Atkins Diabetes Revolution (37 page)

THE ANTIOXIDANT CONNECTION

Even with a better diet, your intake of some important vitamins and minerals may still be on the low side for your needs. Why? Because high blood sugar, high insulin levels, and insulin resistance all cause your body to produce large amounts of free radicals.Your body is normally well supplied with antioxidants—enzymes and other substances that neutralize free radicals. But when your free-radical production is sky-high and your body can’t make enough antioxidants to keep up, it is in a state of what’s called oxidative stress. When free radicals aren’t neutralized quickly, they end up doing significant damage to cells in your body, increasing your need for antioxidants. At the same time, in a process called glycation, the extra sugar in your blood can damage cells.

Damage from free radicals and glycation can contribute to the cycle of worsening diabetes.The current thinking about how this cycle works is this: Insulin resistance causes high levels of glucose in your blood, which causes glycation.Your pancreas pours out insulin to deal with the high blood sugar, resulting in hyperinsulinemia, which in turn causes excessive free-radical production. The oxidative stress of the free radicals can worsen insulin resistance by reducing the number of insulin receptors in your cell walls and impairing their ability to respond to insulin. The free radicals and glycation reduce the amount of insulin your pancreas can put out by damaging the beta cells. What happens then? More insulin resistance, more demand for insulin from damaged pancreatic beta cells, more glucose in your bloodstream— which in turn leads to more glycation and free radicals…we’re sure you get the picture.

Oxidative stress can also do a lot of damage to your blood vessels and nerve endings, which results in most of the complications of diabetes, such as kidney disease, eye disease, neuropathy, and even the need for amputation. Oxidative stress is also thought to play a big role in creating the atherosclerotic plaques that can clog arteries and cause a heart attack or stroke.
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(See Chapter 21 for more on this.)

The best way to avoid all those extra free radicals is to cut the carbs in your diet, lose weight, and be more active. Until you do, and even after you have done so, supplements can give you the extra antioxidants you need to neutralize those free radicals quickly, before they can do their damage.

Another reason supplements are important for people with blood sugar problems: Drugs taken for elevated blood sugar and other chronic conditions can interfere with the absorption of vitamins and minerals from food. Supplements can help make up the shortfall.

Important note:
Supplements that help stabilize your blood sugar could have an effect on the blood sugar medications you’re taking, as well as those you may be taking for other conditions, such as high blood pressure.We suggest that you work with a nutritionally oriented physician who understands and supports the application of the ABSCP and can help you decide which supplements (and dosages) are best for you. (See page 134 for help in finding this type of physician.) Before taking these or any other supplements, discuss a strategy with your doctor about how you will reduce or change your medications as your blood sugar and other values improve. Dosage ranges may differ from those used in other books by Dr.Atkins because they are specific to the issues discussed in this book. For other medical conditions or for patients with multiple conditions,he might as well have prescribed higher doses.

ANTIOXIDANT SUPPLEMENTS

Vitamins

Two vitamins are particularly important for fighting off free radicals: vitamin C and vitamin E. Overall, people with diabetes tend to have low levels of vitamin C, even when they get adequate amounts of it in their diet.
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It’s possible that hyperglycemia is the cause. Unfortunately, people with blood sugar problems need more vitamin C, not less, because vitamin C helps improve insulin action.
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It appears that a good insurance policy for everyone, especially diabetics, is adding vitamin C to the supplement program.Vitamin C also helps improve the ability of blood vessels to open up and let blood flow through them easily.
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Multiple studies have shown that vitamin C can help bring down high blood pressure and prevent heart disease. And in general, a diet rich in vitamin C lowers risk of death from all causes, including heart attack and stroke.
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Vitamin C.
The DRI for vitamin C is 90 mg for men and 75 mg for women.
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Getting that much and more from your diet is very easy.Vitamin C is found in all fresh vegetables and fruits (there’s even some in meat, poultry, fish, and dairy products—and a small amount in legumes and grains). You’ll be eating a lot of those foods on the ABSCP, so you’ll easily meet and surpass the daily minimum. For example, there’s 58 mg of vitamin C in ½ cup of cooked broccoli and 48 mg in ½ cup of cooked Brussels sprouts. If your daily carbohydrate total allows moderate amounts of low-glycemic fruits, you can get additional vitamin C that way.For example,there are 45 mg of vitamin C in 1?2 cup of strawberries.

Dr. Atkins felt that everyone should supplement with at least 1,000 mg of vitamin C every day, but if you have insulin/blood sugar imbalances, the minimum should be 2,000 mg (2 grams). Vitamin C is water-soluble, which means you don’t really store it in your body— any excess simply washes out of your system. To keep your vitamin C levels up throughout the day, take half your dose in the morning and the other half in the evening. Large doses of vitamin C can cause diarrhea in some people. It is not likely to occur at this dose, but if this happens to you, cut back.

Vitamin E.
Vitamin E supplements offer protection against oxidative stress in diabetics and probably improve metabolic control.
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Another valuable benefit of vitamin E is its ability to lower inflammation levels, which are generally much higher than normal in people with diabetes.
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Lowering inflammation is thought to help prevent heart disease by reducing free-radical levels and preventing the growth of plaque inside artery walls.

The DRI for vitamin E is 15 mg, or 22 IU (you may see it listed either way),which can be easily obtained from food,especially if you eat a lot of vegetables, nuts, and seeds.
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But the value of vitamin E in preventing diabetes and other problems kicks in only at higher levels. We suggest taking 400 IU to 800 IU daily. (Please note: It has been observed in clinical practice that a few individuals experience elevated blood pressure while taking vitamin E; if your blood pressure goes up while taking a high dose, cut back.) If you have a tendency to get leg cramps, take your vitamin E at night. Many of Dr.Atkins’patients told him that taking it before bedtime helps relieve leg cramps.

Choose a brand of vitamin E that contains natural mixed tocopherols with selenium—this trace mineral works synergistically with vitamin E, enhancing its effectiveness as an antioxidant. If you cannot find vitamin E with selenium, be sure it is included in one of your other supplements.

Please note:
If you’re already taking a daily aspirin or other drugs to thin your blood, or if you have high blood pressure, discuss vitamin E supplements with your doctor first.

The B Family

All eight members of the B vitamin family are crucial for helping your body metabolize food and turn it into energy. That’s especially important for people with the metabolic syndrome, prediabetes, or diabetes because you may use up these vitamins faster than do people with normal blood sugar. For that reason alone, Dr. Atkins recommended taking a daily supplement that contains, at a minimum, 100 percent of the DRIs for all of the Bs. If needed, in individual cases, he would use far more.We’ll explain in the next chapter why some of the B vitamins are important for preventing heart disease.

Lipoic Acid for Neuropathy

Lipoic acid (also sometimes called alpha lipoic acid or thioctic acid) isn’t technically a vitamin because you produce some of this powerful natural antioxidant in your body. It’s a close relative of the B vitamins, though, so we’ll discuss its value for treating diabetic neuropathy, a painful complication of diabetes. Neuropathy causes severe pain, tingling, and numbness, often in the legs; it’s the result of damage to the nerve endings from years of high blood sugar levels and free radicals run amok.

Doctors in Europe have been prescribing lipoic acid for diabetic neuropathy for years—as did Dr. Atkins. Despite the fact that many studies over the years have shown its effectiveness, it’s only recently that more American physicians have begun to use lipoic acid in treating neuropathy. The most recent study, reported in 2003, was a double-blind, randomized, placebo-controlled study that compared the effects of daily doses of 600 mg of intravenous lipoic acid on patients with similar degrees of diabetic neuropathy.Sixty of the patients got the lipoic acid; 60 got a placebo.After 14 treatments,the lipoic acid group showed remarkable improvement in pain and function, with no side effects. The placebo group didn’t improve.
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Most studies of lipoic acid have used an intravenous dose or a combination of intravenous and oral doses. Dr. Atkins found that patients with milder neuropathies show improvement with oral treatment alone; more severe cases may need intravenous treatment under a doctor’s care.For oral treatment,he recommended 600 mg a day in divided doses. If your condition is persistent, you may need to use lipoic acid for a minimum of three months before expecting to see symptoms diminish.

Biotin and Inositol

A member of the B family, biotin is an interesting vitamin because you don’t get it from food, although some foods, such as egg yolks and nuts, contain biotin. Instead, bacteria in your small intestine manufacture it for you. The DRI for biotin is 30 mcg. Biotin, like the other B vitamins, is important for keeping your nerves functioning properly and for converting the fats and proteins you eat into energy. Large doses of biotin may be helpful in lowering your blood sugar by improving insulin sensitivity.
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Moreover,like lipoic acid,biotin can also help relieve the symptoms of diabetic neuropathy.
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For milder cases of unstable blood sugar and diabetes, a good dosage range is 2,000 mcg to 4,000 mcg per day in divided doses. For people with severe diabetes, especially those requiring insulin, Dr. Atkins recommended a dose of 7,500 mcg (once a day) to 15,000 mcg (in divided doses).

Inositol is a sort of cousin to the B vitamins. As with biotin, bacteria in your small intestine manufacture it, so it’s almost impossible to be deficient under normal conditions. Inositol is a critical part of a molecule used to communicate insulin’s action inside the cell.
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High levels of insulin exhaust the cellular stores of this nutrient faster than your body can supply it. Inositol also plays a role in the management of stress and blood pressure.
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This nutrient, in a form called myoinositol, is found in foods such as nuts and beans. Inositol is a com mon ingredient in blood sugar support formulations and, for this purpose, the dosage ranges from 500 mg to 1,000 mg daily.

BLOOD SUGAR SUPPLEMENTS

Chromium

This trace mineral is essential for helping insulin work properly in your body.If you have a low level of chromium,as many people do,it might be making your blood sugar problems worse. By the same token, raising your chromium level may help improve your insulin resistance.

Exactly how much chromium you need each day isn’t really known, but an adequate intake range for adults is anywhere from 50 mcg to 200 mcg.Even though you need such a tiny amount,numerous surveys show that dietary intake of chromium is inadequate.
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Chromium works in concert with insulin as part of your natural mechanism for controlling blood sugar. Researchers still aren’t sure exactly how, but it’s probably because your body needs chromium to produce glucose tolerance factor (GTF), a compound that helps regulate insulin levels. GTF helps keep your blood sugar steady and may also help increase insulin sensitivity, lower blood sugar, and control your appetite.
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A number of studies support the use of supplemental chromium for people with prediabetes and diabetes. One published in 1997, for example, looked at the effects of chromium supplements on 180 people with Type 2 diabetes. For four months, 60 people were given 100 mcg of chromium picolinate twice a day; 60 received 500 mcg of chromium picolinate twice a day; and 60 got a placebo twice a day.The subjects continued with their usual diet and medications during this time. At the end of two months, the group taking 500 mcg twice a day had significant improvements in blood sugar levels.At the end of four months,both the 500 mcg and 100 mcg groups showed significant improvements, but there was no improvement in the placebo group.As a bonus, the people in the chromium groups also showed improved blood cholesterol levels.
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Other studies suggest that your need for extra chromium is related to how severe your glucose intolerance is. For those with only mild glucose intolerance,an extra 200 mcg seems to be enough; people with more severe cases need larger doses, and certainly more is needed by those who are already diabetics.
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Tiny amounts of chromium are found naturally in a variety of foods,including beef,cheese,dark green leafy vegetables,mushrooms, clams, lobsters, scallops, and barley. There’s only about 20 mcg of chromium in a cup of broccoli, however, so it would be hard to get 200 mcg of chromium a day just from your food—you need a supplement in order to get a therapeutic dose.Your body absorbs chromium best from chromium picolinate or chromium polynicotinate. (Some recent test tube studies seem to suggest that very large doses of chromium picolinate could cause DNA damage.
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The doses used were extremely large, however—far larger than the doses used in the studies mentioned earlier, and far larger than any dose you would ever take.And of course, what happens to hamster ovary cells in a test tube is a very long way from what would happen in your body.) Overall, there’s plenty of good evidence for the safety of chromium supplements in doses of up to 1,000 mcg (1 mg) a day.Dr.Atkins usually suggested a maximum of 1,000 mcg a day for patients with Type 2 diabetes and between 400 mcg and 800 mcg a day for patients with the metabolic syndrome or prediabetes, always divided into three doses.