Atherosclerosis (Hardening of the Arteries)

Atherosclerosis, or hardening of the arteries, is a very common disease of the major blood vessels. It is characterized by fatty streaks along the vessel walls and deposits of cholesterol and calcium. Atherosclerosis of arteries supplying the heart is called coronary artery disease. It can restrict the flow of blood to the heart, which often triggers heart attacks—the leading cause of death in Americans and Europeans. Atherosclerosis of the arteries supplying the legs causes a condition called intermittent claudication.

People with elevated cholesterol levels are much more likely to have atherosclerosis than people with low cholesterol levels. Many important nutritional approaches to protecting against atherosclerosis are aimed at lowering serum cholesterol levels. People concerned about atherosclerosis should also read the section on cholesterol.

People with diabetes are also at very high risk for atherosclerosis. Those with diabetes who are concerned about atherosclerosis should also read the section on diabetes.

People with elevated triglycerides may be at high risk for atherosclerosis. For a discussion about fish, fish oil, and other natural substances that lower triglycerides and may also reduce the risk of atherosclerosis, see the section on high triglycerides.

Lifestyle changes that may be helpful: Virtually all doctors acknowledge that smoking is directly linked to atherosclerosis and heart disease. Quitting smoking protects many people from atherosclerosis and heart disease and is a critical step in the process of disease prevention.

Obesity and type A behavior are both associated with an increased risk of atherosclerosis, while exercise is linked to protection from this condition. These are discussed in more detail in the section on cholesterol.

Dietary changes that may be helpful: The most important dietary changes in protecting arteries from atherosclerosis include avoiding meat and dairy fat, increasing fiber, and possibly avoiding foods that contain trans fatty acids (margarine and other processed foods).

Independent of their effect on serum cholesterol, foods that contain high amounts of cholesterol—mostly egg yolks—can induce atherosclerosis.¹ It makes sense to reduce the intake of egg yolks. However, eating eggs does not increase serum cholesterol as much as eating saturated fat, and eggs may not increase serum cholesterol at all if the overall diet is low in fat. A decrease in atherosclerosis resulting from a pure vegetarian diet—meaning no meat, poultry, dairy, or eggs—combined with exercise and stress reduction has been proven by medical research.²

Garlic acts as a blood thinner³ and may reduce other risk factors for atherosclerosis.⁴ Doctors of natural medicine generally view garlic as an anti-atherogenic agent, and many recommend eating garlic or taking 900 mg of garlic powder per day from capsules. Garlic may also be taken as a tincture in the amount of 2-4 ml, three times daily.

Nutritional supplements that may be helpful: Many cardiologists agree that LDL—low density lipoproteins, or “bad” cholesterol—triggers atherosclerosis only when it has been damaged by reactive molecules called free radicals. Several antioxidant supplements protect LDL cholesterol.

Vitamin E is an antioxidant that serves to protect LDL from oxidative damage⁵ and has been linked to prevention of heart disease in double-blinded research.⁶ Vitamin C also protects LDL,⁷ although it is less clear whether vitamin C protects against atherosclerosis. Virtually all nutritionally oriented doctors recommend 400-800 IU of vitamin E per day to lower the risk of atherosclerosis and heart attacks. Many such doctors also suggest that people take vitamin C—often 1 gram per day. See the section on cholesterol for more details.

In some studies, people who consume more selenium from their diet have a lower risk of heart disease.⁸ ⁹ In one double-blinded report, individuals who already had one heart attack were given 100 mcg of selenium per day or placebo for six months.¹⁰ At the end of the trial, there were four deaths from heart disease in the placebo group but none in the selenium group (although the numbers were too small for this difference to be statistically significant). Some nutritionally oriented doctors recommend that people with atherosclerosis supplement with 100-200 mcg of selenium per day.

Quercetin, a bioflavonoid, also protects LDL cholesterol from damage.¹¹ Several studies have found eating foods high in quercetin lowers the risk of heart disease,¹² ¹³ ¹⁴ but the research on this subject is not consistent.¹⁵ Quercetin is found in apples, onions, black tea, and as a supplement. Dietary amounts linked to protection from heart disease are as low as 35 mg per day.

Blood levels of an amino acid called homocysteine are tightly linked to both atherosclerosis and heart disease in general.¹⁶ Researchers believe that even slight elevations of homocysteine trigger atherosclerosis at its early stages and significantly increase the risk of heart disease.

Higher blood levels of vitamins B6, B12, and folic acid are associated with low levels of homocysteine,¹⁷ and supplementing with these vitamins lowers homocysteine levels.¹⁸ ¹⁹ For the few cases in which B6, B12, and folic acid fail to normalize homocysteine, adding 6 grams per day of betaine may be effective.²⁰ The form of betaine used to lower homocysteine levels is different from the betaine HCL supplement used to acidify the stomach. Of these four supplements, folic acid appears to be the most important.²¹ Attempts to lower homocysteine by simply changing the diet rather than using vitamin supplements have not been successful.²² While several trials have consistently shown that B6, B12, and folic acid are helpful, the amounts used vary from study to study. Many nutritionally oriented doctors recommend 50 mg of vitamin B6, 100-300 mcg of vitamin B12, and 800 mcg of folic acid.

Evening primrose oil helps lower cholesterol levels, which in turn reduces the risk of atherosclerosis.

Chondroitin sulfate is another nutrient that may prove to be important for healthy blood vessels. Preliminary research shows that chondroitin sulfate may prevent atherosclerosis in animals and humans and may also prevent heart attacks in people who already have atherosclerosis.^{23 24} However, further research is needed to determine the value of chondroitin sulfate supplements for preventing or treating atherosclerosis.

Resveratrol, found primarily in red wine, is a naturally occurring antioxidant that decreases the “stickiness” of blood platelets and helps blood vessels remain open and flexible.^{25
26 27}

Limited evidence suggests that octacosanol may help atherosclerosis that affects the neck arteries.²⁸

Royal jelly may play a small role in controlling atherosclerosis, however this has not been substantiated in human research.

Are there any side effects or interactions? (Refer to the individual supplement for complete information.) Vitamin E side effects are very rare, as are side effects from vitamin C. However, some individuals experience diarrhea when taking a few thousand milligrams of vitamin C per day. Selenium in excess of 1,000 mcg per day can cause the loss of fingernails, skin rash, and changes to the nervous system. No clear toxicity has been identified with quercetin. Folic acid, although safe, can mask the symptoms of vitamin B12 deficiency, which is why these vitamins should always be taken together. Vitamin B12 supplements are not associated with side effects. Vitamin B6 side effects are rare, but nervous system changes can occur with dosages above 200 mg per day.

Consistent, reproducible problems from taking evening primrose oil have not been reported.

At intakes of chondroitin sulfate greater than 10 grams per day, nausea may occur. No other adverse effects have been reported. Care should be taken if using a form of chondroitin sulfate that contains sodium, as this may worsen high blood pressure.

Long-term human studies of octacosanol using doses up to twice the typical therapeutic dose (that is, 20 mg each day) have not shown any negative effects.

Occasionally, royal jelly can provoke an allergic reaction in a susceptible individual.

Herbs that may be helpful: As is the case with nutritional supplements and foods that protect the cardiovascular system, herbs that help prevent atherosclerosis are those that provide one of the following actions:

• Reduce the levels of cholesterol and triglycerides in the blood stream
• Reduce the stickiness of platelets in the blood
• Improve the strength of blood vessel walls
• Improve the flow of blood through the body
• Provide antioxidant protection to the cardiovascular system—
particularly with regard to blocking oxidation of LDL cholesterol

For more, detailed information on lowering serum cholesterol and triglycerides using herbs, please refer to the respective herb entries from the checklist.

Are there any side effects or interactions? (Refer to the individual herb for complete information.) Used at the recommended dosage, Asian ginseng and eleuthero are generally safe. In rare instances, ginseng may cause overstimulation and possibly insomnia. Consuming caffeine with ginseng increases the risk of over-stimulation and gastrointestinal upset. Persons with uncontrolled high blood pressure should not use ginseng. Long-term use of ginseng may cause menstrual abnormalities and breast tenderness in some women. Ginseng is not recommended for pregnant or lactating women.

In recommended amounts, there are no known side effects with bilberry extract. Bilberry does not interact with commonly prescribed drugs, and there are no known contraindications to its use during pregnancy or lactation.

Use of more than 100 grams of fenugreek seeds daily can cause intestinal upset and nausea. Otherwise, fenugreek is extremely safe.

The unprocessed fo-ti roots may cause mild diarrhea. Some people who are sensitive to fo-ti may develop a skin rash. Very high doses may cause numbness in the arms or legs.

Most people enjoy garlic; however, some individuals who are sensitive to it may experience heartburn and flatulence. Because of garlic’s anticlotting properties, persons taking anticoagulant drugs should check with their nutritionally oriented doctor before taking garlic. Those scheduled for surgery should inform their surgeon if they are taking garlic supplements. There are no known contraindications to the use of garlic during pregnancy and lactation.

Side effects of ginger are rare when used as recommended. However, some people may be sensitive to the taste or may experience heartburn. Persons with a history of gallstones should consult a doctor before using ginger. Short-term use of ginger for nausea and vomiting during pregnancy appears to pose no safety problems; however, long-term use during pregnancy is not recommended.

Ginkgo biloba is essentially devoid of any serious side effects. Mild headaches lasting for a day or two and mild upset stomach have been reported in a very small percentage of people using ginkgo. There are no known contraindications to the use of ginkgo by pregnant and lactating women.

Modern extracts of guggul have few side effects, although mild abdominal discomfort has been reported with long-term use. Guggul should be used with caution by persons with liver disease and in cases of inflammatory bowel disease and diarrhea. A physician should be consulted for any case of elevated cholesterol and triglycerides.

Hawthorn is extremely safe for long-term use. There are no known interactions with prescription cardiac medications or other drugs. There are no known contraindications to its use during pregnancy or lactation.

Using psyllium in recommended amounts is generally safe. People with chronic constipation should seek the advice of a health care professional.

Turmeric is extremely safe. It has been used in large quantities as a food with no adverse reactions. However, persons with symptoms from gallstones should avoid turmeric.

At higher intakes, rosemary can cause mild stomach upset. The concentrated essential oil should not be taken internally. There is no evidence to indicate that intermittent intake of moderate doses of rosemary poses any threat during pregnancy or lactation.

Nutritional Supplements

Herbs

Homeopathic Remedies

(continued)

(continued)

No homeopathy commonly used for this condition

1. Raloff J. Oxidized lipids: a key to heart disease? Sci News 1985;127:278.
2. Ornish D, Brown SE, Scherwitz LW, et al. Can lifestyle changes reverse coronary heart disease? Lancet 1990;336:129-33.
3. Lawson LD, Ransom DK, Hughes BG. Inhibition of whole blood platelet-aggregation by compounds in garlic clove extracts and commercial garlic products. Thrombosis Res 1992;65:141-56.
4. Mansell P, Reckless JPD. Garlic—effects on serum lipids, blood pressure, coagulation, platelet aggregation, and vasodilatation. BMJ 1991;303:379-80 [editorial].
5. Belcher JD, Balla J, Balla G, et al. Vitamin E, LDL, and endothelium: Brief oral vitamin supplementation prevents oxidized LDL-mediated vascular injury in vitro. Arterioscler Thromb 1993;13:1779-89.
6. Stephens NG, Parsons A, Schofield PM, et al. Randomised controlled trial of vitamin E in patients with coronary disease: Cambridge Heart Antioxidant Study (CHAOS). Lancet 1996;347:781-86.
7. Frei B. Ascorbic acid protects lipids in human plasma and low-density lipoprotein against oxidative damage. Am J Clin Nutr 1991;54:1113S-8S.

8. Salonen JT, et al. Association between cardiovascular death and myocardial infarction and serum selenium in a matched-pair longitudinal study. Lancet 1982;ii:175.
9. Shamberger RJ, Willis CE. Epidemiological studies on selenium and heart disease. Fed Proc 1976;35:578(abstract #2061).
10. Korpela H, Kumpulainen J, Jussila E, et al. Effect of selenium supplementation after acute myocardial infarction. Res Comm Chem Pathol Pharmacol 1989; 65:249-52.
11. Ronzio RA. Antioxidants, nutraceuticals and functional foods. Townsend Letter for Doctors and Patients Oct, 1996:34-35 (review).
12. Hertog MGL, Feskens EJM, Hollman PCH, et al. Dietary antioxidant flavonoids and risk of coronary heart disease: the Zutphen Elderly Study. Lancet 1993;342:1007-11.
13. Hertog MGL, Kromhout D, Aravanis C, et al. Flavonoid intake and long-term risk of coronary heart disease and cancer in the Seven Countries Study. Arch Intern Med 1995;155:381-6.
14. Knekt P, Jarvinen R, Reunanen A, Maatela J. Flavonoid intake and coronary mortality in Finland: a cohort study. BMJ 1996;312:478-81.
15. Rimm EB, Katan MB, Ascherio A, et al. Relation between intake of flavonoids and risk for coronary heart disease in male health professionals. Ann Intern Med 1996; 125:384-89
16. Stampfer MJ, Malinow R, Willett WC, et al. A prospective study of plasma homocyst(e)ine and risk of myocardial infarction in US physicians. JAMA 1992;268:877-81.
17. Selhub J, Jacques PF, Wilson PW, et al. Vitamin status and intake as primary determinants of homocysteinemia in an elderly population. JAMA 1993;270:2693-2698.
18. Ubbink JB, Hayward WJ, van der Merwe A, et al. Vitamin requirements for the treatment of hyperhomocysteinemia in humans. J Nutr 1994;124:1927-33.
19. Manson JB, Miller JW. The effects of vitamin B12, B6, and folate on blood homocysteine levels. Ann NY Acad Sci 1992;669:197-204 (review).
20. Franken DG, Boers GHJ, Blom HJ, et al. Treatment of mild hyperhomocysteinemia in vascular disease patients. Arterioscler Thromb 1994;14:465-70.
21. Ubbink JB, Vermaak WJH, van der Merwe A, et al. Vitamin requirements for the treatment of hyperhomocysteinemia in humans. J Nutr 1994;124:1927-33.

22. Ubbink JB, van der Merwe A, Vermaak WJH, Delport R. Hyperhomocysteinemia and the response to vitamin supplementation. Clin Investig 1993;71:993-98.
23. Morrison LM, Branwood AW, Ershoff BH, et al. The prevention of coronary arteriosclerotic heart disease with chondroitin sulfate A: Preliminary report. Exp Med Surg 1969;27:278-89.
24. Morrison LM, Enrick NL. Coronary heart disease: Reduction of death rate by chondroitin sulfate A. Angiology 1973;24:269-82.
25. Bertelli AA, Giovanninni L, Bernini W, et al. Antiplatelet activity of cis-resveratrol. Drugs Exp Clin Res 1996;22(2):61-3.
26. Chen CK, Pace-Asciak. CR.Vasorelaxing activity of resveratrol and quercetin in isolated rat aorta. Gen Pharm 1996;27(2):363-6.
27. Pace-Asciak CR, Rounova O, Hahn SE, et al. Wines and grape juices as modulators of platelet aggregation in healthy human subjects. Clin Chim Acta 1996;246(1-2):163-82.
28. Batista J, Stusser R, Penichet M, Uguet E. Dopper-ultrasound pilot study of the effects of long-term policosanol therapy on carotid-vertebral atherosclerosis. Curr Ther Res 1995;56:906–8.