Atkins Diabetes Revolution (26 page)

In the end, the amount of protein you eat when you follow the ABSCP may not be that much higher than the amount you ate before you started the program. When the dietary intake of individuals following the ANA has been studied, generally 30 to 35 percent of their calorie intake is protein. Plus, there’s a very positive catch-22 here. Because you allow yourself to eat liberally of the protein foods, and protein is both very satiating and helps control the insulin/blood sugar swings that drive excess hunger, you may end up feeling too full to eat all that much of it! In fact,studies have shown that individuals who reduce their carbohydrate intake actually wind up consuming fewer calories—because they are more quickly satisfied.

PROTEIN SOURCES

The quality of the protein you eat is as important as the quantity. The ideal protein is complete—meaning it contains reasonable amounts of all nine essential amino acids. Meat, poultry, fish, eggs, dairy products, and other animal foods are complete proteins, but grains and legumes are not. Some plant foods contain all nine essential amino acids, but in most of them the quantity of at least one amino acid is very low.For this reason,most plant foods by themselves can’t provide adequate amounts of all of the essential amino acids to meet our protein requirements.Grains,for instance,are generally low in lysine,and beans are low in the sulfur-containing amino acids methionine and cysteine. But people who don’t eat any animal foods can still get enough of the nine essential amino acids by carefully combining different plant foods such as nuts, seeds, legumes, and whole grains. The problem for someone with an imbalanced insulin/blood sugar metabolism is that the foods full of plant proteins typically also contain lots of carbs.

Not all of your protein sources are created equal when it comes to the ABSCP, however. Meats, poultry, fish, and eggs are fair game— they’re pretty much pure protein. Cheese is another good source of low-carb protein. An ounce of Swiss cheese, for instance, contains about 9 grams of protein and only 1 gram of Net Carbs.Watch out for the carbohydrates in milk and yogurt, though.A cup of whole milk or full-fat plain yogurt has 8 grams of protein, but it also contains 11 grams of Net Carbs.If you’d like to get some of your protein from milk or yogurt,try the new reduced-carb “dairy beverage”products and yogurts. The dairy beverage has extra protein and fewer carbs; 8 ounces contain 12 grams of protein and only 3 grams of Net Carbs.

EAT YOUR EGGS

Eggs are such a good source of complete protein that they’re the standard against which all other proteins are compared. Because one large egg contains about 213 mg of cholesterol, however, some doctors recommend limiting or avoiding eggs, thinking they raise blood cholesterol levels. That’s actually true—but the cholesterol that goes up is your good HDL cholesterol.

In a 1994 study, 24 adults who added two eggs to their daily diet for six weeks showed a 10 percent increase in their HDL levels, while their total cholesterol went up only 4 percent. The change in the ratio of total cholesterol to the HDL was not statistically significant.
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Two other studies published since 1999 have found that eggs aren’t the issue.In both of these studies,people were fed eggs and their blood was examined. One author of the study stated that the dietary management of obesity and insulin resistance should emphasize calorie restriction rather than the restriction of fat in the diet.
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In the second study done on healthy, postmenopausal women, Dr. G. M. Reaven stated that large amounts of cholesterol in the diet had little effect on the total or LDL cholesterol level. These results were true regardless of insulin resistance or insulin sensitivity.
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Unfortunately, many people have been brainwashed into thinking eggs are dangerous because they contain cholesterol. James R. came to Dr. Atkins for treatment of high blood lipids. Dr. Atkins stopped James’s statin drug, put him on the Atkins controlled-carb program, and assured him he could eat eggs if he wished. James followed the program but just couldn’t bring himself to believe that eggs were safe. He finally had two scrambled eggs for breakfast one morning—and spent the next ten minutes sitting white-knuckled at his kitchen table, convinced he was about to have a heart attack! He didn’t, of course, and when he came in for his next checkup his blood lipids were better than they had been when he was taking the drug and avoiding eggs.

The nutritional advantages of eggs for people with diabetes are substantial. Eggs have a very low glycemic index ranking and are a good source not just of high-quality protein, but also of vitamins B, D, and E and the minerals calcium, zinc, iron, potassium, and magnesium. Egg yolks get their yellow color from the carotenoids lutein and zeaxanthin, which can help protect your eyes from the sight-robbing condition called age-related macular degeneration.

PROTEIN AND YOUR BLOOD SUGAR

We’ve mentioned the satiety and appetite control benefits of protein, but the advantages of swapping protein for low-quality carbs go far beyond that. Consuming protein is the signal to your body to build muscle.
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This is obviously preferable to consuming an overabundance of refined carbs, which signals your body to store fat!

Adequate amounts of protein also help get your blood sugar under control. This was shown in a recent study that looked at the effect of a higher-protein diet on blood sugar in people with Type 2 diabetes. In this study, for five weeks 12 people with Type 2 diabetes ate a diet with 30 percent of calories from protein,40 percent from carbs,and 30 percent from fat. They then switched for another five weeks to the standard diet recommended by the American Diabetes Association (15 percent of calories from protein, 55 percent from carbs, and 30 percent from fat). What happened? You’ve probably already guessed. When the patients were eating the higher-protein diet, their triglycerides were lower, their blood sugar was significantly lower, and their glycated hemoglobin (A1C) number dropped. In fact, on the higher- protein diet,the A1C went down by 0.8 percent,a significant improvement; it dropped by only 0.3 percent on the standard diabetic diet.
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Note that the participants ate much higher levels of carbohydrates than Dr. Atkins would have recommended for a diabetic patient. His patients typically showed a much larger drop in the A1C, a measure of blood sugar control, when they restricted carbs by following the ABSCP. This would strongly suggest that the improvements for the patients in the study, good as they were, could have been much more dramatic had the carbohydrate amounts been lower.

Other studies have shown the benefit of protein in improving blood sugar metabolism. In one study of overweight women, 12 of the women followed a moderate-protein, reduced-carb (40 percent of calories from carbs) diet for ten weeks. Another 12 women followed the typical American diet, with less protein and 55 percent of calories coming from carbohydrates. At the end of the ten weeks, the women on the higher-protein diet had better results on both the oral glucose tolerance test and the test for fasting blood sugar. Compared with the high-carb dieters, the higher-protein dieters had much more stable blood sugar. Their blood sugar stability continued to improve over the length of the study, while the high-carb dieters experienced more blood sugar swings. And the higher-protein dieters lost more weight!
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These women were not yet diabetic. Their improvement came from decreasing carbohydrates and increasing protein. Yet neither of these studies decreased the carbohydrates enough to show the results Dr. Atkins experienced in decades of caring for patients.
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IS TOO MUCH PROTEIN DANGEROUS?

For people with normal kidney function there’s no evidence that the amount of protein consumed when following the guidelines of the ABSCP is harmful. In fact, there’s some very important evidence to show that eating more protein, especially if it replaces carbohydrates in your diet, is good for you. To take one good example, let’s look at a 1999 study that examined the diets of more than 80,000 women taking part in the Nurses’Health Study.The researchers were interested in the association between protein intake and the risk of heart attack. When they compared the women who ate the most protein with the women who ate the least protein, they found that the group with the highest protein intake had the smallest number of heart attacks. The women who ate the most protein—whether their overall diet was high-fat or low-fat—cut their risk of a heart attack by about 25 percent compared with the women who ate the least protein.
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In the large International Study of Salt and Blood Pressure (INTERSALT), which looked at dietary factors affecting blood pressure among 10,000 people worldwide, the researchers found something similar. The people with the highest protein intake had lower blood pressure than those with the lowest protein intake. This study confirmed what earlier studies had also shown.
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These studies don’t mean, of course, that eating more protein will keep you from having a heart attack or getting high blood pressure, but they do suggest that getting ample amounts of protein could help prevent these problems—and that limiting your protein intake doesn’t help.

HIGH PROTEIN AND YOUR KIDNEYS

Of all the myths about controlled-carb diets, the idea that you eat nothing but meat and that this will somehow destroy your kidneys is the most persistent—and has the least basis in fact. If anything, the ABSCP helps your kidneys by helping you to lose weight, lower your blood sugar, and lower your blood pressure. Contrary to the misinformation put forth about his program, Dr. Atkins recommended eating a wide variety of protein foods, including (but certainly not limited to) red meat.

As a matter of fact, a recent study showed a much greater survival rate in patients with severe diabetic kidney disease who decreased their carbohydrate intake. In this study, one group of nearly 100 patients got 25 to 30 percent of their calories from protein and 35 percent of their calories from carbs. They were allowed to eat protein in the form of chicken, fish, eggs, soy, and dairy sources without restriction; beef and pork were not permitted to decrease iron intake. Another group of nearly 100 patients followed the standard restricted-protein diet for kidney patients, getting only 10 percent of their calories from protein and 65 percent from carbohydrates. Over roughly a five-year period, the high-protein, low-carb patients did much better. In these patients with severe kidney disease, iron intake was also restricted. The researchers concluded that this approach was 40 to 50 percent more effective than standard protein restriction in prolonging kidney function, delaying end-stage kidney disease, and reducing the rate of death from all causes.
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I have seen cases among my patients with diabetes and the metabolic syndrome, whose urinary protein level decreased on a low-carbohydrate plan. Two of my patients are highlighted in this book—Joe McCoy and Pia S. in Chapters 9 and 10 respectively. I monitor urine protein excretion on all of my patients with the metabolic syndrome and diabetes. I have yet to see a case in which urinary protein excretion increased on Atkins. As a matter of fact, I have several patients who have kidney damage from a variety of causes whose protein excretion improved when carbs were controlled. I continue to perform the 24-hour urine test for protein every three months until I have two tests that are stable. Less frequent monitoring occurs as circumstances dictate. If I reach a point where no further improvement in kidney function occurs, kidney- protective medication may be needed.
    —M
ARY
V
ERNON

What if you already have Type 2 diabetes? Will eating protein increase your risk of developing kidney disease? It’s very unlikely. There’s little if any evidence to show that normal or even high-protein intake will increase your risk of developing protein in the urine, an indication of kidney disease.
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A recent article points out that severe protein restriction in those with diabetic nephropathy (kidney disease caused by diabetes) does not seem to slow the progression of kidney disease but rather can cause malnutrition.
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Kidney disease is a serious complication of diabetes, but only some people with diabetes go on to have severe kidney disease. Study after study has shown that those who do develop nephropathy eat no more protein than those who don’t.Study after study has also shown that the major cause of kidney disease among people with diabetes isn’t protein in the diet. It’s the combination of high blood pressure, high blood sugar, and high insulin that is deadly—this trio can do a lot of damage to the tiny blood vessels in your kidneys that filter waste products from your blood.Kidney disease in Type 2 diabetics is the perfect example of the vascular consequences of the metabolic syndrome. If you want to prevent damage to the kidneys,controlling your carbs is your strongest defense in the battle to maintain healthy blood vessels throughout your body, as well as in your kidneys. People diagnosed with kidney disease must follow the ABSCP only under medical supervision.

PROTEIN AND YOUR BONES

The next most common myth about the controlled-carbohydrate program is that eating large amounts of protein weakens your bones by leaching calcium from them.Just the opposite is true:A diet high in protein strengthens your bones and can slow down the process that leads to osteoporosis, a condition leading to thin, brittle bones that break easily.

Let’s look at how this myth got started. Several studies in the 1970s and 1980s showed that a high-protein diet might change the amount of calcium excreted from the body, but the results were inconclusive. One study of young men in 1981, for instance, showed that a high- protein diet increased urinary excretion of calcium.
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Another study, however, showed that a high-protein meat intake did not cause excess calcium excretion.
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