Atkins Diabetes Revolution (22 page)

GETTING WITH THE PROGRAM

The basic phases of the ABSCP parallel those of the Atkins Nutritional Approach (ANA), as you learned in Chapter 10. However, because your primary goal is normalizing insulin/blood sugar, the time you spend in each phase of the program, and when you decide to move on to the next phase, will be based on your lab values, not just on your weight loss.

It All Begins with Induction

Start by lowering your daily Net Carb intake to the Induction level of 20 grams a day, primarily in the form of vegetables. This will start to get your metabolism under control rapidly. Judge your progress at first by your blood sugar numbers. Once they normalize, continue at the 20-gram level until slow, steady weight loss begins. Many patients with diabetes stay at this level for weeks or even months—and a few even must stay at that level indefinitely. (Net Carbs are explained on page 128.)

Moving On to the Ongoing Weight-Loss Phase

One difference between the ANA and the ABSCP is that moving on to this phase should not occur until your metabolism is fairly well under control. Once it is, you can slowly start to add more carbs to your diet. If either your blood sugar or blood pressure rises or weight loss stops, you’ve gone too far, too fast. Your body wasn’t yet ready to expand your carbohydrate budget.

Find Your ACE

When you are following the ANA, the Atkins Carbohydrate Equilibrium (ACE) is the number of grams of Net Carbs you can eat in one day and maintain your goal weight. However, if you’ve already developed the metabolic syndrome, prediabetes, or diabetes, your ACE number will also be the amount of carbohydrates that keeps your blood sugar at an acceptable level, improves your blood lipids, and keeps your blood pressure down. If you’re overweight but have not yet demonstrated blood sugar problems, your Critical Carbohydrate Level for Losing (CCLL) will probably be higher (see Chapter 10) than it would be for someone who shows blood sugar dysfunction. This will also likely be the case with your ACE when you have achieved your goal weight.

How will you know what the right number is for you? Start by following the Induction phase described above. When your lab values have shown improvement, start adding carbs back into your daily diet in 5-gram increments. On the ANA, you can typically increase carbs week by week. On the ABSCP, however, you should proceed more slowly, adding in carbs as you observe the status of your weight, blood sugar (if possible), and blood pressure closely. You’ll know you’ve passed your ACE if:

• You start to regain weight.
  
• Your fasting blood sugar goes up.
  
• Your blood pressure goes up.
  
• Your cravings or hunger increase.
  

If any of these signs of diminished metabolic control occur, cut back on your carb consumption until they improve. When they do, you’ve discovered your ACE. For some of you, that number will be only 20 grams a day; others may be able to go up as high as 40 or even 60 grams a day. As you continue to follow the program, lose weight, and taper off some of the prescription medications that may be slowing or preventing weight loss, you might be able to moderately raise your carb intake. But don’t forget that if you’re reading this book, you are very likely highly sensitive to the effects of carbohydrates in your diet. Because of that, your long-term ACE, even after you lose weight and normalize your blood sugar, may well remain at no more than 60 grams a day and possibly less.

Use the Atkins Glycemic Ranking (AGR)

If you have the metabolic syndrome, prediabetes, or Type 2 diabetes, you need to keep your carbohydrate intake at a level that keeps your blood sugar and blood lipids in a normal range. But quality counts as much as quantity when it comes to carbs.You need to choose your carbohydrates carefully and select those that will have the least impact on your blood sugar. You’ll learn exactly what that means in Chapter 16, but in simple terms,use your carb grams on low-carb veggies and controlled portions of nuts. Most of you will also be able to enjoy some low-glycemic fruit; some of you will also be able to eat legumes, other vegetables, and occasional servings of whole grains.

To get an understanding of how the AGR is organized, we are including the fruit portion below. (Other portions begin on page 468.) When you are still in the earlier phases, you discover whether you can eat a fruit from column 1, such as strawberries, before attempting to introduce those in column 2. Likewise, fruits in column 2 are introduced before those in column 3. Even when you are maintaining your goal weight, you will still primarily choose from foods in column 1. Understand that the AGR is a general guideline, but you may find that you can eat certain foods in a column but not necessarily others. Also, some people are never able to move beyond foods in the first two columns or even in the first column.

Control Carbohydrate Portions

When you follow the ABSCP, you should feel hungry only as mealtime approaches because you’re limiting your intake of carbohydrates. By restricting carbs and adding good fats, protein, and fiber to your diet, you feel satisfied without eating large portions.(You’ll learn a lot more about these dietary components in later chapters.) When you eat this way, your food is absorbed slowly throughout the day, providing a steady stream of nutrition to your cells without blood sugar peaks and valleys. We promise you that once you understand the roles of all the dietary components for maintaining good health, you’ll be able to follow the ABSCP without needing to feel hungry or deprived.

Although most of you don’t have to count calories when you do Atkins, it is important to keep track of your carbohydrate grams. That means keeping track of your portions, because the carbs can add up fast and you may need always to limit your intake to 60 grams a day or less. (Remember, the more you exercise, the more liberal your program can be.) To help you understand how your carbohydrate portions fit into satisfying meals, we’ve included a month’s worth of meal plans in Chapter 26.

Eat Regular Meals

Skipping meals or eating on an irregular schedule can cause your blood sugar to drop. These drops in blood sugar and the body’s hormonal response create excess hunger and carbohydrate cravings, along with energy and mood swings that can disrupt your day and even cause weight gain.

To start, eat at least three meals and one snack, spaced evenly throughout the day. Each meal or snack should contain protein and fat.Always eat your carbohydrates as part of a meal or a snack that also includes protein or fat; eating carbs alone can result in a blood sugar spike. Because you will experience diminished hunger and enhanced satiety, be sure to eat as much at each meal as you need to feel comfortable but not stuffed.However,if you prefer,you can have five or six small low-carb,high-nutrient “feedings”throughout the day.With experience and a little experimentation, you’ll find the eating schedule that works best for you.And once your blood sugar is more stable, you will likely feel less need for snacking.

No matter which meal schedule you choose, it’s important to balance your nutrients over the course of the day. If you save up all your carbohydrates for just one meal, for instance, you’ll get a big blood sugar spike. Instead, spread out your carbs—and everything else— over the day.You’ll keep your blood sugar steadier and get better overall nutrition. As long as you eat regularly, stick to your daily Net Carb limit, combine protein and fat in every snack or meal, and spread out your carbohydrates as evenly as you can over the day; it’s okay to do whatever works best for you.

Eat the Right Foods

Many common foods have been shown to be particularly helpful for people with impaired glucose tolerance and diabetes. Not coincidentally, those foods are also low in carbohydrates and low on the Atkins Glycemic Ranking. Here are the top foods for you:

• Vegetables high in antioxidants and rich in vitamins, minerals, and fiber—such as broccoli, cauliflower, and other members of the cabbage family; and kale, collards, and other dark leafy greens, including salad greens.
  
• Fish, particularly oily cold-water fish such as tuna, salmon, mackerel, and sardines.
  
• Foods high in calcium but low in carbs,such as cheese,tofu (bean curd), and dark leafy greens.
  
• High-fiber whole grains, such as barley, bulgur, and brown and wild rice.But remember,since one size doesn’t fit all,some of you may not be able to include these higher-carb foods on a regular basis or even at all.
  

We’ll explain in detail what makes these foods and others so valuable in later chapters.

SNACK STRATEGY

When you follow the ABSCP, between-meal snacks become an important part of your strategy for maintaining stable blood sugar. Instead of eating junk food such as doughnuts, however, you now snack the lowcarb way. That means you eat a snack that contains protein and fat (a baked chicken leg or a piece of cheese,for example) and,for some of you, a small amount of carbohydrate (a handful of blueberries, say) along with some protein and/or fat. By substituting high-quality protein and fat for low-quality carbs, you satisfy between-meal hunger without sending your blood sugar off into a wild swing.By eating carbohydrates with protein and/or fat instead of alone, you slow the entry of glucose into your bloodstream. That helps keep your blood sugar, your energy, your appetite,and your mood on an even keel.

Eat Healthy Fats

The low-fat message has been so persistent for so many decades that you may have trouble believing that eating
more
fat could actually help you control your blood sugar. Chapter 12 explains why dietary fat is not only good for you, it’s essential. For now, let’s just say that it’s crucial to get a balance of healthy fats from eggs, cheese, meats, poultry, olive oil, flaxseed oil, peanut oil, nuts, avocados, and fatty cold-water fish like salmon, tuna, and sardines. The ABSCP automatically guides you toward foods that have a favorable fat balance.

Count Calories If Necessary

The basic principles of the ABSCP help the vast majority of people overcome the metabolic syndrome, prediabetes, and diabetes simply by controlling carbohydrate intake. For a small number of people, however, controlling carbs isn’t quite enough. Their bodies are so resistant to insulin that they also have to cut back on total dietary intake to reverse their insulin resistance. The culprit could also be a prescription drug; many medications make it more difficult to lose weight, probably by increasing insulin resistance.

Caloric restriction needn’t mean starvation or even going hungry, however. It does mean keeping carbohydrates to a minimum, reducing portions somewhat,and being aware of the calorie content of your foods. As a general rule of thumb, a woman who needs to restrict calories should cut back to between 1,200 and 1,800 calories a day, a man to between 1,500 and 2,000 calories.

An important note about restricting calories: There are 9 calories in a gram of fat and only 4 calories in a gram of carbohydrate or protein. This might lead you into the trap of thinking you should eat more low-fat foods and fewer high-fat foods. Don’t do it. Your body needs those grams of fat and protein to keep your blood sugar stable and provide you with essential nutrients. It also needs them because they are what make you feel satisfied. If you cut the fat, you’ll be cutting calories but virtually guaranteeing hunger and poor nutrition. What happens then? You experience cravings for carbohydrates—and if you give in to those cravings,your blood sugar and insulin levels will skyrocket.

If you must cut calories, do it the Atkins way. Continue to eat moderate amounts of good dietary fat and protein, but decrease your portion sizes, keep your carbohydrates down, and make sure that your primary source of carbs is fresh vegetables.Eat protein,fat,and fiber at every meal. Restricting portion size will speed weight loss and help improve insulin resistance. Once you have things under control, you may well be able to eat larger portions. We recommend the reduced- calorie option only when the natural appetite-control aspect of the ANA/ABSCP, in conjunction with exercise and supplements, does not produce the initial improvement needed in an individual case. Some patients are so far down the diabetes path that, at the start, they need every tool available to pull them back from the brink of metabolic disaster.