Fwd: CARDIOVASCULAR DISEASE, Andrew Weil, M.D.

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From: "JoAnn Guest" Mon, 30 Aug 2004 05:21:30 -0000 CARDIOVASCULAR DISEASE, Andrew Weil, M.D.CARDIOVASCULAR DISEASECardiovascular disease is a collection of illnesses that include heart disease, high blood pressure, stroke and congestive heart failure. It is the leading cause of death in the United States. Here are some compelling statistics on Cardiovascular Disease from the American Heart Association's "Heart Disease and Stroke Statistics" – 2004 Update:Cardiovascular Disease (CVD) has been the number one cause of death in the U.S. since 1990. More than 64 million Americans have one or more types of CVD; 50 million have high blood pressure. More than 13 million Americans have

coronary heart disease. One in five Americans has some form of CVD. One in three men develop CVD before the age of 60, versus one in 10 for women. CVD alone has claimed more lives each year than the next seven leading causes of death combined. Each day, more than 3,850 Americans die of CVD, that's one death every 8.64 seconds. Heart disease or coronary artery diseaseHeart disease or coronary artery disease is caused by atherosclerosis. Atherosclerosis is a condition in which cholesterol-rich plaque builds up along the arterial walls. High cholesterol levels can play a part, though they do not always result in atherosclerosis and atherosclerosis can exist with normal cholesterol levels. But when the coronary arteries are affected, the condition is called coronary artery disease.How does atherosclerosis develop?Atherosclerosis seems to begin with an injury to the endothelial

lining along the artery wall. Interestingly, this process actually can begin at an early age. Once an injury occurs, white blood cells such as monocytes and macrophages, along with lipids, begin to accumulate along the inner layer of the artery as well as the muscle layer. Smooth muscle cells begin to multiply from the irritation and eventually form a plaque. Platelets and other blood clotting factors stick to the rough surface of the artery wall, forming a thrombus (clot). A clot can continue to grow until it completely blocks an artery, cutting off the oxygen supply to a vital organ. Or a clot can break free from the vessel wall and become lodged somewhere else further downstream. This could lead to a heart attack or stroke if the clot completely blocks the blood and oxygen supply to a major artery leading to the heart or brain. Although initially there are no symptoms, once the

arteries become very constricted, one may experience pressure or tightening in the chest due to a lack of oxygen being delivered to the heart (angina). There may also be cramping in the lower extremities due to blockage in the peripheral veins (peripheral vascular disease).Factors associated with heart diseaseResearchers now believe that many different problems can lead to heart disease. And cholesterol can often play a key part.Cholesterol is a waxy, fat-like substance made by the liver. It is an essential component of cell membranes and used to produce hormones and vitamin D. Cholesterol is carried through the body attached to two different compounds called lipoproteins: low-density lipoproteins (LDL) and high-density lipoproteins (HDL). LDL is commonly known as the "bad cholesterol"; it carries cholesterol from the liver throughout the body, making it available to be deposited in artery

walls. HDL is known as the "good cholesterol"; it picks up cholesterol from the arteries and delivers it to the liver to be recycled or eliminated from the body. The body needs cholesterol to function – but too much of it in the blood, or too much of the wrong kind, add up to trouble. The factors leading to heart disease are as follows:High total cholesterol – especially high LDL levels – These two factors combine to form a well known risk factor for heart disease (though people can have heart disease without having high cholesterol). Lifestyle may influence cholesterol levels but the tendency appears to be genetic. Dietary and nutritional supplement treatment of high cholesterol levels are moderately effective. Medications to lower cholesterol are usually very effective. Low HDL cholesterol and high triglyceride levels – This is a different pattern than high total

and LDL cholesterol although someone may have both. This pattern, associated with insulin resistance, is also genetically driven and appears to affect as much as 30 percent of the population. It carries with it a high risk of high blood pressure and diabetes as well as heart disease. Dietary and nutritional supplement treatment for this pattern are different from those for high total and LDL cholesterol levels. Here, lifestyle changes are generally quite effective. Elevated homocysteine levels – This risk factor for heart disease is unrelated to cholesterol levels. Homocysteine is an amino acid that can accumulate in the blood when a person does not get enough folic acid and vitamin B6. This condition is also genetically driven. Folic acid requirements for some individuals may be much greater than the RDA of 400 mcg. Smoking – This habit alone can increase risk of heart disease.

Smoking increases oxidation in the body and is harmful to blood vessels. Family history – a family history of any type of cardiovascular disease increases an individual's risk of developing the disease. Genetic tendencies, however, can be countered by a healthy lifestyle in most cases. If you have a family history of heart disease, we recommend paying particular attention to diet, exercise, stress reduction and supplements. Nutritional supplements and family history of heart diseaseFish oil – The omega-3 fatty acids in fish and fish oil supplements have been shown to be an effective preventive strategy against heart disease. They can lower triglyceride levels, increase HDL cholesterol, help minimize inflammation and blood clotting, and keep blood vessels healthy. Coenzyme Q10 – This antioxidant is thought to be one of the most important antioxidant supplements for protection against

many forms of cardiovascular disease. It helps protect LDL cholesterol from oxidation, maintains healthy blood vessels, protects against clots and plaque rupture, and supports optimal functioning of the heart muscle. What you can do to lower your cholesterolReduce greatly the amount of saturated fat you eat. The richest sources of saturated fat (fat that is usually solid at room temperature) in the diet are dairy foods (except the fat-free versions), especially whole milk, cheese, butter and cream. Red meat is also high in saturated fat. Avoid trans–fat. If you find "partially hydrogenated oil" listed in the ingredient list of food labels, find a healthier substitute. There are many spreads available on the market today that are free from trans-fat. Trans-fat is also found in snack foods like chips, crackers and cookies. It is found in the oils used to cook fast-food

french fries, doughnuts and movie popcorn. Substitute non-gmo soy protein for animal protein. The protein in soy foods have been shown to lower cholesterol levels. Try to incorporate two servings a day into your meals. Choose from tofu, tempeh, soy milk, whole soy beans and roasted soy nuts. Use fresh garlic regularly in your meals. Garlic has been shown to lower both cholesterol levels and blood pressure, and it tastes wonderful, too. Use one or two lightly cooked cloves a day. Drink green tea daily. The antioxidants in green tea help lower cholesterol and prevent the cholesterol in your blood from oxidizing. Eat plenty of soluble fiber. Soluble fiber has a powerful cholesterol-lowering effect. The best sources of soluble fiber are beans and lentils, apples, citrus fruit, oats, barley, peas, carrots and ground flax seed. Lose weight. Even a modest amount of weight loss can lower

cholesterol levels. Nutritional supplements and cholesterolCoenzyme Q10 (CoQ10) – CoQ10 is a powerful antioxidant that has been shown to be beneficial for heart health by protecting LDL cholesterol from oxidation and re-energizing the mitochondria in the heart cells, which is where energy metabolism occurs. This nutrient is very important for the heart cells of patients with heart failure. CoQ10 may also help lower blood pressure. Fish oil – Though omega-3 fatty acids in fish oil don't specifically lower total or LDL cholesterol levels, they do seem to reduce the risk of heart disease by reducing platelet stickiness, inflammation and triglyceride levels. Insulin Resistance (high triglycerides and low HDL cholesterol)Insulin resistance is now being recognized as an important and common condition associated with heart disease, as well as diabetes and high blood pressure. It affects an

estimated 25-30 percent of the non-diabetic population. It is primarily characterized by high triglyceride and low HDL cholesterol levels, although high total cholesterol may also be seen. Genetic factors play a significant role, but diet and lifestyle changes can make a big difference (an even bigger difference than in the previously discussed condition of high total and high LDL cholesterol).A little background: Insulin is a hormone that facilitates the transport of glucose from the blood into cells where it is used as fuel. When blood sugar rises after a meal, the pancreas secretes insulin into the bloodstream. With insulin resistance, the normal amount of insulin secreted is not enough to move glucose into the cells – thus the cells are "resistant" to the action of insulin. To compensate, the pancreas secretes even more insulin in order to maintain fairly normal blood sugar movement into cells and a normal

blood sugar level. The resulting high levels of insulin, however, have several negative effects -- on the enzymes in the liver that produce cholesterol, and on the kidney leading to high blood pressure, as well as on the enzymes in cells that regulate inflammation. Eventually, blood sugar levels rise either because the pancreas stops producing insulin or the cells become more and more resistant to the insulin that is produced. The body's inability to adequately compensate leads to diabetes.Having diabetes, even in the early stages, significantly increases the risk of heart disease. Early diabetes may be the first time insulin resistance is recognized.Warning signs and diagnosis of insulin resistance?Individuals with insulin resistance are often overweight, with their extra pounds accumulating in their abdomens, the classic "apple" shape. They often have family history of

diabetes, high blood pressure or heart disease. Interestingly, although insulin resistance is usually seen in people who are overweight, thin people can also have the problem and be at the same risk for heart disease, high blood pressure and diabetes. The easiest way to diagnose the problem is to take a blood test that looks for the following indicators: A low HDL cholesterol is almost always seen, along with a high triglyceride level. You may also check for a high fasting insulin level. A high uric acid level sometimes accompanies these values.What can you do about insulin resistance?Watch your carbs – The classic low-fat, high carb diet that was the standard recommendation for preventing or treating heart disease for years can actually make insulin resistance worse. Carbohydrates (starches and sugars) raise blood sugar levels and trigger the release of insulin. A moderately

low-carbohydrate diet (40-45 percent of calories) emphasizing low glycemic index sources of carbohydrate (those that raise blood sugar levels slowly rather than quickly) is recommended. In general, foods very rich in fiber are healthy. Cut saturated fats, but keep monosaturated fats --Include moderate amounts of monounsaturated fat (30-35 percent of calories, i.e. extra virgin olive oil, avocadoes) rather than following a low-fat diet. However, in this condition, as with high total and LDL cholesterol, saturated fat makes the situation worse. Eat generous amounts (5 or more servings) of non-starchy vegetables and one to two servings of low-glycemic index fruit every day. Lose weight if you are overweight. Even small amounts of weight lost can improve insulin resisitance. Exercise – Vigorous aerobic exercise decreases the cells' resistance to insulin. Eat fish frequently – The best are

cold-water fish like wild salmon and sardines that are high in omega-3 fatty acids. This type of fat seems to improve cells' response to insulin. Eat small, frequent meals to keep blood sugar levels as stable as possible. Nutritional supplements and insulin resistanceCoenzyme Q10 (CoQ10) – CoQ10 is a powerful antioxidant that has been shown to be beneficial for heart health by protecting LDL cholesterol from oxidation and re-energizing the mitochondria in the heart cells, which is where energy metabolism occurs. This nutrient is very important for the heart cells of patients with heart failure. CoQ10 may also help lower blood pressure. Alpha-lipoic acid – This antioxidant nutrient improves the cells' response to insulin and can reduce blood sugar levels. Magnesium – Higher insulin and blood sugar levels are seen in people with low plasma magnesium levels, and magnesium supplementation improves

insulin resistance in animal studies Chromium – It improves glucose utilization in people with high blood sugar levels and improves insulin resistance in animals. High homocysteine – What is it?Homocysteine is an amino acid that is produced in the body from another amino acid called methionine. One of methionine's main functions is to provide methyl groups for cellular reactions. A methyl group is a small, simple chemical fragment consisting of one carbon molecule and three hydrogen molecules. When methionine donates a methyl group for a cellular reaction, it becomes homocysteine. Typically homocysteine then receives another methyl group from either folic acid or vitamin B6 and is turned back into methionine. Vitamin B12 acts as a cofactor for this reaction.In short, if you don't have enough of certain critical B vitamins, your homocysteine level rises. A high homocysteine level is

primarily a sign of an inadequate intake of folic acid or vitamin B6.Factors that control homocysteine levels:Genetics – There are genetic variations in folic acid absorption and utilization. Some individuals therefore need much more folic acid than the RDA of 400 mcg. Stress – Epinephrine and norephinephrine are stress induced neurotransmitters. Their metabolism in the liver involves methylation, a process that uses methyl groups, and can increase need for methyl donors like folic acid. Coffee consumption – As coffee consumption increases, homocysteine levels increase. The amount of folic acid, vitamin B6 or vitamin B12 in your diet and supplements. What is the relationship between homocysteine, heart disease and strokes?High homocysteine levels are associated with atherosclerosis. Homocysteine is thought to be damaging to the lining of blood vessels,

leading to atherosclerosis. As homocysteine levels increase, the risk of heart disease and stroke increase. (High homocysteine levels are also associated with risk of cancer and cervical dysplasia, as well as neural tube birth defects like spina bifida.)Diagnosing high homocysteineAlthough the reference ranges for homocysteine from most labs show a normal range up to 12, homocysteine researchers are suggesting that any level over 8 should be treated. Nutritional supplements and homocysteineFolic acid, vitamin B6, vitamin B12 and betaine are all involved in the process of adding a methyl group back to the homocysteine molecule. Supplementation of these nutrients will bring high homocysteine levels down. Although the B vitamins (the first three in the list) are found in our multivitamin, we recommend higher doses depending on your homocysteine level. If your homocysteine level is

high, we recommend re-testing it six months after you begin taking supplements. Angina PectorisAngina is chest pain that can occur when there is a dramatic decrease in the blood supply to the heart, an increased demand for oxygen by the heart, or a combination of both. It is a symptom of heart disease or coronary artery disease. If the walls of the blood vessels are hard and unable to relax (for example, as a result of atherosclerosis), the vessels will not be able to dilate properly, which slows down blood flow. Increasing physical or emotional exertion increases the demand for oxygen. If the arteries are so blocked that the heart cannot receive sufficient oxygen to meet its needs, angina can result. What are the factors that cause angina or an oxygen deficit to the heart?Most often, angina is caused by coronary artery disease. In some cases angina can result from a narrowing of the aorta (a major

vessel leading to the heart) due to an aortic valve abnormality; arterial spasms causing a temporary constriction in the artery; or an enlarged heart, in which the blood supply is no longer adequate to supply sufficient oxygen to the heart.What are the symptoms?Look for chest pain that is intermittent, brief and persistent. The length of an attack and the severity can vary. The pain feels like a tightness or pressure in the chest that may radiate to the neck, along the left shoulder or down the left arm. Some experience difficulty breathing and nausea. What triggers an angina attack?Angina can be triggered by emotional or physical stress, exerting oneself after a meal, or extreme temperature changes. Cigarette smoking can also bring on an angina attack.What can I do to reduce my risk of angina?Follow a heart-healthy diet. Don't smoke Nutritional supplements and

anginaCoenzyme Q10 (CoQ10) – CoQ10 is a powerful antioxidant that has been shown to be beneficial for heart health by protecting LDL cholesterol from oxidation and re-energizing the mitochondria in the heart cells, which is where energy metabolism occurs. This nutrient is very important for the heart cells of patients with heart failure. CoQ10 may also help lower blood pressure. Hawthorne Berry - Hawthorne is another antioxidant with heart-enhancing properties. Hawthorne may help improve coronary artery blood flow and circulation to the extremities of the body, therefore improving symptoms of angina. L – arginine – L –arginine is a precursor to nitric oxide that relaxes blood vessels in the heart and has been shown to help angina. High Blood Pressure (Hypertension)Hypertension is the most common form of cardiovascular disease in America, affecting approximately 50 million

people. That's close to one out of four adults. High blood pressure is defined as a reading above 140/90mmHg (systolic/diastolic). (Systolic pressure - the first number - measures the pressure in the arteries when the heart contracts. Diastolic pressure - the second number - measures the pressure in the arteries when the heart is relaxing and filling with blood.) What causes high blood pressure?The heart pumps blood through your arteries (large blood vessels), pushing the blood against the artery walls with a force that is measured as "blood pressure." Normal blood pressure is around 120/80 mmHg. High blood pressure occurs when the artery walls lose their elasticity and cause the pressure of the blood moving through the arteries to rise. This excessive pressure makes the heart work harder, and can eventually lead to an enlarged heart (cardiomegaly), as well as damage to blood vessels in the kidneys and

brain. Hypertension, therefore, increases the risk of heart attacks, stroke and kidney disease. Doctors cannot pinpoint the precise cause of 90 percent of high blood pressure cases, also known as "essential hypertension." However, they do know that certain factors can increase the risk of developing high blood pressure:Stress can cause hypertension by activating the sympathetic nervous system, causing the arteries to constrict. Eating large amounts of sodium can cause excess water retention, expand blood volume and ultimately increase blood pressure. A diet low in calcium, magnesium and potassium can increase blood pressure Insulin resistance can increase blood pressure by causing the kidneys to retain sodium. Regular alcohol intake can increase blood pressure. Being overweight increases blood pressure. What can you do to lower your blood pressure?Follow the DASH

diet. This diet, developed by researchers at the National Institutes of Health's National Heart, Lung, and Blood Institute is based on a large-scale research study which identified the foods that affect blood pressure. The most important parts of the DASH are generous amounts of fruit and vegetables and lowfat or fat-free dairy products providing an adequate calcium intake. The diet is also relatively low in fat and sodium. DASH researchers have shown that diets rich in potassium, calcium and magnesium, and low in sodium, (2,400 mg or less) play an important role in maintaining healthy blood pressure levels. These are the high points of the DASH diet: Eat 8-10 servings of fruit and vegetables per day. Choose low- or non-fat dairy foods, consuming 2-3 servings per day. Limit animal protein to 6 oz per day, emphasizing lean sources. Consume 4-5 servings of nuts, seeds and dry

beans per week (2 Tbsp nuts or seeds, or 1/2 cup cooked dried beans). Eat plenty of fish – Include at least three servings of fish a week, emphasizing cold-water fish like wild salmon and sardines that are rich in omega-3 fatty acids. Limit your caffeine intake - The caffeine in coffee, tea and sodas can contribute to high blood pressure. Limit alcohol intake – Blood pressure increases as your body metabolizes alcohol. Avoid processed foods - These are the biggest sources of sodium in today's diet. Maintain optimal weight - Even a minimal weight loss can improve blood pressure. Exercise – As little as 30 minutes of moderate exercise a day, like walking, can lower blood pressure. Relax –Meditation, yoga, breathing exercises or biofeedback are all relaxation techniques that can help lower blood pressure. Don't smoke – Smoking contributes to all cardiovascular diseases and many other

life-threatening conditions as well. Nutritional supplements and high blood pressureCalcium and magnesium – Inadequate intake of both of these minerals has been associated with high blood pressure. Vitamin C – A supplement of this antioxidant vitamin has been shown to lower blood pressure in people with mild to moderate hypertension. StrokeStroke is the third leading cause of death when considered separately from other types of cardiovascular disease, accounting for about one out of every 14.5 deaths in the U.S., according to the American Heart Association. About three-fourths of stroke victims are over the age of 65, but a person can have a stroke at any age. Although stroke seems to affect as many men as women, more women die of a stroke than men in all age groups.What is a stroke?A stroke, also known as a cerebrovascular accident, is the death of brain tissue caused from a lack of

blood flow and insufficient oxygen to the brain. The brain receives about 25 percent of the body's oxygen supply from a continuous blood flow through two main arteries, the carotid arteries (that come up through both sides of the front of the neck) and the basilar artery (which forms at the base of the skull from the vertebrae arteries). Strokes (like heart attacks) can often result from a blockage in a blood vessel that reduces or cuts off oxygen supply to the cells, resulting in the death of the tissue. It only takes a short period of time without oxygen to cause damage to the brain.There are two main classifications of strokes:Ischemic – The blood supply is cut off to part of the brain, either due to atherosclerosis or a blood clot. Infections, inflammation or certain medications can all contribute to ischemic strokes. These strokes are the most common type, causing about 80 percent of all

stroke cases. Hemorrhagic – These strokes comprise the remaining 20 percent of cases. Hemorrhagic strokes are caused from a ruptured blood vessel, preventing normal blood flow and causing bleeding into an area of the brain. They can be the result of hypertension, which causes excessive pressure on the arterial walls that may already be damaged by arteriosclerosis. A ruptured aneurysm (the rupture of a weakened area in the blood vessel wall), can also cause a hemorrhagic stroke. What can I do to prevent a stroke?Focus on your diet. Follow a diet designed for those with high blood pressure and heart disease – it may be helpful in preventing strokes. Control your blood pressure either through lifestyle changes or medication. If you smoke, quit. Exercise. People who exercise consistently have a lower risk for having a stroke. Limit alcohol. If you drink alcohol, do so only in moderation.

Moderate alcohol intake is defined as no more than one drink per day for women and two drinks a day for men. Take calcium and magnesium. These minerals are helpful in controlling high blood pressure, one of the strongest risk factors for stroke. Manage diabetes and keep tight control of blood sugar levels. Lower cholesterol into a healthy range. Nutritional supplements and strokesCalcium and magnesium – These minerals are helpful in controlling high blood pressure, one of the strongest risk factors for stroke. Congestive Heart FailureCongestive heart failure (CHF) is a very serious heart condition in which the heart cannot pump sufficient blood to keep up with the body's oxygen demand. Even though the condition typically gets worse over time, people are able to live with the disease for many years. What causes congestive heart failure?CHF can stem from any

disease that causes impairment in the heart's ability to contract and pump blood, such as coronary heart disease. Other factors include diabetes, an overactive thyroid gland, a viral or bacterial infection to the heart muscle, or morbid obesity. When the heart is constantly overworked, it first becomes larger – as will any muscle in the body that you consistently exercise and push hard. However, over time, the heart eventually tires out, resulting in a decreased ability to pump an adequate blood supply. What are the symptoms?Fatigue and weakness, particularly when performing physical activities, which stems from a lack of sufficient oxygen to the muscles. Swelling in the lower extremities. If the right side of the heart is affected, fluid builds up in the feet, ankles, abdomen, liver and legs. Left-sided heart failure can cause fluid retention in the lungs, leading to shortness of breath.

Wheezing or coughing up pinkish phlegm. Dizzy spells. Rapid weight gain from fluid retention Nutritional supplements and congestive heart failureCoenzyme Q10 (CoQ10) – CoQ10 is a powerful antioxidant that has been shown to be beneficial for heart health by re-energizing the mitochondria in the heart cells, which is where energy metabolism occurs. This nutrient is very important for the heart cells of patients with heart failure. CoQ10 may also help lower blood pressure. Carnitine – This amino acid that is essential for energy metabolism of the heart muscle. Cordyceps – This medicinal mushroom is a good energy booster and can improve the workload of the heart. http://www.drweil.com/app/cda/drw_cda.html-command=healthConditionDetail-articleType=Condition-pt=Condition-articleId=21Please pass this

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