胰岛素抵抗是心脏病风险的最精确预警信号

The Most Accurate Test to Determine Your Risk for Heart Disease

By Cyrus Khambatta

 

　

在这个博客上，我们谈论了很多关于胰岛素抵抗的原因，我的任务是通过饮食和锻炼为你提供一些策略来逆转它。随着时间的推移，我逐渐意识到胰岛素抵抗是被高度误解的，是我们这个时代最被忽视的健康状况之一。最重要的是，胰岛素抵抗与心脏病的风险直接相关。

　

　

 

我喜欢把胰岛素抵抗看作是一种中枢键，它能提高你患上所有慢性代谢疾病的风险。研究表明，胰岛素抵抗大大加速了心脏病、癌症、2型糖尿病和肥胖的发展，其中4个是我们的主要杀手，而胰岛素抵抗往往在代谢功能障碍开始前几年就被发现。

 

这对你来说意味着什么? 这很简单:测量、控制和逆转胰岛素抵抗可以预防或延迟慢性代谢疾病在未来的发病。

 

预防是美国人做得不好的一种做法。也许这篇文章能阐明预防胰岛素抵抗的必要性，以保护你最重要的器官——心脏。

 

心脏病可不是闹着玩的。

心脏病是全球范围内最大的杀手，导致65-70%的糖尿病患者死亡(2,3)。2015年，仅在美国就有超过60万人死于心脏病，占美国死亡人数的25%。

　

　

 

目前的估计表明，每天有1600多人死于冠心病，每52秒就有1人死亡。

 

在过去的30年里，死于心脏病的比率呈指数增长，每年都有更多的人死亡。但是，对于心脏病的饮食起因的研究越来越令人困惑，因为每天都有大量相互矛盾的信息对消费者产生影响。

 

说糖尿病和心脏病是密切相关的是一个保守的说法。在全人口范围内，糖尿病患者比没有糖尿病的人心脏病发作几率高四倍%。心脏病致死的人数比其他任何原因都多。

　

　

　

糖尿病不会杀死你，心脏病会

重要的是要了解心脏病不是选择性的。尽管1型糖尿病患者总体上比2型糖尿病患者的体重要低，但心脏病风险的增加同样适用于1型糖尿病和2型糖尿病人群。

 

1型糖尿病患者中绝大多数人都存在胰岛素抵抗，了解这一点可以使你对长期高脂肪、低碳水化合物饮食的有害方面有革命性的认识。

 

在Joel Fuhrman博士的书《Eat to Live》中，我看到了一个让我流泪的统计数字:

在1型糖尿病患者中，超过30%的人在50岁之前就会死于心脏病。

 

许多患有1型糖尿病的人认为，仅仅因为他们体重正常，他们患心脏病的风险就很低。事实并非如此，这一传统观点必须修改。

 

研究人员总是在寻找那些能预测心脏病的变量。科学家们设计了数千项研究，以确定哪些变量是最能预测心脏病的因素，然后反复测量这些指标，以教育公众吃什么，如何锻炼，以减少发生危及生命的心脏事件的几率。事实是，有许多变量可以预先警告即将发生的心脏病，包括但不限于:空腹血糖、A1c、胰岛素、总胆固醇、低密度脂蛋白胆固醇、HDL胆固醇、甘油三酯、BMI、腰臀比和血压。

 

有大量证据表明，超重会增加患心脏病的风险，而腹部脂肪过多会比其他任何部位(6-11)更危险。

 

然而，超重或肥胖本身并不足以增加患心脏病的风险。事实上，大部分肥胖人群患心脏病的风险低得惊人，而正常体重人群中，越来越多的人患心脏病的风险高得惊人。怎么会这样呢?

胰岛素抵抗预测心脏病。

 

结果表明，胰岛素抵抗强烈地预测了心脏病发作的风险。为了验证这一点，1981年意大利帕尔马大学的研究人员设计了一项杰出的研究，以确定胰岛素抵抗和心脏病之间的关系。他们在1981-1996年期间调查了近650名健康的非肥胖者，以了解哪些健康标志物能够在以后的生活中预测心脏病。

 

他们的发现令人难以置信——在1981年，他们发现大约25%的人表现出高胰岛素血症——这意味着他们在喝了含有溶解在水中的糖的溶液后分泌过量的胰岛素。到1996年，同样的25%的受试者患心脏病的几率是正常人的三倍，患2型糖尿病的几率是正常人的8倍，患高血压的几率是正常人的两倍。胰岛素抵抗比其他任何指标都更能预测心脏病。

 

他们的结论很简单:除了所有其他变量之外，仅仅知道哪些人分泌过量的胰岛素就足以预测谁将在接下来的15年内患上心脏病(1213)。

 

其他几个研究小组也得出了同样的结论——高水平的胰岛素似乎是最准确的心脏病预测指标，而且比BMI、空腹血糖或A1c(14-21)更准确。

 

胰岛素抵抗比肥胖更能预测心脏疾病

这个发现意义深远: 胰岛素抵抗比肥胖更能预测心脏病。这一证据表明，超重或肥胖者患心脏病的风险也很低是可能的——关键是你必须对胰岛素敏感。

 

如果你的胰腺分泌正常的胰岛素，那么你患心脏病的风险就很低。如果你的胰腺分泌大量的胰岛素，那么你患心脏病的风险就很高。只是这么简单。

 

如何测试你的胰岛素抵抗水平?

为了测试你的胰岛素抵抗水平，请医生给你做葡萄糖耐量测试(GTT)。GTT是一种简单的测试，它包括你喝溶解在水中的葡萄糖溶液，然后测量你的血糖和在接下来的3个小时内产生的胰岛素量。

 

结果1:正常的胰岛素，正常的葡萄糖

如果胰岛素分泌量在正常范围内，你的血糖也在正常范围内，那么研究表明你患心脏病的风险很低。

 

结果2:正常胰岛素，高血糖

如果胰岛素分泌量在正常范围内，但是你的血糖很高，那么你的胰腺就有分泌胰岛素的困难。这可能是你患有1型或2型糖尿病的一个指标。

　

　

　

 

结果3:高胰岛素，正常葡萄糖

如果胰岛素分泌量高于正常值，但你的血糖仍处于正常范围，那你就是胰岛素抵抗。这种状态被称为高胰岛素血症，这仅仅意味着你的胰腺分泌过多的胰岛素在幕后，这就大大提高了你患心脏病的风险。这就是为什么胰岛素抵抗被认为是看不见的——通常情况下，即使你的细胞有压力和超负荷工作，你的血糖仍然正常。你患心脏病的风险很高。

 

结果4:高胰岛素，高葡萄糖

如果你分泌的胰岛素量高于正常水平，你的血糖水平超出正常范围，那么你就会严重胰岛素抵抗，而你的胰腺分泌过量的胰岛素。你患心脏病的风险很高。

 

带回家的消息

当你考虑如何把未来心脏病发作的风险降到最低时，认识到你患心脏病的风险与你的“肥胖”程度关联性很弱，相反，与你的胰岛素抵抗水平密切相关，这是一个彻底的游戏规则改变者。

 

食用低脂肪、以植物为基础的全食物饮食可以教会你，如何为了全身的健康，优先考虑胰岛素敏感性，大大降低你患突发和危及生命的心肌梗塞的风险。

 

向你的医生咨询葡萄糖耐量测试，以评估你患心脏病的风险。

 

心脏病和“肥胖”之间的相关性很弱。

 

即使你的体重正常或很瘦，如果你过度分泌胰岛素，你患心脏病的风险也会很高。

33%的1型糖尿病患者死于心脏病。不要以为你的体重决定了你的心脏病风险。

　

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The Most Accurate Test to Determine Your Risk for Heart Disease

On this blog, we talk a lot about the causes of insulin resistance, and my mission is to provide you with strategies to reverse it through diet and exercise. Over time, I have come to realize that insulin resistance is highly misunderstood, and is one of the most neglected health conditions of our time. Most importantly, insulin resistance is directly related to your risk for heart disease.

 

I like to think of insulin resistance as the central lynch pin that elevates your risk for all chronic metabolic disease. Studies have shown that insulin resistance greatly accelerates the development of heart disease, cancer, type 2 diabetes and obesity, four of our leading killers, and that insulin resistance is often detectable years before metabolic dysfunction begins (1).

 

What does that mean for you? It’s simple: measuring, controlling and reversing insulin resistance now can prevent or delay the onset of chronic metabolic disease for you in the future.

 

Prevention is a practice that Americans don’t do very well. Perhaps this article will shed some light on the necessity of preventing insulin resistance to preserve your most important organ – your heart.

 

Heart Disease is No Joke

Heart disease is the largest killer of people worldwide, and is responsible for the deaths of 65-70% of people with diabetes (2,3). In 2015, more than 600,000 people died from heart disease in the United States alone, which represents about 25% of all deaths in this country.

 

Current estimates indicate that more than 1,600 people die from coronary artery disease every day, at a rate of one death every 52 seconds (4).

 

 

Over the course of the last 30 years, the rate of death from heart disease has increased exponentially, claiming more lives every year. But still, the search for the dietary causes of heart disease becomes increasingly confusing, as an overabundance of conflicting information hits consumers on a daily basis.

 

To say that diabetes and heart disease are closely related is an understatement. On a population-wide scale, people with diabetes experience 400% more heart attacks than those without diabetes. Heart disease kills more people with diabetes than any other cause.

 

Diabetes Won’t Kill You, Heart Disease Will

It is important to understand that heart disease is not selective. Even though people with type 1 diabetes are generally less overweight than those living with type 2 diabetes, elevated heart disease risk applies to both the type 1 and type 2 diabetes populations.

 

Insulin resistance is present in a vast majority of people living with type 1 diabetes, and understanding this can revolutionize your knowledge of the detrimental aspects of a high-fat, low-carbohydrate diet over the long-term.

 

In Dr. Joel Fuhrman’s book Eat to Live, I read a statistic that scared me to tears:

 

More than 30% of all people with type 1 diabetes will die of heart disease before the age of fifty (5).

 

 

Many people with type 1 diabetes assume that just because they are normal weight, that their risk for heart disease is very low. This is not the case, and this conventional wisdom must be rewritten.

 

Researchers are always on the lookout for variables that are strong predictors of heart disease. Scientists design thousands of studies to determine which variables are the strongest predictors of heart disease, then measure those markers repeatedly in an effort to educate the public about what to eat and how to exercise to reduce the chances of experiencing a life-threatening cardiac event. The truth is that there are many variables that may forewarn of impending heart disease, including, but not limited to: fasting blood glucose, A1c, insulin, total cholesterol, LDL cholesterol, HDL cholesterol, triglycerides, BMI, waist-to-hip ratio and blood pressure.

 

There is substantial evidence that simply being overweight increases your risk for heart disease, and that carrying excess fat in your abdomen is more dangerous for your cardiovascular health than any other area (6–11).

 

However, being overweight or obese by itself is not always enough to raise your risk for heart disease. In fact, a large proportion of the obese population is at a surprisingly low risk for heart disease, whereas an increasingly large proportion of normal weight individuals is at a surprisingly high risk for heart disease. How could this be the case?

 

Insulin Resistance Predicts Heart Disease

It turns out that insulin resistance strongly predicts your risk for a heart attack. To test this, in 1981 researchers at the University of Parma, Italy designed a brilliant study to determine the relationship between insulin resistance and heart disease. They investigated nearly 650 healthy, non-obese individuals between 1981-1996 in order to understand which health markers could predict heart disease later in life.

 

What they found was incredible – in 1981 they found that about 25% of these individuals exhibited hyperinsulinemia – meaning that they secreted excess insulin after drinking a solution containing sugar dissolved in water. By 1996, this same 25% of subjects were three times as likely to suffer from heart disease, eight times as likely to develop type 2 diabetes and twice as likely to develop high blood pressure. More than any other marker, insulin resistance was the strongest predictor of heart disease.

 

Their conclusion was straightforward: aside from all other variables, simply knowing which individuals secreted excess insulin was enough information to predict who would develop heart disease in the upcoming 15 years (12,13).

 

 

Several other research groups have come to the same conclusion – high amounts of insulin appears to be the most accurate predictor of heart disease, and is a more accurate variable than BMI, fasting blood glucose or A1c (14–21).

 

Insulin Resistance Predicts Heart Disease Better Than Obesity

What this means is profound: insulin resistance is a stronger predictor of heart disease than obesity. This evidence shows that it’s possible to be overweight or obese and have a low risk for heart disease – the trick is that you must be insulin sensitive.

 

If your pancreas secretes a normal amount of insulin, your risk for heart disease is low. If your pancreas secretes a large amount of insulin, your risk for heart disease is high. It’s just that simple.

 

 

How to Test Your Level of Insulin Resistance

To test your level of insulin resistance, ask your doctor may for a glucose tolerance test (GTT). A GTT is a simple test that involves you drinking a solution of glucose dissolved in water, then measuring both your blood glucose and the amount of insulin produced over the course of the next 3 hours.

 

Outcome #1: Normal Insulin, Normal Glucose

If the amount of insulin secreted is within normal limits and your blood glucose is also within the normal range, then research indicates that your risk for future heart disease is low.

 

Outcome #2: Normal Insulin, High Glucose

If the amount of insulin secreted is within normal limits, but your blood glucose is high, then your pancreas is having trouble secreting insulin. This may be an indicator that you have either type 1 or type 2 diabetes.

 

Outcome #3: High Insulin, Normal Glucose

If the amount of insulin secreted is higher than normal but your blood glucose remains in the normal range, you are insulin resistant. This state is called hyperinsulinemia, which simply means that your pancreas is secreting excess insulin behind-the-scenes, and this is what elevates your risk for heart disease significantly. This is exactly why insulin resistance is considered invisible – often times your blood glucose remains normal even though your beta cells are stressed and working in overdrive. Your risk for heart disease is high.

 

Outcome #4: High Insulin, High Glucose

If the amount of insulin you secreted is higher than normal and your blood glucose is out of range, then you are severely insulin resistant and your pancreas is secreting excess insulin behind-the-scenes. Your risk for heart disease is high.

 

 

 

Take Home Messages

Understanding that your risk for heart disease is weakly related to your degree of “fatness,” and instead is strongly tied to your level of insulin resistance is a complete game-changer when thinking about how to minimize your risk for a heart attack in the future.

 

Eating a low fat, plant based whole foods diet teaches you how to prioritize insulin sensitivity for total body health, significantly reducing your risk for an unexpected and life-threatening cardiac event.

 

Ask your doctor for a glucose tolerance test to assess your risk for heart disease

Heart disease and “fatness” are weakly correlated with each other

Even if you are normal weight or skinny, your risk for heart disease is high if you over secrete insulin

33% of all people living with type 1 diabetes die of heart disease. Don’t be fooled into thinking that your weight determines your heart disease risk

　

　

REFERENCES

 

  1. Haffner SM, Valdez RA, Hazuda HP, Mitchell BD, Morales PA, Stern MP. Prospective Analysis of The Insulin-Resistance Syndrome (Syndrome X). Diabetes. 1992 Jun 1;41(6):715–22.
  2. WHO | The top 10 causes of death [Internet]. WHO. [cited 2016 Apr 26]. Available from: http://www.who.int/mediacentre/factsheets/fs310/en/
  3. Cardiovascular Disease & Diabetes [Internet]. [cited 2016 Apr 26]. Available from: http://www.heart.org/HEARTORG/Conditions/Diabetes/WhyDiabetesMatters/Cardiovascular-Disease-Diabetes_UCM_313865_Article.jsp/#.Vx6w2jArLIU
  4. Kochanek, Kenneth, M.A.; Jiaquan Xu, M.D.; Sherry L. Murphy, B.S.; Arialdi M. Minin˜o, M.P.H., Hsiang-Ching Kung, Ph.D., Division of Vital Statistics. National Vital Statistics Report [Internet]. [cited 2016 Apr 26]. Available from: http://www.cdc.gov/nchs/data/nvsr/nvsr60/nvsr60_03.pdf
  5. Fuhrman J. Eat to live the amazing nutrient-rich program for fast and sustained weight loss. New York: Little, Brown and Co.; 2011.
  6. Liu J, Fox CS, Hickson DA, May WD, Hairston KG, Carr JJ, et al. Impact of abdominal visceral and subcutaneous adipose tissue on cardiometabolic risk factors: the Jackson Heart Study. J Clin Endocrinol Metab. 2010;95(12):5419–5426.
  7. Amati F, Pennant M, Azuma K, Dubé JJ, Toledo FGS, Rossi AP, et al. Lower thigh subcutaneous and higher visceral abdominal adipose tissue content both contribute to insulin resistance. Obes Silver Spring Md. 2012 May;20(5):1115–7.
  8. McLaughlin T, Lamendola C, Liu A, Abbasi F. Preferential fat deposition in subcutaneous versus visceral depots is associated with insulin sensitivity. J Clin Endocrinol Metab. 2011;96(11):E1756–E1760.
  9. Kim S, Cho B, Lee H, Choi K, Hwang SS, Kim D, et al. Distribution of abdominal visceral and subcutaneous adipose tissue and metabolic syndrome in a Korean population. Diabetes Care. 2011;34(2):504–506.
  10. Fox CS, Massaro JM, Hoffmann U, Pou KM, Maurovich-Horvat P, Liu C-Y, et al. Abdominal visceral and subcutaneous adipose tissue compartments association with metabolic risk factors in the Framingham Heart Study. Circulation. 2007;116(1):39–48.
  11. Demerath EW, Reed D, Rogers N, Sun SS, Lee M, Choh AC, et al. Visceral adiposity and its anatomical distribution as predictors of the metabolic syndrome and cardiometabolic risk factor levels. Am J Clin Nutr. 2008;88(5):1263–1271.
  12. Zavaroni I, Bonini L, Gasparini P, Barilli AL, Zuccarelli A, Dall’Aglio E, et al. Hyperinsulinemia in a normal population as a predictor of non-insulin-dependent diabetes mellitus, hypertension, and coronary heart disease: the Barilla factory revisited. Metabolism. 1999 Aug;48(8):989–94.
  13. Ninomiya JK, L’Italien G, Criqui MH, Whyte JL, Gamst A, Chen RS. Association of the Metabolic Syndrome With History of Myocardial Infarction and Stroke in the Third National Health and Nutrition Examination Survey. Circulation. 2004 Jan 6;109(1):42–6.
  14. Facchini FS, Hua N, Abbasi F, Reaven GM. Insulin resistance as a predictor of age-related diseases. J Clin Endocrinol Metab. 2001 Aug;86(8):3574–8.
  15. Yip J, Facchini FS, Reaven GM. Resistance to insulin-mediated glucose disposal as a predictor of cardiovascular disease. J Clin Endocrinol Metab. 1998 Aug;83(8):2773–6.
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  17. Ducimetiere P, Eschwege E, Papoz L, Richard JL, Claude JR, Rosselin G. Relationship of plasma insulin levels to the incidence of myocardial infarction and coronary heart disease mortality in a middle-aged population. Diabetologia. 1980 Sep;19(3):205–10.
  18. Pyörälä K. Relationship of Glucose Tolerance and Plasma Insulin to the Incidence of Coronary Heart Disease: Results from Two Population Studies in Finland. Diabetes Care. 1979 Mar 1;2(2):131–41.
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