Keep Your Pump and Pipes Working
By Karen Wheeler APRN
When I was a nursing student back in the early 1980’s, one of my first rotations was in Coronary Care. I fell in love with the challenge of caring for critically ill patients and did that for 17 years before completing my Master’s Degree as a Family Nurse Practitioner. The heart and the entire circulatory system are so wonderfully complex that here it is nearly 4 decades later and I am still fascinated with the cardiovascular system! Having worked in conventional medicine for so many years, I am comfortable with caring for patients with high blood pressure, arrhythmias, heart attacks and strokes. When I started here at Riordan Clinic in 2014, I made learning the functional medicine approach to heart disease a priority. So it is only fitting that during February, which is America’s Heart Awareness month that I write about cardiovascular disease treatment and prevention.
According to the Center for Disease Control, heart disease is the number one cause of death in this country for both men and women. More than 26.5 million adults are diagnosed with heart disease. It affects people of all races. Professional guidelines recommend screening children as young as 9 years old for high cholesterol in an attempt to intervene early to prevent heart disease.
Commonly quoted risk factors for heart disease are high blood pressure, high cholesterol, diabetes, obesity, tobacco use, physical inactivity and stress. But Dr. Mark Houston, a cardiologist who has an integrative cardiology practice in Nashville, Tennessee, points out that there are close to 400 risk factors in his book “What Your Doctor May Not Tell You About Heart Disease.” That statement really got my attention!
Dr. Houston points out that the root causes of cardiovascular disease start as functional changes in our teens and progress to structural changes as we age. All of those risk factors are making changes in the endothelium which is the lining of the blood vessels. Changes, such as inflammation, oxidative stress and immune dysfunction, cause arterial stiffening and lipid deposits in the sub-endothelial layers of the arteries, which eventually lead to acute events such as heart attacks and strokes.
Every day, people with normal cholesterol levels suffer heart attacks and strokes! This is because just knowing how much cholesterol and what kind your body has is not as important as knowing the particle size and functionality of the different cholesterol’s. This information can be measured using advanced lipid testing which is available through several labs throughout the country.
If the LDL or “bad” cholesterol particles are bigger, they are less likely to infiltrate the endothelial lining. Likewise, the HDL or “good” cholesterol needs to be found in high enough numbers and functionality because it is the “clean-up crew” that neutralizes any damage caused by the LDL. In some people, the HDL level is just too low to keep up with the high amount of LDL while in others it may not be functioning well enough. HDL becomes dysfunctional from inflammation, heavy metal exposure, infection or poor nutrient intake. Addressing each of these factors can improve the functionality of the HDL and therefore lessen the risk of cardiovascular events. C – reactive protein (CRP) is a marker of HDL dysfunction and inflammation and is routinely done to monitor effectiveness of interventions.
Blood pressure is considered a risk factor for heart disease because of the shearing force stress that it puts directly on the blood vessels as well as the heart as a pump. The top number of a blood pressure is called the systolic BP and is how hard the heart has to exert to push the blood out of itself and into the arteries. The bottom number is the diastolic and reflects how much the heart gets to relax between beats. Since the heart cannot ever completely rest, it is imperative to not overwork it so the pump wears out!
Over the years, the numbers that have been considered “normal” blood pressure have changed. The Joint National Committee periodically updates these values to guide practitioners with what this expert panel has determined will give patients the best outcomes based on current research. Currently, the target for an adult is to have their blood pressure <120/80. A person has pre-hypertension with a BP between 120-140/80-90 and is considered to have high blood pressure (AKA hypertension) if their blood pressure is above 140/90.
Blood pressure is affected by many factors such as sodium and water intake, caffeine, tobacco and stress. It varies from minute to minute. Patients often report having “white coat hypertension” because their blood pressure readings are “fine” at home but are high when taken at the doctor’s office presumably from being nervous in that setting. Obviously, the doctor’s office is not the only stressor that the person will experience and, not treating elevated blood pressures when they are found there, is a gamble.
Dr. Houston points out that a person’s blood pressure should “dip” during the night by approximately 10% of their daytime readings and that people who do not “dip” or whose blood pressures elevate during the night are at increased risk of cardiovascular events. He suggests using a 24 hour blood pressure monitor to document a person’s blood pressure including their “dipper” status. He emphasizes that it is not as simple as moving blood pressure medicines to be taken before bed because excessive drops in nighttime blood pressure have increased risk of strokes. There are multiple nutrients that can be used to improve blood pressure such as Hawthorne berry and magnesium. (Do NOT stop any of your medications without proper consultation and monitoring or you risk an acute event or even death!)
Having normal blood sugar is essential to preventing cardiovascular disease. Dr. Houston points out that conventional medicine has been too lenient compared to functional medicine on what is considered acceptable blood sugar levels. While conventional medicine would accept fasting blood sugars of up to 100 as being normal, he considers the ideal fasting blood sugar to be 75! And a blood sugar taken 2 hours after eating a meal is considered normal at 140 but functionally should be limited to 110 to lessen the risk of atherosclerosis since most of the damage to the blood vessels occurs after eating unhealthy foods. There are several supplements and diet changes that can be made to improve blood sugar levels.
Metabolic endotoxemia is being researched as one of the leading causes of cardiovascular disease. This refers to the phenomena of the lining of the gastrointestinal tract being damaged by gluten, sugars and chemicals that are ingested. This damage allows bacteria from the GI tract to enter the blood stream which results in inflammation and infection. This in turn leads to damage in the endothelium which starts the deposits of cholesterol and aggravates the clotting factors that eventually cause heart attacks and strokes.
Nutrients that are helpful with cardiovascular health include red yeast rice which has natural statin effects. Vitamin C and vitamin E can also help lessen inflammation. Eating cruciferous vegetables and a Mediterranean diet that uses olive oil and limits red meat will lower cardiovascular risk. Dr. Houston also recommends garlic, lycopene, resveratrol and niacin. Good balance between GLA, DHA and EPA, he considers essential to cardiovascular health. A patient’s essential fatty acids can be measured to be sure that this balance is in place and, if not able to achieve it with diet alone, supplements can be taken.
Prevention of cardiovascular disease with healthy lifestyle is key. One should limit their sodium intake to less than 2 grams/day. Eat a Mediterranean diet. Avoid all tobacco products. Maintain an ideal body weight and composition with a daily exercise program that consists of 40 minutes of resistance training and 20 minutes of interval aerobic exercise. Dr. Houston recommends increasing potassium intake but I would caution readers to only do this if they know that they have normal kidney function and that they are not on medications that retain potassium such as spironolactone because too high a potassium level can be fatal.
It is beyond the scope of this article to go further into details of the functional approach to cardiovascular disease. If you are currently experiencing chest pain or shortness of breath at rest or with exertion, go to a conventional cardiologist to be sure that you are not having those symptoms because your heart is not getting the blood flow that it needs. We do NOT treat acute heart attacks or strokes here at Riordan Clinic! But, once you are in a stable condition, come see us so we can get to the root of what is causing your heart and blood vessels to be unhealthy because That is OUR specialty!