Diabetes: Heart Disease and Stroke

Most people with diabetes have health problems -- or risk factors -- such as high blood pressure and cholesterol that increase one's risk for heart disease and stroke. When combined with diabetes, these risk factors add up to big trouble. In fact, more than 65% of people with diabetes die from heart disease or stroke. With diabetes, heart attacks occur earlier in life and often result in death. By managing diabetes, high blood pressure and cholesterol, people with diabetes can reduce their risk.

Make the Link ! Diabetes, Heart Disease & Stroke
Did you know that 2 out of 3 people with diabetes die from heart disease and stroke? Make the Link! Diabetes, Heart Disease and Stroke is an initiative of the American Diabetes Association and the American College of Cardiology, aimed at increasing awareness of the link between diabetes and heart disease.

Make the Link! stresses that diabetes management is more than control of blood glucose. People with diabetes must also manage blood pressure and cholesterol and talk to their health provider to learn about other ways to reduce their chance for heart attacks and stroke.

Diabetes, Cholesterol & Heart Disease
Nearly all people with diabetes have abnormal cholesterol levels which contribute to their increased risk for heart attack and stroke. By choosing foods wisely, increasing physical activity and taking medications, you can improve your cholesterol.

Diabetes, Cholesterol & Heart Disease

Cholesterol (ko-LES-ter-ol) is a waxy, fat-like substance that is in all the body's cells, including the blood. Your body needs cholesterol to make some hormones, vitamins, and to help you digest. Your body makes all of the cholesterol it needs. Cholesterol is also found in some foods you eat.

In the blood, cholesterol is carried in small packages called lipoproteins (lip-o-PRO-teens). Two kinds of lipoproteins carry cholesterol through your body. It's important to have healthy levels of both LOW-density and HIGH-density lipoproteins.

Low-density lipoproteins (LDL) can lead to a buildup of cholesterol in the arteries. Some people call LDL "bad" cholesterol. You can remember LDL by thinking, L is for "Lousy." The higher the LDL level in your blood, the greater chance you have of getting heart disease. That's pretty lousy, indeed!

High-density lipoproteins (HDL) are also known as "good" cholesterol (think, H is for "Happy"). HDL helps remove cholesterol from your body, so the higher your HDL, the lower your chance for getting heart disease.

How to Lower LDL

Generally speaking, you want your LDL cholesterol to be less than 100. Here are some things you can do to lower your LDL cholesterol.

Stay physically active.
Eat a diet low in cholesterol, saturated fat, and trans fats.
Keep your weight in a healthy range.
Avoid smoking.

How to Raise HDL

If your HDL cholesterol is lower than 40 you may want to work to raise it. There are many things you can do to raise your HDL cholesterol.

Stay physically active.
Maintain a healthy weight.
Avoid smoking.
Cut trans fats.
Increase monounsaturated fats in your diet. Monounsaturated fats include canola oil, avocado oil, or olive oil.
Add soluble fiber to your diet. Foods with soluble fiber include oats, fruits, vegetables, and legumes.
Some research has also shown that moderate alcohol consumption (1 or 2 drinks per day) can increase HDL levels. Be warned that more than 1 or 2 drinks per day can have a negative effect on your health. Talk to your doctor about using alcohol to raise your HDL levels.

Questions about Heart Disease and Cholesterol

Blood Clotting and Your Heart

Q. I've heard blood clotting is more common in people who are obese or who have diabetes. Is this true -- and is there anything I can do to prevent it?

A: Since the late 1940s, experts have recognized that a substance found in the blood, called "tissue plasminogen activator" or t-PA, is responsible for breaking up clots. Because of technical limitations, however, t-PA was hard to measure or study in patients.

By 1983, techniques improved, and it soon became clear that there was another substance in the blood -- a plasminogen inactivator (PAI-1) -- that balanced the effects of the activator (t-PA). Studies showed that both substances are present in the blood of healthy people in small amounts. They function together like yin and yang, to keep the blood clotting system in balance and prevent both clotting and excessive bleeding.

Since then, doctors have discovered large amounts of PAI-1 (pronounced "pie-one") in patients who have blood clots in their veins, as well as those who have severe coronary heart disease, obesity and diabetes. These high levels of PAI-1 upset the blood's natural balance, and can lead to dangerous blood clots.

Good Fats and Bad Fats

Indeed, some fats are bad. Saturated fats make our cell membranes stiff, raise cholesterol and blood pressure, and are associated with the development of type 2 diabetes and coronary heart disease. Trans-fats, which are found in deep-fried foods and commercially baked goods, are very similar to saturated fats in their physical structure and in their bad effects on cholesterol levels, blood pressure, and blood glucose control. They also raise cardiac mortality rates.

But there's another kind of fat called essential fatty acids -- and they are indeed essential. These unsaturated fats, including omega-3 and omega-6 fats, make our cell membranes more flexible, lower blood pressure and cholesterol, and reduce mortality from heart disease. They are also required for the production of certain hormones that are essential for blood clotting, blood pressure control, and eye and brain function.

Unfortunately, humans are unable to make these fatty acids. So we must get them from the food we eat. Cold-water fish, such as bluefish and salmon, are rich in omega-3 fatty acids, and so are many plants, nuts, and seeds. Omega-6 fatty acids are found in grains, such as corn, along with corn oil and safflower oil, and in the meat of animals that have been fattened on grain. Mother's milk is also rich in essential fatty acids.

Chewing the Fat about Diabetes

What effect do essential fatty acids have on people with diabetes?

To answer this question, consider the research on fish oil supplements. Many studies show that high levels of omega-3 fatty acids significantly reduce the rate of sudden death after heart attack. These effects are thought to occur because omega-3 fatty acids get directly into the cells of the heart, where they lower heart rate and also stabilize the heart's rhythm.

Recommendations: Go for Omega

The Most Diabetes Associations recommend two to three servings of fish per week, in order to obtain adequate amounts of omega-3 fatty acids. The Heart Associations have published similar recommendations.

If you are a vegetarian, consider more plant-based products that contain omega-3 fatty acids. And when looking for the perfect cooking oil, choose canola oil, which has the most omega-3 fatty acids. Flaxseed oil, ground flaxseed meal, and nuts and seeds are also important sources of omega-3 fatty acids.

Sodium and Your Blood Pressure

Humans require only a small amount of sodium in our diet for good health. But many people crave salt. And it can be found just about everywhere these days -- especially in processed foods, where salt is used to preserve the product and enhance its flavor.

Unfortunately, research shows that high sodium intake is linked with high blood pressure (hypertension). Also, some people are "salt-sensitive," meaning that they are more likely to develop high blood pressure when eating salt.

Both high blood pressure and salt-sensitivity are common in people with type 2 diabetes and insulin resistance. Also, people with type 1 diabetes who have kidney damage are at high risk for high blood pressure.

So what's the big deal? High blood pressure is a major risk factor for heart disease and stroke. That's true for all people, not just those with diabetes. But you can help keep your heart healthy with the right diet.

Recommendations: Hold The Salt

Hoping to prevent high blood pressure? The most Diabetes Associations recommend limiting sodium intake to 2,400 mg (2.4 g) or sodium chloride (one teaspoon salt) to 6,000 mg (6 g),about one & half teaspoonful per day.

There are two values here, because the element sodium makes up only about 40 percent of table salt (sodium chloride) by weight. So all recommended daily allowances of sodium may be expressed as grams of table salt or as grams of sodium. One teaspoonful of table salt contains about two grams of sodium, and about five grams of salt.

In addition to watching your sodium intake, it's important to eat a diet rich in fruits, vegetables, and low-fat dairy products. This too will help you fight hypertension -- and help you get enough potassium, magnesium, calcium and other essential nutrients.

The ? Benefits of Red Wine

Belief in the medicinal value of wine is as old as wine itself. The Pharmacopoeia of the United States of America, sixth decennial revision, published in 1882, has listings for 14 different preparations of wine, from vinum album, or white wine, made "from the unmodified juice of the grape, freed from seeds, stems, and skins," to vinum rubrum, or red wine, made "by fermenting the juice of colored grapes in presence of their skins."

The answer to your question lies in these grape skins.

The deep, beautiful purple-red color of red wine is produced by a substance called anthocyanin, which is found in the skin of the grape. In addition to the color of red wine, we can thank anthocyanins for the deep red-purple-black color of black olives; and the berry-red color of strawberries, cherries, and raspberries.

Anthocyanin is one of the four main groups of chemicals that together are called flavonoids. Found in many plants and especially in deeply colored fruits and vegetables, flavonoids are important chemicals in plants.

Drink in the Flavonoids

Research has shown many potential medical uses for flavonoids. For example, they regulate cell growth, function as antioxidants, reduce inflammation, and prevent blood clots.

Red wine may also reduce oxidative stress caused by increased blood glucose levels after meals, consumption of two 100ml glasses of red wine with a meal by subjects with type 2 diabetes significantly reduced the compounds produced by the test meal that could cause vascular damage by the mechanism of "oxidative stress." (Oxidation of LDL "bad" cholesterol causes fatty buildup in the arteries.)

White Pales in Comparison

The protective activity of white wine was only about 20 percent that of red wine !!!!!!

Large clinical trials have shown that antioxidant supplements such as vitamin E do not reduce coronary heart disease mortality or the damage caused by previously formed "oxidation products." the antioxidant power of flavonoid-rich foods such as red wine, apples, onions, green tea, and other deeply colored foods may protect against the causes of oxidative damage when they are consumed daily as part of a healthy lifestyle. Only future research will settle this matter for good.

Is a daily diet of multicolored fruits, nuts, and vegetables, delightfully consumed with red wine or green tea, "good for the heart?"

If you're a scientist at heart, the answer is "probably, but let's see more data."

But if you're a poet at heart, you already know the answer.

How Exercise Helps

Exercise is good for your whole body, inside and out. To help you understand better, let's get into the cellular science of exercise.

Let's begin with glucose, the primary energy source for all living things on earth since life first appeared on the planet. All organisms, starting with the most primitive ones, had to work hard for their food. Glucose was always scarce. So the problem was how to survive with limited resources and how to be prepared to fight or escape from larger or stronger organisms looking for their own next glucose meal.

Producing Energy

Fight or flight. Both reactions require a quick glucose boost and rapid energy production. This energy surge is powered by tiny "energy factories" in our cells called mitochondria, which use the glucose flooding the muscle cells to make high-energy fuel

Glucose usually enters cells with the help of insulin and specialized "glucose transporters." Glucose transporters are protein rings, which float inside the cell. When an insulin molecule attaches to the cell's surface membrane, it causes the glucose transporter protein to merge with the surface membrane. This produces a glucose channel, or pore, that allows glucose to cross into the cell.

In the past 20 years, research has shown that when muscles contract at a moderately intense level, the contractions themselves cause more glucose transporters to merge with the cell membranes. Exercise also increases the number of mitochondria in muscle cells (each cell in our body has thousands of mitochondria), as well as the number of blood vessels in muscles.

Increased blood flow to the muscles during exercise also increases the production of nitric oxide, causing blood vessels to expand, allowing more blood, and thus more glucose and oxygen, to get to the muscles.

If there is no further exercise, the newly activated transporters and extra mitochondria gradually "melt" away over the next two to five days. This "use it or lose it" process has been refined by evolution over several hundred million years and has been clearly demonstrated in rats and humans.

Why We Need to Exercise

High blood glucose levels cause cardiovascular system changes that are the opposite of those caused by exercise. They cause blood vessels to constrict. They cause the mitochondria to produce toxic "free radicals" (which may damage the inner lining of blood vessels and heart muscle). High blood glucose levels also trigger the production of other substances that may damage blood vessels and cause muscle cells to die.

Several recently published clinical studies have shown that people with diabetes who exercise for at least one-half-hour a day have better glucose control and a much lower risk of complications from cardiovascular disease than those who do not exercise. Exercise increases the levels of active glucose transporters and mitochondria in cells, and the amount of nitric oxide in blood vessels. This helps improve glucose control and blood vessel function. Exercise also lowers total cholesterol, raises HDL ("good") cholesterol, lowers triglycerides, and reduces blood pressure.

All of which are pretty good reasons to get cracking on your workout.

Losing Weight for Heart Health

Statistics show that at least 80 percent of those with type 2 diabetes are obese. How are diabetes, obesity, and cardiovascular disease connected?

The amount of weight gained varies greatly from person to person and is dependent, to a large degree, on the choices people make regarding the food they eat and the amount of exercise they get. However, insulin therapy in type 2 diabetes may be associated with weight gain, probably due in part to the effect excess insulin has on turning glucose into glycogen and fat.

Improved Heart & Blood Vessel Function

At the same time, some of drugs have demonstrated highly positive effects on our cardiovascular health. These beneficial changes include lower blood pressure and a more favorable blood lipid (cholesterol and triglycerides) profile. It is generally accepted that the use of metformin with insulin may lessen weight gain.

Among people with type 1 diabetes, weight gain is greatest among those who use insulin as a "carbohydrate credit card," instead of balancing carbohydrate intake with exercise. Most studies of "tight control" in type 1 diabetes have shown metabolic changes associated with improved cardiovascular function, despite varying degrees of weight gain.

The major immediate goal of diabetes care is to control blood glucose, and then to deal with any associated weight gain. But how can you tell if you've gained too much weight?

The Waist Test

Just measure your waist. A value greater than 38 inches in men or 35 inches in women is associated with a substantially increased risk of health complications related to obesity.

How should one deal with weight gain, whether due to eating too much and lack of exercise, or to vigorous attempts at tight control? A diet that is low in simple carbohydrates and saturated fats with adequate fiber, along with regular physical exercise, will help control weight gain and the risk factors for cardiovascular disease.

The most important thing when it comes to managing obesity and diabetes is to start taking control through diet and exercise and to follow the health care regimen recommended by your health care team. Focus on the things you can control with food and exercise and on achieving the best overall health regimen for your diabetes today.