Heart Risk Factors

Combat Insulin Resistance

Wednesday, June 23, 2010 by Stephen Sinatra

Insulin resistance, a precursor to type 2 diabetes, can lead to weight gain and high blood pressure levels.

It’s a complex of factors that results from eating too many refined sugars and carbohydrates (white bread, white rice, cookies, etc.). These foods cause insulin to be secreted in high amounts; and when too much of this hormone circulates in the blood for too long, specialized receptor cells for insulin eventually shut down and refuse it entry. At this point, your body has trouble processing blood sugar. This is insulin resistance.

Fortunately, by adhering to healthy cardiovascular nutrition and support from the right nutritional supplements, the receptor cells will come around and start to open their doors to insulin again. Improvement in insulin receptivity will favorably affect metabolic mediators that in turn will make it easier to control high blood pressure and avoid other cardiovascular problems.

Supplements that can help include:

Grapeseed extract (100–200 mg/day)
Maitake mushroom extract (15–20 drops of Griffon Maitake D-Frac Liquid, three times/day)
Coenzyme Q10 (200–400 mg/day)
Chromium polynicotinate (200 mcg/day)
Coleus (50–100 mg/day in divided doses)
Cinnamon (1/2 teaspoon in oatmeal)

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

Control High Blood Pressure Naturally

Wednesday, June 16, 2010 by Stephen Sinatra

Most doctors and holistic health practitioners will tell you that lowering blood pressure naturally is possible. But it takes a few changes in lifestyle, good cardiovascular nutrition, and the use of targeted nutritional supplements.

It also requires a total commitment, and I do my utmost to support every patient who chooses to go this route. In fact, my belief in a non-pharmacological approach to controlling blood pressure levels is so strong that I wrote a book (Lower Your Blood Pressure in Eight Weeks) about lowering blood pressure naturally.

If you have high blood pressure levels, you’ve undoubtedly been advised to evaluate your lifestyle and start exercising. You may have been told to consider psychotherapy to explore unexpressed or unrecognized emotions like anger, fear, and anxiety. I have written and will continue to write about these topics because they’re essential to lowering blood pressure levels, as well as healing from heart attack and strokes, and almost any other illness.

For more information on natural ways to lower your blood pressure, visit www.drsinatra.com.

Cardiology Terminology: Lp(a)

Tuesday, June 15, 2010 by Jan Sinatra

Lately, Dr. Sinatra has been getting a lot of questions about the very small, dense, and highly inflammatory cholesterol particle known as lipoprotein(a)—or Lp(a) for short.

Good questions! Dr. Sinatra is one cardiologist who just doesn’t think that total cholesterol levels are the evil culprits behind cardiovascular problems that they have been made out to be. In fact, he believes that it is high time we switch the heart disease prevention paradigm from total cholesterol to Lp(a). There are too many folks with normal cholesterol levels having heart attacks not to believe that something is amiss.

But before we discuss ways to lower or prevent high Lp(a) levels, you must first know what you are up against.

Lp(a) is small, dense, highly inflammatory sub-fraction of a cholesterol particle and is made in the liver. Dr. Sinatra believes that it is so dangerous, it should be listed as a specific risk factor for heart disease—instead of total cholesterol.

While we know a lot about what it does in terms of how it affects the body, we are still in the theoretical stages in terms of how Lp(a) is metabolized and all of its physiological functions. So, here is what we’ve got on it to date:

Because of its small dense properties, Lp(a) has been shown to contribute to atherosclerosis;
Your Lp(a) level is often hereditary, with DNA determinants;
Lp(a) is thought to have something to do with coagulation and clot formation;
It can help with wound healing because of its ability to turn on inflammatory reactions; and
At high levels, it can promote excessive inflammation.

In short, Lp(a)’s characteristics include:

small—it can easily sneak in and permeate the cell wall and wreak havoc;
dense— like a stone that sinks to the bottom, it can pile up on the walls of your blood vessels; and
highly inflammatory—it is a provocative little monster.

Everyone should know what their Lp(a) level is, especially anyone with known heart disease. Anyone with a family history of heart disease should also know, since Lp(a) blood levels are inheritable, and its production is controlled by a specific gene (an apolipoprotein(a) gene on chromosome 6q26-27 to be specific). That’s why we see elevated Lp(a) levels run in families. Also, if you are of African-American or some European heritages, you may be more at risk.

Lp(a) levels can range from 0.2 to 200, and because folks with very low Lp(a)s appear to be quite healthy, whatever its functions, they are not thought to be critical. Dr. Sinatra likes to see levels less than 35 nmol/l, according to the Quest Diagnostics standards he usually sees.

Here are the usual parameters, depending on how your lab expresses this level:

Desirable: < 14 mg/dL (< 35 nmol/l)
Borderline risk: 14 - 30 mg/dL (35 - 75 nmol/l)
High risk: 31 - 50 mg/dL (75 - 125 nmol/l)
Very high risk: > 50 mg/dL (> 125 nmol/l)

Should you find your Lp(a) elevated, then you need take action. Later this week, I’ll tell you the most effective natural ways to reduce or even prevent Lp(a) cholesterol.

For more information on cholesterol guidelines and other cardiovascular problems, visit www.drsinatra.com.

Natural Ways to Lower Blood Pressure

Monday, June 14, 2010 by Stephen Sinatra

It’s estimated that 60 million Americans need to control high blood pressure, making this condition the No. 1 concern of cardiologists and internists today. Only about two-thirds of the people who know they have high blood pressure have it under fair control, usually with drug therapy.

Despite lifestyle modifications and drugs, many people’s high blood pressure levels remain uncontrolled. And uncontrolled high blood pressure (known medically as hypertension) is a leading risk factor for both heart attack and stroke, with women even more vulnerable to its ravages than men.

One of the most common consultations I see in my office is someone with high blood pressure levels who can’t tolerate the side effects of prescription drugs or who just doesn’t want to risk taking drugs. I can’t blame them: The fourth leading cause of death in the U.S. is properly prescribed drugs in a hospital environment.

Anti-hypertensive medications can control high blood pressure levels, but at a high cost in terms of side effects and increased risk of other diseases. However, some patients need pharmacological agents, especially those whose hearts and daily life are highly compromised.

There are natural ways to lower blood pressure. They involve good cardiovascular nutrition, as well as simple lifestyle modifications and targeted supplementation. Lowering blood pressure naturally is possible, but it takes commitment and the willingness to make some changes.

For more information on natural ways to lower blood pressure and good cardiovascular nutrition, visit www.drsinatra.com.

Serum Ferritin (Iron) and Heart Disease

Friday, June 11, 2010 by Stephen Sinatra

Serum ferritin, better known as iron, is vital to human life because it stimulates the production of hemoglobin, the red blood cell pigment that carries oxygen to our cells. Without it, we couldn’t survive. However, research suggests that iron overload, or hemachromatosis, is a heart risk factor. Hemachromatosis is an acquired or hereditary defect of iron metabolism in which excess iron is deposited in tissues and not available for oxygen transport. Unless iron is lost through menstruation or donating blood, over the years toxic levels can accumulate in your system.

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.

Women and Iron

Half of American women will die of cardiovascular problems, including 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.

If you are a postmenopausal woman, please be sure to have your doctor or holistic health practitioner check your iron level on a regular basis. This is as important as maintaining healthy cholesterol, healthy triglycerides and health blood pressure when it comes to ensuring your wellness.

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

Healthy Heart Nutrition Does Not Include Sugar

Thursday, June 10, 2010 by Jan Sinatra

Why is it that the summer months conjure up images of cool sugary drinks enjoyed while lounging in the backyard or at a family picnic? As we embrace the lazy, hazy, crazy days of summer, most of us will fall prey to the temptation of easy-to-grab, ice-laden sugary drinks for cold refreshment. So, I just want to remind you: Whoa!

Consider results of research at Louisiana State University where 810 people with varying degrees of concerning blood pressure levels participated in an 18-month experiment to evaluate how exercise, weight loss, and diet would affect their blood pressure levels. They found that cutting back on sugar lowered blood pressure levels. High blood pressure is a risk factor for both heart attack and stroke, and even moderate reductions can lower that risk.

Study participants drank 10.5 ounces (a little less than a can) of a sugary drink every day at the beginning of the study, then cut back. Sugary drinks included soft drinks, lemonade, fruit punch, and fruit drinks sweetened with sugar or high fructose corn syrup.

The answer? Cut the sugar! Opt instead for mineral water sweetened with flavored stevia (I like Sweet Leaf) or Dr. Sinatra’s favorite, club soda with D-ribose and pureed raspberries…yum!

If you have any great, low-sugar or sugar-free cold summer drink alternatives, let us know!

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

Sugar Equals Poor Cardiovascular Nutrition

Thursday, June 10, 2010 by Jan Sinatra

Just this year, Dr. Sinatra wrote in his newsletter Heart, Health & Nutrition about a study from the Journal of the American Medical Association showing that diets high in added sugars raise the levels of blood fats and increase cardiovascular disease risk. Specifically, people who ate about 20 percent of their daily calories in the form of sweeteners of any kind were much more likely to have lower HDL good cholesterol levels and higher triglyceride levels.

In the study, Emory University researchers surveyed about 6,000 adults and determined that average sugar intake was 16 percent of daily calories—21.4 teaspoons, about 359 calories. These findings also support guidelines released last year by the American Heart Association recommending that men keep their daily intake of added sugars below 150 calories (10 tsp.) and women limit themselves to 100 calories (6 tsp.).

I found the study perhaps most interesting for what it didn’t say: that sweeteners contribute to higher blood viscosity, a major overlooked component of cardiovascular problems. Research shows sugar stokes inflammation and increases C-reactive protein (CRP), and the added calories also contribute to weight gain and abdominal body fat, in turn, generating more CRP.

An earlier 2001 Harvard study found ultra-high CRP levels among women who ate large amounts of high-glycemic carbohydrates (ones that break down into glucose more quickly), such as potatoes, cereals, white bread, muffins, and white rice. Those women also tended to be overweight. So go easy on the sugar and limit your intake of foods that contain added sugar. Your body, especially your heart, will thank you.

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

C-Reative Protein (CRP) and Your Heart

Wednesday, June 9, 2010 by Stephen Sinatra

C-reactive protein is a heart risk factor that the medical world has started to take note of. It’s a blood protein that, when found in elevated levels, may indicate a risk for 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 cardiovascular problems, 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 problem than the one-fourth with the lowest levels.

If you have cardiovascular problems or you’ve recently experienced a virus or urinary infection that could cause inflammation, have your doctor check your C-reactive protein levels. CRP can be detected when there is inflammation resulting from trauma or infection (including pneumonia, herpes, chlamydia, and possibly even a viral infection that simulates a cold). A simple blood test is as accurate as cholesterol and homocysteine screening in predicting a person’s risk of heart attack and stroke.

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

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.

The Connection Between Lipoprotein A and Heart Disease

Friday, June 4, 2010 by Stephen Sinatra

Lipoprotein A, or Lp(a), is a component of LDL or “bad” cholesterol and high levels of it in your blood can be a serious heart risk factor.

According to an article in the 1997 Journal of the American Medical Association (JAMA), Lp(a) appears to regulate clot formation (thrombosis) and inhibit blood thinning, which can lead to blood circulation problems.

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 heart disease 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 have their Lp(a) levels checked by their doctor. Further, postmenopausal women with multiple heart risk factors 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 confirming this.

Statin Drugs Will Not Reduce Lp(a)

Statins, drugs commonly prescribed to help you keep good cholesterol levels, are not effective for lowering Lp(a) levels. In fact, a study involving these drugs showed an increase in Lp(a) levels! And therein lies the dilemma.

While cholesterol-lowering drugs can reduce LDL, they can’t reduce Lp(a). If you find that a high Lp(a) level runs in your family, you must attack it with an alternative approach.

Here’s what I recommend:

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 and you can increase the dose to 500 mg a day, twice a day for further protection, or reduce it by no less than 100 mg daily if you have side effects. Twinlabs’ quick-acting Niacin is a good product.
Follow my Pan-Asian Modified Mediterranean (PAMM) diet.
Take 1–2grams of vitamin C and 100–200 mg of standard coenzyme Q10.
Take 1–2grams of fish oil daily.
Take 50mg of nattokinase twice a day.
Take 100mg of delta tocotrienols twice a day.
Exercise regularly.

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. And be aware of other heart disease risk factors, including smoking, high blood pressure, obesity, glucose intolerance, and repressed emotions, all of which can cause cardiovascular problems.

For more information on LDL cholesterol levels and ways to lower them, visit www.drsinatra.com.

Healthy Heart Nutrition: PAMM Diet Salad Recipes

Thursday, June 3, 2010 by Jan Sinatra

With the summer now upon us, what could be better than some delicious PAMM diet salad recipes!

The healthy heart nutrition recipes in this chapter feature Mediterranean flavors and include a few Japanese favorites—to produce great healthy heart meals. Every recipe is comprised of foods naturally rich in critical nutrients such as antioxidants, fiber, and essential fatty acids that help reduce the risk of heart disease and cardiac events. These foods have also proven to be the best for maintaining a healthy weight—better than following a low-fat diet.

Salad Niçoise, Dr. Sinatra-Style
(Makes 2 servings)
½ cup canned, unsalted or low sodium white beans, drained and rinsed
6 oz. cooked wild salmon (or 6 oz. canned low sodium salmon)
1 large egg, hard boiled and sliced
½ cup cherry tomatoes, halved
½ cup cooked green beans, cut in 2-inch pieces
1 Tbsp. olive oil
2 tsp. lemon juice
4 cups baby spinach or green leaf lettuce

Toss all ingredients except greens in a medium bowl. Serve on spinach or lettuce.

Summer Chicken and Rice Salad
(Makes 4 servings)

12 oz. boneless, skinless chicken breast halves (free-range, organic chicken is best)
1 cup green beans, cut into bite-sized pieces
2 cups brown rice and wild rice blend, cooked according to package directions and chilled
1 (14 oz.) jar artichoke hearts, drained and quartered
1 cup red cabbage, shredded
½ cup carrot, shredded
½ cup celery, diced
2 scallions, sliced
5 tablespoons vinaigrette

Brush chicken with the 2 tablespoons of your favorite vinaigrette.
Grill or broil chicken until tender and no longer pink, turning once halfway through cooking—approximately 12 to 15 minutes.
Cut chicken into thin strips.
While chicken is cooking, blanch green beans and cool in ice water; drain well.
In a large bowl, toss together green beans, cooked rice, artichoke hearts, cabbage, carrot, celery, and scallions.
Add 2 to 3 additional tablespoons of vinaigrette over rice mixture and toss gently to coat.
Serve rice mixture topped with chicken.

For more information on healthy heart nutrition, 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.

What To Do Before Opting For Heart Surgery

Friday, May 28, 2010 by Stephen Sinatra

In many cases, the decision to undergo heart surgery is easy—particularly if you are symptomatic with a lot of heart risk factors, you have left main coronary artery disease, and your quality of life is poor. But, if you are asymptomatic, the decision to have surgery may be a difficult one.

Consider Fred, a 56-year-old engineer who came to me several years ago for a second opinion. Fred’s doctor recommended that he undergo bypass surgery immediately. His angiogram indicated two coronary vessels were about 70 percent blocked, and his stress test revealed a small area of what cardiologists call ischemia. No doubt about it: His heart was vulnerable to an attack.

But Fred was satisfied with the quality of his life. He was not symptomatic and he wasn’t suffering from any known or unknown heart risk factors. He could walk three to four miles a day without experiencing symptoms of angina, such as shortness of breath, profuse sweating, or other symptoms of cardiovascular problems.

So I recommended that he delay surgery, take beta blockers and nitrates, switch to a diet that adheres to healthy heart nutrition guidelines, enrich the diet to include vitamins, minerals, amino acids, and coenzyme Q10—a key ingredient in my core nutritional program for healing cardiovascular problems. I also kept him on a walking program. I told Fred, “You have time. We don’t have to rush into surgery. Let’s see if these treatments eliminate the potential need for surgery.”

If, like Fred, you have documented cardiovascular problems but no symptoms and a good quality of life, I think you should consider the alternatives I’ve discussed before rushing into surgery.

Using Your Innate Healing Power

I strongly recommend delaying surgery until you have an opportunity to heal yourself. By that I mean trying alternative approaches to improving your heart health—whether it’s adhering to the healthy heart nutrition tips I’ve shared in this blog, incorporating exercise into your life, or taking nutritional supplements. The key is in being open to helping to heal yourself of the cardiovascular problems that plague you.

In addition, I urge you to take periodic stress tests and be aware of any unusual symptoms you may be experiencing. If the nuclear stress test shows improvement in your blood flow, then you should continue to put off the decision to have surgery. I can’t tell you how many of my patients have healed themselves of their cardiovascular problems, and have never had to have bypass surgery or angioplasty.

Whatever option you choose, I urge you to continue on the path to a healthy lifestyle—not only to help prevent cardiovascular problems but also to limit its progression. Unfortunately, I have had to recommend second surgeries to patients who considered angioplasty or bypass surgery an instant “cure” for their heart disease, only to return to an unhealthy lifestyle.

We physicians and holistic health practitioners do our best to offer options, prescribe medications, and perform surgery, but YOU, and only you, have the power to truly heal yourself and make the most of the “second chance” surgery gives you.

For more information on the path to a healthy heart, visit www.drsinatra.com.

Is Angioplasty Right For You?

Wednesday, May 26, 2010 by Stephen Sinatra

Angioplasty is the right treatment for people with high heart risk factors, and those whose cardiovascular problems involve just one or two blocked vessels.

The procedure has advanced to include the use of devices called stents, which are sheath devices placed in the coronary artery after balloon expansion to prevent reclosure and the return of poor blood circulation.

Stents hold promise for reducing the rate of thrombosis of arteries after angioplasty. With new stent placements, angioplasty has become a high-tech procedure, raising issues about the economic impact of the surgery itself. Both the long-term savings in reducing bypass and the long-term costs of untreated coronary disease make this approach a reasonable one.

I also suggest that if your cardiologist recommends angioplasty—or even a stent procedure—that you check his/her experience with this surgery. I recommend that if you do need angioplasty, have it done by a physician who performs the procedure at least five times a week.

For more advice on cardiovascular problems and what you can do 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.

Bypass Surgery Makes Sense for High-Risk Patients

Monday, May 24, 2010 by Stephen Sinatra

If you have high heart risk factors, you may need to opt for intervention.

Bypass surgery is probably the best option for you when many vessels are involved, or if your single or double-vessel disease is not amenable to angioplasty. In a nutshell, the greater the extent of heart disease, the more I lean toward bypass surgery.

But I want to stress that a bypass is rarely a “cure” for heart disease. It actually is an opportunity to alleviate your painful symptoms so you can begin to participate in your own care and take responsibility for healing yourself. You'll immediately want to control high blood pressure, maintain healthy triglycerides and healthy cholesterol, among other things.

The two most important criteria you and your cardiologist should use to decide whether bypass surgery is necessary are: whether it’s a quality-of-life issue and the condition of your coronary vessels.

In my next blog posting, we’ll discuss if angioplasty is right for treating your cardiovascular problems.

For more information on cardiovascular problems, 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.

On the Road with Dr. Sinatra

Tuesday, May 18, 2010 by Jan Sinatra

Dr. Sinatra’s book Earthing continues to generate buzz.

While Dr. Sinatra and I were at the American Academy of Anti-Aging in April, we were thrilled the cover of the Earthing book on the cover of the May issue of the Townsend Letter! The Townsend Letter, a highly respected journal for physicians and other healthcare providers, is devoted to alternative medicine.

For Dr. Sinatra, the honor of having co-authored a book cutting-edge enough to be the cover story at Townsend is comparable to a musician who “made the cover of Rolling Stone”—a triumph in his profession. In that same issue of the Townsend Letter, there is also an article about the “Awesome Foursome” in cardiology, a cardiovascular nutrition approach that has been discussed for some time in Dr. Sinatra’s books, as well as his monthly newsletter Heart, Health, and Nutrition.

So, the buzz about this groundbreaking book is building, and if you missed the sneak-preview discussions about the incredible health benefits of “earthing” or grounding in recent Heart, Health, and Nutrition newsletters, watch for two upcoming eLetters on the subject.

For those of you who want a jump start to read this paperback book, call 800.228.1507 to order your own copy.

For more "buzz" about Dr. Sinatra, 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.