It's the middle of the night when a deep ache in your calf jolts you awake...
You take a few minutes to stretch and massage out the pain. And soon enough, the pain passes. As you fall back to sleep, you might think to yourself it was just a "charley horse" – a slight muscle cramp. Maybe you overdid your workout or didn't drink enough water during the day.
But that was no simple charley horse. It was something scarier...
Inside your leg, your muscle tissue was suffocating.
It was ischemic, or begging for oxygen that your narrowed, brittle arteries couldn't deliver.
Starved of oxygen, your muscle metabolism started switching gears to stay functional. Lactic acid and other chemical byproducts of this new "Plan B" began building up, causing the terrible cramping.
Then when you stood still to scroll through your phone, the chemical irritants got washed away – along with the pain.
So what the heck was this?
The Slow Suffocation of Peripheral Artery Disease
What you experienced is a common condition, afflicting roughly 10 million Americans aged 40 and older.
And it can't be cured...
It's peripheral artery disease ("PAD").
The typical PAD culprit is plaque buildup and narrowing of the arteries. So blood has trouble reaching various parts of your body. Since they're the farthest from your ticker, the lower extremities tend to be most affected.
For instance, blood has to fight gravity to return to your heart, where it goes to your lungs to get oxygenated, before having to get pumped all the way to your toes.
As a result, the classic symptom of PAD is having pain in your legs, hips, or butt that worsens when you're physically active but improves when you're resting.
Specifically, poor blood flow to the muscles can result in cramping, or intermittent claudication. So it's all too easy to think that it's just some arthritis flaring up when, in reality, it's PAD.
Along with heart attack, PAD can lead to stroke, gangrene, limb amputation, erectile dysfunction, or worse...
In fact, a recently published, large study confirmed these stakes... A 2025 study of more than 4.2 million patients in Denmark aged 40 to 99 years were followed for an average of 15.5 years. And researchers found that the PAD patients faced a 16.2% mortality rate and an 8% major amputation rate – all within just the first year of being diagnosed.
How PAD Sneaks Up on You
Perhaps the most terrifying part about PAD is just how insidious it can be...
PAD can be asymptomatic, where you have the clogging without the symptoms. But as the disease worsens, you can even get pain, weakness, heaviness, cramping, tingling, and/or numbness in your legs, hips, or butt even at rest.
Other warning signs include:
- Skin changes like increased hair loss or shininess
- Nail changes like slow growth, thickening, or increased brittleness
- One foot or leg feels colder than the other
- Problems with wounds healing in the legs, feet, or toes
- Abnormal foot or toe color (like pale, black, bluish, or darkening skin)
You're more likely to develop PAD if...
- You're aged 65 and older
- You have family members with PAD or cardiovascular disease
- You're hypertensive (have high blood pressure)
- You have high cholesterol
- You're diabetic
- You have chronic kidney disease
- You're a smoker or are exposed to secondhand smoke
A doctor specializing in vascular medicine or cardiology typically diagnoses or treats PAD. Using a special device, he or she will likely check the difference between the blood pressure in your arms and legs in what's called an ankle-brachial index. Imaging like CT or MRI scans can also help diagnose and pinpoint areas affected by PAD.
As for managing symptoms and treatments, your doctor may prescribe drugs like blood thinners and vasodilators (to widen the blood vessels). And in more serious cases, surgery (both minimally invasive and major) is another option.
Regardless of the severity, you wield the power to manage your symptoms by making some tweaks to your lifestyle to keep your blood vessels healthy...
These Are Your Options
It might seem like a "Catch 22," that the trigger behind PAD pain is one of the best ways to manage your symptoms and make this disease more bearable...
That's walking and listening to your body.
With this "stop and start" walking regimen, it's simple: You walk until the pain reaches a moderate level and then stop and rest until the pain is completely gone. And then start back up again, aiming for about half an hour of walking time and doing this workout at least three times a week.
By challenging yourself to the point of pain, you're also challenging your body to start growing tiny blood vessels, or detours past the big blockages, in a process called angiogenesis.
While walking kickstarts the process for building those blood vessels, your diet determines how effectively your body builds them. And having inflammation constantly running amok in your body won't help the process.
To combat chronic inflammation, longtime readers know that I'm a big fan of the Mediterranean diet.
Me, I eat whole foods – mainly vegetables, whole grains, and legumes. I use olive oil for cooking and topping my dishes.
And I also love eating fish... It's rich in omega-3 fatty acids. And over the past few decades, PAD studies have shown that omega-3s can protect you from cardiovascular disease by lowering blood pressure, increasing production of nitric oxide (a chemical important for relaxing the blood vessels), and decreasing production of inflammatory molecules (especially within the walls of the blood vessels).
I eat about three servings (each about the size of a deck of cards or the palm of my hand) of fish every week... specifically, varieties low in mercury like salmon, canned light tuna, Atlantic mackerel, herring, cod, and sardines.
What are your favorite ways to eat fish? Share them with us at feedback@healthandwealthbulletin.com. For more of my favorite ways to boost your health (and wealth), look no further than Retirement Millionaire. You can check it out risk-free for 30 days right here.
What We're Reading...
- Something different: The U.S. neighborhood where cars are banned.
Here's to our health, wealth, and a great retirement,
Dr. David Eifrig and the Health & Wealth Bulletin Research Team
April 9, 2026