What's Good for Your Veins Should Be Good for Arteries, Too

Gotu Kola Can Help Prevent Heart Attack and Stroke
TTFCA from gotu kola makes arterial plaque more stable and thus less dangerous
By Will Block

n television coverage of a river flooding a town, it's not uncommon to see footage of raging waters tugging relentlessly at a car that can barely hang on. Sometimes we see the sad outcome, as the car finally breaks loose from its footing and is swept downstream, probably destined to crash into something. Of course, the denser the car (the greater its weight per unit volume), the less likely it is that the water will win this battle in the first place - a denser car is more likely to stay put.

Similar dramas, but on a much smaller scale, play out in the human body all the time. The "river" is our bloodstream, and the "car" is a bit of plaque lodged on the inside wall of an artery - perhaps a coronary artery, which delivers blood to the heart, or a carotid artery, which does the same for the brain. You can see the implication: as long as that plaque - or a blood clot that may have formed on it - manages to hang on against the relentless flow of blood rushing past it, 24/7, you're OK.

Scientists wondered about
increasing the plaque's density,
which would make it more stable
and thus less life-threatening. The
idea was to stimulate collagen
synthesis in the plaque.

But what if, God forbid, the blood wins the battle and the plaque breaks loose and is swept downstream? You know the answer: it could mean a heart attack or a stroke (a "brain attack"). It could mean curtains for you. That, however, is unacceptable. So, how can you prevent it from happening?

Preventing Plaque Is Best

First and foremost, adopt a healthy lifestyle that minimizes the formation of arterial plaque to begin with: good diet, regular exercise, no smoking, moderation in all other vices, and supplementation with agents that promote cardiovascular and cerebrovascular health. In the pages of this magazine, you have read about many such agents, including anticholesterol compounds, such as policosanol, and a variety of antioxidants, such as vitamins E and C. These antioxidants, in particular, play a vital role in minimizing the oxidation of lipids (fatty substances, including cholesterol) in your blood.

The TTFCA group showed a 33%
increase in plaque density (the
control group showed a 9%
decrease), together with improved
texture and no increase in size.

It's not so much the presence of those lipids in your blood - they have to be there, actually, in order for you to stay alive - as it is the chemical oxidation of them, mainly by free radicals, that causes artery-clogging plaques to form. That's why antioxidants are so important for good health: they inhibit the oxidation of blood lipids, among other things.

The Plaque You Do Have Should Be Stable

The better you take care of yourself in the ways mentioned above, the less likely it is that you will ever have to worry about plaque in your arteries. But what if, despite your best efforts, the yucky stuff has settled into some of your favorite arteries and does not want to leave? Now a crucial question arises, so pay attention: How stable are those plaques?

Not all plaques are the same, you see. Some are inherently more stable, i.e., less likely to break away and wreak havoc, than others. That's because plaque is a complex material - it's not just a blob of cholesterol - with a composition and structure that make it variable in form and stability. The smoother and more stable the plaque, the less you need to worry about it. With a little luck, it could just sit there for the rest of your life and do you no harm, other than being a hindrance to blood flow (and that depends on how bulky it is).

So what makes a plaque stable? In a word, density. The denser the plaque, the more likely it is to keep its footing and stay put. Density in this case comes mainly from the fibrous coating, called the stroma, that often forms over the soft lipid deposit and encapsulates it. The stroma consists largely of collagen, a ubiquitous protein that is the primary constituent of connective tissue throughout the body - including two of the four layers of material that constitute our veins and arteries. Some plaques become partly calcified, which also adds to their density.

TTFCA Promotes Vein Health

In two recent articles in Life Enhancement,* we saw how the herb gotu kola - specifically, an extract of this herb called TTFCA (triterpenic fraction of Centella asiatica) - produces dramatic improvements in vein health, in part through its stimulation of collagen synthesis and its protective effect on the layer of endothelial cells that constitute the veins' inside surface.1 These actions help to repair the damage done in the disease known as chronic venous insufficiency (CVI), in which high blood pressure in the veins of the legs (venous hypertension) weakens the walls of the veins.

*"Gotu Kola Promotes Healthy Veins" (May 2002); "Gotu Kola Combats Venous Hypertension" (June 2002).

Venous hypertension leads to a cascade of dire consequences, including varicose veins of the legs. The most common symptom is edema (swelling) of the ankles, owing to capillary leakage. Worst of all, but fortunately much less common, is deep vein thrombosis, the formation of a blood clot deep inside the leg. If such a clot breaks free of its mooring, it can be swept by the bloodstream into a lung and become lodged there; that's called a pulmonary embolism, and it can be immediately fatal.

Low-Density Plaque Is Worst

Blood clots can also form in arteries, of course - most often on plaque deposits, where they form an unholy alliance with the lipids that constitute the bulk of the plaque. Depending on how the lipids and the thrombus (the blood clot) are structured - and depending in particular on the amount of fibrous material that encapsulates them - they may form a relatively smooth, stable aggregate that is not likely to go anywhere, or they may constitute a tiny time bomb waiting to go off. What can happen is an ulceration of the plaque that eventually causes it to rupture, break free, and become an embolism, with potentially disastrous consequences for the heart or brain.

The researchers observed a 63%
increase in plaque density in the
TTFCA group, vs. a 5% increase
in the control group.

Scientists have long known that low-density plaque in the carotid arteries of the neck is associated with a higher rate of "cerebrovascular events," such as stroke, than is true of high-density plaque. This led them to wonder if it would be possible to increase the plaque's density, which would make it more stable and thus less life-threatening. Since the density of plaque depends largely on the collagen content of the stroma, the idea was to stimulate collagen synthesis in the plaque.*

*Plaque density, by the way, is unrelated to the density of the lipoproteins - high-density lipoprotein (HDL) and low-density lipoprotein (LDL) - that circulate in the blood and that are commonly called "good cholesterol" and "bad cholesterol," respectively.

TTFCA Increases Plaque Density

Well, what could do that? Bingo - gotu kola, already well known for its role in promoting collagen synthesis around and within the walls of our veins. So a group of Italian and British scientists tried it. In a randomized, placebo-controlled trial, they used a standardized TTFCA extract of gotu kola at a dose of 60 mg three times daily (180 mg/day) for 12 months (there were no side effects).2 The patients were 87 men and women, aged 49-62, with low-density (hence relatively unstable) carotid-artery plaque and no prior history of stroke, heart attack, or other medical conditions that might confuse the results. The degree of stenosis (narrowing) of their carotid arteries due to the plaque was 45-65%.

The researchers used a sophisticated, high-resolution ultrasound technique to infer the density of the plaque by its echogenicity, the degree to which it produced ultrasonic echoes. In the computerized images of the plaques, the areas of lowest echogenicity (lowest density) appeared black, and those of highest echogenicity (highest density) appeared white. With this technique, the researchers were also able to visualize the size and texture of the plaque by its different shades of gray.

The results were especially encouraging. The TTFCA group showed a 33% increase in plaque density (the control group showed a 9% decrease), together with improved texture and no increase in size. Using magnetic resonance imaging (MRI) of the brain, the researchers found evidence of cerebral ischemic lesions (damage caused by inadequate blood flow) in 7% of the TTFCA group and 17% of the control group; this represents a substantial risk reduction with TTFCA.

The same group of researchers conducted a similar study of the plaque-stabilizing effects of TTFCA (using the same dosage regimen), but in the femoral artery of the leg.3 In this study of 60 patients, aged 49-68, the researchers observed a 63% increase in plaque density in the TTFCA group, vs. a 5% increase in the control group. As before, the treatment group showed improved texture of the plaques, with no increase in size (the median size increase of the plaques in the control group was 23%).

Gotu Kola Is the Way to Go

In a related editorial, two of the authors of the studies cited above summarized their research findings (including those of numerous other studies as well) as follows:4

TTFCA has a very interesting action on edema, on microcirculation, and on collagen production, regulation, and modulation. . . . The possibility of making atherosclerotic plaques more echogenic and therefore stable by increasing collagen content in . . . plaques is a very important, potential therapeutic option.

That about says it. Recognizing the reality that we probably all have some plaque in our arteries, despite our ongoing efforts to prevent it, perhaps we should now also think in terms of making our plaque as stable as possible, so that it stays put. It seems that the way to do that is with TTFCA from gotu kola.


  1. Incandela L, Cesarone MR, Cacchio M, De Sanctis MT, Santavenere C, D'Auro MG, Bucci M, Belcaro G. Total triterpenic fraction of Centella asiatica in chronic venous insufficiency and in high-perfusion microangiopathy. Angiology 2001 Oct.;52 Suppl 2:S9-13.
  2. Cesarone MR, Belcaro G, Nicolaides AN, Geroulakos G, Bucci M, Dugall M, De Sanctis MT, Incandela L, Griffin M, Sabetai M. Increase in echogenicity of echolucent carotid plaques after treatment with total triterpenic fraction of Centella asiatica: a prospective, placebo-controlled, randomized trial. Angiology 2001 Oct.;52 Suppl 2:S19-25.
  3. Incandela L, Belcaro G, Nicolaides AN, Cesarone MR, De Sanctis MT, Corsi M, Bavera P, Ippolito E, Griffin M, Geroulakos G, Sabetai M, Ramaswami G, Veller M. Modification of the echogenicity of femoral plaques after treatment with total triterpenic fraction of Centella asiatica: a prospective, randomized, placebo-controlled trial. Angiology 2001 Oct.;52 Suppl 2:S69-73.
  4. Belcaro G, Nicolaides AN. A new role for natural drugs in cardiovascular medicine. Angiology 2001 Oct.;52 Suppl 2:S1.

The Sky-High Benefits of TTFCA

Flying can be torture. If, like most people, you fly economy class, you know all about it: the cramped seating, the stale air, the lousy food, the crying babies . . . . It's bad enough that the seating can be most uncomfortable (especially for tall people) on a long flight, but worse still, it can kill you - literally. People have died just from sitting in an airplane seat for several hours.

How can that be? It's because sitting motionless with legs bent for a long time, in a low-pressure environment (with lower than normal oxygen levels), can cause your venous system to run amok. The blood in your legs becomes stagnant, your venous blood pressure rises, the capillaries in your feet and ankles become distended and leak fluid into the surrounding tissues, and your ankles swell. It happens to some degree even in the majority of normal people with no circulatory impairment (it's worse, of course, in those who have chronic venous insufficiency, or CVI), and it poses a potential problem for more than 75% of all flying passengers.

The most serious problem - and insidious, because you can't feel it - is the formation of a deep-vein thrombosis, or blood clot, as a result of the unnatural stresses imposed on the legs: the impaired blood flow, high blood pressure, stiff joints, and sore muscles. As described in the accompanying article, this can lead to a pulmonary embolism and sudden death.

Considering how many people fly every day, such events are mercifully rare. They occur often enough, though, that public health authorities are concerned, and many companies are advising their flying employees on how to minimize the risk. Basically, you should move your legs as much as possible: stretch and wiggle them, and get up and walk back and forth until you've annoyed everyone on board. Another tactic is to wear elastic compression stockings, which can really help keep your blood flowing.

TTFCA to the Rescue

A supplement that improves venous health would also be valuable, of course. How about, e.g., taking TTFCA for a few days before the flight? Italian and British researchers tested this idea on 66 adults, aged 30-50, who had mild to moderate superficial venous disease with some varicose veins.1 In a randomized, placebo-controlled trial, the subjects were given 60 mg of TTFCA or placebo three times daily (180 mg/day) for two days before the flight, on the day of the flight, and one day after the flight. The flights were of 3 to 14 hours duration, on major airlines, and the subjects flew economy class.

Tests of venous function both before and after the flights revealed a marked deterioration in venous condition in the control group (placebo) during the flights. The most obvious symptom was edema in the ankles, but other symptoms of circulatory impairment were observed as well. By contrast, the TTFCA-treated group fared much better, with significantly reduced symptoms (and no side effects). Ankle edema in this group, e.g., was 50% less than in the control group on 3-hour flights, and 33% less on 12-hour flights. Because this indicates that venous function was substantially better than it would have been otherwise, it suggests that, for somebody, somewhere, TTFCA might just spell the difference between life and death.

  1. Cesarone MR, Incandela L, De Sanctis MT, Belcaro G, Geroulakos G, Griffin M, Lennox A, Di Renzo A, Cacchio M, Bucci M. Flight microangiopathy in medium- to long-distance flights: prevention of edema and microcirculation alterations with total triterpenic fraction of Centella asiatica. Angiology 2001 Oct.;52 Suppl 2:S33-7.

Will Block is the publisher and editorial director of Life Enhancement magazine.

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