Atkins Diabetes Revolution (4 page)

High-Density Lipoprotein, or HDL Cholesterol.
This is often called the “good” cholesterol, because it carries cholesterol back to your liver, where it can be processed into bile and excreted.

Triglycerides.
These are tiny droplets of fat found in your bloodstream. Triglycerides are stored as body fat.

The Human Cost

Over the long run, the metabolic imbalance that raises your blood sugar causes a host of other very serious health problems, including high blood pressure, abnormal blood lipids, and a sharply increased risk of heart disease. Other complications include kidney disease, blindness, gangrene of the extremities (leading to amputation), and an increased risk of cancer.
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In fact,the dangerous duo of high insulin and high blood sugar has the potential to damage every cell in your body,which is why diabetes and its complications are the sixth leading cause of death in the United States.
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The Financial Cost

Diabetes is also expensive. In 2002, the direct costs of treating the disease in the United States alone were $92 billion. The indirect costs of disability, lost work, and premature death were an additional $40 billion, bringing the total cost for diabetes in just that one year to $132 billion.
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In addition to the monetary cost is the devastating price paid in quality of life by people with diabetes and their families.

RISK FACTORS FOR TYPE 2 DIABETES

The gradual accumulation of several risk factors leads down a long road that results in diabetes. Those risk factors are:

Obesity.
Of all the different risk factors for diabetes, being overweight or obese tops the list. The risk is much greater if the excess weight settles around your abdomen, but in general, the heavier you are, the greater your risk.

Diet.
A diet high in poor-quality, high-glycemic carbohydrates, especially sugary and starchy foods, contributes strongly to both obesity and diabetes.

Sedentary Lifestyle.
Lack of exercise and poor physical condition are major risk factors for diabetes. A sedentary lifestyle increases insulin resistance and contributes to obesity and loss of muscle mass.
Heredity.
Having a close relative, especially a parent or sibling, with Type 2 diabetes increases your risk. But don’t think you’re safe if you have no family history. We have seen numerous patients, even very young ones, well on their way to diabetes because of unhealthy diet and lifestyle alone.

Ethnicity.
Some ethnic groups, including African Americans, Asian Americans, Hispanic Americans, Native Americans, and Pacific Islanders, have a high incidence of Type 2 diabetes.

History of Gestational Diabetes.
Women who have had gestational diabetes or who have given birth to a baby weighing more than nine pounds are more likely to develop Type 2 diabetes later in life.
Metabolic Syndrome.
Also known as syndrome X, this group of signs includes abdominal obesity, hypertension, and abnormal lipids, signaling a major risk for heart disease, prediabetes, and diabetes.
Elevated Blood Sugar.
If your blood sugar is already on the high side, but not yet high enough to constitute a diagnosis of diabetes, you’re at a much greater risk of developing the disease as time goes on. In the meantime, damage to your body from the process that raises your blood sugar has already begun its insidious progression.
Abnormal Blood Lipids.
The combination of high triglycerides and low HDL cholesterol is a major warning sign of abnormal blood sugar metabolism.

High Blood Pressure.
High blood sugar and high blood pressure often go hand in hand. Each is a warning sign of the same underlying metabolic problem.

Age.
Simply growing older increases the risk of Type 2 diabetes, especially in combination with any of the other risk factors.

In later chapters of this book, we will explore these risk factors and what you can do about them in greater detail. For now, the most important things to remember are that Type 2 diabetes almost always develops over a period of years and that it is almost always related to being overweight.Most people have more than one risk factor,and the early warning signs are present long before full-blown diabetes is diagnosed. That’s both the tragedy and the hope of this metabolic problem.It’s a tragedy,because all too often the early signs are ignored until diabetes develops—and by that time, the process leading to Type 2 diabetes may well have resulted in serious damage. But it’s also the hope, because the sooner you recognize those early signs and put the Atkins Blood Sugar Control Program into action,the sooner you can increase your chances of arresting this devastating disease.

WHAT IS YOUR RISK FOR GETTING DIABETES?

Take this quiz to get an idea.

I am overweight.

a. Yes

b. No

I have excess weight around my waist.

a. Yes

b. No

My diet is high in carbohydrates such as bread, potatoes,and pasta.

a. Yes

b. No

I eat starchy snack foods/sweets every day.

a. Yes

No

I exercise fewer than three hours a week.

a. Yes

b. No

I am African American,Hispanic American,
Asian American, Native American, or
Pacific Islander.

a. Yes

b. No

My mother,father,sister,or brother has/had diabetes.

a. Yes

No

I had gestational diabetes.

a. Yes

b. No

My blood sugar is high.

a. Yes

b. No

My blood pressure is high.

a. Yes

b. No

I have high triglycerides.

a. Yes

b. No

I am over age 45.

a. Yes

b. No

Count up your yes answers. The more yes answers you have, the greater the likelihood you will get diabetes—or that you have it already. If you have more than five yes answers, discuss your risk of diabetes with your doctor as soon as possible.

Chapter 2

WRONG TURN: THE LONG ROAD TO DIABETES

The long, slow process of developing Type 2 diabetes can take years. The symptoms can develop so gradually that you don’t really notice them, at least not at first. In fact, many cases of diabetes are diagnosed only because the person went to the doctor for another ailment. Long before you might notice any symptoms of diabetes, your body may already be having trouble regulating your insulin and blood sugar levels.

UNDERSTANDING BLOOD SUGAR

We’ve already used the terms
blood glucose
and
blood sugar
a lot, and we’re going to use them a lot more in this book. Let’s take a closer look at glucose and how your body puts it to use. Glucose is a simple form of sugar that is one of your body’s primary fuels for energy; glucose is derived primarily from carbohydrates. (Fat is your body’s backup energy source.) Blood glucose,then,is the amount of sugar that’s in your bloodstream at any given time. That amount can vary quite a bit over the course of the day—it’s generally higher shortly after you eat something and lower between meals. Under normal circumstances, your body can also manufacture glucose from dietary protein so that your blood sugar level can be maintained.

Although the words
blood glucose
and
blood sugar
are often used interchangeably, glucose and sugar aren’t exactly the same thing. But because
blood glucose
and
blood sugar
are so commonly used to describe the same thing—the amount of glucose in your bloodstream—we’ll use the two terms interchangeably as well.

If your blood sugar mechanism is functioning normally and you eat a high-carbohydrate food such as a bowl of spaghetti, your body starts to break the starchy pasta down into glucose the moment it enters your mouth. (You can prove this to yourself by chewing a strand of plain cooked spaghetti and holding it in your mouth.As enzymes in your saliva start to break down the carbohydrate,you’ll notice a faintly sweet taste.) The carbohydrate continues to be broken down further in your digestive system, but some glucose enters your bloodstream almost immediately.

HOW IT SHOULD BE

As your blood sugar begins to rise, the pancreas releases enough insulin to handle it.The body likes to keep its glucose level within a fairly narrow range, so it quickly releases insulin to carry the glucose into your cells, where it can be converted into energy. If there’s more glucose than the cells can handle, the body can store the extra amount as glycogen in the liver and muscle cells for future energy needs.Once the glycogen storage areas are full, any glucose remaining is then stored as body fat.

Normally,after you eat a meal that contains protein,fat,and carbohydrates, you would expect that the glucose and insulin in your blood would first go up steadily within the proper range and then slowly go down again over the next several hours, without wide swings, which cause stress hormone release.

That’s how it
should
function. However, if you’re at risk for diabetes, your blood sugar and insulin balance can gradually start to get out of sync. It’s a slow process that happens in stages that almost imperceptibly merge into each other.

MILESTONES ON THE ROAD TO DIABETES

Though the progression to diabetes is slow and insidious, Dr. Atkins observed,through decades of evaluating patients with blood sugar abnormalities, that it can nonetheless be divided into six distinct stages. His observations are similar to those of other researchers in this area.
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The first four stages are milestones on the road to diabetes:

1. Insulin resistance of cells
   
2. Insulin resistance with hyperinsulinism (the production of large amounts of insulin)
   
3. Insulin resistance with hyperinsulinism and reactive hypoglycemia (low blood sugar)
   
4. Insulin resistance and hyperinsulinism with impaired glucose tolerance (now called prediabetes)
   
5. Type 2 diabetes with insulin resistance and high insulin production
   
6. Type 2 diabetes with low or virtually no insulin production
   

We’ll be discussing the six stages in more detail as we progress through this book, starting with the first three stages of insulin resistance as it gradually worsens and leads to excessive insulin production and hypoglycemia.

THE PROGRESSION OF INSULIN RESISTANCE

The first steps on the diabetes road usually begin with excessive consumption of carbohydrates (or a high-calorie diet) that leads to excess glucose being stored as fat. The result? Weight gain. As you put on the pounds, you gradually become insulin resistant—meaning your cells begin to be less responsive to the effects of insulin. Why? That’s a very good question,and despite its importance,it’s a question for which the medical profession still doesn’t have a good answer. (Today many researchers believe that one of the underlying causes is inflammation, but we’re just starting to understand what causes the inflammation.)
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As you gain fat, your insulin resistance increases. Though not everyone who is overweight is insulin resistant, the heavier you are, the more likely you are to become insulin resistant.On the other hand, in some people, insulin resistance begins at normal body weight and can worsen due to a high-carb diet even if their body weight stays normal. For these people, insulin resistance may be due to genetic factors or other factors not yet well understood. Fortunately, a controlled- carbohydrate lifestyle benefits just about everyone with insulin resistance, whether or not they are overweight. That’s because controlling carbs alone helps your cells regain their ability to respond properly to insulin, even if weight loss isn’t needed.
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To compensate for insulin resistance, your pancreas pours out extra insulin in an attempt to force your cells to take in glucose and to maintain your blood sugar within the normal range. You now have what doctors call
hyperinsulinemia
or
hyperinsulinism
—meaning excess insulin in the blood. What happens then is that the smooth rise and fall of glucose and insulin in your bloodstream becomes unbalanced after a meal. To clear away the glucose, your pancreas produces a big spike of extra insulin.

As time goes on, your blood sugar and insulin production get increasingly out of sync. Your blood sugar rises, but now the insulin surge takes longer to occur, and when it does happen, you produce more insulin than is needed. When the insulin finally does kick in, your glucose then drops below its normal level, causing reactive
hypoglycemia,
or low blood sugar.

When hypoglycemia occurs,you may suffer from numerous symptoms, including ups and downs in energy level, shakiness, irritability, and even trouble thinking clearly.You’ll probably also feel cravings for your favorite carbs as your body instinctively tries to bring your blood sugar level back up—which puts you right back on the blood sugar roller coaster. A dramatic case of this among Dr. Atkins’ patients was Warren S.,a 35-year-old who came to him because blood sugar swings were causing panic attacks, dizziness, headaches, and an array of other unpleasant symptoms.Within two weeks of starting on the controlled- carb approach, he told Dr. Atkins, “I’m a different person.” And he was—his symptoms had improved almost immediately.