Recently I reviewed some blood test results going back a few years for a person who has a blood clotting disorder. Because of a past history of multiple abnormal blood clots throughout the body even while taking the dangerous anticoagulant drug warfarin prescribed by multiple doctors he’s seen, he began to doubt the doctors’ knowledge as their treatments were not working well. A comprehensive supplementation program including among other things omega 3 fish oils, anti-inflammatories such as curcumin, and proteolytics such as nattokinase, bromelain, and serrapeptase have enabled him to discontinue warfarin and avoid the clots that the warfarin treatment was not successfully stopping.
Based upon the results I examined, it appears the amla (Indian gooseberry, embilica officinalis) and Pycnogenol (brand name of pine bark extract) that he recently added to his array of supplements may be having a powerful beneficial effect on the cardiovascular and clotting risk factors measured by the C Reactive Protein (CRP) and fibrinogen blood tests. The effects appear so strong in a short period of time that I think these supplements should be tried by many people who are at risk for cardiovascular disease or abnormal blood clots. After a period of one to two months, their test results could be easily examined to see if Amla and Pycnogenol are working well as it appears they are for this man.
He was motivated to find something to lower his C Reactive Protein test results after a disturbingly high CRP test result of 6.47 mg/L. Additionally, he had been experiencing chronic pain throughout his body and read that some people with chronic pain such as osteoarthritis experience elevated CRP levels as underlying inflammatory conditions are driving their pain. This CRP result was almost double that of an already poor result of 3.73 about a year earlier when his pain levels were much less, so he suspected it might be connected. In less than a month of usage of a Life Extension product containing AmlaMax, a standardized Amla extract, he saw his CRP test result drop to 1.67 and noted some improvement in pain levels, too. As guidance, Life Extension’s optimal recommendations for CRP for men is less than 0.55 mg/L and the LabCorp reference range for men is less than 3 mg/L.
After about 17 months of using products containing amla including a switch to a higher dosage of AmlaMax at 500mg per day about a year after starting a 380mg per day dosage, his CRP test result is now down to 0.38 mg/L. However, recently his pain levels have become worse again. It is suspected this may be due to various other medical problems, notably his diagnosed adrenal fatigue, that are not directly connected to the CRP test results. This goes to show that even though chronic pain is often connected with a chronic inflammatory condition such as arthritis, sometimes its source is much more elusive and fighting the inflammation may not alleviate the pain.
The improvement in his fibrinogen tests has not been as drastic as the CRP improvements, but is still very significant. It appears that after starting to use pine bark extracts including Pycnogenol and generics that his fibrinogen tests dropped from a range of 311 to 349 mg/dL down to 229 mg/dL after about a year of using various products containing quantities of pycnogenol or related pine bark extracts. As a reference point, Life Extension’s optimal recommendations for fibrinogen are 180 to 250 mg/dL and the LabCorp reference range for the test is 193 to 423 mg/dL.
C Reactive Protein and Fibrinogen Good Predictors of Cardiovascular Disease
CRP and fibrinogen are being viewed today as strong indicators for cardiovascular disease risk. In 2006, a 10 year longitudinal study of 27,742 women was published with findings that elevated CRP and fibrinogen levels are strongly tied to cardiovascular disease risk.
Life Extension reported on these findings to their readers:
Quoted from Life Extension Update
Over the approximate ten year follow-up there were 898 cardiovascular events. Not surprisingly, both fibrinogen and CRP were associated with the risk of cardiovascular incidents. When women whose fibrinogen levels were in the top one-fifth of participants were compared to those in the lowest fifth they were found to have a 35 percent greater risk (adjusted for established risk factors) of experiencing a cardiovascular event. Similar analysis of CRP levels found a 68 percent greater risk among women whose levels were highest. Having an elevated level of both fibrinogen and CRP was associated with the greatest cardiovascular risk. Women whose fibrinogen levels were greater than 393 milligrams per deciliter and whose CRP levels were higher than 3 milligrams per liter had 3.45 times the risk of experiencing a cardiovascular event than those whose fibrinogen was lower than 329 milligrams per deciliter and whose CRP was under 1 milligrams per liter.
“Although both fibrinogen and hs-CRP were positively correlated, their combined effect provided cardiovascular disease risk information that was greater than that provided by either biomarker separately, potentially reflecting different pathophysiological processes in the development of atherothrombotic events,” the authors conclude. They remark that increased adipose tissue is associated both with a prothrombotic and proinflammatory state, which may be reflected in both higher fibrinogen and CRP levels.
You can read the full study Additive Value of Immunoassay-Measured Fibrinogen and High-Sensitivity C-Reactive Protein Levels for Predicting Incident Cardiovascular Events for free online for more details.
Discontinued Warfarin, Using Supplements Instead
Over the past three years, he’s tried a variety of changes to diet and supplement regimens to help reduce the risk of clots and to discontinue the warfarin medication after he learned it causes arterial calcification. Warfarin is a dangerous drug when used long-term as it may increase the risk of clots by clogging up the vascular system with calcium deposits and degrade bones by removing much of their calcium content. So far these changes have been successful. In the approximately 2.5 years since he stopped taking warfarin, he has had zero blood clots. This is compared to several years prior to that on warfarin and suffering at least three known clots while using the widely prescribed anticoagulant drug.
The whole story of what he’s tried to manage the blood clotting problems is quite extensive and warrants further writing. I’ll be covering more about blood clots, the danger of warfarin, and alternatives to it in the future. His full supplement regimen for countering clotting risk is probably overkill for most people who don’t have blood clotting disorders. But the benefits from the amla and pine bark extracts evident in his tests would be useful for just about everybody in their late 20’s and older, even those who have never had an abnormal blood clot. So I’ll be discussing those two supplements further in this article.
Explaining Odd Blood Test Results
The three most beneficial changes I noticed in recent blood test results were a drastic drop in C Reactive Protein (CRP), fibrinogen, and a smaller but still notable drop in HbA1C from 5.3 to 5.0. HbA1C reflects long-term blood sugar control and can also be influenced by antiglycation compounds such as carnosine and P5P, two supplements he is also taking. But this was accompanied by a moderate worsening in LDL cholesterol and triglyceride levels and a big drop in beneficial HDL cholesterol from 41 to 31. Usually you’d not see multiple of these improve substantially while others worsened to this degree, so these results at first glance appear odd.
After discussing what had changed in diet and supplements and reading up on some of the supplements dosages changed in the past year, I have a hypothesis that may explain many of these changes. This individual has a very complex health history, so there’s certainly some room for uncertainty here. He’s also made several changes in supplements, however most of these are brand substitutions or small changes in dosage patterns that I think are unlikely to create such big effects.
Here’s what changed in his diet, supplementation, and medications that seem to explain the changes in the blood test results:
- Reduced niacin supplements from about 2000mg per day (500mg per meal except dinner at 1000mg) to 1000mg per day (dinner only)
- Added niacinamide dosages typically 1500mg to 2000mg per day in 500mg dosages spread throughout day
- Discontinued a red yeast rice plus policosanol supplement due to concerns about muscle pains and possible adverse impact to an already challenged CoQ10 level
- Added IsoCort for cortisol replacement for adrenal fatigue
- Added supplements including Amla extract (brand name AmlaMax) — at first Life Extension Vascular Protect (which is no longer sold) and later a higher dosage of this in Life Extension Advanced Lipid Control
- Added various supplements including pine bark extracts such as Pycnogenol, a brand-name of French maritime pine bark extract
Niacin vs. Niacinamide
He was motivated to reduce the niacin and raise niacinamide based upon recurrent insomnia, anxiety disorders, and low energy levels. Also his liver test results were showing a mild worsening of liver function. Niacin can be hard on the liver in some people. That doesn’t appear to be the case for niacinamide. At a biochemical level, niacinamide also appears to be better able to contribute to energy-releasing reactions in the body. So the motivation for the changes made some sense.
However, I think the drop in niacin dosing from three times to one time per day probably has contributed to the drop in HDL and increase in LDL and triglycerides. Niacin is one of the very few supplements or drugs that have the effect of increasing beneficial HDL cholesterol levels. As such, it is often helpful to use it for anybody who has problems with blood lipid levels who doesn’t have a bad reaction to the supplement such as impaired liver function (especially a problem with time-release variants) or itching/flushing problems that can come from too rapidly absorbing high dosages.
Niacinamide also does not appear to have the LDL cholesterol lowering capabilities of niacin. While the body can convert between the two, it isn’t particular efficient at doing so. So while both niacin and niacinamide are often referred to as vitamin B3, they are different and you may get better results by supplementing with both in small dosages multiple times throughout the day.
I’ve suggested that he go back to taking niacin with each meal to see if that helps improve the blood lipids again. It will probably take a few months and a couple of retests to determine if this helps or not.
For most people with elevated blood lipids, I would also suggest adding L-carnitine supplements to help lower high lipids and blood glucose levels. However, he’s already taking about 2 grams of L-carnitine and acetyl L-carnitine per day in 500 mg capsules or tablets throughout the day. That’s probably enough to get good effect, especially as he is also combining them with the synergistic alpha lipoic acid in its inexpensive RS mixed form at around 1500 mg to 1800 mg per day. His blood lipid tests showed a drop in LDL cholesterol, VLDL cholesterol, and triglycerides along with an increase in HDL cholesterol corresponding to the period between when he started the carnitine supplements and when he was prescribed replacement cortisol which is discussed next.
He had test results showing very low cortisol levels prior to starting cortisol replacement therapy using IsoCort. His doctor told him he suffers from adrenal fatigue and some of his pain problems are likely due to the extremely low levels of cortisol. It’s often very hard to find the root cause for chronic pain and fatigue symptoms but hints may show up in medical tests, particularly in hormone and CoQ10 tests.
The series of test results show that there was a significant increase in blood lipids that occurred about two months after initiation of the IsoCort therapy. As cortisol is known to raise blood glucose and lipids, it’s entirely possible that without the destructively low cortisol levels he had previously that his blood lipid test results would have been even worse. I’ve suggested that he needs to have his cortisol retested to verify that his levels are in the appropriate range as high cortisol is often tied to weight gain and weight-related blood test abnormalities such as elevated lipids. Still, he’s better off with higher blood lipids and healthier cortisol levels along with more energy and less pain than being a burnt out cortisol depleted shell with healthier blood lipid levels.
Red Yeast Rice and Policosanol
Red yeast rice has some of the same active ingredients as in statin medications which are known to cause debilitating muscle pain and cognitive abnormalities probably due to very adverse impact on CoQ10 levels. As this person has experienced a variety of unusual pain conditions and has had past very low CoQ10 test results, I can understand this change. But I do note that red yeast rice appears to have a much lower risk of CoQ10 and pain related side effects than statin medications. This change could explain some of the increase in LDL cholesterol and triglycerides.
Low-Carb High Protein Diet Changes
There were also some diet changes. He’s been eating more animal proteins such as meats and cheeses after discovering multiple essential amino acid deficiencies. These could also elevate LDL cholesterol and triglycerides, too.
So in the end, I think the adverse changes in the blood lipid test results come from a combination of less niacin intake, raising the abnormally low cortisol levels, more fatty animal foods in the diet, and the discontinuation of the red yeast rice and policosanol product. Based upon what he’s said about past experiments with policosanol alone, I suspect the red yeast rice may have had more impact for him.
Benefits from Amla, Pycnogenol, and Nattokinase
As for the beneficial changes, I think these can be largely lied to the Amla and Pycnogenol supplements. Both are strong antioxidants and both have documented impact on C Reactive Protein. After examining studies on the likely effects of amla (Indian gooseberry) and Pycnogenol (French maritime pine bark), it seems like they plus nattokinase (a proteolyic enzyme) may make a powerful one-two-three punch against cardiovascular disease by lowering inflammation, clearing out blood vessels, reducing oxidative damage to lipids and cells, and lowering the amount of clot-inducing fibrinogen that in most people is far higher than they need.
I mention nattokinase for two reasons. One is that the outspoken Dr. David Williams promotes the use of amla with nattokinase to reduce abnormal clotting risk in typical aging people so if you read up on amla you’re likely to run across this discussion. A second is that these test results I’m discussing were achieved after about 3.5 years of supplementation with nattokinase along with other proteolytic enzymes such as bromelain and serrapeptase. However, the dosage of nattokinase, bromelain, and serrapeptase that he’s using today is about 33% less than the peak dosage of about six months to a year ago when the CRP and fibrinogen levels were much higher. In fact he had experimented with increasing nattokinase, bromelain, and serrapeptase in order to lower CRP and fibrinogen but it didn’t seem to be having much effect. But adding amla and Pycnogenol with a somewhat lower dosage of nattokinase, bromelain, and serrapeptase seems to have accomplished much more beneficial results.
The results from before the amla and Pycnogenol but with nattokinase, bromelain, and serrapeptase showed CRP readings of 3.73 and 6.47. Fibrinogen results from around the same period were 361, 374, and 349. After about a month of using the Life Extension Vascular Protect formula, CRP was down to 1.67 and fibrinogen was 292. Several tests after that showed similar or improving results of 1.75, 0.88, and 0.71 mg/L for CRP and 311, 274, and 293 mg/dL for fibrinogen.
Then he introduced the Pycnogenol. So far there has been one more set of test results after about half a year of using various Pycnogenol or pine bark extract products. The latest CRP was 0.38 mg/L and the latest fibrinogen result was 229 mg/dL. So while the improvement obtained with AmlaMax alone appears much larger than the relative improvement after adding the Pycnogenol, it looks like the improvement in fibrinogen may be tied primarily to the Pycnogenol. This is not a total surprise as a related pine bark extract called Enzogenol has been researched for use in smokers where it was found to lower both CRP and fibrinogen. The makers of Enzogenol also point to studies showing reduced blood pressure and other improved health tests.
It’s quite possible the reduction in HbA1C from 5.3 to 5.0 may also be due to the AmlaMax supplementation amla has been reported to reduce average blood glucose levels:
Quoted from Preventing Cardiovascular Disease Naturally
The same study demonstrated important effects of amla on other atherosclerosis risk factors as well. Levels of inflammatory C-reactive protein (CRP), which is associated with higher risk for atherosclerosis,12 dropped by 40% in the supplemented patients at six months.36 Finally, average blood sugar levels dropped from about 110 mg/dL (slightly elevated) to around 90 mg/dL (a level considered optimal by most doctors).36
AmlaMax Supplement Changes
The amla supplement he was initially using was the Life Extension Vascular Protect product. It included 380mg of AmlaMax 25:1 water extract standardized to 35% ellagic tannins which are believed to be among the most active ingredients in products using the amla fruit. It also had 1300mg of a “SproutGarden #1” mix including broccoli, daikon radish, and red radish and 1300mg of a “SproutGarden #2” mix including broccoli, water cress, kale, mustard, and cabbage.
The new Life Extension Advanced Lipid Control formula he switched to after a year dropped the SproutGarden content, increased the AmlaMax to 500mg, and added a Black Tea extract of 350mg standardized to 25% theaflavins.
Research shows that theaflavins do counter inflammation, act as antioxidants, and also inhibit platelet aggregation that could lead to abnormal blood clots. So it’s certainly possible they could have had an effect on the CRP test results. But a large portion of this change doesn’t seem to be explained by this as about the same time he added the Vascular Protect formula he also added Life Extension Theaflavin Standardized Extract which contains the same black tea extract ingredient and dosage. So the change here after the initial period on Vascular Protect was that the AmlaMax dosage was increased from 380mg to 500mg per day, the SproutGarden mixes were dropped, and the pine bark extracts were added. As he’s been taking broccoli and cruciferous vegetable extracts and sulforaphane supplements for even longer than the amla and pine bark and was taking them even at the time of the very high 6.47 mg/L CRP result and over 300 mg/dL fibrinogen results, it seems very unlikely that the big changes in CRP and fibrinogen are connected with the sprouted vegetable extracts.
This discussion of test results seen from using amla and pine bark extracts is based upon one individual’s experience and test results. It is possible that these results may not reflect how the same diet and supplement changes would affect another person. I do believe, however, that these results and related studies suggest that amla and pine bark extracts are very promising. The supplements have a moderate cost, so trying them for a few months to judge effectiveness should not be prohibitive for most people. The tests needed to look for changes in cardiovascular disease risk factors are not all that expensive, either.
It appears to take only a matter of a month or two of usage of amla and pine bark extracts to see some initial big changes in CRP and fibrinogen test results. The supplements appear compatible with many widely used supplements such as omega 3 fish oils and multivitamins. There are no common adverse interactions noted in the studies on the supplements. When you add all of this up, it seems that people at elevated risk for cardiovascular disease (pretty much anybody who is over about age 25 these days given the epidemics of excess weight and pre-diabetes/diabetes) should be trying these supplements as a first step before resorting to potentially more dangerous and expensive pharmaceuticals.
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