Is the Atkins Diet appropriate for people with, or at risk of developing, cardiovascular disease (CVD)?


A growing body of literature demonstrates that complying with a low-carbohydrate diet (LCD), like the Atkins Nutritional Approach, reduces risk factors for CVD and improves related biomarkers. In fact, contrary to longstanding beliefs, studies increasingly show that an LCD can be more effective in reducing CVD risk factors than a low-fat dietary pattern (41). The reduced conversion of carbohydrate to fat in the liver (lipogenesis), plus the low insulin state enabling accelerated fat oxidation, are major factors contributing to the lipoprotein improvements commonly observed in patients following the Atkins Diet. CVD biomarker improvements may include:

  • Decreased Triglycerides: The most consistent response to an LCD intervention is a sharp decrease in plasma triglycerides, most dramatically in those with pre-existing hypertriglyceridemia (7).
  • Increased HDL: The increase in HDL may not occur as quickly as the decrease in triglyceride, but, based on empirical evidence, this slowly developing HDL boost appears to persist long-term even as carbohydrate intake gradually increases (22).
  • Improved LDL Patterns: LCDs increase the prevalence of larger LDL particles, whereas low fat/high carbohydrate diets have the opposite effect. This inverse relationship between dietary carbohydrate content and LDL particle size has been observed over a wide range of carbohydrate intakes (42), and it can have quite dramatic effects at very low carbohydrate consumption levels, as those recommended by the Atkins Diet (12). The more carbohydrate intake is decreased, the more LDL distribution shifts from ‘pattern B’ LDL, characterized by predominantly small LDL particles, to the preferential ‘pattern A’, characterized by a larger proportion of large particles. A growing body of research suggests these LDL patterns may be a better indicator of CVD risk than overall LDL counts.