10 Before You Begin
You are probably raring to start Atkins and begin losing weight. But there are two medically important steps and several practical preparations that will lay the groundwork for your success. First, a crucial warning: People with severe kidney disease (creatinine over 2,4) should not do any phase of Atkins unless ordered to do so by their physician. Also, pregnant women and nursing mothers may do the Lifetime Maintenance phase but should not do any of the weight loss phases of Atkins.
The first thing you must do is review any medications you lake and make a doctor's appointment to get a complete physical, including some blood work and other tests. I'd like you to understand why having a medical workup before beginning Atkins is so important, both from a health perspective and to help motivate you to follow the program faithfully.
A patient of mine named David French a 52-year-old stockbroker had tried countless diets and failed on all of them, He came to me somewhat reluctantly-nagged, I suspect,by his wife and children. During our first coition, he qmckly expressed his skepticism, groaned at the thought of taking vitamins and seemed to me like someone who would not stick with the program. Although be weighed 206 pounds at only five feet eight inches tall, he had no obvious health problems other than generalized fatigue and difficulty with even very mild physical exertion.
"Let's at least check your blood lipid levels, Mr. French," I said, "and then we'll have some idea of whether you have anything to worry about." (The word l/p/ds is medicalese for cholesterol and triglycerides, traditionally regarded as the main blood indicators for heart disease risk.) The blood tests were enlightening. His total cholesterol was a whopping 284 and his triglycerides level was an incredible 1,200. At our next meeting, I let him have it with both barrels: "ff you don't do something soon, I'd say you're probably going to die in the next year or two, Mr. French."
That caught his attention. In all probability, I told him, a heart attack or a stroke would be his undoing. He also showed signs of being a borderline diabetic. His condition was completely reversible, but when he left my office that day I didn't think he'd make the effort to reverse it.
I was wrong. Dave started doing Atkins, and six mouths later, he weighed 162 pounds, his total cholesterol was 1S5 and his triglycerides were 90. He had been a carbohydrate eater his whole life—he'd hit the coffee cart for bagels and rolls, stop on the way home from work fora calzone and drank soda pop every day—but Dave thrived on myprogram, reassured by the fact he could eat until he was completely satisfied. "If you're hungry, eat," I said.
I also persuaded Dave to a half hour of exercise four times a week. He soon found that be slept better and felt far less fired during the day.Also, physical exertion wasno longer beyond him.
Dave is a slim and healthy man now and he won't let himself slip into his old ways."I have a picture that I keep on the desk in my office that shows the maximum me,"he says."I look like I'm going to have a baby.I keep the photo right there where I can see it,to remind me of what I'll never be again.Nowadays,I don't even look like the same person."
Even more important, Dave French probably wouldn't be alive today if the results of his blood work hadn't shocked him into changing his ways.
Review Your Medications
With that sobering thought in mind, let's look at those medical steps you should take before you begin to change your eating habits. You will need lo stop taking any unnecessary over-the-counter medications, such as cough syrup or cough drops, antacids, sleep aids, antihistamines or laxatives. Many prescription medications also inhibit weight loss. For a list of these medications, please turn to Chapter 20, page 262. If you take one or more of the drags listed, you may be disappointed in your weight loss results. Talk to your doctor to see if an alternative can be found. You can also refer to Dr. Atkins' Vita-Nutrient Solution for more natural approaches to deal with your symptoms.
There are also several categories of drugs that can cause adverse effects when taken while on a controlled carbohyd/ate eating plan. First are the 'diuretics, because reducing your carbohydrate intake alone can have a dramatic diuretic effect. Second, since Atkins is so effective at lowering high blood sugar, people who take insulin or oral diabetes medications that stimulate insulin can end up with dangerously Low blood-sugar levels. Third, Atkins has a strong blood pressure lowering effect and can easily convert blood pressure medications into an overdose, If you are currently talcing any of these medications, you will need your doctor's help to adjust your dosages.
Checkup and Blood Work
When you 8o to your doctor, I recommend that you your blood chemistries and lipid levels measured—and quite possibly the glucose-tolerance test (with insulin levels drawu at fasting mad at one and two-hour intervals) before yOUr start the program. Lipid levels will reveal your total cholesterol, HDL (good)and LDL (bad) cholesterol and triglycerides. These indicators often change with drastic dietary intervention. The blood chemistries will measure baseline glucose, kidney and liver function. Be sure your doctor also measures your uric acid levels. Since many people wrongly believe that these indicators are negatively affected by doing Atkins, you may later regret not having a "before" to compare with your "after" results.
If you choose to keep track of those hidden physical changes that are measured in your blood, you'll find that, after you start Atikins, they should begin improving steadily (see "Before and After Tests," opposite). I don't want you to wait to have your initial lab work done until after you start Atkins, because then you may think any abnormalities arc the result of your new way of eating. You may well have had even higher cholesterol and triglycerides before you began.
Your doctor will also check your blood pressure. High blood pressure known as "the silent killer"—and being overweight often go together. Having high blood pressure (also called hypertension) puts you at clear risk for stroke and heart disease and may indicate elevated insulin levels. What happens to high blood pressure on Atkins? It goes down. Nothing is more consistently or more rapidly observed than normalization of blood pressure.
Lou Stazzio was a. good illustration of that. This 40-yearold New York policeman had gained 50 pounds over the previous twenty years and had, in the process, acquired a roof beam.raising blood pressure of 180/110. He was on medication and was constantly fatigued. Doing Weight Watchers only introduced him to the pleasure of starvation.
One day, he read au article about how overweight teenage children lost weight more easily on a controlled carbohyplan than (mn low-fl diet. wen,, why not him? He decided to give Atkins a try.IN eight months on the plan,Lou lost 60 pounds,was taken off his blood pressure medication and now has an unmedicated blood pressure of 118/74-a first-class advertisement for cardiovascular health.
Before and After Tests
After you have been doing Atkins for six weeks or so, have your blood work redone; you may be surprised at the dramatic improvements. A whole body of published literature suggests that you ought to be terrified of eating liberal amounts of eggs, fat and meat, In fact, the most common question I'm asked when I tell a patient what I expect him to eat is 'But won1 my cholesterol go up?" I have no hesitation in answering, "It will probably go down? And in cases where your total cholesterol goes up, what you will almost Invariably find is that your HDL (good) cholesterol goes up more than your LDL (bad) cholesterol does, thus improving the all important HDULDL ratio.
Typically, triglycerides plummet within the first month on Atkins, then HDL begins to rise. In some cases, LDL will rise. If it does, ask your doctor to test for the subtypes of LDL to determine whether it is the Low-risk type of LDL or the high-risk type that has risen. Low-risk LDL, large fluffy Upo-protetn A, is so designated because it doesn't cause plaque to form in the arteries. Research has shown that high-fat diets will raise the beneficial Low-risk LDL.
Your kidney and liver functions should also be excellent,s-e In fact, in my clinical experience, some individuals who have previously had elevated fiver levels due to fatty deposits in the liver have shown improvement after doing Atkins. Your uric acid levels should test normal. If you have elevated uric acid prior to going on the program, you must be sure to keep your water intake up and monitor your uric acid level. An elevated uric acid level can lead to gout; if you suffer from gout I recommend you consult Dr. Atkins' Vita-Nutrient Solution, since certain vitanutrients can help you control your uric acid leveis. YOU can also ask your physician about the drug allopri nol, which consistently lowers uric acid levels.
You should also ask your doctor about your thyroid function. A sluggish thyroid is often responsible for obesity. If you have an underactive thyroid, getting the correct treatmeat may help solve your weight problem. For a detailed discussion of thyroid problems, mm to Chapter 20.
The Blood-Sugar Test
Let's talk about the laboratory test most relevant to peopie starting Atkins—the five-hour giucose-tolerance test (GTT). If, after reading the last few chapters, you suspect you may have a blood-sugar or insulin imbalance that is contributing to your weight problems, discuss it with your doctor and request a five-hour GTI with insulin levels. Since the onset of diabetes is insidious and damage to the body can occur even before full-blown diabetes is first discovered, it is vitally important to be aware of the possibility you have pre-diabetes and of the degree of risk you may already suffer (see Chapter 24).
If you are hesitating, consider this: We are not talking about headaches, acid indigestion or ingrown toenails here. Need I remind you that the conditions the GIT with insulin levels can detect can be precursors to diabetes? Sixteem million people have diabetes,s One in three doesn't know he or she has it.
If you don't want to be drafted into tile diabetic army, it pays to find out right now if you are a potential recruit. If yom' blood tests show you that you're well along the road, you will suddenly have a reason for doing Atkins that is far stronger than your desire to shed excess poundage. (If yon became overweight early in life, this may have serious implications for your children, too. Check your blood-sugar and insulin levels so that you can know what condition they may have inherited from you. Taking early action to address the same issues in their diets can make a big difference.)
The GIT measures your blood sugar after twelve hours of fasting and then over the course of five to six hours after yon drink a sugary liquid with no other food or beverage. Any variation from the normal range may be viewed with suspicion. Ifthe highest reading is over 160 mg/cc, it may suggest pre-diabetes; if the lowest reading is thirty percent below your baseline, or below 60 mg/cc, you may have reactive hypoglycemia (more accurately called unstable blood sugar), an early stage of diabetes. If the difference between the highest and lowest readings is over 90 mg/cc, it may indicate a problem, as does a drop in sugar level of 60 points or more within an hour. Many other criteria exist to show deviations from normal—all of which take on more importance if other symptoms exist, such as dizziness, trembling, palpitations, brain fog, craving sweets, bingeing or other compulsive eating behaviors. If you have a family histo/'y of diabetes, it is essential that you be properly tested.
Insulin levels should be measured along with your bloodglucose levels, at the fasting and oneand two-hour stages. Your fasting insulin should he below 19 units. One hour after the glucose drink, your insulin should be under 100, and two hours after it should be below 60. I see some people in my practice with readings as high as 600.
Note: The GTT results are not considered accurate unless you are consuming at least 150 grams of carbs a day for at least four days before you take the test. Therefore, doing it after you start Atkins wouM mean you'd have to go back temporarily to eating a highcarbohydrate diet (and almost certainly regain some of the pounds you have just successfully lost).
If your GTF results point to problems in your body's ability to metabolize sugar, this alone should motivate you to change your diet. If your results are normal, you can count yourself fortunate that your new way of eating will forestall any future blood-sugar and insulin problems.
Let me remind you that although the Atkins plan has a positive effect on many conditions, if you have serious health problems, you must see your doctor before starting! You will need his or her help in monitoring your changing metabolism.
Now that you've addressed the medical issues, it's time to ready your kitchen, your loved ones and your own mind set. Don't skip any steps; each one will help make this one of the most rewarding experiences of your life.
TAKE YOUR MEASUREMENTS
Before you begin doing Atkins, use a tape measure to record some vital statistics. Measure your. chest, waist, hips, upper arms and thighs, and write down those numbers! When you measure yourself again in a couple of weeks, you'll be happy you did; the more ways you have of gauging your success, the more encouraged you'll be.
FILL OUT THE BLOOD-SUGAR SYMPTOM TEST
This quiz on pages 150-151 is a great way to quantify how much better you'll soon be feeling. Go ahead and fill it out now but make a copy because you'll do it again in a coupleof weeks, at which point I'm confident it will help spell out exactly how significantly your new way of eating will have affected your quality of life.
CONSIDER ADOPTING AN EXERCISE PLAN
If you aren't already exercising, I strongly urge you to start doing so now. Even a half hour of brisk walking four times a week will make a big difference, especially if you are almost completely inactive now. Exercise has enormous benefits for your health, and will speed your weight loss! It's a critical element of the healthy new you, and its importance cannot be underestimated.
H**E THE RIGHT FOOD ON HAND
Stock the refrigerator and the cupboards with the food you're going to eat, including plenty of your favorite protein goodies. The next chapter will give you complete lists of acceptable and unacceptable foods specified for the Induction phase of Atkins.
When you go to the supermarket or health food store, avoid the aisles where the high-carbohydrate temptations are found. Whenever I give this advice, I think of John Connor. He was a 19-year-old, six-foot four-inch patient who dropped his weight from 290 pounds to 209 in six months by doing Atkins. He told me he'd often go to the supermarket to buy legitimate food, get sucked into one of the sugarsaturated aisles and end up walking out of the store with a package of candy bars. During his drive home, self-control would reassert itself, and he'd lower the car window and throw the package into the street!
What acceptable foods are your favorites? Do you love deviled eggs, turkey, chicken, shrimp salad, cheese? Have all these foods and more readily accessible in your refrigerator, along with plenty of Low-cadbohydrate vegetables and salad makings. I can't stress that enough. Better that a little food should be wasted than you should find yourself framing om of the right foods and tempted by the wrong foods when hunger strikes.
Next, get rid of all the foods and beverages you won't be consuming. This is easiest if you live alone and don't need to worry about what anyone else wants in the refrigerator. Invite friends over to finish off the ice cream. Have a "carb blowout" party{ Give away all your forbidden foods, pethaps to a shelter for the homeless or a food bank. As a last resort, just toss them. Alter your mental picture—for you, these foods no longer exist.
In addition to stocking up on the fight foods, you'H want to purchase a good supply of the nutritional supplements I recommend and lipolysis testing strips, all of which you will learn about in Chapter 11. You'll also want to stock up on the wide variety of controlled carbohydrate foods available in your local health food store, drugstore or in most supermarkets.
GET YOUR LOVED ONES ON YOUR TEAM
If you don't live alone, prepare the people who live with you for the "shock" of your new eating style. Actually, unless your nearest and dearest are vegetarians, it shouldn't be too shocking. You will be eating things you've always eaten, but passing up the dishes and items full of carbohydrates.
If you are the chief cook and bottle washer, unless you can convince the other members of your household to share the Atkins experience with you, you'll simply have to cook for yourself and prepare a few additions for them. If they want bread, potatoes and dessert, you may have to suffer a little temptation, but if you really want to lose weight you'll bite the bullet and not the breadstick.
Keep this comforting thought in mind: Human beings are remarkably adaptable, and, in as little as a week, your tastes will start to change, soon you'll find that sugar and refined carbohydrates don't tempt you as much as they used to. Your other great ally will be the appetite suppression that I've told you is a natural consequence of this nutritional plan.
If, for the first few days, you find it a downer watching other folks eating foods that you're fond of and can't touch, remind yourself that right now weight loss is your destiny. These moments of temptation are fleeting. Tell family mem bers that you need a strong show of support and understanding. You certainly don't want them tempting you with illicit food and saying such inappropriate things as "Don't worry, this tiny piece of cake won't hurt you." It will!
That's What Friends Are For
Some people are lucky—-they don't do Atkins alone. Ernesto and Donna Santiago had the perfect buddy system: The two both wanted to lose weight. Emesto is a construction worker, and, at five feet eleven inches and 258 pounds, this 42-yeer-old was definitely hefty. At five feet nine inches tall Donna weighed 210. One day this 36-year-old saw pictures of herself on videotape and broke clown in teats.
The two of them decided to come to the Alkins Center for Complementary Medicine and soon began doing Atkins.
Ernesto says: "When I was tempted to cheat, Donna helped me stay strong. And when she was temptad, I'd help her." As they were slimming clown, they started taking martial arts classes together, and this brought them even closer. After two months doing Atkins, they had each dropped 30 pounds. It took about eight months for Donna to reach 147 and Ernesto to get down to 182. I've seen pictures of them training in jujitsu, and they look like a pretty trim couple to me. Incidentally, Donna lowered her LDL cholesterol from 189 to 137 and raised her HDL from 58 to 74. And Ernesto lowered his LDL from 159 to 126 and raised his HDL from 42 to 62. No cardiologist could ask for anything more.
It is often easier to try something new if you have a partner to share your experience with. if you don't have one, come to our website at www. Atkinscenter, com. We'll serve as your surrogate partner and help reinforce that your efforts will provide you with a healthier life. Or find a friend or co-worker to support each other's efforts.
Tell people in advance that you take Atkins seriously and that you'd appreciate their doing the same. We all know what a tricky, emotion-laden-business food is. It's not uncommon for families to have issues surrounding food. I un. derstand that the other people in your house may not be entranced with your new eating regimen, in the nicest possible way, tell them it's your lifestyle, not theirs. All they need to do is show respect for the major decision you've made. You're about to lose a lot of weight and gain a lot of health. After you've done Atkins, you won't need to request respect for it; the results will speak for themselves.
A Matter of Morale
PsychologicallY, have you made a firm commitment? Don't start something this important with the shallow notion of "Oh well, I'll give it a whirl:' At the least, you should have decided that you're going to commit two weeks of your life—without deviation or compromise—-to doing Atkins.
If you can commit yourself to that, I expect great things for you. By the end of two weeks, you'll be walking with new energy, getting out of bed in the morning with new zest and joyously anticipating your encounters with the bathroom scale. You'll be so impressed with how you look and feel, continuing with the program for life will be a foregone conclusion!
A note about that new energy and zest: Are you ready to increase your current level of physical activity? Another important step in getting ready is to read Chapter 22 and have your exercise plan in place. (You .may not want to implement this plan, however, until after the first two days on Atkins. In that forty-eight-hour period, you may feel tired and a bit off-kilter as your body makes its conversion from burning glucose to burning fat as its primary fuel.)
KEY POINTS!
·Over-the-counter and certain prescription drugs can interfere with weight loss.
·Get a medical checkup to determine your overall physical health and have blood and other tests done that will serve as a baseline for comparison later.
·A fivc-hour glucose-tolerance test with insulin levels will evaluate the degree of stress on your glucoseinsulin-regulating mechanism before you begin Atkins.
·Typically, after six weeks doing Atkins, you can expect to see improvement in virtually all health indicators.
·Practical and psychological preparation is also key to success on Atkins.
A FREQUENTLY ASKED QUESTION:
My cholesterol has gone up since I started doing Atkins. What can I do about it?
Examine the foods you've been eating. Have you been doing Atkins correctly? If you are just starting, be sure you follow the Rules of Induction (see Chapter 11). You may also want to consider a couple of other things that could be happening. First, the increase might be temporary. When a person loses weight, cholesterol usually rises because the body must break down stored fat for energy. Your total cholesterol should drop within two months.
Also, remember to look at your HDL (good cholesterol) levels. A rise in total cholesterol levels could even be a good thing, if it's all attributed to HDL cholesterol. Total cholesterol may temporarily go up due to the rise in HDL.
If you've bceri following the Atkins Nutritional Approach for some time and your cholesterol levels have not come down, something else is going on. Exercise is an important component, as is cutting back on processed meats, such as bacon, sausage and cold cuts, and limiting your intake of hard cheese. You may also need to look at a third component of your blood tests: triglycerides. Cholesterol rises in some people when triglycerides drop significantly. If that drop is greater than the LDL increase, your lipid profile may, again, be improved overall.
High cholesterol that has a genetic component usually responds to changes in diet, but may be difficult to address with diet alone. You may still need to take supplements such as pantethine, essential oils, garlic and fiber. For a detailed discussion of cholesterol-lowering nutrients, see Dr. Atkins' Vita-Nutrient Solution.
TIPS:
·Give your high-carb foods to a soup kitchen or homeless shelter.
·Stock the pantry and refrigerator with your favorite protein goodies.
·Your children may have inherited your blood-sugar irabalances. Eliminating sugarand white-flour-laden junk food from their diets too may be the greatest gift you ever give them.
·Ask your family and friends for their support. Find an Atkins buddy to share your weight loss journey.
CAUTIONS:
·People with severe kidney disease should not do Atkins.
·The weight loss phases of the Atkins Nutritional Approach are not appropriate for pregnant women and nursing mothers.
·If you are currently taking diuretics, insulin or oral diabetes medications, you must undertake Atkins only under the guidance of a physician. Your decreasing reliance on these medications must be monitored and carefuUy adjusted.