Part 24 (1/2)

VASCULAR FUNCTION.

An early event in heart disease, vascular dysfunction is now considered part of metabolic syndrome because of its likely origins in insulin resistance in cells that line the interior artery walls.39 An ultrasound technique that measures the ability of an artery in the arm (the brachial artery) to dilate detects the proper functioning of blood vessels. An ultrasound technique that measures the ability of an artery in the arm (the brachial artery) to dilate detects the proper functioning of blood vessels.40 In previous studies, a high-fat meal has been shown to temporarily impair dilation of the brachial artery. In previous studies, a high-fat meal has been shown to temporarily impair dilation of the brachial artery.41 The adverse effects of single meals high in fat, especially saturated fat, on lipid levels after a meal The adverse effects of single meals high in fat, especially saturated fat, on lipid levels after a meal42 and on vascular and inflammatory functions have been used as evidence to discourage low-carbohydrate diets. The test subject's prior diet history, however, has a fundamentally important effect on the metabolic response to meals. For example, research has repeatedly shown that adaptation to a very-low-carbohydrate diet results in a substantial reduction in the triglyceride response to a high-fat meal. and on vascular and inflammatory functions have been used as evidence to discourage low-carbohydrate diets. The test subject's prior diet history, however, has a fundamentally important effect on the metabolic response to meals. For example, research has repeatedly shown that adaptation to a very-low-carbohydrate diet results in a substantial reduction in the triglyceride response to a high-fat meal.43 This means that studies that show short-term harmful effects of a high-fat meal on vascular function may show very different results after subjects are adapted to a low-carbohydrate diet. This means that studies that show short-term harmful effects of a high-fat meal on vascular function may show very different results after subjects are adapted to a low-carbohydrate diet.

When the effects of a high-fat meal on vascular function are a.s.sessed in subjects with metabolic syndrome who consumed a high-fat, very-low-carb diet,44 there is a marked decrease in the triglyceride response to the high-fat meal. In contrast, control subjects consuming a low-fat diet showed little change. After twelve weeks on a very-low-carbohydrate diet, subjects showed improved vascular function after a high-fat meal compared to a control group of subjects who consumed a low-fat diet. there is a marked decrease in the triglyceride response to the high-fat meal. In contrast, control subjects consuming a low-fat diet showed little change. After twelve weeks on a very-low-carbohydrate diet, subjects showed improved vascular function after a high-fat meal compared to a control group of subjects who consumed a low-fat diet.

THE ATKINS DIET IS GOOD MEDICINE.

A series of low-carbohydrate-diet studies show that improvement in metabolic syndrome is intimately connected with controlling carbohydrate consumption.45 Although metabolic syndrome can manifest in various ways, the nutritional benefits of a low-carbohydrate diet hold the promise of improving Although metabolic syndrome can manifest in various ways, the nutritional benefits of a low-carbohydrate diet hold the promise of improving all all the syndrome's features. Most physicians would treat each symptom individually, with the result that an individual might be taking multiple medications, increasing both the expense and the chance of developing side effects. Because having metabolic syndrome means you're on the fast track to diabetes and heart disease, getting all of its components under control is a unique benefit of the Atkins Diet. In the next chapter, you'll learn that these same dietary modifications can also reduce the likelihood of developing type 2 diabetes or even reverse its course, as evidenced by our final Success Story. the syndrome's features. Most physicians would treat each symptom individually, with the result that an individual might be taking multiple medications, increasing both the expense and the chance of developing side effects. Because having metabolic syndrome means you're on the fast track to diabetes and heart disease, getting all of its components under control is a unique benefit of the Atkins Diet. In the next chapter, you'll learn that these same dietary modifications can also reduce the likelihood of developing type 2 diabetes or even reverse its course, as evidenced by our final Success Story.

SUCCESS STORY 10.

WHEN PROFESSIONAL AND PERSONAL WORLDS COLLIDE.

His self-diagnosis of diabetes launched the Canadian physician Jay Wortman on a personal odyssey of discovery and recovery. It also spurred a professional quest to push the boundaries of diabetes management at a time when the disease is becoming a global health crisis.

VITAL STATISTICS.

Current phase: Lifetime MaintenanceDaily Net Carb intake: 2030 gramsAge: 59Height: 5 feet, 9 inchesBefore weight: 185 poundsCurrent weight: 160 poundsWeight loss: 25 poundsCurrent blood sugar: Under 6 mmol/Ll (108 mg/dL)Current HbAlc: 5.5%Former blood pressure: 150/95Current blood pressure: 130/80Current HDL cholesterol: 91 mg/dLCurrent LDL cholesterol: 161 mg/dLCurrent triglycerides: 52.4 mg/dLCurrent total cholesterol: 272 mg/dLCurrent C-reactive protein: 0.3 mg/dL What is your background?

As a physician who has focused on aboriginal health, I was acutely aware of the high rates of diabetes, as well as obesity and metabolic syndrome, in this population. These epidemics were devastating aboriginal communities and incurring huge costs for health care services. When I traveled to the affected communities, there was almost a feeling that the situation was hopeless. Even in communities with extra resources and research programs, we weren't able to reverse the terrible trend.

Did you have a family history of diabetes?

I grew up in a small village in northern Alberta, Canada. Some of my ancestors were settlers in the Hudson Bay area and had intermarried with aboriginal peoples. Both my maternal grandparents developed type 2 diabetes, as did my mother and other close relatives. The aboriginal genetic tendency toward this disease had slowly snaked its way up through my family tree to bite me.

How did you react to this realization?

I was stunned. As a physician, you somehow believe that you're going to be immune to the diseases that you diagnose and treat in others. This, coupled with the fact that I had a very young son, made my self-diagnosis doubly shocking. Of all the concerns about serious health problems and a shortened life expectancy, however, the prospect of not seeing my two-year-old son grow into maturity was the thing that disturbed me most.

I had taken extra training in diabetes in my last year of family medicine residency and knew about the diabetic diet and how lifestyle change was supposed to be the cornerstone of diabetes management. I also knew that, for the most part, newly diagnosed type 2 diabetics went on drug therapy immediately because of the ineffectiveness of lifestyle interventions and that, even then, most tended to struggle and fail in their attempts to maintain normal blood glucose values. Further complicating my situation was the fact that I abhorred the use of medication.

Did the diabetes occur out of the blue?

Clearly, I'd been in denial. I'd put on some weight and was fatigued all the time. I struggled through bouts of afternoon drowsiness. I got up at night to urinate, was constantly thirsty, and needed to squint to see the television news. My blood pressure was also rising into the zone that would require treatment. I rationalized all these developing problems as the natural and inevitable effects of aging until it suddenly dawned on me that I had the typical symptoms of diabetes. I tested myself and confirmed that my blood sugar was way too high. In order to buy time while I looked at the recent science and formulated a management plan, I decided not to eat anything that would exacerbate my soaring blood sugar. I immediately stopped eating sugar and starchy foods, but at the time I didn't have a clue about low-carb diets.

What was the result of your dietary s.h.i.+ft?

Almost immediately, my blood sugar normalized, followed by a dramatic and steady loss of weight-about a pound a day. My other symptoms swiftly vanished, too. I started seeing clearly, the excessive urination and thirst disappeared, my energy level went up, and I began to feel immensely better. I bought an exercise bike and started riding it for thirty minutes every day as I continued to avoid starches and sugars. It was my wife who pointed out that I was on the Atkins Diet. She had struggled to lose weight after the birth of our son and had tried various diets. I recall that when she brought home an Atkins book I was dismissive, suggesting that it was just another of the fad diets and that it probably wouldn't work over the long haul. As I read the book, I realized that I wasn't actually following Dr. Atkins's phased approach to carb restriction, I was simply avoiding all carbs.

How did your personal situation impact your practice?

As I began to realize that my simple dietary intervention was rapidly and effectively resolving my own diabetes, I naturally started to look at the broader aboriginal diabetes epidemic through this lens. In my travels to First Nations communities, I started to question people, especially the elders, about their traditional ways of eating. It was common, especially in coastal communities, to consume traditional foods like salmon, halibut, and sh.e.l.lfish. Inland, one would eat moose, deer, and elk. It was also common to eat modern fare, such as potato and pasta salads with the salmon and moose, cakes and cookies for dessert, all chased with juices and soda pop.

I began to understand that the traditional diet didn't have a significant source of starch or sugar. People ate berries, but the vast majority of calories came in the form of protein and fat. A number of seasonal wild plants, akin to modern greens, were all low in starch and sugar. The traditional diet was looking very much like a modern-day lowcarb diet in terms of its macronutrient content.

How did you test your theory?

Around this time a medical journal published a study in which a group of overweight men were put on the Atkins Diet and followed it for six months. The men lost significant weight and experienced an improvement in their cholesterol levels. I suggested to my two community medicine specialists that we design a similar study for a cohort of First Nations subjects.

I had started speaking to First Nation audiences about my ideas of a link between their changing diet and the epidemics of obesity and diabetes. Ultimately, the Canadian government agreed to fund a trial study to look at the effects of a traditional low-carb diet on obesity and diabetes. I was also able to spend two years on research leave at the University of British Columbia Department of Health Care.

How is your health today?

For about seven years, I've adhered to the diet and continue to maintain normal blood sugar and blood pressure and a weight loss of about 25 pounds. After the first six months, I had my cholesterol checked. I'd become accustomed to eating lots of fatty foods, including my own wickedly delicious low-carb chocolate ice cream recipe. I have to admit I was afraid. I'd been taught that a diet high in saturated fat would lead to an unhealthy lipid profile. Much to my surprise and relief, I had excellent cholesterol. I was clearly on the right track.

My most recent blood tests continue to demonstrate excellent results. Although my total cholesterol and LDL cholesterol are above normal limits, I know from reading the scientific literature that this is not a concern given that the important markers for cardiovascular risk, HDL and triglycerides, are well within normal limits and my C-reactive protein is exceptionally low. With a pattern like this, although I have not tested for small, dense LDL, I can a.s.sume that my LDL is of the healthy variety. I am convinced that my health is better than it has ever been. I have learned an enormous amount in an area of science that physicians, unfortunately, tend to ignore: nutrition.

Has your research been published yet?

At this point, we're collecting data. After statistical a.n.a.lysis, we'll write the paper and submit it for publication in a scientific journal. Meanwhile, the study and how it affected the people of the Namgis First Nation and other residents of Alert Bay is the subject of the doc.u.mentary My Big Fat Diet. My Big Fat Diet.

(For more information, see pletely silent, as many as 8 million of them are unaware that they have the disease.

The Atkins Diet is more than just a healthy lifestyle. As you've learned in the previous chapter, this way of eating can significantly reduce your chances of developing heart disease and metabolic syndrome. Now you'll learn that the Atkins Diet is also an extremely effective tool to manage diabetes. We've previously pointed out that dietary carbohydrates act like a metabolic bully, demanding that they be burned first and pus.h.i.+ng fats to the back of the line, which promotes the buildup of excess fat stores. Just as an individual who has been bullied for years may stop fighting back, some people's bodies eventually give in to the ongoing stress of too much sugar and other refined carbohydrates. The result is type 2 diabetes, which occurs when the body loses its ability to keep blood sugar within a safe range. When this happens, the swings in blood sugar-sometimes too low, but mostly too high-start to do their damage.

ONE NAME, TWO DISEASES.

Though most people know that diabetes has something to do with insulin, they're generally confused about exactly what that means. That's not surprising, considering that two different conditions (type 1 diabetes and type 2 diabetes) share the name. Both types involve insulin, the hormone that facilitates the movement of glucose into cells to be burned or stored. Simply put, type 1 diabetes reflects a problem in insulin production that results in low insulin levels. Type 2, on the other hand, reflects a problem in insulin action (insulin resistance), which results in high insulin levels. Type 2 occurs mainly in adults and is the much more common form, representing 85 to 90 percent of all cases worldwide. Type 1 is more common in children, but thanks to the rapid increase in obesity among younger people, tragically this age group is also now developing type 2 diabetes.

If you've already been diagnosed with type 2 diabetes and have been testing your blood sugar after meals-or you live with someone who does-you've probably noticed that foods rich in carbohydrates drive blood sugar higher than those composed mostly of proteins and fats. If so, this chapter will confirm your suspicions that a healthful diet should limit carbohydrates to an amount that doesn't elevate blood sugar to the level that can inflict damage. And for the rest of us who don't (yet) have diabetes, it will soon become apparent that the best way to prevent this illness is by reducing dietary carbs to the point where they no longer function as a metabolic bully.

A ”SILENT” DISEASE ... BUT AN ENORMOUS EPIDEMIC About one-third of people with type 2 diabetes in the United States are unaware that they have this disease. Fortunately, diagnosing diabetes is as simple as checking a small amount of your blood for its blood sugar (glucose) level or your blood level of hemoglobin Alc (HbAlc), which indicates your blood glucose level over the last several months. Your health care provider can perform either of these tests at a routine checkup, and many employers provide workplace screening (see the sidebar ”Understanding Blood Sugar Readings” for more on testing). Because diabetes is so common and checking for it is so easy, if you don't know if you have diabetes, there's no reason not to find out as soon as possible.

Understanding the role of carbohydrate restriction in the prevention and treatment of diabetes is especially important because of the enormous scope of the diabetes epidemic. Despite the best efforts of the traditional medical approach, which is based upon aggressive use of drugs, the tide of this disease continues to rise. According to the American Diabetes a.s.sociation, the disease now affects 18.2 million people in the United States, but because the early stages of diabetes can be completely silent, 8 million of them are unaware that they have the disease. Nor are the numbers likely to improve soon. As other nations adopt a diet high in sugar and processed carbohydrates, the epidemic has escalated to involve 246 million people worldwide, with projections of 380 million by 2025.

UNDERSTANDING DLOOD SUGAR READINGS.

The amount of glucose (sugar) in your blood changes throughout the day and night. Your levels vary depending upon when, what, and how much you have eaten and whether or not you've exercised. The American Diabetes a.s.sociation (ADA) categories for normal blood sugar levels follow, based on how your glucose levels are tested.

Fasting blood glucose. This test is performed after you have consumed no food or liquids (other than water) for at least eight hours. A normal fasting blood glucose level is between 60 and 110 mg/dL (milligrams per deciliter). A reading of 126 mg/dL or higher indicates a diagnosis of diabetes. (In 1997, the ADA changed it from 140 mg/dL or higher.) A blood glucose reading of 100 indicates that you have 100 mg/dL. This test is performed after you have consumed no food or liquids (other than water) for at least eight hours. A normal fasting blood glucose level is between 60 and 110 mg/dL (milligrams per deciliter). A reading of 126 mg/dL or higher indicates a diagnosis of diabetes. (In 1997, the ADA changed it from 140 mg/dL or higher.) A blood glucose reading of 100 indicates that you have 100 mg/dL.

”Random” blood glucose. This test may be taken at any time, with a normal blood glucose range in the low to midhundreds. A diagnosis of diabetes is made if your blood glucose reading is 200 mg/dL or higher and you have such symptoms of the disease as fatigue, excessive urination, excessive thirst, or unplanned weight loss. This test may be taken at any time, with a normal blood glucose range in the low to midhundreds. A diagnosis of diabetes is made if your blood glucose reading is 200 mg/dL or higher and you have such symptoms of the disease as fatigue, excessive urination, excessive thirst, or unplanned weight loss.

Oral glucose tolerance. After fasting overnight, you'll be asked to drink a sugar-water solution. Your blood glucose levels will then be tested over several hours. In a person without diabetes, glucose levels rise and then fall quickly after drinking the solution. If a person has diabetes, blood glucose levels rise higher than normal and don't fall as quickly. A normal blood glucose reading two hours after drinking the solution is less than 140 mg/dL, and all readings in the first two hours must be less than 200 mg/dL for the test to be considered normal. Blood glucose levels of 200 mg/dL or higher at any time indicate a diagnosis of diabetes. After fasting overnight, you'll be asked to drink a sugar-water solution. Your blood glucose levels will then be tested over several hours. In a person without diabetes, glucose levels rise and then fall quickly after drinking the solution. If a person has diabetes, blood glucose levels rise higher than normal and don't fall as quickly. A normal blood glucose reading two hours after drinking the solution is less than 140 mg/dL, and all readings in the first two hours must be less than 200 mg/dL for the test to be considered normal. Blood glucose levels of 200 mg/dL or higher at any time indicate a diagnosis of diabetes.

Hemoglobin A1c (HbA1c). This is a substance that goes up as a result of high blood glucose levels, and, once elevated, it stays up for a couple of months. Because blood glucose levels bounce around a lot depending on diet and exercise, the HbA1c test offers the advantage of smoothing out a lot of this variability. A level below 5.5 is considered good; a level above 6.5 indicates a diagnosis of diabetes. This is a substance that goes up as a result of high blood glucose levels, and, once elevated, it stays up for a couple of months. Because blood glucose levels bounce around a lot depending on diet and exercise, the HbA1c test offers the advantage of smoothing out a lot of this variability. A level below 5.5 is considered good; a level above 6.5 indicates a diagnosis of diabetes.

As of this writing, the American Diabetes a.s.sociation is intending to adopt the HbA1c test as a diagnosis for diabetes.

DIABETES AND INFLAMMATION: A CHICKEN-AND-EGG SITUATION?.