Atherosclerosis: The Good, The Bad, The Ugly

I used to work in a supplement store, and I had people come in all the time asking for things that would “clear their arteries” because their doctor said it put them at risk for a stroke. This is absolutely true, but unfortunately there’s also no magic supplement that will help “unclog” those arteries. The best approach is through a combination of lifestyle, diet, and potentially supplementation if warranted. To understand how to approach atherosclerosis, we first have to know what exactly it is.

What is atherosclerosis? (The Ugly)

The basic bottom line is that atherosclerosis is a disease of inflammation and immune system activation. It involves a series of steps that start with your risk factors (many of the things I have mentioned this month already on my Instagram posts) and end in restricted blood flow due to plaque formation [1]:

1. Endothelial (or inner layer of your blood vessels) dysfunction occurs due to cardiovascular risk factors such as smoking, hyperglycemia, hypertension, and elevated free radicals/oxidative stress.
2. This increases the permeability of the membrane, allowing low density lipoprotein (LDL) to invade.
3. LDL is oxidized by free radicals or reactive oxidative species (ROS).
4. The immune system recognizes this as an injury, so it sends immune cells to that region. Both the innate and adaptive immune system are involved.
5. Macrophages (immune cells) attempt to destroy the LDL particles by phagocytosis (basically eating them).
6. Lipid filled macrophages are what forms the fatty streaks – they build up in your arteries.
7. This is a place where macrophages and LDL particles are NOT supposed to be, and additional immune cells and phagocytosis happens. Pro-inflammatory cytokines (immune “signalers”) are also activated in this process.
8. The LDL particles are not able to be cleared from the inner layer of your blood vessels.
9. Formation of fatty streaks (basically a combination of fat and immune cells stuck together) result in proliferation of smooth muscle cells, which creates a fibrous cap over the plaque.
10. The vessels compensate for this additional “mass” by dilation, until it can’t anymore – then the plaque extends into the lumen (where blood flows = decreased diameter of the artery).
11. Chronic inflammation, exposure to ROS, and continued endothelial damage due to cardiovascular risk factors perpetuate this cycle.

What does this mean? (The Bad)

This is one of the reasons why LDL is termed the “bad cholesterol”. This also means that if you even have one cardiovascular risk factor e.g. high blood pressure, you are continually damaging your blood vessels and opening yourself to this cascade. Even diabetes or consistently elevated blood glucose levels have the ability to damage your arteries.

The harm in atherosclerosis is that it reduces the ELASTICITY of your vessels. Your arteries are supposed to be adaptable – when you’re being chased by a bear, your heart pumps faster to allow more blood and oxygen to your muscles, and your arteries expand and contract based on that. However, if there is plaque buildup, you have less of an ability to accommodate any changes, and are susceptible to further damage.

So, what can I do about it? (The Good)

Short answer: TONS! The amount epidemiological, clinical, and experimental studies in the last decade have vastly shown that diet plays a key role in atherosclerosis prevention. If you haven’t already, see my previous article named “Five Ways to Take Care of Your Heart” for ideas on how you can be more heart-conscious (see what I did there?). Antioxidant foods (such as berries, 70+% cocoa dark chocolate, green tea), anti-inflammatory foods (fatty fish e.g. salmon, mackerel, sardines, etc, tumeric, ginger, green leafy vegetables) and supplements help neutralize free radials and decrease damage. A review article found the following:

“An analysis of prospective cohort studies observed a 12% reduction in risk for coronary events and 19% for coronary deaths after the consumption of 10 g/day of dietary fiber.  A meta-analysis shows that ingestion of soluble fiber (2-10 g/day) was associated with a significant 7% LDL-C reduction. The effect is independent of the type of soluble fiber including oat, psyllium, pectin, and guar gum.” [2]

A combination of cardio and resistance exercise has also been found to be effective in glucose control and improving endothelial function in both woman with abdominal obesity and obese adolescents [3,4]. So, get moving!

In addition, one method to assess inflammation in the blood is to check CRP and/or ESR levels. It’s also important to check your blood glucose levels to monitor and/or assess your diabetes risk, as well as your blood pressure. And guess what?! Naturopathic doctors (NDs) are trained to do all of the above!

Naturopathic doctors can also help you with supplementation, if warranted. Supplements considered for atherosclerosis include magnesium, fish oil, red yeast extract, CoQ10, and curcumin – all dependent on your medical history and risk factors. Please consult a ND before starting any supplementation regime.

Keep up to date by following me on Instagram, Facebook, and Twitter (@drtangnd).

Resources: