Heart Disease
Control Tactics for Angina, Blood Pressure
and Cholesterol
A mere generation ago, most doctors told women with advanced heart disease to go home and rest, take their medicines and expect to undergo coronary bypass surgery at some point or another.
And that was it. No advice on what to eat or foods to avoid, whether or not to exercise or how to deal with stress or other risk factors. Preventing heart disease was a pretty revolutionary concept.
A maverick named Nathan Pritikin saw matters differently. In his groundbreaking book, The Pritikin Program for Diet and Exercise, Pritikin argued that sitting around resting and eating high-fat, circa-1960 American cuisine clogged the arteries leading to our hearts, causing heart disease.
Pritikin was more or less written off as an extremist, until research proved him right. These days, many mainstream medical organizations such as the American Heart Association (AHA) recommend a low-fat diet, exercise and stress management to both treat and prevent heart disease. What was once alternative has become conventional.
ROOM FOR IMPROVEMENT
Despite a sea change in medical thought and practice, heart disease is still the number one cause of death among American women. Women tend to get heart disease later in life than men do. Research suggests that the female sex hormone estrogen helps protect our hearts until menopause, when production of this hormone declines and our risk for heart disease climbs. Despite the odds, women tend to underestimate their risks and pay less attention to heart health than they should.
"While the average woman has a 1 in 11 chance of contracting breast cancer, her chances of contracting heart disease are 1 in 2," says Bruno Cortis, M.D., a cardiologist in River Forest, Illinois, and author of Heart and Soul: A Psychological and Spiritual Guide to Preventing and Healing Heart Disease.
Controllable risk factors for heart disease include smoking, high blood pressure and high blood cholesterol. You also have a greater risk of getting heart disease if you don't exercise or if you have a sedentary job, which contributes to one of the leading factors--being overweight. Women with diabetes and those with stress may also be in the higher-risk category.
Risk factors that you can't change include a family history of heart disease and race. African-American women are twice as likely as white women to develop heart disease, for example.
ANATOMY OF HEART DISEASE
Heart disease is the end result of a series of events that take place in your arteries. Frequent or ongoing exposure to norepinephrine and other stress hormones, coupled with high blood pressure, damage the inner lining of the arteries leading to your heart. Once your blood vessels are damaged, they begin to accumulate deposits of low-density lipoprotein (LDL) cholesterol, a sticky blood fat manufactured by the body. As this arterial plaque forms, it obstructs blood vessels and limits the blood flow to your heart.
A diet high in dietary cholesterol, found in animal foods like meat and butter, accelerates heart disease, as does a diet high in saturated fats, found in animal fats and some vegetable fats. Saturated fat prompts your body to produce exceptionally high levels of LDL cholesterol. Saturated fat also lowers blood levels of high-density lipoprotein (HDL) cholesterol. This adds insult to injury, since HDL cholesterol can actually help clean cholesterol from your arteries. Refined sugars and starches can also lead to high cholesterol, according to Glenn S. Rothfeld, M.D., clinical instructor in the Department of Community Health at Tufts University School of Medicine in Boston, a practitioner in Arlington, Massachusetts, and co-author of Natural Medicine for Heart Disease.
A reduction in blood flow to your heart, caused by plaque buildup in your arteries, can trigger chest pain, or angina. It can also lead to arrhythmia, or erratic heartbeat. Both symptoms are warning signs of heart disease. Unfortunately, some women have no warning signs at all. The first tip off that they have heart disease can be a heart attack, says Dr. Rothfeld.
If you have a heart attack, a combination of two things could be going on. Artery plaque can continue to build up until it completely seals off your arteries, shutting off the flow of blood. Or plaque can rupture and prompt blood to clot, which can completely block blood flow in narrow arteries. (If the clot travels to blood vessels leading to your brain, you can experience a stroke.)
Any interruption in blood flow deprives your heart of oxygen and can seriously damage your heart muscle. That's why heart attacks can be deadly.
Standard treatment for heart disease focuses on risk factors that you can change. If you have heart disease, your doctor has probably told you to keep a lid on stress and to eat less saturated fat and cholesterol. She has probably also mentioned that exercise can help control your blood pressure and LDL cholesterol levels and help prevent or slow the buildup of plaque in your arteries. And if you smoke, she has most likely told you to quit, especially if you take birth control pills. Like high blood pressure, smoking damages your arteries, triggering plaque buildup, says Dr. Rothfeld. It also makes your blood stickier and more likely to clot, as does taking the Pill, although the Pill by itself isn't a big risk factor. Smoking and taking oral contraceptives, however, puts you in double jeopardy for heart disease, he says.
But how little fat should you eat? Are there any vitamins or minerals that can help? How often should you exercise? What kind of exercise should you do? Exactly how can you relieve stress? Alternative practitioners have some very specific advice on all counts.
A MENU OF HEART-HEALTHY DIETS
To protect against heart disease in the first place or reverse existing disease, alternative practitioners offer the dietary options described below.
R. James Barnard, Ph.D., professor of physiological science and medicine at the University of California in Los Angeles, suggests that you choose a very low fat diet plan that best suits your tastes.
Order what Dr. Ornish eats. For people at risk for heart disease, the American Heart Association recommends a diet deriving less than 30 percent of calories from fat. But Dean Ornish M.D., cardiologist, assistant clinical professor of medicine at the University of California in San Francisco, director of the Preventive Medicine Research Institute in Sausalito, California, and author of Dr. Dean Ornish's Program for Reversing Heart Disease, says that to truly protect against heart disease, you need to limit fat intake to 10 percent of calories from fat, with minimal amounts of saturated fat.
The Ornish program consists of a very low fat, low-cholesterol vegetarian diet combined with daily exercise and stress reduction programs. The diet consists mostly of vegetables, grains, fruits and beans. Dr. Ornish published studies proving his program could reverse the progression of heart disease.
The AHA considers the Ornish diet to be too austere, calling it impractical for most people. Yet women who try the diet are proof that it can and does work. In a study conducted at the University of California in San Francisco, both men and women with heart disease did significantly better on the Ornish plan than they did following a more liberal diet consisting of about 30 percent of calories from fat. Their LDL cholesterol and blood pressure levels dropped, and plaque deposits were reduced. In comparison, men and women following the conventional diet got worse. (For information on how to follow the Ornish program, see page 132.)
Follow the Pritikin diet. Low in fat, sparing with meat and generous with grains, vegetables and fruit, the Pritikin diet is similar to the Ornish diet--with one exception. You can eat roughly three ounces of very lean meat a day. In a study conducted at the University of California in Los Angeles, men and women with heart disease saw their cholesterol levels drop when they followed the Pritikin diet and exercised regularly. (For information on how to follow the Pritikin diet, see page 137.)
Try a traditional Asian diet. Based on traditional Asian diets, the Asian Diet Pyramid is also similar to the Pritikin plan in that it's mostly vegetarian. Population studies show that most Asian countries have lower heart disease rates than the United States, supporting the use of the Asian Food Pyramid diet in protection against heart disease. (For information on how to follow a traditional Asian diet, see page 154.)
Dine as the Mediterraneans do. Modeled after the cuisines of Italy, Spain and Greece, the traditional Mediterranean diet is also sparing with meat and generous with grains, fruits and vegetables. But compared to the Ornish and Pritikin diets, the Mediterranean diet derives a somewhat generous 25 to 35 percent of calories from fat. Nonetheless, studies show that men and women who eat the Mediterranean way have relatively low rates of heart disease.
Researchers suspect that the benefit comes from olive oil, the primary source of fat in Mediterranean diets. Olive oil is low in saturated fat, so it's less likely to raise blood levels of artery-clogging LDL cholesterol. But olive oil is also rich in monounsaturated fat, which lowers blood levels of harmful LDL cholesterol while it raises blood levels of helpful HDL cholesterol. (For information on how to follow a Mediterranean diet, see page 159.)
Invite garlic to dinner. Savory and kind to your heart, garlic helps lower blood pressure and cholesterol and makes your blood less likely to form unwanted clots, says Varro E. Tyler, Ph.D., professor emeritus of pharmacognosy at Purdue University in West Lafayette, Indiana, and author of Herbs of Choice: The Therapeutic Use of Phytomedicinals.
"The best way to consume garlic and maintain your close friends is to eat enteric-coated capsules containing dried garlic powder," says Dr. Tyler. The coating on these handy capsules keeps them from dissolving until they reach your small intestine. During digestion, your body converts the key ingredient in garlic, a sulfur compound called alliin, into an active form, allicin and related compounds, that comes to your heart's aid. The capsules are more or less odor-free, Dr. Tyler says. They are available in health food stores.
How much garlic should you take? Robert I-San Lin, Ph.D., executive vice-president of Nutrition International in Irvine, California, and chairman of the First World Congress on the Health Significance of Garlic and Garlic Constituents, has reviewed many garlic supplements on the market and says that most will provide significant health benefits if sufficient amounts are taken--usually two to four times the dosage recommended on the label. Look for garlic supplements in health food stores, supermarkets and drugstores.
| How I Healed Myself Naturally A Vegetarian Diet for Out-of-Control
Blood Pressure and Cholesterol Madge Wilson lives in Newark, New Jersey, and works for a nonprofit community organization. Wilson credits a vegetarian diet and fasting for reining in her high blood pressure and lowering her cholesterol, thus lowering her risk for heart attack and stroke. "I developed high blood pressure and high cholesterol when I was 39," says Wilson. Her blood pressure was 160/98. Doctors consider blood pressure readings higher than 140/90 to be too high. And her cholesterol was 290 mg/dl (milligrams per deciliter). Cholesterol levels over 240 are considered high. Wilson knew that her family history of heart and artery disease put her health at risk. "My mother and dad both died of strokes," she says. "My mother was 50 when she died. My father was 43. I felt like I was sitting on a time bomb. "I'd been going from one doctor to another, and every one put me on some kind of medication." None of the drugs worked well, so Madge consulted Joel Fuhrman, M.D., a physician in nearby Belle Mead, New Jersey, and author of Fasting--And Eating--For Health. "Dr. Fuhrman put me on a fast, which he supervised, for 12 days," says Wilson. He told her that fasting is a useful treatment for decreasing blood pressure without the use of drugs. "After the fast, Dr. Fuhrman told me exactly what to eat: vegetables, fruits, legumes, grains, nuts--and nothing else. It's a vegetarian diet. Dr. Furhman told me to cut out all meat and dairy. And he told me not to eat sugar, salt or anything containing sodium. "My new way of eating is really working," says Wilson, who at age 64 has already outlived her mother by 14 years. "I check my blood pressure every day, and it's great--120/80. I haven't needed to take medication for high blood pressure since the fast. Plus, my cholesterol is fantastic--195. And I lost ten pounds. "I exercise every day," she adds. "Every morning at 6:30, I spend half an hour to 45 minutes in the gym. I feel like a new person." |
CARDIO-FRIENDLY VITAMINS AND MINERALS
Evidence suggests that vitamin and mineral supplements can lower heart disease risk in various ways. The American Heart Association doesn't endorse vitamin and mineral therapy. But some alternative practitioners do.
Certain supplements can help treat and prevent heart disease, says Bobbi Lutack, a naturopathic and homeopathic physician and professor of cardiology at Bastyr University of Naturopathic Medicine in Seattle. She suggests that women begin by taking the Recommended Dietary Allowance of most essential vitamins and minerals (excluding iron, unless you're anemic). In addition, she offers the following advice.
Bolster your intake of antioxidants. Evidence suggests that vitamins C and E and the trace mineral selenium protect your heart in three ways. Collectively known as antioxidants, studies suggest that these nutrients come to your heart's defense by neutralizing highly destructive molecules called free radicals. In that way, antioxidants protect your artery walls from the damage that triggers plaque accumulation. They also help inhibit chemical changes that make LDL cholesterol stickier and more likely to clog arteries. And they inhibit blood clots.
Researchers at Boston University have found that 2,000-milligram doses of vitamin C improved blood flow to the heart. And in a British study, men and women with angina were less likely to have heart attacks if they took 400 to 800 international units of vitamin E daily.
Based on this evidence, Dr. Lutack advocates taking at least 1,000 milligrams of vitamin C, 400 international units of vitamin E and 200 micrograms of selenium. (Because we get about 100 micrograms of selenium in our diets, taking more than 100 micrograms in supplement form should be done under medical supervision.)
Don't forget your Bs. Research shows that vitamins B6, B12 and the B vitamin folate help prevent chemical changes that lead to hardening of the arteries. In a Canadian study that followed about 5,000 men and women for 15 years, for example, those with high blood levels of folate were less likely to die of heart attacks than those with low levels. So, make sure that your daily supplements include these B vitamins.
Supplement with magnesium and calcium. These two minerals relax your arteries, lower blood pressure and help regulate heartbeat, Dr. Lutack says. In a portion of the Nurses Health Study, an ongoing study of about 87,000 women, those with the highest magnesium intakes were least likely to have high blood pressures. Dr. Lutack suggests that women take 250 to 500 milligrams each of magnesium and calcium. If you have heart or kidney problems, check with your doctor before taking supplements of these minerals.
Consider coenzyme Q10 and L-carnitine. Studies show that coenzyme Q10, a lipidlike substance found in practically all cells, may help to lower blood pressure, increase the strength of heart muscle contractions and benefit those suffering from mitral valve prolapse (the most common valve disorder in women), especially when combined with L-carnitine, an amino acid, according to Dr. Lutack. So she recommends a daily dose of 30 to 60 milligrams each of coenzyme Q10 and L-carnitine. Look for these supplements in health food stores.
Savor some omega-3 fatty acids. Found in fish oils, walnuts and flaxseeds, omega-3 fatty acids lower LDL cholesterol levels and help prevent blood clots, says Michael Janson, M.D., director of the Center for Preventive Medicine in Barnstable, Massachusetts, in his book The Vitamin Revolution in Health Care.
To increase omega-3 fatty acids in your diet, add ground flaxseed in muffins. Researchers at Incarnate Word College in San Antonio, suggest substituting ground flaxseed for up to half the flour in your favorite muffin recipes. Look for ground flaxseed in health foods stores.
EXERCISE: MORE THAN A STROLL IN THE PARK
The American Heart Association recommends 30 minutes of aerobic exercise, such as swimming, running, brisk walking or cycling, three or four days a week.
Aerobic exercise helps your heart in a number of ways. For one thing, aerobic exercise burns an average of 300 to 400 calories per hour and helps you lose weight. That's important because excess weight puts an excess burden on your heart.
Aerobics also strengthens your heart muscle. When you exercise hard enough to raise your pulse and breathing rate, you also increase the amount of oxygen your blood can carry to your heart. And aerobics lowers both your blood pressure and your LDL cholesterol levels while boosting your HDL cholesterol levels.
Research suggests that to truly protect your heart, you need more than 30 minutes of exercise a day, at least three days a week.
A study at the University of Washington in Seattle finds that exercise may even help dissolve blood clots in coronary arteries before they can cause heart attacks, but you'll have to do more than 20 minutes of aerobics to see similar results. In the study, men and women who walked, jogged or biked three times a week had increased levels of clot-dissolving chemicals in their blood.
To reap this benefit, though, they exercised long and hard. Each session lasted a total of 90 minutes, including a 20-minute warm-up and 20-minute cooldown. "And we had them exercise strenuously enough so that they were at 60 to 80 percent of their maximum heart rates," says Wayne Chandler, M.D., who headed the study and is an associate professor of laboratory medicine at the university. Heart rate is a standard method of gauging exertion.
A growing body of evidence suggests that exercise may be one of the most important steps that a woman can take toward long-term heart health. A strenuous workout, it seems, is a prerequisite for an increase in levels of clot-dissolving chemicals, says Dr. Chandler.
Even if you've had a heart attack, exercise is beneficial. Studies show that women who have had heart attacks live longer if they start exercising.
And in addition to aerobic exercise, you need to include resistance training and some form of flexibility exercise in your routine, says Dr. Rothfeld. Resistance training--strengthening exercises using dumbells and barbells or weight-training machines--is important because it builds muscle. Since muscle burns more calories per hour than fat does, weight training helps you keep your weight in line more than aerobics alone. And stretching will keep you flexible so that you're less likely to strain your muscles and joints when you work out. (For information on starting a program of aerobic exercise, resistance training and stretching, see page 85.)
Chest Pains? See a Doctor If you have unexplained chest pain or irregular heartbeat, call your doctor immediately. If you have chest pain, pressure or heaviness accompanied by sweating, shortness of breath, nausea or heart palpitations, go to a hospital emergency room. It might not be a heart attack, but you're better off in the emergency room until you know for sure, says Glenn S. Rothfeld, M.D., clinical instructor in the Department of Community Health at Tufts University School of Medicine in Boston, a practitioner in Arlington, Massachusetts, and co-author of Natural Medicine for Heart Disease. |
YOGA OFFERS MULTIPLE BENEFITS
Yoga offers all the benefits of stretching and then some. Like stretching, practicing yoga postures daily or several times a week keeps you flexible so that you're less likely to strain your muscles and joints in the midst of your heart-healthy aerobic workouts, says Dr. Lutack.
Yoga also helps you to relax, counteracting the effects of stress hormones that raise your blood pressure and trigger spasms in your coronary arteries. And yoga improves circulation, says Dr. Rothfeld.
For heart-healthy benefits, Dr. Rothfeld recommends a yoga posture called the expansion pose. While standing, hold your arms out at your sides and slowly move them backward until you can interlace your fingers. (You'll have to bend your elbows to do this.) Hold your trunk straight and without straining, slowly raise your arms. Gently arch your back as you begin to lift your locked hands toward the ceiling. Hold for five seconds. Then slowly bend your body farther forward, lowering your head and raising your arms to shoulder level for ten seconds. Then return to an upright position, drop your arms to your sides and relax.
MIND-BODY THERAPY FOR YOUR HEART
Dr. Ornish's program for reversing heart disease goes beyond diet and exercise to include yoga, meditation and other stress-reduction techniques. For total heart protection, more and more doctors are recommending some form of mind-body therapy to the men and women that they counsel.
"To protect your heart, it's not enough just to watch your diet and exercise," says Dr. Cortis. You also have to tend to your mind and spirit, he adds, since your emotional and physical well-being are interdependent.
"Imagine that health is like a stool with three legs," he says. "One leg is your physical body. The second is your mind--the way that you think. And the third is your spirit. You have to care for each."
Diet and exercise take care of your physical requirements. Here's how to care for your mental and spiritual needs.
Jettison stressful thought patterns. Cognitive therapy is a technique that effectively combats stress created by distorted perceptions or negative thinking. A counselor trained in cognitive therapy can help you change the way that you react to stresses that are beyond your control, such as difficult people, demanding jobs or worries about the future. (For more information on cognitive therapy, see page 79.)
Take a meditation break. Meditation reduces levels of stress hormones, decreases blood pressure and reduces the likelihood that your coronary arteries will go into spasm. In an Iowa study, African-American women and men who learned meditation lowered their blood pressure significantly. Since the release of stress hormones can also contribute to angina, meditation may help alleviate chest pain as well.
Imagine a healthy heart. If you have heart disease, you can aid treatment by visualizing your heart as healthy, Dr. Cortis says. Sit quietly, close your eyes and relax. Form a mental image of your heart, surrounded by clear, open arteries and beating regularly and powerfully. Picture the artery walls as smooth and wide, flowing abundantly with oxygenated blood. For best results, repeat daily.
Breathe away tension. Slow, rhythmic breathing can also help you relax when you're stressed out, says Jeff Migdow, M.D., holistic medical doctor and director of yoga teachertraining at the Kripalu Center for Yoga and Health in Lenox, Massachusetts, and co-author of Take a Deep Breath. He recommends the following exercise.
To begin, take five to ten deep breaths, making sure that your stomach expands with each inhalation and falls with each exhalation. Continue this deep abdominal breathing. With each inhalation, imagine that you're breathing into a tense or painful part of your body. Then, with each exhalation, imagine that tension streaming out of your nostrils. Continue for a few minutes or longer.
Give your heart a lift with aromatherapy. Certain scents can reduce heart-hurting stress. Others appear to stimulate circulation, calm heart palpitations and lower blood pressure, says Dr. Rothfeld. Though scents have different effects on different people, he says, most people find chamomile and marjoram oils to be beneficial. Rub the essential oils on your wrist or a hanky and periodically take a whiff.
