I wanted to go a step beyond my articles on combating high cholesterol levels, and present the latest evidence on what you might do to actually reduce the amount of plaque in your arteries. After all, keeping your cholesterol levels low can certainly be beneficial; in particular if you have a lot of those pesky small-dense LDL particles (which unfortunately you can’t tell with the common blood tests). But high cholesterol and in particular high levels of small-dense LDL particles are really just a sign we use to see how clogged the arteries might be. Clogged arteries is what really gets you in the end, after all!
First, a little on terms: there are a lot of terms for clogged arteries: plaqued arteries, hardened arteries, narrowing of the arteries, atherosclerosis, arteriosclerosis, heart disease, cardiovascular disease, and so on. I’ll mostly use the technical term, atherosclerosis, so take that as a synonym for ‘clogged arteries’.
If you don’t know, there’s been some really interesting research on how we can potentially reverse our clogged arteries completely naturally, and if we can really do that, then we can dramatically reduce our chances of any coronary event like a heart attack. Interestingly the research is robust enough that we can see how much difference we might actually make as well, rather than just a general sense of if it’s working or not. Let’s keep expectations reasonable though, seeing a few % improvement per year is a big deal; after-all it took us our entire lifetime to clog those suckers up, we can’t undo the damage in a month!
So, let’s get a baseline on those improvement by talking about Statin Drugs! Woo! Love me some statins.
Yes, numerous studies have examined the effects of statin drugs on atherosclerosis, and found that while those drugs lower cholesterol levels, all studies that use common doses of statins have shown only slowing of the progression of atherosclerosis, not actually reversing it.
This is as you might imagine since the mechanism of a statin is to block the liver from producing cholesterol (ie, stopping this vital organ from doing what it’s trying to do, as if after 2 billion years of evolution our body is just too stupid to know what’s best for itself).
There have however, been a couple of studies showing high dose statins may reverse atherosclerosis. For example, a 1-year study on Lipitor called “Arterial Biology for the Investigation of the Treatment Effects of Reducing Cholesterol” found that the maximum recommended dose of Lipitor reduced intima-media thickness, which is the thickness of the walls of the arteries, from a baseline of 0.625 mm to 0.591 mm which became statistically significant over the 1 year duration of the study (the reductions were not statistically significant after 6 months of treatment). This is about a 5.75% improvement in the thickness of arterial walls.
There was also a study called “Effect of very high-intensity statin therapy on regression of coronary atherosclerosis” which used a different measure; total atheroma volume, which also approximates the amount of arterial plaque that one has. This study lasted 2 years and found after 2 years an improvement in that parameter of an average of 6.8%. Both of these studies were of course funded by the companies making the drugs.
#1 Pomegranate
In contrast to these statin studies, in 2004 the Lipid Research Laboratory in Isreal published a study called “Pomegranate juice consumption for 3 years by patients with carotid artery stenosis reduces common carotid intima-media thickness, blood pressure and LDL oxidation.” This was a human study involving patients with heart disease and high blood pressure. In the control group, those not consuming pomegranate juice, intima-media thickness (a measure of how blocked the arteries are) increased by 9% after 1 year. What about the people consuming pomegranate juice? They reduced that same number, measuring arterial thickness, by a whopping 35%!
Blood levels of oxidized LDL were reduced by 19% in those consuming pomegranate juice, while total blood antioxidants increased by 130%. Systolic blood pressure was reduced by 12% after one year. All these parameters remained stable in pomegranate juice consumers for three years of continued consumption, and there was also a further reduction in oxidation of cholesterol by another 16% after three years. In other words, most of the benefits were found after just one year of consumption, but of course continuing to consume it seems to also be helpful.
A similar study was performed in Chicago in 2009 with a larger sample size, and found there to be significant reductions in plaquing of the anterior wall of the carotid artery, however could not detect differences in the posterior wall. The scientists also noted much bigger differences in the effect of the treatment for people who had particularly high triglyceride levels or particularly low HDL, indicating that the more serious the degree of atherosclerosis, the more noticeable the differences. In this case the pomegranate juice was not standardized to contain large (or even known) amounts of polyphenols, tannins, or punicic acid; the compounds thought to be responsible for pomegranate’s positive effects and yet still some benefits were seen.
Another study, this one in 2005 out of California and published in the American Journal of Cardiology had patients drink pomegranate juice or a placebo every day for three months. After three months, only the group drinking pomegranate showed significant improvement in blood flow to their heart. A reduction in symptoms of ischemia, which is a sign of blocked arteries. The researchers noted that the improvements to blood flow could not be explained by any changes in weight, blood sugar, medications, blood pressure or hbA1c. Pomegranate juice alone made the difference.
In 2009 a pair of scientists from Oklahoma State University had a review of Pomegranate literature published in the journal Nutrition Reviews. Here’s some of what they had to say:
A recently reported study on the supplementation of pomegranate juice … in an atherosclerotic mouse model for 3 months revealed a significant reduction in the atherosclerotic lesion area [of 44%] compared to the water-treated group.
There’s more evidence from the world of animal studies. In 2012 the Journal Evidence Based Complementary and Alternative Medicine published a review on using Pomegranate to fight atherosclerosis. They summed up the effect on atherosclerotic lesions:
PJ [pomegranate juice] supplementation to the atherosclerotic mice reduced the size of their atherosclerotic lesion and the number of foam cells in their lesion, in comparison to control placebo-treated mice that were supplemented with water. We also analyzed the therapeutic potency of PJ by its administration to mice with already advanced atherosclerosis. Atherosclerotic mice at 4 months of age, were supplemented for 2 months with 31 μL of PJ (equivalent to about one glass-8Oz/human/day), and were compared to age-matched placebo-treated mice. PJ supplementation to 4-month-old mice was still able to inhibit the progression of the disease, as it reduced the mice atherosclerotic lesion size by 17%, in comparison to atherosclerotic lesion of the age-matched placebo-treated mice. These results were further confirmed by de Nigris et al, who demonstrated that oral administration of PJ to hypercholesterolemic LDL-receptor deficient mice at various stages of the disease reduced significantly the progression of atherosclerosis.
Atherosclerotic lesion size could be considered a marker for plaqued arteries, as the body’s purpose for creating the plaque in the first place is to patch up atherosclerotic lesions.
What’s better than a pomegranate? Someone peeling it for you.
#2 B-Vitamins
It seems to be that B-Vitamins are not mentioned nearly enough when talking about cardiovascular disease, and I’m not sure why. There’s significant research behind their ability to lower cholesterol (B3, B5), and reduce Homocysteine (B6, B9, B12) – a critical factor driving inflammation in heart disease.
In 2010 a study called “The effect of folic acid supplementation on carotid intima-media thickness in patients with cardiovascular risk: a randomized, placebo-controlled trial” was published in the International Journal of Cardiology. It was a study of 103 patients that supplemented their diet for 18 months with just folic acid (B9), and found that in the folic acid group, but not the placebo group, intima-media thickness (thickness of artery walls) was reduced statistically significantly by about 3%.
In 2005 a study called “Decrease of carotid intima-media thickness in patients at risk to cerebral ischemia after supplementation with folic acid, Vitamins B6 and B12” was published in the journal Atherosclerosis. It was a double blind randomized trial of 50 patients, and found that after 1 year of supplementation those taking the three B-Vitamins had statistically significant reductions in intima-media thickness of about 5.6% (seemingly similar in magnitude of effect to high doses of statins for one year).
In 2007 a study out of Germany called “Niacin regresses carotid intimal medial thickness, reduces vascular inflammation and improves endothelial function in patients with metabolic syndrome” was published in the International Journal of Clinical Practice. Patients were treated with 1000mg per day of extended release Niacin (B3) or placebo. After 1 year the niacin group had statistically significant improvements in intima-medial thickness (arterial plaque – only 1% here), endothelial function (blood flow), high sensitivity C-reactive protein (general inflammation), HDL, LDL and Triglycerides. The placebo group saw an increase in intima-medial thickness.
They tried this same extended release Niacin at Walter Reed Medical Center in the US, and found it helpful for slowing down the progression of atherosclerosis, but only found a reduction in intima-medial thickness (arterial plaque) after 2 years of treatment, and that reduction after 2 years just barely failed to achieve statistical significance (p = 0.055 – which still means it most likely made a difference).
The study previously mentioned out of Germany broke down the data further and noted that in fact, two-thirds of their patients were ‘responders’ to niacin, achieving reductions in intima-media thickening by about 1.5%, but on one-third it seemed to have absolutely no effect.
So it may simply be that if a person is not consuming enough of this important B vitamin in the diet, then supplementing it can in fact be helpful for reducing plaque buildup.
It may also be that niacin (B3) reduces plaque by a different method than B6, B9 and B12, and therefore its effect may be cumulative with those other B Vitamins.
#3 Vitamin K2
Evidence of K2 reversing clogged arteries is pretty scant, but I wanted to mention this one because I believe it’s important (sometimes you just gotta believe!). There was a 2015 study called “Effect of vitamin K2 on progression of atherosclerosis and vascular calcification in nondialyzed patients with chronic kidney disease stages 3-5” that found a paltry dose of 90 mcg of vitamin K2 slowed the progression of carotid intima-medial thickening compared to a control group, and in fact showed a slight reduction in carotid intima-medial thickness in five patients in the trial. The researchers noted this specifically because you never really see a reversal in carotid intima-medial thickness.
There is a current ongoing trial called “Menaquinone-7 Supplementation to Reduce Vascular Calcification in Patients with Coronary Artery Disease” which aims to see to what degree 360 mcg of Vitamin K2 (Menaquinone-7 in this case) can reverse artery calcification over a 24 month period. The rationale for this trial is that when drugs are given to humans or animals that block Vitamin K2’s effect, the side-effect of those drugs is rapid calcification of the arteries. Additionally, observational studies show that people with low levels of K2 tend to have higher levels of arterial blockages and there are several studies showing that K2 supplementation improves the elasticity of arteries (which may already hint that it reduces plaque build up). In their own words: “We hypothesize that treatment with Vitamin K2 will slow down or arrest the progression of Carotid Artery Calcification in comparison to placebo and that Vitamin K2 supplementation may lead to a treatment option for vascular calcification and cardiovascular disease.”
This “Menaquinone-7” they reference is one of the forms of K2, sometimes called MK-7. It’s naturally only found in fermented soybeans, but like MK-4, it seems to have no upper limit for toxicity. At least, they’ve fed animals practically their entire body weight in MK-7 with no ill effects. So, 360 mcg they are using for this trial may still be fairly low. As an aside, there is some uncertainty of which form of K2 is better to supplement with, MK-4 or MK-7, and you’ll find both on the shelf of your health food store. Based on the studies I’ve read, I choose MK-7.
In Japan they use 45 mg doses of MK-4 to treat Osteoporosis, which is about 500 times the dose they were looking at in the first study, and more than 100 times the dose of MK-7 from the second study.
Can 10 mg of Vitamin C produce a statistically significant improvement in something that’s almost impossible to improve? I don’t know Bob, let’s raise $20 million for a trial and find out!
Besides these studies indicating that K2 may be helpful for reversing clogged arteries, there is a plethora of research indicating that it is generally quite helpful for cardiovascular issues.
In 2017 a study was jointly conducted between universities in Lebanon and Greece, along with Tufts University School of Medicine and Harvard Medical School. It looked at arterial stiffness after 8 weeks of MK-7 supplementation at 360 mcg per day improved arterial stiffness.
This was confirmed by another study that year “Oral Consumption of Vitamin K2 for 8 Weeks Associated With Increased Maximal Cardiac Output During Exercise.” This was a double blind placebo control trial used skin-mounted electrodes to measure cardiac output, stroke volume and heart rate. The K2 group but not the placebo group, increased cardiac output by 12%.
In 2016 a review was published, summarizing studies of K2 on both vascular health and osteoporosis. Without going through all the data painstakingly here, I’ll skip to the point. The researchers concluded:
“Vitamin K2 is also associated with the reduction of arterial calcium deposits, by promoting the increase of Vascular Smooth Muscle Cells, and the inhibition of transdifferentiation of Vascular Smooth Muscle Cells to osteoblasts.”
The meaning of which should not be obvious! Basically they are saying that the smooth muscle cells lining our cardiovascular system (our arteries and veins) tend not to change into the type that accumulate calcium, create fibrous caps and stabilize plaque, among people with high levels of Vitamin K2.
In 2010 a review from the Warwick Medical School was published and the title spills the beans: “Research indicates that vitamin K2 intake reduces coronary heart disease events” – this was based on 1 clinical trial and 4 cohort studies.
There have also been a few other human (and one animal) studies that I won’t go through in any detail, but the titles kind of give them away:
- “Vitamin K2 can inhibit calcification of aortic intima in mice” from 2016, “Vitamin K2 administration may reduce the progression of atherosclerosis” from 2015
- “Long-term use of MK-7 supplements improves arterial stiffness in healthy postmenopausal women, especially in women having a high arterial stiffness” from 2015
- “An increase in dietary intake of vitamin K is associated with a reduced risk of cardiovascular, cancer, or all-cause mortality” from 2014
- “A high Vitamin K2 intake reduces the incidence of coronary heart disease” from 2009
- “High dietary Vitamin K2 intake is associated with reduced coronary calcification” from 2009
- “Dietary intake of Vitamin K2 is associated with a reduced risk of coronary heart disease, cardiac mortality, aortic calcification and all-cause mortality.” from 2004
My point here is that K2 is extraordinarily good for your cardiovascular system, and there is at least some evidence it might even help unclog the arteries. Good dietary sources of K2 include liver from grass fed or pastured animals, milk from grass-fed or pastured animals, eggs from pasture raised hens and fermented unpasteurized soybeans. K2 along with Omega-3 to Omega-6 ratio considerations are why some of us in the health community harp on the importance of eating very very high quality animal products. Numerous studies have shown that animals fed grains or soybeans just don’t have adequate levels of Omega-3 fats or Vitamin K2 in their products. This is why I think K2 makes a lot of sense to supplement – we are rarely getting enough in our diets.
The other major consideration: Arterial Stiffness
While this is not directly related to arterial plaque, I’d be remiss not to talk about arterial stiffness. When our arteries are constricted because of plaque, there’s basically two approaches to deal with that situation. Either we try to get rid of the plaque, logical enough, right? Or we improve the elasticity of the artery, so that it can dilate more easily and accommodate more blood flow (thus making the plaque less of an issue, in terms of our mortality anyways). While vitamin K2 does help with this, the other thing that helps here is increasing Nitric Oxide production. Nitric oxide not only helps with vascular dilation, but is healing for the cardiovascular system. Vascular dilation is helpful for bodybuilders who want to get maximum blood flow to the muscles, and is thus well-researched. You’ll find various formulas to increase ‘NO’ in the bodybuilding section of a health food store. Nitric Oxide production is also helpful for older men who experience impotence, which can be a huge canary-in-the-coal-mine for cardiovascular disease.
There’s a great book on the subject by Dr. Louis J. Ignarro who won the nobel prize in medicine for this discovery about nitric oxide’s role in cardiovascular health, and the positive impacts of boosting nitric oxide production. The book is called NO More Heart Disease. In it he makes a pretty strong case that the consequences of heart disease can be completely avoided by increasing Nitric Oxide production. It’s an easy read too, like a mystery novel that unravels his scientific discoveries and their implications; not a boring medical text by any means.
The go-to supplement for improving nitric oxide production in the vascular system is L-arginine, an amino acid our body produces to some degree (but probably not enough as we get older). Beet root is also very helpful here, and you’ll see that is catching on with bodybuilder to increase their ‘pumps’ – it however is probably redundant to take both. Importantly CoQ10 helps the body recycle nitric oxide and makes the vascular system more sensitive to it, so it naturally pairs well with any nitric oxide booster like L-Arginine. CoQ10’s research on heart health is also second-to-none, although it doesn’t seem specifically helpful for reversing arterial plaque.
It took me a second for that one to sink-in as well.
Finally, fish oil has been shown in many studies, and confirmed by a recent meta-analysis to reduce arterial stiffness. While there is some conflicting evidence on fish oil as effective for inflammation, a recent meta-analysis seemed to put that subject to bed, finding that in the highest-quality published research papers on the subject, chronic fish oil consumption indeed reduces almost every blood marker of inflammation. If you like fish, I’d try for 4 -7 servings per week, and the more lightly cooked (if at all) the better. Sashimi and ceviche are my favorite options, health-wise. If that’s not possible for you, I’d go with a flavored monk-fruit-sweetened liquid fish oil supplement so you can take it by the tablespoon.
Getting Practical: Supplement Regimen
I wanted to finish off here by mentioning a good supplement regimen to get started. Nothing will beat personalized treatment to see exactly what is needed by YOUR body, but nonetheless I think there’s a good amount one can do on one’s own. Keep in mind that you can’t out supplement a bad diet & lifestyle, so please consider clean eating (no grains, dairy or sugar) and exercise along with the five things mentioned below.
Fighting Arterial Plaque:
Increasing Arterial Flexibility & Blood Flow:
- L-Arginine with L-Citrulline
- Ubiquinol (Activated CoQ10)
There are two more absolutely critical supplements though: time & patience. None of these studies indicate huge benefits in terms of disease reversal from taking 1 bottle of the stuff. You gotta be persistent!
A bit about these first 5 supplements though:
There’s a number of pomegranate supplements on the market and many should do the trick, but getting one that is ‘standardized’ to contain a certain amount of polyphenols is best. Juice is a great, maybe even preferred option, so long as you honest-to-god take it daily, and it gets quite expensive of course (but it’s delicious). It would be worth taking both! Something like Miracle Reds with Pomegranate as well as other heart healthy ingredients is also a great option; clearly whoever formulated this had cardiovascular health in mind. It’s not necessarily enough pomegranate to make a difference (at least in terms of the proven ingredient in that formula) but it should have a good impact overall and can certainly be taken alongside a supplement like Nature’s Way Standardized Pomegranate that I’ve linked to above.
The Advanced B Complex by AOR I’m afraid is about the most expensive B complex on the market, but in my opinion the only one suited for heart disease because of it’s high dose of Niacin (B3) relative to pretty much everything else out there. There is just no substitution on this one. If it makes you feel better, it’s expensive because it uses the best, most biologically active and bio-available versions of the B-Vitamins, where most of the cheap B-Complexes on the shelves of health food stores do not. Go for the maximum recommended dose on the bottle, which is 3 capsules per day in divided doses (ie, one at each breakfast, lunch and dinner).
For K2, I am happy taking it with D3 as D3 helps it work. Actually, D3 is my favourite therapeutic; in all the research I’ve looked at Vitamin D is the biggest and broadest panacea I’ve found in terms of a supplement; the health effects of which almost compare to exercising and avoiding processed food in terms of all-cause-mortality. It is unquestionably useful for cardiovascular disease. I’d take about 15 drops of this daily, which would yield 7500 IU of vitamin D and 300 mcg of K2. This puts the D3 in the range recommended by the Vitamin D council for most people, and puts the K2 near the range looked at by the promising study I mentioned above. Best to take all at once with a meal.
L-Arginine is well known to boost Nitric Oxide in the vascular system, which leads to more arterial flexibility over both the short and long terms. Many brands will do here, I just find NOW often the most cost effective for good quality on these more simple supplements. This one mixes in some L-Citrulline which has a similar effect to L-Arginine. I’ve seen good success with taking 2 capsules twice a day, preferably on an empty stomach.
Finally Ubiquinol. You’ve probably heard of CoQ10 and also heard that CoQ10 is quite good for your heart. Ubiquinol is simply the activated form, and it turns out this form is very critical for anyone over 40 years of age. That’s because when we take CoQ10 our body must convert it into Ubiquinol for it to be useful. However as we age, we lose the ability to do that; we produce less and less of the enzyme that performs that conversion. The best dose for this is essentially ‘as much as you can afford’ – but I think for most people 200mg per day is where you get the most bang-for-the-buck (this stuff ain’t cheap unfortunately).
That’s it! If you’ve got any questions or comments, please don’t hesitate to contact me.
