PEAK TESTOSTERONE

Arterial Plaque (Atherosclerosis) and Weight Loss

Some men feel paralyzed who find that they have arterial plaque (atherosclerosis) via a Heart Scan (Calcium Score) or IMT.  They realize the gravity of the situation, the increase in risk for heart attack, stroke and erectile dysfunction, etc. but feel overwhelmed at the amount of technical knowledge and lifestyle modifications that are required to reverse the situation.  Most men in this situation have a lot of extra body fat - a safe bet since 1/3rd of American men are overweight and 1/3rd are obese - and need to lose between 10 and 100 pounds.  This article provides evidence that loss of this extra weight can be used as an opportunity to regress a considerable amount of plaque.

Below I will discuss a study that shows that a wide variety of diets from lower carb to lower fat can be used to regress plaque in most men as long as one is losing weight.  The clear message, assuming you have extra bodyfat to lose, that I am presenting is this:  get started!  Lose weight gradually over an extended period of time so as to not negatively alter hormone levels and you should see your atherosclerosis improve.

Of course, I'll say the obvious:  it is always best to work with a physician that has considerable experience reversing plaque.  Much of the subject is actually common sense coupled with recent research, much of which I have summarized in these Pages on Arterial Plaque Regression. However, there are definitely "gotchas," i.e. things that can trip you up, and so I encourage you to keep looking for a doctor that knows that he is doing and doesn't just throw you immediately on a statin. 

CAUTION:  From what I have seen on the Peak Testosterone Forum, you can't usually count on cardiologists unfortunately.  Most of them seem to actually discourage plaque regression!  This is a big mistake according to the research, because Erectile Dysfunction is Associated with Arterial Plaque and heart attacks as well.  I hate to be jaded, but keep in mind that they make much more money via angioplasties and stents than by spending time consulting with you on plaque regression.

So, in the meantime, get started by losing weight gradually.  Let's look at a study that shows that you will probably regress plaque just by doing this alone.  Particpants in this study met the following criterion:

"Eligible participants were aged 40 to 65 years with body mass index (BMI) 27 kg/m2 ; individuals with type 2 diabetes mellitus or coronary heart disease were eligible regardless of age or BMI. Pregnant or lactating women and participants with a serum creatinine 2 mg/dL (176 mol/L), liver dysfunction (2-fold higher than the upper limit of normal in alanine aminotransferase or aspartate aminotransferase), intestinal problems that would prevent adherence to any of the test diets, or active cancer were excluded." [1] Note that 88% of the those in the study were male.  There is a very good chance that the solid majority of men reading this article would fit within these guidelines. 

What were the results?  Before the study, the average IMT reading was 0.817+/-0.17 mm.  IMT stands "intima media thickness" and is measures  the thickness of the tunica intima and tunica media, the innermost two layers of the wall of an artery, thus taking into account any plaque lining the neck (carotid) artery.  However, what the researchers actually monitored primarily was VWV (carotid vessel wall volume) in order to determine if atherosclerosis had receded or not. 

They then divided the groups into a) (quasi) low fat, b) Mediterranean and c) low carb groups and, of course, compared them to controls.What the results showed would be counterintuitive to many:  ALL three groups showed a decrease in VWV of about 5%.  Low(er) fat, low carb, Mediterranean - it didn't matter - all regressed plaque almost exactly the same.  IMT was also examined and "over the two years of diet intervention, regardless of diet group, vessel-wall volumes diminished by 4.9%  while mean IMT improved by 1.1%" [2]

NOTE:  This was NOT a true low fat diet.  Actual fat levels in the "low fat" group were 30% of calories! When most people hear the term "low fat," they think of fat levels in the 10-15% of total calories range.  This is the level that Drs. Ornish and Esselstyn used to regress plaque in their research (and Dr. Barnard to reverse type II diabetes).  However, researchers (for reasons unknown) call that kind of diet "very low fat."  Again, "low fat" to a researcher means more Mediterranean levels.  I would argue that a true low fat diet in the 10-15% range that is low glycemic and heavily plant-based for maximum nitric oxide levels would regress arterial plaque levels even more rapidly in most men.

How much weight did these participants lose in the two years?  The original authors stated the following:

"The mean weight loss was 2.9 kg [6.4 lb] for the low-fat group, 4.4 kg [9.7 lb] for the Mediterranean-diet group, and 4.7 kg [10.3 lb] for the low-carbohydrate group; among the 272 participants who completed the intervention, the mean weight losses were 3.3 kg [7.3 lb], 4.6 kg [10.1 lb], and 5.5 kg [12.1 lb], respectively." [3]

Note that this is modest weight loss.  If you look at those who who actually finished the study, weight loss was between about a quarter pound and a half pound per month.  Most people who lose weight do so much more quickly. However, there is considerable wisdom generally in doing so gradually:  hormone levels are preserved; compliance is easier and plaque regression is extended.

Of course, this is great news and is yet another study that shows that plaque can indeed be regressed and it can be regressed in those that need it the most.  Monitoring of your plaque levels before and after via IMT or Calcium Score is essential in my opinion.

REFERENCES:

1) Circulation. 2010 Mar 16;121(10):1200-8, "Dietary Intervention to Reverse Carotid Atherosclerosis"

2) Medscape, Steve Stiles, Mar 02 2010, "Weight Loss, Regardless of Diet Intervention, Can Reverse Carotid Disease"

3) NEJM, Jul 17 2008, 359(3), "Weight Loss with a Low-Carbohydrate, Mediterranean, or Low-Fat Diet"