Atkins Diabetes Revolution (18 page)

A SECOND LOOK AT STATIN DRUGS

A popular group of drugs used to treat lipid abnormalities,statins (see the sidebar on page 111) are often prescribed for patients with the metabolic syndrome, prediabetes, and diabetes. In fact, if you have high cholesterol, your doctor may feel the only treatment option is to suggest these drugs to you. That’s because doctors today are strongly pressured to follow the recommendations of the National Cholesterol Education Program (NCEP), which advise them to use these medications.
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A large body of research shows that statins lower cholesterol, however, Dr.Atkins rarely needed to use them.Ask your doctor to give you the opportunity to try lowering your cardiovascular risk factors without medication.

Statins were initially thought to exert their cholesterol-lowering effect by blocking production of an enzyme your body uses to make cholesterol. Recent research, however, suggests that much of their effect may not be related to cholesterol lowering at all. Instead, statins seem to work by decreasing inflammation, especially in the endothelial cells that form the lining of your blood vessels.

However they work, these drugs require careful monitoring and have the potential for serious side effects. Because they block the synthesis of a compound called coenzyme Q
₁₀
(CoQ
₁₀
or ubiquinone), used in your cells for energy metabolism, statins can cause liver and muscle damage—including damage to the heart muscle.
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Muscle damage can be so severe that one statin drug (Baychol) was voluntarily withdrawn from the market after some deaths occurred. Liver injury can occur as well. The manufacturers of statin drugs recommend blood tests every three to six months to monitor for evidence of liver damage.
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If there were no other way to improve your lipids, we would agree that the significant health risks of statins were worth it. But here’s why we don’t agree. With regards to lowering risk factors, the same effect that is achieved by the drugs can be achieved by following the Atkins controlled-carb approach. That’s because decreasing insulin concentrations in the body can theoretically lower your production of an enzyme called HMG Co-A reductase—the same enzyme targeted by statin drugs—simply and naturally.And what’s the most effective tool for bringing insulin down to normal levels? Controlling your carbohydrate intake.
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What about the statins’ability to reduce inflammation in the blood vessel lining? The controlled-carb approach can help there, too. High levels of insulin increase inflammation—and controlling insulin levels by controlling dietary carbohydrates can help control inflammation all over the body.
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,
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Also, controlling carbs helps rid the body of excess fat, the secretions of which contribute to the inflammation of the cells that line blood vessel walls.
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Add in the beneficial effect of essential oils from both diet and supplements, which further decrease inflammation, and you’ve got an effective, natural way to impact in- flammation without statins or any other drugs.

TARGETING BLOOD LIPIDS

In 2001,the third Adult Treatment Panel (ATP III) of the NCEP issued new guidelines for the evaluation and treatment of high blood cholesterol.
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The panel significantly lowered the thresholds for high cholesterol. This had the effect of substantially increasing the number of Americans who would be candidates for drug treatment—from an estimated 15 million adults under the old 1993 guidelines to an estimated 36 million under the new guidelines.
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At the same time, the panel issued new low-fat, high-carb dietary recommendations. The panel’s findings were a dream come true for drug manufacturers. The dietary recommendations are practically guaranteed not to work, unless the patient loses weight, meaning more patients will “need” statin drugs.
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Combined with the more aggressive approach to lowering cholesterol, the new guidelines guarantee the drug companies huge profits for years to come.

COMMON STATIN DRUGS

Generic ingredient: atorvastatin

Brand name: Lipitor

Generic ingredient: fluvastatin

Brand name: Lescol

Generic ingredient: lovastatin

Brand name: Mevacor

Generic ingredients: lovastatin and niacin

Brand name:Advicor

Generic ingredient: pravastatin

Brand name: Pravachol

Generic ingredient: Simvastatin

Brand name: Zocor

These guidelines were developed from statistical data on patients who ate the typical high-carb American diet. The guidelines do not take into account the total lipid picture, which includes other cardiovascular risk factors such as homocysteine, lipoprotein(a), fibrinogen, and C-reactive protein. As you already know, in the presence of high glucose and insulin, your cells immediately stop burning fat and prepare to store fat instead. To manage these risk factors effectively, the problem must be corrected where it starts. By controlling carbohydrates, you can prevent the hormonal fat storage effect of excessive insulin, which results in increased cardiovascular risk factors. These include high triglycerides, low HDL, and small, dense, dangerous lipoprotein particles. Standard guidelines focus simply on the total and LDL cholesterol values.
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RESEARCH REPORT: CHOLESTEROL AND CONTROLLING CARBS

Two highly significant recent studies have shown that controlling carbohydrates can have a powerful impact on blood lipids. In the first study,12 healthy,normal-weight men followed a very low carbohydrate diet for six weeks.At the end of that time, their HDL cholesterol was up and their triglycerides were down. Perhaps more important, among the men who had mostly small,dense LDL particles at the start of the study, LDL size went up, moving these men toward a better cholesterol pro- file.
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A similar study of 10 healthy, normal-weight women also showed excellent results. Their triglycerides went down and HDL went up. The beneficial effects of a low-carb approach in women were even stronger than they were in men.Three of the women with small particles at baseline had particles change to the large,fluffier type.
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Whether or not the ATP III guidelines make sense, they’re the ones that set the lipid standards for physicians all over the country. Check the following chart to see what these guidelines are.

ATP III GUIDELINES

Source: National Cholesterol Education Program.

WHEN TLC IS BAD FOR YOU

The latest dietary recommendations from the NCEP are known as TLC, or Therapeutic Lifestyle Changes. The current version of this low-fat, low-cholesterol diet isn’t very different from the diet that NCEP has been promoting for years. This diet calls for keeping total fat to 25 to 35 percent of daily calories and limiting dietary cholesterol to less than 200 mg a day, and it recommends getting 50 to 60 percent of total calories from carbohydrates. This approach may lower your LDL cholesterol somewhat—but at the expense of also lowering your HDL cholesterol. Not only that, the TLC diet may also shift your HDL production to smaller, denser particles that aren’t as good at clearing LDL cholesterol from your blood.And of course, eating all those carbs will probably raise your triglycerides.

THE BETTER WAY TO BETTER BLOOD LIPIDS

The Atkins approach improves all aspects of your blood lipids naturally—not by blasting your body with drugs and judging the results by the numbers on only one blood test. Controlling your carbs is the first step. Your triglycerides will drop as your insulin-glucose metabolism improves. Even before you lose the first ten pounds, you may see an immediate improvement in triglyceride levels. HDL will begin to rise—although in our experience it takes between three and six months to get HDL to its best level—after glucose metabolism is normalized. At the same time, levels of tiny LDL particles will decrease, and LDL will shift toward those larger, fluffier particles that aren’t as dangerous to your arteries.As you follow the program, your lipid pro- file will almost certainly continue to improve.

One of Dr. Atkins’ patients, 68-year-old Claudia W., had the lowest HDL he had ever seen—at only 20 mg/dL. She started following the ABSCP and three months later her HDL had risen to 70 mg/dL. In fact, she was now unusual in a much healthier way, because her HDL number was higher than that of her triglycerides.

Although the dietary changes of the ABSCP are a very effective way to elevate your HDL,exercise and supplements provide additional improvement. Is that because of the exercise itself or because exercise helps you lose weight? It’s hard to tell, because in just about every study that has looked at the effect of exercise on HDL, the subjects lost weight. It’s hard to separate the two effects, but it doesn’t really matter. After all, losing weight also raises your HDL level, along with all its other benefits. And exercise is undeniably good for every aspect of your health.

THE DANGEROUS CHEMISTRY OF ABDOMINAL FAT

In case you thought it was all about your cholesterol, we’re about to disabuse you of that misconception. Cholesterol is only part of the heart disease story. Did you know that it is quite possible to have cholesterol numbers that fall within the normal range and still have a heart attack?

Remember, a heart attack is caused when blood flow to the arteries of the heart is blocked, usually by a blood clot. The biochemical imbalance driving the metabolic syndrome causes an increased tendency toward blood clotting. In part, this is because the abdominal fat that is such a telltale sign of the metabolic syndrome secretes chemicals that raise the level of clotting factors in your blood and make your platelets “stickier” and more likely to form a clot. The inflammatory response that occurs in the metabolic syndrome—partly due to those same secreted chemicals—damages the endothelial cells that line your blood vessels.
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This is a recipe for blood clot formation, arterial blockage, and deep venous thrombosis.If you have ever wondered why our society is plagued by stroke,heart attacks,and blood clots in the lung (pulmonary embolus), now you know.

Here’s the good news! Dr.Atkins observed in his practice that when people with abdominal obesity and the metabolic syndrome, prediabetes, or diabetes start following the Atkins approach, they generally lose proportionally more weight in the abdominal area.In many cases, even when total weight loss is fairly modest,the effect is powerful if the weight comes from fat stored in the abdominal area: HDL cholesterol goes up and triglycerides go down more than the weight loss alone would normally accomplish. Other dangerous substances in your blood,such as clotting factors,also can go down,because you have less of the fat that makes them. Add in some exercise, which also seems to target abdominal fat, and the effect on your lipids and inflammatory and clotting factors is even greater. Losing even small amounts of visceral fat may be enough to bring your metabolic syndrome under control and improve your heart health.

OTHER RISK FACTORS

So much attention gets paid to cholesterol as a risk factor for heart disease that other important risk factors tend to be ignored, especially if your cholesterol is in the normal range. Let’s look at three additional independent risk factors Dr. Atkins considered to be more important than total cholesterol level.

Homocysteine

A normal by-product of metabolizing the amino acid
methionine,
high levels of homocysteine in your blood are an independent risk factor for heart disease from clogged arteries. This automatically raises the risk of death from heart disease for the estimated 25 percent of the population that has a genetic tendency toward high homocysteine levels. And if you have the genetic tendency and also have diabetes, your risk is about 2.5 times greater.
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A recent study in Finland found that even moderately elevated homocysteine is an independent risk factor for fatal heart attacks in people with Type 2 diabetes, even when other risk factors such as smoking and high blood sugar were taken into account. The study found that the elevated risk began at homocysteine levels of 15 µmmol/L or higher—or not that much higher than the upper end of normal.
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Whether or not they have the genetic tendency to high homocysteine, people with insulin resistance or diabetes seem more likely to have high homocysteine levels than do people with normal glucose tolerance; also, people with diabetes and high homocysteine are more likely to have complications such as kidney disease.
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Dr.Atkins would treat his patients who had high homocysteine levels with the dietary changes of the ABSCP and also with additional supplements of vita- mins B
₆
,B
₁₂
, and folic acid. Although the normal range for homocysteine is 5.2 mmol/L to 12.9 mmol/L, his goal for his patients was a homocysteine level of 8 mmol/L or less. Most of them were able to achieve this goal.

C-reactive protein (CRP)

An elevated level of this protein, produced in your liver, is a sensitive marker of inflammation. Because inflammation is believed to be one of the underlying processes that causes your arteries to clog, high CRP levels in general turn out to be a good warning sign of heart disease. In the Physicians’ Health Study, for instance, the men who had higher levels of CRP when the study began were much more likely to have a heart attack over the next ten years than the men who had normal CRP levels—even though they seemed equally healthy based on other measurements, such as their cholesterol.
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Results for women in the Nurses’ Health Study were similar.
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