One American dies every 38 seconds from cardiovascular disease (American Heart Association, as of December, 2009 data). Where are you on that future list? If you are on it, how can you push your spot back?
Our unique metabolic program for heart health and restoration involves several steps, but it is broken down into simple measures which can be done by anyone. It involves the most current and powerful methods available that do not involve prescription drugs.
While they are lifesaving and necessary, there is more to heart health than surgical procedures
Most people think when you have heart disease, either cholesterol elevations or high blood pressure, you take pills until they don’t work or you have a heart attack. Then you have high tech procedures and surgery, go home and take more pills. Some doctors have said that the high tech procedures have not been shown to prolong life or prevent heart attacks—this does not come from us. Others have observed that Americans are 7 times as likely to have these expensive procedures as people in Canada and Sweden. Yet, the number of deaths from heart disease in those countries is identical to ours. In other words, with our greater number of angioplasties and coronary bypass operations, we are not improving our death rate from heart disease.
There is more to heart health than cholesterol
While cholesterol levels are extremely important and are involved in heart disease, the facts are
- about half of the patients with heart attacks do not have high levels of total or “bad” cholesterol;
- when patients are given several drugs to lower their cholesterol, many do not achieve their goals in lower their numbers;
- even when patients do improve their cholesterol numbers, they still have heart attacks;
- recent clinical studies show that sometimes when you lower cholesterol, there is no improvement in the fatty deposits in arteries (shown in the recent ARBITER-6 HALT study presented at the American Heart Association Scientific Sessions in November 2009. The topic is summarized on this site under HEALTH NEWS as “High cholesterol-a surprising report from the AHA”)
The bottom line—there is a lot more to heart health than cholesterol. For instance, the reason cholesterol causes trouble is actually due to inflammation, with oxidative stress and free radicals playing a part. For these reasons, it makes more sense to look at the basic causes, and try to reverse them. This is what we do…
What we do for you
- We document your present habits and program, if any, that impacts your heart;
- We review your family history pertaining to your heart health, and its potential significance;
- We discuss in detail what your personal heart history has been, the effects of various changes, and other relevant information;
- We focus on basic, central aspects of heart health:
- Availability of blood for the heart
- Availability of oxygen for the heart
- Improving the balance between energy available to the heart, and its energy needs to do its job
- Expanding the energy for the heart by adding more energy producing molecules, called ATP
- Promoting more energy conversion from food, so that the heart functions normally
- Stabilizing the electrical system of the heart
- Minimizing inflammation within the heart, which is a fundamental process driving fatty deposits
- Facilitating the production of energy within the powerhouses of the cells, small structures called mitochondria
- Neutralizing oxidative stress that results from free radical accumulation, and all the potential damage that they may bring about.
5. Your concerns and goals are discussed in detail and are carefully considered;
6. A reasonable plan to improve your heart health within a definite period of time is created, with your input;
7. Your customized plan includes specific nutritional, exercise, lifestyle, and supplemental guidelines which are doable, appropriate, and will be effective;
8. Applicable recent research is discussed with you.
We tell you about how to handle the over 17 risk factors for your heart, with tips and secrets about each one of them.
For the details of the metabolic program, an appointment is necessary.
While we do a lot with lifestyle, and will guide you with an awesome heart healthy diet, we will also give you capsules to swallow as part of our program. They will be essential and intended to accomplish the items above. BUT, they will be all natural, virtually free of side effects, and work quite gently, with the body, to heal. They do not block essential chemical reactions to produce their benefits. Lifestyle changes are just a part of our program.
Before we tell you more about the heart, and how lifestyle affects it, we suggest that you just make an appointment and come see us. It is much better to personally analyze, explain and do on a face-to-face basis. Most of the people who visit us are glad they did, and pleased with the results.
THE HEART: what can go wrong
Heart disease, along with other chronic, degenerative diseases that plague us, also called lifestyle diseases, or diseases of civilization, is an enormous problem which has not been adequately reversed, despite amazing advances. First, let’s define some common expressions about heart disease.
The Grim Statistics
The American Heart Association, in their last review of statistics, estimated that about one-third of all adult Americans have one or more types of cardiovascular disease. When you sit at the mall, every third person that passes you suffers with high blood pressure, diagnosed heart disease, stroke, heart failure, or another related problem. Nearly one in four of us over 18 has high blood pressure, nearly 16 million have coronary artery disease (explained below), 8 million have survived one or more myocardial infarctions (heart attacks) [not counting those that died], 9 million have cardiac (heart) chest pain, and 5.6 million have had a stroke. Cardiovascular disease accounts for over 36% of all deaths, or one in 2.8 deaths in this country. Every 26 seconds, one of us suffers a dreaded coronary event. Coronary artery disease is the leading cause of death for everyone, even more than breast cancer in women. Nearly 2,500 of us die from heart disease daily, averaging one death every 36 seconds. In adults, heart attacks cause 1 out of every 5 deaths. According to the National Institutes of Health (NIH) more than 1.3 million heart attacks occur each year in the United States and about 470,000 of these are fatal. Approximately 380,000 people die annually from heart attacks before they can receive medical treatment. About 150,000 that die from cardiovascular disease are younger than 65. Most of this tragic loss is unnecessary, for a majority may be prevented.
Let’s compare this with some other causes of death. In decreasing order, they are cancer (551,000 deaths), accidents (110,000), Alzheimer’s disease (66,000) and AIDS (13,000). Heart disease is responsible for more deaths in women than breast cancer. Heart disease kills a women every minute—one in 6 deaths in women is from heart disease, but only one in 30 is due to breast cancer. This is not to diminish the justified dread women have of breast cancer, but simply to call attention to the unfortunate fact that heart disease is not only a man’s disease. Women generally need greater heart “awareness”, and many organizations have begun major initiatives to alert women about the preventive measures necessary to keep heart disease at bay, and how to recognize early symptoms. CAD is the single largest cause of death for both women and men.
A significant number of people have sudden cardiac death—collapse and die—as their first and last warning of heart disease. Will you be one of those, and what can you do to prevent it? Even more die in the emergency room, or several months after they seek help. Will you be in that category, and how can you delay such a fate? These articles focus on answers to those questions.
Consider this: if all cardiovascular deaths were eliminated, our life expectancy would increase by nearly 7 years to about 86! In comparison, if all cancer deaths were eliminated, our lives would be extended by only 3 years. One in 3 of us will develop ongoing heart disease in our lifetimes, but most of us will either be disabled and/or die from it.
As is usual in health issues, what we do individually plays a major part in our risk, and that applies especially to heart disease. Lifestyle—diet, activity level, thinking, and mind-body measures, play a major part in the development, precipitation, and outcome of heart attacks, possibly more so than in other ailments. Our health is our own responsibility. It is not enough to show up at a PCP’s office, receive prescriptions, and swallow (typically only a part of) the pills received. Personal understanding, commitment, involvement, and action lead to success, in the form of health, happiness, and longevity.
Exactly what is “coronary artery disease” and “heart attack”?—learning the lingo
An artery brings blood carrying oxygen and nutrients to organs in the body, such as the heart, and veins carry blood away from organs. Atherosclerosis is a process during which fatty deposits harden and narrow arteries. In the case of the heart, reduced blood flow in the coronary arteries, which supply fresh blood to the heart, may lead to
- Angina, a particular type of chest pain or discomfort, during which heart oxygenation and nutrition is impaired; or
- Heart attack, also called “myocardial infarction”, resulting from severe or complete blockage of an artery. If this situation is greater than, say, 20 minutes, death of heart muscle occurs. (There is a period of time during which heart muscle may be saved under certain circumstances.)
The name given to this problem is “coronary artery disease” (CAD), “coronary heart disease”, or “ischemic heart disease” (ischemia means decreased blood flow), and all 3 terms mean the same thing. CAD is part of the larger term, “cardiovascular disease” (CVD), which includes all diseases of the heart and blood vessels, not just reduced coronary blood flow. CAD is a common type of heart disease and is the leading cause of heart attacks. When heart muscle dies, it is lost forever, and this is why prevention is so important. When somebody refers to “heart disease” in general, it is assumed they mean CAD.
High blood pressure, also called “hypertension”, and “heart failure”, are other forms of cardiovascular disease. Heart failure, also called “congestive heart failure” (HF) occurs when the heart is unable to pump enough blood to meet the body’s needs. Other organs, such as the brain, the kidney, the lung, etc, do not receive enough blood to do their jobs. In the most common form symptoms of CHF include shortness of breath, swelling in the ankles (edema), and fatigue, and the heart may be enlarged. A sudden or acute form is called “pulmonary edema”, which is commonly explained as “water in the lungs”. While HF may occur from many causes, hypertension and CAD are two of them.
An “arrhythmia” is an abnormality of the usually-steady-and-controlled beat of the heart. This problem includes slow, fast, and irregular heart rhythms. The heart beat may also appear regular, but be quite abnormal in rate or otherwise. An arrhythmia need not necessarily be harmful, and some may simply require reassurance and watchful waiting. Common symptoms from arrhythmias include feeling dizzy, faint, or collapsing, awareness of the heartbeat, such as racing or flutters (“palpitation”), shortness of breath, and apprehension.
A “murmur” is a particular sound that may be heard over the heart, blood vessels, or lung. It may be loud or soft, low- or high-pitched, and is usually associated with altered blood flow or friction. Many types of heart ailments may cause murmurs, including heart valve disease, CAD, high blood pressure, infections, etc. The mere presence of a murmur does not automatically mean heart disease, hence the term “innocent murmur”.
Focusing on CAD, angina may be “stable”; or, “unstable” (UA), meaning it may be more prolonged than usual, may be triggered by less activity, work, or emotional upset than usual, be unexpected, and is usually intense enough to occur at rest, and/or refractory enough to need hospitalization. It may readily lead to a myocardial infarction. Another term, “acute coronary syndrome” (ACS) refers to people with unstable angina or an acute (fresh) myocardial infarction, since in the early stages there may be considerable overlap.
You may also hear of a form of heart disease called a “cardiomyopathy”, referring to disease of the heart muscle itself. Such heart muscle may be impaired from infections, deposits, inherited problems (involving valves as well), and may result from CAD. Then it is called “ischemic cardiomyopathy”.
Advanced, or “end-stage” heart disease may be marked by a large, baggy, failing heart in which much muscle mass has been lost. CAD and hypertension are possible causes. Such a heart may also be prone to arrhythmias—it is sick in all respects.
Sometimes when people say “heart attack”, they don’t really know whether a true myocardial infarction has occurred—they may mistakenly mean severe chest pain, an arrhythmia, or an acute episode of heart failure, such as pulmonary edema. They are really referring to some acute heart event that is alarming. Still, the term “heart attack” actually refers to a myocardial infarction, “infarction” meaning that muscle has died from lack of oxygen and nutrients. All parts of the body need a continuing supply of oxygen and fuel to live and function properly, especially the heart. The heart is extremely vulnerable because it needs so much energy to do its work.
Heart attacks take an average of 15 years of life from each victim. In those people who survive the early stages of a heart attack, there is an increased chance of disease and death that is 1.5 to 15 times higher than in matched individuals without prior heart attacks.
What impact does a healthy lifestyle have? Plenty.
- Healthy heart lifestyles may include
- No smoking
- A healthy weight
- Consuming sufficient vegetables and fruits
- Regular physical activity.
- Healthy lifestyles promote a low heart risk status which may include
- A low serum cholesterol level (<200 mg/dL)
- Untreated blood pressure of <120/<80
- No smoking
- No diabetes (a potent risk factor for CAD)
- No major abnormalities on a heart test known as an “electrocardiogram”, a recording of the electrical activity of the heart.
People with such findings enjoy a 73-85% lower risk of cardiovascular mortality, 40-60% lower overall mortality, and 6-10 years greater life expectancy.
- Individuals following a “Mediterranean Diet”, along with adequate physical activity, enjoy a 63-73% lower all-cause mortality, which includes not only heart disease but also death from cancer. In other words, they live longer. The Mediterranean diet is the only one proven to prolong life.
- When people have no hypertension, normal serum cholesterol values, and do not smoke, their risk for fatal CAD is expected to be more than 71% lower for women, and 51% lower for men. This is one of the best bargains life has to offer.
How About Some Good News?
- From 1950-1999, the total death rate from CAD fell by 59%.
- From 1994-2004, the death rate from CAD dropped by 33%, but the real number of deaths was lowered by 18%.
An important article in the New England Journal of Medicine recently reported on the decline in deaths from heart disease since the 1970s, observed that, over the 20 year period studied, reducing blood pressure, quitting smoking and lowering overall heart risks in the table below prevented as many heart deaths as costly high tech treatments. And, simple aspirin saved over 2.5 times more lives than statin drugs. Here are the percentages in decline of deaths by reducing various risk factors:
| RISK FACTOR |
PERCENT CHANGE (1980-2000) IN DEATHS |
| Smoking |
-11.7% |
| High blood pressure (top number, average) |
-5.1% |
| Inactivity |
-2.3% |
| Serum cholesterol |
-0.34% |
| OBESITY , DIABETES PRODUCE INCREASES IN MORTALITY |
|
| Increases in Weight |
+2.6% (an increase in deaths, offsetting the gains) |
| Rise in Prevalence of Diabetes |
+2.9% (an increase in deaths, offsetting the gains) |
In plain English, about 50% of the fall in coronary deaths in this country from 1980-2000 are attributable to positive lifestyle changes, and 50% to medical therapies. Certainly this supports the notion that, as far as heart disease is concerned, an ounce of prevention is worth a pound of cure. But suppose we were able to increase the lifestyle changes, I mean really give them a boost. We would find, as is outlined in many studies published during 2009 in such impressive journals as Circulation, Atherosclerosis, Thrombosis and Vascular Biology, Diabetes Care, Annals of Internal Medicine, and the like, that about 80% of heart disease and cardiac risk in diabetes, as well as diabetes itself, can be prevented. With no side effects, no drugs to take, no associated expenses.
Consider what this means for a moment. By increasing activity and improving your diet (which also influences blood pressure), you can lower your chances of developing and/or dying from heart disease just as much, if not more than complex, expensive, invasive and uncomfortable therapies and procedures. And these simple measures are within the reach of every one of you right now, without special equipment or undue cost. Certainly this is a better way to go in solving a burden that is crushing our society. Unfortunately, our progress is threatened by two increasingly difficult and prevalent problems: obesity and overweight, and diabetes. Most authorities agree that diabetes, the kind usually found in adults, now being diagnosed increasingly in youngsters, is driven by a striking rise in obesity, particularly in children and adolescents. Over 2/3 of us are overweight, and nearly 35% of us are obese. Unless this changes, over 50 million of us will be diabetic by 2050, at which time we will be a nation 200% more dependent upon prescription medications, marked by sharp increases in all the complications of diabetes—heart and kidney disease, blindness, neurological pain, loss of limbs, impotence, and stroke. When you sit in the mall and think about how every third person passing in front of you has cardiovascular disease, look at how large they are too.
Next we look at the various ways to look at the heart: as a pump overall (fraction of blood ejected), the contribution of various parts of the heart to pump function (synergy of contraction), from the point of view of its electrical system (rhythm), flow of blood through the walls of the heart (perfusion), and biochemically. We must also consider the various effects on all these aspects of heart function whenever we evaluate a strategy, in addition to the overall change in mortality of heart disease and safety profile.
THE HEART: Its Parts and Risk Factors
There are various ways to look at the heart, the way coronary artery disease develops, its “natural history”, and the role of inflammation as a core problem. To introduce what we can do to delay or help cardiovascular disease, diet and exercise are our next topics.
Many people make a big mistake, thinking diet and exercise do not compare to the most potent prescription medications in effectiveness, and some actually prefer to take 9 pills a day, rather than follow a sensible, prudent, healthy lifestyle. Worse, they may believe surgery will keep them from death’s door when they continue unhealthy lifestyles, when the ultimate truth is that bad habits will handily reverse any beneficial effects from surgery. Imagine, many pills and several hundred dollars monthly, just to go to fast food restaurants and be couch potatoes, and such people still lose in the end.
Ways to Look at the Heart
As a Pump. The heart is no longer viewed simply as a “pump”, as it was many years ago. On average, it pumps 1500 gallons of blood per day, generating enough power to drive a car 20 miles each day. Still, the amount of blood the heart pushes out or ejects, compared to the full amount of blood it contains, is an important overall index of heart function. Most people know the heart contains four chambers, two receiving blood from the lung and body, the right and left atria (atrium, singular) respectively, and two that pump blood out to the lungs and body, the right and left ventricles, respectively. The job of the atria is to see to it that the ventricles are filled. [See “How the Heart Works”, animated, at http://www.nhlbi.nih.gov/health/dci/Diseases/hhw/hhw_all.html]. The left ventricle normally pumps from 55%-75% of the blood it contains out to the body with each beat. The corresponding fraction, 0.55-0.75, is called the “ejection fraction”, and is measured both directly during cardiac catheterization and indirectly from an echocardiogram. An EF of 0.40-0.50 usually means damage, but a normal EF can occur even when the heart is damaged. It is an important, fundamental measure of overall heart function.
Normally all parts of the muscular ventricles contract in a coordinated way, to maximize the amount of blood ejected. In disease, some portions of the heart muscle may not be able to contract as much as other, normal areas. When one area of muscle cannot contribute significantly to the ejection of blood, the “synergy” of contraction is impaired. This may be temporary, during an episode of angina, when blood flow to an area of muscle is low, or it may be permanent, as a result of a heart attack, with the death of heart muscle followed by scarring. The total amount of blood flowing through the coronary arteries supplying the heart muscle with oxygen and nutrients is evaluated during cardiac catheterization, at which time the coronary arteries are visualized, and any blockage(s) are identified. Over 80% blockage at a particular point is serious and usually associated with symptoms. The amount of blood flowing through the muscular walls of the heart may be evaluated during various “perfusion scans”, during which non-performing areas of the heart wall are visualized.
As an Electrical System. When resting, the adult human heart beats at about 70 BPM (males) and 75 BPM (females), but this rate varies among people. A normal heart rate is from 80-100, but a resting heart rate over 90 may be a sign of trouble. The heart beats an average of 2½ billion times during a lifetime, but the idea that each person has a fixed number of heartbeats to his/her life is untrue. Most cells in the heart have the intrinsic ability to beat and generate electricity, but certain cells, because they generate and conduct electricity faster than other cells, are part of a specialized electrical or conducting system of the heart. The first cells to create an electrical impulse that will eventually cause a single heart beat are in the “sinus node”, located near the back left atrium. The impulse travels down special fibers through the center of the conducting system, the “A-V node”, then into the ventricles, where is spreads throughout the ventricular muscle to initiate a musclular contraction. The conducting fibers and muscle recover and recharge, getting set for another heartbeat.
Other Ways to Look at the Heart
The biochemical composition of the heart may be altered, if, for instance, potassium or magnesium is depleted in the muscle. Another example is a relative depletion of a chemical needed for energy production within the heart cells, such as coenzyme Q10. The heart also secretes hormones, and participates in various cardiovascular reflexes.
After any intervention to the heart, whether it is dietary, medications, or supplements, one must ask, what will be the effect on muscular contraction, on the conducting system, on blood flow to the heart, on perfusion of the heart wall with blood, and on the biochemistry of the heart? For instance, fish oil may reduce the area of heart muscle that dies when coronary blood flow is lowered and promotes coronary artery dilation. It may also lower the incidence of certain harmful arrhythmias, lower the level of blood fats (triglycerides), and decrease the number of sudden cardiac deaths. Biochemically, the activity of the damaging superoxide free radical is lowered. On the other hand, cocaine may raise heart attack risk 24-fold during the first hour after ingestion, bring about spasm of arteries and strokes, increase the levels of clotting factors, raise an index of inflammation, promote potentially fatal arrhythmias and sudden death, and stimulate an enzyme in the heart which stimulates abnormal heart muscle overgrowth, or hypertrophy, among other ills. In these instances, the effects seem all good for fish oil, and all bad for cocaine. Sometimes, however, the effect on one aspect, such as muscle, may be favorable, and on another, such as causing dangerous arrhythmias, quite unfavorable.
Does Heart Disease Develop?
Atherosclerosis of the coronary arteries is a chronic inflammatory condition in which the inner walls of arteries stiffen and become clogged. As deposits build up, they protrude into the artery, decreasing its diameter, so that less and less blood can flow through it. Actually, the process is more complicated. First, the inner wall, called the endothelium, is damaged in some way, possibly from high blood pressure, cigarette smoke toxins, high levels of cholesterol and fat (lipids) in the blood, changes of diabetes, even infections. Inflammation occurs as a natural way for the body to repair itself. Various inflammatory chemicals, called cytokines, are released that increase clotting, cause blood vessel spasm, stimulate cell growth, attract other cells, and amplify the inflammatory process. Platelets, components of blood that initiate clotting, are activated, and accumulate together with white blood cells (monocytes, lymphocytes) in this festering area of the artery. The smooth muscle in the arterial wall thickens.
As part of the process, damaging, high energy particles are released called “free radicals”, which change “bad” cholesterol—LDL—in the blood to its oxidized form. The clotting components called fibrinogen and platelets, together with oxidized LDL, all become sticky, and adhere to the endothelial lining. These particles then migrate into the inner wall of the artery from the blood, and begin to trap other components, such as calcium. Large white blood cells form and ingest the particles of oxidized LDL, attempting to destroy them. But they too become stuffed and trapped. The entire mass of particles, dead white blood cells, cholesterol, smooth muscle, and later, calcium, form what is called a “plaque.” When seen through the microscope, a plaque has a “cap”, derived from smooth muscle cells, and a core of oxidized LDL, white blood cells, and cell debris, meaning left-over dead parts and trash. During repeated cycles of inflammation, more and more components are added to the plaque. As it grows, three things may happen: (a) the inside of the artery narrows, so less room is available for blood to flow past the plaque, or (b) the cap may become thin, and enzymes may liquefy the core, and the plaque may rupture, allowing a blood clot to form at that site. If blood flow to an area of heart muscle is blocked, the heart muscle may die quickly, producing what is called a myocardial infarction, or heart attack. Or, (c), part of the clot may break apart, travel in the blood, and cause blockages elsewhere. This process is known as embolization, and the migrating clots are called emboli. For oxidation, inflammation, and clot (thrombus) formation are the key processes. The cholesterol component, oxidized LDL, is a participant in the buildup, but is not the “root cause” of the problem. Still, high levels of LDL cholesterol alone can inflame the endothelium. [Oxidation can be regarded as the biological equivalent of rusting. Antioxidants retard this process].
Risk Factors
What are the factors that raise the risk of atherosclerosis? They are usually divided into those that we cannot do much about, and those that we can.
Non-modifiable Risk Factors (Cannot be changed)
- Age
- Gender
- Family history–Inherited tendencies
- Personal history of cardiovascular disease
- Coexisting other diseases, such as kidney disease, that are inherited in large part
Modifiable Risk Factors (Can be changed, at least in part) and associations
- Smoking cigarettes, cigars, or chewing tobacco
- High blood pressure
- Overweight and obesity, especially visceral or abdominal obesity (“apple” rather than “pear” shape)
- High levels of cholesterol in the blood: low density lipoprotein [LDL or “bad cholesterol, or other cholesterol particles: very low density lipoprotein (VLDL), lipoprotein “little a” (Lp(a)), and others], or very small, dense, LDL particles
- Low levels of protective high density lipoprotein (HDL, or “good” cholesterol)
- High levels of triglycerides (common fat) in the blood
- Diabetes (high glucose or high insulin levels, insulin resistance)
- Metabolic Syndrome (high glucose or insulin levels, insulin resistance)
- Physical inactivity
- Inflammatory states, including high levels of C-reactive protein (CRP)
- Inflammatory diseases elsewhere in the body: rheumatoid arthritis, gout, others
- High levels of lipoprotein-associated phospholipase A2 (Lp-PLA2), an enzyme in the blood
- High levels of homocysteine in the blood (some forms are inherited but may still be modified)
- Chronic dehydration
- High levels of fibrinogen in the blood
- Low levels of free testosterone in the blood
- Chronic kidney disease
- Stress, hostility, maladaptive chronic anger, “hot reactors”
- Depression
- Migraine headaches with auras
Other Factors or “Markers” That are Associated with Heart Disease
- High levels of an enzyme called myeloperoxidase in the blood, a marker for inflammation
- Persistent elevations of white blood cell counts
- Low blood levels of vitamin K
- High blood levels of phosphorus
- High values of a marker in the blood called B-type natriuretic peptide (BNP)
- Blood renin content (a hormone released by the kidney that raises blood pressure)
- Ratio of the level of a protein, albumin, to a chemical, creatinine, in the urine
- Certain drug abuse
- Male pattern baldness
- Low levels of anti-inflammatory omega-3 fats in the blood and tissues
- Low or high thyroid function
- Low potassium intake
- Resting heart rate over 90
- Some types of ear lobe creases
- Inherited alterations in inflammatory molecules and the genes that control them
- Small stature
- Sleeping disorder/obstructive sleep apnea
- Very high or very low protein intake
- Small arterioles (small artery divisions) and/or large venules in the retina (back of the eye tissue)
It has been said that 90% of the time, heart risk may be predicted using only the classical, more important risk factors (bold), and that the “novel” risk factors need only be considered 10% of the time. Certain ones, for instance, fibrinogen, are capable of increasing the incidence of heart attacks two- to four-fold. C-reactive protein is not only an important marker for inflammation, but also a cause of further inflammation. Up until now, a composite risk factor was calculated according to data from the Framingham Study, predicting chances of a heart attack over the next 10 years. This Risk Assessor Tool used age, gender, total and HDL cholesterol, smoking history and systolic blood pressure to calculate risk. In women, up to 20% of all coronary events occur without these risk factors. Earlier this year, a more accurate Reynolds Risk Score was validated for non-diabetic women, which includes a history of heart attack before age 60 and the CRP value.
A recent study tracked over 15,000 people who adopted just 4 improved habits after age 45. Only 4 years after they did, they were 35% less likely to have heart disease, and 40% less likely to have died over 4 years than those who did not adopt the good habits. They were (i) eating 5 servings of fruits and vegetables daily, (ii) exercising at least 2 ½ hours per week, (iii) controlling weight, and (iv) not smoking. The study was published in the American Journal of Medicine, July, 2007.
Diet and Physical Activity to Lower Risk for Heart Illness
Human genetic makeup and what it determines—the biochemistry of the body, have not really changed since the Paleolithic period (2.5 million years-10,000 years ago) when we were hunter-gatherers, foraging for food much of the day. Our bodies’ needs and “rules” for handling food components—carbohydrates, fats, and proteins—have remained the same for these many years. The human body in those times, and today, was ideally suited to a diet of vegetables, fruits, and lean meat—high in fiber, beneficial and protective chemicals in plants (phytochemicals and antioxidants), complex carbohydrates, good fats (omega-3, antiinflammatory fats, such as fish oil*), protein, minerals (potassium, magnesium, zinc, selenium, others)—and vitamins. Our ancestors’ diet was low in saturated and trans fats*(both raise cholesterol and the risk of heart disease), salt (sodium), refined sugars and oils, and adulterants (preservatives, additives, etc).
About 10,000 years ago the agricultural revolution began with wheat and barley cultivation, along with pig, goat, and sheep farming in the Middle East. Over time agriculture was able to feed more people, and the population surged, but the fare changed drastically to include salt, butter and cheeses, eventually ice cream, fatty meats, refined white flour and its products, refined sugar and high fructose corn syrup, processed foods and vegetable oils high in omega-6 fats (pro-inflammatory). Along the way, a striking reduction in outdoor physical activity promoted weight gain and reduced the ability of our bodies to make vitamin D… Fast forward to 2009. We are genetically and biochemically the same as our forebears, but we face numerous degenerative, inflammatory diseases—cardiovascular disease (including high blood pressure, coronary artery disease, stroke, peripheral artery disease), arthritis, diabetes, cancer, obesity, osteoporosis and Alzheimer’s disease). Is this related to the mismatch between what we are genetically programmed to need, and our present diet and lifestyles? Science answers with a resounding “yes”.
Current American food intake contains nearly 65% of calories from refined grains (carbohydrates), full fat dairy, sugary drinks, oil and dressings, sugar, and candy. The rest includes “fast foods”—hamburgers, hot dogs, lunch meats, and pizza—about 150 slices/year for each of us. Our most consumed and beloved “vegetable”, source of vitamin C and perhaps potassium—French fries, with its accompanying obligatory fat and salt accompaniment, is an embarrassment to our society (the average intake is 130 orders of fries/person/year, and about 50 large bags of salted potato chips/person/year, in addition to the fries).
GENERAL ASPECTS OF THE HEART HEALTHY DIET
William Castelli MD, Director of the Framingham Heart Study, a distinguished ongoing analysis of the determinants of heart disease, estimated that alterations in diet could lower the risk of heart disease as much as 85%.
Q: What is the best diet to lower the risk of developing cardiovascular disease, and to help those already suffering with heart disease?
A: There is no ideal diet for all persons, because of individual variation, especially with a chronic health problem, when the “best” diet depends upon medical history. However, there are some time-honored, well-proven principles you should learn about and follow.
Fats (lipids)
Our ancestors subsisted on a diet composed of 23% saturated fats*, 20% polyunsaturated fat*, and 57% monounsaturated fat*. The typical “Western” diet contains 53% saturated fat, which raises LDL (“bad”) cholesterol and the risk of heart disease drastically [2% for each unit (mg/dL) rise]. While the amount of dietary fat should be generally low, the type of fat consumed is more important than the amount. Trans fat* ingested is best at zero; saturated fat, the least that you can live with; and heart-healthy polyunsaturated and monounsaturated fats (especially olive oil) making up the difference. The American Heart Association (AHA) and WHO recommend ≤30% of total calories be consumed as fat, with <10% as saturated fat. For those with established risks for heart disease, these decrease to <20% and <7% respectively. Remember that saturated and trans fat drives up cholesterol levels much more than dietary cholesterol, since the amount in our blood comes primarily from the cholesterol we make, rather than from what we absorb from food. Replacing dietary saturated fat with unsaturated fat reduces heart risk more than simply lowering total fat intake.
Polyunsaturated fats come in two varieties—omega-6 and omega-3*. The difference is chemical but important, since omega-6 fats are pro-inflammatory, and omega-3 fats are anti-inflammatory. The ideal ratio of omega-6 to omega-3 fats in the diet is about 1-2:1, but the American diet sports a ratio of nearly 20:1. The ratios that common vegetable oils contain vary from high (peanut, safflower, sunflower, sesame, corn), with ratios over 200:1 to 85:1; to soybean and walnut, which are intermediate; to canola and flaxseed oils, which are low (2.0 and 0.2). Most processed foods such as breads, crackers, chips, cakes, cookies, doughnuts, muffins cereals, pies, pastries, candies and confections—and fast foods—are high in omega-6 fats (and also have trans fats, “high-glycemic” carbohydrates*, sugar, and excess salt to impair your health further). Even one large snack with any of these, or a single fatty meal, may stop arteries from opening for hours. Animal fat is especially harmful. Generally, the more plant foods consumed, the healthier the diet.
Even with the emphasis on reducing dietary fat intake popular in the 1990s, from 1970 to 2003, while the food available for each person in the US rose from 1675 lbs to 1950 lbs along with average caloric intake, per capita consumption of added fats and oils rose 63%, accounting for 42% of the rise in additional calories we each consumed. We gained weight, especially around the middle.
Fish oil and flax oil are two common sources of beneficial omega-3 fats. Fish oil may lower the risk of heart attacks as much as 50%: in one study, the risk of unstable angina or heart attack was reduced by 62% for every 1.24% increase in blood levels of fish oil (EPA and DHA*). In addition, fish oil also stabilizes the electrical system of the heart, and significantly lowers the incidence of sudden death.
The evidence that the omega-3 fat in flax, alpha linolenic acid, reduces the risk of heart disease, is certainly not as strong*. Fresh fish consumption is being limited to 1-2 meals per week, because of mercury and other contaminants in fish, which is not a problem in quality fish oils.
COMPOSITION OF OMEGA-6 AND OMEGA-3 FATS IN SOME OILS.
To find out how much fat you are “allowed” at 30% of total caloric intake, you must make a small calculation*. Examples of calculated results are
| TOTAL CALORIC INTAKE |
AMOUNT OF TOTAL FAT “ALLOWED” (grams) |
| 1,600 |
53 or less |
| 2,200 |
73 or less |
| 2,800 |
93 or less |
Carbohydrates
When grains are processed, the fibrous bran, and portions containing vitamins, minerals, and phytochemicals are removed. The white flour produced, and products made from it, are “high-glycemic”. This means that, after being consumed, they raise blood sugar to relatively high levels quickly. The rapid rise in glucose stimulates insulin release. The process continues as more triglycerides (the fat currency in the body) are synthesized (made) from carbohydrate. Of course, eating sugar and high fructose corn syrup (HFCS) causes the same sequence. Often the foods with the highest glycemic index are also the ones that are heavily processed.
High glycemic diets are associated with insulin resistance, meaning diabetes and the “metabolic syndrome”, a group of findings that tend to cluster together—high blood pressure, abdominal obesity (apple shape), poor sugar tolerance (elevations in blood sugar, insulin resistance/high fasting insulin levels), high blood triglyceride levels, and low levels of protective HDL-cholesterol*. High glycemic diets are also associated with small inflammatory molecules, many released from the abdominal fat* itself. High glycemic diets raise the risk of cardiovascular disease, as do both diabetes and metabolic syndrome*. In fact, the presence of diabetes is considered, from a future risk point of view, equivalent to having already had a first heart attack. In someone who is overweight or who suffers from insulin resistance, a high glycemic diet is particularly likely to raise risk for heart disease. For these reasons, maintaining a healthy weight is a central first step toward preventing future heart attacks.
Whole grains, on the other hand, contain more fiber and essential nutrients, and, when consumed, not only lower blood fats and improve cholesterol ratios, but lower risk of heart disease. Part of this is due to the fiber (soluble, insoluble, and lignans), part to the vitamins and minerals, and part to the antioxidants and phytochemicals they contain. Whole gains are emphasized in every credible heart-healthy diet proposed. They also reduce the mortality from inflammatory diseases. That said, even as the benefits of whole grains is increasingly recognized, the value of consuming more vegetables and fruits, rich in fiber and other nutrients as well, may be even more important.
Fiber is usually noted for its ability to stabilize blood glucose levels and prevention and/or improvement in many digestive disorders, including some cancers. Hunter gatherers consumed >90 grams of fiber daily, compared to only 9-12 grams in the average American diet. Ideally, we should strive to raise this to 35-40 grams, total of both soluble and insoluble fiber, gradually.
Refined sugar and sweets
Sugar consumption is now acknowledged to be a health hazard. Not only is it the epitome of “empty” calories or “junk food”—devoid of nutrients—it is associated with the metabolic problems mentioned above, and is a major player in causing weight gain, producing childhood obesity, raising the risk of diabetes, heart disease, etc. Fructose (HFCS) is even more liable to produce fatty plaques in arteries than glucose. Americans consume over 150 lbs of sugar and 566 cans of “liquid candy”—soft drinks—equivalent to over 52 tsp of added sugars per person per day, over 6 tons in a lifetime. That it is dissolved in drinks misleads us; few of us would actually sit down and eat 25 tsp twice a day. Actually, the sugar is not all consumed in soda. There are also the 195 candy bars and 125 pastries and desserts each of us average annually as well, not including ice cream. Hidden sugar represents about 25% of the daily caloric intake of Americans, and the sugar in soda and other drinks alone contains 8% of our daily calories. We are genetically programmed to consume just a couple of grams daily: in prehistoric times rarely did humans eat sugar, just when they stumbled upon a bee hive. In 1800 Americans averaged only 12 lbs a year; now we are over 150 lb of sugar each per year.
Salt (sodium)
Salt, like sugar, is consumed in huge amounts unnecessarily, again at odds with our genetic and biochemical machinery. Most of the excess, 80%, is hidden in processed foods, which now form a large part of our diets. Sodium intake is a classic risk factor for high blood pressure. While the sensitivity of a given person’s blood pressure to ingested salt varies, most authorities agree (a) functionally, no human needs the extra salt (other than in a couple of very rare diseases), (b) in general, minimizing salt intake does no harm, and (c) in populations, limiting salt intake is an effective means of controlling high blood pressure. In the April 19, 2007 issue of the British Medical Journal, two studies found that reducing salt intake by 25 percent to 35 percent could cut the risk of cardiovascular disease by as much as 25 percent and lower the risk of death by 20 percent.
The FDA recommends 1,500-2,400 mg of salt intake daily; the Institute of Medicine recommends a maximum of 1,500 mg a day. The American average takes in over double this amount, and there are some people who consistently consume 8,000 mg or more per day. A typical single fast food meal can easily contain 5,000 mg. Humans can do well on about 200 mg per day, about one tenth of a teaspoon of salt. Although excess salt intake kills about 150,000 persons annually, it impairs far more, since every American with hypertension (1 out of 3), diabetes, prediabetes and metabolic syndrome (together, 25% of us) may be susceptible to increases in their blood pressures. Salt causes water retention, and so those with heart failure, liver, and kidney disease may be at risk. Salt may also damage the stomach lining and predispose to gastric cancer. A high ratio of salt to potassium intake is also linked to osteoporosis (thin bones), loss of calcium, and relative acidosis. A significant percentage of patients who lose control of their blood pressure, or who are hospitalized with acute water retention, have worsened because of excess salt intake. Even a small but sustained rise in blood pressure raises the risk of heart disease and stroke. High blood pressure is a “silent” disease, and a rise may be undetected for some time. Only 50% of people with it are controlled at any given time, and about 1/3 of people who have high blood pressure don’t know it.
Sources of salt in the American Diet
Excess dietary sodium accounts for 17%–30% of hypertension world-wide. The October, 2009 issue of The Canadian Journal of Medicine 181:605-609 (http://www.cmaj.ca/cgi/content/full/181/9/605) contains a review of the harmful effects of sodium on blood pressure with respect to public health.
Where is the hidden salt? In cans, soups, broths, hot dogs, bacon, ham, sausage, and processed lunch meats, commercial sandwiches, bags of chips, pretzels, crackers, snacks, cookies, bread, rolls, bagels, pies, muffins, cake, doughnuts and other baked goods (baking soda contains sodium), cereal, peanut butter, frozen dinners, salad dressing, milk, cheeses, creams, puddings, butter, mayonnaise, condiments (soy sauce, teriyaki, ketchup, mustards, mixed seasoning, tenderizers), bread crumbs, tomato/pasta sauces, gravies, vegetable juice, jars of jalapenos, pickles, relish, green olives, sauerkraut, pizza, desserts, tacos, enchiladas, tamales, giros, bruschetta, Chinese food (MSG), all fast foods and restaurant meals, and more.
Summary of nutritional and activity recommendations
- Favor a plant-based diet with plenty of vegetables and fruits (9 servings* generally for a ≤2,000 calorie diet, 11-13 for higher caloric intakes).
- Favor whole grains. Avoid refined, “high glycemic” carbohydrates. Follow the rule of whites: avoid white flour and its products (bagels, doughnuts, etc), white bread, white crackers, white rice, white pasta, white potatoes, white salt, and white sugar. This includes pizza dough.
- Eat little red meat, basically using it as a condiment, and keep it lean.
- Favor chicken and turkey breasts grilled, baked, or broiled.
- Eat 1-2 servings of fish weekly, and/or supplement this with quality fish oil.
- Consume fat-free dairy if you use dairy products.
- Chose fats and oils wisely. Keep trans fats to the absolute minimum, saturated fats extremely low. Learn about fats and oils. Consider a small handful of walnuts or almonds 3-4 times per week.
- Drink plenty of water, not sugary drinks or soda pop.
- Drink alcohol in moderation (1 drink daily for women, 2 for men). Consider a glass of red wine daily.
- Take a quality multivitamin/mineral daily.
- Eat in moderation, preferably in smaller, frequent meals. Maintain a healthy weight. Read labels carefully. Be aware of the nutritional content of what you are eating at all times. Avoid mindless eating.
- Get adequate sleep.
- Do not smoke.
- Eat breakfast.
- Be willing to retrain your palate. It takes time to acquire tastes for new foods, and trade in the desire for the texture of fat for the feel of greens.
Our recommendations above are based upon the last 17 years of nutrition research available in the preeminent journals in the field, such as the American Journal of Clinical Nutrition, Nutrition, Nutrition Reviews, Proceedings of The Nutrition Society (UK), Annual Review of Nutrition, and Journal of The American College of Nutrition. Related papers appear in Circulation, Circulation Research, Hypertension, Atherosclerosis, Thrombosis and Vascular Biology, all Journals of The American Heart Association, as well as Diabetes, Diabetes Research, and Endocrinology, published by The Endocrine Society and American Diabetes Association. In addition, they embody the cumulative advice of these organizations to form a consensus of evidence, guidelines, opinions, experience and compassion: the American Heart Association, European Society of Cardiology, American Society of Angiology American College of Angiology, International College of Angiology, European Atherosclerosis Society, International Atherosclerosis Society, Heart Failure Society of America, National Lipid Association, American Society of Hypertension, American Association of Cardiovascular and Pulmonary Rehabilitation, International Society for Heart Research, Society for Atherosclerosis Imaging & Prevention, Council for Cardiology Practice ESC, American Association of Preventive Cardiologists, Lipoprotein & Vascular Disease Section-American Association for Clinical Chemistry World Heart Federation, The Heart Rhythm Society, and the Societe Francaise de Cardiologie (Paris).
The components of health that drive our purpose and methods are summarized in our logo:
Leonardo da Vinci (1452–1519) combined art and science to create the perfectly proportioned human (c1492). Building on Greek mathematical principles, the Vitruvian Man is an illustration of how balance and symmetry in health can produce extraordinary results from several core principles. The most basic of these components were emphasized by Hippocrates, the Father of Medicine. Years later this was expressed as Sit mens sana in corpore sano.
The original work is stored in the Gallerie dell’Accademia, Venice. One of Da Vinci’s most memorable quotes was: “Simplicity is the ultimate sophistication.” This is a variant of Occam’s razor [William Ockham (c. 1285–1349)]: Entia non sunt multiplicanda praeter necessitatem, or “Don’t make things unnecessarily complicated.” Razor refers to shaving off unnecessary assumptions to get to the simplest explanation, which has been used to guide scientists to basic explanations. Unfortunately, the pendulum has swung the other way, since the more science advances, the more we see that Mother Nature is extremely complex.
Commitment includes personal responsibility and ownership of your own health.
Unfortunately, the number of people with diabetes, pre-diabetes, and related conditions of poor glucose control have increased—wildly.
Blood glucose causes damage through a process called glycation, the same process that causes food to brown in an oven. When you cook sugar in a pan, it will become brown caramel. After more cooking it will become sticky. Glycation (defined as sugar molecules reacting with proteins to produce nonfunctional structures in the body) is this process combined with proteins, leading to deposits and disruption of key parts in tissues. Proteins become disfigured and destroyed, causing nerve damage, heart attacks, kidney disease, slow bladders, cognitive and memory loss, blindness, intestinal problems, and more.
We are experts in natural healing, and use an amazing number of natural products, most you may never have heard about. They support and unburden the body, giving it an opportunity to heal itself. Many of these substances and products have several specific effects which produce beneficial structural and functional changes in the person with sugar difficulties. For the most part, they are in the categories below.
This particular antioxidant has been approved for the prevention and treatment of diabetic neuropathy in Germany for nearly 30 years. Intravenous and oral forms reduce symptoms of diabetic peripheral neuropathy. Animal studies have suggested that it is more effective when taken with gamma-linolenic acid, a special anti-inflammatory omega-6 fat.
