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Diabetes, Hypertension and Lipid Abnormalities

What are we dealing with here?

For years traditional medicine has been dealing with these common medical complications as separate entities and for good reason.  Treating each condition seemed to reduce the patient's risk of more complications in the future.

With our limited understanding, we knew treating elevated blood pressure resulted in fewer strokes and heart attacks and lowering a person's blood sugar to "normal" levels also resulted in less heart disease, blindness, kidney failure and amputation.  Additionally, lowering a persons LDL cholesterol (the 'bad cholesterol') is thought to reduce the risk of future or recurrent heart attacks and strokes.

Obviously, preventing future medical complications is a laudable goal but is the use of more and more prescription medications always necessary?

We are now at a moment when a unifying theory of sorts is beginning to unfold that helps us understand the commonality of all 3 of theses medical conditions, not to mention a few others.  Accumulating research is beginning to suggest that these 3 common disorders come from a common underlying metabolic abnormality known as Insulin Resistance. 

What is the most traditional understanding of Insulin Resistance?

 Insulin resistance is a term originally applied to the metabolic abnormalities associated with the development of Diabetes Mellitus Type II (Adult Onset or Non-Insulin Requiring Diabetes).  Our most common and modern perspective of the recent epidemic of Diabetes Mellitus II (DMII) is that of a condition in which repeatedly high levels of blood sugar (glucose), results in repeatedly high insulin levels from excessive exposure to simple carbohydrates (sugars and starches). 

Carbohydrates known to cause high spikes in blood sugars and the subsequent elevation of insulin are known as high glycemic index carbohydrates.

Our present-day model of Insulin Resistance is that our body's over -exposure to insulin then causes the muscle and liver tissue to not react as readily to the insulin; hence the term insulin resistance.  The development of insulin resistance then requires the pancreas to produce more and more insulin in order to keep the blood glucose levels within a safe range. 

When the pancreas can't produce enough insulin to overcome the developing insulin resistance, blood glucose levels rise and the patients are diagnosed with DMII. Additionally, there is an increase in blood levels of molecules known as free fatty acids which are felt to be responsible for elevations in triglyceride and decreases in HDL cholesterol levels.

So what has changed in our perspective towards Insulin Resistance and these 3 disorders?

Many researchers would argue that Insulin Resistance is not a disorder brought about by excessive spikes in blood glucose and subsequent insulin levels but from a broad, systemic reaction of the body to excessive weight, decreased exercise and over-exposure to carbohydrates.

Interestingly, animal studies seem to suggest that damage to the an area of the central nervous system known as the Autonomic Nervous System (ANS) must first occur before any of the metabolic or physical effects traditionally to be a result of present-day model of insulin resistance (see graphic below).  Animal studies are beginning to demonstrate abnormalities of autonomic function that lead to aberrant neurological impulses into the fat cells, our blood vessels and elsewhere in our bodies. 

When these abnormal impulses reach the fat cells, free fatty acids (FFA) levels increase resulting in the tissue changes traditionally associated with the rise in blood sugars.  When FFA are elevated, they cause our muscle and liver tissues to reactive abnormally in such a way that insulin resistance occurs. 

In regards to DMII, it seems we've had the cart before the horse.  It's the elevation of FFA that causes insulin resistance which then leads to increased blood glucose levels; not increased blood glucose levels leading to insulin resistance and increases in FFA.

Additionally, when these abnormal autonomic sympathetic impulses reach the blood vessel system, they cause an abnormal elevation in blood pressure known as Essential Hypertension.  Essential Hypertension accounts for 80% of all individuals with hypertension.

The elevations in FFA also are responsible for the liver to store excessive fat (a condition known a Non-Alcoholic Fatty Liver Disease) as well as to produce too much triglycerides and not enough of our healthy cholesterol known as HDL cholesterol.

There is even a abnormal pattern of autonomic function known as Sympathetic Dominance that is felt to represent the toxic effects of carbohydrates on our autonomic nervous system..

So where does that leave us?

It seems that to treat the 3 of the most common medical conditions, we need to treat insulin resistance.  How do we do that?  Many differ things may contribute to Insulin Resistance:

1. Aging
2. Our genetic make-up
3. Being over weight.
4. Eating too many carbohydrates (sugars and starches).
5. Not enough exercise.

Obviously, the only factors above we can change are to lose weight, eat fewer carbohydrates and exercise more regularly.

Click on this link for the simplified low carbohydrate and exercise instructions I provide to most of the patients in my practice.

How do I know if I have Insulin Resistance?

Insulin resistance is difficult to measure by a simple blood test so doctors depend on a combination of other simple lab tests and medical conditions in order to make the diagnosis.

If one or more of the following is true for you, you may very likely have Insulin Resistance:

• Body Mass Index is equal to or greater than 29.
• Fasting blood sugar level that is higher than normal (>100).
• Fasting triglycerides are higher that 150.
• HDL Cholesterol is less than 50 for women or 40 for men.
• You have an excessive amount of fat around your waist (> 40 inches for Men & > 35 inches for Women; measure a relaxed abdomen at the midpoint between the top of the pelvis and the lowest rib of your flank)
• One (or more) of your brothers, sisters or parents has been diagnosed with diabetes.
• A history of Diabetes during pregnancy.
• Have been diagnosed with Sleep Apnea.
• Have been diagnosed with Polycystic Ovary Syndrome.
• Have been diagnosed with Fatty Infiltration of the Liver.
• You have a skin condition known as Acanthosis Nigricans.