did these bold nutritional adventurers lose weight and feel fine, but they nearly always also showed improvements in their blood-lipid chemistries, which-when it comes to predicting the future-are the holy grails of medicine.
No doubt many doctors raised as disciples of the low-fat creed looked at those results and wondered: Why? How does following Atkins do it? Why doesn ' t those people ' s cholesterol go up? Why do they seem so healthy? What does the guru of controlled carbohydrate eating know that I don ' t?
Many of them-because doctors are an inquiring bunch-have since started to learn what I already knew. It never was a secret formula hidden away in a locked laboratory. The " secret " has been published repeatedly right out in the open in many of the world ' s most respected medical journals. The research that has made controlled carbohydrate nutrition so popular today was trotting along steadily in the 1970s and 1980s; by the late 1990s it was moving at a fast canter, and it is positively galloping now.
So here it is, and you should know it.
The Cluster Effect
What we are learning-careful readers will not be surprised-is that the risk factors for heart disease cluster together. A very prominent cluster is found among the overweight. A little over a decade ago, Norman Kaplan, MD, of the University of Texas ' s Southwestern Medical Center, dubbed four risk factors the " Deadly Quartet." These four-upper-body obesity, glucose intolerance, high triglyceride levels and hypertension-were consequences of a single cause. That cause was our old friend, hyperinsulinism.
Kaplan made a diagram to make this relationship clear.
Hypertension
Glucose | Intolerance-- Hyperinsulinemia-- Hypertriglyceridemia
| Upper-Body Obesity
Kaplan had the good sense to notice the obvious. These conditions, he reasoned, occur in subjects with high insulin levels, and are likely to coexist in the same person. Thirtynine million people in the United States are obese( twenty percent over ideal body weight) 2, and fifty million people are hypertensive. Among the obese, hypertension is three times more common than among the non-obese. High triglyceride levels are twice as common among the obese than among the non-obese. The association is even stronger if one includes patients with upper-body obesity. The middle-aged man ' s paunch is related to metabolic factors that put him at risk for a heart attack.
If you still wonder how strong these associations are, listen to Albert Rocchini, MD, a medical scientist at the University of Minnesota. He writes: " It has been estimated that by the fifth decade of life, eighty-five percent of diabetic individuals are hypertensive and obese,
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