The following information is provided for educational purposes only and has not been evaluated by the FDA. If you have heart disease or think that you may have heart disease, you should seek the help of a Board Certified Cardiologist in your area. If you do not know of any such doctors in your area you should contact your Primary Care Physician who will direct you to the appropriate specialist. If you have already been to a cardiologist, you may also benefit by consulting a Clinical Nutritionist or Naturopathic Physician in your area.
What is Heart Disease?
Heart disease covers a vast number of illnesses, which contain enough information to write volumes of books about. Because of this, we will specifically discuss coronary artery disease, which results from atherosclerosis or in more simple terms, hardening of the arteries.
Let’s first talk about the heart itself.
The heart serves as a pump that sends blood to the tissues that both supplies them with oxygen and removes metabolic waste such as carbon dioxide. It first receives deoxygenated blood from the peripheral tissues that has a high concentration of carbon dioxide. In the peripheral tissues we can say that the blood performs two functions. It drops off oxygen to nourish the tissues and picks up carbon dioxide, which is a form of metabolic waste that the body produces. The blood essentially serves the body by dropping off food (oxygen) and also works as a garbage truck by picking metabolic waste (carbon dioxide). So we can in effect say that the blood serves both as a milkman and a garbageman. The specific molecule within the red blood cell that performs this action is known as hemoglobin. Hemoglobin is like a small bus that drops off oxygen molecules and picks up carbon dioxide molecules.
The heart consists of four chambers: the right atrium and right ventricle and the left atrium and left ventricle. To better explain this, let us trace the path of a blood cell through the heart. We will start in the right atrium.
Blood that has already supplied the body with oxygen and has picked up carbon dioxide now enters the heart at the right atrium. It then dumps the blood into the right ventricle. In the heart, the atrium acts as a holding chamber that ultimately delivers the blood to the ventricle, which serves as a pump.
The right ventricle then pumps the blood via the pulmonary artery to the lungs to accomplish two things. First, to drop off carbon dioxide into the lungs where it is exhaled and second to re-oxygenate the blood so that the blood may go back out to the peripheral tissues and again supply them with oxygen. Once the blood has dropped off its carbon dioxide and picked up oxygen it is now ready to go back out to the peripheral tissues to supply the body with oxygen.
This happens the following way. First, the blood leaves the heart via the pulmonary vein and then enters the left atrium. From the left atrium, the blood is then dumped into the left ventricle where it is pumped out to the peripheral tissues to again supply the body with oxygen.
Let us now summarize the path of a red blood cell through the heart first starting from the body/peripheral tissues toà
1. the right atrium(holding chamber)à
2. right ventricle(pump)à
3. pulmonary arteryà
4. lungs(drop off carbon dioxide and pick up oxygen)à
5. pulmonary veinà
6. left atruim(holding chamber)à
7. left ventricle(pump)à
8. to the body/peripheral tissues(drop off oxygen and pick up carbon dioxide).
Now, some of this blood will supply the heart itself with blood since the heart is a very busy organ and needs a lot of oxygen in order to function. The arteries that supply the heart with oxygen are known as coronary arteries. The problem with coronary artery disease occurs when these arteries become clogged through a process known as atherosclerosis. Simply stated, with age, our arteries can get clogged with fatty deposits as a result of injury to the blood vessels over the years.
When a coronary artery gets clogged, whatever part of the heart that this artery is supplying will not get the oxygen that it needs and this will result in the death of the cells that are supplied by this artery. This process is what is known as a myocardial infarction or in layman’s terms a heart attack.
While many people survive heart attacks many do not. This is not because a small part of the heart has died but is because of a different reason. The reason is the fact that the heart works as a unit. If it did not, it would never be able to synchronize one portion of the heart with another and without proper timing, the heart could not function as it was designed to. Proper timing in the healthy heart is a very good thing, but in the event of a heart attack, this turns out to actually be a bad thing. This is because if one part of the heart goes bad or dies, it can (because the heart functions as a single unit) effect the rest of the heart so that it will no longer function normally.
What often happens is that one part of the heart becomes blocked. This blockage will cause the rest of the heart to stop pumping and go into a quiver which doctors call ventricular fibrillation or v-fib. In V-fib the heart cannot pump blood and the person will die if the condition is not corrected in a very short order.
Having now explained the process of coronary artery disease, let us now explain first what some of the causes are and then what we can do to slow down or interfere with these processes.
Let’s now discuss the causes of coronary artery disease.
The bad news is that there are many contributing factors to coronary artery disease. The good news is that almost all of the causative factors can be effected by lifestyle modification. While the following factors are not in any way intended to be exhaustive, the majority of people with coronary artery disease have at least one or more of the following:
Inflammation is a normal process that the body uses to respond to illness, infections and injuries. Everyone has at least some level of inflammatory activity going on within their body even without an infection or injury and this is not necessarily a problem. The problem occurs when the body’s level of inflammation becomes higher than it needs to be. When this occurs, an individual would then be considered at a higher level of risk for atherosclerosis and heart attack.
This information brings forth a couple of questions. First, what factors subject a person to elevated levels of inflammation? Second, how does one know how much inflammation is in their body at any given time?
Let’s deal with the first question. Being overweight, having higher than normal levels of cholesterol, LDL’s or triglycerides, having diabetes, gum disease and just getting older all predispose a person to increased levels of inflammation.
Second, If a person is interested in finding out how much inflammation is going on in their body there are certain tests that can be performed. One is known as C-reactive protein which is measured in mg/liter. To determine cardiovascular risk one must perform the Cardio C-Reactive Protein Test. An optimal level to be under 1 mg/liter. Between 1-3mg/liter is an average risk and above 3mg/liter represents a higher risk for a cardiovascular event.
Are there supplements that I can take to lower inflammation?
There are indeed. Some examples are bromelain, boswellia, circumin, essential fatty acids, ginger, and magnesium.
Bromelain is a supplement found in pineapple. It acts as an enzyme and also has natural anti-inflammatory properties
Boswellia is an herb that is known to inhibit inflammation
Curcumin a substance found in tumeric, which is used frequently in Indian cooking has anti-inflammatory properties. Circumin also helps maintain healthy cholesterol levels.
Essential Fatty Acids which are found in fish oil and flax oil have strong anti-inflammatory properties.
Ginger has anti-inflammatory properties and helps to maintain healthy cholesterol levels.
Magnesium is involved in hundreds of chemical reactions within the body. When magnesium is deficient, many of these processes are effected and the result is increased levels of unwanted inflammation.
How else can I lower my inflammation levels?
There are several ways that one can effect their inflammation levels.
The first is to lose weight if in fact you are already heavier than you should be. This would include a healthy diet and regular exercise.
In the world of cardiovascular disease, homocysteine should be taken seriously.
Homocysteine is an amino acid that is directly related to coronary artery disease. There are several reasons for this.First homocysteine makes cholesterol more dangerous by allowing it to become oxidized which then leads to arterial plaque formation. Second, homocysteine promotes clot formation and thus makes the blood “stickier” and more likely to form blockages. Third, homocysteine also causes damage to the arterial wall making it more susceptible to plaque formation and also results in a loss of pliability within the blood vessel.
Needless to say, a person who desires optimal health would in no way want to have elevated homocysteine levels. Having discussed the bad news about homocysteine, let’s move on and discuss the good news of how we can keep homocysteine at healthy levels.
Nutrients that are most known for lowering homocysteine levels include vitamins B6, B12 and folic acid. Other nutrients that are also helpful but less often discussed as being helpful against homocysteine include: trimethylglycine, choline, inositol and zinc.
Syndrome X involves the body producing too much insulin. Increased insulin results in salt retention which subsequently results in water retention as well. Excess insulin also results in increased levels of adrenaline which along with increased water retention, results in elevated blood pressure which in itself is detrimental to the arterial wall.
Characteristics of Syndrome X include elevated triglycerides, decreased HDL levels, high blood pressure, increased abdominal fat, increased insulin resistance resulting in impaired glucose metabolism and increased levels of uric acid resulting in an increased risk for gout. If left unchecked, Syndrome X will eventually progress to Type II diabetes.
Syndrome X as bad as it sounds, can be controlled and tamed to the point that individuals with this condition can live long healthy lives. Dietary changes are the first line of defense. Individuals with Syndrome X should reduce their consumption of breads pastas and sweets. Excessive carbohydrate consumption puts Syndrome X into overdrive. Instead, one should consume foods with low glycemic indices. In other words, foods that do not dump sugar into the blood stream too quickly when they are consumed. Specific details about low glycemic index can be found under the heading “Diabetes”. The “South Beach Diet” is based upon the principle of glycemic index and is not only popular these days but sound nutrition as well.
Regular exercise is also an essential for those with Syndrome X. Exercise increases the demand for sugar within the body and thus decreases the body’s tendency toward insulin resistance. First of course you should consult with your doctor to determine the level of exercise that is safe and yet beneficial.
Nutritional supplements to help manage Syndrome X include
oat beta-glucan; antioxidants from berries;
alpha-lipoic acid (ALA);
chromium; biotin; vanadium; phaseolamin (Phase 2);
vitamins that will reduce blood homocysteine levels.
Fibrinogen is involved in the formation of clots. Needless to say it is essential for life since without it we would bleed uncontrollably. On the other hand, too much fibrinogen presents a different set of problems. The most obvious is the occlusion of blood vessels from excessive clot formation. When this occurs in a coronary artery, a heart attack will result. In fact, people with high fibrinogen levels are two times more likely to die of a heart attack than those with normal fibrinogen levels. It is now believed that high fibrinogen levels pose an even greater risk for a heart attack than high cholesterol levels. Factors known to positively influence fibrinogen levels include obesity, cigarette smoking, individuals with depression and exposure to cold. Therefore, qitiing smoking, losing weight and seeking treatment for depression should all provide some degree of help in lowering fibrinogen levels.
Nutritional factors believed to be helpful at keeping fibrinogen levels in check include fish oils.
Cigarette smoking is best known for its link to lung cancer. It is also implicated in heart disease for a host of reasons. Smoking accelerates atherosclerosis, increases free radical production, increases heart rate, disrupts circulation, increases insulin resistance, elevates blood pressure, elevates homocysteine levels, increases inflammation, increases platelet aggregation and results in higher levels of fibrinogen in the bloodstream. Needless to say, if you want to be healthy and stay healthy don’t smoke.
Blood pressure at or above 140/90 is considered hypertension. Hypertension causes blood vessels to become thickened, less elastic and subsequently more prone to plaque formation. Hypertension also causes the heart to work harder to the point that it can no longer function optimally. In addition to heart attacks, congestive heart failure and aneurysms can also result from high blood pressure.
Obesity increases the risk of heart disease in several ways. Obesity causes he heart to work harder and also subjects the obese individual to a greater risk for hypertension and Type II diabetes. Obesity also results in increased inflammation, elevated fibrinogen levels and increased insulin resistance. While an obese person may be discouraged about getting down to the optimal weight and eventually resign themselves from ever being thin, it is important to remember that even moderate weight loss can have a significant effect on the aforementioned risk factors. Therefore, it may be helpful for the overweight individual to set several small goals rather than one big goal.
An article written by Dr Jade Teta and Dr. Keoni Teta mentions recent research that has shown how sprinters have lower subcutaneous fat levels than do marathon runners. While the present mentality for burning fat is to do a slow and steady workout, the latest research according to the Tetas’ article has shown quite the contrary. A workout that involves quick bursts of energy causing the heart rate to rise to 85% of maximum or more for 1-2 minutes sandwiched between rest periods allowing the heart to recharge at 60% to 70% of maximum has been shown to be most effective in reducing subcutaneous fat.
While a slow steady workout at 70% of the maximum heart rate does in fact burn a higher percentage of fat than sugar, a more intense workout may still burn more overall fat even though the relative percentage of fat to sugar burned is lower. For example, a person performing a less intense workout may burn 300 calories in 30 minutes. Sixty percent of the calories burned may be fat calories but a person who burns 500 calories in the same 30 minute period has still burned more fat even if only 50 percent of calories burned is fat and 50% is sugar. It has also been shown that the more intense the workout, the longer the individual burns fat after the workout.
While such a workout may be documented to be effective in weight loss, consulting your doctor before starting any exercise program is essential, especially one that pushes the envelope. If your doctor has given you the green light, it is still wise to phase into a workout involving greater intensity rather than start out full throttle. Even if your heart and lungs can handle it, your muscles and joints may need some time to adjust because injuries can stop workouts cold even for the most dedicated of athletes.
Athersclerosis tends to progress rather rapidly in diabetics in comparison to non-diabetics. This is because with diabetes, monocytes tend to adhere to the blood vessel walls and this in turn makes it easier for cholesterol deposits to build up in the arteries. As a result, congestive heart failure is also more common in diabetics that in non-diabetics. Over 80% of people with diabetes die as the result of heart disease, particularly heart attacks.
Diabetics not only experience elevated blood sugar but also experience episodes of hypoglycemia or low blood sugar as the result of insulin use. This rapid flux of elevated and depressed glucose levels wreaks havoc on the body. Sometimes more severe episodes of hypoglycemia can even mimic a heart attack.
Diabetes tends to worsen inflammation, anything that helps to control blood sugar levels is also helpful. This would include eating foods with lower glycemic indices. The term glycemic index describes how fast sugar enters into the blood stream once the respective food is eaten. The glycemic index is a percentage comparison between how fast the sugar within a certain food enters the blood stream compared to a drink of pure glucose. For example, the sugar within a certain food that enters the blood steam at half the rate of glucose would have a glycemic index of 50 as in 50% as fast as glucose.
Glycemic index is used in the “South Beach Diet” since foods with lower glycemic indices tend to result in less insulin production and thus less weight gain since insulin is a hormone related to weight gain.
Now, there are two types of diabetes: Type I and Type II. It is however important to remember that Type I diabetes is more difficult to control than Type II diabetes since in the case of Type II diabetes, a person can maintain the right weight, eat the right foods, exercise and in many cases may have no need for medication.
With Type I diabetes, a person can live a so-called “perfect life” and notwithstanding, would still be in need of insulin. This is because Type I diabetes results from the body not producing enough insulin in the first place. With Type II diabetes, the body is in fact producing insulin (at least at the onset of Type II) but the insulin dependent cells have developed a resistance to the body’s own insulin. Insulin resistance can be reduced by eating foods with lower glycemic indices, exercising and maintaining a healthy weight level. Of course, doing the opposite with result in increased insulin resistance.
Serum cholesterol as you probably already know consists of both “good cholesterol” and “bad cholesterol”. “Good Cholesterol is commonly referred to as HDL’s or high density lipoproteins. HDL’s are like bloodstream janitors helping to keep our arteries clean. The more of them the less likely or arteries will become clogged. “Bad Cholesterol” is commonly referred to as LDL’s or low density lipoproteins. LDL’s are implicated in atherosclerosis and cardiovascular disease especially when they become oxidized.
Cholesterol has been talked about so much for the past thirty years that people are inclined to think that cholesterol is the only risk factor for heart disease. Based on all of the hype, people may also be inclined to believe that cholesterol has no useful purpose within the body. Neither of these statements is at all accurate.
While elevated cholesterol levels do in fact pose an increased risk for heart disease, cholesterol is nevertheless essential for life. Therefore let us first understand how cholesterol is used in the body and then determine how to keep it at healthy levels.
First, cholesterol is present in every cell in the body, especially in the cell membrane. Second, cholesterol makes up a large portion of the “white matter” part of our brains and without cholesterol, nerves could not properly conduct their impulses. Thirdly, bile, which is produced by the liver and secreted by the gall bladder, consists largely of cholesterol and without bile, normal digestion of fats could not occur. Finally, cholesterol is the precursor for sex hormones, cortisol and Vitamin D.
Having now a basis understanding of how cholesterol is used by the body we can now employ the statement that too much of a good thing is not good at all. In general, an increased risk for heart disease occurs when cholesterol levels exceed 200mg/dl and even more so when levels are above 240 mg/dl. It is however interesting to note that as many as 50% of heart attack victims had normal cholesterol levels. This then brings into play the important fact that there are many other risk factors for heart disease than cholesterol itself. To assume that one is okay just because their cholesterol is below 200mg/dl may be a dangerously wrong assumption especially if their other risk factors are elevated.
While cholesterol levels themselves may pose a risk, the level of oxidation of cholesterol is in itself a risk factor. For example, one individual may have a cholesterol level of 190 while another individual may have their cholesterol at 240. If in fact the individual with their cholesterol at 190 has cholesterol that is more oxidized than the individual with their cholesterol at 240, the individual with the lower number may still have the higher risk. This is because it is not only the amount of cholesterol but also the condition or quality of the cholesterol that poses the risk. Having said that, a diet high in antioxidants such as vitamin E, vitamin A, vitamin C, lycopene and coenzyme Q10 can make for “friendlier” cholesterol at whatever your level might be.
Another factor in predicting cholesterol’s risk in heart disease is the Cholesterol HDL Ratio or stated more simply, the total cholesterol divided by the HDL cholesterol which is also known as the “good cholesterol”. Like golf, the lower your number the better. A ratio of 4.4 or lower is considered a low risk. From 4.5 to 7.0 is considered an average risk. From 7.1 to 11 is an elevated risk and above 11 is a high risk.
Here are some examples: a person with a cholesterol level of 180 mg/dl and with HDL’s at 30 mg/dl would be considered at higher risk for heart disease than someone with a cholesterol level of 240 mg/dl with their HDL’s at 60. Factors known to raise HDL’s include fish oil and exercise. It is also believed that lowering triglyceride levels is also helpful in raising HDL levels as the two are believed to work inversely to one another.
Another factor pertaining to cholesterol as a risk factor is LDL levels or our “bad cholesterol”. Normal levels are considered to be between 90-130 mg/dl although the consensus is that LDL levels below 100mg/dl are optimal.
Now for the million-dollar question: how do we lower cholesterol? The first and most obvious way is via the use of statins, which inhibit the production of cholesterol by the liver. As a prescription is required you must first talk with you doctor to determine if this is right for you. A negative factor related to statins is their tendency to also lower coenzyme Q10, a compound that is known to play a positive role in heart health.
Natural foods and nutritional supplements known to lower cholesterol include fish oil, niacin, curcumin, garlic and policosanol. A diet high in fiber is also known to lower cholesterol levels
Lifestyle modifications to help lower cholesterol include maintaining a proper weight and regular exercise.
While keeping our eyes on our cholesterol level is not a bad idea; it does not say a whole lot about our risk for heart disease unless we look at the other factors directly related to cholesterol. While it is true that the higher the number, the greater the risk, we do not necessarily know how much higher the risk until we have additional information such as oxidation levels, LDL and HDL levels in addition to the myriad of other risk factors mentioned.
It’s the battle of the sexes once again and as expected, the ladies are the winners. One word of caution to the reigning champions: remember the other risk factors that are listed and get on the positive side of as many as possible. Falling on the wrong side of too many of these risk factors can subject you to a host of other illnesses such as cancer and Alzheimer’s. Illnesses such as these are not guilty of sex discrimination like their cohort heart disease. In addition, while you may be less likely to die as soon as a man from heart disease, 500,000 women suffer heart attacks each year albeit at a later age than men on average. In the end, there is no substitute for a healthy diet, exercise and proper supplementation.
Genetics can have an influence several factors including risk for obesity, the tendency toward elevated homocysteine levels, elevated blood lipids and Syndrome X. Other risk factors include genetic predisposition to hemochromatosis, which is a condition that causes the body to retain excessive amounts of iron, which by itself elevates heart disease risk. While we cannot change our DNA we can still apply sound principles that can dampen the effect many genetic aberrations.
Countless research studies have shown that regular exercise has been shown to be beneficial in reducing the risk for heart disease. Exercise decreases blood pressure and increases the blood’s ability to deliver oxygen. Fibrinogen and C-reactive protein are also positively effected by exercise. Exercise also dampens the effect of insulin resistance and syndrome X; but did you really need a research study to tell you what has been considered common sense for generations?
While any exercise is better than no exercise, the best exercise is doing something that you enjoy. You are far more likely to stick to something that provides you with pleasure rather than something that you do merely to obtain a health benefit.