HEART ATTACK RISK FACTOR #10: Low Blood EPA/DHA
Optimal Blood Level:
Commercial EPA/DHA blood tests are expensive and not always readily available. Blood triglyceride levels may be used as a partial surrogate marker to ensure sufficient EPA/DHA intake, along with ingesting the suggested daily amount of EPA/DHA from fish.
Scientists long ago documented that those who ingest lots of EPA/DHA from coldwater fish have markedly lower heart attack rates. Controlled clinical studies substantiate a significant reduction in heart attacks in response to fish oil-derived EPA/DHA.207
A study measured levels of EPA/DHA in patients’ blood and established that low EPA/DHA was an independent risk factor for heart attack. Compared with age-matched controls, the risk of unstable angina or heart attack in these patients was reduced 62% for every 1.24% increase in whole-blood EPA/DHA.208
Drug options: EPA/DHA prescription drugs are available that can cost seven times more than comparable EPA/DHA dietary supplements.
Nutrient options: Fish oil supplements are widely available as dietary supplements. For most people, a daily dose of 1,400 mg of EPA and 1,000 mg of DHA from fish oil provides optimal dosing. The addition of sesame lignans has been shown to improve the efficiency of fish oil in the body via several mechanisms.129,130,209-211 If you are taking 1,400 mg EPA and 1,000 mg DHA and your triglyceride levels are over 80 mg/dL of blood, then you should increase your fish oil intake until triglyceride levels are reduced below 80 mg/dL.
Dietary options: Some studies show that consuming as few as two coldwater fish meals a week reduces heart attack risk.212 We suggest that omega-3 fatty acids (EPA/DHA) should be part of your everyday program, which can be accomplished by eating mackerel, lake trout, herring, sardines, tuna, sea bass, and salmon (and/or by taking EPA/DHA supplements).
HEART ATTACK RISK FACTORS #11 and #12: Low Testosterone and Excess Estrogen (in Men)
Optimal Blood Level:
20-24 pg/mL of Free Testosterone (men only)
20-30 pg/mL of Estradiol (men only)
Aging males can suffer the dual consequence of declining testicular testosterone production, while the testosterone they do produce is often excessively converted (aromatized) into estrogen.
Numerous studies link low testosterone (and excess estradiol) with increased heart attack and stroke risk.40,213-217 Many of these studies have identified specific mechanisms by which an imbalance of these hormones promotes atherosclerosis and subsequent heart attack/stroke incidence.52,218,219 Testosterone, for instance, is intimately involved in the reverse cholesterol transport process that involves the removal of cholesterol from the arterial wall by HDL. Excess estrogen is linked with higher C-reactive protein and a greater propensity for abnormal blood clots to form in arteries, causing a sudden heart attack or stroke.213,220,221
Drug options: To restore testosterone to youthful levels, natural testosterone cream is available as a ready-made prescription drug for around $225 a month, or a physician can prescribe a compounded natural testosterone cream that costs around $20 a month. The dose of testosterone prescribed should be based on blood tests showing what baseline free testosterone levels are. To suppress excess estrogen, the aromatase-inhibitor drug Arimidex® can be prescribed in the low dose of 0.5 mg to be taken twice a week. Men with pre-existing prostate cancer should avoid testosterone until their cancer is cured.
Nutrient options: For men who suffer low testo-sterone (and sometimes excess estrogen) because they express too much aromatase enzyme, nutrients like specialized plant lignans (30 mg a day and higher of HMR™ Lignan) and Bioperine®-enhanced absorption chrysin (1,500 mg a day) may be all that is needed.222-224 Zinc (50 mg/day) may also help suppress excess aromatase.225
Dietary-lifestyle options: Abdominal fat has a propensity to produce excess aromatase, which converts testosterone into estrogen in aging men.226-228 Losing belly fat with the help of nutrients like Irvingia extract can help restore a more youthful hormone balance.30-32 Restoring testosterone to youthful ranges can also help reduce belly fat mass. Excess alcohol consumption can reduce the ability of the liver to remove excess estrogen.
HEART ATTACK RISK FACTOR #13: Excess Insulin
Optimal Blood Level:
Under 5 mcIU/mL of fasting insulin (difficult for aging people to achieve)
Aging people lose their ability to utilize insulin to effectively drive blood glucose into energy-producing cells. As glucose levels rise in the blood, the pancreas compensates by producing more insulin. As “insulin resistance” worsens, even more insulin is secreted in a feeble attempt to restore glucose control.
Excess insulin is associated with greater risks of heart attack, stroke, and many cancers.229-232 Many of the same strategies you read earlier to lower excess glucose also lower excess insulin.
Drug options: The prescription drug metformin helps to improve insulin sensitivity and suppress factors in the body involved in causing excess blood glucose.57,233,234 Metformin is available in low-cost generic form and has a long enough history of safe human use for those with excess blood insulin to consider taking it even if they are not diagnosed as diabetic. Some of the side benefits of metformin include weight loss, which itself is a proven heart attack risk reducer.235 The dose of metformin varies considerably. The starting dose may be as low as 250-500 mg once a day with a meal. If hypoglycemia (low blood sugar) does not manifest, the dose of metformin may be increased to 500-850 mg taken before the two largest meals of the day, all under the supervision of your physician, of course. One side effect of metformin is that it can cause homocysteine levels to elevate.58 Those with impaired kidney function should not take metformin.
Another drug that lowers insulin levels is acarbose, which reduces the absorption of ingested carbohydrates by inhibiting the alpha-glucosidase enzyme in the small intestine. A typical dose is 50 mg of acarbose taken before each meal (three times a day). Some people experience intestinal side effects, but otherwise, acarbose is highly efficacious in reducing blood glucose and subsequent excess insulin release.59-61
Several nutrients block carbohydrate enzymes in the digestive tract in a similar manner to the drug acarbose. Dietary supplements such as Salacia oblonga or Salacia reticulata extracts inhibit the alpha-glucosidase enzyme and thus decrease the breakdown of simple carbohydrates in the intestine, resulting in a slower and lower rise in blood glucose and insulin throughout the day, especially after meals.62,63 Alpha-glucosidase inhibitors (described above) interfere with the breakdown of simple carbohydrates into glucose. Alpha-amylase inhibitors, on the other hand, interfere with the breakdown of large carbohydrate molecules like starch into linked glucose polymers. These simple sugars are then broken down to glucose by the alpha-glucosidase enzyme. The best documented alpha-amylase inhibitor consists of an extract from the white kidney bean (Phaseolus vulgaris). In a placebo-controlled study, those taking standardized white kidney bean extract lost 3.8 pounds over a 30-day period. More importantly, they lost 1.5 inches of abdominal fat and their triglycerides plummeted 26 points (milligrams per deciliter).64 There would appear to be an even greater benefit in combating excess blood glucose and insulin by taking both an alpha-glucosidase and an alpha-amylase inhibitor. Such combinations will soon be available in dietary supplement form.
The ingestion of soluble fiber(s) such as oat beta-glucan,17-19 psyllium,20 guar gum,21,22 pectin,23,24 and/or glucomannan25 can result in significant reductions in post-meal insulin release. The most common way of using these fibers is to mix them in eight ounces of water and drink them before heavy meals. These fibers can also be taken in capsule form. Start off with relatively modest doses and slowly work up to higher amounts to enable your digestive tract to get used to this higher fiber intake. Depending on the type of soluble fiber you choose, taking two to eight grams (2,000-8,000 mg) before each meal is a reasonable target to attain.
Irvingia extract, taken in the dose of 150 mg twice a day is associated with beneficial changes in fasting glucose with weight loss.65-68
The mineral chromium can improve insulin sensitivity and help lower fasting glucose.69-73 The suggested daily dose of elemental chromium is 700-1,000 mcg, preferably in the form of chromium polynicotinate, a highly bioavailable chromium that allows for enhanced absorption and utilization of this critical mineral. Take antioxidants such as green tea extract, curcumin, or grape seed with chromium to mitigate chromium’s potential free radical-generating effects. Make sure your daily supplement program also includes at least 1,000 mcg of biotin to further help maintain glucose control. Biotin enhances insulin sensitivity and increases the activity of glucokinase, the enzyme responsible for the first step in the utilization of glucose by the liver.74-76
The amino acid L-carnitine lowers blood glucose and a measurement of long-term glucose control called hemoglobin A1C.77,78 Carnitine does this by increasing insulin sensitivity and glucose storage, while helping to optimize fat and carbohydrate metabolism. The suggested dose is 1,500-2,000 mg of the more bioavailable acetyl-L-carnitine.
Magnesium deficiency is widespread. Supplementation with magnesium has been shown to reduce fasting glucose and hemoglobin A1C in type 2 diabetics who are magnesium-deficient by improving insulin sensitivity.81 The suggested dose of elemental magnesium is 500 mg a day (and higher for some individuals). Magnesium replenishment can also reduce C-reactive protein.82
Cinnamon contains unique polyphenols that enhance insulin sensitivity and facilitate cellular glucose uptake with subsequent reduction in fasting blood glucose levels. Cinsulin® is a standardized water extract of cinnamon that has demonstrated the most significant glucose control effect in clinical studies.83,84 Cinsulin® has also been shown to reduce triglycerides, total cholesterol, and LDL.85-87 The daily dose of Cinsulin® is 175 mg taken before each meal (three times a day).
Consume a very low-calorie diet (often less than 1,400 calories a day). This is by far the most effective way to dramatically reduce insulin levels. The problem is that few people can adhere to a diet this low in calories.33
Consume a Mediterranean diet, with lots of fresh fruits and vegetables, fish and soy as protein sources, omega-3 and monounsaturated fats (olive oil), while avoiding saturated fats, refined carbohydrates, cholesterol-laden foods, excess omega-6 fats, and most animal products. An increasing percentage of Americans are adopting this kind of diet.34-37
Avoid sugary fruit juices (almost all fruit juices contain too many sugars) and beverages spiked with fructose, sucrose and/or high-fructose corn syrup. Consume a low-glycemic index and low-glycemic load diet.
Hormone options: As humans age, they experience a reduction in insulin sensitivity. This enables excess glucose to accumulate in the blood instead of being efficiently absorbed into energy-producing cells such as muscle. Normal aging is also accompanied by a sharp decline in hormones that are involved in maintaining insulin sensitivity and hepatic glucose control. Restoring DHEA to youthful ranges may help enhance insulin sensitivity and glucose metabolism in the liver.92-95 For men, restoring youthful levels of testosterone has been shown to be particularly beneficial in facilitating insulin sensitivity.96,236 Blood tests can assess your hormonal status so that you can replenish DHEA (and testosterone) to more youthful ranges. Men with pre-existing prostate cancer should avoid testosterone until their cancer is cured and women with certain types of breast cancer are advised to avoid DHEA until their cancer is cured.
HEART ATTACK RISK FACTOR #14: Nitric Oxide Deficit
Optimal Blood Level: Commercial blood tests are not yet available at affordable prices to assess nitric oxide status. Aging individuals should assume they are developing a nitric oxide deficit in their inner arterial wall (the endothelium) and follow simple steps to protect themselves.
Even when all other risk factors are controlled for, the age-related decline in endothelial nitric oxide too often causes accelerated atherosclerosis unless corrective measures are taken.
Nitric oxide is required for healthy inner arterial wall (endothelial) function. Nitric oxide enables arteries to expand and contract with youthful elasticity and is vital to maintaining the structural integrity of the endothelium, thus protecting against atherosclerosis. The age-related deficiency in endothelial-derived nitric oxide predisposes maturing humans to today’s epidemic of heart attack and stroke.237-239
Drug options: One of the little-known benefits of statin drugs is that they promote endothelial nitric oxide synthesis.240 Our current recommendation is for aging people to take the lowest statin drug dose to achieve desired LDL levels. Some people only require 5-10 mg of simvastatin or 20-40 mg of pravastatin per day. At these modest doses, side effects are rare. Supplemental CoQ10 is needed to protect against statin-drug induced coenzyme Q10 deficiency.1,2
Nutrient options: The classic nutrient to boost nitric oxide levels is high-dose arginine, an amino acid found in many foods. Arginine is a precursor to the natural synthesis of nitric oxide in the endothelium. The problem is that arginine is rapidly degraded in the body by five different enzymes, thus requiring dosing of arginine every 4-6 hours. Even if one were to take this much arginine, changes that occur in the arteries of aging people cause rapid depletion of endothelial nitric oxide. A more effective way of boosting nitric oxide is to protect it from excessive degradation. One of the many beneficial vascular effects of pomegranate is its ability to increase endothelial nitric oxide levels.241-243 By virtue of its effect in restoring nitric oxide, pomegranate may help combat endothelial dysfunction—the leading cause of atherosclerosis. Daily consumption of eight ounces of pure pomegranate juice has been used in human studies that show significant regression of markers of atherosclerotic occlusion.50,244-248 There is concern that the sugar calories in pomegranate juice could create glucose control issues. There are standardized pomegranate supplements that provide the active constituents of eight ounces of pomegranate juice in 400-500 mg capsules. Additional nutrients that can protect precious nitric oxide against degradation include a patented SOD-boosting complex called GliSODin® and standardized cocoa polyphenols.249,250
Dietary options: Consuming fruits (pomegranate), berries (blueberry, raspberry), and teas (green tea) that contain polyphenols can protect nitric oxide from oxidative degradation.242,251,252
HEART ATTACK RISK FACTOR #15: Excess Fibrinogen
Optimal Blood Level:
Less than 300 mg/dL of fibrinogen
Many heart attacks and strokes are caused by a blood clot that obstructs the flow of blood to a portion of the heart or brain. When blood flow is interrupted, cells are deprived of oxygen and die. The build-up of atherosclerotic plaque increases the risk of abnormal blood clotting inside arteries.
Blood clots kill more than 600,000 Americans every year, yet conventional medicine has largely ignored well-documented methods of reducing abnormal blood clot formation.253,254
Low-dose aspirin and certain nutrients (like plant polyphenols) provide partial protection against abnormal blood clots, but the risks associated with excess fibrinogen mandate that additional measures be taken to prevent heart attacks and strokes.
Fibrinogen is a component of blood involved in the clotting process. High levels of fibrinogen predispose a person to coronary and cerebral artery disease, even when other known risk factors such as cholesterol are normal.255-258
Drug options: Prescription drugs that lower fibrinogen (like gemfibrozil) have side effects that have precluded their routine use. Statin drugs can indirectly reduce fibrinogen by lowering LDL levels.
Nutrient options: Nutrients that people take to reduce other heart attack risk factors also lower fibrinogen. These include:
- Fish oil in the dose of about 2,000 mg of EPA and 1,250 mg of DHA.259-261
- Vitamin C in the dose of 2,000 mg a day (note that 1,000 mg of vitamin C did not lower fibrinogen in this study).262
- Soy natto extract supplying 2,000 fibrinolytic units of nattokinase (NSK-SD™ in the dose of 100-200 mg a day.263
- New Zealand pine bark proanthocyanidins (Enzogenol® in the dose of 240-480 mg a day).264
- Enteric-coated bromelain proteolytic enzyme extract (2,400 GDU per gram/5,200 FIP per gram activity) in the dose of one 500 mg capsule two times daily.265,266
Dietary-lifestyle options: Avoid exposure to cold temperatures, as cold increases fibrinogen by 11%.267 Incorporate olive oil into your diet and avoid high-cholesterol foods and saturated fats. Keep homocysteine levels low as excess homocysteine interferes with the natural breakdown of fibrinogen in the body (refer to Heart Attack Risk Factor #5 to review ways of suppressing excess homocysteine).
HEART ATTACK RISK FACTOR #16: Hypertension
Optimal Blood Pressure level:
Systolic blood pressure: Under 115 mmHg
Diastolic blood pressure: Under 76 mmHg
This risk factor for heart attack and stroke cannot be detected by a blood test. One’s blood pressure should be checked regularly by a medical professional. Home blood pressure monitoring devices can also help keep track of blood pressure and assess the efficacy of antihypertensive drugs or natural therapies.
High blood pressure causes hundreds of thousands of Americans to needlessly die each year. Most people will develop hypertension at some point in their life. Since hypertension is not new, and antihypertensive drugs are not extensively promoted to the public, vast numbers of even health-conscious people neglect this critical part of a heart attack prevention program.
Many doctors allow a patient’s blood pressure to reach 140/90 mmHg before prescribing antihypertensive drugs. This can be a lethal mistake. While the standard upper limit for blood pressure has been 120/80 mmHg for decades, findings from a myriad of published studies reveal that optimal blood pressure ranges are under 115/76 mmHg.268-271 What this means is that many people are being told by their doctors that their blood pressure is fine, when it really is much too high. Another common error is improperly prescribing antihypertensive drugs that either fail to lower blood pressure enough, or allow gaps at certain times of the day when blood pressure shoots too high.
According to a study published in the Journal of the American Medical Association, the risk of cardiovascular disease incrementally increases when blood pressure readings pass 115/75 mmHg.272 Plain and simple, this means that the vast majority of adults living in the Western world are walking around with blood pressure that is dangerously too high!
Drug options: Concern about side effects has kept too many people from using safe antihypertensive medications. The cleanest and most effective anti-hypertensive drugs are the angiotensin II receptor antagonists. Cozaar® is a popular drug in this class and should be taken in the dose of 25-50 mg two times a day.273 Once-a-day dosing of Cozaar® and many other antihypertensive drugs does not always provide all-day reduction in blood pressure. A once-a-day drug in this class of antihypertensives is called Benicar®, which can be taken in the daily dose of 20-40 mg a day.274 Additional antihypertensive medications can be added if blood pressure is not adequately reduced.
Nutrient Options: There are a number of nutrients that can assist in lowering blood pressure and may help mitigate some of the damaging effects that hypertension inflicts. Under no circumstances, however, should anyone assume that taking these nutrients will protect against a heart attack or stroke if their blood pressure is not brought under control, using either antihypertensive drugs and/or dietary and lifestyle modifications. Nutrients that have been shown to reduce blood pressure include:
- C12 casein peptide (whey concentrate-CVH 15™) in the dose of 1,700 mg once or twice a day as needed.275-277
- Pomegranate standardized for the active constituents found in eight ounces of pomegranate juice (usual dose is 400-500 mg each day).278
- Magnesium in the dose of 500-1,000 mg each day.265,279,280
- Vitamin C in the dose of 1,000 mg a day (and preferably higher).281-283
- Vitamin D3 in the dose of 1,000-6,000 IU a day (and higher for some people).284,285
- Fish oil in the dose of 1,400 mg of EPA and 1,000 mg of DHA each day.271,286-289
- Coenzyme Q10 preferably in the ubiquinol form, in the daily dose of 100-200 mg.290-292
- Grape seed extract in the dose of 150 mg a day.293,294
- Garlic in the dose of 1,200-1,800 mg a day using Kyolic™ aged garlic extract.295
- Adequate dietary or supplemental intake of calcium and potassium.296
Dietary-lifestyle options: Blood pressure can be brought down in a significant number of people if they modify their lifestyle by losing weight, cutting out salt, consuming a healthy diet, and stopping smoking. The Dietary Approaches to Stop Hypertension (DASH) diet is recommended by both mainstream and integrative medical practitioners as a first-line approach to manage hypertension.272,297 The DASH diet is high in fruits, vegetables, and other nutritious foods that are rich in potassium, calcium, and magnesium. People who utilize the DASH diet are encouraged to decrease their saturated fats and replace them with foods high in monounsaturated fats and omega-3 fatty acids, such as those found in fish. Salt restriction is also a major part of the DASH diet—recommendations are that people with hypertension limit their salt intake to less than 2,400 mg (about one teaspoon) a day. Studies have shown that people who follow the DASH diet can decrease their systolic pressure by 11 points and their diastolic pressure by about six points.298 Obesity puts a person at increased risk of developing hypertension at an early age, as well as developing more severe hypertension. With weight loss, hypertension can be significantly controlled. In a seven-year study of people who restricted their salt intake and were on a weight-loss program, 80% of the people who stayed on the diet lowered their blood pressure to such a degree that they were able to completely stop their prescription blood pressure medication.299 A lifelong calorie-restriction program will significantly lower blood pressure, but few people can adhere to these kinds of very low-calorie diets.300,301
Hormone options: Sex hormone receptor sites are present in the inner lining of the arterial system (the endothelium). As men and women age, their sex hormones decline as their blood pressure increases. Men should refer to Heart Attack Risk Factors #11 and 12 to review how they can safely restore testosterone levels to youthful ranges. Aging women (without pre-existing hormone-sensitive cancer) should seek to maintain more youthful levels of estrogens and progesterone to help control blood pressure.