Heart Disease – A Functional Medicine Approach

Heart Disease – A Functional Medicine Approach – Perth clinic

Heart disease is one of the leading causes of death in Perth and Australia wide.  There are a number of natural treatments to assist with the management of heart disease. It is associated with a numerous conditions that cause plaques to build up in the blood vessels causing a restriction of blood flow to the heart, brain and peripheral areas of the body.

Atherosclerosis is a build-up of lipids, cholesterol, calcium, cellular debris and other substances in the inner lining of arteries, forming hard structures called plaques. Over time, these plaques cause narrowing and can eventually block arteries, disrupting the flow of blood and oxygen to organs such as the heart and brain, and causing tissue death. It is one of the leading causes of illness and death in both males and females in western countries.

Atherosclerosis is the usual cause of cardiovascular diseases such as coronary heart disease, stroke and peripheral vascular disease.

Damage to the endothelium caused by factors such as high blood pressure, smoking, trans fats, stress and high insulin leads to the formation of plaques, involving the deposition of cholesterol, calcium, fibrin and immune cells in the arteries, which can eventually build up and obstruct the flow of blood, known as ischemia. There are a number of natural heart disease treatments to reduce and reverse heart disease.

Atherosclerosis can affect various parts of the circulation and symptoms will depend on the blood vessels affected:

• In coronary arteries, connected to the heart, it may cause angina and heart attack (coronary heart disease)
• In cerebral arteries, connected to the brain, it may cause transient ischemic attacks (TIA‘s) and stroke (cerebrovascular disease)
• In the peripheral circulation, it may cause intermittent cramping of the muscles and gangrene

The onset of atherosclerosis may occur over the decades and may even begin in childhood, particularly with the current childhood rates of obesity and dyslipidemias.

Coronary Heart disease (CHD)

Coronary heart disease is caused by a build-up of atherosclerotic plaque in the small blood vessels that supply blood and oxygen to the heart muscle. It is the leading cause of death of both men and women in Western societies.

• Angina is chest pain caused by a partial blockage of the coronary arteries. It generally occurs with stress or exertion, when the heart requires a greater blood flow which it cannot receive due to the narrowing of the arteries.
• A heart attack (myocardial infarction) occurs when the blood flow to a part of the heart muscle is blocked for long enough that the heart muscle is damaged or dies. A heart attack can occur when plaques build up enough or platelets stick to a torn plaque, causing a blood clot.

Cerebrovascular disease / Stroke

A stroke occurs when there is a disruption of the cerebral blood flow to the brain, resulting in temporary or permanent neurologic deficits. There are two types of stroke: ischemic stroke or hemorrhagic stroke.

• Ischemic stroke occurs when a blood vessel that supplies part of the brain is blocked by a blood clot or build-up of atherosclerotic plaque. The clot may form in an artery that is already very narrow (thrombotic stroke) or may break off from another blood vessel and travel up to the brain (embolic stroke).
• Hemorrhagic stroke occurs when a blood vessel in part of the brain becomes weak and bursts open, causing blood to leak into the brain. May be caused by an aneurysm or congenital arteriovenous malformation.
• A transient ischemic attack (TIA) is when blood flow to the brain stops for a brief period of time. The person will have stroke-like symptoms for up to 2 hours. It differs from a stroke in that the blockage breaks up quickly and dissolves, and does not cause brain tissue to die. TIA‘s are a warning sign that a stroke may occur in future.

Causes & Development of Heart Disease

• Since the 1930‘s, medical research has mainly associated atherosclerosis and coronary heart disease (CHD) with elevated serum cholesterol levels and much of the medical treatment still focuses on reducing serum cholesterol
• However, new research is showing that this approach may be too simplistic. Cholesterol is a major component of atherosclerotic plaque but it is thought that this may be a result of damage to the endothelium rather than the primary cause.
• Dyslipidemias, however, are very common and remain an important risk factor for all types of atherosclerotic disease.
  • Elevated serum triglycerides: an important independent risk factor for CHD
    • Increased through excessive energy intake (e.g. high intake sugars, fats and alcohol), obesity, insulin resistance, type II diabetes, hypothyroidism, smoking, HRT and kidney disease.

Low HDL-cholesterol

• May be caused by lack of exercise, smoking, obesity, poor diet (especially if high in sugars and refined carbohydrates and low in omega-3 fatty acids), high triglyceride levels, high blood glucose levels and certain medications (e.g. anabolic steroids)

High LDL – cholesterol

• In the past, dietary cholesterol was thought to be largely responsible for high LDL-cholesterol. However, research has now established that dietary cholesterol has little impact on blood cholesterol.
  • The association between high dietary saturated fat intake and blood cholesterol levels/heart disease remains unclear and the link has never been proven or agreed upon by scientists.  While many studies have shown a positive association between saturated fat intake and heart disease, some recent large systemic reviews and meta-analyses have shown no association.
    • A meta-analysis of 21 studies that followed 350,000 people for up to 23 years found that ―there is insufficient evidence from prospective epidemiological studies to conclude that dietary saturated fat is associated with an increased risk of CHD, stroke or CVD‖ (Siri-Tarino, 2010)
    • In many populations with a high saturated fat intake, the incidence of heart disease is low. For example, the “French paradox” describes the low coronary heart disease death rates in France despite high intakes of cholesterol and saturated fat. However, this may be explained by the inclusion of cardioprotective factors in the French diet such as red wine, olive oil, fruit and vegetables and low processed food intake.
  • However, looking at saturated fat intake alone may be an oversimplification. It is thought that cutting back on saturated fat intake may be beneficial for the heart only if it is replaced by unsaturated fats. The “low-fat” diet of the past 30 years has largely seen saturated fats replaced with sugars and refined carbohydrates, which can raise triglyceride levels and cause inflammation.
  • Many studies have shown that it may be the ratio of saturated fats to unsaturated fats, in particular mono-unsaturated and omega-3 fatty acids, that is more important.
  • Once again, the answer may lie in the Mediterranean-style diet or Paleo style diet, which is high in healthy fats from olive oil, fish, nuts and seeds, and high-fibre, antioxidant foods such as fruit and vegetables; low in sugary and refined foods and refined processed vegetable oils.  Meats should be sourced from grass fed and ideally organic animals.
  • It is also thought that the size and oxidation of LDL particles has a greater impact on CVD risk. Smaller, denser LDL particles are oxidised and therefore inflammatory, causing tissue damage in the arteries and contributing to plaque build-up.  Large LDL particles are not oxidised and are therefore less of a risk.
    • Factors that increase oxidation of LDL include smoking and alcohol (and other toxins) and diets high in trans-fats and sugars and low in anti-oxidant foods such as fruit and vegetables.

Inflammation and Oxidative Stress

• Chronic inflammation in the endothelium eventually damages the endothelial layer, causing deposition of plaque as a reparative mechanism. Inflammation may be caused by:
  • Poor diet: high in inflammatory oxidative foods such as sugars and refined carbohydrates, saturated fats, trans fats, commercially raised animal proteins and alcohol, and low in anti-inflammatory and antioxidant foods such as fruit and vegetables, mono-unsaturated fats and omega-3‘s
  • Smoking
  • Stress
  • Bowel dysbiosis
  • Poor methylation
  • Exposure to environmental toxins and heavy metals

Familial High Cholesterol

• Familial high cholesterol or hypercholesterolemia (FH) is a common inherited condition characterised by higher than normal levels of LDL cholesterol.
  • There are an estimated 10,000,000 people worldwide with FH
  • FH is caused by a defect in the LDL receptor gene, which controls the LDL receptors on target cells.

Defects in the gene changes the number or structure of these receptors meaning that LDL cholesterol is not well absorbed and remains circulating in the blood

Type 2 diabetes

• Type II diabetics typically have high triglyceride concentrations, low HDL, and normal LDL concentrations. However, LDL particles are small and dense.
  • The risk of death from CVD is 2-6 times greater in people with type II diabetes than those without diabetes, and is the leading cause of death in type II diabetes

Hypothyroidism

• Thyroid hormone is known to play a role in regulating the synthesis, metabolism and mobilisation of lipids. In patients with overt hypothyroidism, there is an increase in serum total cholesterol, LDL cholesterol and possibly trigylceride levels.

Risk factors of Heart Disease

• Family history
• Male gender
• Increasing age
• Poor diet:
  • High intake of sugars and refined carbohydrates: raises TG levels and leads to obesity and insulin resistance, both independent risk factors for CHD
  • High intake of trans fats: raises LDL-C, lowers HDL-C and increases inflammation in blood vessels
  • High saturated fat, particularly from commercially raised animals,  to unsaturated fat ratio
  • High sodium intake: increases blood pressure
• Excessive alcohol consumption (especially binge drinking)
• High blood pressure
• Smoking
• Stress
• Insulin resistance and diabetes
• Obesity, especially abdominal
• High homocysteine levels
• Sedentary lifestyle
• Lowered estrogen levels (post-menopausal women)
• Poor liver or gallbladder function
• Hypothyroidism
• Hormone replacement therapy

Signs and symptoms of Heart Disease

May be asymptomatic until artery becomes severely narrowed. Symptoms depend on location of the plaque.

• Coronary arteries: may cause angina (chest pain on exertion) or heart attack

Angina

• Chest pain or discomfort on exertion or emotion which disappears with rest
  • Pain feels heavy or like someone is squeezing the chest
  • Pain may be sub-sternal, in the neck, arms, stomach or upper back.
  • Some people may experience fatigue, weakness or shortness of breath rather than pain

Heart attack

• Chest pain which may be mild or severe and does not disappear with rest
  • Pain is described as crushing, a tight band around chest, heavy pressure on chest or like bad indigestion
  • Pain may radiate to arms, jaw, teeth, neck or back
  • Other symptoms may include anxiety, cough, dizziness, faintness, nausea, palpitations, shortness of breath and sweating
• Cerebral arteries: may cause TIA or stroke. Symptoms usually develop suddenly and without warning:
  • Sudden severe headache < bending, coughing, lying flat. More common in stroke caused by bleeding
  • Change in alertness: sleepiness, unconsciousness, coma
  • Vertigo and loss of balance
  • Muscle weakness / paralysis on one side of face and body
  • Numbness / tingling on one side of the body
  • Changes in senses e.g. hearing, taste, vision
  • Confusion or loss of memory
  • Difficulty swallowing
  • Lack of control over bladder or bowels
  • Loss of coordination
  • Difficulty speaking
  • Difficulty walking

Renal arteries

• Kidney damage

Peripheral arteries:

• Intermittent claudication (pain, aching, cramps, numbness on exertion)
  • Gangrene

Markers of Cardiovascular Disease Risk

• Triglyceride and cholesterol levels are the standard medical markers of CVD risk. The current measure for increased risk are:
  • Total cholesterol (TC): > 5.5 mmol/L: this has been reduced from the previously “normal” level of 7 mmol/L
  • Serum triglycerides:  >1.5 mmol/L (fasting)
  • HDL-C: < 1.0 mmol/L
  • LDL-C: > 2.5 mmol/L (or > 2 mmol/L for high-risk patients)
• However, cholesterol levels alone are not a reliable indicator of CVD risk as elevated cholesterol is seen in as many people without CVD. The following two ratios are thought to be much more reliable indicators of heart disease risk than total cholesterol alone:
  • Total cholesterol (TC) / HDL cholesterol:  shows the total cholesterol in relation to HDL cholesterol. Should be 4.5 of less in men and 4.0 of less in women.
  • Triglyceride (TG) / HDL: thought to be one of the best indicators of heart disease risk.  Should be less than 2.0

• Traditional lipid profiles however to not adequately assess the risk of CVD as they don’t distinguish between the larger LDL particles and the small dense LDL particles.  The small dense LDL particles are the dangerous forms of LDL cholesterol that deposit plaque on the arteries.
• New Liposcreen LDL subfractions testing is available that measures both the larger LDL particles and the small LDL particles.  Having elevated cholesterol alone is not associated with heart attack risk.  It is more important to know the type of cholesterol and which size distribution the particles are rather than the total cholesterol level.
• Approximately 50% of patients that have never suffered a heart attack have higher cholesterol levels while a large portion that have suffered heart attacks have low cholesterol levels.
• Please contact our clinic if you are interested in having your Liposcreen LDL subfractions tested as a much better indicator of the risk of your cholesterol levels in relation to Heart Disease. This is one of the best tests to understand your risk prior to commencing natural treatment of heart disease.

• Some other markers of increased CVD risk should also be assessed:
  • C-reactive protein (CRP): a liver enzyme that is a marker of inflammation in the body. A CRP > 1 mg/L indicates inflammation
  • High-sensitivity CRP (hsCRP): a more sensitive test for CRP and more indicated to measure CVD risk
  • Homocysteine: high homocysteine levels may increase oxidative stress and the formation of LDL cholesterol on the artery wall. High homocysteine may be caused by dietary deficiency of methylating factors needed to convert it to methionine, namely B6, folate and B12.  Homocysteine levels > 10 nmol/L indicates increased CV risk.  Those with MTHFR polymorphisms are at a higher risk.
  • Fibrinogen: > 400 mg/dL
  • Blood Sugar:  Fasting: > 5.4 mmol/L; Random: > 7.7 mmol/L
  • Blood pressure: > 120/80

Natural Treatment Strategy and prevention of Heart Disease

• Address underlying risk factors
• Balance lipid profile
• Reduce systemic inflammation
• Reduce oxidative stress (damage to blood vessels & oxidised LDL cholesterol)
• Reduce platelet aggregation
• Support circulation
• Improve gut health and treat bacterial overgrowth/SIBO if indicated
• Reduce blood pressure
• Balance Methylation and reduce homocysteine (if indicated)
• Address blood sugar regulation
• Address hypothyroidism (if indicated)
• Lose weight (if indicated)
• Support nervous system / reduce stress response

A heart attack or stroke is a medical emergency and requires an ambulance without delay. The earlier the treatment, the less chance of death. Functional and Natural Medicine treatment protocols are aimed at managing atherosclerosis and dyslipidemias and preventing heart attacks and stroke.

Diet plan guidelines & treatment for Heart Disease

• Fresh, whole food, low-GI diet high in fibre, fruits and vegetables, fish, plant proteins and healthy fats
  • The Mediterranean Diet has been shown to significantly reduce dyslipidemia, blood pressure and CHD risk
  • The diet is high in monounsaturated fats (principally olive oil, olives, nuts and seeds) and omega-3 fatty acids (from fish), low in  saturated fat, high in complex carbohydrates from legumes and root vegetables (carrots, turnips, potatoes, onions and radishes) and high in fibre, mostly from fruit and vegetables.
  • Total fat intake can be quite high (up to 40%) but the mono-unsaturated to saturate fat intake is around 2:1, which is much higher compared to other Western cultures (North America, Northern Europe and Australia).  Animal meats should be sourced from grass fed and preferably organic sources.
  • The low-GI aspect is important to lower insulin levels and improve insulin sensitivity as hyperinsulinemia is a major risk factor in CVD
• Balance lipid profile:
  • Avoid sugar, refined carbohydrates, trans fats and alcohol
  • Increase intake of omega-3 and monounsaturated fatty acids from oily fish, nuts and seeds, olives, olive oil and avocado
  • Plant-based sources of protein should constitute at least 50% of the daily protein intake with the remainder being made up of fish and low-fat lean meats.  Animal meats should be grass fed.
  • Bitter foods (e.g. rocket, watercress, lemon juice, etc) should be included to stimulate bile flow and prevent gall bladder insufficiency
• Increase dietary fibre:
  • A diet high in fruits and vegetables provides rich sources of soluble and insoluble dietary fibre
  • In particular, soluble fibre (e.g. fruit pectins, chia and psyllium and algae) slows cholesterol and glucose absorption and lowers serum LDL cholesterol.
  • Fibre intake should be at least 25-30 g per day, with 6-10 g being from soluble fibre.
  • If the individual cannot comply from a dietary perspective, soluble fibre supplements may be recommended.
• Emphasise anti-inflammatory and antioxidant foods: cold-water oily fish, berries, cherries, red grapes, nuts and seeds, turmeric, ginger, green tea, olive oil, fruits and vegetables, green smoothies
• Minimise pro-inflammatory, acid-forming foods: sugar, refined carbohydrates, trans fats, commercially raisded red meat, saturated fats, omega-6 fatty acids, caffeine and alcohol
• Include garlic and ginger to reduce platelet aggregation and promote circulation
• Limit sodium intake to prevent hypertension
• Weight loss diet: essential if obesity is an issue

Natural Supplements that support Heart Disease

• Omega-3 fatty acids –  reduces inflammation, improves lipid profile (reduces TG, increases LDL-C size, increases HDL-C), reduces platelet aggregation
• Garlic –  inhibits platelet aggregation, prevents lipid peroxidation, increases antioxidant status, reduces blood pressure (contraindicated in patients on blood-thinning medication)
• Magnesium –  reduces platelet aggregation; reduces blood pressure and calms nervous system
• Methylating factors to lower homocysteine: vitamins B6, methyl B12 and folinic acid or methyl folate
• Arginine – reduces blood pressure and enhances vasodilation in coronary arteries if angina is an issue
• Bromelain – reduces systemic inflammation and encourages dissolving of arterial plaques.
• Taurine – enhances blood flow, enhances bile production and flow, improves cholesterol metabolism, reduces oxidative stress
• Anti-inflammatory and antioxidant nutrients:
  • Curcumin – anti-inflammatory and improves lipid profile
  • Vitamin C – reduces inflammation and oxidative stress (especially in smokers)
  • Vitamin E – reduces inflammation and oxidative stress, reduces platelet aggregation and improves circulation
  • CoQ10 – reduces oxidation, reduces blood pressure, supports heart muscle energy production. Essential in patients on cholesterol lowering medication as they deplete CoQ10
  • Selenium – antioxidant
  • Resveratrol – associated with an 11% to 16% increase in HDL and an 8% to 15% reduction in fibrinogen
  • Lipoic acid – reduces lipid peroxidation and LDL-C and increases HDL-C. Especially useful in diabetics as it also reduces insulin resistance and is protective against diabetic complications
• Vitamin D3 – depending on status; helps to regulate blood pressure
• Psyllium – fibre supplement if low-fibre diet

Herbal Medicine Treatment that supports Heart Disease Prevention

• Anti-inflammatory – turmeric, ginger
• Antioxidant – turmeric, grape seed, green tea, rosemary
• Circulatory stimulant – ginkgo, ginger, hawthorn, rosemary, cayenne, gotu kola
• Anti-platelet (not in haemorrhagic stroke): turmeric (more potent than aspirin), ginger
• Hypotensives – hawthorn, motherwort, black cohosh, olive leaf, mistletoe
• Cholesterol lowering – fenugreek, globe artichoke, turmeric, gymnema, tienchi ginseng, coleus
• Cardiotonic – hawthorn, dan shen, astragalus, coleus, Korean ginseng
• Antispasmodic – crampbark, white peony, lime flowers
• Nerve tonics: valerian, hops, passionflower, lemon balm, oats, skullcap

Lifestyle / Physical measures

• Quit smoking: both active and passive smoking raise CRP levels causing oxidative damage to vascular endothelium.
• Reduce alcohol intake
• Regular exercise: has a positive effect on body composition, blood pressure, circulation, insulin sensitivity, lipid levels and stress
• Regular exposure to sunshine (Vit D)
• Reduce stress: massage, relaxation, meditation, yoga, work/life balance etc.
• Avoid oral contraceptives if possible

FUNCTIONAL MEDICINE TREATMENT & PREVENTION OF HEART DISEASE

Heart disease is one of the leading causes of death in the western world.  The correct education regarding cholesterol is slowly beginning to become public knowledge after a number of decades of incorrect information blaming cholesterol as the “bad guy” and the main cause of Heart Disease.

We now know that sugars and refined carbohydrates are a much greater concern to heart disease and that dietary cholesterol intake is not directly related to an increased risk of heart disease. 

Our functional medicine model treats the individual patient by assessing the underlying factors that are contributing to heart disease and any other illness the patient may be suffering.  Ensuring a healthy, balanced and unrefined diet coupled with positive lifestyle factors is the number one long term best intervention required to avoid heart disease. 

Investigating and correcting gut dysbiosis, methylation blocks, genetic variations, bacterial and viral loads and nutrient insufficiencies is vital in the long term health of any patient that is at risk of heart disease. 

At our Perth clinic of Advanced Functional Medicine have experience with patients that are at high risk of heart disease

If you or a family member are at high risk of heart disease or worried about your cardiovascular health we would love to hear from you. 

Have you had your LDL subfractions tested?  What are the most successful life changes you have implemented to improve your risk of heart disease?  Have you assessed your methylation status and gut health in regards to heart disease risk?  Please leave a comment below

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