Patient One discusses the role natural supplements can play in heart health with Natural Practitioner Magazine

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Millions of Americans are affected by heart disease, and as the numbers continue to grow, practitioners are more interested in offering natural approaches to standard pharmaceutical treatments.

Heart disease is the leading cause of death in the U.S., killing about 600,000 people every year, according to the Centers for Disease Control and Prevention (CDC).1 And about 80 million people are living today with some form of cardiovascular disease, including coronary artery disease (CAD), cerebrovascular disease (CVD) and peripheral arterial disease (PAD), as well as hypertension, rhythm disorders and congenital valve disease, according to Elizabeth Klodas, MD, FACC, of Preventative Cardiology Consultants and Truhealth MD (Minneapolis, MN), who has been counseling patients on heart health for more than 15 years.

The prevalence of heart disease is increasing as the population ages, especially the types associated with poor diet and an unhealthy lifestyle such as CAD, CVD and PAD. “Although some disorders are inherited or otherwise completely unrelated to lifestyle, cardiovascular disease is, by and large, a food-borne illness,” said Dr. Klodas.

Americans typically have poor diets consisting of too much fat and sodium, particularly from processed and restaurant foods, which raises blood pressure and the risk of heart disease and stroke. These processed foods are to blame for many heart issues, as are foods that are high in saturated fat and sugars, according to Ashley Watson, media content developer at Vermont-based DaVinci Laboratories, a company that has been offering dietary supplements to practitioners for 40 years.

The Institute of Medicine recommends 1,500 mg of sodium daily as the adequate intake level for most Americans, and advises a limit of 2,300 mg per day (a number that many people exceed). However, people over the age of 51, African Americans, those with high blood pressure, those with diabetes and people who have chronic kidney disease should keep their daily intake under 1,500 mg.2

But instead of following these guidelines or improving their lifestyles, many patients, when faced with high cholesterol or high blood pressure, turn to pharmaceuticals such as lipid-lowering agents (statins) and anti-hypersensitive medications. A large portion of people also undergo invasive procedures ranging from stent implantation to bypass surgery, according to Dr. Klodas. “However, these approaches address only the symptoms, not the cause of the disease,” she said. “And more practitioners are questioning whether current practice makes sense or is even sustainable.”

Fortunately, more people are seeking some form of a natural approach, even if it’s due to their pharmacist recommending a replacement of crucial nutrients lost due to medication side effects, said Amber Lynn Vitse, CN, LMT, an ayurvedic practitioner who has been recommending testing, lifestyle changes and nutrition pathways, along with her clients’ medical recommendations from their physicians, for about 13 years.

Further, patients may be turning to natural approaches due to side effects associated with pharmaceuticals. “Most medications for high cholesterol, low HDL, clotting tendencies, high triglycerides, high blood sugar, poor insulin uptake and high blood pressure all have unwelcome side effects,” Vitse said.

What To Look For

Standard tests are often given to patients who have heart health concerns, but unfortunately few delve deep enough to assess true risk. “For decades, doctors and patients have assumed that a healthy lipid profile and normal blood pressure indicate very low risk,” said Kelly C. Heim, PhD, of Pure Encapsulations, a Massachusetts-based company that has been offering dietary supplements to practitioners since 1991. “We now know that these parameters comprise a small part of a clinical puzzle that scientists continue to elaborate.” Normal lipid levels can be within the accepted range, but many people are unknowingly “ticking time bombs” due to inflammation in their bodies, noted Vitse, which is often an underlying cause of cardiovascular health issues. “Free radicals produced by stress, lack of proper nutrition, toxicity and inflammation initiate the process,” she said. “They damage the vessels, leaving areas that attract metals, minerals and cholesterols, forming plaques and blockages. The body’s innate mechanisms of healing are exactly what perpetuates the problem—the cascade of inflammatory signaling molecules, and the ensuing formation of a scab and swelling in a damaged area.”

Beyond the conventional lipid and blood chemistry profiles, Vitse suggested practitioners send any patient with a family history of heart disease or concerning symptoms for the following tests: homocysteine and MTHFR gene mutation if this it comes back high; fibrinogen; C-reactive protein, high sensitivity or cardiac; lipoprotain (a). Further, CoQ10 and other antioxidants, EPA and DHA, arachidonic acid to EPA ratio and fasting insulin levels “should be looked at as a nutritional assessment determining nutritional and antioxidant status, and free-radical risk,” she said, since some people suffering from heart disease start out with metabolic syndrome. Taking a look at these markers will allow for practitioners to step in with preventative measures before too much damage is done. “Natural approaches are more about prevention, which includes maintaining the body’s natural state and normal body functions,” said DaVinci’s Watson. “For instance, homocysteine levels have been linked to the early development of heart disease, so lowering homocysteine levels naturally is one approach. Managing cholesterol, maintaining normal blood viscosity and preventing calcium buildup in the arteries are just a few of the other natural approaches to prevention.”

Lifestyle Changes

Tracking a patient’s diet and lifestyle is a great place to start when addressing heart health problems. “Given that cardiovascular disease is primarily a preventable lifestyle disease, it is especially amenable to lifestyle interventions, specifically around diet,” said Dr. Klodas. “Changing nutritional inputs can result in dramatic health changes— from cholesterol levels dropping in half to patients getting off medications. And this is attainable with relatively small dietary adjustments.”

Dr. Klodas suggested that practitioners keep a detailed dietary history of each patient. “This is a simple thing for practitioners to incorporate into daily practice and it doesn’t take much time,” she said. “In less than a couple of minutes, one can come to understand a great deal about how a patient lives, how that patient may be unwittingly sabotaging their own care and what dietary advice is realistic on an individualized basis.”

She often recommends her patients follow a primarily plant-based diet, avoiding simple carbohydrates and processed foods. “Very regimented dietary interventions (low fat, vegan) have been shown to result in regression of underling CAD/CVD/PAD,” she said. Patients often have several holes in their diets, mainly fiber, omega-3 fatty acids, antioxidants and phytosterols. If that is the case, Dr. Klodas often recommends her line of food products called Truhealth MD, which were formulated based on hundreds of studies documenting the heart health benefits of various ingredients. She also discusses with her patients dietary approaches that include low-fat, vegan diets advocated by Drs. Dean Ornish and Caldwell B. Essylstyn, Jr., such as the vegetarian Mediterranean Diet and the plant-based Portfolio Diet. “I point out to patients that what all of these approaches have in common is they are whole-food and plant-based, with little to no animal protein/ fat and zero processed foods,” Dr. Klodas said. Vitse also starts her clients off with nutrition therapy, along with lifestyle modifications like exercise and stress-reductive therapies. “These should certainly accompany conventional therapies,” she said. “And in mild cases, when a physician is monitoring progress, they can even replace pharmaceutical intervention and demonstrate effectiveness over time.” Vitse said catching a disease early gives more time for natural interventions to be effective before symptoms are too manifested. And as with Dr. Klodas, Vitse recommends an Ornish-style diet that is plantbased, or a Paleo diet when addressing high blood sugar and insulin resistance. “Monounsaturated fats and essential fatty acids are always important,” she added. “Antioxidant status is always important, as well as stress reduction and management. Yet exercise is always crucial!”

Addressing the Problem

Besides recommending a healthier diet and exercise, there is a wealth of supplements practitioners can offer patients for their heart health concerns. “The most thoroughly researched and widely accepted natural approaches include omega-3 fatty acids, coenzyme Q10 (CoQ10), vitamin D3, phytosterols and polyphenols such as resveratrol,” said Pure Encapsulations’ Heim. “Mechanistically, all of these compounds differ from the most common cardiovascular pharmaceuticals. In this respect, their uniqueness stems from a multiplicity of mechanisms, as opposed to a single molecular target.” For example, resveratrol intersects several dozen nodes of cellular signal transduction, while a drug is typically designed to affect one, Heim explained. “In addition, resveratrol touches its cellular targets in a milder manner with low affinity, which accounts, in part, for its high tolerability,” he added. One study on Pure Encapsulations’ Resveratrol showed that a low dose of one capsule daily can deliver significant changes in cardiometabolic parameters, such as oxidative status, cytokine levels and markers of glucose homeostasis, in as little as three weeks, said Heim.

Pure Encapsulations offers about 20 to 30 other products with cardiovascular indications, as well as a wide selection of fish oils, vitamin D3 and CoQ10. The company’s CholestePure Plus provides soluble phytosterols esters and clinically studied Bergamonte extract to support healthy lipid metabolism and overall cardiometabolic health, said Heim. “Supplements containing at least 0.5 g per serving of phytosterols eaten with meals or snacks for a daily total intake of 2 g as part of a diet low in saturated fat and cholesterol may reduce the risk of heart disease,” he added. Studies have shown that phytosterols in the diet help to lower blood total and LDL cholesterol levels, and CholestePure Plus offers 0.5 g of phytosterols. Clinical trials have shown that Bergamonte also helps maintain healthy cholesterol, triglyceride and plasma glucose levels in the normal range*, said Heim. Pure Encapsulations also offers EndoLOX, a supplement that delivers a combination of phytochemicals and NAC that supports healthy vascular gene expression, endothelial function, arterial wall integrity, blood flow and lipoprotein redox homeostasis.*

EndoLOX contains Oligonol, a clinically researched polyphenol preparation that helps to maintain cytokine balance and antioxidant defenses, according to Heim. “It includes berberine, ellagic acid and resveratrol moderate LOX-1, a macrophage receptor involved with binding and breaking down lipoproteins. Quercetin, another cardio protective polyphenol, is delivered in the form of isoquercetin, which offers twoto- six-fold greater bioavailability compared to standard quercetin,” Heim added. Patient One MediNutritionals is another company offering heart healthy supplements. The New York-based company has been formulating for 25 years and launched a product line for health care practitioners in December 2012. “[The] line was created to meet expanding demand for evidence-backed supplements through health care practitioners,” said President Gerard McIntee.

The company offers 10 products in the cardiovascular/heart health category. McIntee suggested those taking statins try Ubiquinol QH, since research has shown that statin drugs have been associated with the depletion of CoQ10. “Patient One Ubiquinol, presented in a liquid vegetable capsule for enhanced absorption, optimizes overall cardiovascular wellness by promoting myocardial energy production, healthy circulation, vascular energy and blood pressure that is already in normal range,” McIntee said. Patient One MediNutritionals also offers CardioOne, which is designed to promote overall cardiovascular health. The supplement contains CoQ10 and a fatty acid proprietary blend of organic extra virgin olive oil and fish oils. The oils play a role in cell membrane fluidity and inflammation modulation that may influence cardiovascular health, stable heart rhythm, arterial elasticity and circulatory health. DaVinci Laboratories also offers a number of heart healthy products, such as Mito-

Fuel, CholestSure, ADK, EPA 825, Cocoa HGH, Cardio- DMG and all of its CoQ10 formulas, as well as essential fatty acid products. DaVinci’s ADK is a dietary supplement that supports cardiovascular function* and contains vitamins A, D3 and K2. The company provides pracitioners information on how to incorporate testing methods using extensive cardio panels so that they can develop a protocol for using the products, said Watson. “If the doctor is new to using nutraceuticals, we encourage them to partner with a doctor who is familiar with these products and integrative therapies,” she added.

Tocotrienol, a member of the vitamin E family, is another supplement worth considering. Chris Leatherman, DC, director of sales at Premier Research Labs in Texas, a company that began supplying the practitioner market in 1999, said practitioners might want to study tocotrienols for use with their patients to supplement prescribed traditional treatment. The company’s newest and most popular product is the tocotrienol product Deltanol. “Tocotrienols are one of the two major subgroups of the vitamin E family, the other being the more well-known tocopherols,” he said. “Deltanol is uniquely sourced from the annatto plant, which provides a virtually tocopherols-free product consisting mostly of gamma-tocotrienols and deltatocotrienols.”

Premier Research Labs’ products are designed in a manner that respects the formulation, and are manufactured without the use of animal glandulars, Dr. Leatherman said. “Our formulations are based on a blend of ayurvedic and traditional Chinese medicine (TCM) traditions as well as Western scientific principals.” The products are made without talc, magnesium stearate, silicon dioxide and other nonnutritive excipients that many consumers seek to avoid, he added.

Putting Into Practice

The best way to incorporate a heart-healthy regimen is to do so holistically, including diet changes, heart-healthy supplements and exercise. Those interested in maintaining good health, especially aging Baby Boomers, are increasingly turning to their physicians to help them navigate the range of supplements available on today’s market, said Patient One’s McIntee. “They also seek their practitioner’s guidance to ensure coordinated care that takes into account their individual health conditions and medications they may be taking,” he said.

Dr. Klodas has found that many of her patients are receptive to advice around nutrition and diet. “[They] are very interested in being active participants in their own care—once they realize that what they eat makes a difference.” She said some practitioners may be comfortable counseling their patients on diet themselves, but others may want to refer patients to nutritionists and dieticians.

Vitse also recommended a holistic approach. “The big picture must be examined and kept in focus,” she said. “The most important contributors must be addressed first. For example, vessel health will not improve if high homocysteine is not addressed, damage will continue to accrue.”

And along with a healthy diet and lifestyle, Vitse recommended stress reducers like yoga, meditation, tai chi, chi gong, prayer and support groups. “These practitioners and educators match well with nutritionists, naturopaths, herbalists, chiropractors, acupuncturists and integrative MDs and DOs to address these health concerns in the most holistic manner, that is from all possible angles and with the whole being in consideration.”

By Carolyn Steber