This piece is the middle part of Chapter 9 of Stones in the Body: More Frightening Than Cancer (Yoon Jong-won). It is a description containing the author's academic hypothesis, and the body, figures, and citations follow the manuscript as written.
[Interaction with Other Risk Factors]
The 5M-related diseases interact not only with DIAH but also with the following factors: benign tumors (uterine fibroids, prostate enlargement), for which hormones (estrogen, testosterone) are the main cause; malignant tumors (cancer), which have complex causes such as gene mutation, environmental factors, and viruses; neurodegeneration (Alzheimer's disease), which has complex causes such as amyloid, tau, inflammation, and heredity (APOE4); and cardiac hypertrophy, for which hypertension (pressure load) is the main cause. The DIAH-calcium pathway acts together with these factors and contributes to the onset of disease.
6M Disconnection (it is cut and severed)
1. "They Say His Toe Rotted and Was Cut Off": The 6M Disconnection We Know
"They say my uncle who had diabetes had his toe cut off." "They say the grandfather next door had leg amputation surgery." "They say his foot is rotting black."
"It rotted," "it was cut off," "it died." What these expressions point to is 6M Disconnection.
What is happening in the foot of a diabetic patient? The blood vessels at the tips of the toes become blocked (1M Obstruction & Rupture). When blood does not flow, oxygen and nutrients are not supplied. When the supply is cut off, the tissue dies. Dead tissue rots. The rotting area must be cut off before it spreads.
Disconnection (斷絶) means "to be cut and severed." 斷 means "to cut," and 絶 means "to be severed, to be cut off." The blood vessels are cut, the nerves are cut, and the connection between tissue and life is cut. It is death. This is the essence of 6M Disconnection.
From 1M to 5M it was "damage." Even when it is blocked, grows dull, is cut off, hardens, and overflows, the tissue is alive. 6M Disconnection is different. 6M is "death." Cells die, tissue dies, and organs die.
2. The Definition of 6M Disconnection: If It Is Severed, It Dies
6M Disconnection is the phenomenon in which blood vessels or nerves become blocked or damaged, the connection is severed, and as a result cells and tissue die.
Think of a tree. Water and nutrients must rise from the roots for the leaves to live. What happens if the stem is cut? Above the cut part, water cannot rise. The leaves wither, dry out, and die.
Our body is the same. Blood goes out from the heart, circulates through the whole body, and supplies oxygen and nutrients. What if the blood vessel going to a certain area becomes blocked? In that area the supply of oxygen and nutrients is cut off. Cells hold out for a few minutes to a few hours without oxygen and then die. When dead cells gather, it becomes tissue necrosis.
6M Disconnection appears in several forms: necrosis (壞死), in which tissue dies and rots; infarction (梗塞), in which a blood vessel is blocked and tissue dies; atrophy (萎縮), in which tissue shrinks due to insufficient supply; and sloughing (脫落), in which dead tissue falls away.
3. From DIAH to Tissue Necrosis: Why Tissue Dies
Let us follow the process by which a diabetic foot rots, from the beginning.
Stage 1: The DIAH Triggers Operate Over a Long Period
Let us think of a diabetic patient. The high blood sugar state persists for several years. High blood sugar can strengthen all four DIAH triggers.
High blood sugar can increase the excretion of calcium into the urine (inducing D Deficiency). High blood sugar causes chronic inflammation in the blood vessel walls (I Inflammation). High blood sugar can make cellular metabolism inefficient and cause acidic substances to accumulate (A Acidosis). High blood sugar damages the microvessels and obstructs the supply of oxygen to the tissue (H Hypoxia).
Stage 2: Blood Vessel Damage Progresses
In diabetes, blood vessel damage progresses through several mechanisms. Advanced glycation end products (AGE) accumulation, oxidative stress, endothelial cell dysfunction, and inflammatory responses act in combination.
Atherosclerosis progresses in the blood vessels going to the foot. The blood vessel walls thicken and harden (4M Hardening). The inner diameter of the blood vessel narrows (1M Obstruction & Rupture progresses). The nerves at the tips of the toes are also damaged and sensation grows dull (diabetic neuropathy).
Stage 3: Vascular Occlusion, 1M Obstruction & Rupture
One day the narrowed blood vessel becomes completely blocked. Or a thrombus forms and blocks it. The blood going to the toes is completely cut off.
This moment is 1M Obstruction & Rupture. The channel has become blocked.
Stage 4: The Oxygen Supply Is Cut Off
When blood does not flow, oxygen is not supplied. Cells cannot make ATP (energy) without oxygen. Without energy, cells cannot maintain their function.
Stage 5: Cell Death, 6M Disconnection
Several hours after the oxygen supply is cut off, cells begin to die. The contents flow out from the dead cells and cause inflammation in the surrounding cells. The inflammation kills more cells. It is a chain reaction.
When dead cells gather, it becomes tissue necrosis. Necrotic tissue turns black. It begins to rot. When bacteria infect it, it progresses to gas gangrene.
This stage is 6M Disconnection. The connection with life has been severed.
Stage 6: Amputation
When necrosis progresses, the rotting part must be cut off. If it is not cut off, the necrosis spreads upward. The toe is cut, the foot is cut, and the leg is cut.
[Other Risk Factors]
In the diabetic foot, in addition to vascular disease, diabetic neuropathy (not noticing wounds due to reduced sensation), reduced immune function (vulnerability to infection), and foot deformity act in combination. Blood sugar control, foot care, smoking cessation, and regular checkups are important.
4. Myocardial Infarction and Cerebral Infarction: 1M Obstruction & Rupture → 6M Disconnection
The diabetic foot is not the only 6M Disconnection. Myocardial infarction and cerebral infarction are the same mechanism.
Myocardial Infarction: The Heart Muscle Dies
When the coronary artery that supplies blood to the heart becomes blocked, it is myocardial infarction.
1M Obstruction & Rupture: the coronary artery becomes blocked.
6M Disconnection: the heart muscle whose blood supply is cut off dies.
The heart muscle holds out for 20 to 40 minutes without oxygen. If the blocked blood vessel is not opened within that time, the heart muscle undergoes necrosis. Necrotic heart muscle does not come back to life. The pump function is permanently damaged.
Cerebral Infarction: The Brain Cells Die
When the cerebral artery that supplies blood to the brain becomes blocked, it is cerebral infarction.
1M Obstruction & Rupture: the cerebral artery becomes blocked.
6M Disconnection: the brain cells whose blood supply is cut off die.
Brain cells are very vulnerable to oxygen. Based on the thrombolytic agent, within 4.5 hours is the golden time. In general, the time window for intravenous thrombolytic treatment is applied within a limited time after the onset of symptoms, and if this window is passed, nerve damage can increase sharply. If the blocked blood vessel is not opened within that time, the brain cells undergo necrosis. Depending on which area dies, paralysis, language disorder, and visual field disorder remain permanently.
The Common Point: 1M → 6M
Myocardial infarction, cerebral infarction, diabetic foot. All follow the same order. 1. Risk factors (including DIAH) operate for several years. 2. Atherosclerosis progresses in the blood vessel and the blood vessel narrows (4M Hardening). 3. One day the blood vessel becomes completely blocked (1M Obstruction & Rupture). 4. The tissue that the blood vessel supplied dies (6M Disconnection).
If 1M Obstruction & Rupture is "the moment of blocking," then 6M Disconnection is, as its result, "the death of the tissue."
[Other Risk Factors]
The risk factors for myocardial infarction and cerebral infarction include hypertension, dyslipidemia, diabetes, smoking, obesity, family history, and arrhythmia (atrial fibrillation). The DIAH-calcium pathway contributes to blood vessel damage together with these risk factors.
5. The 6M of the Kidney and the Eye: Chronic Kidney Failure, Diabetic Retinopathy, Macular Degeneration
6M Disconnection does not come only acutely. There are also cases in which tissue dies slowly, little by little, over a long time.
Chronic Kidney Failure: The Kidney Slowly Loses Function
The kidney has millions of glomeruli. Each glomerulus is a small cluster of capillaries. When glomeruli are damaged by diabetes, hypertension, glomerulonephritis, and the like, they lose function one by one.
It is not that they die all at once as in acute occlusion. Little by little each year, the glomeruli are damaged one by one. After 10 years, 20 years, the functioning glomeruli decrease to half, to a quarter.
When kidney function drops below 15%, dialysis is needed. The main causes of chronic kidney failure are diabetes (first) and hypertension (second). The DIAH-calcium pathway can contribute to kidney damage together with these causes.
Diabetic Retinopathy: The Blood Vessels of the Eye Are Damaged
In the retina, thin capillaries are densely spread. When these capillaries are damaged by diabetes, blood is not properly supplied to the retina.
The area where blood does not flow dies. When the dead area widens, a black spot appears in the visual field, and in the end blindness results. The longer the duration of diabetes, the higher the risk of diabetic retinopathy. In most patients who have had diabetes for 20 years or more, some degree of retinopathy is found.
Diabetic retinopathy is divided into nonproliferative and proliferative. In the nonproliferative stage, microaneurysms, hemorrhages, and exudates appear. When it progresses to the proliferative stage, abnormal new blood vessels grow, and these blood vessels burst easily, causing vitreous hemorrhage or inducing retinal detachment.
Macular Degeneration: The Center of Vision Dies
The macula is the central part of the retina, and it is responsible for the sharpest vision. Reading letters and recognizing faces are all functions of the macula.
In age-related macular degeneration, drusen (waste products) accumulate in the tissue beneath the macula, and the macular cells slowly die (dry macular degeneration). In some cases, abnormal blood vessels grow and cause hemorrhage and edema (wet macular degeneration).
The risk factors for macular degeneration include aging, smoking, family history, obesity, and cardiovascular disease. Chronic inflammation and oxidative stress contribute to macular damage, and among the DIAH triggers, I (Inflammation) and H (Hypoxia) can be involved.
The center of the visual field becomes blurred, straight lines appear bent, and in the end central vision is lost. The peripheral vision remains, so it is not complete blindness, but the daily activities of reading, writing, and recognizing faces become impossible.
6. The 6M of the Nerves: Diabetic Neuropathy, Neurodegeneration
6M Disconnection operates not only in the blood vessels but also in the nerves.
Diabetic Neuropathy: The Nerves Die
When diabetes lasts a long time, the peripheral nerves are damaged. It starts from the tips of the toes and gradually rises upward. At first the feet tingle and feel cold. As it progresses, sensation grows dull, and in the end sensation disappears.
The mechanism of diabetic neuropathy is complex. Direct toxicity from high blood sugar, ischemia due to damage to the nerve blood vessels, advanced glycation end product accumulation, and oxidative stress are involved.
When sensation disappears, one does not notice even if a wound occurs. A small wound becomes infected, the infection spreads, and in the end it leads to a diabetic foot. Diabetic patients with neuropathy have a greatly increased risk of foot amputation.
Alzheimer's Disease and Neurodegeneration: From 5M to 6M
As explained in the 5M Overflow & Burst section, in Alzheimer's disease an abnormality of calcium homeostasis within the nerve cells can contribute to nerve cell damage (5M). When the damaged nerve cells die, it is 6M Disconnection.
Brain nerve cells are not made again. Once they die, they disappear permanently. When a nerve cell dies, the memory, function, and connection that the cell was responsible for disappear. One loses memory, loses judgment, and in the end loses one's very self.
The causes of Alzheimer's disease are complex. Amyloid accumulation, tau protein abnormality, neuroinflammation, vascular factors, heredity (APOE4), and lifestyle are involved. In the DIAH-7M framework, chronic inflammation (I) and abnormality of calcium homeostasis can be understood as contributing to neurodegeneration.
7. The 6M of the Skin and the Intestine: Gangrene, Bedsores, Intestinal Necrosis
6M Disconnection also appears in the skin and the intestine.
Gangrene: Tissue Rots
Gangrene is when tissue dies and rots. When the blood supply is cut off, tissue dies (dry gangrene), and when bacteria infect it, it rots (wet gangrene). When gas-producing bacteria infect it, it becomes gas gangrene.
The gangrene of the diabetic foot is representative. When a small wound becomes infected in a state where blood flow is reduced due to peripheral arterial disease, it progresses rapidly. Amputation must be done before the gangrene spreads in order to save life.
Bedsores: Compressed Tissue Dies
Bedsores occur in patients who lie down for a long time. When the same area is continuously pressed, the blood vessels in that area are compressed and blood flow is blocked. Tissue whose blood flow is blocked dies.
They are common in areas where bone protrudes, such as the hip bone, the heel, and the shoulder blade. The skin reddens, then blisters form, the skin peels off, and in severe cases even the bone is exposed.
For bedsores, prevention is important. One must frequently change position, maintain nutritional status, and keep the skin clean and dry.
Intestinal Necrosis: The Intestine Dies
When the mesenteric artery that supplies blood to the intestine becomes blocked, intestinal necrosis occurs. When the intestine dies, severe abdominal pain, bloody stool, and shock appear. The dead intestine must be resected by emergency surgery.
The causes of mesenteric artery occlusion include embolism due to atrial fibrillation, atherosclerosis, and low blood pressure. It is an emergency disease with a very high mortality rate.
8. Summary of the 6M Disconnection Mechanism
6M Disconnection is the phenomenon in which blood vessels or nerves become blocked or damaged, the connection is severed, and as a result cells and tissue die.
The 6M Disconnection mechanism formula: DIAH operates over a long period → blood vessel/nerve damage progresses → vascular occlusion (1M) or nerve damage → the supply of oxygen/nutrients is cut off → cell death → tissue necrosis
6M Disconnection is the most "final" among the 7M. 1M to 5M are damage, but 6M is death. Dead cells do not come back to life. Dead tissue must be resected.
6M Disconnection mostly occurs after the other M's have preceded it. The blood vessel first hardens (4M), becomes blocked (1M), and then the tissue dies (6M). The nerve cell is first damaged (5M), and then it dies (6M). 6M is the "end" of DIAH-7M.
[Interaction with Other Risk Factors]
The 6M Disconnection-related diseases interact not only with DIAH but also with the following factors: diabetic foot/gangrene, with diabetes (blood sugar control), peripheral arterial disease, neuropathy, and infection; myocardial infarction/cerebral infarction, with hypertension, dyslipidemia, smoking, and atrial fibrillation; chronic kidney failure, with diabetes, hypertension, and glomerulonephritis; retinopathy/macular degeneration, with diabetes, aging, smoking, and heredity. The DIAH-calcium pathway contributes to tissue damage together with these risk factors.
7M Collapse (it falls apart)
1. "They Say Her Bones Have Worn Away," "All My Teeth Fell Out": The 7M Collapse We Know
"They say Grandmother fell and broke her hip." "Mother's back is gradually bending." "My teeth were loose so I had them all pulled out."
"It broke," "it bent," "it fell out." What these expressions point to is 7M Collapse.
From 1M to 6M it was about calcium "leaking out" of the bone and causing problems in the soft tissue. 7M Collapse is different. 7M is when the "bone itself," from which the calcium leaked out, collapses.
Collapse (崩壞) means "to fall apart." 崩 means "to collapse," and 壞 means "to break apart." The bone collapses and the teeth break apart. The structural collapse of the skeletal system and the teeth. This is the essence of 7M Collapse.
DIAH-7M is a circular structure. When the DIAH triggers cause calcium to flow out of the bone, the leaked calcium causes 1M to 6M in the soft tissue. And the bone itself, which has lost calcium, undergoes 7M Collapse. The starting point (bone) and the end point (bone) are connected.
2. The Definition of 7M Collapse: When Calcium Leaves the Bone, It Collapses
7M Collapse is the phenomenon in which calcium flows excessively out of the bone, the density and strength of the skeletal system and the teeth decline, and they collapse structurally.
Think of a concrete building. Concrete is hard because cement and aggregate are combined. But what happens if the cement melts and leaks out little by little? The building looks fine on the outside. But the inside gradually weakens. One day it crumbles down even at a small shock.
Bone is the same. Bone is made of a collagen matrix (playing the role of rebar) and calcium-phosphate crystals (playing the role of cement). When calcium leaks out, the density of the bone lowers and its strength weakens. It looks fine on the outside, but the inside becomes riddled with holes like a sponge. It breaks even at a small shock.
3. From DIAH to Osteoporosis: Why Bones Weaken
Let us follow the process by which osteoporosis occurs, from the beginning.
Stage 1: The Long-Term Operation of the DIAH Triggers
Let us think of a postmenopausal woman. She does not eat dairy products well, so her calcium intake is insufficient (D); she has chronic inflammation from arthritis (I); she has a high acid load from a meat-centered diet (A); and her tissue oxygen supply is reduced from lack of exercise (H).
To this is added the decisive factor of menopause. When estrogen decreases sharply, the activity of the osteoclasts that break down bone increases. The DIAH triggers and the decrease of estrogen act together.
Stage 2: Bone Resorption Exceeds Bone Formation
Normally, bone is continuously remodeled. Osteoclasts break down old bone (bone resorption), and osteoblasts make new bone (bone formation). When young, bone formation is in balance with bone resorption or slightly ahead.
When the DIAH triggers operate, the osteoclasts are excessively activated.
In particular, I (Inflammation) strongly stimulates the osteoclasts through inflammatory cytokines (IL-1β, IL-6, TNF-α). Bone resorption exceeds bone formation. Little by little each year, calcium leaks out of the bone.
Stage 3: Decline in Bone Density
When calcium leaks out of the bone, bone density lowers. Based on normal bone density, a T-score of -1.0 or below is diagnosed as osteopenia, and -2.5 or below as osteoporosis.
Even when bone density lowers, in the early stage there are no symptoms. The bone does not hurt. That is why it is called a "silent disease."
Stage 4: Microstructural Change
It is not only bone density that lowers. The microstructure of the bone also changes. Normal bone is a dense mesh structure. In osteoporosis, the connections of this mesh are severed and the holes grow larger.
Even at the same bone density, if the microstructure is poor, it breaks more easily. This is why the fracture risk differs even at the same bone density.
Stage 5: 7M Collapse, Fracture
Weakened bone breaks even at a small shock. If one slips and falls on one's buttocks, the hip breaks. While lifting something heavy, the spine collapses. In severe cases, even coughing breaks a rib.
This is 7M Collapse. It is when the bone that has lost calcium collapses structurally.
[Other Risk Factors]
The risk factors for osteoporosis include being female, menopause, old age, low body weight, smoking, drinking, steroid use, family history, calcium/vitamin D deficiency, and lack of exercise. The DIAH-calcium pathway contributes to bone loss together with these factors.
4. Osteoporotic Fracture: The Result of 7M Collapse
Osteoporosis itself has no symptoms. The problem is fracture.
Hip Fracture: The Most Fatal
Hip (hip joint) fracture is the most serious among osteoporotic fractures. It mostly occurs while falling.
The one-year mortality rate of hip fracture is about 20 to 30%. It is especially high in elderly patients. Even after surgery, more than half become unable to walk as before. Independent living becomes impossible, and there are many cases of going to a care facility.
Why is it so fatal? When the hip breaks, one cannot move. When one lies down for a long time, complications such as pneumonia, bedsores, and thrombosis arise. Elderly patients often die from these complications.
Vertebral Compression Fracture: The Back Bends
When the vertebrae weaken, they cannot bear the body weight and collapse. While lifting something heavy, or in severe cases even coughing while seated, the spine can cause a compression fracture.
When several vertebral compression fractures occur, the back gradually bends. This is the main cause of senile kyphosis (the "bent-over grandmother"). When the back bends, the lungs are pressed and breathing becomes uncomfortable, and the stomach is also pressed so digestion does not work.
Wrist Fracture: The Most Common
Wrist (distal radius) fracture occurs when one puts down one's hand while falling. It is not as fatal as hip fracture, but it causes great inconvenience in daily life. In particular, when a wrist fracture occurs, it is a signal that the risk of future hip fracture increases.
5. Teeth: The Collapse of Another Hard Tissue
7M Collapse does not apply only to bone. Teeth are also hard tissue.
Periodontal Disease: The Bone Supporting the Teeth Collapses
The teeth are embedded in a bone called the alveolar bone. When gum disease (periodontal disease) progresses, the alveolar bone is destroyed. When the bone supporting the teeth melts away, the teeth become loose. In the end the teeth fall out or must be pulled.
The main causes of periodontal disease are the bacteria in the oral cavity (plaque, tartar) and the inflammation caused by them. Smoking, diabetes, and genetic predisposition are also risk factors.
Periodontal disease and systemic health are connected. There are also studies showing that periodontal inflammation increases systemic inflammation (I), and that periodontal bacteria spread through the bloodstream and raise the risk of cardiovascular disease. Conversely, when one has diabetes, periodontal disease worsens. It is a bidirectional relationship.
Dental Caries (Cavities): The Tooth Itself Dissolves
The enamel, the outermost layer of the tooth, is made of calcium-phosphate crystals (hydroxyapatite). When this is dissolved by acid, it becomes a cavity.
The bacteria in the mouth eat sugar and make acid. This acid dissolves the enamel. When the enamel dissolves, the dentin beneath it is exposed, and when the dentin also dissolves, the nerve is exposed and pain arises. When it progresses further, even the root of the tooth is infected and the tooth must be pulled.
The key to cavity prevention is oral hygiene (brushing, flossing) and limiting sugar intake. Fluoride strengthens the enamel and raises its resistance to acid.
[Teeth and DIAH-7M]
The direct connection between dental health and DIAH-7M is limited. However, there is an indirect connection in that oral inflammation (periodontal disease) contributes to systemic inflammation (I), and the state of systemic health affects oral health. There are also studies showing that alveolar bone loss can be faster in osteoporosis patients.
6. The Paradox of Bone and Soft Tissue: The Calcium Paradox
There is a concept one must know when understanding 7M Collapse. It is the "Calcium Paradox."
The Essence of the Paradox
In an osteoporosis patient, calcium is insufficient in the bone. Yet in the blood vessels of the same patient, calcium is piled up. Calcium leaks out of the bone (7M Collapse), and calcium piles up in the blood vessels (4M Hardening, 1M Obstruction & Rupture). In the body of the same person, a place where calcium is insufficient and a place where it is in excess exist at the same time.
This is the Calcium Paradox. It looks like a paradox, but in the DIAH-7M framework it is explained logically. When the DIAH triggers cause calcium to flow out of the bone, the leaked calcium piles up in the soft tissue. The bone empties, and the soft tissue fills. The cause is one (DIAH), and the results are two (bone deficiency, soft tissue excess).
The Molecular Key to the Calcium Paradox: Vitamin K2 and MGP
In our body there is MGP (Matrix Gla Protein), a "traffic-directing protein" that sends calcium to the bone and keeps it from piling up in the blood vessels. The switch that activates this MGP is vitamin K2.
When vitamin K2 is sufficient, MGP is activated so that calcium goes to the bone and does not pile up in the blood vessels. When vitamin K2 is insufficient, MGP remains in an inactive state, so calcium does not go to the bone and is deposited in the blood vessels.
This is the molecular-biological core mechanism of the Calcium Paradox. This is why, together with management of the DIAH triggers, the intake of vitamin K2 is important.
Clinical Meaning
Osteoporosis patients have a high risk of cardiovascular disease, and cardiovascular disease patients have a high risk of osteoporosis. There are many cases in which the two diseases accompany each other. This is not a coincidence but a result originating from the same cause (the DIAH triggers).
One must not treat only osteoporosis and ignore cardiovascular risk. Nor must one treat only cardiovascular disease and ignore bone health. If the DIAH triggers are blocked, both diseases can be prevented or their progression slowed.
7. 7M Collapse in Turn Reinforces DIAH
7M Collapse is the "end" of DIAH-7M and at the same time can become a "new beginning."