Cardiovascular Disease: 
THE BEAT GOES ON
by Lynn Hinderliter CN, LNC

While there are some hopeful signs overall as far as heart attacks are concerned, Doctors are seeing an increase in problems associated with heart weakness, such conditions as cardiomyopathy and congestive heart failure.  There is a good deal of speculation about the reason for this.  In my opinion, one reason is that these heart weaknesses are the chronic manifestation of poor diet and lifestyle choices, as opposed to the the acute form, which is a heart attack. They should be addressed in two ways:

 one, by modifying lifestyle factors such as diet and exercise,
 two, by the judicious use of nutrients and herbs to protect and support heart function.

 These two approaches can again be divided into two: 

the prophylactic (measures taken to prevent the problem from occurring)
and therapeutic (measures taken to improve the condition).

I am going to start with overall guidelines for a healthy dietary, which are simply expressed: fresh, unprocessed, varied and moderate.  One cannot discount the results of Dr. Dean Ornish's heart treatment regimen, published in JAMA (1998; 280: 2001-7).  To summarize:  there were 20 patients in the experimental group, and 15 in the control.  The experimental group at a diet which was 10% vegetarian, did moderate aerobic exercise, added stress management, and stopped smoking, while the control group followed their individual Doctors' recommendations, followed the American Heart Association's Step 2 diet, and 60% of them took lipid lowering drugs. Experimental patients reduced chest pain by 91% at the end of one year, and 72% after 5 years, while the control group reported as 186% INCREASE in angina frequency after one year, and a 36% increase after 5 years.  Low density lipoproteins were the same in the groups whether they took or did not take lipid lowering drugs.  In the experimental group, coronary artery blockage decreased by 3.1%, in the controls it increased by 11.86% The control group also experienced twice as many cardiac events as the experimental group.  These were, in my opinion, very low impact interventions, since no supplements or vitamins were used, and even so - look at the results!

For my specific recommendations on a healthy dietary, read my article.

Of particular interest, bearing in mind that last remark, is a new analysis from the Erasmus University Medical School in Rotterdam (Am. J. of Clin. Nutr., Feb 99; 69(2):261-6) where subjects were graded by antioxidant intake, and it was found that those in the top third of beta-carotene intake from food (2.11 mg per day) had 55% the risk of heart attack of those in the bottom third (0.84 mg per day).  However, when intake from food and supplements was combined, the risk dipped to 49%.  If the person in question was a smoker, the protection was even greater - only 33% of the risk of heart attack as former smokers with low beta-carotene consumption! (Nutr. Sc. News; July 99: 313).

Of all antioxidants, the most important for heart health is Co-enzyme Q10. 

I remember CoQ10 being attacked in Dr. Gott's newspaper column some years ago, and would like to quote Dr. Julian Whitaker's reply verbatim:

Dr. Judy, of the Southeastern Institute of Biomedical Research in Bradenton, FL, has been conducting research into CoQ10 for nearly two decades.  He reports that studies on over 4200 people show that CoQ10 reduced heart problems in those already suffering from them, improved pumping and heart contraction, and reduced heart volume in almost 90% of those tested within between 24 and 90 days of starting to supplement them with from 100 to 250 mg per day.

In another study of 240 people with ischemic heart disease, 85% of those taking from 30 to 600 mg per day ( Lynn's note - 600 is a VERY high dose!) showed results with lessening of resting angina and exercise induced ischemia.  Arrythmias were also reduced by 50 to 100%.

Dr. Whitaker's book, Guide to Natural Healing, gives a number of other study examples and a search will turn them up in the hundreds:  this is a much researched and highly effective heart nutrient.

CoQ10 is naturally present in our cells, where it is essential for cellular respiration and energy production.  However, our supplies become depleted as we age, and replacing them from food is marginally practicable.  As an example, it would require two gallons of chopped spinach daily to provide 30 mgs of CoQ10.  Not only do we have less CoQ10 in our bodies as we age, but since it is a potent antioxidant, under conditions of oxidative stress - for example, pollution, smoking - available supplies of CoQ10 are used first to answer that need, and less of it is therefore available to supply the needs of the cell.  This sequence of events, where our body contains less of the nutrient through the natural process of aging,  increasing demands for it in its antioxidant role deplete our remaining supplies, and therefore less of it is available for essential energy production in the body's cells, illustrates the vital role CoQ10 plays in heart disease.  It is the energy produced in the cells of our hearts that literally determines the efficiency of our heartbeat!

One of the original clinical researchers into CoQ10's role in cardiovascular health Dr. Per Langsjoen of Tyler TX, went so far as to speak of it as the "crucial factor in cellular bioenergetics and free radical quenching". At this stage, I'm sure no one will be surprised to learn that 100 mg of CoQ10 is the first thing I would supplement with if I had heart problems of any kind. to include high blood pressure.  A minimum dose of CoQ10 would be 30 mg.  It appears to be even more effective if taken in conjunction with Vitamin E, but should in any event always be taken in conjunction with a form of fatty acids for maximum absorption.  There are CoQ 10 products on the market now that are combined with the lipids necessary for best absorption, and while they cost a little more they may be the solution for people who do not wish to supplement with additional EFAs.  See RESOURCES at right.

The information that follows is based on the book Eradicating Heart Disease, by Dr. Matthias Rath. Originally an MD in Germany, he joined Dr. Linus Pauling at his Institute, and worked side by side with the great man for many years.  I met Dr. Rath in California some years ago, and was very impressed by his findings.  Rather naively, I expected them shortly to be on everybody's lips, since they made so much sense to me, were based on excellent scientific studies ,backed by impressive patient results and published in an easy to read book..  But No!  That was not to be at the time - since then, however, I find more frequent mention of Lipoprotein (a), and Dr. Rath is now making a product line that has had great success in Europe available in the US.  See RESOURCES at right.

Dr Rath states that the main reason we experience atherosclerotic deposits in our arteries is that we are chronically  depleted of the vitamins, minerals and amino acids needed to maintain arterial integrity. Over time, as the deficiency of these nutrients continues, the deposits represent a desperate attempt at artery repair by our bodies. He claims without reservation that "optimum daily intake of Vitamins C and E, as well as the natural amino acids Proline and Lysine can help reduce these deposits and thereby reverse existing cardiovascular disease .... Vitamin C, the B-vitamins, Coenzyme Q10 and certain minerals and trace elements ... are therefore key to optimum cardiovascular health."

His thesis is that a diet low in Vitamin C leads to the formation of lesions in the walls of blood vessels, causing the blood vessel to actually leak blood. This prompts a repair molecule called Lipoprotein (a) to apply Apo (a), which we can think of as a kind of repair tape, to the affected area.  As the damage continues to occur, however, the response stimulus overreacts, and the resulting overcompensation leads to atherosclerotic deposits.  Imagine, as long ago as the 1940s, two groups of Doctors - the Canadian cardiologist Paterson, and Trimmer & Lundy in the U.S.  - had already noted that 70 to 80% of their patients had very low plasma levels of Vitamin C.

It is obvious that if the walls of our blood vessels were able to repel the threatened buildup there would be fewer deposits of the lipo protein (a) particles, and this is the role Dr. Rath attributes to Proline and Lysine. Lysine is an essential amino acid:  that is to say, the body is unable to manufacture it and we must obtain our supplies from our diet.  Those of us susceptible to fever blisters may be aware that they erupt when there is too little lysine in relation to Arginine in our diet, and therefore we know how easy it is to be deficient in L-Lysine.  It is also known that L-Lysine is essential for calcium metabolism, and  that calcium plays a role in regulating many of the cellular, biochemical and molecular functions that are frequently abnormal in cardiovascular disease. Proline is classified as a non-essential amino acid ( our body can manufacture it) but it appears that under high risk conditions for heart disease, the body is unable to manufacture enough.  Lysine and Proline are important to this process because they are natural anti-adhesives, not only  preventing  the deposit of further fat globules in the blood vessel wall, but releasing all types of deposits which ate already there such as low density lipoproteins.  Dr, Rath recommends 500 mgs of each per day ,and up to several grams per day therapeutically:  he states that there are no side effects. 

New research on the amino acid L-Arginine is also of interest here, particularly to angina sufferers.  It appears (research by the Mayo Clinic's Dr. A.  Lerman, published in Circulation) that L-Arginine acts on the lining of blood vessels to relax the muscle wall, thereby easing chest pain as well as inhibiting the build-up of plaque.  Another study in Circulation (Feb 1998;97:363-8) showed that intravenously administered Vitamin C, or 1 gm oral Vitamin C daily, led to increased arterial dilation in patients with chronic heart failure.  The method of action appeared to be  inhibiting the oxidation of nitrous oxide, leaving it available to ensure healthy dilation of the blood vessels.

When considering other reasons for the new epidemic of heart problems, it is alarming to realize the connection between NSAIDS ( non-steroidal anti-inflammatory drugs, such as ibuprofen) and heart failure.  Jack Challem, the well known nutrition writer, reports (Lets Live Aug 2000) that Australian researchers show that nearly ONE FIFTH of heart failures may be attributed to these drugs, which are very widely used.  In the same interesting article, Mr. Challem traces the connection between cardiomyopathy and mutation of the Coxsackie's B virus.  While this virus is relatively harmless in its causative role of sore throats and the like, it appears that in the absence of sufficient Vitamin E and/or selenium (both of which are undersupplied in diets of processed foods) it can mutate and attack the heart. 

The putative role of NSAIDS in the increase in heart disease is harder to understand when one looks at new research implicating inflammation generally in  poor heart health: Dr. Giles & colleagues (Am J Respir Crit Care Med 2000;162:1348-1354) examined a study conducted from 1976 to 1992 on 8900 adults, and stated "What we found was that people with an elevated white count were 40% more likely to die from coronary heart disease after taking into account a number of traditional risk factors".  See RESOURCES at right for more info.

The study showed that patients with a WBC count over 7.6 were at much higher risk of dying from Coronary Heart Disease, even after adjusting for other risk factors. The new findings support a role for inflammation as a causal factor in the pathogenesis of CHD, the authors say. "We really don't know whether reducing white count will lower the risk," Dr. Giles added in an interview. "That's where we need more studies."

It would appear that persistent inflammation (triggered by viruses, bacteria and even toxins) causes the formation of a protein called FIBRIN,  which is implicated in blood clots. A Dr. Sumi, in Japan, has recently made the discovery that an enzyme in a food called NATTO, from fermented soybeans, can block this process, and actually resolve thrombi.  It also decreases the viscosity of the blood, and of course, thicker blood means higher blood pressure and more work for the heart.  It goes without saying that this cannot be used by people with bleeding problems, and only under the care of a health professional if you are already on blood thinners.

This may be one of the connections to the fact that high levels of iron are a risk for heart disease:  although iron is an essential and important nutrient, excessive levels can be very dangerous for the liver and the heart, and can cause significant harm. A new study has shown that excess iron can cause damage to the endothelium, the inner lining of blood vessels, increasing a person's chances of developing hardening of the arteries and heart attack. The mechanism of action seems to be that high iron levels impede the action of nitric oxide, a chemical released by the endothelium which aids on keeping blood vessels relaxed. The lead study investigator, Dr. Hidehiro Matsuoka of Kurume Medical Scholl, states that consuming high amounts of iron long term may increase iron levels in the body, and suggests that people over 40 who have other risk factors for heart disease might find it useful to have their iron levels checked.  Researchers in his study injected volunteers with high doses of iron (0.7 mgs per kg of body weight) and used ultrasound imagery to observe the functioning of the artery walls:  they found that the iron raised levels of malondialdehyde, a chemical marker for oxidation, and inhibited normal endothelial function.

Interestingly, with the debunking of the HRT/Women's heart health theory,  which was based on the possibility that  extraordinarily low rate of heart disease in young women was due to hormonal protection, another theory which makes more sense to me comes to the fore:  and that is  that the blood-letting of the menstrual cycle each month keeps IRON levels low in pre-menopausal women.  For a complete report on this,  see RESOURCES at right.

Meeting of the American Heart Association's Council for High Blood Pressure Research, Oct. 2000.  I am indebted to Dr. Mercola for this information:  his wonderful newsletter is at http://www.mercola.com/

I am struck by the fact that each time I address a substance I consider essential for the heart I find myself saying to myself as I write "THIS is the most important one!"  Maybe this is why I had a lady ask me the other day whether I take all the things I write about - well, the answer to that, of course, is that I don't suffer from all the things I write about!  However, I do take a considerable number of supplements, and magnesium is high on my list of musts. One because I did at one point have a mild arrhythmia, two because of its extreme importance in our bodies and three because of the high incidence of magnesium deficiency. I would also add four many people lack the stomach acid to  absorb magnesium.

To take the second point, magnesium plays a part in all the enzyme reactions in the body, and also is essential ( with the other important electrolyte, potassium) for the "firing" of nerves and muscles.  This means that few of the body's vital processes take place efficiently in the presence of low levels of magnesium.

Third and fourth points: among older people, deficiencies of magnesium are especially common because processed foods contain low levels of the mineral, though it is abundant in whole foods.  Magnesium levels are also adversely affected by alcohol consumption, diuretics, antibiotics, diabetes, kidney problems, and HRT. (Among younger women, birth control has the same effect.  Think cramps!)  Then too, production of hydrochloric acid, necessary for absorption of magnesium, decreases with age.  Often these deficiencies go unrecognized, because magnesium levels are inefficiently measured through blood tests: most magnesium is stored in the cells. Ironic, that diuretics, often prescribed for heart patients, deplete the body not only of potassium ( a fact which is often addressed) but also the heart-important magnesium .

One of my preferred reference books is Dr. Werbach's Nutritional Influences on Illness, and I looked in the index to refresh my memory on some of the uses of magnesium:  it did not surprise me to find some 47 health conditions listed, with the relevant research. since some "radical" naturopathic health professionals consider asthma, heart problems, fibromyalgia, menopause, PMS and migraine all the be, to one degree or another, magnesium deficiency diseases.  But I will limit myself to the heart, and give some examples of the excellent results magnesium supplementation can have.

The role of magnesium in cardiac arrythmias was first acknowledged as long ago as 19435, and in 1989, the American Journal of Cardiology (63(14):43G-46G) published a study by Dr. Roden saying "the association between hypo-magnesia (Lynn:  hypo= low) and arrythmias ... has long been recognized.  More recently, acute intervention with magnesium in patients who are not hypomagnesic has demonstrated arrhythmia suppression.."  In cases of High Blood Pressure, a 1981 study found that 50% of patients with HBP had low magnesium levels ( Lynn:  bear in mind this was almost certainly based on blood readings,which refelect circulating levels, not cellular storage amounts, so in my opinion the true number would be much higher!) and their hypertension was reversed when their magnesium levels rose. It is also interesting that many women  who develop HBP do so after menopause, which makes the magnesium connection particularly important for them, especially if they are on HRT.  As a bonus,  Dr. Alan Gaby (NSN Vol.5 #9 p.402) says adequate levels of magnesium in post-menopausal women increase bone density levels.

Another really interesting study showed that when a patient is deficient  in magnesium, normal levels of a medication which would usually take care of the problem are of no help - more is needed to get results, unless the mineral deficiency is addressed.  To restate that in reverse; if an underlying magnesium deficiency is identified and addressed, you may need les of your medication to get results.  If such a deficiency exists and is NOT addressed, you will need higher than normal levels of medication to get results.

Magnesium is also important for patients with Cardiomyopathy, and Dr.  Michael Murray reports that magnesium levels "correlate directly with survival rates".  It is unfortunate that many of the conventional medical drugs used for these conditions, such as calcium channel blockers, diuretics and beta blockers,  deplete the body of  magnesium.

Mentioning Calcium Channel Blockers brings me to some excellent information in Dr. Ronald Hoffman's book, Intelligent Medicine, (Simon & Schuster 1997, p.318-319) where he points out that the method of action of this class of drugs is to block the spasm-inducing effect of calcium, thus keeping blood vessels dilated.  He points out that calcium and magnesium compete for the same receptor sites in the smooth muscle wall of the blood vessel:  magnesium is the nutrient that relaxes spasms, so its presence in greater amounts than calcium will prevent spasms in the same way calcium channel blockers do.  This is why, when my Doctor prescribed a calcium blocker, I went away and took lots of magnesium.  Dr. H. says his protocol in patients with advanced heart conditions is to recommend magnesium in reverse ratio to calcium.  i.e., twice as much magnesium as calcium.  Buy his book, do:  it is full of excellent information. I recommend magnesium bound to either aspartate or citrate as being the most effective for absorption, and also to avoid the possibility of diarrhea that sometimes accompanies high doses.  I have had a hard time up until now finding a means to get extra magnesium in meaningful amounts at an affordable price, but there are now some powdered magnesiums on the market, and I can recommend Magna-Calm as an excellent strategy. See RESOURCES at right.

The following information may be of interest to you:

 Magnesium: Research Misconduct?

For the past 15 years evidence has stacked up showing patients with acute coronary thrombosis improve their survival chances by 50 - 82.5% when given intravenous magnesium of 32-66 mmol in the first 24 hours.  The single negative study showing that magnesium had a worsening effect on survival employed a far higher dose of magnesium (80 mmol) than the other studies. (European Heart J, 1991;12:12158), and one other study showing no benefit with magnesium employed the low dose of 10 mmol in the first 24 hours.

Although it would appear clear to any first year medical student that magnesium worked well for coronary thrombosis within the optimal dosage level of 30 - 70 mmol; that 10 mmol was shown to be too little, and 80 mmol had been shown to be too much, in 1990/91, the Fourth International Study on Infarct Survival decided to do a major study which was to definitely determine whether magnesium was beneficial when used for this purpose. Although their own meta-analysis of all earlier studies showed that magnesium was beneficial, the ISIS4 investigators also decided to test magnesium against the drug Catopril and a coronary vasodilator.

Astonishingly, the ISIS investigators chose to use the 80 mmol dosage for their study, the one dosage that had been found to be harmful.  It should be noted that the ISIS4 study was funded to the tune of almost $10 million by Bristol Myers Squibb, the manufacturers of Catopril.  Not surprisingly, magnesium lagged behind the drugs.

As a result of this paper, many hospitals ceased using magnesium in their treatment of acute coronary thrombosis.

The scandalous decision to use an overdosage of magnesium in this study must have caused the loss of several thousand lives within the study and many other lives in other hospitals that have now stopped using magnesium. Both nutritional pioneer Dr. Stephen Davies and Dr. Damien Downing, editor of the Journal of Nutritional and Environmental Medicine, criticized the designers of the study for clearly selecting too large a dose of intravenous magnesium, and also for giving magnesium too late and then too quickly.  Downing even titled his editorial "Is ISIS4 research misconduct?" (J Nutr Environ Med, 1999;9:513)

Now comes Feb 13th 2002, when Dr. Jeffrey L. Saver of the UCLA Stroke Center told attendees of the American Stroke Association's 27th International Stroke Conference that using magnesium intravenously by paramedics transporting acute stroke victims to the hospital resulted in "dramatic" recovery rates and levels for 25% of the patients.  No side effects were reported at all from a dose of 4 gms given en route, and 16 gms more infused over the following 24 hours. Dr. Saver noted that he instituted the study because of the neuroprotective effect noted for Magnesium in animals.
 

First, however, what it is. The prefix "L" would lead one to suppose that it is an amino acid - but strictly speaking, although its structure is similar to amino acids , it is more closely related to the B vitamins. It is considered a nonessential nutrient in the sense that the body can manufacture it from other nutrients present in the body (Lysine, Methionine, B6 among others, with Vitamin C being a limiting factor), but it is highly essential in its actions! In the diet it is found mostly in muscle meats ( as the name would suggest, coming from the Latin root for meat), and while it is rare for an actual clinical deficiency to exist, sub-optimal levels can lead to many problems associated with diabetes, obesity, cardiovascular disease and possibly Alzheimer's and muscular dystrophy.

The reason L-Carnitine can be involved in such a wide range of problems, and the reason for its extreme importance in the maintenance of heart health, is its influence on the destiny of the massive amounts of carbohydrates in the average American diet. Excess carbs. are stored as fat, and Carnitine facilitates the burning of fat for energy by making it possible for the long chain fatty acids it transports to enter the cell . After all, if the fatty acids cannot reach the mitochondria where they are transformed to cellular energy, it stands to reason they are going to be deposited in places where the body will suffer from their presence, as happens in fatty liver disease, fatty build-up in the heart, and your plain old everyday variety obesity, where fatty build-up occurs in the muscles.. My hero Dr. Whitaker compares the heart deficient in Carnitine to a car without a fuel pump! However, as you can plainly see, the heart is not the only organ that can benefit from more efficient burning of fats for energy: Carnitine has its uses in the following conditions: angina, myocardial infarction, recovery from heart surgery, hypertension and high cholesterol levels, also high triglycerides, Alzheimer's, liver disease (including alcohol induced liver problems) diabetes, diabetic neuropathy male infertility, diabetic neuropathy, Parkinson's and many other more obscure afflictions.

The average amount of Carnitine found in the daily diet is app. 50 mgs: therapeutic levels range from 500 to 1000 mgs. deficiencies may be due to a genetic error in Carnitine synthesis, or to low levels of lysine or vitamin C, high levels of homocysteine, or vegetarianism . There do not appear to be any side effects from its use even at high dosages, but it is wise to increase Vitamin C supplementation, since some studies show that high amounts of Carnitine cause loss of Vitamin C from the body. It is available as Acetyl-l Carnitine, L-Carnitine (these are the preferred forms) and is also marketed as DL-Carnitine, which in my opinion should be avoided since some experts say it interferes with the body's use of natural L-Carnitine.

Athletes have known about Carnitine's ability to burn fat for energy for some time, but heart disease sufferers are just beginning to realize the benefits that come from using a substance that provides the heart with its main fuel: the heart gets two thirds of its energy from burning fat! Less pain and more endurance can be associated with supplementing with L-Carnitine, with no downside! It works synergistically with Coenzyme Q 10.