Cardiometabolic Disease -- A Risk at Any Weight

By James LaValle, RPh, ND, CCN

Just because you are not obese, doesn't mean you're off the hook when it comes to increased risk for heart disease and diabetes -- known as cardiometabolic disease. If you're just a little pudgy around the middle, you may pat your belly and chuckle about those few extra beers you had last night, but it is no laughing matter.

Two studies recently looked at the cardiometabolic health of three categories of white adults: normal weight, overweight, and obese. Researchers measured blood pressure, triglycerides, fasting plasma glucose, C-reactive protein (CRP), high-density lipoprotein (HDL), and assessed whether the study subjects were insulin resistant.

What they found was eye opening -- 23.5% of "normal weight" adults were metabolically abnormal -- and surprisingly, the research done by Wildman's group found that approximately 30% of the "obese" group was actually metabolically pretty healthy.¹ In the "overweight" group, it was split about 50-50 between those who were metabolically healthy and those who were at increased risk according to these measures.

So to summarize, the study found the risk for heart disease and diabetes in the three groups to be: normal body weight, 25% risk; overweight, 50% risk; obese, 70% risk.

Another study by Stefan et al. found that 25% of obese people did not have early signs of heart disease as determined by their blood vessel thickness and an oral glucose tolerance test used to measure insulin sensitivity.² Nor were these people categorized at high risk according to their lipid profiles and blood pressure readings.

Both of these studies assessed whether central adiposity (belly fat) raised the risk of heart disease the most, as has been seen in other studies. According to the American Heart Association, if a man's waistline is greater than 39 inches and a woman's waistline is greater than 34 inches, it's time to take action.

Interestingly, the Stefan study found that in already obese patients, the most "at risk" fat was not belly fat, but liver fat. However, in normal and overweight people, belly fat did increase risk the most. (This may be because it is very unusual to see liver fat accumulating in normal weight people.) The Wildman study also found that normal weight or slightly overweight patients are more at risk for heart disease if they have belly fat.

The blogs are now flying about this research. I have seen statements like, "These studies once again prove that just because you are obese doesn't mean you are unhealthy." And indeed these studies show that if you are obese, you have a 25 to 30% chance of being in the group that hasn't yet developed heart disease or diabetes. But the overwhelming number of studies consistently shows that the vast majority of obese people do have heart disease and/or diabetes.

Even in the Wildman and Stefan studies, only 25 to 30% were escaping risk so far. The other 70% were at risk. In the normal weight category, 75% were metabolically healthy and 25% were at risk. I would take those odds any day.

I know some obese individuals will want to hang on to that 25% chance they may not be unhealthy just because they are severely overweight -- but there are other health problems that can develop too. Certainly if you fall into the obese category, you should at least be thoroughly evaluated to find out.

What are the take home messages from this research? You can be at cardiometabolic risk even if you are at a normal body weight, especially if you have increased waist size. This is not news to me and most health practitioners, but it is a big wake up call for many people.

Increased belly fat/waist size puts you at increased risk for heart disease and diabetes -- and the more overweight you become, the greater your risks. So, no matter who you are, you should take steps to prevent insulin resistance and control your weight to have the greatest chance of avoiding these two devastating diseases.

We also need to further study the 25% of the obese population to see what is keeping them from developing insulin resistance. For instance, the Wildman study found that increased physical activity reduced risk. Other studies have found that increased antioxidant intake from foods like green tea and turmeric may prevent damage to insulin receptors from the oxidative stress that can cause insulin resistance.

Perhaps these individuals have better sources of, or utilization of, the mineral chromium which helps regulate blood sugar. Or, they might have increased vitamin C intake from fruits, vegetables, and supplements which reduces the risk of insulin resistance and diabetes.^3-4

Determining which factors can best lower risk of heart disease and diabetes, even in people who have not been able to lose weight, would be of tremendous value.

References

1. Stefan N, et al. Arch Intern Med. 2008;168:1609-1616.
2. Wildman RP, et al. Arch Intern Med. 2008;168:1617-1624.
3. http://www.nutritionandmetabolism.com/content/5/1/17.
4. Arch Intern Med. 2008;168:1485-1499.

[Ed. Note: James LaValle, R.Ph, ND, CCN, is the founding Director of the LaValle Metabolic Institute, one of the largest integrative medicine practices in the country. He was named as one of the 50 most influential pharmacists in the US by American Druggist magazine. Dr. LaValle is the author of more than a dozen books itxtncluding the bestseller, Cracking the Metabolic Code: 9 Keys to Optimal Health.]

Healthy Living: Rethinking Sodium Restriction for High Blood Pressure By Laura LaValle, RD, LD

If you have high blood pressure, you more than likely have been told to try to lose weight and to reduce your sodium intake. But have you ever been told to reduce your sugar and starch intake? More than likely you haven't. In fact, some people in the medical community believe that it's a myth that high carb intake can contribute to insulin resistance and high blood pressure. What a disappointment.

Many studies over the last decade have shown improvements in blood pressure as a byproduct of low carb diets. However, not many studies have looked specifically at blood pressure as an endpoint on a low carb diet. One study completed in 2003 and reported to the American Association of Clinical Endocrinologists in 2006, found that changing the diet to reduce insulin secretion resulted in a drop in diastolic blood pressure (the lower number) from 96 to 88.5 mmHg after six weeks.^1-2

The diet used in this study was a low carb, high fat and animal protein diet. The only dietary restriction was sugar and starch, the two food groups that elicit the highest insulin secretion. There was no calorie or sodium restriction on the diet.

Although the study's lead researcher stated that they discouraged the participants from consuming too many high sodium processed meats like hot dogs and bacon, some participants ignored that advice and in so doing were consuming as many as 20 grams of sodium per day. (Current medical guidelines are to try to eat no more than 2.3 grams [2300 mg] of sodium per day.)

Despite increased sodium intake, blood pressure came down, and that's not the only thing. Fasting blood glucose and insulin, triglycerides, and VLDL all came down -- and there was an average of 12 pounds of weight loss. And finally, there were positive effects on LDL -- the particle size increased. (Larger particle size LDL is not as likely to become plaque in the arteries as small particle LDL.)

Participants were all patients who were overweight, had elevated blood pressure and blood sugar, and were considered to be at very high risk for heart disease and strokes. By the end of the six weeks, some patients were able to stop their high blood pressure and blood sugar medications altogether, and others were able to reduce their dosages.

This finding led the authors to conclude that medicine needs to stop paying so much attention to sodium and more attention to insulin as the cause of high blood pressure. You would think that news like this would travel fast, yet I have found that almost no one has heard of it.

Those of you who regularly read my husband Jim's and my articles, know that we are big advocates for low carb diets. I just want you to know that in reducing your carb intake, you are not only choosing a diet that is good for your weight, your lipids, and blood sugar, you are benefiting from one of the most powerful ways to reduce blood pressure as well. And by making that change you don't need to be nearly as strict with the salt shaker.

References

1. Abdul-Rahman, M et al. Abstract 201, Endocr Pract. 2006; 12(Suppl. 2), 50.
2. Hays JH et al. Mayo Clin Proc. 2003:78; 1331-1336.

[Ed. Note: Laura B. LaValle, RD, LD is presently the director of dietetics nutrition at LaValle Metabolic Institute (formerly part of Living Longer Institute). She offers personal nutritional counseling at LMI for clients who need help with their diet in relation to illness or disease. Laura also provides educational services in the areas of health promotion, wellness, and disease prevention.]

Healthy Recipes: Romaine Salad with Lemony Garlic Dressing By Laura LaValle, RD, LD

This is a light and easy green salad that highlights a vinegar-free dressing. Look for Romaine lettuce with dark green, tightly packed leaves for maximum nutrient benefits.

Serves: 6
Time to Table: 15 minutes

Healing Nutrient Spotlight
Excellent source of vitamin A and vitamin C
Good source of folate and manganese

Ingredients*
Dressing:
1 tbsp lemon juice
1/4 cup olive oil
1/2 tsp Dijon mustard
1 tsp Tamari soy sauce or Bragg's Liquid Aminos
1 clove garlic, minced
(If you love authentic Caesar salad dressing flavor, you can add a dash of anchovy paste.)
Whisk ingredients together.

Salad:
6 cups torn Romaine lettuce leaves
1 oz. or about 1/4 cup grated hard cheese (goat or sheep's milk) or soy Parmesan
Ground fresh pepper

*Select organic ingredients for optimum nutrition.

Preparation
Tear lettuces leaves and place in large bowl. Toss lettuce with dressing mixture, top with cheese, and grate pepper on top to taste.

Nutrition
112 calories, 11 g total fat, 2 g saturated fat, 7 g monounsaturated fat, 1 g polyunsaturated fat, 5 mg cholesterol, 2 g carbohydrate, 1 g fiber, .5 g sugar, 3 g protein, 1530 IU vitamin A, .2 mg riboflavin, 75 mcg folate, 15 mg vitamin C, .4 mg manganese, 1 mg iron

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These articles appear courtesy of Early to Rise’s Total Health Breakthroughs [Issue 08-26-08] which offers alternative solutions for mind, body and soul. For a complimentary subscription, visit http://www.totalhealthbreakthroughs.com/