The Prevention and Treatment of Cardiovascular Disease (CVD) through Nutrition
by John Starnes
Cardiovascular Disease is a group of disorders of the heart and blood vessels that include, Coronary Heart Disease (Disease of the blood vessels supplying the heart muscle), Cerebrovascular Disease (Disease of the blood vessels supplying the brain), Peripheral arterial disease (Disease of the blood vessels supplying the arms and legs), Rheumatic heart disease (Damage to the heart muscle and heart valves from rheumatic fever, caused by streptococcal bacteria), Congenital Heart Disease (Malformations of heart structure existing at birth), Deep vein thrombosis and pulmonary embolism (Blood clots in the leg veins that can become dislodged and move to the heart and lungs)..
Globally, cardiovascular diseases (CVD’s) kill more people than any other. According to the World Health Organisation (WHO), in 2005 CVD’s were responsible for 2.15 million deaths (representing 26.4% of total deaths) in High Income countries; 5.23 million deaths (28.5%) in Middle income countries and 4.12 million (17.8%) in Low Income countries. WHO estimates that by 2015 around 20 million people globally, per annum will die from CVD’s and they will remain the single leading cause of death for the foreseeable future.
The causes of CVD’s are well known and have been established for many years. The main three factors, which are responsible for around 80% of premature deaths, are: a) Unhealthy diet, b) Sedentary lifestyle and c) Smoking. It is generally accepted that these factors can be regarded as potentially ‘reversible’ or’ modifiable’.
Whilst acknowledged globally that an unhealthy diet is a major contributory factor in CVD’s, governments generally have failed to deal with it, and the food industry (particularly the ‘fast food’ industry), is happy to continue exploiting human weakness.
What is a healthy diet?
A healthy diet is one which reduces the risk of CVD or if already suffering from CVD, will help protect against further problems. The healthy diet achieves this by maintaining a healthy weight, lowering cholesterol levels, maintaining normal blood pressure, preventing the build up of fatty material in the arteries and blood clots forming.
It has also been shown that a healthy diet can help protect against other conditions such as certain cancers and diabetes as well as ensure a strong immune system.
A healthy diet should include plenty of fruit and vegetables, grains, seeds, nuts, pasta, rice and fish and should not contain excessive fat (especially saturated fat), processed foodstuffs, salt and sugar.
Let’s look at some of these in more detail:
Fruit and vegetables
Fruit and vegetables are rich in many essential nutrients including vitamins C and E and carotenoids (which the body converts into vitamin A). These nutrients (antioxidants) help to protect the heart by limiting the damaging affects of cholesterol on body tissues. In addition vegetables that are high in calcium, magnesium and potassium, especially green leafy vegetables and beans, which are high in folate. A minimum of at least five servings of fruit and vegetables a day is recommended. An average serving is around 80g.
Whole grains are products that contain all of the grain that is edible. They include the bran and germ portions which are the parts that contain most of the vitamins, minerals and fibre. Some examples of whole grains are whole wheat, bulgur, oatmeal, whole cornmeal, popcorn, brown rice and whole rye.
Large scale studies in the United States have shown that diets rich in wholegrain food can reduce the risk of CVD by up to 30%.
Wholegrain can be included in most meals by choosing wholegrain breakfast cereals (such as muesli, porridge etc), wholemeal bread and wholegrain varieties of pasta and rice.
Omega3 fish oils, which contain EPA and DHA, have been shown to reduce the risk of heart disease. Anyone who has had a heart attack and starts consuming Omega3 rich fish three time a week, could halve the risk of a further attack.
Increasing fish meals to three per week may also help reduce cholesterol levels.
Studies looking at the diet and health of different population groups have found that eating nuts more than once a week is associated with a decreased risk of CVD. Four clinical trials comparing the effects of diets with and without nuts, found that the diets with nuts seemed to have a greater cholesterol lowering effect.
As well as having potential beneficial effects on blood fats, nuts may protect against heart disease through other mechanisms. For example, some nuts, including almonds, hazelnuts, pecans, peanuts and brazil nuts, are good sources of antioxidants, such as vitamin E and selenium. Walnuts (and walnut oil) are a good source of the omega 3 fatty acid, alpha-linolenic acid.
Studies have shown the consumption of nuts to have a link with longevity. A major study of 26,000 members of the Seventh Day Adventist Church, in the US, showed that those that ate almonds, peanuts and walnuts at least six times a week had an average lifespan seven years longer than the general population.
Sunflower, sesame, pumpkin, linseed, poppy, millet seeds and many more. The benefits of seeds are well known; full of vitamins, minerals and more important for CVD prevention – Omega 3 oils. They can be used as a ‘between meals’ snack or added to cereals, salads and soups Seed mixes are now available conveniently packed from most good health food stores.
Too much fat in the diet, particularly saturated fat, will increase LDL blood cholesterol levels which can increase the risk of developing coronary heart disease. To help reduce cholesterol levels, cut down on the total amount of fat consumed and replace saturated fats with monounsaturates and polyunsaturates and cut down on foods containing trans fats. By reducing the amount of red meat consumed and changing to (e.g.) olive oil for cooking and dressings, the level of LDL (bad) cholesterol can be significantly reduced..
Studies have indicated that elevated blood pressure is strongly associated with high salt (sodium) intake. In some instances this reaction may be genetic with some people inheriting a sensitivity that predisposes them to hypertension.
Reducing the amount of salt added to food will help ensure that blood pressure is maintained at a healthy level and thus reduce the risk of heart disease.
What are dietary supplements?
A dietary supplement (sometimes known as food supplement) is a preparation intended to supply nutrients, (such as vitamins, minerals, fatty acids, amino acids, herbs, etc) that are missing or not consumed in sufficient quantity in a person’s diet. Some countries define dietary supplements as foods, whilst in others they are defined as drugs. In the United States, the definition of dietary supplements includes non-medicinal herbal supplements and hormones, such as DHEA, pregnenolone (both steroids) and melatonin.. Supplements containing vitamins or dietary minerals are recognised by the Codex Alimentarius Commission (the United Nations’ highest authority on food standards) as a category of food.
In the European Union, the Food Supplements Directive requires that supplements be demonstrated to be safe, both in quantity and quality. Some vitamins are essential in small quantities but dangerous in large quantities (such as Vitamin A). Consequently, only those supplements that have been proven to be safe may be sold without prescription. In practice, however, there appears to be little risk to supplement users of experiencing adverse side effects due to excessive intakes of micronutrients.
It is also an established view that food supplements in Europe should not be labeled with drug claims but can bear health claims, although to a degree that differs from one member state to the other.
Let’s look at some supplements that may help prevent and/or treat CVD’s:
Antioxidants such as vitamin E (also called tocopherol) protect cells in the body from oxidation. Oxidation is a process that leads to cell damage. It may play an important role in atherosclerosis — the development of plaque in blood vessels that can cause heart disease and stroke.
Consuming foods rich in antioxidants (like vitamin E and vitamin C, carotenoids, and selenium) may lower the risk of heart disease. Such foods include fruits, vegetables, whole grains, nuts, and seeds. The current recommendation by the American Heart Association is to make sure you include these important nutrients in your diet.
Natural sources: The most abundant sources of vitamin E are vegetable oils such as palm, sunflower, corn, soybean and olive. Nuts, sunflower seeds, kiwi fruit and wheat germ are also good sources.
This vitamin-like substance is, by nature, present in most human cells and is responsible for the production of the body’s own energy. In each human cell, food energy is converted into energy in the mitochondria with the aid of COQ10. Ninety-five percent of all the human body’s energy requirements is converted with the aid of COQ10 Therefore, those organs with the highest energy requirements – such as the heart, the lungs, and the liver – have the highest COQ10 concentrations.
There are several reports concerning the effect of COQ10 on blood pressure in human studies. In a recent meta-analysis of the clinical trials of COQ10 for hypertension, a research group at the Cardiac Surgical Research Unit, Alfred Hospital, Melbourne, Australia reviewed all published trials of COQ10 for hypertension, and assessed overall efficacy, consistency of therapeutic action, and side-effect incidence. Meta-analysis was performed in 12 clinical trials (362 patients) comprising three randomized controlled trials, one crossover study, and eight open-label studies. The research group concluded that COQ10 has the potential in hypertensive patients to lower systolic blood pressure by up to 17 mm Hg and diastolic blood pressure by up to 10 mm Hg without significant side-effects.
Another recent study, in the USA, demonstrated a survival benefit after cardiac arrest if COQ10 is administered.
Natural Sources: Mackerel, Herring, Chicken, Pork and Beef.
Selenium is a trace mineral that is synergistic with Vitamin E, each enhancing the actions of the other. Men apparently have greater need of this compound than women. It is important in the formation of the antioxidant Glutathione and has been associated with reductions in heart disease.
Natural Sources: Selenium is present in a wide range of food, including, Brazil nuts, butter, barley, oats, turnip, pumpkin seed, garlic, almond, onion, radish and carrots.
The Omega3 fish oils have been shown to reduce the risk of heart disease, as has eating fish. Anyone having had a heart attack that starts eating Omega3-rich fish three times a week can halve their risk of another attack.
Trials giving people Omega3 fish oils have proved that they confer protection against heart disease..
Natural Sources, any oily fish (i.e. fish which have oils throughout the fillet and belly cavity around the gut, as opposed to only in the liver, as in white fish.)
Garlic, once entirely part of Folk Medicine, has now found widespread acknowledgment in science.
Garlic has scientific support for the following ailments: high blood pressure, atherosclerosis, heart disease, anemia, fatigue, rheumatism, dysentery, cholera, typhoid, diabetes and hypoglycemia, bacteria, fungus, worms, cancer, bronchitis, pneumonia and heavy metal poisoning.
Carnitine, also known as L-carnitine or levocarnitine, is a quaternary ammonium compound biosynthesized from the amino acids lysine and methionine. It helps in the consumption and disposal of fat in the body because it is responsible for the transport of fatty acids from the cytosol into the mitochondria. Carnitine was originally found as a growth factor for mealworms and labeled vitamin Bt.
Carnitine is biosynthesized within the body from the amino acids lysine or methionine primarily in the liver and kidneys. Vitamin C (ascorbic acid) is essential to the synthesis of carnitine. It is also reported to be especially useful for treating angina and congestive heart failure.
Natural Sources: Highest concentrations are found in red meat, however other natural sources include, nuts and seeds, legumes, green vegetables and cereals
Hawthorn is one of nature’s best strengtheners for the heart. It also fights high blood pressure, palpitations and arteriosclerosis.
Hawthorn contains SOD (superoxide dismutase), an enzyme, which the body uses to stabilize the structure of cells. SOD also removes Superoxide, the most common Free Radical, and is therefore useful for fighting age related complaints. It contains Vitamins. A, C, B-group, E, F and Calcium, Potassium, Phosphorus, Copper, Iron, Sodium and Zinc.
Hawthorn leaves are added (conditionally as unproven) to strengthen heart and circulation, for chronic problems with heart rhythm, and for hypotension.
The patient, male aged 89 at the time, suffered a heart attack and pulmonary edema in December 2005. He was admitted to hospital as an emergency and remained in Coronary Care for 8 days. After a total of 12 days he was considered fit to return home and was discharged. Six weeks later at the end of February 2006 the patient, suffering severe breathing difficulties and chest pain was readmitted to hospital, where he remained for 9 days, before returning home. He was prescribed Bumetanide, Perindopril, Isosorbide as well as an Aspirin (75mg) per day. Over the ensuing 18 months he made no physical improvement.
Up to the time of the initial attack, the patient had enjoyed good health and an active lifestyle. By September 2007, he was essentially confined to a chair, experiencing severe breathlessness when rising and moving from one room to another within the home. He had no appetite and was eating very little. He was depressed. Grave concern was expressed by his carer (his wife) about his apparent decline.
At this time (September 2007) I suggested a way forward with a change of diet, supported by a range of supplements.
With the agreement of the patients GP, the new regime was commenced at the beginning of October 2007.
1. Change of diet
Although the patient had always followed a fairly healthy diet, some minor changes were introduced which included:
- A reduction in red meat consumption (max twice a week)
- An increase in oily fish consumption (min three times a week)
- An increase in fruit and vegetable consumption (particularly deep coloured varieties) to the minimum of 5 portions per day, as well as consumption of more legumes
- Regular consumption of a range of nuts, seeds and grains
- Change from white bread to wholegrain
- Change from butter to ‘Flora pro activ’
- Change from full cream milk to semi-skimmed
- Reduce (halve) the amount of cheese consumed
- Use Olive Oil for cooking and dressings
- Use garlic in foods/cooking as often as possible
- Reduce the amount of salt added to food to an absolute minimum (Less than 3g per day)
- Cut out alcohol
- The patient is a non-smoker.
2. Additional Supplementary Support
High dose/Time release Multi Vitamin and Mineral Supplement:
One per day with breakfast
Vitamin E: 1 x 100iu, 3 times per day, with food
Selenium: 1 x 50mcg, 2 times per day, with food
CO Q10: 1 x 30mg, three times a day with food
Fish Oil: 1 x 1000mg, 2 times per day with food
Garlic: 1 x 1000mg, two times a day with main meal
L Carnitine: 2 x 500mg twice a day, between meals
Hawthorn: 2 x 150mg, 2 times a day with food and
1 x 150mg once a day at bedtime
After 2 months, the patient’s appetite had noticeably been restored and his depression had significantly lifted. He was able to move around the house and perimeter area more easily and with less breathlessness. At this time I amended the supplementation, to allow for the enhanced dietary intake of fish and garlic, by reducing the garlic to 1 x 1000mg a day and reducing the fish oil to 1 x 1000mg a day, whilst increasing Vitamin E to 4 x 100iu a day. After 4 months his activity level was restored almost to pre attack levels; he is daily going to the shops, post office or barbers. In addition he is taking journeys into the next town with his wife, on a regular basis. Currently (five months after the start of the dietary regime) his condition has stabilised and I anticipate there will be little further improvement, considering his age. I would conservatively suggest that his quality of life, since September 2007, has improved 100%. He remains happily on the revised dietary plan and expresses great enthusiasm for continuing with the supplements – quite remarkable considering the patient was formerly a ‘die-hard’ sceptic in regard to complementary therapies and alternative medicine.
Cardiovascular disease can be prevented in 80% of cases by modest lifestyle changes, essentially by adopting a healthy, nutritious diet, avoiding saturated fats, processed foods, sugar and excessive salt, additionally, undertaking daily modest exercise dependent on the individuals’ capacity and giving up smoking (where appropriate). Additionally, where an individual is suffering from CVD, by following the same guidelines, health can be significantly restored and quality of life improved.
On the WHO’s projected figures of 20 million premature deaths globally from CVD’s in 2015, some 16 million lives could be prolonged into healthy old age and untold £trillions saved in health service costs that could be redirected elsewhere for the benefit of mankind.
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