10–15 lbs of weight without even trying, and, in the process, shave a few inches off your waistline. And all this without getting constipated.

Chapter's Summary


Click the Backspace key to return to the referring sentence. Click the [link] or the hyperlink to view the source site or document in the new window (when available).

The references for this essay were compiled in September 2007. Some of the links may not match at a later date because publishers may revise their web sites. In this case, try searching cached pages on Google, or contact the respective publishers.

1. Glucose Homeostasis and Fuel Metabolism; Medical Biochemistry, Baynes J, Dominiczak M; p. 243

2. Lipids. Recommended Dietary Allowances: 10th Edition (Dietary Reference Intakes). National Academy Press. 10th Edition, p. 49

3. Ibid., p. 59

4. Beef, short loin, porterhouse steak, separable lean only, trimmed to ¼ fat, USDA select, cooked, broiled; NDB No: 13469; USDA National Nutrient Database for Standard Reference; [link]

5. Magic in a Box; Ripley's Believe It Or Not; 2004 edition, p. 23