The U.S. Preventive Services Task Force in a draft statement has reaffirmed against carotid artery screening in patients that do not have symptoms. Is this a bad idea?

Their laudable rationale is that risk of death and stroke from surgical repair of carotid blockage is not warranted except in those who have severe carotid obstruction coupled with stroke-like symptoms. Medical therapy for carotid stabilization has also improved. As far as this goes, their logic is on target.

But there is a bigger picture. Artery disease is potentially reversible. And incentives for reversing it are much higher when there is known blockage.

Conventionally artery disease, whether coronary or carotid (the neck artery), is not recognized as being reversible. This is despite definitive published proof by Cleveland Clinic’s Caldwell Esselstyn, Jr. M.D., meticulously explained in his excellent book Prevent and Reverse Heart Disease. As demonstrated definitively, in those with severe coronary artery disease where cardiologists and cardiothoracic surgeons had failed, Dr. Esselstyn succeeded using a very strict vegan no-fat diet.

What causes carotid artery disease? Hypertension is the biggest factor. But it’s control has been applied overzealously. When prescription medicine reduces blood pressure to the 110-120 range, for every stroke prevented, two heart attacks are triggered. A review by the highly respected Cochrane collaboration found that due to side effects of prescription drugs, they are not warranted until systolic blood pressure reaches 160. Nevertheless, target systolic blood pressure at 120-125 utilizing nutrition, lifestyle, and nutrient support for optimal protection from heart attack and stroke; a blood pressure of 135 doubles risk relative to 115.

Is carotid disease reversible? Preliminary research indicates indeed so. Statin cholesterol medicine has been very disappointing, with at most 1% reversibility. In essence, prescriptions have failed. But nutritional approaches offer much promise.

Prevention is the top priority. Artery disease is triggered not only by hypertension and high cholesterol, but also by heavy metals, inflammation, genetic mutations, nutritional and hormonal imbalances. Mercury amalgams in teeth are a major concern for the adjacent carotids. Lead is an equivalent risk factor to cholesterol.

Food sensitivity is the primary cause of inflammation in our clinical practice, followed by a high estrogen/testosterone ratio. Anti-inflammatory and detoxifying glutathione deficiency resulting from toxins, genetic mutations, and vitamin D and B deficiencies associated with a high homocysteine (we find >7 a problem), is crucial.

Appropriate evaluation of carotid disease in our clinical experience requires assessing IgG food sensitivity, micronutrients, heavy metals, hormones, and genetic mutations, especially those impacting methylation and detoxification, lipoprotein (a), and LDL cholesterol oxidation. Side effects of fixing these problems include less Alzheimer’s disease, cancer, osteoporosis, and depression – my type of side effects!
A favorite nutrient may ultimately be the best carotid disease reverser – pomegranate. Preliminary research showed 30% reversal drinking 8 oz. of POM daily for a year. A patient at our practice has reversed carotid disease with pomegranate and diligent nutrition. Side effects in males: higher testosterone, improved coronary artery flow, less diabetes, and improved erectile function – tolerable for most of us males! It absolutely has to be taken six hours apart from prescription medicine as it inhibits drug metabolism. We much prefer getting it in pill form from a quality source, as pomegranate juice has high sugar content.

So carotid screening? Bring it on! does a nice economical screening – check online or watch for their annual screening at neighborhood churches.

Jim Roach, MD, ABIHM, ABFM