How Blood Sugar Affects Cardiovascular Risk, Even for Those Without Diabetes
Being aware of blood sugar management is important for everyone. Even those without diagnosed diabetes. There are so many implications to chronically elevated blood sugar (hyperglycemia), as it affects many body systems. I talk about the importance of getting measures for blood sugar management checked on a routine basis for every individual, no matter current medical diagnoses or family history, because more than 80% of people with prediabetes don’t know they have it! That is, until it has progressed to the point of the individual presenting with symptoms of high blood sugar, and at that point, some damage to the body has already been done. In this blog post I would like to discuss an aspect of elevated blood sugar that tends to get overlooked: its effect on your cardiovascular system.
First we need to start with some education so you more effectively contextualize this topic. My patients always tell me it’s so helpful to understand not just the “why” of an issue, but also the “how”.
To start, our blood cells transport oxygen from our respiratory system to the rest of our body via a protein called hemoglobin. Oxygen is not the only thing that attaches to hemoglobin. Glucose (sugar) also attaches to hemoglobin. This attachment of glucose a normal process called glycation. Where this becomes an issue is when there is a lot of glycation. The more glucose there is in your blood, the more there is that sticks to hemoglobin. This means that if you have chronically elevated blood sugar (whether due to what you eat, the amount of physical activity you get, health conditions or medications that affect blood sugar etc) your hemoglobin will be more glycated, or stuck with glucose.
Hemoglobin that is heavily glycated can act as what is called an advanced glycation end product (AGE). AGE’s attach to certain receptors in cells and can contribute to chronic disease progression via two pathways: NOX and NFKB. While these pathways deserve more detailed attention on their own, I will simply say that AGE’s affect them in ways that seem to perturb inflammation and oxidative stress. A kick in the teeth is that this process is suggested to be involved in a cycle in which production of AGE’s, inflammation and oxidative stress contribute to further production of AGE’s, more inflammation and oxidative stress, and so on, and so on- which we know to be key in the progression of atherosclerotic plaque- that stuff that “clogs your arteries”. And that stuff may eventually occlude an artery or vessel and deprive tissues of oxygen, or break off and travel through the body, causing tissue damage or death which you may know as heart attack or stroke.
What can help to stop this cycle? As you may have guessed, managing your blood sugar. First it is good to know where your blood sugar management stands. A few tests that can give you insight are your fasting glucose, hemoglobin A1C and fasting insulin. You can get these tests done with me at Healthspan or with your primary care provider. When I interpret these tests, I collaborate with the patient to create individualized strategies to better manage blood sugar. The two broad focus areas for this are nutrition and physical activity. The particulars of what we do really depends on your unique needs, preferences, medical history, etc.
Why do I recommend these tests?
Fasting glucose: Measures your blood sugar after a fast (usually people fast overnight while sleeping and then get tested in the morning).
Fasting insulin: Measures your insulin (the hormone responsible for glucose uptake into cells) after a fast. This value may help identify insulin resistance/blood sugar management dysregulation before fasting glucose or HbA1C become abnormal.
HbA1c: Measures how glycated your hemoglobin is. The average lifespan of a red blood cell is about 3 months, and so this test is a reflection of how your blood sugar has been managed the past 3 months. This is also the frequency at which I would retest after introducing strategies to lower blood sugar. It’s also a convenient time frame to retest blood lipids, too (if that is of concern to you- which it should be in the case of cardiovascular health).
A second general tip I could give is to eat plenty of antioxidant-rich foods. The NOX pathway mentioned before generates oxidative stress. Antioxidants help protect against this stress. This blog post gives you a list of fruits highly concentrated with antioxidants.
To conclude, maintaining healthy blood sugar is not just about preventing diabetes. Blood sugar affects many body systems, including the cardiovascular system. Atherosclerosis is a major cause of death and disability in patients with and without diabetes, so it’s important to get your markers for blood sugar management checked on a routine basis.
Need to see a Dietitian to help assess your own health and nutrition needs, or want to know what changes you can make to your health habits and lifestyle to support your health in the long-term? You can book a free consultation with me. Or, see me in person at Healthspan in Grosse Pointe Farms, Michigan.
