Your enlarged aorta

27. August 2010 William Davis (19)
The thoracic aorta lives happily within the chest.

The aorta is the main artery of the body that emerges from the heart, located just under the sternum. It is the "tree trunk" from which all the major arteries branch off to the rest of the body: the arms, brain, abdominal organs, pelvis, and legs. The aorta receives the high-pressure blood ejected directly out of the heart muscle.

However, there are evil forces in the body that work to weaken the aorta. When the aorta is weakened, it enlarges. Enlarged aortas also tend to grow atherosclerotic plaque. Plaque in the aorta poses long-term risk for stroke and and mini-strokes ("transient ischemic attacks," or TIAs), due to fragmentation.

There are many enlarged aortas in this world. I see at least several every week. It is fairly common, particularly in people with high blood pressure and cholesterol abnormalities, as well as those who are overweight. Smokers get it really bad.

Conventional thinking is that, once an aorta enlarges, it will inevitably continue to enlarge at the average rate of 2.0 mm per year (resulting in 1.0 cm enlargement over 5 years). For this reason, conventional discussions on the topic of thoracic aortic aneurysms all say something like "Enlarged aortas should be monitored yearly. Surgical replacement should proceed when the aorta reaches a diameter of 5.5 cm."

This is because an aortic diameter of 5.5 cm is associated with much greater likelihood that the aorta will rupture (fatal within minutes) or the internal lining will tear, a "dissection." The surgery is a major undertaking that involves opening the chest and usually replacing the aortic valve and inserting a synthetic aorta. The procedure is high-risk, especially if any branch arteries are involved.

So putting a stop to any further aortic enlargement is a worthwhile goal. Unfortunately, conventional thought is that there is nothing you can do to stop the inevitable growth of the thoracic aorta.

Nonsense. There are a number of efforts you can make to halt further increase in aortic diameter. (My experience in this is anecdotal and unpublished, but now numbers several hundred patients.)

There are two categories of factors that cause the aorta to increase in diameter:

1) Internal pressure--Think of blood pressure as the internal inflating pressure on this "balloon." Keeping the "inflating pressure," i.e., blood pressure, low exerts substantial effect on slowing growth of aortic diameter. I aim for normal BP or lowish BP (less than 130/80, preferably 100/70).

2) Factors that weaken the aortic wall--Processes like inflammation, glycation, lipoprotein deposition, and nutritional deficiencies will serve to weaken the supportive tissue of the aorta. For that reason, correction of lipoprotein abnormalities (e.g., small LDL and lipoprotein(a)), reductions in carbohydrate intake and thereby blood glucose/glycation, and "normalization" of vitamin D, vitamin C supplementation (for collagen crosslinking), and omega-3 fatty acids all play a role.

To push even farther, there may be additional advantage to following strategies that impair the production and activity of a crucial enzyme that lives within the aortic wall: matrix metalloproteinase, or MMP. MMP degrades the collagen and other supportive tissues within the aorta, weakening it and permitting expansion. Blocking MMP may prove to be among the most powerful new strategies to halt aortic expansion.

Compounds that have potential MMP-inhibiting effects include:
--Vitamin D--A substantial effect
--Resveratrol--One of the polyphenols from red wine
--Doxycycline--This old antibiotic often used for acne treatment has, in preliminary studies, shown important MMP-blocking effects and slowed aortic expansion.

Anyway, there you have it. A bit complicated, but a "recipe" that has failed me only rarely.
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Comments (19) -

  • Kathryn

    8/27/2010 4:26:39 PM |

    These days, with the results of stats from the "gold standard" of testing (which i have seen first-hand & is not as impressive as they claim), i'd much prefer "anedotal" evidence of several hundred patients than to trust the spin of statistics from a drug company.

  • Judy B

    8/27/2010 4:47:18 PM |

    Another good article!  Of course, mainstream medicine will pooh=pooh that.  One has to take drugs!

    KevinMD has a new post that I found very disheartening.  Dr. Eric Van de Graaff has written a glowing recommendation of statin therapy.  He totally dismisses the question of side effects and the dangers of these drugs.

    Will the truth ever come out?

  • Anonymous

    8/27/2010 4:59:05 PM |

    Interesting post.

    But "evil forces in the body"?  Forces, factors, dynamics to be sure, to be sure, but I thought "evil forces" went the way of "bad humors" in medical jargon.... Wink

  • Anonymous

    8/27/2010 5:17:45 PM |

    Do you use conventional bp meds to lower blood pressure?

  • davide

    8/27/2010 5:54:25 PM |

    Dr. Davis,

    Interesting post. I have heard that pine bark extract (opc's)or grape seed extract powerfully binds with collagen to make endothelial tissue, artery walls, etc. more resilient and elastic. Studies actually have found this to be true. Have you heard about this?

  • Pasi

    8/27/2010 6:15:21 PM |

    What about athletes aortas ? Dosn't they also enlarge

  • Anonymous

    8/28/2010 10:05:45 AM |

    Thanks for this.  My dad died of an aortic aneurysm so it's good to know how I can encourage others to avoid that fate.

    You mention glucose and I was thinking of how fructose might also affect the aorta.  I've just watched Dr Lustig's talk on Sugar the bitter truth, particularly targetting high fructose corn syrup.  As I understand it, the different method of entering and interacting within the liver from glucose makes it particularly lethal.

  • ben

    8/28/2010 1:37:03 PM |

    was that you that i heard on Dr. Su's podcast?

  • Anonymous

    8/28/2010 1:44:24 PM |

    Are there any symptoms of a enlarged aorta one could look out for?

  • Jim Sutton

    8/28/2010 2:56:23 PM |

    Thanks for another informative post, Dr Davis.

    I also read the "Van de Graaff has written a glowing recommendation of statin therapy" mentioned by JudyB, and it concludes with this statement:

    "* Remarkably, there are numerous so-called experts who call into question the linkage between cholesterol and heart disease and their websites can be easily found.  The research that implicates cholesterol in vascular disease—starting with the seminal Framingham Heart Study  in the 1950s—is about as ironclad as any concept we have in modern medicine.  Those who can’t get on board with the lipid hypothesis would likely have been the same ones to reject the earth-is-round theory."

    The article can be found at http://tinyurl.com/2dm39en

    Dr Davis, would you be so kind as to give us your take on what Dr VdG has said about cholesterol, the Framingham study, etc?

  • Lub Dub

    8/28/2010 4:57:34 PM |

    Why is resveratrol part of the "recipe"?  Are there studies, preliminary or otherwise, showing an effect on MMP?

  • Kevin

    8/28/2010 5:33:46 PM |

    I don't take statins although my doctor recommended one because my cholesterol was 280.  For other reasons I've been taking an OTC medication called Beta-sitosterol for over a year.  When I donated blood last month the free cholesterol test showed mine was down to 190.  I want to quit the beta-sitosterol because of side effects.  

    I am following a lowcarb diet and trying to not eat wheat products.

    kevin

  • Anonymous

    8/29/2010 9:09:24 AM |

    milk dr. davis i hope you take that up soon Smile

  • Anonymous

    8/29/2010 7:54:21 PM |

    Placebo controlled study finds no benefit for EPA/DHA:

    http://www.reuters.com/article/idUSLDE67S02520100829

    Was the dose (400 mg) too low?

  • Geoffrey Levens

    8/29/2010 8:36:38 PM |

    "I am following a lowcarb diet and trying to not eat wheat products."

    “Do or do not... there is no try.”
    ~Yoda

    ;)

  • Pal

    8/30/2010 8:39:35 AM |

    i would like to point out additionally that vaccinations start the cascading events of neuro degenrative problems like autism and later dementia or cancer and also heart related problems which this site is trying to address, IBS/heart conditions, digestion problems from gluten and other conditions have their root in vaccines and create further damage through a poor diet.

    id urge doctor davis to take a wholistic view of this situation from the start (vaccines) of life.

    goodluck everyone.

  • Anonymous

    8/30/2010 9:58:17 AM |

    Reference the study on "Omega 3 fails to prevent repeat heart attacks".

    This is the dumbest study I have heard about in years.

    They fed them the small amount of omega 3 in MARGARINE!! This heart stopping, artery clogging hydrogenated fat based margarine was fed to them for 40 months, what did they expect would happen other than a repeat heart attack?

    http://mobile.reuters.com/article/Deals/idUSLDE67S02520100829

  • Laura

    8/30/2010 7:23:09 PM |

    Great post, Dr. Davis. Thanks for sharing, it is always informative!

  • Kamila

    8/31/2010 1:53:22 PM |

    Some comments from Cliff Richard on the secret of "eternal youth", can be summed up as tennis, red wine, lecithin and no wheat or dairy products:

    If anyone wants to see the pics:

    http://www.dailymail.co.uk/tvshowbiz/article-1307301/Sir-Cliff-Richard-Pushing-70-hes-got-body-Young-One.html

    Sir Cliff, who turns 70 in October, peeled off for his 2011 calendar.
    He says the secret of his eternal youth is tennis three times a week, two glasses of red wine a day and a daily dose of lecithin – a supplement derived from soya beans, meat and eggs – which experts claim restricts the body’s ability to form fat.
    He has also spent three years following the Blood Type diet, which means he no longer eats wheat or dairy products.

    Winning formula: Sir Cliff peeled off for his 2011 calendar
    ‘Age is not an issue if you are lucky enough to have good health,’ he says. ‘I’ve never had any major problems and spent no time in hospital.
    ‘I heard that 60 is the new 40 so I am making 70 the new 50. If you can prolong your life and hold off death for a while, why not? I would like to play tennis for my 100th birthday and I will.
    ‘My waist measures 30in, the same as 30 years ago. And my weight is 10st 7lb.’

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Blood pressure with exercise

Blood pressure with exercise

27. April 2007 William Davis (10)
Here's a frequently neglected cause for an increasing CT heart scan score: High blood pressure with exercise. Let me explain.

Paul's blood pressure at rest, sitting in the office or on arising in the morning, or at other relatively peaceful moments: 110/75 to 130/80--all in the conventional normal range.

We put Paul on the treadmill for a stress test. At 10 mets of effort (on the protocol used, this means 3.4 mph treadmill speed at 14 degree incline), Paul's blood pressure skyrockets to 220/105. That's really high.

Now, blood pressure is expected to increase with exercise. If it doesn't rise, that's abnormal and may, in fact, be a sign of danger. Normally, blood pressure should rise gradually in a stepwise fashion with increasing levels of exercise. But any blood pressure exceeding 170/90 is clearly too high with exercise. (Not to be confused with high blood pressures not involving exercise.) A handful of studies have suggested that a "breakpoint" of 170/90 also predicts heightened risk of heart attack over a long period.)

I see this phenomenon frequently--normal blood pressure at rest, high with exercise. This also suggests that when Paul is stressed, upset, in traffic congestion, under pressure at work, etc., his blood pressure is high during those periods, as well. I wouldn't be surprised to see other phenomena of underappreciated high blood pressure, like abnormally thick heart muscle (left ventricular hypertrophy), an enlarged thoracic aorta (visible on your heart scan), left atrium, perhaps even an abnormal EKG or abnormal kidney function (evidenced by an elevated creatinine on a standard blood panel).

Unfortunately, the treatments that reduce blood pressure are "stupid," i.e., they have no appreciation for what you are doing and they reduce blood pressure all the time, whether or not you're stressed, exercising, or sleeping.

Blood pressure reduction should begin with weight loss, exercise, reduction of saturated fats and processed carbohydrates (esp. wheat), magnesium replacement, vitamin D replacement. Think about CoQ10. After this, blood pressure medication might be necessary.

The message: Watch out for the blood pressures when you have a stress test. Or, if you have a friend who is adept at getting blood pressures, get a blood pressure immediately upon ceasing exercise. It should be no higher than 170/90.
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Comments (10) -

  • Anonymous

    11/7/2007 8:57:00 PM |

    Dr. Davis,
    Sorry, this isn't about high blood pressure and exercise.  Do you believe there is a connection between high blood pressure and tinnitus?  Also, do you think that there are any vitamins or minerals that could relieve tinnitus?

  • Dr. Davis

    11/7/2007 10:02:00 PM |

    I know very little about tinnitus. However, I have seen some people get relief with niacin (immediate-release).

  • Sara

    5/5/2009 11:02:00 PM |

    Dr. Davis:

    What's the significance of blood pressure that does NOT increase with exercise? I frequently experience a slight blood pressure drop, or a slight rise in systolic but a slight drop in diastolic, even with moderately vigorous exercise; my doctor doesn't think it's a concern (he's only worried about it being high, and I run 115/75 on average when just sitting around), and I haven't been able to find anything on my own. I'd like to know more about what conditions it can signal, and that I should therefore ask my doctor about specifically.

  • blood pressure medications

    8/19/2009 9:02:48 AM |

    What's the significance of blood pressure that does NOT increase with exercise? I frequently experience a slight blood pressure drop,High blood pressure cure supplement, natural herbal remedy to lower & control high blood pressure. Use Alistrol everyday to help maintain healthy circulation and support cardio-vascular health.

  • Anonymous

    6/20/2010 8:06:42 AM |

    Just chiming in on the enzyme called serrapeptase. I have the capsules and only use it when any of my dogs get bitten by a centipede. As soon as they come into the house squirming and licking the bitten paw, I give them one capsule and w/in a few minutes, they stop squirming and licking and fall asleep. So I think it works even if the stomach acid might destroy some of it. BTW, I used to take 1000 mgs of bromelain at night before bed and once when I was taking it regularly for about a week, I took a cholesterol lab test and my results came back showing a big decrease in my LDL and Total cholesterol numbers. The only change I could think of that might have caused the decrease was taking the bromelain.

  • Brian

    9/15/2010 10:26:52 AM |

    I have the same problem as Paul. Low/Good blood pressure while sitting around, but extremely high blood pressure after/during exercising, going up stairs, playing the trumpet, etc.

    Although I understand and agree with all of the natural remedies you listed for lowering blood pressure (exercise, lower carbs, etc), why do you recommend low saturated fat intake? Are there any sources/studies that indicate that saturated fat has a direct effect on BP, and if so, that it's a bad thing? And would these studies take into account other variables such as carbohydrates and trans fats?

    Any information you have would be GREATLY appreciated! Thanks.

    Brian

  • buy jeans

    11/3/2010 3:11:53 PM |

    Blood pressure reduction should begin with weight loss, exercise, reduction of saturated fats and processed carbohydrates (esp. wheat), magnesium replacement, vitamin D replacement. Think about CoQ10. After this, blood pressure medication might be necessary.

  • Brian

    11/3/2010 3:31:04 PM |

    I can understand the weight loss, exercise, and reduction of carbs (although not just processed, IMO) as well as magnesium and Vitamin D supplementation, but why the lower saturated fat? If you're trying to link lower sat fat intake to weight loss, I'd have to ask for a good source of information before I would believe you. In my practical experience in weight loss, I have lost tons of weight even though lots of my calories came from fat, and fat is needed for energy.

  • Mark "High Blood Pressure Causes " Lampson

    3/26/2011 4:27:59 AM |

    Wow, I thought that to get your high blood pressure is to rest for a while. When you are from a walk or something.

  • Mark "High Blood Pressure Causes " Lampson

    3/26/2011 4:27:59 AM |

    Wow, I thought that to get your high blood pressure is to rest for a while. When you are from a walk or something.

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