The Death of Dr. Atkins

In 1994, fat hysteria had reached a fever pitch. The New York Times published an article called “How About Some Popcorn With Your Fat?” that commented on the dangers of going to the movie theater and eating a snack that “absolutely drips with unsaturated fat, the kind that raises blood cholesterol and clogs arteries.” The end of the article took a satirical turn while recommending ways to address the problem:

Theaters could alert an usher trained in CPR whenever a customer orders a large buttered tub. They could also offer, at a modest surcharge, on-the-spot life insurance, like that sold by airport vending machines. Or customers could qualify for extra butter by working out aerobically for 20 minutes on a Nordictrack in the lobby.

While much of mainstream medicine seemed to be in lockstep regarding the dangers of dietary fat, Dr. Robert Atkins loudly and flamboyantly defied prevailing wisdom. He advised people to ditch the popcorn and slather the butter over a steak wrapped in bacon. Though he wasn’t the first to promote a high-fat, low-carb diet, Atkins’ books are widely credited with popularizing carb-restricted eating.

Dr. Atkins’ Diet Revolution was published in 1972 and was a bestseller throughout the 1980s and until the early 2000s. Unlike most diets of the time, Atkins encouraged people to enjoy high-fat foods, calling his diet a “high calorie way to stay thin forever.” The dietary establishment reviled him.

On April 8, 2003, Atkins slipped on an icy sidewalk in New York City, hitting his head and suffering a traumatic brain injury. He was rushed to the hospital and underwent emergency surgery to remove a blood clot. He remained in a coma for nine days until he expired on April 17.

What followed Atkins’ death was a truth-is-stranger-than-fiction medical heist involving a militant vegetarian doctor, a convicted felon, an author of a retracted scientific paper, and a self-proclaimed adult film actor.

Immediately upon the announcement of Atkins’ death, the speculation engine kicked into overdrive. Rivals were quick to call out the doctor for his diet plan’s failure to keep him healthy. They called him “Dr. Fatkins” and alleged the slip and fall were no accident. They speculated his fall was caused by a heart attack. Even then-mayor of NYC Michael Bloomberg weighed in:

The guy was fat. I don’t believe that bullshit, that he dropped dead after slipping on the sidewalk … yeah, right.

This candid statement, made during a photo-op at a Brooklyn firehouse, didn’t come out of nowhere. A longstanding beef between Atkins and the mayor dated back to a visit by Bloomberg to Atkins’ home in the Hamptons, where Bloomberg claims he was served “inedible” food.

No one saw greater opportunity in the death of Atkins than Dr. Richard Fleming of the Fleming Heart and Health Institute in Omaha, Nebraska. Fleming contacted the NYC Medical Examiner’s Office and requested a copy of the medical examiner’s report on Atkins’ death. On Dec. 22, this report was mistakenly mailed out. The contents of the report were shocking:

Blunt injury of head with epidural hematoma.
258 lbs.
h/o of MI, CHF, HTN.

That he died of a blunt injury to the head was already known and not particularly useful to those wishing to blame his diet for his fall. But 258 lb.? This was just the dirt they were looking for. At six feet tall and 258 lb., Atkins’ body mass index classified him as obese. This was alarming for a world-famous weight loss guru.

The third note in the report is shorthand for “history of myocardial infarction, congestive heart failure, and hypertension.” In 2002, the Atkins Foundation released a statement that the doctor had been revived after suffering cardiac arrest. This episode was attributed to cardiomyopathy, a weakening of the heart muscle. His personal physician blamed the condition on a virus, not his diet. Though this information was known prior to his death, it provided fodder for conspiracy theories.

Fleming sent Atkins’ illegally obtained medical examiner’s report to the Physicians Committee for Responsible Medicine (PCRM), a low-fat, vegan diet research and animal rights activism group. Dr. Neal Barnard, head physician of the PCRM, said of the report: “The Atkins website says that his good health and his clean coronary arteries were apparently due to his diet.  An extraordinary claim. And apparently one that was not at all true.”

Treating the whole situation as a matter of serious public health concern, Barnard distributed the medical examiner’s report to the media. The Wall Street Journal accepted the documents and published details in a story:

A medical examiner’s report on the death of diet guru Dr. Robert Atkins suggests that he had a history of heart attack, congestive heart failure and hypertension.

The document, a report of external examination from the chief medical examiner’s office in New York, also says that at his death Dr. Atkins weighed 258 pounds. Dr. Atkins died in April last year at age 72 of a head injury from a fall on ice while walking to work.

Veronica Atkins was outraged by the treatment of her deceased husband in the press. She explained her husband’s weight gain was the result of the fluids pumped into his body while he was in a coma:

My husband was so bloated. He had very slender hands. And when he was in this bed, his hands were like ham hocks, this big. He was bloated, he did look like a balloon.

Her story was corroborated by Atkins’ hospital admissions form, which listed his weight at 195 lb. Numerous attending physicians attested to the weight gain during his final days of life. One thing is absolutely certain, though: During his hospital stay, he was not and could not have been following the Atkins Diet.

To this day, Atkins’ death is still controversial — the myth-busting website Snopes lists his cause of death as “uncertain” — and his dietary recommendations remain highly topical. Many of Atkins’ staunchest critics have walked back on their criticisms. Proponents of a vegan diet still warn of the dangers of eating meat, but some are now promoting a plant-based Eco-Atkins diet. Even Bloomberg has since apologized for his insensitive comments and offered to treat Veronica to a “steak and no potatoes” dinner.

The story could end here, but it would be a travesty not to report the bizarre saga of Dr. Fleming, the cardiologist who misappropriated Atkins’ medical records and exposed them to so much public speculation. This was only one of Fleming’s many ethical transgressions.

In 2009, in the case of Fleming vs. the United States, Fleming pleaded guilty in federal court to one count of health-care fraud and one count of mail fraud. Other counts against him were dismissed as part of his plea deal. The charge of health-care fraud was associated with submitting billing for medical tests that were never performed. The mail fraud charge stemmed from his involvement in a clinical study for a soy chip snack manufacturer. He admitted to supplying false experimental data.

While the jury was deliberating on its verdict, Fleming’s public defender struck a sweetheart deal that kept him out of prison. He was penalized with monetary sanctions, five years’ probation, and six months of in-home electronic monitoring.

Fleming’s medical research career took a hit again in 2018 when he had a paper retracted by a respected journal called Clinical Cardiology. The paper reported the results of a clinical trial studying the effects of three diets (high-carb, low-carb, and vegan) on cardiovascular risk factors. Coincidentally, a few days after submitting the paper, Fleming was debarred by the U.S. Food and Drug Administration due to his felony convictions, and he was banned from providing any services related to pending drug applications for 10 years.

Wiley, the publisher of Clinical Cardiology, withdrew the paper “due to concerns with data integrity and an undisclosed conflict of interest by the lead author.” Fleming then submitted the paper to the Biomedical Journal of Scientific & Technical Research, where it was published in less than two weeks — an astonishingly fast turnaround time for reviewing and publishing a scientific paper. (Numerous pay-to-publish open journals operate online. Some are legitimate, but others are called “predatory journals.” They will publish nearly anything for a few thousand dollars.)

For a full teardown of Fleming’s study, check out blogger George Henderson’s thorough review. In short, Fleming’s paper is chock-full of self-citations, design flaws, and spurious conclusions.

Also, recall for a moment that this article promised “a militant vegetarian doctor, a convicted felon, an author of a retracted scientific paper, and a self-proclaimed adult film star.” By now, you might be wondering: Are these four people actually just one guy?

Yes. They all refer to one Dr. Richard Maximus Fleming.

To deliver on the fourth promise, we must look at the fantastically preposterous case of Fleming vs. Sims. This legal battle involves a dispute over money promised to Fleming in the amount of $250,000 to license patents related to breast cancer and heart disease treatment, and $3,800 for rent payment. The story is surprisingly convoluted, even by Fleming’s standards. From the court document:

According to Larry Sims, the parties first came into contact after Defendants placed a job posting on an adult entertainment job listing website. (See, e.g., ECF Nos. 90 at 1–2, 124 at 1, 188 at 1, 234 at 1, 244 at 1.) Plaintiff [Richard Fleming] allegedly responded to the advertisement and represented himself as an adult film actor and model. (Id.) It appears that during Plaintiff’s interview for the position, the parties first discussed Plaintiff’s research regarding breast and heart disease, the Grant, and the Rental Payment.

What began as a routine interview for an adult film job posting turned into an offer to license medical patents. What could possibly go wrong?

Well, it turns out a lot, and for reasons described variously by the opposing sides, no payment was ever made to Fleming, thus resulting in the lawsuit.

The trial did not go well for Fleming. In the words of Judge William J. Martinez: “Accordingly, default judgment will not be entered in Plaintiff’s favor and Plaintiff’s Motion for Damages is denied. As previously mentioned, the Court frankly suspects that if there is any victim here, it is the Defendants.”

Life has not treated Fleming as well as death has treated Atkins. Low-carb and keto diets are currently surging in popularity. Many of Atkins’ claims about the superiority of his diet for weight loss are now being validated, and new research is showing ketogenic diets to be an effective treatment for Type 2 diabetes and a variety of other metabolic disorders. Low-carb diets are proving beneficial in ways unimaginable to Atkins’ critics. We’re advancing toward a new landscape in nutrition, and Atkins deserves his fair share of the credit, for he remained steadfast despite tremendous pressure to give in to the mob mentality driving fat hysteria.