The Ultimate Lifestyle Disease: Part 1
Reviewing the list of risk factors for heart disease, diabetes (especially type 2, as it affects significantly more individuals) is mentioned prominently in literature presented on the American Heart Association’s (AHA) website. Shortly thereafter, readers are urged to change their lifestyle to reduce their risk of heart disease.
Diabetes and Heart Disease
Having diabetes is considered a major risk factor for heart disease, and the AHA web site mentions specifically that simply having blood glucose under control through medication is not sufficient to reduce risk for cardiovascular disease. You are still urged to address lifestyle issues to reduce your risk.
Generally, the prescription for preventing diabetes (and you can prevent type 2 diabetes) looks amazingly similiar to recommendations for preventing heart disease: eat well, exercise, manage stress, and know your numbers. It is when the diabetes diagnosis occurs, however, that the messages begin to diverge.
According to the AMA, it is never too late to affect change in your body and, potentially, even reverse heart disease. Once diagnosed with diabetes, however, lifestyle changes are encouraged to help manage the disease, but the core strategies for treatment include a regimen of medication and insulin that often leads to lifelong dependence and fails to avoid condition-related complications that could include blindness, neuropathy, kidney failure, and possible amputation of the feet and lower legs.
Diabetes is often cited as a leading cause for all of these conditions. It is currently the seventh most common cause of death in America. Incidence rate for diabetes in the world population will more than double from 2000 to 2030 according to the World Health Organization (WHO), rising from 171 million adults to 366 million during this period.
In contrast, heart disease rates have dropped compared to the 1970s. If prevention is similar for both conditions, what is it about heart disease prevention that has been successful compared to prevention of diabetes? Furthermore, WHO also notes a reversal of the trend in recent years, with heart disease rates edging upward again. Is this new trend simply a manifestation of the diabetes pandemic?
A better question may inquire, instead, why are people encouraged to take charge of their heart health and rely on meds for type 2 diabetes? The answer to this question may be revealed in the results of a study published in June 2011, but first you need to know a bit about the role of insulin in the body and how the progression toward diabetes disrupts your body’s function.
In a healthy individual, the pancreas creates two hormones to regulate energy levels in the bloodstream, which exists as glucose—a simple sugar. Alpha cells produce glucagon, which stimulates the release of glucose from the liver, where it is stored as glycogen, a molecule made up of joined glucose molecules. Insulin, the hormone most commonly associated with diabetes, is produced by beta cells within the pancreas. It has a number of duties within the scope of metabolism, the most urgent of which is reducing blood glucose levels by signaling muscle, fatty, and liver tissue to take in glucose.
On the cellular level, glucose is metabolized for growth and energy. However, all of these tissues store excess glucose as either glycogen or triglycerides—a fat. The presence of insulin triggers a shift in your body from burning fat to burning glucose. Once the body’s energy needs are provided for, excess glucose is stored in muscle and liver tissue as glycogen. However, once the body’s stores of glycogen are replenished, insulin signals the body to remove glucose from the bloodstream by converting it to fat. It is important to understand that, beyond the role of reducing blood-sugar levels, the presence of insulin in the bloodstream prevents the body from burning fat.
In order to understand how diabetes can be reversed, you also need to understand the progression toward meeting the criteria for diagnosis. These days, the results of blood tests confirming a type-2 diabetes diagnosis should not be a surprise. The general risk factors are fairly well known; the presence of heart disease and hypertension should be a strong clue; and a group of precursors have emerged, each signaling that your journey down the superhighway to diabetes has begun.
Of the precursors, prediabetes is the simplest to diagnose and final warning point before onset of full-blown type 2 diabetes. Although the term was not used until 2003, doctors used the terms impaired fasting glucose (IMF) and impaired glucose tolerance (IGT)— depending upon the test used to identify the condition—as early as 1997, and the term borderline diabetes before then.
Because so many of the factors contributing to type 2 diabetes are related to lifestyle and diet, these pre-diabetic conditions were employed to warn patients that their bodies had reached a state of elevated crisis management, and convince patients to change their habits before medical interventions were considered necessary.
Prediabetes can be considered on a spectrum with type 2 diabetes, since the same three tests are used to screen for the condition.
A fasting blood-glucose (sugar) test measures the amount of sugar in the bloodstream after eight hours of fasting. It offers the best results first thing in the morning, since sleep has prevented eating and drinking and has rejuvenated the body. Normal readings are considered between 70 and 99 mg/dl. However, readings of 85 to 90 mg/dl may be considered ideal for health, with higher or lower readings leaving room for improvement. Prediabetes occupies the range from 100 to 125 mg/dl and diabetes exists when readings top 126 mg/dl.
The two-hour glucose tolerance begins with a fasting blood-glucose measurement, then a glucose solution is consumed and another reading is taken after two hours. A result between 140 and 199 mg/dl indicates prediabetes, while diabetes exists for readings above that range.
The test commonly referred to as the A1c measures glycated hemoglobin in the bloodstream. High levels of glucose in the bloodstream are toxic, and with no where else to go, it can penetrate red blood cells and bond directly to hemoglobin molecules, impairing their ability to carry oxygen. The A1c represents the percentage of hemoglobin molecules that have been glycated. Normal readings range from 4 to 5.6 percent. Predibetes exists in the range of 5.7 to 6.4 percent, and diabetes exists in readings above 6.5 percent.
Although the A1c is not useful for day-to-day management of blood-glucose levels, it provides a wider scope for evaluating management of the condition. Once a hemoglobin molecule has been glycated, the body has no process to reverse the situation; so glycated hemoglobin remains in the bloodstream until the red blood cell that contains it completes its life span and is flushed out of the body. The lifespan of a typical red blood cell is 100 to 120 days, so the A1c test provides a picture of how well blood sugar has been managed over a period of two to three months.
According to the National Institutes of Health (NIH), metabolic syndrome is becoming more and more common in the US. The term is used to describe a set of risk factors that, together, accentuate an individual’s risk for coronary artery disease, stroke, and type 2 diabetes.
The two most important risk factors for metabolic syndrome include increased belly fat, leading to an “appleshaped” body type, and the buildup of insulin resistance, which is characterized as the body progressively losing its ability to utilize insulin to enable passage of glucose from the bloodstream into cells. The remaining risk factors contributing to metabolic syndrome are genetic makeup, hormonal changes, and sedentary lifestyle.
The AHA and NIH consider metabolic syndrome to be present if three or more of the following exist:
• Blood pressure of 130/85 mm/Hg or higher
• Fasting blood glucose higher than 99 mg/dl
• Large waist, measured at 40 or more inches for men and 35 or more inches for women
• Low high density lipoprotein (HDL) cholesterol—under 40 mg/dl for men and under 50mg/dl for women
• Trigycerides at or above 150 mg/dl
If assessment indicates that metabolic syndrome is present, NIH recommends that individuals reduce their body weight by 7 to 10 percent (by cutting 500 to 1000 calories each day) and incorporate 30 minutes of exercise into each day with the goal of lowering cholesterol levels (interpret this to mean LDL, or low density lipoprotein), and reducing blood pressure. People who smoke should quit.
The final precursor for type 2 diabetes is insulin resistance, a factor that also contributes to metabolic syndrome. In part II of this series, the importance of insulin resistance in the progression toward type 2 diabetes will be explained, leading to the results of a recent study that confirms the belief that type 2 diabetes can be cured—and, best of all, the reversal happens without the use of drugs or synthetic insulin.
Next Issue: Part 2: Debunking the Myths