© Copyright 2004 by 1st Start Publishing Inc., 777 E. Atlantic Ave., Ste.

Z #356, Delray
Beach, FL, 33483. All rights reserved. No part of this book may be used or reproduced
in any manner whatsoever without written permission from the publisher.

This book is intended to give general information, not personal, one-on-one medical
advice. No action should be taken based solely on the contents of this book; instead,
readers who fail to consult with appropriate health authorities assume the risk of any
injuries.
How to Reverse, Even Cure Heart Disease . . .
Without Drugs or Surgery!

By Robert D. Willix, Jr., M.D., FACSM

1
 DISCLAIMER

The information in this book is provided for educational and

information purposes only. It is not intended to be used as medical
advice or as a substitute for treatment by a doctor or health care
provider.

The information and opinions contained in this publication are believed

to be accurate based on the information available to the author.
However the contents have not been evaluated by the U.S. Food and
Drug Administration and are not intended to diagnose, treat, cure or
prevent disease.

The author and publisher are not responsible for the use, effectiveness
or safety of any procedure or treatment mentioned in this book. The
publisher is not responsible for errors and omissions.

2
 Table of Contents

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

CHAPTER 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
What is Heart Disease?

CHAPTER 2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
A Closer Look

CHAPTER 3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22
In the Doctor’s Office

CHAPTER 4 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41
Heart Healthy Eating

CHAPTER 5 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75
The Exercise Factor

CHAPTER 6 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 86
Lifestyle Choices for a Healthy Heart

CHAPTER 7 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 95
Dietary Supplements for Heart Health

CHAPTER 8 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 111
How Herbs Can Help

CHAPTER 9 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 123
Natural Alternatives to Surgery

CHAPTER 10 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 133
How Complimentary Medicine Keeps You Young At Heart

About the Author. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 145

APPENDIX I. Resources . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 147

APPENDIX II. Glossary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 152

SELECTED REFERENCES. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 158

3
 INTRODUCTION

If you’ve been the victim of a heart attack – or know someone

who is – you know that life afterwards is forever changed. A victim
of cardiovascular disease (CVD) lives in fear of when the next attack
might strike. And if you haven’t been stricken yet, count your
blessings – because in the United States alone:

❚ Nearly 62 million adults have one or more types of

cardiovascular disease.
❚ More than 2,500 people die from heart disease every day.
❚ One person suffers a heart attack every 20 seconds.
❚ Despite new conventional treatments, cardiovascular
disease is on the rise.
Of all the deaths in the United States each year, cardiovascular
disease causes more than 40 percent. Many of these people were
under the age of 65 – and more than half were women. The sad
truth, as you can see from the graph below, is that cardiovascular
disease (CVD) is the No. 1 killer in America – more than cancer,
diabetes or even accidents.

4
 As a former cardiac surgeon, these statistics are indeed disturbing.
I believe that the reason behind these staggering numbers is that
conventional medicine, spurred on by the pharmaceutical industry,
has only focused its attention on part of the problem – cholesterol.
But, despite what your doctor may tell you, high cholesterol levels
aren’t the most important factor in determining whether or not you’ll
develop this potentially deadly disease. Indeed, two other factors –
high homocystine and C-reactive protein levels – are much better
indicators.
There is also compelling scientific evidence that our lifestyle
choices – diet, exercise, whether or not we smoke – can significantly
increase the odds of developing heart disease. In the following pages,
you’ll learn how different, healthier choices can dramatically reduce
or even prevent its occurrence. I’ll also discuss the role modern
medicine plays in heart disease and show you a number of safe,
effective ways you can avoid costly, and potentially dangerous,
surgery and drugs.
Many of the alternatives outlined in this book may be things
you’ve never heard of – either from your doctor or the popular press.
But they are things that can help you live longer, feel better and
prevent or reverse heart disease. Best of all, you can start benefiting
from many of these natural therapies right now. So let’s get started!

5
 Chapter 1

WHAT IS HEART DISEASE?

Your heart is a complex and magnificent organ. Although it only

weighs between eight and fourteen ounces, this hollow muscle is
responsible for circulating blood throughout your entire body. When
it’s working properly, a healthy heart beats 100,000 times a day.
These rhythmic contractions send oxygen-rich blood and nutrients to
the body’s tissues. By the time you are seventy, your heart will beat
nearly 2.6 billion times and pump some 35.8 million gallons of blood.
Your heart is divided into two halves, each designed to direct
blood in one direction only. The right half receives the blood
returning from every part of your body after the oxygen has been
used by the tissues and organs. The right half then pumps this
oxygen-deficient blood into your lungs through a vessel called the
pulmonary artery. There, the blood picks up oxygen before traveling
to the left half of your heart. Think of as the ultimate recycler.

6
 Once this newly oxygenated blood makes its way back to the left
side of your heart, it is pumped into the aorta, the largest artery in
your body. From there, the process starts all over again as the blood is
sent to all of the other arteries in your body.
You may have guessed by now that a steady supply of oxygen is
essential. Unlike other muscles in the body, which can function
without oxygen, the heart depends on this vital gas to function
properly. During the resting period between each heartbeat, the heart
also supplies blood to itself, delivering oxygen and other critical
nutrients that allow it to maintain its constant pumping action. In fact,
the heart needs as much as a pint of blood per minute to work
properly.
One of the most important reasons the heart needs this continual
blood supply is to sustain its electrical activity. Every time your heart
contracts, electrical impulses pass over its surface in a rhythmic
pattern and are transformed into electromagnetic energy waves that
travel through the heart’s muscle cells. This is the same electrical
energy that is detected during an electrocardiogram (EKG).
If your heart becomes stressed, it can form alternative routes to
provide blood supply to the undernourished muscles by adjusting
blood flow and the signals created by the nervous system. Your heart
can also grow new blood vessels. The heart’s amazing adaptability,
however, depends on the health of its coronary arteries, which in turn
depends on the health of each artery’s inner lining.
This inner lining is made up of tissue called the endothelium.
When this tissue is healthy, it maintains the normal tone of the blood
vessels through its effect on the smooth muscles in the outer part of
the vessel wall. The endothelium also plays an important role in
controlling the stickiness of platelets (small cells in the blood).
Although these platelets help stop bleeding when you cut yourself,
they also cling to any tears in the blood vessels lining and can narrow
the arteries.

How Arteries Become Clogged

Heart disease begins when plaque builds up and eventually
narrows the arteries, a condition called atherosclerosis. Plaque is a
fatty substance made up of cholesterol and other fats or lipids,
calcium and a blood-clotting material called fibrin which causes the
endothelium tissue to malfunction. In response, the endothelium

7
releases a chemical that creates a sticky surface which attracts other
cells. Over time, this build-up, known as atherosclerosis, narrows the
arteries and causes blood flow to slow. Ultimately, this narrowing will
prevent the heart from getting the oxygen and nutrients it needs to
function properly.
A heart attack usually starts when this plaque ruptures and forms
a dangerous blood clot. The clot may stay put or it may travel down
an artery until it hits another obstructed area. If it does travel, it may
block up to 95 percent of the blood flow. There may even be a
complete blockage of the artery. Even though only 10 to 20 percent of
the plaques in our body have a high probability of rupturing, they are
responsible for 80 to 90 percent of all serious heart problems,
including chest pain (angina) and heart attacks.
Many of the natural remedies in this book can improve
endothelial cell function. Enhancing this function widens the blood
vessels and reduces the chance that a sudden blockage will occur if a
plaque bursts. In the next chapter, I’ll give you a more detailed look at
how plaque and atherosclerosis can lead to heart disease.

Are You At Risk?

There are a number of risk factors for heart disease.
Unfortunately, some are beyond our control. For example, as we get
older, our hearts don’t work as efficiently. For much of our lives,
gender also plays a role. Until a woman reaches menopause, men
have a higher risk of a heart attack. But after menopause, a woman’s
risk actually triples! By the time a woman reaches the age of 65, her
risk is almost equal to a man’s.
Family history also plays its part. Most people with a strong
family history of heart disease have one or more other risk factors.
Just as you can’t control your age or gender, you can’t control your
family history. Therefore, it’s even more important to address the risk
factors you can control:
• Smoking
• Stress
• Inflammation
• Diabetes
• High Blood Pressure
• High Homocystine Levels

8
 • High Cholesterol and Triglyceride Levels
• Sedentary Lifestyle
• Obesity
Smoking: Kicking the cigarette habit is perhaps the single most
important thing you can do to protect yourself against heart disease.
Consider this:
√ Cigarette smoking is the biggest risk factor for sudden
cardiac death.
√ Of the more than 400,000 Americans who die every year
from smoking, the majority die from heart disease, not
lung disease.
√ Cigarette smoking produces a greater risk for coronary
heart disease in people younger than 50 years.
√ The American Heart Association estimates indicate that
approximately 37,000 to 40,000 people die each year
from heart and blood vessel disease caused by
secondhand smoke.
Inhaling tobacco smoke causes several immediate responses
within the heart and its blood vessels. Within one minute of starting
to smoke, the heart rate begins to rise: it may increase by as much as
30 percent during the first 10 minutes of smoking. Nicotine raises
blood pressure: blood vessels constrict which forces the heart to work
harder to deliver oxygen to the rest of the body. Meanwhile, the
carbon monoxide in tobacco smoke exerts a negative effect on the
heart by reducing the blood’s ability to carry oxygen.
Smoking also tends to increase cholesterol levels. In fact, the
ratio of HDL to LDL cholesterol tends to be lower in smokers
compared to non-smokers. Cigarette smokers also have raised levels
of fibrinogen (a protein which causes blood to clot) and platelets
which make the blood stickier. Carbon monoxide attaches itself to
hemoglobin (the oxygen-carrying pigment in red blood cells) much
more easily than oxygen does. This reduces the amount of oxygen
available to the tissues by forming compound called carboxy-
hemoglobin, which is only present in the blood of smokers. All these
factors make smokers more at risk of developing atherosclerosis.
If you smoke, quit. Yes, it’s hard to do, but it’s well worth it.
Researchers from the World Health Organization say that a smoker’s

9
risk of having a heart attack is slashed by 50 percent after only of
year of quitting.
Stress: While it’s difficult to document the effects of stress on
heart disease, it is clear that constant stress has a very negative effect.
Researchers have found that stress triggers a number of physiological
changes that affect the heart. Stress causes the adrenal glands to
release epinephrine, better known as adrenaline, which makes the
heart pump faster and the lungs work harder to flood the body with
oxygen. The adrenal glands also release the hormone cortisol, which
helps the body convert sugar to energy. While this is a normal
reaction to short-term stress, when stress becomes an all-day, every-
day occurrence, this constant flood of hormones can raise your blood
pressure and damage the lining of your arteries, making it a prime
target for plaque build-up. Blood clots are also more likely to form
during times of stress and could block an already-narrowed artery.
Fortunately, there are a number of ways to reduce stress – many of
which I discuss in Chapter 7.
Inflammation: Inflammation is now recognized as an important
contributing factor to atherosclerosis and heart disease. While short
bouts of inflammation help the body heal itself from injury or
infection, long-term episodes of inflammation within the arteries can
do great damage. It seems that plaque is naturally drawn to the site of
inflammation and, as the years pass, layer after layer is deposited
inside the artery, eventually causing many of the symptoms of
cardiovascular disease, including strokes and heart attacks.
One of the best ways to determine inflammation is by measuring
C-reactive protein, or CRP. CRP is produced in the liver and is a
strong predictor of a first-time heart attack, even in cases where
cholesterol levels are normal. In one study, Harvard researchers
reviewed the data from 1,086 men participating in the Physicians’
Health Study – half of whom had experienced a heart attack, stroke or
blood clot in a major vessel and half who had not. After analyzing the
data, the Harvard team found that the men with the highest CRP
levels were three times more likely to suffer a heart attack and twice
as likely to have a stroke than the subjects with normal levels.
Other studies have also detected CRP in atherosclerotic lesions,
where it has been found to attract white blood cells called monocytes
and increase the production of sticky molecules in endothelial cells.
Because the emerging research is so compelling, doctors should
routinely test CRP levels as part of the battery of blood tests used for
10
determining cardiovascular risk. CRP levels in the blood are
normally undetectable or very low; levels greater than 2.0 are strongly
associated with inflammation. Blood CRP, homocystine, and lipids
(cholesterol and triglycerides) should be tested at least once a year.
Diabetes: Diabetes poses a major threat to your cardiovascular
system, putting you at increased risk of having a heart attack or
stroke. In fact, after analyzing data collected from two large multi-
center clinical trials, Duke University Medical Center researchers
found that patients with diabetes have almost twice the risk of dying
or suffering severe outcomes from heart disease compared to non-
diabetics.
Chronic high blood sugar is associated with the narrowing of the
arteries, increased blood levels of triglycerides, decreased levels of
“good” HDL cholesterol, high blood pressure and heart attack. While
managing diabetes can reverse these effects, the symptoms of diabetes
can often go unnoticed.
People who are unaware that they have diabetes face an increased
risk for heart disease because atherosclerosis may occur at an earlier
age and may cause what is called “silent ischemia” or a silent heart
attack. Silent, in this case, means without typical pain because
neuropathy, or nerve damage, is a result of uncontrolled diabetes.
High Blood Pressure: High blood pressure is a condition that
occurs when the pressure inside your large arteries is too high. Also
known as hypertension, high blood pressure is the first step in the
quiet decent towards heart disease and stroke. In fact, according to the
American Heart Association, high blood pressure was directly linked
to 44,435 deaths in 1998 and indirectly responsible for another
210,000 deaths.
Since high blood pressure rarely shows any symptoms, unless
your doctor monitors your blood pressure on a regular basis, it’s easy
to miss — until it’s too late. A 50-year study by the National Heart,
Lung and Blood Institute (NHLBI), known as the Framingham Heart
Study, found that half of all people who have suffered a first heart
attack also had moderate to high blood pressure.
Normal blood pressure is approximately 119/80 millimeters of
mercury or below. Blood pressure naturally goes up as you age and
the arteries become less elastic. When blood pressure reaches 140/90
or above on a consistent basis, you have high blood pressure. While
aging can cause your blood pressure to rise, obesity, heavy alcohol

11
use, high salt intake, a sedentary lifestyle and stress can also cause
hypertension. Fortunately, these factors are something you can
control.
Homocystine: Homocystine is the normal breakdown product of
the essential amino acid, methionine. Although the body uses small
amounts of homocystine, high levels in the blood can boost LDL
cholesterol levels. Homocystine also irritates the arteries and makes
the blood clot more easily than it should, increasing the risk of blood
vessel blockages. To make matters worse, homocystine prevents the
small arteries from dilating so they are more vulnerable to
obstruction.
Although conventional medicine ignored homocystine for
decades, recent research has found a definite link between heart
disease and high homocystine levels. In one study of 21,500 men,
those with the highest homocystine levels were three times more
likely to die of ischemic heart disease.
How much is too much? A growing number of studies show that a
homocystine level greater than 9 µmol/L is a risk factor for heart
disease independent of other known risk factors such as high serum
cholesterol. According to the New England Journal of Medicine, a
four and a half year examination of the relationship between plasma
homocystine and mortality was carried out by Norwegian researchers
in 587 patients with coronary artery disease. Of the 64 patients who
died during the study, only 3.8 percent of those whose plasma
homocystine was less than 9 µmol/L died, compared with 25 percent
of those with plasma homocystine above 15 µmol/L.

Mortality over four years in 587 patients with coronary artery

disease
Homocystine (µmol/L) Mortality (%)
<9 3.8
9-14.9 8.6
≥15 24.7

Elevated homocystine levels can be caused by genetic enzyme

deficiencies, dietary deficiencies of folic acid and vitamins B6 and
B12, hypothyroidism or certain medications. For example,
glucophage, used to treat diabetes, and cholestyramine, used to treat
high triglycerides, block the absorption of folic acid from the

12
intestines and raise blood levels of homocystine. Lifestyle factors also
play a role, since cigarette smoking and caffeine can increase your
homocystine levels. Unfortunately, homocystine levels also rise
naturally as you get older. But, as you’ll learn in Chapter 7, simply
boosting your vitamin B and folic acid intake can dramatically lower
homocystine levels.
High Cholesterol/High Triglyceride Levels: Cholesterol, a wax-
like fatty substance that is produced in the liver, has gained a
reputation as the primary risk factor for heart disease. But cholesterol
isn’t necessarily bad. In fact, our bodies need cholesterol to form cell
membranes and to make sex and steroidal hormones, including
estrogen, testosterone and cortisol. The trouble begins when we have
too much of the wrong cholesterol.
Low-density lipoproteins (LDLs) are often called “bad”
cholesterol because they carry cholesterol into the arteries, where it
sticks to arterial walls and contributes to plaque build-up. High-
density lipoproteins (HDLs), on the other hand, carry cholesterol out
of the arteries and are known as “good” cholesterol. What really
matters is the ratio of LDL to HDL. Scientific evidence suggests that
LDL levels should not exceed HDL levels by more than four to five
times. For example, if HDL levels are 60 mg/dL and LDL are 180
mg/dL, or three times greater than HDL, cholesterol is within an
acceptable range.
While a poor ratio between LDL and HDL cholesterol can indeed
boost your risk for heart disease, new evidence shows that it may not
be the most important factor. The level of cholesterol in the blood
provides a clue that something is wrong, nothing more.
Cholesterol doesn’t travel around the bloodstream by itself. It is
usually packaged with fats called triglycerides. Triglycerides are the
body’s preferred form of energy storage and usually come from the
foods we eat. The calories that aren’t immediately used by the tissues
are converted to triglycerides and transported to fat cells to be stored.
Hormones regulate the release of triglycerides from fat tissue so they
meet the body’s needs for energy between meals. But high levels of
plasma triglycerides, a condition called hypertriglyceridemia,
damages the arteries and increases your risk of atherosclerosis. People
with high triglycerides often have high LDL and low HDL levels – a
combination that is particularly dangerous. Chapter 4 provides more

13
information on how to lower both cholesterol and triglyceride levels.
Sedentary Lifestyle: The old saying, “move it or lose it,” certainly
applies when it comes to heart disease. Yet, a shocking 24 percent of
all Americans simply won’t exercise – and if they do get the urge to
work out, they simply wait until it passes.
Even moderate amounts of physical activity can reduce your risk
of heart disease. Not only will you lower your weight and get your
blood pumping – as you build muscle, you rev up your metabolism,
causing your body to burn more fat and sugar for energy. This
reduces your blood pressure and the levels of sugar and fat in the
blood. In Chapter 6, we’ll look at ways to fit heart-healthy exercise
into your life.
Obesity: A healthy weight is crucial for a long, healthy life. Yet,
in 1999, almost 61 percent of adults were overweight or obese. Being
overweight dramatically increases your risk of heart attack. It also
increases your risk of developing high blood cholesterol, high blood
pressure and diabetes - each of which also increases your chance of
having a heart attack. What’s more, when you are obese, the wall of
the heart must grow to be able to pump the additional blood volume
required by your body. This makes the heart less efficient. And people
who carry their weight around their waists are at an even higher risk,
even if they have no other risk factors.
The easiest way to figure out if you have crossed the line from
pleasantly plump to obese is to calculate your body mass index
(BMI). Simply multiply your weight in pounds by 704.5. Then
multiply your height in inches by your height in inches, and divide
the first answer by the second answer. For example, if you are 5 feet,
8 inches and weigh 150 pounds:

150 x 704.5 = 105,675

68 x 68 = 4,624
105,675 divided by 4,624 = 22.8

If you’d rather not do the math, there are a number of BMI

calculators available on the internet. Just punch in your weight and
height and – abracadabra! – your BMI is automatically calculated.
What do the numbers mean? A BMI between 19 and 24 is considered
normal. A BMI of 25 to 29 means you are overweight. And a reading

14
of 30 or more indicates obesity.
Admittedly, losing weight can be a tough proposition. But, here’s
the good news: If you are overweight or obese, even a small loss –
just 10 percent of your current weight – will help to lower your risk
of developing heart disease.

A Word About Syndrome X

Syndrome X refers to a cluster of diet-related health problems that
affect as many as 60 million Americans. Unfortunately, many of us
are all too familiar with the signs of Syndrome X: that “spare tire”
around the middle, high blood pressure, high triglycerides, high
cholesterol levels. Although heart disease can be caused by any one of
these risk factors, Syndrome X increases the probability of developing
heart disease.
People who have Syndrome X do not respond well to insulin; they
are insulin resistant. Their pancreas is forced to secrete excessive
amounts of the insulin to dispose of glucose, or blood sugar, by
moving it into muscles and fat cells. These people don’t have
diabetes, because they produce enough insulin to overcome the
resistance, but the high insulin levels lead to elevated blood
triglycerides (fatty acids), low HDL (“good”) cholesterol, high blood
pressure and other signs of Syndrome X.
In one study by researchers at Stanford University, 147

HEART SMART TIP

IF YOU THINK YOU’RE INSULIN RESISTANT:
Ask your doctor for a hemoglobin A1C test. Unlike a glucose
tolerance test, which simply measures the fluctuating blood sugar
levels on a day-to-day basis, an A1C gives you an average of your
blood sugar over the last three months.
As a baseball fan, I like to think of hemoglobin A1C as a way to
figure your season batting average. A score of less than six means
you’re having a terrific season. Ratings over six, however, are
diabetic ranges that can spell trouble.

15
individuals (average age 50 and healthy at the start) were followed for
five years. After reviewing the data, the researchers found that one out
of seven of the subjects with the most insulin resistance had a heart
attack during the study. But in those who were the least insulin
resistant, not a single person had a heart attack.
Are you at risk for Syndrome X? If you are more than 15 pounds
overweight, carry your weight
around your middle, have high Normal insulin
blood pressure, high triglycerides or sensitivity levels:
low HDL levels, you might want to
Fasting — less than 20
have a fasting blood glucose test and
a glucose tolerance test. If your After 1 hour — less than 80
fasting glucose is more than 100 After 2 hours — less than 60
mg/dl and your glucose tolerance After 3 hours — less than 40
results are higher than 140 mg/dl,
there is a good chance you are insulin resistant and may suffer from
Syndrome X.
That said, I believe that insulin tolerance tests are much better
than glucose tolerance tests for diagnosing Syndrome X. The test
measures insulin sensitivity after the patient is given glucose (sugar).
The box at the right lists the levels for someone who doesn’t suffer
from insulin resistance. But don’t panic if your numbers are higher
than those listed. This metabolic condition responds well to the diet,
exercise and nutritional supplement advice outlined in this book.

16
 REMEMBER . . .

➤ The heart can adapt to stress by adjusting

blood flow and electrical activity, and by
growing new blood vessels. But, even
though your heart can make these
adjustments, it can only do so if the
coronary arteries are healthy.
➤ Heart disease begins when plaque builds
up inside the arteries and eventually
narrows them.
➤ A family history of heart disease and age
are two risk factors beyond our control.
But there are a number of risk factors you
can control.
➤ Smoking is the most damaging contributor
to heart disease. Quit now!
➤ CRP has recently been identified as a
major risk factor for heart attack and
stroke. Make sure your CRP levels are
tested at least once a year.
➤ Your diet can contribute to diabetes, high
blood pressure, high homocystine,
unhealthy cholesterol levels and obesity –
all risk factors for heart disease.
➤ Syndrome X, a cluster of diet-related
health problems, also increases the chance
of developing heart disease.

17
 Chapter 2

A CLOSER LOOK

The term “heart disease” or “cardiovascular disease” covers a

variety of heart-related conditions, including arrhythmia, angina,
congestive heart failure and heart attacks. While there are other
causes for these conditions, one common thread is atherosclerosis. In
fact, atherosclerosis contributes to about three-quarters of all deaths
related to heart disease. Here’s an overview of how atherosclerosis
develops, along with the other conditions it can lead to.
Atherosclerosis: Atherosclerosis is the build-up of plaque deposits
inside the arteries. As you learned in Chapter 1, this plaque damages
the arteries, causing them to become narrow and stiff. In the United
States and most other Western countries, atherosclerosis is the leading
cause of illness and death. In the United States alone, it caused almost
1 million deaths in 1992 – twice as many as from cancer and 10 times
as many as from accidents.
Atherosclerosis begins when white blood cells called monocytes
migrate from the bloodstream into the wall of the artery and are
transformed into cells that accumulate fatty materials. In time, these
fat-laden monocytes accumulate, leading to a patchy thickening of
plaque in the inner lining of the artery. Each area of thickening is
filled with a soft cheese-like substance consisting of cholesterol,
smooth muscle cells and connective tissue cells. Plaque may be
scattered throughout the medium and large arteries, but usually they
form where the arteries branch off – presumably because the constant
turbulence at these areas injures the arterial wall, making it more
susceptible to plaque formation.
Arteries affected with atherosclerosis lose their elasticity, and as
the plaques grow, the arteries narrow. Plaques can grow large enough
to significantly reduce the blood’s flow through an artery. But most of
the damage occurs when they become fragile and rupture. Plaques
that rupture cause blood clots to form that can block blood flow or
break off and travel to another part of the body. If either happens and
blocks a blood vessel that feeds the heart, it causes a heart attack. If it
blocks a blood vessel that feeds the brain, it causes a stroke.
Arteriosclerosis: Often referred to as a “hardening of the arteries,”
arteriosclerosis actually defines several different, but related

18
disorders. These disorders are marked by thickening of the arteries,
loss of elasticity and hardening of the artery walls as calcium and
plaque are deposited. As in atherosclerosis, these deposits narrow the
arteries, thus interfering with the normal flow of blood through the
vessel.
For years the cholesterol, fat and calcium deposited on the artery
walls have been thought to be the mechanisms causing heart disease,
and low-fat, low-cholesterol diets are commonly recommended. The
end result of over ten years of these diet programs is an epidemic
increase of fatter and sicker individuals. More logical and conclusive
research recently shows that free radical damage to the artery walls
initiates a natural repair sequence that results in the patching and
buildup of calcium and cholesterol deposits.
Arteriosclerosis can happen to any artery, but is most serious in
those vessels that channel blood to the heart and brain. When vessels
to the heart narrow, not only is blood flow to the entire body
diminished, but a lot of stress is placed on your heart to work harder
as it tries to pump blood through the narrowing passages. Symptoms
include leg cramps while walking, changes in skin temperature and
color, an altered pulse, headaches, dizziness and memory defects. The
problem is that symptoms often do not arise until the problem has
progressed to a dangerous phase.
Angina Pectoris: Angina is a heavy, tight squeezing pain in the
chest caused by insufficient oxygen supply to the heart (low blood
flow to the heart). It generally occurs when the heart is working hard
and requires more oxygen:
during exercise, at times of
A TYPICAL ANGINA stress, in extremes of
Not all forms of angina have the temperature or soon after a
same symptoms. Here are some not- meal. Typically the pain
so-typical signs to look for: develops at the same point in
• Noctural angina (chest daily activity; for example,
pain while resting) while climbing stairs or at a
• Prinzemetal angina (a certain point in your daily
coronary artery spasm) walk. The pain often radiates
through the left shoulder,
• Pain in the jaw or ear
arm, or jaw and can last for
• Shortness of breath up to 20 minutes. For some
• Indigestion the pain might be intense,
while others may feel only a
19
mild discomfort. Some individuals have no symptoms at all.
Irregardless of the level of discomfort, any angina is a gravely
dangerous situation because it is often the precursor of a heart attack.
Cardiac Arrhythmia: Arrhythmias are abnormal or irregular
heartbeats caused by a disturbance in the electrical nerve impulses of
the heart. One cause of arrhythmia is arteriosclerosis, where deposits
narrow the blood vessels and an inadequate blood supply reaches the
heart. Valvular disease, high blood pressure, primary conduction
abnormalities of the heart or myocardidis can all cause arrhythmia in
the absence of atherosclerosis. Arrhythmias occur more frequently
after a heart attack.
Congestive Heart Failure: Heart failure is a serious condition in
which the heart is not pumping as well as it should. In other words,
the heart is failing to pump efficiently and cannot meet the body’s
demand for oxygen, which often results in congestion in the lungs.
When the heart can’t pump enough oxygen-rich blood to function
properly, it tries to overcompensate for the problem, which only
makes things worse.
According to current statistics from the American Heart
Association, there are five million heart failure patients in the United
States, and 550,000 new cases of heart failure diagnosed in the United
States every year. This includes 10 out every 1,000 people over the
age of 65. Of all newly diagnosed patients, 50 percent of heart failure
patients die within 5 years of diagnosis. Males and females appear to
be affected about equally, but a disproportionate number of women
die from the condition (62.3 percent of more than 45,000 deaths).
Heart Attack: Also known as myocardial infarction, a heart attack
is the sudden death of part of the heart muscle. This is caused either
by inflammation of the artery, hardening of the arteries or a sudden
blood clot in an artery which leads to a deficiency of oxygen of the
heart muscle and necrosis (muscle death).
Each year about 1 million people have a heart attack and one-third
of those attacks are fatal. In developed countries, heart attacks are the
single most common cause of death. Anyone who has suffered a heart
attack has an increased risk of suffering another one in the following
few years, especially if lifestyle and dietary changes are not made to
reverse the factors that caused the first heart attack.

20
 REMEMBER . . .

➤ Atherosclerosis (plaque buildup) contributes to

three-quarters of all deaths related to heart
disease.
➤ Arteries affected with atherosclerosis lose their
elasticity and can become narrow enough to
reduce blood flow.
➤ Plaques can rupture and cause blood clots
which can lead to heart attack and stroke.
➤ Angina, or chest pain, is often felt in the left
shoulder, arm or jaw and may signal an
impending heart attack.
➤ An arrhythmia can be a symptom of
atherosclerosis or high blood pressure and may
occur more frequently after a heart attack.
➤ Congestive heart failure is a serious condition
that occurs when the heart is not pumping as
well as it should. Symptoms include shortness
of breath and persistent coughing.
➤ Heart attacks are the leading cause of death
and happen when part of the heart muscle dies
suddenly. Signs of a heart attack include
pressure in the chest, pain in one or both arms,
back, neck, jaw or stomach, or shortness of
breath, cold sweat, nausea and
lightheadedness.
If you experience these symptoms, call 911
immediately.

21
 Chapter 3

IN THE DOCTOR’S OFFICE

Go to any cardiologist and you’ll likely be subjected to a battery

of diagnostic tests. If the results show that you have a higher than
average risk for heart disease, you’ll probably leave the office with a
fistful of prescriptions for statin drugs, ACE inhibitors, beta-blockers
and blood thinners, along with some very conservative advice about
diet and exercise (eat less dietary cholesterol and exercise more).
But, as is often the case, when these measures don’t work, the
doctor will probably order additional tests – more complex and more
expensive. Often these tests convince your doctor that surgery or
other invasive procedures, such as angioplasty or stent placement, is
the only answer. So, depending on the test results, you schedule an
angioplasty or maybe bypass surgery.
Although some heart problems can’t be fixed by drugs or natural
means, surgery should be the last resort. Unfortunately, that’s often
not the case, even though many cardiac surgeries are simply
unnecessary and dangerous. And many of these operations don’t
prolong or improve the quality of a patient’s life.
We’ve all heard of someone whose stent failed or who needs to
have yet another risky bypass operation. While conventional medicine
is learning that their methods aren’t always the best medicine – as
evidenced by the fact that bypass surgery rates dropped 50 percent in
the early 1990s – they are learning far too slowly.
If you are at risk for heart disease, or have already been diagnosed
with it, it’s important to know the risks and benefits of the drugs or
surgical procedures your doctor recommends. What you’ll find below
is an overview of the conventional options modern medicine has to
offer:

22
Diagnostic Tests And Screening The Pros & Cons of
➤ Standard diagnostic testing Prescription Drugs
• Electrocardiogram (EKG): Used to Drugs are one of the
determine normal or abnormal heart
rate and response.
cornerstones of conventional
• Stress testing with EKG: The well- medicine, especially when it
known treadmill exercise test that comes to heart disease. While
helps determine the heart’s reaction prescription drugs can be
to an increased demand for oxygen.
lifesaving under some
• Screening tests for heart disease
and risk factors, which include: circumstances, too often doctors
• Blood pressure hand them out like candy –
• Cholesterol profile: Measures commonly in place of, or in
total cholesterol, HDL (good) and conjunction with, the
LDL (bad) cholesterol, and recommendation to change your
triglycerides.
diet or exercise habits.
• HeartScoring: Detects the
presence of calcium buildup inside Don’t get me wrong. I’m
the major arteries of the heart. not opposed to the use of drugs
➤ Advanced diagnostic testing: to treat heart disease. But, in
• Echocardiography: Used to their blind acceptance of the
determine normal or abnormal
benefits drugs provide, modern
blood flow through heart
chambers and valves. medicine relies far too heavily
• Stress echocardiogram: Looks on them. If they are so effective,
for evidence of previous heart why are high blood pressure
muscle damage and finds any and unhealthy cholesterol levels
areas of the heart that have a rampant? And why are heart
decreased blood supply.
attacks still the No. 1 cause of
• Stress testing with imaging:
death in the U.S.?
Imaging, or nuclear scanning, of
the heart shows how well blood Not only are drugs not the
flows to the heart muscle. magic bullet many folks in the
• Holter monitoring: A continuous mainstream medical community
EKG recording of heart rhythm believe they are, many of them
during normal activity. This test
only treat the symptoms of heart
may be done to determine how a
patient is responding to cardiac disease instead of the root
medication. cause. Of more concern,
• Angiogram: This special X-ray prescription drugs carry a host
test is done to find the spot where of adverse side effects. Let’s
a coronary artery is clogged. It take a look at the benefits and
can reveal how clogged the artery
drawbacks of the main types of
is and determine if the patient
needs treatment such as drugs commonly used to treat
angioplasty or coronary artery heart disease.
bypass surgery or drug therapy.
23
 ACE Inhibitors: Technically known as angiotensin-converting
enzyme inhibitors, these drugs are often prescribed to relieve the
symptoms of congestive heart failure or to lower blood pressure.
People who have suffered from a heart attack may also receive ACE
inhibitors since some studies have
shown that they may prevent Side Effects of
further damage to the heart muscle. ACE Inhibitors
These drugs work by blocking • Dry cough
angiotensin II. Angiotensin II is the • Large drop in blood
chemical responsible for pressure
narrowing blood vessels and raising
• Kidney and liver problems
blood pressure. The body produces
angiotensin II by converting • Rash
another chemical called angiotensin • Inflammation of the
I. It is the angiotensin-converting pancreas
enzyme (ACE) that makes this • Sinusitis
reaction possible. By blocking - or
• Sore throat
inhibiting - the action of that
enzyme, the conversion to • Gastrointestinal upset
angiotensin II is interrupted and • Changes in blood cells
blood pressure is lowered.
Older people may show an exaggerated drop in blood pressure
after the first dose of an ACE inhibitor. Therefore, many doctors give
patients a short-acting ACE inhibitor such as Captropril and watch
their blood pressure for several hours. Longer-acting ACE inhibitors
are given when the patient’s tolerance to Captropril is established.
ACE inhibitors can cause serum potassium levels to rise, so
patients on this type of medication should avoid taking supplemental
potassium. And if you are taking an arthritis drug, be aware that some
can make ACE inhibitors less effective.
Beta-Blockers: Beta-adrenergic blockers or “beta blockers” are a
family of drugs used to treat high blood pressure, angina and heart
arrhythmia. Beta-blockers “block” the effects of adrenaline on your
body’s beta receptors. This slows the nerve impulses that travel
through the heart. As a result, your heart does not have to work as
hard because it needs less blood and oxygen. Beta-blockers also block
the impulses that can cause an arrhythmia.
People with asthma, chronic bronchitis, emphysema or other
respiratory conditions should avoid beta-blockers since they can make

24
these conditions worse by
narrowing the air passages in the Side Effects
lungs. In people with already of Beta-Blockers
reduced heart function, beta • Drowsiness
blockers may decrease the • Dizziness
pumping ability of their heart
• Cold hands and feet
enough to cause heart failure.
• Dry mouth
Beta-blockers interact with a
number of other medications, • Shortness of breath
including anaesthetics and non- • Insomnia
steroidal anti-inflammatory drugs • Digestive problems
(NSAIDS). Taking
• Depression
antiarrhythmics can increase the
heart slowing effects of beta- • Memory loss
blockers. And certain cough and • Erectile dysfunction
cold remedies and appetite
suppressants can cause a dramatic rise in blood pressure if taken with
a beta-blocker.
Blood Thinners: Despite their name, these drugs do not thin the
blood. They do however, prevent the blood from clotting – hence they
are known as anticoagulants. Aspirin is probably the best known and
most widely used blood thinner.
The September 22, 2003 issue of the journal Archives of Internal
Medicine published the results of a meta-analysis of five major
clinical trials which confirmed that aspirin plays an important role in
heart attack prevention. Since that time three more trials concerning
aspirin’s primary prevention benefits have been published. One of the
studies analyzed data from 55,580 randomized participants and found
a 32 percent reduction in heart attack and a 15 percent combined
reduction in the risk of heart attack, stroke and vascular death
associated with aspirin use.
But British researchers at the Wolfson Institute of Preventive
Medicine aren’t nearly as gung-ho on recommending aspirin to
everyone at risk for a heart attack, especially if they have high blood
pressure. Their study included 5,000 men, age 45 to 69 years, who
were at risk of coronary heart disease but had not previously had
heart trouble. The men were randomly divided into four different
treatment groups to accurately establish the effect of aspirin.
The Wolfson team found that those men with low blood pressure

25
got more benefit from taking
aspirin than those with high Side Effects of
blood pressures, not only for Blood Thinners
coronary heart disease but also • Stomach upset
for stroke. They also noted that • Peptic ulcer
men with higher pressures may
• Tendency to bruise
derive no protective benefit from
aspirin. And, according to the • Allergic reactions
Wolfson researchers, even a • Bleeding
modest benefit provided by • Abdominal pain
aspirin doesn’t necessarily • Upper respiratory infection
outweigh the risk of bleeding.
• Depression
Although most of us consider
• High cholesterol
aspirin safe, it isn’t without risk.
According to new evidence, • Irregular heartbeat
many people who take aspirin for • Hepatitis
a heart condition appear to have
an unexpectedly high risk of serious cardiac problems when they stop
the medication, even on a doctor’s order. A recent French study
included a review of 1,236 people hospitalized for heart attacks and
other acute coronary events. Of that group, 500 of them had been
taking aspirin on their doctor’s orders. In that subgroup, 51, or
slightly more than 10 percent, were hospitalized within a week after
they stopped taking the drug. Twenty of those patients had stopped
taking the aspirin without consulting their physicians. But the others
were obeying doctors’ orders to avoid potential bleeding problems
during such medical procedures as dental work or minor surgery.
If aspirin doesn’t sufficiently prevent blood clots or if you’ve
already suffered from a heart attack, your doctor may prescribe either
Coumadin (warfarin) or Plavix (clopidogrel bisulfate). Both of these
pharmaceuticals prevent clotting, but there are some important
differences.
Plavix interferes with the normal functioning platelets so they
resist clumping together or sticking to damaged, irregular areas within
the blood vessel wall. Plavix is used following specific cardiovascular
procedures such as stent supported angioplasty or for patients who
have had a recent stroke or heart attack. But because this drug slows
clotting, it can take longer than usual to stop bleeding.

26
 Coumadin, on the other hand, interferes with the purely chemical
reaction that causes blood to thicken at an injury site. It is commonly
given to patients who have mechanical heart valves, stents in the
pulmonary artery or chronic atrial flutter. But Coumadin may increase
the risk of plaque breaking away from artery walls and lodging at
another point, causing a blockage. Coumadin also interacts with a
wide variety of drugs, supplements and herbs, including vitamin C,
magnesium, garlic and ginkgo biloba.
Calcium Channel Blockers: These drugs are usually prescribed to
treat high blood pressure, angina and arrhythmia. They work by
slowing down the rate that calcium enters the heart and vessel walls.
As a result, the arteries relax and dilate, allowing the blood to flow
more easily. This lowers the demands on the heart and improves
circulation, which in turn lowers
blood pressure.
Side Effects of Calcium
While calcium channel blockers
Channel Blockers
come with a host of side effects,
these problems are minor • Headache
compared to those found in a 1995 • Flushing
study by the University of • Constipation
Wisconsin. In the study, 623 • Nausea
hypertensive patients who had
• Potassium loss
experienced a heart attack were
compared with 2,032 patients with • High cholesterol
high blood pressure but no heart • Swelling in the
attack. They found that those lower extremities
patients taking a calcium channel • Low blood pressure
blocker had a 60 percent higher
• Liver problems
incidence in heart attacks than those
taking other hypertension drugs. • Heart attack

If that weren’t bad enough, a • Cancer

recent review of nine calcium
channel blocker trials found that patients taking these drugs had a
significantly higher risk of heart attack, congestive heart failure and
other cardiovascular events. The study’s authors concluded that
“calcium antagonists are inferior to other types of antihypertensive
drugs as first-line agents in reducing the risks of several major
complications of hypertension and should not be recommended as first-
line therapy for hypertension.” Yet these are often the first choice of
doctors for the treatment of high blood pressure.
27
 Long-term and seemingly unrelated risks have also been linked to
the use of calcium channel blockers. According to a study by Catholic
University in Rome, the long-term use of calcium channel blockers is
linked to the development of cancer, especially lung, colon, urinary
tract, prostate and breast cancer. And a new study of post-menopausal
women taking calcium channel blockers by the Fred Hutchinson
Cancer Research Center in Seattle found that these medications
double the risk of breast cancer in older women – and if a woman
was also on estrogen, the risk jumped to more than eight times that of
women not taking calcium
channel blockers.
Cholesterol Lowering HEART SMART TIP
Drugs: Cholesterol-lowering
drugs are used to treat THE STATIN SCAM
people with higher-than- Many of my colleagues insist that
normal levels of cholesterol statins can lower CRP. They cite a
in their blood when dietary single study conducted at Walter Reed
restrictions, lifestyle changes Army Medical Center. Of 130 heart-
and weight reduction don’t attack victims in the study, those who
do the trick. These drugs, received a statin drug had significantly
known as statins, work by lower CRP levels – up to 36 percent
blocking an enzyme called lower.
HMG-CoA reductase, which
But this one study isn’t nearly
causes the body to make
enough evidence to explain the
LDL cholesterol.
dozens of patients who walk into my
But statin drugs also office with high CRP levels after their
have a dark side. It seems doctor put them on statins!
that the same enzymes
What statins can do is increase the
involved in the production of
risk of cataracts and weaken your
cholesterol are also required
immune system. Take my advice –
for the production of
avoid statin drugs at all costs.
coenzyme Q10. Not
surprisingly, lower If you have high cholesterol,
cholesterol levels in statin check Chapter 8 for safe and natural
users are accompanied by a ways to reign in your levels.
depletion of CoQ10. CoQ10
plays an important role in providing energy to the cells, especially in
the heart – and low levels are implicated in virtually all
cardiovascular diseases, including angina, hypertension,
cardiomyopathy and congestive heart failure.

28
 Statin drugs can also cause rhabdomyolysis, a life-threatening
condition that destroys muscle cells and releases them into the
bloodstream, a condition that can eventually cause fatal kidney
failure. Rhabdomyolysis gained national attention when it was linked
to Baycol, the statin drug that was pulled from the market in 2001
after causing more then 100 deaths and 1,600 injuries.
Rhabdomyolysis isn’t the
only condition triggered by
Side Effects of Cholesterol
statins. Researchers at the
Lowering Drugs University of Pittsburgh
• Headache have reported that lova-statin
• Insomnia could affect attention and
• Liver problems reaction speed. In their study,
patients whose cholesterol
• Abdominal pain
had been lowered with
• Nausea lovastatin paid less attention
• Diarrhea and had delayed
• Gas psychomotor reflexes
compared with those who
• Skin rash
had not received the drug.
• Immune problems Those who had the greatest
• Hepatitis decreases in cholesterol
• Rhabdomyolysis levels suffered the greatest
impairment.
Statins have also been found to suppress certain immune system
cells known as helper T-cells. Helper T-cells act by recognizing
foreign pathogens and then activating the production of the proper
immune cells in response. And a recent multinational study has found
that statin drugs increase the risk of cataracts, especially in patients
who are also taking antibiotics.
Despite mounting evidence that these drugs are unsafe, there are
13 million Americans using statins, making it the most widely
prescribed class of anti-cholesterol drugs on the market.
Digitalis: This natural derivative from the foxglove plant is used
to treat congestive heart failure and arrhythmias. Digitalis can
increase blood flow throughout your body and reduce swelling in
your hands and ankles.
Digitalis works in two ways. First it strengthens the force of the
heartbeat by increasing the amount of calcium in the heart’s cells.

29
When the medicine reaches
the heart muscle, it binds to Side Effects of Digitalis
sodium and potassium
• Dizziness
receptors. These receptors
control the amount of • Shortness of breath
calcium in the heart muscle • Heart palpitations
by stopping the mineral from • Sweating
leaving the cells. As calcium
• Fainting
builds up in the cells, it
• Hallucinations
causes a stronger heartbeat.
Digitalis also helps control • Confusion
irregular heart rhythms by • Depression
slowing the electrical signals • Visual changes
that travel through the heart
• Breast enlargement in men
and regulates the number of
heartbeats. • Erectile dysfunction
Although this drug
originally comes from a natural herb (foxglove), the modern form of
digitalis is anything but natural. It is a synthetic medication known as
digoxin and sold under the name lanoxin.
It has been reported that, when digoxin is combined with certain
anti-arrhythmic drugs, and calcium channel blockers sudden death
can occur. While digitalis can interact with other medications, you
should also avoid caffeine, diet pills, laxatives and cough, cold, and
sinus medicines.
Nitrates: These drugs are
used to prevent and temporarily
relieve angina by expanding Side Effects of Nitrates
the arteries. They may also be • Flushing
used to lower blood pressure
• Headache
and improve heart function.
Millions of Americans with • Restlessness
coronary artery disease have • Insomnia
been prescribed nitrate-based • Nightmares
drugs. The best known, of
• Heart attack
course, is nitroglycerin. But
there are nearly 30 other nitrate
drugs that doctors can choose from. Available in tablet, capsule, patch
or ointment form, the difference in these drugs is how quickly they

30
work to ease chest pain.
While there’s no doubt that these drugs work, new evidence
suggests that the regular use of nitrate drugs actually increase the risk
of future heart attack. This startling new finding came from a
Japanese study that involved 518 patients with suspected coronary
artery disease. The patients were divided into groups based on the
degree of arterial damage (endothelial dysfunction) and how often
they used nitrate drugs. After tracking the patients for 45 months, the
researchers discovered something unexpected – those who regularly
used nitrate drugs were 2.42 times more likely to suffer major
cardiovascular events. The doctors concluded that the effects of
nitrate drugs accelerate atherogenic processes and endothelial
dysfunction and that nitrate drug use causes future cardiovascular
events.
Of course, this study referred to the use of nitrates on a regular
basis, not the occasional use of these drugs. But even occasional use
can lead to problems. Combining nitroglycerin with impotence drugs
like Viagra and Levitra can result in dangerously low blood pressure
and has been linked to heart attacks and more than 500 deaths.
Vasodilators: Like nitrates, vasodilators act directly on the
muscles in blood vessel walls
to make blood vessels widen. Side Effects of Vasodilators
By widening the arteries, these
• Headaches
drugs allow blood to flow
through more easily, reducing • Nausea or vomiting
blood pressure. • Loss of appetite
Vasodilators, like hydrala- • Bloating
zine (Apresoline) and • Joint and muscle pain
minoxidil (Loniten), aren’t a
• Swollen lymph nodes
permanent fix for high blood
pressure, but they can help • Fever
control the condition. • Chest pain
Unfortunately, they may also • Possible birth defects
worsen the problems that result
from heart disease, blood
vessel disease, or a recent heart attack or stroke. This medicine may
also make angina worse.

Is Surgery The Answer?

31
 Sometime drugs aren’t enough to tame heart disease. And that’s
when, according to conventional medicine, it’s time for surgery. But
like drugs, surgery only addresses the symptoms of heart disease, not
the root cause. Worse yet, coronary bypass and cardiovascular
procedures, including balloon angioplasty and stent implantation are
risky and often unnecessary.
Here’s a classic example: B. G., a friend of mine and someone
with whom I competed with in many triathlons in the early 1980s,
recently suffered from severe chest pain after his morning workout.
After being admitted to the hospital, tests discovered the cause of
B.G.’s heart attack – a clot in one of the branches of his left anterior
descending coronary artery. The cardiologist cleaned out the clot,
inserted a stent to open up the artery and sent him home two days
later. Two weeks later, B.G. called me and said, “Bob, I’m having
chest pains again!” I told him to call 911 and get to the hospital
immediately. I knew he was having another heart attack. Why was he
having this second heart attack? According to his doctor, he had
clotted his stent!
We all know of someone WHAT’S IN A NAME?
who has had a bypass or Most patients are under the
angioplasty – they’ve become mistaken impression that all
common terms in modern cardiac procedures are done by a
lexicon. But most of us don’t cardiac surgeon. Nothing could be
really know the whys and further from the truth!
wherefores of cardiac surgery. Cardiac surgeons only perform
So let’s look at the most cardiac bypass surgery or open
common surgical “fixes” used heart surgery. Angioplasty,
today. atherectomies and stent placements
Atherectomy: Used to are all done by a cardiologist.
remove plaque, atherectomies
are sometimes thought of as the Roto-Rooter of cardiac medicine.
During the procedure, the cardiologist places a catheter into the artery
which is equipped with one of several tools to clean out the damaging
plaque. This type of surgery is usually performed when plaque has
become very hard.
Once the catheter is in place, the cardiologist cuts away the
plaque using a either a sharp blade or abrasive material (like
sandpaper) located at the tip of the catheter. As the plaque is removed,
the bits and pieces are stored in a tiny container which is removed

32
when the catheter is withdrawn from the artery. This technique is
useful in larger arteries with “softer” plaque.
Another tool used in atherectomies is a rotoblator, which quickly
grinds the plaque into very small particles. In most cases, these
microparticles can travel safely through the circulatory system. But if
a clot is present, your cardiologist may opt for a transluminal
extraction catheter, which sucks the plaque particles into a vacuum
and expels them from the body. No matter what method the
cardiologist uses, many atherectomies are followed by balloon
angioplasty and stenting.
By removing some of the plaque, blood flow is improved, which
can relieve angina and even help prevent heart attacks and death.
However, without lifestyle changes, it’s likely plaque will reform over
time.
The chance of serious complications during an atherectomy is
quite small, but this type of procedure is riskier than other catheter-
based surgeries like balloon angioplasties. Serious complications can
include abrupt vessel closure, the need for emergency bypass surgery
or a heart attack. Atherectomies may also result in a perforation of a
blood vessel or can cause a blockage created by loose particles of
plaque.
Angioplasty: Balloon angioplasty is a well-established procedure
that can be effective for some patients. In fact, it’s become so routine
that its use has tripled since 1987.
This type of procedure is used to dilate narrowed arteries. A
doctor inserts and advances a catheter with a deflated balloon at its tip
into the narrowed part of an artery. Then the balloon is inflated,
compressing the plaque and enlarging the inner diameter of the blood
vessel so blood can flow more easily.
Numerous studies show that angioplasties can improve angina and
exercise tolerance in heart patients. However, research shows that this
type of surgery can also increase the risk of more serious cardiac
events and death.
In 1999, one million balloon angioplasties were performed in the
U.S. Of those, at least 70 percent included placing a stent in the
artery. Stents are wire mesh tubes used to prop open arteries after an
angioplasty. The stent stays in the artery permanently, holds it open,
improves blood flow to the heart muscle and relieves symptoms. The
problem is, as my friend B.G. knows all too well, stents can fail – and
33
often do. New plaque can grow around the wire mesh with
remarkable speed and clog the artery.

Stent

Expanded stent prevents a

previously blocked artery from
re-closing
Source: Heart
Center Online

Even with stenting, about 40 percent of people who’ve had an

angioplasty find that the dilated segment of the artery narrows again
(a condition called restenosis) within six months after the procedure.
And, in many cases, there are no symptoms. According to a study at
Green Lane Hospital in Auckland, New Zealand, more than half of all
patients whose arteries re-narrow have no symptoms and, as a
consequence, have a silent risk of a future heart attack. Although
another angioplasty might fix the problem if it is identified, most
doctors recommend coronary artery bypass surgery.
Another problem with stents is the metal with which they are
made. A study conducted at University Hospital Eppendorf in
Hamburg, Germany has found that stainless steel coronary stents may
trigger allergic reactions to substances such as nickel, molybdenum or
chromium. Of the 89 patients who experienced restenosis, 10 had an
allergic reaction to either molybdenum or nickel. These findings led
the researchers to conclude that allergic reactions may be a major
factor in causing in-stent restenosis.
While angioplasty and stenting might sound good on paper, when
it comes to their safety and efficacy in people, this medical
experiment has been a huge failure. At the American Heart
Association meeting on interventional cardiology in 1998, Dr. James

34
E Tcheng, Associate Professor at Duke University Medical Center,
said, “For those of you who think that stent implantation is the ‘end
all and be all,’ because it creates a perfect environment that cannot
support a thrombus, I would suggest that assumption is wrong. What
we are doing [with intervention] is creating heart attacks. Whenever
you are blowing up a balloon in a patient’s artery, activating a
rotablator or turning on a laser, you are causing damage to the inside
of the vessel. This sets your patient up for platelet adhesion and
aggregation, vasoactive substance release, thrombus formation and the
potential for abrupt closure and development of acute ischemic
syndrome.”
The new drug-coated stents
SAFETY ALERT! may not be any better. In the
Despite serious problems, rush to build a better
coating stents with drugs is all the mousetrap, the FDA approved
rage among cardiologists. As a these devices after a study
result many doctors are found that stents coated with
experimenting with this the drug paclitaxel reduced
experimental device, using the new return arterial narrowing better
stents aggressively and than stents without the drug.
inappropriately. In some cases, they But that study was small, only
either use the wrong size stent for 176 patients, and a larger trial
the size of the artery or place a failed to confirm the effect.
stent in patients who don’t need it. Nevertheless, over 50,000
drug-coated stents have been
used in patients during the first
three months following its approval. But, even though these devices
appear to reduce restenosis, some scientists are concerned that drug-
coated stents may not be preventing restenosis, but only delaying it.
Another, more serious problem is that these stents can clot within
days of being implanted. On October 28, 2003, the Food and Drug
Administration (FDA) issued a warning letter to physicians about
blood clots and other side effects associated with drug-coated stents,
noting that these devices were responsible for more than 360 cases of
thrombosis (blood clots). Of those, more than 70 patients died.
In other cases, the stent was associated with injuries requiring
medical or surgical intervention. The FDA has received more than 50
reports (some relating to deaths) concerning allergic or hypersensitive
reactions to drug-coated stents. The symptoms include pain, rash,
respiratory problems, hives, itching, fever and blood pressure changes.

35
 As far as I’m concerned, both the bare wire and drug-coated
stents are still experimental, despite their widespread use. Instead of
becoming a guinea pig, the best thing to do is to avoid stents in the
first place by following the recommendations in this book.
Coronary Artery Bypass: This surgery reroutes, or “bypasses,”
blood around clogged arteries to improve blood flow and oxygen to
the heart. The surgeon takes a segment of healthy blood vessel from
another part of the body (typically the leg) and makes a detour around
the blocked part of the coronary artery.

Coronary Artery Bypass Graft

A procedure to bypass a blocked
section of a coronary artery and
to deliver oxygen to the heart

Aorta
One end of the
blood vessel is
attached to
the aorta
Blockage in
coronary
artery

Other end is attached

to the coronary artery
at a point below the
blockage

Source: Heart Center Online

Depending on which blood vessel is used, one end is either sewn

to the aorta or remains connected to the larger artery it originated
from. The other end is attached (grafted) beyond the blockage in the
artery. As a result, blood can flow around the blocked area, increasing
the supply of oxygen and nutrients to the heart muscle.
For patients with severe angina who are unable to participate in
normal activities or someone who doesn’t respond to medication, a
coronary bypass may be the only option. However, people who suffer
from stable angina or those who find relief through medication should
opt for a second opinion since neither of these scenarios are an
indication for surgery.

36
 Short-term complications
can include difficulty breathing,
HEART SMART
bleeding, infection, high blood TIP
pressure and abnormal heart Research shows that total
rhythm. More serious blockage is 16 times more
complications that may arise common in arteries after bypass
include heart attack, stroke or surgery then in those that have
even death. These risks are been left alone. That’s why I
higher for older patients, always advocate getting a second –
diabetics, patients with other or even a third – opinion before
major health problems and agreeing to undergo this risky
those undergoing a repeat surgery.
bypass procedure.
While it’s true that bypass surgery can ease pain, the relief is
often temporary. Since bypass surgery doesn’t actually slow athero-
sclerosis, the disease progresses and the pain inevitably returns. While
three-quarters of bypass patients remain pain-free for three to nine
months after the procedure, according to an investigation by George
Washington University, 45 percent of the patients studied experienced
mild symptoms and 32 percent suffered from severe pain within five
years of this surgery. Worse yet, atherosclerosis speeds up in arteries
that have received grafts. In one study, arteries with grafts develop a
complete blockage in 40 percent of cases compared to only 6 percent
in people without grafts.
Another serious problem many bypass patients experience is
cognitive impairment, including difficulty following directions,
memory problems, personality changes, mood swings and irritability.
Researchers at Duke University confirm that persistent mental
changes are quite common after bypass surgery. They found that six
months after surgery, 25 percent of the patients still showed signs of
decreased mental function.
Defibrillators: Most of us are familiar with the defibrillators used
in hospitals to “jumpstart” the heart of a patient in cardiac arrest. In
fact, medical TV shows make great hay out of whipping out the
paddles and shocking a patient back to life.
But, for patients suffering from chronic arrhythmias involving
ventricular tachycardia or ventricular fibrillation, there is a type of
defibrillator that can be surgically implanted in a patient’s chest. This
tiny implantable cardioverter defibrillator (ICD) monitors the heart

37
and, if necessary, corrects an abnormally fast or “quivering” heartbeat
at the first sign of a problem.
Although inserting a defibrillator is considered minor surgery, it
can result in the formation of a blood clot, a torn blood vessel, heart
attack or stroke. These risks are greater in older people or in those
who are obese.
Pacemakers: Even though
the heart has its own natural Side Effects of Pacemakers
pacemaker that sets its rhythm, • Dizziness
the term “pacemaker” most • Fatigue
commonly refers to an • Bacterial infection
artificial electronic device that
• Bleeding
is implanted in the chest to
regulate the heart’s rhythm. • Blood clot
Generally, pacemakers correct • Tearing of a blood
an abnormally slow heartbeat vessel
by sending electrical impulses • Stroke
to one or more chambers of the
• Heart attack
heart. These signals make the
heart contract at a more regular • Malfunction
rhythm than the chamber
would otherwise.
Nearly 200,000 pacemakers are implanted annually in the United
States. In most cases, people with pacemakers enjoy a significant
improvement in their quality of life. But there are some environments
they must avoid, including metal detectors, MRI machines and slot
machines. Cell phones should be held at least 6 inches from the
pacemaker at all times, even if the phone is turned off.
Some people face the risk of developing “pacemaker syndrome,”
in which the implanted pacemaker is no longer synchronized
with the heart’s own rhythm and attempts to pump blood through a
closed valve. This restricts the flow of blood from the heart, causing
dizziness and fatigue in the patient. It occurs in one of four users of
the single chamber pacemaker (one that stimulates one chamber of
the heart), but there is no risk of this syndrome for users of the
double-chamber pacemaker (which stimulates two chambers of the
heart).
A recent study suggests that up to 20 percent of patients with

38
pacemakers or other implanted devices are at a high risk of
developing bacterial blood infections. Sometimes the device itself is
the cause of the infection. The FDA has issued a number of advisories
on the incidence of staph infection within six years of a pacemaker
being inserted. Another cause for concern is that recalls for
pacemakers increased over the past decade. The FDA has issued
safety alerts affecting 400,000 pacemakers and more than 100,000
ICDs.
Although these procedures are sometimes necessary, you may be
able to avoid them by preventing heart disease in the first place. The
key is to adopt the strategies found in the following chapters: eat a
healthy diet, exercise, lower stress and take heart-friendly
supplements.
What if you already suffer from some form of heart disease?
While cardiac surgery has its place in medicine, if your doctor
recommends any of the above procedures, get a second opinion. If the
surgery’s benefits outweigh the risks, then, and only then, should it be
considered.

39
 REMEMBER . . .

➤ Drugs are not a magic bullet and most carry a

host of side effects.
➤ Although many people rely on aspirin to
prevent heart attacks, this over-the-counter
drug isn’t harmless. Long-term use has been
linked to excessive bleeding and ulcers.
➤ If possible, avoid taking statin drugs to lower
cholesterol. But if you must, make sure you
take supplemental Co-Q10 since statins can
deplete this important nutrient.
➤ Some cardiovascular drugs, especially calcium
channel blockers and nitrates, can actually
increase the risk of heart attack.
➤ Many heart medications can adversely interact
with other drugs, foods or supplements.
➤ Be aware of all your options before agreeing to
invasive cardiac procedures or bypass surgery.
➤ Stents often fail and may be dangerous. The
new drug-coated stents may also cause blood
clots.
➤ Bypass surgery may only offer temporary
relief from chest pain and can accelerate
atherosclerosis.
➤ Total arterial blockage is 16 times more
common after bypass surgery.
➤ The bottom line: Avoid invasive procedures
unless at least two, possibly even three,
cardiologists recommend the procedure.

40
 Chapter 4

HEART HEALTHY EATING

The old adage that “you are what you eat” is especially true when
it comes to your heart. Adopting a heart-healthy diet is one of the
most important steps you can take to prevent heart disease.
Unlike drugs, which only treat the symptoms of heart disease,
eating the right foods will provide your body with the nutrients it
needs to prevent, even reverse, the risk factors for heart disease.
You’ll also see an increase in overall health and vitality. But, before
we look at the way food impacts our health, let’s address a problem
that has become a health epidemic.

The Obesity Factor

In a nation obsessed with dieting, you might think we would all
be thin, fit and healthy. But the truth is, more than three in five
Americans are overweight, and nearly one in three is obese. It’s no
wonder high blood pressure, unhealthy cholesterol levels and heart
disease are at all time highs.
Excess weight lowers the age of first heart attack. A 10-year study
at the Mayo Clinic shows that merely being overweight drops the age
of first heart attack by more than three and a half years. And if you’re
obese, you can expect to suffer a heart attack 8.2 years earlier than
someone at normal weight.
Along with putting a strain on the heart, weight gain –
particularly in the abdominal area – raises CRP levels. But, as
University of Vermont investigators discovered, dropping excess
pounds can also drop CRP. During their 14-month study, the scientists
measured the CRP levels in 61 middle-aged women before putting
them on a weight-loss program. In the women who lost an average of
33 pounds, CRP levels dropped by an astounding 32 percent. The
more weight the women lost, the more their CRP levels fell.
When it comes to losing weight, a little can mean a lot. A modest
weight loss of five to 10 percent of body weight can lower blood
pressure and provide other health benefits even to the very obese, say
scientists at the University Hospital of Antwerp in Belgium, who
looked at several studies measuring the effect of modest weight loss
on blood pressure. For a 250 pound man, that means just 25 pounds.

41
 If you want to win at losing weight, forget fad diets or starvation
schemes. Instead, set a goal of losing one to two pounds a week.
Most women can achieve this by consuming 1,200 to 1,500 calories a
day. Most men can lose the same amount by consuming 1,500 to
1,800 calories a day.
But that may be easier said than done. The typical American diet
seems to undermine our efforts at every turn. Filled with salt, fat,
refined grains and sugar, it’s a prescription for disaster. In the
following sections, I’m going to tell you about two of the worst
dietary offenders for the health of your heart – salt and fat.

Shaking Out The Truth

Salt junkies are quick to point out that this tasty mineral is
necessary for life. They’re right, of course. Salt is naturally present in
every cell in our bodies, in the fluid that surrounds cells and also in
our bones. Sodium aids in muscle contraction and nerve transmission,
helps transport carbon dioxide and moves amino acids from the gut to
cells throughout the body.
But, the problem with this line of thinking is that, when it comes
to salt, a little goes a very long way. In fact, we only need 1,000 to
2,000 mg. of salt a day – much lower than the typical 7,000 to 15,000
mg. of salt most of us consume.
Preliminary evidence has linked high salt consumption with an
increased incidence of cardiovascular disease and death among
overweight people. In fact, a daily increase of just 2,300 mg. of
excess sodium (bear in mind that a single teaspoon of salt contains
1,938 mg. of sodium) can
increase your risk of dying HEART SMART TIP
from heart disease by a
What the Labels Mean
whopping 40 to 60 percent!
Why? Because too much salt An easy way to reduce the amount
can dramatically raise your of salt in your diet is to learn what the
blood pressure. terms really mean:
An interesting study Sodium-Free 5 mg. or less
conducted by the National Very-Low Sodium 35 mg. or less
Heart, Lung, and Blood Low Sodium 140 mg. or less
Institute recently found that
Reduced Sodium 25% less sodium
those people who ate less
salt significantly reduced Light Sodium 50% less sodium

42
their blood pressure, regardless of where blood pressure levels were
when they began. In fact, the people who consumed 1,500 mg. a day
or less showed the biggest drop, and thus greatly lessened their
chances of ever developing high blood pressure.
So, we can all be healthier if we just leave the salt shaker in the
cupboard, right? If only it were that easy. Nutritional experts say that
only 10 percent of dietary sodium comes from adding salt to food at
the dinner table. Instead, the bulk of sodium in our diet comes from
prepared, processed and pickled foods. Lunch meats, prepared cheese,
soda pop, canned soups and vegetables, condiments, salad dressings
and baked goods can all be deceptively high in sodium.
Along with reducing the amount of salt you consume, you can
minimize the negative impact of too much sodium by eating more
potassium. Foods that are particularly high in potassium include fruits
(apricots, avocado, bananas, dates, melons, oranges and peaches),
vegetables (artichokes, broccoli, brussels sprouts, potatoes, pumpkin,
spinach, sweet potatoes and winter squash) dried beans, peas and
lentils.

The Skinny On Fats

Ask anyone what the most hated nutrient in America is and they’ll
probably say fat. For the last 20 years, fat has been linked to obesity,
heart disease, colon cancer and diabetes. The problem is that fat also
performs some critical functions in the body. It cushions and protects
our vital organs and serves as building blocks for cell membranes.
Certain essential fatty acids are indispensable to the prostaglandins
and hormones that regulate numerous body functions. They are also
required for the absorption of the fat-soluble vitamins A, D, E and K.
But not all fats are created equal. To help sort out which kinds of fat
we need and which ones contribute to disease, let’s look at the
different types of fat.
Saturated fat is primarily found in animal and dairy products
(although some vegetable products like coconut oil, palm oil and
vegetable shorting are also high in saturated fat). The liver uses
saturated fat to make cholesterol, so consuming excessive amounts of
foods high in saturated fats can significantly raise blood cholesterol
levels, especially LDL, the “bad” cholesterol. You can always tell if a
fat is saturated because it solidifies at room temperature.

43
 Polyunsaturated fats are
found in corn, soybean,
safflower and sunflower oils. HEART SMART TIP
Some fish oils are also high in Stock Up On EFAs
polyunsaturates. Unlike Essential fatty acids –
saturated fats, polyunsaturates specifically omega-6 and omega-3
may actually lower your total EFAs, are key players in the
blood cholesterol level. The conversion of food to energy, the
trouble is, they can also lower transfer of oxygen to cells, the
HDL (good) cholesterol levels. formation and maintenance of cell
membranes, and the production of
But polyunsaturated fats play a
hormone-like prostaglandins,
special role in human health
which guard against conditions
because they supply essential such as cancer and heart disease.
fatty acids (EFAs). As their As a bonus, adequate EFA intake
name implies, EFAs are will help guard against depression,
indispensable to body function reduce inflammation, and give you
and must be supplied by the healthy nails, hair and skin, faster
diet because our bodies can’t healing and a more efficient level
manufacture them. of fat burning.
The optimum daily dose is only
There are two major
9 to 18 grams of omega-6 and 2 to
deficiencies of EFAs: omega-6
9 grams of omega-3, which can
linoleic acid and omega-3 take the form of a single
alpha-linolenic acid. Although tablespoon of flaxseed or hemp oil
most experts agree that omega- in oatmeal in the morning, or a
6 and omega-3 EFAs should be splash of walnut-oil vinaigrette on
consumed in a 4:1 ratio, most a lunchtime salad.
people overdo omega-6 EFAs • Select organic and unrefined
and consume far too few essential fatty acids
omega-3s. Omega-6 EFAs are • Only buy oils that are
found in most nuts (except packaged in protective opaque
peanuts) and seeds, and in containers
vegetable oils such as • Store EFAs in the refrigerator
sunflower and safflower oils. • Shoot for a daily intake of 2
Sources of omega-3 fatty acids to 9 grams of omega-3 and 9
include flaxseeds and flaxseed to 18 grams of omega-6
oil, pumpkin seeds, walnuts • Discard oils if they start to
and cold-water fish. To get both change color or smell rancid
omega-6 and omega-3 fatty • Do not cook with oils—high
acids from one source, try heat destroys EFAs.
hemp oil. Hemp provides a 3:1

44
ratio of omega-6 to omega-3 and has a wonderful nutty flavor that’s
great in salad dressings.
Monounsaturated fats are found mostly in vegetable and nut oils
like olive, peanut and canola. These fats appear to reduce blood levels
of LDLs without affecting HDLs in any way. But they don’t lower
LDL significantly, so monounsaturated fats should still be used
sparingly.
While the body only requires small amounts of these fats to keep
it humming along, there is one type of fat the body doesn’t need at
all. Trans fatty acids, or trans fats, are shaped differently than the
polyunsaturated fatty acids from which they are made, and they
adversely affect cell membranes and prostaglandin functions. In other
words, trans fats act exactly the same as saturated fats in your body.
Numerous studies have found that trans-fatty acids raise total
cholesterol, lower “good” HDL cholesterol, increase “bad” LDL
cholesterol, interfere with blood sugar and insulin, and decrease
immune function. Researchers at the University of Washington now
report that high levels of trans-fatty acids are strongly associated with
an increased risk of sudden cardiac death.
Their study involved 179 sudden cardiac death victims between
the ages of 25 and 74 and 285 age- and sex-matched controls. Both
cases and controls had blood samples drawn and analyzed for fatty
acid levels in red blood cell membranes. The researchers found that
cardiac arrest victims tended to have significantly higher overall
levels of trans-fatty acids than did the controls. Specifically, they had
higher levels of oleic and linoleic trans-fatty acids and significantly
lower levels of beneficial omega-3 fatty acids. After adjusting for
EFAs and other factors which could affect heart disease, they
concluded that people with a high trans-fatty acid level had a three
times higher risk of sudden cardiac death than people with lower
levels.
Found in over 42,000 food products, trans fat is hard to avoid.
While the average American consumes close to 5 grams of the
substance a day, researchers say even one gram – which can drive up
LDL cholesterol levels – is too much in a healthy diet. According to
Alice Lichtenstein, a nutritional biochemist at Tufts University, if you
double the amount of trans fat you eat, you nearly double your LDL
cholesterol.

45
 The major sources of trans
HEART SMART TIP fatty acids come from partially
hydrogenated vege-table fat,
Just Say No To Trans Fats which is used for commercial
While trans fat is used to make frying, says Lichtenstein. Trans
cookies, crackers and chips, much fat can also be found in
of this phony fat in our diet comes commercial baked goods,
from margarine. Does that mean frozen foods, candy, crackers
you should buy one of the new and even ready-to-eat breakfast
“trans fat free” spreads? Absolutely cereal.
not! These margarines are still The problem is, there’s no
manmade plastics that the body way to know for sure if the
was never designed to handle. food you’re buying contains
Butter, in small amounts, is a trans fats. Even food labeled
better option. Although high in “low in cholesterol” or “low in
saturated fat, butter is a rich source saturated fats” may contain
of vitamins A and D, as well as large amounts of trans fats.
trace minerals like selenium. For Beginning in 2006, all
cooking, choose either ghee ingredient labels will be
(clarified butter available in health required to list the amount of
food stores) or extra-virgin olive trans fat in foods. But in the
oil. A recent study found that ghee meantime, if you see the word
actually helps the body digest ‘hydrogenated’ on a food label,
dietary fat, especially if you are you can assume it contains
also taking a fish oil supplement. trans fatty acids.
Other research has found that olive
Eat Like A Greek – Or
oil decreases oxidative stress. But
Maybe An Asian
remember, these are still fats, so
use them sparingly. Maybe you’ve heard that
the rate of heart disease is
uncommonly low among
people living in the Mediterranean. The reason is simple. Unlike
those of us in U.S., these folks eat lots of vegetables, fruits, grains
and olive oil. And, while most Americans have come to embrace the
benefits of olive oil, it’s not the only thing that makes the
Mediterranean diet heart healthy.
In the largest study ever done on the Mediterranean diet, and one
of the few to test it in adults of all ages, researchers recently found
that the real bang of this way of eating is the combination of all the

46
foods in the diet. Not surprisingly, the researchers found that Greeks
who follow the Mediterranean diet more closely have significantly
lower death and disease rates than those who don’t. But they also
reported in The New England Journal of Medicine that olive oil itself
produced no significant reduction in overall death rates. In fact, when
the researchers looked at the individual components of the
Mediterranean diet, they found no significant decrease in death with
any one type of food.
The researchers studied some 22,000 adults, aged 20 to 86, from
all regions of Greece. The participants answered detailed
questionnaires about their eating habits throughout the four-year
study. Then they were rated on how closely they followed the key
principles of the Mediterranean diet. Sticking to the Mediterranean
diet cut the risk of death from both heart disease and cancer. Those
subjects who most closely followed the traditional diet saw their
death rate drop by 25 percent.
Asians also enjoy unprecedented heart health. Like the
Mediterranean diet, they eat high amounts of grains and vegetables.
But the real secret to their cardiovascular health is fish. Most recent
studies have shown that people who eat fish at least once a week have
a 60 percent lower risk of heart disease than those who rarely eat fish.
Case in point: In Lisbon, Portugal, scientists compared the differences
in heart disease between a fishing village and an inland rural village
on the island of Madeira. The results were startling. Death rates from
heart disease in the fishing village were a mere 310 in 100,000 men
compared to more than 1,200 in 100,000 in the rural village.
Closer to home, researchers at the University of Oregon found
that volunteers who ate salmon every day for four weeks experienced
a 17 percent drop in their cholesterol and a 40 percent reduction in
triglycerides. The Oregon team also found that high fish consumption
lowered the risk of atherosclerosis by preventing platelets from
sticking together. These findings were confirmed by a double-blind,
placebo-controlled trial at Massachusetts General Hospital in Boston,
which found that small amounts of fish oil – the kind found in salmon
and tuna – inhibit platelet aggregation and lower triglycerides. Even
more interesting, the fish oil appeared to significantly reduce systolic
blood pressure by as much as 8 mmHg.
There is also some evidence that the omega-3 fatty acids in fish
can tame C-reactive protein. The American Journal of Cardiology

47
reports that, among 269 cardiac patients, those who had the highest
serum concentration of DHA (short for docosahexaenoic acid, an
important omega-3 fatty acid) as a result of eating fish on a regular
basis also had less risk for coronary stenosis (the narrowing of the
blood vessels).
I strongly recommend
eating fatty fish at least three HEART SMART TIP
times a week. The best sources Feast On Fish
of omega-3 fatty acids are Need to lower CRP? While
salmon, tuna, mackerel, aspirin can lower this marker of
herring, sardines, anchovies inflammation, it can also cause
and trout. But be aware that bleeding, ulcers and low
tuna can harbor unacceptable prostaglandins. And, while statin
levels of mercury and shouldn’t drugs may have a mild effect on
be eaten more than once a CRP, they destroy Co-Q10.
week. This toxic heavy metal
What to do? Include fatty fish
accumulates in the flesh of fish
in your diet at least three times a
and can build up in people who
week – or take supplemental fish
eat more than two servings of
oil. Best choices: Salmon, tuna or
fish a week. Mercury has been
trout.
linked to neurological
disorders, kidney damage and
atherosclerosis. I think all patients with heart disease should be
screened for mercury. Common methods include blood tests,
measuring urinary excretion or hair analysis and I strongly advise
asking your doctor to schedule you for these simple tests.

SAFETY ALERT!
While salmon is relatively low in mercury, if you buy farm-raised
salmon, you might be getting more than you paid for. According to a
new scientific report, salmon from fish farms has significantly higher
levels of polychlorinated biphenyl (PCBs) than wild Pacific salmon.
PCBs, which lodge in fatty tissue, were banned in the U.S. in the late-
1970s because they can cause cancer and birth defects.
To reduce your exposure to PCBs, choose wild or canned Alaskan
salmon instead of farmed whenever possible. If farm-raised salmon is
unavoidable, limit your consumption to once a month. Trim the fat and
skin from the fish before cooking and avoid frying. Broiling, baking or
grilling allows the PCB-laden fat to cook off the fish.

48
 Up Your Antioxidants
Other villains in the development of heart disease are free
radicals. Free radicals are molecules that are missing one electron
(normal molecules have two electrons). To complete themselves,
these unbalanced molecules steal a replacement electron from another
nearby molecule – which creates another free radical, which steals an
electron from one of its neighbors and so on and so on. The result is a
chain reaction that can ultimately damage DNA, proteins and other
cellular building blocks.
Free radicals play a big role in the development of atherosclerosis.
The process of plaque build-up begins when free radicals damage the
wall of the artery, causing a lesion. In an attempt to repair the
damage, white blood cells called monocytes come to the rescue. Once
they enter the artery walls, these monocytes are converted into
macrophages that gobble up fat and cholesterol, especially LDL
cholesterol. Think of it as a biological Pac Man game.
The problem is that, once these macrophages are loaded up with
LDL, they get stuck in the cell walls. Worse yet, macrophages can
also generate free radicals. The result is a build-up of atherosclerotic
plaque. The good news is that we can counteract much of this damage
– as well as our risk of premature aging and disease – with
antioxidants.
For years, scientists have known that antioxidants can neutralize
these unruly molecules and prevent oxidative damage. And for years,
they’ve been studying them – one at a time. But by studying each
individual antioxidant in the hope of finding a magic bullet, they’ve
missed the bigger picture – that antioxidants never occur by
themselves in nature. A strawberry, for instance, doesn’t contain just
one antioxidant. It’s packed full of vitamin C, carotenoids and
flavonoids.
A growing number of important studies have concluded that
antioxidants work in synergy. In other words, consuming a
combination of many different antioxidants is far more potent than
taking just one or two. Here’s a good example: as vitamin E is used
up fighting free radicals, vitamin C helps restore it back to its full
strength.
One study, recently published in the journal Atherosclerosis,
found that a combination of vitamin E and C significantly reduce the
formation of plaque after an angioplasty. In another clinical trial of 23
patients with coronary artery disease, Chilean researchers found that
49
taking supplemental beta-carotene and vitamins E and C can reduce
serum homocystine levels and LDL (bad) cholesterol oxidation.
Antioxidants also play a role after a heart attack. A double-blind,
placebo controlled study of 125 patients tested the therapeutic value
of antioxidants in reducing complications after a heart attack. At the
end of the study, the scientists concluded that combined treatment
with vitamins A, C, E and beta-carotene helped protect heart attack
victims against angina and oxidative stress as they recovered. Better
yet, the antioxidants seemed to lower the risk of another cardiac
event.
Nature’s antioxidants can never be replaced by simply popping a
few pills, so you should always strive to include a wide variety of
fruits and vegetables every day. These foods contain a more diverse
selection of antioxidants than you’ll find in any supplement. And
that’s one reason why a diet rich in these foods lowers your risk of
just about every degenerative disease.

Fuel Up On Fiber
Fiber may just be the unsung hero of heart health. According to a
joint study by Brigham and Women’s Hospital and Harvard Medical
School, boosting your fiber intake can significantly reduce the risk of
cardiovascular disease and heart attack. Dietary fiber lowers LDL and
homocystine levels, as well as blood pressure. Fiber also decreases
the incidence of blood clots that may cause heart attacks and strokes.
Unfortunately, the average American diet contains only half of the
recommended 25 to 35 grams of fiber you should be consuming daily
to promote health. But before you stock up on fiber-rich foods, there
are a couple of things you
Sources of Soluble Fiber need to know.

Barley Parsnips Fiber is the portion of

Flaxseeds Sweet Potatoes plant food that human
Oatmeal Turnips digestive enzymes can’t
Oat Bran Apples break down and there are
Dried Beans Figs two major types –
Lentils Kiwi Fruit insoluble and soluble.
Lima Beans Mangos Insoluble fiber is a
Chickpeas Oranges “non-carbohydrate”
Brussels Sprouts Plums carbohydrate that passes
Artichokes Prunes through the

50
gastrointestinal tract undigested. Unlike soluble fiber, insoluble fibers
aren’t metabolized by intestinal bacteria. Good sources of insoluble
fiber are: corn, popcorn, the skins of many fruits and vegetables,
seeds, nuts and whole grains.
Soluble fiber is that part of the plant that can be absorbed into the
body. About one-quarter of the total fiber in food is the soluble type.
Oats, beans and other legumes, and some fruits and vegetables are all
good sources of soluble fiber. Flaxseeds, which are high in heart-
healthy omega-3 fatty acids, are another source of soluble fiber.
Both types of fiber can help you achieve and maintain your ideal
weight and provide benefits to the digestive system by helping to
maintain regularity. But soluble fiber has some additional benefits to
heart health. Soluble fiber reduces cholesterol by binding to bile acids
and whisking them out of the body. This type of fiber also slows
down the production of cholesterol in the liver – much like bile-
sequestering agents. Adding just 5 to 10 grams of soluble fiber to
your diet every day can reduce cholesterol levels by five points –
which translates to a 10 percent drop in the risk of heart disease.
Here’s a good illustration of just how effective soluble fiber is:
According to researchers at Tulane University, adding legumes (beans
and peas) to your diet on a regular basis can significantly lower the
risk of heart disease. After analyzing the data from their 19-year study
of more than 9,600 volunteers, the researchers found that those who
ate beans four times a week or more had a 22 percent lower risk of
heart disease than the volunteers who only ate legumes once a week.
If you’re not getting enough fiber through your diet, you can take
a psyllium supplement, available in powder, capsule or tablet form.

HEART SMART TIP

Say Nuts to Heart Disease!
Nuts are a great source of vitamin E and healthy fats that help
lower cholesterol levels. And they are full of soluble fiber.
According to the Physician’s Health Study, nuts also contain
compounds with anti-arrhythmic properties which may reduce
sudden cardiac death. So add at least two handfuls of nuts per week
to your diet, especially walnuts or almonds. But eat them raw since
roasting destroys their delicate polyunsaturated fats.

51
Mixed with at least eight ounces of water, psyllium expands tenfold
in your digestive tract to thwart cholesterol. The secret to making
fiber supplements work, however, is water – lots of it. If you use a
fiber supplement, make sure to drink at least 10 glasses of water a
day.

The Joy of Soy

Over the last decade, soy has become a kitchen staple for many
health-conscious Americans. No wonder – soy is high in protein, low
in fat and excellent source of fiber, calcium, the B vitamins and
omega-3 fatty acids.
If that isn’t enough to send you straight to the soy aisle of your
supermarket, the American Heart Association credits soy protein with
lowering both total and LDL cholesterol. The AHA bases its
endorsement on more than 40 studies which show that either adding
soy protein to your diet or replacing animal protein with soy can:
√ Decrease serum LDL levels by 12.9 percent
√ Lower serum triglyceride levels by 10.5 percent
√ Increase HDL levels slightly
But to accomplish this, you need to consume at least 25 grams of
soy protein a day, which is equivalent to two glasses of soy milk or a
half a pound of tofu. As the chart below illustrates, adding just 25
grams of soy protein to your diet every day can reduce cholesterol by
nearly 10 percent. But, as you can see, when it comes to soy, more is
definitely better.

Source: United Soybean Board

52
 Soy contains several compounds that boost heart health –
specifically isoflavones, saponins and phytosterols. Here’s what
makes each of them such stellar protectors of your heart:
• Isoflavones are potent antioxidants that can help
neutralize free radicals. One particularly effective
isoflavone is genistein, which discourages the formation
of potentially dangerous blood clots.
• Saponins bind to cholesterol in the gastrointestinal tract
so that it isn’t absorbed by the intestines. The cholesterol
then passes directly to the colon where it is excreted
from the body.
• Phytosterols lower cholesterol levels by inhibiting
absorption. Studies have found that plant sterol and
stanol esters can lower cholesterol by 10 to 14 percent.
Including soy in your diet is easy. In addition to traditional tofu,
grocery stores now offer an incredibly wide variety of soy foods.
Look for soy burgers, soy milk, soy yogurt, soy cheese and soy
nuts. As soy becomes a staple in your diet, try some tempeh or TVP.
Tempeh is a fermented soy
product with a nutty mushroom Soyfood Grams of protein
flavor and a great addition to Soybeans, 1/2 cup cooked 14
soups, spreads, salads and Soymilk, 1 cup 7
sandwiches. TVP, which stands Roasted soy nuts, 1/2 cup 34
for textured vegetable protein, is Soy flour, 1/4 cup 8
a dried soy-based meat
Tempeh, 1/2 cup 16
substitute that can be used in
TVP, 1/2 cup prepared 11
place of ground meat in chili,
spaghetti sauce, tacos or Tofu, 1/2 cup 10
casseroles.

Glorious Garlic
Garlic is another great food for your heart. Recent studies suggest
that this tasty herb can reduce the build-up of plaque in the arteries.
There is also evidence that garlic lowers blood pressure and protects
against free radical damage. Even more important, garlic helps to
improve the ratio of LDL and HDL. I’ll tell you more about garlic’s
medicinal properties in Chapter 9. Meanwhile, make a conscious
effort to include more garlic in the dishes you create.

53
 The Coffee Question
If you’re like most people, your day probably starts sometime
after your first cup of coffee. Yet studies show that the caffeine in
coffee activates the sympathetic nervous system, which increases your
heart rate and blood pressure. Concerns have also been raised that
high caffeine intake may boost homocystine levels. In fact, a recent
study by Dutch researchers found that brewed coffee increased
homocystine levels by 11 percent within hours of consumption, and
seemed to have a particularly strong effect when taken after meals.
Instead of coffee, try switching to tea. According to new research
from the U.S. Department of Agriculture, regularly drinking black tea
may lower cholesterol levels. In the six-week trial that included 15
participants, nearly half drank five cups of black tea daily for three
weeks. The investigators gave the other subjects colored water that
was flavored like tea. The two groups were then switched, and the
subjects received either the placebo drink or black tea for another
three weeks. By the end of the study, the researchers discovered that
LDL cholesterol dropped an average of 7.5 percent during the three
weeks the participants consumed black tea compared with the placebo
drink.
Earlier research also found that people who drank 12 ounces or
more of black tea a day had more than 50 percent fewer heart attacks.
In one study, researchers at Tufts University examined 1,900 heart-
attack victims. They found that those who drank the most tea before
their first heart attack were 44 percent less likely to die during the
following three to four years.
Green tea may be even better. This Japanese staple is extremely
high in antioxidants, which fights free radical damage and may
reduce the stickiness of platelets. Recent research has also found that
green tea may help the body regulate LDL cholesterol. But to get the
benefits, you need to drink at least three cups of green tea a day.

Go Easy on Alcohol
Occasional drinkers may have fewer heart attacks and strokes than
abstainers and those who drink more heavily. That’s because a little
alcohol can raise levels of good HDL cholesterol and can reduce the
risk of heart attack and stroke by helping prevent blood clots in the
arteries.
But if you’re looking to lower cholesterol, opt for red wine.

54
Cabernet Sauvignon, Merlot, red Zinfandel and other red wines
contain two compounds that can reign in cholesterol levels. The first
is one you may have heard of: Resveratrol. Several studies have found
that resveratrol blocks cholesterol oxidation. The second is a class of
compounds known as saponins. Researchers at the University of
California-Davis recently found these compounds bind to and prevent
the absorption of cholesterol.
The watchword in all of this, of course, is moderation. For men,
that means fewer than two drinks a day. Women should limit
themselves to no more than one drink a day. People who drink
alcohol in amounts that exceed the limits of moderation have higher
death rates than do moderate drinkers, primarily from liver disease,
high blood pressure, alcohol-related heart diseases and some types of
cancer.

55
 Diet Do’s and Don’ts
Admittedly, switching to a heart-healthy diet requires some adjustment. Here are
a few tips to help you make the transition:
• Eat a variety of fruits and vegetables – at least three servings of each a
day.
• Pass up refined breads and pastas in favor of whole grains.
• Avoid convenience foods and commercially-baked goods.
• Switch to low-fat or fat-free dairy products.
• Choose and prepare foods with less salt. For additional flavor, add
herbs, spices or lemon juice.
• Substitute Bragg Liquid Aminos for tamari or soy sauce.
• Steer clear of fried foods. Roasting, steaming, poaching and broiling are
much healthier alternatives.
• Instead of using oil, try sautéing in a bit of water, stock or wine.
• If you must use oil, opt for extra virgin olive oil or organic canola oil
and use as little as possible.
• Instead of fat-filled commercial salad dressings, make your own using
olive or flaxseed oil, flavored vinegars and herbs.
• Substitute mustard or fat-free salad dressing for mayonnaise on
sandwiches.
• Eat more fish and lean poultry. Just remember to remove the skin and all
visible fat from chicken before cooking.
• Replace the milk called for in recipes with plain soymilk.
• If you’re suffering from a snack attack, try frozen fruit or fiber-rich
popcorn. But instead of salt, try adding chili powder or cumin. And
forget the butter.
• Eat more nuts – but opt for raw nuts instead of the roasted, salted
varieties.

56
 Now that you know what foods to eat, make sure you aren’t
undermining your efforts – buy only the freshest, most unadulterated
foods available. Much of what is on grocery store shelves harbors
pesticide residue and chemical additives. And a growing number of
foods have been genetically modified. Dubbed “frankenfoods” by
critics, the long-term safety of consuming these foods has not been
established.
Protect yourself from harmful chemicals and dubious science by
eating organic foods as often as possible. Organic foods offer a safe
and sustainable food supply. Better yet, researchers are finding
evidence that organically-grown produce contains more nutrients than
conventionally grown plants.

Heart Healthy Recipes

Adopting a heart-smart diet can be fun and delicious. Think of it
as cardiovascular creativity. If you need some help putting your new
diet together, there are a number of cookbooks on the market that
offer recipes, menus and cooking tips specifically created to promote
heart health. In fact, gourmet guru Graham Kerr has even written one!
To get you started on a heart-healthy eating plan, here are 25 of
my favorite recipes. All are low in sodium, saturated fat and
cholesterol. But more importantly, these recipes contain high levels of
fiber, antioxidants and beneficial fats. Unless otherwise noted, these
easy-to-prepare recipes contain ingredients available at your local
grocery store. And feel free to substitute canned for dried beans.
However, since processing can destroy some of the nutrients found in
beans, it’s best to soak and cook them yourself if you have time.
Another bonus – dried beans are less expensive than their canned
counterparts!

57
 Breakfast
❤
Garden Omelet
Serves 2
Try this sumptuous omelet for a leisurely Sunday brunch.
1/2 cup mushrooms, sliced
1/2 cup onions, chopped
1/4 cup red bell pepper, chopped
1 cup fresh spinach, chopped
1-1/2 teaspoon olive oil, divided
4 egg whites
2 whole eggs
4 teaspoons water
1/4 teaspoon salt
Dash pepper
1/2 cup Monterey jack-style soy cheese, shredded
Heat one teaspoon of olive oil in a skillet. Add the vegetables and
sauté until just tender. Remove from pan and keep warm. In a
medium bowl, whisk together the eggs, water, salt and pepper. Heat
the remaining oil in the skillet. Pour half of the egg mixture into the
pan, tilting to coat the bottom. Gently lift the edges to allow the
uncooked egg to slide underneath the omelet. When all of the egg has
cooked, slide onto a plate. Add half of the vegetables and 1/4 cup of
the cheese to one half of the omelet. Carefully fold over. Repeat with
the remaining eggs, vegetables and cheese.

Tofu Scramble
Serves 6
Who says you have to give up scrambled eggs? By substituting tofu,
you can enjoy this breakfast standby – minus the cholesterol!
1 small onion, chopped
1/2 cup green pepper, chopped
1/2 cup mushrooms, sliced
1 teaspoon olive oil
2 cups firm tofu, drained and crumbled
1 tablespoon Bragg Liquid Aminos
1 teaspoon parsley flakes
1/2 teaspoon turmeric
Dash pepper
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 Using a large skillet, sauté the vegetables in the olive oil. Add the
remaining ingredients and stir to mix well. Cook for five minutes,
stirring frequently to prevent sticking.

Very Berry Smoothie

Serves 2
Packed with antioxidants, this delicious “breakfast-in-a-glass” is
perfect on a busy morning. Using fresh organic fruit is best, but you
can substitute frozen fruit if desired.
1 cup vanilla-flavored soy yogurt
1/2 cup strawberries
1/2 cup raspberries
1/2 cup blackberries
1/2 cup blueberries
1/4 cup maple syrup
Place all of the ingredients in a blender and blend until thick and
creamy. If the smoothie becomes too thick to blend, add a bit of
vanilla soy milk.

Soups & Salads

❤
Mellow Miso Soup
Serves 6
This traditional Japanese soup is as nutritious as it is delicious. Look
for the seaweed and dashi powder in Asian markets.
1/2 teaspoon dried kombu seaweed
4 dried shiitake mushrooms
8 cups water
1 envelope dashi powder
1/3 cup red miso, or to taste
2 green onions, sliced
Over high heat, bring the water to a rolling boil. Reduce heat and
add the kombu and mushrooms. Cover and simmer for about 45
minutes. Remove the kombu and mushrooms and set aside to cool.
Add half of the dashi powder to the pot and stir. Simmer for 10-15
minutes. Meanwhile, slice the kombu and mushrooms. Add the miso,
kombu and mushrooms to the broth and remove from heat. Garnish
with sliced green onions.

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 Lemony Lentil Soup
Serves 6
This hearty soup offers up a hefty serving of protein, fiber, vitamin A,
folate, calcium and potassium. Its earthy flavor is brightened with a
twist of sprightly lemon.
1 cup brown lentils
6 cups fat-free, low-sodium chicken broth
2-1/2 cups water
1 large onion, chopped
Pinch crushed red pepper
4 cloves garlic, minced
1 bunch Swiss chard, ribs removed and leaves chopped
1/2 cup cilantro, chopped
1/3 cup fresh lemon juice
In a medium saucepan, combine the lentils with the stock and two
cups of the water. Bring to a boil. Reduce the heat, cover and simmer
until the lentils are barely tender, about 30 minutes.
Meanwhile, heat the remaining half-cup of water in a large skillet
over medium heat. Add the onions, crushed pepper and garlic, stirring
to prevent sticking, until the onion is lightly browned. Gradually add
the chard and additional water, if needed, stirring occasionally until
wilted.
Add the chard mixture to the lentils. Cover and simmer for 15
minutes. Just before serving, add the cilantro and lemon juice. Stir
well and serve.

“Heart-y” Minestrone Soup

Serves 6
Don’t let the long list of ingredients fool you. This quick main-dish
soup couldn’t be easier – or healthier!
1 15-ounce can kidney beans
1 15-ounce can garbanzo beans
1 onion, chopped
3 cloves garlic, minced
8 cups water
1/2 cup celery, thinly sliced
1 carrot, peeled and sliced

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1 cup green beans, cut into 1-inch pieces
1 8-ounce can low-sodium tomato sauce
1 15-ounce can crushed tomatoes
1/4 cup parsley, chopped
2 teaspoons dried basil
1-1/2 teaspoons dried oregano
1/4 teaspoon pepper
1 zucchini, chopped
1 cup cabbage, shredded
1 10-ounce package frozen chopped spinach
1/2 cup whole-wheat elbow macaroni
Drain and rinse the beans. Place the beans, onions, garlic and
water in a Dutch oven. Heat to boiling, reduce heat and simmer for
20 minutes. Add the celery, carrot, green beans, tomato sauce,
crushed tomatoes, parsley, basil, oregano and pepper. Continue to
simmer for an additional 30 minutes. Add the zucchini, cabbage,
spinach and macaroni. Cook until tender, approximately 20 minutes.

Asian Kale Salad

Serves 4
This unusual salad is a terrific source of both
vitamins A and C, as well as calcium.
1 bunch kale, roughly chopped
1 bunch romaine hearts, roughly chopped
1/2 red onion, thinly sliced
1/4 cup seasoned rice wine vinegar
1 teaspoon pureed ginger
1/2 teaspoon light sesame oil
5 drops dark sesame oil
1 teaspoon honey
1 teaspoon Bragg Liquid Aminos
Combine the kale, romaine and onions in a salad bowl. Using a
blender, blend the remaining ingredients until thoroughly mixed. Pour
over salad and toss well. (Note: You can substitute bottled dressing,
such as Annie’s Natural’s Shiitake & Sesame Vinaigrette, if desired.)

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 Tex-Mex Black Bean Salad
Serves 6
An excellent source of protein and vitamins A, C and the B vitamins.
This salad is a wonderful dish to bring to potlucks. Everyone loves it!
2 cans black beans, drained and rinsed
1 cup frozen corn kernels, defrosted
1/2 red onion, chopped
1/4 cup olive oil
1/4 cup flaxseed oil
1/4 cup balsamic vinegar
1/2 teaspoon dried basil
2 cloves garlic, minced
1/8 teaspoon pepper
In a large bowl, mix all ingredients except lettuce leaves.
Refrigerate for at least 30 minutes. Line a platter or bowl with lettuce
leaves and spoon the bean salad into the serving dish.

Tabouli
Serves 4
Light and tangy, this refreshing salad is perfect for a summer lunch.
As a bonus, this dish is high in fiber and vitamin A, with respectable
quantities of folate, calcium and magnesium.
1 cup bulgur
2 cups boiling water
2 tomatoes, diced
1 bunch green onions, sliced
3 tablespoons fresh mint, chopped
2 cups parsley, chopped
1/2 cup fresh lemon juice
1/4 cup olive oil
Pepper to taste
Place uncooked bulgur in a bowl; pour water over it and let it
soak one hour, stirring occasionally. Drain well in a fine strainer.
Return the bulgur to the bowl and add all other ingredients; mix well.
Chill least 2 hours before serving.

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 A Better Waldorf Salad
Serves 6
Forget the heavy, mayonnaise-laden salad of yesteryear. This low-fat
version combines plenty of fiber with heart-healthy fats.
5 cups unpeeled apples, cored and chopped
1 cup celery, diced
1/2 cup walnuts, chopped
1/2 cup raisins
1/2 teaspoon lemon juice
1/2 cup plain yogurt
2 tablespoons honey
1 tablespoon pineapple juice
Mix the first 5 ingredients in a large bowl. In another bowl,
whisk together remaining ingredients. Pour the dressing over fruit
mixture and stir until evenly coated. Cover and chill 30 minutes
before serving to give the flavors a chance to mingle. Toss again
before serving.

Sandwiches & Spreads

❤
Harvest Sandwich
Serves 1
This fiber-rich sandwich is wonderful when gardens and farmer’s
markets are overflowing with fresh produce. It’s also a tasty way to
include raw veggies in your diet.
2 slices whole wheat bread
2 tablespoons fat-free Italian salad dressing
Any combination of the following:
Sliced red onions
Sliced tomatoes
Sliced cucumbers
Sliced radishes
Sliced green pepper
Shredded carrot
Spinach leaves
Lettuce leaves
Alfalfa sprouts
Spread each slice of bread with the dressing. Layer the vegetables

63
on one slice and top with the remaining slice.

Herbed Bean & Cucumber Sandwich

Serves 4
Keep this creamy, fiber-filled spread in your refrigerator
for a quick and tasty lunch.
1 cup canned white beans
2 tablespoons parsley, chopped
1 tablespoon green onion, sliced
1 teaspoon dill weed
1/4 teaspoon salt
Pepper, to taste
2 ounces light cream cheese
1 tablespoon lemon juice
8 slices whole grain bread
1 cucumber, peeled and thinly sliced
Lettuce leaves
Broccoli or alfalfa sprouts
Combine beans, herbs, salt, pepper, cheese and lemon juice in a
food processor and process until smooth. Spread the mixture on four
slices of bread. Top with the remaining ingredients and close the
sandwiches.

Lentil Burgers
Serves 12
This low-fat recipe makes 12 patties, so freeze the leftovers for the
next time you’re in the mood for burgers.
1 cup lentils
3 cups water, divided
1 bay leaf
1/2 cup onion, diced
1 tablespoons fresh tarragon, chopped
2 teaspoons fresh marjoram, chopped
1 teaspoon ground cumin
1/2 teaspoon dark sesame oil
1/2 teaspoon lemon juice
1/2 teaspoon salt
1/4 teaspoon pepper

64
3/4 cup rolled oats
3/4 cup whole-grain bread crumbs
In a medium saucepan, combine the lentils with 2-1/2 cups of
water and simmer for about 45 minutes, or until the lentils are tender.
Drain well and return to pan.
Meanwhile, sauté the onion in the remaining water until lightly
browned. Remove from heat and stir in the herbs and spices. Add the
onion mixture to the lentils and stir until thoroughly combined.
Process the oats in a blender or food processor until finely
ground. Add the oats and bread crumbs to the lentils, mixing well.
Shape the mixture into 12 patties.
Preheat the oven to 400°F. Bake the patties on a non-stick baking
sheet until the patties are lightly browned, about 15 minutes. Serve on
whole-grain buns.

Hummus
Serves 4
This middle-eastern spread is great to have on
hand for snacks, sandwiches or dips.
2-1/2 cups canned garbanzo beans, drained and rinsed
1/4 cup lemon juice
Vegetable broth
6 cloves garlic, roasted
1 clove garlic, minced
Zest of one lemon
1/2 teaspoon cumin
1/2 teaspoon coriander
1/8 teaspoon cayenne pepper
Salt to taste
Place the beans and lemon juice in a food processor and puree.
While the machine is running, add enough vegetable broth to form a
creamy texture. Continue to puree as you add the remaining
ingredients. Scoop into an airtight container and chill for at least one
hour. Serve with whole wheat pita triangles or raw vegetables. (Note:
for variation, add 1/4 cup of roasted red pepper to the mixture while
processing.)

65
 Entrees
❤
Honey-Citrus Glazed Salmon
Serves 4
This savory dish is an excellent source of omega-3 fatty acids.
Cooking spray
4 salmon filets
1/4 cup orange juice
1 teaspoon orange zest, grated
1 tablespoon honey
1/2 teaspoon cumin
1 green onion, sliced
Preheat oven to 400°F. Lightly coat a baking sheet with cooking
spray.
In a shallow dish, whisk together orange juice, zest, honey and
cumin. Add salmon and turn to coat. Allow the fish to marinate for 10
to 15 minutes.
Transfer the salmon to the prepared baking sheet and brush with
marinade. Bake for 10 minutes or until the fish flakes easily with a
fork. Garnish with green onions and serve.

Asian Grilled Ahi

Serves 4
This mouth-watering dish is a great source of omega-3 fatty acids
and selenium. But don’t indulge too often. Tuna is high in mercury,
so limit your intake.
4 1-inch thick ahi tuna steaks
2 teaspoons olive oil
Lots of freshly ground pepper
1 teaspoon canola oil
2 tablespoons fresh ginger, peeled and minced
2 tablespoons Bragg Liquid Aminos
1 tablespoon brown sugar
1/4 cup water
1/2 teaspoon dark sesame oil
Rub each tuna steak with a small amount of olive oil and season
generously with pepper. Preheat the grill. Meanwhile, prepare the
sauce: Sauté the ginger in the canola oil for a minute or two. Add the

66
remaining ingredients and simmer for 5 minutes. Remove from heat.
Grill the tuna for 2-3 minutes on each side. Serve with the sauce
on the side.

Chicken Corazón
Serves 4
A good source of low-fat protein, this main dish is low
in cholesterol and high in flavor.
1/3 cup lime juice
1/4 cup Bragg Liquid Aminos
1 teaspoon olive oil
1-1/2 teaspoons chili powder
1-1/2 teaspoons cumin
1-1/2 teaspoons coriander
1/4 teaspoon turmeric
6 cloves garlic, minced
1-1/2 teaspoons honey
1/4 cup white wine
1/4 cup cilantro, chopped
4 skinless, boneless chicken breasts, trimmed of all fat
Mix together the first 11 ingredients in a large baking pan. Add
the chicken and turn to coat. Cover and refrigerate for at least two
hours.
Preheat the broiler. Broil the chicken for 8 to 10 minutes, basting
with the marinade every few minutes. Garnish with cilantro sprigs
and serve with salsa.

Penne Pomodoro
Serves 4
Brimming with fresh tomatoes and basil, this pasta is packed with
lycopene and reservatrol.
6 cloves garlic, minced
1/2 cup red onion, chopped
1/2 cup water
6 roma tomatoes, chopped
1 cup red wine
1 bunch fresh basil, chopped
12 ounces penne pasta

67
Freshly grated parmesan cheese
Sauté garlic and onions in the water until the onions are well
browned. Add the tomatoes and sauté until they begin to break down.
Stir in the red wine and bring to a boil. Reduce heat and simmer for
15 minutes. Add the basil and simmer for an additional 5 minutes.
Meanwhile, boil the pasta. When the pasta is al dente, drain and
return to pot. Mix the sauce with the pasta, tossing well to coat. Serve
with a sprinkling of parmesan cheese.

Whole Bean Chili

Serves 4
This meatless chili is high in folate and lycopene.
Feel free to adjust the spices to suit your taste.
2 cups dried kidney beans
5 cups water
2 onions, chopped
1 green pepper, chopped
3 cloves garlic, minced
1 cup low-sodium tomato sauce
1 15-ounce can low-sodium stewed tomatoes
4 tablespoons chili powder
2 teaspoons cumin
1/4 teaspoon crushed red pepper
1/4 teaspoon turmeric
Soak the beans overnight. Place the beans and water in a Dutch
oven. Bring to a boil, then reduce the heat to low. Cover and simmer
for 1 hour. Add the remaining ingredients and stir to mix well. Cover
and simmer for an additional 2 hours, stirring occasionally. Ladle into
bowls and garnish with my antioxidant- rich onion blend. (Note: For
an extra dose of fiber, serve over brown rice.)
To make the onion blend: Sauté 2 cloves of freshly minced garlic,
one-quarter sliced Vidalia onion and one sliced shiitake mushroom in
one teaspoon of olive oil. Season to taste with pepper and/or turmeric.
(Note: this mixture is also wonderful on steamed or sautéed
vegetables.)

68
 Warming Winter Stew
Serves 6
Hearty and healthy, this vegetarian stew is packed with heart-healthy
fiber, vitamins A and C, folate, iron, and B vitamins. This versatile
stew is open to interpretation, so feel free to add or substitute
different vegetables for the ones listed below. Tasty options include
zucchini, parsnips or Swiss chard.
1 cup lentils, rinsed
4 cups vegetable broth
1 cup water
2 cups sweet potato, peeled and cubed
1/2 cup onion, chopped
1/2 cup celery, sliced
2 cloves garlic, minced
2 teaspoons Bragg Liquid Aminos
2 teaspoons cumin
1 teaspoon coriander
1/2 teaspoon turmeric
1 15-ounce can garbanzo beans
1 1/2 cups green beans
1 1/2 cups broccoli florets
2 green onions, sliced (optional)
In a large pot or Dutch oven, combine lentils with broth and bring
to a boil. Reduce the heat and simmer until lentils are barely tender,
20 to 30 minutes. Add the water, sweet potato, onion, celery, garlic,
Bragg Liquid Aminos and spices, and cook partially covered for
about 40 minutes on medium heat. Add more broth or water if soup
seems too thick. Add the garbanzo beans, green beans and broccoli.
Simmer for 15 minutes. Garnish with green onions, if desired.

Grilled Summer Vegetables

Serves 2
Satisfying and full of antioxidants. Serve with a whole-grain
pilaf for a complete meal.
2 portobello mushrooms
2 zucchini
2 yellow squash
2 red peppers
10 asparagus spears
1/4 cup olive oil
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1/4 cup flaxseed oil
1/4 cup balsamic vinegar
1/2 tsp. dried basil
2 cloves garlic, minced
1/8 tsp. pepper
Remove stem and lightly wash mushrooms. Wash and cut the
zucchini and yellow squash lengthwise into 1/4-inch slices. Cut the
red peppers in half and remove seeds and stem. Rinse the asparagus.
Set all vegetables aside.
To make the marinade: Combine the remaining ingredients in a
blender and blend to mix. Place the vegetables in a large Ziploc bag
and add the marinade. Marinate for 30 minutes.
Meanwhile, preheat the grill. Drain the vegetables, reserving
marinade, and grill over medium heat for 4-5 minutes, keeping a
constant watch to prevent burning. Turn and grill for an additional 2-3
minutes. Arrange on a large platter and garnish with fresh parsley or
green onions. Serve reserved marinade in a separate bowl for dipping.

Desserts
❤

HEART SMART TIP

Get Sweet Without The Sugar

Several years ago, doctors at Chicago’s Rush Medical College

recommended that patients with high triglycerides avoid refined
sugar. It’s not the first time researchers have linked sugar to heart
disease. What’s the alternative? Use honey or stevia (an herb that’s
300 times sweeter than sugar and calorie free!)
As a general rule, use half to 2/3 as much honey as sugar and
reduce the liquid in the recipe by 1/4 cup for each cup of honey
used. If you are using stevia, substitute 1 teaspoon of liquid or
powdered stevia for each cup of sugar.

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 Sparkling Berries
Serves 4
This light, refreshing dessert packs a potent nutritional punch. High
in vitamins A and C, folate, calcium and potassium, it’s the perfect
way to celebrate summer’s berry season.
1/2 cup fresh strawberries, sliced
1/2 cup fresh blueberries
1/2 cup fresh raspberries
1/2 cup fresh blackberries
Sparkling water
Gently combine the berries in a bowl until well mixed. Spoon into
tall goblets or champagne flutes. Just before serving, pour sparkling
water over the berries to fill each goblet.

Blueberry Cinnamon Compote

Serves 4
This is delicious on its own or spooned over
soy-based vanilla ice cream.
3 cups blueberries
1 tablespoon lemon juice
1 teaspoon lemon peel, grated
1/2 teaspoon cinnamon
3/4 cup sugar
Combine all the ingredients in a medium saucepan and simmer
over medium heat for 5 minutes, stirring to dissolve sugar. Serve
warm or allow to cool to room temperature.

Honey Baked Apples

Serves 4
Apples are one of Mother Nature’s original health foods. This
fiber-rich dessert is a smart way to satisfy your sweet-tooth.
1-1/2 cups apple juice
1/4 cup lemon juice
4 tablespoons honey
1/2 teaspoon cinnamon
2 tablespoons raisins
4 baking apples
Preheat the oven to 400°F. In a small saucepan, combine all of the
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ingredients except the raisins and apples. Bring to a boil, stirring
constantly, until the mixture has thickened. Remove from heat and stir
in the raisins.
Core the apples, but do not cut through the bottom. Peel the skin
one-quarter of the way down from the top of each apple and place in
an 8 x 8 glass baking dish. Pour the apple juice mixture over the
apples and bake for 45 minutes or until the apples are very tender,
basting occasionally.

Soylicious Cheesecake
Serves 8
Sometimes nothing but the most decadent treat will do.
That doesn’t mean it has to be bad for you. Weighing in at under
200 calories per serving, this cheesecake is wonderful for
an occasional guilt-free indulgence.
Cooking Spray
1/2 cup oat bran
1/2 cup bran cereal, ground
2 teaspoons maple syrup
2 teaspoons trans-fat free soy margarine*
4 10-1/2 ounce boxes of firm reduced-fat silken tofu
3/4 cup sugar
1/2 cup plus 2 tablespoons cashew butter*
1/4 cup cornstarch
Juice and grated peel of 1-1/2 lemons
1 teaspoon vanilla extract
1/2 teaspoon almond extract
Lemon Glaze (recipe follows)
Preheat oven to 400°F. Spray the bottom and sides of an 8-1/2
inch springform pan with cooking spray. Set aside.
Combine the oat bran, cereal, maple syrup and margarine in a
small bowl. Using your fingers, mix until crumbly. Press into the
bottom of the prepared pan. Bake until golden, approximately 4 to 6
minutes. Cool.
Reduce the oven to 350°F. Combine the tofu, sugar, cashew butter
and cornstarch in a food processor. Add the lemon juice, peel and
extracts. Blend until smooth, occasionally scraping down the sides of
the bowl.

72
 Pour the tofu filling onto the prepared crust and smooth the top
using a spatula. Bake until set, approximately 55 to 60 minutes. Turn
off the oven and allow the cheesecake to “rest” for 10 minutes.
Remove from oven and set on a wire rack, allowing it to cool
completely. Run a knife around the edge of the cake and unhinge the
pan. Carefully transfer to a serving plate.
To make the glaze: In a small saucepan, combine 1/2 cup sugar
with 1 tablespoon plus 2 teaspoons cornstarch. Using a whisk,
gradually add enough water to make a smooth thin paste. Whisk in
the juice and grated peel of 2 lemons. Over medium heat, bring the
mixture to a boil, stirring constantly.
Remove from the heat and cool completely. Pour over the
cheesecake. Chill the finished cheesecake for at least 2 hours before
serving. (* Note: Soy margarine and cashew butter are available in
most health food stores.)

73
 REMEMBER . . .
➤ Excess weight increases the odds that you’ll have a heart
attack and that it will occur at a younger age.
➤ Forget fad diets. A well-balanced low-calorie diet that
helps you lose one to two pounds a week is the smart
way to go.
➤ High salt consumption raises blood pressure.
➤ Not all fats are bad. Essential fatty acids found in some
fish, nuts, seeds and vegetable oils are critical for a
number of bodily functions.
➤ The saturated fat in meats and dairy products can
significantly raise cholesterol levels.
➤ The trans fats in margarine and baked goods have been
directly linked to heart disease and high levels increase
your risk of a heart attack three-fold.
➤ Adopting the principals of the Mediterranean or Asian
diet (which include large amounts of fruits, vegetables
and fish) can significantly reduce the risk of developing
heart disease.
➤ The antioxidants found in fresh fruits and vegetables
help prevent atherosclerosis.
➤ Eating a high-fiber diet naturally lowers LDL
cholesterol, homocystine levels and blood pressure.
➤ Soyfoods can tame high cholesterol and are a good
source of fiber, the B vitamins and omega-3 fatty acids.

74
 Chapter 5

THE EXERCISE FACTOR

Humans start a natural process of losing muscle and gaining fat at

about age 20. This change, though constant, is so gradual that few of
us notice it. But if we don’t do something to halt and reverse this
degenerative process, someday we will find that we can no longer
run, go out dancing or even climb a set of stairs.
In a world of remote controls, desk jobs and drive-throughs, far
too many of us don’t get the exercise we need. Yet, even though a
sedentary lifestyle is a well-known risk factor for heart disease, most
doctors don’t place nearly enough importance on this cost-effective
therapy and few give their patients the help they need to implement or
stick to a fitness routine.
Exercise plays a powerful and effective role in the prevention and
treatment of heart disease. As you’ll see in the next section, exercise
can significantly boost cardiovascular health and add years to your
life.

The Evidence Is In
I’m sure you’ve seen the ads by fitness gurus featuring trim and
beautiful exercise enthusiasts. While it’s true that exercise tones your
body, it also tones your cardiovascular system. In fact, regular
exercise significantly lowers your chances of having a heart attack.
And if you’ve already had one, it can boost your chances of survival.
In my book, there is no better medicine than regular exercise.
Study after study has extolled the heart-healthy virtues of
exercise. According to the Cooper Institute for Aerobics Research in
Dallas, Texas, fit individuals – even those who smoke, have high
blood pressure or elevated cholesterol levels – have a significantly
lower death rate than out-of-shape people who don’t have any of
these risk factors.
Imagine, someone who smokes and works out has less chance of
dying from heart disease than a smoke-free couch potato! Don’t get
me wrong – I certainly don’t advocate smoking (you’ll learn more
about this in the next chapter), but it does point out just how powerful
exercise is in the fight against heart disease.
Even something as simple as walking can improve your

75
cardiovascular system. According to a large study recently published
in the New England Journal of Medicine, women (ages 50 to 79) who
walked 30 minutes a day, five days a week, reduced their risk of
having a heart attack just as much as women who jogged, played
tennis or did aerobics for the same amount of time. Both groups cut
their risk by a third, regardless of age or weight.
While this and other studies show that you don’t need to train like
a professional athlete, the length of time spent exercising does matter.
After looking at the exercise habits of more than 39,000 women,
doctors at Brigham and Women’s Hospital concluded that the length
of time spent exercising was a much more important factor in
reducing heart disease than the intensity of the workout.
That conclusion was reinforced by researchers at Duke University
and East Carolina University, who divided 111 inactive, overweight
men and women with poor cholesterol profiles into four exercise
groups. After eight months, all of the participants had a detailed
lipoprotein profiling done to see what, if any, changes had occurred as
a result of the various exercise programs.
Instead of measuring
cholesterol levels, the
researchers looked at
Beyond The Heart
cholesterol particle size and Here are some of the additional
found that those who exercised benefits exercise provides:
the most had the greatest • Increases muscle strength
positive changes in the size of • Boosts energy
their cholesterol particles. • Strengthens bones
(LDL cholesterol is carried by
• Helps reduce body fat
small, dense protein particles,
not the larger, fluffy particles • Facilitates weight loss
that are less likely to clog • Improves insulin resistance
arteries.) According to the • Aids digestion and elimination
study, the key to developing • Improves immune function
more large protein particles
• Elevates mood
and decreasing the number of
harmful smaller ones – longer • Reduces stress
stints of exercise. • Enhances mental function
Even people with more • Improves sleep
serious heart disease can • Increases self-esteem

76
benefit from exercise. In fact,
German physicians at the EXERCISE AND
University of Leipzig Heart INFLAMMATION
Center speculate that physical Exercise can also reduce C-
activity may be even better reactive protein. Among the nearly
than surgery for clogged 14,000 adults participating in a
arteries since exercise benefits study by the Centers for Disease
the whole cardiovascular Control and Prevention, those who
system while angioplasty exercised the most had the lowest
opens the arteries only where blood concentrations of CRP.
they are clogged.
To back up their theory, they assigned 73 men with chronic heart
failure to either no exercise at all or to two weeks of in-hospital
exercise on a stationary bicycle (10 minutes, four to six times a day)
followed by six months of exercise for 20 minutes a day at home. By
the end of the study, those in the exercise group had significantly
better cardiac function, including lower blood pressure, than those in
the control group.

Get Moving!
Since aerobic exercise improves cardiovascular fitness and
stamina, I’ve always included it in my workout. Aerobic exercise
develops the heart muscle, much the way weight training develops
other muscles. The heart grows thicker and stronger while the inside
of the heart grows bigger, allowing more blood to be pumped with
each heartbeat.
Aerobic activity also improves your blood vessels by increasing
nitric oxide, which causes the blood vessels to relax and expand. As
we age, blood vessels become stiff, causing our blood pressure to
rise. Stiff arteries can also lead to isolated systolic hypertension, a
condition that has been linked to an increased risk of stroke and heart
disease.
According to a study conducted at the University of
Pennsylvania’s Institute for Medicine and Engineering, aerobics may
increase the flexibility of blood vessels in yet another way. Their
research found that, when you exercise, you force more blood through
your blood vessels. This elevated blood flow stresses the walls of the
vessels as it passes over them, reducing inflammation in a way similar
to high doses of steroids.

77
 But the benefits don’t stop there. Aerobic exercise offers your
heart a number of other positive effects:
√ It improves circulation.
√ It increases the number of capillaries that supply the
heart with blood.
√ Your heart rate decreases.
√ LDL levels decrease and HDL levels increase.
Performing aerobics every day will get you in great shape in a
hurry. In fact, according to R. James Barnard, Ph.D., professor of
physiological science at the University of California, Los Angeles,
aerobic activity can significantly improve heart function in less than a
month. Dr. Barnard and several of his colleagues took eleven men,
who were all about 30 pounds overweight, and let them eat unlimited
amounts of whole-wheat bread, pasta, fruit and vegetables. The
subjects also exercised for about an hour every day on a treadmill.
After just three weeks, the risk factors for the participants had
improved dramatically: Oxidative stress had decreased by 28 percent,
cholesterol dropped by 19 percent, blood pressure fell by 14 percent,
free radicals were cut by 28 percent, and insulin and glucose were
reduced by 46 and 70 percent respectively.
Long-term benefits are even more impressive. According to a
published report by the University of Texas Southwestern Medical
Center, six months of moderate-intensity aerobic exercise can actually
make your heart younger. Their study included five middle-aged men
who hadn’t exercised in years. After participating in a six-month
endurance training program, all of the men achieved the aerobic
capacity similar to what they had experienced in their 20s!

HEART SMART TIP

GET YOUR CARDIO
When practiced vigorously for a half-hour, these
activities are fun and heart-healthy.

Bicycling Jogging Spinning classes

Brisk walking Kick-boxing Step Aerobics
Circuit weight training Racquetball Swimming
Cross-country skiing Rowing Synchronized
SwimmingDancing Running Uphill hiking
Elliptical machine workouts Soccer Volleyball

78
 Your Target Heart Rate
The goal of aerobic exercise is to raise your heart rate to a certain
level and keep it there for 20 minutes. When you exercise, your heart
beats faster to meet the increased demand for more blood and oxygen.
The more intense the activity, the faster your heart will beat.
Therefore, keeping an eye on your heart rate during your workout can
be an excellent way to monitor exercise intensity.
Figuring out your target heart rate – the optimal rate your heart
should beat during aerobic exercise – is a simple, two-step process.
First, calculate your maximal heart rate. Then, using that number, you
can determine your target heart rate zone.
Maximal Heart Rate: This number is related to your age, since as
you grow older, your heart naturally beats a little more slowly. To
estimate your maximal heart rate, simply subtract your age from the
number 220.
Target Heart-Rate Zone: This is the number of beats per minute
(bpm) at which your heart should be beating during aerobic exercise.
For most healthy individuals, this range is 50 to 80 percent of your
maximal heart rate. So, if your maximal heart rate is 180 bpm, the
low end of the range (50 percent) would be 90 bpm, and the high end
of the range (80 percent) would be 144 bpm.
Once you’ve determined your target heart-rate zone, you need to
know how to put that information to good use. These numbers serve
as a guideline - an indicator of how hard you should be exercising.

HEART SMART TIP

Finding Your Pulse
There are a number of “sites” used to monitor the pulse rate.
Two convenient sites to use are the radial pulse at the base of the
thumb of either hand or the carotid pulse at the side of the neck. By
using the first two fingers of one hand and locating the artery, a
pulse rate can be easily determined.
Immediately after exercising, isolate your pulse and count the
number of beats in a 10-second period. To determine the heart rate
in beats per minute, multiply the number of beats per 10 seconds by
six. For instance, if your 10-second pulse count is 20, then your
heart rate would be 120 bpm.

79
Those just beginning an aerobic program should aim for the low end
of the zone and pick up the intensity as they become more
comfortable with their workout.
Keep in mind that the target heart-rate zone is recommended for
individuals without any health problems. Additionally, if you are
taking medications that alter the heart rate, consult your doctor before
starting an aerobic program.

Walk Away From Heart Disease

Walking is one of the most popular ways to exercise. It’s also an
excellent way to improve the efficiency of your heart and lose weight.
What’s more, walking doesn’t require any special equipment and
carries the least risk of injury of any form of exercise. Best of all, you
can do it anywhere, whether you live in the city, the country or
somewhere in between.

HEART SMART TIP

Although walking is something you’ve done all your life, there
are a few things to keep in mind before you begin:
• Find a pair of comfortable walking shoes — nothing
undermines your daily walk faster then a painful blister
or two.
• Walk briskly and practice good posture. Develop a
good breathing pattern and keep your body aligned
and relaxed.
• Walk everyday. If inclement weather threatens your
plans, try doing a few laps through a shopping mall or
use a treadmill if you have access to one.

Several studies have found that brisk walking for three to four
hours per week reduces the risk of heart attack and underlying cardio-
vascular disease in both men and women. For example, researchers
working with the Nurse’s Health Study estimate that walking at a
moderate pace for three or more hours a week reduces a woman’s risk
of heart attack by about 30 to 40 percent. Similar results have been
found in studies of men.
The hours spent walking can increase HDL levels, even when the
intensity isn’t high enough to cause much improvement in
80
cardiovascular fitness. Walking on a regular basis is also ideal for
people who are trying to bring their blood pressure under control.
If you’re not used to exercising, start slowly, limiting yourself to a
10 minute walk. As your stamina increases, you should be able to
increase your walk to 45 minutes.

Win With Weight Training

As wonderful as aerobic exercise is for the heart, it should be
balanced by resistance training, more
commonly known as weight lifting.
HEART SMART
Resistance training improves the
muscles and nerve pathways that direct TIP
and control movement. It also increases To prevent sore muscles
and possible injury, it’s
strength and general fitness, including
wise to start slowly.
enhanced function of the respiratory,
Choose the lowest weight
cardiac and metabolic systems. possible and start by doing
For years, the cardiovascular 10 to 12 on each side.
benefits of resistance training were Over the next few weeks,
thought to be merely a side effect of increase the weight and the
lifting weights. But over the last number of repetitions.
decade, it has become clear that weight-
training decreases heart rate, reduces blood pressure, improves
cholesterol profiles, fortifies artery flexibility and increases
cardiorespiratory fitness.
Here’s another bonus: Resistance training thickens muscles – and
the more muscle you have, the more calories you will burn. Like
aerobics, resistance training burns calories during the workout. The
difference is that, once you’re finished doing your aerobics, your
body quickly stops burning calories. But after you’ve finished a
weight lifting routine, your body continues burning calories for up to
one hour.
Along with elevating your metabolic rate and strengthening your
muscles, weight lifting also increases your bone density. And
increased bone density is a frontline defense in the war against the
bone thinning disease, osteoporosis.
Many health clubs, colleges and recreation centers are equipped
with both free weights and weight machines. But before you begin,
make sure you get instruction on the proper way to use the
equipment. Although committing to a regular weight training routine -

81
at least three times a week - may require a bit of will-power, you’ll be
rewarded with a stronger, leaner body and a healthier heart.

Stretch The Benefits

Years ago, stretching served as an introduction to exercise. The
thought was that warming up cold muscles before heavy exercise kept
them from becoming injured. But now, most fitness experts have
realized that stretching cold muscles can actually cause injury.
Think of it this way: If you put a rubber band in the freezer and
then stretch it, it snaps. It’s
the same idea with muscles Safety Alert!
and connective tissue. Avoid these stretching mistakes
Instead of stretching before • Don’t bounce. Holding a
you work out, try jogging stretch is more effective
in place for a few minutes and there is less risk of
to increase the blood flow injury.
to your muscles so that
• Don’t stretch a “cold”
they are more easily
muscle.
extended. Save the heavy-
duty stretching for after • If a stretch hurts, ease up.
your workout. • Don’t hold your breath.
Stretching keeps the
muscles and connective tissues supple, improves posture and helps
keep you flexible. While you should stretch every part of your body,
pay a little more attention to chronically tight muscles. But if you
experience any pain during a stretch, you’re either going too far or
you may have strained a muscle during your workout.
Stretches should be performed slowly and smoothly. If you are a
novice, begin gently with simple stretches and hold each stretch for a
minimum of 10 to 30 seconds. As your flexibility begins to improve,
you should be able to accomplish more complex stretches for longer
periods of time.

The East-West Connection

Incorporating Eastern culture into Western exercise is the latest
trend in fitness – and one that I wholeheartedly support. Activities
like yoga, tai chi and qi gong are a wonderful way for both sedentary
people and exercise enthusiasts to get in shape. Best of all, these
forms of exercise don’t require any special equipment and can be
practiced by anyone, regardless of age.

82
 Yoga originated as a spiritual practice over six thousand years
ago. Over the past thirty years, however, the western world has
adopted yoga as a therapeutic form of exercise that emphasizes deep
breathing, relaxed movements and mental concentration. Among its
many benefits, yoga enhances flexibility, increases strength and
improves circulation. It also cultivates balance and reduces stress.
Yoga is simply a series of “asanas” or poses which are best
learned and practiced under the guidance of a qualified teacher.
Although there are a number of well-illustrated and comprehensive
books on the subject, it’s a difficult art to master from a series of
pictures. Fortunately, a number of yoga centers have established
themselves across the country and offer enjoyable classes suited to all
levels of mastery, from beginner to advanced. In addition, classes can
often be found through your local community center or college.
Although T’ai Chi is a centuries-old offshoot of yoga, it departs
from the still-life asanas of yoga into the world of moving meditation.
The heart of the practice is the Chinese concept of “chi,” roughly
translated to mean the life force or vital energy of the universe. This
energy flows through all of nature, including human beings.
Based on the movements of animals, t’ai chi is composed of slow
dance-like steps and gestures. The weight of the body shifts
continually from one foot to the other as the movements are
performed in a series of circles, arcs and spirals. The fluidity and
grace of this form of exercise encourages relaxation and mental
peace, as well as balance and flexibility. A qualified instructor is
essential and classes are offered at many martial arts schools and
health clubs.
Qigong is an ancient Taoist system of exercise which
compliments both yoga and t’ai chi. Healing qigong combines
breathwork, gentle movements and meditative postures to harmonize
the body, mind and spirit. Because of its positive effect on strength,
stamina, flexibility, posture and concentration, the practice of qigong
will enhance your physical performance, improve sleep, help balance
stress, boost energy levels, and clarify your mind. Unfortunately,
there aren’t many qigong classes available at this time, but it is easy
to learn and there are some excellent videos on the market.

How Much Is Enough?

The Institute of Medicine recently released new guidelines calling
for one hour of daily physical activity – up from the 30-minute goal

83
touted by many other health organizations. But that doesn’t mean you
have to do one hour of sustained activity a day. Break it up into more
manageable and more enjoyable segments. If you work out for 30
minutes in the morning, take a half-hour walk in the afternoon. Or
play some golf or tennis. Not only will this routine keep your
cardiovascular system in shape, it will also keep your weight down
and your muscles toned.
But if you’re new to exercise or very out-of-shape, start slowly –
try five minutes on an exercise bike followed by 10 minutes of
resistance training. Then increase the time you spend on each activity
by a few minutes each day until you are getting an hour of activity
every day.

Stick To It
Starting an exercise program is fairly easy. Sticking with it year in
and year out is quite another matter. Every January, gyms and health
clubs are filled with enthusiastic exercisers. But by April, many of
these folks are nowhere to be seen.
The goal, of course, is to make exercise a regular and enjoyable
part of your daily life. Here are a few motivational tips to help keep
you moving:
√ Find activities you enjoy. After all, if you don’t like
exercising, you won’t do it.
√ Get an exercise buddy. Surrounding yourself with
supportive people will keep you going.
√ Join an exercise class. Just signing up for a class forces
you to schedule it into your routine.
√ Try a trainer. Professional trainers can help you
remember why you started exercising in the first place.
√ Set exercise goals. Tap into your competitive nature and
see how long it takes to achieve your goals.
√ Keep a record of your activities. Reward yourself at
special milestones.
√ Vary your routine. Doing the same thing every day
becomes monotonous. Continually look for new ways to
enjoy working out.

84
 REMEMBER . . .

➤ People who exercise live longer.

➤ It’s not how hard you work out that counts, but how
long.
➤ Regular exercise reduces cholesterol, blood pressure and
CRP.
➤ Aerobic exercise strengthens the heart and improves
blood vessel health.
➤ Other benefits of a cardiovascular workout include a
lower heart rate, less free radical damage and an
increase in capillaries.
➤ For the most benefit, sustain your target heart rate for at
least 20 minutes.
➤ Walking is an excellent aerobic activity.
➤ Balance your aerobic exercise with weight training.
Lifting weights not only strengthens muscles, it
decreases heart rate and blood pressure, improves your
cholesterol profile and boosts artery flexibility.
➤ Don’t stretch before your workout. Wait until after to
perform deep stretching.
➤ Explore more exotic forms of exercise like yoga or tai
chi.
➤ Make exercise fun!

85
 Chapter 6

LIFESTYLE CHOICES FOR A HEALTHY HEART

Along with diet and exercise, there are other things you can do to
lower your risk of heart disease. Four areas that deserve special
consideration are sleep, smoking, stress and, odd as it may sound,
your dental health. Anyone concerned with heart disease needs to pay
special attention to all of these risk factors.
Reigning in these potential problems will not only benefit your
heart, it will set you on a path toward optimum health. Fortunately,
because heart disease develops over a long period of time, we have
many opportunities throughout our lives to make positive changes.

Sleep
HEART SMART TIP When was the last time you
Beating Insomnia got a good night’s sleep? As the
pace of life seems to quicken
• Set a regular bedtime. with each passing year, it can
• Try a warm bath. be difficult to log your eight
• Make sure the room is hours. But chronic sleep
dark and quiet. deprivation can increase your
• Take supplemental risk of heart disease.
calcium or melatonin As part of the Nurse’s
30 minutes before Health Study, researchers at
bedtime. Vancouver General Hospital set
• Herbs like valerian or out to discover what, if any,
passion-flower can impact sleep had on the risk of
also induce sleep. developing coronary heart
disease. More than 71,000
women without heart disease
were asked about their sleep habits. A decade later the group had
recorded a total of 934 heart attacks, including 271 fatal attacks. After
analyzing the data, the Vancouver team found that the women who
reported sleeping five hours or less were 45 percent more likely to
develop heart disease than women who slept eight hours a night. On
the flip side, the researchers found that women who routinely slept
nine hours or more a night also had a higher risk.
But it isn’t just the time you put in sleeping that can adversely
affect your cardiovascular system. When it comes to heart disease,

86
quality also counts. Snoring
may signal that you have HEART SMART TIP
obstructive sleep apnea, a Since being overweight can trigger
condition that causes the throat sleep apnea, some people find
to close and results in short relief by losing just 10 percent of
interruptions in your breathing. their weight.
According to a Mayo Clinic
study, sleep apnea raises blood pressure, lowers blood oxygen levels
and stretches the walls of the atria, making them susceptible to
irregular electrical rhythms – a condition called atrial fibrillation.
Atrial fibrillation is the most common heart arrhythmia. But, as
common as it may be, it can have serious consequences. When the
upper chambers of the heart quiver rapidly and erratically – as many
as 400 times a minute – blood does not move efficiently through the
heart. This pooling blood is more likely to clot, leading to heart
attacks or strokes. The condition can also lead to heart failure by
causing the heart’s main pumping chambers, the ventricles, to
contract rapidly – often more than 100 beats per minute.
Although serious cases of sleep apnea may require surgery, the
most common treatment is nasal continuous positive airway pressure
(CPAP). The patient wears a mask over the nose while they sleep, and
pressure from an air blower forces air through the nasal passages. The
air pressure is adjusted so that it is just enough to prevent the throat
from collapsing during sleep.

Smoking
Let’s face it, every smoker knows that cigarettes are bad for their
health, yet millions of people smoke anyway. If you are one of them
and have or are at risk for heart disease, quitting is one of the very
best things you can do for your heart.
I know that quitting is much easier said than done. Over the past
20 years, I’ve taught smoking cessation to many of my patients and
one thing is clear – cigarettes are more addictive than either heroin or
cocaine. And it isn’t just the nicotine that keeps you coming back for
more. There is evidence that other chemical components in cigarettes
can also cause a physical and psychological dependence. But, while
smoking is the most difficult habit to change, it can be done.
Fortunately, there are a number of ways to quit – nicotine patches,
acupuncture, hypnosis, even drugs. Personally, I’ve found that a

87
 combination approach works
best for many of my patients
Safety Alert! and so my program
Here are some facts that should incorporates behavior
make every smoker think twice
modification, acupuncture,
before they light up:
nicotine patches or gum, and
• Smoking lowers HDL
hypnotherapy. The results
cholesterol.
have truly been amazing, with
• Smoking deteriorates the
up to a 98% success rate.
elastic properties of the aorta,
the largest blood vessel in the No matter what it takes,
body, which increases the risk quitting can greatly benefit
for developing blood clots. your health. Consider this:
• Smoking increases the activity Smoking will significantly in-
of the sympathetic nervous crease your risk of heart
system, putting additional disease. The more you smoke,
stress on the system that
and the longer you have
regulates the heart and blood
vessels. smoked, the greater the risk.
• Smokers have twice the risk of Even light smokers, who may
having a heart attack than non- smoke only 1-14 cigarettes a
smokers. day, have a three times greater
• Smokers who have a heart risk of developing heart
attack are more likely to die, disease than non-smokers.
and die suddenly, than non- Of the 4,000 or so
smokers.
chemicals identified in
• Those who smoke a pack of cigarette smoke, the most
cigarettes a day have almost
damaging to the
two and a half times the risk
for having a stroke as cardiovascular system are
nonsmokers. nicotine and carbon
• People exposed to second-hand monoxide. Nicotine causes an
smoke have a 30 percent immediate increase in blood
higher risk of developing heart pressure, heart rate, cardiac
disease. output and coronary blood
flow. Carbon monoxide binds
to hemoglobin, which reduces
the amount of oxygen delivered to tissues. There is also evidence that
smoking repeatedly damages the lining of blood vessels, setting a
smoker up for atherosclerosis.
If you don’t succeed the first time you try to quit, don’t give up.
Studies show that smokers who have tried smoking cessation in the
past have a much better chance of staying smoke-free with each
88
successive attempt.
However you choose to HEART SMART TIP
stop, just do it! This is one What Happens When You Quit
risk factor that is simply Smoking
not negotiable.
➤ Within 30 minutes of
Stress quitting smoking, your
Stress has been with us pulse rate slows down and
since the beginning of blood pressure drops
time. That’s not toward normal.
necessarily bad. Short-term ➤ Within hours of stopping,
stress can generate the the level of carbon
impetus necessary to monoxide in your blood
convert thought into drops, enabling the blood
action, whether that action to carry more oxygen.
is planting a garden, ➤ Two days after quitting,
meeting a deadline or nerve endings begin to
escaping from a fire. But recover and your sense of
when stress becomes a smell and taste begin to
routine part of our lives, it return.
can spell trouble –
➤ Within 72 hours of
especially if we don’t learn
quitting, lung volume
how to manage it. More
increases.
than 70 percent of all
doctor visits are because of ➤ Months after quitting,
stress-related disease, shortness of breath
many of which involved diminishes.
the heart. In fact, people ➤ In the first year, the risk of
who live in a high state of heart attack attributed to
anxiety are 4.5 times more smoking declines for both
likely to die of a heart men and women.
attack or stroke. ➤ After 10 years, the risk of
The primary reason developing cancer is about
that long-term stress can the same as for
have such deadly nonsmokers.
consequences is that it Source: www.quitsmoking.com
triggers a hormone called
cortisol. In a study of 18 healthy male doctors, researchers at the
Humboldt University of Berlin, Germany, found that high cortisol

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levels can cause red blood cells
to clump together. The blood Safety Alert!
becomes thick and sluggish, Even short bouts of stress can
increasing the risk of lead to heart damage, say
hypertension, stroke and heart researchers at Ohio State
attack. Over time, stress can University.
also change artery walls, causing In their study of 35 women,
them to become ridged. they discovered that stress slows
According to recent the body’s ability to clear
evidence, living the anxious life triglycerides from the blood. And
can also have a negative impact the longer these unhealthy fats
on your lipids. University of circulate in your body, the more
Pittsburg researchers conducted negative impact they have on
a clinical study of 688 middle- your heart.
aged women suffering from
recurrent chest pain and found that those prone to high levels of stress
and anger had a more than four-fold greater risk of high LDL.
But here’s the good news: A growing number of studies suggest
that stress management can help reduce the detrimental effects of
stress on your heart. One study in the journal Archives of Internal
Medicine found that people with severe hypertension were able to
significantly reduce their blood pressure after ten hours of stress
management therapy.
A Duke University study of 94 men with heart disease also found
that those who learned relaxation techniques had fewer heart attacks,
less cardiac surgery and lower medical costs than those who didn’t
learn how to manage their stress. So do yourself and your heart a
favor. Try one of the following techniques to help you get a handle on
stress.
Biofeedback: Biofeedback is a treatment technique in which
people are trained to improve their health by using signals from their
own bodies. Using monitoring equipment, biofeedback is often aimed
at changing habitual reactions to stress that can cause disease. Many
clinicians believe that some patients have forgotten how to
relax.
Feedback of physical responses such as skin temperature and
muscle tension provides information to help patients recognize a
relaxed state. If you think you might benefit from biofeedback
therapy, look for a biofeedback therapist that will assist you in

90
treating your hypertension and other stress-related disorders. To
locate a biofeedback therapist in your area, check the resources at the
end of this book.
Meditation: There are several different types of meditation,
including mindfulness meditation, concentrative meditation and
transcendental meditation (TM). Of those, TM is perhaps the most
widely studied. Not only does TM induce mental relaxation, studies
show that this form of meditation reduces the risk of hypertension,
angina and atherosclerosis. One reason for this, say researchers at
Reina Sofia Hospital in Cordoba, Spain, is that the regular practice of
TM has a significant effect on the sympathetic nervous system. In
their study, 19 practitioners of TM were compared with 16 volunteers
who had never used any type of
relaxation therapy. Throughout
Safety Alert!
the study, the researchers
Biofeedback is very safe.
measured the amounts of
However, if you are undergoing
norepinephrine and epinephrine
any sort of medical treatment,
in the participant’s blood and
you should consult your doctor
found that those practicing TM
before beginning therapy.
had consistently lower plasma
levels of these stress hormones. Biofeedback should not be
used as a substitute for proper
Another study, recently
medical attention since it may
presented at a meeting of the
mask the symptoms of a more
American Heart Association,
serious condition.
found that TM reduced the
severity of risk factors in
Syndrome X. The researchers noted that the people who meditated
decreased their blood pressure, blood sugar and insulin. Other
research has found that meditation helps the body and mind so much
that some patients can reduce their medications, especially drugs used
to treat hypertension and anxiety.
No matter what type of meditation you choose, each form requires
daily practice and I advise learning from a master. The investment
you make learning to meditate will more than pay for itself in
improved health and well-being.
Muscle Relaxation: This method of stress control involves
contracting and relaxing the large muscle groups in your body until
each part of your body is free from tension. This form of relaxation
doesn’t require any special equipment or training. Simply lie on your

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back, arms at your sides,
and begin to breathe HEART SMART TIP
deeply. Tense each muscle
group, starting with your 2-Minute Relaxation
feet, for a count of 10 and Find a quiet corner where you
then relax. Move to the won’t be disturbed. Take a couple of
next muscle group and deep breaths and let your body flop for
repeat, remembering to a minute or two. Slowly come up into
breathe. End by tightening an erect position.
and relaxing the muscles in Practicing this exercise each day
your face. Then take a few has a cumulative effect on your stress
more deep, even breaths levels and will prevent them from
before slowly getting up. escalating.
Relax With Music:
One of the easiest ways to reduce stress is by simply listening to
some soothing music. In a study of recent heart attack victims, those
who listened to music for twenty-minutes experienced a reduction in
respiration and heart rate, as well as a drop in oxygen demands by the
heart. Anxiety was also reduced, an effect that lasted for 30 minutes
after the music stopped.
Music therapy is an ideal do-it-yourself way to combat stress.
Although special therapeutic tapes and CDs are readily available
through either mail-order or from specialty bookstores, they may not
suit your musical tastes. Instead, choose some soothing music from
your own collection. This type of stress-reduction works best if you
are relaxed and comfortable, and are able to fully concentrate on the
music.
Stress-Busting Herbs: Herbs have been used for centuries to calm
anxiety, counteract insomnia and help people adapt to stressful
situations. Nervines, like kava
kava or passionflower, can
soothe mild to moderate anxiety Safety Alert!
without the adverse side effects When listening to music
common to many of the drugs through headphones, take care to
often prescribed for anxiety. keep the music at a low volume.
Adaptogenic herbs, which Prolonged playing of loud music
include ginseng and rhodiola, can cause permanent hearing
can also help your body resist damage.
the negative effects of stress.
Numerous studies have found
92
that both of these herbs also enhance concentration and promote
overall well-being.

See Your Dentist

Most of us don’t make the Safety Alert!
connection between good dental If you have heart disease,
care and heart disease. But some make sure to let your dentist
new studies have found that know – especially if you are
patients with gum disease and taking Coumadin. This drug can
tooth decay are at an increased cause excessive bleeding during
risk for heart disease. extractions or root canals unless
In one study, Dr. Pirkko J. proper precautions are taken.
Pussinen, from the University of For patients with heart
Helsinki, and colleagues looked murmurs or replacement heart
for antibodies to two common valves, antibiotics will be needed
types of dental bacteria in the before, during and shortly after
blood of 1,163 men. Antibodies conventional dental treatments.
are chemicals produced by the
body to fight infection and are an indirect way of determining
whether a particular bug is present. Men with antibodies to the dental
bacteria were 50 percent more likely to have heart disease than men
without these antibodies. Gum disease has also been linked to higher
LDL and total cholesterol. The lesson here is that brushing and
flossing are important, not only for your smile, but for your heart.
And regular visits to your dentist are essential.

93
 REMEMBER . . .

➤You need eight hours of sleep every night. Too little or too
much can increase the risk of heart disease.
➤ Snoring may be a sign of a sleep disorder that can lead
to a heart attack or stroke.
➤ Smoking is the absolute worst thing for your heart. It
substantially increases ALL cardiovascular risk factors.
➤ If you don’t smoke, don’t start. If you do, quit now!
➤ People under constant stress are 4.5 times more likely to
die of a heart attack or stroke.
➤ Stress not only causes red blood cells to become thick
and sluggish, it can also cause artery walls to become
ridged.
➤ Even short-term stress can damage the heart since it
reduces the body’s ability to clear triglycerides.
➤ Practiced regularly, stress-reduction techniques can
reduce blood pressure and heart rate. It can also
improve your cholesterol profile.
➤ Stress reduction can be as complex as biofeedback or as
simple as listening to music. Choose a technique (or
combination of techniques) that fit your schedule and
comfort level.
➤ Gingivitis (gum disease) and tooth decay increase the
risk of heart disease. Make sure to visit your dentist
regularly.

94
 Chapter 7

DIETARY SUPPLEMENTS FOR HEART HEALTH

When it comes to preventing or reversing heart disease, nothing

can take the place of a low-fat diet based on fresh fruits, vegetables
and whole grains. But, since diet alone often isn’t enough, you may
need to add supplements.
Most of these natural supplements are considered safe when taken
at the recommended doses. However, if you are considering adding
supplements at doses higher than the recommendations I’ve made
below, it’s a good idea to consult a professional before you begin.
If you have a pre-existing medical condition – and especially if
you have suffered a heart attack – you should always talk to your
doctor before taking supplements of any kind. Although dietary
supplements normally have fewer side effects than prescription drugs,
some can interact with your medications, enhancing or decreasing the
effect of your prescription.
Finally, like most things in life, quality counts. When shopping
for supplements, choose natural over synthetic whenever possible.
Natural supplements are often more potent and easier for the body to
use.

Vitamins
According to conventional nutritionists, if you eat a balanced diet
that contains six to 10 servings of fruits and vegetables, you’re getting
all of the vitamins you need. HOGWASH! Because of modern
farming practices and food processing, many of the nutrients in our
fruits and vegetables have
been depleted. In other
words, our food just isn’t
HEART SMART TIP
as nutritious as it used to Maximize Your Multi
be. When shopping for a multivitamin,
One way to correct this look for one that also includes a variety
lack of natural nutrition is of heart-healthy minerals, including
by taking a multivitamin calcium, magnesium and selenium.
every day. In fact, the And check the label for other nutrients
American Medical like antioxidants, green foods and herbs
Association even advises a that support cardiovascular health.

95
daily multivitamin for all Americans. But most over-the-counter
multivitamins contain only a smidgen of the essential vitamins we
need. The recommended daily allowances (RDAs) or “daily values”
listed on vitamin labels are only the amounts the average adult needs
to prevent a deficiency – not the amounts required to achieve your
best health. They certainly aren’t the levels needed to prevent or
reverse heart disease.
That said, a multivitamin can provide you with some insurance
against disease. But the following vitamins can be added as needed to
give you even more protection.
Vitamin C: This free radical
Did You Know?
fighter plays an extremely
important role in heart health. This potent antioxidant can
But, unlike animals, the human help lower CRP. According to a
body can’t manufacture its own new study by researchers at Tufts
supply. And, because vitamin C University, consuming 250 mg.
is water-soluble, the body can’t of vitamin C twice a day can
store it, so it must be replenished effectively lower plasma CRP
every day. levels in both men and women.

In one famous study

conducted at the University of California, Los Angeles, researchers
analyzed the vitamin C intake of more than 11,000 people over 10
years. They found that men who consumed more than 300 mg. of
vitamin C a day had a 45 percent lower risk of dying from heart
disease than men who only got 50 mg. or less a day. And, while
women didn’t fare quite as well, vitamin C also cut their risk by 25
percent.
Another recent study involving 11,349 adults found that vitamin C
had a statistically significant benefit in preventing heart disease, and
some researchers have noted that low levels are associated with an
increase in heart attacks.
Although vitamin C is most
often thought of as an immune How Much Should I Take?
booster, it protects against Since fewer than one in ten
atherosclerosis. Not only does people eat the recommended
it inhibit platelet aggregation, daily servings of fruits and
this potent antioxidant plays a vegetables, I recommend taking
role in protecting LDL 1,000 to 2,000 mg. of vitamin C
cholesterol from oxidation. a day.

96
Vitamin C is also crucial for the production of collagen, an important
protein that helps to maintain the integrity of blood vessels and other
tissues.
If that weren’t enough, vitamin C decreases the level of those
proteins that contribute to blood clots. Other activities of this crucial
antioxidant include lowering lipoprotein(a), elevating HDL
cholesterol and regenerating vitamin E.
Vitamin E: Vitamin E is one
of the most commonly used How Much Should I Take?
vitamins. In fact, more doctors I advise all of my patients to
add this potent antioxidant to take 400 to 800 IU of vitamin E
their health care routine than any a day. Vitamin E supplements are
other supplement. No wonder – so safe that the National
the Health Professional’s Academy of Sciences has
Follow-Up Study of 39,910 men established the daily tolerable
found that those who took the upper intake level for adults to be
most vitamin E had a 40 percent 1,000 mg of vitamin E.
lower risk of heart disease.
Vitamin E may also prevent heart attacks in people who already
have atherosclerosis. The
HEART SMART TIP Cambridge Heart
Shopping for vitamin E can be Antioxidant Study
confusing. The vitamin E you’ll find in (CHAOS) tested the effects
drug and health food stores is usually of vitamin E on future
preceded by either a “d” or “dl,” cardiovascular events in
depending on its chemical structure. patients with
While “d-alpha tocopherol” means you atherosclerosis. The results
are getting a natural, more active form were impressive – vitamin
of vitamin E, “dl-tocopherol” refers to a E reduced the risk of a
synthetic compound. subsequent heart attack by
77 percent and the risk of
According to chemists specializing
all cardiovascular events
in this fat-soluble vitamin, the natural
by 47 percent.
form may be as much as twice as
bioavailable as synthetic vitamin E. Scientists are also
And vitamin E supplements that are discovering that vitamin E
labeled as “mixed tocopherols” may be lowers CRP levels.
the most beneficial since they contain Researchers at the
not only alpha-tocopherol, but also University of Texas
beta-, gamma- and delta-tocopherols. Southwestern Medical

97
Center gave 1,200 IU of vitamin E to diabetic patients with high CRP
levels every day for three months. By the end of the trial, the Texas
team found a significant decrease in CRP and suggested that vitamin
E could be an effective therapy in the prevention of atherosclerosis.
B-Complex Vitamins: Like
antioxidants, the B vitamins How Much Should I Take?
appear to work together, To prevent heart disease, look
particularly when it comes to for a vitamin B complex that
lowering homocystine. And three contains 400 mcg. of folic acid,
of these B vitamins appear to be at least 50 mg. of vitamin B-6
superstars: and 500 to 1,000 mcg. of B-12.
√ Folic acid effectively
lowers homocystine levels
and decreases inflammation. In fact, studies have shown
that folic acid alone can cut homocystine levels by 50
percent. But don’t expect this to happen at the 400 mcg.
usually recommended. You need to take 800 to 1,000
mcg. a day to effectively battle high homocystine levels.
√ Vitamin B-6 is another heart protector that inhibits the
formation of homocystine and aids in the prevention of
arteriosclerosis. It also helps the body absorb vitamin
B-12 and magnesium. Vitamin B-6 is usually considered
safe up to 200 mg. a day. More than that can damage
sensory nerves, leading to numbness in the hands and
feet as well as difficulty walking.
√ Vitamin B-12: This B vitamin also helps lower
homocystine and aids folic acid in regulating the
formation of red blood cells. The recommended dose is
500 to 1,000 mcg. in a sublingual form (which is
dissolved under the tongue) to insure better absorption.
Another one of the B vitamins, niacin, has been used for years to
lower cholesterol. In one clinical trial, researchers compared niacin to
a popular statin drug. One-hundred and thirty-six people with high
cholesterol were randomly assigned to receive either niacin or
lovastatin. While both groups saw benefits, the statin was slightly
more effective at lowering LDL cholesterol. But, when it came to
HDL, those in the niacin group experienced a 33 percent increase
compared to only seven percent for the statin group.

98
 But niacin can be tricky. One controlled study has found that
1,000 mg. of niacin per day or more raised homocystine levels. This
B vitamin can also cause flushing and is not tolerated well by some
people. If you are considering taking niacin to lower your cholesterol,
look for non-flushing niacin or take one baby aspirin with your niacin
to prevent flushing.
Beta-Carotene: This
precursor to vitamin A is one of How Much Should I Take?
the carotenoids – plant pigments The most common beta-
that act like powerful carotene dosage is 25,000 IU a
antioxidants. One clinical trial of day, though some people take
1,400 people throughout Europe considerably more than this.
found that those with the highest Unlike vitamin A, beta carotene
levels of beta-carotene in their isn’t toxic at high doses.
bloodstream had the lowest risk
of suffering from a heart attack.
Of course, dietary sources of this antioxidant are best and can be
found in dark green and orange or yellow vegetables. But if you
aren’t eating enough vegetables, it’s a good idea to supplement with
this important vitamin precursor.
Lycopene: Most of us are
familiar with lycopene as a How Much Should I Take?
nutrient that promotes prostate Although no specific
health. But this carotenoid recommendations have been
(which is found in tomatoes, established for lycopene, it’s wise
watermelon and pink grapefruit) to choose a multivitamin that
has recently been targeted by includes this potent antioxidant.
researchers for its ability to
protect against heart disease.
In the most recent study, researchers at Brigham and Women’s
Hospital and Harvard Medical School followed more than 28,000
middle-aged and elderly disease-free women for more than four
years. By the end of the study, the joint team of researchers found that
the women with the highest lycopene levels had a 50 percent lower
risk of developing heart disease than those with the lowest levels.
These findings add to a growing body of research linking
lycopene levels to cardiovascular disease. For example, the European
Study of Antioxidants, Myocardial Infarction and Cancer of the
Breast (EURAMIC) studied adipose tissue for lycopene concentration

99
and risk for cardiovascular disease. That study found that men with
the highest levels of lycopene in their adipose tissue were 48 percent
less likely to develop cardiovascular disease. The Kuopio Ischaemic
Heart Disease Risk Factor Study also found that low serum lycopene
levels were associated with increased risk of heart attack and stroke.
One reason lycopene has such a critical impact on heart disease is
because it helps prevent the oxidation of LDL cholesterol. University
of Toronto investigators found that consuming one to two servings per
day of tomato juice, spaghetti sauce and supplemental lycopene for
just one week doubled blood levels of lycopene, while notably
lowering oxidized LDL levels. Preliminary research has also linked
low lycopene levels in the blood to higher CRP levels.

Minerals
As important as vitamins are, they can’t be assimilated without
the aid of minerals. And though the body can manufacture a few
vitamins, it can’t manufacture a single mineral.
All of the tissues and internal fluids in our bodies contain varying
quantities of minerals, including soft tissue, muscle and blood. While
they are vital to overall mental and physical well-being, certain
minerals, like the ones listed below, are particularly important to
cardiovascular health.
Calcium: Known as the bone-building mineral, calcium also plays
a role in heart health. In one cohort study, researchers at the
University of South Carolina
analyzed data from more than
34,000 postmenopausal women How Much Should I Take?
found that those taking the most While dairy products, salmon
calcium for bone health also had and dark-green vegetables are all
a significantly lower risk of good sources of calcium, it’s hard
atherosclerosis. to get adequate amounts of this
While this important mineral important mineral through diet
appears to lower LDL alone, so it’s wise to take 1,000
cholesterol by slowing down the to 1,500 mg. of supplemental
amount of saturated fat that is calcium a day. But be aware that
absorbed into the bloodstream, the body can’t absorb more than
women taking calcium 500 mg. of calcium at a time, so
supplements may also have take your supplements in divided
higher HDL cholesterol. In one doses

100
clinical trial, 223 postmenopausal women were randomly assigned to
take a placebo or 1,000 mg. of calcium each day for one year. At the
beginning and the end of the intervention, researchers measured the
blood levels of the participants’ total cholesterol, as well as LDL and
HDL cholesterol.
After a year of taking calcium, the researchers noted a slight
reduction in LDL cholesterol. But HDL levels increased by 7 percent
compared to the levels before supplementation. And HDL levels
increased significantly more in the women taking calcium than in
those taking the placebo.
Population-based studies have also suggested a link between
calcium deficiency and high blood pressure. One study monitored
elderly patients with hypertension for 24 hours to evaluate the effect
of calcium supplementation on blood pressure. After taking 1,000 mg.
of elemental calcium, systolic and diastolic blood pressure declined
by 13.6 mmHg and 5.0 mmHg respectively. Other research has found
that taking supplemental calcium also helps to maintain the flexibility
of blood vessel walls.
Magnesium: Without this
essential mineral, your heart
How Much Should I Take?
would cease to function Because magnesium
properly. In fact, when enhances the absorption of
researchers from the University calcium, both supplements
of Virginia examined the dietary should be taken together. The
magnesium intake in 7,172 men recommended dose is 500 to 750
who took part in the Honolulu mg. a day, balanced in a 1:2 ratio
Heart Program, they found that with calcium.
the rate of heart disease was
significantly lower in those with the highest daily magnesium intake
(340 mg. or more) compared with those with the lowest intake (186
mg. or less).
No wonder – magnesium increases the heart’s supply of oxygen,
lowers cholesterol, hinders blood vessel blockages and prevents the
formation of blood clots. It also relaxes the smooth muscles in the
arteries and can restore normal rhythm.
Additionally, population-based research has found that people
with high serum levels of magnesium have lower blood pressure. In
one crossover trial, 60 hypertensive people were assigned to take
either a magnesium supplement or a placebo for eight weeks. The two

101
groups then traded places – those on magnesium were switched to the
placebo and vice versa. By the end of the study, blood pressure was
significantly lower during the time the patients were taking
magnesium – and the best results were seen in those with the highest
blood pressure at the beginning of the study.
Magnesium has also been called “nature’s calcium channel
blocker” because it prevents calcium from entering cells. The result is
that the artery walls relax, allowing more blood to flow through them.
Yet magnesium has none of the adverse side effects common to
pharmaceutical channel blockers.
Selenium: This trace mineral
plays an important role in the How Much Should I Take?
oxidation of lipids and low
You only need about 200 mcg. a day
levels have been linked to
and your daily multivitamin should
atherosclerosis. In one
contain this much. But don’t take
investigation, researchers tested
more than this amount, since toxicity
55 men and 71 women living in
is possible and may harm the thyroid
a rural Japanese seaside village
and nervous system.
and found that those with a
moderate to high selenium
intake also had elevated HDL levels – leading the investigators to
conclude that selenium is an important factor in the prevention of
heart disease.
While selenium is naturally found in the soil, it is severely
depleted in the U.S. As a result, the foods we eat often don’t contain
sufficient amounts of this mineral to meet our requirements.

Antioxidants
As I discussed in Chapter 4, free radicals are unstable molecules
that can damage the arteries and oxidize LDL cholesterol (which
contributes to plaque build-up). But nature has an ingenious weapon
against oxidation – antioxidants.
Antioxidants block the process of oxidation by neutralizing free
radicals. In other words, they convert free radicals to harmless waste
products that get eliminated from your body before they can do
damage. But in doing so, the antioxidants themselves become
oxidized. That is why there is a constant need to replenish our
antioxidant resources.
Along with vitamins C, E, beta carotene and selenium, the

102
antioxidants that follow play a special role in heart health.
Alpha Lipoic Acid: Although
not a true vitamin, alpha lipoic How Much Should I Take?
acid (ALA) is a vitamin-like Although the best source of
antioxidant that is soluble in ALA is through foods like
both fat and water. One of its spinach, beef liver and yeast,
most valuable qualities is that it most of us don’t eat these foods
can re-activate other heart- on a regular basis. For general
healthy antioxidants, including antioxidant protection, I
vitamin C, vitamin E and recommend supplementing your
coenzyme-Q10. diet with 100 mg. of ALA twice
New evidence out of Canada a day.
shows that ALA can modulate
blood lipids, protect against
LDL oxidation and help lower blood pressure. ALA also
improves a number of functions in the heart including oxygen uptake,
cardiac output and energy production. Not only does ALA act like an
antioxidant itself, it also stimulates the production of glutathione,
giving cells a double dose of antioxidants.
This antioxidant is easily absorbed when taken orally, and once
inside the cells, it is quickly converted to its most potent form,
dihydrolipoic acid. Because both ALA acid and dihydrolipoic acid are
antioxidants, their combined actions give them greater antioxidant
potency than any natural antioxidant now known.
Coenzyme Q-10: Co-Q10
How Much Should I Take? plays an important role in
Co-Q10 is present in a providing energy to the cells,
number of foods, including beef, especially those in the heart, and
poultry and broccoli. But if you low levels are implicated in
have heart disease, Co-Q10 virtually all cardiovascular
should be high on your list of diseases, including angina,
essential supplements. I hypertension, cardiomyopathy
recommend taking a minimum of and congestive heart failure.
60 mg. of Co-Q10 twice a day, Unfortunately, Co-Q10 levels
preferably with meals to ensure decrease as we get older. And,
its absorption. Double the dose statin drugs deplete stores of this
(120 mg.) if you’re taking statin critical nutrient, making it an
drugs. indispensable supplement for
anyone taking these medications.

103
 While this enzyme is a potent anti-inflammatory, Co-Q10’s most
important role in heart disease is its ability to lower blood pressure by
decreasing oxidative stress and insulin response. Co-Q10 also has a
positive effect on lipoproteins and HDL cholesterol.
A few years ago, the International Journal of Cardiology
published the results of a double-blind trial which tested the effects of
Co-Q10 on 47 patients who had either suffered a heart attack or had
been diagnosed with angina. Twenty-five of the patients received 60
mg. of Co-Q10 a day, while everyone else got a placebo. In less than
a month, those on the enzyme had a 22.6 percent decrease in
lipoprotein(a) (protein compounds that carry cholesterol in the blood).
LDL also dropped, as did oxidative stress. At the same time, Co-Q10
gave HDL a significant boost. None of these effects were seen in the
participants taking the placebo.
Although there are a variety of Co-Q10 formulations on the
market, look for soft gel caps. Unlike powdered supplements, gel
caps contain Co-Q10 in an oil-based suspension which is
considerably more absorbable.

Amino Acids
Amino acids are the “building blocks” of the body. Besides
building cells and repairing tissue, they form antibodies to combat
invading bacteria and viruses; they are part of the enzyme and
hormonal system; they build nucleoproteins (RNA and DNA); they
carry oxygen throughout the body; and they participate in muscle
activity. While many amino acids can be manufactured by the body,
eight of them (known as essential amino acids) can’t be and so they
must be provided through food or supplements.
While the three amino acids below are non-essential, if you have
heart disease, your body may not be able to make sufficient amounts
to keep up with the demands of a compromised cardiovascular
system. And if you don’t eat much protein or are a vegetarian, it’s
particularly important to take these amino acids in supplemental form.
Arginine: Arginine is quickly gaining a reputation as the artery-
protecting amino acid that boosts nitric oxide levels. As a result,
arterial blood vessels relax, permitting improved blood flow to the
heart and reducing blood pressure. Some researchers also suggest that
the increase in arginine-induced nitric oxide may increase exercise
capacity in people with angina.

104
 To test this theory, Polish
How Much Should I Take?
physicians conducted a double-
blind study involving 22 people Supplements are sold as
with stable angina. Each subject L-arginine and I recommend
took an exercise stress test, taking 1,000 mg. three times a
which was discontinued when day. But, if you are taking
metabolic heart muscle strain nitroglycerin or any other
was detected. For three days, half medication that dilates the blood
the group received a placebo vessels, avoid taking this
while the others took 1,000 mg. supplement.
of L-arginine twice daily. When
the participants repeated the test, those in the placebo group had
increased their exercise time by about one minute. The arginine
patients, however, increased their time by nearly three minutes.
According to Johns Hopkins cardiologist Charles J. Lowenstein,
nitric oxide also has the power to block the release of inflammatory
compounds by cells within the blood vessels. Normally, these cells
activate a process that releases packets of molecules into the
bloodstream that, like tiny hand grenades, explode and discharge
compounds that trigger inflammation. Nitric oxide can move in and
target a protein within the endothelial cells called N-ethylmaleimide-
Sensitive Factor (NSF) that stops the process from happening by
blocking the ability of NSF to push out the molecules.
In addition, some studies have found that arginine lowers
cholesterol and opens clogged arteries. In one study, which was
published in the journal Circulation, patients with high cholesterol
who took arginine on a long-term basis experienced a reduction in the
thickness of plaque. New evidence also indicates that this amino acid
helps to regulate platelet aggregation.
L-Carnitine: L-carnitine may
benefit people with How Much Should I Take?
cardiomyopathy, angina and Most people do not need to
congestive heart failure. In one supplement their diet with L-
clinical trial, 80 of 160 heart carnitine. However, for
attack patients took 4,000 mg. of therapeutic use, the standard
L-carnitine a day for one year. dosage is 1,000 to 3,000 mg. per
Subjects given the L-carnitine day.
showed less mortality and an
improved heart rate, rhythm and
pressure as well as improved blood lipids.
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 Controlled research has also shown that people stand a better
chance of surviving a heart attack if they are given L-carnitine
supplements. And this amino acid has a reputation for increasing
exercise capacity. But much of the research on carnitine’s impact on
exercise in people with congestive heart failure used a modified form
of carnitine called propionyl-L-carnitine (PC). In one double-blind
trail, 500 mg. of PC per day led to a 26 percent increase in exercise
capacity after only six months. In other research, patients with
congestive heart failure given 1,500 mg. a day had a 21 percent
increase in exercise tolerance and a 45 percent increase in oxygen
consumption.
Taurine: This amino acid-like nutrient gained attention after a
study in the Japanese Circulation Journal found it produced a
significant improvement in cardiac output and shortness of breath.
The study also found that taurine helps regulate the heart beat and
maintain cell membrane stability. More recently, Korean researchers
discovered that taurine reduced total cholesterol levels by 32 percent,
LDL by 37 percent and triglycerides by
an impressive 43 percent. How Much Should I
But this amino acid may be Take?
particularly important for diabetics at If you are a diabetic at
risk for heart disease since they are high risk for heart disease,
especially prone to blood clots due to I would advise taking
sticky platelets. While the platelets in 1,500 mg. of taurine a day,
healthy people normally contain a very in divided doses. However
high level of taurine, diabetics typically taurine should be taken
have decreased taurine levels in their only under the supervision
blood and in their platelets. But a of a doctor. Unlike most
recent study by Dr. Flavia Franconi of supplements, taurine has a
the University of Sassari in Italy relative narrow divide
discovered that giving diabetics modest between therapeutic and
supplements of taurine (500 mg. three toxic doses.
times a day) reversed the abnormal
tendency of their blood platelets to clot.
Food sources of taurine include fish and organ meats like liver.
However, when taurine levels are depleted by disease or the body’s
ability to manufacture taurine is inadequate, food sources alone will
probably not be able to restore adequate taurine levels.

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 Fish Oil
How Much Should
Even if you don’t like fish, you
I Take?
need fish oil. The reason is that fish oil
To ensure you’re contains eicospentaenoic acid (EPA)
getting all of the heart- and docosahexaenoic acid (DHA), two
healthy advantages fish oil omega-3 fatty acids that help reduce
has to offer, take 1,000 high blood pressure and modulate many
mg. of an EPA/DHA fish of the mechanisms of atherosclerosis,
oil supplement from cold- including inflammation, blood clotting
pressed pure marine lipid and platelet aggregation (stickiness).
every day. Available in
Fish oil may also reduce the
capsule form, take them
chances of dying from a heart attack.
mid-meal to avoid any
One study in the New England Journal
fishy taste and gassiness
of Medicine began following 22,000
that can occur. And always
men with no known heart problems in
keep your fish oil
1982. In the men who ate fish regularly
supplements in the
– one to four times per week – the risk
refrigerator since these
of heart-attack death was as much as 81
polyunsaturated oils can
percent lower!
go rancid if left at room
temperature. Other research shows that fish oil
can improve your cholesterol profile.
Canadian scientists divided 50 men
with high cholesterol into four groups. One group received either a
combination of 12,000 mg. of fish oil with 900 mg. of garlic, fish oil
alone, garlic alone or a placebo. While the fish oil reduced
triglyceride levels by 37.2 percent after 12 weeks, the researchers
found that those taking the garlic-fish oil combination had a 34.3
percent reduction in both LDL cholesterol and triglycerides and a
12.2 percent decrease in their total cholesterol. Another study
reported that moderate amounts of fish oil – 6,000 mg. a day –
lowered triglyceride levels by 30 percent in diabetic adults.
Fish oil is one of the best supplements you can take to support
heart health, particularly if you’ve already suffered a heart attack. But
diabetics are often told not to take it in supplemental form because it
can raise blood sugar. Recent studies, however, are debunking that
theory. In fact, one clinical trial by Harvard researchers even
concluded that not only did fish oil have no effect on glucose
metabolism, it should be considered an integral part successfully
treating diabetes.

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 Policosanol
Policosanol is the generic name for a mixture of alcohols derived
from sugar cane which can lower the production of the cholesterol to
more favorable levels. Policosanol also enhances our body’s ability to
remove and process LDL cholesterol from the blood and cells. In fact,
study after study has found that this natural supplement is just as
effective as statin drugs.
In one of these studies, a team of German scientists reviewed the
literature on placebo-controlled lipid-lowering trials using policosanol
and found that, at doses of 10 to 20 mg. per day, policosanol lowers
total cholesterol by 17 to 21 percent and LDL cholesterol by 21 to 29
percent. Better yet, policosanol raises HDL cholesterol by 8 to 15
percent – more than statin drugs.
In a direct comparison with statin drugs, policosanol also holds its
own. In a side-by-side evaluation by Chilean researchers, 10 mg. of
policosanol reduced LDL cholesterol by 24 percent compared with 22
percent for Mevacor and 15 percent for
Zocor. But, unlike statins, which
become increasingly toxic with higher
How Much Should
doses, policosanol achieves its I Take?
maximum effect at very low doses and Most studies have
taking more is neither more effective used 5 to 10 mg. of
nor more toxic. policosanol twice a day.
Studies have shown that poli- But I recommend starting
cosanol is generally safe, but there are a out with 5 mg. taken once
few notes of caution. When policosanol a day at dinnertime.
is combined with aspirin, an increased Unlike statin drugs,
blood-thinning effect occurs. This policosanol can take up to
suggests that policosanol should not be 12 weeks before any
taken with blood-thinning drugs results are seen. And early
without the supervision of a doctor. cholesterol testing may
Also, some study subjects have show an increase in LDL,
experienced mild side effects from but this effect is
policosanol, including insomnia, temporary.
headache, diarrhea, nervousness and If you have extremely
weight loss. These short-term side high cholesterol, you can
effects have been reported in less than double the dose to 5 mg.
one percent of the subjects tested. And twice a day, taken at lunch
unlike statin drugs, policosanol has not and dinner.

108
been shown to have a harmful effect on the liver - the organ that
manages the production of cholesterol.
Another concern is that some research indicates that policosanol
may have a negative effect on Co-Q10 levels – but these results are
preliminary and far from conclusive. However, since supplementing
with Co-Q10 is helpful for people with heart disease, some
policosanol manufacturers have added CoQ10 to their supplement
formulas.

Soy Supplements
For years, soy supplements were recommended to help lower
cholesterol. Although the research wasn’t conclusive, some
researchers believed that the isoflavones in soy could reduce both
total cholesterol and LDL. But now, researchers at North Carolina’s
Wake Forest University have found that, unlike whole soy foods, the
isolated soy isoflavones (ISO) in soy supplements don’t lower
cholesterol levels at all.
The researchers divided 60 menopausal subjects into three groups
of 20. The first was fed a milk-based diet likely to lead to
atherosclerosis, the second received ISO supplements and the third
was fed a diet similar to the first group but with added soy foods. At
the end of the study, the group eating the soy food diet had a
significantly lower risk of atherosclerosis than those who consumed
all of their protein from milk. And those eating the soy had 50 percent
lower LDL cholesterol levels than those taking the ISO supplements.
The upshot is that no one really knows for sure if ISO
supplements are beneficial or not. Until researchers have clear-cut
answers, its far better to get your soy from food instead of simply
popping a soy supplement.

109
 REMEMBER . . .

➤ Whenever possible, it’s wise to get most of your

nutrients through a diet rich in fruits and vegetables.
➤ Taking a multivitamin daily is an important safeguard
against disease. But, if you have heart disease, you may
need additional nutrients.
➤ Vitamin C is a key nutrient for protecting against
atherosclerosis because it inhibits platelet aggregation,
prevents the oxidation of LDL cholesterol and lowers
CRP.
➤ Vitamin E also lowers CRP and offers exceptional
protection against heart attack.
➤ If you have high homocystine levels, make sure you are
taking a supplement that provides at least 800 mcg. of
folic acid, along with vitamins B-6 and B-12.
➤ Minerals are also important to cardiovascular health,
especially calcium, magnesium and selenium. These
minerals all work to prevent atherosclerosis.
➤ Low levels of Co-Q10 are implicated in all forms of
cardiovascular disease. This important antioxidant
should be taken by anyone with heart disease and
particularly those taking statin drugs.
➤ Fish oil supplements rich in EPA and DHA can prevent
heart attack, lower blood pressure, decrease CRP levels,
reduce platelet aggregation and improve your
cholesterol profile, making it essential for heart health.
➤ Policosanol is a natural and highly effective alternative
to statin drugs.

110
 Chapter 8

HOW HERBS CAN HELP

Medicinal herbs have a time-tested track record for both

effectiveness and safety. Made from the leaves, stems, roots, bark,
buds and flowers of certain plants, many herbs can still be found in
their traditional form – often as teas. But, thanks to modern
processing, most herbs are now available as tablets, capsules, powders
and tinctures. For the most part, these convenient forms are just as
effective as traditional preparations.
Because these plant-based remedies
are powerful medicine, always tell your
doctor what herbs you are taking, How Much Should
especially if you are scheduled for I Take?
surgery. A few herbs, like garlic and Both the dried bark
ginkgo biloba, have been found to and arjuna supplements
interfere with anesthesia or increase the are available. However, if
risk of bleeding. you’re shopping for an
Arjuna: This traditional Ayurvedic arjuna supplement, look
herb is a powerful vasodilator that for a product that contains
significantly improves the signs and one percent arjunolic acid.
symptoms of cardiomyopathy and I’ve found that 500 mg.
angina, as well as heart function. three times a day is
In the last few years, research on sufficient to reduce
arjuna has exploded. In one study, 58 cholesterol levels.
men with stable angina received either
500 mg. of arjuna every eight hours, a vasodilating drug or a placebo
for one week each with a three day washout period in between the
treatments. During each treatment, the volunteers took part in
treadmill testing. When the researchers compared the data from the
three treatment periods, they found that arjuna was just as effective as
the drug at increasing exercise tolerance.
Arjuna is also a potent antioxidant and at least one study has
shown that it outperforms vitamin E in reducing cholesterol. After
dividing 105 patients into three groups, the researchers measured the
effects of arjuna, vitamin E or a placebo on cholesterol. No changes
were seen in the vitamin E and placebo groups. However, those

111
taking the arjuna had a 12.7 percent
decrease in total cholesterol and a 25.6 How Much Should
percent reduction in LDL. I Take?
Artichoke Leaf: Taken at high While all of the
levels, artichoke leaf has also been studies on artichoke leaf
shown to reduce cholesterol. In one have used fairly high
preliminary trial and one controlled doses of the extract, the
trial, use of a standardized artichoke typical recommendation is
extract was found to lower cholesterol 300 to 640 mg. three
and triglycerides significantly at doses times a day for at least six
ranging from 900 to 1,920 mg. a day. weeks. But if you are
allergic to artichokes or
While scientists don’t really know
have gallstones or other
how artichoke leaves lower cholesterol,
bile-duct obstructions, you
some researchers speculate that the
should avoid this herb.
herb helps the liver regulate how much
cholesterol it makes by boosting bile
output. The flavonoids in the plant also prevent LDL oxidation.
Bromelain: Bromelain is a natural blood thinner because it
prevents excessive blood platelet stickiness. This may explain the
positive reports that bromelain decreases the symptoms of angina. In
one preliminary study, 600 cancer patients were receiving 400 to
1,000 mg. of bromelain per day. Among the patients were 14 people
who also suffered from angina. In all 14 cases, the angina disappeared
within 90 days after starting bromelain.
This pineapple derivative also has an anti-clotting action that may
help prevent ischemic stroke and heart attack. Laboratory testing has
found that bromelain inhibits platelet-
activating factor (PAF), a chemical that
How Much Should signals blood platelets to form clots.
I Take? Inhibiting PAF short-circuits the entire
Although bromelain is clotting process and leads to lower
usually taken as a blood pressure and reductions in chest
digestive aid, if you have pain. Bromelain also breaks down
atherosclerosis, I advise arterial plaques once they have formed.
taking 1,500 to 3,000 mg. Bromelain is generally safe and free
a day. However, if you are of side effects when taken in moderate
allergic to pineapple, amounts. But one preliminary report
avoid bromelain indicates that bromelain may increase
supplements.

112
heart rate. And, because bromelain acts as a blood thinner, talk to
your doctor before combining the herb with aspirin or other blood-
thinning medications.
Cordyceps: This traditional Chinese
medicine (TCM) increases the heart’s
How Much Should
strength while slowing the heart rate. It I Take?
also normalizes cardiac arrhythmias. In The traditional dose is
one clinical trial, over 84 percent of 3,000 to 9,000 mg. taken
patients with cardiac arrhythmia twice a day in powdered
improved following treatment with or tincture form.
cordyceps. Although cordyceps
According to TCM practitioners, has a long history of use,
cordyceps also increases the blood people with hormone-
supply to the arteries and heart, and sensitive diseases like
lowers blood pressure. And breast or prostate cancer
researchers at Mukogawa Women’s should not use it. It should
University in Japan have found that also be avoided if you use
cordyceps contains potent antioxidant anticoagulant drugs,
properties that may fight free radical asthma inhalers or have an
oxidation. autoimmune disease.
A number of studies also show that
cordyceps lowers LDL while raising HDL. In addition, one of these
studies found that the fungus significantly lowers total cholesterol.
What’s even better, this time-honored medicine stops the formation of
cholesterol plaques by stimulating the activity of macrophages that
might otherwise lodge in the artery wall and become a platform for
the accumulation of cholesterol.
Fenugreek: The seeds of fenugreek comprise a potent bunch of
phytochemicals that may prove beneficial for those with high blood
lipids. The most important are compounds known as steroidal
saponins that inhibit both cholesterol absorption in the intestines and
cholesterol production by the liver. Multiple human trials have found
that fenugreek may help lower total cholesterol in people with
moderate atherosclerosis or those with diabetes.
In one of these trials, 20 adults with high cholesterol levels were
assigned to one of two groups. One group consumed 12,500 mg. of
fenugreek a day while the other took 18,000 mg. At the end of 30
days, both groups showed improvement. But the group taking the
higher dose had significantly lower LDL and total cholesterol levels.

113
 Double-blind trials
have also shown that How Much Should I Take?
fenugreek lowers I recommend taking 5,000 to
triglyceride levels in the 30,000 mg. of fenugreek with meals
blood. In one investigation, three times a day. Although fenugreek
diabetic patients took either is extremely safe, avoid taking more
a powdered fenugreek than 100,000 mg. daily since this can
supplement (50,000 mg.) cause intestinal upset and nausea.
or a placebo twice a day Talk to your doctor if you are
for 10 days. By the end of taking an anti-coagulant drug like
the study, all of the patients warfarin or ticlopidine since
in the fenugreek group saw fenugreek contains coumarin-like
a significant reduction in substances and the combination may
total cholesterol, LDL, cause bleeding. Some diabetes drugs,
lipoprotein(a) and especially glipizide, can also adversely
triglycerides. What’s more, interact with fenugreek. However, if
the fenugreek reduced you are on insulin, fenugreek may help
fasting blood sugar and your medication work more efficiently.
improved glucose
tolerance.
Garlic: Perhaps no other
How Much Should I Take?
herb has gotten as much press as
Since there is some evidence garlic. This pungent herb lowers
that fresh garlic is more potent blood pressure and improves the
than garlic supplements, I advise elasticity of blood vessel walls.
my patients to eat two cloves of Garlic also reduces cholesterol
garlic a day – something those and acts as a natural blood
who like garlic find easy to do. thinner. Preliminary animal
But if you don’t like eating garlic studies suggest that garlic may
or if it bothers your stomach, you help lower homocystine levels as
can still reap the benefits by well.
taking 2,400 to 7,200 mg. of an
In one double-blind cross-
aged garlic supplement.
over study of 41 moderately
It is important to carefully hypercholesterolemic men, half
read the label on all garlic took 7,200 mg. of aged garlic
products. Use standardized garlic every day. The other half were
supplements whenever possible given a placebo. After six
to ensure that you are getting a months, the groups switched to
specified concentration of allicin the other supplement for an
and other active substances. additional four months. By the

114
end of the study, the researchers found that the aged garlic
supplement reduced total cholesterol by seven percent and LDL
cholesterol by 4.6 percent. In addition, there was a 5.5 percent
decrease in systolic blood pressure and a modest reduction in
diastolic blood pressure. Their conclusion? Aged garlic supplements
can benefit people with both moderately high cholesterol and blood
pressure.
Garlic supplements have also been found to reduce the size of
plaque deposits by nearly 50 percent. In a four-year study of 152
cardiac patients, a daily dose of 900 mg. significantly slowed the
development of atherosclerosis. Another study, which measured the
flexibility of the aorta of 200 patients, reported that the subjects
taking garlic had more flexibility, indicating less atherosclerosis.
The heart-healthy benefits of garlic are due, in large part, to a
compound called allicin. This sulfur-rich substance is activated when
the clove is crushed and allowed to sit for about 10 minutes. Allicin is
then further broken down to a compound called ajoene, which may be
the substance that inhibits blockage in blood vessels from clots and
atherosclerosis.
Although garlic is generally recognized as safe, it can interact
with certain medications. Avoid taking this herb if you are on aspirin
therapy or other blood-thinners like warfarin. Garlic may also
exaggerate the activity of drugs that inhibit the action of platelets
such as indomethacin or dipyridamole. And if you are scheduled for
surgery, be sure to let your doctor know that you are taking
supplemental garlic. Too much garlic can increase your risk for
bleeding during or after surgical procedures.
Ginger: While you may
think that ginger belongs in your How Much Should I Take?
spice cabinet, this widely-used While most studies use
herb reduces cholesterol levels. extremely high doses of ginger, I
In clinical trials conducted in recommend taking 500 mg. of
India, 5,000 mg. of dried ginger supplemental ginger twice a day.
a day reversed increases in
You can also increase the
triglycerides and LDL levels,
amount you consume by adding
and made blood platelets less
freshly grated ginger to soups,
sticky and less likely to
vegetables and stir-fried dishes.
aggregate – all in as little as
seven days! Another study found

115
that this warming herb lowered total cholesterol and triglycerides by
up to 29 percent, lipoprotein(a) by up to 52 percent and LDL levels
by up to 58 percent. Impressive, to say the least.
Australian researchers have also discovered that ginger may be
more effective than aspirin for preventing blood clots. The researchers
looked at whether the chemicals in ginger could inhibit platelet
activation in human blood and found that gingerol compounds and
their derivatives are even more potent anti-platelet agents than the
over-the-counter drug.
Ginger is available in either tablet or capsule form, or as a tea.
Side effects are rare, but if taken in excessive doses the herb may
cause mild heartburn. Ginger can, however, increase the potency of
medications used to prevent blood clots (aspirin, Plavix or
Coumadin). If you are taking one of these blood-thinning drugs, you
should avoid taking supplemental ginger.
Ginkgo Biloba: Best known
as the memory herb, ginkgo How Much Should I Take?
biloba is also a powerful weapon I recommend taking 120 to
against vascular disease. Ginkgo 240 mg. a day. And it’s best to
flavone glycosides, which take a standardized extract to
typically make up approximately contain 24 percent ginkgo
24 percent of the extract, are flavone glycosides and six
primarily responsible for percent terpene lactones.
ginkgo’s antioxidant activity and But don’t expect immediate
its ability to inhibit platelet results. It can take six weeks or
aggregation. This ability, in turn, more for ginkgo’s benefits to
improves blood flow. appear. After six months,
A few years ago, the however, the results should be
University of Texas conducted a significant.
study on healthy volunteers and
patients who had been diagnosed
with Type 2 diabetes. By the end of the three month study, the Texas
team found that 120 mg. of ginkgo, administered daily, acted as an
effective blood thinner.
Ginkgo has also been used by French and German doctors to treat
intermittent claudication (leg pain caused by obstructed blood flow
related to atherosclerosis). In one 26-week trial, 111 patients with
peripheral arterial disease were divided into two groups. All of the
patients received a placebo for the first two weeks. Half were then

116
given a standardized ginkgo biloba supplement three times a day (120
mg. total) while the other half continued taking the placebo.
Researchers compared the distance the patients could walk
without experiencing pain at the beginning of the study and
periodically throughout the trial. After six months, those taking the
ginkgo could walk twice as far as those taking the placebo. Other
studies have found similar results with increases in pain-free walking
up to 500 feet.
Ginkgo is essentially devoid of any serious side effects, but some
people (less than one percent) may experience mild gastrointestinal
upset. Although no interactions with commonly prescribed drugs are
known, ginkgo shouldn’t be taken with other blood thinners, either
pharmaceutical or herbal.
Green Tea: Although black
How Much Should I Take? and oolong tea also confer health
I strongly recommend benefits, green tea has gained a
drinking four to eight cups of reputation as a cardiac superstar.
green tea a day. But if you’d Unlike other types of tea, green
rather not drink green tea on a tea is made from unfermented
regular basis, you can find it in leaves and contains the highest
supplement form. Some concentration of polyphenols,
supplements provide up to 97 leading some researchers to
percent polyphenol content, suggest that green tea may be an
which is the equivalent of even more potent antioxidant
drinking four cups of tea. than vitamin C. In fact, green tea
contains roughly 30 to 40
percent polyphenols compared
to black tea, which only contains three to 10 percent.
This tasty tea has been shown to mildly lower total cholesterol
levels and improve the cholesterol profile in several studies. In one
study, 1,371 Japanese men were surveyed on how much green tea
they drank per day. Those who drank upwards of ten cups a day had
low levels of total cholesterol, LDL and triglycerides, as well as
healthy HDL levels, regardless of other dietary considerations. Based
on several animal studies, these findings may be due to green tea’s
ability to block the intestinal absorption of cholesterol and promote
its excretion from the body.
The catechins in green tea may also help protect against heart
disease. To test the theory, Dutch researchers analyzed data from the

117
Zutphen Elderly Study, a prospective cohort study of over 800 men,
65-84 years old, beginning in 1985. Health, lifestyle and diet histories
were recorded and dietary intakes were analyzed for flavonoid
content, specifically for catechins. After 10 years of follow-up, the
researchers found that the participants who consumed the most
catechins had a 25 percent lower risk of developing atherosclerosis.
Scientists are also looking at green tea’s ability to prevent LDL
oxidation. And population-based studies indicate that the antioxidant
properties of green tea may help prevent atherosclerosis by making
platelets less sticky. While the evidence isn’t conclusive, it is
promising.
Guggul: A resin from the
How Much Should I Take?
mukul myrrh tree, guggul is a
staple in Ayurvedic medicine I advise taking 25 mg. of
because of its ability to lower guggul extract three times a day
cholesterol and treat for a total of 75 mg. daily.
atherosclerosis. One double- Dosage is based on the amount
blind trial studying the effects of guggulsterones (the
of guggul reported that serum cholesterol-lowering compound
cholesterol dropped by 17.5 in guggul) in the extract and
percent. In another double-blind most are standardized to contain
trial comparing guggul to the 5 to 10 percent of the compound.
drug clofibrate, the average fall Like ginkgo, guggul doesn’t
in serum cholesterol was slightly work quickly. Allow at least 12
greater in the guggul group; weeks before evaluating its
moreover, HDL cholesterol rose effect.
in 60 percent of people taking
guggul, while clofibrate did not elevate HDL at all.
But, doctors at the Medical Hospital and Research Centre in
Moradabad, India have found that for guggul to be truly effective, it
must be combined with a low-fat diet. In their study, 61 patients with
high cholesterol were given 50 mg. of guggulipid or a placebo twice a
day. At the same time, all of the subjects were required to eat a diet
centered around fruits and vegetables. After 24 weeks, the patients in
the guggul group had decreased their total cholesterol by 11.7 percent,
LDL by 12.5 percent and triglycerides by 12 percent. The researchers
also found that lipid peroxides, a marker of oxidative stress, also
declined by 33 percent. As for the subjects in the placebo group, no
change was noted in any of the areas measured. But the study didn’t

118
end there. After 36 weeks, the researchers found that the lipid-lowering
effect of the combination of diet and guggul was just as great as the
effect of modern cholesterol-lowering drugs.
The secret to guggul’s success are guggulsterones, substances also
known as extract isolates ketonic steroid compounds. Guggulsterones
not only prevent LDL oxidation, they also reduce the stickiness of
platelets. What’s more, scientists from the Southern California
University of Health Sciences reported on a clinical trial showing that
guggul also offers anti-inflammatory properties.
Hawthorn: If you could rely
How Much Should on just one herb for heart disease,
I Take? this would be it. Rich in
It’s best to take Hawthorn antioxidants, French researchers
as a liquid extract and I recently found that an extract
recommend taking one to three made from the tops and flowers of
teaspoons two to three times the herb could significantly
a day. reduce LDL oxidation.
Hawthorn is slow acting and Clinical trials have also
may take one to two months for confirmed that hawthorn leaf and
maximum effects to be seen. flower extracts are beneficial for
However, it appears to be safe people with early-stage congestive
and should be considered a heart failure. In one study,
long-term therapy. patients with congestive heart
failure taking 160–900 mg. of
hawthorn extract per day for eight
weeks showed improved quality of life, including greater ability to
exercise without shortness of breath and exhaustion.
But one of the most remarkable studies of hawthorn involved
3,600 patients. The subjects were treated three times a day with 300
mg. of hawthorn standardized to 2.2 percent flavonoids. Although it
was an observational study and not a placebo-controlled trial, the
eight-week results were impressive: Heart palpitations dropped from
an average of 40 percent to 18 percent, edema was reduced from 50
percent to 13 percent and the overall symptom score was lowered
from nine to three. The authors noted that hawthorn provided a
significant overall benefit for patients with the symptoms of
congestive heart failure.
Hawthorn contains large amounts of flavonoids that stabilize
capillaries and strengthen weak blood vessels. Hawthorn is also a

119
wonderful heart tonic since it helps treat elevated cholesterol levels
and slightly lowers blood pressure. And one study has found that
hawthorn leaf and flower extract may help those with stable angina. If
that weren’t enough, this herb acts as a natural calcium channel
blocker and an ACE (angiotensin converting enzyme) inhibitor.
Pycnogenol: Pycnogenol, a
How Much Should standardized extract of French
I Take? maritime pine bark, is one of the
Most recent studies have family of flavonoids known as
used doses that range from 150 oligomeric proanthocyanidins or
to 360 mg. But I’ve seen OPCs. And, until recently, its
evidence that doses as low as 50 biggest claim to fame was as an
to 100 mg. can offer heart- antioxidant. But researchers at the
healthy benefits. University of Arizona recently
found that Pycnogenol reduces
Although generally
platelet activity, lowers high blood
considered safe, Pycnogenol
pressure, relaxes artery
can upset the stomach, so make
constriction and improves
sure you take it with meals.
circulation. Other studies have
found that Pycnogenol dilates
small blood vessels in people with heart disease using doses as low as
100 mg. a day.
But Pycnogenol’s benefits don’t stop there. During a study
comparing Pycnogenol to horse chestnut seed extract’s ability to treat
chronic venous insufficiency, German researchers accidentally
discovered that Pycnogenol also reduces cholesterol. Of the 40 people
taking part in their study, those taking the OPC had a 13 percent drop
in LDL and total cholesterol was reduced by 19.7 percent. Other
studies suggest that Pycnogenol also raises HDL slightly.
Because of its high antioxidant content, Pycnogenol acts as a free
radical scavenger. It’s so effective that some scientists suggest it may
outpace vitamin E’s antioxidant capabilities.
Quercetin: Population studies have found that people with high
intakes of quercetin tend to have lower rates of heart disease. One
reason is that this antioxidant has the ability to dilate blood vessels
and reduce plaque formation.
When a blood vessel is injured (by disease or high blood
pressure), specialized clean-up cells called macrophages accumulate
at the site of the injury. Macrophages contain large amounts of

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cholesterol which can accumulate
and harden into plaques. How Much Should
Quercetin slows the series of I Take?
chemical reactions that cause Although I recommend that
large macrophages to cluster on my patients take 200 to 500 mg.
artery walls, reducing the risk of of quercetin two to three times
plaque formation. In one study, per day, talk to your doctor
quercetin reduced the size of before taking this supplement.
atherosclerotic lesions by 46 Women who are pregnant or
percent and LDL oxidation by 48 those taking estradiol should
percent. not use quercetin. Neither
This herb has a special should people taking the
relationship with vitamin C: immune suppressant drug
Quercetin regenerates oxidized cyclosporine or calcium channel
vitamin C and vitamin C can blockers.
bring quercetin back to life. As a
result, both supplements are often taken together.
Red Clover: While menopause increases a woman’s risk for
developing cardiovascular disease, the isoflavones in red clover have
been associated with a sizeable increase in HDL cholesterol, leading
some researchers to suggest that red clover may help protect pre- and
postmenopausal women against heart disease.
Interestingly, a recent study also found that menopausal women
who took 50 mg. of supplemental red clover a day experienced a
significant improvement in arterial compliance (a measure of the
strength and resilience of the arterial walls) and, as a result, lower
blood pressure. Arterial compliance diminishes during menopause and
may increase a woman’s risk for
How Much Should heart disease.
I Take? Although non-fermented red
The most recommended clover supplements are relatively
dose is 500 mg. two to six times safe, this herb can interact with
a day for menopausal certain medications used to
symptoms. But, since the control heart disease. Check with
research into red clover’s role in your doctor if you are taking an
reducing heart disease is still in anticoagulant like heparin,
the early stages, no amount has platelet-inhibiting drugs or blood
been established for the thinning medications like
treatment of heart disease. warfarin.

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 REMEMBER . . .

➤ Herbs, while generally safe, are potent medicines.

➤ Many herbal remedies are just as effective as pre-
scription drugs. For example, arjuna works as well as
vasodilating drugs for increasing exercise tolerance.
And guggul is just as effective as some cholesterol-
lowering medications.
➤ Along with their primary action, many of the herbs
taken for heart disease are potent antioxidants. As such,
they also fight free radical damage that contributes to
artery damage and LDL oxidation.
➤ Unlike prescription or over-the-counter drugs, herbs
often take weeks or months before their benefits can be
measured.
➤ Along with using supplements, some heart-healthy
herbs like garlic, ginger and green tea can also be
included in your diet.
➤ If you suffer from congestive heart failure or angina,
make sure to include hawthorn in your treatment plan.
➤ Whenever possible, choose a standardized herbal
preparation.
➤ Make sure to tell your doctor what herbs you are taking.
Some herbal remedies can interact with other
medications or can cause adverse reactions during
surgery.
➤ Be careful when combining herbal therapies that have
similar actions. Some can cause negative effects if taken
together.

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 Chapter 9

NATURAL ALTERNATIVES TO SURGERY

What if your heart disease has progressed to the point where diet,
exercise and supplements just aren’t enough? Some patients with
severe heart disease may suffer from unrelenting angina. Or perhaps
they can’t walk half a block without experiencing exhaustion and
breathlessness. These patients need immediate therapy. But is surgery
the only answer?
Fortunately, there are two very powerful alternatives. Unlike
bypass surgery or angioplasty, these therapies aren’t invasive and
involve no hospitalization, sedation or trauma to the body. And,
unlike drugs, they are safe and don’t carry the risk of side effects.
Best of all, they work.

EDTA Chelation Therapy

EDTA chelation is a therapy by which repeated administrations of
a weak synthetic amino acid (EDTA, ethylenediamine tetra-acetic
acid) gradually reduce atherosclerotic plaque and other mineral
deposits throughout the cardiovascular system by literally dissolving
them away. This alternative to angioplasty and bypass surgery has
frequently been compared to a natural “Roto-Rooter” because it
removes plaque and returns the arterial system to a smooth, healthy,
pre-atherosclerotic state.
When EDTA is slowly infused into the blood-stream, it binds with
minerals like calcium, iron or lead and carries them to the kidneys
where they are excreted. Although some minerals (like calcium) are
required for optimum health, when
they build up in the body, they can
Did you know?
speed up the oxidation process. By
EDTA chelation is so
removing excess minerals through
effective at removing
chelation, free radicals are kept
unwanted minerals and
under control and atherosclerosis is
metals from the blood, it has
slowed.
been the standard FDA-
EDTA chelation attacks
approved treatment for lead,
atherosclerosis in other ways too. It
mercury, aluminum and
dissolves excess calcium from the
cadmium poisoning for more
arterial walls, making them more
than 50 years.

123
responsive and better able to dilate.
This action alone can improve blood Safe, Effective and
flow and general circulation. It also Painless!
has blood-thinning effects and EDTA chelation is
discourages the formation of blood administered in a doctor’s
clots. And it’s a powerful antioxidant office, usually once or twice
that limits free radical damage. a week. You sit in a recliner
EDTA was synthesized in and an IV is inserted into a
Germany in 1935, and first used in vein in your arm (the only
industry as a chelating agent, as an part of the treatment that
anticoagulant for clinical laboratory may be uncomfortable).
use and as a treatment for lead Then you simply sit back
poisoning. But in 1955, Dr. Norman and relax while the EDTA
Clarke, then Director of Research of slowly circulates through
Providence Hospital in Detroit, the miles of blood vessels in
Michigan, reported on his use of your body.
intravenous EDTA to dissolve what Each treatment takes
he referred to as “metastatic calcium” about three hours, and a
(calcium deposits in the arteries, complete course is between
joints and kidneys) with generally 20 and 30 treatments.
favorable results. Patients with chronic heart
Among 283 patients treated by problems may, after the
Dr. Clarke and his colleagues from initial series of treatments,
1956 to 1960, 87 percent showed continue their therapy on a
improvement. Heart patients got once a month basis.
better and patients with blocked
arteries in their legs, particularly those with diabetes, avoided ampu-
tation. Since then, hundreds of papers have been published on the
effects of chelation therapy in a variety of chronic diseases, with the
vast majority reporting favorable results.
But in spite of its obvious benefit to heart patients, EDTA fell out
of favor in the mid-1960s for two reasons. First, profitable surgery for
heart and vessel disease was on the rise. Second, the patent on EDTA
(held by Abbott Laboratories) expired, so there was no financial
interest for drug companies to fund any research. Fortunately, a small
group of practicing physicians who used EDTA chelation founded an
organization in 1973 called the American College for the
Advancement of Medicine to educate both consumers and doctors
about the benefits of EDTA chelation therapy.

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 Proven Benefits
The first randomized, double-blind, controlled clinical trial of
EDTA chelation therapy for the treatment of atherosclerosis was
conducted by the University Hospital in Heidelberg, West Germany.
That study compared EDTA chelation therapy to the platelet inhibitor
bencyclan, a drug widely prescribed in Europe to treat
atherosclerosis.
A total of 48 patients were treated – 24 in the bencyclan group
and 24 in the EDTA group. Only patients with peripheral vascular
disease who could not walk 200 meters without the pain of
claudication (caused by impaired blood supply) were included in the
study. Pain-free walking distance was measured before, during and
after therapy on a treadmill. Those in the EDTA group were given
treatments five days a week for four weeks, for a total of 20
treatments while the rest of the subjects took only bencyclan. By the
end of the study, the EDTA group showed a 250 percent increase in
pain-free walking distance compared to only a 60 percent increase in
the bencyclan group.
It’s not unusual for physicians who regularly prescribe EDTA
chelation to encounter heart disease patients who have failed all the
standard treatments but who make remarkable - even unbelievable -
recoveries once EDTA has been given. In fact, many patients on
waiting lists for bypass surgery have found they didn’t need surgery
following a series of EDTA chelation treatments.
One particular study found that when 65 patients who had been
on the waiting list for bypass surgery for an average of 6 months were
treated with EDTA chelation therapy, the symptoms in 89 percent of
them improved so much that they canceled their surgery. In the same
study, 27 patients who had been recommended for limb amputation
due to poor peripheral circulation, underwent EDTA chelation
therapy, which saved 24 of the limbs.
Not all of the studies on EDTA have reached positive conclusions
however. Several studies have found no apparent benefit and two, in
particular, are often cited by critics. But a closer analysis of these
studies revealed problems with both the controls and the
interpretation of the data.
In the first study, Danish researchers gave 153 patients with
claudication either 20 intravenous EDTA treatments or 20 placebo
treatments. While all of the patients were measured for pain-free

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walking distance before and after treatment, the researchers only
selected 30 of the participants for additional testing, which included
an angiogram. Given the limited number of clinical tests and the
subjective nature of the study, it’s impossible to measure any
definitive improvement.
The second study, which came from New Zealand, also concluded
that EDTA offered no benefit to heart patients. But the raw data told a
different story. Upon closer inspection, it was found that 26 percent of
the EDTA-treated patients achieved an improvement of greater than
100 percent in walking distance compared with only 12 percent of the
“placebo” controls. Among nonsmokers or smokers who had quit, 66
percent of the EDTA-treated group increased their walking distance
an average of 86 percent compared with 45 percent of the controls,
who improved by just 56 percent. Reduced blood flow, as measured
by the ankle/brachial index, was found in six percent of the EDTA-

POTENTIAL BENEFITS OF EDTA CHELATION

Prevents cholesterol deposits Improves vision in diabetic
Reduces blood cholesterol levels retinopathy
Lowers high blood pressure Decreases macular degeneration
Avoids bypass surgery Dissolves small cataracts
Avoids angioplasty Eliminates heavy metal toxicity
Reserves digitalis toxicity Makes arterial walls more flexible
Removes calcium from Prevents osteoarthritis
atherosclerotic plaques Reduces rheumatoid arthritis
Dissolves intra-arterial blood clots symptoms
Normalizes cardiac arrhythmias Lowers diabetics’ insulin needs
Has an anti-aging effect Reduces Alzheimer-like symptoms
Reduces excessive heart Reverses senility
contractions Reduces stroke/heart attack after-
Increases intracellular potassium effects
Reduces heart irritability Prevents cancer
Improves heart function Improves memory
Removes mineral and deposits Reverses diabetic gangrene
Dissolves kidney stones Restores impaired vision
Reduces serum iron levels Detoxifies snake and spider venoms
Reduces heart valve calcification
Reduces varicose veins Adapted from Walker M., Gordon G.,
Heals calcified necrotic ulcers Douglass W.C. The Chelation Answer
Reduces intermittent claudication

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treated patients and 35 percent of the controls. Although the authors
of these studies reached negative conclusions, in fact, their data
actually supported the use of EDTA chelation!
Oral EDTA Chelation
Another option is oral EDTA, which has been used for at least as
long as its intravenous cousin. Clinical experience suggests that oral
chelation provides many, but not all, of the benefits of IV therapy.
Overall, the differences in benefits are more those of degree, speed,
convenience and cost per dose than of quality.
Intravenous EDTA chelation has a direct and powerful effect on
the body almost instantaneously. Not as convenient as swallowing a
few capsules of oral EDTA per day, an IV EDTA session usually lasts
several hours, during which about 1,500 to 3,000 mg. of EDTA (plus
vitamin C and other nutrients) are administered. Typical candidates
for IV chelation are people who have been diagnosed with serious
atherosclerosis, symptoms of vascular occlusion or significant
calcification of tissues. A series of needed sessions of IV EDTA will
cost about $2,000 to $4,000. But for patients with less severe forms
of heart disease, oral EDTA may be appropriate and is significantly
less costly – about $15 to $40 per month, depending on one’s intake.
About 15 percent of an oral dose of EDTA is absorbed into the
bloodstream, compared with 100 percent of an IV dose. Yet, due to
continuous daily intake, the amounts add up and can definitely
achieve similar benefits compared with IV chelation.
Oral EDTA is appropriate for people whose condition does not
demand prompt attention. It’s especially desirable for preventing or
delaying the onset of the many complications of atherosclerotic
plaque buildup, including heart disease, heart attack, stroke, high
blood pressure, peripheral vascular disease, mental decline and
impotence.
So why would anyone opt for an invasive procedure like
angioplasty or bypass when a safe and effective alternative exists for
restoring normal or near-normal arterial function? In my opinion,
EDTA should be the first line of treatment, with invasive surgical
procedures as the last-resort alternative, not the other way around.

Enhanced External Counterpulsation (EECP)

Enhanced external counterpulsation, or EECP for short, is an idea
that dates back to the 1950’s. Developed by a Harvard University

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researcher named Harry Soroff as a treatment for angina, EECP is a
mechanical system that actually squeezes the blood out of the lower
extremities and up toward the heart. The result is increased circulation
and reduced chest pain.
But, although Asian countries quickly embraced this new, non-
invasive technology, EECP didn’t get much attention in America until
recently – after dozens of studies supported its use. In fact, research
shows that 80 percent of patients experienced significant
improvement following EECP treatment, many experiencing a
complete end of symptoms.
In the largest such study to date,
EECP vs. Surgery
seven major research institutions
EECP has numerous (including Harvard, Yale and
advantages over traditional Columbia Universities) cooperated in
cardiac surgery: a groundbreaking clinical study that
• Non-invasive was later reported in the Journal of
• Outpatient the American College of Cardiology.
• Low risk Researchers found that patients used
less medication, had fewer angina
• No medication
attacks, and were able to exercise
• No recuperation longer without pain or fatigue after
time receiving EECP treatment. The study
• No side effects confirmed a number of previous
• Patients report studies that had found EECP to
increased objectively improve the coronary
energy after status of patients suffering from
treatment angina.
In an attempt to evaluate the
longer term benefits of the therapy, an investigation was conducted by
the University of Pittsburgh School of Public Health that looked at
EECP patients six months and one year following treatment.
Researchers found that patients not only maintained the gains they
made during treatment, but continued to improve after treatment
ended. In other words, patients continued to get better long after
treatment ended.
How does EECP compare to surgery? An important breakthrough
study by researchers at the State University of New York at Stony
Brook compared the long-term benefits of EECP to angioplasty and
bypass surgery. Researchers found that five-year outcomes for EECP

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patients were virtually the same
as for patients who had The Long-Lasting
angioplasty, bypass surgery, or Benefits
both. The study confirmed that
Several studies conducted at
EECP is an effective long-term
leading university medical
therapy for patients with coronary
centers have shown that patients
artery disease.
who undergo a course of EECP
In a recent issue of experience significant benefits:
Cardiology, investigators report
• They have fewer
that EECP works even better in
episodes of angina
patients who have not yet had
invasive treatment for angina. • The episodes of
Among patients participating in angina are less
the International EECP Patient intense
Registry who received EECP as • They need less anti-
first-line therapy (instead of angina medication
receiving it only after other • They can walk
treatments failed), 89 percent farther without
experienced an immediate experiencing angina
improvement in angina and 84
• They can resume
percent reported that the
work and enjoy
improvement lasted at least six
more social
months. This compares to a 79
activities
percent improvement rate with
EECP among patients who had
already received invasive treatments.

How It Works
While the exact mechanism of this therapy is the subject of much
speculation, EECP appears to have two potentially beneficial actions
on the heart. First, the milking action of the leg cuffs increases the
blood flow to the coronary arteries. (The coronary arteries, unlike
other arteries in the body, receive their blood flow after each heartbeat
instead of during each heartbeat. EECP, effectively, “pumps” blood
into the coronary arteries.) Second, by its deflating action just as the
heart begins to beat, EECP creates something like a sudden vacuum
in the arteries, which reduces the work of the heart muscle in
pumping blood into the arteries. Both of these actions have long been
known to reduce cardiac ischemia (the lack of oxygen to the heart
muscle) in patients with coronary artery disease.

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 Put The Squeeze On Heart Disease
EECP is a painless, non-invasive treatment that uses a series of
inflatable cuffs – much like blood pressure cuffs. These cuffs inflate
and deflate in time with your heartbeat, stimulating increased
circulation back to your heart. This enhanced circulatory flow helps
to develop a network of new vessels that detour around blocked or
narrowed arteries, and deliver more oxygen-rich blood to the heart.
It’s an appropriate alternative to angioplasty, bypass or grafting
and laser revascularization for patients with angina. In fact, some
doctors consider EECP “nature’s bypass.” And, this therapy is safe for
people with pacemakers, diabetes, kidney or lung disease, or other
conditions that may increase the risk of invasive procedures. In fact,
EECP is considered so safe that it’s the only non-pharmacologic, non-
invasive treatment approved by the FDA for angina and congestive
heart failure.
The treatment consists of 35 one-hour treatments over the course
of seven weeks with the patient on a Monday through Friday regimen.
During EECP therapy, the patient lies on a bed and pressure cuffs are
attached to the calves, lower thighs and upper thighs. The cuffs inflate
and deflate, gradually building to full pressure while the machine
works with the heart’s rhythms. The patient’s heart rate and rhythm
are constantly measured during the process.
Most patients tolerate the therapy with little discomfort. The
common complaints include mild headache, mild dizziness, fatigue or
muscle aches, but these effects are temporary and the vast majority of
patients never experience any ill effects. Better yet, unlike surgery or
other medical procedures, patients undergoing EECP therapy don’t
experience any long-term side effects.

Why Your Doctor May Not Tell You About EECP

Despite that fact that EECP therapy is FDA-approved, you
probably won’t hear much about it from your cardiologist. Why? First
of all, EECP doesn’t pay well. A series of 35 treatments costs $5,000
to $6,000 dollars. That’s not chicken feed, but keep in mind that we’re
talking about 35 hours of therapy over 7 weeks, which involves not
only the doctor’s time but also the time of office staff and nursing
personnel. Compared to an invasive procedure like angioplasty, it
simply isn’t profitable.
Then there’s the fact that, to accommodate patients for EECP,

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cardiologists would not only have to purchase expensive equipment,
but would have to radically change the organization of their offices,
their office staff and their space.
Finally, and most importantly, EECP has nothing in common with
what cardiologists do. Cardiologists study and treat the heart – they
stress it, image it, measure it, pace it, shock it, stent it, ablate it,
revascularize it and bathe it in drugs. What they do takes years of
specialized training and expertise, millions of dollars of high-tech
equipment, and tremendous manual dexterity – and it brings them
significant prestige, even within the medical community. Now
they’re supposed to drop all that? Hardly. So it will likely be up to
you to broach the subject.
If your doctor discourages you from pursuing EECP, make sure he
or she gives you a good reason (you don’t have the sort of angina
that would benefit from EECP or your coronary artery disease is of
the type that requires revascularization). Good reasons would not
include: it’s unproven, it doesn’t work, its voodoo or “I’ve never
heard of it.”

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 REMEMBER . . .

➤ There are safe, natural, non-invasive alternatives to

surgery.
➤ EDTA chelation therapy can reduce atherosclerotic
plaque, making it an effectivce alternative to angioplasty
and bypass surgery.
➤ EDTA also dissolves excess calcium and has blood
thinning effects.
➤ Intravenous EDTA is a painless treatment conducted in
the doctor’s office.
➤ Oral EDTA is another option. Although this form of
therapy doesn’t work as quickly as intravenous EDTA,
it offers many of the same benefits and is much less
costly. It is especially useful for less serious forms of
heart disease.
➤ EECP is an excellent alternative to bypass surgery for
treating angina. It also boosts circulation and exercise
capacity.
➤ EECP works by increasing blood flow to the heart and
acts like a vacuum in the arteries to reduce the heart’s
workload.
➤ Many doctors either aren’t familiar with these
alternatives or discount them. Unless your doctor can
give you a solid medical reason why you aren’t a good
candidate for either EDTA chelation or EECP, seek a
second opinion from an integrative physician.

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 Chapter 10

HOW COMPLIMENTARY MEDICINE KEEPS

YOU YOUNG AT HEART

There are many treatments used to treat cardiovascular disease

that fall outside the realm of conventional medicine – many of which
we’ve already discussed. But there’s one more class of treatments that
can support a healthy diet, exercise and heart-healthy supplements.
They can also augment conventional treatment, if that’s the path you
decide to take.
Complementary and alternative medicine, also known as CAM,
has gained enormous popularity and acceptance among patients over
the last fifteen years.
Finding a CAM Practitioner In 1990, Americans
made an estimated
• Many states have regulatory agencies
or licensing boards for certain types of 425 million visits to
practitioners. They may be able to an alternative health
provide you with information practitioner – more
regarding practitioners in your area. than they made to
• Contact a professional organization for primary care
the type of practitioner you are physicians. Today,
seeking. Often, professional one in three people
organizations have standards of
have used a CAM
practice and may provide referrals.
therapy.
• Ask if it is possible to have a brief
consultation in person or by phone In a world of five
with the practitioner. This will give minute doctor visits,
you a chance to speak with the insurance-dictated
practitioner directly. The consultation treatment plans,
may or may not involve a charge. HMOs and spiraling
• After you select a practitioner, make a health costs, a
list of questions to ask at your first growing number of
visit. What benefits can you expect?
informed healthcare
Are there any risks? How long will I
need to undergo therapy?
consumers are open
to trying alternative
• Come to the first visit prepared to
answer questions about your health medical treatments.
history, as well as prescription More importantly,
medicines,vitamins and other they are demanding
supplements you may take. to be treated as a

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person – not simply as a diagnosis – by their health care practitioners.
Mainstream medicine is finally beginning to catch on to the fact
that CAM is good medicine. The realization that conventional
medicine (antibiotics, prescription drugs and invasive surgery) can’t
solve all of America’s health problems has led nearly one-third of
American medical schools – among them Harvard, Yale, John’s
Hopkins and Georgetown Universities – to adopt courses in
alternative medicine. In fact, CAM has become so well accepted that
18 percent of Fortune 500 companies offer alternative medicine as
part of their healthcare compensation packages.
One reason CAM therapies are becoming more popular is the fact
that they treat the whole person – mind, body and spirit – and not just
the physical ailment. This approach is often referred to as “holistic.”
In other words, these therapies look at illness and its prevention and
treatment, in terms of the unique individual rather than just a
collection of symptoms. CAM therapies also acknowledge the body’s
ability to heal itself. The treatments themselves may not “cure” your
disease – but they will help restore the body’s own self-healing
ability. As Voltaire said, “The art of medicine consists of amusing the
patient while Nature cures the disease.”
CAM therapies include not only the remedies I’ve already covered
in this book, they also encompass more “exotic” treatments, including
acupuncture, acupressure, aromatherapeutic massage, osteopathy and
reflexology. While these therapies can have a positive impact on
many aspects of heart disease, one of the greatest benefits you’ll
experience is the power to take charge of your own health.

Acupuncture
Just about everyone has
HEART SMART TIP
heard of acupuncture these Cardiovascular disorders that
days, but few know how this respond well to acupuncture include:
ancient medical therapy • Angina
really works. Or that it can • Cardiac ischemia
be an effective treatment for
• Heart rate variability
angina and high blood
pressure. • High blood pressure

The traditional form of

acupuncture is part of the wider system of Traditional Chinese
Medicine (TCM) and has been practiced in China for thousands of

134
years. The fundamental principal of acupuncture is that there are two
interactive qualities in nature called “yin” and “yang,” which
interweave with each other both in the universe and within each
person. Good health depends on maintaining the balance between the
two. If the balance is disturbed, the result is disease.
Practitioners believe that by influencing “chi,” the life force or
energy that flows through the body in the blood vessels and in a set of
energetic pathways known as meridians which are linked to various
organs, they can balance yin and yang. The result is health.
Situated along these meridians are 500 recognized acupuncture
points, of which about 100 are commonly used. Generally, these are
sites where the meridian runs close to the surface of the body. Hair-
thin acupuncture needles can be inserted into these points to
rebalance the flow of chi when it is disturbed. Once the needles are in
place, they can be stimulated either by hand or electrically to
maximize the effect.
Not surprisingly, most Western doctors have trouble with the
concept of manipulating chi. But they can’t ignore acupuncture’s
heart healthy benefits. Acupuncture treatments have reduced angina
and lowered blood pressure in some patients and, in certain instances,
have effectively treated cardiac ischemia which is caused by an
inadequate supply of blood to
Safety Alert! the heart muscle cells. Other
The risks of acupuncture are research has found that
small when treatment is conducted acupuncture can regulate heart
by a qualified practitioner – much rate.
lower than those of prescription One animal experiment,
drugs. conducted at China’s Norman
Always choose a qualified Bethune University of Medical
acupuncturist. Some states, such as Sciences, found that
California, New York and Florida, manipulating certain
require that acupuncturists become acupuncture points not only
licensed. However, if you don’t live lowered blood pressure in
in a state that requires licensing, mice, it also had a positive
check with either the American impact on the levels of five
Academy of Medical Acupuncture trace elements, including two
or the National Commission for the which are critical for heart
Certification of Acupuncturists for health – calcium and
a list of certified practitioners. magnesium. Several other

135
studies have found that, in addition to lowering blood pressure,
acupuncture also has a blood-thinning effect.
Human studies show a similar effect. In one recent clinical trial,
87 hypertensive patients experienced a significant decrease in their
systolic blood pressure after being treated with acupuncture. A
smaller study found that acupuncture can also reduce diastolic
pressure in patients with high blood pressure.
Modern doctors have speculated that acupuncture’s heart healthy
effects probably come via the endocrine system, since this system not
only releases endorphins (the body’s natural painkillers), but is
responsible for regulating blood pressure, heart rate and
inflammation. To test this theory, a team of researchers at the
University of California-Irvine and Shanghai Medical University in
China increased the levels of a chemical called bradykinin in a group
of cats. Bradykinin is produced when the body reacts to infections
and, in general, works against the relaxing effects of the endorphin
system. The chemical triggers inflammation, raises blood pressure,
and makes the heart pump harder and faster.
Tiny electric probes that simulate acupuncture needles in the lab
reduced bradykinin levels when the researchers applied the probes to
the nerve endings (determined by Chinese acupuncture maps) related
to heart disease. The reduced bradykinin levels quickly resulted in
lower blood pressure and allowed the heart to pump less strenuously.
But these effects disappeared when the researchers injected
naloxone (which inhibits the brain’s endorphin system) into the
bloodstream. Since naloxone blocks nerve cells in the endorphin
system, the scientists concluded that acupuncture was doing its work
by stimulating the body’s natural endorphins.

What To Expect
Acupuncture therapy usually involves a series of weekly or
biweekly treatments in an outpatient setting. A series of treatments
(up to 20) is fairly common.
Acupuncture practitioners, like medical doctors, each have their
own individual style and way of structuring an office visit. But, in
general, an acupuncture visit lasts about an hour. Like a visit to your
doctor, an acupuncture visit includes an exam and an assessment of
your current condition, the treatment itself and a discussion afterward
to suggest self-care tips. During the acupuncture treatment, the

136
practitioner uses disposable sterilized, individually wrapped stainless
steel needles. The amount of pain felt when the needles are inserted
varies from person to person, but most people only experience mild
discomfort.
Before you embark on a course of therapy, however, ask how
many treatments will be required. It may not be possible for the
acupuncturist to give you a precise number, but he or she should be
able to give you a rough estimate. In general, while you may see
some improvement after about five visits, it can often take ten or
more sessions before you notice a difference. If there hasn’t been any
effect after a dozen visits, you may be one of the very few people for
whom acupuncture isn’t an effective treatment.

Acupressure
Although not as well-known as acupuncture, acupressure is
rapidly gaining acceptance as a safe, non-invasive form of care.
Sometimes referred to as shiatsu massage, acupressure very similar to
acupuncture. But instead of inserting needles, acupressure involves
using the fingers, thumbs, palms and heels of the hand to apply
pressure and stimulate specific points along the meridians of the
body.
To see what effect acupressure may have on the cardiovascular
system, a pair of researchers from the Faculty of Health Sciences in
Linkoping, Sweden conducted a study of 24 healthy male volunteers
between the ages of 20 and 36. Their results, which appeared in a
recent issue of Complementary Therapies in Medicine, showed
marked changes in arterial pressure, heart rate and the amount of
blood flow to the skin in those receiving acupressure, leading the
researchers to conclude that these non-invasive stimulation techniques
may be a “low-risk and cost-effective” form of care.
During their study, the subjects were divided into three groups of
eight. One group received active stimulation consisting of pressure on
acupoints; the second received active stimulation via stroking along
the meridians; and the third received controlled stimulation.
Stimulation was performed by way of a 15-centimeter long dental
instrument with a two-millimeter ball-point at each end.
In the pressure group, 24 classical acupoints were stimulated in
order using firm pressure and a gliding movement across the
acupoints. In the stroking group, the acupoints of 13 meridians were

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stimulated by stroking with the tool along the meridians in the
direction of the flow (according to traditional Chinese medicine). The
stimulation in the control group was achieved with very light pressure
along 24 non-acupoints within an inch of the acupoints in the
pressure group.
A variety of measurements were taken while the subjects were
stimulated, including heart rate, systolic arterial pressure, diastolic
arterial pressure, mean arterial pressure and skin blood flow. Data on
skin blood flow, arterial pressure and heart rate were recorded once
every minute, from 20 minutes before stimulation to 30 minutes after.
All measurements were taken by a researcher who was blinded to the
type of treatment the subjects received.
Results of the treatment showed dramatic cardiovascular changes
in the acupressure group. Heart rate, for instance, decreased an
average of seven beats per minute in the group receiving acupressure,
compared to five beats for the stroking group and just one beat per
minute in the control group. Similar changes in arterial pressure and
skin blood flow were seen in the pressure group, but not in the
stroking or control groups.
Based on their observations, the researchers concluded that
applying pressure to acupoints “can significantly influence the
cardiovascular system.” Non-invasive stimulation techniques like
acupressure, they believe, “could be a low-risk and cost-effective
treatment,” particularly in areas where acupuncture needles are
difficult to obtain.

Aromatherapeutic Massage
Aromatherapeutic massage can be defined as the art and science
of combining therapeutic touch with naturally extracted aromatic
essences from plants to balance, harmonize and promote the health of
body, mind and spirit. As a holistic medicine, aromatherapeutic
massage is both a preventative approach as well as an active treatment
during acute and chronic stages of disease. It’s a natural, non-invasive
treatment system designed to affect the whole person – not just the
symptom or disease – and to assist the body’s natural ability to
balance, regulate, heal and maintain itself by the correct use of
essential oils.
Essential oils that are inhaled into the lungs are believed to offer
both psychological and physical benefits; not only does the aroma of

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the natural essential oil
stimulate the brain to trigger a
Safety Alert!
reaction, but the natural
constituents (naturally Aromatherapy, by itself, can be
self-administered. But essential oils
occurring chemicals) of the
are highly concentrated and can be
essential oil are drawn into the
harmful if not used carefully. By
lungs and can also supply
treating essential oils as medicines,
physical benefit. Oils that are you will be well on your way to
applied to the skin are believed safely enjoying the many benefits
to be absorbed into the that aromatherapy can offer.
bloodstream. The components
• Essential oils should never be
of the various oils are believed
used undiluted on the skin.
to aid in a variety of health
Always dilute them in a
conditions, including cardio-
carrier oil like almond or
vascular health.
grapeseed oil.
While a plain massage can
• Some oils can cause
reduce stress that can contribute
sensitization or allergic
to heart disease, an
reactions in some individuals.
aromatherapeutic massage can
When using a new oil for the
lower blood pressure and
first time, place a small
improve blood circulation
amount of the diluted
without putting additional strain
essential oil on the inside of
on the heart. It helps the flow of
your forearm and apply a
blood through the veins and
bandage.Wait 24 hours to see
also stimulates the nerves
if there is any reaction.
which control the blood vessels.
Aromatherapeutic massage has • Not all essential oils are
the added benefit of relaxing suitable for use in
tense muscles and tight aromatherapy. Wormwood,
connective tissues which may pennyroyal, onion, camphor,
have been constricting blood horseradish, wintergreen, rue,
vessels, thus enabling blood to bitter almond and sassafras
flow more freely. are some of the essential oils
that should only be used by a
In one small pilot study
qualified aromatherapy
conducted by the Natural
practitioner, if ever.
Health Centre in Lancashire,
UK, 20 patients were divided • Essential oils should not be
into two groups. The first group taken internally.
received five 45 minute
aromatherapy treatments using

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 grapeseed carrier oil
HEART SMART TIP containing one drop of each
Turn Your Nose Up To of ylang-ylang, clary sage
Hypertension and marjoram essential oil
over a six week period. The
Work carried out by Dr. Gary
second group received the
Schwartz, Professor of Psychology
same massage but without
and Psychiatry at Yale University,
the essential oils. At the end
also found that the aromas of some
of the treatment period, the
essential oils by themselves reduced
results revealed that seven
blood pressure. The scent of spiced
people in the treatment
apple, for example, was found to
group and six in the control
reduce blood pressure by an average
group experienced a
of three to five points in healthy
reduction in their blood
volunteers.
pressure. But those in the
Other essential oils that may help aromatherapy group also saw
lower blood pressure include: an improvement in their
• Chamomile • Cypress pulse rate – an effect that
• Marjoram • Rosewood wasn’t experienced by the
• Clary Sage • Lavender patients in the control group.
The study’s authors
• Rose • Ylang-Ylang
concluded that overall blood
pressure readings in both
groups improved significantly, indicating that this type of tactile
treatment can have a beneficial effect on the raised arterial blood
pressure.

What To Expect HEART

The first appointment generally begins
SMART TIP
with the massage therapist asking what Massage Away
prompted you to get a massage, your Atherosclerosis
current physical condition, medical
A regular massage
history, lifestyle and stress level. The
with juniper and lemon
massage therapist may ask you about your
may help to break down
health goals and what you hope the
fatty deposits. Massage
massage will do to help you achieve those
with the essential oils of
goals.
peppermint, lavender,
For a full-body massage, you will be rose and marjoram may
asked to remove clothing to your level of help strengthen the
comfort. Undressing takes place in private, heart.

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and a sheet, towel or gown is provided for draping. The therapist will
undrape only the part of your body being massaged, ensuring that
your modesty is respected at all times. Your massage, which can last
from 30 to 90 minutes, will take place in a comfortable atmosphere
and on a cushioned table. You should expect a peaceful, relaxing
experience.
Although aromatherapy is an unregulated practice in the U.S.,
massage therapy (including aromatherapeutic massage) is currently
regulated in 30 states and the District of Columbia. The remaining
states leave any regulation of massage therapy to local municipalities.
Statewide regulation of massage therapists may determine if your
insurance directly covers massage by a massage therapist.

Osteopathy
Doctors of osteopathy (D.O.s) truly practice integrative medicine
by combining conventional medical practices with osteopathic
manipulation, physical therapy and education about healthful posture
and body positioning. But the real difference between an M.D and a
D.O. is that osteopaths hold to the common sense principle that a
patient’s history of illnesses and physical traumas are written into the
body’s structure. It is the osteopath’s highly developed sense of touch
that allows the physician to feel the patient’s “living anatomy” (i.e.
flow of fluids, motion of tissues and structural make-up). In fact, a
D.O. can even detect physical problems that fail to appear on an X-
ray.
Unlike a conventional doctor, the osteopath’s job is to “set” the
body up to heal itself. To restore this normal function, the osteopath
gently applies a precise amount of force to promote movement of the
bodily fluids, eliminate dysfunction in the motion of the tissues, and
release compressed bones and joints. In addition, the areas being
treated require proper positioning to assist
the body’s ability to regain normal tissue HEART
function. SMART TIP
Osteopathic physicians not only Osteopathy may
understand that all the body’s systems are relieve angina since
interconnected, but how each one affects tensions in the neck,
the others. They focus special attention on shoulders and back can
the musculoskeletal system, which reflects serve to aggravate chest
and influences the condition of all other pain.
body systems. This system of bones and
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muscles makes up about two-thirds of the body’s mass, and a routine
part of the osteopathic patient examination is a careful evaluation of
these important structures.
Bringing the body into a state of homeostasis (the process of
continual adjustments the body makes to keep itself in a stable
condition and function to the best of its ability), an osteopath can also
improve the way the heart functions. For example, in the blood there
must be a precise quantity of dissolved oxygen within maximum and
minimum levels in order for all the body tissues to work. The body is
constantly readjusting to maintain this balance.

What To Expect
You may be surprised to find that going to see an osteopath is
similar to a conventional doctor visit. Along with a complete physical
examination, you may also undergo diagnostic tests, including blood
and urine tests and X-rays. But, unlike an allopathic physician, a D.O.
will also look at your body structure to assess posture, spine, balance,
tendons and ligaments.
An osteopath undergoes as much training as an M.D. (except
osteopathy emphasizes preventive medicine and training in
musculoskeletal manipulation and hands-on assessment techniques).
Because of this, they are licensed in all states as full physicians and
can prescribe drugs and perform surgery.

Reflexology
Reflexology is a natural healing art based on the principle that
there are reflexes in the hands and feet that correspond to every part
of the body. Through application of pressure on these reflexes,
reflexology relieves tension, improves circulation and promotes the
natural function of the related
areas of the body.
Although reflexology does not
diagnose or treat specific ailments
by definition, it has proven highly
successful over time to relieve
symptoms or ease pain or
discomfort that have manifested
themselves physically in the body
- either as a result of stress,
trauma or disease.

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 Studies have shown that reflexology can reduce stress and its
related problems – an important benefit if you suffer from heart
disease – by positively affecting the central nervous system. For
example, massaging the appropriate areas in the feet is thought to
help reduce raised blood pressure and relieve angina. It also increases
circulation.

What To Expect
You will lie on your back on a massage table, face up, with your
shoes and socks removed. To make your feet and ankles more
accessible to the reflexologist, it’s a good idea to wear shorts or sweat
pants. You will be made comfortable with a blanket and soft music.
Healing oils may be applied before or after session.
Aromatherapy may be diffused in the room to aid relaxation and
increase your senses. Although most of the treatment is focused on
the feet, the last ten minutes is concentrated on the hands. While pain
isn’t something normally experienced,
tender spots will indicate areas that need Safety Alert!
extra attention. Pressure, as in regular Ensure that you go to a
massage, should be “strong but not qualified practitioner and make
uncomfortable.” sure you tell your reflexologist
When you are through you should about any drugs you are taking.
feel relaxed and invigorated. You are then Most practitioners believe that
sent on your way with the expectation reflexology can interfere with
that you will have some internal the effects of some medications.
cleansing take place. It is recommended Reflexology should be used
that you drink plenty of water for the rest only as an adjunct to medical
of the day to facilitate this cleansing treatment and not as a
process. replacement for it.
Regular treatments last approximately
one hour. For preventative maintenance, treatments are recommended
once or twice per month (more if desired). For more serious health
problems, treatments can be done much more frequently.

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 REMEMBER . . .

➤ Complimentary and alternative medicine (CAM)

offers a variety of therapies that help prevent and treat
heart disease. Along with their beneficial effects on
the heart, many of these therapies also reduce stress.
➤ Acupuncture, which uses specialized needles to
stimulate “chi,” is effective for reducing chest pain and
high blood pressure. It may also help treat ischemia
and regulate the heart rate.
➤ Like acupuncture, acupressure is a safe and effective
way to lower blood pressure and heart rate.
➤• Aromatherapeutic massage combines the medicinal
properties of essential oils with healing touch.
➤ Studies show that aromatherapeutic massage can lower
blood pressure and increase circulation. It may also
benefit people with atherosclerosis.
➤ Never use undiluted oils and do a patch test when
using new oils.
➤ Osteopathic physicians combine conventional
medicine with physical manipulation to treat the
whole person and help the body heal itself.
➤ Reflexology is based on the principal that reflex points
on the feet and hands correspond to every part of the
body. By manipulating the proper points, a
reflexologist can increase circulation and lower stress.
It may also reduce blood pressure and chest pain.

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 About the Author

A practicing physician since 1969, Dr. Robert D. Willix, Jr.’s

pioneering work in preventative and integrative health care has earned
him national recognition as a healer, teacher, speaker and author.
Dr. Willix graduated Alpha Omega Alpha from the University of
Missouri Medical School, and did his Internship and Residency in
cardiac surgery at the University of Michigan in Ann Arbor,
Michigan. As the first board-certified cardiac surgeon in South
Dakota, Dr. Willix started the state’s first open-heart surgery program,
performed thousands of coronary bypass operations and taught at the
University of South Dakota Medical School. In 1981, he was
recruited to South Florida as Medical Director for Cardiac
Rehabilitation and Human Performance for a major hospital district.
Yet his study of the mind-body connection and the body’s innate
ability to heal itself inspired him to look at his career in an entirely
new way. Seeing the potential of wellness-oriented, non-surgical
integrative medicine, he left the surgical suite forever and devoted his
practice to making - and keeping - his patients healthy. Convinced
that bypass surgery was a “waste of time” if it wasn’t accompanied
by lifestyle changes, Dr. Willix began a cardiac rehabilitation program
based on nutrition, exercise and natural healing traditions. In 1993, he
expanded his practice to include Ayurvedic medicine, an ancient form
of natural medicine presently being studied by the National Institute
of Health’s division of Alternative Medicine.
In the 80’s, Dr. Willix developed and studied preventive medicine
programs, in the 90’s, Alternative Medicine approaches of Ayurveda,
homeopathy, acupuncture, and other forms of mind-body and herbal
systems of healing. At the turn of the Century 2000, Dr. Willix
expanded his studies to include the ancient energetic healing
technique of the Andean Shaman (the Inka).
Dr. Willix now includes Preventive Medicine, Integrative
Medicine, and Shamanic Medicine into his medical repertoire. He
believes healing and health require “balance of the body, mind, and
spirit.”
In addition to his private practice in Boca Raton, Florida, Dr.
Willix is the author of Age PROOFING - 7 Simple Steps to Super
Vitality at Any Age, Keep Your Miles High and Your Calories Low,
and Healthy at 100. A dedicated amateur athlete, he has competed in

145
14 marathons and 100 triathlons, including the world championship
of triathlons: The IRONMAN in Kona, Hawaii in 1984. Most
recently, he has begun to pursue competition in competitive bicycle
races-The Criterium Series of United States Cycling Federation.

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 Appendix I

RESOURCES

Acupressure Institute
1533 Shattuck Avenue
Berkeley, CA 94709
Phone: (510) 845-1059
Website: www.acupressure.com
The Acupressure Institute offers career training, educational material
and referrals to certified acupressurists around the country.

American Academy of Medical Acupuncture

4929 Wilshire Blvd., Ste. 428
Los Angeles, CA 90010
Office: (323)937-5514
Fax: (323)937-0959
Website: www.medicalacupuncture.org
This professional organization offers a wealth of information on
acupuncture, including research, articles and an online journal.
Consumers can also get referrals to licensed acupuncturists in their
area.

American Association of Naturopathic Physicians

3201 New Mexico Avenue, NW Suite 350
Washington, DC 20016
Toll free: 1 (866) 538-2267
Local: (202) 895-1392
Fax: (202) 274-1992
Website: www.naturopathic.org
Naturopathic medicine includes therapeutic nutrition, botanical
medicine, homeopathy, natural childbirth, classical Chinese medicine,
hydrotherapy, naturopathic manipulative therapy, pharmacology and
minor surgery. This professional organization publishes a listing of
naturopathic physicians on its website.

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American Botanical Council
P.O. Box 144345
Austin, TX 78714
Phone: (512) 926-4900
Fax: (512) 926-2345
Website: www.herbalgram.org
This non-profit educational organization disseminates science-based
information on herbal medicine. Its website offers a wide array of
books, herb monographs, special reports and computer software.

American College for Advancement in Medicine

23121 Verdugo Drive, Suite 204
Laguna Hills, CA 92653
Phone: (800) 532-3688
Fax: (949) 455-9679
Website: www.acam.org
The American College for Advancement in Medicine is a not-for-profit
medical society dedicated to educating physicians and other health care
professionals on the latest findings and emerging procedures in
preventive/nutritional medicine. Most of its members practice chelation
therapy. You can find a practitioner in your area on their website.

American Heart Association

7272 Greenville Ave.
Dallas, TX 75231
(800) 242-8721
Website: www.americanheart.org
The American Heart Association is one of the leading authorities on
heart disease and stroke. While the organization primarily focuses on
conventional solutions, its website is a good source of information on
heart disease. Their website also offers a number of publications and a
heart and stroke encyclopedia.

American Osteopathic Association

142 East Ontario St.
Chicago, IL 60611
Phone: (800) 621-1773
Website: www.osteopathic.org
Osteopathic medicine treats the whole person, not simply the
symptoms of disease. Practitioners undergo as much training as an

148
M.D. and are required to pass state licensing. However, a doctor of
osteopathy (D.O.) receives extra training in the musculoskeletal
system. This training provides osteopathic physicians with a better
understanding of the ways that an injury or illness in one part of your
body can affect another. Along with referrals, this professional group
provides an amazing amount of information to consumers.

The Association for Applied Psychophysiology and Biofeedback

10200 W. 44th Avenue, Suite 304
Wheat Ridge, CO 80033-2840
Phone: 1 (800) 477-8892 / (303) 422-8436
Fax: (303) 422-8894
Website: www.aapb.org
E-mail: [email protected]
This non-profit organization provides a comprehensive explanation of
biofeedback through its website and various publications. It also
sponsors research and offers referrals to qualified practitioners.

EECP.com
180 Linden Avenue
Westbury, NY 11590
Phone: (800) 455-3327 or (516) 997-4600
Fax: (516) 997-2299
Website: www.eecp.com
This is a website run by Vasomedical, Inc., the company that makes
the equipment for EECP, so it is not unbiased. But it does offer an
excellent means of finding a center where you can get EECP in your
area. Unfortunately, there are fewer than 200 centers which offer
EECP, though the number is growing rapidly.

HeartCenterOnline
One South Ocean Boulevard, Suite 201
Boca Raton, FL 33432
FAX: (561) 620-9799
Website: www.heartcenteronline.com
This website is a treasure trove of information on the various aspects of
heart disease. It also offers a personalized health tracker.

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International Institute of Reflexology
5650 First Ave. North
P.O. Box 12642
St. Petersburg, FL 33733-2642
Phone: (727) 343-4811
Website: www.reflexology-usa.net
Along with referrals, this group provides consumer information and
educational workshops, books, charts and videos for practitioners.

The National Association for Holistic Aromatherapy

4509 Interlake Ave N., #233
Seattle, WA 98103-6773
Phone: (888) ASK-NAHA or (206) 547-2164
Fax: (206) 547-2680
Website: www.naha.org
The National Association for Holistic Aromatherapy is an
educational, nonprofit organization dedicated to enhancing public
awareness of the benefits of true aromatherapy. Along with an
extensive list of companies offering pure essential oils, aromatherapy
schools and a list of members, the NAHA also publishes the
Aromatherapy Journal.

National Certification Board for Therapeutic Massage &

Bodywork
8201 Greensboro Drive, Suite 300
McLean, VA 22102
Phone: 1 (800) 296-0664 or (703) 610-9015
Fax: (703) 610-9005
E-mail: [email protected]
If you are looking for a massage therapist, this group can refer you to
a certified practitioner in your area. Along with maintaining a listing of
nationally certified massage therapists and reflexologists, the
NCBTMB also provides education and certification.

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The National Heart, Lung, and Blood Institute
Phone: (301) 592-8573
Fax: (301) 592-8563
Website: www.nhlbi.nih.gov
The NHLBI Health Information Center provides information on a
number of health problems, including angina, hypertension,
arrhythmia, heart attacks and congestive heart failure. Their website
contains interactive tools including a body mass index calculator, a
menu planer and a 10-year heart attack risk calculator.

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 Appendix II

General Medical Terms Relating To

Heart Disease

While learning about heart disease and its symptoms, you may
find a number of unfamiliar terms. This glossary, adapted from the
National Heart, Lung, and Blood Institute of the National Institutes of
Health, offers a quick cheat-sheet to help you decipher some of the
“medical-speak” you’ll come across.
Aneurysms
Small blister-like outpouchings of blood vessel walls. They can
rupture, causing bleeding.
Angina
Angina pectoris or angina is a recurring pain or discomfort in the
chest. It happens when some part of the heart does not receive enough
blood. It can feel like a heaviness, a burning sensation, a discomfort
in the left arm or jaw.
Angioplasty/Balloon Angioplasty
A procedure to open clogged arteries. A catheter, positioned in the
narrowed coronary artery, has a tiny balloon at its tip. The balloon is
inflated and deflated to stretch or break open the narrowing and
improve the passage for blood flow. The balloon-tipped catheter is
then removed.
Arrhythmia
Arrhythmia or dysrhythmia is a change in the normal heartbeat.
Arteriosclerosis
General term for the thickening and the hardening of arteries. Its
development is accelerated by high blood pressure.
Artery
Vessels that carry oxygen-rich blood from the heart to the body.
The major arteries of the heart are called the coronary arteries.
Atherosclersosis
A type of arteriosclerosis in which cholesterol, fat and other
substances in the blood build up in the walls of arteries. As the
process continues, the arteries to the heart may narrow, cutting down
the flow of oxygen-rich blood and nutrients to the heart.

152
Atrial fibrillation
Condition in which the two small upper chambers of the heart, the
atria, quiver instead of beating effectively. Although atrial fibrillation
is not in itself considered life-threatening, people with it are at an
increased risk for blood clots and stroke.
Blood pressure
Blood pressure is the amount of force exerted by the blood against
the walls of the arteries. Usually, blood pressure is expressed in two
numbers, such as 120/80, and is measured in millimeters of mercury
(mm Hg).
Bradycardia
A slower than normal heartbeat.
Bypass Surgery
In a coronary artery bypass operation, a blood vessel, usually
taken from the leg or chest, is grafted onto the blocked artery,
bypassing the blocked area. If more than one artery is blocked, a
bypass can be done on each. The blood can then go around the
obstruction to supply the heart with enough blood to relieve chest
pain.
C-Reactive protein
A useful biological marker for arterial inflammation. High levels
can predict the risk of heart attacks and stroke years before a patient
has his or her first coronary event.
Cardiovascular diseases
Diseases of the heart and blood vessel system, such as coronary
heart disease, heart attack, high blood pressure, stroke, angina (chest
pain), and rheumatic heart disease.
Cerebrovascular diseases
Diseases of the brain and its main blood vessels. In a stroke, for
example, the loss of blood flow results in sudden loss of function of
part of the brain. Stroke may be caused by a clot (thrombosis) or
rupture (hemorrhage) of a blood vessel to the brain.
Cholesterol
A waxy substance produced by the body and taken in with food.
The body needs cholesterol for functions such as making hormones.
When too much cholesterol circulates in the blood, it leads to
atherosclerosis and an increased risk of heart disease. Blood
cholesterol refers to the cholesterol circulating in the bloodstream;
dietary cholesterol is the cholesterol consumed in food.
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Congestive heart failure (CHF)
Also called heart failure. A serious condition in which the heart is
unable to pump enough blood to supply the body’s needs. CHF
occurs when excess fluid starts to leak into the lungs, causing
breathing difficulty, fatigue and weakness, and sleeping problems.
High blood pressure is the number one risk factor for CHF.
Coronary heart disease (CHD)
The most common form of heart disease. This type of heart
disease is caused by a narrowing of the coronary arteries that feed the
heart, which results in not enough oxygen-carrying blood reaching the
heart.
Diastolic blood pressure
The second or bottom number in a blood pressure reading.
Diastolic blood pressure is the minimum pressure that remains within
the artery when the heart is at rest.
Endocarditis
Bacterial endocarditis occurs when bacteria in the blood stream
lands on abnormal heart valves or other damaged heart tissue.
Fibrinogen
A protein molecule synthesized by the liver which is essential for
normal blood clotting. High levels can increase clotting and the risk
of heart disease
Heart disease
Diseases of the heart. These include conditions that affect the
heart’s valves and muscle.
Heart failure
Also called congestive heart failure. A serious condition in which
the heart is unable to pump enough blood to supply the body’s needs.
CHF occurs when excess fluid starts to leak into the lungs, causing
breathing difficulty, fatigue and weakness, and sleeping problems.
High blood pressure is the number one risk factor for CHF.
High blood pressure
When blood pressure stays above normal levels over a period of
time.
Homocystine
An amino acid produced by the body. Elevated levels of
homocystine in the blood can damage blood vessels and disrupt
normal blood clotting, increasing the risk of heart attack, stroke, and
peripheral vascular disease.
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Hypertension
The medical term for high blood pressure (blood pressure reading
of 140/90 mm Hg or higher).
Ischemic
Refers to the state of not having enough blood flow.
Isolated systolic hypertension (ISH)
A condition in older adults in which only the systolic blood
pressure is high (systolic at or above 140 mm Hg and diastolic under
90 mm Hg). ISH is the most common form of high blood pressure for
older Americans.
Lipids
Fatty substances, including cholesterol and triglycerides, that are
present in blood and body tissues.
Lipoprotein Profile
A blood test that measures cholesterol numbers, usually done after
a 9-12 hour fast. The test gives information about total cholesterol,
LDL (bad) cholesterol, HDL (good) cholesterol and triglycerides.
Lipoproteins
Protein-coated packages that carry fat and cholesterol through the
bloodstream.
mm Hg
Abbreviation for millimeters of mercury. It is used to express
measures of blood pressure. It refers to the height to which the
pressure in your blood vessels would push a column of mercury.
Murmur
Heart murmurs are sounds made as the blood moves through the
heart.
Myocardial Infarction
When the heart does not get enough blood flow and the heart
muscle dies. Also known as a heart attack.
Pacemaker
A pacemaker is a small battery-operated electronic device that is
used to help the heart beat regularly. Can be used in the treatment of
arrhythmia.
PTCA - Percutaneous Transluminal Coronary Angioplasty
A procedure to open clogged arteries. A catheter, positioned in the
narrowed coronary artery, has a tiny balloon at its tip. The balloon is

155
inflated and deflated to stretch or break open the narrowing and
improve the passage for blood flow. The balloon-tipped catheter is
then removed.
Risk factors
Risk factors are traits or habits that make a person more likely to
develop a disease. Some risk factors can be controlled, while others -
such as age and gender - cannot be. Controllable risk factors for
hypertension include cigarette smoking, high blood pressure, high
blood cholesterol, overweight or obesity.
Stenosis
Stenosis or narrowing can happen in heart disease to a valve when
the valve is stiff and can’t open all the way. The result is that the heart
must work harder to move blood.
Stent
A stent is a wire mesh tube that’s permanently inserted into an
artery to help keep it from closing up again. Stents can be used along
with angioplasty to help keep an artery open following a heart attack.
Stroke
Sudden loss of function of part of the brain because of loss of
blood flow. Stroke may be caused by a clot (thrombosis) or rupture
(hemorrhage) of a blood vessel to the brain.
Systolic blood pressure
The first or top number in a blood pressure reading. The
maximum pressure produced as the heart contracts and blood begins
to flow. As systolic pressure rises, especially reaching or passing 140,
so does the risk of getting heart disease.
Tachycardia
A rapid heartbeat.
Thrombus
A blood clot.
Triglycerides
Lipids carried through the bloodstream to tissues. Most of the
body’s fat tissue is in the form of triglycerides, stored for use as
energy. Triglycerides are obtained primarily from fat in foods.

156
Unstable Angina
Chest pain that occurs at rest; new onset of pain with exertion; or
pain that has accelerated (i.e., more frequent, longer in duration, or
lower in threshold).
Vascular
A term to describe blood vessels.
Veins
Vessels that carry blood from the body to the heart.

157
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