I was out for a run in the small, Arizona town where I live, and saw a friend of mine I know from my weekly poker game. He was smoking a cigarette. I nodded hello to him as I ran by. He nodded back, took a drag of his cigarette then, when I was right up on him, he said, “Jim Fixx.”
I stopped for a moment to have a thought about the author of The Complete Book of Running. Fixx dropped dead of a heart attack while out for a run one day. Then I continued on.
Recently, I had a stent—a lattice tube placed in an artery to open it if it’s clogged—placed in my heart. Jim Fixx, indeed.
After running thousands of miles and many marathons, including the Boston Marathon repeatedly, Fixx died of a heart attack, in 1984, at the age of 52. I, after having run thousands of miles and many marathons, including Boston and the New York Marathon repeatedly, got a stent put into my right coronary artery at the age of 53. The reasons that Fixx suffered a heart attack, most likely were because he had been a heavy smoker for years before he began running, and he had a genetic predisposition to heart disease. Me, on the other hand, I have diabetes.
When it comes to heart disease and heart attacks, diabetes – both type 1 and 2 (I have had type 1 diabetes for 41 years) – is probably worse than smoking two packs a day for twenty years. At least, that’s what many doctors and many websites say about the situation.
When I spoke to my cardiologist, before my stent procedure, he said that he was caring for a type 1 diabetic patient who was younger, and seemingly healthier, than me. He said his patient received a stent once every three, or four, years. After telling me this, my doctor shrugged, as if to signify that this was simply the way it is for people with diabetes.
People with diabetes don’t really die from diabetes. They often die from one, or several, health complications caused by diabetes. The results of these complications, such as kidney failure; blindness; nerve damage, or neuropathy; and even amputation, lead to serious health problems that curtail life. The biggest of these complications, the most prevalent one, is heart disease
“Heart disease strikes people with diabetes at significantly higher rates than people without diabetes,” according to an article in The New York Times, which pegged that number at two times the rate for people without diabetes.
People with diabetes die of heart attacks more often than people without diabetes. Such a statement naturally begs the question: Why?
In the same New York Times article, Dr. Robert Gabbay, chief medical officer at Joslin Diabetes Center in Boston, provides the answer: “And we don’t fully know why,” he said.
Comforting. Certainly, a lot of it has to do with hyperglycemia.
Some articles suggest that people with type 2 diabetes who are overweight are more prone to suffer from heart disease.
That sounds, you know, fair enough. But, when you really take a look at it, it’s sloppy Internet “science” that suggests having the cause of the condition dictates the effect of the condition that dictates the result of the condition, and… what?
Let’s think more clearly about this. According to an article published in October 2018, “A new Loyola University Chicago Stritch School of Medicine study reveals how, on a cellular level, diabetes can cause heart failure.”
Now we’re getting somewhere.
“In the Loyola study, researchers focused on a molecule called methylglyoxal,” the article said. “When the body transforms food into chemical energy, waste products are generated, including methylglyoxal. Normally, the body does an efficient job clearing out methylglyoxal. But the cleansing process does not work as well in diabetics, allowing methylglyoxal to accumulate. Methylglyoxal attaches to key building blocks of proteins, which can affect how the proteins function.”
Those proteins negatively impact “microscopic lattice-like structures called myofilaments cause heart muscle cells to contract. The cells work in concert to make the heart contract and relax with each beat,” the Loyola study revealed.
Now we have a cellular impact conjoining diabetes and heart disease. It’s the trigger, if you will.
So, how do we treat for that? Who knows? It’s only a study—as stalwart and well meaning as it may be—so it’s a mere baby step to an initial understanding of the cause and effect about how diabetes actually, and for real, impacts the function of the heart. But, it’s progress.
After I got my stent, I read more about Jim Fixx, and about how he died while running. Some said the running actually killed him. (Unlikely.) Others said he had partial, or almost, total blockage of his three major coronary arteries (and each one was truly, severely blocked), and that running extended his life beyond what it might have been otherwise. (Likely.)
There is a sense of impending, mortal fate when one is diagnosed, or even lives for decades, with diabetes. Each one of us deals with, manages, and even comes to terms with that odd sense of managed mortality, in his, or her, own way.
It can feel like an eventual death sentence. It can seem like one hears the muffled sound of a bell, far off, tolling.
At the time Jim Fixx died his lone option for dealing with his heart issues, had he been properly diagnosed, was a triple bypass operation. It’s a brutal, chest-cracking, get right with God, don’t-buy-any-green-bananas, procedure.
I got a stent. I went for a run yesterday. I’m fine.
That was an incredible article, Alex. Thank you so much for writing. I am also a type one diabetic newly diagnosed with a heart condition as well. I’m also an Ironman and have completed many other athletic feats. This can all get in your head and you can wonder if the hits will never stop with type one. I was comforted and motivated by this piece. Now on to my next adventure…
Thanks for the information. I have been wondering the same thing about heart issues and whether keeping blood sugars under control will help or not. I also love how you describe living with mortality every day – some of us hear that bell tolling for a long while.
Heart attacks can happen to anyone at any age and health condition.
I am a 47-year type 1 diabetic, and I’ve often considered myself very healthy in my approach to life – eating, exercise, stress management. I have always denied the recommendation to take a Statin drug. Recently, my new PCP was trying to get me to take the Statin drug, and as a compromise, we agreed that he was ordering a Heart Cathetization (test, I’m not yet sure what it tests), but I agreed to it. I still have to check what my insurance (ugh!!) coverage is on that, but the PCP said it would be free… Anyway, thanks for the… Read more »