Lifestyle | Stop Prediabetes and Bad Circulation

A big reason to lose weight to stop prediabetes and reduce your odds of ending up with type 2 diabetes, are the cardiovascular disease complications often accompanying these conditions including reduced blood flow to your heart, brain and feet compromising your ability to live a functional and independent life.

Lifestyle modifications are the most cost-effective ways to improve the problem-metabolism of obesity, prediabetes and diabetes and the potential reduced blood flow to the heart, brain, feet and elsewhere.

reduced blood flow to foot and toesThe “lifestyle modifications” that top the list include:

  • quitting smoking,
  • making healthy dietary changes
  • participating in some exercise activity

By making some relatively simple changes, you can help prevent, or reduce your odds of getting cardiovascular disease and the potential consequences thereof, including heart attack, stroke, or foot problems placing you at risk for decreased mobility or loss of your foot?

Poor blood flow to the feet and legs is known as peripheral arterial disease (PAD). It is the third leading cause of atherosclerotic cardiovascular disease, and it is often associated with cardiovascular diseases elsewhere in the body such as the blood flow to the heart and/or to the brain.

human blood flow circulationThe circulatory system is a “closed-loop” and disease can occur anywhere along the bloodstream’s course (and in multiple locations). Because of this, an analysis of multiple research studies showed a measure of blood flow to the feet, known as the ankle-brachial index (ABI), can serve as an independent predictor of cardiovascular problems in general.  In other words, if the ABI test suggets you have reduced blood flow to your feet, there is a good chance you have reduced blood flow to your heart and/or brain.


How do you decrease the risk of getting PAD?

PAD is prevalent worldwide and its prevention and management deserves more public health attention. As mentioned above, its lifestyle risk factors are the same as those for other cardiovascular diseases – tobacco use, minimal physical activity and poor diet.

Cigarette smoking is more significantly associated with PAD than with coronary artery disease which affects the heart and even secondhand smoke has been shown to be a PAD risk factor.

Most people understand that smoking is not good for blood circulation and they understand the connection between physical movement and exercise “to keep the blood flowing.” I have previously posted about the benefits of walking for PAD.

But what about the food you eat? Many people do not make a connection between their diet and blood circulation to the feet and legs. As a matter of fact many primary care physicians also stray away from the topic of the diet-health connection as suggested in this report entitled, “U.S. primary care physicians’ diet-, physical activity-, and weight-related care of adult patients.”

Sure, there can be hereditary factors at work, however you can mitigate genetic factors through lifestyle. While a discussion of this phenomenon is beyond the scope of this post, the potential impact of lifestyle as an epigenetic influence should not be underestimated.


Food as medicine for peripheral artery disease?

fast processed foodSo, what about lifestyle change involving food? As I said, most people understand the idea of ample physical-movement and exercise activity for cardiovascular health. They also realize that smoking is harmful, but it seems they struggle with the food aspect of the lifestyle approach to health – for many, improving the quality of the food they eat is easier said than done, especially in light of the numerous readily available fast food outlets.

For example, most people understand they would benefit from eating a diet including at least some fruits and vegetables, but this can be hard advice to follow in light of the fast-paced life so many currently live. Perhaps if they really grasped that food is more than an energy source – that it can actually be like medicine – this would help?

The risk factors for PAD, including tobacco use, sedentary lifestyle and poor food choices, are harmful because they promote damage to the delicate lining of our blood vessels (known as the endothelium) and they promote low-grade inflammation throughout the body.

Therefore, it appears the main ways by which food promotes cardiovascular health are related to the effects of specific food nutrients in supporting:

Regarding the food you eat, there are a number of diets with various names all claiming to be the best approach; Some of this is hype and marketing. Many of the various dietary approaches that are discussed in the media have more in common with each other than their proponents would have you believe.

Generally speaking, when considering the person with the sick metabolism of obesity, prediabetes and diabetes, personal continuous review of the literature and lectures from experts in the field, lead me to believe a diet with a lower carbohydrate perspective (obtaining carbohydrates from vegetables and fruit) is the better approach for many, although each individual needs to know their own carbohydrate tolerance, which in part is associated with one’s activity level. There is not necessarily one best diet for everyone.

Research just published in the Annals of Internal Medicine (Sept. 2014) looking at low-carbohydrate diets versus low-fat diets found,

The low-carbohydrate diet was more effective for weight loss and cardiovascular risk factor reduction than the low-fat diet. Restricting carbohydrate may be an option for persons seeking to lose weight and reduce cardiovascular risk factors.”

Diet and nutrition specialists are working to become better at gauging just how many “carbs” can be removed from a person’s diet to positively affect blood sugar levels. Researchers just published how much carbohydrate lowering would be helpful for a diabetic based on their HbA1c level. The HbA1c is an indicator of a person’s blood sugar level over the prior three months or so.

Not surprisingly, the researchers found that the greater the reduction in carbohydrate intake (g/day), the greater the decrease in HbA1c levels, however more interestingly, they also apparently figured out how much carbohydrate lowering was needed to achieve a certain HbA1c decrease depending on the patient’s HbA1c level before the reduced carb diet was started. They are hopeful their research will lead to a diet approach that

may provide patients with type 2 diabetes with optimal and practical objectives for carbohydrate restriction and prevent restriction from being unnecessarily strict.”
There is a list of additional research studies on the effects of lower carbohydrate approaches on cardiometabolic health below.”

The Mediterranean diet for PAD

mediterannean dietA diet that has been looked at with regard to cardiovascular disease – PAD in particular – is the Mediterranean diet. Although further studies are needed to better clarify this association, the literature suggests a Mediterranean-style diet could be effective in the primary prevention and secondary management of PAD. (1 , 2 , 3 , 4 , 5 )

Although there are several definitions of the Mediterranean diet, it basically boils down to using a good portion of olive oil for cooking and for salad dressings (providing relatively high monounsaturated fat); legumes, unrefined grains, fruits, and vegetables; moderate to high consumption of fish (providing relatively high omega-3 polyunsaturated fat), some chicken and dairy products (mostly as cheese and yogurt), some wine consumption usually in the form of red wine in moderation with meals; and low consumption of red meat products.

The Mayo Clinic provides this definition of the Mediterranean Diet.

It appears the value of a Mediterranean diet, and similar dietary approaches by other names, as an effective and feasible way to prevent or reduce the risk of cardiovascular diseases may be partly explained by their antioxidant properties and by their support of the endothelium (the delicate inside lining of blood vessels) from the high content of polyphenols in the olive oil, fruits, vegetables, and red wine. (1 , 2 , 3 , 4 , 5 , 6 )

I believe most readers are aware of the public health recommendation over the past few decades advising the use of a low-fat diet as the best option to prevent cardiovascular diseases such as PAD; “Fat-free” has been the dietary mantra, however, current evidence suggests diets with higher healthy natural fats found in unprocessed food, such as in the Mediterranean diet mentioned above, are superior to low-fat diets in the control of cardiovascular risk factors.

A just published article (October 2014) out of Harvard’s School of Public Health discusses why the fat-free and low-fat messages of the past few decades were a “public health disaster.”

*See below for additional research studies on lower carb diets and their influence on a poor metabolism.

Regardless of its label, a diet that is adhered to over time and made up of real food that is more plants than animals – and as close to their native state as possible – with sufficient healthy fat, protein, and an absence of processed carbohydrates, is the foundation far a healthy approach to eating in support of cardiovascular health including the blood circulation to the feet and legs which are so important for healthy aging.

In closing…

The literature is demonstrating increasing evidence supporting the preventive role that some nutrients and foods have on the prevention of cardiovascular disease involving blood flow to the heart and brain, and although the association between diet and peripheral arterial disease has not been as thoroughly investigated, this author believes the future will show more clearly the association of food in the health of the blood circulation to the feet and legs just as it has been shown for the lifestyle influences of tobacco and exercise. Food is medicine.


*Some Additional Research Studies – Lower carbohydrate diets

(in chronological order)

  1. Foster GD, Copperman N, Jacobson M. A randomized trial of a low-carbohydrate diet for obesity. New England Journal of Medicine, 2003.
  2. Samaha FF, Iqbal N, Prakash S, et al. A low-carbohydrate as compared with a low-fat diet in severe obesity . New England Journal of Medicine, 2003.
  3. Brehm BJ, Seeley R, Daniels S, et al. A randomized trial comparing a very low carbohydrate diet and a calorie-restricted low fat diet on body weight and cardiovascular risk factors in healthy women . The Journal of Clinical Endocrinology & Metabolism, 2003.
  4. Sondike SB, Copperman N, Jacobson MS. Effects of a low-carbohydrate diet on weight loss and cardiovascular risk factor in overweight adolescents . The Journal of Pediatrics, 2003.
  5. Aude YW, Agatston A, Lopez-Jiminez F, et al. The national cholesterol education program diet vs a diet lower in carbohydrates and higher in protein and monounsaturated fat . Archives of Internal Medicine, 2004.
  6. Yancy WS Jr, Olsen M, Guyton J, et al. A low-carbohydrate, ketogenic diet versus a low-fat diet to treat obesity and hyperlipidemia . Annals of Internal Medicine, 2004.
  7. JS Volek, Sharman MJ, Kraemer WJ. Comparison of energy-restricted very low-carbohydrate and low-fat diets on weight loss and body composition in overweight men and women . Nutrition & Metabolism (London), 2004.
  8. Meckling KA, O’Sullivan C, Saari D. Comparison of a low-fat diet to a low-carbohydrate diet on weight loss, body composition, and risk factors for diabetes and cardiovascular disease in free-living, overweight men and women . The Journal of Clinical Endocrinology & Metabolism, 2004.
  9. Nickols-Richardson SM, Coleman MD, Volpe J, et al. Perceived hunger is lower and weight loss is greater in overweight premenopausal women consuming a low-carbohydrate/high-protein vs high-carbohydrate/low-fat diet . Journal of the American Dietetic Association, 2005
  10. Daly ME, Paisey R, Millward B, et al. Short-term effects of severe dietary carbohydrate-restriction advice in Type 2 diabetes . Diabetic Medicine, 2006.
  11. McClernon FJ, Yancy WS, Eberstein JA, et al. The effects of a low-carbohydrate ketogenic diet and a low-fat diet on mood, hunger, and other self-reported symptoms . Obesity (Silver Spring), 2007.
  12. Gardner CD, Kiazand A, Alhassan S, et al. Comparison of the Atkins, Zone, Ornish, and LEARN diets for change in weight and related risk factors among overweight premenopausal women: the A TO Z Weight Loss Study . The Journal of The American Medical Association, 2007.
  13. Halyburton AK, Brinkworth G, Wilson C, et al. Low- and high-carbohydrate weight-loss diets have similar effects on mood but not cognitive performance . American Journal of Clinical Nutrition, 2007.
  14. Dyson PA, et al. A low-carbohydrate diet is more effective in reducing body weight than healthy eating in both diabetic and non-diabetic subjects . Diabetic Medicine, 2007.
  15. Westman EC, Yancy WS, McDuffie JR. The effect of a low-carbohydrate, ketogenic diet versus a low-glycemic index diet on glycemic control in type 2 diabetes mellitus . Nutrion & Metabolism (London), 2008.
  16. Shai I, Schwarzfuchs D, Henkin Y, et al. Weight loss with a low-carbohydrate, Mediterranean, or low-fat diet . New England Journal of Medicine, 2008.
  17. Keogh JB, Brinkworth GD, Noakes M, et al. Effects of weight loss from a very-low-carbohydrate diet on endothelial function and markers of cardiovascular disease risk in subjects with abdominal obesity . American Journal of Clinical Nutrition, 2008.
  18. Tay J, Brinkworth GD, Noakes M, et al. Metabolic effects of weight loss on a ve ry-low-carbohydrate diet compared with an isocaloric high-carbohydrate diet in abdominally obese subjects . Journal of The American College of Cardiology, 2008.
  19. Volek JS, Phinney SD, Forsythe CE, et al. Carbohydrate restriction has a more favorable impact on the metabolic syndrome than a low fat diet . Lipids, 2009.
  20. Brinkworth GD, Noakes M, Buckley JD, et al. Long-term effects of a very-low-carbohydrate weight loss diet compared with an isocaloric low-fat diet after 12 months . American Journal of Clinical Nutrition, 2009.
  21. Hernandez, Sutherland JP, Wolfe P, et al. Lack of suppression of circulating free fatty acids and hypercholesterolemia during weight loss on a high-fat, low-carbohydrate diet . American Journal of Clinical Nutrition, 2010.
  22. Guldbrand, Dizdar B, Bunjaku B, et al. In type 2 diabetes, randomization to advice to follow a low-carbohydrate diet transiently improves glycaemic control compared with advice to follow a low-fat diet producing a similar weight loss . Diabetologia, 2012.
  23. Krebs NF, Gao D, Johnson SL. Efficacy and safety of a high protein, low carbohydrate diet for weight loss in severely obese adolescents . Journal of Pediatrics, 2010.
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About Robert Creighton

Dr. Creighton is a podiatrist and foot surgeon with over 26 years in podiatric practice treating thousands of patients afflicted with the physiological, physical, and psychological side effects and complications of diabetes and pre-diabetes metabolic syndrome. He believes these disorders present a pressing public health concern that need to be more actively addressed in a multidisciplinary way. Dr. Creighton graduated from what is now the Temple University School of Podiatric Medicine after receiving his undergraduate degree in Biology. He is certified by the American Board of Foot and Ankle Surgery, a member of the American Public Health Association, an American College of Sports Medicine certified personal trainer and a Member of the American Nutrition Association.


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