Metabolic Syndrome —Diabetes-Related Heart Disease

“Until the 1950s, cholesterol was considered the primary culprit in heart disease. But Yale University scientists challenged this notion late in that decade when they showed that patients who had suffered heart attacks were more likely to have high triglycerides than they were to have elevated cholesterol levels. Despite the Yale University researchers’ very persuasive evidence, the medical community was not ready to accept this new idea.”—Gerald Reaven, M.D.

Gerald Reaven, M.D., professor emeritus at Stanford University Medical School, estimates that 25 to 30 percent of us must restrict carbohydrates—even complex carbohydrates. Depending on ethnic background, genes, nutritional status, and how we handle stress, we have varying sensitivity to carbohydrate foods.

If you gain weight easily or if diabetes or heart disease “runs in your family,” you must pay particular attention to your carb intake. People who consume more carbohydrate than their metabolism can handle are at risk of developing insulin resistance and a related cluster of risk factors called Syndrome X.

Metabolic Syndrome is a direct result of the over consumption of carbohydrates and is remedied by carbohydrate restriction. Also referred to as Syndrome X, Metabolic Syndrome is pre-diabetes—chronic high blood sugar and high circulating insulin. Dr. Reaven estimates that 60 to 75 million Americans have Syndrome X. “The Syndrome X culprit isn’t red meat or butter,” he says. “It’s carbohydrates.”1

In his book, Age-Defying Diet Revolution, the late Dr. Robert C. Atkins estimates that there are 15 million Type II diabetics in the U.S. and at least 60 million people who are pre-diabetic. From very different medical backgrounds, Drs. Reaven and Atkins are identifying the same large group of 75 million people for whom the emphasis on dietary carbohydrates is a serious mistake.

A cardiologist (Cornell) and family doctor with decades of clinical experience, Dr. Atkins describes how Type II diabetes inflicts blood vessel damage as it progresses through five stages. The first stage is insulin resistance, the common soil of Type II diabetes, Metabolic Syndrome and coronary heart disease.

In the carbohydrate-sensitive, in response to eating excess carbohydrates—especially high glycemic carbohydrates—body cells resist insulin. Insulin is the powerful blood sugar regulating hormone secreted by the pancreas to regulate or manage blood sugar. Insulin’s job is to escort glucose into cells where glucose is burned for energy. The more a food or meal raises blood sugar, the more insulin is needed to escort glucose and control blood sugar levels. When body cells resist insulin, blood glucose levels begin to increase.

According to Dr. Atkins, insulin resistance is a consequence of the intracellular vitamin and mineral deficiencies, especially magnesium, chromium, zinc, various trace minerals, and the B-complex vitamins. Without a solid nutritional foundation to process energy, cells refuse insulin and its glucose load.

In most people, excess breakfast bars, breads, cereals, cookies, doughnuts, muffins, pasta, and soft drinks raise glucose and insulin to unhealthy levels. In the carbohydrate-sensitive, even excess whole foods such as grains, legumes, and starchy carbohydrates promote insulin resistance.

Dr. Atkins refers to Stage Two as “hyperinsulinism.” Responding to chronic high glucose, the pancreas floods the bloodstream with insulin. An overload of insulin forces some glucose into the nutritionally deficient cells. Like elevated homocysteine, elevated insulin is atherogenic—it can directly damage or injure the endothelial cells lining artery walls.2

In Stage Three, food cravings, fatigue, brain fog, moodiness, and irritability are becoming chronic symptoms of impaired blood sugar control. These various symptoms are brought on by hunger and relieved by food. At this stage, a five-hour glucose tolerance test (GTT) is the best method for diagnosing insulin resistance, mapping your glucose curve.

Type II diabetes is Stage Four. Stages three and four are a continuum. Insulin resistance and hyperinsulinism rule, but in Stage Four blood sugar remains elevated throughout the day. You have recognizable Type II diabetes when there is a three-month history of fasting blood sugar readings above 125 (A1c test).

When the overworked pancreas finally ceases to function, you have reached Stage Five. Only at this stage are Type II and Type I diabetes similar. In Type II, the pancreas initially puts out too much insulin and then falters and stops. In Type I, a congenital autoimmune disease, the pancreas puts out little or no insulin and is destroyed by the body.

Throughout the development of Type II diabetes, blood vessel damage, sticky clot-prone blood, and the risk of heart attack are increasing. If an alert doctor and knowledgeable patient diagnose insulin resistance before it progresses (Stage One), diabetes and coronary heart disease can be prevented.

Metabolic Syndrome starts in the liver where excess glucose is converted into triglycerides—a body-made fat. These tiny fat particles are packed into the same lipoproteins that carry cholesterol throughout the body. These elevated triglycerides are a direct consequence of eating excess carbs.

Also referred to as triglyceride, fat assembled in the gut from dietary fat clears the bloodstream in about two hours. Hungry cells snatch away at this nutrient-dense fat as it circulates in the blood. In contrast, the triglycerides made in the liver from glucose circulate in the bloodstream until they are used for energy or stored as fat.

These are the triglycerides identified in your lipid panel or blood work that cause harm. Elevated triglycerides thicken your blood. In excess, triglycerides promote plaque and blood clots in the arteries as they oxidize cholesterol and sharply increase the risk of a heart attack. According to Dr. Atkins, as your triglycerides go above 100 mg/dl, your risk of heart attack increases in linear fashion.3

Directed to lower cholesterol, most doctors are overlooking the danger of elevated triglycerides. Triglycerides as high as 199 mg/dl are considered normal. But “normal” seldom applies to blood work. Like the other heart disease risk factors, people with “high normal” are at greater risk than those with “low normal” levels.

Excess circulating triglycerides increase the size and number of fat cells and increase the ratio of fat cells to muscle cells. But muscle cells use more glucose. As fat cells increase, glucose-burning muscle cells decrease, promoting continued insulin resistance, weight gain, and obesity.4

Men have a greater proportion of glucose-burning muscle cells and metabolize carbohydrates more efficiently and safely than women. There are also different degrees of insulin resistance; we don’t all respond the same way to blood sugar disorders. You can develop insulin resistance and not gain weight. But if you eat excess carbs, your body will produce excess triglycerides.

For women, elevated triglycerides are an especially good predictor of heart disease. Approximately 75 percent of all heart attacks that women get are associated with elevated triglycerides.5 And women with elevated triglycerides have a 70 percent higher risk of breast cancer than women with levels below 100. (Elevated triglycerides apparently trigger a rise in levels of circulating estrogen, a risk factor for breast cancer.6)

Triglycerides within the so-called normal range have “predictive significance.” This is not true of cholesterol, which has little predictive significance for people age 50 or higher. And like an old-fashioned teeter totter, as triglycerides go up, protective HDL goes down.

Elevated triglycerides are strongly associated with depressed HDL. When the liver makes triglycerides from excess glucose and sends it into the bloodstream, an HDL molecule has to give up its protein and disappear. This is risky because HDL is “reverse transport”—mopping up unwanted cholesterol and transporting it back to the liver for recycling.

We want as much HDL cholesterol as possible. HDL levels of 60 mg/dl or more (70 or more for women) are associated with reduced risk of heart disease:

• In a Finnish study, men with the lowest HDL were three times as likely to develop heart disease as men in the upper quartile.7
• In Harvard University’s Physicians’ Health Study, participants who developed heart attacks had the lowest HDL levels, while their total cholesterol values were the same as those in the healthy control group.
• In the Framingham Study, people who developed heart disease had HDL averages of 43 (men) and 53 (women), both classified “normal” by most doctors—but well below the protective levels of 60 and 70, respectively.8

The ratio of HDL to other blood components is important, especially the ratio of triglycerides to HDL, ideally 1:1. A ratio of 2:1 or higher is associated with an increased risk of heart disease, especially when triglycerides are over 100. A ratio of 4:1 or higher (TG = 200 and HDL = 50) requires immediate attention.9

A 1997 Harvard study conducted by Dr. J. M. Gaziano (published in Circulation, 1997; 96:2520–25) found that participants with the highest triglycerides and lowest HDL (highest 25 percent) were 16 times more likely to have a heart attack than those with the lowest triglycerides and highest HDL. Participants with triglycerides below 100 and HDL over 60 were least likely to suffer a heart attack.10

“No ratio has ever come close to being so predictive of heart disease,”11 said Dr. Robert Atkins, reporting on the Harvard study. The participants’ total cholesterol was not predictive; the ratio of triglycerides to HDL was. In at least 25 to 30 percent of people, a low-fat, high-carbohydrate diet raises triglycerides and lowers HDL cholesterol.

There is no shortage of studies documenting how high triglycerides, low HDL, high blood sugar, and high insulin cluster together. These blood fat abnormalities cause blood cells to become stickier and more likely to clump together (platelet aggregation). As we know, blood clots cause more than 80 percent of all heart attacks.

Kidney failure, nerve damage, blindness, and other complications of diabetes are a consequence of abnormal blood fats and blood clots that get their start from high sugar and high insulin. “The large amounts of blood sugar affect tissues and organs all over the body,” says Dr. Reaven. His research shows that at least 50 percent of hypertension can be linked to Syndrome X. “Several studies have made it clear that insulin resistance and compensatory hyperinsulinemia, the hallmarks of Syndrome X, tend to raise blood pressure.” High insulin elevates blood pressure in part by increasing sodium retention and promoting sticky, clot-prone blood.

High insulin levels raise blood pressure, speed up the heart, and increase the stress hormone cortisol, which, in turn, constricts or squeezes blood vessels. In this deadly cascade, chronic-elevated cortisol drives down DHEA, the most abundant hormone in the body. Less DHEA means less muscle mass and a further reduction of glucose-burning muscle cells.

Your adrenal glands manufacture DHEA from cholesterol. If your doctor is lowering your cholesterol with a drug, he may be compromising your body’s synthesis of DHEA at the same time that high insulin levels may be suppressing DHEA. Low DHEA, says Dr. Atkins, is a much better predictor of heart attacks than cholesterol.15

Low levels of DHEA are associated with cancer, diabetes, heart disease, osteoporosis, and lowered immunity. Conversely, high levels of DHEA are associated with protection from these diseases. You can test your DHEA level and supplement to restore beneficial levels (see 21-Day Plan #19).

Excess highly processed foods and nutritional deficiencies promote insulin resistance. Insulin resistance leads to hyperinsulinism. Hyperinsulinism is an early stage of diabetes. Early stages of diabetes provoke coronary heart disease and a wide range of metabolic and hormonal disorders that shorten your life.