Dr. Sinatra

Let me start out by saying that I realize it may feel strange to discuss cardiovascular problems in the context of your emotions. Your feelings are probably not something you ever thought about in connection with heart risk factors. 

You may already be aware of heart risk factors commonly reported in the popular press and medical journals: older age, unfavorable family history, poor diet, elevated blood fats, obesity, sedentary lifestyle, diabetes, high blood pressure, cigarette smoking and personality type (the infamous “Type A”).

This is why I want to make you aware of how the “lesser known” heart risk factor—your mind—affects your body. I want you to take advantage of new information that could dramatically improve your healing process.

I’m not surprised that you haven’t heard much about heartbreak’s role in heart disease. Heartbreak is not considered a medical “condition” because love is not a recognized physical function. Until recently, physiology has limited itself to the mechanics and chemistry of how organs work and has ignored the impact of various emotional states on those functions. Science is necessarily confined to phenomena that can be measured and quantified.

Although the feeling states lie outside the realm of science, I think it’s a mistake to exclude them from our understanding of the human body. Love is a tremendously vital force in human behavior, and I firmly believe that we must try to understand its nature and the role it plays in our emotional and physical health.

I want to make it clear that love and intimacy cannot “cure” cardiovascular problems. But if you learn to cope with heartbreak, anger, or resentment, rather than suppressing the feelings, you’ll be doing your heart a world of good. You will harness the power of your emotions to heal your body. Honesty, tears, and smiles have as much to do with recovering from cardiovascular problems as eating well, exercising, and taking vitamins.

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.

I also want you to be aware that, because most cardiologists still see heart disease as a male phenomenon, they treat women less effectively and less aggressively than they treat men, often with catastrophic results. For example, if a 45-year-old woman and a 45-year-old man both come into the emergency room with chest pain, most physicians will probably admit the man and tell the woman her symptoms are due to stress and anxiety.
 

This is because most doctors are trained to believe that serious cardiovascular problems have a low probability in women. Not many realize that among peri- and post-menopausal women, the incidence of coronary events quadruples as women approach middle age (45 years old and older.)

Iron is necessary throughout life for stimulating the production of hemoglobin, the red blood cell pigment that carries oxygen to our cells. Without it, we couldn’t survive. And growing children and menstruating women do need to be mindful of their iron consumption.

However, newer research indicates that iron overload, or hemachromatosis, is one of the heart risk factors you need to be paying attention to.

Hemachromatosis is an acquired or hereditary defect of iron metabolism in which excess iron is deposited in tissues and not available for oxygen transport. Iron is stored in muscles and other tissues, and unless it is lost through menstruation or donating blood, over the years toxic levels can accumulate in your system.

No one is yet sure exactly how elevated levels of iron contribute to heart disease, but researchers have a number of ideas. In the early 1980s, Jerome Sullivan, a pathologist, noticed that women who had undergone hysterectomies had increased incidence of heart disease. He suggested that if losing blood protected menstruating women from heart disease, men donating blood might also have similar protection. Sullivan’s findings, published in Lancet in 1981, were years ahead of their time, yet his theories have been accepted only recently.

A 1992 Finnish study examined the role of iron in coronary artery disease. After studying 1,900 men ages 42 to 60 for five years, researchers found that those with excessive levels of ferritin were more than twice as likely to have heart attacks, and that every one-percent increase in ferritin translated into a four percent increase in heart attack risk.

Women and Iron

Half of American women will die of cardiovascular problems such as heart attack and stroke. Yet risk levels among women vary tremendously. Menstruating women produce estrogen, which is heart protective, and most lose a significant amount of iron in the blood each month. This can add up to 400–500 mg of ferritin iron per year (about equal to two pints of blood).

In contrast, postmenopausal women are four times more likely to have heart attacks. Not only do they lose the protection of regular menstrual iron depletion, their levels of ferritin begin to rise steadily after menopause, more than doubling between 55 and 65, and even more after that.

Are You in a State of Iron Overload?

Ten percent of American adults may carry the gene for hereditary hemochromatosis. Physicians are often perplexed by their symptoms of fatigue, abdominal pain, organ failure, immune dysfunction, skin bronzing, irritable bowel syndrome, menstrual irregularity, hair loss, and explosive diarrhea. Many people have such symptoms for years but iron overload is not diagnosed until years of damage have taken place.

CAUTION: If you complain of fatigue to your doctor, he or she might prescribe iron, which is the last thing you need! If you are already in iron overload, this can be dangerous. So before you take iron supplements, insist that your physician order up a special iron test called a serum ferritin. If your serum ferritin level is greater than 120, you need to take steps to reduce it. In addition, if two other parameters of iron measurement—serum iron binding capacity and serum iron—are elevated, you have iron overload or hereditary hemochromatosis.

The Dr. Sinatra Solution

1. Know your serum ferritin level. Women of child-bearing age should have ferritin levels roughly between 15 and 45. Men and postmenopausal women should be between 50 and 120. If your levels are over 120, reduce iron in your diet. If levels are over 200, donate blood at least two to three times a year.
2. Cut iron consumption. Remember, red meat is loaded with iron and high quantities of saturated fats and cholesterol. Be aware of “iron fortified” grains and cereals, and avoid any that contain more than 25 percent of the RDA of iron.
3. Do not take multivitamins fortified with substantial doses of supplemental iron.
4. Do not use iron cookware unless you are iron deficient.
5. If you are in an iron overload situation, do not take more than 300 mg of vitamin C per day. Vitamin C can enhance the absorption of iron and become a pro-oxidant rather than an antioxidant.
6. Have your water supply assessed for environmental toxins as well as iron. Iron is ubiquitous in vitamin/mineral preparations and foods, as well as in our water supply. Consider a water filter.

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!

Many people trying to prevent blood clots are taking the blood thinner, Coumadin. But…

There’s something about Coumadin and its cousins that elicits an “anything-but-that-Doc” response from about half the folks who are on it. Many of my patients have asked to discontinue Coumadin because, in addition to the side effects and fear of bleeding, they dislike the nature of the drug (it’s rat poison in high quantities), as well as the discomfort and inconvenience of blood tests every 4–6 weeks.

In fact, whenever I lecture, someone in the audience always asks: “Is there some alternative to Coumadin?” So, let’s review anticoagulants like Coumadin and try and allay some of your concerns.

Before I discuss alternatives to Coumadin, let me tell you why this is the most frequently prescribed anticoagulant. In a nutshell, Coumadin has an unparalleled ability to thin the blood and prevent blood clots. More specifically, studies have shown that Coumadin can protect you from a stroke if you have:

• Mechanical heart valves (their surfaces encourage blood platelets to stick to them).
• Suffered an embolic stroke, one of three types of stroke caused by a fragment or clot of blood pumped from the heart to the brain.
• Atrial fibrillation (AF), where atria fail to contract; blood forms pools and becomes sluggish.
• Had an extensive heart attack (scar tissue weakens heart muscle tissue, which in turn weakens contraction of the left ventricle, possibly allowing blood to stagnate and clot).

Like any drug, Coumadin has side effects. Although the major one is excessive bleeding (bleeding gums, eye hemorrhages, blood in the urine and even a few bleeds in the brain), other rare reactions include weakness, cold sensations, itchy skin, fever and abdominal discomfort.

Indeed, blood thinning is a double-edged sword. While anticoagulants help prevent thrombotic and embolic strokes, I have to bear in mind that the risk of a stroke-induced hemorrhage is higher for those on Coumadin.

So now you can see why people trying to prevent blood clots struggle with this popular anticoagulant and often ask to trade it in for aspirin or other blood-thinning alternatives.

How Yolan Chose To Prevent Blood Clots

Yolan, 78, suffered with cardiovascular problems and, consequently, had a heart attack a few years ago. She began taking Coumadin but reported that she just didn’t feel right. Yolan experienced several unusual body sensations, which she attributed to the drug.

Against her doctor’s wishes, Yolan went off Coumadin and her symptoms abated. She now takes 324 mg of aspirin every other day (more about aspirin in a moment) and says she feels much better.

I’ve gotta tell you, folks, the decision to go off Coumadin can be a very difficult one; patients and their doctors often struggle together for the right answer. So let me offer some guidelines to help make this decision easier for you.

Coumadin is your best therapy—mandatory even—to prevent blood clots if you have mechanical heart valves. Studies show that it’s more effective than aspirin with other anti-platelet drugs. It should also be your first choice if you’ve suffered an embolic stroke.

Coumadin has been shown to protect patients with left ventricular clots and from AF, which can cause thrombotic strokes. Now, if you have AF, a common cardiac condition—you may wonder if you can take aspirin instead of Coumadin. If you have AF, your best bet is still Coumadin. If you’re not on conventional blood thinners like Coumadin, your risk of stroke is at least 5–6 times greater than those who are. This in itself is a disaster! In fact, approximately 75,000 strokes a year are attributed to AF.

Remember, with AF, the upper chambers of the heart may fail to empty completely, creating a perfect breeding ground for blood clots and poor blood circulation. As clots are formed and pumped out from the heart, they can wander around in the bloodstream until they find a vessel too small to get through and then you can have a major log jam in the brain, the leg, the kidney, in fact, anywhere at all. But the carotid artery is the number one spot to worry about because it’s a direct shot to the brain as the blood is pumped out of the left ventricle.

At least 90 percent of my AF patients take Coumadin; the other 10 percent take aspirin. But aspirin is less effective for preventing clots and strokes, particularly in women and people over 75. The best advice I can give anyone with more than two episodes of AF a year is to take Coumadin. If you have fewer episodes of AF and no other health problems like diabetes, congestive heart failure, leaking heart valves, or an enlarged heart, aspirin is a second choice.

For years now, I’ve been telling my readers and patients to avoid acetaminophen—especially the extra-strength variety—because of the potential for liver problems. I’ve also said to avoid NSAIDs because of the potential for gastrointestinal bleeding, liver damage, and kidney dysfunction.

My advice is clearly supported by a report from the Harvard School of Medicine’s ongoing Nurses' Health Study that suggests that the use of painkillers can make it difficult for women to control high blood pressure. 

The report, published in the September 2005 issue of Hypertension, concluded that women are at increased risk for high blood pressure if they take daily doses of non-aspirin painkillers—such as extra-strength acetaminophen (Tylenol) and ibuprofen (Advil and Motrin).

This observation is especially troubling for pain-ridden patients looking for alternatives after learning a few years ago that prescription NSAID painkillers (such as Vioxx) are associated with higher risk for cardiovascular problems. 

The Harvard study involved 5,123 women age 34 to 77, none of whom had high blood pressure at the onset. Here are the results:

• For women not taking painkillers, the risk of developing high blood pressure levels was about 1 to 3 percent a year.
• Women who were taking an average daily dose of more than 500 mg of acetaminophen (one extra-strength tablet) had a 93 to 99 percent increased risk of developing high blood pressure (and, most likely, a more difficult time maintaining healthy blood pressure) within three years, compared to women taking less than 500 mg.
• Women who were taking more than 400 mg a day of over-the-counter NSAIDS (the equivalent of two ibuprofen) had a 60 to 78 percent increased risk of developing high blood pressure levels, compared to women taking less than 400 mg.
• The widespread use of acetaminophen and over-the-counter NSAIDs may contribute to the high prevalence of chronic hypertension in the United States.

Please take this information to heart. If you take painkillers regularly, please inform your doctor. He or she may have some safer recommendations. Here are a few of mine:

• White willow bark (180 mg twice a day); or
• Low-dose aspirin (325–650 mg a day as tolerated, but discontinue if you experience abdominal discomfort); or
• SAM-e (200–400 mg, once or twice a day as needed).

Remember, there are always safer alternatives to “the business-as-usual” drugs we’re being marketed in the media.

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.