Atkins Diabetes Revolution (15 page)

Different blood pressure cuffs should be used for children and people of various sizes. The standard blood pressure cuff may be too small for people with large arms, for instance, giving an inaccurate reading.
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THE BLOOD PRESSURE–BLOOD SUGAR CONNECTION

High blood pressure often goes hand in hand with obesity, high blood sugar, the metabolic syndrome, prediabetes, and diabetes because in many cases they share the same metabolic root cause. If you have any one of those conditions, there’s a good chance you’re hypertensive, too. People with hypertension are almost 2.5 times more likely to develop diabetes than those with normal blood pressure.
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In a study of almost 70,000 individuals, 30 percent of men over 40 years of age with a systolic blood pressure of between 140 and 159 mm/Hg had impaired fasting glucose, or prediabetes.
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Although very common, the combination of high blood pressure and high blood sugar is quite dangerous. If you have both, you are at much greater risk for blood vessel injury, leading to stroke, heart attack, kidney failure, blindness, and amputations. But don’t get discouraged.Research has shown that even small improvements in blood pressure and blood sugar—along with weight loss—can improve your chances of avoiding those dire outcomes.
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It’s worth noting that none of these studies restricted carbohydrates.We see much better results in patients using the Atkins program.

The increased risks in people with diabetes begin at blood pressure readings of 120/70 and above—in other words, as soon as you reach the prehypertension level. That’s why most experts agree that people with blood sugar abnormalities should aim for a target blood pressure of less than 130/80—and preferably lower.
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Let us remind you that the Atkins Blood Sugar Control Program is designed to address the underlying metabolic abnormalities that are largely responsible for high blood pressure. Once patients have been following the program for a few months, it is not unusual to find blood pressure readings that reflect optimal health—that is, 120/70 or lower—often without medication. This is no Band-Aid!

When 71-year-old Dorothy W. came in for her annual physical, she was five feet tall and weighed 151 pounds. She had been taking three medications to control her blood pressure, but it was still 196/84, meaning she would need yet another drug. She would also need a medication for her lipids, as her lab results showed the following: fasting blood sugar: 122; glycated hemoglobin (A1C): 5.8; total cholesterol: 282; triglycerides: 485; HDL: 38. Her LDL cholesterol could not be evaluated due to her extremely high triglycerides.

Dorothy was interested in decreasing her medications, so under my supervision, she began the Atkins Nutritional Approach, with frequent follow-up visits. After three months, during which I tapered her medications, Dorothy’s triglycerides had dropped to 86; her total cholesterol was now 209, with HDL of 86 and LDL of 57. Seven months later, she was able to eliminate one of her blood pressure medications. She is now down to 123 pounds, takes a very small dose of one medication, and her blood pressure is 120/70. Her fasting blood sugar is 112; c-peptide:2.3; A1C: 5.1; total cholesterol: 197; triglycerides: 39; HDL: 74; and LDL: 115.
    —M
ARY
V
ERNON

THE NONDRUG APPROACH TO HYPERTENSION

What can you do to lower your blood pressure without drugs? You’ve probably already guessed the single most important step you can take: Control carbs! When you control both the quantity and quality of the carbs you eat, you directly address the metabolic abnormality that drives blood vessel damage—damage that is the basis for the long list of complications we’ve just discussed. When you control carbs, fat is no longer stored. Rather, the proper level of carb intake allows the body to burn excess body fat for energy.

Other very important lifestyle steps to lower your blood pressure include:

• Be more physically active. Lack of exercise, especially in combination with obesity,makes you more likely to develop high blood pressure. Adding exercise brings your blood pressure down— and helps your blood sugar levels and insulin resistance as well, which in turn helps bring your blood pressure down even further. Before starting an exercise program, read Chapter 22 and check with your physician.
  
• Limit alcoholic beverages. If your blood pressure is elevated and you drink alcohol, stop drinking altogether and observe the impact on your blood pressure. If your blood sugar is abnormal and/or you are overweight, you probably should not be consuming alcohol at all. (We’ll discuss this more in Chapter 19.)
  
• Stop smoking or using other forms of nicotine.
  

DIET AND BLOOD PRESSURE

As soon as you start the Atkins Blood Sugar Control Program (ABSCP) and eliminate worthless carbs from your diet, you start to normalize your metabolism. This helps to lower your blood pressure in two ways. First, because your primary source of carbohydrates is now leafy green vegetables and other low-glycemic vegetables (those that have a limited effect on blood sugar), you’re naturally getting a lot more potassium, magnesium, and calcium. These minerals have been found to be effective for lowering your blood pressure.
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Second, controlling your carbs will stop the abnormal salt and water retention caused by your former high-carb way of eating—fluid retention that can raise blood pressure.You may assume this has something to do with the salt content of foods. Although in salt-sensitive people, salt in the diet does lead to fluid retention, by no means is everyone with high blood pressure salt sensitive. In Dr.Atkins’ experience, and according to some research, a high-carbohydrate diet and high insulin levels are more likely to cause fluid retention than salt does.
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We find that on the ABSCP, salt restriction is rarely needed. Some people may actually need some supplemental salt (a cup of bouillon will do the trick) to prevent nausea or weakness when they burn fat rapidly. When you control your carbs, your body soon self- regulates to a more normal salt and water balance. Others who have studied this type of dietary approach concur with this advice.
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Also, on the ABSCP, you will probably find that your taste buds become much more sensitive to the taste of salt (and to sugar). So, instead of salting your food before tasting it,let your newly sensitive taste buds be your guide.

EXERCISE AND BLOOD PRESSURE

Exercise is an integral part of the ABSCP and crucial for lowering blood pressure and blood sugar. In fact, a recent meta-analysis of 54 major studies on the value of exercise for high blood pressure showed without question that regular exercise can lower your systolic blood pressure by nearly 4 points and your diastolic pressure by nearly 3 points. Best of all, you get the benefit no matter how old you are, how much you weigh, or how high your blood pressure is.
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Understand that exercise alone will not fix all the problems caused by excessive carbohydrate intake. It must be done in concert with controlled-carb nutrition to get the full benefit. (See Chapters 22 and 23 for more information on the value of exercise.)

STRESS AND BLOOD PRESSURE

The word
hypertension
sounds as if it should have something to do with stress. It is true that any stressful situation will make your blood pressure go up. However, that rise is normally temporary. Blood pressure usually returns to normal when the situation is over,even if it takes days or weeks. Whenever you’re under stress, your body produces extra batches of the stress hormones, such as cortisol and epinephrine. These “fight-or-flight” hormones ready your body for action by raising your blood pressure, blood sugar, and heart rate; by making you more alert; and by stimulating your body to draw energy from stored fat and muscle.These hormones raise your blood sugar—so that there will be plenty of glucose available for immediate energy needs during the crisis. The aftermath of this hormonal outpouring? Carbohydrate cravings. Ever found yourself finishing off a giant bag of chips when you’re on a deadline for work or school?
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Under normal circumstances, when the crisis is over, a complex series of feedback loops tells your body to turn off the stress hormones. But when stress is continual—as it often is in modern life—the stress switch gets stuck in the “on”position.When hormone levels remain elevated,the body is in a state of chronic biochemical stress,resulting in insulin resistance,increased hunger,cravings for carbohydrates and other comfort foods, elevated blood pressure, and weight gain. This stress- related weight gain, which usually ends up around your waist, is linked with the metabolic syndrome.
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The solution? Find healthy ways to cope with stress.They include:

• Stabilize your insulin/blood sugar metabolism by implementing the ABSCP.
  
• Start or step up your exercise regimen,according to the guidelines in Chapters 22 and 23.
  
• Establish a regular schedule for eating, exercising, and sleeping.
  
• Implement relaxation techniques such as meditation and yoga.
  
• Reach out to friends and family for support.
  
• Avoid sleep deprivation. When you’re short on sleep, you produce more stress hormones; getting more sleep can help flip off the switch.
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DRAWBACKS OF DRUGS

Current guidelines recommend starting drug treatment for people with diabetes as soon as their blood pressure reaches the prehypertension level of 130/90.
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If a patient’s systolic blood pressure is in the 130–139 range,or diastolic blood pressure is in the 80–89 range,and if after a maximum of three months lifestyle changes have not improved the blood pressure, then medication(s) should be prescribed. This usually means taking two and sometimes three different drugs in combination. (For a list of pharmaceuticals used for hypertension, as well as other conditions, see pages 94–96.)

While drugs for hypertension are effective, they often have unpleasant side effects, such as dry cough, fatigue, and erectile dysfunction. They can also cause
orthostatic hypotension
—blood pressure that’s too low when you’re standing up—in people with diabetes. That’s bad enough, but if you have blood sugar abnormalities, some blood pressure drugs, particularly beta-blockers (Inderal, Lopressor, Corgard), as well as thiazide diuretics (drugs that make you urinate more), could raise your blood sugar even more and tip you over into diabetes.
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The combination of a beta-blocker and a thiazide diuretic can make you six times more likely to become diabetic. There’s also some evidence suggesting that for people with blood sugar problems, treating hypertension with a thiazide diuretic alone or with a combination of a beta-blocker and a thiazide diuretic may actually
increase
the risk of having a heart attack.
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We have seen all too many patients who have ended up in worse health as a result of taking drugs for high blood pressure. In the case of Allison C., for instance, her doctor failed to realize that her high blood pressure was a sign of the metabolic syndrome. He didn’t investigate any further, which means he never discovered that Allison already had high blood sugar.Instead,he treated her high blood pressure as an isolated problem and prescribed a thiazide diuretic. Sure enough, the drug raised her blood sugar to the point that she became diabetic. When she came to Dr. Atkins, he put her on the ABSCP and stopped her medications. Her blood pressure came down right along with her blood sugar.

All of that said,there is a place for blood pressure medication.Lowering your blood pressure the natural way through weight loss, exercise, and other lifestyle changes takes time. The risks of uncontrolled high blood pressure are serious. While you should avoid some antihypertensive drugs if you have high blood sugar, others such as ACE inhibitors, calcium channel blockers, and angiotensin receptor blockers (ARBs) don’t negatively impact blood sugar and may be safe for you. Discuss the use of hypertension medications with your doctor and weigh the pros and cons carefully.Remember that your doctor is probably following recommended guidelines that advise beginning treatment with thiazide diuretics.

DRUGS FOR HYPERTENSION

Doctors now have a truly impressive array of pharmaceuticals from which to choose when it comes to treating high blood pressure. Here’s a rundown of the current arsenal. (Note: Every time you combine two drugs,as is often the case when treating hypertension,you increase the risk of side effects and adverse reactions; when you combine even more drugs, the odds of a negative interaction go up considerably.)

Diuretics

The first drug most hypertension patients are prescribed is a diuretic—a drug that makes you excrete more water and salt. Why do these drugs help? If you are eating a high-carb diet, high insulin levels can make you retain both salt and water,which raises your blood pressure.
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Diuretics reverse this, but of course they don’t solve the underlying condition that is causing your hypertension. Diuretics fall into three categories:

• Thiazides. One of the most commonly used drugs, especially when first beginning drug treatment of hypertension, thiazides cause a moderate amount of water, salt, and mineral loss. These drugs can worsen glucose metabolism to the point of causing Type 2 diabetes and/or gout.
  
• Loop diuretics. Loop diuretics cause greater salt and water loss than thiazides—so much so that these drugs are usually given with a potassium supplement and may cause severe dehydration.
  
• Spironolactone. This commonly used diuretic is potassium- sparing—you retain more potassium in your body instead of excreting it, which helps prevent dangerous electrolyte imbalance. It must be used cautiously in combination with other drugs to avoid excessive potassium retention.