February was “heart month,” and this is another column about the major causes of heart disease — the number one cause of death in the U.S. Previously, high cholesterol, hypertension, and sleep apnea were covered.

In their books “Beat the Heart Attack Gene” and “Healthy Heart, Healthy Brain,” Bale and Doneen present evidence that 70 percent of heart disease in this country is driven by prediabetes and diabetes. There are two types of diabetes, type 1 and type 2. Type 1 often appears in childhood, and is an autoimmune disease in which the patient’s immune system destroys the beta cells in the pancreas that produce insulin. Today’s column is about type 2 diabetes, which is ten times more prevalent than type 1, and which for the most part is a lifestyle disease caused by insulin resistance (IR).

---

---

EXTENT OF THE PROBLEM: Only 1 in 8 Americans are metabolically healthy — with optimal weight, waist circumference, blood pressure, blood sugar, cholesterol, HDL (good cholesterol), and triglycerides. Over 34 million U.S. adults have diabetes and more than 7 million of those are undiagnosed, either because they haven’t had their blood sugar checked or because they had unreliable tests. Over 88 million have prediabetes, and 84 million are undiagnosed. These conditions are becoming more prevalent in all age groups, but particularly in young adults—and we can’t call type 2 diabetes “adult-onset diabetes” any longer because 5,000 children are now diagnosed with it annually.

COMPLICATIONS OF DIABETES include cardiovascular disease, manifested by heart attacks, strokes, erectile dysfunction, peripheral vascular disease that can lead to lower extremity amputations, and multiple-small-stoke dementia. Other complications include Alzheimer’s; chronic kidney disease; diabetic retinopathy that can impair vision and result in blindness; peripheral neuropathy that can lead to chronic pain and numbness in the legs and feet; and a weakened immune system (e.g. diabetics are at much higher risk for dying from COVID). It’s important to realize that all these complications can occur not only in diabetics but also in people with prediabetes.

---

---

DIAGNOSIS OF INSULIN RESISTANCE: 1. This disorder is due to extra fat around the middle (apple-shaped obesity). Waist circumference refers not to belt size but to waist measurement at the point of greatest circumference — above the hips, at about belly button level. Caucasian men with a circumference of 40 inches and women 35 inches or more have insulin resistance. Cutoffs are lower in Asians and people of East Indian heritage. People who look at their naked profile in the mirror and notice even a small belly also likely have insulin resistance, even if their waist circumference is less than the aforementioned cutoffs.

2. Low HDL (good cholesterol) accompanied by high triglycerides almost always means insulin resistance.

3. If fasting glucose is over 92, insulin resistance is likely.

4. A1C is a blood test that measures the average blood sugar over the preceding 3 months. Normal is < 5.7, diabetes 6.5 or greater, and prediabetes 5.7 to 6.4.

5. The gold standard for determining insulin resistance is a 1 and 2-hour glucose tolerance test: Fast for 12 hours, drink a bottle of water with 75 grams of glucose, and have a blood glucose drawn 1 and 2 hours later. If the 1-hour is > than 125 or the 2-hour > 120, insulin resistance is present.

WHY IS INSULIN RESISTANCE SO DANGEROUS? If you have extra weight around your belly, you also have fat in and around your internal organs, in your muscle cells, and in cells of other tissues. This abnormal fat deposition prevents your tissues from using insulin like they should — a condition called insulin resistance. Your body tries to compensate for this by making more and more insulin, and with time the pancreas eventually wears out — eventually type 2 diabetics often have to take insulin. Furthermore, these extra fat cells secrete toxic inflammatory compounds that cause cardiovascular disease and many other health problems.

PREVENTION, TREATMENT, AND REVERSAL: Diabetes has a genetic component, but whether or not these genes get turned on depends on diet and exercise (“genetics loads the gun, but environment pulls the trigger”). There is a new specialty called lifestyle medicine, whose members understand the latest information on diet to prevent, treat, and reverse diabetes, but unfortunately the training of most physicians does not include nutrition or disease prevention. Therefore, diabetics often are not given the latest, evidence-based information on nutrition.

People who mainly eat vegetables, fruit (not fruit juice though), unprocessed grains, legumes, nuts, and seeds (basically a plant-based, whole food diet with no salt, sugar, or added oil diet) and exercise regularly have a very low incidence of central obesity, prediabetes, and type 2 diabetes. It should be noted that autoimmune diseases including type 1 diabetes are also rare in these populations. This same diet also reverses prediabetes and recently-diagnosed type 2 diabetes. (If diabetes has been present for a long time most of the insulin-producing cells in the pancreas have been destroyed, preventing reversal, although blood sugars improve on this diet even in those people).

For more information, a good book to read is “Dr. Neal Barnard’s Program for Reversing Diabetes.” Dr. Barnard is a physician-researcher at George Washington School of Medicine in Washington, D.C., who is founding president of PCRM (Physician Committee for Responsible Medicine).

Dr. Feinsinger is a retired family physician with special interest in disease prevention and reversal through nutrition. Free services through Center For Prevention and The People’s Clinic include: one-hour consultations, shop-with-a-doc at Carbondale City Market, and cooking classes. Call 970-379-5718 for appointment, or email gfeinsinger@comcast.net