Templeton Times: Supplements for Coronary Artery Disease By Donald W. Miller, Jr., MD from LewRockwell.com

Supplements for Coronary Artery Disease

April 25, 2015

My wife recently went to see her doctor for a checkup. A blood test showed that her cholesterol, the calculated low-density lipoprotein one, was elevated. Though feeling well, her doctor ordered a coronary calcium scan, taking into account the fact that she has a family history of heart disease (her father died from a heart attack when she was 12 years old). Quite unexpectedly her calcium score was quite high. The score one wants to have on a CT (computed tomography) coronary calcium scan is 0, which indicates no evidence of coronary artery disease (CAD). A score of 1-10 gives minimal evidence of CAD, 11-100 is mild evidence, 101-400 moderate evidence, and a score over 400 is extensive evidence indicating the presence of coronary artery disease. My wife’s coronary calcium score was over 400.
Her doctor recommended that she start taking a statin right away (along with an 81 mg baby aspirin). This all happened right after I had submitted a paper titled “Fallacies in Modern Medicine: Statins and the Cholesterol-Heart hypothesis” for publication in the Journal of American Physicians and Surgeons. (It has undergone peer review, been accepted for publication, and will be in the Summer 2015—Volume 20, Number 2—issue of this journal.)
My research into this subject and many years spent performing and teaching heart surgery has convinced me that the cholesterol theory of heart disease is wrong, and statins do more harm than good.

Atherosclerosis is an inflammatory disease. My colleague, the late Russell Ross, a professor of pathology at the University of Washington, showed that dysfunction of endothelium, the inner lining of arteries, brought on with or without some form of injury (e.g., from smoking), starts what is called atherosclerosis. Immune cells—macrophages and T lymphocytes—mediate the ensuing inflammatory response to this dysfunction. An integral part of their response is to promote the proliferation and migration of smooth muscle cells. Russell demonstrated that atherosclerosis is a chronic inflammatory and fibroproliferative process that is fundamentally no different than that seen in cirrhosis, rheumatoid arthritis, and chronic pancreatitis.
Cholesterol does not cause it. Heart surgeon Michael DeBakey and his team 52 years ago found no correlation between blood cholesterol levels and severity of atherosclerosis in 1,700 patients undergoing surgical treatment of atherosclerotic cardiovascular disease. I have observed the same thing with my heart surgery patients.
Cholesterol combats inflammation and works to quell it. (Blaming cholesterol for atherosclerosis is like blaming firemen for the fire they have come to put out.) Statins are very effective at lowering cholesterol, but whatever benefits they may have, however small, in dealing with atherosclerosis comes from their anti-inflammatory effects.
This is in my (soon-to-be-published) article on statins and cholesterol:

“Lovastatin (Mevacor), the first statin, is a naturally occurring molecule isolated from a fungus named Aspergillus terreus. Newer statins are synthetic variations of these mycotoxins that fungi produce. Fungi make statins, as a “secondary metabolite,” to kill predatory microbes. They also kill human cells. In a review of [the book, published in 2012] How Statin Drugs Really Lower Cholesterol and Kill You One Cell at a Time by James and Hannah Yoseph, Peter Langsjoen writes:

Many practicing physicians have a healthy understanding of the current level of corruption and collusion among big pharmaceutical companies, governmental agencies such as the NIH and FDA, and major medical associations such as the American Heart Association, but the reader of this book will come away with the disturbing conclusion that it is even worse than imagined. Statins may be the perfect and most insidious human toxin in that adverse effects are often delayed by years and come about gradually. Further, statins frequently impair mental function to such a degree that by the time patients are in real trouble, they may lack the mental facilities to recognize the cause.”

The last thing I want my wife to do is to take a statin. Fortunately, there are a number of nutritional supplements that also have anti-inflammatory effect like that of statins—and without their adverse effects. Other supplements, like vitamin D and vitamin K2 spawn (vitamin D) and activate (vitamin K2) a protein that sucks calcium out of blood vessels. Others, like omega-3 fatty acids, vitamin E (the natural d-alpha tocopherol, not the synthetic dl-alpha form), and gingko biloba decrease platelet adhesiveness (makes them less sticky), thin the blood, and improve blood flow.
These are the supplements I have my wife taking for her newly diagnosed coronary artery disease (along with a multivitamin supplement which has vitamins B6, B9-folic acid, B12, and vitamin A):

Supplements (all obtainable through Amazon):	How many a Day
Omega-3 fatty acids: 425mg EPA, 270 mg DHA in Super EPA (Thorne)…….	2
Vitamin C: 1000 mg, Lyco-Spheric Vitamin C packets (LivOn Labs)……….	2
Vitamin E:
Ultimate E—mixed tocopherols (Thorne)………………………	2
Unique E Tocotrienol (A.C. Grace)……………………………	1
Alpha lipoic acid: 100 mg, as R-Lipoic Acid (Thorne)………..……………	3
Coenzyme Q10: 100 mg, Q Best (Thorne)…………………….……	2
Magnesium: 135 mg, Magnesium Citramate (Thorne)………………	3
Selenium: 100 mcg in Pic Mins +
Zinc: 15 mg in Pic Mins (Thorne)……..…………………………….	2
Curcumin: 500 mg in Meriva 500 (Thorne)………………………….	4
Quercetin: 250 mg, Quercetin Phytosome (Thorne)…………..……..	3
Gingko Biloba: 120 mg (Natrol)……………………………………………..	2
Vitamin D: 10,000 IU (Thorne)……..……………………………….	1
Vitamin K2 (Menaquinone-7): 90 mcg (Jarrow Formulas)…….……..	2
Resveratrol: 100 mg as Poly-Resveratrol-SR (Thorne)……..……….	2
.

Their Physiologic Mechanisms of action:

Omega-3 fatty acids: Among other things, the Omega-3 fatty acids EPA and DHA prevent heart disease (and cancer). EPA thins the blood. Both EPA and DHA regulate the expression of many genes involving antioxidant capacity, oxidative stress response, and ones that produce chemicals which reduce inflammation and improve blood flow through the coronary arteries.

Network antioxidants:

Vitamin C: Along with its role as an antioxidant, vitamin C reduces the level of the inflammation-causing C-reactive protein (CRP) and thus helps prevent/quell inflammatory atherosclerosis. Vitamin C is an essential cofactor for protein synthesis, notably collagen, which makes up 25 percent of the proteins in the body and is the structural component of connective tissue in blood vessels, bone, teeth, cartilage, ligaments, and skin. (In its role as an electron donor, vitamin C transfers electrons to iron. The iron in enzymes that make collagen transfers its vitamin C-supplied electron to oxygen, thereby enabling it to combine with hydrogen as a hydroxyl [-OH] group. Hydroxyl groups attach to the amino acids in collagen, forming cross links that give this protein its tensile strength.) Vitamin C in the form selected here, packed in lyposomal nano-spheres, is very highly absorbable.
Vitamin E: As an antioxidant vitamin E protects cell membranes by extinguishing various singlet oxygen and polyunsaturated fatty acid radicals. Vitamin E helps reduce high levels of the inflammation-causing proteins, CRP and interleukin-6 (IL-6), which play a role in causing atherosclerosis. The Ultimate E supplement contains all four tocopherols—d-alpha, gamma, beta, and delta (gamma tocopherol neutralizes free radicals that the alpha form cannot douse). It contains natural d-alpha tocopherol, which works better than synthetic dl-alpha tocopherol, the most common form of vitamin E found in multivitamin supplements. The d-alpha form makes platelets less sticky, whereas platelets cannot absorb the dl-alpha synthetic kind. The Unique E Tocotrienol supplement contains the delta and gamma forms of tocotrienol.
Alpha lipoic acid: Reduces the risk of atherosclerosis. It is soluble in both fat and water and is one of the most powerful antioxidants in the body. In addition, it restores the other network antioxidants when oxidized (vitamin C, vitamin E, coenzyme Q10, and glutathione) back to their functional, reduced antioxidant state. ALA aids glucose entry into cells, improves insulin sensitivity, and reduces the risk of diabetes. It also plays an integral role in producing the energy molecule adenosine triphosphate (ATP), feeding pyruvate from the glycolytic cycle into the Krebs cycle.
Coenzyme Q10: A strong antioxidant that removes oxidized low-density lipoproteins (LDL), a leading culprit in atherosclerosis. The body synthesizes it but in insufficient quantities, especially in people who take statins to lower cholesterol. CoQ10 also plays a critical role in mitochondrial energy production and is a required ingredient in the electron transport chain that produces ATP through oxidative phosphorylation.

Minerals:

Magnesium: A deficiency in magnesium can cause angina, from spasm of the coronary arteries; high blood pressure; and heart rhythm disturbances, including sudden death. Some 80 percent of the enzymes in the body require magnesium in order to function.
Selenium: Bound to cysteine in place of sulfur and called the “21st amino acid,” selenocysteine is the active site in some 35 proteins. Glutathione peroxidase, which plays a major role in free radical defense and combating inflammation contains four selenium atoms. Plasma selenoprotein P protects endothelial cells against damage, including those susceptible to injury lining the coronary arteries.
Zinc: A constituent of more than 3,000 different proteins in the body, studies show that a lack of zinc leads to an increased risk of cardiovascular disease by triggering inflammation and lowering levels of protective compounds that guard against atherosclerosis.

Botanicals:

Curcumin: An orange-yellow curry spice that comes from turmeric root, curcumin suppresses inflammation by down regulating nuclear factor-kappa B (NF-kB), a transcription factor concerned with intensifying the inflammatory response. (The small benefit that statins offer with atherosclerotic CAD is derived from their anti-inflammatory effect, especially on their ability to down regulate NF-kB. Curcumin does the same thing without having any of the adverse effects that statins have.) Curcumin also blocks eicosanoid synthesis of inflammatory leukotrienes, prostaglandins, and thromboxanes derived from arachidonic acid. It is also an antioxidant. In the supplement used here, Meriva 500, curcumin is complexed with phosphatidylcholine for superior bioavailability.
Quercetin: This bioflavenoid prevents oxidation of LDL cholesterol in blood vessel walls. Quercetin inhibits inflammation in a way different from that of curcumin, which makes it worthwhile taking both together. It inhibits the delta-5-lipooxygenase enzyme, which initiates the production of inflammatory eicosanoids. (Quercetin also inhibits tumor initiation and growth.)
Ginkgo Biloba: Extracted from the 200 million-year-old maidenhair tree (the oldest living tree species on earth), ginkgo biloba thins the blood and decreases platelet adhesiveness, like aspirin, without the side effects that aspirin has. Ginkgo biloba increases blood flow through the body, especially in the heart and brain. Like curcumin (and statins), it suppresses inflammation by inhibiting NF-kB. (Ginkgo biloba also improves mental functioning and memory in older people and may well exert a protective effect against developing Alzheimer’s dementia and Parkinson’s disease.)

Others:

Vitamin D: Controls the expression of more than 1,000 genes throughout the body, notably in endothelial cells making up the delicate inner layer of blood vessels. Vitamin D also expresses genes that blunt the immune system-mediated inflammatory response that propagates atherosclerosis and congestive heart failure.
Vitamin K2: Calcium deposits in the walls of blood vessels play an active role in the formation of atherosclerosis. K2 activates the protein called “matrix Gla (carboxyglutamic acid) protein ” by carboxylating the glutamate residues in matrix Gla protein, enabling it to bind and remove calcium from blood vessels and thus prevent the formation atherosclerotic calcific plaques. Vitamins D and K2 work together in this regard because vitamin D expresses the gene that makes matrix Gla protein. (Vitamin K comes in two forms, K1 and K2. K1 is a cofactor for blood coagulation; and K2, in addition to activating matrix Gla protein, activates osteocalcin, a protein secreted by osteoblasts that plays a role in bone mineralization and calcium ion hemostasis.) Menaquinone-7 is the natural form of vitamin K2, which is better than synthetic menaquinone-4, the more widely marketed form of vitamin K2.
Resveratrol: It controls the expression of more than 100 genes, including Sirtuin 1, the DNA-repair “survival” gene. Notable among its effects, resveratrol is a potent antioxidant and anti-inflammatory agent, suppressing transcription factor NF-kB, like statins. It also plays a role as a COX inhibitor and normalizes blood sugar. Resveratrol protects the endothelium of arteries from oxidative free radical damage, and it helps protect the production of nitric oxide, a critical chemical produced by endothelium that keeps blood vessels dilated.

The cost of these 15 supplements, produced by Thorne Research, LivOn Labs, AC Grace Company, Natrol, and Jarrow Formulas, comes to $14.65 a day. Purchasing lowest-cost alpha lipoic acid, coenzyme Q10, magnesium, curcumin, quercetin, vitamin D, and resveratrol on Amazon drops the price to $6.88 a day, which is not much different than the $5.98 cost of Crestor (rosuvastatin, 40 mg/day), the most widely prescribed statin.
There is no good substitute for lyco-spheric vitamin C, since it is by far the best absorbed form of orally-administered vitamin C. Regarding vitamin E, the investment in Thorne’s Ultimate E mixed tocopherols, (or AC Grace’s equally good Unique E tocopherols), and AC Grace’s Unique E Tocotrienol is well worth it. In these preparations, the natural forms and relatively full spectrum of this vitamin brook no substitute. Thorne’s curcumin (in Meriva 500) and quercetin (as Quercetin Phytosome) also have added value in their being very well absorbed. An equally good (if not better) alternative to Thorne’s Resveratrol (as Poly-Resveratrol-SR) at the same price is the resveratrol Longevinex produces. It can be purchased online at www.longevinex.com (Amazon does not carry it).
Ideally, health care agencies would fund a long-term randomized trial comparing these 15 supplements (made by these manufacturers) with a statin, and aspirin, for people with atherosclerotic coronary artery disease. But with no patents in the offing such a study will never be done. Nevertheless, there is sufficient evidence to justify taking the supplements I have listed here and avoiding statins, with their negligible benefit and wide spectrum of adverse effects.
High-quality Thorne Research and LivOn vitamin C supplements are fairly expensive. I view them as an important investment in my wife’s health.
(The author has no relationship, financial or otherwise, with the supplement companies named here.)

The Best of Donald W. Miller, Jr., MD