High Blood Pressure, High Cholesterol and Heart Disease

by John G. Connor, M.Ac., L.Ac. edited by Barbara Connor, M.Ac., L.Ac.

Introduction
What is High Blood Pressure?
Chinese Medical Syndromes Corresponding to High Blood Pressure
Research on How Acupuncture Benefits Blood Pressure
Overview
Useful Foods for Lowering Blood Pressure
Herbs and Supplements which Lower Blood Pressure
Foods and Herbs to Avoid with High Blood Pressure
The Problem with Licorice
Medications and Supplements to Avoid with Hypertension
Insulin Resistance and High Blood Pressure
Understanding High Cholesterol
Useful Foods for Lowering Cholesterol
Useful Herbs & Supplements for Lowering Cholesterol
Free Radicals and High Blood Pressure
Useful Antioxidants for Heart Health
Foods to Avoid in order to Lower Cholesterol
Drugs which can Elevate Cholesterol
Side Effects of High Blood Pressure Medications
Side Effects of Statins
What about Aspirin?
The Effect of Fish Oils on Heart Health
Lifestyle Recommendations
References

1. INTRODUCTION
Barbara and I treat high blood pressure, high cholesterol and heart disease using a combination of acupuncture, craniosacral therapy, dietary and lifestyle  recommendations, and when appropriate herbs and supplements.  The purpose of this article is to give you a better understanding of the various forces at work in high blood pressure, high cholesterol and heart disease and the things you can do to improve your heart health. According to an article in Newsweek magazine (Aug. 23, 2004 p. 43) “…inflammation is also now viewed as a key mechanism in heart disease — more important than the anatomical narrowing of coronary arteries by cholesterol deposits…” We invite you to read our article entitled Inflammation and Its Role in Disease for a summary of inflammation and its role in cardiovascular disease. For a more information about this vital subject please refer to our articles on Understanding Heart Attacks and Heart Disease and Understanding Atrial Fibrillation.

2. WHAT IS HIGH BLOOD PRESSURE?
An estimated 50 million Americans have high blood pressure or hypertension. Hypertension affects more than half of all Americans over the age of 65. 

High blood pressure is usually divided into two categories: primary and secondary. Primary hypertension is high blood pressure that is not due to another underlying disease. It is also known as idiopathic or essential hypertension and accounts for over 90% of all cases of high blood pressure. Secondary hypertension is due to an underlying disease such as kidney disease, hormone disorders, neurological conditions or pregnancy. These cases need to be evaluated by a physician and treated accordingly. 

Risk factors associated with primary hypertension include cigarette smoking stress, obesity, excessive use of coffee, tea. drug abuse, high sodium intake and use of oral contraceptives. 

Normal blood pressure readings (in mm/ Hg) for adults vary from 110/70 to 140/90, while readings of 140/90 to 160/95 indicate borderline hypertension. Any pressure over 180/115 is severely elevated. High blood pressure must always be evaluated by a healthcare professional and severely elevated blood pressure always requires treatment with conventional medicine. 

According to a study published in The Journal of the American Medical Association in May 1996 hypertension is the most common risk factor for congestive heart failure.

3. CHINESE MEDICAL SYNDROMES CORRESPONDING TO HIGH BLOOD PRESSURE
According to Chinese Medicine high blood pressure can be due to the following:
If Kidney Yin is deficient it fails to nourish Liver Yin which leads to hyperactivity of Liver Yang, the rising of Liver Yang and Liver Wind causes high blood pressure and its typical symptoms of headache, dizziness and tinnitus.

Another common pattern is Hyperactive Liver Yang with Deficient Spleen Qi, commonly seen as headache with hypoglycemia, in those with this tendency who do not eat at sufficiently regular intervals. Hyperactive Yang can also arise when there is Deficient Spleen and Liver Blood.

Stagnant Heart Qi may combine with Phlegm to give rise to Heart Phlegm and this may combine with Fire to produce Heart Phlegm Fire. All these Heart patterns can contribute to hypertension. headache, myocardial infarction or cerebrovascular accident.

Other patterns which correspond to hypertension Include: Liver Fire Rising, Deficient Yin with Excessive Yang, Obstruction of Phlegm and Dampness, Interior Movement of Liver Wind, and Deficient Kidney Yin and Yang.

4. RESEARCH ON HOW ACUPUNCTURE BENEFITS BLOOD PRESSURE
A study published in the J Tradit Chin Med 1996;16:273-4 by Weihai et al reported that it was found that acupuncture treatment and nifedipine (an antihypertensive medication) were equally effective in reducing blood pressure in 62 patients with hypertension. These positive results are supported by other controlled trials.

According to a study done by Bobkova et al it was shown that acupuncture-related decline of arterial pressure occurs in participation of pituitary and adrenal hormones as well as the polypeptides beta-endorphin and neurotension.

According to a study done by Anshelevich et al it was concluded that acupuncture resulted in a hypoaldosteronemic effect which showed statistically significant correlation with a decrease in the arterial blood pressure. The results obtained made it possible to regard the effect of acupuncture as one of the most significant mechanisms of its therapeutic action in hypertension.

A study done by Radzievsky et al established that as a result of acupuncture a stable hypotensive effect, improvement or normalization of contractile function and diastolic values, a decrease of energy loss, reversal of myocardial hypertrophy were achieved. It is the decrease of sympathetic influences on the circulation system that plays an Important part in the onset of these positive changes,

According to a study reported in the Journal of the British Medical Acupuncture Society the clinical picture Improved in 96% of those patients with hypertension who were treated with acupuncture.

A recent study which appeared in the American Journal of Physiology by Chao et al showed that electroacupuncture significantly reduced myocardial ischemia and improved regional myocardial dysfunction. This finding suggests that electroacupuncture causes myocytes in the ischemic region to resume near-normal contractile function. The authors conclude that acupuncture may be a useful therapeutic approach for the treatment of angina in some patients. In this regard success with this approach has been reported.

5OVERVIEW
Dietary manipulation has been proven to be an effective treatment method for hypertension. A high fiber, low fat, low salt and low sugar diet is suggested.  Numerous studies reveal that a simple reduction of body fat is often enough to reduce blood pressure to healthier levels.

Relatively higher intakes of calcium, magnesium and potassium and relatively lower intake of sodium appear to be beneficial.

According to a recent study which appeared in Stroke 2000;31:2287-2294 the risk of stroke can be as much as 58 percent lower among those who consume vegetables 6 to 7 days per week compared to those who only consume them up to 2 days a week.

 6USEFUL FOODS FOR LOWERING BLOOD PRESSURE
Eat a high fiber diet. Drink green tea and use cayenne and curry spice in your cooking 

Eat plenty of fruits and vegetables, such as apples, asparagus, bananas, broccoli, cabbage, cantaloupe, eggplant, garlic, grapefruit, green leafy vegetables, melons, peas, prunes, squash and sweet potatoes. 

Celery – contains a compound called 3-n-butyl-phthalide which has been demonstrated in animal studies to lower blood pressure by 12 to 14 percent. The amount in the animal study was equivalent to four stalks of celery. 

Oranges and green leafy vegetables contain folate which may reduce the risk of developing heart disease by lowering levels of the ammo acid homocysteine which has been linked to arteriosclerosis. 

Eat grains like brown rice, buckwheat, millet and oats. Get protein from vegetable sources, grains and legumes instead of from meat. 

Flavonoids – found in citrus fruits, berries and yellow onions (quercetin) have been found to reduce stroke incidence significantly. Flavonoids strengthen blood vessels and connective tissue.

7HERBS AND SUPPLEMENTS WHICH LOWER BLOOD PRESSURE
Apple pectin aids in reducing blood pressure.

Arginine In order for the body to make nitric oxide (the vasodilator that relaxes arteries and lowers blood pressure) it must have adequate supplies of the ammo acid arginine. Arginine is produced in the body. However, foods high in arginine include: carob, chocolate, coconut, dairy products, oats, peanuts, soybeans, walnuts, wheat and wheat germ.

Arjuna is a famous Ayurvedic herb made from the bark of the Terminalia arjuna. Modem clinicians are just beginning to use arjuna for coronary artery disease, heart failure and high cholesterol. It seems to work by Improving cardiac muscle function and the pumping activity of the heart. A 1999 study indicated that arjuna was more effective than a standard drug for angina. Arjuna also benefits cardiomyopathy. or weakening of the lower muscle of the heart and may help patients recovering from heart attacks. Arjuna seems to be quite safe. No toxicity or adverse reports are noted in the scientific literature. For congestive heart failure 500 mg of extract four times per day has been used in studies. You can also purchase the bulk herb, dried and shredded, and brew it into a tea.

CoenzymeQ10 – has tremendous clinical value in the treatment of hypertension, congestive heart failure, cardiomyopathy and mitral valve prolapse. In a 1994 study done at the Univ. of Texas by Dr. Peter Langsjoen 109 hypertensive patients were treated with an average daily dose of 225 mg of CoQlO in addition to their prescribed drug regimen. Within 54 months a remarkable 51% of the patients were able to come off one to three anti-hypertensive drugs.

EPA and DHA oils from fish oil and LA and ALA oils from flaxseed oil.  EPA and DHA. the omega-3 fatty acids, lower blood pressure according to a meta-analysis of 31 trials which appeared in Circulation 1993;88:523-33. In another study in humans, GLA from borage oil relaxed blood vessels and lowered blood pressure in response to stress. Over 60 double-blind studies in which fish oils were administered to hypertensive patients observed that blood pressure did indeed fall with supplemental omega-3 fatty acids.

Folate  A recent study found that younger women who consumed at least 100 micrograms per day of total folate (dietary plus supplemental) had a decreased risk of hypertension compared with those who consumed less that 200 micrograms per day.  The researchers concluded that higher total folate intake was associated with a decreased risk of incident hypertension, particularly in younger women. (Forman et al 2005)

Garlic – lowers blood pressure according to a meta-analysis that included ten double-blind studies which appeared in the Journal of Hypertension 1994; 2:463-8. All of these trials administered garlic for at least four weeks, typically using 600-900 mg of garlic extract per day.

Magnesium – has therapeutic effects on the cardiovascular system. It is essential for numerous enzyme functions and it plays an important role in relaxation of the muscles in the blood vessel wall. A published review of the literature shows that magnesium has a significant effect on hypertension. It says that extra magnesium helps relax the smooth muscle of blood vessels, probably by modulating contractility caused by bradykinin, angiotensin II, serotinin, prostaglandins and catecholamines.

Other studies suggest that magnesium deficiencies may predispose individuals to elevated blood pressure and other cardiovascular conditions. Magnesium is also one of the most important minerals for the prevention and reversal of insulin resistance. Food sources include: daily products, fish and seafood, almonds, cashews, dulse, kelp, walnuts, wheat bran, garlic, tofu, brown rice, apples, bananas, avocados and brewer’s yeast.

Potassium – Recent studies confirm the value of potassium in managing blood pressure. A meta-analysis of 33 randomized control led trials of 12,609 patients showed that potassium supplements significantly lowered both systolic and diastolic pressures. Food sources include: dairy foods, fish, fruit, legumes, poultry, vegetables and whole grains. It is specifically found in apricots, avocados, bananas, blackstrap molasses, brewer’s yeast, brown rice, dates, dulse, figs, dried fruit, garlic, nuts, potatoes, raisins, winter squash, wheat bran and yams.

Reishi mushroom A study in 1997 showed that those taking reishi mushroom, as opposed to those taking a placebo, experienced a significant reduction in both systolic and diastolic blood pressure suggesting that it may be helpful for persons suffering from mild hypertension. However, as reishi has pronounced anti-platelet aggregating effects those on anticoagulant therapy should probably avoid concomitant use.

8. FOODS AND HERBS TO AVOID WITH HIGH BLOOD PRESSURE
Avoid foods such as aged cheeses, aged meats, anchovies, avocados, chocolate, fava beans, picketed herring sour cream, sherry wine and yogurt. 

According to Julian Whitaker, MD, excess intake of sugar and refined carbohydrates has been demonstrated to promote sodium retention which increases blood volume and in turn raises blood pressure. 

According to Andrew Weil a number of herbal remedies can increase blood pressure and should be avoided by hypertensives. Licorice root contains a compound called glycyrrhizin that can cause sodium and fluid retention and can raise blood pressure. (It is safe to use deglycyrrhizinated licorice extract, or DGL, which contains no glycyrrhizin). The stimulant herbs ephedra, guarana, kola nut, yerba maté, and yohimbe can also increase blood pressure. Plus, Asian ginseng and eleuthero (Siberian) ginseng may raise blood pressure, so people with hypertension should use them with caution. (Weil, 2003)

9. THE PROBLEM WITH LICORICE
Licorice contains glycyrrhizin, saponins, asparagine, sugars, resin, bitter principles, a volatile oil and other compounds. The main constituents of licorice are the triterpenoid saponin glycyrrhizin and a mixture of calcium and potassium salts of glycyrrhizinic acid. Glycyrrhizinic acid (glycyrrhizin), a saponin glycoside, is one of the compounds obtained from the root extract of licorice. The active compound of licorice, glycyrrhizic acid, is hydrolyzed to form glycyrrhetinic acid, which inhibits renal 11 beta-HSD2 (a steroid metabolizing enzyme) and by that mechanism increases access of cortisol to its receptors to produce renal sodium retention and potassium loss. 

A study published in 2000 by Frey and Ferrari found that in the most sensitive individuals regular daily intake of no more than about 100 mg of glycyrrhetinic acid, corresponding to 50 g of licorice sweets (assuming a content of 0.2% glycyrrhetinic acid), seems to be enough to produce adverse effects (hypokalemic hypertension in the absence of a renal artery stenosis). Most individuals who consume 400 mg glycyrrhetinic acid daily experience adverse effects. Provided glycyrrhetinic acid has no other effects at lower doses the following consideration with respect to health hazards can be made: 100 mg glycyrrhetinic acid per day is the lowest observed adverse effect level. If a safety factor of 10 is considered, a daily intake of 10 mg of glycyrrhetinic acid represents a safe daily dose for healthy adults. 

Another study published in 2003 by Lin et al found that an elderly man who suffered from hypokalemic paralysis had ingested tea flavored with 100 g of natural licorice root containing 2.3% glycyrrhizic acid daily for 3 years. His blood pressure was 160/96mm Hg and he was suffering from hypokalemia (plasma K+ concentration, 1.8 mmol/L and metabolic alkalosis (HCO -3, 36 mmol/L). 

One may draw preliminary (although by no means definitive) conclusions from the data published from these two studies about the safe dosage of licorice root to administer for healthy adults. For example, if one were to administer a Chinese herbal formula which contains 5% licorice root (gan cao) and the suggested dosage for the entire herbal formula was 6.3 grams per day that would be equivalent to consuming 315 mg of licorice root per day. Assuming licorice root contains 2.3% glycyrrhizic acid (as in the study by Lin above) that would be equivalent to consuming 7.25 mg of glycyrrhizic acid per day — well within the safe daily dose range for healthy adults of 10 mg per day of glycyrrhetinic acid recommended in the study by Frey and Ferrari above. 

The question arises as to the lowest dosage of licorice to produce no effect on hypertension. A study was performed by van Gelderen et al in 2000 to test this. From the results of their study a no-effect level of 2 mg/kg was proposed, from which an acceptable daily intake of 0.2 mg/kg body weight could be extrapolated with a safety factor of 10. This means consumption of 12 mg glycyrrhizic acid/day for a person with a body weight of 60 kg. This would be equal to 6 g of licorice a day, assuming that licorice contains 0.2% of glycyrrhizic acid. 

Preliminary conclusions may also be drawn from the van Gelderen study above. Based on our hypothetical Chinese herbal formula above consisting of consumption of 6.3 grams of Chinese herbs per day out of which 5% is licorice; this would produce a total licorice consumption of only 315 mg per day — equivalent to 19 times lower than the lowest dosage of 6 g licorice necessary to produce no effect on hypertension. 

In a study published in 2003 comparing hypertensive patients with normal controls Sigurjonsdottir et al investigated if hypertensive patients are more sensitive to liquorice-induced inhibition of 11 beta-hydroxysteroid dehydrogenase (11 beta HSD) type 2 than normotensive subjects; and if the response depends on gender. Healthy volunteers and patients with essential hypertension, consumed 100 g of liquorice daily for 4 weeks corresponding to a daily intake of 150 mg glycyrrhetinic acid. They found that the mean rise in systolic blood pressure after 4 weeks of liquorice consumption was 3.5 mm Hg in the normotensive subjects and 15.3 mm Hg in hypertensive subjects. The mean rise in diastolic blood pressure was 3.6 mmHg in normotensive subjects and 9.3 mmHg in hypertensive subjects. They concluded that patients with essential hypertension were more sensitive to the inhibition of 11 beta-HSD by liquorice than normotensive subjects, and that this inhibition causes more clinical symptoms in women than in men. 

In another study by Sigurjonsdottir et al published in 2001 they found that “since liquorice raised the blood pressure with a linear dose-response relationship, even doses as low as 50 g of liquorice (75 mg glycyrrhetinic acid) consumed daily for 2 weeks can cause a significant rise in blood pressure.” 

In a review of the literature by Stormer et al published in 1993 it was concluded that in the most sensitive individuals a regular daily intake of no more than about 100 mg glycyrrhizic acid seems to be enough to produce adverse effects. Most individuals who consume 400 mg glycyrrhizic acid daily experience adverse effects. Considering that a regular intake of 100 mg glycyrrhizic acid/day is the lowest-observed-adverse-effect level and using a safety factor of 10, a daily intake of 10 mg glycyrrhizic acid would represent a safe dose for most healthy adults. 

One can also draw preliminary conclusions from the Stormer study above. If one were to administer a Chinese herbal formula which contains 5% licorice root and the suggested dosage for the entire herbal formula was 6.3 grams per day that would be equivalent to consuming 315 mg of licorice root per day. Assuming licorice root contains 2.3% glycyrrhizic acid (as in the study by Lin above) that would be equivalent to consuming 7.25 mg of glycyrrhizic acid per day — well within the safe daily dose range for healthy adults of 10 mg per day of glycyrrhizic acid recommended in the study by Stormer et al above. 

A deglycyrrhized licorice (DGL) is available for situations where regular use of licorice at significant dosage is intended. DGL is commonly prescribed for gastrointestinal ulceration and GERD. 

If you are hypertensive or taking any of the drugs listed below consult your health care provider before consuming licorice or taking herbs containing licorice: 

Licorice taken in high dosages or used long-term causes low blood levels of potassium. Loop diuretics also cause potassium loss. Therefore one should avoid taking licorice withloop diuretics. DGL licorice (deglycyrrhizinated licorice) should not affect potassium levels and so should not pose a danger for loop diuretic users. 

Whole licorice can cause sodium retention and increase blood pressure, thus counteracting the intended effects of ACE inhibitors. DGL (deglycyrrhizinated licorice) is an altered form of the herb that should not cause these problems. 

Licorice should never be taken along with potassium sparing diuretics. Potassium-sparing diuretics such as Amiloride and Aldactone cause the body to retain potassium whereas licorice has the opposite effect causing the body to lose potassium and thus directly counteracts the effect of these drugs.

Licorice can interact with diuretics negating the blood-pressure lowering effect of these drugs and causing irregular heartbeats from increased potassium loss. Licorice mimics the effect of aldosterone, an adrenal hormone that causes sodium retention and potassium loss.

Licorice can interact with corticosteroids causing salt and water retention, lowered blood potassium, elevated blood pressure, elevated blood sugar and excessive immune suppression by inhibiting an enzyme that breaks down corticosteroids, thus increasing blood levels of the drug.
Licorice can interact with digitalis or other cardiac glycosides causing increased sensitivity increased toxicity and increased hypokalemia.
Licorice can interact with thiazide diuretics enhancing their effects.
Licorice may cause increased hypokalemia if used with diuretics.
Licorice can interact with corticosteroids to enhance their effects.
Licorice increases the cardiac effects of anti-arrhythmic drugs.
Licorice may cause increased hypokalemia if used with antihypertensives.

 10. MEDlCATIONS AND SUPPLEMENTS TO AVOID WITH HYPERTENSION
A myriad variety of therapeutic agents or chemical substances can induce either a transient or persistent increase in blood pressure, or interfere with the blood pressure-lowering effects of antihypertensive drugs. Some agents cause either sodium retention or extracellular volume expansion, or activate directly or indirectly the sympathetic nervous system. Other substances act directly on arteriolar smooth muscle or do not have a defined mechanism of action. (Grossman & Messerli 2012) Many of the medications that are linked with a rise in blood pressure are quite widely used, says Prof. Grossman, whose research provides an overview of which medications are related to high blood pressure. Examples include contraceptive pills, various anti-depressants, anti-inflammatory pills to control pain, and bacterial antibiotics. (Science Daily Mar. 20, 2012)

Avoid ibuprofen-containing medications such as Advil or Nuprin. 

Avoid supplements containing the amino acids phenylalanine or tyrosine. Also avoid the artificial sweetener aspartame which contains phenylalanine. 

Heavy metals such as lead, mercury, cadmium and copper can significantly raise blood pressure.
    11. INSULIN RESISTANCE AND HIGH BLOOD PRESSURE
    According to Julian Whitaker in insulin resistance the insulin receptors on the cells do not respond adequately and are unable to move sufficient amounts of glucose into the cells. Glucose remains in the blood stream signaling the pancreas to secrete even more insulin. This results in very high levels of both insulin and glucose. Type II diabetes may eventually develop. No one really knows exactly how insulin resistance elevates blood pressure. It may interfere with intercellular communication and thus with the body’s blood-pressure-regulating systems. Lack of exercise is a major cause of insulin resistance and obesity is a hallmark of insulin resistance. 

    According to Andrew Weil a high level of insulin in the blood can have devastating effects on the body: It causes the liver to dump artery-clogging triglycerides into the blood stream. It triggers the release of substances that can cause blood clots. It makes the blood vessels narrower and less elastic and forces the kidneys to retain sodium and water, which can lead to high blood pressure.

     12. UNDERSTANDING HIGH CHOLESTEROL
    High cholesterol levels are among the primary causes of heart disease because cholesterol produces fatty deposits in arteries. Elevated blood cholesterol and triglyceride levels lead to plaque-filled arteries, with impeded blood flow to the brain, kidneys, genitals, extremities and heart. High cholesterol levels are also implicated in gallstones, impotence, mental impairment and high blood pressure. Colon polyps and cancer (especially prostate and breast cancer) have also been linked to high serum cholesterol levels. 

    Despite its current unsavory reputation, cholesterol is actually necessary for the proper functioning of the body. About 80% of the total body cholesterol is manufactured in the liver, while 20% comes from dietary sources. Cholesterol travels from the liver through the bloodstream to the various tissues of the body by means of a special class of protein molecules called lipoproteins. 

    There are two main types of lipoproteins low-density lipoproteins (LDLs) and high-density lipoproteins (HDLs). LDLs are known as “bad” cholesterol. And HDLs are known as “good” cholesterol. LDLs are heavily laden with cholesterol, because they are the molecules that transport cholesterol from the liver to all the cells of the body. HDLs carry relatively little cholesterol and circulate in the bloodstream removing excess cholesterol from the blood and tissues. If there is too much cholesterol for the HDLs to pick up promptly, or if there are not enough HDLs to do the job, cholesterol can form plaque that sticks to artery walls and may eventually cause heart disease. According to Julian Whitaker, MD, it is theoxidation of LDL cholesterol – not cholesterol itself -that promotes the buildup of plaques in the arteries. 

    Persons with high HDL levels and relatively low LDL levels have a lower risk of heart disease. In those who already have dogged arteries or have had a heart attack, an increase in HDL levels and a decrease in LDL levels can result in improvement of arterial obstruction. 

    The safe level for total serum cholesterol (including both LDL and HDL is 200 milligrams per deciliter of blood (mg/dl) A reading above 200 indicates an increased potential for developing heart disease. The normal HDL level for adult men in the US is 45 to 50 mg/dl and for women it is 50 to 60 mg/dl. It is suggested that higher levels such as 70 or 80 mg/dl may protect against heart disease. An HDL level under 35 mg/dl is considered risky. So if you have a cholesterol reading of 200, with HDL at 80 and LDL at 120, you are considered a low risk for heart disease. On the other hand, even if you have a total cholesterol level well under 200 if your HDL level is under 35 you would still be considered at increased risk.

    13. USEFUL FOODS FOR LOWERING CHOLESTEROL
    Drink fresh juices, especially carrot and celery juices. Carrot juice helps to flush out fat from the bile in the liver and this helps lower cholesterol.

    Cranberries contain flavonoids which may inhibit blood dotting, promote increased blood vessel diameter and protect against oxidation of cholesterol in the bloodstream, reducing atherosclerosis. Anthocyanins also protect against LDL oxidation.

    Fish and flaxseeds contain high amounts of omega-3 fatty acids which can have a marked effect on reducing cholesterol and triglyceride levels

    Garlic Studies show that garlic can decrease mildly elevated blood pressure, lower total cholesterol and help reverse insulin resistance. A recent study in Atherosclerosis 1999,144237-249 showed that participants in the study taking garlic experienced a significant reduction in the amount of plaque buildup over the course of the study, while those taking the placebo had an increase in plaque volume. The results from forty clinical studies show that on average, cholesterol levels decreased 10.6 percent when standardized allicin tablets were taken for three weeks to ten months. Garlic is also a heavy metal chelator and it has the ability to stimulate the production of the amino acid glutathione, a powerful anti-oxidant and detoxifier.

    Grapes – have the same effect as red wine in reducing the risk of heart disease. Purple and red grapes contain resveratrol, a flavonoid that has powerful antioxidant properties which may impede development of atherosclerosis. They also contain anthocyanins (see “Cranberries” above).

    Grapefruit pectin protects against heart disease by lowering blood cholesterol. They also contain flavonoids that may have the ability to reduce blood clotting which is important in preventing stroke and heart disease. Lycopene in pink and red grapefruit and watermelon protects the body against damaging free radical oxidation. Recent studies have shown that lycopene may have a protective effect against heart attacks as well as certain types of cancer.

    Oat bran and brown rice bran are some of the best foods for lowering cholesterol. Whole-grain cereals (in moderation) and brown rice are good as well. Water soluble dietary fiber is very important in reducing serum cholesterol. It is found in barley, beans, brown rice, fruits and oats. Since fiber absorbs the minerals from the food it is in, take extra minerals separately from the fiber. Soluble fiber in whole grains lowers LDL cholesterol levels by removing bile acids from the intestine without changing HDL cholesterol levels.

    Olive oil when substituted for cholesterol-elevating saturated fatty acids helps to reduce total and LDL cholesterol levels without reducing HDL cholesterol levels.

    Soy protein contains isoflavones that may work hand in hand with soy protein to exercise cholesterol-lowering activity. Researchers at the Univ. of Illinois recently found that eating as little as 20 grams of soy per day can reduce levels of LDL Another study at the Univ. of Minnesota found that women who included isoflavones in their diet lowered their LDL cholesterol readings by 7.6 to 10 percent, improved their HDL reading by 10.2 percent and improved their LDL to HDL ratios by 13.8 percent. And researchers at St. Michael’s Medical Center in Toronto concluded that soy may reduce cardiovascular risk without increasing the risk of hormone-dependent cancers.

    14. USEFUL HERBS AND SUPPLEMENTS FOR LOWERING CHOLESTEROL
    In a study published in 1999 examining the cholesterol-lowering effects of red yeast rice it was found that total cholesterol concentrations  decreased significantly compared with the placebo-treated group.  LDL cholesterol and total triacylcglycerol were also reduced, but HDL cholesterol did not change significantly. (Heber D et al, 1999

     In a systematic review done by Thompson-Coon and Ernst  they found that guggul (Commiphora mukul), fenugreek (Trigonella foenum-graecum), red yeast rice and artichoke(Cynara scolymus) have demonstrated reductions in total serum cholesterol levels of between 10% and 33%. (Thompson-Coon JS & E Ernst, 2003

    Turmeric extracts were found to lower LDL and total cholesterol in one human study. (Soni, 1992)

    Arjuna has been shown to reduce total cholesterol and increase HDL (good cholesterol) in animal studies

    Hawthorn (Crataegus oxyacantha) – European physicians routinely prescribe hawthorn extracts for heart disease, hypertension, congestive heart failure and angina. Clinical trials also show that hawthorn can lower serum cholesterol levels and prevent arterial plaque buildup. However, it takes up to six weeks to work. Dosage: 360 milligrams daily of a hawthorn extract standardized to contain 1.8 to 22 percent vitexin flavonoids.

    Guggul  –  Studies have shown that guggul significantly reduces cholesterol levels without side effects. When guggulipid was compared to the drug clofibrate (Aroid-S) it came out about the same, without the side effects.

    15. FREE  RADICALS AND HIGH BLOOD PRESSURE
    Free radicals contribute to atherosclerosis and arteriosclerosis. The atherosclerotic process begins with injury to the endothelial cells lining the arterial wall. This may be caused by an infectious agent, a chemical toxin, impairments in the activity of nitric oxide (a vasodilator that relaxes arteries and lowers blood pressure) or the physical pounding that results from elevated blood pressure. Platelets and monocytes then adhere to the injured area and initiate the abnormal growth of smooth muscle cells and the buildup of oxidized LDL cholesterol and macrophages which change into foam cells and burrow into the artery wall.

    16. USEFUL ANTIOXIDANTS FOR HEART HEALTH
    Vitamin C – prevents the generation of free radicals which are believed to contribute to atherosclerosis. It helps repair damage to arteries preventing the deposit of plaque at the site of injury. It strengthens and restores the elasticity of the blood vessels and improves vasodilation by restoring nitric oxide activity. It also elevates HDL cholesterol levels. According to a recent study which appeared in Stroke (Yokoyama et al, 2000) high concentrations of dietary vitamin C appear to reduce the risk of ischemic and hemorrhagic stroke,

    Vitamin E – protects the arteries from the devastating effects of oxidized LDL cholesterol. Oxidized LDL cholesterol is a primary factor in the genesis of atherosclerosis and high blood pressure, as it inhibits the production of nitric oxide. Dosage: 800 IU of natural vitamin E per day (preferably d-alpha-tocopherol with mixed tocopherols).

    Vitamin A and Beta-Carotene – Vitamin A is capable of neutralizing highly reactive free radicals. It also prevents LDL cholesterol from being oxidized by free radicals.

    Vitamin B-6, Vitamin B-12 and Folic Acid – convert toxic homocysteine (a product of protein breakdown and digestion) into the harmless amino acids methionine or cysteine. If one is deficient in these B vitamins homocysteine builds up inside the cells and eventually spills into the blood stream, stimulating the production of a highly reactive form of homocysteine called homocysteine thiolactone. This toxic compound interferes with oxygen utilization and results in the formation of free radicals that harm the lining of the arteries. It also encourages the formation of blood clots and allows LDL cholesterol to be more easily deposited. Dosage: 800 micrograms of folic acid daily, 100 micrograms of vitamin B-12 daily, 75 milligrams of vitamin B-6.

    Omega-3 fatty acids – from fish oil and flaxseed oil have the following positive effects on heart health: 1) They can have a marked effect on reducing cholesterol and triglyceride levels 2) They reduce the production of a dangerous substance known as thromboxaneA2 that stimulates abnormal blood clotting and thus decreases the risk of heart attacks and strokes. 3) They reduce the tendency of platelets to dump together and initiate a dot. 4) Over 60 double-blind studies in which fish oils were administered to hypertensive patients observed that blood pressure did indeed fall with supplemental omega-3 fatty acids. 5) They also help prevent atherosclerosis.

       17. FOODS TO AVOID IN ORDER TO LOWER CHOLESTEROL
    Reduce the amount of saturated fat and cholesterol in your diet. Saturated fats include all fats of animal origin as well as coconut and palm kernel oils. Saturated fats have been shown to increase cholesterol levels even more than dietary cholesterol does.·        

    Eliminate all hydrogenated fats and hardened fats and oils such as margarine, butter and lard. Consume no heated fats or processed oils and avoid animal products especially pork and pork products. and fried or fatty foods. Heating fat, especially frying food in fat, also produces toxic trans-fatty acids, which seem to behave much like saturated fats in clogging the arteries and raising blood cholesterol levels. Many people use margarine or vegetable shortening as a substitute for butter because they contain no cholesterol. However, these products contain compounds called cis-and trans-fatty acids that become oxidized when exposed to heat and can clog arteries. They have been linked to the formation of damaging free radicals.·        

    Do not consume alcohol, cakes, candy, carbonated drinks, gravies, nondairy creamers, pies, processed or refined foods, refined carbohydrates, tea, tobacco, white bread or coffee. A study in The New England Journal of Medicine observed that as the intake of coffee rises, the amount of cholesterol in the blood goes up. Sugar and alcohol both raise the level of cholesterol which the body itself produces.  

    18. DRUGS WHICH CAN ELEVATE CHOLESTEROL        
    Certain drugs can elevate cholesterol levels. These include steroids, oral contraceptives, Lasix, and other diuretics, and levodopa (L-dopa sold under the brand names Dopar, Larodopa and Sinemet).

    19.  SIDE EFFECTS OF HIGH BLOOD PRESSURE MEDICINES

    Diuretics – decrease the fluid volume in the circulatory system which then lessens the pressure on the vessel walls. However, diuretics Influence the electrolyte balance leading to a decrease in potassium, calcium and magnesium levels. These minerals play a part in lowering blood pressure and may also help to prevent heart attacks. In addition, cholesterol and triglyceride levels may also rise with diuretic use.    

    Beta blockers - lower blood pressure by reducing heart rate, decreasing the force with which the heart contracts and relaxing smooth muscle of the arteries, causing them to dilate. A problem with beta blockers is that they may result in less blood reaching distal areas such as the hands, feet and head resulting in cold hands and feet, impotence and impaired mental functions. Beta blockers may also lead to triglyceride and cholesterol level increases thereby promoting atherosclerosis. The beta blockers propranolol and metaprolol have been shown to Inhibit CoQlO dependent enzymes.

    ACE inhibitors A common side effect of ACE inhibitors is a chronic cough that persists as long as one is on that medication.

    20. SIDE EFFECTS OF STATINS
    Statins work by inhibiting HMG-CoA Reductase which plays a key role in producing cholesterol.  Hence it lowers cholesterol. 

    The absolute risk for incident diabetes
     was about 31 and 34 events per 1000 person years for atorvastatin and rosuvastatin, respectively. There was a slightly lower absolute risk with simvastatin (26 outcomes per 1000 person years) compared with pravastatin (23 outcomes per 1000 person years). Our findings were consistent regardless of whether statins were used for primary or secondary prevention of cardiovascular disease. (Carter et al 2013)

    If our findings are generalizable, clinical and public health recommendations regarding the ‘dangers’ of cholesterol should be revised. This is especially true for women, for whom moderately elevated cholesterol (by current standards) may prove to be not only harmless but even beneficial. (Petursson et al 2012)

    In view of the mounting evidence of a higher risk of diabetes with statins, specifically from the randomized trials — the FDA recently announced a label change to some statin therapies. Based on current evidence from the literature, a note of ‘an effect of statins on incident diabetes and increases in HbA1c and/or fasting plasma glucose’ has been added to the safety labelling of all drugs in the statin class. (Sattar & Taskinen 2012)

    Dr. Shirya Rashid — senior author of the study and assistant professor in the department of medicine at McMaster University — notes that a staggering 40 per cent of people taking statins are resistant to their impact on lowering blood LDL. (From research presented October 28, 2012 at the Canadian Cardiovascular Congress, reported inScience Daily, Oct. 28, 2012)

    Statin medication use in postmenopausal women is associated with an increased risk for diabetes mellitus (DM). This may be a medication class effect. Further study by statin type and dose may reveal varying risk levels for new-onset DM in this population. (Culver et al 2012)

    Although reductions in all-cause mortality, composite endpoints and revascularisations were found with no excess of adverse events, there was evidence of selective reporting of outcomes, failure to report adverse events and inclusion of people with cardiovascular disease. Only limited evidence showed that primary prevention with statins may be cost effective and improve patient quality of life. Caution should be taken in prescribing statins for primary prevention among people at low cardiovascular risk. (Taylor et al 2011 Cochrane Database Syst. Rev.)

    Even when low density lipoprotein cholesterol (LDL-C) targets are attained, over half of patients continue to have disease progression and clinical events. This residual risk is of great concern, and multiple sources of remaining risk exist. Though clinical evidence is incomplete, altering or raising the blood high density lipoprotein cholesterol (HDL-C) level continues to be pursued. One study by Brugts et al 2009 found the relative risk reduction from statin use for primary prevention was comparable to that for secondary prevention. (Kones R 2011)

    Statin use seems to be associated with an increased risk of developing rheumatoid arthritis. (de John et al 2011)

    Even brief exposure to atorvastatin causes a marked decrease in blood CoQ(10) concentration. Widespread inhibition of CoQ(10) synthesis could explain the most commonly reported adverse effects of statins, especially exercise intolerance, myalgia, and myoglobinuria (the presence of myoglobin in the urine, usually associated with rhabdomyolysis or muscle destruction). (Rundek et al 2004) 

    Individuals prescribed statins that have a greater impact on CoQ10, such as atorvastatin, may benefit from higher CoQ10 dosage levels. (Stargrove et al 2008) It appears that levels of coenzyme Q10 are decreased during therapy with HMG-CoA reductase inhibitors, gemfibrozil, Adriamycin, and certain beta blockers. (Sarter B 2002)

    Some of the side effects of Atorlip (a statin) include nasopharyngitis, arthralgia, diarrhea, pain in the extremity, UTIs., muscle spasms, tremor, vertigo, memory loss, decline in cognitive function and raised liver enzymes. (from Drugs.com)

    Herbal Remedies Supply a Novel Prospect for the Treatment of Atherosclerosis: A Review of Current Mechanism Studies – Increasing lines of evidence have questioned the statins-dominated treatment for atherosclerosis, including their dangerous side-effects such as the breakdown of muscle when taken in larger doses. Given the complicated nature of atherosclerosis and the holistic, combinational approach of herbal remedies, we propose that mixed herbal preparations with multiple active ingredients may be preferable for the prevention and treatment of atherosclerosis. (Zeng et al 2011)

    21. WHAT ABOUT ASPIRIN?
    Aspirin is often prescribed by doctors to reduce heart disease. However, according to a report which appeared in American Journal of Gastroenterology 2000,95:2218-2224 use of low-dose aspirin increases by threefold the risk of an upper gastrointestinal bleed requiring hospital admission, and enteric coating of the aspirin does not reduce this risk. The problem increased when low-dose aspirin was combined with NSAIDs.

    22. THE EFFECT OF FISH OILS ON HEART DISEASE
    According to a critical review done by Nair et al which appeared in the Journal of Nutrition March 1997 issue all the studies reviewed, both in animals and in the human intervention trials, leave little doubt that dietary supplementation of fish oils confers beneficial effects on the heart particularly in the prevention of cardiac arrhythmias.

    When a region of the heart becomes ischemic, the electrical properties change, leading to arrhythmias. The most common fatal arrhythmia is known as ventricular fibrillation, in which electrical impulses from damaged cardiac muscle cause the normal synchronicity of heart contractions to break down. It is believed that at least half of the deaths due to coronary artery disease in the United States are caused by disturbances in the electrical stability of the heart, terminating in ventricular fibrillation.

    23. LIFESTYLE RECOMMENDATIONS
    Get regular light to moderate exercise. In one study of nearly 15,000 Harvard male alumni it was found that those who did not engage in vigorous activity were at 35% greater risk of hypertension that those who did.

    Avoid stress because stress results in an overproduction of the natural cholesterol which the body itself produces. Music, meditation, tai chi, qi gong or yoga can be used to reduce stress. 

    Try laughing on a regular basis.

    Keep your weight down. If you are overweight, take steps to lose the excess pounds.

    Have your blood pressure checked at least every 4 to 6 months.

    If you are pregnant, have your blood pressure monitored frequently by your health care provider.

    Heavy snorers are more likely to have high blood pressure than silent sleepers. In reference to sleep apnea a news item in the April 12, 2001 Raleigh News & Observer reported that a recent study by Mayo Clinic physician and researcher Virend K. Somers found that blood pressure skyrocketed to 240/120 during sleep apnea attacks. (Normal is 120/80) Another striking change included constriction of blood vessels.

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