Stephen Sinatra, MD, FACC, FACN
We all know what inflammation is. We recognize it as the redness, heat, and swelling that accompany injuries or infections. Although we may not like how it feels, inflammation is actually a beneficial process.
We all know what inflammation is. We recognize it as the redness, heat, and swelling that accompany injuries or infections. Although we may not like how it feels, inflammation is actually a beneficial process. It means that our body's immune system is mobilizing cells to combat invading germs, remove damaged cells, and seal off the affected area so that it may heal.
A Destructive Defence System
But inflammation isn't always beneficial. Inflammation in the coronary arteries, which supply life-giving oxygen to the heart, is dangerous. Scientists are only now beginning to understand the role that inflammation plays in heart disease. For decades it was believed that heart disease was caused by deposits of cholesterol (plaque) along artery walls, causing the arteries to stiffen and narrow, leading to atherosclerosis ("hardening of the arteries"). When coronary arteries become clogged, blood is unable to reach the heart and the person suffers a heart attack. People were told that if they avoided cholesterol, they would not suffer from heart disease.
Today, scientists know that an array of lifestyle and environmental factors assault the delicate lining of the arteries. Cholesterol and inflammatory substances can enter the arterial wall, causing a plaque lesion within.
Sometimes, the nasty contents of the lesion can be contained by smooth muscle cells that form a dense "cap." This is called "stable plaque." Sometimes, however, inflammation causes the cap to be thin and unstable. This is called "vulnerable plaque." And although stable plaque isn't a good thing - it narrows the arteries - it isn't as lethal as vulnerable plaque, which is always in danger of rupture. When a plaque lesion ruptures, it releases its deadly contents into the bloodstream, forming a clot. If the clot is localized within the coronary arteries, it can cause a heart attack.
So the most important battle today isn't against cholesterol - in fact, 50 percent of people hospitalized for heart disease have normal cholesterol levels - it is against vulnerable plaque and inflammation in the arteries.
How can you tell if you have inflammation? Most people are familiar with blood tests that assess cholesterol levels. You probably have also heard of "bad" (LDL) and "good" (HDL) cholesterol. Newer blood tests look for C-reactive protein (CRP), homocysteine, ferritin, fibrinogen, Lp(a) lipoprotein, AA/EPA ratio, and oxidized LDL. These important markers provide clues as to the presence or absence of silent inflammation.
Lifestyle and Environmental Factors
A family history of early coronary heart disease and advancing age will place you at high risk for heart disease. Obviously, we can't control these factors. But most risk factors are avoidable and are a result of our environment and lifestyle.
Environmental factors include exposure to radiation, industrial wastes, toxins (such as mercury and heavy metals), certain bacteria, and viral infections. Lifestyle factors include cigarette smoking, consumption of hydrogenated oils, sugars, chemicals, refined flour products, and emotional stress. Obesity and high insulin levels are prime contributors to inflammation.
Diet and Weight Loss
Many North Americans think they're taking care of their heart by eating margarine and saut?g in canola oil. They're wrong. Margarine and canola contain hydrogenated oils, and they contribute to inflammation. Consumers have also been told that carbohydrates such as bread and pasta should form the "base" of a food pyramid. Wrong again. Too many refined flour products in the diet add extra weight and raise the level of blood sugar in the body, causing insulin levels to soar.
A heart-healthy meal consists of a ratio that will keep insulin levels in a smart zone:
Carbohydrates - 40 to 45 percent
Protein - 25 to 30 percent
Fat - 25 to 30 percent
Carbohydrates - The best carbohydrates are "low-glycemic," meaning they don't cause the body's blood sugar to rise excessively. Lentils, chickpeas, and broccoli are ideal low-glycemic carbs. Organic fruits like cherries, plums, and grapefruits are also good choices. The key is to keep your use of refined flour products and simple sugars to a minimum.
You can eat unlimited amounts of organic vegetables, such as zucchini, asparagus, onions, tomatoes, and greens. They're packed with heart-healthy nutrients that actively fight the process of oxidation (antioxidants).
Protein - Proteins should be lean and preferably vegetarian, such as tofu, tempeh, and nuts. Fish is an excellent source of both animal protein and the healthy oils EPA and DHA.
Fat - Choose monounsaturated fats such as olive, almond, and avocado oils, and take fish oil supplements. Do not excessively heat oils because hot oil can become saturated; rather, use small amounts of olive and/or almond oil in salads and vegetable dishes.
Even if you eat an ideal diet you may still need additional nutrients to help reverse the inflammatory process. There are numerous supplements available at health food stores and through reputable supplement companies online. Here are some of the most important ones:
Detoxifying the body of chemicals, toxins, and heavy metals is a must. Since the liver is the prime-detoxifying organ of the body, any supplemental formula you choose should contain liver-supporting nutrients, such as milk thistle, artichoke, and L-carnitine.
Alpha-lipoic acid helps to sequester heavy metals.
Indole-3-carbinol helps remove petroleum-based chemicals from the body.
Coenzyme Q10 supports heart cell bioenergetics and helps strengthen the cells within the heart. This nutrient is crucial for individuals taking statin drugs, commonly prescribed to lower cholesterol, which deplete CoQ10.
L-carnitine is an amino acid that enhances the metabolism of fatty acids while removing excess harmful substances from cell membranes.
Omega-3 fatty acids from pharmaceutical-grade fish oil rich is the most powerful weapon against inflammation. It makes the blood platelets less sticky, reduces blood fats, helps with abnormal heart rhythms, and lowers C-reactive protein. Best of all, it actually enters vulnerable plaque lesions and helps stabilize them.
Garlic is known to reduce cholesterol levels and bring down high blood pressure.
Vitamin C is a well-known antioxidant that supports nitric oxide (a friendly cellular agent in the arterial wall).
Vitamin B complex and several other B vitamins are known to be effective against heart disease. For example, folic acid reduces homocysteine, a marker of cardiac inflammation.
Conventional Drug Therapy
Cholesterol-reducing drugs called statins are among the most common medications prescribed for cholesterol reduction and reducing cardiac inflammation. However, they can have side effects (such as muscle pain and weakness). Most of the time, they're over-prescribed. However, for treating documented coronary artery disease, statins are necessary and life saving.
It is important to work with an integrative practitioner who understands when and how to use conventional medications together with complementary approaches.
I like to call the program that I've just outlined metabolic cardiology because it utilizes a combination of supplements and diet that works synergistically to optimize the metabolism of cardiac cells. I predict that metabolic cardiology will be one of the great emerging fields of the twenty-first century in combating cardiac inflammation.