Atkins Diabetes Revolution (21 page)

Metabolic Improvement

You want to return your metabolism to its optimum function to be healthy and energetic, to feel great, and to take as few medicines as possible. That’s the aim of the ABSCP. For years you’ve been experiencing the metabolic abnormalities we’ve discussed. It may take some time to turn all this around.You’ll have to do your part: It is up to you to learn how to manage your metabolism with carbohydrate control, to include exercise in your daily routine,and to take the necessary supplements to support your body’s return toward normal. This book, based on Dr.Atkins’clinical experience,will provide the road map,but you must stay the course.

FINDING A NUTRITIONALLY ORIENTED PHYSICIAN

As an increasing number of physicians become aware of the science supporting the Atkins approach and see how much their patients benefit, many are recommending Atkins to their patients. Even though the subjects of controlled-carbohydrate nutrition and ketogenic diets are not commonly taught in medical school,your own physician might have experience in monitoring and supervising them. If your physician does not have specific training or is uncomfortable with Atkins,he or she may be able to refer you to a provider who is.If your doctor is unable to make such a referral, you can contact one of the following organizations, which have a focus on nutrition. Understand that not all their members are familiar with controlled-carbohydrate nutrition. (See page 139 for questions you might ask to ascertain an individual physician’s expertise and level of comfort with the Atkins approach.)

American College for Advancement in Medicine: www.acam.org

American Society of Bariatric Physicians: www.aspb.org

Stabilized Insulin and Blood Sugar

The Atkins Blood Sugar Control Program is designed to improve blood sugar levels. By this we don’t mean simply using drugs to drive your fasting blood sugar below the magic number of 100 mg/dL. Rather, Dr. Atkins designed the ABSCP to treat the underlying problem—the whole person, not just your blood sugar number. The goal is to teach you a way to keep your insulin/blood sugar steady at a healthier level.

Improved Blood Lipids

A common initial finding related to insulin and blood sugar imbalance is disturbed lipid levels, particularly high triglycerides and low HDL, which are recognized as serious risk factors for heart disease. Even if your blood lipid numbers are within the normal range, you may still be at increased risk, because high blood sugar shifts these lipid particles toward a smaller, denser, more dangerous form. (For more on this, review Chapter 9, The Cardiac Connection.) Controlling your carbs moves you toward a more desirable lipid profile.

Lowered Blood Pressure

High insulin and blood sugar levels go hand in hand with high blood pressure. Getting your insulin/blood sugar levels under control by controlling your carbs will simultaneously help tackle the cause of hypertension. (Review Chapter 8, Twin Peaks: High Blood Pressure and High Blood Sugar.) Exercise and weight loss (if necessary) will bring down your blood pressure even more.

Reduced Medication Needs

The average adult with Type 2 diabetes takes several different prescription drugs to treat various aspects of the disease. All those drugs may succeed in temporarily producing test results that
appear to
indicate improved health, but the reality is that most of them are doing nothing to solve the underlying problem. In addition, all those drugs may actually create a downward spiral of worsening health.Reducing medications with your doctor’s help means fewer chemicals for your liver to process and less chance of a dangerous drug interaction. You may think these interactions are rare; they’re not. According to a study published in the
New England Journal of Medicine,
about 25 percent of all prescriptions lead to some adverse event.
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Here’s something else you probably didn’t know. In a study published in the
Journal of the American Medical Association,
reporting on adverse drug reactions in the United States in 1994,it was found that about 100,000 hospitalized patients died as a result of a drug interaction—making legally prescribed and administered drugs somewhere between the fourth and sixth leading cause of death for that year.
6

Weight Loss

Why have we saved this important goal for last? Because until you get your blood sugar under control, and perhaps until you can reduce or eliminate some of the drugs you are now taking, you may find it difficult to lose weight. Most of Dr. Atkins’ patients with the metabolic syndrome, prediabetes, or diabetes did gradually lose weight once they began the program. Although the loss can be agonizingly slow at first, it almost always picks up once patients get their insulin and blood sugar normalized and reduce their medications. For those of you with the metabolic syndrome who are not presently taking medications, of course, weight loss could happen quickly. Whether or not you are taking medications, if you already have prediabetes or Type 2 diabetes, the weight-loss process will likely take a while to begin and may initially go slowly.

In the short run,there is much benefit to be gained from even small amounts of fat loss. Remember that even a small change in the amount of stored fat has been shown to favorably impact the risk factors for heart attack and stroke.
7
In the long run, once your insulin/ blood sugar metabolism normalizes, you will find it easier to decrease your fat stores.

A good example of metabolic improvement with minimal weight loss is Pia S., a 48-year-old, who came to see me with a fasting blood sugar of370.At the time of her first visit, she weighed 217 pounds.Two weeks after starting the ABSCP she had lost only 3 pounds but her blood sugar was down to 268. One month later, her blood sugar dropped to 198 although her weight stayed the same. After six months, her blood sugar was down to 150, her glycated hemoglobin (A1C) went from 12.5 to 7.6, her cholesterol from 242 to 156, her triglycerides from 118 to 63, her LDL from 161
to 93, and her CRP from 12.9 to 5.5. In addition, her 24-hour urine test for microalbumin (a test to measure kidney function, which I monitor every three months) went from 482.9 to 390.6. Although she lost only 10 pounds, her waist went from 45 inches to 42. At eight months, her fasting blood sugars were down to 120, and she weighed 202 pounds.
    —M
ARY
V
ERNON

The basic principles of the Atkins Blood Sugar Control Program are straightforward and scientifically sound. But can you put theory into practice and still enjoy good food without a lot of fuss? Absolutely.You’ll learn how in the next chapter.

WHAT IS KETOSIS?

One of the most frequent misconceptions concerning both the ANA and ABSCP is about the body’s normal production of ketones. To understand why following the ABSCP is safe for your kidneys and the rest of your body, you’ll have to understand a bit about your metabolism. When you initially cut back on carbohydrates the Atkins way,your body starts primarily burning fat for energy,a process that’s known as lipolysis.Your body breaks down fat into chemicals called ketones, which are used by your muscles and other cells for energy.Most of the cells in your body can “burn” both glucose and ketones for energy production, so your stored fat can be used for energy. That’s how you lose fat when you control carbohydrates.When your body burns fat very rapidly, some of the ketones escape into your breath and urine. The process is entirely normal; in fact, our bodies use ketones for energy when we are asleep. When you produce more ketones than you can burn, and extra ketones are excreted,then you are said to be in ketosis,more accurately called benign dietary ketosis. Remember, you can be making and burning ke- tones without them showing in your urine, meaning you are still burning fat even without “spilling”ketones.(Occasionally,ketones turn up in the urine even without a change in your weight.)

Benign dietary ketosis is a perfectly safe bodily function. Did you know that even on an overnight fast, a normal individual may produce ketones? Humans are adapted to live for long periods of time this way—
that’s how we are able to survive periods of famine. It’s worth noting that a 30-day fast (drinking water but eating no food) raises ketones to ten times the levels experienced by individuals who are restricting carbohydrate intake.

All too often, benign dietary ketosis is confused with the dangerous metabolic state called “ketoacidosis,”which may occur in Type 1 diabetics with very high blood sugar or in severe alcoholics after a binge.

HOW TO TEST FOR KETONES

The presence of ketones in your urine indicates that you are now burning fat for energy—a perfectly normal bodily response to controlling your carbohydrate intake. To determine if ketones are present, you can use lipolysis test strips (also called ketosis testing strips). You can buy these in any pharmacy.

If you want to know if you’re in ketosis, test your urine before your evening meal or before bedtime. Simply follow the instructions on the package.Understand that the color the test strip turns varies by individual—in some people the strip turns dark purple, in others it turns only pale pink. And in some people the strip never turns color. That doesn’t necessarily mean you’re not following the program correctly. Even if you’re making and burning ketones, and therefore still burning fat, you might not be making enough ketones to “spill” over into your urine. Don’t panic. As long as your blood sugar level, weight, and blood pressure are improving, and your appetite is under control, the presence of urinary ketones is irrelevant. And if you’ve reached the point of eating 50 grams or more of Net Carbs, you probably won’t be spilling ketones anymore, even though you will probably still be losing weight. Again, this is perfectly normal.

DOES YOUR DOCTOR UNDERSTAND THE ABSCP?

We strongly suggest that you work closely with your doctor as you follow the Atkins Blood Sugar Control Program. To see if your physician understands the controlled-carb approach and is experienced in managing patients who decide to follow it, ask these questions as a basis for a dialogue:

1. What dietary approach do you usually recommend?
   
2. What experience do you have in following patients on a controlled-carb diet?
   
3. Have you worked with patients following the Atkins approach?
   
4. Do you use nutritional supplements for blood sugar, blood pressure,or lipid disorders?
   

Chapter 11

TAKE ACTION

You now have a good knowledge base about insulin/blood sugar problems,the metabolic syndrome,and diabetes.We’ve also explained how and why the Atkins Blood Sugar Control Program (ABSCP) can help you turn your health around. It’s finally time to tell you how to put the plan into action—and get you on your way to a healthier life.

FIRST THINGS FIRST

As we said in the previous chapter, before you start the ABSCP, it’s important to visit your doctor to assess your current state of health. In particular, you need to know if you have any special medical problems that will require monitoring and you need your baseline lab results.

Know Your Numbers

You’ll be measuring your success
not so much by weight loss
as by improvements in your blood sugar, your blood pressure, and your blood lipids. When your goal is metabolic control, you use your lab values and body measurements, such as your waist-to-hip ratio, as a way to gauge results.When you visit your doctor for a complete checkup, he or she will order tests to reveal your baseline numbers. When you repeat the tests after following the ABSCP for even three months, you may be pleasantly surprised to find evidence of your metabolic improvement. (Note that once you are controlling carbohydrates, there is no need to repeat the GTT.) After six months, you’re likely to be even happier. As you see from the chart that follows, routine blood chemistries and lipids are monitored fairly soon. These time frames are simply guidelines.Your physician will determine timing individualized to your situation. Dr. Atkins recommended the following tests, which may vary from those your physician usually recommends:

THE IMPORTANT TESTS

* See page 63. ** See page 71. † See Chapter 9.

If these numbers begin to change for the worse or get stuck at undesirable levels, it will be a clear indication that you need to drop back to a lower level of carbohydrate intake.