The importance of vascular (blood vessel) health to overall health and longevity cannot be overstated. In fact, unhealthy blood vessels are at the root of some of our most common chronic diseases. The vascular system is responsible for delivering oxygen and vital nutrients throughout the body, and when blood vessels are damaged the tissues they supply suffer. The manifestations of vascular disease are varied, affecting many parts of the body and ranging from inconvenient to life-threatening. Some examples include hypertension, heart disease (our #1 killer), dementia, stroke, aneurysms, blood clots, and peripheral vascular disease, which can in turn cause leg pain and weakness, non-healing wounds, and sexual dysfunction.
Researchers and health professionals have known for decades that vascular disease is nearly entirely preventable, and often treatable, with meaningful lifestyle changes. Unfortunately, the ubiquity of these conditions has given the impression that they are a normal part of aging, leading many people to view them as inevitable. In reality, vascular disease is not normal at any age, it can make your life miserable in a whole variety of ways, and it’s both preventable and treatable with measures you can take in your own life.
Endothelial Health is Critical to Blood Vessel Health
As discussed in the hypertension post, our blood vessels are lined by a delicate layer of cells, called the endothelium. This layer has many functions including narrowing and widening the blood vessel, regulating inflammation, preventing or inducing blood clots, acting as a barrier to damaging substances, and coordinating the production of new blood vessels. Vascular disease typically starts with injury to the endothelium. Many lifestyle-related factors can injure the cells that comprise this layer including smoking, high blood pressure, high blood sugar, high salt intake, high cholesterol, and chronic inflammation. Note that many people have more than one of these risk factors affecting their endothelium on any given day.
Overtime, repeated insults lead to changes in the blood vessel itself. One possibility is atherosclerotic disease, whereby the injured endothelium allows inappropriate cholesterol deposition in the blood vessel wall leading to a localized inflammatory response, plaque build-up, and eventual narrowing of the vessel. Rupture of these plaques causes heart attacks and some strokes. Other downstream effects of a damaged endothelium include increased risk for blood clots, such as deep vein thromboses, vascular remodeling leading to persistently high blood pressure, and aneurysms, a condition in which a weakened portion of a blood vessel balloons out and is susceptible to rupture, which can constitute a life-threatening emergency.
Vascular disease can kill you quickly, as is the case with a fatal heart attack, stroke, or ruptured aneurysm. Or, it can kill you slowly, taking bits and pieces of your health and wellbeing at a time. In fact, many of the negative experiences we associate with aging, like cognitive decline, decreased physical capacity, and sexual dysfunction are often attributable to this disease process. The good news is that, as touched on in the beginning of this article, vascular disease does not need to be anybody’s fate.
Lifestyle as Friend or Foe
Multiple lifestyle factors are known to negatively affect the health of the endothelium, and thereby increase risk for vascular disease. A particularly potent endothelial-damaging habit is smoking. The constituents in cigarette smoke provoke an inflammatory response within the blood vessel wall and temporarily impair its ability to produce nitric oxide, a gas responsible for dilating blood vessels and promoting endothelial cell health. This results in impaired endothelial function and increased blood pressure. Sustained overtime, this injury leads to blood vessel remodeling, a process that leaves blood vessels less compliant and generally stiffer. (Interestingly, air pollution exposure has also been found to induce endothelial dysfunction and can precipitate heart attacks and strokes, further illustrating the importance of breathing clean air.) There are many resources available to assist you in quitting smoking, and smokefree.gov is a good place to start if you’re feeling ready to take this step in your own life.
Chronically elevated blood sugars, as seen in pre-diabetes and diabetes, will also impair nitric oxide production and damage endothelial cells. High blood pressure exerts a mechanical, shearing force that takes its toll over time. Therefore, keeping both your blood sugar and blood pressure in normal ranges is absolutely critical to preserving the health of your blood vessels. To learn more about these conditions and how to prevent them, see our blog posts discussing insulin resistance and hypertension.
Chronic stress can also lead to endothelial dysfunction and vascular damage. Stress causes a release of chemical mediators called cytokines, which promote inflammation, as well as various hormones that can impair the blood vessel’s ability to dilate. Therefore, it is important to find ways to manage stress that are sustainable and effective. Mindfulness is a great place to start. Other options including getting outside, reaching out to loved ones, and ensuring good quality sleep.
Regular exercise is a great tool to improve the health of your blood vessels. Moderate-intensity aerobic activity increases the production and availability of nitric oxide, leading to improved blood flood, and also has an anti-inflammatory effect on the endothelium. In addition, exercise plays a role in maintaining normal blood sugar levels, the importance of which was discussed above, and optimizing cholesterol levels, which brings us to the next risk factor.
A discussion of vascular health is not complete without touching on blood lipids. Indeed, elevated lipids, including cholesterol and triglycerides, is one of the most common vascular disease risk factors encountered in westernized society. When cholesterol and triglycerides are increased above normal levels, they exert a toxic effect on endothelial cells leading to increased cell death as well as inflammation in the vessel wall. In addition to participating in the initial endothelial injury, elevated cholesterol plays a central role in the build-up of atherosclerotic plaque. Thus, keeping cholesterol levels in a healthy range is essential to preventing vascular disease. While a tiny minority of people will have significantly elevated blood lipids secondary to a genetic predisposition, the vast majority of people are able to exert a large influence over their lipid levels with diet. This holds true even in people who have a family history of high cholesterol or atherosclerotic heart disease. Remember that heart disease is our #1 killer, which means pretty much everyone has a family history of it. In addition, heart disease is a modern plague, being an uncommon cause of death as recently as the early 20th century but becoming the commonest cause of death by the 1960s. This means that for nearly all of human history, high cholesterol and heart disease have not been a major concern. Certainly, our genes haven’t suddenly changed in the just last several decades to make us vulnerable to heart disease. But our diets most definitely have.
The standard American diet, which is largely centered around animal and processed foods, leads to vascular disease in a variety of ways. The saturated fats, trans fats, and cholesterol present in animal products and processed foods will directly increase your cholesterol and triglyceride levels. Saturated fat is also known to increase insulin resistance, and therefore risk of diabetes. Processed foods are rich in refined sugars and sodium, and thus increase risk for diabetes and hypertension. Given the above, it stands to reason that a diet predicated on whole plant foods would be protective against vascular diseases, and indeed this is the case. The fiber and nutrients found in whole plant foods can actively decrease lipid levels and overall inflammation. In addition, these foods are naturally low in sodium and saturated fats, and devoid of refined sugars. By eating a whole-foods, plant-based diet you will be limiting your intake of foods that promote vessel disease while consuming those that actively protect you against it, thereby getting the best of both worlds.
The powerful effect of diet on vascular health has been borne out in research, with both Caldwell Esselstyn, MD and Dean Ornish, MD showing reversal of atherosclerotic heart disease when study participants followed a whole-foods, plant-based diet that was low in fat. Importantly, this is the only dietary pattern found to actually reverse heart disease, something not even the Mediterranean diet has been shown to accomplish. Dr. Ornish utilized other measures in his study participants as well, including exercise, social support, and stress management, demonstrating that heart disease is multifactorial, grounded in lifestyle, and should be approached holistically.
If you are struggling with the consequences of vascular disease in your own life, rest assured that it’s never too late to institute the changes discussed above. Remember, research has demonstrated reversal of established disease, decades in the making, through the adoption of basic lifestyle modifications. No medication or procedure will give you similar results and in fact, the simplest interventions are often the most powerful. See our resources page for a list of websites, books, and more to get you started on the right path. As always, we are available for one-on-one consultation if you would like more individualized guidance.
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