In the view of modern medicine, heart disease is its deadliest and most intractable adversary, one that can only be vanquished by the most powerfully suppressive drugs, the most sophisticated surgery, the greatest state-of-the-art technology. Attempting to treat this - still the number one killer in the West - by alternative medicine, in the view of most doctors, is akin to attempting to cure cancer with a facial.
But this world view of heart disease ignores clear scientific evidence demonstrating that many alternative remedies are far more potent in preventing or treating heart disease - heart attacks, arterial disease, high blood pressure - than all of medicine's most sophisticated armaments put together.
Dying of a broken heart
Modern medicine has never convincingly answered the question: what causes heart disease in the first place?
Dr Dean Ornish, assistant clinical professor of medicine at the School for Medicine, University of California at San Francisco, has collected copious research on the various causes of heart disease. He has discovered that while smoking, obesity, a sedentary lifestyle and high-fat diet are important risk factors, they only account for half of all heart disease. In Dr Ornish's research, none appears more important than isolation - from other people, from our own feelings and from a higher source. In one study in San Francisco and another in Eastern Finland, of the nearly 20,000 people observed for up to nine years, those who were lonely and isolated socially were two to three times more likely to die from heart disease and other causes than those who felt connected to others. These results occurred independently of risk factors such as high cholesterol levels or high blood pressure, smoking and family history (Am J Epidemiol, 1979; 109: 186-204; Am J Epidemiol, 1988; 128: 370-80). Diet, heart disease in the family, even smoking had less to do with someone having a heart attack than loneliness.
Studies of other populations, such as Japanese-Americans, demonstrate, again, that social networks and social support protect them against heart disease - regardless of whether they smoke or suffer from high blood pressure (Am J Epidemiol, 1983; 117: 384-96). In another study among over 200 elderly, healthy adults, those with good support networks had lower blood cholesterol levels and higher levels of immune function than those without this emotional support. Again, how much you smoked or what you ate didn't seem to have as much bearing on your heart as whether you were lonely and isolated.
Although animal studies cannot be extrapolated to humans, researchers conducting heart studies on rabbits have been flabbergasted to find that among animals given high cholesterol-producing diets, those who were played with and petted by researchers developed less cardiovascular disease than those who were in cages out of reach and left alone (Science, 1980, 208; 1475-6).
In other words, whether in animals or humans, a high-cholesterol diet doesn't have as much to do with heart disease as a lack of love.
This lends a certain credence to the view that how we get ill is a metaphor for our lives; many people suffering heart problems literally die from a broken heart.
Unremitting stress caused by living in a cramped, unnatural way also has been fingered as a major culprit in heart disease. Even in the animal kingdom, when animals are introduced in competitive environments with constant power struggles and a confusing social hierarchy - in short, the typical dog-eat-dog environment of your average work place - stress has more to do with heart disease than diet or other risk factors (Arteriosclerosis, 1982; 2: 359-68). In humans, chronic stress causes the body to overproduce cortisol, our 'fight or flight' stress hormone, which increases the formation of arterial plaque.
Dr Ornish has also found studies showing that people who are self-absorbed, cynical and hostile to the world after feeling isolated also tend to die from a heart attack. One study actually found that the number of times a person used 'I' words like 'I', 'me' and 'mine' in an ordinary conversation multiplied the risk of a person's dying from heart disease (Psychosom Med, 1986; 48:187-99). 'Anything that promotes a sense of isolation leads to chronic stress and, often, to illnesses like heart disease,' writes Ornish (Reversing Heart Disease, Century, 1990). 'Conversely, anything that leads to a real intimacy and feelings of connection can be healing . . .' By connection, Dr Ornish means both connection with others, our feelings, our inner peace, and also with a higher, spiritual force.
The body-mind connection
Some of the most successful alternative treatments for heart disease concentrate on techniques which will remove stress and foster internal connectedness. Dozens of studies have examined whether stress management has a bearing on high blood pressure. One of the best studies, which had a four-year follow-up, attempted to show that reducing stress is one of the most important lifestyle changes you can make. In the study of nearly 200 patients, all the subjects were given information sheets on modifying such bad habits as smoking and consuming too much animal fat in the diet (they were not placed on any diet or monitored to see if they followed through on the recommendations). However, half the group were also given lessons in breathing exercises, relaxation and meditation, and managing stress.
The group practising relaxation recorded a significantly greater reduction in blood pressure than the others, and this difference was maintained over four years. Most strikingly, although there were no differences between the two groups in terms of cholesterol levels, the group not given the relaxation lessons suffered a much higher incidence of ischaemic heart disease, fatal heart attack and narrowing of heart blood artery flow than the group that meditated (BMJ [Clin Res], 1985; 13: 1103-6).
In another study, 34 patients with hypertension and trained in yoga were able to lower their blood pressure from an average of 168 / 100 to 141 / 84 mmHg. The untreated group were then given yoga training, at which point their blood pressure also fell to levels similar to those of the other group (The Lancet, 1975; 2: 93-5).
With Transcendental Meditation, a group of men over 55 were randomly divided into three groups: one received TM, another was taught Progressive Muscle Relaxation (PMR, similar to Autogenic Training) and the third was simply given advice on diet and lifestyle. After three months, both the TM and PMR groups reduced their blood pressure significantly, but TM was found to be twice as effective as PMR, reducing systolic blood pressure by 10 points (Hypertension, 1995; 26: 820-7).
One study, which attempted to determine the actual physiological effect of TM or yoga, when comparing a group of patients with similar behaviour, exercise and family history of hypertension, found that the group practising meditation recorded a lower percentage of those cells that stimulate the body's 'fight or flight' mechanism (J Psychosom Research, 1990; 34: 29-33).
But in many other instances, relaxation techniques haven't worked at all (BMJ, 1990; 300: 1368-72) or only worked in a minority of cases (J Psychosom Res, 1987; 31: 453-62).
Much appears to depend on which types of techniques you choose; overall, yoga and Transcendental Meditation - those disciplines likely to put you in touch with your own spirituality, in addition to providing relaxation - have outperformed techniques like stress management and biofeedback, which solely concentrate on relaxing the body.
Other studies have been able to quantify the power of love in preventing heart disease. One study showed that old people with pets have lower blood pressure than those without; both interaction with the pet and the pleasure derived from stroking it were thought to be responsible (J Behav Med, 1988; 11: 509-17).
There is also evidence that suggestibility plays a part in lowering blood pressure. In one study, a group of patients told their blood pressure would lower with relaxation did have it fall by 7 or 8 points, whereas those told the techniques would have no effect only registered half that change in blood pressure (Hypertension, 1993; 11: 293-6). In another study, high blood pressure was completely eliminated during hypnosis, whether or not a patient was on antihypertensive drugs (Am J Clin Hypn, 1973; 16: 75-83).
It is always difficult to subject individualistic treatments like homeopathy to a scientific trial for the simple reason that classical homeopaths tailor the treatment to the individual constitution.
Nevertheless, two good scientific trials provide some evidence that homeopathy can be used to prevent or treat heart disease. In one controlled double-blind trial, among 32 elderly hypertensive patients confined to bed at one of two nursing homes, half were given Baryta carbonica and half a placebo. Among the group as a whole, those taking the homeopathic remedy didn't show much improvement. Nevertheless, the four subjects who'd been consid-ered sensitive, in homeopathic terms,
had strongly positive results (B Homeop J, 1987; 76:114-9).
In another study, 42 patients on antihypertensive medication were divided into two groups. Ten were given a placebo and advised to reduce weight, decrease salt intake and engage in exercise, relaxation, yoga and meditation. The remaining 32 patients were given homeopathic drugs alone. Among the diet-exercise-relaxation group, 60 per cent had no improvement in blood pressure. But among the homeopathic group, 75 per cent showed improvement in blood pressure and, within 60 days, 86 per cent had been able to gradually taper their standard hypertensive drugs (Br Homeopathic J, 1987, 76: 120-1). In this particular trial, a variety of home-opathic remedies were used, including Adrenalin 30, Adrenalin 200, Eel Serum 6 and Baryta Mur 30.
For general prevention of arterial damage, perhaps the most studied remedy is Ginkgo biloba, a herb from the Maidenhair tree. Ginkgo is known to help with respiratory complaints like asthma, but it's also known as a circulatory stimulant which increases blood flow to the brain. Patients with peripheral arteriopathy of the lower extremities (where blood doesn't flow well to the lower extremities) also benefit from Ginkgo biloba.
In one double-blind French trial conducted for more than a year, where 36 patients given the herb were matched against 35 patients given a placebo, Ginkgo biloba gave significantly greater pain relief and helped patients walk longer distances than placebo. Ginkgo has also been found to 'thin' the blood in patients suffering from arteriosclerosis experimentally given blood clotting substances (Wie Med Wochenschr, 1989; 139: 924).
Besides Ginkgo, several multiherbal preparations have excellent success rates in alleviating arterial problems. Abana, a preparation from Ayurvedic medicine, which contains a variety of herbs and minerals, has been shown to affect blood pressure among 80 per cent of patients in a study comparing it to medication (Japan Heart J, 1990; 31: 829-35). Padma 28, a Tibetan herbal combination of 28 herbs (which must be made up by a practitioner of Tibetan medicine), has been shown to help poor circulation in the legs. Researchers were actually able to record a number of biochemical improvements in the blood (Fibrinolysis,1994; 8: 47-9; Forsch Komplementarmed, 1994; 1: 1-13).
For angina, bromelain, the enzyme from the stem of the pineapple plant, has been shown to reduce angina (Erfahungsheilk, 1978; 5: 274-5) as can extract of the hawthorn berries, leaves or flowering tops (Crataegus pinnatifida) (J Trad Chin Med, 1984; 4: 293-4) and khella (Ammi visnaga), an ancient medicinal plant (N Engl J Med, 1951; 244: 315-21). Fenugreek can reduce cholesterol levels (Phytother Res, 1991; 5: 145-7), and so can milk thistle (Acta Med Hung, 1989; 46: 289-95). Ginger has also been known to thin the blood (Med Hypoth, 1986; 20: 271), and there's some evidence that artichoke extract can help get blood cholesterol levels back to normal (Arzneim Forsch, 1975; 25: 1311-4).
A number of Chinese herbs also have proof of exerting profound effects on the heart. Andrographis paniculata nees has been found useful in preventing restenosis (recurrent clogging of the arteries) after coronary angioplasty (J Tong Med Univ, 1993; 13: 193-8). Many other studies show astounding results with a number of Chinese herbs. Astragalus membranaceus, the Chinese herb, has been demonstrated to help preserve cardiac function (Chung-Kuo Hung Hsi i Chieh Ho Tsa Chih, 1995; 15: 141-3). Many other Chinese herbs claim to help heart conditions, but all such research is reported in Chinese journals, which tend to publish uncritical research.
The herb Terminalia arjuna has helped with symptoms and signs of heart failure over more than two years (Int J Cardiol, 1995; 49: 191-9).
Among naturopathic treatments, some simple foodstuffs have amazing properties on the heart. There is much scientific evidence to back up garlic's reputation as a potent cholesterol reducer of the blood. In one of the best studies, a number of German centres banded together to put garlic to the test under extreme conditions. They chose two months over the Christmas-New Year season to see whether the reputed benefits of garlic would stretch over the season with the highest cholesterol-laden meals. Of the 43 patients studied in the randomised, double-blind, placebo-controlled trial, one group was given a product containing garlic (Allium plus) and Ginkgo biloba and the other group, a placebo. Among the treated group, 35 per cent recorded improvement in cholesterol levels that was significantly better than in the control group, with an average 10.4 per cent reduction in cholesterol after two months. After the study, those treated abstained from taking Allium for two weeks. When their cholesterol levels were measured, they were found to be identical to the levels they started with, demonstrating that the garlic-Ginkgo combination was definitely responsible for the lowering of cholesterol in the trial (Arzneim Forsch, 1993; 43: 978-81). Outside of the holiday season, standardised garlic powder tablets (such as Kwai and Sapec) have been shown to lower total cholesterol levels by an average of 12 per cent and triglycerides by an average of 17 per cent (Arzneim Forsch, 1990; 40: 1111-6).
Garlic has also been used to treat arterial disease of the legs. In one study, a daily dose of 800 mg of garlic powder enabled patients with intermittent claudication (cramp-like pain on walking caused by arterial disease of the legs) to walk further than a matched set of controls. Interestingly, this increase in walking distance didn't occur until the fifth week of treatment - at the same time that the researchers observed a thinning of the blood. Blood pressure, cholesterol concentration and blood viscosity also decreased (Clin Invest, 1993; 71: 383-6).
Besides the more conventional body-mind techniques, many of those therapies considered 'paranormal' have achieved some success in healing so-called cardiac risk factors.
Remote healing has been shown to lower blood pressure, and having someone pray for you is also a tried-and-tested method which has finally been legitimised by science (see the examples of cardiac patients on p 14). Furthermore, the effects of praying or healing extend beyond those of simple feel-good activities. For instance, playing music or suggestion tapes hasn't been shown to have any effect in intensive-care situations (J Clin Hypnos, 1995; 37: 32-42). There is also solid evidence that the Chinese therapy Qigong can be useful for patients with hypertension (JTrad Chin Med, 1987; 7: 169-70).
Acupuncture also has a place in the treatment of cardiac disease. Most studies have examined its role in alleviating the pain of angina. Thus far, the results of tests are mixed. However, there are at least two successful studIes. In one randomised trial, where half the subjects received acupuncture and the other half a sham treatment, the patients receiving acupuncture showed they were able to increase the work capacity of their hearts significantly (J Clin Epidemiol, 1990; 43: 1191-9). Acupuncture is also helpful in hypertension; in one study, it showed immediate effects among all patients and a longer-term effect among two-thirds (J Trad Chin Med, 1992; 12:133-6).
In Western terms, the good effects of acupuncture may be traced in part to its effect on the blood. One study comparing the blood biochemical parameters of a group of volunteers undergoing acupuncture to a set of controls found a significant increase of free fatty-acid concentration. This accords with what we know of the beneficial effects of omega-3 fatty acids in protecting the heart (Anaesthetist, 1976; 25: 235-8).One of the most astounding successes occurred in a randomised, prospective, prevention trial among 605 patients who'd already suffered a heart attack, comparing an adaptation of the Mediterranean diet, as followed in Crete, with the usual 'prudent' diet usually prescribed to cardiac patients. After a follow-up of more than two years, all cardiovascular events, new heart attacks and death were decreased by 70 per cent among the group given the Mediterranean diet.
When researchers attempted to find out why, they discovered that the protective effects had nothing to do with blood cholesterol levels, good or bad. What they mainly observed were changes in the blood fatty acids. An increase in omega-3 fatty acids and oleic acid, and a decrease in linoleic acid, resulting from higher intakes of linolenic and oleic acids (omega-3 fatty acids from fish or flaxseed oils) and lower intakes of saturated fatty acids and linoleic acid (omega-6 fatty acids from corn, safflower and soy oils), proved protective. Patients on the Mediterranean diet also recorded higher levels of the antioxidant vitamins C and E (Am J Clin Nutr, 1995; 61 [6 Suppl]: 1365-7S).
The astonishing fact is that this diet, followed by heart patients with no other intervention, yielded results more than twice as good as the very best results achieved by medicine with cholesterol-lowering drugs.
In one study by Dr Dean Ornish, the coronary arteries of a group of vegetarians had widened by 3 per cent while those of a control group, who did not make the same lifestyle changes, had narrowed by 4 per cent. In all, 82 per cent of the experimental group had shown improvement (Lancet, 1990; 336: 129-33). A more recent study measuring coronary arteries with a special CAT scan showed that heart disease was being reversed in 99 per cent of patients over five years (JAMA, 1995; 274: 894-901).
Dr Ornish achieved similar results with patients suffering from ischaemic heart disease (blood flow reduction due to narrowing of the arteries) (JAMA, 1983; 249: 54-9). Nevertheless, there is some question about which low-fat diets are appropriate. Some very low-fat diets can change levels of HDL ('good') cholesterol or result in low levels of essential fatty acids, associated with an increased risk of heart attack (JAMA, 1996; 275: 1402-3). Even Ornish and another heart doctor, who performed the vegetarian diet studies, disagree over whether patients should be strict vegetarians or have a high- or low-carbohydrate diet (JAMA, 1996; 275).