In 1961, analysis of data from the Framingham Heart Study revealed the dangers of high cholesterol levels and diabetes mellitus.

In 1977, lipid and lipoprotein values were defined as major risk factors for cardiovascular disease.

Taken all together, reversing diabetes, reducing high cholesterol and correcting high blood pressure protects against heart disease and stroke!

There are medications to control high cholesterol and hypertension. They certainly should be used while reversing type 2 diabetes. Eventually, remission of diabetes usually makes taking most of those medications less important.

To learn more about programs Herd Healthcare offers, our website is:
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Cholesterol Metabolism Causing Cardiovascular Disease

Lipid and lipoprotein values, including fasting triglycerides (TG), low density lipoprotein cholesterol (LDL) and total cholesterol levels (TChol) are major risk factors for cardiovascular disease. High density lipoprotein cholesterol (HDL) is a protective factor against coronary artery disease.

Cholesterol is essential for life. It is necessary to make hormones and digestive fluid and to build cells. But it doesn’t dissolve in blood. It is carried to where it’s needed in fat molecules called lipoproteins.

Those lipoproteins vary in size, shape and density. Some high weight lipoproteins are safe carrying cholesterol to and from the cells they enter. They are called High Density Lipoproteins. More of them, low in weight are not safe because they become trapped and held in cells. They are called Low Density Lipoproteins.

Over years, more and more of the low density lipoproteins becomes lodged in cells lining the arteries, especially arteries to the heart, brain and legs. Those cells eventually can become thickened enough to obstruct the flow of blood. How soon that happens depends on the amounts of cholesterol laden low density lipoproteins circulating in blood.

Cholesterol and lipoproteins are partly absorbed from fat in food and partly created by metabolism in the wall of the intestinal tract and the liver. The more fat that gets absorbed and the longer it takes to get cleared from the blood, the more cholesterol and low density lipoprotein gets built up in the walls of the arteries.

Cholesterol And Lipid Metabolism in Diabetes

Type 2 diabetes (T2DM) is associated with changes in body weight and composition. Most adult men and women with T2DM are obese. Men weigh about 30 lb more than normal men with healthy weight and women weigh about 25 lb more. The length around the middle of the abdomen of adult men and women with T2DM is about 5 inches more than the waist circumference of normal adults with good health.

We define diabetes by the high levels of sugar circulating in the blood. We could just as accurately define diabetes by the abnormally high levels of fat (called triglycerides) and cholesterol that circulate. The high levels of triglycerides cause the liver to form and secrete large, dense fat molecules.

These large, dense fat molecules are broken into small low density lipoproteins (LDL) which carry cholesterol into cells. There’s less formation of high density lipoproteins (HDL) which carry less cholesterol in and out of cells.

Both the high levels of LDL cholesterol and the low levels of HDL cholesterol predict earlier and more severe obstructions of arteries. The result is to increase the early occurrence of heart attacks and strokes.

Weight Reduction And Lipid Metabolism

Obesity associated with T2DM develops because more sugar, fat and protein are consumed than metabolism and physical work can handle. There’s no room left in skeletal muscle or liver to store excess nutrients. The high levels of sugar and fat in the blood that persist all day and all night cause the pancreas to secrete more and more insulin. The high levels of triglycerides cause the liver to secrete more and more lipoproteins containing cholesterol.

Decreasing intake of food decreases the levels of sugar and fat enough so they can be cleared from the blood between meals and overnight. The effect of reducing intake of food enough to cause rapid loss of body weight also decreases levels of insulin, sugar, fat and cholesterol in the blood.

Investigators in Denmark tested the effect of reducing daily intake of food to amounts containing less than 1,000 kilocalories per day for 8 weeks. They studied the changes in 11 men and women with T2DM who did not require daily injections of insulin to control their diabetes.

As shown in the table, all subjects had mild T2DM with BMI > 35, fasting blood sugar of 146 mg/dL and fasting insulin levels of 176 pmol/L. (Healthy levels of fasting blood sugar are < 100 mg/dL and healthy fasting insulin levels < 50 pmol/L.)

After 8 weeks of restricted food intake, body weight fell -11%, fasting sugar levels fell -21% and triglyceride levels fell -39%. Levels of fasting insulin fell more than -50%. Levels of LDL cholesterol fell -17%.

These results indicate that food restriction to less than 1,000 kcal/day rapidly reduced the dangerous metabolic effects of excess food consumption.

Education And Coaching In Nutrition And Exercise

Reducing excess food consumption to balance daily energy requirements for metabolism and physical work is difficult. Short term studies lasting a few weeks or months show substantial improvements in T2DM. However, studies lasting several years are less effective.

The effects of intensive education and personal coaching for 12 months has been tested in several states of the U.S. Investigators in 16 Clinical Centers recruited, educated, coached and supervised nutrition and physical activity of 5,145 men and women with T2DM. Approximately 15% were using daily injections of insulin.

Averaged over 4 years, the subjects who received intensive coaching and supervision had substantially greater reductions in weight. The objective was a -7% weight loss at year 1 that was maintained for the duration of the study. Subjects were assigned 1,200 to 1,800 kcal/day depending on initial weight. Liquid meal replacements were provided free of charge. The greatest loss in weight was -8.6% achieved by the intensively coached group at the end of 12 months. After the end of intensive coaching, the average weight loss was -4.7%.

The greatest reduction in HbA1c was achieved by the intensively coached group. Here, again the reductions achieved during intensive coaching in the first year diminished during the following years. However, the reductions were maintained even when insulin injections and oral agents were reduced during the following years. More of the medications were continued in the group that was less intensively coached.

Reductions of -10% to -20% in levels of triglycerides were measured in blood samples from the most intensively coached subjects. These values were about twice the reductions measured in the group that was less intensively coached. During the years after intensive coaching, triglycerides decreased until they were about equal.

Reductions in LDL cholesterol were less than -10% and increases in HDL cholesterol were less than +10% during the first 4 years.

Greater use of lipid lowering drugs occurred during the first several years of the trial. Changes in Total cholesterol and LDL cholesterol may have been caused by the introduction of those new drugs which were not restricted during the study.

The modest -5% reduction in body weight simply was not enough to improve the management of T2DM. Reductions in body weight of -10% to -20% do decrease LDL cholesterol enough to reduce the severity of cardiovascular disease and prevent the occurrence of heart attacks and strokes.

Reductions in body weight less than -10% are not effective in reversing diabetes.

Exercise And HDL Cholesterol Metabolism

Regular endurance exercise has been shown to reduce the occurrence of cardiovascular disease. Both aerobic endurance exercise and resistance strength training have proved to be effective.

Improving HDL cholesterol levels is particularly effective during aerobic endurance training. This has been best demonstrated in subjects who have high triglyceride levels and low levels of HDL cholesterol in their blood.

This combination of lipid levels is seen most often in subjects who have a maximum waist circumference greater than 40 inches in men and 35 inches in women. T2DM also is commonly associated with abnormal waist circumference along with low levels of HDL cholesterol and high levels of triglycerides.

The effect of aerobic endurance training has been demonstrated as part of the HERITAGE Family Study conducted in Canada and the US. The subjects were 62 men approximately 42 years of age, BMI > 25, and maximum waist circumference was approximately 40 inches.

Laboratory values of prediabetes were measured in all subjects. Triglyceride values were 217 mg/dL, HDL cholesterol values were 29 mg/dl and fasting insulin levels were approximately twice the normal healthy values.

Aerobic endurance training consisted of 30 minute sessions pedaling at moderate intensity on a stationary bicycle 3 days each week for 20 weeks.

Results after 20 weeks included decrease of triglyceride values of -18% and an increase in HDL cholesterol of +18%.

Results of this study indicated improved lipid metabolism including HDL cholesterol in men with abdominal obesity and elevated triglyceride levels.

Summary

Modest weight reduction in obese patients with type 2 diabetes has a small effect on triglyceride and cholesterol metabolism.

In contrast, reversal of T2DM with body weight reduction of -10% to -20% restores lipid metabolism towards normal values. Medications for lowering LDL cholesterol continue to be important if Total cholesterol minus HDL cholesterol continues above 130 mg/dL.

Aerobic endurance exercise and resistance strength training both are effective in restoring cholesterol and lipid metabolism towards normal healthy values.

Aerobic endurance exercise is particularly effective in restoring HDL cholesterol towards normal. Resistance strength training is particularly effective in restoring insulin resistance towards normal healthy values.

Let us help you prevent and correct high triglyceride and low HDL cholesterol values by reversing type 2 diabetes.

We are pleased to share our blog articles with you, and we are always interested to hear from our readers. Our website address is: www.herdhealthcare.com

Time invested for good health reduces costs now and prolongs health and life. 

Contact us and get started. Health planning now is more important even than financial planning.

Extend Life and Good Health Years:

Reversal of Diabetes is an Astounding Investment! It immediately returns more time and saves more money than you might invest along the way. Even before Remission.

Diabetes Risk Alert is a signal about a sure thing. Diabetes Risk is not like  risk of fire or flood. If the house doesn’t get burned down or flooded out, everything is okay. Maybe for a hundred years.

Diabetes Risk absolutely predicts there will be years of disability and distress before some final event. No one knows when that will start or when that will end but it certainly will happen sooner than it would without diabetes.

We do know when the average Caucasian non-Hispanic person with diabetes can expect healthy years will be lost and when life will end. Investigators analyzed data from 3992 participants in a National Survey (NHANES 2003-10). Results showed causes of type 2 diabetes and cardiovascular disease included excess body weight as well as age and gender.

Total years of life lost for very obese men and women ranged up to 8 years. Even more striking was the loss of healthy life-years that were 2 to 4 times greater in every category. Those with type 2 diabetes, obesity and cardiovascular disease lost as much as 19 years of healthy life!

The figure shows how body weight affected the results. Weight has been presented as Body Mass Index.

• BMI 30 – 35 defines Mild Obesity. A man who is 70 inches tall in this range would weigh 220 to 240 pounds. A woman who is 66 inches tall in this range would weigh 190 to 210 pounds.
• BMI 35+ defines High-risk Obesity. High risk obesity is about 40% over ideal body weight. High risk obesity for that man would be over 240 pounds. For that woman, her weight would be over 210 pounds.

Note that men and women with high risk obesity had the greatest losses, especially losses in healthy life-years.

The figure also shows how age of onset for type 2 diabetes affected results. Note that patients who developed diabetes at a young age had the greatest losses. 

The next figure shows more clearly which categories had the greatest loss in years of life.

• At 30 years of age, obese adults of low risk had 13 years of poor health until death 7 years prematurely.

• At age 50 years, those with high-risk obesity also suffered 13 years of poor health before death 5 years prematurely.

• At age 70 years, those who escaped diabetes until their later years still had several years of poor health that could have been avoided before death 7 years prematurely.

Diabetes Risk Alert signals inevitable loss of what could have been many more years of good health. They turned into years of poor health. We just don’t know how or when that will happen. Diabetes is one of the costliest and long-lasting causes of chronic illness in the U.S.

Results are obvious. Years of enjoying good health turn into years of compromise, disability and distress.

Limitations Because of Diabetes:

Employment

Diabetes endangers ability to work. Many lose employment and can’t find a job because they can’t do the work. Diabetes also causes work loss time, job limitations and decreased productivity. This all limits earning a living as well as losing employer-sponsored healthcare insurance.

Family, Friends and Community

Limits on things to do and places to go make it difficult to enjoy being with others. It’s especially difficult for someone with severe diabetes being with children and mixing in the community.

Recreation and Entertainment

Most activities are seriously limited when places are difficult to reach and actions are hard to perform. Many complications of diabetes pretty much rule out most vigorous activities. Its becomes impossible to be in many sports or join in recreations. Also, it’s hard to get around the stadium or the playground or the beach. It even becomes difficult to walk in the park.

Improve Quality of Life:

Reversing diabetes almost immediately improves physical mobility, strength, mood and intellect.
The Look AHEAD Study included 5000 people in the U.S. who were Overweight or Obese and had Diabetes. They were treated for eight years. About half were treated with Intensive Lifestyle Intervention (ILI) and half were given standard Diabetes Self-Education (DSE). The group treated Intensively had substantially better results in controlling body weight and increasing physical activity. They also had fewer symptoms of Depression.
The figure shows the results for mental health. During the Study, the group treated Intensively (ILI), shown in the Gold bars, had many fewer symptoms of Depression. The most improvement was during the most intense treatment. Both groups drifted towards more symptoms as they became older and had less contact with their counsellors in self-management.
The next figure shows the results of physical ability to go about their daily lives. During the Study, the subjects treated Intensively (ILI), again shown in Gold bars, were better able to do what they wanted to do during the day. Again, as self-management skills drifted away, so did their quality of life.The Study did not tell us which individuals did the best. We only know that subjects in the group with Intensive Lifestyle Intervention had better quality of life than those given standard Diabetes Self-Education.

We do know that the group with Intensive treatment had higher quality of life and well as more complete reversal of their diabetes.

Diabetes Risk Alerts:

It’s obvious that diabetes is a threat to physical and mental health as well as damaging financial health. Diabetes Risk Alerts tell you when it’s urgent to avoid unwanted results.     

• Overweight/Obesity

More than 3 pounds per inch is a danger alert for diabetes.

“Track your weight—keep it in a good range.”

Waist Circumference Maximum

Another danger alert for diabetes is a maximum waist circumference that is 40 inches or more for a man and 35 inches or more for a woman.

“Diabetes Risk Alert: Pay attention to your waist size.” 

• Eyesight

Good vision is needed to pass the eye tests for keeping a driver’s license. Bleeding in the back of the eyes or early cataracts can be the first sign of diabetes.Even mild loss of vision is a major Risk Alert because diabetes is the most common cause of blindness at any age.

“Be sure to have regular eye exams.”

• Peripheral Nerve Function

Loss of sensory and motor nerve function in arms and legs make it hard to feel and handle things, to use muscles and coordinate movement. Nerve damage from diabetes can also cause pain as well as numbness. Pain caused by diabetic neuropathy is one of the most common and most distressing complications of diabetes.

“Diabetes Risk Alert:  Numbness of the skin and weakness of muscles.”

• Peripheral Vascular Disease

Poor circulation to legs and feet is a serious handicap to walking and climbing stairs. Diabetes not only affects major arteries, it also affects smaller vessels especially in the feet. Skin ulcerations occur frequently and take a long time to heal. Peripheral vascular disease is a very serious alert about complications of diabetes.

“Diabetes Risk Alert: Check your feet for breaks in the skin.”

• Memory and Mental Function

Forgetting things combined with difficulty thinking and making decisions may all be caused by diabetes. Unfortunately, diabetes may progress to cause vascular dementia and Alzheimer’s disease.  Difficulty with memory and IQ function are major risk alerts for diabetes and its complications.

“Diabetes Risk Alert: Forget things you usually remember.”

Pay Attention To Diabetes Risk Alerts:

There are no medical, surgical or mental health treatments that can match personal decision, dedication and persistence. Reaching happy, independent Golden Years depends on investment in health right now.

Contact us. We’ll help you get the Good Health Years you want.

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Good Health Planning for Retirement is more important than Financial Planning. Money can’t buy Good Health but Diabetes Remission saves Money. Contact us and we’ll get you started toward saving money.

Annual Medical Costs

Have you checked your medical expenses for 2018? Are your expenses more than you expected? The average for everybody in the USA today is more than $10,000. If you have diabetes, your expenses likely are more than twice the expenses of people with ideal weight and no diabetes.

Take a look at the figure. The orange column indicates costs on the average for everybody. Note that people who are obese pay an average of about $12,000. People with ideal body weight spend about half that amount or about $6000. Now look at the blue column at the left of the figure. People with diabetes pay almost $14,000 per year, or more than twice the amount paid by people with ideal body weight and no diabetes.

Of course, there’s been a big change in how we pay our bills for medical care. Fortunately, most people have healthcare insurance. During the past 10 years, the average individual healthcare insurance premium has gone up from $160 per month to $390 per month. That’s a three-fold increase! At the same time the deductible for individual healthcare insurance has gone up from $2000 per year to $4000. That’s a twofold increase. Since medical treatment for diabetes has risen from about $150 per month to more than $500, the additional $2000 is unavoidable expense. In addition, copayment (flat fees) or coinsurance (percent costs) is charged for every medical service after reaching the deductible.

Finally, some healthcare insurance plans are increasing rates according to pre-existing medical conditions.

Cost of Chronic Illness

We tend to think about hospitalization for acute illness, surgery and emergencies as terrible costs for medical care. Certainly, we carry healthcare insurance to help us pay for something that requires hospital care. In fact, chronic illness is far more expensive for all of us year after year. Chronic illness causes 86% of all healthcare spending. The combination of diabetes and obesity is the most expensive cause of chronic illness in the USA. The figure shows the relative costs in each major category of illness. You can see in this figure that diabetes and obesity cause medical expenses more than cardiovascular disease or cancer. Both also contribute even more to cost as major causes of cardiovascular disease, cancer and Alzheimer’s disease.

Both diabetes and obesity result from too many calories taken in and too few used for energy. Both can be corrected and would save more than 10% of total healthcare costs in the USA.

Remarkable Cost Savings with Weight Reduction

Saving money by reducing diabetes and obesity actually has been demonstrated by keeping accounts of money spent on healthcare in an HMO. During 12 months, the medical expenses for men and women with diabetes and obesity were recorded. Those who reduced their weight had less cost for medical care than those who gained weight. All of the savings were from decreased costs of anti-diabetes medications including insulin.    

                                               In the figure, we can see the amounts spent by those who lost more than 3.3% of body weight, those who had no change, and those gained more than 3.6% in body weight. Those who lost weight spent $1700 less in one year than those who gained weight.

Those who lost 5 pounds spent $600 less than those whose weight stayed the same. Those who gained 5 pounds spent $600 more. That’s $120 more or less for every pound of body weight gained or lost.
Since the time these people with diabetes were studied, the cost of diabetes medications has more than doubled. Today, the savings for reducing weight at least 5 pounds would be more than $1200. That would be $240 per pound!

Consider all the Costs of Disability and Death

In addition to costs of medical treatment, there are costs because of reduced productivity at work, at home and in the community. Those personal costs increased total cost by about 40%.
Patients with diabetes and obesity are less able to work or interact with family, friends and community. In addition to increasing total cost, intermittent and permanent disability seriously degrade quality of life.

Lifetime Medical Costs

From birth to the end of life the cost for medical treatment for everybody is about $300,000.
In the figure, you can see that treatment of diabetes increases healthcare costs by about $5,000 every year. That includes costs for treating complications of diabetes as well as treating complications of heart disease, stroke, cancer and dementia.
Here, again, overweight and obesity increase medical costs as well as contributing to the cause of diabetes, heart disease, cancer, dementia and stroke.

The $ Value of Good Health

We all know we should save money for retirement. Also, we need good health for length and quality of life after retirement. Money can’t buy health but good health saves money. Reversing diabetes provides good health and the money to enjoy long life in retirement.

One Small Request:

If you enjoyed reading this article, kindly give it a share. Your share is extremely helpful to spread our message and help more like you.

We are pleased to share our blog articles with you, and we are always interested to hear from our readers. Our website address is: www.herdhealthcare.com

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]]> https://herdhealthcare.com/diabetes-remission-saves-money-telehealth-in-texas/feed/ 0 https://herdhealthcare.com/telehealth-in-biobehavioral-training-to-reverse-diabetes/ https://herdhealthcare.com/telehealth-in-biobehavioral-training-to-reverse-diabetes/#respond Tue, 06 Nov 2018 15:23:27 +0000 https://www.diabetesriskalert.com/?p=1592 Neurocognitive Function in the Maturing Brain:-

Since birth, the brain stores information about situations, actions and results. Judgements and rules are made with implicit bias towards perceived best outcomes without consideration about long-term effects. Repetitions and consistency of response favor less and less conscious appreciation of behavioral events. Eventually 95% of brain activity controlling behavior is beyond our conscious awareness.

A defining feature of the human brain is executive control over subconscious thoughts and actions. We do make conscious decisions and deliberate plans. We can achieve favorable long-term results even against implicit bias!

Diabetes Remission: An Investment Opportunity:-

Reversal of diabetes at 50 years of age can recapture an additional 10 years of Good Health beyond age 70 and prevent premature death.

If you have Overweight Diabetes, rising costs for medical care will make it likely that your out-of-pocket expenses for insurance premium, deductible and copayment will be at least $5,000/year more for you than everybody else who is just like you except you have diabetes.

Remission gives you an opportunity to recapture Good Health, prolong life and reduce cost. An Investment Opportunity you can’t buy directly with dollars.

We can show you what to do and help you do it. Our video platform provides you with real-time access to one-on-one coaching that is convenient for you day-by-day.

Prevalence of Diabetes:-

Risk of Diabetes surrounds us. Two thirds of people all around us are overweight or obese and half of them have diabetes or prediabetes. Eventually, if nothing changes, prediabetes progresses to diabetes. Diabetes medications are effective managing blood levels of glucose and preventing acute crises caused by uncontrolled diabetes. Unfortunately, medications to control levels of glucose in the blood are not effective preventing chronic complications of diabetes.

 Cost of Treating Diabetes:-

The direct medical costs of treating diabetes and its complications, during a lifetime, in the United States ranges from around $55,000 to $130,000, depending on age at diagnosis and sex, with the average being $85,200. Many medical insurance plans distribute costs associated with pre-existing conditions such as diabetes over the total population with insurance. If you are insured under a plan that charges more for pre-existing conditions you pay more of the medical expenses treating your diabetes.

Risk for Diabetes:-

What is your height? How much do you weigh? How many inches around the middle of your abdomen?

As a general rule weight should be no more than 2.5 lb per inch of height. Maintaining healthy weight each day requires about 25 calories per inch. More calories per day increases weight. An increase in weight to greater than 3 lb per inch more than doubles your risk for diabetes. Measure your waist in the middle of your abdomen. If it is more than 40 inches for a man, or 35 inches for a woman, you are in the diabetes danger zone. In the danger zone, there is about a 50% chance you have prediabetes or diabetes.

Diagnosis of Diabetes and Prediabetes:-

Even if you do not have diabetes, this chart shows years of life gained if abdominal circumference is no more than half your height.

Telehealth Diabetes Prevention and Remission:-

We help you to make a plan and record progress. Also, we help you adjust it to keep improving.

Remote Monitoring:-

You measure and keep track of your health at home and report results using your smartphone or tablet.

Measure Blood Glucose                                    Steps Per Day

   Body Weight                                                Blood Pressure

Measurements and Medications                     MyFitnessPal Food Diary

Telehealth Coaching:-

With internet connection, you can show us right away how the action plan is working. If the action plan is not effective, you report that to us and we work together to improve it.

Eventually you don’t have to even think about it!

One Small Request:

If you enjoyed reading this article, kindly give it a share. Your share is extremely helpful to spread our message and help more like you.

Call Us or Contact Us:

Diabetes Prevention & Remission 

James Alan Herd, MD

Call: 713-669-0271
Email: Jaherdmd@herdhealthcare.com
Website: www.herdhealthcare.com

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