Positive Health Online

In part one of this article I discussed how, despite decades of health advice to reduce saturated fat and cholesterol, heart disease is still the number one killer in the UK and a leading cause of death worldwide, ahead of AIDS and famine. This would suggest that a change of focus is required in the approach to this major health issue.

Heart disease doesn't just involve the heart but the whole circulatory system. This includes  the arteries and veins which, respectively, carry blood to and away from the heart. The three principles of heart disease are thicker blood containing clots, atherosclerosis (the blocking of the arteries with a deposit called atheroma - the Greek word for porridge!) and finally, arteriosclerosis (the 'hardening' of the arteries as they lose elasticity and flexibility).

The result is a heart attack if the blood supply to the heart is blocked, or a stroke if the blood supply to the brain is blocked. So, having exploded the cholesterol myth, what are the real causes of heart disease? The following factors should be taken into account and can be laboratory tested through a nutrition practitioner.

Oxidative Stress

Oxidation is a chemical reaction occurring continuously in the body. Breathing, digestion, the conversion of fat and carbohydrate into energy, and detoxification of harmful substances such as alcohol or drugs all involve oxidation. Oxidative stress occurs when potentially harmful free radicals outnumber the antioxidants which have the capacity to neutralize them. The heart and blood vessels are a major target for damage by free radicals produced by oxidation.[1] Factors leading to an imbalance between free radicals and protective antioxidants are lack of exercise, stress and insufficient fruit and vegetables in the diet.

In addition, when free radicals attack LDL cholesterol, it converts into the form that promotes atherosclerosis. It is cholesterol in this damaged, oxidized form that poses a threat rather than cholesterol per se. Damaged cholesterol is more difficult to clear from the arteries and injures the artery wall.

Elevated Fibrinogen

Fibrinogen is a protein in the blood involved in the clotting process. Elevated levels thicken the blood and causes excess clotting. In addition high fibrinogen promotes damage to the blood vessel wall by attaching itself to plaques.

Elevated Homocysteine

Homocysteine is a substance produced from dietary protein. If not metabolized, homocysteine builds up in the blood. It promotes clotting, the oxidation of cholesterol and artery damage and is probably a better predictor of cardiovascular disease than cholesterol. Vitamins B6, B12 and folic acid are known as methyl donors. This means they allow the vital process of methylation to take place, on which the metabolism of homocysteine is dependent. Low levels of these B vitamins lead to high homocysteine.

Inflammation

A substance in the blood called C-reactive protein (CRP) is a marker for inflammation and a predictor of cardiovascular problems. It is linked with damage to the delicate lining of the blood vessels (endothelium) and increased blood coagulation.

Insulin Imbalance

Metabolic Syndrome with associated abdominal obesity and high blood pressure is linked with a significantly increased risk of heart disease. The insulin dysregulation associated with this condition results in damage to blood vessels. Increased sugar consumption is likely to be a major factor in the development of insulin resistance whereby the cells become desensitised to insulin resulting in over production.

Stress

There is a link between stress and cholesterol, since cholesterol is the raw material for making stress hormones. So when we are stressed, cholesterol production will increase. Cholesterol will test high after stressful events such as surgery. Then it will decrease again. Stress also produces a high amount of free radicals which cause oxidative damage.

Nutrition Solutions

Foods

Research has shown that a diet rich in antioxidants, despite exposure to other cardiovascular risk factors such as dietary fat, is associated with lower incidences of cardiovascular events.[2] The richest dietary sources of antioxidants are fruit and vegetables.

Turmeric (Curcuma longa) is an extremely potent antioxidant, with the ability to significantly reduce oxidation of fat.[3] In one study[4] 20mg turmeric reduced high fibrinogen levels. After only 15 days, previously elevated levels of fibrinogen dropped dramatically in all eight subjects. No adverse effects were noted.

Include plenty of anti-inflammatory foods in the diet such as ginger (put a 1oz piece in a juicer with an orange, 2 carrots and 1 apple for a delicious and healthy drink), garlic, green juices and green vegetables.  Garlic also contains sulphur compounds which are important for cardiovascular health.

Onions, garlic, kale, French/runner beans and apples contain bioflavonoids which are anti-inflammatory, promote good blood circulation and strengthen capillaries. Hesperidin and rutin, two flavonoids which are very beneficial for varicose veins, are found in abundance in citrus fruits. Other flavonoids called catechins found in green tea, red wine, peaches and hawthorn berries are very protective to the heart.

Bitter foods, according to Chinese medicine, are very cleansing and supportive to the heart, digestive and circulatory systems e.g. endive, chicory, asparagus, artichoke, very dark chocolate with at least 70% cocoa solids, green tea.

Foods to minimize are refined carbohydrates, for example white bread or pasta, baked foods and refined cereals and replace with low glycaemic foods (which are mainly whole grain foods). This will help maintain balanced insulin levels.

Supplements

A review[5] involving 100,00 middle-aged and older people, found a clear reduction in cardiovascular disease associated with vitamin D levels. The much publicized low vitamin D levels amongst the general population, due to lack of sun exposure, is now of widespread concern. Oily fish is the best food source of vitamin D but often supplementation is necessary.

• Vitamin C forms collagen, the substance which give arteries their elasticity;
• Magnesium is important for the functioning of the heart muscle and for the cardiovascular system generally. It helps keep blood pressure at a healthy level;
• Calcium helps regulate the heart beat;
• B vitamins  B6, B12 and folic acid  help maintain healthy homocysteine levels and support heart function.[6] A brand new study has shown that low levels of vitamin B6 increases the risk of cardiovascular disease. The researchers found that the people with the lowest levels of B6 had the highest levels of inflammatory marker, CRP and oxidative stress;[7]
• Vitamin E has been found to be far more effective than aspirin in reducing the likelihood of heart attack in patients with coronary heart disease;[8]
• L plantarum is found in fermented foods of plant origin and some probiotic supplements. It has been found to decrease fibrinogen concentrations in blood.[9]  It was also found to reduce blood pressure and LDL cholesterol;[10]
• COQ10 enhances cellular energy production and has a particular affinity for heart muscle. It is anti-clotting and low in people with congestive heart failure.  If given within 3 days of a heart attack, COQ10 reduces the likelihood of further attacks. People taking statins should supplement COQ10 as this medication causes deficiency of COQ10;
• Pine bark extract (patented as Pycnogenol) has been found to contain a unique combination of procyanidins, bioflavonoids and organic acids and offers benefits for cardiovascular health. A study[11] found pycnogenol significantly lowered the inflammatory marker CRP to within normal levels in patients with elevated levels and levels of fibrinogen and reactive oxygen species were also lowered.

The benefits of omega 3 from fish oil, nuts and seeds are well researched in relation to cardiovascular health.[12] In part three I will discuss in more detail the benefits of the right fats for cardiovascular health and also explore the emotional aspect of heart problems in the context of Chinese medicine and the theory of the five elements.

References

1. Cai H and Harrison DG. Endothelial dysfunction in cardiovascular diseases: the role of oxidant stress. Circulation Research 87: 840-844. 2000.
2. Phyllis E Bowen PE and Borthakur G. Oxidative Stress. Department of Human Nutrition, University of Illinois at Chicago. 1991.
3. Ramirez-Bosca A, et al. Antioxidant curcuma extracts decrease the blood lipid peroxide levels of human subjects. Age, 167-169.1995.  Ramirez-Bosca, A, et al.  Effects of the antioxidant turmeric on lipoprotein peroxides: implications for the prevention of atherosclerosis. Age; 20:165-168. 1997.
4.  Ramirez-Bosca A. et al. An hydroalcoholic extract of Curcuma Longa lowers the abnormally high values of human-plasma fibrinogen. Mech Aging Dev;114: 207-220. 2000.
5. Parker Hashmi et al.  Levels of vitamin D and cardiometabolic disorders: systematic review and meta-analysis.  Maturitas; 65 (3): 225-36. 2010. Epub 2009.
6. Wotherspoon F, et al. The effect of oral folic acid upon plasma homocysteine, endothelial function and oxidative stress in  patients with type 1 diabetes and microalbuminuria. International Journal of Clinical Practice; 62(4):522-4, 2008.
7. Shen J. et al. Association of vitamin B6 status with inflammation, oxidative stress and chronic inflammatory conditions. Boston Puerto Rican Health Study. American Journal of Clinical Nutrition; 91:2:337-342. 2010.
8. Stephens N. et al. Randomised controlled trial of Vitamin E in patients with coronary disease:Cambridge Heart Antioxidant Study. Lancet; 347. 1996.
9. Molin G.  Probiotics in foods not containing milk or milk constituents, with special reference to Lactobacillus plantarum 299v1. American Journal of Clinical Nutrition; 73:2: 380-385. 2001. 
10. Naruszewicz M et al. Effect of Lactobacillus plantarum 299v on cardiovascular disease risk factors in smokers. American Journal of Clinical Nutrition 76:6;1249-1255. December 2002.
11. Belcaro G. et al. Variations in C-reactive protein, plasma free radicals and fibrinogen values in patients with osteoarthritis treated with pycnogenol. University of Munster, Germany. Research article.
12. Robinson J, Stone N. Antiatherosclerotic and Antithrombotic Effects of Omega-3 Fatty Acids. The American Journal of Cardiology; 98:4, 39S-49S, 2006.