Cardio-metabolic disorders and Cardiovascular disease

Heart disease is a silent killer. It kills more people in India than any other disease. The incidence of heart disease has reached alarming proportions. The sad part is that there is still a lot that we need to know  about the causal factors, and how we can treat it or prevent it.

Heart disease is the number one cause of death of men and women and each year more than a million individuals experience a heart attack. Traditional risk factors for Coronary Artery Disease (CAD) include hypertension, obesity, cigarette smoking, diabetes, physical inactivity, family history of premature CAD, age (men >44 yrs; women >54 yrs), and abnormal serum lipids – but this only accounts for 1/2 of the CAD risk.

Cholesterol & Heart Disease

Over 50% of heart attack victims and 80% of patients with CAD have normal cholesterol levels. As little as 25% of premature CAD is attributable to elevated LDL-C.

Insulin insensitivity and the ensuing metabolic syndrome is recognized as a major contributing factor to the development and progression of Cardiovascular Diseases.

Many of the multiple metabolic risk factors for cardiovascular disease can be reduced or eliminated with innovative testing and individualized integrative therapies.While an investigation into the physiology is necessary, cardio-metabolic treatments deliver the best results when a person is treated.

Specialized testing in Functional Medicine


For the past 25 years, the emphasis on Cardiovascular (CV) Risk stratification and treatment has focused on the Total Cholesterol and LDL-Cholesterol values. Recent data indicates that measurement of LDL-particle number (LDL-P) turns out to be a more accurate assessment of LDL-related risk than LDL-C concentration. In other words, knowing the KIND of cholesterol is more important than just knowing the overall cholesterol levels.

The CV Health Profile from Genova Diagnostics analyzes blood for state-of-the-art lipid markers and independent risk factors that illuminate the clinical complexity of cardiovascular disease (CVD). Together, these markers provide a thorough assessment of cardiovascular health status, revealing the biochemical environment associated with inflammation, lipid deposits, endothelial dysfunction, and clotting factors underlying cardiovascular disease.

The CV Health Profile is a comprehensive evaluation featuring an advanced lipid profile that utilizes NMR fractionation technology, independent risk markers (including lipoprotein-associated phospholipase or Lp-PLA2), and a novel Insulin Resistance Score. All of these advanced markers play a critical role in a person’s cardiovascular health. The insight they provide allows the clinician to more accurately address abnormalities relating to cardiac and vascular diseases. With its unique combination of standard lipid markers, lipid fractionation analysis, and novel independent risk factors, the CV Health Profile assists physicians in identifying nearly 85% of individuals with cardiovascular disease.

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Lipids – Know Your (Particle) Number. While the focus has been on the amount of cholesterol a person has and their risk of heart attack, we now know that the KIND of cholesterol is actually more important than overall levels.

LDL-Particle Number (LDL-P) includes small and large LDL particles, and is independent of the cholesterol concentration within the particles. An individual with low/normal LDL-C concentration, but high LDL-P, is still at high-risk for plaque build-up. Increased LDL-P is associated with increased risk of carotid atherosclerosis, angina, myocardial infarction and future coronary events.

 LDL-Size is highly associated with triglycerides and insulin resistance. Individuals with a preponderance of LDL particles of smaller size are at increased risk for coronary artery disease (CAD) and increased CAD severity.

HDL-Particle Number (HDL-P) indicates increased risk of coronary events for individuals with a low HDL-P number, and is independent of major lipid and non-lipid CVD risk factors. HDL-P is an important secondary risk factor, as it strongly relates to atherosclerosis in those individuals with optimal levels of LDL-P. Increasing HDL-C without increasing HDL-P offers little clinical benefit.

The CV Health profile provides a combination of standard lipid measures and particle numbers, independent risk factors focused on inflammation, and lipid fractionation to identify insulin resistance risk. This profile can be used to help optimize a patient’s cardiovascular health, to reduce heart attack and stroke risk, and to reduce inflammation in the cardiovascular system.

The CV Health plus Genomics is a profile that measures a variety of lipids and inflammatory markers as well as genetic markers that can predispose a person to developing cardiovascular disease. Together, these markers provide a thorough assessment of cardiovascular health status, revealing the biochemical environment and cardiogenomic risk associated with inflammation, lipid deposits, endothelial dysfunction, and clotting factors underlying cardiovascular disease.


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The CardioION is a comprehensive nutritional and metabolic profile measuring amino acids, fatty acids, vitamins, minerals, metabolic markers, and cardiovascular health markers.

The Cardio/ION identifies key nutritionally modifiable risk factors for CVD, including:

  • Fatty acid imbalances which can lead to chronic inflammation. Current research finds levels of specific fatty acids to be strongly correlated to CVD.
  • High fibrinogen is associated with increased risk of clots and CVD.
  • Homocysteine is an important risk factor for not only CVD, but stroke and dementia as well.
  • Coenzyme Q10 (CoQ10) is essential for proper mitochondrial function and energy use. It also acts as an antioxidant. Cardiac cells have high mitochondrial demand. Statins can decrease CoQ10 levels.
  • Fasting insulin is an indicator of insulin resistance. Hyperinsulinaemia has been associated with a cluster of CVD risk factors.
  • Insufficient antioxidant status is associated with increased oxidation. Oxidative damage is believed to play a role in heart and vascular disease by promoting inflammation.

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Functional & Integrative Medicine really helps 

Functional medicine aims to investigate and modify the underlying causes of disease. It stresses preventing disease and optimizing health. A core value is improving the body’s physiological functioning. It recognizes that no two persons are the same and therefore treatment also differs.

We perform comprehensive tests to determine the cause of your disease, whether it is due to metabolic, nutritional, toxic, microbial, or oxidative challenges. Depending on the results, a holistic treatment plan is then designed and administered to you.

A patient-centric approach rather than a disease-centric approach will allow for true healing. And this is what functional and integrative medicine does. Rather than treating an individual risk factor such as blood cholesterol or blood pressure, the aim is to evaluate a patient’s inner biochemistry to address the underlying causes of those risk factors and develop a treatment plan to restore balance and health to the system.

Example Treatments Used in Metabolic Syndrome and Cardiovascular Disease

  • Low-glycemic diets are used when patients have high insulin resistance. Remove grains, flours, sweets, chips, cookies, white rice, soda, and fruit juices. Try to eat more meats, veggies, nuts and seeds. Eat whole fruit only in moderation.
  • Regular exercise is very important to help usher sugar efficiently into the cell.
  • Anti-inflammatory herbs may be used to lower inflammation
  • B-complex, especially B12, B6, and folate
  • Niacin
  • Fish oil
  • Carnitine
  • Nattokinase
  • Chromium
  • Vanadium
  • Magnesium
  • CoQ10
  • D-Ribose
  • L-Arginine
  • Consider other testing (stool testing, for example) if there is a chronic elevation of inflammatory markers
  • Remove allergenic foods

Blood Sugar Balance and Diabetes

Did you know that diabetes or high blood sugar is the most common non-communicable disease in the world? Did you know that India is the diabetic capital of the world?

These are startling facts, but diabetes is often born of a poor lifestyle and fortunately it can be prevented and even reversed.

The advent of refined and processed foods is the primary culprit disrupting our metabolic balance and increasing our blood insulin levels.

All of the cells in our body use sugar, fat, and amino acids to make energy. Insulin is the hormone whose job it is to help sugar get into the cell and thereby keep the blood sugar levels (outside the cell) in the healthy range. If blood sugar levels are chronically elevated, it can lead to many health complications, especially diabetes.

When insulin is high for too long, the cells stop listening to insulin signals. The cells therefore cannot utilise the insulin and it remains in the blood stream while blood glucose continues to rise. High blood glucose means that sugar is trying to get into the cells to make energy but insulin (the gatekeeper) is not allowing glucose to go inside. This condition is called, “Insulin Resistance”  — the cells are actually resisting the action of insulin.  A person with insulin resistance will have high blood sugar and high insulin. This is the major metabolic problem in a person with Type 2 Diabetes.

Insulin Resistance is one defining characteristic that describes patients with “Metabolic Syndrome.” Metabolic syndrome is a group of risk factors that increase a person’s chances of developing heart disease and diabetes. The following factors define a patient with metabolic syndrome:

  • Increased waistline or excess abdominal fat
  • High blood glucose
  • High triglycerides
  • Low HDL (low levels of the good cholesterol)
  • High blood pressure

When a person fits these criteria, his/her risk for heart attack, stroke, and diabetes increase. A person with metabolic syndrome has twice the risk of developing diabetes and five times the risk of developing heart disease than a person without metabolic syndrome.

Genetic factors and environmental factors determine whether a person will develop insulin resistance or diabetes. Since genetics cannot be changed, diet and exercise are the most powerful treatments for a person with insulin resistance or metabolic syndrome.

Clinicians often counsel patients to make dietary and lifestyle changes so their cells will permit glucose to enter.  Removing refined carbohydrates from the diet is very important. Avoid grains, flours, sweets, chips, cookies, cake, white rice, soda, potatoes, fruit juices, and other starchy foods or high glycemic fruits. Patients are encouraged to eat more meats, vegetables, nuts and seeds. Whole fruit is permitted in moderation. Daily exercise is also very important to help usher sugar efficiently into the cell.   These changes can enhance weight loss, improve insulin sensitivity, and improve energy levels. It helps lower blood sugar and insulin levels and reduces insulin resistance.

Specialized testing in Functional Medicine:

Genova Diagnostics offers a line of tests that can help determine if a person is pre-diabetic or at risk for cardiovascular disease. The PreD Guide and MetSyn guide are profiles designed to look at sugar and insulin levels, inflammatory markers, and other proteins involved in metabolism. The CardioION is a comprehensive nutritional and metabolic profile measuring amino acids, fatty acids, vitamins, minerals, metabolic markers, and cardiovascular health markers. Finally, the CV Health plus Genomics is a profile that measures a variety of lipids and inflammatory markers as well as genetic markers that can predispose a person to developing cardiovascular disease.


PreD Guide measures stages of pre-diabetes and progression toward Type 2 Diabetes Mellitus (T2DM) using metabolic and inflammatory biomarkers. PreD Guide focuses on the importance of early assessment and correction of risk factors.

This diagnostic tool utilizes a combination of inflammatory and metabolic biomarkers to provide an early assessment of a patient’s path towards diabetes – and guide targeted therapies. Obesity is not the only characteristic of a person with insulin resistance. There are many people who have normal body weight who are pre-diabetic. Testing can help reveal these metabolic problems so that diabetes can be avoided.

The interplay of these biomarkers is illustrated across the stages of pre-diabetes, and results in stage-specific therapeutic interventions.

The PreD Guide gives clinicians the ability to evaluate where the patient falls amid stages of pre-diabetes, determine the impact of inflammation, and individualize treatment. This clinical tool ensures, as the CDC notes, that “progression to diabetes among those with pre-diabetes is not inevitable.”

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Identifying the Underlying Driver: Inflammation

Research suggests that inflammation precedes and accelerates the progression to diabetes. Five different biomarkers provide an assessment of the patient’s unique expression of inflammation. Given the complex manner in which they interact, a synthesized average Inflammation Score is provided to indicate severity of the degree of inflammation present.

  • High Sensitivity C-Reactive Protein (hs-CRP)
  • Interleukin 6 (IL-6)
  • Tumor Necrosis Factor alpha (TNFa)
  • Interleukin 8 (IL-8)
  • Plasminogen Activator Inhibitor Type 1 (PAI-1)

The MetSyn Guide is very similar to preD Guide but in addition it measures total cholesterol, HDL-C, and triglycerides. Moving beyond BMI, the MetSyn Guide assists clinicians in identifying patients who are developing insulin resistance and who are at risk for pre-diabetes. Advanced lipid markers are added to highlight the changes in lipid metabolism that occur in insulin resistance.

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We understand that each individual is unique and there is no 'one size fits all' approach to medicine. Through functional medicine we formulate customized treatments for each individual.

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Heal Wellness Center
35/3078 G, Pukalakkat Complex,
Mahakavi Vailoppilli Rd,
Palarivattom, Erbakulam,
Kerala - 682025

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