Category Archives: 25. Heart Health

Mitochondrial Primer 4: Role of CoQ10

References: Mitochondria and Future of MedicineMortenson JACC Heart FailureLangsjoen Biofactors,

You should know what CoQ10 is by now. It is in every mitochondrion, in every cell in your body. Ubiquitous. It sits between Complexes 1,2 and 3 and passes on electrons, thereby playing a critical role in the electron transport chain. About 2% of electrons escape the electron transport chain, and CoQ10 soaks those escaped little electrons up before they can cause damage. You make lots of it when you are young. You make much less when you are older. It was discovered in 1957 and in 1972 the level of its deficiency was linked to congestive heart failure. Many cardiologists got interested in it and it became a widely used supplement, particularly with statins and muscle pain.

Initial studies of it were not exactly positive, perhaps because lab measurements were not as precise or available as they are today, thereby leading to inconsistent doses. But the Mortenson JACC study showed that 100 mg three times a day compared to conventional drug therapy alone reduced CV mortality by 42%, and all-cause mortality by 44%. That caught people’s attention.
Dr Sinatra has been one of its most prominent advocates and claims that the threshold of effectiveness is 2.5 ug/ml, and that one will not see much clinical benefit below that. He laughs off older studies that do not mention or measure blood levels. I personally see most folks with levels of .7 and 1.2 with very few above 1.5. Hmmm. As we age, we are all deficient.
The other controversy about CoQ10 is whether one should take the common cheap form, ubiquinone, or the fancy expensive stuff, ubiquinol. They do switch back and forth in the body quite easily, but the -ol form is a more potent anti-oxidant. The manufacturer claims that the expensive form is worth it and backs it up with a very small study of 7 people who had failed with the -one. In that study, the average ejection fraction went from 22% to 39%, and their average New York Heart Association CHF class dropped from IV to II. Very impressive. A very small study, not blinded so open to lots of problems.

The number two reason to visit a doctor is “fatigue”. If your mitochondria are weakened by low protection secondary to low CoQ10, one will have decreased heart pumping which will mean decreased delivery of blood to muscles. In muscles, the same low CoQ10 level will result in reduced muscle ability. We call that fatigue.

www.What will work for me. What I think is going on is that most folks never get to the threshold of effective therapy. With random dosing of CoQ10 from variable sources, I suspect some folks just aren’t getting enough, and some folks are getting knockoff CoQ10 that isn’t even the real drug. With the ability to measure its level, we can now really check. A starting dose should be 100 mg 3 times a day. And then ask your doctor to check the level. You are looking for a level of 2.5. Nothing less will do. If less, double your dose. Check again.

Pop Quiz

  1. What is the role of CoQ10 in the mitochondria?                      Answer: two roles. 1) Passing on electrons between complexes in the electron transport chain, and 2) catching loose ones that get away from the electron transport chain.
  2. What happens to CoQ10 levels as we age?                               Answer: Drop precipitously.
  3. How much will a heart’s ability to pump increase if you get a level above 2.5?            Answer: Mortenson’s study showed over 40% reduction in mortality and a very small study of the reduced form showed a 22-39% increase in cardiac output.
  4. What blood level of CoQ10 do you want for yourself?             Answer: 2.5 and above
  5. And what is the dose you need to get that?                               Answer: Start with 100 mg 3 times a day. Then test and then double the dose.

Statin Rage

Statin Rage

References: QJMPharmacotherapyPharmacotherapyTrans NeurodegenAm J MedATVBScientific AmericanGraveline,

You know statins are widely advertised as being good for your heart. And the literature supports that if we look at you as a “walking heart” with little more attached on the outside. Considering that the house of medicine makes the most money off you for heart disease, cardiologists hold a lot of sway over the health care system. Hence, when the heart doctors (aka medical “God”) say, “Thus spoketh….., thou shall take statins!” the house of medicine snaps to attention and does so. I’m not here to argue the whole case, just the case of cognitive damage as shown in “statin rage”. These are not innocuous drugs, and you are more than just a heart. Your brain might be important too. If you act like a jerk, your love relationships suffer and they might be more important to you than your arteries.
What does the literature say about cognitive effects? Quite a lot actually. What caught my attention was a plea from a client who has repeatedly felt terrible anger when exposed to statins. And he is a very high risk for heart disease, and “needs” his statin. Or does he? Is there another way? (Hint: YES!!)
I reviewed several studies. The first in Translational Neurodegeneration suggests there are two competing processes going on. They review all the studies of cognitive decline, and find design problems with all the studies: for example, most patients in some studies are on low dose statins whereas high dose is what makes the side effects, and most patients are actually on higher doses. But they end up concluded that there really are some folks who get pretty severe memory issues, and get better when the statin is stopped. They plead that we be aware of those effects and be brave enough to stop the statin if memory issues occur. Just stop!
In the QJM study, four patients were found with “manifestations of severe irritability” included homicidal impulses, threats to others, road rage, generation of fear in family members, and damage to property. All got better on stopping the statin, and worse again when it was restarted. Conclusion: be brave enough to stop!
There is more. Scientific American has a nice review on memory loss and statins. Duane Graveline, NASA astronaut, lost his memory for the duration of being on statins and wrote a book about it. You might want to read that book if it catches your eye.
www. What will work for me. Loss of memory, road rage. How much can you take? These effects may not be common, but they are indications that there is brain damage/effects of taking statins. And published studies in randomized fashion of cognitive ability again show damage, albeit not that commonly. One could ask, just how well do the people selling the drug report of effects that could damage their sales? Only you can answer that one. As for me, I’ll change my diet to avoid taking statins. There are other answers that are just as effective. For example, consider Gundry’s report at the American Heart meeting just a month ago. Hmmm. Cheaper, better, no side effects.

 

Pop Quiz

  1. Statins can damage your brain. T or F                                     Answer. True as shown by memory loss, cognitive decline, rage, and mood…….
  2. The only organ that matters in your body is your heart, and as long as you let your heart be the only organ that is talked about, statins are useful. T or F                 Answer: Ok, do you get the irony?
  3. Randomized studies, conducted by the folks selling a product, are likely to be absolutely clear about picking up pervasive, subtle shifts in cognitive ability?       Answer: Can you tell that I’m on a rant here? I’m deeply skeptical about the integrity of our pharmaceutical industry, considering their demonstrated history.
  4. Is there a role for statins?                                                                              Answer: I think there is. Someone who wants to keep eating donuts and ice cream, sugar and white flour, and has had a heart attack, likely needs to be on a statin. Those willing to eat differently and let their lab tests, including their cholesterol, be their guide, there are choices.
  5. How common is statin rage?                                                                 Answer: Rare. It’s there, but not common. Many other brain effects. It’s a “no brainer”. Gotta stop.

 

 

Avoiding Lectins Reverses Endothelial Dysfunction – The Proof

References: ATVBBill Davis of Wheat Belly,

Gundry has got his smoking gun! A poster presentation at the AHA meetings with an abstract is now on the books. This is bigger than you may think. It certainly is the first step. This is exactly along the same line as Bill Davis, of Wheat Belly fame. 
Endothelial dysfunction is code word for the first step to vascular disease. Vascular disease is the process that ends up with a heart attack or stroke. Half of us are dying from it, so this is getting right to the “heart” of the matter. But Gundry has now collected and published the data that proves how you eat can reverse the first steps, and reverse the driving dynamic behind heart disease. 
What Gundry is reporting here is not the strongest of evidence because of the design of the study he has done. He took 200 folks in sequence who presented to his clinic. Higher quality studies get subjects at multiple sites with multiple varied doctors reviewing them, and randomize them with a placebo group. This study involved subjects ages 51-86, M:F ratio 3/2, with known vascular risk factors of high blood pressure, diabetes, high cholesterol, prior heart attack, a stent or heart surgery. They were enrolled in a dietary program which emphasized large amounts of leafy green vegetables, olive oil, radical reduction of grain products, legumes, nightshades, and fruits; and generous amounts of grass-fed animal proteins, emphasizing shellfish and avoiding commercial poultry. All patients were instructed to take 2-4,000 mg of high DHA fish oil, 200mg of grape seed extract, and 50 mg of Pycnogenol per day. All patients had endothelial reactivity testing before and after a 5-minute arm occlusion using the EndoPAT 2000 machine (Itamar, Israel) at baseline and at 6 months.

Their Endothelial Reactivity went from 1.88+/-0.7 to 2.25+/-0.5 (range 1.2-3.6) (p<0.01) over 6 months. Only 40/200 (20%) remained with ED, but all had increased ER numbers. Ten patients stopped the polyphenols after a normal PAT; all redeveloped Endothelial Dysfunction all over again on repeat PAT. Put simply, eating the supplements with the diet made the patients arteries get stretchier, and stopping the program made them worse again.

That’s what you want to see. A stretchy artery helps carry the pulse wave forward. A rigid, stiff artery pushes back against the heart and cuts down on the blood flow in the heart as it shortens the time between heart beats during which blood flows into cardiac vessels. Our elders called it “hardening of the arteries” and it was. The endothelium (think “the lining”) of your artery does much more. 
Your vascular tree of blood vessels is huge and the lining of it, called the “endothelium” is the largest organ in the body, considering that we have about 100,000 miles of blood vessels in our bodies. Its ability to function properly is right at the nexus of what we eat and what our cells see. Many chemicals flood into the blood from your gut and the endothelium of blood vessels is the last barrier between the outside world and your precious, vulnerable cells. A proper working endothelium is critical for many functions; filtering out dangerous chemicals, carrying the pulse wave along, watching for invading bacteria. And Gundry just proved that taking care of it is the first step in the right direction. It can be reversed. Plain and simple. 
To reiterate: Supplement with pycnogenol, fish oil, and grape seed extract. Avoid lectin-rich foods: wheat, legumes, nightshades, grains and animals fed those foods like poultry and cattle. Eat lots of green, leafy vegetables and not so many roots. And lose the sugar. In all its forms. Your arteries will heal. 
WWW.what will work for me. I already was taking the fish oil and the pycnogenol but I will start with the grape seed extract. I have an ED machine in my office and have a baseline. If I had calcium in my arteries, I would be doing this all the more passionately. I also want to start measuring the reactivity of my blood to adequate carotenoids. That’s next week. Stay tuned.

Pop Quiz

  1. What is the largest organ in the body?                                  Answer: Ok, ok, we can fight about it. The liver is the biggest of the traditional internal organs and the skin gets the prize for size. Recently the “interstitium” which is all the additional connective tissue has been touted as the biggest. But if you get down to that detail, the lining of your blood vessels wins – the endothelium.
  2. High endothelial reactivity demonstrates out of control blood pressure? T or F Answer: FALSE. No, you want a stretchy, flexible endothelium. The stiff, rigid low score means you are stiff and rigid. Getting old. Gundry showed an increase of 1.88 to 2.25 in just 6 months with his program.
  3. How does all this improvement work?                                 Answer: Stay tuned. We don’t know all the details but Gundry’s books make the arguments that the lectins in plants that set off inflammation collectively damage our endothelium. Our bodies have not had enough time to adapt to them after we came out of Africa. Avoiding bad foods is the first step. Then, providing the tools to calm down inflammation is the next layer
  4. Why fish oil on the list?                                                          Answer: Fish oil is a rich mix of omega three fats which are the precursors to building anti-inflammatory messengers. Giving more precursors pushes the balance of inflammation towards being calmed down instead of amped up which regular fats do.
  5. Why is grape seed extract included?                                   Answer: Proanthocyanidins and catechins are the potent antioxidants in grape seeds that are believed to be 20 times greater than vitamin E and 50 times greater than vitamin C

Chelation Therapy for Coronary Artery Disease – the TACT Study

References: NIHJAMAAHA, EHP,

Imagine my surprise when a doctor calls me and asks me to do chelation on himself for coronary artery disease. He referenced the TACT study which I had not read. Now I have and here are the results. I’ll try and put it into the context of risks and what is going on.
Chelos is Greek for claw. Chelation is making a chemical claw around a substance that is otherwise inert, dangerous or insoluble. Lead meets the inert quality. Iron meets the dangerous criteria. Chelation has been used medically to reduce both of those substances when they are toxic. But there is conflicting evidence about iron levels and risk of coronary artery disease and recent trends of studies appear to be on the side of it NOT being a problem. This flies in the face of initial enthusiasm about iron reduction, like that generated by the Finish study showing an 88% reduction in risk by frequent blood donation. This study from Helsinki followed 2,862 males aged 42-60 for 9 years. Heart attack rates for blood donors was only 0.7%, compared to 12.5% for non-donors. It’s hard to get that sort of effect unless something real is going on. Now, they didn’t account for the frequency of saunas, which many Finns do (building codes in Finland require every new apartment and home to have a sauna built in it). One study from Finland showed that frequent saunas are as beneficial as exercise for reducing heart risk.
What does chelation do? It sucks bad things out of your body by enveloping the target chemical, making it water-soluble by that envelopment, and then excreting it. It’s not just iron that gets enveloped. It’s whatever happens to be around. Lead is one of those enemies. The evidence of lead and hypertension is very strong. The subsequent association with coronary artery disease isn’t quite as robust, but is also strong. Both lead and iron get chelated when exposed to the chelating chemical, typically EDTA. But so is cadmium, mercury, thallium, uranium and on and on. All of these metals are dangerous and to date, not having been studied much. We just don’t know data on multiple, combinations, and likely never will. Research questions tend to focus on one variable at a time.
How do you do chelation? Properly done, you take mineral supplements before and in-between treatments (a fortified vitamin pill). EDTA is given by IV over about 3 hours once a week. And get a reverse osmosis filter at home to keep the dangerous metals out of your water.
What does the TACT study show? Well, in diabetic men, who represent about 1/3 of the 1,708 men in the TACT study, EDTA chelation reduced the risk of subsequent heart attack by 52%, and fatal heart attack by 41%. Taking high dose vitamins and minerals along with the EDTA to rebuild up “good minerals” resulted in the greatest benefit. My read of heart disease risk is that abnormal blood sugar is anything over 86, which differs dramatically from medicine’s range of blood sugar being ok up till 124. But benefit did not accrue to men in the traditional range of diabetes.

WWW.What will work for me. What would I do if I had a heart attack? It is pretty reasonable to suggest that spending 9 months of weekly EDTA visits is worth it. Heart attacks kill. In fact, 50% of us are done in by them.  For now, I’m working on reducing my heart attack risk by getting my blood sugar lower so I turn off the engine that drives heart disease.

Pop Quiz

  1. Chelation does what to water-insoluble metals?                                Answer: encases them in a water-soluble “claw” and allows them to dissolve into blood, and be excreted in the urine.
  2. How much can chelation reduce the risk of a heart attack?             Answer: If you are diabetic, your chance of recurrent heart attack can be cut in half.
  3. Is it worth it?                                                                                             Answer: Let’s see. A simple heart attack with 5 days in the hospital and 6 months of rehab will likely run you around $ 75,000 with a 13% chance of death. Your answer.
  4. How do you do chelation?                                                                     Answer: It takes in IV treatment of about 3-4 hours once a week for about 9-12 months.
  5. Is the science robust for reduction of iron and reduction of heart attack risk? Answer: It appears to go back and forth. In younger years, iron deficiency is the most common nutritional deficiency in America. As we get older and keep absorbing iron, it flips.  The conflicting results may be because of that.

What’s the Big Deal with Homocysteine?


Reference: Amer Jr Clin NutritionNutrition JournalLIfe Extension,

We’ve known about the risks of homocysteine since the late 60’s when a Harvard researcher by the name of McCulley brought it to the world’s attention with his research. At that time there was a brutal PR war going on about lipids and cholesterol as being the cause of heart disease, which the pharmaceutical industry took up with enthusiasm (because there was so much money to be made). McCulley was essentially booed off the stage with his ideas and homocysteine was swept under the rug, despite continuing research showing that it had an association with headaches, heart attacks, strokes, osteoporosis, macular degeneration, and dementia. Ok, which of those don’t you have? This is the perfect portfolio of what we are getting sick from in this 21st century, and homocysteine is sitting right in the middle of it.
What does homocysteine do? Well, it is really just a shuttle bus moving methyl groups around inside your cell. It backs up when you don’t have enough. That simple. But what do you need methyl groups for? Ah, there’s the rub. (Poor Hamlet, thinking of suicide) Methyl groups are needed to label DNA so that you know which DNA to turn on and off. Having sufficient Methyl-FOLATE, one of the key sources of methyl groups is so powerful that women trying to get pregnant who take METHYL-FOLATE starting one year prior to conception will have as much as a 70% reduction in premature delivery. Wow! Throw in B12 (the other source of methyl groups in nature) with the methyl folate and spina bifida drops 5 fold during pregnancy. I could go for pages describing these effects in the literature, but you get the gist. You need methyl groups to tag and label DNA so that you can turn on the right genes at the right time. Add B6 and methyl glycine (a reservoir chemical to give methyl groups to folate and B12) and you will have pristine, perfect homocysteine levels.
The other thing methyl groups do is to be the first step in making “gunk” water soluble so you can excrete it through your kidneys. Lots of neurotransmitters are “methylated” on their way to excretion, as are all our hormones. Without sufficient methyl groups, we back them up and make more dangerous models.
Where do you get methyl-folate from? The foods are essentially all peas and green vegetables (spinach, asparagus, broccoli), foods we don’t eat anymore. If you eat lots of greens and black-eyed peas (yummy southern soul food cooking) you get lots of good folate.
The real problem is that we don’t measure homocysteine routinely. In fact, many health networks forbid measuring it because it’s not on their list of approved lab tests. Trust me. I know. I’ve gone to battle with one large local health care system only to be told by a nurse reviewer that it doesn’t meet their criteria.
And the irony is that it is ridiculously easy to lower to a normal range. Bredesen in his online training and his book, The End of Alzheimer’s, wants your homocysteine to be 7 or below. You lower it by taking B vitamins.
And that’s what this week’s studies show. B vitamins help slow cognitive decline in aging men. You can correlate that with high homocysteine. The average man in America has a level of 12 but I’ve seen as high as 42 now. For every 1 point above 7, you get a 16% increased risk of Alzheimer’s. Dropping your homocysteine from 12 to 7 halves your risk. Isn’t that just peachy! So simple, so easy, so elegant.
How did we get in this pickle? We evolved eating lots of green leafy vegetables in Africa. We lived to 35. It didn’t harm us then. Bruce Aime’s Triage Theory points out that until a nutrient deficiency makes a biological imperative for evolutionary pressure, it won’t cause trouble. We can skate along the edge of deficiency and not be affected until we fall over that cliff.

WWW.What will work for me. Well, the “cliff” appears to be about age 50 when we seem to get into trouble with sufficient B vitamins. I see very few folks with normal homocysteine. I had a level of 12 when I started and on daily B vitamins, I get down to about 9. I’ve just started with more methyl-folate and I’m waiting to test myself again. I’m bracing for paying the lab fee myself as I know my insurance may not cover it.

Pop Quiz

  1. What does homocysteine do?                                        Answer: It’s a passive amino acid shuttle that carries a methyl group off to attach to other chemicals. It’s simply a marker of sufficient methyl groups for everything else downstream.
  2. Soul food is inherently unhealthy? T or F                    Answer: Timeout. Probably the best way to get methyl folate through food. At least if you are eating greens and black-eyed peas.
  3. What should women wishing to become pregnant do in regard to methyl folate?                        Answer: Take it continuously for at least one year prior to pregnancy initiation in order to reduce their risk of premature delivery as much as 70%
  4. Why doesn’t lack of B vitamins hurt us more sooner? Answer: Bruce Ames triage theory explains that it does hurt us if we put on the right glasses to see it’s effect. It takes years of labeling DNA badly for the effect to show
  5. For every point increase in homocysteine over 7, my risk of dementia goes up how much? Answer: 16% You should know your homocysteine. Always.

Sufficient Vitamin D Improves Vascular Health

Sufficient Vitamin D Improves Vascular Health

References: Indian Jr Endo MetabAmerican Journal of Cardiology,

I was excited last year when it was reported that Vitamin D helped folks with congestive heart failure. When 233 patients with congestive heart failure were randomly given Vitamin D, their 6 minute walk time didn’t improve, but their ejection fraction increased 23% relatively, or 6% absolutely. The dose was 4000 IU a day, with no loading dose. Note, half of us will die of congestive heart failure, so this is a big deal for older folks, particularly those with congestive failure. You may not be able to walk further, but you are still walking. Most folks with an ejection fraction (the percent of blood your heart can pump out with each stroke, where normal is 65 and dead is 18) in the low 20s die within a year or less. So, being around fora year to finish a study is cool. I added Vitamin D to my Congestive Heart Failure protocol.

I’ve been watching for mechanisms of just how it works. Here it is! In this study, 103 folks with Vitamin D deficiency (below 20 ng) were given 60,000 IU a week for 8 weeks. Measurements were taken of vascular function like carotid-femoral pulse wave velocity, brachial-ankle pulse wave velocity, arterial stiffness index and oxidative stress markers like serum malondialdehyde levels and total antioxidant status. They demonstrated about a 10% reduction in pulse wave velocity, (996 cm.sec to 899 cm/sec) and systolic blood pressure from 115 to 106. All were statistically significant. Lowering blood pressure (996 cm.sec to 899 cm/sec) and systolic blood pressure from 115 to 106. All were statistically significant. Lowering blood pressure even 2 points reduces risk for vascular disease 4-6%.
[Now, there are any number of studies that are referenced in this article where Vitamin D didn’t help heart disease. Many of these have been highlighted in the popular press to suggest that vitamin D supplementation doesn’t work.

Cardiologists like to quote them to justify having a cath instead of taking D. Hmmm. Just about every one of those studies gave lower doses of D, in the 2000 iu range, for 6-8 weeks at a time. This is a good example of the utter stupidity of most studies that essentially don’t understand the physiology of Vitamin D. Your bodies fat tissue soaks up D and stores it. It is fat soluble. You are a big tank. If you are overweight, you are a bigger tank. When you start a new dose, it will take your body a full year before a new homeostasis is achieved. In the long run, a dose of 3-4,000 IU a day is sufficient in most folks to get to a level of 50 ng, my definition for replete.

This study effectively gives a loading dose. 60,000 IU a week gets to threshold.   I give 100,000 IU because that has been proven to raise your D level 14 ng a day. If someone is low, < 20 ng, you can give two doses in a row. They will add 14 ng a day and in two days will be at 45-50. Finally, Vitamin D works as your stem cell hormone, telling stems cells to wake up and start maturing into mature cells. Mature cells can do their function. It takes months for a mature cell to grow and start doing its function. If your D level is rising so slowly that you don’t have enough for a year, a study lasting 12 weeks, with an inadequate dose of D will never show an effect.

The final point to make about D is the clear need for it to be accompanied by K2. Weston Price highlighted this in the 1920s because that is what he observed when he documented the lifestyles and diets of “primitive” people. Like every pioneer, Weston Price didn’t get everything right, and his foundation has a few tangents that are off base, but by and large, he opened the door on omega fats, K2 and D, something we didn’t appreciate for another 70 years. When you look at D in isolation, you will often likely miss the beneficial effect if you don’t control for Vitamin K input. Increasing recognition of the complexity of our metabolism can be seen in the interplay of D and K2. They are really part of a biological partnership. Both are fat soluble.

www.What will work for me. I’m getting a better understanding of how D and K work together. Seeing a study where adequate doses of D make an impact when similar inadequately dosed folks didn’t get an impact is an important distinction. The self righteous deniers of this effect can’t explain that. Once they are ensconced in nay-saying, they keep nay-saying. As for me, I cheerfully take my D, 3500 IU a day in the form of 100,000 once a month. And I wear a hat and sun screen. Just one more skin cancer to take off my back.

Pop Quiz

  1. Vitamin D works by……….? Activating many genes, (10% of the human genome) which stimulates stem cells to become mature cells.
  2. It takes Vitamin D how long to change your blood level? Answer: If you don’t take enough, you will never get to an adequate blood level but generally you reach a new homeostasis in about a year after starting a new dose.
  3. To get to an adequate blood level Vitamin D, you need a loading dose of …..? Answer: 100,000 IU for every 14 ng you are deficient. If you want to get to a level of 50, and your level is 8, you need ………….? Answer: 3 doses of 100,000 IU, one day apart each.
  4. Your arterial blood velocity will drop when you take Vitamin D, which means your arteries have gotten stretchier and your blood pressure has dropped. T or F
    Bingo.
  5. To prove that Vitamin D works on heart disease, you likely need to do what in terms of designing a study? Answer: It has to run longer than a year, have a loading dose, and take sufficient D to get to a level of 50. This has never been done. Any study with less, shorter, and no loading dose, no monitoring of blood level and no randomization will not show scientifically meaningful results. Meanwhile, the physiology of benefit sits right here, in this study.