A while back I wrote about various ways a heart’s function can become compromised. Think of the heart as having electricity, carpentry and plumbing. Today’s post focuses on the plumbing. Heart attacks are a plumbing problem, a blockage in the blood vessels, or pipes, of the heart. Yes the heart has its own blood supply. Blockages are caused by a clot, or a thick layer of plaque. If blood can’t pass through a vessel, then all the cells beyond the blockage quickly become starved for oxygen, after which they die. This is a heart attack.

The risk of a heart attack is markedly increased by diabetes. High blood sugars cause blood vessel walls to stiffen. The higher your blood sugars, the faster the blood vessels harden. The longer blood sugars remain high, the more quickly hardening occurs. So the less well-controlled your diabetes, the harder your arteries become and the worse your circulation gets.

This problem affects more than just the coronary arteries. Once arteries start to harden, it’s a problem everywhere. Each of these complications has its own name. Blockages in the heart cause heart attacks. Blockages in the brain cause strokes. Blockages in the legs cause peripheral vascular disease, followed, if the disease becomes severe enough, by amputation. Blockages in the kidney cause renal insufficiency, leading to end stage renal disease. Blockages in the retina of the eye cause diabetic retinopathy.

These are not exactly separate diseases. They are one disease with a variety of manifestations depending on location. And they start with a problem called hyperinsulinemia.

Hyperinsulinemia, also called metabolic syndrome, is a pre-diabetic state, and an underlying cause of type 2 diabetes, high blood pressure, high triglycerides and low HDL, polycystic ovarian syndrome (PCOS, a cause of infertility in young women), and obesity. High insulin levels also stiffen blood vessels.

Long before people are diagnosed with diabetes, their bodies cope with elevated blood sugars — occasional at first and then more frequent — by releasing extra insulin to manage the blood sugar spikes. But, over time, high blood sugar itself causes resistance to the insulin, which results in the need to release even more insulin. Unfortunately, it becomes a vicious cycle. Rising blood sugars require ever greater amounts of insulin to clear, and the amount of circulating insulin continues to rise in order to keep blood sugars in the normal range. Think of this as compensated high blood sugar. 

But if a person continues to eat, move and live in exactly the same way, making exactly the same choices, the day finally arrives on which they are no longer able to make enough insulin to manage their ever-rising high blood sugars. Technically speaking, this would be their first day of diabetes. After this day, blood sugars begin to rise even higher and faster. The body is still releasing loads of insulin, but it is no longer enough to keep blood sugars in the normal range. This would be uncompensated high blood sugar.

Diabetes increases the likelihood not only of heart attacks, but also of stroke (brain arteries), amputation (leg arteries), kidney disease and dialysis (renal arteries), blindness (retinal arteries), dementia (small vessel ischemic disease, or hardening of the small blood vessels in the brain), and erectile dysfunction (penile arteries). Hardening of the arteries also causes erectile dysfunction, which is why it is considered a proxy for heart disease. Hardening of the arteries anywhere increases the risk of hardening of the arteries everywhere.  

Blood sugar issues often begin years, even decades, before people are diagnosed with diabetes. For a long time, their blood sugars spike after they eat, and then take too long to return to normal. For all that time, damage slowly accrues. People diagnosed with diabetes are thought to already have ten years worth of damage to their blood vessels at the time of their diagnosis. In other words, we diagnose diabetes ten years after it really starts. I dream of a time when the paradigm changes so that doctors recognize diabetes before the damage begins. Consider what it would mean to identify people who are just entering that ten-year period. To diagnose people at the beginning of those ten years would protect patients from ten years of damage to their blood vessels. Otherwise, as the years go by, arteries continue to harden.

If you would like to reduce your risk of hardening of the arteries, one thing you can do is to reduce your consumption of stripped carbohydrates and manufactured fats as you shift your diet in the direction of more fruits and vegetables, more nourishing fats, and more high-quality protein. You don’t have to do it perfectly, just a little more than you used to.