About half of the stents placed in people’s coronaries are of questionable value and even inappropriate in some cases. Fortunately, more doctors are emphasizing preventive lifestyle changes much earlier in the course of heart disease. If they need to resort to pharmaceuticals, up-to-date doctors prescribe the oldest, safest and cheapest medications they have:
“If patients were prescribed [thiazide] diuretics for hypertension rather than the more expensive medications, the nation would save $3.1 billion every decade in prescription drug costs alone-and hundreds of millions of dollars more by avoiding stroke treatment, coronary artery bypass surgery and other consequences of high blood pressure.”
The best would be to educate patients on nutrition to avoid using 80% of pharmaceutical drugs in the treatment of heart problems. Health boils down to METABOLOMICS (see late July blog), or the management of energy and information in good food by healthy microbes in the gut. The cutting edge science pointing in this direction is so strong that Big Food is trying to cash in on it; but, their muddled thinking in pursuit of profits, not our health, produces laughable results: they are now marketing macaroni and cheese with a whiff of veggies in them. “What will they think of next?” Hugo Rodier, MD
HEART AND THE GUT
Bad organisms in the gut (due to poor diets, too many antibiotics, acid blocking drugs, etc.) modulate food metabolism, which triggers the inflammation that leads to heart disease. This concept is yet another neglected mechanism by which bad diets lead to heart disease, or any disease for that matter. A recent study showed that even young people without “traditional” risk factors, such as smoking, high blood pressure, cholesterol, etc., but with gut problems have a higher risk of heart attacks. A lack of fiber in processed diets is one of the root problems. Fiber (prebiotics) in whole food diets feed probiotics or friendly bacteria in the gut. Then, our friendly microbiota is able to metabolize the food we eat well, which leads to less disease and longer lives. This includes less heart disease:
“Dietary fiber is important in digestion, and its relationship with chronic disease has been a topic of great interest for many years. Fiber consists of undigestible plant carbohydrates in both soluble and insoluble forms. Soluble fiber (eg, fruit pectin) dissolves in water to form a gel, whereas insoluble fiber (eg, cellulose from wheat bran) does not. Both increase stomach distension, which increases satiety, and slow nutrient absorption. Soluble, and to a lesser extent insoluble, fiber is fermented by intestinal bacteria to produce short-chain fatty acids, which affect hepatic insulin sensitivity and lipid synthesis. The main function of insoluble fiber is to increase fecal bulk. Because these changes are thought to protect against the development of chronic diseases, a fiber-rich diet similar to that of early man is probably healthier than current Western-type diets.”
Understanding this vital connection between our diets, how we metabolize food in the gut chronic diseases explains some puzzling connections between diseases previously perceived as unrelated to other diseases. The fact that skin diseases like “Psoriasis increases risk of Coronary Artery Disease by 6%“ would be extremely puzzling, unless we consider the “Prevalence of the Metabolic Syndrome in Psoriasis.” In other words, how we metabolize our food in the gut determines practically all diseases, including heart disease.
Another gut link to heart disease is how the gut handles the amino acid arginine, whose research won the Nobel Prize in Medicine in 1998. Pfyzer used it to create Viagra, a drug initially developed as an anti-hypertensive drug. Its better know function was discovered serendipitously when male study subjects were coming in the next day with huge ..smiles on their faces… But I digress. It turns out that poor diets and poor gut function leads to poor absorption of arginine. The following quotation is for eggheads and doctors only:
“Endothelium-derived nitric oxide (NO) is vasoprotective, as it enhances endothelial cell survival and proliferation, inhibits the excessive proliferation of vascular smooth muscle cells, and suppresses the adhesion of platelets and inflammatory cells to the vessel wall. Substantial evidence from preclinical studies and human research indicates that impairment of the endothelial NO synthase (NOS) pathway accelerates vascular disease and increases the risk for major adverse cardiovascular events. Impairment of the NOS pathway is multifactorial, but it is increasingly apparent that circulating inhibitors of NOS play an important role. Asymmetrical dimethylarginine (ADMA) and monomethyl-L-arginine(MMA) are endogenous competitive inhibitors of NOS. Most human studies have focused on ADMA, as it is the more prevalent species in human plasma. Plasma ADMA is elevated in patients with cardiovascular disease or with risk factors, and it contributes to vascular resistance and stiffness. Notably, several large studies have shown that plasma ADMA is an independent biomarker for cardiovascular morbidity and total mortality. Accordingly, endogenous mechanisms that regulate ADMA are deserving of further scientific attention.”
This means that a lack of arginine triggers changes on blood vessel walls that lead to plaque formation and poor blood vessel tone. A marker for a lack of arginine is the molecule DMSA, much like homocysteine goes up when we lack B vitamins. Eggheads need to know this, because focusing on how much arginine we have on board is not the final arbiter, but DMSA is. This is why some doctors dismiss studies on the benefits of arginine, despite the literature. I am guessing hey do so because arginine is an “alternative” food supplement..until it is turned into a drug (Viagra,) of course.
Arginine is also an antioxidant; a lack of antioxidants is yet another mechanism that leads to all diseases, including heart disease. The June 24th issue of the journal Cell has on its cover a picture of the remarkable disfiguring seen in oxidized proteins. So, a lack of antioxidants in our diet contributes to the dysfunction seen on proteins, especially those composing cell membranes. This leads to poor cell communication and management of energy and information (metabolism), the slippery slope of disease. A diet high in antioxidants (fruits and veggies) prevents this problem:
“Predictors of Omega-3 Index in Patients With Acute Myocardial Infarction.” Eat more fish, olive oils, avocados, and nuts. J. Mayo Clin Proc. July 2011 86(7):626
“Trans-Fatty acids, insulin resistance/diabetes, and cardiovascular disease risk.” Get off processed fats. Journal Metabolism Clinical and Experimental 2011;60:901
“N-3 Fatty Acids in Cardiovascular Disease,” including strokes, NEJM 2011;364:2439
“Cruciferous vegetable consumption is associated with a reduced risk of total and cardiovascular disease mortality.” Eat more broccoli, cauliflower, cabbage, etc.
J Clin Nutr 2011;94:240
Stress, inactivity and environmental toxins also contribute to heart disease:
“Effects of 1 day of inactivity on insulin action in healthy men and women: interaction with energy intake.” Just one day vegetating on the couch increases risk of heart disease.
Journal Metabolism Clinical and Experimental 2011;60:941
“Counting strenuous work, physical activity minimum would go from 64% up to 71%.” If you are exhausted at the end of the day after hard labor, don’t feel too bad if you can’t go running.
“Healthy Psychological Functioning and Incident Coronary Heart Disease.” The less well we cope with stress, the higher our chances of having heart problems. See my last blog (July 2011)
J. Arch Gen Psy 2011;68:400
“Tai Chi Exercise in Patients With Chronic Heart Failure.” Any stress management technique will help our heart. J. Arch Int Med 2011;171:750
“Statin Dose and Risk of Incident Diabetes,” Intensive Rx increases risk of diabetes, which increases the risk of heart disease. Yet another reason why Simvastatin 80 mg is being taken off the market, if the FDA quits dragging its feet: it does not work any better than the 40 mg tablet.
JAMA 2011;305:2556 & 2011;306:143
“Even short term NSAIDs is risky after a heart attack.” A few days on Ibuprofen also increase the risk of heart problems. See below for more on these problematic drugs.
J. Family Practice News, June 1st 2011, 16
GETTING HEARTBURN, YET?
Sure, you don’t want to be in pain, so, you follow the commercial’s advice to take advil-like drugs. But, they can increase the risk of high blood pressure and heart attacks. Before that happens, you may get plenty of warning: stomach problems, particularly heartburn. So, you decide to follow another commercial advice and start taking acid blocking pills. Too bad they alter the delicate balance of the gut microbiota, leading to the problems discussed above. These drugs are 53% to 69% of the time over-prescribed.
Refusing to believe this data, a young wife recently insisted that her husband stay on the purple pill and abandon my diet plan, designed at his request, to cure his heartburn and Barrett’s esophagus. No doubt she bought into the fear-driven use of pharmaceuticals, ignoring yet another study that cancer of the esophagus is seen in only 0.13% of patients like her husband.
 JAMA 201;306:53
 “The Best Medicine,” J. Scientific American, July 2011, p6
 Book “Eat, Drink and be Healthy,” by Dr. Willet
 “The hybrid science of diet, microbes, and metabolic health,” Am J Clin Nutr 2011;94:1
 Marion Nestle, PhD and author of book “Food Politics.” Salt Lake Tribune, July 10th 2011
 “Cardiovascular disease: The diet-microbe morbid union,” Journal Nature, April 2011;472:40
 J. Family Practice News, June 15th 2011, p16
 “Dietary Fiber Intake and Mortality in the NIH-AARP Diet and Health Study,” J. Arch Intern Med 2011;171(12):1061
 “Do the Health Benefits of Dietary Fiber Extend Beyond Cardiovascular Disease?: Comment on “Dietary Fiber Intake and Mortality in the NIH-AARP Diet and Health Study,” J. Arch Intern Med 2011;171(12):1069
 J. Family Practice News, June 15th 2011, p128, commenting on J. Ann Rheum Dis 2010;69:325
 J. Arch Derm 2011;147:419
 “DDAH Says NO to ADMA,” J. Arterioscler Thromb Vasc Biol. 2011;31:1462
 J. Neurology June 15th 2011
 ” Opportunities to Decrease Inappropriate Uses of Proton Pump Inhibitors,” J.Arch Intern Med 2011;171(11):1004
 JAMA 2011;306:256