Recent Diabetes and Cardiovascular Disease Conferences

The lifetime risk of type II diabetes is now estimated to be about 40% for an American.¹

Type II diabetes (formerly called adult-onset diabetes) accounts for 95% of diabetes cases, distinct from type I (previously called juvenile-onset diabetes), which accounts for 5% of cases.² Type II diabetes is usually caused by abdominal obesity, physical inactivity, or excess sugar consumption.^3-5

The fact that high blood sugar may be more damaging to blood vessels than high blood lipids might be indicated by the fact that diabetes greatly increases risk of cardiovascular disease. Middle-aged diabetic men have triple the rate of cardiovascular deaths as nondiabetic men in the same age-group.⁶ About 80% of diabetics die of heart attack or stroke, while a substantial number of the remainder die of kidney failure.⁷ Blood vessel damage in diabetes includes damage to vessels in the kidneys.^8,9

In healthy persons, elevated blood glucose from a meal causes pancreas cells to secrete insulin. Insulin causes muscle cells to absorb glucose, fat cells to store fat, and liver cells to store rather than produce glucose.

In a prediabetic condition (metabolic syndrome), the responsiveness to insulin by muscle, liver, fat, and other cells diminishes (insulin resistance), although not to the same degree in every tissue.¹⁰ Even though about 80% of obese persons have insulin resistance and symptoms of metabolic syndrome, nearly 40% of normal-weight people also have metabolic syndrome symptoms.¹¹

Due to the close connection between diabetes and cardiovascular disease, both the World Congress on Insulin Resistance, Diabetes & Cardiovascular Disease held in Los Angeles and the Cardiovascular Disease Prevention Symposium held in Miami are very similar. The Miami conference is organized by Michael Ozner, MD, who is a member of the Life Extension® Scientific Advisory Board.

Both annual conferences are attended by physicians concerned with diabetes and cardiovascular disease. I have previously reported on these conferences in Life Extension Magazine® (July 2015 and July 2014). This report will provide updates based on the most recent conferences which were held in November 2015 and February 2016.

Can Food Be Addictive?

Avena

Nicole Avena, PhD, a research neuroscientist at New York Obesity Research Center, Columbia University, studies food addiction. Although food is required for survival, some people overconsume food, displaying symptoms comparable to what is seen with drug addiction, including compulsive bingeing, tolerance, withdrawal, and cross-sensitization to other addictive substances. Food is comparable to alcohol insofar as only a minority of consumers exhibit addictive symptoms.

Dr. Avena has observed that people do not binge on broccoli, but are most likely to binge on sugar or, to a lesser degree, on fat (especially when combined with sugar).¹² Dr. Avena has shown that sugar-addicted rats demonstrate activation of the same regions of the brain as are activated by drug addiction.¹³ Sugar-addicted rats deprived of sugar will increase their intake of alcohol, thereby displaying cross-sensitization.¹⁴

Dr. Avena suggests that the sugar fructose contributes to obesity more than glucose because glucose (from starches and sucrose) releases insulin, which reduces appetite,¹⁵ whereas fructose does not cause insulin release.¹⁶ A survey of 175 countries showed that increased availability of sugar is associated with increased diabetes, an association not found with any other food type.¹¹

Is Sitting a Health Hazard?

La Forge

Ralph La Forge, MSc, CLS, a clinical lipid specialist at Duke Lipid Clinic, Durham, North Carolina, is concerned with the health hazards of sitting. More than half of the average person’s waking hours are spent sitting.¹⁷ Spending much time sitting has been associated with greater risk of dying from cancer and cardiovascular disease.¹⁸

The greatest health hazard is seen for those who are the least active.¹⁹ Obese and overweight individuals who were induced to walk for 2 minutes every 20 minutes showed reduced blood glucose and insulin.²⁰ But a study of healthy individuals who get moderate exercise showed no mortality risk associated with the amount of time spent sitting.²¹ Treadmill workplace desks have been shown to reduce blood glucose and raise blood HDL, but standing desks did not show this benefit.²² Treadmill desks reduce work performance, whereas desks where it is possible to cycle while sitting do not interfere with work.²³

Types of LDL Cholesterol

Krauss

Ronald Krauss, MD, director of Atherosclerosis Research at California’s Children’s Hospital Oakland Research Institute, is concerned about the fact that low blood LDL cholesterol often is not a good predictor of low risk for coronary heart disease because the size of LDL particles is more important than the level of LDL cholesterol.

Persons with the highest concentration of small, dense LDL particles have triple the incidence of metabolic syndrome,²⁴ and are more insulin resistant than persons with large, buoyant LDL.²⁵ Small, dense LDL is not only more easily oxidized than the larger particles, it is more easily glycated (modified by sugar).

Even in healthy persons, the amount of glycated LDL is several times larger than the amount of oxidized LDL.²⁶ Dr. Krauss has shown that diets low in fat and high in carbohydrate increase small, dense LDL in proportion to the amount of carbohydrate.²⁷ Aside from dietary influences, Dr. Krauss has established that many people do not benefit from LDL-lowering statin drugs because of inherited genetic factors.^28,29

Blood Lipids in Diabetes

Underberg

James Underberg, MD, an internist at NYU Medical Center, New York City, is an expert in metabolic abnormalities most often found in diabetics (diabetic dyslipidemia), which are characterized by high blood triglycerides and lipoprotein composition that promotes atherosclerosis.³⁰ The amount of triglycerides divided by the amount of HDL cholesterol is an excellent predictor of insulin resistance and cardiovascular disease risk when the ratio is high.³¹ A high carbohydrate diet has been shown to increase this ratio, indicating increased risk.³²

Atherosclerosis is most strongly predicted by small, dense LDL, low HDL, and remnant cholesterol particles.³³ Remnant cholesterol is calculated as non-fasting total cholesterol minus HDL cholesterol, minus LDL cholesterol.^34,35 Remnant cholesterol is associated with chronic inflammation, whereas LDL cholesterol is not.³⁶ Remnant cholesterol induces endothelial dysfunction through oxidative stress.³⁷ According to one study, high remnant cholesterol is more predictive of myocardial infarction (heart attack) than any other lipid particle.³⁸

Benefits of HDL Cholesterol

Brinton

Eliot Brinton, MD, associate professor at University of Utah School of Medicine, Salt Lake City, spoke about the role of HDL cholesterol in protecting against cardiovascular disease. Unlike LDL cholesterol, which can contribute to atherosclerosis by its deposition in the walls of arteries, HDL can prevent atherosclerosis by removing cholesterol from arteries.³⁹ HDL can also help to prevent or to correct endothelial dysfunction (the reduced ability of blood vessels to dilate), another condition that contributes to atherosclerosis.⁴⁰ A third means by which HDL can protect against atherosclerosis is by its anti-inflammatory properties.⁴⁰

Approximately 10% of patients given statin drugs to lower LDL cholesterol cannot tolerate those drugs. These patients can benefit from the increased HDL resulting from taking nicotinic acid (niacin, vitamin B3).⁴¹ But no benefit is seen for most patients attempting to combine statins with nicotinic acid.⁴²

Insulin Secretion and Insulin Resistance

DeFronzo

Ralph DeFronzo, MD, professor of medicine at the University of Texas Science Center, San Antonio, is a renowned diabetes expert who edited International Textbook of Diabetes Mellitus.

In the 1980s, Dr. DeFronzo showed that although muscle is the most important tissue associated with insulin resistance (resistance to glucose-uptake induced by insulin),⁴³ insulin resistance of the liver prevents the liver from reducing its glucose production.⁴⁴ More of the glucose produced by the liver comes from protein than from glucose that has been stored in the liver as glycogen.⁴⁵ According to Dr. DeFronzo, obese type II diabetics tend to be insulin resistant in both their liver and muscle, whereas lean type II diabetics have defective insulin secretion in response to blood glucose.⁴⁶ But as type II diabetes progresses, both lean and obese diabetics exhibit increasingly defective insulin secretion as well as defective insulin sensitivity.⁴⁶

Dr. DeFronzo and his associates have shown that insulin sensitivity and glucose utilization decrease in proportion to increasing amounts of free fatty acids in the blood.⁴⁷ But the ability of insulin to suppress free fatty acids is impaired in type II diabetes, creating a vicious cycle. ^48,49 Dr. DeFronzo has shown that reducing free fatty acids in the blood of type II diabetics improves glucose utilization in mitochondria (energy producing parts of cells).⁵⁰

Branched-Chain Amino Acids in a High Fat Diet?

Kim

Sun Kim, MD, assistant professor of medicine at Stanford University, has attempted to understand research by Duke University’s Dr. Chris Newgard indicating that adding branched-chain amino acids to a high-fat diet increased insulin resistance above that seen with a high-fat diet alone.⁵¹

In healthy people a test drink of branched-chain amino acids has been shown to increase blood insulin even more than a pure glucose drink.⁵² Another test on healthy humans showed that combining branched-chain or aromatic amino acids with carbohydrates doubled the insulin increase of carbohydrates alone.⁵³ Unlike other amino acids, which are oxidized primarily in the liver, branched-chain amino acids are primarily oxidized in skeletal muscle.⁵⁴ Although Dr. Kim has confirmed the association between certain amino acids and insulin resistance, she has questions about what causal relationships exist.⁵⁵ Dr. Newgard has not yet published data confirming a causal relationship, but he cautions persons at risk of type II diabetes from eating foods high in fat and branched-chain amino acids such as meat and some milk products.

Heart Failure and High Blood Pressure

Jessup

Mariell Jessup, MD, professor of medicine at the University of Pennsylvania, discussed treatment and prevention of heart failure. In heart failure the heart is unable to pump enough blood to meet the needs of the body. One American in five over the age of 40 will develop heart failure.⁵⁶ Heart failure is the leading cause of hospitalization for people over age 65, with up to half of the victims dying within one year.⁵⁷

A heart failure victim has shortness of breath, is easily tired, and can accumulate fluid in tissues. Fluid retention (congestive heart failure) in the lungs causes breathing difficulties and a hacking cough, whereas peripheral fluid retention (edema) is associated with swollen limbs. Poor kidney function is the best predictor that a heart failure victim will die.⁵⁸

High blood pressure is the greatest modifiable risk factor for heart failure,⁵⁹ along with diabetes and being overweight.⁶⁰ Losing weight is an effective way to reduce blood pressure. Every increased unit of body mass index (BMI) is associated with a 5% increased risk of heart failure in men, and a 7% increased risk in women.⁶¹ Cardiovascular disease risk increases in direct proportion to all blood pressure readings above 115/75 mmHg.⁶²

Concluding Remarks

 

Insofar as these conferences were mainly concerned with preventing cardiovascular disease risk, they did not acknowledge the fact that type II diabetes greatly increases the risk of getting cancer.⁶³

Excess weight and lack of exercise are obvious contributors to type II diabetes and death by cardiovascular disease or cancer.

Metformin is the most commonly used drug to lower blood glucose for prevention and treatment of type II diabetes.⁶⁴

Most attempts to lose weight by dieting fail in almost all cases, nearly all the weight is regained within five years, with a third of dieters gaining more weight than they lost.⁶⁵ Bariatric surgery, by contrast, is usually a successful way for the very obese to lose weight.⁶⁶

Rather than reducing food consumption, changing to a vegetarian diet can be an effective way of losing weight without regaining it. Vegetarians have lower body weight,^67,68 and a lower risk of metabolic syndrome.⁶⁹ Dr. Michael Ozner (who organized the Miami conference) recommends a Mediterranean diet.

Reducing carbohydrates can also be a way of losing weight. In many cases a low carbohydrate diet has led to reduction or elimination of medications being used to treat type II diabetes.⁷⁰

Lower risk of cancer, diabetes, and cardiovascular disease by dietary changes that don’t require restricting food intake can be the simplest way to better health. This lifestyle change can often be achieved without a protracted or difficult period of adjustment.

If you have any questions on the scientific content of this article, please call a Life Extension^® Wellness Specialist at 1-866-864-3027.

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