Dr. Stephen Sinatra - Questions and Answers
Newsletter readers were invited to submit some general heart health questions and here are the questions with the answers from Dr. Sinatra.
Dr. Stephen Sinatra is a rare breed of doctor-an integrative cardiologist who has used both conventional and "alternative" treatments in his nearly forty years in medical practice.
Now retired, he lectures widely on the metabolic approach to cardiovascular disease and electromedicine. His latest book is Earthing:The Most Important Health Discovery Ever?
In it, he introduces the discovery of major health benefits resulting from direct physical contact with the Earth's natural, subtle surface energy by walking barefoot outside or sitting, working, or sleeping indoors connected to conductive systems that transfer the energy from the ground into the body.
Question 1: Do you believe in the Pauling Rath Theory of Heart Disease and agree that large doses of vitamin C, lysine, and proline, can reverse and prevent cardiovascular disease?
Dr Sinatra: Initially I was hopeful that this protocol could lower Lp(a), which is the most inflammatory small particle cholesterol. I was, however, disappointed after trying it on several patients. I went in other directions and found that simple niacin, omega-3 fatty acids, nattokinase, and delta tocotrienol, either singly or in combination, was more effective in the neutralization of Lp(a).
Question 2: What should we be concerned about or ask our physician when the blood panel shows that the AST went from the normal range to out of normal range after starting higher doses of a statin drug?ă€€
Dr Sinatra: AST is a test for aspartate aminotransferase, an enzyme found in the liver. The test is used to diagnose and monitor liver disease. Basically, if this liver function value is rising it means the body is rejecting the drug. The statin could be causing mild inflammation of the liver.
If a patient of mine showed any elevation of a liver function test, even to a minimum degree, I would take them off the drug. In general, the only people I recommend take statins are men between the age of about 50 to 75 with documented coronary artery disease.
If I prescribed a statin I would also use a minimum of 200 milligrams of a good quality soft-gel CoQ10 supplement (not the capsule form). Statins deplete the body of this very important antioxidant and central ingredient in cellular energy production. If the liver test shows a rise, you have to ask the doctor if the statin should be continued.
Question 3: Can arterial inflammation be caused by a chronic low-grade blood infection, and what, besides low dose statins reduce inflammation?
Dr Sinatra: Low-grade blood infections can absolutely cause arterial inflammation. A classic example is periodontal (gum) disease. I have written about this connection in my 2008 book, Reverse Heart Disease Now, as well as in my monthly newsletter, Heart, Health & Nutrition.
The medical literature confirms what I have found in my clinical practice: gum disease can definitely lead to a higher incidence of atherosclerosis. Infections stimulate the release of inflammatory substances that can take part in inflammatory activities in other parts of the body.
One effective way to stop gum disease is to brush your teeth after each meal with baking soda, then immediately pop a capful of apple cider vinegar into your mouth and swish it around. You'll get a reaction between the alkaline baking soda and the acidic vinegar. The result is a terrific 1-2 anti-bacterial knockout punch that I learned a few years ago from the head of the periodontal department at a university dental school. He had been recommending this simple approach for many years.
There are many other factors that can contribute to inflamed arteries. I list them in my book. Eating excess sweeteners is at the top of the list. One surprising new inflammatory factor that I have become increasingly aware of in recent years is "electro toxicity" from the wireless and wired electromagnetic frequencies that surround us.
Question 4: I have very high cholesterol that runs in my family. I really can't tolerate statins at all; even low doses cause me to get sick. I've had liver issues in the past when drug treatments have been combined. Are there any new treatments on the horizon? Are there any supplements that can help?
Dr Sinatra: I have discussed this issue extensively in my newsletter. First of all, much of what is called "high cholesterol" is totally harmless. Your body makes and needs cholesterol. The numbers don't mean much.
What means something is the type of cholesterol fraction patterns that are present. For instance, do you have a dominant pattern of small, dense cholesterol particles, which are the ones to be concerned about. They are the inflammatory type. You want your cholesterol particles to be predominantly large and "fluffy."
Ask your doctor to prescribe one of the new generation cholesterol tests, not the standard test that has been around for years and is pretty meaningless. The tests I recommend are the VAP test at www.atherotech.com or the lipoprotein particle test at www.spectracell.com. Both are covered by Medicare and most insurance plans.
If you have a lot of small, dense particles I suggest taking a straight niacin (vitamin B-3) nutritional supplement. It helps neutralize toxic particles. The only problem with niacin for many people is that it can cause a temporary and discomforting hot, tingling feeling that they can't tolerate.
The "niacin flush," as it is called, can develop a while after taking the supplement and last for a half hour or an hour. It usually goes away within a few days or a week as the body gets accustomed. I would start low, with 100 milligrams, taken at the end of a meal. Then increase slowly, say up to 250 milligrams in a week's time, and in that way, go up to 1,000 or 2,000 milligrams. It is very safe. It is just a matter of being able to tolerate the flush. Some people can't. I would also recommend 1 to 2 grams a day of omega 3 fatty acids, such as from fish oil. A garlic supplement is also good.
Question 5: I have been reading about the role of a substance called nitric oxide and its role in atherosclerosis. As nitric oxide is released from the lining of our arteries it helps keep them flexible and relaxed to enhance blood flow, especially during exercise. This same substance also protects against inflammation by helping arteries dilate to accommodate for the narrowing that can result as we age. Can you elaborate on this train of thought?
Dr Sinatra: The discovery of nitric oxide as a significant contributor to endothelial health is very exciting. NO, for short, is involved in vasodilation and also the protection of the sensitive lining of blood vessels. Fortunately, there are many nutritional supplements that can enhance nitric oxide.
L-arginine, an amino acid, is a reliable NO booster. I recommend 2-4 grams for heart patients. The blood pressure lowering effect of vitamin C (500 milligrams daily) is thought to be linked to NO release. Grapeseed extract (50-100 milligrams) also helps produce NO. One of my favorite newer generation supplements to stoke NO is glycine-propionyl-l-carnitine, a form of the amino acid carnitine. I recommend 1 gram daily on an empty stomach.
Question 6: Is there any good evidence that the strong continual rise in congestive heart failure may be linked to the heavy use of statins in the last 20 years? Since it has been shown to cause cardiomyopathy and heart failure due to the depletion of CoQ10, my theory of the steady rise in HF is due to the statin use.
Dr Sinatra: I'm on the same page as you. Although there has been a decline in coronary artery disease, there has been a definite increase in heart failure. Statin cardiomypoathy may be one of the contributing factors.
In my book Metabolic Cardiology, I discuss how statins can cause diastolic dysfunction of the heart because of its impact, as Dr. Graveline has pointed out many times, on the mevalonate pathway. Here, among other things, cholesterol is synthesized.
The "other things" include CoQ10 production which is so necessary for cellular energy. Statins lower cholesterol and can deplete CoQ10. Diastolic dysfunction means the heart fails to relax enough to allow an adequate amount of blood to fill the left ventricle. When diastolic dysfunction occurs, there is a drop in the production of ATP (adenosine triphosphate), the fuel that drives the actions of all the cells, including heart cells. CoQ10 plays a central role in the production of ATP.
Diastolic dysfunction can go on for a decade or two and be totally unnoticed by doctors or patients, and then lead to systolic dysfunction and heart failure. Systolic dysfunction means the heart fails to contract forcefully enough to pump blood out through the aorta. Diagnosing the difference between the two forms requires a careful echocardiographic analysis of blood flow across the mitral valve.
Question 7: I have read that fasting after approximately eight hours can cause the liver to produce excessive cholesterol.ă€€Since people are required to fast for a cholesterol test, could this cause a higher cholesterol reading than what a person would have if they could eat normally?
Dr Sinatra: It is possible that a short 8-12 hour fast could cause a mild cholesterol elevation. But it would be insignificant. The reason for the fast is that eating before a test could alter the cholesterol picture.
Question 8: Do statins help a bicuspid aortic valve that has a moderate leak?
Dr Sinatra: A bicuspid aortic valve is considered the most common congenital heart anomaly. The valve is normally tricuspid, that is, has three leaflets acting as doors that allow blood out of the pumping heart and into the big aorta artery that feeds out into the rest of the body. The valve also prevents blood from leaking backwards into the left ventricle chamber.
There is evidence a statin might help prevent or reduce a calcification process over a long period of time. A bicuspid valve may be more prone to inflammation and calcification. Statins have anti-inflammatory properties and could help reverse or head off calcification.
Statins can be a blessing or a curse. But if they can help preserve the integrity of the valve this could be one situation where they are a blessing. A low dose statin might be the way to go. But be sure to take CoQ10 because statin drugs deplete the body of CoQ10. The CoQ10 would also be helpful, especially if there is pressure overload to the valve as well as a leak. I recommend a minimum of 100 to 200 of CoQ10 (in the soft gel form) a day, taken with meals.
Dr. Stephen Sinatra, M.D., F.A.C.C., F.A.C.N.
Dr. Sinatra's website is www.drsinatra.com
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