From The March 1999 Issue of Nutrition Science News
By Jill Stansbury, N.D.
Intelligent lifestyle choices plus the right mix of supplements and herbs comprise a heartwise plan
Modern lifestyles are fraught with risk factors that contribute to heart disease. From secondhand smoke to sedentary lifestyles and diet, all take their toll on heart health. The good news is that preventive measures can keep the heart healthy and ward off more serious conditions for those at risk.
Cardiovascular disease affects millions and one reason why is high blood pressure--a condition so common in the adult population that one in five Americans have it.  Two other conditions, atherosclerosis, a buildup of fatty deposits on the insides of artery walls, and arteriosclerosis, a loss of elasticity and integrity of artery walls, are common diseases that contribute to hypertension and degeneration of the heart muscle. High blood pressure may develop as the fatty deposits and loss of elasticity narrow blood vessels and raise pressure. The high pressure further damages the blood vessels, creating a vicious cycle.
More than 90 percent of hypertensive patients, defined as those with blood pressure consistently above 150/90, have primary or essential hypertension, meaning no apparent disorder or disease process can account for their elevated blood pressure. In this circumstance, natural therapies, particularly lifestyle and dietary modifications, can result in significant improvements.
|Heart disease is the leading cause of death in the United States, responsible for 20 percent of all deaths.|
People at risk for heart disease should pay attention to their emotional well-being as well. Stress and emotional turmoil can cause or exacerbate high blood pressure.  One way to reduce both is through regular exercise, which should be a part of everyone's lifestyle for various reasons, not the least of which is that physical fitness is associated with lower blood pressure. [3 ]
Following are some dietary and nutritional considerations for improving cardiovascular health.
7 Dietary Considerations
Those looking for dietary modifications to prevent or treat heart disease can discuss these suggestions with a health care provider. The best approach is often tailored to each patient's needs.
Monitor quality and quantity of fats. There is a direct correlation between blood cholesterol, triglyceride levels and the risk of cardiovascular disease. Reduce total fat intake and favor vegetable oils over animal fats.
Reduce or eliminate caffeine. Caffeine raises blood pressure temporarily, but the effects of long-term use remain uncertain. In
general, coffee drinkers tend to have slightly higher blood pressure than those who don't drink coffee.  Be aware that many so-called energy tonics feature herbs with caffeinelike effects such as ephedra (Ephedra sinica), guarana (Paullinia cupana), maté or ilex (Ilex paraguaiensis) and tea or camellia (Camillia sinensis).
Reduce or eliminate alcohol. Regular alcohol use
correlates with elevated blood pressure. [5 ]Alcohol taxes the liver and reduces its ability to detoxify blood, thus causing more oxidizing and damaging substances to remain in circulation where they can harm blood vessels. Further, if the liver is busy processing alcohol, it is less able to process fats, leading to elevated cholesterol levels. If the liver becomes congested, stagnation in the portal veins--those that deliver blood to the liver--can increase blood pressure in all other vessels downstream.
Reduce or eliminate excess salt. Excessive salt (sodium chloride) consumption challenges the kidneys' ability to regulate blood pressure. High salt intake is especially difficult on the body when potassium and magnesium ingestion is low. High sodium relative to potassium increases water retention and can elevate blood pressure. One way to increase potassium and magnesium consumption is to eat more fresh fruits and vegetables.  Improving potassium intake while restricting sodium will also reduce vasoconstriction and may help reduce blood pressure. Limit sodium intake to 1 to 2 g per day.
Increase fiber intake. Water-soluble fibers such as oat bran, apple pectin and psyllium may lower both cholesterol and blood pressure.  Fiber collects ingested fat trapped in the intestines and prevents the fat from being absorbed.
Eat fewer animal products. An increased heart-disease risk is associated with eating animal products, which are known to provide undesirable types of fats and raise cholesterol levels. Overall, there is less occurrence of heart disease among vegetarians than nonvegetarians,  but simply eating fewer animal products and more whole, plant-based foods promotes good health. Although there is some concern that favoring certain carbohydrates such as bread, sugar and pasta may promote diabetes in those who are prone to it, increasing consumption of other carbohydrates such as carrots, green leafy vegetables and whole fruits appears safe for everyone.
Limit dairy. Several studies suggest a correlation between dairy product consumption and increased cardiovascular disease risk.  Milk may reduce magnesium absorption because of its calcium content, which competes with magnesium for absorption. Magnesium is important because it promotes muscle relaxation and may help reduce blood pressure by relaxing the muscular layer of the blood vessels. The calcium content of dairy products may also contribute to calcifications within the arteries. Excessive calcium ingestion is known to play a role in atherosclerotic plaque development. [10 ]
Milk also lacks B vitamins, which are needed to convert homocysteine, an amino acid that damages blood vessels, into less harmful metabolites. Homocysteine is known to play a role in the development of cardiovascular disease,  and many physicians have begun using homocysteine levels as a marker of disease risk. Produced from the metabolism of the amino acid methionine, homocysteine is plentiful in animal protein and can be converted back into methionine and/or excreted from the body with the help of B vitamins.
Other researchers believe that the theory of calcium-ingestion is debatable. In fact, some studies on the pathophysiology of atherosclerotic plaque indicate calcium entry may be a passive phenomenon that does not directly contribute to the disease. Other studies say calcium lowers blood pressure. Some experts say the problem with dairy (if any) is related to its pesticide and hormone content.
5 Supplements for Heart Health
By effecting change at a cellular level, these supplements promise to protect vascular health and produce energy within the heart muscle.
Antioxidants such as vitamins C and E and the mineral selenium help protect the insides of veins and arteries from disease-producing oxidizing agents. Vitamin C and E, in particular, reduce oxidative damage and improve blood lipids. Vitamin C helps prevent fat accumulation in the blood vessels  and supports connective-tissue integrity within the vessel walls.  Vitamin E appears to protect blood vessels from free radical damage.  It also inhibits aberrant platelet aggregation  and the inflammatory processes they initiate.
Selenium, a trace mineral with antioxidant activity, is a component of the enzyme glutathione peroxidase, which is used throughout the body to protect cellular membranes, and within the liver to process toxins.  Low glutathione levels are associated with an impaired ability to detoxify offensive substances. If the liver's ability to excrete wastes and detoxify oxidizing agents is limited, more toxins remain in the bloodstream where they can damage blood vessels. Like vitamin E, selenium also reduces platelet aggregation. 
The B vitamins reduce the risk of cardiovascular disease in several ways.  For one, vitamin B6 helps the body convert homocysteine into a harmless amino acid and excrete homocysteine as waste. Other B vitamins, including folate (B9) and B12, are also involved in removing homocysteine and are associated with reduced risk of heart pathology. [19 ] Vitamin B3, better known as niacin, reduces elevated cholesterol, but the dosage required to do so may cause side effects such as a sensation of heat and flushing, and even liver damage or glucose intolerance.  Consequently, it is safest to supplement with only moderate niacin levels or a multiple B formula, thereby avoiding large niacin doses. Another form of niacin, known as inositol hexaniacinate, produces virtually no side effects and is highly effective at lowering cholesterol and triglycerides.
Co-Q10 levels are often lower among patients with congestive heart failure, hypertension and angina than among subjects without cardiovascular disease. Clinical studies have further shown
Co-Q10 is valuable in treating these conditions, presumably by improving energy production within the heart. 
L-carnitine is a nonessential amino acid used as a co-factor in reactions to move fatty acids into cellular mitochondria where they provide energy. Both skeletal muscles and the heart muscle use fatty acids as a primary energy source, and L-carnitine helps transform long-chain fatty acids for energy production. L-carnitine can be synthesized from lysine and methionine, so it is not considered an essential amino acid.
Supplementation with L-carnitine may benefit people with cardiovascular diseases including cardiomyopathy, angina and congestive heart failure, as well as peripheral vascular diseases. In one clinical trial, patients with stable angina taking 900 mg per day improved their exercise tolerance by an average of 10 percent.  A higher dose, 2 g daily, was used in a larger trial of 737 angina sufferers. At this dose patients improved exercise tolerance by an average of 22 percent.  Patients taking L-carnitine in addition to their regular medication decreased the need for the drugs while improving cardiac function.
In yet another trial, daily doses of 4 g
L-carnitine were investigated for the ability to improve consequences and life expectancy for postmyocardial infarction patients. In one trial of 160 patients who suffered a myocardial infarction, half the subjects were given 4 g of L-carnitine daily for one year. Subjects given the L-carnitine showed less mortality and an improved heart rate, rhythm and pressure as well as improved blood lipids. [24 ]
Magnesium is known to have relaxing and antispasmodic effects on the blood vessels and may reduce angina, cardiovascular spasms  and cardiac arrhythmias.  Epidemiological studies have noted a correlation between low magnesium levels and cardiovascular-related deaths.
Because of magnesium's ability to relieve vascular spasms, many hospitals now use intravenous magnesium preparations for patients suffering acute myocardial infarction or severe angina.  Magnesium also appears to improve high-density to low-density lipoprotein ratios  as well as reduce platelet aggregation.
3 Heartwise Botanicals
While hawthorn is probably the herb most associated with heart health, garlic and ginkgo also appear to increase blood flow and minimize clotting and cholesterol deposits, thereby reducing the risk of heart attacks.
Garlic (Allium sativum) is a hypotensive agent that is able to break down fibrous material and improve elasticity of blood vessel walls. The vast majority of studies also show that garlic reduces cholesterol  and platelet aggregation,  acts as a vasodilator, and reduces both systolic and diastolic hypertension. To improve blood lipids and blood pressure, researchers have used doses ranging from 1,800 mg fresh garlic  to 18 mg garlic oil  to 900 mg dry garlic powder standardized to 1.3 percent allicin. 
Research also shows that aged garlic extract standardized to contain s-allyl-
cysteine, a water-soluble sulfur-containing amino acid, has cardioprotective effects. Double-blind studies showed significant reductions in blood pressure among patients taking this form of garlic. [33,34]
Ginkgo (Ginkgo biloba) tree leaves have a relaxing effect, serving to dilate vessels, reduce blood pressure and promote perfusion in the brain, in the periphery of the body and in the heart muscle itself. Ginkgo flavonoids also have an antioxidant effect, which helps reduce lipid peroxidation and free radical damage. Ginkgo products are often standardized to 24 percent ginkgo flavonoids, also known as heterosides. Numerous human trials have demonstrated ginkgo to be useful in cases of arterial insufficiency, intermittent claudication, ischemic heart disease and other cases of oxygen deficiency in tissues. 
Hawthorn (Crataegus oxyacantha, C. monogyna) contains many complex chemical constituents including large amounts of the flavonoids anthocyanidins and proanthocyanidins, as well as condensed polyphenolic tannins known as procyanidolic oligomers (PCO). Hawthorn is standardized to 10 percent proanthocyanidins and 18 percent PCOs. PCOs are also extracted from grape seeds, pine bark, hazel leaves and lime flower bracts. These flavonoids stabilize capillaries when taken at a dose of 150 to 300 mg per day.  They also reduce vascular permeability and fragility. The hawthorn tree's leaves, flowers and particularly the berries can be used to make a cardiotonic tea.
Hawthorn has long been used as a heart tonic for both hypertension and hypotension, and modern studies show hawthorn helps treat elevated cholesterol levels, high blood pressure, angina pectoris and atherosclerosis. [37,38] Hawthorn is thought to act both as a natural calcium channel blocker as well as an ACE inhibitor,  serving both to lower blood pressure and strengthen heart-muscle function. ACE, short for angiotensin converting enzyme, refers to an enzyme involved in synthesizing the hormone aldosterone. Aldosterone causes the kidneys to retain sodium and elevate blood pressure. Therefore, drugs that inhibit ACE prevent aldosterone-induced sodium retention and blood pressure elevation.
Though heart disease is currently the nation's No. 1 killer, those interested in preventive health care can make dietary and lifestyle changes to help reduce their risk. Cardioprotective measures include adopting a healthy diet and taking nutritional supplements, plus cutting back on alcohol, cigarettes and salt. Complement with regular exercise and stress-reducing activities for a heartwise wellness plan.
Jill E. Stansbury, N.D., maintains a private practice in Battleground, Wash., where she specializes in botanical and natural therapies. She heads the botanical medicine department at the National College of Naturopathic Medicine in Portland, Ore.
Changing The Lifestyle Changes the Prognosis
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