1. ATKINS NUTRITIONAL APPROACH From weight loss to lifestyle Jacqueline A. Eberstein, R.N.

2. Rationale: Atkins Lifestyle Stored fat is the body’s backup fuel source. Stored fat is the body’s backup fuel source. The body cannot store more than a 2 day supply of carbohydrate. The body cannot store more than a 2 day supply of carbohydrate. In the absence of significant dietary carbohydrate and adequate protein, fat becomes the primary fuel. In the absence of significant dietary carbohydrate and adequate protein, fat becomes the primary fuel. The steady burning of fat produces more energy while dramatically decreasing appetite. The steady burning of fat produces more energy while dramatically decreasing appetite.

3. From glucose burning to fat burning metabolism The lipolytic pathway is the second of two primary pathways for energy The lipolytic pathway is the second of two primary pathways for energy The body can readily produce the enzymes involved in fat mobilization (lipolysis). When fat is burned for energy ketones are produced. The body can readily produce the enzymes involved in fat mobilization (lipolysis). When fat is burned for energy ketones are produced. When fat is being mobilized, it neither accumulates nor deposits. When fat is being mobilized, it neither accumulates nor deposits.

4. The truth about ketones Ketones are produced on any weight loss plan where fat is burned. Ketones are produced on any weight loss plan where fat is burned. When controlling carbs the presence of ketones is a positive sign and should NOT be confused with ketoacidosis. Acidosis does not result from controlling carbs. When controlling carbs the presence of ketones is a positive sign and should NOT be confused with ketoacidosis. Acidosis does not result from controlling carbs. Ketoacidosis is a concern in people primarily with uncontrolled type 1 diabetes or alcoholism. Ketoacidosis is a concern in people primarily with uncontrolled type 1 diabetes or alcoholism.

5. Ketones “Doctors are scared of ketosis…But ketosis is the normal physiological state of man. Rather than being poison, which is how the press often refers to ketones, they make the body run more efficiently and provide a back-up fuel source for the brain.” Richard Veech, NIH researcher “Doctors are scared of ketosis…But ketosis is the normal physiological state of man. Rather than being poison, which is how the press often refers to ketones, they make the body run more efficiently and provide a back-up fuel source for the brain.” Richard Veech, NIH researcher Veech calls ketones “magic” and has shown that both the heart and brain run 25% more efficiently on ketones than on blood sugar. Veech calls ketones “magic” and has shown that both the heart and brain run 25% more efficiently on ketones than on blood sugar.

6. Levels of ketones “Dietary” ketosis vs. “diabetic” hyperketoacidosis Fed state: 0.1 mmol/L Fed state: 0.1 mmol/L Overnight fast: 0.3 mmol/L Overnight fast: 0.3 mmol/L Ketogenic diet: 1-3 mmol/L Ketogenic diet: 1-3 mmol/L 21 day fast: 10 mmol/L 21 day fast: 10 mmol/L Uncontrolled diabetes: more than 25 mmol/L Uncontrolled diabetes: more than 25 mmol/L

7. Ketones as a fuel source Results in a decrease in appetite. Results in a decrease in appetite. Insulin is not involved in ketone production. Insulin is not involved in ketone production. Lowered insulin requirements decrease: Lowered insulin requirements decrease: triglycerides, blood pressure, adrenaline, cortisol, PCOS and cancer death rates. triglycerides, blood pressure, adrenaline, cortisol, PCOS and cancer death rates.

8. Four phases of the ANA Phase 1 Induction Phase 1 Induction Phase 2 Ongoing weight loss Phase 2 Ongoing weight loss Phase 3 Pre-Maintenance Phase 3 Pre-Maintenance Phase 4 Lifetime Maintenance Phase 4 Lifetime Maintenance

9. The ideal controlled carb nutritional approach: therapeutic principles Every person has a level of carb intake below which weight loss is automatic and a level below which weight maintenance is automatic. Every person has a level of carb intake below which weight loss is automatic and a level below which weight maintenance is automatic. Find the Critical Carbohydrate Level for Losing (CCLL) and stay at or below this level until goal weight is reached. Find the Critical Carbohydrate Level for Losing (CCLL) and stay at or below this level until goal weight is reached. Once at goal, stay at or slightly below your Atkins Carbohydrate Equilibrium (ACE). The amount of carbs you can eat without losing or gaining weight. Once at goal, stay at or slightly below your Atkins Carbohydrate Equilibrium (ACE). The amount of carbs you can eat without losing or gaining weight. Select the most nutrient-dense carbs, fats and proteins within established levels. Select the most nutrient-dense carbs, fats and proteins within established levels.

10. Phase 1: Induction Ingest about 20 grams of Net Carbs with an adequate protein and fat intake. Do not overeat. Generally expect a 4 to 16 pound weight loss in 2 weeks. Ingest about 20 grams of Net Carbs with an adequate protein and fat intake. Do not overeat. Generally expect a 4 to 16 pound weight loss in 2 weeks. Most people begin here and follow for 2 weeks. May follow longer if there is a lot of weight to lose. Most people begin here and follow for 2 weeks. May follow longer if there is a lot of weight to lose. Do not stay on Induction until at goal. Move on. Do not stay on Induction until at goal. Move on. Drink 64 ounces of water during the day. Drink 64 ounces of water during the day. Be sure to eat 3 to 4 cups of salad and vegetables daily from the approved list. Be sure to eat 3 to 4 cups of salad and vegetables daily from the approved list. Read labels- avoid many commercially prepared products. Read labels- avoid many commercially prepared products. Avoid or limit caffeine, trans fats AKA partially hydrogenated oils and margarine. Avoid or limit caffeine, trans fats AKA partially hydrogenated oils and margarine. Use Splenda and limit all sweeteners to 3 packets daily. Use Splenda and limit all sweeteners to 3 packets daily.

11. Induction cont’d Unlimited to satiety: Unlimited to satiety: Protein-chicken, turkey, beef, lamb, fish, shellfish, pork, veal, eggs, etc. Protein-chicken, turkey, beef, lamb, fish, shellfish, pork, veal, eggs, etc. Fat-oils, butter Fat-oils, butter Limited: Limited: Carbohydrate-cheese (hard and fresh) 3 to 4 ounces, vegetables 3 to 4 cups, olives 10, avocado-1/2, cream - up to 4 ounces, lemon/lime juice- 3 tablespoons. Carbohydrate-cheese (hard and fresh) 3 to 4 ounces, vegetables 3 to 4 cups, olives 10, avocado-1/2, cream - up to 4 ounces, lemon/lime juice- 3 tablespoons. After 2 weeks can add 1 ounce of walnuts, almonds, pecans, Brazils, macadamias, sunflower or pumpkin seeds. After 2 weeks can add 1 ounce of walnuts, almonds, pecans, Brazils, macadamias, sunflower or pumpkin seeds.

12. Induction cont’d Omit: Beverages with caffeine and alcohol Beverages with caffeine and alcohol Medications with sugar such as lozenges, cough syrups etc. Medications with sugar such as lozenges, cough syrups etc. All foods with added forms of sugar and trans fats. All foods with added forms of sugar and trans fats.

13. Nutrient analysis 0f 20 gram, 2000 calorie menu based on RDI

14. Nutrient analysis of 20 gram, 2000 calorie menu based on RDI

15. Symptoms On The Induction Plan Withdrawal from carbs can trigger headaches, moodiness, irritability and fatigue. Usually begins within 12 to 24 hours of starting Induction. Withdrawal from carbs can trigger headaches, moodiness, irritability and fatigue. Usually begins within 12 to 24 hours of starting Induction. If there is a history of migraines, the withdrawal may trigger a migraine. If there is a history of migraines, the withdrawal may trigger a migraine. Carb cravings may continue for 4 or 5 days, rarely up to a week. Carb cravings may continue for 4 or 5 days, rarely up to a week.

16. Carb Addicts During the transition phase (the first 4 or 5 days) maintain an adequate protein and fat intake. Snack as needed and don’t miss meals. During the transition phase (the first 4 or 5 days) maintain an adequate protein and fat intake. Snack as needed and don’t miss meals. In rare, severe cases when you can’t go cold turkey, remove a carb food group every 3 days until you get to Induction. In rare, severe cases when you can’t go cold turkey, remove a carb food group every 3 days until you get to Induction. days 1-3 eliminate only sugars days 1-3 eliminate only sugars days 4-6 eliminate flour containing foods days 4-6 eliminate flour containing foods days 7-10 eliminate fruit and juice days 7-10 eliminate fruit and juice days 11-13 eliminate starches and legumes days 11-13 eliminate starches and legumes

17. Ketones vary Time of day Time of day Sex Sex Age Age Activity level Activity level Hormone status-ketones can decrease before the menses. Hormone status-ketones can decrease before the menses. Medications Medications Finger stick method is best Finger stick method is best

18. The Carb Ladder As the program progresses, moving from one phase to another add back carbs in this order: As the program progresses, moving from one phase to another add back carbs in this order: Salad and vegetables Salad and vegetables Nuts and seeds Nuts and seeds Soft fruits i.e. berries Soft fruits i.e. berries Other fruits i.e. melon, pineapple Other fruits i.e. melon, pineapple Starch vegetables and legumes Starch vegetables and legumes Whole grains- unrefined Whole grains- unrefined

19. Ongoing Weight Loss- OWL Each week add 5 grams of extra carbs per day following selections from the carb ladder. Each week add 5 grams of extra carbs per day following selections from the carb ladder. Continue to add each week as long as weight and/or inches are lost. Continue to add each week as long as weight and/or inches are lost. If cravings or increased hunger occur, stop the latest addition and allow yourself to re-stabilize. If cravings or increased hunger occur, stop the latest addition and allow yourself to re-stabilize. You are determining your CCLL-critical carb level for losing. The maximum amount of carbs that can be consumed while still losing weight. You are determining your CCLL-critical carb level for losing. The maximum amount of carbs that can be consumed while still losing weight. The level is an individual one. Varies due to age, sex, amount of muscle mass, activity level etc. The level is an individual one. Varies due to age, sex, amount of muscle mass, activity level etc. Plan on losing more slowly- about 1 to 2 pounds a week on average. Plan on losing more slowly- about 1 to 2 pounds a week on average. Stay on OWL until within 5 to 10 pounds of goal weight. Stay on OWL until within 5 to 10 pounds of goal weight.

20. Pre-Maintenance About 40 to 90 grams of carbs About 40 to 90 grams of carbs Allow 2 months to lose the last few pounds Allow 2 months to lose the last few pounds Important phase that helps to instill permanent dietary behavior changes Important phase that helps to instill permanent dietary behavior changes Add 10 grams daily of extra carbs each week as long as less than 1 pound of weight is lost Add 10 grams daily of extra carbs each week as long as less than 1 pound of weight is lost Follow the carb ladder for choices Follow the carb ladder for choices Usually when higher glycemic fruits, legumes, starches and unrefined whole grains are added. Usually when higher glycemic fruits, legumes, starches and unrefined whole grains are added.

21. Lifetime Maintenance Once you have reached pre-maintenance and you have not lost any weight for at least 4 weeks you have found your ACE-Atkins Carbohydrate Equilibrium. The amount of carbs you can consume without gaining to losing weight. Once you have reached pre-maintenance and you have not lost any weight for at least 4 weeks you have found your ACE-Atkins Carbohydrate Equilibrium. The amount of carbs you can consume without gaining to losing weight. To maintain goal weight, stay at your ACE. To maintain goal weight, stay at your ACE. Maintain your goal weight within 3 to 5 pounds. Never allow yourself to gain more than 5 pounds without taking action. Maintain your goal weight within 3 to 5 pounds. Never allow yourself to gain more than 5 pounds without taking action. Average grams of Net Crab is 40 to 120 grams a day. Average grams of Net Crab is 40 to 120 grams a day. Engage in regular exercise; those who exercise regularly usually have a higher ACE. Engage in regular exercise; those who exercise regularly usually have a higher ACE. Your ACE can change over time. Readjust your diet to adapt to a higher or lower ACE. Your ACE can change over time. Readjust your diet to adapt to a higher or lower ACE.

22. control of eating control of eating increased sense of well-being increased sense of well-being decreased risk factors for disease decreased risk factors for disease loss of size loss of size management of weight management of weight What is Success?