Editor's Note:
This is the first in a series of articles drawn from The Sinatra Solution, Metabolic Cardiology by Stephen T Sinatra, M.D.

Whether you are a practicing cardiologist, afflicted with a heart disease or simply the responsible owner of an adult body, we are confident you will find The Sinatra Solution an invaluable asset to achieving and maintaining optimum health.

My journey as an integrative cardiologist has been an exciting period in my life, and it has brought me endless moments of satisfaction and joy. Yes, it is joyful when you can reduce human suffering and improve the quality of life for someone else. l have shared many moments of sublime satisfaction with my patients and their families, after their life has been improved or spared through the many alternative, pharmaceutical and technical tools of modern cardiology. But the specialty I hold so close to my own heart still has considerable limitations.

Pharmaceutical drugs, bypass surgery, angioplasty, stent emplacements, pacemakers and implantable defibrillators all have their place, and many lives would be lost without these high-tech interventions. Cardiologists face a daily dilemma concerning the best diagnostic procedures to refer for their patients and then, based on those test results, which surgical and/or pharmaceutical interventions to select. To complicate the choice, the evaluations we order and the treatments we select may actually create unnecessary risks for patients-risks that are out of proportion to the benefits they will experience. Continuing technological advances, although necessary, add to the complexity of the decision-making process.

Cardiologists have grown reliant upon these sophisticated medical processes. But somewhere along the way, something has gone amiss. There has been much mistrust of the conventional medical model among the public recently. Starving for new information, massive numbers of patients are consulting alternative therapy practitioners and are visiting book and health food stores in record numbers, creating a multibillion dollar industry outside of the mainstream medical community.

What is driving even our most conservative patients to look at other forms of therapies? There are many reasons for the increased popularity of alternative medicine, including patient dissatisfaction with ineffective conventional treatments, pharmacologic drug side effects and the high price of medications. Perhaps most important is the fact that traditional medicine has become too impersonal with the involvement of high-tech modalities and time-limited office visits.

Obviously, the medical consumer is searching for less invasive, safer and lower cost interventions. Some of this comes out of necessity; managed care plans have driven our patients into seeking cost-effective medical care delivery, as more of their health care dollars are coming out of their own pockets.

Many patients are now questioning the need for potentially life threatening drugs and invasive interventions that carry considerable risk of side effects, complications and even mortality.

Recent research has suggested that 2 million lives are lost each year as a result of complications from" standard-of-care" interventions, medical errors and complications. When we consider that the fourth leading cause of death in the United States is properly prescribed medications in a hospital setting, something's gotta give!

Even in 2005, coronary artery bypass surgeries (CABS) are performed on the basis of clogged arteries alone with no regard to quality of life issues. This is not smart medicine. Rates of complications from CABS-such as heart attack, infection, stroke, and central nervous system (CNS) dysfunction-are disturbing. It is important to note that CNS dysfunction was observed in an alarming 61 percent of patients six months after CABS. People are naturally looking for less risky and fewer surgical alternatives in lieu of such downsides.

During my 30 years of practicing cardiology I have seen a slow paradigm shift regarding the perceived availability of effective, natural alternatives for the treatment of a wide range of cardiovascular disorders-problems like angina, arrhythmia, high blood pressure and congestive heart failure (CHF). More physicians have expanded their approach to heart disease and accept and recommend complementary therapies as equally judicious treatment interventions. However, invasive CABS is a sound approach to improve quality of life and possibly advance longevity when alternative or medical therapy fails to correct a patient's symptoms of refractory angina (chest pain, shortness of breath and so on).

An integrative cardiologist is one who brings conventional methodologies to the table and also offers complementary and alternative interventions that can boost patients to an even better quality of life. Integrative cardiologists are as comfortable prescribing diet and lifestyle changes, a vast array of nutritional therapies and mind/body approaches as they are scheduling a treadmill stress test, recommending angioplasty and handing out a medication. They integrate the best of both worlds when caring for their patients.

For example, I have encountered an endless number of patients awaiting heart transplants-those with the most seriously compromised heart function-who have been literally "cured" by nutritional therapies. Those who want to improve the quality of their lives through both conventional and alternative approaches.

Getting well requires that the physician and the patient share in the healing process. I believe that we physicians don't really "cure" anyone. We merely coach, care for and support our patients . . . only nature heals.

A good physician assists patients in finding and stimulating their own healing capabilities. Over the years I've learned that real healing takes place when the intention of the healer matches the intention of the patient.

The real essence of "doctoring" employs elements from physical, emotional and spiritual realms to reduce human suffering and enhance quality of life. Integrative physicians who use whatever it takes to help heal the patient, are practicing good medicine, as well as what I refer to as smart medicine. And physicians who listen to "the messengers" around them are open enough, and wise enough, to understand that not only can they can learn from their teachers and colleagues, but also from their own patients as well.

I know that many of my own patients are interested in how I became involved in nutritional and other non-conventional therapies. Most tell me how hard it is to find a physician comfortable with what (I'm sorry to say) we still call "alternative" approaches, and ask how I "fell into it." First of all, many of the practices we now call alternative are actually mainstream healing methods that we've abandoned in our age of technology. Indigenous and advanced cultures alike still use these therapies appropriately and with good results.

I didn't "fall" into practicing and endorsing complementary forms of healing at all. I truly believe that I was led here. Within a year after passing my cardiovascular boards and becoming a credentialed invasive cardiologist, I began to realize something was missing. For instance, I started asking myself why I saw the same patients coming back into the emergency room with the exact same problems that had brought them there just months earlier-after we thought we'd "fixed" them. Too many times I would take care of a medical crisis, patch the patient up and send him back out, only to see them return again. Surely something was amiss.

I didn't quite get it. I sincerely thought that I was doing the right things, but I wasn't really helping anyone's body heal itself. Instead, I was performing in the hospital like that proverbial boy desperately sticking his finger in a hole to patch up a dike doomed to break down. I was prescribing drugs and different therapies aimed at directly "fixing the problem," and they did-in the short term. Then I realized what I was failing to see was the bigger picture: I was doing nothing to actually help prevent or even cure the real, complex, underlying problems.

MY JOURNEY
At that juncture, I decided I needed to enter a psychotherapy training program to become more open to other modalities of healing, including mind-body medicine. Over the next decade I studied mind-body interactions, became a certified psychoanalyst and read all I could about nutritional medicine. I spent nine years studying bio-energetic psychotherapy, an approach that confirmed my experience and belief that stress in the psyche can translate into physiological processes that create "dis"-ease in the body. Eventually, I coupled this approach with learning all I could about providing better care for the psyche and the body. The latter brought me into the field of nutritional approaches as well as to cellular healing.

It was at this point that I had my first encounter with coenzyme Q10. It seems no accident that I came across an article in the Annals of Thoracic Surgery reporting how patients taking coenzyme Q10 were able to be weaned more quickly from the heart-lung bypass machine we use during open heart surgeries. I'd recently lost a dear patient after a successful mitral valve replacement operation because he had failed over and over to come off that same pump-a nightmare scenario that happens on extremely rare occasions. So that article really grabbed me and made a strong impression. What regrets! What if I had known about coenzyme Q10 before I'd sent that kind man to a surgeon? His death had been a real heartbreak for me and one that still strays into my thoughts.

I couldn't bring that one gentleman back, but from then on I could, and did, tell patients awaiting open heart surgeries to start taking a daily dose of 30 milligrams (mg) of coenzyme Q10 two weeks in advance. Thanks to the lessons from one patient, they all came off the heart-lung bypass machine without a problem.

All through the 1980s I found myself driven to learn all I could about mind-body and nutritional medicine. It consumed most of my spare time. By 1986, I was convinced enough to start using coenzyme Q10 for more cardiac situations, like arrhythmias, hypertension, coronary artery disease, CHF and angina. In 1990 I actually began to develop my own vitamin and mineral formulas using coenzyme Q10, B vitamins, vitamins C, E, and D, carotenoids, flavonoids, calcium, fish oil, green tea and so on, and I believe that they all have merit in the treatment and prevention of heart disease.

I read reams of research, and even authored several books and journal articles to share the success stories I was observing with my own patients, many of whom were transcending the kind of improvements I had only hoped and prayed for. As I watched those tears of joy and enjoyed hugs from my patients and their family members, it was obvious that we were onto something . . . something big! I didn't realize it, but in the future I would become a metabolic cardiologist.

A few years later I started using L-carnitine and was truly amazed at how this combination of two nutraceuticals (coenzyme Q10 and L-carnitine) provided an even bigger quality of life boost for people. Frankly, when I look back I don't know how I ever practiced cardiovascular medicine without them. Now it's unthinkable not to recommend them to my patients with heart failure, arrhythmia, angina and hypertension. Knowing what I know now, withholding information about these nutraceuticals would be tantamount to malpractice for me.

It was a new beginning in my practice of medicine to be able to offer my patients alternative therapies that were safe and efficient-and that truly worked. Because nutrition had not been a part of the curriculum when I went to medical school, I had to make time to study it at great length, but my physician colleagues were often skeptical that I knew what I was talking about. So to be sure that I was qualified, I dug in, learned more and took the board examination given by the American College of Nutrition (ACN). I studied for two years, passed the exam and added CNS (Certified Nutrition Specialist) to my credentials.

MITOCHONDRIAL DEFENSE
In the 1990s I was recommending nutraceuticals to support the mitochondrial defense system in the cell. You may recall from high school biology that the mitochondria is nicknamed the "powerhouse of the cell" because it's primary function is to generate ATP, that complex energy substrate generated by the Krebs cycle (a long chemical process I hope you never had to memorize for a test question.) I serendipitously came to learn that preserving the mitochondrial adenosine triphosphate in our precious heart cells was really the answer in sustaining the pulsation of cells and life itself.

I learned that pulsation in the body is the key to vibrancy and life itself in my bioenergetic training for certification. Even prehistoric man knew that life depended upon the pulsating heart. Another light bulb went off! I realized that the health of the heart cell's mitochondria was the key to pulsation and contraction. I became driven to devote my energies to studying the relationships among mitochondria, the heart and cardiological diseases.

This complex relationship is the essence of metabolic cardiology.

In 2002 I met Dr. James Roberts at a conference in Las Vegas and listened to his research on the utilization of D-ribose in the cardiac patient. D-ribose is a five-sided sugar that is the missing link in energy transformation. I was truly amazed by Dr. Roberts' presentation and we have become colleagues over the past few years. I have such a genuine respect for Dr. Roberts that I asked him to write the introduction to my book. A well-credentialed integrative cardiologist himself, Dr. Roberts knows the vital importance of D-ribose in providing and sustaining energy, particularly in hearts that are compromised.

After using D-ribose dozens and dozens of times and becoming convinced of its efficacy, I wrote a newsletter article about it in my "Sinatra Health Report." I wanted to give this new and vital information to my 50,000-plus subscribers describing the emerging field I call "Metabolic Cardiology."

As my knowledge and experience evolved, I came to realize that when you treat the mitochondria and nurture the heart on a cellular level, then you can improve the health of the whole organism. The study of mitochondrial energy and pharmacokinetics became such a passion that I wanted to write this book to get this life-saving information out to more and more people.