Deadly Merge

Having either high blood sugar or high cholesterol is bad enough,
but put them together and your heart is really in trouble. Learn about how both
factors play a part in what the medical world now calls “cardiometabolic risk”—
and how avoiding this scary pair can help keep your bloodstream flowing freely.

By Lisa James

February 2007

   In a world where blood-sugar levels and diabetes rates keep soaring in unison, there’s bound to be all sorts of unhealthy consequences. One such consequence that the average person isn’t aware of: Excess glucose can actually trigger an increase in cholesterol. Like two cars speeding into an intersection, these twin circulatory hazards are headed towards a spectacular cardiovascular wreck.

Even those who have problems controlling their blood sugar are often unaware of the glucose-cholesterol link. “People with diabetes think it can make you blind, cause kidney disease or cause amputation,” says Om Ganda MD, Harvard Medical School professor and director of the Lipid Clinic at the Boston-based Joslin Diabetes Center. “That’s true, but it is also the single biggest reason for heart disease.”

As potentially deadly as this duo can be, they are only part of a much larger danger. “This problem goes beyond blood-sugar levels and cholesterol; we are calling it cardiometabolic risk,” says Frederic Vagnini, MD, FACS, director of the Heart, Diabetes and Weight Loss Centers of New York and author of Overcoming Metabolic Syndrome (Addicus Books) and 30 Minutes a Day to a Healthy Heart (Reader’s Digest Books). This risk embraces a number of factors, including:

   • Visceral adiposity, or belly fat
   • High blood pressure; normal is defined by the American Heart Association (AHA) as 120/80 mm Hg, high as 140/90 and up, borderline high as anything in between
   • High glucose, which Vagnini believes starts at 90 mg/dL (the American Diabetes Association says 100); diabetes starts at 126
    • High triglycerides, or blood fats; normal is less than 150 mg/dL, high starts at 200
    • Cholesterol abnormalities—a desirable total count is less than 200 mg/dL, with high starting at 240; for low-density lipoprotein (LDL), the potentially problematic variety, the numbers are 100 and 160; conversely, high-density lipoprotein (HDL), the good type, should be at least 40, with 60 or more being optimal

Additional factors include “high levels of inflammation, as measured by C-reactive protein,” according to Vagnini, who adds, “Another thing that occurs in men is low testosterone levels and we also see elevated uric acid levels, which cause gout.”
     The excess weight that two out of every three Americans carry is a key factor. “People who are obese don’t even have to be diabetic to start having heart problems,” says Ganda. In people who are genetically prone to blood-sugar problems, obesity sets the stage for glucose levels that fall between normal and outright diabetic—a condition known as prediabetes or insulin resistance.

Arterial Hazard

Excess glucose tends to attach itself to various proteins in a process called glycation. (Doctors take advantage of that fact by measuring hemoglobin A1c to check how blood-sugar levels fluctuate over time.) One of those proteins is LDL, which is actually a combination of the fatty cholesterol and a protein carrier that allows it to move through the watery bloodstream. “Glycation creates a negative charge on the protein’s surface, so the more glycated it is, the more attracted it is to the artery wall,” Ganda explains. “The higher the level of blood sugar, the more glycation of LDL takes place.” And while LDL can stick to vessel walls even without glucose’s help, “in diabetes the concentration required is a lot less,” he continues. “An LDL of 100 in someone with diabetes is like an LDL of roughly 130 in someone without it.” As a result, health authorities recommend yearly LDL testing for everyone with diabetes.

Glucose isn’t finished making trouble, though. “High glucose levels cause an elevation of triglycerides, as belly fat is broken down into free fatty acids in the liver,” says Vagnini. “This causes the LDL particles to become smaller—and smaller, denser LDL particles get through into the arterial lining.” On top of that, levels of insulin, the hormone that controls blood sugar, increase, “and insulin prevents the breakdown of fat,” Vagnini says. “Belly fat also puts out inflammatory substances, which causes atherosclerosis (arterial plaque development) to progress and makes blood clotting more prominent.”

Threat Reduction

The best way to avoid the hazards posed by excess blood sugar is to stop glucose from climbing in the first place. “Prediabetes, when blood sugar is between 100 and 125, is the period of opportunity to prevent diabetes and cardiovascular problems,” says Ganda. “The incidence of prediabetes is very underestimated,” Vagnini adds. “People should be aware of their fasting glucose levels and their hemoglobin A1c.” In one study, heart disease risk dropped by 27% in individuals whose A1c levels declined (ADA Sci Sessions, 6/06).

The first step: Lose weight through the time-tested methods of diet and exercise. “Even a 10-pound loss can have a very meaningful effect on diabetes control,” Ganda says. “Joslin was part of the multicenter Diabetes Prevention Program, which followed roughly 3000 people with blood sugar levels between 100 and 125 for three years. We found that a 5% to 7% reduction in body weight, and reducing calories by 150 a day, can reduce progression to diabetes by 58%.”
Vagnini has found the same beneficial changes among his clients. “We recommend cross-training—combined aerobic and resistance training,” he says, “and a modified low-carb Mediterranean diet: plenty of fish, salads, vegetables and olive oil, along with some red wine.”

Supplements play a big role in Vagnini’s program, although he will use prescription meds in some cases: “Supplements fill gaps created by less-than-perfect eating habits and metabolic changes that happen naturally with age.” (You should always work with a trained practitioner to lower blood sugar and/or cholesterol.) He starts with a multivitamin. A high-quality one will provide B vitamins to control homocysteine, a risk factor for heart disease, and vitamin D, which helps the body absorb blood pressure-reducing calcium, while cooling off inflammation and providing antioxidants, which mop up the free radicals that can make LDL adhere to artery walls.

For glucose control, Vagnini uses chromium, cinnamon and beta-glucans, along with fenugreek. In addition, he finds the minerals vandanium and zinc useful, as well as glucomannan, a fiber derived from the Asian konjac plant, which researchers have found to also promote weight loss. Vagnini’s natural cholesterol-lowering arsenal includes niacin, a B vitamin long used for this purpose, along with red yeast rice, oat fiber and guggul. The green food supplement barley grass has also been shown to reduce LDL in people with type 2 diabetes (Food Science and Agricultural Chemistry 2003). Omega-3 fatty acids can decrease triglycerides.

Vagnini also uses supplements to help clients lose weight. He finds that both hoodia and garcinia cut appetite and promote fat burning; the latter apparently also helps blunt glucose spikes induced by sugar intake. Forskolin, a coleus extract, helps promote the development of lean body mass and drop blood pressure.

So if your blood sugar is high, find a diet, exercise and supplementation regimen that keeps your cardiometabolic risk factors under control.

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