Comment from one of our readers ...
I did find it interesting that your list of recommended books did not include any by Ornish, McDougall and others. But then I recognize that you stress the elimination of sugar while the others stress the reduction of fats. It seems to me to be different paths to the same place of greater health.
Mary Ann
Winnipeg, Manitoba
Discussion:
So much for genetics ...
My father had diabetes, my mother had diabetes and of course, you would expect that at some point, I would have it . Some would point to a "genetic" pre-disposition. I feel that it is much more likely a "lifestyle" pre-disposition. I drank a lot of cow's milk as a child and ate more than my share of "boxes of 24 Clark bars from the local Shell gas station."
The Eisenhower tunnel 1974
Driving through the Eisenhower tunnel in the fall of 1974 I had this "unusual" pain in my chest. I thought to myself then -could this be angina? January 1975 I would self-medicate myself through a bad episode of bilateral pyelonephritis (kidney infection). Fall 1990 on an attempted 20 mile run around Lake Wawasee in Indiana, I would stop at twelve miles due to severe chest pain into my left arm, relieved by rest. That afternoon still feeling bad, I would sit and wonder what they would do if I went to an emergency room. How could this be angina? I was in year thirteen of a daily running streak and had been vegan for all those years. About three years later, circa spring 1993, I headed out for a seven mile run from Broad Ripple in Indianapolis on the beautiful canal path, only to have to stop in the first half-mile. That is the first and last run I have ever had to stop anytime in the first mile. I had severe chest pain into my throat, left arm then right arm, then the whole upper half of my body. This was accompanied by some dizziness, disorientation and an extreme uneasiness. I managed to run / walk another six miles. I would rest for a while, let the pain subside, then run till it got bad again, and then rest.
The answer ...
I would have to wait until July 5th, 1997, to get my answer. On June 23 of that year I fell and broke the fifth metatarsal in my right foot. I managed to run the next day, but it was very painful. However, the fracture healed very rapidly. While at work on Saturday July 5th, I had one of the Radiology techs at St. Anthony's hospital take a film. I was right about the fracture as I had suspected. Being a Radiologist trained to look at the whole film, I as usual, examined the whole film. I couldn't believe it when I saw it. Atherosclerotic vascular calcification of the Monckeberg variety (diabetes), in my right foot. I expected to see that in films of other people, especially at VA hospitals, but never in my own foot.
The last "six pack of Pepsi and late night box of Mike and Ikes" ...
That was the end of my "almost a six pack of Pepsi every day" habit. That was my last late night box of Mike and Ikes. How could this be happening to me, a running vegetarian. I had been a great fan of Dr. Dean Ornish, the "black sheep" Cardiologist who now is not quite such a black sheep, who advocated a low fat vegetarian diet to reverse heart disease. I pulled his book out of my library and reread it and I quote, "There is no proven relationship between sugar and coronary artery disease." Something here is not quite right.
Sudden death from "heart attack" in diabetics
I remember from my medical school days the old adage that "approximately 50% of all people dying with their first heart attack with no prior history of coronary disease, would turn out to have adult onset diabetes mellitus." How can you explain that the days after my anginal episodes I would run normally with no angina as I still do "mostly" in the 26th year of my running streak? Significant obstruction of any of the major coronary vessels would not go away the next day. Why do so many people with diabetes die with unexpected and undiagnosed coronary disease?
Coronary arteries and arterioles
Coronary artery disease that we talk about is usually that which we can diagnose. To make the diagnosis, contrast is injected into the coronary arteries and then rapid sequence images are obtained. However, modern imaging techniques can only measure the larger vessels. To date, there is no way to image the extremely small vessels (arterioles) where the oxygen and nutrient transport takes place. There are basically two types of atherosclerotic changes. Those that occur around areas of normal turbulence, ie wherever an artery bifurcates, there will be some turbulence from boundary layer separation. I associate that type of change with animal protein and fat ingestion. Then there is the sugar induced calcification that involves the entire artery. It is systemic and generally speaking if you have it anywhere -you have it everywhere.
Stiff pipes ...
What does the calcification of the arteries and arterioles do? It causes the artery or arteriole to become stiff, rigid and "non-compliant." This becomes a rather significant problem whenever one ingests a large fat load, especially some of the bad fat loads that are out there today. The normally compliant arteriole can expand to let the larger fat molecules pass. The stiff, diabetic and non-compliant arteriole cannot accommodate the larger fat molecule and voila ... it becomes blocked. Does this cause angina? You bet! It blocks oxygen and nutrient transport as surely as a permanent lesion in one of the larger arteries proximal to the arteriolar level. There is however, one major difference -once the fat clears, if you survive, the blockage can be gone.
Don't be "half-right" ...
Before my first severe episode of angina I had eaten some fat (olive oil on toast) that I had never had before. About twelve miles into that run I had severe angina. The day before the worst episode in Broad Ripple, I had eaten a vegan scone in Bloomington, that was loaded with all kinds of bad fats. Most diabetics who die with their first heart attack usually have eaten a big meal, just before the heart attack occurs. Dr. Ornish is definitely right about eating low fat. But, that is only half of the equation. The other and very much the larger half, is NO SUGAR -PERIOD.
Thank you for your time.
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