High Triglycerides, Diabetes, Metabolic Syndrome, and Beer Bellies/Apple Figures

As pointed out by researchers and obesity experts, fat tissue is not like an inert storage depot. It is a very dynamic organ that is actually producing hormones and chemical messengers.

Date:   2/21/2008 4:53:37 PM   ( 16 y ) ... viewed 15927 times

Excerpted from:
http://www.reducetriglycerides.com/G_metabolic_syndrome.htm

It is estimated that about 50 million U.S. adults have the metabolic syndrome. Nearly one in four women has that syndrome -- but doesn't know it!
As you know, hypertriglyceridemia is the key symptom of the metabolic syndrome which has become increasingly common in the United States.

Because of its close association with insulin resistance, in which the body can’t use insulin efficiently, metabolic syndrome is also called the insulin resistance syndrome.

People with this syndrome are at increased risk of coronary heart disease and other diseases related to plaque buildups in artery walls (e.g., stroke and peripheral vascular disease) and type 2 diabetes.

According to the current criteria, the metabolic syndrome is identified by the presence of three or more of the following components:

    * Central obesity, the so called apple figure, present in most people with insulin resistance, as measured by waist circumference: in men - greater than 40 inches, or >101 cm; in women - greater than 35 inches, or >89 cm
    * High blood triglycerides: greater than or equal to 150 mg/dL, or 1.7 mmol/L
    * Low blood HDL-"good" cholesterol: in men - less than 40 mg/dL, or <1.0 mmol/L; in women - less than 50 mg/dL, or <1.3 mmol/L
    * High blood pressure: greater than or equal to 130/85 mmHg
    * Pre-diabetes: fasting glucose greater than or equal to 110 mg/dL

In other words, you are at risk for the insulin resistance syndrome, if you have three or more of these symptoms.

If not controlled properly, this syndrome, also called pre-diabetic syndrome can lead to:

    * heart disease
    * non-alcoholic fatty liver
    * colon cancer or
    * ovarian cancer.

Elevated blood triglycerides are the most common lipid (blood fat) disorder in people with pre-diabetes or diabetes. Poor sugar control in type 2 diabetes directly increases triglyceride levels (Hyperlipidemia and diabetes mellitus. Mayo Clinic Proceedings 73:969–976, 1998). Therefore, monitoring triglycerides is essential in order to avoid the macrovascular complications - heart attacks, strokes, and limb amputations in the future.

If you have the metabolic syndrome correcting blood triglyceride levels should be your priority.


    Risk Factors for Insulin Resistance in Women     
     
In people with diabetes, a triglyceride level of 100 mg/dL, or 1.1 mmol/L is considered to be a target value.

Many of the risk factors for insulin resistance are the same as they are for developing diabetes. It applies to women in particular who are overweight, especially with

    * central obesity (with a waist circumference, at the navel, to hip circumference ratio of more than 0.8 or with a body mass index over 27)
    * a strong family history of diabetes
    * a history of gestational diabetes in pregnancy
    * a history of hypertension
    * dyslipidemia especially having high triglycerides and low HDL-"good" cholesterol, and
    * polycystic ovary syndrome.

Another strong predictor in women is a skin change called acanthosis nigricans which is a velvety, mossy, flat warty-like, darkened skin change occurring at

    * the neck
    * the armpits (axillae) and
    * underneath the breasts.

Almost 90 percent of women with these skin changes have insulin resisitance. Additionally, insulin resistance may be worsened by

    * reduced physicial activity
    * aging
    * tobacco smoking, or
    * drugs such as diuretics, certain anti-hypertensives, or steroids.


    Do Not Mess With Diabetes!     

With 800,000 new cases each year it is not surprising that diabetes ranks high among the list of conditions expected to accelerate. While not simply as a result of diabetes, 31 percent of all U.S. households are watching their sugar intake (Natural Marketing Institute, 2001).

Type 2 diabetes is a nasty, degenerative illness which will gradually and slowly suck the life out of you and contribute to a miserable existence.

It can damage many of the body systems leading to such serious medical complications as

    * heart disease (heart attack, stroke) - the most common consequence
    * cataracts and/or glaucoma, leading to blindness (due to retinopathy)
    * kidney damage
    * amputations from gangrene and/or from damage to nerves (neuropathy).

Approximately 25 percent of 21 million diabetics in the United States will develop foot problems and 6 to 10 percent will undergo amputation (data for 2002).

Complications of diabetes are the third leading cause of death in the United States. Diabetes is associated with one-third of the heart attacks and two-thirds of the strokes.

Diabetics spend more time in the hospital for foot complications than for all other aspects of their disease combined.

Among the urologic complications of diabetes mellitus, the most common form of organic sexual dysfunction in male diabetics is erectile impotence.

Up to 75 percent of male patients who had diabetes for 15 - 20 years suffer from this disorder.


    Preprandial (Before Meal) Blood Sugar Levels     

Current medical standards state that diabetes is formally diagnosed at fasting blood sugar level of 126 mg/dL, or 6.93 mmol/L.
Your 8-hour fasting (preprandial) blood sugar is normal if it's 70 milligrams per deciliter (mg/dL), or 3.88 millimoles per liter (mmol/L), to 100 mg/dL, or 5.55 mmol/L.

If your fasting blood sugar level is between 100 mg/dL (5.5 mmol/L) and 125 mg/dL (6.9 mmol/L), you are considered pre-diabetic.

Some clinics, however, as a biomarker of coronary heart disease, risk use a fasting blood sugar of 90 mg/dL (5 mmol/L) or higher.

Insulin Levels
With fasting insulin levels, the lower the better. Below 5 uU/ml is good, but 2 or 3 uU/ml would be far better.

Although most physicians use fasting insulin levels of over 15 uU/ml to diagnose type 2 diabetes or insulin resistance, any fasting insulin level over 10 uU/ml is a major problem and is a serious risk factor for diabetes.


    Glycated Hemoglobin (HbA1c) Levels     
 
Most diabetic specialists feel HbA1c is the single most important blood test for known diabetics.
Even if you test your own blood glucose daily you still need the glycated hemoglobin test. This test, also called "hemoglobin A1c" or "glycohemoglobin" and sometimes incorrectly referred to as "glycosylated hemoglobin test", is an important "quality control" test used to determine how well one’s diabetes is being managed.

The fasting blood sugar test, which is still the mostly commonly performed test for diabetes, does not reflect the true picture of diabetic control over a long period of time. It only measures the level of sugar in the blood at the moment it is taken from the finger or arm.

The HbA1c test is used primarily to monitor the overall blood glucose (sugar) control of diabetics for the past two to three months. Periodic determinations of glycated hemoglobin provide an accurate time-averaged reflection of patient glucose levels and the effectiveness of the control of glucose.

Tight control of glucose levels, as assessed by HbA1c test, can lead to substantial reductions in the risk of developing the long-term microvascular complication of diabetes such as retinopathy, nephropathy, and neuropathy. Also the risk of myocardial infarction (the main cause of premature death in diabetes) can be improved by reducing HbA1c values.

What Is Glycated Hemoglobin?
The glycated hemoglobin test was introduced as a routine test in the late 1970s and early 1980s. It measures how much glucose is spontaneously attached to hemoglobin A cells - the primary form of hemoglobin in adults and the part of the blood carrying oxygen in the red blood cells. As the hemoglobin floats around in the blood, it picks up glucose in about the same proportion as the glucose that exists in the bloodstream.

The more glucose that is in the blood, the more that binds to hemoglobin A. In other words, if your blood glucose is generally running high, the hemoglobin will have more "glucose coating" (glycosylization). If glucose generally runs low, it will obviously have less.

This combination of glucose and hemoglobin A is called HbA1c, or glycohemoglobin. A1c levels do not change quickly but will shift as older red blood cells die and younger ones take their place. Since the red blood cells have around a two to three-month life span in the body before they are recycled, the "glucose coating" of a sample of hemoglobin can be measured.

Every person, with or without diabetes, has a certain amount of glycosylization present. Because of more sugar in their blood, people with diabetes have a greater amount of glycosylization present.

These determinations are therefore powerful tools for the assessment of time-averaged glucose levels, which are not affected by the momentary fluctuations of glucose resulting from exercise or recent food intake.

Hemoglobin A1C Target Level
For most people with diabetes the HbA1c goal should be less than 7 percent.
The HbA1c test results are generally expressed as a percentage of total hemoglobin. For people without diabetes, the normal range is between 4 and 6 percent. For most people with diabetes the HbA1c goal should be less than 7 percent, according to the American Diabetes Association.

In other words, if the A1c number is less than 7, blood glucose control is “good.” An A1c number higher than 8, or between 7 and 9, means that your glucose control is “average” so you need to take action as you are at a greater risk of developing eye disease, kidney disease, or nerve damage.

A number greater than 9 means your diabetes control is “poor,” meaning that your blood glucose is too high and you are at serious risk of developing the long-term diabetes complications.

In other words, the closer a diabetic can keep the HbA1c to 6 percent, the better his or her diabetes is in control. The poorer the glucose control, the higher the A1c result will be, increasing the chances for serious consequences of diabetes. Therefore, lowering the A1c number – by any amount – can improve the chances of staying healthy.

Frequency of the HbA1c testing depends on 1) the type of diabetes, 2) how well diabetes is controlled, and 3) on a doctor. The American Diabetes Association recommends testing HbA1c:

    * 4 times each year - if you have type 1 or type 2 diabetes and use insulin, or
    * 2 times each year – if you have type 2 diabetes and do not use insulin, or
    * more frequently – if your diabetes control is not good.

HbA1c is generally monitored at least every three months in patients who are being treated with insulin. It is frequently ordered on newly diagnosed diabetics to help determine how elevated their uncontrolled blood glucose levels have been. HbA1c may be ordered several times while control is being achieved, and then several times a year to verify that good control is being maintained. Those who have their diabetes under good control may be able to wait longer between the HbA1c tests, but experts recommend checking at least twice a year.

While HbA1c is not currently used for an initial diagnosis, it is useful for determining the severity of diabetes. However, it can be used to help predict complications in people who have fasting blood glucose levels between 100 mg/dL (5.5 mmol/L) and 125 mg/dL (6.9 mmol/L), which are above normal but do not indicate full-blown diabetes.

Hemoglobin A1C Test Limitations
The HbA1c test results can be affected adversely by high levels of blood lipids and nutritional supplements.
A 1 percent change in the HbA1c result reflects a change of about 30 mg/dL, or 1.67 mmol/L in average blood glucose. For instance, an HbA1c of 6 percent corresponds to an average glucose of 135 mg/dL, or 7.5 mmol/L, while an A1c of 9 percent corresponds to an average glucose of 240 mg/dL, or 13.5 mmol/L.

However, the correlation between mean plasma glucose (MPG) levels and HbA1c levels is estimation only, depending on methodology used for the calculation as well as other factors, such as the red blood cells life span. Therefore, the exact MPG value reported on your laboratory report may not coincide exactly with the formula given above.

Several limitations have been known to interpreting glycemic control with HbA1c test. What may falsely lower glycated hemoglobin values is, for instance, the presence of hemoglobin variants.

Unfortunately, the current methods do not recognize hemoglobin variants and the calculation for the glycated component is only related to hemoglobin A1c (HbA1c), not to HbS1c, HbC1c, or to HbD1c, which may result in very low glycated hemoglobin values.

The prevalence of the most common hemoglobin variants (HbS, HbC, and HbD) depends on the genetic background of the population being analyzed. Although relatively rare in white individuals, these variants are common in populations with heterogeneous ethnic backgrounds. In such populations, misleadingly low glycated hemoglobin values have been identified by some methods, but not by others.

In addition, several other factors besides the presence of genetic variants or chemically modified derivatives of hemoglobin, such as drugs, anemia, uremia, and alcoholism, may falsely lower HbA1c results.

Also if you have an abnormal type of hemoglobin, such as sickle cell hemoglobin, you may have a decreased amount of hemoglobin A (HbA). This will affect the amount of glucose that can bind to your hemoglobin and may limit the usefulness of the HbA1c test.

Your test results may be falsely low, if you have hemolysis or heavy bleeding. On the other hand, if you are iron deficient, you may have an increased A1c measurement.

Other abnormalities that can affect the results of the HbA1c test include supplements such as Vitamin C and E and high levels of blood lipids. Kidney disease and liver disease may also affect the result of the HbA1c test.

Nevertheless, the impact of the effects of these interferences in routine clinical practice has not yet been well established.

Brittle Diabetes and Hemoglobin A1C Test
Because the HbA1c test measures average glycemia it will not reflect temporary, acute blood glucose increases or decreases in someone who has “brittle diabetes,” also known as “unstable diabetes,” or “labile diabetes” - when a blood sugar level often swings quickly from high to low and from low to high.

It can result in some individuals only achieving their treatment goal at the expense of a poor quality of life, as a result of frequent, disabling, and unpredictable hypoglycemia.

Home Hemoglobin A1C Test
The FDA has cleared for non-prescription use of the HbA1c test for people with diabetes to help monitor long-term control over blood glucose levels. Over-the-counter status means that the test can now be purchased without a prescription and used at home. To perform the test, one takes a blood sample from the finger with a lancet and places it in a monitor. The monitor displays test results in eight minutes. And there is no need to send the sample back to the physician to get results. The results are available on the spot.

The information on the average level of glucose in the body over a two to three-month period complements the results obtained from daily finger stick blood glucose tests that measure glucose only at a single point in time.




    The Risky Apple Figure     
      
For men with the apple figure - and excess weight in the middle - the risk for heart disease goes up two and a half times, for women - the risk rises eightfold.


Why is the apple figure risky?

Fat cells located in the abdomen release fat into the blood more easily than fat cells found elsewhere. Release of fat begins 3 to 4 hours after the last meal compared to many more hours for other fat cells.

This easy release shows up as higher triglyceride and free fatty acid levels. Free fatty acids themselves cause insulin resistance.

It is estimated that one out of every four people in the U.S., or 80 million Americans, have insulin resistance and they are more prone to heart disease, even though they may never actually develop diabetes.


    The Waist-to-Height Ratio     
      
Your waist size in inches should not be greater than one half your height in inches.
The waist-to-height ratio (WHtR) is one of the simplest (and the most accurate) cardiovascular risk formulas and ratios.

The ratio between waist girth and height indicates the degree to which fat has accumulated around the waist. Typically, it is a male pattern of fat distribution, but females do exhibit this also!

A waist-to-height ratio under 50 percent is generally considered "normal." Tthe greater your abdominal girth relative to your height, the fatter you are, and, consequently, the greater your risk of cardiovascular disease.

Also the WHtR gives a more accurate assesment of health for serious athletes, especially body builders, who have a higher percentage of muscle and a lower percentage of body fat, and for women who have a "pear" rather than an "apple" shape.

Insurance companies are good at making money because their actuaries are very knowledgeable in determining risks.

Why do you think they insist on knowing your height and waist measurements as part of your insurance physical?

As you already know, increased abdominal girth is a strong (and useful) indicator of:

    * hyperinsulinemia
    * pre-diabetes
    * diabetes and, consequently
    * cardiovascular disease.


    The Risky Beer Belly     
      
Your belly becomes really risky when the girth crosses 102 cm, or >40 inches.
Fat sticking around the abdomen creates a "beer belly," also called ‘hypertriglyceridemic waist.’ Actually, it can forecast a cardiologist in your future as the beer belly is also associated with a higher risk of high blood pressure and even certain forms of cancer.

“Hundreds of studies have led to the conclusion that any fat [in excess] can be problematic, but it’s much, much more dangerous when it’s accumulated in the abdomen,” said Dr Jeffrey Flier, researcher at the prestigious Beth Israel Deaconess Medical Center in Boston.

How big is big?

Usually, dangers begin to emerge in men who have a belly that measures more than 94 cm. or >37 in. around the middle.

To find out whether you have an apple figure, determine your waist-to-hip ratio:

    * Take your waist measurement with a tape measure around your waist an inch above the navel.
    * Then take your hip measurement by measuring your hips at their widest point.
    * Determine your waist-to-hip ratio by dividing your waist measurement by your hip measurement.

An unhealthy accumulation of fat in the middle, or an apple figure, suggests, for women, ratio over 0.8; for men - over 1.0.


    Excess Weight as Disease     
      
There is a common misconception – shared by both patients and doctors - that excess weight is nothing to worry about until high blood pressure and poor cholesterol develop, and those can then be treated with medications.

Obesity has not been hyped. In fact, it should be defined as a disease - a real public health crisis.

Middle-aged people who are obese - or grossly overweight - are over 40 percent more likely than normal-weight people to die of heart disease. They are also four times as likely to be hospitalized for heart disease.

As pointed out by researchers and obesity experts, fat tissue is not like an inert storage depot. It is a very dynamic organ that is actually producing hormones and chemical messengers. And even without elevating blood pressure or cholesterol, these substances can

    * damage blood vessels
    * increase the risk of blood clots and
    * cause insulin resistance that makes people prone to diabetes.

In other words, being too fat causes cardiovascular problems and excess weight alone is an independent risk factor for heart attacks, strokes and diabetes.

So, if you are an overweight middle-aged individual with normal blood pressure and cholesterol levels you are kidding yourself if you think your health is just fine. You need to pay strict attention to your weight even if you do not have an unhealthy risk factor profile yet.


    The Importance of Lifestyle Changes     
      
Although genetics may make you susceptible to diabetes - it usually occurs in people with a family history of diabetes - perhaps more than most diseases, type 2 diabetes (maturity-onset, non-insulin-dependent, or insulin-resistant) is associated with poor diet and unhealthy lifestyle.

In fact, nine out of ten cases of type 2 diabetes could be prevented - if people

    * ate better
    * exercised more
    * stopped smoking, and
    * adopted other healthy behaviors.

Diet then and at least moderate exercise program are the the most important steps you should take to avoid metabolic complications.

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