Holistic Health Practitioner

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.

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.

• Age 55 or older
• Heredity/family history
• Men
• History of heart attack and/or stroke
• Medical conditions such as diabetes, high blood pressure levels, vascular disease, atrial fibrillation, and sickle cell anemia
• Drug/alcohol abuse
• Poor diet
• Sedentary lifestyle
• Living in the southeast US (“stroke belt”)
• Low socioeconomic status

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.

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.

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.

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.

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.

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

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

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

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

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

When Should You Get Your Homocysteine Tested?

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

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

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

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

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

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

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

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

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

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

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

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

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

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

How Yolan Chose To Prevent Blood Clots

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

On the Road with Dr. Sinatra - November 2009

I am lucky to travel the country with Dr Sinatra, and it always excites me to watch and listen while he lectures, whether he has an audience of MDs, NDs, allied health professionals, or subscribers. But what really warms my heart is sitting “in the bleachers” as my husband speaks to eager students about integrated medicine. They totally “get” that blending the best of both worlds is where it’s at.

Traditional medicine reigns supreme for emergency, surgical, and urgent medical situations: it’s both a science and an art form that takes years to learn and lots of compassion to do well. But when it comes to helping folks with the host of chronic diseases we now recognize, less mainstream professionals—like highly trained naturopaths (NDs), acupuncturists, holistic dentists, and energy workers—are very important players to include.

Dr. Sinatra has a vision. He is investing in our youth: our doctors of the future. It’s his belief that it is critical to send the message about integrated medical approaches to graduate students even before they select their future professions, as well as to medical students before their education becomes totally influenced by “Big Pharma.”

My husband has addressed students at the University of Connecticut Medical School, where he is assistant professor; at Albany Medical School, where he is an alumnus and serves on the Dean’s Council; and at Bastyr University, where his son Drew and our daughter-in-law Briana trained as NDs.

Thanks to Dr. Harry Preuss, this past week Dr Sinatra brought his enthusiasm for integrated medicine to Georgetown University, where he encouraged graduate students to consider doing research into integrative approaches and working from this new and promising paradigm. He motivated those thinking of medical school to be part of “the shift.” It was SO rewarding to feel their passion for learning, and for assuming the role of change agents for the future.

These past years, Dr. Sinatra has also been busy behind the scenes coordinating a summer program for which some MD students from Albany Med and UConn attend a month long course on CAM (Complementary and Alternative Medicine) at Bastyr University, where he is one of the guest speakers. 

Dr Sinatra also figures that if Albany Med students can get an MD/PhD in six years, then why not create a program to earn an ND/MD within the same time frame? Sound far out? I am his biggest skeptic, but believe it or not, his small efforts have been gaining momentum.

Next year, students from Georgetown will be invited to join the summer CAM program. Dr. Sinatra feels so strongly that the “doctor of the future” will be a specialist in integrated approaches that he continues put up scholarship money for students who want to attend the summer CAM programs at Bastyr, and is “lobbying” with these schools to develop an MD/ND program.  

For updates on this mission of his, or to watch some live video of, check out www.heartmdinstitute.com. To catch a younger Dr. Sinatra being interviewed about the future of healthcare visit http://www.youtube.com/watch?v=Bygt63qsQvU.