Testosterone and Diabetes

A recent interview on Beyond 50 Radio featuring Dr. Sanjay Kapur

Click on this link above and listen to my interview with Daniel Davis on Beyond 50 Radio show where we discussed how Testosterone plays an important role in our lives and possibly has some link with Diabetes.

Low Testosterone has been shown to cause conditions like insulin resistance, metabolic syndrome, central obesity, which further lead to problems like type 2 diabetes and cardiovascular disease. Research studies have shown a link between low levels of testosterone and abnormal lipid levels, increased inflammation, high blood pressure etc. However, it is still not quite clear what comes first- is it that low testosterone levels cause type 2 diabetes or is it that type 2 diabetes result in testosterone level drop. Some research groups have seen improvements in insulin sensitivity, reduction of mid-section obesity, decreased cholesterol levels etc., by testosterone replacement therapy. Some other studies have shown that high doses of testosterone do not have the same benefits as shown by normal physiological levels. Therefore, it is important to monitor testosterone levels using proper testing methods, especially if one is supplementing testosterone to ensure that any supplementation is kept within physiological levels.

Stress and Heart Disease

Fruit Drinks, Energy Drinks and Heart Disease

New Definition of Metabolic Syndrome

Did you know the new definition of Metabolic Syndrome? Did you know that waist circumference is now one of five criteria that physicians can use to diagnose metabolic syndrome?

The ATP III guidelines earlier did not consider the waist circumference as an important criteria, to diagnose metabolic syndrome, but a recent statement published online on October 5, 2009 in Circulation actually is a step forward to streamline the use of abdominal obesity in determination of risk of developing metabolic syndrome. The new statement on metabolic syndrome is a combined effort by International Diabetes Federation (IDF), the National Heart, Lung, and Blood Institute (NHLBI), the World Heart Federation, the International Atheroschlerosis Society, and the American Heart Association (AHA).

According to the new definition, people with any three of the following five criteria are considered to have the metabolic syndrome:
1. Increased waist circumference (population and country specific cut points)
2. High triglycerides (≥150 mg/dL)
3. Reduced HDL cholesterol (<40 mg/dL for males and <50 mg/dL for females)
4. Elevated blood pressure (Systolic ≥130 mm Hg and/or diastolic ≥ 85 mm Hg
5. Increased fasting glucose ≥ 100 mg/dL

How does stress level affect overall risk of getting heart disease?

Stress and depression, both have been linked with diabetes and heart disease. Understanding these two factors can actually help our doctor formulate a suitable treatment plan. So, it is important that we share this with our health care provider even if they forget to ask. Any kind of stress or depression can lead to more complications, if left untreated.

Stress causes release of some hormones which can further lead to elevated blood glucose levels. When the blood glucose levels increase and if there is not enough insulin being produced by the body or if the insulin is not working properly, then this results in excessive glucose in the blood, which can ultimately lead to development of diabetes.

Stress can come from many sources, including stress from one’s occupation, job strain especially in this economy as we are going through recession; many of us are losing jobs, homes, which is very sad and unfortunate. So, this stress can cause increased production of a stress hormone called cortisol, which then makes the liver produce more glucose, which means more glucose in blood and less usage of glucose by the tissues, less insulin production by our pancreas, thereby causing a condition called insulin resistance. This insulin resistance can finally lead to diabetes and/ or heart disease.

It is extremely important to maintain blood glucose levels, especially in diabetics and this can be done through stress management training. Sharing the cause of stress with the primary care doctor, family or friends is always helpful. Sometimes, social support can reduce the stress and this way it can reduce the risk of heart disease.

Similarly, depression causes several changes in our hormones thereby leading to a hormone imbalance, can decrease body’s immunity; can affect changes in bone metabolism; and can cause cardiovascular dysfunction. This can result in decreased quality of life. People living under any kind of depression are at higher risk of getting type 2 diabetes or heart disease.

What should be done to avoid becoming a victim of conditions like stress and depression?

Hormone balance, in addition to healthy diet and exercise, is the answer. Hormones affect everyday health and wellness by interacting with every single cell inside our bodies, and if these do not do their job well, a negative ripple effect is created thereby disrupting overall homeostasis resulting in damaged and disturbed physiology. Therefore, it has been suggested by various published scientific studies that keeping the hormone levels of the body in proper balance within the normal ranges helps in reducing risk of getting diagnosed with conditions like heart disease and diabetes.

Heart Disease- Diabetes- Obesity: What Have we Achieved so Far?

We know that the heart disease and diabetes pose significant threats to our health, especially as we grow older and of course major challenges to the medical community. Although there have been major advancements in the medical field as far as detection and treatment of these conditions is concerned, but unfortunately these problems continue to result in serious health complications, disability and premature death. The sad part is that the overall incidence of these diseases is still going to increase as more and more people continue to age and also with rise in obesity rates, especially in US.
Did you know that few scientific studies came out in 2005 which showed that the life expectancy has declined for the first time in this country!!! How did this happen? We thought that we were working hard to create better world with so much of advancement in all field including medical science. Yes, no doubt we HAVE made a lot of progress in terms of finding cure and treatment for so many different conditions....BUT why still almost a MILLION Americans die of cardiovascular disease every year, which means 1 death every 34 seconds, and out of all those about 50% are above the age of 50 and this is just due to heart disease. What about Diabetes? Did you know that as of today almost 20 million Americans have diabetes and this number has increase by more than 60% since last 10 years, and again more than 50% people who have diabetes are above the age of 50. It is unfortunate that now we have started to see more and more cases of children with diabetes, which we could never imagine earlier, because at one point diabetes was considered as a condition in only the adults.

Can you IMAGINE how much it costs us every year in terms of dollar figure to fight against both heart disease and diabetes? Collectively, these conditions cause more than 1 million deaths every year and result in more than $620 billion in direct and indirect costs.

So, what happened? Where did we go wrong? Should we stop and rethink what did we do differently OR what did we NOT do that we have to see such increase in the prevalence of these conditions?

I think the problem is that we have a luxury of choosing a bad lifestyle and as we age we start to realize that the choices we made earlier in life were probably not the smartest ones.

What do you think?

What is CardioMetabolic Risk? Is it different from Metabolic Syndrome?

Cardiometabolic Risk is clustering of various risk factors, which put an individual at high risk of developing type 2 diabetes and cardiovascular disease. It also includes the abdominal obesity (the visceral obesity) and several other markers that have not been considered traditionally while defining overall risk of cardiovascular disease.

Cardiometabolic risk is not something different from Metabolic Syndrome; neither it has been coined to replace Metabolic Syndrome. We have known that metabolic syndrome involves insulin resistance, obesity in terms of large waist, high triglycerides, high blood pressure, low HDL cholesterol. Cardiometabolic Risk includes, in addition to all these risk factors, high LDL cholesterol, Inflammation (high C-reactive protein), smoking, physical inactivity, unhealthy eating, some psychosocial issues like stress and depression and high blood glucose, in addition to race, gender, age and family history.

All of these together and also each one of these independently increase the risk of disease and other related complications. So, cardiometabolic risk is a global risk condition involving all these markers that increase an individual’s overall risk of developing type 2 diabetes and cardiovascular disease.

Therefore, it is very important to detect, treat and control for these factors well in time, before it is too late. Lifestyle modifications like weight reduction, regular exercise/ physical activity, healthy diet, quitting smoking, all have benefits in terms of reducing the risk. We must understand that improvement in any one of these health markers results in improvement in other markers because our body does not work in isolation. Similarly, when there is any one of these risk factors present in a person, there could be other related conditions also that have not been diagnosed. So, clinicians should screen patients during their regular visits for any or all of these risk factors for cardiovascular disease and diabetes.

How will the screening help?

This will help them:

1. Understand the comprehensive picture of their patient’s overall health and alert them about any possible future health condition.
2. Facilitate better communication with their patient to make better clinical decisions, one they have identified different markers.
3. Intervene at an early stage, as we know that conditions like insulin resistance and hyperglycemia occur long before the clinical diagnosis of diabetes.

Routine screening and early assessment may help both the physician and their patient work together to address important lifestyle changes like healthy eating, qutting smoking if they smoke, include 30 minutes or more of exercise or physical activity of any kind 5 days a week, to avoid risk of developing type 2 diabetes and cardiovascular disease.

Such assessments provide great tools to clinicians and their patients for a comprehensive and broader management of different health conditions, especially for cardiovascular disease and diabetes risk.

Dried Blood Spot Screening for Cardiometabolic Risk Markers shows Benefits of Exercise

The prevalence of diabetes and cardiovascular disease is increasing at an alarming rate. Several clinical and observational studies have demonstrated reduced risk of diabetes when physical activity increases. Simple screening tools are needed to monitor effects of treatment interventions in individuals at high risk.

At ZRT Laboratory in Beaverton, Oregon we assessed the application of dried blood spot technology to measure important cardiometabolic risk markers. Dried blood spot collection has advantages compared to conventional blood draws, such as minimal invasiveness, low sample volume, convenience of repeated measurements and ease of sample storage and transport.

Fifteen participants (28- 63 years of age) enrolled in a fitness study that included 30 minute exercise/ brisk walking five days a week for four months. Levels of insulin, hemoglobin A1c, C-reactive protein and triglycerides were measured in blood spot samples obtained by a simple and easy finger stick before and after the program. Dried blood spot samples were stored at -20C until used for analysis using modified methods developed in house from commercially available assays.

Insulin levels decreased significantly ; triglycerides dropped by 18% and C-reactive protein levels also showed significant improvement. The HbA1c levels remained unchanged during the program.

In conclusion, exercise/ brisk walking for 30 minutes five days a week for four months improved cardiometabolic risk factors independently as confirmed by dried bloodspot testing. This simple screening method has important implications for monitoring overall cardiometabolic health of high risk individuals.