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Science Says: Atkins Diet Makes You Die Sooner Than Plant-Eaters
September 9, 2010 8:30 AM Subscribe

A major study was just published in the Annals of Internal Medicine from Harvard. In approximately 85,000 women who were followed for 26 years and 45,000 men who were followed for 20 years, researchers found that all-cause mortality rates were increased in both men and women who were eating a low-carbohydrate Atkins diet based on animal protein. However, all-cause mortality rates as well as cardiovascular mortality rates were decreased in those eating a plant-based diet low in animal protein and low in refined carbohydrates. [Previously in Me Fi]
posted by Pirate-Bartender-Zombie-Monkey (65 comments total) 13 users marked this as a favorite

I read the abstract, but I don't get what the "higher" and "lower" are relative to. Average, "background" rates? Or each other, with both being lower than average?
posted by DU at 8:34 AM on September 9, 2010

For comparison, do we know what the mortality rates are for a similar cohort divided simply into vegetarians and omnivores? That is, to what extent did the low-carb aspect affect these results and to what extent do the results simply reflect the fact that eating less meat and more vegetables is good for you?
posted by jedicus at 8:44 AM on September 9, 2010 [1 favorite]

What about gummi bears? I want to know if one can live on gummi bears.
posted by stormpooper at 8:46 AM on September 9, 2010 [10 favorites]

You'll pry my steak from my cold... um, never mind.
posted by No Robots at 8:47 AM on September 9, 2010 [7 favorites]

For those interested, the good one is called the "Eco-Atkins".
posted by blue_beetle at 8:49 AM on September 9, 2010

It's that whole "low in refined carbs" thing that will get you. Because you know what's absolutely the most delicious thing? Refined carbs. Hello pasta, bread, pastries, potatoes of all kinds, tortillas and doughnuts. How I love you.
posted by stoneweaver at 8:50 AM on September 9, 2010 [4 favorites]

I wish Dean Ornish had explained a little more

"Participants with a higher animal low carbohydrate score were heavier and were more likely to be smokers, whereas those with a higher vegetable low carbohydrate score consumed more alcohol and whole grains. Variations in lifestyle and other dietary issues, such as smoking status, family history of colorectal cancer, aspirin use, and history of hypertension were controlled in the analyses."

How many smokers? How much more alcohol?
posted by Ideefixe at 8:50 AM on September 9, 2010

I can already see Huffington Post is diving right in with correlation == causation with the "Atkins Diet Increases All-Cause Mortality" headline. How about eating more meat increases the probability of using significant amounts of oils with trans-fats? Maybe people more apt to eat vegetables are more likely to have bikes, do gardening, and all that active outdoor lifestyle stuff?
posted by crapmatic at 8:51 AM on September 9, 2010 [2 favorites]

I find it astonishing that there are people in tens of thousands (never mind in this cohort) that have stuck with the Atkins Diet for 20+ years.
posted by Wordwoman at 8:53 AM on September 9, 2010 [2 favorites]

Can we all just agree to subsist on a nutrient paste to avoid having every trip to the market turn into a harrowing existential crisis?
posted by The Whelk at 8:56 AM on September 9, 2010 [18 favorites]

Eat food. Not too much. Mostly plants.
-Michael Pollan, In Defence of Food
posted by bumpkin at 8:58 AM on September 9, 2010 [15 favorites]

How many smokers ? How much more alcohol?

Does it matter if these factors were controlled for in the analysis?
posted by londonmark at 8:59 AM on September 9, 2010 [2 favorites]

Interesting post that deconstructs the study (thanks to my wife for sending the link). "Bottom line: In this study, when you look closer at the data, differences in mortality appear to be unrelated to animal product consumption."
posted by crapmatic at 9:07 AM on September 9, 2010 [9 favorites]

How much aspirin?
posted by Civil_Disobedient at 9:10 AM on September 9, 2010

My doctor was asking about family history and asked what caused my dad's death and I told her "old age". She said, "no one dies of old age."

I assume the death certificate will read heart failure or pneumonia, etc. but I thought it amusing that humans defy nature and if you do everything right you can live forever.
posted by Bitter soylent at 9:12 AM on September 9, 2010 [1 favorite]

Oh please. Can we please stop trumpeting questionnaire science with non-randomized groups as concrete findings? This is worthy of being a New Scientist post, if only it involved some sort of time traveling quantum sausage.

Also, did they account for salt being the actual cause of cardiac mortality?
posted by benzenedream at 9:17 AM on September 9, 2010 [2 favorites]

Tobacco is a plant. Zappa said that it was food. QED...
posted by humanfont at 9:18 AM on September 9, 2010 [1 favorite]

...if you do everything right you can live forever.

Maybe it's just that no one has managed to do everything right yet.
posted by octothorpe at 9:18 AM on September 9, 2010

A study shows that some people react this way, but not all of them do. News at 11.
posted by Melismata at 9:20 AM on September 9, 2010

then, soylent green is out, eh?
posted by HuronBob at 9:21 AM on September 9, 2010

Maybe it's just that no one has managed to do everything right yet.

This, of course, includes picking the right parents.
posted by Confess, Fletch at 9:22 AM on September 9, 2010

I'm not sure what you folks can see, but here at work I can see the full paper. Their conclusions aren't leaping out at me in the "OH MY GOD - EAT MEAT AND YOU WILL DIE" way the Huffington post is presenting this. Of course I don't have time to really disect it right now.

The things I notice are that they're only looking at the low carbohydrate portion of the overall cohort, so for the very extreme deciles you're only talking about 1000 individuals. Also, the low carb people are still getting a lot of energy from carbs (37% for the low vs. 60% from the high) so this isn't the slury of purified bovine serum albumin in melted lard diet that I've seen some Atkins devotees trend towards. Similarly, the plant based low carb group is getting 30% of their energy from animal fats and proteins, so this isn't the veagans vs. meat eaters rumble they're making it out to be.

The difference in number of smokers is a few percent. If I'm reading this right, the high carb eaters (bottom 10%) are less likely to be a smoker than low carb eaters (top 10%).
posted by Kid Charlemagne at 9:25 AM on September 9, 2010 [5 favorites]

Is this study based on self reporting of food consumption by the test subjects? If so, I ain't convinced.
posted by spicynuts at 9:27 AM on September 9, 2010 [1 favorite]

However, all-cause mortality rates as well as cardiovascular mortality rates were decreased in those eating a plant-based diet low in animal protein and low in refined carbohydrates.

Fine. So apparently my wife is right.
posted by Doohickie at 9:29 AM on September 9, 2010

Hi. I'm a clinical epidemiologist. Some answers:

I read the abstract, but I don't get what the "higher" and "lower" are relative to. Average, "background" rates? Or each other, with both being lower than average?

The study used a prospective cohort design, in which a group of people are assembled based on some shared characteristic or exposure, and followed over time, with the exposure (in this case, relative amount of carbs in diet, total and from animal and plant sources), outcome (in this case, mortality, all-cause, cancer and CVD) and possible confounders assessed at regular intervals. Prospective cohorts are generally considered the highest standard of evidence in observational studies, i.e., studies in which individuals are not randomly assigned to receive an intervention or not.

This study used a technique called survival analysis to model the relationship between the exposure of interest (low carbs) and the risk of death at any follow-up period. Using the all-carb measure, individuals in the lowest 10% of carb consumption had an elevated risk of death compared to individuals in the highest 10%, specifically, the individuals in the low carb group had a 12% higher risk of dying at each follow-up period compared to the highest carb group. However, individuals in the lowest vegetable carb group had a 20% lower risk of death at any followup period compared to individuals in the highest vegetable carb group.

Thus, the observed rates are not representative of the broader study population but only reflect the rates within the cohort at that time. However, given the large sample size, the long follow-up period, and the high follow-up rate, we can be confident the results are not overly effected by selection bias. (Also, the Nurses' Health Study is a famous prospective cohort which, along with the Framingham study has provided a great deal of the evidence around diet/"lifestyle" and cardiovascular health.)

Also, crapmatic's link makes some good points. Summarised: In nutritional studies, the devil is always in the details of how exposure (i.e., what were people eating?) is assessed.
posted by docgonzo at 9:36 AM on September 9, 2010 [18 favorites]

Living an extra year or two isn't worth ~70 years of eating bland crap.

I'll likely feel different about this once I'm older, but for now, I'll stick to my plan of exercising a lot, and eating whatever the heck I want.
posted by schmod at 9:45 AM on September 9, 2010 [1 favorite]

So I can do bacon and eggs for breakfast, cheese for lunch, and a huge plate full of veggies and fruit for dinner, right? Oh, and lots of ice cream for dessert. Well, it tastes good, and I feel fine and energetic and am nearly converged to a mesomorphic body shape, so I guess my body likes it. Fish would be better for sure but fuck, this is Ontario, not Florida.
posted by seanmpuckett at 10:03 AM on September 9, 2010

There has been some good analysis on this in the low carb blogosphere.
Brand-Spankin’ New Study: Are Low-Carb Meat Eaters in Trouble?
Why The Latest Low Carb Scare Study is Flawed.

If you look at the data, the group with the most "low carb" points was eating over 100 grams of carbs a day, which no low carb eating plan recommends. But really the "eco atkins" isn't so bad, if you look at the data it doesn't show that much of a difference. The meat eating low carbers got 25% of their calories from animal fat, the eco-atkins got 17%. Not exactly a Ornish-style vegan diet.

But what's unfair is using this data to evaluate Paleo or Atkins. It's a study on a general population of health professionals. Many grouped in the low carb category here might have never heard of these diets. The study data says that in the general population eating lower carb (not low carb) diet relatively high in meat is associated with some issues. I wouldn't use it to say "OMG LOWCARB VEGAN IS TEH BEST" or "Atkins causes cancer!"

What we really need here is a clinical study on eco-atkins or paleo. Study the actual diet before drawing conclusions!
posted by melissam at 10:05 AM on September 9, 2010 [2 favorites]

"Low carb diets" in this study: 37%-60% carbohydrate.
Actual low carb diets: about 10% carbohydrate.
posted by callmejay at 10:08 AM on September 9, 2010 [6 favorites]

Can we please agree to never link to the joke that is the Huffington Post where SCIENCE! is even tangentially implicated in a post?
posted by Inspector.Gadget at 10:12 AM on September 9, 2010 [6 favorites]

I don't get all the "bland" and "miserable" comments about vegetarians. OMGILOVEBACON jokes aside, meat is really not all that awesome. I eat it and it can be yummy, but the quality of my life is not defined by how much meat I can cram onto my plate.

Actually, I probably do get the bland misery charges: The only plants you've eaten are boiled carrots and lettuce. Trust me, I've been there. I used to say that, other than tomato sauce, there should be ZERO plant matter on a pizza. That's due to my Mom's bland midwest, protestant cooking. Meatloaf + boiled, soggy vegetables and if we're getting crazy you can put salt on the brussel sprouts.

Eventually I'm at the point I am now, which is: I would probably be vegetarian except for a few dishes kind of need meat (hamburgers, tacos, etc). If you think you hate eating plants, make some salsa or guacamole, eat a pepper, try some fruit. There's a lot of really tasty, non-"elitist" plant-based foods out there.
posted by DU at 10:20 AM on September 9, 2010 [10 favorites]

It is a bit difficult to do a double blind placebo controlled randomized study of food intake over a period of twenty years with tens of thousands of subjects. Give the researchers and Journals some slack. They are not the one's who create the headlines. There was nothing sensational in either the title or the conclusions of the study. It is a piece of information--let the serious carnivores and vegans fight over the last scrap of something else. I say kudos for the attempt to build a data base on an issue that currently is very difficult to research using traditional experimental designs.
posted by rmhsinc at 10:20 AM on September 9, 2010 [1 favorite]

Great. More evidence for vegetarians to fart out of their complex carbohydrate digesting colons in their relentless campaign to make us all as miserable as they are for the rest of our now interminably longer lives. I suspect we will now live just long enough to make up for all the time we have spent being hectored.

Great, another chance for meat eaters to pretend vegetarians are out to harass them when none have done anything remotely like that during the discussion.
posted by furiousxgeorge at 10:34 AM on September 9, 2010 [18 favorites]

I'm still eating beef. So lay off, science.
posted by grubi at 10:36 AM on September 9, 2010

OMGILOVEBACON jokes aside, meat is really not all that awesome.

Shut your heathen mouth.

That aside, I don't hate vegetables. Love 'em. Certain ones, of course, but I can eat loads of delicious veggies and happily, I might add. But I do prefer the taste of meat. It really is awesome to me (both senses of the word). I don't really crave carrots (which I love), or tomatoes (which I love), or corn (which I love), etc etc. But I do physically crave meat periodically. Last night, I was absolutely jonesing for meat of almost any kind. This tends to happen if i ease up on the meat-eating quite a bit. But as it turns out, I'm one of those types of folks who need a slightly higher protein diet than average. Not all burgers all the time, per se, but one serving of steak that is the size of a deck of cards will not satisfy.

But don't tell me it's not awesome. Don't tell me I've been eating the wrong vegetables cooked the wrong way. Don't tell me I have some weirdo anti-elitist bias that causes me to favor meat. You haven't the slightest idea what you're talking about.
posted by grubi at 10:43 AM on September 9, 2010 [4 favorites]

Fat and happy vegetarian here. Never tried to tell anyone what to eat in my life, though carnivores are constantly all "bacon, bacon, bacon, you're a veggienazi". In fact, I've never heard any of the many vegetarians I've known, ever (well, since college anyhow), tell anyone else what to eat or what not to eat.

Somehow, every dietary conversation on metafilter eventually comes back to someone talking about how awful vegetarians are. WTF?
posted by Erroneous at 10:48 AM on September 9, 2010 [7 favorites]

all-cause mortality rates were increased in both men and women who were eating a low-carbohydrate Atkins diet based on animal protein.

The science editor of the Daily Mail has just come in his pants.
posted by biffa at 10:51 AM on September 9, 2010

Always have the science news cycle in mind when reading about studies in the mainstream media.
posted by dirigibleman at 11:01 AM on September 9, 2010

Don't tell me I've been eating the wrong vegetables cooked the wrong way.

I won't, because you don't meet the criteria I set out: People calling vegetarian diets "bland" or "miserable".
posted by DU at 11:04 AM on September 9, 2010

I don't think vegetarian diets to be bland. From what I can tell from various friends and (formerly) my wife's vegetarian diets, there's incredible variety and choice. I would find it frustrating to eat absolutely no meat, but I wouldn't call it "bland".

"Miserable", sure...

Also, I don't mean my former wife; I mean my current wife formerly was a vegetarian. But she eats so little meat now, I wouldn't say she's swung the other way 100%.
posted by grubi at 11:15 AM on September 9, 2010

Actually, I'm a vegan and I am kind of unhappy sometimes with the way I eat. Not because of the plant-based diet, but because our society is so meat-centric that it's very difficult (in my town, anyway) to enjoy the convenience and cheap-quick eating omnivores enjoy.

I've never been stronger and more energetic, and my mood is much improved from my meat eating days...but yeah, until there are vegan fast food chains around the country, I'm gonna have some grumpy days.
posted by Pants McCracky at 11:25 AM on September 9, 2010 [3 favorites]

At the height of the early 00s Akins craze, I had just started a new job. All of the women at my office were doing the low-card thing. I'll never forget one of my co-workers' lunches: She was dipping pork rinds into Mexican white cheese dip. She looked up at me and said "I'm on Atkins!"
posted by vibrotronica at 11:38 AM on September 9, 2010 [5 favorites]

Again, the problem in reading studies like these is that we can't disentangle the various factors that may be responsible for the outcomes, and furthermore, we rarely get a pure play isolated factor to measure reliably.

For those who may want to get some clarity on the issue of animal/vegetable source protein and carbs, I can offer the following. The key factor here when it comes to protein is a small group of amino acids, methionine the most prominent among them. I don't have the time to round up a gaggle of studies, but go to PubMed, and perform a search using "methionine longevity".

The thumbnail summary is as follows: it's the methionine content of the protein. It's an essential aa, but should not be consumed in more than minimum quantities (i.e. only enough not to have deficits). The kicker in all this is that the met content of protein is not simple for people to asses. Go to tables that specify met content of the protein you consume. Very broad rule: animal protein has more met than vegetable sources. Salmon, a fatty fish that has long chain omega 3 and other goodies is v. high in met - for that reason and others, I wouldn't recommend consuming it more often than 1 time a week, 2 absolute max, and small portions. Egg whites - very, very high in met. The protein may be very complete and high quality, but if you're taking in a ton of met, that's not going to be good. So, for that reason - among others - vegetable protein is better - BUT, there are many exceptions, for example some beans have very high met content, rice is highish too.

There are other factors associated with protein consumption (fatty acid profiles, obviously), but also things like AGEs, manner of preparation and so on, that impact how healthful the protein is. Still, keep in mind: methionine.

And so too in this study: everything is mixed up. You may have two individuals, both consuming low carbs, high vegetable source protein. But one of them will consume protein that's high in methionine, or AGEs, etc., and his outcome could be much, much worse. Yet both outcomes get averaged out in a subgroup, so we say "20% longevity advantage", when in fact, it may be for the low met, low AGE guy it may be 40%, while the high met guy it may be 10% vs the animal protein guys. But, we often either can't get enough granularity in these studies, or we can't get pure play factors isolated, because most people mix up some good with some bad etc.

In short: it's complicated.
posted by VikingSword at 11:43 AM on September 9, 2010 [5 favorites]

"Somehow, every dietary conversation on metafilter eventually comes back to someone talking about how awful vegetarians are."

I don't think I've ever met an actual vegetarian. They're not very plentiful here in Utah.

My daughter did bring a friend over once who claimed to be a vegetarian, but then she dived right in and ate fried chicken with us. I guess she considered chickens vegetables?
posted by mr_crash_davis mark II: Jazz Odyssey at 12:05 PM on September 9, 2010

So basically...any kind of dieting is better than a regular old american diet, eh scientists?

I smell a Nobel.
posted by hal_c_on at 12:06 PM on September 9, 2010 [1 favorite]

I have a theory that speaking English gives you a heart attack.
posted by The Whelk at 12:08 PM on September 9, 2010 [1 favorite]

I'm only shopping for one, but I think it's all about having a balanced and varied diet.

Eat less, move more, eat lots of fruits & veggies, and stay away from junk food.
-Marion Nestle
posted by rageagainsttherobots at 12:44 PM on September 9, 2010

In fact, I've never heard any of the many vegetarians I've known, ever (well, since college anyhow), tell anyone else what to eat or what not to eat.

You guys realize that this post is a link to an article by a vegetarian telling the rest of us that we should be following vegetarian diets, right?
posted by enn at 1:07 PM on September 9, 2010 [1 favorite]

Pants McCracky: ...until there are vegan fast food chains around the country, I'm gonna have some grumpy days.

I'm only half-kidding about this, but wouldn't that kind of be "the produce aisle of the local supermarket"?
posted by Greg_Ace at 1:11 PM on September 9, 2010

You guys realize that this post is a link to an article by a vegetarian telling the rest of us that we should be following vegetarian diets, right?

That's an odd way to read either article. All I see is talk comparing two types of Atkinsy diets. Vegetarianism per se isn't really discussed.
posted by Erroneous at 1:53 PM on September 9, 2010

I guess she considered chickens vegetables?

Well, Ronald Reagen thought that ketchup was a vegtable, so sure why not?
posted by Confess, Fletch at 2:15 PM on September 9, 2010

You guys realize that this post is a link to an article by a vegetarian telling the rest of us that we should be following vegetarian diets, right?

No, but don't let that stop anyone from vegetarian bashing!
posted by furiousxgeorge at 2:39 PM on September 9, 2010

The chicken-as-vegetable thing is kind of odd but I've come across it a lot. Also variations of "You don't eat FISH? I thought vegetarians ate FISH" and "I'm vegetarian, I eat meat like once every two weeks".

I mean, I don't care what anyone else eats. Your digestive tract is your own damn business. But I've been handed a lot of chicken and fish over the years by people who thought, as a vegetarian, that they were really going out of their way to include me.
posted by Erroneous at 2:50 PM on September 9, 2010

So what, the pig will get you in the end anyway.
posted by sammyo at 4:02 PM on September 9, 2010

What a haphazard mess of a study.
posted by Nattie at 5:51 PM on September 9, 2010

So I still get to cook all my vegetables in rendered bacon or duck fat right?
posted by JackarypQQ at 6:03 PM on September 9, 2010

Look, I just want all my nutrients to come in shot glasses, pint glasses, and champagne flutes. And as it stands I am well on my way.
posted by turgid dahlia at 6:13 PM on September 9, 2010 [1 favorite]

Or, conversely, were they doing it ultra-right?
posted by turgid dahlia at 7:57 PM on September 9, 2010

"It's not a great idea to eat paint and big chunks of rust."

"THE HELL WITH YOU GUY I WILL EAT ALL THE PAINT AND RUSTCHUNKS I WANT"

"Okay, I don't really care."

"STOP STUFFING YOUR OPINIONS DOWN MY THROAT"

"Just a suggestion dude."

"FFFFFFUUUUU-"
posted by turgid dahlia at 8:00 PM on September 9, 2010 [1 favorite]

If you read the Atkins book, you will see that by the time you are "done", you have adjusted to eating pretty much a dead-standard good diet. Few ounces of lean protein, a spoonfull of complex carbs like beans or rice and a giant salad with a glass of wine.

Atkins was never meant to be "high fat", it was only meant to be low carb. In fact, he says to keep the saturated fats to a minimum. Just not to obsess about OMG FAT. The main goal is to first, lose a bunch of weight to make you feel better, and second, eat a diet low in refined carbs.

The lard-asses eating whole pork loins smothered in bacon while drinking a glass of whipping cream were not doing it right.

Since I'm probably the only one here who is a minor low-carb celebrity (I don't have a book, but I'm invited to conferences, featured on blogs, on first-name basis with various authors, etc.), I can definitely say this is wrong. High fat always was and continues to be the cornerstone of the diet. In Sweden they are clearer about this and call it low-carb high-fat (LCHF). Even Loren Cordain, who for the longest time was one of the few low carbers still cautioning about saturated fat, has recently come around.

Cordain would point out that the issue with the pork loin there is excessive amounts of omega-6 and dairy, which can lead to inflammation.
posted by melissam at 8:09 PM on September 9, 2010

FTR, on a modified ketogenic diet for epilepsy, gjc, I could not keep weight on if I tried--and I ate a lot, because the modifications remove the calorie restrictions. You can eat pretty much whatever...if you keep the carbs under 15g/day. That includes sugar alcohols and all things ending in -dextrin, so it's fun. And consume some ungodly amount of saturated fats. Anyway, with the addition of some spinach with high-fat dressing, I was pretty much eating exactly the meal you describe. Right down to drinking whipping cream.

So, maybe these 'lard-asses' were not doing Atkins right, but if you are consuming mostly saturated fat and are genuinely staying low-carbohydrate as well, it's difficult to consume enough calories to put on weight. Hell, a significant side-effect in the literature--and it's real--is being too nauseated to eat. If we're going to throw around slurs, let's at least be accurate about what life on the diet you describe is really like. (Boring. Even with that much bacon in your life.)

I might sound like a shill, but Keppra XR was a long-acting formulation worth making.
posted by Uniformitarianism Now! at 8:19 PM on September 9, 2010 [1 favorite]

I continue to be intrigued by the comments criticizing this study in the absence of any posts leading to other serious longitudinal, empirical or experimental studies on the subject. This is very difficult stuff to study. Not only is the content of the study complicated but the subjects (humans) are notoriously uncooperative. While animal studies are can be useful they certainly are not conclusive nor do they lead to a smooth extrapolation of human nutrition and health. The Framingham Study was probably some what messy methodologically but it provided and excellent framework to move ahead with further studies on the impact of hypertension, smoking and cholesterol on heart disease. Oh well, according to some of the posts I have to watch the specific proteins I eat, become a vegetarian, have whipped cream and meat 7 times a day, cut out salt and start smoking. Wait, I know--I will just exercise moderation in the amount I eat and variety in the foods.
posted by rmhsinc at 9:59 AM on September 10, 2010

The best reaction I've read basically says: "this is bullshit because they're talking about diets with 4x-10x the amount of carbs we are recommending."

Choice quote:

Some of these “low carbers” were eating up to 60% of their diet as carbohydrates (first decile), which-last time I checked-is kind of not low-carb. Even the lowest low-carb eaters were still eating over 37% of their calories from carbohydrates. Whoever decided to call this study “low carbohydrate” is nuttier than a squirrel turd.

So, yeah, back to my cheese and olive oil lunch. I won't be hungry until six.
posted by seanmpuckett at 10:42 AM on September 10, 2010

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Science Says: Atkins Diet Makes You Die Sooner Than Plant-Eaters September 9, 2010 8:30 AM Subscribe

Science Says: Atkins Diet Makes You Die Sooner Than Plant-Eaters
September 9, 2010 8:30 AM Subscribe