Atkins Diabetes Revolution (17 page)

PROTECTING YOUR HEART

Heart disease and diabetes are a deadly duo. In fact, if you have diabetes, your risk of having a first heart attack is about as high as the risk of someone without diabetes who’s already had a heart attack.
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In other words,the moment you officially become a diabetes patient,you are automatically at risk for heart disease, even if you’ve never had any heart problems.During the decades in which you gradually developed diabetes, your blood vessels were suffering the kind of damage that often leads to a heart attack.

Because you can control what goes in your mouth, you have a unique opportunity right now to choose the alternative path to better health. Heart disease and diabetes aren’t inevitable—there’s plenty you can do to minimize your risk. In addition to getting your blood sugar and blood pressure under control, you also need to look at your blood lipids—the cholesterol and fats in your blood. And instead of relying on the standard pharmaceutical approach of cholesterol- lowering drugs to manage high blood lipids, wouldn’t you rather target the underlying reason for this condition? That’s what you’ll do on the Atkins Blood Sugar Control Program (ASBCP).

RESEARCH REPORT: A HIGHER RISK OF HEART DISEASE

Wherever you are on the road to diabetes,your risk of heart disease is already substantially higher than that of people not on the diabetes continuum. How much higher? According to results from the 118,000 women in the Nurses’ Health Study, it’s almost four times as high. The researchers in charge of this long-running study observed the women over a 20-year period.At the start, about 1,500 already had diabetes and
394 had a history of a heart attack. Over the next two decades, nearly
6,000 more developed diabetes and 2,500 women were newly diagnosed with coronary heart disease.The study found that women with both diabetes and prior heart disease were 20 times more likely to die from any cardiovascular disease such as a stroke and 25 times more likely to die from coronary heart disease.
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The risk doesn’t apply just to women. Middle-aged men with high blood sugar levels, even if they don’t have diabetes, are at greater risk of death not just from heart disease but also from all causes.We know this from a revealing analysis of three long-term studies conducted in Europe.Over a 20-year period,the health of some 17,000 men was carefully followed. The researchers found that among all three groups, the men who fell into the top 20 percent of the normal blood sugar range had an overall risk of death 1.6 times higher than the men whose blood sugar was in the lower 80 percent of the normal range. The men whose blood sugars were in the upper 2.5 percent of the normal fasting and normal two-hour glucose ranges were about 1.8 times as likely to die from heart disease as the men with low-normal blood sugar.
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Here’s an example of how well the program works—even for people who have suffered years of health problems related to their blood sugar. When 73-year-old Muriel R., whom you met in Chapter 4, first came to see Dr.Atkins, she had been a Type 2 diabetic for 30 years. She was on numerous medications to control her blood sugar and lipids— and they weren’t working. Her blood sugar was high, her total cholesterol was 318, and her triglycerides were almost off the chart at 1,455. After just three months on the ABSCP, she had lost only five pounds, but her risk factors for a heart attack had dropped considerably. Her blood sugar was down, her total cholesterol had fallen to 202, and her triglycerides had plummeted to 101! Muriel is a classic example of how it’s never too late to improve your health.

A SILENT KILLER

The classic symptoms of a heart attack include a crushing sensation in the chest,chest pain (angina),pain radiating into the left arm or up into the jaw, and shortness of breath. However, it’s important to realize that women and people with diabetes may not experience these symptoms. For them, symptoms are more likely to include nausea and vomiting, tiredness,sweating,and collapse.Doctors call these silent heart attacks. They are actually more dangerous than the more obvious sort, because life-saving,heart-preserving intervention may be delayed or never even administered.

The message: Don’t wait until you’re facing a crisis. If you have the metabolic syndrome, prediabetes, or diabetes, discuss with your physician a course of action should you experience any of these symptoms. It is in these emergency situations that standard American medicine shines—but you must recognize the signs and get help quickly.

Heart attacks are not the only problem. Obesity alone can overwork your heart to the point where its ability to pump blood efficiently is severely compromised.
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This problem,heart failure,can also be caused by hypertension and the leftover scarring caused by a heart attack.Among people with heart failure,20 to 40 percent have diabetes.
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UNDERSTANDING BLOOD LIPIDS

Throughout this book, we talk a lot about your blood lipids: LDL cholesterol, HDL cholesterol, and triglycerides. Now that we’re talking about your heart health, it’s time to take a closer look at them.

People with the metabolic syndrome, prediabetes, or Type 2 diabetes almost always have low HDL cholesterol, high triglycerides, and normal or only somewhat elevated levels of LDL cholesterol. As more and more research shows, the combination of low HDL and high triglycerides is practically a formula for a heart attack.
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Whether or not you need to lose weight, if you have problems with your lipids, controlling your carbs will help. A high-carb diet is often associated with bad lipids, and controlling your carbs can help lower your triglycerides, raise your HDL, lower your LDL, and shift your overall cholesterol production toward less dangerous forms.

IS LDL CHOLESTEROL BAD?

High levels of LDL cholesterol in your blood are associated with a greater risk of vascular disease such as heart disease and stroke from clogged arteries—that’s why it’s often called the “bad” cholesterol. Calling LDL cholesterol “bad,”however, is a simplistic approach that’s more useful for selling cholesterol-lowering drugs than it is for helping you to avoid blocked arteries. When you look closely at LDL cholesterol, the picture is more complex.

Types of LDL can be divided into subfractions based on the size of the cholesterol particles. Very low density lipoprotein (VLDL) particles are fairly large; intermediate-density lipoprotein (IDL) particles are smaller, and low-density lipoprotein (LDL) particles are the smallest of all. The smaller the particle, the more potentially atherogenic (damaging to the arteries) it is.
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In people with the metabolic syndrome, prediabetes, and diabetes, the particles tend to be mostly small, dense LDL cholesterol, rather than the bigger, lighter, “fluffier, less dangerous”particles.

The reason for this is a lot more complex than we have space to discuss here.Suffice it to say that high insulin levels shift your production of cholesterol away from the larger, lighter particles and toward the smaller,denser particles.Lower your insulin by controlling your carbs, and you help move your cholesterol production back in a healthier direction—think of it as loosening or “fluffing up” these particles of cholesterol.
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Why are we explaining this in such detail? After you’ve been following the ABSCP for a few months, your LDL cholesterol number will probably be the same or might even go up a bit, even as your HDL cholesterol rises and your triglycerides drop.For most people,the LDL increase is modest and temporary and not at all harmful,and it’s more than offset by the improved HDL/triglyceride ratio. In almost all people following the ABSCP properly, LDL numbers drop back to normal levels in three to six months. If your LDL did go up, see your physician to discuss further evaluation,as discussed below.Ask him or her to pay attention to other positive changes in your blood lipids. He or she is likely to respond to a rise in your LDL—or even to no drop in your LDL—by reaching for the prescription pad and writing out an order for a statin drug.

Before you take a drug to lower your LDL cholesterol,ask your doctor to investigate your LDL further to find out the proportions of dense and light particles. Even if your total LDL number has gone up, there’s a good chance that your switch to a controlled-carb approach has raised the proportion of lighter, fluffier particles and shifted you toward what doctors call Pattern A. Recent studies have confirmed that the Atkins Nutritional Approach can shift your LDL to the favor- able,“fluffy”type.
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You can also ask your doctor to do a blood test for a type of lipid called
lipoprotein little a
and written lipoprotein(a), or lp(a) for short. This is another form of blood lipid that has been shown to be an independent risk factor for heart disease.
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Even if your LDL cholesterol is normal, your lp(a) number could be high. Most doctors believe that your lp(a) number is inherited and can’t be changed by diet or anything else, but Dr. Atkins reported seeing some cases where it went down when the patient went on a controlled-carb program and lowered his or her insulin levels.

An example of such improvement resulting from dietary changes also occurred in one of my patients. Maureen Y., a 28-year-old woman who weighed only 100 pounds, lowered her lipoprotein(a) from a dangerously high 64 mg/dL to a safer level of 36 mg/dL, simply by controlling her intake of carbohydrates. The process took about six months—and her other blood lipids, which had been on the high side, improved as well. All this happened without weight loss, which was not appropriate in her case.
    —M
ARY
V
ERNON

Research in this area is still emerging; however, there’s not enough information yet to say that lowering your insulin can also lower your lp(a) number.

WHY IS HDL CHOLESTEROL GOOD?

Offsetting the LDL cholesterol is HDL cholesterol, the “good”or “protective” cholesterol. HDL cholesterol clears unused cholesterol from your bloodstream and carries it back to your liver. The higher your HDL level, the more cholesterol is being removed from your bloodstream before it has a chance to oxidize and damage your blood vessels; this explains the current thinking about why high HDL levels are protective of your heart and arteries.
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Like LDL, HDL comes in different particle sizes, or subfractions. People with the metabolic syndrome not only have low HDL levels,but their type of HDL tends to be small, dense particles, just as is the case with LDL. These particles, called HDL
₃
, aren’t as efficient as the large, fluffy variety (called HDL
₂
) at transporting stored lipids to your liver. The more you have of the lighter, larger HDL
₂
particles, the lower your risk of heart disease. And as with LDL cholesterol, high insulin levels shift your cholesterol production away from HDL
₂
particles and toward smaller, denser particles called HDL
₃
. Lower your insulin level by following the controlled-carb approach,and you help shift your HDL production toward the more desirable,lighter HDL
₂
particles.
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The fat globules in your blood known as triglycerides are sometimes called triacylglycerol. High levels of triglycerides are undesirable. Dr. Atkins felt the optimum number should be under 100. Here’s where controlling your carbs really pays off, because high levels of carbs in the diet translate directly into high triglycerides in the blood.
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Just about everyone who follows the controlled- carbohydrate approach finds that his or her high triglyceride levels drop considerably.We have seen triglycerides that were literally off the chart drop to less than 100 within a few months of the patient’s starting to control carbohydrates. The combination of lowering triglycerides and raising HDL markedly improves your cardiac risk.
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STATIN DRUGS AND LDL CHOLESTEROL

Because people with diabetes often have normal or only slightly elevated LDL cholesterol levels, there’s been some question as to whether these patients should still try to lower their levels to the low-normal range. Some researchers say yes and believe all patients with diabetes should take statin drugs, even if their LDL is normal.

But we say: Not so fast. Some studies of statin drugs show that modest lowering of LDL, even if it’s not on the high side, may help some people with diabetes lower their risk of heart disease. What they don’t prove is that you need statin drugs to do this, although of course the patients in the studies were treated with statins. The drugs weren’t compared with a controlled-carbohydrate program. Dietary changes that control carbohydrates are a very effective way to improve your lipid profile.So why take an expensive drug that can cause muscle pain and weakness, liver problems, and a possible increased risk of heart failure, when you can accomplish the same thing with the ABSCP? Most patients who follow the Atkins program correctly manage to bring their blood lipids to normal or near-normal levels within three to six months without the use of drugs.

Some of you who have a strong hereditary tendency toward extremely high cholesterol and triglycerides may not want to disagree with your physician on the issue of cholesterol-lowering drugs. Even if that is the case, taking the drugs shouldn’t prevent you from following the ABSCP. Many will be pleasantly surprised by the results you will experience in your lipid values and other blood work—results that you didn’t get from taking the drugs alone. Once your doctor sees these results, he or she may be willing to discuss making an adjustment in your medication.