For decades, the general public has been interested in the prevention and treatment of cardiac disease. To the public, however, the medical community is rather backward, if not reactionary, in attitude towards any form of self-help. The result has been a general public that is often more informed and more sophisticated than the health care professional.
Often described as ‘bad medicine,’ or ‘lacking in scientific evidence,’ the use of non-prescription medications has been ignored or rejected by mainstream medical practitioners. Strange it is that medicines are only useful and effective as long as they are available only by prescription, only while protected by brand-name, and only while actively marketed. In fact, twice as much money is spent in the US economy on alternative medical care than is spent on ‘traditional’ medicine. This is more a testament to the obstreperous attitude of the medical community than it is to the lack of wisdom on the part of the population.
We, as physicians, may well be our own worst enemy. Unfortunately, ignorance and educational provinciality has resulted in damage to our patient’s health and well being. In short, medical stubbornness has resulted in delay in basic preventative health intervention. Presented here are a few basic interventions that are widely used by the medical communities abroad, used locally by the American Public, and only reluctantly by our American medical peers.
In spite of the over-used statement that there are no ‘double-blinded, double placebo controlled studies,’ there are many hundreds of peer-reviewed articles that demonstrate the scientific basis for many non-prescription treatments.
It should be curious that fish oil, long observed to result in increased longevity and improved health, was only considered ‘effective’ after the introduction of an expensive, prescription fish oil product. Even more curious is the fact that the fish oils that has been, or should have been part of our diets are only effective if properly marketed and priced to the level of the average car-payment.
In fact, the body of knowledge is extensive and expanding. Nobody is going to make a marketing effort to teach this information to the practitioner. Nobody is going to bring donuts or lunch to teach the benefits of nutritional intervention.
It is the responsibility of the physician to learn actively, not be taught passively.
Historically, physicians have been slow to change attitudes, and for the most part, this is more of strength than of a weakness. In dealing with new medicines, surgical options and treatment programs, rigorous testing and re-testing reduces the chances of introduction of dangerous medicines. Double-blinded, placebo-controlled studies are very useful, but these studies rarely involve non-proprietary medicines and non-patentable chemicals. Oddly, most of these studies are scientifically flawed, and oddly they tend to be contradictory in nature, reflecting the needs of the sponsor of the study. Strange, indeed.
Essentially, there is no profit in funding a quality study investigating the efficacy of a cheap, widely available vitamin or supplement.
We must, therefore learn to think for ourselves, buy our own lunches and dinners, and teach ourselves the basics.
Omega-3 Fatty Acids
Epidemiological data has demonstrated the cardio-beneficial effects of the “Mediterranean Diet.” Individuals, ethnicities and sects that eat larger amounts of olive oil and fish have long been recognized as having fewer problems with atherosclerosis and obesity. While it is easy to attribute these differences to genetics, it is curious, indeed that the epidemiological advantages of ‘genetics’ seems to disappear when these same ethnicities move to North America. It is unlikely that the genes themselves evolve only after persons immigrate to this country.
Omega-3 fatty acid (fish oil) administration is an interesting, new intervention for the treatment and prevention of coronary artery disease (CAD). Certain omega-3 fatty acids have biochemical properties that promote atherosclerotic plaque stability and thereby decrease the incidence of cardiac ischemia and ischemic cardiac arrhythmias. An ever-increasing body of evidence supports the role for omega-3 fatty acids, i.e. fish oil, in through a role as Antiarrhythmic agents, through anti-thrombotic effect, and through atherosclerotic plaque stabilization, probably as a result of topical anti-inflammatory action.
Long after the public has used fish oil supplements as cardio-protective agents, physicians are now slowly realizing the benefits of Omega-3 fatty acids. The data demonstrate reduction in coagulability, decrease in blood viscosity and reduction in the inflammatory response. Unfortunately, it took the introduction of a prescription fish oil preparation to shake up the established school of thought. It is predictable that physicians will prescribe the ‘new’ cardiac omega-3, after the customary lunch or dinner meeting, paid by the sponsor. Unfortunately, the prescribed product is no better, but certainly more expensive, than the long-available over-the-counter preparations. Gratifying, indeed, to prescribe a $140/month oil capsule when your patient can benefit, equally with one costing $20.
One can only wonder when the medical establishment will recognize the value in these inexpensive, basic interventions, and how much longer it will take before the preventive value is recognized. In addition to the remarkable cardiac effects of Omega-3 EFA’s, these oils improve arthritic symptoms, reduce GI transit times, reduce the risks of colon cancer and improve the appearance of the skin & hair.
Dosage requirement is between 2 and 3 grams per day, in divided doses. The preferred cardiac ratio of 3:2 EPA/DHA. Patient should begin with 1 mg per day, increase over a week or two to the desired daily dosage. In patients that have oil-deficient diets, that is patients who eat little olive oil or fish, a gradual increase in dose permits the pancreas time to produce sufficient lipase to digest the oil.
The real public health issue, as it pertains to fish, fish oil and fish oil products involves the contamination of the fish supply with mercury. Recognizing this, several factors must be taken into consideration when recommending or dispensing a fish oil product. First, mercury levels increase as fish size increases. This is a result of bio-accumulation. For purposes here, recommended fish oil products should be derived from small fish, not large predators. Secondly, distilled oils are often free of mercury and other heavy metal contaminations. The better products will undergo multiple distillations. Not only does this extract the mercury, but it extracts the fish proteins that many patients find distasteful. The best fish oil capsules leave little, if any aftertaste. The very best of all have no taste, at all.
CO Q-10 (Ubiquitone)
Long used by the health-aware public, Co Q 10 has been mainstay in the treatment of angina as well as for muscle pain in statin-prescribed patients. A relatively unknown member of the B vitamin family, Co Q-10, sometimes known as co-enzyme Q10 or Ubiquitone, enhances systolic function in chronic heart failure. It has been used in Europe, for many years, as a primary treatment modality for patients with angina. More recently, it has been recognized for utility in the treatment of myalgia, myopathy and cardiomyopathy that results from statin use.
The average effective dosage is 50-100 mg per day, and GI absorbance is enhanced if is taken simultaneously with a fish oil capsule. Patients should be advised to use pharmaceutical-grade CO-Q-10, that is, manufactured and not inferior soy-lecithin product.
Folic Acid (Vitamin B-9)
Folic acid, in high dose, has been demonstrated to reduce serum cholesterol levels, decrease atherosclerotic plaque formation, increase arterial wall flexibility, and improve renal function in diabetics. Folic Acid has been demonstrated to increase cardiac function in women. Essentially devoid of detectable side-effects, folic acid is inexpensive. Therapeutic dosage is 5 mg, which is 12 to 14 times the recognized RDA. While the commonly available dosage of Folic Acid is 400 mcg, prescription-strength Folate is available in 1 mg dosage. Remarkably, a 5 mg (5000 mcg) dosage is available without prescription, for as little as $0.10 per day. If the cardiovascular effects of Folic Acid were not enough, high dose Folic Acid has demonstrated potential to prevent the neuron-fibrillatory changes that result in Alzheimer ’s disease.
Folic Acid (Vitamin B-9) Molecular Structure
Hawthorn Berry Extract
Used for decades by the health-conscious public, Hawthorn Berry Extract has salutary effects on the heart and peripheral vascular system. Commonly used to enhance cardiac output, hawthorn has been demonstrated to modestly increase cardiac output in early congestive heart failure. Solid evidence has been elucidated, demonstrating that hawthorn may reduce ischemia/reperfusion-injury, and evidence demonstrates anti-arrhythmic, hypolipidemic (LDL lowering ) and hypotensive effects of Hawthorn Berry. It must be used with caution in patients receiving Coumadin, in that the effective dose of Coumadin is reduced by 50% or more. When used in combination with fish oil, Hawthorn improves symptoms of intermittent claudication and auto-immune vasculopathies.
Carnitine may be beneficial to patients, suffering from heart disease as well as kidney failure. Useful in the treatment of congestive heart failure and cardiac ischemia, L-carnitine offers a low risk medical tool in the control of this disease state. At doses of 1500 mg to 6000 mg per day, L-carnitine administration has been demonstrated to reduce fatal results and improved heart failure following myocardial infarct.
Taurine is an interesting amino acid, useful as an anti-oxidant, but it has tremendous benefits for patient with ASCVD and acute myocardial infarct. Demonstrating effectiveness in modulating platelet aggregation, Taurine also demonstrates a modulating effect with regards to the inflammatory response that precedes and accompanies acute myocardial events. Taurine has anti-atherosclerotic activity in animal models, due to its effect on macrophage-derived myeloperoxidase, integral in the atherogenic process.
It is important for the medical practitioner to have a basic understanding regarding the use of herbal and non-prescription treatments for common maladies. A few, commonly used modalities have been discussed. Solid scientific data are readily available, to the interested party, to demonstrate the indication, dosage, and pit-falls of these modalities. It is increasingly imperative for the medical practitioner to look outside of the usual study materials and strive to achieve a level of understanding that meets and exceeds that of the patient. In short, it makes us all look rather foolish when the patients are significantly more sophisticated in these overlooked areas of medicine.
- Education is a career-long endeavor. The most meaningful and valuable education is often self-instructive in nature.
David S. Klein, M.D. FAPM, FAAMP
Stages of Life Medical Institute
1917 Boothe Circle
Longwood, FL 32750