In the case of the Endothelial Glycocalyx (EGC), what you don’t know CAN kill you. So you definitely want to know what it is, how it becomes damaged, the subsequent effects of damage, and how to repair it. 

The endothelium is the one-cell thick lining of blood vessels- arteries, veins, and capillaries. It is often shown as a very smooth coating that is slippery and normally prevents cells from sticking to it. The prevailing (but totally wrong) theory is, simplistically stated, that too much cholesterol “clogs this covering, eventually leading to plaque build-up, and hence atherosclerosis (a.k.a.- arteriosclerosis). For the past 30 or more years, drugs that reduce cholesterol (Statins) are used to “treat” elevated cholesterol, which is supposed to prevent or reduce cardiovascular disease. So how is that working out? In adults 65 years and older,  diseases of the heart was the leading cause of death in 1980 as well as 2018, with only a slight decrease in total deaths from this cause, this despite the fact that Pfizer’s cholesterol drug Lipitor is the best-selling drug of all time, and Atorvastatin (generic Lipitor) leading with over 24 million prescriptions in 2019. 

The endothelium is anything but smooth however. The EGC is a micro-thin gel, about 200 microns thick,  covering the endothelial surface of every vessel of every type. It looks like cilia (hairs), or maybe a lawn growing on top of the endothelial cells. 


Microphotographs of normal endothelial lining and endothelial glycocalyx 

Damage to the EGC and the underlying endothelial cells subsequently leads to development of cardiovascular disease and ultimately to atherosclerosis and plaque formation. Plaque can then block arteries causing heart attacks or ischemic stroke or it can break free. If it then blocks an artery in the brain, a stroke will result; in the lungs a pulmonary embolism may occur.

By relaxing or contracting, the endothelium maintains normal vascular tone and blood pressure. It acts as a barrier system like others in the body such as skin, GI or lung barrier to regulate transport of nutrients, oxygen, signaling molecules including  hormones, across cell membranes. It also modulates interactions between immune cells and the blood vessel wall. Ultimately it is an unwanted immune response that leads to inflammation, blood vessel damage, and development of cardiovascular disease. The normal endothelium releases chemicals that help prevent clotting, and secretes vasoactive substances that regulate various blood vessel functions. One can see the critical importance of maintaining endothelial health. 

In fact it is the EGC that plays a key role in many of the above functions. Blood flowing across the micro-tentacles causes a shearing effect that leads to nitric oxide production that is a key factor in maintaining normal blood pressure. A critical anti-oxidant for the vascular system called Superoxide Dismutase (SOD) is stored in the EGC. It acts as a selective barrier to allow or prevent crossing of chemicals and white blood cells across the blood vessel. Normal EGC prevents platelet aggregation and white blood cell adhesion that leads to eventual plaque formation. 

It should be obvious that maintaining health of the EGC and therefore the endothelial lining is essential to preserve blood vessel well-being, and to prevent development of cardiovascular disease. So what are some of the major factors that cause vascular damage? I imagine the pharmaceutical companies would like you to believe that it is the absence of or low circulating levels of Statin drugs that leads to blood vessel damage, but sadly for them, this is not the case.

Actually the main factors leading to damage are:

  • High blood pressure
  • High blood sugar and insulin
  • Inflammation from any cause
  • Oxidative damage
  • Toxins- both manmade and those created by the body
  • Drug use (both recreational and prescription)
  • Smoking
  • Chronic infections
  • Stress
  • Lack of sleep/sleep apnea
  • Genetic factors
  • Age
  • Essential nutrient deficiencies

If this list looks familiar, it should. These are the same factors responsible for ALL of today’s chronic, degenerative conditions, including: diabetes, Alzheimer’s, autoimmunity and cancer. Functional Nutrition (a.k.a. Functional Medicine) seeks to find underlying or root causes for chronic conditions. The above list includes the majority of those underlying reasons why cardiovascular disease develops. Please note that cholesterol is not on that list. Elevated cholesterol is an effect of the above causes in the vast majority of cases. It is the body’s best available response to repair the damage done from these causes. (Please read: The Cholesterol Myths by Uffe Ravnskov, MD, PhD. And The Great Cholesterol myth by Jonny Bowden, PhD and Stephen Sinatra, MD). 

High blood pressure and blood sugar are major contributors to EGC damage, which explains why diabetics have a much higher incidence of cardiovascular disease and stroke. A pro-inflammatory chemical called TNF-alpha, increased plasma volume called hypervolemia which,  along with elevated hyaluronidase enzyme, matrix metalloproteins, natriuretic peptide, and bacterial endotoxins damage the EGC. These are all things that can be tested for, but routinely are not by primary care physicians and cardiologists, who seem to be largely focused on cholesterol. 

A number of medications and natural substances can help restore the EGC. Unless one corrects the underlying conditions causing the problem, taking medications and Nutriceuticals may not be as effective. Reducing blood pressure, blood sugar, inflammatory and toxic burden, and oxidative damage are essential for success. 

Nutriceuticals and appropriate dietary intervention are important components of a EGC restoration program.  Nutriceuticals that help reduce blood sugar, oxidative damage, and that improve liver detoxification and kidney excretion are beneficial. 

Attenuation of EGC damage may be enhanced by long-term use of N-Acetyl Cysteine (NAC), and therefore reduce progression of arteriosclerosis. High doses of Vitamin K2 has been shown to reduce arterial stiffness and inhibit arterial calcification. Vitamin K2 is an essential cofactor to  GLA Matrix Protein, which prevents calcium deposition on artery walls. 

Of note, a number of recent studies show that  a product derived from two types of marine algae (called Monostroma Latissium andMonostroma Nitidum), combined with grape and green tea extract, and plant polyphenols, is effective in improving arterial elasticity, reduce plaque and inflammation, and decrease blood pressure. These studies will be discussed in detail in my next blog.

About the Author: Dr. Douglas L. Weed

Dr. Weed practices Functional Nutrition, Chiropractic care, and offers weight loss solutions in Napa, CA at Heun Chiropractic, Inc. He has a doctorate in Chiropractic care and he has received certifications in physical rehabilitation and as a Qualified Medical Examiner. With a post-graduate certification in Functional Medicine, focusing on functional endocrinology, digestive disorders and Peripheral Neuropathy, he is committed to lifelong education and helping patience transform their health.