Now that you have a better understanding of the progression of this epidemic disease and all the health risks associated with it, you are probably more than ready to get started on your new path. We couldn’t be happier about that.The sooner you start dealing with your metabolic imbalance, the better.
Before telling you about the right way to eat for your condition, let us briefly introduce you to the wrong way to eat if you have insulin- blood sugar abnormalities. If you have seen your physician and have received a diagnosis of either the metabolic syndrome, prediabetes, or diabetes,he or she has likely prescribed a diet endorsed by groups such as the American Diabetes Association (ADA) and the American Heart Association (AHA). By now you won’t be surprised when we tell you that Dr. Atkins would recommend another approach.
His 40 years of experience treating patients with the metabolic syndrome, prediabetes, and Type 2 diabetes made it clear to him that these low-fat, high-carb diets are likely to make you feel worse—and your blood sugar, blood pressure, and blood lipid measurements will probably get worse, too. You may have discovered this for yourself. Perhaps you have followed your doctor’s advice, only to find that you actually gained weight—meaning fat—and your blood sugar, blood lipids, and blood pressure numbers worsened instead of improving. Sometimes, the lack of improvement in your blood tests might lead your dietary counselor to believe that you didn’t follow his or her recommendations, even though you did. Your doctor may tell you that you have no choice but to resort to medications.
Health care practitioners who really understand carbohydrate metabolism know that this sequence of events—from diagnosis to dietary changes that don’t work to medication—is about as predictable as the sun rising each morning. Indeed, recent research is now confirming Dr.Atkins’years of clinical experience. (See Scientific Studies That Validate the Atkins Nutritional Approach, page 448, for a comprehensive list of recent work in this area.) What is a surprise is that much of the medical establishment persists in this outdated thinking when rapidly accumulating evidence points to the fact that these programs don’t work for the vast majority of people.
Whether you have the metabolic syndrome, prediabetes, or diabetes,if you want to do all you can to prevent your condition from getting worse (and who in their right mind wouldn’t?), these dietary recommendations could hinder you. They are simply too high in carbohydrates for many people.You have learned in the first few chapters of this book about what eating excessive carbs do to your body. Let’s take another look, step-by-step:
This cycle is more common in overweight individuals, but it can occur even if you are slim, especially if you eat the standard American diet (or SAD), which is high in refined carbohydrates. Eating excessive amounts of carbs or even frequently eating refined carbs triggers the fat-storage mechanism. Remember, insulin promotes the storage of fat. Your body burns sugar (derived from carbohydrates) for energy and stores the excess sugar as fat for future use. Fat can be stored anywhere in the body,including around the belly,in the liver,around your internal organs,and even in the walls of the blood vessels.Triglycerides are one form in which fat is transported in your bloodstream. Other lipoproteins also transport fat—and insulin is involved in regulating their production. So when you put the wrong kind or amount of carbohydrates in your mouth,insulin goes up—and so do the fats in your bloodstream. Now let’s talk about your new lifestyle—the diet, exercise,and supplement program that’s going to turn your health around.
THE ATKINS WAY
The Atkins Blood Sugar Control Program (ABSCP) is designed to help you control your individual metabolism through food and other lifestyle choices. We stress the word individual because, with ABSCP, one size doesn’t fit all. For many of you, this program will be the very tool that prevents further blood sugar stress (such as hypoglycemia), and takes diabetes off your road map altogether. For those of you who have later stages of blood sugar stress (prediabetes) or full-blown diabetes, it will help you to control your blood sugar and even normalize it, which means you may be able to minimize or even stop the use of some prescription medications.
As Dr. Atkins routinely observed in his patients, the ABSCP increases patients’ energy, decreases aches and pains, improves numerous other symptoms,and enhances the overall quality of life.Likewise, published studies of people with diabetes and the metabolic syndrome document improvements in blood sugar and blood lipid values on a controlled-carbohydrate program. This dietary approach provides the tools you need to take control of your metabolism.
Because the ABSCP is based on the famed Atkins Nutritional Approach (ANA), let’s start with an overview of this safe, effective, controlled-carbohydrate approach to rebalancing the metabolism, managing weight, and improving health. Later we’ll look at how the ABSCP differs from the ANA.
If you’re overweight or if you have only a slightly impaired insulin/glucose mechanism, the ANA alone will probably help you lose weight as well as lower and stabilize your blood sugar and insulin levels. At the same time, you’ll improve your health in other important ways, because weight loss and normalizing blood sugar help improve lipids,lower blood pressure,and reduce the inflammation markers associated with heart disease. As your blood sugar stabilizes, you’ll have more energy, and you’ll probably find that your mood and mental sharpness improve as well.
Some of you undoubtedly are already familiar with the ANA as a weight-loss program. For those of you who are not acquainted with it, a brief review of the four phases is in the next section.When people are on the ANA,their body fat slowly,steadily,and safely vanishes; most of them do not experience food cravings after the first few days. You progress toward your goal of improved health without feeling deprived.And this is not a temporary fix; learning how to do Atkins provides you with a tool for lifelong control of your weight and metabolism. A brief review of the ANA follows.
THE FOUR PHASES OF THE ATKINS NUTRITIONAL APPROACH
Phase 1: Induction. To kick-start weight loss, limit your carbohydrate intake to 20 grams of Net Carbs a day. (The simple way to calculate Net Carbs in a whole food is to subtract the grams of fiber from the total number of carbohydrate grams in the portion. Net Carbs are the only carbohydrates that have an appreciable impact on your blood sugar.) During this phase, which lasts a minimum of two weeks, you satisfy your appetite with foods high in protein and natural fats, along with carbohydrates in the form of 3 cups of salad greens (dressed with olive oil and vinegar, lemon juice, or your favorite controlled-carb dressing). Alternatively, you can have 2 cups of salad and a cup of fresh,nonstarchy cooked veggies,such as broccoli or zucchini.You can also eat 3 to 4 ounces of aged cheese, a handful of olives, and half an avocado each day.
Phase 2: Ongoing Weight Loss (OWL). When you move on to OWL, you deliberately slow your weight loss as you continue to eat protein and natural fats,along with salad greens and nutrient-dense and fiber- rich vegetables. As you continue to lose weight, you gradually add back nutrient-rich carbohydrates. Each week, you increase your daily carb count by just 5 grams of Net Carbs by eating more vegetables, nuts and seeds, and even berries. After incorporating these foods, some people can even reintroduce small portions of legumes (beans) and fruits other than berries—until weight loss stalls. At that point, drop back 5 grams of Net Carbs and you should have discovered your Critical Carbohydrate Level for Losing (CCLL)—the amount of Net Carbs you can eat while continuing to lose weight. To continue your steady progress, keep your carb intake at or below your CCLL.
Phase 3:Pre-Maintenance. When you are within five to ten pounds of your goal weight, you’ll want to slow down your rate of weight loss even more, so that your new, improved eating habits become in- grained. (Expect it to take at least two months to trim the last ten pounds.) You can now broaden your food choices to include moderate portions of starchy vegetables such as sweet potatoes and peas and even some unrefined whole grains. Each week, simply add another 10 daily grams of Net Carbs to your program—or treat yourself to an extra 20 to 30 grams of high-quality carbs twice a week—until weight loss stops. Then drop back down 5 or 10 grams, and you will have found your revised CCLL. Continue at this level until you reach your goal weight. When you have maintained your goal weight for one month or more, you will have achieved your Atkins Carbohydrate Equilibrium, or ACE, the number of grams of Net Carbs you can eat without gaining or losing weight, and you are now officially in the Lifetime Maintenance phase.
Phase 4: Lifetime Maintenance. Now that you’ve achieved your goal weight, you can continue to enjoy a wide range of delicious foods. Of course,you still need to keep an eye on your total carb intake.Remember, this program is not simply about the quantity of carbs, but their quality as well. Accept the fact that junk food is a thing of the past; instead, spend your carb allowance on nutrient-rich and fiber-rich foods. Understand that you may or may not be able to add back whole grains, such as oats, brown rice, wild rice, and barley, and higher-carb fruits (like bananas) and vegetables (like potatoes). Your ACE will depend upon your age, gender, activity level, hormonal status, and any metabolic issues you have. Most people can raise their ACE if they exercise regularly.
For more details on weight loss and the science behind controlled- carb intake for weight control, good health, and disease prevention, read Dr.Atkins’ New Diet Revolution,Atkins for Life, and The Atkins Essentials or visit www.atkins.com.1–3 To track your carbohydrate intake easily, we recommend using Dr. Atkins’ New Carbohydrate Gram Counter.4
THE NEXT STEP
When it comes to weight loss, the ANA works for just about everyone. And because slimming down almost automatically ameliorates many health problems—including blood sugar abnormalities—losing even a moderate amount of weight might well be enough for you to start feeling a lot better.
But if your health picture now includes the metabolic syndrome, prediabetes, or diabetes, you may well need to take a next step beyond the ANA. Why? Because you must work on reversing health problems that have developed over months or even years. That’s where the Atkins Blood Sugar Control Program comes in.As in the ANA, weight loss is a crucial component of the program, but now there are also other very important goals. In fact, some of you may be at normal weight or only slightly overweight but still have blood sugar abnormalities, high blood pressure, high blood lipids, and other markers of metabolic imbalance.
The ABSCP concentrates on getting your metabolism back into balance by normalizing your insulin/blood sugar levels and blood lipids, reducing other markers associated with impending heart disease, and lowering your blood pressure. As your metabolism improves, you will almost certainly lose weight (if you need to).
A LITTLE CAN DO A LOT
The loss of stored fat and an improved ability to burn fat are very important steps on the road to improved health. However, weight loss may be secondary to the other improvements on the ABSCP. In fact, it is possible to improve your blood sugar, lipids, and blood pressure numbers without losing all—or even very much—of your excess fat. Your journey back to health begins with improvements that will happen before the pounds begin to fall away. Until these occur, your weight loss may well be slow or even nonexistent—and that’s just fine. More important than seeing the numbers on the scale move down is stabilizing your metabolism. For now, your lab values (your blood sugar number, for instance) are more important than how much extra fat you have.When you start following the ABSCP,these lab values can be positively improved early on, even before significant weight is lost. When those numbers improve, it means you can reduce the dose or even stop taking some or all of the medications you might be on.
A 75-year-old patient with diabetes named Jim H. came in to see Dr.Atkins; at the time he was taking nine different drugs to control his blood sugar, blood pressure, blood lipids, and some other ailments. After six months on the ABSCP, Jim was down to just three drugs (and lower doses of those), and his blood sugar was under control. Jim had lost just five pounds in that time.
I had a patient who likewise did not lose a lot of weight, but the weight she did drop made a tremendous difference in her health. At age 37, Maureen J. had the lab results of someone twice her age. Weighing 197 pounds and five feet six inches tall, she had a total cholesterol of 327; her triglycerides were 298; her HDL, 53; and her LDL, 214. Moreover, her blood pressure was creeping up to 138/80. I put her on the Induction phase of the Atkins Nutritional Approach for two weeks and she then moved to 25 and later 30 grams of carbohydrates a day. After six weeks,although she had only lost ten pounds, Maureen’s improvement was remarkable: Her total cholesterol was down to 199, her triglycerides, to 121; her HDL was 46 and her LDL was down to 172. Her waist was also two inches smaller. —MARY VERNON
Remember, long before your lab values become abnormal, the gradual shift from good health to increased risk and finally to outright illness has been set in motion.Years before tests reveal that you have a problem, damage to the blood vessels in your heart, eyes, nerves, kidneys, and brain may have been silently accumulating. Although some of these changes may be permanent, the good news is that you can impact your metabolism immediately by simply changing the food you eat. This will give your body every chance to repair itself.
On the other hand, if you do need to lose weight, don’t take this as license to settle for only minimal weight loss as your final goal. We’re not going to let you off the hook that easily. You owe it to yourself to ultimately take off those extra pounds, which increase your risk for a litany of diseases and contribute to the insulin/blood sugar abnormal- ities.Fat is not only a sign of the problem; excess fat also contributes to the problem.
It is important to understand that we are talking about a permanent lifestyle change. If you have a tendency toward the metabolic syndrome or diabetes, you can manage this with careful attention to your diet—but your blood sugar problems don’t ever go away. If you return to your old way of eating, the old symptoms and risk factors will come roaring back. To get your blood sugar under control and keep it there, you’ll almost certainly need to follow the basic principles of the ABSCP for a lifetime.
THE ATKINS BLOOD SUGAR CONTROL PROGRAM
The ABSCP is fundamentally very simple: Control carbohydrates— meaning both quantity and quality—to control blood sugar, insulin levels, and your metabolism. As with the ANA, you can eat satisfying portions of a wide variety of nutritious,delicious foods,and you never have to go hungry. The difference is that in addition to careful carbo hydrate control,your diet will be rich in foods that have been shown to help control not only blood sugar but also lipid levels, high blood pressure, and the many other health problems that go along with the metabolic syndrome, prediabetes, and diabetes. Two of the reasons that the Atkins Blood Sugar Control Program is so easy to follow are that those foods can be found in any supermarket and that they just happen to taste great.
SEE YOUR DOCTOR
Dr. Atkins designed the ABSCP to help the specific health issues caused by the metabolic syndrome,prediabetes,and Type 2 diabetes.But before you begin to follow this program,you must have a complete medical examination and discuss the results with your doctor.
The ABSCP is safe and effective, but you may have special medical problems, such as advanced kidney disease, which may mean this program is not right for you—unless it is prescribed and monitored by a physician trained in this type of metabolic management. You also need to know your baseline lab results for important markers such as insulin/blood sugar,blood lipids,and blood pressure before you begin the program.Finally,if you take prescription medications,you need to plan ahead for possible changes in the doses as your metabolism normalizes.
SETTING REALISTIC GOALS
In the earlier chapters of this book we explained exactly what happens to your body when your insulin and blood sugar levels rise. With that information in mind, now let’s look at your objectives as you start following the ABSCP.
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.5 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. —MARY VERNON
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: