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I'm also at risk for cardiometabolic disease??!

I'm also at risk for cardiometabolic disease??!
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I was diagnosed with estrogen-driven breast cancer at 35. Learning as much as I could about estrogen and estrogen-positive cancers became my sole focus. I forgot about the rest of my gene variations.

Because Margie and I always refer to our own DNA results when sharing our story, I got mine out the other day to ensure what I was saying was correct. I was shocked to see that I had completely glossed over the fact that I have a risk for cardiometabolic dysfunction too! 

This is why we love DNA results: you will refer to them for the rest of your life. Always with new eyes, new focus, and new research. I did my genetic tests a long time ago, almost 9 years now, yet I am still honing my personalised protocol.

What is cardiometabolic dysfunction?

Cardiometabolic dysfunction is the term for the combination of cardiovascular and metabolic diseases. The cardiovascular diseases might include raised blood pressure, high cholesterol, and elevated blood fats. the metabolic diseases might include high blood sugar, impaired glucose tolerance, insulin resistance, increased intra-abdominal belly fat (fat around your abdominal organs). 

Together, they increase your chance of developing atherosclerosis, cardiovascular disease (CVD) and diabetes type 2 are significantly enhanced as a result of insulin resistance and atherogenic dyslipidemia. Atherogenic dyslipidemia is characterized by elevated levels of triglycerides and small-dense LDL ('lousy' cholesterol), and low levels of HDL ('healthy' cholesterol).

What are the criteria for cardiometabolic dysfunction?

The NCEP ATP III DIAGNOSIS has the following 5 criteria for cardiometabolic dysfunction - you need any 3 of the following 5 signs to be diagnosed with cardiometabolic dysfunction:

1. Increased waist circumference (>89cm in women, 101cm in men)
2. ↑ Blood Pressure (> 130/85 or on blood pressure meds)
3. ↑ Blood Sugar (>100 mg/dl)
4. ↑ Triglycerides (>150)
5. ↓ HDL Cholesterol (<50 women, <40 men)

NOTE:

The NCEP ATP III definition is one of the most widely used criteria of metabolic syndrome. It incorporates the key features of hyperglycemia/insulin resistance, visceral obesity, atherogenic dyslipidemia and hypertension. It uses measurements and laboratory results that are readily available to physicians, facilitating its clinical and epidemiological application. It is also simple and easy to remember. Importantly, it does not require that any specific criterion be met; only that at least three of five criteria are met. Thus, the definition does not take into account the underlying cause of metabolic syndrome, whether it is insulin resistance or obesity.

It's not just about blood sugar control

Research has shown that just lowering blood sugar levels actually increased the risk of death. Blood sugar control is not the ONLY goal! You need to reduce the other factors in cardiometabolic dysfunction as well.

It's not just about blood LDL reduction

If you only reduce your LDL reduction, there is no benefit. But if you reduce your LDL and CRP, then there is a benefit. CRP measures inflammation. So, inflammation is the differentiating variable! Some degree of inflammation is involved in almost every lifestyle-related chronic disease, including cancer. A good place to start treating inflammation is in your GUT!  Inflammation drives insulin resistance. Insulin resistance can develop into cardiometabolic dysfunction and diabetes.

Inflammation from your gut

One of the greatest sources of inflammation is from your gut. Bad choices such as junk food, sugary foods, bad oils, no fermented foods, stress, and lack of sleep can damage the gut lining resulting in leaky gut. Bacterial by-products called lipopolysaccharides leak through into the bloodstream and trigger the immune system which triggers inflammation. Inflammation then drives up insulin resistance and the development of atherosclerosis.

Probiotics can help reduce insulin

Probiotics have been shown to have beneficial effects on blood glucose levels before and after eating, glycated haemoglobin, insulin, insulin resistance and the onset of diabetes.

Oxidised VLDL

When VLDL ('very lowsy') cholesterol becomes oxidised, it can be even more dangerous. The liposcan test can measure the degree of VLDL oxidation.

Stress and coronary artery (arteries in the heart muscle) disease (CHD)

  • Stress can cause coronary vasoconstriction and increased platelet stickiness that promotes clot formation
  • Type A behaviour, depression, anxiety, hostility, stressful life change events have all been linked to CHD
  • Stress increases homocysteine, CRP and fibrinogen, all of which are associated with increased risk for CHD
  • Stress causes deep abdominal fat deposits which secrete inflammatory cytokines that promote insulin resistance and the cardiovascular complications of metabolic syndrome

Women are different!

Research has shown that cardiometabolic dysfunction is a stronger risk factor for subclinical atherosclerosis in women than in men. So, in women, diagnosing cardiometabolic syndrome earlier could help predict whether or not they are at risk of cardiovascular disease such as a heart attack, stroke, aneurysm. They could then make better choices to reverse their risk.

Mitochondrial dysfunction and diabetes

Research: “…, it has been elucidated that some environmental factors, pollutants, and mitochondrial toxins are involved in the pathogenesis of type 2 diabetes. Taken together, we suggest that mitochondrial dysfunction plays a role in the pathophysiology of insulin insensitivity….” (Wang CH, Wang CC, Wei YH. (2010). Mitochondrial dysfunction in insulin insensitivity: the implication of mitochondrial role in type 2 diabetes. Ann NY Acad Sci. 1201:157-65).

Reframe how you look at these diseases

The following disease states can be involved in cardiometabolic dysfunction:

  • Pro-inflammatory state
  • Insulin resistance
  • Abdominal obesity
  • Elevated blood pressure
  • Atherogenic dyslipidemia
  • Pro-thrombotic state (increase clotting risk)
  • Fatty Liver
  • Obesity
  • Cardiovascular disease
  • Immune dysfunction
  • Endothelial dysfunction
  • Beta-cell dysfunction in the pancreas
  • Lipotoxicity
  • Osteoporosis
  • Type 2 Diabetes
  • Hypertension
  • Dyslipidemia
  • Cardiovascular disease
  • Osteoporosis
  • Obesity
  • PCOS (Polycystic Ovary disorder)
  • NAFLD
  • Type 3 Diabetes
  • Cognitive Decline / Alzheimer's Disease
  • Sarcopenia
  • Erectile dysfunction
  • Sleep Apnea

How can I prevent or reverse cardiometabolic dysfunction?

Nutrition, environment, and lifestyle interventions have been shown to be more effective than medication - they were shown to reduce the incidence of diabetes by 58% and metformin by 31% as compared with placebo (Chandalia M, et al. Beneficial effects of high dietary fibre intake in patients with type 2 diabetes mellitus. N Engl J Med. 2000;342(19):1392-1398).

Food, environment and lifestyle choices are information to your DNA

Your nutrition, environment and lifestyle choices can change the way for DNA expresses itself. For example, food is now seen as beyond just calories; it regulates gene expression. Nutrigenomics is the study of how nutrition can determine whether or not, and the degree to which, an illness will present. You can find the nutrigenomic genetic test on our site. The DNA | Health + Diet test would give the best over for cardiometabolic dysfunction potential.

 

 

Which changes should I make?

  • Diet
  • Exercise
  • Sleep
  • Behaviour

“Of the ten leading causes of illness and death in the U.S., seven could be greatly reduced if the following lifestyle habits were modified - alcohol abuse, lack of exercise, poor diet, smoking, and unhealthy maladaptive responses to stress and tension.”

1. REDUCE INSULIN SPIKES
If you have insulin resistance:
  • Decrease insulin stimulation – (help the pancreas not wear out over time from overuse)
  • Increase cellular responsiveness to insulin – (muscle and fat assimilating
  • glucose helps

You can decrease insulin stimulation by reducing foods that cause a rise in blood sugar and therefore insulin. Carbohydrates, and to a smaller extent protein, are the main macronutrients that cause blood sugar elevations.

The options are:

A. Change the QUANTITY of carbohydrates and replace them
with fat (which causes no glucose response)

… and/or

B. Change the QUALITY of carbohydrates

2. INCREASE 'GOOD' VS. 'BAD' CARBOHYDRATES 
  • Increase intake of complex, whole, low glycemic index (GI) carbohydrates
  • Remove all refined and simple sugars (these include excess alcohol)
3. INCREASE LEAN 'CLEAN' PROTEIN
  • Wild caught fish, free-range, naturally -raised chickens
4. INCREASE 'GOOD' VS. 'BAD' FATS
  • Increase omega 3 fatty acids from oily fish, flax and chia seeds.
  • Increase unroasted, unsalted nuts and seeds
  • Decrease saturated fats and remove all trans fats, hydrogenated fats
5. INCREASE FIBRE INTAKE (SOLUBLE AND INSOLUBLE)
  • INSOLUBLE fibre scrubs the colon wall and improves whole-body insulin sensitivity. Psyllium husk fibre can increase your level of HDL (good cholesterol)
  • SOLUBLE fibre helps to slow the absorption of carbohydrates into the bloodstream and soaks up excess fats and cholesterol in the gut
  • Tru to get a 50/50 mix is best
  • The goal is to get to 35g of fibre per day

The high-fibre diet reduced plasma total cholesterol concentrations by 6.7%, triglyceride concentrations by 10.2%, and VLDL concentrations by 12.5% (Chandalia M, et al. Beneficial effects of high dietary fibre intake in patients with type 2 diabetes mellitus. N Engl J Med. 2000;342(19):1392-1398)

6. TAKE PROBIOTICS 
  • Probiotics have been shown to help reduce insulin and inflammation levels and play a role in weight loss. 
7. IDEAL WEIGHT
  • Keep your weight within the normal range
8. EXERCISE
  • Do moderate exercise regularly.
  • Weight loss and exercise can improve insulin sensitivity and prevent disease complications.
7. SLEEP
  • Get good sleep for 7-9 hours per night.
8. REDUCE STRESS
9. CHANGE BEHAVIOURS AND HABITS
  • Change behaviours and bad habits
  • Set goals to achieve results




To learn more, visit our integrated and curated CARDIOMETABOLIC SHOP.

Dr Heidi

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