Diabetes and CVD: Sometimes You Don’t Want A Sweet Heart

candy-hearts-editJay Cutler, Chicago Bears. Nick Boynton, Blackhawks. Kelli Keuhne, LPGA. Sean Busby, snowboard. Scott Verplank, PGA. Jay Leeuwenburg, NFL. Bobby Clarke, Flyers. Cory Vaughn, Mets (who plays with an insulin pump in his pocket). What do these athletes have in common?  Diabetes. You know, that group of metabolic diseases in which a person has high blood sugar, either because the pancreas can’t make enough insulin, or because cells don’t respond to the insulin that is produced. Frequent urination, increased thirst and a voracious appetite are symptoms.

Type 1 diabetes results from the body’s inability to produce insulin, and means the person has to inject insulin or wear an insulin pump…at least for now. Originally called juvenile diabetes, it can be diagnosed at any age. Type 2 diabetes results from insulin resistance, a state in which cells cannot use insulin the right way. Once in a while there’s an absolute insulin deficiency. This used to be called adult-onset diabetes. Gestational diabetes may be the third type, affecting pregnant women without a prior diagnosis who develop a high glucose level. This could lead to type 2.

Diabetes is bad enough, but the complications, especially if the diabetes is untreated, can be a nightmare. If the cardiovascular system is involved—and it often is—it’ll be worse than a nightmare. It might take ten or twenty years, but one complication or another is likely to pop up. In fact, a person might experience the complication before he even knows he has diabetes. Atherosclerosis, angina, heart attack, stroke and peripheral artery disease are not uncommon. But then there is damage to the smallest blood vessels, the capillaries. This microvascular affliction can lead to blindness and can cause scarring changes in kidney tissue. Diabetic neuropathy causes numbness, tingling and pain, especially in the feet, perhaps leading to amputation. Cognitive function is at risk, too. In the heart, small vessel disease is called cardiac syndrome X, non-obstructive coronary disease or microvascular angina, all names for microangiopathy.

The upper threshold of fasting glucose has been lowered from 140 to125 mg/dL. The upper threshold for normal glycemia has also been reduced, from 115 to 110 mg/dL. A fasting glucose of 110 to 125 mg/dL is now classified as impaired fasting glucose (IFG). Today, from the perspective of a cardiologist, diabetes is a cardiovascular disease (Grundy, 1999). The sad fact is that about sixty-five percent of people with diabetes die from heart disease and stroke. What happens is that sugar actually coats red blood cells, making them stiff and sticky and interfering with blood flow. That can cause a plaque to develop on the wall of an artery. At the same time, levels of the powerful vasodilator, nitric oxide, drop significantly, which raises blood pressure. After all this, the CVD risk for men with diabetes is twice that of men without; for women it’s three times (Howard, 2000). Nasty business, this diabetes stuff, but what can we do to control it?  We would like to see you lose that thing hanging over your belt. A half hour a day of brisk walking will help you do that. Reduce salt and sugar consumption and stick with lean proteins, which can include meat and especially fish. And you don’t want to smoke.

Atherosclerosis is now treated as an inflammatory disease, not purely a cholesterol-driven one (Libby, 2005). Diabetes is a contributor to that inflammation, which may also affect cognitive function (Beilharz, 2013). But there are dietary interventions that offer promise in diabetes management. In a double-blinded and placebo-controlled Chinese trial, subjects with type 2 diabetes were fed agaricus mushrooms as part of their treatment regimen. After twelve weeks, their insulin resistance improved (Hsu, 2007). In some foods where the amino acid lysine is structurally bound to protein, we find alpha lipoic acid, a sulfur-based anti-oxidant enzyme. Kidney, heart, liver, spinach, broccoli and yeast extracts are the better food sources, but contain too little to have a significant physiological effect. Amounts are more reliable in a supplement, and have been found to improve glucose status in both lean and obese patients, using 400 mg twice a day for a month (Konrad, 1999). Glucose disposal is the rate at which glucose is taken from the blood by peripheral tissue, increases of which are desirable. Alpha lipoic acid enhances that activity while simultaneously addressing diabetic neuropathy issues (Jacob, 1995, 1996, 1999).

In the olden days, we used to call it roughage. Today, it’s what it is—fiber. Every part of a plant we can’t digest fits the description. Fiber passes through the GI tract relatively intact. The soluble kind dissolves in water to form a gel, which can help to lower cholesterol and glucose. Oats, peas and beans, apples, citrus, carrots, barley and psyllium are examples. The insoluble kind moves stuff through the GI system until it gets to the exit. Whole wheat flour and bran, nuts, beans, cauliflower fit the category. Both kinds are beneficial in helping to prevent sickness, but psyllium (as in Metamucil®) can be taken from the spoon in water or juice, and is safe, well-tolerated, and improves blood glucose and serum lipids (Anderson, 1999) (Pastors, 1991). It also can be mixed into a meal (Wolever, 1991).

It isn’t easy to eat broccoli every day to get the chromium that’s been found to control blood sugar. What’s more, agricultural and manufacturing practices can affect content of the mineral, so supplements have been made available. Surprisingly, in a study performed at the U of TX, chromium not only tamed glucose response in diabetes patients, but also lowered triglyceride levels by seventeen percent after two months’ supplementation of the picolinate form (Lee, 1994). Combined with biotin, this mineral has proved itself a valuable tool in the diabetes management armamentarium (Singer, 2006). Recent meta-analysis hammers the point home (Abdollahi, 2013).

Need more? Magnesium intake is inversely associated with diabetes risk, even in groups with bad habits and a family history of disease (Lopez-Ridaura, 2004), and it provides greater insulin sensitivity (Fung, 2003) to lower the risk of developing type 2. Maybe what comes out of a person’s mouth is what defiles him in the view of others, but what goes in can sully the whole machine from the hidden side. Eating well is more than just a magazine title.

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*These statements have not been evaluated by the FDA.
These products are not intended to treat, diagnose, cure, or prevent any disease.

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