Tag Archives: Pre-diabetes

Type II Diabetes Epidemic

Diabetes Increases Risk for Heart Disease

Obesity ConceptMillions of people have Type II diabetes and the number is growing with the obesity epidemic. At first, as blood sugars rise, Type II diabetes is a silent disease without recognized symptoms, but behind-the-scenes, excess sugar molecules in the blood are causing harm.

Diabetes occurs when inadequate insulin is available for sugar metabolism. Instead of being used by cells for energy, the sugar molecules increase in the blood and interfere with cell function. This leads to heart disease, high blood pressure, strokes, vision impairment and kidney damage.

Type II diabetes is a complex metabolic problem. Although the body produces enough insulin at first, it isn’t being used properly because at the cellular level, insulin resistance develops. This stimulating the pancreas to produce more and more insulin, until the cells become distressed and die off, leaving the body unable to maintain proper insulin production. The disease worsens.

Treatment for diabetes is variable. It can be very complex, requiring numerous medications, self testing and the addition of insulin injections. Some people do very well for years in a pre-diabetic state. If a fasting blood sugar is minimally elevated, just taking the oral medication metformin, may reduce progression. But if the sugar continues to rise, additional treatment must be started as soon as possible to normalize the sugar.

If someone you know is overweight, particularly if the weight is carried around the waistline, blood sugar levels should be monitored and treated if elevated. Losing weight will help, but weight loss is not easy.

Best results occur with reduced caloric intake and healthful food choices, combined Family exercisewith exercise. Even walking thirty minutes a day, helps lower blood sugar, burns calories and improves longevity.

Type I diabetes is different from Type II. Type I is usually seen in young often thin people, including infants and children. Cells in the pancreas that make insulin are destroyed and are unable to produce insulin, a hormone essential for sugar metabolism. Insulin cannot be taken orally. It must be injected or taken as a nasal spray.

obesityType II diabetes had been a disease of aging people until recent years when overweight children began developing this serious problem. Like adults, children are at risk for serious cardiovascular disease. Elevated blood glucose levels damage arteries throughout the body. Over time the vessels become so narrowed they cannot carry an adequate supply of oxygen-rich blood and nutrients to vital organs. As more children become obese, more of them develop diabetes and are at risk for early heart disease.

So, what should we do? First, understand that Type II diabetes is a serious health risk even when no symptoms are apparent. The American Diabetes Association recommends having a fasting blood sugar test performed at least annually. Blood is taken after having nothing to eat or drink for at least eight hours. A fasting blood sugar above 100 is abnormal.

Another blood test, the hemoglobin A1C, measures red blood cell glucose attachment. This test correlates directly with the blood glucose levels over preceding weeks/months. If the A1C is 8, the glucose average has been 183mg/dl. Until more information becomes available, specialists believe an A1C goal of <7% is valuable in reducing health risks.

Symptoms of High Blood Sugar:
Excess urination (Ex.-Getting up at night repeatedly.)
Excess water consumption (Ex.-Drinking water during the night.)
Increased appetite, blurred vision, low energy
Neuropathy (burning pain and numb feelings in hands and feet)

Additional information regarding diabetes, healthful eating and weight control can be found on the following websites:
www.realage.com, www.diabetes.orgDiabetes Health in your handsBetty Kuffel, MD


cropped-vitruvian-heart-woman1.jpgSome of my friends believe they can make better choices to attain maximum health and yet I see them regularly exercising and eating wisely. These are two very important actions in the scheme of health and living longer. After seeing parents and relatives die young from smoking, heart disease, diabetes and obesity, they vowed to make personal choices that correlate with better health.

 Other people I know do not exercise and eat wantonly. A common breakfast choice by one particular person is a bacon/sausage omelet with a side of pancakes. This person is more than 100 pounds overweight, has high blood pressure, out-of-control diabetes and has had a heart attack. His choices and health issues provide a view of factors seen in many who contribute to current world statistics placing heart disease as the leading cause of death in women and men.

Coronary artery disease, also called atherosclerosis is a disease in which arteries narrow because of metabolic abnormalities related to lifestyle choices. In the United States, 18% of all deaths are from coronary artery disease. Inflammation is a large component of this disease in conjunction with the accumulation of LDL-cholesterol fat inside blood vessels. Increasing weight leads to Type 2 diabetes and diabetes contributes to the disease process.

You have probably read or heard this scenario so many times you find it boring. Some people say they have tried everything and can’t lose weight. Losing weight is not magical. It doesn’t matter what time of day you eat, whether you drink water before, during or after meals. It doesn’t matter whether your largest meal is in the evening, whether you graze all day, or eat one meal per day. What matters is how much you eat and what you eat. In other words, it is important to balance your food intake with your energy output.

We all need to eat for energy. Without proper food, our body processes are impaired. But when we eat more food than we burn off each day, the body stores that extra food as fat. If the stored fat isn’t burned, it continues to accumulate — that is how the body evolved to survive during times of sparse food.

 Consider these examples:

If you eat one scoop of ice cream (about 400 calories) in addition to your daily calorie needs, you must walk one hour just to burn off that extra 400 calories. If you don’t exercise to burn the extra fuel, your body will store the calories as fat.

Even eating one extra little banana per day (about 100 calories) can add up. In one month you will have consumed 3100 more calories than you needed to maintain your energy needs. At the end of one year, your scale will show you are up by 10 pounds.

One weekly meal that includes a bacon cheeseburger, fries and a shake (about 1500 calories) can put you on the road to obesity. Over a year, without significant additional exercise, that daily fast food meal alone can add up to a 20 pound weight gain per year.

The first step in taking control of your health is to learn how. Making a healthy lifestyle change is within your power. By making healthy changes in your diet and adding exercise to your daily routine, you will begin the road to better health and possibly even extend your life. Just like adults, obese children show signs of early heart disease. Teaching kids to eat right and exercise can also reverse the negative effects of their overeating.

Your Heart is a health guide. Scientific studies over many years support healthy food choices like the Mediterranean diet and vegetarian eating, too. Choose to eat healthy.

Make 2014 the year for better health choices for you and your family. Don’t smoke. Avoid sweets and all fried and fatty foods. Eat fresh fruits and vegetables and add exercise to your day.

Beginning today Your Heart is available at a reduced price in both paperback and Kindle through December 24th. To purchase, click on Kindle Heart book or Paperback Heart book

Happy Holidays



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Yesterday, experts in cardiovascular disease prevention published new guidelines for heart and vascular health. Based on hundreds of clinical research studies, this is the latest science-based analysis on heart disease and stroke prevention. Source: American College of Cardiology and the American Heart Association.

 My father died in 1960 of coronary heart disease. He was 52 years old. His first heart attackIMG_5818 occurred at age 46. Like many people today, he had familial cholesterol elevation and smoked. Had he known what actions to take to improve his health and the opportunity to take a statin drug to lower his cholesterol, I’m sure he would have added many years to his life. With the new guidelines, we all have the Links to Living Longer.

 The information below is provided to help others take steps to improve cardiovascular health and live longer through healthy actions. I appreciate feedback and questions.

 Thank you,

Betty Kuffel, MD

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 Cardiovascular disease is the number one cause of death.

It is preventable and treatable.

Many people do not follow lifestyle recommendations and do not take medications known to prolong life. These guidelines provide a standardized basis for the best approach to reduce risks and save lives.


Eat Healthy

Vegetable heartCalculate your calorie requirements and follow a Mediterranean or plant-based diet that includes a predominance of fresh foods with 4-5 servings of fruits and vegetables per day, high fiber and whole grain foods, fat-free or low-fat milk products, nuts, lean meat/poultry/fish, limit saturated fat and trans fat, limit sweets and added sugar.

Reduce High Blood Pressure

See your physician for a health evaluation and laboratory studies. Blood pressure monitoring and treatment may be necessary. Reducing salt/sodium intake below 2,000/ day is recommended for most adults. Monitor your own blood pressure and read food labels. Avoiding processed food and salty soups will help reduce blood pressure.

Reduce High Cholesterol

Because of common inherited disorders many people cannot reduce cholesterol to healthy levels even when eating a low fat vegetarian diet and attaining low weight. Some must take a drug to treat the abnormal lipids. (Lipid is a generic term for fat and cholesterol.)

If Necessary, Take Statins

Statins are the most effective drugs to reduce harmful LDL cholesterol. The new guidelines strongly recommend the use of statins while at the same time decreasing your intake of all types of saturated fat including full fat milk products, coconut/palm oil, and all trans fats found in “partially-hydrogenated” fat products. These include margarine and many commercial baked goods. Under new guidelines statins are indicated for people diagnosed with heart disease, Type 2 diabetics aged 40-75, and an LDL of 190 or higher, and other factors if determined to be at risk. LDL is the bad cholesterol. Remember – taking a statin does not mean you can continue to eat bacon cheeseburgers – healthy eating is imperative to reduce risks of heart disease even when taking statins.

Lose Weight

If you are overweight like most Americans, no matter what your age, you are at higher risk for arterial heart disease and vessel disease throughout your body. Children as young as five years old, who are obese, are at risk for early heart disease and diabetes.

With weight gain, fat accumulates in the body contributing to high LDL (bad) cholesterol, higher triglycerides and high blood pressure. All are known to be detrimental to health.

In addition, weight gain correlates with the development of Type 2 diabetes and blood glucose elevation making your risk of heart disease even higher. Avoid diabetes. Treat pre-diabetes (mild elevations of blood glucose).

 To calculate your ideal weight and develop a plan for better heart health, see your physician for guidance. Note: Many websites such as www.realage.com  provide calculators for calorie needs and BMI to determination obesity range. BMI is Body Mass Index. Knowing these guidelines will help you take appropriate action to reduce your health risks.

Be Active

Risk reduction recommendations include activities such as brisk walking for 40 minutes at least 3-4 times a week.

Factors contributing to cardiovascular health include: race, gender, age, total cholesterol, HDL cholesterol, blood pressure, diabetes and smoking.

Uncontrolled high blood pressure, cholesterol abnormalities, excessive weight, diabetes and tobacco use are high risk factors contributing to arterial narrowing, heart disease and stroke.













Diabetes Health in your handsType 2 diabetes is preventable, treatable and partially reversible in many people. If you have prediabetes or borderline blood glucose without aggressive treatment including weight loss, you will likely progress to full blown diabetes within ten years. With proper medical care, exercise and healthful food choices, you can take control and improve your health.

 Until the epidemic of obesity around the world occurred, Type 2 diabetes was a disease of older people, not teenagers. We are now seeing overweight adolescents with Type 2 diabetes. Of grave concern is evidence of heart disease present in overweight 5-year-olds.obesity

Bad food choices and lack of exercise contribute to Type 2 diabetes & heart disease.

Even if heart disease runs in your family you have the ability to reduce hereditary risks and live longer. Interventions need to begin in childhood and continued throughout life, but it’s never too late to start. The American Heart Association recommends children should have a blood lipid panel before age twenty to help determine risks and begin treatment when appropriate. Do you know your lipid numbers?

You can offset “bad cholesterol genes” by making healthy choices.

 When vessels become narrowed with inflammatory cholesterol plaques, symptoms can be intense with crushing chest pain radiating into the neck and down the arms, weakness, sweating and collapse. However, that is not always the case. In fact, arteries may be more than 90% closed and generate no symptoms. Just because you have no chest pain, it doesn’t mean you don’t have cardiovascular disease.

 Major risk factors for coronary artery disease include: tobacco use, uncontrolled high blood pressure, cholesterol abnormalities, obesity, diabetes, low activity, alcohol and other drugs, high levels of calcium supplements (over 1200mg/day) and hereditary factors. In addition, microvascular dysfunction, a form of coronary artery disease in small vessels is common in women. This is because women more often develop autoimmune disorders such as rheumatoid arthritis, MS and lupus. In addition, anemia, polycystic ovary disease, hormone changes and Type 2 diabetes all contribute to the metabolic mix.

Even if you have been diagnosed with Type 2 diabetes, coronary artery disease, peripheralMed.Food vascular disease, or have had a heart attack, stents or a stroke, there is hope for improvement. Exercise and normalizing weight, blood pressure and blood glucose, in addition to a medication regimen to improve lipids — all contribute to lowering risks and reducing the closure of arteries and stents. Taking a statin to lower your cholesterol is not a ticket to eating fried foods, bacon cheeseburgers or eggs. Good dietary practices are essential to long term health.



A recently released study from Johns Hopkins University not only confirms the relationship of coronary artery disease to Type 2 diabetes but emphasizes the importance of preventing progression of associated heart and vascular disease in young women.

When researchers analyzed data on 10,000 men and women without a history of heart disease, clear gender differences surfaced. Men with Type 2 diabetes did not develop the same increase in heart disease they found in women. Under age sixty, when women are usually at less risk for heart disease than men — they found presence of Type 2 diabetes increased female risk up to four times.

 Uncontrolled glucose in diabetes stimulates an inflammatory process affecting the whole body. Tissues become insulin resistant and blood sugar rises. This contributes to the development of artery narrowing and reduced blood flow to the heart and other organs. Arteries stiffen, cholesterol accumulates and arteries develop thick areas called plaques that begin blocking blood flow.

Coronary arteries supply the heart with blood and nutrients, when the arteries become too narrow to carry enough oxygen, discomfort may occur. At first the disease is silent. There are no symptoms. In some women, symptoms are subtle and not recognized as heart-related. These include: jaw aching, upper back discomfort, breathlessness or upset stomach. When these potential heart symptoms are recognized, both patients and their physicians must search for the cause.

In women, a special type of coronary artery disease called microvascular dysfunction may occur. This problem involves tiny branching arteries supplying the heart muscle. Often large surface arteries are open and even a specialized invasive study of the inside of the vessels called a coronary angiogram is normal. Further testing is needed to identify the cause. Risk factors must be reviewed, other reasons must be ruled out and an exercise tolerance test combined with nuclear medicine or echocardiogram is needed to make the diagnosis.

Women must be cognizant of symptoms and seek medical attention for full evaluation of heart risks and laboratory studies to evaluate blood glucose, blood lipids (cholesterol) and other silent diseases such as thyroid abnormalities and anemia.

♥  Sixty-four percent of women who die of sudden death had no recognized heart symptoms.

 ♥  Fifty percent of people who have heart attacks die before reaching the hospital.

 With cardiovascular disease the leading cause of death in adults, it is past time to take control, make lifestyle changes and improve health.

 Dr. Betty



One year ago Michael Mosley, MD, published his book The Fast Diet  with the 5/2 concept of intermittent fasting. Benefits of calorie restriction have been known for many years. There are many variations on this theme.

True fasting – eating nothing – can trigger a reduction in the body’s metabolic rate. This slowdown stimulates efficient calorie storage and weight gain when eating resumes. Known as a starvation response, it is part of our genetic makeup.

Ancestors who survived long droughts and periods of starvation carried the surviving genes of longer life.  With these favorable genes came the body’s natural ability to pack on weight easily during good times in preparation for periods when food was scarce. In the past, this was life-saving. Today, those same genes carry some of the responsibility for obesity, but not all.

 With food easily available and daily exercise reduced, one-third of our society has become obese. People are eating more calories than they need. The excess calories are stored in tissues as fat. Over time, the natural process of fat storage as energy reserve produced the obesity epidemic.

With the dramatic increase in obesity in the US and around the world in developed countries, we see an upsurge in related diseases. With excess weight, there is an associated increase in heart disease, Type 2 diabetes, sleep apnea, arthritic joints, high blood pressure and strokes. Many forms of cancer are also associated with obesity.

 Overweight people try many gimmick diets to lose weight and fail. If the dietary recommendations are non-sustainable over a lifetime, the excess weight returns. Learning and practicing healthy eating is the key to success.

 I am proposing  a variation on Dr. Mosleys concept. A 5/2 eating plan combined with the Mediterranean cuisine. Even if you are busy and eating in restaurants daily, this is effective, easy and can be followed over a lifetime.   I will explain more below.

First, a little background and recommended reading: The China Study, a book published in 2005, and the Mediterranean and plant-based food choices.

The China Study

A twenty year study began in 1983 with T. Colin Campbell, an American biochemist and nutritional expert at Cornell University and his physician son Thomas M. Campbell, in association with the Chinese Academy of Preventive Medicine, Cornell University and the University of Oxford. Using dietary surveys and blood work, these men examined the effect of diet on 48 forms of cancer and chronic disease on 6,500 people in 65 counties in China.

 Many complex analyses were made on the data, but in the final judgment, consuming animal-based protein increased blood cholesterol, heart disease, diabetes, autoimmune diseases and many forms of cancer. These diseases common in Western countries were extremely low in the Chinese population. This led to their recommendation of the vegan (animal product-free) plant-based diet.

Following President Bill Clinton’s diagnosis of coronary artery disease and bypass surgery, Clinton began eating vegan. His health improved. He lost weight and became a supporter. Sanjay Gupta, MD, CNNs chief medical correspondent is an advocate of plant based eating. Long time advocate of whole food eating and minimal animal product consumption, Dean Ornish, MD, combined this eating pattern with exercise and yoga. His patients with advanced heart disease showed evidence of reduction in arterial blockages.

 In 1970, a University of Minnesota physiologist, Dr. Ancel Keys published a report on cardiovascular disease related to diet. The initial research involved 12,000 men in Finland, Greece, Italy, Japan, Holland the United States and Yugoslavia. The highest incidence of heart disease was found in the US and Finland. These two countries also had the highest intake of saturated fat and cholesterol. Mediterranean and Japanese inhabitants with low saturated fat intake had very low incidence of heart disease and lived longer.

The Mediterranean diet, as it was later named, consists primarily of fresh fruits, vegetables, nuts, olive oil and olives, wine, whole grains, fish, limiting red and fatty meat.

 Mediterranean and Plant-based Cuisine Combined with a 5/2 Eating Plan

The Greek island of Crete had 57% fewer cardiac deaths than Finland. Their intake was also the highest in olives and olive oil, monounsaturated fats. Vegetarian or plant-based eating typically kabob vegavoids meat, but may include eggs, cheese and milk products. Omit meat and all animal products, and you are vegan.

This is the weekly menu for the 5/2 Mediterranean Plan for Weight Control and Lifelong Healthful Eating:

         5 days of a healthful eating following Mediterranean or plant-based food consumption and avoiding all fried foods

         2 non-consecutive days of eating 500-600 calories/day, such as Monday and Thursday

(Note: A low calorie intake like this done on consecutive days is more likely to induce the starvation response and reduce your metabolic rate. It is important to separate the days and add exercise to counteract this effect.)

         One hour of exercise each day, such as walking

 Utilizing the information above, you have the tools for eating healthy. If you are overweight, following the 5/2 calorie reduction plan is healthful. If you are taking medications for heart, blood pressure or Type 2 diabetes, discuss the 5/2 plan with your physician before using this. (This is not a plan for Type 1 diabetics or women who are pregnant.)

Weight Control Math

To review: One pound = 3500 calories. If your normal intake is 2500 calories/day and you eat 500 calories two days/week, your calorie reduction each week could be 4,000 calories or more than one pound in weight loss. This is approximately 4-5 pounds per month and 48-60 pounds in a year. In addition, if you choose lower calorie foods, (more vegetables, less fat and sugar), you may lose more. Most people find this plan easy to follow for long periods.

To be effective and long-lasting, the manner of eating must be sustainable. It must become a way of life something you can do for the rest of your life. If you have a lot of weight to lose, this would be a life-changing method of controlling your eating and reducing weight. Once you reach your ideal weight, omit the 2 light calorie days and continue eating a Mediterranean or plant-based cuisine daily.

 Animal and human studies examining the effects of fasting, show a heart benefit, along with reduced blood pressure and lower cholesterol levels. Intermittent fasting also decreases diabetes development in lab animals. Eating fewer calories two days a week is not true fasting but produces health benefits.

Because Dr. Mosleys unique concept of marked calorie reduction for two out of five days lacked scientific evidence to support the process in reduction of heart disease and diabetes in humans, I was hesitant to include it in my evidence-based book, Your Heart. However, as I was writing that portion of the book a very exciting scientific review in the British Journal of Diabetes and Vascular Disease was published!

 An Aston University team in the UK, led by Dr. James E.P. Brown evaluated various approaches to intermittent fasting, looking for any evidence of advantage for its use in treating Type 2 diabetes. In their review, they found intermittent fasting was just as effective, possibly even more effective, than daily calorie restriction and calorie counting. Other favorable findings: even markedly low calorie days (not true fasting) can reduce inflammation, reduce both glucose and lipids, and reduce blood pressure.

 In Your Heart Prevent and Reverse Heart Disease, there is a significant amount of information on the Mediterranean cuisine and plant-based eating and more information on the 5/2 eating plan with sample menus.

With the right knowledge and actions, the number one cause of death in women and men is preventable. If you already have heart disease, vascular disease or Type 2 diabetes you can take control and improve your health.

 Let me know how it works for you.

Betty Kuffel, MD


Person's Hands Pricking Their Finger with a Glaucometer

Type 2 Diabetes Increases Heart Attack Risk

Would you jump out of the way of a rolling car if you knew the inevitable impact might kill you? Type 2 diabetes is like a rolling car.

 If you have Type 2 diabetes, elevated blood sugars and accumulating intra-abdominal fat have already released your ‘brakes’ setting you in motion for a health crisis.

The bad news is: Type 2 diabetes often leads to coronary heart disease, the leading cause of death in both women and men.

 The good news is: Type 2 diabetes and coronary artery disease are preventable. And —you have the ability to stop the progression of both diseases by eating healthy and making good lifestyle choices.

 If you’ve been told you have pre-diabetes or “borderline” blood sugar elevations, it is time to take control to stop cholesterol plaques from forming inside the large vessels on the surface of the heart. The build up of cholesterol gradually slows, and then stops blood flow causing a heart attack. Other arteries around the body are also affected. Blood flow in the neck and arteries feeding kidneys, eyes and limbs also become diseased.

A study presented this month at the American Heart Association High Blood Pressure Research Scientific Sessions reported important findings: Women of all ages, from 19 to 84, showed Type 2 diabetes was a major contributor to arterial plaque buildup regardless of age, family history, smoking or having high blood pressure.

 If borderline blood glucose levels are present, Type 2 diabetes can be prevented with weight control, exercise and the addition of the medication, Metformin. Men and women with Type 2 diabetes who keep their weight in check, eat healthy, exercise and take glucose-lowering medication also reduce their risks for heart disease, kidney damage and visual loss.

 Obesity is a major contributing factor to developing diabetes. Because so many people are overweight, the incidence of Type 2 diabetes has increased. Screening females for cholesterol plaques at younger ages is now recommended so the disease can be identified and aggressively treated. This may also pertain to men with Type 2 diabetes, although this particular study only included women.

Scale measuring tape jpeg Stop your run-away car. Take control. If weight is a problem for you, read my next blog on a new approach to lifetime weight management.

Betty Kuffel, MD