Vitamins and Vascular Disease

As I stated earlier, one of the earliest observations, somewhere around the early 1930s, was that persons with the highest intakes of vitamin C had the lowest incidences of heart attacks and strokes. The more we learn about vitamin C, the more we can begin to appreciate its almost miraculous health effects. This water-soluble vitamin does a lot more than just strengthen collagen tissue and act as an antioxidant, it also plays a vital role in immunity, controls brain levels of neurotransmitters, acts as an energy source, protects the nervous system from glutamate toxicity, and has antiviral and antibacterial properties. Its role in building collagen tissue is also very important in protecting our blood vessels, since collagen gives them their strength.

A recent news story created quite a stir because it suggested the possibility that vitamin C caused atherosclerosis. Unfortunately, the news media got the facts all wrong. The article reported a study using male smokers that used ultrasound to measure the thickness of the arterial wall. Results demonstrated that subjects placed on vitamin C developed a thickening of their arteries.

There are several problems with this study. Most glaring is the fact that smokers have extremely low vitamin C levels, and as a result, develop thinning of the arterial wall caused by a loss of collagen. Because vitamin C thickened these weakened vessels, the test subjects actually reduced their risk of atherosclerosis. Furthermore, researchers did not measure atherosclerotic plaque formation or blood flow, both of which can be measured by this same technique. In fact numerous, better-controlled clinical and laboratory studies have shown that vitamin C slows the development of atherosclerosis.376

For example, one recent study followed 520 smoking and non-smoking men and postmenopausal women for three years and examined them for progression of atherosclerotic disease using an ultrasonogram to make the measurement objective.377 Researchers found that men given a combination of vitamins C and E experienced a 74 percent reduction in atherosclerosis. Other studies have shown that vitamin C improves the function of the endothelial cells within blood vessels, which greatly improves blood flow.378

Clinical studies have shown that vitamin C supplementation can reduce coronary heart disease mortality by as much as 42 percent.379 It has also been shown to be effective in cases of chronic heart failure by improving the strength and elasticity of blood vessels.

B Vitamins

Several B vitamins have also shown effectiveness in reducing atherosclerosis. A recent article in Annals of Vascular Surgery reported that vitamin B i (thiamine) protects against the early causes of atherosclerosis in cases of diabetes, a condition which is also associated with an extremely high incidence of atherosclerosis.380

One of the best-studied connections between vitamin deficiencies and atherosclerosis is with three of the B vitamins: folic acid (folate), vitamin B12 (methylcobolamin), and vitamin B6

(pyridoxine). These three vitamins are cofactors in the metabolism of methionine. If one or more of these vitamins is deficient, blood and tissue levels of homocysteine will rise. Several recent studies have shown that even modest elevation of homocysteine, even within the normal range, can significantly increase the risk of a heart attack, stroke, or peripheral vascular disease.381 Smoking, obesity, inactivity and stress can all increase homocysteine levels. Homocysteine is an independent risk factor, possibly having more importance than cholesterol levels.

Deficiencies of these three vitamins are very common in the elderly, reaching an incidence as high as 80 percent in carefully done studies of normal elderly.382 One of these three vitamins may have an additional benefit in preventing atherosclerosis, long before the first pathological signs begin to appear. In 1949 two researchers named Rinehart and Greenberg found they could reproduce atherosclerosis in monkeys simply by maintaining them on a diet deficient in vitamin 1*6 for two-and-a-half years. Unfortunately, since scientists at that time were unable to explain why this could result in atherosclerosis, they did what leading scientists have always done: they simply ignored it. Besides, cholesterol had just arrived on the scene and seemed to offer a far more direct connection.

In the early 1980s Dr. C. I. Levene, a pathologist with the Department of Pathology, University of Cambridge, England, read the 1949 study and found a possible explanation of the effect.383 He already knew that atherosclerosis tends to occur at places of maximum stress in arteries, and discovered that a weakness occurred at these stress points because collagen and elastin had not developed properly.

It seems that the strength of collagen and elastin, the substances that gives strength and elasticity to blood vessels, requires a cross-linking process for full development. This molecular bridging utilizes an enzyme, lysyl oxidase, that requires vitamin B6 for it activity. A B6 (pyridoxine) deficiency leads to a weakening in the blood vessels so that increased stress at arterial branching points and sharp curves leads to small tears in the wall of the vessel. This increases the likelihood of accumulation of oxidized LDL cholesterol, and explains why atherosclerosis is more severe at places of high-flow stress. It also explains why people with hypertension have higher rates of atherosclerosis.

Dr. Levine noted that during pregnancy, the physiological requirements for vitamin B6 increase greatly, leading to a high incidence of vitamin Bg deficiency in the mother as well as the child. This would explain the presence of early changes of atherosclerosis found in infants and small children. Deficiency in pyridoxine has also been shown to interfere with the conversion of alpha-linolenic acid (flaxseed oil) to EPA and DHA, especially affecting DHA production. These oils play a major role in preventing atherosclerosis.

Deficiencies in vital antioxidants, and an increase in free radicals and lipid peroxidation products, have been found to worsen as the damage to the heart increases. One study of twenty patients with heart failure found that as heart-failure rates increase, the levels of markers for lipid peroxidation and the superoxide radical also increased significantly. At the same time, critical antioxidant enzymes, such as catalase, glutathione reductase, and super-

oxide dismutase (SOD) decreased. This creates a very dangerous situation that will eventually lead to a heart attack or stroke. When a group of these heart failure patients were given vitamin Bg, all of these factors markedly improved.

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