People with diabetes are at an increased risk for cardiovascular disease – coronary heart disease, cerebrovascular disease, & peripheral artery disease. But why?
by, IDS Director of Lifestyle and Nutrition, Jenny Smith
People with diabetes are at an increased risk for cardiovascular disease – CVD, defined as coronary heart disease, cerebrovascular disease, and peripheral artery disease (PAD). But why?
The pathophysiology (exactly what leads to it) is poorly understood due to the majority of data coming from Type 2 diabetes (T2D) or analysis of all people with diabetes without distinction to T1D vs T2D.
What we do know is that food is a major player in heart disease risk even without diabetes.
Due to the fluctuations in glucose that occur with diabetes, this is one factor that research has shown increases CVD risk.
Food has a direct impact on BG levels. If insulin isn’t timed well and medications are poorly adjusted, the rise in BG in the bloodstream above established targets (from those without diabetes) causes damage to the inside of the vessels as well as on the nerves. The more damage, the more the body must try to fix it. Think of the vessels like a straw. If you damage the inside, you create the potential for a leak. If you patch that, and it gets damaged again the more patches you add, the smaller the inside of the straw/your vessel gets. This smaller space makes it harder and takes more pressure to push fluid through and the same happens for the vessels that carry blood. The more patches to the damage and the narrower the vessel becomes. The harder the heart pumps to push blood through the more blood pressure (BP) goes up, inflammation in the body increases and blood markers of CVD increase.
As I noted before, food plays a major role in heart disease. We need more studies directly in T1D to provide specific strategies and management approaches that will directly benefit those with T1D. Current approaches to reducing CVD come mostly from what has been done with or without success in T2D.
An article in Healio reported research from a 6-year study comparing half the participants with T1D to the other half without. The evaluation used a food frequency questionnaire to calculate and compare nutrient intake over the 6-year time. Diets evaluated included the Mediterranean plan, the DASH diet and the AHEI (alternative healthy eating index) – all are typically recommended in the management of established CVD.
Within the evaluation of dietary intake was an analysis of blood markers that show inflammation associated with CVD risk. These included c-reactive protein and homocysteine to name a few. The research found evidence of high fat intake (mostly saturated animal fat) in those with T1D which was assumed to be related to trying to reduce carbohydrate intake. Compared to those whose dietary report suggested eating habits close to the Mediterranean and DASH diet, those who had high fat intake from reported sources of high-fat animal foods fared worse in terms of CVD risk.
Interestingly, this begs further evaluation for those with T1D in regard to dietary fueling strategy and education. Not only from a standpoint of glycemic management but also in terms of prevention or reduction of CVD risk. Some studies in lower carb/higher protein diets have shown improvement in cardiovascular markers, while some show no improvement in CVD but a major change in glucose and weight management. The question in this boils down to prevention vs healing once CVD is already present. If someone with T1D finds they have CVD does diet help to offset further progression, does it heal and put things back to a state of no damage? Or is prevention from the beginning the most important with the focus on glucose control to avoid the damage long term?
What is best?
Education for the person with T1D needs to be provided by a skilled clinician who can assist the person with T1D in an individualized approach.
Mediterranean diet may be beneficial for someone leaning toward a more plant-based diet that needs to be cleaned up (real food vs all processed). The same goes for someone who prefers more protein from animal-based sources. What often gets missed in the message is the details of how/why one plan proves to be beneficial vs another. The devil is in the details. Most people who are trying to follow a particular “diet” plan fail to follow through completely or to stick with it and this is what makes the difference in the end. If you follow Mediterranean or paleo or even Ketogenic, then know what you need to do, follow the plan and stick with it for the long haul. Evaluate your baseline of lab markers prior to starting and then evaluate again once you have the fueling plan consistent.
If you feel you’d like a detailed look at your own lab markers along with a diet overhaul that will be individualized, give Integrated Diabetes Services a call. We can help you pull all the details together to help keep your cardiovascular system in top shape…and this includes your diabetes management as well!
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