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A Q&A with Stephen Sinatra, MD
Interview by Karina Gordin
Karina Gordin (KG): Thank you for taking the time to speak with Well Being Journal about two major chronic conditions affecting Americans today—diabetes and heart disease.
Stephen Sinatra (SS): The topic is dear to me—diabetes is the main reason why I became a physician. My mother developed brittle diabetes in her late 30s following overzealous use of corticosteroids to treat glaucoma. As a young boy, I frequently had to administer to my mom, which helped pave the way to my becoming a physician. In addition, my maternal grandmother was also diabetic and since the mitochondrial DNA comes from the maternal side, my risk of diabetes is considerable. So, I am mindful of what I eat and try to avoid high glycemic carbohydrates whenever possible. In my years as an internist and cardiologist, the relationship between diabetes and heart disease has been especially noteworthy.
Heart Disease and Diabetes are Closely Related
KG: Diabetes and heart disease are often thought of as two separate conditions, but in fact are closely related. How do the conditions overlap?
SS: Type 1 diabetes, which tends to occur in children and young adults, results from an insufficient production of insulin coming from the pancreas. Type 2 diabetes usually occurs in older people and is frequently associated with weight gain, overzealous use of sugar, and insulin resistance (which seems to be more prevalent in the country today). Coronary heart disease and diabetes overlap as they are inflammatory conditions. In other words, both diabetes and heart disease share inflammatory mechanisms.
KG: What role can pre-diabetes and insulin resistance play in cardiovascular health?
SS: Pre-diabetes and insulin resistance can be the beginnings of silent inflammation, which plays a significant role in further endothelial cell dysfunction and subsequent cardiovascular disease. Endothelial cell dysfunction is actually the harbinger in the early genesis of hardening of small vascular tissues.
KG: Do heart disease and diabetes share common warning signs and symptoms?
SS: Although heart disease and diabetes can share common ground with features such as excess weight, inflammation, and fatigue (to mention a few), symptoms of heart disease and diabetes are usually not the same. In other words, the presenting symptom of coronary heart disease can be chest pain or discomfort and diabetics may have a delayed or a silent predisposition for such symptoms. For example, diabetics have been known to have more “silent” heart attacks where they might not show the common warning symptoms of coronary heart disease. One symptom that patients with heart disease and diabetes may have in common is what physicians call orthopnea—shortness of breath when lying down at night.
The Diabetes Warning Zone
KG: According to the Centers for Disease Control and Prevention, six in ten Americans live with at least one chronic disease, such as heart disease. stroke, cancer, or diabetes. What tests can a doctor order if a patient is suspected of being in the “diabetes warning zone”?
SS: There may be over 100 million diabetics or pre-diabetics in the population today. Simple tests can be ordered to investigate these possibilities. For example, a HgA1C and fasting blood sugar are two tests that can easily determine whether one is diabetic or pre-diabetic. Another test—fasting insulin level—can also shed light on whether a person is entering the diabetic stage. Any of these tests will help physicians address diabetic/metabolic considerations.
KG: Which biomarkers (eg, triglycerides or HDL) can be considered red flags?
SS: Overweight females with very high triglycerides are at enormous risk for cardiovascular disease! In any patient with diabetes or pre-diabetes, fasting triglycerides must be done because when elevated, they are very pro-inflammatory and increase cardiovascular risk. Many such patients also have a lower HDL, which is also a red flag and must be addressed.
KG: What measures to treat diabetes can in turn help treat heart disease?
SS: In an overweight, mature onset diabetic with high pro-inflammatory mediators, a weight loss program can result in improved inflammatory mediators. Diminished HgA1C, and lower fasting blood sugar often improve the risk profile of not getting coronary heart disease. Since higher blood sugars are much more detrimental than higher cholesterols, getting blood sugars at more normal levels will help lower inflammation and thus lower cardiovascular disease risk.
KG: So, type II diabetes and heart disease are largely preventable conditions and can be reversed with healthy diet and lifestyle choices. What simple steps could be taken to help stabilize sugar and support a healthy heart?
SS: The easiest way to stabilize blood sugar and support the heart is omitting high sugary foods as much as possible. This includes any colas, white table sugar, highly processed foods, and so forth. From what I’ve observed, a diet that is higher in protein and healthy fats and lower in sugary carbohydrates is the best diet to follow. For example, I like to see around 45 percent of calories from mostly complex carbohydrates and the remainder of calories from healthy fats and proteins. Generally speaking, fat and protein do not elicit a significant insulin response.
How to Keep Blood Sugar Steady
KG: Can you recommend herbs and supplements for keeping blood sugar steady?
SS: I’ve been using herbs and supplements to regulate blood sugars for years. Using cinnamon is a great substitute for sugar and my favorite go-to supplement is Crominex. Specifically, Crominex is a chromium derivative. Also, years ago, metformin was considered the darling by anti-aging doctors for blood sugar control. Many of my colleagues and I have replaced it with berberine, which drives enzymatic reactions in the right direction while supporting blood sugar at the same time.
Multiple studies examining patients with type 2 diabetes taking berberine have demonstrated reductions in fasting blood sugar and A1C when combined with diet and lifestyle changes. Berberine in addition to enhancing blood sugar uptake also improves insulin sensitivity. Interestingly, with all the new research on vitamin D and with more people taking vitamin D to help bolster blood levels to help combat viruses, increased blood levels of vitamin D have shown improved blood sugar relationships as well!
Two other favorite supplements include magnesium and alpha lipoic acid (ALA). I’ve used them for years in my cardiovascular population to help support and improve type 2 diabetes. When compared to placebo, magnesium and ALA can help support blood sugar relationships.
Let’s also consider more fiber in the diet. It is a well-known fact that the average American only takes in about 11 to 20 grams of fiber in the diet. If this can be increased with soluble and insoluble fibers, the absorption of sugar is somewhat curtailed thus improving one’s overall risk profiles. Remember, when it comes to coronary artery disease, higher sugar (glucose) in the bloodstream sets the stage for inflammation.
KG: What are the best (and worst) sweeteners and sugar alternatives?
SS: Sugar is out. Small amounts of maple syrup, honey, or molasses can be enjoyed if you prefer a sweetener. If you must have a sweetened dessert after dinner, I recommend small squares of extra dark chocolate rich in polyphenols.
I do not recommend the artificial sweeteners such as Splenda and Sweet & Low. Aspartame and sucralose are also bad since they may increase blood sugar relationships in the body. Xylitol and stevia are an option; however, some people develop reactions from xylitol and should not be utilized if GI upset occurs. Stevia has a very low glycemic index but is very sweet so a little goes a long way.
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Stephen Sinatra, MD, is a highly respected and sought-after cardiologist with more than 40 years of clinical practice. He founded the New England Heart Center, where he combined conventional medical treatments for heart disease with complementary nutritional, anti-aging, and psychological therapies. Sinatra is a Fellow of the American College of Cardiology (FACC) and American College of Nutrition (FACN), a Certified Nutrition Specialist with the American Nutrition Association, (CNS), and a Certified Bioenergetic Psychotherapist (CBT). He is a best-selling author of more than a dozen books, including, The Great Cholesterol Myth and Reversing Heart Disease Now, and has appeared on major media outlets, such as CNN, MSNBC, and The Dr Oz Show. Learn more at HealthyDirections.com.
