An ancient surgical procedure, called trepanation, consisted of drilling a hole in the head and removing a piece of the skull. It is thought this practice was used to release evil spirits that caused mental illness, migraine headaches and other ills. Nowadays, however, if you went to your naturopath with complaints of headaches and she pulled out her drill, you would bolt from her office in horror.
Sadly, when it comes to heart disease, it seems we haven’t advanced all that much. When future humans look back to 2010 and the way we treat heart disease, they will shake their heads in disbelief. Much of heart care today, in both conventional and alternative medicine, ranges from harmful to hopelessly misguided.
Although cancer recently took the top spot, heart disease has long been the leading cause of death since the advent of processed foods almost 100 years ago, and it’s no wonder. The root of disease almost always begins in the gastrointestinal (GI) tract, with problems compounding in the immune and endocrine (hormone) systems, which in turn stress the heart. That gut health and immunity status affects the heart is lost on most conventional doctors, including many holistic ones.
These days we see two extreme viewpoints of cholesterol, both of which are incomplete. In conventional medicine, cholesterol is the defining marker for heart disease. While your local MD’s approach to treating high cholesterol has been seriously questioned and successfully challenged by reputable science, the standard of treatment — low-fat diets and Lipitor, for example — hasn’t budged. And when this model fails to prevent heart disease, as it often does, doctors simply blame the patient for not toiling long enough in the prison of low-fat diets.
In holistic medicine, on the other hand, cardiovascular health is often dismissed when symptoms are lacking, and high cholesterol is brushed away. Although the nutritional model is safer (for statin drugs can have devastating side effects), it too falls short when it doesn’t address the risk of high cholesterol levels.
As always, the answer lies in the middle of these two extremes. Conventional doctors miss the mark when they look at cholesterol levels in isolation, as do holistic doctors when they hardly consider it at all. The truth is, high cholesterol is a risk when inflammation is present.
When looking at what causes heart disease and how to treat it, atherosclerosis, the formation of plaque within the arteries, is the bottom line. But it’s shortsighted to simply blame atherosclerosis on high cholesterol. Rather, atherosclerosis comes from an immune response. The immune response creates inflammation, with this inflammation gradually worsening into lesions in the arterial walls. Since the body’s priority is to stay alive now, even if means self-sabotage in the long run, it speedily delivers cholesterol to the lesions to patch them up, hence causing atherosclerosis.
The key for the practitioner then is not simply to lower cholesterol, leaving the arterial walls more vulnerable to failure, but rather to ferret out what’s driving the inflammation. This is where the skill and ongoing education of the practitioner come in. For instance, newer research shows that some people develop atherosclerosis due to an autoimmune disease in which the body attacks it’s own arterial wall tissue. Is a prescription for either Lipitor or CoQ10 going to do much for these folks? Obviously not.
The sleuthing for inflammation starts by understanding that atherosclerosis starts where the gastrointestinal, hormonal, and immune systems meet (and yes, they do meet!). But for the sake of simplicity, lets look at each individually.
The gut connection to heart disease
Although many practitioners understand that poor digestion creates inflammation, a couple of problems specific to the GI tract can trigger atherosclerosis. For instance, bile secreted by the gallbladder escorts cholesterol out of the body. However, with dysbiosis — when there is more bad bacteria than good bacteria in the gut — this process falters or fails. The result is a rise in cholesterol (not to mention estrogen and various toxins). In this case, a simple gut detox and inoculation with beneficial bacteria lowers cholesterol.
Also critical is the link between helicobacter pylori infection and atherosclerosis. H.pylori, a bacterium unique in its ability to survive the highly acidic environment of the stomach, is best known for causing peptic ulcers, gastritis, and duodenitis. What’s less known, however, is that h.pylori also destroys vascular tissue; autopsies are turning up h.pylori in the lesions of stroke and heart attack victims.
Our gut is exposed to many pathogens, including h.pylori, daily. A healthy stomach sufficient in hydrochloric acid (HCl) destroys pathogens as soon as they enter. It’s estimated that 90 percent of Americans are deficient in HCl, and that h.pylori can be found in 50 percent of the world’s population, so it’s easy to see why this may be the most common infectious disease worldwide. Not to mention that most, if not all, chronic users of antacids harbor excess h.pylori.
So why hasn’t medicine launched a full-scale attack? Because an h.pylori infection is asymptomatic, quietly wreaking havoc before more telltale signs such as gastric ulcers enter the picture. And since most practitioners, both conventional and natural, practice based on symptoms, it can easily go unnoticed until it’s too late.
I do not like using the serum antibody test for h.pylori. A retest will not show whether we have successfully treated the infection, for the antibody levels stay elevated for up to a year after treatment. The breath test is more useful diagnostically. Because this bacteria is so contagious (by saliva), I have found treating an individual for h.pylori does not have lasting success unless the entire family is treated. I once had a patient whose h.pylori infection kept rebounding, despite treating his family. It was when he sheepishly brought in his mistress for treatment that we were finally able to kick the infection for good.
The immune system and the heart
We typically don’t think of a weak immune system as having much to do with heart health, but as with h.pylori, undetected viruses and other antigens can prey on the cardiovascular system. Although I am wary of making diagnoses based on symptoms, my patients who complain of chronic pain and fatigue are often suspects for chronic viruses. Most often they are the ones I screen for antibodies to antigens associated specifically with atherosclerosis: Cytomegalovirus, coxsackievirus, chlamydia pneumonia and porphyromonas gingivitis (for this last one, proper oral hygiene is key). I then track the treatment with follow-up tests that look at antibodies and the viral load, even if patients report they are feeling wonderful. Sometimes nutritional support helps relieve symptoms tremendously, but the virus persists and we either need to dig deeper or find a more effective treatment. Asking, “How do you feel?” to treat your patients is a standard for failure.
Natural medicine offers the most effective treatment against viruses, compared to the prescription drug Interferon, which has caused more suicides than all other drugs combined throughout history. The goal, along with correcting the patient’s diet and digestion, is to boost the natural killer cells to combat the virus. This can be done quite nicely with a synergistic combination of botanicals.
When considering heart disease and immunity, one also needs to consider liver function, especially when running tests for C-Reactive Protein (CRP) and homocysteine. CRP is made in the liver as a response to inflammation. If your patient’s CRP comes back normal while other markers for atherosclerosis are present, it could be due to fatty liver, the use of multiple drugs, or other issues that impair liver function. When the liver is impaired, it simply won’t crank out the CRP like it should, and lab levels for CRP will come back normal. Likewise, statin drugs lower CRP and produce a kosher lab panel, but this is rather like removing the engine light instead of fixing the engine.
Another heart culprit is the amino acid homocysteine, which destroys arterial walls and promotes atherosclerosis. Most people understand high homocysteine levels to be related to B vitamin deficiencies, but hypochlorhydria (too little stomach acid), and the use of estrogen creams and birth control pills can also raise homocysteine. A lesser-known culprit is poor liver function, when the liver’s methylation pathway is not functioning. Therefore this pathway should always be supported in conjunction with the usual homocysteine-lowering therapies. Methly-B12 and Metacrin DX both support clearing the liver’s methylation pathway.
Hormones and the heart
When we think of hormones, we typically think of the sex hormones and how clumsily they function for many people. What most provokes atherosclerosis, however, is a less glamorous but exceptionally touchy hormone that we tend to abuse: Insulin. After years of a high-carb, sugar-laden diet that calls on the pancreas repeatedly to flood the system with insulin, the body’s cells become insulin resistant. This leaves excess amounts of insulin circulating through the bloodstream, leading to high blood pressure, thicker blood (which can gum up the cardiovascular system), and an increase of the enzyme activity that elevates cholesterol. In men, testosterone protects the cardiovascular system, just as estrogen does for women. In cases of insulin resistance, however, we see men becoming estrogen dominant (developing “breasts”) and women becoming testosterone dominant (growing “beards”), and we know cardiovascular destruction is well under way. These are the folks who fatigue after meals, whose fasting blood sugar is over 100 and who typically show high LDL and triglyceride levels. For these folks, regulating dysglycemia is imperative to heart health.
Thyroid health also plays an important role in cholesterol levels and heart health. When a person’s thyroid is under functioning, he or she makes fat more quickly than it is burned, which drives up triglycerides, cholesterol and LDL cholesterol. Hypothyroidism also makes the liver and gallbladder sluggish, which contributes to high cholesterol.
The autoimmune or neurological connection to the heart
There are times when I have exhausted all the possibilities, and still arterial inflammation and high cholesterol persist. It is then that I suspect autoimmune disease, when the body is attacking it’s own arterial walls, hormones or environmental compounds such as heavy metals, that in turn lead to high cholesterol and atherosclerosis. At that point we run an immune panel for direction in taming the autoimmune response. This information is vital in knowing specifically how to treat each autoimmune case, as the wrong approach can exacerbate the condition. Additionally, an understanding of functional neurology is important. When brain degeneration is accelerated due to autoimmune disease, insulin surges, nutrient deficiencies and other factors, autonomic function can begin to fail. Knowing how to assess and address neurological function can aid in heart health.
For ideas on how to modulate an autoimmune condition, see my book Why Do I Still Have Thyroid Symptoms? Although it addresses the thyroid, the autoimmune mechanics are the same for any tissue being affected.
To lower or not to lower cholesterol?
As long as we are addressing the source of inflammation, I still feel it is prudent to lower overly high cholesterol in order to put the brakes on artery-clogging atherosclerosis. I do this with compounds that contains red yeast rice extract, which studies show to be more effective than statin drugs, while absent of the dangerous side effects. (This compound proved so beneficial that the FDA banned it, citing it was “too effective to be a natural agent.” When the ban was lifted and it came back on the market, the pharmaceutical industry successfully bankrupted about half the manufacturers through expensive litigation.) If cholesterol levels refuse to lower with these compounds, I then look for gallbladder congestion. As mentioned earlier, bile escorts cholesterol from the body, so a sluggish and congested gallbladder will hamper this mechanism.
Doing the work
Like other practitioners, I also prescribe sufficient essential fatty acids, antioxidants and vitamin D on top of specific therapies. Healing cardiovascular damage naturally requires patience, dedication and thoroughness, not only from the practitioner, but especially from the patient. As all practitioners know, noncompliance can sabotage the best of care. When my patients present with inflammation markers and poor cardiovascular health, I always ask them, “How deep do you want to go? Here are 10 steps I’d like to take with you,” and I outline what I have presented in this article. In the end it’s up to them whether they want to do the work, but it’s only when I give them all their options that I can sleep at night. I need to know I have done more than the modern equivalent of drilling a hole in their head.