Cardiovascular disease (CVD) is the most common interference with healthy aging and long life in the modern world. Here are a number of proactive ideas and tips to help you prevent the problems associated with heart disease. The triad of primary risk factors is smoking (nicotine addiction), high blood pressure, and high cholesterol. Even if your parents had high cholesterol or early heart disease, you can override, or at least delay, these influences with a proactive, healthy lifestyle.

There is a cholesterol controversy between integrative medicine and Western-focused doctors. All believe now that inflammation is the key, and oxidation of cholesterol molecules is really the underlying concern. Most docs believe that statin drugs are the answer to CVD troubles, yet PREVENTION is truly the answer. So, let’s take a look at some ideas and actions for preventing these common problems.

1. Maintain your ideal weight as closely as possible. If you smoke, do everything in your power to stop.

2. Minimize your intake of saturated animal fats, especially excessive dairy products, as they seem to raise cholesterol more than other foods. Also avoid hydrogenated oils that clog and stress the cardiovascular system. All of these fats increase both total cholesterol and the harmful form of cholesterol (LDL), especially when oxidized.

3. Minimize your intake of high-calorie, low-nutrient foods like baked goods, chips, boxed sugared cereals, and other processed foods, as well as the salty snacks from chips to cured meats. These foods contribute to obesity, a leading risk factor for CVD. Avoiding chemical exposure as much as possible will lessen the irritation/inflammation of the blood vessels, believed to be the main starting point of plaque formation and arteriosclerosis of blood vessels, the beginning of cardiovascular disease.

4. Exercise regularly with a balanced program that includes stretching for flexibility, aerobics for endurance, and weight training for strength. This can help to lower body weight, blood pressure, and cholesterol. Exercise also lowers your harmful cholesterol (LDL) and raises your good cholesterol (HDL). And exercise makes your body, mind, and heart happy.

5. Eat more high-fiber, high-nutrient, lower-calorie foods, such as vegetables, whole grains, legumes, and fruits. This diet can help you to live longer.

6. Get good-quality oils by eating nuts and seeds (ideally raw, unsalted, and organic), such as almonds, walnuts, sunflower seeds and pumpkin seeds, as well as omega-3 oily fishes that include salmon and sardines (good with green salads). Use olive oil as your main vegetable and cooking oil.

7. Nutritional supplements to consider for protection against cardiovascular disease include: antioxidant vitamins C and E, omega-3 fatty acids, and the B vitamins (especially B-6, B-12, B-3, and folic acid) to maintain normal cholesterol metabolism and minimize homocysteine levels.

8. Special nutrients that can be helpful in preventing and treating early disease include L-carnitine, Co-enzyme Q-10, chromium, and higher levels of niacin, mainly the regular flushing niacin as this may work better to metabolize blood fats, although many people use the non-flushing (but not time-released) inositol hexanicotinate.

9. Learn to manage your stress, let go of anger and frustrations, and communicate your feelings in a safe and non-aggressive way. Practice forgiveness and moving forward in life, still being aware of what you have learned from your life experiences (to avoid repeating mistakes in behavior).

10. Develop close personal relationships that you can count on for support. Continue to expand your ability to give and receive in your friendships/loving relationships. Love is healing at many levels.

Even if heart disease “doesn't run in your family,” this article is for you. Even if you have low cholesterol levels and your blood pressure is normal, this article is for you, too. This information doubles as both prevention and treatment— and its knowledge is critical for us all.

In the past, you may have thought of heart disease as an illness that you associated predominately with men. These days, we know that more than one in three women have some form of cardiovascular disease. As of the 2016 fact sheet from the American Heart Association, 398,086 females passed away from cardiovascular disease or congenital cardiovascular disease, with 402,851 males passing away from the same. Further, they've found that 90 percent of women have one or more risk factors for heart disease or stoke and that fewer women survive their first heart attack than men. This illness clearly does not favor one gender.

So, what causes heart disease? Simply put, cardiovascular disease results when the lumens of the coronary arteries, which carry blood, oxygen, and nutrients to the heart, become smaller. This constriction can be caused by excess salt in the blood pulling fluid from the arteries. Arteries are further constricted by a buildup of fats, oxidized cholesterol, excess calcium, and plaque in the artery walls. Angina, or chest pain, occurs when the heart fails to receive enough oxygen through these narrowed arteries. When these arteries become obstructed, a heart attack can occur, resulting in damage to the heart tissue. This process of plaque buildup and obstruction is known as atherosclerosis, or hardening of the arteries.

What Are the Risks?
There are over 250 risk factors for heart disease that have been identified. However, you'll be relieved to know that a large number of these factors—including many that are especially dangerous—can be lowered with lifestyle choices and changes. However, two risk factors associated with heart disease are beyond your control: heredity and age. For both men and women, the closer your blood-tie to a relative who suffered from heart disease, the greater your risk of developing it. In addition, age is a factor for women. As women reach menopause, their risk factor of developing heart disease rises significantly. Regardless if your family history predisposes you to a higher risk or not or your current age, there are certain risk factors that you should be mindful to pay close attention to. Let's touch on a few that you can begin making changes to reduce today.

High Blood Pressure
Hypertension, or high blood pressure, is both a cause and an effect of cardiovascular disease. The exact cause of hypertension is generally unknown, but what we do know is that high blood pressure often accompanies heart disease. The excessive force of the blood against the arteries weakens the cellular walls, allowing LDL (“bad”) cholesterol, excess calcium, and other toxic substances to form deposits that eventually block the arteries. Almost 50 percent of all midlife women are diagnosed with hypertension by age 50. Most who have hypertension are unaware of it because it usually produces no physical symptoms. Routine blood pressure checks, at least every two years, can detect potential hypertension; blood pressure readings above 140/90 may spell danger. Because so many test results have shown a direct relationship between high salt intake and hypertension, removing the salt shaker from your table would be wise. Sodium is a factor in hypertension because it causes fluid retention, which adds stress to both the heart and the circulatory system. Hypertension, left undiagnosed or untreated, can result in stroke, heart attack, kidney failure, and other serious diseases.

Smoking
Let's face facts: if you still smoke, your chances of dying from heart disease are almost three times as great as those of dying from lung cancer. The negative effects of smoking on your cardiovascular system are related to several actions. Nicotine causes blood platelets to become sticky, increasing plaque formation. Smoking also has been shown to decrease levels of HDL (“good”) cholesterol and increase LDL (“bad”) cholesterol. Cigarettes are high in cadmium, a toxic mineral that damages heart tissue. The Nurses' Health Study, conducted by Harvard researchers, found that women who smoked just one to four cigarettes a day had nearly two and one-half times the rate of heart disease of nonsmokers. Keep in mind that even secondhand smoke increases your risk of heart disease, so make your home and car smoke-free environments.

Obesity
Unfortunately for us, weight appears to be a more significant risk factor for women than it is for men. A study by Harvard researcher JoAnn Manson, MD, found that in obese women, seven out of ten cases of heart disease resulted from their excess weight. Even women who are at the high end of their “normal” range seem to have an increased risk. To compound the problem, overweight women tend to be sedentary; they are also more likely to develop hypertension, high LDL cholesterol and triglycerides, and type 2 diabetes, all of which increase the likelihood of heart disease. How the weight is distributed on your body also seems to have an impact.

Women with an apple body shape—who have a proportionally higher amount of fat around their abdomen than elsewhere on their body—have higher rates of heart disease, hypertension, and diabetes than their pear-shaped sisters, who carry their excess fat in their hips and thighs. Scientists believe this association relates to the hormone cortisol, which causes fatty acids to be released into the bloodstream from the central fat cells. These cells are located close to your liver; the released fatty acids stress the liver, causing cholesterol, blood pressure, and insulin levels to rise. Psychology researcher Elissa S. Epel has also discovered that apple-shaped women feel stress more and produce more cortisol as a result than do pear-shaped women.

Diabetes
For us women, diabetes is an additional risk factor for heart disease. Blood platelets in diabetics seem to stick together more readily than in non-diabetics, causing clogging of the arteries. Diabetics also have higher total cholesterol and lower HDL cholesterol levels. Research shows that women over the age of 45 are twice as likely as men to develop type 2 (formerly known as adult-onset) diabetes, and female diabetics are at double the risk of heart disease of male diabetics. The good news is that type 2 diabetes can be managed with diet and exercise.

A Sedentary Lifestyle
Movies depicting life on the nineteenth-century American frontier and Canadian wilderness are harsh reminders of just how physically demanding everyday life once was. We might enjoy watching someone else chop wood, carry buckets of water long distances, and walk behind a plow horse, but few of us would trade in our computers, microwave ovens, and central heating to live that life. All our muscles, including our heart, need exercise, however. Exercise helps lower LDL cholesterol and raise HDL cholesterol. Regular aerobic exercise—such as walking, running, jumping rope, and dancing—reduces the risk of heart disease by about 30 percent in postmenopausal women. It also influences several other risk factors.

People who exercise regularly have a 35 percent lower risk of hypertension, as well as a lower risk of diabetes. Exercise stimulates production of serotonin, endorphins, and other brain chemicals that reduce anxiety and stress and create a balanced sleep-wake cycle, helping to control cortisol levels. When you exercise, you also aid calcium metabolism, triggering the calcification process within your bones so excess calcium does not build up in your blood vessels. And you don't even need to spend one to two hours a day in strenuous activity to achieve cardiovascular benefits. Do keep in mind that over exercising can be just as harmful as being a couch potato. Moderate exercise, performed regularly, significantly decreases your risk of heart disease.

No matter your age, stage, and gender, it's import to make daily choices that love your heart and your health.

Heart and blood vessel (cardiovascular) disease is the number one killer of Americans, and study after study points to elevated cholesterol as a major contributor to the problem. Some authorities have indicated that for every one-percentage point that cholesterol levels are reduced, the risk for cardiovascular disease is reduced by two points. In addition, most people with diabetes have increased risk for heart disease and stroke, due in part to high cholesterol and triglyceride levels, which can result in death. In fact, more than 65 percent of people with diabetes die from heart disease or stroke. By managing diabetes, and blood lipids (cholesterol and triglycerides), however, diabetics can greatly reduce this risk.¹

The current conventional medical treatment is cholesterol- lowering prescription drugs, along with low saturated fat diets. In addition, it makes sense to work with your doctor in trying one or more of the following relatively risk-free dietary supplement approaches as part of your total program for lowering cholesterol and reducing risk of cardiovascular disease.

Plant Sterols And Stanols
Plant sterols are natural substances found in small quantities in many fruits, vegetables, nuts, seeds, cereals, legumes, vegetable oils, and other plant sources. Research has demonstrated that taking plant sterols orally significantly reduces total and low-density lipoprotein (LDL) cholesterol levels, but has little or no effect on high-density lipoprotein (HDL) cholesterol levels. LDL is considered to be the “bad cholesterol,” while HDL is considered to be the “good cholesterol.” The way it works is that plant sterols block cholesterol absorption in the intestines, which in turn results in lowered LDL cholesterol in the bloodstream. Plant sterols has been reported to decrease LDL cholesterol levels nine to 20 percent, and usual doses have ranged between 800 mg to six grams per day and given before meals. Plant sterols are typically given in conjunction with a low-fat diet.^{2,3,4,5,6,7,8,9,10,11} Orally, plant sterols are usually well tolerated. Ezetimibe (Zetia), a medication used to lower cholesterol levels, inhibits intestinal absorption of plant sterols.

Similar to sterols, plant stanols are natural substances that occur in even smaller quantities in many of the same sources. Like sterols, stanols block the absorption of cholesterol in the intestines. Taking plant stanols orally is effective for reducing total and LDL- cholesterol in about 88 percent of adult patients when used alone or in combination with a low-fat diet or statin drug (drug that inhibits the production of cholesterol in the body).^{12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27} When used alone it can reduce total and LDL cholesterol levels by 10 to 15 percent. When added to statin drugs, sitostanol reduces total cholesterol and LDL cholesterol by an additional three to 11 percent and seven to 16 percent, respectively. Clinical studies have used from 800 mg to four grams per day.²⁸ Orally, plant stanols seem to be very well tolerated. Plant stanols can reduce absorption and blood levels of beta-carotene, so it should be used at a different time if you are taking beta-carotene supplements.

Inositol Hexanicotinate High amounts (several grams per day) of niacin lower cholesterol; an effect recognized in the approval of niacin as a prescription medication for high cholesterol.²⁹ At such intakes, however, acute symptoms (flushing, headache, stomachache) may be severe. In an attempt to avoid the side effects of niacin, alternative health practitioners increasingly use inositol hexanicotinate (aka, “no-flush niacin”), recommending 500 to 1,000 mg, taken three times per day, instead of niacin.^30,31 This special form of niacin has been reported to lower serum cholesterol but so far has not been found to cause significant toxicity.³²

Omega-3 Fatty Acids From Fish Oil Including fish as a regular part of the diet has been shown to increase HDL cholesterol³³ and is linked to a reduced risk of heart disease in the majority of studies.³⁴ One reason that it has this effect is its oils contain the omega-3 fatty acids (O3FA) which appear to protect against heart disease.³⁵ When used supplementally, however, there is contradictory evidence about the effects of fish oil on blood fat levels. Some clinical research shows fish oil supplementation can decrease elevated triglyceride levels, and decrease LDL cholesterol and increase levels of HDL cholesterol.^36,37,38 However, other clinical research did not show beneficial effects on cholesterol levels.³⁹ Nevertheless, fish oil from supplements or from dietary sources has been shown to reduce triglyceride levels by 20 to 50 percent. This effect appears to be dose-dependent.^40,41,42,43Fish oil preparations providing 465 mg of eicosapentaenoic acid (EPA) and 375 mg of docosahexaenoic acid (DHA) is particularly effective in conjunction with dietary modifications.⁴⁴

In addition, research suggests that fish oil supplementation may be superior to the cholesterol-reducing drug rosuvastatin (Crestor®) for patients with heart failure. In a study published in The Lancet,⁴⁵ researchers gave 1,000 mg of omega-3 fatty acids from fish oil to about 3,500 patients with heart failure, while another 3,500 heart failure patients received a placebo. After four years researchers found that those taking the omega-3 fatty acids had a nine percent relative risk reduction of dying, and an eight percent relative risk reduction for being hospitalized. The researchers concluded their study demonstrated that long-term administration of 1,000 mg daily omega-3 fatty acids effectively reduced all-cause mortality and admissions to hospital for cardiovascular reasons.

The same researchers conducted a parallel study, giving rosuvastatin to 2,285 heart failure patients, and placebos to 2,289 heart failure patients. After four years researchers found little difference in heart failure rates between those given omega-3 fatty acids and those given rosuvastatin. In comparing the results, the researchers concluded that the omega-3 fatty acids were slightly more effective than rosuvastatin.⁴⁶

Dietary Considerations
I would be remiss if I did not briefly recount the incredibly important role that diet plays in cardiovascular health. Specifically, the Mediterranean diet has extensive patient-oriented outcome data showing a significant risk reduction in mortality rates and in rates of fatal and nonfatal heart attack.⁴⁷ Strong evidence support Mediterranean dietary patterns, including intake of vegetables and nuts, as protective against coronary heath disease.⁴⁸

The Mediterranean Diet

The Mediterranean diet is based upon the diets of at least 16 countries that border the Mediterranean Sea. Although there are many differences in culture, ethnic background, religion, economy and agricultural production which result in variations in food intake among the population groups, there is still a common Mediterranean dietary pattern which includes:

• High consumption of fruits, vegetables, bread and other cereals, potatoes, beans, nuts and seeds
• Olive oil is an important monounsaturated fat source
• Dairy products, fish and poultry are consumed in low to moderate amounts, and little red meat is eaten
• Eggs are consumed zero to four times a week
• Wine is consumed in low to moderate amounts

In addition, there is strong evidence for the protective effect of monounsaturated fatty acids and prudent dietary patterns.⁴⁹ Research clearly demonstrates that the people at low risk for CVD eat lots of vegetables, fruits, beans, whole grains and fish: a prudent diet.

Those at high risk for CVD eat the typical Western pattern diet loaded with red meat, processed meat, refined grains, sweets and desserts, fried foods and high-fat dairy products.^50,51 Furthermore, strong evidence has also shown a clear and harmful relationship between CVD and the intake of trans-fatty acids and foods with a high glycemic index or load.⁵²

In 2006 the American Heart Association released guidelines that integrate recommendations from a variety of diets into a single plan. The emphasis should be on diets that are rich in fruits, vegetables, and healthful fatty acids and that limit saturated fat intake. A stepwise individualized approach may be a practical way to help reduce your cardiovascular disease risk.⁵³ Visit www.americanheart.org for more information.

Conclusion
There are many dietary supplements that may be used as part of your total program for lowering cholesterol and/or otherwise help in reducing risk of cardiovascular disease. Good choices include plant sterols/stanols, inositol hexanicotinate, and omega-3 fatty acids from fish oils. In addition, a healthy dietary program such as the Mediterranean diet should be the first line of defense for reducing the risk of cardiovascular disease.

References:

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Overweight, often diagnosed as obesity, has become a major health issue in the United States as well as other countries. During the last four decades the prevalence of obesity has been growing at alarming rates, increasing risk factors that constitute the cluster of metabolic syndrome (MS), a condition characterized by, and rise in the risk of a variety of ailments, notably heart disease, stroke, inflammation, diabetes and certain cancers.

Hallmarks of the metabolic syndrome include abdominal obesity, increased blood pressure, (hypertension), elevated triglycerides and LDL cholesterol, that are harmful lipids, a reduction in plasma high density lipids, HDL cholesterol (the good cholesterol), and insulin resistance, a condition in which the body cannot use its insulin to move sugar into cells for energy, resulting in high blood sugar and diabetes. Studies now show that metabolic syndrome or its components, such as overweight, are associated with increased risk of cardiovascular disease as well as the development and progression of cancers of the breast, endometrium, colorectal, pancreas, liver and kidney.

Overweight And Health Problems
Both clinical and experimental studies have established that overweight increases the risk of a variety of detrimental health conditions, including oxidative stress, high blood pressure, high LDL and triglycerides, promoting atherosclerosis, coronary heart disease and stroke. Overweight can harm other aspects of health. It is a major cause of gallstones, can worsen degenerative joint diseases, play a role in cancer and sleep apnea. Lowering weight to a healthy level reduces these risk factors and causes blood to circulate more effectively. Overweight and frank obesity can lead to low-grade inflammation that is associated with the fat tissue that produces and secretes a variety of inflammatory molecules, increasing the risk of CVD and other pathological conditions.

Adiponectin
Adiponectin is the most abundant protein secreted by fat tissue into the bloodstream. It is considered a protective protein and has anti inflammatory, anti atherogenic as well as insulin sensitizing properties. Ironically, and contrary to expectations, despite being produced in fat tissue, adiponectin is decreased in obesity and its levels are inversely correlated with the percent of body fat; that is, the fatter the person the lower adiponectin levels. Adiponectin has regulatory functions that help combat risk factors associated with metabolic syndrome, including regulation of metabolic changes that occur in persons with conditions of type 2 diabetes, obesity, and atherosclerosis; adiponectin protective effects include increased insulin sensitivity and a lowering of the risk of cardiovascular disease. In cases of overweight and obesity, where adiponectin is low, an enhancement of adiponectin levels would be of therapeutic value.

The search to reduce the risk of the adverse effects of metabolic syndrome and overweight discovered garlic (Allium sativum L.). Garlic has been used as a nutrient with beneficial cardiovascular effects. However, fresh garlic is not for everyone, as its beneficial effects are offset by its pungent odor that lingers on breath and skin and its ability to often cause indigestion. An alternative source of garlic that is odorless and rich in antioxidants is the natural supplement Kyolic Aged Garlic Extract (AGE), having a wide range of health effects, that are often more effective than the fresh bulb.

Kyolic Aged Garlic Extract^TM (AGE)
Kyolic Aged Garlic Extract (AGE), is an odorless natural garlic supplement, manufactured by Wakunaga of America, from organically grown garlic that has been extracted and aged for 20 months, at room temperature. Rich in water-soluble organosulfur compounds, such as S-allyl cysteine and S mercaprocysteine, that has antioxidant activity; AGE is found, in experimental and clinical studies, to help prevent a wide range of ailments, notably coronary plaque formation and atherosclerosis, thereby reducing the risk of heart disease and stroke. Other health benefits include anti-inflammatory effects, boosting immunity, lowering blood pressure, reducing the risk of certain cancers, notably colorectal cancer, and preventing the toxic effects of radiation and certain drugs, such as acetaminophen, that when taken in high doses can cause liver failure. AGE is highly bioavailability and its wide range of health effects have been proven in clinical and experimental studies, reported in over 700 peer reviewed scientific and medical publications.

AGE And Adiponectin
A clinical trial, by D. Gomez-Arbelaez and colleagues, set out to investigate the effects of AGE on adiponectin and metabolic risk factors that constitute the metabolic syndrome. The clinical trial was a double blind, placebo controlled, randomized, crossover study, carried out on a Colombian urban population with metabolic syndrome.

The Study
The study selected 46 men and women over 18 years old with a metabolic syndrome diagnosis, a diagnosis based on obesity (waist circumference larger than 90 cm for males and greater than 80 cm for females).

Other hallmark characteristics included: triglycerides above 150 mg/dL, HDL lower than 40 mg/dL (male) and 50 mg/dL (female), blood pressure higher or equal to 130/85 mmHg, and fasting plasma glucose levels higher than 100 mg/dL. The investigators divided the subjects into two groups of 23, with each group being randomly assigned to ingest either 1.2 g/day of AGE (Kyolic) or placebo; Following 12 weeks of supplementation, treatment was reversed for another 12 weeks; that is, the ones who received AGE now received a placebo and those who were on placebo received AGE. The subjects received AGE or placebo as identical capsules, taken twice day, with breakfast and dinner. All subjects received recommendations for a lifestyle that included a diet lower in fat and sugar and exercise, and an exercise regimen of 30-minutes/day moderate walking. The subjects were followed every four weeks to evaluate clinical endpoints. At the beginning and end of each phase of the study (week 12 and week 24), investigators assessed weight, height, body mass index (BMI), that measures body fat, depending on height and weight, waist and hip circumferences and blood pressure.

The Findings
Results from the study showed that AGE intake for 12 weeks increases adiponectin levels. The increase in adiponectin, following AGE, was statistically significant, an important finding, since decreased adiponectin levels (4 µg/mL) are associated with doubling the frequency of coronary heart disease, independent of other cardiovascular risk factors, as well as insulin resistance, diabetes type 2, atherosclerosis and hypertension.

This first demonstration of AGE enhancement of adiponectin has a wide range of potential results; adiponectin increases cellular glucose uptake by cells and prevents excess blood glucose levels; adiponectin inhibits inflammation and oxidative stress, protecting blood vessels against oxidative damage that can cause cell death. AGE-induced increase in adiponectin would result in AGE influencing the improvement of insulin resistance and increasing sensitivity, thus playing an important role in helping prevent diabetes.

Another mechanism which can be linked to AGE increasing adiponectin levels and AGE protection against cardiovascular disease, is the regulatory mechanism associated with nitric oxide (NO). Nitric oxide is a regulator of blood pressure and is important in cardiovascular protection. AGE enhances NO production, and NO regulates adiponectin levels, which, as shown above is critical in modulating risk factors in metabolic syndrome.

AGE Improves Metabolic Parameters In Obese Models
While AGE, by enhancing the levels of adiponectin helps protect obese individuals against heart disease and other pathological aspects of metabolic syndrome, an experimental study from Korea, by Seo and colleagues studied the effects of AGE in experimental models fed a high fat diet, and made to exercise. AGE proved to have an additive anti-obesity and cardio-protective effect, reducing body fat, lowering cholesterol and triglycerides and reducing inflammation.

The Bottom Line
The study by Arbelaez adds to the wide range of important AGE health effects. The clinical study shows for the first time that AGE, added to the diet of overweight men and women with metabolic syndrome (MS), for 12 weeks, increases adiponectin, lowering their risk against heart disease, stroke, insulin resistance, diabetes type 2 and other conditions associated with metabolic syndrome. In addition, the study by Seo et al shows that AGE has anti-obesity properties.

Putting the two studies together, AGE can reduce body fat and potentially prevent the onset of MS; moreover, in the situation where a person is already overweight or frankly obese and diagnosed with metabolic syndrome, AGE added to the diet can, within a short period of 12 weeks, help protect against the symptoms of MS by increasing adiponectin production.

References:

Diego Gomez Arbelaez, Vicente Lahera, Pilar Oubina et al Aged Garlic Extract Improves Adiponectin Levels in Subjects with Metabolic Syndrome: A Double Blind, Placebo Controlled, Randomized, Crossover StudyMediators Inflamm. 2013;2013:285795. doi: 10.1155/2013/285795. Epub 2013 Feb 28.

Weiss N, Papatheodorou L, Morihara N, Hilge R, Ide N. Aged garlic extract restores nitric oxide bioavailability in cultured human endothelial cells even under conditions of homocysteine elevation. J Ethnopharmacol. 2013;145:162 7.

Seo DY, Lee S, Figueroa A, Kwak YS, et al. Aged garlic extract enhances exercise mediated improvement of metabolic parameters in high fat diet induced obese rats. Nutr Res Pract. 2012: 6; 513 9. doi: 10.4162/nrp.2012.6.6.513. Epub 2012 Dec 31.

Ahmadi N, Nabavi V, Hajsadeghi F, et al. Aged garlic extract with supplement is associated with increase in brown adipose,decrease in white adipose tissue and predict lack of progression in coronary atherosclerosis Int J Cardiol. 2013;168:2310-4. doi: 10.1016/j.ijcard.2013.01.182. Epub 2013 Mar 1.

The heart is a functioning muscle and needs oxygen and fuel in order to do its work. It is the job of the coronary arteries to supply the necessary oxygen and nutrients to the muscle. When one of the three major coronary arteries become narrowed or blocked, blood flow to the muscle is reduced, resulting in angina pectoris—a feeling of tightness or pressure in the chest often associated with shortness of breath. At first, angina may only be obvious during periods of exercise or emotional stress, and may go away when the activity ceases. Later, it may occur even while resting. If the blood flow to an area of the heart completely stops, heart muscle cells die, causing a heart attack, or myocardial infarction. While healing, the infarcted or damaged area forms a scar, but is no longer a functioning part of heart muscle.

Conventional medical treatments for angina include blood vessel dilators such as nitroglycerine and other nitrites and calcium channel blockers. If arteriograms show clogged coronary arteries, bypass surgery is usually recommended.

Dietary Supplements: Primary Recommendations

Vitamin C
Those pesky little free radicals really get around. They seem to be involved in almost every cardiovascular condition, and angina is no exception.^1,2 Consequently, it's not surprising that vitamin C and other antioxidants, which neutralize free radicals, are beneficial in the prevention and treatment of angina. In fact, studies have shown that men and women with lower blood levels of vitamin C have a higher risk for angina.^3,4,5,6 Furthermore, research has also shown that vitamin C supplementation, with or without other antioxidants, has been able to reduce the incidence of angina.^7,8,9 About 2,000 mg of vitamin C daily is recommended.

Co-enzyme Q10
Co-enzyme Q10 is a vitamin-like substance involved in cellular energy metabolism. It is also an antioxidant, like vitamin C, that is beneficial in the prevention and treatment of angina. In a study, which reviewed the scientific literature, Co-enzyme Q10 was revealed to be used in oral form to treat various cardiovascular disorders including angina.¹⁰ In one study, patients with acute myocardial infarction experienced a significant reduction in angina, arrhythmias (abnormal heartbeat), and poor heart function when supplemented with 120 mg of Co-enzyme Q10 daily.¹¹ Of course everyone knows that exercise is good to prevent cardiovascular disease. But in one study, patients with ischemic heart disease/effort angina were found to experience a faster loss of Co-enzyme Q10 during exercise.¹² Does this mean that you shouldn't exercise if you have angina? No, it just means you should supplement with Co-enzyme Q10. In another study, 150 mg of Co-enzyme Q10 given to angina patients not only increased their blood levels of Co-enzyme Q10, but also increased their ability to exercise longer. These results lead the researchers to conclude, "This study suggests that Co-enzyme Q10 is a safe and promising treatment for angina pectoris."¹³ (Note: If you have acute angina, you should only exercise in accordance to a program approved by your physician.)

Vitamin E
Vitamin E is considered by many to be the granddaddy of all antioxidant and cardiovascular support vitamins—and this reputation certainly holds true in the case of angina. As with vitamin C and Co-enzyme Q10 previously discussed, vitamin E protects against the free radical damage associated with angina. But what happens when there are inadequate levels of vitamin E? Not surprisingly, research shows that blood levels of vitamin E are significantly lower in patients with angina, and that these lower levels render them more susceptible to further cardiovascular damage.^14,15,16 And what happens if vitamin E is supplemented? Various studies show that vitamin E supplementation, with or without other antioxidants, is able to successfully decrease the incidence of angina in affected patients.^17,18,19 In fact, in a study, which examined vitamin use in 2313 men, vitamin E supplementation was found to have the strongest association with a reduced risk of ischemic heart disease, including angina.²⁰ Finally, vitamin E supplementation together with conventional anti-anginal drug therapy has been found to bring a higher response and exercise improvement, as well as other positive changes, than drug therapy alone.²¹ About 100 –400 IU of vitamin E daily is recommended.

L-Carnitine
L-carnitine is an amino acid involved in energy metabolism. Extensive research has also shown that l-carnitine has a valuable role to play in cardiovascular disease, especially where angina is concerned. Several studies have demonstrated that supplementation with l-carnitine (2000 to 4000 mg daily) is able to reduce the incidence of anginal attacks in cardiovascular disease patients.^22,23,24,25 Furthermore, in studies involving patients with angina pectoris and effort angina (i.e., angina induced by physical effort, such as exercise), supplementation with l-carnitine (2000 or 3000 mg daily) was able to improve exercise performance.^{26,27,28,29,30} Furthermore, in a study where l-carnitine was given to patients with effort angina along with anti-arrhythmic drugs, the l-carnitine was found to improve the action of those drugs.³¹

Hawthorne
Germany's Commission E has validated the use of Hawthorn in cases of cardiac insufficiency, resulted in an improvement of subjective findings as well as an increase in heart work tolerance, and a decrease in pressure/heart rate product.³² (Although Hawthorne Berry products are often marketed, it is the Hawthorne leaves and flowers which have been so carefully researched and validated.). In one study, a 60 mg hawthorn extract taken three times per day improved heart function and exercise tolerance in angina patients.³³

L-Arginine
Typically physicians will give their angina patients a prescription for nitroglycerin tablets, which are used in case of an angina attack. Nitroglycerine works through dilation of arteries, which in turn, works through an interaction with nitric oxide, which stimulates dilation. It is interesting to note that nitric oxide is made from the amino acid arginine. Furthermore, blood cells in people with angina have been shown to make insufficient nitric oxide,³⁴ (possibly due to abnormalities of arginine metabolism). Of greatest significance is research showing that 2 grams (2,000 mg) of arginine, three times per day for as little as three days improved the ability of angina sufferers to exercise.³⁵ Additional research has shown that the mechanism by which arginine operates is through stimulating blood vessel dilation.₃₆ (Note: If you have an active herpes virus, you should avoid arginine supplements since they can "feed" the virus.)

Dietary Supplements: Secondary Recommendations

Magnesium
The heartbeat normalizing effects of magnesium has been described repeatedly since 1935, both as a factor in human disease and in animal experiments. Nevertheless, this therapeutic effectiveness is rarely mentioned in textbooks. Both the therapeutic effect of magnesium and the correction of magnesium deficiency have been used in treatment of digitalis toxicity (a drug used to treat angina), angina, as well as in arrhythmia (abnormal heartbeat) of unknown origin. Magnesium deficiency can be caused by a number of situations. Of possible concern to the angina sufferer are the uses of drugs such as digitalis, diuretics, gentamicin, as well as cisplatinum, which appreciably enhance urinary magnesium loss. Correction of magnesium deficiency should lead to recovery.₃₇ About 300 – 500 mg daily is recommended. Please note, however, that it may take weeks or even months of magnesium supplementation, to achieve an angina-relieving result.

Omega-3 fatty acids
The omega-3 fatty acids EPA and DHA have been studied in the treatment of angina. Some research indicates that 3 grams or more of omega-3 oils (e.g., fish oils) three times per day (providing a total of about 3 grams of EPA and 2 grams of DHA) have reduced chest pain as well as the need for nitroglycerin, a common medication used to treat angina.₃₈ However, other research did not confirm these benefits.₃₉ In any case, if omega-3's are used, vitamin E should be supplemented with it, since the vitamin E may protect the oils against free radical oxidation.₄₀ Also, if you are using any type of blood-thinning medication, consult with your doctor before using omega-3 fatty acids.

Bromelain
Bromelain acts naturally as a blood thinner agent since it prevents excessive blood platelet from clumping together,₄₁ which would otherwise cause "sludgy" blood. Furthermore, there have been positive reports in a few clinical trials of bromelain to decrease thrombophlebitis (inflammation of veins) and pain from angina and thrombophlebitis.^42,43 About 1200–1500 mg daily (derived from at least 900 GDU/Gram material) is recommended.

References:

1. Ito K, et al, Am J Cardiol(1998) 82 (6):762-7.
2. Kugiyama K , et al, J Am Coll Cardiol (1998) 32(1):103–9.
3. Ibid.
4. Riemersma RA, et al, Ann NY Acad Sci (1989) 570:29–5.
5. Riemersma RA, et al, Lancet (1991) 337(8732):1–5.
6. Ness AR, et al, J Cardiovasc Risk (1996) 3(4):373–7.
7. Ito K, et al, Am J Cardiol (1998) 82 (6):762–7.
8. Kugiyama K, et al, J Am Coll Cardiol (1998) 32(1):103–9.
9. Singh RB, et al, Am J Cardiol (1996) 77(4):232–6.
10. Greenberg S, Frishman WH, J Clin Pharmacol (1990)30(7):596–608.
11. Singh RB, et al, Cardiovasc Drugs Ther (1998) 12(4):347–53.
12. Karlsson J, et al, Ann Med (1991) 23(3):339–44.
13. Kamikawa T, Am J Cardiol (1985) 56 (4):247–51.
14. Miwa K, et al, Cardiovasc Res (1999) 41(1):291–8.
15. Miwa K, et al, Circulation (1996) 94(1):14–8.
16. Pucheu S, et al, Free Radic Biol Med (1995) 19(6):873–81.
17. Rapola JM, et al, JAMA(1996) 275(9):693–8.
18. Singh RB, et al, Am J Cardiol (1996) 77(4):232–6.
19. Motoyama T, et al, J Am Coll Cardiol (1998) 32(6):1672–9.
20. Meyer F, Bairati I, Dagenais GR, Can J Cardiol (1996)12(10):930–4.
21. Pimenov LT, Churshin AD, Ezhov AV, Klin Med (1997) 75(1):32–5.
22. Singh RB, et al, Postgrad Med J (1996) 72(843):45–50.
23. Davini P, et al, Drugs Exp Clin Res (1992) 18(8):355–65.
24. Fernandez C, Proto C, Clin Ter (1992) 140(4):353–77.
25. Ferrari R, Cucchini F, Visioli O, Int J Cardiol (1984) 5(2):213–6.
26. Kobayashi A, Masumura Y, Yamazaki N, Jpn Circ J (1992) 56(1):86–94.
27. Cacciatore L, et al, Drugs Exp Clin Res (1991) 17(4):225–35.
28. Canale C, et al, Int J Clin Pharmacol Ther Toxicol(1988) 26(4):221–4.
29. Cherchi A, et al, Int J Clin Pharmacol Ther Toxicol (1985) 23(10):569–72.
30. Kamikawa T, et al, Jpn Heart J (1984) 25(4):587–97.
31. Mondillo S, et al, Clin Ter (1995) 146(12):769–74.
32. Blumenthal, M., et al, The Complete German Commission E Monogrpahs: Therapeutic Guide to Herbal Medicines/CD version (1998) American Botanical Council, Austin, Texas.
33. Hanack T, Bruckel MH, Therapiewoche (983) 33:4331–33 [in German].
34. Mollace V, et al, Am J Cardiol (1994) 74:65–68.
35. Ceremuzynski L, Chamiec T, Herbaczynska-Cedro K, Am J Cardiol (1997) 80:331–33.
36. Egashira K, et al, Circulation (1996) 94:130–34.
37. Laban E, Charbon GA, J Am Coll Nutr (1986) 5(6):521–32.
38. Saynor R, Verel D, Gillott T, Atheroscl (1984) 50:3–10.
39. Mehta JL, et al, Am J Med (1988) 84:45–52.
40. Wander RC, et al, J Nutr (1996) 126:643–52.
41. Heinicke R, van der Wal L, Yokoyama M, Experientia (1972) 28:844–45.
42. Nieper HA, Acta Med Empirica (1978) 5:274–78.
43. Seligman B, Angiology (1969) 20:22–26.

Most of the substances that are classified as vitamins were discovered decades ago. Required in tiny amounts for normal growth and development, vitamins must be obtained from the diet. Determining vitamin status is not quite as straight forward as this suggests, which is one reason that new vitamins on occasion still are discovered. Ergothioneine, an amino acid that is relatively abundant in certain mushrooms, currently is being proposed by a number of scientists as the latest new vitamin. Evidence includes the existence of a specific cellular transporter, accumulation of the compound in cells followed by its retention.^1,2 Solomon Snyder at the Johns Hopkins University School of Medicine not only has suggested that ergothioneine may be a vitamin, but also has concluded that for some purposes this would-be vitamin is as potent as glutathione, one of the body's most potent endogenous antioxidants and detoxifiers.³

Anti-Aging Potential for Heart and Mind
Mushrooms are rich sources of both ergothioneine and the well-known nutrient, glutathione.⁴ The edible fungi that are high in the one have been found to be high in the other. As a dietary source of these compounds, it is significant that mushrooms remain viable sources even after cooking,something not true of many nutrient sources.

The antioxidant functions of glutathione include recycling (reducing) the vitamins C and E as well as serving as a critical free radical scavenger to support antioxidant activity in all tissues, especially the liver and phase 2 detoxification reactions. In its reduced (non-oxidized) form, glutathione acts as a substrate in conjugation reactions. Whereas phase 1 detoxification makes fat-soluble toxins more water soluble in preparation for elimination from the body, a step that actually can increase toxicity, phase 2 detoxification binds toxins to carriers, such as glutathione, sulfate, glycine and glucuronic acid. One role for ergothioneine may be cardiovascular protection.⁵ This could involve amelioration of chronic inflammatory states, such as are found in heart disease and related condition.⁶ As part of its anti-inflammatory function, it is interesting that ergothioneine is found together with glutathione in mushroom sources. Although glutathione is often almost totally depleted in the face of oxidative stress, ergothioneine concentrations tend to remain relatively stable. "These properties suggest a role for ET [ergothioneine] as a bulwark, a final defense for cells against oxidative damage. Its stability may help mitochondria cope with otherwise overwhelming stresses encountered even during relatively physiologic metabolism."⁷

Ergothioneine has been shown to be involved in protecting injured tissues.⁸ In this and a number of other functions, there is a clear overlap with glutathione. Of particular interest is the impact on neurodegenerative diseases. As one of the primary ergothioneine researchers, Robert Beelman of The Pennsylvania State University, recently commented,

"It's preliminary, but you can see that countries that have more ergothioneine in their diets, countries like France and Italy, also have lower incidences of neurodegenerative diseases, while people in countries like the United States, which has low amounts of ergothioneine in the diet, have a higher probability of diseases like Parkinson's Disease and Alzheimer's. Now whether that's just a correlation or causative, we don't know. But, it's something to look into, especially because the difference between the countries with low rates of neurodegenerative diseases is about 3 milligrams per day, which is about five button mushrooms each day."⁹

A study published last year by researchers in Singapore adds support for Dr. Beelman's hypothesis that ergothioneine is neuroprotective. As already mentioned, the compound seems to accumulate preferentially in tissues subject to oxidative stress and inflammation. Based on this, the Singapore-based scientists looked at whole blood levels in older individuals. Their finding was that ergothioneine levels were significantly lower in those over 60 years of age. In subjects suffering from mild cognitive impairment, blood levels, again, were lower than in age-matched controls. Researchers concluded that the decline suggests that deficiency in ergothioneine may predispose individuals to neurodegenerative diseases.¹⁰

Of common edible mushrooms, ergothioneine concentration is highest in the porcini, an Italian favorite. Also tested and found adequate as sources, descending order of richness (strongly dependent on which portion of the growth cycle is involved), are shiitake, oyster, maitake, king oyster, and then, in a dead heat, portabellas, crimini and white button mushrooms.

Unexpected Benefits
Let's face it, consuming mushrooms merely as sources of an arcane newly discovered vitamin is not nearly as appealing as eating your favorite fungi for properly gourmet reasons (pizza topping, steak sauce, ravioli filling, etc.) while accruing unexpected benefits, such as weight maintenance or even weight loss. Recent studies suggest that one can be both gourmand and lean.

For instance, University of Minnesota research found that mushrooms are more filling based on roughly equal amounts of calories than is 93 percent lean ground beef.¹1 Thirty-two healthy participants (17 women, 15 men) consumed two servings of mushrooms or meat for ten days, i.e., mushrooms (226 grams) and meat (28 grams) eaten in a randomized open-label crossover study. On the first day, fasted participants consumed protein-matched breakfasts of containing either mushrooms or meat. Participants rated their satiety using visual analogue scales at start and at regular intervals after the meal. Three hours later, participants were served an ad libitum (eat as much as desired) lunch. Participants were given mushrooms or meat to consume at home for the following nine days. Under these conditions, mushroom eaters consumed more fiber, but there was no significant difference in calorie intake over the ten days of the trial. The findings were that consuming the mushrooms led to less hunger during the day, greater feelings of satiety after meals and less desire to eat within three hours of the mushroom meal.

The above trial lasted only ten days. The real question is "what happens if mushrooms are substituted for meat, say, for a year?" In fact, that trial has been conducted. A one-year, randomized clinical trial conducted by researchers at the Weight Management Center at Johns Hopkins Bloomberg School of Public Health and funded by the Mushroom Council found that substituting white button mushrooms for red meat enhanced weight loss and helped maintain that loss in among 73 obese adults (64 women and 9 men).¹² Subjects substitute one cup of mushrooms per day for a protein serving while keeping the rest of their diet the same. Controls followed their normal diets. At the end of the trial, participants on the mushroom diet reported lower intakes of energy and fat, had lost more pounds and percentage body weight (an averaged seven pounds), had a lower body mass index, exhibited a smaller waist circumference (decreased by an average of 2.6 inches), had less total body fat, and had lower systolic and diastolic pressure (-7.9 and -2.5 mmHg, respectively).

Mushrooms are relatively high in fiber and low in calories, meaning that they are not calorically dense. They also help to modulate blood sugar, a benefit that likely factors in to their impact on satiety. Whatever the mechanisms of action, being useful for achieving and maintaining significant weight loss over the course of a year while adding variety and taste to meals is a worthy achievement.

The Latest on Mushroom Supplements

Mushrooms used in cooking are the fruiting bodies, not mere mycelium. This is an important distinction, as well, for mushrooms used as dietary supplements. Unfortunately, supplements far too often are based only on the mycelium. A recent United States Pharmacopeia study confirms a lack of medicinal compounds in many Reishi supplements. As pointed out in a press release by the Nammex company, nineteen different Reishi mushroom products sold in the United States were tested for the compounds that characterize real Reishi mushroom (fruiting body).

Researchers used scientifically identified and validated Reishi mushrooms as their standard. Various highly accurate testing methods were utilized, including HPTLC, Colorimetric method, GC-MS, and High Performance Size-exclusion Chromatography. The results of their study demonstrated clearly that only 5 of 19 samples could be verified as genuine Reishi mushroom. Most of the other products lacked characteristic triterpenoids and also had a starch-like polysaccharide profile that was inconsistent with Reishi mushroom.

The researchers themselves concluded that the "results showed that the measured ingredients of only 5 tested samples (26.3%) were in accordance with their labels, which suggested the quality consistency of G. lucidum dietary supplements in the U.S. market was poor, which should be carefully investigated." ¹³

References:

1. Gründemann D, Harlfinger S, Golz S, Geerts A, Lazar A, Berkels R, Jung N, Rubbert A, Schömig E. Discovery of the ergothioneine transporter. Proc Natl Acad Sci U S A. 2005 Apr 5;102(14):5256–61.
2. Gründemann D. The ergothioneine transporter controls and indicates ergothioneine activity—a review. Prev Med. 2012 May;54 Suppl:S71– 4.
3. Paul BD, Snyder SH. The unusual amino acid L-ergothioneine is a physiologic cytoprotectant. Cell Death Differ. 2010 Jul;17(7):1134 – 40.
4. Kalaras MD, Richie JP, Calcagnotto A, Beelman RB. Mushrooms: A rich source of the antioxidants ergothioneine and glutathione. Food Chem. 2017 Oct 15;233:429– 433.
5. Servillo L, D'Onofrio N, Balestrieri ML. Ergothioneine Antioxidant Function: From Chemistry to Cardiovascular Therapeutic Potential. J Cardiovasc Pharmacol. 2017 Apr;69(4):183–191.
6. Grigat S, Harlfinger S, Pal S, Striebinger R, Golz S, Geerts A, Lazar A, Schömig E, Gründemann D. Probing the substrate specificity of the ergothioneine transporter with methimazole, hercynine, and organic cations. Biochem Pharmacol. 2007 Jul 15;74(2):309–16.
7. Paul BD, Snyder SH. The unusual amino acid L-ergothioneine is a physiologic cytoprotectant. Cell Death Differ. 2010 Jul;17(7):1134–40.
8. Halliwell B, Cheah IK, Drum CL. Ergothioneine, an adaptive antioxidant for the protection of injured tissues? A hypothesis. Biochem Biophys Res Commun. 2016 Feb 5;470(2):245–250.
9. http://news.psu.edu/story/491477/2017/11/09/research/mushrooms-are-full-antioxidants-may-haveantiaging-potential
10. Cheah IK, Feng L, Tang RMY, Lim KHC, Halliwell B. Ergothioneine levels in an elderly population decrease with age and incidence of cognitive decline; a risk factor for neurodegeneration? Biochem Biophys Res Commun.2016 Sep 9;478(1):162–167.
11. Hess JM, Wang Q, Kraft C, Slavin JL. Impact of Agaricus bisporus mushroom consumption on satiety and food intake. Appetite. 2017 Oct 1;117:179–185.
12. Poddar KH, Ames M, Hsin-Jen C, Feeney MJ, Wang Y, Cheskin LJ. Positive effect of mushrooms substituted for meat on body weight, body composition, and health parameters. A 1-year randomized clinical trial. Appetite. 2013 Dec;71:379–87.
13. Wu DT, Deng Y, Chen LX, Zhao J, Bzhelyansky A, Li SP. Evaluation on quality consistency of Ganoderma lucidum dietary supplements collected in the United States. Sci Rep. 2017 Aug 10;7(1):7792.

We each have about 60 trillion cells in our bodies and every one of them needs energy in order to perform the important tasks they need to carry out every day. Our body needs nutrients in order to help cells to grow and repair when they become damaged, make biochemical's such as neurotransmitters and hormones, as well as make our immune system strong enough to avoid the development of chronic diseases. Co–enzyme Q10 plays a crucial role in this process as we can see from the following basic benefits of this nutrient.

• CoQ10 works in the energy centers in our cells called the mitochondria to facilitate the energy production process. Most enzymes play this role as facilitators.
• CoQ10 acts as an antioxidant to protect the nucleus of the cell and the mitochondria from free radical damage from toxins like pesticides and air pollution.
• CoQ10 helps in the replacement of old or damaged mitochondria so that our cells can stay healthy for as long as possible.

CoQ10 for the prevention and reversal of disease

Some organs in our bodies need more energy than others because they are required to work 24/7: the brain, the heart, the liver and the kidneys are good examples. Other body parts like skin, muscles and bones get a chance to rest and thus need much lower levels of mitochondria and energy. If there is not enough energy being produced for the most important organs then they can become weak and damaged over time. Here are some examples from clinical studies about how CoQ10 has been able to play a key role in the prevention and even the reversal of certain illnesses.

• In a very famous clinical trial 50 percent of patients with kidney disease were able to be taken off of their dialysis after taking 180 mg of CoQ10 for three months.
• Several clinical trials have been shown to help patients prevent and even reverse heart disease using CoQ10 as part of a nutritional protocol.
• Several clinical studies have been able to prove that Parkinson's disease can be significantly slowed down using high doses of CoQ10.

These, and other similar studies, have proven the ability to reduce the need for surgery, replace or reduce the need for prescription medications as well as reduce the need for expensive medical treatments. Although these studies appear in many medical journals there is still resistance for the use of CoQ10, and other proven nutrients, due to lack of education, influence from the drug industry, and resistance from insurance companies and hospitals.

It is difficult to achieve therapeutic levels of CoQ10 from food alone because the best sources are red meat and dairy. The Harvard Food Pyramid does not support high amounts of these foods, so the best source for CoQ10 is usually supplementation.

Doctors like Stephen Sinatra recommend the ubiquinol form as apposed to the ubiquinone form due to its superior absorption. And Life ExtensionMagazine has published an article in their October 2016 issue indicating that selenium is a good partner for CoQ10 because it helps to produce and accumulate more of this impressive nutrient. Perhaps CoQ10 should be part of your nutritional supplement program.

In mid-2012, Nestlé Health Science acquired a stake in Accera®, the U.S. maker of Axona®, a medical food targeted at people with mild to moderate Alzheimer’s. Aside from the fact that the purchase shows that Nestlé is placing a strategic bet on the future direction of medical food demand, this acquisition also is interesting for its potential validation of a tropical oil that alternately has been damned and praised for its role in health: coconut oil.

On the one hand, there are those who still maintain that coconut oil, a source of more saturated fat than butter, lard or beef tallow, is the devil incarnate for brain and heart health. On the other hand, current science is in the process of validating the high regard that the coconut oil enjoys in the Ayurvedic and Chinese traditions of healing.

Indeed, coconut oil bears a striking overlap in its metabolic implications, in this case for Alzheimer’s disease, with medical foods designed to provide the brain alternate fuel sources. A nice introduction to this topic is Alzheimer’s Disease: What If There Was a Cure? by Mary Newport, MD.

The scientific backtracking regarding coconut oil recently was put in a nutshell in a New York Times interview of Thomas Brenna, a professor of nutritional sciences at Cornell University.¹ Dr. Brenna observed that coconut oil’s bad reputation for cardiovascular health rested mostly on partially hydrogenated coconut oil, oil designed specifically to raise cholesterol levels in the rabbits being used in experiments. Virgin coconut oil differs dramatically in a large number of ways from the trans-fat laden partially hydrogenated item. Even the health dangers of the saturated aspect of coconut oil currently are being debated. As Dr. Brenna remarks in the interview, “I think we in the nutrition field are beginning to say that saturated fats are not so bad, and the evidence that said they were is not so strong.”

Coconut Oil—A “Good” Saturated Fat
Coconut oil is saturated (it is solid up to 76° F), consisting of 86.5 percent saturated fatty acids and 5.8 percent monounsaturated fatty acids.² Lauric acid makes up approximately 46 percent of coconut oil and generally is considered to be the villain in terms of serum cholesterol. However, in clinical trials, the effects of dietary supplementation with coconut oil usually have been found to be either no effect or a small increase in LDL cholesterol and a significant increase in HDL cholesterol, meaning that the ratio—and cardiovascular risk—improves with supplementation.^3,4

Moreover, extra virgin coconut oil consists mostly of medium-chain fatty acids (MCFA), with 50 percent being lauric acid. Medium-chain fatty acids have been used for many years for special health purposes. They have attracted attention as part of a healthful diet because they are absorbed and transported directly into the liver via the portal vein and thereafter metabolized rapidly by beta-oxidation, thus increasing diet-induced thermogenesis.⁵

One derivative of coconut MCFA is medium-chain triglyceride (MCT) oil, which is 75 percent caprylic and 25 percent capric acids, fatty acids very similar to lauric acid and present in virgin coconut oil in smaller amounts. MCT oil often is found in the hospital nutrient mixtures for bedridden patients who are dependent upon intravenous nutrition. These fats were developed in part because they do not require the action of bile for digestion, but rather are absorbed directly through the walls of the small intestine and transported to the liver to be used immediately as fuel.

The special characteristics of coconut MCFA mean that the body prefers to burn it for fuel rather than to store it. You might say that the body treats coconut fatty acids more like it does carbohydrates, but without getting involved with insulin. Scientists know this because of experience with MCT oils. In my book Anti-Fat Nutrients (revised 4th edition, Basic Media), I discuss MCT oil at length. In seriously catabolic patients, MCT oil was found to help prevent the body from depleting lean and muscle tissues. Again, MCT fatty acids are not readily stored as body fat, but rather they are preferentially burned in the mitochondria of the cells to provide energy.⁶ For some athletes and bodybuilders, this quality has proved useful since excess training depletes the glycogen stores of the muscles, and continued training after that point can only take place partially through the break down of muscle protein for fuel.⁷ Coconut oil medium-chain fatty acids have properties similar to those of MCT oil, but not as pronounced.

Does this mean that coconut oil can help dieters? Yes, as long as there are not too many expectations. Indeed, the nutrition author Ray Peat, PhD, has remarked that in the 1940s farmers attempted to use coconut oil for fattening their animals, but they found that it made them lean, active and hungry instead! The fatty acids found in coconut seem to promote the burning of fat for fuel and, as already noted, have a pronounced thermogenic effect. However, the thermogenic and fat-burning qualities of medium-chain fatty acids seem to be more significant for healthy subjects of normal weight and for those moderately overweight than for those who are clinically obese (fortunately, a category that excludes most of us). Moreover, medium-chain fatty acids serve to protect the body’s protein in the lean tissues during the use of low calorie and low carbohydrate diets.⁸

Immune and Digestive Benefits
Coconut oil has many other benefits. Two names are closely associated with the research in this area. These are Jon J. Kabara, PhD, one of the primary researchers into the benefits of lauric acid, and Mary G. Enig, PhD, the great researcher in the area of fats and one of the first (literally decades before the mainstream medical researchers) to point out the health dangers of trans-fatty acids.

Dr. Enig was the keynote speaker in 2001 at the 36th Annual Conference of the Asian Pacific Coconut Community. There she gave her talk on the benefits of the coconut as a functional food. She noted that approximately 50 percent of the fatty acids in coconut fat are lauric acid, which has the additional beneficial function of being formed into monolaurin in the human body. Monolaurin is a monoglyceride used by the human metabolism to destroy lipid-coated (that is, fat-coated) viruses and a number of other undesirable organisms.

Approximately 6–7 percent of the fatty acids in coconut fat are capric acid. Dr. Enig points out that capric acid is another medium-chain fatty acid that has a similar beneficial function when it is formed into monocaprin in the human or animal body. Monocaprin has beneficial effects similar to those found with monolaurin.

In his accessible, yet thoroughly researched book, The Healing Miracles of Coconut Oil (HealthWise), author Bruce Fife, ND, ranges across a number of health topics for which coconut oils has proven to be effective. He notes that coconut oil is so stable that it helps to preserve other oils, thereby reducing antioxidant requirements. Populations that eat large amounts of coconut and coconut products, such as the oil, are characterized by low rates of heart disease. Lauric acid and other medium-chain fatty acids are found in mother’s milk, where among other things, they improve the uptake by the baby of nutrients such as amino acids, calcium and magnesium. Similar effects upon nutrient assimilation have been found in the very ill and in the elderly. Moreover, these health benefits do not even take into account the long accepted uses of coconut oil to nourish the skin and the hair.

Benefits for Brain Health?
Let’s return to Nestlé Health Science acquired a stake in Accera, the U.S. maker of Axona, a medical food targeted at people with mild to moderate Alzheimer’s. The basic argument for this medicinal food is that in Alzheimer’s disease, the brain is starved for energy because it has a reduced ability to metabolize glucose. Reduced energy means reduced levels of cognition and memory. Fortunately, there is an alternative to glucose known as ketone bodies. Axona is a proprietary formulation of caprylic triglyceride that is converted by the liver into ketone bodies.

Recall that coconut oil is a good source of medium-chain triglycerides (MCTs), the fatty acids that are converted in the liver to ketones. Ketones can provide energy to cells without the need for insulin. This is important for several reasons, not the least being that Alzheimer’s is related to insulin resistance and the attempt to get glucose to the brain with a high carbohydrate diet is counterproductive.⁹ Moreover, access to ketones may more generally promote neurologic health—several neurologic conditions have shown promising results with ketogenic diets. Ketogenic diets may help treat difficult cases of epilepsy and Parkinson’s disease as well as other neurological disorders, indeed perhaps improve cognition and health in general.

The use of coconut oil with the conditions above at this point is promising, but hardly proven. Moreover, there are not yet much in the way of set rules or recommendations. Dr. Newport was giving her husband as much as 11 tablespoonsful per day, with four to eight tablespoonsful seeming to be a regular recommendation. At 115 calories per tablespoon, a coconut oil supplemented diet should not otherwise continue to be the standard American diet built upon a foundation of refined carbohydrates. Those wanting to add serious amounts of coconut oil to their everyday diets, as opposed to merely switching to it as a cooking oil, might find it useful to explore high protein/low carbohydrate options more generally. The chief warning to those who would try such diets is that Paleolithic-type diets need to include plenty of vegetables and reasonable amounts of whole fruit (avoiding fruit juice).

Summing Up
In his book, Bruce Fife asks the rhetorical questions, “If there was [sic] an oil you could use for your daily cooking needs that helped protect you from heart disease...other degenerative conditions, improved your digestion, strengthened your immune system, protected you from infectious diseases, and helped you lose excess weight, would you be interested?” Surely this is a good question. Aside from the record of traditional use, numerous research papers and United States Patents argue for the health-promoting benefits of coconut oil. Now that organic coconut oil/extra virgin coconut oil is readily available in health food stores, perhaps it is time for health-conscious shoppers to give it a try.

References

1. Melissa Clark, “Once a Villain, Coconut Oil Charms the Health Food World.” New York Times March 1, 2011.
2. “Nutrient database, Release 24” (http://ndb.nal.usda.gov/) . United States Department of Agriculture. http://ndb.nal.usda.gov
3. Assunção ML, Ferreira HS, dos Santos AF, Cabral CR Jr, Florêncio TM. Effects of dietary coconut oil on the biochemical and anthropometric profiles of women presenting abdominal obesity. Lipids. 2009 Jul;44(7):593-601.
4. Mensink RP, Zock PL, Kester AD, Katan MB. Effects of dietary fatty acids and carbohydrates on the ratio of serum total to HDL cholesterol and on serum lipids and apolipoproteins: a meta-analysis of 60 controlled trials. Am J Clin Nutr. 2003 May;77(5):1146-55.
5. Aoyama T, Nosaka N, Kasai M. Research on the nutritional characteristics of medium-chain fatty acids. J Med Invest. 2007 Aug;54(3-4):385-8.
6. Babayan VK. Medium chain triglycerides and structured lipids. Lipids 1987 Jun;22(6):417-20.
7. Nosaka N, Suzuki Y, Nagatoishi A, Kasai M, Wu J, Taguchi M. Effect of ingestion of medium-chain triacylglycerols on moderate-and high-intensity exercise in recreational athletes. J Nutr Sci Vitaminol (Tokyo). 2009 Apr;55(2):120-5.
8. Dias VC, et al. Effects of medium-chain triglyceride feeding on energy balance in adult humans. Metabolism 1990;39:887-891.
9. Seneff S, Wainwright G, Mascitelli L. Nutrition and Alzheimer’s disease: the detrimental role of a high carbohydrate diet. Eur J Intern Med. 2011 Apr;22(2):134-40.

In Part 1 of this series, we reviewed the discovery of coenzyme Q10 and the initial studies that established CoQ10 as a very effective natural therapy for the prevention and treatment of cardiovascular disease. In addition to being a powerful antioxidant, early studies also revealed that CoQ10 is an essential for the generation of cellular energy (ATP) within the mitochondria of every cell in the body with the exception of red blood cells.

Coenzyme Q10's dual functions (antioxidant and energy production) make it essential for the health of virtually all human tissues and organs. As a fat-soluble antioxidant, it protects proteins (like LDL-cholesterol), enzymes, fats (all cell walls/ membranes) and especially DNA from free radical damage. In terms of energy production, areas of the body with high rates of metabolic activity (high energy demands) such as the heart, lungs, kidneys, brain and immune system are especially sensitive to low levels of CoQ10.¹

Coenzyme Q10 and Cancer/History

Early CoQ10-cell culture studies revealed that coenzyme Q10 resulted in an 80 percent reduction in the growth of cancer cells within 90 days.² Animal studies published in the late 1990s reported that treatment with coenzyme Q10 resulted in suppression of tumor growth, reduced size and/or shrinkage of tumors and increased survival time.^3,4,5

In the late 1980s, Dr. K. Folkers began analyzing coenzyme Q10 levels in cancer patients. His testing revealed that virtually all cancer patients have CoQ10 levels that are extremely low. In 1994, Drs. K. Lockwood and K. Folkers reported treating 32 "high-risk" breast cancer patients with antioxidants, fatty acids, and 90 mg. of CoQ10.

Six of the 32 women showed partial tumor regression. In one woman, the dosage of CoQ10 was increased to 390 mg. In one month, her tumor was no longer palpable and in another month, mammography confirmed the absence of tumor. Encouraged, another case having a verified breast tumor, after non-radical surgery and with verified residual tumor in the tumor bed was then treated with 300 mg. CoQ10. After three months, the patient was in excellent clinical condition and there was no residual tumor tissue.⁶

In 1996, William Judy and Dr. Folkers reported the results of a CoQ10-prostate cancer study. Their results revealed that men with prostate cancer who were treated with 600 mg of CoQ10 daily achieved dramatic reductions in both PSA and tumor size.⁷ An interesting aspect of this study is that the men did not begin to show any signs of response until about 90 days into the trial.

Several clinical trials have also reported that coenzyme Q10 substantially protects against and/or reduces side effects in patients undergoing various forms of chemotherapy.

A New Understanding of Cancer: In healthy cells, mitochondria utilize oxygen to produce energy. In cancer cells, energy production switches from away from oxygen and instead begins to utilize glucose/sugar for energy production. This was first discovered and explained by Otto Warburg, MD. Warburg was awarded the Nobel Prize in 1931 for discovering that cancer cells are low in oxygen because cellular respiration has switched from using oxygen to the fermentation of sugar. To summarize, healthy cells utilize oxygen to produce energy whereas cancer cells begin to utilize sugar for energy production. It is damage to mitochondria that causes this change in energy production.⁹

"Cancer as a Metabolic Disease: On the Origin, Management and Prevention of Cancer" is the title of a very important book written by Thomas N. Seyfried, MD. Dr. Seyfried advances Otto Warburg's theory of cancer in a way that revolutionizes our understanding of cancer. Up until now, most scientists have assumed that cancer is a genetic disease resulting from DNA mutations/damage.

Instead, Seyfried teaches us that cancer is a metabolic disease due to mitochondrial damage, which hinders the ability of cells to produce adequate energy. This causes the metabolic shift from oxygen to glucose for energy production, which is the hallmark of cancer cell metabolism.

Coenzyme Q10/Cancer Answer: Drs. Warburg and Seyfried did not explain coenzyme Q10's role in protecting mitochondria from free radical damage and in mitochondrial energy production. In this article, we will explain how CoQ10 deficiency results in mitochondrial damage that progresses to metabolic changes in energy production, which results in the origin and progression of cancer.

The Miracle Nutrient: Coenzyme Q10. Coenzyme Q10 plays two critical roles in this scenario. First, CoQ10 is required in several steps for energy production within mitochondria. Thus, coenzyme Q10 deficiency impairs mitochondria's ability to use oxygen for energy production. This causes a shift to using sugar, which characterizes cancer cell metabolism.

Secondly, CoQ10 is a powerful antioxidant that neutralizes free radicals. This is especially important in mitochondria, because more free radicals are generated in mitochondria during the process of energy production than anywhere else in the body. Thus, coenzyme Q10 deficiency is a "double whammy" in that it weakens mitochondria's ability to produce energy (like an engine running out of gas) while also accelerating free radical damage to mitochondrial DNA (causing damage to the engine so it cannot function).

Causes of Coenzyme Q10 Deficiency: The synthesis of coenzyme Q10 in the body is a complex process that requires multiple nutrients as cofactors. Over the past 80 years there has been a dramatic and continual decline in the nutritional content of our commercial/agricultural food supply. Reasons for this decline include:

a) Rising levels of atmospheric CO2 is causing reductions in the mineral content of plants.¹⁰

b) Massive use of pesticides and herbicides on agricultural crops, which kills the microbiome (bacteria) in the soil. Bacteria in the soil are necessary for the breakdown of organic matter and the delivery of nutrients into the plant.¹¹

c) A high percentage of the food that Americans consume are highly processes. Food processing results in substantial losses of nutritional content of the foods.¹²

d) In "The Drug-Induced Nutrient Depletion Handbook," Ross Pelton lists multiple reports following classes of commonly prescribed drugs that cause depletion of coenzyme Q10: statin cholesterol-lowering drugs, oral contraceptives, hormone replacement therapy (HRT), drugs for diabetes, tricyclic antidepressants, major tranquilizers, beta-blockers, thiazide diuretics and vasodilators.¹³ Many more drugs probably deplete CoQ10, but just haven't been tested yet for their effect on CoQ10 biosynthesis.

e) Increasing age, after 20 years of age, reduces CoQ10 synthesis in man (International CoQ10 Association).

Other Therapeutic Applications: In addition to cardiovascular disease and cancer, studies have also been published showing that CoQ10 can provide therapeutic benefits in the following conditions: diabetes, radiation injury, periodontal disease, gastric ulcers, mitochondrial disorders, migraine headaches, obesity, kidney failure, acquired immune deficiency (AIDS), Parkinson's disease and Alzheimer's disease.

CoQ10 and Life Extension: In addition to the many ways CoQ10 can help prevent and treat many disease conditions, it is also one of the most important nutrients for life extension and healthy longevity.

When you understand CoQ10's critical roles in protecting mitochondria and producing energy, it seems obvious that it would slow down the onset of chronic degenerative diseases and increase longevity with healthy additional years. Imagine a growing number of vibrant, energetic centenarians.

Coenzyme Q10 Doubles Lifespan in Mice: Emile Bliznakov, MD, who wrote "The Miracle Nutrient: Coenzyme Q10," conducted the following experiment. Dr. Bliznakov started his experiment with 100 "old" female white mice that were 16 to 18 months of age. One week for mice is roughly equivalent to one year of human life. Thus, the mice were in their 60s to 70s in human terms and already beginning to show some signs of decreased immunity and aging bodily functions.¹⁴

These old mice were divided into two groups of 50 and maintained on optimally nutritious diets. One group were controls while the second group were regularly given doses of CoQ10.

• At 28 weeks after the beginning of the study, 70 percent of the control mice had died compared to only 40 percent of the CoQ10-treated mice.
• At 36 weeks, 100 percent of the control mice were dead while about 40 percent of the CoQ10-treated mice were still alive and active with most not showing the normal signs of physical deterioration that are commonly associated with advanced age.
• At week 56, 10 percent of the CoQ10-treated mice were still thriving (2X longer than these mice would normally be expected to survive beyond the beginning of the experiment).
• At the 80th week (remember the last control mouse died at week 36), four mice were still alive; at the 82nd week, the last mouse died. In human terms, this is a life span of roughly 130 years of age!

Dr. Bliznakov explained the following remarkable visual differences between the two groups of mice towards the end when some of the control mice were still alive. The fur on the control mice that had not received CoQ10 had lost its sheen, became dull, coarse, matted and on some mice, clumps of hair had fallen out, leaving bald patchy spots and they were also very listless and spent most of their time lying around and not socializing. On the other hand, the fur in the coats of the CoQ10-treated mice remained smooth and soft, and they maintained a much greater level of activity and socialization. Another interesting feature was the fact that the CoQ10-treated mice still engaged in sexual activity whereas sexual activity had stopped among the control mice months earlier.

Human clinical life extension trials will be conducted in our lifetime. Several studies have reported CoQ10's therapeutic benefits in a wide range of disease states. This certainly suggests that CoQ10 enhances and extends life and improves quality of life. Three rather large clinical studies support the influence of CoQ10 on longevity. The first was a 30-year study that was completed by Dr. Folkers and Judy. In this study 500 congestive heart failure patients were divided into two groups. One group was treated with 200 mg CoQ10 daily and conventional therapy. The other group was treated with conventional therapy only. The conventional therapy group were all deceased in seven years. In the CoQ10 group 42 percent were still living at seven years. At 15 years, 24 percent were still living. At 30 years two individuals were still living. Both were in their late 90's and in good health. Both had been on CoQ10 for over 35 years and were only on a diuretic and CoQ10.

Other long-term studies have been conducted by Dr. Alihanen and his group in Sweden. In this study thousands of elderly patients were supplemented with CoQ10 for 10 years. The 10- year survival rate was 45 percent. In another study in Class III and IV congestive heart failure conducted by Dr. Sven Mortensen and his group showed a two-year survival compared to the control group of 48 percent. The morbidity was reduced by 52 percent and the classification of heart failure was reduced to Class II or I. The acute hospitalizations were reduced by 52 percent (Q-Symbio multicenter clinical trial 2014. A.J. Clinical Cardiology, 2014.

Ubiquinone/Ubiquinol: After the discovery of coenzyme Q10 (ubiquinone) in 1956, clinical trials began in the mid-1960s. In the ensuing half-century, the vast majority of clinical trials have been conducted with the ubiquinone, which is the oxidized form of CoQ10.

In 2006, the Kaneka Corporation in Japan began producing and marketing the ubiquinol (reduced) form of CoQ10 after learning how to stabilize the compound and keep it from oxidizing back to ubiquinone. Kaneka claims that the ubiquinol/ reduced form of CoQ10 is more active and better absorbed than ubiquinone. This has been a very successful marketing strategy for Kaneka, but actually, the claims are not scientifically correct.

There are several issues to discuss when confronting Kaneka's claims that ubiquinol is superior to ubiquinone. Many companies are private labeling Kaneka's ubiquinol CoQ10, which are substantially more expensive. However, studies reveal that when Kaneka's reduced CoQ10 is taken orally, it rapidly gets converted into ubiquinone in the stomach. Hence, people are paying more for ubiquinol, which actually gets converted back into ubiquinone when taken orally.

For a full explanation of the issues and controversies between ubiquinone and ubiquinol, read a report titled Coenzyme Q10 Facts or Fabrications by William Judy, Ph.D. Dr. Judy has been educating people around the world about the importance and benefits of coenzyme Q10 for over 40 years. He has also conducted CoQ10 clinical trials and served as a consultant for many companies on CoQ10 product formulations. Hence, he is well qualified to address both the scientific and the marketing issues related to the ubiquinone/ubiquinol controversy.

The Recrystallization Problem: Many CoQ10 products on the market have abysmally low rates of absorption. Here's the problem. The melting point of CoQ10 is about ten degrees higher than human body temperature, which is 98.60F. Hence, most coenzyme Q10 products crystallize in the softgel capsule after cooling to room temperature. Even CoQ10 products that are dissolved in oil by heating to 50 degrees centigrade recrystallize in the softgel capsule when cooled to room temperature. Crystals consist of many millions of single CoQ10 molecules. Humans can't absorb crystals. We can only absorb single molecules of any substance. This explains why CoQ10 products on the market do not achieve significant increases in plasma CoQ10 levels compared to that of the pure crystal free CoQ10 products.

^{Crystal Free Coenzyme Q10:}
Crystal free CoQ10 is the new era in the CoQ10 industry. The dry powder CoQ10 entered the marketplace in 1974 as a comp softgel product. These were crystalline CoQ10 in an oil and water base. When CoQ10 was deregulated from a drug to a natural product in Japan the consumer market in Japan increased so significantly that the CoQ10 producers in Japan could not meet the world demand. The price of CoQ10 increased from $800 to $4500 a kilogram. In the USA almost no one could afford the CoQ10. Thus, the need for a more highly absorbable CoQ10 that could offset the poorly absorbed CoQ10 and its high price.

Three companies in the USA took the challenge and started developing a crystal free CoQ10 product between 2002 and 2006. All three products had different solvents and were crystal free at an encapsulation temperature of 50 degrees centigrade. Their single dose absorption was between six and eight percent of a 100 mg dose. However, when the capsules cooled to room temperature, two of these products recrystallized and the absorption and steady state bioavailability was no better than a crystalline CoQ10 in a lipid based softgel.

The higher absorbable CoQ10 and steady state bioavailable allows the consumer to attain the health benefits for the clinical conditions describes in Part I of this series. Two of the developed products were unstable and recrystallized in the softgel capsule. One remained viable as a pure crystal free product.

A crystal free product at body temperature manufactured in Scandinavia was used in a major long-term clinical trial in Sweden. This trial has continued for over 10 years in thousands of patients (Ailhagen Sweden). In this study, the 10-year survival was 50 percent. In a multi-center study in 500 class III and IV congestive heart failure patients the 250 in patients on CoQ10 and conventional therapy has a heart failure mortality rate 56 percent less than the control group on conventional therapy only. In this study, the morbidity was 48 percent less and the degree of failure was 58 percent less than the control group. The CoQ10 treated patients admitted to the hospital was 43 percent less than the conventionally treated patients (Q-symbio trial, Mortensen. Am J Clinical Cardiology. 2014). The new era of crystal free CoQ10 has proven that it has the potential to be effective in the management of congestive heart failure, age related degenerative diseases such as cancers, chronic fatigue, Parkinson's disease and high blood pressure.

The newest and most stable of the crystal free products, and the new therapeutic era for CoQ10 in the USA is marketed by the Cyto Health Company. It will soon be in the USA marketplace. For more information please call 941-920-2824.

1. Saini R. Coenzyme Q10: The essential nutrient. J Pharm Bioallied Sci. 2011 Jul-Sep;3(3):466-467.
2. Bliznakov E. (1986) "The Miracle Nutrient: Coenzyme Q10." New York. Bantam Books.
3. 1995 Merck
4. 1996 Duke Univ.
5. 1997 North Carolina Univ
6. Lockwood K, et al. Partial and complete regression of breast cancer in patients in relation to dosage of coenzyme Q10. Biochem Biophys Res Commun. 1994 Mar 30;199(3):1504–8.
7. 1996 Judy and Folkers
8. 1984 Judy and Toth
9. John AP. Dysfunctional mitochondria, not oxygen insufficiency, cause cancer cells to produce inordinate amounts of lactic acid: the impact of this on the treatment of cancer. Med Hypotheses. 2001;57:429–31
10. Weigel, H. Plant quality declines as CO2 levels rise. eLife 2014;3:e03233.
11. Aktar, W, et al. Impact of pesticides use in agriculture: their benefits and hazards. Interdiscip Toxicol. 2009 Mar;2(1):1–12.
12. Karmas E, Harris RS. (Dec. 2012) Nutritional Evaluation of Food Processing. Springer Science & Business Media
13. Pelton R, et al. (2001) "The Drug-Induced Nutrient Depletion Handbook." Macedonia, Ohio. Lexi-Comp.
14. Bliznakov E. (1986) "The Miracle Nutrient: Coenzyme Q10." New York. Bantam Books.

I’m being sarcastic, right? The official health wisdom — the wisdom everybody knows is right (because all the top health officials repeat it over and over again) — is that if you “restrict” the salt in your diet, you’ll live longer.

That’s because (once again, according to those official pronouncements) your blood pressure will be lower, putting you at less risk for a heart attack or stroke, the #1 and #3 causes of death in the U.S.

There’s only one problem with that widespread “health wisdom,” as I’ve been telling my patients and readers for many years. It’s not true! And a recent article in the May 4, 2011 issue of the Journal of the American Medical Association is the latest evidence to run counter to the medical (and mistaken) myth of “Low Salt Good, High Salt Bad.”

Low-Salt Diet = 4X Death Rate From Heart Disease
The study was conducted by researchers at the University of Leuven in Belgium. First, they measured the urinary sodium levels of 3,681 healthy people in their 40s. Then they tracked their health for the next eight years. The folks with the highest urinary sodium levels — a sign of a higher dietary intake of salt — had the lowest risk of developing heart disease. Looked at another way, the low-sodium folks had four times the rate of dying from heart disease, compared to the high-salt folks.

The conclusion of the researchers was straightforward: “Our current findings refute the estimates of lives saved and health care costs reduced with lower salt intake. They do not support the current recommendations of a generalized and indiscriminate reduction of salt intake.”

The recommendations they’re talking about are those from the American Heart Association (AHA), which suggests you limit your intake of salt to 1,500 milligrams (mg) per day — way down from the 4,000 or so mg most of us eat every day.

What did the study researchers have to say about the lowsalt pronouncements of U.S. heart honchos? Yes, they agree, salt restriction may be a good idea if you already have high blood pressure or congestive heart failure. But for the rest of us? Previous scientific research has overestimated the effect of salt intake on healthy people, they say. And, they point out; hardly anyone actually achieves the level of salt restriction suggested by the AHA — a sign that the salt-needing body naturally triggers you to eat more salt when you try to cut back.

Of course, this isn’t the first study to report that salt isn’t bad for you. (And, in fact, it’s good for you.) Many other studies say the same thing.

Food poisoning bacteria E. coli and Salmonella certainly inflict misery and, in weakened persons, can be deadly. Fortunately, after the nausea and diarrhea run their course, they are not heard from again unless we eat something contaminated.

H. pylori (Helicobacter pylori) also affects the stomach but is more deadly and long-lasting. It can lead to ulcers that claim 9,000 Americans yearly and stomach cancer that kills 11,000. H. pylori is not in the news despite being the world's most common bacterial infection—it stays under the radar because it acts slowly.

You might suspect an H. pylori infection if you have one or more of these issues: heartburn, stinky breath (without a serious gum problem), bloating, stomach pain, or nausea or vomiting an hour or so after a meal. It also interferes with our stomach acid; so you should be concerned if you also have symptoms of stomach acid deficiency listed in my book. (Osteoporosis is one example.) H. pylori is also believed to be involved in migraine headaches, rosacea, one type of arthritis, anemia, B12 deficiency, glaucoma, heart disease, atrial fibrillation, asthma, and morning sickness.

In spite of all those potential clues, doctors do not usually test for H. pylori unless the patient has a raging ulcer. It is too typical in our medical system to just treat each symptom individually with a prescription drug. Third-party payers don't reimburse physicians for the time needed to analyze history and test for an underlying cause, and waiting for the system to change probably isn't a viable option. There is much we can do ourselves though, and prevention is always better than the most enlightened treatment.

H. pylori prevention raises two obvious questions: why don't all people who are exposed become infected? And why do only one in six who harbor H. pylori come down with a diagnosable stomach disease? We know that H. pylori bacteria are transmitted through tainted food or water, so improved sanitation reduces exposure. However, its ability to infect and cause trouble depends largely on the condition of the potential host (that's us).

For example, two-thirds of stomach cancer cases occur in people over age 65. That is when our bodies begin to exhibit the accumulated insults of smoking, alcohol excess, unsatisfactory diet, stress, toxic buildup, and medication usage. (Note that alcohol excess is an H. pylori risk, but moderate alcohol is actually protective—apparently it sterilizes the stomach.) Those who eat the most smoked and highly salted foods, but few fruits and vegetables, are also at higher risk to stomach cancer.

A key protector against H. pylori is sufficient stomach acid. Stomach acid is our first line of defense against invaders but typically declines after age 50. That's coincidentally when the risk of H. pylori infection goes up. Acid-blocking drugs like Nexium and Prilosec purposely deplete stomach acid. Not surprisingly, folks who regularly take that type of drug are at much greater risk for dying of pneumonia! A second line of defense is our beneficial bacteria called probiotics. These good guys compete with the bad guys for space and food and they attack pathogens with natural anti-bacterial chemicals.

Individuals who have healthy gastrointestinal mucous membranes do not become infected with H. pylori, or at least do not develop symptoms. To maintain that important barrier we must not only eat food rich in tissue-repair nutrients, we must also be able to digest and absorb those nutrients. Aiding proper digestion is another key role of friendly bacteria.

In fact, probiotics benefit almost every function in the body directly or indirectly. Our very life depends on the several pounds of good bugs that should live in our gut. They create vitamins (A, B1, B2, B3, B6, B12, K and Biotin); feed the gut lining; help digest food; detoxify dangerous substances; help remove hormone excess; help maintain healthy cholesterol and triglyceride levels; increase the number of immune cells; help cells reproduce normally; reduce inflammation and stimulate cell repair mechanisms. Knowing those fundamental functions, you can imagine the health trouble and potential for infection that ensues if the probiotics become weakened. There is one beneficial bacterial strain, TH10, which has been shown in the laboratory to be especially effective against H. pylori. TH10 is only contained in the probiotic system, Dr. Ohhira's Probiotics.

If you are suspicious that you may have an H. pylori infection, your doctor can use a diagnostic breath test. That type is more meaningful than a blood test, which doesn't indicate if the bug is still active. The standard medical treatment for H. pylori involves strong antibiotics. This is ironic since the general overuse of antibiotics has allowed H. pylori to develop into more resistant strains. The antibiotics also kill our probiotics—a side effect that can produce broad and lasting damage.

If a person is not in grave condition, it makes sense to me that he or she would first try the natural remedies listed below. If antibiotics are necessary, the natural remedies can still be added for their own benefits. At the very least, folks should protect themselves from the unwanted effects of the antibiotics by using probiotics. Probiotic supplements should be taken throughout the course of antibiotics (and after), but taken at a different time of day.

Other natural substances that help fight H. pylori are sulforaphane (found in cruciferous vegetables such as cauliflower, cabbage, kale, and broccoli), turmeric (the familiar yellow spice), mastic gum (a Mediterranean food ingredient from tree resin), ginger, cranberry, vitamin C, berberine (an herb constituent), DGL (a special form of licorice), and zinc carnosine (which also helps heal the GI membranes). Keep in mind the same items used as remedies can also be used for prevention.

More details about H. pylori diagnosis and current medical treatment options can be found on the Helicobacter Foundation website (www.helico.com).

For over 40 years the conventional medical establishment has been telling us that high cholesterol levels are the main cause of heart disease. However, many scientific studies have shown that this is not the case.

• A Massachusetts Institute of Technology study examined the scientific literature on cholesterol and could not find one study with a clear cause and effect relationship between cholesterol and heart disease. Many similar studies have now confirmed this fact.
• Dr. Stephen Sinatra published a book entitled The Cholesterol Myth in which he recounts the original research on cholesterol over 50 years ago when 45 out of 50 studies could not find a clear connection between cholesterol as the cause of heart disease.
• Dr. Mark Hyman reviewed the literature on the effectiveness of statin drugs, the number one cholesterol medication, and determined that 150 people would need to take the drug before one person would live longer than they would have without taking the drug.

Yes, statin drugs do lower cholesterol, but it is very clear that they do not save many lives. And, this would seem to answer the question in the title of this article, that people still experience heart attacks even if they have perfect cholesterol. In fact, 50 percent of people who experience a heart attack have perfect cholesterol levels. So, if cholesterol is not the cause of heart disease, what is? There are several factors, but probably the main one is the presence of inflammation in the body. Inflammation can be caused by many factors including the following:

• Nutrition- eating eggs, dairy, animal protein, sugar, processed foods and non-organic foods.
• Toxins- chemicals in the air, water and food that we consume.
• Genetics- some people make fewer enzymes than needed, make too much cholesterol in their livers or have weaknesses in their arteries.
• Exercise- many people do not get enough exercise, which is needed to help arteries expand and contract.
• Stress- many people are overstressed, which causes the body to make cortisol, a hormone that can damage our arteries.
• Poor diet- beyond the bad foods mentioned above, many people simply do not eat enough nutritious food and are deficient in vitamin B, vitamin C, vitamin D, vitamin E, Omega 3 fats, magnesium and many other nutrients that are important for the heart and cardiovascular system.

Many of these causes contribute to the development of inflammation in the body due to the oxidative process. When we consume or are exposed to unhealthy foods, toxins, stress or acidic foods, free radicals are created. These molecules have a missing electron, which steals an electron from one of our healthy cells. This creates a pothole in our arteries that must be repaired as soon as possible. The patching material is made in the liver and it is called, you guessed it, cholesterol. So, cholesterol is at the scene of the so-called crime, performing a very important function. Cholesterol also helps to make vitamin D3 and many other biochemicals. Lowering cholesterol too much can actually cause serious health issues in many parts of the body. This patching process could be completely avoided if people consumed enough antioxidants that can give back the missing electron that is often needed. And, where are these antioxidants found? They are in the more nutritious foods such as fruits, vegetables, nuts and seeds with high levels of vitamin C, vitamin E, selenium, zinc, and astaxanthin.

Based on this initial assessment on the cause of heart disease here are some beginning strategies.

• Eat a diet, such as the Mediterranean Diet, with an emphasis on vegetables, fruits, nuts, and seeds.
• Exercise at least 45 minutes every day with aerobic, strength and flexing included.
• Manage stress with avoidance, meditation, yoga, music, deep breathing, etc.
• Do not drink tap water due to the presence of fluoride and chlorine.
• Take nutritional supplements to optimize key nutrient levels such as vitamin C, vitamin D, magnesium, vitamin B, and Co-Enzyme Q10. These, and other, heart-friendly nutrients are deficient in the diets of a majority of people in the United States.
• And, if you want to take control of your personal health, and reduce the risk of ever having a heart attack, make sure you get the right tests to determine if you are beginning to move in that direction.

Most people get their blood tested as part of the health insurance program provided by their employer.

Others, who are not employed must arrange for tests on their own through Medicare or via personal health insurance plans. In any case, these tests are not usually adequate because of cost restrictions, or doctors who are not aware of the best blood tests to utilize. Here is an explanation of these blood test alternatives.

Tests usually provided in common situations:

• Cholesterol- usually total cholesterol, LDL cholesterol and HDL cholesterol
• Glucose- either total glucose or A1C glucose (fasting level)
• Insulin- total insulin (fasting level) • Triglycerides- total triglycerides

Tests often added by personal request from the patient, or a progressive doctor:

• Hormones- either the male or the female panel
• C-reactive protein- measures the level of inflammation in the body
• Homocysteine- measures the level of vitamin B6, vitamin B12 and folate (methylators)
• Cortisol- measures the level of stress in the body
• RBC magnesium- this test is superior than current magnesium tests
• Glucose tolerance- this test can identify cellular sugar challenges five to seven years earlier

Tests rarely provided due to high cost and lack of awareness of their importance:

• INR- measures the thickness of the blood and thus the likelihood of clots forming
• Omega 3- measures the level of this healthy fat in the body
• CoQ10- measures this enzyme important for energy production and providing the DNA in our cells
• Heavy metals- measures the level of these dangerous toxins in the body
• Apolipoprotein B- measures the level of this early warning protein before LDL increases
• Galectin 3- measures Galectin levels which is an early warning marker for heart disease and cancer
• TMAO- trimethylamine N-oxide is a bacteria produced compound that measures the amount of choline in the body, which is known to contribute to the production of blood clots and plaque.

Many people might look at these tests and say why should I pay hundreds of dollars to get all of these tests? The answer could be that you probably only need to have these tests done every three to five years, depending on your age and health status. The more important reason would be that these tests could provide an early warning system, five to ten years earlier, for the future development of heart disease. By getting these tests every three to five years, and following the lifestyle guidelines previously mentioned, there is a high probability that you will never experience a heart attack or a stroke in your long and healthy lifetime.

When people read an article like this many will ask questions such as, “don’t I get all of the nutrients I need from the food I eat” or “can I take one pill to get all of the nutrients that are not in my food?” The answer to both questions is NO! It is virtually impossible to get all of the nutrients we need from food alone. In a study by the National Cancer Institute of over 16,000 people aged 2 to 80, the researchers could not find one person with a truly healthy diet. In fact, vast majorities were deficient in 11 out of 14 nutritional categories. They were not eating enough vegetables, fruits, healthy fats, nuts, and seeds. This is due to declining nutrients in the soil, over processing of foods, poor selection by shoppers, overcooking, poor chewing and compromised digestive systems. People are simply not getting the nutrients they need to sustain the healthy functioning of their cells. That is one of the main reasons why the number of adults with a chronic illness has increased from 10 percent over 60 years ago to nearly 70 percent today. When cells do not get the nutrients they need they go through a gradual deterioration process in five stages, as shown on the following page.

The recommended blood tests can identify changes in the body’s chemistry at the stressed and weakened stages of cellular deterioration, five to ten years before more serious problems develop.

A strategy to prevent and even reverse heart disease
Some people are very interested in avoiding heart disease, stroke, and other cardiovascular illnesses. They eat what they think is a healthy diet; they exercise as much as they feel is necessary; they avoid stress; they take nutritional supplements, and they get their blood tested every year. These are all good lifestyle decisions, as far as they go. However, as we have seen in this article these steps may not be sufficient to prevent heart disease or some other chronic illness. The blood tests that have been recommended can help to provide an early warning mechanism for anyone, which can then be augmented with nonbiochemical tests such as thermography, MRI for the carotid artery evaluation, and even a CT scan if it is deemed necessary. (Excess radiation exposure should be factored in.)

Nutritional superstars for the heart and cardiovascular system.
Conventional medicine will tell you that there is no science to support the use of nutritional supplements to improve your heart and circulation system. They even have a web site that repeats these erroneous messages on a regular basis. However, this is absolutely not true and there are thousands of clinical studies to prove that nutritional supplements help to prevent chronic illness and often reverse it. Some good sources for these studies are Life Extension Magazine, GreenMedInfo, Metagenics, and books entitled “The Encyclopedia of Natural Medicine” and “The Prescription for Nutritional Healing.” There are over 40,000 scientific studies that prove nutritional supplements work very well, but the pharmaceutical industry does not want you to know that. Here are the top ten nutrients you should look into to protect your body from heart disease.

1. Co-enzyme Q10- protects our cellular nucleus and improves energy production in mitochondria.
2. Magnesium- is the transport agent for all glucose and insulin into the cell, to make energy.
3. Vitamin C- is the key antioxidant for reducing free radicals that cause damage to our arteries.
4. Vitamin D- regulates calcium levels, which impacts how nerves carry messages to the heart.
5. Resveratrol- protects blood vessel walls and promotes healthy levels of LDL and HDL.
6. Garlic- controls blood pressure, encourages blood vessels to stay open and slows plaque build-up.
7. Pycnogenol- helps thin the blood and control levels of dangerous choline in the body.
8. Omega 3 oils- reduces apolipoprotein B, triglycerides, and VLDL, all heart challengers.
9. Vitamin B- niacin (B3) lowers LDL and triglycerides; increases HDL and improves circulation. Vitamin B6, B12 and folate lower homocysteine levels (inflammation).
10. Modified citrus pectin- reduces heavy metals, lowers cholesterol, removes plaque and helps keep Galectin 3 levels in balance. Also, lowers PSA levels. Prevents cancer and kills cancer cells.

These nutrients perform many other useful functions to help keep our bodies healthy. CoQ10 helped reverse kidney disease in one study. Magnesium helps to prevent and reverse type 2 diabetes. Vitamin C treats many cancers effectively. Vitamin D3 reduces the risk of breast cancer by 77 percent and prostate cancer by 83 percent. These are truly the superstars of nutritional supplements. There are many other effective nutrients for heart health, and there is excellent science behind each and every one of them. This is merely a snapshot of what is possible in terms of improving someone’s ability to develop an evidence-based strategy for optimum heart health. Now you can complete this journey to better health by researching the recommendations presented here and working with your health care providers to find the best future strategy for you.

Face it. Life is a balancing act. Between work, relationships, parental duties, staying fit, academic efforts, maintaining friendships, community involvement and personal fulfillment, it’s a wonder most of us can even find time to catch our breath. Yet we soldier forward with all our obligations and commitments because we have to, and in most cases, we want to. But when life gets so hectic the stress of it all impacts our mental and physical well-being, it’s time to take action.

Becoming familiar with the ways different types of stress can affect our minds and bodies, specifically our immune system, as well as learning about the available tools that have been clinically proven to manage the impact of stress on the immune system, are proactive steps toward keeping healthy. Lessening the impact of harmful invaders on our immune system entails not just strengthening it to combat the bacteria and viruses that cause common illnesses, but also ensuring that our immune system’s response to such external stimuli as allergens is not too strong—as asthma and other long-term health implications can result. In short, keeping our immune systems in check, but more importantly, in balance, is imperative to our overall health.

How Stress Affects the Immune System
While many aspects of our daily lives can negatively impact our immune systems—a less-than-optimal diet, travel, pollution, changing seasons, overexertion during exercise, lack of sleep and even the normal aging process—stress can also interfere with a healthy immune system.

Certain physiological changes occur to help an individual cope with stress. Chronic activation of the neurological pathways associated with stress result in the production of hormones and neurotransmitters/ chemicals, which then alter the function of certain cells of the immune system. These altered cells cause the immune system to respond improperly, either by over-responding or under-responding, to bacteria, viruses, allergens, fungi and parasites.

In addition to impacting the human immune system, stress that is mismanaged and remains too high for prolonged periods of time can lead to a variety of symptoms associated with very serious illnesses, including heart disease, anxiety disorders, high blood pressure, coronary artery disease, respiratory disorders, accidental injuries and cirrhosis of the liver. Stress has been linked to all of these illnesses, all of which are leading causes of death in the United States.

Types of Stress
There are certain types of stressful events and situations called “stressors” that our bodies react to in different ways. Surprisingly, not all types of stressors negatively affect us. “Acute stressors” are time-limited and temporary. Public speaking and academic testing are examples of short-term stressors that temporarily boost, or over-stimulate, the immune system. The body quickly adapts itself to respond to short-term stressors through the “fight or flight” response by releasing such chemicals as adrenaline that enable our pupils to dilate, our awareness to intensify, our sight to sharpen, our impulses to quicken and our immune system to mobilize and increase activation. Much of the time increased immune system activity is a benefit to us, as it helps to ready the body for challenges, but in some cases an over-reactive immune system can result in allergies, asthma, chronic inflammation and autoimmune diseases.

“Sequential stressors” include major events that give rise to a series of related challenges, such as the loss of a spouse or a natural disaster. “Chronic stressors” are ongoing, persuasive demands that force people to restructure their identity or social roles and have no end in sight. Examples of such stressors include caring for an aging spouse or elderly parent, being victim of an event that leads to a permanent disability or fleeing a third-world country because of violence or war.

Both sequential and chronic stressors suppress, or under-stimulate, the immune system, leaving the body open for attack and more vulnerable to illness. Other manifestations of these types of stress include: fatigue and exhaustion; headaches or migraines; neck and back pain or stiffness; gastrointestinal problems (nausea, diarrhea, constipation or colitis); chest pains or palpitations; sleep disturbances; family conflicts; job tensions; and a change in sexual energy.

A Tool for a Balanced Immune System: EpiCor
While we may be able to employ various proven tactics to reduce our stress level, such as exercise, meditation, acupuncture and/ or massage therapy, the fact remains that certain amounts of stress will be present in our lives; especially in today’s increasingly over-scheduled society. So, if escaping our stressors is not an option—and for most of us it’s not—we may need some extra help in keeping our immune system in balance while we deal with daily stress.

One such all-natural tool that can be used in this capacity is a product called EpiCor™, which is comprised of metabolites that nourish and balance the body’s immune system. EpiCor strengthens resistance and maintains wellness before immune health issues develop by helping the body modulate its immune response.

Just like the medical breakthroughs penicillin and X-rays, EpiCor was discovered by accident! When the parent company experienced minimal health insurance premium rate increases several years in a row and the incidences of employees using sick days were rare, a series of scientific studies were conducted. Findings confirmed that production workers who had been exposed to the ingredient experienced significantly higher immune activity than those workers who had not been exposed. EpiCor is unique in that just one 500 milligram capsule per day helps the immune system stay strong and healthy through balance. A strong immune system is not one that has only been stimulated or boosted. Those actions can certainly be helpful at specific times, but as we have just learned, there are times that the immune system can over-respond, leading to health issues. A strong immune system is one that is balanced and can respond appropriately, depending on the situation at hand. These two actions—boosting and suppressing—constitute EpiCor’s proven methodology known as “immune balance.”

Research on EpiCor and What it Means to Us
Unlike so many other immune health supplements, a bevy of scientific research supports EpiCor’s effects on the immune system. Favorable efficacy profiles have been observed for Epi- Cor in clinical trials, and studies at the cellular (in vitro) level have suggested its mechanisms of action. Multiple toxicological studies have been performed that prove the safety of EpiCor. In addition to finding that EpiCor has no contraindications, ongoing research has also confirmed EpiCor fights free radicals through its high antioxidant activity and helps to manage inflammation.

Most recently, a published study found that EpiCor has a significant impact on the incidence and duration of the common cold and flu. Specifically, this randomized, double-blind, placebo-controlled clinical trial found that taken once a day, a 500 milligram EpiCor capsule significantly decreased the incidences of cold and flu symptoms as well as observable symptom duration. These results translate into fewer sick days for people taking EpiCor, which is of great importance to American businesses dealing with health care costs, employee sick days and lost revenue.

Now think of what this research on EpiCor means for our personal overall health which, as we have learned, is directly affected by our stress levels. If we are healthy, we are not staying home sick from work and falling behind. If we are healthy, we are more likely to be fully engaged when interacting with our partners, children and friends, thus strengthening those relationships instead of aggravating them by being over-stressed and irritable. If we are healthy, we have more physical energy to participate in personal fulfillment activities that interest us and allow us to decompress, such as gardening, cooking, exercising and reading. And finally, if we are healthy, we are not spending money on medial deductibles, treatments or unnecessary prescriptions, which is a major concern according to the American Psychological Association’s (APA) recent national survey reporting that money is the leading cause of stress for 75 percent of all Americans. The APA also found that 77 percent of people suffering from stress reported physical symptoms including fatigue, headache, upset stomach, muscle tension, change in appetite, teeth grinding, change in sex drive and feeling dizzy.

Sound familiar?

Isn’t it time we broke this vicious stress-illness cycle? Keeping our immune system balanced is the first step. In addition to giving our immune system the very basic things that help to keep it healthy—good nutrition and plenty of sleep—there are other things we can do to support it as well. One such thing is EpiCor. As an all-natural, safe and economical way of supporting the immune system, EpiCor just may be the key to a balanced and healthy life.

• Jensen, G, et al. An anti-inflammatory immunogen from yeast culture induces activation and alters chemokine receptor expression on human natural killer cells and B lymphocytes in vitro. Nutrition Research (2007), 27:6, 327–335.
• Moyad, M, et al. Effects of a modified yeast supplement on cold/flu symptoms. Urologic Nursing (2008), 28:1, 50–5.
• Padgett, DA, et al. How stress influences the immune response.
• TRENDS in Immunology (2003), 24:8, 444–8. Segerstrom SC, et al. Psychological stress and the human immune system: a meta-analytic study of 30 years of inquiry. Psychological Bulletin (2004), 130, 601–30.

Dear Readers,

Happy Father's Day

Welcome to the June 2019 issue of TotalHealthOnline Magazine.

Charles K. Bens, PhD, asks “Is Cholesterol The Cause Of Heart Disease?” Statin drugs do lower cholesterol, but it is very clear that they do not save many lives. And, this would seem to answer the question in the title of this article. The main cause is the presence of inflammation in the body. Inflammation can be caused by many factors including the following: nutrition, toxins, genetics, exercise, and stress. Read Dr. Ben’s recommendations on what you can do to protect your heart.

Gene Bruno, MS, MHS, RH(AHG), presents “Organic Foods: Are They Really Better?” Bruno explains the difference between non-organic and organic food, the farming, and the food production. The conclusion reached is yes—organic foods are more expensive but when you look at the big picture—if a person can afford the prices—the organic food is healthier for you, your family and the world environment. Thank you Gene for your take on the subject.

“Smart Tips: Estrogen,” by Ann Louise Gittleman, PhD, CNS. If you are a follower of Dr. Gittleman you know she is a fan of flax seed. She explains the benefits to the body, how to prepare it and how to incorporate flax into your diet. Smart Fats are one of the top strategies for natural hormone therapy. You will not be disappointed with her sharing her expertise with you.

Sherrill Sellman, ND, reports on skin care in “Yes, You Can Create Youthful Skin at Any Age.” Many skin and personal care products contain many of the 10,500 toxic chemical ingredients that have been known to cause inflammation, free radical damage and aging to the skin. Become an educated consumer and choose only the purest products. It sounds familiar to other articles in this issue. A more youthful appearance is possible for all of us. Nourishing our skin with an organic diet, adequate water intake, plenty of rejuvenating sleep, regular exercise and daily de-stressing strategies are the foundation for healthy skin.

Gloria Gilbère, CDP, DAHom, PhD, contributes “Crust-Less Zucchini Spinach Quiche.” In addition Gilbère offers several variations in the recipe as well as several serving suggestions. The article is followed by her new cookbook and video offer free to our readers.

Shawn Messonnier’s, DVM, topic this month is "Parvovirus in Pets". Commonly it affects young puppies. Certain breeds such as Doberman Pinschers, Rottweiler’s, Pit Bulls, and Labrador Retrievers may be more severely infected than others.

Thank you to our authors, readers and advertisers. You make TotalHealthOnline possible.

Best in health,

TWIP—The Wellness Imperative People

Click here to read the full June 2019 issue.

• Is Cholesterol The Cause Of Heart Disease?
  Charles Bens, PhD
• Organic Foods: Are They Really Better?
  Gene Bruno, MS, MHS
• Yes, You Can Create Youthful Skin at Any Age
  Sherrill Sellman, ND
• Smart Tips: Estrogen
  Anne Louise Gittleman, PhD, CNS
• Crust-Less Zucchini Spinach Quiche
  Gloria Gilbère, CDP, DAHom, PhD
• Parvovirus In Pets
  Shawn Messonnier, DVM

Click here to read the full June 2019 issue.

Garlic, a popular culinary herb, has been used as a medical remedy in traditional medicine, for centuries and confirmed for its protective health benefits in current medical science. The intake of fresh garlic, in amounts needed for its health efficacy is accompanied by side effects of unpleasant odor that lingers on the breath and skin and potential gastrointestinal adverse effects of diarrhea and flatulence. Thus, many shun this important herb and are deprived of its benefits.

An important and effective alternative was developed by the Wakunaga Company, originally in Japan and now also as Wakunaga of America, in California. The company manufactures Kyolic® Aged Garlic Extract (AGE™), an odorless supplement that has been shown in over 700 peer reviewed scientific and medical publications to have the health benefits of fresh garlic and often even a higher efficacy, without any of the side effects of the fresh bulb.

While the health benefits of AGE are many, helping protect against cardiovascular disease, neurodegenerative disease, some forms of cancer, and has anti-aging and anti-inflammatory effects, this article will focus on the cardiovascular benefits as proven in research and in the clinic.

Aged Garlic Extract
Aged garlic extract is manufactured from organic fresh garlic, by extraction and aging for 20 months at room temperature. The result is a highly bioavailable odor-free supplement, rich in organosulfur compounds, largely water soluble, such as S-allyl Cysteine and S-allyl meractocysteine (unique to AGE), as well as other substances with antioxidant activity, including oil soluble organosulfur compounds, allixin, selenium, saponins and flavonoids. AGE is a supplement with high quality control, standardized by S-ally cysteine, its key compound.

Risk Factors for Cardiovascular Disease
Risk factors for cardiovascular disease include oxidative stress, elevated LDL cholesterol and triglycerides, low HDL (the good cholesterol), hypertension and high homocysteine; being overweight also increases risk.

High LDL cholesterol promotes inflammation in the arteries, causing further accumulation of cholesterol in the arterial walls; this in turn produces more inflammation. Eventually the deposited cholesterol hardens into a plaque, which can rupture and lead to blood clots that cause heart attacks and strokes.

Oxidant Stress
Reactive oxygen species and oxidant stress are implicated in cardiovascular diseases. Oxidative damage to DNA, proteins, lipids, and other molecules rank highly as a major cause in the onset and development of these diseases. Reactive oxygen species, including free radicals, that are the cause of oxidant stress, in the absence of enough antioxidants, are byproducts of normal metabolism and increase during infection and inflammation, elevated homocysteine and exposure to exogenous sources, including environmental pollutants, smoking, certain drugs (e.g., acetaminophen), and radiation.

AGE and Cardiovascular Disease
AGE, with its antioxidant activities, has been shown to modulate cardiovascular risk factors in both clinical and preclinical settings. AGE has been found to reduce blood pressure, inhibit platelet aggregation and adhesion, lower LDL and elevate HDL cholesterol, reduce smoking-related oxidative damage, inhibit the production of prostaglandins involved in inflammation, and lower homocysteine. S-allyl cysteine has been found to lower cholesterol by deactivating the enzyme involved in cholesterol synthesis (3-hydroxy-3-methylglutaryl-CoA) by as much as 41 percent. AGE efficacy in reducing cholesterol synthesis is additive with statins. Other possible contributors to protection against cardiovascular disease are the effects of AGE in increasing microcirculation and protecting the lining of arteries, (endothelial cells) from oxidative damage, a factor notably important in diabetes, where microvasculature is damaged and the risk of heart disease is high. AGE can also temporarily increase, by 30–40 percent, the synthesis of cellular nitric oxide that helps regulate blood pressure. Major findings have shown that AGE inhibits the progression of coronary-artery calcification, thus reducing the risk of a myocardial infarct.

Calcification and Heart Disease
Calcium deposition in the walls of coronary arteries is an active process. Calcification is an early feature of atherosclerotic plaque formation, beginning with fatty-streak formation and continuing throughout the development of the plaque, resulting in a narrowing of the arteries.

Studies by Dr. Matthew Budoff and colleagues at the University of California (UCLA) have shown repeatedly in a number of placebo-controlled randomized clinical studies, that AGE significantly reduces the progression of plaque formation compared to placebo, as determined by serial coronary artery calcium measurements, as described below. Other findings in patients taking AGE showed improved endothelial function, reduced LDL cholesterol, a lowering of an inflammation marker C reactive protein, and homocysteine and improving HDL cholesterol. The investigators concluded that the study, “helps establish garlic therapy as an anti-atherosclerosis therapy in patients with, and without coronary artery disease.”

The early one year study by the Budoff group on the role of AGE in plaque progression, was a placebo-controlled, double-blind, randomized pilot study to determine if atherosclerotic plaques, detected by electron beam tomography, will progress at a different rate with the intake of AGE, as compared with a placebo. 19 patients (14 men, five women, mean age of 59.9 ± 10.5 y) completed the study. Subjects received either 1200 mg AGE a day or the equivalent amount of placebo. The patients were on statin therapy and aspirin during the study. The blood marker used for compliance was S-allyl cysteine, the major active compounds in AGE, considered the only reliable human compliance marker in studies on garlic consumption.

The results of this yearlong study showed that patients taking AGE had an absolute change in the calcium score, (indicating plaque progression) of 45.2 +/-57.2, while the placebo group was 129.0 ± 102.1, significantly greater than the AGE group. All patients in this study were on statin therapy, meaning that the improvement seen by the intake of AGE was additive to the benefit of statin therapy. Plaque progression was at a rate of 22.2 percent per year in the placebo group, while the intake of AGE reduced progression to 7.5 percent. In the most recent study, presented by Dr. Budoff's group at the American College of Cardiology's 64th annual scientific meeting, in May 2015, the investigators pooled four placebo-controlled, double-blind, randomized studies to examine AGE's effect on blood pressure as well as progression of calcification. The studies involved 161 people, randomized to take, daily, either 1000 mg AGE or placebo, for one year. Blood pressure was checked at the beginning and end of the study. Testing was done to examine coronary artery calcification.

One year later, the UCLA researchers found a reduction in blood pressure in the subjects taking AGE; AGE also inhibited the progression of coronary artery calcification by 1.78 fold, compared with placebo, over the course of the study. The principal investigator, Dr. Matthew Budoff, stated, "these new findings provide cardiologists and internists with an additional tool for patients who are at a high risk of cardiovascular disease. It also gives patients with mild to moderate cardiovascular disease a proactive way to reduce those risk factors."

Homocysteine
Elevated homocysteine damages endothelial cells that line blood vessels and induces thrombosis that can lead to heart attacks and stroke. Homocysteine produces breaks in DNA and induces apoptosis, a programmed cell death. Consumption of AGE has been shown to reduce homocysteine levels. In a preclinical study, levels of homocysteine in a 4-week folatedeficient diet containing AGE were compared with a folatefortified diet containing AGE. Plasma homocysteine was 30 percent lower in the folate-deficient models that received AGE, but not in those with adequate folate. The results suggest that AGE may serve as an added treatment in hyperhomocyteinemia. A clinical study, showing that AGE inhibits the progression of coronary artery calcification, also showed a trend in lowering homocysteine levels.

Age And Inflammation
Prostaglandins, play a key role in Inflammation, a risk factor in heart disease as well as other pathological conditions, including neurodegenerative disease and cancer. In a study by Rahman and colleagues the role of AGE in modifying prostaglandins was tested in smokers and non smokers. At the start of the trial, the plasma concentration of prostaglandin 8 iso PGF2ƒ¿ was about 58 percent greater in smokers than in nonsmokers. A 14 days supplementation with AGE resulted in a 35 percent reduction in the plasma prostaglandin in smokers, and a 29 percent reduction in non smokers.

The prostaglandin studied plays a role in cardiovascular disease by increasing the stickiness and adhesion of platelets, thus increasing the risk of plaque formation, constriction of arteries and atherosclerosis; the prostaglandin has been shown to be present in increased amounts in human atherosclerotic vascular tissue compared with healthy tissue. The decrease in 8 iso PGF2ƒ¿ following AGE intake supports earlier findings of AGE decreasing platelet aggregation. This study further confirmed that dietary supplementation with AGE with its powerful antioxidant capabilities, can protect against heart atherosclerosis and heart disease, which are associated with increased oxidative stress and inflammation.

Bottom line
Kyolico Aged Garlic Extract (AGE), a natural odorless supplement produced from organically grown fresh garlic, by Wakunaga of America has a wide range of health effects including the ability to lower the risk of heart disease. AGE has been shown in clinical studies to reduce atherosclerotic plaque formation, lower LDL cholesterol and triglycerides, decrease hypertension, prevent platelet aggregation, lower levels of homocysteine, and other inflammatory factors, including a critical prostaglandin. AGE taken daily can help reduce the risk of heart disease that is a major cause of death in our society.

1. Varshney R, Budoff MJ. Garlic and Heart Disease. J Nutr. 2016 Jan 13. pii: jn202333. [Epub ahead of print] Review.
2. Budoff M. Aged garlic extract retards progression of coronary artery calcification. J Nutr. 2006 Mar;136:741S.4S.
3. Allison GL, Lowe GM, Rahman K. Aged garlic extract inhibits platelet activation by increasing intracellular cAMP and reducing the interaction of GPIIb/IIIa receptor with fibrinogen. Life Sci. 2012 Dec 17;91(25.26):1275.80. doi:10.1016/j.lfs.2012.09.019. Epub 2012 Oct 13.
4. Dllon SA, Lowe GM, Billington D, Rahman K. Dietary supplementation with aged garlic extract reduces plasma and urine concentrations of 8-iso-prostaglandin F(2 alpha) in smoking and nonsmoking men and women. J Nutr. 2002 Feb;132:168.71.
5. Ide N, Keller C, Weiss N. Aged garlic extract inhibits homocysteine-induced CD36 expression and foam cell formation in human macrophages. J Nutr. 2006 Mar;136:755S.8S
6. Borek C. Garlic reduces dementia and heart-disease risk. J Nutr. 2006 Mar;136: 810S.812S.

Findings slated to be presented at the 5th Science of Nutrition in Medicine and Healthcare Conference in Australia, provide clear evidence that supplementing with AGE can effectively reduce blood pressure levels. In addition, AGE has a positive impact on arterial stiffness. The double-blind, placebo-controlled study, which was jointly conducted by Australia's National Institute of Integrative Medicine, Bond University, and the University of Australia, divided 88 patients with uncontrolled hypertension into two groups. One group was given 1.2 grams of AGE daily and the other was given a placebo. After 12 weeks, the researchers found that the patients taking AGE saw an average 11.5 mmHg reduction in their systolic blood pressure and an average 6.3 mmHg drop in their diastolic blood pressure compared to placebo. In addition, the study's authors note that AGE improved pulse wave velocity, a measure of arterial stiffness. The study also flushed out smaller benefits to the inflammatory marker TNF-α, total cholesterol, LDL cholesterol, and apolipoproteins—all factors that increase the risk of a future heart attack.⁴

Another study recently presented at the American College of Cardiology's 64th Annual Scientific Session & Expo lends further evidence to Aged Garlic Extract's ability to lower blood pressure. During the study, which was conducted at the Harbor-University of California, Los Angeles Medical Center, four placebo-controlled, double-blind, randomized studies were pooled to examine AGEs effect on blood pressure. The studies involved a total of 161 people who were randomized to take either 1,000 mg of AGE or a placebo daily for one year. All of the subjects had their blood pressure checked at the beginning and the end of the study. Testing was also done to determine the progression of coronary artery calcification. One year later, the UCLA researchers noted marked reductions in diastolic blood pressure among the participants who took AGE. Coronary artery calcification was also significantly lower in those who had taken the AGE supplements. In fact, AGE inhibited the progression of coronary artery calcification an average 1.78 fold compared to the placebo over the course of the study.⁵ These findings build upon previous research in the journal Maturitas which found that AGE reduced systolic blood pressure an average of 10.2 mm Hg compared to placebo, leading the researchers to conclude that AGE offers benefits similar to first-line medication used to treat uncontrolled hypertension.⁶

References

1. CDC: Vital signs: awareness and treatment of uncontrolled hypertension among adults—United States, 2003–2010. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6135a3.htm.
2. CDC: Deaths: Final data for 2009. www.cddc.gov/nchs/data/nvsr60/nvsr60_03.pdf.
3. Yoon SS, Burt V, Louis T, et al. Hypertension Among Adults in the United States, 2009–2010. NCHS data brief, no 107. Hyattsville, MD: National Center for Health Statistics. 2012.
4. Ried K, Travica N, Sali A. Aged Garlic Extract for hypertension and arterial stiffness: The AGE at heart trial. Scheduled for presentation at The 5th Science of Nutrition in Medicine and Healthcare Conference. Pullman Melbourne on the Park, Australia. May 2–3, 2015.
5. Hom C, Luo Y, Budoff M. The Effects of Aged Garlic Extract on Coronary Artery Calcium Progression and Blood Pressure. Presented at ACC.15 64th Annual Scientific Session & Expo. San Diego, CA March 14–16, 2015.
6. Ried K, Frank OR, Stocks NP. Aged garlic extract lowers blood pressure in patients with treated but uncontrolled hypertension: a randomized controlled trial. Maturitas. 2010;67(2):144–50.

Virtually everyone has stress. In fact, According to the Stress in America™ survey by the American Psychological Association,¹ 39 percent of respondents said their stress increased over the past year, and 44 percent said that their stress had increased over the past five years. The question is, how well do you handle your stress, how does it affect your life, and what can you do about it? The same Stress in America survey indicates the following percentage of Americans is only fair or poor at:

• Preventing themselves from becoming stressed (44 percent)
• Managing or reducing stress once experienced (39 percent)
• Recovering fully or recharging after they’ve been stressed (31 percent)

The ramifications of chronic stress include increases in illness, including headaches, heart disease, immune deficiencies and digestive problems. To a large extent, this appears to be due to an increased production of stress hormones and decreased immune function.²

So what can be done to help control stress and reduce its ill effects? The answer is really multifaceted and may include a program of diet, exercise, stress-management techniques such as yoga, and even psychological counseling. In addition, when stress rears its ugly head, nature’s chill pill, L-theanine may be able to help.

L-THEANINE’S MECHANISM OF ACTION
Asian cultures have often used teas for relaxation effects. The relaxing effect is, at least in part, caused by the presence of a neurologically active amino acid, L-theanine (gamma-ethyl-amino- L-glutamic acid). Tea has the reputation of having less caffeine than coffee but it is the L-theanine in the tea that lessens the stimulant effect of caffeine on the human nervous system. In the brain, L-theanine increases both serotonin and dopamine production³, and possibly GABA as well.⁴

Evidence from human electroencephalograph (EEG) studies show that it also significantly increases brain activity in the alpha frequency band which indicates that it relaxes the mind without inducing drowsiness. Alpha activity is also known to play an important role in critical aspects of attention. Research indicates that L-theanine has a significant effect on improving mental alertness while promoting relaxation.⁵

L-THEANINE AND RELAXATION
According to Mason, two small human studies⁶ showed that within 30–40 minutes of consuming 50 or 200 mg of L-theanine there is an increase of alpha wave activity/electrical signals produced by the brain. The perceived relaxation effect in the subjects coincided with the detection of alpha waves. This shows that L-theanine fosters a state of alert relaxation, which is consistent with the fact that anxious people have fewer or smaller alpha waves.

The journal Human Psychopharmacology Clinical and Experimental published a double-blind placebo-controlled study⁷ in which sixteen healthy volunteers received 200 mg L-theanine, a pharmaceutical anxiolytic or placebo. The results showed that L-theanine induced feelings of tranquility in the volunteers.

L-THEANINE, STRESS AND ANXIETY
The journal Biological Psychology published a double-blind, placebo-controlled study⁸ in which twelve participants underwent four separate trials: one in which they took L-theanine at the start of an experimental, stress-inducing procedure, one in which they took L-theanine midway, and two control trials in which they either took a placebo or nothing. The results showed that L-theanine intake resulted in a reduction in some physiological indicators of stress within 15 minutes, compared to the placebo or control condition. Moreover, analyses of heart rate variability indicated that reductions in heart rate were likely attributable to a reduction of sympathetic nervous activation, suggesting that L-theanine had anti-stress effects via the inhibition of cortical neuron excitation.

Similarly, a placebo-controlled study⁹ conducted with pharmacy students found that L-theanine (200 mg, twice a day, after breakfast and lunch) was effective at suppressing the initial stress response of students.

The Journal of Physiological Anthropology published a placebo- controlled study¹⁰ in which 14 participants took either L-theanine + placebo, caffeine + placebo, or placebo only (L-theanine 200 mg, caffeine 100 mg) while performing mental tasks and physiological activities under conditions of physical or psychological stress. The results showed that L-theanine significantly reduced anxiety and reduced the blood-pressure increase in high-stress-response adults. Caffeine tended to have a similar but smaller inhibition of the blood-pressure increases caused by the mental tasks.

The Journal of Functional Foods published a double-blind, placebo-controlled study¹¹ in which 18 normal healthy subjects were divided into two groups referred to as high anxiety propensity group and the minimal anxiety propensity group. Both groups received 200 mg L-theanine and placebo (at different times)(200 mg/100 ml water) and placebo (100 ml water) in a double-blind repeated measurement design protocol. When tested at 15–60 minutes after consumption, results showed significantly enhanced activity of alpha bands, descending heart rate, elevated visual attentional performance, and improved reaction time response among high anxiety propensity subjects compared to a placebo. However, no significant differences were noticed among subjects with a minimal anxiety propensity.

L-THEANINE AND MENTAL FOCUS
The journal Neuropharmacology published a double-blind, randomized, cross-over study¹² in which 27 participants received 100 mg L-theanine, 50 mg caffeine, a combination of the two, or a placebo. The results were that L-theanine and caffeine each significantly reduced error rates during a sustained attention task. It was noted that the combination of L-theanine and caffeine did not confer any additional benefits over either compound alone.

Another study¹³ examined “sensory gating.” Sensory gating describes the processes of filtering out redundant or unnecessary stimuli in the brain from all possible environmental stimuli. Being able to do this is obviously beneficial when you’re trying to focus on a mental task. In the study, L-theanine was given to 14 healthy subjects, and tests were conducted 90 minutes later. The results were that 200 mg and 400 mg significantly improved sensory gating.

CONCLUSION
Research shows that L-theanine is effective at helping to promote relaxation while reducing feelings of stress and anxiety. Furthermore, this amino acid is even helpful in promoting mental focus. Truly, L-theanine is nature’s chill pill.

1. American Psychological Association. Stress in America™: Our Health at Risk. Released January 11, 2012. 78 pgs.
2. Head KA, Kelly GS. Nutrients and botanicals for treatment of stress: adrenal fatigue, neurotransmitter imbalance, anxiety, and restless sleep. Altern Med Rev. 2009 Jun;14(2):114–40.
3. L-Theanine monograph. Alternative Medicine Review 2005;10(2):136-8.
4. Lu K, Gray MA, Oliver C, et al. The acute effects of L-theanine in comparison with alprazolam on anticipatory anxiety in humans. Hum Psychopharmacol Clin Exp 2004;19:457–65.
5. Nobre AC, Rao A, Owen GN. L-theanine, a natural constituent in tea, and its effect on mental state. Asia Pac J Clin Nutr 2008;17 Suppl 1:167–8.
6. Mason,R. 200 mg of Zen. Alternative & Complementary Therapies 2001; 7(2):91–95.
7. Ibid. Lu K, Gray MA, Oliver C, et al.
8. Kimura K, Ozeki M, Juneja LR, Ohira H. L-Theanine reduces psychological and physiological stress responses. Biol Psychol 2007;74(1):39–45
9. Unno K, Tanida N, Ishii N, et al. Anti-stress effect of theanine on students during pharmacy practice: positive correlation among salivary á-amylase activity, trait anxiety and subjective stress. Pharmacol Biochem Behav. 2013 Oct;111:128–35.
10. Yoto A, Motoki M, Murao S, Yokogoshi H. Effects of L-theanine or caffeine intake on changes in blood pressure under physical and psychological stresses. J Physiol Anthropol. 2012 Oct 29;31:28.
11. Higashyama A, Htay HH, Ozeki M, Juneja LR, Kapoor MP. Effects of l-theanine on attention and reaction time response. Journal of Functional Foods. 2011;3(3):171–8.
12. Foxe JJ, Morie KP, Laud PJ, Rowson MJ, de Bruin EA, Kelly SP. Assessing the effects of caffeine and theanine on the maintenance of vigilance during a sustained attention task. Neuropharmacology. 2012 Jun;62(7):2320–7.
13. Ota M, Wakabayashi C, Matsuo J, et al. Effect of L-theanine on sensorimotor gating in healthy human subjects. Psychiatry Clin Neurosci. 2014 May;68(5):337–43.

MISSION VIEJO (February 1, 2016)—Supplementing with Kyolic Aged Garlic Extract can halt—and even reverse—the accumulation of deadly low-attenuation plaque in arteries, according to new research in the Journal of Nutrition. The amount of low attenuation, or “soft,” plaque in the arteries contributes to the development of atherosclerosis and predicts a future acute coronary event like a heart attack or stroke. Since cardiovascular disease is the No.1 killer in America, these findings provide potentially life-saving hope for millions of people.

You don’t need to believe that “men are from Mars, women are from Venus” in order to accept that men and women have different nutritional needs. Men lead in eight of the top ten causes of death in the United States. As is often observed, because men are more reluctant than women to seek medical care, when they do so, their illnesses typically have advanced to a more serious degree. It would seem that men, even more than women, would do well to adopt defensive measures to preserve their health. Women are not only the fairer sex, but when it comes to health, they are in general, also savvier. However, men should not depend on the supplements used by their wives or women friends. Some preventative measures are strictly gender-specific. For example, whereas calcium and iron are good for women, these minerals may not be good supplement choices for men.

For men, the primary health issues today probably are cardiovascular disease and conditions affecting the prostate. Heart disease is the leading cause of death in men and prostate cancer is the seventh. Are matters improving? It is hard to tell. For instance, the incidence rate of prostate cancer went up in the period from 1995 to 2000, although the death rate appeared to have stabilized. Fortunately, the rate of lung cancer continues to decline. As for heart disease, our current emergency medical interventions are so effective that the death rate is declining. However, actual cardiovascular health is not improving—the rate of occurrence of first heart attacks is going up. How could it be otherwise? Obesity, diabetes and hypertension are all increasing. Diabetes in adults males over the age of 20 is estimated to now occur at a rate of 9.3 percent (data for 1999–2000) compared to 7.9 percent in the period from 1988 to 1994. For men aged 60 or over, the rate in 1999–2000 was roughly 19 percent. The following suggestions are designed to help men take charge of their health while the ball is still in their court.

Cardiovascular Disease
Cardiovascular health is a common topic of conversation. The reason, of course, is that heart disease in its various forms is the leading cause of death in adults and is especially prevalent in males. By age 60, one in five men will have already suffered a heart attack. The conditions to watch usually have been taken to be dysregulated blood lipids, homocysteine levels, hypertension, and obesity. More recently, it has been suggested that chronic low-level inflammation is a major causal factor in cardiovascular disease and that the Metabolic Syndrome (insulin resistance) is the actual underlying condition responsible for many or even most of the risk factors traditionally treated as indicators of heart and circulatory health.

Antioxidants, Essential Fatty Acids and Minerals
So-called “bad” cholesterol, low-density lipoprotein (or LDL), according to much current thinking, is only harmful if it has been damaged by oxygen and/or free radicals. Therefore, a protective program might include vitamin C (500 mg—2 grams daily) taken along with vitamin E as gamma-tocopherol (200 IU daily) and plant antioxidants. Tocotrienols, compounds from the same family as vitamin E, may be even more protective. A spate of studies have shown that the beneficial effects of vitamin E are much more pronounced in the gammatocopherol form and that vitamin E should not be supplemented alone, but rather in conjunction with vitamin C and the other antioxidants mentioned here. Indeed, many researchers now believe that the vitamin antioxidants are much more effective if used together and along with a variety of plant-derived antioxidants.

Grape seed extract (100–300 mg daily) is commonly used in Europe by individuals who experience vascular and general circulatory problems. According to epidemiological data, safe and effective means of reducing heart disease risks include the ingestion of many such flavonoids, catechins and other polyphenols found in fruit extracts and tea. With regard to tea, these benefits come not just from green tea, but also from the theaflavins found in black and oolong teas. Another set of plant compounds that support heart health are lignans. Flax is especially rich in lignans. Tea, of course, is a beverage and flax is a food. Other food sources being mined for special antioxidants include olives and various highly colored berries.

Similarly useful nutrients include the combination of L-carnitine (500–1,500 mg daily) and coenzyme Q-10 (30– 300 mg daily). Specialty forms of L-carnitine include L-carnitine fumarate, GPLC (glycine propionyl L-carnitine hydrochloride) and acetyl L-carnitine. Alpha-Lipoic acid (100–300 mg daily) is another good choice, and one with a particularly broad range of benefits. Minerals to supplement are chromium (200–600 mcg daily), magnesium (400 mg daily, preferably as magnesium aspartate) and selenium (200 mcg daily). A good broad-spectrum mineral supplement containing the Reference Daily Intake of copper should be considered if using the higher recommendation of vitamin C or if elevated triglycerides are a problem. Emerging evidence also supports supplementation with the lesser-known mineral silicon in the form of orthosilicic acid.

Of great importance, for instance, in controlling inflammation, is the right balance of fats in the diet. It is accepted by most researchers that the modern Western diet is very poor in the essential fats known as omega-3 fatty acids. Sources of omega-3 fatty acids are flaxseed oil (1–2 tablespoons daily) and fish oil capsules (follow manufacturers’ recommendations). Just how important are these oils? Well, when the fish-supplemented trials are removed from statistical analyses of the standard low-fat dietary interventions routinely touted in medical circles, the benefits with regard to heart disease are marginal and overall mortality rates actually increase! Gamma-linolenic acid (GLA, 100–300 mg daily) can be taken in conjunction with omega-3 fatty acids for further protection against inflammation and to maintain immune balance when large amounts of fish oils are ingested. Finally, to protect against elevated blood homocysteine levels, supplement with vitamin B-6 (15–50 mg daily), vitamin B-12 (250 mcg daily) and folic acid (400 mcg daily).

Prostate Health
What can go wrong with the prostate? Plenty. Prostate problems typically can be catalogued under four headings: prostatitis, prostatodynia, benign prostatic hyperplasia (BPH), and prostate cancer. Prostatitis is really a catch-all term for several types of prostate problems. It always involves inflammation of the prostate and may also include considerable pain, whereas BPH may not involve any pain (as opposed to discomfort). Prostatitis is fairly common in adult males. It sometimes has a bacterial infectious component, but it often has no clear cause. Abstaining from alcohol and spicy foods helps in some cases. Prostatodynia, which is most common in young and middle-aged men, often appears as pain and/or discomfort in the groin, perineum, testicles, lower back, and penis. Smooth muscle spasms in the prostatic portion of the urethra and in the neck of the bladder are at work here. Fatigue in the muscles in the pelvic region and emotional stress appear to be powerful contributory factors in prostatodynia.

Benign prostatic hyperplasia (formerly called hypertrophy) involves the renewed growth in the number of prostate cells late in life. Unfortunately, nearly 60 percent of men age 40 to 59 are likely already to suffer from BPH. This usually does not present a noticeable problem until after age 50, but by the age of 80, some 85 percent of all men suffer from one or more symptoms of BPH. The primary effect of BPH is a progressive decrease in the ability to empty the bladder as the prostate enlarges and applies pressure to the urethra. BPH should not be confused with prostate cancer,although there is an overlap of symptoms between the two. Men over age 50 should regularly visit their urologists to discover and distinguish between these two conditions. Fortunately, prostate cancer is one of the slowest growing of all cancers. Antioxidants, Essential Fatty Acids and Minerals

Prostate problems are far easier to prevent than to deal with after they have manifested. Moreover, especially in the case of prostate cancer, epidemiological studies routinely find that eating more fruit and vegetables is strongly protective, whereas consuming large amounts of milk (especially more than two glasses per day) appears to have a strongly negative effect upon prostate health. Studies suggest that supplementing with vitamin E (200 IU daily), lycopene (5–10 mg daily), and the minerals selenium (400 mcg daily) and zinc (15 mg daily) are good protective measures. Flaxseed oil (1–2 tablespoons daily) can be quite beneficial, as can the regular consumption of pumpkin seeds. Men should avoid margarine, hydrogenated vegetable oils and fried foods whenever possible. The jury is still out with regard to the effects of calcium supplementation in men. Some epidemiological studies indicate that higher intakes of calcium are correlated to higher risks of prostate cancer, perhaps through a negative effect upon the levels of active vitamin D in the body or through some other mechanism. The work of E. Giovannucci of Harvard Medical School has been instrumental in uncovering the calcium/prostate cancer connection and the protective effects of fruit consumption nd an adequate intake of vitamin D (but not more than 400 IU daily).

Isoflavone Herbal Preparations
Although it may surprise most men, many of the same isoflavones and phytoestrogens that are helpful to women are also helpful to men. Men and women both produce estrogen. As males age the ratio of testosterone to estrogen is reduced. This reduced ratio of testosterone to estrogen appears to be the key cause of prostate problems. Plant estrogens, which are very weak in comparison with the estrogen itself, can actually reduce the impact of hormonal estrogen at the level of cell receptors. Isoflavones found in soybeans and red clover represent a promising approach to prostate health management. Also useful are extracts of saw palmetto berries and flower pollen. Indeed, specialty flower pollen extracts (from mostly rye pollen) have an unusually broad range of benefits for the prostate in that they have proven to be useful not only in cases of BPH, but also in prostatitis and prostatodynia.

Stress
Prolonged stress poses a very real health risk, one with which men are less physiologically equipped to cope than are women. Higher rates of heart disease and high blood pressure are but two results. In the pre-modern world, many or even most threatening or challenging situations (“fight or flight” situations) led to a physical response which consumed and directed the energy made available by the release of hormones such as epinephrine into the blood stream. Physical responses, however, are not usually possible or even desirable in the face of stalled traffic or office frustrations. In such cases, the released energy is “bottled up,” as it were. This results in disturbances in sleep, immune function, blood pressure regulation and other bodily systems. As the “fight or flight” reference suggests, the best responses to stress are often physical. Try to get some vigorous physical exercise every day, but also consider practicing yoga or some similar form of relaxing physical therapy.

Nutrients and Herbs for Relaxation
Generalized emotional and physical stress leads to oxidative stress. Therefore, a broad-spectrum antioxidant mixture is an excellent countermeasure. Be sure to include in the diet, as well, the recommended daily intake of all of the B vitamins. The amino acids taurine (500 mg to 1 gram daily) and glutamine (750 mg to several grams daily) play important roles in the body’s response to stress. These are best utilized if taken between meals with a small carbohydrate snack. The bioflavonoid known as chrysin (1–3 grams daily) is an important stress-reducing compound, as are theaflavin, valerian and skullcap (see manufacturers’ directions). Also useful are calming herbal teas. The best known of these is chamomile.

Sports Aches and Pains of the Weekend Warrior
Exercise is important. In some studies, men who exercised regularly had a 70 percent reduced risk of death from all causes and a 39 percent reduced risk of death from heart attack. This is the good news. The bad news is that those of us who are sedentary for five days out of the week and then try to make up for this in the remaining two days of the weekend may find that we end up with more than our share of aches and pains. The body responds best to regular exercise, which is to say, exercise at least every other day. Cramming a week’s worth of exercise into the weekend is asking for trouble. And, of course, as we get older our ability to “bounce back” from strenuous physical exertion diminishes. Fortunately, there are some ways to prevent problems and to help make them go away once they develop.

Antioxidants
Conditioned athletes are actually able to produce more of certain antioxidant enzymes within their bodies to cope with this heightened demand, and this fact indicates that training may produce a type of “reserve capacity” for antioxidants. However, it is still true that exercise puts oxidative stress on the body. In various studies, athletes who ingested an antioxidant “cocktail” before working out experienced faster recovery and fewer aches and pains than those who did not take the antioxidants. The daily antioxidant intake might include vitamin C (500 mg–2 grams), vitamin E (100–200 IU as gammatocopherol), coenzyme Q-10 (30–300 mg), alpha-lipoic acid (100–300 mg), plus a number of plant antioxidants, such as mixed citrus bioflavonoids (1,000–3,000 mg). Individuals who are involved in contact sports might consider either grape seed or pine bark extracts (200–300 mg) to help prevent bruising. Glutamine (750 mg to several grams daily) recently has become one of the favored supplements by serious athletes because of its benefits in recovery and in sparing the destruction of lean tissues due to excessive exertion.

Nutrients for Repair
Ligament and cartilage injuries are common in sports. Glucosamine and chondroitin sulfate are often recommended in osteoarthritis to improve the repair of cartilage, and these compounds can also be used to speed up repair—or to improve general resilience—of the joints, ligaments and tendons in sports. (Follow manufacturers’ directions.) Sadenosylmethionine (SAMe) is another nutrient that improves tissue repair and indirectly reduces pain and inflammation; the dosage is typically 400–800 mg of SAMe per day. Expect to wait from one to four weeks to experience the benefits of these supplements if you are just starting to use them. These items improve the body’s ability to heal itself and are not directed at symptoms as such.

Hair Loss
Roughly one half of the men in Western industrialized countries suffer from Male Pattern Baldness (MPB), and this syndrome accounts for some 90 percent of all cases of hair loss. However, the presence of MPB does not mean that other factors are not at work, such as reduced circulation. For instance, increases in hair loss in certain areas of the scalp correlate with the development of heart disease. For example, extreme thinning specifically on top of the head (rather than merely receding from the front) appears to be more strongly associated with circulatory disease than is balding elsewhere on the head. Hence, this problem is not always cosmetic and concern may not be limited to vanity.

Hair Nutrients
Deficiencies in the B vitamins biotin, inositol, pantothenic acid, and PABA are particularly linked to hair loss and to premature graying. A number of nutritionists have suggested that high-potency supplementation with the entire range of B vitamins, with special attention paid to biotin, inositol and pantothenic acid, may prove to be helpful. Vitamin C (1–2 grams daily) is important for the circulation, but also for the production of collagen, a component of the hair. Coenzyme Q-10 (30–300 mg daily) is another antioxidant often suggested to improve scalp circulation. Alpha-lipoic acid (100–300 mg daily) similarly appears to be effective and seems to be useful in hair loss if supplemented for at least six months. The amino acid cysteine (1–3 grams daily), also supplemented as Nacetyl-cysteine (NAC, 500–750 mg daily), can help to increase the speed at which the hair grows. A new and really interesting item that improves the quality of the hair is choline-stabilized orthosilicic acid (BioSil)—it is worth a shot. No major improvements in scalp health or hair loss should be expected in less than three months’ time (the hair follicles need to be activated and the hair must grow out). For many men, increasing protein in the diet may also prove useful in increasing the rate at which the hair grows. This may reflect an effect upon thyroid function, in which case, adding omega-3 fatty acids to the diet is also a good idea.

Conclusion
Men’s nutritional needs differ from those of women. It is not difficult however, to meet these special needs. A well-structured program of nutritional insurance should include as a foundation a balanced multivitamin/mineral supplement. Then plan in advance to provide nutritional support for any special needs. As always, it is recommend that you tell your doctor or health care provider what supplements or herbs you are taking. Even if he or she is not overly familiar with them, this knowledge is useful for monitoring your health.

Meet Omega-7 - The New "Kid" on the Block

Make way for omega-7. It is the latest powerhouse Smart Fat, which someday may rival coconut in popularity. Studies from Harvard, The Cleveland Clinic, Hawaii, and Japan have suggested that omega-7 is a force to be reckoned with. This awesome omega can be found in its most biologically available form in anchovies, while sea buckthorn is the highest source of a vegan omega-7. Macadamia nuts and macadamia nut oil are not far behind. Research suggests that anchovies or their highly purified, pharmaceutical oil may be your best bet of all.

According to some rather compelling studies, this previously unrecognized omega ignites effortless weight loss even more than comparable omega-3s. Out of 400 fatty acids studied for regulating lipid metabolism, omega-7 was the most active. Omega-7 dramatically improves heart health and insulin sensitivity and reduces a fatty liver.

In fact, when researchers from Harvard observed omega-7 interact with fat cells in a petri dish, they found that omega-7 acts like a fat burning signaling agent to fat cells-which can become inactivated because of age, stress, or environmental toxins.

It elevates satiety hormones over 25 percent and can decrease food intake almost as much. Stubborn fat doesn't have a chance now that omega-7 has arrived!

This one-of-a-kind fatty acid also quells cellular inflammation. While this is a benefit not unlike other omegas, the results of omega-7 supplementation make the others pale in comparison. Inflammatory markers like C-reactive protein can fall within 30 days by nearly 75 percent. Now that's something to write about!

Besides revving up fat burning, purified Omega-7 has an impressive reputation for also reducing levels of fat and triglycerides in the blood, which make it such a boon for cardiovascular conditions.

In one month-long study, test participants who supplemented with 210 mg of purified omega-7 per day demonstrated a moderate increase in the "good" HDL cholesterol, a drop in the "bad" LDL cholesterol, and a nearly 20 percent decrease in triglycerides.

Smart Tips: Omega-7s

So how can you add the rising superstar omega-7 into your diet?

1. 1. Aim for anchovies. They pack big flavor into a tiny fish. You can use anchovies to add flavor to sauces, salad dressings, pasta and soups. Anchovies are filled with omega-3s, which lower inflammation, as well as boost metabolism. Anchovies are also the fish with the least amount of mercury that are safe to consume. Check out my Party Pate recipe to see how to creatively hide the strong taste of anchovies into a yummy dip. Oh and don't forget that a traditional Caesar salad dressing is typically made with anchovies, too.
2. 2. Buddy up with Barlean's Heart Remedy Oil. Just one teaspoon of Barlean's delicious berry flavored oil contains the study-backed dose of 210 mg of purified omega-7. This oil can be creatively used in no-cook recipes like vinaigrettes, parfaits, and pies. Who would ever guess that it contains purified anchovy oil?
3. 3. Munch on macadamias and cook with macadamia nut oil. Macadamias are seriously satisfying and a small amount goes a long way. These were the nuts that my late friend, Dr. Robert Atkins used to nibble on when he was in his office, his radio show on WOR, or on an airplane.
   
   The macadamia nut oil will fire up your metabolism while packing an amazingly rich taste at the same time. This oil can stand serious heat, up to 400 degrees F, and serves up considerably more antioxidants than any other cooking oil I know of. It is great for making popcorn or stir-frying some veggies, all the while helping you achieve your weight loss goals.
4. 4. Shore up with sea buckthorn seed oil. This exotic oil can be taken as a dietary supplement in softgels or in liquid form to boost metabolism. Well known in China, Russia, and Europe as one of nature's most incredible healers, sea buckthorn has the highest source of natural carotenoids like beta-carotene and zeaxanthin, lycopene and lutein. It is exceptionally high in medicinal antioxidants. Used topically, sea buckthorn oil can aid mouth ulcers, rosacea, eczema, and burns. It has widespread applicability for gastrointestinal health by reducing inflammation. In general, it is a powerful collagen enhancer and heals skin by calming down redness.

Butter - The Better Margarine Substitute

Butter sure is better-but ideally should be from grass-fed or better still, pasture-raised animals. Butter derived from these cows is much higher in nutrients than butter from grain-fed cows raised in conventional feedlots. The grains used in feedlots are typically corn-based and are spliced with genetically modified organisms (GMO). The cows stockpile toxins and pesticides like dioxin in the fat tissue. Therefore, when you consume non-organic grain-fed dairy, you are likely dining on pesticides and herbicides from the cow's feed.

Grass-fed assures you that the cows at least have not been fed grains-which reduces the probability of GMOs-a good thing. Organic butter that is pasture-raised is the highest in nutrients because it means that pesticides have not contaminated the soil the grass is grown in.

With organic pastured butter, you will be getting the purest natural source of CLA-which is also contained in higher quantities in cream from organic pastured cows. So, while you enjoy the delicious taste of butter in your food, you are also ingesting one very stable Smart Fat that holds up well in the frying pan or in the fridge. Its rich CLA stores will target your tummy fat while preserving lean muscle mass.

This "X Factor" Smart Fat is the ideal substitute for just about all transfat laden kinds of margarine and shortening, which clog up arteries, accelerate aging, may cause cancer and block vegetable oils from converting into metabolism raising prostaglandins.

When I dropped the "butter is better" bombshell with the publication of my first book in 1988, most people were still in disbelief. They were so thoroughly indoctrinated with the anti-fat message of the decade. I distinctly remember one particular lecture in my hometown of West Hartford, Connecticut. When I began explaining how the transfats in margarine could create heart disease and even cancer over time, you could have heard a pin drop in the room of 350 women. They were visibly shaken. No wonder, the audience were all members of my mother's Hadassah group and were Jewish women who never mixed meat with butter at a meal because of kosher dietary laws. Margarine was a staple on their dining tables-as it was in my home for nearly 30 years!

In case any of you need more convincing than the Time magazine cover story, below are other great reasons to include pastured butter into your diet:

Butter, like other saturates including cream, is needed for energy storage, to cushion organs against shock and to insulate vital tissues against the cold. The body's capacity for energy storage in the form of fat cells is an evolutionary marvel. Nature in her infinite wisdom provides extra protection for women for childbearing and nursing by storing extra reserves in their buttocks and thighs.

Butter is filled with the fat-soluble vitamins A, D, E, and K2. The "mysterious X factor" first identified by Dr. Weston Price over fifty years ago in the diets of indigenous people has now been identified decades later as the fat-soluble K2, so important for proper calcium utilization and the prevention of cancer, osteopenia, osteoporosis and cardiovascular disease. Since fat-soluble vitamins can be missing from the diet without enough bile production, having butter as a handy whole food source of supplementation is more than good news.

Butter contains healthy saturated fats, which raise HDL (good) cholesterol, and lower LDL (bad) cholesterol levels. Remember that the latest studies have confirmed there is no association between consuming saturated fats and developing heart disease.

Butter contains a mix of the short and medium chain fatty acids (MCTs) that are so high in coconut oil. This means that these types of saturated fats can also bypass bile emulsification-good news for those without a gallbladder or who have had troubles digesting fats.

Butter lowers your risk of obesity. Over the past several decades Americans have been told to use low-fat dairy products to get calcium without all the "bad" fats and high calorie count. However, eating high-fat dairy products will NOT make you fat. A recent study looked at the role of high-fat dairy on obesity and metabolic disease. Their findings proved that high-fat dairy lowers your risk of metabolic disease while reducing your risk of obesity.

1. 1. Opt for organic pastured butter-or just organic if it is not available-in place of margarine. Use it in your favorite recipes, stir a teaspoon into your morning coffee, melt it on veggies, baked potatoes or yams, gluten and/or grain-free breads, muffins and crackers. Truly, I can't think of a single food that is not improved with the addition of a pat of butter.
2. 2. Allergic to dairy? Try ghee. Ghee is a clarified form of butter that retains all the health benefits of butter but has the casein and other milk proteins removed which can cause an allergic reaction. Ghee is used in India and many eastern cultures for high heat cooking and has far more flavor and nutrients than traditional butter. Use ghee in curries, soups and especially stir-fry's because of its high smoke point.

Summing it up
Metabolism can be sabotaged by a number of sneaky factors that can derail your weight loss efforts. These saboteurs include your thyroid; a lack of essential fats that turn jiggly white fat into slimming brown fat (adipose tissue), or even scrambled cellular communication. In all of these cases, Smart Fats can help to reset metabolism. Identifying intolerant foods that block weight loss is another key component to addressing cravings and food addiction. But probably none of this compares to the devastating impact of unrelenting stress that you will meet head-on in next month's article--all of which you can take control of.

Current blood tests are very inadequate and usually detect chronic disease five to ten years after it has already begun. Good examples are kidney disease, liver disease, heart disease, breast cancer, Alzheimer’s, Parkinson’s Disease and diabetes.

• Kidneys can be diseased by 90 percent before tests ever indicate a problem.
• Liver disease is often detected after the liver is 70 percent diseased.
• Heart disease has often been developing 20 years before traditional tests reveal a problem.
• Breast cancer is usually detected with a mammogram, which is eight to ten years before cancer begins to develop.
• Diabetes tests include the AIC test, which often detects a problem five to ten years after it could have been detected.
• Alzheimer’s cannot be detected, by conventional medicine, until there is a beginning of loss in cognitive function.
• Parkinson’s Disease is only detected when a slight trembling occurs in one finger of one hand. By then about 80 percent of all dopamine receptors in the brain have died or been seriously damaged.

1. Stressed cells happen when there is poor nutrition,high toxin levels, high stress levels and genetic or biochemical deficiencies.
2. Weakened cells occur when cells have been stressed too long, and cells lose their energy level.
3. Dysfunctional cells are the third stage of deterioration when cells begin to experienced functional challenges. This is when most traditional tests detect a problem, such as high blood pressure, high glucose or chest pain known as angina.
4. Mutated cells occur when the nucleus of the cell becomes damaged and can no longer produce a healthy replacement cell.
5. Diseased cells happen when the cell cannot function and begins to damage other neighboring cells.

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.

For many years, I have been teaching patients, and doctors, about the life-giving benefits of Coenzyme Q10 and L-carnitine. Looking back, using them in my practice represented our first steps into the world of metabolic cardiology—the treatment of heart disease on a cellular level by improving individual cell function and energy production. The effect of these nutrients on cellular energy has now been experienced by thousands of heart patients, who improved the quality of their lives by the simple supplementation with these “Twin Pillars” of cardiac health.

Now a new nutrient, D-ribose, has arrived on the scene, heralding a second generation of metabolic cardiology. In combination, these nutrients provide the metabolic support hearts and other body tissues need to generate and maintain the energy required to promote health and vitality. I’ve watched nutritional interventions improve and literally save lives when traditional medicine just wasn’t enough. Now, I employ them as my first line approach whenever I can.

One of the most important discoveries physicians and scientists have made in recent years is the evolving study of cellular energy, or bioenergetics, and the impact cellular energy metabolism has on heart function. In her recent book, ATP and the Heart, Dr. Joanne Ingwall writes about the role of ATP (adenosine triphosphate, a biochemical required for cellular energy) in heart function:

“A major clinical challenge today is to develop strategies to preserve or improve [heart] pump function while maintaining cell viability. To achieve this goal, an understanding of the metabolic machinery for ATP supply and demand is required . . . Every event in the cell, directly or indirectly, requires ATP. Myocytes [heart cells] need ATP to maintain normal heart rates, pump blood and support increased work, i.e., recruit its contractile reserve. The myocyte needs ATP to grow, to repair itself, to survive. The requirement for ATP is absolute.”

Dr. Ingwall's credentials are impressive, and she is particularly well qualified to make these statements. As a professor of medicine (physiology) at Harvard Medical School, and senior biochemist and director of the nuclear magnetic resonance (NMR) laboratory in the cardiovascular department of Boston's Brigham and Women’s Hospital, Dr. Ingwall has spent her professional life studying the role of energy metabolism in the heart. Her book, published in 2002, supports the need for understanding the complex mechanisms of cellular energy metabolism when devising therapies for treating cardiovascular disease. ATP and the Heart should be required reading for any professional working in this field.

To supply this absolute and continuing need for energy, the body’s many complex systems rely on a variety of nutrients that are used within the cell to drive, control, and facilitate the myriad biochemical reactions that provide energy to the cell. Because none of these nutrients works independently, a “synergy” of nutrients is oftentimes what’s needed to offer results superior to that of any single nutrient. Improving the function of one cog in the wheel of metabolic machinery for energy production increases overall efficiency when the other cogs in the machinery are also working at their peak. It’s not “fuzzy math” at all.

Think of it this way: in simple math, things are additive; one plus one clearly equals two. But when you combine the right nutrients together to work synergistically, the advanced math results can be exponential; one plus one can equal five or even ten! You don’t merely add up the benefits of each nutrient in sequential fashion. Instead, these synergistic effects mean that an explosive combination of nutrients can have an exciting, positive impact on one’s well-being, and even on life itself.

Unfortunately, the understanding of the metabolic role of energy in heart function is not well-known by medical practitioners, and the impact of supplementing the heart with energy-supplying nutrients is not appreciated. Here is an example of how this lack of understanding caused one man unnecessary despair, as well as a delay in treatment.

Jim was a 76-year-old living with congestive heart failure and ischemic heart disease. In 2003, his disease worsened to the point that he could hardly walk. Jim’s examination and testing at his cardiologist revealed an ejection fraction of only 14 percent.

Jim had heard about D-ribose, L-carnitine, and Coenzyme Q10, so he asked his doctor if he should try these supplements to improve the energy in his heart. Jim was told, “No. There simply isn’t enough science to show that these work.” Undaunted, Jim made an appointment with a second, and then a third, cardiologist to seek advice on taking these important, life-giving nutrients.

In every case, Jim’s request was refuted and he was either advised that there was “insufficient science” to show their effectiveness, or that “these supplements don’t work,” by physicians who just weren’t doing their homework. Clearly, these strongly biased doctors failed to understand the vital role that energy metabolism plays in heart function.

Still skeptical, but anxious about going against the advice of these medical professionals, Jim contacted me for an appointment and was evaluated by my associate, Dr. Sun King Wan, an invasive interventional cardiologist. Following a complete cardiovascular workup, my “first-knight” nurse, Rosie—who’s been with me for thirty years—started Jim on a cocktail of nutrients, including D-ribose, L-carnitine, Coenzyme Q10, and a mixture of B vitamins. Jim simply mixed what he refers to as “Rosie’s cocktail,” in orange juice three times per day. Within four days, Jim could walk farther than he’d been able to in months. A couple of weeks later, Jim was painting the rails on his porch, and within four weeks his ejection fraction had improved to 24 percent.

While there’s still improvement for Jim to make, within a month his heart function had improved by over 50 percent simply because his heart was able to restore the energy—on a cellular level—that was being sapped by his disease. Following Jim’s progress, my clinic partner, with his modest prior understanding of the importance of energy metabolism in heart function, was so impressed that he now recommends these nutrients to all his heart patients, too.

When it comes to heart disease, D-ribose, L-carnitine, and Coenzyme Q10 have become the triad of nutrients we rely on for healing and prevention. You will soon see that these nutrients can rocket your heart and muscle energy to new heights. They do this by maximizing the amount of oxygen that your heart and skeletal muscle can extract from your blood, by accelerating the rate at which the food you eat is converted to energy in your cells, and by keeping your cellular energy pool healthy.

This book reflects a twenty-year learning curve in my practice of integrative cardiology. I’ve been using Coenzyme Q10 during that entire twenty year period, L-carnitine for the past ten years, and D-ribose these last couple of years.

The synergistic combination of D-ribose, L-carnitine, and Coenzyme Q10 has been a tremendous breakthrough in the treatment of heart disease, and has become my personal nutritional arsenal for boosting the heart’s energy. You see, whatever the patient’s cardiac condition, getting back to a healthy heart is about supporting each individual heart cell and encouraging them to join forces and strengthen the heart as an energy pump. So the bottom line for your heart is always about ENERGY!

Because L-carnitine and Coenzyme Q10 both work in the inner mitochondrial membrane, the clinical purpose of these nutrients is to complement one another in accelerating energy supply to heart cells. D-ribose works to maintain the healthy pool of energy substrates needed by L-carnitine and Coenzyme Q10 to work effectively. Clinically, working together these nutrients can help assuage cardiac arrhythmia, reduce the risk of heart failure, overcome the severe weakness and fatigue of coronary artery disease, increase exercise tolerance, relieve cramping and soreness in the lower extremities (claudication), T and improve the quality of life for patients suffering with these conditions.

This triad is not only remarkably effective in preserving heart health, but is also outstanding in the treatment of neuromuscular diseases, such as fibromyalgia, that are also affected by failures in cellular energy metabolism.

Although hundreds of scientific papers have been published in noteworthy scientific and medical journals describing the individual roles of these naturally occurring compounds in preserving the energy health of your heart, skeletal muscle, and other tissues, you've probably never heard or read about the exciting combination of D-ribose, L-carnitine, and Coenzyme Q10.

Nor are you likely to have heard about these revolutionary treatments from your doctor. Why? Because even though the scientific literature clearly presents the science, and thousands of clinical applications have documented that these compounds have proven beneficial for treating a wide variety of clinical cardiac conditions, therapies like D-ribose, L-carnitine, and Coenzyme Q10 are still largely ignored by a majority of clinical cardiologists as well as most of the conventional medical establishment. Despite the fact that these three nutrients are used by many board-certified cardiologists in the United States, Europe, and Japan, most clinical cardiologists generally remain biased by ignorance or a deep-rooted reliance on pharmaceuticals. Unfortunately, the many patients who are not helped by conventional treatments alone or whose treatment could be greatly enhanced by the addition of D-ribose, L-carnitine, and Coenzyme Q10 will never be offered the chance to receive them.

Besides the widespread ignorance about supplemental treatment with this triad, it is equally tragic that there is so much negative bias against these nutritional therapies. One of the major obstacles to evaluating the benefit of nutritional therapies is the claim by many physicians that there is a lack of scientific data on the subject. Although most conventional wisdom is subject to the current "gold standard" of evidence-based scientific controlled studies, there are literally scores of studies on Coenzyme Q10, L-carnitine, and D-ribose demonstrating this exact rigorous standard of controlled analysis. For example, if you go to the Internet and type in “Coenzyme Q10” as a search word on the Pub Med site, you will see 1,254 published articles in various scientific and medical journals. Type in Q10's generic name “ubiquinone,” and the count rises to 5,769, most of which represent sound science-based inquiry. L-carnitine and D-ribose will bring up thousands of results. So, I'm confused when my peers say “there's no data.”

The rejection of D-ribose, L-carnitine, and Coenzyme Q10 as potent, nonprescription treatment defies imagination. It's apparently difficult for highly trained medical personnel, well versed in pharmacology and technology, to believe that anything so simple and so natural could be as effective as the highly engineered drugs modern medicine has to offer.

Most American cardiologists cannot acknowledge that a natural substance not manufactured by pharmaceutical industry giants could be so valuable. These factors have rendered therapies including D-ribose, L-carnitine, and Coenzyme Q10 victims of politics, bias, insufficient marketing, economics, and ignorance regarding the results of real science.

That is not to say that the nutritional supplement industry is blameless. Too many dietary supplements—claiming to treat everything from heart health to weight loss to male sexual enhancement—have hit the market with major media campaigns, plenty of claims, and a host of promises, with little, if any, science behind them. There can be no doubt that this “hype versus science” attitude in the nutritional supplement industry has placed major roadblocks in the path of acceptance of those natural therapies that do have solid science and demonstrable clinical benefit, and has encouraged many morethan- skeptical attitudes among health care providers.

Another dilemma is the not-all-are-created-equal issue regarding nutritional supplements. While many products are pure, many others fail to live up to the ingredients and dosages listed on their labels. The FDA monitors our pharmaceuticals, but not the supplement industry. While FDA involvement would spuriously skyrocket the cost of many vitamins and supplements and place them outside the affordability range for many people, it is not easy to know which products are worthy of your financial investments at present. This darkens the cloak of suspicion for many physicians. For now, I can only advise you on the products I've tested and found to be of high quality, and hope for some standards to be developed in the future.

It is also true that manufacturers and distributors of D-ribose, L-carnitine, and Coenzyme Q10 do not have the financial and physical resources to “detail” these products to physicians as major medicinals, as the pharmaceutical companies do with their new drugs. These companies have thousands of sales representatives on the street visiting doctors everyday, and they are able to start and run campaigns to educate physicians about new products. Such campaigns can cost tens, or even hundreds, of millions of dollars. This effort is simply too costly for smaller companies trying to reach the broad and highly diverse audience of health care professionals suffering from a complete lack of knowledge about these revolutionary treatments.

This book will specifically discuss the importance of energy metabolism for cardiovascular health and the impact of these three nutrients on the cardiovascular system. But the story should not end there. All three of these miracle ingredients—D-ribose, L-carnitine, and Coenzyme Q10—are being used right now in a wide variety of serious degenerative diseases, including heart disease, high blood pressure, cancer, periodontal disease, chronic obstructive pulmonary disease, diabetes, neurological disorders, neuromuscular disease, male infertility, and even aging itself.

Part three of the series from The Sinatra Solution, Metabolic Cardiology will appear in the next issue of totalhealth.

So far we have learned a good deal about how the “Awesome Foursome” of Coenzyme Q10, L-carnitine, D-ribose, and magnesium helps our hearts metabolize energy more efficiently and protects them from the stress of cardiovascular disease. This powerful combination of nutrients goes directly to the basic biochemistry of cellular energy metabolism. Now let’s take a closer look at how Coenzyme Q10, L-carnitine, D-ribose, and magnesium work in synergy to promote cardiovascular health.

We’ll start our discussion on the important synergy of Coenzyme Q10, L-carnitine, D-ribose, and magnesium with a short summary of how each works individually. Let’s begin with Coenzyme Q10.

Coenzyme Q10: Energy Recycling through the Electron Transport Chain
Coenzyme Q10 is a powerful antioxidant that helps protect the mitochondrial membrane, mitochondrial DNA, and cell walls from free-radical attack. But its most important function in the body is its central role in energy metabolism.

Most—about 90 percent—of the ATP used by cells is recycled as food (fuel) and oxidized in the mitochondria. Fatty acids, carbohydrates, and, occasionally, proteins are carried across the mitochondrial membrane and enter the Krebs cycle, moving from step to step and spinning off electrons. These electrons are then handed off to the electron transport chain, where, in the presence of oxygen, the energy from the electrons is captured as a phosphate group is added to ADP to form ATP. This recycling of ATP is called oxidative phosphorylation, and the by-products of these pathways are CO2 and water.

Coenzyme Q10 is the “electron clearing house” in the mitochondria. Coenzyme Q10 accepts electrons coming out of the Krebs cycle and passes them off to other constituents of the electron transport chain called cytochromes. In this fashion, Coenzyme Q10 acts as a gatekeeper of electrons, making sure they are carried to just the right place to pass on their life-giving energy.

The activity of the electron transport chain is highly complex and beyond the scope of our discussion. What is critical, however, is the simple fact that without Coenzyme Q10 the electron transport chain would totally break down. And since the electron transport chain is (by far!) the largest contributor to cellular energy turnover, its loss would be catastrophic. It is also important to know that there has to be an excess of Coenzyme Q10 in the mitochondria to be maximally effective. Having just enough isn’t sufficient to do the job properly, and having a deficiency seriously affects the mitochondria's ability to supply the cell with energy.

To keep the electron transport chain running at peak efficiency, there must be enough Coenzyme Q10 to accept electrons immediately as they are spun out of the Krebs’ cycle, carry them to the cytochromes where they are passed off, and then return to wait in line for yet another electron. If there is not enough Coenzyme Q10 waiting in this queue, electrons will not be captured and their energy will be lost.

Think of this process in terms of a warm-up drill before a basketball game. During these warm-ups basketball players stand in a line at the free-throw line. One of their coaches stands under the basket and throws the ball to the first player in line to start the process going, much like the Krebs cycle throwing off an electron. The first player in line quickly carries the ball to the basket, hands it off to the basket in a lay-up, and runs back to the end of the line. The coach then throws another ball to the next player in line, and the cycle continues. However, if there is no player waiting in line to collect the throw, the ball will spin out of control to the other end of the court and will never make its way to the basket.

The same is true with Coenzyme Q10. Electrons are passed out of the Krebs cycle and accepted by the next Coenzyme Q10 in line. Coenzyme Q10 then carries the electrons to the basket (the cytochromes), passes them off, and returns to the back of the line. If you can imagine this as a continually moving line with millions of basketballs in play you can visualize why so much Coenzyme Q10 is needed to keep the process running smoothly. When there is a Coenzyme Q10 deficiency, many of the electrons spin out of control and never make their way down the energy pathway.

Cellular stress can cause Coenzyme Q10 deficiency, which places a severe strain on Coenzyme Q10 availability. People with heart disease, hypertension, gingival disease, Parkinson’s disease, and the other disorders we’ve discussed are known to be deficient in Coenzyme Q10. Whether these deficiencies are the cause or the effect of these varied medical problems, the end result is that they sap the life out of their mitochondria and reduce their energy supplies. You see, Coenzyme Q10 cannot function properly if electrons are not coming out of the Krebs’ cycle, and the Krebs cycle won’t work without the fuel that’s transported into the mitochondria by L-carnitine.

L-Carnitine: Transporting the Cellular Energy Fuel
Fatty acids are the preferred energy fuel for hearts and most other cells in the body. Fatty acids are long-chain molecules that are broken down by beta oxidation into two-carbon fragments. These two carbon fragments are used to fuel the Krebs’ cycle so electrons can be extracted to run down the electron transport chain. The two-carbon fragments plucked from long-chain fatty acids are picked up by Coenzyme A (CoA) forming activated CoA esters. The mitochondrial inner membrane is almost totally impermeable to these CoA esters, and that’s where L-carnitine comes in.

L-carnitine resides in the mitochondrial inner membrane and works like a ferry carrying freight across a river. L-carnitine picks up two-carbon fragments on one side of the mitochondrial membrane and transports them to the other side. The primary job of L-carnitine in energy metabolism is the transport of these fuels into the mitochondria, making them available for ongoing energy metabolism in the Krebs’ cycle. In this process Coenzyme A “hands off” the two-carbon fatty acid fragment to L-carnitine, forming acetyl carnitine. Acetyl carnitine then moves across the membrane and again passes off the two-carbon fragment to another CoA living inside the mitochondria. So, like a ferry, L-carnitine picks up the two-carbon fatty acid fragment, gives it a ride across the inner mitochondrial membrane, and delivers it to another CoA waiting on the other side. The CoA receiving the fatty acid fragment then delivers it to the Krebs’ cycle for processing into energy.

L-carnitine facilitates the beta oxidation of fatty acids as energy fuel. And since fatty acids are the preferred fuel for energy recycling in cells, this action is critical to cell and tissue function. Unfortunately, L-carnitine is deficient in people with heart disease, peripheral vascular disease, lipid metabolic disorders, mitochondrial disorders, and many other disease syndromes we reviewed earlier. This L-carnitine deficiency disrupts the normal metabolism of fatty acids, reducing available energy supplies and leading to the accumulation of toxic by-products of fatty acid metabolism. L-carnitine supplementation revives fatty acid metabolism and restores normal mitochondrial function. But even this powerful improvement in cellular energy metabolism cannot make up for the energy drain that comes from the loss of energy substrates caused by low oxygen delivery to the tissue. Only D-ribose can do that.

D-Ribose: Rebuilding the Cellular Energy Pool
As long as cells and tissues have plenty of oxygen, the pool of energy substrates in the cell remains high. And as long as there is enough L-carnitine and Coenzyme Q10 available, the process of energy utilization and supply can proceed unimpeded. However, the cellular supply of oxygen can be restricted by acute or chronic heart disease, peripheral vascular disease, any number of skeletal- or neuromuscular diseases, or even high-intensity exercise.

When cells are deprived of oxygen the mitochondrial energy turnover becomes inefficient. Remember, oxygen is required to let the oxidative pathway of energy recycling work properly. If the mitochondria are not able to recycle energy efficiently, cellular energy supply cannot keep pace with demand. But the cell has a continuing need for energy, so it will use all its ATP stores and then break down the by-product, adenosine diphosphate (ADP), to pull the remaining energy out of this compound as well. What’s left is adenosine monophosphate (AMP). Since a growing concentration of AMP is incompatible with sustained cellular function it’s quickly broken apart and the by-products are washed out of the cell. The net result of this process is a depletion of the cellular pool of energy substrates. When the by-products of AMP catabolism are washed out of the cell, they are lost forever. It takes a long time to replace these lost energy substrates even if the cell is fully perfused with oxygen again.

Ribose is the only compound used by the body to refill this energy pool. Every cell in the body has the capacity to make ribose, but hearts, muscles, and most other tissues lack the metabolic machinery to make ribose quickly when the cells are stressed by oxygen depletion or metabolic insufficiency. Ribose is made naturally in the cells from glucose. In stressed cells, however, glucose is preferentially metabolized for energy turnover and is not available for ribose synthesis. So when energy pools are drained from stressed cells, the cells must first wait for the slow process of ribose synthesis before they can begin to replace their lost energy stores.

Acute ischemia, like that which takes place during a heart attack, heart surgery, or angioplasty, drains the cell of energy. Even when oxygenated blood flow returns, refilling the energy pool may take ten or more days. But when oxygen deprivation is chronic, or when energy metabolism is disrupted by disease, there may be so much continual strain on the energy supply that the pool can never refill without the assistance of supplemental ribose. Conditions like ischemic heart disease or congestive heart failure fall into this category. In these situations, supplementing the tissue with exogenous ribose is the only way the cell can keep up with the energy drain.

Magnesium: Switching on the Energy Enzymes
Magnesium is an essential mineral that's critical for energy requiring processes, in protein synthesis, membrane integrity, nervous tissue conduction, neuromuscular excitation, muscle contraction, hormone secretion, maintenance of vascular tone, and in intermediary metabolism. Deficiency may lead to changes in neuromuscular, cardiovascular, immune, and hormonal function; impaired energy metabolism; and reduced capacity for physical work. Magnesium deficiency is now considered to contribute to many diseases, and the role for magnesium as a therapeutic agent is expanding.

Magnesium deficiency reduces the activity of important enzymes used in energy metabolism. Unless we have adequate levels of magnesium in our cells, the cellular processes of energy metabolism cannot function. Small changes in magnesium levels can have a substantial effect on heart and blood vessel function. While magnesium is found in most foods—particularly vegetables—deficiencies are increasing. Softened water and a trend toward lower vegetable consumption are the culprits contributing to these rising deficiencies.

SUPPORTING THE LINKS IN THE ENERGY CYCLE CHAIN. THE SYNERGY
Clearly, each member of the “Awesome Foursome” is fundamental to cellular energy metabolism in its own right. Each plays a unique and vital role in supplying the heart with the energy it needs to preserve its contractile force. Each is independently effective in helping hearts work through the stress of disease. And while each contributes immeasurably to the energy health of the cell, in combination they are unbeatable. Allow me to reiterate the step-by-step, complicated cellular processes involved to be sure that you really understand the rationale for using these nutrients.

The cell needs a large, sustained, and healthy pool of energy to fuel all its metabolic functions. Contraction, relaxation, maintenance of cellular ion balance, and synthesis of macromolecules, like proteins, all require a high energy charge to carry their reactions to completion. The energy pool must be preserved, or these fundamental cellular functions will become inefficient or will cease to operate altogether. To keep the pool vibrant and healthy, the cell needs ribose. But even with supplemental ribose, the cell needs the efficient turnover of its energy stores to balance ongoing energy utilization with supply. That's where Coenzyme Q10 and L-carnitine come into play.

The converse is also true. Even if the cell is fully charged with energy, cellular energy supply will not keep pace with demand if the mitochondria are not functioning properly. Coenzyme Q10 and L-carnitine work to keep mitochondrial operations running at peak efficiency, and one side cannot work effectively without the other. Even though Coenzyme Q10 and L-carnitine can make the energy turnover mechanisms work more efficiently, they cannot increase the cell's chemical driving force, and their action will be only partially effective. Ribose, on the other hand, can keep the energy pool supplied with substrate, but the value of energy pool repletion cannot be fully realized if the substrate cannot be maximally utilized and recycled. Ribose fills the tank; Coenzyme Q10 and L-carnitine help the engine run properly.

Magnesium is the glue that holds energy metabolism together. By turning on the enzymes that drive the metabolic reactions, magnesium allows it all to happen. These four nutrients must be utilized by cardiologists and other physicians as they treat patients day-to-day. On my own journey, using Coenzyme Q10 for two decades, L-carnitine for more than ten years, D-ribose for two years, and magnesium equally as long, I've seen this “Awesome Foursome” reduce suffering and improve the quality of life for thousands of patients.

The future of nutrition in conventional medicine is very bright, although the integration of nutritional supplements has been a slow and, at times, lonely process. For example, the Canadian government has just placed a warning on their HMG-reductase statin labels, warning that these drugs can diminish ubiquinone (Coenzyme Q10) levels, which can cause heart failure. This is a mammoth step for the Canadian government, and I applaud them for raising this issue with their population. Unfortunately, our own Food and Drug Administration is not so enlightened yet. Now that governments are getting involved in doing the right thing, perhaps the traditional medical community will follow suit. But first we have to educate them to do so.

As most of you may know, representatives from pharmaceutical companies make regular rounds to the offices of prescribing medical professionals such as physicians, physician assistants (PAs), advanced practice nurses (APRNs), and nurse practitioners (NPs) to keep them informed about the latest drugs their companies are releasing. This is called “detailing” a pharmaceutical because it involves educating the practitioner about all the various “details” of the drug, from how it works and interacts with other medications, to dosing and possible side effects. Drug companies obviously spend a lot of money on this one-to-one approach in order to bring this level of education to each individual health care practitioner, but it does let them get more comfortable with drugs new to the market.

Not so with nutraceuticals. There just isn't anyone “detailing” health care providers about nutrients and supplements in this manner, so many doctors don't believe in their effectiveness. As research continues, the mysterious relationship of ATP and energy in the heart will be recognized by more and more physicians who will then be comfortable recommending these life-saving supplements.

L-carnitine and Coenzyme Q10 are finally gaining the recognition they deserve. Dribose is emerging as a new player in the complex understanding of metabolic cardiology, and doctors are beginning to discuss the important role of magnesium deficiency in heart patients. As a practicing cardiologist for over thirty years, I see metabolic cardiology as the future for the treatment of heart disease and other complex disease conditions, as well.

The Sinatra Solution, Metabolic Cardiology by Stephen T. Sinatra, M.D. is published by Basic Health Publications, Inc. and is available at health food stores and bookstores or call 1.800.575.8890 to order.

This article is the fourth in the series that began with “Solving the Mystery of the Multivitamin.” The focus now shifts to reasons for taking a multivitamin/mineral as we enter the second half of life and, more importantly, the overall approach to nutrition that should inform any anti-aging program. Readers will discover that some, but not all of the gender-specific nutritionaln needs covered in earlier articles become less meaningful in later life. As individuals approach 60, overall physiology changes in ways that tend to lead to a convergence of nutritional requirements.

Female and Over 40?

Today, turning 40 is less about being “over a hill” and more synonymous with “running up a hill,” as women in this age bracket tend to be at the peak of busyness. Surveys and census data show more women over the age of 40 are starting families, getting married and are at the pinnacle of their careers. But running at such a fast pace can lead to critical mistakes with your health that can potentially make you feel and look older than your real age. Here are my top two health mistakes women over age 40 make and what you can do to reverse the damage.

Mistake No. 1: Neglecting Heart Health

It is a common misperception that heart disease is primarily a man’s disease. But in fact, this leading killer of men is also the leading killer in women. In fact, 10 times more women die of heart disease every year than from breast cancer. There are simple diet and lifestyle habits that are very effective at preventing or even reversing this disease if you already have it. For example, never smoke; favor a plant-based diet and nix the junk foods and carbs; exercise daily—even a 30-minute brisk walk can significantly lower your risk; go to bed before 10 P.M. (staying up to midnight regularly can double your risk); and reduce the damaging effects of stress by practicing an effective stress-reducing technique daily, such as meditation or yoga. Certain supplements including omega-3 fatty acids and vitamin D3 can also help protect against several cardiovascular risk factors. You can find out exactly what your omega-3 and vitamin D levels are by taking a home-test that can be purchased at www.nutrientpower.org. I'm on the scientific advisory board for nonprofit, Organic & Natural Health Association and they are leading an international research initiative for omega-3 and vitamin D right now that will result in even more scientific data on the power of these important nutrients for a wide variety of health conditions, including heart health. By purchasing this kit and having your levels tested you will be part of this initiative.

Mistake No. 2: Mismanagement of Menopause.

Early menopause is currently defined at age 44, but new research is showing menopause is hitting women even earlier. A recent study in the journal Human Reproduction found that girls, who start their periods at age 11 or younger, are more likely to go through menopause in their 30s. Being aware of the symptoms (including mood swings, hot flashes, night sweats, memory problems, irritability and fatigue) and knowing your options to manage menopause miseries will give you a leg up on addressing these issues before they become problematic.

I don't recommend running to your doctor for hormone replacement therapy because of its potentially dangerous side effects. For decades, HRT (hormone replacement therapy) was promoted as the fountain of youth. It was said to lower the risk of heart disease, strokes, and Alzheimer's disease. But several studies in the early 2000s, including the Women's Health Initiative Study—the largest ongoing prospective study of women—found mostly the opposite is true. Women who take HRT have an increased risk of heart disease, strokes, blood clots, gall bladder disease and invasive breast and ovarian cancer. You might think that bio-identical hormones are a much better alternative, however, there are no long-term studies proving their safety. Early studies show they appear to be less harmful when compared to synthetic pharmaceutical hormones, but they still may increase your risk of breast cancer.

A much safer choice when it comes to improving menopausal symptoms is to restore balance to your physiology through healthy diet and lifestyle choices. For additional help, I recommend taking an effective, safe, plant-based supplement. A relatively new formula that thousands of gynecologists are recommending here in the United States is called Relizen (www.relizen.com).

Discovered by accident, a Swedish beekeeper noticed that his bees seemed more energetic when they consumed the pollen from particular flowers growing in his fields. He then wondered if it would have the same effect on people. So, he gave it to men and women and although he was unimpressed by the pollen's ability to improve energy; he was quite impressed and surprised to find it appeared to provide great relief for menopausal women. The first pollen extract product was released in Europe in 1999. Made from the extracts of several Swedish flowers— specifically from the grass (Poacea) family including rye (Secale cerale )—this product was recently introduced in America a few years ago by the name, Relizen. To date, over one million women worldwide have used this supplement with great satisfaction; and it is currently the number one non-hormonal menopausal product used in France.

Gynecologists recommended Relizen to their patients because it has been studied with the same rigors used for a pharmaceutical medication proving its effectiveness. This is one of the reasons why I have recently been working with Relizen to educate more women about the advantages of this supplement. For example, a randomized, double-blind, placebo-controlled study published in 2005, and a large controlled clinical trial in 2015 that was conducted by 90 gynecologists found that Relizen works through non-estrogenic pathways to help alleviate menopausal symptoms including hot flashes, night sweats, sleep disturbances, mood swings and fatigue.

Exactly how the pollen extract works is not fully understood, but it has been found to contain over 180 nutrients and is high in antioxidants and anti-inflammatories. In addition, according to a publication in 2016, it also increases serotonin—a neurotransmitter that stabilizes mood and improves depression. Because it is non-hormonal it is considered safe for women who have had breast cancer. Just to note—the manufacturer says they use a state-of-the art manufacturing process to remove the allergenic husk, reducing the worry if you have a pollen allergy.

References:

1. Winther K, Rein E, Hedman C. Femal, "An herbal remedy made from pollen extracts, reduces hot flashes and improves quality of life in menopausal women: a randomized, placebo-controlled, parallel study." Climacteric. 2005; 8: 162–70.
2. Simon, J., Druckman, R., "Nonhormonal Treatment of Perimenopausal and Menopausal Climacteric Symptoms" presented at the American College of Obstetricians and Gynecologists Annual Scientific and Clinical Meeting 2016.
3. Goldstein SR, Espie M, Druckmann R. "Does purified Swedish pollen extract, a non-hormonal treatment for vasomotor symptoms, inhibit the CYP2D6 enzyme system?" Menopause. 2015;22(11):1212–14.

Tomatoes and natural tomato complex may be the ultimate women’s health food

Heart disease, breast cancer, ovarian cancer, skin cancer, endometrial cancer and osteoporosis— what do they have in common? They are all caused by oxidative stress, they attack women and they can all be prevented by tomatoes. The tomato may very well be one of nature’s most perfect foods, containing phytonutrients that help prevent oxidative damage which serves to protect against the leading health problems of women.