Heart Health Nutrition

I am often asked what the best exercise is. I answer that the best exercise is the one you will do.

There’s no point recommending an exercise if the person you’re recommending it to won’t do it. I also tell people to think of it as “movement” rather than “exercise.” That doesn’t sound like so much work, and, after all, the whole goal of exercise is to get out and get moving.

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.

Studies have shown 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.

Grape juice, like red wine, can help prevent blood clots and improve blood circulation.  Resveratrol, commonly found in grapes and other plants, is being studied for its antioxidant properties and its ability to minimize cardiovascular problems.  The “Dr. Sinatra recommended dosage” of Resveratrol is 2–5 mg daily.

Secondly, drinking flavonoid-rich green tea is an easy way to avoid cardiovascular problems and encourage resistance against chronic degenerative diseases, including chronic hypertension, heart attack and stroke.

While plain green tea itself has a delicate flavor, try it in one of the many formulas combining it with lemongrass and other herbs. Add a little honey and lemon, and I think you will find that this healthy heart nutrition tip really is quite delicious. If you can break your coffee habit in the process, you’ll be doubly rewarded, as you’ll also be reducing the amount of caffeine you ingest.

It absolutely amazes me how nature gives us so many opportunities to nurture our bodies and to keep cardiovascular problems at bay.

You may have heard of polyphenols, flavonoids, flavones, Pycnogenol (pine bark), grapeseed, catechins, tannins, quercetin and flavonol. You’ve also probably heard about the benefits of red wine, green tea, and grape juice. All are in the family of oligomeric proanthocyanidins (OPCs), which are really the cream of the crop.

Discovered about 50 years ago, OPCs are abundant in nature: There are approximately 6,000 flavonoids in the plants around us! These free-radical scavengers are quickly absorbed into the bloodstream where they cross the blood/brain barrier. They show great promise in helping to improve blood circulation and they support blood vessel elasticity, blood stickiness, clotting, plaque buildup, and vein integrity. In addition, they promote healthy blood pressure and good eye health.

You can find grapeseed extract and pine bark extract (under the patented brand name Pycnogenol) in your local health food store.  My “Dr. Sinatra recommended dosage” is 30–60 mg daily.

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.

HMG-CoA reductase inhibitors, more commonly known as statins, are among 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 good job of reducing cholesterol levels, while also decreasing the number of deaths from heart attack and stroke. However, they do come with a host of side effects, including a slight increased risk of breast cancer for women taking statin drugs. Because of the studies, I prefer to err on the side of caution when it comes to their use.

In my next blog post, I’ll share safe, natural solutions that can help you maintain healthy cholesterol levels.

C-reactive protein (CRP) is a little-known marker of heart disease 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. CRP can be detected when there is inflammation resulting from trauma or infection.

Let’s look at some study results:

• A 1985 Finnish study found that half of patients with coronary heart disease had high levels of an antibody known as C-reactive protein, compared with only 17 percent of healthy controls.
• 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.
• In healthy postmenopausal women with levels of C-reactive protein and 11 other substances, the one-fourth with the highest C-reactive protein levels were 4.4 times more likely to have had a heart attack or other cardiovascular problems than the one-fourth with the lowest levels.

I encourage all of my patients to have their C-reactive protein levels checked annually.

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.

Lipoprotein(a), or Lp(a), is a component of LDL or “bad” cholesterol. LDL cholesterol levels that are too high can lead to cardiovascular problems and thus increase your risk of heart disease. Many factors influence blood levels of Lp(a).

According to an article in a 1997 Journal of the American Medical Association (JAMA), Lp(a) appears to regulate clot formation (thrombosis) and inhibit blood thinning. We know that Lp(a) increases in unstable diabetics and menopausal women with elevated levels due to lowered estrogen levels. This may be why the incidence of cardiovascular problems among menopausal women quadruples.

Conversely, Lp(a) decreases with estrogen replacement therapy. For this reason, it’s imperative that all menopausal and perimenopausal women with a strong family history of heart disease and other cardiovascular problems have their Lp(a) levels checked by their doctor. Further, post-menopausal women with multiple risk factors for heart disease should consider natural, topical estrogen replacement therapy, particularly if their Lp(a) is elevated.

Research shows that elevated Lp(a) levels appear to be even stronger predictors for the development of premature heart disease in men. JAMA reported a study of 2,191 men, ages 20 to 54, confirming this.

 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.

Lipoprotein(a), or Lp(a), is a component of LDL or “bad” cholesterol. LDL cholesterol levels that are too high can lead to cardiovascular problems and thus increase your risk of heart disease. Many factors influence blood levels of Lp(a).

According to an article in a 1997 Journal of the American Medical Association (JAMA), Lp(a) appears to regulate clot formation (thrombosis) and inhibit blood thinning. We know that Lp(a) increases in unstable diabetics and menopausal women with elevated levels due to lowered estrogen levels. This may be why the incidence of cardiovascular problems among menopausal women quadruples.

Conversely, Lp(a) decreases with estrogen replacement therapy. For this reason, it’s imperative that all menopausal and perimenopausal women with a strong family history of heart disease and other cardiovascular problems have their Lp(a) levels checked by their doctor. Further, post-menopausal women with multiple risk factors for heart disease should consider natural, topical estrogen replacement therapy, particularly if their Lp(a) is elevated.

Research shows that elevated Lp(a) levels appear to be even stronger predictors for the development of premature heart disease in men. JAMA reported a study of 2,191 men, ages 20 to 54, confirming this.

C-reactive protein (CRP) is a little-known marker of heart disease 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. CRP can be detected when there is inflammation resulting from trauma or infection.

Let’s look at some study results:

• A 1985 Finnish study found that half of patients with coronary heart disease had high levels of an antibody known as C-reactive protein, compared with only 17 percent of healthy controls.
• 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.
• In healthy postmenopausal women with levels of C-reactive protein and 11 other substances, the one-fourth with the highest C-reactive protein levels were 4.4 times more likely to have had a heart attack or other cardiovascular problems than the one-fourth with the lowest 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.

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.