As indicated in part 1 of this article (see Nutrition & Healing, April 2014), being more relaxed and less stressed will make a big difference in preventing plaque rupture. But there are also herbal measures that can help. Preventing infections as much as possible with immune herbs such as Echinacea root has already been mentioned. We can also speculate that herbs able to improve the stress response (adaptogens) such as Rhodiola, ashwaganda and Eleutherococcus will be beneficial, together with regular use of calming herbs like valerian and kava.
Stabilizing vulnerable plaque with supplements
If vulnerable plaque is a wound that has not healed properly, using herbs to promote healing should help to stabilize it. By an amazing coincidence, we actually have clinical evidence that a key healing herb does exactly that. In two remarkable placebo-controlled clinical trials, gotu kola actives stabilized low-density carotid1 and femoral plaques.2 The dose used in both trials was 180 mg/day of gotu kola triterpenoids for 12 months. This clinical outcome was assessed by significant and marked increases in the echogenicity of plaques compared to placebo.
As noted in part 1, unstable plaque has been linked to low levels of omega-3, so eating plenty of fish and supplementing with oils rich in long-chain omega-3 fatty acids (EPA and DHA) is essential. If you are vegetarian, then algal and fungal sources of EPA and DHA are available, but make sure you take adequate amounts: at least 1,000 mg/day of EPA plus DHA.
Inflammation makes plaque more vulnerable. In particular, CRP and other inflammatory markers such as matrix metalloproteinase 9 (MMP-9) and interleukin-6 (IL-6) have been linked to vulnerable plaque. It is thought the ongoing inflammatory processes inside vulnerable plaque are key factors in its instability. A fascinating study assessing the clinical impact of Ginkgo on a number of novel cardiovascular risk factors, especially nanoplaque formation and lipoprotein(a), was published a few years ago. Now the authors have revisited blood samples taken from the trial participants and subjected them to further analysis.3 As well as nanoplaque formation being reduced by 14.3% and nanoplaque size by 23.4%, oxidised LDL was reduced by 21%, lipoprotein(a) by 26.3%, interleukin-6 by 12.9%, MMP-9 by 32.9%, white blood cell (WBC) count by 7.5% (mainly from monocytes and eosinophils) and highly-sensitive CRP (hs-CRP) by 39.3%.
CRP is usually measured to less than 5mg/L. When it was realized that values less than this might also contribute to cardiovascular risk, a more sensitive technique was developed to measure these low numbers (hs‑CRP). Interestingly, the Ginkgo reduced CRP regardless of the starting value. Hence, one patient with a relatively low value of 1.60 exhibited a reduction to 0.64, while in another a reading of 46.6 (indicating a high degree of inflammation) dropped to 29.3. The latter observation suggests Ginkgo might be a significant anti-inflammatory treatment in its own right. WBC count is emerging as a significant risk factor in patients with pre-existing arterial disease. In particular, eosinophil activation has been linked to major adverse events in several clinical trials, especially in patients with stents.4 Other anti-inflammatory herbs will also be valuable, such as turmeric and its derivatives (especially as bioavailable forms of curcumin).
Unstable plaque has also been linked to lower plasma glutathione. All the Nrf2/ARE priming herbs such as turmeric, rosemary, green tea and Ginkgo will help boost plasma glutathione levels.
Two steps to reducing your rupture risk
If someone already has arterial plaque (and most of us do), there is probably only a modest benefit in reducing the formation of new plaque by addressing that first set of risk factors, the ones predicting your risk for plaque development. Stable plaque narrows arteries, and may eventually cause stable angina or intermittent claudication, but other than that it has little adverse health consequences. Instead, a more risk-based approach will focus on vulnerable plaque, since in the majority of cases it is responsible for serious life-threatening events (heart attacks and strokes).
In addressing the risk posed by vulnerable plaque, a two-pronged strategy is suggested: firstly stabilize the plaque, and secondly avoid those things known to trigger plaque rupture. Consequently, a number of lifestyle, herbal and dietary measures are recommended such as avoiding stress (multiple herbs will help here) and taking Echinacea root (reducing acute infection risk), Ginkgo (reducing inflammation and increasing plasma glutathione), turmeric and curcumin (reducing inflammation, priming Nrf2/ARE), gotu kola (healing plaque) and fish oil. If you need to lower your cholesterol, then fine, do it. But ignoring the elephant of unstable plaque means you will be missing out on a huge extra benefit, one that might save your life.
Wishing you the best of health,
Dr. Jonathan V. Wright
Nutrition & Healing
Vol. 8, Issue 5 – May 2014
Full references and citations for this article are available in the downloadable PDF version of the monthly Nutrition and Healing issue in which this article appears.