Diabetes and Your Heart: Natural Ways to Control Your Blood Sugar

Dr. Drew Sinatra: More than 10% of people in the United States have diabetes, and many of them don't even know it.

Dr. Steve Sinatra: Diabetes impacts people across all social, economic and ethnic backgrounds and can be deadly, if not managed well.

Dr. Drew Sinatra: But there's another danger of diabetes, we don't talk about enough, and that's to your heart.

Dr. Steve Sinatra: People with diabetes are two times more likely to have a heart attack or stroke than people without diabetes.

Dr. Drew Sinatra: Today, we're going to share some ways to manage diabetes, what to watch out for, and the best ways you can protect your health and your heart.

Narrator: Welcome to Be HEALTHistic. The podcast that is more than just health and wellness information. It's here to help you explore your options across traditional and natural medicine so that you can make informed decisions for you and your family. This podcast illuminates the whole story about holistic health by providing access to the expertise of doctors Steve and Drew Sinatra who together have decades of integrative health experience. Be HEALTHistic is powered by our friends at Healthy Directions. Now, let's join our hosts.

Dr. Drew Sinatra: Hi folks, if you like what you hear today and you want to listen to future conversations and all things integrative and holistic health, subscribe to our podcasts on Apple podcasts or wherever you download your favorite podcasts. Also, check out and subscribe to our YouTube channel which will feature video versions of our episodes plus video extras you won't want to miss.

Dr. Drew Sinatra: Finally, we have more with me Dr. Drew Sinatra, my dad, Dr. Steve Sinatra and other healthy directions experts over on the Healthy Direction site. Visit healthydirection.com to explore our database of well researched content information and of course you can always follow us on our social media channels.

Dr. Drew Sinatra: Welcome everyone to another episode of Be HEALTHistic, I'm Dr. Drew Sinatra and I'm joined today with my father Dr. Steven Sinatra.

Dr. Steve Sinatra: It's good to be a Drew.

Dr. Drew Sinatra: All right. Today we're going to be talking about diabetes in the heart and what are the connections between having blood sugar issues and heart conditions? So, Dad, I've never asked you this question before but I'm very curious. I know your mom was a type one diabetic. Was there any reason for you becoming a cardiologist because of that?

Dr. Steve Sinatra: Oh, yeah, I've thought about this for years and there's no doubt about it. I mean, when I was 10 years old, I'd come home from fourth grade elementary school and I see my mother in diabetic shock, sweating, shaking and she would say, "Give me sugar." I used to give her sugar or orange juice back then. Sometimes, she would go the other way. She would go into high blood sugars and become very sleepy and develop calmer. She even asked me to give her insulin shots.

Dr. Steve Sinatra: When I was growing up as a young boy 10, 11 and 12, I lived with diabetes firsthand. I can remember being in fourth, fifth grade and I'd hear a siren go down the block, an ambulance and I'm saying, "I hope it's not for my mom." I used to live in fear of that. Did diabetes in my family shape my introduction into a medical career? Of course it did. There's no doubt about it. One thing led to another, I was lucky to get into college and medical school and the universe has been very good to me so to speak.

Dr. Drew Sinatra: That's a great story. I never really had all that information so thanks for sharing that dad. Well dad, today we're talking about diabetes. This is a major problem right now in America. In fact, we know now that there's over 34 million people that have diabetes. Also they're saying around 100 million total people that have blood sugar issues, including pre diabetes. Almost one third of the population is having some sort of blood sugar issue right now and that's a major concern.

Dr. Steve Sinatra: This is a problem. I mean, this is a major problem because remember, it's not just diabetes that's the issue, it's all the complications of diabetes that can end people's lives earlier. They get heart disease, they get high blood pressure, obesity can be a factor in type two. I mean, there's so many elements of diabetes that can really weaken the medical system going forward, because it puts a big stress on the medical system.

Dr. Steve Sinatra: Diabetes ages you quicker. There's no doubt about it. You age quicker, and now we know it's age glycation, and that's a big factor in diabetes. For our listeners, what it means is, if your blood sugar is high, like in a diabetic, and if you have a lot of proteins circulating in the blood, like we normally do, the proteins combined with the blood sugar, and they form these age glycation byproducts, which accelerates the whole aging process. That's why diabetes is really crucial in the whole aging phenomena.

Dr. Drew Sinatra: Yeah, from my understanding, like you just said, I mean, diabetes is really helping speed up heart disease. We know that there's micro vascular complaints. There's macro vascular complaints and issues. There's inflammation, there's more oxidative stress, there's even hyper configurability that exists with diabetes. It makes sense that it is facilitating this speed up of heart disease.

Dr. Steve Sinatra: Absolutely. The big crucial factor there is endothelial cell dysfunction which is related to surges of insulin going up and down. That's what happens in a diabetic person. Insulin goes up, insulin goes down. Whether they inject it, whether you're a type two. It's just a standard fact that the diabetic person needs to really take control of their health. If you are diabetic and you do listen to this podcast, or you know somebody who is or it's in your family, hopefully you can get some tips to really improve the whole situation because remember, our motto has been for years what? Prevention is easier than cure, right?

Dr. Drew Sinatra: Than cure, exactly.

Dr. Steve Sinatra: Basically, that's what you want to really... One of the pivotal points our listeners need to get from us is that if I do have insulin resistance, if I do have higher blood sugar, if I am headed for diabetes, what can I do to prevent it and prevent the complications of diabetes, which can be deadly and also short lifespan at the same time?

Dr. Drew Sinatra: Yeah, we're definitely going to jump into some of those things in the middle of this podcast here. First dad, I wanted to get into... In your practice, when you saw someone with diabetes come in, what was your major concern? Let's talk about type two diabetes. Non insulin dependent diabetes, what was your main concern regarding the heart for them?

Dr. Steve Sinatra: It was classic Drew. It's amazing. I would see patients come into the office with higher blood pressure, higher triglycerides. A little bit plump around the waist. A guy would be approaching 40 inches, a woman would be about 35 inches. They might have some borderline hypertension. Instead of reaching for two or three drugs or whatever, trying to treat the high triglycerides, the high blood pressure, maybe the borderline high blood sugars or the borderline haemoglobin A1C's, I would recognize offhand that hey, wait a minute you got insulin resistance?

Dr. Drew Sinatra: Sounds like metabolic syndrome.

Dr. Steve Sinatra: Yeah metabolic syndrome and the people would say, what do you mean? What's that? I would say look, your blood sugar is borderline. Your haemoglobin A1C is going up. Which remember, hemoglobin A1C is a measure of a long blood sugar like a 30 day blood sugar. It's a direct measurement of how your blood sugar has been over four or five, six weeks. These people were shocked Drew.

Dr. Steve Sinatra: They would say, "Wait a minute, you're telling me I could have diabetes?" I go, "Yes." Sometimes they would come on which is borderline hypertension or come in with hypertriglyceridemia, or come in with increase in abdominal girth. But whatever, it was type two diabetes. I looked at this, oh my gosh. I would see this almost, I would say, every day in my practice. It's amazing how common it was even back then and it's getting more and more common now. When you think one and 3.3 3.4 people can have this situation. I mean, it's serious.

Dr. Drew Sinatra: Dad, I run a haemoglobin A1C on everyone that walks through the door. I also do fasting blood sugar, and maybe even a fasting insulin if we're thinking about diabetes. You know what gets me though, is sometimes people come in and they've had a haemoglobin A1C of... Let's say someone in their 40s and 50s have had a haemoglobin A1C of 5.8, 5.9. So they're technically pre diabetes.

Dr. Steve Sinatra: Yep.

Dr. Drew Sinatra: Their doctor hasn't talked to them about it. It's like they haven't really considered it a major concern. I do find that... That's a red flag in my opinion that we need to hit this pretty quickly to lower this blood sugar or else we're going to lead to some of these complications with heart disease. I do hope that if there's any physical listening to this that you really do address pre diabetes as something that is preventable. At least if someone has it. We can help reverse that pretty quickly back into the regular range at least for haemoglobin A1C, wouldn't you agree?

Dr. Steve Sinatra: Oh yeah with diet and exercise, we can reverse it immediately. I got to tell you Drew, when I had men and women come into your office with this abdominal girth situation and I'll tell you, a mere five pound weight loss, just a five pound weight loss could change these blood chemistries. As a heart specialist I was looking at this continuously in my patients because again, I practice a lot of preventive cardiology in my earlier days.

Dr. Drew Sinatra: Well that's such a key point you made their dad. It doesn't take that much in order to make a big change with blood sugar. For example, if someone comes in they're not eating that good foods or they're not exercising or they're smoking or they're overweight or they're not taking any supplements to help support blood sugar. If you get even one or two, maybe even three of those things on board, you can see drastic changes within a couple weeks, even a couple of months.

Dr. Steve Sinatra: Oh absolutely, I mean a little walking program, replacing carbohydrates with healthier proteins and healthy fats. Remember, people don't realize this, but when you take in protein and healthy fats, your insulin response is minimal compared to a high carbohydrate diet. If you're on a high carbohydrate diet, your insulin response is major. The secret to diabetic control or getting the right metabolic situation is really cutting back on carbohydrates and burning up the sugar even more with a low level walking program.

Dr. Steve Sinatra: Walking the dog, climbing steps. There's so many things. Parking your car at a parking space that's further than you'd like it to be. A lot of people want to park as close as they can to the building. I used to tell my patients, park the furthest away and burn up blood sugar, burn up calories because you'll be doing yourself a lot of good. Little tips like that. Even walking the dog. I have so many patients walking the dog, because it's not only good for the dog, but it's good for you. So it makes sense.

Dr. Drew Sinatra: Well, let's talk about exercise and movement and all that because I think it's so important here. I always recommend people, even if they're working at their desk to stand up. Because even if they stand up, there's going to be minor contractions happening in their skeletal muscle, more utilization of that glucose into the tissues. Even doing a lunge or a stretch at work or moving around. Just get up from your desk and just move around. Then if you've had lunch, take a walk because that's probably the best thing you can do after you've eaten a meal is to go for a little bit of walk to help with that glucose utilization.

Dr. Steve Sinatra: One of the things I do Drew a lot is, I have dinner and I'll go for a beach walk. The reason being is when I'm walking on the beach, not only am I grounding, which reduces inflammation but now the walking alone I'm burning up calories. It's just a great way to support the metabolic situation of the body. Remember, a walking program you can lose a few pounds.

Dr. Steve Sinatra: You don't need to lose a lot of weight to make a difference. I know we've said it on this podcast but I got to really emphasize that. Even the New England Journal studies showed that study in Metformin. Remember that? Metformin and a walking program was as good as taking insulin almost? I mean, that's amazing. How you can reverse type two diabetes and even I had type ones in my office. I was able to get him off insulin. That's amazing. That's one of the greatest joys of being a physician when they can do stuff like that.

Dr. Drew Sinatra: The little things that make big changes. I love that. Now dad, you talked about having or focusing more on a low carb diet for diabetes. Is there any other dietary recommendations that you make? Anything else that you think of?

Dr. Steve Sinatra: I like a lot of healthy fat and good quality proteins. Organic proteins as much as possible. Good healthy fats because again, the insulin response is minimal. Now, there are certain foods that... I love avocados and diabetes for example. It's monounsaturated fats. Again, you don't get the insulin response. Avocado support glutathione production.

Dr. Steve Sinatra: If you take it with selenium and vitamin C, then they have glutathione peroxidase which is the best natural anti oxidant of the body to support the immune function. When it comes to fruits and vegetables, I like lower glycemic fruits certainly. I wouldn't want to tell a pre diabetic to be eating a lot of watermelon even though watermelon has a lot of lycopene, it's good for you. But again, it's a sugary fruit.

Dr. Steve Sinatra: You want to reduce the sugary fruits and give the lesser glycemic types of fruits and vegetables. That's what I aim for. Again, if you can reduce the carbs, the pastries, the cakes, the bagels, the cookies. The white semolina pastas. The higher protein pastas I endorse. I really like that because you don't get the insulin response. But anyway, just the carbohydrates in the diet. Less carbohydrates is really key.

Dr. Drew Sinatra: I completely agree. I know dad, you've talked about this 100 times before, that the sugary drinks, the sodas, the high fructose corn syrup. Those are also important things to avoid, of course, because those can certainly cause issues with blood sugar regulation.

Dr. Steve Sinatra: Major insulin response. Remember Drew, when we talk about these foods, we want to bring fiber into the equation. Remember this, the average American only takes in this different data on this. Some research say 15 to 21 grams of fiber when we should be taking in 35 to 45 grams of fiber. It's really important for our listeners to realize the more fiber you take in, what happens is, not only are you getting more bowl cleansing, which is really good. But with the fiber, now you're absorbing the sugars slower into the gastrointestinal tract.

Dr. Steve Sinatra: You're giving the body a longer time to respond to the carbohydrate or the sugar surge. That's important. Your peaks and valleys of insulin are less. There dampen so to speak. A high fiber diet. I really like because again, it slows down the absorption and it prevents these rapid rises in insulin.

Dr. Drew Sinatra: Yeah, I'm glad you brought that up. That's really important. Dad, is there an alternative to sugar? White table sugar that you recommend?

Dr. Steve Sinatra: My patients used to push back on this all the time. When I was seeing patients on a day to day basis. I love ribose because ribose it gives people a sweetener, but it has a negative glycemic effect. In fact, given ribose to type one diabetics, I used to always have them save... If they drop the blood sugar too much they would have to maybe take a little orange juice to overcompensate the drop in blood sugar.

Dr. Steve Sinatra: But ribose was good because ribose would add a little sweetness. If they needed something in their green tea for example, which was very good because green tea has great polyphenols. I would suggest a little ribose to it. Now what are some other good sugars? I think honey is a good sugar in small amounts as is maple syrup. Maple syrup has some medicinal value. Small amounts of maple syrup or honey. I'm not a big fan of some of the synthetic sugars like the agave sweeteners. I just don't like them.

Dr. Steve Sinatra: Molasses, in small amounts it could be okay. But like I said, you got to fit the sugar to your patient because some patients may have preferences. But remember when it comes to these sugars, less is more. Not two tablespoons of honey. Maybe a half a teaspoon of honey. Something like that.

Dr. Drew Sinatra: Yeah, great. What about other beverages Dad? What about alcohol? Do you tell diabetics to generally avoid alcohol or what's your take on that?

Dr. Steve Sinatra: Less alcohol. Absolutely, because alcohol is sugar.

Dr. Drew Sinatra: Exactly.

Dr. Steve Sinatra: Even wine. I would tell my diabetics to be really careful. Look at beer for example. Beer has maltose in it. high glycemic situation. I had so many men with big bellies Drew. Again, they were insulin resistant, they were beer drinkers. They didn't know it. Once I told them, and I said, "Look, beer is... This could make you diabetic because of the maltose situation." They would get it and they would say, "Well Doc, can I have a gin and tonic? Could I have a glass of wine?"

Dr. Steve Sinatra: I said, once you lose your belly, yes. I would give them that reward. Because again you can't restrict everything as a doctor.

Dr. Drew Sinatra: You got to choose your battles.

Dr. Steve Sinatra: You got to choose your battles. Good point, Drew. Excellent.

Dr. Drew Sinatra: Did you ever have any of your patients wear a continuous glucose monitor. Do you ever have them do that?

Dr. Steve Sinatra: They would come in into vogue when I was going out of practice. Some of them were doing it, some of them were doing the insulin pumps at the time. It was new back then. I would suspect it's a lot better today and a lot easier. I mean, even checking blood sugars. I had some patients who would check two or three blood sugars in a day trying to correct it. But back then they were doing the finger sticks which isn't... It's not comfortable, but it's not major uncomfortable, but they were doing it.

Dr. Drew Sinatra: I bring up the continuous glucose monitor because I've certainly known some patients that have used it and they swear by it in terms of learning what foods or what beverages are causing a high glycemic response in their body or high insulin response for that matter. They'd used it for exercise to see how much exercise lowers their blood sugar or even for stress or an illness that may cause spikes in blood sugars.

Dr. Drew Sinatra: I feel like for a lot of people, they really want to dive into this and learn more about their blood sugar. Look into getting a continuous glucose monitor to really learn about how these factors in your life, the foods you're eating, the stress you're under. Illness, et cetera. Exercise can all help regulate your blood sugar better.

Dr. Steve Sinatra: Drew, you said it so clear. I got the divine chill on that. You know why? Whenever you can teach you have patience the phrase, awareness is curative. The more your patients are aware and the more they can get directly involved in their self care, just the way you said it. You have a monitor, you realize oh that fruit is not good. Oh, walking lowered my blood sugar level. I mean, this is really cool. This is great stuff. When patients get that immediate feedback, that awareness is so curative in itself, then they help begins to soar. Because then they get more and more motivated. That's what you want. You want motivated patients to really carry the ball for you. Make your job less cumbersome and tedious.

Dr. Drew Sinatra: Once someone is motivated, they're going to see the changes, there going to start to feel better. They might lose some weight, they'll see more regulation with their blood sugar. That's going to give them even more motivation to keep going.

Dr. Steve Sinatra: When the blood pressure goes down and the waist size goes down, and the triglycerides go down. Drew, it's like Nirvana, they get really excited.

Dr. Drew Sinatra: Exactly.

Dr. Steve Sinatra: Oh, it's a good point.

Dr. Drew Sinatra: Now, moving over to some medications and supplements to help support blood sugar here. I know Metformin is obviously really big in the antiaging community. A lot of type two diabetics are on Metformin. What's your overall impression these days of Metformin. Are you pro, against, in the middle?

Dr. Steve Sinatra: Being in the antiaging movement for more than 25 years, a lot of my colleagues took Metformin and it made sense, but right now, I think berberine would be a better choice over Metformin. I just feel that even with this new data about berberine and activating AMPK. I mean, AMPK activity is relatively new in the medical world. Universally at the conferences I'm going to and the journals that I'm reading is, whenever you can stimulate AMPK activity, you're driving your metabolic machinery in the right direction.

Dr. Steve Sinatra: In other words, you are supporting the body and you're not wearing the body out or wearing the body down. Whenever you can activate this enzyme, it's driving the body into a healthier condition.

Dr. Drew Sinatra: Got it. Thanks for that explanation dad. I think I'm on the same page with you on Metformin. I too like to more use something like berberine as an alternative to that. I do find that berberine are pretty effective for not only helping with blood sugar, but they also can have an effect on lipids as well. That's going to have a positive effect on the heart.

Dr. Steve Sinatra: Correct. To my knowledge, I have not seen any downside or negative literature on berberine? It's amazing. That's one thing about medicine. You'll find so many papers for and you occasionally find a paper against but I have not found any negativity on berberine yet. Could it happen? It's possible, but I haven't seen it.

Dr. Drew Sinatra: Well, there was a 2008 pilot study in the Journal of metabolism. This was done, I believe in Japan. They looked at berberine versus Metformin. What they found was that over a 13 week period, berberine was pretty much comparable to Metformin in terms of blood sugar, but it had an improvement in triglycerides and total cholesterol which Metformin did not. In that article, I didn't read anything about side effects and such from berberine.

Dr. Drew Sinatra: I've been using it for a long time. I've also used it for treating certain gut conditions like [inaudible 00:22:55] dysbiosis in the intestines. Berberine's an amazing antimicrobial as well. It has all these functions to it that make it such a versatile herb to use in someone's practice. Now in addition to berberine, what other herbal medicines or even supplements do you think of for supporting blood sugar for people?

Dr. Steve Sinatra: Well, we used to think of chromium, for example. Chromium polynicotinate, there are some exciting new forms of chromium. [inaudible 00:23:23] is one, for example, I'm really excited about. I saw the research on that. I think chromium metabolically again, does everything right. I'm a big fan of chromium. There's certainly cinnamon. Cinnamon can have an effect on the blood sugar lowering as a herb. It works. [inaudible 00:23:42] is one I used years ago that has a supporting impact on blood sugar.

Dr. Steve Sinatra: But again, Drew, I think the easiest thing is just avoid as much sugar in the diet as possible. Just reduce the carbs, and then you're given your metabolic machinery a rest. That's what you need to do because we don't want to wear out our pancreas. We don't want to do that and that's the problem. We're wearing it out because... I came across this statistic a few years ago when I was writing my book with Johnny Bowden, great cholesterol myth.

Dr. Steve Sinatra: That the average American was eating 150 pounds of sugar a year. Well, guess what, over the last five years, because we've just rewritten the book, now it's up to 160, 165 pounds. I mean, that's insanity. Americans are eating too much sugar. I hope with this broadcast, we can get into the heads of our listeners and say, "Look, stop the sugar." You mentioned the sodas which is a big one, but we just have to stop the sugar as much as we can.

Dr. Drew Sinatra: Yeah, dad I couldn't agree more. As long as someone is motivated to make those changes and change up their diet and start moving more and doing other things like that, we see lowering of blood sugar. I'm finding too that people come in though and let's say they're at a 6.2 for haemoglobin A1C. It might just take longer to help lower that just by using, movement and diet. Therefore I've been using lots of berberine. I also use gymnema and bitter melon, and chromium like you said, and cinnamon. Obviously a really good multivitamin as well.

Dr. Drew Sinatra: I also like Apple lipoic acid as not only an antioxidant but there is some insulin regulating effects with that as well or at least insulin sensitizing effects. I do find that if you really get on a really good exercise movement program, the low carb diet, like you were saying, add on some of these nutraceuticals that we just talked about. I mean, people can literally go from being diabetic to go into pre diabetes and then back to being normal blood sugar within two three months.

Dr. Drew Sinatra: I should say, three months is probably the minimum. But I've seen people go from 7.9. I had a woman recently that went from 7.9 down to 6.4. Now she's at 5.4 and that was three and a half months later. We also did HCG diet with her. She also lost 45 pounds and radically changed everything in her life to really make that big of an effect. But it can happen. It can happen after two, three months of significant lowering blood sugar.

Dr. Steve Sinatra: Well, that's what you're doing Drew. You're involving the patient in your care. Whenever you empower a patient where they can be their own self physician, that empowerment is incredible. That's a great job. I mean, you really did a remarkable job with that lady. I mean, getting that hemoglobin A1C down is just terrific. Well done.

Dr. Drew Sinatra: Well dad, and I've learned this from you too, is that you got to tie in everything in the body. Since we're talking about diabetes today and its relationship to the heart, on all these patients, I'm generally running a lot of these cardiovascular inflammatory biomarkers that we've talked about in previous podcasts. Like homocysteine or fibrinogen, or LP little A, Lp-PLA2, CRP ESR, all those types of things and we're running on those people because I do like to see changes in those markers as well over time.

Dr. Drew Sinatra: Because I'm always concerned about the risk of cardiovascular disease with blood sugar abnormalities. For our listeners out there, there's more than just haemoglobin A1C, fasting blood sugar, fasting insulin, if you're going to run that as well to really look into to monitor your progress and supporting your blood sugar and preventing heart disease.

Dr. Steve Sinatra: Yeah, drew and for our listeners, I should mention that you were the lead author on that article that was published in alternative medicine on inflammatory mediators in cardiovascular disease. So yeah, you mentioned them and they're important. Again, for being a cardiologist, whenever you can reduce your inflammatory mediators. I mean, there's a lot of press on C reactive protein, for example, but even taking coenzyme Q10 you can lower C reactive protein.

Dr. Steve Sinatra: I mean, that's just amazing. So even lower LP little A with coenzyme Q10. In other words, whenever you can lower these inflammatory mediators, again you're optimizing the body, you're delaying the aging process. You're feeling... In most cases, these people are feeling better at the same time. That's why that woman, that case study I had is so crucial because she's participating in our own health which is just fantastic.

Dr. Drew Sinatra: Well, and just to follow up with that too because she has been a remarkable role model for me to continue doing these things with people because she comes in and she feels so good dad. That's the most important piece here. She comes in and she has so much more energy. Her sex drive is back, she's sleeping better. I mean, everything is improved in her life. That's what gives her, like we talked about previously, the motivation to continue doing what she's doing and feeling so good.

Dr. Drew Sinatra: That to me, that's the best part about being a doctor is when you're not necessarily... At least we the doctors aren't making these major changes in people. They're making the major changes and seeing the effects from that. That's what makes me just so happy about medicine.

Dr. Steve Sinatra: Yeah and a dividend is you say to her, Drew, I'll see you in a year.

Dr. Drew Sinatra: Right, you don't even need to come see me anymore. You know what to do.

Dr. Steve Sinatra: See me in a year. That's the greatest thing. That's what works.

Dr. Drew Sinatra: Well, since we're talking today about diabetes and heart disease. I feel like we should talk about lipids. What's been your experience with treating lipid abnormalities in diabetics?

Dr. Steve Sinatra: Here's the problem. Most diabetics have elevated triglycerides. I've always felt that elevated triglycerides were more inflammatory than elevated cholesterol. Now, here's a problem. A typical diabetic, whether you're type two or type one could have let's say atriglycerides of two, three, 400 and an HDL of 30 or 35 which is low. The triglyceride to HDL ratio gets high. You want that ratio less than two to be ideal. I mean, ideal is around two or less.

Dr. Steve Sinatra: Unfortunately, I would see these diabetics, Drew, with ratios of seven, eight, nine and ten. I mean, think of it. If you have a triglycerides of 300, you have an HDL of 30, which is typical for a type two diabetic, that ratio is 10. That ratio is not good when it comes to cardiovascular situations. I mean, I think that's one of the worst ratios to have because it can precipitate cardio possible cardiovascular events. The tie in here and the takeaway here is, whenever you can reduce your triglycerides and improve HDL, you're improving your cardiovascular risk profile. That's the takeaway. That's where... I also try to get my patients down to those lower ratios.

Dr. Drew Sinatra: Dad, can you speak to the protective quality of HDL?

Dr. Steve Sinatra: Yeah, first of all, we used to think in the old days, the old days maybe five years ago, that the higher the HDL the better. If we saw a patient's HDL, so 90 or 100 and 110, we would say, oh, wow, this is awesome. Now, in the last five years, we've determined that HDL can be dysfunctional in people because there's different types of HDL. There's different varietals like there are of LDL.

Dr. Steve Sinatra: We noticed small particle LDL, which is highly inflammatory and a fluffier type of LDL, which is less inflammatory. Same thing is true of HDL. Now, recently we think... I've scanned literature on this. That if you have HDL's in the range of let's say, 45 to 65. That seems to be the sweet spot, where numerically now, numerically you have a really good HDL. Over 65 you could have some dysfunctional components. Under 45, we'd like to see the HDL higher, but under 45, again the risk of the triglycerides, the ratio can go higher. Basically, I'm concerned about the possibility of dysfunctional HDL.

Dr. Drew Sinatra: Has there been anything that you've seen that has been very good at increasing HDL?

Dr. Steve Sinatra: Well, I think exercise is easy. I mean, weight reduction can increase HDL. Certainly things like niacin. Fast acting niacin can increase HDL. There are certainly little things people can do which can have a big impact on HDL. But I would say, weight reduction exercise, and less carbohydrates and healthier fats. Again, olive oil showed that in the pre demand study, actually can increase HDL. That's just amazing.

Dr. Drew Sinatra: Got it. Okay. Well dad, let's talk about some takeaways then for this podcast today relating diabetes and the heart. From what I've gathered talking to you, I mean, little simple things can make a big difference. That's just moving around the office a little bit more, going for a walk after dinner or lunch, stretching. Whatever it is you're doing to move your body more. That can have a significant impact on blood sugar.

Dr. Steve Sinatra: Absolutely. Movement is key.

Dr. Drew Sinatra: Then we talked about diet as well. So generally speaking, a lower carb diet, a diet high in good fats and a moderate level of protein can be very beneficial for blood sugar and you want to avoid all those drinks and beverages like the sodas and the high fructose corn syrups and the sugar particularly, that's going to lead to all sorts of dysfunction and blood glucose levels.

Dr. Steve Sinatra: Yeah, I've said this before and I'll say it again. We don't have white table sugar in our house. We don't buy it. Sugar is public enemy number one for coronary artery disease. Not cholesterol and fat. It's sugar hands down.

Dr. Drew Sinatra: Not to mention too but the addictive nature of sugar is so common in so many people. I feel like I had a sugar addiction growing up. I really did, even though you didn't have it in your home, I'd go to my friends houses and try to get as much sugar as I could. Dad as a final takeaway here. We also talked about certain supplements like berberine or bitter melon or Dyneema or mineral chromium to help with blood sugar regulations. There are other options out there besides Metformin. If someone does want to lower their blood sugar a little bit more than would help with exercise and diet.

Dr. Steve Sinatra: Correct. What I would say to that is, again, I think berberine is a good adjunct of supplement to take. Even just 500 milligrams a day.

Dr. Drew Sinatra: All right, is there anything you want to leave our listeners with in terms of this whole diabetes, heart disease connection? Anything else?

Dr. Steve Sinatra: I think the most important thing about podcasts today, Drew, is that people have control over their blood sugar. This is a situation where we have to empower our patients where they can become their own doctor. When it comes to high blood sugar issues, over weight status, insulin resistance, our patients can take control over their health. All we need to do is give them the right information.

Dr. Drew Sinatra: Well said dad, I love it. For today's wellness wisdom segment, I want to focus on another risk factor of heart disease that often gets underplayed or overlooked despite the fact that it is truly at the root cause of most diseases. That significant risk factor is inflammation. Now, as an integrative cardiologist, I've been talking about this for decades, but the prevailing wisdom in conventional medicine for a long time has been that cholesterol is the main risk factor for heart disease.

Dr. Drew Sinatra: Don't believe it folks. Inflammation is the most significant lifestyle driven risk factor for the development of coronary artery disease, plaque instability and plaque rupture. Let's talk about inflammation a bit and discuss some actionable steps that you can take now, to keep it in check. It's important to note that inflammation is not always a bad thing. It's one of the body's natural defense mechanisms.

Dr. Drew Sinatra: If you sustained a one time acute injury like a banged up knee, the inflammatory mediators in your body do their job, and your body quickly heals and returns to normal. However, problems arise when the inflammation in your body becomes chronic. At that point, it can begin to cause real damage. What are some common causes of chronic inflammation? Infections, high blood sugar, being overweight and having sticky blood are a few causes.

Dr. Drew Sinatra: Any of these mediators increases the chances that you'll develop arteriosclerosis. Perhaps one of the biggest and most avoidable causes of inflammation is dietary sugar. When you eat sugar, your body releases insulin which is one of the most endothelial unfriendly hormones around. Meaning it damages the lining of your arteries. Unlike that banged up knee, damage to your arteries is chronic. Creating a constant state of inflammation in your body and setting you up for heart disease.

Dr. Drew Sinatra: What can you do about this? Here are a few easy tips you can do to keep inflammation in check. Limiting or better yet eliminating sugar from your diet since sugar fuels inflammation. It just makes sense. Reducing processed foods from your diet and eating a hot healthy diet like the pan Asian Modified Mediterranean diet. Maintaining a healthy weight and getting moderate exercise. Limiting alcohol, eating turmeric or taking a turmeric supplement which helps to quell the harmful free radicals that lead to inflammation. Reducing your exposure to pollution including pesticides. Grounding or earthing, connecting to mother earth energy.

Dr. Drew Sinatra: Additionally, there are foods you can begin to incorporate into your daily diet that help promote a healthy inflammatory response. Ginger, not only is ginger flavorble, but science has shown that fresh ginger can help to support a healthy inflammatory response. I love cooking with ginger. I add it to stir fries and other dishes. Green tea, few foods have as many health benefits as green tea because it contains powerful antioxidant flavonoids which helps to reduce oxidative stress throughout the body and protect against free radical damage.

Dr. Drew Sinatra: Plus, green tea contains theobromine which helps to relax the blood vessel walls to promote better circulation. Pomegranate, this delicious fruit is one of my top recommended hot healthy super foods. That's because it's one of the richest sources of protective antioxidant flavonoids that support good health. Cocoa powder. I've long advocated eating dark chocolate, the darker the better.

Dr. Drew Sinatra: In moderation of course, due to the antioxidant benefit you From cocoa. The flavonoids in cocoa powder are powerful antioxidants that promote good cardiovascular health and a healthy inflammatory response benefiting your heart and entire body. Remember, not only will keep inflammation in check help your heart, it will help to prevent other degenerative diseases such as diabetes, Alzheimer's disease and arthritis. Let's do everything we can to keep that inflammation low, and our bodies healthy.

Dr. Drew Sinatra: Remember everyone, if you liked what you heard today and you want to be an active member of the Be HEALTHistic community, subscribe to our podcasts on Apple podcasts or wherever you download your favorites and subscribe to the healthy directions YouTube channel. You can also find more great content information from us and the healthy directions team at healthydirection.com. I'm Dr. Drew Sinatra.

Dr. Steve Sinatra: I'm Dr. Steve Sinatra.

Dr. Drew Sinatra: This is Be HEALTHistic.

Narrator: Thanks for listening to Be HEALTHistic. Powered by our friends at healthy directions with Dr. Drew and Steve Sinatra. See you next time.