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Arterial plaque

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10 Nov 2010 15:37 #5346 by loquat1
loquat1 created the topic: Arterial plaque
Hi Doc,

Long time no speak. I have several questions 4 u, but 4 now will just confine myself 2 this one.

Is there any evidence, anecdotal or empirical, that fasting removes plaque build-up from arterial walls, or repairs the damage to arterial walls caused, 4 eg, by inflamation?

Thx,
Costas

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10 Nov 2010 15:55 #5347 by TheFastDoctor
TheFastDoctor replied the topic: Re: Arterial plaque
As always your posts and questions are excellent, dear loquat! The only objective evidence I have of plaque mobilization is the increase in cholesterol (particularly LDL) during the first week of a fast, followed by a decrease later. The same hold for short fasts: Increase during the first few, then a decrease. The only rational explanation is that deposits are mobilized and when there are no more to mobilize, the serum level drops.

It would be unethical to expose a patient to the risk of (coronary) angiography just to test this hypothesis.

Concerning inflammation, the general measures of inflammation like CRP and ESR (Sedimentation rate) does decrease meaninfully during a fast but once more the limitation is that we cannot identify the specific site with these general tests.

Thus we will for the foreseeable future approach fasting with a reasonable serving of faith..

André

All my posts are "generic", based on my opinions and experiences only and are not intended to replace the advice of your own licensed medical practitioner.

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10 Nov 2010 16:20 #5348 by loquat1
loquat1 replied the topic: Re: Arterial plaque
Wow, that was fast. & thanks 4 the compliment - u r 2 kind.

A supplementary ?'n if I may. If your hypothesis is correct, does that 'mobilised' plaque not represent a threat to life & limb, 4 eg, in the form of a TIA or coronary attack?

Thx,
Costas

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10 Nov 2010 17:01 #5350 by TheFastDoctor
TheFastDoctor replied the topic: Re: Arterial plaque
Thanks for the thanks.

Indeed if a piece of plaque breaks off, it can cause a thrombosis, (TIA or even real stroke), etc.. but during fasting, the plaque is not PHYSICALLY moved.. it is slowly DISSOLVED.. and the part in contact with the blood is dissolved first. Thus it is unlikely that the plaque will become unstable from this activity, as its base should remain firmly embedded in the blood vessel wall.

Sure this hypothesis is theoretical but it is at least better than leaving the plaque where it is, as it tends to "grow" in time and cause either spontaneous embolization (Break off into the blood stream) or complete obstruction of the blood vessel..

André

All my posts are "generic", based on my opinions and experiences only and are not intended to replace the advice of your own licensed medical practitioner.

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12 Nov 2010 17:58 #5357 by Meditating
Meditating replied the topic: Re: Arterial plaque
FAST DOCTOR:

I certainly do hope your hypothesis is true.

Two questions:

1) Why do you suspect the plaque is dissolved rather than dislodged?

and

2) Are there any circumstances under which initiating a fast would cause the liver to surrender more cholesterol into the bloodstream?

Thanks,
Meditating

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12 Nov 2010 21:02 #5358 by loquat1
loquat1 replied the topic: Re: Arterial plaque
Hmmm, %ing follow-up Meditating. I'd b %ed in Doc's reply 2 those as well, but I suspect this is not an exact science. I also have a further ?'n 4 the good Dr, if I may piggy-back on yours:

Granted that it would b unethical/risky to employ invasive surgical procedures just 2 determine the levels of 'furring' pre & post fasting, could a non-invasive technique such as an ultra-sound doplar scan of carotid flow not b used 2 good effect in this situation? Or is the implication that any reduction of furring would b so marginal that it could not b detected by such a scan?

Thx again,
loquat1

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13 Nov 2010 01:57 #5365 by TheFastDoctor
TheFastDoctor replied the topic: Re: Arterial plaque
Excellent questions, Meditating.. I'm not sure I'll be able to answer amply.. but let's try:

1. I have administered fasting over 34 years with an average of 30 patients in attendance and there were no heart attacks or stroke.. that's about 1000 patient-years without such incident. Now many of these patients must have had plaques (plain statistically).. Also, during fasting, the blood per se becomes cholesterol-absorbent as other parts of the body sends out signals that it needs energy. The blood flows over the SURFACE of the plaques, not their bases.. where it can be dissolved. The bases is approached slowly and from the surface, thus should not dislodge.

2. ALL fasting causes the liver to surrender cholesterol to the circulation, thus depleting the "stores" of cholesterol from the liver itself. As you are not supplying raw material to the liver it cannot make new cholesterol.. and your body needs at least some form of energy.

Andre

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13 Nov 2010 02:02 #5366 by TheFastDoctor
TheFastDoctor replied the topic: Re: Arterial plaque
Yes Loquat, I would have liked to have a more accurate measure of plaques during fasting. But at least I have had a few patients who no longer needed their bypass operations.. anectodal evidence, I agree, but placebo controlled double blind studies are unfortunately out of the question in this context.

I would LOVE to have access to doppler of the carotids in a meaningful number of patients on this regime, but it is unlikely we'll raise the finances for that.. not really in the interest of the pharmaceutical industry, where most sponsorhips come from! Perhaps an open minded academic institution, not in the pockets of big pharma, might be willing to do just this. Let me know if you find one!

Ultrasound/doppler is becoming more sensitive by the day, and hopefully soon it will be adequate to demonstrate this.

André

All my posts are "generic", based on my opinions and experiences only and are not intended to replace the advice of your own licensed medical practitioner.
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13 Nov 2010 04:23 #5367 by Meditating
Meditating replied the topic: Re: Arterial plaque
FAST DOCTOR:

I asked my previous second question wondering if there was something else that perhaps spiked when a fast began that would cause the initial rise in blood cholesterol. Is there any reason that you can think of that might involve what the liver is doing?

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13 Nov 2010 10:08 #5371 by TheFastDoctor
TheFastDoctor replied the topic: Re: Arterial plaque
I did consider that's what you meant, was not sure, dear Meditating. Yes it is possible that upon entering the fast, the liver might "round up" the last HMG-CoA available and turn it into cholesterol, "stocking up" for the expected fast.

But this would be unlikely as there is no specific function (other than energy) for more cholesterol being available during a fast. And other fats are as good if not better.

André

All my posts are "generic", based on my opinions and experiences only and are not intended to replace the advice of your own licensed medical practitioner.

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