WHAT IS ATHEROSCLEROSIS?
The medical term atherosclerosis comes from the Greek words athero (meaning gruel or paste) and sclerosis (hardness). This refers to the name of the process in which deposits of fatty substances, cholesterol, cellular waste products, calcium and other substances build up in the inner lining of an artery into a substance called plaque. Plaque deposits can accumulate and significantly reduce the blood’s flow through an artery. They can also dislodge and block blood flow to the brain, heart, or another body part. When plaque blocks a blood vessel that supplies the brain it is known as a stroke. Atherosclerosis has been shown to start in childhood for some individuals. Coronary artery disease (CAD) occurs when plaque builds up and inhibits blood flow to the coronary arteries. Causes of atherosclerosis and CAD include:
RISK FACTORS FOR HEART DISEASE YOU CAN CHANGE
- High blood pressure
- High blood cholesterol
- Physical inactivity
- Blood sugar balance
- Omega 3 fatty acid level
- Reaction to stress
- Nutrient deficiencies such as magnesium
- Cardiovascular blood risk factors
Dr Stengler tests for blood risk factors go well beyond regular cardiovascular blood tests and include:
C-Reactive Protein – A marker of inflammation in the body, including the blood vessel walls. It is considered the best predictor of heart disease.
Homocysteine – Build-up of this toxic metabolite increases plaque formation in the artery walls. Genetics, low thyroid, B vitamin deficiencies, and high animal protein diet increase the level.
Lipoprotein (a) – A more specific cholesterol marker and a stronger risk factor than LDL cholesterol.
Fibrinogen – Plays an important role in blood clotting. Elevated levels increase the risk of stroke and coronary artery disease.
Apolipoprotein B – A type of lipid which binds to LDL cholesterol and accelerates plaque formation.
Apolipoprotein A-1 – Found in HDL cholesterol and provides a protective effect against heart disease.
Apolipoprotein B and Apolipoprotein ratio – An overall predictor of heart disease risk.
Glucose/hemoglobin A1C – Diabetes predisposes one to early heart disease.
Insulin – Elevation of this hormone is seen with “syndrome X”-a condition characterized by rising blood sugar and insulin levels. Spiked Insulin levels increases arterial inflammation, as well as triglyceride, cholesterol, and blood pressure levels. It also contributes to weight gain.
Iron – Excessive iron in the body produces free radicals and oxidative damage.
Omega 3 fatty acid index – High levels of omega 3 fatty acids reduced the risk of heart attack and stroke.
Toxic metals – Heavy metals such as lead increase risk of heart disease.
Fungal overgrowth – Contribute to inflammation.
Hormone Imbalances (such as cortisol, estradiol, testosterone) – Imbalances contribute to inflammation of the arteries.
Obstructive Sleep Apnea
We all have been told, or have read, that excessive cholesterol in the blood accumulates in the artery walls. However, there appears to be more to the story.Research over the past decade has shown that much of the artery problem caused by cholesterol is the result of oxidation. Oxidation occurs when free radicals (unstable negatively charged molecules) damage cells of the body. Free radicals are the by-product of energy production by the body’s cells, as well as the exposure to pollutants and radiation.
Oxidized cholesterol (particularly LDL cholesterol) then initiates inflammation and eventual plaque build-up in the blood vessel wall, which inhibits blood flow through the arteries. This oxidation leads to inflammation and damage in the artery walls.
Your body has a defense mechanism against free radicals and oxidation. Substances called antioxidants are an integral part of that defense mechanism. Antioxidants neutralize or reduce the effects of cell-damaging free radicals. Though your body has naturally occurring antioxidant enzyme systems, you also need antioxidants from foods, particularly plant foods such as fruits, vegetables, and legumes.
ARE STATINS OVER-PRESCRIBED?
In the July 13, 2004, issue of Circulation: Journal of the American Heart Association, the National Institute of Health’s National Cholesterol Education Program (NCEP) published new guidelines for LDL cholesterol levels. According to the NCEP, “These options include setting lower treatment goals for LDL (‘bad’) cholesterol and initiating cholesterol-lowering drug therapy at lower LDL thresholds.” These new recommendations were based on the review of five major clinical trials using a group of cholesterol lowering drugs known as “statins.”
The science behind these new conclusions was challenged by more than three dozen physicians, epidemiologists, and other scientists, together with the Center for Science in the Public Interest (CSPI). In a letter that detailed their objections, physicians and scientific researchers urged the National Institute of Health (NIH) to seek an independent panel to re-review the studies. They wrote:
“There is strong evidence to suggest that an objective, independent re-evaluation of the scientific evidence from the five new studies of statin therapy would lead to different conclusions than those presented by the current NCEP. The studies cited do not demonstrate that statins benefit women of any age or men over 70 who do not already have heart disease.”
In the letter, doctors from the CSPI also cited concerns that were raised after one study showed statin therapy significantly increases the risk of cancer in the elderly. In addition, researchers noted, three of four studies involving people with diabetes showed that these patients got no significant benefit from increased statin use.
And there was another alarming discovery as well. Eight of the nine authors of the new LDL recommendations had financial ties to manufacturers of statin drugs, including the pharmaceutical companies Pfizer, Merck, Bristol-Myers Squibb, and AstraZeneca. (Normal medical publishing requires the disclosure of financial ties associated with the authors of a study.)
Authors of the CSPI letter summarized their suspicions about the NCEP report by stating, “The sad fact is that these lifestyle recommendations are being largely ignored, partly because the ‘experts,’ many of whom have conflicts of interest through their relationships with statin manufacturers, focus ever more attention on lowering cholesterol with expensive drugs.” The response from the Acting Director of the National Institutes of Health National Heart, Lung, and Blood Institute was to declare that the scientific basis was adequate and there was no conflict of interest from panel members.
DIET AND LIFESTYLE
The Mediterranean diet with its emphasis on heart-healthy olive oil, fruits, vegetables and fish combats cardiovascular disease. While there is no one specific Mediterranean diet (since 16 countries border the Mediterranean Sea) they do have the following in common:
- high consumption of fruits, vegetables, bread and other cereals, potatoes, beans, nuts and seeds
- olive oil is an important monounsaturated fat source
- dairy products, fish and poultry are consumed in low to moderate amounts, and little red meat is eaten
- eggs are consumed zero to four times a week
- wine is consumed in low to moderate amounts
The Mediterranean diet is associated with lower incidence of coronary heart disease, and two randomized trials indicated that it improves prognosis of coronary patients. A more recent study evaluated the association of following a modified Mediterranean diet, in which unsaturated fats were substituted for monounsaturated fats. Researchers then looked at survival among elderly with previous history of a heart attack. The study involved 2671 EPIC participants from nine countries were 60 years or older. The median follow up was 6.7 years. Researchers found that an increased adherence to modified Mediterranean diet was associated with 18% lower overall mortality rate.
(Trichopoulou A, Bamia C, Norat T, Overvad K, Schmidt EB, Tjønneland A, Halkjær J, Clavel-Chapelon F, Vercambre MN, Boutron-Ruault MC, Linseisen J, Rohrmann S, Boeing H,Weikert C, Benetou V, Psaltopoulou T, Orfanos P, Boffetta P, Masala G, Pala V, Panico S,Tumino R, Sacerdote C, Bueno-de-Mesquita HB, Ocke MC, Peeters PH, Van der Schouw YT, González C, Sanchez MJ, Chirlaque MD, Moreno C, Larrañaga N, Van Guelpen B,Jansson JH, Bingham S, Khaw KT, Spencer EA, Key T, Riboli E, Trichopoulos D. Modified Mediterranean diet and survival after myocardial infarction: the EPIC-Elderly study. Eur J Epidemiol. 2007 Oct 10; (Epub).
Vitamin K in the diet is important as well to prevent calcium deposition in the arteries. Forms of vitamin K include phylloquinone (K1) and menaquinone (K2). Vitamin K1 is abundant in the diet in dark green leafy vegetables such as lettuce, spinach and broccoli. However, vitamin K2 is better absorbed and remains active in the body longer than vitamin K1. The best food source of vitamin K2 is natto (fermented soybeans) and to a lesser degree, fermented cheeses (the type with holes, such as Swiss and Jarlsberg), butter, beef liver, chicken and egg yolks.
Pomegranate Juice has proven to be a powerful food for arterial health. It is loaded with antioxidants called polyphenols that prevent cholesterol oxidation and improve blood flow. Israeli researchers discovered its effectiveness in a three-year study of patients with carotid artery plaque. The study included 19 men and women, 65 to 75 years old, who had severe carotid artery blockage. Ten participants received 1.7 ounces (50 ml) of 100% pomegranate juice and nine participants drank a placebo. Results: Among juice drinkers, plaque thickness decreased an average of 13% in the first three months and 35% after one year. Systolic blood pressure was also reduced. Participants who did not drink pomegranate juice had a 9% increase in plaque thickness after one year. Aviram M, Rosenblat M, Gaitini D, Nitecki S, Hoffman A,Dornfeld L, Volkova N, Presser D, Attias J, Liker H, Hayek T. Clin Nutr. Pomegranate juice consumption for 3 years by patients with carotid artery stenosis reduces common carotid intima-media thickness, blood pressure and LDL oxidation. Clin Nutr. 2004 Jun;23(3):423-33.
Vitamin E is not just one vitamin, but rather a family of eight slightly different molecular structures that function differently in the body. There are two principal categories of vitamin E—tocopherols and tocotrienols. Each of these has four subcategories—alpha, beta, gamma and delta.
Tocotrienols reduce triglycerides, inflammation of arterial walls, promote dilation and flexibility of arteries, improve blood flow, change LDL cholesterol to a form that does not promote plaque formation, and lower blood pressure. They also help to reduce plaque in the arteries, particularly delta tocotrienols.
A four year study from Elmhurst Medical Center in Queens, New York, involved 50 participants who had plaque in their carotid arteries (main arteries that carry blood to the brain.) This dangerous condition can lead to a stroke if plaque breaks off and lodges in the brain arteries. Among the participants who took 240 mg a day of tocotrienols along with 60 mg of alpha-tocopherol , 88% experienced stabilization or actual reduction of plaque improved. Among participants taking a placebo, 60% experienced a worsening of their condition and only 8% stabilized or improved.(Kooyenga, D.K., T.R. Watson, M. Geller, M. L. Bierenbaum. 2001. Micronutrients and Health: Antioxidants modulate the course of carotid atherosclerosis: A four-year report. Nesaretnam, K., L. Packer (Eds). Illinois: AOCS Press. 366-375.)
Tocotrienols also combat cholesterol. A review published in the Journal of the American Nutraceutical Association, supplementation with gamma and delta tocotrienols at 75 mg to 100 mg per day for two months reduced total cholesterol levels by 13% to 22% and cut LDL “bad” cholesterol by 9% to 20%.
Cholesterol levels alone are not predictive of heart attacks—in fact, about half of people who suffer heart attacks do not have high cholesterol. However, tocotrienols may contribute to heart and arterial health in several other ways. LDL cholesterol molecules in their natural state are soft, large and fluffy. They become a problem only if they oxidize (get damaged by negatively charged molecules known as free radicals), which makes them dense and more likely to cling to artery walls. Tocotrienols are powerful antioxidants that protect LDL against harmful oxidation.
In addition, tocotrienols…
- Change LDL cholesterol to a form that does not promote plaque formation.
- Reduce triglycerides (blood fat) that can contribute to cardiovascular disease.
- Inhibit the biochemical process that triggers damaging inflammation of arterial walls.
- Promote dilation and flexibility of arteries, increasing blood flow.
- Lower blood pressure, further protecting arteries.
Dosage: Take 240 to 300 mg daily.
Safety: Discontinue tocotrienol supplementation 10 to 14 days prior to scheduled surgery to reduce the risk of excess bleeding.