Atkins Diabetes Revolution (7 page)

If you’re overweight and also have low HDL cholesterol and high triglycerides, there’s a pretty good chance that you’re also insulin resistant and could be well on your way to prediabetes or diabetes. Add in high blood pressure or any other diabetes risk factor and the odds are even greater. Even if you’re not yet insulin resistant and have normal cholesterol and blood pressure, you’re still not immune to diabetes and other health problems. The following table gives you a good idea of exactly how your risk for a number of chronic diseases increases if you’re overweight or obese, compared with your risk if your weight is normal (BMI of 24.9 or less).

INCREASED RISK OF WEIGHT-RELATED DISEASES

Source: The Lewin Group,“Costs of Obesity,”September 2000, available at:
http://www.lewin.com/Lewin_Publications/Uncategorised/Publication-8.htm

THE INFAMOUS LOVE HANDLES

Strange as it sounds, carrying most of your excess weight in the abdominal area—sometimes described as having an “apple” shape— gives you a higher risk of diabetes. This very important risk factor is discussed in the next chapter. Study after study has shown that having a high waist-to-hip ratio or a large waist is a powerful predictor of diabetes risk. Even if your weight is within the norm for your height, how your body fat is distributed plays an important role. The more abdominal fat you have, the greater your risk of diabetes.
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–
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Also, when researchers compare people with the same BMI—in other words,those who are roughly the same weight and height—they invariably find that the ones who have the most abdominal fat have the worst lipid profiles.

STRESS-RELATED OVERINDULGING

Everyone knows stress is bad, but the myriad ways it sabotages your health might surprise you.Many people overeat when they’re stressed, so high stress levels can lead to obesity, which in turn can lead to dia betes. But there is another, insidious factor at work when you’re under a lot of stress: Your body produces large amounts of stress hormones, such as cortisol. Among other things, stress hormones increase your appetite and raise your insulin levels. High insulin levels often lead to cravings for carbohydrates and sweets. And the cycle goes on. What’s worse, the weight you put on as a result tends to accumulate in your abdominal area—which, as we’ve said, further increases your risk of moving on to diabetes.
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Some people eat when they get stressed. Some people drink more alcohol. Some do both. Alcohol abuse is yet another risk factor that can nudge you toward diabetes.
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One reason is that heavy alcohol consumption increases your cortisol levels. Another is that long-term alcohol abuse can damage your pancreas and disrupt the normal production of insulin.Alcohol abuse also damages your liver—and because your liver plays an important role in controlling your blood sugar, this can contribute to developing diabetes.Adding to the unhealthy cycle is that abusing alcohol can also pile on the excess pounds.

Being overweight may be the biggest risk factor pushing you toward Type 2 diabetes, but it’s not the only one. Having any one risk factor is a warning sign that you’re probably already on the diabetes path. However, the more risk factors you combine, and the longer you have them, the greater the likelihood that you will eventually develop diabetes.In the next chapter,we’ll look at a cluster of other disease risk factors that are likely to accompany you as you continue down the path to diabetes.

DO YOU UNDERSTAND THE BMI?

1. You’re in the normal weight range when your BMI is: ___

2. You’re in the overweight range when your BMI is: ___

3. You’re in the obese range when your BMI is: ___

4. You’re in the morbidly obese range when your BMI is: ___

Answers

1.20–24.9.2.25–29.9.3.30–39.9.4.40 or more.

Where do you stand on the BMI chart?

My weight: _______

My height: _______

My BMI is:

Normal _______

Overweight _______

Obese _______

Chapter 4

A DEADLY QUINTET: MEET THE METABOLIC SYNDROME

The metabolic syndrome is a group of five garden-variety risk factors that, when combined, indicate you are likely to develop diabetes, hypertension, and coronary artery (heart) disease.
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If you have this syndrome and do nothing about it, you are almost guaranteed to end up with a life-threatening illness. Because current medical practice does not recommend, as Dr. Atkins believed it should, the earliest possible comprehensive testing for insulin/blood sugar imbalances, each of you needs to take action now and be vigilant on your own behalf. We all must be active partners in our health care if we are to effectively confront the epidemic of what Dr.Atkins called “diabesity.”The symptoms of the metabolic syndrome must be identified early and taken seriously. If we can teach you to recognize the warning signs of this perilous syndrome, you can take action to stop it in its tracks. After you finish reading this book we’re confident that you will understand why controlling carbohydrates with the Atkins Blood Sugar Control Program (ABSCP) is really the best—and only—solution.

HOW IT ALL BEGINS

Like diabetes, weight gain is a gradual process. The pounds of fat can creep up over the years, virtually unnoticed. Even before you’ve let your belt out a couple of notches, however, those extra pounds have started to damage your health.

We tend to think of excess weight as simply the body’s way of storing extra fat—and we think of those rolls of flesh as soft storage banks. In fact, your body fat doesn’t quietly sit there; it’s metabolically active, continually secreting chemicals such as hormones and cytokines. These chemical messengers are innocent members of your body’s normal cell-to-cell communication system. In large amounts, however, they can cause inflammation in your cells. Just as an infection on your finger causes swelling, warmth, and redness in the area, this overload of chemical secretions from excess body fat does the same to your
endothelium
—the cells that line your blood vessels.The difference is that you can’t see or feel the inflammation. The process is complex and happens slowly at first, but it begins almost as soon as you start to put on extra pounds.

The cells of the endothelium regulate how nutrients and other substances in your bloodstream get into your cells. When the endothelium becomes inflamed, normal body processes start to get out of whack. As you continue to gain weight—especially from an inactive lifestyle and a high-carb diet—the inflammation worsens and the effect on your endothelium becomes more severe. You develop endothelial dysfunction. And what goes hand in hand with endothelial dysfunction? Insulin resistance.In fact,it’s the chicken-or-the-egg scenario: endothelial dysfunction and insulin resistance are so intertwined that it’s extremely difficult to tell which triggers which.
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COINING A TERM

For decades doctors noticed a pattern in a large percentage of patients. People who were overweight tended also to have high blood pressure, diabetes, and heart disease.As a cardiologist, Dr.Atkins long ago saw a link between excess fat, insulin resistance, heart disease, and diabetes. It wasn’t until the early 1980s, however, that some perceptive researchers, particularly Dr. Gerald Reaven of Stanford University, started connecting more of the dots. What they noticed was that patients who had abdominal obesity, high blood pressure, high triglycerides, low HDL cholesterol, and sometimes high fasting blood sugar were more likely to develop Type 2 diabetes, hypertension, and coronary artery disease.
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Doctors call a group of related signs and symptoms a syndrome, so Dr.Reaven coined the term for this cluster of signs
syndrome X.
It’s still sometimes called that, but today most researchers and doctors call it the metabolic syndrome. Although many nutritionally oriented doctors have been diagnosing this syndrome, with or without a name, for years, the American medical establishment accepted its existence only in 2001, when the third Adult Treatment Panel (ATP III) of the National Cholesterol Education Program (NCEP) officially defined it. In keeping with the drug treatment approach to disease, which is the hallmark of Western medicine, the ATP III stated that control of the metabolic syndrome was secondary to the goal of controlling LDL cholesterol. This approach misses the point of correcting the underlying imbalance leading to the metabolic syndrome. We’ll discuss this further in the chapter on heart disease.
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Another definition for the metabolic syndrome had been released by the World Health Organization (WHO) in 1999. The two definitions are somewhat different, but because the ATP III definition is the one used in the United States, that’s what we’ll use here.
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(See page 38 for the WHO definition.)

DEFINING THE METABOLIC SYNDROME

You officially have the metabolic syndrome if you have
three or more
of these signs:

• Abdominal obesity: a waist circumference greater than 40 inches (102 cm) in men and 35 inches (88 cm) in women (more on this important risk factor on page 114)
  
• High triglycerides: 150 mg/dL or more
  
• Low HDL cholesterol: under 40 mg/dL for men and under 50 mg/dL for women
  
• High blood pressure: 135/85 mmHg or greater
  
• High fasting blood sugar: 110 mg/dL or greater
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How many people fit those criteria? Far too many. Today, about 25 percent of all American adults have the metabolic syndrome. The older you get, the more likely you are to have it: Forty-four percent of the U.S. population over the age of 50 meets the criteria.
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In reality, even more than 44 percent of the population probably has it. The ATP III definition doesn’t include insulin resistance as a symptom—only high fasting blood sugar counts. Unfortunately, by the time you develop noticeably high blood sugar, you’ve probably had insulin resistance for many years—and the damage to your body has been ongoing for those many years. Dr. Atkins saw countless patients who were slightly overweight, had mild high blood pressure, and only slightly elevated triglycerides. Although they didn’t yet meet the formal definition of the metabolic syndrome, they already exhibited the early stages. He recommended intervention at this stage to avoid progression to diabetes and its complications.

THE WHO DEFINITION

In 1998, the World Health Organization proposed a definition of the metabolic syndrome that is now widely used outside the United States.
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There are some significant differences among the components in the WHO definition and the ATP III definition used in the United States. The WHO definition puts more emphasis on blood sugar, uses a higher cutoff point for high blood pressure, and includes the presence of small amounts of protein in the urine,known as
microalbuminuria.

According to the WHO definition,you have the metabolic syndrome if you have impaired glucose tolerance, impaired fasting glucose, diabetes, or insulin resistance, along with two or more of these other signs:
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• High blood pressure: 140/90 mmHg or higher
  
• High triglycerides: 150 mm/dL or greater (1.7 mmol/L or greater)
  
• Low HDL cholesterol:35 mg/dL or less (0.9 mmol/L or less) for men; 39 mg/dL (1.0 mmol/L) for women
  
• Central obesity: waist-to-hip ratio greater than 0.90 for men;
  0.85 or greater for women and/or a BMI greater than 30
  
• Microalbuminuria: urinary albumin excretion rate of 20 µg/ min or more or an albumin-to-creatinine ratio of 30 mg/g or more
  

THE METABOLIC SYNDROME AND PREDIABETES

The metabolic syndrome and prediabetes are essentially interchangeable. Both are precursors to full-blown diabetes. Only about 13 percent of people who go on to develop diabetes
don’t
meet the formal definition of the metabolic syndrome.
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As a cardiologist, Dr. Atkins long ago recognized the link between gaining fat, insulin resistance, and the ultimate development of diabetes and heart disease. If you don’t have high blood sugar, the other criteria for the metabolic syndrome still put you at higher risk for heart disease and stroke. When you consider that the elevated triglycerides and low HDL that are part of the metabolic syndrome are a result of abnormal insulin/glucose metabolism, the link is clear.
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These warning signs are all intertwined and interdependent, and when you combine a few of them, the resulting scenario is like a ticking bomb.