Read The Great Cholesterol Myth Online
Authors: Jonny Bowden
The Great Cholesterol Myth (26 page)
The other half of the vitamin E story concerns the four components known as the
tocotrienols
. Tocotrienols are turning out to be the real heavy lifters in the vitamin E family, at least when it comes to benefits for the heart. They have more potent antioxidant activity than tocopherols do.
32
They also increase the number of LDL receptors, which helps with LDL removal.
33
Tocotrienols provide significant lipid-lowering effects in experimental animals, and most prospective studies have demonstrated the same thing in humans.
34
If you take vitamin E, we recommend that you always get it from a supplement labeled “mixed tocopherols” in order to avoid the problems that can occur with pure alpha-tocopherol supplementation. A vitamin E supplement that is 100 percent alpha-tocopherol is less effective and may even be problematic in high doses. Virtually all the studies showing negative results used the alpha-tocopherol form or,
worse, the synthetic dl-alpha-tocopherol form. (The dl-alpha-tocopherol form should be left on the shelf to rot!)
If you add 200 IUs of mixed tocopherols or high-gamma vitamin E to a regimen that also includes vitamin C and CoQ
10
, you should be fine!
If you’ve read this book sequentially, you’re already familiar with omega-3 fatty acids from our extensive discussion of them in
chapter 5
, so here we’ll highlight just a few of the many studies demonstrating the value of omega-3 fats for the heart. (We should also point out that there is equally compelling research documenting the positive effect of omega-3s on the brain as well,
35
but because this is a book on cholesterol and cardiovascular disease, we’ll focus on the heart.)
More than thirty years ago, scientists began to notice very low rates of cardiovascular disease among Greenland Eskimos compared to age- and sex-matched Danish control subjects. Shortly afterward, they were able to link these low rates of heart disease to high consumption of omega-3s in the Greenland diet.
36
This discovery triggered an enormous amount of research on the role of fish oil in preventing heart disease. (On the day of writing this—December 7, 2011—a National Library of Medicine search for the term “omega-3 fatty acids cardiovascular” produced 2,524 citations.)
One recent review of omega-3s and cardiovascular disease by Dariush Mozaffarian, M.D., of the Harvard School of Public Health, concluded that omega-3 consumption “lowers plasma triglycerides, resting heart rate, and blood pressure and might also improve myocardial filling and efficiency, lower inflammation, and improve vascular function.”
37
Mozaffarian also noted that the benefits of omega-3s seem most consistent for coronary heart disease mortality and sudden cardiac death.
In case your eyes were beginning to glaze over from all the medical journal speak, let’s sum it up in plain English:
There is reliable and consistent research evidence demonstrating that omega-3 fats, mainly from fish, lower the death rate from heart disease and lower the risk of sudden cardiac death
. This is hardcore evidence that fish oil saves lives.
One of the landmark clinical studies of omega-3 supplementation in a high-risk population was published in 1999 and was known as the GISSI-Prevenzione trial.
38
More than 11,000 patients who had suffered a heart attack within the past three months were randomly assigned to receive either 1 g a day of omega-3s, 300 mg of vitamin E, both, or neither, in addition to whatever standard therapy they were receiving. Vitamin E had no effect, but omega-3s were associated with a 20 percent reduction in mortality and a whopping 45 percent reduction in the risk of sudden death. These effects were apparent within a mere three months of therapy.
39
International guidelines recommend 1 g of omega-3 fats daily for all people who’ve already had a heart attack or for patients with elevated triglycerides.
40
Experts believe these guidelines will soon be extended to patients with heart failure as well.
41
It’s worth mentioning that the overwhelming majority of research on omega-3s and heart disease
was done using the two omega-3s that are found in fish, EPA and DHA. But other studies have also found that ALA—the omega-3 found in plant foods such as flax and flaxseed oil—has benefits for the heart as well. One review of the literature pointed out that both
in vitro
(test-tube) studies and animal studies have shown that ALA can prevent ventricular fibrillation, the chief mechanism of cardiac death, and that it might be even more efficient at preventing this than EPA and DHA are. The review also noted that ALA was effective at lowering platelet aggregation, which is an important step in thrombosis (a stroke or nonfatal heart attack).
42
Even if you’re already on a statin drug and have decided to remain on one, fish oil can still help you. One study found that among more than 3,600 people with a history of cardiovascular disease—many of whom were on antiplatelet drugs, antihypertensive agents, and nitrates—daily fish oil supplementation led to a statistically significant 19 percent reduction in major coronary events compared to the control group.
43
Omega-3 fats, particularly from healthy, wild fish, are your heart’s best friend, whether you’re recovering from a heart attack or hoping to prevent one. They lower triglycerides. And they lower blood pressure. And best of all, omega-3s are among the most anti-inflammatory compounds on the planet, meaning they have a beneficial effect on the root causes of heart disease.
We recommend that you take 1 to 2 g of fish oil daily, and that you eat cold water fish (such as wild salmon) as often as you can. (We both recommend Vital Choice, an impeccable source of wild salmon from pristine Alaskan waters that is reasonably priced and shipped in dry ice directly to your door.)
When you supplement with fish oil, remember that the total amount of omega-3s is not what’s important. Bargain-basement omega-3 supplements often tout on their labels how much omega-3 they contain. This number by itself is meaningless. You want to know specifically how much EPA and DHA are contained within each capsule. These are the gold nuggets in the prospector’s tin—you don’t care about the
total
amount of stones in that pan, you care about the
gold
. EPA and DHA are the gold. Try to get at least 1 g daily of combined EPA and DHA. (For many of his patients, Dr. Sinatra prefers higher DHA, as it penetrates more into the heart, brain, and retina than EPA does, so he frequently uses squid or algae oil in addition to fish oil because of its higher DHA content.)
Pantethine is a metabolically active (and somewhat more expensive) form of vitamin B
5
(pantothenic acid
)
. The blood tests of patients with dyslipidemia—a fancy way of saying that their blood levels of cholesterol are too high—significantly improve with pantethine supplementation. And although this can’t be seen on a blood test, pantethine also reduces the oxidation of LDL.
44
No fewer than twenty-eight clinical trials in humans have shown that pantethine produces significant positive changes in triglycerides, LDL cholesterol, and VLDL, along with increases in HDL cholesterol.
45
In all of these trials, virtually no adverse effects were
noted. The mean dose of pantethine in these studies was 900 mg per day given as 300 mg three times daily. This appears to be the optimal dosage, and it is the one we recommend.
According to a review of the literature on pantethine published in
Progress in Cardiovascular Diseases
, Mark Houston, M.D., noted that in most studies, at the end of four months pantethine reduced total cholesterol by 15.1 percent, LDL by 20.1 percent, and triglycerides by 32.9 percent, with an increase in HDL of 8.4 percent.
46
Houston also noted that in studies of longer duration, there appeared to be continued improvement. (The only adverse reactions were mild gastrointestinal side effects in less than 4 percent of the subjects.) As previously stated, we recommend 900 mg of pantethine divided into three daily doses of 300 mg each.
Picking the “top” supplements for treating any health issue is always difficult. In trying to keep the list from being too overwhelming, you’re always going to leave a few good things out. There’s also the very real issue of compliance. Most people don’t like to take a lot of pills, even if the pills in question are natural substances that will boost or protect their health. We consider the following supplements important, and we suggest that you read about what they do and consider using them in addition to the key supplements discussed above.
Vitamin C.
Vitamin C is one of the most powerful antioxidants in the world, and because heart disease is initiated by oxidative damage (damage caused by free radicals), any help you can get in the antioxidant department is a good thing. And the evidence is not just theoretical: A large 2011 study published in the
American Heart Journal
found that the lower the level of vitamin C in the blood, the higher the risk for heart failure.
47
Take 1,000 to 2,000 mg a day.
Worth knowing: Vitamin C is extremely safe, and side effects are rare because the body can’t store the vitamin. (In some cases, doses exceeding 2,000 mg a day can lead to a little harmless stomach upset and diarrhea.) The bigger danger is the fact that vitamin C increases the amount of iron absorbed from foods. People with hemochromatosis, an inherited condition in which too much iron builds up in the bloodstream, should not take more than 100 mg of supplemental vitamin C.
Curcumin.
This extract from the Indian spice turmeric has multiple benefits, not the least of which is that it’s highly anti-inflammatory. Scientific research has demonstrated its anti-inflammatory, antioxidant, anti-thrombotic, and cardiovascular protective effects.
48
Curcumin also reduces oxidized LDL cholesterol.
49
In animal studies, it was shown to protect the lining of the artery walls from damage caused by homocysteine.
50
The synergistic relationship of curcumin with resveratrol is espeically important.
Resveratrol.
Resveratrol is the ingredient in red wine that’s best known for its “anti-aging” activity. It helps protect the arteries by improving their elasticity, inhibits blood clots, and lowers both oxidized LDL and blood pressure.
52
Not a bad résumé! It’s both a strong antioxidant and a strong anti-inflammatory, inhibiting a number of inflammatory enzymes that can contribute to heart disease. It also inhibits the ability of certain molecules to stick to the arterial walls, where they can take up residence and contribute to inflammation.
53
The recommended daily dose is 30 to 200 mg of trans-resveratrol, the active component of resveratrol. Read labels carefully to see what percentage of the capsule is actually the “trans” variety, because that’s the only kind you care about.
Hyperviscosity refers to sticky, or sludgy, blood. When blood thickens, it bogs down as it moves through the blood vessels, causing platelets to stick together and clump. Blood vessels become more rigid, less elastic, and frequently calcified. The danger lies in the tendency to form clots that can block vessels leading to vital organs.
Nattokinase is extracted from the traditional fermented soy food natto, believed by many researchers to contribute to the low incidence of coronary heart disease in Japan. It provides a unique, powerful, and safe way to eliminate clots, or reduce the tendency to form clots, and thus decrease the risk of heart attack and stroke.
51
Lumbrokinase, developed in both Japan and China, comes from an extract of earthworm, a traditional source of healing in Asian medicine. These two separate products of dynamic Asian research share a powerful and common property of great interest to anyone who wants to protect their cardiovascular system: They are natural clot eaters.
Here’s how it works: Your body naturally produces
fibrin
, a fibrous protein formed from fibrinogen. (A fibrinogen test is one of the blood tests we recommend—see
chapter 9
—because it is a good marker of how much fibrin you’re making.) Fibrin is both good and bad. Its clot-forming action is immediately activated when bleeding occurs, so that’s a good thing. But excess fibrin activity can produce consistently thick blood, and that’s a big problem.
To offset the danger—and to create thinner blood—the body produces another substance called
plasmin
, an enzyme whose job is to break down excess fibrin. A nice system of checks and balances. But if plasmin, the natural anticlotting agent, becomes overwhelmed and can’t keep up with the job, there’s trouble in River City. And that’s where nattokinase and lumbrokinase come in. If blood clots in an already narrowed blood vessel, you’re basically screwed. So if you can dissolve the clotted material, you can open arteries and improve blood flow. If you reduce the clot even just a tiny bit, you get a significant blood flow boost.
Nattokinase and lumbrokinase are natural blood thinners. They can literally turn your blood from the consistency of ketchup to the consistency of red wine! Best of all, they work pretty quickly, within minutes to hours.
If you take these supplements preventively, you may not form clots in the first place.
Cocoa flavanols.
Plant chemicals in cocoa known as
flavanols
help the body synthesize a compound called nitric oxide, which is critical for healthy blood flow and healthy blood pressure. Nitric oxide also improves platelet function, meaning it makes your blood less sticky. It also makes the lining of the arteries less attractive for white blood cells to attach to and stick around. Researchers in Germany followed more than 19,000 people for a minimum of ten years and found that those who ate the most flavanol-rich dark chocolate had lower blood pressure and a 39 percent lower risk of having a heart attack or stroke compared to those who ate almost no chocolate.
54