February was heart months, and this is another column in a series about the major risk factors for heart attacks. According to the effective Bale-Doneen Method of heart attack prevention, 70% of heart disease is driven by insulin resistance (IR).

What is IR? The beta cells in the pancreas secrete insulin, which controls blood sugars. Think of insulin as the key to the lock that allows sugar to get inside cells to use as energy. If cells are clogged with fat, the key doesn’t work. Blood sugars rise and the beta cells produce more and more insulin in an attempt to lower blood sugars. This abnormal situation is known as IR, which is basically synonymous with prediabetes. Eventually the pancreas wears out, fasting blood sugars rise, and a diagnosis of diabetes is made, but by then a lot of damage has been done.

How prevalent is IR? Over 34 million U.S. adults have diabetes, with more than 7 million of those undiagnosed—either because they haven’t had their blood sugars checked or because they had unreliable tests. Over 88 million Americans have prediabetes, with the large majority of them undiagnosed. As Americans of all age groups become heavier, these conditions are becoming more prevalent–particularly in young adults. We used to call type 2 diabetes adult-onset diabetes, but with 5,000 children diagnosed with this condition annually we no longer use that term.

Diagnosis of insulin resistance/pre-diabetes: 1) If people have excess belly fat, they also have fat in and around their internal organs and in their muscle cells. Measure your waist at the level of maximum circumference—above your hips at about belly button level (NOT your belt size). If you are a Caucasian man and your waist circumference is 40 inches or greater, or a woman 35 inches or greater, you almost certainly have IR. Cutoffs are lower in Asians and East Indians. There are some people who have just a small belly when viewing their naked profile in the mirror, and even though they don’t meet the aforementioned benchmarks for genetic reasons they still have prediabetes. 2) Low HDL (good cholesterol) combined with high triglycerides signifies IR. 3) If fasting glucose is > 92, IR is likely. 4) A1C is a blood test that measures average blood sugar over the previous 3 months. If it is 5.6-6.4 prediabetes is present; 6.5 and above means diabetes. 4) The gold standard for diagnosing IR is a 1 and 2-hour glucose tolerance test:  fast 12 hours (water only), go to a lab where they will give you a drink with 75 grams of glucose in it, have a blood glucose drawn 1 and 2 hours later. A 1-hour result of 125 or greater or a 2-hour result of 120 is diagnostic of IR.

Why is IR so dangerous? Complications of diabetes, which can also occur with prediabetes, include the following:  1) cardiovascular disease, including heart attacks and strokes; 2) chronic kidney disease, which can lead to dialysis; 3) diabetic retinopathy, which can lead to blindness; 4) peripheral neuropathy, which can lead to chronic numbness and pain in the lower extremities, and even amputations; 5) weakened immune system; 6) erectile dysfunction in men; 7) dementia including Alzheimer’s.

Prevention, treatment and reversal of IR: Heart attack prevention doctors are always looking for signs of IR in their patients, and when they find it they treat it aggressively. In the prediabetes stage IR is reversible. Diabetes diagnosed in an early stage is also reversable. However, if someone has had diabetes for years, the beta cells in the pancreas have been destroyed to the point of no return—which is why most people with diabetes for years end up on insulin. A plant-based, whole food diet with no salt, sugar, or added oil prevents, treats, and reverses prediabetes and early diabetes, in part due to resulting in optimal body weight. Certain herbs such as barberries help, as do certain medications.

For more information, read “Dr. Neal Barnard’s Program for Reversing Diabetes,” or “Healthy Heart, Healthy Brain” by Bale and Doneen.

Dr. Greg Feinsinger is a retired family physician who started the non-profit Center For Prevention and Treatment of Disease Through Nutrition. For questions or to schedule a free consultation about nutrition or heart attack prevention contact him at gfmd41@gmail.com or 970-379-5718.