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 Diabetes and Heart Disease: Reducing the Risk 
 
The following is one in an ongoing series of columns entitled Mind Over Matter by . View all columns in series
The fact that diabetics are more likely to suffer from heart disease isn't news. Even the finding that 75% of people with Type II diabetes (the most common form) die of heart attacks or strokes isn't surprising.

Yet new research published recently in the January issue of JAMA (the Journal of the American Medical Association) is raising some eyebrows especially in medical circles. While it's been well-established that high blood pressure and low levels of HDL or "good cholesterol" account for about half the higher than normal risk for heart disease, scientists now have a clue that just might add the most important piece to this perplexing puzzle. And better yet, the discovery itself, reveals a practical treatment strategy.

Let's take a few minutes to review the differences between the two types of diabetes. Type I diabetics typically experience the disease in childhood due to the failure of specific pancreatic cells to produce insulin, a hormone needed to drive glucose into cells. On the other hand, Type II diabetics (approximately 14 million in our nation) tend to develop the disease later in life. They typically have sufficient or even elevated levels of insulin, yet their insulin receptors do not function properly. Conventional treatment strategies for Type I diabetics include insulin replacement and diet. Type II patients are frequently treated with diet and oral agents, although some eventually need insulin.

For our cells to properly utilize glucose as an energy source, insulin must be produced in sufficient quantities and insulin receptors must function properly. Here's a simple analogy; opening a locked door requires a specific key (insulin) and a matching keyhole (insulin receptor) which accepts the key.

Now that we've established a framework for understanding diabetes, let's proceed to explore the new findings reported by Dr. James Meigs and colleagues of Massachusetts General Hospital who set forth to better understand the diabetes/heart disease connection. In the early nineties, they studied over 3,000 people who were enrolled in the Framingham Offspring Study, one of the most highly regarded, long-term cardiac risk factor evaluation programs in history.

These researchers discovered a simple yet fascinating correlation. Subjects with elevated insulin levels also had increased amounts of a substance termed the PAI-1 antigen, a chemical that inhibits our blood's ability to dissolve clots. This fact takes on great significance as one of the most important underlying processes resulting in heart attacks and strokes is diminished blood flow secondary to ... you guessed it - clots!

Let's take a few moments to consider the fact that the typical Type II diabetic's insulin receptors perform their job inadequately. The medical term used to describe this condition is "insulin resistance." When insulin resistance is detected through a built-in feedback mechanism, our bodies simply respond by increasing the production of insulin, which we now know is associated with increased clotting.

Yet this story doesn't end here for Type II diabetics. The most important question is how to reduce their blood's tendency to clot. The answer suggested by the investigators is based upon an intervention that has been extensively proven to diminish insulin resistance. It's not an expensive drug, a popular supplement, or a genetically engineered vaccine. It doesn't require state-of-the-art medical technology and it won't be challenged by your healthcare insurer.

The recommended treatment strategy is none other than... exercise!

The phenomenal implication of this research is that exercise may enable diabetics to lower their risk of heart disease by helping to prevent clotting. This conclusion is so practical that it's almost a let down. Our ancestors had the answers all along, while we seem to be spinning our wheels developing technologies to prove what they recognized as everyday common sense strategies for wellness.

In any event, the data speaks for itself. It's time to turn off the tube, get out there and move those achy joints to the rhythm of your own drummer. And by the way, the association between high insulin levels and the PAI-1 antigen was also noted in pre-diabetics - people who are expected to develop diabetes at a later time. That could be any one of us!

So if risk reduction is in your cards, there's no better time than the present to improve your odds for living a healthy and happy life. Forget the excuses and put on your sneakers. To quote a famous industry leader, "Just do it!" - Mind Over Matter!

© 2000 Barry Bittman, MD all rights reserved

Barry Bittman, MD is a neurologist, author, international speaker, inventor and researcher. He is the CEO and Director of the Mind-Body Wellness Center, 18201 Conneaut Lake Road in Meadville, phone (814) 724-1765, fax (814) 333-8662, www.mind-body.org.

Contact Dr. Bittman

      
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 About The Author
Barry Bittman, MD is a neurologist, author, international speaker, award-winning producer/director and inventor. As CEO and Medical Director of the Mind-Body Wellness Center, a......moreBarry Bittman MD
 
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