May 20, 2019

Reversing Heart Disease

Chauncey Crandall, MD, a cardiologist in Jupiter, Florida, knows about coronary artery disease firsthand. Despite his extensive training as a physician, Crandall, married and a father of two, wasn’t caring for himself properly, often working long hours and eating poorly as he focused on the welfare of his patients.

After giving a lecture in the metropolitan New York area, Crandall experienced shoulder pain while lifting his suitcase on the trip home. “I didn’t really pay any attention to it, because I’m the cardiologist—you know, why should I have a heart attack or underlying heart disease? I knew all the risk factors, but I wasn’t really living a lifestyle of prevention,” he recalls.

Crandall had no more symptoms until, back at home, he went on a nighttime excursion to look for sea turtles on the beach. As he walked through the sand, he felt severe chest pain. He remembers thinking to himself, “I’m too young to have a heart problem. I’m only 48. I’m not a diabetic, and I’m not a smoker. I don’t have a family history of heart disease.”

Supplemental Heart Help

While most people have heard of vitamin E’s effects on heart health, this powerful antioxidant is actually part of a nutrient package that includes the tocotrienols. A member of that family, gamma-tocotrienol, has been found to reduce creation of triglycerides, an unhealthy blood fat (Journal of Atherosclerosis and Thrombosis 10/27/10 online). Vitamin D, the subject of intense reserach in recent years, has also been found to support heart health by helping to regulate blood pressure. Vitamin D is now available in combination with resveratrol, the healthy component in red wine, which has been shown to help short-circuit arterial plaque development.

Only animals make cholesterol, which is used as a building block for cell membranes and hormones. Plants make a similar group of substances; known as plant sterols, they have been found to reduce absorption of dietary cholesterol.

Several herbs have demonstrated heart-healthy effects. Hawthorn, one of Europe’s oldest cardiac tonics, increases the heart’s pumping capacity and encourages better blood flow. Green tea, which is available in extract form, has been found to reduce the risk of dying from cardiovascular disease. And garlic, the best-known heart herb, promotes healthy circulation while helping to keep blood pressure in check.

One nutrient that plays a key role in blood pressure control is the mineral magnesium. Japanese researchers found an increased risk of plaque development in people with low bloodstream magnesium levels (American Journal of Hypertension 12/10). In other studies low magnesium has been associated with higher fasting glucose readings. Potassium has been linked to lower blood pressure levels
and low potassium may increase stroke risk.

Muscle cells in the heart use a lot of energy to keep blood moving throughout the body. This helps explain why the heart contains so much CoQ10, a nutrient crucial to energy production. Now available in a more usable form called ubiquinol, CoQ10 also helps reduce the incidence of abnormal blood clotting, a key factor in heart- attack prevention.

The pain subsided when Crandall returned to his car but returned the next morning. His wife took him to the hospital, and he discovered that he had what is called the “widow-maker”—a critical blockage in the main artery of his heart.

Since Crandall had treated many patients with heart disease, he knew what he had to do. He immediately went on the Ornish diet, which emphasizes vegetables and low-fat foods. In addition to taking medicine to get his cholesterol and blood pressure down to target levels, he began walking for 90 minutes every day. Eventually, he made some adjustments, sticking to a vegetarian diet during the week, but allowing looser eating restrictions on the weekends.

Crandall also made sure to reduce the stress in his life. “I made major changes in work. I no longer worked until 11 every night. I was always home for dinner,” he says. Western culture, Crandall notes, is far too stressful, adding, “We’re in a vicious cycle of chaos and we need to reevaluate, readjust and move forward by making lifestyle changes.”

Can heart disease be reversed? Not completely, experts say, especially if your genetic heritage leaves you vulnerable to cardiovascular difficulties. But the good news is that diet and other lifestyle changes can go a long way towards blunting its effects. “If you treat heart disease right, you can basically eliminate the clinical manifestations,” says K. Lance Gould, MD, a professor of medicine at the University of Texas Medical School at Houston and the author of Heal Your Heart (Rutgers University Press).

The idea of preventing and even reversing heart disease first gained traction in the 1990s. That’s when results of the groundbreaking Lifestyle Heart Trial were first published. This study was conducted by researchers including Gould and Dean Ornish, MD, who developed his diet and exercise program based on the trial’s findings.

Confronting a Killer

The leading cause of death in the United States, heart disease claims the lives of more than 616,000 people annually. While commonly recognized symptoms include chest pain, heart palpitations and shortness of breath, many with heart disease—in some cases, even those at a fairly advanced stage—are completely symptom-free, making the condition both dangerous and unpredictable. In other instances, vague symptoms such as nausea and dizziness may be attributed to indigestion or other minor health concerns.

The most common form of heart trouble is coronary artery disease (CAD), a gradual process in which cholesterol accumulates in the walls of the coronary arteries, those that feed the heart itself. “These plaques slowly build up over many years,” explains Gould. “At one point, they either clog up enough that people get symptoms or, more commonly, little plaques suddenly break loose and cause a localized blood clot that blocks blood flow.” If this happens to the heart muscle, a heart attack happens. Cholesterol can gather in arteries throughout the body. For example, the same process may occur in the brain; if an artery there becomes blocked, a stroke occurs.

For people who have been diagnosed with coronary artery disease or had a cardiac event such as a heart attack, the reversal process generally begins with significant lifestyle changes. However, people who are genetically predisposed to heart disease (“Mother Nature can be brutal,” notes Gould) may require conventional medical interventions to get them to the point where they can focus primarily on diet and other lifestyle alterations.

Healthier Living

Changing one’s diet is crucial to reversing CAD. In order to help get cholesterol levels down, Gould 
recommends a diet that focuses on low-fat, low-carbohydrate foods, including chicken, turkey, fish, egg whites and no-fat or low-fat dairy products. While Gould believes that a vegetarian diet is beneficial, he notes that it can take extra effort to minimize carbs and get adequate protein. Moderate-to-high protein intake, Gould notes, is important because it curbs your appetite, and he cites Greek-style high-protein yogurt, ideally with blueberries or strawberries, as a good option.

Timothy McCaffrey, MD, an associate research professor of cell biology in the Department of Medicine at Weill Cornell Medical College in New York City, has done extensive research on coronary artery disease and notes that fish oil can be particularly beneficial for arteries, the heart and blood pressure. He says that fish oil affects the way blood clots. McCaffrey also points to recent research on the antioxidant resveratrol as promising. “Studies seem to show that it has anti-aging effects,” he says, “and that’s reflected in your arteries.”

Getting more exercise is also essential in reversing heart disease. Gould emphasizes, however, that the key to making workouts effective is moderation, noting that even professional athletes can fall victim to heart disease. “It has to do with consistency more than intensity. The extremes don’t make sense,” Gould says. He recommends 30 to 40 minutes of exercise five days a week, which can involve walking outside or on a treadmill and/or some combination of weights, swimming and aerobics. 

By adhering to these diet and exercise guidelines—and, for smokers, quitting tobacco—the process of reversing some of the damage caused by CAD can get underway. What 
happens to the body as these changes occur? Most significantly, cholesterol levels become much more balanced. This means reducing levels of low-density lipoprotein (LDL), commonly known as “bad cholesterol,” as low as possible, and elevating levels of high-density lipoprotein (HDL), or “good cholesterol,” as high as possible. “That will minimize the damage to your arteries,” McCaffrey says.

Plaque reduction occurs when HDL is better able to take cholesterol back to the liver—as opposed to LDL moving cholesterol from the liver to other regions of the body, most notably arterial walls. “Over a period of six to 24 months the cholesterol deposits in the artery are reabsorbed, and so the artery is left without this cholesterol plaque,” Gould explains. This allows blood to flow freely to the heart, resulting in improved coronary health. Weight also becomes more manageable and blood pressure, another key to arterial health, tends to come down as well.

Gould adds, “If you’re at target weight, you’re eating right, you’re working out, and you’re reaching the cholesterol goals—LDL below 70, HDL over 45—then there’s a 90% decrease in the chance of stroke, heart attack or heart failure.”

Never Too Late

If you’re worried that you’re too old to reverse heart disease, consider the reduced risk of lung disease when stopping smoking late in life. “If you smoke until you’re 60, there’s still a benefit to stopping,” McCaffrey says. Similarly, with heart disease, “the evidence is that, even starting at the age of 60, putting those available risk factors back into order—controlling your weight, blood pressure, cholesterol, stopping smoking—all of those things still have a benefit,” he says. “Whether they’re going to reverse the tide or at slow the progression probably depends on the particular person.”

Gould agrees. “I’ve been treating people for many, many years, and I’ve got a collection of 90-year-olds—they’ve got calcified arteries, but they’re stable as a rock. They’re smart, they’re lively and they’re walking,” he says.

Both Gould and Crandall say that one of the problems is getting people to stick with the program, with men often being the most resistant. Gould has found that most people have something that will convince them to make the commitment—but it can be difficult finding each person’s motivating factor. He says, “I talk to somebody until I understand them, and they start to trust me. They usually have a trigger—they really care about their kids, or they just don’t want to die.”

Reversing coronary artery disease may not be easy. But as more people take on this challenge, it’s possible that heart disease may claim far fewer lives.