Diet important to reducing postprandial levels and cardiac risks

CHICAGO — Postprandial factors, including lipids, glucose and triglycerides, are the “drivers” of atherosclerosis, according to James O’Keefe, Jr., MD, FACC, who presented on Tuesday at the 57th Annual Scientific Sessions of the American Academy of Cardiology.

“Upwards of 40% of Americans are walking around with postprandial glucose well above 100 mg/dL, 110 mg/dL, 120 mg/dL or even 130 mg/dL,” O’Keefe, professor of medicine at the University of Missouri in Kansas City, said during the April 1 presentation. He explained that this problem is a powerful forecaster of the course of adverse events, such as cardiac risks.

Calorie-dense, easily digestible diets that are high in fat and refined carbohydrates cause glucose and triglycerides to spike in a short period of time. Meanwhile, nitrotyrosine and inflammation of the C-reactive protein increase and endothelial function deteriorates, which is a problem for patients with diabetes, prediabetes and young, healthy individuals.

“When you eat a meal of highly processed food that is calorie dense and you’re already overfed and not very good at metabolizing and sopping up these nutrients, you basically outstrip the metabolism,” O’Keefe said.

Simple solutions

To combat impaired glucose tolerance and reduce postprandial levels, O’Keefe stressed the importance of the Mediterranean diet and eating whole, natural foods. He recommended being particular about protein and avoiding foods high in saturated fat.

In terms of medication, O’Keefe challenged physicians to consider a healthy diet when treating patients with prediabetes, diabetes or coronary disease and to bear in mind the effect medications have on post-meal glucose.

“Postprandial glucose and postprandial triglycerides, when determining postprandial dysmetabolism, are very important, very prevalent and largely unrecognized and untreated phenomena. The best way to treat it is diet and exercise. We have good medications that address the issue, and there is a lot of work to be done about it in the coming years,” O’Keefe concluded. – by Stacey L. Adams

As an endocrinologist, the first thing that happens when you actually do make the diagnosis of diabetes is the postprandial glucose rises much earlier — perhaps five years, before the fasting glucose rises over 126 mg/dL. So, having an increased fasting blood sugar is, of course, a way of making a diagnosis of diabetes as a sensitive marker. Obviously, it’s very specific.

– James M. Falko, MD

Professor Emeritus of Internal Medicine
Ohio State University, Columbus

For more information:

O’Keefe JH. Atherosclerosis: A postprandial phenomenon. Presented at: 57th Annual Scientific Sessions of the American College of Cardiology. March 29-April 1, 2008; Chicago.