HIGH BLOOD FATS AND DIABETES: An Endocrinologist Explains the Connection

By now, people who are diagnosed with type 2 diabetes – as well as many in the general population – know that the disease can lead to a host of medical issues, among them eye problems, kidney disease and nerve damage which may lead to amputations. What is perhaps less known is that there is a direct relationship between diabetes and high lipid (fat) levels in the bloodstream. This condition, commonly referred to as lipid disorders, is caused by a combination of genetic predisposition and dietary intake and is an abnormality with both good and bad cholesterol and triglycerides.

Cholesterol is a soft, waxy substance not readily soluble in water and produced within all cells in the body. Cholesterol is necessary for normal cell and body function, however very high levels of it can lead to plaque buildup in arteries and eventually may cause blockage of blood flow. Cholesterol comes in two major forms: high-density lipoproteins (HDL)—often referred to as the “good cholesterol”—which removes fats and cholesterol from the serum and cells and transfers them back to the liver for reuse or excretion, and low-density lipoproteins (LDL), the “bad cholesterol,” which is the leftover cholesterol after it has provided substances to the cells to create hormones and to strengthen cell membranes (the wall of the cell). The leftover LDL is also reabsorbed by special receptors on the surface of the liver. Triglycerides (TG) are a type of primary fat which provides energy to the appropriate tissues in the body. TG are formed in the liver and are found in the blood. Excess TG are stored in fat cells to use as energy when needed. When the body needs a source of energy, the liver breaks down glucose and signals the fat cells to release fatty acids it has stored as triglycerides, which are then metabolized into energy. High levels of triglycerides in the blood have been found to worsen other lipids particles and contribute to plaque formation.

Lipid abnormalities are dangerous because they are associated with an increased risk for blood vessel disease, especially heart attacks and strokes. In fact, prevention is key in reducing the occurrence of stroke or myocardial infarction (the medical term for a heart attack), which is more likely to be fatal in people with diabetes.

LIPIDS AND BLOOD GLUCOSE

“The relationship between blood lipid levels and elevated blood glucose levels is compelling,” says Dr. Yehuda Handelsman, an endocrinologist and expert in the management of patients with diabetes who are at high risk for cardio-metabolic problems. “The type of lipid disorder we typically see in those with diabetes shows high triglycerides in the blood, low good cholesterol, which is HDL, and then the bad cholesterol, the LDL (low-density lipoproteins), which are typically not very high by value.” But because the particles are small there are more of these bad particles in people with diabetes, which puts them at further risk. “Because of the high triglycerides, the low HDL particles and the background of high glucose and insulin found in type 2 diabetes, the LDL particle size is smaller and denser and there are many more particles,” he continues, “and those are much moredangerous in causing heart disease.”

Consequently, physicians treating patients with lipid disorders first focus on management of the LDL cholesterol by reducing the number of particles coursing through the bloodstream. And getting the LDL under control is typically achieved through the use of statins, a medically prescribed class of medicines that lower LDL levels by blocking the action of a chemical in the liver that is necessary for making cholesterol.

Although reports have surfaced suggesting that the use of statins can have side effects like muscle pain, occasionally may affect memory and rarely may contribute to the development of diabetes, Dr. Handelsman is quick to point out most people who take statins have few or no side effects and the benefits outweigh risks by far. “Because side effects happen so rarely, it’s truly not a reason not to use the medication, as this is practically the only class of drugs to show long-term reduction in disease and mortality,” he says. “In fact, we have outcome data that shows in people who do have diabetes, taking statins may give more benefit than with people who do not have diabetes, but have the same LDL level."

Beyond statins and other available medications which can reduce LDLs, he suggests patients make efforts to further reduce the triglycerides in the blood by significantly reducing their intake of saturated fats such as those found in fatty cuts of meat, fried foods, and most oils and butter, as well as reduce intake of carbohydrates. The body utilizes excess cholesterol by transforming it into TG. Dr. Handeslman recommends substituting leaner protein, choosing canola or olive oil, focusing on produce and products on the market which are low in fat and in refined glucose and high in fibers and grains. (For more information about supplements used to treat high cholesterol, visit: http://www.empoweryourhealth.org/vol4-issue2/Exploring-Supplements-to-Treat-High-Cholesterol )

Handelsman says that yet another crucial factor in managing high blood fats is glucose control, particularly when it comes to ingestion of carbohydrates. “When your body is taking in more energy in the form of calories than it is putting out, insulin in the body will direct the extra glucose to areas in the liver that will translate that extra glucose from carbohydrates into fatty acids that will be carried through the body to the fat cells.”

Dr. Yehuda Handelsman is the American College of Endocrinology’s (ACE) President. He is the medical director and principal investigator of the Metabolic Institute of America and an endocrinologist in solo private practice in Tarzana, California, where he developed and successfully utilizes comprehensive and unique multiple interventional approaches to the cardiometabolic high risk patient, preventing and managing obesity, diabetes and cardiovascular disease. He has been listed repeatedly in “Top Doctors of Los Angeles,” “Southern California Super Doctors” and “Best Doctors of America."