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The Heart of the Matter

Integrative care offers heart-health help


Exciting research is combining natural compounds with conventional medicines to prevent and even reverse heart disease. Learn about this integrative approach that shows great promise for other health applications.

A passionate advocate of healthy living, alive editor-in-chief Stuart Harries has long maintained that the future of health care is integrated. Rather than being “either/or,” integrative care combines the best that complementary and conventional medicine have to offer.

Heart health care is one field that’s experiencing tremendous success in integrating conventional medicine and natural modalities. It’s an area that you could say is close to Stuart’s heart.

The Vancouver resident, who exercises regularly and eats a mostly wholesome diet abundant in vegetables and fruit, has a family history of heart disease.

Stuart recently visited Dr. Matthew Budoff, a professor of medicine at the David Geffen School of Medicine at UCLA, who is seeing positive results with the integration of statins (cholesterol-lowering drugs), aspirin, and a specific form of garlic called aged garlic extract (AGE) to stop and even reverse heart disease.

“Though I firmly believe in the benefits of a good lifestyle, I know it can’t always affect heredity—what gets passed down in our genes,” Stuart says. In his role at the helm of Canada’s most trusted source of information about natural health and well-being, Stuart is always seeking out the latest in innovative health care. He has a particular passion for integrative care.

“I think natural health and conventional medicine will continue to come together in a way that is complementary. Dr. Budoff has been working specifically with integrating conventional preventive therapies, including Aspirin and statins, with natural products, such as aged garlic extract, and I wanted to see and hear first-hand what the results were.”

Here’s a review of some of the promising results Stuart discussed with Budoff.


The journey of AGE begins

Budoff is the Division of Cardiology Program Director and the Endowed Chair of Preventive Cardiology at the Los Angeles Biomedical Research Institute. He has published more than 200 scientific papers on the topic of cardiology; lately, much of this research has focused on AGE.

A colleague introduced him to existing evidence on garlic’s role in reducing cholesterol and blood pressure several years ago. Intrigued, if not entirely convinced, Budoff launched a study into the progression of atherosclerosis—a gradual narrowing and hardening of the arteries that is implicated in heart attack and stroke—with AGE.

“I was able to show slowing of atherosclerosis in a small cohort,” Budoff tells alive. “So I continued on to further studies with larger numbers and reliably showed that atherosclerosis progression is slowed and soft plaque is mildly reduced with garlic.

“We have completed four randomized studies to date, and all have led us to concur that AGE is both beneficial for slowing atherosclerosis and reversing the early stages of heart disease,” he adds. “I was a cynic at one time, but four randomized studies, plus randomized studies done by other investigators, make me confident that the effect is real and reproducible.”

The production of AGE is a three-year process that begins with the growing of organic raw garlic without the use of chemical fertilizers, herbicides, or pesticides.

  • Using a unique and standardized aging process, the active, bioavailable compounds are concentrated for up to two years, resulting in an odourless extract in an antioxidant, supplemental form.
  • Extraction generally increases the potency and bioavailability of various crude botanicals while eliminating harsh and toxic properties such as allicin.
  • Although not all active ingredients of garlic are well understood, AGE’s most abundant compound is S-allylcysteine (SAC), which has been shown to protect against oxidation and free radicals.

Budoff’s initial research was published in 2004 in the journal Preventive Medicine. The placebo-controlled, double-blind, randomized pilot study set out to determine whether the atherosclerotic plaque burden changed at a different rate under the influence of AGE as compared to placebo over the course of one year.

Involving 19 patients who were on a stable course of statin therapy and Aspirin, the study indicated the potential ability of AGE to inhibit the rate of progression of coronary calcification, a process in which the interior lining of the coronary arteries develops a layer of hard substance known as plaque, which restricts blood flow. This calcification increases the risk of heart attacks and eventual heart failure.

The study concluded that AGE could be useful for patients who are at high risk of future cardiovascular events, such as unstable angina—acute chest pain due to decreased blood supply to the heart muscle—or myocardial infarction (heart attack).

However, the study was limited by its small size. So Budoff and other researchers set forth to dig deeper.


AGE and coenzyme Q10: A potent duo

In 2012, Budoff and others published a study in the journal Nutrition. This one looked at the effects of AGE in conjunction with coenzyme Q10 (CoQ10) in a group of 65 firefighters.

CoQ10 is a key component of the mitochondrial electron transport chain and has been shown to have multiple antioxidant properties. Why firefighters? The risk of major adverse cardiovascular events is three times higher in these professionals than in the general population, and the leading cause of line-of-duty fatalities in firefighters is sudden cardiac death, accounting for approximately 45 percent of duty deaths. Plus, a stressful lifestyle is a well known risk factor for the presence and progression of atherosclerosis.

The Firefighter Aged Garlic Extract Investigation with Coenzyme (CoQ10) as a Treatment for Heart Disease (FAITH) study, a randomized, placebo-controlled trial, was the first to demonstrate a benefit with a combination of AGE and CoQ10 on atherosclerotic progression over one year in intermediate-risk firefighters with high occupational stress.

Significant improvements, independent of statin therapy, were seen in the firefighters’ vascular elasticity—which allows blood vessels to expand and contract continuously as blood pulses along—and functioning of the endothelium, a single layer of smooth, thin cells that lines the heart and blood vessels. Coronary calcification was also significantly lower. These positive changes were consistent with the slowing of the overall atherosclerotic process.


AGE and different types of plaque

A study published in the Journal of Nutrition & Food Sciences in 2015 looked specifically at the effects of AGE on coronary artery calcium (CAC). CAC progression has been shown to be the strongest predictor of cardiac events.

Four placebo-controlled, double-blind, randomized studies involving 182 patients were pooled to determine whether the atherosclerotic plaque burden detected by CAC would change at a different rate under the influence of AGE, compared to placebo.

There were more promising results. At one year, median CAC progression was significantly lower in the pooled AGE group. The effect of AGE on CAC progression was found to be independent of statin therapy and similar in men and women.

Although those previous studies demonstrated that AGE inhibits the progression of coronary artery calcification, its effect on non-calcified plaque hadn’t been established. To address that gap, Budoff co-conducted a study looking at AGE’s effect on “low attenuation plaque” (LAP) in coronary arteries in patients with metabolic syndrome. (The study has been accepted to the Journal of Nutrition.) The study involving 55 patients found that the percentage of LAP was significantly reduced among the AGE group compared to the placebo group.

What is metabolic syndrome?

  • Metabolic syndrome is the name for a group of risk factors that raises the risk for heart disease, stroke, and diabetes.
  • The risk of having metabolic syndrome is closely linked to being overweight or obese and a lack of physical activity.
  • Approximately 21 percent of the adult Canadian population is diagnosed with the condition.
  • Nearly half of people diagnosed with coronary artery disease also have metabolic syndrome.

While AGE and other natural products have evidence to support the role they play in heart health, Budoff and his team of researchers caution that still more study is needed. However, there’s no denying that compounds found in nature have the potential to transform the way heart disease is treated and prevented.


More natural heart health news

Aged garlic extract isn’t the only natural substance that appears to improve heart health in an integrated way.



A powerful antioxidant that may help protect cells from damage, lycopene is a naturally occurring red pigment that gives certain fruits their colour and that’s found in abundance in tomatoes. It has been shown to relieve the impairment of blood vessels, which could help explain why people who eat a Mediterranean diet have a reduced incidence of cardiovascular disease.

A study published in 2014 in PLOS ONE looked at the effects of oral lycopene supplementation on vascular function in people with heart disease who were receiving statin treatment and in healthy volunteers.

The randomized controlled trial found that vascular function among those with cardiovascular disease taking lycopene improved by 53 percent; there was no effect on those without the condition. Ten times more potent than vitamin E, lycopene improved and normalized function of the endothelium (the inner lining of blood vessels) in volunteers with cardiovascular disease, researchers from the University of Cambridge found.

Constriction of the blood vessels can lead to heart attack and stroke. Having a healthy endothelium is a key factor in preventing the development of heart disease. The study authors noted that the potency of lycopene appears to be enhanced when consumed puréed, such as in ketchup, or in the presence of olive oil.


Nitric oxide

Success has also been seen using nitric oxide (NO) to help reduce the risk of heart disease. Not to be confused with nitrous oxide, a gas used in anesthesia, NO has been described as the “miracle molecule” because of the role it plays in the health of nearly every cell in the body.

Its impact on heart health is well established: researchers from UCLA received the Nobel Prize in Medicine in 1998 for discovering that NO is a signalling molecule responsible for the dilation of blood vessels.

One of those researchers, pharmacologist Louis Ignarro, went on to write NO More Heart Disease: How Nitric Oxide Can Prevent—Even Reverse—Heart Disease and Strokes (St. Martin’s Griffin, 2006). The book explains how the arteries produce nitric oxide to lower blood pressure and improve blood flow to organs. The substance widens and relaxes the arteries so that more blood can flow through them, lowering the pressure within the arterial system.

When nitric oxide is deficient, people are at greater risk of high blood pressure, arteriosclerosis, and heart disease. The body makes NO through physical activity—increased blood flow through the arteries stimulates nitric oxide production—as well as through the use of two amino acids. The predominant one is arginine, which is found in vegetables, garlic, green tea, meats, grains, and fish; the other is citrulline.

Integrative cardiologist Stephen Sinatra says that nitric oxide is the single most important chemical compound for cardiovascular health. Based in Lancaster, Pennsylvania, Sinatra says on his website that “adequate NO production is the first step in a chain reaction that promotes healthy cardiovascular function, while insufficient NO triggers a cascade of destruction that eventually results in heart disease”.


Omega-3 fatty acids

Omega-3 fatty acids are also known for their positive effects on heart health. One study that backs up these claims was published in the Journal of the American College of Cardiology Foundation in 2011; the researchers concluded that these polyunsaturated fatty acids reduce the risk of cardiac death. The omega-3 fatty acids were found to improve vascular and cardiac function, thrombosis (blood clotting), and arrhythmia, a condition in which the heart beats in an irregular or abnormal rhythm.

The researchers suggested that doctors recommend fish consumption to patients. They also said that government and public health agencies should implement strategies to help people meet the recommended levels of fish and omega-3 fatty acid consumption to reduce the burden of mortality due to coronary heart disease and sudden cardiac death.


Plant sterols

Found naturally in foods such as grains, vegetables, fruits, legumes, nuts, and seeds, plant sterols (phytosterols) can help lower LDL (bad) cholesterol without affecting HDL (good) cholesterol levels. According to studies, the effect of plant sterols in the body is to mimic cholesterol in the small intestine which has the effect of partially blocking cholesterol absorption.


Want to learn more?

For more information, check out these additional tips on keeping your heart healthy:

Keeping your heart healthy

Despite the promise of integrated cardiovascular care, supplements or pharmaceutical medications alone shouldn’t take the place of a healthy lifestyle. The good news is that there’s plenty we can do to keep our heart healthy.

Eat well

Increasing your intake of vegetables and fruit is one way to start improving your heart health immediately. Eating four to 10 servings every day may help reduce the risk of heart disease and stroke.

Vegetables and fruits abundant in vitamin C and beta carotene, a form of vitamin A, which work as antioxidants can help slow down or prevent atherosclerosis by reducing the build-up of plaque from cholesterol in the arteries.

Foods rich in vitamin C include broccoli, red peppers, strawberries, oranges, kiwi, and cantaloupe. Beta carotene, which gives food a distinctive dark orange, red, or dark green colour, is found in high amounts in carrots, tomatoes, squash, pink grapefruit, sweet potatoes, and Swiss chard.

You need <some> good fat in your diet, because certain types supply calories and help your body absorb fat-soluble vitamins. However, consuming too many of the wrong kinds of fats, such as some saturated fats (from processed meats, for example) and all trans fats, may raise levels of unhealthy LDL (bad) cholesterol and lower those of healthy HDL (good) cholesterol. This can increase the risk of high blood pressure, atherosclerosis, heart attack, and stroke.

Omega-3 is a type of polyunsaturated fat, which helps lower triglycerides, a blood fat linked to heart disease. The best sources of omega-3 fatty acids are cold-water fish such as mackerel, sardines, herring, rainbow trout, and salmon. Other sources include walnuts, flaxseeds and flaxseed oil, as well as hempseed oil.

Limit salt intake About one-third of people are sensitive to the sodium component of salt, and eating too much of it can increase the amount of blood in the arteries, raising blood pressure and increasing the risk of heart disease and stroke.

Salt is sneaky and can be lurking where you least expect it. Be sure to check the nutrition labels on any canned, boxed, or processed foods. You might be surprised at how much salt is hiding in your favourite canned soup.

Exercise regularly

Physical activity can drastically reduce the risk of heart disease and stroke. It helps prevent or control risk factors such as high blood pressure, high cholesterol, and obesity. It also helps decrease stress levels

Adults should get at least 150 minutes of moderate- to vigorous-intensity aerobic physical activity per week. These can be accumulated in short bouts lasting 10 minutes or more. Strengthening and flexibility activities are important to incorporate, while endurance exercises—continuous activities such as walking or cycling—are especially beneficial for the heart.

Examples of moderate-intensity activities include brisk walking, swimming, and water aerobics. Vigorous effort is required for activities such as aerobics, fast swimming, hockey, jogging or running, hockey, and basketball.

Achieve or maintain a healthy weight

Being a healthy weight, through healthy eating and regular exercise, is one of the most important strategies when it comes to protecting your heart.

It can be hard to get to a weight that’s considered healthy, but health care practitioners can provide support. If you are overweight, losing as little as 10 pounds (4.5 kg) can reduce blood pressure. Slow weight loss of about one to two pounds (1 kg) a week suffices.

Stop smoking—or don’t start

Smoking cigarettes raises the risk of heart disease and stroke. Nicotine is a highly addictive drug that raises blood pressure, makes the heart work harder, and can result in blood clots.

As soon as you become smoke-free, your risk of heart disease and stroke starts to go down. Within one year, the chance of dying from smoking-related heart disease is cut in half.

Keep stress levels in check

Being stressed often or not having good coping skills can raise the risk of heart disease, high blood pressure, chest pain, or irregular heartbeat, according to the American Heart Association. Stress management classes can help.



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