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Heart disease: the insulin connection

Reading time: 13 minutes

Nancy Bradley dropped her dog’s leash when she suddenly felt a crushing pressure like someone was sitting on her chest. A shot of pain ran up her neck into her jaw and down her left arm simultaneously. A month earlier she had gone to the hospital with milder sensations like this, but they had dissipated while she waited in the emergency room. Then, an ECG and blood tests hadn’t shown anything abnormal, so a doctor sent her home with a bottle of antacids.

She was skeptical; both her older brother and sister had suffered heart attacks, and her dad had died following a quadruple bypass at age 53. Nancy was 57. Now, on a warm morning in August 2017 as she walked her terrier mix Marley alone on a forest trail, the agony returned with a vengeance.

At first, she thought her struggle for breath was caused by the smoke from wildfires that had hung in the air for weeks and settled on the mountain landscape in Kamloops, British Columbia, like a sea fog. As nausea swept over her and she started trembling, she knew it wasn’t that.

She fumbled in her pocket and found her pack of cigarettes but remembered she had left her phone at home. Sweat dripped off the end of her nose. She could barely move her legs. The trees started to spin, and she crumpled to the ground. I’ve got to make it home, she thought, or I’m going to die on this trail.

Usually Nancy would pass neighbors out jogging or walking their dog, but this Saturday morning, there wasn’t a soul in sight. Marley stayed by her side, however, for the whole 40 minutes it took Nancy to crawl the five-minute walk back to her home.

On the phone to 911, she became unresponsive, and a second ambulance with a cardiologist was dispatched. A team was waiting for her in the operating room; scans revealed permanent damage to her heart tissue, and she underwent immediate surgery to place a stent in a major artery that was 95 percent blocked.

Nancy became a survivor of an event that strikes one American every 25 seconds and claims the lives of 17.9 million people across the globe every year. Heart disease is still the leading cause of death worldwide, and groups like the American Heart Association like to remind us that for half of the people who suffer from it, the first symptom will be sudden death.

However, some cardiologists believe that statistic can be slashed and cite a large body of published science that identifies those people who are most at risk for heart attacks before they happen. Better yet, they have numerous suggestions on how to counter those risks and put your heart right to prevent a heart attack from ever striking.

“There is a mantra I would like you to repeat over and over,” says holistic cardiologist Joel Kahn, professor of clinical cardiology at Wayne State University in Detroit, Michigan, and director of the Kahn Center for Cardiac Longevity: “Heart attacks are preventable.”
Kahn is convinced that upwards of 90 percent of heart attacks can be thwarted, primarily through fewer than 10 diet and lifestyle changes. The enormity of this assertion is staggering. It means that in the United States alone, more than 700,000 of the 785,000 first-time heart attacks experienced each year could be prevented. More than 360,000 of the nearly 400,000 lives claimed by heart disease annually could be saved.

That’s nearly four football stadiums packed to the rafters with fathers, mothers, brothers, sisters, cousins, friends and coworkers – to say nothing of the dent a new health paradigm might put in the $555 billion expended each year on medical costs and lost productivity from heart disease in America alone.1

Like other cardiologists critical of mainstream medicine, Kahn, who has used an integrative approach to treat and reverse heart disease in more than 10,000 patients, says the current paradigm not only is a colossal failure, but actually contributes to heart disease by treating everyone with pills or balloons and stents, which carry dangerous side-effects and a false sense of security.

“In current cardiology, none of the pills, none of the drugs, none of the procedures, none of the surgeries, have one single, solitary thing to do with the causation of the illness. However, we’ve built a billion-dollar industry over an illness that does not exist in half the world,” Caldwell Esselstyn Jr., director of the cardiovascular prevention and reversal program at The Cleveland Clinic Wellness Institute, told WDDTY.

Trying to change this cardiac paradigm is “a little bit like turning the Queen Mary,” Esselstyn added, because it is built on profit. “What you get paid for doing a bypass and what you get paid for inserting a stent doesn’t compare to what you get paid for talking to your patient about Brussels sprouts and broccoli.”

Cholesterol nightmare
For the past 30 years, the pharmaceutical industry has produced slick anti-cholesterol campaigns such as one television commercial that equates cholesterol – a natural component of every single cell in the human body – to greasy fat choking up the plumbing of a kitchen sink like ‘clogged’ arteries causing heart attacks.

Consequently, for more than a decade, cholesterol-lowering statins have been among the world’s best-selling drugs. Just one of them – Pfizer’s Lipitor – generated the company more than $100 billion between 2003 and 2011 when its patent expired. Even with competition from generic drugs, it still rakes in more than $2 billion annually.

Over the years, the definition of a healthy cholesterol level has changed time and again. Whenever the threshold is lowered, the statin market massively widens its net as millions more people become eligible for cholesterol-lowering drug prescriptions.
Twenty years ago, the threshold for ‘elevated’ cholesterol in the US was 240 mg/dL (equivalent to 6.2 mmol/L, as it’s measured in the UK), while today, “healthy” is defined as 200 mg/dL (5.0 mmol/L). In one large-scale study of over 39,000 American adults, average total cholesterol fell from 204 mg/dL (5.3 mmol/L)in 1999 to 189 mg/dL (4.9 mmol/L) in 2013.2

It is no coincidence that most of the research on statins has come directly from the pharmaceutical industry itself or has a money trail leading to it. For example, a recent study examining concerns about dangerous side-effects of statins, for the elderly in particular, concluded that despite “less definitive direct evidence of benefit” in those over age 75, statins were still worth the risk.

Yet nearly every researcher included in the group that authored the paper – the Cholesterol Treatment Trialists’ Collaboration – had received grants and/or “personal fees” from statin manufacturers including Pfizer, Merck and AstraZeneca. The authors’ influence reveals how medical education and training as well as research have been captured by industry interests.3

About one in 400 people inherit a genetic inability to metabolize cholesterol, according to Dr Kahn. Nancy Bradley may be one of them, given her family history, although she was never genetically tested and her cholesterol levels were normal when they were last measured, two years before her heart attack. She says that the statins she was given after her heart attack seem to have helped, since two arteries that were 40 percent blocked are down to 25 percent blocked. But she’s been hoping to cut her statin prescription at least in half soon because of the muscle and joint pain she has been experiencing lately, which are typical side-effects.

Now, the evidence is pointing to a different underlying pathogenesis of the disease. “Increasingly, it would appear that inflammation is a very important element,” says Dr Esselstyn of the Cleveland Clinic, author of Prevent and Reverse Heart Disease (Avery, 2008).
He cites a landmark 2017 study from Brigham and Women’s Hospital in Boston, which monitored more than 10,000 heart attack victims who had raised leve
ls of inflammation. These patients were given an anti-inflammatory drug, canakinumab, which didn’t affect their ‘bad’ low-density lipoprotein (LDL) cholesterol levels at all.

But the drug still reduced the study participants’ risk of a second heart attack (usually about a 25 percent risk within five years) by between 15 and 17 percent over 25 years when their inflammation levels were also lowered. Their need for bypass surgery and angioplasty was also cut by 30 percent, blowing cholesterol-lowering drugs out of the water.

The drug canakinumab has its own troubles, though, and the study researchers noted that one in every 1,000 participants suffered a fatal infection, likely due to the drug’s suppression of the immune system. It is another nail in the coffin of the cholesterol theory, however, and there are many safer, non-pharmaceutical, alternative strategies to fight inflammation.4

In chronic inflammation, the immune system is activated by stimuli such as smoking, and immune system factors interact with metabolic risk factors to begin producing a buildup of plaque in the arteries (atherosclerosis), which may suddenly form a clot leading to a heart attack. Just 30 minutes of passive smoking increases platelet activity that can lead to blood clotting, and recent declines in cardiovascular disease are tied to falls in smoking rates.

Dr Aseem Malhotra, British cardiologist and outspoken critic of mainstream approaches to heart disease, calls chronic inflammation the “twin brother” of insulin resistance, claiming that “the more insulin resistance in an individual’s body, the more systemic inflammation, and vice versa.”

In fact, a 2009 study that analyzed all the known risk factors for heart disease concluded: “Insulin resistance is likely the single most important cause of CAD [coronary artery disease].”

Preventing insulin resistance alone would slash heart attacks by a whopping 42 percent, the researchers found, compared to 36 percent for cutting high blood pressure and just 16 percent for lowering LDL cholesterol.5

The diet and lifestyle changes described on the following pages have been proven to protect the heart by targeting inflammation and metabolism – without a prescription pad.

Risky business

Here are our top seven practical recommendations from leading holistic cardiologists that you can put in place today to prevent and reverse cardiovascular disease.

Eat real
Except smoking, nothing impacts heart health so much as what you put in your mouth. Just one apple a day offers better protection than a statin.6

There are so many books and websites from doctors offering their advice on how to eat for a healthy heart, with all sorts of conflicting advice. The best solution is to look for the common denominators. Here are the fundamentals that most heart health diets have in common:

Eat more vegetables and berries. Most heart-healthy diets are referred to as “plant-based” for a reason: they include lots of fresh vegetables. Make sure raw and cooked, preferably pesticide-free vegetables occupy the majority of your dinner plate.

Ditch sugar, especially the processed kind. Sugar fuels diabetes, and soaring blood sugar levels are behind insulin resistance. When you want something sweet, have a piece of fruit or a square of organic dark chocolate.

Eliminate all processed foods, especially ultra-processed, packaged foods including bagged breads, cookies, crackers, cakes, breakfast cereals, granola bars, fast foods and anything that contains heat-destroyed, processed vegetable oils.

Eat a handful of fresh nuts every day. A 2013 study of nearly 18,000 people published in the New England Journal of Medicine found that those who ate the most nuts lived the longest. In fact, the more nuts they ate, the less likely they were to die from cancer, heart disease and respiratory disease.7

A number of holistic cardiologists advise some kind of fasting period, whether it’s once or twice a week for a 24-hour period, or only eating within an eight-hour window every day (intermittent fasting). Aseem Malhotra recommends skipping breakfast, although he does drink coffee with coconut cream in the morning.

Fasting may improve the way your body metabolizes sugar, which reduces insulin resistance. One recent study found that men who ate three meals within an eight-hour window (at 1 pm, 4pm and 8 pm) had decreased blood glucose and insulin concentrations compared to those who ate three meals over 12 hours (at 8 am, 1 pm and 8 pm). They also had increased levels of adiponectin, a hormone that reduces inflammation and improves insulin sensitivity.8

Get physical
Hundreds of studies point to the heart benefits of regular exercise, but a 2017 study of 130,000 people in 17 countries underscores that you don’t need a gym membership to get the benefits.

The Prospective Urban Rural Epidemiology (PURE) study showed that any activity – from running on a treadmill to walking to work or mopping a floor – allows people to meet the current guideline of 30 minutes of activity a day, or 150 minutes a week, to raise the heart rate.

Meeting the guideline by any means reduced the risk for death from any cause by 28 percent and death from heart disease by 20 percent.9 According to Dr Salim Yusuf, director of the Population Health Research Institute at McMaster University in Canada and the principal investigator of the PURE study, “If everyone was active for at least 150 minutes per week, over seven years a total of 8 percent of deaths could be prevented.”

What’s more, the more physical activity – in whatever form taken – the greater the benefits, with no indication of a ceiling effect. People getting more than 750 minutes of physical activity per week had a 36 percent reduction in their risk of dying.

Chelate toxins
Toxic metals such as lead and arsenic and hormone-disrupting chemicals like phthalates and bisphenol from plastics have all been increasingly linked to heart disease.10

In 2013, a massive $31 million study by the US National Institutes of Health shocked cardiologists when it reported a modest reduction in heart-related events among patients who received a form of chelation therapy – which removes metals from the body – compared to controls.

Notably, chelation therapy was linked to a 40 percent decline in bad outcomes, with few side-effects, in the heart patients with diabetes, with a more modest decline among nondiabetics. Combined with multivitamins, the therapy was even more effective. 11

Dr Kahn recommends that his patients use N-acetylcysteine to help flush toxins from the body and eat cruciferous vegetables like cauliflower, broccoli and bok choy, which also help chelate metals.

One study of N-acetylcysteine given at a dose of 1.8 grams per day for just four weeks found that the supplement reduced levels of the inflammatory molecule homocysteine and lowered blood pressure regardless of patients’ cholesterol status or whether they smoked.12

Sweat it out
Sweating is a key way for the body to dump toxins including metals like lead, arsenic and mercury, and to rid itself of unwelcome phthalates from plastics.13 Many studies have found that regular sauna use is linked to favorable cardiovascular health. Sauna has been found to lowe
r blood pressure and improve artery function.14

One 2018 study by researchers in Finland concluded that the more often people frequent a sauna and the longer they stay in one, the less likely they are to have a fatal cardiovascular event in middle age.15

Berberine, a brightly colored derivative of the goldthread plant, has been used in Chinese medicine for more than 2,500 years, and interest in its medicinal effects on the heart has grown in the West recently. A 2015 review describes positive effects of berberine on heart failure, high blood pressure, high cholesterol levels, insulin resistance, heart rhythm abnormalities and blood clotting,16 and it has also been shown to reduce blood sugar levels, fight obesity and have antioxidant and anti-inflammatory activity.17
Suggested daily dosage: 500 mg three times per day.

The essential mineral magnesium is necessary for blood pressure regulation, glycemic control and the breakdown of fats in the body. It’s also critical to cardiovascular function. According to a 2018 review, roughly 42 percent of hospitalized patients are deficient in magnesium. 18 Another study in a cardiac intensive care unit found that more than half (53 percent) of patients had magnesium levels below the lowest normal control.19
Suggested daily dosage: 400-800 mg, but 500 mg twice a day if you have heart palpitations. Choose magnesium chelate or glycinate, and avoid magnesium oxide, which may irritate the digestive tract.

Coenzyme Q10
Mitochondria are the powerhouses in every cell in your body. Oxidative damage to these little batteries contributes to a wide range of issues including cardiovascular disease. For 50 years, researchers have known that coenzyme Q10 (CoQ10) has an antioxidant effect and is critical to the energy transfer that takes place within mitochondria. Statins, however, have been shown to radically deplete CoQ10, which may explain their common side-effect of fatigue and pain in the muscles.

Though it is not widely followed advice, some studies have recommended that doctors prescribe CoQ10 to their patients taking a statin to counter this effect of the drugs. However, data has been mixed as to whether or not it provides any benefit.1 One possible reason for these mixed results is the difficulty of delivering CoQ10 inside the cell where it is needed.

Recently, researchers have developed mitochondria-targeted antioxidants to overcome this problem. The supplement mitoquinone (MitoQ) links a fat-soluble molecule to CoQ10 in order to help it penetrate inside the membranes of mitochondria.

A study published in 2018 in the American Heart Association journal Hypertension adds to a growing body of animal and human research that this novel antioxidant could be a powerful tool in the war against heart disease along with a host of other conditions.

Researchers from the University of Colorado at Boulder testing the supplement on healthy men and women found that compared to a placebo, mitoquinone increased blood vessel dilation by an astounding 42 percent, which, in practical terms, meant their blood vessels were performing like those of someone 15 to 20 years younger.

The study also showed that mitoquinone reduced oxidative stress in the mitochondria. These latest findings, if correct, suggest that mitoquinone could lead to a 13 percent drop in heart disease.2

Don’t forget to breathe
Stress has been extensively linked to heart disease.
Exercise, prayer and meditation, community volunteering and yoga are all recommended as ways to defuse killer stress from taking its toll on the heart. Stress is related to shallow, rapid breathing, so slowing down and deepening the breath has the opposite calming effect on the mind, the body and the heart. Dr Kahn prescribes a 90-second breathing exercise to counter palpitations and stress anywhere, called 4-7-8:

1. Sit up straight in a chair.
2. Place the tip of your tongue up against the back surface of the front teeth and keep it there throughout the exercise.
3. Breathe in silently and slowly to the count of 4.
4. Hold your breath for a count of 7.
5. Exhale through your mouth for 8 counts, making a slight audible sound (and still keeping your tongue in place on the teeth).
6. Repeat the 4-7-8 breathing cycle another three times, for a total of four 4-7-8 cycles.

More heart savers
Current medical research points to many powerful alternatives to statins and hypertensive drugs, minus the side-effects. Here are a few:

Blue light. University of Surrey researchers have found that exposure to visible blue light (radiating at 450 nanometers) produces positive effects on blood pressure, arterial stiffness and blood flow compared to a placebo condition. The light also boosts levels of heart-protective nitric oxide compounds in the circulation, similar to those produced by daily sunlight exposure.1

Vitamin D, the ‘sunshine vitamin’ our skin manufactures after exposure to sunlight, is highly heart protective, especially for those at very high risk who have already had one heart attack. University of Sydney researchers showed that vitamin D was able to stop the formation of cells that cause inflammation and scar tissue after a heart attack, and so reduce the likelihood of a second attack.2

Suggested daily dosage: The Vitamin D Society recommends that people maintain 25(OH)D blood levels between 100-150 nmol/L or 40-60 ng/ml, or take at least 4,000-10,000 IU daily

Ashwagandha. Also known as Indian ginseng, ashwagandha, used in Ayurvedic medicine for centuries, is known as an ‘adaptogen’ for its ability to counter stress effects on the body. Ashwagandha has been shown to increase the production of nitric oxide by white blood cells,3 which may explain its anti-inflammatory effects and benefits to cardiovascular health.

Suggested daily dosage: 500 mg twice daily, to counter stress, recommends cardiologist Joel Kahn

L-theanine, an amino acid found in green and black tea and some mushrooms, has been shown to reduce stress and stress-induced changes in blood pressure,4 which in turn have been linked to increased risk of heart attack and stroke.
Suggested daily dosage: Kahn recommends 200 mg twice per day

Rhodiola rosea, or Arctic root, is another stress-busting herb that has been demonstrated to control irregular heart beat.5
Suggested daily dosage: 100 mg

Main article

American Heart Association. Cardiovascular Disease: A Costly Burden for America. 2017
JAMA Cardiol, 2017; 2: 339-41
Lancet, 2019; 393: 407-15
N Engl J Med, 2017; 377: 1119-31
Diabetes Care, 2009; 32: 361-6
BMJ, 2013; 347: f7267
N Engl J Med, 2013; 369: 2001-11
J Transl Med, 2016; 14: 290
Lancet, 2017; 390: 2643-54
Environ Pollut, 2018; 242: 814-26; BMJ, 2018; 362: k3310; Am J Physiol Heart Circ Physiol, 2017; 313: H1044-53; Cardiovasc Toxicol, 2014; 14: 339-57
JAMA, 2013; 309: 1241-50
Am J Clin Nutr, 2015; 102: 1014-24
J Environ Public Health, 2012; 2012: 184745; ScientificWorldJournal, 2012; 2012: 615068
J Clin Hypertens (Greenwich), 2012; 14: 553-60; J Hum Hypertens, 2018; 32: 129-38
BMC Med, 2018; 16: 219
Chronic Dis Transl Med, 2016; 1: 231-5
Biochem Cell Biol, 2015; 93: 479-86
Open Heart, 2018; 5: e000668
Am Heart J, 1986; 111: 475-80

Coenzyme Q10

1 Ochsner J, 2010; 10: 16-21
2 Hypertension, 2018; 71: 1056-63

More heart savers

1 Eur J Prev Cardiol, 2018; 25: 1875-83
2 Heart Lung Circ, 2018; 27: 967-75
3 Life Sci
, 2003; 72: 1617-25
4 Nutrients, 2016; 8: 53
5 J Cardiovasc Electrophysiol, 2016; 27: 1093-101

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