ANN ARBOR, MI - We hear it over and over again: America has a weight problem. But what we may not understand are the serious health risks that we begin to carry along with the extra pounds.

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So what can we do to reduce our risk for diabetes and diabetes-related heart disease? It’s another phrase that seems to be on repeat, but perhaps not taken to heart: Eat healthy and get active!

Lee A. Green, M.D., a physician with the University of Michigan Health System’s Department of Family Medicine, wants every overweight person to understand the risks involved with Type 2 diabetes and how anyone who carries around a few extra pounds can take action to reduce their risk of diabetes-related heart attack, stroke or even heart failure.

So what is Type 2 diabetes?

“Type 2 diabetes is an insulin resistance condition. It’s caused by your body not responding to the insulin you make — instead of having too little, you have too much,” says Green, adding that insulin is a crucial hormone in our bodies that allows our cells to get energy from the food we eat. It helps sugar get from the bloodstream into individual cells. But in people with Type 2 diabetes, cells don’t respond as well to insulin’s efforts and sugar builds up in the bloodstream. Doctors call this “insulin resistance.”

Fat cells are the chief culprit of insulin resistance. So, as people become more overweight and add more of these fat cells, they become more prone to Type 2 diabetes.

And that’s what troubles Green and many other experts: As the number of obese people in America increases, so too will the number of people with Type 2 diabetes.

“The more America becomes overweight, the more America becomes sedentary, the more America becomes diabetic,” says Green.

In the United States, more than 13 million people already have Type 2 diabetes and the numbers are on the rise, especially among middle-aged people. But this age group, even at the highest risk is not what concerns health professionals the most. Their concern is that adolescents and young adults, people in their mid-20’s, are developing Type 2 diabetes, putting them at a high risk of developing heart disease very early on in life.

These “twenty-somethings” are not thinking about the risk for diabetes or heart disease — even though these risks begin to pile up with each year of eating a poor diet and not exercising.

“Instead of seeing people showing up with heart attacks and strokes in their 50’s, 60’s and 70’s as we have in the past, we’re going to start seeing people in their 30’s showing up with serious coronary heart disease. We’ll see cases of heart failure in people in their 40’s, things that we really shouldn’t see in a healthy population,” says Green.

Diabetes, specifically Type 2 diabetes, has such an impact on heart disease because of the higher insulin levels. These skewed insulin levels often cause cholesterol and blood pressure to rise, putting people with diabetes at higher risk of heart disease.

“Insulin actually has growth hormone-like effects on cholesterol plaques,” which clog up blood vessels, restrict blood flow and can cause blood clots that lead to heart attacks and strokes, says Green.

And Type 2 diabetes, with its relation to obesity and with inactivity, is already associated with a high cholesterol level, which is a sign that arteries may be plugged up.

In other words, Type 2 diabetes acts as a double whammy: the higher insulin levels help plaque to build up and grow in your vessels, and that coupled with a lack of exercise plus obesity means that the plaque is sure to be there, which makes the diabetes patient at very high risk for heart disease or stroke, says Green.

Additionally, people with diabetes also tend to have higher blood pressure, which also increases the risk for these problems.

“Essentially, if you have Type 2 diabetes and you’ve had it for any length of time, you really should consider that you probably have coronary heart disease and treat it accordingly,” says Green.

What can be done?

The good news is a lot of the damage from Type 2 diabetes can be reversed. Green points to two crucial steps to reducing your risk: eating healthier and exercising more.

“If people lose weight, if they become physically active, if they get their cholesterol down, if they get their blood pressure down, there’s pretty good evidence that the cholesterol plaques can be shrunk, they can be reduced, and the risk of heart disease and the risk of stroke can be brought back down to a lower risk level,” says Green.

Follow these guidelines to reduce the risk of heart disease and stroke:

• Stop smoking.
• Know your blood pressure. A healthy level reads lower than 120 over 80.
• Keep your cholesterol in check. A healthy amount of LDL (bad) cholesterol is below 100 while a healthy amount of HDL (good) cholesterol is above 40 in men and above 50 in women.
• Get physical for at least 30 minutes per day to lose weight and help lower blood pressure and cholesterol. Aerobic activities such as walking, dancing and swimming help make the heart stronger.
• Eat heart-healthy foods such as oatmeal, whole grains, fruits and vegetables. Increase the amount of fiber in your diet, while cutting back on foods high in saturated fat or cholesterol, such as meats, butter and eggs.
• Talk to your doctor about having a test of your blood glucose levels. An A1C test can tell you your average blood glucose for the past two to three months. A healthy target for most people is below seven.

“Developing Type 2 diabetes, it’s by far the most crucial health risk people can face, aside from smoking. It’s also one that is easy to do something about,” says Green. “If you eat better, exercise more, take the right medications, if you treat your diabetes before it leads to chronic heart disease, your risk can be brought down significantly.”

For more information about diabetes, heart disease, diet and exercise, visit the following websites:

U-M Health Topics A to Z

Obesity:
http://www.med.umich.edu/1libr/aha/aha_obesity_crs.htm

The Healthy Diet:
http://www.med.umich.edu/1libr/aha/aha_healthy_crs.htm

Controlling cholesterol:
http://www.med.umich.edu/1libr/guides/choles.htm

Lowering your blood pressure:
http://www.med.umich.edu/1libr/primry/life05.htm

National Institutes of Health: Prevent Diabetes Problems: Keep your heart and blood vessels healthy
http://diabetes.niddk.nih.gov/dm/pubs/complications_heart/index.htm

Written by Erin Block

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