For years, I followed what I thought was the “right” lifestyle—low-fat diets, marathon running, and avoiding medications or supplements. But despite all my efforts, I discovered that I had arterial plaque, the precursor to heart attacks and strokes. The realization hit hard, but it also set me on a path to reversing 20 years of plaque buildup and reclaiming my cardiovascular health.
This is my story of how I identified and reversed my arterial plaque, and the steps I took to stabilize my risk for good.
The Wake-Up Call
At age 57, I was shocked to learn that my arteries had more plaque than those of an average 73-year-old. I had always believed I was healthy—teaching preventive medicine at Johns Hopkins, running marathons, and following a low-fat diet. But when I underwent a Carotid Intima-Media Thickness (CIMT) test, it revealed significant plaque in my arteries.
The realization that my healthy habits weren’t enough was devastating. What would my health look like if I hadn’t exercised and eaten well? Could I already have had a heart attack? These questions drove me to dig deeper into my metabolic health.
What I Learned About Arterial Plaque
Heart attacks and strokes are often associated with plaque buildup in arteries, but the reality is more complex than the idea of “clogged pipes.” Plaque doesn’t simply coat the inside of your arteries like grease in a drain. Instead, it forms between specific layers of the arterial wall, with distinct stages of stability and risk.
How Plaque Forms in the Arteries
- Location Matters: The Intima and Media
The arterial wall consists of multiple layers, but two are most relevant for plaque formation:
- Intima: The innermost layer that interacts with blood, responsible for regulating metabolic exchanges like oxygen delivery and waste removal.
- Media: A muscular layer that helps the artery expand and contract to maintain blood flow.
- Plaque forms between the intima and media, not on the inner surface as many assume. Small, dense LDL cholesterol particles seep into the intima when the arterial lining is damaged, often due to inflammation, high blood sugar, or oxidative stress. Once there, they become oxidized, triggering an immune response.
- The Danger of Soft Plaque
- Soft plaque is filled with inflammatory goo, including immune cells, lipids, and enzymes.
- This unstable plaque has a thin fibrous cap, making it prone to rupture.
- When soft plaque ruptures, it spills its contents into the bloodstream, triggering a rapid clotting response. These clots (not the plaque itself) are the direct cause of heart attacks and strokes.
- Stabilizing Plaque Through Calcification
- As inflammation subsides, the body responds by calcifying the plaque, essentially “scarring” the area.
- Calcified plaque is more stable, with a thick fibrous cap that is less likely to rupture.
- While calcification is a sign of healing, it still indicates the presence of underlying metabolic dysfunction that requires ongoing management.
The presence of soft plaque is a much stronger predictor of cardiovascular events than calcified plaque, underscoring the importance of identifying and stabilizing soft plaque early
The Limitations of Common Diagnostic Tools
1. Stress Tests: Missing the Real Risk
Stress tests are widely used to assess heart health by measuring blood flow during physical exertion or medication-induced stress. However, they have significant limitations:
- What Stress Tests Measure: Blood flow to the heart, detecting blockages that impede circulation.
- What They Miss: Soft plaque that hasn’t yet obstructed blood flow. Since heart attacks are often caused by the rupture of soft plaque rather than blocked arteries, stress tests fail to predict most heart attacks.
2. Calcium Scores: Only Part of the Picture
A coronary calcium score (CAC) measures the amount of calcified plaque in the arteries. While helpful, it has key limitations:
- What CAC Scores Show: The total burden of calcified plaque, which reflects the body’s healing response to inflammation.
- What CAC Scores Miss: Soft, unstable plaque that is most likely to rupture and cause a heart attack.
- The Interpretation Challenge: High calcium scores can indicate either a healed, stable plaque or ongoing inflammation, making it difficult to assess risk without additional tests.
While CAC scores are valuable for detecting advanced atherosclerosis, they fail to identify individuals with high-risk soft plaque
Why Metabolism is Key to Plaque Formation
Plaque formation isn’t just about cholesterol—it’s a metabolic issue at its core. Insulin resistance and high blood sugar levels are major drivers of the inflammation that initiates and fuels plaque development.
The Role of Insulin Resistance
- Inflammation: Insulin resistance leads to chronic inflammation, damaging the endothelial lining of arteries and creating entry points for LDL cholesterol.
- Triglycerides: High insulin levels impair the body’s ability to break down triglycerides, further contributing to plaque formation.
- Impaired Healing: Insulin resistance hampers the body’s ability to stabilize and heal existing plaque, increasing the risk of rupture.
Individuals with insulin resistance were more likely to develop soft plaque, even when their cholesterol levels were within a normal range
My Personal Discovery: Prediabetes and Plaque
When I performed an oral glucose tolerance test (OGTT), my blood sugar spiked to over 160 mg/dL, a clear indicator of prediabetes. This metabolic dysfunction explained why I had developed arterial plaque despite my active lifestyle.
- What This Means: Even in individuals who exercise regularly and maintain a healthy weight, insulin resistance can silently cause arterial damage if left unchecked.
The Changes I Made
Reducing arterial plaque requires a multifaceted approach. Here’s an expanded look at the lifestyle, dietary, and medical interventions I made that helped reverse 20 years of plaque buildup, improve my cardiovascular health, and lower my heart attack risk.
1. Shifted from Low-Fat to Low-Carb Diet
Why Low-Fat Didn’t Work
For decades, I followed a low-fat diet, believing it was the gold standard for heart health. This approach limited fat intake but often replaced it with carbohydrates, which caused spikes in blood sugar and insulin—both of which are major contributors to arterial plaque formation.
Switching to Low-Carb, Whole-Foods-Based Diet
I made a significant shift to a low-carb diet, which helped stabilize my blood sugar and reduce inflammation.
- What I Avoided:
- Processed carbs like white bread, pasta, and sugary snacks.
- Grain-based products, which contribute to insulin resistance and inflammation.
- What I Focused On:
- Leafy Greens: Spinach, kale, and arugula, rich in fiber and antioxidants.
- Healthy Fats: Avocados, olive oil, nuts, and seeds for anti-inflammatory omega-9 fatty acids.
- Fatty Fish: Salmon, mackerel, and sardines for omega-3 fatty acids, which improve endothelial function and reduce inflammation.
- Nutrient-Dense Whole Foods: Foods high in vitamins, minerals, and fiber, with minimal processing.
The Results
Within a year, my Carotid Intima-Media Thickness (CIMT) score dropped dramatically. My arterial age decreased from 73 to 52, reversing nearly two decades of plaque buildup.
2. Integrated Ketosis
The Role of Ketosis in Plaque Reduction
Ketosis occurs when your body switches from burning carbohydrates to burning fat for fuel. This state reduces blood sugar and insulin levels, which are critical for preventing further arterial damage.
- How I Maintained Ketosis:
- Staying Mildly Ketotic: I limited my carbohydrate intake, keeping my body in a state of fat-burning for five days a week.
- Breath Ketone Monitoring: I consistently measured 5–20 parts per million of acetone, confirming I was in ketosis.
The Impact
Becoming fat-adapted helped stabilize my metabolic health, reduce inflammation, and lower my risk of cardiovascular events.
3. Adjusted Exercise Habits
Why Marathon Running Wasn’t Enough
While marathon running improved my cardiovascular endurance, it didn’t address the metabolic dysfunction driving my plaque formation. To better manage my blood sugar and improve muscle insulin sensitivity, I introduced:
- High-Intensity Interval Training (HIIT):
- Short bursts of maximum effort activity followed by rest.
- I included uphill sprints, which increased capillary density and mitochondria in my leg muscles, making them more metabolically active.
- Resistance Training:
- Focused on building strong leg muscles, which act as metabolic sinks for glucose and insulin.
- Exercises included squats, lunges, and deadlifts.
Why It Worked
Exercise improves insulin sensitivity, reduces systemic inflammation, and enhances vascular health.
4. Started Targeted Supplements
The Role of Supplements in Plaque Management
While I once dismissed supplements, I’ve come to understand their value in reducing inflammation, improving blood flow, and supporting overall metabolic health.
- Vitamin D3 (5,000 IU daily):
- Supports immune function and reduces systemic inflammation.
- Low vitamin D levels are linked to arterial stiffness and plaque progression.
- Vitamin K2 (400 mcg daily):
- Directs calcium away from arteries and into bones, preventing calcification.
- I also incorporated natto, a fermented soy product rich in K2.
- Magnesium:
- Helps regulate blood sugar and relaxes blood vessels, improving circulation.
- Garlic and L-Citrulline:
- Improve nitric oxide production, which enhances endothelial function and lowers blood pressure.
Scientific Evidence
A 2017 meta-analysis in Nutrition Journal highlighted that vitamin K2 supplementation reduced arterial calcification and improved vascular health
5. Embraced Medications (Cautiously)
Low-Dose Rosuvastatin (Crestor)
I started taking a low dose of rosuvastatin (5 mg two or three times a week), not to lower LDL cholesterol but to reduce cardiovascular inflammation.
- Why It’s Effective:
- Statins reduce C-reactive protein (CRP) levels, a marker of inflammation that contributes to plaque instability.
Baby Aspirin:
I added low-dose aspirin to prevent clot formation but only after confirming the presence of plaque through diagnostic testing.
The Results
These medications, combined with lifestyle changes, stabilized my plaque and reduced inflammation markers without significant side effects.
Scientific Evidence
Low-dose statins reduced cardiovascular events by targeting inflammation rather than just lowering LDL cholesterol
The Results: Reversing and Stabilizing Plaque
Over the course of several years, these changes led to:
- A CIMT score reduction from 1.2 mm to 0.67 mm.
- A decrease in arterial age from 73 to 58 years.
- Stabilized plaque that was predominantly calcified, significantly lowering my risk of heart attack or stroke.
Key Takeaways for Reducing Plaque
- Metabolic Health is Central: Focus on stabilizing blood sugar and improving insulin sensitivity through diet, exercise, and lifestyle changes.
- Diagnostic Testing is Crucial: Tools like CIMT and OGTT provide actionable insights that standard cholesterol tests miss.
- Comprehensive Approach: Combining a low-carb diet, targeted exercise, supplements, and medications (when necessary) is the most effective way to reverse and stabilize plaque.
Key Takeaways for Reversing Plaque
Reversing arterial plaque and reducing heart attack risk isn’t a simple task, but it’s achievable with a targeted, multifaceted approach. Below are the critical steps for identifying and addressing the underlying causes of plaque buildup, stabilizing it, and improving overall cardiovascular health.
1. Know Your Numbers
Relying on standard blood tests like total cholesterol or fasting glucose can miss early warning signs of cardiovascular risk. Advanced diagnostic tools provide a clearer picture of your health:
- Carotid Intima-Media Thickness (CIMT):
- Measures plaque buildup and arterial wall thickness.
- Unlike stress tests or calcium scores, CIMT can identify soft plaque, which is the most dangerous because it’s prone to rupture.
- Research in Atherosclerosis highlights CIMT as a strong predictor of future cardiovascular events, even in asymptomatic individuals
.
- Coronary Calcium Scan (CAC):
- Detects calcified plaque in coronary arteries. While it can’t measure soft plaque, it’s a valuable tool for identifying overall plaque burden.
- Oral Glucose Tolerance Test (OGTT):
- Measures how your body responds to a glucose load, identifying insulin resistance and prediabetes
- OGTT detects insulin resistance in individuals with normal fasting glucose levels
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Why It’s Important
These advanced tests reveal hidden risks that can’t be detected through standard metrics like LDL cholesterol alone. Identifying plaque early allows for targeted interventions before a heart attack or stroke occurs.
2. Address Insulin Resistance
Insulin resistance is a primary driver of arterial plaque formation. Reducing insulin resistance through dietary changes can significantly improve arterial health.
- Switch to a Low-Carb or Ketogenic Diet:
- Low-carb diets reduce blood sugar spikes and lower insulin levels, decreasing systemic inflammation.
- A ketogenic diet enhances fat metabolism, helping stabilize blood sugar and improve insulin sensitivity.
- Focus on Whole, Nutrient-Dense Foods:
- Avoid: Processed carbs, sugary snacks, and high-glycemic foods like bread and pasta.
- Prioritize: Leafy greens, healthy fats (avocados, olive oil), fatty fish (salmon, sardines), and nuts.
Scientific Evidence
Low-carb diets improved insulin sensitivity and reduced markers of inflammation, two critical factors in plaque formation and stabilization
3. Exercise Regularly
Physical activity improves insulin sensitivity, reduces inflammation, and promotes healthy blood flow, all of which contribute to stabilizing plaque and reducing cardiovascular risk.
- High-Intensity Interval Training (HIIT):
- Combines short bursts of intense exercise with rest periods.
- HIIT improves glucose uptake in muscles and reduces insulin resistance.
- Strength Training:
- Builds metabolically active muscle, particularly in the legs, which act as glucose reservoirs.
- Strong leg muscles are critical for managing blood sugar spikes and reducing systemic inflammation.
Research Support
A study in The Lancet highlighted that both aerobic and resistance training significantly reduced cardiovascular mortality, especially in high-risk individuals
4. Stabilize Plaque
Complete plaque reversal isn’t always possible, but stabilizing plaque is key to reducing the risk of heart attack or stroke. Stabilization involves:
- Reducing Inflammation: Chronic inflammation destabilizes plaque, making it more prone to rupture. Lowering inflammation helps solidify the fibrous cap over the plaque, preventing rupture.
- Promoting Calcification: Calcified plaque is more stable and less likely to cause clots.
How to Stabilize Plaque:
- Adopt a low-carb diet to reduce blood sugar and inflammation.
- Incorporate anti-inflammatory foods, such as omega-3-rich fish, turmeric, and leafy greens.
- Use medications or supplements when necessary, such as low-dose statins to reduce inflammation markers like C-reactive protein (CRP).
5. Lifestyle is King
No medication or supplement can substitute for a foundation of healthy lifestyle habits.
- Diet: Focus on low-carb, nutrient-dense foods to support metabolic health.
- Exercise: Maintain a consistent routine that includes HIIT and strength training.
- Sleep: Prioritize 7–8 hours of quality sleep each night to improve metabolic function and reduce inflammation.
- Stress Management: Chronic stress raises cortisol, which contributes to insulin resistance and arterial damage. Incorporate mindfulness or relaxation practices into your routine.
Why Lifestyle Matters Most
Reversing or stabilizing plaque requires a proactive, comprehensive approach. By addressing insulin resistance, adopting a low-carb diet, exercising regularly, and focusing on overall lifestyle changes, you can significantly reduce your cardiovascular risk and improve your long-term health.
Remember, the earlier you start, the better your results. Your heart health is in your hands—take control today.
Final Thoughts
If you’ve discovered plaque in your arteries, don’t despair. You have the power to stabilize—and in some cases, reverse—it through informed lifestyle changes and targeted interventions. Whether it’s adjusting your diet, optimizing your exercise routine, or incorporating supplements and medications, each step brings you closer to a healthier heart and a longer life.
Remember, as the saying goes: “Aging isn’t for sissies.” But with the right approach, you can age gracefully—and healthfully—while keeping your heart and arteries strong.