Heart disease

  • A Natural Approach to Cholesterol Reduction & Heart Health

    Heart and blood vessel (cardiovascular) disease is the number one killer of Americans, and study after study points to elevated cholesterol as a major contributor to the problem. Some authorities have indicated that for every one-percentage point that cholesterol levels are reduced, the risk for cardiovascular disease is reduced by two points. In addition, most people with diabetes have increased risk for heart disease and stroke, due in part to high cholesterol and triglyceride levels, which can result in death. In fact, more than 65 percent of people with diabetes die from heart disease or stroke. By managing diabetes, and blood lipids (cholesterol and triglycerides), however, diabetics can greatly reduce this risk.1

    The current conventional medical treatment is cholesterol- lowering prescription drugs, along with low saturated fat diets. In addition, it makes sense to work with your doctor in trying one or more of the following relatively risk-free dietary supplement approaches as part of your total program for lowering cholesterol and reducing risk of cardiovascular disease.

    Plant Sterols And Stanols
    Plant sterols are natural substances found in small quantities in many fruits, vegetables, nuts, seeds, cereals, legumes, vegetable oils, and other plant sources. Research has demonstrated that taking plant sterols orally significantly reduces total and low-density lipoprotein (LDL) cholesterol levels, but has little or no effect on high-density lipoprotein (HDL) cholesterol levels. LDL is considered to be the “bad cholesterol,” while HDL is considered to be the “good cholesterol.” The way it works is that plant sterols block cholesterol absorption in the intestines, which in turn results in lowered LDL cholesterol in the bloodstream. Plant sterols has been reported to decrease LDL cholesterol levels nine to 20 percent, and usual doses have ranged between 800 mg to six grams per day and given before meals. Plant sterols are typically given in conjunction with a low-fat diet.2,3,4,5,6,7,8,9,10,11 Orally, plant sterols are usually well tolerated. Ezetimibe (Zetia), a medication used to lower cholesterol levels, inhibits intestinal absorption of plant sterols.

    Similar to sterols, plant stanols are natural substances that occur in even smaller quantities in many of the same sources. Like sterols, stanols block the absorption of cholesterol in the intestines. Taking plant stanols orally is effective for reducing total and LDL- cholesterol in about 88 percent of adult patients when used alone or in combination with a low-fat diet or statin drug (drug that inhibits the production of cholesterol in the body).12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27 When used alone it can reduce total and LDL cholesterol levels by 10 to 15 percent. When added to statin drugs, sitostanol reduces total cholesterol and LDL cholesterol by an additional three to 11 percent and seven to 16 percent, respectively. Clinical studies have used from 800 mg to four grams per day.28 Orally, plant stanols seem to be very well tolerated. Plant stanols can reduce absorption and blood levels of beta-carotene, so it should be used at a different time if you are taking beta-carotene supplements.

    Inositol Hexanicotinate High amounts (several grams per day) of niacin lower cholesterol; an effect recognized in the approval of niacin as a prescription medication for high cholesterol.29 At such intakes, however, acute symptoms (flushing, headache, stomachache) may be severe. In an attempt to avoid the side effects of niacin, alternative health practitioners increasingly use inositol hexanicotinate (aka, “no-flush niacin”), recommending 500 to 1,000 mg, taken three times per day, instead of niacin.30,31 This special form of niacin has been reported to lower serum cholesterol but so far has not been found to cause significant toxicity.32

    Omega-3 Fatty Acids From Fish Oil Including fish as a regular part of the diet has been shown to increase HDL cholesterol33 and is linked to a reduced risk of heart disease in the majority of studies.34 One reason that it has this effect is its oils contain the omega-3 fatty acids (O3FA) which appear to protect against heart disease.35 When used supplementally, however, there is contradictory evidence about the effects of fish oil on blood fat levels. Some clinical research shows fish oil supplementation can decrease elevated triglyceride levels, and decrease LDL cholesterol and increase levels of HDL cholesterol.36,37,38 However, other clinical research did not show beneficial effects on cholesterol levels.39 Nevertheless, fish oil from supplements or from dietary sources has been shown to reduce triglyceride levels by 20 to 50 percent. This effect appears to be dose-dependent.40,41,42,43Fish oil preparations providing 465 mg of eicosapentaenoic acid (EPA) and 375 mg of docosahexaenoic acid (DHA) is particularly effective in conjunction with dietary modifications.44

    In addition, research suggests that fish oil supplementation may be superior to the cholesterol-reducing drug rosuvastatin (Crestor®) for patients with heart failure. In a study published in The Lancet,45 researchers gave 1,000 mg of omega-3 fatty acids from fish oil to about 3,500 patients with heart failure, while another 3,500 heart failure patients received a placebo. After four years researchers found that those taking the omega-3 fatty acids had a nine percent relative risk reduction of dying, and an eight percent relative risk reduction for being hospitalized. The researchers concluded their study demonstrated that long-term administration of 1,000 mg daily omega-3 fatty acids effectively reduced all-cause mortality and admissions to hospital for cardiovascular reasons.

    The same researchers conducted a parallel study, giving rosuvastatin to 2,285 heart failure patients, and placebos to 2,289 heart failure patients. After four years researchers found little difference in heart failure rates between those given omega-3 fatty acids and those given rosuvastatin. In comparing the results, the researchers concluded that the omega-3 fatty acids were slightly more effective than rosuvastatin.46

    Dietary Considerations
    I would be remiss if I did not briefly recount the incredibly important role that diet plays in cardiovascular health. Specifically, the Mediterranean diet has extensive patient-oriented outcome data showing a significant risk reduction in mortality rates and in rates of fatal and nonfatal heart attack.47 Strong evidence support Mediterranean dietary patterns, including intake of vegetables and nuts, as protective against coronary heath disease.48

    The Mediterranean Diet

    The Mediterranean diet is based upon the diets of at least 16 countries that border the Mediterranean Sea. Although there are many differences in culture, ethnic background, religion, economy and agricultural production which result in variations in food intake among the population groups, there is still a common Mediterranean dietary pattern which includes:

    • High consumption of fruits, vegetables, bread and other cereals, potatoes, beans, nuts and seeds
    • Olive oil is an important monounsaturated fat source
    • Dairy products, fish and poultry are consumed in low to moderate amounts, and little red meat is eaten
    • Eggs are consumed zero to four times a week
    • Wine is consumed in low to moderate amounts

    In addition, there is strong evidence for the protective effect of monounsaturated fatty acids and prudent dietary patterns.49 Research clearly demonstrates that the people at low risk for CVD eat lots of vegetables, fruits, beans, whole grains and fish: a prudent diet.

    Those at high risk for CVD eat the typical Western pattern diet loaded with red meat, processed meat, refined grains, sweets and desserts, fried foods and high-fat dairy products.50,51 Furthermore, strong evidence has also shown a clear and harmful relationship between CVD and the intake of trans-fatty acids and foods with a high glycemic index or load.52

    In 2006 the American Heart Association released guidelines that integrate recommendations from a variety of diets into a single plan. The emphasis should be on diets that are rich in fruits, vegetables, and healthful fatty acids and that limit saturated fat intake. A stepwise individualized approach may be a practical way to help reduce your cardiovascular disease risk.53 Visit www.americanheart.org for more information.

    There are many dietary supplements that may be used as part of your total program for lowering cholesterol and/or otherwise help in reducing risk of cardiovascular disease. Good choices include plant sterols/stanols, inositol hexanicotinate, and omega-3 fatty acids from fish oils. In addition, a healthy dietary program such as the Mediterranean diet should be the first line of defense for reducing the risk of cardiovascular disease.


    1. Diabetes: Heart Disease and Stroke. American Diabetes Association. Retrieved October 4, 2008 from http://www.diabetes.org/diabetes- heart-disease-stroke.jsp.
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    8. Anon. FDA authorizes new coronary heart disease health claim for plant sterol and plant stanol esters. FDA. 2000. Available at: www. fda.gov/bbs/topics/ANSWERS/ANS01033.html.
    9. Lichtenstein AH, Deckelbaum RJ. Stanol/sterol ester-containing foods and blood cholesterol levels: a statement for healthcare professionals from Nutrition Committee, Council on Nutrition, Physical Activity, Metabolism of American Heart Association. Circulation 2001;103:1177–9.
    10. Matvienko OA, Lewis DS, Swanson M, et al. A single daily dose of soybean phytosterols in ground beef decreases serum total cholesterol and LDL cholesterol in young, mildly hypercholesterolemic men. Am J Clin Nutr 2002;76:57–64.
    11. Neil HA, Meijer GW, Roe LS. Randomised controlled trial of use by hypercholesterolaemic patients of a vegetable oil sterol-enriched fat spread. Atherosclerosis 2001;156:329–37.
    12. Nguyen TT, Dale LC, von Bergmann K, Croghan IT. Cholesterollowering effect of stanol ester in a US population of mildly hypercholesterolemic men and women: a randomized controlled trial. Mayo Clin Proc 1999;74:1198–206.
    13. Vuorio AF, Gylling H, Turtola H, et al. Stanol ester margarine alone and with simvastatin lowers serum cholesterol in families with familial hypercholesterolemia caused by the FH-north karelia mutation. Arterioscler Thromb Vasc Biol 2000;20:500–6.
    14. Weststrate JA, Meijer GW. Plant sterol-enriched margarines and reduction of plasma total- and LDL-cholesterol concentrations in normocholesterolaemic and mildly hypercholesterolaemic subjects. Eur J Clin Nutr 1998;52:334 –43.
    15. Gylling H, Miettinen TA. Cholesterol reduction by different plant stanol mixtures and with variable fat intake. Metabolism 1999;48:575–80.
    16. Gylling H, Puska P, Vartiainen E, et al. Serum sterols during stanol ester feeding in a mildly hypercholesterolemic population. J Lipid Res 1999;40:593–600.
    17. Gylling H, Radhakrishnan R, Miettinen TA. Reduction of serum cholesterol in postmenopausal women with previous myocardial infarction and cholesterol malabsorption induced by dietary sitostanol ester margarine: women and dietary sitostanol. Circulation 1997;96:4226–31.
    18. Gylling H, Miettinen TA. Serum cholesterol and cholesterol and lipoprotein metabolism in hypercholesterolaemic NIDDM patients before and during sitostanol ester-margarine treatment. Diabetologia 1994;37:773–80.
    19. Gylling H, Miettinen TA. Effects of inhibiting cholesterol absorption and synthesis on cholesterol and lipoprotein metabolism in hypercholesterolemic non-insulin-dependent diabetic men. J Lipid Res 1996;37:1776–85.
    20. Gylling H, Puska P, Vartiainen E, et al. Retinol, vitamin D, carotenes and alpha-tocopherol in serum of a moderately hypercholesterolemic population consuming sitostanol ester margarine. Am J Cardiol 1999;145:279–85.
    21. Hallikainen MA, Uusitupa MI. Effects of 2 low-fat stanol estercontaining margarines on serum cholesterol concentrations as part of a low-fat diet in hypercholesterolemic subjects. Am J Clin Nutr 1999;69:403–10.
    22. Jones PJ, Ntanios FY, Raeini-Sarjaz M, et al. Cholesterol-lowering efficacy of a sitostanol-containing phytosterol mixture with a prudent diet in hyperlipidemic men. Am J Clin Nutr 1999;69:1144 –50.
    23. Gylling H, Siimes MA, Miettinen TA. Sitostanol ester margarine in dietary treatment of children with familial hypercholesterolemia. J Lipid Res 1995;36:1807–12.
    24. Miettinen TA, Puska P, Gylling H, et al. Reduction of serum cholesterol with sitostanol-ester margarine in a mildly hypercholesterolemic population. N Engl J Med 1995;333(20):1308-12.
    25. Vanhanen HT, Kajander J, Lehtovirta H. Serum levels, absorption efficiency, faecal elimination and synthesis of cholesterol during increasing doses of dietary sitostanol esters in hypercholesterolaemic subjects. Clin Sci (Colch) 1994;87:61-7.
    26. Plat J, van Onselen EN, van Heugten MM, Mensink RP. Effects on serum lipids, lipoproteins and fat soluble antioxidant concentrations of consumption frequency of margarines and shortenings enriched with plant stanol esters. Eur J Clin Nutr 2000;54:671–7.
    27. Hallikainen MA, Sarkkinen ES, Gylling H, et al. Comparison of the effects of plant sterol ester and plant stanol ester-enriched margarines in lowering serum cholesterol concentrations in hypercholesterolaemic subjects on a low-fat diet. Eur J Clin Nutr 2000;54:715–25.
    28. Law M. Plant sterol and stanol margarines and health. BMJ 2000;320:861–4.
    29. Guyton JR, Blazing MA, Hagar J, et al. Extended-release niacin vs gemfibrozil for the treatment of low levels of high-density lipoprotein cholesterol. Niaspan-Gemfibrozil Study Group. Arch Intern Med 2000;160:1177–84.
    30. Head KA. Inositol hexaniacinate: a safer alternative to niacin. Alt Med Rev 1996; 1:176–84.
    31. Murray M. Lipid-lowering drugs vs. Inositol hexaniacinate. Am J Natural Med 1995; 2:9 –12.
    32. Dorner Von G, Fisher FW. Zur Beinflussung der Serumlipide undlipoproteine durch den Hexanicotinsaureester des m-Inositol. Arzneimittel Forschung 1961; 11:110–3.
    33. Santos MJ, Lopez-Jurado M, Llopis J, et al. Influence of dietary supplementation with fish on plasma total cholesterol and lipoprotein cholesterol fractions in patients with coronary heart disease. J Nutr Med 1992;3:107–15.
    34. Kromhout D, Bosschieter EB, Coulander CdL, The inverse relation between fish consumption and 20-year mortality from coronary heart disease. N Engl J Med 1985;312:1205–9.
    35. Albert CM, Manson JE, O’Donnoell C, et al. Fish consumption and the risk of sudden death in the Physicians’ Health Study. Circulation 1996;94 (suppl 1):I-578 [abstract #3382].
    36. Petersen M, Pedersen H, Major-Pedersen A, et al. Effect of fish oil versus corn oil supplementation on LDL and HDL subclasses in type 2 diabetes. Diabetes Care 2002;25:17048.
    37. Chan DC, Watts GF, Barrett PH, et al. Regulatory effects of HMG CoA reductase inhibitor and fish oils on apolipoprotein B-100 kinetics in insulin-resistant obese male subjects with dyslipidemia. Diabetes 2002;51:2377–86.
    38. Friedberg CE, Janssen MJ, Heine RJ, Grobbee DE. Fish oil and glycemic control in diabetes. A meta-analysis. Diabetes Care 1998;21:494–500.
    39. Balestrieri, G. P., Maffi, V., Sleiman, I., Spandrio, S., Di Stefano, O., Salvi, A., and Scalvini, T. Fish oil supplementation in patients with heterozygous familial hypercholesterolemia. Recenti Prog Med 1996;87(3):102–5.
    40. Roche HM, Gibney MJ. Effect of long-chain n-3 polyunsaturated fatty acids on fasting and postprandial triacylglycerol metabolism. Am J Clin Nutr 2000;71:232S–7S.
    41. Deslypere JP. Influence of supplementation with N-3 fatty acids on different coronary risk factors in men--a placebo controlled study. Verh K Acad Geneeskd Belg 1992;54:189–216.
    42. Simons, L. A., Hickie, J. B., and Balasubramaniam, S. On the effects of dietary n-3 fatty acids (Maxepa) on plasma lipids and lipoproteins in patients with hyperlipidaemia. Atherosclerosis 1985;54(1):75–88.
    43. Nikkila, M. Influence of fish oil on blood lipids in coronary artery disease. Eur J Clin Nutr 1991;45(4):209–13.
    44. Reliant Pharmaceuticals. Omacor package insert. Liberty Corner, NJ; December, 2004.
    45. Effect of n-3 polyunsaturated fatty acids in patients with chronic heart failure (the GISSI-HF trial): a randomised, double-blind, placebocontrolled trial. Lancet; Published online ahead or print, 31 August 2008, doi:10.1016/S0140-6736(08)61239–8.
    46. Effect of rosuvastatin in patients with chronic heart failure (the GISSI-HF trial): a randomised, double-blind, placebo-controlled trial. Lancet; Published online ahead or print, 31 August 2008, doi:10.1016/S0140-6736(08)61240–4.
    47. Walker C, Reamy BV.Diets for cardiovascular disease prevention: what is the evidence? Am Fam Physician 2009;79(7):571–8.
    48. Mente A, de Koning L, Shannon HS, Anand SS. A systematic review of the evidence supporting a causal link between dietary factors and coronary heart disease. Arch Intern Med 2009;169(7):659–69.
    49. Mente A, de Koning L, Shannon HS, Anand SS. A systematic review of the evidence supporting a causal link between dietary factors and coronary heart disease. Arch Intern Med 2009;169(7):659–69.
    50. Hu FB, Rimm EB, Stampfer MJ, Ascherio A, Spiegelman D, Willett WC. Prospective study of major dietary patterns and risk of coronary heart disease in men. Am J Clin Nutr 2000;72(4):912–921.
    51. Liu S, Manson JE, Lee IM, Cole SR, Hennekens CH, Willett WC, Buring JE. Fruit and vegetable intake and risk of cardiovascular disease: the Women’s Health Study. Am J Clin Nutr 2000; 72(4):922–928
    52. Mente A, de Koning L, Shannon HS, Anand SS. A systematic review of the evidence supporting a causal link between dietary factors and coronary heart disease. Arch Intern Med 2009;169(7):659–69.
    53. Walker C, Reamy BV.Diets for cardiovascular disease prevention: what is the evidence? Am Fam Physician 2009;79(7):571–8.
  • Coconut OIL

    In mid-2012, Nestlé Health Science acquired a stake in Accera®, the U.S. maker of Axona®, a medical food targeted at people with mild to moderate Alzheimer’s. Aside from the fact that the purchase shows that Nestlé is placing a strategic bet on the future direction of medical food demand, this acquisition also is interesting for its potential validation of a tropical oil that alternately has been damned and praised for its role in health: coconut oil.

    On the one hand, there are those who still maintain that coconut oil, a source of more saturated fat than butter, lard or beef tallow, is the devil incarnate for brain and heart health. On the other hand, current science is in the process of validating the high regard that the coconut oil enjoys in the Ayurvedic and Chinese traditions of healing.

    Indeed, coconut oil bears a striking overlap in its metabolic implications, in this case for Alzheimer’s disease, with medical foods designed to provide the brain alternate fuel sources. A nice introduction to this topic is Alzheimer’s Disease: What If There Was a Cure? by Mary Newport, MD.

    The scientific backtracking regarding coconut oil recently was put in a nutshell in a New York Times interview of Thomas Brenna, a professor of nutritional sciences at Cornell University.1 Dr. Brenna observed that coconut oil’s bad reputation for cardiovascular health rested mostly on partially hydrogenated coconut oil, oil designed specifically to raise cholesterol levels in the rabbits being used in experiments. Virgin coconut oil differs dramatically in a large number of ways from the trans-fat laden partially hydrogenated item. Even the health dangers of the saturated aspect of coconut oil currently are being debated. As Dr. Brenna remarks in the interview, “I think we in the nutrition field are beginning to say that saturated fats are not so bad, and the evidence that said they were is not so strong.”

    Coconut Oil—A “Good” Saturated Fat
    Coconut oil is saturated (it is solid up to 76° F), consisting of 86.5 percent saturated fatty acids and 5.8 percent monounsaturated fatty acids.2 Lauric acid makes up approximately 46 percent of coconut oil and generally is considered to be the villain in terms of serum cholesterol. However, in clinical trials, the effects of dietary supplementation with coconut oil usually have been found to be either no effect or a small increase in LDL cholesterol and a significant increase in HDL cholesterol, meaning that the ratio—and cardiovascular risk—improves with supplementation.3,4

    Moreover, extra virgin coconut oil consists mostly of medium-chain fatty acids (MCFA), with 50 percent being lauric acid. Medium-chain fatty acids have been used for many years for special health purposes. They have attracted attention as part of a healthful diet because they are absorbed and transported directly into the liver via the portal vein and thereafter metabolized rapidly by beta-oxidation, thus increasing diet-induced thermogenesis.5

    One derivative of coconut MCFA is medium-chain triglyceride (MCT) oil, which is 75 percent caprylic and 25 percent capric acids, fatty acids very similar to lauric acid and present in virgin coconut oil in smaller amounts. MCT oil often is found in the hospital nutrient mixtures for bedridden patients who are dependent upon intravenous nutrition. These fats were developed in part because they do not require the action of bile for digestion, but rather are absorbed directly through the walls of the small intestine and transported to the liver to be used immediately as fuel.

    The special characteristics of coconut MCFA mean that the body prefers to burn it for fuel rather than to store it. You might say that the body treats coconut fatty acids more like it does carbohydrates, but without getting involved with insulin. Scientists know this because of experience with MCT oils. In my book Anti-Fat Nutrients (revised 4th edition, Basic Media), I discuss MCT oil at length. In seriously catabolic patients, MCT oil was found to help prevent the body from depleting lean and muscle tissues. Again, MCT fatty acids are not readily stored as body fat, but rather they are preferentially burned in the mitochondria of the cells to provide energy.6 For some athletes and bodybuilders, this quality has proved useful since excess training depletes the glycogen stores of the muscles, and continued training after that point can only take place partially through the break down of muscle protein for fuel.7 Coconut oil medium-chain fatty acids have properties similar to those of MCT oil, but not as pronounced.

    Does this mean that coconut oil can help dieters? Yes, as long as there are not too many expectations. Indeed, the nutrition author Ray Peat, PhD, has remarked that in the 1940s farmers attempted to use coconut oil for fattening their animals, but they found that it made them lean, active and hungry instead! The fatty acids found in coconut seem to promote the burning of fat for fuel and, as already noted, have a pronounced thermogenic effect. However, the thermogenic and fat-burning qualities of medium-chain fatty acids seem to be more significant for healthy subjects of normal weight and for those moderately overweight than for those who are clinically obese (fortunately, a category that excludes most of us). Moreover, medium-chain fatty acids serve to protect the body’s protein in the lean tissues during the use of low calorie and low carbohydrate diets.8

    Immune and Digestive Benefits
    Coconut oil has many other benefits. Two names are closely associated with the research in this area. These are Jon J. Kabara, PhD, one of the primary researchers into the benefits of lauric acid, and Mary G. Enig, PhD, the great researcher in the area of fats and one of the first (literally decades before the mainstream medical researchers) to point out the health dangers of trans-fatty acids.

    Dr. Enig was the keynote speaker in 2001 at the 36th Annual Conference of the Asian Pacific Coconut Community. There she gave her talk on the benefits of the coconut as a functional food. She noted that approximately 50 percent of the fatty acids in coconut fat are lauric acid, which has the additional beneficial function of being formed into monolaurin in the human body. Monolaurin is a monoglyceride used by the human metabolism to destroy lipid-coated (that is, fat-coated) viruses and a number of other undesirable organisms.

    Approximately 6–7 percent of the fatty acids in coconut fat are capric acid. Dr. Enig points out that capric acid is another medium-chain fatty acid that has a similar beneficial function when it is formed into monocaprin in the human or animal body. Monocaprin has beneficial effects similar to those found with monolaurin.

    The work of Dr. Jon Kabara and others shows that coconut oil components exert their health benefits in a way that is very safe to humans. In general, it is reported that the fatty acids and monoglycerides produce their inactivating effects by destabilizing the membrane that surrounds pathogens, for instance, by causing the disintegration of the virus envelope. Despite such sometimes quite potent actions against unwanted microbes, there is no evidence of any negative effect on probiotic organisms in the gastrointestinal tract.

    In his accessible, yet thoroughly researched book, The Healing Miracles of Coconut Oil (HealthWise), author Bruce Fife, ND, ranges across a number of health topics for which coconut oils has proven to be effective. He notes that coconut oil is so stable that it helps to preserve other oils, thereby reducing antioxidant requirements. Populations that eat large amounts of coconut and coconut products, such as the oil, are characterized by low rates of heart disease. Lauric acid and other medium-chain fatty acids are found in mother’s milk, where among other things, they improve the uptake by the baby of nutrients such as amino acids, calcium and magnesium. Similar effects upon nutrient assimilation have been found in the very ill and in the elderly. Moreover, these health benefits do not even take into account the long accepted uses of coconut oil to nourish the skin and the hair.

    Benefits for Brain Health?
    Let’s return to Nestlé Health Science acquired a stake in Accera, the U.S. maker of Axona, a medical food targeted at people with mild to moderate Alzheimer’s. The basic argument for this medicinal food is that in Alzheimer’s disease, the brain is starved for energy because it has a reduced ability to metabolize glucose. Reduced energy means reduced levels of cognition and memory. Fortunately, there is an alternative to glucose known as ketone bodies. Axona is a proprietary formulation of caprylic triglyceride that is converted by the liver into ketone bodies.

    Recall that coconut oil is a good source of medium-chain triglycerides (MCTs), the fatty acids that are converted in the liver to ketones. Ketones can provide energy to cells without the need for insulin. This is important for several reasons, not the least being that Alzheimer’s is related to insulin resistance and the attempt to get glucose to the brain with a high carbohydrate diet is counterproductive.9 Moreover, access to ketones may more generally promote neurologic health—several neurologic conditions have shown promising results with ketogenic diets. Ketogenic diets may help treat difficult cases of epilepsy and Parkinson’s disease as well as other neurological disorders, indeed perhaps improve cognition and health in general.

    The use of coconut oil with the conditions above at this point is promising, but hardly proven. Moreover, there are not yet much in the way of set rules or recommendations. Dr. Newport was giving her husband as much as 11 tablespoonsful per day, with four to eight tablespoonsful seeming to be a regular recommendation. At 115 calories per tablespoon, a coconut oil supplemented diet should not otherwise continue to be the standard American diet built upon a foundation of refined carbohydrates. Those wanting to add serious amounts of coconut oil to their everyday diets, as opposed to merely switching to it as a cooking oil, might find it useful to explore high protein/low carbohydrate options more generally. The chief warning to those who would try such diets is that Paleolithic-type diets need to include plenty of vegetables and reasonable amounts of whole fruit (avoiding fruit juice).

    Summing Up
    In his book, Bruce Fife asks the rhetorical questions, “If there was [sic] an oil you could use for your daily cooking needs that helped protect you from heart disease...other degenerative conditions, improved your digestion, strengthened your immune system, protected you from infectious diseases, and helped you lose excess weight, would you be interested?” Surely this is a good question. Aside from the record of traditional use, numerous research papers and United States Patents argue for the health-promoting benefits of coconut oil. Now that organic coconut oil/extra virgin coconut oil is readily available in health food stores, perhaps it is time for health-conscious shoppers to give it a try.


    1. Melissa Clark, “Once a Villain, Coconut Oil Charms the Health Food World.” New York Times March 1, 2011.
    2. “Nutrient database, Release 24” (http://ndb.nal.usda.gov/) . United States Department of Agriculture. http://ndb.nal.usda.gov
    3. Assunção ML, Ferreira HS, dos Santos AF, Cabral CR Jr, Florêncio TM. Effects of dietary coconut oil on the biochemical and anthropometric profiles of women presenting abdominal obesity. Lipids. 2009 Jul;44(7):593-601.
    4. Mensink RP, Zock PL, Kester AD, Katan MB. Effects of dietary fatty acids and carbohydrates on the ratio of serum total to HDL cholesterol and on serum lipids and apolipoproteins: a meta-analysis of 60 controlled trials. Am J Clin Nutr. 2003 May;77(5):1146-55.
    5. Aoyama T, Nosaka N, Kasai M. Research on the nutritional characteristics of medium-chain fatty acids. J Med Invest. 2007 Aug;54(3-4):385-8.
    6. Babayan VK. Medium chain triglycerides and structured lipids. Lipids 1987 Jun;22(6):417-20.
    7. Nosaka N, Suzuki Y, Nagatoishi A, Kasai M, Wu J, Taguchi M. Effect of ingestion of medium-chain triacylglycerols on moderate-and high-intensity exercise in recreational athletes. J Nutr Sci Vitaminol (Tokyo). 2009 Apr;55(2):120-5.
    8. Dias VC, et al. Effects of medium-chain triglyceride feeding on energy balance in adult humans. Metabolism 1990;39:887-891.
    9. Seneff S, Wainwright G, Mascitelli L. Nutrition and Alzheimer’s disease: the detrimental role of a high carbohydrate diet. Eur J Intern Med. 2011 Apr;22(2):134-40.
  • Eat Less Salt and Die?

    I’m being sarcastic, right? The official health wisdom — the wisdom everybody knows is right (because all the top health officials repeat it over and over again) — is that if you “restrict” the salt in your diet, you’ll live longer.

    That’s because (once again, according to those official pronouncements) your blood pressure will be lower, putting you at less risk for a heart attack or stroke, the #1 and #3 causes of death in the U.S.

    There’s only one problem with that widespread “health wisdom,” as I’ve been telling my patients and readers for many years. It’s not true! And a recent article in the May 4, 2011 issue of the Journal of the American Medical Association is the latest evidence to run counter to the medical (and mistaken) myth of “Low Salt Good, High Salt Bad.”

    Low-Salt Diet = 4X Death Rate From Heart Disease
    The study was conducted by researchers at the University of Leuven in Belgium. First, they measured the urinary sodium levels of 3,681 healthy people in their 40s. Then they tracked their health for the next eight years. The folks with the highest urinary sodium levels — a sign of a higher dietary intake of salt — had the lowest risk of developing heart disease. Looked at another way, the low-sodium folks had four times the rate of dying from heart disease, compared to the high-salt folks.

    The conclusion of the researchers was straightforward: “Our current findings refute the estimates of lives saved and health care costs reduced with lower salt intake. They do not support the current recommendations of a generalized and indiscriminate reduction of salt intake.”

    The recommendations they’re talking about are those from the American Heart Association (AHA), which suggests you limit your intake of salt to 1,500 milligrams (mg) per day — way down from the 4,000 or so mg most of us eat every day.

    What did the study researchers have to say about the lowsalt pronouncements of U.S. heart honchos? Yes, they agree, salt restriction may be a good idea if you already have high blood pressure or congestive heart failure. But for the rest of us? Previous scientific research has overestimated the effect of salt intake on healthy people, they say. And, they point out; hardly anyone actually achieves the level of salt restriction suggested by the AHA — a sign that the salt-needing body naturally triggers you to eat more salt when you try to cut back.

    Of course, this isn’t the first study to report that salt isn’t bad for you. (And, in fact, it’s good for you.) Many other studies say the same thing.

  • Is Your Hectic Lifestyle Making You Sick ?

    Face it. Life is a balancing act. Between work, relationships, parental duties, staying fit, academic efforts, maintaining friendships, community involvement and personal fulfillment, it’s a wonder most of us can even find time to catch our breath. Yet we soldier forward with all our obligations and commitments because we have to, and in most cases, we want to. But when life gets so hectic the stress of it all impacts our mental and physical well-being, it’s time to take action.

    Becoming familiar with the ways different types of stress can affect our minds and bodies, specifically our immune system, as well as learning about the available tools that have been clinically proven to manage the impact of stress on the immune system, are proactive steps toward keeping healthy. Lessening the impact of harmful invaders on our immune system entails not just strengthening it to combat the bacteria and viruses that cause common illnesses, but also ensuring that our immune system’s response to such external stimuli as allergens is not too strong—as asthma and other long-term health implications can result. In short, keeping our immune systems in check, but more importantly, in balance, is imperative to our overall health.

    How Stress Affects the Immune System
    While many aspects of our daily lives can negatively impact our immune systems—a less-than-optimal diet, travel, pollution, changing seasons, overexertion during exercise, lack of sleep and even the normal aging process—stress can also interfere with a healthy immune system.

    Certain physiological changes occur to help an individual cope with stress. Chronic activation of the neurological pathways associated with stress result in the production of hormones and neurotransmitters/ chemicals, which then alter the function of certain cells of the immune system. These altered cells cause the immune system to respond improperly, either by over-responding or under-responding, to bacteria, viruses, allergens, fungi and parasites.

    In addition to impacting the human immune system, stress that is mismanaged and remains too high for prolonged periods of time can lead to a variety of symptoms associated with very serious illnesses, including heart disease, anxiety disorders, high blood pressure, coronary artery disease, respiratory disorders, accidental injuries and cirrhosis of the liver. Stress has been linked to all of these illnesses, all of which are leading causes of death in the United States.

    Types of Stress
    There are certain types of stressful events and situations called “stressors” that our bodies react to in different ways. Surprisingly, not all types of stressors negatively affect us. “Acute stressors” are time-limited and temporary. Public speaking and academic testing are examples of short-term stressors that temporarily boost, or over-stimulate, the immune system. The body quickly adapts itself to respond to short-term stressors through the “fight or flight” response by releasing such chemicals as adrenaline that enable our pupils to dilate, our awareness to intensify, our sight to sharpen, our impulses to quicken and our immune system to mobilize and increase activation. Much of the time increased immune system activity is a benefit to us, as it helps to ready the body for challenges, but in some cases an over-reactive immune system can result in allergies, asthma, chronic inflammation and autoimmune diseases.

    “Sequential stressors” include major events that give rise to a series of related challenges, such as the loss of a spouse or a natural disaster. “Chronic stressors” are ongoing, persuasive demands that force people to restructure their identity or social roles and have no end in sight. Examples of such stressors include caring for an aging spouse or elderly parent, being victim of an event that leads to a permanent disability or fleeing a third-world country because of violence or war.

    Both sequential and chronic stressors suppress, or under-stimulate, the immune system, leaving the body open for attack and more vulnerable to illness. Other manifestations of these types of stress include: fatigue and exhaustion; headaches or migraines; neck and back pain or stiffness; gastrointestinal problems (nausea, diarrhea, constipation or colitis); chest pains or palpitations; sleep disturbances; family conflicts; job tensions; and a change in sexual energy.

    A Tool for a Balanced Immune System: EpiCor
    While we may be able to employ various proven tactics to reduce our stress level, such as exercise, meditation, acupuncture and/ or massage therapy, the fact remains that certain amounts of stress will be present in our lives; especially in today’s increasingly over-scheduled society. So, if escaping our stressors is not an option—and for most of us it’s not—we may need some extra help in keeping our immune system in balance while we deal with daily stress.

    One such all-natural tool that can be used in this capacity is a product called EpiCor™, which is comprised of metabolites that nourish and balance the body’s immune system. EpiCor strengthens resistance and maintains wellness before immune health issues develop by helping the body modulate its immune response.

    Just like the medical breakthroughs penicillin and X-rays, EpiCor was discovered by accident! When the parent company experienced minimal health insurance premium rate increases several years in a row and the incidences of employees using sick days were rare, a series of scientific studies were conducted. Findings confirmed that production workers who had been exposed to the ingredient experienced significantly higher immune activity than those workers who had not been exposed. EpiCor is unique in that just one 500 milligram capsule per day helps the immune system stay strong and healthy through balance. A strong immune system is not one that has only been stimulated or boosted. Those actions can certainly be helpful at specific times, but as we have just learned, there are times that the immune system can over-respond, leading to health issues. A strong immune system is one that is balanced and can respond appropriately, depending on the situation at hand. These two actions—boosting and suppressing—constitute EpiCor’s proven methodology known as “immune balance.”

    Research on EpiCor and What it Means to Us
    Unlike so many other immune health supplements, a bevy of scientific research supports EpiCor’s effects on the immune system. Favorable efficacy profiles have been observed for Epi- Cor in clinical trials, and studies at the cellular (in vitro) level have suggested its mechanisms of action. Multiple toxicological studies have been performed that prove the safety of EpiCor. In addition to finding that EpiCor has no contraindications, ongoing research has also confirmed EpiCor fights free radicals through its high antioxidant activity and helps to manage inflammation.

    Most recently, a published study found that EpiCor has a significant impact on the incidence and duration of the common cold and flu. Specifically, this randomized, double-blind, placebo-controlled clinical trial found that taken once a day, a 500 milligram EpiCor capsule significantly decreased the incidences of cold and flu symptoms as well as observable symptom duration. These results translate into fewer sick days for people taking EpiCor, which is of great importance to American businesses dealing with health care costs, employee sick days and lost revenue.

    Now think of what this research on EpiCor means for our personal overall health which, as we have learned, is directly affected by our stress levels. If we are healthy, we are not staying home sick from work and falling behind. If we are healthy, we are more likely to be fully engaged when interacting with our partners, children and friends, thus strengthening those relationships instead of aggravating them by being over-stressed and irritable. If we are healthy, we have more physical energy to participate in personal fulfillment activities that interest us and allow us to decompress, such as gardening, cooking, exercising and reading. And finally, if we are healthy, we are not spending money on medial deductibles, treatments or unnecessary prescriptions, which is a major concern according to the American Psychological Association’s (APA) recent national survey reporting that money is the leading cause of stress for 75 percent of all Americans. The APA also found that 77 percent of people suffering from stress reported physical symptoms including fatigue, headache, upset stomach, muscle tension, change in appetite, teeth grinding, change in sex drive and feeling dizzy.

    Sound familiar?

    Isn’t it time we broke this vicious stress-illness cycle? Keeping our immune system balanced is the first step. In addition to giving our immune system the very basic things that help to keep it healthy—good nutrition and plenty of sleep—there are other things we can do to support it as well. One such thing is EpiCor. As an all-natural, safe and economical way of supporting the immune system, EpiCor just may be the key to a balanced and healthy life.

    • Jensen, G, et al. An anti-inflammatory immunogen from yeast culture induces activation and alters chemokine receptor expression on human natural killer cells and B lymphocytes in vitro. Nutrition Research (2007), 27:6, 327–335.
    • Moyad, M, et al. Effects of a modified yeast supplement on cold/flu symptoms. Urologic Nursing (2008), 28:1, 50–5.
    • Padgett, DA, et al. How stress influences the immune response.
    • TRENDS in Immunology (2003), 24:8, 444–8. Segerstrom SC, et al. Psychological stress and the human immune system: a meta-analytic study of 30 years of inquiry. Psychological Bulletin (2004), 130, 601–30.
  • L-Theanine: Nature’s Chill Pill

    Virtually everyone has stress. In fact, According to the Stress in America™ survey by the American Psychological Association,1 39 percent of respondents said their stress increased over the past year, and 44 percent said that their stress had increased over the past five years. The question is, how well do you handle your stress, how does it affect your life, and what can you do about it? The same Stress in America survey indicates the following percentage of Americans is only fair or poor at:

    • Preventing themselves from becoming stressed (44 percent)
    • Managing or reducing stress once experienced (39 percent)
    • Recovering fully or recharging after they’ve been stressed (31 percent)

    The ramifications of chronic stress include increases in illness, including headaches, heart disease, immune deficiencies and digestive problems. To a large extent, this appears to be due to an increased production of stress hormones and decreased immune function.2

    So what can be done to help control stress and reduce its ill effects? The answer is really multifaceted and may include a program of diet, exercise, stress-management techniques such as yoga, and even psychological counseling. In addition, when stress rears its ugly head, nature’s chill pill, L-theanine may be able to help.

    Asian cultures have often used teas for relaxation effects. The relaxing effect is, at least in part, caused by the presence of a neurologically active amino acid, L-theanine (gamma-ethyl-amino- L-glutamic acid). Tea has the reputation of having less caffeine than coffee but it is the L-theanine in the tea that lessens the stimulant effect of caffeine on the human nervous system. In the brain, L-theanine increases both serotonin and dopamine production3, and possibly GABA as well.4

    Evidence from human electroencephalograph (EEG) studies show that it also significantly increases brain activity in the alpha frequency band which indicates that it relaxes the mind without inducing drowsiness. Alpha activity is also known to play an important role in critical aspects of attention. Research indicates that L-theanine has a significant effect on improving mental alertness while promoting relaxation.5

    According to Mason, two small human studies6 showed that within 30–40 minutes of consuming 50 or 200 mg of L-theanine there is an increase of alpha wave activity/electrical signals produced by the brain. The perceived relaxation effect in the subjects coincided with the detection of alpha waves. This shows that L-theanine fosters a state of alert relaxation, which is consistent with the fact that anxious people have fewer or smaller alpha waves.

    The journal Human Psychopharmacology Clinical and Experimental published a double-blind placebo-controlled study7 in which sixteen healthy volunteers received 200 mg L-theanine, a pharmaceutical anxiolytic or placebo. The results showed that L-theanine induced feelings of tranquility in the volunteers.

    The journal Biological Psychology published a double-blind, placebo-controlled study8 in which twelve participants underwent four separate trials: one in which they took L-theanine at the start of an experimental, stress-inducing procedure, one in which they took L-theanine midway, and two control trials in which they either took a placebo or nothing. The results showed that L-theanine intake resulted in a reduction in some physiological indicators of stress within 15 minutes, compared to the placebo or control condition. Moreover, analyses of heart rate variability indicated that reductions in heart rate were likely attributable to a reduction of sympathetic nervous activation, suggesting that L-theanine had anti-stress effects via the inhibition of cortical neuron excitation.

    Similarly, a placebo-controlled study9 conducted with pharmacy students found that L-theanine (200 mg, twice a day, after breakfast and lunch) was effective at suppressing the initial stress response of students.

    The Journal of Physiological Anthropology published a placebo- controlled study10 in which 14 participants took either L-theanine + placebo, caffeine + placebo, or placebo only (L-theanine 200 mg, caffeine 100 mg) while performing mental tasks and physiological activities under conditions of physical or psychological stress. The results showed that L-theanine significantly reduced anxiety and reduced the blood-pressure increase in high-stress-response adults. Caffeine tended to have a similar but smaller inhibition of the blood-pressure increases caused by the mental tasks.

    The Journal of Functional Foods published a double-blind, placebo-controlled study11 in which 18 normal healthy subjects were divided into two groups referred to as high anxiety propensity group and the minimal anxiety propensity group. Both groups received 200 mg L-theanine and placebo (at different times)(200 mg/100 ml water) and placebo (100 ml water) in a double-blind repeated measurement design protocol. When tested at 15–60 minutes after consumption, results showed significantly enhanced activity of alpha bands, descending heart rate, elevated visual attentional performance, and improved reaction time response among high anxiety propensity subjects compared to a placebo. However, no significant differences were noticed among subjects with a minimal anxiety propensity.

    The journal Neuropharmacology published a double-blind, randomized, cross-over study12 in which 27 participants received 100 mg L-theanine, 50 mg caffeine, a combination of the two, or a placebo. The results were that L-theanine and caffeine each significantly reduced error rates during a sustained attention task. It was noted that the combination of L-theanine and caffeine did not confer any additional benefits over either compound alone.

    Another study13 examined “sensory gating.” Sensory gating describes the processes of filtering out redundant or unnecessary stimuli in the brain from all possible environmental stimuli. Being able to do this is obviously beneficial when you’re trying to focus on a mental task. In the study, L-theanine was given to 14 healthy subjects, and tests were conducted 90 minutes later. The results were that 200 mg and 400 mg significantly improved sensory gating.

    Research shows that L-theanine is effective at helping to promote relaxation while reducing feelings of stress and anxiety. Furthermore, this amino acid is even helpful in promoting mental focus. Truly, L-theanine is nature’s chill pill.

    1. American Psychological Association. Stress in America™: Our Health at Risk. Released January 11, 2012. 78 pgs.
    2. Head KA, Kelly GS. Nutrients and botanicals for treatment of stress: adrenal fatigue, neurotransmitter imbalance, anxiety, and restless sleep. Altern Med Rev. 2009 Jun;14(2):114–40.
    3. L-Theanine monograph. Alternative Medicine Review 2005;10(2):136-8.
    4. Lu K, Gray MA, Oliver C, et al. The acute effects of L-theanine in comparison with alprazolam on anticipatory anxiety in humans. Hum Psychopharmacol Clin Exp 2004;19:457–65.
    5. Nobre AC, Rao A, Owen GN. L-theanine, a natural constituent in tea, and its effect on mental state. Asia Pac J Clin Nutr 2008;17 Suppl 1:167–8.
    6. Mason,R. 200 mg of Zen. Alternative & Complementary Therapies 2001; 7(2):91–95.
    7. Ibid. Lu K, Gray MA, Oliver C, et al.
    8. Kimura K, Ozeki M, Juneja LR, Ohira H. L-Theanine reduces psychological and physiological stress responses. Biol Psychol 2007;74(1):39–45
    9. Unno K, Tanida N, Ishii N, et al. Anti-stress effect of theanine on students during pharmacy practice: positive correlation among salivary á-amylase activity, trait anxiety and subjective stress. Pharmacol Biochem Behav. 2013 Oct;111:128–35.
    10. Yoto A, Motoki M, Murao S, Yokogoshi H. Effects of L-theanine or caffeine intake on changes in blood pressure under physical and psychological stresses. J Physiol Anthropol. 2012 Oct 29;31:28.
    11. Higashyama A, Htay HH, Ozeki M, Juneja LR, Kapoor MP. Effects of l-theanine on attention and reaction time response. Journal of Functional Foods. 2011;3(3):171–8.
    12. Foxe JJ, Morie KP, Laud PJ, Rowson MJ, de Bruin EA, Kelly SP. Assessing the effects of caffeine and theanine on the maintenance of vigilance during a sustained attention task. Neuropharmacology. 2012 Jun;62(7):2320–7.
    13. Ota M, Wakabayashi C, Matsuo J, et al. Effect of L-theanine on sensorimotor gating in healthy human subjects. Psychiatry Clin Neurosci. 2014 May;68(5):337–43.
  • Nutritional Needs of Men

    You don’t need to believe that “men are from Mars, women are from Venus” in order to accept that men and women have different nutritional needs. Men lead in eight of the top ten causes of death in the United States. As is often observed, because men are more reluctant than women to seek medical care, when they do so, their illnesses typically have advanced to a more serious degree. It would seem that men, even more than women, would do well to adopt defensive measures to preserve their health. Women are not only the fairer sex, but when it comes to health, they are in general, also savvier. However, men should not depend on the supplements used by their wives or women friends. Some preventative measures are strictly gender-specific. For example, whereas calcium and iron are good for women, these minerals may not be good supplement choices for men.

    For men, the primary health issues today probably are cardiovascular disease and conditions affecting the prostate. Heart disease is the leading cause of death in men and prostate cancer is the seventh. Are matters improving? It is hard to tell. For instance, the incidence rate of prostate cancer went up in the period from 1995 to 2000, although the death rate appeared to have stabilized. Fortunately, the rate of lung cancer continues to decline. As for heart disease, our current emergency medical interventions are so effective that the death rate is declining. However, actual cardiovascular health is not improving—the rate of occurrence of first heart attacks is going up. How could it be otherwise? Obesity, diabetes and hypertension are all increasing. Diabetes in adults males over the age of 20 is estimated to now occur at a rate of 9.3 percent (data for 1999–2000) compared to 7.9 percent in the period from 1988 to 1994. For men aged 60 or over, the rate in 1999–2000 was roughly 19 percent. The following suggestions are designed to help men take charge of their health while the ball is still in their court.

    Cardiovascular Disease
    Cardiovascular health is a common topic of conversation. The reason, of course, is that heart disease in its various forms is the leading cause of death in adults and is especially prevalent in males. By age 60, one in five men will have already suffered a heart attack. The conditions to watch usually have been taken to be dysregulated blood lipids, homocysteine levels, hypertension, and obesity. More recently, it has been suggested that chronic low-level inflammation is a major causal factor in cardiovascular disease and that the Metabolic Syndrome (insulin resistance) is the actual underlying condition responsible for many or even most of the risk factors traditionally treated as indicators of heart and circulatory health.

    Antioxidants, Essential Fatty Acids and Minerals
    So-called “bad” cholesterol, low-density lipoprotein (or LDL), according to much current thinking, is only harmful if it has been damaged by oxygen and/or free radicals. Therefore, a protective program might include vitamin C (500 mg—2 grams daily) taken along with vitamin E as gamma-tocopherol (200 IU daily) and plant antioxidants. Tocotrienols, compounds from the same family as vitamin E, may be even more protective. A spate of studies have shown that the beneficial effects of vitamin E are much more pronounced in the gammatocopherol form and that vitamin E should not be supplemented alone, but rather in conjunction with vitamin C and the other antioxidants mentioned here. Indeed, many researchers now believe that the vitamin antioxidants are much more effective if used together and along with a variety of plant-derived antioxidants.

    Grape seed extract (100–300 mg daily) is commonly used in Europe by individuals who experience vascular and general circulatory problems. According to epidemiological data, safe and effective means of reducing heart disease risks include the ingestion of many such flavonoids, catechins and other polyphenols found in fruit extracts and tea. With regard to tea, these benefits come not just from green tea, but also from the theaflavins found in black and oolong teas. Another set of plant compounds that support heart health are lignans. Flax is especially rich in lignans. Tea, of course, is a beverage and flax is a food. Other food sources being mined for special antioxidants include olives and various highly colored berries.

    Similarly useful nutrients include the combination of L-carnitine (500–1,500 mg daily) and coenzyme Q-10 (30– 300 mg daily). Specialty forms of L-carnitine include L-carnitine fumarate, GPLC (glycine propionyl L-carnitine hydrochloride) and acetyl L-carnitine. Alpha-Lipoic acid (100–300 mg daily) is another good choice, and one with a particularly broad range of benefits. Minerals to supplement are chromium (200–600 mcg daily), magnesium (400 mg daily, preferably as magnesium aspartate) and selenium (200 mcg daily). A good broad-spectrum mineral supplement containing the Reference Daily Intake of copper should be considered if using the higher recommendation of vitamin C or if elevated triglycerides are a problem. Emerging evidence also supports supplementation with the lesser-known mineral silicon in the form of orthosilicic acid.

    Of great importance, for instance, in controlling inflammation, is the right balance of fats in the diet. It is accepted by most researchers that the modern Western diet is very poor in the essential fats known as omega-3 fatty acids. Sources of omega-3 fatty acids are flaxseed oil (1–2 tablespoons daily) and fish oil capsules (follow manufacturers’ recommendations). Just how important are these oils? Well, when the fish-supplemented trials are removed from statistical analyses of the standard low-fat dietary interventions routinely touted in medical circles, the benefits with regard to heart disease are marginal and overall mortality rates actually increase! Gamma-linolenic acid (GLA, 100–300 mg daily) can be taken in conjunction with omega-3 fatty acids for further protection against inflammation and to maintain immune balance when large amounts of fish oils are ingested. Finally, to protect against elevated blood homocysteine levels, supplement with vitamin B-6 (15–50 mg daily), vitamin B-12 (250 mcg daily) and folic acid (400 mcg daily).

    Prostate Health
    What can go wrong with the prostate? Plenty. Prostate problems typically can be catalogued under four headings: prostatitis, prostatodynia, benign prostatic hyperplasia (BPH), and prostate cancer. Prostatitis is really a catch-all term for several types of prostate problems. It always involves inflammation of the prostate and may also include considerable pain, whereas BPH may not involve any pain (as opposed to discomfort). Prostatitis is fairly common in adult males. It sometimes has a bacterial infectious component, but it often has no clear cause. Abstaining from alcohol and spicy foods helps in some cases. Prostatodynia, which is most common in young and middle-aged men, often appears as pain and/or discomfort in the groin, perineum, testicles, lower back, and penis. Smooth muscle spasms in the prostatic portion of the urethra and in the neck of the bladder are at work here. Fatigue in the muscles in the pelvic region and emotional stress appear to be powerful contributory factors in prostatodynia.

    Benign prostatic hyperplasia (formerly called hypertrophy) involves the renewed growth in the number of prostate cells late in life. Unfortunately, nearly 60 percent of men age 40 to 59 are likely already to suffer from BPH. This usually does not present a noticeable problem until after age 50, but by the age of 80, some 85 percent of all men suffer from one or more symptoms of BPH. The primary effect of BPH is a progressive decrease in the ability to empty the bladder as the prostate enlarges and applies pressure to the urethra. BPH should not be confused with prostate cancer,although there is an overlap of symptoms between the two. Men over age 50 should regularly visit their urologists to discover and distinguish between these two conditions. Fortunately, prostate cancer is one of the slowest growing of all cancers. Antioxidants, Essential Fatty Acids and Minerals

    Prostate problems are far easier to prevent than to deal with after they have manifested. Moreover, especially in the case of prostate cancer, epidemiological studies routinely find that eating more fruit and vegetables is strongly protective, whereas consuming large amounts of milk (especially more than two glasses per day) appears to have a strongly negative effect upon prostate health. Studies suggest that supplementing with vitamin E (200 IU daily), lycopene (5–10 mg daily), and the minerals selenium (400 mcg daily) and zinc (15 mg daily) are good protective measures. Flaxseed oil (1–2 tablespoons daily) can be quite beneficial, as can the regular consumption of pumpkin seeds. Men should avoid margarine, hydrogenated vegetable oils and fried foods whenever possible. The jury is still out with regard to the effects of calcium supplementation in men. Some epidemiological studies indicate that higher intakes of calcium are correlated to higher risks of prostate cancer, perhaps through a negative effect upon the levels of active vitamin D in the body or through some other mechanism. The work of E. Giovannucci of Harvard Medical School has been instrumental in uncovering the calcium/prostate cancer connection and the protective effects of fruit consumption nd an adequate intake of vitamin D (but not more than 400 IU daily).

    Isoflavone Herbal Preparations
    Although it may surprise most men, many of the same isoflavones and phytoestrogens that are helpful to women are also helpful to men. Men and women both produce estrogen. As males age the ratio of testosterone to estrogen is reduced. This reduced ratio of testosterone to estrogen appears to be the key cause of prostate problems. Plant estrogens, which are very weak in comparison with the estrogen itself, can actually reduce the impact of hormonal estrogen at the level of cell receptors. Isoflavones found in soybeans and red clover represent a promising approach to prostate health management. Also useful are extracts of saw palmetto berries and flower pollen. Indeed, specialty flower pollen extracts (from mostly rye pollen) have an unusually broad range of benefits for the prostate in that they have proven to be useful not only in cases of BPH, but also in prostatitis and prostatodynia.

    Prolonged stress poses a very real health risk, one with which men are less physiologically equipped to cope than are women. Higher rates of heart disease and high blood pressure are but two results. In the pre-modern world, many or even most threatening or challenging situations (“fight or flight” situations) led to a physical response which consumed and directed the energy made available by the release of hormones such as epinephrine into the blood stream. Physical responses, however, are not usually possible or even desirable in the face of stalled traffic or office frustrations. In such cases, the released energy is “bottled up,” as it were. This results in disturbances in sleep, immune function, blood pressure regulation and other bodily systems. As the “fight or flight” reference suggests, the best responses to stress are often physical. Try to get some vigorous physical exercise every day, but also consider practicing yoga or some similar form of relaxing physical therapy.

    Nutrients and Herbs for Relaxation
    Generalized emotional and physical stress leads to oxidative stress. Therefore, a broad-spectrum antioxidant mixture is an excellent countermeasure. Be sure to include in the diet, as well, the recommended daily intake of all of the B vitamins. The amino acids taurine (500 mg to 1 gram daily) and glutamine (750 mg to several grams daily) play important roles in the body’s response to stress. These are best utilized if taken between meals with a small carbohydrate snack. The bioflavonoid known as chrysin (1–3 grams daily) is an important stress-reducing compound, as are theaflavin, valerian and skullcap (see manufacturers’ directions). Also useful are calming herbal teas. The best known of these is chamomile.

    Sports Aches and Pains of the Weekend Warrior
    Exercise is important. In some studies, men who exercised regularly had a 70 percent reduced risk of death from all causes and a 39 percent reduced risk of death from heart attack. This is the good news. The bad news is that those of us who are sedentary for five days out of the week and then try to make up for this in the remaining two days of the weekend may find that we end up with more than our share of aches and pains. The body responds best to regular exercise, which is to say, exercise at least every other day. Cramming a week’s worth of exercise into the weekend is asking for trouble. And, of course, as we get older our ability to “bounce back” from strenuous physical exertion diminishes. Fortunately, there are some ways to prevent problems and to help make them go away once they develop.

    Conditioned athletes are actually able to produce more of certain antioxidant enzymes within their bodies to cope with this heightened demand, and this fact indicates that training may produce a type of “reserve capacity” for antioxidants. However, it is still true that exercise puts oxidative stress on the body. In various studies, athletes who ingested an antioxidant “cocktail” before working out experienced faster recovery and fewer aches and pains than those who did not take the antioxidants. The daily antioxidant intake might include vitamin C (500 mg–2 grams), vitamin E (100–200 IU as gammatocopherol), coenzyme Q-10 (30–300 mg), alpha-lipoic acid (100–300 mg), plus a number of plant antioxidants, such as mixed citrus bioflavonoids (1,000–3,000 mg). Individuals who are involved in contact sports might consider either grape seed or pine bark extracts (200–300 mg) to help prevent bruising. Glutamine (750 mg to several grams daily) recently has become one of the favored supplements by serious athletes because of its benefits in recovery and in sparing the destruction of lean tissues due to excessive exertion.

    Nutrients for Repair
    Ligament and cartilage injuries are common in sports. Glucosamine and chondroitin sulfate are often recommended in osteoarthritis to improve the repair of cartilage, and these compounds can also be used to speed up repair—or to improve general resilience—of the joints, ligaments and tendons in sports. (Follow manufacturers’ directions.) Sadenosylmethionine (SAMe) is another nutrient that improves tissue repair and indirectly reduces pain and inflammation; the dosage is typically 400–800 mg of SAMe per day. Expect to wait from one to four weeks to experience the benefits of these supplements if you are just starting to use them. These items improve the body’s ability to heal itself and are not directed at symptoms as such.

    Hair Loss
    Roughly one half of the men in Western industrialized countries suffer from Male Pattern Baldness (MPB), and this syndrome accounts for some 90 percent of all cases of hair loss. However, the presence of MPB does not mean that other factors are not at work, such as reduced circulation. For instance, increases in hair loss in certain areas of the scalp correlate with the development of heart disease. For example, extreme thinning specifically on top of the head (rather than merely receding from the front) appears to be more strongly associated with circulatory disease than is balding elsewhere on the head. Hence, this problem is not always cosmetic and concern may not be limited to vanity.

    Hair Nutrients
    Deficiencies in the B vitamins biotin, inositol, pantothenic acid, and PABA are particularly linked to hair loss and to premature graying. A number of nutritionists have suggested that high-potency supplementation with the entire range of B vitamins, with special attention paid to biotin, inositol and pantothenic acid, may prove to be helpful. Vitamin C (1–2 grams daily) is important for the circulation, but also for the production of collagen, a component of the hair. Coenzyme Q-10 (30–300 mg daily) is another antioxidant often suggested to improve scalp circulation. Alpha-lipoic acid (100–300 mg daily) similarly appears to be effective and seems to be useful in hair loss if supplemented for at least six months. The amino acid cysteine (1–3 grams daily), also supplemented as Nacetyl-cysteine (NAC, 500–750 mg daily), can help to increase the speed at which the hair grows. A new and really interesting item that improves the quality of the hair is choline-stabilized orthosilicic acid (BioSil)—it is worth a shot. No major improvements in scalp health or hair loss should be expected in less than three months’ time (the hair follicles need to be activated and the hair must grow out). For many men, increasing protein in the diet may also prove useful in increasing the rate at which the hair grows. This may reflect an effect upon thyroid function, in which case, adding omega-3 fatty acids to the diet is also a good idea.

    Men’s nutritional needs differ from those of women. It is not difficult however, to meet these special needs. A well-structured program of nutritional insurance should include as a foundation a balanced multivitamin/mineral supplement. Then plan in advance to provide nutritional support for any special needs. As always, it is recommend that you tell your doctor or health care provider what supplements or herbs you are taking. Even if he or she is not overly familiar with them, this knowledge is useful for monitoring your health.

  • The Sinatra Solution, Metabolic Cardiology Part I

    Editor's Note:
    This is the first in a series of articles drawn from The Sinatra Solution, Metabolic Cardiology by Stephen T Sinatra, M.D.

    In his introduction to this landmark work, James C. Roberts, M.D., FACC states the following: "Nutritional science provides answers to many lingering questions in medicine. It's the difference between natural science and the man-made science of drug therapy.
    Pharmaceuticals do play an important role in medicine and Dr. Sinatra and I study their use, but more drugs are not the only answer. A better answer is for physicians and patients to learn more about the biology of disease and the biochemical keys to energy production. This knowledge provides the insight needed to support the heart and the recovery of our health, well beyond what drug and surgical therapies can provide. That is why I'm so passionate about metabolic cardiology and that's what you will learn about in this important book.

    Whether you are a practicing cardiologist, afflicted with a heart disease or simply the responsible owner of an adult body, we are confident you will find The Sinatra Solution an invaluable asset to achieving and maintaining optimum health.

    My journey as an integrative cardiologist has been an exciting period in my life, and it has brought me endless moments of satisfaction and joy. Yes, it is joyful when you can reduce human suffering and improve the quality of life for someone else. l have shared many moments of sublime satisfaction with my patients and their families, after their life has been improved or spared through the many alternative, pharmaceutical and technical tools of modern cardiology. But the specialty I hold so close to my own heart still has considerable limitations.

    Pharmaceutical drugs, bypass surgery, angioplasty, stent emplacements, pacemakers and implantable defibrillators all have their place, and many lives would be lost without these high-tech interventions. Cardiologists face a daily dilemma concerning the best diagnostic procedures to refer for their patients and then, based on those test results, which surgical and/or pharmaceutical interventions to select. To complicate the choice, the evaluations we order and the treatments we select may actually create unnecessary risks for patients-risks that are out of proportion to the benefits they will experience. Continuing technological advances, although necessary, add to the complexity of the decision-making process.

    Cardiologists have grown reliant upon these sophisticated medical processes. But somewhere along the way, something has gone amiss. There has been much mistrust of the conventional medical model among the public recently. Starving for new information, massive numbers of patients are consulting alternative therapy practitioners and are visiting book and health food stores in record numbers, creating a multibillion dollar industry outside of the mainstream medical community.

    What is driving even our most conservative patients to look at other forms of therapies? There are many reasons for the increased popularity of alternative medicine, including patient dissatisfaction with ineffective conventional treatments, pharmacologic drug side effects and the high price of medications. Perhaps most important is the fact that traditional medicine has become too impersonal with the involvement of high-tech modalities and time-limited office visits.

    Obviously, the medical consumer is searching for less invasive, safer and lower cost interventions. Some of this comes out of necessity; managed care plans have driven our patients into seeking cost-effective medical care delivery, as more of their health care dollars are coming out of their own pockets.

    Many patients are now questioning the need for potentially life threatening drugs and invasive interventions that carry considerable risk of side effects, complications and even mortality.

    Recent research has suggested that 2 million lives are lost each year as a result of complications from" standard-of-care" interventions, medical errors and complications. When we consider that the fourth leading cause of death in the United States is properly prescribed medications in a hospital setting, something's gotta give!

    Even in 2005, coronary artery bypass surgeries (CABS) are performed on the basis of clogged arteries alone with no regard to quality of life issues. This is not smart medicine. Rates of complications from CABS-such as heart attack, infection, stroke, and central nervous system (CNS) dysfunction-are disturbing. It is important to note that CNS dysfunction was observed in an alarming 61 percent of patients six months after CABS. People are naturally looking for less risky and fewer surgical alternatives in lieu of such downsides.

    During my 30 years of practicing cardiology I have seen a slow paradigm shift regarding the perceived availability of effective, natural alternatives for the treatment of a wide range of cardiovascular disorders-problems like angina, arrhythmia, high blood pressure and congestive heart failure (CHF). More physicians have expanded their approach to heart disease and accept and recommend complementary therapies as equally judicious treatment interventions. However, invasive CABS is a sound approach to improve quality of life and possibly advance longevity when alternative or medical therapy fails to correct a patient's symptoms of refractory angina (chest pain, shortness of breath and so on).

    An integrative cardiologist is one who brings conventional methodologies to the table and also offers complementary and alternative interventions that can boost patients to an even better quality of life. Integrative cardiologists are as comfortable prescribing diet and lifestyle changes, a vast array of nutritional therapies and mind/body approaches as they are scheduling a treadmill stress test, recommending angioplasty and handing out a medication. They integrate the best of both worlds when caring for their patients.

    For example, I have encountered an endless number of patients awaiting heart transplants-those with the most seriously compromised heart function-who have been literally "cured" by nutritional therapies. Those who want to improve the quality of their lives through both conventional and alternative approaches.

    Getting well requires that the physician and the patient share in the healing process. I believe that we physicians don't really "cure" anyone. We merely coach, care for and support our patients . . . only nature heals.

    A good physician assists patients in finding and stimulating their own healing capabilities. Over the years I've learned that real healing takes place when the intention of the healer matches the intention of the patient.

    The real essence of "doctoring" employs elements from physical, emotional and spiritual realms to reduce human suffering and enhance quality of life. Integrative physicians who use whatever it takes to help heal the patient, are practicing good medicine, as well as what I refer to as smart medicine. And physicians who listen to "the messengers" around them are open enough, and wise enough, to understand that not only can they can learn from their teachers and colleagues, but also from their own patients as well.

    I know that many of my own patients are interested in how I became involved in nutritional and other non-conventional therapies. Most tell me how hard it is to find a physician comfortable with what (I'm sorry to say) we still call "alternative" approaches, and ask how I "fell into it." First of all, many of the practices we now call alternative are actually mainstream healing methods that we've abandoned in our age of technology. Indigenous and advanced cultures alike still use these therapies appropriately and with good results.

    I didn't "fall" into practicing and endorsing complementary forms of healing at all. I truly believe that I was led here. Within a year after passing my cardiovascular boards and becoming a credentialed invasive cardiologist, I began to realize something was missing. For instance, I started asking myself why I saw the same patients coming back into the emergency room with the exact same problems that had brought them there just months earlier-after we thought we'd "fixed" them. Too many times I would take care of a medical crisis, patch the patient up and send him back out, only to see them return again. Surely something was amiss.

    I didn't quite get it. I sincerely thought that I was doing the right things, but I wasn't really helping anyone's body heal itself. Instead, I was performing in the hospital like that proverbial boy desperately sticking his finger in a hole to patch up a dike doomed to break down. I was prescribing drugs and different therapies aimed at directly "fixing the problem," and they did-in the short term. Then I realized what I was failing to see was the bigger picture: I was doing nothing to actually help prevent or even cure the real, complex, underlying problems.

    At that juncture, I decided I needed to enter a psychotherapy training program to become more open to other modalities of healing, including mind-body medicine. Over the next decade I studied mind-body interactions, became a certified psychoanalyst and read all I could about nutritional medicine. I spent nine years studying bio-energetic psychotherapy, an approach that confirmed my experience and belief that stress in the psyche can translate into physiological processes that create "dis"-ease in the body. Eventually, I coupled this approach with learning all I could about providing better care for the psyche and the body. The latter brought me into the field of nutritional approaches as well as to cellular healing.

    It was at this point that I had my first encounter with coenzyme Q10. It seems no accident that I came across an article in the Annals of Thoracic Surgery reporting how patients taking coenzyme Q10 were able to be weaned more quickly from the heart-lung bypass machine we use during open heart surgeries. I'd recently lost a dear patient after a successful mitral valve replacement operation because he had failed over and over to come off that same pump-a nightmare scenario that happens on extremely rare occasions. So that article really grabbed me and made a strong impression. What regrets! What if I had known about coenzyme Q10 before I'd sent that kind man to a surgeon? His death had been a real heartbreak for me and one that still strays into my thoughts.

    I couldn't bring that one gentleman back, but from then on I could, and did, tell patients awaiting open heart surgeries to start taking a daily dose of 30 milligrams (mg) of coenzyme Q10 two weeks in advance. Thanks to the lessons from one patient, they all came off the heart-lung bypass machine without a problem.

    All through the 1980s I found myself driven to learn all I could about mind-body and nutritional medicine. It consumed most of my spare time. By 1986, I was convinced enough to start using coenzyme Q10 for more cardiac situations, like arrhythmias, hypertension, coronary artery disease, CHF and angina. In 1990 I actually began to develop my own vitamin and mineral formulas using coenzyme Q10, B vitamins, vitamins C, E, and D, carotenoids, flavonoids, calcium, fish oil, green tea and so on, and I believe that they all have merit in the treatment and prevention of heart disease.

    I read reams of research, and even authored several books and journal articles to share the success stories I was observing with my own patients, many of whom were transcending the kind of improvements I had only hoped and prayed for. As I watched those tears of joy and enjoyed hugs from my patients and their family members, it was obvious that we were onto something . . . something big! I didn't realize it, but in the future I would become a metabolic cardiologist.

    A few years later I started using L-carnitine and was truly amazed at how this combination of two nutraceuticals (coenzyme Q10 and L-carnitine) provided an even bigger quality of life boost for people. Frankly, when I look back I don't know how I ever practiced cardiovascular medicine without them. Now it's unthinkable not to recommend them to my patients with heart failure, arrhythmia, angina and hypertension. Knowing what I know now, withholding information about these nutraceuticals would be tantamount to malpractice for me.

    It was a new beginning in my practice of medicine to be able to offer my patients alternative therapies that were safe and efficient-and that truly worked. Because nutrition had not been a part of the curriculum when I went to medical school, I had to make time to study it at great length, but my physician colleagues were often skeptical that I knew what I was talking about. So to be sure that I was qualified, I dug in, learned more and took the board examination given by the American College of Nutrition (ACN). I studied for two years, passed the exam and added CNS (Certified Nutrition Specialist) to my credentials.

    In the 1990s I was recommending nutraceuticals to support the mitochondrial defense system in the cell. You may recall from high school biology that the mitochondria is nicknamed the "powerhouse of the cell" because it's primary function is to generate ATP, that complex energy substrate generated by the Krebs cycle (a long chemical process I hope you never had to memorize for a test question.) I serendipitously came to learn that preserving the mitochondrial adenosine triphosphate in our precious heart cells was really the answer in sustaining the pulsation of cells and life itself.

    I learned that pulsation in the body is the key to vibrancy and life itself in my bioenergetic training for certification. Even prehistoric man knew that life depended upon the pulsating heart. Another light bulb went off! I realized that the health of the heart cell's mitochondria was the key to pulsation and contraction. I became driven to devote my energies to studying the relationships among mitochondria, the heart and cardiological diseases.

    This complex relationship is the essence of metabolic cardiology.

    In 2002 I met Dr. James Roberts at a conference in Las Vegas and listened to his research on the utilization of D-ribose in the cardiac patient. D-ribose is a five-sided sugar that is the missing link in energy transformation. I was truly amazed by Dr. Roberts' presentation and we have become colleagues over the past few years. I have such a genuine respect for Dr. Roberts that I asked him to write the introduction to my book. A well-credentialed integrative cardiologist himself, Dr. Roberts knows the vital importance of D-ribose in providing and sustaining energy, particularly in hearts that are compromised.

    After using D-ribose dozens and dozens of times and becoming convinced of its efficacy, I wrote a newsletter article about it in my "Sinatra Health Report." I wanted to give this new and vital information to my 50,000-plus subscribers describing the emerging field I call "Metabolic Cardiology."

    As my knowledge and experience evolved, I came to realize that when you treat the mitochondria and nurture the heart on a cellular level, then you can improve the health of the whole organism. The study of mitochondrial energy and pharmacokinetics became such a passion that I wanted to write this book to get this life-saving information out to more and more people.

  • The Sinatra Solution, Metabolic Cardiology Part II

    For many years, I have been teaching patients, and doctors, about the life-giving benefits of Coenzyme Q10 and L-carnitine. Looking back, using them in my practice represented our first steps into the world of metabolic cardiology—the treatment of heart disease on a cellular level by improving individual cell function and energy production. The effect of these nutrients on cellular energy has now been experienced by thousands of heart patients, who improved the quality of their lives by the simple supplementation with these “Twin Pillars” of cardiac health.

    Now a new nutrient, D-ribose, has arrived on the scene, heralding a second generation of metabolic cardiology. In combination, these nutrients provide the metabolic support hearts and other body tissues need to generate and maintain the energy required to promote health and vitality. I’ve watched nutritional interventions improve and literally save lives when traditional medicine just wasn’t enough. Now, I employ them as my first line approach whenever I can.

    One of the most important discoveries physicians and scientists have made in recent years is the evolving study of cellular energy, or bioenergetics, and the impact cellular energy metabolism has on heart function. In her recent book, ATP and the Heart, Dr. Joanne Ingwall writes about the role of ATP (adenosine triphosphate, a biochemical required for cellular energy) in heart function:

    “A major clinical challenge today is to develop strategies to preserve or improve [heart] pump function while maintaining cell viability. To achieve this goal, an understanding of the metabolic machinery for ATP supply and demand is required . . . Every event in the cell, directly or indirectly, requires ATP. Myocytes [heart cells] need ATP to maintain normal heart rates, pump blood and support increased work, i.e., recruit its contractile reserve. The myocyte needs ATP to grow, to repair itself, to survive. The requirement for ATP is absolute.”

    Dr. Ingwall's credentials are impressive, and she is particularly well qualified to make these statements. As a professor of medicine (physiology) at Harvard Medical School, and senior biochemist and director of the nuclear magnetic resonance (NMR) laboratory in the cardiovascular department of Boston's Brigham and Women’s Hospital, Dr. Ingwall has spent her professional life studying the role of energy metabolism in the heart. Her book, published in 2002, supports the need for understanding the complex mechanisms of cellular energy metabolism when devising therapies for treating cardiovascular disease. ATP and the Heart should be required reading for any professional working in this field.

    To supply this absolute and continuing need for energy, the body’s many complex systems rely on a variety of nutrients that are used within the cell to drive, control, and facilitate the myriad biochemical reactions that provide energy to the cell. Because none of these nutrients works independently, a “synergy” of nutrients is oftentimes what’s needed to offer results superior to that of any single nutrient. Improving the function of one cog in the wheel of metabolic machinery for energy production increases overall efficiency when the other cogs in the machinery are also working at their peak. It’s not “fuzzy math” at all.

    Think of it this way: in simple math, things are additive; one plus one clearly equals two. But when you combine the right nutrients together to work synergistically, the advanced math results can be exponential; one plus one can equal five or even ten! You don’t merely add up the benefits of each nutrient in sequential fashion. Instead, these synergistic effects mean that an explosive combination of nutrients can have an exciting, positive impact on one’s well-being, and even on life itself.

    Unfortunately, the understanding of the metabolic role of energy in heart function is not well-known by medical practitioners, and the impact of supplementing the heart with energy-supplying nutrients is not appreciated. Here is an example of how this lack of understanding caused one man unnecessary despair, as well as a delay in treatment.

    Jim was a 76-year-old living with congestive heart failure and ischemic heart disease. In 2003, his disease worsened to the point that he could hardly walk. Jim’s examination and testing at his cardiologist revealed an ejection fraction of only 14 percent.

    Jim had heard about D-ribose, L-carnitine, and Coenzyme Q10, so he asked his doctor if he should try these supplements to improve the energy in his heart. Jim was told, “No. There simply isn’t enough science to show that these work.” Undaunted, Jim made an appointment with a second, and then a third, cardiologist to seek advice on taking these important, life-giving nutrients.

    In every case, Jim’s request was refuted and he was either advised that there was “insufficient science” to show their effectiveness, or that “these supplements don’t work,” by physicians who just weren’t doing their homework. Clearly, these strongly biased doctors failed to understand the vital role that energy metabolism plays in heart function.

    Still skeptical, but anxious about going against the advice of these medical professionals, Jim contacted me for an appointment and was evaluated by my associate, Dr. Sun King Wan, an invasive interventional cardiologist. Following a complete cardiovascular workup, my “first-knight” nurse, Rosie—who’s been with me for thirty years—started Jim on a cocktail of nutrients, including D-ribose, L-carnitine, Coenzyme Q10, and a mixture of B vitamins. Jim simply mixed what he refers to as “Rosie’s cocktail,” in orange juice three times per day. Within four days, Jim could walk farther than he’d been able to in months. A couple of weeks later, Jim was painting the rails on his porch, and within four weeks his ejection fraction had improved to 24 percent.

    While there’s still improvement for Jim to make, within a month his heart function had improved by over 50 percent simply because his heart was able to restore the energy—on a cellular level—that was being sapped by his disease. Following Jim’s progress, my clinic partner, with his modest prior understanding of the importance of energy metabolism in heart function, was so impressed that he now recommends these nutrients to all his heart patients, too.

    When it comes to heart disease, D-ribose, L-carnitine, and Coenzyme Q10 have become the triad of nutrients we rely on for healing and prevention. You will soon see that these nutrients can rocket your heart and muscle energy to new heights. They do this by maximizing the amount of oxygen that your heart and skeletal muscle can extract from your blood, by accelerating the rate at which the food you eat is converted to energy in your cells, and by keeping your cellular energy pool healthy.

    This book reflects a twenty-year learning curve in my practice of integrative cardiology. I’ve been using Coenzyme Q10 during that entire twenty year period, L-carnitine for the past ten years, and D-ribose these last couple of years.

    The synergistic combination of D-ribose, L-carnitine, and Coenzyme Q10 has been a tremendous breakthrough in the treatment of heart disease, and has become my personal nutritional arsenal for boosting the heart’s energy. You see, whatever the patient’s cardiac condition, getting back to a healthy heart is about supporting each individual heart cell and encouraging them to join forces and strengthen the heart as an energy pump. So the bottom line for your heart is always about ENERGY!

    Because L-carnitine and Coenzyme Q10 both work in the inner mitochondrial membrane, the clinical purpose of these nutrients is to complement one another in accelerating energy supply to heart cells. D-ribose works to maintain the healthy pool of energy substrates needed by L-carnitine and Coenzyme Q10 to work effectively. Clinically, working together these nutrients can help assuage cardiac arrhythmia, reduce the risk of heart failure, overcome the severe weakness and fatigue of coronary artery disease, increase exercise tolerance, relieve cramping and soreness in the lower extremities (claudication), T and improve the quality of life for patients suffering with these conditions.

    This triad is not only remarkably effective in preserving heart health, but is also outstanding in the treatment of neuromuscular diseases, such as fibromyalgia, that are also affected by failures in cellular energy metabolism.

    Although hundreds of scientific papers have been published in noteworthy scientific and medical journals describing the individual roles of these naturally occurring compounds in preserving the energy health of your heart, skeletal muscle, and other tissues, you've probably never heard or read about the exciting combination of D-ribose, L-carnitine, and Coenzyme Q10.

    Nor are you likely to have heard about these revolutionary treatments from your doctor. Why? Because even though the scientific literature clearly presents the science, and thousands of clinical applications have documented that these compounds have proven beneficial for treating a wide variety of clinical cardiac conditions, therapies like D-ribose, L-carnitine, and Coenzyme Q10 are still largely ignored by a majority of clinical cardiologists as well as most of the conventional medical establishment. Despite the fact that these three nutrients are used by many board-certified cardiologists in the United States, Europe, and Japan, most clinical cardiologists generally remain biased by ignorance or a deep-rooted reliance on pharmaceuticals. Unfortunately, the many patients who are not helped by conventional treatments alone or whose treatment could be greatly enhanced by the addition of D-ribose, L-carnitine, and Coenzyme Q10 will never be offered the chance to receive them.

    Besides the widespread ignorance about supplemental treatment with this triad, it is equally tragic that there is so much negative bias against these nutritional therapies. One of the major obstacles to evaluating the benefit of nutritional therapies is the claim by many physicians that there is a lack of scientific data on the subject. Although most conventional wisdom is subject to the current "gold standard" of evidence-based scientific controlled studies, there are literally scores of studies on Coenzyme Q10, L-carnitine, and D-ribose demonstrating this exact rigorous standard of controlled analysis. For example, if you go to the Internet and type in “Coenzyme Q10” as a search word on the Pub Med site, you will see 1,254 published articles in various scientific and medical journals. Type in Q10's generic name “ubiquinone,” and the count rises to 5,769, most of which represent sound science-based inquiry. L-carnitine and D-ribose will bring up thousands of results. So, I'm confused when my peers say “there's no data.”

    The rejection of D-ribose, L-carnitine, and Coenzyme Q10 as potent, nonprescription treatment defies imagination. It's apparently difficult for highly trained medical personnel, well versed in pharmacology and technology, to believe that anything so simple and so natural could be as effective as the highly engineered drugs modern medicine has to offer.

    Most American cardiologists cannot acknowledge that a natural substance not manufactured by pharmaceutical industry giants could be so valuable. These factors have rendered therapies including D-ribose, L-carnitine, and Coenzyme Q10 victims of politics, bias, insufficient marketing, economics, and ignorance regarding the results of real science.

    That is not to say that the nutritional supplement industry is blameless. Too many dietary supplements—claiming to treat everything from heart health to weight loss to male sexual enhancement—have hit the market with major media campaigns, plenty of claims, and a host of promises, with little, if any, science behind them. There can be no doubt that this “hype versus science” attitude in the nutritional supplement industry has placed major roadblocks in the path of acceptance of those natural therapies that do have solid science and demonstrable clinical benefit, and has encouraged many morethan- skeptical attitudes among health care providers.

    Another dilemma is the not-all-are-created-equal issue regarding nutritional supplements. While many products are pure, many others fail to live up to the ingredients and dosages listed on their labels. The FDA monitors our pharmaceuticals, but not the supplement industry. While FDA involvement would spuriously skyrocket the cost of many vitamins and supplements and place them outside the affordability range for many people, it is not easy to know which products are worthy of your financial investments at present. This darkens the cloak of suspicion for many physicians. For now, I can only advise you on the products I've tested and found to be of high quality, and hope for some standards to be developed in the future.

    It is also true that manufacturers and distributors of D-ribose, L-carnitine, and Coenzyme Q10 do not have the financial and physical resources to “detail” these products to physicians as major medicinals, as the pharmaceutical companies do with their new drugs. These companies have thousands of sales representatives on the street visiting doctors everyday, and they are able to start and run campaigns to educate physicians about new products. Such campaigns can cost tens, or even hundreds, of millions of dollars. This effort is simply too costly for smaller companies trying to reach the broad and highly diverse audience of health care professionals suffering from a complete lack of knowledge about these revolutionary treatments.

    This book will specifically discuss the importance of energy metabolism for cardiovascular health and the impact of these three nutrients on the cardiovascular system. But the story should not end there. All three of these miracle ingredients—D-ribose, L-carnitine, and Coenzyme Q10—are being used right now in a wide variety of serious degenerative diseases, including heart disease, high blood pressure, cancer, periodontal disease, chronic obstructive pulmonary disease, diabetes, neurological disorders, neuromuscular disease, male infertility, and even aging itself.

    Part three of the series from The Sinatra Solution, Metabolic Cardiology will appear in the next issue of totalhealth.

  • The Sinatra Solution, Metabolic Cardiology Part III

    So far we have learned a good deal about how the “Awesome Foursome” of Coenzyme Q10, L-carnitine, D-ribose, and magnesium helps our hearts metabolize energy more efficiently and protects them from the stress of cardiovascular disease. This powerful combination of nutrients goes directly to the basic biochemistry of cellular energy metabolism. Now let’s take a closer look at how Coenzyme Q10, L-carnitine, D-ribose, and magnesium work in synergy to promote cardiovascular health.

    We’ll start our discussion on the important synergy of Coenzyme Q10, L-carnitine, D-ribose, and magnesium with a short summary of how each works individually. Let’s begin with Coenzyme Q10.

    Coenzyme Q10: Energy Recycling through the Electron Transport Chain
    Coenzyme Q10 is a powerful antioxidant that helps protect the mitochondrial membrane, mitochondrial DNA, and cell walls from free-radical attack. But its most important function in the body is its central role in energy metabolism.

    Most—about 90 percent—of the ATP used by cells is recycled as food (fuel) and oxidized in the mitochondria. Fatty acids, carbohydrates, and, occasionally, proteins are carried across the mitochondrial membrane and enter the Krebs cycle, moving from step to step and spinning off electrons. These electrons are then handed off to the electron transport chain, where, in the presence of oxygen, the energy from the electrons is captured as a phosphate group is added to ADP to form ATP. This recycling of ATP is called oxidative phosphorylation, and the by-products of these pathways are CO2 and water.

    Coenzyme Q10 is the “electron clearing house” in the mitochondria. Coenzyme Q10 accepts electrons coming out of the Krebs cycle and passes them off to other constituents of the electron transport chain called cytochromes. In this fashion, Coenzyme Q10 acts as a gatekeeper of electrons, making sure they are carried to just the right place to pass on their life-giving energy.

    The activity of the electron transport chain is highly complex and beyond the scope of our discussion. What is critical, however, is the simple fact that without Coenzyme Q10 the electron transport chain would totally break down. And since the electron transport chain is (by far!) the largest contributor to cellular energy turnover, its loss would be catastrophic. It is also important to know that there has to be an excess of Coenzyme Q10 in the mitochondria to be maximally effective. Having just enough isn’t sufficient to do the job properly, and having a deficiency seriously affects the mitochondria's ability to supply the cell with energy.

    To keep the electron transport chain running at peak efficiency, there must be enough Coenzyme Q10 to accept electrons immediately as they are spun out of the Krebs’ cycle, carry them to the cytochromes where they are passed off, and then return to wait in line for yet another electron. If there is not enough Coenzyme Q10 waiting in this queue, electrons will not be captured and their energy will be lost.

    Think of this process in terms of a warm-up drill before a basketball game. During these warm-ups basketball players stand in a line at the free-throw line. One of their coaches stands under the basket and throws the ball to the first player in line to start the process going, much like the Krebs cycle throwing off an electron. The first player in line quickly carries the ball to the basket, hands it off to the basket in a lay-up, and runs back to the end of the line. The coach then throws another ball to the next player in line, and the cycle continues. However, if there is no player waiting in line to collect the throw, the ball will spin out of control to the other end of the court and will never make its way to the basket.

    The same is true with Coenzyme Q10. Electrons are passed out of the Krebs cycle and accepted by the next Coenzyme Q10 in line. Coenzyme Q10 then carries the electrons to the basket (the cytochromes), passes them off, and returns to the back of the line. If you can imagine this as a continually moving line with millions of basketballs in play you can visualize why so much Coenzyme Q10 is needed to keep the process running smoothly. When there is a Coenzyme Q10 deficiency, many of the electrons spin out of control and never make their way down the energy pathway.

    Cellular stress can cause Coenzyme Q10 deficiency, which places a severe strain on Coenzyme Q10 availability. People with heart disease, hypertension, gingival disease, Parkinson’s disease, and the other disorders we’ve discussed are known to be deficient in Coenzyme Q10. Whether these deficiencies are the cause or the effect of these varied medical problems, the end result is that they sap the life out of their mitochondria and reduce their energy supplies. You see, Coenzyme Q10 cannot function properly if electrons are not coming out of the Krebs’ cycle, and the Krebs cycle won’t work without the fuel that’s transported into the mitochondria by L-carnitine.

    L-Carnitine: Transporting the Cellular Energy Fuel
    Fatty acids are the preferred energy fuel for hearts and most other cells in the body. Fatty acids are long-chain molecules that are broken down by beta oxidation into two-carbon fragments. These two carbon fragments are used to fuel the Krebs’ cycle so electrons can be extracted to run down the electron transport chain. The two-carbon fragments plucked from long-chain fatty acids are picked up by Coenzyme A (CoA) forming activated CoA esters. The mitochondrial inner membrane is almost totally impermeable to these CoA esters, and that’s where L-carnitine comes in.

    L-carnitine resides in the mitochondrial inner membrane and works like a ferry carrying freight across a river. L-carnitine picks up two-carbon fragments on one side of the mitochondrial membrane and transports them to the other side. The primary job of L-carnitine in energy metabolism is the transport of these fuels into the mitochondria, making them available for ongoing energy metabolism in the Krebs’ cycle. In this process Coenzyme A “hands off” the two-carbon fatty acid fragment to L-carnitine, forming acetyl carnitine. Acetyl carnitine then moves across the membrane and again passes off the two-carbon fragment to another CoA living inside the mitochondria. So, like a ferry, L-carnitine picks up the two-carbon fatty acid fragment, gives it a ride across the inner mitochondrial membrane, and delivers it to another CoA waiting on the other side. The CoA receiving the fatty acid fragment then delivers it to the Krebs’ cycle for processing into energy.

    L-carnitine facilitates the beta oxidation of fatty acids as energy fuel. And since fatty acids are the preferred fuel for energy recycling in cells, this action is critical to cell and tissue function. Unfortunately, L-carnitine is deficient in people with heart disease, peripheral vascular disease, lipid metabolic disorders, mitochondrial disorders, and many other disease syndromes we reviewed earlier. This L-carnitine deficiency disrupts the normal metabolism of fatty acids, reducing available energy supplies and leading to the accumulation of toxic by-products of fatty acid metabolism. L-carnitine supplementation revives fatty acid metabolism and restores normal mitochondrial function. But even this powerful improvement in cellular energy metabolism cannot make up for the energy drain that comes from the loss of energy substrates caused by low oxygen delivery to the tissue. Only D-ribose can do that.

    D-Ribose: Rebuilding the Cellular Energy Pool
    As long as cells and tissues have plenty of oxygen, the pool of energy substrates in the cell remains high. And as long as there is enough L-carnitine and Coenzyme Q10 available, the process of energy utilization and supply can proceed unimpeded. However, the cellular supply of oxygen can be restricted by acute or chronic heart disease, peripheral vascular disease, any number of skeletal- or neuromuscular diseases, or even high-intensity exercise.

    When cells are deprived of oxygen the mitochondrial energy turnover becomes inefficient. Remember, oxygen is required to let the oxidative pathway of energy recycling work properly. If the mitochondria are not able to recycle energy efficiently, cellular energy supply cannot keep pace with demand. But the cell has a continuing need for energy, so it will use all its ATP stores and then break down the by-product, adenosine diphosphate (ADP), to pull the remaining energy out of this compound as well. What’s left is adenosine monophosphate (AMP). Since a growing concentration of AMP is incompatible with sustained cellular function it’s quickly broken apart and the by-products are washed out of the cell. The net result of this process is a depletion of the cellular pool of energy substrates. When the by-products of AMP catabolism are washed out of the cell, they are lost forever. It takes a long time to replace these lost energy substrates even if the cell is fully perfused with oxygen again.

    Ribose is the only compound used by the body to refill this energy pool. Every cell in the body has the capacity to make ribose, but hearts, muscles, and most other tissues lack the metabolic machinery to make ribose quickly when the cells are stressed by oxygen depletion or metabolic insufficiency. Ribose is made naturally in the cells from glucose. In stressed cells, however, glucose is preferentially metabolized for energy turnover and is not available for ribose synthesis. So when energy pools are drained from stressed cells, the cells must first wait for the slow process of ribose synthesis before they can begin to replace their lost energy stores.

    Acute ischemia, like that which takes place during a heart attack, heart surgery, or angioplasty, drains the cell of energy. Even when oxygenated blood flow returns, refilling the energy pool may take ten or more days. But when oxygen deprivation is chronic, or when energy metabolism is disrupted by disease, there may be so much continual strain on the energy supply that the pool can never refill without the assistance of supplemental ribose. Conditions like ischemic heart disease or congestive heart failure fall into this category. In these situations, supplementing the tissue with exogenous ribose is the only way the cell can keep up with the energy drain.

    Magnesium: Switching on the Energy Enzymes
    Magnesium is an essential mineral that's critical for energy requiring processes, in protein synthesis, membrane integrity, nervous tissue conduction, neuromuscular excitation, muscle contraction, hormone secretion, maintenance of vascular tone, and in intermediary metabolism. Deficiency may lead to changes in neuromuscular, cardiovascular, immune, and hormonal function; impaired energy metabolism; and reduced capacity for physical work. Magnesium deficiency is now considered to contribute to many diseases, and the role for magnesium as a therapeutic agent is expanding.

    Magnesium deficiency reduces the activity of important enzymes used in energy metabolism. Unless we have adequate levels of magnesium in our cells, the cellular processes of energy metabolism cannot function. Small changes in magnesium levels can have a substantial effect on heart and blood vessel function. While magnesium is found in most foods—particularly vegetables—deficiencies are increasing. Softened water and a trend toward lower vegetable consumption are the culprits contributing to these rising deficiencies.

    Clearly, each member of the “Awesome Foursome” is fundamental to cellular energy metabolism in its own right. Each plays a unique and vital role in supplying the heart with the energy it needs to preserve its contractile force. Each is independently effective in helping hearts work through the stress of disease. And while each contributes immeasurably to the energy health of the cell, in combination they are unbeatable. Allow me to reiterate the step-by-step, complicated cellular processes involved to be sure that you really understand the rationale for using these nutrients.

    The cell needs a large, sustained, and healthy pool of energy to fuel all its metabolic functions. Contraction, relaxation, maintenance of cellular ion balance, and synthesis of macromolecules, like proteins, all require a high energy charge to carry their reactions to completion. The energy pool must be preserved, or these fundamental cellular functions will become inefficient or will cease to operate altogether. To keep the pool vibrant and healthy, the cell needs ribose. But even with supplemental ribose, the cell needs the efficient turnover of its energy stores to balance ongoing energy utilization with supply. That's where Coenzyme Q10 and L-carnitine come into play.

    The converse is also true. Even if the cell is fully charged with energy, cellular energy supply will not keep pace with demand if the mitochondria are not functioning properly. Coenzyme Q10 and L-carnitine work to keep mitochondrial operations running at peak efficiency, and one side cannot work effectively without the other. Even though Coenzyme Q10 and L-carnitine can make the energy turnover mechanisms work more efficiently, they cannot increase the cell's chemical driving force, and their action will be only partially effective. Ribose, on the other hand, can keep the energy pool supplied with substrate, but the value of energy pool repletion cannot be fully realized if the substrate cannot be maximally utilized and recycled. Ribose fills the tank; Coenzyme Q10 and L-carnitine help the engine run properly.

    Magnesium is the glue that holds energy metabolism together. By turning on the enzymes that drive the metabolic reactions, magnesium allows it all to happen. These four nutrients must be utilized by cardiologists and other physicians as they treat patients day-to-day. On my own journey, using Coenzyme Q10 for two decades, L-carnitine for more than ten years, D-ribose for two years, and magnesium equally as long, I've seen this “Awesome Foursome” reduce suffering and improve the quality of life for thousands of patients.

    The future of nutrition in conventional medicine is very bright, although the integration of nutritional supplements has been a slow and, at times, lonely process. For example, the Canadian government has just placed a warning on their HMG-reductase statin labels, warning that these drugs can diminish ubiquinone (Coenzyme Q10) levels, which can cause heart failure. This is a mammoth step for the Canadian government, and I applaud them for raising this issue with their population. Unfortunately, our own Food and Drug Administration is not so enlightened yet. Now that governments are getting involved in doing the right thing, perhaps the traditional medical community will follow suit. But first we have to educate them to do so.

    As most of you may know, representatives from pharmaceutical companies make regular rounds to the offices of prescribing medical professionals such as physicians, physician assistants (PAs), advanced practice nurses (APRNs), and nurse practitioners (NPs) to keep them informed about the latest drugs their companies are releasing. This is called “detailing” a pharmaceutical because it involves educating the practitioner about all the various “details” of the drug, from how it works and interacts with other medications, to dosing and possible side effects. Drug companies obviously spend a lot of money on this one-to-one approach in order to bring this level of education to each individual health care practitioner, but it does let them get more comfortable with drugs new to the market.

    Not so with nutraceuticals. There just isn't anyone “detailing” health care providers about nutrients and supplements in this manner, so many doctors don't believe in their effectiveness. As research continues, the mysterious relationship of ATP and energy in the heart will be recognized by more and more physicians who will then be comfortable recommending these life-saving supplements.

    L-carnitine and Coenzyme Q10 are finally gaining the recognition they deserve. Dribose is emerging as a new player in the complex understanding of metabolic cardiology, and doctors are beginning to discuss the important role of magnesium deficiency in heart patients. As a practicing cardiologist for over thirty years, I see metabolic cardiology as the future for the treatment of heart disease and other complex disease conditions, as well.

    The Sinatra Solution, Metabolic Cardiology by Stephen T. Sinatra, M.D. is published by Basic Health Publications, Inc. and is available at health food stores and bookstores or call 1.800.575.8890 to order.

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