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Another important consideration somewhat related to diabetes is Arteriosclerosis or hardening of the arteries. Atherosclerosis is a specific type of arteriosclerosis that involves a restriction in the flow area of the arteries resulting from a build-up of plaque (fatty deposits) on the arterial walls.  This flow restriction can result in circulatory issues and severe cases can result in bypass surgery.  While arteriosclerosis has a variety of causes, some of which are genetic and some are lifestyle-related.  Lifestyle-related causes include:

  • Various forms of tobacco (and possibly similar non-tobacco) consumption.
  • Obesity, diabetes/insulin resistance.
  • High cholesterol and/or high triglycerides (related to blood lipids/fat)

The prevention of Arteriosclerosis is similar to the control of Type 2 Diabetes:  not smoking and maintaining healthy weight.  Maintaining a healthy weight requires a healthy diet and staying physically active.

I mention Arteriosclerosis because there has been some controversy about eating a low fat (and especially low cholesterol) diet in order to control [blood] serum cholesterol and triglycerides.  There are 2 kinds of serum cholesterol: HDL (High-Density Lipoprotein: “good” cholesterol) and LDL (Low-Density Lipoprotein: “bad” cholesterol). LDL Cholesterol (LDL-C) causes plaque to form on arterial walls but HDL Cholesterol (HDL-C) scavenges some of the LDL from the bloodstream and carries it to the liver for excretion.

Excess calories (from carbohydrates, proteins, & fats) in the body are converted into triglycerides and stored in fat cells throughout the body.  While there are many kinds of triglycerides, they can simply categorized as either being saturated or unsaturated.  Saturated meaning that the available molecular positions are occupied by hydrogen atoms and saturated fats are typically solids (as opposed to liquids) at room temperatures.  High levels of both LDL Cholesterol and Triglycerides have been linked to heart disease so it is better to keep these in check.

Fats (and oils) are composed of three fatty acid molecules combined with a glycerol (aka glycerin) molecule . Fatty acids are long, straight chain carboxylic acids and glycerol  is an organic compound containing multiple hydroxyl groups. Omega-3 fatty acids are a particular kind of polyunsaturated (fat molecules that have more than one unsaturated carbon bond in the molecule) fatty acid that is important for normal metabolism and that the body is not able to manufacture.  While Omega-3 fatty acids can be obtained from plant-based sources (such as seeds and nuts), fish (such as salmon, mackerel, tuna, herring, and sardines) are an especially rich source.  The best forms of cooking oils are the ones that have a lower levels of Omega-6 fatty acids such as olive oil, avocado oil, coconut oil, and red palm oil.  Good refined vegetable oil alternatives are canola oil and palm kernel oil.

The liver manufactures the majority (about 80%) of the cholesterol in your body with the remaining 20% coming from the food you eat. As a result, it is difficult to control LDL cholesterol levels purely with changes to your diet.

There are 7 types of LDL cholesterol (LDL-1, LD-2, LDL-3, ... LDL-7).  Pattern A LDL cholesterol consists of Types 1 & 2 (LDL-1, LDL-2), which are benign and the good forms of LDL cholesterol while Pattern B consists of the remaining Types 3-7, which are the bad forms. The main risk from high levels of LDL cholesterol is that glycation of the Pattern A LDL from high levels of blood sugar which converts cholesterol to the Pattern B LDL.  High levels of Pattern B cholesterol are the ones that form the plaques in Atherosclerosis.  Increasing blood glucose levels tends to increase LDL glycation so this is another excellent reason to keep blood glucose in control. Glycated LDL modules (Pattern B) become more damaged when they are oxidized and they are more prone to oxidation in the presence of Omega-6 fatty acids.

While Lipids are frequently tested in Laboratory Blood Work, doctors generally do not request the advanced lipid particle size test (Lipid Electrophoresis: a lipid subfraction test) that identifies the LDL type proportions (ie, Pattern A & B).  A good way to estimate whether you have Pattern A or Pattern B is through the Triglyceride and HDL tests.  LifeLabs indicates a target range of <1.71 mmol/L of Triglycerides and >1.29 mmol/L of HDL Cholesterol in their Lipid Tests.

Lipid Test High Likelihood of Primarily
Pattern A LDL-C
High Likelihood of Primarily
Pattern B LDL-C
Triglycerides
Target: <1.71 mmol/L
<0.5 mmol/L
<9.0 mg/dL
>2.0 mmol/L
>36 mg/dL
HDL Cholesterol
Target: >1.29 mmol/L
>1.5 mmol/L
>27 mg/dL
<0.4 mmol/L
<7.2 mg/dL
Triglyceride/ HDL-C
Ratio Calculation
<0.8 mmol/mmol
<1.8 mg/mg
>1.8 mmol/mmol
>4 mg/mg

Eggs can be good source of Omega-3 fatty acids if the chickens are fed an enriched diet.  While eggs contain both unsaturated and saturated fats, the saturated fats in eggs tend to have a high HDL to LDL ratio.  Even so, one egg per day (or a total of 7/week) is a safe recommended limit for healthy people, while a somewhat lower consumption (up to a total of 4/week) has been recommended for diabetics.  Since eggs have a glycemic index of zero, egg consumption should help to reduce blood sugar levels, which would in turn reduce the risk of cardiovascular disease.  If you're already on a low-glycemic-index-carb/high-fat diet and your blood sugar is under control, it would appear that egg consumption would actually be beneficial part of your diet.

Trans Fats are generally vegetable oils that have been partially hydrogenated but some animal fats (eg, beef fat & dairy fat) also contain small amounts of trans fats.  Saturated fats are fully hydrogenated.  Hydrogenation make vegetable oils more stable and rancid-resistant.  Trans Fats have adverse effects on human health and their consumption should be avoided or at least minimized.  Trans Fats are bad because they simultaneously raise LDL and lower HDL cholesterol and they contribute to insulin resistance and create inflammation.

 


Glucose Pathology

Glycated Proteins (Advanced Glycation End-products - AGEs) have a multiple of nasty effects in the body in addition to damaging LDL cholesterol from healthy Pattern A to CVD-causing Pattern B.  Related to Cadiovascular Disease is peripheral artery disease (blockage in arteries leading to the limbs) and carotid artery disease (blockage in arteries leading to the brain).  High blood glucose is responsible for also causing:

  • Retinopathy - damage to blood vessels in the retina
  • Nephropathy - damages to the tiny filtering units of the kidney
  • Neuropathy - damage to nerves, often causing a loss of sensation in the feet and toes
  • Pancreatic beta cell dysfunction and necrosis
  • Osteoarthritis - damage to cartilage
  • Fibromyalgia - widespread musculoskeletal pain accompanied by fatigue, sleep, memory and mood issues
  • Cancer - links between obesity and cancer.
  • Premature Aging - premature cellular senescence in human skin fibroblast and higher degree of collagen cross-links

Researchers have found a link between Alzheimer's Disease and insulin resistance and some have gone as far as identifying Alzheimer's Disease as Type 3 Diabetes.

Insulin Pathology

People being treated for Type 2 Diabetes with insulin injections often require increasingly higher doses of insulin to combat insulin resistance.  While high blood sugar is damaging to tissues, high levels of insulin are also damaging to some tissues.

  • Hypertension - high blood pressure
  • Leptin Resistance - inability to sense when caloric needs are satisfied, leading to overeating

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