Chapter 4 Chapter 2 Blood sugar has endless troubles

In 1998, in Germany alone, the outpatient and inpatient treatment of 3.5 million type 2 diabetics cost nearly 3 billion marks.This is the survey result of the International CODE Research Institute announced not long ago.The main cause of the huge costs is various complications, first of all, the destruction of the microvessels of the eyes, kidneys and extremities, the so-called microangiopathies.In Germany, an average of 6,000 diabetics go blind each year, and 214,000 patients must undergo kidney dialysis (dialysis).Recently, it has also been found that the mental and intellectual status of diabetic patients will deteriorate rapidly, which shows that the brain blood vessels are also damaged.

Large blood vessels in people with diabetes also age prematurely.Serious consequences of this so-called macrovascular disease are myocardial infarction and cerebrovascular infarction.Although this disease does not kill people every time, for some people, it means a long treatment process.People with diabetes are three to four times more likely to suffer from such heart and circulatory diseases than people with normal sugar metabolism.In Germany, about 27,000 people suffer from myocardial infarction and 44,000 people suffer from cerebrovascular infarction every year.Now it seems that these statistics about diabetes must add another important item: unknown syndrome.

Dear readers, if you want to understand this issue in depth, it is necessary to know the ins and outs of the physiological phenomena and the causal relationship in medicine.So, in this chapter, and only this chapter, I will use some technical terms, even if it is a bit obscure and dry, but please stick to it, and you will definitely gain something. According to the most pessimistic estimates, at least half of today's adults between the ages of forty-five and sixty-four live at risk of hyperglycemia without knowing it.This is not surprising, since until now, only fasting blood glucose levels were measured during routine health checks.Only when this value reaches the standard of diabetes, which is higher than 126 mg per 100 ml on an empty stomach, or higher than 200 mg per 100 ml two hours after ingesting glucose, will it be noticed or considered therapeutic necessary.

Earlier, this critical value was only obtained when microvascular disease was caused, because most people's blood sugar reached such a high concentration before such severe symptoms appeared.Usually only people who meet this standard will receive treatment to lower blood sugar.However, as we now know, long before a person's blood sugar reaches the level of diabetes, the cause of microvascular disease, that is, the risk of aging heart and circulatory system, already exists. According to more than 20 epidemiological investigations and long-term observations of more than 100,000 people around the world, if the blood sugar concentration continues to rise on an empty stomach and two hours after glucose intake, the relative risk of heart and circulatory system disease The death rate continued to increase.It is impossible to set a definite critical value, because this is a process of quantitative change. Starting from the normal value (80 mg per 100 ml), any form of increase in blood sugar value will bring a health crisis.

So far, it is considered that a slightly high or normal high blood sugar concentration is enough to increase the risk of heart and circulatory system disease by 30%︱60%, and this is related to whether a person is obese or has other pathogenic factors irrelevant.When the blood sugar concentration is within the range of the so-called impaired glucose tolerance, that is, the stage before the onset of diabetes, the incidence of heart and circulatory system diseases will increase by 80%︱ to 270%! Undoubtedly, the aging of the large blood vessels in the circulatory system precedes the onset of diabetes, which precedes damage to the microvessels of the eyes and kidneys.Observations support this inference: People who have had diabetes for a long time do not die at higher rates of heart and circulatory disease than those who have recently been diagnosed with diabetes.

In addition, people with insulin resistance and impaired glucose tolerance tend to also have high blood pressure and high blood fats, the two most common risk factors that also attack the walls of blood vessels.There are many other recently recognized causative factors of the heart and circulatory system in these individuals (see appendix).For example, these people have severely impaired blood vessel walls because their bodies produce too little nitric oxide (NO), which relaxes blood vessel muscles, keeps blood pressure in the normal range and blocks dangerous blood components, For example, some platelets and inflammatory cells enter the blood vessel wall.

As we have known not so long ago, having too much fat in the blood enhances blood clotting and increases the likelihood of blood clots forming.As we all know, the long-term existence of this thrombus is the ultimate cause of myocardial infarction and cerebrovascular embolism.Each of these symptoms can lead to arteriosclerosis, and together they are even more dangerous.It is not surprising that people with these symptoms often die of myocardial infarction. With a little care, people with insulin resistance are easy to spot during health checks.People with diabetes in family members have a higher incidence rate and should be checked regularly for this.Even if there is no diabetes in the family, it should not be taken lightly.People with a Body Mass Index (BMI) greater than 27 and blood pressure exceeding 145/90mm are suspected.Suspicions are heightened if your belly measures more than your hips, as fat deposits in the midsection and upper body are especially likely to cause insulin resistance.

Forgive me for this tactful question, dear reader: do you have round cheeks?Many people think that this is a sign of health, but it is not.People with round faces are likely to have fat accumulation in the abdomen.Researchers at the Mayo Hospital in the United States have confirmed this connection. Also, do you usually exercise a lot?not much!You should spend some time on this issue.First, do a blood fat analysis.If the ratio of total cholesterol (total cholesterol) to high-density lipoprotein cholesterol (HDL-C) is greater than five (in the case of normal or slightly high low-density lipoprotein levels), your suspicion will also deepen.Insulin resistance is more typically characterized by high triacylcycerols and low HDL cholesterol.A ratio of the two above five can also pose a danger.

Now that you've checked your blood fats, you might as well check your fasting blood sugar and insulin levels as well.If the blood sugar is above 110 (mg/100ml), there is almost no doubt about it.If the above values ​​are normal but other signs of insulin resistance are present, an oral glucose tolerance test (OGTT) must be done.In some people, the effect of insulin exerted during the night for eight hours can normalize the blood sugar in the fasting blood test the next morning, resulting in the false appearance of normal glucose tolerance.But these people may have high blood sugar for hours after breakfast, and no one knows it.

If we only look at the results of the fasting blood glucose test, we can only identify some people who are at risk of insulin resistance.Therefore, only through the oral glucose tolerance test can be foolproof.When doing this test, drink a drink containing 75 grams of glucose on an empty stomach, and measure your blood sugar two hours later.At this time, the blood sugar concentration should be lower than 140 mg/100 ml.We already know that elevated blood sugar brings about harmful changes that often do not affect the circulatory system until after the body consumes glucose, that is, in the hours after eating.Therefore, this inspection is extremely important.

You can refer to the appendix at the end of this book to check your risk of suffering from unknown syndrome and the possible myocardial infarction caused by it.This test was conducted by Jerrod.Designed by Professor Gerald Reaven, the father of Unknown Syndrome. It is becoming increasingly clear that the hours after a meal are critical to health.What changes have taken place in the human body during this period of time?When food is fully digested and nutrients enter the bloodstream from the small intestine, a series of chemical reactions take place.One of its products is a free radical with active oxygen molecules, which destroys everything unless there are special defense substances against this attack called antioxidants.As this substance is continuously consumed, its concentration in the blood decreases.Once the concentration is too low, the oxidation of free radicals has the upper hand again, and a bad state will appear in the blood at this time, which is called oxidative stress. Under certain circumstances, the production of free radicals increases substantially.And just a large increase in blood sugar seems to be particularly likely to cause this kind of stress.The massive secretion of insulin changes the structure of postprandial elevated blood fat.Insulin splits large LDL molecules into dense, small particles, so that slightly bad LDL cholesterol becomes extremely bad LDL.As mentioned earlier, low-density lipoproteins with smaller particles can enter the blood vessel wall in large quantities and be fully oxidized.The higher the concentration of blood sugar and blood fat after a meal, the stronger this oxidative stress.The increased concentration of sugar, insulin and fat in the blood will enhance the coagulation of blood, and easily form thrombus, which will lead to myocardial infarction and cerebrovascular infarction. People with insulin resistance and people with impaired glucose tolerance, no matter what they eat, their blood sugar and blood fat concentrations are always high.Even if they eat no fat at all and only eat carbohydrates, their blood fat will rise because their liver is wrongly programmed to make excess fat itself and send it into the blood.People with high blood sugar are always under the shadow of oxidative stress every time they eat. However, it doesn't matter.Elevated blood fat itself is also suspected of causing damage to various proteins in the blood.The most obvious victim is hemoglobin, the hemoglobin in the blood that transports oxygen throughout the body.In the case of hyperglycemia, they are loaded with sugar and become glycosylated.The higher the glucose concentration in the blood, the stronger this effect is.Glycated hemoglobin is easier to measure and is used as an indicator to determine how high the average blood sugar concentration has been over the past three months.Unfortunately, this item is rarely used as a routine health check. Glycated protein structures are generally particularly susceptible to oxidation.The result is that the blood vessels fail to relax and lose their elasticity due to insufficient supply of an indispensable substance called nitric oxide. If we know that the period after eating is an important period for harmful chemical reactions to occur, then there should be countermeasures.For example, a key preventive measure is to control the increase in postprandial blood sugar concentration as much as possible, the smaller the increase and the shorter the duration, the better. Now we are getting closer to the real subject of this book: dietary nutrition.Because the magnitude and duration of elevated blood sugar and blood fat depend largely on what we eat.This is especially true for people who already have dysregulated sugar and fat metabolism which means mostly obese and inactive adults. In fact, the type and quantity of carbohydrates in food directly affect the blood sugar response.At present, the blood sugar response of major foods to the human body has been determined through quantitative standards.We call this the glycemic index (GI) of a food.A higher glycemic index means a larger and longer-lasting rise in blood sugar, which is exactly what eating starchy foods, such as white bread, does.Conversely, if you eat a rougher, naturally fermented rye bread or an apple, the blood sugar rises in a smaller range and for a shorter time, and the glycemic index is also lower.We can see this in later chapters and in the appendix at the end of the book. You will soon find out, dear reader, that learning about the glycemic index is not a waste of time.Now, let me tell you about the latest and most worrying news on this front In early 1997, epidemiologists from Harvard University in Boston published the results of a long-term investigation.The respondents were 65,000 men and 43,000 women.All were healthy at the start of the investigation, only to suffer from one ailment or another over time.After six years, 915 women and 523 men developed diabetes.The researchers correlated these changes with the diets of these people and found that the glycemic index and glycemic load are related to the formation of diabetes: the higher the glycemic index, the more and more often starch-rich foods are eaten, the more likely you are to suffer from diabetes. High, and it has nothing to do with whether the subject is fat or thin, whether he likes to exercise, whether he has a family medical history or whether he smokes. In early 2000, the results of the female part of the above-mentioned survey on the effect of foods with a high glycemic index on myocardial infarction were published.We have seen that the more such foods are eaten, the greater the risk of myocardial infarction.This effect is particularly prominent in overweight people.This probably won't surprise you too much.But you start to feel uneasy when you read the numbers: The same research team also found, in the same women, that diabetics were nearly 50 percent more likely to develop bowel cancer than non-diabetics , and were 140 percent more likely to die from bowel cancer.Other recent investigations have also confirmed this relationship. Another investigation, from the United States, completes the grisly picture.This six-and-a-half-year observation of 6,000 elderly people showed that with the increase of fasting blood sugar and two-hour postprandial blood sugar and insulin levels, the risk of colon cancer also increased linearly, and it was related to whether I had Diabetes has nothing to do.Those with high levels of insulin were twice as likely to develop bowel cancer.The risk of developing cancer already exists when you have impaired glucose tolerance, not necessarily when you have diabetes! The relationship between blood sugar and cancer can be explained by the long-term high insulin content and its effect on other hormones in this complex network system.We mainly infer that insulin has a direct effect on certain growth hormones, and certain conditions are also required for the growth of cancer cells.Importantly, elevated postprandial blood glucose and insulin levels persist longer in older adults than in younger adults because insulin resistance increases with age.It is worth adding that a number of epidemiological studies have shown that a large intake of foods with a high glycemic index will increase the risk of colon cancer, which has nothing to do with other carcinogenic factors, but works alone.The risk is highest in people who are obese, physically inactive, and eat low amounts of crude fiber. In 1998, staff at Australia's Deakin University looked at the effects of diet in exploring this question.When analyzing the composition of stool, they focused on those substances that are believed to induce bowel cancer, and compared the Western-style diet, which is generally considered unhealthy, with a healthy Chinese-style diet. The former contains higher fat (3-4%), protein (10%) 7%) and less carbohydrates (4-5%), the latter contains a lot of carbohydrates (72%, but low sugar content), very little fat (17%) and less protein ( twelve%).However, the results were puzzling: all carcinogens were significantly higher in the diet rich in complex carbohydrates (cereals, rice) than in the other group. The most famous cancer research expert in Europe, Carlo of the University of Milan.pull.Caro La Vecchia and his staff published their findings in the American Journal of Clinical Nutrition in late 1999.In an exhaustive case-surveillance study, they compared the eating habits of 3,336 cancer patients with 3,526 healthy subjects.Some important factors with potential influence, such as age, whether smoking and drinking, body weight (BMI), intake of fruits and vegetables and crude fiber, were taken into account in the statistical data, so as to find out an exact risk factor as much as possible .The result, especially for Italians and all Italian fans, is astonishing: people who eat more refined pasta, such as macaroni, pizza, bread and rice, have a higher glycemic index than people who do not eat the above foods. The risk of cancer of the mouth, throat and esophagus is 60% higher, the probability of stomach cancer and colorectal cancer is 50% higher, rectal cancer is 30% higher, and thyroid cancer is 100% higher! Just imagine, if you were on vacation in Italy, the kids would have been delighted by the snack bars, pizzerias and delicious treats you frequented.When you sit down in a restaurant and pick up the menu, what you see is a reminder written in six languages: The Minister of Health warns consumers that eating Italian food may be harmful to your health!You look out your window in bewilderment and see flags flying at half mast everywhere, presumably all of Italy The media has been surprisingly silent on these cancer-related issues.How long will this situation last?Don't those media practitioners see it?Or are they so familiar with the shortcomings of their profession that they turn a blind eye to them?Did the Mafia, or the Vatican, take this carb-filled casket under its protection?At least in Germany, this question has never been heard.The media here prefers to repeat their old tune; stoking the fear of meat!Mad cow disease has become a regular topic, although only one case has been detected in Germany in the past ten years, and that was in a foreign cow. All these scientifically proven new insights remained indifferent to the German nutrition authorities, their followers and those who aspired to join them.They continue to insist that eating as much complex carbohydrates as possible, that is, foods rich in starch, is good for health Causative factors of unknown syndrome For the definition and classification criteria of hyperglycemia, a sugar metabolism disorder, please refer to the appendix of Chapter 1 for details. Hyperinsulinemia is only a high level of insulin, that is, it has nothing to do with insulin resistance and other pathogenic factors. Whether it directly constitutes a risk of disease is still controversial.However, high insulin content caused by insulin resistance is indeed a risk of disease. It has been proven that the mechanism of action of insulin harmful to the body is not yet fully understood.To be sure, insulin in the kidneys suppresses the excretion of salt, allowing the body to retain more water.In addition, insulin stimulates the sympathetic nervous system.Both of the above can increase blood pressure. The blood vessel walls of people with high blood pressure will gradually calcify and harden over time, and the resulting resistance forces the heart to work harder to inject enough blood into the circulatory system.The heart and arteries are overloaded, causing damage to the heart muscle and blood vessel walls.In addition, high blood pressure can cause changes in the blood clotting system, leading to blood clotting and thrombosis. Within a certain blood pressure range, the risk of heart and circulatory system diseases is minimal.We call this range ideal blood pressure.Its highest limit is 120/80 in the quiet state.According to the definition of the American Heart Association, blood pressure below 130/85 can still be considered normal.Systolic blood pressure between 130 and 139, and diastolic blood pressure between 85 and 89 are slightly higher.A systolic blood pressure of 140 to 159 and a diastolic blood pressure of 90 to 99 are defined by the society as mild hypertension or primary hypertension.A systolic blood pressure between 160 and 179 and a diastolic blood pressure between 100 and 109 are considered moderately high blood pressure or grade 3 high blood pressure.If it reaches 180/110, it belongs to severe hypertension or grade 3 hypertension. Most people with unknown symptoms of high cholesterol have low total cholesterol (TC) and low-density lipoprotein cholesterol (LDL).But one of the characteristics of this syndrome is that the composition of blood fat leads to arteriosclerosis.This condition is known as atherogenic lipoprotein profile (ALP).Usually there is a high concentration of very low-density lipoprotein, triglycerides and so-called small dense LDL particles in the blood, while high-density lipoprotein cholesterol (HDL) is greatly reduced.Each of these factors is a causative factor for coronary thrombotic heart disease (KHK). Particle Size and Density of LDL Cholesterol particles can be distinguished by their size and density.If the small and dense lipoprotein particles predominate, it is called the B-type pattern (Patter B).Compared with the type A pattern, which is dominated by large and loose low-density lipoprotein particles, the risk of coronary thromboembolic heart disease is twice as high in the type B pattern.Atherosclerosis is caused because small, dense particles are more likely to enter the vascular endothelium and are more prone to oxidation. Oxidized LDL Oxidation of LDL particles plays a central role in the development of atherosclerosis.People with insulin resistance had significantly more oxidized low-density lipoprotein (ox-LDL) in the blood, independent of LDL cholesterol levels and other pathogenic factors.The oxidized low-density lipoprotein attracts T lymphocytes and monocytes, enhances the absorption of low-density lipoprotein by macrophages, reduces the activity in the cell wall of macrophages, and leads to the formation of foam cells.In addition, oxidized low-density lipoproteins also damage the inner walls of blood vessels. Very low-density lipoprotein cholesterol Very low-density lipoprotein (VLDL) is a lipoprotein rich in triglycerides, and its serum concentration is closely related to the concentration of triglycerides.Triglyceride-rich lipoproteins, such as medium-density lipoprotein and very low-density lipoprotein, were not previously thought to be harmful.Now epidemiological studies have proved that the so-called lipoprotein remnants, that is, lipoprotein particles that have been partially decomposed and become smaller, can lead to atherosclerosis and are a direct pathogenic factor of coronary thrombosis heart disease.People with insulin resistance, regardless of other pathogenic factors, have higher concentrations of lipoprotein residues in the blood than people with insulin sensitivity.These residues can promote the formation of loose and easily peelable deposits in blood vessels, which are extremely dangerous. Triglycerides After a long debate, high triglycerides (TG) are today recognized as a direct cause of coronary heart disease, especially when combined with low levels of HDL cholesterol. very dangerous triggers.A high triglyceride concentration directly affects the concentration of medium-density lipoprotein, very low-density lipoprotein and small, dense low-density lipoprotein particles in the serum.People with insulin resistance, regardless of other predisposing factors, had higher triglycerides.Large postprandial elevations in triglycerides, in particular, constitute an atherosclerotic risk.In people with insulin resistance, postprandial triglycerides are always significantly higher than in people with normal insulin function. Low HDL cholesterol is a direct risk factor for coronary thrombosis heart disease.Even a 1 percent reduction in this cholesterol can increase the risk of cardiovascular disease by 2 to 3 percent.If high levels of HDL cholesterol are maintained, even high levels of LDL cholesterol and triglycerides will not pose a significant risk of disease to the heart and circulatory system.The mechanism of action here is that cholesterol is sent back to the liver from the surrounding organs, and then reacts with bile acids to enter the intestinal tract and be excreted from the body.Other protective mechanisms include inhibition of low-density lipoprotein oxidation, inhibition of cell adhesion, and platelet activation. The ratio of triglycerides to high-density lipoprotein cholesterol (TG/HDL-Quotient) People with insulin resistance tend to have a higher ratio of triglycerides to high-density lipoprotein cholesterol.Regardless of a person's other fat parameters, this ratio was more likely to cause coronary thromboembolic heart disease than higher LDL cholesterol. The ratio of total cholesterol to high-density lipoprotein cholesterol (TC/HDL-Quotient) Many people with insulin resistance have a high ratio of total cholesterol to high-density lipoprotein cholesterol.Of all fat parameters, this ratio was the most powerful predictor of coronary thromboembolic heart disease, surpassing the ratio of low-density and high-density lipoprotein cholesterol in importance.The reason is likely to be that in total cholesterol, a VLDL aspect was also factored in, which in turn could be considered as a surrogate parameter for triglycerides.People with insulin resistance may have normal low-density lipoprotein cholesterol, or just normal high, but the ratio of total cholesterol to high-density lipoprotein cholesterol is very high, which is also very unfavorable, because at this time very low-density lipoprotein cholesterol Cholesterol is too high and HDL cholesterol is too low. Endothelial function The function of the muscle endothelium on the inner wall of human blood vessels plays a key role in the health of the circulatory system.Normally the endothelium expands the inner diameter of blood vessels and thereby regulates blood pressure.It also prevents the adhesion of platelets and inflammatory cells, thus preventing hardening of the arteries and formation of thrombus.To maintain this health-sustaining function, the endothelium requires adequate nitric oxide.Nitric oxide is produced by the blood vessel walls themselves. There are multiple conditions that promote nitric oxide production and others that inhibit it.For example, high-intensity physical activity will promote the production of nitric oxide.Insulin also stimulates nitric oxide production in the endothelium.Because the generation of nitric oxide is inhibited, people with insulin resistance tend to degenerate endothelial function, resulting in increased blood pressure, a large number of cells and molecules enter and attach to the cell wall, which in turn accelerates arteriosclerosis, thrombosis and local defects. The formation of blood. Coagulation factors are signaling substances produced in blood vessel walls that control the ability of platelets to adhere, coagulate, and aggregate, as well as their ability to dissolve clots (fibrinolysis).Coagulation tendency and dissolution function are inhibited, which will accelerate the process of arteriosclerosis.The plasminogen activator produced in the blood vessel wall can promote fibrinolysis, while the plasminogen activation inhibitor (PAl-I) inhibits this process.Thus, an imbalance caused by the dominance of plasminogen activation inhibitors leads to atherosclerosis.High blood insulin concentrations increase the production of plasminogen activation inhibitors.People with insulin resistance, regardless of other causative factors, have higher blood levels of plasminogen activation inhibitors than people with insulin sensitivity, which is another reason for their higher risk of myocardial infarction.