Dr Carlos A Román investigates the link between refined carbohydrates, diabetes and heart disease, and how they can affect the ageing process
Humans are generally unable to handle a lot of refined carbohydrates. When we eat large amounts of dessert, bread, pasta, rice and other highly processed starches and sugar, our ability to utilise insulin becomes impaired—we become insulin resistant and glucose intolerant.
We put out excessive amounts of insulin which, in turn, creates diabetes, hypertension and atherosclerosis; the garden variety form of heart disease.
In the early 20th century, Thomas L Cleave carried out research that found a link with diabetes and heart disease to the consumption of refined carbohydrates in a typical Westernised diet. His work found that anyone who is genetically prone to diabetes and coronary heart disease and who also eats a high carbohydrate diet, is almost certain to make that genetic tendency manifest.
In the year 1900—a time before heart disease had become a leading cause of death—Americans consumed more carbohydrates than today, but only a relatively small percentage of them could be classified as refined. At that time, grains were not milled to such an extent that they lost their nutrition.
While people did eat a lot of sugar, it was often in the form of unrefined molasses; a rich source of iron and B vitamins. More importantly, the fats they ate were chiefly butter and lard—trans fats hadn’t yet been invented.
Heart disease and diabetes are inextricably linked with a diet high in carbohydrates. Refining of carbohydrates is, in reality, the greatest unacknowledged cause of death in world history.
Type II diabetes, also known as adult onset or noninsulin diabetes, affects 95% of the 16 million diabetics in America. An additional 60 million Americans who are very likely pre-diabetic are afflicted, whether they know it or not, with some form of insulin disorder. These disorders progress in stages from insulin resistance to a diagnosis of full-blown diabetes.
Each stage has its own findings and, even though new symptoms may not be noticeable, each opens a door to a range of degenerative diseases we associate with ageing. It is worth knowing the stages of this disease to help understand the connections between carbohydrates, disease and ageing.
In stage one, insulin—a hormone made in the pancreas—can no longer perform its major roles in the body to their full extent. This situation is referred to as insulin resistance.
Insulin’s major role is to convert excess sugar, or glucose, into a storage form of energy—glycogen. Glycogen is used as a fuel for periods between meals, but excess glycogen can be converted into stored fat, or triglyceride.
Insulin resistance is hard to diagnose in normal medical practice because it involves the simultaneous measurement of glucose from an artery and a vein in the same leg. Instead, we diagnose the condition by inference—weight gain or the finding of the second stage of diabetes.
The major breakthrough in understanding diabetes was the introduction of technology to measure serum insulin levels. Much to everyone’s surprise, it was quickly discovered that type II diabetics were the polar opposite of type I insulin-dependent diabetics. Type II sufferers create too much insulin—they have hyperinsulinism. As type I diabetics have a damaged pancreas, they don’t create any insulin.
The scientific community clearly demonstrated the difference between the two illnesses—type I coming from lack of insulin and type II deriving from insulin resistance. However, the American Diabetes Association erroneously insists that they are variants of the same disease and usually treats type II patients with insulin or insulin-releasing drugs.
Shortly after the discovery that insulin levels could be measured, it was established that excessive insulin could itself lead to heart disease and other illnesses. Dr Gerald Reaven of Stanford University summarised the impact of hyperinsulinism, to which he gave the name “Syndrome X”. The five major features of Syndrome X include abdominal obesity, hypertension, a variety of blood sugar abnormalities, and two heart risk factors; high triglycerides and low HDL cholesterol.
Therefore the link between diabetes and heart disease begins with the second stage of pre-diabetes—the condition can cause heart disease before it is even recognised as diabetes.
Blood sugar abnormalities
Diagnosing the common stage three requires a glucose tolerance test (GTT). It is such an important test that I have ordered more than 1000 at my own complementary medicine clinic. The GTT shows when the insulin disorder is starting to affect the blood sugar’s response to oral intake of glucose.
The abnormality sometimes appears at the beginning of the test, when the blood glucose rises to a point higher than that of a normal person’s, which is generally considered to be 160mg/dl. More often, however, it appears on the downward slope. Affected by the increased quantity or effectiveness of the insulin hyperactivity, the glucose level drops at a rate exceeding 50 points in a single hour, or 100 points in total.
Interpreting the GTT is occasionally quite subjective, but it’s often obvious when the criteria of abnormality are exceeded in a major way. I always administer the GTT in conjunction with a symptom questionnaire—the symptoms of blood sugar instability, as noticed by the patient, are every bit as important in establishing a diagnosis as the GTT.
The major symptoms resulting from unstable blood sugar response are hourly changes in energy level, mood and brain function, and irritability brought on by hunger which is relieved by food or caffeine. Carbohydrate cravings, prominent hunger and excessive tiredness are also commonly noted.
If a patient’s dietary habits include large amounts of refined carbohydrates, fruit juice, caffeine, sweets or alcohol, the suspicion that they may be in the third, and last, pre-diabetic stage may serve them just as well as the certainty that they are.
Stage three is quite common. I see bona fide abnormalities in GTT in patients four times more often than I see diabetes, suggesting there are four times more pre-diabetics than diabetics. Around 8–9% of the adult American population is thought to have diabetes, meaning one third of Americans has one of the stages of pre-diabetes. Once the third stage has been recognised, it is possible to avoid progressing to stage four by making necessary dietary changes and taking appropriate vitanutrients.
Diabetes stage four
There is little difference between the typical form of type II diabetes and stage three pre-diabetes. No new symptoms develop, there is rarely a change in the obesity problem that plagues more than 80% of sufferers and there is rarely a worsening of heart symptoms. The insulin resistance and hyperinsulinism that define stages 1–3 are still there. The key symptom is that the blood sugars are generally elevated throughout the day.
Type II diabetes responds to the same low-carbohydrate diet and vitanutrients that bring the pre-diabetic stages under control. However, many diabetologists recommend continuance of high-carbohydrate food consumption and prescribe drugs, which can include those which increase the insulin levels and therefore the likelihood of a fatal heart attack.
Not all stage four type II diabetics continue to create excessive insulin throughout their illness. They do, however, continue to have blood sugar elevations for the reason common to all five stages of type II; they are insulin resistant. It is not until this late stage of diabetes that insulin output reduces and insulin failure leads to stage five.
Diabetologists who confuse type I with type II diabetes are justified in their error only when stage five is reached. By this point, in a type II diabetic’s life, their insulin output has finally become subnormal.
It is best to test type II diabetics by drawing insulin levels before and after a high-carbohydrate test meal. If there is any elevation of insulin after breakfast, it can come only from a functioning pancreas. In our diabetic patients, only 10% produce insulin levels that are inadequate to be managed without an insulin supplement.
Around 44% of type II diabetics who consult diabetes specialists are prescribed insulin, the majority of which are unnecessary. If excessive insulin is harmful to an early-stage diabetic, it has been demonstrated to be equally harmful to a late-stage one.
It is important to have an understanding of the technical aspects of diabetes—both to recognise the condition in practice and understand its connection with ageing. The avoidance of diabetes-related illness is a key factor to consider in the treatment of ageing. By restricting carbohydrates, my heart patients almost always report improvement in symptoms and are able to reduce or stop medications for heart disease, high blood pressure, and/or diabetes.
Dr Carlos A Román is a specialist in complementary medicine who has focused his practice on nutritional medicine and metabolic lesions.
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