DECEMBER 2004 Newsletter - Be a smart patient; Updates on Heart Disease; Success stories
Dear Friends and Patients:
As we approach the Christmas/Hanukkah holiday season and realize how fast this year has gone by, it is always appropriate to take time to count our blessings. The staff of the Preventive Medicine Center and I would like to thank our patients, colleagues, and friends who have referred patients and family members to us. We appreciate the confidence you have in us. We wish you all the happiest of Holiday seasons.
One of the things I try to do in this newsletter is to give a different perspective of health issues than a reader will normally see in the public press. A “no spin zone” so to speak. It is often difficult to find balanced information on health issues, and in this issue I will present new information on heart disease. As you all know, I have an integrative medical practice where traditional therapies and alternative/complimentary therapies are combined to treat patients. The lack of understanding and utilization of correct nutrition to improve physiological functioning of the human body is unfortunately widespread in conventional medicine. Drug therapies, which work by suppressing physiological function, are better understood but have much lower margins of safety. I recently had a patient come in for a routine visit for her hormonal and nutritional therapies. She felt great and thanked me for helping one of her friends whom she referred who was severely depressed but wasn’t responding to traditional anti-depressant drug therapy. Her friend improved under my care once her nutritional deficiencies and neurotransmitter imbalances were corrected. She stated that this patient’s friends told her she was seeing “the weird doctor.” Rather than being offended, I just smiled. Reality depends on your perspective and personal experience. I tell my children, who are both in college, that the most valuable part of my Duke University education was not book knowledge, but the ability I gained to see different sides of an issue (in debate class we had to debate either side of the assignment) and form an independent opinion.
Medicine is full of examples of “normal science” becoming obsolete, and newer theories ignored because they don’t fit the old paradigm. The medical model of a single disease, a single medication, and a single cause is out-dated but is still widely held. For example, cardiovascular disease may be triggered by insulin resistance, folate deficiency, occult infections, elevated homocysteine, heavy metal toxicity, hereditary factors, stress, and other factors that increase inflammation. The success of medical therapy rests on making the proper assessment of the root cause(s). Applying the classic low-fat diet (= high carbohydrate diet), beta-blocker and statin drug may actually exacerbate the underlying problem in a patient with insulin resistance.
Part of the problem is that some things in medicine are not based in science, but rather opinion. At the beginning of the last century, medicine thought diseases such as scurvy, rickets, beriberi, and pellagra were due to “foreign invaders” or a “toxic factor.” This was entirely in keeping with the infectious model of disease at the time. In 1914, Joseph Goldberger, an officer in the US Public Health Service, doubted the infection theory, because no medical personnel caught pellagra from their patients. He showed pellagra was caused by a deficiency of a vitamin. Few people believed him as no one had ever “seen” a vitamin. It wasn’t until many years later that the Nobel peace prize for vitamins was awarded. But out of this discovery the model of a single vitamin preventing a single disease was born, and the concept of the minimum daily requirement of a vitamin to prevent a disease followed. This viewpoint, still widely held today, is outdated for a number of reasons. Vitamins are multifunctional substances with broad and varied roles in human biology. A single vitamin may catalyze hundreds of biochemical reactions. Suboptimal levels may lead to cellular and molecular dysfunction that is not recognized as a deficiency disease. The notion that higher doses may be needed for optimal human functioning is not generally accepted, despite new evidence that suboptimal nutritional status may contribute to “long-latency” deficiency diseases such as cardiovascular disease, cancer, osteoporosis, neurodegenerative disease, and immune dysfunction. Dr. Roger Williams, a pioneer in nutritional biochemistry and the discoverer of pantothenic acid and folic acid, was the first to recognize that nutritional status can influence the expression of genetic characteristics. He was also the first to challenge the standard recommended daily allowances as adequate for the entire population. The human body has approximately 30,000 genes and 1.5 million genetic variations called SNP’s (single nucleotide polymorphisms) that make each person “unique.” One third of these SNPs or mutations have their function directly affected by vitamins and minerals at co-enzyme binding sites. What we do at the Center is use data such as a hair mineral analysis or a SpectraCell intracellular vitamin analysis to diagnose deficiency states and customize a person’s supplements on an individual basis. Conventional medicine has just recently recognized that taking a multivitamin is a good idea, but this is a far cry from individualizing nutritional therapies to each persons needs and condition.
I encourage my patient’s to be “independent, critical thinkers” and ask questions regarding their medical conditions or proposed treatments, not just during their visits to the Center, but from whomever they are receiving health care. Examine the evidence and come to your own conclusions. Weigh risks vs. benefits. Just because many people believe it, including so-called experts, doesn’t make it so. Consider other interpretations and be willing to tolerate uncertainty. If something doesn’t make sense, ask questions or ask for written information. I am not afraid to say “I don’t know.”
Is Cholesterol the “Enemy”?
Patient’s are often surprised at the answers I give them when they discuss “cholesterol” with me. The “war” on cholesterol to reduce heart disease has been going on for decades, yet this disease remains the number one cause of death in the U.S.. The number of deaths from this disease has not changed in the past 25 years, in spite of new cholesterol lowering drugs, advances in heart surgery with stents and angioplasties, a myriad of foods that are cholesterol-free. Why is this? If high cholesterol was the answer, then why do half of all patients who die from heart disease have a cholesterol that is “normal” or below 200mg/dL? The United States has 5% of the world’s population, but accounts for 50% of the heart surgeries. In Europe and Canada, stents or by-pass surgery are treatments of last resort, rather than primary treatment. Why the difference in treatment? Or why do people who eat a Mediterranean diet have a 50% lower death rate from all causes, including heart disease, even if their cholesterol is high?
Cholesterol is a substance that is produced by the body and is also consumed in the diet. 90% of the body’s cholesterol is produced by the liver and only 10% is dietary. Because cholesterol has been portrayed as an “enemy” most people do not realize that cholesterol is critical for health and is a precursor to sex hormones such as testosterone, estrogen, and progesterone. Elevated cholesterol is only one of many risk factors in the development of heart disease, and is not very accurate as a predictive factor for death from heart disease. What is important is whether cholesterol is sticking in the arterial wall or not in response to inflamation. The concept of heart disease being an inflammatory disease is relatively new.
There are multiple variables that contribute to heart disease risk. Some of the following data was presented at the May 2004 ACAM (American College for Advancement in Medicine) conference I attended. I have condensed this data due to space considerations. A more comprehensive discussion is published under “Topics of Interest” on our Internet site at www.prevent-doc.com.
ACAM Conference Updates on Heart Disease – Facts and Risk Factors
Balz Frei, Ph.D., who is the Director and Endowed Chair of the Linus Pauling Institute spoke at the ACAM conference and shared with us research on oxidative stress, adhesion molecules, and atherosclerosis. He pointed out that atherosclerosis is an oxidative event where LDL cholesterol is oxidized, and where anti-oxidants may prevent this process. Ascorbate (vitamin C) and Glutathione are the most abundant anti-oxidants naturally occurring within the cells. Transitional metals such as mercury, lead, iron, and copper may play a role in the development of atherosclerosis, but by adding metal chelators to cell cultures, atherosclerosis and adhesion molecules are blocked. He further pointed out that arterial narrowing by itself did not cause a heart attack or stroke. There must be a rupture of the arterial plaque, exposing the surface of the artery causing vasospasm, platelet aggregation (clumping together of platelets), and clot formation leading to complete blockage or occlusion. Once this happens, a heart attack or stroke occurs. Nitric oxide blocks this from occurring. As little as 500mg of vitamin C a day dramatically improves vascular function by improving nitric oxide production.
Another wonderful presentation on emerging concepts of heart disease was given by Dr. Allan Magaziner, D.O.. He is the current president of ACAM and the author of The All-Natural Cardio Cure: A Drug-Free Cholesterol and Cardiac Inflammation Reduction Program (Avery, 2004). Well known statistics and risk factors are as follows :
• Cardiovascular disease remains the leading cause of death in the U.S.
• 750,000 deaths per year or 1 in 5 deaths.
• The number of deaths has not changed in the last 25 years.
• 250,000 people die from heart attacks every year without even making it to the hospital.
• 1 in 5 heart disease deaths are linked to smoking. Another 40,000 are linked to second hand smoke.
• More than 350,000 people undergo by-pass surgery and more than 600,000 have angioplasties each year.
• Diabetes is a tremendous risk factor – 80% of diabetics die of heart disease.
• Other risk factors are obesity, hypertension, sedentary life style, stress, family history, hypercholesterolemia. Smoking is the #1 risk factor.
• Half of all patient who have heart attacks do not have elevated cholesterols.
New risk factors are emerging that include the following:
• Inflammation
• Infections including periodontal disease
• Oxidized LDL cholesterol
• Homocysteine
• Fibrinogen
• Lipoprotein(a)
• Platelet dynamics and blood viscosity
What Is the Most Accurate Marker for Heart Disease Risk?
HS (high sensitivity) CRP or Cardiac CRP is a marker of inflammation, and is now recognized as the single most significant diagnostic tool for assessing health risk associated with future risk of heart attack and stroke. Simply measuring cholesterol levels is inadequate. Those with HS CRP levels in the highest quartile are three times more likely to develop heart attacks compared to those in the lowest quartile. Those with severe periodontal disease are more likely to have elevated blood levels of HS CRP. Levels below 1.0mg/L are associated with low heart disease risk. HS CRP is measured by a simple lab test.
Another risk factor is homocysteine, an amino acid derived from dietary protein. High levels of homocysteine may account for 25 – 30% of all cases of heart disease. Levels above 15 can damage arterial walls and are associated with accelerated plaque formation. Optimal levels are below 10. High homocysteine can be corrected in most cases with vitamins B6, B12, and folic acid. As many of you know, we have also been measuring homocysteine and HS CRP levels, in addition to cholesterol profiles, since the Center opened.
Statin Drugs vs. Natural Supplements to Lower Cholesterol
Patients often come to the Center and ask me about Statin drugs that they are taking or are advised to take by their primary care physicians who are concerned about a total cholesterol level above 200mg/dL.. Statin drugs are touted to lower cholesterol, but they actually work by reducing arterial inflammation and lowering HS CRP. Because there have been deaths from these drugs and they deplete CoEnzyme Q10 levels which is necessary for heart muscle health, in my opinion they should be used as a last resort. Co-Q-10 depletion may be a contributing factor in the potentially fatal muscle disease associated with statins, rhabdomyoloysis. There are alternatives in lowering HS CRP including eating cold water fatty fish, pineapple, ginger, blueberries, soy products, green tea, shiitake mushrooms, and garlic and onions. Vitamin E reduces inflammation and HS CRP in diabetic patients, and Omega 3 fish oils inhibit naturally prostoglandins that cause blood vessel inflammation. Eskimo’s whose diets are high in omega 3 oils, have the lowest incidence of heart disease on the North American continent.
Red Yeast Rice is a fermented product of rice on which red yeast is grown. It has been used for centuries in China. Red Yeast Rice contains 9 different monacolins, that are substances that inhibit cholesterol production. One of these monacolins is Lovastatin. There have been no reports of liver enzyme elevation or renal impairment, although rare headaches and stomach discomfort may occur. We do not know if there is Co-Q-10 depletion while taking this product.
Another product that lowers cholesterol naturally is Policosanol, which is extracted from sugar cane. It inhibits cholesterol formation in the liver and also inhibits the aggregation of platelets, which improves exercise response in patients with heart disease. A study published in 1999 compared patients taking 10mg/day of Policosanol with taking Pravastatin for eight weeks. Policosanol reduced the total cholesterol by almost 14%, LDL by 19.3%, increased HDL by 18.4%. The benefits were similar to the drug. We carry this product at the Center.
EDTA Chelation Therapy and Subsequent Cardiac Events
EDTA is a synthetic amino acid approved by the FDA for use in lead detoxification. Although chelation therapy has been used safely for decades, there is still a lot of controversy among traditional Western physicians as to whether it works and why it works. Heavy metal toxicity with lead, mercury, cadmium, and other heavy metals poses a significant risk factor not generally recognized in the development of heart disease by either the public or traditional Western physicians. We live in a polluted environment and heavy metals oxidize LDL cholesterol which causes arterial injury. They also deplete vitamins B6, B12 and folate by putting nutritional stress on the detoxification pathways, causing an increase in homocysteine levels. Removing these metals with chelation therapy is now thought to be the mechanism by which chelation works to reduce the risk of heart disease. A large, multi-center study called the TACT trial is being funded by the National Institutes of Health and is currently underway in the U.S. to further evaluate EDTA’s benefits in patients with known heart disease.
Terry Chappell, M.D. presented a very exciting, unpublished study at the ACAM conference where 246 patients with known vascular disease were treated with EDTA chelation therapy and underwent a 3 year follow-up to determine the incidence of cardiac events. The data was analyzed by Rakesh Shukla, Ph. D., who is a specialist in biostatistical analysis at the University of Cincinnati Center for Biostatistical Analysis.
In this study 71% were males, average age 64 (range 40 – 85 years) and the mean number of treatments was 58, with a minimum of 20 treatments followed by monthly maintenance treatments. 17.6% smoked at the beginning of treatment, 8.5% at the end of treatment. In this group there were NO deaths, NO heart attacks, and 3 minor strokes (all of which resolved over time). 5 patients (2%) underwent cardiac bypasses and 3 (1.2%) underwent angioplasties. 4 patients (1.8%) had the onset of cancer. What was also interesting about this study was 35% of the patients had been told that they should undergo vascular surgery and refused, and another 10% were told they needed surgery but that they were too high risk. In other words, 45% of patients had surgical severity of disease but underwent chelation instead.
167 patients had symptoms at the beginning of treatment whereas 118 (70.7%) were symptom-free at the end of the 3 year period. These results were far better than one would expect in a high-risk population.
The chelation group was then compared with other published groups, matching age, numbers in the study, smokers, gender, etc.. and follow up interval of three years. These other groups were divided into 3 categories:
1) Those initially treated with angioplasty.
2) Those initially treated with CABG (by pass surgery) .
3) Those initially treated with standard medical therapy.
Findings at the end of 3 years are summarized:
Heart attacks Deaths Need for Angioplasty Need for By Pass
Angioplasty group 7.3% 3.2% 22.3% 11.8%
CABG group 7.8% 4.0% 5.5% 1.2%
Medical Therapy 3.6% 1.3% 4.4% 15.5%
Chelation group 0% 0% 1.8% 2.7%
This analysis suggests that the rates of cardiac events, strokes and death from all causes appear to be much lower in patients with cardiovascular disease if they receive EDTA chelation therapy.
Summary
The etiology of cardiovascular disease includes a much broader approach than cholesterol alone. Nutritional supplements play a vital role in the prevention and treatment of heart disease. Exercise, smoking cessation, proper diet and stress reduction must be part of a comprehensive cardiovascular disease reversal program. Chelation therapy is a safe therapy when properly administered and is a secondary prevention tool for vascular disease.
A Success Story
Mrs. C is an 80 year old patient whose daughter brought her to see me last December. She experienced sudden confusion and memory problems after receiving a flu shot elsewhere. She was also feeling out of breath, fatigued and weak. She was taking multiple medications, including Vioxx, Lasix, Aceon, Evista and Zocor. The confusion was an adverse reaction to the flu vaccine and it resolved within a week after nutritional detoxification. The patient was also in congestive heart failure causing her shortness of breath and fatigue. I was concerned this was related to depletion of CoEnzyme Q10 by the statin medication she had been taking. The patient underwent a nutritional evaluation and was found to have multiple low vitamin levels on SpectraCell analysis, including a suboptimal level of CoEnzyme Q10. There were multiple low mineral levels on hair analysis. The patient was taken off Zocor and Lasix, and placed on nutritional therapies to correct the deficiencies on the lab tests. This included high doses of CoEnzyme Q10 and L carnitine to improve heart function. Her shortness of breath and weakness resolved within several weeks, and within three months the patient was off all medications and stated “I feel the best I have in years.” She continues to remain active and doing well one year after initially being seen.
Another Success Story – Treating the Flu
Mrs. B is a very nice lady in her 50′s who had a bad viral upper respiratory infection or flu. She was running a low grade fever, had malaise, cough, and was unable to go to work. Mrs. B was taking vitamin C and Echinacea on her own, but this didn’t seem to help much. She was having a hard time sleeping due to her cough. Examination confirmed a viral illness. Mrs. B was given an I.V. with pharmaceutical grade hydrogen peroxide over three hours, and then placed on an LDM-100, an herbal preparation which acts like a natural antibiotic, that we have an herbalist make especially for the Center. The patient improved rapidly within 48 hours and returned to work.
The use of dilute intravenous hydrogen peroxide to treat infections of all kinds has been used for over 90 years. This therapy was pioneered by Charles Farr, M.D., PhD. in the 1900′s, for which he was nominated for the Nobel Peace Prize. He used this therapy in hospitalized patients who were ill with a variety of infections, including tuberculosis, influenza, various bacterial and viral infections. With the advent of Penicillin and other antibiotics, this type of treatment fell out of favor.
The herb Lomatium Dissectum comes from the root of a plant that native Americans have used for centuries. During the severe influenza pandemic in the 1930′s, herbalists brewed this plant in a tea to treat influenza successfully. My experience of over 15 years using this herb has been nothing short of a miracle for upper respiratory illness, skin infections, and urinary tract infections. We have this herb available in a tincture. With the upcoming flu season, these are some of alternative therapies that we use to help people get well.