Heart Disease Made Worse By Having Diabetes Ongoing high blood sugar levels create an inflammatory cascade of health concerns

Let’s get straight to the point about this—there is no question that diabetes greatly increases the risk of heart disease. According to the American Heart Association (AHA), at least 68 percent of diabetic adults who are 65 and older die from heart disease, and about 16 percent die from stroke. In addition, adults with diabetes are up to four times more likely to die of heart disease; the AHA considers diabetes to be one of the top seven major risk factors for cardiovascular disease.

The latest diabetes statistics from the Centers for Disease Control (CDC) are rather alarming: 34.2 million Americans—1 in every 10—have diabetes, and 88.8 million adults—1 in every 3—have prediabetes, though many aren’t aware of their condition. And for the ten-year period between 2008 and 2018, the number of young Americans under age 20 who have been diagnosed with type 1 and type 2 diabetes has “significantly increased”.

The CDC goes on to state that diabetes and heart disease “go hand in hand”. Having diabetes doubles a person’s risk of having a stroke or heart attack at a younger age, and that risk increases the longer a person has diabetes. Conditions such as high blood pressure and high cholesterol are also common in diabetics—both of these can be precursors to cardiovascular disease (CVD).

How Does Diabetes Lead to CVD?

Diabetes creates risk factors for a number of other conditions that can lead to heart disease. High glucose levels associated with diabetes damage blood vessels by lowering the levels of nitric oxide in blood vessels; nitric oxide molecules (vasodilators) serve the extremely important function of relaxing inner blood vessel muscles, allowing them to widen, thereby increasing blood circulation. When nitric oxide levels decrease, muscles in veins and arteries tighten and narrow, restricting blood flow.

Ongoing high blood sugar levels can also weaken capillaries that supply nerves with nutrients and oxygen. This leads to autonomic neuropathy, a condition that interferes with brain-organ-nerve messaging and damages the nerves that control involuntary bodily functions and internal organs, including those that control the heart itself. Blood vessels that supply nourishment to the nerves are also damaged, and problems with blood pressure and heart rate, as well as other organs and vital functions, can also develop.

Some of the symptoms of autonomic neuropathy, a frequent indicator of diabetes, include:

  • lightheadedness, dizziness or fainting upon standing or when physically active
  • rapid heartbeat
  • sudden increase or decrease in heart rate
  • inability to feel chest pain during a heart attack or when the heart is oxygen-deprived
  • change in breathing patterns
  • change in sleep patterns
  • slower stress reactions
  • digestive problems
  • bladder function
  • sweating too much or too little, causing body temperature irregularities

Lifestyle Risk Factors for Developing CVD

Certain lifestyle risk factors are known to lead to cardiovascular disease, and these risks are increased in those with diabetes.

It’s common knowledge that smoking leads to a myriad of health problems; besides the increased risk of causing heart disease in general, both smoking and diabetes cause blood vessels to narrow, restricting blood flow to the heart and creating an elevated potential for heart disease and damage to blood vessels. When blood flow to the heart, organs and muscles is impacted, it becomes more difficult to exercise or engage in normal physical activities, which is another contributing factor to diabetes-related CVD.

High blood pressure, a common health condition in diabetics, forces the heart to work harder, which damages blood vessels and puts a strain on the heart. Both of these resulting issues can lead to CVD, including heart attack and stroke; having both hypertension and diabetes doubles the risk of developing cardiovascular disease.

Insulin resistance, typically not tested for by conventional medicine prior to a diagnosis of diabetes, can be associated with a lipid disorder. Obesity is not only a major risk factor for developing CVD, it can also cause insulin resistance and is a cause of high blood pressure. The American Heart Association states that “insulin resistance or diabetes in combination with one or more” other risk factors mentioned here put individuals at “even greater risk of heart disease or stroke.”

Not getting enough regular physical activity, which has become a common problem today, can lead to becoming overweight or obese, especially if a sedentary lifestyle is coupled with poor dietary choices such as processed or fast foods and diets high in sodium and/or sugars. Lack of physical activity can also lead to insulin resistance and high blood pressure.

As you can see, each individual risk factor above contributes to other risk factors, so taking steps to manage or eliminate even one, such as high blood pressure or smoking, can help reduce the chance of developing others. But the good news is that every one of these risk factors can be reversed, managed or improved without the use of medications, which can create new health issues.

Conventional Medicine vs. Functional Medicine Approach

For conventional medicine, a comorbidity scenario (diabetes coupled with CVD) goes something like this:

  • A patient taking one or two medications for diabetes begins experiencing occasional chest pain when he’s exercising or physically active.
  • He is diagnosed with some form of CVD and given a diagnosis-dependent prescription, possibly a beta blocker for arterial plaque, as well as a statin.
  • He’s also told to take one aspirin daily. A recommendation for low-fat, low cholesterol diet modification as well as regular physical activity is given and he’s sent home.
  • Months later, when his blood pressure remains high, a new medication to lower blood pressure is added to the existing medication mix, and when that causes leg swelling, he’s prescribed a water pill.
  • This patient is now on a cocktail of six or seven medications that can cause serious side effects (some of which require hospitalization) or lead to additional health issues like psoriasis, muscle pain and weakness, heart irregularities and more.

Should a heart attack occur anyway, which many times is the case, a surgical procedure is likely performed. However, the patient may be left with a general feeling of tiredness and an inability to engage in normal physical activities without becoming short of breath. This is called congestive heart failure.

  • At this point, the dosage of prescribed diuretic is increased and will likely negatively impact kidney function.
  • Since he’s no longer able to enjoy fulfilling activities and has more health issues than ever, the impact on the patient and his family can take a psychological toll, resulting in depression.

The above scenario may seem extreme, but it’s not out of the ordinary.

A holistic, functional medicine approach

When the same diabetic patient with CVD who is taking the same initial two or three medications visits a functional medicine doctor, that doctor will investigate further. The patient’s health history, current health issues, lifestyle, stress levels, stressors and more are examined during an hour-long initial visit. During this discussion, the doctor will look at the whole timeline, including paperwork, and begin to uncover underlying root causes like high blood pressure, high glucose levels, inactivity, etc. For example, there could be a significant amount of stress for the patient that is taxing his adrenals. Or, workplace pressure that causes significant amounts of stress eating.

A functional medicine doctor would look at how the heart is affected by toxicity (or, the inability to properly detoxify), microbiome imbalances, food allergies and sensitivities and more. Coupled with comprehensive blood work, a functional doctor ferrets out important avenues of inquiry using independent, functional laboratories that examine more than blood chemistry. So, gut microbiome, DNA testing, hormone analysis, organic acids, and so on.

The results of these provide insights that can be dealt with naturally through various dietary corrections and supplementation. Over time, problematic symptoms can disappear or become minimal and manageable; in many cases, medications are no longer necessary or may be significantly reduced. New health problems due to adverse reactions to over-the-counter or prescription medications can be avoided and deteriorating conditions can be reversed.

While the connection between diabetes and cardiovascular disease is undeniable, it is not inevitable if the proper course of action is taken. Further complications due to diabetes-related CVD can be avoided, managed, or reversed without the risks presented by medications.

Beyond Diabetes: Insulin Resistance a Precursor to Cardiovascular Disease Functional medicine imparts new wisdom into how Insulin resistance affects heart health

Most of what we usually hear regarding insulin deals with medications you can take that lower your risk of developing type 2 diabetes, and less about the deleterious effects of the disease, or what blood sugar really is, and how our bodies use it for fuel. Insulin resistance also has been found to be a “major underlying abnormality driving cardiovascular disease” (National Institutes of Health, August 2000), including heart attack and stroke. Unfortunately, most patients don’t even fully understand the warning signs or the symptoms, as insulin resistance is considered a common health problem in the United States. The predominance of those who have insulin resistance—many times unbeknownst to them—is continually increasing.

What is Insulin Resistance?

Insulin resistance is a metabolic disorder characterized by extreme fatigue after meals, brain fog and similar slowing down of metabolism that leads to weight gain, high blood pressure, and lack of motivation. In a technical sense, the body doesn’t allow insulin into the cell, especially to brain cells, where glucose is the primary fuel. This isn’t something that happens suddenly—it’s a slow process caused by any of the factors listed below (primarily high-sugar and high-carb intake) as more insulin is needed by your body to keep your blood sugar at the right level. That said, it affects children in early, pre-pubescent childhood. Another misconception is that everyone with insulin resistance or elevated blood sugar is heavy or fat.

The inability to regulate blood sugar sets off an inflammatory cascade that leads to cardiovascular disease in a couple of different ways. One way this can happen is when insulin resistance alters a person’s systemic lipid metabolism, which then leads to high levels of triglycerides, small dense low-density lipoproteins, and low levels of high-density lipoprotein; this combination contributes to the formation of plaque in the arteries and vascular damage.

Another contributor to arterial plaque formation caused by insulin resistance is endothelial dysfunction, which is a type of coronary artery disease where the large blood vessels on the surface of the heart narrow instead of opening. Evidence of the fact that insulin resistance can directly lead to the formation of fatty plaque in arteries was borne out in the Insulin Resistance Atherosclerosis Study.

Hyperinsulinemia—when the amount of insulin in the blood is higher than normal—can lead to salt and water retention in the body, which in turn leads to hypertension, a condition that can cause heart failure, coronary artery disease, heart muscle thickening, and other cardiovascular diseases. Insulin resistance can also be at the root of obesity, high blood pressure, and high cholesterol—when all three are present, it’s called metabolic syndrome—which are all known to cause cardiovascular disease. Because insulin resistance can be at the root of these and so many other different types of cardiovascular issues, it’s considered a “multifaceted syndrome that increases significantly the risk for cardiovascular disease” (National Institutes of Health).

Risk Factors for Developing Insulin Resistance

There are a number of factors that can lead to insulin resistance, including:

  • high carbohydrate diet
  • sedentary lifestyle
  • diet high in sugars
  • trans-fats in the diet
  • obesity
  • smoking
  • hormonal disorders
  • poor sleep
  • certain prescription medications
  • out-of-balance gut microbiome
  • diet low in healthy fats
  • chronic stress
  • environmental toxins

These risk factors, among others, cause oxidative stress and damage insulin-making beta cells in the pancreas, as well as triggering insulin resistance. Hyperglycemia occurs when the pancreas can’t manufacture enough insulin, leading to oxidative stress, which then contributes to a number of health issues including vascular damage.

Conventional Approach vs. Functional Medicine Approach

Unfortunately, conventional medicine doesn’t usually monitor insulin resistance or take action until a person’s blood sugar numbers reach dangerous levels or they have a full-blown cardiac or diabetic event. The standard approach is to “watch” rising blood sugar levels, monitoring them periodically through fasting blood tests until a high-risk level is reached. However, insulin levels are not typically taken at all, yet they can rise before blood sugar, serving as an indication to take action. On the other hand, there are cases where blood sugar levels are normal but insulin levels are very high—these risky insulin levels are not usually found by convention medicine because doctors are not testing for them. The resulting cardiac event will then be treated, but attention may not be paid to the underlying cause of insulin resistance.

Standing by and watching a person’s health deteriorate until it reaches a crisis level is not and never has been the approach used in functional medicine. The loss of sensitivity to insulin is progressive and would be spotted by a functional medicine doctor through regular comprehensive lab tests that pick up the problem early in its development. If a patient already has insulin resistance, a case-specific plan can be put in place to pinpoint the areas where corrective action needs to be taken in order to reverse the condition—without dangerous medications.

This Single Ingredient Is Damaging to Heart Health Added sugars—not fats—are behind the high rates of heart disease

For decades, Americans – and people around the world – were led to believe that fats were the true evil behind cardiovascular disease. Doctors preached that a protein-packed breakfast of eggs and meat should be replaced by whole grain cereals and other carb-based choices. But now JAMA Internal Medicine, the American Heart Association and the British Heart Foundation report that it is actually added sugars, not fats, that contribute to an increased risk of cardiovascular disease.

Many people don’t realize how much sugar they’re ingesting on a daily basis, mainly because they’re used to unhealthy choices being a regular part of their lives. Sometimes consumers don’t realize how much added sugar is actually in the products they’re eating, and other times packaged or processed products contain hidden sugars, which can be labeled with about 60 different terms that can be unrecognizable or have healthy-sounding names.

Sweetened drinks like sodas, sports/energy drinks, bottled iced tea drinks, specialty coffees and others top the list of the most heavily consumed sugar-added products. For perspective, a 12-oz. soda can contain anywhere between 9-1/2 to 12-1/2 teaspoons of sugar – if you drink a 16 oz., 20 oz. or larger container or if you have more than one soda per day, you can see how quickly your sugar intake increases just from soda alone. Then add in even more sugar from these commonly consumed culprits (and many others):

  • Sweetened breakfast cereals and oatmeal mixes
  • Jams, jellies, preserves, honey, spreads, syrups
  • Cakes, candy, cookies, etc.
  • Low-fat yogurts with sweetened fruit at the bottom
  • Pre-made sauces and gravies
  • Other processed foods like packaged meals.
  • Juice drinks, including green drinks, apple juice, orange juice, and so on

There are a few different ways that sugar takes a toll on heart health. First and most obviously, an excess of sugar can lead to becoming overweight or obese, both of which are known to increase the risk of heart disease. But regardless of weight, sugar also raises blood pressure and creates inflammation in the body, which is associated with an increased risk of cardiovascular disease, cancer, and other health problems.

The Conventional Approach Leads to Skyrocketing Cases of Heart Disease and Diabetes

The American Heart Association has revised its recommendation for sugar consumption, stating that women should have less than 6 teaspoons of sugar per day and men should consume less than 9 teaspoons per day. One small 12 oz. soda already exceeds both of those numbers. But does anyone really understand how serious the numbers are or what that recommendation means?

The amount of sugar being consumed by most people is staggering. JAMA reports that most adults consume 10% of their calories from added sugar. That added sugar crowds out other nutrient-dense calories and only contributes to our already elevated societal-wide sweet tooth. What’s worse, one out of every 10 adults get a whopping 25% or more of their calories from added sugar. In many cases, not because of personal choice but because they have limited food options. Sugar is cheap. When researchers compared these two groups to people who get less than 10% of their calories from added sugar, there was a significant difference in cardiovascular disease rates and mortality.

Just how serious are these numbers? The study showed that adults who consumed a fifth of their caloric intake from added sugars had more than twice the risk of a heart attack. Even more staggering: those with the highest sugar intake raised their risk of cardiovascular disease by 400%. Those are some pretty serious numbers.

Functional Medicine’s Focus On Food as Nourishment, Not Entertainment

Most children, teens and adults are consuming far more added sugar than is considered safe, but the good news is that it’s easy to find healthy alternatives that will benefit you in multiple ways and begin to reverse the effects of added sugars. For some families, it’s as easy as making better decisions at the grocery store to replace sugary snacks with fresh fruits, seeds, nuts and the like, squeeze citrus fruits into sparkling water or cold still water to replace soda and “enhanced” waters, and use fresh vegetables, rice and meats rather than frozen or prepackaged products. For countless others it’s about knowing what constitutes a healthy option on the go, and how to plan and prepare small snacks for throughout the day that contribute to blood sugar stability. And for too many, it’s about overcoming food scarcity and pushing back on the amount of processed white flour and sugar that is provided at meals.

This is where functional medicine is helping to change the healthcare landscape. Not only is it possible to work with a doctor who can individualize the best approach; but through functional medicine, food (not calories) are seen as an essential strategy to restore health, avoid medications, and recover from illness.. In part, a functional medicine doctor will run comprehensive lab tests that include glucose and insulin, , blood pressure readings, testing for overall carbohydrate and essential fatty acid metabolism, and so on . These tests will not only help guide decision making about food and food timing, but will advocate deeper connections and causes for disease than standard allopathic models do. Together, with your doctor you determine additional risk factors for heart disease and diabetes in order to take a holistic approach to address any underlying factors you may not even be aware of and put you on the path to whole body wellness.

Dr. Doug Pucci is a functional medicine practitioner who was honored in 2020 to receive both The Best Of 2020 Awards for Functional Medicine in Oradell, NJ, and entry into Trademark Publications’ Who’s Who Directory, Honors Edition, for his pioneering work. He provides comprehensive testing for health biomarkers, advanced discovery into brain/body well-being and personalized nutrition for a diversity of people and symptoms.

For more information, call 201-261-5430 or visit