Cardiovascular Risk and Pathology

Paul L. Reller L.Ac. / Last Updated: August 03, 2017

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Utilizing Complementary Medicine and Integrative Medical Approaches Effectively to Reduce Cardiovascular Risk and Treat Atherosclerosis and Recurrence of Stroke and Heart Attack

In 2014, experts at the Cedars-Sinai Heart Institute in Los Angeles, California, and the Brigham and Women's Hospital, in Boston, Massachusetts, U.S.A. released the findings of a large randomized controlled human clinical trial of traditional acupuncture stimulation for the adjunct or integrated treatment of ischemic heart disease. This study noted that patients receiving 3 treatments per week for 12 weeks improved significantly with measures of autonomic and vagal nervous systems function. This is just one of many studies being conducted that finally confirm the obvious benefits of TCM therapies for cardiovascular care. To see this study, click here: http://www.ncbi.nlm.nih.gov/pubmed/25103909 . Numerous studies of specific herbal chemicals are proving that this could be a valuable adjunct therapy as well. In 2014, research at the Fourth Military Medical University, in Xi'an, China found that the herbal chemical berberine from Coptis Chinensis, or Huang Lian, was effective to prevent myocardial ischemic reperfusion injury via modulating of various biochemical pathways, such as Bcl-2, Notch 1, Akt signaling, caspase and other improved mitochondrial function in heart muscle. To see this study, click here: http://www.ncbi.nlm.nih.gov/pubmed/25824534 . These are just 2 of many sound scientific studies that are proving that an array of treatment protocols in TCM, combined in clinical practice, are effective to prevent heart attack and cardiovascular disease. To see many of these studies, go to the section of this article entitled Additional Information.

The goal for many cardiovascular patients is to reduce risk of thrombosis, or formation of a blood clot, that is the leading cause of strokes. Atherosclerotic plaque on the inside of major arteries is highly associated with thrombosis, as well as stenosis, or narrowing of the artery. An emobolism is an obstruction or occlusion of an artery by a detached thrombus. When an atheroembolism, or large blood clot composed of atherosclerotic plaque, breaks off in the Aorta, or large central artery, or in the carotid artery, the obstruction, or occlusion of blood flow, to parts of the brain, causes destruction of some of the brain tissue. This is called a stroke, or if mild, a transitory ischemic attack (TIA). Much research has been accomplished to elucidate the exact mechanisms of formation of these atheroembolisms in the last 10 to 20 years. These modern findings are vitally important for the patient that tries to find the best way to reduce risk of stroke. We have come a long way from early assumptions that atherosclerotic plaque is composed mainly of cholesterol, and that lowering cholesterol will prevent atherosclerosis and stroke. An array of important cardioprotective and restorative benefits can be obtained from Complementary and Integrative Medicine and the specialty of Traditional Chinese Medicine (CIM/TCM) and short courses of frequent acupuncture with individualized protocols with herbal and nutrient medicine will provide the holistic protocol that is needed.

There are two main assumptions driving the standard treatment of atherosclerosis and atherembolism. One, that atherosclerotic plaque is caused by a simple high amount of cholesterol in the circulating blood. We have come a long way from this simplistic explanation. Two, that recurrence of atheroembolism in the distal aorta, which is the leading mechanism of strokes, is treatable by simply staying on anticoagulation and antiplatelet drugs. This also may not be true. When considering the need for more comprehensive complementary therapy to reduce risk of stroke and atherosclerosis, the patient needs to understand these two health mechanisms and make objective decisions on the best course of overall care. To repeat, the goals of therapy are, one, to reduce, reverse, or prevent atherosclerotic plaque, and two, to prevent the formation of embolism. These are the main causes of both strokes and heart attacks. Some patients may also need to explore other cardiovascular problems, such as sustained high blood pressure, weak or thin areas of the arteries, or problems with the heart muscle and valve tissues. Today, many progressive M.D.s, such as Dr. Andrew Weil, state that the scientific evidence and clinical data may show that herbal and nutrient medication will produce a better long-term outcome than the pharmaceuticals, and have none of the side effects and risks associated with treatment.

We now know that atherosclerotic plaque is formed by inflammatory injury to the inside of the artery. A new standard of risk assessment is the C-reactive protein (hsCRP), which indicates levels of arterial blood heat and inflammation. When chronic inflammation continues in the body, the system of repair of the arterial walls, via the inflammatory system, is not working properly. The body is not able to achieve the goal of the inflammatory process, which is to repair and replace old or injured tissue with healthy new tissue. Instead, inflammatory mediating chemicals and clotting agents build up on the artery wall and calcium deposits gather, causing further irritation. Behind this accumulation of inflammatory mediating immune cells, or macrophages, and collected calcium deposits, cholesterol that is being transported in the blood may accumulate. Around this accumulation is scar tissue, or fibrosis, and collagens. The most problematic portion of this accumulated plaque is the macrophages, which release nitric oxide and other toxins that contibute to tissue necrosis and debris. A number of factors play a role in this immune dysfunction.

One of these factors, or dysfunctions, that contribute to atherosclerotic plaque, are advanced glycosylation endproducts, or AGEs. While the term given to these metabolites sounds complicated, the dysfunction is actually rather simple. When our bodies process sugar, or carbohydrates, these sugar metabolites of course combine with other molecules, such as fats (lipids) and proteins (amino acid combinations). This is called glycosylation. Our diets are now composed of simple sugars, or carbohydrates, to a large extent. This is a rather modern phenomenon, and our bodies are still adapting to these processed simple sugars, or carbohydrates. The main type of these AGEs is called A1C, which is a sugar metabolite that is attached to hemoglobin protein in your red blood cells. Too much of this hemoglobin A1C is highly associated with diabetes, and this test is now an important test that the M.D. runs to check for diabetes. AGEs, or advanced glycosylation endproducts, are also highly associated with atherosclerosis, for three reasons. One, these sugar metabolites link with arterial lining cells, or lipoproteins, and what we call cholesterol, or LDL, and harden these cells. Hardening of the arteries occurs. Two, the AGEs react with receptors on the immune cells, and they produce too many inflammatory mediators and oxidants, or free radicals, which are highly associated with atherosclerosis. Three, AGEs also inhibit nitric oxide, a cellular chemical that is important in vasodilation, lowering blood pressure, and maintaining a healthy arterial lining. High AGE levels in your body, such as A1C, create atherosclerotic plaques independantly from diabetic states, according to recent scientific study.

Imbalances in the AGE receptor (RAGE) metabolism are highly associated with atherosclerosis. A number of factors create this imbalance. When there are excess AGEs over time, when there is insulin resistance, when there is chronic inflammatory dysfunction, and when there is high circulating glucose, even episodically, there may be too few circulating AGE receptors open (esRAGE), and an excess of total AGE receptors (sRAGE). This creates a thickening of the arterial lining over time, called hardening of the arteries, which is almost synonymous with atherosclerosis. Atherosclerosis does not cause symptoms, and goes unnoticed, until it becomes severe. The smart patient starts early in life and prevents this severe atherosclerotic plaque from becoming severe enough to cause stroke or heart attack. A comprehensive treatment protocol with Complementary Medicine will balance the AGE metabolism, control chronic inflammation, help the antioxidant metabolism, decrease arterial plaque accumulation, lower blood pressure, and help your body achieve improved health of the arterial linings and tissues of the heart.

Scientific study has found that a number of healthy nutritional supplements and herbal chemicals help to reduce AGE (advanced glycoylation endproducts). P5P, the active form of Vitamin B6, helps inhibit AGE formation and platelet clumping. Vitamin B1 thiamine, and the metabolite of thiamine, benfotiamine, both protect cells from excess AGE, and inhibit superoxide radicals and excess inflammatory mediators called nuclear factors (NFKbeta). There are many different antioxidants, and some of them are particularly effective in inhibiting AGE formation and accumulation. These include L-Carnosine, N-acetyl cysteine, and alpha-lipoic acid (ALA). Of course, dietary changes, such as eating less simple carbohydrates, or refined foods, and more real whole grains, fresh vegetables and whole beans and legumes, will also help. Herbs have been well studied and various medicinal herbs have been shown to reduce AGE and arterial plaque accumulation, aid healthy sugar metabolism, improve inflammatory function, lower blood pressure, and provide antioxidant chemicals. Unlike pharmaceutical medications, herbal formulas contain many chemicals that work synergistically to provide a complete and holistic treatment.

Atherosclerotic plaque begins to build up on the endothelial lining of arteries when pro-inflammatory mediators create adhesion molecules that adhere monocytes to the arterial wall. A number of factors stress the arterial wall and stimulate inflammatory mediators, including sustained high blood pressure, stress, and modified low density lipoproteins (LDL). A number of Chinese herbs have now been proven effective in decreasing atherosclerotic plaque by inhibiting specific pro-inflammatory mediators, such as tumor necrosis factor alpha. The most studied in this regard is the herb Huang lian (Coptis chinensis), which contains berberine, and a number of formulas that contain this herb have now undergone clinical trials and have been proven effective. TNFalpha also increases reactive oxygen species, which is a major cause of vascular inflammation, and the reason that antioxidants are important in the reversal of atherosclerosis. As research progresses, professional herbal formulas are modified to deliver the most proven combination of herbal chemicals to achieve the goal of preventing and reducing atheroscleritic plaque and promoting healthy arterial linings. Drugs in standard medicine do not achieve these goals, and thus integration of professional herbal formulas, specific nutrient medicines, and acupuncture are important if your goal is actual restoration of healthy arteries to decrease cardiovascular risk. In time, these regimens may create arterial health, normalize blood pressure, reduce stress, stimulate healthier immune response, and promote better metabolic balance, reducing the need for long term use of pharmaceuticals.

Maintenance of the vascular endothelial lining is very important in reducing cardiovascular risk and atherosclerosis as well. As stated above, research in Taiwan in 2012 showed that the level of endothelial progenitor cells (EPCs) in circulation is integral to healthy maintenance of the vascular walls, and that Metabolic Syndrome, fatty tissue accumulation in the liver, and insulin resistance are factors shown to decrease the levels and function of EPCs. Herbal formulas to address liver health and function, changes in the diet, especially avoidance of high-fructose corn syrup and trans-fats, use of D-chiro inositol, and other herbal medicines are now proven to improve fatty liver, decrease insulin resistance at the fat cell, and resolve Metabolic Syndrome. To learn more about Metabolic Syndrome, go to the web article on this website entitled Metabolic Syndrome.

Directly treating the formation and accumulation of atherothrombi with safe and effective herbal and nutrient medicines is now proven effective

Research has uncovered a number of effective anti-thrombotic treatments that are safe and effective in Complementary Medicine. Enzymes are proteins that regulate the rate of our physiological processes, and certain enzymes are now proven to help break up atherothrombi, or clot accumulation on the inside of unhealthy blood vessels. Nattokinase and serratiopeptidase are two of these natural enzymes that have passed human clinical trials and shown to be both safe and effective to break up unwanted clots, fibrins, and atherothrombi. These potent enzymes should be prescribed professionally, though, with individualized attention to dosage and the patient cardiovascular history. With patients at risk of cerebral blood vessel damage and microbleeds, taking too much anti-clotting medicine can be as much a risk as taking too little, especially when aspirin is taken daily. We have taken the question of daily aspirin therapy as a sensible and safe therapy to prevent atherothrombi too lightly. As far back as 1993, large studies have indicated that daily aspirin use, even at a low dose, comes with considerable adverse effects. A study by Monash University in Prahran, Victoria, Australia in 1993 (Clin Pharm 1993;(54), 84-89), followed 400 patients on low-dose aspirin, and found that in a randomized, placebo-controlled human trial, there were significantly higher rates of gastrointestinal symptoms, bleeding, and decreases in hemoglobin. This signified that aspirin was negatively affecting the body's ability to maintain tissue respair and health, and increasing the risk of bleeding, including cerebral microbleeds. Large studies even predating this were conducted in Great Britain in 1988, showing that while low-dose aspirin could reduce the incidence of fatal strokes, that the evidence of overall benefit greater than risk was not evident. The use of aspirin was finally promoted purely as a safer treatment for many patients without risk of cerebral bleeding than anti-platelet medications as a prophylactic treatment.

What has been overlooked in the preventive therapy for atherothrombi are the proper treatment protocols with professional herbal and nutrient medicine. A study at the Chungchou Institute of Technology in Changhua, Taiwan, in 2009, studied 47 patients with high lipids, comparing the effects of placebo to nattokinase 50 mg, and nattokinase combined with Red Yeast Rice extract. The patients receiving this combination therapy reduced triglycerides by 15%, total cholesterol by 25%, low density lipoprotein cholesterol (LDL-C) by 41%, and increased the high density lipoprotein by 7.5%. These levels were achieved in the first month and sustained for the trial during 6 months time. The added benefits would occur with decrease in atherothrombi and fibrins with nattokinase, and the potential of effecting long-lasting benefits that would be sustained without supplements. Addition of Chinese herbal formulas to the treatment protocol may enhance these effects as well, without risk of adverse effects. A 2010 study at Guangzhou University of Chinese Medicine, and China, studied the effects of two common herbs included in cardiovascular formulas, Dang gui and Hong hua, and found that both exhibited antithrombotic effects in animal studies, but when given concurrently with the drug clopidogrel, did not increase the specific effects of this drug. An array of Chinese herbs have now demonstrated antithrombotic effects, and a number of studies are cited below in additional information with links describing these findings. The combination of proven nutrient medications with Chinese herbal formulas can no longer be doubted.

Understanding the physiology of atherosclerosis and reversing this process over time

There is perhaps no more important issue in preventive medicine than atherosclerosis, but we continue to see little effort to reduce this problem holistically, despite the wealth of scientific evidence confirming the efficacy of key herbs and nutrient medicines. It is estimated that one in four Americans are affected by atherosclerosis, and this causes approximately 42% of all deaths. About half of these deaths are due to atherosclerotic plaque affecting the heart and coronary arteries. Many other deaths related to atherosclerosis affect the brain, where strokes occur when arterial plaque breaks off, or when arteries in the brain become unhealthy. Atherosclerois is the hardening of arterial walls and decrease of the potential flow of arterial blood through both inflexiblity of the vessels and stenosis, or narrowing due to plaque accumulation. Consequences of atherosclerotic plaque accumulation include obstruction of small arteries, formation of thrombi on roughened arterial plaque, hemorrhage of the artery under the atherosclerotic plaque, breaking off of the plaque deposit and creating an obstruction of blood flow downstream, and encroachment of the plaque into the arterial wall, causing a weak spot, and aneurysm. The goal of therapy should not be just to block cholesterol production and lower blood pressure, but to actually decrease atherosclerotic plaque and repair and maintain healthy blood vessels.

Standard medicine has created a culture of denial with regards to atherosclerosis and cardiovascular maintenance. The widespread belief that simply taking statin drugs to reduce cholesterol and anti-hypertensive drugs to control blood pressure, perhaps adding baby aspirin, is enough to reverse the widespread problem of atherosclerotic plaque accumulation has led us to a state of denial overall. The use of stents when the atherosclerosis becomes problematic seems logical, but numerous studies have shown this treatment to be ineffective in the long run. We need to integrate Complementary Medicine to truly reduce the widespread phenomenon of atherosclerosis that contributes to such a great number of strokes, heart attacks and cardiovascular deaths in our society.

A sensible approach by the patient involves restoring healthy tissue to these arteries, as well as the muscles and valves of the heart. As stated, one way that our poor diets have contributed to this hardening of the arteries is through advanced glycosylation endproducts (AGEs), which gradually accumulate when circulating sugars and high oxidative stress combine. Another way is when red meat consumption becomes too much a part of our diet, producing an excess of unhealthy essential fatty acids, namely arachidonic acids, which are not offset by healthy omega-3 and omega-6 fatty acids. While we are led to believe that all of our omega-3 fatty acids are gotten from fish oil capsules, the truth is that many foods contain these healthy essential fatty acids, and supplements, as their name implies, are only meant to supplement our normal intake via a healthy diet. Currently, the subject of omega-3 fatty acids is not being made clear to the patient, though, and a profit driven approach is contributing to fatty acid imbalance in many patients. The important aspect of essential fatty acid balance in our bodies is the word balance. When there is a chronic imbalance of excess omega-6 arachidonic acid, increased omega-3 acids, especially EPA and DHA, may be needed, but many patient concurrently minimize red meat consumption and take omega-3 supplement, which may throw the balance in the other direction. This too may create problems with inflammatory regulation. A more extensive article on omega-3 fatty acid metabolism is found on this website. Our diet should also contain healthy and effective antioxidants, of which there are a wide variety. Deficient consumption of antioxidant chemicals also plays a part in formation of atherosclerotic plaque, particularly when poor health, overwork, tissue injury, or emotional problems cause an excess of harmful oxidants, or free radicals. These free radical, or oxidant, producing factors are called stress.

One result of these physical stressors, besides formation of excess free radical oxidants, is a chronic adrenal stress syndrome. The adrenal glands are part of the kidneys and constantly respond with hormonal regulators to protect and restore metabolic balance. When chronic stress produces adrenal dysfunction, one of these hormonal regulators, cortisol, is not produced efficiently to maintain the health. The slow adrenal responses mean that not enough cortisol is produced at one time of the day, and subsequently, an excess is produced later. Excess cortisol accelerates atherosclerosis by increasing high blood pressure, insulin resistance, and increasing fatty accumulation in the organs, especially the liver, which controls both inflammatory mediators and cholesterol regulation. Cortisol imbalance may also contribute to thyroid deficiency, hypothalamic deficiency, and overall hormone imbalance. When estrogen and progesterone deficiency occurs, the lack of estrogens, and the estrogen progesterone imbalance, reduces the ability of your body to decrease atherosclerotic plaque accumulation. Estrogen has been shown to contribute a potent antioxidant effect in cardiovascular tissue, as well as the liver and uterus. Progesterone has been shown to present a significant antioxidant effect in brain tissue. Relative excess of testosterone has been shown to decrease antioxidant effects of superoxide dismutase, leading to increased lipid peroxidation. To protect yourself and restore all of the factors that contribute to atherosclerosis, holistic approach to hormonal and metabolic balance is necessary. There is no simple solution.

How does the body try to decrease this accumulated atherosclerotic plaque? Phagocytosis is the term used to describe the body's attempt to clear the atherosclerotic plaque. This phagocytosis is impaired by oxidative stress. The low density lipoproteins (LDL) that accumulate are oxidized LDL. Oxidized blood cells need to be reduced, including oxysterols, and antioxidants are created by your body to reduce them. There are so many types of antioxidant chemicals in the body that we are still discovering new ones. Not only antioxidant chemicals in your diet, but also your ability to produce antioxidants is important. A number of effective antioxidants and antioxidant building blocks are now used in nutrient medicine. Alpha-lipoic acid, N-acetyl-cysteine, and L-carnosine have been mentioned and proven effective in scientific study. Co-Q10 is a powerful antioxidant that is often deficient in our body and proven effective to decrease atherosclerosis with antioxidant activity. Atherosclerotic plaque also contains certain proteins and peptides that increase irritating nitric oxide and other irritants. Some of these proteins are even associated with the cellular plaque deposits noted with Alzheimers, namely amyloid precursor protein and beta-amyloid peptide. These unhealthy protein accumulations need to be cleared just like the free radicals, or excess oxidants. The body uses proteolytic enzymes to clear these problematic proteins and parts of proteins, which are called peptides. Nutrient medicine also utilizes effective proteolytic enzymes in therapy, and high quality antioxidants and proteolytic enzymes are a key part of the overall treatment protocol. Nattokinase and serratiopeptidase are two proteolytic enzymes discovered that are especially effective.

In addition of antioxidants and proteolytic enzymes, a number of herbs have been thoroughly studied and proven to benefit the reduction of atherosclerotic plaque accumulation. Well known herbs, such as aged garlic, are widely used by the public now, but Chinese research has found evidence to support the use of a number of herbs to reduce atherosclerotic plaque, utilized in a formula of synergistic herbs. Not only choice of the herbs, but also quality and professional production methods are important. In an unregulated industry, many companies fail to process and select the herbs properly, reducing or nullifying their effects. A professional herbalist looks into quality and selection to insure success. Besides herbal formulas and tinctures, and antioxidants and proteolytic enzymes, key essential fatty acids help the body to regulate inflammatory processes better and are highly recommended in the treatment protocols around the world. The essential fatty acids EPA and DHA were discovered when researchers found that people native to the arctic regions had almost no incidence of cardiovascular disease. They found that these essential fatty acids were a big part of their diet, consumed in fresh ocean fish. Vegans may increase the EPA and DHA by taking dried powders of the blue-green algaes, such as chlorella and spirulina, or may focus on the balance of omega-6 and omega-3 essential fatty acids by consuming ALA, GLA, and CLA. Balance of essential fatty acids in the body should be the goal, and this needs to analyzed individually and intelligently. Simply following the one-size-fits-all advice of advertising and standard medicine with regards to nutritional medicine is not the best course. Herbal and nutrient medicine is a complex science.

In addition to these strategies in cardiovascular maintenance, high levels of homocysteine in the body are now known to be an important key, or marker, to formation of large atheroembolisms, and herbal and nutrient therapy is effective to control this hyperhomocysteinemia, which indicates an imbalance of the glutathione metabolism of cellular detoxification and antioxidant clearing. Use of just one type of supplement may have limited benefit. A combination of these herbs and nutrients individually tailored to the patient may have a profound effect. Such information may be utilized by professional herbal and nutrient companies to create better products, and may now be easily researched by a knowledgeable professional herbalist, such as a Licensed Acupuncturist and herbalist.

While none of us wants to take a large number of nutrient supplements, it is important to keep in mind that a proper course of therapy will produce the results we need, eliminating the need for long-term use. Utilizing the right prescription of herbs and nutrients will achieve goals in health care quickly, and thus reduce the number of pills needed in the long run. Health maintenance after correction of the problem in cardiovascular care may involve healthy dietary and exercise habits, and the Complementary Medicine physician can advise the patient on the most efficient and individualized changes in this regard. Maintenance with Complementary Medicine may involve a periodic checkup and therapy, with advice to keep you on course. Compare this with the allopathic approach of staying on pharmaceutical medicines forever with increasing side effects, and potentially decreasing overall health. The decision for many is to utilize Complementary Medicine and work with your medical doctor to decrease chemical dependancy and improve overall health to achieve a preventative state.

Quality of herbs and nutrients is essential to effective therapy, and this cannot be emphasized enough. For example, researchers found that certain types of aged garlic, such as Moascus pilosus, that was properly fermented in aging, was potently effective in inhibiting atherosclerotic plaque, while standard commercial powders were often ineffective. This quality aged garlic had a number of beneficial effects, reducing triglycerides and LDL-C, antioxidant effects, inhibiting free radicals and glycation endproducts, and significant reduction of thrombocyte and erythrocyte aggregation. While raw garlic had beneficial effects on artery dilation, it showed no effects on reducing LDL-C, or these other cardiovascular benefits. Numerous media articles and even television ads stated that garlic did not achieve these cardiovascular benefits, promoting pharmaceutical therapy instead. These nuances of professional herbal medicine are not easy for the public to keep track of, and hence, there is much confusion and purchase of products that do not work. The professional herbalist utilizes quality professional products and often does the research to insure that proven herbal remedies with quality herbs and nutrients are used in your care. This type of research evidence is now widespread as the popularity and proof of Complementary Medicine expands exponentially. This area of scientific research may be confusing to the lay person, and when one reads that a study found that garlic is ineffective in reducing cardiovascular risk, few people look to see whether they were testing raw garlic or aged Moascus pilosus variety. To be certain of the health facts, consult with a knowledgeable professional.

A Healthy Diet is proven to dramatically reduce cardiovascular risk, even more than standard pharmaceutical therapy

A February 2013 posting on the website of the prestigious New England Journal of Medicinereported the findings of the first major clinical trial to measure the effects of diet on reduction of cardiovascular risk, and these findings startled experts. This study found that for patients age 55 to 80, eating what is called The Mediterranean Diet with healthy fats reduced the risk of cardiovascular disease and death by about 30 percent compared to patients on a standardly recommended low-fat diet. The New York Times, in a February 25, 2013 article entitled Mediterranean Diet Can Cut Heart Disease, Study Finds, quoted Dr. Rachel Johnson, spokesperson for the American Heart Association and professor of nutrition at the University of Vermont: "Really impressive, and the really important thing - the coolest thing - is that they used very meaningful end points. They did not look at risk factors like cholesterol or hypertension or weight. They looked at heart attacks and strokes and death. At the end of the day, this is what really matters." This echoes a growing concern that for too long standard medicine has defined cardiovascular risk only by the reduction of these factors for which the pharmacological products were prescribed, creating a false presentation to the public. This study was a large cohort investigation utilizing 18 M.D. experts brought together for the PREDIMED Study in Spain, and following 7447 patients. This large cohort study followed both patients prescribed standard cardiovascular drugs and those not on medication, and found similar benefits in both groups.

The Mediterranean Diet is inspired by the traditional diets of Spain, Greece and Southern Italy, and emphasizes a proportionally high consumption of healthy plant-based oils and fats, vegetables, whole grains, legumes, and fruits, compared to a moderate consumption of fresh fish, dairy, and wine, and a relatively low proportional consumption of red meat and meat products. In other words, a delicious and healthy diet of whole foods that is primarily plant-based, which has been the recommendation in Complementary Medicine for many decades. Numerous scientific studies have touted this dietary protocol in recent years, and a 2011 meta-analysis of 50 studies, including 35 clinical trials, and about 535,000 men and women, published in the Journal of the American College of Cardiology, found that this diet significantly prevented and treated Metabolic Syndrome. A 2012 study in Israel, published in the New England Journal of Medicine, found that even people who switched from a low-fat diet and gained a little weight when adopting the Mediterranean Diet derived lasting benefits from the change. The PREDIMED study in Spain found that even those patients instructed to consume 4 tablespoons a day of cold-pressed olive oil had this significant reduction of cardiovascular risk.

Other experts in the field of nutrition and cardiovascular disease cite a growing body of evidence that a vegan diet, with emphasis on even healthier fats than olive oil, can even reduce cardiovascular disease and Metabolic Syndrome more than the Mediterranean Diet. Former President Bill Clinton is one of the foremost proponents of this change to a vegan diet, spurred by research and the urging of his daughter Chelsea, who urged him to finally do all that he could to preserve his health as he aged, and achieve a healthy longevity. President Clinton credits Dr. Dean Ornish, a physician and president of the Preventive Medicine Research Institute in Sausalito, California, and Clinical Professor of Medicine at the University of California, San Francisco, for finally convincing him that he should adopt a healthy vegan diet. Dr. Cornish' program is so supported by human clinical trials and scientific studies that Medicare now covers it under the benefit category "intensive cardiac rehabilitation", which will pay for certified providers to administer a 72 hour training program for patients who have been diagnosed with cardiac disease. Dr. Cornish states that this proven program can treat and prevent cardiovascular disease without drugs or surgery.

Some facts to discuss with your cardiologist and/or Complementary Medicine physician

  • European health organizations now strongly recommend the use of fish oil, with inflammatory regulating essential fatty acids, to prevent future cardiovascular problems. The best fish oil is krill oil, high in EPA and DHA (omega 2 fatty acids), and containing a natural preservative to prevent the oxidative deterioration that occurs easily in other fish oils. A balance of omega 3 and 6 fatty acids is the important factor, though, for each individual, and a knowledgeable Complementary Medicine physician may help you to understand how to best create a better essential fatty acid balance geared to your individual diet and health profile. Studies have also demonstrated that with utilization of herbal products high in a variety of beneficial fatty acids, such as sea cucumber, a type of sea animal, plasma levels of total cholesterol, LDL-cholesterol, and atherogenic index were significantly decreased, while HDL-cholesterol was significantly increased, and excess liver production of triglycerides and phospholipids were prevented. A variety of treatment options is available in Complementary Medicine, and the experienced Licensed Acupuncturist and herbalist, as well as the experienced Naturopathic doctor, can individually tailor a protocol that is most effective.
  • European studies in 2005 found that pomegranate juice, with true OPCs and other essential chemicals, lowered the incidence of angina and chest pain following a heart attack by 50%. This was a dramatic finding. Now, pomegranate juice is acidic and may contain a high amount of fructose, and the taste is not to the liking of many patients. The highest concentration of these OPCs and antioxidants in pomegranate is found in the seed, rind and calix of the fruit, and a quality extract delivers these beneficial chemicals in a concentrated pill form. Pomegranex, a tablet form of pomegranate that avoids the sugars and acids, and includes the beneficial chemicals of the rind and calyx. These European studies also found that aspects of the diet may increase the incidence of angina and chest pain following a heart attack, and sound advice, individualized for each patient, concerning diet, may be very important in these circumstances.
  • Studies also confirm that aged garlic is very effective in decreasing plaque buildup that clogs arteries. Herbal products and formulas, such as AstraGarlic formula by Health Concerns, which combines beneficial herbs for the heart and cardiovascular health, as well as the immune response, with quality aged garlic, and dependable professional quality herbs, is an example of the type of utilization of this research one sees from the professional Licensed Acupuncturist and herbalist.
  • Numerous studies have found extreme differences in quality and quantity of ingredient chemicals in commercial herbal and nutrient supplements because of the lack of FDA oversight in this business. I guarantee that the products that I provide for you are of the highest quality and rigorously tested. The FDA is still being swayed by big money in the supplement industry to allow complete freedom to swindle you with commercial products. Use professional herbal and supplement products, and depend on me to keep track of this field.
  • Coumadin, or Warfarin, is the drug of choice to prevent future strokes and heart attacks. How does it work and what are the negative considerations? None of my patients seem to have this discussion with their cardiologist. It works by inhibiting Vitamin K, an important chemical in the body. It has numerous problems with drug interactions, and numerous conditions may alter its response in the body, leading to unwanted ill effects and fluctuations in the levels of platelets and clotting factors in the blood. Drug interactions that are harmful mainly occur because various drugs compete for the same enzyme actions in the liver that control the rate of the chemical entering the bloodstream. Various foods and a few herbs may also compete for these liver enzymes, but this danger is still largely theoretical, whereas drug interactions have been proven to alter the effects of coumadin in a dangerous way. Unwanted clotting responses from Coumadin/Warfarin may occur if the patient has elevated temperature, diarrhea, poor fat digestion, poor nutrition, congestive heart disorder, poor liver function, hepatitis, cancer, or vitamin K deficiency, or has a vascular collagen disease or a blood dyscrasia (low production of red blood cells). A list of drugs, foods and herbs that may negatively interact with Coumadin/Warfarin can be found in the prior section of this article, Problems with Current Pharmaceuticals and Cardiovascular Health. A 2006 study has confirmed that the decrease in risk is equal with taking of low-dose aspirin or coumadin, so you may want to discuss this safer option with your cardiologist.
  • Angioplasty: a rigorous 7 country study was completed in 2006, showing that patients receiving angioplasty fared worse than patients who took the drug regimen only. The National Heart, Lung and Blood Institute found that 17% of angioplasty patients had a recurrence of serious heart attack within 4 years, compared to 16% that relied only on drugs. The institute recommended that angioplasty only be used in the first 12 hours following heart attack. Attention to cardiovascular health by integrating Complementary Medicine could add much to the individual protocol to reverse atherosclerosis and risk of heart attack.
  • Studies of coumadin/warfarin use by doctors, such as those at the Washington University School of Medicine in St. Louis, Missouri, (published in Archives of Internal Medicine vol. 166, 2006), concluded that Alternative Medicine should be strongly recommended or considered in the treatment and prevention of irregular heartbeat and other heart and cardiovascular problems. A study of 1200 patients confirmed that risks and side effects from Coumadin/Warfarin long-term use were significant and that use of aspirin and other supplemental medicines were nearly as effective and had few side effects. The study found that long term use of warfarin was associated with osteoporotic fractures and other serious risks. These experts, like many across the world, recommended that anticoagulant medication be used only for short courses when needed.
  • Coumadin/Warfarin acts by inhibiting the Vitamin K in the body. Vitamin K is essential to activate clotting factors and bone proteins to maintain a healthy system of arterial repair and bone health. Coumadin/Warfarin levels may fluctuate with use, depending on diet and stress of the liver function, individual Vitamin K levels, and concurrent use of other drugs. Excess levels of Coumadin/Warfarin may cause serious problems. One of these potential problems in the aging population would be an increase in the risk of arterial bleeding in the brain. Head trauma from falls is a serious problem with the aging population, and deficient Vitamin K and clotting factors could increase the risk of subdural hematoma. Many patients also are shown now to have an intrinsic deficiency of Vitamin K, making coumadin therapy ineffective for these patients. By assuming that all patients are alike, standard cardiology is ignoring the potential problems in the individual, and creating a false sense of security.
  • Research has revealed a number of healthy herbs and supplements that help dissolve blood clots and thrombi. Nattokinase is a proteolytic enzyme derived from fermented soy (natto) that is proven to help dissolve blood clots and thrombi before they break off and contribute to a stroke (2006 study at the University of Michigan College of Pharmacy). Studies at the Hamamatsu University School of Medicine in Japan in 2003 showed that nattokinase suppressed arterial wall thickening (atherosclerosis) produced by arterial injury in laboratory animals, and enhanced thrombolysis, or the dissolution of thrombi, as well. For patients with a risk of arterial bleeding, high dosage of nattokinase may be contraindicated, especially used concurrantly with aspirin. Professional prescription suited to each individual insures safe and effective use of such nutrient and herbal medicines. Improper use and self-prescription of these potent herbs and supplements is not recommended for patients at risk. Licensed Acupuncturists and herbalists now have access to a growing amount of sound research presented by the U.S. NIH PubMed medical database with which to guide the use of evidence-based herbal therapy to both reduce the threat of clot and thrombus, and improve the health of the vascular lining, or endothelium. Some of these studies are presented below with links.
  • Study by such groups as the Erasmus University Medical Center Inspectorate of Health Care in the Netherlands (Archives of Internal Medicine, vol. 166, 2006), concluded that patients receiving corticosteroid medications had a significant increase in incidence of atrial fibrillation, or heart irregularity, which can be fatal, and is often the cause of a heart attack. Corticosteroids are used as asthma and respiratory medications, injections for pain, treatment for autoimmune and skin disorders, and other problems.
  • Aspirin works by binding to platelets and inhibiting their accumulation as unwanted clots and thromboses in the arteries. Unfortunately, long term use of aspirin has some serious ill effects on the stomach and intestinal linings and with inflammatory regulation. When the patient discontinues the aspirin, the risk of platelet aggregation may increase suddenly. It may be best to regulate the platelet and clotting factors in the body by helping the body to become healthier in this regard rather than to use synthetic or drug chemical blocking methods. Short term use of aspirin or other drugs while you improve your health is generally recommended to assure decreased risk. Long-term strategy may involve a comprehensive holistic treatment protocol. It is best to rely on a knowledgeable Complementary Medicine practitioner rather than to follow the advice of advertisements when trying to do what is best.
  • Studies such as those at McGill University in Quebec, Canada, and numerous studies at European Universities and medical schools, conclude that oxidative stress plays and important role in the development of cardiovascular disease, and recommended antioxidant compounds. Alpha-Lipoic Acid (ALA) has been found to be most effective in this regard. N-acetyl-cysteine, L-Carnosine, and Co-Q10 are also proven effective. The R isomer of this nutrient chemical, R-lipoic acid, has been found to be the form utilized by human cells, and thus a more bioactive version of ALA. Low doses of ALA are also found in spinach, broccoli, tomato, garden peas, brussel sprouts, and rice bran (highest to lowest concentrations). Taking ALA with these foods will increase its effectiveness and absorption. Green tea was also found to be effective as a preventative antioxidant in a large study on women's health and cardiovascular disease. Green teas contain catechins that suppress high triacyl and homocysteine conditions that are a significant risk factor for coronary heart disease, especially in the female population. Leantain, a formula with green tea extract and hoodia, is safe and effective, also helping to reduce excess appetite when taken properly, for those women wishing to reduce weight at well as reduce cardiovascular risk.
  • Studies such as those conducted by the University of Milan, Italy (Journal of Nutrition, vol. 134, 2004), showed that a diet containing soy proteins (tempeh and miso are recommended), nuts (walnuts and soaked almonds are recommended), plant sterols (beta-sitosterol and stigmasterol was found to decrease cholesterol absorption by over 40%, exerting a modulatory effect), and plant fibers (whole grains or fiber supplements etc.), with avoidance of trans-fats and reduction of excess saturated fats (red meat), was as effective in lowering cholesterol and C-reactive protein marker as was a statin-drug regimen. The American Heart Association and the USA National Cholesterol Education Program recommended this protocol. (Journal of Nutrition, vol. 134, 2004). Statin drugs have a high incidence of serious side effects that almost precluded their allowance on the market by the FDA when they were introduced, and an early form of statin, Baycol, was removed from the market due to these concerns. The most serious consideration is the accumulation of protein fragments in tissues that leads to chronic inflammatory painful conditions because of the inhibition of protein expression by the statins. While acute protein fragment accumulation (rhabdimylosis) is rarely seen, gradual accumulation with chronic use of statins is believed to be very common, and explains a gradual increase in muscle and joint pain. If you have this condition, new research has uncovered powerfully effective proteolytic enzymes to help the body clear this protein accumulation and decrease inflammatory problems (nattokinase and serratiopeptidase for example). Protein fragment inflammatory conditions may occur in the blood vessels and heart tissues as well as the joints and muscles. For most patients, this effect is gradual, and goes unnoticed and undiagnosed. Another potential problem is the blocking of healthy cholesterol production at the genetic level, which is one mechanism of statin drugs. Since cholesterol is the building block for a number of essential chemicals in the body, including bile, steroid hormones, and Vitamin D3 prohormone, the potential problems in degrading this healthy cholesterol metabolism are many. Other proven effective herbs and supplements to correct cholesterol and lipid imbalances are available, with niacin, gugulipid, omega 3 fatty acids, aerobic exercise, and weight loss all proving effective in dramatically boosting levels of healthy HDL. The most dramatic of these herbs and nutrients in research is the Red Rice Yeast extract (the original natural statin), but certain palm and citrus extracts (sytrinol) are also proven effective, as well as a variety of herbs and supplements, to achieve lowering of excess cholesterol and normalizing of the triglyceride metabolism. Your recent blood test analyses should be brought to the Complementary Medicine physician to create the right individualized treatment protocol. Other health problems common with statin use include peripheral neuropathy and other nerve pathology (published in the medical journal Neurology, May 14, 2002, vol. 58, by Dr. D. Gaist et al). ALSO: the Center for Clinical Cardiology and Research, Sartori Memorial Hospital, concluded from studies that drug therapies to lower total cholesterol and triglycerides did not have significant success without improving the diet, and diet control alone appears to significantly reduce these lipid levels, resulting in reduced need for medications (PMID: 8810649). The number of studies in standard medicine devoted to the subject of potential problems with utilizing standard cholesterol lowering drug regimens, and depending upon these protocols alone, indicates that this is not just a concern of so-called alternative medicine.
  • Vitamin B6 deficiency and homocysteine imbalance have been found to be significant possible causes of increased stroke and heart attack risk. High homocysteine levels are associated with B6, folic acid and B12 deficiencies. This is because high homocysteine is a marker for a deficient glutathione metabolism (refer to the article on glutathione balance on this website). Taking a B vitamin complex may not correct these problems. It is advisable to supplement with injections or sublingual B12, and take a folic acid (active form is 5MTFHF), as well as B6 (active form is P5P). Since vitamins store in the body as part of a healthy liver function, herbal formulas to aid liver function, along with acupuncture, could be very helpful to correct these deficiencies. Studies that lowered homocysteine levels did not succeed in lowering risk, but the HOPE-2 study showed a 25% reduction in stroke incidence with the taking of the above 3 vitamins. Since B12 absorption may be problematic, oral supplements may not have significant benefit, and a liquid B12 methylcobalamin is recommended for best absorption. Taking this combination of supplements, and ensuring the quality of product, within a comprehensive course of therapy, assures benefits.