Diabetes or Heart Disease

If you have a family history of diabetes or heart disease, you no doubt have been told to watch your diet—to consume whole grains, olive oil, lean protein, tons of produce, and maybe some red wine. But could some of those supposedly hearthealthy foods actually be increasing your risk? Yes, depending on a particular gene that you may have, a gene that even many doctors don’t know about. Your family’s ailments may be linked to a gene known as apolipoprotein E (APOE), which determines how your body metabolizes certain foods. According to cardiologist Suzanne Steinbaum, DO, author of Dr. Suzanne Steinbaum’s Heart Book, if your diet suits your APOE type, you should be able to avoid following in your family’s unfortunate medical footsteps. “The APOE genotype is like a light switch—it is going to activate only if you turn it on by eating foods that are wrong for your type,” she says.

There are three genotypes (gene subtypes) associated with the gene—APOE2, APOE-3, and APOE-4. A person inherits one of these from each parent. About two-thirds of people have a “3/3” pairing, meaning they inherited APOE-3 from their mother and APOE-3 from their father. These lucky folks don’t need to adhere too closely to any particular type of diet in order to avoid heart disease and diabetes, provided they follow a reasonably healthful diet, control their weight, exercise regularly, and don’t smoke. However, people who inherited the APOE-2 gene from one or both parents (a bit more than 10 percent of the population) have trouble metabolizing carbohydrates.


A blood test can determine which genotype you have inherited. Dr. Steinbaum often recommends the test because she has found that patients generally comply better with dietary advice when there’s a scientific indication that a particular diet will be especially protective for them. Some insurance policies cover the test (which costs about $150 or more, depending on the lab), so ask your insurance company. If you choose not to get the blood test, you can get some idea—though not with certainty—of whether you carry the APOE-2 and/or APOE-4 genes. People who inherited the APOE-2 gene from one or both parents tend to have:

  • High triglycerides and blood sugar
  • A family history of diabetes and obesity

Diet recommendations: People with APOE-2 often crave foods like cookies, jelly beans, bread, and soda—but their bodies cannot metabolize sugars and simple carbohydrates, and they often wind up overweight or obese, Dr. Steinbaum says. Lean proteins and moderate amounts of complex carbohydrates (such as whole grains and legumes) are the keys to good health for these people. Note: Even though a glass of red wine with dinner is often said to be hearthealthy, Dr. Steinbaum advises APOE-2 carriers against drinking wine because it is loaded with sugars. People who inherited the APOE-4 gene from one or both parents tend to have:

  • High LDL “bad” cholesterol
  • A family history of coronary artery disease

Recommended: If this is your profile, you’re likely to gravitate toward Buffalo wings, cheeseburgers, rich ice cream, and other fatty foods—yet your body has a hard time breaking down and absorbing fats, and the receptors that are supposed to sweep up LDL “bad” cholesterol are suppressed. Dr. Steinbaum says, “For these people, I usually advise following an extremely low-fat diet, preferably a vegetarian or vegan diet, with less than 7 percent of calories coming from saturated fats.” Even plant-based fats such as olive oil and nuts, which are considered heart-healthy for other people, should be consumed only in moderate amounts by people with the APOE-4 gene. You should also be aware that cholesterol-lowering statin drugs are less effective in APOE-4 individuals than in other people, so even if you take a statin, a low-fat diet is still very important for you. People who inherited the APOE-2 gene from one parent and the APOE-4 gene from the other parent tend to have:

  • High triglycerides, high blood sugar, and high LDL cholesterol
  • A family history of both diabetes and coronary artery disease

Recommended: If you have a “2/4” pairing, you’re in the unfortunate minority of people who have trouble metabolizing not only sugars and simple carbohydrates but also fats. Your best choice is to be a vegetarian, Dr. Steinbaum says. Focus primarily on vegetables, legumes, whole grains, and other complex carbohydrates, and avoid sweets, wine, white bread, white pasta, and other simple carbs. You also need to keep your fat intake quite low, consuming only modest amounts of plant-based fats and little or no animal fat. Your healthiest food options are vegetables, legumes, whole grains, and other complex carbohydrates. Knowing your APOE gene can be very empowering. “When you think of heart disease as being genetic, you might assume, ‘Well, my dad got it, my aunts got it, and my grandfather got it, so I’m going to get it too.’ But if your dad’s whole family had eggs for breakfast, chicken for lunch, and beef for dinner most days, the real problem lies in the fact that everyone was eating the wrong way for their gene type,” Dr. Steinbaum says. The same goes for a family legacy of diabetes when the family diet tended toward high-carb foods. So remember—whether your genetic legacy leaves you vulnerable to heart disease, diabetes, or both, committing to the right type of diet for you might well be enough to break that chain.

The Shocking Diabetes Trigger That Can Strike Anyone

Everyone knows about high blood sugar and the devastating effects it can have on one’s health and longevity. But low blood sugar (hypoglycemia) can be just as dangerous—and it does not get nearly the attention that it should. Simply put, hypoglycemia occurs when the body does not have enough glucose to use as fuel. It most commonly affects people with type 2 diabetes who take medication that sometimes works too well, resulting in low blood sugar.

Shocking Diabetes Trigger

Who gets overlooked: In other people, hypoglycemia can be a precursor to diabetes that is often downplayed by doctors and/or missed by tests. Having low blood sugar might even make you think that you are far from having diabetes when, in fact, the opposite is true. Hypoglycemia can also be an underlying cause of anxiety that gets mistakenly treated with psychiatric drugs rather than the simple steps (see page 13) that can stabilize blood sugar levels. That’s why anyone who seems to be suffering from an anxiety disorder needs to be seen by a doctor who takes a complete medical history and orders blood tests. When a patient comes to me complaining of anxiety, hypoglycemia is one of the first things I test for. What’s the link between hypoglycemia and anxiety? A sudden drop in blood sugar deprives the brain of oxygen. This, in turn, causes the adrenal glands to release adrenaline, the “emergency” hormone, which may lead to agitation, or anxiety, as the body’s fight-or-flight mechanism kicks in.


Hypoglycemia has sometimes been called carbohydrate intolerance, because the body’s insulin-releasing mechanism is impaired in a manner similar to what occurs in diabetics. In people without diabetes, hypoglycemia is usually the result of eating too many simple carbohydrates (such as sugar and white flour). The pancreas then overreacts and releases too much insulin, thereby excessively lowering blood sugar. The good news is that hypoglycemia—if it’s identified—is not that difficult to control through diet and the use of specific supplements. Hypoglycemia should be considered a warning sign that you must adjust your carbohydrate intake or risk developing type 2 diabetes.

Caution: An episode of hypoglycemia in a person who already has diabetes can be life-threatening and requires prompt care, including the immediate intake of sugar—a glass of orange juice or even a sugar cube can be used.

Common symptoms of hypoglycemia include: Fatigue, dizziness, shakiness and faintness; irritability and depression; weakness or cramps in the feet and legs; numbness or tingling in the hands, feet, or face; ringing in the ears; swollen feet or legs; tightness in the chest; heart palpitations; nightmares and panic attacks; “drenching” night sweats (not menopausal or perimenopausal hot flashes); constant hunger; headaches and migraines; impaired memory and concentration; blurred vision; nasal congestion; abdominal cramps; loose stools; and diarrhea.


Under-the-radar hypoglycemia (known as subclinical hypoglycemia) is difficult to diagnose because symptoms may be subtle and irregular, and test results can be within normal ranges. Technically, if your blood sugar drops below 70 milligrams per deciliter (mg/dL), you are considered hypoglycemic. But people without diabetes do not check their blood sugar levels on their own, so it is important to be aware of hypoglycemia symptoms. If you suspect that you may have hypoglycemia, talk to your physician. Ideally, you should arrange to have your blood glucose levels tested when you are experiencing symptoms. You will then be asked to eat food so that your blood glucose can be tested again. If this approach is impractical for you, however, talk to your doctor about other testing methods.


If you have been diagnosed with diabetes, hypoglycemia may indicate that your diabetes medication dose needs to be adjusted. The sugar treatment described earlier can work in an emergency but is not recommended as a long-term treatment for hypoglycemia. Left untreated, hypoglycemia in a person with diabetes can lead to loss of consciousness and even death. In addition to getting their medication adjusted, people with diabetes—and those who are at risk for it due to hypoglycemia—can benefit from the following:

  • A high-protein diet and healthful fats. To keep your blood sugar levels stabilized, consume slowly absorbed, unrefined carbohydrates, such as brown rice, quinoa, oatmeal, and sweet potatoes. Also, get moderate amounts of healthful fats, such as those found in avocado, olive oil, and fatty fish, including salmon, and protein, such as fish, meat, chicken, soy, and eggs. Recommended protein intake: 10 to 35 percent of daily calories. If you have kidney disease, get your doctor’s advice on protein intake.
  • Eat several small meals daily. Start with breakfast to give your body fuel for the day (if you don’t, stored blood sugar will be released into your bloodstream) and then have a small meal every three to four waking hours.
  • Avoid tobacco, and limit your use of alcohol and caffeine. They cause an excessive release of neurotransmitters that, in turn, trigger the pancreas to deliver insulin inappropriately.
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