Heart Attack and Stroke

Prevent Blood Clots by Reducing Fibrogen

Monday, June 7, 2010 by Stephen Sinatra

Arteriosclerosis, or narrowing of the arteries, is the most common cause of heart disease, but in women younger than 45, we see more heart attacks caused by improper blood clotting that can be triggered by high fibrinogen levels.

Too much fibrinogen, an inflammatory product of blood coagulation, can make the blood clot too fast.

High fibrinogen levels aren’t the sole province of younger women. At age 57, one woman went to her doctor with signs of unstable angina. She had bypass and angioplasty, followed by drugs to help her maintain healthy cholesterol, as well as other conventional treatments.

Nine years later, she had a second heart attack and underwent a cardiac catheterization to reopen some of the grafts that had closed. In her mid-60s and depressed about the recurrence of her heart disease, she came to see me seeking alternative ways of minimizing her cardiovascular problems and healing her heart.

I prescribed a fish oil (EPA-DHA) supplement to promote “slippery” blood platelets and help improve blood circulatin by neutralizing her fibrinogen and triglyceride levels. I also put her on my PAMM diet, my cardiovascular nutrition plan that includes much lower levels of carbohydrates (to combat her insulin resistance), plus healthy fats and garlic. I also recommended that she exercise to help her lose weight.

If these measures failed to support these critical blood parameters enough within three to six months, she agreed to go on natural estrogen therapy. Estrogen is important because fibrinogen levels rise with falling estrogen. Recent research suggests that estrogen replacement therapy can significantly reduce plasma fibrinogen levels.

The most important contributor to high fibrinogen levels is cigarette smoking: Smoking is just about the worst thing you can do for your health. According to research, almost half of all heart risk factors can be attributed to cigarette smoking.

While there may be some variations among laboratories, an acceptable range for serum fibrinogen is less than 300 mg/dl; anything over 350 mg/dl is considered undesirable.

For more information on heart risk factors and how to prevent them, visit www.drsinatra.com.

Heart Risk Factor: Homocysteine

Wednesday, June 2, 2010 by Stephen Sinatra

Historically, maintaining healthy cholesterol has been at center stage of the quest to minimize the risk of coronary artery disease. But there is now evidence that elevated homocysteine levels are also one of the top heart risk factors.

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, which results in homocysteine.

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.

When Should You Get Your Homocysteine Tested?

If you adhere to healthy cardiovascular nutrition, 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 40 mg of vitamin B6 per day. Natural sources of folate include dark green leafy vegetables, beans, legumes, oranges, orange juice, and fortified cereals.

To read about other heart risk factors and how to prevent them, visit www.drsinatra.com.

Cardiology Terminology: Angina

Tuesday, May 25, 2010 by Jan Sinatra

Jan Sinatra defines angina, its symptoms and causes, and how it is different than a heart attack or myocardial infarction.

I find that a lot of folks I counsel often confuse the cardiology term angina with heart attack or myocardial infarction (MI). Maybe that is because we refer to an anginal episode as an “angina attack.” To help you understand these terms, let’s look at their similarities and the differences.

Some refer to angina as a heart cramp, which is actually a very apt term. Angina is a symptom of ischemia, which is a lack of adequate blood flow to the heart muscle cells. If you think of the heart as a muscle, which it is, then a cramp there is similar to a cramp in your leg muscle. Muscles “cramp” because of an imbalance of electrolytes in their cells—or from dehydration, fatigue, or overuse.

The bottom line is a lack of funds in your electrolyte or hydration accounts is a common source of muscle cramps. And your heart is no different. The heart muscle also “cramps” when the supply of oxygen does not meet the energy demands in the cells of the constantly beating heart muscle.

Stable Angina

We refer to angina as “stable” when it occurs in response to an increase in energy demand, such as physical exercise. It also indicates that it is fairly “predictable.” Stable angina is usually reproducible during exercise stress testing. When angina is suspected and/or diagnosed during a stress test, an angiogram or cardiac catheterization is needed to define the “native anatomy,” or circulatory system, of the heart.

If an invasive procedure like a stent or coronary bypass is not recommended (or is deferred for some reason), then medication is usually prescribed to keep the heart below the “anginal threshold” —the pulse range and blood pressure level at which symptoms of ischemia are provoked. (The higher heart rates and blood pressures needed to respond to exertion place an extra oxygen and energy demand on your heart)

Stable angina is relieved with rest. Some people may take nitroglycerine under the tongue to assist the heart.

Unstable angina happens unpredictably. The symptoms are the same as stable angina, but unstable angina can happen when you are resting, or when you are emotionally upset.

Angina Symptoms

Typical symptoms of angina include chest pain/pressure/discomfort, shortness of breath, and fatigue. Less typical are a pain, pressure, or discomfort in the jaw (and/or teeth), the arm (including the elbow and wrist), or indigestion. Some folks describe a feeling that if they could just “burp” they would feel better.

Angina Versus Heart Attack

The BIG difference between an angina attack and a heart attack is that angina is a warning, but is TEMPORARY and there is no permanent muscle damage to the heart. Rest and/or nitroglycerine will relieve the symptoms and the ischemia.

Sadly, even a person with no prior history of angina can have a heart attack. Myocardial infarction is the Latin-based medical term for heart attack, which also was referred to as a coronary thrombosis back when I was a kid. “Myo” is Latin for muscle, “cardio” for heart, and “infarct” is a term for tissue death.

So, the good news is that someone with angina has not damaged their heart. The “bad” news is that folks with angina do have heart disease, and need to see a cardiologist regularly to evaluate and track their heart disease, as well as learn their treatment options.

There are many faces and names for heart disease. If you have terms you’d like to know more about, please let us know here at blog.drsinatra.com so we can explain them to you.

For more information on heart risk factors and what you need to know, visit www.drsinatra.com.

Heart Attack and Stroke on the Menu at the Heart Attack Café

Thursday, May 20, 2010 by Jan Sinatra

Most of you probably enjoy a good joke as much as the next guy. You know, every profession banters and teases to deal with the stress, and lend a little levity to the situation. And medicine is no different. Of course, cardiology is no laughing matter; it is fraught with the stress of resuscitations, emergency situations, near death experiences, and complex decision-making. But being able to laugh at ourselves is a great stress reliever that may even loosen us up about some aspects of our personality that we bring to any situation.

I recall entering the waiting room of a psychotherapist colleague many years ago, where a homemade coffee table book caught my eye. It contained varying jokes about seeking psychiatric help and related topics had been cut and pasted from magazines like the Reader’s Digest, and left there for patients to read.

At first it seemed odd. But as I flipped the pages and enjoyed the parodies and the satire, it struck me as actually so appropriate. To be able to laugh at a situation we find ourselves in always makes it a little easier to deal with.

I borrowed this great idea and blew up a cartoon I had found in Gary Larson’s Far Side, one of my favorite cartoon columns. I fit it in one of those 8x10 plastic box-style frames and hung it on the wall in front of cardiac rehab treadmills. There, sketched in black and white, was a nurse cranking up a treadmill on some poor struggling person with a sadistic smile on her face. Then, I waited to see what would happen.

The patients were in stitches and insisted that we make the nurse a nametag with my name on it, a request that I quickly followed through on. We had a ball with that cartoon. Laughter is such good medicine! And I loved listening to them chuckle their way through the drudgery of indoor treadmill walking and medically supervised exercise, and add their own witty commentaries.

Before you know it, patients who’d endured heart attacks and strokes and open heart surgeries were cutting out and bringing in cartoons of their own to be sized, framed, and hung around the exercise room, too. There were jokes about surgery, doctors, nurses, exercise, poor lifestyle choices, healthy diets—all kinds of related things!

I revisited that great memory a couple of weeks ago when a colleague at Healthy Directions forwarded an email about a “coronary café” in Arizona called the “Heart Attack Grill.” It is a

creative marketing schema, and certainly offers a Larsonesque edge.

First off, I have to tell you that their onsite “doctor” is not recognized by the AMA. Also, those rehab patients of mine would have lots to say about the fetching “nurses” at the establishment, as well as entrees like the quadruple bypass burger, unfiltered cigarettes, and caffeine-laden sugary drinks.

While the restaurant is real, it’s also a real reminder that diet is a major and controllable heart risk factor. At least the name (Heart Attack Grill) and the name of its food items (single, double, triple, and quadruple bypass burgers) are completely honesty about what’s in the food being served. What for a change!

So if you or someone you know could use a good chuckle—or a gentle nudge to remember that “you are what you eat”—pull up a chair, check out the video, put on a napkin, and enjoy.

For more information on healthy heart nutrition, visit www.drsinatra.com.

Exercise, But Do It Carefully

Wednesday, May 19, 2010 by Stephen Sinatra

While exercising, I urge you to learn to listen to your body. Is the exercise you’re doing causing pain? Tight muscles? Does it hurt your posture? Is it affecting your sleep? Is it disturbing your breathing, digestion, vision, or other functions not normally associated with fitness?

If you experience any of the following symptoms, stop immediately.

Lightheadedness or dizziness
Palpitations
Shortness of breath (unable to carry on a conversation)
Jaw pain
Arm tingling or numbness
Tight feeling in the lungs (bronchospasm)

Be aware of any symptoms that come up during or up to an hour after exercise. If you feel ill, stop and rest. If symptoms persist after three to five minutes of rest, seek medical attention immediately.

Let me stress, however, that some form of exercise is of paramount importance to your health. It can help improve circulatory problems, reduce triglycerides, and fight chronic hypertension. Exercise can also help you to maintain good cholesterol levels. And, believe it or not, just a daily walk around the block goes a long way toward helping you to prevent blood clots, heart attack and stroke.

For more information on cardiovascular health, visit www.drsinatra.com.

Exercise is a Great Way of Lowering Blood Pressure Naturally

Monday, May 17, 2010 by Stephen Sinatra

I am often asked what the best exercise is. I answer that the best exercise is the one you will do. Afterall, there’s no point recommending an exercise if the person you’re recommending it to won’t do it.

You can’t be truly healthy without exercise and it is great for people who are dealing with circulatory problems, need help reducing cholesterol levels, or are trying to maintain healthy triglycerides.

Exercise also is just what this doctor orders when it comes to lowering blood pressure naturally. As you know, maintaining healthy blood pressure levels is one of the smartest things you can do to reduce your risk of risk for heart attack and stroke.

Two of the best forms of movement are also the most pleasant—walking and dancing. Research, including some of my own, has continued to reinforce this view.

Research has demonstrated that exercise reduces the incidence of coronary heart disease, diabetes, depression, and osteoporosis. Now we can add stroke to the list. In a study reported in the Journal of the American Medical Association (JAMA), 4,065 nurses ages 40 to 65, without cardiovascular disease or cancer, completed detailed physical activity questionnaires. The surveys revealed that walking was associated with reduced risk of stroke.

If all this isn’t enough to get you off the couch, consider that if you have been relatively sedentary most of your life, you are likely to lose 30 to 40 percent of your muscle strength by the time you’re 65. By age 75, more than a quarter of American men and two-thirds of American women can’t lift a gallon of milk above their waist with one hand.

Exercise burns calories and increases body metabolic rate, which means that your body burns more calories even as you rest. So let's get moving!

For more information on lowering blood pressure naturally, visit www.drsinatra.com.

Coenzyme Q10 and L-Carnitine Help You Avoid Heart Risk Factors

Monday, May 3, 2010 by Stephen Sinatra

I have long considered CoQ10 a wonder nutrient because of its ability to help prevent cardiovascular problems, including heart attack and stroke.

The heart is one of the few organs in the body to function continuously without resting; therefore, the heart muscle (myocardium) requires the highest level of energetic support. Any condition that causes a decrease in CoQ10 could impair the energetic capacity of the heart, thus leaving the tissues more susceptible to free radical attack.

Recommended dose: Take at least 100–400 mg of CoQ10 per day. Dietary sources of CoQ10 come mainly from beef heart, pork, chicken livers, and fish (especially salmon, mackerel and sardines). Vegetarians typically will not get enough CoQ10 unless they eat large quantities of peanuts and/or broccoli. The average person only gets 2–5 mg CoQ10 a day from diet. (You may consult other blog entries for additional tips on cardiovascular nutrition.)

If your response to your initial dose is less than optimal, work with your physician or holistic health practitioner to increase the dosage and maintain it over time. As with most nutritional supplements, it is best to take CoQ10 in divided doses with your meals.

L-Carnitine: Fuel for the Heart

While CoQ10 sparks energy within the cells, L-carnitine is like a shuttle, bringing fuel into heart cells to be burned as energy. I’ve observed some dramatic effects in my patients teaming up these two nutritionals.

Recommended dose: Take 250–500 mg L-carnitine fumarate three to four times daily. Start at the low end of the dosage scale and work up until you achieve the effect desired. Both L-carnitine and coenzyme Q10 may require fine-tuning to obtain the optimal therapeutic blood level and symptom relief.

CoQ10 and L-carnitine work together to promote healthy blood pressure and to reduce a wide variety of heart risk factors.

To learn more on how to avoid heart risk factors, visit www.drsinatra.com.

Fight Heart Risk Factors With Nutraceutical Support

Friday, April 30, 2010 by Stephen Sinatra

Vitamin and mineral supplements are not substitutes for a proper diet, but even the rare American who eats a balanced diet does not get the amount of nutritionals needed to combat the toxins and heart risk factors that threaten his/her health. This is why it’s critical that you take a quality multivitamin/mineral supplement with antioxidants every day with your meals. It’s just smart cardiovascular nutrition.

Hundreds of studies have shown that antioxidant nutrients protect cells from free radicals, neutralizing these molecular marauders before they do serious damage. Antioxidants protect your genetic DNA, cellular membranes, and even the enzyme systems that support cell metabolism. These activities have implications far beyond daily health. They can be found at the heart of aging itself.

Additionally, there are some key nutritional allies that reduce your risk for many of the cardiovascular problems out there today, including heart attack and stroke. For example, taking the right supplements is one of the best natural ways to lower blood pressure levels, improve poor blood circulation, and maintain healthy cholesterol and healthy blood pressure. Check out my previous postings, then consult with your doctor or holistic health practitioner to find out what’s best for you.

To read more on how to fight heart risk factors, visit www.drsinatra.com.

Cardiology Terminology 101

Thursday, April 29, 2010 by Jan Sinatra

Every specialty has its own special language. From the stock market to texting, we all shorten lengthy words and sometimes substitute abbreviations to make things quicker and

simpler for those working in that particular field to articulate.

This "lingo" also occurs in the world of medicine. However, I’ve found that, as a nurse, when medical professionals use this shorthand with patients, it can be a bit confusing. So I thought a little cardiology terminology 101 may help make some complex communications with your doctor or healthcare provider a bit less formidable.

To start with, let’s look at the term ejection fraction, otherwise known in cardiology circles as EF.

To understand ejection fraction, you first need to understand how your heart pumps your blood through your body. Most people think that the heart pumps out ALL the blood that comes into it. However, the reality is that your heart works more like a bucket used to bail out a boat. If you don’t turn the bucket upside down, then you’ll toss out most of the water, but not all, before you refill it. Instead, some sloshes back to the “bottom of the bucket.” The same is true of your heart.

The blood moves through the four chambers of the heart, making a quick stop between the right side and the left side of the heart to pick up a fresh supply of oxygen in the lungs. The right and left atria (atria is plural for atrium) are “receiving chambers.”

The atria then pump blood out to the ventricles, the two larger, lower chambers that in turn pump blood out to the lungs and the aorta. Blood comes in from the largest veins in the body (the vena cava) to the right atrium, then down to the right ventricle, then out to the lungs for oxygen, back to the left atrium, down to the left ventricle, then out of the heart again to the aorta and the body.

So the path is:

Vena Cava—Right Atrium—Right Ventricle—LUNGS—Left Atrium—Left Ventricle—AORTA

Measuring Ejection Fraction

Ejection fraction is used to evaluate the heart’s primary function as a pump. It is measured at the point where the left ventricle pumps blood out into the aorta. It can be calculated non-invasively with an echocardiogram, or more directly during an angiogram of the heart. A non-invasive MUGA scan of the heart will also estimate the ejection fraction.

A healthy heart is able to eject, or “bail out” about 50 to 70 percent of the blood that comes in. The person with a 50 to 70 percent ejection fraction feels great (from a cardiac standpoint anyway).

When the ejection fraction is less than 50 percent, their heart may have trouble keeping up with the oxygen demand of physical activity. Some may start to have symptoms at ejection fractions of 35 to 45 percent, but not always.

People with advancing heart failure—where the heart muscle has trouble moving blood in a forward fashion—have ejection fractions below 35 percent. Those awaiting heart transplants often have an even lower ejection fraction—often 10 to 15 percent—and it’s all they can do to sustain simple activity, such as getting from a bed to a chair.

One of the reasons for this is that a low ejection fraction results in blood backing up into the lungs, creating the breathing difficulties commonly experienced in someone with congestive heart failure. Other cardiovascular problems that can adversely affect ejection fraction include heart attack, long-standing high blood pressure levels, valvular issues, and infections of the heart muscle.

Periodically, I’ll be discussing additional cardiology terms. Let me know if there is one that’s confusing for you. Next time, I’ll explain the difference between a heart attack and an angina attack. Stay tuned!

To read more about how to prevent cardiovascular problems, visit www.drsinatra.com.

Heartbreak, Cardiovascular Problems, and the Type A Personality

Tuesday, April 27, 2010 by Stephen Sinatra

There really is a link between heartbreak, cardiovascular problems, and the Type A personality. Let me explain.

I’m sure you are familiar with the Type A personality—a volatile mixture of aggressive, impatient and hostile behavior. And you know that certain aspects of Type A behavior, especially uncontrolled anger and hostility, can be a risk factor for cardiovascular problems. But let’s delve a little deeper—what creates Type A behavior? I’m not alone in the belief that it’s lack of love and intimacy.

Research has shown that lack of love can set the stage for Type A behavior. Few people will admit that they were unloved as children. Even patients undergoing psychotherapy have considerable difficulty accepting this possibility. Generally, it is only after they have experienced the pain of their heartbreak that they are willing to recognize that one or both parents had considerable negative feelings toward them. Parental love is a human need; unfortunately, it is not always a reality in life.

Type A Kids Become Type A Adults

Early childhood experiences governed by conditional love form the basis for the Type A person, who is driven to achieve as a way to overcome low self-esteem due to early rejections. Children who shut down their hearts to avoid subsequent rejection and heartache pay the price of loneliness (as well as cardiovascular problems later in life). Loneliness results from the fear of loving, so vital connections are not made. When approval is based on performance alone, as it often is in our culture, children learn to avoid intimacy, contact, and commitment. Hoping to gain acceptance and acknowledgment first at home, then at school, and later at the workplace, children falsely assume that success will “buy” them love.

In the pursuit to gain lost parental love and overcome such profound heartbreak, children begin to sacrifice their true self for the illusion of success. Schoolwork and performance, newly substituted passions, displace lost love. If children become too involved in their image at the expense of who they really are (i.e., emphasizing who they wish to be as opposed to who they actually are), they can lose the capacity to experience the present moment. If this pattern continues into adulthood, whereby true feelings are denied, an individual becomes increasingly vulnerable to pushing and striving beyond healthy limits.

It is this denial of feeling, or repression of feeling that contributes to heart risk factors. As adults these children can develop circulatory problems, have difficulty maintaining good cholesterol levels and healthy blood pressure, and become victims of heart attack and stroke.

Most physicians and holistic health practitioners today will concur that it is important to do what we can to raise emotionally healthy children so that they don’t suffer from cardiovascular problems later in life.

For more information on how to avoid cardiovascular problems, visit www.drsinatra.com.

Eat This Way For Good Cardiovascular Nutrition

Friday, April 23, 2010 by Stephen Sinatra

After a great deal of research, I’ve concluded that the best overall diet for healthy blood pressure, healthy cholesterol, healthy triglycerides and to reduce your risk of heart attack and stroke is a combination of Mediterranean and Asian eating.

In essence, this combines the healthy eating of Mediterranean cultures with the Asian emphasis on soy foods and seaweed. They have in common an absence of saturated and hydrogenated fats and an emphasis on fish and vegetables. There’s a remarkable amount of research to back up this healthy and delicious approach to nutrition. And best of all, it’s not really a “diet” so much as a lifestyle choice.

My Pan-Asian, Modified-Mediterranean (PAMM) Diet

I have been a proponent of the modified Mediterranean diet for years—even before it became fairly mainstream. In recent years, I’ve expanded that foundation to include the Japanese diet, because I believe that combined, they deliver the best of both worlds. They share an absence of saturated and hydrogenated fats and emphasize fish and vegetables. However, while Mediterranean people do not consume a lot of soy or seaweed, the Asians do.

I decided to call this updated approach to healthy eating the PAMM diet. It includes fresh fruits and vegetables in season, fish, and whole grains. Meat is used sparingly, often just enough for flavoring. Meals are based on numerous small portions for lots of variety, and the lightest meal is at the end of the day, when the body is quieter and the metabolism slower.

My PAMM eating plan includes 45 to 50 percent slow-burning, low-glycemic index carbohydrates; 30 percent healthy fats; and 25 percent protein. I’d also urge you to eat organic as much as possible.

Moderate Carbohydrates, More Protein and Healthy Fats

In a nutshell, the Mediterranean diet encourages eating cold-water fish such as salmon and halibut; “healthy fats” such as olive oil; low-glycemic carbohydrates such as beans, lentils, and oatmeal; and plenty of fruits, vegetables and nuts.

Instead of eating large chunks of meat, Mediterranean people use meat to flavor their sauces. At most meals, they eat fiber-rich fruits and vegetables teeming with phytonutrients and packed with vitamins, carotenoids, flavonoids, polyphenols and monounsaturated fats crucial to well-being and cardiac health. Their diets are naturally rich in omega-3 fatty acids, coenzyme Q10, potassium, calcium and magnesium.

The Mediterranean diet can help balance blood sugar and insulin levels and give you more energy. My patients report that they consistently feel better and experience a better quality of life.

For more information on cardivascular nutrition, visit www.drsinatra.com.

Reducing Cholesterol With Statin Drugs

Monday, April 19, 2010 by Stephen Sinatra

HMG-CoA reductase inhibitors, more commonly known as statins, are the most aggressively marketed drugs for producing good cholesterol levels. In clinical studies statins achieved a striking reduction in cardiovascular problems such as heart attack, bypass, and hospitalization.

Statins are potent anti-inflammatory drugs that have been shown to be able to do a phenomenal job of reducing cholesterol levels, while also decreasing the number of deaths from heart attack and stroke.

Interestingly, these drugs are particularly effective for men, but less so for women. And, there’s a slight increased risk of breast cancer for women taking statin drugs. Because of the studies, and the fact that statins are still relatively new, I prefer to err on the side of caution when it comes to their use.

Common Statin Drugs

Some of the most commonly prescribed statin drugs include 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 good cholesterol levels. In addition:

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 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.

For more information on cholesterol lowering diets, visit www.drsinatra.com.

On the Road with Dr. Sinatra

Friday, April 16, 2010 by Jan Sinatra

Go Red for Women Fundraiser

Last weekend, Dr. Sinatra and I participated in a fundraiser to benefit the American Heart Association’s Go Red campaign to raise awareness about heart disease in women.

The fundraiser organizer was “Take-Down Tommy” Gleason, Dr. Sinatra’s wrestling team comrade and sparing partner from Mepham High School in Belmore, NY. Tommy and his wife now reside in Florida, and over the past few years that we have also been living in Florida, I’ve really been touched and impressed with how Tommy gives back to his community.

Every year, he puts together a golf tournament that always benefits a local cause. He and Margaret spend a lot of time organizing, recruiting attendees and volunteers, and attending to all the details that go along with a well-run golf tournament—including a raffle to raise even more money. And the Gleasons do it with so much love and thoughtfulness—and, of course, Tommy’s indomitable candor and spunk!

While Dr. Sinatra often participates in all of Tommy’s fundraisers, this year was particularly meaningful to us, as Tommy set his sites on a national cause: women and heart disease. He even made sure to schedule the 18-hole golfing event on a day that Dr. Sinatra could be there in support.

At the luncheon, Dr. Sinatra spoke to those gathered on the seriousness of cardiovascular problems in women. As he discussed in his book HeartSense for Women, as well as his newsletter Heart, Health and Nutrition, American women are five times more likely to develop heart disease than breast cancer. And, sadly, cardiovascular problems such as heart attack and stroke kill more women annually than any other illness—including all the cancers combined.

Clearly, we all need to support any cause that raises awareness about heart health. So, there I was, the only woman in their usual male foursome—including a golf pro! And while I’ve never been much of a golfer (and hadn’t played in years…talk about intimidated!), the guys were really patient with me, and gave me a lot of great pointers. And, in the meantime, we focused on the charity at hand. And I encourage you to do the same. If you belong to a civic-minded community looking to get behind a worthy endeavor, please consider the Go Red Program.

You can visit www.goredforwomen.org, a great place for women to learn and network. It’s a great resource, and you can even find or even sponsor a “Go Red Luncheon” in your area.

I know that next year, Tommy will be “going red” once again, and we will be there to support him. And this time the guys will need to watch out. I’ll be practicing and getting team shirts for the 2011 foursome, so we will at least have the wardrobe advantage!

For more information on cardiovascular problems in women, visit www.drsinatra.com.

Elevated C-Reactive Protein (CRP) Levels Precurser to Heart Attack and Stroke

Friday, April 16, 2010 by Stephen Sinatra

C-reactive protein (CRP) is a little-known heart risk factor that the medical world is starting to take note of.

It’s a blood protein that, when found in elevated levels, may indicate risk of heart attack and stroke.

The Physicians Health Study indicated that C-reactive protein could predict future vascular events such as heart attack in healthy and high-risk individuals and that high levels of this protein increase risk for heart attack and stroke.

A New Weapon to Fight Heart Disease

If you have heart disease concerns or you’ve recently experienced a virus or urinary infection that could cause inflammation, have your doctor check your C-reactive protein levels. A simple CRP blood test is as accurate as cholesterol and homocysteine screening in predicting a person’s risk of heart attack and stroke.

Once you have this test done, what should you do?

Some researchers believe you should take antibiotics to inhibit inflammation. I feel that more research is needed on anti-inflammatories before we begin foisting antibiotics on patients.

Research shows that estrogen therapy is associated with favorable lipid and oxidation levels, which also seem to assuage inflammation. But if you’re not postmenopausal and want to lower your protein, your best natural approach to combat CRP is to take immune-boosting supplements.

My top recommendations are:

CoQ10 is one of the best nutrients available for promoting the immune system and avoiding cardiovascular problems. Take 100–200 mg daily or 2–4 softgels.
Beta ⅓, ⅙ glucan, a yeast-based nutrient, scavenges for free radicals. There is no toxicity or side effects with this nutrient. Take 10–20 mg daily for one month on, one week off, for three months' duration.
Bromelain. This enzyme from the pineapple plant reduces inflammation and acts as an antibiotic. Take 100–500 mg daily. Note: Allergic reactions, although rare, can occur.
Ginger root/ginger tea. Ginger promotes an anti-inflammatory response and is a great substitute for aspirin, which many people can’t tolerate.
Fish oil promotes thinning of the blood and helps to reduce your risk of circulatory problems. It also combats inflammation. I recommend 1–2 g daily.

For more information on how you can prevent heart attacks and strokes, visit www.drsinatra.com.

On the Road with Dr Sinatra

Thursday, April 1, 2010 by Jan Sinatra

This past week, Dr. Sinatra and I were in California, where Dr. Sinatra addressed an audience of enthusiastic naturopathic doctors at a cardiology-focused conference sponsored by the California Naturopathic Doctors Association. There, the NDs posed a common magnesium question: Which form of magnesium is best for my patients?

Not a surprising question, given that magnesium has been one of Dr. Sinatra’s cardiology mainstays for decades, and is one pillar in his “awesome foursome.” You see, magnesium is a critical mineral that’s needed for normal muscle function and scores of enzymatic reactions, including the production of adenosine triphosphate (ATP), which is your body’s basic cellular fuel.

A low blood magnesium level is also the most common nutrient deficiencies we see. The mineral is often “used up” and thus depleted in patients with diabetes, congestive heart failure, atherosclerosis, chest pain, high blood pressure levels, cardiac arrhythmias, heart muscle disease, heart attack, and even sudden cardiac death.

In fact, intravenous magnesium treatment has long been a mainstay for many cardiac emergency situations, from runaway arrhythmias and high blood pressure levels to acute heart attack—even the pre-eclampsia of pregnancy should blood pressure levels be skyrocketing out of control.

Choosing Your Magnesium

Magnesium supplements come in so many different forms, the most common of which is magnesium oxide. The oxide form is used in many supplements, including multivitamins, because it’s just so darn easy to pack into a pill. Magnesium oxide acts most potently on the colon, igniting elimination, which makes it the magnesium of choice if you’re looking for a laxative effect. To give you a common reference, your mother or grandmother probably took Milk of Magnesia for constipation, as it provides a potent dollop of magnesium oxide.

However, despite it’s great a cleansing affect, magnesium oxide is not very bioavailable when it comes to the rest of the body. Very little magnesium is absorbed for utilization, which is an important fact if you are looking for lowering blood pressure levels, or using this mighty molecule to treat other cardiovascular problems.

The best way to ensure that your whole body has enough magnesium on board is to take a variety of forms, specifically glycinate, orotate, citrate, and taurinate. All four are all well-absorbed, and work synergistically, meaning they are most effective when taken together.

Dr. Sinatra and I personally take a broad spectrum magnesium (along with the other “awesome foursome” pillars—D-ribose, L-carnitine, and coenzyme Q10—whenever we exercise, whether it be with a personal trainer, a Pilates or yoga class, or our daily brisk walk.

If you want more details on magnesium, visit Dr. Sinatra’s Web site or even check out The Magnesium Miracle by Carolyn Dean, MD, ND. She is one of Dr. Sinatra’s Top Fifty Docs and I highly recommend her book.

For more information on holistic health practitioners, visit www.drsinatra.com.

CoQ10 Helps You Avoid Heart Risk Factors

Wednesday, March 31, 2010 by Stephen Sinatra

I have long considered CoQ10 a wonder nutrient because of its ability to help prevent cardiovascular problems, including heart attack and stroke.

Occasionally, patients report a sense of “too much energy,” and a few even say it’s as though they’ve had too much caffeine. Should this occur, adjust the dose down to a more comfortable level.

In my next post I'll introduce you to L-Carnitine. It works with CoQ10 to promote healthy blood pressure and reduce the risk of a variety of heart risk factors.

For more information on avoiding cardiovascular problems, visit www.drsinatra.com.

Good Cardiovascular Nutrition

Monday, March 29, 2010 by Stephen Sinatra

After a great deal of research, I’ve concluded that the best overall diet for healthy blood pressure, healthy cholesterol, healthy triglycerides, and to reduce your risk of heart attack and stroke is a combination of Mediterranean and Asian eating.

In essence, this combines the healthy eating of Mediterranean cultures with the Asian emphasis on soy foods and seaweed. They have in common an absence of saturated and hydrogenated fats and an emphasis on fish and vegetables. There’s a remarkable amount of research to back up this healthy and delicious approach to nutrition. And best of all, it’s not really a “diet” so much as a lifestyle choice.

My Pan-Asian, Modified-Mediterranean (PAMM) Diet

My PAMM eating plan includes 45 to 50 percent slow-burning, low-glycemic index carbohydrates; 30 percent healthy fats; and 25 percent protein. I’d also urge you to eat organic as much as possible.

If you’re trying to drop a few pounds, I invite you to visit my online Weight Loss Center. There I provide tips, recipes, and support that will help you along your journey toward your ideal weight.

For more information on good cardiovascular nutrition, visit www.drsinatra.com.

On the Road with Dr. Sinatra

Thursday, March 25, 2010 by Jan Sinatra

There’s always hope in a prayer.

This month, Dr. Sinatra did a full-day fellowship training for physicians working toward certification in anti-aging medicine with the A4M group (American Academy of Anti-Aging). I believe my husband is as energized by the enthusiasm and inquiry of his students as they seem excited and appreciative to hear from him about how to practice metabolic cardiology.

As we reflected on the day during dinner, I asked him if there was one particularly salient and memorable part of his experience with the other MDs. He paused to pick that “one best” thing that made the exchange personally valuable for him, and retold stories that doctors there had shared with the group when he was addressing the topic of energy healing.

In one case, a surgeon described a life-threatening experience in the operating room. His patient was losing blood—a lot of blood—and very rapidly. Everything they tried had been of no avail. Quietly an OR nurse spoke out loud “please, help us!” gazing at the ceiling—the kind of spontaneous prayer we all do but so often discount. Gradually, the bleeding subsided. The tide had turned, and the patient stabilized and survived.

A second MD had been challenged by a patient who had come to him for a serious and horrible skin rash. Despite all the drugs and creams he offered, the patient begged him to just put his hands on her head and pray over her. He resisted…and resisted…and finally surrendered to her request. That day, her rash started to fade and disappear…without “medicine” per se.

As my husband shared these simple human stories, we were both reminded of the work of Dr. Byrd, who first studied the effects of distant prayer back in the 1990s. He reported that patients hospitalized for heart attacks recovered significantly faster when someone else prayed for them—even when that someone was a total stranger praying for them from a distant location.

As Dr. Sinatra concluded his stories that day, we realized that the medical profession is so often invested in technological solutions for healthcare problems—or even finding just the right vitamin supplement or mind-body approach—that we forget the power of prayer.

So remember, whatever your belief system, your answer may only be a thought and a positive intention away…all you need do is ask.

God bless. Namaste.

For more information on Dr. Sinatra, visit www.drsinatra.com.

How Type A Kids Become Type A Adults

Wednesday, March 24, 2010 by Stephen Sinatra

Early childhood experiences governed by conditional love form the basis for the Type A person, who is driven to achieve as a way to overcome low self-esteem due to early rejections.

If this pattern continues into adulthood, whereby true feelings are denied, an individual becomes increasingly vulnerable to pushing and striving beyond healthy limits.

It is the denial of feeling, or repression of feeling that contributes to cardiovascular problems, including heart attack and stroke and chronic hypertension.

But, don’t despair. There are things you can do to fight back, many of which you’ll find in my blog postings.

I’m especially passionate about eating for good cardiovascular nutrition. Take some time to visit my web site page where I provide smart tips and tasty recipes to help you along the way.

How Can Heartbreak Cause Cardiovascular Problems?

Tuesday, March 23, 2010 by Stephen Sinatra

There really is a link between heartbreak, chronic hypertension, heart attack and stroke, and other cardiovascular problems. Let me explain.

But let’s delve a little deeper—what creates Type A behavior? Many doctors and holistic health practioners believe that it comes from a lack of love and intimacy. I agree with them and I fully acknowledge that noted research has shown that lack of love can set the stage for Type A behavior.

Few people will admit that they were unloved as children. Even patients undergoing psychotherapy have considerable difficulty accepting this possibility. Generally, it is only after they have experienced the pain of their heartbreak that they are willing to recognize that one or both parents had considerable negative feelings toward them. Parental love is a human need; unfortunately, it is not always a reality in life.

Type A behavior often develops in a family situation in which love for the child is conditional upon the child’s accomplishments and achievements. In Western culture, where success has become the most important “virtue,” many parents see their child’s success as a mark of their own narcissistic desires. Too often, parents’ egos are involved in their children’s status and performance in school, or in extracurricular activities like music and sports. But, love conditioned upon performance is not love at all.

Conditional love always carries with it the possibility that at some time or another the parents will withdraw their love if the child’s performance has not met their expectations. True love surrounds people with warmth and affection for who they are, not for what they do. If young children receive the message: “You are not acceptable the way you are,” basic insecurities may develop.

In my next post, I’ll discuss how Type A kids become Type A adults and run the risk of developing a myriad of cardiovascular problems.

To read more about preventing cardiovascular problems, visit www.drsinatra.com.