Atkins Diabetes Revolution (2 page)

This book is the natural extension of Bob’s clinical practice. Over decades, although it was not conventional medical practice, he ordered thousands of insulin and blood sugar tests for patients who came to him with a variety of medical problems. Along with his patients’ symptoms, their test results allowed him to see the relationship between blood sugar and lipid values and the deterioration of the blood sugar mechanism that ultimately results in diabetes. He foresaw the epidemics of obesity and Type 2 diabetes before it was fashionable to talk about them. He was especially concerned with what he saw happening to the health of young people.

Bob believed he had the answer—not just for treatment—but also, more important, for prevention. Even if diabetes was already established, Bob believed he could effectively treat it—if the patient was willing to do what it takes to achieve and maintain a reasonable weight. In most cases, the pancreas could recover, protecting what function it still possessed. Controlling carbohydrate intake was always essential to this goal.

His more important mission was to partner with his patients to educate them about their risks, so that they could prevent the onset of diabetes and its potentially serious results. It is this philosophy that is explored in detail in this book. Despite having already authored more than a dozen books, Bob often spoke of writing one about preventing diabetes, which would be the culmination of his life’s work. Although he did not live long enough to complete
Atkins Diabetes Revolution,
those of us who worked with him and understood his commitment and courage have done that. This is that book, and I believe it is an appropriate legacy for this man of vision.

Bob had clearly conceptualized this book and had mapped out the contents. His excitement about the project was infectious, and he and I spent many hours talking about how he envisioned it. While Dr. Mary Vernon and I wrote this book, the dietary advice and nutritional principles come directly from Bob’s teachings and my decades of experience working with him. We may be the authors, but we want you to realize that it is really
his
voice speaking loud and clear. Most case histories are taken directly from Bob’s patient records. (For clarity, the case studies that come from Dr.Vernon’s practice are indicated in italics,followed by her name.) We have used pseudonyms in case histories in which only a first name is used.We owe a debt of gratitude to all the individuals who have shared their personal stories in this book.

Bob Atkins’ teachings can help you be a partner in your health care and health maintenance. You too can learn about your risks for diabetes and what to do about them. You can practice prevention for yourself and your family.Making lifestyle changes is not as easy as taking a drug, yet the results are immeasurably better and will positively impact all aspects of your life.

I know that Bob would feel his mission was accomplished if you, with the help of your health care provider, are able to use the information in this book to make permanent lifestyle changes—changes that become the framework of your personal health solution. In doing so, you will become part of the larger solution to the epidemics of obesity and diabetes that are fast becoming a public health nightmare.

—Jacqueline A. Eberstein, R.N.

Director of Nutrition Information

Atkins Health & Medical Information Services

Introduction

Let me share with you some frightening facts that could have a devastating effect on your life:

• One of every three children born in the year 2000 will develop diabetes.
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• Diabetes is the leading cause of heart disease.
  2
  
• About 75 percent of people who have diabetes will die of heart disease.
  3
  
• In the United States, diabetes has increased nearly 50 percent in the past ten years alone, according to estimates of the Centers for Disease Control and Prevention (CDC), and the incidence of the disease is expected to grow another 165 percent by 2050 under current trends.
  4
  
• Diabetes prescription costs create such a financial burden that one in five older adults with diabetes reports cutting back on prescription medication.
  5
  
• Total medical cost of diabetes in the United States in 2002 was $92 billion; add in indirect costs of $40 billion—disability payments, days of work lost, and premature death—and the total comes to $132 billion.
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• Overall, the risk of death for people with diabetes is about twice that for people without it.
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Behind all these numbers are millions of people and their families. My practice is simply a microcosm of the impending health care crisis. Every day I see in my patients’lives the devastating impact of these statistics—which, as you will learn from this book, is intimately linked to being overweight or obese. Excess weight and its associated metabolic imbalances—resulting in diabetes, coronary artery disease, and hypertension—are costing them their health and, in some cases, even their lives.

I have been interested in controlled-carbohydrate nutrition for years. As a family physician, I saw my patients fail in their attempts to use the standard recommendations I was schooled to give them. I could see that they needed to control their weight and metabolism. I felt helpless, with nothing to offer them that would make a significant impact. The ubiquitous low-fat, low-calorie approach to weight loss was difficult for my overweight patients to use. They complained of hunger and irritability. I needed an effective tool to help them control their appetite so they could achieve long-term success in losing weight and keeping it off.

Back to the books I went to reeducate myself about effective ways to manage weight and metabolism. I was eventually driven to pursue my interest in bariatric medicine, the treatment of obesity and its associated conditions. (I am now board certified in bariatrics.) Like every physician,I studied metabolism in medical school,including the role carbohydrates play in fat storage. But this time around, I saw how the information applied directly to my patients.I now wanted to make it clear to them, too. Much of this book is devoted to conveying in the simplest terms possible the complex biochemical functions of insulin production and blood sugar regulation.

I decided to examine the available tools for carbohydrate control, rather than reinvent the wheel. I reviewed all the popular plans that control carbohydrate intake. The Atkins Nutritional Approach appealed to me because it was simple (no calculator or food scale required) and because it could be individualized. Using controlled- carbohydrate nutrition,which has its own natural appetite-suppressing effect,I was able to help my patients.

I was amazed at their significant improvements in lipid and cardiovascular risk factors, as well as insulin and blood sugar control. I also began to hear my patients say the very things that Dr.Atkins had written about in his books. They told me that their energy levels had increased, their moods were more stable, and they had fewer aches and pains, less acid reflux and indigestion, and an improved sense of well-being. My patients’ results convinced me I was on the right track.

I met Bob for the first time in 2000 at a continuing-medical- education conference on low carbohydrates in New York City. There, I spoke with other clinicians whose patients were experiencing the same success. I also met researchers, including Dr. Eric Westman and Dr. William S.Yancy Jr., both of Duke University. They were among those who had been conducting clinical trials and whose findings demonstrated the safety and efficacy of the Atkins Nutritional Approach both for weight management and improvement in cardiovascular risk factors. As I related my own experiences, Dr. Westman agreed to analyze my patient data, which confirmed my observations. My successful clinical experiences with Type 2 diabetic patients were published in the fall 2003 edition of
Metabolic Syndrome and Related Disorders.

Other researchers at equally prestigious institutions were also taking an unbiased look at the Atkins Nutritional Approach (ANA). By 2002, the first two studies supportive of the ANA were published in peer-reviewed journals or presented at conferences. (As I write this introduction, there are now 27 studies supportive of the ANA,
^*
two of which I am proud to say I authored.) Although many people had experienced success doing Atkins and had long embraced this approach, the publication of an article by science writer Gary Taubes in the
New York Times Magazine
in July 2002 was a major turning point. Entitled “What If It’s All Been a Big Fat Lie?”the article made clear that the lowfat approach had minimal scientific underpinnings and that, in fact, emerging research was supportive of controlling carbs. For this kind of information, written by a respected science writer, to appear in the
New York Times
was a watershed moment.

In September 2002, I met Bob again when he lectured at the American Society of Bariatric Physicians conference. Dr. Westman and I presented our data on the Atkins Nutritional Approach, showing the benefits of the ANA compared with a low-fat, calorie-restricted diet. Overall, there was huge interest in the emerging science validating the Atkins approach as well as personal support for Bob. He clearly felt vindicated by this reception.“You see?” he said.“I’ve known for years how amazing this is!” Over several meals with Bob and Veronica Atkins, he and I shared our clinical experiences. He came to realize that I had a full understanding of his approach and shared his commitment to patient care.

Our conversations continued over the ensuing months. Bob followed my presentations and reviewed my clinical results with excitement. He then paid me the ultimate compliment: When I visited The Atkins Center for Complementary Medicine in November 2002, he asked me to join his practice.Coincidentally,during that visit I had the thrill of being with Bob the day that Dr. Westman’s research comparing the Atkins Nutritional Approach with the American Heart Association (AHA) recommendations was presented at the association’s annual meeting. Finally,AHA members were presented with an excellent, randomized, controlled trial that confirmed results similar to those Bob had long put forward. He relished the scientific confirmation of his clinical experience.

Bob and I continued to discuss the possibility of my joining his practice up until the accident that resulted in his death.Things did not turn out as planned. Now, instead of working as his colleague at the Atkins Center,I am a member of the Atkins Physicians Council (APC), whose members have expertise in fields such as diabetes, pediatrics, women’s health, bariatrics, and orthopedics. As part of Atkins Health and Medical Information Services, this group is committed to educating the medical community, health consumers, and policy makers on the merits of controlled-carbohydrate nutrition, which can play a major role in addressing the epidemics of obesity and diabetes.As part of that effort, the APC has already presented the Atkins Lifestyle Food Guide Pyramid (see page 473) as an alternative dietary guideline. As a member of the APC, I am honored to be a co-author of this book— helping to impart the knowledge Bob acquired in his lifetime of work. I take on this task with deep respect.I could have spent a lifetime learning from Bob.Instead,I honor his legacy by helping to complete his last and most important work. It is anticipated that the other members of the APC will also write future publications under the Atkins banner.

I would not presume to tackle this important task alone. With Jacqueline Eberstein as my partner, this book has come to fruition. Since Jackie lived those years of discovery with Bob, she can translate decades of clinical practice into the words he would have used. Everything about how to implement controlled-carbohydrate nutrition is imprinted in her mind. And as we have worked together on this book, we have often been amazed by the similarities in our day-to-day clinical experiences using this approach.

Another person who is integral to carrying on Bob’s legacy is, of course, his wife,Veronica. During their time together, she was not just his helpmate, but was also intimately involved in many aspects of his work, including collaborating on a cookbook. Together, they were committed to furthering independent research on controlled-carb nutrition and to that end established the ongoing Dr. Robert C.Atkins Foundation, of which Veronica is chairperson. Grant money has already been used to fund research at institutions such as Duke University, Albert Einstein College of Medicine, Ball State University, the University of Connecticut, Pennsylvania Hospital, the University of Kansas, and Beth Israel–Deaconess Medical Center.

As a bariatrician, I recognize the need to personalize each patient’s program. Individuals with chronic diseases such as diabetes, hyper- tension, and cardiovascular disease should work with their physician to find a treatment plan that specifically benefits them. The contents of this book provide information about a program that many have found effective. Although this book is written in language most non- professionals can understand, it is by no means intended as a replacement for the physician-patient relationship.

I take great joy in offering my patients lifestyle choices that empower them to improve their health.Jackie and I believe that this book will provide
you
and
your
health care practitioner with information that will empower you in the same way. After all, as a pioneer in complementary medicine, Bob’s most enduring legacy is the gift of knowledge. He truly practiced the “art of medicine,” a skill that is the foundation of inspired patient care.

—Mary C.Vernon, M.D., C.M.D.

Member, Atkins Physicians Council

Part One

Blood Sugar and Your Health

Chapter 1

THE DIABETES CROSSROADS