Atkins Diabetes Revolution: The Groundbreaking Approach to Preventing and Controlling Type 2 Diabetes

By Robert C. Atkins, Mary C. Vernon and Jacqueline A. Eberstein

A new framework for fighting Type 2 diabetes, based on the science of the doctor and #1 New York Times–bestselling author.

As a respected physician and pioneer in the field of complementary medicine, Dr. Robert C. Atkins recognized early on that diabetes and obesity are twin epidemics, and that the way to reverse both is to permanently change the way people eat. Yet much of the mainstream medical establishment continues to advocate the treatment of diabetes with insulin and other drugs, neglecting the major role nutrition and eating habits can play.

The Atkins Blood Sugar Control Program (ABSCP) helps you identify the metabolic signposts that indicate trouble long before the onset of Type 2 diabetes so you can stop it in its tracks. If you already have the disease, the ABSCP offers you and your physician a strategy for weight management and blood-sugar control, while minimizing your exposure to drugs.

Atkins Diabetes Revolution presents a comprehensive lifestyle program, including diet, exercise, and nutrient supplementation. The book also contains meal plans, recipes, a fitness routine, and case studies. This revolutionary book, a fitting tribute to Dr. Atkins, tackles one of the greatest health challenges you and your family may ever face.

“Valuable nutritional information.” —Publishers Weekly

• Language: English
• Publisher: Open Road Integrated Media
• Release date: Mar 17, 2009
• ISBN: 9780061738272

Robert C. Atkins

Robert C. Atkins, M.D., was the founder and medical director of the Atkins Center for Complementary Medicine. A 1951 graduate of the University of Michigan, he received his medical degree from Cornell University Medical School in 1955, and went on to specialize in cardiology. He was a practicing physician for over thirty years and is the author of several books. As a leader in the areas of natural medicine and nutritional pharmacology, he had built an international reputation. He was the recipient of the World Organization of Alternative Medicine's Recognition of Achievement Award and was the National Health Federation's Man of the Year. His many media appearances, where he had discussed diet and health, included "Larry King Live," "Oprah," "CBS This Morning," and "CNBC," among others. Many magazine and newspaper articles have featured his work, and he also had a nationally syndicated radio show. Dr. Atkins was the editor of his own national monthly newsletter, "Dr. Atkins' Health Revelations." He died in April 2003.

Book preview

Atkins Diabetes Revolution

The Groundbreaking Approach to

Preventing and Controlling

Type 2 Diabetes

Based on the teachings of

ROBERT C. ATKINS, M.D.

with

Mary C. Vernon, M.D., C.M.D.,

and Jacqueline A. Eberstein, R.N.

There is only one person to whom we could have dedicated this book: Bob Atkins. His vision inspired us and influenced our professional careers. His courage, passion, steadfastness, and willingness to think outside the box have galvanized us—and many others—to carry on his legacy.

Contents

Acknowledgments

Foreword

Introduction

PART ONE: BLOOD SUGAR AND YOUR HEALTH

1. The Diabetes Crossroads

2. Wrong Turn: The Long Road to Diabetes Success Story: A New Path Without Pills

3. Weighing In: The Number One Risk Factor

4. A Deadly Quintet: Meet the Metabolic Syndrome Success Story: A Healthy Lifestyle Is Music to His Ears

5. Warning: Prediabetes!

6. Diagnosis: Diabetes

7. Managing Your Diabetes

8. Twin Peaks: High Blood Pressure and High Blood Sugar Success Story: A Sparkling Achievement

9. The Cardiac Connection Success Story: A New Lease on Life

PART TWO: TAKING CHARGE OF YOUR HEALTH

10. The Atkins Blood Sugar Control Program

11. Take Action Success Story: A Lucky Hostess

12. The Importance of Good Fats

13. The Importance of Protein

14. The Atkins Glycemic Ranking Success Story: Fighting His Own Way

15. Fiber Facts

16. The Bountiful Harvest Success Story: Man on a Mission

17. Controlling Your Carbs—and Liking It

18. Sugar Nation

19. Drink to Your Health

20. Getting Extra Help: Supplements for Blood Sugar Control

21. Getting Extra Help: Supplements for Heart Health Success Story: An Alternative to Drugs

22. Walking Away from Diabetes

23. Your Personal Exercise Program

24. It’s Not Just Baby Fat Success Story: Bouncing Baby Joy

25. Type 2 Diabetes and Your Child

PART THREE: LIVING THE PROGRAM

26. Meal Plans

27. Recipes for Success

Glossary

Scientific Studies That Validate the Atkins Nutritional Approach

Appendixes

1. Acceptable Induction Foods

2. Moving Beyond Induction

3. The Power of Five and Ten

4. The Atkins Glycemic Ranking

5. The Atkins Lifestyle Food Guide Pyramid

6. Drugs for Hypertension

Reference Notes

Subject Index

Recipe Index

About the Author

Other Titles from Atkins

Credits

Copyright

About the Publisher

Acknowledgments

In true Atkins tradition, producing this complex book was a team effort, led by Michael Bernstein, senior vice president of Atkins Health and Medical Information Services at Atkins Nutritionals, Inc. (ANI). Olivia Bell Buehl,vice president and editorial director,coordinated the day-to-day operations.Paul D.Wolff,chairman and chief executive of- ficer of our company, and Scott Kabak, president and chief operating officer,were both instrumental in getting this project off the ground.

To ensure the accuracy of the nutritional information, nutrition- ist Colette Heimowitz, M.S., vice president and director of education and research, reviewed the manuscript and worked closely with us throughout the project. Dietitian Marlene Koch, R.D., developed all the meal plans and accompanying recipes that allow even individuals who have to severely restrict their carbs to enjoy tasty, varied, and easy-to-prepare meals. Nutritionist and coordinator of education and research Eva Katz, M.P.H., R.D., spent untold hours tracking down often elusive scientific references and ensuring the accuracy of all the references. Leyla Muedin and Shannah Johnson, R.D., assisted her. Leyla also reviewed Dr.Atkins’patient files to find those whose clinical experiences included in these pages represent the thousands who consulted Dr. Atkins for blood sugar disorders and related issues.

Contributing writer Sheila Buff put our thoughts into words, patiently reworking the manuscript as we refined the content. Contributing editor Lynn Prowitt-Smith gave the manuscript a final polish to help simplify an often complex subject.

Nutritionist and executive editor Christine Senft, M.S., and Web site content manager Rachel Fireman helped find many of the individuals whose experiences are related in this book, assisted by Kathy Maguire. Freelance writers Janet Cappiello Blake, Catherine Censor, and Mary Selover interviewed them and wrote the case studies. Special thanks also to the individuals who shared their personal stories with us. Senior food editor Allison Fishman reviewed all the meal plans and made valuable suggestions. Associate food editor Kelly Staikopoulos oversaw the testing of all recipes.

Atkins Nutritionals medical director Stuart L. Trager, M.D., reviewed the entire manuscript. As a triathlete, he also gave valuable assistance on the fitness program.Likewise,pediatrician,researcher,and member of the Atkins Physicians Council Stephen Sondike, M.D., vetted the chapters on childhood obesity and diabetes. Food scientist and vice president for product development at Atkins Nutritionals Matt Spolar and his associate Paul Bruns, Ph.D., contributed valuable expertise on the intricacies of sugar alcohols and were always ready to answer the most arcane questions.

Finally,this project would not have occurred had it not been for the superb efforts of our editor, Sarah Durand, and her team at William Morrow. Special thanks to Jane Friedman, Cathy Hemming, Michael Morrison, Libby Jordan, Lisa Gallagher, Debbie Stier, Kristen Green, Kim Lewis, Chris Tanigawa, Lorie Young, Juliette Shapland, Betty Lew, Richard Aquan, Barbara Levine, and Jeremy Cesarec.

—M.C.V. and J.A.E.

I would like to thank Tricia Thomann, R.N., Melissa Transue, R.N., and Heather Yates, P.A., as well as the rest of my dedicated staff, whose support allows me to pretend to be in three places at once.I am also indebted to my family, patients, and partners for their support. Eric Westman, M.D., was always just a telephone call away when I had a question that needed an immediate answer.

—M.C.V.

I would like to thank my husband, Conrad, for his patience and understanding of all the late nights and weekends this project consumed.

—J.A.E.

Foreword

For 29 years I worked side by side with Bob Atkins in a variety of roles, including nutrition counselor and director of medical education at the Atkins Center for Complementary Medicine, until his death in April 2003. From the very beginning of our relationship, it was obvious to me that Bob’s mission was to put an end to the twin epidemics of obesity and Type 2 diabetes.His desire to address this dual crisis became even more immediate in the last decade of his life as he was diagnosing more people—and more younger people—with diabetes.

But first let me tell you a little bit about myself.In the five years after I graduated from nursing school, my experience was primarily in a conventional medical setting, including intensive care and the recovery room. I began to work with Bob quite by accident. In my initial interview I told him bluntly that I was highly skeptical of his dietary approach. As I reluctantly accepted his offer to work as a staff nurse in his medical practice, I doubted that I would stay long.

Within a few short weeks, I was surprised to observe firsthand the benefits his patients experienced. Not only did they lose weight without experiencing hunger, they also invariably reported improvements in an array of symptoms. As Bob was not yet using complementary therapies, these improvements were clearly related solely to diet.

Like many young women, I was always concerned about my weight. I began to put on extra pounds at age 12 and struggled for years to keep my weight under control by skipping meals and low- calorie dieting. I never let myself gain more than ten pounds before I took action,because my family history of diabetes and morbid obesity scared me. As a nurse, I knew where I was headed.

Even though I was able to lose those extra ten pounds easily, when I was dieting I was always hungry and fighting carbohydrate cravings. I also experienced symptoms such as irregular heartbeats, palpitations, tremors in my hands, insomnia, weakness, and a host of other symptoms that no 25-year-old should have.

Never once did any of the doctors I consulted ask me about what I ate or my family history. Nor did it ever occur to me that my symptoms were related to my weight-loss efforts. After ruling out an over- active thyroid and an adrenal tumor, doctors treated my symptoms with cardiac drugs.I was convinced my problem wasn’t with my heart, and I soon stopped taking them.

A few months after beginning to work with Bob,I experienced a recurrence of the symptoms.When I told Bob about my medical history and the tests I had been given, he asked me why I had never had a glucose tolerance test (GTT). I didn’t have an answer. In those days, hypoglycemia—the only reason someone would take a GTT—was considered a fad diagnosis and not taken seriously, so the test was never even suggested.

Bob routinely ordered a GTT as a part of his new-patient workup, so I joined the next group of new patients and finally had my diagnosis: severely unstable blood sugar that by today’s definition would fit the diagnosis of diabetes—at the ripe old age of 25.

I have Bob to thank for the good health I enjoy today. I am grateful for his courage, commitment, and perseverance in his beliefs. I share this personal information because I know what it is like to confront the health issues we talk about in this book—and I want you to know that you can succeed just as I have.

When Bob’s widow, Veronica, approached me about completing this book, I was deeply honored. And although Bob’s shoes are very large ones to fill, I am confident that I can transmit the message, as he would have expressed it himself. In fact, after working closely with him for many years, I find that I use the same words and phrases he so often used because I intimately know his approach to both obesity and diabetes. The basics were set forth in Dr. Atkins’ New Diet Revolution, as well as in the many, many newsletter articles he penned, presentations he made at medical conferences, radio shows he hosted, and, most important, the records he left behind.

I am fortunate that my partner in this endeavor is Mary Vernon,M.D., C.M.D., a family practitioner and vice president of the American Society of Bariatric Physicians. Bob had a significant influence on the way Mary practices medicine. He was a larger-than-life character, but in many ways Mary reminds me of him. She shares his enthusiasm for caring for and interacting with patients.Like him,she has a natural curiosity and is willing to learn from her patients and other practitioners. Mary is equally open to exploring complementary approaches and began to use Bob’s controlled-carbohydrate approach because she could see that it worked for her patients.Last but not least, not only is Mary as intelligent as Bob was, but like him she loves going to work each day and helping people get better.

This book is the natural extension of Bob’s clinical practice. Over decades, although it was not conventional medical practice, he ordered thousands of insulin and blood sugar tests for patients who came to him with a variety of medical problems. Along with his patients’ symptoms, their test results allowed him to see the relationship between blood sugar and lipid values and the deterioration of the blood sugar mechanism that ultimately results in diabetes. He foresaw the epidemics of obesity and Type 2 diabetes before it was fashionable to talk about them. He was especially concerned with what he saw happening to the health of young people.

Bob believed he had the answer—not just for treatment—but also, more important, for prevention. Even if diabetes was already established, Bob believed he could effectively treat it—if the patient was willing to do what it takes to achieve and maintain a reasonable weight. In most cases, the pancreas could recover, protecting what function it still possessed. Controlling carbohydrate intake was always essential to this goal.

His more important mission was to partner with his patients to educate them about their risks, so that they could prevent the onset of diabetes and its potentially serious results. It is this philosophy that is explored in detail in this book. Despite having already authored more than a dozen books, Bob often spoke of writing one about preventing diabetes, which would be the culmination of his life’s work. Although he did not live long enough to complete Atkins Diabetes Revolution, those of us who worked with him and understood his commitment and courage have done that. This is that book, and I believe it is an appropriate legacy for this man of vision.

Bob had clearly conceptualized this book and had mapped out the contents. His excitement about the project was infectious, and he and I spent many hours talking about how he envisioned it. While Dr. Mary Vernon and I wrote this book, the dietary advice and nutritional principles come directly from Bob’s teachings and my decades of experience working with him. We may be the authors, but we want you to realize that it is really his voice speaking loud and clear. Most case histories are taken directly from Bob’s patient records. (For clarity, the case studies that come from Dr.Vernon’s practice are indicated in italics,followed by her name.) We have used pseudonyms in case histories in which only a first name is used.We owe a debt of gratitude to all the individuals who have shared their personal stories in this book.

Bob Atkins’ teachings can help you be a partner in your health care and health maintenance. You too can learn about your risks for diabetes and what to do about them. You can practice prevention for yourself and your family.Making lifestyle changes is not as easy as taking a drug, yet the results are immeasurably better and will positively impact all aspects of your life.

I know that Bob would feel his mission was accomplished if you, with the help of your health care provider, are able to use the information in this book to make permanent lifestyle changes—changes that become the framework of your personal health solution. In doing so, you will become part of the larger solution to the epidemics of obesity and diabetes that are fast becoming a public health nightmare.

—Jacqueline A. Eberstein, R.N.

Director of Nutrition Information

Atkins Health & Medical Information Services

Introduction

Let me share with you some frightening facts that could have a devastating effect on your life:

One of every three children born in the year 2000 will develop diabetes.1

Diabetes is the leading cause of heart disease.2

About 75 percent of people who have diabetes will die of heart disease.3

In the United States, diabetes has increased nearly 50 percent in the past ten years alone, according to estimates of the Centers for Disease Control and Prevention (CDC), and the incidence of the disease is expected to grow another 165 percent by 2050 under current trends.4

Diabetes prescription costs create such a financial burden that one in five older adults with diabetes reports cutting back on prescription medication.5

Total medical cost of diabetes in the United States in 2002 was $92 billion; add in indirect costs of $40 billion—disability payments, days of work lost, and premature death—and the total comes to $132 billion.6

Overall, the risk of death for people with diabetes is about twice that for people without it.7

Behind all these numbers are millions of people and their families. My practice is simply a microcosm of the impending health care crisis. Every day I see in my patients’lives the devastating impact of these statistics—which, as you will learn from this book, is intimately linked to being overweight or obese. Excess weight and its associated metabolic imbalances—resulting in diabetes, coronary artery disease, and hypertension—are costing them their health and, in some cases, even their lives.

I have been interested in controlled-carbohydrate nutrition for years. As a family physician, I saw my patients fail in their attempts to use the standard recommendations I was schooled to give them. I could see that they needed to control their weight and metabolism. I felt helpless, with nothing to offer them that would make a significant impact. The ubiquitous low-fat, low-calorie approach to weight loss was difficult for my overweight patients to use. They complained of hunger and irritability. I needed an effective tool to help them control their appetite so they could achieve long-term success in losing weight and keeping it off.

Back to the books I went to reeducate myself about effective ways to manage weight and metabolism. I was eventually driven to pursue my interest in bariatric medicine, the treatment of obesity and its associated conditions. (I am now board certified in bariatrics.) Like every physician,I studied metabolism in medical school,including the role carbohydrates play in fat storage. But this time around, I saw how the information applied directly to my patients.I now wanted to make it clear to them, too. Much of this book is devoted to conveying in the simplest terms possible the complex biochemical functions of insulin production and blood sugar regulation.

I decided to examine the available tools for carbohydrate control, rather than reinvent the wheel. I reviewed all the popular plans that control carbohydrate intake. The Atkins Nutritional Approach appealed to me because it was simple (no calculator or food scale required) and because it could be individualized. Using controlled- carbohydrate nutrition,which has its own natural appetite-suppressing effect,I was able to help my patients.

I was amazed at their significant improvements in lipid and cardiovascular risk factors, as well as insulin and blood sugar control. I also began to hear my patients say the very things that Dr.Atkins had written about in his books. They told me that their energy levels had increased, their moods were more stable, and they had fewer aches and pains, less acid reflux and indigestion, and an improved sense of well-being. My patients’ results convinced me I was on the right track.

I met Bob for the first time in 2000 at a continuing-medical- education conference on low carbohydrates in New York City. There, I spoke with other clinicians whose patients were experiencing the same success. I also met researchers, including Dr. Eric Westman and Dr. William S.Yancy Jr., both of Duke University. They were among those who had been conducting clinical trials and whose findings demonstrated the safety and efficacy of the Atkins Nutritional Approach both for weight management and improvement in cardiovascular risk factors. As I related my own experiences, Dr. Westman agreed to analyze my patient data, which confirmed my observations. My successful clinical experiences with Type 2 diabetic patients were published in the fall 2003 edition of Metabolic Syndrome and Related Disorders.

Other researchers at equally prestigious institutions were also taking an unbiased look at the Atkins Nutritional Approach (ANA). By 2002, the first two studies supportive of the ANA were published in peer-reviewed journals or presented at conferences. (As I write this introduction, there are now 27 studies supportive of the ANA, * two of which I am proud to say I authored.) Although many people had experienced success doing Atkins and had long embraced this approach, the publication of an article by science writer Gary Taubes in the New York Times Magazine in July 2002 was a major turning point. Entitled What If It’s All Been a Big Fat Lie?the article made clear that the lowfat approach had minimal scientific underpinnings and that, in fact, emerging research was supportive of controlling carbs. For this kind of information, written by a respected science writer, to appear in the New York Times was a watershed moment.

In September 2002, I met Bob again when he lectured at the American Society of Bariatric Physicians conference. Dr. Westman and I presented our data on the Atkins Nutritional Approach, showing the benefits of the ANA compared with a low-fat, calorie-restricted diet. Overall, there was huge interest in the emerging science validating the Atkins approach as well as personal support for Bob. He clearly felt vindicated by this reception.You see? he said.I’ve known for years how amazing this is! Over several meals with Bob and Veronica Atkins, he and I shared our clinical experiences. He came to realize that I had a full understanding of his approach and shared his commitment to patient care.

Our conversations continued over the ensuing months. Bob followed my presentations and reviewed my clinical results with excitement. He then paid me the ultimate compliment: When I visited The Atkins Center for Complementary Medicine in November 2002, he asked me to join his practice.Coincidentally,during that visit I had the thrill of being with Bob the day that Dr. Westman’s research comparing the Atkins Nutritional Approach with the American Heart Association (AHA) recommendations was presented at the association’s annual meeting. Finally,AHA members were presented with an excellent, randomized, controlled trial that confirmed results similar to those Bob had long put forward. He relished the scientific confirmation of his clinical experience.

Bob and I continued to discuss the possibility of my joining his practice up until the accident that resulted in his death.Things did not turn out as planned. Now, instead of working as his colleague at the Atkins Center,I am a member of the Atkins Physicians Council (APC), whose members have expertise in fields such as diabetes, pediatrics, women’s health, bariatrics, and orthopedics. As part of Atkins Health and Medical Information Services, this group is committed to educating the medical community, health consumers, and policy makers on the merits of controlled-carbohydrate nutrition, which can play a major role in addressing the epidemics of obesity and diabetes.As part of that effort, the APC has already presented the Atkins Lifestyle Food Guide Pyramid (see page 473) as an alternative dietary guideline. As a member of the APC, I am honored to be a co-author of this book— helping to impart the knowledge Bob acquired in his lifetime of work. I take on this task with deep respect.I could have spent a lifetime learning from Bob.Instead,I honor his legacy by helping to complete his last and most important work. It is anticipated that the other members of the APC will also write future publications under the Atkins banner.

I would not presume to tackle this important task alone. With Jacqueline Eberstein as my partner, this book has come to fruition. Since Jackie lived those years of discovery with Bob, she can translate decades of clinical practice into the words he would have used. Everything about how to implement controlled-carbohydrate nutrition is imprinted in her mind. And as we have worked together on this book, we have often been amazed by the similarities in our day-to-day clinical experiences using this approach.

Another person who is integral to carrying on Bob’s legacy is, of course, his wife,Veronica. During their time together, she was not just his helpmate, but was also intimately involved in many aspects of his work, including collaborating on a cookbook. Together, they were committed to furthering independent research on controlled-carb nutrition and to that end established the ongoing Dr. Robert C.Atkins Foundation, of which Veronica is chairperson. Grant money has already been used to fund research at institutions such as Duke University, Albert Einstein College of Medicine, Ball State University, the University of Connecticut, Pennsylvania Hospital, the University of Kansas, and Beth Israel–Deaconess Medical Center.

As a bariatrician, I recognize the need to personalize each patient’s program. Individuals with chronic diseases such as diabetes, hyper- tension, and cardiovascular disease should work with their physician to find a treatment plan that specifically benefits them. The contents of this book provide information about a program that many have found effective. Although this book is written in language most non- professionals can understand, it is by no means intended as a replacement for the physician-patient relationship.

I take great joy in offering my patients lifestyle choices that empower them to improve their health.Jackie and I believe that this book will provide you and your health care practitioner with information that will empower you in the same way. After all, as a pioneer in complementary medicine, Bob’s most enduring legacy is the gift of knowledge. He truly practiced the art of medicine, a skill that is the foundation of inspired patient care.

—Mary C.Vernon, M.D., C.M.D.

Member, Atkins Physicians Council

Part One

Blood Sugar and Your Health

Chapter 1

THE DIABETES CROSSROADS

It’s a frustrating fact of life: We don’t have much say over whether we fall victim to life-threatening diseases such as cancer, Alzheimer’s, or, to a large extent, some types of heart disease. However, there is one, all-too-common killer disease over which we have a great deal of say. Most people do have a choice when it comes to Type 2 diabetes.Astonishing as it sounds, this epidemic disease is almost entirely preventable. Of course, no one consciously chooses to get diabetes. Various factors—some in our control and some not—combine to create the unfortunate scenario. But if we all took proper care of our bodies and kept vigilant rein on the factors that are within our control, there would be no diabetes epidemic.Do you think we’re overstating things? No way. In fact, what we hope we have created with this book is a realistic and practical guide to wiping out Type 2 diabetes, one individual at a time.

According to the National Institutes of Health, in 2002, a record number of Americans—18.2 million, or 6.3 percent of the population—were thought to have diabetes.Of these,13 million were already diagnosed, while 5.2 million probably have diabetes but haven’t been diagnosed yet.1 That means many millions of Americans are blindly chugging down this dangerous road. Sadly, in our experience, many well-meaning health care professionals give their patients the standard information, some of which perpetuates the very disease it’s supposed to cure or prevent. That’s why Dr. Atkins felt it was crucial to write this book.

In 2002 and 2003, the American Diabetes Association redefined and standardized the criteria for blood sugar abnormalities. Unfortunately, none of these changes were implemented in order to find patients earlier in the process. Our interest is in identifying patients with these metabolic problems long before they advance to the official blood sugar level defined as diabetes.2–4

If you know what to look for, you can identify the metabolic sign- posts that signal trouble even earlier in the process—and intervene immediately. If you are reading this book, you are clearly concerned about your health or perhaps it’s someone you love about whom you’re concerned. Either way, congratulations to you for picking up this book. Let’s not waste another minute.

We will show you how to make relatively simple lifestyle changes that can significantly reduce your risk of ever getting diabetes, even if you already have some of the preliminary symptoms. And if you have already been diagnosed with diabetes, this book can help you mitigate its effects or maybe even stop further progression.

We can be your guides on the road to better health, but it is you who must take control of your destiny by making and implementing the right choices. Imagine that you are standing at a crossroads in the map of your life. Ahead of you lie two paths. One almost inevitably leads to diabetes and its accompanying health problems; the other leads to optimal health. Which will you choose?

THE RIGHT ROAD

Let us tell you about the path that Dr. Atkins recommended to his patients for decades. It differs dramatically from the treatment with drugs most health care practitioners have been taught. Instead, his path identifies risks for diabetes as early as possible, focuses on prevention, and involves permanent lifestyle changes to address the underlying metabolic problems that lead to diabetes. These lifestyle changes can be as simple as changing what you put on your plate—a better option, we think you’ll agree, than swallowing an array of expensive and potentially dangerous drugs. Those of you who have read Dr. Atkins’ other books will recognize a point he hammered home for decades: Instead of treating the symptoms, his approach can correct the problem itself.

Finally, for individuals whose blood sugar abnormalities are further advanced or who already have diabetes, this path decreases or eliminates the need for drugs to treat these conditions. (Did you know that some of these drugs actually make it harder to lose weight? Talk about a vicious cycle.) Whether you’re just beginning to be concerned about diabetes or you’ve already been handed the official diagnosis, controlling carbohydrates is the vehicle that will take you off the rutted road of self-destruction and onto the smooth one of recovery and excellent health.

The decision to improve your health is an obvious one, but to follow this right road—and stay on it—you need clear directions and a good map. That’s what the Atkins Blood Sugar Control Program (ABSCP) gives you. The ABSCP is a highly individualized approach to weight control and permanent management of the risk factors for diabetes and cardiovascular disease. And it works.

I’ve witnessed these life-changing improvements in patients such as this 45-year-old woman. Ruth L. weighed 375 pounds, with a body mass index (BMI) of 60.5 and uncontrolled Type 2 diabetes. Although Ruth took three medications daily in an effort to control her blood sugar, her glycated hemoglobin (A1C) was 11 (more than two times the norm, demonstrating very poor blood sugar control). The day she began the program, I had her stop all her blood sugar medications. After two months, her A1C was down to 7.7. After 18 months, she had lost 132 pounds, her lab values were normal, with an A1C of 5.4, and she remained off blood sugar medications.     —MARY VERNON

The ABSCP builds on the basic controlled-carbohydrate concepts of the famed Atkins Nutritional Approach and individualizes it specifically for people like Ruth who have—or are at risk for—blood sugar abnormalities and diabetes.

Once you’re heading in the right direction, the program helps you to stay with it and map your progress as you pass milestones along the way. The ABSCP includes controlled-carbohydrate nutrition; supplementation with vitamins, minerals, and other nutrients; and exercise—all of which are customized to your needs.

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A WORLDWIDE PROBLEM

The diabetes epidemic is growing by leaps and bounds around the world. According to the World Health Organization, in 2000, the total number of people worldwide with Type 2 diabetes was 176 million plus. By the year 2030, that number is estimated to rise to some 370 million people.In 2025,the worldwide prevalence of diabetes in adults will have increased by 35 percent, and the number of people with diabetes will have increased by 122 percent.5 The countries with the largest number of diabetics in 2030 will be India (an estimated 80.9 million), China (an estimated 42 million),and the United States (an estimated 30 million).6

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To begin, you need to understand more about this insidious disease. Let’s start with the basics.

WHAT IS DIABETES?

Diabetes is defined as a condition in which blood sugar (glucose) levels are above the normal range.In a minority of cases,this happens because your body is no longer producing the hormone insulin, which carries glucose into your cells where it can be converted into energy. This is known as Type 1 diabetes, sometimes called juvenile diabetes or insulin-dependent diabetes mellitus (IDDM). In Type 1 diabetes, the specialized beta cells of the pancreas stop producing the hormone insulin,which is necessary for moving glucose into the cells,where it is burned for energy. Type 1 diabetes usually starts in childhood; currently people with this form of diabetes require lifelong insulin administration and careful dietary management to survive. Recently, it has been reported that stem-cell transplants have been successful in curing this disease. Type 1 diabetes accounts for about 5 to 10 percent of all cases of diabetes.10 The cause of Type 1 diabetes is in most cases an autoimmune disease in which the body mistakenly attacks and destroys the cells in the pancreas that produce insulin. Type 1 diabetes usually strikes very suddenly—the person may appear fine one day and be very sick just a few weeks or even days later.

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GESTATIONAL DIABETES

Each year some 4 percent of pregnant women, or about 135,000 women in the United States, develop gestational diabetes.7 If you’re over age 25, are obese,have blood sugar or blood pressure problems,a family history of diabetes, or belong to certain ethnic groups, you may be at risk for gestational diabetes.

Gestational diabetes can be a serious problem, because it can result in an infant with a dangerously high birth weight,which causes difficulties during labor, including a higher risk for cesarean delivery. These women are also more likely to develop hypertension during pregnancy and have it persist after delivery.8 There is also risk to the infant. Babies exposed to high concentrations of glucose before birth may have problems maintaining their blood sugar in the first few days after delivery. They are also more likely to have breathing problems and require oxygen supplementation if born early.

Gestational diabetes can generally be controlled by diet and sensible exercise during pregnancy. Blood sugar levels usually return to normal after delivery.If you had gestational diabetes,however,you have about a 20 to 50 percent chance of developing Type 2 diabetes within the next five to ten years.9 Also, your baby may be more likely to become over- weight and develop diabetes later in life because he or she has inherited your metabolic tendencies.

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Because Type 2 diabetes is by far the most common type of diabetes, and because it can be prevented and treated through diet and lifestyle changes, it will be the focus of this book. Although some of the advice in this book can be helpful for people with Type 1 diabetes as well, in general, whenever we talk about diabetes we are referring to Type 2 diabetes.

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POLYCYSTIC OVARY SYNDROME

Women who have polycystic ovary syndrome (PCOS) have a high risk of developing Type 2 diabetes. Like diabetes, PCOS is associated with increased insulin resistance and high insulin secretion.11

PCOS is a hormonal imbalance that can cause irregular menstruation,infertility,weight gain,and excessive hair growth.PCOS is surprisingly common—estimates are as high as 11 percent of all women aged 20 to 40.12 Fortunately, PCOS responds extremely well to a controlled- carbohydrate approach. Many of our PCOS patients return to normal blood sugar levels within a few months of doing Atkins, and their other symptoms often improve as well. Some patients even report being able to conceive when following this approach.

Of women who have PCOS, 35 percent have been shown to progress to diabetes five to ten times faster than women without this condition.13

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Ninety to 95 percent of the people with diabetes have Type 2, a disease that is quite different from Type 1.14 In the large majority of cases of the Type 2 variety, the individual still makes insulin—in fact, he or she may make large amounts of it—but the cells respond more slowly to its presence. This slowed response is called insulin resistance. If you have Type 2 diabetes, over time, as your cells become more resistant to the insulin signal, blood sugar rises above normal levels. What’s happening? It’s as if the insulin knocks at the doors of the cells and asks that the glucose be let in, but the cells don’t answer the door. So the amount of glucose circulating in the blood increases—you become hyperglycemic—and that causes a lot of damage. To force the glucose to enter the cells, your pancreas pours out more insulin. Eventually, the pancreas becomes unable to produce such high levels of insulin; as a result, insulin must be administered in order to control the blood sugar level.

Kids and Diabetes

Until recently, Type 2 diabetes was primarily a problem for older adults. It was very rare for children and people in their twenties or even thirties to have Type 2 diabetes.Today,even children are being diagnosed with this disease. Some experts now suggest that as much as 45 percent of all children with newly diagnosed diabetes have Type 2.15 The causes are similar to those for adults: obesity, a sedentary lifestyle, and a high-carbohydrate diet. Kids with Type 2 diabetes are more likely also to have a family history of the disease. Children with this disease face a future of serious health problems that will likely shorten their life spans and significantly affect their quality of life. Fortunately, as we’ll explain in Chapter 25, the Atkins Blood Sugar Control Program is very effective for young people.

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THE LOW-DOWN ON LIPIDS

The term blood lipids(lipid is another word for fat) is used as an overall way to describe the various types of cholesterol and fat that are normally found in the bloodstream. People with blood sugar abnormalities or diabetes typically have characteristic abnormalities in their blood lipid profiles. We’ll be discussing lipids in detail in other parts of this book, especially Chapter 9 on heart disease,but for now let’s go over the main types:

Cholesterol. Technically, cholesterol isn’t a fat. It’s a waxy substance that’s a sort of kissing cousin to fat—the main difference is that you don’t burn cholesterol for energy in your cells as you do fat. Cholesterol is essential for your health.Among the many other functions it serves in your body,it’s used to make the membranes of your cells,to form the insulating layer of your nerve cells, and to manufacture many hormones, including the sex hormones testosterone,estrogen,and progesterone. Low-Density Lipoprotein, or LDL Cholesterol. To move the waxy cholesterol around in your watery blood to where it needs to go, your liver coats it with protein. LDL cholesterol is often simplistically called the bad cholesterol, because high levels of it in the blood are statistically associated with an increased risk of heart disease.

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.

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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.16 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.17

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.18 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