Cardiovascular Nutrition

• 1 Tbsp. flaxseeds, ground
• ½ cup fresh fruit—blueberries, a peach, kiwi, banana, or whatever you like
• 8 oz. organic rice milk, organic skim milk, organic yogurt, or unsweetened juice (you can also use water or a combination)
• 1 serving size (follow directions on package) of soy or whey protein powder

Some of the most commonly prescribed drugs for maintaining good cholesterol levels are statins like Zocor (simvastatin), Lipitor (avorastatin), Mevacor (lovastatin), Pravachol (pravastatin), and Lescol (fluvastatin).

These drugs can be dangerous if taken with high levels of long-acting niacin (vitamin B3). Side effects also include dizziness, headache, extreme fatigue, swelling of the ankles, muscle weakness, and liver toxicity.

In both men and women, statins may weaken the heart muscle because they lower CoQ10 levels. In women especially, statin drugs may deplete levels of CoQ10, contributing to a weakened immune system.

Still, if you have moderate to severe heart disease involving multiple vessels, I recommend statin drugs to help you obtain and maintain healthy cholesterol levels. In addition, I recommend the following natural solutions:

• Make sure you take a minimum of 150 mg of standard CoQ10 per day, or 50–60 mg of the hydrosoluble form, to offset the drug’s depleting effect.
• Niacin is one of my favorite cholesterol-lowering agents if you are not on a statin drug, because of its ability to increase HDL cholesterol (the “good” cholesterol) and lower LDL cholesterol levels (the “bad” cholesterol). Low doses in the range of 100–300 mg three times daily are often effective without resulting in side effects of flushing, heartburn or gout attacks. A prescription form called Niaspan (750–1,500 mg) appears to be well-
  tolerated by most people with minimal side effects.
• Tocotrienols are antioxidants in the vitamin E family. Research suggests that they act much like statin drugs, minus the adverse side effects, by interfering with the liver’s ability to produce cholesterol. As little as 50 mg per day can have a positive effect.
• My Pan-Asian Modified Mediterranean-type diet (PAMM) is great for this and for overall cardiovascular nutrition. It’s rich in fiber, healthy fats (omega-3s from fish and fish oil), garlic and onions (two potent cholesterol-busters), and fresh fruits and vegetables. Fiber helps soak up cholesterol and cleanse the colon, preventing rapid absorption of cholesterol.
• Flaxseed is high in alpha linolenic acid and fiber, vital for healthy heart function.
• Soy helps prevent the oxidization of LDL and subsequent buildup of artery-clogging plaque. Soy also can help with reducing cholesterol levels, help ease menopausal symptoms, and may help protect against cancers of the breast and prostate.
• L-arginine—2–4 grams three times a day. TwinLab and Great Earth make good supplements that are widely available in health food stores.

My campaign to make heart disease a thing of the past is rooted in an ongoing quest to stabilize and root out the calcified plaque that chokes our arteries.

For decades conventional medicine has relied on invasive procedures to unclog our arterial highways but, as most people with cardiovascular problems know, this has been met with very limited success.

That’s why I’m so excited about vitamin K2. K2 gets calcium in the bones, where you want it, and out of your arterial walls, where you certainly don’t want it. Thus, K2 is crucial for both bone and arterial health and is a godsend for individuals with blood circulation problems and other heart risk factors.

Coumadin, the popular blood thinning drug once also thought to be a godsend, works against vitamin K. Researchers suggest that Coumadin inhibits the K2-dependent MGP protein system that keeps calcium out of arterial walls. Thus, Coumadin may actually encourage cardiovascular calcification as an adverse side effect.

As you might imagine, this dilemma has many doctors and holistic health practitioners concerned and our patients with cardiovascular concerns aren’t sure of exactly what to do.

What Should You Do?

If you are taking Coumadin, don’t use any form of vitamin K2 supplement, as it might neutralize the effect of the drug.

On the other hand, vitamin K is critical for your bone and arterial health. Because of this, I tell all of my patients with cardiovascular problems to eat some green leafy vegetables and try to add some cheese and natto (if they can get it) to their diets to get some natural vitamin K. I don’t want them to become vitamin K deficient. I can always adjust their Coumadin level if necessary.

Drugs typically prescribed for reducing cholesterol have no impact on Lp(a) levels. In fact, a study involving these drugs showed an increase in Lp(a) levels! And therein lies the dilemma.

While drugs prescribed to help you attain and maintain healthy cholesterol can reduce LDL, they can’t alter Lp(a). If you find that Lp(a) runs in your family, you must attack it with an alternative approach. Here’s what I recommend:

• Follow my Pan-Asian Modified Mediterranean diet, making sure to eat fresh fish at least two to three times a week. Eat fresh fruits, legumes, cold-water fish such as salmon, sardines, and mackerel or fish oils, particularly docosahexaenoic acid (DHA), which blocks the inflammatory and blood-clotting capabilities of Lp(a). Omit saturated fats. Instead, choose monounsaturated fats like olive oil and polyunsaturated fats like alpha-linolenic acid, found in flaxseed and flaxseed oil.   (These are excellent tips to adhere to for overall cardiovascular nutrition.)
• Take 100 mg of niacin, twice a day. If you experience side effects like flushing, headache, and diarrhea, follow the diet and stop the niacin. You can try a lower dosage at a later date, then slowly increase the dose to 500 mg a day, twice a day for further protection. TwinLabs' quick-acting Niacin is a good product.
• Take 1–2 grams of vitamin C and 100–200 mg of CoQ10 each day.
• Policosanol—20 mg daily at bedtime.
• Exercise regularly.
• Ask your doctor about screening techniques to assess your heart risk factors. If you’re concerned, you and your family members should have your Lp(a) and other risk factors (homocysteine, fibrinogen and serum ferritin) evaluated by your doctor.
• Be aware of other risk factors for cardiovascular problems, including smoking, high blood pressure, obesity, glucose intolerance and repressed emotions, which can have a harmful effect on the health of your heart.

 Drugs typically prescribed for reducing cholesterol have no impact on Lp(a) levels. In fact, a study involving these drugs showed an increase in Lp(a) levels! And therein lies the dilemma.

While drugs prescribed to help you attain and maintain healthy cholesterol can reduce LDL, they can’t alter Lp(a). If you find that Lp(a) runs in your family, you must attack it with an alternative approach. Here’s what I recommend:

• Follow my Pan-Asian Modified Mediterranean diet, making sure to eat fresh fish at least two to three times a week. Eat fresh fruits, legumes, cold-water fish such as salmon, sardines, and mackerel or fish oils, particularly docosahexaenoic acid (DHA), which blocks the inflammatory and blood-clotting capabilities of Lp(a). Omit saturated fats. Instead, choose monounsaturated fats like olive oil and polyunsaturated fats like alpha-linolenic acid, found in flaxseed and flaxseed oil.
• Take 100 mg of niacin, twice a day. If you experience side effects like flushing, headache, and diarrhea, follow the diet and stop the niacin. You can try a lower dosage at a later date, then slowly increase the dose to 500 mg a day, twice a day for further protection. TwinLabs' quick-acting Niacin is a good product.
• Take 1–2 grams of vitamin C and 100–200 mg of CoQ10 each day.
• Policosanol—20 mg daily at bedtime.
• Exercise regularly.
• Ask your doctor about screening techniques to assess your risk factors for heart disease. If you’re concerned, you and your family members should have your Lp(a) and other heart risk factors (homocysteine, fibrinogen and serum ferritin) evaluated by your doctor.

Diabetes. Diabetic women have a higher risk for heart disease than diabetic men. This is because the incidence of diabetes and its complications (including heart disease) is much higher in women. If you are a diabetic woman, your risk for heart disease is five to seven times normal, compared with a risk of only two to three times normal for a diabetic man. For you, proper heart sense means you should increase your physical activity and watch your diet to maintain a healthy body weight.

Overweight. Women have a higher heart disease risk from being overweight than men do. Recent studies indicate that being only 20 pounds overweight doubles your risk of heart disease. If you are overweight, I don’t want you to go on a diet. Instead, get physically active—it’s your most powerful weapon against fat—and begin eating more fresh fruits and vegetables, pasta, fish and lean poultry.  Eating this way is what I call “healthy heart nutrition” and it just makes sense. (See other blog entries for additional advice on cardiovascular nutrition.)

Cholesterol. Women have a higher risk for heart disease than men if they don’t have good cholesterol levels. More specifically, if they have have low levels of HDL (“good” cholesterol) they increase their heart risk factors.

You probably already know that there are two types of cholesterol. LDL is the “bad” cholesterol, which oxidizes in your blood and forms the plaque that clogs arteries. HDL carries LDL out of your blood vessels before it can do its damage. Volumes of data have shown that a high LDL is a powerful risk factor for heart disease in men. But for women, the story is different. Recent research indicates that a low HDL, not a high LDL, is the more significant risk factor for a woman to develop heart disease. (This means that some women may need to increase HDL cholesterol levels.)

The good news is that HDL is sensitive to factors such as smoking, obesity and lack of exercise. If your HDL is low (less than 35 mg/dL) you can raise it by quitting smoking and dropping excess weight through a combination of smart eating, healthy heart nutrition, and physical activity such as walking and dancing. If you are postmenopausal, you might also consider estrogen replacement therapy (ERT), which raises HDL, lowers LDL, and has other beneficial effects on your heart. Have your HDL level checked six weeks after you start an HDL-raising program. Chances are you will see a change for the better.

High Triglycerides. When you get your cholesterol checked, I also want you to have your doctor check to see if you have healthy triglycerides levels. Triglycerides are another type of blood fat. A high triglyceride level is more dangerous for women than for men, so if your triglycerides are elevated (above 200 mg/dL), I want you to put some effort into lowering them, especially if you are a diabetic. This is because if you are a diabetic woman who also has high triglycerides, your risk of developing heart disease increases to 200 times normal. Please stop and think about this. You can lower your triglycerides using the powerful combination of exercise and weight control.

Many of today’s fad diets revolve around modifying insulin resistance by consuming low-carbohydrate, high-protein foods and also advocate eating foods high in saturated fats and dairy products. This type of diet is likely to contain high levels of insecticides, pesticides, and radiation, which in the long run may increase your risk of cancer of the bowel, prostate, and breast and can increase your heart risk factors.

Also, as you start to lose weight and your body is forced to break down stored fat for energy, your good cholesterol levels may be challenged and it may become difficult to keep them within the recognized cholesterol guidelines. This may be an artificial rise in cholesterol, however, it is a good idea to be cautious and work with a physician if you decide to start one of these diets.

Based on this, I suggest that anyone trying to lose weight adhere to a diet akin to my Pan-Asian Modified Mediterranean diet, making sure to eat fresh fish at least two to three times a week. You’d can also enjoy fresh fruits, legumes, cold-water fish such as salmon, sardines, and mackerel or fish oils, particularly docosahexaenoic acid (DHA), which blocks the inflammatory and blood-clotting capabilities of Lp(a).

I’d also urge you to omit saturated fats. Instead, choose monounsaturated fats like olive oil and polyunsaturated fats like alpha-linolenic acid, found in flaxseed.

Historically, it was assumed that if you couldn’t keep good cholesterol levels, you were at risk for coronary artery disease and other cardiovascular problems. But there is now evidence that elevated homocysteine levels is another serious heart risk factor. 

Multiple studies have confirmed the connection between high-plasma homocysteine levels and occlusive artery disease, including coronary atherosclerosis, peripheral vascular disease, and carotid artery disease. In fact, some research shows that 42 percent of strokes, 28 percent of peripheral vascular disease, and approximately 30 percent of premature cardiovascular disease are directly related to excessive levels of homocysteine.

High homocysteine levels can be caused by foods—red meat, avocados, sunflower seeds, wild game, poultry, and ricotta cheese. These foods contain the amino acid methionine. If you don’t get enough B vitamins, your body cannot break down methionine, resulting in homocysteine.

These deficiencies can be further exacerbated by caffeine and alcohol, which cause excessive urination and wash out precious B vitamins from our bodies. (That’s why it is so important to adhere to the healthy heart nutrition tips I often share here in this blog.)

Research also shows that five percent of the population may have inherited a rare genetic enzymatic defect that leads to higher homocysteine levels and premature heart disease (which can lead to heart attack and stroke). Because of this new genetic data, the evaluation of serum homocysteine levels should become standard in preventive cardiology, especially in anyone with a family history of premature heart disease.

When Should You Get Your Homocysteine Tested?

If you eat a healthy diet, supplement with vitamins and minerals, exercise, and have no family history of heart disease and or other heart risk factors, then you don’t need to be tested for homocysteine. But if there was a sudden death of a family member at a young age from stroke or heart disease, or if you have heart disease (especially if you are under age 60), you should be tested for homocysteine.

Research has shown that 400 mcg of folic acid a day will help prevent high homocysteine levels. However, to be safe, I recommend 800 mcg folic acid and 20 mg of vitamin B6 per day. Natural sources of folate include dark green leafy vegetables, beans, legumes, oranges, orange juice, and fortified cereals.

Ground flaxseed has the ability to lower your blood pressure levels and to help you to reach good cholesterol levels. It can also reward you with healthier skin, improved digestion, and a cleaner bowel, which results in less energy drain on the liver – the most important filter of the body.

You see, you can get two key types of essential fatty acids from flaxseed because it contains 19 percent activated omega-6s and 48 percent of an omega-3 precursor, alpha linolenic acid. This makes it a perfect food for people who are looking for natural ways to lower blood pressure and maintain overall good health.

In general, freshly ground flaxseed is better than flax oil because you’re assured the oil in the seed is fresh, plus you’re getting extra fiber and plant lignans. Simply grind two tablespoons of flaxseed and sprinkle on food or blend in a breakfast drink three to four times per week.

Click here for a delicious smoothie recipe using flaxseed and here for the recipe for a heart healthy flaxseed bran muffin to go with it!

As a cardiologist and a holistic health practitioner, I take blood pressure levels of every patient who comes into my office. And sadly enough, oftentimes, I find that that their blood pressure levels are too high. As you probably know, high blood pressure levels are often a precursor to serious cardiovascular problems, including heart attack and stroke, so this is a situation that I take very seriously.

Some of these patients, however, tell me that they are doing all they can to control high blood pressure and that when they go home and measure it themselves, their blood pressure levels are normal. Occasionally they’ll ask if the instruments in my office are off, or if my staff misread the result.

The actual problem, however, is a common condition called white-coat hypertension (WCH). It’s used to describe people who become anxious over a visit to a physician, dentist, or medical facility. The visit evokes a fight-or-flight response, and their blood pressure levels go up.

Research has shown that abnormally high blood pressure readings in a medical setting could be more than just a benign byproduct of anxiety.  Although the condition is poorly understood, WCH could be a precursor to high blood pressure levels, poor blood circulation, and other cardiovascular problems.

A Danish study published in the Journal of Human Hypertension found a heightened cardiovascular event risk for patients with WCH over a 10-year period. A Japanese study reported in the journal Hypertension Research suggests that WCH contributes to carotid arteriosclerosis. And in another Japanese medical report, based on eight years of observation, researchers suggest that WCH is a “transitional condition to hypertension” and may carry a “poor cardiovascular prognosis.”

If you experience WCH, I suggest you take the following high blood pressure remedies to get it under control and avoid potential cardiovascular problems:

• Introduce a regular stress-reduction program into your life. That could include activities such as exercise, tai-chi, meditation, or yoga. This is a wonderful way of lowering blood pressure naturally.
• Watch the salt (again). This cardiovascular nutrition tip can’t be stressed enough.
• Start taking blood pressure-friendly supplements on a daily basis—such as fish oil (2,000-3,000 mg), magnesium (400-800 mg), hydrosoluble CoQ10 (50-150 mg), and a garlic supplement high in allicin (500-1,000 mg). You can find these supplements in most health food stores.

One of the many things you can do to control high blood pressure levels is to carefully watch your salt intake. Doing so is one of those simple high blood pressure remedies that doesn’t involve a doctor’s visit or a pill -- and that’s a very good thing!

Your body requires sodium (a component of salt) to regulate fluid balance and distribution, as well as nerve and muscle cell function. But, while you need some sodium, the standard diet includes way too much. This is one of the reasons why so many people have blood pressure levels that are too high and suffer with a myriad of other cardiovascular problems.

The current recommendation for salt consumption is less than 2,400 mg of sodium a day, which amounts to about one teaspoon of salt. Recent research suggests that people ingesting less than 1,500 mg of sodium a day are better able to maintain healthy blood pressure. If you have high blood pressure levels, you should definitely aim for that number. Don’t use salt from the shaker, and read labels to add up the amount you’re taking in.

Many items at fast food restaurants are high in salt, so you can easily exceed the recommended level with one serving.   That’s why I’ve always strongly urged people who are looking for natural ways to lower blood pressure levels, improve blood circulation, or to reduce their risk of heart attack and stroke to avoid fast food restaurants. Going to one once in a while is okay for most people, but regular visits are a sure way to cause cardiovascular problems.

You can easily make up for the reduced salt in your diet by cooking with fresh herbs and spices such as basil, garlic, oregano, rosemary, chives, parsley, and onion. What’s more, all of these flavorings contain natural substances that make them good for any cardiovascular nutrition program, but also good for your overall health.

1. Combine all the ingredients in a blender or food processor and blend until smooth and creamy.
2. Store in airtight container. Keeps one to two days.

For decades I’ve been making spaghetti sauce for family and friends. As I prepare the sauce over the course of a day, I repeatedly taste it to make sure that I get it just right.

Twenty or so years ago, I noticed that the day after the meal I had gained a few pounds—and I was unusually thirsty as well. I was perplexed until I investigated and learned that the canned tomatoes, pastes, and purees I was using were high in salt.

Here I was, a cardiologist, as well as a holistic health practitioner, and I hadn’t made the connection. Excess salt contributes to water retention, and that was my problem. Of course, too much salt also makes it difficult to control high blood pressure and contributes toward a myriad of other heart risk factors.

I quickly changed my ways and my spaghetti sauce recipe. I started avoiding foods high in salt, which meant reading labels on foods in the grocery store. (This one act alone is an excellent way to naturally maintain good blood pressure levels.)  Most people don’t think they eat too much salt because they didn’t use a salt shaker. Unfortunately, that’s simply not the case.

The average adult consumes the equivalent of nearly two teaspoons of salt a day—practically two times the upper limit for good health. And the majority of that excess salt is hidden in processed foods, such as canned spaghetti sauces, soups, and dill pickles.

I’ll never forget a patient of mine who had chronic hypertension and ate his fill of canned ham (packed with salt) on Easter Sunday. The next day he was in the emergency room with a hypertensive crisis and acute heart failure. His heart just couldn’t handle the large amount of salt he had consumed.

His was an extraordinary situation, but it underscores the need to be careful with salt intake. So let his story and mine be lessons for you as well. 

There are many types of arrhythmias, but basically the term refers to an irregular heart rhythm, which can also be noted as an irregular pulse. Essentially, the heartbeat goes off cadence and this irregularity may or may not be felt in your body. Many people are aware of skipping, strongly palpitating, or rapid heartbeats, while other asymptomatic individuals may learn of an arrhythmia at a doctor’s office visit when it shows upon an electrocardiogram.

Arrhythmias are very common and affect both genders and all ages. About 20 or 25 percent of patients with arrhythmias are not in any danger.

To prevent arrhythmias, you’ll need to minimize caffeine, sugar, and alcohol intake. I cannot emphasize this enough. I am a huge wine lover—I even have a wine cellar in my house—but if I had arrhythmia, I’d never touch a drop again.

I also suggest that you develop techniques (such as prayer or meditation) to control stress.

Additionally, there are several supplements that are very effective for straightening out heartbeat irregularities. For otherwise healthy people, the best one-two combination to suppress skipped heartbeats are daily doses of:

• Magnesium (400 mg),
• CoQ10 (100 mg),
• Fish oil (2 grams),
• L-carnitine (500 mg), and
• D-ribose (5–10 grams).