Dr. Stephen Sinatra’s
A Cardiologist’s Guide to Total Wellness
Volume 17, Number 6
Stephen Sinatra, MD
Inside this issue:
■ Dick Cheney’s Heart—
Medical Success
or Failure?. . . . . . . . . . . . . . . 2
■ Blood Thinners—Drug
Review. . . . . . . . . . . . . . . . . . 5
■ Heart Beat: Statin Mania;
Mini-Stroke Warning. . . . .6
■ Mailbag: Drugs and
Supplements; Lecithin and
Soy Allergy. . . . . . . . . . . . . . 8
Dear Reader
I believe we can gain wisdom
from people who live long, healthy
and meaningful lives. Walter
Breuning, who was the world’s
oldest living man before passing
away last April at the age of 114,
set a stellar example.
The Minnesota-born supercentenarian gave several interviews
during the last year or so of his
life, and conveyed these key points
of his philosophy, which I find
inspiring:
■ Embrace change, no matter how
it hits you.
■ Stick with a healthy diet and
keep your weight down.
■ Be kind to others and help
them.
■ Think of every day as a good
day, and make it one.
■ Work as long as you can, because
the money will come in handy
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June 2011
and by keeping your mind and
body busy, you’ll feel better.
Mr. Breuning, who spent
most of his life in Great Falls,
Montana, followed his own advice.
He ate only two meals a day;
welcomed change, from automobiles to computers; worked hard
until age 99; cared about others;
and maintained a strong, positive
personality.
I try to live by my advice and
know that you do, too. You can’t
imagine how gratified I feel when,
at subscriber seminars, I meet
lively, vigorous octogenarians who
say my recommendations and
supplement line are instrumental
in keeping them active and happy.
What tops that off? Seeing some
of you radiate health, vigor, and
positivity into your nineties and
beyond. Keep up the good work!
June, 2011
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Women’s Health
Alert: Could You
Have A Stroke And
Not Know It?
“I am EMF sensitive.
Earthing cured my
severe insomnia
caused by computer/
wireless Internet use.
I sleep in a “recovery
sac” and severely
limit any EMF
exposure. — C.F.
comment on my May
12 post on Earthing.
2 Easy Secrets For
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Pressure
High HDL + High
C-Reactive Protein =
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Dick Cheney’s Heart—Medical Success
T
he heart problems of former Vice President
Dick Cheney have often made headlines over the
years, but no reporter has ever asked a very important question: Is Mr. Cheney receiving only half the
medical care that could help his heart?
This may seem like an odd thing to ask, given that
the country’s top doctors and hospitals are at his
disposal. However, there is a noticeable absence of
media reports of the former vice president being
treated with metabolic cardiology or any type of
complementary medicine.
I strongly believe that any patient—whether a
prominent public figure or your next-door neighbor—is being treated only halfway, if the care
is limited to conventional medicine. Obviously, a
high-tech approach, using surgery and medical
devices, produces immediate results and is necessary, particularly in life-threatening, emergency
situations. But once a crisis is over, why not add
comparatively low-tech nutrition and other complementary therapies to give patients the best of both
worlds? Such an integrative approach can save so
many lives.
The metabolic approach is one I’ve taken for over
30 years, and I can tell you that it helps to restore
heart function. I’ve had hundreds of patients with
serious heart conditions—some as advanced as
Mr. Cheney’s—and am proud to say that they all
A Transplant Success Story
I never cease to be amazed by the benefits of CoQ10.
Recently, after I gave a talk at a central Florida
church, an elderly couple came up to me. The lady told
me that 23 years ago she heard me speak about CoQ10
at a health conference and, afterward, had asked for
my advice. Back then, her husband had just received
a heart transplant, and after doing some reading she
wanted him to start taking CoQ10. But his doctors
discouraged it. She reminded me that I recommended
her husband take the supplement anyway, despite
other doctors’ opinions.
I don’t know how much CoQ10 had to do with
it—maybe a little, maybe a lot—but here was her
husband, more than two decades later, looking very
good and still taking his CoQ10. I do know this: The
average lifespan of somebody with a heart transplant
is around fifteen years, so this gentleman was way
ahead of the curve.
Keep track of what I’m up to on Twitter at twitter.
com/SinatraMD.
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H e a rt, H e a lt h & N u t r i t i o n • J u n e 2 0 1 1
or
Failure?
experienced improvement. The degree varied, from
slight to remarkable, but consistently, each patient
lived a better life.
Half the Treatment Is Not Enough
Mr. Cheney has had five heart attacks, the first
when he was only 37. His heart has been rescued
by arterial stents, bypass surgery, aneurysm resection, and an implantable defibrillator. Yet, despite
these good medical interventions, he has developed
congestive heart failure.
Last summer, after undergoing surgery to implant
a small mechanical heart pump, he said he was
“entering a new phase of the disease,” with increasing heart failure. The new pump would enable
him to resume an active life. As we went to press,
Mr. Cheney, now 70 years old, had not decided
whether he intends to live indefinitely with the
device or to sign up for a heart transplant.
Here’s a high-profile individual who has survived
more than three decades with heart disease in a
pressure-cooker career. Obviously, he can handle
stress. Medically, he’s been very fortunate to receive
the most royal of conventional treatments, but
there’s a missing component.
In my mind, the looming possibility of a heart
transplant points out limitations of the conventional
medical system. High-tech treatments do save lives
but they only represent half the available care. To
bring real healing to the table, you have to combine
conventional and metabolic medicine.
I don’t know whether or not Mr. Cheney has
received any complementary treatments but if he
were my patient, he would have started a metabolic
cardiology program long ago and very possibly,
would not be contemplating a heart transplant.
Even at his advanced stage of heart disease,
I would recommend my metabolic approach (see
Nutritional Rx, next page).
Change in Medicine Is Very Slow
Tragically, conventional medicine still boycotts
alternatives, and metabolic cardiology is not considered standard care in a system that embraces
primarily pharmaceutical and surgical treatments.
Maybe that’s slowly changing. I lecture to doctors
all over the country and find increasing acceptance
of alternative ideas in cardiology.
Despite its resistance to change, the medical
community is aware of the fact that conventional
treatment has not solved the problem of heart
failure. A 2009 review of research in the Journal
of the American College of Cardiology pointed out
that, despite major advances and high costs, the
outcomes of heart failure treatment remain unimpressive, and suggested further study of key nutritional supplements involved in cardiac metabolism,
such as CoQ10, carnitine, and taurine.
“Heart failure is often accompanied by a deficiency
in key micronutrients required for unimpeded
energy transfer,” wrote the researchers. “Correcting
these deficits has been proposed as a method to
limit or even reverse the progressive myocyte
dysfunction and/or necrosis in heart failure.” (In
plain English, a “myocyte” is a heart muscle cell,
and “necrosis” means cell death.)
I agree 100 percent with these researchers.
However, they noted that correcting nutritional
deficits “has been proposed” as a way to reverse the
process of deteriorating heart muscle cells. In my
experience of more than three decades, “proposed”
is an understatement. CoQ10, carnitine, and other
nutritional supplements do, in fact, restore the function of heart muscle cells, at least to some degree.
Other research, which I covered in my July 2010
newsletter, supports the fact that nutrients regenerate cells of the heart muscle. And if that weren’t
enough, medical textbooks thoroughly cover the
underlying nutritional mechanisms.
Change occurs very slowly in the medical establishment. Although supplementation is starting to creep
into mainstream thinking, implementation is still
probably a decade away.
Nutrients Reduce Hospitalizations
Feeding the heart with the right nutrients is much
like fertilizing a lawn, and it enables our vital organ
to function to the best of its capacity. Costs—a
major issue today—can also be reduced with nutritional therapy that, despite skeptics’ derision, has
been producing results for a long time.
Years ago, I personally experienced how remarkably integrative medicine works—sparing patient
suffering and costs. As a hospital staff physician,
I used to keep the intensive care units full. Then,
after I became nutritionally savvy and adopted
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Nutritional Rx for Failing Hearts
I’ve put folks awaiting transplants on this program
and subsequently, some took themselves off the waiting list. For heart failure, my metabolic cardiology
program includes a foundational multi-vitamin and
mineral formula along with fish oil and my “awesome foursome”—CoQ10, carnitine, magnesium, and
D-ribose. Energy-starved cardiac cells are deficient
in these “awesome” nutrients, which ignite failing
mitochondria, boost cellular energy, and enhance the
heart’s pumping action. They can improve the quality
of life for most heart failure patients.
I recommend these dosages:
■CoQ10 (hydrosoluble ubiquinone or ubiquinol):
150–300 mg twice daily
■Carnitine (broad spectrum: l-carnitine, acetyll‑carnitine, and propionyl-l-carnitine): 1 g on an
empty stomach two or three times daily
■Magnesium (broad spectrum): 200–300 mg
twice daily
■D-ribose: 5 g three times daily
■Fish or squid oil: 1–2 g once daily
If there is no improvement after taking the above
for six weeks, I would add another 100 mg of CoQ10
and another gram of carnitine. If those additions don’t
achieve sufficient improvement, add these:
■Hawthorn berry, a great general tonic for the heart:
500 mg three times daily (avoid if taking digoxin)
■Taurine, an amino acid shown to improve cardiac
function: 2–3 g daily
For more details on my metabolic cardiology program,
visit resources.drsinatra.com/heart-health.
alternative treatments, my admission rate took a
nosedive. My patients benefited big time because
they maintained better health and I was able to
keep them out of the hospital.
Jim Roberts, M.D., a Toledo cardiologist and my
co-author for Reverse Heart Disease Now (Wiley,
2007), had the same experience. After integrating
heart-healthy nutrition into his treatment strategies, he admitted far fewer patients to the hospital.
This is the best approach: Prevent things from going
wrong in the first place by giving the body the nutrition it requires. Keeping people out of hospitals
Zucker and Jan DeMarco-Sinatra, MSN, CNS, APRN.
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Heart, Health & Nutrition is dedicated to the
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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, PA 17604-9915, or send email to
feedback@drsinatra.com. He maintains a website
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www.drsinatra.com.
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H e a rt, H e a lt h & N u t r i t i o n • J u n e 2 0 1 1
3
Remember the “Awesome
Foursome” Basics
It’s always good to keep in mind why CoQ10,
carnitine, magnesium, and D-ribose hold the keys to
preventing and healing most forms of heart disease. As
you know, mitochondria are the furnaces that generate
energy in all cells of the body, and they simply wear out
over time. The heart suffers from energy starvation more
than any other muscle, because each heart cell contains
far more mitochondria: about 5,000 per cell, compared to
about 200 per cell in your biceps. So, the health of these
microscopic furnaces, or lack of it, makes the difference
between a healthy heart and a diseased one.
For fuel, the heart’s mitochondria depend primarily
on fatty acids. Carnitine is the ferry boat that shuttles
fatty acids into the mitochondria and, once they’re
burned, takes out toxic waste products. CoQ10 is the
spark plug that gets the engine going and enables the
energy-production process to keep running smoothly.
D-ribose is necessary for ATP to be produced when
cells are deprived of oxygen or under stress from
disease or intense exercise. And energy metabolism
cannot function normally without adequate levels of
magnesium, which today’s diets don’t provide.
These nutrients also play additional roles. For
example, they protect against atherosclerosis, lower
blood pressure, and reduce the stickiness of platelets.
They literally delay the aging process of the heart.
doesn’t enrich hospital profits (75 percent of heart
failure treatment costs go toward hospitalization).
But it sure makes people happy.
True Help for Failing Hearts
I know, firsthand, that supplementation improves
how the heart pumps, the quality of life, and
the length of life. Every case of heart failure I’ve
treated nutritionally has improved by at least some
degree, usually significantly.
I began treating patients with CoQ10 about
30 years ago and since then, have seen more and
more evidence documenting its efficacy. For example, in a 1993 study, doctors in Italy reported that
by giving CoQ10 to heart failure patients, they
could reduce the incidence of pulmonary edema by
a whopping 50 percent and the number of hospital admissions by 20 percent. Pulmonary edema
is a life-threatening complication of heart failure
where the lungs fill rapidly with fluid, and when
this happens, only hospitalization and emergency
measures can save the day. But why get to that
point if it can largely be prevented?
In the Italian study, participants took a daily dose
equivalent to 2 mg per kilogram of body weight. That
equates to about 0.9 mg per pound, or 90 mg for a
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100-pound person, 135 mg for a 150-pound person,
and 180 mg for someone weighing 200 pounds.
I would estimate that for most people, such a quantity
of CoQ10 would cost about $75 per month. Compare
that to the cost of hospitalization to treat lung complications—about $50,000 per incident. And that figure
doesn’t take into account the human suffering and
possible further damage to the heart muscle.
I was a huge advocate of CoQ10 for my patients
before that Italian study, and a bigger one afterward.
Since then, I’ve been repeatedly gratified to see ongoing research support my enthusiasm. For example, in
a 2008 issue of the Journal of the American College
of Cardiology, a group of New Zealand researchers
reported significant data demonstrating that higher
blood levels of CoQ10 improved survival in congestive
heart failure patients.
Fish oil is another supplement that has accumulated
a strong body of evidence. I learned about it 20 years
ago and immediately made it part of my anti-plaque
tool box, and I continually track emerging research.
For example, in a 2007 newsletter, I reported that the
European Society of Cardiology recommends 1 gram
of omega-3 fish oil daily to prevent a second heart
attack (myocardial infarction, or MI). That recommendation came after a large-scale Italian study.
Conducted at multiple medical centers, it found that
after an initial heart attack, among patients taking
an omega-3 fish oil, there was a big reduction in death
from subsequent heart attacks.
In this country, even though there’s plenty of
evidence that strongly supports supplementation,
some cardiologists ignore omega-3s. Perhaps they’re
too busy prescribing drugs.
Hopefully, a nutritional approach will soon
become part of standard care for patients with
heart failure. The system desperately needs it.
Patients desperately need it. Dick Cheney, for
example, may be a walking advertisement for
high-tech medical interventions but he would
benefit from my nutritional program. If he does
opt for a heart transplant, I hope his doctors will
at least put him on some CoQ10 in the meantime,
to reinforce his immune system and promote optimum cardiac energy production. ■
References (click below for more info)
Berman M, et al. Coenzyme Q10 in patients with end-stage heart failure awaiting cardiac transplantation: a randomized, placebo-controlled study. Clin
Cardiol. 2004;27(5):295–299.
GISSI-Prevenzione Investigators. Dietary supplementation with n-3 polynsaturated fatty acids and vitamin E after myocardial infarction: results of the
GISSI-Prevenzione trial. Lancet. 1999;354(9177):447–455.
Molyneux SL, et al. Coenzyme Q10: An independent predictor of mortality in
chronic heart failure. J Am Coll Cardiol. 2008;52(18):1435–1441.
Morisco C, et al. Effect of coenzyme Q10 therapy in patients with congestive heart failure: a long-term multicenter randomized study. Clin Investig.
1993;71(8 suppl):S134–136.
Soukoulis V, et al. Micronutrient deficiencies an unmet need in heart failure.
J Am Coll Cardiol. 2009;54(18):1660–1673.
Cardio Drugs Review—Most Popular Blood Thinners
The most popular drugs in this class are warfarin
(Coumadin), aspirin, and clopidogrel bisulfate (Plavix).
B
lood thinners are most commonly prescribed for the
prevention of stroke and clots. They are technically
called “anticoagulants,” because they prevent or treat
coagulation, the formation of clots. But I think the
nickname comes from “paint thinner.”
If you’ve had a stroke or are at high risk for one, or
have atrial fibrillation, or deep venous thrombosis, doctors will likely prescribe a blood thinner. The drugs
are also prescribed after a hip or knee replacement to
prevent embolisms, as was the case after my hip was
replaced a year ago.
Although advertising influences which drugs patients
request from their doctors (and doctors, sadly, all too
often oblige), there is no simple, cookie-cutter approach.
Anticoagulation therapy needs to be individualized.
Benefits
Coumadin, the oldest drug in this class, has been
around for 60 years. It has shown unparalleled ability
to thin the blood and prevent unwanted blood clotting.
It decreases blood clot formation by reducing the body’s
level of vitamin K1, which regulates clotting.
Other blood thinners work in different ways. Aspirin
and Plavix prevent platelets from clumping. Platelets
are irregularly shaped cell fragments in the blood, that
can cause sticky blood and thus enhance clotting. In my
own clinical experience with Plavix, I’ve seen very few
adverse symptoms. It seems to be tolerated better than
aspirin as an anticoagulant.
Aspirin is useful for individuals with arterial disease
and those who have undergone stenting or bypass surgery.
In such cases, doctors often prescribe aspirin, sometimes
as an accompaniment to a more potent anticoagulant.
Despite its potential benefits, the only time I condone
regular aspirin use is when someone has documented
coronary heart disease and can tolerate the drug.
(I personally can’t tolerate it.) Should you have heart
disease, I suggest a full aspirin every other day, to give
your system a rest and still get the best effect.
Aspirin is a major cause of GI bleeding and hospitalizations, and can trigger insomnia, rapid heartbeat,
and liver damage. As I’ve reported previously (see
March 2010 issue), an authoritative publication for doctors and pharmacists unequivocally stated that the
risks of long-term aspirin use should disqualify this
practice from being considered for primary prevention.
Side Effects
The major side effect of blood thinners is excessive
bleeding. For that reason, doctors require routine blood
testing to monitor a measurement of coagulation called
INR (International Normalized Ratio). Normal clotting ability on the INR scale is 1.0. For anyone with
atrial fibrillation, the therapeutic INR target for effectively reducing risk for stroke is a reading of 2–3. An
excess of any single anticoagulant, or of a combination
of them, has the potential to raise your number and
increase the risk of bleeding.
Coumadin is the most dangerous of the blood thinners for bleeding. However, aspirin can also cause
bleeding, particularly in the gastrointestinal tract, and
sometimes in other tissues. One of my patients on aspirin therapy had bleeding into his eye but could tolerate
the aspirin well, without any GI distress whatsoever.
With Coumadin and/or aspirin therapy, I’ve had
patients develop multiple ecchymoses, purple discolorations
of the skin in various parts of the body. It’s caused by blood
passing from ruptured blood vessels into tissue under the
skin. This is not uncommon, especially if people suffer
some minor trauma to their hands, arms, or legs.
Other possible side effects include nausea, vomiting,
diarrhea, fever, bruising, anemia, blood in the urine,
and rash. With Plavix in particular, side effects may
include flu-like symptoms, headache, dizziness, pain,
diarrhea, and upset stomach or indigestion.
Nutritional Deficiencies
The Downsides
Blood thinners (except aspirin) can cause vitamin
D and calcium deficiencies that can lead to softening,
weakening, and thinning of bones. With elderly patients
who suffer from atrial fibrillation and take Coumadin,
one of my biggest fears has always been this: What if
they were to fall and fracture a hip, or even worse, crack
their heads and suffer a fatal subdural hematoma?
Blood thinners are a double-edged sword. While the
drugs help prevent heart disease and strokes, they
also raise the risk of bleeding, even a stroke-induced
hemorrhage.
I’ve seen these things happen. In treating such cases,
cardiologists are always engaged in a challenging and
delicate balancing act. However, taking supplements to
counteract the depletions can help to avert disaster.
For many years, doctors have routinely prescribed
aspirin for primary heart attack and stroke prevention.
But I’ve been cautioning patients and you, my readers,
to think outside that box.
I recommend patients on blood thinners take daily
supplements of 2,000 IU of vitamin D, and calcium:
500 mg for men and 750 mg for women. Although green
leafy vegetables, a rich source of vitamin K1, are usually
H e a rt, H e a lt h & N u t r i t i o n • J u n e 2 0 1 1
5
restricted, I allow my patients to have a 4-ounce serving
three or four times per week.
I also recommend shoring up one’s vitamin C status.
Blood thinners can deplete this fundamental nutrient,
which might contribute to spontaneous bruising, loose
teeth, and swollen and bleeding gums. Aspirin alone
can cause a deficiency of folic acid, vitamin C, iron,
sodium, and zinc. Follow a foundation vitamin/mineral
program containing vitamin C, folic acid, and zinc.
Who Must Take Prescription Blood Thinners
If you have a prosthetic heart valve (metal or plastic),
Coumadin is the only anticoagulant to take, and you
must take it. No ifs, ands, or buts.
If you have atrial fibrillation, you need a blood thinner, and Coumadin is usually prescribed. If you don’t
have an enlarged left atrium or significant mitral
regurgitation, consult with your doctor about using a
combination of aspirin and the nutritional supplement
nattokinase (see Alternatives).
A New Anticoagulant
Last fall, the Food and Drug Administration
approved a German blood thinner, Pradaxa (dabigatran etexilate), which may be promising. The first of
a new generation of anticoagulants, it is designed to
prevent stroke and blood clots in people who suffer
from atrial fibrillation that is “non-valvular,” meaning not due to a heart-valve problem. In the United
States, the drug maker estimates that about 95 percent of atrial fibrillation cases are non-valvular.
Previously, Pradaxa has been marketed in Europe.
Only time will tell how much better the new anticoagulant works, compared to Coumadin. American drug
makers are expected to get new drugs into the mix
soon, for a U.S. market estimated at more than $20
billion annually.
Patients with stents, including drug-eluting (medicated
or drug-coated) stents, need long-term anticoagulation
therapy to prevent the danger of clotting at the stent site.
Plavix is necessary for anyone with a drug-eluting stent.
Who Should Not Take Blood Thinners
Anyone who has a stomach ulcer, hemophilia, or any
other condition that may cause bleeding should not take
blood thinners. Coumadin and Plavix should not be used
by people who have high, uncontrolled blood pressure.
I wouldn’t give a prescription blood thinner to
someone with atrial fibrillation who is over 90 and is
unsteady on their feet, because their risk for falling
injuries trumps stroke prevention. But if that same
person has a mechanical (metallic or plastic) valve,
Coumadin therapy is a must. Aspirin won’t cut it
because it isn’t strong enough.
Alternatives
In my practice, when elderly people need a blood
thinner, I often put them on nattokinase (50 mg twice a
day) and fish or squid oil (1–2 grams daily). But beware,
never take nattokinase with Coumadin. Anyone taking
Coumadin, Plavix, or aspirin can take the same dose
of fish or squid oil but should be sure not to take more
than 2 grams daily.
These are other suitable alternatives to try: garlic
(1–2 grams daily) and ginger in the form of a daily
tea. You can boil diced ginger, adjusting the strength
to your taste, or buy ginger tea at a health food store.
However, if you want to try any alternatives, you must
always work with your doctor.
Earthing (grounding) is another great, natural
method to prevent red blood cell clumping and improve
zeta potential (a measure of blood stickiness). We know
that anybody on a pharmaceutical blood thinner who is
Earthing themselves must work closely with their doctor to monitor their INR level and avoid too much thinning of the blood. ■
The Heart Beat: What’s Good,
What’s Not, in Cardiology
No Cure in Sight for Statin Mania
This isn’t the first time you’ve heard me say this:
The medical system seems totally fixated on driving
cholesterol down to ridiculously low levels. A recent
report appearing in The Lancet, a British medical journal, provides more evidence of such statin mania.
This time, researchers from England and Australia
did a statistical analysis of 26 different statin studies. They claim these show that further reductions
in LDL, via more intensive statin therapy, definitely produce fewer vascular events, even when the
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H e a rt, H e a lt h & N u t r i t i o n • J u n e 2 0 1 1
LDL level is lower than what is currently recommended—70 mg/dL.
My blood boiled, as it usually does when I see this
kind of insanity, when I read their number crunching of data. In total, the studies they analyzed
included about 170,000 patients, monitored for up to
about five years, and demonstrated benefits down to
LDL levels of around 50 mg/dL.
The researchers said the numbers and benefits applied
to patients at high risk for cardiovascular disease
and, in those cases, the benefits were “massive,” and
without any hazard. For lower-risk patients, they
added, the risk reductions would be much smaller, and
therefore not advocated as a public health strategy.
The only time I recommend statins is for men between
50 and 75 with heart disease and therefore at high
risk. I do so not for any cholesterol-lowering effect but
for the anti-inflammatory properties of statins.
There is a key fact that conventional medicine
ignores: All cholesterol is not created equal. Large,
fluffy LDL particles are harmless. It’s the small,
dense LDL particles and oxidized LDL that promote
inflammation and lead to coronary disease, and
I endorse lowering this type of cholesterol.
However, I am very wary of the mania to indiscriminately lower LDL, especially to the levels
being promoted today. The body requires cholesterol
to make strong, pliable cell membranes and steroid
hormones, and to support the immune system.
I am aware of too many side effects, resulting from
statins and low cholesterol, that typically go unreported. Moreover, statins deplete the body of CoQ10,
which is a major metabolic antioxidant and raw
material for cellular energy production. You’ve heard
all this before, so I won’t dwell on it. (For more information on the subject, visit my Cholesterol Health
Center at resources.drsinatra.com/cholesterol.)
The researchers did admit to one adverse effect
of concern. Their overall analysis turned up 500
confirmed hemorrhagic strokes—the deadliest
of strokes. There were 257 such strokes among
the lower-cholesterol statin subjects compared to
220 among non-statin takers. They called this “a
non-significant excess.”
Two studies that did not qualify for their analysis
would have pushed the incidence of strokes into the
“significant excess” zone. However, said the researchers, this additional increase in strokes would still have
been too small a hazard to offset the overall benefits.
Any kind of hemorrhagic stroke concerns me. So
does the incidence of transient global amnesia and
other nonlethal side effects that tend not to be
reported, or to be dismissed by doctors as unrelated
to use of statins.
With this in mind, I was attracted to one of the
studies in this latest review. It looked at about
2,000 patients with a history of heart attack who
were randomized to take either 80 or 20 mg daily
of simvastatin (Zocor). There was an insignificant
difference in vascular events between the two groups.
However, there were many more cases of muscle
weakness (myopathy) among those taking the higher
dosage—53 versus 2. Myopathy is a common side
effect of statins, a result of depleted CoQ10.
Medical statin-mania is alive and thriving. But it
scares the heck out of me.
References (click below for more info)
Baigent C, et al. Cholesterol Treatment Trialists’ (CTT) Collaboration. Efficacy and
safety of more intensive lowering of LDL cholesterol: a meta-analysis of data from
170,000 participants in 26 randomised trials. Lancet. 2010;376(9753):1670–1681.
Armitage J, et al. Study of the Effectiveness of Additional Reductions in Cholesterol and Homocysteine (SEARCH) Collaborative Group. Intensive lowering of LDL cholesterol with 80 mg vs. 20 mg simvastatin daily in 12,064
survivors of myocardial infarction: a double-blind randomised trial. Lancet.
2010;376(9753):1658-1669.
Mini-Stroke Doubles Risk of
Heart Attack
The risk for heart attack after a mini-stroke (also
known as a TIA, or transient ischemic attack) is more
serious than we used to think. This is the conclusion
of Mayo Clinic researchers who took a new look at this
issue, using sophisticated statistical analysis.
For individuals who have had a TIA but no known
coronary artery disease, risk for a heart attack is
more than double that of the general public. If someone suffers a TIA before age 60, their risk for a heart
attack increases 15-fold. Other risk factors include
being a man, taking cholesterol-lowering medications, and getting older. Statistics aside, this piece of
research clearly shows that TIAs are not just a disorder of the brain and carotid arteries, which supply
oxygenated blood to the head and neck.
The Mayo Clinic findings reinforce my longstanding
take-home message to patients: Vascular disease is
generalized. If you have inflammation and occlusion
in the carotid arteries, and develop a mini-stroke,
it’s likely that you also have arterial inflammation
and occlusion elsewhere.
Here’s another way of looking at this: People think
that if they have coronary artery disease and a
heart attack, it affects only that part of their body.
Not so. If you have plaque in one area, you can bet
that you also have plaque in other areas. Plaque can
be in your carotid arteries, your aorta, your femoral
arteries, your coronary arteries, or your kidneys.
Or, if you’re a man, maybe it’s at the root of your
erectile dysfunction.
Plaque is plaque and it develops throughout multiple vessels of the body. Think systemic. There’s an
old plumber’s adage that applies here: “Rotten in
the basement, rotten in the attic.”
Previous studies have incriminated coronary artery
disease as the leading cause of death in the first five
to ten years after a TIA. They showed a 24–64 percent
increase in risk for heart attack, but only a 12–28
percent increase in risk for stroke. The new study
from the Mayo Clinic is the first one to show that, in
comparison to the general public, TIA patients—even
if they seem to be free of heart disease—have a markedly increased risk for heart attack.
H e a rt, H e a lt h & N u t r i t i o n • J u n e 2 0 1 1
7
I’ve always tried to convey to my patients that a TIA, even one that
lasts only a few minutes, is a very serious warning. Unfortunately,
because many people improve after such an event, they believe they
are out of the woods when, really, that isn’t the case. A TIA always
signals the need for an intensive investigation.
Reference (click below for more info)
Burns JD, et al. Incidence and predictors of myocardial infarction after transient ischemic attack:
a population-based study. Stroke. 2011;42(4):935-940.
Dr. Sinatra’s Mailbag
Keep those questions coming! Send an email to
feedback@drsinatra.com, or write to me at Dr. Sinatra
Feedback, P.O. Box 3264, Lancaster, PA 17604-9915.
Easing Off an ACE-Inhibitor
I have atrial fibrillation and high blood pressure. Can I take
Seanol with Coumadin (warfarin), and maybe get off my ACE
inhibitor?—From a recent subscriber seminar
I see no contraindication for using Coumadin along with Seanol,
a marine anti-inflammatory that I really like. Seanol might have a
bit of ACE-inhibiting activity, and may help stabilize blood pressure. Monitor your blood pressure and work with your doctor to see if
you can ease off the ACE inhibitor while taking the supplement.
Taking Magnesium with Coumadin
Can a patient on Coumadin also take the magnesium supplement you suggest?—MH, via email
I have never heard of an interaction. It makes sense, in fact,
to supplement. Keep in mind that more than two-thirds of the
population is deficient in magnesium, an absolutely essential
mineral involved in hundreds of physiological reactions.
The magnesium I like is a blend of four different forms of the mineral
that are particularly well absorbed and utilized by the body. They are
magnesium glycinate, orotate, citrate, and taurinate. You can order this
broad-spectrum supplement at drsinatra.com or call 800-304-1708.
I also like a topical spray form of magnesium oil you can purchase
through Swanson’s Health Products online at www.swansonvitamins.
com/SWU481/ItemDetail?n=0. Two or three sprays a day does the trick.
Lecithin and Soy Allergy
I’m allergic to soy. Does that mean I can’t take supplemental
lecithin?—From a recent subscriber seminar
If you have a strong reaction to soy products, I wouldn’t try
lecithin. If you have a very mild reaction, you could experiment
with a small amount of the supplement. Lecithin is a good
source of choline, a primary constituent of phosphatidylcholine,
a molecule that contributes to healthy elasticity and permeability
of cell membranes, including red blood cells and platelets. Lecithin
is also a raw material for “good” HDL cholesterol. Many of you will
remember that lecithin was wildly popular a quarter century ago as
a heart-healthy supplement. I still like it as part of a good overall
supplement program.
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H e a rt, H e a lt h & N u t r i t i o n • J u n e 2 0 1 1
Get More of Dr. Sinatra
In Future Issues
■ What to Do When Your Doctor
Says “No” to Supplements
■ Antiarrhythmics Drug Review
In Dr. Sinatra’s Blog
at blog.drsinatra.com
■ Catching Up with the
“Dr. Sinatra Walking Club”
■ Heart Beat 101
In Upcoming Eletters
■ How to Survive a Heart Attack
■ What You Need to Know About
High Blood Pressure
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Healing the Heart Seminar
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2 nights at the Kripalu Center
in Stockbridge, Massachusetts,
July 29–31, 2011. For more
information: kripalu.com or
866-200-5203.
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“
Q
uality is never an
accident; it is always the
result of intelligent effort.”
— John Ruskin, 1819–1900
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.