Dr. Stephen Sinatra’s

A Cardiologist’s Guide to Total Wellness Dear Reader, Metabolic syndrome, as you likely know, is a widespread precursor of diabetes, kidney disease, and coronary artery disease. The condition, which includes abnormalities in insulin, blood pressure and cholesterol, has no symptoms but it does have one telltale sign—a large waist—which too many people ignore at their own peril. This is why Stephen Sinatra, MD I want to tell you about a simple test that can be a wake-up call for anyone who is ignoring an expanding waistline. The test itself—a simple check for albumin in your urine—is not new, but was recently identified as a marker of metabolic syndrome and health risk. Your doctor is familiar with the test but likely doesn’t realize it can be used for this purpose, so you’ll have to ask for it. Albumin is a protein that should stay in your blood and not build up in your urine. It is usually measured in a ratio with creatinine, a byproduct of normal muscle breakdown. More than 30 milligrams of albumin per gram of creatinine in a single urine test is a common marker of metabolic syndrome. And now, such a test result is also believed to forecast the development of kidney and coronary artery disease. You can also check for metabolic syndrome at home. Wrap a cloth tape measure around your abdomen, just above the hip bone. Keep the tape snug and measure your waist while breathing out, with your abdomen relaxed. These waist sizes indicate metabolic syndrome: 35 inches or more for a woman and 40 inches or more for a man. Belly fat is both unsightly and harmful. This particular fat secretes a steady stream of chemicals that kindle inflammation throughout the body, damaging the lining of arterial walls, including the coronary arteries and blood vessels in the kidneys. Do yourself a favor. If your waist girth exceeds the metabolic syndrome limits, please get your urine albumin checked and improve your lifestyle. If your waist size is smaller but you have a family history of diabetes, I also recommend getting the albumin test because in some people, metabolic syndrome can occur without a large waist. In both situations, you can control the condition by being more physically active and eating less sugary, starchy, and processed food. While I’m dishing out advice, be sure to avoid overeating and don’t be a couch potato. For more heart-healthy diet advice, visit my Food & Nutrition Center at drsinatra.com. And for an easy way to get moving, I invite you to join my Walking Club at blog.drsinatra.com.

AUGUST 2011

Get More of Dr. Sinatra In Dr. Sinatra’s Blog at blog.drsinatra.com ■ Get the Latest on the “Dr. Sinatra Walking Club”

■ Avoid Summer Hazards In Upcoming Eletters ■ The Difference Between Squid and Krill Oil

■ What You Need to Know About Cholesterol Not receiving Dr. Sinatra’s free eletters? Sign up today at drsinatra.com.

Heart-Healthy Recipes Be sure to visit the “Recipe of the Week” section of drsinatra.com to gain access to 100 delicious and nutritious recipes that promote optimal heart health. Facebook and Twitter

facebook.com/SinatraMD twitter.com/SinatraMD Stephen Sinatra, MD, FACC, FACN, CNS is a board-certified cardiologist and certified bioenergetic analyst with more than 30 years of experience in helping patients prevent and reverse heart disease. Dr. Sinatra integrates the best conventional medical treatments with complementary nutritional and psychological therapies. Dr. Sinatra is an Assistant Clinical Professor at the University of Connecticut School of Medicine and is author of numerous books including Lower Your Blood Pressure in Eight Weeks, Heart Sense for Women, Reverse Heart Disease Now, and Earthing. He is a Fellow of the American College of Cardiology; Fellow of the American College of Nutrition; board certified in internal medicine and cardiology; and certified in anti-aging medicine, clinical nutrition, and bioenergetic analysis.

Your Doctor Says “No”

to

Supplements—Now What?

“My mother, who’s 73, recently had triple bypass surgery. The week after her surgery, I took her some of the supplements you recommended to help her get through recovery and to strengthen her heart. I gave her CoQ10, D-ribose, and your multivitamin. She said she’d ask her cardiologist if it was okay to take them. He said he “didn’t know enough about them,” so he couldn’t recommend the supplements. Now, my mom is afraid to take them.”

A

member of my editorial team shared this story with me but she isn’t alone. For years, I’ve heard variations on this theme: I recommend certain nutritional supplements for heart health. Then, patients ask their other doctors about the supplements and often, receive negative or indifferent answers such as “they may cause harm,” or “there’s no science.” Such responses are cop outs, to put it mildly. There’s an immense body of powerful research supporting the use and safety of supplements, and any smart doctor should certainly be up on the subject.

Supplements Are Safe Here’s a revealing statistic: The American Association of Poison Control Centers reports 11 deaths, supposedly, from supplement use during the last 27 years. I say “supposedly” because the circumstances linking the supplements to actual deaths are questionable. This is a tremendous safety record. Now, compare prescription drugs. A 2011 study reveals that each year in this country, adverse effects cause about 4.5 million visits to doctors’ offices and hospitals. In fact, prescription drugs are our fourth leading cause of death, killing more than 27,000 people in 2007—more than heroin and cocaine combined. In addition to being safe, supplements are generally necessary because so many people have poor diets. Moreover, many medications cause nutritional deficiencies. I find it ludicrous that doctors believe supplements may cause harm but seem less concerned about the potential dangers of drugs. Keep in mind that medical doctors get little, if any, nutritional training in medical school and rarely attempt to fill their knowledge gap once in practice. Years ago when I was a hospital medical Heart, Health & Nutrition (ISSN# 1554-2467) is published monthly by Healthy Directions, LLC 7811 Montrose Road, Potomac, MD 20854-3394. Telephone: (800) 211-7643. Please call or write to P.O. Box 3264, Lancaster, PA 17604-9915. if you have any questions regarding your subscription. Postmaster: Send address changes to Heart, Health & Nutrition, P.O. Box 3264, Lancaster, PA 17604-9915. Periodicals postage at Rockville, MD, and at additional mailing offices. Author: Stephen Sinatra, MD, FACC, FACN, CNS • Managing Editor: Vera Tweed • Research Editors: Martin Zucker and Jan DeMarco-Sinatra, MSN, CNS, APRN.

2

education director, I had a hard time trying to encourage my physician colleagues to accept nutritional medicine. Most were simply annoyed by my efforts. They demanded to see studies, which I didn’t mind providing, but I had to spoon-feed them to make any progress.

What You Can Do If your doctor disapproves of supplements, don’t be intimidated but be a messenger! Tell your doctor if you’ve had positive experience with certain supplements—convey your passion—and stick the evidence under his or her nose. To empower you, below I’ve capsulized information about supplements you are very familiar with: CoQ10, fish oil, and vitamin E. I chose them because a recent survey of physicians, including 300 American cardiologists, found that heart patients most often ask about these. The survey also found that 37 percent of cardiologists take supplements regularly and 57 percent take them “at least occasionally.” If you face a reluctant or doubting physician, I hope that the key information and studies I’ve summarized here will help you to make your case.

CoQ10 Overview A deficiency of CoQ10 was first identified in heart patients back in 1972. I started using the supplement in my practice in 1982 and have never been disappointed by its ability to help patients, in particular to boost the energy of weak, compromised hearts. Peter Mitchell, a British biochemist, won the 1978 Nobel Prize in Chemistry for showing how biological energy is created in cells, a process in which CoQ10 plays a central role. CoQ10 is a member of my “awesome foursome” nutrients (along with magnesium, carnitine, and D-ribose) that

Annual subscription $69.99. © 2011 by Healthy Directions, LLC. Photocopying, reproduction, or quotation strictly prohibited without written permission of the publisher. Bulk rates available upon request.

PA 17604-9915, or send e-mail to feedback@drsinatra. com. He maintains a Web site with additional information and services at www.drsinatra.com.

Heart, Health & Nutrition is dedicated to the prevention and treatment of disease. Heart, Health & Nutrition cannot offer medical services; Dr. Sinatra encourages his readers to seek advice from competent medical professionals for their personal health needs. Dr. Sinatra will respond in the newsletter to questions of general interest, and urges you to write him at P.O. Box 3264, Lancaster,

Dr. Sinatra is compensated on the sales of the supplements he formulates for Advanced BioSolutions, a division of Doctors’ Preferred, LLC. He is not compensated for other companies’ products that he recommends in this newsletter.

H E A RT, H E A LT H & N U T R I T I O N • A U G U S T 2 0 1 1

provide essential raw materials to the mitochondria, the energy-producing structures of cells. Moreover, CoQ10 is a major antioxidant. In 1992, after years of trying to convince my colleagues, I was able to finally put CoQ10 on the pharmaceutical formulary of Manchester Memorial Hospital in Connecticut, meaning that patients in the hospital could be prescribed CoQ10. I regard CoQ10 as a necessity for aging and ailing hearts, especially for individuals taking cholesterollowering statin drugs. Statins deplete the body of CoQ10, leading to problems such as muscle weakness and pain that reduce quality of life. In 2004, the Canadian Government ordered that all statin prescriptions carry a warning about CoQ10 depletion. I’m still waiting for that to happen in this country.

Important CoQ10 Studies In 2008, a group of New Zealand doctors described CoQ10 concentration in the blood as an independent predictor of mortality in heart failure patients, and found that a deficiency leads to worse outcomes. My clinical observations over the years indicate that

the bigger the deficiency, the more severe the symptoms. Heart failure patients are less symptomatic and have improved quality of life when they have CoQ10 blood levels greater than 2.5 mcg/mL (0.6– 0.8 mcg/mL is considered normal). In 1994, a study of more than 2,500 Italian heart failure patients at multiple medical centers showed that 50–150 mg of CoQ10 daily, taken for three months, produced a variety of significant improvements in symptoms and clinical signs. Among these: cyanosis (tissue near the skin becoming blue as a result of low oxygen), 78 percent; edema, 79 percent; pulmonary rates, 78 percent; shortness of breath, 53 percent; palpitations, 75 percent; subjective arrhythmias, 63 percent; vertigo, 73 percent; and insomnia, 66 percent. A 2011 study demonstrated that 300 mg of CoQ10 improved mitochondrial and endothelial function after eight weeks, in patients with left ventricular dysfunction as a result of coronary artery disease. My Recommendations: For prevention: 50–100 mg daily; for heart disease: 100–200 mg or more; for heart failure: 300–600 mg. Choose a ubiquinone form for best absorption and always take CoQ10 with food.

News You Can Use—CoQ10

for

Dental Health

Some years ago, I had a barber who suffered terribly from dry mouth. I wished I could help him but at the time, a nutritional solution had not been found. Now, recent research has discovered that 100 mg of CoQ10 daily increases saliva production and relieves dry mouth symptoms.

douses inflammation that accompanies gum disease and reduces the depth of pockets in the gums. These pockets are hard to clean and are key breeding grounds for bacteria, so this action of the nutrient is extremely beneficial. Vitamin C, folic acid and zinc are other good nutrients for dental health.

With dry mouth, the salivary glands don’t produce enough saliva. This causes discomfort when chewing, swallowing and even talking, and increases the risk of dental decay and other infections in the mouth which, in turn, contribute to chronic inflammation and heart disease. Gum disease—the chief cause of adult tooth loss—is also dangerous.

To keep your mouth in good shape, I recommend nutritional lozenges with these dosages in a daily serving: ■ CoQ10: 100 mg ■ Folic acid: 300 mcg ■ Vitamin C: 90 mg ■ Zinc: 4.5 mg

I view the mouth as a window to the heart. In the case of gum disease, bacteria in the mouth can migrate through the gums and into the bloodstream. Being foreign invaders, these bacteria trigger an immune response—internal inflammation—much like a splinter makes your finger turn red. And that internal inflammation leads to heart disease, or makes it worse. That’s why gum disease is so important to prevent or, where it exists, treat. CoQ10 plays a key role in this scenario. Studies that go back nearly 20 years have found that CoQ10

In addition, make sure you brush your teeth along the gum line, twice daily, with a soft-bristled brush, and floss before you go to bed. Drinking a cup of green tea before eating also helps to prevent harmful bacteria from staying in your mouth. For more details on good nutrition for dental health, go to drsinatra.com. References (click below for more info) Ryo K, et al. Effects of coenzyme Q10 on salivary secretion. Clin Biochem. 2011;44(8–9):669–674. Bullon P, et al. Mitochondrial dysfunction promoted by Porphyromonas gingivalis lipopolysaccharide as a possible link between cardiovascular disease and periodontitis. Free Radic Biol Med. 2011;50(10):1336–1343.

H E A RT, H E A LT H & N U T R I T I O N • A U G U S T 2 0 1 1

3

Omega-3 Fatty Acids Overview

Online Resources for Nutritional Studies

For many years, scientific research has recognized that omega-3 fatty acids, found in marine life, nourish the heart. For more than two decades, I have recommended fish oil to my patients and have seen it produce significant improvements in racing hearts, arrhythmias, atrial fibrillation, high blood pressure, and suppressed heart rate variability. Fish oil also helps to neutralize the toxic effects of Lp(a) (an ultra-inflammatory cholesterol particle), reduce arterial inflammation, improve endothelial function, and promote healthier blood flow and clotting. Recently, I switched from fish to squid oil, for two reasons:

For copyright reasons, I can’t reproduce scientific articles here but with the Internet, you can easily find research, print it out, and take it to your doctor. (All the more reason to develop computer skills, as I pointed out in the last newsletter.) These are some good sources for supplement science and information: ■ The Linus Pauling Institute at Oregon State University http://lpi.oregonstate.edu ■ The International Coenzyme Q10 Association www.icqa.org ■ University of Maryland Medical Center (click on supplements or herbs) www.umm.edu/altmed/ ■ The U.S. National Library of Medicine www.pubmed.gov

Salmon, tuna, herring, sardine, and anchovy stocks are being depleted, yet these are the most common sources for supplements. Squid breed more rapidly and are not endangered. And, harvesting of squid does not harm the ecology of the sea floor. Squid omega-3 fatty acids contain more DHA (docosahexaenoic acid) than EPA (eicosapentaenoic acid). DHA represents the more beneficial and protective component of the two, especially for the heart, brain, and retinas.

Important Omega-3 Studies The most impressive study to date was done in Italy, where researchers followed more than 11,000 patients with a history of heart attacks, at 172 medical centers. Individuals who took 1 gram of fish oil daily had a 30-percent reduced risk of sudden death, from heart disease or any other cause, during the year following a heart attack—the period when they are the most vulnerable. Another large-scale Italian study showed that fish oil provides protection for people with chronic heart failure. Among patients already receiving conventional treatment, approximately 2 grams of fish oil daily reduced deaths and hospital admissions. According to the researchers, fish oil helps to normalize heart rhythm and slow progression of heart failure. A 2009 review of medical literature strongly validated the use of fish oil to prevent coronary artery disease and delay its progression. Researchers found that omega-3s reduce inflammation, lower blood pressure, and help to prevent fatty deposits that clog blood vessels. My Recommendations: For general prevention, take 1–2 g daily, or eat fish (not fried—see next page) at least once a week. If you have heart disease, take 2–3 g daily. For fish recipes, visit drsinatra.com. 4

H E A RT, H E A LT H & N U T R I T I O N • A U G U S T 2 0 1 1

Vitamin E Overview Vitamin E has been in the limelight as a heartfriendly antioxidant since the 1950s but over time, research results have been inconsistent with the most common type of vitamin E supplement: alpha tocopherol. In fact, this ingredient is only one of eight components that make up vitamin E in nature. One reason for study inconsistencies may be the use of alpha tocopherol in isolation, without other members of the vitamin E family, leading to an imbalance of vitamin E components. Another may be that many supplements contain a synthetic form—dl-alpha tocopherol—rather than the natural form known as d-alpha tocopherol. (To avoid confusion, you can think of the “dl” in the synthetic form as “delivers less.”) Yet another problem stems from taking too much vitamin E. An antioxidant in lower doses, alpha tocopherol in very high doses (800 or 1200 IU daily) can work in the opposite way and increase oxidation. In recent years, research has begun to show that vitamin E should be taken in a form that more closely mimics nature. This includes the alpha tocopherol form and its sibling compounds, particularly gamma tocopherol and delta-tocotrienol, the most potent antioxidant substances in the family. As I reported in March 2009, delta tocotrienol is particularly effective in reducing inflammation and deposits in arteries. In the early stages of atherosclerosis, it inhibits the activity of adhesion molecules—sticky substances produced in the walls of blood vessels.

For many years, I have routinely recommended a natural vitamin E formula with alpha and gamma tocopherol. In addition to its positive cardiovascular effect, vitamin E also protects the lungs from air pollution and the large bowel from carcinogens.

Important Vitamin E Studies A 2008 review of previous studies by researchers at the University of Cambridge showed that vitamin E reduces the risk of heart disease. A 2010 Chinese study using animal models found that delta tocotrienol may retard atherosclerosis by activating certain genes that influence energy metabolism and inflammation. Laboratory studies have shown that mixed tocopherols are “much superior” to alpha tocopherol alone in protecting cell cultures from oxidative damage. “Lack of efficacy of commercial tocopherol preparations in commercial trials,” one study suggested, “may reflect absence of gamma- and delta-tocopherols.” My Recommendations: Different components of vitamin E are listed separately on supplement ingredient labels. In a daily dosage, look for: 200 IU of d-alpha tocopheryl succinate, an especially absorbable form of natural d-alpha tocopherol; 50–100 mg of gamma tocopherol; and 25–50 mg of a combination

of different tocotrienols (broad spectrum). And, a few times a week, eat foods that are rich in gamma tocopherol—almonds and wheat germ are best. References (click below for more info) Sinatra S, Roberts J, Zucker M. Reverse Heart Disease Now, Wiley, New York, 2008. Sinatra S. The Sinatra Solution: Metabolic Cardiology. Laguna Beach, CA: Basic Health Publications; 2011. Centers for Disease Control and Prevention. Prescription Drug Overdoses: An American Epidemic. Sarkar U, et al. Adverse drug events in U.S. adult ambulatory medical care. Health Serv Res. 2011;May 10. [Epub ahead of print] Dickinson A, et al. Use of dietary supplements by cardiologists, dermatologists and orthopedists: report of a survey. Nutr J. 2011 Mar 3;10:20

CoQ10 Studies Molyneux SL, et al. Coenzyme Q10: an independent predictor of mortality in chronic heart failure. J Am Coll Cardiol. 2008;52(18):1435–1441. Baggio E, et al. Italian multicenter study on the safety and efficacy of coenzyme Q10 as adjunctive therapy in heart failure (interim analysis). Clin Investg. 1993;71(8 Suppl):S145–149. Dai YL, et al. Reversal of mitochondrial dysfunction by coenzyme Q10 supplement improves endothelial function in patients with ischaemic left ventricular systolic dysfunction. Atherosclerosis. 2011;216(2):395–401.

Omega-3 Studies Marchioli R, et al. Early protection against sudden death by n-3 polyunsaturated fatty acids after myocardial infarction: time-course analysis of the results of the Gruppo Italiano per lo Studio della Sopravvivenza nell’Infarto Miocardico (GISSI)-Prevenzione. Circulation. 2002;105(16):1897–1903. Marchioli R, et al. Omega-3 fatty acids and heart failure. Curr Athersoscler Rep. 2009;11(6):440–447. De Leiris J, et al. Fish oil and heart health. J Cardiovasc Pharmacol. 2009;54(5):378–384.

Vitamin E Studies Ye Z, Song H. Antioxidant vitamins intake and the risk of coronary heart disease: meta-analysis of cohort studies. Eur J Cardiovasc Prev Rehabil, 2008;15(1):26–34. Li F, et al. Tocotrienol enriched palm oil prevents atherosclerosis through modulating the activities of peroxisome proliferators-activated receptors. Atherosclerosis. 2010;211(1):278–282. Chen H, et al. Mixed tocopherol preparation is superior to alpha tocopherol alone against hypoxia-reoxygenation injury. Biochem Biophys Res Commun. 2002; 291(2):349–353.

Heart Beat: What’s Good, What’s Not,

in

Cardiology

Heart failure strikes one in five people, and postmenopausal women face particularly high risk. But the way you cook your fish affects your odds of developing the disease. So concluded an analysis of information from the famous Women’s Health Initiative observational study.

reduction if you eat fish six times weekly, they do make good sense to me, and support some basic, well-established facts. We know about the benefits of marine omega-3 fatty acids, eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA)), found in high amounts in fish. These fats decrease inflammation and improve the function of the heart and linings of blood vessels (endothelial function).

Researchers looked at data on more than 80,000 women between the ages of 50 and 79, who were tracked for an average of 10 years. After crunching the numbers, they found that eating more baked or broiled fish may lower risk of heart failure, while eating more fried fish may raise the risk.

Omega-3 fatty acids are less liable to be damaged by baking and broiling than by the high heat of frying. In addition, trans fats, in the form of partially hydrogenated oils, are frequently used for frying, and these increase inflammation and oxidative stress, and negatively affect endothelial function.

More specifically: Eating more than 5 servings of baked or broiled fish per week lowered risk by 30 percent. However, eating more than 1 serving of fried fish per week increased risk by 48 percent.

Bottom line: Eat baked and broiled fish as often as possible. For more heart-healthy foods, check out Sinatra’s Super Foods at drsinatra.com.

While overall statistics like these can’t guarantee that you, personally, will have a 30-percent risk

Belin RJ, et al. Fish intake and the risk of incident heart failure: The Women’s Health Initiative. Circ Heart Fail. 2011;May 24. [Epub ahead of print]

Baked or Broiled vs. Fried Fish

Reference (click below for more info)

H E A RT, H E A LT H & N U T R I T I O N • A U G U S T 2 0 1 1

5

Cardio Drugs Review—Diuretics This class of drugs includes Lasix (furosemide), Demadex (torsemide), Bumex (bumetanide), Lozol (indapamide), and HydroDIURIL (hydrochlorothiazide). ften referred to as “water pills,” diuretics are with heart failure, diuretics are used to prevent routinely prescribed by doctors (including me) fluid buildup in the lungs. For high blood pressure, for patients with a history of heart attack, conges- the strategy is to reduce the amount of fluid flowtive heart failure, high blood pressure, and edema. ing through the blood vessels and thus, the pressure Diuretics increase the amount of urine produced by against the arterial walls. During my first few weeks the kidneys, a process technically called “diuresis,” of medical practice, I put a woman on a diuretic for which clears excess fluid from the body and lungs. blood pressure and she developed such potassium depletion that she could hardly move for three days. The most important use of diuretics is in a scary, life-threatening situation called pulmonary edema, I believe that long-term use of diuretics will be increasingly challenged and eventually discourwhich requires immediate hospitalization. Fluid aged because of the mineral-wasting risks. The builds up in the lungs due to a “power failure” in famous government-sponsored Multiple Risk Factor the left ventricle, the left lower chamber of the Intervention Trials (MRFIT, or “Mr. Fit” studies) heart that receives blood and pumps it out under of the 1970s and 1980s showed that men treated high pressure to the rest of the body—at least routinely with diuretics had a higher incidence of that’s what it’s supposed to do. Heart failure or a death despite lowered blood pressure. This developheart attack can debilitate the left ventricle and ment contributed to the subsequent introduction of then, blood backs up, the lungs fill with fluid, the patient can’t breathe, and bubbles foam out of their potassium-sparing diuretics because low potassium mouth. I’ve seen this with dozens of patients. At that could predispose someone to a cardiac arrhythmia. However, those newer drugs didn’t account for the critical point, they need oxygen and an intravenous loss of other minerals. Magnesium loss, for instance, diuretic to push fluid out of the lungs. Once they may be one factor leading to heart dysfunction. start urinating, everyone breathes a sigh of relief.

O

Downsides of Diuretics Thirty-five years in practice have taught me to be wary of the insidious potential for drugs to deplete or block the absorption of nutrients—and doctors are often unaware of the connection. Important as diuretics are in emergencies, long-term use disturbs the natural physiology of the body, to a degree that may be dangerous. An editorial in the Journal of the American College of Cardiology recently described these drugs as “necessary evils whose use should be minimized as much as possible.” Here’s the problem: Diuretics cause substantial loss of potassium and magnesium—two minerals that are essential for heart health. Taking a diuretic is akin to opening the flood gates of a dam. You reduce water volume, which is a beneficial effect, but you also lose a lot of the good things in that water. Over time, the result is mineral wasting—a loss of potassium, magnesium, calcium, zinc, and other important minerals that disturbs the body’s physiological balance. Today, as many as 40 percent of adults over 65 may be taking diuretics on a long-term basis. In people 6

H E A RT, H E A LT H & N U T R I T I O N • A U G U S T 2 0 1 1

Vitamin B1 (thiamine) is another important nutrient that may be depleted by diuretics. Symptoms can include depression, reduced mental alertness, fatigue, muscle weakness or cramps, stomach troubles, and in severe cases, difficulty breathing.

Side Effects Many of my patients have reported night-time muscle cramps and weakness, the result of diureticinduced mineral loss and thiamine deficiency. Other side effects include dry mouth, excessive thirst, lethargy, drowsiness, restlessness, low blood pressure, abnormal heart rate, gastrointestinal problems (upset stomach, nausea, vomiting, abdominal discomfort, diarrhea), rash, dizziness, and headache. Potassium-sparing diuretics, such as Amiloride (also referred to as Amiloride hydrochloride or Amiloride HCI), can also cause some of the same problems as regular diuretics, as well as loss of appetite, mental confusion, fever, and impotence.

Nutritional Support If you’re on a diuretic, be sure to tell your doctor if you develop any of the side effects I just mentioned.

In most cases, they can be reduced by dietary and nutritional support. Here’s what I recommend: ■

■

■

■

■

■

To offset the loss of minerals and thiamine, take a good multi-vitamin and mineral supplement with thiamine and other B vitamins. Minimize processed or fast food, which is high in salt and woefully low in potassium and magnesium. Avoid coffee and alcohol as these also deplete potassium and magnesium. To counteract depletions, include these foods in your diet: raisins, prunes, apricots, papaya, dates, avocados, bananas, strawberries, watermelon, cantaloupe, oranges, beets, greens, spinach, peas, squash, tomatoes, mushrooms, baked potato, beans, peas, turkey, fish, and chicken. Take 400–800 mg daily of a broad-spectrum magnesium supplement (preferably with magnesium glycinate, orotate, citrate, and taurinate) and eat plenty of magnesium-rich green, leafy vegetables and whole grains. Get 3 grams daily of potassium. The mineral is more challenging to take as a supplement because a potassium pill contains no more than 99 mg, about the amount in two bites of a banana. Eat these foods to reach the

daily potassium goal of 3 grams: sweet potato (700 mg), cooked or raw beet greens (½ cup = 650 mg), baked potato (600 mg), coconut water (1 cup = 600 mg), plain yogurt (8 oz = 580 mg), prunes (stewed ½ cup = 400 mg) and prune juice (¾ cup = 530 mg), carrot juice (¾ cup = 517 mg), halibut (3 oz = 490 mg), lima beans (½ cup = 484 mg), winter squash or soybeans (½ cup = about 445 mg), banana (420 mg), spinach (½ cup = 419), dried peaches or apricots (¼ cup = 400 mg), and lentils (½ cup = 365 mg). As part of my daily routine, I blend a variety of fruits and vegetables and coconut water, for a solid serving of potassium as well as magnesium.

Other Options For people with mild fluid retention, I recommend drinking a cup of ginger tea daily. Organic ginger tea is available in health food stores. You can also make your own from ginger root: Chop the root into small pieces and boil for about five minutes. However, for anyone who has seriously weakened left ventricle function, there is no substitute for diuretics. Reference (click below for more info) Gottlieb SS. Diuretics: are our ideas based on knowledge? J Am Coll Cardiol. 2011;57(22):2242–2243.

Nutrient Science—Mirtogenol

Y

ou may already know that during World War II, British Royal Air Force pilots ate bilberry jam before night flights, because the fruit helps with night vision. Today, we have much more nutritional science but bilberry continues to be a key food for the eyes. In fact, a bilberry extract has been combined with a very strong antioxidant from French maritime pine bark to create a special nutritional blend that protects the eyes as we get older. The new blend is called Mirtogenol (pronounced “mir-toj-en-all”). It’s a combination of a standardized bilberry extract and Pycnogenol (pronounced “pickgnaw-jen-all”), a powerful and thoroughly studied antioxidant. Mirtogenol is an exact, proprietary blend of these two ingredients that has been tested in studies, and was found to deliver very specific vision benefits. This research is new—not even published yet—but I want you to have the knowledge. Mirtogenol reduces high intraocular pressure. Here’s what that means: The eyeball is surrounded by fluid

for

Vision

and optimum pressure of that fluid is what maintains a healthy round shape of the eye. With age, pressure in the fluid can increase and damage the eye. This type of damage is a leading cause of glaucoma, vision loss that begins with loss of peripheral vision and can progress to total blindness. Glaucoma is one of the leading causes of vision loss. I know how debilitating vision loss can be. You may remember me telling you about my mother and grandmother, who would tilt their heads in various ways, squint uncomfortably, and do whatever they could to get the best light on different things they were looking at. Controlling intraocular pressure—the pressure on the eyeball—is something we can now do to give our eyes the best chance of serving us well for a long time, and Mirtogenol can help us do just that. I recommend taking 120 mg of Mirtogenol daily. For more ways to protect your eyes, I encourage you to visit my blog at blog.drsinatra.com. H E A RT, H E A LT H & N U T R I T I O N • A U G U S T 2 0 1 1

7

Special Web Features Visit my Website

for

August, 2011

Read my Blog

Join me on Facebook

Featured Videos

Top Tips for Bone Health

8 Ways to Outsmart Poison Ivy

Lower Cholesterol with Three Simple Diet Swaps

Heart-Healthy Nutrition: Chicken with Peapods and Zucchini

“I buy my organic foods and grassfed meat directly from the farmers at farmer’s markets. That’s the best way to get higher quality organic foods for a good price.” —C.B., comment on my June 27 post about fresh fruits and veggies

Premature Ventricular Contractions: When They Matter

Get a Leg Up on Healthy Knees

Volume 17, Number 8

INSIDE THIS ISSUE: ■ Dear Reader: A Simple Test

That Can Save Your Life . 1 ■ What If Your Doctor Says

“No” to Supplements?. . . . 2 ■ CoQ10 for Dental Health . 3 ■ Fish: Baked or Broiled vs.

Fried. . . . . . . . . . . . . . . . . . . . 5 ■ Diuretics—Drug Review. 6 ■ Mirtogenol: New Nutrient

for Healthy Vision. . . . . . . .7

IN FUTURE ISSUES ■ Best Multi—His and Hers ■ Cold Hands or Feet? Relief is

Finally Here

A

“

ny idiot can face a crisis—it’s day-to-day living that wears you out.” —Anton Chekhov, 1860–1904

8 Ways to Prevent Tick-Borne Illnesses

Cardinal Principles of my Heart Health Program Why I Became an Integrative Cardiologist

Q & A Session Keep those questions coming! Send an email to [email protected], or write to me at Dr. Sinatra Feedback, P.O. Box 3264, Lancaster, PA 17604-9915.

Better Drug for Arrhythmias Which medication do you favor for arrhythmias, beta blockers or calcium channel blockers?—JT, via email Dr. Sinatra replies: First, let me explain how these two types of drugs work. Beta blockers inhibit adrenaline, a stress hormone that constricts arteries and stimulates our fight-or-flight response (the sympathetic nervous system). By blocking this stress response, the drugs calm the heart. Calcium channel blockers work differently. They inhibit calcium from entering muscle cells of the heart and arteries, and by doing so, reduce electrical stimulation of the heart and dilate arteries. I favor beta blockers because they also help to improve heart rate variability. As well as having a calming effect on arrhythmias, this reduces risk for sudden cardiac death. Moreover, they are very safe drugs. Beta blockers, however, have a few downsides. They can drain CoQ10 from the body and so must be taken with a CoQ10 supplement. I recommend taking 100 mg of CoQ10, once or twice a day, if you are taking beta blockers. And, these drugs should not be used by diabetics, because they can mask symptoms of hypoglycemia, or patients with chronic obstructive pulmonary disease, because they exacerbate breathing difficulties. You can learn more about arrhythmias by going to my Health Centers at drsinatra.com and selecting “Heart Health,” and on my blog at blog. drsinatra.com.

See more Q & As online at drsinatra.com 8

H E A RT, H E A LT H & N U T R I T I O N • A U G U S T 2 0 1 1