Near-death experience with nattokinase

16. May 2010 William Davis (22)
This is a true story that I personally witnessed.

A 60-some year old man heard that nattokinase "thinned the blood." So he had been taking it for the past 6 months.

One week before he came to see me, he abruptly became quite breathless. He was unable to walk more than 20 feet or bend over to tie his shoes due to the breathlessness.

He came to see me in the office. I was alarmed by how breathless he was without signs of heart failure or other obvious explanation. I sent him for an immediate CT pulmonary angiogram. Within 30 minutes, we had the diagnosis: a large "saddle" pulmonary embolus, meaning a large blood clot that straddled the right and left main pulmonary arteries. One wrong move and . . . bang! He would have been dead within a couple of minutes, since a large clot can completely occlude the large arteries feeding the lung, essentially corking any blood circuiting through the lungs and back to the left side of the heart. (Causing, incidentally, electromechanical dissociation, in which the heart keeps beating for a few minutes but no blood is being pumped. CPR can keep you alive for a few minutes, then it's over.)

When I advised the patient of the diagnosis (after initiating the REAL anticoagulants), he said, "But I was taking nattokinase!"

Exactly. Blood clots are no laughing matter. They are potentially fatal events. Betting your life on some company's advertisement is nothing short of foolish.

Anyone who reads The Heart Scan Blog knows that I am an avid supporter of nutritional supplements. I even write articles and consult for the supplement industry. But I truly despise hearing unfounded marketing claims that some supplement companies will make in the pursuit of a fast buck.

There is no doubt that we need better, safer methods to deal with dangerous blood clots, whether in the lung, pelvis, or other areas. But, before anyone takes a leap based on the extravagant marketing claims made by a supplement manufacturer, you want to be damn sure there are real data--not marketing claims, REAL data--before you use something like nattokinase in place of a proven therapy.

Don't confuse the very interesting, though unpalatable, natto with nattokinase. Natto contains vitamin K2 and some other interesting compounds, including nattokinase.
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Comments (22) -

  • Anonymous

    5/15/2010 10:41:58 PM |

    Interesting that your warning about nattokinese is FOLLOWED immediately by an advertisement for.... nattokinase extracts!

  • mongander

    5/16/2010 1:29:07 AM |

    Actually most nattokinase does not contain vitamin K2.  When nattokinase is extracted from natto, the K2 is separated and sold as another profitable byproduct.

  • Anonymous

    5/16/2010 1:29:07 AM |

    Wait a minute though! Was there any indication that he needed a real blood thinner before his clot? Maybe he was just taking it like a daily aspirin to "thin the blood" not for therapeutic blood anticoagulation. His clot was unfortunate but probably could have occurred with a cardiologist sactioned baby aspirin.

  • Dr. William Davis

    5/16/2010 1:07:24 PM |

    Anon--

    He was taking aspirin, as well.

    However, aspirin does NOT prevent deep vein thromboses that lead to pulmonary emboli, regardless of dose. Aspirin is a platelet-inhibitor, not a true "blood thinner" that works by way of clotting proteins.

  • sfr

    5/16/2010 2:18:50 PM |

    Was he using nattokinase as an excuse not to take his warfarin, or something like that? Otherwise it seems very unlikely that the nattokinase had anything to do with the clot. If anything, I'd worry about nattokinase causing bleeds, not clots.

  • Anonymous

    5/16/2010 5:58:24 PM |

    Curious if you ever recommend pycnogenol in cases where there is a risk of DVT? I believe there is at least one study showing a reduced risk of DVT in those who took pycnogenol.

    I'm not saying it's better than anti-coagulants, but it may be better than aspirin.

  • Myron

    5/16/2010 6:08:01 PM |

    Real anti-coagulants?  Like the red clover extract coumadin?  Patients on coumadin even with careful control often suffer excessive bleeding or more clots and strokes.    
    I guess the point is that clotting control is very difficult and that the number one drug is a natural medicine, herbal extract.

  • Anonymous

    5/16/2010 11:25:24 PM |

    One time, I was at a local vitamin shop when I saw that the supplement I was thinking about buying contained nattokinase.  Having read your blog and knowing what you think of nattokinase, I put the product back on the shelf.  The proprietor of the shop asked me why I did not want that supplement, because in his opinon it was a very good product.  I said that I did not want to take anything with nattokinase in it, and he said, "What do you have against nattokinase?"  I didn't bother to explain myself to him, figuring that I would just be wasting my breath.

  • Eric

    5/17/2010 1:37:14 AM |

    What is your opinion about doing higher dose mixed tocopherols, which do work on the clotting cascade. Or garlic and omegas which decrease platelet aggregation. What is your stand on normalizing your vitamin K content and then titrating your dosage of coumadin up to theraputic INR. As far as the nattokinase is concerned, do you like any of that style of enzyme? lumbokinase, serrapeptase. Although they don't have any effect on INR they should have an affect on FDPs

  • Paul

    5/17/2010 3:40:36 AM |

    That title is misleading.  People have been known to have near death cardiac events while taking fish oil, vitamin D3, and high dose niacin too.

    As well, on rare occasion, people have been known to have a recurrent DVT and/or PE while on warfarin therapy, even with an INR as high as 2.5.  Therefore, does that mean warfarin is an ineffective anticoagulant?  Of course not.

    This whole blog is about how we as individuals need to take control of our own health.  That just because we're taking a therapeutic medication or supplement, it does not therefore absolve ourselves from further investing in a life style that is proven to lower risk factors that may cause catastrophic health events.  

    I totally agree that some of the marketing claims made concerning nattokinase are inflated and frankly, unbelievable - particularly about its capabilities as a thrombolysis.  And I agree that if your doctor advices that you need heprin or warfarin therapy in order to prevent a catastrophic health event, you certainly need to heed that advice.

    But, count me down as someone who has extensively studied this subject and is still open to the possibility that nattokinase may contain some attributes in the prevention of venus thrombosis from a novel approach that needs further clinical investigation.

  • Dave

    5/17/2010 3:57:54 PM |

    Dr. Davis,

    I wouldn't be so quick to blast nattokinase because of this isolated incident or lack of research.

    Nattokinase is a "mild" blood thinner. Taking it once a day will not do more than relieve inflammation and slightly improve a person's circulation.

    A person would have to take it every 4 times a day (800 IU) on an empty stomach for if he desires a therapeutic effect. I would be curious if this patient of yours even took 200 IU per day (because a lot of products don't even contain that much).

    I have personally witnessed an improvement in circulation after taking nattokinase.

  • Dave

    5/17/2010 4:03:09 PM |

    I would like to add one more thing...

    I'm sure you have had experience with patients who took 400 IU of vitamin D in tablet form, and did not see any results after six months either. Was it because vitamin D is a worthless supplement, and should not be used?

  • Dave

    5/17/2010 4:42:33 PM |

    Sorry, I was misspoke about the dosage. Nattokinase is measured in fibrinolysis units (FU), not IU, and the effective dose ranges anywhere from 2,000-8000 FU per day.

    Also, here's actual scientific research (albeit small), not marketing hype, on nattokinase.

    http://www.ncbi.nlm.nih.gov/pubmed/19358933

    http://www.ncbi.nlm.nih.gov/pubmed/18971533

  • StephenB

    5/17/2010 6:40:37 PM |

    I've like the taste of natto from the moment I tried it. I am, however, a bit weird. ;)

  • Aaron

    5/17/2010 8:19:54 PM |

    Dr. Davis -- my question here is, could the nattokinase cause the blood clot (doesn't seem the be the case)?  Are you saying that it didn't matter that he was taking nattokinese because it doesn't reach the bloodstream to clear clots (so he would of had the clot anyway)

    Secondly, if he was taking nattokinese that had vitamin K2 <--- is it possible that increases in K2 might cause abnormal blood cloting?

  • Dr. William Davis

    5/17/2010 9:44:34 PM |

    Vitamin K2 does not cause blood clotting any more than topping up your gas tank makes your car go faster.

    Whether nattokinase has other effects is not my point. My concern is that people frequently ask if they should treat their DVT or pulmonary embolus with nattokinase. This is a death sentence. It should NOT be used for a such a purpose unless there were a large treatment trial proving equivalence or superiority to existing therapies.

  • Paul

    5/18/2010 12:50:58 AM |

    Eric,

    High dose mixed tocopherols use the same mechanisms as Wafarin/Coumadin.  They block the reabsorption of vitamin-K in the liver.  Vitamin-K is necessary for the liver to synthesize and release clotting proteins in the blood.  Warfarin/Coumadin is much, much more consistent than tocopherols in maintaining vitamin-K malabsorption and a safely prescribed INR range.  

    Titrating a Warfarin/Coumadin dosage never made sense to me. It is not toxic other than causing vitamin-K deficiency. What difference does it make if the dosage is 20 mg or 20 mcg to maintain a therapeutic INR?  Your liver will need to be equally deficient in vitamin-K no matter how you caused the deficiency.

    Garlic, ginger, ginkgo, curcumin, n-3, aspirin, N-acetylcysteine, Plavix, and yes tocopherols too all are anti-platelet agents.   They are effective at preventing arterial thrombosis, where anticoagulants have little effect. Conversely, anticoagulants are effective at preventing venous thrombosis, where anti-platelet agents (unfortunately) have little effect.

  • Michaela

    5/18/2010 7:36:40 AM |

    I'm giving my son nattokinase, one tablet daily and he also takes Vitamin K2. He has not been prescribed blood thinners, only aspirin which I stopped many months ago.
    Are you warning of not replacing prescribed blood thinners with natural therapies?
    If blood thinners have not been prescribed, is it of benefit to supplement with nattokinase?

  • rob_scheuneman

    5/18/2010 11:31:00 PM |

    Hi Dr. Davis

    I was wondering if you could help me with something.

    I've been monitoring my blood glucose recently with a basic monitor, and my readings would suggest that I am on the verge of impaired glucose tolerance, but not quite there yet.

    I was reading about continuous glucose monitoring systems. I would love to have on if these to more thoroughly monitor my blood glucose, but every model out there requires a prescription to obtain one. I don't understand this, because they are not dangerous in any way.

    Do you know of any way a non diabetic can purchase one of these?

    Any information you can give me would be greatly appreciated. Thank you.

    Rob

  • Anonymous

    9/25/2010 9:36:39 PM |

    Dr. Davis, i am a 45 year old female who recently started taking Lovasa for high triglycerides , i am also on garlic tabs and one baby asprin per day . Is is safe to replace the garlic and asprin with one tab of Natto- K per day and is it safe to take with Lovasa? I am about 20 lbs overweight do not drink or smoke and swim and or walk 3 days per week. i am genetically predisposed to high triglycerides but never had a problem until i gained the weight. Until i get the weight off i am trying a more natural approach. Help!

  • Kelly D

    8/10/2013 3:24:08 AM |

    Acta Haematol. 2010;124(4):218-24. doi: 10.1159/000321518. Epub 2010 Nov 13.

    In vivo evaluation method of the effect of nattokinase on carrageenan-induced tail thrombosis in a rat model.
    Kamiya S, Hagimori M, Ogasawara M, Arakawa M.
    Source
    Nagasaki International University, Sasebo, Japan. kamiya@niu.ac.jp

    Abstract
    Thrombosis is characterized by congenital and acquired procatarxis. Nattokinase inhibits thrombus formation in vitro. However, in vivo evaluation of the therapeutic efficacy of nattokinase against thrombosis remains to be conducted. Subcutaneous nattokinase injections of 1 or 2 mg/ml were administered to the tails of rats. Subsequently, κ-carrageenan was intravenously administered to the tails at 12 h after nattokinase injections. The mean length of the infarcted regions in the tails of rats was significantly shorter in rats administered 2 mg/ml of nattokinase than those in control rats. Nattokinase exhibited significant prophylactic antithrombotic effects. Previously, the in vitro efficacy of nattokinase against thrombosis had been reported; now our study has revealed the in vivo efficacy of nattokinase against thrombosis.

    PMID: 21071931

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Are happy people more likely to reduce heart scan scores?

18. December 2006 William Davis (0)
I was talking to Darryl, a patient today: 71 years old with a heart scan score of 378, as well as an enlarged aorta (4.5 cm).

We had identified numerous lipoprotein abnormalities 12 months ago and advised him on a program for correction. His patterns included small LDL, high triglycerides, sky-high IDL (VERY important when you have an enlarged aorta), and lipoprotein(a). Blood pressure was also high, another crucial fact to correct when the aorta is enlarged.

Anyway, Darryl corrected lipoproteins to perfection: basic lipids were substantially better than 60-60-60; lipoprotein(a) was reduced well into the desirable range; IDL was eliminated; blood pressure was 108/64. Repeat heart scan score: 354.

There's nothing spectacular about Darryl's story, except that, despite these issues, Darryl was a happy man. He smiled throughout our conversation. He has told me on several occasions how grateful he is for the life he has.

Darryl is not wealthy. He retired around 4 years ago and fills his day with helping his wife, walking outdoors, helping out at his church, and contributing to the care of his grandchildren. Through all this Darryl is incurably, unfailingly, and irrepressibly happy.

It made me think back through all the other people who've also had great succes in their Track Your Plaque program. It struck me that, for the most part, they too were a happy bunch: generally optimistic, happy, not overly stressed nor prone to extremely stressful responses to stressful situations. All seem to also be grateful for the good in their lives, though most had no more money than the average person and had their share of difficulties in life. In fact, I can only recall one person who reversed coronary plaque who was an angry, pessimistic personality. Just one.

Could it be that happy, optimistic people are more likely to reverse coronary plaque? It would, after all, be consistent with all the other observations that type A personalities have more heart attack, etc.

Anyway, this is just an informal observation but one that seems very consistent. Track your plaque--and be happy!

Don't overdo the vitamin D

17. December 2006 William Davis (1)
As time passes and I advise more and more people to supplement vitamin D, I gain increasing respect for this powerful "vitamin". I am convinced that vitamin D replacement is the reason for a recent surge in our success rates in dropping CT heart scan scores. I believe it is also explains the larger drops we've been witnessing lately--20-30%.

But vitamin D can be overdone, too. Too much of a good thing . . .

Despite being labeled a "vitamin", cholecalciferol is actually a hormone. Vitamins are obtained from food and you can thereby develop deficiencies because of poor intake. Deficiency of vitamin C, for instance, arises from a lack of vegetables and fruits.

Vitamin D, on the other hand, is nearly absent from food. The only naturally-occuring source is oily fish like salmon and sardines. Milk usually has a little (100 units per 8 oz) because milk producers have been required by law to put it there to reduce the incidence of childhood rickets.

A woman came to me with a heart scan score of nearly 3800, the highest score I've every seen in a woman. (Record for a male >8,000!) She was taking vitamin D by prescription from her family doctor but at a dose of 150,000 units per week, or approximately 21,000 units per day. This had gone on for about 3-4 years. This may explain her excessive coronary calcium score. Interestingly, she had virtually no lipoprotein abnormalities identified, which by itself is curious, since most people have some degree of abnormality like small LDL. Obviously, I asked her to stop the vitamin D.

Should you be afraid of vitamin D? Of course not. If your neighbor is an alcoholic and has advanced cirrhosis, does that mean you shouldn't have a glass or two of Merlot for health and enjoyment? It's a matter of quantity. Too little vitamin D and you encourage coronary plaque growth. Too much vitamin D and you trigger "pathologic calcification", or the deposition of calcium in inappropriate places and sometimes to extreme degrees, as in this unfortunate woman.

Ideally, you should have your doctor check your 25-OH-vitamin D3 blood levels twice a year in summar and in winter. We aim for a level of 50 ng/ml, the level at which the phenemena of deficiency dissipate.

"It must have been the statin"

13. December 2006 William Davis (0)
After four years of trying, Randy finally reduced her heart scan score. It not only dropped, it plummeted. After four previous scans that showed 25% or more increases, she'd finally dropped her score 23%. (I Blogged about Randy's case a few weeks ago.)

Randy also works for a cardiologist. When she told him that she had reversed her coronary plaque and reduced her heart scan score by 23%, he said, "It must have been the statin agent."

Randy was indeed on a statin drug at a low dose. But she also had taken great efforts in exercise, food choices, fish oil, and vitamin D. In fact, her score had progressed dramatically while she was taking the drug. Put simply, it was not the statin.

But that is the mindset of the conventionally thinking cardiologist. Stent, bypass, or statin drug--what else is there? Even with crystal clear evidence for coronary plaque regression, they refuse to acknowledge that tools that are not in their everyday consciousness could have achieved so spectacular a result.

Given a choice, 9 out of 10 cardiologists would rather put a stent in and walk away $2000 richer for an hour of work. Don't allow them to have this choice. Take control now.

12. December 2006 William Davis (0)
Statin Drugs May Help the Healthy:
Cholesterol-Lowering Statin Drugs May Benefit People Without Heart Disease

That's the headline on WebMD, reporting the findings of a recent study published in the Archives of Internal Medicine. In reality, it wasn't really a study at all, but a re-analysis of previously published data, a so-called meta-analysis.

Nonetheless, the University of Toronto group re-analyzed the results of several studies, pooling data on 28,000 people, none of whom had known coronary disease. The results were similar to the results of the studies that were reported individually: a 29% reduction in heart attack and other "events" in people taking statin drugs.

What's surprising to me is this notion that statins, or any other treatment for that matter, prevent heart attack in people without heart disease. This is idiotic. Of course they had coronary heart disease. You can't have a heart attack in the absence of coronary disease. (There are very rare exceptions, like cocaine users, who experience coronary spasm from the drug).

What the study shows is that people with unrecognized heart disease experienced a reduction in heart attack. What it also means is that many, many people truly without heart disease were unnecessarily treated. As you'd predict, the drug manufacturers love this sort of broad, untargeted use of their drugs. It's an approach that brings in billions of dollars of revenues. The article on WebMD, in fact, was accompanied by three ads for various cholesterol drugs on this single page story.

What if only people with heart disease, as identified by CT heart scan scores, were treated? You would indeed witness an even larger reduction in heart attack risk, because the group receiving treatment both has the disease and is thereby at greater risk. Treatment should yield even greater risk reduction than treating broad groups who superficially appear to not have heart disease.

Ignore this nonsense about statin drugs reducing heart attack risk in people without heart disease. If you don't look for it, you won't know you have it. Once again, you can be lots smarter than the media. Get a heart scan and find out if your risk is worth reducing.

Heart attack guaranteed

10. December 2006 William Davis (0)
What if you knew for a fact that your risk for heart attack was 100% by, say, age 58? This is indeed true for many people, though at age 60, 65, 70--or 45.

In other words, unless something were done about the causes of heart disease, you would inevitably suffer a heart attack at 58.

What sort of action could you take at age 45?

Obviously, not smoking is an absolute requirement. Continue and you may as well start getting your affairs together.

How about exercising and eating a generally healthy diet? Will your risk be reduced to zero? No. It might be reduced 20-30%, depending on genetic factors.

How about a statin drug? Watch TV ads during Oprah, and you might think it's a cure. But in reality, while it is a financial bonanza for the drug manufacturers, it will reduce risk for heart attack by 30%.

(Note that risk reduction by following multiple strategies is not necessarily additive. In other words, if you have a healthy lifestyle and take a statin agent, is risk reduced 60% (30 + 30)? No, because the effects may overlap.)

So, eating healthy, exercising, and taking a statin drug might reduce risk 35-40%, maybe 50% in the best case scenario. Would you be satisfied? Most would not.

Add fish oil at a truly therapeutic dose. Risk reduction by itself: 28%.

Add niacin or other strategies for correction of your individual, specific causes of heart disease: Now we're up to 90% reduction.

Throw in a tracking process to prove whether or not atherosclerotic plaque has progressed or reversed. Now we're approaching 100% if plaque reverses. The only way I know how to track plaque is through CT heart scans. What other test is readily available to you with low radiation exposure, yet is relatively inexpensive and precise? It certainly is not stress testing, heart catheterization, CT angiograms, or other techniques. Cholesterol won't tell you. Besides CT heart scans, there's nothing else I know of.

Let's fact it: For many people, uncorrected risk for heart attack is truly 100% at some age. Take action while you can.

That, in a nutshell, is the Track Your Plaque program.

Heart scan curiosities 3

10. December 2006 William Davis (7)


This is a sample image from the heart scan of a 54-year old, 212 lb, 5 ft 2 inch woman. The heart is the whitish-gray in the center; lungs are the dark (air-filled) areas on either side of the heart. Note the massive amount of surrounding gray tissues that encircles the heart and lungs. This is fat. At this weight, the diameter of total fat exceeds the combined diameter of the heart and lungs. If we were to show the abdomen, there would be even more fat. (The image shows the body not well centered because the technologist centers the heart, since this is, after all, a heart scan.)





This is a 55-year old, 151 lb, 5 ft 4 inch woman. Note the contrast in the quantity of fat tissue surrounding the chest, a much more normal appearance. Note that this woman is still around 25 lb over ideal weight, but not to the extreme degree of the woman above.

Another curious observation: Note the more whitish streaking in the heavier woman's lungs. Heart scans are performed while holding a deep inspiration (a deep breath inwards), mostly to eliminate lung respiratory motion during image acquisition. Nonetheless, the heavier woman's lungs are not as fully expanded as the more slender woman. In other words, the heavier woman cannot inflate her lungs as effectively as the thinner woman. Ever notice how breathless heavy people are? Some of this effect is just being out of shape. But there's also the added effect of the abdominal fat exerting upwards compression on the lung tissues, and the constrictive effect of the encircling fat mass. At the beginning of inspiration, the chest fat exerts the resistance of inertia to inspiration that is absent, or less, in a slender person. With each breath, the heavy woman must move 50 lbs or so of surrounding fat mass just to inhale.

The heavier woman is, in effect, suffocating herself in fat.

The distortions to the human body incurred by extreme weight gain are both fascinating and shocking. I hope you're breathing easily.

The shameful "standard of care"

10. December 2006 William Davis (1)
John's initial heart scan four years ago showed a score of 329. His physician prescribed Zocor for a somewhat high LDL cholesterol.

One year later, John asked for another scan. His score: 385, a 17% increase. John exercised harder and cut his fat intake.

This past fall--3 years after his last scan--John had yet another heart scan. Score: 641, a 66% increase over the last scan, all the while on Zocor.

John sought an opinion from a reputable cardiologist. He concurred with the prescription of Zocor and advised annual stress tests. That's it.

Followers of the Track Your Plaque approach know that the expected uncorrected rate of increase in heart scan score is 30% per year. On Zocor or other cholesterol reducing statin agent, a common rate of growth is between 18-24% per year--better but not great. Plaque growth is certainly not stopped.

But that is the full extent of interest and responsibility of your cardiologist. Prescribe a statin drug, perform a stress test, and the full extent of his obligation has been fulfilled. In legal terms, your physician has met the prevailing
"standard of care". No more, no less.

In other words, the prevailing standard of care falls shamefully short of what is truly possible. For the majority of the motivated and interested, coronary plaque reversal--reduction of your heart scan score--should be the standard aimed for. It's not always achievable, but it is so vastly superior to the prescribe statin, wait for heart attack approach endorsed by most cardiologists.

Heart scan curiosities 2

9. December 2006 William Davis (2)


This is an example of a so-called "hiatal hernia", meaning the stomach has migrated through the diaphragmatic hiatus into the chest--the stomach is literally in the chest. This example is an unusually large one. Hiatal hernias can cause chest pain, indigestion, and a variety of other gastrointestinal complaints. Heart scans are reasonably useful to screen for this disorder, though very small ones could escape detection by this method.

Sometimes, you can actually hear the gurgling of stomach contents (the common "growling" stomach) by listening to the chest. Large ones like this actually crowd your heart (the gray structure above the circled hernia), irritating it and even causing abnormal rhythm disorders. The dense dark material within the hernia represents lunch.

I would not advocate CT heart scans as a principal method to make a diagnosis, but sometimes it just pops up during a heart scan and we pass it on to the person scanned.

Vitamin D: New Miracle Drug

6. December 2006 William Davis (0)
At the meetings of the American Society of Bone and Mineral Research, Dr. Bruce Troen of the University of Miami detailed his views on the extraordinary benefits of vitamin D replacement. He also talked about the enormous problem of unrecognized vitamin deficiency.

“There’s a huge epidemic of hypovitaminosis D, and the real key here is not just that it’ll benefit you from a bone and neuromuscular standpoint, but if you correct hypovitaminosis D and the corresponding secondary hyperparathyroidism, then you’re going to decrease prostate cancer, colon cancer—actually “up to 17 different cancers, breast cancer included.”

Unfortunately, Dr. Troen did not talk much about the heart benefits of vitamin D, likely since the data is scant, nearly non-existent. However, if the Track Your Plaque experience means anything, I predict that vitamin D replacement will become among the most powerful tools you can use to gain control over coronary plaque.

Read the text of a report from the Internal Medicine World Report to read more of Dr. Troen's comments.


http://www.imwr.com/article.php?s=IMWR/2006/11&p=40

Heart disease "reversal" by stress test

5. December 2006 William Davis (3)

Here's an interesting example of a 71-year old man who achieved "reversal" of an abnormality by a nuclear stress test.

This man underwent bypass surgery around 10 years ago, two stents three years ago. A nuclear stress test in April, 2005 showed an area of poor blood flow in the front of the heart. On the images, normal blood flow is shown by the yellow/orange areas. poor or absent blood flow is shown by the blue/purple areas within the white outline.

Now, I can tell you that this man is no paragon of health. He's only accepted limited changes in his otherwise conventional program--in other words, someone who I'd be shocked achieved true reversal of his heart disease. (I didn't have him undergo any CT heart scans because of the difficulties in scoring someone who has undergone bypass surgery and stents, and because of limited motivation. True plaque reversal is for the motivated.)This patient did, however, accept adding fish oil and niacin to his program.

Nonetheless, stress testing can be helpful as a "safety check". Here's the follow-up stress test:
You'll notice that the blue/purple areas of poor blood flow have just about disappeared. This occurred without procedures.

Does this represent "reversal"? No, it does not. It does represent reversal of this phenomenon of poor flow. It does not represent reversal of the plaque lining the artery wall. That's because improvement of flow, as in this man, can be achieved with relatively easy efforts, e.g., improvement in diet, statin drugs, blood pressure control, etc. True reversal or reduction of coronary plaque, however, is tougher.

If blood flow is improved, who cares whether plaque shrinks? Does it still matter? It does. That's because the "event" that gets us in trouble is not progressive reduction in blood flow, but "rupture" of a plaque. A reduction in plaque--genuine reversal--is what slashes risk of plaque rupture.