Stroke and heart attack – can you reverse atherosclerosis?

We examine research on ways ‘experts’ claim you can reverse atherosclerosis, the build-up of plaque in your arteries, leading to heart attack and stroke.

How inflammation, cholesterol, and calcium cause a stroke

Atherosclerosis, which comes from the Greek and means ‘paste hardness’, is the term used for ‘hardening of the arteries’, a slow, lengthy process originated and maintained by inflammation. 

First, raised levels of blood sugar promote increased insulin levels causing inflammation of the arteries.

As a result, cholesterol sticks to the inflamed wall and collects there. The more cholesterol in your blood, the more sticks to the inflamed artery. The body usually reacts to these deposits with a macrophage immune attack, causing more inflammation. In particular, low density lipoprotein (LDL) causes the biggest problems (1). This is oxidised in the artery wall and macrophages and inner lining vascular cells increase in number and migrate outwards towards the Intima, the outer lining of the artery.

The next step is calcification. 99% of the calcium a healthy person consumes goes to their bones and teeth. The excess remains in the blood, where it responds to inflammation and/or injury. Thus calcium can build up in abnormal areas such as the arteries, brain or kidneys. Calcification is also a crucial factor in ductal breast cancer. Within the arteries, calcification is often referred to as ‘plaque’.

In summary –  a cholesterol build-up causes inflammation, immune attack and oxidation in the inflamed artery and this prompts the formation of more inner artery cells and their movement and calcification and plaque in the area. This localised ‘stress’ results in greater inflammation, and the whole process can spiral and quicken. 

All this started from the effects of higher blood sugar and insulin.

TIA and Stroke risk

The calcification causes a stiffening and widening of the walls of the arteries and, when that progresses, eventually the blood flow is restricted by the widening walls. If this occurs in the carotid arteries, you may then have a TIA (a transient ischemic attack), which is a temporary blood clot produced when fibrin in your bloodstream causes the formation of a ‘fishing net’ and waxy cholesterol can stick to it. This blood clot causes a blockage of blood flow and therefore oxygen, to the brain. In two out of three cases, after a short while this blood clot dislodges and enzymes in the blood break it down.

People invariably recover, but it is indicative that a full-blown stroke is on its way if you don’t take action. Once you have had one, you are very likely to have another.

Calcification of the heart valve

Another dangerous area of calcification is aortic stenosis, a narrowing of the valve that controls blood flow from the heart to the rest of the body. The American Heart Association estimate that one in eight people over 75 have aortic stenosis to some degree.

Calcification of the arteries is common

According to The Cleveland Clinic, coronary artery calcification increases with age and in the over 70s, deposits are found in 90% of men and 67% of women. Women are more likely to have a TIA than men.

Can you reverse atherosclerosis, a thickening of arteries?

   i) Lifestyle:

Perhaps the best example of this came during the second World War, where people who had been on restricted diets were shown to have far, far less atherosclerosis. But as they started to eat a normal Western diet again, their arteries worsened.

So diet is a major factor, particularly refined foods, high sugar, high cholesterol, high dairy and calcium diets. They cause this inflammatory downward spiral. 

Cutting down on all forms of sugar, refined and processed foods, dairy, omega-6 seed oils and following a lifestyle Rainbow Diet programme of unsaturated olive oil, oily fish, avocado oil, nuts like walnuts, seeds, pulses (lentils), vegetables, with sunshine, regular exercise, regular sleeping patterns, reducing your waistline has all been shown to lower the risks of atherosclerosis-induced heart attack and stroke (9).

One of the biggest factors in the Mediterranean diet is the polyphenol content. Over 500 known polyphenols are commonly present in the diet which majors on consuming olive oil and olives, fish, vegetables, fruits, herbs, spices and nuts and seeds.

In particular, allicin from raw garlic reduces atherosclerosis via your gut bacteria and the reduction of a compound called TMAO (10). Researchers from Melbourne showed that raw honey with its high levels of polyphenols and antioxidants reduces the oxidation and inflammation processes which make LDL cholesterol so dangerous in the artery wall; and honey can even reverse the build up of atherosclerosis. (11). In an 8-year study on Italian adults, the consumption of chili was linked to a lower death rate from cardiovascular disease, ischemic heart disease and cerebrovascular events (12). Chili peppers are rich sources of capsaicin, a polyphenol which again has high antioxidant and high anti-inflammatory properties. Finally, other polyphenols in fresh lemons or limes – not just the juice but the peel too – had a major influence in reversing cholesterol involvement in artery walls. In research, the antioxidant levels rose in the bloodstream and the fatty streaks in the arteries declined in the group given the juice (13).

   ii) Vitamin K2:

Research is mixed. In a 2022 study in the American Heart Association journal ‘Circulation’, a randomised, double-blind, placebo-controlled trial found vitamin K2 and vitamin D supplements did not slow the progression of calcium deposits on the aortic valves of older men once the process had begun (2). 

This followed several other studies that suggested K2 supplementation (with or without vitamin D3) might prove helpful. An August 2021 study (3) suggested that there were less hospitalisations for cardiovascular disease related to plaque build-up in people who ate a diet rich in vitamin K2.

Since the first trial was relatively short-term it may mean that long term consumption of K2 may help prevent, but not reverse, existing build up.

WebMD, the website of 5 Pharma companies, states that ‘Vitamin K breaks down calcium in our bodies, and this helps prevent hard deposits (calcium and fatty material) from forming in artery walls. This ensures healthy circulation, reducing the risk of harmful blood clots and heart disease. Studies show that a person’s risk of dying from heart disease falls by 9% for every 10 micrograms K2 consumed a day.’  

K2 is not found in natural foods but is made by bacteria – it is typically found in fermented foods such as Natto, kefir and sauerkraut, plus blue cheese, chicken and egg yolk. 

iii) Berberine:

As we said above, Vascular Smooth Muscle Cells (VSMC) actually migrate and proliferate as atherosclerosis forms. The herb Berberine has blood sugar lowering and antiinflammatory properties and is known to regulate and prevent VSMC migration (4).  It has been shown to have curative effects on VSMCs and can prevent their proliferation and migration. Berberine is also known to suppress macrophages.

Berberine is also known (for example in cancer) to activate the Akt pathway; which has been shown to reduce vascular calcification (5). In research, vascular calcification was significantly restricted by berberine treatment in vivo and in vitro.

Berberine (3 x 500 mg per day) is known to cut blood sugar levels even better than diabetes drug Metformin, while possessing strong anti-inflammatory, anti-pathogenic and homocysteine-lowering benefits that Metformin does not have.

iv) Fish oils:

Many cardiovascular events are caused by the plaque in the artery wall ‘rupturing’. Long-chain omega-3 fatty acids (fish oil) have a plethora of data for stabilising vulnerable atherosclerotic plaques as well as reversing atherosclerosis (6). Researchers talk of the ability of fish oils to ‘remodel’ the arthrosclerotic artery wall.

Of course, a drug (Vascepa) has been produced from ‘highly purified fish oil’! It has been shown in research to reduce plaque in the heart’s arteries. It lowers the risk of heart attack and stroke by 26% in people at high risk for those serious problems (7). The research was called the ‘Evaporate Trial’ and it concluded that the group taking the drug had less unstable (dangerous) plaque and the total volume of plaque was also lower than for the control group. Harvard Health stated that the fish oil compound ‘Helps Shrink’ plaque in the arteries.

v) Boswellia (Frankincense):

In research (8), mice were induced to have atherosclerosis lesions in their arteries. Boswellia, a proven anti-inflammatory, reduced lesion size by 50 per cent, reduced the activity of several genes involved in atherosclerosis, reduced macrophage activity and the conclusions stated that ‘the inhibition of NF-κB activity by plant resins from species of the Boswellia family might represent an alternative for classical medicine treatments for chronic inflammatory diseases such as atherosclerosis’.

Atherosclerosis – The bottom line

While your doctor wants you to take blood thinners and statins, there is clearly much you can do to help yourself. There are a plethora of YouTube doctors extolling the virtues of a number of reducers of atherosclerosis, and we have checked those claims.

For K2 the research is actually mixed. For other compounds such as garlic, honey, lime juice, fish oils and chili there definitely is consistent research. And with berberine and boswellia we brought something new into the mix.

Changing your diet and lifestyle, taking fish oils, berberine and boswellia, plus chili, lime, allicin and raw honey, definitely offer you positive benefits and the potential of reversing hardening arteries and lowering your risk of strokes and heart attacks.

Go to: How choline in fatty meats and eggs increases heart attack risk

Go to: Boswellia and Frankincense

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References

1. Low-density lipoprotein cholesterol is predominantly associated with atherosclerotic cardiovascular disease events in patients with evidence coronary atherosclerosis; Mortensen MB, Dzaye O, Betker HE, Jensen JM, Maeng M, Bentzon JF, Kanstrup H, Sørensen HT, Leipsic J, Blankstein R, et al. Circulation. 2023; 147:1053–1063. 
2. Vitamin K2 and D in Patients With Aortic Valve Calcification: A Randomized Double-Blinded Clinical Trial: Axel C.P. Diederichsen et al; Ciculation, Vol 145; No 18. April 25 2022. 
3. Vitamin K Intake and Atherosclerotic Cardiovascular Disease in the Danish Diet Cancer and Health Study; Jamie W. Bellinge et al; JAHA 7 August 2021 
4. Effects of Berberine on Atherosclerosis; Rui Rui et al; Front Pharmacol. 2021; 12: 764175.
5. The Ameliorative Effect of Berberine on Vascular Calcification by Inhibiting Endoplasmic Reticulum Stress; Li, Liuying MM et al; Journal of Cardiovascular Pharmacology 80(2):p 294-304, August 2022.
6. The Benefits of Omega-3 Fats for Stabilizing and Remodeling Atherosclerosis; James J. DiNicolantonio et al; Mo Med. 2020 Jan-Feb; 117(1): 65–69. 
7. Effect of icosapent ethyl on progression of coronary atherosclerosis in patients with elevated triglycerides on statin therapy; Matthew J. Budhoff et al; European Heart Journal, Volume 41, Issue 40, 21 October 2020, Pages 3925–3932
8. Antiinflammatory and Antiatherogenic Effects of the NF-κB Inhibitor Acetyl-11-Keto-β-Boswellic Acid in LPS-Challenged ApoE−/− Mice; Clarisse Cuaz-Pérolin et al; 21 Nov 2007, Thrombosis, and Vascular Biology. 2008;28:272–277
9. How a colorful Mediterranean diet reduces heart attack and stroke risk – https://www.canceractive.com/article/heart-risk-reduced-by-switching-to-a-mediterranean-diet 
10. Atherosclerosis amelioration by allicin in raw garlic through gut microbiota and TMAO; Nature 27 Jan 2022
11. Honey and Its Role in Relieving Multiple Facets of Atherosclerosis; Huong Thi Lan Nguyen et al; Nutrients. 2019 Jan; 11(1): 167.
12. Chili Pepper Consumption and Mortality in Italian Adults; Marialaura Bonaccio et al; J Am Coll Cardiol, 2019 Dec 24;74(25):3139-3149
13. Impacts of fresh lime juice and peel on atherosclerosis progression in an animal model; Maryam Boshtam et al; ARYA Atheroscler. 2013 Nov; 9(6): 357–362