What is endothelium?(Part 3)

Ways of preventing injury to the endothelium

Correcting yourhigh level of LDL-cholesterol

It has been reported that if the level of your LDL-cholesterol is very much above the normal ranges, the production of nitric oxide (NO) by your endotheliumwill be reduced[1]. When this takes place, the following complications will follow {other complications were discussed in Powertec (148)}:

Leukocyte adhesion[1]

As mentioned inPowertec (148), there are three types of cells in the blood. One type of these cells is called the white blood cells (WBCs). The WBCs are also called the leukocytes.When the production of NO is depressed, the adhesion of leukocytes to each other and to other substances is very much increased, conducive to the formation of clots and plugs that will obstruct the passageway of blood. In fact, this change in the property of the leukocytes will further accelerate the formation of the so-called plaques which attach themselves in the endothelium, leading to the narrowing of the tubular blood vessels.

Oxidative stress[1]

When the LDL-cholesterol is oxidized, the formation of the substance called caveolin-1 leads to decrease in the concentration of NO. This biochemical mechanism has been considered as the initial and primary cause of atherosclerosis. Since NO is known to prevent the oxidation of LDL-cholesterol, its availability in your blood should always be high. If its level is low and the level of yourLDL-cholesterol is high, the probability that the lipoprotein will be oxidized is high. Thus, the level of yourLDL-cholesterol should always be checked and controlled.

Drug of choice to correct your elevated LDL-cholesterol

To correct your high level of LDL-cholesterol, your medical doctor will prescribe you with a class of drug known as statins. Generic names belonging to this class of drug are rosuvastatin, atorvastatin, and fluvastatin—to mention some. Your medical doctor needs to prescribe you with this class of drug because statins have been found to not only lower your LDL-cholesterol but it has other beneficial effects for the improvement of your endothelial function[1].

 

Correcting your blood sugar

The other disease which could be injurious to your endothelium is diabetes mellitus (DM)[3]. If you have DM, your blood sugar is very much increased—also called hyperglycemia in medical parlance. As much as possible, when you have detected for the first time—with the help of your medical doctor—that your blood sugar is increased, that you have immediately taken action to correct it. If your medical doctor prescribed you with a certain drug, or set of drugs, you should have taken them regularly and religiously.If your blood sugar is left unchecked for a considerable number of years, it will enhance the attachment of plaques in your endothelium, leading to the development of atherosclerosis, hypertension, and other cardiovascular complications of diabetes. However, up to the present time, a detailed explanation, in terms of biochemical and cellular connections, between high blood glucose levels and complications in the cardiovascular structures remains incompletely understood [2].

While there has been no clear and detailed explanation on the link between hyperglycemia and endothelial dysfunction, it is known that in diabetic state there is an increased tendency for oxidative stress and oxidation of lipoproteins, especially the LDL-cholesterol[2]. As mentioned in the preceding, these two factors have been established as possible causes ofNO depletion. Hence, hyperglycemia has a big role in the destruction of endothelium, and there is a need to control it.

The simplest way to find out if your diabetes has more or less adversely affected the competence of your endothelium is to request for urinalysis. If protein, specifically albumin, is detected in your urine, it is possible that endothelial dysfunction has started[2], and you really need to control your blood sugar.

(To be continued)

References:

  1. Davigon J, Ganz, Peter. Atherosclerosis: evolving vascular biology and clinical implications, role of endothelial dysfunction in atherosclerosis. Circulation. 2004;109: III-27-III-32. doi: 10.1161/01.CIR. 0000131515.03336.f8.
  2. Hadi H, and Suwaidi J. Endothelial dysfunction in diabetes mellitus. Dovepress, Vascular Health and Risk Management. 2007;Dec; 3 (6):853-876.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2350146/

  1. Preston RA, WencheJy, Jimenez, JJ, Mauro, LM, Horstman, LL, Valle, M, Aime, G, and Ahn, YS. Effects of severe hypertension on endothelial and platelet microparticles. Hypertension. 2003;41:211-217. doi: 10.1161/01.HYP.0000049760.15764.2D.

What is endothelium?(Part 2)

Ways of preventing injury to the endothelium

Controlling your high blood pressure

In the study of Preston, RA et al, titled “Effects of severe hypertension on endothelial and platelet microparticles”, two markers were used to find out if indeed hypertension injures the endothelium. One of these markers is called endothelial microparticles (EMP), and it   is released in the bloodstream when the lining of the endothelium is damaged or destroyed. In this study, investigators found out that EMP was very much elevated in the subjects with high blood pressure[1]. This shows that existing high blood pressure could continually and inevitably injure your endothelium, and there is an urgent need to control it.

There is therefore a need to see your medical doctor soonest to control your high blood pressure. If synthetic drugs will be prescribed to you, the drug of choice should be any one belonging to the class of angiotensin-converting enzyme (ACE) inhibitors, because this has been shown to contribute in the restoration of good endothelial function [2]. Examples of generic names belonging to this classare captopril, perindopril, imidapril, and many more. The generic names underthis class of drugs end in “pril”. Thus, if you have elevated level of LDL-cholesterol, in addition to having high blood pressure, ensure that yourmedical doctor prescribes you with any pill belonging to this class of anti-hypertensive drug.

Correcting yourhigh level of LDL-cholesterol

It has been reported that if the level of your LDL-cholesterol is very much above the normal ranges, that the production of nitric oxide (NO) by your endotheliumwill be reduced[2]. When this takes place, the following complications will follow:

Arteries constrict[2]

Since NO is responsible for the dilation of your blood vessels, the arteries in particular, its low level will lead to the elevation of your blood pressure, since the constriction of your arteries will predominate.

Platelets clump and attach themselves in the endothelial injury[2]

In your blood, there are three types of cells: (1) white blood cells, (2) red blood cells, and (3) platelets. The platelets play a significant role in the formation of blood clots which serve as plugs to any cut in your arm, legs, or in any external part of your body. Without platelets, it is difficult to stop any form of bleeding. When the level of NO in your blood is very much reduced, theplateletseasily form a clump and attach themselves at the injured site in your endothelium forming the so-called plaques which eventually block your arteries and make them inelastic.

This change in the properties of platelets was also shown in the study of Preston, RA et al as stated in the preceding wherein platelet microparticles (PMP) were elevated in subjects whose blood pressure was very high[1], indicating that platelets have changed in their biological behavior. It is possible that low NO initiates this change in the platelets, and severe hypertension aggravates it.

Smooth muscle cells grow in number and migrate[2]

Your smooth muscle cells which compose the walls of your blood vessels are well-behaved when the level of NO in your blood is normal. However, when its level decreases as a result of having elevated LDL-cholesterol in your blood, your smooth muscle cells become active and aggressive, such that they go out of their way and go to other places which normally are not their territories. They cannot be controlled, and they go astray! Consequently, even in the lining of your endothelium which is in intimate contact with your flowing blood, they grow and invade. These seemingly foreign invaders make your endothelium thicker and more inelastic leading to the development of atherosclerosis and hypertension.

(To be continued)

References:

  1. Preston RA, WencheJy, Jimenez, JJ, Mauro, LM, Horstman, LL, Valle, M, Aime, G, and Ahn, YS. Effects of severe hypertension on endothelial and platelet microparticles. Hypertension. 2003;41:211-217. doi: 10.1161/01.HYP.0000049760.15764.2D.
  2. Davigon J, Ganz, Peter. Atherosclerosis: evolving vascular biology and clinical implications, role of endothelial dysfunction in atherosclerosis. Circulation. 2004;109: III-27-III-32. doi:10.1161/01.CIR. 0000131515.03336.f8.

What is endothelium?(Part 1)

Nature of endothelium

Endothelium is also called tunica intima, and it is the innermost layer of your artery and your other blood vessels {Refer to Powertec (146)}. As part of your artery,  you will surely arrive at a conclusion that its main function is to support your arterial wall. To some extent, it does, but it has other functions much more important than being support of your artery. This will be the center of discussion in this article.

Functions of endothelium

Aside from serving as the innermost lining of your artery, the endothelium has the following more important functions:

  1. Maintenance of the vascular tone. It produces the substance nitric oxide which is responsible for the dilation of your artery. It also produces endothelin and angiotensin II which are responsible for the constriction of your artery[1]. For all of these reasons, the endotheliumcontrols the diameter of your artery, increasing or decreasing it as needed. If there is a need to increase your blood pressure to a certain degree, then your endothelium increases it by effecting constriction of your arteries; if there is a need to lower it, then your endothelium will dilate your arteries. Your endothelium does this spontaneously without your knowing it and without waiting for you.
  2. Inhibition and stimulation of smooth muscle cell proliferation and migration[1]. The smooth muscle cells should be located at the right places. If their multiplication and migration are not controlled, then they will wreak havoc to your cardiovascular For this reason, the endothelium balances these two processes. If, however, your endothelium is being injured by an abnormality in your body, it may react spontaneously to allow the proliferation and migration of smooth muscle cells to protect itself.
  3. Inhibition and stimulation of thrombogenesis and fibrinolysis[1].Thrombogenesis refers to the formation of obstructions in your blood vessels, particularly in the arteries. Fibrinolysis, on the other hand, refers to the dissolution and dis-aggregation of possible obstructions.

From the foregoing discussion, it can be gleaned that if the endothelium is damaged, the balances that it does so that no opposing force will predominate will be damaged as well, and you will have a lot of problems.

Factors injurious to the endothelium

High blood pressure

Being the innermost lining of the artery, the endothelium takes the brunt of the flowing blood. If the blood pressure is very much elevated compared to the normal ranges, it will injure the endothelium, and this injury is the beginning of a process which will develop into atherosclerosis, then leading to hypertension {Refer to Powertec 146}.

High level of LDL-cholesterol

When the level of your LDL-cholesterol is very much above the normal ranges, it suppresses the endothelium to produce nitric oxide[1]—a substance whose one function is to dilate the blood vessels. In the absence of sufficient nitric oxide, your blood vessels, specifically the arteries, constrict leading to hypertension, which will, in turn, lead to the development of, or aggravate existing, atherosclerosis.

Ways of preventing injury to the endothelium

Control the high blood pressure

You should know your current blood pressure. You are very much negligent of your health if at this time you still do not know your current blood pressure! If your blood pressure is above the normal ranges, you need to consult a medical doctor so that you will be prescribed with the necessary medications. In addition, you will be requested to have blood and urine examinations whose results will provide your medical doctor with an idea on the severity of your medical condition. It is not enough that your blood pressure is controlled; in addition, other aggravating factors, such as abnormalities in your blood chemistry, need to be corrected, so that your hypertension will not get worse.

(To be continued)

Reference:

  1. Davigon J, Ganz, Peter. Atherosclerosis: evolving vascular biology and clinical implications, role of endothelial dysfunction in atherosclerosis. Circulation. 2004;109: III-27-III-32. doi:10.1161/01.CIR. 0000131515.03336.f8.

Role of cholesterol in the development of cardiovascular diseases(Part 2)

Anatomy of the blood vessel wall

You have three types of blood vessels: (1) arteries, (2) veins, and (3) capillaries. Your arteries carry the blood from your heart and deliver them to different parts of your body. You veins collect the blood from the different parts of your body and return it to the heart. Your capillaries, on the other hand, connect your network of arteries to your network of veins.In the development of hypertension and heart diseases, the type of blood vessels that are primarily involved are the arteries.Therefore, the center of discussion in the next few sections will be on them.

Your arteries can be likened to your water pipes at home. They are tubes wherein fluid passes through. In your water pipes, water passes through them; in your blood vessels, blood will pass through them. Your arteries are relatively thick tubes, and they are made this way because they need to withstand the high pressure generated by your blood and the regularpumping of your heart.

Tunica adventitia

The wall of your arteries are made up of three layers: (1) tunica adventitia, (2) tunica media, and (3) tunica intima, also known as the endothelium.The tunica adventitia is the outermost layer, the tunica media is the middle layer, and the tunica intima is the innermost layer. The tunica adventitia is responsible for attaching your arteries to the surrounding tissues, thereby preventing them from moving astray. In addition, it provides some strength for your arteries. The tunica media is mainly responsible for providing the strength of your arteries to contain your varying blood pressure. Meanwhile, the tunica intima provides the internal lining of your arteries.

Important role of the tunica intimaor endothelium

Since the tunica intima or endothelium is the innermost lining of your arteries, it is in intimate contact with the flow of your blood. As your blood flows in your arteries, your endothelium offers a frictional resistance to such flow; therefore, the endothelium receives the brunt of the flowing blood. In the parlance of medicine, this is called the shearing effect of the flowing blood. When your blood pressure is very much increased compared to the normal values, this shearing effect also increases, and your endothelium will be injured. The higher the blood pressure is, the higher and more serious the injury to your endothelium will be. This injury will be the beginning of developing the so-called atherosclerosis wherein fatty substances are attached to the lining of the endothelium, giving rise to inelastic arteries which will, in turn, lead to the development of hypertension and heart diseases.

Injury to the endothelium and high level of LDL-cholesterol

In the development of atherosclerosis (deposition of fatty substances in the endothelium), it has been established that the first stage in the process is the infliction of injury to the endothelium.This injury to the endotheliumare caused by increased blood pressure and the increased level of LDL-cholesterol[1]. Hence, if you have elevated blood pressure and you have elevation of the LDL-cholesterol, your hypertension will get worse as days go by, if you do not take medicines to control your high blood pressure and the elevated level of LDL-cholesterol.

The LDL-cholesterol has dual effects in the causation and worsening of atherosclerosis. Firstly, it decreases the production of nitric oxide which is responsible for the dilation of the arteries[1]. Thus, in the absence of nitric oxide, you are prone to have elevated blood pressure because of constriction of your arteries.Secondly, with increased level of LDL-cholesterol in the blood, these fatty substances, together with platelets, could attach themselves in the injured sites in the endothelium. This will make the arteries inelastic and obstructed—be it partial or total—leading to the development of hypertension and heart diseases.

Reference:

Davigon J, Ganz, Peter. Atherosclerosis: evolving vascular biology and clinical implications, role of endothelial dysfunction in atherosclerosis. Circulation. 2004;109: III-27-III-32. doi:10.1161/01.CIR. 0000131515.03336.f8.

Role of cholesterol in the development of cardiovascular diseases(Part 1)

Nature of cholesterol

Cholesterol is a form of fatty substance needed by your body for the maintenance of cell membranes,and production of bile acid and hormones[1]. With insufficient cholesterol, your cells will be adversely affected because the integrity of the cell membrane which encloses all its structures will be impaired. In addition, the quality of your bile acid which is one of the components of your bile and the different hormones that you need every minute of your life will deteriorate.

Cholesterol can be sourced from: (1) the foods and drinks that you take, and (2)the different chemical reactions taking place in your body. Because it is produced in your body, it has been postulated that probably you do not need the cholesterol coming from your foods and drinks! Hence, the cholesterol being produced in your body is enough to meet your needs[1]! However, it is not possible to totally remove all the cholesterol that is in your foods! It is impossible! Thus, if you want to control your dietary intake of it, you need to be choosy with your foods, selecting only those which are not rich in it (Consult Powertec 144). Examples of foods rich in cholesterol are meats, liver and other organ meats, dairy foods, egg yolks, and shellfish[2].

Transfer and elimination of cholesterol

When cholesterol is absorbed in your gastrointestinal tract, it travels in the bloodstream in the form of lipoproteins. It cannot travel as cholesterol; it has to be in the form of lipoproteins. There are two lipoproteins that carry cholesterol: (1) the low density lipoprotein (LDL) and the (2) high density lipoprotein (HDL). The LDLcarry the majority of cholesterol, around 75 to 85%, while the HDL carry approximately 15 to 25%[1]. Thus, they are called either LDL-cholesterol or HDL-cholesterol.

Aside from having different densities, the LDL-cholesterol and the HDL-cholesterol have different behavior when they are in the bloodstream. The LDL-cholesterol tends to bring the cholesterol away from the liver; that is, it brings its passengers to the far-flung structures of the body, such as in the blood vessels and peripheral tissues. Consequently, the cholesterol molecules are deposited in these organs. Specifically, when the cholesterol molecules are deposited in the inner lining of your medium to large blood vessels, these structures become inelastic, leading to the development of hypertension. When they are deposited in the small blood vessels of your heart, you will have heart disease and possible heart attack[3]. Since the LDL-cholesterol contributes to the development of cardiovascular diseases, such as hypertension and heart diseases, it is also known as the bad cholesterol.

The HDL-cholesterol, on the other hand, carries cholesterol molecules from the peripheral organs, such as the muscles and blood vessels, and brings them back to the liver—otherwise known as the reverse cholesterol transport—where they are taken up and incorporated as part of the bile. In a way, these cholesterol molecules were removed from the bloodstream, without inflicting any damage to the blood vessels and other organs of your body. Since the HDL-cholesterolhelped to remove cholesterol in the blood, it is also referred to as the good cholesterol.

Injury to the inner lining of blood vessels and cholesterol deposition

The innermost layer of your blood vessels is called the endothelium, and lately this structure has been receiving a lot of research attention because it has been becoming more clear that it is very much involved in the causation of atherosclerosis (deposition of fatty substances in the blood vessels) andhypertension. It has been postulated that the deposition of fatty substances is preceded by the injury of the endothelium.

(To be continued)

References:

  1. Sacher, Ronald A. and Richard A. McPherson. Widmann’s Clinical Interpretation of Laboratory Tests. F. A. Davis Company, Philadelphia, 2000.
  2. http://www.nhlbi.nih.gov/news/spotlight/fact-sheet/questions-and-answers-cholesterol-and-health-nhlbi-nutritionist-janet-de-jesus-ms-rd
  3. http://www.nhlbi.nih.gov/health/resources/heart/heart-cholesterol-hbc-what-html

Relationship between the intake of saturated fats and the development of cardiovascular problems

Nature of saturated fats

Saturated fats (SFs) are also known as saturated fatty acids. They are found in meats, coconut, palm oil, palm kernel oil, butter, egg yolks, milk, and milk products (except fat-free) [1] {Consult Powertec 63}.SFs come in different names, and examples are formic, acetic, propionic, butyric, valeric, caproic, caprylic (octanoic), capric (decanoic), lauric, myristic, palmitic, stearic, arachidic, behenic, and lignoceric[2]. Thus, if a food product that you are buying contains one or more of these, then you know that it contains SFs, and the best way to find out the SFsincorporatedin any grocery product is to look at the “Nutrition Facts” wherein the different substances contained in it are listed, including the quantity in terms of percent.

Relationship of saturated fats with cardiovascular diseases

It has been established from researches that if your diet is high in SFs, the level of your low-density lipoprotein(LDL) cholesterol is also high[3]. You should remember that LDL cholesterol is also known as the bad cholesterol, because it carries cholesterol away from yourliver and deposited them to far-away structures, such as the blood vessels. When LDL cholesterol is deposited in the internal lining of the blood vessels, atherosclerosis takes place, and the blood vessels become inelastic, leading to the development of hypertension.

Neutralizing the adverse effects of saturated fats

Substitution of saturated with polyunsaturated fats

One of the ways of counteracting the adverse health effects of SFsis to replace them with the polyunsaturated fats(PFs). If PFs are taken in instead of SFs, the LDL cholesterol decreases, and the ratio of total cholesterol with the high density lipoprotein (HDL) cholesterol, which is known as the good cholesterol, decreases, too [3],           implying that either the total cholesterol decreases, or the HDL cholesterol increases, or both scenario happen. When the LDL cholesterol decreases and the HDL cholesterol increases, the combination is a perfect recipe for the prevention of heart and blood vessel diseases.

PFs are abundantly found in safflower oil, soybean oil, sunflower oil, soybeans, tofu, and fish[1]{Consult Powertec 63}. In simpler terms, what you will do is to replace meat with fish, and replace animal-based cooking oil with the ones taken and derived from plants.

 

Avoidance of replacing saturated fats with carbohydrates

When carbohydrates are used to replace SFs, it was found out that the level of both the triglycerides (another form of fat) andLDL cholesterol are elevated in the blood while the HDL cholesterol decreases. These consequences are all the more pronounced if the carbohydratesare refined and added with sugar[3]. This is bad for the heart and the blood vessels. Thus, it should be avoided.

Dietary cholesterol should be avoided if significant saturated fats have been in the diet

Based on animal researches, it was determined that if the dietary cholesterol has been increased,   the tendency of saturated fat to increase the LDL cholesterol level in the blood is also increased. This means that working alone, saturated fats increase the LDL cholesterol level in the blood. If the intake of dietary cholesterol is increased, it will aggravate the LDL cholesterol-raising effect of saturated fats. Therefore, as much as possible, the simultaneous intake of significant amount of dietary cholesterol and saturated fats should be avoided [3].

Foods rich in cholesterol are the following: eggs, roast beef, leg lamb (lean), leg lamb (lean and fat), pork chop (lean), chicken leg (fried, meat and skin), crabmeat (canned), salmon (canned), shrimp (canned) [1]. You need to avoid taking these foods if you have been taking a lot of saturated fats.

References:

  1. Roth, Ruth A. Nutrition and Diet Therapy. Singapore: Delmar Learning, 2007.
  2. Murray, Robert K., Daryl K. Granner, Peter A. Mayes, and Victor W. Rodwell. Harper’s Biochemistry. Appleton and Lange: Stamford, Connecticut, 2000.

Siri-Tarino, P., et. al. (2010). Saturated fatty acids and risk of coronary heart disease: modulation by replacement nutrients. http://www.ncibi.nlm.nih.gov/pmc/articles/pmc2943062/

Medical implications of diabetes mellitus combined with lipid abnormalities (Part 2)

Complications of diabetes

Hypertension

When your blood sugar is very much elevated, this will promote the deposition of fatty substances along the internal lining of your different blood vessels—medically known as endothelium. With the deposition, the endothelium is thickened, and, to some extent, it becomes inelastic. With this development, the blood pressure rises.

Lipid abnormalities

Lipid abnormalities refer to the elevations—over normal values—of the blood concentrations of either cholesterol, triglycerides, or low-density lipoprotein, or combinations of them. The more elevations there are, the worse will be the outcome in the years to come.

Complications of lipid abnormalities

Coronary heart disease

With persistent elevations of the lipids, the small vessels supplying the heart with blood—otherwise known as the coronary arteries—are little by little deposited with fatty substances leading ultimately to their partial obstruction or, worse, total obstruction. When your coronary arteries are partially blocked, you will start to experience chest pain which is precipitated or provoked by physical exertions, such as lifting heavy objects, going up the stairs, running, or being excited on something. The worst part, however, is when the obstruction is total or complete wherein a certain area in the muscle of your heart is completely deprived of blood supply. When this happens, you will have heart attack, or medically known as myocardial infarction, and you may die from it.

Hypertension

With increased levels of lipids in your blood, the deposition of fatty substances, known as plaques, in your endothelium is hastened. This deposition does not only narrow the opening of your blood vessels; it further injures your endothelium making it more inelastic. This will surely lead to the development of hypertension.

Commonalities of diabetes and lipid abnormalitiesin terms of complications

Based on the discussion in the preceding sections, you will find out that there are commonalities of diabetes and lipid abnormalities in terms of complications. Both of them could cause hypertensionand coronary heart disease. Therefore, the occurrences of these life-threatening diseases would be very likely—almost 100 percent—if you have both diabetes and lipid abnormalities. Life-threatening as they are, the situation is made worse whenhypertension starts in your systems, because it could also start new, and exacerbateexisting, complications, such as damage of the kidneys, heart, and the eyes. Since these organs have been very much damaged previously by diabetes, then their destruction is very much faster than when only one—diabetes or lipid abnormalities only—exists. Thus, the combination of diabetes and lipid abnormalities is extremely dangerous!

Management of this life-threatening situation

The most appropriate time to start managing this medical situation is when the two problems have been noticed for the first time, as revealed by blood chemistry examinations. Once it has been established that diabetes co-exists with lipid abnormalities, you need to consult your medical doctor at once and without delay, even if you have not been experiencing any discomfort or complaints lately. You need to start your medications at the soonest time possible. If your problems are discovered when you are still young, your taking of the most appropriate medications will greatly delay the onset of the various complications. However, when they are discovered when you are relatively older, say 60 or 70 years old, the different complications have already set in, and you will surely need an array of medications! You will surely need medications for diabetes and   lipid abnormalities—and most probably hypertension. You will surely spend so much for your medications.

Thus, the moment you find that you have both diabetes and lipid abnormalities, consult your medical doctor immediately and take your medications as religiously as possible. This is the only way you can avoid having the complications soonest and avoid taking a number of medications, reducing significantly your expenses.

(Last of a series of 2)

Medical implications of diabetes mellitus combined with lipid abnormalities (Part 1)

Diabetes Mellitus

Diabetes mellitus is a medical problem wherein your fasting blood sugar (FBS) is above and over the normal range. The normal range of FBS is 70-100 mg/dl. Hence, if your FBS is greater than the said range, you are suffering from diabetes. If you discover that you are a diabetic, waste no time! Visit your medical doctor for consultation and follow faithfully and religiously all the instructions that he will give you. Specifically, take all the medications that he will prescribe to you, follow the diet that he will tell you, and do the physical exercises that he wants you to pursue.

Complications of diabetes

If your elevated fasting blood sugar is not treated for a number of years, you will reap the complications of diabetes. Since it is a systemic disease, it adversely affects several of your important organs, such as your eyes, nerves, heart, blood vessels, and kidneys. Consequently, you might go blind, your skin becomes insensitive to touch, you may experience chest pain due to heart problem, and your blood pressure rises.

Coronary heart disease

One adverse effect of having elevated blood sugar for so many years is the development of coronary heart disease wherein the small blood vessels which supply the heart with blood—otherwise known as coronary arteries—are gradually being clogged by fatty deposits. When the clogging becomes total—that is, the opening of one or more of yourcoronary arteries is completely blocked—you might suffer from heart attack!

Glomerulonephropathy

The other complication of diabetes is the destruction of your kidneys medically known as diabetic glomerulonephropathy, wherein their ability to filter the blood is gone. They cannot remove the waste products of metabolism in your body, such as the blood urea nitrogen (BUN) and blood creatinine, so their concentrations in the blood are elevated and beyond the normal values. If your BUN and blood creatinineare very much higher than the normal range, then your kidneys are compromised. You may need dialysis!

 

Retinopathy

In your eyes, at the back area of your eyeball, there is a structure called retina. It is very sensitive to the light that is entering your eyes, and it transmits the light to the brain for interpretation, in terms of color, intensity, temperature, and other characteristics. If your blood sugar has been elevated for a decade or more, without taking proper medications, the retina will be destroyed, and you might go blind!

Neuropathy

The nerves responsible for the sensations coming from the skin are not spared from the complications of diabetes. They are damaged when the small blood vessels—medically known as the vasa nervorum—are blocked as a result of lingering diabetes. When these small blood vessels are blocked, preventing the flow of blood, the nerves reaching and supplying your skin are damaged, resulting in the loss of sensation. Thus, diabetic patients, after so many years of harboring the disease, could not feel from their skin. Their skin is numb and deprived of the much needed sensations.

Cardiomyopathy

Aside from causing coronary heart disease wherein the small blood vessels—known as coronary arteries—are blocked and occluded, diabetes also damages the heart at the cellular lever. This means that the smallest parts of the muscles of the heart are damaged, resulting to what is known as cardiomyopathy. Consequently, all the muscles could not do their proper function, and the heart fails—known as heart failure. You should remember thatcardiomyopathy is different from coronary heart disease; however, both of them—at the end—will disable the heart.

(To be continued)

Obesity as a risk factor for chronic diseases

Obesity is one of the most common disorders in medical practice. In the United States about 60 million people are now obese (more than 30%) and 68% of population is overweight.  It is alarming that overweight rates among children have doubled and among adolescents even tripled, increasing the number of years they are exposed to the health risks of obesity. Obesity is defined as an excess of body fat. The best way to classify obesity is to use body mass index (BMI). It closely correlates with excess fat tissue, and it’s calculated by dividing measured body weight in kilograms by the height in meters squared.  A normal BMI is defined as 18.5 – 24.9. Overweight is defined as BMI 25-29, 9 and obesity is BMI over 30. Class I obesity is 30-34.9, class II obesity 35-39, 9 and extreme obesity, or class III is over 40. Obesity is a risk factor for developing type 2 diabetes, cardiovascular diseases, especially coronary disease, hypertension, obstructive sleep apnea , knee osteoarthritis, hyperlipidemia (high blood cholesterol levels) and even cancer.  It is also an important risk factor for stroke, abdominal angina, obesity hypoventilation syndrome (Pickwickian syndrome) and deep vein thrombosis (which is a risk factor for developing pulmonary embolism).  For example, except the fact that diabetes is the risk factor for developing coronary disease it is also the leading cause of amputation of the lower limbs throughout the world.

The main cause of obesity in the most of cases is sedentary life and chronic ingestion of excess calories. But, nowadays, it has been discovered that genetic influences are very important, to even 40-70 %. Most probably is that obesity develops from the interactions of multiple genes, environmental factors and behavior. Since there is a rapid increase in obesity in the last 30 years it is obvious that environmental factors have the most important role in the development of this disease. Upper body obesity (excess fat around waist and flank) is much more dangerous than lower body obesity (fat in the thighs and buttocks) and it is a greater risk for developing diabetes mellitus, stroke, coronary artery disease and early death. Of course, it is important to know  that obesity itself leads to hyperlipidemia, which leads to atherosclerosis, and that’s the most important risk factor for developing cardiovascular and cerebrovascular disease, and they are the leading cause of death in the Western World. Of course atherosclerosis will develop even if people have low cholesterol levels and if they are slim, but the process will be slower and the stenosis of the arteries probably won’t be significant.  Also, some studies have shown that being only 10 pounds overweight increases the force on the knee by 30-60 pounds with each step. Overweight women have nearly 4 times the risk of knee osteoarthritis; for overweight men the risk is 5 times greater. For a woman of normal height, for every 11 lb weight loss (approximately 2 BMI units), the risk of knee osteoarthritis dropped > 50%. Conversely, a comparable weight gain was associated with an increased risk of later developing knee OA. It is obvious that obesity plays an important role in the development of the most important chronic diseases today and by controlling our weight we can significantly decrease the risk of sudden and early death as well as the disability caused by stroke, heart attack, osteoarthritis or diabetes.

References:

1. Role of Body Weight in osteoarthritis, http://www.hopkinsarthritis.org/patient-corner/disease-management/role-of-body-weight-in-osteoarthritis/

2. Maxine A.Papadakis, Current Medical Diagnosis and Treatment 2014, Visceral Artery Insufficiency (Intestinal Angina), p 453-454

3. Diabetes and Amputation, http://www.diabetes.co.uk/diabetes-and-amputation.html

4. Kumar and Clark, Clinical Medicine, 2005, 6th edition, Obesity p.252-257

5.Robert B.Baron, MD, MS, Nutritional Disorders, Obesity, , Current Medical Diagnosis and Treatment 2014, 53rd edition p.1213-1215

6. Robert F.Kushner, Evaluation and Management of Obesity, Harrison’s Principles of Internal Medicine (18th edition), p 629-634

Precautionary measures for diabetics before working out

Have your fasting blood sugar checked

The major problem among diabetic   patients is that their blood sugar is high, but it is low in the different tissues of different organs. For example, it is low in the muscles which are used in doing physical exercises. Hence, it is very dangerous to engage in any form of physical exercises because the muscles are deprived of the sugar very much needed for muscular contractions. With family history of diabetes mellitus, or with established diagnosis of diabetes mellitus, you need to submit yourself to a periodic fasting blood sugar examination so that you will know if your blood sugar is  low, normal  or high. If high, you need to have medicine(s) needed to have your blood sugar absorbed and used by your different bodily systems.

Take your medicines regularly   

If you have been prescribed with medicine(s), take them regularly as scheduled. Do not reduce or increase the dosage(s) of your  medicine(s) without the approval of your medical doctor. Always remember that the anti-diabetic drugs you have been taking are active drugs which could drastically affect the level of your blood sugar. If you reduce them, your blood sugar will increase; if you increase them, they could drastically reduce your blood sugar, and you will experience the clinical manifestations of hypoglycemia, such as sweating,  dizziness, shaking of the extremities, increased heart rate, anxiety, hunger, dizziness, headache, blurring of vision, confusion, abnormal behavior and loss of consciousness.

Avoid physical exercise(s) if the dosages of your medicines are being calibrated   

If you  are a newly diagnosed diabetic patient, the first set of medicine(s) that your medical doctor has prescribed to you is still under observation. After two or four weeks of using the said medicine(s), your fasting blood sugar will be checked to find out if  your blood sugar has been controlled—that is, your fasting blood sugar falls within the normal range! If controlled, then the dosages of your medicines will be continued. If not controlled, your dosages will be increased, or another class of anti-diabetic drug will be added. If your sugar is very much lower than the normal range, then your set of medicine(s) may be so high for you that your medical doctor needs to lower your dosages. During this period of observation and calibration, it is very precarious to engage in physical exercise(s)—especially the intense ones—because you are still unsure of the effect(s) of your present medicine(s). If your blood sugar has turned out to be low, and you engaged in intense physical exercises, you could experience the various clinical manifestations of  hypoglycemia as described above, and you will suffer!  The safest attitude is to wait for the right dosage(s) of your medicines before you engage in physical exercises.

Take your meals regularly and as scheduled

If you are taking anti-diabetic drug(s), it is presumed that you are taking your meals as scheduled. If you are taking your medicines regularly but delaying your meals, you might suffer from hypoglycemia! As mentioned in the preceding, your anti-diabetic drugs are active! Hence, they will effect the absorption and usage of your blood sugar! They will not wait for you to take your meals before they will act! Their actions are very independent from taking your meals. Once you have taken them by mouth, they will start to take effect, regardless of whether you took your meals or not! Hence, your blood sugar will lower considerably if you took your anti-diabetic  medicines but not your meals!

Have regular physical exercises once the right dosages of your medicines have been determined

The blood sugar of a diabetic individual is high because the insulin which is responsible for the uptake and use of blood sugar is either low in quantity or poor in quality. A  person may have the right quantity of insulin; but if they are of poor quality, he may contract, or experience, diabetes mellitus in his lifetime! There are reports in various literatures, however, that regular physical exercises will improve the competence of the insulin! Hence, by doing regular physical exercises, a diabetic person may require lesser drugs compared to someone who remains sedentary.