Does the Atkins diet cause heart disease?

I’m an advocate of diets relatively rich in protein and low in carbohydrate. Not uncommonly when I addressing an audience regarding this, someone will ask me about the Atkins’ diet and my opinion of it. Digging a bit it usually turns out that the individual is thinking that I’m advocating an Atkins-like diet, and we all know that these sort of diets are bad news for the heart, so it seems like I’m advocating a diet that is bad for the heart. Given my qualified support of the Atkins diet, and the generally unhealthy reputation this diet has, then questions of this nature are valid and pertinent.

However, what is the evidence that the Atkins or similar diet is bad for the heart? Some of this notion is connected with the concept that the Atkins diet is high in fat, particularly saturated fat that ’causes heart disease’. The thing is, though, there is no good evidence that saturated fat causes heart disease. See here for more on this.

Another common cause for concern regarding the Atkins diet is the amount of protein in it. Some people have come to the conclusion that protein is somehow bad for the heart. I’m not sure where this notion originated. It might be part of the anti-Atkins propaganda that includes the telling us that protein is bad for the kidneys and bones too. While protein intake may need to be limited by those with compromised kidney function, there is no evidence that it is damaging to individuals with normal kidney function (the vast majority of us). And studies suggest that higher protein intakes are actually associated with improved bone health.

But what about the relationship between protein and heart health? One recent study that has shed some light on this looked at the relationship between protein levels in the diet and blood pressure [1]. This study, conducted in Japan, found that the higher animal protein intake was, the lower blood pressure was found to be too.

This is not the only study to have found that higher protein intakes are associated with lower blood pressure [2].

Higher protein diets have also, generally speaking, been found to bring about favourable changes in the other markers for risk factors for heart disease including lowered levels of blood fats known as triglycerides and raised levels of ‘healthy’ HDL cholesterol.

One of the ways protein might exert its apparent beneficial effects on the cardiovascular system is because it displaces carbohydrate from the diet (the more protein people eat, the less carb they tend to eat). And this is important because carbs are the primary drivers of insulin secretion, one effect of which is ‘sodium retention’. One potential consequence of retaining sodium in the body is elevated blood pressure. Elevated levels of insulin, sometimes as part of a condition known as ‘metabolic syndrome’, are associated with elevated levels of triglyceride and lower HDL levels. It can also lead to ‘insulin resistance’ and type 2 diabetes, which are risk factors for heart disease.

But even before insulin levels start to be raised, spikes in blood sugar from eating an excess of carbs can lead to a variety of effects believed to enhance heart disease risk including increases in ‘oxidative stress’ (free radical damage), inflammation (a key underlying process in heart disease), protein glycation (glucose ‘bonding’ to proteins in the body and damaging them), and coagulation (essentially, making the blood ‘stickier’ and more likely to clot).

I was partly triggered to writing about this today because recently the Journal of the American Dietetic Association published a case-study which claims that a man’s heart disease was induced, and quickly at that, by the Atkins diet [3]. Look, anything is possible, but the evidence (for those that care to look) strongly suggests that such a diet, if anything, actually reduces the risk of heart disease overall.


1. Umesawa M, et al. Relations between protein intake and blood pressure in Japanese men and women: the Circulatory Risk in Communities Study (CIRCS). Am J Clin Nutr 2009;90: 377-384

2. Hu FB. Protein, body weight, and cardiovascular health. American Journal of Clinical Nutrition 2005;82(1); 242S-247S.

3. Barnett TD, et al. Development of symptomatic cardiovascular disease after self-reported adherence to the Atkins Diet. J Am Diet Assoc. 2009;109:1263-1265.

21 Responses to Does the Atkins diet cause heart disease?

  1. Alan 24 July 2009 at 3:18 pm #

    What are your thoughts on the process of ketosis? Do you think it safe? Like you, I also think there is plenty of evidence to suggest that a diet based mainly on natural fats and protein (with many lower carb vegetables and some fruit) is the ideal one for our bodies. What worries me is that ketosis seems a little extreme. I have tried it several times and always feel terrible – even coming out of it hurts! Do you think it is actually required or was just added as a gimmick, designed to catch the attention of all us faddy dieters who love to try something novel!

  2. Dr John Briffa 24 July 2009 at 4:54 pm #


    I see ketosis as a normal response to restricted carb intake. It most certainly should not be confused with ketoacidosis (which is a complication of raised blood sugar levels and potentially hazardous).

    Having said that, individuals do not generally need to be ketotic to lose fat and have good biochemical/physiological markers such as triglyceride, HDL, insulin and glucose levels.

    In short, I don’t see ketosis as a risk to health, but it’s usually unnecessary for individuals to achieve their health goals anyway.

  3. damaged justice 24 July 2009 at 5:02 pm #

    I’d rather be keto-adapted than in ketosis. Why pee out perfectly good ketones that your body could be using for fuel?

  4. Luther Anthony 24 July 2009 at 5:14 pm #

    I have been on a low carb diet since November of last year and along with reasonable exercise, I have lost 26 pounds and feel great.

    For snacks I eat alot of Brazil nuts and Walnuts as well a pork skins.

    My question is as follows: Are pork skins OK as a snack food? I can easily eat a large sack of skins in two days.

  5. Edward 24 July 2009 at 7:11 pm #

    Ref ketosis, I think this is linked to one of the common misconceptions about the Atkins diet.

    In his book Atkins discusses ketosis as a marker for the change-over to burning fat rather than carbs (either that or achieving a high enough proportionate protein intake). This is in the context of the “Induction” phase of the diet which is deliberately extreme and intended to be for only a couple of weeks. After that, there is a phased re-introduction of some carbs, which takes you back out of ketosis.

    I think a lot of people read only the “no carbs at all” section and assume that Induction is all there is, ignoring the Maintenance phase altogether.

    If you do follow the book sufficiently diligently to buy some urine test strips, then seeing proof from the tests that you’re into ketosis and definitely doing something different can be a good motivator in the hardest part of the work. I personally found it a boost.

    On the other hand, if ketosis isn’t good for you then I agree you should listen to your body and not take it too far.

  6. Jackie Bushell 24 July 2009 at 8:35 pm #

    Presumably our ancestors went for days on end with only meat or perhaps nothing at all to eat. When they did find a source of carbs such as roots, seeds and berries this might have taken them out of ketosis for a while, but my guess is that they spent a lot of their time back in it. So I reckon ketosis is a natural phenomenon physiologically, and therefore unlikely to be ‘dangerous’.

    I can think of two main reasons why people feel yuk going into (and coming out of) ketosis. One is that to go into ketosis you stop eating certain foods – to which you may be allergic (in the food sensitivity sense of the word). And as food sensitivity of this sort has an addiction aspect to it, you literally get withdrawal symptoms. Since grains are one of the foods you give up to get into ketosis, and grains, especially wheat, are the foods people are most likely to have food sensitivity/addiction to, this seems very likely. And you might also get symptoms when you come out of ketosis, in other words, when you re-introduce the foods to which you’re allergic/sensitive,

    The other reason is that your body can function with a carbohydrating-burning or a fat-burning metabolism (the one that produces ketosis). But not both at the same time. It has to ‘switch’ from one to the other. During the ‘switch’ to fat-burning, you may feel tired and sluggish with little energy.

    Dr Atkins’ interest in ketosis was not really a gimmick – he realised it would be very helpful to dieters for at least two reasons:

    1) You stop feeling hungry when in ketosis (part of the body’s way of sparing you the pain of hunger when there is a famine) which is obviously an advantage when you’re trying to consume fewer calories than your body ‘wants’

    b) A fat-burning metabolism is more wasteful of calories than a carb-burning one. This may be the underlying reason for the so-called ‘metabolic advantage’ that Atkins described. Again, good news for dieters as you can lose/maintain your weight on a slighly higher level of calories than you could otherwise. If you have a relatively low calorie requirement (like me and millions of others, worse luck!) this ‘advantage’ is really important to help you avoid depressing your metabolism by drastically reducing your calories, which means you then need fewer calories, which makes your metabolism slow down even further etc …


  7. Dr David 25 July 2009 at 12:32 am #

    I support the Atkins diet when patients ask me about it, except for his use of artificial sweeteners in the recipes (aspartame, saccharine etc) which I believe to be quite toxic, and can induce hypoglycaemia as they stimulate insulin secretion despite having no calories, so result in severe hunger pangs. I had it once myself (from sugar-free gum) and ate 2 chocolate bars in about 10 seconds!

    Similarly for ALL ‘diet’ products like diet fizzy drinks etc – really nasty stuff.

  8. Hellistile 25 July 2009 at 1:52 am #

    I was on an Atkins like diet for almost 4 years and I’m 59 and eliminated almost all my health concerns and dropped some weight. My lipids were perfect (done in November) and I will compare them with anyone of any age.

    42 days ago I went zero carb and have dropped another 17 pounds. I call zero carb my “healing diet”.

    I am no longer concerned with studies as I’m too old for scientists to come to a consensus on what we should be eating. I now listen to MY body and it seems to be liking what I’m doing. And I am not in the least bit concerned. After all, we were eating meat for millions of years before we started harvesting plant food in earnest about yesterday in evolutionary terms.

  9. Anna Salvesen 25 July 2009 at 8:05 pm #

    The “Atkins” diet is discussed a lot by the media, by medical personnel, by dieters, but rarely do people really know what the Atkins diet really involves. Most haven’t even read even one of the versions of the diet plan – all they focus on is the fat and ketosis. One has to take into account the immense amount of ignorance out there about what is and isn’t the Atkins diet.

    And then there is the choice of food one consumes while on the Atkins diet. Sure, one can eat one’s fill of packaged processed foods that meet the Atkins carbohydrate numbers, and the diet will probably lose weight. But they will be starving for nutrients.

    One can also follow the Atkins plan with real, minimally processed foods that one prepares as home (not instant, heat-n-serve, ready-to-eat) and actually nourish the cells while losing weight.

    In general, I find people use the Atkins label as a catch-all for any attempt to lower carbs, but they rarely are really describing the actual diet plan.

  10. Helen 27 July 2009 at 11:32 am #

    Hellistile – I couldn’t agree with you more! I believe very soon people will start to realise that it is their body they should be listening to and not someone who bearly knows them! Being on Low Carb is the healthiest thing I have ever done in my life.

  11. Marcus 27 July 2009 at 1:31 pm #

    It’s the people that have the hardest time following a low carb diet that has the most to gain from it.

  12. Chris 27 July 2009 at 6:50 pm #

    Helen, how might you describe your regime before adopting a Low Carb adherence?

  13. Trinkwasser 11 August 2009 at 9:59 pm #

    Hmmm, would you believe anything Neal Barnard is involved in, or would you prefer Michael Eades?

    FWIW my body responds best when I’m on the edge of ketosis and can smell ketones in my morning pee but not the rest of the time (when presumably they are being utilised). The shift from carb to fat burning can make you feel a bit rough, but long term I have much more energy and much less need for constant snacks, and like most people who try it my lipids have improved remarkably.

    Even if I have my heart attack tomorrow the general improvement in how I feel and how I act will have been worth it!

  14. Ken 3 September 2009 at 3:17 am #

    After following a low carb diet for a month I noticed a remarkable difference in how I feal. No food cravings and no digestion issues. I used to suffer from acid reflux, bloating, gas and a general discomfort. All gone. So I binged on carbs one the 30th of August, and the bloat, gas, and dicomfort all returned. Following a low carb ketonic diet is the best thing I’ve done. I will make a point of having my lipids checked, as I have historicaly had high triglycerides. If they are in check, I will continue with carb restriction for life.

  15. Robert Ahmed 29 April 2010 at 2:00 am #

    Atkins Diet have helped me a lot to maintain a very good physique. My mom is also on an Atkins Diet. .

  16. brian (scotland) 23 January 2011 at 9:17 pm #

    i have just started my atkins diet and already feel better i am going into my 2nd week and i also feel lighter if you have tryed every other diet and they did not work then why not try the atkins.

  17. Captain 17 March 2013 at 1:49 am #

    I have been on the Atkins diet for two years. I have lost 121 pounds as of yesterday. This is the best diet ever and all of my blood levels have returned to better than normal. Yeah bacon!!!!!!


  1. Mem mới theo lowcarb cần giúp đỡ - 4 September 2009

    […] khuyến khích người viết không nên lo lắng thái quá . ’ịa chỉ trang ’ó ’ây Does the Atkins diet cause heart disease? | Dr Briffa’s Blog hãy ’ọc sẽ thấy người ’àn ông ’ó viết những câu mà cậu viết ’ể giải […]

  2. Busting the Myth: Atkins Diet and Reactive Hypoglycemia | Paleo Village - 18 September 2011

    […] hours after eating are going to drop your blood sugar much too low.” Continue reading… First thing’s first, what exactly is Reactive Hypoglycemia? Well, another name for reactive hypogl…"> the first term. So, in very […]

  3. The Story of the Atkins Diet Part 1 | Diet Plans That Work - 19 September 2011

    […] and subscribe to our podcast where we discuss our on going struggles with weight loss… A profile of Dr. Robert Atkins, the diet doctor diet whose theories on nutrition have changed the w… A profile of Dr. Robert Atkins, the diet doctor diet whose theories on nutrition have changed the […]

Leave a Reply