 
# Diabetes Control- Preventing Heart Disease and Strokes Naturally

# Second Edition

by Thomas E Nelson

Copyright 2013 Thomas E. Nelson

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License Notes

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# Disclaimer

By using this document you are accepting all the terms of this disclaimer notice. If you do not agree with anything in this notice you should not use this book.

This document is for general health information only; it is not to be used as a substitute for medical advice, diagnosis or treatment of any health condition or problem. Users of this document should not rely on information provided within this document for their own health problems.

Any questions regarding your own health should be addressed with your own physician or other healthcare provider. There are neither warranties nor express or implied representations whatsoever regarding the accuracy, completeness, timeliness, comparative or controversial nature, or usefulness of any information contained, or referenced in this document.

The author of this document does not assume any risk whatsoever for your use of the information contained herein. Health-related information changes frequently and therefore information contained within this document may be outdated, incomplete or incorrect. Statements made about products have not been evaluated by the Food and Drug Administration. Use of this document does not create an expressed or implied physician-patient relationship.

You are hereby advised to consult with a physician or other professional health-care provider prior to making any decisions, or undertaking any actions or not undertaking any actions related to any health care problem or issue you might have at any time, now or in the future. In using this document you agree that the author of neither this document nor any other party is or will be liable, or otherwise responsible, for any decision made or any action taken or any action not taken due to your use of any information presented within this document.

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> "Dedicated researchers seek better treatments and cures for diabetes, kidney disease, Alzheimer's and every form of cancer. But these scientists face an array of disincentives. We can do better." -Michael Milken

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# Table of Contents

Disclaimer

Chapter 1-Introduction

Chapter 2-How Your Heart Functions

Chapter 3-The Vascular System

Chapter 4-About Blood Clots

Chapter 5-Silent Heart Attacks

Chapter 6-About Blood Pressure

Chapter 7-About Cholesterol

Chapter 8-How Diabetes Causes Cardiovascular Disease and Strokes

Chapter 9-Preventing Cardiovascular Disease and Strokes

Basic Plaque Removal Program

Metabolic Enzymes

Heart Healthy Food

Glycemic Index Foods and Glycemic Index Foods Table

Chapter 10-End Notes

Appendix

Basic Cellular Function

How Diabetes Messes with Basic Cellular Function

Homeostasis

About the Author

Other books by the Same Author

## Chapter 1-Introduction

One of the greatest issues in diabetes is "disbelief," or denial. Diabetics cannot accept the fact that the symptoms they experience, if any symptoms are experienced, are as serious as they actually are. Most reason that the symptoms will simply go away after time. Unfortunately, most of the serious damage that diabetes causes produce no symptoms at all; diabetes is a very dangerous progressive disease. The same is true for heart disease. One of the problems is that the symptoms that do appear vary in intensity from one person to the next. The symptoms of developing heart disease are:

Severe or uncomfortable pressure in the chest area (center)

Moderate or severe indigestion

Pain in the neck, shoulders, or arms

Weakness or excessive fatigue

Heart palpitations

Paleness, cold sweat, and anxiety

A person does not have to experience all of these symptoms to be experiencing a heart attack; in fact, as you will later learn, some diabetics experience silent heart attacks where no symptoms develop. If any one or more of the above symptoms should occur seek medical help immediately.

Diabetes is one of the most prevalent chronic diseases that has an elevated (high) association with death from cardiovascular diseases. Experts believe that it is due to the existence of myocardial defects caused by diabetes, that are independent of vascular disease. There are proteins that regulate the contraction of the heart muscle (myosin ATPase and its isoenzymes), and other proteins that regulate heart function that function abnormally in diabetics. These abnormalities along with a reduced sensitivity to calcium in the cells are believed to play a large role in causing the impaired cardiac function. Diabetes is a complex disease that results in large and small vessels disease and impaired organ function. Studies have shown that learning how to control blood sugar, and properly regulate insulin, can reverse many of these mysterious abnormalities.

Most diabetics are unaware that they are 4 times more likely to develop heart disease than non-diabetics. Nearly 9 out of every 10 diabetics (85%) will die of a heart attack or stroke. However, it doesn't have to be that way. It is entirely possible for every diabetic to significantly reduce their chances of developing heart disease, or suffering from a stroke. It is entirely possible for diabetics to scrub the plaque from their arteries and significantly reduce their risk of suffering a stroke. They can restore damaged blood vessels (capillaries), and significantly strengthen their lung and heart muscles.

Most diabetics think that low blood sugar is not as damaging as high blood sugars. While the majority of diabetics have frequent high blood sugars, anything that will cause low blood sugars will significantly impact the risk of developing heart disease. Low blood sugars (hypoglycemia) are very stressful on the heart. Low blood sugars also increase the risk of a stroke; 3-5 times more likely. In fact the risk of developing heart disease is greater due to low blood sugars than high blood sugars (hyperglycemia).

However, the chances of surviving a heart attack are lower for those with high blood sugars. Low blood sugars cause heart palpitations, which are followed by autonomic nervous system responses to low blood pressure that cause a very rapid heartbeat. Your body's control room (hypothalamus) will significantly increase your heart rate in hopes of circulating any glucose in the vascular system to carry it to your, brain, heart, and nervous system. The heart, central nervous system, and brain are highly dependent upon glucose to function; in fact, your central nervous system cannot function on any other type of fuel.

Heart disease in diabetics is a complication of diabetes, meaning that the things that caused your diabetes to manifest set up conditions that will lead to cardiovascular disease; unless steps are taken to control those factors. Diabetic complications, including heart disease, eye issues (cataracts, blindness, and others), neuropathy (pain and loss of feeling in the extremities), memory loss, weight gain and weight control issues, high blood pressure, high cholesterol, high triglycerides, slow healing sores that can lead to amputations, and others, have specific causes that can be corrected and controlled if you learn how. The book "Diabetes Control-6 Steps to Gaining Complete Control over Diabetes," describes in a step-by-step process how to accomplish that.

Over the past 100 years our diet has changed in many unhealthy ways. Our ancestors ate all of the things that our doctors now tell us not to eat every day, yet diabetes, and 30 other inflammatory diseases, were almost unheard of then. Let's take a quick look at those changes.

Farming went from small family run organic farms, to massive conglomerate farms (upwards of 7,000 acres). The conglomerate farms are large corporations that are profit driven. They hired scientists to develop chemical herbicides, fertilizers, fungicides, and pesticides that heavily coat the food that they produce. They started genetically engineering the crops to produce massive volumes of crops, that are insect, disease, and drought resistant. Unfortunately, they are significantly lower in nutrients than the original strains. They abandoned crop rotation, which has led to severe soil depletion of vital nutrients. Crops are now harvested before the food is ripe, because it has to be shipped long distances to market; which lowers the already low nutritional value.

Livestock were once allowed to leisurely graze in fields on grass, usually for up to 5 years before being prepared for market. Today they are raised primarily in feedlot farms. The animals are forced to live in very crowded conditions. They are fed grain diets (an unnatural diet for them) that cause them to become sickly, because the feed is highly acidic and very difficult for them to digest. Consequently, they have to be fed antibiotics to keep them alive long enough to reach a marketable size. They are fed growth hormones which brings them to market in as little as 6 months. When the meat is collected, nitrates, nitrites, and food colorings are added to preserve the meat for longer periods of time.

Much of your food is now pasteurized, and dairy is also homogenized. Pasteurization kills living enzymes and destroys beneficial bacteria that our body relies upon for proper digestion. Homogenization breaks the saturated fats down into miniscule particles that are no longer digested, but instead enter your bloodstream directly and collect in our arteries. Homogenized dairy is now credited with causing a massive increase in heart disease in all of the countries that practice homogenization of dairy.

Salt and sugar are now highly processed, which alters their chemistry causing them to be detrimental to your health; totally unusable by your body. Table salt now contains numerous additives that are chemically based and useless to your body; and detrimental to your health; including aluminum. The good news is that some processors are now switching to sea salt, which is not processed. Pressures from the public have led to processors switching to other forms of sweeteners, like high fructose corn syrup, and artificial sweeteners; both of which, are very bad for diabetics.

World War II spawned the development of processed foods, which were needed to feed armies all around the world. Women began working in factories to support the war effort, but did not go back home after the war ended. The processed food industry flourished and continues to grow. Competition in the processed food industry led to the introduction of chemical food coloring, texture and flavor enhancers, and preservatives. Fear of recalls for E coli outbreaks led the processed food industry to begin cooking the food items at extreme temperatures, which significantly reduces the nutritional value.

During the 1950's the fast food industry developed and flourished. Fast food is very high in calories, and fats, and is nutrient void. Currently, the average family eats nearly 1/3 of their meals at a fast food restaurant.

Your food is now grown on conglomerate farms, exposed to a massive amount of chemicals, grown in soil that is depleted of nutrients, harvested too soon, and genetically engineered. Then it is shipped to processing plants where it is cooked at extreme temperatures, has additional chemicals added to make it look better, taste better, and preserve it. Then it is canned in plastic lined cans, which the Federal government now believes is instrumental in the development of childhood obesity. Your diet is low in nutrients (vitamins and minerals), living enzymes, and essential amino acids. Consequently, your diet is also very low in antioxidants, which you will soon learn is not a good thing.

Over the past 100 years over 80,000 new chemicals were invented. The average person is now exposed to over 7,000 chemicals each day. Your drinking water contains trace amounts of 700 different chemicals. The air you breathe is loaded with trace amounts of chemicals; some cities more than others. Chemical exposure has become a very serious issue. Nearly everything you touch or are exposed to is chemically based.

Antibiotics were invented in the late 1940's, which have saved many lives. Unfortunately, antibiotics kill beneficial bacteria along with the pathogens. The beneficial bacteria in your gut make up nearly 80% of your immune system. Diabetics suffer a loss of a massive amount of their beneficial bacteria when they become diabetic; scientists do not know why. Doctors now seriously overprescribe antibiotics and other medications. Most medications kill beneficial bacteria in your gut as well. Your body's beneficial bacteria population has taken a major hit over the past years, because of chemical exposure, medications, antibiotics, and your diet.

Every cell in your body has small antenna-like structures called antigens; all 10 trillion cells. They sample everything that enters your body, from any source, and they determine if that substance is beneficial, neutral, or detrimental to your body's health. If it is not natural, or beneficial, your antigens will signal your immune system to seek it out and destroy it. Since the average diabetic's immune system is already impaired, the immune system will be severely overworked; will become fatigued/exhausted. Every meal is potentially loaded with pesticides, fungicides, chemical fertilizers, food coloring, chemical texture and flavor enhancers, antibiotics, growth hormones, and preservatives. The air you breathe, the water you drink, and the food you eat are loaded with pro-oxidants [chemicals that cause immune (inflammatory) responses], and void of antioxidants that stop inflammation. Your immune system, despite being impaired due to diabetes, is severely overworked and exhausted, because your body is unnecessarily bombarded, daily, by chemical invaders. All of this has serious consequences. Studies have proven that pesticides contribute significantly to the risk of developing heart disease; especially in diabetics.

The chemicals that you are exposed to every day, cause massive amounts of inflammation due to your immune responses. Your body uses inflammation to destroy invaders; anything that your antigens identify as unnatural or detrimental to your health. If your body is incapable of shutting down inflammation, due to a lack of antioxidants, your immune system cannot shut down violent oxidation, which results in damage to healthy cells throughout your body.

Inflammation and vitamin and mineral deficiencies cause a rapid increase in visceral fat (belly fat), which leads to fatty liver, insulin resistance, insulin management issues, elevated blood sugars, and more weight gain. A vicious cycle begins that leads to a slow, general, downgrade in health. Diabetes manifests and continues to progress leading to numerous dangerous complications; including cardiovascular disease.

The next several chapters will explain how your heart and vascular system works, then you will learn how diabetes messes with their function, and leads to cardiovascular disease and an increased risk of strokes. Then you will learn how you can take charge of your risk management process, and significantly reduce your risk of developing cardiovascular disease; including how to remove arterial (artery) plaque, lower your blood pressure, cholesterol, and triglyceride levels to normal. You will learn how to repair damage, help your body produce more nitric oxide (heart healthy), and strengthen your cardiovascular system. There are three sections in the APPENDIX that you are highly encouraged to read before you get into the balance of this book (Cellular Basics, How Diabetes Messes with Cellular Basics, and Homeostasis). They will provide a solid foundation for understanding diabetes, how diabetes impacts your health, and how to fix it. Taking complete charge of your diabetes involves a 6 step process that is very important for you to learn and adapt. You will learn how your body functions, how diabetes messes with that, how to interpret what your body is doing, and how to fix it. You can find those 6 steps outlined in great detail in the book "Diabetes Control- 6 Steps to Gaining Complete Control over Diabetes" Second Edition.

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# Chapter 2-How Your Heart Functions

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Your cardiovascular system is made up of your heart and all of your blood vessels. Your heart is simply a pump that moves the blood around throughout your body; it is essentially a muscle. It is approximately the size of your fist. It pumps approximately 72 times every minute, 4,320 times each hour, 103,680 times per day, and 37,843,200 times each year. Your heart circulates all of the blood in your body up to 25 times every day.

Like any muscle your heart must have a steady supply of oxygen, glucose, amino acids, and a proper ratio of calcium, potassium, and sodium in order to contract or function properly. All of these important nutrients are carried in the blood. When your heart muscle contracts, it contracts with all of its force, which makes it unique. Your skeletal muscles only exert the amount of force needed to meet the current need. Every heartbeat lasts approximately 8/10 tenths of a second. It then rests for approximately 4/10 tenths of a second. Each beat of your heart pumps approximately 70 ml (2 tablespoons) of blood from each side of your heart. A professional athlete's heart pumps approximately 140 ml of blood per side with each beat. During an average life span (approximately 70 years) the heart pumps approximately 250,000 gallons of blood (1 million liters).

Your heart's walls are made up of three layers. Your heart is divided into four parts (cavities); two upper chambers and two lower chambers. The upper chambers are named the right and left atria. The two lower chambers are named the right and left ventricle. The upper right chamber (right atrium) is called the coronary sinus. It is the larger of the two upper chambers and has very thin walls. The upper right chamber opens into the right lower chamber (right ventricle). They are separated by the right tricuspid valve (atrioventicular) which will only allow blood to flow in one direction; top to bottom (atria into the ventricle). Your right ventricle draws the used blood from your entire body and pumps it to the lungs. Your lungs re-oxygenate the blood; the tiny capillaries in your lungs pick up oxygen from the air you breathe and transfer it to the blood. Your left atrium receives this re-oxygenated blood from your lungs, through the pulmonary veins. Your left atrium is smaller than the right atrium and has very thick walls. Your left atrium pumps the re-oxygenated blood through the left bicuspid valve (atrioventicular) into the left lower chamber (left venticular). Your left ventricle and your left bicuspid valve are also smaller than the corresponding right valve and chamber. Like the right valve, the left valve will only allow the blood to flow in one direction. The blood that is pumped out of the left ventricle chamber enters the aorta artery. The aorta artery is the largest artery in your body. The blood is then circulated to all of the peripheral areas of the body.

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# Chapter 3-The Vascular System

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> "Worry affects circulation, the heart, the glands, the whole nervous system, and profoundly affects the heart. I have never known a man who died from overwork, but many who died from doubt." Charles F. Mayo

Your vascular system is made up of arteries, veins and capillaries. One third of your vessels carry blood, nutrients, and oxygen from the heart to all areas of your body. Your arteries are larger vessels that feed into the smaller and smaller branched veins and finally into the capillaries. They form what looks like an upside-down tree. The arteries are like the trunk, the veins like the branches, and the capillaries form the very small branches. Your veins become smaller and smaller as they branch out and finally end with the capillaries, which are very small hair-like vessels. Your capillaries have very tiny holes in them that will allow nutrients and oxygen to leak out into your muscle tissues and your organs. Your capillaries (venule system-below) also have specialized cells that pick up waste materials (CO2 and others) from your body's tissues and organs and carries the waste matter off to be disposed of.

Unlike your other veins, your arteries assist your heart by providing a pulsating pressure. They react to the pumping action of your heart. Your veins (venule system-below) pick up blood from your vital organs and tissues and carry it back to the heart to be re-oxygenated and recharged with nutrients. Your body has two types of arteries; systemic and pulmonary arteries. The systemic arteries carry red, re-oxygenated and nutrient rich blood away from the pulmonary arteries into your body's tissues and organs. Your pulmonary arteries carry blue blood, which is no longer oxygenated back to your heart to be re-circulated through your lungs. While it is sometimes called blue blood, it is actually darker red than the systemic blood, because the oxygen has been removed by your body's cells. The blood vessels appear to be blue due to the way light refracts off of the veins; like those on the bottom side of your wrists.

You actually have 3 vascular systems. The arteriole vessels are filled with oxygen and nutrient rich blood that is pumped under pressure from the largest vessels (systemic arteries) through smaller and smaller vessels, until they enter the capillary blood vessels which are nearly microscopic in size; as described. The capillary blood vessels are designed to leak blood out into the tissues throughout your body and to flow past all 10 trillion of your body's cells. Your cells utilize specialized transporters and gates to collect the nutrients from the blood flowing by, and transport them into the inside of each cell.

The used-up blood (nutrients removed by cells) are picked up, in part, by the second vascular system; the venule system is a duplicate copy of the arteriole system, except in reverse- smallest to largest. The two systems form a loop that starts and ends at the heart. The venule system capillaries vacuum up about 17 quarts of used-up blood from around the cells each day, and returns it to the heart to be reprocessed; recharged with oxygen and nutrients. The venule system's capillary vessels connect to the end of the arteriole capillary vessels. But, instead the slits in the capillaries draw the used blood back into the vessels to be returned to the heart.

The third system is the lymph vessels, which are a part of the lymph system. They have capillary vessels that also pick up what the venule system misses, which is about 21 quarts of fluid each day. Your daily activities (muscle movements) provide a pumping action, which carries the fluid upward to the neck area where it dumps the fluid back into the venule system to be recharged. The lymph system does more than just return fluids to your heart for recharging. The lymph system picks up fats (triglycerides and fatty acids) from your intestines during the digestion of food, and carries them upward along with the used-up blood from around cells in your tissues. Your lymph system has lymph nodes that are specialized nodules that store large amounts of white blood cells (immune system cells) that will attack and destroy any bacteria or other intruders as the blood passes through.

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# Chapter 4-About Blood Clots

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> "Although a blood clot is jellylike and filled with fibers and platelets, it is actually 99 percent water." Science Digest

As discussed blood clots cause heart attacks and strokes. Your body produces blood clots to protect the body from blood loss after an injury. They are intended to seal wounds. After the wound heals your body will break the clot down and dispose of it. The process is called hemostasis. But, when the clotting process goes wrong the blood clots become dangerous; even fatal.

Your body has a substance known as fibrin, or fibrinogen, in your bloodstream that floats around waiting for the time that it is needed. Fibrin forms a clot by binding platelets together to form the clot; it is like glue. Normally, your body will use a special protein (plasmin) to dissolve the fibrin after a wound heals. Your platelets and your thrombin system are the major players in the process of forming a clot. Platelets are very tiny cellular elements that travel in your bloodstream. Platelets are manufactured in your bone marrow. Their primary purpose is to be ready to spring into action if an injury occurs to help stop blood loss.

Your thrombin system is made up of several blood proteins that activate when an injury occurs. A cascade of chemical reactions takes place that manufacture fibrin. Fibrinogen is a long string-like sticky substance. When these chemical reactions take place your platelets become stickier, which causes them to activate. Once the platelets are activated they begin to adhere to the damaged area of the blood vessel's walls. They form a white clot, which is called white clots because they have a white appearance. The fibrin will begin to collect and form a web-like structure that collects red blood cells and a clot is formed. The fibrin binds to the platelets to form a very tight structure.

When plaque builds up in your arteries, it eventually can become brittle and crack which provides a place for clots to form. When a clot forms in an artery the process is more dependent upon platelets to form a clot. When the clot occurs in a blood vessel the thrombin system is responsible for the formation of a clot. Both systems are involved in some form to cause the development of clots in all areas of the body.

There are other circumstances that can trigger the formation of a blood clot. If a clot forms in an area where it obstructs an artery or a blood vessel it is called a thrombus. When a clot breaks loose from the area where it formed and travels in the bloodstream, and becomes lodged in a smaller blood vessel, it is known as embolus. Both thrombus and embolus cause a blockage of blood flow.

Clots become very dangerous and life threatening when they lodge in any of the following areas:

the lungs (pulmonary artery)

the carotid arteries (head and neck)

the femoral artery (thighs)

the abdominal area (abdomen).

Again the most common cause of clot formation is when blood is allowed to pool. The most common causes of blood pooling are a slowing down of blood circulation, abnormal heart rhythm (atrial fibrillation), and peripheral vein disorders in the deep veins of the legs.

The pulmonary artery is located between your heart and lungs. When a blockage occurs in this area it is called a pulmonary embolism which causes damage to the lung, and usually results in death.

The symptoms of a clot in the lungs are:

sharp chest pains

rapid heart rate (tachycardia)

blood-tinged coughing (hemoptysis)

shortness of breath (dyspnea)

low grade fever

Pulmonary embolisms are usually caused by clots traveling from the legs to the lungs. To treat clots in the legs, a combination of heat, medications (for pain), and thrombolytics (dissolve clots), anticoagulants, elevating the legs, and bandaging the area to reduce swelling are used. The treatments will vary depending on the size of the clot and the severity of symptoms.

Your coronary arteries are located on your heart's surface. They provide your heart muscle with oxygen-rich blood and other needed nutrients. If any of your coronary arteries become clogged a heart attack will occur. These types of blockages are usually the result of a plaque rupture. When a plaque deposit on the inner wall of an artery fractures the loose particle travels through the bloodstream to a smaller area where a blockage occurs. These particles can also travel to other areas of the body and lodge. Blood clots form because of atherosclerosis, valvular heart disease (diseases of the heart valves), past heart attack(s), an enlarged heart, atrial fibrillation (abnormal rhythm), or heart failure.

The carotid arteries are located in your neck. They supply your brain with nutrients and oxygen. Blockages in the carotid arteries lead to strokes, or TIA (a mini-stroke- transient ischemic attack). These clots will cause visual problems, weakness, seizures, or impaired speech. The femoral arteries are located in your legs. Claudication is the pain that occurs when a blockage forms. Typically a lack of color and weakness will occur in the area near the blockage. Tissue death will occur if medical treatment is not received immediately. The condition will lead to an infection and possibly gangrene. The pain is very sudden if the clot is located in an artery. Swelling occurs and a slight blue coloration will appear at the site. When the blockage occurs in a vein swelling and tenderness will occur. When clotting occurs deep within the limbs, usually the legs, it is known as DVT (deep vein thrombosis). If a deep vein clot breaks loose it will travel to the lungs and lodge causing a PE (pulmonary embolism). PE's are most common after an extended hospital stay, long term bed rest, long car trips, long airplane trips, and from certain types of cancer; due to long periods of inactivity. The abdominal arteries are located in the stomach area of the abdomen. If a clot forms in this area severe abdominal pain will result, along with vomiting and/or diarrhea.

Other causes of blood clots are diseases, medications, genetic mutations, and others. APS (antiphospholipid syndrome), also known as sticky blood, is an autoimmune system disorder that causes the body to make antibodies that attack phospholipids (fats). Phospholipids are found in every cell membrane in your body; including your blood vessel's lining. APS causes the creation of antibodies which trigger the formation of blood clots. APS is common in women; commonly the cause of miscarriages during pregnancies. Disorders of the bone marrow, like PV (polycythemida vera) and thrombocythemia, can produce too many blood cells. PV causes blood clots because the blood is thicker. When there are too many red blood cells blood flow slows. PV is a rare blood disease. Thrombocythemia is a disorder where too many platelets are produced causing them to stick together and form clots.

Two rare conditions are TTP (thrombotic thrombocytopenic purpura) and DIC (disseminated intravascular clotting), both of which cause clotting. TTP forms clots in the very small blood vessels in the brain, heart, and kidneys. DIC (disseminated intravascular coagulation) occurs during pregnancy which causes severe infections, and/or severe trauma; where blood clots form throughout the body. Medications that contain estrogen increase the risk of clotting. Estrogen disrupts the normal clotting process. Other medications, such as Heparin, that are intended to reduce the risk of clotting, can cause an increase in clotting in some patients. Smoking increases the likelihood of platelets sticking together. Smoking substantially increases the risk of blood clots. Smoking also causes damage to the lining of blood vessels; an increased risk of blood clots.

Homocysteine, an amino acid, increases the risk of blood clots when present in higher concentrations. Your body normally regulates the homocysteine levels naturally; but only if 100% of the daily requirement of all of the primary vitamins and minerals are present (most diabetics are seriously deficient in 10 or more vitamins and minerals). Homocysteine levels are greatly impacted by your folic acid and B vitamins (B6 and B12) levels in your bloodstream; oral diabetic medications cause vitamin B12 deficiencies. They play key roles in the breaking down of homocysteine into many other very important amino acids that are needed by the body. Folic acid deficiencies are common in patients with heart disease. Other causes of high homocysteine levels are low levels of thyroid hormones, kidney disease, psoriasis, certain medications, and genetics. Dehydration is common in the overwhelming majority of adults, especially diabetics, and usually goes undetected. Dehydration causes your blood vessels to narrow which increases the risk of clotting.

Studies have demonstrated that insulin resistance increases the numerous factors that lead to a higher risk of forming blood clots; like fibrin levels. The reasons for these changes have not been discovered. However, obesity has been found to play a major role. A high fat diet is also a cause. Elevated insulin levels are also a major factor.

### Thrombosis

Thrombosis is the tendency to develop blood clots. Deep vein thrombosis (clot formation) is of considerably greater risk to diabetics, especially those that are blood type A and AB. As stated, diabetics have excess fibrin, the clot forming matter) in their bloodstream, and a deficiency in plasmin, the protein enzyme that dissolves fibrin and clots. Arteries have thin muscles that are within their walls. They have to be strong enough to withstand the pressure caused during the pumping action of the heart. The pressure has to be great enough to force blood into the farthest points (extremities) of the body. The blood vessels do not have a significant amount of muscle in their walls. Physiology pumps the blood back to the heart, which means that muscle activity employed to move our arms, legs, head, and large muscle groups forces the blood back to the heart. They squeeze the veins during normal daily activity.

There are two primary types of blood vessels in your legs. The superficial veins are found just below the skin, many can be seen in the skin. The deep veins are located deep inside the muscles. The blood flow is from the superficial veins into the deep veins via small perforator veins. They are constructed with one way valves that only allow the blood to flow in one direction. Thrombosis occurs when a clot forms in the deep veins of the legs. They are not dangerous, unless parts of them break off and travel back through the heart into the lungs. If they become lodged in the veins in one of the lungs a pulmonary embolism will occur. If clots form in the superficial veins there is no real danger of causing a pulmonary embolism. The perforator vein check valves act like a sieve that prevents the clots from passing through into the deep veins.

Prolonged sitting, as is common during long trips in a car, train, bus, or airplane, or long periods of bed rest, will cause the pooling of blood in the legs which can promote clot formation. They are sometimes more common following surgery, and extended hospital stays. They can also be of greater risk during pregnancy or up to 8 weeks after delivery.

Blood is designed by nature to be constantly moving. Anything that promotes a slowdown in flow, especially pooling, will promote the formation of blood clots. Damage to the veins and inflammation can lead to clotting. Inflammation does not imply that an infection is present. The symptoms of deep vein thrombosis are pain in the leg, redness, warm feeling, and swelling. It is possible that only one of these symptoms manifest. Prompt treatment is very important.

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# Chapter 5-Silent Heart Attacks

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> "In 2012, an international task force defined six different types of heart attack. The distinctions are important because each type may be treated differently. Because some heart attacks do not cause symptoms, the presence of a protein called troponin in the blood, plus chest pain or evidence of heart attack on an electrocardiogram or imaging test, is required to make the diagnosis."-Harvard Heart Letter

Most diabetics are aware that they are at a higher risk for developing heart disease, or suffering a stroke. But, most are not aware that they are up to four times more likely to develop heart disease or have a stroke. Most do not know that nearly 9 out of 10 diabetics (85%) will die of a heart attack or stroke. Very few are aware that there is a silent form of heart attack, and that they are highly prone to suffering a silent heart attack. Silent heart attacks show very few, if any, symptoms. An estimated 200,000 silent heart attacks occur each year. They typically are virtually undiagnosed. An estimated 40-60% of all heart attacks are undetected (undiagnosed) every year. It is estimated that one in five heart attacks that occur each year in patients over 65 are silent heart attacks. Remember that heart attacks occur when blood clots form and block the flow of blood from a coronary artery to the heart muscle. The resulting blockage causes the heart muscle to scar or die.

The heart attack can range from mild to severe, depending upon the amount of damage done. All areas of the heart, large and small, are ultimately affected. They are almost always life threatening, especially if they are not treated immediately. Silent heart attacks have similar symptoms, if felt at all, as other types of heart attacks. The symptoms are vertigo, mild back pain, sweating, and indigestion, shortness of breath, nausea, and possibly fainting. The patient may experience mild chest pain or discomfort, and pain in the jaw and arms, and may tire easily, which goes away with rest. There are two types of silent heart attacks. An attack that is truly silent will produce no symptoms whatsoever. The second type has symptoms that are very mild. They are ignored because the patient does not associate the symptoms with that of a heart attack. Both types increase the chances of the developing heart disease. The attacks can become more advanced which can cause additional, more severe, heart attacks.

The discovery of the existence of silent heart attacks is recent, so research and treatment is very limited. Since most patients are unaware that the attack has occurred complicates the process. What is known is that being elderly, a smoker, and/or diabetic, has high stress, and a family history of heart disease are common risk factors. Silent heart attacks are also known as non-Q-wave silent attacks. Twice as many people die from a silent heart attack as from myocardial infarction; where chest pains develop. Non-Q-wave attacks occur more frequently in those that have had a prior attack and in individuals that are taking medications on a regular basis. The nerve endings in your heart muscle suffer damage if you have a heart attack. The cause of the death of nerve endings is usually autonomic neuropathy (AN); where high blood sugars cause damage to the capillary blood vessels that feed the nerve endings. You may recall that neuropathy kills the nerve endings in your feet and legs, and in the muscles surrounding your intestines. But neuropathy, if untreated, will also affect the nerve endings in your heart muscle. You will also recall that neuropathy causes a complete loss of feeling in the area of the damage.

Silent heart attacks cause symptoms after-the-fact. The symptoms may be very intense fatigue where exercise may be more difficult than before. Treating all types of heart attacks is the same, which is centered on restoring blood flow to the heart muscle. When a clot develops thrombolysis treatments are used to remove the clot, or they may use angioplasty to restore blood flow.

Diagnosing a heart attack can be very involved. It will start with a review of family medical history and some basic tests. An EKG (electrocardiogram) is conducted by passing an electrical current through your heart muscle. During the test the machine plots a graph of your heart's pumping activity. Any damage will show up on the graph. If you have suffered a heart attack the attack will leave a signature "Q-wave" on the graph.

There is a new diagnostic technique (DE-CMR), delayed-enhancement cardiovascular resonance that uses magnets and radio waves to enhance images of the heart. It picks up damage that can be missed during an EKG. The test has found heart damage due to heart attacks in patients that have no history of a heart attack. Of those tested 35% did not display a Q-wave signature; but they did display evidence of coronary disease. Studies have shown that patients with non-Q-wave silent heart attacks are 11 times more likely to die from any cause. They are 17 times more likely to die from heart disease than those without damage. All diabetics should have an EKG screening at least once each year.

Discovering damage early is very important for proper treatment. Therapy can be initiated to reduce the risk of additional damage. As stated damage from silent heart attacks is not found until long after the damage occurred. Heart damage is permanent.

Most doctors put diabetics on an aspirin per day therapy as a precaution. Every diabetic should have an annual stress test, blood tests, urine screening, sonograms of the major arteries, and an EKG screening routinely (annually). Preventing silent heart attacks is the same as the practices used to prevent all other types of heart attacks. Stop smoking, limit alcohol consumption, exercise regularly, lose all the excess body fat, manage blood pressure, triglycerides, and cholesterol, and eat a healthy diet.

****

# Chapter 6-About Blood Pressure

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> "People with high blood pressure, diabetes-those conditions brought about by lifestyle. If you change the lifestyle, those conditions will leave." -Dick Gregory

> "Your pantry is your first line of defense against food-borne illness and things like high blood pressure and cholesterol." -Joe Bastianich

One of the first things that are done during a doctor's visit is the checking of your blood pressure. That should signify that it is very important. High blood pressure, also known as hypertension, is very common in diabetics, and very dangerous. Hypotension is the opposite of hypertension; meaning that hypotension is very low blood pressure, which can be equally dangerous. The majority of diabetics do not know the causes of high blood pressure, or how they can enable their body to regulate it. Blood pressure readings are comprised of two numbers, an upper and lower number that are a complete mystery to most diabetics. Understanding how to monitor and maintain blood pressure is too important to be ignored. Blood pressure is categorized by cause. If the cause of high blood pressure is unknown it is referred to as primary or essential hypertension. It is called secondary hypertension is the cause is known. For example, kidney disease is a known cause of hypertension. Chronic hypertension is a major risk factor for heart disease; or strokes.

High blood pressure is credited for over five hundred thousand strokes each year, and over one million heart attacks. Up to 85% of diabetics will die from a heart attack or stroke.

One of the biggest myths about diabetes is that you can tell when your blood pressure is high. Wrong! Not even when it is extremely high. Most think that if it doesn't hurt it doesn't deserve attention. So it remains a silent killer. If a person consistently has blood pressures 50% higher than normal their life expectancy is less than 5 years. That is why doctors call high blood pressure the silent killer.

Blood pressure is the force per unit area; the actual pressure, exerted on the walls of your blood vessels. The pressure is created by the pumping action of your heart. Each time your heart beats your heart's muscle will contract forcefully. It has to in order to move blood through the many miles of blood vessels in your body; especially those in your extremities. If you are overweight you have even more blood vessels that need to be fed.

Research has shown that high blood-pressure problems are not due to excessive salt intake, but due to an overactive hormone system, which results in an increase in renin levels. Elevated renin levels cause a physiological need for salt. Low sodium levels in the body have not shown a decrease in cardiovascular deaths, or any changes in life span, as compared to high sodium levels. In fact, low sodium diets have shown substantial increases in heart attacks (400%) in men. Lower sodium levels elevate fasting insulin levels. It also elevates the LDL (bad) cholesterol levels, which is a primary factor in the development of cardiovascular disease. Low sodium levels will affect mood and energy levels, as well as mental clarity.

Salt-restrictive diets can raise blood pressure, bring on accelerated ageing through cellular degeneration, cause adrenal exhaustion and tire the valves of the heart muscle. Studies have shown that salt restriction may be linked to organ damage. If the heart and the kidneys are damaged by low blood sodium levels (hyponatraemia), hypertension (high blood pressure) may become worse. A sodium deficiency in the summer months can lead to heat exhaustion. Heat exhaustion is a severe mineral disturbance that causes fainting and sometimes a stroke; or a heart attack. Sea salt will regulate blood pressure whether it is too high or too low. The process can take 2-3 months to produce consistent results. Sea salt scours the body looking for excess salt deposits in the tissues lowering blood pressure as it removes these deposits through the kidneys.

A normal blood pressure reading is 120/80 mm Hg. Some doctors prefer 115/75 mm Hg. When your blood pressure raises above the normal level your risk of heart disease and kidney damage increases dramatically. Due to friction and other factors your actual blood pressure drops at your extremities as compared to right at your heart. Your blood pressure will drop approximately 5 mm Hg at the farthest point.

Some of the causes of high blood pressure are:

Atherosclerosis; which is due to plaque buildup in the arteries. As the amount of plaque in the arteries builds up the artery becomes constricted making it harder to pump the blood which increases the blood pressure.

Your kidneys possess the ability to constrict, or relax, your blood vessels. When the vessels are constricted your blood pressure will rise. The kidneys seek to maintain enough blood pressure to force the blood through their filters.

Obesity is a cause of elevated blood pressure. Obesity causes a significant increase in the GGT enzyme, which contributes to high blood pressure and high cholesterol. GGT (an enzyme found primarily in the liver) is especially high when the bile ducts are clogged; which is common in diabetics. In all men and women over 45 the normal range is from 6-37 Units/Liter, and 5-27 U/L in women under 45 (some measurements are taken as IU/L). Liver disease can be caused by elevated levels of GGT. The GGT enzyme is particularly sensitive to alcohol, medications (drugs), and chemicals. GGT levels are used to diagnose liver blockage (obstructive jaundice), liver metastiasis, acute pancreatitis, kidney disease, recent surgery, an early warning of developing heart disease, and metastiasis of prostate cancer. Elevated GGT levels can increase the risk of heart disease by 1.5-2 times normal. Elevated liver enzymes can be caused by hypothyroidism, but often decreases the GGT levels. GGT levels are directly associated with obesity, and diabetes.

Fatty liver is a contributor to elevated GGT levels. Certain medications and liver disease can elevate the GGT levels. The amount of fatty liver present is directly associated with the amount of excess visceral/adipose (belly) fat.

GGT enzymes play a critical role in the transfer of amino acids and phosphates across cell membranes. Besides the liver it is found in the cells of the kidneys, pancreas, gallbladder and bile ducts, spleen, heart, brain, and seminal vesicles. It is involved in the metabolism and degradation of glutathione (amino acid).

Fat cells are fed by many miles of blood vessels, especially in the belly area. More pressure is required to supply the additional blood vessels. Belly fat increases insulin resistance which interferes with your body's utilization of insulin. When glucose builds up in your blood vessels your kidneys will retain sodium which causes higher blood pressure. This is the primary reason why diabetics are three times more prone to have high blood pressure.

High blood sugars increase (above 180) the viscosity (thickness) of the blood; which will make it much more difficult to pump; resulting in higher blood pressure. Your blood becomes syrup-like in consistency. Slower blood flow increases the risk of clot formation.

Vitamin deficiencies, especially vitamin D and calcium, will cause your blood pressure to rise.

Diet that is low in antioxidants will cause an increase in blood pressure. Antioxidants protect and increase the body's supply of nitric oxide which relaxes blood vessels.

High consumption of table salt will cause an increase in blood pressure.

### Lowering Blood Pressure

So what exactly is blood pressure? Blood pressure is the actual pressure, the force per unit area, exerted on the walls of each blood vessel when blood is pumped by the heart. Your heartbeat is actually the pumping action of your heart. When your heart muscle contracts, it contracts with enough force to force blood to move through the many miles of blood vessels in your body. The blood has to be pumped with enough pressure to reach all of the extremities of your body. Your vascular system is very similar to a tree. The trunk of the tree is the major arteries which branches off into the various smaller and smaller branches until each branch terminates in the very tiny, hair-like, capillaries. Your capillaries have very small holes in them that allow the distribution of oxygen and nutrients, and the removal of waste products.

Blood pressure in the body decreases as the blood moves further and further from the heart. A drop of 5 mm Hg at the extremities (toes) is considered average. Blood pressure is measured at the brachial arteries; located in both arms at the elbow. Each time your heart beats the pressure will maximize due to the contraction of the heart muscle, and then the pressure will drop as the heart muscle relaxes. The maximum pressure, or peak pressure, is called the systolic pressure. The lowest pressure of the pump cycle is called the diastolic pressure. For example a reading of 120/80 would mean that 120 is the systolic pressure (peak pressure), and 80 is the diastolic pressure. The unit of measure for blood pressure is mm Hg (millimeters of mercury). You can still find a few of the original devices that were used to measure blood pressure in doctor's offices. However, few doctors still use them. It was these old style devices that established the unit of measure for blood pressure. The testers have a glass tube (column) that contains liquid mercury. Behind the column of mercury is a scale in millimeters. The scale was read by looking through the glass tube at the top of the mercury column and a reading of millimeters was taken at the top of the mercury column; thus a reading of millimeters of mercury. It is similar to the measuring tape (scale) on the wall that a person stood against to measure their height. By reading the scale at the top of their head revealed their height in feet and inches.

To use the device a cuff was placed around the upper part of the arm; either the right or left arm. A squeeze bulb was repeatedly compressed to increase the squeezing (contraction) pressure on the arm. When the pressure in the cuff is increased, a corresponding amount of pressure was applied to the column of mercury, which causes it to rise against the millimeter scale. When the pressure in the cuff was released, a corresponding decrease in pressure on the column of mercury will occur; the column will drop against the millimeter scale. The doctor or nurse would increase the pressure in the cuff while holding a stethoscope over the vein at the elbow; on the brachial artery.

The pressure in the cuff is increased until the blood flow through the brachial artery is cut off (stopped). It is much like applying a tourniquet to stop blood flow after an injury. The doctor or nurse then slowly releases the pressure in the cuff to allow blood flow to resume. The stethoscope will allow them to hear the exact point where the blood flow resumes. At the exact point where the blood flow resumes a "swooshing" sound will be heard in the stethoscope; referred to as the first Korotkoff sound. It is at this point where the first reading would take place. They would read the millimeter scale at the top of the mercury column. The maximum reading (systolic pressure) in millimeters of mercury, or mm Hg, is recorded. Then the pressure in the cuff is released until no sounds can be heard; known as the fifth Korotkoff sound. The mercury column would again be read against the millimeter scale and recorded as the diastolic reading; diastolic arterial pressure reading. The two values are then compared to the standard pressures (ideal or normal pressures) 120/80 mm Hg. Some experts prefer a lower value of 115/75 as a normal reading.

If a blood pressure reading is higher than 120/80 the risk of heart disease, and kidney disease, increases. Some doctors will take readings on both arms to detect arterial disease; obstructions in the arteries. A difference in excess of 10 mm Hg is considered significant. Both the systolic and diastolic pressures can change from heartbeat to heartbeat. These variations are due to a large number of factors and are considered normal; stress, physical activity, nutritional factors, drug reactions, talking, or simply standing up can cause a change. Your nervous system plays a part in the maintenance of your blood pressure by controlling (constricting or relaxing) the size of your blood vessels and altering your heart's pumping action. It is often compared to placing a finger over the end of a water hose to increase the pressure.

Your kidneys are also capable of regulating your blood pressure by adjusting the volume of fluids (blood) in your body. Your body monitors the sodium concentration in your blood very aggressively; as it does for acidity (pH), glucose, and fluids. If the sodium concentrations become higher than the normal range, your kidneys will retain water (increase the fluid volume) to bring the concentration back to within the normal range.

The excess sodium and fluids will eventually be removed to maintain the body's fluid levels within the normal range. Some is lost to perspiration; most is discharged in the urine. Since 25% of all the body's blood is pumped from the heart to the kidneys to be filtered, blood pressure is important in order for the filtration system to work properly. If the blood volume decreases, the kidneys will seek to increase the volume in order to increase the pressure. A normal blood pressure provides the optimal pressure for forcing blood through the filters of the kidneys. Your kidneys also have the ability to cause your blood vessels to constrict or relax which impacts blood pressure. There are several causes of high blood pressure. Plaque build-up in the arteries is a common cause of high blood pressure. Obesity also causes an increase in blood pressure. Fat cells are fed by many miles of blood vessels, especially the fat cells in the belly area (adipose tissue). Higher blood pressure is required to pump blood through all of the extra vessels and capillaries.

## Types of High Blood Pressure

The most common of high blood pressures (hypertension) is where both the systolic and diastolic pressures are higher than normal. But, there actually are three additional types of high blood pressure; isolated systolic high blood pressure, white coat high blood pressure, and borderline high blood pressure. Isolated systolic high blood pressure is where the systolic pressure is high. Recall that the systolic pressure is the top number; immediately after the heart muscle contracts. A systolic pressure above 140 is considered high.

**Isolated systolic hypertension (ISH)** is defined as a systolic pressure above 140 mm Hg. It is most common in the elderly. It usually is associated with a diastolic pressure below 90 mm Hg. It is caused by an increased wide pulse pressure (wide being the difference between the systolic and diastolic pressures). An increase in the systolic pressure without an increase in diastolic pressure increases the pulse pressure. The most common cause is a stiffening of the arteries (plaque buildup). It should not be ignored as it represents an increased risk for heart disease. Electrolyte and sodium imbalances can cause an unusual spread in the systolic blood pressure relative to the diastolic pressure. Restoring the electrolytes will sometimes correct the problem. If the systolic pressure increase is due to atherosclerosis (plaque buildup) systemic enzymes can be used to dissolve and remove the plaque (discussed later).

Isolated systolic hypertension can be caused by a leaky heart valve; which is rare. It can also be caused by an overactive thyroid gland (hyperthyroidism), which is not common in diabetics, adrenal gland issues, kidney disease, anemia, and sleep apnea. Elevated systolic pressure is also associated with the development of dementia. For a long period of time doctors focused on diastolic blood pressure, thinking that the body could tolerate elevated systolic pressures. Consistently high diastolic pressure can lead to dangerous health issues. However, the thinking has shifted to include elevated systolic pressures in the risk of developing health issues; in fact more important in people over 50 years of age. Some medications used to treat elevated systolic pressure can dangerously lower the diastolic pressure, which increases the risk of heart attack or stroke. The diastolic pressure should not be less than 70 mm Hg long term.

**White coat hypertension** is simply a reaction to being in a doctor's office. It is not unusual for patients to display a high blood pressure while in their doctor's office due to anxiety. It is usually only temporary.

**Borderline high blood pressure** is when the blood pressure is mildly elevated above 140/90 mm Hg. It is usually age related. It can be a warning that frequent checks need to be taken, and treated if it persists above the normal range.

Obesity causes insulin resistance which interferes with your body's utilization of insulin. Your body will not be capable of properly utilizing its insulin to remove glucose from your bloodstream. In type II diabetics the body will produce more insulin in an attempt to remove the excess glucose. When insulin levels in your bloodstream are high your kidneys will retain sodium, which results in higher blood pressure. This is one of the primary reasons why type II diabetics are up to three times more likely to have high blood pressure. When blood sugars are high (above 180) the viscosity of the blood increases (becoming syrup-like). Your heart has to work much harder to pump thicker blood.

Because diabetics are deficient in up to 10 primary vitamins and minerals the management of insulin and glucose is compromised. Chromium, zinc, magnesium, and potassium-along with calcium and vitamin D- are important in the management of blood pressure and heart health. Antioxidants reduce blood pressure by protecting the body by stopping inflammation, and because they promote the production of nitric oxide; known to relax blood vessels and lower blood pressure. When your blood pressure is high, for any reason, damage will result in the filters of the kidneys which will eventually lead to kidney disease. Any damage to the kidney's filters is permanent, and there are no symptoms while damage is occurring.

Foods That Help Lower Blood Pressure:

Plant based diets that include fruits and vegetables will aid in lowering and maintaining lower blood pressure.

Celery contains phytochemicals that relax artery muscles and lower blood pressure.

Cold water fish (wild caught) contain lots of omega 3 fats that lower blood pressure and reduce heart disease risk. Omega 3 fatty acids thin the blood and reduce the tendency to clot.

Broccoli is very high in antioxidants and anti-inflammatory agents. Broccoli is high in potassium, fiber, calcium, magnesium, and vitamin C; all of which lower blood pressure; it calms the sympathetic nervous system, relaxes blood vessels, it protects nitric oxide, and removes some heavy metals.

Dandelion greens, flowers, and roots are good for the liver, eyes, and skin. It lowers blood pressure. It is a natural diuretic. Dandelion releases excess sodium without a loss of potassium, which lowers blood pressure. Potassium helps regulate blood pressure. Magnesium dissolves blood clots, stimulates the production of nitric oxide, and promotes heart health.

Whole grain oats are known to reduce blood pressure. They are high in fiber and magnesium.

Black beans and soy beans are high in fiber which lowers blood pressure and cholesterol. Black beans are high in magnesium. They are high in folate, which synthesizes into folic acid, which reduces blood pressure by relaxing blood vessels. Soy beans are high in potassium and fiber.

Berries of all types are high in fiber and antioxidants. Blueberries, strawberries, and raspberries are among the best for lowering blood pressure. They are high in vitamin C, antioxidants, and fiber.

Spinach is loaded with magnesium and folate.

Nuts and seeds are high in magnesium, but best if unsalted.

Bananas are high in potassium. When the potassium levels are high the body will dump sodium which will lower blood pressure. Bananas balance the sodium potassium levels.

Dark chocolate is very high in antioxidants and vital nutrients. Some experts claim that 1/2 oz per day of dark chocolate will normalize blood pressure and improve heart health. However, it should be noted that it is high in calories.

Green tea helps lower blood pressure and maintains healthy levels. If consumed with a meal, along with black pepper, the numerous benefits of green tea are multiplied by 130%.

Salmon is high in protein, vitamin D and low in fat.

Avocados are high in vitamin B6, magnesium, and folic acid. They contain more potassium than a banana.

Studies have shown that a CoQ10 deficiency can cause hypertension. The administration of 60 mg of CoQ10 twice daily to patients already taking antihypertensive medications demonstrated a significant increase in the protection of the beta cells of the pancreas, liver cells, arterial smooth muscle cells, and the endothelial cells due to its antioxidant protective action. CoQ10 reduced the systolic pressure by 16 mm Hg on average in the study groups, and a decrease in diastolic pressure of 9 mm Hg. The participants of the study also demonstrated a reduction in triglycerides, lipid peroxides, fasting insulin and glucose levels. They also demonstrated and increase in HDL cholesterol, vitamins A, C, and E, and beta carotene.

It is estimated that for every 2 pounds of excess fat removed, a corresponding systolic pressure drop of 1 mm Hg will result. By significantly reducing the consumption of saturated fats and dairy, combined with an increase in fruits and vegetables can lower the systolic pressure by 8-14 mm Hg. Eliminating excess salt in the diet can lower the systolic pressure by 2-8 mm Hg. Exercising 30 minutes (min.) several times each week can lower the systolic pressure by 4-9 mm Hg. One glass of wine each day can lower your systolic pressure 2-4 mm Hg.

****

# Chapter 7-About Cholesterol

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> "I mean, when you've had a problem in your past, whether it's attributed directly to high cholesterol or not, you want to lower your cholesterol. You want to eat healthy. You want to feel healthy. You want to have a little more energy." -Mike Ditka

> "And if you have high cholesterol, you would feel the same as if you had low cholesterol because there are no side effects, no symptoms of having high cholesterol." -Mark Spitz

The name cholesterol is derived from the Greek word chole (bile) and stereos (solid) and the chemical suffix ol (alcohol). Cholesterol is found in every cell in the body and bloodstream. It is a soft waxy substance (lipidic alcohol). It is found along with other fats; which are also known as lipids. Cholesterol and fats do not dissolve in the blood, because they are only slightly water-soluble. They will dissolve and travel in the bloodstream, which is water-based, only in very small concentrations. Lipoproteins transport fats through the body in the bloodstream. Lipoproteins are biochemical assemblies that contain both lipids (fats) and proteins. The lipids, or their derivatives, form a chemical bond similar to that of pair bonding in atoms. Lipoproteins can be enzymes, structural proteins, transporters, antigens, adhesions, or toxins. HDL cholesterol is a high density lipoprotein, and LDL is a low density lipoprotein. The lipoproteins are water soluble on the outside, and fat soluble on the inside. It is a perfect substance for the body, because it enables the cholesterol fats to travel throughout the body without separating out as fats normally would; but instead float diluted in the bloodstream. It is important that the cholesterol be able to reach all areas of the body in order to perform its many functions.

When the majority of people hear the word cholesterol they think of it as a bad thing. The fact is that every cell in your body needs it in order to function. The body also uses cholesterol to manufacture hormones. Cholesterol is a good thing as long as it is properly maintained. Cholesterol is a waxy steroid of fat that is essential to the structural integrity of your body's cell membranes. Cholesterol creates cell membrane permeability, and fluidity, which enables the essential substances to pass through the membrane to the inside of the cells. Cholesterol enables cell communication which allows several biochemical pathways within your cells to function. Your body uses vitamin D to manufacture cholesterol inside your body and it aids in the manufacture of bile, which is needed for proper digestion of food. Normal cholesterol levels (values) are; total cholesterol under 200 mg/dL; LDL under 130 mg/dL; HDL over 35 mg/dL; and triglycerides under 200 mg/dL.

Your liver converts excess LDL cholesterol into bile fluid and stores it in your gallbladder. Bile contains salts that are used during digestion to break down fats in your intestine. It makes fats soluble so that they can be absorbed; including making the fat soluble vitamins (vitamins A, D, E, and K) soluble so that they can be absorbed and stored as well. Bile enables the synthesis of steroidal hormones like the adrenal gland hormones cortisol and aldosterone, and the sex hormones progesterone, estrogen, testosterone, and others.

Hypercholesterolemia will develop when cholesterol levels are elevated. That means that the LDL (bad) cholesterol concentrations are higher than normal, and the HDL (good) cholesterol concentration is lower than normal. It is a major risk factor in the development of heart disease and stroke. LDL, which stands for low-density lipoprotein, is the primary cholesterol transporter in your blood. They enable a multiple of different fat molecules to be transported around your body including cholesterol; again, fat is not soluble in water. Your blood is primarily water. LDL provides a mechanism to carry the cholesterol molecules around the body without separating out. LDL particles can be large or small. The larger LDL particles provide a survival advantage for us. The difference in size is impossible to see with the naked eye. The difference in size is measured in nanometers (nm) which is a billionth of a meter. The large particles are 25.5 nm in diameter or larger. The small particles are less than 25.5 nm in diameter. Both are thousands of times smaller than one single red blood cell; but, they are larger than a cholesterol molecule. Some estimates claim that 10,000 small LDL particles would fit within the space occupied by one of the periods on this page. The size of an LDL particle will determine if it will stick to the walls of an artery or not. The size is important in determining if you are a candidate for heart disease or stroke. It is the smaller particles that are troublesome. The term high cholesterol refers to the count of smaller LDL particles. The very low density lipoproteins (VLDL), is the critical factor.

Your liver creates packages of various proteins (like apoprotein B) and fats (like triglycerides) to form VLDL particles and releases them into the bloodstream. VLDL particles include both large and small particles. Things happen inside the bloodstream that determines if the particle will become large or small. You can control how many small particles are produced. The VLDL particles leave the liver with the intent of producing offspring. Like an egg they are loaded with energy producing substances (triglycerides). How many VLDL particles are produced is determined by your diet; high or low fat diet. The amount of triglycerides in the VLDL particle will vary. The number of triglycerides in the bloodstream will determine how many VLDL particles are released. The VLDL particles travel through the bloodstream socializing with other lipoproteins. The VLDL particles will give triglycerides to both LDL and HDL in return for a cholesterol molecule.

The liver then removes the triglycerides provided by the VLDL, the smaller particle depleted of both triglycerides and cholesterol returns to the bloodstream. When your triglyceride levels exceed 133 mg/dL, you will develop small LDL particles. Cholesterol and triglyceride levels are tested while fasting, because the values will increase substantially after eating. However measuring the triglyceride levels within 2 hours of eating is becoming a better way of predicting the risk of heart disease. Anything that increases the liver's production of VLDL particles, or increases the triglyceride content of the VLDL particles, will cause the increase in small particles that is troublesome.

Obviously fatty foods will be high in triglycerides, which include animal fat, butter, and dairy products, which will provide increased amounts of triglycerides; however, only to a small degree. While the triglyceride volume increases, it also shuts down the body's own production of triglycerides. The body is capable of producing far more triglycerides than taken in during an average meal. The actual triglyceride level stays approximately the same. The fact is that carbohydrates, which contain no triglycerides, stimulate the production of insulin, which in turn, stimulates the liver's synthesis of fatty acids; which floods the bloodstream with triglycerides; can potentially increase them to over 1000 mg/dL, depending upon genetics. The higher levels can be sustained for very long periods of time, as long as the carbohydrates (particularly high glycemic) keep being consumed.

The higher the level of insulin in the bloodstream the greater will be the number of triglycerides. Any food that will cause a vigorous increase in blood sugars will spike the triglyceride levels in the blood, and an associated increase in small LDL particles. When the volume of visceral (belly) fat is high, the fat will act as a repository that allows a constant flow of triglycerides into and out of the cells and into the bloodstream. That increases the VLDL production. Wheat and oats are two of the greatest generators of the production of triglycerides. Now you can understand how a low fat, high carbohydrate, diet can cause an increase in triglycerides; especially if the carbohydrates are grains.

When the LDL cholesterol levels are high, along with high levels of free radicals, inflammation will occur. The LDL will be oxidized by the free radicals which will result in the formation of plaque; accumulated small LDL particles and other substances. By now you know that the buildup of plaque is the primary cause of heart disease and stroke. Again, the oxidation of LDL cholesterol makes it stickier so that it will readily stick to the walls of the arteries and accumulate. HDL, which stands for high-density lipoprotein, carries between one fourth and one third of the total blood cholesterol.

When your artery walls are damaged the damage is called lesions. Two of the most common causes of these lesions is high blood sugars and homogenized dairy. The cells in your arteries are unique (like 6 other areas in your body; brain, pancreas, intestines, kidneys, nerves, and red blood cells. These cells are unique because they do not have insulin receptors on their membranes. That means that the glucose level inside the cell is not regulated like other cells. If the blood sugar is high outside of these cells, it will also be high inside, which is a very bad thing. When the glucose level inside the cells is too high, a process called apoptosis will begin; where the cells commits suicide. The damage to the tissue in the arteries sets up a perfect environment (lesions) for the collection and buildup of plaque.

Lesions provide a docking point for oxidized cholesterol. The process is a deliberate attempt by your body to protect the injury. Exercise and other vigorous physical activity increases the HDL levels in your body. Likewise, being a couch potato is a major risk factor for heart disease; because the LDL levels will be higher and the HDL levels will be lower.

Causes of high cholesterol:

Low fiber in your diet. Fiber captures LDL cholesterol in the intestines and carries it out of your body. If inadequate amounts of fiber are present the LDL will be reabsorbed back into your bloodstream.

A diet high in saturated fats.

A CoQ10 deficiency due to medications.

Sedentary life style.

Smoking and pollution lower the HDL levels in your body and increases the risk of clotting.

Alcohol raises the HDL levels in your body, but is offset by the increase in other risk factors.

### More About Cholesterol

First, it is important that you recall that cholesterol is an important substance needed by the body for overall good health; but if mismanaged can be a very bad thing. Cholesterol is used to build and maintain cell membranes, and it regulates membrane fluidity. It is also used in the cell signaling process; which means that it is a precursor molecule in several biochemical pathways within cells. The liver converts cholesterol into bile fluid, which is stored in the gallbladder. Bile contains salts. These salts make fats soluble in the intestines. Bile aids in the absorption of fat molecules; as in the absorption of the fat soluble vitamins (vitamins A, D, E, and K). Bile plays an important role in the synthesis of vitamin D and the steroid hormones like adrenal gland hormones (cortisol and aldosterone) and the sex hormones (progesterone, estrogens, testosterone, and other derivatives). When cholesterol levels are high a condition of hypercholesterolemia develops; which means that the LDL (bad) cholesterol concentrations are higher than normal and the HDL (good) cholesterol concentration is lower. Hypercholesterolemia is a major risk factor for heart disease and strokes.

Lipoproteins are very complex spherical particles. They have an exterior which is composed of proteins and fats. The outward-facing surfaces are water-soluble. Their inward-facing surfaces are fat-soluble. The cholesterol found in all the lipoproteins is identical; some cholesterol is carried as "free" alcohol, others are carried as fatty acyl esters (cholesterol esters). Each lipoprotein has Apo-lipoproteins (proteins that bind to lipids to form lipoproteins) that serve as ligands (signal triggering molecules that target specific proteins) on cell membranes. These specialized mechanisms direct the lipids that they carry to specific tissues. Triglycerides and cholesterol esters are carried on the inward facing surfaces. Phospholipids and cholesterol (amphipathic) are transported in the surface layer of the lipoprotein particle. There are many kinds of lipoproteins; however HDL and LDL are the primary ones. LDL is the primary cholesterol transporter in the blood. When LDL (bad) cholesterol levels are too high, along with the presence of free radicals, the LDL cholesterol will be oxidized by the free radicals; resulting in the formation of plaque. The plaque will form on the walls of the arteries leading to the heart and the brain. Oxidation of LDL cholesterol makes it stickier; more inclined to attach to the artery walls. Lipoprotein particles are molecular addresses; they determine where they start and finish. The LDL level should not exceed 160 mg/dL, and should be maintained at a level below 100 mg/dL. Doctors usually have heart patients keep their levels below 70 mg/dL.

HDL carries between one fourth and one third of all blood cholesterol. HDL collects LDL cholesterol and carries it away from the arteries. As stated, it is carried to the liver where it is added to the bile fluids in the gallbladder, and is ultimately discharged into the small intestine where fiber collects it and carries it out of the body. If the amounts of fiber are adequate, the LDL will no longer present a threat to health. If the fiber intake is inadequate, the LDL will be reabsorbed back into the bloodstream. When the HDL concentrations fall below 40 mg/dL in men, and 50 mg/dL in women, the risk of heart disease and stroke is much higher. Higher levels of HDL protect against heart disease. A genetic variation of LDL [Lp (a)], also known as lipoprotein (a), is an important risk factor for the development of atherosclerosis. Lipoprotein (a) is more commonly found in the African American population; which accounts in part for their higher risk of heart disease and stroke. How it contributes is not fully understood. Again, when the artery walls are damaged they are called lesions; which provide a docking point for plaque to attach. It is believed that Lp (a)'s interact with lesions to provide for the attachment of plaque and other fatty deposits.

The liver produces around 1,000 mg of cholesterol every day. That accounts for about 20-25% of the total cholesterol production in the body each day. Some cholesterol is produced in the intestines, adrenal glands and the reproductive organs. Diet accounts for the balance. Animal fats, dairy, poultry, eggs, and shellfish are the primary diet sources.

There is no cholesterol found in seeds, nuts, and grains. The body will generate all of the cholesterol that it needs naturally; dietary sources are not needed. It is estimated that the average adult male consumes 340 mg of cholesterol in their diet each day. Women consume 220 mg on average of cholesterol each day in their diet. Doctors recommend limiting the daily intake of cholesterol to 200 mg; which is the equivalent of 6 oz. of lean meat or poultry per day. The most dangerous fats are Trans fats and saturated fats.

Hypothyroidism can cause blood cholesterol to rise. Successfully treating hypothyroidism will help lower the cholesterol levels. See the "Diabetes and Hypothyroidism" chapter for more information. Physical inactivity (couch potato) is a major risk factor for heart disease. Exercise and vigorous physical activity increases the HDL level in the body. Smoking lowers the HDL levels and increases the risk of blood clots. Alcohol consumption raises HDL levels; but is offset by the increase in other risk factors. All foods that contain animal fat contain cholesterol in varying amounts. Animal fats are a complex mixture of triglycerides, Trans fats, and saturated fats. They play a larger role than all other cholesterol intake on blood cholesterol levels. Dairy products contain saturated fats. Chocolate, and many oils, contain saturated fats. Unsaturated fats that are partially hydrogenated derive Trans fats. They are not needed by the body.

When blood tests are conducted for cholesterol the LDL levels are not directly measured. The cost would be prohibitive. Instead the Friedewald formula is used. The total HDL is measured, and then subtracted from the total cholesterol, minus 20% of the triglyceride count, which nets the estimated LDL level; this test is a fasting test meaning that no food is consumed for 6 or more hours prior to the test. Triglyceride levels vary greatly with food intake, and will otherwise skew the results of the test.

Diabetes is very damaging to your cardiovascular system. High blood sugars (hyperglycemia) cause damage to blood vessels; especially the capillaries. High blood sugars cause your blood pressure to rise and increase your heart rate. Scientists still do not understand all of the reasons why high blood sugar damages blood vessels and capillaries, but they have established that high blood sugars are the cause. Low blood sugars (hypoglycemia) also increase your heart rate. Erratic blood sugars cause depression, vitamin and mineral deficiencies, and can lead to heart disease.

Scientists have established that there is an increased susceptibility for diabetics to have an increased level of low-grade inflammation of the arterial lining. The damage occurs in all areas of your body. Your heart is also impacted. Your heart muscle gets all of its nutrients, which includes oxygen, blood, calcium, magnesium, and potassium from your blood vessels; particularly from your capillaries. Your heart muscle is totally covered with capillary veins. Nearly nine out of ten diabetics will die from a heart attack or stroke.

## Heart disease is the leading cause of death for diabetics.

Diabetics commonly have high cholesterol, high blood pressure, and high triglyceride levels in their blood. Your body manufactures cholesterol and some comes from diet. As stated, cholesterol is used by the body in a number of important functions. It is a good thing when properly managed. Cholesterol is essential to all forms of animal life. It becomes a bad thing when it goes out of control. Your liver manufactures all cholesterol and places it into the bloodstream. Your vascular system carries it throughout your body. The HDL cholesterol collects LDL (bad) cholesterol as it travels, and carries it back to your liver. The LDL cholesterol is removed by your liver and mixed in the bile fluids. The bile fluids are secreted into your small intestine as an aid to digestion. If you eat adequate amounts of fiber your body will dispose of the LDL cholesterol. If you don't get enough fiber in your diet the LDL cholesterol will be reabsorbed back into your bloodstream. If you are a typical diabetic you get less than half the fiber your body needs each day.

Inflammation contributes to the problem. LDL cholesterol is oxidized which makes it stickier. It will more readily stick to the damaged area in the vessels and arteries. The cholesterol, along with other substances, will collect and form plaque. When the plaque breaks loose and travels through the bloodstream that bad things happen. You will suffer a stroke if the blood supply to the brain is blocked. Brain damage will result and can result in death. The blockage can be caused by a blood clot or plaque.

Symptoms of a stroke vary. The symptoms may include sudden weakness, numbness of the face, arm, or leg; typically on one side of the body. The patient will be confused, have difficulty in talking, and an inability to understand conversation. They will experience sudden dizziness, loss of balance, and difficulty in walking, a loss of vision, or double vision, in one or both eyes along with a severe headache. The symptoms sometimes occur then disappear.

Transient ischemic attacks (TIA), or mini strokes sometimes occur. When any of these symptoms occur treatment should be sought as quickly as possible. Most of the damage due to a stroke can be avoided with prompt attention. Approximately 80% of diabetic strokes are ischemia type attacks which is caused by a fatty buildup in the vessels that lead to the brain; or are caused by particles of plaque that break loose from arteries where they accumulated. If the clumps of plaque travel to the brain and lodge in a smaller vein, or a capillary vein, the blood flow will be blocked. The brain will suffer the loss of nutrients and oxygen so that particular part of the brain will begin to die. Twenty percent of diabetic strokes are cerebrovascular strokes. They occur when a blood vessel in the brain begins to leak, or bursts. The blood buildup applies pressure on the brain. Blocked or restricted blood flow can cause angina which is a pain in the chest, shoulders, arms, or in the back. The pain will become more intense when exercising or excited, but usually subsides while at rest. Common symptoms, other than pain, are weakness and sweating.

The problem will progress over time if not treated. It is possible that a person will not feel the pain if damage to capillaries has starved nerve endings resulting in damage or death. A heart attack will occur if the blood vessels near the heart are clogged, which cuts off the oxygen and nutrients to the heart muscle. Your heart muscle cannot function without them. Symptoms of a heart attack include nausea, light headedness, shortness of breath, extreme weakness, indigestion, pain in the chest, arms, shoulder, jaw, and neck. It will also include sweating.

Peripheral arterial disease (PAD occurs if the blood vessels in the legs become restricted. The symptoms include pain in the legs (cramping) while walking, climbing stairs, or exercising are the most common symptoms. Slow healing sores, numbness, or tingling in the feet or legs are also symptoms. If the pain continues, even after resting, and the foot or lower leg is noticeably cooler than other areas of the body, the PAD may be severe. PAD should not be confused with neuropathy, which has a common cause, which is a lack of circulation in the legs and feet.

Neuropathy is typically caused by capillary damage that causes the death of nerve endings. Elevated blood sugars cause a scaring of the insides of the capillaries, which disrupts the capillary's ability to distribute blood and nutrients to the body's cells (and nerves). Since some nerve cells do not have insulin receptors (like the others mentioned-brain, intestines, pancreas, kidneys, arteries, and red blood cells), the elevated blood sugar will also cause elevated blood sugar levels inside these nerve cells; which will set up apoptosis (cells death). It will impact the sense of pressure, temperature, or cause pain in the skin. When your blood sugars are high glucose attaches to proteins in your red blood cells (glycation), which alters their structure and function. Your blood vessels become more elastic and thicker which restricts blood flow. Your red blood cells live for approximately 90 days. Periodically you have blood tests; which includes the A1c test (glycated hemoglobin test). Every three months your body replaces its red blood cells. The blood test measures the extent that glucose has bonded to your red blood cells over the previous three months. The reading will gauge how well you have managed your blood sugars over the previous three months; how many glucose molecules have bonded to red blood cells forming AGE's. It also serves as a measure of how much damage has occurred over the past three months to other areas of the body.

Your body reacts to damage in your vascular system by attempting to coat the damaged areas with plaque. That is one of several reasons why diabetics are two to four times more likely to develop heart disease than normal. AGE's (advanced glycosylation end-products) form whenever blood sugars rise above 110. Glucose attaches to the proteins of red blood cells and other proteins in the body. Obviously AGE's are much higher in diabetics, and are credited by scientists as being one of the primary causes of the manifestation of diabetes. AGE's damage arteries and accumulate throughout your body's tissues and joints. AGE's also from as the result of eating processed foods that contain chemical additives and preservatives.

Again, plaque buildup in your arteries is called atherosclerosis. It is the narrowing of your vessels which restricts blood flow. Restricted blood flow slows the flow of blood through the vein. Anything that slows the flow of blood, or allows the formation of blood pools, causes a substantial increase in the risk of clotting. If your blood pressure rises due to causes outside of the control imparted by your kidneys, damage will result to the filters in your kidneys that will lead to kidney disease.

Cholesterol is a driving force for heart disease, because HDL (good) cholesterol is typically lower than normal in diabetics. It is a key player in the body's quest to repair damage to the vascular system. When the HDL levels are lower, that means less LDL (bad) cholesterol will be removed from the bloodstream. Triglycerides are the most common form of fat in your body. Triglycerides are formed primarily in the liver during the conversion of excess glucose and fructose that is converted and stored in the liver, and the adipose tissue as belly fat. Your muscle tissue typically stores glycogen (converted glucose) as an energy source for future needs during physical activity and exercising. Triglycerides contribute to the formation of cardiovascular disease.

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#  Chapter 8 How Diabetes Causes Cardiovascular Disease and Strokes

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> "Think about it: Heart disease and diabetes, which account for more deaths in the U.S. and worldwide than everything else combined, are completely preventable by making comprehensive lifestyle changes. Without drugs or surgery."- Dean Ornish

Diabetes is an inflammatory disease. That means that inflammation played a major role in the manifestation of diabetes. Earlier we discussed how pro-oxidant (inflammatory) rich, and antioxidant void diet set up massive amounts of inflammation (immune system responses). Inflammation led to increased visceral (belly fat), fatty liver, insulin resistance, insulin control issues, additional weight gain, and the manifestation of diabetes and diabetic complications.

It will prove very helpful to understand what insulin resistance is, because insulin resistance drives many diabetic complications; including cardiovascular disease. Below you will find an illustration of a typical human cell. The illustration provides an opportunity to see how the capillary vessels look and function, as well as the many other organelles and parts that are found on a typical human cell. Each cell is encapsulated by a membrane, which separates the inside environment of the cell from the outside environment. The membrane contains many thousands of specialized mechanisms that enable to cell to react with its outside environment.

Before we discuss insulin resistance further there are a couple of things that you should know about the human cell. The arteriole capillary (upper left) pumps blood out around each cell in your body's tissues. The blood flows all around each cell allowing each cell to draw the oxygen and nutrients needed to function and pass them through the membrane into the inside of the cell. If you look at the upper right side of the membrane you will discover the antigens. You will recall earlier, where we spoke about how antigens sample everything that enters or contacts your body to determine if it is detrimental or beneficial to your body. If something is detrimental your body's immune system will dispatch white blood cells (immune cells) to the area to encapsulate and destroy the invader. The used-up (spent) blood will be picked up by the venule and lymph capillaries and carried back to the heart to be processed (recharged with oxygen and nutrients).

When you eat a meal all of the food is converted into glucose, fat, or protein, and is absorbed into your bloodstream. That means if you eat the wrong things, like high glycemic index foods, or too much food, your body will dutifully convert it all into glucose and place it into your bloodstream. Your body will automatically secrete an appropriate amount of insulin into your bloodstream; based upon what and how much you eat.

At the lower left side of the cell (above) you will discover the insulin receptors and gates. All cells store small amounts of glucose inside, which will be processed and combined with hormones that will enable the glucose to be taken in by the mitochondria and burned to produce body heat and energy to power the cell; to enable it to function. The large globe (center right above) is the nucleus, where your DNA is stored. Your DNA regulates what is going on inside each cell. When the stored glucose is used for fuel, the DNA will signal the insulin receptor to activate, capture, and utilize insulin, that is floating around in the bloodstream, to actuate the gate to allow one molecule of glucose to enter the gate, and then into the inside of the cell to replace the glucose that was used.

When the insulin docks on the receptor enabling the glucose to enter the gate/cell, both the insulin and glucose in the bloodstream will be reduced; the blood sugar will be reduced by one molecule each of glucose and insulin. When 10 trillion of these cells are up-taking insulin and glucose, it should be easy to understand how the blood sugar would drop; because they have been removed by the cells.

### Insulin Resistance

Insulin resistance occurs when the insulin receptors malfunction. The DNA may be sending signals to the insulin receptors, but some of them are not responding. Consequently, the glucose cannot enter the gates, or the cell. The blood sugar will continue to flow (circulate and recirculate) throughout the body at an elevated level. Your brain's control center (hypothalamus) will react by instructing your pancreas (if you are not insulin dependent) to pump more insulin into your bloodstream. Your brain will act very aggressively in an attempt to get the excess glucose and insulin out of the bloodstream quickly, because they are very toxic substances. Insulin resistance confuses your brain. Longer term elevated blood sugar is not a normal occurrence.

Your body is designed to maintain between 4-5 grams of glucose in order to prevent damage to the blood vessels; especially the capillaries which will be easily damaged. Four grams of glucose (less than 1 teaspoon of glucose) will raise your blood sugar to 80 mg/dL, and 5 grams (one additional gram) will raise your blood sugar to 100 mg/dL. Your hypothalamus will do the only thing that it knows how to do, which is pump more insulin into your bloodstream; hoping that it will reduce the blood sugar level.

When the hypothalamus's efforts to reduce the excess glucose fails, the excess insulin will signal the liver to convert the excess glucose into triglycerides and stuff them into fat cells in the adipose (belly area) tissue for storage. It is very important to note that your body's liver, muscle tissues, and cells have a very limited capacity for glucose. That means that if you overeat, as most diabetics do, or you eat the wrong things (high glycemic index foods), the excess is going to be stored as fat. The book "Diabetes Control-6 Steps to Gaining Complete Control over Diabetes" has a section that explains what to eat, how much to eat, and how to determine portion sizes to avoid elevated blood sugars. It also explains how to balance calories, carbohydrates, proteins omega 3's and omega 6's, which is very important for preventing heart disease.

Insulin resistance can be traced to some of your genes, however, excess fat, excess insulin, and a lack of exercise contribute heavily to its development and intensity. Poor sleep patterns can contribute; particularly less than normal amounts of sleep.

Elevated blood sugar is the only symptom of insulin resistance; provided that the pancreas is producing insulin- not insulin dependent. However, as you will learn continuous elevated blood sugar will eventually destroy enough beta cells (insulin producing cells in the pancreas), that the type II diabetic will become insulin dependent type II diabetic; will require insulin injections. A pre-diabetic will progress into type II diabetic, and then finally into insulin dependent type II diabetes; if the blood sugar is not controlled; and the progression of diabetic damage is not stopped.

Most diabetics believe that heart attacks and strokes are associated only with an elevated cholesterol level. Unfortunately, the risk for developing cardiovascular disease entails far more than just elevated cholesterol levels. Insulin resistance has a direct link between diabetes and cardiovascular disease. The role played by insulin resistance is too often overlooked. Diabetes and heart disease share a complex number of phenomena that cause both conditions to progress. If a person has these phenomena present they are much more likely to develop heart disease and diabetes. In fact, if a person has diabetes, they are equally at risk for suffering a heart attack as a person that has a person that has already been diagnosed with heart disease. The American Heart Association actually labels diabetes as a cardiovascular disease.

Studies have shown that 50% of people that have been diagnosed with heart disease, but have no previous history of diabetes, have been diagnosed with disturbances of glucose metabolism. The same studies demonstrated that 16% had full blown diabetes, and 36% had impaired glucose tolerance. Another study showed that 66% of persons hospitalized with more advanced, unstable heart disease symptoms (known as unstable angina) met the criteria for diabetes; despite not having been diagnosed as diabetic. The more extensive their heart disease, the higher their blood sugar tended to be. The good news is that these insights illustrate that any strategies that reduce the risk of heart disease will also reduce the risk of diabetes manifestation or complications.

Insulin resistance is the root cause of elevated blood sugars (as discussed), elevated blood pressure, elevated triglycerides, reduced HDL (good) cholesterol, an increase in small LDL (bad) cholesterol, increased inflammation, and the increased risk of developing atherosclerosis (artery plaque), blood clots and heart disease, suffering a stroke, or developing diabetes; also known as metabolic syndrome, pre-diabetes, or syndrome X.

Insulin resistance can drive the growth of artery plaque at an alarming rate, even when all other factors, like LDL, are at normal levels. Insulin resistance intimately links diabetes and heart disease. Doctors can gauge the extent of insulin resistance through simple blood tests, but rarely do. Insulin resistance follows weight gain (belly fat) that preceded, often by many years, the diagnosis of diabetes. Once insulin resistance becomes established, the die is cast. That means that if you had the signature type II diabetic "pot belly" before you were diagnosed, as most do, you had already set up most of the risk factors for developing heart disease; possibly years before being diagnosed as diabetic.

Once again, because it is so important, there are 7 areas in your body where cell damage (even cell death) is accelerated when your blood sugars are elevated. Most of the cells in your body have a protective mechanism that limits how much glucose enters each cell. Insulin receptors that are located on the membrane of cells (see the illustration above) are activated when the cell needs more glucose inside; the glucose is used for the production of energy (ATP) in order to function. When those receptors are activated they attract and capture insulin, which in turn starts a process that opens a gate allowing one particle (molecule) of glucose to enter the cell. As discussed, insulin resistance causes those insulin receptors to malfunction, which does not allow the gates to open to allow glucose to enter. Consequently, the glucose is not removed from the bloodstream, and the blood sugar level remains high after a meal.

When your blood sugar is high (above 110 mg/dL) the glucose level inside the cells of your brain, pancreas, intestines, kidneys, arteries, nerves, and red blood cells will also be high. There are no insulin receptors on the cell membranes in these areas, so the glucose entering these cells are unregulated. If the glucose level on the outside of the cell (bloodstream) are elevated, the glucose level on the inside of the cell will also be high. High glucose levels inside a cell is not a good thing. Elevated glucose levels inside a cell will stress the DNA and cause the cells to commit suicide; a process called apoptosis.

Atherosclerosis (plaque buildup in the arteries), is started by damage (and/or death) to the cells of the artery's walls. When the elevated blood sugar enters, unregulated, into the inside of the artery cells, the cells die off causing a spongy tissue in the artery walls; a perfect scenario for the collection, and accumulation of cholesterol, fibrin, and a wide variety of other substances that collect in the damaged tissue.

Chemical exposure, particularly in the diet (food additives and preservatives), sets up inflammation that attacks the insulin producing cells of the pancreas; and others. So your pancreas falls victim to damage from a variety of causes. When the inflammation levels increase throughout the body a high CRP (C Reactive Protein) level develops; in response to an immune response. CRP is produced by the liver and is found in the bloodstream. CRP is normally used by the body to assist the immune system response to infections or other pathogen attacks; however when acute inflammation is present the CRP level can very quickly rise up to 50,000 fold. An increased CRP (>3.0 mg/L) can triple the risk of a heart attack.

Studies have shown that a high fat diet can increase the CRP production by up to 73%. Sleep apnea will cause and significant increase in CRP; CPAP therapy significantly lowers the CRP level. Exercise will significantly reduce the CRP levels; especially if associated with a low fat diet. Patients that have a high CRP level are more prone to developing a stroke, heart attack, or develop peripheral vascular disease.

The CRP blood test is a valuable tool to gauge hidden, imperceptible inflammation. The higher the CRP level, the higher the inflammation level, and the higher the risk for heart disease or stroke and diabetes. When an elevated CRP occurs along with elevated small LDL particles, both of which are common in insulin resistance, the risk of developing a heart attack increases 7 fold. When the CRP is elevated the risk of a multiple of complications escalates.

Type II diabetics with insulin resistance also have an increase in fibrinogen (fibrin) in their blood. Fibrinogen is a protein found in your bloodstream that is instrumental in the clotting of blood after an injury. Your blood becomes thick and sticky when the fibrinogen levels are high. Your blood will form clots more readily as a result. Your blood also contains other proteins that are higher than normal that assist the fibrinogen in the clotting process (coagulation). When the risk of clotting is higher the risk of strokes are also higher.

Diabetics also have a deficiency in plasmin; a protein that the body uses to dissolve blood clots. Because you are diabetic you are more prone to developing contracture of digits and limbs. Contracture of digits and limbs is a thickening of the soft tissues in your muscles, which leads to the wasting of the muscle tissue, because of disuse. It is a form of atrophy.

Atherosclerosis is also more common in diabetics. It impairs the blood flow to your body's tissues which causes local pain, muscle twitching, painful walking, and cramping. The muscle begins to die because of the lost circulation (infarction). When you have your quarterly laboratory tests your doctor requests that your blood is tested for certain muscle enzymes called CPK (creatine phospokinase) and aldolase. CPK is found mainly in your heart muscle, your brain, and your skeletal muscles. The test also measures the different forms of creatine in your blood. Creatine is an organic acid that occurs naturally that helps supply energy to your body's cells; primarily in muscles (95%). It is produced from amino acids primarily in the kidneys and liver. Aldolase is a protein that your body uses to break down sugars to produce energy. The test is a fasting test, which means that you do not eat for 6 or more hours prior to the test. The test is used to predict the extent of liver and muscle damage due to being diabetic. The normal levels of aldolase are 1.0-7.5 units per liter. The normal range for CPK is 60-400 IU per liter. Atherosclerosis affects your heart muscle. It can lead to the development of a heart attack.

Diabetes, primarily high blood sugars, leads to circulation problems. The tiny capillaries are damaged or destroyed, which normally supply your nerves and tissues with blood and nutrients. Circulation issues impact your intestines, feet, and hands. It causes wasting of the muscles around your shoulders and hips (diabetic amyotrophy) long term. The symptoms can be twitching or pain when the condition is severe. When capillaries are damaged or destroyed they can no longer feed nerve endings throughout the body, especially in the extremities. The nerve endings will die leaving a numbness or lack of feeling. It is referred to as neuropathy. While the nerve endings die, sharp, jabbing pains will result. An itchiness of the skin may develop that cannot be satisfied by scratching.

Consequently, diabetics suffer a loss of neurons that tell some muscles when to contract or relax. Neurons are the basic building blocks of your nervous system. They are inside and outside of your central nervous system. They deliver electrical impulses from the brain that instruct muscles to function when needed. One specific area that is impacted in diabetics is a loss of some of the neurons on the muscles that surround the intestines. As discussed, these muscles serve to massage the wall of the intestines to move matter through your intestines. When the loss of neurons in the intestinal muscles occurs the intestinal muscles lose tone. They lose the ability to properly move matter through the intestines. The intestines increase in diameter, and the intestinal wall becomes thicker; which can lead to a variety of problems. More water is drawn out of the digesting food, which makes the stool harder. Constipation becomes a common problem.

Your brain is a mere 2% of your total body weight but it uses 15% of the total amount of blood pumped by your heart. It also uses 20% of the oxygen in your blood. When you suffer from a stroke your brain is cut off from the blood supply that it so desperately needs. It begins to die; its neurons that control your ability to walk, talk, or swallow are starved so they begin to die. The damage from a stroke is permanent.

Infections, diseases, and high blood pressure cause damage to your heart that can lead to heart failure. Heart failure can be caused by a heart attack. When the arteries that lead to your heart muscle become blocked a heart attack occurs. Muscle damage will occur to the heart that will prevent the heart from pumping sufficient amounts of blood to supply your body's needs. Heart failure develops slowly over time. The symptoms of heart failure are shortness of breath, fatigue, and weakness. These symptoms should not be confused with the symptoms of a heart attack. The symptoms develop because the body is not moving blood quickly enough throughout the body's veins. The blood will slow to the point where it will begin to pool in certain areas, which causes swelling of the ankles and legs.

Clots will form very easily when blood pools. When the blood becomes congested, congestive heart failure occurs. Heart attacks weaken and damage the heart muscle. When the arteries become clogged the heart muscle has to work harder. When blood sugars are high the heart has to work harder. Insulin resistance causes the blood to become thicker which causes the heart to work harder. Capillary damage in the heart muscle, due to high blood sugar, will weaken the heart muscle. High blood pressure places more stress on the heart. All of these things can contribute to heart failure.

As stated, high blood sugars cause an over production of the hormone (epinephrine) that relaxes blood vessels; called vasodilation. Vasodilation relaxes the smooth muscles that surround blood vessels. While the over production of epinephrine should be a good thing, in diabetics the over production of this hormone has the opposite effect. Instead of relaxing blood vessel, it causes them to constrict (vasoconstriction), which restricts the flow of blood. Insulin normally increases vasodilation, but even in very high dosages, insulin cannot overcome the effects of the poor vasodilation that is caused by high blood sugars. High blood sugars also reduce the production of nitric oxide which promotes vasodilation. The primary purpose of vasodilation is to increase blood flow, which decreases blood pressure, and increases blood flow to areas that are in need of blood flow; it is often in response to a need for oxygen, nutrients, glucose, or lipids in a particular area. When the hormone constricts the blood vessels your blood pressure increases.

The overproduction of epinephrine has one additional significant affect on heart health. Epinephrine regulates the intensity of the heart beat; the heart muscle contraction force. The excess epinephrine causes the heartbeat to be more severe in intensity. So, diabetics that are insulin resistant and have elevated blood sugar stress their heart muscle much more than that of a non-diabetic.

Studies have shown that high blood sugars impair cognitive function in the brain, because of damage to the brain caused by elevated blood sugars. Some brain damage is caused by high insulin levels in the brain. High blood sugars cause memory loss, and cause the brain to shrink in size. A diabetic suffers a loss of brain size appreciably faster as compared to that of non-diabetics when blood sugars are not tightly controlled. Studies have shown that diabetics have greater blood vessel constriction in the brain, are more atrophied (shrunken), and had more damage in the gray matter, frontal, temporal, and parietal regions of their brain. The effects impair short term memory, walking (balance) and speech the most. Excess glucose triggers the release of adhesion molecules (sVCAM and sICAM) that leads to chronic inflammation, blood vessel constriction, reduced blood flow, and ultimately damage to the brain. You will recall that the brain is one of the 7 areas of your body where the cells do not have insulin receptors that would otherwise regulate how much glucose is inside the cells; relative to the blood sugar outside the cells. Consequently, when the blood sugar is high outside these brain cells, the glucose level will also be elevated inside, which sets up apoptosis (cell death); brain cell loss and shrinkage. High blood sugars disrupt insulin signaling in the brain, and the brain's regulation of neurotransmitters involved in mood and behavior. It can lead to food addictions and obesity.

When a diabetic has elevated insulin levels, because of elevated blood sugar and insulin resistance, an increase in the production of triglycerides occurs, and a decrease in the secretion of apoB, ApoB is a protein (apolipoprotein B) is produced in the liver and used to assemble the VLDL cholesterol. However, in diabetics the apoB secretion is increased, and the apoB clearance (removal from circulation) is decreased. These changes in apoB metabolism is believed to drive cardiovascular disease in diabetics. ApoB are essential for the development of atherosclerosis. Normally, insulin would regulate the apoB secretions, and would clear the circulating apoB particles. Insulin resistance is credited with this dangerous change. High concentrations of insulin increase VLDL secretions. Obesity exacerbates the condition. Some studies suggest that a unique form of insulin resistance develops when triglyceride levels are elevated (hypertriglyceridemia)

When VLDL particles collide with HDL particles in the bloodstream a transfer takes place, where some of the VLDL's triglycerides are exchanged for HDL cholesteryl esters. The resulting triglyceride enriched HDL will hydrolyze the triglyceride. This results in a smaller form of HDL which will be removed from the bloodstream by the kidneys and liver. In a similar fashion the collision of VLDL particles with HDL particles can result in the production of the small LDL particles that are so dangerous. Normally insulin resistant type II diabetics do not have elevated LDL cholesterol levels compared to the general population. But, type II diabetics are more inclined to develop conditions that are favorable to the development of atherosclerosis, and the elevated VLDL particles that are circulating in the bloodstream can easily enter the damaged areas in the artery walls and accumulate as plaque. However, these VLDL particles, because of the collisions with HDL particles, are capable of delivering more cholesterol particles to the vessel's (artery's) walls. Also, since diabetics have lower HDL levels, the protective function of the HDL particles in reducing the accumulation of plaque is lost; some antioxidant reaction is lost as well.

### Obesity and Cardiac Disease

When there is excess belly fat, along with a fasting blood sugar greater than 100 mg/dL, the blood pressure is elevated (>130/85 mmHg), the triglycerides are above 150 mg/dL, and the HDL is low (less than 50 mg/dL for women and less than 40 mg/dL for men) the metabolic syndrome has become established. When the body mass index (BMI) exceeds 27 the likelihood of developing diabetes escalates. Insulin resistance is often present long before the BMI reaches 27; and a waist circumference of greater than 35 inches for women, and greater than 40 inches for men.

Insulin resistance triggers abnormalities in signaling molecules (adipokines). Fat cells, especially the belly area fat (adipose tissue), take on a life of their own and begin to act like an independent new organ in your body. They produce dozens of unique substances. Leptin (a hormone) is produced by these fat cells, that causes white blood cells (immune cells) called macrophages to grab cholesterol particles; which accelerates atherosclerosis (plaque buildup). Another of these unique substances is TNF-alpha (Tumor Necrosis Factor-alpha), which activates inflammatory responses in the blood vessels and increases the release of adhesive molecules; a process that accelerates atherosclerosis. The more belly fat present, the more pro-inflammatory cytokines (especially TNF-alpha) are released.

Insulin resistance places demands upon the adipose (belly area) fat cells that they cannot meet. It impacts the function of genes in the body's cells that causes increased pressure on the fat cells to store energy (more fat). There are specific genes that regulate the fatty acids in the fat cells. The result is that the fat cells cannot uptake all of the free fatty acids, but instead release more free fatty acids into the bloodstream. The liver becomes overwhelmed by the increase in available energy, resulting in increased triglyceride levels in the bloodstream; the liver overproduces VLDL (Very Low Density Lipoprotein) cholesterol. When large amounts of fat are in the bloodstream, it impairs the first pass metabolism (uptake) of insulin. VLDL cholesterol will be discussed in greater detail in the section on cholesterol. Elevated triglycerides lead to a reduction in the HDL (good) cholesterol, and an increase in the small LDL (bad) cholesterol levels. You will recall that it is these small LDL particles that accumulate in the arteries to form plaque; because they are readily oxidized and become sticky.

Dyslipidemia is a name assigned when the blood levels of fats (like free fatty acids, cholesterol, and triglycerides) are elevated. While elevated blood pressure (hypertension) adds significantly to the overall risk of developing heart disease, its link to insulin resistance is not well established. High blood pressure and elevated insulin levels are associated independently of BMI (Body Mass Index). But the link between obesity, insulin resistance, and high blood pressure are not as clearly understood. The link between insulin and elevated blood pressure is not as strong as between insulin resistance and elevated triglycerides; only about 50% of the elevated blood pressure subjects are insulin resistant.

When a diabetic is obese, and has insulin resistance, multiple defects in vascular insulin action occur. Insulin normally stimulates blood flow, however obesity and insulin resistance blunts that action. Insulin normally acutely decreases the systolic pressure (pressure created when the heart muscle contracts). But the process is severely deceased when insulin resistance and excess central obesity (belly fat) is present. The condition is further exacerbated if the triglyceride levels are elevated. Aerobic exercise decreases the fat levels in the blood and increases insulin sensitivity. It should be obvious that a sedentary lifestyle exacerbates the condition.

### Excess Insulin and Heart Disease

Diabetics are typically hyperinsulinemic, which means that they commonly have elevated insulin levels. The general population has 30% more insulin in their bloodstream than was considered average in the 1970's. Hypertension (elevated blood pressure) is also associated with elevated insulin levels. Elevated insulin levels are known to cause increases in atherosclerosis.

It has been well established that elevated insulin can result in increased reabsorption of both sodium and water by the kidneys; which is associated with a fluid volume dependent hypertension; a high fluid level in the body. Studies have shown that high blood pressure patients display elevated insulin levels after meals; more so than normal blood pressure patients. No studies have been conducted to determine how often fluid volume dependent hypertension is present in insulin resistant diabetics. Other studies have suggested that an overactive sympathetic nervous system plays a role in insulin resistant and obese individuals.

Blood clotting is known to be more likely to occur in insulin resistant individuals. The fibrin levels in the blood (fibers that produce blood clots) are significantly higher in insulin resistant diabetics; especially those that are blood type A or AB. Coronary vascular disease risk is directly associated with the amount of excess belly fat (visceral fat), because it is accompanied by insulin resistance and elevated insulin levels.

### Dehydration and Heart Disease

Diabetics are typically dehydrated, because elevated blood sugar causes the kidneys to malfunction and dump large amounts of fluid into the urine. That is why diabetics urinate frequently when their blood sugar is high. When dehydration occurs a condition known as cardiovascular shock (or cardiovascular insult) develops. Your body's 10 trillion cells contain upwards of 2/3 of all of the fluid in your body. Each cell is highly dependent upon retaining its full capacity of fluid in order to function properly. Dehydration strips fluid from all areas of your body, including the inside of your cells.

Dehydration causes the body to go into a state of shock; partly because essential minerals are lost along with the fluids (like potassium and sodium). There are 84 trace and bulk minerals that are essential to maintaining your body's healthy state; all of which must come from your diet or supplementation. A deficiency in even one vitamin or mineral will set up a cascade of decline in cellular function and health. Your cells produce amino acids from vitamins and minerals, that in turn are used to produce hormones and enzymes that are essential to the function and health of each cell. A deficiency in vitamins or minerals leads to a deficiency in amino acids, hormones, and enzymes. Virtually every bodily function is controlled by amino acids, hormones, and enzymes.

Most diabetics are dehydrated for so long that they no longer acknowledge the symptoms; most confuse the symptoms of dehydration with hunger and eat instead of restoring hydration. The level of dehydration develops slowly over time as the pre-diabetic stage progresses into full blown diabetes. Many will drink enough to perceive that they have satisfied their thirst, but will not drink enough to restore hydration. For a rare few the first symptoms of dehydration are fatal; which is totally avoidable. The thirst sensation is not always a reliable indicator that dehydration is present. Elevated blood sugar is not the only cause of fluid loss. Your body loses fluid daily through perspiration, evaporation, and when breathing. The fluids must be replaced daily.

### Blood Pressure and Heart Disease

Again, diabetics have elevated levels of epinephrine (a hormone); up to twice as much as non-diabetics. Epinephrine causes the production of nitric oxide inside the blood vessels, which causes vasodilation; the muscles surrounding the blood vessels relax and increase blood flow-reduced blood pressure. While it would be easy to surmise that twice as much epinephrine would double the nitric oxide production; unfortunately, for reasons unknown it reduces the nitric oxide production.

Abnormalities in vasodilation and blood flow provide a link between elevated blood pressure and insulin resistance. Intravenous injections of insulin in non-diabetics increases vasodilation, which is deficient in obese, insulin resistant, and type II diabetics. Insulin fails to stimulate the secretion of nitric oxide. Free fatty acids can inhibit vasodilation in response to methyl choline, which acts via nitric oxide.

Interestingly, defective vasodilation can contribute to (cause) insulin resistance. Blood flow is a key variable in your body's regulation of glucose uptake by your body's 10 trillion cells. When the blood flow is impaired, small arteriolar vasodilation displays characteristic behavior of insulin resistant individuals. This could be associated with the cell's inability to uptake glucose. Studies have shown that inhibiting vasoconstriction (the constriction of blood vessels) improves insulin sensitivity; reduces insulin resistance. And, as stated, elevated insulin levels contribute to elevated blood pressure. It causes the body to retain sodium and water, which leads to increased blood pressure.

### Causes of High Blood Pressure

Some of the causes of high blood pressure are:

Atherosclerosis; plaque buildup in the arteries. As the amount of plaque in the arteries builds up the artery becomes constricted making it harder to pump the blood which increases the blood pressure.

Your kidneys possess the ability to constrict, or relax, your blood vessels. When the vessels are constricted your blood pressure will rise. The kidneys seek to maintain enough blood pressure to force the blood through their filters.

Obesity is a cause of elevated blood pressure. A significant increase in the GGT enzyme contributes to high blood pressure and high cholesterol. GGT (an enzyme found primarily in the liver) is especially high when the bile ducts are clogged. In all men and women over 45 the normal range is from 6-37 Units/Liter, and 5-27 U/L in women under 45 (some measurements are taken as IU/L). Liver disease can be caused by elevated levels of GGT. The GGT enzyme is particularly sensitive to alcohol, medications (drugs), and chemicals. GGT levels are used to diagnose liver blockage (obstructive jaundice), liver metastiasis, acute pancreatitis, kidney disease, recent surgery, an early warning of developing heart disease, and metastiasis of prostate cancer. Elevated GGT levels can increase the risk of heart disease by 1.5-2 times normal. Elevated liver enzymes can be caused by hypothyroidism, but often decreases the GGT levels. GGT levels are directly associated with obesity, and diabetes.

Fatty liver is a contributor to elevated GGT levels. Certain medications and liver disease can elevate the GGT levels.

GGT enzymes play a critical role in the transfer of amino acids and phosphates across cell membranes. Besides the liver it is found in the cells of the kidneys, pancreas, gallbladder and bile ducts, spleen, heart, brain, and seminal vesicles. It is involved in the metabolism and degradation of glutathione (amino acid).

Fat cells are fed by many miles of blood vessels, especially in the belly area. More pressure is required to supply the additional blood vessels. Belly fat increases insulin resistance which interferes with your body's utilization of insulin. When glucose builds up in your blood vessels your kidneys will retain sodium which causes higher blood pressure. This is the primary reason why diabetics are three times more prone to have high blood pressure.

High blood sugars increase (above 180) the viscosity (thickness) of the blood; which will make it much more difficult to pump; resulting in higher blood pressure. Your blood becomes syrup-like in consistency.

Vitamin deficiencies, especially vitamin D and calcium, will cause your blood pressure to rise.

Diet that is low in antioxidants will cause an increase in blood pressure. Antioxidants protect and increase the body's supply of nitric oxide which relaxes blood vessels.

High consumption of table salt will cause an increase in blood pressure.

### Uric Acid and Heart Disease

Diabetics that are insulin resistant, have low grade inflammation, excess abdominal fat, and impaired immune function, and are highly prone to developing hyperuricemia; which is an elevated uric acid level in their blood. That means that they may be more likely to suffer from gout or other related conditions. Alcohol consumption will exacerbate the condition. Hyperuricemia can also contribute to the development of insulin resistance; they share a bidirectional causal effect.

Hyperuricemia is also a risk factor for cardiovascular disease. It enhances platelet aggregation and adhesion in the arteries, increases the fat levels in the bloodstream, increases blood pressure, increases the viscosity of the blood (thickness), and it enhances the propensity to coagulation. The uric acid levels increase when the insulin levels are elevated and blood sugar control is poor. Hyperuricemia is most commonly observed in older diabetics that have a higher BMI (Body Mass Index), elevated blood pressure, elevated triglycerides, lower HDL and elevated LDL cholesterol, and elevated microalbuminuria (albumin discharged in the urine-from the kidneys).

### Urinary Albumin and Heart Disease

Urinary albumin is measured by using a dipstick to measure the albumin levels in the urine. Normal levels are between 30-300 mg/24 hour period. Higher values predict kidney damage (disease). Urinary albumin can be used to predict the progression of diabetic nephropathy (kidney disease). The amount of urinary albumin is due to damage to the nephron filters of the kidneys (leakage). Microalbuminuria is a significant risk factor for coronary vascular disease in diabetics. It has been correlated with insulin resistance, sodium sensitivity, obesity (belly fat), elevated triglycerides, and elevated blood pressure (especially during the night). Elevated blood pressure (particularly elevated systolic pressure), and an elevated insulin level, has the most effect on the development of microalbuminuria.

###  Fibrin and Heart Disease

As discussed, diabetics that have insulin resistance typically have more of the protein fibrin (fibrinogen), and others, in their blood; especially if they are blood type A, or AB. Fibrin, and the other proteins, are used by the body to create blood clots; so diabetics are more prone to the formation of blood clots. When the fibrin levels are high the blood becomes very thick and sticky. High blood sugars also cause the blood to become more viscous; thicker. Diabetics also have less of the protein plasmin that the body normally uses to dissolve blood clots. Consequently, diabetics are more prone to the formation of blood clots, and less likely to dissolve them if they form. The risk of stroke or heart attack is significantly higher.

Scientists have established that there is an increased susceptibility for diabetics to have an increased level of low-grade inflammation of the arterial lining. The damage occurs in all areas of your body. Your heart is also impacted. Your heart muscle gets all of its nutrients, which includes oxygen, blood, calcium, magnesium, and potassium from your blood vessels; particularly from your capillaries (the smallest blood vessels). Your heart muscle is totally covered with capillary veins.

The problem will progress over time if not treated. It is possible that a person will not feel the pain if damage to capillaries has starved nerve endings resulting in damage or death to the nerves. A heart attack will occur if the blood vessels near the heart are clogged, which cuts off the oxygen and nutrients to the heart muscle. Your heart muscle cannot function without them.

### Symptoms of a Heart Attack and PAD

The symptoms of a heart attack include:

Nausea

Light headedness

Shortness of breath

Extreme weakness

Indigestion

Pain in the chest, arms, shoulder, jaw, and neck

Sweating

Peripheral arterial disease (PAD) occurs if the blood vessels in the legs become restricted.

The symptoms of PAD include:

Pain in the legs (cramping) while walking, climbing stairs, or exercising are the most common symptoms.

Slow healing sores

Numbness, or tingling in the feet or legs.

If the pain continues, even after resting, and the foot or lower leg is noticeably cooler than other areas of the body, the PAD may be severe. PAD should not be confused with neuropathy, which has a common cause, which is a lack of circulation in the legs and feet.

### More About Atherosclerosis

Atherosclerosis is also more common in diabetics; plaque buildup in the arteries. It impairs the blood flow to your body's tissues which causes local pain, muscle twitching, painful walking, and cramping. The muscle begins to die because of the lost circulation (infarction). When you have your quarterly laboratory tests your doctor requests that your blood is tested for certain muscle enzymes called CPK (creatine phospokinase) and aldolase. CPK is found mainly in your heart muscle, your brain, and your skeletal muscles. The test also measures the different forms of creatine in your blood. Creatine is an organic acid that occurs naturally that helps supply energy to your body's cells; primarily in muscles (95%). It is produced from amino acids primarily in the kidneys and liver. Aldolase is a protein that your body uses to break down sugars to produce energy. The test is a fasting test, which means that you do not eat for 6 or more hours prior to the test. The test is used to predict the extent of liver and muscle damage due to being diabetic. The normal levels of aldolase are 1.0-7.5 units per liter. The normal range for CPK is 60-400 IU per liter. Atherosclerosis affects your heart muscle, which can lead to the development of a heart attack.

### Vitamin and Mineral Deficiencies and Heart Disease

If a selenium deficiency is present the risk of developing numerous forms of cancer and/or a heart attack skyrocket; especially if the diet is high in fats and saturated oils. Also, a diet high in saturated fats and oils will cause a selenium deficiency. Diabetics are typically deficient in HCL (hydrochloric acid) production (for digestion), which results in selenium and other vitamin and mineral deficiencies, because they are dependent upon HCL to be absorbed.

You can learn considerably more about, vitamin deficiencies, diabetic dehydration, dietary errors, and how elevated blood sugar damages the other 7 areas in your body by reading the book "Diabetes Control-6 Steps to Gaining Complete Control over Diabetes," by the same author of this book.

CoQ10 is a coenzyme that is a very powerful antioxidant. It is used by every cell in the body to produce ATP; which is energy production needed to regulate blood sugars, muscle contraction, prevent diseases, brain health, and proper heart function. It prevents the oxidation of cholesterol. Ironically, CoQ10 is depleted in the body by medications that are taken for heart disease and for managing diabetes. Most patients that suffer heart failure or heart attack are chronically deficient in CoQ10. It is essential for numerous enzymmatic reactions.

Bad diet (processed foods, food additives, sodas and colas, caffeine, dairy, pork, artificial sweeteners, corn, wheat, soy, and saturated fats) causes inflammation, which results in a rapid accumulation of visceral fat (belly fat), which causes fatty liver, insulin resistance, additional weight gain, and is a cause of diabetes manifestation. Eating grain fed meats (beef, pork, turkey, and chicken) that are loaded with antibiotics, growth hormones, nitrates, and nitrites (some contain food coloring), leads to massive amounts of inflammation, vitamin and mineral deficiencies, and hormone imbalances, that are very destructive in nature. Highly acidic foods like wheat, corn, soy, sodas, and colas cause weight gain, blood sugar management issues, and contribute to the formation of diabetic complications.

Fatty liver disease prevents the liver from removing excess insulin. Consequently, insulin levels rise higher and higher, which can contribute to heart attacks and more abdominal obesity. The presence of high levels of insulin in the blood causes unnecessary water retention in the body, which is a factor in weight gain. Insulin also acts on the brain. It promotes cravings that result in eating more; because the brain instructs the liver to release more glucose. Stress management is also important. But it is the bad diet that has placed a number of conditions in place that you must understand in order to win the fat war. There are a number of interrelated circumstances that contribute to making diabetic weight loss difficult.

### Low Blood Sugar and Heart Disease

When blood sugars are low the body will begin to produce and release cortisol, the stress hormone, in order to raise blood sugars; a secondary (backup) mechanism. Cortisol will break down muscle tissue to convert it into glucose. Cortisol causes inflammation. Cortisol blocks thyroid function, because the liver will divert glucose from converting the T4 thyroid hormone into T3 in order to preserve glucose to maintain blood sugar levels.

When blood sugars drop below normal during the night, the body releases adrenalin which will produce an elevated heart rate (beats per minute). It is a common cause of insomnia. Adrenalin also increases circulation to the brain and heart in order to keep them warm (normal temperature). The change reduces the circulation to the skin and extremities which may then become cold. Alcohol consumption can cause hypoglycemia.

Low blood sugar causes low blood pressure. Normal blood pressure is 120/80. Low blood pressure is 80/60. When a hypoglycemia episode occurs the resulting low blood pressure (a drop of 20 mm Hg or more) can cause the symptoms of dizziness, lightheadedness (and even fainting), concentration issues, blurred vision, nausea (vomiting), flushed skin (cold, clammy, pale skin), rapid or slow breathing, fatigue, and depression. The condition may be more noticeable when standing from a seated position. Low blood pressure causes a pooling of blood in the lower extremities. It is considered a failure of the autonomic nervous system; primarily due to a lack of glucose to the brain. The nervous system which is highly dependent upon glucose to function is slow to react to changes in the blood sugars and blood pressure drop. The condition is more likely to occur if the body is dehydrated; which is very common in diabetics.

### Omega 3's and Heart Disease

Most diabetics each too much fat, as well as too many calories (carbohydrates). When you couple that with a lack of exercise (sedentary lifestyle), the risk of heart disease and diabetic complications escalate. Omega 3's help prevent the development of heart disease.

The American Heart Association has supported the eating of fish high in omega 3 fatty acids twice each week. The unsaturated fats found in fish (omega 3's) play a significant role in reducing the risk for heart disease. Seafood offers a combination of omega 3 fatty acids and other nutrients that provide for the heart healthy benefits from fish. Let's examine what omega 3 fatty acid are and how they benefit your heart.

Atherosclerosis (plaque buildup in the arteries) causes coronary heart disease (CHD). It is a long term process where fatty deposits of plaque build up on the walls of the arteries and the blood vessels that supply your heart muscle with oxygen and nutrients. When the buildup reaches a level where it restricts blood flow to the heart muscle it will be easily blocked by plaque or a clot; the result is a heart attack or severe chest pain (angina).

The plaque buildup begins because of damage caused by elevated blood pressure, inflammation, elevated blood sugar, cholesterol, and triglycerides. Damage to the arteries can also be caused by tobacco smoke, and diabetes. A diet that is high in saturated fats increases the amount of cholesterol and triglycerides in the bloodstream. A total cholesterol level above 200 mg/dL and a triglyceride level above 150 mg/dL will significantly increase the risk of developing heart disease.

Unsaturated fatty acids, as opposed to the saturated fats found in meat products, will lower your cholesterol level. Fatty acids are a type of unsaturated fatty acid that reduces inflammation throughout your body. You will recall that inflammation causes significant damage to blood vessels that contributes as a cause of heart disease.

Omega 3's decrease the triglyceride level in the blood, reduces blood pressure, reduces the risk of blood clotting (it thins the blood), and decreases the risk of heart failure, heart attack (especially sudden cardiac death), or stroke. Omega 3's stabilize irregular heartbeats, and can improve learning ability.

Certain fish like salmon, lake trout, herring, sardines, and tuna contain the most omega 3 fatty acids. Others only contain small amounts. Some of the seafood sources for omega 3's are listed on the table below; listed in descending order based upon omega 3 content (Daily Value %).

Your body cannot manufacture the omega 3's needed to support heart health. It must come from your diet. Your body needs two types of omega fatty acids; omega 3's and omega 6's. Omega 6's are readily available from the foods that you eat each day. The average person consumes far more omega 6's than omega 3's daily. The fatty acid tables below show how most foods contain significantly more omega 6's than omega 3's.

Studies have shown that when a diet is high in EPA (eicosapentaenoic acid) and DHA (docosahexaenoic acid) that the risk of developing cardiovascular heart disease is significantly lower. EPA and DHA are sometimes referred to as the marine omega 3's, because they are found in fatty fish. They are typically found in supplement form (fish oil).

There are 3 forms of omega 3's; EPA, DHA, and ALA (alpha linolenic acid). ALA comes exclusively from plant sources. ALA is a short chain omega 3, and EPA and DHA are long chain omega 3's. Your body has to convert the ALA into a long chain form (EPA or DHA) in order to use it. Unfortunately the process is very inefficient (less than 5%). Despite the fact that some food items, like flaxseed, show that they provide over 100% of the daily requirement, the benefit is significantly reduced by the time it is converted into EPA and DHA; but, that does not mean that they have little benefit.

To prevent heart disease the omega 3's consumed must be at least half that of the omega 6's consumed daily. Clearly it would be an arduous task to keep track of how much of each are being received from the diet each day. The best way to ensure that you uptake enough omega 3 to offset the amount of omega 6 consumed is to take fish oil supplements. If you take 1000 mg of EPA and 500 mg of DHA daily you will ensure that you are getting enough of both.

The American Heart Association recommends that heart patients (those already diagnosed), which includes diabetics (even those not diagnosed with heart disease), can take up to 1 gram of EPA and DHA daily. Those with elevated triglycerides can take up to 3 grams daily; more than 3 grams per day is not recommended unless under the supervision of a doctor; because of the blood thinning effects of EPA and DHA. Fresh wild caught fish are the best source of omega 3's, because they are also high in arginine, glutamine, and selenium, which are heart healthy substances.

It is important to note that the quality of supplements vary considerably source by source. Read the label to ensure that the EPA and DHA contents are listed. Some list their IU (International Units) content, which has no direct conversion into EPA and DHA values. It is also important that you ensure that the fish oil is purified to remove toxins.

However, eating too much fish can be detrimental. The older, larger, predatory fish often are high in toxins. The toxicity in fish will depend upon where they are caught. Some lakes, rivers, and coastal areas are more polluted than others. Shark, swordfish, king mackerel, and tilefish (golden bass or golden snapper) contain large amounts of methyl mercury, which is a dangerous heavy metal; especially to small children and pregnant women. Shrimp, canned light tuna, Pollock, salmon, and catfish have the lowest levels of mercury. Some freshwater fish can be high in PCB's (polychlorinated biphenyls), which is known to cause cancer; including lake trout, smelt, and freshwater bluefish. PCB's are common in farmed fish. Other common freshwater pollutants are dioxins, which also cause cancer, depress the immune system, and can impact the central nervous system.

Steaming fish is the least damaging health wise. Frying, grilling, and broiling destroys nutrients in food.

Never eat farm raised fish. Fresh wild caught fish are significantly higher in omega 3, because they live in their natural environment and eat their natural diet. Farm raised fish often contain pesticides, antibiotics and other chemicals that are exposed to the farm raised fish.

### Alcohol and Heart Disease

When a person drinks heavily the liver becomes overwhelmed. It has to focus a great deal of energy on breaking down the alcohol. It cannot convert glycogen into glucose at the same time; consequently the blood sugars can go too low.

### Nitric Oxide and Heart Disease

Diabetics produce too little nitric oxide, which is a very important substance in lowering blood pressure. The hormone epinephrine causes the production of nitric oxide inside the blood vessels, which in turn relaxes the muscles surrounding the blood vessels; lowering blood pressure. Diabetics produce twice as much epinephrine as non-diabetics. It would be easy to surmise that twice as much epinephrine would double the production of nitric oxide. Unfortunately, for reasons yet to be discovered, it has the opposite effect; reduces the amount of nitric oxide produced. Later, you will learn how to reverse that; force your body to produce more nitric oxide.

### Homocysteine and Heart Disease

Hyperhomocysteinemia, is the official name applied to elevated homocysteine levels. Homocysteine is a very common amino acid, that plays a major role in providing building blocks that produce proteins. It is found in the bloodstream and is an essential amino acid, which means that it must come from your diet; primarily from red meat. Under normal circumstances it is recycled into methionine (another important amino acid), or into cysteine with the help of the B vitamins. Homocysteine is not considered a risk for heart disease unless its levels become too high.

Elevated levels of homocysteine can lead to the early development of heart and blood vessel disease; considered an independent risk factor for heart disease, because it promotes damage to the artery walls. Usually elevated homocysteine levels are associated with deficiencies in vitamins B6 and B12, a deficiency in folate, and kidney disease. Medications, especially oral diabetic medications, cause vitamin and mineral deficiencies; like CoQ10 and vitamin B12. Folic acid and the B vitamins help break down the homocysteine in the bloodstream. Diet and genetics play a large role in the process.

While there appears to be a direct link between the development of blood vessel (artery) damage, atherosclerosis, and the formation of blood clots, the topic remains to be highly controversial. Consequently, there are no universal tests that can be prescribed to measure the homocysteine levels. The tests that currently exist are expensive, not widely available, and are not covered by insurance. Studies have shown that reducing the homocysteine levels will not reduce the risk of heart disease. More research is needed.

How Diabetes Impacts Muscle Tissues (cells)

Diabetes complicates the body's efforts to maintain healthy muscles; it is called diabetic myopathy. Diabetic myopathy is significant, largely overlooked, and very few studies have been conducted to establish links between changes to skeletal muscle metabolic health and its overall impact on blood sugar control, or the body's ability to repair muscle damage. Damage to muscles, and changes in the body's ability to repair muscle damage, is well known to occur during disease development.

There is a specialized cell, called the progenitor cell, which is produced like a stem cell and moves around the body to places where they are needed in the body. They are used (activated) by the body as a tool to repair damage in tissues; damaged, dead, or dying cells. Cytokines or growth factors are commonly used by the body to mobilize the progenitor cells, which causes a higher rate of cell division that leads to the recovery of the tissue. Diabetes reduces the muscle tissue progenitor cell population. It is believed to contribute to the decline of skeletal muscle health.

Normally, skeletal muscle is capable of adapting to numerous stimuli, which results in changes in muscle size, the types of fibers in the muscle, and metabolism. The presence of progenitor cells is critical to the maintenance of plasticity of muscle tissues. Progenitor cells are immature cells that circulate in the bloodstream and contribute to vascular homeostasis; maintain a healthy state in the vascular system. Studies have shown that changes progenitor cells play an important role in the development and progression of all diabetes complications. The mobilization and activation of the progenitor cells is a very complex, and is not a fully understood process. However, the negative impact on muscle health caused by diabetes is well known; particularly the progenitor cell quantity and functionality. The damage to muscle tissues (cells) is progressive, which means that the progenitor cell population progressively declines as diabetes progresses. The most well defined progenitor cell is the satellite cell (SC).

Progenitor cells (also known as EPCs-Endothelial Progenitor Cells) are produced as stem cells in the bone marrow and are released into the bloodstream. EPCs stimulate compensatory angiogenesis, which is the process where new blood vessels are formed from pre-existing vessels. They are a pool of circulating cells that a capable of forming patches for injured blood vessels. Consequently the size of the EPC pool is indicative of the overall health of the vascular system. Virtually all of the risk factors for atherosclerosis have been linked with a decrease and/or the dysfunction of the circulating EPCs; likewise and expanded EPC pool is associated with a significant decrease in cardiovascular mortality.

The studies have reduced understanding EPCs to three related aspects; quantitative evaluation of the EPC pool, an evaluation of the EPC pool's function in the bloodstream, and the EPCs' ability to proliferate (their ability to expand and form colonies). Proliferation occurs locally when growth factors signal the presence of vascular damage. The ability of the EPCs to bond to injured tissue is also important.

As stated type I and type II diabetics have less circulating EPCs than non-diabetics. Also, diabetics display a functional impairment of EPCs, especially proliferation, adhesion, migration, and incorporation into tubular structures. Some of the functional impairment is due to weak bone marrow mobilization, proliferation, and a shortened lifespan in the bloodstream. EPCs are produced and released from the bone marrow in response to complex interaction within the bone marrow environment. Tissue ischemia is the strongest stimulus for EPC mobilization. Ischemia (also spelled ischaemia) is a restriction in blood supply to tissues. It causes a shortage of oxygen and glucose that is needed for cellular metabolism and to keep the cells alive. You will recall that capillary blood vessels spill blood out under pressure, to flow around the cells of a tissue, then is vacuumed up by the capillary vessels of the pulmonary vascular system and returned to the heart. Ischemia is caused when problems develop with the blood vessels, which can result in damage or dysfunction of the tissue; congestion can result from vasoconstriction, thrombosis, or an embolism.

When an injury occurs to the vessel walls a complex process is initiated, which is highly dependent upon adequate oxygen levels, that stimulates the EPCs into action. The DNA of the effected cells plays a major role in the process. The growth factors that stimulate the EPCs in the heart are less active in the heart tissues of diabetics, which is believed to be attributed to the weaker bone marrow stimulation from the ischemic tissues. Studies have shown that insulin therapy, and lowering elevated blood sugar, increased the progenitor cell population size to normal levels; which reduced ischemia in the tissues.

The bone marrow in diabetics is less responsive to EPC mobilizing agents. Unfortunately, the molecular mechanisms that regulate EPC release into the bloodstream are not fully understood. Nitric oxide levels and certain enzyme population sizes are believed to play a role. Once again insulin resistance has been found to play a major role in causing malfunctions in EPC mobilization and function; oxidative stress is also a major factor. Again, insulin resistance reduces nitric oxide production in diabetics. The hostile vascular environment common to diabetes severely, and negatively, impacts EPC proliferation, differentiation, and function. Oxidative stress in the bloodstream directly impacts the amount of circulating EPCs and significantly impairs bone marrow mobilization, proliferation, and causes apoptosis in cells

The reduced population of EPCs in diabetics impairs vascularization in tissues suffering from poor circulation. Diabetic patients with PAD (peripheral artery disease) demonstrate an even greater reduction in the EPC population size. Studies have demonstrated the decrease in EPCs in diabetics is closely correlated with the severity of both carotid and low limb atherosclerosis. They have higher degrees of carotid stenosis (narrowing or restriction), and significantly worse stages of leg claudication (pain) and ischemic lesions; because of the lower level of EPCs. The EPCs in diabetics with PAD demonstrate an even greater impairment in proliferation and adhesion than other diabetics without PAD.

Diabetes predisposes to heart failure and the development of cardiomyopathy. Cardiomyopathy (KAR-de-o-mi-OP-ah-thee) refers to diseases of the heart muscle in diabetics; due to numerous causes, with many symptoms. Very shortly after being diagnosed diabetic contractile depression begins. It can lead to the inability of the heart to circulate blood effectively (heart failure). Fluid will begin to accumulate in the lungs (pulmonary edema), or in the legs (peripheral edema). However, the greatest cause of heart failure in diabetics is due to coronary artery disease (plaque buildup). If no coronary artery blockage is present, the doctors will label it as cardiomyopathy.

When insulin is no longer produced in sufficient quantities (insulin dependent diabetics-type I and type II) changes occur that depress the contractile performance of the heart muscle; because of a diminished production of key enzymes (sarcoendoplasmic reticular Ca2+ATPase). This is less clear in insulin dependent type II diabetics. The contraction and relaxation rates, and pressure development, are decreased. The calcium levels in diastolic and systolic functions become lower in diabetic hearts. The cells in the heart muscle have an impaired capacity to handle calcium in their internal factories (endoplasmic reticulum) that produce crucial enzymes.

Heart failure in diabetics is due to several factors; autonomic neuropathy, where nerve endings that spark the heart muscle to contract die due to neuropathy, abnormal glucose management, increased fatty acid oxidation, the generation and accumulation of free radicals (inflammation), and alterations in ion homeostasis (calcium management). Hyperglycemia followed by hyperlipidemia (elevated blood fat levels), which is common in diabetics, which alters substrate availability to the heart muscle cells and impacts its metabolism; substances needed by the heart muscle cells to survive and function cannot be taken in in sufficient quantities, and the enzyme action to modify them for use by the cell is impaired.

Under normal conditions, fatty acids will supply up to 70% of the fuel requirements for the heart muscle cells. The fuel choice is mainly regulated by availability, the amount of oxygen available (fat can only be burned in the presence of oxygen), and the energy demand by the cells. When the fat and glucose content in the bloodstream is elevated, the heart muscle's choices become limited. The uptake of glucose is decreased by the heart muscle cells, and the fatty acid consumption approaches 100% of the fuel usage by the cells, which contributes to the development of heart disease. Insulin resistance exacerbates this condition.

Experts believe that these alterations in fuel availability (choices) contributes heavily towards the development of contractile dysfunction. Contractile failure begins as a diastolic dysfunction, and progresses to systolic dysfunction, which ultimately leads to heart failure; systolic is the upper number in the blood pressure reading, and the diastolic is the lower (example 120/80). Studies have shown that normalizing blood sugar and fatty acid levels in the bloodstream reverses the impaired contractility.

The heart muscle is highly innervated with autonomic nerves, which regulate the heartbeat. You will recall that the nerves do not have glucose regulators (insulin receptors), which will cause the glucose levels inside nerve cells to become elevated if the blood sugar level is high. Consequently, nerve damage results when blood sugar levels are elevated. The nerve damage in the heart muscle affects the diastolic dysfunction first, which results in a decline in survival rate in diabetics by up to 50%. When combined with ischemia due to vascular disease (plaque buildup) the development of heart disease significantly increases. Neuropathy can also be caused by a loss of blood flow to the nerves due to damage to the capillary blood vessels during elevated glucose episodes. The nerves will be starved of vital nutrients and oxygen and often die.

Your heart muscle's cell, unlike most other cells in your body, are constantly and rapidly challenged to change quickly to meet the body's needs. Calcium is a major player in regulating the electromechanical events, mitochondrial function (energy/heat generators inside the cells), and contractile function that occurs in the cells. Up to 40% of the ATP (energy) production inside each cell is dependent upon calcium. Alterations in this process (homeostasis) will have serious consequences on the heart's function, integrity, and structure. Also potassium plays a major role in heart cell health maintenance and function. Diabetes alters the cell's ability to utilize potassium effectively, partly because insulin plays a role in potassium management. Normalizing insulin levels, largely by correcting glucose abnormalities, will significantly improve potassium management and utilization.

When adolescents become diabetic, their muscles are subjected to muscle damage that is more likely to sustain irreversible changes, which can impact long term muscle health. The impact on type II diabetics is less significant, but equally troubling. Adverse health behaviors, like a sedentary lifestyle and increased belly fat (adiposity), leads to a high incidence of insulin resistance and impaired blood sugar control. If the issues are not addressed the type II diabetics will certainly, eventually, become insulin dependent. Diabetic myopathy is characterized by a significant reduction in physical capacity, strength, and muscle mass; it is directly linked to the influence of the rate of co-morbidity development (cardiovascular disease, neuropathy, and nephropathy).

You will recall that your muscle tissue cells are the secondary fuel tank for glucose; glucose is converted into glycogen and stored. More glycogen is stored in muscle tissue cells than anywhere else in the body; except fat cells if a person is obese. Therefore any changes in your muscle tissue health impacts your whole body blood sugar management (homeostasis).

As stated, muscle growth and development is significantly impaired by diabetes; especially in type I diabetics. The myofiber size, muscle mass, and metabolic control are significantly reduced. Myofibers are rod-like structural parts of a muscle cell that contract to cause muscle action; they make it possible for a muscle to contract (see the cell illustration APPENDIX- "Basic Cellular Function"). The cells switch to glycolytic phenotype, which means they shift to an increased reliance upon anaerobic metabolism of glucose; instead of relying on fatty acids for fuel. Glycolytic phenotype is where glucose is burned without oxygen, even though abundant amounts of oxygen are present. It is a very inefficient energy production process. Glycolytic phenotype energy production is very common in cancers. Currently research is focusing on how to reverse glycolytic phenotype as a means of treating cancers; especially breast cancer.

The maintenance of skeletal muscle is totally dependent upon the SC (Satellite Cell) population. Studies have shown that the capillary density in muscle tissues are reduced by diabetes; above and beyond the damage to the capillaries due to elevated blood sugar. Diabetes also reduces angiogenesis, which is a multiple stage process where new blood vessels are formed from pre-existing vessels to support growth and healing. Muscle function is impaired because of the alterations to muscle structure and metabolism, and the muscle's ability to repair damage.

Diabetes causes the satellite cells to fail to activate properly, which results in a failed regeneration following injury. It produces an extreme catabolic state that promotes the fusion of satellite cells to the adjacent muscle fibers, which is believed to promote the release of factors that function to sustain muscle integrity. Again, this condition is primarily found in adolescent diabetics and to a lesser degree in adult diabetics.

Muscle fibers are broken down into two types. Type I muscle fibers are low force/power/speed production and high endurance fibers. The type IIX fibers are high force/power/speed production and low endurance fibers (white in color). A third type (type IIA fibers) fall in between the two main types. The IIX fibers are also referred to as fast twitch glycolytic fibers. Diabetics display increased glycolytic fiber numbers, but also display more muscle atrophy, and decreased capillary density. They also display increased perturbations to muscle metabolism, which is a change in the normal state, or regular function, and results in a decrease in mitochondrial (intermyofibrullar mitochondrial), content, and an abnormal fat disposition. When this occurs, the muscle becomes metabolically inflexible; it cannot easily switch between burning fatty acids and glucose in response to insulin. These functional impairments will become evident, when muscle strength begins to decline and an increase in muscle fat storage. Studies have shown that when insulin resistance is present, the skeletal muscle plasticity declines.

Skeletal muscles are very highly specialized. They contain two distinct types of mitochondria. The first is the subsarcolemmal (SS) mitochondria, and the second is the intermyofibillar (IMF) mitochondria. The function differently in several ways, which are not fully understood. The IMF mitochondria have a higher level of proteins that changes how they use their structure, enzymes, and energy, that is released by the burning of nutrients, to reform ATP differently than the SS mitochondria.

The two skeletal muscle mitochondria populations appear to be affected differently by disease and exercise. One of the things still not fully understood is these populations contribute to fiber type related and/or training induced changes in how the fatty acids are burned during the production of ATP; or how they regulate carnitine enzymes [carnitine palmitoyltransferase-1B (CPT1B)] that control how the mitochondria uptake the fatty acids in skeletal muscles. The oxidation rates of fatty acids in the SS mitochondria are nearly 9 fold higher, and nearly 5 fold higher in the IMF mitochondria in red versus white muscles (gastrocnemius). A very potent inhibitor of CBT1B completely shuts down fatty acid oxidation in SS and IMF mitochondria in the white muscles, and to a lesser degree in the red muscles.

Endurance training causes mitochondrial adaptations that enhance fatty acid oxidation. Ten weeks of treadmill running can increase the fatty acid oxidation by 100%, and by 46% in the SS and IMF mitochondria. Other beneficial changes occurred as well.

Regular aerobic exercise changes the muscle fiber composition, the number of mitochondria, and their capacity to oxidize fatty acids. Regular exercise causes the mitochondria to adapt, which enables them to regulate the management of fatty acids, and become highly dynamic in meeting the ATP production requirements of the muscle tissues. Endurance exercise not only increases the number of mitochondria, but their size and phosphorylation capacity as well. That enables the muscles to oxidize a wider range of fats and other fuels. These changes enhance athletic performance and improves the entire body's metabolic fitness. Studies have shown that decline in mitochondrial oxidative capacity contributes significantly in the pathophysiology of aging and the development of metabolic diseases.

The SS mitochondria are larger than the IMF mitochondria, and will adapt more readily to exercise and other changes, but will decline more rapidly when exercise is decreased. The rate of oxidation of fatty acids in the SS and IMF mitochondria are very similar under normal conditions; slightly higher in the IMF mitochondria.

Studies have shown that diabetes, and obesity, are associated with a low percentage of type I (red) muscle fibers. A greater insulin sensitivity is found in those with a high percentage of type I (red) muscle fibers; they are also less susceptible to becoming obese. Regular physical activity increases the number of type I muscle fibers, and the corresponding expansion of the mitochondrial population.

As was stated earlier, diabetes impairs skeletal muscle health. Protein degradation studies, with regard to diabetes, are greatly needed. Studies have shown that a high fat diet, and elevated blood sugar, even over a short period of time, significantly impacts the body's ability to repair damage to the muscles. Muscle regeneration is impaired and cellular communication is altered.

The uncontrolled diabetic environment sets up an unfavorable growth and regeneration environment for skeletal muscles. There is a great deal more that needs to be learned about this process. You will recall that the stem cells that float around in the bloodstream that are activated to repair muscle damage is impaired in diabetics.

As diabetes progresses a multitude of pro-inflammatory factors become elevated, which creates a continuous state of chronic low-grade inflammation, or a chronic low-grade inflammatory profile; also referred to as CLIP. This state is found in all types of diabetes, and is believed to be caused by AGE's (Advanced Glycation Endproducts). These factors (those associated with CLIP) independently and collectively influence the function of the stem cells. Both type I and type II diabetics have elevated levels of interleukin-6 (IL-6). Interleukins are a group of cytokines (secreted proteins and signaling molecules) that are expressed by the white blood cells (immune system). IL-6 is an interleukin that acts both as an inflammatory and anti-inflammatory cytokine, which as stated, is secreted by the T cells of the immune system; they regulate the immune system function. Increases in IL-6 promote stem cells proliferation, but as with diabetes, chronically high IL-6 levels is correlated with a significant decline in muscle health. Further, obesity causes significant impairments in IL-6 signaling within their skeletal muscles, even when diabetes is not present.

At the risk of becoming too technical the tumor necrosis factor- α (TNF-α) functions to be a key mediator of the inflammatory processes; for those that want to learn more about how diabetes impacts muscles. TNF- α is correlated with the progression of diabetes, in that it promotes insulin resistance; it alters the uptake of glucose by muscle cells by knocking out its insulin receptors. The presence of CLIP in diabetics alters skeletal muscle homeostasis. Studies in this area are in their infancy, but the value of its potential in treating diabetes is of very great value.

## A Little Practical Advice for Diabetics

All of this illustrates that diabetes is very disruptive to the cardiovascular system. The good news is that you can do something about it. You can essentially remove your name from the list of the 85% of diabetics that will die of heart attack or stroke. You can systematically clean the plaque from your arteries. You can restore damaged blood vessels, and rebuild your capillary vessels. Clearly, most diabetics are living on a tight budget, so buying exotic blends of supplements and enzymes to accomplish that may be out of the question. So, treatments have been organized starting with a basic approach that can remove arterial plaque, but it will take much longer to accomplish. Then additional supplements have been listed that explain how they work, and how much more they will contribute to speeding up the process.

Diabetics have up to twice as much fibrin in their blood, especially when insulin resistant, than non-diabetics. And, they have less (up to 50% less) plasmin, which is used by the body to dissolve blood clots. Both are significantly more problematic if the diabetic is blood type A or AB, or if they are Hispanic, African American, or American Indian.

Diabetes (elevated blood sugar) causes cell death in 7 areas of the body; the brain, pancreas, kidneys, intestines, arteries, nerves, and red blood cells. The cell death in the arteries causes the tissue in the artery walls to become spongy, which produces a perfect environment for the collection of substances that form artery plaque; a major cause of heart disease and strokes.

Diabetics produce less nitric oxide than non-diabetics, because they produce twice as much epinephrine as non-diabetics. Epinephrine (a hormone) will normally cause the production of nitric oxide, which will lower blood pressure by relaxing the muscles surrounding blood vessels. Unfortunately, for reasons unknown, more epinephrine has an opposite effect when it is in excess; it lowers the nitric oxide production. Diabetics can use exercise as a means of producing more nitric oxide.

Research has shown that high blood-pressure problems are not due to excessive salt intake, but due to an overactive hormone system, which results in an increase in renin levels. Elevated renin levels cause a physiological need for salt. Low sodium levels in the body have not shown a decrease in cardiovascular deaths, or any changes in life span, as compared to high sodium levels. In fact, low sodium diets have shown substantial increases in heart attacks (400%) in men. Lower sodium levels elevate fasting insulin levels. It also elevates the LDL (bad) cholesterol levels, which is a primary factor in the development of cardiovascular disease. Low sodium levels will affect mood and energy levels, as well as mental clarity.

Given that diabetics are 4 times more likely to suffer a heart attack or stroke, it makes good sense to focus a great deal of energy into stopping the progression of diabetic damage, and eliminating the health risks that promote heart disease and strokes. The risk of developing heart disease increases significantly when your blood sugars are elevated, and 3-5 times more likely to develop when your blood sugars are too low (below 80 mg/dL). Low blood sugars are very stressful on the heart muscle.

Diabetes is a progressive disease, which means that despite the fact that there is no pain or discomfort, serious damage is slowly destroying cells throughout your body. Doctors do not seek to stop the progression of damage, but to merely slow it down. You can stop the progression of damage caused by diabetes by applying the 6 steps described below. You can significantly reduce your risk of developing heart disease, or suffering a heart attack or stroke.

Heart disease is caused by a number of conditions that develop, coexist, and interact with one another to cause heart disease to progress. Bad diet and a sedentary lifestyle causes a rapid increase in visceral fat (belly fat), which in turn leads to fatty liver, inflammation, insulin resistance, and an increase in other diabetic related complications. A bad diet consists of processed foods (box, bag, can, or bottle) that contain food colorings, texture and flavor enhancers (chemical), and preservatives. It is eating store bought meats that are grain fed, which are laced with antibiotics, growth hormones, nitrates, nitrites, and food coloring. It is eating highly acidic foods like sodas and colas, wheat, corn, or soy. It is eating dairy (high saturated fats), too much alcohol and caffeine, and artificial sweeteners. A bad diet leads to significant deficiencies in vitamins and minerals, amino acids, hormones, and enzymes, which are a contributing cause of diabetes manifestation, and diabetic complications; including heart disease.

Gaining control over these issues and diabetes requires a 6 step process that will stop the progression of diabetic damage; including the risk of heart disease, heart attack, or stroke. An in depth explanation of the 6 steps, and how to implement and monitor them is explained in the book "Diabetes Control-6 Steps to Gaining Control over Diabetes," which is found in the "Other Books by the Same Author" section at the end of this book.

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# Chapter 9-Preventing Cardiovascular Disease and Strokes

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> "Be careful about reading health books. You may die of a misprint"--Mark Twain

> "Health nuts are going to feel stupid someday, lying in hospitals dying of nothing." -Redd Foxx

> "One way to get high blood pressure is to go mountain climbing over molehills."-Earl Wilson

Preventing the development of cardiovascular disease is more difficult for diabetics; especially diabetics that are African American, Asian, Hispanic, or Native American. They are genetically more prone to developing heart disease than other races. They have a genetic predisposition to insulin resistance than other races. Preventing heart disease, like any other diabetic complication, is dependent upon gaining control over blood sugars, insulin resistance, and excess weight. A single percentage point increase in A1c has an associated risk increase of 14%; A1c of 6.5 or greater. Each percentage of increase in your A1c presents a substantial increase in stress on your heart.

When your heart pumps harder the blood vessels feeding the heart muscle open wider to allow more blood flow. For reasons unknown vasodilation is impaired in diabetics. It is believed that high blood sugars are a significant contributor to the loss in vasodilation. Recall that even high dosages of insulin do not overcome the loss of relaxation in the blood vessels in diabetics. This decrease in dilation contributes to the buildup of plaque in your arteries.

The primary goal will be to remove excess weight, reduce insulin resistance, remove the excess plaque buildup in the arteries, reduce LDL cholesterol, increase HDL cholesterol, and exercise; exercise increases nitric oxide production, builds new blood vessels (capillaries), which will increase circulation, oxygenates the body, strengthen the heart muscle, and cleanses the blood.

### Restoring Vitamin and Mineral Deficiencies

Elevated blood sugar causes the kidney's filters to malfunction. Normally, your kidney's filters would capture all of the vitamins and minerals in the blood and pass them through the filter to remain in the bloodstream. Elevated blood sugar (over 110 mg/dL) will cause the filters to malfunction and discharge many vitamins and minerals into the urine; resulting in vitamin and mineral deficiencies. Inflammation causes vitamin and mineral deficiencies. And, medications cause vitamin deficiencies; either by blocking their absorption, or because the liver will use them up attempting to remove the chemicals from the bloodstream. Diabetics are chronically deficient in over 10 primary vitamins and minerals; most of which play significant roles in regulating blood sugar, maintaining a healthy heart and vascular system, and other important bodily functions.

It is vitally important that you restore the deficient vitamins and minerals caused by high blood sugars, inflammation, and medications. The vitamins can be restored by taking a good quality multivitamin daily; extracted from organic sources-not synthetic. That means that you have to buy multivitamins that are extracted from organic sources; they are not chemical substitutes like those found in multivitamins purchased in drug stores, wholesale clubs, or department stores. Then maintain the minimum levels (100% daily requirements) of all the primary vitamins and minerals by making certain that you take the multivitamins every day. Doing so will decrease the destructive actions of inflammation, it will normalize the production and management of amino acids, hormones, and enzymes, and will stop the damage caused by elevated homocysteine levels. Vitamin C and the B vitamins are known to be especially good for the arteries. Restoring the levels of vitamins and minerals will begin the process of healing of most types of damage; especially damage to the blood vessel walls. Vitamins relax your blood vessels and lower your blood pressure.

Nutritional supplements that will benefit diabetics (reduce inflammation and insulin resistance) include:

Fish oil. Omega-3 fatty acids Omega-3s reduce the triglyceride levels, raise HDL, and reduce inflammation. Of all the benefits that omega 3 fatty acids provide, the triglyceride-reducing power of omega-3s represents their most powerful effect; likely responsible for the dramatic reduction in heart attack and stroke seen in diabetics that take them.

Chromium- 200 mcg/day to 1,000 mcg/day improve blood sugar by enhancing the effects of insulin. Chromium is one of the primary minerals universally deficient in diabetics. Studies have shown that chromium supplementation safely reduces cholesterol and triglyceride levels, and may reduce requirements for oral diabetic medications.

White bean extract. An extract of the white bean (Phaseolus vulgaris) is a starch blocker that blocks intestinal carbohydrate absorption by up to 66%. Studies have shown that 445 mg of white bean extract twice daily (in overweight adults) led to 6.4 pounds of weight loss (while maintaining lean body mass) after 30 days compared with only 0.8 pounds in non-treated subjects. White bean extract also improves insulin responses by reducing sugar absorption and through weight loss.

DHEA. (taken at bedtime) is an adrenal gland hormone that enhances the mobilization of abdominal fat, and it reduces insulin resistance and inflammation. The dosage for men and women is 15-75 mg daily. You should ask your doctor to test the DHEA-S blood levels three to six weeks after dosing to assess your body's response.

Vitamin D. A vitamin D deficiency contributes to insulin resistance and raises blood pressure (by increasing the blood pressure-raising hormone renin).47 Vitamin D deficiency is very common in diabetics, particularly in northern climates. Up to 90% of adults have a moderate-to-severe deficiency. In sun-deprived climates, 1,000–5,000 IU/day may be required to raise blood levels to normal, occasionally more. People that lack sun exposure can safely take 2,000 IU/day. However, adequate sun exposure (20 minutes of direct exposure daily) does not guarantee optimal vitamin D levels. Vitamin D status should be assessed during each of the quarterly blood tests. Optimal levels 30-50 ng/mL (75-125 nmol/L) of 25-hydroxyvitamin D in the blood. Discuss vitamin D supplementation with your doctor if you have kidney disease, kidney stones, or a history of high calcium levels. Vitamin D is a crucial modulator of inflammation, especially to cause a dramatic reduction in the inflammatory proteins CRP and matrix metalloproteinase (MMP).

Magnesium. It is needed for more than 300 biochemical reactions and is an important mediator of insulin action, and in reducing inflammation. A daily oral magnesium supplementation substantially improves insulin sensitivity by 10% and reduces blood sugar by 37%. It is one of the primary minerals chronically deficient in diabetics. A failure to take the recommended adequate intake of magnesium (320-420 mg/day) will increase the risk of developing metabolic syndrome and will increase CRP levels. An improved sensitivity to insulin, generated by magnesium replacement, can significantly reduce triglycerides by as much as 75 mg/dL. The reduction in triglyceride level will in turn reduce the triglyceride-rich particles, very low-density lipoprotein (VLDL) and small LDL, which are powerful contributors to heart disease. Magnesium supplementation will also raise levels of beneficial HDL. A magnesium deficiency is common not only from a dietary standpoint, but is also becoming an even larger issue as people turn to bottled water, which contains very little magnesium. Many municipal water treatment plants are more intensively "softening" their water by removing magnesium. The daily minimum dosage is 320 mg/day for women and 420 mg/day for men, and is therefore, a basic requirement for health for most people.

Flavonoids. They are naturally occurring flavonoid compounds that are important for suppressing inflammation. Some flavonoids enhance the insulin response and reduce insulin resistance. Of the thousands of known flavonoids, several, including polyphenols and resveratrol, stand out for these benefits. Polyphenols (derived from green tea, cocoa, and apples) are powerful facilitators of insulin responses and are potent anti-inflammatory compounds. Studies have shown that dark chocolate (which contains beneficial cocoa polyphenols), with white chocolate (non-cocoa), at a dosage of 100 grams per day for 15 days, showed that only dark chocolate improved insulin sensitivity. Another study showed that 37 grams of dark chocolate (containing 148 mg of procyanidins) yielded a 29% decrease in inflammatory leukotrienes and a 32% increase in the anti-inflammatory prostacyclin compared with subjects who received chocolate containing only 33 mg of procyanidins. The net decrease in the plasma leukotriene-prostacyclin ratio, a measure of pro-inflammatory-anti-inflammatory eicosanoid balance, dissipated six hours after subjects ingested the chocolate. That suggests that the consumption of flavonoid sources several times a day is more likely to yield a maximum benefit. Cocoa polyphenols work in synergy with beta glucans; which is an excellent source of low-glycemic carbohydrates. Beta glucans are an excellent form of soluble dietary fiber. They promote satiety and weight loss, and lower CRP levels.

Cinnamon helps to diminish the after-meal surge in blood glucose in some diabetics, due to water-soluble polyphenols that cinnamoncontaines.

Resveratrol. It is a flavonoid found in grape skins and concentrated in red wine. Red wine (12 oz/day) improves insulin responses in diabetics. It suppresses inflammatory mediators and inhibits matrix metalloproteinase; a trigger for atherosclerotic plaque rupture that results in heart attack and stroke. Resveratrol (doses of at least 20 mg/day) are necessary to protect against heart disease. A glass of red wine (about 6 oz or 180 mL) averages just 500 mcg of resveratrol. The resveratrol content in red wines varies considerably (depending on type of grape, soil characteristics, methods of barreling, etc.), but averages around only 2.5 mg/L. Resveratrol is available as a standalone supplement, or mixed with other flavonoids.

Alpha lipoic acid (or R lipoic acid), is also a useful strategy to curtail inflammatory responses and improve insulin responses. Most of the research on lipoic acid (600-1,800 mg/day) has focused on the improvement of painful nerve conditions associated with type 2 diabetes. Lipoic acid also suppresses inflammatory mediators, such as interleukin-6 and plasminogen activator-1. Most diabetics can benefit from dosages starting at 100 mg/day.

### Restoring Hydration

It is equally important that diabetics restore hydration. Elevated blood sugars cause the kidneys to malfunction, which results in a significant loss of body fluids. That is why you urinate more frequently when your blood sugars are high. Also, that is why you are always thirsty when your blood sugars are elevated. To restore hydration you cannot simply drink more water. Your brain will signal your kidneys to remove the excess water before it can rehydrate your body. When you drink a full glass of water it enters your bloodstream immediately, which causes the sodium concentrations in your blood to become diluted. Since your brain monitors your sodium levels very diligently, your brain will instruct your kidneys to quickly draw the excess water out of your blood to restore the blood sodium concentration. You have to trick your body into retaining the water for a couple of hours, which provides enough time for your body's cells to uptake the water to restore hydration. To accomplish that you have to add approximately 1/8th teaspoon of sea salt (never use table salt) into a full glass of water and drink it down relatively quickly. The sea salt will simulate the sodium concentration of your blood, which will fool your brain into ignoring the excess fluid in your body; at least for about 2 hours.

### Meal Planning

Next it is very important that you balance your calories, carbohydrates, proteins, and omega 3's and omega 6's. However, before getting into all of that, you must first eliminate all of the foods that are causing inflammation, weight gain, and blood sugar control issues; which includes all processed foods (anything in a box, bag, can, or bottle that has chemical additives), high glycemic index foods, artificial sweeteners, pork, dairy, wheat, corn, soy, sodas and colas, saturated fats, caffeine, or alcohol. Use the glycemic index table, found near the end of this book, and plan your meals around low glycemic index foods only. If a food item is not found on this table it likely is not a low glycemic index food.

Diabetics must also restrict their daily intake of carbohydrates to around 40-50 grams per day. They must also reduce their portion sizes; if your meal is greater in size than the size of your fist. If you are likely eating too much, or the wrong foods, you will significantly impact your weight control, blood sugar management, and insulin resistance. One hundred years ago our ancestors burned in excess of 3,000 calories each day, mostly because they did not have automobiles, refrigerators, electric or gas stoves, central air and heat, or the many other modern conveniences that we enjoy. During the 1970's the Federal Government reevaluated our caloric expenditure on average, and found that we no longer burned 3,000 plus calories per day. They reset the values to 2,000 calories for men, and about 1,500 calories for women. Unfortunately, despite continued reductions in our physical energy expenditures, those number have become stuck. Our nutritionists and medical professionals still cling to those values. Very few diabetics burn more that 1,200 calories each day. In fact if they do, they lose control over their blood sugar and weight; increased insulin resistance and the associated complications follow.

Use the glycemic index table found in the "Glycemic Index Foods and Glycemic Index Table" chapter to plan your meals. A sample meal plan chart is shown at the end of the glycemic index tables that should be used to plan and log your meals until you are comfortable in how various foods impact your blood sugar management. Log what you eat each day, their calories, carbohydrates, protein, and fiber. Then total each up at the end of the day.

Diabetics need to plan their meals around 1,000 calories per day, 40-50 grams of carbohydrates, 125 grams of protein (not critical and will vary by blood type), and in order to balance their omega 3's and omega 6's, they must take 1000 mg of EPA and 500 mg of DHA (fish oil) each day. They also must incorporate a healthy fat form into their daily diet. The fat soluble vitamins (vitamins A, D, E, and K) require a healthy fat source, every day, in order to be absorbed, stored, or utilized. Two tablespoons of extra virgin oil added to food daily (not heated as in cooking) in order to supply the required amount of healthy fat each day. The critical values are the carbohydrates and fiber; it is not necessary to stress over the other values.

### Balancing the Omega 3's and Omega 6's

Nearly every plant based food you eat has omega 6's in them, and very little omega 3's. Seafood contains omega 3's, but you have to limit your intake to about twice a week in order to avoid getting too much mercury (a dangerous heavy metal). The omega 3's found in plant food are short chained fatty acids (ALA), which must be converted into long chained forms to be utilized by your body (EPA and DHA). Unfortunately, that is a very inefficient process (below 5%). Despite the fact that many plants contain a high level of ALA (omega 3), like flaxseed and walnuts, the amount of omega 3 that they provide (EPA and DHA) is very small.

It is critical that diabetics balance their omega 3's and omega 6's in order to prevent the development of heart disease. The omega 3's consumed each day must be at least half of the omega 6's that are consumed. Since it would be arduous to attempt to keep track of how much of each you consume, it is far easier to take fish oil daily to ensure that they are balanced.

### Fiber

It is critical that diabetics get enough fiber in their diet daily. Most diabetics get less than half of the required amount of fiber in their diet. Women need a minimum of 30 grams of fiber each day, and men need 35 grams minimum each day. Flax meal is the cheapest form of fiber. All that is required for most diabetics is to add a 1/2 cup of flax meal to a full glass of filtered water and stir it thoroughly. Drink it down quickly, because the flax meal will quickly absorb the water and form a thick gel. Many of the commercial fibers, like psyllium powder, contain artificial coloring, flavoring, and artificial sweeteners, which is very bad for diabetics. A larger intake of soluble fiber increases insulin sensitivity (reduces insulin resistance), and it reduces inflammation throughout the body. Fiber helps control blood sugar levels by slowing the absorption of sugars into the bloodstream, which contributes to reducing the insulin response.

### Weight Loss

Of all the changes you can make weight loss will yield the most benefit for reducing insulin resistance, increasing the insulin response, and reducing inflammation; and therefore, reducing the risk of developing heart disease. It will yield dramatic drops in CRP. The amount of weight lost is more significant than how you achieve it. Unfortunately, weight loss for diabetics is easier said than done. Diabetes and nature fight weight loss in numerous ways. There are ways that you can trick your body to overcome the many ways that diabetes, and nature, fight weight loss in diabetics. A detailed explanation of how diabetes fights weight loss in diabetics can be found in the book "Diabetes Control-6 Steps to Gaining Complete Control over Diabetes." (See Other Books by the Same Author" click HERE)

### Healthy Foods

Changing your diet to reduce your risk of developing heart disease is also a significant factor in achieving your goal to reduce your risk of developing heart disease. Earlier we discussed eliminating all processed foods (anything in a box, bag, can, or bottle) that contain chemical additives like food coloring, flavor and texture enhancers, preservatives, insecticides, fungicides, and chemical fertilizers. You also learned that dairy, due to pasteurization, homogenization, and a high saturated fat content, foods that contain artificial sweeteners and caffeine, sodas and colas, wheat, corn, soy, pork, and alcohol should be eliminated from your diet. Animal meats that are grain fed (not grass fed) contain large amounts of saturated fats, antibiotics, growth hormones, nitrates, and nitrites and therefore, should be eliminated from your diet. Grass fed meats are becoming available in numerous retail outlets; Costco, BJ's, Sam's, and even Wal-Mart are selling grass fed meats at discounted prices. Discontinuing the consumption of table salt, high fructose corn syrup, and processed sugar is very important.

Changing your diet to consuming low glycemic index foods only is very important; see glycemic index table in this book. That means eliminating all high glycemic index foods like potatoes, short grain rice, pasta, and wheat. Wheat produces more inflammation (AGE's) than any other food item, and it promotes weight gain more than any other food. The more dark green vegetables you eat the better. Eat 51% of your food each day raw (salads, fruit, and raw vegetables).

Getting a sufficient amount of restful sleep is very important. Adequate amounts of sleep improves insulin function, and reduces the accumulation of abdominal fat. Seven to eight hours of restful sleep every night is necessary to enhance insulin responses. Some diabetics may need to take melatonin supplements to restore their normal sleep-wakefulness cycles. Sleep apnea is very common in diabetics, especially those that are carrying excess belly fat. Sleep studies will identify your risk. Sleep apnea can be a very dangerous condition if not treated.

### Lower Homocysteine Levels

Folic acid and the B vitamins play key roles in breaking down homocysteine in the body. Low levels of folic acid in the bloodstream has been linked as a major risk factor for fatal coronary heart disease and stroke. However, folic acid supplements have not demonstrated an ability to reduce the risk of developing atherosclerosis, or that it will reduce the risk of development or recurrence of heart attacks. The homocysteine levels in the bloodstream are influenced by genetics and dietary choices. The dietary folic acid and vitamins B6 and B12 have the greatest effects in lowering the homocysteine levels. However, researchers have not established how much folic acid and B vitamins is required to lower the homocysteine levels.

### Eliminate Insulin Resistance

To totally eliminate insulin resistance it will be necessary to eliminate the excess belly fat, stop eating processed foods and high glycemic index foods, significantly reducing portion size, restore vitamin and mineral deficiencies, avoid unnecessary chemical exposure, hydrate your body, and start a vigorous exercise program. It is easy to change the diet to eliminate the chemical food additives, antioxidant and nutrient void processed foods, reduce the portion size, reduce the chemical exposure in your environment, and start taking a good quality multivitamin. Losing the excess pounds is not always that easy for diabetics.

Stop using commercial tooth pastes, shampoos, mouth and body washes, and cleaning products. Health food stores sell chemical free products, or they can be ordered on the Internet from a wide variety of sources.

A toothpaste substitute is as follows:

One two oz. bottle of Eco-Dent tooth powder (health food store). Use the entire bottle.

2 oz. of natural calcium bentonite clay powder. Bentonite is sold in 1-2 lb. containers which will make up several years worth of tooth powder at 2 oz. per mixture.

1 tsp. of sea salt

Combine the above ingredients in a sealable Tupperware bowl. Shake thoroughly to mix.

Dip your toothbrush into a bottle of 3% hydrogen peroxide to sterilize the brush and to dampen the bristles. Dip the dampened bristles lightly into the tooth powder mix; only a small amount is needed. Brush as usual and rinse your mouth with filtered water.

Losing the excess weight will take some time, however starting an aggressive exercise program, changing the diet, limiting chemical exposure, hydrating, and restoring vitamin and mineral deficiencies will have an immediate effect on reducing insulin resistance, and will aid in losing the excess body fat.

Reducing the insulin resistance and CRP essentially means paying close attention to what you eat, and how much you eat, exercising and fixing the causes of insulin resistance and inflammation. Reducing insulin resistance will pay off in huge dividends. It will reduce the LDL levels, and increase the HDL levels of cholesterol. It will significantly reduce your triglyceride levels, and your blood pressure; all while your physical stamina and energy continues to increase. All combined will significantly decrease inflammation throughout your body. It will also significantly improve your blood sugar management, and significantly reduce your risk of heart disease.

### Using Exercise to Reduce the Risk Factors for Heart Disease

Studies have shown that 12 weeks of aerobic exercise (at 70-80% maximum heart rate) can reduce CRP by 19% in non-diabetics, and 40% in diabetics. Exercise is one of the most important tools in a diabetic's tool kit, but because it is the least popular it is all too often ignored. Motivating yourself to exercise is a complex undertaking that usually ends badly. Most will begin an exercise program periodically only to abandon it after a short period of time. One of the causes of breaking the routine is due to the fact that exercise is not a daily routine. However, you will learn that exercise is a powerful tool that will significantly speed up the process of gaining control over diabetes and especially weight control. It will empower your body to repair some of the damage caused by elevated blood sugars and diabetes. And, it will enable your body to begin rebuilding systems and shifting away from operating under survival mechanisms; back into normal functional modes.

Exercise promotes health. It can play a significant role for prediabetics to prevent the manifestation of full blown diabetes. Studies have shown that exercise dramatically improves genetic function. Your genes are not static, they turn on or off depending upon the biological signals they receive from other areas of the body. When genes are turned on, they express various proteins that can, in turn, prompt a range of physiological actions in the body. For example, there is a process called methylation, in which methyl groups, a cluster of carbon and hydrogen atoms, attach to the outside of the gene and make it easier, or harder, for that gene to receive and respond to messages from the body. The behavior of the gene is changed, but not the fundamental structure of the gene itself. These methylation patterns can be passed on from generation to generation (a process known as epigenetics).

The methylation process is driven largely by how you live your life. Diet for instance, notably affects the methylation of genes. Scientists suspect that differing genetic methylation patterns result from different diet. A healthy diet promotes healthy methylation, and an unhealthy diet promotes unhealthy methylation; "you are what you eat." Your diet plays a significant role in determining your risk of developing chronic diseases, including diabetes.

But the role of physical activity in gene methylation, until recently, has been poorly understood. Researchers extracted fat cells from healthy, but sedentary individuals, and studied them. Then they initiated an exercise program for the same individuals; under the guidance of a professional trainer. They incorporated hour-long spinning (stationary bicycles) or aerobics classes twice a week for six months. By the end of that period the volunteers had shed fat and several inches from around their waists, their endurance had significantly improved, their blood pressure had dropped, and their cholesterol profiles were significantly improved.

It was noted that the methylation pattern of many of their genes (in their fat cells) were also modified. Their genes had become more methylated, with fewer methyl groups attached; which impacts how the genes express proteins. The genes most impacted were those that play a significant role in fat storage and the risk for developing diabetes or obesity. Other studies have found an equally profound effect on DNA methylation within muscle cells; even after a single workout (where 400 or less calories were burned). The muscle cell methylation changes were far more pronounced among those that had vigorously exercised, versus those that had pedaled more gently; even though their total energy output was the same. The genes most affected are those that are known to produce proteins that affect the body's metabolism. These studies have shown that the earliest adaptations to exercise are the changes in genetic methylation.

Exercise causes an increase in the production of epinephrine, norepinephrine, growth hormones, and causes a decrease in insulin production, which promotes fat burning and the release of fatty acids from storage in the belly area. However, the breakdown of fat into ATP is a slow process, and therefore will not supply adequate amounts of ATP during very high intensity exercise. Still, six molecules of oxygen are required to oxidize one gram of fat, which can supply as much as 70% of the energy needs during exercise. However most athletes do not work out long enough to burn significant amounts of fat as fuel during exercise.

Exercise increases the number of mitochondria inside each of the skeletal muscle cells. The additional mitochondria are required to support the increased muscle output due to the exercise. The additional mitochondria will significantly increase the amount of glucose and fatty acids that can be burned throughout the day; and especially during exercise. Exercise also increases the amount of oxygen that is available to burn the glucose and fatty acids.

Fat is a combination of oxygen, carbon, and hydrogen. When you exercise the oxygen reaches the fat molecules and breaks them down into carbon dioxide and water. Energy is released during this chemical reaction. The carbon dioxide is picked up in the bloodstream and carried to the lungs where it is discharged into the air. The more oxygen that enters your body the more fat your body will burn. Most people use less than 1/5th of their lung capacity. They only draw breath from the upper and middle lobes of their lungs. Exercise causes you breathe more deeply, which causes the diaphragm to force the lungs to use more of the available lobes. Deep breathing causes the body to burn up to 140% more calories than when at rest.

Aerobic Metabolic Pathway

The aerobic metabolism (also called the phosphagen system) is used to fuel energy needs at lower intensity (but can be longer duration) activity. The heart rate is moderate, and the lungs and cardiovascular system is easily capable of supplying oxygen to convert glucose, fats, and protein into ATP. Breathing is easy and comfortable through the nose. The aerobic pathway is slower than the anaerobic, because of its reliance upon the circulatory system to provide enough oxygen. It is the most complex of the three energy systems. Aerobic metabolic reactions are responsible for most of the energy produced inside the cells. But, it is the slowest. Oxygen is often called the patriarch of metabolism, because it controls endurance; it is the sustenance of life. Even though a massive amount of ATP will be produced, it will take longer to happen.

During the aerobic pathway the Krebs cycle (citrus acid cycle) involves an electron transport chain, where glucose from the bloodstream, stored glycogen (compact form of glucose), and fat fuels are used to produce ATP (energy to power the cell). You will recall that this takes place inside the mitochondria (energy/heat generators) inside each cell; called mitochondrial respiration. When the metabolism of glucose, glycogen, and fats occurs (called glycolysis), pyruvate and acetyl CoA are produced. They enter the Krebs cycle and produce ATP. You will recall that glycogen is stored inside muscle tissue, which can only be used by the muscles; not converted into glucose and placed into the bloodstream like the liver can. When the glycogen stores inside the muscle tissue cells begin to fall the cells will uptake more glucose from the bloodstream to replace it; for as long as the bloodstream supply can keep up with the demand.

Your body stores fat (triglycerides) in the adipose tissue; under the skin primarily in the belly area. Triglycerides are also stored within the skeletal muscles (intramuscular triglycerides). Fat is the other primary fuel of the aerobic system. Fat represents the largest source of stored energy inside the body. Insulin resistance in type II diabetics significantly increases the triglyceride storage level of the liver and skeletal muscles; which can contribute to an increase in insulin resistance. The triglycerides have to be broken down before they can be used as fuel. Triglycerides are made up of 3 fatty acids bonded to a glycerol molecule. When the triglycerides are broken down (a process called lipolysis), the three fatty acids (long chain atoms) are transported into the muscle cell's mitochondria separately. Once inside, the carbon atoms are used to produce acetyl CoA (a process called beta oxidation). Once the acetyl CoA are formed, the metabolism is the same as that of carbohydrate metabolism, because the acetyl CoA enters the citric acid cycle in an identical way that it would if from glucose. The electrons produced and transported form ATP and water just as it would from glucose. However, the oxidation of free fatty acids yield many more ATP molecules during the process than would be produced from glucose or glycogen. The oxidation of fatty acids enables you to sustain aerobic activity far longer than an anaerobic system could. The conversion of the fatty acids will produce 129 molecules of ATP, compared to just 36 produced by glucose. This accounts for the "high energy" feeling after an aerobic workout.

Nearly 100% of ATP is produced during aerobic metabolism. The lactate levels will be very low and the resting O2 (oxygen) will be around 0.25 L/minute. The ATP production can increase immediately if needed from a restful state to a higher level of activity, and the oxygen uptake will increase rapidly as well; it will reach a steady state within 1-4 minutes. Once the steady state is reached, the ATP requirements will be met through aerobic ATP production.

Scientists use the term VO2 max to describe the maximum oxygen consumption, which describes the maximum amount of oxygen that the cardiovascular system can provide; the maximum aerobic capacity. That is the point where you are able to carry on a conversation and breath through your nose; not the forced breathing through your mouth as in anaerobic activity. VO2 max is expressed in liters per minute (L/min). It is used to compare the endurance capacity between individuals. The steady state level is reached when the oxygen intake and CO2 exhaled levels off, despite an increase in the activity level; as measured by specialized equipment.

As you increase the level of activity during exercise (starting from rest), the shift from light to moderate to extreme will cause a rapid increase in your breathing rate (oxygen taken in), until you reach the steady state point. Within 1-4 minutes you will reach a point where you can no longer take in and transport enough oxygen to meet your muscle cell's need for oxygen to produce ATP aerobically. Your body will transition into the anaerobic metabolic pathway in order to continue producing ATP; despite the lack of oxygen.

Your body will progress through a process where initially, after increasing your activity level, your cells will quickly use up the oxygen in the bloodstream and the stored PC and ATP. Your cells produce and store small amounts of PC (phosphocreatine) which can be quickly converted into ATP during intense physical activity. The cell's stores of PC will power the cells for only a few seconds. Your body will initially be incapable of providing enough oxygen to support the aerobic metabolic pathway. The cells will be placed under a sudden demand to produce more ATP without oxygen, because the oxygen cannot be replaced instantly. Your cells will temporarily switch to an anaerobic (without oxygen) production of ATP. Your body will seek to quickly catch up. Your body will eventually reach the steady state level, where the oxygen level in the bloodstream will rise, and the cells will be able to switch back to the aerobic metabolic pathway to produce ATP. If you continue to increase your activity level your body will reach a point where the steady state respiration can no longer provide enough oxygen to sustain aerobic metabolism; your body will once again switch back to the anaerobic metabolic pathway.

The first 1-5 seconds of an exercise routine will be supplied by the stored PC and ATP. The amount stored will depend upon the amount stored and the number of mitochondria in the cells. The process can last as long as 20 seconds. The following 5 or so seconds will cause the body to shift to ATP production through glycolysis. If the session continues to longer than 45 seconds to a minute your system will shift from an aerobic (30%) pathway to an anaerobic (70%), then if longer to a 50%/50% (aerobic/anaerobic) pathway after 2 minutes. If the session continues (over 10 minutes) , the ATP will be produced primarily from aerobic metabolism, because the intensity of the workout will have to be adjusted to the steady state oxygen level. As the intensity increases, the body's temperature will rise, more epinephrine and norepinephrine will be produced, and the amount of oxygen required will increase.

When you end your workout session, your body will continue to operate at the elevated level of respiration for a period of time to allow your body to restore the oxygen deficit, and rebuild its stores of PC and ATP. It is called EPOC (Excess Post Exercise Oxygen) by scientists; for the techies that want to learn more about it. The greater the intensity of exercise, the greater the EPOC. The greater the level of intensity the greater the level of epinephrine, norepinephrine, the depletion of PC, and the higher the body temperature. The rate of recovery will depend upon your physical conditioning (due to exercise), and the intensity of the activity. A person that exercises regularly will have a significantly larger capillary bed in their lungs and around muscle tissues, and their heart and vascular system will be healthier; which will speed up the recovery process.

Anaerobic Metabolic Pathway

The anaerobic metabolic energy pathway, which is also known as the phosphate system, or the ATP-CP system, creates ATP exclusively from glucose (from carbohydrates). Lactic acid, which is a byproduct of the process is used in the conversion. The energy is produced through the partial breakdown of glucose (without oxygen), which will supply large amounts of energy for about 10 seconds, or until a buildup of lactic acid is reached; called the lactic acid threshold. When the lactic acid threshold is reached muscle pain, a burning sensation, and fatigue will result. It is used primarily during times of short term intense activity; when the muscle tissue cells require very large amounts of ATP. It is the quickest and most efficient method of producing ATP. The stored ATP is used first (2-3 seconds), then the CP will be used until it runs out, and then the cells will shift to either an aerobic or anaerobic pathway to supply the needed ATP.

CP or CPr (creatine phosphate) is made up of 3 amino acids (methionine, arginine, and glycine). It is activated by an enzyme (creatine kinase). CP acts as a phosphate donor to produce ATP during the first 7 seconds following very intense muscular contractions. It is stored inside the skeletal muscle tissue cells. Systems that would normally use carbohydrates and fat as a fuel source cannot use CP. The regeneration of ATP comes solely from the CP that has been stored. It is used because oxygen is not required to resynthesize ATP. It is the fastest way to resynthesize ATP, and it is used as the predominant energy system during very intense activity (exercise); despite it short lived contribution (10 seconds). As stated, the CP and ATP stores are small and are used up quickly.

When oxygen is limited glucose is broken down into pyruvate. When pyruvate is formed the conversion into lactate and the conversion to acetyl CoA (a metabolic intermediary molecule) occurs. The acetyl CoA enters the mitochondria and is converted into ATP. If the oxygen level is adequate, the pyruvate enters the mitochondria and is converted into ATP. When the oxygen levels are too low there is an increase in hydrogen ions, which causes an increase in the acidity (a reduction in pH) inside the cells resulting in acidosis. Acidosis causes numerous problems inside the muscles. The inhibition of enzymes that otherwise contribute to metabolism and muscle contractions occurs. It inhibits the release of calcium from storage inside the muscle tissue cells, which otherwise triggers the contraction of the muscle. It also interferes with the electrical charge inside the muscles, resulting in a loss of ability to contract effectively; the muscle's force production (intensity) decreases.

During glycolysis, the energy production system used during the first 30 seconds to 2 minutes of intense exercise, is the predominant energy system during the intense exercise activity. It is the second fastest way for your cells to produce energy. Initially glycogen is used from storage, converted into glucose, then used to produce ATP. Enzymes breakdown the glucose into pyruvate. Every molecule of glucose that is broken down into pyruvate produces two molecules of ATP; which is not a lot of ATP, however the trade-off is that it occurs very rapidly.

So, nutrients will be converted into ATP based upon the intensity and duration of physical activity. Carbohydrates (glucose) is the main fuel source for moderate to high intensity activity, and fat will provide energy during lower intensity activity. Fat is very useful during endurance events, or longer term moderate intensity activity, but it is not useful for high intensity activity, because fat must have oxygen available in order to be burned. When you exercise at an aerobic heart rate, where you can still breathe through your nose and carry on a conversation, your lungs and vascular system will be able to provide enough oxygen to continue to burn fat.

As you increase the intensity of activity, carbohydrate metabolism will take over. It is a much more efficient energy source than fat, but it has very limited ATP stores. The glycogen stored in the muscle cells will provide up to 2 hours of moderate to intense activity. Once the glycogen stores are depleted, the body's ability to convert glucose from glycogen (in storage in the liver) into glucose and move it to the cells will fall well short of the cell's requirements. Your body's ability to convert triglycerides into glycerol and individual fatty acids is also a slow process. Both processes are simply too slow to provide fuel for high intensity anaerobic activity. Consequently, you will "hit the wall" as athletes say. You will be forced to reduce the intensity to the level where your body can metabolize fats into ATP to keep you going. Your muscles will become very heavy and sluggish; you will question whether you can continue at the current pace.

Glucose (carbohydrates) are capable of producing up to 20 times more ATP per gram, as long as there is an adequate amount of oxygen present; aerobic versus anaerobic metabolism. With extended, proper training, the body's ability to supply oxygen will increase. The lungs will increase in size, and they will develop thousands of new capillary blood vessels, that will significantly increase the lung's capacity to pick up oxygen and place it into the bloodstream. Also, the heart muscle will be strengthened significantly, and the pumping efficiency will increase significantly. You will enable your body to increase physical activity to greater extents for longer periods of time, due to the increased capacity to supply the cells with oxygen.

When the glycogen is used up, and oxygen levels are inadequate to produce ATP from fatty acids, the body can use proteins as a fuel source. Amino acids, which includes alanine, are products of the breakdown of proteins. The liver can convert alanine into glucose and place it into the bloodstream. But protein sources are a very small part of the total equation (less than 2%), for a duration of 1 hour or so, that will increase to around 5-10% late in a very prolonged-duration exercise (3-5 hours).

Lactate is used as a fuel source during exercise. The lactate produced by the muscle cells can be converted to acetyl CoA and used in the citrus acid cycle. It can be converted into glucose by the liver (Cori cycle)and placed into the bloodstream. Lactate that is produced in one tissue can be transported and consumed in another; called the lactate shuttle.

So, both aerobic and anaerobic systems can work concurrently during exercise, however, the proportion of ATP supplied during each phase will vary according to the intensity and duration of exercise. Energy production actually starts inside the cytoplasm of the cell (fluids). A process called glycolysis takes place where glucose is broken down by enzymes into two primary substances; glucose and pyruvate. Pyruvate is the primary product, which enters the mitochondria through shuttles (receptors). Once inside the mitochondria the pyruvate is processed via the citric acid cycle. Two molecules of ATP are produced inside the mitochondria through the use of several different fuels.

The term metabolism is the sum total of all the chemical processes carried out within each cell. Catabolism is a term used to describe the chemical reactions that break larger molecules down into smaller molecules (an exergonic process), usually accomplished by enzymes. Anabolism is a term used to describe the chemical reactions that assemble smaller molecules into larger molecules (an energonic process).

When fat is burned for fuel it must be combined with oxygen in order for it to be totally consumed. There are actually many kinds of fats, but one particular type (triglycerides -the most common form of fat in your body), which is commonly burned for fuel in your body (formula C55 H98 O6), will require 75 oxygen molecules from the bloodstream in order to be burned completely as fuel. So a single gram of fat will require 2.8 grams of atmospheric oxygen in order to be burned. Fat contains 9 calories per gram

Aerobic breakdown of glucose is a 4 stage process. Each cell imports glucose from the bloodstream, in the majority of cases with the aid of insulin, into the cytoplasm. Enzymes prepare the glucose for combustion (glycolysis). Glycolysis (phase #1) is a 10 step biochemical pathway, where to start the process (step #1), one glucose molecule is split into 2 molecules of pyruvate; 2 ATP are consumed during the process (per glucose molecule). the energy released is 4 ATP molecules, and high energy electrons are trapped in the reduction of 2 molecules; NAD and NADH. The final 9 steps (Krebs cycle, or citric acid cycle) are called respiration.

NADH is broken down into NAD and 3 ATP's, however one ATP is consumed to make the transfer of the NADH's into the mitochondria. For each molecule of glucose the following will be produced:

For anaerobic 2 ATP are consumed and 8 ATP are produced.

For aerobic 0 ATP are consumed and 30 ATP are produced.

Up to 36 ATP's can be generated for each glucose that enters the cell.

The second phase is pyruvate oxidation (pyruvate is a 3 carbon molecule), where in a single step, a carbon is removed from the pyruvate as carbon dioxide (CO2), leaving 2 of the original carbons attached to Coenzyme A (called Acetyl Co-A). Coenzyme A is notable in the synthesis and oxidation of fatty acids, and the oxidation of pyruvate in the citric acid cycle (Krebs cycle). During this process one NADH molecule is produced.

Phase #3 is the Krebs cycle (citric acid cycle), which is a 9 step biochemical pathway. During these 9 steps all of the carbon from the original glucose is converted into CO2, will yield 1 ATP, and will trap high energy electrons in 3 NADH and 1 FADH.

In phase #4 (the electron transport chain) the high energy electrons that are trapped in the NADH and FADH (previous phase) are used to produce ATP (through chemiosmosis). Oxygen is the final acceptor of the high energy electrons. Without oxygen, there is no place for the NADH and FADH to donate their electrons, consequently, no energy can be harvested. Glycolysis occurs in the cytoplasm, and the production of the substances in phase #3 (Krebs cycle) occurs in the mitochondria. The NADH that is produced in the cytoplasm during glycolysis, must be transported into the matrix of the mitochondrion before they will be able to donate their electrons to the ETS (Electron Transport System); one ATP per NADH will be spent to transport each one. Most NADH is produced inside the ETS. The electron transport system is located within the inner membrane of the mitochondria.

To summarize phases #1 through #4:

Glycolysis: glucose produces 2 pyruvates + 2 ATP

Pyruvate oxidation produces 2 pyruvate, which produces 2 Acetyl Co-A +2 NADH

The Krebs cycle nets 2 Acetyl Co-A which produces 4 CO2 +2 ATP + ^NADH + 2 FADH

The electron transport system (ETS) nets:

2 NADH from glycolysis and 4 ATP

2 NADH from pyruvate oxidation and 6 ATP

High energy electrons from the Krebs cycle net 2 ATP

6 NADH from the Krebs cycle and 18 ATP

2 FADH from the Krebs cycle and 4 ATP

The total yield for all 4 phases is 36 ATP

Since glucose contains 720 kcal/mole, and ATP contains 7.3 kcal/mole, 36 ATP are harvested from a single mole of glucose. If you multiply 36 moles of ATP times 7.3 kcal/mole= 263 kcal trapped as ATP. The efficiency of the process is 263/720 X 100= 36% efficiency.

While the above shows a production of 36 ATP per glucose molecule, the actual amount produced (yield) is about 30 ATP per molecule of glucose, because of transport losses inside the mitochondria; which adjusts the efficiency down to 30%.

When glucose is metabolized during the anaerobic glycolysis (fermentation) the process is very different. Human muscles will metabolize glucose aerobically and anaerobically depending upon how much oxygen is available. When your muscles are worked vigorously, they metabolize glucose anaerobically, because they deplete the oxygen levels inside the cells and bloodstream faster than the circulatory system can replace it. During vigorous exercise the respiration rate (breathing rate) and the heart rate (beats per minute) are highly elevated, but the lungs cannot deliver enough oxygen to the bloodstream fast enough to keep up with the oxygen needed to burn glucose aerobically.

Very little ATP can be produced from the fermentation of a single molecule of glucose. However, the fermentation process is very quick, so many glucose molecules can be broken down to provide a large amount of ATP quickly; provided that enough glucose is available. Fermentation is the only option for harvesting ATP from glucose in the absence of oxygen. The ETS (Electron Transport System) can not function without oxygen, so the NADH cannot be used to generate more ATP.

Without oxygen the pyruvate cannot be metabolized either, because its metabolism depends on NADH being oxidized in the ETS. Without a mechanism to recycle the NADH back into NAD, glycolysis would stop. NADH is recycled into NAD through the production of ethanol from pyruvate. Ethanol and CO2 are metabolic byproducts of the anaerobic metabolism of glucose.

Your muscle cells can metabolize glucose anaerobically. To recycle the NADH they produce lactic acid. The point where lactic acid begins to accumulate is called the anaerobic threshold. The regenerated NAD can be used to keep glycolysis and ATP production going even when oxygen is absent. Lactic acid produced during anaerobic activity must be reconverted into pyruvate by reducing NAD to NADH when oxygen is available to remove it; during the recovery period after the intense activity ends. The NADH ultimately donates electrons to O2 in the ETS. When lactic acid accumulates it is called oxygen debt, because oxygen must be used to metabolize it later; after exercise has stopped. All organic molecules that are metabolized as a source of energy, are converted to one of the intermediates of either glycolysis or respiration.

The metabolism of fatty acids yields much more trapped ATP than the metabolism of carbohydrates on a per carbon basis. The preliminary steps of metabolism are called β-oxidation. For a 6 carbon fatty acid, 1 ATP must be invested for every 2 carbons to prime the process, and from every 2 carbons of the 6 carbon fatty acid, the yield is 1 FADH, 1 NADH, and 1 acetyl Co-A. The acetyl Co-A can be metabolized in the Krebs cycle, which generates 3 NADH, 1 FADH, and 1 ATP (as seen previously).

Two carbons will generate a total of 2 FADH, 4 NADH, and 1 ATP at a cost of 1 ATP. Six carbons will generate 6 FADH, 12 NADH, and 3 ATP at a cost of 3 ATP. The total yield is as follows:

6 FADH * 2 ATP/FADH → 12 ATP

12 NADH * 3 ATP/NADH → 36 ATP

Total yield for 6 carbons from fat = 48 ATP

Total yield for 6 carbons from sugar = 36 ATP.

Fats cannot be metabolized anaerobically. Fats will only burn in the presence of oxygen.-

Glucose will have to be completely broken down (glycolysis) to supply ADT during very heavy muscular activity. This will require a two step process. The first stage of glucose breakdown (utilization) called the anaerobic phase because oxygen is not used. The second step, which is used when physical activity becomes even more vigorous, is called aerobic (with oxygen) respiration, where oxygen is used to produce even more energy. Athletic events, like a 400 meter dash, which require heavy physical activity will require more ATP.

The glycogen lactic acid system is the second system, which is anaerobic, where glucose is broken down in the absence of oxygen. Glycogen is drawn from storage in the muscle cell's storage, converted back into glucose, and utilized for fuel; prior to drawing additional glucose from the bloodstream. Each glucose molecule is broken down into two pyruvic acid molecules and energy is released from several ATP molecules, which will provide for about 30-40 seconds of maximum muscle output; this is in addition to the 10-15 seconds provided by the Phosphagen system. The pyruvic acid then partly breaks down to produce lactic acid. If the lactic acid accumulates inside the muscle tissue, muscle fatigue will result; causing cramps and pain.

Phase three is the aerobic system, which is utilized where sports or physical activity requires a longer term and extensive expenditure of energy. Glucose, amino acids, and fatty acids are used as fuel sources. A very large amount of ATP must be provided to the muscles in order to sustain the energy needed to sustain the pace; without producing large amounts of lactic acid. When oxygen is present pyruvic acid breaks down into carbon dioxide (CO2), water, and energy through a very complex process called the citric acid cycle (Krebs cycle). The citric acid cycle will provide essentially an unlimited amount of time to extend the physical activity; at least as long as the nutrient supply lasts.

Oxygen is carried throughout the body inside the bloodstream. Oxygen attaches to the hemoglobin of the red blood cells. Some oxygen is stored inside the muscle's cells. As the oxygen is used up inside the cells for combustion of fuels, the oxygen will have to be replaced. The mechanisms inside the cells that store oxygen (myoglobin) have a much smaller capacity for storing oxygen than the hemoglobin of red blood cells. Consequently the very small quantity of oxygen will have to be replaced frequently during extended, or vigorous exercise. Some forms of physical activity will require the utilization of a combination of these three systems.

Also, not only do you have three different metabolic systems that provide energy for your muscles, you also have different kinds of muscle fibers. Type I muscle fibers are called the slow twitch muscles, and type II muscle fibers, which are called the fast twitch fibers. The different types of muscle fiber enable you to perform different kinds of movement.

The conversion of the NADH and FADH occurs during several steps in what is known as the electron transport chain. NADH and FADH are energy rich molecules that are converted by enzymes into ATP.

The free calcium concentrations within the cell regulate a number of reactions, and is important for proper cell function. Calcium is stored within the mitochondria, which is used to maintain the calcium levels within the cells during homeostasis. The mitochondria's ability to quickly uptake and release calcium makes it a very important part of calcium homeostasis within each cell. However, the majority of calcium is stored within the ER (endoplasmic reticulum), but, there is a significant interplay between the ER and the mitochondria in the process of managing calcium. Calcium is stored in the inner membrane of the mitochondria. Calcium is released into the cytoplasm of the cell via a sodium-calcium exchange, or by a calcium induced release pathway. This process is of particular importance in the release of hormones from the endocrine gland cells, and the release of neurotransmitters in nerve cells. The management of calcium in the mitochondria also plays a very important role in the release of critical enzymes used during the citric acid cycle, and helps reduce inflammation within the mitochondria. Certain mitochondrial functions are performed only in specific types of cells; like the liver's cells, which contain enzymes used to detoxify ammonia (a waste product of protein metabolism).

Fats and ATP Production

The primary mechanism developed to maintain your body during lean times is fat storage. Fat is essentially just excess glucose converted into triglycerides and stored as fat. The fats from your diet are broken down by enzymes into basic fatty acids and glycerol, then reassembled in the intestines into chylomicrons (a form of cholesterol). A glycerol molecule is used as a backbone, and three fatty acids, possibly of different types, will be joined with the glycerol molecule to form the chylomicrons. They are basically triglycerides that are encapsulated in a protein so that they will be able to be carried in the bloodstream; because fat will not dissolve in water. The larger (long chain) molecules are absorbed by the lymph system from the intestines, carried to the neck area, and deposited into the bloodstream. Smaller fat molecules are absorbed directly into the bloodstream from the intestines as a free floating fatty acid. Enzymes in the bloodstream break the chylomicrons down into basic components in the bloodstream. Your body maintains a certain level of fatty acids in the bloodstream. Insulin levels will determine how much is maintained in the bloodstream and how much is stored as fat.

The enzymes that control fat in the bloodstream are highly dependent upon insulin levels. When the insulin levels are high these enzymes (lipoprotein lipases) become more active, and likewise, when the insulin levels are low they become less active; even inactive. Insulin stimulates these enzymes to store the fatty acids in the fat cells, muscle cells, and the liver cells as droplets of fat.

Fat cells do not only store fat, they can also store glucose and amino acids (absorbed into the bloodstream after a snack or meal). They are converted into fat molecules and stored. This is not an efficient process. The conversion of glucose and amino acids into fat is 10 times less efficient than storing fat. One hundred calories of fat, which is about 11 grams, that are floating around in the bloodstream, will require 2 1/2 calories of energy to store them. The same 100 calories of extra glucose, which is about 25 grams, that is floating around in the bloodstream will require 23 calories of energy to convert them into fat and store them.

Between meals your body is not absorbing nutrients and fuel (glucose and fats), and the insulin levels are low in the bloodstream; at least should be. As stated, your body's cells are constantly using fuel to produce energy that will power the cells. Consequently, if your body is not absorbing fuel from the intestines it will have to be drawn from the storage areas of the body. You will recall that glucose is stored as glycogen in the liver and the skeletal muscle cells, and fat is stored in the adipose tissue fat cells that are located primarily in the belly area. Each cell has a limited capacity to store fats and glucose, so as they are used up, they will have to be replaced from the other storage areas.

There are actually two kinds of fat cells; brown fat and white fat cells. Newborns have very little white fat and mostly brown fat. The reason is that brown fat acts as an insulation and a heat generator. The brown fat cells contain a large number of mitochondria, and the brown fat is burned inside the fat cell to produce heat to keep the infant warm; called thermogenesis. As the child gets older the brown fat cells are replaced by white fat cells, which are filled from excess fats from its mother's milk. The white fat cells do not burn the fat droplets internally, but export them as described to be used as fuel elsewhere in the body.

Your body depends upon free fatty acids (FFA's), for energy production; those that are no longer bonded to a glyceride back bone. They are also important substrates as structural components of cell membranes, and they serve as signaling molecules. Most of the smaller FFA's are carried in association with albumin (the primary protein in the blood), however, a small number dissociates from the albumin. These free, unbound, molecules become a part of the aqueous solution. The number of bound FFA's is determined by the number of albumin present. Free fatty acids are important sources of fuel, because when metabolized, they yield large quantities of ATP. Most cell types can use either glucose or fatty acids as a fuel source. The heart and skeletal muscle cells prefer fatty acids. Despite long-standing assertions to the contrary, the brain can use fatty acids as a source of fuel; in addition to glucose and ketone bodies.

Each cell's membranes contain receptors for both the long chain fatty acids (triglycerides), and the short chain FFA's. They attract and capture fatty acids floating in the bloodstream. They transport them into the interior of the cells where they can be stored and used as a fuel source. The receptors are activated by the fatty acids in the bloodstream and the control center of the cell; they are encoded by a special gene.

Your body will break down the stored triglycerides, using enzymes produced inside the fat cells, into the original components (glycerol and 3 fatty acids), and will release them into the bloodstream. These enzymes are activated by hormones (growth hormones, epinephrine, and glucagon); growth hormones are produced in the pituitary gland, epinephrine is produced in the adrenal gland, and glucagon is produced inside the pancreas- all are released into the bloodstream. The glycerol and fatty acids will be converted into glucose in the liver, and some of the fatty acids will be picked up by the cells, stored inside, and used as fuel directly. Some of the triglycerides floating around in the bloodstream will be taken in by the cells, and broken down into the original components inside the mitochondria.

Fatty acids (blood fats) can be found either as free floating molecules, or as bound to other molecules (cholesterol-triglycerides) in the bloodstream. Primarily, the concentration of fats in the bloodstream is determined by diet (high or low fat diet). When the blood fat levels are high the cells will increase their uptake of fatty acids; primarily in the liver, adipocytes (fat cells), and muscle cells.

Pyruvate as Fuel

The mitochondria convert energy from fatty acids, glucose, and pyruvate molecules. When the enzymes inside your cells break down glucose to be used as a fuel, pyruvate is a byproduct that results from the process. Pyruvate is a very important chemical compound, because it is the end product of the breaking down glucose (glycolysis). One molecule of glucose breaks down into two molecules of pyruvate, which is then used to produce energy in two ways. It can be converted into acetyl-coenzyme A (acetyl CoA) during the Krebs cycle when oxygen is present (aerobic). If oxygen is not present (anaerobic) it is broken down into lactate by enzymes and used as a fuel. It is the first step in cellular respiration and it stands at the junction between aerobic and anaerobic pathways (discussed later). It is an important tool used by the mitochondria during the production of energy. They produce energy rich molecules called ATP (adenosine triphosphate), which is used by all of the cell's other organelles to power their activities (functions).

Pyruvic acid is an organic acid, a ketone, which can be converted back into glucose, or into fatty acids. It is also used to produce the amino acid alanine. When oxygen is present it is used to produce energy for the cells, and it also serves as an alternate by fermenting to produce lactic acid when oxygen is not present.

Pyruvate is now available as a supplement and is used for a wide variety of things; like weight loss, obesity treatments, high cholesterol, cataracts, cancer treatments, and improving athletic performance. Liquid forms of pyruvate are applied to the skin as a facial peel, and to reduce wrinkles and other signs of aging. Pyruvate breaks down fat, which accounts for its use in weight control. It causes the outer layer of the skin cells to slough off, which explains why it is used for anti-aging treatments.

Metabolism

One of the most important benefits of exercise is its ability to increase your metabolism. The metabolism is usually the first thing that is mentioned when trying to explain or find the cause of weight gain. Often it is the metabolism that is responsible for weight gain and the inability to lose weight. Exercise is the fourth step in the six step program (Diabetes Control-6 Steps to Gaining Complete Control over Diabetes), just before weight loss, because it is very important that the metabolism is increased before cutting the carbohydrates and calories necessary for weight loss. If the metabolism is not increased prior to cutting carbohydrates and calories, the weight loss process will not be as successful. But, what exactly is the metabolism you hear so much about? Let's take a closer look at what your metabolism is and why it is one of the favorite tools the little man in your control room uses to maintain homeostasis; to keep many bodily functions operating optimally; within the set points established by your DNA. Then you will learn how to use exercise and your metabolism to accomplish many other important things

There are numerous definitions for the term metabolism, but it is most often used to describe the rate at which our body converts glucose and/or other fuels into energy and heat; your body's metabolic rate. Actually, metabolism is used by scientists to describe both the breaking down of organic matter (catabolism), and the use of energy to construct new components of cells (anabolism); like proteins and nucleic acids. The metabolism is a complex network of hormones and enzymes that converts food into fuel, and then determines how quickly the fuel is burned.

The term calories, used by scientists, can be a little confusing. They define a calorie as the approximate amount of energy needed to raise the temperature of one gram of water by one degree Celsius. Celsius is the metric unit of energy used by most scientists. But, it takes energy in the form of heat to raise the temperature of something. The term calorie is used to measure how much heat and energy that is produced from the fuel burned inside the mitochondria (the cell's furnaces/generators).

Each gram of carbohydrate will produce 4 calories of heat and energy. Each gram of fat will produce 9 calories of heat and energy. The enzymes prepare the fuel for the mitochondria by breaking down glucose and other substances within each cell. Oxygen will be mixed with the fuel to increase the energy produced. The mitochondria burns the fuel and oxygen to produce heat and energy. Exercise will increase the amount of oxygen, and the number of mitochondria, which will multiply the efficiency of the process. You will recall that most cells will have as few as one mitochondria (if you are a couch potato), and can have many more in the cells of an Olympic athlete. Some cells, like those in the liver, can contain about 2 thousand mitochondria, your brain cells and heart cells contain upwards of 10,000 mitochondria, because of their very high energy requirements. Their number will depend upon how much energy is needed.

It is the metabolism that determines how much fuel is burned in each mitochondria, and therefore how much heat and energy is produced. Obviously, the more heat and energy produced, the more fuel that is burned; the higher the metabolic rate. It is like your car, the faster the engine runs, the more fuel it burns. Your metabolism will determine how quickly you gain or lose weight. Not everyone burns calories at the same rate. Normally your metabolic rate is fairly consistent and not easily changed. Your metabolism accounts for about 60-70% of all of the calories your body burns each day. The digestion of food accounts for about 10% of the calories burned each day. Some foods require more calories to be digested than others, so diet can be a factor. It is physical activity (and exercise) that accounts for the rest of the calories burned. Physical activity is by far the most variable of all of the factors involved in how active your metabolism is each day.

The Three Stages of Metabolism as Related to Exercise

The little imaginary man in your control room (hypothalamus/brain) controls your metabolism. It is as if he has an accelerator and brake pedal at his desk. He uses this tool to control many things. For example, if you go outside on a cold day without a jacket, your body's sensors will send him a message that your body's temperature is dropping. He will step on the accelerator pedal to increase your metabolic rate, which will increase the amount of fuel (glucose) that is burned inside the mitochondria. Since 60% of the fuel is converted into heat, your body's temperature will rise to compensate.

Exercise increases muscle mass, which in turn causes more calories to be burned to enable them to function. When your muscles are working hard they burn considerably more energy. When you exercise your muscles the little man in your control room has to floor the accelerator to give the metabolism a major boost during the exercise workout. So, let's look at how this process works.

In order for your muscles to contract the mitochondria will have to convert (burn) glucose and fatty acids to produce the energy that will enable the muscle cells to function. The more active the muscles are the more glucose and fatty acids that will be burned. Exercise will cause your metabolic rate to increase to the point where your body's temperature rises from the massive amount of heat generated. The energy produced is burned by the muscle's cells, and the massive amount of heat produced in the process accumulates in your body. Your bloodstream will pick up the heat and carry it to the surface of the skin where it can be dissipated into the air. Your little man in your control room will instruct your sweat glands to begin pouring out massive amounts of sweat to dissipate the excess heat. The evaporation of the sweat will consume a massive amount of the heat when the sweat is converted from a liquid into a gas.

As the glucose level inside the cell drops, due to the mitochondria burning it, the control center will activate the insulin receptors to attract and capture the insulin floating around in the bloodstream. The insulin will be captured and brought inside where the cell will enable a proportional amount of glucose to enter to replace what has been used.

You will recall that your control room will seek to maintain 4-5 grams of glucose in the bloodstream. The balance is maintained in the muscles and in the liver until their cells are full; the excess is stored as fat. As the cells remove stored glucose from the bloodstream, and the muscles and liver (glycogen) the body will be forced to begin burning fat as a fuel source. The entire process will be accelerated if the metabolism is elevated. On the other hand, if the metabolism is shut down the mitochondria will not be burning as much fuel (glucose), the cells will not be taking as much glucose from the bloodstream, and the liver will maintain large amounts of glucose (as glycogen). Excess glucose in the bloodstream will be forced into storage as fat.

To fully understand metabolism you will need to understand that there are actually 3 phases to metabolism, as well as contrasting scenarios that need to be compared. The 3 stages of metabolism are Stage #1 at rest, Stage #2 aerobic (with oxygen), and Stage #3 anaerobic (without oxygen). The contrasting scenarios are "the couch potato" and the" Olympic athlete."

Lets examine the two scenarios first. The couch potato is typically found on the couch watching TV or gaming. The most exercise he gets is walking to the kitchen to get another beer and another bag of potato chips. The couch potato's lungs are average size, he has a much smaller capillary bed on his lungs which picks up the oxygen that provides his body's 10 trillion cells with oxygen to support the burning of fuel in his relatively few mitochondria. You will recall that the mitochondria are the body's fuel furnaces/energy generators. The couch potato will have only a few mitochondria, because his body's energy needs are very low. The couch potato's oxygen levels inside his cells will be relatively low, as will the oxygen levels in his blood; there is no need for extra oxygen if he is just sitting on the couch all day.

The contrasting scenario is the Olympic athlete. He has considerably larger lungs because he has worked out so much. His oxygen requirements are considerably higher because his body's cell's oxygen requirements have increased significantly in order to produce more energy. Oxygen has to be present in order to burn glucose (aerobically) or fat; the more fuel you burn, the more oxygen your body needs. If your body routinely needs more oxygen to support an increase in energy production, your body will respond by increasing the body's capacity to oxygenate the body. The size of the lungs will increase significantly, massive new capillary beds will form, the heart muscle will significantly increase and the heart will pump more efficiently. The body will develop new capillary beds in all of the muscles, tissues, and organs to supply more oxygen to support the increase in activity.

When your muscles move the muscle's cells consume the energy produced by the mitochondria to power their function. The mitochondria will uptake thyroid hormones (T3), which ignite the fuel to produce the heat and energy, they will uptake a fuel source, and they will uptake enough oxygen to support the combustion of the fuel. When fuels burn inside the mitochondria they produce approximately 60% heat, and approximately 40% energy.

The more stress placed upon the muscle, the greater the amount of energy needed (fuel burned) to support the activity. Clearly pumping 300 pounds of iron will require considerably more energy than picking up a bottle of beer. The thyroid hormones used to ignite the fuel, the fuel burned, and the oxygen used will have to be replaced in all of the millions of cells involved in the activity.

Fuel Sources

The primary fuels used by your body's cells are glucose (or glycogen converted to glucose), fat (fatty acids) and cholesterol, micronutrients, amino acids, and protein.

Your brain and central nervous system use glucose as their primary fuel to power their mitochondria, which powers your brain. Their neurons cannot store glucose, so they depend upon the bloodstream to supply it. Your brain uses twice as much glucose as any of the other cells. Neurons demand a great deal of energy to support their communication process. You will recall that cells and neurons communicate with each other continually; day and night. Half of the brain's energy (nearly 10%) of the entire body's energy) is consumed providing for the neuron's communication power needs.

If glucose is the fuel, the glucose will be taken out of the bloodstream, which will lower the blood sugar level. You will recall that your body maintains a very small amount of glucose in the bloodstream because it can be very toxic; excess insulin and glucose destroy capillary blood vessels. So your body stores the excess glucose in the muscles and liver. Your muscles will use their stored glucose (glycogen) first. As the glycogen levels begin to fall, your muscle cells will begin to draw glucose from the bloodstream to replace it. You will also recall that when at rest, your body's 4-5 grams of glucose (1 tsp.) in the bloodstream will supply the body's needs for approximately 20-30 minutes. Then the liver will be called upon to release a small amount of its stored glycogen to restore the blood sugar level to within the set points (80-100 mg/dL or 4.44-5.55 mm/l). When you exercise, your body's fuel requirements will increase significantly. Since your body's primary fuels are glucose, fat, fatty acids, amino acids, and protein, the amount needed to provide for the increased demand will significantly increase depending upon which phase of metabolism you are in.

Your body has a very limited supply of glycogen that is available for use at any given time. You will recall that between 300-400 grams of glycogen are stored inside your muscle tissue cells; which can only be used by the muscle tissue cells. Between 70-100 grams of glycogen are stored in your liver's cells. A small amount of glycogen circulates throughout your body in your blood. The average 150 pound person has about 1,400 calories worth of glycogen available to be used to produce energy during normal processes and exercise.

Your body is constantly burning glycogen in varying amounts; depending upon activity level. When you are at rest your cells burn primarily fat from fat stores; you are burning only a small amount of calories. You are producing energy from glycogen (30%) and fat (70%). As you increase your activity level (intensity) the percentage of glycogen burned increases as compared to fats. How long the glycogen stores last is directly related to the length of time and intensity of activity (exercise). When the glycogen stores are depleted you "hit the wall" as described by athletes. Glycogen stores will not be depleted unless you embark upon a very intense and long duration program. When the glycogen levels become depleted you will experience fatigue and an inability to continue at the current pace. Hitting the wall is more common in those that eat a low carbohydrate diet and exercise frequently. High intensity workouts, and long duration exercise, will require eating more carbohydrates; 55-65 % of the total diet. It is best if carbohydrates and protein are eaten after an intense workout to restore the glycogen stores.

Well trained athletes can store more glycogen in their cells, which will enable them to exercise harder and longer than untrained individuals. A trained muscle can hold approximately 32 grams of glycogen per 3.5 oz. of muscle tissue. An untrained muscle can only hold 13 grams of glycogen. Therefore, an increase in exercise will increase endurance, the muscles will become stronger, and exercise will become easier. The heart, lungs, and muscles increase in capacity and strength, and they store considerably more glycogen.

The brain, skeletal muscles, heart muscles, and the eyes contain the greatest number of mitochondria, which can be as high as 10,000 per cells. The liver cells contain around 2,000 mitochondria. The skin cells contain the fewest. The energy requirements will determine the number of mitochondria .

Phase #1 is at rest (aerobic). When at rest your body does not require a great deal of energy; the muscles are not burning very much energy to function. The energy burned is primarily to generate heat to maintain your body's temperature within the set points (98.6º F ± a degree or two), and to provide the energy needed by your brain, central nervous system, and vital organs to function; which have to function even at rest. The amount of oxygen required will be relatively low, so your heart rate will be lower [60-80 beats per minute (BPM)], your respiration rate will be lower, and your blood oxygen level will be lower. Your cells will not have to stockpile excess oxygen, because they are not anticipating a need for more energy. When muscles are at rest, the metabolic pattern is very different. When at rest fatty acids make up about 85% of the cell's energy needs; 15% glucose.

Phase #2 is aerobic (with oxygen), where additional energy is required to supply a moderate increase in muscle activity. The activity level will be sufficient to increase the breathing rate (respiration) to the point where you can still breathe through your nose and can carry on a conversation. The oxygen needed to support the additional fuel burned has increased, so the body responds by increasing the respiration to replace the oxygen burned, which also means increasing the heart rate (beats per minute).

During the second phase the increase in muscle contractions (muscles can only contract, they cannot push), the rate of glycolysis quickly exceeds the rate possible by the citric acid cycle, and much of the pyruvate formed is reduced to lactate. Some of the lactate flows to the liver and is converted into glucose. These interchanges are known as the Cori cycle. They shift part of the metabolic burden of the muscle to the liver. During this process a large amount of alanine is formed in the active muscles by the transamination of pyruvate. Transaminations is a process where one amino group from one molecule is transferred to another. The process can be used both to synthesize as well as to degrade amino acids. A primary benefit is that it allows a conversion without forming ammonia; which is a toxic byproduct. Alanine, like lactate, can be converted into glucose by your liver. Muscles can absorb and transaminate branched chain amino acids; however, they cannot form urea, consequently the nitrogen is released into the blood as alanine. The liver absorbs the alanine, removes the nitrogen and uses it to produce urea. Then it processes the pyruvate into glucose or fatty acids.

Phase #3 is anaerobic (without oxygen). The heart muscle functions almost exclusively aerobically, which is why the heart muscle has so many mitochondria in its muscle cells. The heart muscle contains almost no glycogen storage of glucose. The heart muscle uses fatty acids as its main source of fuel, but can use ketones and lactate as a fuel source in the event of starvation (very low carbohydrate intake). The fact is, the heart muscle actually prefers acetoacetate (ketones) to glucose.

The adipose tissue, which is fat storing tissue (mostly in the belly area), is a reservoir (storage tank) for metabolic fuel; called triacylglycerols. An average man (154 pounds or 70 kg) has 33 pounds (15 kg) of triacylglycerols, which hold the potential of 135,000 kcal of energy; enough to provide for 65 days of energy requirements at 2,000 calories per day. Triacylglycerols are highly concentrated, reduced, and anhydrous (all water removed) forms of stores of metabolic energy. In contrast, proteins and carbohydrates provide 4 calories per gram, and fatty acids produce about 9 calories per gram.

The liver's cells store the most glycogen of all the organs in the body. It is estimated that 100-120 grams (which amounts to 25-30 grams of glucose) of glycogen is stored in the adult liver. The kidneys store a small amount of glycogen. The other organs like the brain store very little glycogen. Diabetes causes abnormal glycogen storage, due to abnormal levels of insulin. The accumulation can be either too little (depleted) or too much.

We are bombarded with chatter about fats, much of it is conflicting or confusing, when related to eating healthy. The terms saturated fats, omega 3 fats, and trans fats, are familiar to everyone. The terms fats and fatty acids are often used interchangeably. The fact is that fatty acids are actually a sub unit of fats. Technically, most of the common fats in your diet, and the fat stored in your body, are called acylglycerols (asel glis uh rawl,-rol). Acylglycerols are fatty acids (members of the acyl group) that are attached to an alcohol (a member of the glycerol group) via an ester bond; which connects acid + alcohol by eliminating excess water. Acylglycerols (fats) can have one fatty acid(acyl) group + glycerol, which would be called monoacylglycerol or monoglycerides. Acylglycerols that contain two fatty acids (acyl) groups + glycerol are called diacylglycerols or diglycerides. Acylglycerols that contain three fatty acid (acyl) groups + glycerol are called triacylglycerol or triglycerides. Certainly you have heard of triglycerides.

Glycerol is a colorless, odorless, syrupy, sweet liquid. It is usually formed when a vegetable oil or animal fat is mixed with a strong alkali. You will recall the pH scale, where a pH of 0 equals pure acid, a pH scale of 7 is neutral (neither acidic or alkaline), and the higher the pH, like 14 on the pH scale, is pure, very strong, alkaline. Alkaline substances are bases. Bases are the opposite of acid. The term alkali is often used as a synonym for base. Salt is an example of a base. Soda ash is a caustic soda that is mixed with oils to make soap and cleaning solutions.

So, triglycerides are the major form of acylglycerol (fat) that is found in your body and your food. The term acylglycerol is simply a big word invented by scientists that confuses everyone; but scientists. Most of the fatty acids that you eat, and store in your body are triglycerides. Fatty acids are a major component in your cell membranes; called phopholipids. When fats are broken down, which means their ester bond is broken, and taken out of your fat cells (transported in your bloodstream), it must be bonded to a protein, because fats will not dissolve in liquids like your blood; they would separate out like fat on top of water when cooled. The bond to albumin, which is the major plasma protein in your blood.

Most of the confusion stems from the multiple systems used to name these molecules. Fatty acids have three common names (systematic names and numerical names). Most commonly fatty acids are referred to by their common names and numerical names; which include saturated fatty acids, monounsaturated fatty acids, and polyunsaturated fatty acids.

Saturated fatty acids occur most frequently in higher concentrations in animal fat; from foods like butter, cheese, and the fat found in meats. However, saturated fats are found in some plants; like coconut and palm oils, which are extremely high in saturated fatty acids. Excessive consumption of these fats will result in elevated concentrations of total and LDL (BAD) cholesterol.

Monounsaturated fatty acids are found in the greatest concentration in plant foods; like olive oil, most nuts, and avocados. They are also found in the bone marrow of animals, you rarely eat bone marrow. Dietary monounsaturated fatty acids lower blood cholesterol.

Polyunsaturated fatty acids contain two or more double bonds along their carbon backbone. They are classified into two important subgroups; omega 3 and omega 6 fatty acids. Most omega 6 fatty acids come from vegetables and other foods. Some omega 3 fatty acids come from vegetables and other foods, but the majority comes from seafood.

Essential fatty acids are fats that are essential to the diet, because your body cannot produce them; they must come from your diet (food).

The adipose tissue is highly specialized, in that it can process stored fats and release them into the bloodstream in the form of triglycerides (also known as triacylglycerols as stated). Triglycerides are the simplest lipids (fats) formed by fatty acids. As stated, triglycerides are formed when three fatty acids that are linked to a glycerol; thus the name "tri," meaning 3, and glycerol which forms the triglyceride. Most contain two or three different fatty acids. They are not soluble in water (blood). Most triglycerides are formed from vegetable oil, dairy products, and animal fat. They are stored in droplet form in the fat cells, or as oils in the seeds of plants.

When triglycerides are burned, they produce more than twice as much energy than the burning of glucose from carbohydrates. In addition to serving as an energy source, triglycerides that are located under your skin function as an insulation. Triglycerides are important as a fuel, because they are a compact stored form of carbon atoms which produce energy. Your body's peripheral tissues can gain access to the fat energy reserves stored in the adipose tissue through three stages of processing. First the fats must be mobilized, which means that the triglycerides are degraded (broken down) into their initial components; three fatty acids and glycerol. These three components are released from the fat cells in the adipose tissue (belly area) into the bloodstream. They travel to the cells that need them for fuel, and are transported through the cell's membrane. Second, once inside these cells, the fatty acids must be activated by enzymes and transported into the mitochondria. The actual conversion takes place in the outer portion of the mitochondria's membrane. Third, the fatty acids are broken down in a step-by-step process into acetyl CoA, which is then processed into energy (ATP via the citric acid cycle). You will recall that the citric acid cycle is a series of enzyme reactions (aerobic metabolism of fatty acids, carbohydrates, and proteins) that utilizes oxygen to produce carbon dioxide and ATP (energy).

Epinephrine, norepinephrine, glucagon, and adrenocorticotropic hormones activate an enzyme (adenylate cyclase) which initiates the process of breaking down the triglycerides into their individual components; a process known as lipolysis. Insulin inhibits this process. The glycerol that is separated from the fatty acids moves to the liver where it is converted into glucose and pyruvate. The liver is the only place in the body where the necessary enzymes reside that will enable these conversions to be made; which is the primary site for fatty acid synthesis.

The fatty acids are assembled with glycerol phosphate to form the triglycerides initially, which are then transported and stored in the adipose tissue (fat cells) by LDL cholesterol particles (lipoproteins). Insulin initiates the storage process for these triglycerides.

When your blood sugar is elevated the production of triglycerides is increased. The hormone leptin stimulates the oxidation of fatty acids and triglycerides in the skeletal muscles. When your muscles contract they also stimulate the oxidation of triglycerides. Studies have shown that during aerobic exercise, leptin levels in the blood are well maintained. When you are at rest leptin increases the oxidation of fatty acids by as much as 40%, and glucose oxidation is unaffected. Leptin does not have any additional effect on fatty acid oxidation during very intense contractions. As stated, fatty acids, especially free fatty acids (not bound as in triglycerides), are a major source of fuel both at rest and during exercise. The free fatty acids floating around in the blood are the major circulating fat fuel. Moderate intensity exercise can increase the free fatty acid availability by up to four times. Other sources of free fatty acids include the circulating VLDL (very low-density lipoprotein) cholesterol, which comes from diet and is processed by the liver into LDL (low density lipoprotein) cholesterol. VLDL fatty acids account for about 20% of the free fatty acids uptake by cells; however, there has been very little research on this topic.

When you are at rest approximately 40% of the free fatty acids uptake occurs in what the scientists call the splanchnic bed; which is the blood vessels located on the intestines, pancreas, liver, and spleen. When you are at rest your heart and muscles are not using as much fuel. When you are at rest approximately 15-20% of the free fatty acid uptake occurs in your leg muscles. When you begin to exercise your leg muscle cells will uptake 30-60% of the free fatty acids in the blood, and the splanchnic uptake decreases to 15%. During moderate to intense exercise equal portions of triglycerides and free fatty acids are burned by the muscle cells. Of all known factors, the intensity of exercise influences which fuel is used for muscle contraction more than any other.

Exercise is important to the health of the kidneys. One of the primary functions of the kidneys is to produce urine, because the fluids play a major role in excreting metabolic waste products. Most of the material filtered out of the blood is reabsorbed, so only about 2 liters of urine will be produced each day. The water soluble materials that are found in the blood, like glucose and water, are reabsorbed to prevent losing too much. The filtration process in the kidneys require a large amount of energy. Despite being only 1/2 of a percent of the total body mass, the kidneys consume 10% of the oxygen that is used in cellular respiration. A large percentage of the glucose that is reabsorbed by the kidney's filters is carried into the kidney's cells (by the sodium-glucose co-transporter). You will recall that the kidney's cells do not have insulin receptors, so glucose can enter its cells in proportion to the glucose level outside of the cells. Exercise increases the oxygen availability from the bloodstream.

The Age Factor

Your age can be a factor, because your metabolism slows down at a rate of about 5% every decade after the age of 40. Men burn more calories at rest than women. Men have less body fat and more muscle tissue. The more muscle mass you have the higher your metabolic rate will be, because it takes more fuel to allow more muscle to function. Also, your genes will influence your metabolic rate. An obese person requires more calories to function than a thin person. An obese person's metabolism is actually higher than a thin person's, because it takes more energy to move a larger body.

More about Exercise

Earlier you learned about insulin resistance, about how erratic blood sugars and inflammation cause damage to capillaries, and how burning glucose in the major muscle groups can help in weight loss. Exercise multiplies your effort to reduce insulin resistance. Exercise will repair and rebuild damage to your capillaries and oxygenate your body. As the number of mitochondria increase, and the energy requirements increase, due to exercise, your body will build new capillary vessels to supply the additional fuel and oxygen. The muscle tissue and the lungs will develop massive amounts of new capillary vessels to provide for the increased requirements. Exercise will increase the nitric oxide level in your body; which reduces blood pressure, and lowers the risk of heart disease. Exercise will multiply your efforts to burn fat and keep your metabolism running in high gear.

During periods of stress or preparing for exercise, the control room signals the adrenal glands to produce epinephrine or adrenaline, which increases the rate in which the heart beats. The increased output of the heart supplies more oxygen to the muscles. The increased oxygen will enable the muscles to function at a heightened state, and increase the length of time that the muscles will be able to function in response to the increased stress. More oxygen will enable the cells to burn more fat.

Cortisol is released to promote the release of energy. The blood level of epinephrine increases with the intensity of exercise. The epinephrine concentration increases very rapidly at the beginning of exercise. When exercise targets a specific workload, the epinephrine increases even more, but not as rapidly. The increased blood epinephrine concentration is believed to increase the production and release of glucagon, which in turn stimulates the liver to release glucose (converted from glycogen-stored glucose) to replace what has been used by the muscle cells during anaerobic exercise.

Exercising at lower intensity, or when performing intervals (alternating rest and intense exertion) can lower the epinephrine levels. Long duration exercise at a moderate intensity level can elevate the serotonin and dopamine levels, which accounts for the "runner's high" pleasurable feeling after running. Long distance running, cycling, hiking, swimming, yoga, and other endurance sports can cause an increase in serotonin. Exercise has a very direct, very positive, effect on mood and sleep patterns.

Epinephrine controls metabolic responses within your body. It releases oxygen in your muscles, and it dilates or constricts blood vessels, which controls blood pressure. The variation in blood pressure is needed to respond to stressful situations (including exercise), and then recover from them. Epinephrine contains two amino acids (tyrosine and phenylalanine). It sends chemical hormonal messages throughout the body that provides for greater muscle strength, stronger lung function, greater blood volume, and enhances the senses, which allows for greater strength, timing, and endurance. After the workout or stressful encounter epinephrine will return the muscles to a restful state, calm the breathing rate, decrease the senses, and allow other functions (hunger, thirst, and elimination) to reactivate. The key to all of this is that regular exercise empowers the body to use epinephrine more effectively between workouts. The body burns more fat during exercise because epinephrine mobilizes fat molecules in order to provide fat as a fuel source for muscles, and because there is more oxygen available during exercise; to activate muscle energy. The body uses its energy more effectively.

Earlier you learned that there are two basic types of exercise; aerobic and anaerobic. The word aerobic means with oxygen and the word anaerobic means without oxygen. Certain exercises burn calories, while others burn fat. Exercise can help you manage your metabolism; controlling your metabolism is a key to losing weight. Exercise is a powerful tool, and like any tool, you have to learn how to use it properly. You will learn how to calculate the heart rates at which you should exercise; aerobic heart rate and anaerobic heart rate. All of these topics will be discussed in this chapter.

Aerobic exercises burn fat and anaerobic exercises burn calories. Examples of aerobic exercise are swimming, stair climbing, rowing, bicycling, treadmills, long distance running, tennis, and walking; basically any activity that increases the respiration to a level where you can still breathe through your nose and carry on a conversation. Examples of anaerobic exercise are weight training, jumping rope, sprinting, and isometrics; any activity that increases the respiration rate to the point where you can no longer breathe through your nose, but must breath through your mouth. Treadmills and elliptical machines can produce both aerobic and anaerobic heart rates. Aerobic exercises improve the oxygen consumption of the body. When muscles are used they consume oxygen that has to be replaced by the cardio-respiratory system, which includes the lungs, heart, and vascular system. Everyone's cardio-respiratory system has a functional capacity, also known as the aerobic capacity, which is the maximum amount of oxygen that your body is capable of using, and replacing, when exercising; especially if the exercise is more intense. It is the rate that your body is capable of removing oxygen from the bloodstream during exercise.

Your cardio-respiratory performance sets the limits. Before you begin to exercise, your heart rate (at rest) is normal (between 60-85 beats per minute), but will increase as your muscles begin to pull oxygen out of your bloodstream. The increased heart rate indicates that the entire cardio-respiratory system has shifted gears and is working harder to keep the oxygen levels in the bloodstream high. The little man in your control room receives messages that your oxygen level is dropping, so he increases your heart rate and your respiration to speed up the process of oxygenating your blood. As the intensity of physical activity increases your heart rate will increase, which means that your muscles are using oxygen faster than your cardio-respiratory system can replace it. So, your muscles continue to function; but without oxygen (anaerobic).

Over time, as you continue to exercise regularly, your cardio capacity will increase. Your body will increase the number of capillary blood vessels and the oxygen levels within the body will increase. The level where you shift from aerobic to anaerobic will increase over time (because of regular exercise), meaning that your cardio-respiratory system's ability to supply oxygen has improved. The average increase of aerobic capacity is around 17%, however, approximately 10% of individuals will not experience any increase in capacity. Genetics will determine (limit) the amount of increase in capacity for each individual.

As stated, your body will burn fat during aerobic exercises. Fat burning slows down when your body shifts to anaerobic exercise, because fat will only burn in the presence of oxygen. The body switches from burning fat to burning calories during anaerobic exercise.

To optimize your exercise program you should begin with a 10 minute warm-up period, followed by at least 20 minutes of aerobic and anaerobic exercise, and ended after a cool-down period at the end of the routine. It is not necessary that you conduct any special tests, but your doctor can run a VO2 test, which is a stress type test, that will determine what your cardio capacity is. An instrument called a respirometer is used to measure the oxygen consumption during the stress test. The intensity of the exercise is slowly increased during the test. The test will determine the point where the body shifts from aerobic to anaerobic. But, again, this test is not necessary; especially since the values will change over time. When the exercise level increases to the point of becoming anaerobic, anaerobic metabolism will begin. Anaerobic metabolism is where the combustion of carbohydrates occurs in the absence of oxygen. Again, the cardio-respiratory system is no longer able to keep up with the oxygen demands of the muscles during extreme exercise.

More calories are burned during anaerobic exercise because muscle activity generates more force from each cell. When the cells contract because of more force, they switch from burning glycogen as a fuel to carbohydrates as their primary fuel source. These carbohydrates are not the same carbohydrates we refer to when we talk about eating food. They are created when your body converts protein from your muscles into carbohydrates and uses it as a fuel. This increases the metabolic rate (metabolism), which will continue for a period of time after the exercise has stopped. When at rest, the higher metabolism will burn fat.

During aerobic exercise glycogen is converted back into glucose, which in turn is broken down using oxygen to generate fuel energy for the muscles. When the glycogen stored in the muscle tissue is used up, fat is metabolized instead. This is a slower process, and usually is accompanied by a decline in overall performance. Marathon runners use the term "hitting the wall" to describe this phenomenon.

During the initial phases of anaerobic exercise glycogen is burned without oxygen for a short period of time, which is a very inefficient process. Because anaerobic exercise cannot be sustained for longer periods of time, it is limited to short bursts of activity. Athletes use it in non-endurance sports to build power; such as body builders do to build muscle mass.

Muscles develop differently during anaerobic exercise, versus aerobic exercises. Muscles developed during anaerobic exercise will perform better for a short period of time; usually around 2 minutes. The duration and intensity of muscular contractions is far greater during anaerobic exercise. Aerobic exercises strengthen the muscles in the respiratory system, including the lungs, and heart. The flow of air in and out of the lungs is improved, as is the pumping efficiency of the heart. The resting heart rate can be reduced. These improvements are called aerobic conditioning. Aerobic exercise tones muscles throughout the body, increases circulation efficiency, and lowers blood pressure and cholesterol. It increases the number of red blood cells in circulation, which increases the capacity to circulate the transport of oxygen. It improves mental health, reduces stress, and decreases the likelihood of becoming depressed. Aerobic exercise increases the production of DHEA, a very important hormone, which controls many chemical reactions. DHEA is deficient in type II diabetics because of elevated blood sugars.

Aerobic exercise reduces the risk of osteoporosis (bone disease); it increases your body's capacity to store energy within the muscle tissue, which increases endurance. As mentioned, it develops small capillary blood vessels that increase the blood flow through the muscles and lungs. The increased number of capillaries will increase your body's capacity to oxygenate the blood, remove waste products, and increase the distribution of nutrients. You will recall that diabetes damages and destroys capillaries throughout your body. Aerobic exercise increases the speed of metabolism within your muscles, which increases your capacity for intense exercise. It increases your muscle's ability to utilize fats as fuel during exercise. The more aerobic exercise you do, the more efficient your body will become in the burning of fat. It preserves the intramuscular glycogen, and enhances the speed of recovery after more intense exercise. Generally aerobic exercise is used first to burn fat, and then the intensity is increased to anaerobic levels to increase the metabolism.

The workout is split between burning fat (50%) and carbohydrates (50%). Up to 95% of the fuel burned during anaerobic exercise comes from carbohydrates. First, calculate the correct heart rates for aerobic and anaerobic exercise. The formula is very simple; you subtract your age from 220, which gives you a base number. Then multiply that base number by 85% and 65% (anaerobic and aerobic rates).

For example: For a person that is 55 years of age:

220-55=165 Then 165 x 0.85=140 and 165 x 0.65=107

The base number is 165.

Their anaerobic heart rate is 140 beats per minute. Their aerobic heart rate is 107 beats per minute.

You should start out with a stretch period followed by a 5-10 minute warm-up. Dynamic stretches should involve as many muscle groups, and joints as possible. The general warm-up will increase the body's circulation, warm-up the muscles and joints, and center the mind. A warm-up routine can include climbing stairs, using a treadmill or elliptical machine at lower speeds, a bicycle ride, or just walking. Then strive to reach a heart rate of approximately 107 beats per minute (if you are 55 years old) or more, and sustain that level for around 20 minutes minimum. Then increase the intensity to your anaerobic level, 140 beats per minute in this case, for an additional 20-30 minutes minimum. Then spend 5-10 minutes doing cool-down exercises, which are light repetitive exercises that limber up the stressed muscles and allow the heart rate to slowly return to normal. It is during the cool down phase that increases in flexibility are gained. Static stretching techniques can be used.

There is a simple way to check your heart rate during the process. Place your index finger on the inner part of your wrist until you find a pulse. Some find it easier to find it on the side of their neck. Count your heartbeats for 6 seconds, then multiply by 10. Heart rate monitors are available on the Internet that start at around $40.00.

It is possible to burn over 1000 calories in a single session on a treadmill at 4.0 MPH for 1 1/2 hours at a 15% grade. The same is true of an elliptical machine. Obviously it will take several months to build up to that level. Your body must be conditioned slowly for greater amounts of intensity to prevent injury. It is normal for your body to go through adjustments as time passes. You will have to increase the intensity of your exercises in order to reach your minimum heart rates as your endurance levels increase.

Treadmills and elliptical machines offer the most amount of flexibility in altering the routine. By altering the grade, load levels, and speed a wide variety of variations can be created. Some machines have a heart rate monitor. Be aware that cheaper treadmills (lower quality - price range below $1,000) are known to be incorrect. Their readings can be off by as much as 20%; generally to the high side.

It is important that you vary your routine day to day. In fact it is important to vary as many aspects of your daily routine as possible. By varying the routine you keep your metabolism high by keeping the body guessing. Your body will identify routines that are the same day to day, and will adjust, which means that your metabolism will slow down. That is why it is a mistake for those that walk or climb stairs at work every day to think that they are getting adequate amounts of exercise. Their body adjusts to their routine. Obviously climbing stairs is better than just sitting at a desk all day. Finally, don't ignore hydration. It will be important to get enough fluids when you are exercising, before, during and after. Dehydration lowers the metabolic rate.

Exercise Notes

Weight training is especially beneficial for diabetics, especially when it is a part of an overall fitness plan. Many studies have proven the value of weight training along with aerobic exercise for diabetics. The studies have shown that weight training can improve diabetic control as well as overall health. It improves your body's ability to utilize insulin, because it lowers insulin resistance. There will be an increase in lean muscle mass, which increases the metabolism and causes your body to burn calories at a faster rate. It is the burning of these calories that helps keep blood sugars under control. As muscle mass increases your body's management and storage of glycogen improves. Your body fat to muscle ratio decreases, which reduces the amount of insulin needed by your body to store energy in your body's cells.

Strength training helps guard against a number of complications, such as heart disease, high blood pressure, cholesterol, decreased bone density, and atrophy (loss of muscle mass due to age). A properly designed weight training program will include performing movements that work specific muscle groups in all parts of your body. It should be broken down into exercises, reps, and sets. Each exercise will focus on a specific movement that works on a particular muscle group; such as a bicep curl, or a chest press. A rep (repetition) is a single, complete, motion. For example, a single rep of a bicep curl includes lowering the dumbbell fully downward, then raising it to the full upward and starting position. A set is the number reps that are performed together. Sets should be separated by a short rest period.

As a side note, all muscles contract only; they cannot produce a pushing motion. So every muscle action, has a corresponding group of muscles that will contract to reverse the action completed. One set of muscles will contract to turn your head to the left. A second set of muscles will contract to return your head back to the starting position.

Strength training should be done two to three times each week, with at minimum of one day between. The muscles must have time to rest and rebuild. Strength training should include 8-10 weight exercises per session that work all of the major muscle groups (upper and lower body). The exercises should be of lower to moderate intensity. The low intensity exercises should involve two to three sets of 15 reps with lighter weights.

Moderate intensity exercises should involve two to three sets of 15 reps with heavier weights. A rest period of 2-3 minutes between sets is recommended. If you primarily concerned with maintaining good muscle tone do not go overboard by using very heavy weight. Instead, increase your reps and sets using lower weight levels.

A workout should take 60 minutes per session; minimum. To prevent injuries pay attention to proper posture, exhale while exerting a force, and inhale before exerting again. Constantly vary the number of sets and reps. Consider seeking the help of a trainer, or joining a class, but don't hesitate to ask for help at the gym if needed. Always allow the body adequate time to recuperate. If a muscle or joint feels off, or painful, don't push it. Also, always confer with your doctor before embarking on an intense workout program.

Muscles are either growing or shrinking, because of a number of factors. An anabolic state is where muscle tissue is building, or increasing in size (expanding). A catabolic state is where the muscle tissue begins to break down; starts to shrink. Catabolism is a normal, natural process, because your body frequently breaks down muscle tissue protein to produce fuel-energy. The conversion of protein occurs when your body is not receiving adequate amounts of fuel from other sources.

A Little Practical Advice for Diabetics

It is very important that diabetics incorporate exercise into their weekly routine. Exercise will significantly reduce body fat, insulin resistance, low energy issues, and low oxygen levels. Exercise will significantly reduce your risk of heart disease, because it increases your body's production of nitric oxide, lowers blood pressure, and lowers cholesterol. Exercise increases the number of mitochondria (energy/heat generators) in each of your body's cells, which will result in significant improvement in your energy levels and cellular health.

Exercise will help balance hormones due to DHEA deficiencies; which are caused by high blood sugars, hypothyroidism, and other causes. Estrogen, progesterone, testosterone, and DHEA must be kept in balance in order to maintain good health, and prevent the development of other serious complications including cancer.

Take the time to calculate your aerobic and anaerobic heart rate. Join a gym, or start a well planned exercise program. Be certain that you properly stretch and warm up prior to exercising. Start with a 10 minute warm up session, move into an aerobic session which will eventually work up to approximately 30 minutes, then move into the anaerobic phase for an additional 30 minutes, followed by a 10 minute low intensity cool down phase. Exercise every other day (up to 3 times each week). Allow your body to heal and adjust between sessions.

Bear in mind that as you exercise (over time) your body's respiratory efficiency will increase. Your anaerobic and aerobic heart rate will increase (beats per minute). Your at rest heart rate will also decrease due to the higher respiratory efficiency. Your heart and lungs will be stronger and will not have to work as hard to provide your body with the oxygen it needs. Your cellular oxygen levels will improve dramatically; which is a very good thing.

Remember that aerobic exercise burns fat, and that anaerobic burns calories. Anaerobic exercise increases your metabolism for hours after completing a workout. A properly designed exercise program will incorporate both aerobic and anaerobic exercise routines.

Develop exercises for each of the major muscle groups. Work up to 15 reps per set, and increase the number of sets as your muscles adjust to the weight level. Once you reach a level of 5-6 sets of 15 reps, increase the weight level 5-10 pounds and adjust the reps and sets until you reach a challenging, but not stressful level.

Mix up your routine. Do not follow the same routine session after session. Keep your body guessing so that it will not adjust to your routine to maximize the benefit of exercise.

Learn how to breathe properly during exercise. Inhale through your nose when at rest. Then exhale through your mouth while stressing your muscles. Take in as much air as you can, and exhale fully during each breath.

Don't force yourself to continue working out if your muscles are signaling distress. Your muscles will let you know when you need to back off, and not push onward. Simply reduce the intensity or stop that particular exercise for the day. As you increase your muscle tone, fewer of these incidences will occur.

Be certain to eat a low glycemic index food (snack) before exercising (1-2 hours before). Make certain that you hydrate sufficiently. Drink a full glass of filtered water with a pinch of sea salt before and after a workout; more if needed. Do not drink from the drinking fountain at the gym, or in public places. Avoid drinking from plastic bottles; they emit bromide and other harmful chemicals.

# Basic Plaque Removal Program

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> "Basic research has shown that in the arteries in the heart, that inflammatory processes that are reflected by higher levels of CRP may play a role in the development of hardening of the arteries or atherosclerosis." -Charles Hennekens

Most diabetics are unaware that it is possible to remove the accumulated plaque in their arteries. Plaque removal will significantly lower your risk of developing heart disease, or suffering a stroke. Of course you have to commit to a diet that is diabetic friendly to prevent future plaque buildup, keeping excess weight off, and exercising regularly.

Eat at least one fresh ground clove of garlic every day (raw- mixed in food), along with omega-3 (fish oil) and CoQ10; oral diabetic medications cause a deficiency in CoQ10. It is important that the garlic is minced and allowed to be exposed to air for at lease 2 minutes to activate its powerful chemicals. Combined, they will begin the process of striping the plaque buildup from your arteries, and substantially reduce the potential for additional plaque formation. The omega 3 dosage must be at least 2000 mg of EPA and 1000 mg of DHA daily. The better quality omega 3 capsules will contain 500 units of EPA, and 250 units of DHA per capsule; so you will need to take a minimum of four capsules daily. Some holistic doctors prescribe taking 4000 EPA, and 2000 DHA daily; 4 capsules twice daily. Take 100 mg of CoQ10 every day. Take a supplement of Lysine (200 mg per day); it releases the Lp (a) form of cholesterol that is instrumental in the formation of plaque, and prevents additional cholesterol deposits from forming. The amino acid L-proline will work with the lysine to perform the cleansing action by binding to the loosened cholesterol and carrying them to the liver for disposal. These items are primary to plaque removal.

Exercise is important in the process of removing plaque from the arteries. Restoring your vitamin and mineral deficiencies, exercising, losing the excess weight, and changing your diet, will substantially lower your blood pressure, triglycerides, and cholesterol; they will normalize unless other conditions exist. Blood pressure control is of primary importance in lowering the risk of heart disease. Diet changes will usually lower triglycerides substantially; especially lowering your fructose intake. Adequate amounts of fiber will also play a large role in lowering cholesterol levels.

Diet is of primary importance. Eat only low glycemic index foods. Eat smaller portions. Eat according to your blood type. Eat green leafy vegetables, legumes, and grains other than wheat. Focus of eating foods high in antioxidants, fiber, vitamins, and minerals. Fruit is high in vitamins, minerals, and antioxidants. Experiment to discover which fruits work best in your system and do not spike your blood sugars. By now you should have eliminated all processed foods, wheat, sodas and colas, artificial sweeteners (other than stevia, agave nectar, or xylitol), saturated fats (lean cuts of meat only), pork, caffeine-except from green tea, dairy, and alcohol. You can drink one or two cups of green tea each day. Green tea is a diabetic's friend. It helps control blood pressure, it helps in losing weight, it reduces insulin resistance, and it will prevent sore muscles if you exercise too vigorously.

By now you should be working on losing all of your excess body fat. You should be realizing a reduction in insulin resistance. You should no longer have excess insulin in your bloodstream. Your exercise should be reducing insulin resistance, helping in weight loss, and oxygenating your body. Your exercise will now be repairing damage to capillaries and building new ones. It is also increasing your blood circulation. Let's summarize the primary plaque removal program:

Restore vitamin, mineral, amino acids, hormones, and enzymes. Take a good quality multivitamin every day. Supplement the magnesium and zinc to bring the values to 100% of the daily requirement; most multivitamins contain low levels of both. Take 100 mg of CoQ10 each day, 2000 units of EPA, and 1000 units of DHA omega 3 daily, and 200 mg lysine daily. A highly recommended multivitamin is the Garden of Life Vitamin Code multivitamin (available on http// www.Amazon.com)

Rehydrate the body; high blood sugars cause dehydration. Mix 1/8 tsp. of good quality sea salt into a glass of water daily; two or more times daily if exercising.

Change your diet- stop eating all prepared foods, wheat, dairy, saturated fats, sodas and colas, minimize caffeine, artificial sweeteners, pork, and alcohol. Start eating only very lean meats and low glycemic index foods. Eat one or more cloves of fresh ground garlic every day (not cooked). Eat 51% raw foods every day (fruits, vegetables, salads).

Exercise is vitally important for diabetics to increase the production of nitric oxide, lower your blood pressure, increase circulation, replace damaged capillary blood vessels, repair blood vessel damage, oxygenate your blood, and help burn fat.

Lose the excess belly fat.

Above we discussed a basic, but effective method of reducing the plaque buildup in your arteries. However, be aware that it could take 10 years, or more, to cleanse the plaque from your arteries; depending upon how much you have. By making the above listed changes in your routine you will prevent any additional buildup of plaque in your arteries; unless you have other cholesterol issues.

You can substantially speedup the process by taking additional supplements, and a massive number of other benefits can be realized by other therapies like systemic and digestive enzyme therapies. Not only do they substantially speed up the cleansing process, they can resolve many other issues in the process. It all comes down to cost; you have to decide what each is worth to you. We will examine a number of these supplements individually then, combined and allow you to decide if you want to pursue any of these methods.

## Accelerating the process

If you want to speed up the plaque removal process (less than 5 years) consider taking the following items:

A stronger addition to the above mix would be a Vitamin C dosage (10-12 grams daily)

1.5 grams of lysine three times daily, folic acid.

B12 sublingually (under the tongue), twice daily

B6, and trimethylglycine.

Vitamin K2 45 mcg. daily which removes calcium from arteries and moves it into bones would probably also have been a worthwhile addition.

**Choline** (90 mg per day). Choline is an emulsifier that helps the lysine release the plaque.

**EDTA** (450 mg per day) is well known for its ability to bind to heavy metals and calcium (calcium deposits are part of the plaque formation) and carrying them to the liver for disposal.

**Food grade diatomaceous earth** releases massive amounts of silica which is essential, and beneficial, to blood vessel health. DE travels around in your bloodstream removing fats, bacteria, fungi, mold, cholesterol and other pathogens. It is also a mild form of fiber. DE also kills bacteria, fungi, and other pathogens before they enter your bloodstream. It is an inexpensive addition to your regime. The basic formula plus these additional dosages showed in a study after 18 months a complete resolution of all plaques in the carotid arteries.

## Supercharging the Process

You can take the process to the next level, if you choose to, by adding the following:

**Enzyme therapy-** There are three main categories of enzymes: food enzymes, digestive enzymes, and systemic enzymes. The food enzymes are produced and supplied by nature; they come from raw plant foods. Plant food enzymes aid in joint health, arterial health, and support the immune system. They can only be obtained from organic sources of raw fruits and vegetables; that is why eating 50% raw foods in your diet is important. Digestive enzymes aid in the digestion of food. They break down fiber (cellulase), protein (protease), carbohydrates (amylase), and fats (lipase). Their work is done solely in the intestines, where they combat indigestion, bloating, abdominal discomfort, and reduce the production of gas. When a person has adequate amounts of these digestive enzymes they require fewer medications; especially antacids.

Systemic enzymes build and maintain health. They are taken to address specific issues, and to promote the prevention of health issues, and provide for general health support. They break down excess mucus, excess fibrin, toxins, allergens, and clotting factors. Many people take systemic enzymes instead of NSAIDS (non-steroidal anti-inflammatory drugs), because they reduce inflammation. Systemic enzymes isolate and destroy harmful circulating immune complexes (CIC's) without suppressing the beneficial CIC's. Systemic enzymes have specific antioxidant effects on the body. Specific, meaning, that they are most effective in specific organs. There are systemic substances that are known to detoxify the liver, bowels, blood, kidneys, and skin.

The blood can be cleansed by eating chlorophyll; raw greens like collard greens-the darker the better. Chlorophyll is essentially the blood of plants, but has been used extensively through history for its blood cleansing properties. It corrects bacteria-scavenging activity in the bloodstream. Dandelion purifies the blood by straining and filtering out toxins and other waste products in the bloodstream. Yellow dock is also a well-known as a blood purifier; a blood-cleansing substance. Dandelion is the same dandelion that people spend tons of money on buying weed killers to get rid of. It may be a pain in the lawn, but the greens are among the healthiest of all greens. You can cut the greens, wash them, and use them in a salad up to the point of going to seed after flowering. They are a gift of nature, quite tasty, and free of charge.

Systemic enzymes address the following issues:

Fibrosis conditions caused by the protein fibrin.

Reduction of scar tissue, which is also made up of fibrin (blood vessels, kidneys, and liver).

Cleanses the blood of cellular waste and toxins, and improves liver function.

Improves immune system response by improving white blood cell efficiency.

Manages Candida overpopulation (yeast fungi), which places less stress on the liver.

Improve the absorption of nutrients from foods and vitamins and minerals.

When systemic enzymes are taken in combination with a healthy diet, and supplements of digestive enzymes, your body is enabled to fight the effects of aging, reduce the risk of cancer and other serious diseases, and improve overall health.

Systemic enzymes include:

**Protease** (a proteolytic enzyme-peptidase, or proteinase) functions mainly to digest proteins, and is involved in many physiological processes. Protease breaks down the bonds of proteins by a process known as hydrolysis, and converts the proteins into smaller chains (peptides) or even smaller units (amino acids); the liberation and activation of amino acids is of particular importance. They promote the growth of beneficial bacteria in the gut. Proteins have a naturally complex folded structure. Protease disassembles these molecules. Without protease the body would not be able to digest protein, which would have dire health consequences Protease comes from plants (like papaya and pineapple). Protease also digests the cell walls of unwanted and harmful organisms, they break down toxins, cellular debris, and undigested proteins, and cleans the lymph system. Protease prevents a toxin overload.

Protease aids in cellular repair of burns and stomach ulcers. Protease enzymes reduce pain, and speed healing in sprains, bruises, fractures and tissue injuries. Protease boosts the quality of blood cells, which improves their circulatory response and reduces the risk of clots. Enzyme supplements contain between 30,000 and 60,000 HUT of protease. HUT stands for Hemoglobin Units on Tyrosine Basis, and measures the hydrolysis of proteins into peptides and amino acids.

**Bromelain** is a proteolytic enzyme that reduces inflammation and tumor formation. It slows or stops inflammation by neutralizing the biochemicals associated with inflammation.

**Invertase** (also known as fructofuranosidase) is a carbohydrate-digesting enzyme. It splits sucrose into its component parts, glucose and fructose. It is derived from a strain of Saccharomyces cerevisiae and then purified to be used either alone, or as a part of a multi-enzyme formula. When combined with other carbohydrates it enhances the digestion of starches, sugar, and other carbohydrates. Its ability to break down (hydrolyze) the bond between fructose and glucose makes it unique and vital to the digestion of complex sugars into glucose (blood sugar). Invertase is commonly found in bee pollen and yeast sources. Besides its important role in digestion, it is very important in the prevention of disease, rejuvenating the body, and slowing the aging process. Invertase is also unique in that it can remain active within a wide range of pH levels (acidity). Invertase is an antioxidant, and has powerful anti-microbial traits, which enable the prevention of bacterial infestations, and gut fermentation due to oxidation. Invertase reduces the tendency to catch colds, flu, and respiratory infections. Invertase is measured according to the rate of hydrolysis of carbohydrates. One SU (Summer Unit Invertase/Sucrase) is the unit of measure used. It represents the quantity of enzyme that will convert 1 mg of sucrose into glucose and fructose within 5 minutes.

**Glucoamylase** (also known as amyloglucosidase) is a digestive enzyme that breaks off a free glucose molecule from a complex sugar-based chain (starch) or from simple sugar (maltose). The freed sugar is then used as a source of energy for the body. Glucoamylase helps to break down starches that come naturally in vegetables (potatoes, corn, rice, and wheat) or starches that are added as a filler during processing. A specific type of amylase is produced in the mouth and pancreas. Some forms of amylase are produced from other non-animal sources. Glucoamylase is commonly described separately from amylase, because it digests starches in a specific way, which removes free glucose molecules from the end of starchy chains. rather than breaking the longer chains into smaller ones. Glucoamylase is a very important group of enzymes that makes the absorption of nutrients possible, and create energy from some of the most common foods.

The daily diet of the average person contains large amounts of starches. Starch is another word for carbohydrate. The carbohydrates contain some nutritional value, but they cannot be digested or absorbed without the help of enzymes. Glucoamylase is one type of enzyme that is capable of breaking down starches into glucose. These enzymes massively reduce the work load of the digestive system, and prevents bloating, gas, soft stool, and lethargy. Irritable bowel syndrome can be substantially controlled using these digestive enzymes. Studies have shown that digestive enzymes lower autoimmunity responses and inflammation. In autoimmune diseases antigens and antibodies can cause tissue damage if not removed. This condition can lead to other autoimmune diseases like rheumatoid arthritis, lupus, and some types of kidney diseases. Other studies have shown that glucoamylase plays a key role in starch digestion and balancing blood sugars. It also reduces food allergies. The units of measure for glucoamylase (or Amyloglucosidase) is AGU, which defines the amount of glucoamylase that will be required to liberate 0.1 µmol/min of p-nitrophenol . While all of this may be difficult to understand, it provides a means of determining the strength of one product over another, and to ensure that you take an adequate amount of each of these enzymes.

**Papain** is also a powerful digestive enzyme. It is extracted from papaya fruit, so it is referred to as papaya proteinase. It plays a key role in the breaking down of tough protein fibers. It is of particular benefit to those that eat a lot of meat in their diet like blood types O and B, and if of particular benefit to blood types AB, because AB's have a very poor digestive system when it comes to meat. Papain is also a very powerful toxin remover, antioxidant, antiseptic, anti-inflammatory agent, and is very beneficial to overall digestion. The Papaya-enzyme papain is capable of breaking down larger proteins (called endopeptidase) into very small proteins (peptides and amino acids)(called exopeptidase). Papain breaks bonds in the interior of the protein chain, or the end of the chain within a broad range of pH (acidity). This also considerably increases the absorption of nutrients from protein based foods.

Papain's antiseptic and anti-inflammatory capacities is being copied to produce topical medications for burn victims, irritations, and wounds. It will be helpful for bedsores and ulcers. The concentrations of papain are the greatest in the skin of the papaya fruit. Many tropical cultures have used the skin of papaya for skin treatments for many, many, years.

Papain is being studied for its ability to treat cancer and boost immune function. As a proteolytic enzyme it helps modulate leukocytes in the immune system response, and it has anti-tumor capacities. Papain enzyme treatments reduce inflammation, reduce joint inflammation, and reduce prostate inflammation and swelling due to prostatitis. Papain is measured in units of PU's (Papain Units)

Rutin is a bioflavonoid that is composed of buckwheat (4-6%). It strengthens and controls blood permeability of the blood vessel and capillary walls, which strengthens them, and reduces blood pressure. Bioflavonoids lite rutin, quercetin, and hesperidin are powerful antioxidants by nature. Other formulas such as Nattokinase, Lumbrokinase, and Wobenzym contain chymotrypisn, which are very effective and powerful enzymes

# Metabolic Enzymes

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> "If we depend solely upon the enzymes we inherit, they will be used up just like inherited money that is not supplemented by a steady income." - Dr. Edward Howell

> "This points back to the importance of eating raw fruits and vegetables because they are "live foods"; that is, foods in which the enzymes are active. The more enzymes you get, the healthier you are. And the more raw foods you eat, the more enzymes you get." -AIM4health

Metabolic enzymes are protein-like systemic enzymes that act as a catalyst in many thousands of metabolic actions throughout our body. They work within the bloodstream, tissues, and cells throughout the body. They are irreplaceable workers that make the vitamins, minerals, and proteins do what nature intended for them to do. They are responsible for implementing the anabolic process, where simple things are synthesized into complex things, and the catabolic processes, where the breakdown of complex things, into basic smaller things, occurs in our body.

Metabolic protease enzymes regulate the liver and immune system. The term proteolytic is a catchall term that describes enzymes that specifically facilitate the chemical breakdown of proteins by breaking the bonds between amino acids that make up the protein. Proteolytic enzymes are naturally occurring in all organisms. They constitute 1-5 % of the entire gene content. They are polymorphic. The enzyme activity that they stimulate adapts to meet current digestive or metabolic needs. They are able to adapt to the needs of the environment without harming healthy cells. Other healthy cells are protected by inhibitor enzymes and mechanisms.

Enzymes are specialized, in that each is designed to do one specific job. One cannot do the work of another. A shortage of just one enzyme can have a devastating effect on overall health. The enzymes are the first responders on the scene. Life as we know it could not exist without them. There are many thousands of different enzymes in the body.

Everything that makes us sick is a protein or is protected by a protein. Proteolytic enzymes digest and destroy the protein based defense mechanism of every pathogen, leading to their elimination. Wheat, corn, and dairy (and others) are extra-large protein molecules that are only partially broken down during digestion in the small intestine. They are absorbed into the bloodstream as larger than normal proteins that cause the immune system to start creating antibodies; thinking that they are invaders. They are too large to metabolize. The antibodies latch onto these large proteins forming CIS's (circulating immune complexes). The CIC's are first neutralized in the lymphatic system, however, over time; too many of them are created. They overwhelm the elimination process of the body. They overwhelm the immune system, and kidneys. The body's response is to store them in tissues. The immune system continues its attack on them, as if they were allergens causing inflammation. They ultimately can lead to autoimmune diseases. Proteolytic enzymes attempt to compensate for the dietary inadequacies. An excess of these proteolytic enzymes will be required to break the CIC's down and remove the waste products produced in the process. The body may, or may not, produce the required amount of these enzymes on its own.

The common metabolic enzymes (taken as a supplement are: Fibrinolytic enzymes (Serrapeptase and nattokinase) breakdown excess fibrin in the body, fight inflammation, scar tissue (fibrosis), and viruses. They also modulate the immune system and purify the blood. They are also called systemic enzymes, because they work inside the bloodstream. The accumulation of fibrin in the body causes scars to become larger, a shrinking and hardening of major organs decreases the function of organs over time; it is due to a depletion of Fibrinolytic enzymes.

Excess fibrin causes the spider web of scar tissue across the inside of blood vessels. It provides a basis for the formation of a foundation for the formation of arterial plaque in arteries and the kidneys. It contributes to high blood pressure. It causes cognitive impairment in the brain; and senility. A condition called fibromyalgia is caused by an overgrowth of fibrin in the muscles (fibrosis). The Fibrinlytic enzymes dissolve the excess fibrin in the muscles, which relieves the pain. Serrapeptase is the strongest of the fibrinolytic enzymes. Our body produces prostaglandins in response to an injury. Some protaglandins cause inflammation, which leads to redness, swelling, and constriction of blood vessels and a decrease in tissue permeability. Serrapeptase enzymes break down the protaglandins. They rapidly remove cell debris, and work with the repair system to restore health. They prevent the clogging of blood vessels as well. Serrapeptase enzymes block the release of pain-causing molecules from the inflamed tissues. They also control the development of arthritis. The connective tissue in our joints contains fibrin; it forms the ligaments, joints and the muscles.

Supplemental enzymes that have a pH resistant coating should be purchased (known as an enteric coating), to be effective systemically. All enzymes have a pH range that is optimal for each of them. At the two extremes of the acidic range (whether acidic or alkaline) the enzymes will become irreversibly inactive (denatured); this is a common trait of enzymes. The fungal and plant source systemic enzymes exhibit a fairly broad pH range, but, some bacterial source systemic enzymes are less tolerant; especially at a low pH range.

Serrapeptase originates from a bacteria that resides in the gut of silkworms. It cannot be found in fruit or vegetables; it cannot survive on its own. It is derived from a symbiotic organism (one that depends on another to exist); so it is a fragile enzyme. Technological advancements in microbiology have made it possible to isolate the Serrapeptase enzyme for therapeutic use in humans. Serrapeptase has only one role in the gut of the silkworm; which is to make it possible to emerge from its cocoon. Serrapeptase is produced inside the gut of the silkworm, and breaks down the cocoon, without impacting other food matter. When used in humans, Serrapeptase does not breakdown food particles, but instead, acts throughout the body to breakdown proteins like fibrin.

Nattokinase is extracted and purified from beneficial bacteria (Bacillus natto - or Bacillus subtilis natto). Bacillu subtilis natto is commonly found in natto (a Japanese dish), or fermented soy beans. This same enzyme that is used to make natto, causes powerful fibrinolytic activity within the bloodstream. It has the ability to be absorbed intact from the gastrointestinal tract into the bloodstream. Nattokinase enzymes activate many of the 3,000 endogenous enzymes in the human body. It also dissolves fibrin and decreases blood viscosity. While higher blood viscosity is a root cause of arteriosclerosis and atherosclerosis, high blood pressure, peripheral vascular disease, and heart disease, it plays a major role in these conditions. Metabolic protease enzymes are proteolytic enzymes, which are involved in a multitude of physiological reactions; like digesting food, regulating blood clotting, regulating the immune system, breaking down CIC's, and others. Good health is not possible without them. A primary function of metabolic catalase enzymes is to breakdown hydrogen peroxide into water and oxygen; they are composed of many amino acids. Hydrogen peroxide is potentially dangerous if not controlled. Hydrogen peroxide is produced during the metabolism of oxygen of all living things. Catalases are large protein molecules that function to prevent the formation of reactive molecules (radicals); which cause DNA mutations associated with many diseases and even gray hair. Hydrogen peroxide is produced during many metabolic processes as a byproduct of many chemical reactions. When hydrogen peroxide is left intact in tissues, cell damage will occur. Catalase enzymes are found in the majority of your body's living cells and nearly every aerobic cell. Catalase enzymes oxidize toxic organic chemicals.

Like other enzymes the level of catalase enzyme production diminishes with age. The graying of hair is believed to be due to an accumulation of hydrogen peroxide in tissues. There are several enzymes that should be of particular interest to diabetics: you will recall that glucokinase, or simply GK, is an enzyme that monitors glucose (blood sugars). It is found in the liver, brain, intestine, and pancreas. It acts as a sensor to measure the blood sugar levels in all four areas, and signals certain functions to take place that will seek to maintain the blood sugar levels within the normal range (80-100 mg/dL). It triggers shifts in the metabolism, or cell function in response to rising or falling blood sugar levels. The enzyme is active 24/7/365. GK is controlled by a single gene, which is known to mutate to alter the function of the enzyme; for example: the MODY form of diabetes results from a mutation that shifts the "normal range" from an average 90 mg/dL upward to 144 mg/dL.

Again fibrin is an insoluble protein found in the bloodstream. It is one of the primary cofactors in blood clotting. Diabetics have an unusually high level of fibrin in their blood; especially if insulin resistant and blood types A and AB. When an injury occurs the fibrin will from a mesh, collect platelets, and form a clot to stop the bleeding. Thrombin is released by the platelets when they come in contact with injured tissue. Thrombin acts to cause the blood clot to form. Fibrin also lays the groundwork for the healing process to occur. Excess fibrin is responsible for scar tissue, thrombus formation, and inflammation and its associated pain.

Excess fibrin weakens the body's structure. It does not leave enough space for epithelial tissue to grow through the fibrin matrix. It restricts the range of joint and muscle motion and reduces the internal organ's size and function over time. Thrombin is also a serene protease family member. It is a trypsin-like protein enzyme. It performs many functions in the body. It is highly dependent upon vitamin K to be synthesized or function. It is the last of the enzymes to act during the clotting process. It catalyzes the conversion of fibrinogen into fibrin. It inhibits the activities of other enzymes that downgrade the clotting process. So it plays an important role in wound healing and inflammation.

You will also recall that plasmin is an enzyme found in the blood. It is very important for dissolving blood clots and preventing strokes or heart attacks. It dissolves many blood plasma proteins, particularly fibrin clusters (clots), in a process called fibrinolysis. It is also a member of the family of serine proteases; recall that protease enzymes digest proteins. Diabetics, especially those of blood types A and AB, are deficient in plasmin. A deficiency can lead to thrombosis (formation of clots). It can impair liver repair, cause poor healing of wounds, and cause reproductive abnormalities. It can greatly increase the risk of strokes or heart attacks.

So it should be clear by now that you have many options in how you approach the removal of plaque. The basic program outlined above is largely covered by diet choices, vitamins and minerals, a a few additional supplements. The basic formula will get the job done, and it will prevent any additional buildup of plaque. Those with blood type A or AB may elect to use serrapeptase and nattokinase to reduce the amount of fibrin in their bloodstream, and thus reduce their risk of heart disease. If you elect to speed up the process you can add enzymes as selected to address specific conditions. It is simply a matter of choice. The most complete digestive and systemic enzyme treatment (VeganZyme brand) contains all of the above listed enzymes and costs approximately $50.00 per month to use. Using the more complete enzyme formulas could reduce the time required to clean the plaque out of their arteries to as little as 1-2 years in extreme cases. Clearly, each addition to the process also has an impact on improving health. Otherwise, serrapeptase can be purchased singularly at a cost of approximately $10.00 per month; which will take a little longer to remove arterial plaque.

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# Heart Healthy Food

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> "The way you think, the way you behave, the way you eat, can influence your life by 30 to 50 years." -Deepak Chopra

> "Older people shouldn't eat health food, they need all the preservatives they can get." -Robert Orben

Foods that have substantial benefits for heart health, especially for reducing plaque in your arteries, are as follows:

Garlic- one clove per day fresh ground- raw or cooked at low temperatures. Always grind it first to activate its powerful chemicals. Garlic reduces LDL (bad) cholesterol by up to 10%. Garlic is a natural antibacterial, antifungal agent. It contains allin, which is converted into allicin in the body. Allicin is an organosulfur compound that reduces atherosclerosis and fat deposits. It normalizes the lipoprotein balance, and decreases blood pressure. It produces anti-thrombotic, anti-inflammatory actions. It is a mild antioxidant. One to four fresh ground cloves per day provides up to 4,000 mcg of allicin. People that consume even a single clove of garlic per day report that they never catch colds or suffer from flu or other viruses.

Red Seedless Grapes- or lutein supplements- Grapes contain lutein naturally. Lutein is a carotenoid that reduces atherosclerosis. It prevents the thickening of the carotid artery in your neck, and it protects your eyes against oxidative damage and cataracts. It also lowers the inflammation of LDL cholesterol in the bloodstream.

Concord Grape Juice- or grape skin, and/or grape seed extract supplements are powerful artery scrubbers. They protect your artery walls from plaque buildup. Their skin contains a flavonoid called quercetin which is a very powerful antioxidant. Grape skins contain resveratrol which stops cholesterol from sticking to your artery walls. It also stops inflammation, and removes blood clots. Grape juice stimulates arterial relaxation (vasodilation), which is also common in red wine; but it lasts longer (up to 6 hours). Concord grape juice stimulates the production of nitric oxide which relaxes blood vessels.

Cherries- cherries contain 17 compounds that strip plaque from your artery walls. Anthocyanin, which is the pigment of cherries, is one of the primary substances known to clean your arteries.

Strawberries- strawberries contain carotenoids and anthocyanins which are very powerful antioxidants; like vitamins C and E, and ellagic acid. They reduce LDL (bad) cholesterol by up to 10%. Organic strawberries are best, because other commercially grown strawberries are coated with very large amounts of pesticides.

Green tea- green tea is high in antioxidants and flavonoids (polyphenols). It contains procyanidins which help prevent blood clots, and promotes healthy blood vessel and heart tissue. The other benefits of green tea are too numerous to mention here.

Hawthorn Tea- Hawthorne tea is an extract from hawthorn berries which is known to calm palpitations, help restore blood vessel wall elasticity, ease the buildup of fluids in your heart, stop fatty degeneration of the heart, and helps dilate the coronary arteries in the heart which reduces blood pressure.

Apples and Grapefruit - apples and grapefruit contain pectin which is a soluble fiber that lowers cholesterol. Apples contain quercetin, potassium, and magnesium; all of which lower blood pressure. Red Delicious and Granny Smith apples contain procyanidins (flavonoids) which are beneficial to your blood vessels.

Olive Oil- extra virgin olive oil is high in omega 3 fatty acids that fight inflammation by countering the effects of omega-6 fatty acids (found in vegetable oils, soybean oil, or corn oil). Olive oil is a monounsaturated fat that can cut the risk of heart disease by 50%. Monounsaturated oils substantially reduce the amount of plaque formation

Canola Oil, Avocados, and Nuts-are also high in monounsaturated fat, which substantially reduces your risk of heart disease.

Sweet Potatoes- sweet potatoes contain large amounts of fiber which lowers cholesterol levels. They contain potassium, beta carotene, folate, and vitamin C as well. They lower blood pressure and clean your arteries.

Salmon - Herring- Tuna - eat wild caught only. They are an excellent source of omega-3 fatty acid. Never eat farmed fish, because it is laden with toxins, and has very low omega-3 content.

Spinach- spinach is considered one of the most powerful diabetic dietary foods. It is very high in vitamins C and A which prevents the oxidation of cholesterol.

Swiss Chard- Swiss chard is high in vitamin E which is known to stop the oxidation of cholesterol.

Tomatoes- tomatoes are high in carotenoid lycopene which is a powerful antioxidant that can cut heart disease risk by 50%. Tomato paste, tomato juice, and tomato soup are highly concentrated forms of tomatoes.

Garbanzo Beans- legumes contain large amounts of dietary fiber; both soluble and insoluble. The high fiber content helps lower cholesterol.

Herbal Cleanses usually contain the following herbs that are proven artery cleaners, improve blood circulation, and they remove toxins. They should be combined with a diet of fresh vegetables, fruit, protein, and calcium:

Hawthorn- hawthorn is very high in antioxidants and flavonoids. It strengthens and dilates your blood vessels. It cleanses your arteries by increasing the amount of nutrients and oxygen that reaches your heart. A daily dosage of 150-300 mg of hawthorn over a six week period will substantially decrease the amount of plaque in your arteries. Add 2 tsp. of crushed hawthorn berries into a cup of boiling water to make a tea. Allow the water to boil for 5 minutes, then simmer; drink one to two cups per day.

Pomegranate Juice- pomegranate juice is loaded with antioxidants. Add 20 ml of pomegranate juice to a cup of water once daily. The juice must be concentrated.

Bilberry- bilberry is loaded with antioxidants. Bilberry contains anthocyanidins (a phytonutrient) that protects and dilates your vascular system. Eat it as a fruit or as an extract. Take 80-120 mg twice per day of the extract, or a handful of fruit daily. Bilberry can cause severe weight loss if you eat large amounts of it over an extended period of time.

When you are traveling, sitting, or restricted to bed for an extended period of time, it is very important that your legs are exercised periodically to prevent the formation of blood clots. Do not cross your legs when you are sitting, or wear tight clothing below your waist. Remember that blood clots form more readily after surgery; during the recovery period. Your legs and calf muscles should be exercised before surgery and as soon as possible after.

Garlic is high in vitamin B6, manganese, selenium, vitamin C, phosphorous, calcium, potassium, iron and copper. Studies have shown that daily consumption of garlic can reduce the risk of a second heart attack by over 50%. Studies have shown that garlic lowers LDL (bad) cholesterol, and raises HDL (good) cholesterol. Studies have also shown that garlic reduces the risk of cancer by 30%, especially colorectal cancer and stomach cancer.

## A Little Practical Advice for Diabetics

When people reach the age of between 27 and 35 their body begins to reduce the production of the enzymes that dissolve protein. These enzymes are very importance for digesting food. They break up circulating immune complexes (invaders encapsulated by antibodies) in the bloodstream, they can prevent too much fibrin from being deposited in wounds, fractures, and the joints; they remove necrotic debris (bacteria, dead or damaged cells), and excess fibrin from the blood stream.

The immune system can be regulated with enzymes. Enzyme therapy is not practiced in the United States, primarily because enzymes cannot be patented. Pharmaceutical companies cannot profit from these therapies despite their reputation for significant effectiveness as seen in nearly all other parts of the world. As stated, the proteolytic enzymes used in enzyme therapy dissolve excess fibrin. You will recall that diabetics with insulin resistance , especially blood types A and AB, have significantly more fibrin in their bloodstream and less of the protein plasmin that dissolves excess fibrin. When proteolytic enzymes are part of the therapy, they can be powerful enough to gradually digest scar tissue. The process takes time to occur, but eventually will remove all scar tissue.

When there is excess fibrin in the bloodstream the tendon sheaths become thickened. The free movement of the tendon is impaired, because the tendon gets caught in the fibrous tissue. Tissues that contain excess fibrin are weakened. Normally the epithelial tissue grows through the whole fibrin matrix which produces strength, but that space is reduced restricting movement; scarring may take place. This thickening process often takes place in an organ like the heart (after an attack), pancreas (after a pancreatitis attack), or kidneys (after a clot forms).

There are no side effects associated with taking systemic enzymes, even if taken in very large dosages; diarrhea may develop if massive dosages are taken. The maximum recommended dosage is three caplets taken three times per day. The enzymes are typically taken about 45 minutes before, or after, a meal three times each day. Be aware that these enzymes intensify the actions of Coumadin or other blood thinning medications.

Most enzyme formulas contain protease, serrapeptase, papain, bromelain, amylase, lipase, rutin and amia (a rich source of vitamin C). Serrapeptase is a powerful anti-inflammatory substance when compared to other proteolytic enzymes; so it reduces inflammation, balances the immune system, removes viruses, and removes toxins from the blood. It is an enzyme found in the intestine of the silkworm, used by the worm to break out of its cocoon. Besides being a powerful anti-inflammatory agent, serrapeptase is an anti-edema, and fibroinolytic agent.

Rutin strengthens and controls blood permeability of the blood vessel and capillary walls, which strengthens them, and reduces blood pressure. Bioflavonoids lite rutin, quercetin, and hesperidin are powerful antioxidants by nature. Other formulas such as Nattokinase, Lumbrokinase, and Wobenzym contain chymotrypisn, which are very effective and powerful enzymes

Cancer cells are surrounded by a layer of fibrin, which can be up to 15 times thicker than the layers found on normal cells. The fibrin layer protects the cancer cell from destruction from the T killer cells of the immune system. The thick layer prevents the killer cells from detecting the cancer cells. Enzyme treatments remove the fibrin layer enabling the T-killer cells to detect and destroy them. The enzymes stimulate the immune cells increase the production of tumor necrosis factor , which is a family of cytokines (TNF) that cause certain types of cells to self destruct. The cancer will generally recur if the enzyme treatment is stopped, and the dosage is typically very high; however, enzyme treatments are frequently helpful during cancer treatments.

When a virus enters the body and contacts a human cell, the virus' external coating connects to the cell, and contacts DNA, which permits the virus to reproduce in a rapid manner. Proteolytic enzymes consume the exterior coating of a virus rendering the virus permanently inert. To recover from a viral infection requires that enough enzymes be taken to get ahead of the rapid viral replication within cells; which may require 5-10 capsules of enzymes three times daily or more.

One of few things that science has not resolved for prosthetic surgery patients (prosthetic hips-hip replacement surgery, prosthetic knees-knee replacement surgery, heart valve replacement surgery, and others) is that of infections. Bacteria form a biofilm that blocks the action of antibiotic drugs. The medications cannot reach the bacteria to kill them. The prosthetic parts often have to be replaced, because infections cannot be resolved. Systemic enzymes (serrapeptase) enhances the effects of the antibiotics and prevents the formation of biofilms.

Systemic enzymes are very helpful for pulmonary conditions like pulmonary fibrosis. In Pulmonary fibrosis the thin (filmy) alveolar membrane, which enables oxygen to pass through into the bloodstream, and allows carbon dioxide (a waste product) to escape from the bloodstream into the lungs to be discharged, become thickened by layers of fibrin deposits on these membranes; the oxygen and carbon dioxide exchange is greatly impaired. This thickening of the alveolar membrane can cause shortness of breath. Pulmonary fibrosis causes progressive amounts of scarring and inflammation in the alveoli. The systemic enzymes block the inflammation and reduce the scarring by digesting the scar tissue.

The enzymes are also beneficial to asthma patients in that the enzymes reduce the secretions and reduce their viscosity, which makes it easier for the asthmatic person to cough them up. The frequency of episodes will be reduced dramatically. Systemic enzymes reduces the effects of hay fever (certain allergies) by reducing the amount of mucus secretions. Systemic enzymes block the release of pain producing amines due to inflammation. The enzymes (broelain in particular) are an effective migraine, and sinus headache therapy. The systemic enzymes have shown in studies to be especially helpful for arthritis, bursitis, and synovitis pain. The enzymatic therapy reduces inflammation, reduces pain, and stops the circulation of inflammation causing immune complexes (antibodies). Many arthritis medications contain bromelain, papain and other systemic enzymes. These enzymes can block, or substantially reduce, pain in any area of the body; it is especially effective for systemic lupus Erythematosus, because it digests the circulating immune complexes that would otherwise deposit in many areas of the body and cause inflammation.

Fibromyalgia, which predominantly attacks women between the ages of 20-40, causes severe unrelenting pain and tenderness in areas where the muscles and tendons merge. It causes fatigue, headaches, and severe sleep disorders. The reason that women are the primary target of the disease is because estrogen causes the deposition of fibrin, which leads to impaired circulation, and slow sludgy blood flow in the areas of fibrin accumulation. One of the causes of fibromyalgia is believed to be Candida overpopulation, which is common in diabetics, and commonly coexists with hypothyroidism, parasite infestations, and diabetes. Diabetics typically have a reduced beneficial bacteria population, which leads to parasite, and Candida population explosion. When parasites and Candida populations get out of control they produce massive amounts of neurotoxins which damage the cells of the thyroid gland, and impair endocrine gland function; especially the hypothalamus and hypo-adrenal function. If you suspect that you have hypothyroidism you should read the book "Diabetes Control-Diagnosing and Treating Diabetic Hypothyroidism, Candida, and Parasites" See Other Books by the Same Author at the end of this book. Fibromyalgia has been successfully treated by using the Japanese enzyme nattokinase, which is made from fermented soybeans. The enzyme reverses the adverse effects of fibrin production and improves circulation into fibrotic areas. Other helpful enzymes are Wobenzyme, Vitalzyme, and Lumrokinase.

Diabetics are highly prone to kidney disease (acute nephritis), which is caused by high blood pressure, high blood sugars, and dehydration. Their body typically has large amounts of circulating antibody complexes and other circulating bacterial organisms. Scarring of the kidneys and fibrin formation are common; kidney failure can result. Systemic enzymes will digest scarred tissue, remove the fibrin deposits, destroy circulating immune complexes and improve the filtration process of the kidneys.

Systemic enzymes in large dosages can block pain and inflammation from occurring after surgical procedures, like tooth extraction, hip or knee replacement, or an automobile accident. Immediate therapy with enzymes can substantially reduce the length of time of recovery, and render the condition painless. Taking large dosages of systemic enzymes immediately after a surgical procedure will prevent the normal occlusion by fibrin in small blood vessel lacerations, which cause an oozing of blood after the procedure; a practice that has been used in Europe for many years. Bromelain and serrapeptase are particularly effective in pain relief in large dosages (900 mg three times daily of bromelain, and 10 mg of sarrapeptase twice daily). The key is to take large dosages early, rather than later after the pain and inflammation are well established. Massive dosages (15-20 capsules three times daily) will not cause any adverse effects. Systemic enzymes should never be taken 3 days prior to a surgical procedure.

Estrogen excess in the body produces fibrosis, and leads to fibrocystic breasts, fibroids of the uterus, endometriosis, polycystic ovaries, benign prostatic hypertrophy, cancers of breast, prostate, uterus, and ovary. Estrogen excess is caused by a breakdown of petrochemicals, pesticides, herbicides, plastics, sodium sulphate from cosmetics, propylene glycol, vehicle emissions, excessive use of estrogenic hormones (growth hormones used in feedlot livestock- cattle and chickens), pharmaceutical estrogens (Premarin), oral contraceptives, misuse of estrogen therapy (instead of mixing natural estrogen with progesterone), and diets high in sugar and dairy, low in fiber; which causes a recycling of estrogen into the bloodstream. Enzyme therapy can stop the development of uterine fibroids and fibrocystic breast disease.

Estrogen excess can be addressed by using DeAromatase enzymes, which blocks the actions of the enzymes aromatase and 5-alpha-reductase, which allows estradiol, testosterone, and progesterone levels to return to normal. Androstenedione and testosterone are otherwise steadily converted into estrogen (estradiol). The enzyme 5-alpha-reductase converts testosterone into di-hydrotestosterone, which is believed to be a cause of prostate enlargement. Both testosterone and progesterone promote the p53-gene, which leads to healthy cell death (apoptosis) while estradiol promotes the Bel-2 oncogene, which blocks normal cellular death and causes cancer.

## The Difference Between Systemic Enzymes and Digestive Enzymes

You will recall that enzymes perform many thousands of functions throughout the body. Enzymes are catalysts that cause chemical reactions that would otherwise require years to be completed to occur in a mere fraction of a second. Every cell in your body uses enzymes for building, maintaining, or repairing tissues. The body produces many of the enzymes needed on its own, but the natural production of enzymes diminishes with age; consequently many functions controlled by enzymes diminish as well, such as pain management, circulation issues, slow healing, and an increase in medical issues and diseases occur.

American doctors are unfamiliar with enzyme therapy; but it has been used, where it was developed, in Europe and the Far East for many years. Instead doctors rely heavily upon pharmaceuticals to resolve inflammation and pain. Some plastic surgeons have discovered that these enzymes are effective in reducing inflammation and reducing scarring after surgery.

Plaque can be dissolved away with the natural treatments of food, vitamins, and exercise. The natural treatments work together to reduce fats, cholesterol and other agents in the blood system that causes plaque blockages and shrink the plaque blockages. Besides the many listed benefits of taking systemic enzymes is stopping the progression of arteriosclerotic plaque, and potentially reducing the amount of accumulated plaque. Enzyme therapy removes many of the building blocks for plaque. Plaque blockages occur in the main arteries leading from the heart. However, doctors have found that plaque blockages are also appearing in arteries in the legs, arms, stomach, and kidneys. These arteries are hard to reach for surgery

Vitamins inhibit plaque formation and unlike conventional medication are symptom free. They can shrink plaque blockages in the walls of arteries when taken together. Niacin raises HDL, which is known as "good cholesterol". HDL cholesterol removes bad LDL cholesterol and arterial plaque. According to the FDA, "Niacin is the best agent known to raise blood levels of HDL, which helps remove cholesterol deposits from the artery walls.  
Vitamin C is crucial in repair and healing of the endothelial layer of cells inside of coronary and carotid arteries. Coenzyme Q10 strengthens arteries and veins and cleans out accumulated plaque. Digestive enzymes help break down the food our body does not digest. When taken on an empty stomach, they enter the bloodstream intact. As they circulate, they remove toxins and break down the fats responsible for plaque formation. Digestive enzymes in supplements and raw foods help prevent heart disease.  
Serrapeptase is a particularly potent digestive enzyme when it comes to dissolving arterial plaque. It has the unique ability to digest non-living tissue that is a by-product of the healing response without harming living tissue. Serrapeptase is used to dissolve non-living tissues to include: scar tissue, fibrosis, blood clots, cysts and arterial plaque.  
The herb hawthorn helps remove plaque blockages by widening blood vessels. Horsetail is rich in silica and can aid removal of plaque by strengthening artery walls. Other helpful herbs include ashwagandha, ginger, garlic and guggul.

It has been well established that HDL (High Density Lipoprotein), the good cholesterol, serves to remove the cholesterol that has bonded to the artery walls and transport it to the liver to be disposed of. HDL also collects excess LDL (bad) cholesterol and carries it to the liver for disposal. HDL cholesterol also protects the LDL cholesterol against oxidation, which makes it sticky; enabling it to bond to the artery walls. HDL cholesterol inhibits chronic inflammation, vascular adhesion molecules, and platelet activation factors that will contribute to atherosclerosis. That is why it is so important that the HDL levels be maintained above 50 mg/dL of blood.

HDL cholesterol relies upon an enzyme [paraoxonase-1(PON-1)] to perform its beneficial functions. The enzyme is secreted by the liver. The enzyme attaches itself to the surface of the HDL cholesterol. As humans age the PON-1 levels decline, which reduces the HDL's ability to protect against heart disease and stroke. The build up of plaque becomes accelerated; even to the point where healthy arteries can rapidly occlude with plaque. That is why certain stain drugs lose their effectiveness in some elderly patients.

The peroxidation (free radical reaction) of lipids (fats) severely damages the membranes of cells and causes many degenerative diseases. PON-1 blocks this destructive reaction. Consequently it would be of immense benefit to the elderly to maintain the PON-1 enzyme as they age. When PON-1 anchors to the HDL a significant reduction atherosclerosis, diabetes, stroke, arthritis, and some cancers occurs. Significant amounts of money is being invested in research to solve this puzzle; chemically; in hopes of finding a chemical substitute.

Holistic medicine has used pomegranate juice, flower, leaves, and seed oil extensively to increase the HDL levels in the blood. Studies have shown that pomegranate juice reduced cholesterol production by 32%, and increased the amount of LDL cholesterol collected and disposed of by the liver by 37%. Also, the polyphenol found in pomegranate (punicalagin) reduces the triglyceride levels by up to 40%. Oxidized LDL cholesterol is highly inflammatory, and it decreases reduces the production of nitric oxide. Pomegranate juice restores nitric oxide production levels. Holistic medicine uses quercetin [a flavonoid (plant pigment)], which is found in fruits, vegetables, leaves, and grains, to increase the PON-1 levels. Quercetin is used as an ingredient in supplements, beverages, and foods. Quercetin is widely distributed throughout nature. Organically grown fruits and vegetables contain significantly more quercetin than chemically grown; as much as 79% more (tomatoes).

PON-1 protects the body from OP intoxication and cardiovascular disease (CVD). PON-1 prevents the oxidation of LDL cholesterol, and the production of LDL's. PON-1 also hydrolyses homocysteine. OP's are chemicals commonly found in pesticides and chemical warfare agents. PON-1 is capable of hydrolyzing (detoxifying) a large number of OP's, and plays a major role in OP sensitivity; a PON-1 deficiency will significantly increase a person's sensitivity to OP's. Studies have not quantified how much PON-1 is spent in the process of detoxifying OP's in food. Studies have suggested that lower levels of PON-1 activity is directly associated with the risk of developing atherosclerosis and heart disease. Obesity also significantly and negatively impacts PON-1 levels and function.

Inflammatory conditions decrease PON-1 gene expression. Polyphenols, especially quercetin, increase gene expression in diabetics that have been diagnosed with kidney disease, HDL deficiencies, and cirrhosis of the liver. Patients diagnosed with kidney disease have 30% less PON-1 activity than normal; which causes a 127% decrease in the HDL's antioxidant function. High fat diets decease PON-1 activity. Moderate alcohol consumption increases it; particularly wine and some polyphenols from fruit juices (likely due to their antioxidant activity). Wine is known to increase nitric oxide production and function. Consuming 40 g/day of wine in men and 30 g/day in women, increases HDL cholesterol by 6.5% and PON-1 by 3.7%. Olive oil. Particularly oleic acid, protects PON-1 from inflammation. And as stated, pomegranate juice increases PON-1. Vitamins C and E are also positively associated with PON-1 production and function.

PON-1 plays significant roles in diabetes and its complications. It helps manage blood sugar spikes and the production of AGE's (Advanced Glycation Endproducts). When blood sugars spike, the liver increases the secretion of PON-1, which is believed to be the body's way of compensating for the toxic (oxidative) effects of glucose on the vascular system, but significantly decrease between meals in diabetics. Homocysteine causes the HDL to become dysfunctional, which is characterized by reduced PON-1 activity.

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## Glycemic Index Foods and Glycemic Index Food Table

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> "The point to keep in mind is that you don't lose fat because you cut calories; you lose fat because you cut out the foods that make you fat-the carbohydrates." -Gary Taubes

Glycemic Index

Understanding Glycemic Index

The glycemic index is a powerful tool for gaining control over weight and blood sugars; but in order to use it effectively, it must be understood. Nearly everyone knows that carbohydrates are in some way responsible for weight gain, and that it directly affects blood sugar levels. The glycemic index and glycemic load can simplify the process of gaining control over diabetes.

You will recall that nearly everything eaten is broken down primarily into a liquid, or very small particles, so that it can be absorbed by very small blood vessels (capillaries), and placed into the bloodstream. All carbohydrates and fats, and approximately 60% of all proteins, are converted into glucose. Glucose is picked up, along with nutrients (vitamins and minerals), from the digestive tract and is transported to the liver. The liver filters the blood that is transporting the nutrients. It removes toxins and bacteria before the blood is distributed throughout the body. Glucose is converted to glycogen which is a compact form of energy. Glycogen is stored in the liver, muscle tissue, the brain, and all of the major organs. Glycogen provides energy for all of the body's cells; which enables them to function. Excess glucose is converted into triglycerides and stored in the liver; the balance is stored in the adipose tissue as belly fat (pot belly).

There are two types of carbohydrates; complex carbohydrates, and simple carbohydrates. The complex carbohydrates act like time release capsules, which means that they break down and convert very slowly. They have very long chains of sugar molecules, which take more time to break down into simple sugars. Their cell membranes are made up of cellulose fiber, which resists digestion. Breaking down these cellulose fibers and larger, longer, structures take longer, which slows the absorption process. The capillary vessels cannot pick up the larger substances until they have been reduced in size.

Simple carbohydrates, on the other hand, are shorter, smaller, structured foods. They readily enter the very small openings in the capillary vessels, so they enter the bloodstream very quickly. They do not have to be broken down as much as the complex carbohydrates, and their structures are not as difficult to break apart; digestion is rapid. Examples of these foods are fruit juices, corn syrup, sugary foods, and honey.

The complex carbohydrates are less likely to spike blood sugar levels (hyperglycemia), while the simple carbohydrates are converted into glucose quickly and enter the bloodstream quickly. They typically cause blood sugar spikes- high blood sugar readings. Those that breakdown into glucose slowly and enter the bloodstream gradually over time are called low glycemic index foods. Those that enter the bloodstream quickly, and usually spike blood sugars, are called high glycemic index foods. When blood sugars spike, because of eating high glycemic index foods, they typically are followed by a crash (hypoglycemia). The body manages four things very aggressively: glucose, sodium, pH (acidity), and fluid levels. After the liver places the glucose into the bloodstream, sensors (GK enzyme) in the brain, pancreas, liver and intestine alert the pancreas that the blood sugars are raising. The pancreas produces a hormone (insulin) that is released into the bloodstream. It is released in proportion to the amount of glucose detected. In other words it will release only as much as is perceived needed to remove the glucose from the bloodstream.

Since lower glycemic index foods are less likely to raise the blood sugar levels less insulin will be produced and released. Likewise, high glycemic index foods will result in a more rapid rise in glucose levels, which will prompt a higher level of production of insulin to be released into the bloodstream. Type II diabetics have a condition called insulin resistance which prevents the body's cells from utilizing both glucose and insulin properly. Consequently, both will buildup in the bloodstream. The pancreas responds by producing even more insulin.

Excess insulin will impact the amount of glucose that is stored as fat. When glucose accumulates in the bloodstream, the body uses insulin in an attempt to remove it. If the muscle tissues, brain and organs do not uptake the glucose, the excess insulin will force the excess glucose into storage as fat. It is converted into triglycerides and is forced into the adipose tissue and stored as belly fat. The excess insulin will also block its release. Lower glycemic index foods increase insulin sensitivity within the body. Lower amounts of insulin will allow the body more time to use the glucose, and will limit the amount of glucose stored as fat. Overall, lower glycemic index foods provide clear benefits for weight control.

A number of factors are considered in determining the glycemic index of a given food item. For example, the type of starch (amylose vs. amylopectin) that is found in the food, how the starch molecules are physically entrapped within the food, the fat and protein content of the food, and the amount of organic acids or salt that are present in the food all impact the glycemic index. Some substances, such as vinegar, will lower the glycemic index of food. Fats (like olive oil) or soluble dietary fiber will slow the gastric emptying rate (how fast the food moves from the stomach into the intestines), resulting in a lower glycemic index.

Unrefined grains and brown rice will lower the glycemic index because they contain higher amounts of fiber. Refined (processed) flour has all of its fiber removed. Consequently white flour and white flour products have a very high glycemic index. Some bakers add additives (enzymes) to their unrefined grain breads to make the crust soft. The enzyme makes the starches in the bread more accessible which results in a very high glycemic index. Organic breads have a very hard crust.

Activities such as exercise can cause a rapid drop in blood sugar levels. Muscle tissues burn more glucose for energy during periods of vigorous activity. Low glycemic index foods extend the time that it takes for the glucose to be released into the bloodstream, which maintains a more constant glucose supply preventing the sudden drops in blood sugar. It is primarily carbohydrates and starches that are converted into glucose. However, it should be noted that proteins, which contain no carbohydrates, are partially converted into carbohydrates in the body (up to 60%).

The Insulin Index

Insulin index is another method used to measure the body's response to various foods. It is similar to the glycemic index; but is based upon changes in blood insulin levels instead of glucose level changes. In non-diabetics the insulin index is more useful than the glycemic index. However, since diabetics do not have a normal blood insulin response it is not useful. In type I diabetics the blood insulin level is determined by how much insulin is injected. In type II diabetics the blood insulin levels can be abnormally high due to insulin resistance. Also, pre-diabetics, and those that have a large amount of belly fat, can have insulin resistance which will skew the readings for blood insulin levels. For these reasons it is most common to use the glycemic index instead. Glycemic index is based upon values that remain consistent. They are independent variables that typically occur during the weight loss process.

Proteins and lean meats cause an insulin response despite the fact that they have a glycemic index of zero; because a portion of them will be converted into carbohydrates. In non-diabetics they have a high insulin response and a low glycemic index. Proteins like dairy products, eggs, meat and fish contain no carbohydrates; but they will stimulate an increase in insulin production. Low carbohydrate diets are based upon this process. Small amounts of glucose are generated by these converted carbohydrates, which stimulates the body to convert body fat back into glucose to supply energy to the body's cells. Weight gain is a matter of small effects. As little as 11 extra calories per day can lead to a gain of one pound per year, which can accumulate to a point of obesity.

How the Glycemic Index is Determined

To determine the glycemic index of a food item 50 volunteers (healthy - non-diabetic) that have fasted for at least 12 hours are fed 50 grams of a single food item; for example spinach. Their blood sugars are measured starting before they eat the food item, and again periodically over a period of several hours. The readings are recorded. The values are plotted on a graph to demonstrate how quickly the food item is broken down into glucose, absorbed into the bloodstream, and removed by the insulin (absorbed). The rate that the glucose levels raise is as important as how quickly the level drops. The mathematical curve is compared to a standard. The standard curve is that of sugar (glucose or white bread); which has an assigned value of 100. The area under the curve is calculated for the standard and for each sample. The values are multiplied by 100 and compared. The average values for all of the participants are published as the glycemic index for that specific food item. Since a serving size is rarely 50 grams (the amount given to the volunteers), the actual impact on a person will vary based upon the actual size of a serving. A serving size of 50 grams of marshmallows is obviously much larger than a 50 gram serving of cabbage; and neither represents what a normal serving would contain.

Scientists developed a second value (glycemic load) which converts the glycemic index into a value that represents what a normal serving size would generate. Glycemic index is a more realistic value for comparing how the body will react to specific food items. For example: if 50 grams of a food item has a glycemic index of 75 and the serving size is 6 grams the glycemic load will be 0.75 X 6 = 4.5 (the glycemic index is expressed as a decimal). Recall that the value of 75 is compared to that of pure sugar which has a value of 100. The value of 75 suggests that the food item will spike the sugar levels about 3/4 of that which would result with pure glucose. The glycemic value of hundreds of food items can be found on various Internet sites. Many of them are processed foods; so they will not appear in the glycemic index table below. Certain foods do not have published glycemic index values; because it is very difficult to get 50 volunteers to starve themselves for 12 hours, then eat 50 grams of a very unpleasant food item like chili powder. It is not uncommon for the values from one laboratory to differ from those of another laboratory for the same food item. The difference is usually due to the fact that the average of separate groups of 50 volunteers will vary.

What is important is that the values, even though they may vary, are still representative of how a food item will react on the average. Knowing how a food item that is low on the glycemic scale will react, will serve as a reliable guide for selecting foods when planning meals.

The key is that anyone attempting to lose weight, or gain control over their diabetes, should consume low glycemic index foods only. Since no two individuals will have an identical reaction to the same food item, each individual should start by selecting low glycemic index foods for their diet, and evaluate how each food item reacts in their body. Some diabetics, for example, will experience blood sugar spikes from certain low glycemic index foods like fruit. Once they discover what effects a particular food item has on their body they can include or exclude those items from their list of meal items. It is also important to note that the glycemic index or load is for a single food item. Meals rarely are limited to one food item; but instead can include several. A total of 100 on the glycemic index or 10 of glycemic load per day or less is recommended. The glycemic index, or load, of an entire meal (conversion rate) will vary based on what is eaten. The result of glycemic load, for the meal, could actually be lower than the sum of the individual glycemic loads of the individual items. High fiber foods, especially those that have soluble-fiber, will significantly lower the glycemic load of a meal. Fat and protein will also lower the meal's glycemic load.

Fiber is the indigestible portion of food. Certain foods such as legumes, certain grains like oat bran, nuts seeds, vegetables, phylum seed husks, and fruits have large amounts of fiber. Soluble fiber comes from the parts of plants that store water in the plant. Soluble fiber dissolves in water, and expands forming a gel. It slows the passage and absorption of food in the intestines, which results in a lower glycemic index and load. Most of the carb-blocking products on the market (like PGX), are primarily glucomannan, which is a soluble fiber. Glucomannan is a very efficient water-soluble polysaccharide that forms a dense gel when exposed to water. Legumes naturally contain large amounts of both soluble and insoluble fiber.

To calculate the glycemic index, or load, for a meal, multiply the percent of total carbohydrates of each of the food items in the meal, by their respective glycemic index or load, then add (total) the results. The resulting sum is the glycemic index or load for the meal. Again, the results may be skewed if the meal contained high fiber foods, fats or proteins. As stated up to 60% of proteins are converted into carbohydrates; however, less than 4% of the meats and fats results in the formation of glucose; it can take up to four hours for that to occur. That is why proteins like meat have an assigned glycemic index of zero. It is important to note that when meat is added to other carbohydrates in a meal, the meat does not alter the rate that the carbohydrates are converted into glucose or absorbed into the bloodstream. For this reason, meats (proteins) are ignored when calculating the total glycemic index of a meal. Since fiber is not digested it does not become glucose, nor is it absorbed into the bloodstream.

The net carbohydrates of a food item are determined by subtracting the net grams of fiber from the net grams of carbohydrates. If a serving of fruit has 16 grams of carbohydrates, and has 8 grams of fiber (16 - 8 =8 net grams of carbohydrates). The serving has a net of 8 grams of carbohydrates. It is the net grams of carbohydrates that will be converted into glucose and absorbed into the bloodstream. There are other factors that will alter the glycemic index of foods. The cooking temperature can substantially alter the glycemic rating of a food item. The highest glycemic index is found when a food is cooked and served. Reheating food or serving cooked foods (left-over food) cold will have a lower glycemic index. The longer a food is cooked, or the higher the temperature, the higher the glycemic index; which is one of the arguments for raw diets. Refrigerating food items increases the glycemic index. Ripeness of food items can substantially alter the glycemic rating of a food item; particularly with fruit like bananas. The amount of natural sugars can increase as the fruit becomes ripe. The value can be altered by as much as 30%.

Different varieties of the same food can have very different glycemic index values. Extra-long grain rice, particularly brown rice, has a substantially lower glycemic index than short grain rice, especially sticky rice. The glycemic index can vary from 38, which is low glycemic index, to 94 which is a high glycemic index rating. The difference is determined by the amount of amylose that it contains, and the magnesium/calcium ratio of the different types.

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Glycemic Index Table

For a free printable copy of the complete glycemic index table (42 pg) contact the author Click Here

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"Lowering inflammatory factors is important for reducing a broad range of health risks. Showing that a low-glycemic-load diet can improve health is important for the millions of Americans who are overweight or obese." -OPTIMAL HEALTH RESOURCE

The table that follows lists over 300 food items and their corresponding glycemic index rating. Do not eat anything in the high glycemic index tables, and limit the consumption of the food items in the Medium GI tables. There are many other food items that may not appear on the table. Items like sodas, energy drinks, and processed foods are not listed; because they contain synthetics that are detrimental to overall health, and should not be consumed. Never buy vegetables or fruit in a can. Their nutritional value is near zero, due to processing and cooking at ultra-high temperatures, and they contain preservatives and other chemical additives. Also, most cans now have a polymer lining that is currently the subject of heated debate. Some bakery products are listed, but their consumption is not advised. Processed flour and all products made from it are highly pro-oxidative (including most pasta food items). Dairy products are listed, but should also be severely limited due to the fact that they are highly pro-oxidative as well. Cereals are typically high on the glycemic index scale, and most are made from processed flour which renders them unacceptable. Oatmeal (old fashion) is one exception.

Everyone, especially diabetics, should experiment with each of the low glycemic index foods, especially fruit (certain fruit contain large amounts of glucose). Each person will need to determine how sensitive his/her system is to each specific food item. Some foods, like pastas and pizza, have a tendency to disrupt glucose levels for up to 20 hours.

All vegetables, fruit, and legumes are high in living enzymes. Every effort should be made to minimize over-cooking to prevent killing the living enzymes in the food item. Food should never be cooked at temperatures above 120 degrees F. Many fruits and vegetables can be eaten raw, which maximizes the exposure to living enzymes, however, anything eaten raw should be washed thoroughly to remove pesticides, herbicides, and parasites. Food grade hydrogen peroxide (35%) in water is an effective way to wash raw food items. Add a capful to one gallon of water to wash vegetables and fruit. All fruit and vegetables are high in natural fiber. Legumes are especially high in soluble-fiber, which is very important. Always choose a vegetable or food item by color intensity. The darker (or brighter) a food item is, the higher the antioxidant content, and bioflavonoid content. For example, purple onions are much higher in nutrients than yellow onions. White onions are very low in nutritional value. Red, yellow, orange or other bright colored peppers are superior to green peppers.

Protein items such as meat (beef, pork, chicken and turkey) and seafood have a glycemic index of zero, despite the fact that some of the protein is converted to carbohydrates during digestion. They typically do not interfere with glucose levels. All forms of commercially raised livestock will contain antibiotics, growth hormones, nitrates, and nitrates. It is always best to purchase organically raised meat products.

How to Use the Glycemic Index Tables

The key to overall good health is multifaceted. It is vitally important that the body receives 100% of the daily requirement of vitamins and minerals every day. A minimum of 30 minutes of exercise is required at least 3 times each week. The body must be properly hydrated. All excess body fat, especially belly fat (pot belly) must be shed. The diet must be changed to eliminate all processed foods, wheat, dairy, caffeine, saturated fats, artificial sweeteners and alcohol. Sodas and colas should be eliminated, and only very rare meats consumed. Dairy should be limited to small servings of cottage cheese. All meals should be low glycemic index only, and the portion sizes limited. Three smaller meals and two between meal snacks, three snacks are better, are highly beneficial.

It is becoming increasingly more difficult for individuals to get 100% of the daily requirement of vitamins and minerals due to genetic engineering of seeds, neglected soils, and food processing. Inflammation, high glycemic index foods, and insulin resistance, along with high blood sugars cause vitamin and mineral deficiencies. A good quality multivitamin taken daily will ensure that the body gets what it needs. However, the multivitamin must be derived from organic foods-not synthetic. Recent studies have shown that the vast majority of adults are deficient in numerous essential vitamins and minerals. Diabetics are typically deficient in up to 10 essential vitamins and minerals, half of which play important roles in the management of glucose and insulin.

Everyone is unique in that their body requires a specific number of carbohydrates each day to provide fuel for their body, based on their metabolism and their activity level. As discussed, if low glycemic index foods are selected, and the portion size controlled, their body will produce less insulin (non-insulin dependent diabetics). As long as the amount of carbohydrates (grams per day) is equal to the number the body requires in order to function; weight gain will cease. For diabetics blood sugars will be easily controlled, and will stay closer to normal ranges.

The trick to using this table is to log what is eaten each day. Record your body weight, calories, protein, and net carbohydrates each day. Include your snacks. Total up the values at the end of the day. At the end of the first week, if the body weight has remained constant, the neutral point (range) has been found. The neutral point is the range where weight remains stable; no gain or loss. If weight gain was observed, the number of carbohydrates should be cut slowly until the neutral point is found. The neutral point range will become the target range for each day. If weight loss is the goal, the carbohydrate count should be slowly lowered until up to 3 pounds per week is lost.

Maintain that level until the goal weight (ideal weight) is reached. It may be necessary to adjust the carbohydrate count per day as weight is lost. Never cut the carbohydrate count per day below 30 grams per day. Type II diabetics will need to lower their carbohydrate consumption to below 70 grams per day typically or less. Type I diabetics and non-diabetics can consume around 40-50 grams per meal.

Make certain that the proper fiber level is maintained (35 grams per day for men, 30 grams per day for women). It may prove difficult for some, especially type II diabetics, to get the proper amount of fiber in their diet. It likely will be necessary to take fiber supplements.

If a food item does not appear on the low glycemic index table, it may not have been tested as of this date, or it may not be low glycemic index; check the medium and high glycemic index table to locate it. If it is a prepared food it will not be listed, partly because it should not be eaten, and largely because many manufacturers do not provide a glycemic index value for their products.

It is always wise to buy fresh foods; preferably organic. Always wash fresh food items thoroughly. A cap full of food grade hydrogen peroxide (35%) in a gallon of water will kill dangerous bacteria and parasites. After washing, most vegetables will stay fresh for up to a week longer, because the bacteria that would normally cause decomposition is gone.

Always cook vegetables at the lowest possible temperature (below 120 degrees F) to avoid killing enzymes and destroying vitamins and minerals. Meat must, however, be cooked well enough to kill dangerous bacteria. Steaming, crock pot, or pressure cooking is an economical and effective way to cook food (both meat and vegetables). Never grill, broil, or fry food. Boiling removes the water soluble vitamins; so unless the water will be part of the recipe, don't boil vegetables. Never use canned vegetables other than legumes. Fish should always be wild caught, never farmed. The table does not list all of the spices; they can be highly beneficial. Generally, the amount used in a recipe is too small to impact the overall glycemic load of a meal.

The glycemic load should be maintained between 10 and 20 per day; the lower the better. Or a glycemic index of 100 or less. There are foods on the table that have very low glycemic index values or have a glycemic index of zero. These foods (listed in bold type) are considered "free foods", because the body burns more calories converting them than they provide. It is suggested that they be used as snacks (between meals and before bedtime), which will curb appetite, maintain an elevated metabolism, and reduce the risk of weight gain.

Blood Type Ranking

Items that have a blood type followed by a number 1, 2, or 3 indicate that the food items are as follows:

O, A, B, or AB followed by a numeric 3 (example B3) are detrimental foods for that blood type; they should be eliminated from the diet.

Blood type O, A, B, or AB followed by a numeric 2 (example A2) are neutral foods for that blood type.

Blood type O, A, B, or AB followed by a numeric 1 (example O1) are beneficial for that blood type.

If no blood types are listed the rankings are unknown. All listings are for "secretor" types for each blood type. Non-secretors are not listed due to their rare nature. Ratings are based on research conducted by Dr. Peter D'Adamo. If you don't know if you are a secretor or non-secretor assume that you are a secretor; the vast majority of people are secretors.

Note: the symbol < means less than, and the symbol > means greater than.

Low Glycemic Index Food Items (<50).

For a free printable copy of the complete glycemic index table contact the author Click Here

The following sample table shows how to log your meals each day. Record the values for each food eaten from the table above. Then total them up each day.

This meal plan includes 3 meals and 2 snacks during the day. This meal plan shows that a smoothie was made for lunch. The unflavored gelatin is a protein substitute that is particularly beneficial for diabetics that are hypothyroid; most are hypothyroid to some degree. The values on the table are based upon the serving size listed. If your serving size varies, you will need to adjust the values to correspond to the serving size you use.

It is very helpful to record your weight (measured each morning before dressing) and the blood sugars. It the weight and/or blood sugar varies it will be easy to review the food log for the day to determine the cause for the change.

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# Appendix

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# Basic Cellular Function

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" _The human cell is a living miracle, an absolute marvel, in that something that is 1/10th the diameter of a human hair can be an independent living organelle, that contains thousands of different functioning things, like enzymes; some of which number in the millions." Tom Nelson_

" _You can free yourself from aging by reinterpreting your body and by grasping the link between belief and biology."-Deepak Chopra_

" _In Darwin's time all of biology was a black box: not only the cell, or the eye, or digestion, or immunity, but every biological structure and function because, ultimately, no one could explain how biological processes occurred."-Michael Behe_

Since diabetes starts and functions at the cellular level, we will examine some basic facts about cellular function. At times you're going to wonder why a book about diabetes is focusing on things like cellular basics and homeostasis. But, you will soon learn that a simple basic understanding of these two topics will significantly increase your ability to interpret the things that your body is doing, and know how to resolve them. If you are not a techie, you simply don't care about how your body functions, or how diabetes impacts it, focus instead on the section at the end of the chapter (A Little Practical Advice for Diabetes). However, you are encouraged to at least try reading through this material, it will prove to be very rewarding if you do.

Every living thing is made up of cells. Some are made up of only one cell (single cell organisms-bacteria and protozoa), while others contain trillions of cells; like us humans. All cells are independently living and functioning organelles, whether they are a single cell organism, or if they are a small part of a larger system, where the cells function in concert with each other. So, your body is constructed from 10 trillion individual, independently operating, cells that work in concert with one another to keep you alive and functioning. In all cases, these cells are too small to be seen by the naked eye; a microscope will be required to see them. The average human cell is about 1/10th the diameter of a human hair (about 10 microns).

All of these cells have adapted over many billions of years to where there are a very large number of them that are capable of living in a very wide range of environments, and to function in very varied and specific roles. For example, nerve cells have a very long (up to several feet long) thin extensions and serve to enable the transmission of nerve signals; and accomplish that very quickly. Muscle cells are usually long and tapered at each end, and are capable of contracting and relaxing as needed to perform acts; like lifting a weight and setting it down. Most of your tissue cells are ball shaped.

As stated, there are approximately 10 trillion cells in your body. Your body has over 200 different types of cells; each designed to perform a specific function. Some are very rigid; like the enamel of your teeth, or the structure of your bones. Others are very soft, some are transparent; like the cells of your eyes. Cells not only vary in type, but size as well. The largest and smallest cells in your body are sex cells; called the gamete cells. The largest cells in the human body are the female gamete cells (the egg or ovum), which is about 1,000 micrometers (one millimeter) in diameter, which is just large enough to be visible to the naked eye; without needing a microscope to see it. They are about the diameter of a human hair. The large size is necessary to provide nourishment before it implants itself into the uterus. The smallest cells in the human body are the male's gamete cells, which is the spermatozoan (sperm cells), at about 60 micrometers long. Regardless of how much they differ in size, structure, and function, they are all reliant upon the same basic things to maintain their structure, keep things inside that are critical to their function, keep things outside that could be detrimental, to allow specific things to pass into, or out of, their inside environment, to replicate themselves, maintain their health, and to function.

Everything that happens in your body starts at the cellular level, including healing an infection or a broken bone, fighting bacteria, or even reproducing. Even glucose and insulin management starts at the cellular level. Anything that has to do with your genes (DNA) has to do with your body's cells. Advancements in technology regarding DNA has changed every aspect of your life, and will continue to do so throughout your life. Genetic engineering has become a huge industry not just in agriculture, as we will discuss later, but in medicine and our legal system as well; including fighting crime, because DNA is found in every cell. So, it stands to reason that diabetes starts at the cellular level; all types-type I, type II, MODY, LADA and others.

Glucose is the primary fuel your body's cells rely on to function. Just as your car relies upon gasoline as a fuel to function, your body's cells rely on glucose and fat as a fuel source to function. So understanding blood sugar management has to start at the cellular level as well. Diabetes damage begins at the cellular level and progresses beyond the cellular level. So it only makes sense that you understand how your cells function, and how diabetes messes with your cells. Then your efforts to interpret what your body is doing, repair damage, or restore proper function will make perfect sense.

The Amazing World Inside Each Cell

The inside of each cell is an amazing place. As stated, the average cell is about 1/10th the diameter of a human hair, and not visible to the naked eye, yet it contains millions of things that are responsible for maintaining the function of the cell. Just for fun pull a single strand of hair off of your head, then look at it from one end. Then think about the fact that each of your body's cells are 1/10th the diameter of that strand of hair.

The cells of your body are fluid filled (called cytoplasm). Your body's fat cells are about 85% liquid fat instead of cytoplasm. Your cells hold 2/3rds of the total fluid contained in your entire body. Seventy percent of the interior of a cell is fluid, the remaining thirty percent is the other support organelles and supplies. This fluid is packed with a massive amount of cellular machinery, structural elements, hormones, enzymes, amino acids, fats, and nutrients. The number of proteins found inside your cells outnumber those found outside the cells.

Each cell is like a giant warehouse, despite its very small size, that stores a huge number of microscopic sized substances needed by the cell in order to function. Shortly, you will learn how specialized mechanisms, like the cilia, receptors, gates, and transporters on each cell's outer membrane are constantly taking in supplies from the river of nutrient rich blood that flows past the cells, allowing the cell to attract, capture, and uptake those nutrients to restock its shelves to replace what has been consumed.

The Parts of the Cell

All cells regardless of size or function contain the same organelles, which are independent functioning miniature organs, that make it possible for your cells to function and to replicate. Let's examine each of these parts and discover how they contribute to cell function. It may prove helpful to refer to the following illustration to develop a mental picture of each part, which will help you remember what they are and what they do.

Human Cell (Figure 1)

The Cell's Membrane

All cells have an outer protective layer called the membrane. The membrane is a highly specialized shell-like structure, that is equipped with many specialized mechanisms that attract, capture, and transport specific substances into, or out of, the inside of the cell. They are selective filters called transporters, gates, or receptors. Each transporter is designed to attract and capture a specific substance, like insulin, or a vitamin. The membrane has to be selectively permeable to many substances inside and outside of the cell. It permits the passage of small molecules, but blocks large molecules from passing through. These specialized ports (transporters, receptors, and gates) are specially designed to allow the larger molecules through as needed (discussed individually shortly).

As stated, there is a river of blood flowing past each cell (discussed shortly), which supplies each cell with all of the substances that are needed in order to function (described in detail later). However, there are many substances that can be found in the bloodstream that could be detrimental to the cell if allowed to enter. So the membrane's primary function is to protect the cell from the bad things in its surrounding environment, while providing an ideal environment inside to allow the cell to function efficiently.

The cell membrane allows water, nutrients, oxygen, and many other substances to enter the inside of each cell. However, the fluid inside the cells is not blood. It is a mixture of water taken from the bloodstream, and the many substances needed to support cellular function.

The cell membrane is also permeable, which means that fluids can be allowed, but are regulated, to pass through the membrane to the inside, or from the inside to the outside of the cell. The cell membrane is sometimes called the plasma membrane. The cell membrane are constructed from fat based molecules (phospholipids), which control how much fluid (water) passes through the membrane, if any. As mentioned, your cells are full of fluid (cytoplasm), which we will discuss in greater detail shortly. The fluid level of the cell must be maintained very diligently in order maintain the cell's health and enable it to function. In Step #2 you will learn how diabetes causes dehydration, which robs the cells of the fluid inside that is so important to cellular function. Then you will learn how to rehydrate your cells and maintain proper hydration.

The cell's membrane regulates what is known as passive diffusion and osmosis. These are simply more technical terms that scientists love to throw around. There are many very small molecules and ions, such as carbon dioxide (CO2) and oxygen (O2) that can move through the membrane by diffusion (a passive transport process). When substances build up on one side of the membrane, or the other, the difference in their concentration gradient across the membrane sets up what is called an osmotic flow for the water. Water (fluid) will move through the plasma membrane from a region of high concentration to a region of low concentration; called osmotic pressure. The substances of different concentrations will seek to equal out on both sides of the membrane. Osmosis is referred to passive, because it does not require energy to occur.

An example of this process would be when you fill a glass with a very cold drink; including ice cubes. Heat will move from an area of high concentration to an area of low concentration. The air surrounding the drink is warmer than the drink. Heat will slowly move from the area around the drink into the drink, which will slowly equalize the temperature of the drink to be equal to that of the air surrounding it. Or, if you put hot food on a plate, the temperatures will eventually equalize in like manner. Likewise, substances in your blood that are in high concentration, will seek to move through the membrane into the inside where the concentration is lower. The membrane's job is to regulate that process and only allow just enough through to the inside to provide for the cell's needs; to restock the warehouse.

The chemistry and structure of the cell's membrane is considerably more complex than what you have just read, but, you are not looking to become an expert on membrane structure, you just need a basic understanding of the part it plays in cell function.

Antigens

The membrane also houses a very specialized protein structure called an antigen (an ti jen). Antigens are specific, antennae like structures, that are particular to each of the 4 blood types; each blood type has a unique antigen, which is why blood types are important during blood transfusions. Antigens are unique to each individual; in addition to their specific blood type characteristics. It is very rare that any two individuals have identical antigens.

The antigens serve to protect your body from invaders, or unnatural substances. Nearly every cell in your body contains antigens. Everything in existence has its own unique antigen. Anything that enters your body, whether inhaled in the air you breathe, ingested in the food or water you consume, or anything that you apply to, or that touches your skin, will be subjected to inspection by the antigens of your body's cells. If they are compatible, or neutral, with your body's antigens they will be allowed to enter without conflict. However, if they are detrimental (not complementary), or are unnatural (synthetic-chemical), the antigens will initiate an alarm signal to your immune system to destroy it. We will be taking a much closer look at how all of this works later. You will discover latter how chemical exposure in your food and environment have caused your antigens to initiate an immune response that contributed to weight gain, and the manifestation of diabetes.

Receptors, Transporters, and Gates

Nutrients [including glucose, fats, vitamins and minerals, and essential amino acids (those from food)]must enter the cell in order to be utilized, and waste products have to be removed from the cell to be disposed of. Some cells manufacture hormones, enzymes, and amino acids that are placed into the bloodstream to be transported to other areas of the body; like insulin, which is produced in the cells of the pancreas, placed into the bloodstream, then utilized by cells throughout the body.

Transporters (also called transmembrane transporters, receptors, and gates) selectively attract, capture, and transport various specific substances through the membrane. Each transporter (receptor) and gate are protein structures that are specially designed to capture and transport one specific substance. For example, there are insulin receptors that capture insulin; but no other substance but insulin. Others capture cholesterol, and others capture and transport the thyroid hormones (T3 and T4), just to name a few. Once the insulin molecule has docked on the insulin receptor, a series of enzyme reactions will activate gates that allow a single molecule of glucose to enter. The glucose enters through a specialized gate that will only allow glucose to enter; but again, not until after an insulin molecule has docked to activate the gate.

In specific cases, cell membranes can capture and engulf substances; a process called endocytosis (en dō sī tō sis). The membrane creates a small deformation (inward- called a invagination). Once the desired substance enters, the deformation pinches off from the membrane on the inside of the cell resulting in the transport of the substance to the inside of the cell. It is as if a bubble forms on the outside of the cell, which encapsulates a desired substance, then moves inward and bursts releasing the substance to the inside of the cell. This process requires energy to be completed (discussed later).

A similar process, known as exocytosis (ek sō sī tō sis), discharges substances from the inside of the cell to the outside. In a similar fashion, a small deformation is created on the inside of the membrane, which engulfs a substance, and transports it to the outside. Exocytosis is frequently used to export enzymes and hormones that are manufactured inside the cell to the bloodstream for use elsewhere. They also play a role in the function of the Golgi apparatus (discussed shortly), which also packages substances and transports them through the membrane to the bloodstream.

The membrane of each cell is actually a bilayer (two layered) structure. The membrane consists primarily of a thin layer of fat, water repelling (hydrophobic) surface and a water attracting surface (hydrophilic). You are likely aware that fat will not dissolve in water. These fat layers are impermeable to most substances, including water, amino acids, certain acids, carbohydrates, proteins, and ions, but they do allow the passing (diffusion) of other important substances. Together, the bilayers maintain a separation between the inner and outer environments. You will learn later about how cholesterol plays a major role in maintaining this bilayer membrane and its permeability.

Cilia

The outer membrane is also covered with hair-like structures called cilia. They are microscopic organelles that play a vital role in everyday life. They are only about 1-10 microns long and are only one micrometer wide, which is very tiny.

There are two types of cilia [motile cilia and non-motile (primary) cilia], which function separately, but sometimes together. The motile cilia are found on nearly every cell in the human body. They are found in very large numbers on the outer surface of the membrane of a cell, and they beat in a coordinated wave pattern. Their wave motion propels fluids past the cells. They are best known for their function in the lungs, respiratory tract, and the middle ear. They serve to keep your airways clear. The term motile means moving, which means that they wave back and forth to perform numerous functions; like clearing mucus and dirt from your airways, allowing you to breathe easier, moving blood towards the many receptors, transporters, and gates, and they reduce irritation. They also propel sperm.

The non- motile cilia serve primarily as sensory organelles. There is typically only one on each cell. They enable the cells to communicate with one another. They are found in the urinary tract, and it is the flow of urine past them that enables you to feel the flow of urine; indicating that urine is flowing. In your eyes they are found inside the light-sensitive cells of the retina, where they form a microscopic track that guides the transport of vital molecules from one end of the photoreceptor to the other.

Cytoplasm/Cytosol

Your body contains approximately 5 liters (or 5.28 quarts) of fluid, of which 2/3rds is inside your 10 trillion cell's membranes; which means 1/3rd is blood and 2/3rds cytoplasm. Cytosol is the actual fluid within which all of the cell's organelles reside (all the hardware shown inside the cell in the above diagram), and where the majority of the cellular metabolism takes place. Cytoplasm is a collective term for the cytosol plus the organelles that are suspended within it. It ranges between 70-90% water and is usually colorless. It is composed of salt (sodium) and other organic molecules. Most of the cellular activities occur within the cytoplasm; even cell division.

The cytoplasm serves as a warehouse for everything that will be required for the cell to carry on daily (moment to moment) functions. While it may sound like a contradiction of terms, the cytoplasm is a microscopic, but giant, warehouse. Microscopic because it is so small in actual size 1/10th of the diameter of a human hair, yet giant, because it houses multiples of millions of enzymes, hormones, food molecules, oxygen, glucose, fatty acids, and numerous organelles.

If just one of your cells were to be compared to a life-sized warehouse, it would have to be very large, and would require a very sophisticated computer system to manage the shipping, receiving, manufacturing, and warehousing of all of the substances needed to allow it to function efficiently; then imagine there being 10 trillion of them, all of which are 1/10th the diameter of a single hair.

The Nucleus (Control Center)

The cell's nucleus functions as the brain of the cell. Virtually everything that occurs inside the cell is monitored, and likely controlled, by the nucleus. It is not always found in the center of the cell, however it is rarely found near the outer edges of the cell; possibly to protect it. It is the largest organelle inside the cell. The outside of the nucleus is a double membrane that is covered with pores that serve to aid in the nucleus' communication with other organelles inside the cell. The nucleus is surrounded by cytoplasm (cellular fluid). The nucleus contains a complete copy of the DNA and RNA for the body. Each cell, therefore, contains a complete copy of the DNA and RNA. However, the cells of a particular organ, for example, will only read the DNA for that particular organ, despite the fact that the DNA is present for every other part of the body.

The nuclear envelope, the membrane of the nucleus, surrounds the nucleus and all of the other contents. When the cell is at rest, chromatin (made from DNA and RNA) is in the nucleus. DNA and RNA are the nucleic acids inside each cell. When it is time for the cell to divide the chromatin becomes very compact, and when chromatin becomes very compact, it condenses. When the chromatin are condensed, the chromosomes become visible under a microscope, and appears like a nucleus inside the nucleus.

The nucleus sends out ribosomes, which take position on the rough endoplasmic reticulum, which play a major role in the synthesis of proteins (like amino acids).

Endoplasmic Reticulum

The endoplasmic reticulum (ER) are a network of tubular membranes located within the cytoplasm of each cell. There are two types, the rough endoplasmic reticulum and the smooth endoplasmic reticulum. They are both involved in the transport of materials. Both types have membranes. About half of the total membrane surface in animals and humans is provided by endoplasmic reticulum (ER). They are both very important in the manufacture of fats (lipids), and many proteins; including amino acids and enzymes. The proteins and manufactured and exported to other organelles. The two types reside separate from one another inside each cell.

Rough Endoplasmic Reticulum

The rough endoplasmic reticulum is an extensive organelle. As stated it is a greatly convoluted, flattish, sealed sack, which is continuous with the nuclear membrane. Its name comes from the rough appearance due to the numerous ribosomes that stud its surface. The surface is in direct contact with the cytosol (fluid). The rough endoplasmic reticulum are named "rough" because its outer surface is studded with ribosomes, which gives it a very rough appearance.

Ribosomes are a large and complex molecular machine. They are a primary site for the production of proteins (amino acids and enzymes). They link amino acids together according to the recipe provided by the RNA in the control center. The sequence of DNA encoding for a protein may be copied many times into the messenger RNA chains, which are of a similar sequence. Ribosomes can use RNA as a template to produce many different types of proteins: to ensure that the correct recipe is followed. The proteins they produce are either used within the cell, or are exported to the outside of the cell; into the bloodstream. The protein production is initiated in the ribosomes, then transferred into the inside of the ER, where their structure is completed. Some proteins are sent to the Golgi Apparatus for final processing. Then they are delivered to their final destination. The ribosomes are firmly attached to the outer surface of the ER. They are called membrane bound ribosomes, that number in the millions (about 13 million are found in the liver's cells). Their density becomes greater near the Golgi Apparatus.

Certain types of cells produce and use more amino acids and enzymes than others. Many produced within the intestinal tract are digestive enzymes. Some produced within the liver help produce and manage cholesterol, and others modify glycogen so that it can be inserted into the bloodstream as glucose.

Smooth Endoplasmic Reticulum

The smooth ER are tubular in shape and do not have the rough surface; they do not have the ribosomes attached to their surface. It forms a separate sealed interconnecting network, and it is evenly distributed throughout the cytoplasm. It is devoted nearly completely to the manufacture of lipids, and in some instances the metabolism of them or associated products. An example would be found in the liver. Within the liver's cells the smooth ER enables glycogen, which is stored on the external surface of the smooth ER, to be broken down into glucose, transferred to the Golgi Apparatus , then transported into the bloodstream. The smooth ER also participates in the production of steroid hormones inside the adrenal cortex, and the endocrine glands.

The smooth ER do not package proteins; like their counterpart the rough ER. The smooth ER carry out a number of metabolic reactions within its membrane. Its functions vary from carbohydrate metabolism, to lipid (fat) synthesis, and also includes breaking down (detoxifying) drugs; primarily in the cells of the liver. The drugs and other chemicals are modified to become water soluble, which makes it easier for the kidneys to filter them out and dispose of them; including medications you take.

So, you will see that the organelles within the cells of specific organs will serve specialized purposes. For example, the ER in the pancreas produce insulin and release it into the bloodstream to be used by other cells. Cells within your liver capture and process chemicals and other harmful substances to remove them from your body. The same organelle can be found in all cells, each serving specific functions as directed by your DNA.

The smooth ER also play an important role in the storage of calcium ions, which is very important for muscle contraction. When an electrical impulse from the nerves stimulates a muscle to function, these calcium ions rush into the cytosol and trigger the actual muscle contraction.

The smooth ER inside the liver detoxifies a large number of organic chemicals, by converting them into safer water soluble substances that can be removed by the kidneys. The smooth ER detoxify alcohol after drinking, and barbiturates from overdoses. If drug exposure is common, the smooth ER is capable of doubling its surface area within a short period of time; a few days to a week. It will return quickly to its normal size if the overconsumption discontinues.

The Golgi Apparatus

The Golgi Apparatus is named after Camillo Golgi (Italian physician), the person that discovered it. It is an organelle consisting of 5 to 60 layers of cup shaped flattened sacs (called cisternae), that look like a stack of flattened balloons. the number of Golgi Apparatus will vary from cell type to cell type depending upon the cell's function. It is usually located close to the cell's control center (nucleus).

The Golgi Apparatus collects and processes secretory and synthetic substances from within the cells; especially the smooth and rough endoplasmic reticulum (cellular factories that produce enzymes, hormones, and amino acids). It can be compared to the shipping department of a factory. The Golgi Apparatus prepares substances that are to be exported from the cell into the bloodstream, then becomes a transporter that moves the substances through the membrane and discharges it into the bloodstream.

The Golgi Apparatus modifies proteins and fats (lipids) that have been manufactured inside the endoplasmic reticulum (ER factories), prepares them for export and for transport to other areas within the cell. The smooth and rough endoplasmic reticulum produce products and release them inside a protective bubble (lysosomes). The bubbles are picked up by the Golgi Apparatus where the substances are released from the protective packaging, further processed, combined with other molecules, or modified, then released in the area where they will be used. The substances enter in one end of the apparatus and exit, completed, from the other end. There are a number of substances that are manufactured inside the Golgi Apparatus

Mitochondria

Mitochondrion (or mitochondria plural) is an organelle surrounded by a membrane, much like all of the other organelle inside the cell's cytoplasm (fluid). They range in size from 0.5-1.0 micrometer (μm) in diameter. They are commonly referred to as the cell's power plant, because they burn a variety of fuels inside each cell to produce ATP (adenosine triphosphate), which is a form of chemical energy. However, the mitochondria are involved in other important tasks, such as signaling, cellular differentiation, and cell death. They control the cell's growth and cell cycle.

Mitochondria are composed of compartments (regions), each designed to carryout a specific function. The regions include the outer membrane, inter-membrane space, the inner membrane, and the cristae and matrix regions (described below). In humans there are over 600 distinct types of proteins found within each of the mitochondria. Mitochondria have a separate nucleus, which is distinct from the nucleus of the cell it is found in. It is believed to be a carryover from evolution, where mitochondria were believed to have been single celled functioning organelles that had been gobbled up by larger cells. Despite evolving, the cell's mitochondria retained their nucleus. The DNA found in the nucleus of the mitochondria is not an exact match to the DNA found in the cell's nucleus, and it shows similarities to bacterial genomes.

There are several characteristics that make them unique. The number of mitochondria in the body's cells will vary widely, depending upon which tissue or organ it is found in, and how active a person is; each cell's energy requirements. Some cells will only contain one mitochondria, while others like the brain and heart, can contain upwards of 10,000 mitochondria. The liver's cells contain about 2,000 mitochondria. It is all dependent upon how much energy the cells require in order to function.

There are five distinct parts to a mitochondrion. The mitochondria's membrane is a double membrane that is very similar to that of the cell's membrane; made up of phospholipid bilayers and proteins. The outer membrane is the first part. The second part is the inner membrane space, which is a space between the outer and inner membranes. Third is the inner membrane. Fourth is the cristae space, which is formed by the in-folding of the inner membrane. And the fifth part is the matrix, which is space within (inside) the inner membrane.

The outer membrane encloses the entire structure (organelle), and it contains a protein to phospholipid ratio that is similar to that of the cell's membrane, except that larger proteins can enter the inside if a signaling transporter sequence is functioning. The mitochondria's outer membrane can communicate with the endoplasmic reticulum membrane, which transfers lipids (fats) from the ER to the mitochondria.

The ATP is produced inside the inner membrane. The inner membrane is compartmentalized into numerous spaces, which increase the surface area of the inner membrane. The increased surface area increases its ability to produce ATP. This is especially true of muscle cells, which have even more compartments.

The matrix is the space inside the mitochondria, which is enclosed by the inner membrane. It houses approximately 2/3rds of the total protein, which is held inside the mitochondria. The matrix plays a major role in the production of ATP synthesis. It contains a highly concentrated mixture of hundreds of enzymes, specialized mitochondrial ribosomes, RNA, and copies of the mitochondrial DNA genome. The primary enzyme inside the mitochondria are specialized in the oxidation of pyruvate and fatty acids, and they play major roles in the citric acid cycle.

As stated, the mitochondria have their own genetic material, which means that they manufacture their own RNA and proteins. The mitochondrial DNA sequence has over 16,500 base pairs encoding a total of 37 genes. There are 13 mitochondrial peptides (amino acids) in humans, which are integrated into the inner membrane.

The mitochondria have been linked to a number of human diseases; like mitochondrial disorders, cardiac dysfunction and even in the aging process. Pesticides cause mitochondrial damage that is believed to lead to later onset of Parkinson's disease. Mitochondrial disorders are often a contributor to neurological disorders, and can manifest as myopathy, diabetes, and a variety of other diseases. Mitochondrial disorders are also linked to schizophrenia, bipolar disorders, dementia, Alzheimer's disease, epilepsy, strokes, cardiovascular disease, and retinitis pigmentosa.

As stated, the number of mitochondria in each cell varies, depending upon the energy needs of the cell. The liver cells contain between 1,000-2,000 mitochondria per cell, which accounts for approximately 20% of the entire cell volume. The primary function of mitochondria is to produce ATP, which is often referred to as the energy currency of the cell (citric acid cycle-or the Krebs cycle). Energy is produced by oxidizing glucose, fatty acids, pyruvate, and NADH, which are produced inside the cytosol (called cellular respiration or aerobic respiration); all of which require the presence of oxygen.

When oxygen is not readily available glucose is converted into ATP through a process called anaerobic fermentation. Anaerobic fermentation is a process that is independent of the mitochondria, where pyruvate is a byproduct, which is used to produce energy, but the yield is considerably lower. The production of ATP from glucose yields 13 times more energy during aerobic respiration compared to anaerobic fermentation. For example, when a person engages is extreme physical activity, the body will not be able to provide oxygen at a rate that will enable the body to keep up with the rate that the fuel is burned (to keep up with the energy needs of muscles); known as anaerobic exercise.

So we have established that the mitochondria are the power plants of the cells. They make it possible for the cells to make efficient use of fuel molecules. They use a process called oxidative metabolism to convert food into fuel energy. Oxidative metabolism converts more fuel into energy during aerobic processes (with oxygen) than it does during anaerobic (without oxygen) processes. Cells can be much larger in size, because of mitochondria; they are capable of producing more energy to support the larger size. The mitochondria function very much like batteries, because they convert energy from one form into another (food nutrients into ATP). Often, when greater energy needs are required more batteries can be placed in parallel or series to increase the amount of energy available. Cells do the same thing by increasing the number of mitochondria to provide for the energy requirements of the cell. The energy requirements of a couch potato will be significantly less than that of an Olympic athlete.

Later you will learn how your mitochondria controls your metabolism. Then you will learn how to use your metabolism to help regulate blood sugars and your body weight. You will learn how to use your mitochondria, and your metabolism, to burn the excess fat that is so difficult for diabetics to remove.

Cellular Energy Production in the Mitochondria

The overwhelming number of activities that take place inside each cell, every second of every minute, requires energy to occur; which can include chemical reactions, the synthesis of proteins (amino acids and enzymes) or even the contraction of a muscle cell, just to name a few. Energy is the ability (potential) for doing work, or to cause motion. The common forms of energy include heat, light, sound, electrical energy, mechanical energy, and chemical energy. Chemical energy is the primary source of energy in your body. When the bonds between the atoms of molecules are broken, energy is released.

The food consumed during a snack or meal in the form of carbohydrates, fats, and proteins, are broken down during digestion (usually by enzymes), inserted into the bloodstream and circulated throughout your body, picked up by your cells, stored, and then used as fuel. The fuel is burned to produce a storable form of energy called ATP, which you will learn more about shortly. All of this is in the interest of accumulating a variety of fuels that can be selectively used, through a wide variety of conditions, as needed to provide for the body's energy needs; they all produce energy in the same form, which is ATP.

Bottom line, your body's cells will require different amounts of energy, depending upon what you are doing, whether it is sitting on a couch watching cartoons, or participating in an iron man competition. Your body's energy production system is designed to meet those needs quickly and as efficiently as possible. Your body is programed to provide energy to deal with any scenario, especially in the event of fight or flight for survival.

Some of the cells in your body plug along using about the same amount of energy day-in and day-out regardless of how active you are; like your skin cells, hair cells, and others. On the other hand, some cells like your heart muscle, and skeletal muscle cells, will have varying amounts of energy requirements; depending upon activity levels. Very little energy will be needed while sitting on a couch watching cartoons, but massive amounts will be needed quickly and reliably during an iron man competition. There are a massive number of variables at play at any given moment.

Your body's cells have preferences as to the type of fuel they use, with glucose being the overall favorite. Certain cells can only use glucose as a fuel (they cannot use any other form of fuel), like your central nervous system, so your body has to make certain that there is always a store of glucose available to keep them functioning. Other cells like your heart and brain can function on other types of fuel in a pinch, but their overall performance will suffer. So your body will seek to use glucose if at all possible.

Because there are so many variables, your body had to be ingeniously designed to be able to provide the energy needed in any type of activity, yet manage the stores of fuel to ensure that the body is capable of responding to any kind of emergency. You will learn later about how your body has adapted (evolved) to a feast or famine lifestyle, as was common with our ancestors 45,000 years ago, so that your body would not run out of fuel at important times. Your body developed specialized storage systems that enable your body to maintain fuel stores that can maintain energy production for many days; nearly 90 days for the average person.

Lysosomes

Lysosomes are small enzyme packages, which are found in every cell. The enzymes that they contain are widely varied, and are manufactured within the cell. Their purpose is to digest things, like break down food, including glucose, and even to digest the cell when it dies. Lysosomes are produced inside the Golgi apparatus. The enzymes are originally formed within the rough endoplasmic reticulum (ER). Then they are transported to the Golgi apparatus where they are assembled into the lysosomes. The lysosomes are released into the cytoplasm where they float around until they are needed. Lysosomes have a single membrane and are considered organelles.

When the cell takes in a food molecule (particle), the lysosomes attach to the molecule and release their enzymes. The enzymes break the molecule down into simpler forms so that they can be used as fuel. If the cell is starving, the lysosomes will receive a message from the control center. The lysosomes can attach to organelles within the cell and digest them into smaller forms that can be consumed as fuel (amino acids). Why the lysosomes do not digest the cell itself, or its critical organelle, is still unknown.

Extracellular Matrix

Tissues are not made up solely of individual cells. In fact, a large part of the tissue's volume is extracellular space; where the blood flows. The extracellular space is largely filled by an intricate network of macromolecules that make up the extracellular matrix. Most cells have structural cable-like structures that connect each cell to others surrounding it. Communication systems are housed in the membranes of the cells. They continually communicate with all of the other cells and the surrounding environment; sending and receiving messages.

The extracellular matrix connects (groups) all of the cells together to form a tissue, and the matrix can occupy more space than the cells connected together by the matrix. The extent of the matrix will depend upon the type of tissue, but it determines the tissue's physical properties; examples will include cartilage and bone, spinal chord, and the brain. Tissues can contain a wide variety of cell types. They can be calcified to form the enamel on the teeth.

The extracellular matrix serves as a structural scaffolding that can take many forms, including taking a rope-like form like tendons, which has an enormous tensile strength. It serves a very complex and active role in regulating the behavior of cells, which contributes to their survival, development, migration, proliferation, shape, and composition. There is still a great deal that needs to be learned about all of its functions and influences on cellular function.

The structure of the matrix is made up of specialized substances (proteins) produced within the cells of the matrix. The orientation of the microfilaments within each cell determines many of the structural characteristics of the matrix. The fibrous material used to make up the matrix have both structural and adhesive functions, and are found in many shapes and sizes. They form highly hydrated, gel-like substances within which the fibrous materials reside. The gel-like substances resist compressive forces on the matrix, while permitting a rapid flow of nutrients, metabolites, and hormones between the blood and the tissue cells. The collagen fibers strengthen and help organize the matrix. The rubber-like elastin fiber provide for resilience. The matrix proteins enable the cells to attach to their appropriate locations.

Cell Replication (Division)

A new cell is created when an old cell divides, or when two cells (like a sperm and an egg cell) fuse. Both events set off a cell-replication program that is controlled by your DNA, and are executed by proteins. The process involves a period of cell growth, during which proteins are manufactured from amino acids, and your DNA is replicated, only then can the cell division take place. When the cells divide the two cells are called daughter cells. The body regulates which cells divide, and how often, based upon the cell's age, or when new cells are needed in response to a new need. Examples include the development of new muscle cells after exercise, or to replace damaged cells. The process also replaces red blood cells every 90 days, or if a person travels to a higher altitude, where more red blood cells are needed to increase the body's capacity to capture more oxygen. Later, you will learn how the replication of your red blood cells every 90 days plays a significant role in determining what your A-1 C reading is; which is prescribed as part of your quarterly blood work to determine how well you have managed you blood sugars over the previous 3 months. Cancer occurs when cells that are not needed by the body begin to divide out of control.

The majority of cell divisions occur based upon messages sent by your body's internal clocks. You will learn shortly, that your body has over 100 internal body clocks, each regulating specific functions. Each cell moves through a sequence of phases, called the cell cycle, during which your body's DNA is duplicated. A complex mechanism monitors where each cell is in its cycle, and causes the cell to develop according to nature's plan. The rate of change will vary by type of cell. A bacteria cell, which is similar to ours, completes its entire replication cycle every 30 minutes. Most human cells proceed through all four phases over a period of 10-20 hours. That means that most of your body's cells are replicated every day. That is amazing considering that your body contains 10 trillion cells.

When a cell divides the process is called mitosis. Just before the cells divide a special mechanism, called the mitotic (mī toh tik) apparatus, is produced inside the cell. It is a special machine that divides the pair of chromosomes in the control center of the cell into two separate copies (they exist in pairs), and pushes and pulls them to opposite sides of the cell; the mitotic apparatus is a temporary structure. When the cell divides new membranes are formed and the DNA replicates to recreate the pairs of chromosomes that each cell will contain.

As stated, cells have a limited life span. A process called programmed cell death plays a very important role in the control process in terms of cell growth and balance. The process gets rid of unnecessary cells, and it is how your body controls cancer cells or other unwanted cells, which has numerous important functions. Scientists claim that our hands and feet would be webbed if it were not for the programmed cell death function. The digits of your fingers and toes are sculpted by the programmed cell death of the cells in the spaces between your fingers and toes. But the process prevents runaway cell replication, like tumor formation, unless something goes wrong that causes a loss of control. Programmed cell death is called apoptosis, where the cell shrivels and is consumed by the immune system. The cell is directed to actually commit suicide by the removal of an essential factor from the cell, when an internal signal is activated. Later you will learn how diabetes, and especially high blood sugars, can cause cells in certain parts of your body to self-destruct; resulting in memory loss, loss of brain cells, loss of pancreas cells, intestinal damage, kidney damage, and artery damage.

Mitochondria divide in a manner similar to that of cell division; called binary fission. The division varies from cell type to cell type. In some, the division and growth are linked to the cell's cycle. When cells divide, each daughter cell must have at least one mitochondrion. The division is usually synchronized with the division of the nucleus. In other cells mitochondria replicate their DNA and divide mainly in response to the energy requirements of the cell; not based upon the cell's cycle. If the energy requirements are high the mitochondria will grow and divide. If the energy requirements are low, the mitochondria will be destroyed or become inactive.

The mitochondria are inherited from one parent only. In humans, when an egg is fertilized by a sperm, the nucleus of the egg and the nucleus of the sperm each contribute equally. However, the mitochondria DNA comes from the egg only; from the mother. The mitochondria of the sperm enters the egg, but does not contribute to the genetic information to the embryo. The mitochondria are inherited from one of the parents only. The egg contains only a few mitochondria, but those that survive and divide will populate the cells of the embryo's organism.

Types of Cells

As stated, there are 200 different cell types; each serving a specific purpose. Scientists categorize cells by how their genetic material is packaged, instead of by their size or shape. In some cells the DNA is not inside a separate membrane, separated from the cytoplasm, in which case they are called a prokaryote (prō kār rē ōt). However, these cells are single cell organisms like bacteria, and are not a cell type found in the human anatomy, so we will not spend much time on them. As discussed, when the DNA is encapsulated within a membrane (nucleus) the cell is called a eukaryote (yu ker ē ōt). Some eukaryotes are also single celled, free living, organisms, but most are found in all plants and other multicellular organisms; like your body. Once again, your body contains about 10 trillion of them. Eukaryotic cells all have other structures (organelles) inside that are encapsulated within a membrane as well; like the mitochondria.

Scientists postulate that all the known cells, and living organisms, on earth today originated from one specific single cell that existed nearly 4 billion years ago. They were very unstable originally, and evolved to develop the more stable DNA molecule we see today. The many functions that are performed by your cells evolved as well. It is the presence of a nucleus, or the lack of one, is a defining feature in cells. This evolution was considered a major advance in the evolution of cells. Again, scientists believe that mitochondria and other internal organelles evolved, because the original single cells engulfed them as a food source, but instead of digesting them, they became an independent functioning organelle within the cell.

The Vascular System and Cell Function

Your vascular system is made up of all of your blood vessels and your heart. It is essentially a super highway used to transport the numerous things needed by each of your body's 10 trillion cells in order to function. Blood is obviously a liquid, called plasma, that contains several different kinds of cells. The average-sized man has between 5 1/4-6 1/3 quarts (5-6 liters) of blood, and women contain a little less. Your are likely aware that your heart pumps the blood around inside your body through your vascular system. Your vascular system forms a loop; one side is pressurized by your heart, and the other is a vacuum; where the heart draws blood from areas of your body. Both sides have specialized valves that will only allow the blood to flow in one direction. The pressurized side is called the arteriole side, and the vacuum side is called the venule side.

Your primary vascular system is like a tree, only it has a mirror image. It starts with arteries, which are large vessels. The arteries branch off into smaller and smaller vessels; called arterioles and veins on the pressurized side, and venules and veins on the vacuum side. The arteriole side veins branch off to become smaller and more numerous veins that end in millions of tiny hair like vessels; called capillary blood vessels. The capillary vessels are specially designed to allow leakage of fluid into, and out of, the tissues. There is two halves to each capillary vessel. One side is pressurized to allow fluid to flow out of the vessel to flow around each cell in the tissue. The other half allows spent fluid to be drawn out of the tissue to be recirculated back to the heart, recharged with nutrients and oxygen, then reused; recirculated.

The blood flows around each of the cells in your bodies tissues enabling them to draw the nutrients that they need from the blood. The blood that leaks out of the capillaries does not contain any red blood cells, platelets, and plasma proteins; it becomes what is known as interstitial fluid (tissue fluid).

Blood and interstitial fluid are very similar, in that they contain the same things; except for the missing red blood cells, platelets, and plasma proteins in the interstitial fluid. Essentially, your heart pushes water out of the capillaries. The interstitial fluid is made up of oxygen, white blood cells, sugars, salts, fatty acids, amino acids, coenzymes, hormones, neurotransmitters, and waste products that have been discharged by the cells. The composition of the interstitial fluid will be determined by the type of cells in the area. Different types of cells will require different types of substances in order to function; they will attract and uptake substances according to their needs leaving substances they don't need or use.

The red blood cells make up about 40% of your blood's volume. One drop of blood contains about 5 million red blood cells. Since red blood cells have a life span of about 90 days (3 months), a constant supply of new red blood cells have to be manufactured each day (several million). Your red blood cells contain a chemical (hemoglobin) that binds to oxygen, enabling the red blood cells to carry the oxygen from the lungs to all areas of your body.

Your blood also contains white blood cells, called leukocytes, which are your immune cells. There are a number of different types of white blood cells, each serving a specific function in protecting you against invaders and pathogens. You will learn a great deal more about these cells in Step #6 when you learn how to restore and maintain your immune system. Your blood also contains platelets, which are tiny cells that are used to develop blood clots when you are injured. These white blood cells seek out and destroy invading bacteria and other pathogens.

Plasma is the liquid part of your blood, which makes up about 60% of your blood's volume; mainly water. The blood also contains many other support substances like hormones (including insulin), antibodies, amino acids, enzymes, glucose, fatty acids, salt, oxygen and many others. If you suffer a puncture wound the blood will spill out, and certain plasma proteins will clump together to form a clot (a plug) for the wound; the remaining clear fluid is called serum.

Your blood serves several very important functions. It serves as a transport system to carry oxygen from your lungs to all 10 trillion cells in your body. It picks up waste products (like carbon dioxide) from your cells and carries them to be disposed of. And, it carries vitamins, minerals, amino acids, hormones, and many other important life sustaining substances to all areas of your body.

Your blood plays an important role in maintaining your body's pH (acidity), which you will learn more about in the next section. It also plays an important role in maintaining your body's temperature. Your cells would not live but mere seconds without it.

Let's look at what goes on outside the cells. You will recall that when you eat a snack or a meal the food is broken down into its basic components. The vitamins and minerals in the food are released and absorbed into the bloodstream. The food item itself is broken down into molecule sized particles and released into the bloodstream as well. Much of the meal or snack is broken down into glucose and fat, and are absorbed into the bloodstream as well. Without your vascular system, you would not live but a few seconds.

There are actually three different vascular systems in your body. The first system is a pressurized system; called the arteriole system. Each time your heart pumps one half of the heart creates a vacuum, which draws blood in (the venule system), and the other half of the heart pressurizes the blood (the arteriole system), which forces the blood through the blood vessels of the pressurized system. So, each time your heart beats the pumping action creates a vacuum, which causes the second system to pick up excess tissue fluid (interstitial fluid) throughout your body and carry it back to your heart. The third system picks up the excess fluid that was not captured by the second system. That system is called the lymph system. Your lymph system carries the excess spent blood upward to the neck area where it is inserted back into your bloodstream to be re-oxygenated and restocked with nutrients.

Your vascular system is shaped like a tree (or three separate trees), which serves as the massive highway (transportation) system. The trunk is the arteries in your body, which branches out throughout your body into smaller and smaller branches. As stated, the branches culminate into very small microscopic vessels called capillaries. The capillaries are designed to leak, which enables the tissue fluid and all of its contents, to flow outward and surround the individual cells. Again, this river of blood contains oxygen, food particles, vitamins, minerals, amino acids, hormones, enzymes, cholesterol, fats, glucose, and numerous other substances that are needed by each cell.

Your cell's cilia, receptors, gates, and transporters are constantly capturing specific substances needed to replenish the inventory of components inside of the cell, that have been used up during the operations inside the cell. As the blood is depleted of these supplies the blood is picked up the second identical vascular system (called the pulmonary vascular system), and returned to be replenished with fresh oxygen, more food particles, nutrients, and other support substances. In the pulmonary vascular system, the capillaries are vacuuming up some of the spent blood and transferring it to larger and larger vessels. The pulmonary vascular system collects about 17 liters (or nearly 18 quarts) of blood each day. Your blood is circulated through your body 25 or more times each day. Spent blood does not turn blue as many myths claim. Certain blood vessels will appear to be blue in color due to the way the vessels filter (diffuse) light. Blood actually becomes darker red when the oxygen levels drop.

So, your blood circulates through a massive network of vessels, leaks out from the capillaries, which produces a river of blood that flows around each of most of your body's ten trillion cells. Each cell attracts and captures what it needs from the blood, transports each substance to the inside of the cell, warehouses some for future needs, and uses the supplies to enable the cell to function. Then waste products, or manufactured goods are exported out of the cells and into the bloodstream to be delivered to other areas of the body to be used.

A third system, the lymph system, acts like your body's storm sewer system, and collects the excess fluids that the pulmonary system misses, and transports it upward to your neck area where it is emptied into the pulmonary vascular system. The lymph system picks up about 20 liters ( or a little over 20 quarts) of excess spent blood per day.

A Little Practical Advice for Diabetics

Every living thing is made up of independently living and functioning organelles, better known as cells. Life as we know it would not be possible without them. Each one is a small part of a larger system. Cells function in concert with one another to accomplish amazing things. Despite the fact that they are only one 10th the diameter of a human hair, the world inside of a cell is a very busy place. It is here that diabetes influences your health the most. The small amount of time spent to understand how your cells function and how diabetes messes with that is an investment that will pay off in huge dividends. You will empower yourself to interpret what diabetes is doing inside your body and how to treat it.

The average adult's body contains 10 trillion of these single cells, of which there are 200 different types. Some are very hard like the enamel on your teeth or your bones, while others are very soft and transparent like the cells of your eyes. Their shapes will depend upon their function, for example muscle cells will be long and tapered at each and, while most of the other cells are more ball shaped.

Virtually everything that occurs in your body originates at the cellular level. Every cell in your body contains a copy of your DNA. Since diabetes is genetically based, it too starts at the cellular level. It was changes in the DNA in each of every cell of your body that led to the manifestation of your diabetes. So the damage starts at the cellular level, and progresses beyond the cellular level to every area of your body. You will learn as you progress through this book different ways that you can influence your DNA, and guide your body towards resolving many issues.

To fully understand cellular function, it will be necessary first, to understand how the vascular system functions. Technically your vascular system is really three completely unique systems. The first, starts at the arteries of your heart and progresses upward in all directions into smaller and smaller vessels until they end in what are called capillary vessels. Most of the vessels are simply flexible piping of various sizes that directs the flow of blood to the area where it is needed. The capillary blood vessels are unique in that they are designed to leak. Capillaries are located in the areas around each of the individual cells, where the blood that is rich in nutrients, and other important substances, leaks from the capillary blood vessels and flows around each of the individual cells.

This river of blood, rich in nutrients and supporting substances, flows closely around the perimeter of the cells. The perimeter of the cell, officially called the membrane, is equipped with numerous specialize apparatus, called transporters or receptors, each of which attract, capture, and transport specific nutrients to the inside of each cell. Once inside the cell, the nutrients are stored in what we call the warehouse, until needed by the organelles inside the cell to function. These nutrients provide the cell with all of the basic ingredients, so to speak, that are necessary to empower the cell to function.

A second part of the vascular system, which is a near duplicate of the primary feed system, works in reverse. Instead of the capillaries leaking blood out into the tissue surrounding the cells, those small holes will allow the spent blood to the vacuumed up and returned to the circulatory system. By spent, we mean that most of the nutrients and oxygen that were in the blood have been taken up (removed) by the cells. The blood then returns to the lungs to be re-oxygenated, move on to have additional nutrients added, and then be recirculated. This secondary vascular system vacuums up approximately 17 quarts of blood each day and returns it for rejuvenation.

The third part of the vascular system is actually the lymph system. The lymph system has the same tiny capillary blood vessels as the other two vascular systems, which like the secondary system, picks up the excess blood and returns it to the upper part of the body where it enters the secondary vascular system to be rejuvenated as well. The lymph system picks up approximately 21 quarts of blood each day. It acts like a storm drain sewer system, in that one of its primary functions is to pick up excess fluid and return it to the system to be renewed. As you progress through the 6 steps of this program, you will be systematically restoring the healthy state of these three circulatory systems, repairing damage, restoring the production of substances that will relax the blood vessels, lower blood pressure, and reduce cholesterol and triglycerides, which wreak havoc throughout your arteries and blood vessels.

Each cell has a membrane that fully encapsulates it. On that membrane are specialized mechanisms, called receptors or transporters and gates, that are designed to attract, capture, and transports specific molecules of important substances into the inside of the cell where they will be stored until needed. There are numerous different receptors, because there is a large number of specialized substances that have to be transported to the inside of the cell where they will be stored until needed and used.

For example, glucose cannot enter the cells to be stored, converted, and utilized by the cell as fuel, unless the insulin is attracted to and captured by specialized insulin receptors first. The insulin receptors attract and capture the insulin, which in turn initiates a process that opens a specialized gate that will enable a small amount glucose to enter the inside of the cell. If the insulin cannot dock on the receptors, which is what happens in the case of insulin resistance (due to diabetes), then it will be impossible for glucose to be transported to the inside of the cell. Insulin resistance causes the insulin receptors to malfunction so that the insulin is not attracted the receptor, and captured, which causes the blood sugar to remain high, because the glucose cannot enter the cells.

Note that this process (malfunctioning insulin receptors-insulin resistance) is occurring on many of your body's 10 trillion cells. That means that if the insulin receptors are not functioning properly a significant amount of glucose will build up in the bloodstream, because it cannot enter the cells. Unfortunately your body is not designed to function this way, and the excess glucose and insulin will begin to destroy those tiny capillary vessels throughout your vascular system and your vital organs. Later, you will learn that there are 5 areas in your body (brain, pancreas, intestines, kidneys, and arteries) where insulin receptors are not present, but glucose is permitted to enter the cell unaided. Unfortunately, if your blood sugar is high, the cells in these areas will also have a high glucose concentration inside, which is very devastating; even deadly to the cells. It will explain in part, why diabetics are more prone to heart disease and strokes, why they lose insulin production capacity, why they begin to experience memory and cognitive function, and why they experience intestinal (bowel) issues. Stopping the progression of damage will take on a whole new level of urgency, because the much of the damage is permanent and cumulative.

Inside each cell is a control center called the nucleus. The nucleus contains your DNA, which contains the genetic instructions that guide all of the organelle inside each cell. Everything inside each cell is directed, and controlled, by these instructions issued by the DNA. When they say "you are what you eat," that is literally true. Particles of everything you eat enters your nucleus and comes in direct contact with your DNA. Good food elicits a positive and healthy DNA response, and junk food will elicit a negative unhealthy response. What you eat influences how your DNA directs your cellular, and therefore, your body's reaction to the food you eat.

Each cell is equipped with three factories. Two of them are called ERs (which stands for endoplasmic reticulum). One is the smooth ER, which means that it has a smooth surface. The second ER is called the rough ER, because it has a very rough surface. The rough ER receives recipes or instructions from your DNA, that dictates what the factory will produce (manufacture). Most of the things produced are produced in a multi step process. These factories produce primarily proteins, which begins with the production of over 1000 different amino acids. These amino acids are assembled into enzymes and hormones. A single enzyme or hormone can be constructed from hundreds of different amino acids.

For example, if the cell is an insulin producing cell in your pancreas (beta cell), it produces insulin by combining 37 different amino acids to produce it. In the case of the insulin hormone the production will begin in the rough ER, and the insulin will move into the smooth ER or further development, then it will move to the third factory, which is called the Golgi apparatus. The insulin hormone will undergo the final steps in its development, will be transported through the membrane of the cell and discharged into the river of blood, and then transported throughout the body; via your 3 circulatory systems to be utilized by all of the cells.

There are 20 primary amino acids that our body needs. Eight of those are called essential amino acids, because your body cannot produce them; they must come from the food you eat. Those 20 amino acids are a part of the over 1000 amino acids produced and utilized by your body. The 20 primary amino acids just happen to be the most commonly needed amino acids. The recipe provided by the DNA, which is sent to the factories, dictates which amino acids, and how much of each, are going to be produced in the factories. The type and number of amino acids that are produced is influenced by your diet; how food particles interact with your DNA.

There are also nearly 1000 different enzymes produced by these factories. Each enzyme will have its own unique recipe, will require its own unique combination of amino acids, and each enzyme will perform one single task once it is released into the inside of the cell. Enzymes are basically catalysts, which means in scientific terms, that they significantly speed up chemical reactions. Enzymes breakdown the nutrients that are stored in the warehouse into usable substances that are needed by the cell to function. For example, they break down the sugar molecules that have been taken in from the bloodstream, into pure glucose which in turn can be used to produce fuel energy that is needed by the cell to function. The cells will not be capable of producing the energy that it needs to function without these enzyme interactions. The same is true of fats or any other form of fuel. Enzymes also play a major role in the production of new proteins and tissues. Step #1 will focus on restoring the amino acid and enzyme production your body's cells require in order to manage your blood sugar and insulin, and to function. So, when you eat an unhealthy diet you cause changes in your DNA, which causes changes in the type and number of amino acids produced, and therefore the number and type of enzymes and hormones produced as well.

Inside each cell there are energy producing/furnaces-generators, called the mitochondria, that combine oxygen and specialized hormones that convert the glucose (fuel) into pure energy called ATP. These specialized hormones are produced inside the factories inside the cells, which are inside the thyroid gland; located in your neck. These hormones are called T3 and T4 hormones, which are released from the thyroid gland into the bloodstream and travel to each of the cells. They are taken in by a special receptors, and are used to ignite the fire inside the mitochondria which will use fats and glucose to produce the ATP energy needed to power your body's cells. Much of the activity that takes place inside the cells will be directed towards producing the ATP energy that is required to make each cell function. Specialized cells will produce hormones and enzymes that will export them into the bloodstream to be transported and used elsewhere in the body.

Finally, there are specialized mechanisms, called antigens, on the membranes of every cell in your body. It is very important that you recognize the importance of these antigens. The antigens sample everything that enters your body, whether it be inhaled with the air you breathe, in your food, or the water (fluids) you drink, or if it's something that comes in contact with your skin. Their only function is to determine if anything inside the body is an invader, and does not belong inside the body. If the invader is perceived to be detrimental to your health, the antigens will signal the immune system to seek out the invader and destroy it. That means that anything that enters your body that is not natural, such as chemicals, bacteria, viruses, or anything that is not compatible with your body, will be identified through this process and destroyed. You will learn that these antigens played a significant role in the manifestation of your diabetes. And they will have a significant impact the changes you make in your lifestyle, diet, and your environment. For example many popular multivitamins, bargain brands that are commonly advertised on TV, are synthetic (chemical) imitations, that will cause your antigens and immune system to severely react, they will offer little benefit; and they will be destroyed and rejected quickly to be discharged in your urine if you take them. Many will cause your urine to become fluorescent yellow in color within a couple of hours. Some actually claim that doctors recommend them, or that they are the standard for clinical tests. The key point is that diabetes, diet, and chemical exposure cause massive amounts of immune system activity, which should be avoided as much as possible. More on this later.

What you should have gained from all of this "tech talk" is that your body is a structure, built by a combination of hundreds of specialized types of cells that number in the trillions. Everything you encounter and everything you eat, will influence how your DNA responds, which amino acids, hormones, and enzymes are produced, how many are produced, and what they will accomplish; "you are what you eat."

The practical side of all of this is, as you will soon learn, that there are basic changes in your lifestyle and diet that will dramatically influence your control over cellular health, diabetes, and its complications. You will learn how lifestyle and dietary errors dramatically impact your body beginning at the cellular level.

Step #1 will explain how the vitamin and mineral deficiencies that are caused by diabetes causes your cells to malfunction. Then you will learn how to restore those deficiencies, and cellular function. In Step #2 you will learn how diabetes causes you to become dehydrated, how the loss of fluid impacts your cellular function, and then you will learn how to restore hydration and maintain it. In Step #3 you will learn how certain foods damage your DNA, alter your cellular function, how food impacts diabetes control, and then how to plan your meals to optimize cellular health and your overall health. In Step #4 you will learn how you can use exercise to improve cellular function, repair damage caused by diabetes, and much more. In Step #5 you will learn how you can use all of the information learned in Steps #1 through Step #4 to lose the excess weight that drives diabetes and its complications, and how to keep the excess weight off. Then in Step #6 you will learn how to balance your hormones and restore your immune function to normal, both of which had been seriously impacted by diabetes.

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#  How Diabetes Messes with Cellular Function

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> "There are cells that produce insulin, cells that produce glucagon, cells in the liver that control blood glucose levels in the bloodstream, and cells that control fatty acid levels in the bloodstream. Most of all of the body's cells require glucose, fatty acids, and insulin in order to function. Diabetes modifies the processes and performance of all levels of glucose and insulin management in negative ways." -O. Schmitz and B. Brock, Denmark

As stated, there are a number of areas in your body where the cells do not have insulin receptors. Glucose can freely enter the cells without being regulated by insulin and insulin receptors. Those areas are your brain [the areas of the brain that control memory and cognitive function (your ability to think, reason, and remember)], your pancreas, your kidneys, your intestines, and your arteries. Consequently, when your blood sugars are high, the glucose level inside these cells are high as well, which is not a good thing.

The excess glucose will overwhelm the cell and its DNA. In many cases the excess glucose will trigger apoptosis, which is a fancy scientific term that describes programmed cell death; your cells will commit suicide. That partially explains the loss of insulin producing cells in the pancreas, which will ultimately lead to insulin dependence; the need to take insulin injections. The process will lead to loss of cognitive function and memory issues. The process will also lead to kidney damage that can lead to kidney disease and failure. The damage to the intestines goes unnoticed by most doctors and diabetics, but the result is very real. The damage to the intestines will cause a loss of function, absorption of nutrients from food, digestive function, and often leads to constipation or other intestinal disorders. That also explains in part why diabetics are more prone to heart disease. The damage to the arteries provides for the buildup of arterial plaque (arteriosclerosis). More about this later.

Kidney damage in diabetics varies considerably individual to individual, however all diabetics suffer kidney damage to some degree due to diabetes (elevated blood sugar and blood pressure). Kidney damage is also common in the kidneys of diabetics due to excessive accumulation of extracellular matrix proteins in the normally thin membrane that supports the capillary vessels, and in what is called the basement membrane, which is a specialized sheet-like structure within the extracellular matrix that separates each cell from the surrounding connective tissue. The basement membrane serves as a boundary for the tissue. The extracellular matrix swells (becomes thicker), which restricts the capillary blood vessels, and therefore their ability to function (supply blood and nutrients). The capillaries thread their way through the extracellular matrix.

The damage is caused by elevated blood sugar and the formation of AGE's; both cause inflammation in tissues throughout the body; especially in the kidneys. They cause changes in how the genes manage the building of extracellular matrix and their maintenance. And, they exacerbate the formation of neuropathy (loss of feeling-numbness and nerve damage), which contributes to the damage to the kidney's filters [nephrons (nef ron) or glomeruli (gloh mer yū luh)]. These changes are a major cause of kidney damage, which can lead to kidney failure due to neuropathy. More on AGE's later.

As the cell's matrix expands it impinges on the capillaries of the filters (nephrons or glomeruli) as well. It reduces the surface area for filtration, and narrows the diameter of the vessel, which requires that greater blood pressure be applied to force the blood through; which increases blood pressure. The increased pressure opens the openings in the filters. The declining glomerular function correlates with the extent of the damage that is caused. This type of damage is common in all types of diabetes, but is greater in magnitude in type II diabetics. The condition is known as glomerulosclerosis. Diabetic neuropathy plays a large role in this process. you will learn more about neuropathy and AGE's later.

The genes in the control center of cells that control the extracellular matrix can be damaged, or altered, when the glucose levels inside the cell are elevated. Researchers have identified 70 genes that are damaged by high intracellular glucose levels, an additional 26 genes that are altered, and an additional 100 genes that are down-regulated.

Whenever your blood sugars go over 110 mg/dL (or 6.1 mm/l), glucose molecules bond to protein molecules throughout your body; they are called AGE's (Advanced Glycation Endproducts). The AGE's that form accumulate and initiate massive amounts of inflammation.

Again, certain cells within the body do not require insulin to be present in order to uptake glucose. As stated, insulin is required for glucose uptake in muscle tissues, adipose tissues, and most other tissue cells. These cells have the GLT-1 transporters that are needed to move glucose across the membrane to the inside of the cell. But, there are notable exceptions as stated, like the brain, pancreas, red blood cells, intestinal mucosa, arteries, and kidney filters, which therefore, do not need insulin in order for glucose to enter the cell. It will prove helpful to refer back to the illustration of the human cell at the beginning of the cellular basics chapter.

Consequently the cells in these areas will have elevated glucose levels inside when blood sugars are high outside of the cells. When blood sugars are elevated inside the cell, the ER (endoplasmic reticulum) become stressed; a stress response is initiated. The glucose levels inside these cells increase as the levels outside of the cells become elevated. When the glucose levels inside the cell are elevated the levels of NADH and FADH increase as well. NADH and FADH are electron carriers, which play a major role in the production of energy (ATP). When the NADH and FADH levels increase too much, damage to the DNA results in the beta cells of the pancreas, and a down-regulation of insulin in type II diabetics will result. A significant increase in the production of AGE's inside the cells will occur. AGE's (Advanced Glycation End products) in extracellular matrix proteins contribute to the failure of sensory nerve regeneration in diabetics, and contributes markedly towards the development of neuropathy; resulting in nerve damage or nerve death.

ER stress contributes heavily towards the exhaustion of beta cells in type II diabetics. Proinsulin, which is a precursor of insulin in a multistep process, is synthesized in the ER of the beta cells, and is then stored inside the beta cells until glucose levels increase and insulin is released.

The ER is responsible for many different things, besides manufacturing amino acids, hormones, and enzymes, and is highly dependent upon and sensitive to its environment. When the environment is out of balance a number of stress responses will occur that will seek to keep the ER functioning properly. The primary stress response is called the unfolded protein response (UPR), where the ER expands in size, undergoes an increased folding capacity, a reduction in protein (amino acid and enzyme) production occurs, and if that does not work, and the ER does not return to a normal state, cell death can result. If the stress is severe enough, the ER will send a signal to the control center that will initiate apoptosis, which is programed cell death; especially within the beta cells.

Significant evidence exists that suggests that ER stress due to elevated blood sugars is a significant contributor to the manifestation of type I diabetes. The ER of the beta cells of the pancreas are very highly developed in order to permit them to produce very large amounts of insulin in a relatively short period of time if needed; which renders them particularly vulnerable to ER stress. The beta cells have to be largely exhausted before insulin dependent type I or type II diabetes can manifest. As the beta cells are damaged or destroyed additional stress is placed upon the remaining functioning cells to meet the body's requirements for insulin. The stress leads to the UPR (unfolded protein response- swelling), which results in a reduction in the amino acid and enzyme production capacity; resulting in cell death.

One of the primary functions of the ER is to fold proteins (amino acids)into specific shapes, such as enzymes and hormones. When the ER is stressed errors can occur in the folding process, which renders the completed product useless. When the energy supply is inadequate, or the ER becomes exhausted, and accumulation of improperly folded or unfolded proteins occurs, it will cause the ER to self destruct. Nutrient deficiencies (vitamins and minerals) and glucose shortages will cause severe ER stress. If calcium is mismanaged, a large number of improperly folded proteins will accumulate. ER stress and UPR are implicated in a wide range of chronic diseases, including diabetes, neurodegenerative diseases, pathogenic infections, atherosclerosis, and others.

Diabetes (elevated blood sugars) causes alterations of the extracellular matrix (ECM) in both the large and small arteries. High levels of circulating non-esterified fatty acids (NEFA's) are present when insulin resistance is present along with type II diabetes. It is believed that high concentrations of NEFA's alter the basement membrane composition in the artery wall cells, smooth muscle cells, where cholesterol and other substances collect. NEFA's are free, unsaturated fatty acids, which are the major components of triglycerides (primarily from fat stores in the body). They consist of three fatty acids that are linked to a glycerol backbone.

Inflammation inside the mitochondria of the heart muscle cells plays a role in the deterioration of the heart muscle in diabetics (type II). Increased amounts of fatty acids inside the heart muscle cells cause fatty acid oxidation inside the cells. A process develops where the mitochondria uptake extra oxygen, which contributes to the fatty acid oxidation. However, the increase in fatty acid oxidation does not produce any additional ATP (due to what is called uncoupling), which is an irregularity in the function of the inner membrane of the mitochondria, that limits its ability to uptake and utilize calcium inside the mitochondria. The loss of calcium signaling inside the mitochondria causes cardiac issues for diabetics.

A Little Practical Advice for Diabetics

It's important that diabetics be aware that there are five areas in their body where their cells do not have insulin receptors. The majority of the cells in your body require that insulin dock on the insulin receptors, before the cell can uptake glucose. Since these cells, which include the pancreas, the brain, the intestines, the kidneys, and the arteries do not require an insulin receptor to uptake glucose, the glucose level inside the cell will be the same as the glucose level outside of the cell. Consequently, when the blood sugar in the blood stream is high, and the blood sugar inside the cell is high, bad things begin to happen.

High blood sugars cause serious damage to the inside of the blood vessels; especially to the capillaries. High blood sugar inside the cells damages the DNA, and usually results in the death of the cell. That explains why a the beta cells of the pancreas are lost in type I diabetics, and eventually occurs in type II diabetics; type II diabetics eventually will become insulin-dependent due to this loss of insulin producing cells. The damage to the blood vessels significantly increases the risk of developing arterial plaque, which will lead to cardiovascular disease; heart attacks and strokes. The damage to the kidneys is cumulative and results in damage that will lead to a an elevated risk of kidney disease or failure. The accelerated loss of brain cells will result in loss of memory, and memory issues, and loss of cognitive function.

The loss of cells in the intestinal walls will lead to a loss of production of digestive enzymes and a reduction in absorption of vital nutrients. Diabetes causes the loss of beneficial bacteria within the intestines, which is a leading cause of constipation and other issues. High blood sugars, and the associated damage to the vascular system, leads to a loss of neurons on the muscles of the intestines, which is the cause of diabetic neuropathy and the death of nerve cells throughout the body. The damage to the capillary blood vessels causes a loss of blood flow to these very important cells, which starves them of needed nutrients resulting in their death. The death of the nerves that normally stimulate the muscles of the intestines to function, and move matter through the intestines as it's being digested, causes a loss of muscle tone in the muscles that surround the intestines. So, the loss of muscle tone in the intestinal wall of diabetics will slow down the transit of matter through the intestines, will increase the amount of water drawn out of the food being digested, will increase the risk of constipation, will cause the intestine to be larger in diameter, and will cause the intestinal wall to become thicker.

Inflammation, which accompanies high blood sugars, causes damage to the mitochondria (the energy/heat generators inside cells) and contributes to the deterioration of the heart muscle in type II diabetics; a major contributor to the development of heart disease. Elevated blood sugar increases the amount of fatty acids inside the tissue of the heart muscle and causes the inflammation inside the cells. It also causes the cells of the heart muscle to underutilize calcium, which also contributes to cardiac issues for diabetics.

Hopefully, the lesson that you learned from this chapter, is that high blood sugars cause significant damage throughout your body. Whenever your blood sugars rise above 110 mg/dL the cells throughout your body, and your cardiovascular system, are subjected to significant amounts of damage; including the death of many cells. The higher your blood sugar goes, the greater the amount of accumulated damage. Some medical professionals tell diabetics that it's okay for their blood sugars to go as high as 140, but based on what you've just read, it should be clear that that is not okay. Bear in mind that medical professionals do not seek to cure diabetes, or stop the progression of damage, but merely to slow down the progression of diabetic damage. The six steps outlined in this program will stop the progression of diabetic damage if you implement all of the steps into your daily routine.

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# Homeostasis

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> "In healthy people the minerals come back into relationship soon; in sick people the minerals stay out of proper relationship for hours, and sometimes the balance does not return at all. When minerals are out of balance day after day, year after year, and possibly through generations, the body's ability to balance back into homeostasis is exhausted. The body can no longer fine-tune itself."-Nancy Appleton:

> "It seems not impossible that the means employed by the more highly evolved animals for preserving uniform and stable their internal economy may present some general principles for the establishment, regulation and control of steady states, that would be suggestive for other kinds of organization."- Walter Bradford Cannon

Once again, this section may appear to be off topic, but if you stick it out, you will find that the time spent will be well invested. There are so many aspects of diabetes that are impacted by these bodily functions, and likewise so many bodily functions that are impacted by diabetes. Understanding the basic cellular function, and homeostasis will significantly increase your ability to understand how your body is responding to diabetes, as well as why your body is doing what it is doing. It is an additional tool that will empower you to make the right decisions regarding your diabetes treatment and management.

You learned in the last section that many important functions occur inside each of your body's 10 trillion cells. Collectively, they influence how your body functions as a whole. But, what you haven't learned is how your body controls all of these important functions. A process called homeostasis is the tool that your body uses to accomplish controlling everything that goes on; inside and outside of your body. This section will help you understand why your body has lost control over blood sugar, insulin, and body fat as well as many other functions because of diabetes.

Homeostasis is used to describe how nature keeps things running the way they should. Homeostasis is a process that nature designed and implemented into every living thing. It is a collective term that describes your body's process of keeping things working properly; keeping you alive. Your body cannot heal itself or maintain a healthy state unless it is in balance.

Homeostasis is of particular interest to diabetics, because diabetes like 30 other chronic diseases, is due to a breakdown in the body's ability to maintain important functions (like glucose and insulin) within their normal levels (homeostasis). You will discover that there are many seemingly simple and unimportant functions, like body temperature, sodium (salt) levels, blood sugars, and acidity (pH), that actually must be kept within very tight limits in order to keep you alive; they actually are very important. So, we're going to look at these specific functions, and a few others, with blood sugar being of particular interest, to see how homeostasis controls their levels, and how diabetes messes with that process.

The term homeostasis comes from Greek "homoios" which means similar, and "stasis," which means standing still. Homeostasis describes your body's internal regulatory system that is responsible for maintaining normal function in all areas of your body. It maintains stability within your body. There are many conditions that must, as stated, be maintained in your body within strict limits in order to keep you healthy; even alive.

Everything you come in contact with is constantly acting on your body. Many things in your life are capable of altering many internal functions that could easily go out of their acceptable (normal) range. So, homeostasis acts like the thermostat in your home. You set the thermostat to the desired temperature you want, and it maintains that temperature within a narrow range; within a few degrees. Homeostasis keeps things working inside your body within the limits set by nature (genes); called "set points." Your body is equipped with special sensors, each specially designed to monitor specific things, like blood sugar or temperature, that constantly signal your brain as changes occur. Your brain compares those signals with the set points [set by nature (genes)] and causes things to happen that will make corrections to keep the system in balance (stable), within the comfort zone (set points). Again, many diseases are a direct result of a disturbance of homeostasis; known as homeostatic imbalance. Diabetes is the result of imbalances in homeostasis; your body can no longer control blood sugars, blood pressure, and cholesterol.

As your body ages, it will lose efficiency due to changes in the control system (changes in the set points). Homeostatic inefficiencies gradually result in an unstable internal environment, which increases the risk for health issues. Many environmental, dietary, lifestyle, emotional, and numerous other stimulus slowly reprogram your set points; the set points shift upward or downward, and your body loses its ability to maintain a truly healthy balance.

You will recall that a bad diet directly impacts (changes) your genetic makeup. A bad diet causes changes in the amino acids produced, and consequently the number and type of enzymes and hormones. These changes result in a decline in cellular function and health. The result is a slow methodical change in your homeostasis as well. Your brain adjusts to managing the new set points that have been established.

Originally, when you were born, nature had set all of your set points at levels that optimize perfect health; unless a genetic mutation has occurred that transfers erroneous information. A homeostatic imbalance is responsible for the physical changes associated with aging. Heart failure can be caused because nominal negative feedback mechanisms become overwhelmed, and destructive positive feedback mechanisms take over; the set points are reset to unhealthy levels and your brain dutifully maintains the wrong levels.

When you eat a diet made up of processed foods (anything in a box, bag, can, or bottle), high glycemic index foods, wheat, dairy, saturated fats and oils, artificial sweeteners, caffeine, sodas and colas, pork, and alcohol, which is the normal diet for most diabetics, your body is challenged numerous times every day; every time you eat. These pro-oxidant substances, which we will learn more about very shortly, cause massive amounts of inflammation throughout your body. The chemicals and undesirable substances alter your body's genetic response to what you eat, and can slowly alter the types and quantities of amino acids and enzymes that each cell produces. You will learn much more about what inflammation is and how it works in the next chapter, and how a diet low in antioxidants causes a loss of control over the destructive inflammation.

You will recall that everything you eat impacts your genes throughout your body; you actually are what you eat. When you eat a processed food that contains many chemical additives (food coloring, texture enhancers, flavor enhancers like processed sugar and processed table salt, trace amounts of pesticides, fungicides, and chemical fertilizers), feedlot meats (growth hormones, food coloring, nitrates, nitrites, and antibiotics-discussed in detail later), all of those chemicals enter our body's cells and come in direct contact with your body's genes. You will also recall that your genes are located in every cell of your body (control center of each cell), and they communicate every change they encounter with the other genes throughout your body. When you eat broccoli, for example, the broccoli actually causes a positive genetic response that is communicated to all of the other genes in your body (every living cell). A good diet causes a favorable response throughout your entire body. When you eat a bad diet, those chemicals are capable of causing your genes to flip switches that can very adversely affect how your body responds, throughout your body; because those chemicals come in direct contact with your genes. These changes in genetic makeup is a slow process, but can be permanent if sustained and once the genetic switches are flipped. Shortly, you will learn how this process played a primary role in your becoming diabetic.

Our environment is also a powerful stimulator. The temperature outside your body, humidity, air pollution, chemicals in our drinking water, chemicals from plastics (plastic bottles), soaps, shampoo, toothpaste, mouth wash, laundry soaps, dish soaps, cigarette smoke (first, second, or third hand), and many, many, others are a daily part of our lives. Your body absorbs these chemicals, and reacts to its environment with the same effect.

Many centuries ago, the original, and only blood type was blood type O. As populations grew, and competition for space and food increased, our earliest ancestors began to migrate to other areas of the globe to find food. They were exposed to new types of food, different animals to hunt, water from different sources, and very different environments (temperatures, elevations, and more). Their genes were exposed to a different diet and environment. Consequently, over time, we now have four very distinctively different blood types (O, A, B, and AB); four distinctly different sets of antigens. Each blood type is the result of genetic mutations, caused by environmental pressures, that eventually changed the genetic makeup of blood, enough that one cannot be transfused into the other, without causing a very severe, possibly fatal reaction. Physical characteristics, including physical size, skin color, body shapes, and many other characteristics changed. Since genetic changes are passed on to offspring, new unique races developed over time. Their genetic exposure to changes in diet, lifestyle, and environment slowly changed their cellular function, and resulted in significant changes in their body and blood.

Diseases that commonly result from a homeostatic imbalance are diabetes, lupus, Crohn's disease, rheumatoid arthritis, asthma, osteoporosis, arthritis, and many more. Other conditions are dehydration, hypoglycemia, hyperglycemia, gout, and diseases caused by toxins that build up in the bloodstream. There are over 30 chronic diseases that are a result of homeostatic imbalances. All of these conditions result from the presence, a buildup, of environmental or dietary substances. Normally, homeostatic control mechanisms prevent this imbalance from occurring, but, in some people, the mechanisms do not work efficiently enough, or the balance is too far out of normal range, where the levels can no longer be managed. Medical intervention becomes necessary to restore the balance, or permanent damage to the organs may result.

Every illness is to some degree a result of lost homeostasis. We live in a constantly changing world. Your body's cells and tissues survive in a constantly changing microenvironment. The "normal" or "physiologic" state then is achieved by adaptive responses to the ebb and flow of various stimuli permitting the genes, cells, and tissues to adapt and to live in harmony within their microenvironment; so homeostasis is preserved. It is only when these stimuli become more severe, or the response of the organism breaks down, that disease results. This is as true for the whole organism as it is for each individual cell. So, you will discover that you have more control over your health than you might have previously thought.

Homeostasis is an automatic system that functions without your being consciously aware that it is working. It has to be that way, because it would be impossible for you to be continually monitoring, what amounts to many thousands of important functions; to watch for changes and make adjustments. You would get nothing else done, because it would occupy all of your time. There are too many variables for you to consciously control all of them at once; simultaneously. So, your brain (hypothalamus) does it for you (homeostasis).

Homeostasis can take many forms. Homeostasis controls your body's temperature, acid levels (pH), fluid levels, sodium concentrations, nutrient balance, blood sugar, and many, many, others. It can even control your behavior. When circumstances in your life move outside of the acceptable, expected, range homeostasis can intervene, cause panic, or an emotional response. This of course implies that you have the ability to change some of the set points that your brain will then use as a reference to control your body's health. You will learn later how to change your body's set points to finally lose stubborn diabetic weight, and to program your body (homeostasis) to actually maintain your new lower weight; permanently. So, your body's responses that are controlled by homeostasis are not only hormonal, chemical, and electrical, but emotional as well. You will also learn how to plan your meals so that your body will regain a significant amount of control over your blood sugar, blood pressure, triglycerides, and cholesterol; even to the point where you no longer need most of your current medications.

The whole process begins with a stimulus, which is anything that will seek to alter how your body functions. Your environment will pressure your body to make changes that will seek to alter the current status relative to the established set limits; to reset your set points. Your body's specialized sensors (receptors) identify the stimulus, measure the change, and send a message to your brain (hypothalamus). Your brain interprets the threat, or the change, that is occurring, and orchestrates the actions of your body (effectors) that produce the desired response; which is to move the system back to within the set limits.

This process explains why weight loss can be so difficult. Your brain has established set points, which are based upon your current weight. Over time, as you gained weight, your brain reprogrammed your body weight set points to your new weight level. Your brain will very aggressively control your bodily function, and behavior, to make certain that your weight does not go down. Nature built a survival mechanism into your body that encourages obesity, but not weight loss. To lose weight you have to learn how to trick your brain into resetting your body weight set points lower and maintain them.

It is a lot like driving your car. Your eyes monitor where your car is in terms of the lines painted on the road. As your car gets too close to the center or the edge of the lane or road, your brain receives the visual message, and instructs your arms and hands to turn the steering wheel just enough to keep the the car within the set points; between the lines. At the same time your brain is tracking your speed and making adjustments, navigating towards your destination, correcting the temperature settings inside the car, changing the radio station, watching for policemen running radar, reading road signs, checking out how many cars are at Wal-Mart, spotting garage sale signs, checking out sale signs in the windows of stores you pass, the current gas prices as you pass gas stations, checking your gas gauge, answering your cell phone and carrying on a conversation (hopefully not texting), watching for pedestrians, talking with people in your car, tracking other cars in front, beside, and behind you, and watching for aggressive drivers, or those that appear as though they may be about to pull out in front of you from a side street; just to list a few environmental variables that are monitored and controlled simultaneously. There are many, many, things that your brain has to do just to control your car to reach your chosen destination. But your brain is capable of monitoring those many environmental influences that could easily cause an accident, or put you and your passengers at risk, and constantly make changes to ensure your safety, and get you to your destination; with minimal thought. All of which is going on simultaneously with all of the thousands of functions that your body is monitoring internally every second of every day.

The important thing is that the better you understand homeostasis, the less power it will have over your life. Homeostasis will engage regardless of whether a stimulus (change) is positive or negative, good or bad, pure wisdom, or pure foolishness. The intensity of your fear and resistance is directly related to the size (magnitude) and pace of the change, but not necessarily the quality of the change. Fearful reactions are often simply your programmed natural resistance to change.

The Hypothalamus

Homeostasis is controlled by your brain's control center, which happens to be a very small organ called the hypothalamus. It is the size of an almond, and it is located in the center of your brain directly in from each ear. Your hypothalamus will seek to vigorously satisfy needs, to maintain control, but it is not necessarily concerned about how it accomplishes that. For example, if sensors indicate that your body is low on nutrients, the hypothalamus will stimulate food cravings to satisfy the need; to get the issue resolved quickly; any food item will meet the need.

On each side of your hypothalamus there are two small (pearl sized) organs called the amygdala, which complement the hypothalamus. They are very particular about how you satisfy needs. For example, if your hypothalamus receives a message that you are low on a nutrient, your hypothalamus would be satisfied by promoting the eating of just about anything, just to get the job done. However, your amygdala can overrule many decisions made by your hypothalamus. They will determine what specific type of food you should eat, what spices you put on the food, right down to choosing the brand of food you eat. If your hypothalamus receives sexually stimulated signals, the hypothalamus would not be particular about how the need is satisfied, only that the need be resolved. The amygdala will override the urges of the hypothalamus, and be very specific about the requirements that need to be met; including the physical characteristics of a partner, the color of their hair, how they dress, and even how they smell.

You might picture your hypothalamus as a control room similar to that for the space program, where hundreds of screens monitor many thousands of functions simultaneously. Each screen has a corresponding control panel where an operator can flip switches or effect many changes as needed to keep things in balance. Virtually everything you do or encounter causes changes within your body; like stepping outside on a cold day without a jacket, eating a bowl of very hot soup, or running to catch a bus. All of which pressures your body to change based upon the experience.

There are many thousands of wires coming into your control room, that in reality are nerves; part of your central nervous system. There are many thousands of neurons (sensors) located throughout your body (an estimated 25,000) that are constantly monitoring conditions and reporting the changes to your body's control center. Some of these wires allow messages to be sent from all areas of the body to the control room only; one direction only, called afferent nerves. Others allow signals from the control room to flow in an outward direction only to all areas of your body; called efferent nerves.

Again, there are many thousands of environmental, dietary, stress related, or other external and internal pressures that are seeking to change how your body functions. It is the control room's (hypothalamus) job to ensure that they don't cause a change that will impact your health. You will discover soon that even minor changes in some bodily functions could be devastating, even fatal. So correct, timely, responses by this control room are vitally important.

As the data is received in your control room, an imaginary little man compares the data received from all over your body to charts that list the upper and lower limits for each set of data. As long as the data readings from the sensors are within the allowable limits (listed on the charts) no major action will be taken. As stated, those limits are called set points, which are set by your body's genes (DNA). The little man considers the values between the high and low set points to be within the normal range. When the data approaches or moves outside of the high or low set point on one of those charts, the operator will begin to make changes on the control panel to effect a change; to bring the readings back to within the limits set by the set points. You will learn that over time, minor changes in the set points can occur, that can cause the man in your control room to maintain erroneous, incorrect, set points; which can result in health issues. Many "age related" issues are not actually due to age at all. The body's set points have drifted out of the normal range; the range that would otherwise prevent the problem from occurring. For example, you will learn later how vitamin B12 deficiencies cause most of the age related problems; like falling, memory loss, brain fog, incontinence, tremors, and even dementia.

What becomes difficult to appreciate is how your hypothalamus, for its very small size, can accomplish all that it does. Your hypothalamus is simultaneously receiving virtually many thousands of signals every moment of every day and night. Yet somehow, it is miraculously capable of acknowledging the signals, making decisions (comparing data to set points), and effecting changes to control all of these thousands of signals instantly, and simultaneously. If this process were run by humans it would require a massive room, with a massive number of operators. Only a super computer could duplicate what the hypothalamus does. It is also amazing that your body will allow you to function in a wide variety of different environments, and still maintain these many thousands of vitally important functions within a very limited range. Some areas of your body are less tolerant of changes than others. Your brain, central nervous system, and your heart are very intolerant of dramatic changes, while many muscle tissues and organs are less capable of resisting dramatic change.

Besides the homeostatic systems of the hypothalamus, there are other systems that deal with large and unpredictable changes of the environment that may require a change in behavior and physiology. These responses (called allostatic responses -another scientific term) range from the recognition of, and the appropriate adjustments to a stimulus; like the presence of a loved one, or a life threatening attack. The responses can include resetting various set points (an increase in body temperature or blood pressure), as well as endocrine adjustments (such as cortisol and adrenaline release when you feel threatened). These include abrupt and dramatic alterations of behavior, such as mating or a fight or flight response.

In addition to making adjustments to the internal controls that support homeostasis, and responding to urgent external events, the hypothalamus also helps anticipate daily events that are triggered by your body's numerous body clocks. All of which have a predictable influence like setting the times for eating, drinking, sleeping, and sexual behavior. They are regulated by the circadian body clock (timing system) that is located in your brain. Your body uses this master clock to anticipate various demands and opportunities. For example, wakefulness (the process of waking up in the morning and getting going). Cortisol levels peak at the appropriate times of day as necessary to cause you to forage for food, or to orchestrate how your body's temperature will fall a full degree while you are sleeping, because many bodily functions will slow down while you sleep; a fast metabolism isn't needed.

Your body is actually equipped with over 100 body clocks, including one in each of your vital organs, every type of tissue, and inside many cells. They all have to be synchronized by the body's two master clocks. The two master clocks are the SCN (suprachiasmatic nuclei- another scientific term), which is located in your control room (hypothalamus), and another that is, as yet, unidentified, that regulates your body temperature and alertness. The activities of the second clock are well established, but exactly where it is located within the brain remains a mystery. All of your body's cycles are controlled by hormones that control your body's clocks.

These clocks are divided into three types;

Ultradian rhythms (those that are shorter than 24 hours). They include controlling heartbeat, body temperature, breathing, and blink rates.

Circadian rhythms (24 hour cycles), which includes the day/night (light/dark) cycle.

Infradian rhythms (those that cycle in rhythms greater than 24 hours), includes a women's menstrual cycle.

Our calendars, our seven day week, and our 24 hour clocks were all imposed by nature's cycles. Nature's cycles control all living things. They control how we perform, our endurance, our mood, our ability to remember things, to feel things, express our emotions, how well we perceive our world, how alert we are, our safety, and many others. Even the moon's cycles impact us in countless ways. These cycles along with the hypothalamus control our body and all of its functions.

We have established that your body has set points that determine the limits of all your bodily functions. So, how exactly, does your control room control all of this? The hypothalamus and amygdala can be compared to the sail and rudder of a sailboat. The wind is the stimulus for change, and the sail like the hypothalamus determines the general direction that the boat will move. Adjusting the sail can alter the effect that the wind has on the vessel; increase or decrease pressure on the sail. The amygdala is like the rudder of the boat, which fine tunes the navigational process. Again, the amygdala compliment the hypothalamus. The hypothalamus provides general guidance, and the rudder refines the instructions to provide more specific direction.

This control center we have been describing, is sometimes called the reflex center, which includes the hypothalamus, the amygdala, and many miles of nerves and neurons. The hypothalamus functions in a number of ways. The most common is by instructing endocrine glands to produce and excrete hormones that travel in the bloodstream to stimulate numerous bodily functions in response to sensor messages received from all around the body.

Let's look at an example of this process in action. First sensors (sensory neurons) that are located throughout your body, measure the existing condition; which is called the stimulus. Each neuron is designed to monitor a specific function; like body temperature, or another to measure your blood sugar level. Again, there are two types of neurons, afferent which bring signals to the brain, and efferent, which carry signals away from the brain to the organ(s), gland(s), or muscles. You can easily remember which is which by remembering that A comes before E (Afferent -stimulus versus Efferent-response). Organs, glands and muscles are the effectors that will respond and correct a problem. The response generated by these effectors is called the reflex.

Every organ in your body has the capacity to contract, secrete substances, or a combination of the two. Obviously your muscles can contract, your gallbladder secretes bile fluids, your stomach contracts and secretes the food into your intestines, as well as secreting digestive fluids into the food in the stomach, your liver secretes numerous substances (cholesterol, triglycerides, glucose, hormones), and your kidneys secrete waste products and urine, just to name a few. Your brain is an exception. It is not considered an effector, because it does not do anything that does not manifest itself physically; but it does activate the other effectors. Your thoughts are expressed through physical actions (responses). If, somehow, the nerves between your brain and a part of your body are damaged, you will lose control over that response.

Your body does not connect most of your sensory neurons directly to your brain. Your nerves end in your spinal chord at what is called a synapse; which is a small gap at the end of each neuron. The gap controls how information passes from one neuron to another. Synapses (open spaces) occur where nerves connect with other nerves, as well as where the nerves end, or connect to muscles or glands. Neurotransmitters, which can be made up of amino acids or other substances, allow the message to be transmitted, or to jump across the gap, to the next nerve or destination, which triggers an electrical impulse. This special arrangement allows reflex actions to occur very quickly by activating spinal motor neurons. There is less delay, because the signal does not have to be routed through the brain. Your brain still receives the sensory input, but as the reflex action occurs; the reaction, like pulling your finger away from a hot stove after touching it, has already occurred. The hot stove example explains why it is important that a faster reaction is possible.

There are three types of homeostasis reflexes:

Neural reflexes- like body temperature control, or a reflex action (touching something hot). Where nerves directly effect and cause an action or reaction.

Hormonal (endocrine) reflexes-like stimulating the thyroid gland to produce hormones to control energy, metabolism, and body temperature. The body produces hormones that activate specific activities. The hormones are secreted into the bloodstream and travel to the intended destination. An instant response time is not necessarily critical.

Neural-hormonal (endocrine) reflexes- like controlling fluid levels in the body. Control is effected through a combination of nerves and neurons, and hormones.

NOTE: the following sections illustrate how homeostasis regulate a number of bodily functions like temperature, pH (acidity), sodium levels, wake/sleep cycles, hunger, and sexuality. Homeostasis related control over blood sugar will be covered in the next chapters. If you do not care to read through these sections, simply skip to the end of the chapter. They are included because they illustrate how your hypothalamus functions. So now, lets look a little closer on how all of this works to control several important bodily functions.

The Regulation of Body Temperature

Temperature regulation is an important example of a homeostatic reflex. When you arrive at your doctor's office, you will find that one of the first things the nurse does is check your temperature. The nurse has no idea as to why you are there to see the doctor, but taking your temperature is considered one of the most important things that they check in every patient. That is because your body's temperature is very important to sustaining a healthy lifestyle; even staying alive.

Your temperature will vary in different parts of your body. Your oral temperature (under your tongue) is about 98.6º F. (37º C) at around 4:00 PM each day, and your core body temperature (rectum) is 99.6º F. (37º C). It is very important that your control room (hypothalamus-homeostasis) maintain your body temperature within a very narrow range, because it affects the rate of chemical reactions. You will recall that the millions of enzymes in your body's cells, which act primarily as catalysts (speed up chemical reactions) will cease to function if the temperature varies too much, either too high or too low. If your body's enzymes are not working well, your entire body falters.

But why 98.6º F. (37º C)? Your normal body temperature is the perfect temperature (balance), because it is warm enough to control fungal infections, allow the body's critical chemical reactions to function efficiently, but not hot enough to stimulate a desire to eat constantly to maintain a high metabolism; which would be required to maintain a higher body temperature. You will recall that the mitochondria (energy/heat generators) in each cell produce your body's heat. Your metabolism controls how much energy and heat is produced; how much glucose is burned in the furnaces (mitochondria). Studies have shown that fungal species can thrive, and therefore infect, a body by an increased 6% for every 1.8º F. (1º C) rise in temperature. Tens of thousands of fungal species infect reptiles, amphibians, and other cold-blooded animals. Only a few hundred species are harmful to mammals, because of the higher body temperature. We humans maintain a temperature much higher than most animals.

Temperature is a measure of kinetic energy (energy of motion) of the molecules of a system. The lower the kinetic energy the lower the temperature, and the higher the kinetic energy the higher the temperature. When the temperature is higher the number of collisions of molecules, which can alter the chemical state; increases the potential chemical energy. Enzymes cause nearly every chemical process in the body to occur very rapidly, otherwise the chemical reaction would occur so slowly that they would not benefit us. Enzymes must collide with and bind to a substrate at the active site in order to function properly. Each enzyme has a temperature range in which it will achieve a maximum reaction; it is called the temperature optimum of the enzyme. The rate of chemical reactions, the rate of enzyme actions, and the rate of catalyzed reactions increase as the temperature increases. A mere 18º F (10º C) increase in temperature can increase the enzyme activity by up to 100%. A change in reaction temperature (as low as 1º-2º) can change the reaction rate by 10-20%. If the temperature rises too high, adverse effects begin to occur. There is a maximum level, a point where enzymes become denatured (temperatures above 104º F- 40º C). The loss of enzyme reaction declines more rapidly as the temperature declines. That is why doctors panic when fevers reach the 104º F (40º C) level. The feverish patient is immersed in ice water to lower their temperature to prevent serious damage.

The temperature on the surface of your skin is the most likely to change. The air around your body is almost always cooler than the inside of your body. Your body's skin temperature is usually about 10º lower than your internal body temperature. The temperature of your skin causes changes in how your body regulates heat more than any other area.

Your body generates heat when it burns glucose as fuel. More than half (60%) of the energy given off during the burning of glucose is in the form of heat. Again, it is similar to a light bulb. Most of the energy is in the form of heat instead of light. When we use our muscles we burn glucose to provide the energy to make the muscles function, which results in the generation of heat; especially during exercise (15-20% increase in metabolic rate). When you eat a meal, the digestive process generates heat. The body's metabolic rate (the rate at which glucose is burned) increases by up to 20% due to the chemical reactions that are taking place during digestion; called food induced thermogenesis. It is highest after eating proteins.

Also, your body temperature goes through a cycle daily. Your body's temperature drops, starting around 6:00 PM, and continues to drop throughout the night until about 4:00 AM. The lowest temperature, called the basal temperature, is approximately 1º (97.7º F - 36º C) lower than in the evening. Women experience temperature variations monthly due to their menstrual cycle. Elevated progesterone levels can increase the body's basal temperature by as much as 1.º

Your body loses heat, because it radiates from the skin. Heat always flows naturally from the warmer areas to the cooler areas. Recall that your body's temperature is almost always higher than the surrounding area. Your body is capable of dilating or constricting the blood vessels in the skin to control the amount of blood at the surface of the skin. By controlling the blood flow to the surface of the skin your body can regulate the temperature of your skin, and how much heat is radiated to the air surrounding it. By dilating or constricting the blood vessels in your skin your body can control how much heat is lost to the air; which can serve to reduce the internal body temperature if it is high. If you immerse your hands into ice water, your blood vessels will constrict to prevent heat loss to maintain the body's temperature. If you are overheated, your body will dilate the blood vessels in the skin to radiate more heat to the air surrounding the skin.

Your body can lose body heat due to evaporation of sweat from the skin. Your body produces sweat to enable the excess body heat to evaporate the sweat, which discharges larger amounts of heat. When a liquid passes from a liquid state (phase) to a gaseous state (phase), a great deal of energy has to be expended. The molecules of the liquid have to be excited enough to undergo the phase change, which is accomplished by increasing the heat applied. Your imaginary technician in your control room will turn on the sweat glands to produce sweat to discharge the excess body heat into the air. The process of evaporating the sweat will consume a massive amount of body heat, and dissipate it into the air.

On the other hand, the humidity of the environment surrounding the body can alter the process. The more humid the surrounding air, the slower the rate that sweat will evaporate. At 100% humidity the sweat will not evaporate, but will run off as a liquid instead. That is why humidity increases the heat index, which is how warm the air feels relative to the actual temperature. At 100º F (37.78º C) the heat index is 195º F (91º C), which means the air will feel like 195º F (91º C) against your skin. Sweating only cools the body if evaporation can occur. You will still sweat, but it will have minimal cooling effect. The risk of heat stroke will significantly increase, because your control room is unable to lower your body's temperature, your cellular enzyme activity will be too excited and bad things will begin to happen.

Every time you exhale air from your lungs you discharge heat and moisture into the air around you. You lose water and heat from your body. An estimated 20% of body heat is lost due to breathing. Your lungs are the coolest parts of your body. Some animals pant when they are warm, because they do not sweat. Their body has to discharge any excess heat into the air as they exhale; called insensible water loss.

Your body's set points for temperature are set by your genes at 98.6º F (37º C) ±0.5 degrees. It is referred to as the Thermoregulatory Reflex Center (TRC). The TRC activates effectors to compensate for stimuli that would otherwise change your body's temperature to higher or lower than the set points.

Thermoreceptors (sensory neurons) located throughout your body send messages to your control room, constantly updating the technicians (hypothalamus) on temperature changes in your body (through the afferent pathway). The control center (imaginary technician) compares the temperature readings received, to your body's set points (charts) to determine when action is required. When the set points are exceeded (higher or lower), the imaginary technician will initiate effectors to restore the temperature within the set point range. The output signals (efferent pathways) go to effectors like the cutaneous blood vessels (skin), sweat glands, skeletal muscles (shivering), and glands [to secrete hormones that will speed up cellular respiration (increase the amount of glucose burned in the mitochondria) to produce more heat]. Different effectors will be signaled based upon the degree, and type of response needed. Different parts of the body will be regulated at different temperatures. For example the skin surface temperature is maintained at a temperature that is lower than the internal temperature. The oral temperature (under the tongue) is maintained between 98.1º F (36.7º C) and 99.1º F (37.28º C), and the internal body temperature (internal organs) is maintained slightly higher.

If a person is exposed to prolonged temperatures (several hours) of 131º F (55º C) the body will no longer be able to manage its internal temperature; hyperthermia will occur. Death will occur if the body is exposed for an extended period of time to 167º F (75º C). Hyperthermia can occur in humans if they are exposed to 95º F (35º C) for six or more hours. Again, you will recall that important enzyme activity will cease to function when temperatures are too high, or too low. Hypothermia is when the environmental temperature lowers body temperature to a dangerous or fatal level [55.4º F (13.0º C)].

TRC Reactions to Low Temperatures

When the body's temperature drops below the set points, the following hypothalamic adjustments will be made by your imaginary technician:

A person will first feel cold. The central nervous system will be the first line of defense, which will initiate behavioral changes. Behavioral responses like putting on a sweater will occur, eating something that is hot, or turning up the thermostat in the home.

The body stops producing sweat.

Minute muscles under the surface of the skin (arrector pili muscles) that are attached to each individual hair follicle, contract, which causes the hair to stand upright and helps hold heat close to the surface of the skin.

The body will react by constricting blood flow to the skin to minimize heat loss. Your appearance will appear pale because of the reduced blood flow to the skin.

The body will begin to shiver, because the skeletal muscles will be activated to constrict, which causes the shivering response. Shivering causes the muscles to produce heat. People increase the heat in their body by rubbing their skin, running in place, or becoming more active to produce heat.

The mitochondria (the furnaces of the cells) begin to burn fat to produce heat.

The adrenal glands will be instructed to produce adrenalin and your thyroid gland will produce the hormone thyroxin which serve different purposes, but both increase cellular respiration to speed up the break down food faster and produce heat; to increase mitochondria activity. The thyroid gland increases the metabolic rate which increases the heat produced within cells.

People will begin to crave heavy carbohydrates to keep up with their increased metabolism.

When the homeostatic reflexes are activated because the body temperature has risen above the upper set limit temperature the following will occur:

The person feels warm. The central nervous system again initiates behavioral changes, like removing excess clothing, drinking more cold beverages, turning on the air conditioning, and standing in front of a fan.

The cutaneous blood vessels (skin) will dilate to allow more blood flow to discharge more heat. The skin will take on a flushed appearance.

The person will being to sweat to increase heat dissipation.

The thyroid gland and adrenal glands will secrete fewer hormones to reduce heat generation. Reduced thyroxin and adrenalin production will lower the metabolic rate.

Most of your body's heat is generated in the deep organs, especially your liver, brain, heart, and skeletal muscles. When your body is hot the hair on your body will lay flat to increase air flow and to not hold heat near the body.

A fever is a regulated increase in body temperature that is caused by circulating pyrogens (fever producing substances) produced by your immune system.

The Regulation of pH (acidity)

Your body's pH (acidity) is simply a measure of how acidic or alkaline your body's fluids are. Your body's fluids include fluid (water) inside cells (about 2/3 of total body fluid), outside of cells, which includes your blood and tissue fluids (eyes, lymphatic system, joints, nervous system, and between protective membranes surrounding cardiovascular, respiratory, and abdominal cavities).

Your control room (hypothalamus-homeostasis) also regulates the acidity of your body. The set points of your body's pH level is 7.35-7.45, which is again set by your DNA (genes). The acidity scale ranges from 0-14; 0 being pure acid, and 14 being pure alkaline. A change of one single point is a 10 fold difference one to another; a pH of 5.0 is ten times more acidic than a pH of 6.0. A liquid that has a pH of 4 is 100 times more acidic than one at 6.0. Pure water has a pH of 7.0 or it is neutral. Sodas and colas have a pH of around 3.0, which is extremely acidic, when compared to pure water (10,000 times).

Your body must be very aggressive in maintaining its pH level, because a variation of ±0.5 on the scale can cause death. Your body will sacrifice bone health in order to maintain the proper pH by stealing calcium from your bones and teeth to neutralize acids to balance the pH level; it's that important. Calcium, potassium, and sodium are alkalizing minerals that your body will steal from other areas of your body and use them to restore the pH balance.

Like temperature, your body is highly dependent upon close regulation of the pH level in order for chemical reactions to occur inside your body, especially the chemical reactions involving proteins. Proteins have to maintain a specific geometric shape in order to function. The three-dimensional shape of proteins is extremely dependent upon pH level maintenance. Very slight changes in pH will have a dramatic impact on protein function. Every cell in your body is primarily protein, and continually exchanging chemicals, like nutrients, waste products, and ions, with external fluids that surround the cells. The surrounding fluid exchanges these chemicals with the blood that is circulated throughout your body. So, the chemical concentrations of your body's fluids and blood are extremely important to cellular health. The exchange and utilization of chemicals throughout your body are highly dependent upon pH level management. As your body's cells produce energy, by burning fat or glucose, the pH of your body fluids can be altered. Your body's cells produce different acids and release them into your bloodstream and the fluids outside the cells. Acids are a natural byproduct of energy production.

The pH and chemical composition inside and outside the cells must be kept relatively constant; that is where your imaginary technician in your control room (homeostasis) comes in. There are two main forces that daily impact your body's pH level. Diet is a primary cause of changes; eating acidic foods and drinking acidic drinks like sodas and colas. The second is the acids produced during normal daily metabolic processes.

Homeostasis is accomplished primarily by promoting the production and management of buffers that are dissolved in your blood. Some of your internal organs aid in the homeostatic function of the buffers. For example, your kidneys remove excess chemicals from your blood, including excess hydrogen ions which increase acidity in the blood, as well as removing excess buffers that may have accumulated in your blood. Your kidneys help control acids (hydrogen ions) and bases (bicarbonate), since they can excrete/retain hydrogen ions if needed. They also control the excretion/retention of bicarbonate (HCO3). If your blood is acidic, your kidneys will try to excrete hydrogen ions, and retain bicarbonate. If your blood is alkaline, your kidneys will try to retain hydrogen ions and excrete bicarbonate. The drawback of this is that it takes a few days to be effective. Your body was not designed to eat a diet of highly acidic or alkaline foods, but a balanced diet instead.

As stated the process can be a slow process, so if a highly acidic condition exists the acidity of the blood could become too high; which is known as acidosis. Your lungs will also discharge hydrogen ions with the air that is exhaled. Your lungs work faster in lowering blood level acidity than your kidneys. Your lungs extract acids and CO2 from the blood and discharge them when you exhale. This is especially important in exercise, when your breathing rate increases, along with additional acids that are produced during exercise. However, if your lungs cannot keep up with the production of CO2, the risk of acidosis increases (respiratory acidosis).

When the pH of your blood gets too low (below 7.35) acidosis will result, which leads to central nervous system depression. Severe acidosis (below 7.0) can lead to coma or death. Likewise, when the pH rises above 7.45 alkalosis results, which causes all of the nerves of the body to become hypersensitive (over excitable) resulting in muscle spasms, nervousness, and convulsions. The convulsions can result in death if severe. Breathing usually controls the pH level and maintains the set points, by discharging the acidic components in your breath. Food, medications, exercise, sodas, and tap water can substantially increase the acidity of your body.

Your body regulates the pH level in three ways. Your body uses blood buffers, which are bicarbonate buffers, protein buffers, and phosphate buffers, respiratory mechanisms, which increase or decrease your rate of respiration, and your body uses a renal mechanism, which is a process of reabsorption of bicarbonate (excretion of hydrogen ions, etc.).

Of all of the buffers bicarbonate is the most important. It is formed when CO2 (carbon dioxide) dissolves in your blood. When CO2 combines with electrolytes it is capable of countering changes in the acidity level in your blood. Your body's phosphate buffer system uses different phosphate ions to neutralize strong acids and bases. About 85% of the phosphate buffers come from calcium phosphate salts, which come from your bones and teeth. So, when you expose your body to highly acidic substances for a long period of time your body is forced to remove calcium phosphate from your bones and teeth to supply this buffer system. Long term, it can result in serious weakness in both your bones and your teeth. It can also result in the development of kidney stones, because the amount of calcium in the urine increases.

As stated, exercise can alter the pH of your blood. Exercise uses up the oxygen in the blood, and produces CO2 and hydrogen as the glucose is burned for fuel. Carbon dioxide and hydrogen combine to produce lactic acid which increases the acidity level of your blood. Some of the effects are increased due to the increase breathing rate, elevated blood pressure, and elevated heart rate produced during the exercise. More blood is pumped to the surface of your skin in an effort to dissipate the excess heat buildup resulting from the exercise. Anaerobic exercise, where the heart rate is increased to the point where you are forced to breathe through your mouth, forces your body to function without oxygen, which also produces lactic acid, which enters your bloodstream. However, the heavy breathing due to the exercise, discharges much of it into the air.

Acid/base buffers change the pH of your blood. When hydrogen ions (protons) or hydroxide ions are added, or removed, the acidity level can be altered. Salt is the most basic base. A base neutralizes acids. Acid/base buffers typically are weak acids, and salts. The concentration of the weak acid and the salts in a solution will determine the resulting pH of a fluid. If hydroxide ions are added the salts will neutralize them to the extent that they can. Higher amounts of acids added will require larger amounts of salts to be added to balance the pH. Likewise, if large amounts of alkaline (base) is added from an outside source, the acidic portions will be reduced, or used up, increasing the pH of the fluid. When carbonic acid is added to an acidic solution water and CO2 is produced as the acid is neutralized.

A highly acidic diet (wheat, corn, soy, and some of the other grains, tap water, sodas and colas, and some meats) will overtax your body's ability to maintain your proper pH set points, which will lead to serious health issues (like osteoporosis), because your body is forced to leach important minerals out of your bones to neutralize it.

Your control room imaginary technician (hypothalamus) instructs the production and release of hormones that instruct your kidneys to filter out, or retain, bicarbonate or hydrogen ions to control their concentrations. The pH level in your blood will direct your control room (hypothalamus) in making the decision as to which needs to be increased or decreased, and how much, in order to restore balance. Your control room technician is also capable of increasing your breathing rate in order to increase the discharge of excess CO2 and hydrogen ions.

Your body uses trace minerals as a buffer to neutralize acids in the intestines after digesting a meal. You will learn later how vitally important these trace minerals are to your overall health. Since most diabetics are deficient in many trace minerals, because dietary issues, especially sodas and colas, deplete your body of these important buffers; they force your body to extract minerals from the vital organs.

Sodium and Body Fluid Regulation

Your kidneys are charged with the responsibility for regulating the volume of your bodily fluids and the sodium concentrations of your body, along with many other things. Your kidneys are directed by your control room (hypothalamus). Together, fluids and sodium defend your body against all possible disturbances in the volume and osmolarity of the body fluids. Before we progress any further, we need to define osmolarity.

Your blood is comprised of many different substances that make up what we call body fluid. They are all suspended in water. Osmolarity and osmolality are fancy scientific terms that define how much of each of the different substances are present in your blood; their concentration in your body's fluid. They determine how easily the fluid will pass through the membrane of cells. As stated, both osmolarity and osmolality are defined in terms of osmoles. Scientists define an osmole as a unit of measurement that describes the number of moles of a compound that contribute to the osmotic pressure of a chemical solution...huh? Let's interpret that. The fluids that surround your body's cells have to pass into and out of the inside of each cell. They pass through the cell's membrane. That is how each cell gets the nutrients, water and other support substances that it needs to function. That is also how cells get rid of waste products that are produced within the cells. Osmolarity is a term that describes the concentration [osmoles of a substance (nutrients, oxygen, glucose, sodium, or many other substances) per liter (approximately a quart) of solution (osmol/L or Osm/L)]. Osmosis is the ability of a solution to pass through a cell's membrane. How easily a fluid can pass through the membrane is partially dependent upon the concentration of other substances in the fluid. These scientific terms are included in this book, because many readers have requested that scientific terms be included, which enables them to conduct their own expanded research.

So, what does all of this have to do with homeostasis? Your blood, and the fluids that surround all of your cells are very salty. Your body contains many different types of salts, but sodium chloride is the primary salt (sodium) in your body. It comprises 0.4% of your entire body's weight, which is very similar to that of sea water. A person that weights 50 kg. or 110 pounds will have 200 grams of sodium in their body; which equates to about 40 teaspoons of sodium. Obviously a heavier person will have significantly more sodium in their system. A person that weighs around 150 pounds will have around 55 teaspoons of sodium in their bodily fluid. Your body contains approximately 5 quarts of fluid. If you add 50 plus teaspoons of salt to 5 quarts of fluid, the sodium concentration will be quite high; it would have a very salty taste.

Your hypothalamus works very hard at regulating the sodium concentration and the fluid levels within your body. The regulation of the concentration (osmolarity) of the blood is balanced by controlling intake and removal (excretion) of sodium with the fluid levels. Your body uses sodium in many thousands of bodily functions. Your life is dependent upon sodium. During past wars, doctors were able to keep wounded soldiers alive when blood plasma was in short supply by administering salt water. Sodium is by far the major substance in the extracellular (outside of cells) fluids, which explains why it is so effective in determining the osmolarity of these fluids.

The regulation of osmolarity (the ability of a fluid to pass through the cell's membrane) is accomplished by controlling the amount of fluid in the body and the amount of sodium in the fluid. When you drink a full glass of water, the water quickly passes into the fluids of your body, which dilutes the concentration of sodium in the fluid. The change in concentration complicates the passage of the fluids, which contain all of the substances needed by each cell, into, or out of, each cell.

That is why dehydration is so dangerous for diabetics. High blood sugars cause your kidneys to discharge large amounts of water to flush out excess glucose. The resulting dehydration equates to an incorrect concentration of water and sodium; as well as other substances. Your body's cells cannot properly take in nutrients or glucose, or discharge waste, when the body is low on fluids; their function is greatly impaired. Most diabetics are dehydrated, and do not realize it.

How Your Body Controls Fluid Levels

Controlling fluid levels has a major impact on the sodium concentration in your body's fluids. When you change the volume of water in your body, without changing the sodium levels, it causes the the concentration of sodium in the fluid to change. Reducing fluid volume increases the sodium concentration, and increasing the fluid volume decreases the sodium concentration.

Your control room technician (hypothalamus) is charged with keeping your sodium concentrations and fluid levels under control (balanced). Your control room technician makes you feel thirsty when more water is needed (by initiating the secretion of the hormone ADH). The amount of water taken in with food or drink (and the amount created by metabolism) has to be balanced with the water lost to excretion (sweat, breathing, and urination). Your body loses almost a liter (about a quart) of water through the skin, lungs, feces, and urine (from the kidneys) each day. So, the supply side is controlled through behavior mechanisms (thirst or salt cravings).

Your kidneys directly control your body's fluid volume by how much is excreted as urine. Or, your kidneys can retain water. The actual amount (concentration) of water in the urine will vary relative to the amount of water in your blood and cellular fluids. The concentration of waste products in the urine can vary throughout the day. Your morning urine is considerably higher in concentration of waste products than water, because you have not been drinking water while you slept.

So how does your hypothalamus regulate how your kidneys regulate fluids? Your kidneys each have approximately one million finger-like tubule filters. A bit like your pinky finger. They are hollow, with one end draining into channels that go directly to your bladder. Blood pressure forces blood, which contains mostly water and many other substances (good and bad), through these filters into the inside of these tubules (filters). The inside of each of these tube-like filters is lined with millions of specialized cells called transporters. Each transporter is specialized in that they will attract, capture, and force a specific item back through the wall of the filter, back into the bloodstream. There are transporters that will each attract and capture a specific vitamin or mineral, and return it to the bloodstream. Others capture calcium, others capture sodium, there are transporters for each of the primary substances the body needs to survive. Only those items that are natural, needed, and complimentary to the body will be captured and returned back into the bloodstream. All other synthetic, chemical, or unnatural (non-complimentary) items will remain inside the tubule filter and will be discharged into the bladder with urine.

The cells in the hypothalamus produce an Anti-Diuretic Hormone (ADH-vasopressin) from arginine (amino acid); which makes it a peptide hormone (produced from amino acids). ADH is sent to the pituitary gland where it is stored prior to being released. The filters of the kidneys also control how much fluid is allowed to pass to their inside, or back into the bloodstream. The ADH hormone instructs your kidneys as to how much of the water that has passed to the inside of its filters is to be reabsorbed back into the bloodstream. Vasopressin prevents the loss of water from the body by reducing the production of urine, and causing the kidney's filters to retain or move more water back into the bloodstream. When your body's fluid levels are low, more ADH hormones will be excreted, which will increase the amount of the water that is captured and returned back into the bloodstream. ADH secretion is influenced by a number of other factors. Anything that stimulates the production of ADH, also stimulates the "I am thirsty" response as well. It is believed that elevated blood sugar is a contributor to the kidney's loss of control over retaining fluids; thus partially explains the frequent urination when blood sugars are high. Diabetics are frequently deficient in ADH (vasopressin). Vasopressin (ADH) also raises blood pressure by constricting (narrowing) the blood vessels. Let's look at a few of them:

Special receptors in the control room (hypothalamus) are sensitive to any increase in plasma osmolarity [when the plasma (blood) becomes too concentrated]. When the concentration increases, more ADH production will result.

Receptors in the atria (upper chamber) of the heart sense when a larger than normal amount of fluid (blood) volume is returning to the heart from the body's veins. These receptors will signal a decrease in the secretion of ADH (vasopressin), which will cause a discharge of more water into the urine. This also happens when you drink a full glass of water. The water moves instantly into the bloodstream. It increases the fluid volume, and decreases the sodium concentration. The control room receives signals that the fluid volume is higher than it should be, so the production and release of ADH (vasopressin) is suppressed. Consequently, you will have to urinate soon after, because the filters of the kidneys left the excess water inside the filters, which drains into the bladder.

Receptors in the aorta and carotid arteries are stimulated when blood pressure drops, which stimulates the production and secretion of ADH (vasopressin). The body will then retain water, which means more water will pass back through the filters and enter the bloodstream. As the fluid volume increases, the blood pressure will increase.

The hypothalamus can also signal the posterior pituitary gland to release vasopressin (a hormone) that causes water to spill over into the urine. The blood level of vasopressin (VP) is low in type I and type II diabetics, which is believed to be due to the resetting of the osmostat [the part of the hypothalamus that controls osmotality of the extracellular fluid (bloodstream)]. Diabetes insipidus is a condition where the kidneys lose their ability to conserve water when blood sugars are elevated, or due to other causes.

Sodium balance

Sodium levels control cellular health. Extreme variations in osmolarity will cause the cells to swell, or shrink, which can damage or destroy the cells, and seriously disrupt their function. Also, the nervous system is highly dependent upon sodium to allow the transmission of messages across the gap at the end of each neuron, and as discussed salt (sodium) is used to balance pH (acidity). Your body needs 1.5 grams (1/2 tsp.) of salt (sodium) each day to replace what is lost each day in sweat, or used up in other bodily functions. The average adult has about 50 grams of sodium in their body. When a person is severely dehydrated, the cells in their brain swell and suffer major damage. Restoring hydration is a very delicate process, the fluid levels have to be restored very slowly. When sodium levels are elevated, due to dehydration, or high salt intake in the diet, the production of nitric oxide is substantially reduced, which causes high blood pressure. The blood vessels constrict, instead of relaxing. Nitric oxide relaxes the muscles that surround the blood vessels.

Diuretics cause the kidneys to excrete sodium, which reduces the sodium concentration. The body responds by reducing the fluid levels to balance the sodium concentrations.

There are special nervous system sensory receptors, called the osmoreceptor system, that are located in the hypothalamus that monitor the osmotic pressure of the blood. Which essentially means that they sense the sodium concentration of the blood, and signal changes to regulate it.

When the sodium concentration is altered too much (too high, or too low), the permeability of the cell membranes in nerves and muscles is jeopardized. If too severe, permanent damage can result. The cell's membrane can become depolarized, with possible fatal consequences. Sodium is a positive ion. It cleanses cells, and acts as a transporter for some important substances. (nutrients and waste).

As discussed the ADH hormone plays a role in lowering osmolarity (reducing the sodium concentration) by increasing the amount of water retained (reabsorbed) by the kidneys. For example, if you place a spoonful of salt into the bottom of a glass, then add only one inch of water and stir it up, the salt concentration will be very high. The water may even appear cloudy because there is so much salt in it. If you fill the glass, and stir it up again, the salt concentration will be dramatically lower, the water will appear clear, as if there is nothing suspended in it.

Besides increasing the fluid levels by using ADH (vasopressin), the kidneys have another tool that will prevent the osmolarity from decreasing too much below normal. The kidneys also have a mechanism for reabsorbing sodium that has passed through the filters of the kidneys. Aldosterone, which is a steroid hormone, is produced by the adrenal gland. The secretion of aldosterone is managed in two different ways:

The adrenal gland is capable of directly sensing sodium concentrations in the blood. When the sodium concentration increases above the set points (normal level as set by the genes), the production and release of aldosterone will stop. Less aldosterone will cause less sodium from being captured and transported back into the bloodstream. The excess sodium will pass in the urine. If the ADH secretion is increased more water will be conserved, which complements the effect of low aldosterone levels which decreases the concentration of sodium. Less urine will be discharged, which increases the concentration of the urine.

When the kidneys sense low blood pressure, which impairs the function of the filters, the kidneys trigger a complex response that will increase the blood pressure, and conserve fluid volume. Specialized cells, called juxtaglomerular cells, [afferent and efferent arterioles (small blood vessels that carry oxygenated blood from the arteries)] begin to produce a hormone called renin. Renin is a peptide hormone (made from amino acids) that initiates a cascade of hormonal activity that ultimately produces angiotensin II, which stimulates the adrenal gland to produce aldosterone.

When the body is seeking to conserve water (increase volume, and decrease sodium concentration), the ADH secretions will stimulate the reabsorption of water, because aldosterone is also acting to increase sodium reabsorption. So the net effect is a retention of fluid that is roughly the same sodium concentration as the body's fluids. The amount of water excreted into the urine declines and the concentration of the urine will increase.

This illustrates that homeostasis of sodium concentrations, and fluid level, are managed by the hypothalamus and the adrenal gland through the production and secretion of hormones.

Sleep/Wakefulness Regulation

Scientists do not have a complete understanding of all that occurs regarding your hypothalamus and the sleep/wake cycle. But, they do know that staying awake and remaining alert, or sleeping restfully throughout the night depends entirely upon your hypothalamus. Your hypothalamus will shut down the arousal system, which wakes our body up to start the day, during the sleep cycle, and it will slow other processes down during the sleep cycle. The sleep wake cycle, which is approximately 16 hours of attentive wakefulness, and 8 hours of restful sleep, are very important to ensuring and maintaining the overall health of your body.

Researchers discovered that when laboratory animals were deprived of sleep they developed incapacitating, and ultimately fatal, disorders in their body's ability to control temperature, immune function, and metabolic balance. Sleep saves calories, because the body is immobile, which is integral to deep sleep. A sleeping body does not radiate as much heat, which conserves body heat, and metabolic energy. The technicians in your control room will slow the burning of glucose in your mitochondria (energy/heat producing furnace); which means that your metabolism slows down. Sleep somehow enables the body to restore its capacity to regulate both heat and metabolism. After a good night's sleep the body is better suited to adjust to changes in the environment, especially temperature, and it improves how the body utilizes food.

After about two weeks of sleep deprivation laboratory animals began to overeat, but continued to lose weight. They constantly sought sources of heat, while their body temperature continued to drop. Their body's ability to retain heat failed to function properly. If the animals were totally deprived of sleep for four weeks death resulted. If the animals wore continually deprived of sleep, where their REM sleep was continually interrupted over a period of six weeks, lead to death. REM (Rapid Eye Movement) sleep only occupies 15-25% of sleep. Most of the deaths were due to massive infections caused by a bacterial invasion of the bloodstream; which originated in the animals intestinal tract. This implies that the health and function of the immune system is highly dependent upon sleep. When normal sleep patterns were allowed the animals recovered very quickly. Interrogators have long known and practiced sleep deprivation as a powerful tool to break down prisoners.

Your ability to learn is also highly dependent upon sleep. When sleep is deprived, many learning skills have to be relearned from scratch. Adequate sleep increases the ability to learn.

Irritability, moodiness, and disinhibition (loss of control) are common in people that do not get enough sleep, or are not getting restful sleep. They may experience apathy, slowed speech, and flattened emotional responses, impaired memory, and an inability to multitask. Each person has unique sleep needs, but in general, most need an average of 8 hours of sleep. The need for sleep does not decline with age as some myths claim. Poor sleep patterns, or inadequate amounts of sleep can impair brain function, nervous system function, cardiovascular function, and immune function. High blood pressure, insomnia, accidents, heart disease, obesity, diabetes, alcohol, and drug abuse can impair proper sleep patterns.

The disruption of kidney function, which results in frequent urination, including during the night, causes a disruption of sleep patterns. Quality sleep patterns are broken repeatedly. Sleep deprivation is a known contributor to the manifestation of a pre-diabetes condition, because it resembles insulin resistance, which causes elevated blood sugars. Sleep disorders contribute to obesity, which plays a major role in the manifestation of diabetes. Obesity is a major cause of sleep apnea, which causes loud snoring, and pauses in the breathing rhythm. When a person is not sleeping well, they tend to be low in energy, which usually leads to eating a poor diet, while seeking a source of energy.

Stress is the number one cause of short-term sleep issues. Traveling between time zones has a major impact. Environmental factors such as noise, temperature, and light have a dramatic effect. Arthritis, pain, or discomfort has a major impact. Women's menstrual cycles can alter sleep patterns. Many medications have adverse side effects that impair sleep patterns, especially blood pressure medications, decongestants, steroids, asthma medications, and antidepressants. Low blood sugar levels will significantly impair sleep patterns.

Research has identified a number of important techniques that diabetics should apply to improve sleep quality. You should keep a regular schedule, by going to bed at the same time every night, and rising at the same time each morning. Avoid drinking or eating just prior to going to bed, which includes avoiding or minimizing caffeine. Limit alcohol consumption, and do not eat heavy meals. Stop smoking. Get regular exercise. Control the sleep environment, by eliminating noise, excess light, and keep the temperature at a comfortable level. Seek to wake up without the need for an alarm clock. Going to bed for a few nights earlier than usual, will sometimes correct sleep disorder issues.

Your hypothalamus controls neurons that are located within the hypothalamus [called the ventrolateral preoptic nucleus (VLPO)], which connect directly to the many arousal-promoting centers in the brain. Rather than stimulating activity in these areas; signals from VLPO neurons inhibit their activity. When the hypothalamus shuts down these arousal centers, the VLPO promotes sleep.

The process of maintaining a stable sleep period, and a stable wakefulness period, is the result of "mutual inhibition," which is a term the scientists use to describe the process of switching from one to the other, the wakefulness promoting neurons, and the sleep promoting neurons; only one can function at any given time. The areas of the brain that maintain wakefulness, by activating the cortex, also inhibit the VLPO neurons, and conversely, when the VLPO neurons fire rapidly they induce sleep, but they also inhibit the arousal centers. The transition between these very different, and very stable, states occur within a few seconds. Researchers call it the "flip-flop switch," because is resembles an electrical switch in an electrical circuit. The switch is activated by changes in forces (like darkness or light), which become strong enough to flip the switch; to change states. Similar switching mechanisms are responsible for changes in sleep patterns for both rapid eye movement (REM), and non-rapid eye movement sleep (NREM). However, it should be noted, that different groups of neurons in the brainstem are involved in switching from REM to NREM sleep patterns.

It takes up to 20 minutes for you to calm down and relax enough to fall asleep (called sleep onset), where your body will enter the deepest stages of sleep. Sleep onset and the associated loss of consciousness occurs within seconds once that point is reached. This point can be very dangerous if a person is very tired, because falling sleep can occur at dangerous times, like when driving a vehicle. Many people are unable to enter this state unless there is a complete absence of light or noise. Waking up can also occur very rapidly; within a second or so, for example, when their alarm clock goes off, but some individuals are slower to become fully alert after awaking.

One area that is still not fully understood, is how the hormone adenosine, which is one of the chemicals believed to accumulate during the prolonged wakefulness period, serves to induce sleep by inhibiting wakefulness-promoting neurons. Scientists have identified that caffeine inhibits the actions of adenosine, which accounts for the inability to fall asleep after consuming it.

The timing of this process, the switching between wakefulness and sleep, and back again, is closely tied to your body's internal clock [located in the suprachiasmatic nucleus (SCN)]. The SCN, which is very small (50,000 brain cells-each cell is about 1/10th the diameter of a human hair), receives the light signals from the eyes (though the optic nerve), which resets the clock to correspond to the day/night cycle. This clock regulates the timing of dozens of different internal bodily functions (temperature, hormone release, and the sleep/wakefulness cycle). The SCN clock promotes the sleep cycle by turning off the alerting signal, and promotes the wakefulness cycle by producing a powerful alerting signal that shuts down the sleep drive. It also maintains sleep throughout the night, even after the sleep drive has dissipated during the second half of the night.

During the wake cycle the hypothalamus increases the neurotransmitter activity (by sending arousal agents), in the cerebral cortex, which is the largest area of the brain. It covers the entire uppermost part of the brain, and is the wrinkled portion that is depicted in pictures of the brain. The cerebral cortex is the outermost sheet of neural tissues of the cerebrum of the brain. It is divided into the left and right hemispheres. It plays a very major role in memory, attention, perceptual awareness, thought, language, and consciousness. It determines intelligence, personality, motor function, planning and organizing, and touch sensitivity. It is the gray colored matter (called gray matter). You will recall that the neurotransmitters are substance that increase (allow) the communication between cells and neurons. As long as the neurotransmitter activity is elevated, your body will remain alert and wide awake. So, as a part of the process of switching to the sleep cycle, the hypothalamus will slow the neurotransmitter activity in the largest area of the brain.

Histamine is one of the neurotransmitters released during the waking cycle. You may have noticed, or experienced, that anti-histamine medications cause drowsiness. Now you know why; they slow the neurotransmission process between neurons in the brain. They block the arousal process from functioning properly. Another neurotransmitter (orexin, also known as hypocretin) is released by neurons during the arousal period. It directly stimulates the arousal center as well as the entire cerebral cortex.

Sensors in your body identify changes in light at dusk. A cascade of electro-chemical signals flow from the eyes to the hypothalamus that signal changes in the light/ dark cycle. The hypothalamus recognizes the change, communicates with the SCN clock mechanism, and signals your pineal gland to begin the production and release of the hormone melatonin, which controls the sleep and wake cycles. Your body's natural internal clock controls how much melatonin is released. As the light continues to fade in the evening the level of melatonin will increase, and then decrease in the morning as the sun comes up.

The SCN body clock regulates activities that impact your entire body. It regulates all of the wake up functions in the morning, like increasing your metabolism, raising your body's temperature, and releasing and regulating hormone secretions. During the wake cycle, the secretion of melatonin is suppressed.

The Hypothalamus and Eating

Since eating is necessary for survival, it stands to reason that the hypothalamus would be in charge of controlling it. We would like to think that we have full control over what we eat, and when, but we fail to realize how much the hypothalamus and amygdala influences it. The body clock and the hypothalamus (prompted by nutritional decline) set off the hunger pangs that remind us that it is time to eat. The amygdala significantly influences what we eat and how much. Certainly, it is possible for you to reprogram these signals to a different schedule, how much you eat, as well as your food preferences. You will learn later how this is important in the process of taking charge of your diabetes control.

The process of eating involves a complex interaction of pathways that regulate hunger and feeding behaviors, which involves the gastrointestinal tract, hormones in the blood, and pathways inside the brain. Inside the brain many different neurotransmitters play an important role. Some stimulate and some inhibit the drive to eat.

Your body will always be primed to eat except when your brain senses appetite-suppressing neurochemicals (notably the hormone leptin). Your hormones signal your brain when your stomach is full, and your intestines send hormones with messages about what nutrients it has processed. Your brain also monitors the level of insulin in the blood, which reflects the amount of fat that is stored in your body. All of these signals reach your brain, which is wired to respond to certain psychological factors:

Diabetes and the hypothalamus make it very difficult to lose weight long term. Your body is wired by nature to promote obesity, and to resist weight loss. It will become harder and harder to reduce food intake, and harder to lose weight, even if you are eating less. Many of the chemicals in your brain inhibit or stimulate feeding, are involved in the modulation of mood, and your perceived reward. This link between feeding and mood is a powerful tool used by your hypothalamus to motivate you to find food, even in the face of danger. Chronic dieting is often associated with uncomfortable feelings, and feeding is associated with a sense of satisfaction or reward.

For many years obesity was considered a moral weakness, that people did not control their food intake. Research has now identified chemicals in your brain that play an important role in causing obesity, along with dietary errors. The hormone leptin is of particular focus in research. Leptin circulates in the body's bloodstream in proportion to the amount of body fat content. The brain has leptin receptors that can signal a reduction in the amount of food eaten. Leptin can cause the hypothalamus to significantly increases food intake. Genetic mutations can occur that will result in leptin deficiencies and therefore obesity, but is very rare. The levels of leptin produced will increase with an increase in body fat. Leptin resistance is common in diabetics and obese individuals. Leptin resistance means that despite elevated levels of leptin, the hypothalamus does not get the message as to how much fat is stored in the body. Therefore, the technicians in the control room will assume that the levels of fat storage are low and will increase the appetite to build fat stores. The leptin receptors simply do not attract or capture the leptin, so it continues to circulate unused.

Few people that are obese, however, have been found to be obese because of a leptin deficiency or due to any other brain chemical. Certainly genetics play a significant role, but typically genetic mutations do not change in a very short period of time. The cultural changes that have taken place over the last 3-4 decades, which include poor diet and lack of exercise, cannot be blamed solely for the dramatic increase in obesity in the world's population. Scientists now believe that it is a combination of genetics, cultural changes and psychological factors.

Alterations in brain chemistry are believed to be responsible for eating disorders like anorexia nervosa, where, typically women, perceive themselves to be fat and deprive themselves becoming thinner and thinner. An over activity of serotonin has been found to be a contributing factor. The restriction of food causes a reduction in tryptophan (an amino acid) which makes serotonin. By limiting the production of serotonin the person is relieved from an overpowering sense of anxiousness.

How the Hypothalamus Controls Body Weight

As stated, the hypothalamus is a very small, but very important part of the brain. It contains a very large number of nuclei and fiber tracts that communicate with neurons and glands throughout the body. The hypothalamus is believed to house the body clock that is responsible for hunger, body temperature, and hormone secretion, which are those that vary over a period of time throughout the day. It is also believed to control functions that vary over a period of many days, like the menstrual cycle.

The area within the hypothalamus, called the ventromedial nucleus, which happens to be the largest and most prominent area of the nuclei (hypothalamus), controls eating. Lesions or damage to the ventromedial nucleus is credited for causing overeating and extreme obesity. It also causes a chronic irritable mood and an increase in aggressive behavior; it is called hypothalamic rage. By contrast, these lesions result in anorexia (lack of appetite). In extreme cases death by starvation can result. This area is also called the feeding center, or the satiety center (pronounced sə-ˈtī-ə-tē).

These opposing centers of the hypothalamus define the set points for body weight; according to the set point theory for weight control. The weight control set point theory postulates that when the body's weight goes below the set point (-5% of total body weight), the hypothalamus is activated and the appetite is increased; also, the metabolism is shut down. When the body's weight goes above the set point (+25% of total body weight), the ventromedial nucleus (inside the control room-hypothalamus) is activated and the appetite is decreased. The neurons in both areas respond to glucose, free fatty acids, and the insulin levels based upon the set point theory. Both areas display a strict reciprocal relationship that is appropriately correlated with the level of hunger or satiety.

An example of this set point theory in action would be as follows; lets take a 200 pound man for example. If the set points will allow a weight loss of -5% of his body weight, that means that the control room (hypothalamus) will stand by and allow him to drop 10 pounds. If he loses 11 pounds his hypothalamus will crank up his appetite, and shut down his metabolism. Obviously, the increase in appetite will compel him to eat more, and when the metabolism is shut down, the body's mitochondria (energy/heat generator) will stop burning glucose, which will build up in the bloodstream, cause increases in insulin production, and will end up stored as more fat; weight gain. He will struggle to lose more than 10 pounds because his control room is programmed to maintain a higher weight limit.

On the other hand, his control room technician will allow him to gain +25% of his current weight, which is an additional 50 pounds, before the technician in the control room will act to prevent any additional weight gain. So, he can reach 250 pounds before his body will shut down his appetite, and increase his metabolism to maintain the new 250 pound level. If he maintains his new weight level of 250 pounds for 21 days, his set points (an new chart will replace the old one on the wall of the control room) will shift upward to where 250 pounds is the new mean weight, which means that his new limits will be -5%, or minus 12.5 pounds or a +25% , or a gain of 62.5 pounds; an new allowable weight of 312.5 pounds.

This mechanism was modified in the human body many thousands of years ago, when our ancestors were hunters and gatherers. It was not uncommon for them to go extended periods of time without food, because game had migrated, or vegetation (berries and vegetables) was out of season. So, the body was modified to adapt by collecting and storing excess fat to carry them through the lean times. Their body was also designed to create very strong hunger pangs which drove them to find something to eat to prevent weight loss. You will learn how to lose more than the -5% of your total body weight without shutting down your metabolism, and suffering massive hunger pangs; which will enable you to reset your set points lower and maintain it.

Your hypothalamus coordinates the use of energy and food intake in order to control your body weight. When a person becomes obese it is due to a mismatch in these important factors. When at rest our energy requirements are basically just what is needed to keep our vital organs functioning properly. The regulation of the energy consumption levels is called the basal metabolism. When physically inactive the metabolism will slow down, and when physically active the metabolism will increase. Energy expenditure is the key to weight control. However, there are many factors (known and unknown) that play a part in the body's regulation of weight.

The end result is a consequence of the balance between the amount of energy ingested (from food), and the amount of energy the body uses to function. Hormone levels and balance, changes in the hormone receptors, and mutations in metabolic enzymes can dramatically influence appetite and energy consumption. Weight gain is due to an accumulation of energy (glucose) that was not burned, and therefore stored for future use (as fat).

Again, everything you eat is converted into glucose (liquid) and is absorbed into a set of blood vessels that travel between your stomach, intestines, and liver. The glucose travels to your liver where it is processed and inserted into your body's main bloodstream. Your body will produce, if able, an equivalent amount of insulin and place it into the bloodstream with the glucose. Insulin will open the many billions of cells to allow the glucose to be taken into the inside of your cells. Your cells will store a small amount of the glucose, and the balance will be burned as a fuel (in the mitochondria) to produce energy for the cell to function. Your cells have a limited capacity for how much glucose they can take in, store, and/or burn. When they are full, they will shut down the insulin receptors, and will not take anymore glucose or insulin in.

If you eat more than your body needs, your body will still convert it all into glucose, and all of it will be inserted into your bloodstream, along with a proportional amount of insulin. If you eat too much food, too much glucose and insulin will accumulate in your bloodstream. The excess glucose and insulin has to go somewhere, because your body is programmed to get the concentration of glucose and insulin in your blood down to the normal range (80-100 mg/dL). Excess insulin and glucose is very toxic if left in the bloodstream for long periods of time. So, your body will allow insulin to process the excess glucose into fat and stuff it into your fat cells for later use. Unfortunately, if you don't reach a point where you need to use the stored fat, before you overeat at the next meal, the fat will continue to build up. If you fill up all of your fat cells, your body will produce new ones to allow (encourage) the process to continue. The new fat cells will remain in your body for the rest of your life.

Everyone has a BMR (Basal Metabolic Rate) based upon diet and lifestyle; activity level. Your body uses a set amount of energy daily in order to function (basic organ function); which typically amounts to about 20% of your consumed energy. Your heart, brain, nervous system, and vital organs are constantly using glucose as a fuel in order to perform their vital functions. Your muscle tissue will also burn fuel in order to function based upon your activity level. So, activity level is a key factor in fuel consumption. Our ancestors (100-150 years ago), both men and women, burned around 3,000 kcalories per day to perform their daily chores, because they didn't have all of the modern technology you enjoy. Their bodies used between 25-30% of their total energy intake each day. A lumberjack that used hand tools in years past, like axes and hand saws, could burn 5,000 kcalories per day. People that have a heavy activity level can burn around 3,500 kcalories per day.

When doctors speak of consuming less calories than are needed during an average day to lose weight, this is what they are referring to. Based upon how active you are, what your metabolic rate is, will determine how much fuel (food) you need to take in in order to accomplish a weight loss. That means that you have to learn how many calories per day your body needs in order to function, then eat less than that in order to lose weight. Your body will be forced to draw fat from storage in order to supply the body with the fuel that it needs to function.

In the past it was assumed that appetite control would automatically adjust hunger feelings, and produce a feeling of satiety that would cause us to restrict our food intake to maintain our ideal weight based upon our activity level. In today's society, people use considerably less energy to conduct their daily physical activity. Many adults now only require around 500 kcalories per day to function. Appetite control must now operate within a very limited range to not exceed what is burned. Exceeding the body's basic requirement for fuel is not difficult. A single small chocolate pastry can exceed the daily caloric intake requirement.

The appetite center located in your hypothalamus is composed of at least two classes of neurons; primary neurons and secondary neurons. The primary neurons sense metabolite levels, and the levels of the regulating hormones. There are two types of primary neurons; stimulatory, and inhibitive. The stimulatory neurons stimulate the appetite by secreting hormones [neuropeptide Y (NPY), and agouti-related peptide (AgRP)]. The inhibitory neurons suppress the appetite by secreting proopiomelanocortin (POMC). A feeling of hunger can be stimulated or depressed depending upon which hormones are secreted. The secondary neurons synchronize incoming information from the primary neurons and coordinate bodily functions by sending signals.

There are several hormones that control your appetite center. Some are used to increase hunger, while others suppress the urge to eat. They have short term and long term actions that influence appetite. They are instrumental in the control of body fat. Ghrelin is a peptide hormone that is released from your stomach, and activates the NPY/AgRP releasing neurons which stimulate the appetite. It is released when your stomach is empty, and quickly stops when food enters your stomach. A peptide is a string of bonded amino acids. A second hormone is PPY3-36, which is a small peptide that is released from special cells in your intestines, which inhibit appetite.

Two other hormones, insulin and leptin, also play a role. Insulin, which is released by your pancreas after you eat carbohydrates and protein during a meal or snack. Insulin has short and long term effects on weight control. Insulin dampens your appetite by stimulating the inhibitory neurons in your hypothalamus (restrictive hormones).

We have discussed leptin extensively above. Again, it regulates appetite and hunger, as well as your metabolism. It functions by binding to leptin receptors in your control room (hypothalamus). The amount of leptin circulating in your body is proportional to the amount of body fat present. Leptin acts on the leptin receptors in your hypothalamus, where it inhibits your appetite. Leptin counteracts the actions of neuropeptide Y, which is a very powerful appetite stimulator, that is produced and released inside your intestines and your hypothalamus. It also counteracts anandamide, which is another very powerful appetite stimulant. Leptin also promotes the synthesis of aMSH which is also an appetite suppressant. It is easy to see how an absence of leptin would lead to uncontrolled eating, and eventually obesity.

When you diet and reduce fat levels, you decrease the amount of leptin that is produced. The levels continue to climb as you become more obese. Everyone has a leptin floor, but none of us have a leptin ceiling. The brain is starving, while the body is obese. Leptin is also a part of the reward system. When leptin levels are low, food becomes even more appealing. But when the leptin levels in obese individuals are high, the leptin does not impact the reward system to stop overeating; a vicious cycle begins. Insulin resistance causes leptin resistance. High insulin levels in your blood block leptin from working in your hypothalamus, and causes brain starvation.

Researchers claim that the average person today produces twice as much insulin, for the same amount of glucose, compared to 30 years ago. High triglyceride levels block the transport of leptin into the brain. Lowering triglyceride levels is very important for many reasons, not just to increase leptin transport. Researchers blame the overproduction of insulin on the average bad diet of modern society. Over 30% of the food consumed today is fast food. The overwhelming majority of foods consumed today are processed, which contain chemical additives, are genetically engineered, and are severely overcooked. The average person's body's pleasure center in their brain has been retrained to prefer a substandard inflammatory diet.

The hormone amylin, which is also a peptide (made up of 32 amino acid residues) is secreted from the beta cells of the pancreas, along with the insulin. Amylin slows the movement of food from the stomach into the small intestine, which slows the rise in blood sugars. Amylin also works with insulin to inhibit the production of glucagon (a hormone) that stimulates the liver to convert glycogen (stored glucose) back into glucose and insert it into the bloodstream. The net result is that the liver will not be increasing the insertion of glucose into the bloodstream at a time when the blood sugars are already too high. Normally, the liver will convert the glycogen back into glucose and insert it into the bloodstream to maintain the blood sugars within the normal range when the blood sugars drop between meals. Amylin controls weight, curbs appetite, and helps regulate blood sugars. Diabetics typically have a deficiency in amylin; by as much as 50%.

Amylin is believed to act primarily centrally, perhaps at the area postrema in the brain stem. The area postrema is the area that controls vomiting, it plays a major role in the central nervous system, including monitoring the blood for sodium and fluid levels. The hypothalamus and the amygdala work together in regulating the basic drives like eating, sleep, and sexual behavior. The amygdala can override the hypothalamus to enhance the reward value of food items, or other stimuli. Their dual role is believed to explain certain addictions, obesity, and sleep disorders.

Adiponectin is a hormone produced in the adipose tissue (belly area) from 147 amino acids. Women naturally have a higher concentration than men. It is deficient in type II diabetics, those with insulin resistance, and those that are obese. It plays an important role in the regulation of circulating glucose and fatty acids in the bloodstream. The deficiency develops when a person becomes obese and plays a significant role in the manifestation of type II diabetes. The level of adiponectin increases during weight loss. Medications that reduce insulin resistance and increase insulin sensitivity increase the blood levels of adiponectin. Adiponectin stimulates the body to use glucose, and to oxidize fatty acids in the bloodstream. It also plays a part in regulating blood pressure and reducing the risk of heart disease.

Weight loss is highly dependent upon an elevated metabolism in order to burn excess fat. Research has learned that leptin triggers the production of aMSH (a peptide)in the hypothalamus. The aMSH protein is one of the most powerful stimulators of an increased metabolism. The aMSH protein stimulates the hypothalamus to produce and release hormones that travel to the pituitary gland, which in turn produces the TSH hormone (thyroid stimulating hormone), which stimulates the thyroid gland to produce more of the T4 and T3 thyroid hormones that boost the metabolism. The T4 hormones are converted into the active form T3. The T3 hormone fires up the cellular mitochondria (furnace) that produces energy. Future weight loss programs will likely focus on ways to promote the production of aMSH. You will learn much more about how diabetes influences weight loss/gain, and thyroid function later.

Hypothalamus and Sexuality

Your hypothalamus controls the production and release of the hormone GnRH (Gonadotropin-Releasing Hormone), which stimulates the pituitary gland to release FSH (Follicle Stimulating Hormone) and LH (Luteinizing Hormone), which work together. They ensure normal functioning of the ovaries and testes. Studies have shown that the higher the blood oxygen level in the hypothalamus of males, the greater their response will be to sexual stimulus, and the associated response.

The primary hormones essential to sexual development and reproductive capability are released on a schedule that is closely associated with sleep. The development of the body, including the ratio of muscle to body mass, is regulated by growth hormones; 95% of which are released during sleep. In some animals, sexual intercourse immediately follows sleep; lying still during sleep favors fertility. Sexual capacity, sexual performance, and efficiency are all enhanced by sleep.

The sex drive is another good example of how much activity in the body that is controlled by the hypothalamus. Even though sexual behavior is regulated by the hypothalamus, the amygdala, and the nucleus accumbens, other parts of the body, such as the spinal cord and some endocrine glands, are also involved. The endocrine glands, such as the testicles in men, ovaries in women, and adrenal glands in both sexes, secrete the sex hormones (sex steroids), such as testosterone, estrogen, and progesterone. While the secretion of the sex hormones is partially influenced by the brain, the hormones also provide feedback to the brain, which has an effect on some brain functions.

The hypothalamus's regulation of sexual behavior is very complex; not fully understood by science. Your sex drive motivates a wide range of planned automatic behaviors, including making eye contact to clothing choices, or the type of car you drive. You can be sexually aroused by a vast array of sensory experiences; simply through your imagination at work. Some people are aroused by other people's feet. Arousal, and the sex act itself, cause the autonomic nervous system to stimulate numerous parts of your anatomy. The experience and its effects are not limited to your genitals, but also reflected by an increased heart rate and breathing, sweating, erect nipples, muscle spasms in various parts of the body, and the pleasure of orgasm.

Research has broadened our understanding of human sexual functioning. You experience a sequence of physiological responses to sexual stimulation. The sexual response cycle is usually divided into four phases:

Desire

Excitement

Orgasm

Resolution

Men typically experience only one orgasm per cycle, while women often experience more than one. Each sex responds to different external erotic stimuli. Men are more visual, while women respond more to romantic stories or tactile stimulation. The frequency and intensity of sexual intercourse varies from individual to individual in both sexes. Personal satisfaction with the quality of sex life is very important, and popular social generalizations about frequency of sexual intercourse do not necessarily apply to everyone.

Sexual behavior is determined by various factors; and is very diverse. Numerous circumstances like relationships, life circumstances, stage of development, and culture play important roles. Sexual behavior may be considered acceptable in one culture, but not acceptable in another (extramarital sex, masturbation, oral sex). Sexual behavior develops continuously throughout your life cycle. Early sexual experience often starts with genital play as an infant, which is a part of normal development. Gender identity ("I am male/female") is typically established by or before the age of 2 or 3. Puberty is marked by a rapid development of secondary sexual characteristics. The ability to engage in sexual intercourse and reproduction is entirely possible. Sexuality peaks by early adulthood, then gradually declines with age. Contrary to popular belief, satisfactory sexual functioning is possible at an advanced age; depending upon a person's health and physical condition.

While sleep appears to be a simpler activity when compared to sex, it has complexities that are only beginning to be understood. There are two states of sleep, which are rapid eye movement (REM) and non-REM (NREM). During REM sleep, a your eyes move quickly back and forth behind your eyelids. Your muscles remain still, but your brain is very active. REM sleep is when most of your dreaming occurs, where your electroencephalograph (EEG) readings of your brain resemble those of an alert person. NREM sleep comes in stages, which includes light dozing to deep, to very sound sleep. Your regular night's sleep includes several hours of both NREM and REM states, coming in cycles. Studies have shown that each of these states serve a vital purpose for your brain.

Sexual functioning can be impaired in two ways. First, there may be a disturbance related to a particular phase of the sexual cycle, or the disturbance can involve unusual objects or activity. The first group of sexual dysfunctions is sexual desire disorders, which is characterized either by a lack of sexual fantasies and desire for sexual activity, or by aversion to, or avoidance of genital contact. Sexual arousal disorders are characterized by the failure to attain or maintain erection in men, or a failure to attain or maintain lubrication in women. Orgasm disorders include a recurrent delay or inability to achieve orgasm, or in men, an inability to achieve ejaculation (or the so-called premature ejaculation); another dysfunction includes painful sex. The second group (called paraphilia) involves unusual fantasies, urges, or practices like exposing oneself (flashing), sex with minors, sadistic sex, and so on. Homosexuality is neither considered a dysfunction, nor abnormal behavior.

People sometimes experience sexual dysfunctions that have no detectable or obvious cause or that may result from a medical condition, like diabetes mellitus, prostate surgery, trauma, substance abuse (chronic abuse of alcohol and other drugs), medications (for hypertension, depression, heart conditions, and others), or psychological problems which is due to a conflict with a partner, depression, or anxiety.

Healthy sexual function requires good physical health and a good relationship with a partner. Sexual dysfunction can be caused by obesity, lack of physical stamina, illnesses, chronic exhaustion, smoking, substance abuse, or chronic conflict. A healthy diet, adequate exercise, and a healthy lifestyle help maintain a healthy satisfying sexual life. There are various misconceptions about sex that can hamper sexual functioning further. The best approach to treating an impairment of sexual functioning is to discuss it with a doctor, complete a physical examination along with laboratory tests, to help reveal the underlying cause(s). Do not self-treat with over-the-counter substances; they are mostly of unproven efficacy or could be dangerous.

As stated, the sex hormones are estrogen and testosterone, which are basically chemical messengers that direct sexual function. Again, both men and women produce both hormones, but in different ratios. They act in two ways;

Centrally, which determines the amount of change in arousal that is produced by a stimulus.

Peripherally, which determines the amount of receptor responses to the stimulus.

Your hypothalamus controls both hormones, which in turn, regulates sexuality. The primary difference between individuals is their differing personal experiences, and cultural aspects, not so much as hormones. The hormones are produced based upon the stimulating circumstances. The hypothalamus stimulates the pituitary gland to release the hormones. The sexual drive will be proportional to the amount of the hormones released. These hormones stimulate the sexual organs, including the ovaries to produce eggs and estrogen. The hormones make feedback loops to the brain and develop sexual characteristics that distinguish males from females.

The feedback controls the production of gonadal hormones. The hypothalamus stimulates the hypophysis to release a hormone into the bloodstream that circulates to the ovary or testis, which are thereby stimulated to release the gonadal hormone into the bloodstream. The gonadal hormone is detected by the pituitary gland and the hypothalamus, which then inhibit the release of additional hormones. Testosterone is produced by the testis.

# Chapter 10-End Notes

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Hopefully, from all of this you have learned that diabetes sets up the conditions that promote and cause heart attacks and strokes to occur. You learned that you could be one of the 9 out of 10 diabetics that die from heart disease or stroke; However you can remove your name from the list of those that will die due to the diabetes related causes of heart disease. The choice is yours.

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# About the Author

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Thomas Nelson was diagnosed type II in 1996. He became frustrated with the lack of information provided by his doctors; so he began researching diabetes and has been conducting research on diabetes ever since. After realizing how valuable his research would be to other diabetics he began publishing his findings. He has published over 50 articles on diabetes, written two books on diabetes; his first was published March 2011-Diabetic's Handbook 853 pages. He has a number of other books in the process of completion.

Thomas devotes most of his time helping diabetics. He volunteers as an instructor for courses on diabetes in his community. He conducts free diabetes courses via email, and he serves as a volunteer administrator on two diabetes forums. Doctors in his community hand out copies of his writing to their diabetic patients. He has helped many diabetes educators learn about the proper use of glycemic index and understand other important self-treatment topics. He is considered by many to be an expert on diabetes. He has helped thousands of diabetics gain control over their disease and stop the progression of diabetes.

Thomas lives in Central Florida with his wife and family. He has three degrees, AAS Mechanical Engineering, Bachelor of Science-Business Administration-Magna Cum-Laude, and an MBA-Business Administration

Contact the Author-Thomas E Nelson

Facebook thomas.nelson.77377@facebook.com

Twitter- Thomas E Nelson@Cobra426

Website-http://www.diabeticshandbook.com

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# Other Books by the Same Author

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Title 1-Diabetic's Handbook-853 pages-A complete reference guide for diabetics. Available in print and ebook versions on various online book seller's websites. ISBN -10: 1456034537, ISBN-13: 978-1456034535

Title 2-Diabetes Control-6 Steps to Gaining Complete Control over Diabetes ASIN: B0050V80JC Smashwords ISBN: 9781301929122

Title 3-Diabetes Control-Diagnosing and Treating Hypothyroidism, Candida (yeast-fungi), and Parasites- ISBN: 9781301792993

Title 4-Diabetes Control-Preventing Heart Disease and Stroke Naturally- ISBN: 9781301403516

Title 5-Diabetes Control-How to Lower Blood Pressure Naturally-

Title 6-Diabetes Control -How to Lower Cholesterol Naturally-ISBN: 9781301936335

Title 7-Diabetes Control- How to Lower Triglycerides Naturally- ISBN: 9781301284269

Title 8-Diabetes Control- How to Lose Stubborn Diabetic Belly Fat-Permanently- ISBN: 9781301749577

Title 9- A Prediabetic's Guide to Stopping the Progression of Diabetes - ISBN: 9781301024193

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