Category Archives: Heart Health and Diabetes

Fats are not all bad for your health. In fact, fats can be thought of as “the good, the bad, and the ugly”.

Why do we need fats in our diet?
Dietary fats are an essential part of a healthy diet. They provide us with essential fatty acids, which the body is unable to synthesize itself. We need fats for energy, to protect our organs, and to help keep us warm. Fats are needed to absorb some nutrients (e.g., fat-soluble vitamins like vitamin A, vitamin D, and vitamin E) and they are important for proper cell structure and function, blood clotting, muscle movement, inflammation, and the production of many important hormones (1, 2).

What are the different types of fat?
There are four major dietary fats in food (1). The “good fats” are monounsaturated and polyunsaturated fats, the “bad fats” are saturated fats, and the “ugly fats” are trans fats.

These different types of fats all have nine calories in every gram of fat, while carbohydrates and proteins contain four calories per gram. If you consume too many calories, regardless of the source (good fat, bad fat, protein, or carb), it can lead to weight gain. But if you consume high levels of “the bad” and “the ugly” fats, you also increase your risk of heart disease and stroke. This is because these fats raise bad LDL cholesterol levels (1). For more information about LDL cholesterol, see our previous article “Bad” versus “good” cholesterol.

The different types of fats have different structures, which is why some fats (the good ones) are liquid at room temperature, while the bad ones are solid at room temperature (2). It is all to do with the bond formation between the carbons in the fats (3).

• Unsaturated fats contain one (mono-) or more (poly-) double cis bonds, therefore they can’t bind to as many hydrogen atoms and there is a bend at each double cis bond.
• Saturated fats contain only single bonds, therefore the carbon atoms are bound to as many hydrogen atoms as possible (i.e. they are saturated with hydrogens).
• Trans fats are also unsaturated but the double bond is a trans bond (instead of a cis bond). This results in a straight chain (rather than a bent chain like the unsaturated fats).

This article focuses on “the good” monounsaturated and polyunsaturated fats.

Monounsaturated fats
Good sources of monounsaturated fats include:

• Olive oil
• Peanut oil
• Canola oil
• Avocadoes
• Most nuts

The Mediterranean diet is a diet that is high in monounsaturated fats (olive oil) and is associated with a low rate of heart disease, despite being a somewhat high-fat diet (2).

Polyunsaturated fats
Polyunsaturated fats are essential fats, which means they are required for normal functions (e.g., making cell membranes) but the body is unable to produce them so must obtain them from dietary sources. The two main types of polyunsaturated fats are omega-3 fatty acids and omega-6 fatty acids (2).

Omega-3 fatty acids have a wide range of health benefits, including reducing blood pressure, raising good HDL cholesterol, and lowering triglycerides–all things that help prevent heart disease and stroke (2). Good sources of omega-3 fatty acids include:

• Salmon
• Sardines
• Flaxseeds
• Walnuts
• Canola oil

Omega-6 fatty acids also offer protection from heart disease (2). Good sources of omega-6 fatty acids include:

• Safflower oil
• Soybean oil
• Sunflower oil
• Corn oil

The “bad fats” and the “ugly fats”
Saturated “bad fats” are common in the American diet and are found in red meat, whole milk, cheese, coconut oil, and many commercially prepared foods. A diet high in saturated fats is associated with higher cholesterol levels, particularly increased bad LDL cholesterol levels, which increase the risk of atherosclerosis and heart disease. Most experts recommend limiting saturated fats to under 10% of calories a day (2), with the American Heart Association recommending just 5-6% of calories from saturated fats (4).

See our previous article here for more information about atherosclerosis.

Trans fats are the worst type of fat. Some trans fats are naturally occurring (from some animal products), while other trans fats are produced artificially by adding hydrogen to liquid vegetable oils to make them more solid. Trans fats raise bad LDL cholesterol, lower good HDL cholesterol, and are associated with a significantly increased risk of heart disease and stroke, as well as an increased risk of type 2 diabetes (5).

How can I check my cholesterol levels?
We offer a range of at-home tests for checking the impact of your diet on your cholesterol levels. See the Related Tests section at the bottom for all the tests that we have available. Each of these tests just requires a tiny blood sample from a self-collected finger-prick. No need to make a doctor’s appointment for sample collection and your results are available online as soon as testing is complete.

References:
1. Dietary Fats. (Reviewed Nov 2021). American Heart Association.
2. The truth about fats: the good, the bad, and the in-between. (Dec 2019). Harvard Health Publishing, Harvard Medical School.
3. Marchand V. (2010). Trans fats: What physicians should know. Paediatr Child Health. 15(6): 373-375.
4. Saturated Fat. (Reviewed Nov 2021). American Heart Association.
5. Trans Fats. (Reviewed March 2017). American Heart Association.

Maybe you want to keep your cholesterol at a healthy level but you are a bit confused about what to eat and what not to eat. In this article, we briefly discuss what cholesterol actually is, why you should limit your cholesterol intake, and cholesterol content in common foods.

What is cholesterol?
Cholesterol is a waxy type of fat (lipid), which travels around the body in the blood. It is an essential molecule, as it is required for building cells, producing bile for digestion, and making vitamins and hormones. Cholesterol is produced in adequate quantities in the liver, but can also be obtained from foods from animals (1).

Why should you limit your cholesterol intake?
There are both “bad” and “good” forms of cholesterol, referring to how the cholesterol is packaged to move around the body. “Bad” LDL cholesterol is what gets deposited in blood vessel walls and increases the risk of heart disease. “Good” HDL cholesterol is the cholesterol that has been scavenged from around the body and is getting delivered back to the liver for recycling and excretion (2).

For more information about the different types of cholesterol, see our previous article “Bad” versus “good” cholesterol.

Keeping your cholesterol at healthy levels is very important for good cardiovascular health, but there are also other factors that can influence the risk of heart disease. See our article “What are the risk factors for heart disease?”

How much cholesterol should I consume?
If you have risk factors for heart disease (e.g., high blood pressure, high cholesterol, obesity, and diabetes), it is important to limit your cholesterol intake to 200 mg or less per day. If you do not have any risk factors, an intake of up to 300 mg per day is acceptable (3).

What common foods are high in cholesterol?
Cholesterol is only found in animal foods, while fruits, vegetables, grains, and all other plant foods do not contain any cholesterol (3). So let’s go over a few common animal foods that contain quite a lot of cholesterol, and also alternatives that are a good choice to reduce cholesterol intake.

• Whole milk: 1 cup has 33 mg cholesterol. But if you choose a low-fat or non-fat option, you can cut your intake to just 10 mg or 4 mg, respectively.
• Yogurt: 1 cup has 29 mg cholesterol. Once again, a non-fat option is a lot healthier, containing only 10 mg.
• Cheddar cheese: 1 oz has 30 mg cholesterol. Consider choosing low-fat cottage cheese instead for just 10 mg in 1 cup.
• Butter: 1 teaspoon has 11 mg cholesterol, but the same quantity of vegetable oil doesn’t contain any cholesterol.
• Eggs: 1 egg contains approximately 212 mg of cholesterol, but research has shown that cholesterol from eggs doesn’t increase blood cholesterol levels the same as other animal foods. In fact, many studies have shown that an egg a day does not increase the risk of heart disease for most people. Although, egg intake should be limited to three per week for those with other heart disease risk factors or who already have heart disease (4).
• Meats:
  • Ground beef: 3.5 oz has 78 mg cholesterol.
  • Porkchop: 3.5 oz has 85 mg cholesterol.
  • Chicken (without skin): 3.5 oz has 85 mg cholesterol.
  • Lamb (foreshank): 3.5 oz has 106 mg cholesterol.
• Fish:
  • Salmon: 3.5 oz has 63 mg cholesterol
  • Tuna (in water): 3.5 oz has 30 mg cholesterol
• Consider other protein options to reduce your cholesterol intake, such as tofu and pinto beans, which don’t contain any cholesterol.

What are ways to reduce cholesterol?
Obviously reducing your consumption of animal foods can reduce blood cholesterol levels. Other options include increasing your fiber intake, limiting carbohydrate, alcohol, and fat intake, losing weight, increasing your physical activity, and abstaining from smoking (5).

How can I measure my cholesterol levels?
We offer a range of tests to measure your cholesterol levels, and each test just requires a tiny blood sample self-collected from a simple finger-prick.

• Cholesterol, Total
• High-Density Lipoprotein (HDL) Cholesterol
• Low-Density Lipoprotein (LDL) Cholesterol
• Lipid Panel (Heart Health)
• Lipid Panel (Heart Health) with hsCRP (Inflammation Assessment)
• Lipid Panel (Heart Health) with hsCRP (Inflammation Assessment) and HbA1c (Diabetes Risk Assessment)

References:
1. What is Cholesterol? American Heart Association. (2020).
2. HDL (Good), LDL (Bad) Cholesterol and Triglycerides. American Heart Association. (2020).
3. Cholesterol Content of Foods, Patient Education. UCSF Health.
4. Are eggs risky for heart health? (June 2019). Harvard Health Publishing, Harvard Medical School.
5. LDL and HDL Cholesterol: “Bad” and “Good” Cholesterol. CDC. Reviewed Jan 2020.

Type 2 diabetes is by far the most common form of diabetes, accounting for 90–95% of all diabetics. Type 2 diabetics cannot use insulin efficiently and therefore cannot keep their blood sugar at normal levels.

For more information about type 2 diabetes, see “Type 2 Diabetes Quick Facts“. In this article, we discuss in more detail the factors that are associated with an increased risk of type 2 diabetes.

Obesity and fat distribution
People who are carrying excess body weight have a higher risk of type 2 diabetes. This is especially true if that extra fat is predominantly around in the abdomen (1). Obesity is classed as having a body mass index (BMI) of 30 or more, but even individuals with a BMI of 25–29.9 (overweight) are still at risk of type 2 diabetes. Calculate your BMI using this simple online calculator to see if you should lose a few pounds.

Family history of type 2 diabetes
A family history of type 2 diabetes is associated with an increased risk of disease, partly due to inherited genetic variants and also related to lifestyle influences (e.g., eating and exercise habits). There is no clear pattern of inheritance for type 2 diabetes because multiple different genetic variants all play a role (2).

High blood pressure
High blood pressure is linked to an increased risk of type 2 diabetes. Having type 2 diabetes is also linked to an increased risk of high blood pressure. The combination of both type 2 diabetes and high blood pressure significantly increases the risk of diabetic complications as well as cardiovascular health issues (3).

Altered lipid levels
Low levels of “good” HDL cholesterol and high levels of triglycerides are associated with an increased risk of type 2 diabetes. This increased risk occurs even when there are normal levels of “bad” LDL cholesterol (4).

Lack of physical activity
Physical activity is important for maintaining a healthy weight, using up extra glucose, and increasing cell responses to insulin. Therefore, those that are not getting enough exercise are at increased risk of type 2 diabetes, by not only increasing their risk of obesity but also influencing how their body responds to insulin (5).

Smoking
Smokers are 30–40% more likely to develop type 2 diabetes compared to non-smokers. High levels of nicotine can lessen the effects of insulin, meaning that smokers have to produce more insulin to get a proper response (6). Smoking is also associated with a higher likelihood of the serious health complications of diabetes, including heart disease, kidney disease, infections, ulcers, and eye problems (7).

Gestational diabetes
Gestational diabetes is a type of diabetes that develops during pregnancy, but blood sugar levels usually return to normal after delivery. However, about 50% of women with gestational diabetes go on to develop type 2 diabetes later in life. Gestational diabetes also increases the risk of the baby developing type 2 diabetes later in life too (8).

Prediabetes
A diagnosis of prediabetes means blood sugar (glucose) levels are above the normal range but are not considered high enough to be diabetes. However, prediabetes is taking a step in the wrong direction in regards to metabolic health. People with prediabetes have an increased risk of developing type 2 diabetes. The good news is, prediabetes can be reversed before developing any health complications associated with diabetes. See our previous article here for more information about prediabetes.

Race and ethnicity
People of certain races and ethnicities have an increased risk of type 2 diabetes, although the reasoning for this increased risk is still not fully understood. Races and ethnicities with an increased risk include African American, Alaska Native, American Indian, Asian American, Hispanic/Latino, Native Hawaiian, and Pacific Islander (1).

Age
Type 2 diabetes develops over many years, as the body struggles more and more to control the high level of glucose in the blood, combined with increasing insulin resistance as well as impaired pancreatic islet function with aging. The pancreatic islet cells are where insulin, the hormone that controls blood sugar, is produced. Therefore, increasing age is associated with an increased risk of type 2 diabetes, particularly after 45 years of age (9).

Polycystic ovary syndrome
Polycystic ovary syndrome (PCOS) is a common cause of female infertility. Affected women may have elevated androgen levels (hyperandrogenemia) and/or small cysts on one or both ovaries (polycystic ovaries) (10). Women with PCOS are often insulin resistant, meaning that their body is not effectively using insulin. This increases the risk of type 2 diabetes, with more than half of women with PCOS developing type 2 diabetes by 40 years of age (11). See our previous article here for more information about PCOS.

Depression
Depression is a risk factor for type 2 diabetes, with comparable importance to smoking and physical inactivity (12). Studies have also shown that more severe depression is associated with a higher risk of type 2 diabetes. In addition, type 2 diabetics have an increased risk of depression (13).

Areas of darkened skin
Areas of darkened skin, known as acanthosis nigricans, are a strong predictor for future diabetes. This is because excess insulin stimulates normal skin cells to reproduce at a rapid rate and these new skin cells contain more melanin so appear darker than the surrounding skin (14).

How is type 2 diabetes diagnosed?
Type 2 diabetes is diagnosed by measuring blood sugar (glucose) levels. The most effective method for this is with an HbA1c test, which is available here. HbA1c is glycated hemoglobin. It forms when hemoglobin within red blood cells joins with glucose. HbA1c levels reflect the average blood glucose level during the preceding 2-3 months. This differs from a blood glucose test, which measures the concentration of glucose at only the point at which the blood sample was collected.

• Healthy HbA1c levels are less than 5.7%
• 5.7% – 6.4% indicates prediabetes (increased risk of developing diabetes)
• >6.5% supports a diabetes diagnosis

How can type 2 diabetes be prevented and treated?
Simple, proven lifestyle changes can help prevent or delay the onset of type 2 diabetes. These include losing excess body weight, eating healthier (especially reducing sugar and carbohydrate intake), and getting regular physical exercise. There are also different medication options available to help lower blood sugar levels. Read our previous article here for more tips to lower your blood sugar.

References:
1. Risk Factors for Type 2 Diabetes. (Reviewed Dec 2016). NIH, National Institute of Diabetes and Digestive and Kidney Diseases.
2. Ali O. (2013). Genetics of type 2 diabetes. World J Diabetes. 4(4): 114-123.
3. Golden SH, et al. (2003). Blood pressure in young adulthood and the risk of type 2 diabetes in middle age. Diabetes Care. 26(4): 1110–1115.
4. Krauss RM. (2004). Lipids and lipoproteins in patients with type 2 diabetes. Diabetes Care. 27(6): 1496–1504.
5. Venkatasamy VV, et al. (2013). Effect of physical activity on insulin resistance, inflammation and oxidative stress in diabetes mellitus. J Clin Diagn Res. 7(8): 1764–1766.
6. Cigarette smoking: A risk factor for type 2 diabetes. FDA.
7. Smoking and Diabetes. (Reviewed August 2021). CDC.
8. Gestational Diabetes. (Reviewed August 2021). CDC.
9. Kirkman MS, et al. (2012). Diabetes in older adults. Diabetes Care. 35(12): 2650–2664.
10. Ndefo UA et al. (2013) Polycystic Ovary Syndrome. Pharmacy and Therapeutics. 38(6): 348-355.
11. PCOS (Polycystic Ovary Syndrome) and Diabetes. (Reviewed March 2020). CDC.
12. Knol MJ et al. (2006) Depression as a risk factor for the onset of type 2 diabetes mellitus. A meta-analysis. Diabetologia. 49: 837–845.
13. Deleskog A, et al. (2019). Severity of depression, anxious distress and the risk of type 2 diabetes – a population-based cohort study in Sweden. BMC Public Health. 19, 1174.
14. Barwell J, Reviewed by Cobb C. (2019). Acanthosis Nigricans. Healthline.

Diabetes is a disorder that occurs when the pancreas is no longer able to make sufficient insulin, or when the body cannot make good use of the insulin it produces. This inhibits the control of blood glucose (sugar) levels and leads to raised blood glucose (hyperglycemia), which causes damage to various tissues and organs in the body.

What exactly is insulin?
Insulin is an essential hormone (messenger molecule) normally produced by the beta cells in the pancreas. It controls the amount of glucose in the bloodstream, helps move that glucose into the liver, fat, and muscles, and regulates the metabolism of carbohydrates, fats, and proteins (1).

What happens if there is not enough insulin?
When the body doesn’t produce enough insulin (or the cells do not respond properly to the available insulin), blood glucose levels increase. The cells around the body also don’t receive the energy that they would normally obtain from blood glucose, so fatigue and weakness can occur. Weight loss may also occur if the body seeks energy from other tissues instead (e.g., fat and muscle) (2).

How do insulin production and response differ in type 1 and type 2 diabetes?
Type 1 diabetics cannot produce insulin, so that essential hormone is absent and there is no control of blood glucose levels. Type 1 diabetes is due to an autoimmune reaction that targets the body’s own insulin-producing cells in the pancreas.

Type 2 diabetics can produce insulin but cannot use it efficiently, so blood glucose levels are not controlled properly. Type 2 diabetes is commonly caused by lifestyle factors, such as obesity, inactivity, smoking, and high cholesterol (3).

Are the symptoms the type 1 and type 2 diabetes the same?
Yes, generally the same symptoms occur in both types of diabetes. Symptoms can include:

• Frequently very thirsty and hungry
• Frequent urination
• Fatigue
• Blurry vision
• Cuts or sores that don’t heal properly or take a long time to heal
• Mood changes
• Numbness and tingling in hands and feet

When do symptoms appear?
Although type 1 and type 2 diabetics share the same symptoms, the onset of these symptoms varies a lot. Symptoms in a type 1 diabetic usually develop quickly, over just a few weeks, with symptoms usually appearing in childhood or adolescence. In contrast, type 2 diabetics develop symptoms over many years (usually in adulthood), or they may not even experience any noticeable symptoms until other health complications occur (4).

Are type 1 and type 2 diabetes caused by the same factors?
No, the causes are quite different.

Type 1 diabetes occurs due to an aberrant immune response. Basically, the body’s own immune cells target and destroy the insulin-producing beta cells in the pancreas. These are the only cells in the body that can produce insulin, so when they are destroyed, there is a complete absence of insulin production (5). The underlying cause of this aberrant immune response is not fully understood. It could be due to genetic factors and environmental factors, such as exposure to a virus that affects how the immune system responds.

Type 2 diabetes is predominantly caused by lifestyle factors, with some genetic variation also playing a role in the risk of this common disorder. Lifestyle factors that increase the risk of type 2 diabetes include obesity, high blood pressure, alter lipid levels (e.g., high LDL “bad” cholesterol), lack of physical activity, and smoking (3).

How common are type 1 and type 2 diabetes?
Type 2 diabetes is much more common than type 1 diabetes. Type 2 diabetes accounts for 90–95% of all diabetics, which in the United States equates to 30–32.5 million people! And there are another 88 million adults in the United States who have prediabetes, which is when blood glucose is higher than normal but not as high as a diabetic. Prediabetes can be thought of as the first step down the path to type 2 diabetes (6).

How are type 1 and type 2 diabetes diagnosed?
The same blood tests are used for the diagnosis of both type 1 and type 2 diabetes. An HbA1c test is commonly used. This test measures your levels of glycated hemoglobin, which provides an average blood glucose level for the previous 2–3 months. We offer an HbA1c test from a small blood sample collected from a self-collected finger prick. More information about our HbA1c test is also available here.

Alternatively, a blood glucose test can be taken. A blood sample for a glucose test is commonly collected after a period of fasting (usually overnight). We offer a blood glucose test here.

References:
1. Jaffe L & Hess-Fischl A. (Updated October 2021). What is insulin? Endocrine Web.
2. What is insulin? (Updated Nov 2018) Hormone Health Network.
3. What causes diabetes? Find out and take control. American Diabetes Association.
4. Diabetes Symptoms. CDC. April 2021.
5. What is Diabetes. CDC. June 2020.
6. National Diabetes Statistics Report, 2020. CDC. Reviewed August 2020.

A diagnosis of prediabetes means that you have blood sugar (glucose) levels that are above the normal range but are not considered high enough to be diabetes. However, prediabetes is taking a step in the wrong direction in regards to metabolic health. People with prediabetes have an increased risk of developing type 2 diabetes. The good news is, prediabetes can be reversed before developing any health complications associated with diabetes.

How is prediabetes diagnosed?
Prediabetes is diagnosed by measuring blood glucose levels. The most common test is an HbA1c test, which is available here. This test provides an average blood glucose level for the preceding 2–3 months. An HbA1c test result of 5.7–6.4% is classified as prediabetes (1). For more information about HbA1c testing, see our previous article here.

Prediabetes can also be diagnosed by a glucose test (available here). However, this test often requires fasting (an HbA1c test doesn’t) and only provides a blood glucose level for the specific time that the blood sample was collected. Blood glucose levels fluctuate throughout the day and are dependent on recent food consumption and exercise etc., so a blood glucose test does not provide the same average blood glucose level as the HbA1c test (2). A fasting blood glucose test result of 100–125 mg/dL is indicative of prediabetes (3).

Does prediabetes cause any symptoms?
There are no clear symptoms of prediabetes, which is why many people are unaware of their diagnosis. In fact, more than 84% of approximately 88 million prediabetic American adults do not know that they have prediabetes (4).

What increases the risk of prediabetes?
Several factors increase the risk of prediabetes and type 2 diabetes (2), including:

• Obesity
• Family history of type 2 diabetes
• High blood pressure
• Altered lipid levels (e.g., elevated LDL “bad” cholesterol)
• Lack of physical activity
• Smoking
• Previously had gestational diabetes

How can I reduce my blood sugar back to normal healthy levels?
If you are overweight, losing even just a small amount of weight (5–7% of your body weight) is beneficial. Combing this weight loss with regular physical activity (150 minutes a week) is the best approach to lower blood glucose levels and reduce the risk of developing type 2 diabetes (4). Read our previous article here for more tips for lowering high blood glucose.

Should I get regular blood sugar tests?
The CDC recommends people over the age of 45 should get screened for diabetes and prediabetes. An HbA1c test is the most informative and convenient test for this screening. People who have normal HbA1c values (<5.7%) usually don’t need to be screened again for three years, while those with prediabetes levels (5.7-6.4%) should be tested again in 1-2 years (1).

People under 45 years with certain risk factors may also need to take an HbA1c test. These risk factors include begin overweight or obese, high blood pressure, history of heart disease, and physical inactivity (1).

References:
1. All About Your A1C. CDC. (Reviewed August 2021)
2. Fonseca V, Inzucchi SE, Ferrannini E. (2009). Redefining the diagnosis of diabetes using glycated hemoglobin. Diabetes Care. 32(7), 1344- 1345.
3. Diabetes Tests. CDC. Reviewed August 2021.
4. Prediabetes – Your chance to prevent type 2 diabetes. CDC. Reviewed June 2020.

What is type 2 diabetes?
Diabetes is a metabolic disorder that occurs when the pancreas is no longer able to make sufficient insulin, or when the body cannot make good use of the insulin it produces. This inhibits the control of blood glucose (sugar) levels and leads to raised blood glucose (hyperglycemia), which causes damage to various tissues and organs in the body.

Type 2 diabetes is by far the most common form of diabetes, accounting for 90–95% of all diabetics. Type 2 diabetics cannot use insulin efficiently and therefore cannot keep their blood sugar at normal levels. This form of diabetes develops over many years and is usually diagnosed in adulthood, although it is becoming a more frequent diagnosis in children and teens (1).

Other forms of diabetes are type 1 diabetes and gestational diabetes. Type 1 diabetes occurs due to an autoimmune reaction that targets the body’s own insulin-producing cells in the pancreas. It usually develops quickly and is often diagnosed during childhood or the teenage years. Gestational diabetes develops in pregnant women and is associated with health risks for the unborn baby, as well as an increased risk of developing type 2 diabetes later in life for both the mother and child (1).

What are the signs of type 2 diabetes?
The symptoms of type 2 diabetes can slowly develop over several years, while some type 2 diabetics may not notice any signs at all (2). If symptoms are present, they can include:

• Increased frequency and need for urination
• Often thirsty
• Often hungry
• Fatigue
• Increased frequency of infections, e.g., yeast infections

What increases the risk of type 2 diabetes?
Type 2 diabetes is caused by your cells in the body not responding well to insulin. The pancreas increases insulin production to try to overcome this, but eventually, it cannot produce enough insulin, and blood sugar rises.

Several factors increase the risk of type 2 diabetes (3), including:

• Obesity
• Family history of type 2 diabetes
• High blood pressure
• Altered lipid levels (e.g., elevated LDL “bad” cholesterol)
• Lack of physical activity
• Smoking
• Previously had gestational diabetes 

How is type 2 diabetes diagnosed?
Type 2 diabetes is diagnosed by measuring blood sugar (glucose) levels. The most effective method for this is with an HbA1c test, which is available here (4). HbA1c is glycated hemoglobin. It forms when hemoglobin within red blood cells joins with glucose. HbA1c levels reflect the average blood glucose level during the preceding 2-3 months. This differs from a blood glucose test, which measures the concentration of glucose at only the point at which the blood sample was collected.

• Healthy HbA1c levels are less than 5.7%
• 5.7% – 6.4% indicates prediabetes (increased risk of developing diabetes)
• >6.5% supports a diabetes diagnosis

How can type 2 diabetes be prevented and treated?
Simple, proven lifestyle changes can help prevent or delay the onset of type 2 diabetes. These include losing excess body weight, eating healthier (especially reducing sugar and carbohydrate intake), and getting regular physical exercise. There are also different medication options available to help lower blood sugar levels. Read our previous article here for more tips to lower your blood sugar.

References:
1. What is Diabetes. CDC. June 2020.
2. Diabetes Symptoms. CDC. April 2021.
3. What causes diabetes? Find out and take control. American Diabetes Association.
4. Manage Blood Sugar, Diabetes. CDC. Reviewed April 2021.

High blood sugar is also known as high blood glucose and hyperglycemia. Glucose is required by the body for energy and blood glucose levels are usually controlled by insulin, a hormone produced by the pancreas. However, when the body isn’t properly using insulin or is unable to make enough insulin, blood glucose levels can increase to dangerous levels (1).

High blood sugar is what occurs in diabetic people. Type 1 diabetics are unable to make insulin, while type 2 diabetics may have insulin resistance (their cells don’t respond properly to the insulin) or they may not be producing enough insulin (1).

What blood sugar levels are unhealthy?
There are different ways to measure blood glucose levels. A glucose test measures the levels of glucose in the blood at the specific time the blood sample was collected. If the sample is taken in a fasting stage (no food for the previous eight hours), healthy levels are < 100 mg/dL, while 100–125 mg/dL indicates prediabetes and ≥ 126 mg/dL indicates diabetes (2).

The hemoglobin (Hb) A1c test is another way to measure blood glucose levels. It provides an average blood glucose level for the preceding 2-3 months. This provides a better understanding of where your blood glucose levels are at over an extended period. HbA1c tests also have the distinct advantage of not requiring fasting. Normal HbA1c values are <5.7%, while 5.7–6.4% indicates prediabetes and ≥ 6.5% is supportive of a diabetes diagnosis (3).

Steps to lower high blood glucose
A combination of diet, exercise, and medication can lower blood glucose levels.

Let us first focus on the recommended dietary changes to help keep blood glucose at a healthy level (4).

• Limit sugar intake. Choose water to drink instead of juice or soda, and snack on a piece of fruit rather than a sweet treat.
• Limit carbohydrate intake. Carbs (e.g., pasta and bread) cause blood sugar to rise more than eating an equivalent amount of proteins or fats.
• Limit alcohol intake.
• Eat plenty of vegetables, fruits, and whole grains. Non-starchy vegetables (e.g., broccoli, carrots, spinach) keep you feeling full for longer, provide lots of nutrients, and have fewer calories and carbs. Fruits are also loaded with vitamins, minerals, and fiber, and can help satisfy that sweet tooth without added sugar. Whole grains are a great source of fiber and lots of other beneficial nutrients.
• Control your food portions, such as following the Plate Method. 

Are there any “superfoods” for lowering and controlling blood sugar?
According to the American Diabetes Association, there are several “diabetes superstar foods” (5).

• Kidney, pinto, or black beans are high in fiber and full of important vitamins and minerals.
• Dark green leafy vegetables (e.g., spinach, collards, and kale) are low in calories and carbs, but high in lots of vitamins and minerals.
• Citrus fruits are excellent sources of vitamin C, folate, potassium, and fiber.
• Berries are tasty treats that can not only satisfy a sweet tooth craving, but also provide lots of antioxidants, vitamins, and fiber.
• Tomatoes provide lots of vitamin C, vitamin E, and potassium.
• Fatty fish (e.g., salmon) are an excellent source of healthy omega-3 fatty acids.
• Nuts are another excellent source of healthy fats, as well as magnesium and fiber.
• Whole grains (e.g., whole oats and quinoa) provide lots of fiber as well as vitamins and minerals.
• Milk and yogurt are good sources of calcium as well as vitamin D (in fortified products). Just make sure to choose options that are low in fat and added sugar.

Exercise is also important for controlling blood sugar
Regular physical exercise is essential for maintaining healthy blood sugar levels. When you are active, insulin is able to signal to your cells more efficiently to stimulate glucose uptake from the blood and lower your blood glucose levels (6).

And there is no need to sign up for a marathon (although no harm in that either!). Any exercise is better than nothing. Start small with a walk around the block and build from there. Go out dancing or swimming, even doing some housework can be exercise! The main aim is to consistently get some physical activity (20-25 minutes each day) to help control your blood sugar, weight, and improve your overall health.

An important thing to note is that very high blood sugar (above 240 mg/dL) can actually make physical exercise dangerous. People with values this high should check their urine for ketones before exercising, and consult with their health care professional about other ways to safely lower blood sugar (7).

Medication options for controlling blood glucose
There are different types of medications that are available to lower blood sugar levels. We won’t go into the details here, as this is something that you need to discuss with your health care professional, but they each work in different ways to maintain healthy blood sugar levels. For example, alpha-glucosidase inhibitors block the breakdown of dietary starches and slow the breakdown of some sugars to slow the rise in blood sugar that occurs after a meal, biguanides (e.g., metformin) decrease the amount of glucose produced by the liver, and meglitinides (e.g., Starlix) stimulate the pancreas to release more insulin (8).

References:
1. Hyperglycemia: What Is High Blood Sugar? Endocrine Web. Updated June 2021.
2. Diabetes Tests, Diabetes. CDC. Reviewed August 2021.
3. Understanding A1C. American Diabetes Association.
4. Manage Blood Sugar, Diabetes. CDC. Reviewed April 2021.
5. What superstar foods are good for diabetes? American Diabetes Association.
6. It’s a great time to get moving. Fitness. American Diabetes Association.
7. Get Active. Diabetes. CDC. Reviewed May 2021.
8. Oral Medication. What are my options? American Diabetes Association.

Your test results came back stating that you have high cholesterol? What does this mean? And what foods should you avoid to improve your heart health?

What does a high cholesterol result mean?
Cholesterol is a waxy type of fat (lipid), which travels around the body in the blood. It is an essential molecule, as it is required for building cells, producing bile for digestion, and making vitamins and hormones. But when cholesterol is elevated, it increases the risk of cardiovascular issues.

The desirable range for cholesterol in adults is < 200 mg/dL, while 200–239 mg/dL is considered borderline high, and ≥ 240 mg/dL is an unhealthy high cholesterol reading (1).

For children, desirable levels are below 170 mg/mL, borderline high is 170–199 mg/dL, and ≥ 200 mg/dL is unhealthy (2).

How can you lower your high cholesterol?
A combination of losing weight, diet, and exercise is beneficial for improving your cholesterol. Changes include increasing fiber intake, limiting carbohydrate, alcohol, and fat intake, and choosing healthier unsaturated fats instead of saturated and trans fats. Abstaining from smoking and exercising for at least 30 minutes each day is also beneficial (3).

What are specific foods that you should be avoiding or limiting?
The biggest dietary contributors to elevated cholesterol are saturated fats and trans fats. The American Heart Association recommends limiting saturated fat to less than 6% of daily calories (4). This means you should limit your intake of animal products, such as full-fat dairy products and red meats, tropical oils (e.g., palm and coconut oils), cakes, and biscuits.

Trans fats are also naturally found in some animal products, while artificial trans fats can be found in hydrogenated fat, which is in some processed foods.

Limiting your intake of added sugars, salt, and alcohol is also important. Men should have no more than two drinks per day, and women should have no more than one (5).

What foods should you eat instead?
Fats are important in our diet, as they are needed for energy, supporting cell growth, protecting our organs, keeping us warm, absorption of some nutrients (e.g., fat-soluble vitamins), and hormone production (6). So going completely fat-free is not a good idea.

However, there are good and bad fats. The bad ones are saturated and trans fats, which can raise “bad” LDL cholesterol levels in your blood. So, we want to limit those ones.

But there are also good fats – monounsaturated and polyunsaturated fats. These ones can actually lower “bad” cholesterol levels. Good sources of unsaturated fats include oily fish (e.g., salmon), nuts, seeds, avocados, and vegetable oils (6).

A heart-healthy diet includes lots of fruits, vegetables, whole grains, poultry, fish, nuts, and non-tropical vegetable oils, with limited quantities of red and processed meats, salt, and added sugar (4).

References:
1. Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) final report. (2002). Circulation. 106 (25), 3143-421.
2. American Academy of Pediatrics, Committee on Nutrition. Cholesterol in childhood. Pediatrics 1998:101(1);141–147.
3. LDL and HDL Cholesterol: “Bad” and “Good” Cholesterol. CDC. Reviewed Jan 2020.
4. Prevention and Treatment of High Cholesterol (Hyperlipidemia). American Heart Association. Reviewed Nov 2020.
5. Preventing High Cholesterol. CDC. Reviewed Sept 2021.
6. Dietary Fats. American Heart Association.