Metabolic syndrome and low-carbohydrate ketogenic diets in the medical school biochemistry curriculum.

One of Robert Atkins contributions was to define a diet strategy in terms of an underlying metabolic principle ("the science behind Atkins"). The essential feature is that, by reducing insulin fluxes, lipids are funnelled away from storage and oxidized. Ketosis can be used as an indicator of lipolysis. A metabolic advantage is also proposed: controlled carbohydrates leads to greater weight loss per calorie than other diets. Although the Atkins diet and its scientific rationale are intended for a popular audience, the overall features are consistent with current metabolic ideas. We have used the Atkins controlled-carbohydrate diet as a focal point for teaching nutrition and metabolism in the first-year medical school curriculum. By presenting metabolism in the context of the current epidemic of obesity and of metabolic syndrome and related disorders, we provide direct application of the study of metabolic pathways, a subject not traditionally considered by medical students to be highly relevant to medical practice. We present here a summary of the metabolic basis of the Atkins diet as we teach it to medical students. We also discuss a proposed mechanism for metabolic advantage that is consistent with current ideas and that further brings out ideas in metabolism for students. The topics that are developed include the role of insulin and glucagon in lipolysis, control of lipoprotein lipase, the glucose-glycogen-gluconeogenesis interrelations, carbohydrate-protein interactions and ketosis. In essence, the approach is to expand the traditional feed-fast (post-absorptive) cycles to include the effect of low-carbohydrate meals: the disease states studied are generalized from traditional study of diabetes to include obesity and metabolic syndrome. The ideal diet for weight loss and treatment of metabolic syndrome, if it exists, remains to be determined, but presenting metabolism in the context of questions raised by the Atkins regimen prepares future physicians for critical analysis of clinical and basic metabolic information.