Chapter 11 

Despite nearly a century's worth of therapeutic innovations, the likelihood of a diabetic's contracting coronary artery disease is no less today than it was in 1921, when insulin was first discovered. Type 2 diabetics can still expect to die five to ten years prematurely, with much of this difference due to atherosclerosis and what has been called an "extraordinarily high incidence" of coronary heart disease. 

Most believe the complications are caused by the toxic effect of high blood sugar, but this does not explain why atherosclerosis in diabetics has remained impervious to insulin therapy! 

Specialists have thought of diabetic atherosclerosis as if there is no relevance to general atherosclerosis and heart disease, as though knowledge on heart disease can come only from heart research to diabetology and not the other way around. 

An extreme example is the assumption that saturated fat is a problem for heart disease in diabetics as it is "for everyone", this led to the 1970s recommendation that diabetics eat more carbs, despite the absence of trials, and despite the evidence that carb restriction controls blood sugar. 

Research on metabolic syndrome suggests that knowledge should flow from diabetes to heart disease! 

Consider a continuum. This curve is marked by ever worsening disturbances of carbohydrate and fat metabolism, Type 2 diabetes lies on the end, but we all live on the same curve. The mechanisms that cause atherosclerosis are the same in all of us; only the extent of damage differs. Insulin resistance leads to diabetes and heart disease, but not everyone becomes diabetic. 

Raising blood sugar increases the production of reactive oxygen species (AKA oxidants/free radicals) and AGEs (advanced glycation end-products), both of which are equally toxic. Reactive oxygen species are generated primarily by the burning of glucose (blood sugar) for fuel in the cells. Glycation is where a sugar is haphazardly linked to a protein. These accumulate in the lens, cornea and retina of eye, kidneys, nerve endings, and artery lining. Also collagen, making skin look prematurely old in diabetes. It is a form of accelerated aging, like the toughening of leather in body tissue. Part of the problem with diabetes, and aging in general, is you end up with stiff tissue: stiffness of hearts, lungs, lenses, joints... that's all caused by sugars reacting with proteins. 

AGEs also cause oxidation of LDL particles. Oxidized LDL and cholesterol trapped in the artery wall resists normal removal from circulation. 

Glycation is a critical factor in diabetic complications and heart disease, and has been linked directly to both diabetic complications and aging itself, and AGE accumulation correlates with the severity of symptoms.  That glycation and AGEs are critical factors has recently been demonstrated by experiments with compounds known as anti-AGE compounds or AGE breakers. These will reverse arterial stiffness, and ameliorate the adverse cardiovascular and kidney-related changes associated with aging, diabetes and hypertension. Whether these or similar compounds will work in humans remains to be seen. 

When biochemists discuss oxidative stress, glycation and AGEs, they often compare what's happeing to a fire simmering away in our circulation. The longer the fire burns and the hotter the flame, the more damage is done. Blood sugar is the fuel, as the ADA recently stated. 

But there is no reason to believe that glucose-induced damage is limited only to diabetics, or those with metabolic syndrome. Glycation and oxidation accompany every fundamental process of cellular metabolism. They proceed continuously in all of us. Anything that raises blood sugar - in particular, refined carbs - will increase the generation of oxidants and free radicals; it will increase the rate of oxidative stress and glycation, and the formation and accumulation of AGEs. This means that anything that raises blood sugar will lead to more atherosclerosis and heart disease, more vascular disorders, and an accelerated pace of physical degeneration, even in those of us who never become diabetic!