4) DIABETES AND HEART DISEASE
d) Blood Lipid Chemistry
Surprisingly, individuals with type 2 diabetes should not be aiming at a LDL ("low density lipoprotein", the "bad" form of cholesterol) and triglyceride levels of 100 to 130. Rather they should be aiming at levels of 70 to 80. For reasons that are poorly understood, individuals with type 2 diabetes are just much more sensitive to LDL cholesterol and triglyceride levels. Deposits seem to form much more readily in the blood vessels of someone with type 2 diabetes. It could be that the "poisoned proteins" or AGEs that are so prevalent in diabetes act as a glue which binds LDL and triglycerides to the walls of the blood vessels. It could also be that the walls of the blood vessels are stiffened by protein poisoning and that blood lipids stick easier to a blood vessel which is stiff and unflexible. It could also be that poisoned proteins interfer with the action of specialized cells which remove deposits from the walls of blood vessels. It could be that the protein portion of the LDL cholesterol is poisoned and crosslinked in such a way that the liver has a difficult time eliminating it from the body. It could be that the good HDL cholesterol is inactivated by protein poisoning. It could be all of these and more concepts as yet unthought of.
Because most persons with diabetes die from heart disease, blood lipid (blood fats) profiles are probably almost as important as blood sugar levels. There are two schools of thought on the effect of bad blood lipids from the diet on heart disease, one school is that LDL cholesterol is the culprit and one school is that triglycerides (both are blood lipids) are the culprit. And the two schools of thought are miles apart. The truth of the matter is that they are both right, if the deposits inside the arteries of a heart patient are analyzed it turns out the deposits are a combination of both cholesterol and triglycerides. High glycemic index carbohydrate intake tend to give high triglycerides and saturated fat intake tend to give high cholesterol, both resulting in bad blood lipids and heart disease. It should be noted that the liver is capable of converting either carbohydrates or fats into either cholesterol or triglycerides, so the exact picture is somewhat murky. It is clear that both refined carbohydrates intake and high "feedlot" saturated fat intake are bad for everyone's heart, especially if a person has type 2 diabetes. It is only in the mechanism by which that damage is done that the research is ambiguous.
Blood vessel deposits with more triglycerides tend to be so called "soft" deposits as compared to high LDL cholesterol deposits. There is some indication that "soft" deposits break free and form blockages easier than "hard" deposits. So some physicians say that excess triglycerides formed by excess carbohydrate ingestion are worse than high LDL cholesterol. And some studies have shown that cholesterol intake per say does not correlate well with heart disease, even though intake of saturated fat intake does correlate well with heart disease. But all in all, there just isn't enough research to say whether or not triglycerides or LDL cholesterol (and thus high glycemic carbohydrates or saturated fats) are significantly different in their importance to heart disease. It is clear that high levels of LDL cholesterol and high levels of triglycerides in the blood are both very detrimental to heart health. And it has to be remembered that saturated fats have over twice the calorie content of refined carbohydrates so saturated fats add to the large blood vessel disease process by keeping the weight up in addition to forming deposits in the blood vessels.
HDL (High Density Lipoprotein) is the "good form" of cholesterol and the levels need to be high. HDL apparently functions by removing LDL deposits from blood vessels and transporting the LDL to the liver where it is disposed of. HDL levels in people with type 2 diabetes tends to be very low, especially if that individual has metabolic syndrome. Unfortunately there is no magic pill which raises HDL significantly. The only way to raise HDL is prolonged and vigorous exercise.
For reasons that are somewhat unclear another lipid has a large effect on heart health. Omega 3 fatty acids seem to be extremely beneficial to a healthy heart. Another blood lipid, omega 6 fatty acids, seems to have either no effect or a negative effect. Omega 6's seem to counteract the good effects of omega 3's. In Paleolithic times the basis of the human food chain was green leafy plants high in omega 3 fatty acids and low in saturated fats and low in omega 6 fatty acids. This was what both man and the animals he ate both ate. Now both man and the animals he eats eat largely grains and cooked processed soybeans, which are high in omega 6 fatty acids and very low in omega 3 fatty acids. The whole basis of man's food chain has changed considerably in just a few generations. We've gone from cattle who were selectively eating green plants to cattle who are held in muddy lots and fed soybeans and grain. The same is true of chickens, pigs, farmed salmon, farmed tilapia, and farmed shrimp. The basis of the food chain for both early eskimos and early Masai was green plants (microscopic green algae in the sea for eskimos' fish, green plants for Masai Cattle), not grains and cooked soybeans. Masai cattle are not held in feedlots. We've gone from ingesting equal amounts of omega 3's and omega 6's to eating ten to twenty times more omega 6's than omega 3's. This change is huge, and could well be one of the major reasons for our "modern" health problems, including type 2 diabetes and heart disease.
There are some physicians and dieticians, such as Doctor Atkins, that don't see a lot wrong with the feedlot saturated fats in beef and pork. But there is a lot of good statistically significant research says feedlot saturated fats AND high glycemic carbohydrates are BOTH bad! The feedlot meat we eat today is nothing like the meat our ancestors ate. This is where the Atkins diet missed the point. Atkins repeatedly slams "modern carbohydrates". And that criticism is well deserved. But the doctor failed to recognize that "feedlot meats" are just as bad because the basic fats they contain are now large amounts of saturated fats and zero omega 3 fats, instead of the small amounts of saturated fats and relatively large amounts of unsaturated omega 3 fats found in wild game. Wild game has omega 3 oil contents of 0.1 to 0.5%. Domesticated animals such as cattle and pigs have zero omega 3 oils in them. The amount of saturated fat in pork has increased by a factor of 60 times as the pig was domesticated (this is why game meat such as venison is commonly cooked wrapped in bacon, the added fat is needed to tenderize the meat). Feedlot saturated fats (beef, ham, bacon, hamburger, pork) also are typically eaten well cooked, which increase the levels of poisoned protein (AGEs) in the blood stream. If wild game is well cooked it becomes extremely tough, so Paleolithic man probably did not cook his meat to the "well done" stage, if at all (eskimos eat their meat raw, preserved by drying or preserved by literally allowing it to spoil, Masai eat raw uncooked blood mixed with raw milk). These are huge changes and to assume that the human body can adapt to that degree of change in several generations is naïve.
Current Chapter: 4) DIABETES AND HEART DISEASE
a) Introduction
b) Small Blood Vessel versus Large Blood Vessel Disease
c) Large Blood Vessel Mechanisms
d) Blood Lipid Chemistry
e) Diabetes and "Heart Failure"
f) Peripheral Arterial Disease (PAD)
g) Blood Proteins, Diabetes and Heart Disease
h) Genetic Risk Factors for Diabetes and Heart Disease
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