Atherosclerosis – Plaque Regression

Str!ke

Jedi
Atherosclerosis – Plaque Regression

This is not a definitive guide, nor a replacement for your doctor, but it’s worth knowing and sharing (and applying).
Index
  1. Atherosclerosis
    1. Plaque composition
    2. Collagen/Vitamin C
    3. CPR
  2. A Major Event
    1. Heart attack
    2. Stroke
  3. If There's Still Time
    1. EECP
    2. Other
  4. Risk Factors
    1. Conventional
    2. Risk Calculators
    3. Malcolm Kendrick
      1. Comments about Viagra
    4. Bale-Doneen Method
    5. James Roberts
    6. Aseem Malhotra, plaque regression with Meditation
    7. More Things
      1. Air Pollution
      2. Oxidized Fats
      3. Artificial Sugars and Sugar Alcohols
      4. Microplastics
  5. Tests
    1. Stress tests
    2. CIMT
    3. CAC Score
    4. CTA
    5. Cardiac Catheterization Angiogram
    6. For PAD
      1. fIMT
      2. ABI
Plaque Regression Approaches
  1. Cyclodextrin
    1. James Roberts' Videos and Experiences
    2. Mark Sircus' Experience
    3. Facebook Experiences
      1. Good Ones
      2. Bad and Neutral Ones
      3. Other
        1. Increasing and Decreasing Lipids
        2. Ear Ringing
        3. Hemorrhoids
    4. Where to Get It
      1. Australia
      2. Other ways of administration and other types of cyclodextrins
      3. Importing it
    5. Reputation of Australian Companies
      1. Kyle Hodgetts and Cavadex/Cholrem
      2. Reputation of Atherocare
    6. How to administer it
      1. User's experiences on how to apply it
    7. Ordering from China
      1. Quotes or Price Estimations
      2. Another supplier (not recommended)
      3. Importing it
    8. DIY or Mixing Your Own (MYO)
      1. Other things to know
  2. Cheng's Orthomolecular Approach
    1. Case Reports
    2. What he recommends
    3. Some observations
      1. About High Dose Niacin
      2. Hormone Replacement Therapy (HRT)
      3. Pauling Protocol
      4. Aminoacids
  3. Other things that help
    1. Plaque stability
      1. Collagen and more
      2. High Blood Pressure
    2. Lowering Fibrinogen
    3. The Glycocalyx
    4. Chondroitin Sulfate
    5. Nattokinase
    6. Pomegranate
    7. Aged Garlic
    8. Berberine
    9. Licorice
    10. Bergamot
    11. Pycnogenol and Gotu Kola/Centella Asiatica
    12. Fisetin
    13. Speculative idea for decalcification - Citrate
    14. Ford Brewer's Plaque Regression
    15. Angiogenesis
      1. VEGF
      2. Nitric Oxide
      3. Inhibitors (not good)
  4. The Sauna or EZ Water Approach
    1. Stephen Hussey
    2. Couple
    3. A Midwestern Doctor
      1. Structured water
      2. Zeta Potential
        1. Zeta aid
    4. Infrared Sauna
    5. Grounding
  5. My Mother's Case - PAD
    1. Symptoms
    2. Blood Tests
    3. Risk Factors of Atherosclerosis that She Has
    4. What She's Doing

So… given that cardiovascular disease is the #1 killer in the world with heart attacks and strokes being the most common cause (~80%). Atherosclerosis, hardening and narrowing of arteries due to formation of plaque, comprises ⅔ (or 50% another one says) of all deaths because that plaque can rupture and that causes a clot to form that leads to a major event – heart attacks and strokes.
75% of acute myocardial infarctions occur from plaque rupture”

Usually a silent disease. When you have symptoms it’s when it’s already progressed a lot, usually at a stenosis (narrowing of arteries) of >70%.

Commonly, the plaque has 3 parts. The soft plaque: a lipid core (~5-27%), and fibrous tissue (~60-80%); and hard plaque: calcification (~7-20%)
Usually, the hard plaque doesn't rupture and it’s more stable. It is usually the soft plaque that ruptures, creating a clot that clogs an artery causing a major event.

Most (68%) heart attacks occur before 65 years old in men and 72 in women, and with <50% coronary stenosis. And 86% of heart attacks occur with <70% stenosis. (They say they happen more often in the morning due to cortisol and dehydration resulting in more coagulable blood.)
Notably, 50% of heart attack patients have low cholesterol levels (<100mg/dL) the levels for ‘prevention’.
So, always try to minimize inflammation as that can rupture the plaque, up your collagen intake or Vitamin C at least, because collagen can maybe stabilize plaque, making it less likely to rupture. But too much collagen can worsen stenosis, supposedly. (I don’t think Vitamin C/Collagen is enough protection, but it’s better than nothing.) [Or who knows, maybe it is...]

CPR

It’d be good to learn how to do Cardio Pulmonary Resuscitation (CPR), because 50% of heart attacks end up in sudden death/cardiac arrest. Mercola says ‘nine out of 10 cases, the person experiencing cardiac arrest dies because help doesn’t arrive quickly enough’. Survival odds decrease by 10% for every minute CPR is delayed.
So the time between cardiac arrest and when the paramedics arrive is critical. Preferably locate a defibrillator beforehand.
Now, not necessarily a heart attack leads to cardiac arrest but if the person is unconscious and gasping for air or not breathing from a heart attack then he needs CPR.

[Yikes, it's not uncommon to break the sternum, especially on the elderly, while doing CPR, because you have to press down deeply, 2 inches, into the chest...]
[Some videos of CPR - 1, 2, 3, 4, 5]


A Major Event

Heart attack

Symptoms of heart attack may be different for men and women (symptoms Mercola)

Women are more likely to experience unconventional heart attack symptoms such as fatigue and nausea, in contrast to men who commonly manifest classic signs, including chest pain. This may be why, despite a greater incidence of heart attacks in men compared to women, females have an elevated one-year mortality rate post-attack.

Researchers with Nova Southeastern University in Florida conducted a systematic review of 74 studies examining differences in heart attack symptoms among women and men, revealing certain parallels. Both genders commonly reported chest pain and chest tightness or pressure as prevalent symptoms upon hospital arrival, as indicated in the findings published in Cureus.

However, men reported chest pain as their primary symptom 13% to 15% more frequently than women and displayed a higher propensity for experiencing burning or pricking pain and sweating. Shared symptoms among both genders included chest, arm or jaw pain with sensations of dullness, heaviness, tightness or crushing. Women, on the other hand, were prone to atypical symptoms, including nausea, vomiting, dizziness and fear of death.

Noteworthy variations were observed in the location of pain, with women more frequently experiencing discomfort in the jaw, neck, upper back, left arm, left shoulder, left hand and abdomen. Additionally, women exhibited a broader spectrum of symptoms, with a higher prevalence.
In comparison to men, women aged 18 to 55 reported 10% more symptoms during a heart attack, while those aged 75 and above had 17% more symptoms.

Further, some people experience subtle symptoms in the days and weeks leading up to a heart attack. In some cases, symptoms may begin a year in advance. Known as prodromal symptoms, these occur more often in females than males and include, in order of prevalence:

  • Feeling tired or with unusual fatigue
  • Sleep disturbance
  • Anxiety
  • Shortness of breath
  • Arm, back or chest pain

Symptoms from Bale-Doneen:
Pain in areas of the upper body, including the jaw, neck, back, shoulders, or arms Fullness, squeezing, or pressure in the chest or a choking sensation that may feel like heartburn
Dizziness or feeling light-headed
Nausea with or without vomiting
Shortness of breath
Abnormally heavy sweating or breaking out in a cold sweat that may feel stress-related Unusual fatigue, extreme weakness or anxiety, or a sense of impending doom
Rapid, irregular, pounding, or fluttering heartbeats
Sudden confusion
Abdominal pain that may feel like indigestion or severe abdominal pressure that may feel like an elephant is sitting on your stomach

If you’re having a heart attack, I’ve heard to chew an aspirin and call for emergencies.
If the person is unconscious, or gasping for air or not breathing, begin CPR immediately and call emergency services.
Time is critical, the more delay for treatment, the more heart damage.

don’t let them brush off the symptoms as anxiety, heartburn, or other noncardiac causes without doing tests. EKGs frequently have normal or inconclusive findings in heart attack patients, particularly in women, so you should insist on having your levels of cardiac enzymes measured” (Bale-Doneen)

Blood tests to confirm heart damage are troponin or creatine kinase-MB.

In the hospital they can do an echocardiogram and electrocardiogram with cardiac catheterization and an angiogram to see the blockage, and then either do: 1) an angioplasty with a stent, a procedure done to open up a blocked artery and then put a metal mesh tube (stent) to keep open a narrowed artery; or 2) a vein bypass grafts, open-heart surgery, in which a vein of yours is grafted around the blocked artery so that blood flows through the graft instead of the blocked artery. It’s done whenever the stenosis is severe and a stent wouldn’t be appropriate.

They say stents put as prevention don't work and that’s 90% of them, supposedly; only stents put in emergencies are necessary as life savers and the ones put to reduce unstable angina – chest pain not improving at rest or with medication. I’ve also heard, and Gaby says too, to not choose the drug-coated stents (drug-eluting stents), only the bare metal stents.

[I wonder whether very high dose nattokinase or such enzymes (plus DMSO) would be able to dissolve the clot that caused a major event, rendering most of these procedures unnecessary?]

After a heart attack, Mercola says to have <50mg Methylene blue on hand and 10mg sublingual melatonin, within minutes of the event to reduce reperfusion injury
[I remember years ago, that ALA (Alpha Lipoic Acid) also helped reduce reperfusion injury]
[I don’t know if Niacin is good after a heart attack. On the one hand here it says “it may limit reperfusion injury” and on the other I remember something like it lowered circulation on the coronaries because it vasodilated the skin capillaries, so it wasn’t good after heart attacks.]

Midwestern doctor says DMSO can be given in an emergency like heart attacks and cancer up to 2g/kg.
Maybe high dose chondroitin sulfate (1.5g-6g). Lester Morrison tells of a case of the heart being healed with it, as measured by the EKG not showing evidence of a prior event after a few months of chondroitin sulfate intake.
Midwestern doctor briefly mentions stem cells, exosomes and peptides to heal the heart. Here, he mentions some brands: Khavinson and Taxorest for the lungs.

Stephen Hussey, a heart attack survivor, briefly mentions in his book he was advised after his heart attack to take blood pressure medication while the heart heals to prevent the cardiac remodeling, which can lead to chronic heart failure, which is common after a heart attack. So he took blood pressure medication for one month and then switched to Ouabain (James Roberts’ description of it), an extract that increases the parasympathetic activity on the heart and prevents heart failure.
So, either Ouabain or blood pressure medication.
And he took 6 months of anticoagulant because he had a stent placed. Time, rest and medications to recover as much heart function.
[The ouabain is expensive, though, and Thomas Cowan is the only seller it in the US. (Makes me think it’s not that necessary? Although blood pressure medication does have side effects.)]

To improve ejection fraction rate, in chronic heart failure, I've read D-Ribose, Sauna and Pycnogenol with CoQ10 can do that.


Stroke

If you think you’re having a stroke, use the F.A.S.T warning signs to evaluate calling for emergencies:

F.A.S.T. Warning Signs of Stroke​

Use the letters in F.A.S.T. to spot a Stroke
  • F = Face Drooping – Does one side of the face droop or is it numb? Ask the person to smile. Is the person's smile uneven?
  • A = Arm Weakness – Is one arm weak or numb? Ask the person to raise both arms. Does one arm drift downward?
  • S = Speech Difficulty – Is speech slurred?
  • T = Time to call 911 – Stroke is an emergency. Every minute counts. Call 911 immediately. Note the time when any of the symptoms first appear.

Other Stroke Symptoms​

Watch for Sudden:
  • NUMBNESS or weakness of face, arm, or leg, especially on one side of the body
  • CONFUSION, trouble speaking or understanding speech
  • TROUBLE SEEING in one or both eyes
  • TROUBLE WALKING, dizziness, loss of balance or coordination
  • SEVERE HEADACHE with no known cause

Then at the hospital they’ll do a CT scan to know whether it's a hemorrhagic or a ischemic stroke. If it’s the latter, they give a clot buster medication or put a stent retriever to grab the clot; if it’s the former, blood pressure medication and possibly brain surgery to relieve intracranial pressure and remove the accumulation of blood. So, there’s much more damage on a hemorrhagic one.
Time is critical – the treatments must be administered within 3 hours, for less damage to the brain.
They say to NOT give anything to eat or drink. Stroke can impair swallowing ability, creating a choking risk or causing aspiration pneumonia.

After an ischemic stroke, Mercola says ginkgo biloba “shows promise for improving cognitive function after stroke when used early, giving your brain more support to rebuild”. [But don't take it while on anticoagulants]
For the subsequent anxiety/depression, “start talking therapy within six months — it makes recovery [of anxiety/depression] more likely — The earlier you get support for anxiety and depression after a stroke, the better your results”

Mercola also mentions that singing words/phrases can help patients to recover speech.
“•Music reach people when nothing else can — Fleming shares how melodic intonation therapy, which uses singing to activate speech in stroke and traumatic brain injury patients, has restored language in people who could no longer talk, sometimes after just one session. “Singing enables them to recapture the words they were trying to communicate,” she says.”

Midwestern doctor [1, 2, 3] says to have experience rubbing DMSO on the carotids for a better recovery, or even avoiding disability if put right after the event.

Note: in my opinion, IV DMSO would have been ideal (and more effective) in those situations, but in each case, it was not feasible to implement.

Likewise, many compelling cases have been recorded of individuals who treated their strokes with DMSO:

A Los Angeles school teacher had a major stroke shortly after the start of the Christmas break. She was unconscious on her living room floor. DMSO treatment was started immediately after the stroke. The DMSO was first applied topically to her head within minutes of the stroke. Less than one hour after the stroke she was given DMSO by intramuscular injection. This patient was never taken to the hospital for this stroke. A prominent surgeon who was a family friend told the husband of this patient that it was important to keep her out of the hospital. The surgeon said that even though the treatment was completely legal, it would be difficult to get approval to give the DMSO especially by injection at his hospital.

This patient made a dramatic recovery. She regained consciousness later in the day in which she had her stroke. Treatment continued for the next week. Each day she received two topical applications of DMSO, one intramuscular injection of DMSO, and two doses of one teaspoonful of DMSO in juice. Her condition improved each day. When school resumed after the first of January, this teacher was back in the school teaching the students as if nothing had happened during the Christmas vacation. She never even mentioned it to the other people at the school. She continued teaching until she retired. She retired healthy with no disability.
Note: if you drive someone to the ER (and call in ahead to let the ER know you are coming), you have numerous opportunities to administer DMSO prior to placing the patient in the ER without delaying their care there (e.g., emergency brain surgery for a hemorrhagic stroke).

A lady was in a coma in a convalescent hospital and had been in the coma since her stroke three months ago. She was given little chance of recovery and was expected to remain in a vegetative state until her death.

When I first observed this lady, there was no response to any type of stimulus. She was alive, but appeared lifeless. It was decided that her treatment should be topical DMSO applied to her head daily either by her husband or by one of the nurses at the facility.

One month after the start of treatment, there were positive signs in the lady. Her brain was starting to respond to the DMSO. The treatment continued, and four months after treatment started this lady was able to return to her home. After her return to her home, this patient started drinking one teaspoonful of DMSO in a small glass of water each day in addition to the daily topical treatment. This treatment continued for a period of years.

Three years after the start of DMSO treatment this writer returned to visit this patient. At this time the lady was living a normal life, not the life of a stroke victim. She was able to look after the house and walked normally.

The only lingering effect of the stroke was a slight speech defect. At this time she said that her memory was better than that of her husband who had not had a stroke and who was considered to be completely normal.
Note: there are also many reported cases of individuals who took DMSO for musculoskeletal or pain disorders (by far the most common use of DMSO) who then experienced a permanent improvement of stroke symptoms.

[...]
Note: people I am very close to would have likely had a lifetime of disability if I had not been able to get them to use DMSO once their stroke started so I feel very strongly about this concept being known.




One of the interesting effects of DMSO is that it is both excellent for structure and stabilizing liquid crystalline water but simultaneously excellent for dispersing areas of blood congestion (e.g., you can use it topically to remove clots under the skin) and significantly restoring blood circulation throughout the body. One of the most remarkable applications of DMSO is for strokes.

I, in turn, have had a few cases where I clinically diagnosed a stroke, determined where the likely site of blood flow obstruction in the brain was, applied DMSO topically (it absorbs through the skin and quickly goes everywhere in the body) to the artery feeding that spot, sent the patient to the ER with instructions to continue applying it on the way there. By the time they arrived, the stroke was gone. Similarly, you can also administer DMSO after a stroke has occurred to heal a significant amount of the brain damage they cause (which works best if done intravenously, although IV DMSO is a bit expensive).


Also consider
High dose chondroitin sulfate (1.5g-6g). Lester Morrison tells of a case that it reduced sequelae of stroke.
Hyperbaric Chamber

After a stroke, there’s a window of heightened neuroplasticity of 3-6 months (but I get the feeling it’s less than that) when the brain is most receptive to change and rehabilitation, leading to the most significant functional recovery. So, the more rehabilitation/exercises you can do right away, the better.
Stroke of luck exercises book to attempt to recover the lost functions.
[The exercises are not that many.. Probably needs more.]
Anat Baniel, successor of Moshe Feldenkrais, her exercises helped recovery in hemorrhagic stroke on Jill Bolte Taylor “It took eight years for Dr. Jill to completely recover all of her physical function and thinking ability.”
They are neuroplasticity exercises focusing on the movements you are able to do and progressing from there instead of focusing on the ones you can't do, reinforcing the negative and hindering progress.
[Don't know more details of the exercises]
[Don't read Jill’s book if you're after treatments, because she doesn't explain how to recover]
Someone mentioned Peter Levine’s “Stronger after stroke[Haven't read it]


If There’s Still Time

If there’s still time (not in need of an emergency procedure), if you have it available where you are, and don't have fully blocked coronary arteries, look for the therapy Enhanced External Counter Pulsation (EECP), in which pressure cuffs are put in your body and are synced with your heart beat so that they inflate in between heart beats causing more blood returning to the heart stimulating the growth of new blood vessels, resulting in ‘collateral circulation’ (natural bypasses) despite having severe stenosis. A full course therapy involves 35 one-hour sessions.
MidWestern doctor says EECP can also help restore organs like the brain, heart and kidney that were failing due to reduced blood flow.
And that it can also work on vaccine injuries like from COVID, restoring microcirculation.

I’ve also heard people go for intravascular lithotripsy, in which a catheter is introduced in the artery and attempts to destroy the calcified plaque using sonic pressure waves to fracture it. Not widely available, it seems.
Or someone mentioned rotoblation to drill out the plaque to then put stents.


Risk Factors

If there’s still time and you can work on it, these are the risk factors that I’ve found and some solutions/recommendations:

Conventional

1. Conventional Risk Factors:​
“age, sex, tobacco use, physical inactivity, non-alcoholic fatty liver disease, excessive alcohol consumption, unhealthy diet, obesity, genetic predisposition and family history of cardiovascular disease, raised blood pressure (hypertension), raised blood sugar (diabetes mellitus), raised blood cholesterol (hyperlipidemia), undiagnosed celiac disease, psychosocial factors, poverty and low educational status, air pollution, and poor sleep.” Also psychological stress.

2. Qrisk UK Risk calculator:​
• Age
• Sex
• Smoking
• Diabetes
• Total cholesterol/HDL ratio
• Raised blood pressure
• Variation in two blood pressure readings
• High BMI
• Chronic kidney disease
• Rheumatoid arthritis
• Systemic lupus erythematosus (SLE)
• History of migraines
• Severe mental illness
• On atypical antipsychotic medication
• Using steroid tablets
• Atrial fibrillation
• Diagnosis of erectile dysfunction
• Angina, or heart attack in first degree relative under the age of 60
• Ethnicity
• Postcode

[Another risk calculator here: MESA ]

[I’ve heard the risk calculators are not accurate in predicting your risk; I put them to be aware of the risk factors.]


Malcolm Kendrick

3. Malcolm Kendrick
A doctor known to be anti statins and pro saturated fat, believes atherosclerosis is the process of creating blood clots from damage to the endothelium over and over thickening the plaque or by having blood that is more coagulable.
In his book ‘The Clot Thickens’ mentions these risk factors, and some excerpts (I didn't include his explanations for each of the most common risk factors):
This rather changes the angle of attack does it not? Cholesterol crystals, and much of the other cholesterol found in plaques, arrived there as the free cholesterol found in red blood cells, not LDL.

[..]
#Lp(a)
• Lp(a) is designed to protect against the arterial damage caused by vitamin C deficiency (and other forms of arterial damage)
• Lp(a) is incorporated into blood clots that form on damaged artery walls
• Lp(a) makes blood clots far more difficult to remove
• Lp(a) can be found in high concentrations in atherosclerotic plaques
• A raised Lp(a) level can, at least, triple the risk of cardiovascular disease
[...]

#DVT
Prolonged immobility is not always needed to trigger a DVT. A long-haul flight can be enough. Sitting in the same position for hours on end, putting pressure on a vein and stopping blood flow, along with a degree of dehydration. For some people, that is all that is required.

[..]
[#Glycocalyx]
However, it is not just fish that have a glycocalyx to make them slippery, and protect them from infections, and suchlike. Our endothelial cells are also covered (on one side) by this amazing and complicated layer that protects the endothelium from damage. It also contains a whole series of enzymes and other chemicals.

Problems start to happen, and a plaque will kick-off and continue to grow, if:
• There is an increased rate of endothelial damage
• The blood clot formed is bigger, or more difficult to break down, than normal
• The repair systems are impaired in some way

[..]
#Periodontitis
“Researchers have found periodontal pathogenic bacteria in atherosclerotic plaque and in the arterial walls. Periodontal pathogens are associated with endothelial dysfunction.” 178

“Periodontitis had significant direct effect, and indirect effect through diabetes, on the incidence of CKD. Awareness about systemic morbidities from periodontitis should be emphasized.” 179

Because of these strong and consistent connections between ‘infections’ and CVD, several researchers, some of whom I know well, believe that the primary cause of CVD is infectious disease. I simply nod and reply that infectious diseases are one of many different causes. They are just another stone with which to build the thrombogenic house.


[..]
[#Risk Factors]
Instead, you must ask what can they do? In this way you can bring together a whole world of factors that, at first sight, appear to have nothing in common. For example:
• Smoking
• Lead/other heavy metals
• Exhaust fumes
• Raised blood pressure
• SLE
• Migraines
• Raised blood sugar levels
• Bacterial infection
• Periodontal disease
• Avastin/bevacizumab
• Pulmonary emboli
• Chronic kidney disease
• Sickle cell disease
• Lp(a)
• Hughes’ syndrome
• COVID19
• Steroids/cortisol
• Strain/stress
• Scurvy/ Vit C deficiency

Everything on this list increases the risk of CVD because they can all do one of three things. In some cases, all three:
• Damage the glycocalyx/endothelium
• Create bigger, more difficult to shift blood clots
• Interfere with the repair process


In the end it turns out that Paul Rosch was truly a genius. To understand CVD, you must not look at what (causes it), you have to look at how (it is caused). At which point the windowpane disappears, and you can fly free.
[..]
Which takes us to the most important factors that can lead to endothelial damage, in the greatest number of people are:
1 Raised blood sugar levels/type 2 diabetes
2 HPA-axis dysfunction/mental illness/use of steroids (cortisol)
3 Smoking
4 Air pollution
5 Raised blood pressure
6 Periodontal disease
7 Drugs/cocaine
8 Use of prescription drugs e.g., drugs to reduce acid in the stomach
9 Homocysteine

[...]
[#Glycocalyx]

When you get down to it, the glycocalyx needs proteins to make it, repair it and replenish it. Therefore, it would seem a good idea to take supplements containing the same type of proteins that are found in the glycocalyx. Which means supplements such as chondroitin sulphate, glucosamine and hyaluronan.
Many people already use these to help with arthritis. They can (severe pharmaceutical company woo-woo warning) improve the health of the cartilage – which also contains a high concentration of glycoproteins. Not only can they help with arthritis, there is strong evidence that they can also reduce the risk of CVD.

“Habitual glucosamine use was associated with a 15% lower risk of total CVD events and a 9%-22% lower risk of individual CVD events (CVD death, coronary heart disease, and stroke).” 230
“Osteoarthritic patients treated with high doses of chondroitin sulfate (CS) have a lower incidence of coronary heart disease.” 231

Japanese researchers also found that chondroitin sulphate acts as a potent anticoagulant reducing the risk of blood clots forming on the arterial walls.232
Almost certainly because a healthy glycocalyx stops blood clots forming. So yes, it does appear that you can keep the glycocalyx much healthier by taking protein supplements. The main ones are:
• Chondroitin sulphate
• Glucosamine
• Hyaluronan
All three can reduce the risk of CVD. Not massively, but significantly.

[He recommends this for #nitric oxide, even viagra/sildenafil:]
1 Increased sun exposure
2 L-arginine
3 L-citrulline
4 Co-enzyme Q10
5 Sildenafil
6 Breathe through your nose
7 Certain vegetables
8 Dark chocolate
9 Red wine
10 Meat/animal organs e.g. liver

[About #Viagra:]

However, researchers in Manchester did do a long-term observational study where they looked carefully at the use of sildenafil in men, with diabetes, who had also suffered a heart attack.

There were significant reductions in risk. The two most important were:
• The risk of a heart attack dropped by 38%
• Overall mortality fell by 15.4% (40.1% vs 25.7%)245

These men were certainly in a very high-risk group. A previous heart attack and diabetes. Which is why the mortality rates were so high. Four in 10 died in the control group, in under 10 years.

Even with such a high rate of death, a 15.4% reduction in the risk of dying, over 7.5 years, equates to around 10 years additional life expectancy. For any actuaries in the audience, yes, this one becomes a bloody complex sum. But I am going with 10 years.

Let us now compare and contrast this with the largest ‘high risk’ statin trial. Which was the Heart Protection Study (HPS). This lasted five years, and the reduction in overall mortality was 1.8%.246 Which makes Viagra five point seven times more effective than a statin, at reducing the risk of death. Let’s call it six, for luck.

I will let you decide which of these two medications you feel provides a longer and significantly higher quality of life. I will give you a clue. It begins with an s (or a V), and it isn’t a statin. Would it also work for women – I don’t see why not. [He means sildenafil, aka Viagra]



[..]
#Clotting
Before that I want to cover a few things that increase blood clotting and therefore should, in general, be avoided.
1 Physical stress (hot and cold)
2 Dehydration
3 Not moving
4 Acute mental stress
5 Non-steroidal anti-inflammatory drugs (NSAIDS)

[..]
#Lp(a)
Now to move onto a couple of specific pro-coagulant conditions that need to be mentioned. 1 Raised lipoprotein(a) Lp(a)
2 Hughes’ syndrome/antiphospholipid syndrome

“High Lp(a) level ≥50 mg/dl is found in 10%–30% of the population with an estimated 1.43 billion people affected globally.”

[#Recommendations for High #Lp(a)]
I would also strongly advise aspirin to reduce clot formation. It has been found that aspirin can reduce the CVD risk by over 50% in those with high Lp(a). So low dose aspirin, 75 mg daily is definitely a good idea.263 Best ways to lower Lp(a), or reduce the risk of having a high Lp(a) • Do NOT smoke
• Check for other clotting factors e.g., factor V Leiden
• Do not take drugs that increase blood clotting risk, if possible, e.g., ibuprofen, naproxen, or suchlike… or cocaine
• Take 75 mg aspirin a day
• Take B3/niacin, as much as you can tolerate
• Take co-enzyme Q10 ~ 30 mg a day
• Take one gram of vitamin C per day
• Reduce carbohydrate intake

[..]
[#Recommendations]
So, what other things should you look out for… or do? I am going to restrict this to five: 1 Magnesium
2 Vitamin C
3 Thiamine
4 Chelation therapy
5 Enhanced External Counter Pulsation therapy EECP

[..]
[Risk Factors]
The study was called “Can machine-learning improve cardiovascular risk prediction using routine clinical data?” Here is what they found to be the top 10 risk factors for CVD, in order, with number one being highest risk, and number 10 lowest risk:
1 Chronic obstructive pulmonary disease
2 Oral corticosteroid prescribed
3 Age
4 Severe mental illness
5 Ethnicity South Asian
6 Immunosuppressant prescribed
7 Socio-economic-status quintile 3
8 Socio-economic status quintile 4
9 Chronic kidney disease
10 Socio-economic status quintile 2

Where is diabetes? It is wrapped into most of the other factors.
Where was LDL? Well, it came 46th… out of 48. Essentially, it was of no significance at all. None. I wrote to the authors of this paper to find out why they failed to mention this complete and utter lack of impact of LDL. The reply was a masterclass in obfuscation. I cannot blame them. See under Kilmer McCully. So long as you don’t directly mention LDL, you can get away with demonstrating that it has nothing to do with cardiovascular disease. It slips under the radar.

[#Recommendations]
I think that the main thing that this list highlights is that there are not too many things that most people need to greatly worry about. Do not breathe in really nasty toxic stuff. Keep your cortisol levels down and keep your HPA-axis healthy by remaining calm and by nurturing your friends and family. Do the type of exercise you most enjoy, get out in the sunshine… just get outside. Eat, local, natural food.

As for supplements. Here are the ones I believe to be most important:
• Vitamin D – in the winter
• Vitamin C
• Potassium
• Magnesium
• L-arginine/citrulline If you already have diagnosed heart disease
• Chondroitin sulphate
• Thiamine
• Co-enzyme Q-10
• Consider Viagra…
• Consider aspirin, low dose, especially if you have a clotting disorder
• Avoid non-steroidal drugs, long term, if possible
• Avoid proton pump inhibitors, long-term, if possible

If you have diabetes
• Low carb diet
• Short burst exercise
• Reduce alcohol
• Consider chelation therapy

And always, smile, count your blessings and do things that make you feel good about yourself. Volunteer, join a club, meet people. Nurture yourself.

And… if you do have serious medical problems, do not avoid mainstream medicine. I do not wish to give the impression that mainstream medicine has no solutions, nothing of benefit in this area. If you have a heart attack – get thee to the hospital. If your blood pressure, or blood sugar are flying out of control – get thee to a doctor. The model of cardiovascular disease they are using is, I believe, wrong. However, many of the solutions still work.


[...]

[On his blog he additionally mentions these: ]

What factors can lead to the situation where damage outstrips repair? First, we need to look at those factors that increase the rate of damage. There are many, many, things that can do this. Here is a list. It is non-exhaustive, it is in no particular order, but it may give you some idea of the number of things that can cause CVD, by accelerating endothelial damage:

  • Smoking
  • Systemic Lupus Erythematosus
  • Use of oral steroids
  • Cushing’s disease
  • Kawasaki’s disease
  • Rheumatoid arthritis
  • High blood pressure
  • Omeprazole
  • Avastin
  • Thalidomide
  • Air pollution
  • Lead (the heavy metal)
  • Mercury
  • High blood sugar
  • Erythema nodosum
  • Rheumatoid arthritis
  • Low albumin
  • Acute physical stress
  • Acute mental stress
  • Chronic negative mental stress
  • Chronic Kidney Disease
  • Dehydration
  • Sickle cell disease
  • Malaria
  • Diabetes/high blood sugar level
  • Bacterial infections
  • Viral infections
  • Vitamin C deficiency
  • Vitamin B deficiency
  • High homocysteine level
  • Chronic kidney disease
  • Acute renal failure
  • Cocaine
  • Angiotensin II
  • Activation of the renin aldosterone angiotensin system (RAAS) etc.
Blimey, yes, that list was just off the top of my head, I could get you another fifty without much effort. And no, I did not just make it up. I have studied every single one of those factors, and many more, in exhaustive detail. The extent of how many factors there are, should not really come as a surprise to anyone, but it usually does.
[..]
Moving on, we need to look at factors that make the blood more likely to clot and/or make blood clots that are more difficult to shift. Again, in no particular order here and non-exhaustive:

  • Raised fibrinogen levels
  • High lipoprotein (a)
  • Antiphospholipid syndrome (Hughes’ syndrome)
  • Factor V Leiden
  • Raised plasminogen activator inhibitor 1 (PAI-1)
  • Raised blood sugar levels
  • High VLDL (triglycerides)
  • Dehydration
  • Stress hormones/cortisol
  • Non-steroidal anti-inflammatory drugs (NSAIDs)
  • Acute physical stress
  • Acute mental stress.
[..]
To my surprise, a raised fibrinogen was found to be the most potent risk factor in the Scottish Heart Health Study, ranking above smoking [But apparently smoking raises it...] Because I don’t want to make this blog too long, I will simply say that all the other things in the list above both increase the tendency of the blood to clot and increase the risk of CVD.
Finally, we can look at factors that impair the repair systems. There are two basic parts to the repair systems.

  • Formation of a new layer of endothelium, to cover the blood clot
  • Clearing away of the debris left by the blood clot within the artery wall
What sort of things stop new endothelial cells being created?

  • Avastin
  • Age – which reduces endothelial progenitor cells (EPC) synthesis
  • Thalidomide
  • CKD – reduces EPC synthesis
  • Diabetes
  • Omeprazole
  • Activation of the renin-angiotensin aldosterone system (RAAS)
  • And drug that lowers nitric oxide synthesis
  • Lack of exercise.
What sort of things damage the clearance and repair within the artery wall?

  • Steroids
  • Age
  • Immunosuppressants
  • Chronic negative psychological stress
  • Certain anti-inflammatory drugs
  • Many/most anti-cancer drugs.
There are a few things that I have mentioned that will greatly increase the risk of CVD with no need for anything else to be present. They are:

  • Steroids/Cushing’s disease
  • Chronic Kidney Disease
  • Sickle cell disease
  • Antiphospholipid syndrome
  • Immunosuppressants
  • Avastin
  • Diabetes
  • Systemic Lupus Erythematosus
  • Kawasaki’s disease.

Kendrick mentions viagra, but I have some comments to make here I think you need to know:
================================
SOME #COMMENTS ABOUT #VIAGRA
================================
[Nick Norwitz recently published an article that those on Viagra have 69% less risk of #Alzheimer’s… [Speaking of Alzheimer's Norwitz also says that Lithium has been found to lower Alzheimer’s risk, and Rhonda Patrick says that too although she says lithium carbonate and Norwitz lithium orotate 5mg]
[Mercola says that in animals, the response to viagra is weaker if Vitamin D levels are low]
[And another article finds these reductions with tadalafil and sildenafil (Viagra). Seems to have higher reductions with tadalafil than statins do:


  • Mortality: 34% reduction with tadalafil, 24% with sildenafil
  • Heart Attack: 27% reduction with tadalafil, 17% with sildenafil
  • Stroke: 34% reduction with tadalafil, 22% with sildenafil
  • Venous Thromboembolism: 21% reduction with tadalafil, 20% with sildenafil
  • Dementia: 32% reduction with tadalafil, 25% with sildenafil
Tadalafil, which remains active in the bloodstream longer than sildenafil, showed more substantial results across each category. Both drugs are PDE-5 inhibitors, which relax muscles and blood vessels.

The benefits of tadalafil for patients treated for lower urinary tract symptoms were even more pronounced. Among over 1 million men aged 40 or older diagnosed with lower urinary tract symptoms, those treated with tadalafil showed marked reductions in mortality (56%), heart attack (37%), stroke (35%), venous thromboembolism (32%), and dementia (55%) compared to patients who did not receive these medications for lower urinary tract symptoms.
https://www.utmb.edu/utmb/news-article/utmb-news/2024/11/19/study-finds-erectile-dysfunction-medications-associated-with-significant-reductions-in-deaths--cardiovascular-disease--dementia
]
[
That said…
Someone on FB says it can increase homocysteine though…
And more importantly, recently, Anette Bosworth’s [2] healthy husband took a drug for ED and
suddenly went blind in one eye within 30 minutes of taking it… He didn’t even need the drug, just wanted to try it.

A youtube comment says that AI mentions it’s been associated, though not definitively, with sudden eye loss due to interrupted blood flow to the optic nerve (NAION).

And a study says that (NAION) has been reported and other side effects with viagra. So, be careful.

In that case, maybe, just maybe, DMSO eye drops could potentially restore vision loss, (or maybe even orally or topically on the head). Midwestern doctor mentions a few cases where it did (but were unrelated to viagra).

Some sources:

[Youtube Comment]
What AI SAYS

• Condition: Erectile dysfunction drugs have been tied to NAION, with most reported cases involving sildenafil (Viagra).
• Symptoms: This can cause sudden, permanent vision loss due to interrupted blood flow to the optic nerve.
• Risk: The risk appears to be highest in individuals with pre-existing cardiovascular risk factors, such as high blood pressure or heart disease, though a definitive causal link has not been established.


[Study]
Overall, the most common adverse effects of sildenafil are strongly associated with its pharmacological nature as an inhibitor of PDE5 (headache, nasal congestion, ageing and dyspepsia) and as a weak inhibitor of PDE6 (visual impairment), being dose-dependent and observed in 6–18% of men taking sildenafil [53]. In this sense, visual side effects were reported in 3–11% of men taking 25–100 mg of sildenafil, 50% of men taking 200 mg and 100% of men taking 600 or 800 mg [31,54,55,56] (center for drug evaluation). Although subjective visual changes are common, studies on healthy volunteers [55,57], men with ED [54,58] and patients with previous visual pathologies such as age-related macular degeneration (AMD) [56] who were taking sildenafil either as a single dose [55,56,57] or following a long-term treatment [54,58] have not found significant differences in psychophysical testing of visual function, except for color discrimination, predominantly in the blue–green range, in some studies [59]. The effects on retinal function are shown as modest and transient visual symptoms, commonly reported as blue vision, increased sensitivity to lights and blurred vision, more often at high doses [41,60]. Karaarslan’s study has reported visual symptoms up to 21 days after taking sildenafil [41]. Although the cause of blue-tinted vision is unknown, it is thought that it can be related to PDE6 inhibition in the retina [61] but data are nonconclusive [62]. Because PDE5 is expressed in the endothelial and smooth muscle cells of the choroidal and retinal vessels, sildenafil may affect ocular blood flow [63]; thus, it is reasonable to think that may cause other visual symptoms apart from those derived from the nonselective inhibition of PDE6 [11,64]. In fact, severe effects such as an increase in intraocular pressure (IOP) [65,66,67], retinal and choroidal vasodilation and altered blood flow [68,69], and nonarteritic anterior ischemic optic neuropathy (NAION) [45,70,71] have been reported as a consequence of the intake of sildenafil. Since many of the symptoms are dose-dependent, further studies are needed to establish the dose above which adverse effects occur in sildenafil users.

Visual Side Effects Linked to Sildenafil Consumption: An Update - PMC
]

[Midwestern doctor DMSO on the eye]

“Human Case Studies
In addition to those two studies, a variety of individual case histories support DMSO’s value for the eyes.

One author reported on DMSO being used by Stanley Jacob for more severe cases of eye damage such as:

•A man who had been blind for more than 30 years after having dynamite explode in his face who started seeing flashes of light after applying DMSO to the head.

•A man who lost sight in the right eye (along with other functions of the eye like focusing) and gradually lost it in the other after an almost fatal impact by an automobile while skating down the road. After trying DMSO for hair loss, he noticed a sensation in the back of his right eye, so Stanley Jacob decided to try applying DMSO to that eye, eventually settling on a high concentration (that stung for several minutes, caused tears, and left the eyes bloodshot for about 20 minutes). After this, sight rapidly returned to the right eye.

A man who had been blind for many years in one eye (only able to distinguish light and dark) regained his sight in that eye with DMSO (e.g., he demonstrated this by walking unaided in public areas and describing objects and events while his good eye was covered).

•A man who was almost blind (leading to him being completely dependent on others like his wife to take him anywhere, cut his meat or keep his house clean) after a year on DMSO regained his sight and no longer needed assistance to do anything (which was of great relief to his family).


Note: these results led to Jacob testing DMSO on a series of patients with incurable blindness. Sadly, in many cases (which ophthalmologists had pronounced incurable), regardless of the remarkable results, the ophthalmologists tended to insist there was either no improvement or it was just a coincidence.”
[…]

"Applying DMSO to the Eyes:
Note: please remember not to wear contacts when applying DMSO to the eyes.

A few different approaches exist for applying DMSO to the eyes: immersing the eyes in a cup (so the entire eye is bathed in DMSO), applying DMSO drops to the eyes with a dropper, or applying DMSO drops to the eye which also contain something else.

Note: in all cases where it’s used, DMSO was diluted with sterile isotonic solution. You can get away with using purified water as well, but saline (which can easily be bought at any drug store) is ideal and less likely to irritate the eyes. However, if you buy saline, you need to make sure it doesn’t have other chemicals added to it.

•In the case of eye baths (which I suspect is a more potent route of administration), the highest concentration I’ve seen used for this approach is 50% (for 30 seconds), but unfortunately I could not find as much data on it.

•In the case of eye drops, while 50% worked, the most common dosing physicians used was one drop of 40% DMSO applied to each eye each day, but many prefer 20% or 30% (and will often start at 20% then gradually raise to 30% and then 40%). However, many have also reported success with lower doses (e.g., the previously mentioned reader with the eye spasms stated that he has been applying 10% eye drops to end his episodes, and likewise the reader with the vitreous detachment also found 10% fixed it). I personally think you should start with 10% DMSO, and only raise it under the guidance of an ophthalmologist or in slow and well-thought out increments.

•In the case of retrobulbar administrations, ACAM physician Dr. Becquet (who I mentioned earlier) would instill 5 mg of DMSO in one cc of normal saline placed retrobulbar under Tenon's capsule behind the equator or to wherever the area of activity is.

•When used for cataracts (but not macular degeneration), ACAM physicians found DMSO eye drops needed to be combined with super oxide dimutase (SOD)—although others have reported success for cataracts with DMSO alone. In this application, 5mg of 2cc DMSO was combined with 2cc SOD for a 4cc solution, while another used one drop of a solution composed of 2cc of SOD and 25mg of DMSO (which they used for both cataracts and glaucoma).
Note: from how the ACAM protocols were described, it was not completely clear what was being done, but I assumed 100% DMSO was mixed 50/50 with the SOD dismutase solution for a 50% DMSO solution (and from what’s been written here, an integrative ophthalmologist would quickly be able to figure out the ideal protocol). Conversely, another author interpreted this to mean that 5mg of pure DMSO was diluted in 1 liter of isotonic (and has had clinical success with that much lower dosage).

Additionally, when treating AMD (which results from systemically impaired blood circulation), concurrent oral consumption of DMSO is often needed. Likewise, nutritional therapies (e.g., omega-3 fatty acids, zinc, carotene, and vitamins C and E) often also have a positive effect on the conditions. For example, Jonathan Wright MD, for decades has treated dry macular degeneration with roughly a 70% success rate that patients worldwide have sought him out. Colleagues of mine witnessed his work, and a cornerstone of his protocol was targeted nutraceutical therapies.
Note: it is still possible for interested patients to see Wright for macular degeneration.

Additionally, we have found that many eye issues relate to inadequate drainage from the eyes (especially of the lymphatics). In these cases, besides DMSO, one of the most valuable agents we’ve found (which in some ways works very similar to DMSO) is Standard Process AC Carbamide. This osmotic diuretic has a high affinity for reducing fluid congestion in the eyes. Likewise, improving zeta potential (e.g., with zeta aid) can often be quite helpful for the eyes.”

How DMSO Cures Eye, Ear, Nose, Throat and Dental Disease

===============================
===============================
 
BaleDoneen Method

4. BaleDoneen Method
A doctor and nurse, known for their preventive and ‘reversing’ of atherosclerosis, they have treated difficult and at high risk patients. By reversing, they mean using lipid lowering drugs and risk factor reduction, so the lipid part of the plaque shrinks to a degree or progresses more slowly. Also, they include sleep apnea as a risk factor and also emphasize oral infections, not just as a risk factor but as a cause of the disease. [Their study of that]. They are fond of lowering blood pressure to 120 mmHg. And believe in lowering LDL plus lowering inflammation.
Authors of the ‘Healthy Heart, Healthy Brain’. Here are some of their risk factors and excerpts:

[They don't include a list of risk factors, and they don't mention two (gut and systemic infections) in the book that they briefly mention in their study, and I get the feeling they explain more in their courses like maybe using Niacin or PCSK9, but I gathered:
Risk Factors:
Age
Ethnicity
Sleep Apnea
Bad sleep/<6 hours of sleep
Low Vitamin D

Atrial fibrillation / history of irregular heartbeats

Oral infections, including Periodontitis and Endodontic, periapical abscesses, infected Root canals
Systemic Infections
Gut dysbiosis


9P21 gene
Haptoglobin 2-2 gene
Apo E4 genotype; diet depends on genotype
Familial Hypercholesterolemia
Xanthomas
High Lp(a)
KIF6 genotype, makes atorvastatin (Lipitor) and pravastatin (Pravachol) protect only 60% of people
Atorvastatin is less effective on women, and even less with insulin resistance. Better to use rosuvastatin (Crestor)
Atorvastatin more effective in male heart patients with a certain KIF6 genetic variant
4q25 gene – 140% higher risk of Atrial fibrillation, Quintuples the risk for strokes and doubles it for heart attacks or dementia


Smoking
Substance abuse
Asthma
Taking corticosteroids

Mental disorders
Migraines
Stress/Working long hours
Women divorce


Sedentarism
Insulin Resistance
Metabolic Syndrome
Triglycerides/HDL ratio
>3.5 (white);​
>3.0 (Hispanic);​
>2.0 (Black)​
High LDL/ High ApoB
Blood pressure >120 mmHg

Autoimmune disease,
Lupus
Psoriasis
Rheumatoid Arthritis

A ring around the colored part of your eye (Cholesterol and triglycerides deposit).
Earlobe with a diagonal crease called Frank’s sign (Nobody knows why, but they are at x3 risk for Coronary Artery Disease and “better predictor of risk for severe CAD, heart attacks, and peripheral artery disease”).

Male pattern baldness
Erectile Dysfunction

Prematurely gray hair or wrinkles on Women
Miscarriages
Premature births
On Hormone Replacement Therapy [They are not fond of it]

Antibiotic Azithromycin dangerous in high risk patients
Antibiotic Septra and Bactrim, don't combine with antihypertensive medications (RAAS inhibitors) because it can raise your potassium dangerously high

High inflammation markers:
F2-Isoprotane/Creatinine Ratio: > 0.86 ng/mg​
Fibrinogen >370 mg/dL​
hs-CRP >1​
Microalbumin/Creatinine Urine Ratio (MACR) -​
Men, >4 mg/L​
Women, >7.5 mg/L​
Lp-LPA2 - high in oral infections. >200 nmol/min/mL​
Myeloperoxidase (MPO) - ‘the worst of them all’, high in oral infections, otherwise appears to be genetically influenced. >420 pmol/L]​

NT-proBNP >125 pg/mL

Their optimal medical therapy:
“Dr. Serruys and his team define OMT [Optimal Medical Therapy] as receiving four types of heart medications: an antiplatelet drug, a statin, a renin-angiotensin system inhibitor, and a beta-blocker”

]

Excerpts:

About one in four heart attacks and strokes are repeat events, according to the Centers for Disease Control and Prevention (CDC).1

BaleDoneen Method rapidly shrinks and stabilizes arterial plaque in the first year of treatment, helping people avoid heart attacks and strokes.

It was also proven that our method eradicated lipid-rich arterial plaque (the most dangerous kind) in 100 percent of cases.

[...]
he’d needed emergency quadruple coronary bypass surgery at forty-two to treat severely clogged arteries that were putting him at high risk for a heart attack. “It was the worst thing I’d ever gone through,” he told us. “They split me open like a clam and after the operation, I was in so much pain I had to go on short-term disability. I told my wife I’d rather die than go

Over the next ten years, he underwent an additional sixteen stenting procedures to reopen clogged arteries all over his body, including those in his heart, legs, kidneys, and gut.

However, we assured her that we’ve successfully treated many patients who were even sicker than he was, including two of the patients you’ll meet later in this book: Joe, who was in such poor cardiovascular health when he plugged into our method that he’d been told he needed a heart transplant; and Camille, who told us that after suffering a near-fatal heart attack at forty, she was so terrified she’d have another one that she dreaded going to sleep at night, fearing she wouldn’t wake up in the morning.

[..]
Moreover, a major study done nearly thirty years ago found that 86 percent of heart attacks occur in patients whose coronary arteries are less than 70 percent blocked, and 68 percent happen when the major arteries supplying the heart are less than 50 percent obstructed. A number of other studies have similar findings.


[#Sleep Apnea]
Like about 22 million other Americans, he had obstructive sleep apnea (OSA), a disorder marked by brief, repeated episodes in which the person stops breathing during sleep. Characterized by such symptoms as loud snoring, daytime drowsiness, and a dry mouth or sore throat upon awakening, OSA frequently goes undiagnosed. If untreated, this sleep disorder doubles the risk for heart attack, stroke, high blood pressure, heart failure, atrial fibrillation, diabetes, and other cardiovascular problems. Recent studies, however, have shown that treatment of OSA eliminates this excess risk and helps improve blood pressure control.26 Neal’s case bears this out: After he started using a CPAP (continuous positive airway pressure) machine to keep his airways open at night, his blood pressure improved dramatically.

[#blood pressure]
Therefore, we recommend that patients whose blood pressure is even slightly above normal (which is a level below 120/80) be evaluated to see if they need treatment. We also believe in setting individual—not aggressive—treatment goals. Certain patients, including those with type 2 diabetes, can be harmed if their blood pressure is reduced to a level below 120/80.

[#genes]
example, like about 50 percent of Americans, Neal is a carrier of the 9P21 gene, which is often called “the heart attack gene,” because it is an independent predictor of risk for these events, even when such factors as family history, high blood pressure, diabetes, obesity, and elevated levels of the inflammatory marker C-reactive protein are taken into account. A recent study, however, found that when carriers of the 9P21 and other high-risk genes stay physically fit, they can reduce their risk for CVD by up to 50 percent, highlighting the amazing power of an optimal lifestyle to keep your heart healthy, no matter what is written in your DNA. Like about 25 percent of Americans, Neal is also a carrier of another high-risk gene called Apo E4. This genotype not only dramatically raises risk for CVD, but it also puts people who carry it at up to twenty times higher risk for developing Alzheimer’s disease. In chapter eleven, we will look at these and other high-risk genes more closely and also discuss the best genetically guided strategies people who carry them can use to protect themselves, including a diet and exercise plan based on your Apo E genotype.


[#medical history]
For each family member, record as much of the following data as possible:
Date of birth
Sex
Ethnicity
Medical conditions, including the age at which they occurred
Dental disorders, such as gum disease, oral infections, and tooth loss
Pregnancy complications, such as gestational diabetes, preeclampsia (high blood pressure and protein in the urine), miscarriages, and stillbirths
Mental health conditions
Red flags for heart attack, stroke, and dementia, such as those listed in chapter three
Lifestyle, including smoking, substance abuse, and diet and exercise habits
For deceased relatives, list the age at death and the cause

[#insulin resistance]
We recommend that everyone with known arterial disease get the OGTT [Oral Glucose Tolerance Test], regardless of their weight or BMI. Here’s why: If you have atherosclerosis, there is a 70 percent risk that you also have IR or diabetes.

[..]
For example, Camille did need a statin, but the one that was prescribed after her heart attack wasn’t an effective therapy for people with her genotype.

[#Erectile Dysfunction]
Although a variety of conditions can interfere with a man’s sexual performance—including stress, sleep disorders, diabetes, alcohol consumption, smoking, anxiety, depression, and the use of certain medications—CVD is the leading culprit. A 2019 analysis pooling the results of studies of more than 150,000 men found that those with ED were 59 percent more likely to have CVD,

[#Migraines]
Migraine headaches, particularly those preceded by sensory symptoms known as an aura (such as seeing flashing lights or zigzag lines, or a disturbed sense of smell, taste, or touch), are strongly linked to increased risk for stroke, particularly in women.

[#Periodontitis]
Other research has shown that people with gum disease are at 70 percent higher risk for Alzheimer’s disease than those with healthy gums, and among those who already have the memory-robbing
Oral pathogens have also been linked to an increased threat of many other chronic conditions, including diabetes, rheumatoid arthritis, and even colon cancer.
15 A 2021 study of more than five hundred patients with COVID-19 reported that those with gum disease were 3.5 times more likely to need ICU care, 4.5 times more likely to be put on a ventilator, and nearly nine times more likely to die, compared to those without gum disease.

[#autoimmune]
Other research suggests that people with lupus—an autoimmune disorder best known for causing a butterfly-shaped rash across the nose and cheeks—are particularly vulnerable to heart disease. A 2018 study found that young women with this disease are fifty times more likely to die from a heart attack than young women without lupus. Researchers believe that immune system cells called neutrophils may be the culprits: A recent study found that in lupus patients, these normally protective cells go rogue, leading to stiff, inflamed, and plaque-filled arteries.

[...]
[#sleep apnea]
Loud snoring or frequently waking up in the night for no apparent reason are both common symptoms of OSA. As you learned in chapter two, this often-undiagnosed sleep disorder is one of the most common root causes of high blood pressure that doesn’t respond to prescribed medications, as turned out to be the case with both Neal and J.P. If you fit this scenario, talk to your medical provider about having a sleep study, even if you don’t think you snore, since many people with OSA are unaware of their symptoms. Several studies have also shown that having OSA doubles risk for heart attacks, strokes, and other CV events. The good news is that if this sleep disorder is treated, the excess risk can be eliminated.

[..]
[#gout]
Three years before his heart attack, he was diagnosed with gout, an inflammatory form of arthritis that occurs when uric acid builds up in the body, leading to joint pain and swelling, especially in the big toes. Although gout and diabetes are different diseases, people who have one are more likely to get the other. If you have gout even occasionally, we recommend having your blood sugar checked with the OGTT, since discovering and treating this very common condition is a key component of our prevention plan. When we tested J.P. after his heart attack, he turned out to be prediabetic.

[...]
[#stress]
Working long hours Not only is clocking long hours on the job stressful, but it can take a toll on your cardiovascular health. In a recent analysis of studies that included more than 600,000 initially healthy men and women, those who worked fifty-five or more hours a week had a 13 percent higher rate of heart attacks and 33 percent higher rate of strokes, compared to those who worked thirty-five to forty hours a week.25 The participants were tracked for seven to eight years. Working long hours has also been linked to increased likelihood of weight gain, smoking, and excessive drinking.26

[#Asthma ]
Having persistent asthma symptoms can double your risk for a cardiovascular event, such as a heart attack, stroke, or related complication of arterial disease, a recent study found.27 Another study found that taking daily medication (such as oral or inhaled corticosteroids) for chronic asthma boosts risk for such events by 60 percent over a ten-year period, as compared to having intermittent asthma that doesn’t require controller medications.28 What’s the link between asthma—a respiratory disease that affects about 25 million Americans—and heart risk? Inflammation plays a key role in both conditions, as do genes.
In fact, children are up to five times more likely to develop it if their mother has asthma and up to twice as likely if their father does.29 In the study of users and non-users of asthma control medications, those with persistent symptoms requiring daily treatment had much higher levels of systemic inflammation than those with intermittent symptoms. The findings align with a large body of research tying other inflammatory

[#divorce]
For example, a 2015 study found that one divorce raises women’s heart attack risk by 30 percent—and two divorces doubles their risk! The same study found that men must be divorced at least twice to have any increased heart attack risk.

[#optimism]
Optimism. People with an upbeat outlook have a 35 percent lower risk for heart attacks, strokes, angina, and death from CV causes, according to a 2019 analysis of studies that included nearly 130,000 men and women who were tracked for about fourteen years.32

[#Earlobe #Red flags]
For example, when we teach healthcare providers about cardiovascular red flags in our continuing medical education (CME) course, we show them a photo of coauthor Brad Bale’s earlobe, which has a diagonal crease called Frank’s sign. People with this tiny wrinkle or fold, which looks like the backslash on your computer, are at more than three times higher risk for CAD than those without it, according to a recent study.33 Another study concluded that Frank’s sign is a better predictor of risk for severe CAD, heart attacks, and peripheral artery disease than such well-known risk factors as smoking, high blood pressure, and high cholesterol.

[#men #baldness]
Male pattern baldness
A 2014 study linked this form of hair loss, which affects the front and top of the scalp, to a 40 percent rise in heart attack risk, as compared to that of men the same age with a full head of hair.36 And the earlier this pattern of hair loss begins, the stronger its impact on cardiovascular risk, the researchers reported. Although scientists don’t yet know the reason for this link, other studies have reported similar findings. For example, a 2017 study of two thousand men found that in those under forty, male pattern baldness was a bigger risk factor for developing CAD than obesity is.37 That’s why even young men with male pattern baldness should get a comprehensive cardiovascular evaluation with the tests recommended in this book. Such a workup would have identified Neal, who started to go bald in his early thirties, as being at very high risk—long before his arterial disease grew so severe that he needed emergency bypass surgery.

[#gray hair #wrinkles #women]
Prematurely gray hair or wrinkles
The researchers also reported that young men with heart disease were more likely to have prematurely gray hair than their healthy counterparts, suggesting that accelerated aging may play a role. Going gray at a young age, or excessive wrinkling in sun-protected areas is also linked to elevated heart risk in women.

[#familial hypercholesterolemia #red flags]
A ring around the colored part of your eye
Primarily found in people with an inherited form of extremely high cholesterol (familial hypercholesterolemia, or FH), this condition creates a deposit of cholesterol and triglycerides in an arc on either the top or bottom of the iris (the colored portion of your eye), inside the cornea.38 Because people with FH are at extremely high risk for heart attacks and strokes, early detection and treatment can be lifesaving. If untreated, people with FH are twenty times more likely to develop CAD than those without FH—and are up to 50 percent more likely to suffer a fatal or nonfatal heart attack by fifty.39

[#xanthomas]
Yellowish, waxy skin growths
Known as xanthoma, these fatty growths can be a sign of high cholesterol. They can be as small as a pinhead or as big as a grape and can occur in many areas, including the corners of your eyes, your hands, and the back of your legs. In one large, long-term study, people who had them were at a 48 percent higher risk for heart attacks.

[#genes]
Moreover, he had a variant of the haptoglobin gene called Hp 2-2 that raises lifetime risk for arterial disease as much as smoking does, and also increases the likelihood of developing autoimmune diseases and cancer.5 Not only is this gene probably related to Casey’s psoriasis—an autoimmune disease that is known to increase heart attack and stroke risk—but, more significant, people with his genotype do best if they follow a gluten-free diet. He also got some genetic good news from our tests: He carries a copy of the heart-protective Apo E2 gene, which may counteract

[#Lp(a) #genes]
The researchers report that patients with one copy of the gene responsible for elevated Lp(a) levels are 58 percent more likely to develop coronary heart disease (CHD) while taking a statin for prevention than those without the gene, while risk for CHD is more than doubled in statin users with two copies of the Lp(a) gene!

[#LDL #ApoB]
public enemy number one by the medical profession. Yet none of the hundreds of cholesterol studies performed to date has ever shown that LDL causes heart attacks. This unscientific belief has become so ingrained in medical thinking—as well as cardiology guidelines—that it’s been termed “the great cholesterol hoax.” Indeed, a large body of research suggests that your level of LDL is the worst lipoprotein predictor of your heart attack risk.11 Instead, the most predictive measurement is apolipoprotein B-100 (ApoB),

[#triglycerides]
Conversely, the standard cholesterol test only measures the amount of cargo, such as LDL cholesterol, that the fleet of submarines is carrying. Why does this distinction matter? In a recent study called JUPITER, there was no correlation between the 11,186 participants’ initial blood levels of LDL (as measured by the standard test) and their subsequent rate of heart attacks, strokes, and other cardiovascular (CV) events over the next two to five years, while their baseline numbers for ApoB and triglycerides (TG) strongly predicted future CV risk.13

[ #antibiotic #azithromycin]
In fact, as she soon found out, it was her second heart attack: She’d been misdiagnosed during her first visit to the ER five days earlier. The antibiotic that was mistakenly prescribed, azithromycin, is extremely dangerous for someone in the throes of a heart attack. A 2020 study of nearly 3 million people found that those treated with this antibiotic had nearly twice the risk of dying from cardiovascular or other causes in the next five days, as compared with people treated with amoxicillin, an antibiotic not associated with CV events.

have reported increased risk for cardiovascular deaths, serious heart arrythmias, or heart attacks in patients who received azithromycin.
2 While deaths linked to this widely prescribed antibiotic are rare, the highest rates were seen in patients with cardiovascular disease.

[#genes #statin]
For example, like about 40 percent of Americans, Juli has a KIF6 genotype that makes the statin her doctors had prescribed after her second heart attack, Lipitor (atorvastatin), ineffective when taken as a sole therapy.12 That meant she was getting zero protection against heart attacks, strokes, and other complications of arterial disease. Other research suggests that this medication doesn’t work as well in women as in men, and is also less effective for people with insulin resistance. Because many doctors are unaware of these individual differences in statin response, Lipitor is so widely prescribed to patients of both sexes that it’s the world’s bestselling drug.13 A key reason for its popularity: In clinical trials that mostly included men, Lipitor was spectacularly successful at saving lives—in male heart patients with a certain KIF6 genetic variant.14


[#Heart attack #symptoms on #women]
Women’s symptoms can be much more varied and subtle than those in men and may not involve the chest at all. Although such symptoms are often labeled as atypical, they are extremely common in 51 percent of the population: women.

A study of more than 1.1 million heart attack patients found that almost 15 percent of the women died in the hospital after a heart attack, compared to 10 percent of the men, largely due to misdiagnosis and delays in getting care.20 Younger women with atypical symptoms were at 20 percent higher risk for death after a heart attack than their male counterparts.

If there is any suspicion a person may be having a heart attack (see the ten warning signs listed below), it is best to be cautious and call 911 immediately, because every second counts. Patients who arrive by ambulance usually get faster care—and treatment can start on the way to the hospital. Tell medical providers that you think it’s a heart attack and don’t let them brush off the symptoms as anxiety, heartburn, or other noncardiac causes without doing tests. EKGs frequently have normal or inconclusive findings in heart attack patients, particularly in women, so you should insist on having your levels of cardiac enzymes measured, using a blood test called high-sensitivity troponin, which checks for elevated levels of proteins that are released when muscle cells in the heart are damaged, as occurs during a heart attack.22

Pain in areas of the upper body, including the jaw, neck, back, shoulders, or arms Fullness, squeezing, or pressure in the chest or a choking sensation that may feel like heartburn
Dizziness or feeling light-headed
Nausea with or without vomiting
Shortness of breath
Abnormally heavy sweating or breaking out in a cold sweat that may feel stress-related Unusual fatigue, extreme weakness or anxiety, or a sense of impending doom
Rapid, irregular, pounding, or fluttering heartbeats
Sudden confusion
Abdominal pain that may feel like indigestion or severe abdominal pressure that may feel like an elephant is sitting on your stomach


[..]
[#PCOS #women]

Polycystic ovary syndrome (PCOS) is the most common endocrine disorder in women, affecting up to 19 percent of women during their childbearing years. Its name describes the hallmark of this disease: numerous small cysts (fluid-filled sacs) in the ovaries. Although the exact cause of PCOS is unknown, in women who have it, the ovaries produce abnormally high levels of male sex hormones called androgens, which can lead to excessive amount of facial and body hair, male pattern baldness or thinning hair, and weight gain, especially around the belly. Other symptoms include infrequent or irregular periods, infertility, acne or oily skin, and dark skin patches under the breasts, in the armpits, and on the back of the neck. Women with PCOS are at increased risk for chronic diseases, including diabetes, obesity, high blood pressure, and CVD. The disorder is also strongly associated with insulin resistance, and many women who have it also meet medical criteria for metabolic syndrome, a gang of five cardiovascular bullies that we’ll look at more closely in part two. These include high blood pressure, high cholesterol, high triglycerides, and a large waistline—and when they attack in tandem, risk for heart attacks and diabetes soars.23 Not only does having PCOS greatly magnify a woman’s risk for cardiometabolic disorders, but their first-degree relatives (mothers, fathers, sisters, and brothers) are at a similarly high risk for the same clusters of abnormalities, according to a recent analysis of fourteen earlier studies.24 Indeed, some researchers have reported that the brothers of women with PCOS are at just as high risk for insulin resistance and metabolic syndrome as the women themselves!


[#Red flags #miscarriages #premature]

In Juli’s case, we detected a previously overlooked red flag for cardiovascular peril: Long before her heart attack, she’d suffered two miscarriages. In a 2015 study of more than sixty thousand women, those who had experienced at least two pregnancy losses were at 75 percent higher risk for heart disease as compared to women with no miscarriages, even when other health factors were taken into account.25

Researchers have also linked delivering a premature baby or having two or more pregnancies to increased risk for CVD.

[#Hormone Replacement Therapy #HRT #women]

There has been intense scientific controversy about the cardiovascular effects of HRT, fueled by wildly conflicting studies. In the early 2000s, millions of women were scared away from HRT by frightening media reports about the potential dangers of its most common form: combination therapy, which combines doses of two hormones that regulate women’s menstrual cycles—estrogen and progesterone. This type of HRT is the only option for women who have not had a hysterectomy, since the other form of HRT, which only contains estrogen, raises risk for uterine cancer. The addition of progesterone prevents this problem. In 2002, data from the Women’s Health Initiative (WHI), a large, U.S. government–run clinical trial, triggered an avalanche of alarm by reporting large increases in heart attacks, strokes, blood clots, heart disease, and breast cancer in women who received HRT that contained the hormones estrogen and progesterone, compared to women who had received a placebo.

.” It holds that there is a critical “window of opportunity” after menopause during which HRT helps ward off CVD in recently menopausal women who are under sixty, while not providing the same benefits in older women.

The trial, which sought to find out if HRT helped prevent heart disease and other chronic illnesses, even included first-time HRT users as old as seventy-eight.

The researchers then compared rates of fatal and nonfatal cardiovascular events in women under sixty with those in women over sixty. They found that both younger and older HRT users were at increased risk for stroke, mini-stroke (transient ischemic attack), and blood clots, compared to women the same age who didn’t use HRT, and that risk for these events rose with age among women who take hormones. However, younger HRT users were not at increased risk for fatal or nonfatal heart problems, including heart attacks.


We recommend that if you do decide to take HRT, after weighing the risks and benefits discussed in this chapter and consulting your medical provider, that treatment should start soon after menopause, at the lowest possible dose for symptom relief, taken for the shortest time possible.



#stroke
After weeks of being poked, prodded, and scanned by various specialists, she was told that her healthcare team considered her case a medical mystery. “One of the doctors said that 25 percent of the time, they can’t pinpoint what happened,”

Of those who survive, only 10 percent make a full recovery and 25 percent recover with minor impairments, according to the American Stroke Association.

The rest experience moderate to severe impairments, with about 10 percent of stroke survivors requiring care in a nursing home or other long-term care facility.


#ultrasound #tests
carotid duplex can’t detect plaque inside the arterial wall, even if it’s highly inflamed (the kind that sparks heart attacks and strokes). Therefore, the lack of blockages in Melinda and Nikki’s arteries was not proof that they were free of atherosclerosis. What most patients—and many doctors—don’t know is that 99 percent of plaque—including areas of highly inflamed plaque—does not block blood flow at all, according to a startling 2004 study by Dr. Steven Nissen of the Cleveland Clinic.7 These findings suggest that tests that only check for blockages, such as carotid duplex and treadmill stress tests, may miss up to 99 percent of people at risk for heart attacks and strokes. Melinda and Nikki are cases in point. When they were checked with the cIMT test discussed more fully in the next chapter, this fifteen-minute ultrasound scan detected plaque in their neck arteries, solving the mystery of why they’d had strokes.

Lifesaving Lesson No. 4: Even Small Plaques Can Be Potentially Lethal, If Untreated.


In Nikki’s case, we also checked a part of the head that most doctors ignore: her mouth. A dental evaluation revealed that she had previously undiagnosed periodontal (gum) disease. About 50 percent of Americans over thirty have this chronic oral infection, which has also been linked in very recent studies to increased risk for developing memory impairment and loss. Like many of these patients, Nikki, who has a beautiful smile, was unaware that she had high levels of periodontal bacteria circulating in her bloodstream until she had a simple oral-swab DNA test that will be discussed in chapter ten.

As we’ll explain more fully in chapter fourteen, statin therapy is one of the cornerstones of our evidence-based disease reversal plan for patients who have arterial plaque.

#Lp(a) #LDL
There’s also some evidence that keeping levels of LDL (bad) cholesterol as low as possible helps people with elevated Lp(a) avoid cardiovascular events.

#Root Canal #abscess
She’d also undergone gallbladder removal surgery, ten root canals to treat endodontic disease (infection of the tooth’s pulp), and five emergency extractions of severely infected teeth after their root canals had failed.

#Periodontitis #particle size #LDL
People with infected gums have up to twice as much small, dense LDL cholesterol (the most dangerous kind) in their blood as those with healthy gums, according to a recent study. The size of cholesterol particles matters: Some are big and buoyant, so they tend to bound off arterial walls, and others are small and dense, making it easier for them to penetrate the arterial lining and form plaque. Think of the difference between beach balls and bullets. In addition, people with high levels are at up to eight times higher risk for developing metabolic syndrome, even when other risk factors, such as obesity and inflammation, are taken into account, a 2019 study reported.


#Ultrasound #Tests #CIMT #fIMT
The walls of the carotid arteries can be examined directly with the cIMT test, the coronary arteries can be checked for calcified plaque with CACS, and the aorta can be checked for abdominal aortic aneurysm (a weak, ballooning area in the body’s largest artery).

similar, but much less widely available, test called femoral artery intima-media thickness (fIMT) can be used to measure the IMT of the femoral artery, one of the major vessels that supplies the legs with oxygenated blood.

Due to its calcium content, echogenic plaque can be associated with arterial stiffness (hardening of the arteries).7 It’s also possible to have plaque deposits that contain a mix of soft and hard plaque: This is called heterogenous plaque. The higher the lipid content of these areas, the greater the risk of plaque rupture and associated events.



#AAA #Abdominal Aortic Aneurysm #gene #Aneurysm
Although AAA is often stereotyped as a disease of older male smokers, nearly half of the people who develop it are women, nonsmokers, or people under sixty-five, the study cited above reported. While the exact cause is still under investigation, it shares many of the same risk factors as CVD, including smoking, obesity, diabetes, high cholesterol, high blood pressure, and genetics. A 2020 study and earlier investigations have identified twenty-four genes that play a role.15 Carriers of the 9P21 gene are at up to a 75 percent higher risk for AAA than noncarriers. Not only can the AAA scan reliably detect an aneurysm, but it can also identify calcification (atherosclerosis) in the artery wall that signals increased risk for a heart attack or stroke.


#gene #peripheral artery disease #Abdominal aortic aneurysm #PAD #AAA #Aneurysm
the 9P21 gene also boosts the threat of PAD and AAA.

#Aneurysm
Aneurysms measuring less than 1.6 inches in diameter are classified as small. Medium aneurysms measure 1.6 to 2.2 inches, and large ones exceed 2.2 inches. Surgery generally isn’t advised for small aneurysms, since the risks of the procedure outweigh those of rupture.

#Peripheral Artery Disease #PAD

Ankle-Brachial Index (ABI) What It Checks: This rapid test is used to diagnose peripheral artery disease (PAD), the circulatory problem that caused Neal to be unable to walk more than twenty-five feet before excruciating leg pain forced him to stop. This disorder occurs when plaque buildup narrows arteries, reducing blood flow to your extremities (usually the legs).
If you have heart disease, there is a 42 percent probability that you also have PAD.18 Smokers are up to six times more likely to develop PAD.19 Smoking ten cigarettes a day can magnify your risk for developing PAD by as much as 50 percent.20 About 90 percent of the people who develop this debilitating disorder are current or former smokers.21 People with the 9P21 gene and those with a family history of PAD are also at increased risk.
The classic symptom is leg pain or cramps when you’re walking that improve with rest. However, up to 40 percent of people with PAD—a serious, but treatable condition—have no symptoms, so the disorder often goes undiagnosed. That’s dangerous, since having PAD, particularly if it goes untreated, more than doubles heart attack and stroke danger.22

#Ankle Brachial Index #test #PAD #ABI
The Procedure: Ankle-brachial index is a simple, painless exam that compares the blood pressure in your lower legs to that in your arms. After you’ve been resting on your back for ten minutes, a healthcare provider measures the pressure in your arms, using a standard blood pressure cuff, then measures the pressure in arteries near your ankles using a blood pressure cuff and an ultrasound probe (or stethoscope). Blood pressure readings may be taken while you’re at rest and again after you’ve walked on a treadmill. The test takes about fifteen minutes.

We recommend ABI if you are fifty or older, even if you have no symptoms, or at any age if you do. We also recommend starting screening for PAD at forty if you have any of these risk factors: diabetes, high blood pressure, high cholesterol, atherosclerosis, abdominal aortic aneurysm, a family history of CVD, or if you are a carrier of the 9P21 gene.

Some older adults, or those with a history of kidney disease or diabetes, may develop stiff blood vessels that don’t compress easily with a blood pressure cuff. Consequentially, their ABI results may be inaccurate. For these patients, a similar test called toe-brachial index (TBI) is sometimes used instead of the ABI, since the toe’s blood vessels rarely become rigid.

Any number lower than 0.9 indicates some degree of compromised blood flow to the feet, signaling that you have PAD, while a measurement above 1.4 indicates stiff arteries (often due to buildup of calcified plaque, a condition known as calcified atherosclerosis). If you have PAD, it can often be treated with lifestyle changes, including quitting smoking, exercising more, and eating a healthy diet. You may also need medication, such as anti-clotting drugs. These include low-dose aspirin or clopidogrel bisulfate (Plavix). For severe blockages, such as those that affected Neal, treatment may also include balloon angioplasty and/or stents to reopen the obstructed arteries.

#Test
imaging tests, such as carotid duplex and the treadmill stress test discussed below, look for indirect evidence of disease (reduced blood flow to the brain or heart).

#Stress test
If you think you don’t need cIMT or CACS because you’ve already been screened with a treadmill stress test, here’s some news that may make your heart skip a beat: when used for screening, this test is so unreliable that it misdiagnoses up to 40 percent of patients, with the highest error rate in women.24 Like the carotid duplex test, the stress test checks for arterial blockages.

A number of studies indicate that the stress test is a highly inaccurate vascular screening tool, prompting the US Preventive Services Task Force to recommend against using it to check the heart health of low-risk people who lack symptoms.


The downside is that stress tests have a high rate of false positives (healthy people being told they have disease), leading to anxiety, fear, and unnecessary additional tests, as well as false negatives (missing disease). This occurred with one of our patients, who was extremely physically fit and always passed his annual stress test with flying colors despite having 100 percent blockage in one area of his coronary arteries, and 70 percent blockage in another! Overall, the stress test misdiagnoses up to 40 percent of patients, with the highest error rate in women.

#CAC score
One way the body tries to repair the damage from plaque is by removing the lipid (cholesterol) and replacing it with collagen and calcium. These substances are denser than lipid, so as the plaque “heals,” it shrinks and becomes calcified. In fact, calcium can comprise up to 20 percent of the volume of some plaque deposits.30 Calcium is what creates the hardness in hardening of the arteries.

CAC score screening
Evidence-based guidelines developed by the Society for Heart Attack Prevention and Eradication (SHAPE) task force advise vascular screening with either CACS or cIMT for almost all men forty-five or older and almost all women fifty-five or older.34 The only exception is men or women in these age groups who are at extremely low risk for heart attack or stroke because they meet all of the following criteria: they don’t smoke, have total cholesterol below 200 and blood pressure below 120/80, don’t have diabetes, and have no family history of CVD.


#inflammation #heart attacks #LDL
In a medical version of physics’ “unified field” theory, some scientists have even theorized that chronic systemic inflammation—driven by such factors as obesity, a large waistline, insulin resistance, lack of exercise and periodontal disease—may be at the root of all chronic diseases.

Yet studies have shown that only about 50 percent of heart attacks happen to people with elevated levels of bad cholesterol, creating a scientific conundrum: If high LDL is the instigator of these life-threatening events, why do the other 50 percent occur in people with normal or even “optimal” levels of bad cholesterol?5 A rapidly growing body of scientific evidence has zeroed in on another culprit.

The latest evidence has revealed an amazing fact that most physicians still don’t know: In people with healthy arteries, cholesterol particles, which are extremely tiny, routinely flow through the tennis court and all three layers of the artery wall—the intima, the media, and the adventia—without causing disease, even in people who have high cholesterol.7 This surprising discovery explains why some people with extremely high cholesterol never develop plaque,enabling them to avoid heart attacks and strokes, despite having one of the leading risk factors for these events. Conversely, even low levels of LDL can spell trouble in people with an unhealthy lifestyle, the primary driver of chronic inflammation.


Here’s what happens in people with healthy arteries: After passing through the arterial layers, cholesterol particles normally exit on the advential side, where they are picked up by the veins and lymph vessels. After that, these waxy particles are recirculated throughout the body, where they perform many essential functions, from waterproofing cell membranes to helping produce vitamin D, bile acids that help you digest fat, and many types of hormones, including the sex hormones testosterone, estrogen, and progesterone. It also helps form synapses, the wiring that lets nerve cells communicate with one another. In fact, without cholesterol, you couldn’t survive!

is now recognized that arterial disease results from a triple whammy called the atherogenic triad. Inflammation, driven by such factors as obesity, insulin resistance, a poor diet, lack of exercise, a high stress level, sleep deprivation, and gum disease, is the key culprit in each step of the disease process, which begins when contractile smooth muscle cells in the media undergo a genetic transformation that turns them into migratory smooth muscle cells. These cells move to the deep layer of the intima and produce a Velcro-like substance that latches on to apolipoprotein B-100 molecules (ApoB), a major component of all the dangerous cholesterols we discussed in chapter four, including LDL and lipoprotein (a).

When ApoB gets stuck in the intima, it becomes oxidized, which in turn sparks a fire in the arteries by activating the immune system. The tennis court releases proteins that trap white blood cells and allows them to pass through to the intima, where these Pac-Man-like compounds try to clean up the mess by gobbling them up. If the inflammatory triggers for the genetic transformation persist, more and more ApoB gets trapped, oxidized, and engulfed by the white blood cells. Eventually, they get so engorged with cholesterol that they become foam cells that form fatty streaks and evolve into the cats in the gutter.

In 2012, two groundbreaking genetic studies were the first to prove that atherosclerosis is an inflammatory illness. In one of the studies, researchers analyzed 82 previous studies that included more than 200,000 people and demonstrated a cause-and-effect relationship between an inflammatory biomarker called interleukin 6 (IL-6) and the creation of the cat in the gutter.

Chronic inflammation harms, rather than heals, because the immune system attack never stops. Think of it as similar to being shot by “friendly fire” during a never-ending war raging inside the body, ignited by the disorders discussed earlier in this chapter. In people with the IL-6 variant, however, the malignant effects of arterial fire are dampened because these men and women have relatively few IL-6 receptors, which act as molecular switches to turn on the inflammatory cascade. As a result, people with this variant have significantly lower rates of arterial disease and associated events, as compared to people without this variant, even when numerous risk factors are taken into account. In other words, their genes act as natural firefighters.

The second 2012 study found that people with two copies of the IL-6 variant get twice the reduction in CVD risk as those with one copy (a 10 percent drop, as compared to a 5 percent drop).9


The team tracked the participants’ health for nearly four years and reported in 2020 that those who received canakinumab were 15 percent less likely to suffer cardiovascular events—including fatal or nonfatal heart attacks and strokes—or need invasive procedures, such as bypass surgery or angioplasty to reopen blocked arteries.12 The drug reduced their risk by lowering their levels of hs-CRP, without reducing cholesterol at all. The canakinumab group also had a nearly 50 percent lower rate of cancer death, but a slightly higher rate of fatal infections, as compared to the placebo group.

In October 2018, however, the drug maker announced that its application had been declined because the FDA didn’t consider the CANTOS data sufficient to support this proposed use. Sold at a staggering list price of $200,000 a year, it’s a monoclonal antibody—a type of drug that acts like a smart bomb—that selectively targets an inflammatory substance called interleukin-1 beta (IL-1B). As we’ll discuss more fully in chapter eleven, some people carry IL-1A or IL-1B genes that heighten their response to inflammation, greatly raising their risk for CVD.


#blood test #aging
How fast is your body aging? The test that can tell: F2 Isoprostanes What the Test Checks for: We’ve dubbed this blood test the Lifestyle Lie Detector because it can reveal whether our patients are practicing heart-healthy habits.

A normal F2 isoprostanes level is less than 0.86 ng/L, while an optimal result is less than 0.25 ng/L. Although abnormal levels typically signal an unhealthy lifestyle that could cause premature aging, as was true in Catherine’s case, an important caveat is that some professional athletes or very dedicated amateur fitness buffs may also have increased oxidation, due to the extreme stress they’re putting on their bodies.

#inflammation markers #Fibrinogen #CRP #MACR
Fibrinogen, high-sensitivity C-reactive protein, and microalbumin/creatinine urine ratio are biomarkers of endothelial (tennis court) inflammation. [Missing Lp-LPA2, Myeloperoxidase]

In a meta-analysis that pooled results of thirty-one studies that included more than 154,000 patients, risk for heart disease and stroke rose by 82 percent for each 100 mg/dL increase in fibrinogen levels above 250 mg/dL, even when the results were adjusted for the participants’ ages, genders, and numerous major cardiovascular risk factors, including smoking, diabetes, high blood pressure, high cholesterol, and obesity.21


Another large study called the EUROSTROKE project reported that “fibrinogen is a powerful predictor of stroke,” including both fatal and nonfatal strokes, as well as first-time strokes, ischemic strokes, and hemorrhagic strokes (those caused by a torn or ruptured blood vessel).

The researchers found that people with the highest fibrinogen levels were nearly seven times more likely to suffer a hemorrhagic stroke than those with the lowest levels, and had double the risk of a fatal stroke. The study also found that high blood pressure plus high fibrinogen packed a double whammy, magnifying risk even more than high fibrinogen alone. That’s probably because fibrinogen and its by-products, such as fibrin, contribute to vascular disease by damaging the blood vessel lining, while high blood pressure further increases wear and tear that makes it easier for plaque to burrow inside. Plaque often contains large amounts of fibrin. High fibrinogen has also been linked to other diseases, including diabetes, cancer, and high blood pressure, and is frequently elevated in people with insulin-resistant conditions, such as metabolic syndrome, which will be discussed in depth in the next chapter. And for people with coronary artery disease, elevated fibrinogen increases the risk that a clot will form if plaque ruptures or erodes, setting the stage for a heart attack.

What the Results Mean: The normal value is less than 370 mg/dL. In one study, having a fibrinogen level of 600 mg/dL was associated with a 200 percent increase in the risk for cardiovascular events, compared to people whose fibrinogen level was normal.


#CRP
thousand women, results of the hs-CRP test were more accurate than cholesterol levels in predicting risk for cardiovascular events. The researchers reported that women with the highest levels of CRP were 4.4 times more likely to suffer a heart attack or stroke than were women with lowest levels.

A score of under 1.0 mg/L is normal, while a score of 0.5 is optimal, indicating that short-term risk for cardiovascular events is very low. However, it’s important to have the test repeated periodically since even a slight elevation could be an early warning sign of increased heart attack or stroke risk.

#Fibrinogen #CRP #MACR
If MACR is normal and hs-CRP and/or fibrinogen are high, this is most likely due to some other health issue, such as insulin resistance, diabetes, an infectious illness, or an inflammatory disorder, such as arthritis.

#MACR
Microalbumin/Creatinine Urine Ratio
What the Test Checks for: This test detects small amounts of albumin, a blood protein, in the urine. The term “microalbumin” refers to amounts of albumin that are too small to detect in the urine dipstick test used for routine urinalysis during annual physicals.

Therefore, an abnormal UACR is an important warning sign of cardiovascular danger, even if your hs-CRP and fibrinogen levels are normal. The researchers found that people with an elevated UACR had 20 percent higher rate of CV events, even when other risk factors were taken into account.27 Another insight from research is that MACR is more accurate than the conventional albumin urine test often used in routine annual physicals because MACR considers how much water the patient has consumed and calculates the concentration of albumin in the urine accordingly.

women whose MACR was above 7.5 and men with a ratio above 4 had nearly triple the risk for heart attacks, strokes, and other cardiovascular events during six years of follow-up in that study.28 Therefore, ratios of 7.5 or lower for women and 4 or lower for men are optimal, rather than the much higher numbers that are still considered normal by standard care.29

#Lp-PLA2
A biomarker of risk serves only as a warning that arterial disease may be in progress. However, treatments that reduce levels of that biomarker have no effect on the end disease. For example, if your car’s “check engine” light went on, removing the light bulb wouldn’t solve the mechanical problem.

Large studies have also shown that people with elevated Lp-PLA2 levels are up to twice as likely to suffer heart-related events as those with normal levels and that this biomarker independently predicts CV risk as accurately as a person’s blood pressure or cholesterol levels.

Research has also revealed that people with periodontal disease (PD) are nearly twice as likely to have elevated Lp-PLA2 levels than those with healthy gums.31 The good news, however, is that treating this chronic oral infection significantly decreases Lp-PLA2 levels—and helps patients avoid tooth loss and other complications of PD.32


Lp-PLA2 values of less than 200 ng/mL are considered normal. In the Mayo Heart Study, 95 percent of patients with scores under this threshold did not have a heart attack or stroke in the next four years, even though they had coronary artery disease (CAD).35 The researchers also found that the higher Lp-PLA2 levels, the greater the risk for a first attack, stroke, or major CV event. Compared to patients with normal levels, those with scores of 200 to 266 ng/mL had a 70 percent higher risk of these events over the next four years, while a level of 267 or above more than doubled risk.

#MPO #Myeloperoxidase
Are you in imminent danger of a heart attack or stroke? The test that can tell: Myeloperoxidase (MPO) What the Test Checks for:

This FDA-approved blood test measures myeloperoxidase, a white blood cell–derived inflammatory enzyme that the immune system uses to fight infection. Normally, MPO is only found at elevated levels at the site of an infection. In our patients, we find that elevated MPO frequently occurs in tandem with dental infections, a topic we will discuss more fully in chapter ten.

We call MPO the joker because if it’s elevated throughout the body—as occurs in about two in fifty people, a similar distribution to the jokers in a deck of cards—all bets are off. Of all the inflammatory biomarkers, it’s the worst: If this wild card, which appears to be genetically influenced, gets played, without the right treatment your game of life might be over.


One reason that this malevolent joker is so dangerous is that it produces numerous oxidants that make all cholesterol compounds more inflammatory. This includes HDL, the good cholesterol that normally helps clean the arteries, protecting against plaque buildup. If your blood levels of MPO are high, HDL goes rogue and joins the gang of inflammatory bullies. The joker also interacts with hydrogen peroxide in the bloodstream to produce hypochlorous acid (the active ingredient in bleach).


The joker contributes to creating vulnerable plaque in two ways: It can make the normally protective fibrous cap that covers plaque more prone to rupturing explosively or it can eat holes in the tennis court, leading to plaque erosion and a subsequent CV event. On average, serum levels of MPO are higher in people who suffer erosive events, a 2018 study found.38

The normal value is less than 480 pmol/L. Unlike hs-CRP, levels of MPO in the blood are not likely to be elevated due to infections or illness: This enzyme is a specific biomarker of blood vessel inflammation and vulnerable plaque (the dangerous kind that can lead to heart attacks and strokes). Elevated MPO predicts future risk for coronary artery disease and cardiovascular events, including fatal heart attacks and strokes. In a recent study, people with high levels of the joker were 2.4 times more likely to die from heart disease over the next thirteen years.

One of the most common culprits for a spike in MPO is dental infections. If untreated, these can trigger heart attacks or strokes in people with vulnerable plaque. For example, as you read in chapter six, shortly after Melinda’s seemingly inexplicable stroke, she was treated for a severely infected tooth, which required extraction. If you have elevated MPO, ask your dental provider to check you for tooth and gum infections, both of which are highly treatable, using the therapies in chapter ten. If you’re being treated for atherosclerosis, elevated MPO can be a warning that your current therapies are not doing enough to cool and stabilize your disease.



#meditation #exercise
We recommend devoting ten minutes a day to mindful meditation. Sit in a relaxed position, close your eyes, and focus on your breathing and the present moment as you let stressful or upsetting thoughts float away. Prayer is another great way to soothe the mind and spirit, enhancing cardiovascular wellness.
Step up physical activity. Why does regular exercise greatly reduce heart attack and stroke risk? While you might guess that physical activity keeps the heart healthy by lowering cholesterol, blood pressure, and body weight—all of which help protect against cardiovascular (CV) events—the well-known Women’s Health Study found that the number one cardiovascular benefit of regular exercise is reducing inflammation.42 Aim for at least thirty minutes of aerobic exercise, such as brisk walking, jogging, or biking, daily. Check with your healthcare provider before starting a new fitness regimen to make sure it’s right for you.

#Fiber
What’s more, people who eat a diet that is high in fiber (found in most produce) are nearly 60 percent less likely to die from CV causes, according to a study of nearly 400,000 people ages fifty and older.

#soda
Ditch sweet drinks.
Consuming just one or two sugar-sweetened beverages daily—such as energy drinks, fruit drinks, soda, or coffee drinks—raises risk for a heart attack or dying from CVD by 35 percent, diabetes risk by 26 percent, and stroke risk by 16 percent, according to a 2015 study in the Journal of the American College of Ca
rdiology.


#Metabolic syndrome
Among the many perils they face, according to other recent studies, are atherosclerosis, strokes, fatty liver (fat buildup in the liver), obstructive sleep apnea (OSA), polycystic ovary syndrome, gallstones, diabetes, cancers of the liver, colon, bladder, breast, uterus and pancreas, heart attacks, and Alzheimer’s disease, which is twelve times more likely to strike people with the syndrome as those without it.6

#hypertension #sleep apnea #exercise
We also made adjustments in his medications and advised him to use a CPAP machine at night to treat his OSA, both of which, along with an improved lifestyle, helped get his hypertension under control. Regular exercise helps treat or prevent more than forty diseases, including diabetes, cancer, CVD, obesity, Alzheimer’s disease, and arthritis—with effects comparable or even superior to medication, according to a 2018 American Heart Association scientific statement.
 
Part 2 of Excerpts from Bale and Doneen’s “Healthy Heart, Healthy Brain”

#Metabolic Syndrome
A Dangerous Disorder You Can Diagnose Yourself

1: A large waist.
Up to 70 percent of people with the syndrome are saddled with excessive belly fat, giving them an apple shape.21 Sometimes called middle-age spread, this type of fat is metabolically active, releasing compounds that contribute to chronic inflammation, insulin resistance, and high blood pressure, all of which increase your risk for CVD and other chronic diseases. A waist measurement of thirty-five or more inches for a woman, or forty or more inches for a man, is one strike, according to the standard definition of the disorder. Recently, however, researchers have reported that the numbers vary by ethnicity as follows: For Africans and Middle Easterners, the abnormal numbers are 37 and 31.5 inches respectively for men and women; for most Asians and people from Central South America, 35.5 (men) and 31.5 (women); and for the Japanese, the abnormal number for men, 33.5 inches, is smaller than the number for women: 35.5 inches.22 To tell if you might be at risk, wrap a tape measure around the top of your pelvic bones (where the love handles grow) and exhale before measuring. Don’t assume that your belly button

Recently, the American Heart Association and American College of Cardiology updated their blood pressure guidelines, with 130/80 mm Hg as the new threshold for a hypertension diagnosis, while systolic pressure (the top number) between 120–129 and diastolic pressure (the bottom number) below 80 is classified as “elevated.”

Low HDL cholesterol. HDL (high-density lipoprotein) is the good cholesterol. An HDL level below 50 mg/dL for women, and under 40 mg/dL for men, is another strike for metabolic syndrome. Many people who are headed for arterial disease and diabetes will have low HDL levels. If you are being treated for low HDL, you have a strike even if the levels are above 50 and 40 mg/dL. Along with measuring your HDL level, the standard cholesterol test also provides a number that ranks as one of the top predictors of heart attack risk: your total-cholesterol-to-HDL ratio (TC/HDL).28 For decades, TC/HDL ratio has been the only cholesterol number that most life insurance companies look at, since they stand to lose millions of dollars if they rate applicants’ risk incorrectly. Although they typically consider a ratio of 5 or below acceptable—explaining why Dwayne (whose ratio was 5) qualified for a policy—research shows that a lower number is much safer. Based on scientific evidence from multiple studies, we consider a ratio of 3.5 to be a desirable target and a number below 3 to be optimal.

What to do if you have this risk factor: If you use tobacco or nicotine in any form, here’s yet another reason to kick this deadly habit: Several studies link quitting to a rise in HDL levels. Eating oily fish (such as salmon, tuna, and sardines) or other foods that are high in omega-3 fatty acids helps boost levels of good cholesterol, while reducing inflammation. Olive oil is also a healthy fat that helps raise HDL and contains heart-healthy antioxidants.30 For an added benefit, use it to dress a salad that contains purple produce, such as red cabbage, blueberries, black raspberries, or blackberries. These tasty foods contain disease-fighting antioxidants called anthocyanins, which fight inflammation, reduce disease-inducing free radicals, and have been shown to increase HDL by up to 19 percent in small clinical trials (using an anthocyanin supplement, not fresh produce).31

High triglycerides. Like cholesterol, triglycerides are a type of fat (lipid) found in your blood. When you consume more calories than you burn, the extra calories are converted into triglycerides and stored in fat cells until they’re needed for energy. In other words, when fat accumulates on your thighs or belly, that’s where excess triglycerides end up. If your triglyceride level is 150 mg/dL or above, you have acquired another strike. If you are being treated for high triglycerides, it is a strike even if the level is below 150 mg/dL. In Dwayne’s case, it was his eye-popping triglycerides (nearly triple the normal number) that astonished his doctor, not his cholesterol levels, which were only mildly abnormal.

A Harvard-led study reported that having high triglycerides alone magnifies heart attack danger by nearly threefold, while people with the highest ratio of triglycerides to HDL had nearly sixteen times the risk of heart attack than those with the lowest.

5: High fasting blood sugar. Fasting means you have not consumed anything with calories for at least ten hours. A level of 100 mg/dL or higher counts as a strike. Fasting blood sugar levels of 100 mg/dL to 125 mg/dL indicate that you’re prediabetic, while a level above 125 mg/dL is diagnostic of diabetes.


To prevent or reverse prediabetes, the treatment that surpasses all others is aerobic exercise, such as running, brisk walking, biking, and swimming. Working out thirty minutes daily, five or more times a week, has been proven to prevent prediabetes from progressing to full-blown diabetes 60 percent of the time, while the success rate rises to 70 percent if regular exercise is combined with moderate weight loss (5 to 7 percent of your body weight), large studies report.36 Even low-intensity exercise, such as walking slowly, substantially improves insulin sensitivity for the next twenty-four hours, according to a position statement from the American Diabetes Association.37 Research also indicates that weight loss plus boosting physical activity is far more effective than medication at preventing prediabetes from progressing to full-blown diabetes.

#OGTT
Oral Glucose Tolerance Test
Some people with “normal” blood sugar results may be in the early stages of insulin resistance. Historically, the ADA has defined an OGTT two-hour sugar level of less than 140 mg/dL as normal, a level of 140 to 200 mg/dL as marking prediabetes, and a level above 200 mg/dL as diagnostic of diabetes.

#Ha1c
Her A1c measured in the prediabetic range (5.7 to 6.4 percent), when the highly accurate OGTT showed that she was diabetic, with a two-hour sugar level of 228 mg/dL. Moreover, our study found that 27 percent of the patients who were classified as prediabetic by the A1c had normal blood sugar when checked with the highly accurate OGTT. An A1c below 5.7 percent is considered normal, and a level of 6.5 percent or higher indicates diabetes.

Action Step: Move More to Trim Your Risk for Insulin Resistance
. Taking short activity breaks from sitting helps prevent insulin resistance, researchers recently reported. The study found that even among people who spent most of the day parked in a chair, those who took the most activity breaks—even ones as brief as a minute at a time—had, on average, thinner waists (by nearly two inches) and lower levels of inflammatory markers, triglycerides, and blood sugar.


#Periodontitis
Even though they have beautiful white teeth, are extremely diligent about brushing and flossing, and got annual dental checkups, both of them turned out to have previously undiagnosed periodontal disease (PD), a chronic bacterial infection of the gum tissue and bone supporting the teeth.

#Heart attacks and #strokes
People with periodontitis are 2.5 times more likely to suffer heart attacks than those with healthy gums, according to a pooled analysis of studies that included more than seven thousand people.

Another study found that people with infected gums are nearly 50 percent more likely to suffer strokes or angina (chest pain due to narrowing or blockages in the heart’s major arteries), compared to people without PD.3 Later in this chapter, we’ll tell you a surprising discovery we made that explains these findings—and offers a new way to protect yourself from CV events.

#Diabetes
There is a two-way relationship between PD and diabetes: People with diabetes are three times more likely to have infected gums than nondiabetics. Having gum disease also raises the risk of developing diabetes in the first place, by contributing to insulin resistance and rising blood sugar levels.4 In addition, people who have diabetes and severe PD have triple the risk for fatal cardiovascular or kidney complications, compared to diabetic people with healthy gums. The good news, however, is that treating PD greatly reduces these threats.

#Cancer
A long-term study found that people with severe gum disease have an 80 percent higher risk for colorectal cancer and double the risk for lung cancer than people with mild PD or healthy gums.6 In a study of nearly seventy-four thousand women, those with PD faced a 14 percent higher threat of breast cancer. Among former or current smokers, breast cancer risk was 36 percent higher.7 Any form of nicotine use is the leading risk factor for gum disease, offering yet another powerful motivation to kick this deadly habit.

#Erectile dysfunction
Men who struggle with erectile dysfunction are three times more likely than other men to have periodontal disease.8 Studies have also shown that treating PD rapidly improves the quality and duration of men’s erections, as well as enhancing both their oral and heart health.9

#Frailty
A study of more than 1,200 older men found that those with poor oral health were twice as likely to develop signs of frailty, such as a weak grip, slow walking speed, and exhaustion.10 Frailty raises risk for hospitalization, disability, physical and mental decline, and a shorter life span.

#Obesity
Excess weight is the second biggest risk factor for gum disease, doubling or even tripling the likelihood of developing it. In an intriguing study, researchers analyzed oral bacteria collected from about 550 women of various weights. Simply by checking the bacterial samples for high levels of a periodontal bug called Selenomonas noxia, the team was able to identify the overweight women with greater than 98 percent accuracy. Research is needed to explore the possibility of Selenomonas noxia being a contributory cause of obesity.

#Rheumatoid arthritis
While the initial trigger for this chronic inflammatory disease of the joints is still under investigation, studies have reported very high rates of PD in people with rheumatoid arthritis (RA). In one recent study, patients with RA were more than twenty times more likely to have PD than a control group of age- and gender-matched patients without RA.11 Treating gum disease has been shown to reduce pain, number of swollen joints, and morning stiffness—and researchers are now investigating if optimal oral care could help people at high genetic risk for RA avoid getting the disease.12

#Alzheimer’s disease and #dementia
As we will discuss more fully in chapter twelve, a wave of recent studies has linked gum disease with increased risk for cognitive impairment and memory loss. For example, a large study found people with PD are up to 70 percent more likely to develop Alzheimer’s disease and other memory-robbing conditions, especially vascular dementia.13 “That really scared us, because my husband’s mom had a horrible seventeen-year battle with dementia and I lost to my father to vascular dementia. He was a very brilliant man with multiple college degrees who used to read five or six books a week,” says Kellee. “It was heartbreaking to see that disease rob him of everything, particularly in the last year and a half of his life, when his eyes were blank and he could no longer recognize us.”

Many factors, including smoking, poor oral hygiene, stress, obesity, IR, and an unhealthy diet, can adversely affect your oral microbiome, leading to increased growth of the bacteria that cause periodontal disease.

A landmark 1954 study was the first to show that oral germs, such as those that cause gum disease, frequently enter the bloodstream and quickly spread throughout the body.16 Among the ways this can happen are chewing food, brushing, flossing, periodontal cleaning, and tooth extractions.17
The spread of these pathogens throughout the body can result in chronic inflammation, the fire that ignites arterial disease. Research suggests that the harmful cardiovascular effects of PD are due to a gang of five high-risk oral bacteria: Aggregatibacter actinomycetemcomitans (A.a.), Porphyromonas gingivalis (P.g.), Tannerella forsythia (T.f.), Treponema denticola (T.d.), and Fusobacterium nucleatum (F.n.).

In 2017, we conducted our own rigorous analysis and made a landmark discovery of our own, drawing on Level A evidence: Gum disease isn’t just a risk factor for developing arterial plaque: it is a potentially preventable cause of the disease, as we demonstrated in a peer-reviewed study published in Postgraduate Medical Journal.

#periodontitis
People with gum disease have up to twice as much small, dense LDL cholesterol (the most dangerous kind) in their blood. When LDL is converted to small, dense LDL, levels of ApoB also rise.20 As you learned in chapter four, ApoB is a major component of all the bad cholesterols circulating in your blood. People with gum disease take large LDL particles and convert them to small dense particles. If the person had X number of large particles they end up with 2X the number of small dense particles. Since ApoB is woven into all LDL particles, the person doubles the amount of ApoB they possess. ApoB is the most predictive lipid (cholesterol) measurement for risk of heart attack, partly because it gets electrostatically attached in the wall of the artery to proteoglycans. Small dense LDL has two potential points for that attachment. This basically doubles the risk of it building up in the artery wall. This is one of the reasons people with gum disease have increased risk for forming arterial disease. Chemicals produced by high-risk oral bacteria make the walls of the artery more permeable, so it’s easier for bad cholesterol to invade. Since people with PD due to these pathogens also have higher blood concentrations of small, dense LDL cholesterol and ApoB, this creates a one–two punch on the arteries, much like a gang assault on a house with broken windows or doors. Substances produced by high-risk bacteria can also make the inner layers of the arterial wall (where plaque forms) stickier, much like Velcro, so bad cholesterol is more likely to get trapped there and create plaque deposits, resulting in a triple threat to arterial health.

#Root canal #endodontic #periapical #abscess #thrombosis #DVT
New and recent research has shown that endodontic disease (tooth decay) can also drive heart attack and stroke risk. For example, in a study of 101 people who were in the throes of an acute heart attack, Dr. Tanja Pessi and colleagues removed the culprit blood clots and used DNA analysis to check for oral pathogens.21 They also analyzed arterial blood samples from the same patients and found that the concentration of these bacterial villains was sixteen times higher in the clot than the arterial blood, revealing that the pathogens came from the ruptured plaque deposit that had caused the heart attack. The DNA analysis also revealed that 75 percent of the clots contained the strep bacteria that cause endodontic disease and 35 percent contained periodontal bacteria.

Thirty of the patients studied received panoramic CT scans and of this group about 50 percent had periapical abscess, pockets of pus at the root of a tooth, typically caused by a bacterial infection. That meant they had endodontic disease, which also appears to play a role in deep vein thrombosis (DVT), according to a 2018 study.22 DVT is a serious disorder that occurs when a blood clot forms in the deep veins of the body, most commonly those in the thigh or lower leg. Symptoms can include swelling, discoloration, or cramping pain in the affected leg. If undiagnosed and untreated, DVT can put people at risk for pulmonary embolism: a blood clot in the lung that can be potentially life-threatening if untreated.

The 2018 study also found that strep bacteria from endodontic disease may also contribute to ischemic stroke risk. The researchers analyzed blood clots removed from stroke patients, nearly 80 percent of which tested positive for DNA from strep bacteria, and those removed from DVT patients, more than 50 percent of which also tested positive for strep bacteria DNA. The key takeaway from these groundbreaking studies is that regular dental care should be a crucial component of your heart attack, stroke, and chronic disease prevention plan. In chapter twelve, we will also show you how maintaining optimal oral wellness is one of the keys to safeguarding your memory and achieving a health span that matches your life span.

#tests #CBCT
In a recent analysis of studies, CBCT was 96 percent accurate for finding periapical abscesses and other signs of endodontic disease, as compared to a 73 percent accuracy rate for conventional dental X-rays.23
Adds Dr. Thompson, “If you’ve never had a cavity in your life, it’s very unlikely that you’d need cone beam CT since your risk for endodontic disease would be extremely low.”

#pockets
A healthy pocket typically measures 1–3 millimeters, and a depth of 4 millimeters or more suggests gum disease. Having pockets that bleed during the exam is another common symptom
. “Periodontal disease is now staged the same way cancer is, with stage one indicating gingivitis and stage four indicating advanced periodontitis with substantial loss of bone support (very loose or missing teeth) and deep pockets of infection,” says Dr. Thompson.

#genes
BaleDoneen Method recommends using diagnostic tests that measure oral pathogens through DNA analysis, including OralDNA, OraVital, Direct Diagnostics, and Hain Diagnostics.
Because people without gum disease can also harbor these dangerous bacteria, Duval recommends this painless oral testing for all dental patients: “I’ll even test children if one of their parents has a high load of oral pathogens, since the bacteria can spread easily between family members through kissing or sharing food. Dogs are another potential source of bacterial infection, so avoid letting your pet lick you or your kids on the face. Always wash your hands after handling objects your dog has licked or chewed, such as their toys or food bowl.”

#oral #hygiene
Disinfect your entire mouth daily.
In the study of older adults, those who brushed and flossed daily outlived people with neither habit, which prompted Duval to strongly recommend both practices to her patients, as does the American Dental Association.
However, a 2015 review of the scientific evidence published in the Journal of Clinical Periodontology concluded that “the majority of available studies fail to demonstrate that flossing is generally effective in plaque removal.”24
Dr. Thompson advises his patients to clean between their teeth with a water flosser device, such as Water Pik or Oral-B Water Flosser, instead of using dental floss, but adds that his recommendations for home care are personalized for each patient.
“The most important thing is a thorough daily method of removing bacteria from between the teeth that you’re comfortable with, whether it’s water flossing or using dental floss,” he says. If you use dental floss, be sure to employ the proper technique: Avoid snapping the floss up and down, which irritates your gums and does a poor job of cleaning. Instead, glide it gently up and down in zigzag motion as you clean the tooth surface and under the gum, with the floss contoured in a C-shape to wrap around the tooth. Also be sure to floss the back surface of the last teeth on each side of your lower and upper jaw. Use a clean section of floss for each tooth. Along with water or dental flossing, Dr. Thompson and Duval also recommend the following ways to safeguard your smile and overall wellness:

To reduce harmful bacteria in your mouth, don't just brush your teeth and gums. Also brush your cheeks, the roof of your mouth, and the vestibule (the area between the teeth, lips, and cheeks).
Use a tongue scraper-not a toothbrush-to clean your tongue.
After dental or water flossing, also use dental picks (such as GUM Soft-Picks) to efficiently remove debris between teeth that floss doesn't reach.
Fight bacterial buildup by using a high pH (alkaline) toothpaste, such as CariFree or CloYS. These companies also have high pH mouthwashes.
Choose dental products that contain xylitol, a compound with an antimicrobial effect.
Xylitol products, such as toothpaste, chewing gum, and lozenges, help prevent cavities and may reduce risk for gum disease. Important warning: If you have pets, keep all xylitol products out of their reach-xylitol is extremely toxic or even fatal to dogs, even in small amounts.
Go to bed with a clean mouth. Since your mouth makes less saliva when you are sleeping to wash your teeth and gums, it's particularly important to disinfect your mouth thoroughly at bedtime.
Avoid mouthwashes that contain sugar or alcohol.
Step 4. Get a dental cleaning at least twice a year or as advised by your dental provider.
Doing so could save your life! In the study of older adults, those who hadn't seen a dentist in the previous year had a 50 percent higher death rate than those who went multiple times a year.

"One of our goals is to keep all of our patients in what I call the safety zone, as opposed to the danger zone where gum disease and high-risk bacteria create a perfect storm of inflammatory responses that leave people susceptible to heart attacks and strokes," says Duval.
To stay in the safety zone, it's crucial to get dental checkups and any necessary treatments on the schedule advised by your dental provider. If you have gum disease, treatments include nonsurgical periodontal therapy, a daily
program of self-care to follow at home, prescription mouthwashes, dental trays with l antibacterial gel (Perio Protect), and in some cases, a short course of antibiotics
. Regardless of which treatment is prescribed, the DNA testing should be repeated to make sure the treatment was suc-cessful, says Dr. Thompson. "Unlike gingivitis,which can be reversed, periodontitis is not curable, but with the right treatment, it can be halted and stabilized to prevent further damage, usually with three to six months of active treatment, followed by maintenance care to keep the disease from reactivating."

#dementia #missing teeth
Another startling finding from the study: One major predictor of early death was missing teeth, even when other risk factors were taken into account. A subsequent study of these participants also found that older adults who neglected their teeth were up to 65 percent more likely to develop dementia than those with excellent oral health!


#Atrial Fibrillation
We’ll also alert you to the best ways to avoid AF, which is now on the rise, especially among people over forty. It’s also highly treatable and to date, Babs has not suffered any AF complications.

#MPO #periapical #abscess
A few years ago, both had sudden spikes in their levels of myeloperoxidase (MPO), the inflammatory marker we call the joker. Since elevated MPO often occurs in tandem with dental infections—and warns of imminent heart attack and stroke danger—we advised them to get an immediate oral health evaluation. Paul credits this advice with saving his life. “I had no symptoms and nothing showed up in the regular dental X-ray, but when I went to a specialist and had 3-D cone beam tomography, there were two abscesses,” he says. “That scared me because if they’d gone undetected and untreated, I could have had a fatal heart attack.”

#genes #haptoglobin 2-2 #diabetes
If you have diabetes, you’ll want to know about an inexpensive blood or saliva test discussed in this chapter that checks for a variant of the haptoglobin gene that raises heart attack and stroke danger in diabetics as much as smoking does. This genotype also magnifies the threat of other serious complications of diabetes, such as heart failure, end-stage kidney disease, and diabetic retinopathy (damage to the retina, the light-sensitive part of the eye), a condition that can cause vision problems or even blindness. If you have this variant, the wonderful news is that an inexpensive vitamin supplement, sold over the counter at every drugstore, can almost completely eliminate the added cardiovascular menace that this variant would otherwise pose.

#vitamin E
Surprisingly, the same supplement that can be lifesaving for people with this haptoglobin variant appears to be downright dangerous for everybody else. In fact, studies suggest that this supplement raises the threat of heart attacks and even early death from cardiovascular causes for people without this polymorphism.4 This is a powerful example of one of the biggest benefits of genetic testing: lifesaving and easy-to-implement insights from inexpensive, one-time testing. If you are not diabetic, this haptoglobin test can also reveal if you have a genotype linked to increased risk for intestinal, autoimmune, and inflammatory disorders—and if you’d benefit from a gluten-free diet and probiotics to ward off these threats.


#weight loss #weight gain #ApoE
Later in this chapter, we'll reveal the surprising reason why some people gain weight on low-fat or low-carb diets. Neal, for example, was shocked to learn that the keto diet he was following was the worst possible eating plan for his genotype. You'll also learn how your genotype can influence your response to commonly prescribed medications and even nutrients in your food—and which easy actions to take if you have any of the potentially harmful variants discussed in this chapter.


#genes #tests
One important limitation of the DTC health panels currently on the market is that they don’t include all five of the genes now known to be the most powerful predictors of lifetime risk for cardiovascular disease and related conditions: 9P21 (the heart attack gene), 4q25, variants of the apolipoprotein E (Apo E), KIF6, and haptoglobin (Hp) genes.

Some of the tests we recommend in this chapter used to be hard to get. Now all five are widely available. Your medical provider can order blood or saliva tests for these genes through several American genetic diagnostics laboratories, including Quest Diagnostics, Boston Heart Diagnostics, and Cleveland HeartLab. There are additional companies offering these tests and we anticipate home testing availability. If you’ve already had DTC testing through 23andMe, Helix, Futura Genetics, or similar companies, you may already know your Apo E genotype, which predicts risk for CVD and Alzheimer’s disease.

Currently, we recommend that all patients get tested for the 9P21 (the heart attack gene), 4q25, variants of the apolipoprotein E (Apo E), KIF6, and haptoglobin (Hp) genes described in this section. If your total cholesterol level is very high (above 290 mg/dL), we also recommend that you be screened for familial hypercholesterolemia (FH), an inherited cholesterol disorder that affects about one in 200 to 250 people.

#9P21 Genotype
Identifies Carriers of the Heart Attack Gene and Offers Insight into the Safest Blood Sugar Management Strategy for People with Type 2 Diabetes This blood or saliva test checks for the 9P21 gene, often called the heart attack gene, because it’s an independent predictor of increased risk for cardiovascular events even when such factors as family history, diabetes, high blood pressure, elevated levels of the inflammatory marker C-reactive protein, and obesity are taken into account.11 People with this genetic variant have an impaired response to interferon, a signaling protein that helps protect against the formation of arterial plaque.

Produced by a variety of cells, interferons are one of our natural defenses against threats to our health. Best known for their ability to fight viral infections and treat certain cancers, these proteins are produced by many cells of the body, where they serve a variety of roles. In the arteries, interferons usually help block the initial stage of the disease process: cellular changes in the inner layers of the arterial wall that make them stickier, like Velcro, increasing the risk that cholesterol will get stuck there and form plaque.

In people with the 9P21 gene, interferons appear to offer little protection against this vascular danger. Recent research suggests that a diminished response to interferons is one of the main reasons why 9P21 carriers often develop severe coronary artery disease (CAD) at a relatively young age, even if they have “normal” cholesterol levels.12 About 25 percent of Caucasians and Asians are homozygous for 9P21, meaning they have inherited the gene from both of their parents,

Studies link this genetic profile to a:
102 percent rise in risk for suffering a heart attack or developing heart disease at an early age, compared to non-carriers of the gene13
56 percent overall increase in lifetime heart attack and heart disease risk14
47 percent rise in risk for ischemic (clot-induced) stroke and 60 percent rise for hemorrhagic (bleeding) stroke15
200 percent rise in risk for death from cardiovascular causes16
74 percent jump in risk for aortic abdominal aneurysm, a weak, ballooning area in the heart’s largest blood vessel that’s often fatal if it ruptures17
Type 2 diabetics with this genotype have persistent poor glycemic control. If they have an HgbA1c greater than 7.0 per cent for ten years, their risk of a heart attack increases 400 percent and their risk of death doubles.18

About 50 percent of Caucasians and Asians are heterozygous for 9P21. Since they only carry one copy of the gene (inherited from one parent), studies calculate that they have half the risk of each of the outcomes above. The frequency of this gene in African Americans and other populations has not yet been determined. As we emphasize to our patients, DNA does not have to be destiny. Regardless of their genotype, no one has to feel like a heart attack or stroke waiting to happen
. Diane H., Camille, Catherine, and Dwayne are all homozygous for 9P21, yet have overcome their arterial disease by following our AHA for Life plan. Recently, Camille celebrated sixteen years of being heart attack and stroke free while under our care—and Diane H., Catherine, and Dwayne have never experienced either of these events despite their very high-risk genotypes.

In the study, which included more than 500,000 people who carried genes that put them at high risk for developing CAD, including 9P21, those who got the most aerobic exercise had a 49 percent lower rate of CAD than those who worked out the least, helping them avoid heart attacks, strokes, dementia, and other serious complications of arterial disease.19 Participants were tracked for ten to fifteen years and asked to log how often they worked out. They also wore activity trackers and measured their grip strength (how hard they could squeeze an object, an indication of the person’s overall strength). In chapter thirteen, we’ll take a closer look at the best workouts to boost your heart and brain health, including fun ways to get strong and fit. If you have diabetes, knowing your 9P21 and haptoglobin genotypes can guide important—and even lifesaving—changes in treatment, as occurred in Neal’s case.
Neal’s 9P21 status revealed that he needed tight glycemic control to avoid serious or fatal complications of his disease.

#AAA
At forty, get an abdominal aortic aneurysm (AAA) scan. If the results are normal, have the test repeated every five years, while abnormal results will require more frequent follow-up, as advised by your healthcare provider, to see if the aneurysm is growing. Typically, only large aneurysms require treatment to prevent rupture. Ruptured AAA kills about ten thousand Americans a year.23 This ultrasound test is described more fully in chapter seven.

Avoid smoking. Not only is smoking the leading risk factor for heart attacks and strokes, but it also greatly increases the threat of developing an aneurysm. Other aneurysm risk factors include obesity, diabetes, high cholesterol, high blood pressure, and genes.

Method recommend getting at least thirty minutes of aerobic exercise at least five days a week, plus muscle strengthening exercises (such as weight-lifting or resistance training) at least two days a week.

As you learned in chapter eight, it’s also key to pay attention to your total-cholesterol-to-HDL ratio—the best predictor of heart attack risk in the Women’s Health Study—and your ratio of triglycerides (TG) to HDL. In chapter fifteen, you’ll find a list of the optimal treatment targets we recommend, plus tips on how to achieve them.

#ApoE #genes #diet #weight
Apo E Genotype: Predicts Heart Disease and the Best Diet to Avoid It This blood or saliva test analyzes your Apolipoprotein E (Apo E) genotype, which predicts lifetime risk for CAD and Alzheimer’s disease, and also influences how your body metabolizes nutrients in your diet, including fats and carbs. As Neal and many of our other patients have discovered, certain Apo E genotypes make common foods that are healthy for people with other Apo E genotypes potentially harmful.

was then following a strict ketogenic (low-carb, high-fat) diet that had helped other people he knew slim down. Nor had this eating plan improved his heart health—instead, he kept getting sicker and sicker. A recent study comparing various low-fat and low-carb diets found wildly varying results: Some people lost as much as thirty pounds with each of these diets, while others gained ten pounds.

The Apo E gene has three variants (E2, E3, and E4), resulting in six possible genotypes: Apo E 2/2, Apo E 2/3, Apo E 2/4, Apo E 3/3, Apo E 3/4, and Apo E 4/4.

Here are a few insights from research: The Apo E 2/2 and 2/3 genotypes, which occur in 11 percent of the population, are associated with the lowest risk for CVD. If you have one of these genotypes, your best bet for disease prevention is a moderate-fat diet containing about 35 percent fat from heart-healthy sources, such as omega-3 rich oily fish or olive oil.
Some people with these Apo E genotypes have high triglycerides and often get dangerously flawed advice, since providers often tell everybody with this disorder to cut down on fat. However, this seemingly heart-healthy advice can raise heart attack and stroke risk in people with Apo E 2/2 or 2/3 genotypes! That’s because, paradoxically, their levels of small, dense cholesterol (the dangerous kind that can triple heart attack risk) increase if they eat less fat. Instead, people with this genotype get the best cardiovascular perks by cutting down on carbs, which helps lower LDL and the amount of small, dense particles
.

People with the Apo E 2/4 and 3/3 genotypes, which are found in 64 percent of the population, have an intermediate cardiovascular disease risk and benefit from the conventional Mediterranean-style diet that’s typically advised to protect heart health. This diet should contain about 25 percent fat. We also recommend “eating the rainbow” by including colorful fruits and vegetables in your diet. Colorful produce is a great source of heart-healthy micronutrients and disease-fighting antioxidants. For people with the Apo E 2/2, 2/3, and or 3/3 genotypes, moderate alcohol consumption (a maximum of one drink a day for women and two for men) is beneficial to heart health. In chapter thirteen we’ll take a closer look at the latest findings about moderate drinking and heart health, some of which may surprise you. However, it’s important to remember that even though alcohol is good for some people’s hearts, it can have health risks. For example, having even one drink a day increases the risk for breast cancer in women.

About 25 percent of people, including Neal, have the Apo E 3/4 or 4/4 genotypes, which are linked to the highest lifetime risk for CVD. This group can trim the threat by following a very low-fat diet (no more than 20 percent fat) and limiting or avoiding alcohol consumption. That meant Neal’s low-carb, high-fat keto diet was the worst possible choice for his Apo E genotype, explaining why this popular weight-loss plan was of no benefit to his arterial health or his waistline.


Compared to people who don’t have the Apo E 4/4 genotype, those with one copy of this gene (such as Casey) have three to five times higher risk for late-onset Alzheimer’s, the most common form of the disease. Those with two copies are at fifteen to twenty times higher risk.25 However, the memory-robbing disorder also occurs in people with other genotypes, while many people with the 4/4 genotype never develop AD. Even if you have the Apo E 4/4 genotype, there’s a lot you can do to keep your memory sharp as you age. In the next chapter, you’ll find a three-step plan to safeguard your memory. It draws on landmark new research by the world’s leading experts on AD and dementia, including the first guidelines for the prevention of these disorders, issued by the World Health Organization in 2019. We’ll also tell you how the right lifestyle can clobber AD risk—reducing it by as much as 60 percent!

#genes #statin
KIF6 Genotype: Predicts Statin Response and Heart Attack Risk This blood or saliva test checks for a variant of the KIF6 (Kinesin family member 6) gene. The KIF6 gene’s job is to make a protein that transports other substances, such as protein complexes and messenger RNA, within cells. Which version of the gene you carry influences both your risk for a heart attack and whether you’ll get any benefit from the statins most likely to be prescribed for heart attack prevention. Here’s scary news: If you’re on Lipitor (atorvastatin)—the most commonly prescribed statin—or Pravachol (pravastatin)—as your sole therapy, there’s a 40 percent chance that you’re getting no cardiovascular protection at all, even if your cholesterol numbers look great. Three large randomized clinical trials found that these drugs only reduce the risk for heart attacks, strokes, and mortality from cardiovascular causes in the 60 percent of Americans who have the KIF6 variant. These statins had no effect on rates of these events in patients who didn’t carry the variant. About 40 percent of European Americans are noncarriers. Few studies have examined carrier and noncarrier rates among people of other ancestries.

Because Lipitor and Pravachol are so commonly prescribed—usually without checking the patient’s KIF6 status—we wonder if ineffective treatment explains why 33 percent of heart attacks and 25 percent of strokes occur in people who have already survived one or more of these events. Had we not used genetic testing, Camille might well have fallen into that group. To get the best protection from these events, it’s essential to learn your KIF6 status so your healthcare provider can tailor your treatment to your DNA.

In addition, women should be aware that in a very large clinical trial, taking Lipitor raised women’s heart attack risk by 10 percent while reducing risk by 42 percent in men.26 While the researchers concluded that the increased risk in women was not statistically significant, because the study included fewer women than men, the findings suggest that Lipitor may not be an effective treatment choice for women. In chapter fourteen, we’ll tell you about a new genetic test that can help your medical provider identify the most effective medications for your genotype and avoid ineffective or harmful treatments.


There’s controversy about the effect of the KIF6 variant on lifetime CVD danger. In five large studies, untreated carriers of the variant had up to a 55 percent higher risk for heart attacks, strokes, or death from cardiovascular causes, compared to untreated participants without the variant. In two clinical trials, carrying the variant had a bigger impact on raising heart disease risk than being over fifty-five, having abnormal levels of LDL or HDL cholesterol, or having high blood pressure. Only smoking and diabetes ranked above the KIF6 polymorphism for boosting disease risk.


#Atrial Fibrillation #Genes
4q25: Predicts Increased Risk for Atrial Fibrillation
Available at labs all over the U.S., this blood test checks to see if you are a carrier of the 4q25 gene. Compared to noncarriers of this gene, those who have it are at 140 percent higher risk for atrial fibrillation (AF), the most common type of irregular heartbeat (arrhythmia). It occurs when rapid, disorganized electrical impulses cause the heart’s upper chambers (atria) to beat rapidly and chaotically, getting out of sync with the lower chambers (ventricles). As a result, the ventricles don’t fill properly and blood may pool in the heart, raising risk for blood clots, heart failure, and other complications. AF quintuples the risk for strokes and doubles it for heart attacks or dementia.

#Red flags
Most common in older adults, AF strikes 20 to 33 percent of Americans at some point in their lives, depending on their risk factors, the Framingham Heart Study recently reported.28

Red flags for developing AF including the following:
Diabetes
Obesity and/or poor cardiovascular fitness
A resting heart rate above 84 beats per minute
Obstructive sleep apnea High blood pressure
Chronic obstructive pulmonary disease (COPD)
Rheumatoid arthritis
Low levels of magnesium and/or potassium
Thyroid disorders
Kidney disease
A family history of AF
Use of alendronate (a medication for osteoporosis sold under such brand names as Fosamax and Binosto)
Having an ischemic (clot-caused) stroke, particularly if the cause was unclear
Advanced age (AF is most common in people sixty-five and older)

#olive oil #om3
The same strategies that help keep your heart healthy can also reduce your risk for AF, such as exercising regularly, maintaining a healthy weight, avoiding all nicotine use or exposure, and managing high blood pressure. Reducing your systolic blood pressure (the top number) below 130 mm Hg has been shown to cut risk for AF by 30 percent, compared to a reading above 142 mm Hg.29 For people with particularly high risk for atrial fibrillation, medications may be advised, along with lifestyle modification.
In a recent study of older adults, those with the highest levels of Omega-3 fatty acids in their blood had a 39 percent lower rate of AF, compared to people the same age with the lowest levels. Omega-3 fatty acids are found in oily fish (such as salmon, tuna, lake trout, sardines, and herring), nuts, flax seeds, vegetable oils, and leafy green vegetables. If your levels of Omega-3 are low, ask your medical provider if a supplement is appropriate for you.
In another recent study of adults fifty-five and older, those who followed a Mediterranean diet that included 50 grams (about 4 teaspoons) of extra-virgin olive oil daily had a 38 percent reduction in their rate of AF, compared to a control group.30
Studies vary about the effects of drinking coffee, with most research finding that a daily intake of two to three cups is safe and either neutral or beneficial in protecting against AF and stroke.

#genes #haptoglobin #Vitamin E
Haptoglobin Genotype: Predicts Cardiovascular
Danger in Diabetics and Identifies People Who Can Benefit from a Gluten-Free Diet

This blood or saliva test, which can also be performed through a simple oral rinse, checks for variants of the haptoglobin (Hp) gene and provides valuable information if you have diabetes, which now ranks as the world’s fastest-growing chronic disease. Not only can you find out if you have an Hp gene variant that quintuples the lifetime threat of CVD, but if you do have this high-risk genotype, one of our recent peer-reviewed publications and other new research suggests that the results can guide precision-medicine therapies that almost eliminate this risk.32 These treatments include dietary changes and an inexpensive, over-the-counter supplement that most people should avoid. However, it can be lifesaving for diabetic patients with a certain Hp genotype. If you don’t have diabetes, you can still benefit from this test by finding out if you have a genotype linked to increased risk for intestinal, autoimmune, and inflammatory disorders and if you’d benefit from a gluten-free diet and probiotics to ward off these health threats. The Hp gene has two alleles, called Hp1 and Hp2.

Since you inherit one allele from each of your parents, there are three possible combinations:
Hp 1-1 (low risk for heart disease)
Hp 2-1 (intermediate risk)
Hp 2-2 (high risk)
Seven independent long-term studies have demonstrated that the Hp 2-1 and 2-2 genotypes predict increased risk for coronary artery disease (CAD) in type 2 diabetes. If you are diabetic and have the Hp 2-2 genotype, your lifetime risk for CAD is triple that of a diabetic with the Hp 2-1 genotype and five times higher than that of a diabetic with the Hp 2-2 test.33

About 16 percent of people carry the Hp 1-1 genotype, 48 percent carry the Hp 2-1 genotype, and 36 percent carry the Hp 2-2 genotype. Finding out your Hp genotype is also extremely important for protecting your arterial wellness. The Hp gene regulates haptoglobin, a protein produced by the liver that binds to hemoglobin, a substance produced when red blood cells die.34 If hemoglobin isn’t bound quickly, it will release iron, which can harm your blood vessels. For example, the iron will oxidize LDL (bad) cholesterol, making it even more harmful to your arteries. When Hp binds to hemoglobin, white blood cells can quickly clear this damaging substance from your blood, neutralizing these dangers. In diabetics, iron can also bind to HDL (good) cholesterol, negating many of its usually heart-protective properties. Therefore, the Hp 2-2 genotype packs a double punch of bad news!

Our study, which was published in Frontiers of Cardiovascular Medicine in 2018, and other peer-reviewed research has revealed that type 2 diabetics can counteract almost all the increased risk for heart disease by taking 400 IU of vitamin E daily. While you might wonder if everyone with diabetes should take this inexpensive supplement—and skip the gene test—studies show that unless you have the Hp 2-2 genotype, taking vitamin E not only has no CV benefits, but it can be downright dangerous for your heart. In most people, vitamin E supplementation raises the risk for heart attacks and early death. The only people who benefit from it are diabetics with the Hp 2-2 genotype. This actionable insight is why we recommend that all type 2 diabetics get this test. Before taking any dietary supplement, discuss the potential risks and benefits with your medical provider. We also recommend that all patients follow a diet based on their Apo E genotype, as described earlier in this chapter, whether they have diabetes or not.
It is also very important for diabetic patients with the Hp 2-1 and 2-2 genotypes to practice tight glycemic control, as we also recommend for those who carry the 9P21 gene. Talk to your medical provider about the best ways to manage your blood sugar.

#CGM #gluten
FDA-approved technologies like the Freestyle Libre sensor, which automatically measures blood sugar levels once a minute. Getting immediate feedback from the sensor helped Neal, who has the 2-1 genotype, better understand how his diet was impacting his sugar levels.

For example, after switching to a gluten-free diet, he started including brown rice in his meals, only to discover via continuous glucose monitoring that it was causing his sugar to spike.

There is now strong scientific evidence that diabetic and nondiabetic patients with the Hp 1-2 and Hp 2-2 genotypes benefit from a gluten-free diet as part of their heart-attack-and-stroke-prevention plan, while there’s no CV advantage for those with the Hp 1-1 genotype.
Here’s why: Recent studies have identified Hp2’s precursor protein, zonulin, as “the biological door to inflammation, autoimmunity and cancer.”35 Zonulin has been linked to many chronic conditions, including autoimmune and inflammatory disorders.36 As you learned in chapter eight, inflammation is also a key player in causing arterial disease. Once plaque has formed in the arteries, this fiery process can also ignite a heart attack or stroke. Think of plaque as kindling and inflammation as the match.

Since gluten activates the zonulin pathway with adverse effects on the intestines, the lining of blood vessels, and other parts of the body, increasing risk for chronic disease, including CAD, we recommend that people with the Hp 1-2 and Hp 2-2 genotypes limit or avoid gluten in their diet and consider taking a daily probiotic supplement to protect and enhance their gut health, after consulting with their medical provider to make sure a probiotic is appropriate for them.

#genes #Familial Hypercholesterolemia
Action Step: Find Out If You Need Screening for Familial Hypercholesterolemia
Affecting about one in every 200 to 250 people, familial hypercholesterolemia (FH) is a genetic disorder that greatly increases the risk for developing arterial disease at a young age. It stems from an inherited abnormality in how the body recycles LDL cholesterol, leading to very high levels building up in the blood. Without treatment, people with this condition are twenty times more likely to develop coronary artery disease than those without it. If untreated, men with FH have a 50 percent risk of suffering a heart attack by fifty and untreated women have a 30 percent risk of having a heart attack by sixty, reports the CDC.37 However, if it’s found and treated early, risk for CAD drops by 80 percent!38 Tragically, this potentially life-threatening condition often goes undiagnosed and untreated. Although it’s estimated to affect about 1.3 million Americans, only about 10 percent of those with FH are aware they have it, leaving the other 90 percent in extreme vascular peril, according to the American Heart Association.39 It’s possible for people with this disorder to develop heart disease as early as their twenties. The leading warning signs of FH are a total cholesterol level above 290 mg/dL or an LDL level above 190 mg/DL in an adult or total cholesterol above 260 mg/dL or LDL above 155 mg/dL in a child. Other clues that you could be at risk include a family history of early heart disease, high cholesterol levels, and/or FH. To check for this disorder, most providers use a widely accepted diagnostic tool called Simon Broome criteria, which include an evaluation of the patient’s cholesterol numbers, symptoms, family history, and, in some cases, genetic testing. Once it’s diagnosed, FH is treatable with medications and lifestyle changes, helping people who have it avoid heart attacks, strokes, and other complications of arterial disease. In fact, early detection and treatment can be lifesaving!

#Alzheimers #app #dementia
One of the most important underlying messages from the hundreds of new publications on dementia prevention is simple: “Heart health equals brain health.”

1. Protect your brain from injury by optimizing your arterial wellness.
Proven strategies to combat inflammation include weight loss, aerobic exercise, eating anti-inflammatory foods and improving your oral health. Not only is inflammation a key characteristic of AD, but researchers are actively exploring therapies to extinguish fire in the brain as a potential new approach to treatment.

Like your body, your mind needs exercise to stay fit. The Lancet paper and other studies show that highly educated people are less likely to suffer memory loss, possibly because keeping the brain active boosts its cognitive reserve, allowing it to work efficiently even if some of its neurons are damaged.16 A wide range of activities provide healthy intellectual stimulation and help increase your cognitive reserve, including studying a foreign language, taking adult education classes, doing crossword and other puzzles, and brain training.

In a Harvard study of people in their fifties and sixties, those who were the most socially connected had half the rate of memory loss during the six-year study as those who were socially isolated.


#red flag
report that even mild hearing loss raises dementia risk, while more severe hearing loss doubles or triples the threat. Hearing may be important to protecting memory because of what the Lancet paper’s lead author, Gill Livingston, calls the use it or lose it model. “We get a lot of intellectual stimulation through hearing,” Dr. Livingston reports.18


The latest research suggests that one of your best bets is to follow a Mediterranean diet that is high in fruits, vegetables, fish, seeds, and nuts.19 Healthy oils are also important, but as you learned in chapter eleven, the amount of fat in your diet should be guided by your Apo E genotype. Also stay hydrated and drink adequate water.

Other studies suggest that mindfulness may change the brain, by expanding areas involved in focused attention. We recommend fifteen minutes of mindful meditation daily, using a focus word or object or an app, such as Calm.

Give your brain plenty of stimulation by listening to music, studying a new language, trying brain training games (such as Lumosity), volunteering, and social engagement. Great ways to connect with others include book clubs, current event discussions, online groups, and even chatting with friends. Laughter does your heart—and brain—good by improving blood pressure and increasing levels of nitric oxide, a naturally produced substance that acts as the best “food” for your arterial lining and protects its health.21

Skimping on slumber or not sleeping well contributes to beta-amyloid deposition, adversely affects blood pressure, and often causes weight gain, potentially leading to insulin resistance and diabetes, which in turn raises risk for developing dementia. A recent study found that even one night of sleep deprivation resulted in a significant increase in the brain’s beta-amyloid burden.22 There are many tools available to measure your sleep, including apps, wrist devices, certain beds, and the Ōura Ring. If you snore loudly or frequently experience unexplained daytime drowsiness, getting tested and, if necessary, treated for obstructive sleep apnea (OSA) can be lifesaving. A recent study of older adults found that those with untreated OSA had more than double the risk of developing AD within the next five years, as compared to people the same age without this sleep disease.23 The study also found that people whose OSA was treated reduced their risk for AD diagnosis and death by 77 percent, versus those who were untreated.


In a study of Alzheimer’s risk that included more than 378,000 participants sixty and older, those with high levels of vitamin D had a 38 percent lower risk for AD.24 Why? The sunshine vitamin helps reduce oxidative stress, prevents neurons from dying, and aids the clearance of beta-amyloid plaques by activating macrophages (the Pac-Man-like immune cells that gobble up harmful substances). If you don’t know your vitamin D level, ask your healthcare provider to check it. All that’s involved is a simple, universally available blood test. The optimal level of the sunshine vitamin is 40–60 ng/mL.

The oral bacteria that cause periodontal (gum) disease can infect the brain and inflame your arteries. These oral pathogens have also been implicated in the development of AD
. To tease out the associations between gum disease, the bacteria that cause it, and AD, a 2020 study by the National Institute of Aging analyzed the oral and cognitive health of more than eight thousand middle-aged and older adults. All participants received a baseline dental exam and blood tests for antibodies to nineteen species of causative bacteria, then were tracked for up to twenty-six years. Of the nineteen, Porphyromonas gingivalis (Pg) was the microbe most strongly linked to AD in older adults. Compared to people without antibodies to causative bacteria, those with Pg antibodies had a 36 percent higher risk for AD mortality.25 Pg has also been found in the brains and spinal fluid of AD patients.26 A key takeaway from the latest research: Your dental provider is a lifesaving member of your dementia prevention team! The findings also offer powerful motivation to follow the four-step oral health plan in chapter ten.

Get your cholesterol checked. What cholesterol goal should you strive for to help prevent dementia? Studies show that if your total cholesterol is above 200 mg/dL, risk for AD rises by 23 percent, and if total cholesterol is above 250 mg/dL, risk is doubled.27 Therefore, maintaining a cholesterol level below 200 mg/dL should be a top priority. Watch your total cholesterol-to-triglycerides ratio (your total cholesterol number divided by your triglycerides number), which should be below 3. Pay attention to your HDL level as well: this “good” cholesterol is brain food. In a recent study, people whose HDL level was below 40 mg/dL had a 53 percent higher risk for memory loss, compared to those with a level above 60 mg/dL.

#blood pressure
An even newer study linked having blood pressure above 120/80 at fifty-three to brain volume shrinkage and small vessel disease of the brain by seventy.31 The best time to measure blood pressure is in the morning. Treatments for elevated blood pressure include exercise, laughter, mindfulness, proper sleep, a low-salt diet, staying hydrated, and, if necessary, medication, a topic that we will discuss more fully in chapter fourteen.

#gut
Ways to enhance gut health include eating prebiotic and probiotic foods such as fermented foods like sauerkraut, kombucha, kefir, and tempeh, and yogurt, asparagus, garlic, dandelion root, and apples. Epidemiological studies have shown that coffee intake can also be a healthy food for the gut because of its antioxidant, anti-inflammatory, and antiproliferative effects on the mucosa. Avoid saturated fats, artificial sweeteners, and all soft drinks.33

#drugs #aspirin #statins #blood pressure
For example, daily low-dose aspirin, which is frequently prescribed for heart attack and stroke prevention, has also been shown to decrease cognitive decline in women. However, this over-the-counter medication shouldn’t be taken without a provider’s supervision because it can have dangerous side effects, including increased risk for gastrointestinal bleeding.

The signal from recent studies of statins, which are commonly prescribed to lower cholesterol, indicates that these medications may significantly lower risk for AD. That signal is so strong that the National Institutes of Health has started a $90 million clinical trial called PREVENTABLE to secure a definitive answer.

ACE inhibitors, a class of blood pressure drugs, have been linked to slowing of cognitive decline and a 32 percent drop in stroke danger. However, there’s an important caveat: None of these drugs are approved solely for AD prevention. If your provider has prescribed them for the conditions listed above, or to treat arterial disease, you may also be getting a marvelous side effect: memory protection!
 
Part 3 of Excerpts from Bale and Doneen’s “Healthy Heart, Healthy Brain”

#dancing
If you love to dance, here’s some delightful news from the research front: Moving to the beat boosts brain health and helps keep your memory sharp. One study examined the impact of eleven types of physical activities on older adults—including biking, exercise classes, golf, and swimming—and found that only one of them, dancing, decreased risk for memory loss.37

Participants were tracked for about five years and those who danced frequently were 76 percent less likely to develop Alzheimer’s disease or other forms of dementia, compared to those who danced rarely or never, even when a wide range of risk factors were taken into consideration.

In an intriguing paper published in Scientific American, Columbia University neurologist John Krakauer reports that synchronizing music and movement offers “a pleasure double play”: Music lights up the brain’s reward centers, while dance stimulates its sensory and motor circuitry.38 Dr. Krakauer also reports that even watching others dance is intellectually stimulating because subconsciously you are choreographing their next moves, and if they execute them with expert skill, your brain’s reward centers activate.

Moving to the beat improves mood, reduces stress, and helps the brain form new neural connections in regions involved in long-term memory, planning, and executive function according to a recent report from Harvard Medical School.39 Busting some moves on the dance floor also provides an excellent cardiovascular workout, helps you maintain a healthy weight, and improves balance and coordination. Dancing also raises levels of the feel-good brain chemical serotonin.


#Lp(a)
elevated levels of lipoprotein (a), the inherited cholesterol disorder that we call the mass murderer because it triples risk for heart attacks and strokes.

#lifestyle #quote
Our answer is that it’s never too late—or too soon—to start reaping the miraculous benefits of adopting healthier habits. Numerous studies have come to the same conclusion: If optimal lifestyle was a medication, it would far outperform every drug on the market by preventing or treating dozens of dangerous disorders, including cardiovascular disease, diabetes, depression, obesity, high blood pressure, chronic inflammation, arthritis, and cancer.

#optimal
Some of our other prescriptions for optimal cardiovascular wellness surprise and even delight our patients. These include laughter, hugs, making love with your significant other, taking frequent vacations, listening to your favorite music, getting a relaxing massage, and taking a daily “dose” of dark chocolate (in moderate amounts). As we like to tell our patients, “Not all heart medicines are hard to take!”

#Exercise
Battle belly fat and keep chronic disease at bay with interval training, aerobics, and strength training. If you saw an ad online for a pill that promised to protect your memory, aid weight loss, improve your sleep, reduce stress, anxiety, and depression, boost your sex drive, and prevent dozens of dangerous diseases, you’d rightfully dismiss it as an internet hoax. However, there is something that has been scientifically proven to do all these things and more: exercising regularly.15 The benefits of physical activity start immediately and rapidly multiply over time:

Even one exercise session improves cardiovascular health for several days.16 In a twelve-week study, previously sedentary people who walked briskly for thirty minutes a day, five days a week, whittled their waists by about an inch, enjoyed a six-point drop in their systolic blood pressure (the top number), and reduced their hip measurement by an inch.17 At every age, keeping fit has numerous health perks.

Regular exercise lowers your risk for thirteen types of cancer (including those of the breasts, colon, uterus, lungs, stomach, bladder, and kidneys) by up to 42 percent, halves it for heart attacks, and reduces it for diabetes by 70 percent.18 A fifteen-year study that included nearly 140,000 older adults found that the more seniors walked, the longer they lived
.19
Another study found that on average, regular exercisers outlive their sedentary counterparts by seven years!20 Daily physical activity also enhances the brain’s cognitive reserve and helps keep your memory sharp. In another recent study of seniors, those who kept fit were 31 percent less likely to develop dementia and 55 percent less likely to experience other brain-related disabilities or motor skills impairments.

#alcohol #drinks #ApoE
For example, a 2017 study of nearly 2 million initially healthy people who were tracked for up to 30 years reported that nondrinking elevated the threat of heart attack by 32 percent, fatal coronary artery disease by 56 percent, heart failure by 24 percent, peripheral artery disease by 22 percent, and stroke by 12 percent, as compared to moderate drinking, while heavy drinking was linked to higher risk for numerous blood vessel issues, including strokes, heart failure, and death from coronary artery disease.36 Heavy alcohol intake also boosts the threat of dementia, according to a study of more than 31 million people.37

It’s also important to take your genetics into account. If you are one of the 25 percent of Americans who carry the Apo E 3/4 or Apo E 4/4 genotypes, we strongly advise limiting or avoiding alcohol as part of your heart attack, stroke, dementia, and chronic disease prevention plan.

#diet
In chapter eleven, we discussed the cardiovascular benefits of an eating plan guided by your Apo E genotype—which provides insight into whether to follow a very low-fat diet, the conventional Mediterranean-style diet that is widely recommended to protect heart health, or a moderate-fat diet that includes heart-healthy oils—and your haptoglobin genotype, which helps you tell if you’d benefit from going gluten-free.

Although the tasty treats are high in calories, they can also help people avoid long-term weight gain or obesity, other research shows.49 Moreover, eating almonds or hazelnuts may raise HDL (good) cholesterol, while pistachios help lower triglycerides. The BaleDoneen Method recommends eating a palmful of nuts daily, preferably tree nuts with skins, such as almonds, walnuts, hazelnuts, and pistachios.


In the IJE study discussed above, eating 2½ ounces or more of red meat per day raised colon cancer risk by 20 percent. While plant-based veggie burgers and other “meatless meats” might sound like a healthier alternative, in reality these foods are ultra-processed and relatively high in saturated fat and sodium, delivering no cardiovascular benefits over animal-based meat, a 2020 study found.60

#Saturated fat
For fifty years, saturated fats were demonized as the number one dietary culprit for arterial disease. However, the effect of cutting down on saturated fats depends on how you replace them. Swapping them with healthy fats (such as those found in oily fish, olive oil, most nuts, and avocados) or high-fiber carbs (such as whole grains) may benefit heart health, while replacing saturated fat with refined carbs (such as baked goods or sweets) is likely to do the opposite. In fact, sugar is worse for heart health than saturated fats.

#sex
In the statement, they reported that it’s usually safe for patients with stable cardiovascular disease to have sex. However, people with severe heart disease that sparks symptoms, such as chest pain during light physical activity like walking short distances, or when they are at rest, should refrain from sexual activity until their symptoms have been successfully treated and stabilized.

#viagra
It also reported that drugs to treat erectile dysfunction (ED), such as Viagra, Levitra, and Cialis, are usually safe for men with CAD. However, men who take nitroglycerin for heart-related chest pain should not use these ED drugs due to the risk of harmful drug interactions.

A large study of older adults, sixty-five and older, who were tracked for fourteen years also found that seniors who remain sexually active had a 28 percent lower risk for death from any cause during the study period, compared to seniors who were celibate.69


#prostate
That’s right—making love with your significant other can save your life! Other research has shown that men who have more than twenty-one orgasms a month have a 50 percent lower risk of prostate cancer, as compared to men who climax four to seven times a month.71 Here’s some extra motivation to follow the optimal lifestyle recommendations in this chapter: Staying physically fit has been shown to improve sexual performance, increase libido, and heighten sexual pleasure in both men and women.72 Researchers have also linked a heart-healthy lifestyle to improved sexual function, increased sexual frequency, and having more fun in bed.


#laughter
For example, a 2020 study found that the more you laugh, the less likely you are to have a heart attack, stroke, or die from cardiovascular causes. The researchers tracked 17,152 patients for an average of 5.5 years and reported that laughing once or more a week slashed the risk for suffering a cardiovascular event by 40 percent and risk for death from heart-related causes by 50 percent, as compared to laughing less than once a month.73

We find this and other studies with similar findings so persuasive that we actually prescribe laughter to our patients. One wonderful way to include more humor in your life is laughter yoga, which combines self-triggered mirth with yogic breathing to draw oxygen deep into the body.
Also try watching sitcoms on TV, taking your significant other to a comedy club on date night, reading funny books, or checking out hilarious internet videos of pets and children doing silly things. Ask your friends to tell their favorite jokes or get a joke-a-day calendar to help you start each day with a chuckle.

#polyphenols
Red Lycopene is the pigment that gives some fruits, such as tomatoes, their ruby hue. Studies suggest that tomatoes, which are also high in disease-fighting antioxidants, vitamins A and C, folic acid, and beta carotene, have surprisingly powerful benefits for vascular health, including reducing levels of oxidized LDL cholesterol (the kind that can form plaque in the coronary arteries) and reducing blood sugar.75 Eating tomatoes or tomato products is also linked to reductions in blood pressure and inflammation. A large study also found that high consumption of lycopene from tomatoes reduced stroke risk by 55 percent.76

Purple and blue These colors result from pigments called anthocyanins that may enhance brain health. Indeed, blueberries are often called brain berries because studies link them to reduced risk for age-related memory loss. For example, the Nurses’ Health Study reported that women who ate the most blueberries and strawberries had slower rates of cognitive decline and lower heart attack risk than those who ate the least.

#drugs #optimal #cornerstone
Dr. Serruys and his team define OMT [Optimal Medical Therapy] as receiving four types of heart medications: an antiplatelet drug, a statin, a renin-angiotensin system inhibitor, and a beta-blocker, all of which will be discussed in depth later in this chapter.

#Supplements #Vitamin D #Vitamin C #OM3
For example, a six-month study found that only 3 percent of prediabetic patients treated with vitamin D supplements progressed to full-blown diabetes, as compared to 28 percent of those who received a placebo.13

Unlike other antioxidants, vitamin C showed no adverse effects in any of the subgroups the researchers looked at.


Omega 3
For example, we prescribe a lower dose for people with the Apo E 3-4 or 4-4 genotypes, who benefit from a very low-fat diet, than the dose we recommend for people with other genotypes.

#CoQ10
If you take statin medication, this supplement can improve muscle-related side effects, according to 2018 analysis of twelve clinical trials in which participants were randomly assigned to take CoQ10 or a placebo.17 Compared to the placebo group, the CoQ10 group had reductions of 60 percent or more in muscle pain, weakness, cramps, and fatigue.

#Berberine
Blood glucose
also helpful for people with diabetes and prediabetes because it reduces glucose production in the liver and lowers blood sugar.

#Cinnamon
This tasty spice helps reduce blood sugar and lipid levels in people with type 2 diabetes, according to an extensive literature review and pooled analysis of studies.19 In a 2020 randomized clinical trial, cinnamon was also shown to improve glucose tolerance significantly in prediabetic patients, as compared to a placebo.

#cornerstone #aspirin
Cornerstone #2: Low-Dose Aspirin

In 2018, findings from three large randomized clinical trial (RCT) studies were published that highlighted the challenges of deciding if the benefits of low-dose aspirin therapy (taking one 81 mg tablet daily) outweigh the potential harms. You may have seen media headlines like these: “Daily Aspirin Could Be Harmful for Older Adults,” “Daily Aspirin: Risks Outweigh Benefits, According to New Research,” and “Does Daily Aspirin Therapy Work?” Here is a look at some of the latest scientific findings, including those from these three trials, with key takeaways about how to decide, in consultation with your healthcare provider, if daily low-dose ASA is right for you.

The effectiveness of low-dose ASA for people who have already suffered one or more heart attacks or strokes remains undisputed. The standard of care calls this use of daily aspirin secondary prevention, while primary prevention is defined as aspirin therapy to prevent cardiovascular disease (CVD) in people who have not yet had a heart attack or stroke. For secondary prevention, more than two hundred studies have shown that ASA significantly reduces rates of repeat heart attacks and strokes, with this potentially lifesaving benefit clearly outweighing the low, but serious risk for bleeding associated with this drug.

As an added benefit, taking daily low-dose aspirin has been shown to reduce risk for colon cancer, and there is some evidence that it may also help protect against prostate, gastroesophageal, and breast cancer.24 In addition, a 2021 pooled analysis of studies that included more than 100,000 people linked the use of low-dose aspirin to a 25 percent reduction in risk for developing dementia or major cognitive impairment, compared to nonusers of ASA. The researchers also reported that ASA users had a 46 percent lower risk for Alzheimer’s disease.25 Several RCTs have evaluated the effects of treating pregnant women at high risk for preeclampsia (a dangerous pregnancy complication marked by high blood pressure, swelling of the legs, and signs of damage to the liver, kidneys, or other organs) with aspirin. A recent comprehensive review of evidence from these trials found that low-dose ASA use reduced rates of preeclampsia by 24 percent and preterm birth by 14 percent, with no harms to the mom or baby identified.26

The USPSTF only recommends the drug for people who are fifty to sixty-nine, have a 10 percent or higher ten-year risk for CVD, and are at no increased risk for bleeding. The USPSTF considers the evidence insufficient to recommend low-dose ASA for people under fifty or over sixty-nine, regardless of the magnitude of their risk.

This is where the standard of care and the BaleDoneen Method differ. As discussed more fully in chapter three, risk-factor profiling has been shown to be a highly inaccurate predictor of heart attack and stroke danger.

Despite thirty years of randomized controlled trials—the gold standard of scientific research—the role of ASA in primary prevention has remained controversial. Five RCTs conducted between 1988 and 2003 linked aspirin use to a 32 percent reduction in first-time heart attacks.29 Since then, additional RCTs have been published with inconsistent findings, leading to inconsistent guidelines, with some medical societies and government agencies in the U.S. and Europe recommending low-dose aspirin for primary prevention and others recommending against it. Here are key findings from the three latest RCTs (the ones that made headlines in 2018):

During nearly five years of follow-up, rates of CV events were 11 percent lower in the ASA group, but the researchers didn’t consider the difference to be statistically significant. No testing was done to find out if the participants had arterial plaque. The authors concluded that “The use of low-dose aspirin as a primary prevention strategy in older adults resulted in a significantly higher risk of major hemorrhage and did not result in a significantly lower risk of CVD than placebo.”

The authors concluded that “Aspirin use prevented serious vascular events in persons who had diabetes and no evident cardiovascular disease at trial entry, but it also caused major bleeding events. The absolute benefits were largely counterbalanced by the bleeding hazard.”

we advocate a precision-medicine, three-tiered approach, in which the decision about which patients would benefit from ASA is based on the presence or absence of disease (plaque):

Primary prevention In the absence of arterial disease, the risk for a heart attack or stroke is so low that the benefits of ASA would be overshadowed by its potential harms. Instead, these patients should receive personalized therapies to reduce any potential risks they may have for future development of CVD, including genetic risks.

Secondary prevention We propose the use of this term for patients who have arterial plaque but have not yet experienced a CV event. Given the presence of plaque, especially in patients who also have chronic inflammation, the risk for a heart attack or stroke outweighs the potential harms of low-dose ASA.

Tertiary prevention We propose this term to describe what the standard of care currently calls secondary prevention, i.e., patients who have already experienced one or more CV events. The benefits of aspirin for this group are thoroughly documented in numerous studies

#aspirin #test
We strongly recommend that patients who are being treated with low-dose ASA for prevention of CV events be screened for aspirin resistance, using a simple, inexpensive, and widely available urine test, such as AspirinWorks. This testing, which we typically perform one month after starting a patient on low-dose aspirin, checks levels of a biomarker called thromboxane, the compound that makes platelets sticky. High levels of thromboxane indicate that your dosage of aspirin is not effective, in which case, your healthcare provider may increase your dose to full-strength aspirin (325 mg) or switch you to a different anti-platelet medication, such as Plavix. In addition, if your levels of thromboxane are high, this result will alert your provider to check you for coexisting conditions that can cause aspirin resistance, such as insulin resistance, high blood pressure, heart failure, and inflammatory disorders.

Here’s another reason why it’s important to find out if you are aspirin resistant. In a meta-analysis of 1,813 patients with CVD from twelve prospective studies, the average prevalence of aspirin resistance was 28 percent.32 Aspirin-resistant patients were also found to have nearly quadruple the rate of CV events, compared to aspirin-responsive patients. Despite the dangers of aspirin resistance, many providers neglect to tell patients about this simple test, which only needs to be done once in a lifetime and costs about twenty dollars. If you are on aspirin therapy and your provider hasn’t ordered this test, ask for it! Finding out if you have this common condition—and if so, having your treatment adjusted accordingly—could save your life.

#Cornerstone #3: Statin Therapy
most of whom already had very low levels of LDL (bad) cholesterol, statin therapy reduced their risk of dying in the next two years by 35 percent, as compared to a control group.33 In addition, a number of RCTs have reported sizable reductions in heart attack and stroke rates in at-risk patients with average or even superb lipid numbers.34 There is also an excellent reason why the BaleDoneen Method advises statin therapy for all patients with arterial disease, regardless of their cholesterol numbers: These medications deliver a cardiovascular grand slam by protecting and enhancing arterial health in several ways.

On average, people who take these drugs will see their LDL (bad) cholesterol numbers plummet by 40 to 60 percent, according to an analysis of 164 RCTs, published in British Medical Journal.35 The researchers, who only examined short-term trials, also linked statin use to a 60 percent drop in heart attacks and a 17 percent reduction in strokes, compared to study participants who received a placebo.

Statins do a superb job of reducing two biomarkers that warn of arterial peril: high-sensitivity C-reactive protein (hs-CRP), which rises when the endothelium (tennis court) becomes inflamed, and Lp-PLA2, which can signal that arterial plaque is hot and growing. Having high levels of Lp-PLA2 doubles heart attack risk in people with diseased arteries.37 In a recent statin trial, participants who achieved the greatest drop in their initial Lp-PLA2 levels over the next twelve months had a 27 percent lower rate of heart attacks and other major coronary events.38 The researchers reported that the majority of the risk reduction from the statin was due to its lowering of Lp-PLA2, as opposed to its lowering of LDL. Statins also have immediate antiplatelet and antioxidant effects that start to kick in within two hours of the first dose and progressively increase during the first week of treatment,

#periodontitis #statins
Earlier research suggests that these medications also help prevent the creation of the arterial Velcro that snares cholesterol, decrease the amount of cholesterol in plaque, and strengthen the fibrous cap that keeps the cat in the gutter safely caged. These factors help protect against the formation of a clot that could stop the flow of blood to your heart.40 A small but intriguing twelve-week 2012 study found that statin therapy reduced periodontal inflammation by 57 percent in people with gum disease. The researchers also reported that improvements in periodontal inflammation correlated to similar improvements in carotid artery inflammation. In other words, statin therapy appears to quell oral-systemic fire.41 Another dental study reported that statins protect smiles as well as arteries: People who take these drugs have a 30 percent lower risk for tooth loss.

In a five-year study of 1,674 older adults (sixty or older), those who were taking statins had 48 percent lower risk for dementia, even after the researchers took a variety of risk factors, including genes and history of strokes or diabetes, into account.

A much larger 2016 study of more than 405,000 Medicare patients linked statin use to a 20 to 25 decrease in Alzheimer’s incidence.44 Does it matter which statin you take? Combined results of the large statin trials indicate that these medications are highly effective at reducing cardiovascular risk and vascular inflammation, but when you look at some of the newer trials individually, important differences emerge. It appears that one statin, Lipitor (atorvastatin), may not be the best choice for women or people with insulin resistance (IR), including those with type 2 diabetes or metabolic syndrome. In fact, in one RCT, taking atorvastatin increased IR by up to 45 percent and raised blood sugar, as compared with a placebo.

Several randomized, placebo-controlled trials have looked at the effects of atorvastatin on women with high cardiovascular risk. In the large ASCOT trial, which included both men and women, women in the Lipitor group had a 10 percent higher rate of CV events of atorvastatin (including heart attacks and strokes) than women in the placebo group, while this medication reduced rates of these events by 42 percent in male study participants.46 In a women-only RCT called CASHMERE, which included about four hundred participants who were postmenopausal with arterial plaque, the statin-treated women had no improvement whatsoever

Based on these findings and other research with similar results, we avoid prescribing Lipitor to our female patients, such as Diane G., and those with IR/prediabetes, diabetes, or metabolic syndrome. For women with arterial disease, Crestor (rosuvastatin) can be an excellent option. In a recent gender-specific analysis of outcomes in the very large JUPITER primary prevention trial, which included more than 6,800 women, this statin reduced CV events in women at a rate similar to that in men.47 Specifically, Crestor-treated women’s rates of these events fell by 46 percent, compared to a 42 percent drop in men.

As discussed more fully in chapter eleven, Lipitor or Pravachol (pravastatin) only provide cardiovascular protection to the 60 percent of Americans who carry the KIF6 variant. Three large randomized clinical trials found that these drugs do not reduce the risk for heart attacks, strokes, and death from cardiovascular causes in the 40 percent of Americans who are noncarriers of the KIF6 variant, such as Juli, Diane H., Jack, Melinda, and Catherine.48 We advise noncarriers of the KIF6 variant to discuss other treatment options with their providers. We also prescribe statins to certain patients who don’t have a cat in the gutter, such as those with elevated LDL or ApoB cholesterol and people with vascular inflammation. Until recently, the mainstays of cholesterol management were lifestyle modification and statins. If these treatments are not effective enough, current guidelines from the American Heart Association and American College of Cardiology also advise the use of non-statin drugs, such as ezetimibe and PCSK9 inhibitors, for two categories of patients: those who can’t achieve the guideline-recommended cholesterol targets even on the maximum tolerated dosage of statin therapy and those with the inherited cholesterol disorder familial hypercholesterolemia.


#side effects #statins #Vitamin D #CoQ10 #sleep apnea #myopathy
Side effects of statins can include muscle pain and weakness or, in rare cases, muscle breakdown. Frequently, statin-related myopathy (muscle pain) is driven by vitamin D deficiency, low level of CoQ10, or even obstructive sleep apnea (OSA). In these cases, myopathy can be mitigated through using a statin at a very low dose, along with supplements to boost vitamin D or CoQ10, or treating the OSA. In a 2019 scientific statement, the American Heart Association recommended against the use of statins during pregnancy or breastfeeding.51 Although statins have been rumored to potentially increase risk for dementia, in reality, the signal from the latest studies suggest that the opposite may be true. In fact, the National Institutes of Health (NIH) has sponsored a $90 million, seven-year study to explore the possibility that these medications may help prevent dementia.52

#drugs #blood pressure
#Cornerstone #4: Renin-Angiotensin Aldosterone System Inhibitors

Since angiotensin II also promotes blood clotting and can contribute to arterial wall inflammation and oxidative stress, it’s not surprising that medications that decrease the effects of this hormone have been shown in many studies over the past two decades to lower heart attack and stroke risk.

We strongly support that recommendation; however, we go one step further and prescribe RAAS inhibitors for patients with plaque in any of their arteries, not just those that supply the heart. To us, it doesn’t make sense to focus only on heart attack prevention (by treating patients with CAD) and ignore patients with plaque in their neck

In the 2015 SPRINT trial, which looked at the effects of reducing blood pressure to a level below 120/80, achieving this goal reduced rates of heart attacks and strokes by 33 percent, and also decreased fatalities by as much as 25 percent.

RAAS inhibitors have been shown to shrink cardiovascular risk in patients with blood pressure as low as 110/70 mm Hg (a superb level). RAAS inhibitors also help promote nitrous oxide to the artery wall, making it stronger and more resistant to plaque rupture.


The ACEs are the oldest medications in the RAAS inhibitor category and have a wealth of data showing significant reductions in heart attacks, strokes, heart failure, and kidney failure.56 Among the RAAS inhibitors, the ACEs have the best outcome data for preventing both cardiovascular events and fatalities.

No other ACE has been shown to be nearly as effective for preventing diabetes. That’s a very important benefit for our patients with arterial disease and/or high blood pressure, since many of them are also on the road to type 2 diabetes, as Diane G. was at the start of her treatment.
For people who are already diabetic, ACEs are superior to other types of RAAS inhibitors for reducing CV risk.
A 2018 study found that in patients with Alzheimer’s disease, ACEs may slow cognitive decline, independent of their effect on blood

#side effects
However, ACEs do have some drawbacks. The most common side effect, occurring in about 5 percent of those who take this type of medication, is a dry, hacking cough. While nitrous oxide is marvelous for the blood vessel lining, it can irritate the airway lining, leading to coughing. If this occurs, we switch patients to a different type of RAAS inhibitor, such as angiotensin receptor blockers (ARBs). The most serious side effect of the ACEs—affecting about one in 1,000 users—is sudden swelling of the mouth and back of the throat that demands immediate treatment in an emergency room. Like many drugs, ACEs are not safe during pregnancy.

Angiotensin receptor blockers
Many healthcare providers prefer to prescribe angiotensin receptor blockers (ARBs) instead of ACEs, because the ARBs don’t cause coughing. Commonly prescribed ARBs include Benecar (olmesartan) and Diovan (valsartan). As the name suggests, ARBs block the action of angiotensin by preventing it from binding to receptors in blood vessels and other tissues, much as filling the lock on your front door with cement would render your house key useless.

#antibiotic
We warn patients who are being treated with RAAS inhibitors not to take an antibiotic sulfamethoxazole-trimethoprim, sold under such trade names as Septra and Bactrim. Combining these drugs can cause your potassium level to become dangerously or even fatally high.63 This antibiotic is frequently ordered for bladder, kidney, or middle-ear infections. Other antibiotics are not associated with this danger.

Beta blockers
Sold under such brand names as Corgard (nadolol), Bystolic (nebivolol), Coreg (carvedilol), and Torol (metoprolol), beta blockers lower your blood pressure and reduce stress on your heart. They work by blocking the effects of certain hormones, such as adrenaline, the fight-or-flight chemical that revs up the body for exertion to escape danger. In one of the newest studies, published in 2020, the use of beta blockers after a heart attack reduced risk for suffering additional CV events in the next year by 20 percent and decreased mortality risk by 31 percent.64 When beta blockers were prescribed in combination with RAAS inhibitors, one-year risk for CV events dropped by 30 percent and mortality risk by 45 percent. The study included more than fifteen thousand heart attack survivors.

#aspirin
Dual anti-platelet therapy (DAPT)
This type of treatment involves combining low-dose daily aspirin therapy with an additional medication that also helps prevent clots, such as Plavix (clopidogrel), Effient (prasugrel), or Brilinta (ticagrelor). DAPT is most commonly prescribed to patients who have experienced a stroke or transient ischemic attack (TIA or mini-stroke), have been treated with stents, or have peripheral artery disease. In a 2019 study of 5,590 stroke and TIA patients, those started on DAPT within twenty-four hours of their events had a 26 percent lower rate of subsequent strokes, as opposed to patients who only received aspirin.65

#Diabetes #insulin resistance
Actos (pioglitazone), a drug that improves insulin sensitivity, thereby reducing blood sugar. Like optimal lifestyle and statin therapy, Actos delivers a wealth of arterial benefits: It reduces inflammation, reduces the trapping of ApoB cholesterol in the wall of the artery, supports endothelial health, slows or halts the progression of CVD in both prediabetic and diabetic patients, and has antiplatelet effects, recent studies have revealed.66 It also helps prevent new-onset diabetes.67

#drugs #tests #genes
Called MyPGt, it checks for genetic variants that affect your response to hundreds of commonly prescribed medications and supplements. Not only can your results help you avoid drugs that don’t work, or are likely to cause side effects, but this one-time saliva test can also offer guidance on medications that may be prescribed in the future, thus enabling your provider to fine-tune your medical care throughout your life, based on your unique DNA. Your healthcare provider collects a sample of your DNA, using a simple oral rinse method, and sends it to the MyGenetx laboratory for analysis. You will also be asked for a list of your current medications, so a personalized report can be sent to your provider. The test covers many genes that determine how your body processes a wide range of common medications, including those often prescribed for heart disease, high blood pressure, chronic pain, depression, and other disorders.

When we ordered the MyPGt test, it revealed that the beta blocker he was on was completely ineffective for his genotype, so he was getting no cardiovascular protection from this medication. Therefore, we switched him to a different beta blocker that did work for people with his genotype. In addition, when we reviewed the other medications he was on, we found that many of his symptoms were actually drug side effects that could be eliminated by other changes in his medication. Instead of reevaluating him every time a new medication had been prescribed, using the results of MyPGt testing,


#sleep apnea #symptoms
OSA symptoms, such as loud snoring, waking up at night for no apparent reason, persistent daytime drowsiness despite adequate rest, and morning headache or sore throat. He denied having any of these symptoms, so we also questioned his wife.

People with OSA are often unaware of their loud snoring—the leading warning sign of this frequently undiagnosed disorder. His wife was equally adamant that OSA couldn’t possibly be the problem. Nevertheless, we persuaded the patient to go, very reluctantly, to a lab near his home for an overnight sleep study. The next morning, we received an urgent call from the sleep specialist who conducted the test, telling us that our patient had the worst case of OSA that the physician had ever seen in his many years of clinical practice
.

#blood pressure
If your blood pressure is below 120/80 (normal), the AHA advises being screened for hypertension at least once every two years (since risk rises with age). If your blood pressure is higher, have your provider check it more frequently and discuss treatment, which is likely to include lifestyle changes and, in many cases, medication. Here are four other things to know about high blood pressure, particularly your systolic blood pressure (the top number in a blood pressure reading):

Your morning blood pressure may be the best predictor of heart attack and stroke risk.

A recent study of nearly twenty-two thousand people with hypertension found that morning measurements (when blood pressure tends to be the highest) were more accurate for predicting heart attack and stroke risk than readings taken at home in the evening or those taken by clinicians in medical settings.11 The study found a significantly higher rate of CV events in people whose morning systolic blood pressure was 145 or higher, versus those with a reading below 125

Elevated systolic blood pressure is more dangerous than smoking or obesity!
A 2017 study that examined data from 8.69 million people from 154 countries found that systolic blood pressure (SBP) of 110 or higher is one of the leading risks for health problems, including coronary artery disease, stroke, and chronic kidney disease. The researchers also reported that 30 percent of the disease burden fell on those with SBP of 110 to 135.

While SBP of 110 to 119 is not cause for concern, you may want to discuss natural ways to maintain healthy blood pressure with your medical provider. These include mindful meditation to reduce stress (an important contributor to elevated blood pressure), beet juice (which has been shown to reduce SPB 4 to 5 points within hours of drinking it), eating foods that are rich in magnesium (which helps regulate blood pressure), such as dark green leafy vegetables, unrefined grains, and legumes, and getting seven to eight hours of sleep a night (skimping on slumber boosts risk for hypertension).


Lowering systolic blood pressure from 140 to 120 saves lives!


Until recently, a commonly recommended treatment target for systolic blood pressure was 140. The landmark SPRINT clinical trial compared outcomes in people treated to this goal (with an average of two medications) to those who received a more intensive therapy to lower SBP to 120. The researchers found that the more intensive therapy (using an average of three medications) lowered rates of cardiovascular events, such as heart attacks, strokes, and heart failure, by nearly one-third, and fatalities by 25 percent. The study included about 9,300 people fifty and older of diverse ethnicities with high blood pressure and at least one other risk factor for heart disease.

we set an initial blood pressure target of 130 for his SBP and 70 to 88 for his diastolic pressure. Similarly, some people with significant chronic kidney disease, which can result in narrowing of the arteries feeding the kidney, may also be in trouble if their pressure is lowered too much. For certain patients with heart failure, a 2018 study linked SBP levels below 120 to a 36 percent higher risk of death within the ensuing year and a 17 percent jump in risk mortality within six years.13 The key takeaway from this research is that each patient needs to be followed closely when they are receiving BP treatment and appropriate lab tests should be followed to make sure the pressure is not reduced too much. In a healthy population, scientific data would suggest that we’d be better off with a blood pressure just above the point where we might pass out. Some trials, however, have set very low blood-pressure goals for people who are not healthy, such as diabetics. Tragically, some participants in the “aggressive” treatment arm of these studies did very poorly and some even died. In this type of study, everyone in a certain arm of the study is treated the same. However, no two people are exactly alike. Excellent outcomes require personalizing care—not standardizing the same care for everyone!

#blood test #proBNP
Is Your Heart Happy?
Most people have pondered the question of how “happy” their heart is from the emotional standpoint—and a positive answer is beneficial for their psychological well-being. But most patients don’t know that it can also be important to find out if their heart is happy from the physical standpoint as well. That’s right—there is a simple, widely available blood test that can quantify how “happy” your heart is.

When the heart muscle is under stress or struggling to function properly—due to such conditions as a clogged artery, an arrhythmia, muscle damage from a heart attack, heart failure, or issues with a heart valve—it produces extra amounts of a hormone called B-type naturetic peptide (BNP). Essentially SOS messages that the heart is in distress, naturetic peptides cause the body to excrete more fluid, decreasing the amount the heart has to pump each time it beats. These peptides also cause arteries to dilate, lessening the force the heart must generate to circulate blood. Both effects reduce a struggling heart’s workload.

B-type naturetic peptide is easy to measure with a rapid, inexpensive blood test known as NT-proBNP. We call it the happy heart test, because when the level of this cardiac distress marker is below 125 pg/mL, there is a 98 percent probability your heart is very happy!14 Any test in medicine that can give you those odds is phenomenal. We recommend this test for everyone over fifty and younger people who have hypertension, arterial disease, or a history of heart attacks, strokes, and other cardiovascular events, or who have undergone heart procedures to prevent these events. Elevated NT-proBNP has been shown to be a significant predictor of risk for heart attacks, strokes, transient ischemic attacks, and other CV events in seemingly healthy, symptom-free people. In fact, in a recent study of more than five thousand initially healthy men and women who were tracked for nearly thirteen years, NT-proBNP was the only biomarker test, of several that were studied, that accurately predicted both coronary and cerebral danger after the researchers made rigorous adjustments for every risk factor they could think of.15

In 2020, results from the very large, ethnically diverse MESA study linked elevated levels of NT-proBNP to a 55 percent rise in risk for dementia.16 Other research shows that this test can be also valuable for screening asymptomatic patients for ventricular dysfunction: abnormal stiffness in the heart’s lower chambers (the ventricles), which pump blood out of the heart. How worried should you be if your NT-proBNP level is 125 ng/dL or higher? If that’s the case, there is a 33 percent chance that your heart is not totally happy and is experiencing dysfunction.17 While there is still a decent chance that you are okay even if this biomarker is elevated, the odds that there may be a problem are high enough that your provider may order additional tests to further evaluate your heart health, such as an electrocardiogram (EKG) or an echocardiogram.

Although Joe needed several changes in his medications, transitioning him to more effective treatments was a gradual process. In this scenario, we only make one medication change at a time, then follow up in four to six weeks with lab or other testing to see how well the new medication is working. Managing Joe’s blood pressure proved challenging since we had to try three different drugs to find one that was effective for him. Ultimately, ramipril helped him achieve—and then exceed—the blood pressure target we’d set for him. During his first year of treatment his blood pressure gradually dropped from 150/90 to 120/70. That’s a blood pressure he really can live with!



#quote
Even after more than two decades of practicing the BaleDoneen Method, we continue to marvel at the heart’s amazing ability to heal and regain happiness, even in the most challenging scenarios, when it’s provided with optimal medical therapy, an excellent lifestyle and genetically guided care. As you strive to improve your arterial wellness, we urge you to follow the sage advice of Martin Luther King, Jr.: “Take the first step in faith. You don’t have to see the whole staircase, just take the first step.”


James Roberts

5. James Roberts
Integrative cardiologist. He’s always looking for more therapies and has a lot of them. He does too lower LDL and inflammation. More details on his website about each of his therapies. These are his Risk Factors and checklist steps:
Factors associated with Increased CIMT and/or Rate of CIMT Progression​
High LDL​
Oxidized LDL​
Low HDL​
High Triglycerides​
Lipoprotein (a)​
Hypertension​
Smoking​
Diabetes​
Mercury​
Arsenic​
Low Antioxidant Defense Level​
Overweight​
Homocysteine​
Insulin Insensitivity
Low Vitamin D​
Oxidative Stress​
Infectious Burden​
Sleep Apnea​
Hypothyroid​
Low Selenium​
Low Magnesium​
High Fibrinogen​
Kidney Failure​
High Stress​
Depression​
Family Hy of CHD​
Standing at Work​
Low Testosterone +/- High Estradiol in Men
Periodontal Disease​
ADMA​
Inflammation​
Air Pollution​
Allergy and Asthma​

Therapies associated with Delay or Prevention of CIMT Progression and/or CIMT Regression​
Lipid Reduction​
Statins​
Niacin​
Fibrates​
Sugar Control with Metformin and Actos (but not with Sulfonylurea agents)​
Estradiol in Women​
Tamoxifen in Women​
Smoking Cessation​
Probucol​
Thyroid Hormone​
Antioxidants​
Pomegranate Juice
GliSODin​
Fish Oil​
Colestipol + Niacin​
Metoprolol​
Calorie Restriction​
Quinapril​

https://heartfixer.com/CHC - Diagnostic Studies - CIMT.htm#:~:text=Factors associated with Increased CIMT and/or Rate of CIMT Progression


[...]



The Atherosclerosis Check List below will help you and I apply this science to your health. We can check each and every box, but obviously some steps will be more important than others, based upon your genomic and nutritional status, individual disease burden(s), preferences, resources, and whether we do or do not have the luxury of times. If you are my patient, then this Atherosclerosis Check List will become your Problem List within your medical record, and it is our shared responsibility to make sure that each of the major causes of atherosclerosis, and the corresponding neutralizing treatment(s), have been considered. You don’t have to do all of this, but I need to bring up these concepts to you!

James C. Roberts MD, FACC, FAARFM 12/22



Atherosclerosis Check List[​

? Lipid Cholesterol Management
? Lipoprotein (a)
? Oxidative Stress
? Endothelial Function and EndoPAT Assessment
? Hypertension
? Insulin Insensitivity, Diabesity, and Metabolic Syndrome
? Reverse Cholesterol Transport with PPC
? Reverse Cholesterol Transport with Cyclodextrin (CavadexÔ)
? Homocysteine
? Inflammation Reduction
? TMAO
? Plaque stabilization with Colchicine
? Vitamin K2
? Hormonal Support
? Heavy Metal Detoxification
? Organic Pollutants
? Detoxification is Your Responsibility
? Fibrinolytic Supplementation
? Nutritional Optimization
? Elevated Viscosity due to Erythrocytosis and/or Elevated Fibrinogen
? Genomic Predisposition
? Rapamycin
? Peptide Vascular Bioregulation
? Stem Enhance Ultra
? NAD+/NMN
? Arterosil

https://heartfixer.com/CHC - Integrative Approach to Atherosclerosis.htm#:~:text=FAARFM 12/22-,Atherosclerosis Check List,-? Lipid Cholesterol
 
Aseem Malhotra

6. Aseem Malhotra
Cardiologist and Chief Medical Adviser of MAHA, friends with RFK Jr. , known to be anti-statins and believes saturated fat isn't to blame for heart disease. But in his book he recommends a low carb Mediterranean diet, while on a video he mentions mediterranean ketogenic.

He says that even those with Familial Hypercholesterolemia, both in research and in his patients, 70% of women and 50% of men don’t develop premature heart disease despite having the same levels of LDL, and those that do are the ones with high Lp(a), high fibrinogen, insulin resistance, type 2 diabetes, hypertension, smoking.

And he is
fond of saying to do daily meditation for 40 minutes, because of the Mount Abu trial that lowered 30% (Big reduction! Max. 30%, Average 18% in the study) of plaque with a low-fat diet, exercise and meditation, but an analysis showed that the effects were attributed to meditation, supposedly.

In his book ‘Statins Free Life’
, he mentions he does give low dose statins and aspirin when you already have plaque. Some excerpts:


----------------------
Foreword by Dr Ross Walker

#statins #side effects
But, in the real world where I practise, I would suggest to you that as many as 20% of people develop muscle pain, stiffness, weakness, cramping and even loss of muscle bulk, and especially those who take fat-soluble statins (atorvastatin or simvastatin) suffer some neuro-cognitive problems such as issues with memory and concentration, depression, fatigue, anxiety, irritability or poor sleep.

Although I do see a place for statin therapy in very high-risk individuals – which does include most patients who have had a prior heart attack, stent or coronary artery bypass – it is my view that this should represent only 10% of the overall management.


---------------------

The presumption was made that the association of blood cholesterol and heart disease was linear; in other words, the higher your cholesterol, the higher your risk of suffering heart disease and, of course, the lower your cholesterol, the better. What is clear is that for more than 90% of the population who did not fall into the extremes of very high cholesterol (greater than 9.88mmol/L or 330mg/dl) or very low cholesterol (less than 3.9mmol/L or 150mg/dl), according to the FHS, their total cholesterol alone didn’t determine whether they were going to develop heart disease or not.

[..]
nor LDL alone were the consistent predictors. Instead, it was the total cholesterol:HDL ratio that proved most important (see pages for some case studies of patients).
The FHS also threw up some interesting statistics not widely known or publicised. For every 1mg/dl drop in cholesterol per year, there was a 14% increase in cardiovascular death and an 11% increase in mortality in the following 18 years in those aged over 50.

This would later prove to have more relevance in more recent published research that I co-authored, revealing that for older people high LDL cholesterol is not correlated with heart disease at all and may actually protect from an early death.8

A total cholesterol:HDL ratio of less than 4 is desirable, with the lowest risk less than 3.


In 2020 I co-authored a peer-reviewed, evidence-based BMJ research paper with two other cardiologists to answer this specific question.17 We analysed data from 35 randomised, controlled drug trials for LDL-lowering from three different classes of drugs: statins, PCSK9 inhibitor and ezetimibe. What we found was quite extraordinary. Firstly in 75% of the trials, there was no statistically significant reduction in mortality, i.e. no prolongation of life for any of the participants.

Secondly, our analysis determined that there was no significant correlation between reduction in LDL cholesterol and reduction in heart attacks or strokes. In other words, according to the data, a lowering total and LDL cholesterol is not necessarily better at reducing the risk of a heart attack. In fact, it could be potentially harmful: other research has found that in patients who were admitted with heart attacks and then monitored for 3 years, those with LDL levels lower than 105mg/dl (2mmol/L) showed double the death rates of those with higher LDL levels, even after correcting for all the same baseline characteristics, including age and degree of heart disease.18 It’s also instructive to note that in the former group (with higher death rates) there were significantly more people already on statins on admission to hospital.

When it comes to longevity in the general population without known heart disease, the latest, most comprehensive research published in the BMJ in 2020 found that the optimum level of LDL associated with living longer is 3.6mmol/L (139mg/dl). The same research determined that both very low levels of LDL and very high levels (>4.9mmol/L or >190mg/dL) were associated with shorter lifespans.

Prior to the mass prescription of statins, which has steadily increased since 2000, a study in 1997 compared important cells of the immune system between healthy middle-aged men with low cholesterol (average total of 151mg/dl/3.9mmol/L) and those with higher levels (261mg/dl/6.7mmol/L).20 The men with lower average levels of cholesterol had significantly lower circulating lymphocytes, fewer total T-cells and fewer CD8+ cells. In other words, those with higher cholesterol levels appeared to have better immune protection. Studies involving hundreds of thousands of patients followed up over 10 years reveal that those with higher levels of total cholesterol tend to have significantly fewer urinary tract infections and skin infections, and a reduced risk of being admitted to hospital with pneumonia and influenza.


#statins #benefits #pleiotrophic
Findings revealed that, in those patients prescribed Simvastatin 40mg for an average of just over 5 years, versus those on a dummy pill, there was a 30% reduction in death rates and a 70% reduction in cardiovascular events (heart attacks and strokes).

A number of subsequent studies did show a benefit from statins – in those patients who had significant heart disease or who had suffered a heart attack – but none as strong as that of the 4S trial.

More plausible, however, is that the small benefit that statins do exert in those who don’t suffer side effects and can tolerate them is likely to be through anti-inflammatory or anti-thrombotic (anti-clotting) mechanisms.


The overwhelming majority of patients taking a statin with heart disease will receive no benefit whatsoever. Let me repeat that. The overwhelming majority of patients taking statins with heart disease, or who have suffered a heart attack, will receive no benefit whatsoever.

What is quite astounding is that studies have revealed that the majority of patients prescribed a statin (up to 75%) in the community stop the drug within a couple of years. The largest statin survey in the USA, conducted in 2012, revealed that 62% of those who stopped taking the drug within a year said it was because of side effects.29 The most common complaint, as experienced by Mr Patel, is muscle pain or fatigue.


#statins #side effects
I would say up to a third will experience genuine side effects that will interfere with the quality of their life at some point. The most common side effects include muscle pain, fatigue, stomach upset, memory disturbance, erectile dysfunction and cataracts, but essentially every system in the body is affected. The

Known risk factors predisposing patients to clinically relevant side effects include the following: high-dose statin therapy, advanced age (over 70 years), female sex, family history of muscle disorders . . . vitamin D deficiency, renal (kidney) and hepatic (liver) impairment problems . . . untreated hypothyroidism . . . alcohol abuse, Asian ethnicity, low body mass index, genetic polymorphisms (e.g., genes associated with drug and muscle metabolism), surgery with severe metabolic demands, heavy and/or unaccustomed exercise and interactions with concomitant medication . . .


#saturated fat #diet
Looking at all the data, including studies of patients with heart disease who were advised to reduce their saturated fat intake, there was no reduction in death rates, heart attack or stroke. One fascinating study specifically looked at progression of heart disease by assessing coronary angiograms 3 years apart in older women diagnosed with heart disease and given dietary advice.31 The patients who ate more saturated fat had less progression of coronary artery disease compared to the women who ate more carbohydrates and polyunsaturated fat such as seed oils and cholesterol-lowering margarines.

So, in 2016, myself and a number of co-authors published new peer-reviewed research in the BMJ Open assessing how strong the association between LDL cholesterol, heart disease and mortality was in those aged over 60.37 What we found was quite extraordinary. Not only was there no association with heart disease, but there was also an inverse association with all causes of death. In other words, the higher your LDL cholesterol after 60, the less likely you are to die. How can this be

#testimony #aspirin #blood pressure
What Tony had done to inform himself is very unusual, particularly the way he had used his mathematical reasoning to evaluate risk. In addition to understanding the biochemical implications of the drugs he had been given, he looked up parameters such as the absolute benefit of each medication he was taking, quickly realising that none was compelling: for example, the NNT (number needed to treat) for aspirin following a heart attack was 77 to prevent a recurrent attack within 5 years, and 333 to prevent death. There was no real benefit in taking a beta blocker after one year and, in someone with normal left ventricular ejection fraction (his heart pump function was normal), there was no clear justification for taking the ramipril. He knew the clopidogrel had likely been of great initial value in helping to prevent blood clots forming around his stent, but that after 12 months its chance of being helpful faded away. The post heart-attack data for statins gave an NNT of 39 for preventing another non-fatal episode and a somewhat shocking 83 for mortality. He kept this information in mind and started to research the potential benefits of following a low carbohydrate, high-fat (LCHF) diet, having been made aware of this approach through newspaper and medical journal articles I had written. In early 2016 he eliminated sugar, fruit juice, cakes, starchy carbohydrates and processed foods from his diet and replaced them with non-starchy vegetables, eggs, oily fish, full-fat dairy, nuts and mixed berries. He also removed all inflammatory inflammatory fats such as seed oils and margarines, and replaced them with natural fats such as olive oil, coconut oil, butter and lard.

His total cholesterol:HDL ratio was now just above 4. More importantly, his triglycerides had dropped below 1mmol/L. Remember from Chapter 2 that William Castelli’s analysis of the Framingham Heart Study data had suggested an optimal ratio of less than 4; but if above 4, then as long as triglycerides were less than 1, this fitted with a more favourable cholesterol profile that predicted fewer of the small dense LDL particles.

I suggested he may wish to consider going back on aspirin and that there was a good chance he wouldn’t experience side effects from a lower-dose statin (atorvastatin 20mg), but there was no specific, strong data I could point to that a low-dose statin would have any benefit in reducing cardiovascular events in his case.

As to the Ironman event, I explained that from a health perspective he didn’t need to do it and that there was no extra benefit from more exercise with regards to heart disease after doing regular moderate activity
(150 min/week); in fact I suggested he may actually be increasing his risk of a potentially lethal heart rhythm disturbance by tackling such an arduous challenge.


And when one looks at the data, this fear is not without foundation because approximately half of patients who suffer a heart attack have no prior warning that it might occur, and half who actually suffer a heart attack will not make it to hospital alive.


#symptoms #heart attack #cardiac arrest
The typical symptom of a heart attack is a crushing pain or tightness in the centre of the chest that is sometimes simultaneously felt in the neck, jaw and/or the left arm.

A cardiac arrest basically means the heart stops beating. In that situation the only way to revive the patient is by defibrillation – deploying an electric shock to the chest to restore the rhythm so that the heart can start pumping normally again.

Which heart-attack patient will suffer an electrical rhythm disturbance leading to a cardiac arrest is usually random and not related to the size of the heart attack. It most commonly occurs within 24 to 48 hours of the event itself. That’s why all heart attack patients usually go to a special cardiac ward, a coronary care unit for the first couple of days where their heart is continuously monitored.

I’ve personally managed scores of patients who, after suffering a heart attack in the community, were resuscitated, then treated with an emergency stent in hospital, before going on to make a full recovery with such minimal damage to their heart muscle that many were able to get fully back to normal activities, some even to extreme fitness, as in the case of Tony Royle (see page).

What causes the plaque to suddenly rupture at a particular time is not fully understood but can often be initiated by psychological stress.

This is also part of the reason why heart stents, which are traditionally deployed at areas of severe narrowing (more than 70%), don’t actually prevent heart attacks in people with angina, and therefore don’t prolong life, although for a minority of patients they can improve symptoms and quality of life for up to a year.
In summary, heart disease needs to be understood as a dis-order of inflammation and clotting that is driven and exacerbated by metabolic risk factors (see page).

Familial hyperlipidaemia (FH), however, which affects 1 in 250 people, is very strongly associated with premature heart disease. In these patients, in addition to the small potential benefit of cholesterol-lowering drugs, what appears to be a much more important preventative predictor is having low insulin and a low waist circumference (see page).
Approximately 50% of men and 70% of women with FH will not develop premature heart disease without any treatment.


#LDL
LDL being a potential major risk factor should be increased to greater than 4.9mmol/L (190mg/dL),

LDL cholesterol that is too low is associated with higher deaths from infection and higher deaths from cancer.


#Blood pressure
However, the only real benefit from taking drugs to reduce blood pressure occurs once blood pressure goes above 160mmHg/100mmHg.

#insulin
Insulin also has pro-thrombotic and pro-inflammatory effects. So, when it comes to the development of heart disease, chronically high insulin is a major issue.

One fascinating study in healthy people revealed that, even when blood glucose was kept within the normal range, a high insulin level significantly interfered with fibrinolysis (the enzymatic breakdown of the fibrin in blood clots): in effect, high insulin doubled a factor in the blood that inhibited the body’s ability to break down clots.47 Similarly, when insulin was kept normal, high blood glucose increased blood clotting. The effects would likely be even more profound and potentially damaging in those who were unhealthy or had underlying disease.

#metabolic syndrome
Markers of being metabolically unhealthy 1. Blood pressure (>120/80mmHg); 2. Pre-diabetes (HbA1c 5.7–6.4%) or type 2 diabetes (>6.5%); 3. Raised blood triglycerides (>1.7mmol/l); 4. Low HDL cholesterol (<1mmol/l); 5. Increased waist circumference of over 102cm in men and over 90cm in women. For south Asians, it is 90cm in men and 85cm in women. This is because those from the Indian subcontinent are more prone to health problems, including heart disease, at lower levels of body fat.

To put this in perspective, up to 40% of those with a normal BMI will have metabolic syndrome, and it’s this group that have an even higher risk of death than those with a higher BMI.


. A very simple, useful surrogate is dividing one’s waist circumference (measured at the navel) by height. Anything greater than 0.5 is a useful indicator that you have excess body fat – but this is not always accurate.

a combination of lifestyle factors: namely healthy diet, the right type and amount of exercise, and the most neglected but perhaps most important linked factor – reducing chronic psychological stress.


#tests
An angiogram is an invasive procedure with a small risk of major complications with 1 in 1,000 patients suffering a heart attack, stroke or death, so it’s not a test a cardiologist would undertake without a reasonable clinical indication.

There are a number of safer, non-invasive investigations that cardiologists can perform, including an exercise ECG (monitoring the ECG on a treadmill), or stress echo (ultrasound imaging of the heart muscle pump function) to gauge whether someone would then require a coronary angiogram.

#CAC score #tests
The results are then given a score, measured in Agaston units (named after the doctor who invented the test). A score of 0–100 is considered low risk; 100–400 moderate risk; 400–1,000 high risk and over 1,000 is very high risk (although the result will need to be adjusted by age, gender and race, as age itself is an independent risk factor for heart attack).

In patients with established heart disease, calcium scores have revealed that there is approximately 20% more calcium in the arteries each year. So, for example, a patient with a calcium score of 100 would on average expect it to be 120 a year later. When following up patients who started with no symptoms of chest pain, in other words no evidence of severe blockages, those who had a greater than 15% increase in calcium score per year revealed in one study a 17 times greater chance of suffering a heart attack compared to a rate of progression of less than 15% followed up over a 3-year period.50 Similarly, in research involving over 4,000 adults aged between 50 and 70 followed up for just over 4 years, those who suffered a heart attack had a median increase of calcium of 247 Agaston units, and in all those who didn’t suffer a heart attack the median increase was just 4 units.

#trans fats
Trans-fats were commonly found in fast food and many packaged foods, such as pastries, biscuits and frozen pizza. Being pro-inflammatory, trans-fats were found to be quite toxic to the coronary arteries. When trans-fats were virtually eliminated from the food supply in Denmark, several thousand cardiovascular deaths were estimated to have been prevented within just a few years.

#saturated fat
When it comes to heart disease, saturated fats are neither beneficial nor harmful. This has been confirmed by much larger-scale and up-to-date population studies than those conducted by Ancel Keys, which found no association between saturated fat and heart disease (see page). In addition, higher quality research in the form of randomised trials also revealed that reducing saturated fat intake in people with significant heart disease, or those who have suffered heart attacks, doesn’t translate into a benefit in preventing further heart attacks or in reducing death rates. Despite this overwhelming evidence, post heart-attack care guidance given to patients in hospitals advises them to reduce saturated fat in foods such as red meat and to swap butter for ultra-processed ‘proven to lower cholesterol’ margarines, which are in fact something I tell my patients to avoid, as you’ll learn later (see page).

#french #paradox
It’s also interesting to note that recent population studies have found an association with increased dairy consumption and lower rates of heart disease, which may in part be explained by the fact that medium-chain, dietary, saturated fatty acids decrease insulin resistance. This may be part of the reason that France, which has the highest consumption of saturated fat in Europe, making up 15.6% of calories, has always had one of the lowest prevalence of heart disease in the population.

#diet #mediterranean
Although it’s likely that this was due to a combination of lifestyle factors, published studies suggest that the benefits were mostly through diet, specifically: consuming extra virgin olive oil as the main source of fat, an abundance of whole fruits and vegetables, oily fish, nuts and seeds and dairy from cheese and yoghurt.With some variations in the Mediterranean countries of Greece, Italy and Spain, Mediterranean diets tend to be high in omega 3 fats, oleic acid, fibre and anti-oxidants.

Death occurred in 34/303 (8.0%) of those on the AHA diet plan versus only 14/302 (4.6%) among those in the Mediterranean diet group. There were 17 (8.2%) new cancers in the AHA diet group versus only 7 (2.3%) in the Mediterranean diet group. Finally, there were 33 (8.2%) non-fatal heart attacks in the AHA group versus 8 (2.6%) in the Mediterranean group.

(NNT) were: 18 for preventing a heart attack; 18 for preventing cancer; and 30 for preventing or delaying death. In other words, for every 18 people prescribed the Mediterranean diet, 1 heart attack was prevented compared to those following the standard so-called heart-healthy, low-fat AHA diet; and for death the NNT was 30. You already know that the most effective drug post heart attack in the history of medicine are statins in which the NNT over 5 years is 83 for mortality and 39 for heart attack.

fibre is very marginal but, as a good rule of thumb, if the ratio of carbohydrate to fibre from ‘whole grain’ foods is greater than ten, then it’s a low-quality carb.

The other reason that cutting refined carbohydrates has huge relevance in heart disease is that it’s the only intervention that on its own can rapidly improve metabolic risk factors and reverse metabolic syndrome in up to 50% of patients, even in as little as 21–28 days.

#exercise

In my last book, The 21-day Immunity Plan (2020), I pointed out that athletes who do more than one hour of vigorous exercise per day had four times the frequency of respiratory tract infections per year compared to those doing moderate activity, and twice as many as those who are completely sedentary. This is because the excess stress they place on their body, including the excess production of cortisol through overexertion, depresses their immune system.

Other studies have revealed similar findings, including that marathon runners experience a frequency of cardiovascular events (heart attacks and strokes) similar to a population who already have established heart disease, which again suggests that too much exercise may be harmful.

#sugar

They found that for every 150 calories of excess availability for consumption of sugar (typical of a can of Coca-Cola), compared to 150 calories of fat or protein, there was an 11-fold increase in the prevalence of type 2 diabetes, which was independent of both body weight and physical activity. In other words, even if you have a ‘normal’ BMI and undertake regular exercise, consuming too much sugar increases your risk of developing type 2 diabetes.

#loneliness #social
The impact of severe loneliness on health and lifespan in those aged over 50 is the equivalent of smoking 20 cigarettes per day, another major risk factor for a heart attack.

Over a 7-year period, none of the scores of patients who have been regular clients of the stress reduction expert Sherezade Ruano have suffered a further heart attack.

#sleep
Just one night of poor sleep also makes you less insulin-sensitive. Equally, with less sleep, testosterone has been shown to slide and cognitive performance to diminish, making us even less in control of healthy food choices. After one night of restricted or broken sleep, we may perform poorly all round and have a greater propensity to make poor ‘pick me up’ food choices throughout the day.


#diet
In fact, Tony would describe it as a low-carbohydrate, Mediterranean-style diet abundant in extra virgin olive oil, nuts, oily fish, eggs, meat, some berries and a mixture of non-starchy vegetables. He’d continued to be extremely active, averaging around 300 minutes per week of moderate to vigorous activity,


triglyceride:HDL ratio is the strongest predictor of the extent of coronary artery disease. A ratio of greater than 4 has the highest risk, and less than 1 has the lowest. Tony’s triglyceride:HDL ratio was less than 1.

Dean Ornish, and he used the gold standard of coronary angiograms to measure coronary artery narrowings before and after the programme. Results after 1 year and 5 years revealed an average diameter reduction of artery narrowings of 1.75% and 3.1% respectively, compared to their original diameter. In contrast, the average percentage diameter narrowing in the control group (the group being advised standard care) increased by 2.3% and 11.8% at 1 year and 5 years, respectively. Furthermore, there was more than double the number of cardiac events (heart attack, hospital admissions for angina) in the control group versus the intensive lifestyle group.

But, as you already know from a multitude of randomised diet and drug trials done since then, reducing saturated fat and LDL respectively has little benefit in preventing heart attacks so it’s highly unlikely in my view that this difference in the dietary approach was crucial to the reversal of heart disease.66

The intervention group averaged approximately 3.5 hours (210 minutes) of moderate aerobic exercise per week versus close to 3 hours in the control group but the differences didn’t achieve statistical significance. The time taken for meditation/stress reduction was, however, markedly higher in the group that showed some regression of coronary disease, which achieved almost 50 minutes/day of meditation/stress reduction. By contrast, the group following standard care achieved only 8 minutes/day of meditation/stress reduction and on average showed a slight increase in progression of coronary blockages.

#mount abu #meditation
Following on from this trial, the Mount Abu Heart Trial (a much larger study but not randomised) studied 123 patients with more significant heart disease to assess the impact of lifestyle changes on regression of coronary narrowings over a 2-year period and the results were quite extraordinary.67 Studying 360 coronary blockages filling at least 50–70% of the diameter of the artery the trial showed that those patients who adhered most to the prescribed lifestyle plan had an average decrease in the percentage of narrowing of a staggering 18%. Heart attack rates were also four times less common than in those with least adherence when followed up over a 6-year period. So the lifestyle interventions didn’t just reduce the narrowings, but they also reduced heart attacks. Remember that in Chapter 5, I explained that the plaques most vulnerable to rupturing and causing heart attacks are not usually severely narrowed.

The single biggest independent predictor of reversal was engaging in raja yoga meditation for 40 minutes per day.



#testimony #william davis
So which of the protocols Paddy O’Rourke was asked to follow likely dramatically reduced his calcium score from 1,200 to 800 within a year? He was asked to cut out all sugar and grains, and take vitamin D3 supplements and fish oil, under the advice of Donal O’Neill and biochemical engineer Ivor Cummins.

They had also consulted US-based cardiologist Dr William Davis, who had managed hundreds of patients with a similar dietary protocol and seen the overwhelming majority either reduce their calcium scores or stop significant progression of their condition over the years.68

Lack of adequate vitamin D is associated with an almost six-fold increase in the development of heart disease. Its devastating impact was also exposed by the Covid 19 pandemic, during which more than 80% of those who died were found to be severely deficient in vitamin D with a more than ten-fold increase in mortality.

What’s more, but little known, is that a high-sugar diet reduces the ability of the active form of the vitamin D3 to work effectively in the body.

cardiologist Dr Ross Walker in Sydney prescribes an almost identical protocol to William Davis, though without restricting saturated fat.

I have visited his clinic and witnessed Ross regularly carrying out repeat coronary calcium scores on his cardiac patients with excellent results, revealing minimal progression over time and even reduction. What’s perhaps more important is that none of the patients who have fully adhered to his advice over a several-year period have either suffered a heart attack or been admitted to hospital with a related illness such as heart failure.


#statin
If your risk is greater than 10%, then the benefit improves to approximately a 1-in-100 chance that a statin will prevent a non-fatal heart attack or non-fatal stroke but, again, it will not prolong your life. If you’ve already suffered a heart attack or stroke or been diagnosed with a severe coronary blockage or more than 70% narrowing of the artery, then the benefit of taking a statin is a 1-in-39 chance of it preventing a non-fatal heart attack, a 1-in-125 chance of it preventing a non-fatal stroke, and a 1-in-83 chance that it will save your life or delay your death.

what I routinely do with my own patients (while also informing their GP), is either to lower the dose or to go completely cold turkey from the statin for a couple of weeks to see if the symptoms markedly improve or disappear.


#familial hypercholesterolemia #statins
My personal view on who should be offered statins is just those who have had a heart attack or are at very high risk of one, and those with familial hyperlipidaemia (FH), the overwhelming majority of whom have an LDL over 4.9mmol/L. Unfortunately, there have not been any randomised controlled trials to assess the absolute benefit of statins in patients with FH so we don’t know what the true benefit is for such patients. What we do know is that those with low insulin and low waist circumference are at much lower risk of a heart attack – only slightly higher than the general population – so the primary focus in ALL patients with FH and/or a strong family history of heart disease should be strict adherence to a healthy lifestyle, whether or not those patients decide to take a statin or another cholesterol-lowering drug as well. And if you’re a man over 40 or a woman over 50 diagnosed with FH or with an LDL over 4.9mmol/L (>190mg/DL), then a coronary calcium score will help determine your risk even better. If it’s zero or close to zero, you are unlikely to derive any benefit from taking a statin. Whether or not you decide to take a statin, it should not be a substitute for following a healthy diet and lifestyle, which will not only optimise your heart health but most likely also improve your quality of life.

•Three meals per day maximum, eating only until you feel full. Take your time over meals, eat with others if you can, and enjoy your food.
•At least 2–4 tablespoons of extra virgin olive oil (EVOO) daily.

#exercise
You want to aim to get your heart rate within a range of 50–70% of your maximum, which is related to your age. The benefit of this heart rate range is based on numerous studies revealing the beneficial physiological changes – including reduced insulin resistance – that start to occur once you exercise at this level.69

To calculate this heart range, you deduct your age from 220. For example, if you’re aged 40, then the figure would be 180. You will need to aim to get your heart rate working at between 50–70% of that number, which in this instance would be 90–126 beats per minute. For those of South Asian origin, this should be the bare minimum (due to their genetic tendency to reduced cardio-respiratory fitness).

length of time you walk, so 40–45 minutes, 5 times per week. If you’re starting to exercise like this for the first time, then perhaps start in bouts of 10 minutes per day and build up gradually over a few weeks. Listen to your body; if you start to feel exhausted, your body is telling you that you’re overdoing it. Ideally, you should be aiming to move as much as you can. Do not sit for more than 45 minutes at a time – take 2-minute movement breaks. I suggest getting up and doing ten squats. Take the stairs wherever possible and, most importantly, move in ways that you enjoy, whether it be dancing, cycling or even having sex.

If you’ve already been diagnosed with heart disease but are physically able to walk, I suggest trying to do 2 30-minute brisk walks or an hour of moderate activity a day, five times per week. For heart disease reversal, 300 minutes per week appears to be optimal.



#diet
Addressing popular myths
Can I eat red meat? The World Cancer Research Fund recommends a maximum weekly limit of 500g of red meat and, if possible, less of the processed forms, such as bacon. Although there is no strong link between red meat and heart disease, there are concerns that consuming excess quantities of red meat above the weekly max-imum, especially if it is processed meat, could increase the risk of colon cancer. To put this in perspective, eating two rashers of bacon that have been preserved in nitrites every day for a lifetime gives you approximately a 1-in-100 chance of developing colon cancer. From a nutritional point of view, red meat is still an excellent source of protein, iron and vitamin B12. The reality is that, as long as you’re getting the base of this plan

What about salt? Salt consumption is an ongoing area of controversy. For years we’ve been told to keep salt consumption to a minimum because of its link to raised high blood pressure. Cardiovascular research scientist James DiNicolantonio has researched this area extensively and concluded that insulin resistance is a much more important predictor than salt and, once this is corrected, then salt doesn’t have much effect, if any, on blood pressure.70

If, however, you see your blood pressure creeping up or it’s not coming down, then I suggest you significantly reduce salt intake for a month and see if it makes any difference.

#drinks #alcohol
no more than a large glass of red wine (250ml) with your evening meal, which at that dose may even provide a benefit in protecting your heart. All red wines are not the same when it comes to health benefits in relation to the anti-inflammatory compounds they contain, which are known as procyanidins. This has been extensively researched by Professor Roger Corder, and is outlined in his fascinating book, The Wine Diet (2014). The wines that tend to have the highest procyanidin content include Tanat (especially Mardiran from southwest France) and the Italian Sagrantino, Aglianico and Nebbiolo grape varieties. As a lover of red wine myself, I can tell you that they all taste great
 
More Things

Air Pollution


Some approaches for air quality and mitigation of air pollution.

From Midwestern doctor [1, 2, 3, 4], DMSO, nebulized glutathione, IV Vitamin C and things that improve zeta potential can help.

For example, smoking is well recognized to cause heart disease because it damages the blood vessels (e.g., by creating plaques and impairing their ability to make nitric oxide), but much less thought is given to why it does. However, it’s been repeatedly demonstrated that fine particulate matter (which is found in cigarette smoke) directly causes these changes, evidenced by the fact similar damage occurs from breathing in pollution particulates such as those in coal mines, crowded cities (see this study and this study), cooking with a wood burning stove or being exposed to wildfire smoke.

https://www.midwesterndoctor.com/p/the-great-cholesterol-scam-and-the?utm_source=publication-search#:~:text=For example, smoking,wildfire smoke.



In the case of wildfires (and the particulates they release):


Utilize treatments that restore the physiologic zeta potential of the body.
Note: one aspect of restoring zeta potential is drinking deionized water (which also tends to be the most purified water available), and having a sufficient amount of that water is particularly important when addressing wildfire injuries.

Intravenous Vitamin C (when administered early, it greatly helps with wildfire-induced inflammation).

•Treatments directed at treating the underlying chronic inflammation in the patient (e.g., what existed before the wildfire smoke exposure).

•Nebulized Glutathione.

•DMSO
, as DMSO heals a variety of challenging lung disorders, it treats allergic lung conditions (e.g., asthma), improves circulation throughout the body (e.g., DMSO is very helpful for strokes) and effectively heals burn injuries. For example, after sheep experienced a lung injury from inhaling smoke, nebulized DMSO with heparin was found to significantly reduce lung damage to their lungs.

https://www.midwesterndoctor.com/p/what-wildfire-illness-can-teach-us?utm_source=publication-search#:~:text=•Utilize treatments that,their lungs.



In turn, DMSO has been shown to significantly reduce the damage caused by airway toxins. For example:

•After sheep experienced a lung injury from inhaling smoke, nebulized DMSO (with heparin) was found to reduce the damage to their lungs significantly.

In human lung cells, cooking oil fume condensate caused genetic damage, increasing DNA breaks, micronucleus frequency, and multinucleated cells—which DMSO effectively reduced.

•Giving DMSO before alloxan (a toxin) was found to prevent the inflammation, cellular damage, and edema alloxan causes in the lungs.

•Many disinfectants have been created by combining them with DMSO. One which combined formaldehyde vapor with DMSO, beyond being more potent was less irritating to the lungs than formaldehyde alone.

In human lung cells exposed to harmful cigarette smoke, a mixture of tea polyphenols and DMSO provided strong protection by significantly reducing DNA damage, chromosome abnormalities, and gene mutations, showing that DMSO combined with antioxidants can help shield cells from smoke-related genetic harm.

Since smoking is quite challenging to quit, this hence implies DMSO could be taken to counteract the harmful effects of that habit. I do not believe this is wise, as one study that combined DMSO soluble particles with cigarette smoke found low doses protected the vascular smooth muscles. In contrast, higher doses (which would likely be exceeded with chronic smoking) increased the harm and cell death in the blood vessels. As such, I believe if someone with COPD plans to implement a DMSO nebulization protocol, they must first be done with smoking.

https://www.midwesterndoctor.com/p/dmso-heals-the-lungs-and-cures-chronic?utm_source=publication-search#:~:text=In turn, DMSO,done with smoking.

From Rhonda Patrick. In a recent article, she mentions a HEPA filter, sauna/sweating, sulforaphane, and Omega 3 (to blunt fibrinogen increase) to help protect against air pollution.

A simple air filter could cut indoor pollution in half and even lower your blood pressure if it’s already on the high side.
[..]
The biological mechanisms are well established. PM₂.₅ drives oxidative stress, systemic inflammation, and endothelial dysfunction and disrupts autonomic control, increases blood coagulability, and accelerates atherosclerosis, creating multiple pathways to cardiovascular harm that likely explain why cardiovascular disease risk is higher in people exposed to more air pollution (and even why short-term spikes can elevate heart attack and stroke risk).

[10:00 min] Sulforaphane increases excretion of benzene by 60% after 24 hours. Acrolein by 23% too
Sweat by exercise or sauna bathing, mercury is excreted through sweat

[12:00] Pollution increases fibrinogen levels
Omega 3, blunted fibrinogen increase


[16:00] Babies post mortem, in Mexico city, had amyloid plaques
[17:00] Alzheimer's, inflammation from things inhaled can have sort of direct route, cross the blood brain barrier. HEPA filter
[18:00] Moved away from city road home
Honeywell HEPA filter in each bedroom, later a medical grade from IQAir
[21:00] You cant really fatigue the antioxidant response from glucoraphane and sulforaphane
[24:00] Preferably have them before the exposure
May have some value after the injury
Nature lowers cortisol by 10%

Avoid trans/hydrogenated fats, oxidized fats because they lead to oxidized LDL and then more damage to the glycocalyx, endothelium and then more plaque. Paul Mason considers seed oils worse than sugar in heart disease.

Avoid artificial sugars including erythritol and xylitol, Mercola says:
“Research shows erythritol, a sugar substitute, weakens protective brain cell functions, increases oxidative stress, and compromises the blood-brain barrier integrity
Erythritol consumption causes rapid platelet clumping and accelerated blood clot formation, dramatically increasing stroke and heart attack risks
Like erythritol, xylitol increases platelet reactivity and clotting risks, with effects persisting for hours after consumption


“Cut artificial sweeteners completely — Stop consuming erythritol, xylitol, and other products that contain sugar alcohols right away. Even if they're labeled "natural," these sweeteners increase clotting risks and cause harmful inflammation in your blood vessels.


Microplastics

And microplastics, another problem for atherosclerosis and various organs.

Again a HEPA filter may help lower exposure and sauna for detoxification, and water filtration and/or fenugreek/okra for water purification.

Saladino mentions some common exposures of plastics to be aware of:

Releases more chemicals when plastic is hot, frozen or contains fatty foods
Bad if plastic was sitting in shelf of costco for 6 months
Bad if in the car with 200 F heat
Worse in hot liquids in plastic
Worse in soup cans
Worse in tea bags

Fish bioaccumulates
Meat defrosting with hot water
Even stainless steel coffee machines, like espresso pots, have plastic tubes insides running with hot water..
Curtis coffee pots, they are aluminum and tin, also bad
Good ones are pour-over coffee, or french press in stainless steel
Chemicals in clothing, like PFAS aka forever chemicals, in women leggings
Polyester underwear decreased sperm counts and in females something similar happens

Additionally, Mercola recently wrote a paper about novel strategies to eliminate microplastics with like psyllium, chitosan, a probiotic (L. paracasei and plantarum), UDCA/TUDCA for bile flow, autophagy with rapamycin and spermidine.

Many people now consume roughly 5 grams of plastic per week — the weight of a credit card — from foods, drinking water, and even from breathing polluted air

https://articles.mercola.com/sites/articles/archive/2025/08/26/glass-bottles-microplastics.aspx#:~:text=Many people now consume roughly 5 grams of plastic per week — the weight of a credit card — from foods, drinking water, and even from breathing polluted air


A study found microplastics embedded in artery plaque, and affected patients were over four times more likely to experience heart attacks, strokes or death
Plastic particles trigger inflammation and immune responses when lodged in tissues, raising disease risk even in people without conventional risk factors

[..]
•Microplastics ranked in the top 10 predictors of chronic disease — The study found that microplastics were among the top risk factors for chronic illness. For instance, microplastic exposure showed a strong correlation with stroke, placing it on par with other high-risk variables like racial minority status or lacking health insurance.
[..]
Researchers analyzed plaque removed during surgery from patients with advanced carotid artery disease.

•They confirmed the presence of plastic compounds — This included varieties common in food containers, pipes and packaging. Out of 257 participants, 150 — over half — had detectable levels of these plastics embedded in their plaque.

•Those with plastic-laden plaque had far worse health outcomes — Patients who had plastics in their plaque were more than four times as likely to experience a heart attack, stroke or die from any cause within the three-year follow-up period than patients with no detectable plastics.

•The researchers found jagged, foreign plastic fragments inside immune cells — The study also showed that these plastics had embedded deeply into tissue. Electron microscopy revealed sharp-edged particles wedged inside foam cells — immune cells that gather in artery walls during plaque formation.

Most particles were smaller than 1 micron — smaller than the width of a red blood cell — suggesting they were nanoplastics, which are even more dangerous because of their ability to penetrate cells.
[...]
Researchers also found that the presence of plastics correlated with higher levels of certain inflammatory markers that are known to worsen vascular inflammation and increase the risk of sudden plaque rupture. This is what causes many heart attacks and strokes. Plastics also coincided with greater immune cell presence, meaning the body was actively responding to the foreign material like a chronic infection.

https://articles.mercola.com/sites/articles/archive/2025/05/21/microplastics-chronic-disease.aspx

A: Yes. In the study published by ACS Omega, fenugreek removed up to 93% of microplastics, while okra achieved 80% removal in seawater.6 Their combination cleared about 77% from freshwater. By comparison, polyacrylamide — the most common synthetic treatment — only removed 54% under the same conditions.

https://articles.mercola.com/sites/articles/archive/2025/07/12/okra-fenugreek-remove-water-microplastics.aspx#:~:text=A: Yes,the same conditions.


Natural Strategies to Eliminate Microplastics Are Being Explored​

Studies are now looking at strategies to help the human body filter, trap, and eliminate microplastics before they can spread throughout your other systems. These methods offer a multi-angle approach to help reduce your internal plastic load and support overall health. I’ve recently written a paper discussing these methods in detail, and while it is still under peer-review, I’ve provided the key findings below.

Cross-linked psyllium could help eliminate microplastics — One key system that plays a role in removing microplastics from your body is your gut. A 2024 study showed that acrylamide cross-linked psyllium (PLP-AM) removed over 92% of common plastic types like polystyrene, polyvinyl chloride (PVC), and polyethylene terephthalate (PET) from water.

Because of its high swelling ability and sticky, gel-like texture, cross-linked psyllium could be adapted to work inside the gut, where it may trap plastic particles before they’re absorbed into the body. While the study was conducted in a water treatment setting, the results are also promising for human health.3

Chitosan, a natural fiber derived from shellfish, also shows promise for clearing microplastics from your body — A recent animal study published in Scientific Reports found that rats given a chitosan-enriched diet were able to eliminate about 115% of the polyethylene microplastics they were fed, compared to just 84% in the control group.

This suggests that chitosan not only helps bind and eliminate new plastic particles but might even help pull out some that were already absorbed. However, while it's generally considered safe and already used in supplements, people with shellfish allergies are advised to steer clear of it.4

Psyllium and chitosan work through physical adsorption, where hydrophobic (water-repelling) and electrostatic forces stick microplastic particles to the fiber, keeping them from being absorbed. However, one drawback with these binders is that they can also soak up nutrients if not timed carefully. Hence, they need to be used strategically to provide the most benefit, such as ingesting them with processed or packaged foods, which are more likely to contain plastics.

Certain beneficial bacteria strains can help clear microplastics from the gut — A 2025 animal study found that two specific strains, Lacticaseibacillus paracasei DT66 and Lactiplantibacillus plantarum DT88, were able to bind to and eliminate tiny polystyrene particles in lab tests.

These probiotics work by forming protective biofilms that trap plastic particles, making them easier to flush out.5 When combined with dietary fibers like psyllium and chitosan, the result could be a more effective and natural way to sweep microplastics out of the gut before they’re absorbed.

The liver also plays an essential role in clearing microplastics from the bloodstream — Specialized immune cells in the liver, known as Kupffer cells, help trap these foreign particles and route them into bile for elimination via the intestines. However, while this method may work on smaller plastics, larger ones can linger and build up, especially if your liver function is compromised.

To support this natural detox pathway, researchers are studying the use of compounds like ursodeoxycholic acid (UDCA) and its variant tauroursodeoxycholic acid (TUDCA), which stimulate bile production and improve particle flow out of the liver.

Researchers are also looking at strategies to enhance autophagy to eliminate microplastics — Autophagy is your body's natural cellular recycling system. Researchers are looking at compounds that can help promote this system, mainly rapamycin and spermidine.

Rapamycin works by inhibiting the mTOR pathway, a nutrient-sensing mechanism that normally suppresses autophagy. When mTOR is turned off, cells ramp up their cleanup efforts, forming membranes that can collect and isolate plastic particles for breakdown or removal.

Meanwhile, spermidine is a naturally occurring polyamine found in foods that enhances cellular resilience and supports the clearance of toxic substances. In lab and animal studies, the combination of spermidine and rapamycin helped reverse mitochondrial dysfunction and reduce oxidative stress caused by microplastics.

The table below summarizes these novel strategies to eliminate microplastics, including their mechanisms of action, how much testing has been done, and important safety considerations. It shows that although several different approaches may be needed, clearing plastics from your body naturally is possible. Of course, reducing your exposure is still the ideal preliminary course of action.

strategies-to-eliminate-microplastics.jpg


https://articles.mercola.com/sites/articles/archive/2025/08/20/microplastics-liver-mitochondria-damage.aspx#:~:text=Natural Strategies to,course of action.



Tests


Stress tests, a procedure used to measure heart function during physical activity, don't tell much about plaque, so it’s better not to do it, and if you do, know that it’s not uncommon to have false-positives and false-negatives. (Bale-Doneen and Ford Brewer books)

CIMT

Carotid duplex/doppler ultrasound is not the right one to detect plaque, so it's not uncommon to have a false negative of ‘no plaque’ with this ultrasound; whereas, if you get the right one, the Carotid Intima Media Thickness test (CIMT) ($75-$400 USD), this would tell you how much carotid plaque you have in mm which tends to rise with age. Usually if you have plaque there, you have in other arteries of the body, but not always, in <5% of people they can have plaque in coronaries but not in the carotids (false negatives).

It’s the least risky of the tests, but apparently, it’s really hard to find a well-trained one. I've seen CardioRisk laboratories recommended for this, they also provide a comparison of your amount of plaque in mm with other people of your same age, so you can know whether you have more plaque than average.

Bret Scher says the most important thing about CIMT is where you get it – operators' experience and technique make a difference. Get it from the same institution and operator.
It may be more predictive in younger and lower risk populations. Good for tracking progression or regression of plaque.
“they can show if the plaque is what we call “Echolucent or Echodense.” Echolucent plaque having sort of a higher risk of stroke or cardiac event, compared to echodense plaque, which tends to be a little bit more stable. So knowing the type of plaque can be really helpful.”

If you want to know how fast it’s progressing, you’d have to do it twice in a 1 year interval.
Normally, it progresses at 0.014 mm/year (James Roberts). Thing is, in a not well performed CIMT, the margin of error is .1 mm.
Each increase of .1 mm increases risk of a major event by 11-18% of cardiovascular events and for each increase of .168 mm increases risk by 51% of strokes.

From Ford Brewer’s Prevention Myths book:
“Between 2 and 4% of CIMT tests could be false negatives. Occasionally plaque develops in the arteries of the heart but not the carotids. While it is highly unusual, it does happen in less than 5% of patients. [...]
Regionalized disease (in the area of the heart but not the carotids or other vascular beds) is more common in people with congenital heart defects or in people who have had surgical work on their heart.”

“Here is the takeaway: . . . the piece that your physician and every primary care physician on the planet should understand: IMT successfully identified 98.6% of those who went on to have a heart attack and/or stroke and it did so BEFORE they had their event. “

“It is this: If you want those you love to know whether or not they have risk for a future heart attack and/or stroke – they need to get an IMT exam from a laboratory that has a peer-reviewed and published protocol which demonstrates their ability to perform it reliably. The sooner they get this test, the sooner they can get prescriptive advice from their physician to prevent such an event.”
“If you reduce progression of CIMT . . . you will also reduce cardio and cerebrovascular events.”"


CAC score

Calcium score or CAC score ($75-$200), it's a CT scan of your thorax without contrast. They say the radiation is low at 1 mSv. For comparison, the annual background radiation is at ~3 mSv; a mammogram is at .5 mSv. Can be a quick test, done in as little as 10 minutes. Insurance coverage varies widely.

Gives you an estimate of your risk, because it can’t tell you the percentage of stenosis nor how much soft plaque there is, it only tells you a score of the calcified plaque.

Usually a CAC score of 0 has low risk, but you can still have soft plaque even with a score of 0, just not calcification. If your score is >400, it’s high risk.
[Philip Ovadia says >100 is high risk].
More importantly, is the rate of progression, so you have to do the scan twice. A 20% increase per year in your CAC score is expected, higher than that is high risk with bad outcomes; less than 15% per year has favorable outcomes no matter if you have a high CAC score.
So, someone with a low score progressing at the same rate as a high scorer, has less problems.
But someone with a high score of 1000 progressing slowly, is better off than someone with a lower score of 100 progressing rapidly.
[Malhotra says instead, that >15% per year is high risk in asymptomatic patients.]


CTA

CTA, a CT angiogram with iodine contrast
, which can be hard on vulnerable kidneys, like in diabetics, CKD or dehydration. [The MRI angiogram version also exists]. Expensive ($800-$2000 USD) and more radiation (at ~10 mSv) but can give the full volume of both types of plaque, soft and hard and degree of stenosis. The test also depends on a slow heart rate so you may have to take medication. Can take 2 hours for the whole test. Insurance rarely covers it.

It’s also dependent on a good radiologist, and if you do a subsequent AI analysis for more details with an additional cost ($850) with like Cleerly, Heartflow or QAngio, choose the last two, because Cleerly had very different results for some reason on a ketogenic study.


Cardiac Catheterization Angiogram

Cardiac/Heart Catheterization Angiogram: By IV Ultrasound
(more in research settings) or with Xray (at ~8 mSv). Expensive ($4k-8k USD), is the gold standard, but it’s much more invasive – a catheter tube is introduced in your groin artery to scan coronary arteries (but can't see if there's collateral circulation if it’s too small according to a book). Usually done when the patient has angina, chest pain, or other pain suspicious of coronary artery disease, or a heart attack and then they usually take the opportunity to put a stent (15-20 mSv, $11k-$41k USD), if you give consent beforehand, or helps them plan a bypass procedure.

It allows them to see if there are blockages and can give stenosis percentage from plaque in the arteries.

But it has risks: “It is important to understand that between 1 and 2 angiograms per 100 still result in a significant problem. The most common issue is bleeding from the femoral artery in the groin at the injection site. Occasionally the guidewire tears an arterial wall. The femoral artery is a large, high-pressure artery. Of course, the procedure can disrupt unstable plaques poised for rupture, it can also dislodge blood clots. There is always a risk of infection. Also, the process is uncomfortable, time-consuming, and expensive.” (Prevention Myths)

Stephen Hussey got PAD (atherosclerosis on the leg) from the procedure done from this angiogram…


For PAD

And if you have plaque on the legs (Peripheral artery disease – PAD), you can have a femoral Intima Media Thickness test (fIMT) ultrasound if you can find one (I didn’t come across much info about this one, and they are not widely available).
Otherwise, you can have the normal artery leg doppler ultrasound. I believe it’s not very accurate, though, but it’s better than nothing.

Or an Ankle Brachial Index test (ABI), a ratio between the blood pressure of the ankles and arms. The test is simple, inexpensive, can be completed in just a few minutes and could be done by anyone. The test is similar to a blood pressure test with pressure cuffs, but more involved. Here’s an example on how to do it. In a clinical setting, the patient is asked to do moderate exercise and then is measured with ultrasound.
If the ratio is <.90 this implies peripheral disease in the arteries between the heart and ankle, which could include plaque or flow disruption. If it’s >1.40, it means there’s calcification. In the book Prevention Myths, they recommend leaving the ABI test to the experts, though.
An ABI result of ≤ 0.90 increases the lifetime odds of having a heart attack and stroke by as much as 400%



Now the really good parts. While there have been cases of plaque regression with statins, it’s usually only the lipid part of the plaque that shrinks, but the calcified part increases, and almost never regression of calcification (CAC scores) occurs. They say that’s a good trade off, because calcification is more stable - less prone to rupture. So, given that it’s so difficult, I want to share with you and bring to your attention what we/I’ve found for reversing plaque, which is normally thought as impossible, especially the calcification part.

And do please point out, comment or express your thoughts on this.



First cyclodextrin…
 
Plaque Regression Approaches

Cyclodextrin


So, 2-hydroxypropyl-beta-cyclodextrin (2HPBCD, now referred to as cyclodextrin for short) is a cyclic oligosaccharide, a starch says James Roberts, that is cone shaped. It is already used as a carrier agent in many consumer products like in creams, fragrances, and has other applications because it increases solubility and absorption of the substance.

Chemically, it’s water soluble on the outside and fat soluble inside. So, it can grab lipids and carry them on the bloodstream for elimination through the kidneys or liver to then excrete it.

For our anti-atherosclerotic purposes, it’s commercially available as a mini retention enema that Facebook users say to hold for hours to absorb it.

The one that has the most experience with it is James Roberts. His website about it and this video is a good summary. Now, he's an integrative cardiologist which utilizes multiple therapies for atherosclerosis (link to his integrative approach), so cyclodextrin is not used alone, but he says he would give it to almost everybody with plaque.

The video says this with notes of mine:

Keep in mind, whenever he mentions Cavadex he means cyclodextrin. Cavadex is the name of the cyclodextrin product made by Remchol/Cholrem, one of the two companies that sell it.

He has experience with it for 2 and a half years with 100s of patients.
In 2-4 weeks there is symptom relief because of the nitric oxide it generates
And longer term 3-6 months symptoms resolve, if underlying risk factors are addressed.

It’s applied rectally, as a mini retention enema

[It can’t be ingested because he says that digestion breaks it down into glucose, and on the website he says it’s absorbed 3% and it binds to fats]

He says:
Cyclodextrin removes cholesterol from the vascular wall, cell membrane, lipid droplets, crystallin and oxysterol in a fashion that generates nitric oxide, our natural vasodilator, while also turning down vascular inflammation. If you're experiencing symptoms such as chest tightness or shortness of breath that grows with effort due to a blocked coronary artery compromising blood flow to the heart muscle, or leg pain with walking – intermittent claudication – likely you’ll experience an initial symptomatic benefit in 2 to 4 weeks.

Now, in this time frame we're not rapidly opening up your arteries – this is a slow process that occurs molecule by molecule – we are improving blood flow by increasing nitric oxide and anti-inflammatory effects with longer use 3 to 6 months depending on your symptomatic status and disease burden and particularly if we identify and resolve your risk factors the underlying causes of your vascular disease. We anticipate that your symptoms will fully resolve with ongoing risk factor reduction and some form of Maintenance therapy, say cyclodextrin one to three times a week, with 30 days twice a year, then you should be home free with minimal symptoms and a low risk for future vascular events.

He believes widespread acceptance utilization of Cavadex is going to save millions of lives, spare the need for vascular procedures and save billions of dollars both in reduced health care and lost worker productivity.

Cyclodextrin it’s not a drug, but a natural molecule from starch fermentation from digestion [?]. Enzymes are used to make the molecules cone shaped. A starch treated with digestive enzymes.
It cannot cause harm.
Stimulates the Reverse Cholesterol Transport that reabsorbs plaque.
It is used as a drug delivery vehicle to improve solubility and absorption, used in the Johnsons & Johnson covid vaccine. FDA lists it as GRAS generally regarded as safe and considers it as inert and an excipient.
Also approved as an orphan drug for Niemann Pick Type C autosomal recessive lipid storage disease, these kids don't make Niemann Pick protein that promotes egression of cholesterol out of the cell. They can make cholesterol but can't get rid of it. They die before adolescence from brain and liver failure. They tried intravenous and subcutaneous injections, and they did remove cholesterol from the liver, but not from the brain because it doesn't cross into the brain. For that, they injected it intrathecally into the spinal fluid, and the children survived, but lost hearing.
But using it rectally or intravenously, it doesnt cause hearing loss.
Supposedly, it goes to the cholesterol in the vascular wall, expelling it through the kidney and into the liver. It plucks cholesterol from the cell membrane.

Repurposing cyclodextrin for atherosclerosis

The first time was used intravenously in 1992, and they saw that cholesterol came out in the urine. But they didn't follow on that.
Supposedly, it's safe in animals.
Zimmer tested it in animals under arterial plaque in 2016.

He says that cyclodextrin is more efficient than HDL at removing cholesterol from the arterial wall, because it plucks it from the cell membrane into the urine or delivers it to HDL. Lipid droplets within the cell are dissolved to then create free cholesterol to replace the cholesterol of the cell membrane. Stimulates Reverse Cholesterol Transport.

Cyclodextrin also eliminates diacylglycerols that inhibit production of nitric oxide. Nitric oxide dilates our arteries, provides a 'Teflon' coating that keeps white blood cells and platelets from adhering, it’s a vascular protective chemical that we are not making in our diet high in fats. [?]
That's why you feel better in a few weeks. This happens to all people who have some plaque.

If you have a more vulnerable plaque, full of foam cells which are white globules engorged with oxidized lipids, generating an immune response against oxidized lipids, confusing them as microbes, and then release oxidative and inflammatory mediators worsening atherosclerosis.
This inflammation converts smooth muscle cells that cover the artery and normal endothelial cells into these inflammatory foam cells.

Now, these cells drink fluids, called pinocytosis, and quickly incorporate cyclodextrin molecules, that way gaining access to the lipid droplets and cholesterol crystals. These cholesterol crystals are particularly malignant because they promote plaque destabilization and precipitate acute events. So we are removing lipid droplets and cholesterol crystals, and as we dissolve the crystals we create molecules called oxysterols, which the body doesn't like and prompts to generate cholesterol efflux pumps (ABCA1 and ABCG1). They embed themselves in the cell membrane and actively pump cholesterol out of the cell, docking with the HDL.

So, this inflammatory foam cell with the cyclodextrin becomes an anti-inflammatory cell turning off inflammation, oxidative stress, generating nitric oxide and actively pumping cholesterol out of the arterial wall, docking with the HDL.

So the worse the plaque you have, the better, because foam cells drink up the cyclodextrin in a process that turns off inflammation and generates nitric oxide. Nitric oxide also promotes collateral circulation if you have blocked arteries.


[Adding to that, on his website, also mentions this: “Cyclodextrin is just the right size (nanoparticle) to stimulate the production of lysosomes and their hydrolytic activity. Oxidized LDL, the initiator of atherosclerosis, poisons the lysosome. Oxidized LDL thus cannot be processed to free cholesterol; it hangs up within the poisoned lysosome, and then crystallizes (crystalline cholesterol is far more problematic than lipid droplet esterified cholesterol). Cyclodextrin rights this metabolic wrong, accelerating lysosomal degradation of crystalline cholesterol. Autophagy, lysosomal recycling of aged or dysfunctional structures, declines with age and disease states. Thus we cannot "clear out the dead wood", compromising cellular (and overall) health. Many principles of anti-aging medicine (rapamycin, intermittent fasting, caloric restriction), are designed to stimulates autophagy - we can now add HPbCD [Cyclodextrin] to this list. Thus cyclodextrin is going to provide benefits above and beyond reverse cholesterol transport and plaque regression. Many patients relate that they "just feel better" with cyclodextrin.
[...]
Indeed, risk factor control is problematic for many of you (you can’t tolerate lipid-lowering therapy or there are cost constraints). CD [Cyclodextrin] is well tolerated, safe (side effects are nuisance in nature related to rectal delivery), and cost is not excessive. In a sense CD is the universal antidote for atherosclerosis.]

[Also on a previous video of two years ago, he said:
“[Cyclodextrin] is now the most important anti atherosclerotic therapy in my armamentarium”] [And he knows quite a few therapies]
[That said, remember to deal with your risk factors I posted above]


James Robert’s Experiences with Patients


According to his experience with his patients, there is plaque regression.

In the video he mentions 2 bad experiences out of 200 patients.
One of those, he mentions he needed bypass surgery but didn't do it, and did cyclodextrin for 9 months and for 5 months he worked with Roberts, and still got two vessels blocked and had to get a bypass surgery. He thinks it was too late for cyclodextrin.

Keep in mind that bypass grafts last on average for 7 years.
The second experience was a patient of his for 20 years with a second bypass that lasted that long with his multiple therapies. Later, he had chest pain and instead of using EECP, they used cyclodextrin and felt better, but then one day was walking and felt chest pain, and it turns out one of his bypasses, that was open 5 years ago, was closed; while the other closed bypass from 5 years ago, was now open. He received stents and still uses cyclodextrin every day and is doing well.

His best experience (IMO) was in someone that couldn't tolerate lipid lowering drugs, and in just about 5 months with weekly maintenance of cyclodextrin along with other therapies (Phoschol, Pauling protocol for Lp(a), and Lumbrokinase) her stenosis went from 70% to 27%.
[Although, you should know the 27% analysis was done by Cleerly, a company that uses AI to analyze angiograms, and I mention that because there was a controversial study of ketogenic diet that used Cleerly that showed much more plaque progression than other AIs… So, I’m not sure how much stenosis this person really has, but it seems that cyclodextrin and other supplements were very beneficial quite rapidly.]​
[Also, know that on his website he says more details of the patients, this patient in particular also had GI infections “including SIBO (small intestinal bacterial overgrowth), H. pylori gastritis, yeast overgrowth” and gut infections also drive atherosclerosis. So, despite having gut infections, cyclodextrin worked for her! Good to know, and without lowering her lipids too! (I still wonder how to get those results.)]


Honestly, because it doesn't fully reduce the plaque, I tend to think cyclodextrin only shrinks the lipid part of the plaque. But there have been cases of lowering calcification too as evidenced by lower CAC scores. Nobody really knows why that happens. More of those with imaging studies here. But notice, they are not big reductions, but mostly mild and one moderate, and it stabilizes the progression. Some of those cases he mentions on the video:


Another good case is someone with controlled hypertension, diabetes, high Lp(a), sleep apnea. Her CAC score progressed 127% per year, so it bothered him a great deal. Started with higher K2 for the calcification, and double dose of cyclodextrin for 5 months. Repeated CAC score showed regression of 6%. Now asymptomatic, and now he takes it for 30 days, twice a year.

Another case of regression of overall 8% with 5 months on cyclodextrin.
[But he doesn't mention there was more calcification in other arteries according to his graph. I wonder why that happens? So, it lowers calcification overall, but some arteries still progress in calcification, in this case.]

Then he explains on the video that they were going to do a pilot study of plaque regression with their patients, to quantify how good it can reverse calcification.
[But now on his website it says the FDA embargoed Cavadex, as they didn't comply with what FDA asked them to do like removing health claims and interviews resulting in shipments not being delivered, so their study had to stop.]

He believes the lower your cholesterol in the blood, the more benefit you get from the cyclodextrin


A case of fainting due to dehydration, a carotid ultrasound showed 90% stenosis but a Magnetic Resonance angiogram showed 65-70%, so surgery is not mandatory unless symptoms appear. [On his website, he adds he also gave him lipid lowering medications and Pauling Protocol for Lp(a) ]
Then did 4 months of cyclodextrin along addressing underlying causes and other therapies, and it regressed ~3% [With ultrasound doppler, not CIMT though]

He says, the most important predictor of your outcome is the degree of your endothelial function. Are you making enough nitric oxide to dilate your arteries and coat your blood vessels from white blood cells and platelets infiltration?
He says, you can measure it with flow mediated dilation (FMD), and in his experience all of his patients improve on this measure with cyclodextrin. So, it does increase nitric oxide.

Carotid Intima Media Thickness (CIMT) tends to rise with age, but more important is how fast it is progressing.
Then Roberts mention two very complex patients with chronic infections and Lyme, that have seen integrative clinicians around the world, and their CIMT rose a lot, so they did cyclodextrin for a year and a half along with ‘really good things’, and their CIMT plummeted (4-11% regression) and says he’s never seen that fast of a regression.

Case of diabetes and statin intolerant, high Lp(a), dyslipidemia, with chest tightness and shortness of breath with 70% stenosis, borderline for a stent. Did risk factor reduction and got better. A few years later the shortness of breath got worse and began cyclodextrin and did well, with symptoms resolution after 6 months and some plaque regression.

He himself tried IV cyclodextrin, not rectally like all of his patients, 50 infusions and says that he had more carotid plaque on the left side than on the right. He thinks because he exposed his left side when doing xray angiograms years past and that he used to do them a lot. Not anymore, and he runs marathons. So, with IV cyclodextrin he did it on and off various times a week, but says you should do it more frequently than he did and still got results reducing his plaque.

The strange thing is that, for the initial 3 months, his carotid plaque got 12% worse and then it decreased… to the initial value when he began 8 months ago. Still, it’s a good thing because it didn’t progress more in the end. He thinks his cells of the arteries were getting enlarged a little bit as they pump cholesterol out, and the inconsistent use were the reasons that happened.


About lipids

He says cyclodextrin does not block Hmg-CoA reductase (statins do), nor cholesterol production, but it can decrease LDL.
[Although on Facebook, some people report an increase of LDL while on cyclodextrin.
[This study says it increases cholesterol synthesis in response to extracting cholesterol from the membrane, resulting in more cholesterol in the blood… Whereas Roberts tells of two patients that his LDL-C lowered by ~10%. Also the founder of the company, Kyle Hodgetts, did it intravenously and lowered his dyslipidemia.
So, it can either increase or decrease lipids..]

Mentions a patient with two heart attacks, 3 rounds of stents and was doing everything Roberts can do except lowering his cholesterol because he’s intolerant to all lipid lowering drugs/supplements. So he did 3 months of cyclodextrin and his LDL decreased by 10% including small LDL and particle number. [Unlike statins that lower the large LDL particles which are said to be less damaging.]

He says when the liver is inflamed it generates more cholesterol because it thinks there is an infection. Can be inflamed because of leaky gut, overweight, smoking, lousy diet. He thinks cyclodextrin lowers lipids by lowering cholesterol from fatty liver.


Cyclodextrin and Heart Failure


A patient with heart failure with no blocked arteries improved with cyclodextrin with multiple diseases: kidney disease, COPD, Atrial fibrillation, hypertension, normal pump function, and MR, TR [?]
Pro-BNP, a lab marker of heart failure, is released by the heart in response to strain. Hers was steadily rising and then he did his therapies and it fell, then added cyclodextrin for 5 months and felt better and it fell even more. Then she stopped cyclodextrin and it rose again and felt worse, so she does cyclodextrin 3 times a week now. Unsure why it works on heart failure, but maybe due to nitric oxide, because it improves cardiac performance.


Side effects


He says they are essentially nil.
Hearing loss occurs when given intrathecally like in those with Niemann-Pick Type C disease. When it enters the brain there’s hearing loss because cyclodextrin plucks the cholesterol out of the cochlear hair cells. But when given IV or rectally, hearing loss does not occur because it doesn’t reach the brain.

In cats, there was hearing loss but they gave them x50 times the normal dose.
Cyclodextrin doesn't lower cholesterol too much.

If anything, there is a nuisance because of using it rectally. You can't take it orally because digestion turns it into glucose. So, the nuisance is more in those with IBS with gas, bloating and cramps. Introducing it rectally may exacerbate those symptoms. Those with angina who can't do another bypass, they’ll have to tough it out, and those whose disease isn't as urgent, they can do it every two or three days.

Others report nausea, more bowel movements with an increase of fatty content, which are the lipids of the artery wall, he says.

Dosing


You might get better with cyclodextrin, but he underscores that you need to address the risk factors in your case. Otherwise the disease is going to come back. If your disease burden is high, you can do twice a day dosing until you get better. Normally, it’s done once a day, rectally as a mini retention enema (~9g/10ml).
[Atherocare, the other company that sells it, says to hold it for 30 minutes.
But people on Facebook do it at night, holding it while sleeping to absorb all of it for 8 hours, because they say that the colon can absorb it all but takes a lot more time.]

IF there are arteries totally blocked, they can't be reopened.

About the FDA embargo.

When a substance is approved for one disease, then doctors are free to use it for other diseases. 2 years ago, shipments from Australia (Cavadex/Cholrem company) were embargoed because the products advertises it ‘lowers cholesterol’ and from the FDA perspective that's a drug claim, so they were advised to change it to say it ‘improves vascular health’ which worked for a while, but then 8 months ago it was embargoed again because it’s an ‘unapproved drug’.


Commercially, it's sold by two australian companies Remchol/Cholrem/Cavadex and Atherocare, which were created by the same person. More on that further below.

Some more notes of a previous video:

Atherosclerosis is maladaptive response to what the body perceives as an infection…
When you have 70% stenosis it does not compromise blood flow. When you have 85-90% it does. If you can lower 90 to 80% it doubles the blood flow
[Others say at >50% stenosis blood flow is compromised]



He would also give it on asymptomatic patients with plaque
He insists that cyclodextrin cannot harm you
Ablow, the interviewer asks, if cyclodextrin is taking out cholesterol, ‘Well, doesnt every cell needs cholesterol, what if it’s depriving cells of cholesterol?’
He answers that the liver can compensate by producing more because it's not being inhibited.. [BUT he also uses statins with cyclodextrin! And statins inhibit cholesterol production…]
Patients have also told him improvements in mood and mental clarity and memory
Patients tell him a lot, ‘I know you give it for 3-6 months, but I want to keep taking it all the time, not just as maintenance’
Just to be clear, he’s not saying forget about interventions and just take cyclodextrin. No, his patients need procedures from time to time, but he minimizes it
When you have chest pain, it's too late for cyclodextrin, you need to go to a catheterization lab and stent
But there have been people that do cyclodextrin, and decline the procedures, and they all do seem better.
In theory, if we have the luxury of time [with patients], unless its 99% stenosis, cyclodextrin and everything else he has been doing for 39 years will help
FDA embargo. Some shipments go through depending on the mood of the customs of that day, but mostly wont go through…
Cyclodextrin is working better than expected

Any bad stories?

It has never worsened anginas.
[But on Facebook, two did worsen their angina, so they stopped it after one month]
2 patients had diverticulitis, took antibiotics and then resumed cyclodextrin. Thinks that was a fluke because they had a history of that

Believes IV cyclodextrin would be better, but it’d be more costly.
[I don’t know who sells IV or where to get it. Two persons on Facebook have done IV on their own, sterilizing the jars with an oven and being assisted by a nurse, but there’s not much info how. And one of them had temporarily worsened kidney function.. Could be either the powder he used wasn't as pure or it was too high of a dose, because he’s impatient, he says.]

If you have disease, do everything that he gives and also take cyclodextrin
No medicine in the world has reversed calcification,
K2 might be part of French Paradox, because cows on France do eat grass unlike the US cows that are fed corn and soybean
Statins lower CoQ10, K2, and testosterone in men. Increases calcification by depleting K2



If you are looking for a few more details and more of his testimonies, James Roberts puts those on his website. There are not that many, but it is the best we have.

That said, besides James Roberts' patients, are there more people experiences with it?

Other Experiences


Mark Sircus

I happen to come across Mark Sircus, you know the alternative naturopath that speaks a lot about chlorine dioxide, magnesium and sodium bicarbonate. Well, he was in deep trouble recently from atherosclerosis with two almost obstructed (unclear at what percentage – maybe 90-98% I heard) coronary arteries and managed to avoid 2 stents with cyclodextrin and his other therapies that he mentions in his book ‘Unclogging your arteries’. Therapies like “magnesium, sodium bicarbonate, chlorine dioxide, DMSO, hydrogen inhalation therapy, oxygen, selenium, and carbon dioxide inhalation, as well as various enzymes.”

His story as told in his book:

My Personal Health Story and This Book
I should be dead, but I am not. Here I am at 72. The reasons I am not dead might save
millions of lives, which is why I wrote this book. I promise you I am not exaggerating.
The most significant cause of death in the world is cardiovascular disease, and what I
have learned and what I am going to share with you is how to avoid death from heart
failure and stroke by cleaning out the arteries of the plaque that most of us have in our vascular system.

In April of 2024, I was an emergency heart patient after finally agreeing to a
catheterization exploration. Two cardiac arteries were almost completely blocked. The doctor said I needed urgent care, but I was put on a waiting list to have stents put in.
After my sister, who is a nurse, saw my tests, she was surprised they had even let me
out of the hospital. However, the doctor went on vacation, and the hospital went on
strike. So, by the time they called me 3 months later, my Natural Allopathic protocol
was helping enough for me to ask to be put on the end of the waiting line.
Though in the beginning, I was desperate and would have jumped to get the
stents, by this time, I had done enough research to understand there was a 2 percent
chance of serious complications from stents that no one likes to talk about. Since I was feeling better, I thought it best not to take a chance, and what might one day be considered a miracle cure (cyclodextrins) for atherosclerosis was in the mail from
Australia, so I held off.
I was a walking dead man who could barely walk when diagnosed. I fell three
times and, for weeks, could hardly get out of bed. It was a condition that had been
building up for decades. There was one night, I was threatened with triple bypass
surgery, and that completely freaked me out. I have never been more afraid in my life.
However, my progress has been extraordinary after three months of cyclodextrin liquid suppositories, which is one of the primary subjects of this book. Some call them liquid enemas, but they are small tubes that one can apply easily at home with or without a doctor's care. After one month on the cyclodextrins, the doctor called again for the stents, and I said thank you, but no thank you, and took me off the list.
Before starting the cyclodextrins, I was, and still am, flooding my body with
hydrogen and oxygen inhalation, CO2 inhalation, chlorine dioxide, magnesium,
selenium, and iodine, and using enzymes and numerous other substances. Vital on this list is magnesium, and for years, I have told my patients that the only reason I am alive is that I had more magnesium massages than anyone alive
. Fifteen years ago, I wrote a book, Magnesium – The Ultimate Heart Medicine. However, it is not the ultimate vascular medicine.
The cyclodextrin I was waiting for is an exciting new substance that quickly
resolves cholesterol embedded in blood plaque and reduces calcium scores. It is the
only such substance that can be done conveniently at home. I lived long enough and did not have a heart attack or stroke, primarily because of my religious adherence to magnesium supplementation and my dedication to slow breathing.
Because magnesium controls calcium, which is crucial to cardiovascular
problems, it must be considered a top priority in cardio care along with cyclodextrins.
Calcium is toxic in the face of magnesium deficiencies, which are widespread in
modern populations. Magnesium is also crucial in the insulin and blood sugar story
and is the only reason I avoided diabetes. When I was 68, I was diagnosed with
diabetes and cured it in two weeks with massive amounts of magnesium.
I finally broke down when I was 70, went to a cardiologist for blood pressure
medications, and was diagnosed with 30 percent blockage in my cardioid artery. She wanted to do a catheterization, but I chickened out, electing my natural treatments, which were only partially effective. Then, a year later, the crisis hit, and I went back to the city and had the test, which showed almost complete cardiovascular blockages.

It was a terrible time when I was at my worst. I got depressed, and for a being
like me, and indeed for my wife, it was too much. I cannot afford negative thoughts
because my mind is overly strong. When my wife started crying after caring for me
for months, that pierced my heart, and I began to come out of my deep funk.
Now, I wear a smile on my face and am grateful for all that I have. Of course,
the experience has led me to write this book, which will be paired with my online
course on diabetes. It seems to be my karma to leverage my personal health and
medical experiences as profound learnings I can share with the world through my
writings and medical research.


[BTW, he mentions high dose magnesium ‘curing diabetes in two weeks’.. Is that really possible?...]

But.. on a recent video of his, after 8 months on cyclodextrin on almost every day, he says he still has long ways to go, and that his long walking distance hasn't improved, but he’s alive and working every day. Who knows how obstructed he is now or how much the stenosis decreased.
[Also in the comments, he mentions he has 3 teeth (but on the video I see more teeth??), so probably has periodontitis too and therefore infections. But still, good to know that it worked for him even with possible periodontitis, previous diabetes and possible high blood pressure! But know he also takes other supplements that he doesn’t mention on the video]


There’s also Joel Kahn, a popular vegan cardiologist who also puts cyclodextrin on his list of recommendations. I don’t know his experiences with it, though.


Facebook

Then there are people’s experiences on a Facebook group called “Cyclodextrins, Nattokinase & Cardiovascular disease”, but know that they use it along with nattokinase and other supplements like K2 and lowering lipid drugs: either statins with ezetimibe and/or PCSK9.

The testimonies aren't many and are scattered throughout comments, so I read the ones I came across and compiled them: About 4 were bad, 4 neutral and 22 were good.
I’ve come to expect some plaque regression and/or slower progression, judging by their CAC scores.
Mostly, their angina symptoms resolve with more months of usage as well as their Erectile Dysfunction improves.
Some say it lowers their blood pressure a bit, others say it doesn't. The problem is, nobody really mentions how much their stenosis decreased, but one (severe to moderate on stress test imaging).
Probably, because repeating an angiogram is not easy (cost and risks), and CIMT isn't that easy to find a good one.

People recommend doing it for a year instead of 6 months, and keep doing it every other day for longer.
The longest with it, has 4 years on it seemingly without side effects, but also takes 40 other things.

The best experience is this one, I think, but he also takes a lot of supplements. No mention of stenosis percentage, but went from severe to moderate blockage in ~1 year, with stress test imaging, though.

  1. One of the best examples. Uses a lot of things. Late 70s, he had 4 stents, angina, shortness of breath, erectile dysfunction (but notice he also takes tadalafil). All improved as well as energy, mind clarity, and also does strength training. 9 months in, it went from severe to moderate blockage, but with stress test imaging.

Bill Byrne
Steve Wall. How long did it take to accumulate it? The process is ongoing. The important thing is that a slow reversal will occur. I have had four stents done (the last was in 2022. In 2023 I had chronic angina, shortness of breath and ED.
I started on Cavadex January , 2024. About a month in, my energy level was improving and my angina had pretty much abated.
I began exercising just about every day. After about 6 months, I began to experience more frequent and better erections. My mind was clearer. After about 9 month I took a treadmill stress test with imaging. It showed one artery section have gone from 'severe' to moderate blockage.
I cut back administering the enema to every other day. I'm 77 years old now.
Will I still have some blockage for the rest of my life? Probably.
But how many 77 year old men can work out hard at the gym with free weights up to 35 lbs per hand, treadmill for 1/2 hour at up to 4 mph, AND have daily sex with a full, stiff erection?
18 months ago, I was worried about having another MCE at event at any time. Now I'm planning for a 30 mile wilderness hike in a couple of weeks.


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More about what he recommends to take:

Too many here are looking for that one 'silver bullet' when it comed to reversing arterial plaque progression.
I'm here to tell you that I am certain that one can (and I have done it) reverse plaque progression faster than new plaque accumulates.
But there is no single 'silver bullet'.
Instead, there is a proven protocol. It consists of: 2-hydroxypropyl beta cyclodextrin (enema administered), vitamins K2 (as MK-7) and D3, nattokinase, chondroitin sulfate, Coq10, citrus bergamot, berberine, and omega-3. Two prescription drugs would be a low dose of rosuvastatin and ezetimibe.
Add to that, a balanced healthy diet (Mediterranean works), exercise (both resistance and cardio), hydration, and sleep.
Note: if your body can't tolerate (or you refuse to take) the statin, with the rest of the protocol you should still be able to get ahead of any plaque progression.


https://www.facebook.com/groups/1538189873584084/posts/1933838454019222/?__cft__[0]=AZVtdHi444tZ58zRpHHFi8l7TTS-r-aI7vOTQQJh3AbWNT2dYdQ8fGHMGyXG2Lcc6WbSQHDxU4F5XzEkPR69t6yefdKkT-80Rj6TrFCLtJqGe2nsRlv3gKMU-h1IB8kIo2iQPYIRFA6cK5jDd86GcMfk&__tn__=,O,P-R

What he actually takes…:

For those who might be interested, I made significant changes to my morning Supplement protocols. Now that I'm no longer concerned about any eminent major adverse cardiac event ( thanks to 2-hydroxypropyl beta cyclodextrin and nattokinase), I developed a strong curiosity about stem cell activators which is reflected in the changes to my 'stack'. I will give you one hint. My 77 year old male pattern baldness is starting to fill in with actual HAIR! And I also feel GRRREAT.
Morning Yerba Mate /Cacao Blend.
* Brew together: 1 pint filtered water, 2 1/2 tbsp Yerbalance Yerba Mate, 1 tbsp 95% curcumin turmeric, 6 tbsp Terrasoul cold pressed cacao powder.
Stir in 1 tbsp of Earthborn Elements marine hydrolyzed collagen peptides; 1/2 tsp each of the following powders: ginger root; radix panax ginseng root; ceylon cinnamon; sea buckthorn; chaga mushroom; maitake d-fraction; gotu kola; astragalus; 1 tsp MCT oil, 2 tbsp raw honey.
Morning Supplements & Medications:
* Prescriptions: Propranolol 30mg,
Lisinopril 10mg rosuvastatin 10mg, tadalafil 5mg (Cialis).
* Supplements (with supplier and cost per dose):
* Bioperine 10mg (Piping Rock, $0.065)
* Berberine high bioavailability with sodium caprate, 250mg (Hi-Tech, $0.29)
* GlyNAC Ethyl ester 100mg (Lipmaxmall $0.20)
* Liposomal NR 1500mg (Orgabay, $0.44)
* Urolithin A 2000 mg + other (Vivalifer 0.33)
* Quercetin 600mg (Double Wood, $0.19)
* CoQ10 200mg (Piping Rock, $0.14)
* Shilajit 400mg (Double Wood, $0.10)
* Astaxanthin 12mg (Double Wood, $0.28)
* Citrus bergamot 600mg (Sotalix Healthy Cholesterol Formula, $0.18)
* D3+K2 (as MK7) 5000 IU/90 mcg $.08) (Futurebiotics);
* L-serine 500mg (Double Wood, $0.09)
* MSM 2000mg (Horbaach $0.14)
*B-Complex + C (Naturebell $0.04)
*Trans-pterostilbebe 200mg (HMS Nutrition $0.12)
*L-serine 1000mg (DoubleWood 0.14)
*Advanced Omega-3 Krill & Fish oil (Qunol 1200 mg. $0.34)
* Liposomal NMN 300mg (Prohealth $O.72)
*Fisetin Liposomal 600mg (Kayseari $0.35)
*Calcium AKG 600mg (Toniq $0.24)
*Guggul Extract 720mg (Herbal Secrets $0.21)
*Bitter Melon Extract 600mg (Nutricost $0.06)
*Chondroitin Sulfate 600mg (Now Foods $0.34)
*Liposomal Nattokinase Serrapeptase 12000fu (Naering $0.78)
Mid-Morning Green Drink:
* 2 tbsp apple cider vinegar, 2 tbsp apple juice, 2 tbsp cranberry/pomegranate juice, 1/2 tbsp honey, 1 tsp of each of these powders; matcha tea; wheatgrass; spirulina; chlorella; psyllium husk; bacopa monnieri; bladderwrack; inulin; moringa; and aronia berry stirred into a pint of water.
I'll post my evening routine and my workout routines separately in the next few days.
As always, questions and comments are more than welcome.

https://www.facebook.com/groups/1538189873584084/posts/1819289345474134/?__cft__[0]=AZWIASWDSPI87wA2zeA-QoQ-eBqP10-RBRwYhseuQIU30vMlDuVJdSAeLU4vdBSbZd-ZSMr9nz8QflqdUqdEzkzKoIF2y8gPBQ6nPLx9TmKoFTzvjzyJeykk17u-_pCp1LZEczmvZ3OJKpouXbndWW2c&__tn__=,O,P-R


And the bad ones:
One person's angina worsened even after a month of cyclodextrin. So he stopped taking it.
Another also his angina worsened when he switched company to Atherocare.
[But Sircus used Atherocare too and it worked, so.. Unless Atherocare switched to a worse supplier something Cavadex accuses them for]
And another's angina didn't get better after 8 months on it, but his lipids and blood pressure did improve significantly.


Some say they have ear ringing after application, while others say it doesn't.
Careful about developing hemorrhoids due to diarrhea or their lubricator, otherwise you might need to take a break from it to heal, or do it twice a week, depending on the severity. [Or also treat it with DMSO]



Testimonies List

Here is the list of good, bad, neutral and other testimonies.
Note: When people mention Remchol/Cavadex/Atherocare or HPbCD, CD all refer to cyclodextrin.

Good Ones
Bonus: This one did it without cyclodextrin.

Arthur Andrew Medical Neprinol AFD, brand of Nattokinase
[...]
My angiogram on my LAD artery went from 50% blockage to 35% after 1 year of 12,000 Nattokinese.

8000 in the morning and 4000 in the evening on an empty stomach. I also take 500 mg of niacin and a 81 mg aspirin and 20 mg of Lipitor daily.


https://www.facebook.com/groups/1538189873584084/posts/1795197184550017/?__cft__[0]=AZWVMpynSn7oZhj2hV86d937v7Awn8-HscqBEvnqmmryZd33jG-0gig1vQu9RE0G8Iuf0d_sYvMx1Wy2zaMsfYhfQsSjNZLTuuvfKLFObWeHc2Hjn-8VgazNKnCkFIJ8NltBZMr7uZDQYzhHPXio1TiA&__tn__=,O,P-R

1. One of the best examples. Uses a lot of things. Late 70s, he had 4 stents, angina, shortness of breath, erectile dysfunction (but notice he also takes tadalafil). All improved as well as energy, mind clarity, and also does strength training. 9 months in, it went from severe to moderate blockage, but with stress test imaging.
Bill Byrne
Steve Wall. How long did it take to accumulate it? The process is ongoing. The important thing is that a slow reversal will occur. I have had four stents done (the last was in 2022. In 2023 I had chronic angina, shortness of breath and ED.
I started on Cavadex January , 2024. About a month in, my energy level was improving and my angina had pretty much abated.
I began exercising just about every day. After about 6 months, I began to experience more frequent and better erections. My mind was clearer. After about 9 month I took a treadmill stress test with imaging. It showed one artery section have gone from 'severe' to moderate blockage.
I cut back administering the enema to every other day. I'm 77 years old now.
Will I still have some blockage for the rest of my life? Probably.
But how many 77 year old men can work out hard at the gym with free weights up to 35 lbs per hand, treadmill for 1/2 hour at up to 4 mph, AND have daily sex with a full, stiff erection?
18 months ago, I was worried about having another MCE at event at any time. Now I'm planning for a 30 mile wilderness hike in a couple of weeks.

Log into Facebook

More about what he recommends to take:

Too many here are looking for that one 'silver bullet' when it comed to reversing arterial plaque progression.
I'm here to tell you that I am certain that one can (and I have done it) reverse plaque progression faster than new plaque accumulates.
But there is no single 'silver bullet'.
Instead, there is a proven protocol. It consists of: 2-hydroxypropyl beta cyclodextrin (enema administered), vitamins K2 (as MK-7) and D3, nattokinase, chondroitin sulfate, Coq10, citrus bergamot, berberine, and omega-3. Two prescription drugs would be a low dose of rosuvastatin and ezetimibe.
Add to that, a balanced healthy diet (Mediterranean works), exercise (both resistance and cardio), hydration, and sleep.
Note: if your body can't tolerate (or you refuse to take) the statin, with the rest of the protocol you should still be able to get ahead of any plaque progression.


https://www.facebook.com/groups/1538189873584084/posts/1933838454019222/?__cft__[0]=AZVtdHi444tZ58zRpHHFi8l7TTS-r-aI7vOTQQJh3AbWNT2dYdQ8fGHMGyXG2Lcc6WbSQHDxU4F5XzEkPR69t6yefdKkT-80Rj6TrFCLtJqGe2nsRlv3gKMU-h1IB8kIo2iQPYIRFA6cK5jDd86GcMfk&__tn__=,O,P-R

What he actually takes…:

For those who might be interested, I made significant changes to my morning Supplement protocols. Now that I'm no longer concerned about any eminent major adverse cardiac event ( thanks to 2-hydroxypropyl beta cyclodextrin and nattokinase), I developed a strong curiosity about stem cell activators which is reflected in the changes to my 'stack'. I will give you one hint. My 77 year old male pattern baldness is starting to fill in with actual HAIR! And I also feel GRRREAT.
Morning Yerba Mate /Cacao Blend.
* Brew together: 1 pint filtered water, 2 1/2 tbsp Yerbalance Yerba Mate, 1 tbsp 95% curcumin turmeric, 6 tbsp Terrasoul cold pressed cacao powder.
Stir in 1 tbsp of Earthborn Elements marine hydrolyzed collagen peptides; 1/2 tsp each of the following powders: ginger root; radix panax ginseng root; ceylon cinnamon; sea buckthorn; chaga mushroom; maitake d-fraction; gotu kola; astragalus; 1 tsp MCT oil, 2 tbsp raw honey.
Morning Supplements & Medications:
* Prescriptions: Propranolol 30mg,
Lisinopril 10mg rosuvastatin 10mg, tadalafil 5mg (Cialis).
* Supplements (with supplier and cost per dose):
* Bioperine 10mg (Piping Rock, $0.065)
* Berberine high bioavailability with sodium caprate, 250mg (Hi-Tech, $0.29)
* GlyNAC Ethyl ester 100mg (Lipmaxmall $0.20)
* Liposomal NR 1500mg (Orgabay, $0.44)
* Urolithin A 2000 mg + other (Vivalifer 0.33)
* Quercetin 600mg (Double Wood, $0.19)
* CoQ10 200mg (Piping Rock, $0.14)
* Shilajit 400mg (Double Wood, $0.10)
* Astaxanthin 12mg (Double Wood, $0.28)
* Citrus bergamot 600mg (Sotalix Healthy Cholesterol Formula, $0.18)
* D3+K2 (as MK7) 5000 IU/90 mcg $.08) (Futurebiotics);
* L-serine 500mg (Double Wood, $0.09)
* MSM 2000mg (Horbaach $0.14)
*B-Complex + C (Naturebell $0.04)
*Trans-pterostilbebe 200mg (HMS Nutrition $0.12)
*L-serine 1000mg (DoubleWood 0.14)
*Advanced Omega-3 Krill & Fish oil (Qunol 1200 mg. $0.34)
* Liposomal NMN 300mg (Prohealth $O.72)
*Fisetin Liposomal 600mg (Kayseari $0.35)
*Calcium AKG 600mg (Toniq $0.24)
*Guggul Extract 720mg (Herbal Secrets $0.21)
*Bitter Melon Extract 600mg (Nutricost $0.06)
*Chondroitin Sulfate 600mg (Now Foods $0.34)
*Liposomal Nattokinase Serrapeptase 12000fu (Naering $0.78)
Mid-Morning Green Drink:
* 2 tbsp apple cider vinegar, 2 tbsp apple juice, 2 tbsp cranberry/pomegranate juice, 1/2 tbsp honey, 1 tsp of each of these powders; matcha tea; wheatgrass; spirulina; chlorella; psyllium husk; bacopa monnieri; bladderwrack; inulin; moringa; and aronia berry stirred into a pint of water.
I'll post my evening routine and my workout routines separately in the next few days.
As always, questions and comments are more than welcome.

https://www.facebook.com/groups/1538189873584084/posts/1819289345474134/?__cft__[0]=AZWIASWDSPI87wA2zeA-QoQ-eBqP10-RBRwYhseuQIU30vMlDuVJdSAeLU4vdBSbZd-ZSMr9nz8QflqdUqdEzkzKoIF2y8gPBQ6nPLx9TmKoFTzvjzyJeykk17u-_pCp1LZEczmvZ3OJKpouXbndWW2c&__tn__=,O,P-R

2. Lowered blood pressure. It worked despite high cholesterol (but how high?). Used for over a year. [BUT many dont report blood pressure changing while on cyclodextrin]
I have been using it for a while now probably over a year and cholesterol is still high but BP has dropped considerably, I feel great and will probably use cyclodextrin for life.

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3. Cyclodextrin 1.5 months and 2.5 years of Pomegranate lowered his CAC score progression to 10% per year
Thanks for the great recommendations! Might I also suggest pomegranate juice or powder?
I had some success with this 8 oz a day, or 5 grams powder. My CACs were progressing at 28% a year (for 6 years), which is crazy high. I did another CAC 4 years later, and the last 2 1/2+ of those years I drank PJ daily or took the powder, plus did 1.5 months of Cavadex. My increase was only 10% averaged per year.
PJ has *punicalagin*, a type of polyphenolic compound (an ellagitannin), that metabolizes to Ellagic Acid, and is linked to benefits for atherosclerosis. It’s a potent anti-oxidant that neutralizes free radicals, reducing oxidative stress and prevents LDL cholesterol oxidation.
There’s some research coming out of Israel regarding this.
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4. Regressed CAC score by 9.5% with 2 months of cyclodextrin plus 6 months of nattokinase

I'm a patient of Dr Roberts. I had a CAC score of 178 a couple years ago and went on cyclodextrin rectally everyday for 2 months prior to my next scan. CAC went down to 161. It was the first decrease I had ever seen after 4 previous scan had all gone up. Also had been doing nattokinase for 6 months prior.

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5. Improved angina after a few weeks, and feels great after half a year. But in other posts he says he has to take it for longer because he has too much plaque​
Depending on the severity of your atherosclerosis (amount of plaque) you may want to use it for a year or even longer. In my experience it was a matter of just a few weeks and i could feel my angina symptoms declide, then your fitness starts improving. I have been using it for half a year now and i feel great.
I could decide to stop at this point, but I don't want to because I know that there is a lot more plaque that may be cleared, even after my symptoms are gone....
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6. Lowered blood pressure, improved numbness on feet and hands, shortness of breath. On twice a day dose
Laurel Hosking
Ive been using Cavadex since 19th Oct. 2023 and what John has written is very similar to my reaction. My score wasn’t as high however my blood pressure was all over the place ranching from very high to high. Since using Cavadex the BP has settled down - I’ve not changed anything else re diet / lifestyle. The numbness in the feet and hands has lessened, shortness of breath has improved remarkably. I only use the smallest amount of lubricant as I found the lubricant caused most of my discomfort. I’m using 2 a day and will continue to for the first 2 months as advised. The support from the company is excellent and I’d like to thank Kyle, the man who has put his hard earned money and time into making this available . Will keep you posted on my progress
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7. Angina pains have lessened and the frequency of it. On twice a day dose
I'm also doing the aggressive dose for 2 months. I've just done my 27th dose this morning. My angina pains have lessened as well as the regularity of them.

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8. Lowered blood pressure and improved lipids. Improved angina and energy with bypass blocked at 70%. Same person that developed hemorrhoids​
Ian Kleiman
Jeremy Hawkins I don't want to post results, but my blood pressure dropped to normal and I stopped the BP meds. Also, my lipid numbers improved. I took about 4 1/2 boxes daily and being naive, got hemorrhoids really bad from not caring for my anus and having a kind of regular diarrhea. I had to stop taking the remchol for a few months and use various salves and do sitz baths to clear up the hemorrhoids (it took maybe 6-12 months to fully clear the hemorrhoids). I then restarted the remchol, only a few times a week, using generic preparation h as a lubricant and a nail file to smooth the ends of the tube. Now I take two tubes of the remchol on Fridays and Sunday nights (i.e., a double dose) and rest my butt the other nights. It seems to be maintaining my recovery. I also added a bidet from Amazon to my toilet. That thing really helps with anal health.

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His supplements:

Ian Kleiman
Jesse Dupree the list is long. Main ones are k2, D3, c, ryr [Red Yeast Rice], omega 3, coq10, magnesium

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Ian Kleiman
Chris Cangelosi I don't have any test results because I haven't had any tests that measure plaque or calcification since I began the cavadex. I only have my experience and the positive changes in my advanced lipid test numbers. I may go back to my local cardiologist one of these days and he might do some testing. It would be nice to confirm that the artery which had over 70% blockage has improved. I'm assuming it has, since my angina has mostly stopped and it was scaring me before I began the cavadex.
The other thing that I've been doing that I consider very significant is exercising
. I swim about 1/3 of a mile two or three times a week. I've been doing this since before taking the cavadex. It helped even before, buty symptoms were progressing until I began the cavadex.

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Ian Kleiman
Chris Cangelosi that's what happened to me. One of my bypasses was blocked at 70% or more. I was having angina and my energy level was way down. I just felt like I was gradually deteriorating. That's when I began using the cavadex. I was about ready to throw in the towel and have an angiogram and probably get a stent. the cavadex has given me a reprieve. I also do some other things. I've been seeing Dr Roberts proactively for some time and I'm taking a variety of supplements to intervene in various pathways. But they weren't enough.

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9. Possibly lowered blood pressure and improved angina. On cyclodextrin for 27 days​
Bill Certain
Chris Cangelosi I got two stents in December and that is when all of the test and scans happened. I got blood work done 2 days before I started cavadex and I have been using cavadex for 27 days/ 1 per day.
I can say my angina has went away and my blood pressure seems to be down. I’m on BP meds and still have always been in the high 120 or low 130 and I checked my bp today and it was 114/68. So it’s a little too soon to tell but I am very optimistic.

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Bill Certain
Still seeing my cardiologist and doing all the regular scans and test as normal. Not telling him about it until I know it’s working. I will let him tell me if the plaque is going away. I can’t go to him and say well I think I feel better and the angina I was feeling has went away. At my last visit he told me I had a 50% and another 60% clog that he didn’t fix while I was in the Cath lab in December. So I will keep it to myself for now.

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Part 2 of Good Ones — Facebook’s Testimonies List of Cyclodextrin

10. Lowered blood pressure and decreased cholesterol. Angina and energy improved.

Chris Cangelosi My cholesterol numbers improved significantly as well as my blood pressure. Haven't done any plaque scans, but my angina is nearly never from a scary level and my general energy level has improved. For me, this stuff has been a lifesaver.

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11. Some regression of CAC score by 2.8% after 6 months, despite taking statins (they increase calcification). Also takes more supplements.​

Had very pleasing test results today.
About 2-3 months ago my ldl and apob spiked. Ldl was over 4.2. I later found that this was quite likely due to using a Beef Tallow moisturizer that was being absorbed via skin into blood. This stopped and
I had statin changed from 40mg atorvastatin, to 20mg Rosuvastatin and 10mg Ezetimibe. And I requested a CT Angiogram.
Have been using Cavadex for 6 months.
Just had bloods tested - LDL down to 1.0. And CT Angiogram gave a calcium score of 272 - 8 points less than 12 months ago.
Very pleased.
I take a number of supplements and work-out at gym - mix of resistance, cardiovascular and HIIT.

https://www.facebook.com/groups/1538189873584084/?multi_permalinks=1930809624322105&hoisted_section_header_type=recently_seen&__cft__[0]=AZUcCrl2dshX-JB5KdCi0MoIwKFAwOjWeY3e9Y4s1cGYiw6dni6uaa8T2TE_03uFjxGaF1RiVTruyc-qdvAL_xKJHcj9L1rtW3CCrCztwDQyZG7ekFtLxOrcahQ8IS5vFqFIsBSJJQOBvoe-nXK21kNL&__tn__=,O,P-R

His supplements:

Nattokinase, Vit D, Vit K2mk7, Hawthorn extract, pomegranate extract, magnesium, garlic extract, vitb complex, sulforafane.

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12. Angina gone after 90 doses. No side effects other than loose stools
My hearing is fine & I've taken 126 6g doses so far this year. No side effects other than loose stools. Angina started easing up after 60 doses & completely gone after about 90.

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13. Angina went away in a week, and also opened up airways
Angina went away within a week. But, the most unexpected was that my airways opened up within a couple days, and i continue to see progress there. I've had lifelong allergies and let me tell you it was awesome!
I said that before about my airways and someone thought it was odd. No. Blood flow affect your entire body! Why wouldn't we have other awesome side effects?

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14. Mild angina went away in days
Its interesting... As there still seems to be alot they don't know about Cyclodextrins when it comes to treating heart disease. My mild Angina went away within days and that's something most experience on here and have confirmed... And as a medical layman you can only be read that as a sympton that something positve is happening... Reading internal plague reduction on a monthly or more regular basis is for obvious reasons a lot more difficult to confirm...

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Bonus. Unconfirmed, potentially reducing gout

Dominic Hayhoe My Cardiologist has numerous patients on Cavadex since it was brought to market... I said to him anecdotally what else has it reduced and he said without hesitations... Gout... Go figure

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15. Erectile dysfunction improvement with 1 year and 5 months and reduced ear wax
I have been taking 2HPCD for 1 year and 5 months now. I believe its working for me. My anecdotal evidence is a turnaround in ED & cerumen significantly reduces when I'm taking it (https://pubmed.ncbi.nlm.nih.gov/8486262/). I will take another CTCA in a couple of years to compare the progression of my CAC scores for confirmation.

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16. Erectile dysfunction improvement after 8 months. Also very slow CAC score progression by 4%. Lowered blood pressure way too much...
Guys, you can believe these ##s or not . In August of 2018 I was shocked to find out I had a calcium score of 891. I retested in August of 2021. I was incredibly bummed that my Calcium score increased to 1456. I had a whole bunch of test. Nuclear stress test, EKG and an angiogram. The angiogram reflected a 50% blockage in my LAD and 50% in my Right Coronary Artery. I have worked out 5-6 days a week all my life. My Dad passed away from his 2nd heart attack at 48 years. I have been on heavy stains, most recently 80mg Atavorstatin,10 mg ezetiminbe, and Rapatha.( Also 50mg Losartan/hctz). This has just reduced my cholesterol but only worsened my calcium/plaque scores. I had my 3rd calcium score in August of 2024 where my score increased to just over 1600. Please note, when you have cad your scores typically increase by 20%-25% annually. I had expected my score to be approx 2600( 1456 x 1.2% over 3 years). I had only been on Cavadex for 7 or 8 months( heard about 2 Beta Cyclodextrin and Cavadex in February of 2024). So my score still increased but only by 4% per year( not the 20%-25% that my Drs and myself had expected). Other benefits ( my blood pressure has dropped from 180ish/95ish to 115ish/ 60. Also I have had ED for approximately 10 years, now I wake up like an 18 year old( every night). Sorry, to be so blunt, but I sleep like a baby and can exercise ( hard) for a few hours 6-7 days a week. I have spoken , texted and emailed many people that have seen their calcium scores drop. I really think mine did( 2600-1600). Believe me or not. Just passing on my info and experiences. Blessings to all.

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17. Tinnitus disappeared after a year and blood pressure decreased by 10 mmHg, but he also takes a lot of supplements. [Although in someone else, tinnitus increases and then subsides]​
The sound of silence....

There has been quite a bit of discussion on the otoxity of HPBCD Cyclodextrin, hearing damage caused most likely by a cholesterol "shortage" which occurred mostly in Niemann-Pick treatment with IV injection of HPBCD.

So I suppose you would like to hear a positive note to this regard, after listening to high-pitch sound in my ears for at least 2 decades, today is the third day this week that my Tinnitus suddenly has disappeared !

So I can listen to the sound of silence, it is breath-taking !

And this happens unexpectedly after now almost a whole year of daily use by enema of first 12 grams and later 8 grams of HPBCD cyclodextrin.

I will never know what exactly caused this, my BP also appears to have dropped recently from 130/80 to 120/70


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What he takes:

I asked Grok 4 (the only AI I have an 'advanced' subscription for at the time) to dig through my supplements list, looking for the ones that are likely linked to my disappearing Tinnitus, here goes:
Alpha lipoic acid (1200 mg total): Yes—multiple studies show reduced tinnitus severity/handicap, especially with metabolic issues or antioxidants.
Vitamin D3 (100 mcg total): Potential link—deficiency is common in tinnitus patients, and supplementation may reduce symptoms by supporting vascular health and reducing inflammation.
Vitamin E complex (500 mg total): Limited/mixed—may help as an antioxidant in blends for noise-induced tinnitus, but no standalone trials show consistent relief.
Magnesium citrate (400 mg total): Yes—evidence suggests it reduces tinnitus handicap and severity, especially in deficiency or noise-related cases, via neuroprotective effects. A phase 2 trial showed benefits on handicap scores.
Fish oil (4000 mg total, high EPA/DHA): Mixed—dietary omega-3s (e.g., from fish) link to lower tinnitus risk in longitudinal studies, but supplements may not help and could increase risk in some. Potential via anti-inflammation
Curcumin (40 mg micelles): Limited—animal studies show protective effects on cochlear cells, but human evidence is sparse; may reduce via anti-inflammation.
CoQ10 (400 mg total): Yes—clinical trials show it decreases tinnitus severity and disability, especially in presbycusis (age-related hearing loss), via antioxidant support.
Fenugreek seeds powder (3000 mg total): Anecdotal only—no clinical evidence, though some herbal sources suggest it for circulation.
Pine bark extract (200 mg total, 95% proanthocyanidins): Yes—studies (as Pycnogenol) show it improves cochlear blood flow and reduces tinnitus symptoms in short-term trials.
Kyolic garlic (2000 mg total): Limited—aged garlic extracts show minor circulation benefits, but evidence for tinnitus is weak.
Ginkgo biloba extract (260 mg total, with Siberian Ginseng): Mixed—some RCTs show reduced tinnitus severity via improved blood flow, but Cochrane reviews find inconclusive/no benefit over placebo.
Neprinol (4 tablets total): Limited—no direct evidence, but enzyme blends (including nattokinase/serrapeptase) may reduce inflammation; anecdotal for circulation.
Quercetin (200 mg total): Limited—protective in ototoxicity models, but no strong human tinnitus data.
Niacin (1000 mg total): Mixed—older uses for circulation, but high doses can cause/worsen tinnitus; some trials show no benefit
Vitamin B-complex (high dose with 1000 mcg B12): Yes for B12—if deficient, supplementation improves symptoms in some studies; B-complex may help overall.
Spirulina powder (1 g): Yes—studies show reduced tinnitus scores via antioxidants/downregulating NMDA receptors.
Chlorella powder (1 g): Limited—similar to spirulina for antioxidants.
Pomegranate juice (100 ml): Limited—protective in ototoxicity studies, may reduce hair cell damage.
Creatine: Limited—protective in noise-induced hearing loss models.
Taurine: Yes—animal studies show it attenuates tinnitus via inhibitory tone
Pauling protocol: Limited, although I as a human have the feeling this helped me to lower my blood pressure ?
Reminder: There is no set of supplements that can compensate for a unhealthy lifestyle, I am taking no meds, not even a baby aspirin !

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Jeremy Hawkins I take 18 grams of vitamins C. 12 x 1 gram time released ascorbic acid (one every two hours) then in between 6 x 1 gram liposomal C 6 x 1 gram l-lysine and 4 x 500mg l-proline. I think it is essential to spread the doses out through the day as much as possible as these all get flushed out or used up very quickly. Come join us in the Linus Pauling Protocol group ?

I think the Pauling protocol is what helped my BP drop 10 points recently but I am sure there is more to it when it comes to my tinnitus, which is again absent this morning !

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18. The longest on cyclodextrin for 4 years, now on every other day dose, along with 40 other things without apparent side effects

I got into this 'adventure' after talking with my friend Jeff Sirpinger who was one of the earliest customers of Cholrem over four years ago. He's still using 2HPBCD (my method) today and feels great.
[..]

I just had to jump in and say that I second your sentiment. I still take the stuff because I'd like to think it's keeping me clean. Time will tell. I'm only 57 and that's about the time my father (who turned 85 this year), was having his first heart attack...and he was an AVID "walker" for about 35 years now (about 30 miles a week for the health aspects of it). And I sit for a living...meaning - I don't have a chance to walk even TWO miles a week...(I work 6 days a week and 12 hours a day sitting in a chair "doing" cybersecurity stuff for the U.S. Army in Kuwait). I feel like I have few to no options other than controlling my diet, taking supplements (like D3 and Nattokinase (which is only 2 out of 40 that I take daily)) and...cyclodextrin. MANY contractors just plop over, dead, out here...all heart problems. At least a couple a year go like that that I know of...and I don't want to be one of them. So yes: maintenance. Bill's method of "DIY for cheaper!" is GOLD... Been doing that now for a week, and upped my maintenance to do as Bill does: every other day. I feel better now doing that than I did doing it two days a week (back to back). So, my thought: if you can afford $12 a week to "DIY for cheaper" for maintenance - do it. Gives me GREAT peace-of-mind!

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19. From another FB group. One stenosis gone with other blockages unchanged, and CAC score increased. Lowered blood pressure; did it for 6 months and had to reduce blood pressure medication by half, and more energy

UPDATE: I had my scan and the initial results show an increase in my CAC score from 383 to 515 over the last 10 years. Although my CAC score has increased, blockage percentages are virtually unchanged, with one of the 5 blockages gone. I have a follow up appointment with my cardiologist August 14th.

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So I've been using 8gm doses for the past 6 months. For the first 3 months I used it every day, then 2 times a week after that. Around the 4th month I noticed I was getting a little light headed at times. Turns out my blood pressure was getting low and I had to cut my Losartan BP medication in half. I feel like I have more stamina as well as I can play Pickleball 3 hours a day without getting winded or exhausted. My next step will be to get another heart scan. Last one I had was 10 years ago with 5 plaque blockages. No stents as none were greater that 50%. Should be interesting to see what it looks like now.

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20. From another FB group. Cyclodextrin + Supplements regressed CAC score by 9.5%, then stopped taking it and CAC score increased again​
David Dahlman
Terris Stoddard It's been a long path with mixed results because I'm such a bad patient. I had a CAC score of 178 and about six months after that result I began nattokinase and then 3 months later I found cyclodextrin and used it for 3 months before another CAC which was 161. This was the first decreased result as the prior 4 tests were 78, 84, 113 and 134. Always went up. I then got lazy and used those products on and off, definitely not consistently. A year later my CAC was 194. Since that score last February I am consistent with cyclodextrin about 5-6 times a week, natto everyday for a few weeks then I switch to lumbrokinase everyday and then back to natto. I alternate about every few weeks. The PlaqueX I take everyday. We'll see when I have the next CAC test.

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What he takes:

Supplement stacks are discussed everyday and we are still building plaque. This is why my focus is removing plaque with nattokinase, lumbrokinase, cyclodextrin and phosphatidylcholine (PlaqueX).

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21. Recent comment on a Midwestern doctor article. Back to walking miles every day and feels wonderful. Also takes a lot of supplements​
Thank you for another excellent article that hits close to home. I am 75 y.o. and have severe atherosclerosis. I have zero interest in statins, stents, or surgery, and I have been doing my own research and trying anything that seems likely to help.
I wish you would enlarge your discussion of plaque formation and how to address that. You did not at all address calcified plaque. I mention that because rather than "markers" of heart disease, I prefer a real measure, such as the Coronary Artery Calcium Score. Unfortunately my CAC Score is 6100, and although stable plaque may in general be less of a threat than soft plaque, a score like that still indicates significant blockage. Could you please add anything about calcified plaque or how to address that?

I have been taking Neprinol (in addition to extra high dose natto), berberine, high-dose Vit C, lysine & proline, Vit D & K, quercetin, Alpha lipoic acid, curcumin, molecular hydrogen, nitric oxide boosters, grounding, nasal breathing, exercise, sensible diet, good sleep, etc, etc.
One of the more recent additions to my self-care program is 2-hydroxy-propyl Beta-Cyclodextrin
. I started buying and mixing it myself while FDA was blocking its import, but currently I am using the Atherocare product from Australia. As of today, I have taken 146 doses (117 Atherocare, and 29 of my own prep, dissolving 5 tsp - approx 11 g - in distilled water, with a bit of sterile saline, and applied with an enema kit). As much as I loved and shared your many DMSO articles, I think you could really energize your readers if you addressed 2hp-bCD. Dr John Roberts (www.heartfixer.com) has treated hundreds of patients, who often are free of angina or any other symptoms with 3-4 weeks !!!, and he truly speaks "from the heart" that this treatment can save millions of live and billions of dollars. I am back to walking miles every day, and I feel wonderful (but hot here in FL), and I totally agree with Dr Roberts. Please consider an article on this.

What They Don't Tell Us About Heart Disease

22. Potentially better or worse with DMSO? This one mixes it with DMSO with angina improvement and topically ‘down there’ with DMSO gel for his Erectile Dysfunction, and noticed improvement.
It’s unclear if it’s better or worse with DMSO. AIs say it could potentially make it less effective or maybe synergy. Some user don't think it's better because you don't want more absorption, as it might go to other places like the cochlea hair cells and cause hearing loss. But who knows…​
Maybe Mark Sircus used it with DMSO, but who can tell if that made it better or worse in his case?​
Also another user that combines it with ¼ tsp DMSO, has complained of fatigue while on cyclodextrin, but he doesn't mention if the fatigue stopped after weeks of cyclodextrin​

Shahid Chohan
Actually this is the way I have been doing it all along. I use the liquid form of dmso and add anywhere between 0.1 - 0.2 ml by injecting it into the micture and then shake it well before use. The idea is that Dmso wil give a far better penetration and absorption when added just like it does with everything else. And I suspect this is the ingredient that propably is added to the Cavadex's top product wich is claimed to have a better absorption.
While we are touching this topic I can also share that I have also applied dmso gel mixed with Cavadex topically on the penis and it defenately has an effekt there as well 😎

Fred Mills
Shahid Chohan as an ED protocol?

Shahid Chohan
Fred Mills yes, first apply dmso, then add the cyclodextrin bit by bit. Obviously its a sugar so it gets sticky, so I add a little water and more dmso as I go along. As mentioned earlier, I have been using the cyclodextrin mixed with dmso from day one. And I noticed the benefits and reduction in angina already after 5 days, so I dont think it disturbes the absorption, rather the other way wich has been the intention all along

[Couldnt find the source link for this conversation, as if it disappeared/deleted?]

https://www.facebook.com/groups/1538189873584084/posts/1943371613065906/?__cft__[0]=AZU6jsCkTAdERXhVWHW31JjUYoTbKqCwz1uj8YliPcIlpxRm5lDg_Eq7mcO0pT1V3A6xTd4ZYehjxhbjqWcJbFx1ZbTOLd8vpu49nFD4mqfnrUomNdMWrzKrxVt7bJMOLtN06pihkIO0y44PIoajDb09&__tn__=,O,P-R-R
]

[DMSO + ¼ tsp]

(2-Hydroxypropyl)-Beta-Cyclodextrin (HPBCD) is not a starch. Its a derivative of a starch but it's not a starch. I combine it with sterile water, 1/4 teaspoon of dmso and a teaspoon of frankincense essential oil. The frankincense keeps the hpbcd from being so sticky and it helps it to penetrate into the vascular system. It also counteract the dmso smell. I have ordered an rectal injector but I may continue with the transdermal. The rectal injector would only require hpbcd to be mixed with a small amount of water.

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Anybody feel exhausted during the first week of using Is 2-Hydroxypropyl-beta-cyclodextrin the generic form of Cavadex?

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Bad and Neutral Ones

23. Worsened angina after a month with it, so he stopped doing cyclodextrin.​
Couldnt find the source, but I remember this.

24. Worsened angina after changing brands to Atherocare, but Sircus used this brand too and it worked for him, unless they switched suppliers, something Cavadex accuses them for…​

I don't normally comment on facebook but I have to say that I was on Cavadex for 2 months. My angina went away and my cholesterol and blood pressure went down. I ordered Atherocare and tried it for a month but my cholesterol went back up and my angina came back. I don't think Atherocare is the same as Cavadex.

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25. Neutral. Not much improvement in angina even after a year​
Just an update: I have now completed 52 weeks of daily Cavadex, the severity of the Angina has dropped about 2 points out of 10, I also take K2 and 12000 of Natto so the combination appears to have helped but I still have a long way to go, am I happy with the results, no not really seeing so many folks report Angina free after several weeks, so I hang on in there in the hope that it will continue to improve, wish me luck fingers crossed etc.

https://www.facebook.com/groups/1538189873584084/posts/1830806147655787/?__cft__[0]=AZVYi6SMv-s1X9a4niJF8Ekn1JSGzPZyimPY3yOyQYrRPgHX07J8hC_QoQXaqMOpo2wNuuY40qP2IC6gJkh-c2s6m3uODZfLU-cqORca9HD9d6TUKZNLO8PjtlAc6ewx6wKz2rXLVv2ijmCaOoGfNcxm&__tn__=,O,P-R-R

26. Neutral or good one? CAC score did not lower. It progressed by 18% in ~1 year. But still, lower progression than average at 20%​
Bart Adriaanse didn’t mine…mine went up

Debra Stein a year and 3 months. 575 to 680

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27. Improved lipids and blood pressure, but angina got worse​

I've been using mostly low dose Cavadex and Atherocare for 8 months, and while my lipid numbers and blood pressure have significantly improved, I'm sad to say it has not made a dent in my angina attacks which have actually gotten worse. I will be consulting with Dr. Roberts in a few days to see if I am doing something wrong and listen to his recommendations.

Allan A on Dr.Sircus

28. Neutral. Angina did not improve much after 82 weeks​
Just a quick update, I have been using Cavadex now for 82 weeks, the last several months I've been using 5 days a week, my Angina severity has reduced by about 3 points but I still get the occasional level 9. So I'm a bit disappointed in the progress as so many people report getting rid of their Angina within 4 weeks, I also take Natto and K2, Berberine, Aged Garlic, Hawthorn and Ginko, 7gm of Vit C, Im about to add Magnesium as my last blood test I was on the low side. I still have 3 boxes of Cavadex to work through before I decide on how to continue, Im also on a mostly plant based diet and have been for over 10 years, the cold air and walking triggers the Angina and it will also wake me most nights about every 1-1/2 hours , a spray of Nitro knocks it off within a couple of minutes. Winter has just ended here tho its still pretty cold lets see how I cope during spring/summer. Cheers the battle continues.
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29. Neutral. No beneficial effect?​

I would be very interested, cavadex dosent do much for me

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30. Possibly worsened vision? Although the founder Kyle Hodgetts mentioned his got a bit better on IV cyclodextrin, supposedly.​
One person mentioned in one of these groups that their vision got worse.
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Eyesight deteriorated since using Cavadex? My eyesight has rapidly and very markedly deteriorated this year, since I began daily using Cavadex in January. Could there be a correlation? - Cataracts, floaters, blurred vision, myopia.
Has anyone else experienced this?
I am very concerned. Any thoughts please?

https://www.facebook.com/groups/1538189873584084/posts/1761091534627249/?__cft__[0]=AZXijdTBUE8VR6fQnqkOcDeb1uCr5nh6pEjBFQoS8yVyvI8XpsvGX-AGEdkMNdG8PEbbsLaLXy3_2cHbknZou34TGub9qWEt6WjfuuIZHv_FZ0-1M8DSR1Lknj9uyRDjeOQCQTSZqk3O-OR-Xb_f2FqDW7drZVtv5ZmoCmjitFf3GIe7u5Hs3jKo4KjodYMMras&__tn__=,O,P-R

31. Possibly worsened blood sugar? Although other diabetics report no sugar spikes while on cyclodextrin
I have been pre-diabetic for many years and have kept it under control for the most part through diet and exercise. I also have atherosclerosis and have had by-pass and 12 stents placed since the by-pass in 2005. I have been giving CD a try the only change I have made and my AC1 went up into the range of diabetic 6.7. I discontinued using CD about a month and a half ago because I had seen some posts suggesting seeing its a starch it could affect glucose levels. My AC1 has dropped down to 5.4. Take it for what you will but I have done fasting glucose tests before and after taking CD and they run about 10-12 points higher after use?
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32. Complains of fatigue, and nausea for 40 mins after cyclodextrin. Also the one who takes it DMSO complained of fatigue, but I don't know if he still has fatigue.​
This stuff makes me feel exhausted, sick and nauseous 40 min to an hour after taking it.

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33. Possibly worsened yeast overgrowth​
My first week of TUDCA (twice daily before meals) and 10ml HPBCD at bedtime. I developed itchy bumps on my thighs and buttocks after starting this protocol. Not sure if it's a detox or allergic reaction of some kind. Has anyone experienced red itchy bumps after taking HPBCD?

It's yeast, the hpbcd is a sugar and your butt and thighs are warm and could be damp, I developed it, oil of oregano on a cotton ball (mix it 50/50 with either olive oil or jojoba oil)twice daily and keep the area clean and dry.
Traditional yeast medication didn't work for me, only the oregano mix worked

yes, I'm a nurse so I recognize yeast
Red, bumpy and itchy,
The hpbcd is a perfect food for yeast, my body isn't acidic so yeast can grow easily when fed
People who eat bread, drink beer or wine are also susceptible to yeast as are low acid people

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Other

Increasing and Decreasing Lipids

According to a study, it could increase cholesterol production in response of extracting cholesterol by cyclodextrin. So, I’ve read people reporting both decreasing or increasing their LDL numbers.

34. Possibly increased his LDL from 3.1 to 4.2 mmol​
I've been using cavadex daily for 4 months - some days missed.
Take a supplement stack as well as statin, asprin and ace inhibitor.
Exercise in gym. BMI 26.
Blood pressure down nicely to 117/75.
Just had bloods tested. Hdl and triglycerides really good. Fasting glucose good. But LDL cholesterol shot up to 4.2 mmol/l (162 mg/dl).
Use a low carb diet which can cause ldl to spike.

[...]
Lipids always tested fasted. Last test 7 months ago was 3.1 mmol/l. Has been as low as 2. On atorvostatin (lipitor) 40mg
[..]
Am low carb, higher protein. Currently using omega 3, vit k, nattokinase, coq10, vit b complex, bergamot, citrulline, taurine & enzymes
[..]
Diet is whole foods based. Enjoy more wine than i should on weekends.
Exercise 4-5 times per week.

https://www.facebook.com/groups/1538189873584084/posts/1878566309546437/?__cft__[0]=AZViCltcMZE1EzIZf-NBe7qmrJRcNwqcv2Q60ZbQ413FicZtFNYwa2KG5kx9deXSl0JafWIJOyOyAffYXjprnUEiGzyo6EzUwMeeTTmL4h3BhbCCLe0Hq4XoxFeCA4sOO6i3cSr_8CPX31kHn1JQCSBo&__tn__=,O,P-R-R

35. Possibly increased lipids and triglycerides​
My lipids and triglycerides went up after 6 months of home-made treatment. Treated the day before a fasting test. No other obvious changes but will watch keep watching. Next time, I will abstain for a week prior to testing.

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36. Possibly increased Lipids. After 3 months went from 5.6 to 7.6 nmol, but he stopped taking statins.​

Remchol hasn't helped to reduce my serum cholesterol over three months. I still need to get a calcium score done to determine its efficacy on crystallised cholesterol.
The attached photo shows my blood test results on 13th September 2023 (green square) - this is the date I started taking Remchol - compared with my blood test results on 8th December 2023 (red square).
I agreed with my GP to temporarily stop my statins (Vytorin) until we got these follow up blood test results on 8th December 2023.
My serum cholesterol levels have shot-up in these three months (total cholesterol from 5.6 to 7.6), so I am going back on statins today.
Recently, I have read about Nattokinase. I am considering trying this now as well. I am almost through my third box of Remchol. At the moment I am intending to finish this third box, and going onto the maintenance protocol of 2-3 doses per week for the fourth box and maintain this until I have further information.

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37. Possibly lowered lipids​

After 3 months of Cavadex my Cholesterol dropped into the normal range without any medication. I had been taking 1mg of Livalo but decided to just stop taking it. I was not using Cavadex when I had the Labs drawn. Was taking a cyclodextrin vacation. Very happy as I've always had high cholesterol.

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Ear Ringing
38. Possible ear ringing after application​
So l asked if anyone else has had any effects on hearing a few months ago because l had ringing in my ears after application lasted a few hours. I have now developed what I thought was a ear infection in my left ear. After 2 months I went to a ENT and they thought it was menieres syndrome. They did a hearing exam and l had slight hearing loss in the higher range. The doctor did not know what l was talking about when I told him l was using this product. So I don't know if it has anything to do with it or not? But am reluctant to continue with the treatments as my ear problem seems to be getting better since I quit using it.

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Chris Taylor Yes I am in the USA but thank you I may just do that unless I can find for sure its not affecting my ears. Many have said a little hearing loss is not that bad but its not just that but its very uncomfortable having the pressure in the ear and it also affects your balance when it gets bad. The ENT thinks its Menier's syndrome but that is supposedly real rare in the US and there is no test to see if its that. Some have said covid and or vaccine side effects but this all started after I began using remchol?? He had no idea about the product when I told him I was using that so could not rule it out.

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39. Ear ringing after application. Although others mention no hearing worsening​
I have noticed ringing in my ears after application for a few hours.
[...]
Chris, both my brothers have Tinnitus, so I kind of think it's kind of normal for a 61 year old. I will monitor, but I feel the risk of heart issues are greater than my hearing slowly regressing. I have been making my own 2 beta Cyclodextrin enima(2 per day). Hopefully this is reducing plaque. Feel good and sleep good

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Hemorrhoids
40. Careful about developing hemorrhoids due to diarrhea, otherwise you might need to take a break​
You need to be careful about the diarrhea irritating your anal area and causing hemorrhoids. I finally bought a bidet attachment for my toilet and I'm very careful about using it. I also bought some salve with natural ingredients, and I use a generic version of preparation h as lubricant in lieu of the stuff that's shipped. Proactive anal care can save you some real grief. If you start to get irritation or swelling, pause your usage for awhile and heal it up before it turns into hemorrhoids. I was ignorant about this and got really bad hemorrhoids after about 4-5 months of daily use. It took 6mos to a year to really heal up. I finally figured out that keeping the anal area really clean is the best way to stop the hemorrhoids.
I take it at night before showering and then bed. I can retain it all night. I finally figured out that the easiest way is standing next to a counter and bending at the hips before inserting the tube. No muss, no fuss.


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Ian Kleiman

Jeremy Hawkins I don't want to post results, but my blood pressure dropped to normal and I stopped the BP meds. Also, my lipid numbers improved. I took about 4 1/2 boxes daily and being naive, got hemorrhoids really bad from not caring for my anus and having a kind of regular diarrhea. I had to stop taking the remchol for a few months and use various salves and do sitz baths to clear up the hemorrhoids (it took maybe 6-12 months to fully clear the hemorrhoids). I then restarted the remchol, only a few times a week, using generic preparation h as a lubricant and a nail file to smooth the ends of the tube. Now I take two tubes of the remchol on Fridays and Sunday nights (i.e., a double dose) and rest my butt the other nights. It seems to be maintaining my recovery. I also added a bidet from Amazon to my toilet. That thing really helps with anal health.

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Where To Get It


AFAIK, if you want a finished product, there are only two companies that sell it as a mini retention enema, created by the same founder, Kyle Hodgetts, both in Australia.

Cavadex.com, the one that shipments to the US won’t go through because of the FDA embargo and whose product is more expensive, and Atherocare.com which they offer a one-time code for 20% (“NEW20” newsletter sign-up) plus 15% off from subscription. [There’s also the 15% discount code “CNACSUB”, if you’ve already used the 20%] It takes about a month to reach the US with express shipping with Atherocare.

And even though there’s a US tariff for Australia, there were no reports of paying taxes from that, as of July 31th.
On August 25th, Atherocare sent an email saying that due to the recent US tariffs they will not raise their prices, but change courier; whereas Cavadex is or was thinking of increasing theirs by 100%...
Recently, Cavadex filed a lawsuit against Atherocare. [I wonder what will happen to Atherocare..]
Also, I was told to only order for 6 months of Atherocare, because if you order for more at once it might get retained at customs.
Recently, on Sept 9th, Atherocare posted on their FB group that for the US customers, Fedex will sometimes ask, usually by email or phone call, for a TSCA (Toxic Substances Control Act) authorization letter to deliver. For that Atherocare says to fill out a form they put on their website and send it to support@atherocare.com and they’ll take care of the rest.


Or if you want to DIY/Mix Your Own (MYO), order the powder from China and prepare it. More on that further below.

There are other ways to administer it and from other vendors, even another type of cyclodextrin, but with even less testimonials and unknown benefits. But here they are if you want to know them. From James Roberts:
HPbCD Troches: In relation to the FDA Cavadex embargo, I asked Kieu Okuley RPH, of Okuley's Compounding Pharmacy, in Defiance Ohio, to create a non-rectal HPbCD. Kieu did the research and came up with 1000 mg
HPbCD troches. These semi-solid cubes, placed between your cheek and gum, will dissolve slowly, such that the HPbCD is taken up by the oral capillary microcirculation, as opposed to swallowed into the GI tract. I have
taken the troches twice a day without GI distress. How HPbCD troches will compare to rectal HPbCD is a great question that I will try to answer, based upon how my patients respond. HPbCD troches can be obtained from
Okuley's with a physician prescription. While the HPbCD troches dose is fixed at 1000 mg, it is up to us as to how many troches to take per day (they take 20 minutes to dissolve).

Albedextrin formulated by Spencer Feldman of remedylink (remedylink.com) is a blend of alpha and beta cyclodextrin, designed for oral use. I learned about Albedextrin from a patient (like everything else I do that is good).
Talking with Mr. Feldman is like talking to my organic chemistry professor is college - Spencer knows his formulation chemistry! I will not give away the secret, but Spencer found a way to enhance cyclodextrin absorption. Albedextrin is provided in powder form. You mix one pouch with water, store it in the fridge, and take a dose on a regular schedule (instructions on the remedylink.com website), cutting back on the dose or frequency if
nuisance GI side-effects occur. As oral cyclodextrin can bind up phosphatidylcholine and fat-soluble vitamins, Spencer recommends corresponding supplementation if long-term use of Albedextrin is planned. Spencer has a
number of other quite interesting supplements, several of which I am now taking. His website provides a plethora of information. As with cyclodextrin troches, over I time I will develop a feel as to how these new cyclodextrin approaches compare to rectal HPbCD, the benefits of which are documented elsewhere on this web page..


https://heartfixer.com/Cyclodextrin.htm#:~:text=In the meantime, we can't let this regulatory snafu set your back, and in relation to the FDA Cavadex embargo, three alternative sources of HPbCD have been brought to my attention, as presented below:


One albedextrin experience from the author/vendor:

Paulo Desouza
yes Shahid Chohan . Spencer Feldman took this compound orally for 33 days. He had ultrasound images of his carotid arteries done before and after. The largest carotid deposit blockage showed a regression of 5%. It comes in a powder form. It sort of floats on the top of the water in your glass before it dissolves, unlike regular cyclodextrin powder. There is no marketing campaign behind the product. This 5% drop in such a short time is a very significant result.

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And one study using oral alpha cyclodextrin, if you’re interested:

Alpha-cyclodextrin was the most effective inhibitor of [Cholesterol Crystals] CC-induced complement activation, with the reduction in deposition of complement activation products being significantly different from the reduction induced by 2-hydroxypropyl-β-cyclodextrin. We also found that α-cyclodextrin was able to dissolve CCs.
Conclusions
This study identified α-cyclodextrin as a potential candidate in the search for therapeutics to prevent CC-induced inflammation in atherosclerosis.

[...]
In humans, oral intake of ACD has also been shown to have beneficial effects. In obese type II diabetic patients, oral intake of ACD was shown to increase insulin sensitivity and to reduce LDL-cholesterol in the patients that begun the study with hypertriglyceridemia [27]. In overweight patients, oral intake of ACD reduced body weight and reduced LDL-cholesterol and total serum cholesterol [28].
In healthy individuals, oral administration of ACD reduced the blood level of smallLDL particles and fasting plasma glucose concentration [29]

https://www.sciencedirect.com/science/article/abs/pii/S0021915019300589#:~:text=Alpha-cyclodextrin was,in atherosclerosis.


Importing It

If you are in Brazil, Mark Sircus, on the same video, mentions that his Atherocare packages were retained at customs twice. Then they used DHL and it got through.


Reputation of Australian Companies

Kyle Hodgetts and Cavadex/Cholrem

It’s time to mention Cavadex/Cholrem and Atherocare founder, Kyle Hodgetts, a video game programmer. There were rumors of him being a ‘known conman’ and the reference I could find was an australian article (and 2) in 2015 of him saying that he was seeking damages over a TV program for defaming him. The program was about “Hodgetts’ alleged overdue rental payments, fraudulent tenancy applications and various name changes. Hodgetts claims it led to the subsequent derailing of his career.” And he claims he lost so much money because his game was going to be the biggest next thing but not anymore due to defamation. He sought to claim $2.4 billion in damages…

Now, If you want to know some of his story with cyclodextrin, from his perspective, is here (mini book) and this video.

Despite his possible bad past history, we owe it to him for the bravery and intelligence of researching a substance and successfully trying it on himself, and making it available to the public, spreading to other doctors.

That said…
Back to the present, from what I read on his facebook group (a different one) (2 months ago), people can still pay for their order and the package isn't delivered in the US because of the FDA embargo. I don't know if it has changed now – I don't think so, because he didn't comply with the FDA in removing the health claims and interviews – but it is scammy, to say the least, that his company still accepts orders from the US and yet won't deliver, effectively robbing people… Customer support won't answer and won't issue refunds, maybe send replacements but what's the point if they don't arrive? Notice, it also happened to someone in Spain, not in the US... (And I've seen he deletes posts on FB.)
So, these people have to dispute the charge with their credit card.


Also the text testimonials on his website sound more incredible to me than the ones people report on a different Facebook group, but who knows…

And I didn't include the testimonies from his facebook group because some seem too unrealistic for me, compared to the other facebook group. But if you want to see some of them, have a look:

1. So it improved everything, including glucose? CAC progression at 9.8%​
Guys, I also am a big fan of Cavadex. I have been on for 1 year. All of my numbers have improved ( blood pressure, ldl, glucose ect). Sleep has improved, my stamina has increased( big time along with my ED [Erectile Dysfunction] issues). My August 2025 CAC score was stable (1600 vs 1456)from my August 2022 score( surprisd my Cardiologist). I am excited to have this calcium test redone. I also plan on a new Angiogram ( as soon my Cardiologist will agree to schedule). Everyone with calcium/plaque issues need to consider this wonderful product 🙏. I am always available to tell my testimony in greater detail. Blessings to all

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2. Ear ringing after application​
-Tim Bruin Hi Tim, have you experienced any temporary loss of hearing? At high doses (much more than in the tubes), I've read studies that show Cyclodextrin can cause temporary, then permanent loss of hearing.

Top contributor
Robert Zickefoose no. But to be fair, there have been times that I have noticed a buzzing in my ears for 30 minutes after applying

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3. Unrealistic. Yeah right, apnea improvement (wonder how), lowered tachycardia on mild exertion, and CLEAR stents and arteries WITHIN a YEAR from 90% blockages?!
had a hereditary form of accelerated atherosclerosis that led to six major blockages and four minor heart attacks between 2017 and 2023. I required six coronary angiograms leaving me with a mid-LAD stent and four LCx stents. I started on RemChol in early 2024 and after nine months use, in November 2024, I had my first clear angiogram in seven years. When starting on RemChol it took about three months for my noctounal dysponea to stop, and probably around six months for the tachycardia upon mild exertion to lift. My Interventional Cardiologist went ahead with an angiogram in November 2024 due to my cardiac history, and it was a pleasant surprise for both of us, to say the least, to find the arteries and stents were clear. I had been growing 90% blockages within existing stents in under a year, and was told my plaque build-up was around twenty times faster than conventional lifestyle driven atherosclerosis. RemChol can put someone like me into remission, and should be the very first therapy offered to atherosclerosis sufferers.

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4. CAC score regression by 33%, unclear how long did it take. Stopped angina, palpitations and shortness of breath​

My calcium score was 225 and now is 150. I was having chest pain and palpitations and now I’m not. I was short of breath with work and now I can work all day without feeling out of breath.

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5. 20% plaque regression in one year with diet, medications, supplements and 3 months of cyclodextrin…

Chris Cangelosi I went from 70% blockage to 50% blockage.

my right coronary artery was the one that was 70% blocked and now it’s 50% blocked. The second scan was done on a different machine (original machine damage in flood).
I don’t know what combination of the things helped lower my plaque but this is what I did over the last year:
-Almost completely whole food plant based diet with the exception of pizza twice a month and wild salmon twice a month
-walk about 3 miles a day and easy weight lifting 2 times a week
-Cavadex for 3 months
-Rosuvastatin 20mg
-Ezetimibe 10mg
-Nordic Naturals Algae Omega 715mg
-Kyolic Cardiovascular Health Aged Garlic 1000mg
-Life Extension Arterial Protect
-CoQ10 200mg
-Magnesium 250mg
-Vitamin D3 5000 UI
-Vitamin K2 100mg
-Homocyteine Supreme

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6. Stopped progression​

I have taken it for 40 days. Got my carotid artery ultrasound. Last year 50%. This year 50%. So not sure yet. Guess after I finish last topic, two packages and get tested next year
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7. Lowered blood pressure he had to stop medication, without lifestyle changes…​
Blood pressure was steadily creeping up to 130-135/85-90. CTA revealed a calcium score of 346 although stress test showed good blood flow. Put me on blood pressure meds and statins. Felt horrible. Started taking Cavadex and within 3 weeks blood pressure dropped so low doctors removed me from blood pressure meds. My pressure now after 6 boxes of Cavadex is routinely on average 110-115/70-75 with no other lifestyle changes.

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8. Unrealistic. 20% plaque regression in 3 months…​

I’m a fairly new customer. I took chelation by IV before the pandemic and stopped because the pandemic. (It was not a prescription and not covered.). A few years later I took chelation by pill form (this time by prescription and it was covered!!) But it didn’t help with blockage/narrowing at all.
My Dr. recommended cavadex. My ct angiogram and ultrasound showed 70% blockages. After taking the kickstarter package, the same tests show less than 50% blockage!!!
That’s OmaZing results in 3 months!!!

I ordered more cavadex.

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9. Lowered blood pressure so much he had to lower his medication various times… AND within a week(s)...​

As I have said repeatedly I would never be without Cavadex, I have a 2,663 calcium score I've had two sets of two stents put in my heart I've had my carotid artery cut open scraped out and stitched together with pig skin I've had a stroke and I was on four ramipril and still not controlling my blood pressure then I got on Cavadex and within two days I had to drop down to three ramipril by the end of the week I had to drop down to two because my pulse and my blood pressure were getting too low and I ended up getting down to one ramipril within 2 weeks amazing stuff there's no downsides healthwise it's not a drug what's the problem bunch of idiot lawmakers don't know shit from shinola

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10. Even using it on and off, angina stopped with better blood pressure..​

Ive been on off for two years. Im lazy. Had a stent put into my left descending 21 months ago. My bp is better. Angina stopped. Am on repatha shot and no statins. 4 months ago trig. around 100 n total chlor. Is in the fifties.

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11. Unspecified improvement​

My husband has severe cardiac disease and this is the ONLY thing that has made a difference!!! So thankful to find Cavadex!

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He says he did communicate with RFK Jr. about the FDA embargo and cyclodextrin benefits, but haven’t heard back.

The studies published that he did on himself were in 2019 and 2021. On the latter, he experienced a worsening of kidney function, with 26 infusions of high-dose (16g on youtube, 12g on book) IV cyclodextrin, and the plaque regression was about ~30% (big!) on the carotid in just over 40 days.
Maybe that’s the real way to do it, who knows, because he even did it with an unhealthy lifestyle
consisting of: “half a bottle of scotch a day, 40 smokes, eating whatever” and while having ~1,000-2,000 Triglycerides mg/dL, overweight, hypertension.

The weird thing is, the preeminent investigator, professor Laurence Howes, that made the previous study, who believes this “will be the greatest therapeutic advance in cardiovascular medicine since the introduction of the statins.”, and “Nobel prize material”, suddenly died, despite being on cyclodextrin, they say…
[I didn't try much, but I couldn't figure out why he died. Rumor has it that his heart was in excellent condition ‘for someone his age’ they said...]

And they also claim, from a comment of theirs on youtube, “Clinical and observational studies have shown reductions in plaque size of up to 30-45% within weeks to months of use, depending on the severity of the condition and dosage.”
[That seems too high, I don't really know how much reduction you can expect rectally, though. <15%?]


Reputation of Atherocare

It’s better to order through Atherocare, with the discount codes, since their shipments go through in the US and their product is less expensive. But, you need to know that Michael Saaranen is the owner. He was a trusted former employee of Kyle Hodgetts, but Kyle put Michael as the owner of Atherocare despite Kyle being the founder. His reasoning was that if the FDA blocks Cholrem/Cavadex, they wouldn’t block Atherocare because it’s under a different owner.
But later on, Michael basically betrayed him, took over the company and now runs it as his own…
So, they are at odds with each other, so much so that Kyle says Atherocare is of inferior quality and will damage your kidneys. And recently, Cavadex filed a lawsuit against Atherocare. [Will Atherocare survive?]

Also, if you ask Michael, he’s active on the Facebook group, for a Certificate of Analysis, he won't provide it, which is suspicious, and just says “the cyclodextrin we use is 0.03% betadex and undetectable for propylene glycol.” So, about 99.96% pure a user says, if true.. This user says a good target to seek is 99.8% pure or higher. So, it sounds like it’s too pure, it’s unrealistic.


How To Administer It

It bears repeating that the tubes from Atherocare or the ones you mix, are applied rectally as a mini retention enema, not taken orally.

Watch the video from Atherocare here (and this new video too) to correctly open the tubes, and follow the instructions to administer it rectally.

Other things to know:
  • Keep in mind, it might cause you to have loose stools and gas. [Some have, some not as much]
  • Some say they need to use nail file to smooth the tube ends after opening
  • The tubes sometimes wont open when twisting the tip, for that you can contact support for replacement or find a solution [Someone used a knife..]. They don’t recommend opening them with scissors because it makes sharp edges.
  • Have towel paper on hand to clean your hands after lubricating it. I’ve heard you can submerge the nozzle into the lubricant satchet, that way you don't get your hands dirty with it.
  • You could use a different lubricant as this one has parabens and PEG, but it has to be a water-based lubricant and not oil-based like coconut oil. [Someone used glycerin and Customer Support says it’s fine as long as it’s 100% pure, so maybe this one].
  • When withdrawing the tube from the rectum, keep squeezing the tube. That’s so the contents won't come back inside the tube.
  • Take care of your anal health. If you develop hemorrhoids, due to irritation or diarrhea, you might need to take a break if it’s severe, or use it twice a week if it’s moderate (Roberts). Also a user on FB says bidet helps for anal health. [Midwestern doctor mentions DMSO can treat hemorrhoids]
  • You could do it twice a day. Customer service says some have tried one right after another, or one in the morning and one in the evening holding it while sleeping. Some people prefer in the morning as in the evening they don't sleep as well with it.
  • [I don’t know if it matters to be in a fasted state, or doing it hours away from meals.]
  • Cholrem's documentation says it’s absorbed in the colon up to 25%, 1g the first 30 min. A research nurse on FB with experience on rectal medications, says it’s possible to absorb it all if you hold it for 8 hours (the standard tubes have 9g). [Source:

Billie Starr
Tim Bruin the higher dose is a waste of money, the rectum won't absorb that thick of solution as well, the skin in your rectum is similar to the skin in your nose, there's a general consensus in the group it's a marketing tactic.
I'm a research nurse at Bastyr and we have done many trials on best absorption for rectal medications for hospice patients and patients that can't take medication by mouth.
In the first 30/60 minutes you absorb about 3 grams, after that your rectum is saturated and absorbed more slowly about 1/2 gram per 30 minutes
I'm happy you are having results I'm a huge advocate for hpbcd

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Billie Starr
Bart Adriaanse this one was hpbcd specific, in 8 hours you can absorb 10 grams, I use 9/10 grams hpbcd to 8/9 ML water and it all absorbs
This isn't also weight and height depending, if you are overweight there is less absorption
We have studied over 90 different rectal absorbency things, from pain meds to antibiotics
My professor and the team at Bastyr decided to do the study for hpbcd, they are pretty excited about the implications but now are having a hard time getting funding

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  • Someone used a toothpaste squeezer, like this one, to squeeze most of its contents, especially on frail people
  • Customer support told me it can last 2 years from production date and storage temperature is recommended at 30°, but it’s stable below and beyond this

Some user’s experiences on how to apply it
After taking the top off the tube and snipping the lube pouch, I lay face down and then had both hands free to reach behind myself, lube up and wipe the lube off my fingers, and insert the tube. I squeeze the very end with the fingers on one hand, and without letting go, I use the other hand to squeeze right next to where my fingers of the first hand are, then without letting the second fingers go, I move the first hand to just in front of the second hand. In this way, like climbing on a ladder, I can squeeze all the contents out and remove the tube before letting go of the tube - which would allow some contents to suck back in. I then continued to lie face down for half an hour before finally rolling to one side and being able to go to sleep. I did need to go to the toilet about two hours later, but I'm pretty happy with 2 hours on my first attempt.

Then I noticed after the first week of use, the long tube end was still full of liquid .. So now after emptying the tube with a relaxed butt (with one hand holding and squeezing and the other just squeezing) I kink or fold the tube over on itself at the base to empty the last bit out in the long nozzle... Then clench and tighten your butt as you remove... I also dip the long end nozzle into the gel pack after opening the gel pack as wide as I can get it... Holding the tube on its side this stops the gel going everywhere Good luck…

Having a shirt on, or towel, or cloth with you will allow you to wipe off your hand to make it less slippery after lubing up.

Also, I find lying on my back best, and it allows me to use primarily one hand, but the other just to stabilise the tube as I push up the tube with my thumb and forefinger up the tube on the other hand... like a small tube of toothpaste.

I don't let goes of the tube before removing otherwise it sucks the contents back in. Hope this helps !



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Ok so i started using this, but for some reason i alwats have extra left over in the tube- can’t seem to get it all out - sounds crazy as i type this- but does anyone have any tips?

Christian Allan
You have to be able to squeeze between thumb and side of index finger, while working then slowly up the tube. You can use your middle finger to back up the index finger as your sliding them up the tube.
Continue to keep it squeezed at the top, as you scrunch up your cheeks at the end and pull the tube out.
Don't unsqueeze until AFTER you pull it out, or it will suck some back in.
The first couple weeks seemed a little messy, but after 16 months, seems pretty easy

2h

Christian Allan
Debra Stein I pull down underwear, then roll onto my bed, on my right side. Lift left leg them insert.
Then I try to roll my hips so my left hip goes up in the air and the tube is now angled down and in slightly before squeezing

https://www.facebook.com/groups/1538189873584084/posts/1943273533075714/?__cft__[0]=AZUMoLRTjGkGpZ0ZSJNrQu-8uCJVY_OhjKZUoGtWJ2oaytC63czPRmmrAa_4g2MtNjeAQ8pF4qHRjcmHvRHXly5zlGFokjiyeduKraf4BC29htxTciLxDKVClP5psRcDX39iSZSm79zBgdp2hfiNby17&__tn__=,O,P-R-R
 
Ordering From China

A few months ago, some people (3 or 4) think this one is the best and have ordered from Zibo Qianhui Biological Technology Co. (www.cyclo-dextrins.com) with Harden Hao, email harden@zbqianhui.cn. Ask for 2-hydroxypropyl-beta-cyclodextrin CAS #128446-35-5 at highest possible purity [I also added: for intravenous use in atherosclerosis] [I say intravenous, but the real use is rectally]. And he responded to me saying it's USP Injection grade.
They are paid by bank transfer, though.

Recently, their subsidiary (trading department), Zibo Weyes, employee joined the FB group, and told me she can be paid through “Bank Transfer, Paypal, Western Union, Alibaba, etc”. They told me Zibo Qianhui is the manufacturer and Zibo Weyes is the trading company, and that the products are the same. Why she gave me prices 30% lower than Harden’s is something I still don’t know, even though I asked for the same USP injection grade.
Her contact is Cassie Ding, she can be found on the FB group.
Website: www.zbweyes.com
Email: Cassie@zbweyes.com
Tel/WhatsApp/WeChat/Zalo: +86 19050316763
[She also offers nattokinase.]


Quotes or Price Estimations

I’ve seen people order 2kg and take it for a year every other day or so, or somewhere in between like every day for 3-6 months and then every other day.
For a full year on a daily dose of 9g, you’d need ~3.3kg.
Atherocare’s ~6 month package is 1.5kg.


To the UK, someone on Facebook was charged $210 USD for 1kg including shipping, ~3 months ago. Took 2 weeks, arrived from UPS. [I think it was quoted by Harden]
To the Netherlands, another one was charged $316 USD for 2kg a month ago. It took one week to arrive from UPS. [I think it was quoted by Harden]
To France, Cassie says it’s $112 USD per kg, including shipping. Then add the import duties, I think for this is 6.5%, plus the VAT at 20%. (The tariffs are paid by yourselves, not to the supplier.)
$112*2kg*1.065 duties*1.2 VAT = $286.272 for 2kg. Cassie Ding

To the US, Harden told me it’s $158 USD per kg, including shipping. Then add the Trump tariffs (30%). (The tariffs are paid by yourselves, not to the supplier.)
$158*2kg*1.3 tariff = $410.8 for 2kg. Harden
$108.50*2kg*1.3 tariff = $282.1 for 2kg. Cassie Ding

To Mexico, Harden says $161 USD per kg, including shipping. Then add the recent tax to foreign products not on TMEC (33.5% or 19% if it comes by air waybill or bill of lading) plus the IVA tax (16%) (The taxes are paid by yourselves, not to the supplier.)
$161*2kg*1.335 tax*1.16 IVA = $498.6492 for 2kg Harden
$161*2kg*1.19 tax*1.16 IVA = $444.4888 for 2kg Harden, maybe it’s this one for Harden​
$112*2kg*1.19 tax*1.16 IVA = $309.2096 for 2kg Cassie Ding, I think at 19% tax because she sends it by air, UPS.​

Harden also offers a wholesale price of 108 USD/kg to the US and 111 USD/kg to Mexico by ordering 20kg. Which is pretty much the price given by Cassie without needing to order that much…

For comparison, Atherocare (Australia) the lowest possible price is $634.28 USD for 1.5kg (including express shipping to the US) for ~6 months (12 boxes of 14 doses, each with 9g = 1.5kg) AND that’s by using a one time discount of 20% (“NEW20” from newsletter) plus 15% off subscription. [There’s also the 15% discount code “CNACSUB” if you’ve already used the one time 20% discount]


If you can read Certificates of Analysis, here there are different suppliers, if you want to look at it. Apparently, Zibo Qianhui looks the best with Betadex at .066% and Propylene Glycol at .012%. [So, 99.92% pure?]


Another supplier: (not recommended but it's another option)
In the past, one used the powder from Chemcenter/RND Center from Amazon or cheaper from the official website. He was a drug addict, and had Erectile Dysfunction (ED). He mixed and sterilized it to make an IV solution, but ‘real progress’ was made when he injected it ‘down there’ and his ED improved faster. He also had prostate flare-ups resolved, but also moments of worsened kidney function (eGFR decreased, who knows if it’s because the powder wasn't as pure at just 99.5% or because of a high dose because he's impatient, he says). His Ask Me Anything is here. He has done 4kg of cyclodextrin, 200-400 grams per month by IV, and still does twice a month. At one point he did notice an increase of blood sugar on high dose (25g) (unclear if rectally or IV, because on other posts he has mentioned he did high dose enemas too).
[It could be that rectally there's not much problem with this one on the kidneys, because it's absorbed more slowly... Or who knows, because it has more betadex that it's more difficult on the kidneys as it's not as pure.]


Importing It

If you have trouble importing the powder from China to EU, say it’s a moisturizer component, like a user on facebook:


Just to help all EU members in customs. Please consider utilising the following transcript for approval:
I am importing Hydroxypropyl Beta Cyclodextrin (cas 128446-35-5) for personal use in formulating my own cosmetic moisturiser. HPβCD is a widely used cosmetic excipient that serves as a solubilizer, stabilizer, and carrier for active ingredients in skincare products.
Safe Use and Justification
Cosmetic Application:
HPβCD is commonly used in skincare formulations to improve the stability and absorption of active ingredients, reducing skin irritation and enhancing moisturization.
It is listed as a safe ingredient in the International Nomenclature of Cosmetic Ingredients (INCI).
Non-Hazardous Nature:
HPβCD is a non-toxic, non-irritating cyclic oligosaccharide derivative, widely recognized for its safety in topical applications.
It is used in over-the-counter (OTC) and commercial skin care products, including serums, creams, and lotions.
Handling and Storage Compliance:
I will store HPβCD in a clean, dry, and airtight container to prevent contamination.
It will be handled following standard cosmetic formulation safety guidelines, ensuring proper hygiene and measuring techniques.
Regulatory Compliance:
My intended use adheres to EU cosmetic regulation (ec 1223/2009).
The final moisturiser formulation will be for personal use only
I hope this meets your requirements. Please let me know if you need any further information.
Kindest regards


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And someone in Australia did this to import the powder from China:

I made good use of ChatGPT, which wrote me a great justification for importing the product and telling customs how I was going to make moisturiser with it. That worked. Customs charged me AU$54 'Import Duties', but that was ok, because at least we got it.

We bought a magnetic stirrer plate from AliExpress to mix the product with distilled water. We set it going and leave it for a couple of hours. The stirrer plate works really well. No mess or mucking around.
https://www.facebook.com/groups/1538189873584084/posts/1870432500359818/?__cft__[0]=AZXCVadWyXVxBFA676LML7wjOCr50Ej4jODQE64SBAYcJDotLNNTl0pG9D5zezxOEp1xb2oq--3upu8QeKL1bC4KRbdAYOppJx73yOyNKbUPr7KxMsqac2Fgwr3GJm8Wf6P_LQ2Q5-yGu-1LqqNqVc7-&__tn__=,O,P-R-R


DIY or Mixing Your Own (MYO)


So, let’s say you have the powder, and now you want to mix your own.
Honestly, I doubt it can be done with just a glass mixing stick, as their guide mentions that [Example Amazon] because some users use a magnetic stirrer for hours.. to mix the powder with distilled water.
[Dont know if it has to have a heat function to dissolve it better as someone say to use ‘slightly warm water and let it sit for hours’]​
[Also know that the stir bar (little capsule) that comes in magnetic stirrers is made of Teflon – PTFE. So, consider a metal or glass one]
[Might need a weight scale]​
[Might need a beaker to mix it in, or maybe a glass jar is sufficient.]​
Different concentrations exist, but some use 56g powder to 40ml distilled water. Or better, as it gets less viscous/sticky, use ~50/50 at 9.5g to 10ml, and fill 7 syringes, with ~10.5ml of the mix.
Sterilize the syringes and tips by boiling and then fill them.

[Examples Syringes Amazon 1, 2, 3, 4. Or Aliexpress someone used this, shortened with a knife].​
[Rubber tips from Aliexpress (someone used this) or the cannula that some of these syringes come with, sterilized by boiling.]
Lubricate with water-based lubricant [Someone said glycerin]. And apply.
That lasts for a week dose.
Don't refrigerate it as it crystallizes.

Someone used lubricant applicators (Amazon) instead of syringes.
Many reuse the tubes from Cavadex or Atherocare. Sterilized by boiling.

Some sources:
Updated 'How I "roll my own":
Thanks to my two 'mentors', Billie Starr and Darren Godfrey.
I hope you saved some Cavadex tubes. If not, you might just want to buy one box, or use an alternative delivery shown at the bottom. (very similar to what Billie does).
But I've found the Cavadex tubes work perfectly to reuse with ChemCenter's 2-hydroxypropyl beta cyclodextrin powder.
Prep by cutting 4 Qtips in half to make the cap to seal your tubes immediately after filling. I've found the best sealant for the head of each Qtip to be Secure Denture Adhesive from Amazon.
Then pour 1/2 bottle of powder (50 grams) into a mixing bowl. Add 55 ml of filtered, sterile water and stir until completely dissolved. (It takes a while). Using a 10 ml syringe, you can fill 7 boiled sterilize Cavadex tubes with the cyclodextrin solution with no waste. Immediately plug the filled tubes with the 1/2 Qtip with the cotton head coated with the dental adhesive, making sure that you've adequately coated around the Q-tip head to get a good seal.
If you do this once a week, you will be able to make a week's worth of cyclodextrin tubes if you use 1 a day.
By refilling the used tubes with water and boiling to re-sterilize, you can re-use those tubes many times.
That should do it. Feel free to comment or ask if you have any further questions.
BTW, I started with 3 boxes of Cavadex, then transitioned to mixing my own solution using ChemCenter 2-HPBCD powder. I've noticed NO difference except for the cost: My last order calculated to $2.16 per tube - I believe that is about 1/4th the cost of Cavadex.
Nor do I have to wait for shipping, and I am my own quality control manager.
A very good alternative to using the Cavadex tubes, first presented by Billie Starr and recently posted by Christian Allan.
You could use something like what is shown below to put your solution into the syringe, then attach to the catheter part. You just sterilize the catheter part every day.
GNEGKLEAN 150ML Enema Syringe Cleaning Douche System https://a.co/d/8J7qq0l

https://www.facebook.com/groups/1538189873584084/posts/1727053791364357/?__cft__[0]=AZV8zNq8zQHhYxNqLodNe1LAb4BX534zpt1HybkeePwNcFPz9WMsCF1ll-57ujcZbBj0Ml41JZ9Hc8Tnr2p80CXlLgFgg3RgqF6ffr35z6TIPVLVITj1SWq8hRw77R29aRmV0PuGQNzNZI4WTumCNk8k&__tn__=,O,P-R


Mix with 9g with 8 ml of water is the ratio

Natalie Nelson if you are administering via enema, you mix your required daily dosage in 8ml lukewarm sterilised water and apply via a rectal administration tool.
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At the same time I have improved my mixing processing, preparing 7 days of solution by using a glass mixing stick (from Amazon) in a glass jar, adding 56 grams of HPBCD powder to 40 ml of distilled water to create 7 x 10.5 ml of solution with 8 grams daily dosage.
Then there is this enema I made using rubber klysma tips and 12 ml (bent tip) syringes from aliexpress, both of which I shorten a bit with a sharp knife. This makes the administration so much easier, quicker and efficient, less waste, less air bubbles, I would not want to go back to the plastic enema's even if I could get them for free and it saves some plastic waste load on the environment.
[...]
some links:
https://www.aliexpress.com/item/1005006123712487.html
https://www.aliexpress.com/item/1005004949729828.html


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Guide 2
After receiving their 2HPβCD, many of our users are using the following MYO instructions:
Prepare 7 days of solution by using a glass mixing stick (from Amazon) in a glass jar by adding 56 grams of HPBCD powder to 40 ml of distilled water to create (7x) 10.5 ml of solution with 8 grams daily dosage.
Store at room temp, ideally in a small closed glass jar in a cupboard. Refrigerating is not recommended as the solution will start cluttering and eventually crystallization may occur.
One means of administration used by our members is: an enema made using rubber klysma tips and 12 ml (bent tip) syringes (purchasable from aliexpress), both of which one can shorten a bit with a sharp knife. This makes the administration much easier, quicker and efficient, less waste and less air bubbles.

https://www.facebook.com/groups/1538189873584084/posts/1892777448125323/?__cft__[0]=AZVjlHkhvG6FCtWtRAyaStb7tOTIhGOgFpyDYvZ9ESNBYkDdCc9iobUfhqJixzLtBlDvUvjp1Qes6I5Tws_Ib3werfIPTTom7tKF_fWF4sZrW5bgXlrkB0cn_ReoTgUzWSO_2WCtHyqraepGMWBXJ8k0xg14DGYV4-z3Iv7ztrFETxRy1Kt7kYju8yjIclHftAo&__tn__=,O,P-R



I use a plastic syringe from Amazon. Works well. clean between usages Amazon.com: 20ml Syringe for Liquid, Oral, Scientific Labs, Measurement, Dispensing, with Cap- 3 Pack 20ml Syringes : Industrial & Scientific

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Another how I roll my own post
I have started mixing my own 2-hydroxypropyl beta cyclodextrin enema solution. I have been able to dissolve 150 g of 2HP𝛽CD in 100 ml of distilled water, resulting in 200 ml of solution. This gives a solution with a concentration of 0.75 g/ml, or 7.5 g for 10 ml. It takes a long time, and a lot of mixing to get everything to dissolve completely. For my latest batch I mixed with a stir plate. Before dissolution is complete, there is a sticky blob in the mixing vessel, but it does all dissolve after a day or two. I have tried mixing a bit more concentrated, but the 2HP𝛽CD started precipitating out of solution.
I ordered my 2HP𝛽CD powder from: https://www.lelworld.com/.../hydroxypropyl-beta.../ and got 500 g for $130 US w/ free shipping (2X 250 g bottles.) This is cheaper than the ChemCenter material on Amazon.
For application I use these round nose syringes that hold 10 ml (max.) https://www.amazon.com/dp/B0B5T49GV6?psc=1... These are available from multiple sellers on Amazon. If you use some water soluble lubricant on the barrel of the syringe and "entry point", they insert easily (if you are relaxed View attachment 112007.) They are reusable and easy to clean, but you need to pay special attention to make sure the nozzle opening on the syringe gets completely clean, as the openings are the only rough spot on the syringes. I dip the syringe tip in 70% isopropyl alcohol to sanitize before drawing the solution into the syringe to prevent contaminating the stock solution. They also come with a silicone cap if you want to fill more than one at a time.
I store the solution in a tightly closed mason type jar.
I have been using 10 ml at night (7.5 g dose), which is the max the syringe can hold.

https://www.facebook.com/groups/1538189873584084/posts/1698368444232892/?__cft__[0]=AZWYFaI2qWTPNH4qQnVxl53jYcJqmcYpDyZH0bArtxXFl6h9r--ziPIU3ZUUp5q28xclzOoYhI3hhNTpKEL-naimM7aehfRRU8ttcYe04-2Z4xEJwWK6lXx6Efms4VImoEJAu-fyroJ4jrsJ62Uq3jKou3GFp1N3NruEBPsmxEaApP7GviYJ2ykRyvW4mK6zBiz62iiVkueE_JvbSiBRA6KT&__tn__=,O,P-R


Douglas Powell maybe I worded it wrong
We use 9.5 grams to 10 ML of water
So each dose has 9.5 grams
The science behind 2 beta says it's solubility is at 40%,but best absorption is the way we all are doing it with more water
The papers also say 3 fully absorbed grams is enough to see results
The rectum absorbs 1.5grams per hour (of course weigh dependant and also if there is stool in the rectum)

So your way is perfectly valid!

[...]
Billie Starr
Douglas Powell but at the 60/40 ratio 60% hpbcd 40% water the colon doesn't absorb it well, it's too viscous to absorb well, that's why the closer to 50/50 with actually just a dab more water absorbs better and faster
The texture and porosity of the colon lining absorbed thinner fluids better



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I had a magnetic stirrer, but without the heating feature. I returned it and got one that has the heating feature, as well as a stand for holding the glass stirring rod in place. This proved very useful, as when initially mixing, the powder clumps up and clings to the stir rod. I definitely suggest getting one with heating, although you'll need to play with it to find the right temperature setting. I cover the top with plastic wrap to prevent evaporation. A couple hours and I get a nice, clear well-mixed solution.
https://amzn.to/4kgqOsZ

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We bought a magnetic stirrer plate from AliExpress to mix the product with distilled water. We set it going and leave it for a couple of hours. The stirrer plate works really well. No mess or mucking around.
https://www.facebook.com/groups/1538189873584084/posts/1870432500359818/?__cft__[0]=AZXCVadWyXVxBFA676LML7wjOCr50Ej4jODQE64SBAYcJDotLNNTl0pG9D5zezxOEp1xb2oq--3upu8QeKL1bC4KRbdAYOppJx73yOyNKbUPr7KxMsqac2Fgwr3GJm8Wf6P_LQ2Q5-yGu-1LqqNqVc7-&__tn__=,O,P-R-R

I've been mixing 10 days worth at a ratio of 110ml of water to 100gm 2HPßCD. I tried using the ratio listed above, but despite using a magnetic plate stirrer for hours, I couldn't get it to fully dissolve. Would warming the solution help? The magnetic stirrer plate has a heating function.

Cyclodextrins, Nattokinase & Cardiovascular Disease | Facebook

10 mL is perfect, Bill Byrne and I mix 9.5 gm of 2 beta in 10 mg slightly warm water and it all mixes to perfect solubility (after sitting for a few hours)
The average rectum can only keep in 10 ML of liquid
We tried mixing it 50/50 but it gets sticky in the rectum.


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Other things to know:

  • The mixture is not to be refrigerated as it crystallizes. You want it as a liquid.
  • About concerns of worsening kidney function. IIRC, it puts a load on the kidneys because it has to filter the cyclodextrin complexes it forms with lipids, and it has to filter the betadex which the less purer your cyclodextrin is, the more betadex there is. And on IV, people have tried higher dose and faster so the kidneys get overloaded, whereas rectally it doesn't happen because it’s a lower dose and absorption is slower. Or so they say on FB. They also recommend being well hydrated.
  • Some do an enema cleanse before introducing the cyclodextrin, to be able to retain the cyclodextrin better.
 

Cheng’s Orthomolecular Approach

Now about the Orthomolecular approach and other things that can help.

Richard Cheng, Orthomolecular editor-in-chief, has the most unbelievable plaque regression I’ve seen – 2 cases from 60-80% stenosis down to ZERO in two years, and other cases of carotid plaque down to nothing! Which is generally thought to be impossible even in those in the alternative approach, because calcification is really hard to get rid of.

Everyone needs to know this!

His 10 case reports of Atherosclerotic Cardiovascular Disease (ASCVD):
(I was not able to post all of the images because of post limitations.)

FOR IMMEDIATE RELEASE
Orthomolecular Medicine News Service, November 27, 2024


A Holistic Approach to ASCVD:Summary of a Novel Framework and Report of 10 Case Studies​

Richard Z. Cheng, M.D., Ph.D., Lei Duan, MBA, Tom E. Levy, M.D., J.D.​



Abstract​

Despite decades of intensive research and substantial investment in therapeutic development, atherosclerotic cardiovascular disease (ASCVD) remains the leading cause of death worldwide. A key reason may be the significant limitations of the prevailing lipid-lowering approach in ASCVD management. While this approach may slow plaque progression, studies show only modest reductions in cardiovascular events and mortality. It generally fails to reverse existing plaque or address other critical factors like inflammation, oxidative stress, and insulin resistance, which are known drivers of ASCVD. Furthermore, statin side effects can affect patient compliance, and the "one-size-fits-all" model often overlooks individualized needs and essential lifestyle factors. Research suggests that LDL-cholesterol functions more as an intermediary mechanism rather than a root cause of ASCVD, with the limited progress in ASCVD outcomes likely due to an overemphasis on these intermediary factors rather than addressing the full array of root causes.

Our work re-analyzes known and emerging risk factors for ASCVD, categorizing them into root causes and intermediary mechanisms contributing to ASCVD (including coronary heart disease, carotid plaque, stroke, and peripheral artery disease). Based on this analysis, we developed a holistic approach focused primarily on root causes while also accounting for intermediary mechanisms.

In this first paper, we outline the limitations of current ASCVD management and introduce a novel, holistic framework that addresses both root causes and intermediary mechanisms. We also present 10 patient cases demonstrating significant improvement, including complete ASCVD reversal. Future papers in this series will delve deeper into root causes, intermediary mechanisms, and targeted clinical interventions.

Introduction​

ASCVD remains the leading cause of mortality worldwide, despite significant advancements in prevention and treatment(1,2). While statins have been effective in lowering LDL cholesterol, their impact on reducing cardiovascular events and overall mortality has been less substantial than expected(3,4). This highlights a significant residual risk of cardiovascular events, even with optimal traditional risk factor management(2). Current treatment paradigms often fail to address root causes and intermediary mechanisms driving ASCVD development, such as chronic inflammation, oxidative stress, and metabolic dysfunction(5,6). There is a growing recognition of the need for a more holistic approach to ASCVD prevention and treatment, targeting multiple biological pathways and addressing both lipid levels and systemic inflammation(7,8).

LDL-cholesterol functions more as an intermediary mechanistic factor rather than a root cause of ASCVD.​

Recent research challenges the traditional view of LDL-cholesterol as the primary cause of ASCVD. The effectiveness of statins in reducing ASCVD risk is also questioned, with some studies suggesting their benefits may be modest and not strongly mediated through LDL-cholesterol reduction(9–11). While some studies maintain that LDL-cholesterol causes ASCVD(12,13), others suggest it may be more of an intermediary mechanistic factor(9,14).

Recent research underscores the complex nature of ASCVD risk factors, extending beyond traditional markers. Lifestyle factors such as sedentary behavior, low-quality diet, and psychosocial stress play significant roles in elevating ASCVD risk(15,16). Dietary patterns high in carbohydrate(17–22), ultra-processed foods(23–29), and high omega-6 seed oils(30,31) have been associated with increased ASCVD risks. Hormonal imbalances significantly contribute to the risk of atherosclerotic cardiovascular disease(32–36). A recent study underscores the importance of inflammation in ASCVD risk, demonstrating that chronic inflammation, alongside lipoprotein(a) and cholesterol levels, is significantly associated with long-term cardiovascular outcomes in women(14). One of us (TEL) has extensively argued that inflammation is a fundamental root cause in the development and progression of atherosclerotic cardiovascular disease (ASCVD)(37–41).

Linus Pauling’s unifying theory of atherosclerotic cardiovascular disease (ASCVD) proposed decades ago offers an alternative to the traditional view that LDL-cholesterol is the primary cause of ASCVD(42). Pauling argued that ASCVD is driven more by nutrient deficiencies—particularly in vitamin C—which weaken arterial walls, making them susceptible to damage. In this scenario, lipoproteins, including lipoprotein(a), act as a vascular “repair” mechanism rather than as the root cause. This perspective aligns with recent research that challenges the role of LDL-cholesterol as the primary culprit in ASCVD, suggesting instead that it functions more as an intermediary mechanism in the disease process.

These findings indicate a need for a more comprehensive approach to understanding and assessing ASCVD risk.​

There is an urgent need for earlier and holistic approaches to effectively prevent ASCVD and its complications(8). This paradigm shift emphasizes comprehensive risk assessment and integrative management starting earlier in life.

This series of papers will explore the limitations of the current ASCVD management paradigm and propose a novel, holistic approach that addresses not only symptoms but, more importantly, the underlying root causes of ASCVD. By incorporating lifestyle modifications such as dietary interventions, targeted supplementation, identification, prevention, and detoxification of environmental toxins, and hormonal balancing when necessary, this approach aims to reduce cardiovascular event risk while enhancing overall metabolic health.

Key Limitations of the Current Paradigm:​

  1. Overemphasis on LDL Cholesterol: Cholesterol is treated as the central player in ASCVD, while other factors like chronic inflammation, endothelial dysfunction, insulin resistance and oxidative stress are not adequately addressed.
  2. Neglect of Root Causes: Poor dietary choices, environmental toxins, insulin resistance, and metabolic imbalances contribute significantly to the development of ASCVD, yet they remain under-recognized in standard treatment.
  3. Pharmacological Dependence: While statins and other drugs reduce LDL levels, they do not fully resolve the underlying mechanisms driving cardiovascular disease.

A Novel Holistic Approach to ASCVD​

To improve ASCVD outcomes, we propose a holistic framework based on addressing the root causes, targeting the intermediary mechanisms, and preventing the final outcomes such as plaque formation and cardiovascular events.

Core Elements of the Holistic Approach:​

  • Dietary Interventions: A low-carbohydrate, anti-inflammatory diet rich in nutrition and healthy fats, such as the low carb ketogenic diet, can reduce insulin resistance, inflammation, and oxidative stress.
  • Targeting Inflammation and Oxidative Stress:Integrative strategies including healthy lifestyle and proper nutrition supplements such as vitamins and antioxidants (vitamins Bs, C, D, E and K2), omega-3 fatty acids, magnesium, selenium, and play a crucial role in reducing the intermediary mechanisms of disease progression.
    • Identification and removal of existing chronic inflammatory foci, especially oral and dental inflammations are of paramount importance(40,43–49).
  • Metabolic and Hormonal Health: Addressing insulin sensitivity through dietary and exercise interventions, and hormonal balance if necessary, improves metabolic health, which is essential in preventing ASCVD.
  • Environmental Detoxification: Heavy metals, pesticides, and other environmental toxins contribute to oxidative stress and inflammation. A structured detoxification protocol helps reduce the burden on the cardiovascular system.
  • Exercise and Stress Management: Physical activity, stress reduction techniques, and mental health support are key components for improving overall cardiovascular health.

A Report of 10 Cases of Successful ASCVD Reversal​

To further illustrate the effectiveness of this holistic approach, we present 10 case studies where patients successfully reversed their ASCVD diagnosis through integrative methods. These cases highlight the critical role of addressing diet, lifestyle, and metabolic health in reversing cardiovascular disease.

Case #1 (#ZSXQ186): Complete reversal of coronary stenosis​

A 62-year-old man with a history of symptomatic coronary artery disease (CAD) showed a complete reversal of his multi-site coronary stenosis after adopting our integrative orthomolecular medicine protocol (a low carb ketogenic diet, high dose vitamin C, omega-3 supplementation, other antioxidants and mitochondrial nutrients as well as regular exercise(50).

Prior to start our intervention, he had 2 CT-angiogram (CTA) exams ~5 months apart which showed that he had diffuse stenosis of his left anterior descending artery (LAD) which is responsible for ~50% of blood supply to the entire heart, ranging from mild (24-49% stenosis) in the proximal portion to moderate to severe (50-69 and up to 70-80%) of the mid portion LAD, as well as ~50% stenosis of her right coronary artery (RCA) stenosis, Figure1. We advised our Integrative Orthomolecular Medicine Protocol(1). Repeated CTA at 8 months showed significant reduction of stenosis and complete reversal (no stenosis seen anywhere in the coronary arteries) 18 months later.

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Figure 1. Computed Tomography Angiography (CTA) examinations of the coronary arteries.

  • Left (Mar. 31st, 2020, 5 months prior to the start of our program): 70% diffuse stenosis of the mid Left Anterior Descending (LAD) artery, 80% stenosis of the first diagonal branch of the LAD, and 50% stenosis of the mid Right Coronary Artery (RCA).
  • Center (Aug. 19th, 2020, just before beginning our program): mild stenosis (25–49%) of the proximal LAD and moderate stenosis (50–69%) of the mid LAD.
  • Right (Feb. 25th, 2022, after 18 months on our program): no stenosis observed in any artery.

Case #2 (#ZSXQ787): Complete reversal of coronary stenosis, lung nodules as well as significant reduction of facial age spots and the thyroid nodules.​

A 64-year-old woman with coronary heart disease, characterized by significant coronary artery stenosis (60–70% stenosis) observed on repeated CTA scans in 2021 and 2022, as well as pulmonary and thyroid nodules, began our Integrative Orthomolecular Medicine Protocol for ASCVD. After one year on the program, a repeat CTA in July 2023 showed marked improvement in her coronary artery stenosis, with stenosis reduced to 1–24%. After two years, a follow-up CTA revealed complete resolution of the coronary artery stenosis (Figure 2a). Repeat chest CT scans also showed resolution of the pulmonary nodules, and ultrasounds indicated a reduction in both the size and number of thyroid nodules (data not shown). Additionally, her daughter noted a significant fading of a large, distinct age spot on her left cheek (Figure 2b).

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Figure 2a: CTA, Progressive Changes in Coronary Artery Stenosis and Plaques (from left to right).

  • Left (September 2021): One year prior to starting our program, CTA shows non-calcified plaques in the mid Left Anterior Descending (LAD) artery with moderate stenosis (50–60%).
  • Center Left (June 2022): Just before starting our program, follow-up CTA indicates progression to moderate to severe stenosis (60–70%) in the mid LAD, with persistent non-calcified plaques.
  • Center Right (July 2023): After one year on our Integrative Orthomolecular Medicine Protocol for ASCVD, the mid LAD exhibits mild stenosis, with non-calcified plaques still present.
  • Right (June 2024): After two years on our program, the latest imaging reveals that the plaques have disappeared, with no stenosis observed anywhere in the coronary arteries compared to July 2023 and 2022.

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Figure 2b. Left: Oct. 2020; Center: Jul. 23rd, 2023; Right: Dec. 3rd, 2023. Notice the significant fading of the facial age spot.

Case #3 (#ZXSQ74): Reversal of carotid plaques​

A 61-year-old man was diagnosed on October 6, 2020, with bilateral carotid artery plaque formation via ultrasound. After approximately six months on our integrative intervention, including a low-carb diet, orthomolecular nutrition, and bioidentical hormone balance (BHRT)(50), his overall condition improved significantly: on April 9, 2021, a carotid artery magnetic resonance angiography (MRA) showed no significant abnormalities. His other health problems (gallbladder wall thickening and roughness, signs of chronic cholecystitis) resolved, and Hashimoto's thyroiditis reversed, with antibodies turning negative.

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Figure 3. Ultrasound and MRA examinations of the carotids,

  • Left, ultrasound exam of the carotids (Oct. 6, 2020): Bilateral carotid artery plaque formation.
  • Right, MRA exam of the carotids (April 9th, 2021): no abnormalities seen in the carotids.

Case #4 (#ZSXQ7110): Reversal of carotid plaques​

A 67-year-old woman, diagnosed with 75% carotid artery stenosis. A repeat examination at the same hospital showed a significant reduction in carotid artery stenosis, decreasing from ~75% to 62%, after being on our integrative protocol for just 3 months, including low carb ketogenic diet, orthomolecular nutrition and BHRT(50). The patient stated: “I went to the same hospital for the checkup. The doctor couldn't believe it and thought I had met a miracle doctor or taken a miracle drug”.

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Figure 4. Ultrasound examinations of the carotids.

  • Left (June 27th, 2023): Carotid Intima-Media Thickness (CIMT) with atheromatous plaque formation and local luminal stenosis (~75%) in the trunk and bifurcation of both common carotid arteries. Atherosclerotic plaques form in both common carotid arteries at the origin of the right subclavian artery.
  • Right (Sept 19th, 2023): Carotid Intima-Media Thickness (CIMT) with atheromatous plaque formation and local luminal stenosis (62%) in the trunk and bifurcation of both common carotid arteries. Atherosclerotic plaques form in both common carotid arteries at the origin of the right subclavian artery.

Case #5 (#ZSXQ7784): Reversal of carotid intima-media thickness (CIMT) and osteopenia​

A 55-year-old woman came to us in April 2022 with carotid intima-media thickness (CIMT) and osteopenia. We recommended our integrative protocol, including a low-carb ketogenic diet, orthomolecular nutrition, and liver detox. The patient followed our advice intermittently. However, despite the intermittent adherence, her carotid intima-media thickness (CIMT) completely resolved, and her bone density significantly improved over a two-year period, as evidenced by the reduction in T-scores on her DEXA scan (Figure 5a&b).

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Figure 5a. Ultrasound examinations of the carotids.

  • Left: Jan. 25th, 2022. Carotid Intima-Media Thickness (CIMT, 1.0 mm).
  • Right: Dec. 12th, 2023. No Abnormality seen.

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Figure 5b. Bone density scan examinations (DEXA) (Lumbar).

  • Left: Feb. 25th, 2022. T: -2.4 (osteopenia).
  • Right: Nov. 29th, 2023. T: -1.8 (osteopenia)

Case #6 (#GD-F001): Reversal of carotid plaque​

A 61 years old woman with a history of bilateral carotid plaque formation came to our service. We placed her on our program of integrative orthomolecular emdicine protocol of primarlily low carb ketogenic diet and orthomolecular medicine. Eight months later, repeat ultrasound exam showed that her bilateral carotid/subclavian artery plaques disappeared (Figrue 6).

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Figure 6. Ultrasound examinations of the carotids.

  • Left: Aug 18th, 2023.
    1. Plaque formation at the origin of the right subclavian artery (7.6 x 2.7 mm, mixed echo plaque).
    2. Plaque formation at the left carotid sinus (4.7 x 1.5 mm low echo plaque).
  • Right: Apr. 22nd, 2024: Bilateral carotid arteries, vertebral arteries, and subclavian arteries: no abnormalities were found.

Case #7 (#ZSXQ6550): Reversal of carotid intima-media thickness (CIMT)​

Dr. Z, 42 years old, male, also a practicing physician, verbally reported that his fatty liver improved from moderate to mild and his carotid intima-media thickness (CIMT) improved from 1.2 to 1.0 (data not shown).



Figure 7. “Dear Dr. Cheng, I have been following your advice and taking supplements. My fatty liver went from medium to mild and CIMT went from 1.2 5o 1.0 mm. Thank you very much for your instructions. I can’t find methylene blue on your website and I want 4 more bottles of methylene blue”.

Case #8 (#ZSXQ188): Reversal of carotid plaques​

Mr. C, 68-year-old male, following an integrative approach including our dietary and nutritional supplements, found his carotid plaques gone in 3 years.

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Figure 8.

  • Left (Feb. 24, 2021): Carotid artery ultrasound, found soft plaque formation at the bifurcation of the left common carotid artery and the bifurcation of the right brachiocephalic trunk.
  • Right (May 16, 2024): Carotid artery ultrasound, the soft plaque disappeared, only carotid intima-media thickness (CIMT) seen.

Case #9 (#ZSXQ10137): Reversal of carotid plaques​

“My father has been on a low-carb ketogenic diet for more than a year and a half, without taking any medication or statins. Under the guidance of Dr. Cheng, he also received near-infrared irradiation and took about 15 grams of VC orally every day. Vit K2, Vit D3, potassium, magnesium, Vit B100, etc. were taken regularly. Comparison of carotid artery B-ultrasound on September 5, 2023 and July 20, 2024: The largest plaque on the left side went from about 2.5 cm down to 0. 5 cm, and the largest plaque on the right side went from about 4.3 cm to 0.4 cm. The thickness of the plaque on the right side changed from 75% stenosis of the lumen at the largest point to 50% stenosis at the largest point. I hope it can be completely reversed. Thank you very much for the advice of Dr. Richard Cheng”

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Figure 9.

  • Left (Sep 5, 2023): Carotid artery plaque, left maximum 25mm; right maximum 43mm, with 75% stenosis.
  • Right (Jul 20, 2024): Carotid artery plaque, left maximum 5mm; right maximum 4mm, with 50% stenosis

Case #10: Reversal of varicose veins.​

A 37-year-old man reversed his severe varicose veins over 8 months using vitamin C as part of our integrative orthomolecular medicine program. Although varicose veins are not part of ASCVD, they are also a condition involving blood vessel structural integrity. Vitamin C plays a critical role in supporting collagen synthesis, which is essential for maintaining vascular strength and resilience.

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Figure 10. Significant change of his varicose veins of his left leg after being on our integrative approach for 8 months.

Conclusion​

The conventional ASCVD management paradigm, primarily focused on lowering cholesterol, has proven insufficient in meaningfully reducing the cardiovascular disease burden. This paper introduces a holistic approach that addresses the root causes, intermediary mechanisms, and final outcomes of ASCVD, offering a more effective and sustainable solution. The case studies presented demonstrate the potential of this integrative framework to not only manage but also reverse ASCVD, significantly enhancing overall cardiovascular health. Future papers in this series will delve further into the specific strategies and interventions that define this innovative approach to ASCVD management.

Shared Root Causes and Intermediary Mechanisms Across Diseases​

Many chronic diseases, including ASCVD, share common root causes and intermediary mechanisms, such as oxidative stress, inflammation, and impaired cellular repair. Addressing these foundational factors can lead to improvements across multiple conditions, as demonstrated in our case studies.

For example, in Case #2, the patient not only experienced a complete reversal of 70% coronary stenosis but also saw significant improvements in other areas, including resolution of lung and thyroid nodules and the fading of a facial age spot. Similarly, in Case #10, varicose veins were also reversed using this integrative approach. These multi-faceted recoveries underscore the power of targeting root causes rather than merely addressing symptoms.

In traditional Chinese medicine, this approach is known as "Treating Different Diseases with the Same Treatment" (异病同治). By focusing on shared underlying mechanisms, we can promote healing across multiple systems, achieving broader and more comprehensive health outcomes. This integrative strategy reinforces the interconnectivity of bodily systems and highlights the potential of a holistic, root-cause-focused approach to improving outcomes across a range of chronic conditions.


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What he recommends:

Integrative Orthomolecular Medicine Approach for Cardiovascular Disease (ASCVD)​

Posted on August 1, 2024 by Dr. Cheng
Integrative Orthomolecular Medicine (I-OM) is a holistic, science-based approach that aims to optimize health by addressing the root causes of disease. Rooted in the principles of orthomolecular medicine, I-OM integrates conventional medical practices with the use of micronutrients, lifestyle modifications, and natural therapies to support long-term well-being. Key elements of this approach include:

  1. Healthy Diet: A cornerstone of I-OM is a diet that is low in carbohydrates, especially refined sugars and grains, while avoiding ultra-processed foods (including omega-6 rich seed oils), and any. This dietary pattern helps reduce inflammation, stabilize blood sugar levels, and support metabolic health, all of which are crucial for preventing and managing chronic diseases, including cardiovascular and metabolic conditions.
  2. Avoiding Toxins: I-OM emphasizes the importance of minimizing exposure to toxins, including agricultural and industrial pollutants. Environmental toxins, such as pesticides, heavy metals, and industrial chemicals, contribute to oxidative stress and inflammation, which can damage cells and disrupt normal physiological functions. Reducing toxin exposure is essential for maintaining overall health and preventing chronic illnesses.
  3. Addressing Infections, Especially Hidden Infections: Chronic, often hidden infections (e.g., viral, bacterial, or fungal) are recognized as potential contributors to a variety of diseases, including autoimmune and cardiovascular disorders. I-OM focuses on identifying and treating these infections through targeted therapies, which can help restore balance to the immune system and prevent chronic inflammation.
  4. Micronutrient Insufficiencies/Deficiencies: I-OM pays special attention to deficiencies in key micronutrients, particularly those critical for mitochondrial function, such as magnesium, CoQ10, and B vitamins. Mitochondria are the powerhouse of the cell, and deficiencies in nutrients required for their optimal function can lead to fatigue, muscle weakness, and other chronic health issues. I-OM aims to restore these nutrients to optimal levels, supporting cellular energy production and overall vitality.
  5. Antioxidant Support: Oxidative stress—caused by an imbalance between free radicals and antioxidants—plays a key role in the aging process and the development of chronic diseases. I-OM includes antioxidant therapies (e.g., vitamin C, vitamin E, selenium) to combat oxidative damage and protect cells from harmful free radicals.
  6. Hormonal Balance: Hormonal imbalances, especially involving the thyroid, adrenal glands, and sex hormones, are common contributors to various health issues, including fatigue, mood disturbances, metabolic dysfunction, and immune dysregulation. I-OM focuses on restoring hormonal balance through both lifestyle interventions and, when necessary, targeted supplementation or bioidentical hormone therapy to optimize thyroid function, adrenal health, and sex hormone levels.
By addressing these interconnected areas, Integrative Orthomolecular Medicine seeks to optimize health and prevent disease through a comprehensive, individualized approach that focuses on restoring balance within the body.

Healthy Lifestyle

  1. Healthy Diet
    1. Low carb/ketogenic diet:
      1. Eat animal-based high-quality proteins (such as meats and fish) and fats;
      2. Avoid ultra-processed foods;
      3. Avoid high omega-6 seed oils (such as soybean oil, rapeseed oil);
      4. Avoid high-oxalic acid (such as spinach), high-lectin fruits and vegetables and other plant-based foods with high levels of potential toxins such as phytoalexins and phytic acids. eat less sweet fruits;
      5. Avoid calcium supplements and foods that contain high amounts of calcium such as milk.
    2. Intermittent fasting: any form is intermittent fasting is fine. My favorite is 16/8, e.g., fasting for 16 hours or more daily.
  2. Check and eliminate any chronic infections in your body, especially oral and dental infections. Pay special attention to root canal treated teeth. If you had any root canal treatment in the past, you should have your root canal treated teeth checked to make sure you don’t have hidden apical abscess. Usually this requires special X ray such as 3D Cone X ray examination.
  3. Exercise: HIIT (High Intensity Interval Training) is recommended. I personally love badminton games, which is a form of HIIT training.
  4. Others like relaxation, outdoor activities to include regular sunshine, and quality sleep.
Nutritional Supplements

  1. TotoCell NutritionTM is our basic comprehensive nutrition package that contains the following:
    1. Vit A: 4.5 mg
    2. Vit B1 (thiamine): 100 mg
    3. Vit B2 (riboflavin): 100 mg
    4. Vit B3 (niacin): 25 mg
    5. Vit B5 (pantothenic acid): 75mg
    6. Vit B6 (pyridoxine): 100 mg
    7. Vit B7 (biotin): 2 mg
    8. Vit B8 (inositol): 140 mg
    9. Vit B9 (folate): 0.8 mg
    10. Vit B12 (cobalamin) : 2 mg
    11. Vit C (ascorbic acid): 2,000 mg
    12. Vit D3 (cholecalciferol): 5,000 IU
    13. Vit E (alpha-tocopherol): 700 IU
    14. Vit K2 (Mk7): 0.2 mg
    15. Magnesium glycinate: 500 mg
    16. Zinc gluconate: 25 mg
    17. Selenium (yeast): 0.1 mg
    18. Proprietary blend of:
      1. Alpha L-Carnitine
      2. Alpha Lipoic Acid
      3. Glycine
      4. Lysine
      5. N-Acetyl Cysteine
      6. Proline
      7. Resveratrol
      8. Taurine
      9. XOS (Xylo-oligosaccharides)
  2. Additional supplements: In addition to TotoCell NutritionTM, higher doses of the following are often recommended:
    1. Vit C: 10,000 mg
    2. Niacin: 2,000 – 3,000 mg
    3. Magnesium: 1,500 – 2,000 mg
    4. Vit K2 (Mk7): 45 mg
    5. Omega-3 Fatty acids: 2,000 – 4,000 mg
    6. Liver Detox
  3. Other agents that we recommend
    1. BHB (Beta-hydroxybutyrate)
    2. GlyNAC (high dose glycine, NAC)
    3. Methylene blue
    4. NIR/PBMT (660 nm/850nm)
    5. Intravenous Vit C infusion (HDIVC)
    6. BHRT (Bio-Identical Hormone Replacement Therapy)
  4. Lab testing:
    1. Anti-Aging Lab Testing

Some Observations

He is the only one I’ve seen that truly doesn't use statins when you have plaque (others use low-dose statins due to its pleiotropic effects such as being antiinflammatory and antithrombotic).

It's about high doses of Vitamin C, Niacin, Omega 3, Magnesium and K2 with aminoacids: NAC, Glycine, Taurine, Carnitine, Lysine and Proline, and on a Ketogenic/low carb diet with intermittent fasting of 16 hours.


About High Dose Niacin

If you do it, remember to titrate it and take it with/after meals (There are three formulations: Immediate release (the normal one), the extended release (less flushing) and sustained release. Never take the sustained release, and some say the extended release is fine at half the dose). I’ve heard from Stephen McConnell, a lipidologist that uses niacin, that you can take an Alka-Seltzer (or aspirin) and 3tbsp of apple sauce to reduce flushing. He recommends Rugby’s Niacin 1,000 tabs, but it has calcium. If you want to avoid calcium, maybe Life Extension’s Niacin is a better choice. Don’t consider ‘No-flush’ Niacin (inositol hexanicotinate) or Niacinamide because they don't have the cardiovascular effects.

If using the normal niacin (immediate release) titrate by 50mg each day, or whenever the flush has stopped developing, or it's just a little bit. Later you can increase it by 125mg or so; total maximum dose of 2-3g (Keenan mentioned up to 6g, but that’s way too much than others say). They say thrice a day.

If using extended release niacin (wax-based like Enduracin) titrate by 250mg twice daily for the first week, then increasing to 500mg twice daily on the second week, then 750mg twice daily on the third week; total maximum dose of 1.5-2g (Keenan).
Know that Stephen McConnell doesn't like the extended release one, but some do; the immediate release one is safer for the liver, but there’s more flush.

Side Effects

At this high dose it can worsen your insulin resistance (by 22-42%) and fasting glucose
(by 5-10 mg/dL – Sam Tsimikas) So if you have diabetes, it needs to be well controlled. I don't remember well two things, 1) I think Cheng said that these glucose effects from niacin don't matter while on a ketogenic diet; he says he still takes it everyday. And 2) somewhere Ford Brewer mentioned that these glucose effects only lasts for 3-9 months, unlike statins’ glucose worsening effects – they perdure. [Someone mentioned that Masterjohn said taking it with chromium to negate those glucose effects.] Keenan also mentions the glucose elevation returns to baseline after several months.

Increase in liver enzymes.
For this Masterjohn, mentions taking niacin 1:1 with TMG and half of it glycine, should theoretically make it less likely to be toxic to the liver. Mercola mentions to take it with TMG to reduce flushing. [My mother does find that when she takes it with TMG, she has no flush, or very little, like Mercola said.]
Keenan says to eat methyl donor foods: kale, fish, nuts or supplement methionine, folic acid, betaine or choline. (Niacin Breakthrough book)
Cheng gives a ‘Liver detox’ supplement (I don’t know what it contains).
James Roberts says to take it with NAC/Silymarin/ALA to avoid that, along with B6 or 50mg of P-5-P, B12, folate because niacin increases homocysteine.

It might raise uric acid, so a higher risk of gout, as well as increase bleeding risk with an anticoagulant, and it might lower blood pressure additionally with an antihypertensive medication [1]
Some (14% on Extended Release) had diarrhea, and others nausea, vomiting.
Some reported, they had more dental pain and sensitivity while on niacin.
Some had eye problems while on niacin that resolve on niacin cessation [1, 2]
Chinese people had more myopathies (muscle pain) while combining it with statins. So, some hesitate to combine it with statins while others are fine with it provided you don’t have side effects, IIRC.

Keenan mentioned that 10% of people were hypersensitive to niacin and have liver toxicity from less amount, emphasizing monitoring liver blood tests at 4-6 weeks and symptoms (dysphoria, nausea, pain, jaundice), and with just <1g they could get the cardiovascular benefits. Ford Brewer mentioned he had one patient that with just 250mg he had the benefits.

If liver enzymes go higher than twice the normal level, the NA [Niacin] dose needs to be cut by 50%. (Despite the cut, lipid improvements usually remain the same.)”
(Keenan, Niacin Breakthrough)

Rare side effect: dark patches on the skin (acanthosis nigricans) that resolve with niacin cessation.

They say not to take it when there’s an active gastric ulcer, and new onset of atrial fibrillation.

Life Extension/William Davis says: Keep in mind that it may take three months or longer to realize the full lipid-optimizing benefits of niacin.

“People with liver disease, unexplained elevation of liver enzymes, active peptic ulcer disease, or a history of abnormal bleeding should consult their physician before beginning niacin treatment. Those with a past history of liver disease, jaundice, peptic ulcer disease, gastritis, or alcoholism should exercise caution with niacin. Gout may flare up when niacin is used, so talk to your doctor if you have a history of gout.”

That said, it’s one of the few things that can lower LDL/ApoB and lower the small LDL particles unlike statins that lower the large particles, lower Triglycerides, increase HDL, lower Lp(a) (by 20-30%, and McConnell takes it at 4.5g to lower it 70%, supposedly, unlike statins that can increase it by ~20%), lower fibrinogen (by 14%), may lower blood viscosity, lower arterial inflammation (Lp-LPA2 by 20% and possibly Myeloperoxidase) and lower CRP (by 15%), increase NAD+ levels and may limit reperfusion injury, improve kidney function with baking soda and calcium carbonate (Stephen McConnell), reduces LDL oxidation, and supposedly reduce heart attack risk from pathogenic oral bacteria (although statins can do something similar by inhibiting P. Gingivalis.)
Also there was just a little bit of CIMT regression by .7% and .4% and improved endothelial function. [1, 2, 3]

[You can read Stephen McConnell’s posts on reddit, if you want to know more about his perspective on niacin. He likes to educate about niacin, he can be reached at mcconsd55@gmail.com.]
[If you’re into NAD+, I’ve heard experiences with Niacin increasing NAD+ with 600mg and another with 3g. A much better choice than the other expensive NAD+ precursors like NR and NMN. Alternatively, Mercola recommends 50mg of Niacinamide, three times a day to increase NAD+.]

But if niacin is so good why doesn't it translate to amazing results in large studies? I don't know. There are good/fair results with it and neutral, the bad ones have explanations for that, IIRC.



Cheng recommends HIIT Exercise. I don’t think that’s good on the elderly, I recall that after ~40 If you do intense exercise, the risk of atrial fibrillation increases, but Cheng recommends it and he is ~65 years old and plays badminton 2 hours ‘non-stop’ several times a week and in a fasted state. [He does mention on his blog that for the older, walking or power walking]

No mention of nitric oxide precursors for some reason, or just Resveratrol
Not many polyphenols, but Resveratrol
No mention of CoQ10 for some reason
No mention of fibrinolytic enzymes like nattokinase
(Or maybe that’s because those are too many supplements to recommend…)

Notice no dairy because of calcium. Gives high dose of Magnesium 500mg elemental and also a higher dose of 1,500-2,000 but it's unclear if that’s elemental as well or from threonate that he mentions on his blog. Cheng says magnesium can dissolve calcium deposits, his reference: “Soft tissue calcification treated with local and oral magnesium therapy” (link).

Notice he mentions the need of resolving hidden infections, especially oral ones.
 
As well as the need to address hormonal imbalances, like thyroid, adrenal and sex hormones.

About that... Some recommend only hormone replacement therapy (HRT) within 10 years after menopause, not so much on older women. But nobody seems to know well if it does good on someone with heart disease. Some say oral estrogen is thrombotic while dermal estrogen isn't, and that if you have breast cancer you shouldn't take it. Although in ‘The Great Menopause Myth’ they say that breast cancers that develop when using estradiol replacement are more benign. They mention to take, always bioidentical, estradiol transdermally dosing estradiol and progesterone everyday or progesterone preferably cyclically: for two weeks every monthly cycle; and a quantity to achieve premenopausal physiologic levels (no mention of how many mg).

Testosterone only when dosed and timed correctly and after estradiol has been optimized, because it has risks, they say. [However, there's a thread on the forum about testosterone for women on perimenopause providing benefits.]
[Some risks, though, that other people say is that it can raise hemoglobin and hematocrit making the blood more coagulable (explained further below). I cannot say that's the reason, but my mother has those elevated while on HRT with testosterone.]

(The book also mentions to avoid supplements that act as phytoestrogens during HRT, like curcumin >500mg, DIM/I3C, Black Cohosh, Ginkgo Biloba, Wild Yam, Soy products and others.)

Dinkov says instead “tissue estrogen is often high [not low] in menopausal women, and that hormone therapy based solely on bloodwork often makes things worse” “The most popular kind of breast cancer is estrogen receptor-positive. How can you have an estrogen-driven disease if you're deficient in estrogen?”

I’ve heard that progesterone up to 200mg, either sublingual or transmucosal in your gums, protects you from colon, breast and endometrial cancers.

Mercola recommends 25-50mg of progesterone dissolved in Vitamin E put in your gums before bed, DHEA 20-50mg and pregnenolone 30-50mg both dissolved in ghee or butter.

Someone says that Ray Peat liked progesterone and that it prevents ‘degenerative calcification’.

Cancers and HRT, and Contraindications:

Metastatic estrogen receptor positive (ER+) breast, ovarian, endometrial, or uterine cancers are often considered disqualifiers from systemic HRT use. That said, locally applied topical hormone therapies, including lubricants using estradiol, DHEA, or testosterone, are often possible and can protect these women from the genitourinary issues that arise from hormone deprivation. Additionally, provided the cancer was not progesterone receptor positive (PR+), progesterone can be used to protect the body from further cancers for the vast majority of women and its use will be fine.

Don’t take it if the woman is on aromatase inhibitors. If she’s on selective estrogen receptor modulator (SERM), HRT will be less effective.
[..]
Any cancers of any family members where the onset was after the age of sixty are actually not equated to a “family history” of cancer relevant to HRT eligibility.
Cancer in two or more first-degree family members where onset was before age sixty does, however, constitute “family history” and may be relevant to HRT eligibility—but even in these instances more data are needed.
Provided a woman herself does not have preexisting cancer lesions, the benefits of HRT outweigh the risks—in most instances. Even more important, however, is the fact that among women with a family history, those who used HRT had a significantly lower risk for total mortality than did women who had never used HRT, including total cancer-related mortality.


[...]


MEDICAL CONDITIONS THAT MAY REQUIRE HRT AVOIDANCE
Active acute chronic liver disease with dysfunction, Active deep vein thrombosis (DVT), pulmonary embolism (PE), migratory thrombophlebitis (Trousseau’s sign of malignancy), or factor V Leiden mutation or a history of these conditions, especially during pregnancy. Active or recent (within the past year) arterial thromboembolic disease (such as transient ischemic attack, stroke, or myocardial infarction), Advanced coronary heart disease (atherosclerosis), Chronic active portal vein thrombosis Known or suspected metastatic estrogen receptor positive breast, ovarian, endometrial, or uterine cancer, Pregnancy, Severe and/or advanced cardiovascular, peripheral vascular, or cerebral vascular disease, Severe hypertension, Uncontrolled cardiac arrhythmias, Undiagnosed vaginal bleeding after full investigation.

Second to cancer, the next most common reason women believe they are ineligible for HRT use is due to having clotting disorders such as factor V Leiden, deep vein thrombosis, or pulmonary embolism. Similar to the considerations around cancer, nuance is needed here. Generally, the perceived risks around HRT and blood clots are often due to the route of administration (oral) and/or the form of HRT used (synthetic). By following best practices for HRT selection as outlined in chapter 12, the risk of clotting is minimal to nonexistent for the vast majority of women.
[...]
Potential Contraindications:
Screening for challenges such as severely compromised metabolic health or conditions such as Lynch syndrome should be looked at alongside personal medical history, symptom severity, and lifestyle factors when making HRT eligibility determinations. In many instances, HRT can improve these conditions but special consideration and caution should be taken, nonetheless.
[..]
With respect to transdermal HRT creams, gels, and oils, one of the main relative contraindications is the potential for transference to family members and pets.
[..]

Extremely poor gut health is another potential relative contraindication. Severe gut microbiome dysbiosis, significant permeability of the gut membrane (leaky gut), chronic IBS/IBD (whether diarrhea or constipation), chronic proton pump inhibitors (PPI) use or gastroesophageal reflux disease (GERD), and gastric bypass history all pose challenges to HRT effectiveness. Accordingly, working on healing one’s gut before or concurrent with starting HRT is essential.

Use of certain medications, such as antidepressant and antiseizure medications, can make HRT challenging but still possible. Often, the HRT provider will need to work with the particular medication prescriber to manage dosing adjustments that may be required given the positive influence of HRT on these conditions.

And although HRT has been shown to lower a woman’s risk of various autoimmune conditions, systemic lupus erythematosus (SLE) is an outlier. HRT does have the potential to induce SLE flares. For this reason, women with active SLE disease or those with antiphospholipid (aPL) antibodies should not undertake HRT. HRT can, however, be used by women without active disease or antiphospholipid antibodies.

Finally, an unstable uterus usually requires some sort of imaging before beginning HRT. This means a pelvic or transvaginal ultrasound is recommended for women with the following:

Abnormal ovarian cysts Adenomyosis History of unexplained dysfunctional uterine bleeding during the previous twelve months Polycystic ovary syndrome (PCOS) for more than thirty years Suspected or known history of fibroids Unexplained pelvic pain

None of these conditions is absolutely contraindicated for HRT but, in some instances, a hysterectomy may be advised by your doctor in order to gain the most benefit from HRT with no exacerbation of symptoms.

Does Age Matter?
The prevailing narrative for much too long has been that if a woman is more than ten years past reaching menopause or over the age of sixty, she is not a candidate for HRT. In addition, women are told that once they reach the age of sixty, they should stop taking HRT. All of these beliefs could not be further from the truth and are based on poor data. In fact, no study has demonstrated a lack of safety with the use of non-oral bioidentical HRT in women over the age of sixty or more than ten years postmenopausal, and yet the standard (wrong) narrative is that HRT in these women is unsafe.
[..]
In fact, because HRT is effective for osteoporosis and other hormone deprivation issues, such as genitourinary health, sleep, libido, skin and hair, mood and cognition, and more, these groups suggest that extended use of HRT is reasonable when the woman and her provider agree that the benefits outweigh any potential individual risks.

The truth is that women who spend an extended amount of time with depleted and insufficient hormones are already at greater risk for heart disease, cancer, clots, and more.

For this reason, adjusting lifestyle to create a healthy host for HRT along with pre-initiation screening of cardiovascular status via tests such as a coronary artery calcium scan and a fractionated lipid panel that includes measuring lipoprotein(a) and fibrinogen are strongly recommended. If such test results are acceptable and metabolic health is not markedly poor, there is no reason for a woman of any age without any absolute contraindications to avoid HRT based simply on age or time since menopause.

From ‘The Great Menopause Myth’

On men, Jeffrey Dach says testosterone can be good only when hematocrit and iron stores are in check (with blood donations) [and probably fibrinogen needs to be in check too, James Roberts], otherwise it might make the blood more coagulable, as seen in one study that had a small increase of heart attacks with testosterone. An interviewee from Mercola, also mentions testosterone can raise hematocrit, hemoglobin, and red blood cells.
Rhonda Patrick, on a recent email, says something similar that it can push red blood cell production too high, erythrocytosis, making the blood thicker and that the TRAVERSE trial suggest that restoring testosterone to the lower-normal range didn’t significantly increase cardiovascular risk, but they did find higher rates of atrial fibrillation, pulmonary embolism, and acute kidney injury in the testosterone group. It can also hurt male fertility, if not an outright contraceptive. Mentions it’s better to try supplements first before testosterone replacement.
But Jeffrey Dach does mention testosterone replacement lowers mortality, especially in diabetics.


The thyroid is really important too. Thomas Levy in his book “Hidden Epidemic” says that having good levels of thyroid hormones can keep the dental infections local – not spreading to the body. I’ve heard functional medicine and Kresser say to have TSH within .5-2 ideally, and if you choose to take thyroid hormones, take the natural desiccated one because the synthetic doesn't improve symptoms. Or maybe use red light. Mercola used red light on his thyroid when he wanted to taper off thyroid hormone medication, he mentions 5-10 min a few times a day.


About Vitamin E, from what I’ve mentioned earlier with BaleDoneen, they say it’s only beneficial in diabetics with the haptoglobin 2-2 genotype, otherwise it could be worse and increase risk for heart attacks. Kresser says something similar, that alpha-tocopherol might increase risk of heart disease and that it's better to take it as tocotrienols. So, Cheng says alpha-tocopherol, but tocotrienols might be better, specifically from annatto 200mg, says Kresser.

Cheng mentions a high dose of K2 MK7 45mg, but he probably meant it as MK4, because there’s no MK7 at that dose that I could find. Some say it doesn't always work for calcification, while others say it’s really the only way to lower calcification. If you have the Apo E4 genotype, you may need a lot more K2, because you clear it from the body faster, about 900mcg MK7 (Mercola). Ford Brewer recommends 400mcg MK7, James Roberts 1,000mcg. Cheng 200mcg MK7 + 45mg MK4.

Cheng says Omega 3 2g-4g, but that might be too much, as I’ve heard people have palpitations after a while on a higher dose >1g. Mercola says so too, the higher you go, the higher the risk of atrial fibrillation. Someone on FB said that only happens if you have a genetic risk and that 2g should be fine.
Seems that it only happens with supplementation and not from eating fish.

Although I’m trying to explain more of the important supplements, if you want some, not all, of his explanations for these supplements, here it is on his blog (2019)
But I don't know how updated it is, because on his blog he mentions Mediterranean Plant-based and meat as condiment... Whereas in his case reports, he mentions low carb/ketogenic animal based. So, now I wonder whether his ketogenic diet is Mediterranean keto like others advocate.

On a recent zoom video, (Zoom video, Password: G21$rY*v , Slides), he says occasional carbohydrates 2 days a week.
Cheng also mentions he has cured cancers, helped liver failure and others
[Impressively, he also mentions reversal of renal insufficiency, eGFR from 39 to 81 in ~10 months, which reminds me of the lipidologist I mentioned, Stephen McConnell also says to reverse one stage of Chronic Kidney Disease with Niacin, Baking soda and Calcium carbonate.]


Pauling Protocol

I’d like to explain why the Pauling Protocol: Vitamin C, Lysine and Proline to blunt Lp(a).

Cheng says:“Pauling argued that ASCVD [Atherosclerotic CardioVascular Disease] is driven more by nutrient deficiencies—particularly in vitamin C—which weaken arterial walls, making them susceptible to damage. In this scenario, lipoproteins, including lipoprotein(a), act as a vascular “repair” mechanism rather than as the root cause. “

So, Pauling and Rath, “hypothesized that Lp(a) serves as an evolutionary surrogate or substitute for vitamin C in animals that do not endogenously synthesize vitamin C, such as humans and monkeys” “Pauling noted that our ancestors’ loss of the ability to synthesize vitamin C and the acquisition of Lp(a) synthesis both occurred about 40 million years ago.”

They saw that guinea pigs, that are unable to synthetize Vitamin C, had Lp(a) and “they further found that vitamin C deficiency in these animals promoted the development of atherosclerotic plaque and that supplemental vitamin C prevented its development and the accumulation of Lp(a) in the arterial wall.”

Lp(a) is particularly more atherogenic than LDL, 6 times more they say, and its levels are generally thought to be mostly unmodifiable and genetically determined. It’s associated more with, in order, aortic valve stenosis, peripheral artery disease, carotid stenosis and heart attacks, IIRC.
But I’ve also found that inflammation increases it, sleep apnea as well (
Mike Mutzel), and Kresser has seen it lower 40% after addressing all of the imbalances like gut, infections, HPA axis, nutrient imbalance, heavy metals, mold.
Statins can raise Lp(a) in 63% of people by ~20%... Someone (penultimate slide) got a 145% increase with statins…
Sam Tsimikas (scroll down), leader in Lp(a), says statins, low fat diets, and garlic can increase it by 10-25% [increasing Lp(a) is not a good thing.]

Although studies have shown Lysine, Proline and Vitamin C does not reduce Lp(a), it might still help by another way. Because Lp(a) has a lysine-binding protein, the idea is to take lysine and proline for Lp(a) to bind to these aminoacids instead of the artery wall. James Roberts says that his patients that take it, their stents take longer to obstruct again. [It’s not uncommon for stents to obstruct again.]

Some say that lysine is a precursor to carnitine and that can lower Lp(a) to some degree by 8% or 21% in diabetics.
[Apo E4 slows clearance of Lp(a), leading to higher levels]
[CoQ10 can lower it by ~20%]
[High dose niacin 2-3g is one of the few things that can lower Lp(a) by ~30%. Lipidologist, Stephen Mcconell (reddit post) claims Niacin can lower it by 70% if you go even higher at 4.5g]
I’ve heard aspirin can lower Lp(a) by 50%-80%, but I don't understand why it’s not used for that if it’s so good at that? Because almost nobody that speaks about Lp(a) mentions aspirin.

Doses vary a lot. Pauling gave it 3g-6g Lysine/2g Proline with 3-18g Vitamin C. Others say 1-3g Lysine/1-3g Proline. Cheng 2.5g/1g. James Roberts 2g/1g. Vitamin C ranges 2-20g.
Pauling had cases of angina improvement with that. [1, 2]
There are testimonies (Owen Fonorow site) with just using that Pauling Protocol with success, although I’ve heard others were not as great because they needed more vitamin C, they say.
[Know that lysine can increase calcium levels, so maybe it’s better to take it with magnesium]
[They say to take the protocol away from food.]


Aminoacids

Cheng says a study used 4g/day carnitine. “Helps mitochondrial function and energy production by facilitating the transport of fatty acids into mitochondria. In a double-blind trial, 160 patients with acute MI [Myocardial Infarction] received 4 gm/d of L-carnitine or no L-carnitine after hospital discharge for 1 year. After 1 year, the mortality rate was 90% lower in the L-carnitine group than in the control group: 1.2% vs 12.5%; p<0.005. {Drugs Exp Clin RES. 1992;8:355-365.}”

Can also lower intermittent claudication (pain when walking) on peripheral artery disease (PAD – atherosclerosis on the legs) [Examine]

No explanation for taurine from Cheng, but I’ve heard it can reduce blood pressure, regulate intracellular calcium, increase TUDCA bile acids and bile flow, and lower Myeloperoxidase (marker of arterial inflammation). Supposedly, both carnitine and taurine together can inhibit calcification.
James Roberts says 1g twice a day.
[Speaking of UDCA, 500mg of it can counteract the insulin resistance effects of statins (Nick Norwitz) Will it work on niacin as well? I don't know]
Mercola says taurine on animals showed increased longevity, stronger bones, less body fat, boosted immune activity and mitochondrial function, had less DNA damage and inflammation. Exercise can boost taurine levels. However, in animal models taurine makes leukemia worse; unconfirmed in humans.

Although Cheng doesn't give an explanation, the glycine and NAC that he mentions seem really important too for lowering oxidized LDL and increasing glutathione, resulting in much less risk of cardiovascular deaths. Kresser says:

Studies suggest that people with low levels of glutathione have higher levels of oxidized LDL and a greater risk of heart disease. For example, one study found that people with the lowest levels of glutathione peroxidase activity had approximately 2.3-fold greater risk of death from cardiovascular disease compared to those with the highest levels. This difference was exacerbated in those who had both low glutathione peroxidase activity and low levels of HDL. Those individuals had an approximately sixfold higher risk of death from cardiovascular disease.

Now, to put this in perspective, people with this combination appear to be at greater risk for heart disease mortality than that attributed to moderate hypertension, type 2 diabetes, smoking a pack of cigarettes a day, or having an LDL cholesterol in the 200 mg/dL range, so that’s a pretty significant risk profile.


In another study, researchers found that glutathione was severely depleted in the heart tissues of patients with coronary artery disease when compared to healthy controls. Also, studies have shown that polymorphisms in genes controlling glutathione production are associated with an increased risk of heart disease. Finally, a meta-analysis of 42 case-controls in three prospective studies found an inverse association between circulating levels of glutathione peroxidase and coronary heart disease.

Here they found NAC improves coronary and peripheral vasodilation.
 
Other Things That Help

Plaque Stability

Now I want to talk about plaque stability.

How does plaque actually rupture? They say the soft plaque has a necrotic core, made of lipids and cellular debris, like dead foam cells which generate inflammation, and it’s covered by a fibrous cap, made of collagen and smooth muscle cells. When it gets too thin from inflammation/high glucose/low collagen it makes the plaque unstable and more likely to rupture causing the necrotic core contents to spill into the bloodstream and activating the coagulation cascade leading to a clot clogging an artery – a major event.

So, stabilizing the plaque is of paramount importance, because you could have a lot of plaque, but if it’s stable you wouldn’t have a major event; whereas the opposite also happens, people with not much plaque, ruptures causing a major event.

I don't know if it’s proven, but I tend to think that everything that increases collagen (Vitamin C, Collagen, Polyphenols, Bone Broth, Aminoacids) should help stabilize the plaque, but apparently, there’s also the other end of the spectrum of too much collagen worsening stenosis (old reference). I don't know how much is too much collagen that could worsen it. [But I guess, someone could say stenosis is a better trade-off than plaque rupture...]

Cheng says, on his blog, both Pycnogenol and Gotu Kola (Arterial Protect from Life Extension) both help stabilize the soft plaque by improving synthesis of collagen.


Paul Mason says that secretion enzymes like MMP-9 destabilize the plaque. Foam cells can secrete it. High glucose levels stimulate its secretion; type 1 and type 2 diabetics have higher levels of this enzyme. Mentions seed oils and phytosterols contribute to premature heart disease, and that those are even worse than sugar/carbohydrates.
Says NAC and antioxidants are protective. As mentioned before, low glutathione increases 2.3-6 times the risk of death from cardiovascular disease (Kresser).
Patrick Theut says astaxanthin can lower MMP-9 and MMP-2. Technically, 10mg of doxycycline can too.

Someone on FB said Omega 3 (6g – risky!) and statins (daily, low dose Rosuvastatin 5mg) to thicken the fibrous cap, stabilizing it.
Many use statins also for this reason as it lowers the lipid part of the soft plaque (but not always), and stabilizes the plaque by increasing calcification, which should lead to less major events.

Gil Carvalho, mentions a study that found exercise lowers the necrotic core, making it more stable.


Lowering markers of arterial inflammation like Lp-PLA2 and Myeloperoxidase should make it more stable. I’ve found these things can lower it:
Rosuvastatin, Ezetimibe, Fenofibrates.
Omega 3, Niacin, ALA, Curcumin, Resveratrol, EGCG, Vitamin D, Melatonin, Pycnogenol, Quercetin, Carnitine, Taurine (Nick Norwitz), Arginine, CoQ10, Zinc if deficient.
Exercise, Resolving Oral infections (Bale-Doneen)
Worse levels in excess body fat

Apparently, intermittent fasting can help stabilize plaque too.

[EZ Water/Structured water or zeta potential maybe could help stabilize it too. More on that further below.]


High Blood Pressure

Rupturing from high blood pressure. Midwestern doctor believes high blood pressure doesn't matter as much in the elderly as it could be more like a compensation the body does to get enough blood where it’s needed, and everyone else believes it does matter, but hypertension could(?) explain why some people get a heart attack after/during exercise as blood pressure increases during/after exercise, rupturing the plaque. [I’ve read a few instances where a person had a heart attack after exercise.]

So, IF blood pressure matters, maybe try Hibiscus tea, 3 cups a day can lower blood pressure by 7-13 mmHg, the higher end in hypertensive people, a comparable reduction to a single antihypertensive medication.
[Apparently it can increase structured water as well, says Thomas Cowan, but it’s unverified.]

I don’t know if it's true, because I’ve seen reported other numbers, but Gil Carvalho says regular isometric exercise lowers blood pressure more than walking (3 mmHg), aerobic (6-7 mmHg), HIIT (4 mmHg), and strength training (4-5 mmHg), by 8-10 mmHg – a standard dose of an antihypertensive, he says. Isometric exercises, like wall squats – a squat supported on the wall, sustained position for 2 minutes, 1-4 min of rest, repeated 4 times a day, thrice a week.

Bosworth finds in her patients that lowering insulin, with a ketogenic diet, lowers blood pressure resulting in stopping antihypertensives.

[Pycnogenol or Grape Seed Extract can help lower blood pressure, finds my mother. It’s not working anymore for her probably due to other reasons.]

Saunatwice weekly for three months decreased blood pressure in hypertensive men from 166/101 mmHg to 143/92 mmHg, a result similar to taking one blood pressure-lowering medicine.” And if combined with exercise, the reductions were greater than just exercise alone.

Midwestern doctor say that improving zeta potentialoften causes a dramatic improvement in one’s blood pressure” with zeta aid product or homemade (more on that further below).
Grounding increases zeta potential and there’s this study that lowered blood pressure by 14.3% if grounded for >10 hours.
[Honestly, I really doubt it, but a reader of his mentions 100-150mg of Niacinamide lowered his blood pressure from 180 to 120, supposedly, even at 93 years old.]

I don’t know how true this is, but Ray Peat said that breathing in a paper bag a few times a day can lower your blood pressure by as much as 30 points by increasing your CO2 and that it stabilizes there after a few days of repetition.

[Rhonda Patrick mentionsA simple air filter could cut indoor pollution in half and even lower your blood pressure if it’s already on the high side.”]

And Cheng says, if you do need a drug for it, choose a calcium channel blocker as it has an anti-atherosclerotic effect and lowers all-cause mortality.

Midwestern doctor mentions these side effects from calcium channel blockers:

3: Calcium channel blockers: These reduce the force of contraction of the heart, dilate arteries by relaxing the smooth muscle in them, and somewhat slow the heart rate. The major issues with these drugs are that they cause edema (swelling) throughout the body (affecting between 5.7-16.1% of users depending on if a low or high dose is taken) and frequently cause dizziness, lightheadedness, or constipation. These drugs are often quite helpful for resetting an abnormal heart rhythm, but also can cause other symptoms such as tiredness, headaches, abnormal heart rates, and shortness of breath.


Lowering Fibrinogen

High levels of it can be a risk factor for plaque, as it makes blood more coagulable/viscous.
James Roberts says >350 mg/dL is high risk, and he gives pentoxifylline, turmeric and lumbrokinase.
Malhotra says >300 mg/dL is associated with premature cardiovascular disease.
BaleDoneen, >370 mg/dL. Infections, Insulin resistance and inflammation can increase it.
Oral infections can increase it too.
Rhonda Patrick, air pollution increases it. Omega 3 can blunt that increase.
Smoking increases it [However, there’s the Japanese paradox of a high number of men smoking and yet lower rates of lung cancer AND cardiovascular disease despite having multiple risk factors like high blood pressure, LDL-C, glucose, diabetes. Some say maybe it’s because of their natto consumption.]
Chondroitin sulfate can make fibrinogen less likely to stick to surfaces as it can reduce fibrinogen adsorption.

Other things that lowers it:
Garlic, Vitamin E, Ginkgo Biloba, Niacin, U-shaped relationship with alcohol; moderate alcohol lowers it, Folate, regular Exercise, Nattokinase, Quality sleep.
Gemfibrozil, Bezafibrate, Ticlopidine.


The Glycocalyx

Because the glycocalyx (means “sugar coat”), found on the outer layer of the endothelial cells lining the blood vessels, seems to be important as it protects the endothelium against clotting, inflammation, produces nitric oxide, makes the vessel wall slippery and creates structured water. Cheng says it’s damaged by high glucose, blood pressure, smoking, inflammation, increasing the risk of thrombosis and plaque development. Paul Mason says it’s also damaged by oxidized LDL. Kendrick says it can be repaired in a single second. (But probably it doesn't repair itself if there’s constant damage.) MidWestern doctor says it can generate liquid crystalline water/EZ Water.

They say that these sulfated polysaccharides/glycosaminoglycans like heparan sulfate, hyaluronic acid, glucosamine, and chondroitin sulfate help repair it.


Chondroitin Sulfate

So, I want to talk about Chondroitin sulfate, because it seems it’s very helpful. Maybe because of healing the glycocalyx or some other reason.

Apparently, before statins came about, there was Lester Morrison that used chondroitin sulfate for atherosclerosis, and it seems to help reduce the plaque, contributes to the elasticity of blood vessels, and even healing the heart after a heart attack (EKG showed no evidence of a prior heart attack) [link] [link] He says it has stronger anticoagulant properties than heparin, inhibits calcification, coagulation and plaque, and if you give it to mice, it reduced 60% of plaque despite being fed a high fat diet. He found in his patients that 70-80% improved and had less major events, one had less stroke sequelae, another resolution of angina. Thing is, he often used a high dose at 6g or more, then tapering to 1.5g.

It can also lower the amount of fibrinogen available to bind to surfaces and interact with cells, which is important for preventing blood clots and managing inflammation.

While chondroitin is usually given for the joints, apparently those who take it have less cardiac events.
Midwestern doctor says:

Note: supplements which heal the glycocalyx (e.g., hyaluronic acid) have also been shown to prevent heart disease. For example, one study found habitual glucosamine use was associated with a 15% lower risk of total CVD events and a 9%-22% lower risk of individual CVD events (CVD death, coronary heart disease, and stroke), while another study found osteoarthritic patients treated with high doses of chondroitin sulfate (CS) have a lower incidence of coronary heart disease.

Malcolm Kendrick adds in his book:

“Albumin is physiologically bound within the glycocalyx, protecting against shedding and contributing to the maintenance of vascular integrity and normal capillary permeability. Owing to these properties, albumin has the potential to improve outcomes in clinical scenarios characterized by damaged glycocalyx.” 228
[...]

Japanese researchers also found that chondroitin sulphate acts as a potent anticoagulant reducing the risk of blood clots forming on the arterial walls.232 Almost certainly because a healthy glycocalyx stops blood clots forming. So yes, it does appear that you can keep the glycocalyx much healthier by taking protein supplements. The main ones are:

• Chondroitin sulphate
• Glucosamine
• Hyaluronan

All three can reduce the risk of CVD. Not massively, but significantly.

There’s a study that used 800mg of chondroitin sulfate daily and it reduced risk of acute myocardial infarction by 40% [link] (glucosamine didn't lower it), much more so than the purported risk reductions of statins (~20-30%), and PCSK9 (~15-20%).

And then someone that has Abdominal Aortic Stenosis at 80% and PAD (peripheral artery disease) said he benefited the most with Pauling Protocol and Chondroitin Sulfate – it lifted his 60% walking disability. 5g a day for some months though. [link]

Overdose (I don't know how much), could cause GI symptoms, diarrhea


Nattokinase

Nattokinase, a fibrinolytic enzyme found on the Japanese fermented soybean food called natto. (In natto there’s also Vitamin K2 Mk7 and Bacillus Subtilis, besides the enzyme nattokinase). It can dissolve fibrin, possibly clots, the spike protein of COVID, eye floaters, reduce blood pressure and blood clotting. Possibly degrades the amyloids fibrils in prions diseases. Apparently it can reduce lipids somewhat.

The main study about nattokinase that people share is this one:
High dose nattokinase at 10,800 FU daily with up to 39.5% carotid plaque regression for 66.5% of participants in one year [link]. That’s by adding K2 180mcg, aspirin 100mg and >5,000 steps as exercise. I’ve heard people take Neprinol for their nattokinase and other enzymes.

Although that study did it with aspirin, I’m wary because the older you are, the more likely you are to have cerebral microbleeds, and so combining aspirin, which increases bleeding risk, with nattokinase might be dangerous. [If I understood correctly.]
There is an adverse event case on examine associated with nattokinase. She was taking aspirin 100mg and other medications for Parkinson, but also had a previous stroke 1 year prior and family history of intracerebral hemorrhage, and the combination resulted in intracerebral hemorrhage. She took 400mg (8,000 FU) of nattokinase for 7 days.
So, I think choose one or the other, but not both nattokinase with aspirin.

And another case, one that used serratiopeptidase, another fibrinolytic enzyme, after a week his tooth abscess got dissolved, spreading to the buccal space. He had to take antibiotics and had the pus drained.
So, I think if you have a tooth abscess, from infected root canals or non-vital teeth, it’s probably better not to take fibrinolytic enzymes.

James Roberts gives Lumbrokinase so that plaque doesn't progress and it lowers fibrinogen.


Pomegranate

Cheng says: “[Pomegranate] It is anchored to the surface of HDL which helps to cleanse arterial walls of plaque, protects LDL against oxidation and inhibits chronic inflammation, vascular adhesion molecules and platelet activation all of which leads to atherosclerosis.” “Enhances nitric oxide synthesis and supports reverse cholesterol transport by HDL which can result in shrinking of atherosclerotic plaques”. James Roberts says it stimulates the antioxidant system Nrf2.

A study of Pomegranate 50ml daily fresh juice found up to 30% regression in CIMT in one year, BUT it did not reduce further even after two more years on it, versus 9% progression on the placebo group. 60% of both groups were on statins and anti-hypertensive drugs.
Conversely, another study found it didn't lower CIMT significantly, but it may have slowed progression in those with oxidative stress.
It’s high in FODMAPs, so it can give you gastrointestinal symptoms.


Aged Garlic


This study found that it reduced blood pressure by 7-16 mmHg (systolic), while another say it's milder by 3-5 mmHg. Has some lipid lowering effects.
Lowered CAC score progression to ~7% compared to ~26% placebo.
But Sam Tsimikas says garlic can increase Lp(a)
And it can cause diarrhea in those sensitive..


Berberine

Best known to lower glucose and insulin resistance, with lipid lowering effects and adjunct for SIBO treatment.
Stimulates mucin secretion in the gut, promoting Akkermansia growth – a keystone bacteria for gut health, says Mercola.
Mercola says berberine has protective cognitive effects.
[Taken before eating to lower glucose response or at night, or away from workouts, so that it doesn't affect workout performance]

In one study 1g regressed CIMT by 3.2% in 4 months.
On FB, someone says that it also increases Reverse Cholesterol Transport
James Roberts: “Berberine can cause diarrhea or constipation which is dose-related; should these occur don’t stop berberine but rather decrease the dose to a tolerable level.”
However, people say it’s a Complex 1 inhibitor, a ‘mitochondrial poison’, like Metformin. So, I’ve heard people saying their workout’s performance worsens while on Berberine/Metformin and don’t gain muscle (or even lost gains), supposedly. For that reason, they take it at dinner, rather than at breakfast.


Licorice

DGL (deglycyrrhizinated licorice) only this kind to reduce the risk of increasing blood pressure.

Can soothe and protect the gut lining.
This study found 200mg decreased CIMT by 8.7% in one year.


Bergamot


It works like a statin does, as a HMG-CoA Reductase inhibitor, with similar side effects, I’ve heard. Preferably taken with CoQ10, for that reason.
Decreases the small dense LDL particles, unlike statins.
In this study, Bergamot juice extract containing 150mg of flavonoids decreased CIMT by 25% over 6 months.

Inhibits P450 enzymes
like grapefruit does, which slows the metabolism of certain drugs, resulting in an increase in their concentration in the blood. So, careful with that.
Can give nausea.
James Roberts says he doesn't see it working well with his patients, and thinks it’s maybe a quality issue in the US, but that it works well in the European studies.


Pycnogenol and Gotu Kola/Centella Asiatica

Joel Kahn says it halted new calcifications and decreased 10% in the number of calcifications.
Cheng says, on his blog, that they both slow plaque progression and stabilize it, and that they work better together. Pycnogenol can improve endothelial function, stimulate nitric oxide production, reduce calcification, inflammation, lower expression of adhesion molecules in the arterial walls, lower oxidative stress and oxidized fat, improve ejection fraction rate and treadmill walking distance, and lower blood pressure.
The strange thing is that Cheng only used Resveratrol as polyphenol on his atherosclerosis case reports and not Pycnogenol with Gotu Kola.

Sayer Ji says Pycnogenol can give you the benefits of aspirin without the bleeding risks.

James Roberts says, if I understood correctly, that you could use Grape Seed Extract instead of Pycnogenol.

Life extension has such a product (Arterial Protect) and they say
“The extract blend led to 7.4 times lower progression of the disease over the study period of 42 months. In addition, cardiovascular events (hospitalization, chest pain, heart attack, or stroke) occurred in 4.4% of the combination extract group, as compared to 16% in the standard care group.22”
"Plaque progression was observed in 5.3% of those in the dual-extract group, but it was found in over 20% of the two groups that did not receive the extracts. Major cardiovascular events (such as heart attack or stroke requiring hospitalization), occurred in:3
  • 22% of the control group, but
  • Less than 4% of those taking the extracts and aspirin."

Fisetin

A polyphenol found in strawberries, apples, onions, cucumbers, and persimmons. Mercola says it can prevent arterial calcification and its progression. It also lowers lipid, insulin resistance, blood pressure, oxidative stress, anticancer properties and supports endothelial function.
It’s also a senolytic, and people report it lowers their brain fog, BUT it may inhibit angiogenesis – the growth of new blood vessels.


Speculative idea for decalcification – Citrate

Adding magnesium in the form of citrate for decalcification could be a good idea, because citric acid can potentially be used to decalcify tissues like the heart valves, and it’s used more commonly to dissolve limescale in appliances and in the bathroom.

There's actually a product for atherosclerosis that has sodium citrate, Citrichel, but I don’t know how good it really is. I read someone on Facebook got relief from angina when he used it for 2 1/2 months, 3 tabs twice a day, but who knows if it was the Pauling Protocol (Vitamin C, Lysine and Proline, although Citrichel doesn’t have proline) or the Sodium citrate that's in it that he got the benefits from.

They claim sodium citrate has a high affinity for ionic calcium, resulting in removal of arterial calcification. (They also claim their product is ‘superior to EDTA’ in that you can take higher doses.)

Apparently, Sodium citrate is also used as an anticoagulant in blood specimens and in dialysis to prevent clots in the catheter. So, there’s that too.
[Sodium citrate can also improve zeta potential that Midwestern is fond of talking about.]
However, using magnesium citrate could give you diarrhea.


Ford Brewer’s Plaque Regression

Ford Brewer (age 68), retired John Hopkins preventive medicine specialist, says that he was able to reverse his carotid plaque in one year by changing to low carb, HIIT exercise, niacin, nattokinase, Vitamin D 5,000 UI, K2 400mcg + tbsp natto, Magnesium Threonate, Kyolic Aged Garlic, L-Citrulline, Omega 3, Salmon, very low dose 2.5mg-5mg Rosuvastatin twice per week, (in another video he mentions also Ramipril and Metformin 1g 3-4 days/week).

Although he makes some changes to what he's taking in various videos (most recently he took out niacin), more importantly, if you look at his measurements at various videos, you can see his progression goes down and up, and overall it regressed 17% over 8 years.

Which is pretty good, but what is he missing? Why is he unable to lower it all like Cheng in two years?


Notably, Cheng says that his parents' carotids are “squeaky clean”, their age 90, and 88 (Zoom video @20min, Password: G21$rY*v , Slides)
Which is quite remarkable, because James Roberts and Ford Brewer still have carotid plaque themselves. So, either Cheng used not the right carotid test that doesn't quite measure the plaque (he mentions Doppler ultrasound and not CIMT), hence no plaque? Or his approach is, well.. Miraculous. ]

What I still don't understand, and would really like to know, what makes Cheng's approach so unbelievably good? Because it's nothing new to what James Roberts has used in the past, except maybe a ketogenic diet, and Roberts’ patients don't go from 70% stenosis to 0% like Cheng’s. So, something Cheng is doing right that others are not.

Unless, the ketogenic/low carb plus niacin in combination with other things is the winner combo.. But Ford Brewer has done something similar to that and still has carotid plaque.
Or maybe the high dose K2 MK4 combination with high Mk7 that Cheng does? Along with resolving infections like oral ones…Thing is, someone I mentioned before with Abdominal Aortic Stenosis at 80% and PAD tried something similar and many other things (~500 things !) and the stenosis didn't lower, AFAIK. He did get better symptomatically, and his 60% walking disability was cured with Pauling Protocol and Chondroitin Sulfate (5g/day though, for some months).

So, I don’t know how reproducible Cheng's results are.



Angiogenesis

Another possibility is increasing angiogenesis
, the process of growing new blood vessels, with Vascular Endothelial Growth Factors (VEGF). The body can grow new blood vessels when there’s severe stenosis, so it can happen that you can have blocked arteries in the heart but the body was able to create new blood vessels over time, years prior the blockage, resulting in ‘collateral circulation’. That’s the idea behind the EECP therapy creating collateral circulation.

Some of the things I know that can increase angiogenesis and VEGF:

Hyperbaric Chamber
KAATSU (Blood Flow Restriction (BFR)) bands, or exercise. [For seniors and with compromised health, KAATSU manufacturer says to use the Cycle mode, the one that inflate and deflate the cuffs, not the Constant mode, which doesn't deflate, because it’s safer for them.]
Cyclodextrin
EECP
Increasing Nitric oxide (precursors like Citrulline/Arginine; and: vitamin C, CoQ10 (Kendrick), regular exercise, sunlight, sauna, red and infrared light, polyphenols, nitrates/beets, viagra but can be risky, nasal breathing/mouth taping at night, no alcohol-based mouthwashes, technically smoking lowers its production, magnesium, meditation, humming)
[Notably, humming greatly increases it by 15 times, and intensive humming 4 times a day practically eliminated chronic sinusitis, and greatly reduced arrhythmias in a patient.]

I don't know which one stimulates angiogenesis the most, but I think the hyperbaric chamber and EECP, maybe the BFR bands, because the body is stimulated when there’s reduced blood flow, increasing these growth factors. Or the sauna as its angiogenic activity lasts for up to 96 hours, supposedly. [Couldn't find the full source, though]

[But in cancer, angiogenesis is bad, they say.]

And apparently, fisetin, and aspirin (and probably more things), even DMSO? seem to inhibit (not good) angiogenesis…
 
The Sauna or EZ Water Approach

Stephen Hussey


Aaaand lastly, there’s Stephen Hussey (age 39), heart attack survivor, who claims he reversed his PAD (Peripheral artery disease – atherosclerosis on the legs), in two years. In one year it went from 70-99% to 0-49% and in the second year to 0% stenosis. He is a type 1 diabetic controlled with low carb diet, Lean Mass Hyper Responder (those that on low carb their LDL skyrocket; he had it very high at 372mg/dL), but otherwise very healthy – he was told he had minimal plaque when he had the heart attack and had a CAC score of 0. He says his PAD was caused when the catheterization angiogram was performed on him after the heart attack, because it developed a few months after the procedure.

In his book, he wonders whether it was stress that caused the heart attack. On a Sunday night he received stressful bad news of a close family member, then he couldn't sleep that night nor the one after that, and on Tuesday 45 mins after doing his usual exercise he felt a lot of pain in his chest, resulting in a heart attack.

[Right after the heart attack he did 6 months of anticoagulant and 1 month of blood pressure medication, then switched to ouabain to prevent heart failure after heart attacks plus supplements. He had an ejection fraction rate at 30-40% but he managed to improve it to 50-55% in three months.]

On the video, he claims that the only different thing he did to reverse PAD was increasing structured water by doing a lot of infrared sauna, grounding and sunlight; he already was on a low carb diet and did exercise before the heart attack and PAD. Additionally, in his book, he doesn’t tell the story how he reversed his PAD plaque, but he mentions he was taking magnesium, taurine, carnitine, arginine, ouabain, in addition to sauna, exercise and diet.


Couple

Which reminds me of a couple (late 30s) where the husband reversed his plaque (had a CAC score of 186 despite great lab values) in 5 years with exercise, a ketogenic diet: meat based with butter and saturated fat. Added vitamin d3 and k2, some sauna, some magnesium and ‘all the weird things biohacker people do’ and his CT angiogram showed he was ‘crystal clear’, so much so they wonder whether the first CAC score was wrong. And that’s despite having some family history of heart attacks; his grandfather died in his 50s from a heart attack.
So, it’s unconfirmed plaque regression, but I think he did have plaque and reversed it with those things.


Back to Stephen Hussey, he says EZ Water/structured water is like an anticoagulant gel layer, and oxidative stress/inflammation breaks it down. And that if there is EZ Water, its properties don't allow for LDL particles to penetrate the arterial wall.

He mentions these can damage the structured water:

Glucose
Based
Metabolism
Oxidized FatsHeavy Metals"Infectious"
Illness
Fluctuating
Blood Sugars
EndotoxemiaSmoking/ Air
Pollution
Decreased
Endothelial
Progenitor Cells
Advanced
Glycation End-Products
Psychological
Stress
Bisphenol-AInsulin
Resistance



He lists these things can create EZ water, and that infrared light is the number one thing that structures water (at 3000 nm):
  • Good water (spring water, glacial melt, vortexed water, no toxins in water)
  • Avoid toxins (glyphosate, plastics, heavy metals, etc.) - (Abha, S., et al. 2018)
  • Avoid nnEMF's (reduce EZ 15-20%) - (Lec, J.W., et al. 2021, Abdi, S., et al. 2016)
  • Optimize Circadian Rhythm (sync body to day/ night cycle, lipid metabolism. leptin, melatonin, insulin resistance)
  • Eat good fats (ghee, butter, lard, tallow, etc.)
  • Grounding/ earthing (increases Zeta potential and blood flow) - (Chevalier, G., et al. 2013, Chevalier, G., et al. 2015)
  • Infrared light exposure (infrared sauna, sunrise, sunset) - (Imamura, M., et al. 2001)
  • Exercise (especially to the point of creating heat)
  • Cold exposure (increase structured water production in mitochondria)
  • Positive loving relationships/ express gratitude — (Radin, D., et al. 2006)


A Midwestern Doctor

So, IF structured water/EZ water/liquid crystalline water is that important, well Midwestern doctor speaks a lot about it and the related zeta potential. He says they are both strongly related, and that many things affect both, but not always.

Some of his explanations: Zeta potential of a fluid is the degree to which particles in it will repel to each other. If there’s low zeta potential in a fluid, it will begin to clump together; in the body, if it's low the blood flow is slowed until it stops. He claims increasing it helps in circulatory/cardiovascular disorders, COVID vaccine injuries, long haul covid, lowers blood pressure (often “dramatic improvement”), fatigue, neuropathies, tinnitus, migraines and even atrial fibrillation.

“Because of this, poor zeta potential is arguably a primary cause of arterial damage (and the inability of vessels to then repair themselves) and the lethal clots damaged endothelium can form.”
[link]

"This worked (treating his severe heart arrhythmia) and gradually caught on (initially for heart conditions and then a variety of other ailments like dementia and poor wound healing). In turn, while readers here have reported a variety of improvements from restoring their physiologic zeta potential (e.g., fatigue, neuropathies, cold fingers or tinnitus), the most common feedback I’ve received is that restoring their physiologic zeta potential fixed their atrial fibrillation.
Note: I also had a reader who reported drinking my favorite bottled water brand (which has zeta potential enhancing ingredients) greatly improved her heart palpitations along with a few other issues like waking up with extreme dryness in the middle of the night."
[link]


Structured water is when water behaves like a semisolid, a liquid crystal quantified by Pollack, and because it has a semisolid structure, it will push everything out and not allow anything to pass through it, leading to its boundary being referred to as an Exclusion Zone (EZ), but it’s not a perfect barrier. Infrared light can initiate and grow the EZ size.

Structured water has a number of significant effects in the body, such as: giving structure and stability to the body and the insides of cells, creates a barrier that allow each surface within the body to slide frictionless, protects cells from external damage, maintains cellular integrity by preventing things from passing throughout, functions as energy source that facilitates physiologic functions, and it creates movement of fluids – if not the primary driver of fluid movement within the body.
“•Lubricates many surfaces, allowing them to slide past each other (e.g., the tendons and fascia are covered with a layer of this water). Conversely, as it disappears, tissues start to stick together (creating problematic adhesions), arthritis onsets, and the blood vessels become vulnerable to injury and atherosclerosis begins.”[link]

Structured water is found coating the lining of blood vessels, created by the glycocalyx.

[Previous threads on the forum about structured water: link, link]


He mentions all of this creates or increases structured water/liquid crystalline water/EZ water [1, 2]:
He says: "Presently I believe the two most helpful approaches, as detailed in this article, are to make sure you have an adequate protein supply and to have healthy fats in your diet.

[Google mentions also by vortex, a swirling motion in the water and with magnetic fields]

Infrared light increases it, particularly at 3000 nm; while blue light shrinks it
Freezing water increases it, whereas fever can transform liquid crystalline water into regular water (presumably not a good thing)
Sunlight [melanoma from lack of sun exposure; sun/UV for tuberculosis]
Debatable, energy workers (reiki), or bioenergy fields (orgone) increase it
Maybe hugging
Sound
may affect the formation of it; ultrasound disrupts it
Deuterium disrupts it; maybe deuterium depleted water increases it
Maybe dry fasting

Vegetable juices done ‘right’
(Cold-pressed and consumed right away)
Chia seeds soaked in water forming a gel; easiest way to consume large amounts of liquid crystalline water, but can cause inflammation, maybe due to lectins
Cucumbers
Bee Propolis

Maybe Hibiscus tea; Thomas Cowan claims it does, but it’s unverified

DMSO
Sulfates
: Heparin, but if done for too long some can develop an autoimmune response; Magnesium Sulfate triggers the production of crystalline water. Seneff says cobalamin to make sulfates. Sunlight helps create cholesterol sulfate. [Google mentions Chondroitin sulfate can increase EZ Water]

Ethanol/Alcohol; u-shaped relationship [Moderate is good]
Not high amounts of these increase it: aspirin, culturelle probiotic, turmeric, tulsi, coconut water, EDTA
Glyphosate lowers it

Saturated fats: ghee, coconut, lard increase it
[In the reference, it says ghee has an exceptional capacity to make EZ water]

Hyperbaric Chamber
. Speculated its effects are temporary as those that benefit from it (Lyme, Migraines, COVID vaccine-injured patients) need it regularly

Maybe the Budwig diet for cancer, which consists of flax seed oil and cottage cheese, with sunlight and grounding, also improves zeta potential and liquid crystalline water.

A good ionic foot bath

Grounding
(negative ions) increases zeta potential, but Pollack says it can also increase structured water.

Anesthetics destroy it, except maybe lidocaine
Maybe emotional traumas are stored as clumped fluids
EMFs shrink EZ water by 10-15%


And he mentions these for increasing zeta potential:
Grounding (negative ions) increases it, but Pollack says it can also increase structured water. A reader shared a study where they used grounding to significantly benefit those afflicted by COVID-19.

Riddick found acidity lowers zeta potential, while alkalinity increased it

DMSO
Sulfates
: Heparin, but if done for too long some can develop an autoimmune response; Magnesium Sulfate; Seneff says cobalamin to make sulfates. Sunlight helps create cholesterol sulfate.
[Google says Chondroitin Sulfate increases it too]

Sodium Citrate
Maybe
hyperbaric chamber
Zeta aid
; product or homemade (more on that below)
Low doses of aluminum-free EDTA
Hydroxychloroquine
Low-molecular weight dextran
[Reference says it was used as adjunct for severe acute chronic arterial insufficiency, pregangrene, multiple arterial occlusions, chronic ischemia, acute arterial occlusion. But effects stop if discontinued.]
714-X, an alternative cancer therapy

Heavy metals lower it.
Aluminum lowers it. Main sources of exposure: water supply, processed foods (baking powder, salt), pharmaceuticals, vaccines, cookware, food containers (aluminum foil, cans). To detoxify aluminum: Malic acid (e.g., Magnesium Malate), EDTA, Silica (like silica-rich water such as Fiji water); zeolites are unlikely to detoxify it as they contain aluminum or heavy metals.

Excess sodium with low potassium lowers it. He adds that aluminum in salt is a greater issue than sodium itself.

Riddick found that too much fat at once could sometimes create intravascular coagulation; high glucose associated with diabetes appeared to do so too. As well as too much alcohol.
Maybe pasteurized diary also creates intravascular coagulation; maybe unpasteurized doesn’t. Recommends A2 dairy.

Positive ions alter zeta potential negatively.
Increased atmospheric positive ions worsen the 20% of people that are sensitive to it, causing increased psychiatric effects (and more crimes), leg edema, more heart attacks, more traffic accidents, more aggression. These positive ions increase serotonin [not good].
Indoor AC and EMFs create more positive ions.

EMFs disrupt zeta potential causing the blood cells to clump together and they also impair mitochondrial function. Mentions a study that measured blood clumping and the Iphone did that with just 5 minutes, and walking didn't fully restore that clumping.
Reduced zeta potential in patients like in chronic migraines, Lyme or mold, are more susceptible to EMFs. Recommends an EMF canopy by Swiss Shield Naturell. [Mercola also sells a EMF tent]

Negative ions restore zeta potential.
Burns and respiratory issues respond well to negative ions since they can restore zeta potential.
Natural environments with higher negative ions are those with aerosolized water like beaches and waterfalls, and those by slightly radioactive materials (e.g., granite). Conversely, the ones with the highest concentration of positive ions were typically those with significant air pollution (especially after wildfires) and certain indoor electrical ones.
Oxygen Ion 3000 by Dr. Engler provides inhaled negative ions that benefit the respiratory tract.

Ovalbumin, egg white, maintains zeta potential. Aging lowers albumin levels, which are linked to disability in daily activities and correlated with an increased risk of death. 4 common causes of low albumin levels: infections and inflammation, liver disease, kidney disease, malnutrition from lack of protein, poor protein digestion, or absorption. Recommends Betaine HCl and digestive enzymes if your stomach acid is low, like in the elderly.

For blood flow. Manual therapies for fluid circulation and blood letting as in Chinese medicine, as well as herbs, Ginkgo Biloba, nattokinase (recommends Neprinol product), pentoxifylline, viagra [which has risks], DMSO.

“The most compelling case report I heard with it was a vaccine injured patient who had so much blood clotting it was impossible to draw blood anywhere, including from a jugular line without the line clotting out (this is very unusual). After two weeks on Neprinol AFD they were able to draw his blood and continue with his regimen.”


Maybe the Budwig diet for cancer, which consists of flax seed oil and cottage cheese, with sunlight and earthing, also improves zeta potential and liquid crystalline water.

Liposomal melatonin, but believes it’s not good long-term on a daily basis because the body will stop producing its own, and his mentor observed women had an increased rate of cancer on those taking it long-term.

Possibly PEMFs increase zeta potential, such as the BEMER mat, but depending on the direction it can shrink or enlarge cancer cells, so he hesitates recommending it

A good ionic foot bath

Possibly
Bob Beck blood electrification device – possibly for HIV, and the Lakhovsky Multiwave Oscillator (MWO) – possibly for cancer

Infections lower zeta potential

Probably oxidative therapies restore zeta potential. Therapies like: Hydrogen peroxide, IV Vitamin C, Chlorine Dioxide, Ozone, UVBI (Ultraviolet light blood irradiation), Hyperbaric chamber

“The critical thing to understand about oxidative therapies is that when the source of a positive charge comes from a pathogenic organism, unlike a metal, it can be oxidized and completely neutralized. So in instances where repeatedly administering zeta potential restoring electrolytes only provides a temporary benefit, it suggests that the issue is an excess of positive charges, and the specific source of them must be evaluated.”


He mentions at various times the zeta aid’ product that can be homemade for zeta potential. These are the instructions for making it homemade:

Second, basic zeta potential regimens (e.g., taking zeta aid) are often immensely helpful for circulatory disorders (and COVID vaccine injuries). Because of this it’s normally one of the top three things we focus on in patients with cardiovascular disease.
Note: the ways to treat zeta potential are discussed in more detail here (e.g., in certain cardiovascular patients with significant venous stagnation we often use the German isopathic remedy mucokehl, something which [when given intravenously] is often also quite helpful for COVID vaccine injuries).

https://www.midwesterndoctor.com/p/what-they-dont-tell-us-about-heart#:~:text=Second, basic zeta potential,for COVID vaccine injuries


So to review, get 50 grams of potassium citrate, mix it with 10 grams of sodium bicarbonate (baking soda) or potassium bicarbonate and a liter of distilled or reverse osmosis water (the reason for using de-ionized water will be discussed later), then store that in your fridge. Mix 15-30 grams of it daily with a liter of de-ionized water and drink that (which works out to around 1-2 teaspoons in a glass of water).

This whole process is simple, and the main issue is ensuring that you get a good source of potassium citrate powder (Jungbunzlauer is probably the best producer—and many companies like those on Amazon who sell it in bulk source it from Jungbunzlauer). This is not difficult to do, but since citrate is made from citric acid, which is made from black mold, some people who are extremely sensitive to mold toxins get ill if they consume lower-quality products made with citric acid.

Note: one of the only two allopaths (the other is mentioned below) I was ever able to find who was able to successfully treat his patients during the 1918 influenza (most M.D.’s failed abysmally) used potassium citrate and baking soda. His focus was on restoring the alkalinity of the body rather than its zeta potential, as potassium citrate was known at the time as one of the most powerful alkalinizing agents in existence.

Quite a few people I know have adopted this regimen and felt that they have benefited from it. However, it was only the first one Riddick developed, and over time, he realized better ones could be created.

The company Zeta Aid sells a later version of Riddick’s mixture which is more effective than the one described above. Our experience in giving it (or other combinations of the electrolytes) to vaccine-injured patients (and those with long-haul COVID) is that it typically helps. Still, the degree of benefit highly varies from person to person. For example, some people find that taking it for a month mostly returns them to normal. Others find they receive some improvement from it, but the improvement is temporary and only lasts 1-3 hours after consuming it.

Zeta Aid specifically requested that the use of their productfor the purpose of treating COVID-19 vaccine injuries NOT be widely publicized because they could not afford to get shut down for selling it. That is why I have avoided mentioning it up to this point and am also providing a DIY way of getting Zeta Aid.

Note: Alka-Seltzer contains many similar ingredients to Zeta Aid and coincidentally became a popular home remedy for COVID-19 after a few people incidentally discovered it worked for the disease and the idea went viral online. Mountain Dew also has a high amount of citrate in it (I believe it used to have the ideal potassium citrate and now has sodium citrate). Because of this, one of my colleagues successful used Mountain Dew to abort a bystanders heart attack (due to its effect on zeta potential). I also found an interesting case study where stopping Mountain Dew caused a patient to develop numerous kidney stones (as poor zeta potential causes the dissolved calcium to clump together into a stone) which the physicians directly attributed to the patient no longer having access to Mountain Dew’s high potassium citrate content.

Shortly before Riddick died, he settled on a final formula incorporating potassium phosphate. I inherited this formula under the condition that I would not share it, and I believe, but cannot confirm, that it is the same as the one Zeta Aid sells. For reasons I still do not know, my formula tends to get better clinical results than Zeta Aid (although that one is still great).

Note: due to the dirty process of phosphate mining, the quality of potassium phosphate significantly varies, and it is somewhat challenging to find a clean source.

Finally, that formula can also be adjusted by increasing the potassium citrate content (often necessary in patients with heart issues), and sometimes adding a small amount of potassium chloride. This requires a lot of experience, so I would not advise attempting to figure it out on your own.

Regardless of how you approach it, it is essential to remember you must thoroughly dilute the substance before you consume it (so potassium citrate pills are effectively useless). It is also very easy to take too much (which pushes you too far down the U-shaped curve and reverses the colloidal dispersion created by Zeta Aid). Additionally, if you consume Zeta Aid without performing a sufficient second dilution (e.g., you pour the main mixture in twice as much water), that amount of potassium is sufficient to serve as an unpleasant laxative.

Note: I believe migraines often result from blood sludging in the brain, a condition that is a consequence of poor zeta potential. In turn, we frequently observe zeta aid (along with the complete lifestyle regimen) to be highly beneficial for these patients.

https://www.midwesterndoctor.com/p/how-to-improve-zeta-potential-and?utm_source=publication-search#:~:text=So to review,for these patients

He says to dilute it with de-ionized water for the benefits, but I asked the zeta aid producer and she mentions they don’t use de-ionized water... So, I don’t know if it really matters.

Riddick and the doctor who brought his work forward felt that it was critical to drink de-ionized water. That, in combination with Zeta Aid, resulted in each patient's zeta potential could be significantly improved. Still, restoring their zeta potential was often impossible with only one but not the other. Reverse osmosis purification did not exist in Riddick's time, so he did all of his work with distilled water. However, once reverse osmosis became available, the doctors working with zeta potential enthusiastically endorsed it. I prefer reverse osmosis water and credit my good health with drinking it for decades.

How to Improve Zeta Potential and Liquid Crystalline Water Inside the Body.


Infrared Sauna

EZ water and zeta potential sounds pretty good, but let’s also remember some of the many benefits of infrared saunas (which are amazing) because that’s one of things they did that worked for the couple I mentioned and Stephen Hussey
.

[Previous threads on the forum about it: link, link, infrabed ]

So, besides structuring water, regular use can:
[Sources for this: 1, 2, 3, 4, 5, 6, 7, 8, 9]

Persistent Circulatory Benefits. “During FIR exposure, peripheral vasodilation occurs due to thermal effects on vascular smooth muscle and increased nitric oxide (NO) production (Lin et al. 2018). Research indicates that this vasodilation persists for up to 24 hours post-treatment, maintaining improved microcirculation to tissues (Matsushita et al. 2008).

A study by Kihara et al. (2009) demonstrated that patients with chronic heart failure who received FIR sauna therapy showed improved endothelial function and reduced oxidative stress that persisted for 48 hours after treatment.

“ Imamura et al. (2011) found that regular FIR sauna sessions produced improvements in flow-mediated vasodilation that lasted up to two weeks after the final treatment, suggesting long-term enhancement of vascular health.”

“Documented progressive improvements in vascular function, blood pressure regulation, and lipid profiles that extended beyond the immediate post-treatment period.” Mimicking the effects of light to moderate exercise. [So, it’s great for those that can’t do much exercise]

“sauna twice weekly for three months decreased blood pressure in hypertensive men from 166/101 mmHg to 143/92 mmHg, a result similar to taking one blood pressure-lowering medicine.” And if combined with exercise, the reductions were greater than just exercise alone.

increases left ventricular ejection fraction and reduces left ventricular ejection time ” [So, that’s how Stephen Hussey improved his ejection fraction rate]

Stimulates the production of VEGF and nitric oxide for growth of new blood vessels, angiogenesis, for up to 96 hours. [Couldn't find the full source, though]

In PAD [Peripheral Artery Disease], 50 sessions demonstrated improvements in pain levels, walking endurance, and lower extremity blood flow

safe for patients with severe PAD and potentially effective as evidenced by a substantial decrease in the pain score, increases in ABI and blood flow assessed by laser Doppler perfusion imaging, and by formation of new collateral vessels on angiography. In addition, ischemic ulcers present in 7 limbs healed or improved markedly.

“In some cases, ischemic ulcers have been reported to have markedly improved healing without the need for invasive therapy”
“His
large skin ulcer healed completely after 15 weeks of Waon therapy, and limb amputation was avoided


Less cardiovascular deaths
. Those that used 4-7 times a week had 50% less cardiovascular deaths and 52% less sudden cardiac death if their sessions were at least 19 min.

And they also had a 65% reduced risk of developing Alzheimer's disease.




Increased Metabolism Rate. A single 30-minute FIR sauna session increased resting metabolic rate by approximately 15-20% for up to 6 hours post-exposure.

Improved fasting glucose in diabetics, and enhanced insulin sensitivity, for up to 24 hours.


Detoxification. Mobilization of toxins (cadmium, lead and mercury) excreted through urine for up to 48 hours and higher concentrations of heavy metals in sweat. Promotes the elimination of mold mycotoxins. “In a case report, a patient recovering from mercury poisoning used sauna sweats to help recover after chelation therapy.”

Rhonda mentions BPA and phthalates can be excreted through sweat.


Immune function. Triggers heat shock proteins for up to 48 hours and contribute to enhanced cellular resilience and immune response. Stimulate the production and activity of natural killer (NK) cells for up to 24 hours. “Hyperthermia can enhance the effectiveness of traditional cancer treatments by increasing tumor sensitivity to radiation and chemotherapy (Datta et al.)”

“Sauna use is associated with reduced risk of developing certain chronic or acute respiratory illnesses, including pneumonia” “The risk of developing pneumonia among men who reported using the sauna 4–7 times per week was 41% lower” “sauna bathing demonstrates effectiveness in reducing the incidence of common colds.” “frequent sauna use may decrease pulmonary congestion and promote other aspects of healthy lung function, including vital capacity, tidal volume, minute ventilation, and forced expiratory volume ”
“A single session of Finnish-style sauna increased white blood cell, lymphocyte, neutrophil, and basophil counts in both trained and non-trained athletes


Lowers inflammation. Lowered CRP for up to 72 hours.


Cellular repair. Mitochondrial biogenesis, increased new mitochondria for up to 72 hours. Lipid peroxides lowered for 24 hours. Increased antioxidant enzymes like glutathione and SOD from Nrf2 activation.

[For arthritis] “Early research suggests FIR may enhance cartilage health by supporting chondrocyte (cartilage cell) activity and promoting collagen production—offering more than just symptom management.”

“Sauna use promotes transient growth hormone release” “Seventeen men and women who were exposed to two 1-h sauna sessions at 80 °C (176 °F) dry heat (typical Finnish-style sauna) per day for 7 days exhibited a 16-fold increase in growth hormone levels by the third day (Leppaluoto et al., 1986). The growth hormone effects generally persisted for a few hours post-sauna (Hannuksela and Ellahham, 2001). It is noteworthy, however, that sauna use and exercise work synergistically to significantly elevate growth hormone when used together (Ftaiti et al., 2008).”

Whole-body hyperthermia may preserve or increase muscle mass” [So, great for the elderly]


Pain reduction and recovery. Pain relief for 48 hours. Effects on muscle recovery for 72 hours. Reduced pain in patients with fibromyalgia.


Nervous system. Activates parasympathetic relaxation for hours and days, increasing HRV. “Users often report not only falling asleep faster but also staying asleep longer and waking more refreshed.” “FIR exposure has also been shown to help regulate circadian rhythms—your internal sleep-wake clock—by promoting melatonin balance and synchronizing thermal cues that guide the onset of deep sleep.And it lowers cortisol.
Effects dose dependant: 45 minutes lasted for 36 hours.


Mental Health. “Men participating in the KIHD study who reported using the sauna 4–7 times per week had a 77% reduced risk of developing psychotic disorders”. Hyperthermia increases BDNF to promote neurogenesis. “A single session of whole-body hyperthermia in which core body temperature was elevated to 38.5 °C (101.3 °F) experienced an acute antidepressant effect that was apparent within 1 week of treatment and persisted for 6 weeks after treatment” “individuals diagnosed with major depressive disorder received whole-body hyperthermia demonstrated that the participants' antidepressant response correlated with reductions in core body temperature in the 5 days post treatment”. Increases endorphins.
individuals diagnosed with mild depression, participants who received 4 weeks of sauna sessions experienced reduced symptoms of depression, such as improved appetite and reduced somatic complaints and anxiety”


But it can hurt male fertility:
“ two 15-minute sauna sessions at 80 °C to 90 °C (176 °F to 194 °F) every week for 3 months, the men experienced reduced sperm counts and motility. These measures returned to normal, however, within 6 months of sauna use cessation ”
[I recall Mercola puts a bag of ice, or something like that, ‘down there’ when he enters the sauna.]


And
contraindications: “alcohol use, hypotension (especially in older adults), recent myocardial infarction, unstable angina pectoris, severe aortic stenosis (Eisalo and Luurila, 1988; Luurila, 1992), and among individuals with altered or reduced sweat function, which can occur with autoimmune disorders, spinal cord injury, neurological disorders, and in young children (Saari et al., 2009; Shibasaki et al., 1997; Swinn et al., 2003; Trbovich et al., 2020). Decompensated heart failure and cardiac arrhythmia are relative contraindications. Sauna use in patients with a history of stroke or transient ischemic attacks has not been studied, so it should be avoided until the condition stabilizes (Hannuksela and Ellahham, 2001). Individuals with acute illness accompanied by fever or those with inflammatory skin conditions should avoid sauna use”
“People who already have heat sensitivities, such as those with multiple sclerosis, probably want to avoid the sauna. (53)”

“one study reported that sauna use near conception for the mother or father and in early pregnancy for the mother were linked to increased brain tumors in the children.” “ If you are adamant about wanting to continue the sauna during pregnancy, play it safe and consider decreasing the duration and temperature, or avoiding it during the first trimester altogether.”

“Most sauna accidents and death involve alcohol consumption. (51, 52) Don’t mix the two.”


Being well hydrated: “Accompanying the loss in fluid is loss of electrolytes, especially sodium, chloride, potassium, magnesium, and calcium (Sawka and Montain, 2000). Skeletal muscle cramps and fatigue are associated with dehydration and electrolyte deficits. Sauna users should take care to drink sufficient fluids prior to and after sauna sessions and should consume electrolyte-rich foods post-sauna use, such as cooked spinach, avocado, tomatoes, fish, nuts, and seeds‘


“Saunas can feel relaxing and luxurious, but don’t forget that they are also stressful for the body. Be smart about it. Go into the sauna well hydrated, don’t stay beyond your comfort level, and don’t exceed the recommended 20 to 30 minutes, even if you are not yet feeling uncomfortable.”



Grounding


And lastly, these are some of the benefits of grounding (I think its effects are milder, but who knows…):

[Previous threads on the forum about it link, link, link, link, link]

[Sources for this: 1, 2, 3, 4, 5, 6]

Improves body circulation:
“In another study of 40 patients, blood flow regulation and circulation to the head, face, torso, and extremities, were enhanced within a 1-h session of grounding in a chair. [...]The results were surprising. Just 1 h of grounding restored facial blood flow regulation suggesting enhanced repair of skin tissue in the participants leading to improved facial appearance and other improved implications of overall health [26].”

Lowers blood pressure: “All ten patients reduced their blood pressure and many were able to reduce their reliance on hypertensive blood pressure medication. Systolic blood pressure levels decreased 8.6%–22.7% with an average reduction of 14.3%. The pilot study clearly demonstrated that grounding for a minimum of ten to 12 h per day resulted in remarkable blood pressure lowering [19].”


Increases zeta potential, thus less Red Blood Cells clumping and blood viscosity:
“Earthing or grounding increased zeta potentials in all samples by an average of 2.70 and significantly reduced RBC aggregation.
Grounding increases the surface charge on RBCs and thereby reduces blood viscosity and clumping.
Grounding appears to be one of the simplest and yet most profound interventions for helping reduce cardiovascular risk and cardiovascular events.”
“In our study, participants relaxed for 2 h while being grounded and there was an astonishing 273% reduction in blood viscosity [9]”


Blood viscosity is important because the more viscous it is, the higher the risk of major events: “A meta-analysis evaluating the connection between blood viscosity and CVD demonstrates clearly that the risk of major cardiovascular events increase with higher blood-viscosity levels.38

In the Edinburgh Artery Study, a population of 4860 men 45–59 years of age was observed for 5 years. The 20% of the men with the highest blood viscosity had a 3.2 times greater risk for cardiac events, compared with the 20% of men with the lowest blood viscosity. Fifty-five percent (55%) of major cardiovascular events occurred in the highest blood-viscosity group versus only 4% in the lowest blood-viscosity group.”

Their definition of zeta potential: “ Zeta potential is defined as a net negative charge on red blood cells creating force that pushes them apart resulting in a lowering of blood viscosity. Obviously the lower viscosity or the thinner your blood is the less vulnerable it is to clotting or thrombosis”

RBC zeta potential is lower in diabetics and in cardiovascular disease: “In 2008, Adak and colleagues reported the presence of both hypercoagulable blood and poor RBC zeta potential among diabetics. Zeta potential was particularly poor among diabetics with cardiovascular disease ”


Increases glucose utilization: “In twelve patients with non-insulin dependent diabetes mellitus being grounded to the earth's field increases glucose utilization. The researchers suggested lack of contact with the earth may have an opposite effect and perhaps may have an impact on diabetes, obesity and even high blood pressure [18].”

A case report of a diabetic ulcer healed in two weeks with 30 min each day, and it stopped being painful


Positive effects on the nervous system
: “increases in parasympathetic activity18,34 and, most recently, increases in heart rate variability (HRV)

“In this study, these pre-term babies were grounded and it was determined that the baby's autonomic nervous system was able to sense the environment and the babies were more relaxed when grounded. There was improved vagus-nerve tone among the premature babies which could potentially enhance regulatory mechanisms [28].”

When grounded during sleep, it lowers cortisol at night, improves sleep and reduces pain and stress.


Improvements in COVID-19 infection
: “Ober and Oschman reported in the International Journal of Clinical Endocrinology and Metabolism an anecdotal case where grounding patches placed on the chest of a woman during a Covid-19 infection. The husband of the woman with the infection gave the following feedback “A grounding patch on her chest has helped her immensely” [11].

In the patients that were grounded, the complication of blood clots was not seen as opposed to the patients that were not grounded. After 1–3 days of grounding, most patients experienced improvement in fever, dyspnea, cough, weakness, headache, chest pain, body pain and even taste and smell loss. Twenty patients of the 59 had severe illness and 17 improved, two were lost in follow-up and one expired. In 28 with moderate illness, all improved; and in 11 with mild illness, all improved and no deaths were reported. Mousa concluded that grounding demonstrated significant preventative as well as curative aspects in the treatment of Covid-19 [12].”


Maybe it could help in osteoporosis, or at least reduce renal excretion of electrolytes:
“In one experiment with nonmedicated subjects, grounding during a single night of sleep resulted in statistically significant changes in concentrations of minerals and electrolytes in the blood serum: iron, ionized calcium, inorganic phosphorus, sodium, potassium, and magnesium. Renal excretion of both calcium and phosphorus was reduced significantly. The observed reductions in blood and urinary calcium and phosphorus directly relate to osteoporosis. The results suggest that Earthing for a single night reduces primary indicators of osteoporosis.”

“Seven (7)–hour earthing of an insulated human body causes the decrease of serum concentrations of iron, total protein, and albumins while it increases the concentration of globulins, whereas 1-hour interruption of human contact with Earth causes the increase of iron, total protein, and globulins concentrations.”


Some other positive reports, like in autoimmune disease: “Some subjects reported significant relief from asthmatic and respiratory conditions, rheumatoid arthritis, PMS, sleep apnea, and hypertension while sleeping grounded. These results indicated that the effects of earthing go beyond reduction of pain and improvements in sleep.”
“A repeated observation is that grounding, or earthing, reduces the pain in patients with lupus and other autoimmune disorders.”


In exercise and athletes
Reduced inflammation in DOMS
: “A pilot study on delayed-onset muscle soreness demonstrated a remarkable reduction of inflammatory mediators, including a reduction in white blood cell count (lymphocytes, neutrophils, and eosinophils)

Improved healing and reduced pain: “In another investigation, grounding during cycling exercise significantly reduced the level of blood urea, a marker of less muscle and protein breakdown [35]. Such findings represent a major recovery benefit for training athletes. Among American cyclists during the Tour de France competitions, it was found that grounding produced very rapid healing and minimal signs of inflammation despite the fact that many of the cyclists had significant superficial wounds resulting in major discomforts”

Another case report of pain and inflammation: “33-year-old woman who had a gymnastics injury at age 15. The patient had a long history of chronic right knee pain, swelling, and instability, and was unable to stand for long periods. Simple actions, such as driving, increased the symptoms. [...] After 6 days of grounding, she reported a 50% reduction pain and said that she could now stand for longer periods without pain, and no longer needed to sleep with pillow between her legs. After 4 weeks of treatment, she felt good enough to play soccer, and for the first time in 15 years felt no instability and little pain. By 12 weeks, she said her pain had diminished by nearly 90% and she had no swelling. For the first time in many years, she was able waterski.”


Caution if using blood thinners:
“One very important caveat of grounding is to exercise extreme caution in any patient taking Coumadin-like blood thinners as the combination of pharmaceutical blood thinning and grounding can virtually make the blood too thin. Cardiologists have seen this occurrence in their patients who were grounding and simultaneously taking blood thinners as bleeding became apparent. It is thus imperative that when patients take Coumadin-like derivatives, that they discuss earthing or grounding with their doctor to avoid the possibility of any adverse bleeding complications.”

And might need to lower thyroid medication:
“K. Sokal and P. Sokal drew blood samples from 6 male and 6 female adults with no history of thyroid disease. A single night of grounding produced a significant decrease of free tri-iodothyronine and an increase of free thyroxin and thyroid-stimulating hormone. The meaning of these results is unclear but suggests an earthing influence on hepatic, hypothalamus, and pituitary relationships with thyroid function. Ober et al. [12] have observed that many individuals on thyroid medication reported symptoms of hyperthyroid, such as heart palpitations, after starting grounding. Such symptoms typically vanish after medication is adjusted downward under medical supervision. Through a series of feedback regulations, thyroid hormones affect almost every physiological process in the body, including growth and development, metabolism, body temperature, and heart rate. Clearly, further study of earthing effects on thyroid function is needed.”

Possible caution: C’s Session May 7th, 2016 they mention to Laura not to overdo it with artificial methods as it can reverse the effect. Preferably grounding through nature by being outdoors.


About the living matrix: “The living matrix includes the extracellular and connective tissue matrices as well as the cytoskeletons of all cells.31 Integrins at cell surfaces are thought to allow for semi-conduction of electrons to the cell interior, and links across the nuclear envelope enable the nuclear matrix and genetic material to be part of the circuitry.23

It is not widely appreciated that collagen and other structural proteins are semiconductors.
“We now know that water plays crucial roles in enzymatic activities and semi-conduction. Hydrated proteins actually are semiconductors, and have become important components in the global microelectronics industry. Organic microcircuits are preferred for some applications, because they can be made very small, self-assemble, are robust, and have low energy consumption.37,38”

The living matrix (or ground regulation or tissue tensegrity-matrix system), the very fabric of the body, appears to serve as one of our primary antioxidant defense systems. As this report explains, it is a system requiring occasional recharging by conductive contact with the Earth’s surface – the “battery” for all planetary life – to be optimally effective”
 
My Mother’s Case

Peripheral Artery Disease (PAD) – Atherosclerosis On The Legs

I would like to know your thoughts on my mother’s case (late 60s), as we are currently battling this.

She has PAD (atherosclerosis on the legs) at 60-81% stenosis by leg doppler ultrasound. She opted for no CT scans, so we don’t have a CAC score nor CT angiogram for coronary plaque, and we couldn't find a CIMT test for the carotids, nor fIMT for the femorals; catheterization angiogram is more invasive, so we don't have that either. So, we don't know if there’s plaque on carotids or coronaries, but it is very likely; once you have plaque, it’s probably in other places.

[ABI test is unknown too (the one with pressure cuffs). She’d rather not measure it, because she doesn't like how she feels with the pressure cuffs on the arms, like tingling/pins and needles sensations]

I don’t know how reliable leg doppler ultrasounds truly are because in the span of two months, she’s had two very different results and it’s unlikely she worsened that fast. The first one said 53%, and now 60-81% stenosis

It took a while to get a diagnosis because doctors didn’t pay much attention to her symptoms, until we probed further. Less or more symptoms such as less hair on the legs, leg cramps not relieved by electrolytes, pain when walking (intermittent claudication), cold feet, leg tiredness, burning pain in the soles and pale color are very indicative of PAD. There can be symptoms on the thighs and buttocks, and Erectile Dysfunction is an early indicator.

And having PAD puts you at greater risk of a major event.

On severe PAD, critical limb ischemia (CLI), when there is gangrene, non-healing wounds or ulcers, or pain/intermittent claudication that isn't improving with rest, persistent burning pain, then that’d mean she needs surgery. She currently walks for a minute and then she feels pain, and nightly cramps – IV Magnesium Sulfate helped with that, whereas supplementation not really.
There’s a 20-30% of people with CLI that are not candidates for surgery with stents or bypass and limb amputation is necessary


Symptoms

Diarrhea
On a good day she has diarrhea 3 times; on a bad one 10 times :( … Average 4-6 times a day
. So, rehydration is essential, solving its cause too, and not allowing malnutrition…
When she has a lot of diarrhea, her blood pressure increases to 160 mmHg from ~130 mmHg.
Low FODMAPs don't fully work.
Even when we did a ketogenic diet ~10 years ago, with zero carbs for like ~6 years, she still had some diarrhea. It got worse a few months ago. She has too tried days with no supplements and still has diarrhea. There were some weeks that resistant starch helped, but not anymore.
Recently, she’s been on butyrate, immunoglobulins, and probiotics, but the diarrhea is the same.

Current diet, low carb with meat, raw eggs (boiled gives her sometimes diarrhea), some rice or potato. Sometimes kefir, berries and homemade popcorn with nothing added.
She can’t take some of the supplements I mentioned on the previous posts because it gives her diarrhea (things like aged garlic, berberine, too much betaine, pomegranate, sometimes iron, too much progesterone)

Conventional Feces tests are all normal, if anything it shows starches in her stool, and we don't have functional tests that are easily available or are way too costly.
The Dr. might try antibiotics to treat it ‘empirically’ presumably for SIBO.

Also, if she walks for a few minutes that almost always triggers diarrhea. So, it’s very difficult for her to go out.
There must be something we are overlooking.


Lack of Appetite
. She ends up eating once a day and not much protein because of lack of appetite and diarrhea :( … Fasting for ~20 hours. Added Betaine HCl or apple vinegar.
Yesterday, the doctor requested a breath test for H. Pylori and it turned out positive. So, we’ll see his treatment.
Could her diarrhea be from H. Pylori infection? And, will she get reinfected from her periodontitis, given that H. Pylori can be found there too?

[As an example, this is Kresser’s treatment for H. Pylori]
[And she may have to stop niacin if she were to have a gastric ulcer from H. Pylori. She doesn’t seem to have symptoms of an ulcer, though, maybe starting to have more obscure stools, but that could be from the iron supplement?]


Highish insulin and glucose. She has glucose at 106, and insulin at 10.6. Maybe it’s because of the constant fasting for long hours? Or lack of more vigorous exercise? (She can't quite do that..)


Overall Fatigue. :( … Dr. thinks it's because of low ferritin (20 mg/dL) and told her to do 2 IV iron – Renegy. She’s thinking about it, maybe will do it; she is taking vitamin C, betaine with red meat (maybe some liver) and she was trying an iron supplement that Masterjohn recommends – ferrous bisglycinate, but it seems it can also give her diarrhea…

[Kresser says that Vitamin C, red meat, beta-carotene, sugar and alcohol increase iron absorption (also some Amazon reviewers mention to take lysine), and recommends as supplement: Proferrin Heme iron or better like Liposomal Iron Smartiron, or IV iron if these don’t work]


Insomnia. Sleeps like <6 hours most days; some days even less (4) :( ... A big big risk factor for everything.
Already tried many supplements, but not much luck. Molecular hydrogen seems to help her as well as apigenin and seriphos, maybe CBD, but doesn't always work.
In case she has hydrogen SIBO, we are unsure whether molecular hydrogen makes diarrhea worse; she has tried on and off without much difference or sometimes she thinks her diarrhea worsened because of it, and when she doesn’t take it she sleeps even less :(

Humming, meditation, breathing, doesn't quite help her, nor lavender oil.
Dr. told her to take 200mg of progesterone, but that much sometimes gives her diarrhea. So she’s trying about 50-150mg. Helps somewhat.
Also has headaches, anxiety, and brain fog.


High blood pressure. She normally was a month ago at 115-125 mmHg and 69 HR, but recently, we think, due to too much diarrhea in days consecutively, her blood pressure increased and heart rate too, to 160 mmHg, and 93 HR, and sometimes it lowers to 135 mmHg and 80 HR, sometimes it doesn't lower as much, to 145 mmHg and 73 HR. :(

She’s doing Isometric exercises as wall squats, but haven't seen her blood pressure drop as they said; maybe it's too early, she has done it for 1 week and a half.

Nor does hibiscus tea seem to lower blood pressure, yet..

Pycnogenol or Grape Seed Extract used to lower it, but now they don’t. And she is taking more potassium citrate in her electrolytes. But it’s not quite working either, nor grounding, nor zeta aid. She has yet to try breathing in a paper bag consistently.

Probably an infrared sauna will do the job, and probably a better job at other aspects too than any supplement, but we are still considering models… (they can be expensive! Oh god)
She doesn’t want to take medication for this.


‘Vibrations’. For two weeks now, she’s starting to feel, she says, vibrations or spasms on the left side of her body, daily when waking up and when trying to sleep or when she hasn’t slept well. We have yet to ask the Dr.

[Are these episodes of Atrial Fibrillation? She might have an electrocardiogram. Her heart rate isn’t overly high but I’ve read palpitations aren't always the symptom of it, it can be fatigue...]


Periodontitis and oral health. She’s had advanced periodontitis for decades, somewhat managed with cleanings and oil pulling. She somehow still conserves all of her teeth despite >80% bone loss.

Thomas Levy (Rapid Virus Recovery ebook) spoke about 2 tbsp of hydrogen peroxide in 200ml in Water Pik to solve periodontitis (in one video he mentioned it cured a woman in two weeks, IIRC). But even that amount of hydrogen peroxide gives her diarrhea, so she stopped :( (Does that mean hydrogen SIBO?)
Maybe we’ll try cleanings with ozonated water instead?

We were considering LANAP surgery ‘hope for hopeless teeth’ for periodontitis, but even one of them that initially was willing to do it, refrained from doing so in the end without explanation.

She also has a tooth abscess, a root canal and about 20 non-vital teeth with possible periapical abscesses. And third molars with tooth decay.

Like I mentioned when I spoke about nattokinase, I think she can’t use high dose nattokinase or other fibrinolytic enzymes because the risk is that abscesses can spread with fibrinolytic enzymes (the study used serratiopeptidase). Technically, a 3D Cone Beam CT scan could see if she has periapical abscesses, but she doesn't want to or can't do one just yet.

All dentists, conventional or biological, want to extract all of her teeth, and she doesn’t quite want that. Unsure what to do for her oral health.

So, for now our best bet is to have good thyroid hormones that Thomas Levy (Hidden Epidemic book) says can keep oral infections local. But Drs. don’t see anything wrong with her thyroid.
Are her thyroid hormones good? (TSH at 3, but Total T3 above range at 1.75, Free T4 on lower normal range at 1.1 – So, looking at TSH you kind of want to take natural hormone, but because of high Total T3, you can’t quite do that?)

She has some hypothyroid symptoms though, like hair falling out (or maybe due to low ferritin), dry skin, sometimes feeling cold, fatigue…

She also needs to fast for less hours and eat more…


PAD. Already mentioned it, she’s at 60-81% stenosis with some arteries unmeasurable for some reason. She mostly struggles with leg tiredness and lower legs pain when walking for a minute. Most likely IV Magnesium Sulfate helped her cramps, where nothing else worked.

The alternative clinics only give EDTA chelation therapy for atherosclerosis and told her 16 IV infusions was going to be enough, but it didn’t lower her stenosis. But she did feel her legs better. Who knows if that was because of EDTA, or the Vitamin C, Heparin, Glutathione or Magnesium Sulfate that the infusion contained.

Our hope is what I shared with you about the approaches for plaque regression, but some supplements she can’t take because of diarrhea.

We are missing an infrared sauna, but I worry her dehydration will worsen from too much diarrhea and sweating. Is the infrared sauna still beneficial if you don’t sweat?
I hope so…


Blood Tests

If you’d like to take a look at her blood test results, they are on this spreadsheet. There you can find two sheets: one with lab ranges, and the other with functional ranges and other ranges I’ve gathered. It contains Complete Blood Count, Blood Chemistry, Lipids, Lp(a), ApoB, Glucose, Insulin, HOMA-IR, Iron Panel, Thyroid Panel with antibodies, Amylase and Lipase, Vitamin D, ESR and CRP-hs, Fibrinogen, Homocysteine, G6PD, ANA antibodies and Rheumatoid Factor, Hormones panel, Urine exam, Feces exams, Pharyngeal culture, Calprotectin, Candida antibodies and H. Pylori Breath test.

Blood pressure used to be in the 115-127/60-73 mmHg range. New range since a week ago 145-160/77-83 mmHg range. Resting heart rate was 60-70. Now it’s 73-80. Temperature 36.4-36.5°C / 97.52 - 97.88 °F


Risk Factors of Atherosclerosis That She Has

Family history
: Grandmother had high cholesterol and high blood pressure; passed away at 101 years old. But my uncles and aunts seem mostly fine and healthy. One aunt has dementia, and another had a stroke.
Bad sleep; insomnia and sleeps for a few hours <6
Severe stenosis on the legs at 60-81% with some arteries unmeasurable for some reason; walks for a minute and legs feel painful
Decades of Periodontitis, but she still conserves all of her teeth, and doesn’t seem to have high inflammation apparently
3rd Molars have extensive tooth decay
At least one tooth abscess
; probable various periapical abscesses and a root canal
Gut problems
: Very prone to diarrhea; when walking, she often needs to go to the nearest bathroom, with constant loss of electrolytes; dehydration. And H. Pylori infection
High Lp(a)
: 168 nmol/L
High Fibrinogen: 397 mg/dL
High LDL: 239-310 mg/dl. Unclear if at this level it’s bad, and whether it’s high because of Familial Hypercholesterolemia (she has no xanthomas) or Lean Mass Hyper Responder or infections that Kresser/Functional medicine say that can get it high.
High ApoB: 177 mg/dL
Hypertension. She used to have <130 mmHg of blood pressure, but recently it has increased to ~145 mmHg or more. I think it's because of severe diarrhea, because one day she had too much diarrhea and it went up to 160 mmHg.
Thyroid Function; unsure if it’s on good values
She has Frank’s sign on the earlobe that BaleDoneen mention have it worse vascular-wise
7 pregnancies: 2 miscarriages, 2 died shortly and 3 alive with 1 preterm birth with c-section
Don't know about her genetic risks
Highish insulin, glucose
; highish HOMA-IR, insulin resistance
Don't know if her high glucose and insulin are due to fasting for >20 hours.. She only eats one meal a day due to diarrhea and no appetite.

On the positive side:
No high BMI, high HDL, low Triglyceride/HDL ratio at ~1, no apparent sleep apnea, high vitamin D, not high CRP, no alcohol, normal homocysteine, had EDTA and hyperbaric chamber therapies.


What She’s Doing

We can’t implement everything I’ve mentioned for plaque regression, because it's simply too much or too much money or gives her diarrhea, but she’s trying:

Diet: Rice or Potatoes with meat and/or raw eggs (she likes that; she thinks boiled eggs give her diarrhea). Sometimes kefir, berries, or homemade popcorn with nothing added. Usually one meal a day or two close together because of lack of appetite and diarrhea. So, fasting for >20 hours..

She has done 16 IV EDTA chelation therapy with Magnesium Sulfate, Vitamin C, Glutathione, Heparin, B12, but is unsure whether that helped her much, at least that didn’t quite lower her stenosis. In the first 10 she mentioned she felt her legs better, but who knows which of the things it has that helped her in the beginning. She stopped doing them because on that last one she had a lot of diarrhea before it and felt worse after with the therapy. The magnesium helped her reduce nightly cramps.

She’s had 10 Hyperbaric chamber sessions at 2.3 ATAs, but even in there her foot goes numb. Unsure whether her diarrhea worsened with it, maybe it did, so she stopped.

Cyclodextrin. She’s at ~80 doses, daily double dose – right after another, but she can only hold it for 3 hours, instead of 8 hours, because of bowel movements, so she doesn't absorb all of it resulting in less benefits. Despite that, she thinks it has lowered the burning sensation on her legs and says she kind of feels better overall with it.

Hibiscus tea and wall squats: for blood pressure and possibly structured water. Along with some walking as exercise. She's going to try breathing in a paper bag and she grounds herself with a cable to a ground plug sometimes – no grass readily available. She has yet to have results from this.

No sauna, but one infrared bulb on the legs. It’s better than nothing… (...Maybe we’ll get an infrared sauna, who knows…)

Homemade zeta aid for zeta potential without de-ionized water, just distilled. Unclear if it’ll work without it like Midwestern doctor says it won’t (but the vendor told me it does), because I have yet to see the ‘dramatic improvement’ in blood pressure from it… Maybe it’s too soon (she’s been taking it for a few days).

DMSO sometimes; unsure if it makes diarrhea worse. Although Midwestern doctor says it doesn't promote peristalsis, sometimes it seems it triggers diarrhea, other times not so much. [IF it does, would that mean it’s the third type of SIBO, hydrogen sulfide? But no rotten smell, though.]
[Tip: A gallon of DMSO is cheaper than buying the small ones.]

For sleep, supplements and mouth taping, with a nasal strip to breathe better and sleeping on the side. All of that is supposed to help in mild apnea. When she does the nasal strips she sleeps somewhat better.

Supplements.
But guess what, she sometimes sees the full capsule in the bathroom.. So, she gets even less benefits from these. And not everyday takes all of them, as well.
Betaine HCL, ~600mg
Vitamin D3, 5,000 UI every other day with 500mcg K2 Mk7 and 15mg Mk4
Chondroitin sulfate 800-1,200mg
Omega 3, 1g
Collagen 10g, either from powder or bone broth
Magnesium Glycinate 400-500mg
Liposomal Vitamin C 1g
Lysine 2.5g/ Proline 500mg
Pycnogenol with Gotu Kola, or Grape Seed Extract
Curcumin .5-1g
Niacin, titrating to 2-3g. Currently at 1.2g with TMG or B6
Taurine 2g
Carnitine 1.5g
Lavender oil – for sleep
Apigenin 50-100mg – for sleep
Molecular Hydrogen or CBD – for sleep
Glycine 3g – for sleep and glutathione
Nattokinase at night 1 cap, 2,000 FU


Meditation, I try to encourage and remind her, but doesn't quite manage to do it

She’s not on an anticoagulant. Technically she should, but I worry of intracranial hemorrhage; sometimes she hits her head although not hard.. And is taking nightly nattokinase lower dose (if it even does something at that dose.. But it’s better not to combine it) And might take ginkgo biloba if it doesn’t give her diarrhea.

So, I don't want to combine an anticoagulant with various blood thinners effects like ginkgo biloba, niacin (lowers fibrinogen, and they say a higher risk of bleeding with a blood thinner), chondroitin sulfate, OM3, aged garlic (although stopped taking to maybe lower diarrhea), nattokinase (low dose), curcumin (sometimes), DMSO (sometimes), pycnogenol/grape seed.

But maybe I’m mistaken. But still, should she combine an anticoagulant with supplements? I don't know.


She was on Hormone replacement therapy, just finished two pellets for a year. Unsure whether to do it for longer. It has 100mg of DHEA, 150mg Testosterone, 100mg Progesterone + sublingual progesterone drops (~150mg).

Maybe we’ll take out testosterone as she has high hemoglobin and hematocrit that testosterone increases, (but dehydration also increases those…)

In “The Great Menopause Myth” they don’t recommend pellets, though, because it makes the blood more viscous, results in high levels and you can't change the dose if you need to.



So, that's all.

What do you think we are overlooking?
What do you think we should be doing?
We are open to suggestions, and your input is greatly appreciated.

And, ultimately, I hope the things we/I shared with you, and what we are doing works. For you, us, our loved ones and more people.

Thank you for reading.
 
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