Atkins Diabetes Revolution (30 page)

HOW MUCH FIBER IS ENOUGH?

New dietary guidelines from the Institute of Medicine recommend that women should get 21 to 25 grams of fiber daily and men 30 to 38 grams daily.
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Not surprisingly, given our high refined-carbohydrate diet, the average American typically gets only 16 grams of fiber a day.
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Although it’s obvious that the average American is not getting enough fiber to fulfill the standard recommendations, it’s difficult to put a number on exactly how much fiber you really need. Keep in mind that these recommendations were developed based on studies of people whose diets did not restrict carbohydrate intake.

If you eat at least five standard servings of fresh vegetables and salad greens every day, you still might not take in the recommended amount of dietary fiber, but you would, so long as you’re doing it properly, be getting excellent nutrition and probably more high- quality fiber than most Americans. Even if you need to restrict your carbs to the Induction level of 20 grams,you’ll still be getting five servings per day.

At the very least, the amount of fiber in your diet should be the amount necessary to maintain comfortable bowel movements. That amount can vary considerably from person to person.When you follow the ABSCP,you may well end up eating more fiber than you did on your high-carb diet.Once you remove the refined carbs and start eating a lot of leafy greens, low-glycemic-index vegetables, nuts and seeds (see the AGR charts beginning on page 467), you’ve already made a beneficial change.

You may certainly add a fiber supplement to increase your fiber in- take. Remember that any dietary change may change your bowel pattern temporarily. Attempt to maintain a bowel pattern that is normal for you—most people will have a comfortable bowel movement at least every other day. If you had frequent diarrhea prior to starting the ABSCP, you may experience fewer loose stools.

Sheila W. is a patient of mine who had part of her colon removed. For several years she avoided lettuce and other raw veggies because of rapid onset of diarrhea after consuming these foods. She began the ABSCP to support a family member who was using it to address metabolic problems. To her amazement, Sheila’s bouts of diarrhea disappeared with a controlled- carb plan. She was able to reintroduce salads and other raw veggies without needing to stay near a restroom.
    —M
ARY
V
ERNON

For proper bowel function, be sure to drink eight 8-ounce glasses of water each day and engage in regular exercise. As you know, these are integral components of both the ANA and the ABSCP.Experiment a bit with your vegetables to find higher-fiber choices you enjoy. You might try substituting chicory for some of the other salad greens, for example. One cup of chicory has 7 grams of fiber and only 1 gram of Net Carbs. Compare that with 1 cup of shredded romaine lettuce, which has only 1 gram of fiber and about ½ gram of Net Carbs. With such small adjustments, you come out way ahead on fiber without adding very much at all to your Net Carb count for the day.

To increase dietary fiber, try a dose of crushed flaxseeds or un- processed bran.Both these excellent natural remedies for constipation are available at any health food store. Stir 2 teaspoons of flaxseeds into a glass of water and drink it down in the evening, or sprinkle them on your salad at dinner—you’ll probably get results the next morning. The advantage of flaxseeds is that in addition to your dose of fiber you get some additional omega-3 fatty acids, plus some extra magnesium and zinc. If you don’t like flaxseeds or find them inconvenient, an alternative is a bulk-forming fiber supplement made from psyllium (Fiberall, Metamucil). To avoid adding sugar, select only the unflavored, sugar-free form of these products and follow package directions. Because the digestible fiber from flaxseeds and psyllium passes through you instead of being absorbed, the Net Carbs per dose are basically zero. (Have your flaxseed or psyllium dose a few hours apart from any medications and supplements.If you take them together,the fiber may block your absorption of drugs or supplements.)

Increasing your fiber intake too rapidly, whether from high-fiber foods or from a supplement, can cause digestive upset, including gas, bloating, cramps, and diarrhea. To minimize these problems, increase your intake gradually by adding a little more fiber every few days and giving your digestive system a chance to adjust.

When you eat fresh, low-carb vegetables, nuts, seeds, and lowglycemic fruits, you get not only fiber the natural way, but also lots of other important nutrients. Read on to the next chapter to learn more and realize how varied and delicious your diet will be as you follow the Atkins Blood Sugar Control Program.

WHAT’S YOUR FIBER IQ?

1. The two kinds of dietary fiber are:

1. digestible and nondigestible
   
2. edible and inedible
   
3. fructose and sucrose
   

2. How do you find the Net Carbs per food serving?

1. subtract the carbs from the fiber
   
2. subtract the fiber from the carbs
   
3. add the fiber and the carbs
   
4. divide the carbs by the fiber
   

3. Which foods are good sources of digestible fiber?

1. chicory
   
2. peas
   
3. apples
   
4. beans
   

4. Which foods are good sources of nondigestible fiber?

1. celery
   
2. nuts
   
3. collards
   
4. oranges
   

Answers

them.4.a,b,c.
1.a.2.b.3.all of

Chapter 16

THE BOUNTIFUL HARVEST

Vegetables offer an amazing variety of flavors,colors,and textures.But there’s more to vegetables than just their great looks and tastes.A basic principle of the Atkins Blood Sugar Control Program (ABSCP) is that you trade in low-quality, low-nutrient foods (such as refined carbohydrates) for high-quality, high-nutrient foods—and the majority of vegetables fall into the latter category.

Simply replacing poor-quality carbs with high-quality veggies may be enough to make an improvement in your blood sugar. It’s a winwin situation: When you begin eating a greater variety and quantity of vegetables, you realize that they taste so good you won’t really miss re- fined carbs. Plus, vegetables are packed with the nutrients that are missing in most refined carbohydrates. And they’re a rich source of fiber, which can help to stabilize your blood sugar levels. If your daily carb allowance will let you, you can also enjoy many of the same benefits from low-glycemic fruits.

LAYING THE FOUNDATION

Fresh vegetables and low-glycemic fruits are important in the ABSCP because eating these foods can help stabilize your blood sugar—if you eat them instead of refined carbohydrates. People who choose to eat this way early on may actually protect themselves from developing blood sugar problems.

RESEARCH REPORT: VEGETABLES AND HEART HEALTH

In addition to helping to prevent and treat diabetes,all those servings of asparagus, broccoli, cauliflower, and their kin are essential for helping prevent cardiovascular disease. If you have the metabolic syndrome, prediabetes, or diabetes, you know your risk of heart disease and stroke is sharply elevated—and you can use all the help you can get in this area. Let’s look at the results from a recent study that examined the connection between vegetable and fruit intake and the risk of cardiovascular disease.The study,published in 2002 in the
American Journal of Clinical Nutrition,
looked at almost 10,000 adults who had been followed for nearly 20 years as part of the first National Health and Nutrition Examination Survey.
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Among the study participants, those who ate vegetables and fruits three or more times per day had a 42 percent lower risk of dying from a stroke compared with those who ate produce once a day or not at all.The produce eaters also had a 27 percent lower risk of dying from cardiovascular disease, a 24 percent lower incidence of death from clogged arteries causing heart disease, and a 15 percent lower risk of dying from any cause.
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A study published in 1999 helped to provide more support for the importance of eating vegetables.Eleven hundred subjects completed a food frequency questionnaire and underwent a glucose tolerance test. Those who ate salad and raw vegetables had significantly less incidence of Type 2 diabetes and impaired glucose tolerance than those who ate salad and raw vegetables infrequently. Notably, there was not a statistically significant difference recorded in glucose measurements for those who ate fruit.
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This confirms the benefits Dr.Atkins observed in his patients when they consumed the minimum recommended amount of vegetables. When you’re doing Atkins properly, of course, you should be eating a minimum of five servings of vegetables a day.

VEGETABLES AND BLOOD SUGAR

What is it about vegetables that makes them so good for you? Well, they are generally pretty low in carbs, and almost all nonstarchy vegetables are both low on the glycemic index (GI) and low in glycemic load (GL). Just by replacing high-carb, high-GL foods with low-carb, low-GL foods—substituting broccoli for a baked potato, for instance—you will improve your blood sugar levels. But there’s more to it than that. What may be just as important is that these foods are packed with fiber, antioxidants, vitamins, minerals, and phytonutrients. We know that these nutrients are particularly important if you have the metabolic syndrome, blood sugar abnormalities, or diabetes.

FANCY FRUIT—IN MODERATION

Now let’s take a detour to talk about fruit, before we return to vegetables. Overall, fruits are higher in carbs than an equivalent serving of vegetables.That’s why when you do eat fruits,you should have them as a snack with a food containing protein and fat, or eat them as dessert after a meal that contains protein and fat. Doing so helps keep the sugar in the fruit from entering your bloodstream too quickly. To avoid getting too many carbs from fruits, be aware of portion size. A typical fruit portion on the ABSCP is one small apple, half an orange, or a ½ cup of red grapes or blueberries.

When you get to the point in the program where you can add fruits, begin with those on the “eat regularly”list of the AGR (check the AGR charts beginning on page 467). If you need to limit your carbs, these foods must now be only occasional treats that are always eaten with protein and fat. The few fruits, such as bananas and raisins, that fall into the “eat sparingly” category are basically off-limits if your carb threshold is 60 grams of Net Carbs a day or less.

When you begin to add fruit to your diet,start with only a few servings a week, carefully observing your symptoms and blood sugar response. If you notice that your blood sugar goes above 140 mg/dL 90 minutes after a meal,or if you experience sensations that you associate with blood sugar ups and downs, then hold off on fruit. Perhaps your metabolism has not yet improved enough to allow the level of natural sugar in fruits.In that case,if you’re at the stage where you want to add more carbs to your daily allowance,opt for more low-glycemic vegetables instead and then try adding small amounts of fruit again at some point in the future.

If your insulin/blood sugar metabolism is severely compromised, you may at best tolerate only one serving of fruit a day.As time goes by and your insulin/blood sugar improves, you may be able to increase the amount of fruit you eat, but you’ll probably always have to be aware of portion size.

WHAT’S A SERVING?

We strongly recommend that you eat,at the very least,five servings a day of fresh low-glycemic, low-carb vegetables—more if your daily carb budget allows. We also recommend that if you are consuming between 20 and 40 grams of Net Carbs a day,you eat no more than two daily servings of fruit (other than olives, avocados, or tomatoes, which are regarded as vegetables even though they are actually fruits). What’s a serving? In the ABSCP,a vegetable serving is 1 cup of raw leafy greens or
1/2
cup of cooked nonstarchy vegetables, such as broccoli or Brussels sprouts. In the case of vegetables like tomatoes or spinach, which cook down significantly,be sure to measure them raw to avoid overconsumption of carbs.A fruit serving is one small fruit,such as an apple,or
½
cup of berries. Be aware of portion size and check your carb gram counter when in doubt.

HOW ARE WE DOING?

After more than a decade of advertising and public education about the nutritional value of vegetables and fruits,how is the average American doing? Not that well. Between the years 1990 and 1996, according to a 2000 study,only about 45 percent of Americans actually ate five or more servings a day.This is up from 32 percent between 1989 to 1991.
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That is an improvement, yet more than half of American adults are still below the minimum recommended amount.

But here’s the bad news: The nutritional quality of those fruits and vegetables is still low. Only five fruits and vegetables accounted for 30 percent of consumption: iceberg lettuce, tomatoes, French-fried potatoes, bananas, and orange juice. In other words, a significant portion of the fruits and vegetables the average American eats is either very low in nutrients (iceberg lettuce) or high in carbohydrates (bananas and orange juice), or both (French fries). While tomatoes are fairly low in carbs and are a good source of vitamin C, lycopene, and fiber, the average daily amount eaten was only half a standard serving, or about the amount that comes on top of a fast-food burger.

In the same study, the researchers found that for the average person, white potatoes represented 30 percent of total vegetable intake. Of that 30 percent, one-third was French fries. By comparison, broccoli made up only 0.4 percent of vegetable intake. Only 3 percent of the population eats any broccoli on any given day! Although nutritionists classify the potato as a vegetable, it really belongs in the same category as other high-GI carbohydrates such as pasta. In terms of glycemic response, eating potatoes is almost exactly the same as eating an equivalent amount of pure sugar. In fact, it’s worse—a baked potato or a serving of French fries will spike your blood sugar and insulin levels even faster and higher than eating a candy bar.
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