In general, organically grown whole grains (including wheat germ and wheat bran) and vegetables are rich sources of magnesium, as are good quality sea salt and sea vegetables (such as kelp). Other good sources include almonds, peanuts, and tofu. You can even get magnesium by adding Epsom salts (which are magnesium sulfate) to your bath, which allows the magnesium to be absorbed through the skin.
Magnesium supplements come in several forms, including magnesium oxide, magnesium chloride, and chelated magnesium. (Magnesium is also sold in combination with calcium.) If you’re healthy, start with 200 mg twice a day. If you have cardiovascular challenges, boost it to 500 mg twice a day. (You’ll know you’ve reached your limit when you develop loose stools.) Transdermal magnesium formulated by Norm Shealy, M.D., Ph.D., is also available. (See Resources.) (For more information on magnesium, read The Miracle of Magnesium [Ballantine Books, 2003] by Carolyn Dean, M.D., N.D.)
Calcium
Calcium is needed by every cell in your body, including the electrical system of the heart. Adequate calcium intake also helps keep blood pressure normal. This mineral works in tandem with magnesium, and therefore it’s important to make sure you get enough of both. In general you want to be sure that your calcium is balanced with magnesium in either a 1:1 or 2:1 ratio. Take 500–1,200 mg/day with meals, depending upon how much calcium is present in your diet.
Antioxidants
Thousands of studies have documented the ability of antioxidants to help your heart, blood vessels, and every other tissue in your body resist free-radical damage and thus stay healthy. Here’s an overview of my favorites—though there are others.80
COENZYME Q10: This nutrient is concentrated in organ foods such as liver, kidney, and heart. It helps produce ATP, the basic energy molecule in every cell of the body. It is also a powerful antioxidant. Numerous studies have documented its beneficial effects on the heart, both in maintaining health and in healing from disease. (High doses have even been found to reverse some types of cardiomyopathy.)81
Coenzyme Q10 improves the ability of the heart to pump effectively and has also been shown to help reduce high blood pressure and congestive heart failure in those who already have heart disease. It is also very important for breast health. CoQ10 levels in heart muscles can be ten times greater than in other tissues because the heart functions continuously, without resting. That’s why any condition that impairs the ability of the heart to do its work leaves this organ more susceptible to free-radical damage.
As already noted, coenzyme Q10 can be depleted in women who take statin drugs, including lovastatin (Mevacor), pravastatin (Pravachol), and atorvastatin (Lipitor), to lower their cholesterol.82 Studies have shown that almost half of patients with hypertension have coenzyme Q10 deficiencies. Taking 50 mg twice a day for ten weeks has been shown to significantly lower blood pressure.83 For those individuals already on medication for elevated blood pressure, the need for antihypertensive medication declined gradually in about four and a half months in half the patients who took CoQ10 (225 mg per day); some were able to stop taking blood pressure medication altogether.84 A randomized, placebo-controlled study of people taking coen-zyme Q10 supplements with or without statin drugs found that CoQ10 supplementation reduced the risk of heart attack and death by 50 percent, whether the subjects were on the statin drug or not.85
The minimum dose of coenzyme Q10 I recommend is 30 mg/day. For anyone with any family history of heart disease, I’d recommend 60–90 mg/day to help prevent the disease from developing. The dose can go up to 300–400 mg per day for those with advanced heart disease.86 (For more information, read The Coenzyme Q10 Phenomenon, by cardiologist Stephen Sinatra, M.D. [Keats Publishing, 1998].)
CAROTENOIDS: There are dozens of studies that show that individuals who consume high amounts of pigment-rich foods are at lower risk for heart disease. These foods are loaded with carotenoids such as beta-carotene, which has been shown to decrease risk of freeradical damage to the heart and blood vessels. In one study of individuals who had already had unstable angina and had undergone coronary artery bypass, the addition of beta-carotene to their diets decreased subsequent major cardiovascular events such as heart attack, stroke, need for additional bypass procedures, and cardiac death by 50 percent.87 Beta-carotene prevents the lipoprotein LDL (“bad” cholesterol) from becoming oxidized. The usual dose of betacarotene is 25,000 IU per day in supplement form.
However, a mix of the carotenoids is better than taking just one. For example, lutein is present in HDL (“good” cholesterol) and may help prevent LDL cholesterol from oxidizing. The best way to get lutein is in fruits and vegetables, but it is also available in health food stores as a supplement; take 3–6 mg per day. Lycopene is another good antioxidant; eating tomatoes a couple of times a week will give you all the lycopene you need.
VITAMIN E: This antioxidant has been shown to keep blood platelets “slippery,” thus decreasing the risk of blood clots. Vitamin E is an anti-inflammatory in the heart muscle. It may also inhibit arrhythmia and cardiomyopathy. In the Nurses’ Health Study, participants taking 400–800 IU of vitamin E per day reduced their risk of heart attack by 30 percent.88 The Cambridge Heart Study, which looked at the effects of vitamin E on 2,000 patients with documented heart disease, found that those who took between 400 and 800 IU of vitamin E per day had a 77 percent decrease in cardiovascular disease over a year’s time.89 And a 2009 study of more than 77,000 midlife residents of Washington state showed that taking vitamin E supplements may reduce the risk of dying from cardiovascular disease by 28 percent.90 (The same study showed that taking multivitamins may reduce the risk of dying from heart disease by 16 percent.)
A 2005 meta-analysis of previous studies by Edgar Miller III, M.D., Ph.D., created quite a stir when it suggested that high-dose vitamin E supplementation may increase mortality in adults.91 Yet Dr. Miller’s analysis excluded many of the larger studies with thousands of subjects because the total mortality rates were low. None of those studies showed that vitamin E increased mortality. On the other hand, many of the studies Dr. Miller did include were smaller (with less than one thousand people), and it’s only the smaller studies that showed significant adverse effects from taking vitamin E. Quite a few of those studies looked at abnormal populations, i.e., older adults who already had advanced chronic degenerative disease. Also telling is that the researchers’ secondary analysis showed that differences in death rates were statistically insignificant; at the highest dose of vitamin E, the risk of death was actually lower! The bottom line: not only is there solid evidence like that from the Nurses’ Health Study and the Cambridge Heart Study showing vitamin E boosts cardiovascular health, but other studies show that vitamin E is associated with a significant reduction in bowel cancer,92 reduces the risk of dementia,93 and even slows the development of cataracts.94 Vitamin E should definitely be part of a comprehensive supplementation program.
Dosage is 200–800 IU per day of d-alpha-tocopherol (natural vitamin E; check the label) or mixed tocopherols.
TOCOTRIENOLS: Tocotrienols are part of the vitamin E family of compounds. But compared with regular vitamin E, they are 40 to 60 times more powerful as antioxidants. Tocotrienols have a positive effect on all three of the major physical risk factors for coronary artery disease: total cholesterol levels, oxidation of low-density lipoprotein (LDL, or “bad” cholesterol), and the clumping of red blood cells that makes stroke more likely.95 Free-radical damage (oxidative stress from poor diet, psychological stress, smoking, etc.) that accompanies LDL oxidation is particularly dangerous because it can cause serious injury to artery and vein walls.
Tocotrienols lower cholesterol by promoting the natural degradation of an enzyme (HMG-CoA reductase) that controls your liver’s breakdown of LDL cholesterol. This is the same enzyme that statin drugs affect, except that tocotrienols work through a different mechanism. For that reason, you can often lower your cholesterol with tocotrienols instead of statins.
Most multivitamins don’t have
significant amounts of tocotrienols, so you have to add them. If you plan to use tocotrienols to lower cholesterol, take about 50 mg daily for a month, and then lower the dose to about 30 mg (two capsules per day) thereafter. (If you’re already on a statin drug, add tocotrienols, because they work synergistically with statin drugs, thus enhancing their effectiveness; use about 30–55 mg per day.) Sometimes tocotrienols are included in a vitamin supplement and sometimes they are available separately. Fresh fruits, dark green leafy vegetables, almonds, peanuts, and wheat germ also contain tocotrienols and the other types of vitamin E.
SELENIUM: This antioxidant has been shown to decrease the risk of free-radical damage to blood vessel walls. The usual dose is 50–200 mcg per day.
OLIGOMERIC PROANTHOCYANIDINS (OPCS): The proanthocyanidins are in the class of foods known as the flavonoids. Cardiovascular disease risk is inversely proportional to flavonoid intake.96 OPCs are derived from grape seeds or pine bark (one brand is Pycnogenol). This is a supplement I wouldn’t live without because of its many benefits. OPCs are quickly absorbed into the bloodstream, help to regenerate the body’s levels of vitamin E, and also prevent the oxidation of LDL cholesterol by free radicals. In addition, they improve blood vessel and skin elasticity by helping prevent free-radical damage to collagen, reduce or eliminate the discomfort of arthritis, help prevent circulation problems, and reduce excessive blood clotting. They also help prevent all the symptoms of allergy and hay fever. The usual dose is 40–120 mg/day.
ALPHA-LIPOIC ACID (ALA): Alpha-lipoic acid is a unique antioxidant in that it is both water-and fat-soluble. That means that it can stand guard against free-radical damage in every part of the cell. It has also been shown to help preserve intracellular levels of vitamins C and E and to help regenerate another antioxidant known as glutathione. Alpha-lipoic acid is also helpful for the metabolism of insulin, and in Germany it has been approved for the treatment of diabetic neuropathy (nerve damage). It has been shown to improve blood flow both to the nerves and to the skin. The usual dose is 50–200 mg/day.
VITAMIN C: This powerful antioxidant helps protect the endothelial lining of your blood vessels and has also been found to aid the absorption of calcium and magnesium, two key minerals for heart health. A dose of 1,000 mg per day has been shown to significantly reduce systolic blood pressure, though the mechanism is not clear. I recommend taking it in the form of plain old ascorbic acid. If you have a sensitive stomach, use the ascorbate form. I recommend at least 1,000–5,000 mg/day.
VITAMIN D: Many studies now link vitamin D with heart health. A 2009 review of the medical literature revealed that lower vitamin D levels are associated with an increased risk of hypertension, several types of vascular diseases, and heart failure.97 Research is ongoing, and I expect we’ll be hearing a lot more about the vitamin D–heart health connection in the near future.
One promising study conducted at the Intermountain Medical Center Heart Institute in Murray, Utah, and presented at the 2010 conference of the American College of Cardiology reported that treating vitamin D deficiency with supplements may help to prevent or reduce the risk of cardiovascular disease.98 The researchers looked at more than 9,400 men and women whose blood tests revealed low vitamin D levels during a routine doctor’s visit. Patients who raised their vitamin D levels to above 30 ng/ml by their next followup visit (about half the group) were 33 percent less likely to have a heart attack, 20 percent less likely to develop heart failure, and 30 percent less likely to die in the next year. The same research team then crunched data on more than 41,000 patients and found that those diagnosed with severe vitamin D deficiency were most likely to also have been diagnosed with heart disease or stroke. On the other hand, the data showed that those patients who increased their levels of vitamin D to 43 ng/ml had the lowest rates of heart disease and stroke.
I often recommend supplementing with 2,000–5,000 IU of vitamin D daily, although the exact amount that is right for you depends on several factors, including where you live and how much exposure to the sun you get. For a full discussion on vitamin D, including how much of this vital nutrient you need, how to safely get vitamin D from the sun, and how to design a supplement program, see chapter 12.
B Vitamins, Folic Acid, and Niacin
Over half of all women don’t get the folic acid they need. This not only puts their babies at risk for neural tube defects such as spina bifida, but also increases their risk for arteriosclerosis and heart disease. It has been found that the individuals with the highest homocysteine levels also have the lowest levels of folic acid, B12, and B6. A higher dose of folic acid than the RDA is associated with a lower risk of heart attack (it may inhibit platelet aggregation and prolong clotting time) and is also the antidote for high homocysteine.99 Women with adequate B vitamin and folate levels have a definite decreased risk for heart disease.100
Niacin (vitamin B5) is a naturally occurring “statin” that helps increase HDL, reduce inflammation, and lessen arterial constrictions. Studies show that niacin may work by keeping the liver from eliminating HDL cholesterol. One such study published in 2008 compared niacin to the prescription statin drug Zetia (ezetimibe). Zetia is often prescribed in addition to a regular statin for patients who have very high cholesterol or are at high risk for heart attack or stroke. After fourteen months, according to study results, niacin significantly reduced plaque buildup, while Zetia actually increased it. In addition, nine people taking Zetia died during the trial (compared to two deaths for patients taking niacin). Although the time-release prescription niacin used in the study is not available over the counter, the study concluded that adding niacin to existing treatment for high cholesterol was more beneficial than adding Zetia.101
The usual doses of the B vitamins are: vitamin B6, 40–80 mg per day; niacin, 20–50 mg per day, vitamin B12, 20 mcg per day; and folic acid, 400–1,000 mcg per day. It’s always best to take these together with the entire B complex. (See chapter 7.)
Red Yeast Rice
Red yeast rice (a fungus grown on a form of rice common in Asia) contains the naturally occurring statin lovastatin (which happens also to be the generic name for a drug manufactured by Merck). Many studies show that taking red yeast rice is in fact as effective at reducing LDL as statins, and it doesn’t cause the associated muscle pain often reported by patients who take synthetic statins.102 One such placebo-controlled study reported those taking this supplement reduced their total cholesterol by 18 percent and their LDL by 22 percent over a twelve-week period.103 In a later placebo-controlled trial, red yeast rice reduced total cholesterol by an even greater 27.7 percent and LDL by 21.5 percent after eight weeks of treatment.104 A Chinese study published in 2008 that looked at 5,000 people who had had a previous heart attack showed that red yeast rice reduced the risk for nonfatal heart attack by 62 percent and coronary disease mortality by 31 percent.105
Because red yeast rice does contain a statin, it depletes natural levels of coenzyme Q10, as do synthetic statins, so those who choose to take red yeast rice should also take 30–100 mg of coenzyme Q10 every day.
Some experts have warned that because the quality of supplements varies and isn’t always guaranteed, taking red yeast rice isn’t safe and isn’t appropriate for those who have very high cholesterol levels. While the concerns about supplement quality in general are valid, if you purchase a supplement that is manufactured according to pharmaceutical-grade standards or one that is sold in a physician’s office, the product should be perfectly safe. I recommend 600 mg of red yeast rice two or three times a day.
Recent research shows that combining red yeast rice with fish oil may well be the best alternative to synthetic statin drugs. Researchers at Chestnut Hill Hospital in Philadelphia gave patients in one group 40 mg a day of the statin simvastatin, while giving patients in another group a combination of fish oil (containing 2,106 mg of EPA and 1,680 mg of DHA from an oceanic source) plus red yeast rice (with a total monacolin content of 5.3 mg, of which 2.53 mg was in the form of monac
olin K [lovastatin]). The second group also followed suggested lifestyle changes. After twelve weeks, participants taking the fish oil/red yeast rice combination reduced their LDL by 42.4 percent, and those taking statins reduced theirs by 39.6 percent.106 In addition, the red yeast rice/fish oil group reduced their triglycerides by 29 percent and their weight by 5.5 percent—both significantly more than the statin group.
FOODS FOR HEART HEALTH
FISH: The American Heart Association now recommends that all adults eat fish (preferably fatty fish) at least twice a week because the evidence that the omega-3s it contains fight heart disease is very com-pelling, including findings that omega-3 fatty acids decrease risk of arrhythmias, decrease triglyceride levels, slow the growth of atherosclerotic plaque, and even slightly lower blood pressure. The wellknown Nurses’ Health Study showed that women who ate fish once a week cut their risk of stroke by 22 percent (and those who ate fish five or more times per week cut their risk by a whopping 52 percent!)107 Studies have shown that 3 g per day of fish oil containing both EPA and DHA is cardioprotective because it makes platelets more slippery and decreases cellular inflammation.108 A number of recent studies also show that fish oil lowers triglyceride levels and possesses powerful anti-clotting properties.109
The best way to get omega-3s is by eating cold-water fish (I recommend three servings per week), such as salmon, mackerel, swordfish, or sardines. One 4-oz serving of salmon contains about 200 mg of DHA. If you don’t eat fish regularly, supplement your diet with omega-3 supplements, from either fish oil, flax oil, hemp oil, or algae-derived DHA (good for vegans). The usual dose of DHA is 100–200 mg per day; for other omega-3 fats it is 1,000–5,000 mg per day.
The Wisdom of Menopause Page 74
