75% of the early deaths in diabetics are related to coronary artery disease. The mechanisms of arterial disease in diabetic patients appear to be multiple but increased levels of glucose and fructose play havoc with blood vessel walls. A cascading series of adverse events follows the onset of high blood sugar and can only be controlled by reduction of free sugar in the diet and comprehensive diet revision associated with increased exercise.
The risk of stroke is 2.5 times higher in people with diabetes. The mechanisms in diabetic patients appear to be multiple but increased levels of glucose and fructose injure blood vessel walls. A cascading series of adverse events follows the onset of high blood sugars. The problems of diabetics can be generalized somewhat to all people with atherosclerosis and other blood vessel diseases. Inflammation mediated by cells of the immune system and necrosis are the most striking features observed in patients with vasculitides. Small vessel vasculitides (SVV) are a peculiar group of systemic disorders electively involving small intraparenchymal arteries, arterioles, capillaries, or venules and leading to different levels of vascular obstruction, tissue ischemia and risk of infarction; they can be divided into anti-neutrophil cytoplasmic antibody-associated vasculitides and immune complex vasculitides.
Atherosclerosis is often referred to as "hardening of the arteries". This is actually a complex disease that involves tumor-like growths in the wall of arteries. These tumors accumulate high-cholesterol fat and grow to obstruct blood flow through the artery. As the fatty tumors age and grow, they become scarred and often calcified. Restricted blood flow to any organ reduces its ability to function and obstruction leads to death of tissue. Sudden obstruction of a narrowed blood vessel is often caused by a clot forming in a narrowed region of the vessel (thrombosis). If the tissue is vital, such as the heart or brain, arterial obstruction may be lethal or, at best, disabling.
Serum cholesterol is a predictor of coronary heart disease (but not strokes). Recommendations have progressed from target goals of less than 200 /dL to less than 100 for blood levels. "Normal levels" usually range from 180-300 /dL depending on age and sex. Strict vegetarians may have serum cholesterol levels of less than 100 /dL. Elevated blood glucose is associated with increased blood fat and is atherogenic. High glucose promotes the generation of free radicals in blood vessels, reduces the vasodilator effects of nitric oxide, and activates platelets to stick together, promoting blood clots. In addition to large artery diseases smaller blood vessels may develop inflammation that reduces blood flow. A prudent policy would be to reduce the sugars, sucrose and fructose, in the diet of all people at risk (that means almost everyone, including children). Other food-related problems, especially immune responses to food proteins (food allergies) may contribute. Delayed patterns of food allergy may occur in circulating arterial blood, damaging blood cells, vessel walls and triggering the clotting mechanism. The sooner diet revision is begun, the better.
More can be done to limit or prevent the cardiovascular complications of diabetes. Both MDs and patients tend to be complacent in the early stages of the disease and the penalty for neglect may be disaster. In a Canadian study, Ross et al found that only 30% of diabetes with hypertension received treatment for the high blood pressure; only 3% with serum cholesterol levels above 6.2 were on a diet or received lipid lowering drugs. They observed that patient compliance with treatment was poor - 90% of diabetics failed to use their medications as prescribed; 70% failed to follow diet guidelines and 50% with established heart disease dropped out of rehabilitation programs after a year.
Arterial pathogens in the food supply
Clearly, heroic efforts are more that justified to change life-style determinants of the disease early on so that the terrible consequences of neglected diabetes are avoided.
Adverse Consequences of Diabetes
Elevated Blood Fats
Some of the vascular disease can be explained as atherosclerosis and attributed to abnormalities in blood fats. A high sugar and fat in the diet of diabetics is a lethal combination. More than 60 % of non-insulin dependent diabetes have elevated blood fat levels.