What is Atherosclerosis?
Atherosclerosis is the process of the hardening of an artery due to the build-up of cholesterol-containing plaque. Atherosclerosis is responsible for coronary artery disease—the leading cause of death in America—and many cases of stroke. Altogether, atherosclerosis is responsible for at least 43 percent of all deaths in the United States.
What are the Signs and Symptoms of Atherosclerosis?
Atherosclerosis is often referred to as the “silent killer” because the first symptom or sign in many cases is a fatal heart attack or stroke. Most people with significant atherosclerosis have a history of elevated cholesterol levels and may also experience angina.
What Causes Atherosclerosis?
The initial step in the development of atherosclerosis is damage to the lining of an artery. This damage is usually the result of free radicals (highly reactive toxic chemicals) and/or inflammation. Once the artery lining has been damaged, the site of injury attracts monocytes (large white blood cells) and platelets (small blood cells involved in the formation of blood clots). These monocytes and platelets adhere to the damaged area, where they release growth factors that stimulate plaque formation and the accumulation of fat and cholesterol deposits. Reducing the risk of heart disease and strokes involves reducing or, when possible, eliminating the following major risk factors:
- Elevated blood cholesterol levels
- High blood pressure
- Physical inactivity
If two or more of these major factors apply to you, your risk increases significantly (see Table 1). For example, if you smoke, have high cholesterol and have high blood pressure, you are more than 700 times likelier to have heart disease —and you will probably die 20 to 30 years sooner—than someone without any of these factors.
Table 1: The More Major Risk Factors Present, the Greater the Risk
|Condition||Increased Risk of Heart Disease|
|Presence of 1 major risk factor||30%|
|High cholesterol + high blood pressure||300%|
|High cholesterol + smoking||350%|
|High blood pressure + smoking||350%|
|Smoking + high blood pressure + high cholesterol||720%|
In addition, there are several other risk factors that have been shown in some studies to be even more important than the so-called major risk factors:
- Elevations of markers of silent inflammation like C-reactive protein and fibrinogen
- Low levels of omega-3 fatty acids
- Low consumption of dietary antioxidants
- Low levels of magnesium and potassium
- Low levels of folic acid, which leads to elevations in homocysteine
Which Dietary Factors are Important in Atherosclerosis?
I recommend the following diet to reduce the risk of atherosclerosis:
- An abundance of plant food, including fruit, vegetables, breads, pasta, potatoes, beans, nuts and seeds
- Minimally processed foods, with a focus on seasonally fresh and locally grown products
- Fresh fruit as the typical daily dessert, with sweets containing concentrated sugars or honey consumed a few times per week at the most
- Daily consumption of dairy products, principally cheese and yogurt, in low to moderate amounts and in low-fat varieties
- Regular consumption of fish
- Moderate consumption of poultry and eggs—about one to four times weekly—or not at all
- Small, infrequent amounts of red meat
- Olive oil as the principal source of fat
- Wine in low to moderate amounts, normally with meals
The two components of the Mediterranean diet that have received a lot of attention are red wine and olive oil. Red wine is thought to be responsible for the “French paradox,” a term used to explain why the French consume more saturated fat than Americans, yet have a lower incidence of heart disease. This is thought to be the result of the flavonoids in red wine, which protect against oxidative damage to the arteries from LDL (bad) cholesterol.
In addition to oleic acid—a heart-protective monounsaturated fatty acid—olive oil also contains several antioxidant agents that prevent circulating LDL cholesterol from becoming damaged and then subsequently damaging the arteries. Olive oil lowers amounts of LDL cholesterol and increases the level of protective HDL cholesterol. It has also been proven to reduce elevated blood triglycerides (another risk factor for heart disease), though it is not as effective as fish oils.
Which Nutritional Supplements Should I Take for Atherosclerosis?
Foundation Supplements. High potency multiple vitamin and mineral formula; Vitamin D3 2,000-5,000 IU/day; Fish oil, EPA+DHA 1,000 to 3,000 mg/day.
Fish oil. Of all the available nutritional supplements to prevent heart disease, the most important without question is a pharmaceutical-grade fish oil, which is rich in omega-3 fatty acids. It is now estimated that individuals whose diets include a higher intake of fish oils reduce their risk of heart disease and strokes by roughly 47 percent compared to people who do not eat fish or take fish oil supplements. In fact, the level of omega-3 fatty acids in the body (the Omega-3 Index) has been shown to be the most accurate predictor of heart disease risk. It is a more sensitive indicator than other well-recognized markers such as total cholesterol, LDL or HDL cholesterol, CRP or homocysteine levels. A combined 1,000 mg of EPA and DHA omega-3s daily is required to achieve the Omega-3 Index shown to be protective. If you have high triglycerides or other risk factor for heart disease, take 3,000 mg EPA+DHA daily.
Grapeseed or pine bark extract contain flavonoids known as procyanidolic oligomers (PCOs) that have exceptional antioxidant and free radical–scavenging activity. Take 300 mg of PCOs daily. Note: Green tea extract can be substituted for PCOs; take 300 mg of green tea catechins (polyphenols) daily.
My clinical experience as well as an enormous body of scientific evidence shows that atherosclerosis can be stopped and even reversed through dietary, supplementation and lifestyle measures. Treatment and prevention includes reducing all known risk factors. For specific recommendations for dealing with the major risk factors, please see the appropriate selection: high cholesterol, diabetes and high blood pressure.
How do I Know if the Recommendations are Working?
As atherosclerosis is a silent disease, it is difficult to monitor without medical assistance. A regular physical exam and laboratory analysis is recommended on an annual or as-needed basis.