Life Extension Magazine®

Running man at risk for aortic stenosis

Avoiding the Catastrophic Event

What kills those who take extraordinary steps to stay healthy? Often just one catastrophic event can launch a cascade of degenerative processes ending in death. Aortic stenosis is one such catastrophe. Health pioneer Jack LaLanne did almost everything right, but he may have fallen victim to one omission that resulted in him developing aortic stenosis.

Scientifically reviewed by Dr. Gary Gonzalez, MD, in August 2023. Written by: William Faloon.

William Faloon
William Faloon

A question we are asked nowadays is, “What causes people to die who take extraordinary steps to remain healthy?”

Our response is that in many cases, there is one precipitating catastrophic event that ignites a cascade of degenerative changes that culminate in death.

A classic example is an otherwise fit elderly individual who sustains a bone fracture. The combination of trauma, systemic inflammation, loss of mobility, hospital confinement, and psycho-logical stress can result in several diseases emerging that conspire to kill the victim in a relatively short time.

Catastrophic events are by no means limited to accidents. Surgical trauma or the impact of temporary loss of blood flow can also initiate a downward spiral from which an aging person never recovers.

Aortic stenosis is a catastrophic event that strikes aging individuals, but may be thwarted by a supplement that was introduced in 1999.1,2

It is too early to know for sure, but there is provocative evidence that what members already do to protect against atherosclerosis and bone loss also prevents calcification of the aortic valve.3,4

The Aortic Valve

Blood exits the heart to nourish the body from the left ventricle. With each heartbeat, the aortic valve opens (to let blood out) and closes to enable the left ventricle to fill with fresh oxygenated blood from the lungs.

In aortic stenosis, the aortic valve narrows and does not open fully. The result is the left heart ventricle enlarges as it desperately tries to force blood out through the constricted aortic valve. If not treated surgically, the aortic valve may either constrict so tightly that blood cannot exit the heart, or congestive heart failure may set in as the left ventricle deteriorates in response to having to squeeze harder to push blood through the narrowed aortic valve.

Avoiding the Catastrophic Event

In the case of aortic stenosis, the catastrophic life-threatening event can emanate from surgical trauma (which can inflict short- and long-term side-effects) and anti-coagulant drugs like warfarin5-8 that will slowly poison a person to death if not used properly. Aortic valve replacement also increases stroke risk even with warfarin.9-11

There is no validated therapy other than surgery to reverse advanced aortic stenosis. Many doctors and their patients have valiantly tried but failed to remove the calcium deposits that constrict the aortic valve. Prevention of this potential catastrophic disease is thus crucial.

Prevalence of Aortic Stenosis

While 2-9% of people over age 65 are diagnosed with aortic stenosis,12 48% of those over age 85 have aortic sclerosis, which is the calcification and thickening of the valve without left ventricular constriction.13

Aortic sclerosis is considered a precursor for eventual constriction (obstruction of blood flow out of the heart) that is ultimately diagnosed as aortic stenosis. Most of those with aortic sclerosis succumb to another disease before frank stenosis manifests.

Historically, most cases of aortic stenosis were thought to result from the “wear and tear” of aging.14 This perception is changing.

Taking steps to protect against calcification and thickening of the aortic valve would be expected to significantly reduce stenosis risk in one’s older years, when surgical procedures are of particular risk.

What Causes Aortic Calcification?

Calcium is always circulating in the blood. Our body goes to great lengths to maintain calcium blood levels in a very narrow range. Too much or too little blood calcium is invariably fatal.15,16

Lining our arteries and heart valves is a protein that regulates whether or not circulating blood calcium infiltrates (calcifies) our vasculature. The name of this calcium-regulating protein is matrix gamma-carboxyglutamic acid. To avoid having to repeat this tongue-twister again, we will refer to it from now on as MGP.

MGP is synthesized in the vascular walls and plays a key role in regulating vascular calcification.7,17-19 Whether MGP allows vascular calcification or inhibits it depends on its state of carboxylation. When MGP is under-carboxylated, vascular calcification spontaneously occurs.18,20 When MGP is fully carboxylated, it functions as a potent inhibitor of vascular calcification.21-23

What Causes Aortic Calcification?

Carboxylation of MGP is dependent on vitamin K. In fact, MGP is classified as a vitamin K-dependent protein because it cannot shield against calcification without adequate vitamin K.1,24,25

Epidemic of Systemic Calcification

In the aged population, vascular calcification is ubiquitous. Autopsy reports show that 75-95% of men and women suffer some degree of vascular calcification.26

Since calcification occurs in soft tissues throughout our body, including the kidneys, lungs, heart, and brain, this calcification epidemic is of great concern to those seeking to avoid a “catastrophic event” that precipitates a lethal downward spiral.27,28

It is fortunate that we are not dependent on a future breakthrough discovery to protect against vascular calcification as it may be prevented by correcting a vitamin K deficiency.29-32

Europeans Have Access to Less Invasive Technique

Human Clinical Data

An interesting study published in 2008 measured the amount of under-carboxylated MGP in the blood of healthy individuals and compared it to those with severe vascular diseases including aortic stenosis. The findings showed that virtually all diseased subjects had under-carboxylated MGP levels below the normal adult range.20 If only these individuals with severe vascular disease had maintained adequate vitamin K status, they may not have been on death’s door.

The most frequently cited data about vitamin K and vascular disease risk came from a study of more than 4,800 subjects who were followed for 7-10 years in the Netherlands. People in the highest one-third of vitamin K2 intake had a 57% reduction in risk of dying from cardiovascular disease, compared to those with the lowest intake. In the group with the highest vitamin K2 intake, risk of severe aortic calcification plummeted by 52%.2

It is doubtful that any of these European study subjects were taking vitamin K supplements. This means that just the tiny microgram amounts obtained in their diets is what may have produced this 52% reduction in risk of severe aortic calcification.

Based on findings that maximal carboxylation of MGP requires significantly higher levels of vitamin K than obtained through diet, those taking vitamin K supplements might obtain greater benefit.33-36

The missing part of this puzzle is controlled clinical studies showing that vitamin K supplements themselves prevent aortic stenosis. Instead, we rely on intriguing clinical data that consistently show low vitamin K status in those who develop aortic valve calcification.1,35-37 We know that vitamin K is essential for MGP-carboxylation, which in turn shields heart valves and arteries from pathological calcification.37 We also know that vascular calcification is an active and therefore potentially preventable process if vitamin K intake is increased.38,39

Europeans Have Access to Less Invasive Technique
Europeans Have Access to Less Invasive Technique

Since 2007, Europeans have had an option to avoid the horrific surgical trauma associated with aortic valve replacement.40

Instead of open heart surgery, a balloon catheter carrying a highly compressed bovine tissue replacement valve is inserted into an artery in the leg and threaded to the heart. Once the catheter reaches the beating heart, the balloon inflates and secures the new valve in place to replace the calcified aortic valve. Patients are functional within days as opposed to sometimes months of recuperation required for conventional open heart procedures. In addition to improved survival, patients experienced substantially better quality of life afterwards.41

This method is being used around the world, but the FDA has not yet approved it. This is unfortunate as many elderly Americans are so sick that they cannot qualify for open heart surgery, and if they do, they may die from surgical complications. 

By way of real world example, an 88-year-old relative of this magazine’s editor was told by her cardiologist that she had only a short time to live if she did not have her aortic valve replaced. She was taken to four different surgeons in New York City, who all wanted to do conventional open heart surgery. There are many concerns with a person this age, including cognitive deficits that occur in many patients placed on heart-lung machines and heightened risk of pneumonia and other infections during the long recovery phase.

Dr. Michael Ozner, a member of Life Extension’s Scientific Advisory Board, informed our editor of the PARTNER trial in which surgeons were inserting a bovine tissue valve with a cobalt-chromium frame via catheter without open heart surgery. None of the top-rated surgeons who were initially visited were aware of this new procedure. The editor found that there was a trial location in New York at Columbia-Presbyterian Hospital. His relative was enrolled in the program not knowing if she would be randomized for open heart surgery or this new procedure. Fortunately, she was chosen to be a part of the experimental group and was spared open heart surgery. The procedure was done on Thursday, she was up and walking on Friday, and was home on Monday. Two years after the procedure and now approaching age 91, she continues to work out with her trainer and takes her supplements. Equally as impressive, she does not need to take Coumadin® or other anti-coagulant drugs that mechanical valve patients require for life. Coumadin® increases vascular calcification and accelerates osteoporosis by depleting vitamin K.42

The PARTNER trial reported preliminary results on April 3, 2011, at the annual meeting of the American College of Cardiology. The study compared 699 elderly patients. Half received the catheter-inserted aortic valve while the other half received an open-heart surgery-implanted valve. The overall death rate was slightly lower at one year for the group receiving the catheter-implanted valve, though there were twice as many major strokes in the catheter-implanted group in the post-surgical period.43 Doctors anticipated improvements in future versions would reduce stroke risk.

The study is scheduled to enroll a total of 1,040 patients with a completion date anticipated in year 2014.

Other Factors Involved in Aortic Stenosis

Like the modern day scourge of atherosclerosis, there are many risk factors for aortic stenosis.

Famous Individuals Who Had Aortic Valve Surrery
Famous Individuals Who Had Aortic Valve Surgery

While the majority of individuals who develop coronary atherosclerosis do not suffer aortic stenosis, the two diseases nonetheless share common risk factors.44

Those with elevated LDL,45-47 triglycerides,48,49 total cholesterol,50-53 and other atherogenic lipids have higher rates of aortic stenosis. Elevated C-reactive protein levels are also correlated with aortic valve disease.54,55

Underlying conditions that predispose people to coronary atherosclerosis such as hypertension,56-59 smoking,60,61 and diabetes62-64 have been consistently linked to the development of aortic stenosis.

Other factors associated with aortic stenosis include osteoporosis, which is also strongly associated with vitamin K deficit.65-71 Those suffering from elevated blood calcium,72,73 obesity,60,61,74 and renal failure75-77 have higher incidences of aortic stenosis, which is why annual blood testing is so important to identify correctable problems before irreversible disease takes hold.

Please remember that the use of calcium supplements is not the cause of increased blood calcium levels. Healthy persons have an intricate regulatory system that precisely controls how calcium is utilized in the body. When calcium is deficient in the blood, parathyroid hormone acts to remove it from the bone to ensure blood levels are maintained.78

Without adequate calcium intake, parathyroid hormone will continue to remove calcium from bone to the point that a person becomes osteoporotic. Since calcium is required for vital life functions beyond bone density, the body will continuously rob bones of calcium to ensure stable blood levels if there is not sufficient intake from diet or supplements. So the body makes sure there is always enough calcium in the blood to sustain vital life functions. The side effect of the body’s vigilant maintenance of blood calcium is that this calcium is freely available to calcify tissues (including our heart valves).

In the presence of enough vitamin K, however, calcium binds to the skeletal matrix where it is needed to maintain bone density and is simultaneously inhibited from infiltrating the vasculature (including arteries and valves).79-81

Risk Factors for Aortic Stenosis Overlooked by Most Doctors

Risk Factors for Aortic Stenosis Overlooked by Most Doctors

In order for calcium to infiltrate the aortic valve, there is first an initial injury to the endothelium (inner vascular lining).82,83 Homocysteine is a prime culprit that causes the initial endothelial injury that leads to atherosclerosis and possibly aortic stenosis later in life.83-85 What conventional doctors fail to acknowledge today is homocysteine’s role in initiating damage to the vascular system.

A group of doctors at the Cleveland Clinic assessed the association between homocysteine levels and various degrees of aortic valve disease in 76 surgical patients. In patients with normal aortic valves, mean homocysteine level was 10.9 (µmol/L). Patients with aortic sclerosis had homocysteine mean levels of 11.4. Those with the more severe aortic stenosis had a significantly higher mean homocysteine level of 15.4! While the small size of this study limited its predictive value, the doctors stated, “It is conceivable that the elevated homocysteine levels seen in patients with renal impairment or older age could contribute to the more rapid progression of aortic stenosis observed in these patient populations.”83

The take-home lesson for anyone concerned about aortic stenosis is that virtually every risk factor for heart attack—be it excess body weight, hypertension, excess blood lipids, and even continued tobacco use—predicts the rate of aortic disease progression.

Triumphs and Tragedy of Jack LaLanne

In December 2009, Jack LaLanne at age 95 underwent aortic valve replacement surgery. A little over 13 months later, he died at age 96 of respiratory failure due to pneumonia. Even in healthy elderly individuals, the traumatic impact of aortic valve surgery can be the “catastrophic event” that leads to a rapid downward spiral culminating in death.

Jack LaLanne
Jack LaLanne

There may never be a better example than Jack LaLanne of someone who did virtually everything right, but appears to have missed out on one key nutrient—vitamin K2—that may have prevented calcification of his aortic valve. Jack LaLanne was a pioneer hero who promoted and followed very healthy lifestyle practices—decades before others knew about them.

When Jack LaLanne first proposed intensive exercise with weights in 1936, mainstream doctors warned that it would cause all kinds of terrible medical problems. This was the same medical establishment who said cigarette smoking was not dangerous. Jack LaLanne not only promoted lifelong physical activity, but also calorie moderation and avoiding all unhealthy foods.

Jack LaLanne’s last book was published in 2003. The supplement regimen he recommended, however, appears to have been trapped in 1970s ideology. He mentioned the importance of vitamin K1 only in the context of normal blood clotting and recommended green leafy vegetables as the main source. We now know, of course, that almost everyone obtains enough vitamin K for their blood to clot, but not nearly enough vitamin K2 to protect against soft tissue calcification.

As we often observe with elderly individuals, they tend to remember facts dating back decades but find new concepts difficult to grasp. Out of enormous respect for Jack LaLanne being scientifically ahead of his time regarding healthy eating and exercise, nowhere in his last book is there any mention about other critical steps that aging men should follow, such as maintaining youthful hormone balance. Low DHEA, for example, can compromise immune function,86-90 and the pneumonia Jack LaLanne acutely died of is common in elderly individuals with weakened immunity.

We don’t know what supplements Jack LaLanne was using, but based on the recommendations made in his last book, there was no mention of omega-3s, CoQ10, amino acids like carnitine, dipeptides like carnosine, vitamin K2, higher-dose vitamin D, or many of the other nutrients that enlightened individuals take today.

In reading Jack LaLanne’s last book (titled Revitalize Your Life), I can confidently state that if everyone in America followed his strict dietary and exercise programs, incidence of today’s major killers would plummet to extremely low levels. Jack LaLanne’s stern recommendations to avoid junk and other unhealthy foods alone could bail this country out of the health care cost crisis it now faces.

At the same time we pay tribute to Jack LaLanne’s foresight, we must acknowledge the lethal consequence of omission. New information is published daily that provides clues as to what aging individuals can do to prevent the lethal “catastrophic event” that initiates a downward spiral of endless degenerative disease. When these clues become substantiated in well-controlled human studies, it is imperative for aging individuals to incorporate them into their own daily programs. We fear Jack LaLanne’s omissions may have created his personal catastrophic event.

Life Extension Members Enjoy Significant Protection

The encouraging news for long-time Life Extension members is that they have been way ahead of the curve in protecting against aortic stenosis. Annual blood tests enable them to take affirmative steps to suppress excess C-reactive protein, LDL, homocysteine, triglycerides, glucose, and other vascular system-destroying factors.97

Members also ingest high-potency supplements that provide 24-hour blood levels of critically important vitamin K2. Long-acting vitamin K2 is emerging as an exciting player in the prevention and potential regression of coronary atherosclerotic plaque.

According to some researchers, vitamin K2 has so many functions not associated with vitamin K1 that it should be viewed as a different vitamin entirely. In the largest human study to date, higher intakes of vitamin K2 reduced cardiovascular issues by 57%, whereas intake of vitamin K1 had no effect.2 Those following certain vegetarian diets may not be getting enough vitamin K2, thus exposing themselves to significant calcification disease risk even though they assume they are eating healthy.

What is not yet known is whether higher intakes of vitamin K2 will reverse aortic calcification. Based on what has been published to date, there is a considerable basis to believe it will inhibit calcification in tissues throughout our aging bodies, thus reducing our odds of encountering the “catastrophic event” that could prematurely terminate our lives.

Vitamin K2 Is Lacking in Healthy Diets

Certain plant foods contain vitamin K1, but it is poorly absorbed into the bloodstream.91 Very little plant-based K1 converts to a long-acting form of vitamin K2 called MK-7.92 The body needs vitamin K around the clock to shield itself from calcification.

The US Department of Agriculture lists the following foods with the highest vitamin K2 content:93-95

Hard cheese
Soft cheese
Egg yolk
Chicken liver
Chicken breast
Ground beef

Aside from natto (which few Americans can tolerate from a taste standpoint), the vitamin K2-rich foods listed above are considered unhealthy. So those who try to follow healthy diets that involve eating lots of vegetables in place of foods high in saturated fat and cholesterol are unwittingly setting themselves up for systemic calcification due to deficiency of vitamin K2.96 Low-cost vitamin K2 supplements are widely available to thwart this deficit.

For longer life,

For Longer Life

William Faloon

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