Originally published on Jeffrey Dach MD
Aged garlic shows promising effects on reducing elevated coronary calcium scores while also acting as a gut-friendly antimicrobial
How to Reduce Calcium Scores
Jim has an elevated coronary calcium score in the 95% percentile indicating high risk for future heart attack. He is being treated by his cardiologist with daily aspirin and atorvastatin (lipitor), a statin drug to reduce cholesterol.
Currently we are following a number of similar patients with elevated coronary calcium score treated with statin drugs by their cardiologist. The elevated calcium score indicates higher risk for future coronary event such as chest pain, angina, heart attack etc. Current cardiology dogma dictates treatment with statin drugs to lower cholesterol, thus preventing heart disease.
Cholesterol Theory has Been Falsified
The problem with this cardiology dogma is the cholesterol theory of atherosclerotic disease has been falsified by many studies which are summarized nicely by Dr. William R Ware from the University of Ontario. Dr. Ware's fine article in Medical Hypotheses 2009, reveals there is no correlation between serum cholesterol and the amount of atherosclerotic plaque when reviewing either autopsy studies or coronary calcium score studies.(9) Thus, the theory that elevated cholesterol causes atherosclerotic plaque is essentially falsified.
Statin Drugs Disappointing for Calcium Score
Two randomized trials using statin drugs to reduce calcium scores showed disappointing results.(10,11) Above Image CAT scan showing calcified coronary artery (yellow arrow).
In Dr. Houslay's trial published in Heart 2006, 102 patients were randomized and treated for two years with either 80 mg/d atorvastatin (lipitor) or placebo.(10) As expected, the statin treated group had a 53% reduction in LDL cholesterol, while the placebo group had no change in theirs. The researchers were expecting benefit from the statin treatment. They found the opposite. Paradoxically, the statin group had greater increase in calcium score (26%) than the placebo group (only 18%). The authors concluded:"statin treatment does not have a major effect on the rate of progression of coronary artery calcification."(10)
The second trial by Dr Schmermund in Circulation 2006 randomized 471 patients with no pre-existing coronary artery disease, treated for one year with either low dose (10mg/d) or high dose (80 mg/d) atorvastatin therapy. In the high dose group (80 mg/d) the LDL cholsterol was reduced from 106 to 87 mg/dL (approximately 20% reduction). However, the low dose statin group had no change in LDL cholesterol from baseline (108 vs 109 mg/dL). The authors were expecting reduction in progression of calcium score in the high dose statin group with a 20% reduction in LDL cholesterol. They were surprised to find no difference in calcium scores between the two groups. The high dose atorvastatin group actually had slightly greater progression of calcium score (27%) vs (25%) for the low dose group. The authors concluded,"Coronary artery calcification (CAC) progression showed no relationship with on-treatment LDL cholesterol levels." (11)
According to Dr. Gill in a 2010 report: as of the year 2010 there had been five randomized controlled studies showing that statin drug treatment does not reduce coronary calcium score. Worse, the statin treatment showed progression of coronary calcium score indistinguishable from the non-treated placebo group.
What Interventions Have Been Successful in Reduced Calcium Score ?
As we can see from the above studies, statin drugs are quite effective for lowering cholesterol, yet fail to reduce or slow progression of calcium score. Again, this provides even more evidence falsifying the cholesterol theory of atherosclerotic heart disease. Perhaps we should look elsewhere for a treatment modality in the patient with elevated calcium score. Left image courtesy of Matthew J Budoff MD and OCWeekly Magazine.
Dr. Matthew J Budoff did just this, exploring the use of Aged Garlic in retarding progression of calcium score in three studies. (1-3)
In the first study published in 2006 Journal of Nutrition, twenty three "high risk" patients maintained on a stable dose of statin drug and aspirin were randomized to either placebo or 4 mL of Aged Garlic (1200 mg KYOLIC Aged Garlic Liquid) After one year of treatment, the Aged Garlic group showed a 7.5 % progression of calcium score, considerably lower than the 22.2% progression in the placebo group. (1) Remember that both groups were maintained on statin drugs during the one year study.
In the second study by Dr Budoff published in Preventive Medicine 2009, sixty five "intermediate risk" patients, all maintained on statins, were randomized and treated for one year with either placebo or Aged Garlic Extract (250 mg). (2) In addition, the garlic group was vitamins: Vitamin B12 (100 microg), folic acid (300 microg),Vitamin B6 (12.5 mg) and l-arginine (100 mg) . (The product used was: Kyolic 108 Aged Garlic by Wakunaga) After one year of treatment, the Aged Garlic Group had significantly less Coronary Artery Calcification progression (6.8%) compared to the placebo group (26.5%). (see Table 2, Budoff Preventive Medicine 2009). In addition the Garlic Group had "favorable improvement in oxidative biomarkers and vascular function"(1)
Above Image: Fig 2 showing Aged Garlic Group left and placebo right. Aged Garlic Group(left bars) shows lower progression of calcium score (blue bar), reduction in IgG IgM MDA LDL, IC/apoB oxidative bio-markers and reduction in Homocysteine (red bar) compared to placebo (right). Courtesy of Aged garlic extract retards progression of atherosclerosis Budoff Preventive medicine 2009 .
A third study by Dr Matt Budoff in the 2012 Journal of Cardiovascular Research randomized 65 firefighters to one year treatment with either Aged Garlic plus Co-Q-10 (Kyolic Aged Garlic-Co-Q10 Formula 110, Wakunaga ) or to placebo. (3) Some were taking statin drugs. About 25% of the Aged Garlic+CoQ10 were on statins, compared to 31% of placebo group were on statins.
After one year of treatment the aged Garlic group showed less progression of calcium score (32 vs. 58 absolute) and (18.9% vs 27.4%). CRP was also lower in the Garlic group. See Above Image :Table One courtesy Budoff 2012 (3).
Additional Benefits of Garlic
In a 2013 study by Dr. Kumar, Garlic was found beneficial as an adjunct to Metformin 500 mg twice a day (BID) in obese diabetics.(12) Garlic lowers blood pressure has been found useful in hypertensive patients.(13) In addition, Garlic has anti-microbial properties and has uses as an anti-microbail agent (4-8).
Garlic Reduces Calcium Score Progression, Mechanism of Action
My previous article discussed the failure of the cholesterol hypothesis, and recent revelations about atherosclerotic plaque as infected biofilm, and the association with increased gut permeability, also called "Leaky Gut". This would certainly explain our somewhat paradoxical findings in the three studies by Dr Matthew Budoff showing Garlic more effective than statin drugs. A natural antimicrobial agent, the lowly Garlic bulb, shows ability to retard progression of calcium score while the high and mighty statin drug fails, even though cholesterol is reduced.
Garlic as Anti-Microbial
Although various mechanisms have been proposed to explain the benefits of Garlic in cardiovascular disease, I would like to concentrate on Garlic as an anti-microbial agent.(4-8) Unlike conventional antibiotics which may disrupt the normal intestinal flora, Garlic's antimicrobial properties act against pathogenic gut bacteria with relative sparing of the beneficial, "friendly" gut bacteria.(4) Dr Bayan in 2014 says: "garlic exerts a differential inhibition between beneficial intestinal microflora and potentially harmful enterobacteria"(4) Dr Rees studied Garlic's antimicrobial activity finding broad spectrum activity against "many bacteria, yeasts, fungi and virus. All microorganisms tested were susceptible to garlic."(5) Dr Filocamo in 2012 studied Garlic in a bacterial population representative of the colonic microbiota. Lacto-baccillus was more resistant to Garlic compared to the Clostridial which was was more susceptible. The author suggested the "consumption (of garlic) may favor the growth of these beneficial bacterial species in the gut. Garlic intake has the potential to temporarily modulate the gut microbiota."(6) A full discussion of the antimicrobial spectrum of Garlic can be found in an excellent article in 2015 by Dr Packia Lekshmi (7) Mark Slevin's 2012 article reported on natural products with vascular protective properties and significant anti-atherogenic potential. Dr Slevin mentions Aged Garlic, Resveratrol and Green Tea extract (ECGC ) as the most promising (8)
Pseudomonas BioFilm in Atherosclerotic Plaque Material
Dr Bernard Lanter studied athersclerotic plaque specimens, identifying Pseudomonas 16S rRNA genes in 6 of 15 cases, indicating colonization by Pseudomonas biofims. (14) The virulence of Pseudomonas is attributed to Quorum Sensing, the ability of the bacterial cells to communicate with one another to form Bio-Films. (16) Dr. Bjarnsholt considers disruption of this Quorum Sensing to be the key to controlling Pseudomonas Biofilm infections. That is exactly what Garlic does. In Vitro and In Vivo animal studies show Garlic inhibits quorum sensing and virulence of Pseudomonas. (15) An excellent way to study the effect of Allicin, the active ingredient in Garlic, on the Pseudomonas organism is to tag the bacteria with the Green Flourscent Protein (GFP). This was done published in the 2013 with an elegant series of in-vitro experiments using Allicin treated GFP-modified Pseudomonas organisms.(17) Dr. Lihua's group showed that:
Allicin treatment not only reduced the adhesion ratio of P. aeruginosa, but also inhibited EPS (extracellular polysaccharide) secretion and down-regulates production of some Quorum Sensing -controlled virulence factors. These results imply that allicin can disturb the formation and
maturation of P. aeruginosa biofilm, and suggest that allicin may represent a promising therapeutic candidate for the management of P. aeruginosa biofilms.(17)
Poly-Microbial Colonization
Others have found diverse colonies of bacterial, fungal and protozoal life-forms colonizing biofilms in atherosclerotic plaque specimens (18-20), In view of this, investigating other botanical agents with known antimicrobial activity might also be useful, such as Olive Leaf extract, Oregano Oil, Berberine, etc. Perhaps a combination of such natural products would have a more powerful synergistic effect. Other natural anti-microbials such as colloidal silver, and Iodine should be considered as well. This would be a fertile area for future research.
Our program for Elevated Calcium Score:
Aged Garlic,
Co-Q-10,
L-Arginine
Reveratrol, Pterostilbene
Homocysteine reducing program (B6, B12, Methylfolate)
LinusPauling Protocol (Lysine, Proline, Vitamin C, Tocotrienols)
William Davis Track Your Plaque Protocol (Niacin, Omega-3 Fish Oil, Vitamin D3, Vitamin K2, Eliminate Wheat products)
Weight Reduction,
Hormone Optimization (optimize thyroid, testosterone, estrogen progesterone)
Heal the Leaky Gut (Probiotics, Glutamine, Colostrum)
Eliminate NSAIDS, PPI's which cause dysbiosis and leaky gut.
Eliminate Pesticides, Glyphosate and GMO food, eat Organic.
Articles With related Interest:
Atherosclerotic Plaque as Infected Biofilm
Preventing Heart Attacks with Ouabain
Thyroid Pills Prevent Heart Attacks
How to Reverse Heart Disease with the Coronary Calcium Score
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Sign in to commentGarlic Reduces Plaque in Genetically Modified Mice
Garlic and Atherosclerotic Plaque Regression – Ayelet Gonen
Above image Fig. 1. Allicin reduced the atherosclerotic lesion area in aortic sinus. Stained sections showing plaque (red arrows) from apoE knockout mice (A Allicin treated, B placebo treated) Courtesy of Antiatherogenic effect of allicin Pathobiology 2005 Gonen.
Future Research
As mentioned above, independent researchers have found polymicrobial organisms colonizing biofilms in atherosclerotic plaque.
One question I have is this: Why not conduct a series of experiments using these same techniques to look for infected biofilms in the atherosclerotic plaque material in animal models of atherosclerosis ? Perhaps the Institute of Lipid and Atherosclerosis Research might share mouse plaque specimens with the labs of Drs. Fry, Lanter and Ott. This could answer important questions. What is the timing of the infection in the plaque? Is infection a prerequisite for plaque formation. Does infection seed the plaque later ? Exactly when in the life cycle of the atherosclerotic plaque does the infection occur? Is the explanation for Garlic as a preventive agent due to preventing LDL oxidation and inhibiting macrophage uptake as Dr Gonen speculates ? Or does infection also play a role in these supposedly “pristine” animal models of knockout mice genetically bred to form atherosclerosis ? These and other question could be answered by studying plaque from animal models using the 16s RNA cloning and flourescent imaging techniques used in Dr Lanter, Ott and Fry’s labs.
jeffrey dach md