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

Jay 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.

Abdollahi M, Farshchi A, Nikfar S, Seyedifar M. Effect of chromium on glucose and lipid profiles in patients with type 2 diabetes; a meta-analysis review of randomized trials. J Pharm Pharm Sci. 2013;16(1):99-114.

Anderson JW, Allgood LD, Turner J, Oeltgen PR, Daggy BP. Effects of psyllium on glucose and serum lipid responses in men with type 2 diabetes and hypercholesterolemia. Am J Clin Nutr. 1999 Oct;70(4):466-73.

Anderson RA, Cheng N, Bryden NA, Polansky MM, Cheng N, Chi J, Feng J. Elevated intakes of supplemental chromium improve glucose and insulin variables in individuals with type 2 diabetes. Diabetes. 1997 Nov;46(11):1786-91.

Beilharz JE, Maniam J, Morris MJ. Short exposure to a diet rich in both fat and sugar or sugar alone impairs place, but not object recognition memory in rats. Brain Behav Immun. 2013 Dec 3. pii: S0889-1591(13)00575-8.

Bĕlobrádková J, Filipenský B. The heart in diabetics. Vnitr Lek. 2003 Dec;49(12):921-6.

Betteridge DJ. Lipid control in patients with diabetes mellitus. Nat Rev Cardiol. 2011 May;8(5):278-90.

Fung TT, Manson JE, Solomon CG, Liu S, Willett WC, Hu FB. The association between magnesium intake and fasting insulin concentration in healthy middle-aged women. J Am Coll Nutr. 2003 Dec;22(6):533-8.

Garvey WT, Hermayer KL. Clinical implications of the insulin resistance syndrome. Clin Cornerstone. 1998;1(3):13-28.

Scott M. Grundy, MD, PhD, Ivor J. Benjamin, MD; Gregory L. Burke, MD; Alan Chait, MD; Robert H. Eckel, MD; Barbara V. Howard, PhD; William Mitch, MD; Sidney C. Smith Jr, MD; James R. Sowers, MD AHA Scientific Statement Diabetes and Cardiovascular Disease:A Statement for Healthcare Professionals From the American Heart Association Circulation. 1999; 100: 1134-1146

Harris SB, Zinman B, Hanley A, Gittelsohn J, Hegele R, Connelly PW, Shah B, Hux JE. The impact of diabetes on cardiovascular risk factors and outcomes in a native Canadian population. Diabetes Res Clin Pract. 2002 Feb;55(2):165-73.

Herlitz J, Malmberg K. How to improve the cardiac prognosis for diabetes. Diabetes Care. 1999 Mar;22 Suppl 2:B89-96.

Hildebrandt PR, Snorgaard O, Melchior TM, Seibaek MB, Torp-Pedersen CT. Treatment of diabetic patients with ischaemic heart disease. Ugeskr Laeger. 2000 Jul 31;162(31):4125-8.

Howard BV, Magee MF Diabetes and cardiovascular disease. Curr Atheroscler Rep. 2000 Nov;2(6):476-81.

Hsu CH, Liao YL, Lin SC, Hwang KC, Chou P. The mushroom Agaricus Blazei Murill in combination with metformin and gliclazide improves insulin resistance in type 2 diabetes: a randomized, double-blinded, and placebo-controlled clinical trial. J Altern Complement Med. 2007 Jan-Feb;13(1):97-102.

Huerta MG, Roemmich JN, Kington ML, Bovbjerg VE, Weltman AL, Holmes VF, Patrie JT, Rogol AD, Nadler JL Magnesium deficiency is associated with insulin resistance in obese children. Diabetes Care. 2005 May;28(5):1175-81.

Jacob S, Henriksen EJ, Schiemann AL, Simon I, Clancy DE, Tritschler HJ, Jung WI, Augustin HJ, Dietze GJ. Enhancement of glucose disposal in patients with type 2 diabetes by alpha-lipoic acid. Arzneimittelforschung. 1995 Aug;45(8):872-4.

Jacob S, Henriksen EJ, Tritschler HJ, Augustin HJ, Dietze GJ. Improvement of insulin-stimulated glucose-disposal in type 2 diabetes after repeated parenteral administration of thioctic acid. Exp Clin Endocrinol Diabetes. 1996;104(3):284-8.

Jacob S, Ruus P, Hermann R, Tritschler HJ, Maerker E, Renn W, Augustin HJ, Dietze GJ, Rett K. Oral administration of RAC-alpha-lipoic acid modulates insulin sensitivity in patients with type-2 diabetes mellitus: a placebo-controlled pilot trial. Free Radic Biol Med. 1999 Aug;27(3-4):309-14.

Konrad T, Vicini P, Kusterer K, Höflich A, Assadkhani A, Böhles HJ, Sewell A, Tritschler HJ, Cobelli C, Usadel KH. alpha-Lipoic acid treatment decreases serum lactate and pyruvate concentrations and improves glucose effectiveness in lean and obese patients with type 2 diabetes. Diabetes Care. 1999 Feb;22(2):280-7.

Lee NA, Reasner CA. Beneficial effect of chromium supplementation on serum triglyceride levels in NIDDM. Diabetes Care. 1994 Dec;17(12):1449-52.

Lopez-Ridaura R, Willett WC, Rimm EB, Liu S, Stampfer MJ, Manson JE, Hu FB. Magnesium intake and risk of type 2 diabetes in men and women. Diabetes Care. 2004 Jan;27(1):134-40.

Medical College of Georgia. New Evidence Of How High Glucose Damages Blood Vessels Could Lead To New Treatments ScienceDaily. ScienceDaily, 12 May 2009. .

Meyer KA, Kushi LH, Jacobs DR Jr, Slavin J, Sellers TA, Folsom AR. Carbohydrates, dietary fiber, and incident type 2 diabetes in older women. Am J Clin Nutr. 2000 Apr;71(4):921-30.

Pastors JG, Blaisdell PW, Balm TK, Asplin CM, Pohl SL. Psyllium fiber reduces rise in postprandial glucose and insulin concentrations in patients with non-insulin-dependent diabetes. Am J Clin Nutr. 1991 Jun;53(6):1431-5.

Peter Libby, MD; Pierre Theroux, MD Pathophysiology of Coronary Artery Disease Circulation. 2005; 111: 3481-3488

Piot C. Metabolic considerations in the treatment of coronary disease in diabetic patients. Diabetes Metab. 2001 Nov;27(5 Pt 2):S25-9.

Rett K. The relation between insulin resistance and cardiovascular complications of the insulin resistance syndrome. Diabetes Obes Metab. 1999 May;1 Suppl 1:S8-16.

Scheede-Bergdahl C, Benee Olsen D, Reving D, Boushel R, Dela F. Cardiovascular disease markers in type 2 diabetes: the effects of a moderate home-based exercise training programme. Diab Vasc Dis Res. 2009 Oct;6(4):291-6.

Shah PK. Pathophysiology of coronary thrombosis: role of plaque rupture and plaque erosion. Prog Cardiovasc Dis. 2002 Mar-Apr;44(5):357-68.

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