Chapter 7: Atherosclerosis (Coronary Artery Clogging With Cholesterol)

Opinion: Complete prevention of atherosclerosis is possible in the vast majority of people.

The process of where cholesterol gets deposited abnormally in a person’s arteries is called atherosclerosis. Deposition of cholesterol within the artery wall can reach a dangerous level after which dire consequences may occur such as a heart attack. The current day theme is that bad cholesterol (LDL), when it is at an elevated level in our blood will get deposited in the wall of our blood vessels. And thus it is thought by taking medicine agents which lower cholesterol we will be safe. The problem with this way of thinking is that it is not the elevated cholesterol alone that is the danger. It is more important, I believe, that we must look at why the cholesterol is elevated, and why it gets deposited in the wrong place at all. Deposition of cholesterol may start at a very young age. This deposition may occur even in a healthy vessel wall. The way this occurs is as follows: cholesterol is in a continuous state of movement and transport to reach its target, whether that target be the cell wall where it is incorporated or inside the cell where it is transformed into other products such as hormones. If the body is not able to carry this out in a healthy efficient manner then we will end up with an excess of cholesterol, which has not been utilized. If, in addition the body is producing an excess amount of cholesterol, specifically LDL (the “bad” cholesterol), then we will have an even higher excess of cholesterol in the blood and hence result in excess cholesterol present between the cells. What should happen is that HDL (which is considered the helpful cholesterol) should remove this excess, and if not, then one of the body's defense cells, the macrophages should engulf this excess cholesterol and remove it. Instead what ends up happening (when atherosclerosis is the case) is that these macrophages are energy deficient and too weak to do the job and end up dying. This process occurs repeatedly and these dead macrophages actually turn into what we call foam cells. Eventually we also get the body responding with an inflammatory process to these dead cells. This will lead to fibrous tissue formation and eventually the dreaded plaque formation. This plaque formation is dreaded because it can become severe enough that it makes the inside of the artery (which we call lumen) smaller, the so called “clogging”. When the lumen is small enough then we can experience symptoms of chest pain (anginal), which is because the heart is not getting enough blood in a certain area of its muscle. Another danger here is that because of the presence of this cholesterol plaque inside the wall of the artery, this vessel wall is not healthy and can actually end up rupturing on its inner aspect (and inner to this flows the blood), which stimulates the formation of a clot inside the blood vessel (arterial) lumen. This will shut off all blood flow in an artery and hence all heart muscle supplied by that artery will be injured. This is what happens in a heart attack.
Let's look at the 2 main players in the above process. The 1st player is where the cholesterol is being overproduced. The common cause for this excess is excess calorie intake. Therefore an easy way to decrease LDL is decreasing calorie intake (I know… easier said than done, but it is a must). Note to doctors - In this context it is also preferable to have a lower carbohydrate intake because higher blood insulin levels (stimulated by glucose from carbohydrates) stimulate HMG-CoA reductase, which promotes cholesterol formation. On the other hand lower blood glucose will stimulate secretion of glucagon, which inhibits the activity of HMG-CoA reductase, and hence discourages formation of cholesterol.
So, one way to prevent this excess cholesterol from occurring is to refrain from eating food in excess, avoid refined sugars and avoid refined starch.
The 2nd major player leading to high levels of LDL is lack of utilization of cholesterol. This will occur when the unhealthy condition of the body is expressed at the cellular level. In this unhealthy mode the cells are sedentary (not very active or energetic), and because of this lack of energy the cholesterol won’t get incorporated in the cell walls, or be transformed into hormones, or be removed with ease.
Prevention of the body and the body’s cells from becoming sedentary is by applying the principles outlined in The Pillars Of Health previously. In a more detailed explanation as it relates to atherosclerosis: the body's cells can be made to be energy abundant (macrophages included) by the person sleeping regularly and sufficiently, exercising enough, eating healthy, and avoiding harmful substances. The role of sleeping in this context is as outlined in the chapter that dealt with sleeping. With regards to exercising this is the process of conditioning the body where it will be able to have an abundance of energy at all levels specifically at the cellular level. This conditioning occurs by virtue of exercise leading to the stimulation of production of hormones in the body whose effect will be to utilize body fuels to produce readily available energy. Specifically I am talking about adrenaline, cortisol, thyroxin, and growth hormone. All of these are increased in a normal physiological fashion as a result of regular physical exertion. We can help the body to produce its own hormones above by ensuring intake of the correct nutrients to actually build those hormones. The main nutrients and vitamins within the context of atherosclerosis are protein, iodine, folic acid and vitamin B 12. The role of the protein is to provide the amino acid precursor (s) in the case of adrenaline, thyroxin and growth hormone. In the case of cortisol, the enzymes responsible for its formation are protein based who manufacture it out of cholesterol. The iodine is essential for thyroxin production. The folic acid and vitamin B 12 are essential for the formation of SAM (s-adenosyl methionine). This last substance is essential for providing the methyl group to noradrenaline to transform it into adrenaline. My preference as mentioned elsewhere for vitamin B 12 is taking it by injection or sublingually. Note to doctors - homocysteine is a bystander and not a player.

This last statement was added by me at the time, at the initial publication of The Pillars of Health: The Prelude, May 2002, because of quite a bit of interest in homocysteine as an instigator of atherosclerosis development [*3]. Then and now I still don't believe that it (homocysteine) plays any significant role in atherosclerosis development. As I expected then, and seeing now, more and more proof for that belief is coming to light [*4]. That being said, the conclusion of not recommending vitamin B supplementation to prevent cardiovascular events, I disagree with [*5]. They are safe, they are cheap, and if used in conjunction with the pillars of health they will help prevent cardiovascular disease.

I have seen mentioned vitamin B 6 (pyridoxine) as one of the vitamins, which help lower homocysteine and hence help prevent atherosclerosis. I advise using this sparingly and not to exceed 10 –20 mg per day until there is more evidence about its role. The reason I am reluctant to endorse this vitamin is that its excess has some potent adverse effects on the nervous system.
There is an uncommon condition though, called hereditary hypercholesterolemia which has a high level of cholesterol due to a different cause. This condition will not respond to the measures above satisfactorily. It is uncommon and not the form we usually see. I am not going to go further into that condition.
In the context of atherosclerosis a very harmful activity I would like to mention here is smoking. The main danger of smoking I believe is by its characteristic of increasing carbon monoxide and decreasing oxygen in the bloodstream and thereby hindering the production of energy (which needs oxygen) by the body and it cells and ultimately preventing macrophages from doing its job of removing excess and unused cholesterol.
I don't think fat intake (saturated, unsaturated, hydrogenated or any other form) has any role in the promotion of atherosclerosis except when calorie intake is excessive. For further information see the chapter on nutrition in addition to below.
The three populations who have the lowest incidence of myocardial infarctions worldwide are the non-westernized Eskimos, the people living in France, and the people living in Japan. The Eskimos have a very high intake of fat in their diets and the French also. The people of Japan on the other hand have a very low intake of fat in their diet (11%). The most important nutritional factors that have a bearing on atherosclerosis shared between these three peoples are they all have a good protein intake and a good constant source of cyanocobalamin. Seal (uncooked usually) for the Eskimos. Cheese and red wine for the French. Fish (uncooked - Sushi) for the Japanese.
Other nutritional factors that can have a bearing on atherosclerosis development for any population is the availability of iodine as it is an essential component of thyroxin. This last being an important factor in producing energy for the body and its cells.
Don’t take the message from above that diet alone dictates the occurrence of atherosclerosis, rather take the message that atherosclerosis won’t develop if The Pillars Of Health are adhered to. That applies to almost all Homo sapiens.
Another message to take is that if you start The Pillars Of Health, then atherosclerosis development will halt after a relatively short interval (I firmly believe this – but this still needs to be proved more scientifically). This will depend though on how much a person is able to apply of The Pillars, and what other illnesses the person suffers from. I am of the opinion that the atherosclerosis already present will very likely reverse by application of above, with some limitations. The reversal is contingent upon the atherosclerosis lesions not having developed fibrous tissue yet. If fibrous tissue, which is tantamount to scarring, has developed then any reversal will be much more difficult, if at all possible. Time and research will tell.
A few additional words about aspirin. In the case of aspirin it is known that it reduces the risk of myocardial infarction by a formidable percentage. That effect is believed to be due to it lowering the adhesiveness of platelets in the blood and thence decreasing the possibility of clot formation. That is reasonable. In addition I believe it plays a significant role in actual prevention of development of atherosclerosis by virtue of its effects on the hormone carrying proteins in the blood. What happens is that the aspirin attaches itself to the protein in the blood and thereby decreases the areas available to hormones to be attached to the same protein. This will shift the hormone dynamics towards easier release and arriving at its target tissues. This as a whole will enhance hormone function and efficiency and ultimately allow more efficient tissue function and more energy availability. This will help in utilization and disposal of unused cholesterol that can result in the cholesterol plaques.
HDL is another thing I would like to talk about. HDL (high density cholesterol) is considered to be the “good cholesterol” as it has been seen that people with low levels of it have higher rates of development of atherosclerosis. Also vice versa it has been seen that people with high levels of HDL tend to be at less risk for atherosclerosis. The explanation I believe is due to the fact that HDL in addition to its function in removing LDL cholesterol from different tissues in the body is also a vehicle by which one form of the thyroid hormone is transported. If we have a more abundant amount of HDL then it follows that the thyroid hormone will be more available also. This will again enhance production of energy at the cellular level and help prevent atherosclerosis. HDL is known to increase with exercise, certain forms of fat intake, vitamin B3 (niacin), and certain medications. Implement The Pillars Of Health and you probably won’t need medications at all.
Regarding stress, it will make things worse if it prevents The Pillars Of Health from being implemented and thereby promote atherosclerosis. If a person is able to maintain The Pillars Of Health in spite of the stress, then atherosclerosis should not be able to get a foothold.