More and more of what I read about diabetes implicates inflammation. So when Dr. Michael Jaff told me about its role in peripheral arterial disease (PAD) I took the opportunity to delve into what he could tell me about both inflammation and PAD.
Dr. Jaff is the medical director of the Vascular Diagnostic Laboratory at Massachusetts General Hospital and a specialist in treating PAD. My previous article here reported on our discussion of the role of exercise in preventing PAD, which is one of the complications of diabetes.
Inflammation is a broad term. It includes everything from peritoneal disease to muscle soreness and plaque in our arteries.
"We all think about inflammation as in inflamed joints after we exercise," Dr. Jaff began. "Things like that. But there is a fairly common pathway for all forms of inflammation."
We have certain cells that cause inflammation, and they are white blood cells. Most people think of white blood cells as those that fight off infection, but in fact white blood cells also promote inflammation, he continued. That's the body's response to dealing with an area of injury. For example, when we strain a muscle and the next day it's sore, it's likely that a little inflammation has developed.
"Plaque is also an area of injury," Dr. Jaff told me. "It is an injury to the inner lining of an artery, the endothelium. That injury, in simply terms, promotes inflammation -- the body's response to injury."
The problem is that the blood vessel is not accustomed to handling inflammation nearly as well as our joints can. Over time we might develop some fluid around a joint.
"If you just take a non-steroidal anti-inflammatory drug like Advil, everything goes away," he says. "That's not the case with artery disease."
Inflammation is a central problem with atherosclerosis in general. "As plaque begins to form, these intense inflammatory cellular infiltrates come to the area of damage and and make the plaque form faster."
But more importantly than that, the inflammation makes the plaque unstable, Dr. Jaff says. If that happens, it is more likely than to just cause a narrowing of an artery. It can actually cause a sudden rupture of the plaque and lead to a blood clot forming over the area of narrowing.
"When this happens, someone will change from either feeling totally well or having minimal symptoms to suddenly suffering a major catastrophic cardiovascular event, like a heart attack or a stroke," he warns. "Inflammation is a major player in how people go from being generally well to being suddenly facing a very serious and potentially mortal situation."
Clearly those of us who have diabetes need to take every step we can to minimize the inflammation in our bodies. This month I even had my dentist put in a new crown to close up a 6 millimeter pocket between two teeth. Because of that gap I had some periodontal inflammation that undoubtedly increased my blood glucose level.
Whole books are devoted to the thesis that inflammation causes diabetes. I don't go that far. But I know that when we can keep all forms of inflammation in check, we can control our diabetes more easily.