How Diabetes Destroys the Body – Jesse Santiano M.D.

Part 1: Deranged Apoptosis of the Endothelium

All good things come to pass. Like the cells in our body. Cells that are old and lose their functions die. Apoptosis is programmed cell death. It is built into the genes. In ancient Greek, apoptosis means “falling off.” A type of white blood cell called the macrophage then comes in and eats (phagocytose) the old cells as they apoptose. Phagocytosis came from the ancient Greek word phagein, meaning ‘to devour,’ kytos, meaning ‘cell,’ and -osis, meaning ‘process.’

The white blood cell that assumes the role of the phagocyte engulfs the broken up dead cell and recycles the nutrients for later use. Apoptosis gets rid of cells that may be precancerous, damaged, and useless. In turn, new cells are made and take the place of the old ones.

Structural Organization of the Body

Cells make up tissues. Tissues make up an organ. Organs become systems. Systems together make up the body.
An example will be cells forming a muscle fiber. Muscle fibers become a muscle. The muscle works together with the bones and becomes the musculoskeletal system. The musculoskeletal system works with the blood vessels (vascular system) and nerves to make muscle contraction and movement. If the process of apoptosis is working, then you have new cells being developed every day, that are functioning correctly to create a well-functioning tissue, organ, organ system, and body.

The Never-Ending Renewal

The renovation in the body is thorough. It is not just a paint job where only the visible parts are made to look new. The repair goes down to the simplest elements. All this happening in a complex system in real-time. It is like changing the rivets in the wings of a Boeing 747 while flying 45,000 feet in the air. That is how amazing the body is.

Apoptosis Balance

Apoptosis can be affected by many factors. Cell death and cell proliferation should be in balance. In cancer cells, where there is less apoptosis, the cancer cells multiply. In a neurodegenerative disease like Parkinson’s disease, the apoptosis goes unchecked, and the early and excessive demise of healthy tissues happens.

For the purpose of this blog which is all about how to get and stay healthy and avoid diseases, especially the metabolic syndrome, we will focus on fasting and diabetes as examples.

Normal Endothelial Function

The endothelial cells multi-task. They have to be in a single layer and thin enough so that they can filter nutrients. They ensure that the blood is flowing and unnecessary clotting is avoided. They are responsible for the blood vessel tone so that the arteries can adjust their size depending on the supply and demand for blood and nutrients. If there is an injury, the endothelial cells call upon the white blood cells (neutrophil recruitment) to clean up and repair. Hormones are also secreted by the endothelial cells for communication and coordination for all these tasks. So you can imagine that the endothelial cells can get worn out and want to retire someday. That awaited day is when apoptosis happens.

Diabetes and Apoptosis

In situations with high blood sugar (hyperglycemia) that you see in the metabolic syndrome and diabetes, the inner lining of the blood vessels (endothelium) is prevented from doing apoptosis. The endothelium made up of a single layer of cells. The blood passing by brings oxygen and nutrients to other parts of the body. That is why blood must reach their destination without a problem. If blood does not flow, you have organ malfunction and even cell death (infarction) like heart (myocardial) infarction or brain (cerebrovascular) infarction.

In diabetes, there is an imbalance in apoptosis, so the old cells stay, and the new ones cannot do their job. Instead of a single layer, the cells pile up. The endothelial cells become thick and cannot filter the nutrients well. The cells within the blood, passing by start sticking to each other. The blood vessels cannot make adjustments in their diameter to meet the everchanging supply and demand. The communication between the cells lines made possible by hormones is down. No synchrony. No coordination. No harmony. It is all a terrible mess. Ineffective cells result in an inefficient organ system and result in disease.

That is how end-organ complications develop like blindness (diabetic retinopathy), renal failure (nephropathy), and heart attacks and strokes from blockages of the artery (atherosclerosis) and blood clots within (thrombosis) the blood vessels and blood clots dislodged (embolism) from the thrombus.

There are multiple other mechanisms on how metabolic syndrome and diabetes damage the blood vessels. This apoptosis derangement is only one.

This article is part of a series of different mechanisms on how diabetes damages the blood vessels.

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