The Low-Carb Diabetes Solution Cookbook (3 page)

If you have been diagnosed with diabetes or prediabetes, you are profoundly carbohydrate intolerant. This is what diabetes is: an inability to safely metabolize carbohydrates. It is bewildering to us that so many authorities recommend a low-fat diet rich in carbohydrates for people with diabetes, prescribing medication to “cover” the carbohydrate intake. We see this as akin to giving a peanut-allergic child a peanut butter sandwich and then injecting him with epinephrine and giving him steroids. It makes no sense. It is a losing game.

We at HEAL have a simpler, more elegant solution: Stop eating what's making you sick.

HEAL patients achieve actual, normal blood glucose levels—and with them, the cessation of that “inevitable” damage.

HEAL Diabetes & Medical Weight Loss Clinics are the outgrowth of Dr. Westman's research and clinical experience, and his determination to bring his simple but profound low-carbohydrate protocol to people across the United States.

HEAL also draws on the vast experience of Jacqueline Eberstein, R.N. For thirty years, she was the director of medical education at the Atkins Center for Complementary Medicine. During that time, she supervised the treatment of thousands of people with diabetes by slashing their carbohydrate intake to 20 grams per day.

Dr. Westman first saw carbohydrate restriction used in a clinical setting when he visited the Atkins Center in 1999, after observing its success in a few of his patients. It changed the course of his career. He met Robert C. Atkins, M.D., and Jackie Eberstein and persuaded Dr. Atkins to fund clinical research on low-carbohydrate diets. That research led to the HEAL Protocol.

According to Dr. Westman, the link is a no-brainer: “It's taught in Physiology 101 that what raises blood sugar is carbohydrates in the diet. There's no controversy about that.” Accordingly, Dr. Westman started putting people with diabetes on a very low-carbohydrate diet—with a daily maximum of just 20 grams of carbohydrate.

The result? To date, 95 percent of people with diabetes who stick to the protocol achieve
normal
blood sugar, 100 mg/dL (5.5 mmol/L) or less, while reducing or eliminating the need for medication; 75 percent eliminate medication entirely.

You don't have to wince at every step. You don't have to go blind. You don't have to wind up on dialysis, undergo a foot amputation, or die young. You don't. You can be well—free of the constant worry and the medical treadmill. You can have normal blood sugar.

All you have to do is stop eating what's making you sick.

At the same time, HEAL medical advisors dramatically cut medication, because dosages of diabetes medications are based on the assumption that patients will be eating carbs. It is HEAL's aim to have people with diabetes completely medication free, with normal blood sugar. Not controlled blood sugar. Normal blood sugar.

In nutrition, “essential” has a specific meaning: Your body must have it
and
cannot make it itself no matter what other nutrients you eat. Your body needs a little bit of glucose (the simple sugar we mean when we say “blood sugar”), it's true, but only a very little bit; a healthy person should have only 5 grams of glucose in his or her bloodstream at any time. That's just over a teaspoon. Your body can easily make this much glucose in your liver, a process called gluconeogenesis
.
(Indeed, many
people with diabetes are all too good at gluconeogenesis; this is what causes elevated blood sugar on rising, often called the “dawn effect.”)

On the HEAL program, you will shift from being a sugar-burner to being a fat-burner, converting free fatty acids and ketones into energy. The medical term for this dietary approach is “ketogenic diet.”

A ketogenic diet shifts the body to burning fat for fuel. We do this by removing carbohydrates, which are overwhelmingly the main source of glucose. You've read that various exercise programs will put you in your “fat-burning zone”? There's a more direct route: Stop giving your body carbohydrates, and it will adjust and start burning fat for fuel. Ketones are a breakdown product of that process and are also a form of fuel.

However, many people misguidedly believe that ketones are dangerous and even poisonous because they are usually discussed in the context of insulin-dependent diabetes, in the form of
ketoacidosis
. For example, the Joslin Diabetes Center states: “Without enough insulin, glucose builds up in the blood. Since the body is unable to use glucose for energy, it breaks down fat instead. When this occurs, ketones form in the blood and spill into the urine. These ketones can make you very sick.” In this condition, not only are ketone levels elevated far beyond levels induced by carbohydrate restriction, but blood glucose levels are also dangerously elevated. In addition, the blood becomes acidic.

Nutritional or dietary ketosis is a distinct con-dition. Because carbohydrates are strictly limited, blood sugar cannot rise dangerously. There is no runaway buildup of ketones, sugar, or acids in the blood.

Because modern diets revolve around grains and sugars, there has been an assumption that glucose is the “normal” fuel of the body. But ketones are produced any time you burn fat for fuel, and any time you fast, even just overnight. If you are burning fat, you are producing ketones. The more of your fuel you derive from fat, the more ketones you will create. The Joslin Diabetes Center also advises, “Positive ketones are not a problem when blood glucose levels are within range and you are trying to lose weight.” This is exactly the condition you want.

In the
Journal of the International Society of Sports Nutrition
, we find this useful description: “During very low carbohydrate intake, the regulated and controlled production of ketone bodies causes a harmless physiological state known as dietary ketosis. Ketone bodies flow from the liver to extra-hepatic tissues (e.g., brain) for use as a fuel; this spares glucose metabolism via a mechanism similar to the sparing of glucose by oxidation of fatty acids as an alternative fuel. In comparison with glucose, the ketone bodies are actually a very good respiratory fuel.
Indeed, there is no clear requirement for dietary carbohydrates for human adults
.” (My italics.)

One more thing about ketones, and a cheerful thing it is: They suppress appetite, often to a remarkable degree. Sure makes it easier to walk past the doughnuts.

If you are managing your diabetes with medication, your dosages have been prescribed based on the assumption that you will eat a certain quantity of carbohydrate foods with each meal. If you simply stop eating carbohydrates while continuing medication, you risk severe hypoglycemia (abnormally low blood sugar), even insulin shock. This is potentially fatal. For this reason,
it is imperative that you be under
a doctor's supervision while making this transition.

At HEAL Clinics, it is standard to both discontinue oral hypoglycemic drugs and halve insulin dosages from the first day. From there, blood sugar is closely monitored, and drugs adjusted up or down as needed. A doctor's supervision is essential during this process.

If you are not on medication, and do not yet have true diabetes, go ahead and cut out carbs. It's a wonderfully healthful way to eat. And no, you won't wind up “carb deficient.”

In 1956, a pair of British researchers named Kekwick and Pawan published in
The Lancet
their groundbreaking study of the effect of the kind of calories eaten—carbohydrate, protein, or fat—on weight loss. They found that patients could gain a little weight on 1,000 calories per day of carbohydrate, while losing a bit on 1,000 calories per day of protein, and losing far more on 1,000 calories per day of fat. The same patients, when the diet was liberalized, would maintain or even gain weight on 2,000 calories per day of a “mixed” or “balanced” diet, but would lose weight easily on 2,600 calories per day of a protein and fat diet, with very little carbohydrate. For those of you who have struggled miserably to lose weight on 1,200 calories per day, this is very good news indeed.

In 1971, the
American Journal of Clinical Nutrition
published a study of moderately obese college men assigned to diets that had the same calorie count—1,800 per day—and the same amount of protein. However, one group got 104 grams of carbohydrate per day, another 60 grams, and the third 30 grams. The result? “Weight loss, fat loss, and percent weight lost as fat appeared to be inversely related to the level of carbohydrate in the isocaloric, isoprotein diets. No adequate explanation can be given for weight loss differences.” In other words, with calorie and protein intakes kept identical, the lower the carbohydrate intake, the greater the weight and fat loss—and the researchers did not know why.

In a 2003 study of obese adolescents at Schneider's Children's Hospital in New York, kids were given either a low-fat diet or a low-carbohydrate diet for twelve weeks. The low-carb eaters lost twice as much weight as those in the low-fat group, while eating, on average, 60 percent more calories. Kids have an edge, since they're growing, but that's still a heck of a difference.

Despite the old refrain of “a calorie is a calorie is a calorie,” we have ample evidence that the body,
being a complex living system, reacts differently to different kinds of calories, and that carbohydrate restriction gives a metabolic edge.

Add to this three other things:

You'll be getting access to all that stored fuel you've been carrying around. As your insulin levels drop, your body will relearn how to use that fuel and will finally start to burn it.

If you have genuine, physical addictions to some carbohydrate foods, most commonly sugar and wheat, consuming the addictive substance only drives further cravings. Cut the addictive substance out, and physical sanity will reinstate itself.

And you will be less hungry. Between the satiating effects of protein and fat, the stabilization of your blood sugar so you no longer are battling crashes, and the appetite-killing effects of ketones, you are likely to find that you are automatically eating the right quantity of food for your body. Combine that with the metabolic advantage of a low-carbohydrate diet, and the weight will start coming off.

This means that many foods you have considered healthful are not. The starches suggested by the National Institutes of Health in their booklet
What I Need to Know about Eating and Diabetes
—including bread, potatoes, tortillas, pasta, rice, corn, crackers, yams, pretzels, and cereal—all will spike your blood sugar as much as, or more than, an equivalent quantity of table sugar.

How about fruit, juice, honey, and natural sugars? They're still sugars. No matter the source, a glucose molecule is a glucose molecule.

For the moment, ignore it all. You have just one job: Keep your total carb intake to 20 grams per day or fewer. That's it.

I'm not saying that none of that endless advice has merit. I, by way of example, buy grass-fed butter, raise my eggs in my backyard, and don't eat gluten.

But I have been eating this way for twenty years now. I'm comfortable with it. I'm clear on what is and is not loaded with carbs. You, on the other hand, are a newbie. Focus on carbs. Just carbs.