What tests can you have to see if you are at risk of a premature heart attack or stroke and what lifestyle changes can you make to prevent this?
Despite advances in medicine problems like obesity, type 2 diabetes and heart disease are still major health concerns and even children are now being diagnosed with type 2 diabetes. Problems with high blood sugar and insulin are major factors in cardiovascular disease and also play a big role in weight gain.
Gamma Glutamyl Transferase
Gamma Glutamyl Transferase (GGT) is a liver enzyme which is very cheap and easy to measure by a blood test. GGT gives such a good insight into health and mortality risk, that the actuaries in life / health insurance companies, put GGT top of the pile for risk both men and women for predicting disease.
A quote ‘liver function tests particularly, GGT have become central to life insurance underwriting process’
GGT is supposed to be about 15. Over 30 you need to look into it. 40 -50 + you must address it.
GGT liked to making glutathione, which is the body’s main detoxification molecule, but too much GGT can lead to glutathione break down or it is showing you have a high demand for glutathione due to a burden of compounds the liver needs to detoxify/remove.
As fatty liver, hyperinsulinemia / insulin resistance (pre diabetes) develop GGT levels start to rise, so it is possible to use GGT as a marker to catch fatty liver and pre-diabetes early.
Slim people can also develop fatty liver and insulin resistance, and are more at risk of not being diagnosed as they appear healthy on the outside. Fatty liver and insulin resistance are now appearing in young people and children so finding it early is key to preventing health problems later in life. Fatty liver and insulin resistance can be reversed.
As GGT is also a marker for inflammation as GGT starts to lower weight loss will follow as inflammation is a major factor in fat storage. I will give some suggestions on how to lower GGT towards the end of the blog
Quick summary so far
- GGT is a great marker for what is going on in the liver metabolically and reports on liver inflammation or over-burden
- GGT is a marker for undiagnosed liver disease , Insulin resistance and Increased oxidative stress (free radicals)
- High GGT (in the top 5th of the population) is linked to liver cancer, CV disease, Type 2 diabetes and other cancers. 
- Slim people can be insulin resistant, inflamed or have fatty liver so measuring GGT can help find metabolic problems early.
Fatty liver, Insulin Resistance, Cardiovascular disease & GGT
As the body is pushed into insulin resistance you will push yourself towards fatty liver and you start to see athlerogeneic dyslipidemia. This is a medical term for a lipid panel (also incorrectly called ‘a cholesterol test) that is telling you that you could be at risk of a heart attack or stroke.
Total cholesterol alone is not useful for predicting heart disease. It is to do with the ratios of LDL:HDL. LDL:HDL ratio above 5 and elevated triglycerides or high triglycerides:HDL ratio are a risk for cardiovascular disease. LDL levels alone wont tell you much and elevated LDL alone is not considered a reliable marker anymore for CV disease.
To learn more about cholesterol and lipids watch my interview with Glyn Wainwright who is a biochemist and has studied cholesterol for 15 yrs.
This dyslipidemia along with high GGT is a very good indicator of insulin resistance, so it is actually telling you about your insulin sensitivity / resistance, as research now shows that high blood sugar, elevated insulin and insulin resistance are the culprits in heart diseases, rather than cholesterol or saturated fat. 
When the liver becomes insulin resistant this correlates with visceral (abdominal) fat building up around and in the organs, which can happen to slim people too.
An insulin resistant liver will mean higher blood sugar, blood insulin as well as high blood pressure. For people which high blood pressure with no obvious cause (idiopathic) it has been found to be linked to insulin resistance hyper insulinemia , meaning sugar is the issue NOT salt, to lower blood pressure insulin levels need to be lowered.
What else can I get tested along with GGT to determine my risk for diabetes or heart disease?
As heart disease is linked to blood sugar levels, fasting blood sugar can give useful insights into metabolic health. Blood sugar can be unexpectedly high in the morning ‘The Dawn Effect’ in a non diabetic person so multiple readings should be taken to get the full picture. Testing blood sugar after meals will also give an indication on how well your body deals with glucose. You can buy your own blood glucose monitor so does not require many visits to the doctors.
|Below 5.5 mmol/l
Below 100 mg/dl
|5.5 to 6.9 mmol/l
100 to 125 mg/dl
|7.0 mmol/l or more
126 mg/dl or more
To measure fasting serum insulin levels you do need a blood test from the doctors and it should be below 25mlU/L or 174pmol/L. Other factors can give rise to elevated insulin which include;
- Acromegaly or too much growth hormone for a tumor or supplementing
- Cushing’s syndrome
- Drugs such as corticosteroids, levodopa, oral contraceptives
- Fructose or galactose intolerance
HbA1c is another common blood test you can get to investigate blood sugar levels and this measures glycated haemoglobin (haemoglobin with glucose attached). Haemoglobin is a protein within red blood cells that carries oxygen throughout your body and measuring how much glycated haemoglobin (HbA1c) there is, clinicians are able to get an overall picture of what your average blood sugar levels have been over a period of weeks/months.
|Normal||Below 42 mmol/mol||Below 6.0%|
|Pre-diabetes||42 to 47 mmol/mol||6.0% to 6.4%|
|Diabetes||48 mmol/mol or over||6.5% or over|
Heart disease tests
Another very useful test or investigation to catch heart disease early is a coronary artery calcium (CAC) scan, which is an ultrafast computerized tomogram (CT)provides pictures of your heart beating that can enable your doctor to detect and measure calcium-containing plaques (blockages) in the arteries.
What are the consequences of not having these tests?
Without being morbid, a heart attack or death. We all know someone who suddenly had a heart attack out of the blue who appeared fit and health on the outside.
What makes people have elevated GGT?
The liver can be damaged by many factors such as infection, drugs and alcohol. Some people have a genetic predisposition to liver damage.
Dietary factors which elevate GGT
- Excess fructose/sugar/starches particularly processed starch like white flour, corn flour and high fructose corn syrup
- Excess inflammatory Omega-6 from cheap processed vegetable oils like soy, canola, peanut and other seeds
- Not enough omega 3, vitamin D3, sunlight, vitamin K2 and Magnesium.
As I said previously GGT reports on insulin resistance as they are biochemically intertwined so the same factors listed above cause people to become insulin resistant, inflamed and fat
What Can I Do?
For the average person who drinks moderately changing diet will make the biggest difference particularly eliminating sugar, fructose and omega 6 (vegetable oils), and cutting down on starches. Eating more healthy fats such as grass fed butter, coconut oil, avocado oil and other non processed saturated fats. So this would mean following a low carb, ketogenic or carnivore diet.
Some clinicians and scientist now believe that fructose found in some sodas are almost as bad as alcohol for the liver, as previously fatty liver was blamed on alcohol consumption.
Fasting and intermittent fasting are also great ways to lower blood sugar, insulin and GGT. Watch my video to learn more about how to fast and the health benefits it offers.
Dr David Unwin, in the UK, uses GGT as a marker and tracked 120 patients who followed a low carb diet for a year and as GGT lowered all other markers (eg LDL:HDL, Blood sugar, body fat %, serum insulin) also improved.
Following the correct lifestyle changes patients will see a drop in GGT in a matter of weeks, so fatty liver and insulin resistance can be reversed. The amount of time it takes to reverse these conditions will vary from person to person and can take up to a year for some.
1. GGT and Disease https://www.ncbi.nlm.nih.gov/pubmed/30580846
2. High Serum Insulin links to disease https://www.ncbi.nlm.nih.gov/pubmed/9472456
3 . Fat, Sugar, Whole Grains and Heart Disease: 50 Years of Confusion