When you first begin controlling your carbs, your focus is understandably going to be on what you can and can’t eat. Don’t forget, however, that you’ll likely need to make some changes in what you drink. If you’re not a big water drinker, it’s time to develop a relationship with the office water cooler. It’s all too easy to forget that the liquid carbs count just as much as the solids. On the Atkins Blood Sugar Control Program (ABSCP), you also need to give careful thought to the pros and cons of drinking alcohol.
STAY LIQUID
Most medical authorities agree: For good health, you should drink at least 64 ounces of water each day. That’s eight 8-ounce glasses, or 2 quarts, or about 2 liters. (However, individuals diagnosed with renal function decline need to follow the advice of their physician with regard to water intake.) That might sound like a lot, but it really isn’t, especially when you spread it out over the day. Bear in mind that a typical can of soda pop or other beverage contains 12 ounces, and that today’s supersized beverages often contain 20 ounces or more. These beverages do not count toward your 2 liters a day; water is still the best drink of all and diet sodas should be only a small part of your daily fluid intake.
Getting plenty of fluids keeps your system hydrated and flushes waste products from your body efficiently. Regardless of your dietary approach, if you drink less than you should, you may experience constipation and an increased risk of kidney stones.
There’s another problem with not drinking enough: It may increase your food intake. That’s because it’s common to confuse thirst with hunger,especially if both sensations happen at the same time.In- stead of drinking, you eat. That fools you into thinking your thirst has been quenched, even though you haven’t taken in any fluids. Next time you feel hungry between meals, try drinking something instead, or having a drink along with a small protein/fat snack such as some nuts or a piece of cheese.You may be surprised to see how quickly your hunger goes away. Likewise, having something to drink before you eat a main meal may help you avoid overeating. The liquid fills you up a bit so that your meal satisfies you faster. For some reason, hot drinks seem to work better than cold ones—try a cup of hot tea or herbal tea or some hot broth about half an hour before suppertime.
By the time your body signals that it’s time for some fluid,you’re already a little dried out. Also, as you get older, your sense of thirst generally gets less acute, and it’s easier to become dehydrated. You also need to drink more in both hot and cold weather. Hot weather makes you lose fluid by sweating; in cold weather, the air is usually dry, which pulls moisture from your body.
THIRST IS A DANGER SIGNAL
Increased thirst, increased hunger, and increased urination are all classic symptoms of diabetes. If you notice these symptoms, even if you’ve already been diagnosed with diabetes, check with your doctor immediately.(See Chapter 6,Diagnosis: Diabetes.)
WATER, PURE AND SIMPLE
What’s the best thing to drink when you’re following the ABSCP? Water. Convenient and carb-free, water is the way to go. Bottled water, mineral water, and filtered water are good choices. If you prefer something with a bit of flavor, look for no-carb flavored water and flavored seltzers; you can also add a squirt of lemon or lime juice or some sugar-free flavored syrup to your water or club soda.
Fruit juice, despite its reputation for being “healthy,” is actually high in carbohydrates and low in fiber. Whether they’re made only with pure fruit juice or contain some juice and additional high- fructose corn syrup, fruit juices are higher on the glycemic index than whole fruit.1 Whole fruit is a better choice if your carb threshold allows you to include fruit, because the fiber content slows down the absorption of fructose.2–4 Once your palate adjusts to your new eating style, you will be amazed by how sweet fruit juice tastes.
NOT MILK?
When you choose your beverages, remember that an 8-ounce glass of whole milk has more than 11 grams of carbohydrates, mostly in the form of lactose, or milk sugar. It’s not acceptable on Induction. For active kids and teenagers who can add more carbs to their diet, however, using up some carbs each day on a glass or two of full-fat milk is fine— the protein and calcium in the milk are important nutrients.If you want the taste of milk without all the carbs, try one of the new reduced-carb dairy beverages, which have about 3 grams of Net Carbs per cup. Those few grams of carbs are in the form of lactose,however.If you’re very lactose intolerant,you still might not be able to drink these beverages.
You’ll still be getting dietary calcium when you follow the ABSCP, because you’ll be eating a lot of green vegetables, along with cheese and nuts.(One ounce of almonds has 80 mg of calcium and about 4 grams of Net Carbs.) Leafy green vegetables, such as kale, Swiss chard, collard greens, and broccoli, are excellent sources of calcium. Unlike milk, they also contain the other vitamins,minerals,and flavonoids that are essential for helping your body absorb calcium and use it to build your bones.
You may have heard something about calcium in greens not being absorbed as easily. The calcium in some greens is bound up to some extent by other natural substances such as phytates and oxalates. Some dark leafy greens,such as beet greens,spinach,and Swiss chard,are high in oxalate. Individuals with a predisposition to form calcium oxalate kidney stones should consult with their physicians. The calcium in broccoli, however, is easily absorbed. Cheese is a great source of calcium—and it’s definitely an indulgence you can enjoy during all phases of Atkins. One ounce of Cheddar cheese has 204 mg of calcium. Some emerging research also suggests that the calcium and protein in dairy products may have a potential benefit for weight loss.5
CAFFEINE AND YOUR BLOOD SUGAR
Coffee and tea are the world’s most popular beverages,and that means caffeine is perhaps the world’s most widely used drug. Caffeine is perfectly legal, of course—in fact, caffeine is the only drug that can legally be added to foods in the United States. You may find that caffeine can cause a slight, temporary rise in your blood pressure; it may also interfere with your sleep. Excessive caffeine also seems to have an effect on blood sugar and insulin—so,especially at the beginning of the ABSCP, you may want to switch entirely to decaffeinated beverages. (See Caffeine and Insulin on page 238.)
Tea is a better source of caffeine than coffee because it also contains a lot of valuable antioxidants and other substances, such as vitamin K, which can benefit your health. We discourage excessive caffeine in- take, but 1 or 2 cups of green tea or black tea a day may well be bene- ficial. However, if you have blood sugar abnormalities or diabetes, you may find that you are more sensitive to caffeine and may need to limit it.
CAFFEINE AND INSULIN
A study in 1993 confirmed what Dr.Atkins had long observed in many of his patients with unstable blood sugar: Caffeine in large quantities can make you feel hungry, even if your blood sugar is normal. The amount of caffeine used in the study was 400 mg,or about the amount found in 4 cups of strong brewed coffee.6
Two studies in 2002 suggested that caffeine can decrease insulin sensitivity. In the first study, 12 healthy volunteers were given either a caffeine-loading dose or a placebo and their insulin response was measured. When they got the caffeine, their insulin sensitivity decreased by about 15 percent. The amount given was equal to a “moderate” caffeine intake. The authors noted that the decrease in insulin sensitivity was roughly the same as the improvement in insulin sensitivity that is obtained from drugs used to control blood sugar, such as metformin.7 The second study looked at the effects of caffeine on how well skeletal muscles took up glucose—another way of looking at the effect of caffeine on insulin resistance. Seven healthy volunteers were given doses of caffeine and then they exercised for an hour; their blood was tested for insulin levels before and after. The researchers concluded that caffeine decreased the ability of the muscles to take up glucose, although exercise can reduce the effect of caffeine.8
Do the studies indicating that caffeine increases insulin resistance mean you should give up your morning coffee? Not necessarily—unless you are unusually sensitive to caffeine, but it does mean you should have no more than 1 or 2 cups of caffeinated coffee a day, taken with meals.
When you get up in the morning, your blood sugar may well be on the low side, because you haven’t eaten anything during all the hours you were asleep. But if you have a breakfast of only java, or coffee with a sweet roll, you’ll probably spike your blood sugar too high. A few hours later, your blood sugar could crash and send you on a seek-and-devour mission for carbs and more coffee. Following the ABSCP, however, you start the day with a good breakfast containing protein, fat, and a small amount of allowable carbohydrates along with your morning cup of coffee. That keeps your blood sugar steady and maintains it on an even keel for several hours. You’ll then find it much easier to resist the doughnuts in the break room later in the morning.
If you can bite the bullet and substitute decaf for regular coffee,you may find that your carbohydrate cravings decrease. If you’re a con- firmed caffeine addict, taper off slowly by combining caffeinated and decaffeinated coffee and then gradually increasing the amount of decaf over a week or so. (Watch out for flavored coffee drinks, even if they are decaf. They often contain added carbs and trans fats. Choose sugar-free, milk-free versions.) Although tea has far less caffeine than coffee (only about 50 mg in 8 ounces of brewed tea), you may also experience mild withdrawal symptoms if you go cold turkey—follow the same combination approach, using decaffeinated tea.
Most colas and some other soft drinks contain caffeine—in fact, some have added caffeine for an extra jolt.If you want to consume soft drinks,choose the sugar-free,caffeine-free versions.And be aware that those caffeine-laden energy drinks in the little cans are full of carbs.
Some herbal teas, such as maté and guarana, and tea mixtures also contain caffeine. Most herbal teas are caffeine-free, however, and make a good alternative to caffeinated coffee and tea. Caffeine also occurs naturally in chocolate, although the amounts are minimal— about 20 mg in an ounce of dark chocolate.
TEA AND YOUR HEALTH
Tea—either black tea, the kind most commonly consumed in the United States, or green tea—can have a very positive effect on your health. Numerous studies of large groups of people have consistently shown that those who drink the most tea also have the lowest risk of heart disease. In a study of men and women in the Boston area, for example, the participants who drank at least 1 cup of tea a day had a 44 percent lower risk of a heart attack than those who drank no tea.9
When it comes to controlling blood sugar, it’s also possible that tea can be helpful. In a study in Taiwan in 2003, twenty people with diabetes who were taking an antihyperglycemic drug were randomly assigned also to drink either 1,500 ml (about 6 cups) of oolong tea (a type of tea that is halfway between black and green) or an equal amount of plain water every day for 30 days. They then switched off and repeated the process. The researchers found that after 30 days of tea drinking, the participants had markedly lower blood sugar levels. There was no change after 30 days of drinking plain water.12 It’s probably the catechins and other chemicals called polyphenols in tea—not the caffeine—that have the beneficial effect.
RESEARCH REPORT: THE HEALTH BENEFITS OF TEA
A daily cup or two of brewed black or green tea could be beneficial to your overall health—and might even help speed up weight loss. One health benefit is that tea can help keep your bones strong as you age. A study of over 1,200 older British women found that those who drank tea had higher bone mineral density levels in their spines and hips than those who drank no tea at all.Because higher bone mineral density generally means a lower risk of fracture (from falling, for example), it appears that tea had a definite protective effect for these women.10
What about tea and weight loss? There is some suggestive evidence that green tea could increase your metabolic rate and slightly help speed up weight loss. A recent study of ten healthy young men showed that when they took capsules containing green tea extract, they had an increase in their energy expenditure that was greater than when they took capsules containing caffeine or fiber. In other words, the green tea extract made their metabolism run faster so they burned more fat. The study is a small one, done on healthy young men in a highly controlled setting. Even so, it shows that it’s not the caffeine in tea that causes the metabolic increase. The researchers believe the effect comes from the catechins,a group of natural chemicals found in tea.11
Given all the other beneficial effects of tea, Dr. Atkins recommended drinking 1 to 2 cups of brewed green tea each day.This type of tea has the most catechins and polyphenols and the least caffeine,with only about 30 mg to 40 mg per 6-ounce cup. There’s no reason not to sweeten the tea with your favorite sugar substitute if you like. Let the tea steep for at least three minutes in boiling water to get the most benefit from the leaves.
TO IMBIBE OR NOT?
The question of whether you should drink alcoholic beverages is a complex one without an easy answer. Some recent research suggests that moderate alcohol consumption in the form of red wine may decrease your risk of diabetes and possibly decrease oxidative stress.13 Even so, the researchers are always quick to point out that the benefits of alcohol are very minor relative to other steps such as losing weight and exercising more.
Alcohol in Moderation
Once your insulin/blood sugar metabolism has normalized and other markers, such as high blood pressure, have gone down, you can enjoy a glass of wine or other low-carb alcoholic beverage, but we strongly recommend that you limit your alcohol consumption to no more than one drink a day—and preferably less. (And remember, Induction is an alcohol-free zone.) To minimize the effects of alcohol, always have it with a meal that contains protein and dietary fat. A drink is one standard unit of alcohol: 12 ounces of beer, 1.5 ounces of distilled spirits (gin, rum, vodka, whiskey, scotch, bourbon), or 4 ounces of wine.
Drawbacks of Alcohol
People with blood sugar problems need to be aware of alcohol’s drawbacks:
Excessive alcohol can distort the results of the glycated hemoglobin blood test and make them seem higher than they are. (Check Chapter 6 for more information on this test.)17
The bottom line is this: Only if your blood sugar is under control can you consume a moderate amount of alcohol (one drink or less a day) and then only as part of a full meal.
WHAT’S YOUR FLUID IQ?
1. How many ounces of water should you drink each day?
2. Which of these beverages contain caffeine?
3. Green and black tea may:
4. A standard serving of wine is:
Answers1.c.2.a,b,d.3.d.4.b.