Angina
Easing the Squeeze
Angina is actually a symptom, not a disease. This squeezing or dull, pressure-like pain--a kind of charley horse in the chest--is telling you that your heart muscle isn't getting enough oxygen to meet its needs. The pain is most likely to occur with exercise, stress or cold weather or after a big meal.
Just like the pain of a heart attack, angina can radiate to the left shoulder and down the inside of the left arm, straight through to the back and into the throat, the jaw, and even the right arm. The pain typically lasts for only 1 to 20 minutes. If it lasts longer or gets worse, get to a hospital--fast! You could be having a heart attack.
People who get angina usually have coronary heart disease. The spaghetti-size arteries that deliver blood to the heart muscle have been narrowed or clogged by plaque, which forms from cholesterol and scar tissue. Plaque reduces blood flow to the heart muscle and makes arteries more likely to go into spasm, which reduces the blood flow even more. And if a fatty deposit ruptures or develops a crevice or fissure where blood can enter, it invites clot-forming platelets to congregate at the scene. The end result of this whole mess can be a full-blown blood clot that obstructs blood flow and causes a heart attack.
"Drugs such as nitroglycerin, beta-blockers and calcium channel blockers offer predictable help," says Robert DiBianco, M.D., associate clinical professor of medicine at Georgetown University School of Medicine in Washington, D.C. "These drugs dilate blood vessels and reduce the heart's oxygen needs. Nitroglycerin and beta-blockers may also help protect the heart from the damage associated with oxygen deprivation in the early hours of a heart attack." Sometimes cholesterol-lowering drugs are prescribed.
Standard treatment also includes a diet that cuts total fat to less than 30 percent of calories and saturated (animal) fat to under 10 percent of calories--the same fat-trimming diet used to cut your risk of further artery clogging, Dr. DiBianco says.
Some medical experts take these low-fat guidelines to extremes. They recommend that no more than 10 percent of calories come from fat--a diet that in some cases makes cholesterol deposits shrink and that often reduces muscle spasms and clotting. They also call for nutrients that may help prevent atherosclerosis, such as vitamin E. And they add other nutrients, such as magnesium, which is thought to help the heart function better under less than ideal circumstances.
Here's what research shows may help.
Vitamin E: All-Around Heart Help
Vitamin E appears to play a role when it comes to beating heart disease. A study by Harvard University researchers found that men who took at least 100 international units of vitamin E daily for at least two years reduced their chances of developing heart disease by about 40 percent. (For the full story on vitamin E and other nutrients to prevent and treat heart disease, see page 285.)
Since angina is a symptom of heart disease, there's good reason to believe that vitamin E can help relieve angina pain. And in fact, British researchers found that people who had the lowest levels of vitamin E in their blood were 2½ times more likely to have angina than those who had the highest levels.
Vitamin E may work directly in helping to prevent the buildup of fatty plaque that restricts blood flow to the heart muscle, says Balz Frei, Ph.D., associate professor of medicine and biochemistry at Boston University School of Medicine. "It helps prevent the oxidation of LDL cholesterol (the 'bad' kind) in the artery wall, which is one of the first steps in the development of heart disease," he says.
Vitamin E also helps prevent blood-blocking clots in arteries by its action on platelets, disk-shaped components of blood that regulate coagulation, explains Dr. Frei. "Adequate amounts of vitamin E inhibit the tendency for platelets to stick to each other and to the inside walls of blood vessels," he explains.
The best amount of vitamin E to relieve angina? Doctors who recommend this nutrient suggest 100 to 400 international units a day. These large amounts require supplementation, since most people don't get much more than 15 international units a day from vegetable oils, nuts and seeds, the usual food sources for this vitamin.
| Food Factors To ax angina, choose foods that help keep your arteries free-flowing. Here are the details. Trim fat to the bone. If you can get below 20 percent of calories from fat and see a big drop in your cholesterol levels, you may even begin to reverse clogged arteries, says Robert DiBianco, M.D., associate clinical professor of medicine at Georgetown University School of Medicine in Washington, D.C. The best way to go super low fat? Eat mostly vegetarian, with a meal or two of fish each week. Stick to low-fat or nonfat dairy products, and use olive oil or canola oil sparingly to season salads and other vegetables. Eat some mucilage. No, not library paste. It's the gummy soluble fiber found in flaxseed, oat bran and many fruits. (The bulk laxative Metamucil has psyllium, one of these soluble fibers.) Mucilage soaks up cholesterol-laden bile acids, secreted into the intestines by the liver. Your cholesterol levels drop, so you're less likely to develop blockages in your coronary arteries, Dr. DiBianco explains. Get stinky. Scientific studies have shown that the chemical components of onions and garlic help counteract increased platelet stickiness after a high-fat meal. Platelets are disk-shaped components of blood that can stick together and to artery walls, causing clots. Go gingerly. This fiery spice also reduces platelet stickiness. Indian researchers found that two to three teaspoons of powdered ginger significantly inhibited platelet stickiness after a fatty meal. Munch on mackerel. Omega-3 fatty acids, found in oily fish such as mackerel, tuna, salmon and sardines, help blood vessels relax, research suggests. These fatty acids help reduce levels of two potentially harmful types of blood fats: LDL cholesterol and triglycerides. They also reduce the tendency for blood to clot. "But this is not a food source to pile on, since fish oil is fat and contains nine calories in each gram," says Dr. DiBianco. |
| Prescriptions for Healing For easing the pain of angina, some doctors recommend both a low-fat diet and these nutrients. Nutrient Daily Amount
Magnesium 400 milligrams Selenium 50-200 micrograms Vitamin E 100-400 international units
MEDICAL ALERT: If you have angina, you should be under a doctor's care. People who have heart or kidney problems should not take magnesium supplements without medical supervision. Selenium in doses exceeding 100 micrograms daily should be taken only under medical supervision. If you are taking anticoagulants, you should not take vitamin E supplements. |
Add On Some Selenium
There's also some evidence that selenium, a mineral that teams up with vitamin E, can offer protection from angina.
One study, by researchers in Poland, found that people with a particularly dangerous kind of angina called unstable angina were more likely than normal to have low levels of both vitamin E and selenium.
Another study found that people with heart disease who took 200 international units of vitamin E and 1,000 micrograms of selenium a day (a very high dose that requires medical supervision) had significant reductions in angina pain compared with patients taking placebos (blank pills).
Doctors who recommend selenium supplements to their heart patients generally stick to 50 to 200 micrograms a day. Supplements in excess of 100 micrograms should be taken only under medical supervision, however. (The Recommended Dietary Allowance is 70 micrograms for men and 55 micrograms for women.) To up your intake from foods, munch on whole-grain cereals, seafood, garlic and eggs.
Magnesium May Smooth Things Out
Magnesium is well-known for its ability to relax the smooth (involuntarily controlled) muscles. These include the muscles that wrap around blood vessels, bronchial tubes and the gastrointestinal tract. That's why magnesium seems to be helpful for disorders that may include muscle constriction, such as high blood pressure, Raynaud's disease, migraines and at least some kinds of angina.
In several studies, magnesium given intravenously was effective in stopping variant angina, spasms in the coronary arteries not related to a permanent blockage.
"Oral magnesium also seems to be helpful, at least for some kinds of angina," says Burton M. Altura, Ph.D., a leading magnesium researcher and professor of physiology and medicine at the State University of New York Health Science Center at Brooklyn.
Unfortunately, magnesium deficiency seems to be all too common in people with heart disease. Studies show that up to 65 percent of all people in intensive care units and 20 to 35 percent of people with heart failure come up short on magnesium.
Magnesium deficiency can be induced by drugs meant to help heart problems, Dr. Altura says. Some types of diuretics (water pills) cause the body to excrete both magnesium and potassium, as does digitalis, a commonly prescribed heart drug. Signs of magnesium deficiency include nausea, muscle weakness, irritability and electrical changes in the heart muscle.
If you have angina, talk to your doctor to see if your diet is adequate in magnesium. Your doctor might suggest making changes in your diet to increase the magnesium content. If you're still low on magnesium, he may recommend magnesium supplementation, Dr. Altura says. How much magnesium you need to take depends on the results of a so-called magnesium loading test, Dr. Altura explains. For this test, you take a large dose of magnesium, and the doctor checks the amount of magnesium in your urine to see how much your body retains. "Not everyone needs to take the same amount," Dr. Altura says.
Although magnesium is considered to be a fairly safe mineral, even in high doses, don't take supplemental magnesium without medical supervision if you have kidney or heart problems. You could have a dangerous buildup of magnesium in your blood, or your heart could slow down too much.
The Daily Value for magnesium is 400 milligrams. Based on his research, Dr. Altura has calculated that 70 percent of men get only 185 to 260 milligrams daily, while 70 percent of women get 172 to 235 milligrams daily.
Diets rich in vegetables and whole grains are much higher in magnesium than diets that include lots of meats, dairy products and refined foods.
