Arterial disease, atherosclerosis

In our last blog we looked at why matters of the Heart and Mind can affect lifestyle issues that can play a big role in cardiovascular (CV) issues. Here we are going to look more at what happens in the tubes.

Arterial disease accounts for the vast majority of patients that suffer from cardiovascular disease, and maybe accompanied by diseases of the veins and heart.  The primary arterial disease is atherosclerosis, a progressive disease of large and medium large arteries that is marked by the formation of plaques or atherosclerotic lesions in the lining of the blood vessels.  The term arteriosclerosis is the same pathology, and is used when discussing the atherosclerotic lesions that can occur in the smaller arterioles. The major complications of atherosclerosis include Poor circulation to the Heart (ischemic), Heart attacks (myocardial infarction), and gangrene of the extremities.  Atherosclerosis is one of the leading causes of death in North America, a percentage of the population that has been on the rise steadily since the turn of the last century.

Areas to consider: high blood pressure, elevated blood cholesterol and triglycerides (including chylomicrons, very low density lipoproteins (VLDL), low density lipoproteins (LDL) and high density lipoproteins (HDL)); blood sugar issues.

Medical treatment: At this time modern medicine has no specific treatment for atherosclerosis, but is focused on inhibiting or alleviating signs and symptoms, or providing treatments that change or modify the results of laboratory investigations.

High blood pressure is perceived as being a risk factor for atherosclerosis, and is managed symptomatically through the use of pharmaceuticals to lower blood pressure.

High blood fats is generally perceived as a risk factor for atherosclerosis largely based upon the use of cholesterol lowering pharmaceutical agents, and an observed reduction in the risk of coronary heart disease events and overall mortality.  The primary cholesterol lowering drug consists of HMG-CoA reductase inhibitors or “statins” which inhibit the rate-limiting step of cholesterol synthesis in the liver, thereby lowering serum cholesterol, LDL-cholesterol, and triglyceride levels.  Adverse effects include CoQ10 depletion, hepatotoxicity and myopathy. We discuss this issue in more detail in an earlier blog.  Example HMG-CoA reductase inhibitors include pravastatin, simvastatin, lovastatin, atorvastatin, and rosuvastatin.

Holistic treatment

Generally speaking, the holistic perspective on the origin of atherosclerosis is related to an underlying metabolic dysfunction caused by alterations in diet and lifestyle.  In other words, the origin of atherosclerosis is more of a software (or lifestyle) issue than a hardware (physiological) issue, even though it can have very strong hardware implication if it goes too far. This idea is based on sound epidemiological and anthropological research that indicates that the incidence of atherosclerosis is for the most part a disease of people that eat a highly refined modern diet, rich in carbohydrates, plentiful in oxidizing and toxic compounds, and deficient in key nutrients including minerals, vitamins, essential fatty acids, and plant-based antioxidants. Or in other words the Standard American Diet (SAD).  Associated factors include a sedentary lifestyle (which promotes insulin resistance and thus sugar related issues) and environmental pollutants, e.g. cigarettes, air pollution etc., some of which are easier to control (i.e. smoking, exercise) than others (i.e. air pollution).  The results of this exposure to environmental toxins, a lack of exercise, and poor eating pattern are metabolic problems such as metabolic syndrome, chronic diabetes, insulin resistance, hyper-insulinemia and dyslipidemia, free radical production, and impaired detoxification. Thus the focus in holistic treatment is to reduce the glycemic load of the diet, and supplement with key nutrients that may be deficient and can enhance antioxidant and detoxification pathways in the body.

While fatty deposits on the inside or arteries (atheroma) are fingered as the causal agent of atherosclerosis, and indeed, defines the nature of the condition, a holistic perspective suggests that the atheroma develops as a transient response to injury of the blood vessels, to inhibit further injury by promoting a local thickening of the blood vessel lining: essentially, chewing gum stuck in a crack of a dam about to burst.  The transient and reversible nature of the atheroma suggests that if correct measures are taken to eliminate endothelial injury the atheroma will eventually be replaced by normal endothelial tissue.  If the factors that causes damage are chronic however, the temporary method the body uses to protect against further injury becomes a secondary source of injury, narrowing the vessels, placing stress on the heart, and then eventually, occluding the vessel so as to promote ischemia.  The process of atherosclerosis is thus dependent upon chronic, underlying factors that promote the continuance of the atheroma, in much the same way that a scab that is constantly picked will never heal, and will result in a much larger lesion than originally sustained.

From a traditional herbal perspective, atherosclerosis can be seen as a problem of blood itself, specifically, in its constitution and its movement.  The constitution of the blood is in large part a manifestation of digestive processes, and thus an assessment of digestion should be carefully undertaken.  Specifically, it is the job of the liver to build, replenish and filter the blood, and thus problems relating to the constitution of blood (e.g. blood viscosity, dyslipidemia etc.) demonstrates a need for upregulating liver function with the use of cholagogues, e.g. Barberry, Turmeric, Dandelion, Buplerum, and Chelidonium.  In Chinese and Ayurvedic terms an increase in blood viscosity or dyslipidemia relates to the accumulation of phlegm, and thus phlegm-reducing remedies such as, Reishi, Ginger, Cayenne, Rosemary and Garlic can be used in conjunction with cholagogue remedies.

Given the obstructive nature of atherosclerosis the movement of blood is an extremely important consideration, and the nature of the treatment can be implemented based on the presenting signs and symptoms.  Generally speaking, it is always wise to include stimulants such as Ginger, Cayenne and Garlic in any therapy directed to atherosclerosis to enhance the processing of blood via the liver, and to dispel the archetypal accumulation of phlegm that underlies the obstructive nature of the atheroma.  In many cases however the atherosclerotic patient will present with a substantial deficiency, qi deficiency in Chinese terms.   Besides typical symptoms of cold hands and feet, there will be chronic fatigue, poor digestion, and weak pulse.  Treatment is orientated to building up the vital essence and restoring the natural heat of the body with nutritive, blood-moving herbs such as Reishi, Cordyceps, Dong quai, Astragalus, Ginseng, Ashwagandha.

Besides the condition and movement of the blood, attention must also be directed to the integrity of the vessel walls.  In Chinese medicine the vessels are said to be regulated by the Spleen, and thus in chronic Spleen qi deficiency the vessels are weak and become susceptible to damage and rupture.   Once again, qi-restorative herbs such as those described above are similarly appropriate.  Attention should also be directed to using botanicals that have a tonic function on the blood vessel lining.  Many of these botanicals are particularly rich in polyphenols such as flavonoids and tannins (e.g. ellagitannins, proanthocyanidins) including Ginkgo, Bilberry/Blueberry, and Gota Kola.  

Overall, the holistic approach in the treatment of atherosclerosis is as follows:

1. Reduce the glycemic load of the diet. Adopt a low-carbohydrate diet, and eliminate all refined carbohydrates including sugar, candy, soda pop, cookies and deserts for a minimum period of two to three months.  After which time, whole-grain carbohydrates can be rotated back into the diet.

2. Eliminate toxic foods from the diet. Including hydrogenated and trans-fats (e.g. margarine, deep-fried foods), feed-lot meat and farmed salmon, dairy.

3. Supplement for deficient nutrients.

• vitamin B complex, 25 – 50 mg daily
• folic acid, 1 mg daily
• B-12, 1000 mcg daily
• vitamin C, 1-5 g; 2 – 3 times daily
• vitamin E (d-alpha tocopherol, with mixed tocopherols), 400-800 IU daily, increase dose gradually (start at 100 IU if recent heart attack)
• EPA/DHA, 2000 – 6000 mg each daily
• magnesium, 800 mg daily, in divided doses, with meals
• chromium, 200-300 mcg daily
• selenium, 100 mcg daily
• chelated multimineral, taken with the above minerals; or high quality kelp (seaweed) supplement (5-15 g daily)
• CoQ10, 100 mg daily
• Flavonoids (mixed, e.g. quercitin, rutin, anthocyanidins), 3-5 g daily

4. Support liver, enhance detoxification: Barberry, Turmeric, Dandelion Root, Reishi
5. Promote circulation and blood flow, reduce blood viscosity (i.e. phlegm): Ginger, Cayenne, Rosemary, Garlic
6. Cardiovascular tonics: Ginkgo, Bilberry, Reishi, Cordyceps, Hawthorn etc.

7. Rebuild the vital essence:g. Dong Quai, Astragalus, Reishi, Cordyceps, Ginseng, Ashwagandha

Exercise: in particular, anaerobic exercise (muscle-building) is more effective than aerobic exercise (jumping, running) to reduce insulin resistance, e.g. calisthenics (e.g. pushups, lunges, chin ups etc.), walking or bicycling uphill, hiking, martial arts, weight-lifting; note that any exercise regimen should be implemented gradually

Suggested Program

Breakfast

Reishi/Cordyceps (3 capsules)

Garlic (2 capsules)

B complex (1 tablet)

Essential Fatty Acid (2,000 mg)

Niacin (50-100 mg)

Snack  Vitamin C (500 mg).

Lunch  Vitamin C (500 mg).

Snack Same as morning snack.

Supper Same as breakfast.

Drink 1- 4 cups of Ginger root tea daily.