Atkins Diabetes Revolution (8 page)

LIFESTYLE CAUSE AND EFFECT

The two main lifestyle factors that cause the metabolic syndrome are exactly the same as those that can lead to diabetes: a high-carb diet combined with physical inactivity. But just as lifestyle plays the most important role in causing the metabolic syndrome, lifestyle can play the most important role in preventing or reversing it. Therefore, with lifestyle in mind, let’s take a closer look at the five symptoms of the metabolic syndrome:

Abdominal Obesity

You might call it love handles, a spare tire, a potbelly, or even a beer gut. Doctors call it truncal obesity, abdominal obesity, central obesity, or visceral adiposity. Whatever the name, your protruding abdominal outline is caused by fat stored around your intestines and abdominal organs as well as right under your skin. Fat stored in this way is much more dangerous to your health than fat stored under the skin of your buttocks and thighs.
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Doctors use the waist-to-hip ratio (WHR) or waist circumference to define the point at which your abdominal fat stores are posing a health risk. This is because excessive abdominal fat makes the circumference of your waist bigger than that of your hips. To find your WHR, measure your waist at the navel and measure your hips, then divide the waist number by the hip number. For example, if your waist is 36 inches and your hips are 40 inches, your WHR is 0.9. The higher your WHR, the more “apple-shaped”you are. A less scientific way to evaluate yourself is to look at your body profile in a mirror. If your silhouette is bigger around the middle than around the hips, you have an “apple” shape. If your silhouette is larger at the hips, you have a “pear” shape. If you’re apple-shaped, you have greater risk of health problems related to blood sugar than someone who’s pear- shaped, even if you’re both the same height and weight.
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Now, all you pear-shaped folks, don’t think you’re off the hook. Even if your weight settles below the belt,you still have a greater risk of health problems than those who are normal weight, especially if your BMI is above 30.
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No matter where it is on your body, the more fat you have, the more likely you are to develop the metabolic syndrome.

The powerful effect of abdominal fat can lead to a paradoxical condition: You could be of normal weight for your height and build, or just slightly heavier than ideal, but nonetheless be what’s called
metabolically obese.
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I have a patient who is a very good example of metabolic obesity. Selma M. was 48 years old, five feet three inches tall, and weighed 158 pounds, giving her a BMI of 28, when she came to me. Selma was overweight but not obese; still, she already had the worst lipid profile imaginable. Her HDL cholesterol was only 20, while her triglycerides were a sky-high 2,208! I put her on the Atkins Nutritional Approach—and the changes over the next year were remarkable. Her weight only dropped one pound, but her HDL cholesterol rose to 31 and her triglycerides dropped to just 147. Even better, her body fat dropped from 36 percent to 27.5 percent. After almost five years, she has lost a total of ten pounds, has a total cholesterol of 149, triglycerides of 84, and an HDL of 39. I should add that she did not begin an exercise program until 2002, so these remarkable outcomes were due to her dietary treatment alone.
    —M
ARY
V
ERNON

We don’t understand exactly why abdominal fat is so detrimental. Nor do we understand why some people are more sensitive to abdominal fat. But, like Selma, some folks will develop dramatic and dangerous blood sugar and lipid problems despite only a moderate amount of excess weight—when that weight is concentrated in the torso. It’s important to realize that even being on the high end of normal is sometimes enough to trigger the metabolic syndrome, especially if that excess weight is in your midsection.

The good news is that the ABSCP can reverse the metabolic syndrome, regardless of how much weight you’re carrying or where you carry it. Numerous studies have shown that modest weight loss and moderate daily exercise, which builds muscle mass, can be enough to help you lose some of that abdominal fat and pull back from the brink of the metabolic syndrome.

Dr. Atkins often saw this happen with his patients. Marty K. is a typical example. When first seen, Marty carried 208 pounds on a five- foot-eight-inch frame and had already been diagnosed with the metabolic syndrome and insulin resistance. His primary-care doctor put him on a low-fat, low-protein diet (which by definition is a high- carbohydrate diet). All that did for Marty was sap his energy to the point that he could hardly get around at all, much less exercise. When he found that he not only wasn’t losing weight but was now starting to have hypoglycemic episodes, he decided the time had come to visit Dr. Atkins for a different approach. Marty was immediately placed on the controlled-carb program. Within five weeks, he had lost weight and his hypoglycemic episodes stopped, his blood sugar and lipids improved markedly, and he soon felt energetic enough to begin an exercise program. That accelerated his weight loss and improved his blood sugar and lipids even more.

RESEARCH REPORT: THE PERILS OF POTBELLIES

How much does having the metabolic syndrome increase your risk of heart disease and diabetes? A lot, according to the results of numerous studies. Let’s look at just one recent one, the West of Scotland Coronary Prevention Study.This study followed a group of more than 12,000 men who had slightly elevated LDL cholesterol.When the study began, none of the men had diabetes or had had a heart attack,but about 26 percent of them had the metabolic syndrome, based on the NCEP (National Cholesterol Education Program) definition.When it ended nearly five years later,the men with the metabolic syndrome had developed heart disease at nearly twice the rate as that for the men without it. In other words, their risk of heart disease because they had the metabolic syndrome was the equivalent of being ten years older than their actual age,or of being a smoker.The rate for diabetes was even more shocking.The men with the metabolic syndrome had 3.5 times the risk of developing diabetes as the men without the syndrome. When the researchers looked at the men who had four of the five signs of the metabolic syndrome (instead of the minimum of three),the risk of diabetes soared to 24.5 times higher than that for the men without the metabolic syndrome.
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This was no surprise to Dr. Atkins, who had observed this connection for many years because of his standard evaluation of insulin and glucose abnormalities using tests more extensive than those currently recommended. He developed the ABSCP to address this problem at its source, since it only makes sense to intervene as early as possible, especially when the consequences are severe, as this study so clearly demonstrates.Avoiding these disastrous outcomes benefits not only the patients themselves but also our whole society,by allowing more people to be productive longer and avoiding the astronomical costs of treating heart attacks,strokes,and diabetes.

High Triglycerides

The triglycerides in your blood are nothing more than tiny droplets of fat. The more of them you have floating around in your bloodstream, the greater your risk of a heart attack. If your triglyceride level is 150 mg/dL or more, your risk is definitely elevated; as your triglyceride level goes up, so does your risk. Dr. Atkins believed that the danger from high triglycerides is so serious that the optimum level should be below 100 mg/dL. Fortunately, triglycerides respond well to lifestyle changes. Remember Selma M., who was an extreme case with a triglyceride count of over 2,000?

HIGH CARBS, HIGH TRIGLYCERIDES

It’s an accepted truth: A high-carbohydrate diet causes high triglycerides—and this effect is independent of how heavy you are or whether your insulin levels are abnormal.
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We know from treating thousands of patients that triglycerides drop quickly and consistently in response to a decrease in carbohydrate consumption. Control your carbs, and your triglyceride number will drop sharply.

According to the American Heart Association,substituting carbohydrates for fats may raise triglyceride levels and may decrease HDL (“good”) cholesterol in some people.
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Yet most doctors persist in telling patients who gain weight easily to cut down on fat and meat. For some, this advice is a recipe for disaster. Why? Decreasing fat and protein in the diet inevitably means increasing carbohydrates. This shifts the metabolism toward fat storage—and higher triglycerides. Not only that, it also leaves the person feeling hungry all the time and subject to blood sugar swings.When the situation is reversed, however—when carbs are cut and replaced with dietary fat and protein—the opposite happens. Blood sugar metabolism normalizes, triglycerides go down, HDL cholesterol goes up,and body fat is lost.
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All of these benefits occur without the hunger and irritability that are trademarks of low-fat, reduced-calorie diet plans. Add in exercise, and you optimize HDL levels and accelerate fat burning.

A more typical situation will respond equally well to controlling carbs. One that really stands out is that of Muriel R. When Dr. Atkins first saw Muriel,she weighed 150 pounds at five feet tall.With a 30-year history of Type 2 diabetes, she was taking five medications. Her initial lipids showed a total cholesterol of 318, triglycerides of 1,455, an HDL of 63, and a fasting blood sugar of 196.After three months, her cholesterol had dropped significantly to 202,her triglycerides had dropped to 101,her HDL was 56,and her fasting blood sugar was 143.

Low HDL Cholesterol

High-density lipoprotein (HDL) cholesterol is often called the “good” cholesterol, because it carries cholesterol out of your arteries and other storage sites and back to your liver, where it is recycled. The more HDL cholesterol you have, the better. People with the metabolic syndrome usually have levels that are too low: 40 mg/dL or less for men and 50 mg/dL or less for women.Lifestyle factors that lower HDL include smoking, sedentary lifestyle, and, of course, a high-carb diet.
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LDL, STATINS, AND THE METABOLIC SYNDROME

You might have noticed that having a high level of low-density lipoprotein (LDL) cholesterol, many times called the “bad”cholesterol because high levels of it are associated with heart disease,isn’t one of the signs of the metabolic syndrome. Even though the advertising for statin drugs, which lower LDL cholesterol, would have you believe that high LDL is a near guarantee of a heart attack,that’s not always the case.A more likely near guarantee of a cardiac event, as shown by numerous studies, is the combination of low HDL and high triglycerides.

Despite all the hype, statin drugs do very little to lower triglycerides or raise HDL. What does improve these numbers is a controlled-carbohydrate eating plan along with exercise. Controlling carbs will stabilize blood sugar levels first. During this time your weight may not diminish rapidly. After blood sugar metabolism has normalized, triglycerides drop. HDL rises at the same time, although in Dr. Atkins’ experience it may take three to six months for the HDL to reach the optimal level you can achieve.In many patients,LDL also drops.Sometimes, however, there is a temporary increase in LDL and total cholesterol; these levels typically drop later as your metabolism regains its normal balance.
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As you’ll learn in Chapter 9, however, LDL, HDL, and total cholesterol do not tell the whole story.By controlling your carbs,you influence the complex feedback loops in the hormones and enzymes that control your blood lipids. For example, controlling carbs puts a stop to the overproduction of insulin. When less insulin is circulating in your bloodstream, the enzymes in your liver react in a way that affects the production of lipids.Theoretically,this is the same mechanism targeted by statin drugs, but enabling this mechanism through diet alone means no worrisome side effects induced by drugs.In addition to avoiding side effects and the considerable cost of drugs, you’re getting the benefit of lower triglycerides and higher HDL cholesterol—factors that may be the most important predictors of heart disease.

High Blood Pressure

Because your doctor routinely checks your blood pressure at every of- fice visit,and because you can easily check it yourself,high blood pressure (hypertension) might be the first symptom of the metabolic syndrome you notice. The latest medical guidelines for diagnosing high blood pressure, according to the National Heart, Blood and Lung Institute, say that slightly elevated blood pressure—between 120/80 mmHg and 139/89 mmHg—is now considered prehypertension.
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It’s a warning sign that hypertension may be in your future unless you start taking better care of yourself. How? Blood pressure is generally very responsive to fat loss and increased exercise. Is this beginning to sound familiar?

Blood pressure is also responsive to the Atkins Blood Sugar Control Program. It does this by normalizing your high insulin levels, which decreases sodium retention, which in turn releases excess fluid. For many of you,this means your blood pressure will probably come down quickly.As more progress is made with fat loss and exercise,your blood pressure may well return to normal even without medication.

High Fasting Blood Sugar

High fasting blood sugar (100 mg/dL or higher) first thing in the morning after not eating for at least eight hours is a sign of the metabolic syndrome and an independent warning that diabetes could lie in your future. Of all the signs of the metabolic syndrome, it’s the one that’s most likely to alarm your doctor,especially now that prediabetes has been established as an official diagnosis. (See Chapter 5 on prediabetes for more on this.) If you are really paying attention,you will note that the criterion for the metabolic syndrome is a blood sugar of 110 mg/dL or higher; however,the more recent definition of prediabetes is actually lower at 100 mg/dL.