Health & Fitness

Cross out the untrue parts of the following sentence: The insulin our bodies produce may cause avoidable heart attacks many physicians can't explain in millions of apparently healthy, non-diabetic Americans like you and me without warning symptoms. Next, cross out the parts that are not worrisome. Then go back and cross out the parts that are exaggerated or rare.

(No) surprise: You should not have crossed out anything. More than 30 million non-diabetic U.S. residents have asymptomatic insulin resistance that probably threatens their hearts, and physicians are not being aggressively informed of it. Any nourishment elevates our blood glucose (sugar). Simple carbohydrates such as junk food and white breads, potatoes, and pasta produce especially strong blood glucose surges. To control the glucose level, our pancreas secretes insulin, which enables the glucose to leave the bloodstream and enter our fat cells for storage and our muscle cells to produce energy. When these cells resist insulin's effect, blood glucose remains elevated, prompting the pancreas to keep blood insulin levels high. As long as the pancreas manages to keep producing enough insulin to keep the blood glucose below 127, we do not have diabetes, by definition.

But this is not about diabetes. This is about significantly elevated risk of coronary heart disease associated with blood sugar levels that are slightly elevated but below the diabetes threshold and thus once thought safe. But evidence it starting to show that even if our weight, blood pressure, total cholesterol, dietary fat, pulse, heritage, and SUVs are cool, slightly elevated blood sugars trigger insulin levels that may cripple or kill us via heart disease.

Insulin causes heart disease? Well, the word, causes may be premature, but in published studies of hundreds of healthy non-diabetics, the subjects with the highest insulin resistance had at least 15 times the heart attack rate of the least insulin resistant.

In 90% of insulin resistant people the extra insulin required to keep blood sugar below the diabetes level triggers a well-understood cycle that raises blood triglycerides >200 and lowers healthy cholesterol (HDL) levels <40. Just these numbers may elevate heart attack risk in insulin resistant people so dramatically that the other so-called Syndrome X, or metabolic syndrome, criteria -- high BP, family history, and sedentary lifestyle - are merely icing on the Twinkie.

Oh, great! Now we can be slim, yet still on the road to serious heart trouble if we are insulin resistant and enjoy high glycemic index foods, which, by definition, drive our blood sugar up sharply. A major culprit is processed foods -- all of the manufactured stuff many people eat in place of food. You know -- cheese stuff, potato stuff, white bread and cake and cookie and cracker stuff, sugar stuff, 7-11 stuff, movie lobby stuff, vending machine stuff -- all of this packaged stuff that comes out of assembly line nozzles and gets packed in cardboard and plastic, instead of coming off bushes and vines and trees and, sorry to say, from unwitting animals. Geez louise ... is all this stuff more important to people than their very lives or their survivors' grief? Wouldn't you prefer to get hit by a meteor while jogging a marathon at age 90 than by a heart attack while running one at 55?

Sounds like the scaremongers' and booksellers' Disease Of The Month, doesn't it? So how many of us have this "insulin resistance" thing ... three? No. Thirty. Thirty million, that is, in the U.S. alone. Specifically, studies show that 25 to 30 percent of non-obese, non-diabetic people with normal blood pressure are insulin resistant. Do the math, and you'll see the 30,000,000 wag is conservative.

Dr. Gerald Reaven of Stanford has done some of the insulin resistance studies, is sounding the alarm, and is being heard. He has a name, explanation, prognosis and treatment for this problem, described at length in his extensive medical publications and his latest layman's book. The drug company whose medicine fights this problem was a major ally, but they ceased educating physicians on insulin resistance the day their patent on the medicine expired. Now that they have a new, patented medicine that happens to combat Syndrome X, your family physician will start hearing more about it.

Don't presume you don't have Syndrome X, because it's easy to make an educated guess from numbers you should already know. If your HDL is under 40 and your triglycerides are over 200, you need to check one more number - your blood glucose level -- the next time you have your cholesterol checked this year. If your non-fasting blood glucose is below 90, relax. If it's over 90, a fasting blood glucose test is advisable. If that's over 126, you have a much more immediate problem -- you have diabetes. If your fasting glucose runs between 110 and 126, you are insulin resistant and it is dangerous. You should start educating yourself and your doctor now (or finding one who reads more, if necessary).

The tendency for insulin resistance is probably half genetic, but it's primarily excess weight and sedentary lifestyles that drive it over the edge. Exercise, moderate weight loss, and a moderate decrease in your carbo intake may save your life if you're insulin resistant.

Does this mean Dr. Atkins' high-grease/high-cow diet is healthy, that the high-protein promoters simply disagree with Dr. Reaven, and that time will tell who's right? No, no, and no, because they misquote his research to support their claims and he considers their misinterpretations dangerous. High protein/high fat/low carb diets still overwork our kidneys and liver, and their saturated fat intake drives our cholesterol up much more than excess weight or sloth does.

It just means insulin resistant people should reduce their carbo intake to about 45% of their caloric intake rather than the normally ideal 60% or so. It's also best if most of that 45% is low-glycemic-index foods, or at worst occasionally guiltier foods eaten with at least eat some protein, fiber, and maybe some mono- or unsaturated- fats to slow its digestion and thus its effect on blood sugar. Beans, olive oil, nuts or a dash of lean meat are an excellent adjunct to these high-glycemic foods because they add protein, fiber, maybe a little fat, and/or lots of flavor to a meal, and they reduce the sugar spike of straight carbos. Chemical intervention is usually necessary only for those who refuse to lose weight and exercise enough to lower their insulin resistance.

BTW, some of the diet books claim carbos and the resulting insulin make us fat. That's Bogus Science, aka BS. Nothing's changed; it's still CALORIES (minus exercise) which make us fat. As Dr. Reaven says, "Nobody has yet repealed the laws of thermodynamics." If anything, insulin resistance should make us lose weight because it impairs fat storage.

Get your glucose levels checked (via the same simple fasting blood sample used to measure your cholesterol properly). If your fasting glucose level is over 110, buy Dr. Reaven's book, "Syndrome X: Overcoming the Silent Killer That Can Give You a Heart Attack". It's front and center in every major bookstore in the country, near Dr. Atkins' and the carbo addicts' books. The main difference, from what I've read, is that Reaven's book belongs in the medical section, whereas those others may fit better in the science fiction section. If you're going to buy sci fi, you may as well buy Battlefield Earth instead. At least it obeys the Hippocratic oath; it does no harm. And get the book; it's a hundred times better than the movie.