Cardiovascular Disease- Andrew Weil. Ph.D.

[Guest guest]

Cardiovascular Disease

JoAnn Guest

Feb 08, 2003 19:37 PST

www.drweil.com

 

 

 

Cardiovascular disease is a collection of illnesses that include

heart disease, high blood pressure, stroke and congestive heart

failure. It is the leading cause of death in the United States.

 

Here are some compelling statistics on Cardiovascular Disease from

the American Heart Association's 2001 Heart and Stroke Statistical

Update, 2000:

 

Cardiovascular Disease (CVD) has been the number one cause of death

in the U.S. since 1990.

 

Almost 60 million Americans have one or more types of CVD; 50

million have high blood pressure.

Over 12 million Americans have coronary heart disease.

One in five females has some form of CVD.

One in three men develop CVD before the age of 60, versus one in 10

for women.

 

CVD alone has claimed more lives each year than the next seven

leading causes of death combined.

Each day, more than 2,600 Americans die of CVD -- that's one death

per 33 seconds.

 

Heart disease or coronary artery disease--

 

Heart disease or coronary artery disease is caused by

atherosclerosis.

Atherosclerosis is a condition in which cholesterol-rich plaque

builds up along the arterial walls.

 

High cholesterol levels can play a part, though they do not always

result in atherosclerosis and atherosclerosis can exist with normal

cholesterol levels.

 

But when the coronary arteries are affected, the condition is called

coronary artery disease.

 

How does atherosclerosis develop?

 

Atherosclerosis seems to begin with an injury to the endothelial

lining along the artery wall. Interestingly, this process actually

can begin at an early age.

 

Once an injury occurs, " white blood cells " such as monocytes and

macrophages, along with lipids, begin to *accumulate* along the

inner

layer of the artery as well as the muscle layer.

 

Smooth muscle cells begin to multiply from the irritation and

eventually form a " plaque " .

 

Platelets and other blood clotting factors stick to the rough

surface of the artery wall,

forming a thrombus (clot).

 

A clot can continue to grow until it completely blocks an artery,

cutting off the oxygen supply to a vital organ.

 

Or a clot can break free from the vessel wall and become lodged

somewhere else further downstream.

 

This could lead to a heart attack or stroke if the clot

completely blocks the blood and oxygen supply to a major artery

leading to the heart or brain.

 

Although initially there are no symptoms, once the arteries become

very constricted, one may experience pressure or tightening in the

chest due to a

*lack of oxygen* being delivered to the heart (angina). There may

also be cramping in the lower extremities due to blockage in the

peripheral veins (peripheral vascular disease).

 

Factors associated with heart disease

 

Researchers now believe that many different problems can lead to

heart disease. And cholesterol can often play a key part.

Cholesterol is a waxy, fat-like substance made by the liver.

 

It is an essential component of cell membranes and used to produce

hormones and vitamin D.

 

Cholesterol is carried through the body attached to two different

compounds called " lipoproteins " :

low-density lipoproteins (LDL) and high-density lipoproteins (HDL).

 

LDL is commonly known as the " bad cholesterol " ;

it carries cholesterol from the liver throughout the body, making it

available to be deposited in artery walls.

 

HDL is known as the " good cholesterol " ;

it " picks up " cholesterol from the *arteries* and " delivers " it to

the

liver to be recycled or eliminated from the body.

 

The body needs cholesterol to function –--

but too much of it in the blood, or too much of the wrong kind, add

up to trouble.

 

The factors leading to heart disease are as follows:

 

High total cholesterol –--

especially high LDL levels – These two factors combine to form a

well known risk factor for heart disease (though people can have

heart

disease without having high cholesterol).

 

Dietary and nutritional supplement treatment of high cholesterol

levels are effective.

 

Low HDL cholesterol and high *triglyceride* levels –

This is a different pattern than high total and LDL cholesterol

although someone may have both.

 

This pattern, associated with *insulin resistance*, is also

genetically

driven and appears to affect as many as 30% of the population.

 

It carries with it a high risk of high blood pressure and diabetes

as well as heart disease.

 

Dietary and nutritional supplement treatment for this pattern are

different from those for high total and LDL cholesterol levels.

 

Here, lifestyle changes are generally quite effective.

 

Elevated *homocysteine* levels –

This risk factor for heart disease is unrelated to cholesterol

levels at all.

 

Homocysteine is an amino acid that can accumulate in the blood

when a person does not get enough folic acid and vitamin B6.

Folic acid " requirements " for some

individuals may be much greater than the RDA of 400 mcg.

 

Smoking – This habit alone can increase risk of heart disease.

Smoking increases " oxidation " in the body and is harmful to blood

vessels

 

Family history – Genetic tendencies, however, can be countered by a

healthy lifestyle in most cases.

 

If you have a family history of heart disease, we recommend

paying particular attention to diet, exercise, stress reduction and

supplements.

 

Nutritional supplements and family history of heart disease

 

Fish oil –

The omega-3 fatty acids in fish and fish oil supplements have

been shown to be an effective preventive strategy against heart

disease.

 

They can lower triglyceride levels, increase HDL cholesterol, help

minimize inflammation and blood clotting, and keep blood vessels

healthy.

 

Coenzyme Q10 – This antioxidant is thought to be one of the most

important antioxidant supplements for protection against many forms

of

cardiovascular disease. It helps protect LDL cholesterol from

oxidation, maintain healthy blood vessels, protects against clots

and

plaque rupture, and supports optimal functioning of the heart

muscle.

 

What you can do to lower your cholesterol

 

Reduce greatly the amount of saturated fat you eat.

The richest sources of saturated fat (fat that is usually solid at

room temperature) in the diet are dairy foods (except the organic

fat-free versions),

especially whole milk, cheese, butter and cream. Red meat is also

high in saturated fats.

 

Avoid trans–fat.

 

If you find " partially hydrogenated oil " listed in the ingredient

list on food labels, find a healthier substitute. There are many

spreads

available on the market today that are free from trans-fat.

 

Trans-fat is also found in snack foods like chips, crackers and

cookies. It is found in the oils used to cook fast food french

fries, doughnuts and movie popcorn.

Substitute non-gmo soy protein for animal protein.

The protein in non-gmo soy foods have been shown to lower

cholesterol levels.

 

Try to incorporate two servings a day into your meals. Choose from

organic tofu, tempeh, soy milk, whole soy beans, and roasted soy

nuts. For best results try to obtain an organic variety as soybeans

currently undergo genetic manipulation.

 

Use fresh garlic regularly in your meals. Garlic has been shown to

lower both cholesterol levels and blood pressure -- and it tastes

wonderful,

too. Use one or two lightly cooked cloves a day.

 

Drink green tea daily. The antioxidants in green tea help lower

cholesterol and prevent the cholesterol in your blood from

oxidizing.

 

Eat plenty of soluble fiber.

 

Soluble fiber has a powerful cholesterol-lowering effect. The best

sources of soluble fiber are beans and lentils, apples, citrus

fruits,

oats, barley, peas, carrots – especially do not forget ground flax

seed.

 

 

 

Lose weight. Even a modest amount of weight loss can lower

cholesterol levels.

 

 

Nutritional supplements and cholesterol

 

Guggulipid – This extract of an Ayurvedic herb (Commiphora mukul)

lowers cholesterol levels to the same degree as many medications.

 

Coenzyme Q10 (CoQ10) – CoQ10 is a powerful antioxidant that has been

shown to be beneficial for heart health by protecting LDL

cholesterol

from oxidation and re-energizing the mitochondria in the heart

cells,

which is where energy metabolism occurs. This nutrient is very

important

 

for the heart cells of patients with heart failure. CoQ10 may also

help

lower blood pressure.

 

Fish oil – Though omega-3 fatty acids in fish oil don't specifically

lower total or LDL cholesterol levels, they do seem to reduce the

risk

of heart disease by reducing platelet stickiness, inflammation and

triglyceride levels.

 

 

Insulin Resistance (high triglycerides and low HDL cholesterol)

 

Insulin resistance is now being recognized as an important and

common

condition associated with heart disease, as well as diabetes and

high

blood pressure. It affects an estimated 25-to-30% of the non-

diabetic

population.

 

It is primarily characterized by high triglyceride and low

HDL cholesterol levels, although high total cholesterol may also be

seen.

 

Genetic factors play a significant role, but diet and lifestyle

changes can make a big difference (an even bigger difference than in

the previously discussed condition of high total and high LDL

cholesterol).

 

A little background: Insulin is a hormone that facilitates the

transport

 

of glucose from the blood into cells where it is used as fuel. When

blood sugar rises after a meal, the pancreas secretes insulin into

the

bloodstream. With insulin resistance, the normal amount of insulin

secreted is not enough to move glucose into the cells – thus the

cells are " resistant " to the action of insulin.

 

To compensate, the pancreas

secretes even more insulin in order to maintain fairly normal blood

sugar movement into cells and a normal blood sugar level.

 

The resulting high levels of insulin, however, have several negative

effects -- on the enzymes in the liver that produce cholesterol, and

on the kidney leading to high blood pressure, as well as on the

enzymes

in cells that regulate inflammation. Eventually, blood sugar levels

rise

 

either because the pancreas stops producing insulin or the cells

become

more and more resistant to the insulin that is produced. The body's

inability to adequately compensate leads to diabetes.

 

Having diabetes, even in the early stages, significantly increases

the

risk of heart disease. Early diabetes may be the first time insulin

resistance is recognized.

 

Warning signs and diagnosis of insulin resistance?

 

Interestingly, although insulin resistance is usually seen in

people who are overweight, thin people can also have the problem and

be at the same risk for heart disease, high blood pressure and

diabetes.

 

The easiest way to diagnose the problem is to take a blood test that

looks for the following indicators.

 

A low HDL cholesterol is almost

always seen, along with a high triglyceride level. You may also

check for a high fasting insulin level.

 

A high uric acid level sometimes accompanies these values.

 

What can you do about insulin resistance?

 

Watch your carbs – The classic lowfat, high carb diet that was the

standard recommendation for preventing or treating heart disease for

years can actually make insulin resistance worse.

 

Carbohydrates

(starches and sugars) raise blood sugar levels and trigger the

release of insulin.

 

A moderately low carbohydrate diet (40-to-45% of calories)

emphasizing low glycemic index sources of carbohydrate (those that

raise blood sugar levels slowly rather than quickly) is recommended.

In

general, foods very rich in fiber are healthy.

 

Cut *saturated* fats, but keep *monosaturated* fats --

 

Include moderate amounts of monounsaturated fat (30 to 35% of

calories)

rather than following a low-fat diet.

 

However, in this condition, as with high total and LDL cholesterol,

saturated fat makes the situation worse.

 

Eat generous amounts (5 or more servings) of non-starchy vegetables

and

one to two servings of low-glycemic index fruit every day.

 

Lose weight if you are overweight. Even small amounts of weight lost

can

 

improve insulin resisitance.

 

Exercise – Vigorous aerobic exercise decreases the cells' resistance

to insulin.

 

Eat fish frequently – The best are cold water fish like salmon and

sardines that are high in omega-3 fatty acids. This type of fat

seems to improve cells' response to insulin.

 

Eat small, frequent meals to keep blood sugar levels as stable as

possible.

 

Nutritional supplements and insulin resistance

 

Coenzyme Q10 (CoQ10) – CoQ10 is a powerful antioxidant that has been

shown to be beneficial for heart health by protecting LDL

cholesterol

from oxidation and re-energizing the mitochondria in the heart

cells,

which is where energy metabolism occurs. This nutrient is very

important

 

for the heart cells of patients with heart failure. CoQ10 may also

help lower blood pressure.

 

Alpha-lipoic acid – This antioxidant nutrient improves the cells'

response to insulin and can reduce blood sugar levels.

 

Magnesium – Higher insulin and blood sugar levels are seen in people

with low plasma magnesium levels and magnesium supplementation

improves

insulin resistance in animal studies

 

Chromium – It improves glucose utilization in people with high blood

sugar levels and improves insulin resistance in animals.

 

High homocysteine – What is it?

 

Homocysteine is an amino acid

that is produced in the body from another

amino acid called methionine.

 

One of methionine's main functions is to

provide methyl groups for cellular reactions.

 

A methyl group is a small,

simple chemical fragment consisting of one carbon molecule and three

hydrogen molecules.

 

When methionine donates a methyl group for a

cellular reaction, it becomes homocysteine.

 

Typically homocysteine then

receives another methyl group from either folic acid or vitamin B6

and is turned back into methionine. Vitamin B12 acts as a cofactor

for this reaction.

 

In short, if you don't have enough of certain critical B vitamins,

your homocysteine level rises. A high homocysteine level is

primarily a sign of an inadequate intake of folic acid or vitamin

B6.

 

Factors that control homocysteine levels:

 

Genetics – There are genetic variations in folic acid absorption and

utilization. Some individuals therefore need much more folic acid

than the RDA of 400 mcg.

 

Stress – Epinephrine and norephinephrine are stress induced

neurotransmitters. Their metabolism in the liver involves

methylation,

a process that uses methyl groups, and can increase need for methyl

donors like folic acid.

 

Coffee consumption – As coffee consumption increases, homocysteine

levels increase.

 

The amount of folic acid, vitamin B6 or vitamin B12 in your diet and

supplements.

 

What is the relationship between homocysteine, heart disease and

strokes?

 

High homocysteine levels are associated with atherosclerosis.

Homocysteine is thought to be damaging to the lining of blood

vessels,

leading to atherosclerosis.

 

As homocysteine levels increase, the risk

of heart disease and stroke increase. (High homocysteine levels are

also

 

associated with risk of cancer and cervical dysplasia, as well as

neural

 

tube birth defects like spina bifida.)

 

Diagnosing high homocysteine

 

Although the reference ranges for homocysteine from most labs show a

normal range up to 12, homocysteine researchers are suggesting that

any

level over 8 should be treated.

 

Nutritional supplements and homocysteine

 

Folic acid, vitamin B6, vitamin B12 and betaine are all involved in

the

process of adding a methyl group back to the homocysteine molecule.

 

Supplementation of these nutrients will bring high homocysteine

levels

down.

Although the B vitamins (the first three in the list) are found

in our multivitamin, we recommend higher doses depending on your

homocysteine level.

 

If your homocysteine level is high, we recommend

retesting it six months after you begin taking supplements.

 

Angina Pectoris

 

Angina is chest pain that can occur when there is a dramatic

decrease in

 

the blood supply to the heart, an increased demand for oxygen by the

heart, or a combination of both. It is a symptom of heart disease or

coronary artery disease.

 

If the walls of the blood vessels are hard and

unable to relax (for example, as a result of atherosclerosis), the

vessels will not be able to dilate properly, which slows down blood

flow. Increasing physical or emotional exertion increases the demand

for

 

oxygen. If the arteries are so blocked that the heart cannot receive

sufficient oxygen to meet its needs, angina can result.

 

What are the factors that cause angina or an oxygen deficit to the

heart?

 

Most often, angina is caused by coronary artery disease. In some

cases

angina can result from a narrowing of the aorta (a major vessel

leading

to the heart) due to an aortic valve abnormality;

arterial spasms

causing a temporary constriction in the artery; or an enlarged

heart, in

 

which the blood supply is no longer adequate to supply sufficient

oxygen

 

to the heart.

 

What are the symptoms?

Look for chest pain that is intermittent, brief and persistent. The

length of an attack and the severity can vary. The pain feels like a

tightness or pressure in the chest that may radiate to the neck,

along

the left shoulder or down the left arm.

 

Some experience difficulty breathing and nausea.

 

What triggers an angina attack?

Angina can be triggered by emotional or physical stress, exerting

oneself after a meal, or extreme temperature changes. Cigarette

smoking

can also bring on an angina attack.

 

What can I do to reduce my risk of angina?

Follow a heart healthy diet.

 

 

 

Nutritional supplements and angina

 

Coenzyme Q10 (CoQ10) – CoQ10 is a powerful antioxidant that has been

shown to be beneficial for heart health by protecting LDL

cholesterol

from oxidation and re-energizing the mitochondria in the heart

cells,

which is where energy metabolism occurs. This nutrient is very

important

 

for the heart cells of patients with heart failure. CoQ10 may also

help

lower blood pressure.

 

Hawthorne - Hawthorne is another antioxidant with heart-enhancing

properties. Hawthorne may help improve coronary artery blood flow

and

circulation to the extremities of the body, therefore improving

symptoms

 

of angina.

 

L – arginine – L –arginine is a precursor to nitric oxide which

relaxes

blood vessels in the heart and has been shown to help angina.

 

 

 

High Blood Pressure (Hypertension)

 

Hypertension is the most common form of cardiovascular disease in

America, affecting about 50 million people.—that's close to one out

of

four adults.

 

High blood pressure is defined as a reading above

140/90mmHg (systolic/diastolic). (Systolic pressure (the first

number)

measures the pressure in the arteries when the heart contracts.

 

Diastolic pressure (the second number) measures the pressure in the

arteries when the heart is relaxing and filling with blood.)

 

What causes high blood pressure?

 

The heart pumps blood through your arteries (large blood vessels),

pushing the blood against the artery walls with a force that is

measured

 

as our " blood pressure. " Normal blood pressure is around 120/80 mm

Hg.

High blood pressure occurs when the artery walls lose their

elasticity

 

and cause the pressure of the blood moving through the arteries to

rise.

 

This excessive pressure makes the heart work harder, and can

eventually

lead to an enlarged heart (cardiomegaly), as well as damage to blood

vessels in the kidneys and brain.

 

Doctors cannot pinpoint the precise cause of 90 percent of high

blood

pressure cases,also known as " essential hypertension. " However, they

do

know that certain factors can increase the risk of developing high

blood

 

pressure:

 

Stress can cause hypertension by activating the sympathetic nervous

system, causing the arteries to constrict.

 

Eating large amounts of sodium can cause excess water retention,

expand

blood volume and ultimately increase blood pressure.

 

A diet low in magnesium and potassium can increase blood pressure

 

Insulin resistance can increase blood pressure by causing the

kidneys to

 

retain sodium.

 

 

What can you do to lower your blood pressure?

 

Follow the DASH diet.

 

This diet, developed by researchers at the

National Institutes of Health's National Heart, Lung, and Blood

Institute is based on a large-scale research study that identified

the

foods that affect blood pressure.

 

The most important parts of the DASH

are generous amounts of fruits and vegetables and organic lowfat or

fat free

dairy products providing an adequate calcium intake. The diet is

also

relatively low in fat and sodium.

 

DASH researchers have shown that diets rich in potassium, calcium

and

magnesium, and low in sodium, (2,400 mg or less) play an important

role

in maintaining healthy blood pressure levels.

 

These are the high points

of the DASH diet:

 

Eat 8-10 servings of fruit and vegetables servings per day.

 

Choose low- or non-fat dairy foods, consuming 2-3 servings per day.

 

Limit animal protein to 6 oz per day, emphasizing lean sources.

 

Consume 4-5 servings of nuts, seeds and dry beans per week (2 Tbsp

nuts

or seeds, or 1/2 cup cooked dried beans).

 

Eat plenty of fish –

 

Include at least three servings of fish a week,

emphasizing cold water fish like salmon and sardines that are rich

in

omega-3 fatty acids.

 

Limit your caffeine intake -- The caffeine in coffee, tea and sodas

can

contribute to high blood pressure.

 

 

Avoid processed foods -- These are the biggest sources of sodium in

today's diet.

 

 

Exercise – As little as 30 minutes of moderate exercise a day, like

walking, can lower blood pressure.

 

Relax –Meditation, yoga, breathing exercises or biofeedback are all

relaxation techniques that can help lower blood pressure.

 

Don't smoke – Smoking contributes to all cardiovascular diseases –

and

many other life-threatening conditions as well.

 

 

 

Nutritional supplements and high blood pressure

 

Calcium and magnesium – Inadequate intake of both of these minerals

has been associated with high blood pressure.

 

Vitamin C – A supplement of this antioxidant vitamin has been shown

to lower blood pressure in people with mild to moderate

hypertension.

 

Stroke

 

Stroke is the third leading cause of death when considered

separately from other types of cardiovascular disease, accounting

for about one out of every 14.5 deaths in the U.S., according to the

American Heart Association.

 

About three-fourths of stroke victims are over the age of

65, but a person can have a stroke at any age. Although stroke seems

to affect as many men as women, more women die of a stroke than men

in all age groups.

 

What is a stroke?

 

A stroke, also known as a cerebrovascular accident, is the death of

brain tissue caused from a lack of blood flow and insufficient

oxygen to the brain.

 

The brain receives about 25 percent of the body's oxygen

supply from a continuous blood flow through two main arteries, the

carotid arteries (that come up through both sides of the front of

the neck) and the basilar artery (which forms at the base of the

skull from the vertebrae arteries).

 

Strokes (like heart attacks) can often result

from a blockage in a blood vessel that reduces or cuts off oxygen

supply

 

to the cells, resulting in the death of the tissue. It only takes a

short period of time without oxygen to cause damage to the brain.

 

There are 2 main classifications of strokes:

 

Ischemic

 

The blood supply is cut off to part of the brain, either due

to atherosclerosis or a blood clot. Infections, inflammation or

certain medications can all contribute to ischemic strokes. These

strokes are the most common type, causing about 80 percent of all

stroke cases.

 

Hemorrhagic –

 

These strokes comprise the remaining 20 percent of cases.

Hemorrhagic strokes are caused from a ruptured blood vessel,

preventing normal blood flow and causing bleeding into an area of

the brain. They can be the result of hypertension, which causes

excessive pressure on the arterial walls that may already be damaged

by arteriosclerosis. A ruptured aneurysm (the rupture of a weakened

area in the blood vessel wall), can also cause a hemorrhagic stroke.

 

What can I do to prevent a stroke?

 

Focus on your diet - The diets outlined for high blood pressure and

heart disease are useful in preventing strokes.

 

 

Exercise – People who exercise consistently have a lower risk for

having a stroke. .

 

Limit alcohol – If you drink alcohol, do so only in moderation.

Moderate

 

alcohol intake is defined as no more than one drink per day for

women and two drinks a day for men.

 

Nutritional supplements and strokes

 

Calcium and magnesium –

 

These minerals are helpful in controlling

*high blood pressure*, one of the strongest risk factors for stroke.

 

Congestive Heart Failure

 

Congestive heart failure (CHF) is a very serious heart condition in

which the heart cannot pump sufficient blood to keep up with the

body's oxygen demand.

 

Even though the condition typically gets worse over

time, people are able to live with the disease for many years.

 

What causes congestive heart failure?

 

CHF can stem from any disease that causes impairment in the heart's

ability to contract and pump blood, such as coronary heart disease.

 

Other factors include diabetes, an overactive thyroid gland, a viral

or bacterial infection to the heart muscle, or morbid obesity.

 

When the

heart is constantly overworked, it first becomes larger – as will

any muscle in the body that you consistently exercise and push hard.

However, over time, the heart eventually tires out, resulting in a

decreased ability to pump an adequate blood supply.

 

What are the symptoms?

 

Fatigue and weakness, particularly when performing physical

activities,

which stems from a lack of *sufficient* oxygen to the muscles.

 

Swelling in the lower extremities. If the right side of the heart is

affected, fluid builds up in the feet, ankles, abdomen, liver and

legs.

Left sided heart failure can cause fluid retention in the lungs,

leading to shortness of breath.

Dizzy spells.

 

Nutritional supplements and congestive heart failure

 

Coenzyme Q10 (CoQ10) – CoQ10 is a powerful antioxidant that has been

shown to be beneficial for heart health by re-energizing the

mitochondria in the heart cells, which is where energy metabolism

occurs. This nutrient is very important for the heart cells of

patients

with heart failure. CoQ10 may also help lower blood pressure.

 

Carnitine – This amino acid that is essential for energy metabolism

of the heart muscle.

 

 

Cordyceps – This medicinal mushroom is a good energy booster and can

improve the workload of the heart

 

Reishi medicinal mushrooms are also beneficial to the heart and

immune system as well.

 

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JoAnn Guest

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