An integrative cardiologist and assistant clinical professor of medicine at the University of Connecticut School of Medicine, Stephen T. Sinatra, MD, is the author of several books on cardiovascular disease and metabolic cardiology.

Taste for Life: Besides a healthy, plant-based diet and regular exercise, how can Americans prevent high blood sugar and insulin resistance that lead to Type 2 diabetes?
Stephen T. Sinatra, MD: The best way to prevent high blood sugar and insulin resistance is to avoid sugars in the diet. That means sweets, high-fructose corn syrup, and high-glycemic foods like bagels, breads, cakes, cookies, crackers, sweets, and especially sodas. It’s important to eat more healthy fats, such as monounsaturated fats and saturated fats that do not elicit an insulin response. Of course, omega 3s should be considered as well.

Weight loss is also an absolute when it comes to diabetes. When we combine exercise and a low-sugar diet, weight loss usually follows, and this in itself is the best prevention for insulin resistance and diabetes.

TFL: Although Type 2 diabetes is considered an age-related condition, even children are developing this disease today. What (if any) supplements would you recommend for school-age children and teens?
Dr. Sinatra: Certainly cod liver oil and/or fish oil. These supplements may help not only IQ but also vision. Fish oils suppress inflammation and have been shown to help offset insulin resistance. Something else I like for school-age children to use is cinnamon. If they sprinkle cinnamon on their oatmeal or have cinnamon on fresh fruit in the morning, this wonderful nutraceutical can help offset hyperglycemic surges.

TFL: The American Academy of Pediatrics (AAP) recently recommended that children as young as two years of age be tested for cholesterol and that those as young as eight be given statin drugs. What’s your response to this advice?
Dr. Sinatra: It’s tragic and cruel—a pharmaceutical industry ploy to create a new market. School-age kids should be playing games and learning multiplication tables—not taking drugs that have significant side effects in many of the adults who use them.

According to Jatinder Bhatia, MD, professor of pediatrics at the Medical College of Georgia and one of the Academy’s panel of experts, “The risk of giving statins at a lower age is less than the benefit.” Dr. Bahia adds there’s not much data on pediatric use of cholesterol-lowering drugs.

Nor is there any evidence of how lowering kids’ cholesterol may affect their growth, development, or overall health. For example, cholesterol is the raw material used to make sex hormones. What effect will lowering it have on sexual development? Cholesterol also helps fight infections. Will lowering it make kids more vulnerable to infections or less able to fight them off?

If the AAP feels a true sense of urgency on this, it should recommend and promote better education on nutrition and exercise for both kids and parents. Only after meaningful action that improves lifestyle habits should the Academy target cholesterol in kids. And then it should insist on using real science.

TFL: These drugs and CoQ10 appear to use the same metabolic pathway. How will long-term use of statins impact this natural antioxidant in the body?
Dr. Sinatra: The production of coenzyme Q10 is severely compromised with the use of statins. Anyone taking a statin must supplement with CoQ10 at the same time.

TFL: What (if any) additional therapy (including supplements) would you recommend for people with Type 2 diabetes?
Dr. Sinatra: The most important nutraceutical is undoubtedly CoQ10. Data show that Type 2 diabetics have low levels of this antioxidant. CoQ10 is absolutely essential in building ATP (energy of life), which is the basis of my book Metabolic Cardiology. In addition I recommend alpha lipoic acid, cinnamon, chromium, fish oil, and Gymnema sylvestre.

New research suggests that vitamin D deficiency predisposes people to metabolic syndrome and Type 2 diabetes. If a Type 2 diabetic is especially overweight, I now obtain vitamin D serum levels. If the level is less than 50, I supplement with additional vitamin D.

TFL: How does diabetes lead to cardiovascular disease?
Dr. Sinatra: Diabetics tend to have large swings in both sugar and insulin, which are very toxic to the endothelial lining of blood cells. High glucose in the blood accelerates aging, and high insulin causes enormous oxidative stress to blood vessels, leading to inflammation and eventually cardiovascular disease. I have to emphasize that weight loss, exercise, and a noninflammatory, low-carbohydrate diet that does not provoke insulin are really the trifecta for preventing heart disease in people with Type 2 diabetes or metabolic syndrome.

TFL: Are people with Type 2 diabetes at greater risk for heart attack?
Dr. Sinatra: Absolutely, including silent heart attack. Diabetics may have degenerating nerves around the heart. When degeneration of nerve fibers occurs, these patients may not get the pain response that other people may experience, thus delaying hospital attention. For people with diabetes, shortness of breath, profound fatigue, or profuse sweating can be symptoms of an impending heart attack.

TFL: What tests do you recommend for people with Type 2 diabetes to identify their risk or degree of heart disease?
Dr. Sinatra: Standard cardiovascular tests (e.g., an echocardiogram or an exercise stress test) suffice, but I prefer CT scans of the heart that demonstrate coronary calcium. If Type 2 diabetics do have coronary calcium, it’s a sign of accelerated aging and extreme vulnerability to a heart attack—especially if the calcium score is over 1,000. In such a case, then a plaque stabilization/reversal program, which is the basis of my book Reverse Heart Disease Now, is needed.

TFL: Few cardiologists are as knowledgeable as you are about nutrition. How does someone who wants to try a natural approach—before turning to pharmaceutical drugs—find a qualified integrative physician?
Dr. Sinatra: It’s important to find a physician who practices smart medicine: That means a doctor who knows about nutrition, energy healing, and pharmaceutical drugs. Finding such a qualified integrative physician may be difficult. But newsletter editors like Dr. Jonathan Wright, MD, Michael Murray, ND, and I offer good information. Patients can also go to the Web sites of the American College for Advancement in Medicine (www.acam.org) and the American Academy of Anti-aging Medicine (www.worldhealth.net).