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Link in a deadly chain

Millions of overweight Americans now suffer from insulin resistance, which raises the risk of heart disease and diabetes.

October 18, 2004|Judy Foreman | Special to The Times

Just as important, cytokines from fat also mess up the delicate system by which insulin, the hormone that escorts sugar into cells, sends its chemical signals inside cells. Faulty insulin signaling in turn triggers insulin resistance, which forces the pancreas (which makes insulin) to work harder and harder until it finally gives out, resulting in full-blown diabetes.

Meanwhile, fat cells also release free fatty acids, which flock to the liver, where they are linked together into little bundles (triglycerides) and pumped back into the blood. In high enough amounts, triglycerides disrupt cholesterol balance, making levels of "good" cholesterol fall.

"Fatty acids are also toxic in themselves," said Dr. George L. Blackburn, associate director of nutrition in the Division of Nutrition at Harvard Medical School.

Not a pretty picture. You can take statin drugs such as Lipitor or Zocor to lower LDL (low-density lipoprotein), or "bad" cholesterol, and reduce C-reactive protein levels. You can take diuretics, ACE inhibitors or other drugs to lower blood pressure. You can take Lopid or Tricor to lower triglycerides and Niaspan to boost "good" cholesterol.

You can also take some drugs that are approved for diabetes but not yet for insulin resistance, among them Glucophage, Avandia and Actos.

But the best solution is to take a tape measure and measure your waistline. If your girth is too great, get serious about losing weight.

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