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Jacqueline A. Eberstein, R.N. worked closely with Dr. Robert Atkins for 30 years in a number of capacities including a full time practitioner of complementary medicine. She is co-author of Atkins Diabetes Revolution and is presently a consultant in controlled carbohydrate nutrition.
Are ketones a healthy or an unhealthy sign?
Ketones in the urine can be a danger sign if your blood sugar is too high and insulin levels are too low. It can indicate acidosis, an abnormal condition usually occurring in people with out of control type 1 diabetes requiring immediate medical attention. Ketones can also occur because of other metabolic conditions.
However, if you have ketones in your urine simply because of following an Atkins program, then it is actually a good sign. You are burning dietary fat or your excess fat stores. Contrary to the misinformation regarding ketones while low carbing, they do not cause acidosis even if you are a type 2 diabetic: this is true as long as your blood sugar is well controlled. The ability to use ketones as a source of energy for the body is programmed into our system for survival. Ketones are an alternate fuel source. The heart can use ketones for fuel under normal circumstances, as can the brain.
Is a calorie always a calorie when trying to lose weight?
For weight management, we hear that it’s only about calories in and calories out. This concept was created in a laboratory under controlled conditions. We know that our bodies are not as well controlled as a lab experiment. Nor are we all alike. Thus one size does not fit all when it comes to losing and maintaining a healthy weight.
Beyond calories, there are a number of factors that influence our ability to lose weight. Several studies have documented a metabolic advantage when following a low carb program. In one study, one group ate more calories and lost more weight than the control group that ate a higher carb but lower fat and protein intake.
Not all foods have the same hormonal effects in our bodies. Foods that have a larger glycemic response can stimulate excessive insulin, leading to increased fat storage. For this reason, a person with a family history of diabetes or with metabolic syndrome is likely to be more carb sensitive. This can lead to a difficult time managing weight on a low calorie, high carb plan, compared to low carb.
A higher protein intake replacing poor quality carbs decreases hunger, allowing you to find the right amount of food without actively counting calories. Adherents to the calorie theory often quote the first law of thermodynamics as an absolute. They ignore the second law, which points to a metabolic advantage.
The lesson from all of this is that to manage your weight, find the lifestyle that works for you: one that controls your hunger and normalizes your lab values. Then follow that plan for a lifetime.
Does higher protein intake stress kidneys?
We often hear this statement. Even the guidelines for a “healthy” diet recommend that we consume about 15% of our calories from protein. Is there proof that increasing protein beyond 15% damages healthy kidneys? The answer is no. The recommendation to limit protein came from research done on people with end stage kidney disease, not people with normal kidney function. This was then expanded to include everyone. People with existing kidney disease are often placed on a low protein diet.
People with diabetes are especially cautioned about protein. Yet kidney complications from diabetes are caused by high blood sugars, not protein intake. If you are following a low carb plan, it is likely that blood sugars are better controlled than if you are eating the 60% carb diet recommended by many. Practitioners who use low carb diets for patients with diabetic nephropathy have noted improved urine markers over time because of better glycemic control. Note that changing your diet if you have diabetes requires oversight by your healthcare provider.
What are the benefits of increasing my protein intake?
Increasing protein, especially by replacing high glycemic carbs (as is recommended in an Atkins type diet), can lead to easier weight management. Hunger is better controlled with the regular intake of protein. Research has demonstrated this.
Include protein at each meal and snack time. It is especially important to start off the day with a breakfast that contains protein, to ensure a more stable blood sugar. When your blood sugar is more stable, energy and moods are more even. One recent study demonstrated that an egg-based breakfast controlled hunger better and lead to a more controlled calorie intake for the next 36 hours, compared to a bagel-based breakfast with the same calorie intake.
It is thought that our ancestral diet contained at least twice as much protein as the 15% now recommended for a “healthy” diet.
There are a number of supplements to consider. For starters, a good iron-free (unless your doctor specifically recommends iron) multivitamin/mineral is the foundation. One study showed that people with diabetes who took a multivitamin had fewer infections than those in the control group.
Chromium is a mineral that is useful for better insulin/blood sugar control. It is thought that 90% of Americans’ intake is too low in this very important mineral.
Antioxidant nutrients such as Vitamin C and E are also quite useful, because high blood sugar levels increase oxidative stress leading to cellular damage. Both nutrients have a positive impact on blood vessel health.
Magnesium levels are often low in people with diabetes. It is one of the most important nutrients for heart health and insulin and blood sugar regulation.
Calcium stimulates the pancreas to make insulin and can be useful, especially in those whose insulin levels are dropping due to loss of beta cell function. It is important to get enough calcium if you are taking metformin.
Zinc levels are often low in people with diabetes. Zinc is needed to make a number of antioxidant enzymes in the body, as well as in the production of insulin and insulin transport of glucose.
For decades alpha lipoic acid has been used to treat diabetic neuropathy in Europe. It is a part of Dr. Atkins’ protocol for this condition and is quite effective, along with B vitamins.
For people taking statins. co enzyme Q 10 should be supplemented. This very important nutrient has many vital functions, and its manufacture is blocked by statin drugs.
To design your nutrient protocol it is helpful to find a practitioner who has experience with supplementation.
Are sugar alcohols in low carb products a concern?
There are a number of types of sugar alcohols used in low carb or some sugar free products. They are usually less sweet than sugar, are absorbed less rapidly, and contain about 1/2 to 1/3 less calories than sugar.
There are two concerns. The first is the impact on the gastrointestinal tract. Gas, bloating, abdominal pain, and diarrhea are common side effects, especially in amounts of more than 25 grams daily. Many people are sensitive to smaller amounts of sugar alcohols. Each person needs to find a comfort level. The best tolerated are usually maltitol and erythritol.
Even though sugar alcohols are slowly absorbed, there can be some conversion to glucose, thus having an impact on blood sugar levels. This is especially problematic in those with diabetes. If you are going to use products with sugar alcohols, choose those with the smallest amount per serving and check your blood sugar level about 90 minutes after eating. Note that lactitol and xylitol have little or no conversion to glucose.
One word of caution: any product containing sugar alcohols should be used judiciously. Remember that the Atkins lifestyle is about eating whole foods. Products are not necessary to successfully do Atkins.
How often should I weigh myself when following an Atkins program?
It is normal to have variations on the scale within each day and from day to day. These variations are usually because of changes in water balance. This is especially true during hot, humid weather and for women before the menses. Certain medications can also cause water retention.
When starting a low carb plan, weigh yourself first thing in the morning without clothes. Take the following body measurements: widest part of the upper arm, chest or bust; waist (area around the navel); hips (usually about 8 inches below the navel); and widest part of the upper thigh. Record these readings in a diary. Weigh weekly and take repeat measurements every two weeks, always measuring the same side of the body.
Because there are times when scale changes will be erratic, it is best to pay attention to loss of size rather than weight. Many people have gotten discouraged and failed when dieting by having unrealistic scale expectations or not understanding all the reasons that lead to shifts in fluid balance. Have a size goal in mind rather than a weight goal.
Some people, especially women, are so addicted to their scales that they weigh numerous times a day. This is a path to failure. If you have a scale addiction, increase your chances of success by putting your scale out of sight.
There can be a significant loss of inches when low carbing that is not reflected on the scale. As your large size clothes get too big, enjoy getting them tailored or donating them. You have reached your goal when you are comfortably in your goal size.
Is it true that if we eat a balanced diet, vitamin supplements are unnecessary?
It is unfortunate that this statement is still frequently heard from nutrition experts, even though research is piling up on the benefits of certain nutrients beyond the amounts available in food.
Even if we ate the perfect diet, there are numerous reasons why supplementation is helpful. Soil depletion, use of pesticides and chemical exposure, and loss of nutrients in transporting food and in cooking can leave us with less than ideal amounts of available nutrients.
Since most people don’t eat a perfect diet, some health experts recommend that all adults take a multivitamin each day to make up for shortfalls in their diet. This is a smart recommendation. We still need to make healthy food choices because a supplement by itself will not make up for a poor diet.
Beyond that, many common medications deplete nutrient levels. Chronic stress increases our need for certain vitamins, and refining of foods often removes important nutrients that were present in the whole food. A good example is chromium, needed for blood sugar control. Much of it is lost in processing, leaving 90% of Americans with intakes that are too low.
This is true of other nutrients as well. Vitamin D is a good example: Recent research suggests that larger than recommended intakes may be protective for a number of serious illness, including autoimmune illnesses, cancers, and even heart disease. Of course, vitamin D is important for bone health in the young. As we age and make less D, causing less absorption of calcium, our bones can be at risk.
There are not many good food sources of vitamin D. Sun exposure is needed to manufacture vitamin D in the skin. Sunscreens, dark skin, time of day, latitude, and season can affect vitamin D levels.
The best form of D is D3. Unfortunately, some foods fortified with D contain D2, not a well absorbed or very effective form.
There are numerous other examples of the importance of supplementation. It is always best to work with a practitioner familiar with nutritional therapy to determine which supplements will meet your needs and their correct doses.
Mar 1, 2007
Diabetes Health is the essential resource for people living with diabetes- both newly diagnosed and experienced as well as the professionals who care for them. We provide balanced expert news and information on living healthfully with diabetes. Each issue includes cutting-edge editorial coverage of new products, research, treatment options, and meaningful lifestyle issues.