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Diabetes, Heart Disease, and Obesity

Sep 10, 2015

Victor S. Sierpina, MD

One of the red flags that often push people to really work to lose weight, either surgically or non-surgically, is the diagnosis of diabetes. Images of blindness, kidney failure, amputation, and insulin syringes abound. Perhaps lesser appreciated is that diabetes is a major risk factor for heart disease.

 Diabetes usually — though not always — occurs in the presence of obesity. Thus, the term, “diabesity” has come into common usage. Besides the usual concerns about managing blood sugar, diabesity creates additional risks or co-morbidities for heart disease by affecting lipids like triglycerides and cholesterol and elevating the risk of hypertension or high blood pressure.

If you have diabetes, chronic inflammation of the blood vessels is the underlying phenomenon that increases risk of vascular problems in the heart, brain, eyes, kidneys, and extremities. Fat cells produce more inflammatory chemicals that accelerate the damage to blood vessels with the buildup of cholesterol rich plaques and blockage of arteries. Thus, diabetes puts atherosclerosis into overdrive. Especially if coupled with inactivity, smoking, and a family history of heart problems, diabetes is a superhighway to a destination called a heart attack or its predecessor, coronary artery disease.

While major advances in medications, procedures such as bypass surgery and cardiac stenting can help preserve heart muscle and protect against heart attack, these interventions cannot and do not in and of themselves reverse heart disease.

Dr. Dean Ornish, a cardiologist, has published important and paradigm shifting studies showing how an extremely low fat (<10% saturated fat) primarily vegetarian diet couple with gentle yoga, regular meditation, and group support can actually reverse heart blockages caused by atherosclerosis. He published his findings in the prestigious Journal of the American Medical Association over two decades ago Yet, these lifestyle approaches have yet to be adopted by most cardiologists and patients on any widespread basis. It seems easier to take a pill or do a procedure than make a lifestyle change as studied in the Ornish program.

One of the amazing health effects of bariatric surgery is that it can actually cure diabetes, often within a few days of surgery. This effect shows up even before weight loss occurs and is likely due to a change in insulin signaling and other processes in the gut and pancreas. Once you shut down the diabetic process, the downhill ride to heart disease is slowed, and may even be stopped or reversed.

So, if your doctor has recently diagnosed you with diabetes, know your risk for heart disease just jumped about 5 times. This is the time to become more active, monitor your diet, and lose some weight before it is too late. Be sure to control other manageable risks like cholesterol, high blood pressure, and smoking.

You can make it if you try. Give your heart a chance.

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