Cardiac Protection - The East and West View
One of the most serious medical issues in this country today is high blood pressure (HBP). Often called the silent killer, this problem has now reached massive proportions. Below we will examine the problem from both the Western and Traditional Chinese Medicine (TCM) perspectives, explore the role of high cholesterol in this epidemic, present some holistic options and offer some cautions about mixing herbs and medications.
Heart disease is the leading cause of death in this country. It is widely acknowledged that there are four major risk factors in its development: high blood pressure, high cholesterol, diabetes and cigarette smoking. This section will focus on the first two.
Fifty million Americans suffer from high blood pressure (hypertension), and yet nearly one third are unaware of their condition. In May of 2003, the National Heart, Lung, and Blood Institute (NHLBI) issued new guidelines redefining acceptable blood pressure levels. Levels once thought to be within the realm of normal (above 120/80 but below 140/90) are now considered to be pre-hypertensive. Normal and optimal blood pressure is now below 120/80. Under the new definition, the population thought to be at risk of developing hypertension (and the complications associated with it) increase by 45 million, bringing the total number up to ninety five million - a staggering number, by any standards!
Blood pressure is determined by measuring the pressure in the blood vessels using a compression cuff. The top number (systolic) is the amount of pressure when the heart is contracted. The lower number (diastolic) is the amount of pressure in the blood vessels/heart when the heart is relaxed between beats.
While the exact cause is usually unknown, there are many factors that increase one's risk of developing hypertension. Some of these factors include aging, weight gain, smoking, diabetes, heavy drinking and diet. A number of western medications including birth control pills, steroids, nasal decongestants, non-steroidal anti-inflammatory drugs and diet pills can also cause high blood pressure.
Increasingly there is concern that high cholesterol levels, particularly the LDL (low density lipoproteins) levels, correlate with plaque formation in the arteries and are thus prognosticators for HBP. Total cholesterol levels above 200 mg/dL, LDL above 130 and HDL less than 40 are cause for concern. It is likely that these levels, like the blood pressure readings described above will be reevaluated. Already doctors are treating middle aged people with total cholesterol in the 180-200 range with medication. (Note that a lot of the research on cholesterol is supported by the drug companies). It is important to remember that cholesterol is a substance vital to the body in the formation of hormones and the production of cell membranes. Normal levels must be maintained for good health.
Generally, high blood pressure, like high cholesterol, has no obvious symptoms. It can increase the risk of stroke, heart attack, heart failure and kidney failure, without any outward manifestations.
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Western Medical Treatment
Western hypertensive medications typically fall into one of five categories: diuretics, ACE inhibitors, beta-blockers, vasodilators, and calcium channel blockers.
Diuretics cause the body to excrete water and salt.
ACE inhibitors block an enzyme that indirectly causes blood vessels to constrict.
Beta-blockers block the effects of adrenalin, causing the blood vessels to widen and the heart to relax.
Vasodilators expand the blood vessels for easier flow.
Calcium channel blockers help decrease contractions of the heart and widen the blood vessels.
Unfortunately, all of these medications have side effects. Symptoms may include: loss of sex-drive, incontinence, cold hands and feet, fatigue, depression, memory loss, and heart arrhythmias.
If your blood pressure is dangerously high (160/100 and higher), treatment with pharmaceutical drugs is essential, at least for the short term.
The most commonly prescribed medication for controlling cholesterol levels is Lipitor (atorvastatin). Lipitor belongs to the class of medicines called Statins. All statins are inhibitors of HMG-CoA reductase, an enzyme involved in the synthesis of cholesterol in the body. The brand names of these drugs are Zocor, Mevacor, Pravachol, Lescol and Baycol. All these drugs can hurt the liver and blood testing to monitor ones liver function must be done before and during the treatment. Of greater concern is the incidence, albeit rare, of a serious muscle wasting disease called Rhabdomyolysis. This side effect presents as muscle tenderness, soreness or weakness and can lead to death via kidney damaged if not identified. 100 such deaths have been attributed to Baycol which was recalled by the FDA in August 2001. Milder forms of this muscle toxicity do exist and some researchers think that up to 1 in 10 people taking statins may manifest this as mild fatigue, or simply having trouble getting out of a low chair. One possible explanation of this muscle damage is that the statins as they reduce HMG-CoA reductase, also cause CoQ10 deficiency in the tissue mitochondria (the energy factories of the cells). Dr. Rabinowitz encourages all patients on statins and natural anti-cholesterol regimes to take Coenzyme Q 10 supplements.
Since cholesterol is important in the formation of cell membranes another alarming side effect is the observation reported in a large Danish study that long-term statin users had a 4 to 14 times higher risk of peripheral neuropathy, nerve damage that can cause weakness, numbness, tingling and pain in the hands and feet. The incidence of this side effect increases with prolonged use.
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2. Traditional Chinese Medical View
Hypertension is not a TCM diagnosis rather it is noted as a consequence of other underlying patterns of disharmony that are causing the pressure to rise. The Chinese medical approach to HBP is to determine what that pattern is. The TCM practitioner examines three main organ systems that are commonly involved in HBP: the heart, liver and spleen organ systems. (Note that the TCM organ systems discussed here do not refer to the actual anatomical organ.) We also look for 3 patterns of energy imbalances: liver fire rising, phlegm dampness and blood stagnation, to identify the root of the problem.
The 3 Main Organ Systems
In Chinese medicine, the heart is responsible for moving the blood around the body and is the seat of consciousness (spirit) and mental state. Diseases of the heart can manifest as heart palpitations, heart pain, oppression in the chest and shortness of breath. And if the imbalance affects the spirit, there may be symptoms such as, forgetfulness, insomnia, profuse dreaming, anxiety and being easily frightened.
The Liver The liver stores the blood and governs the free coursing of Qi throughout the body, and controls the sinews and tendons. Storing the blood refers to the liver retaining and regulating the amount of blood in the body when the body is at rest or in activity. The liver's free coursing function means that it causes Qi to course freely around the body, ensuring normal emotional activity.
Stress commonly hurts the liver. This is the reason that most health professionals include stress reduction as part of a cardiovascular protection program. Diseases of the liver can manifest as flank pain, bitter taste in the mouth, irritability, anger, menstrual irregularity, and blurred vision.
The spleen extracts the nutrients from food in the stomach and transports them throughout the body for nourishment for all of the tissues and organs. Fatty, sweet and rich foods can damage the spleen and stomach. So diet is another important factor in cardiovascular protection.
The result of poor dietary choices is an accumulation of phlegm and dampness that impedes the free flow of energy around the body. Diseases of the spleen can manifest as poor appetite, diarrhea or constipation, obesity and fatigue.
The 3 Energetic Imbalances Involved With HBP
Every individual that comes for treatment has his or her own particular energetic imbalance. Here are some possible imbalances that can be found in Chinese medicine that are responsible for high blood pressure.
Liver fire rising
This pattern is commonly seen in patients with a high stress lifestyle. In this condition, excessive stress causes the Qi to stagnate. When the Qi stagnates, fire is generated and rises upwards. This excess of yang energy creates symptoms like red eyes, dry mouth, irritability, headache and insomnia.
This condition can be found in people who are overweight and have a diet high in animal fat and salt. The spleen and stomach are responsible for transforming and transporting the nutrients from the food we eat. When the spleen and stomach do not function properly, fluids accumulate and stagnate and become pathological dampness. Phlegm dampness symptoms include digestive disturbances, obesity, and shortness of breath.
Blood stasis occurs when there is impairment of the normal free flow of blood. When blood stagnates, tissues do not get properly nourished and pain can result. The symptoms from this stagnation can manifest as a soot black complexion, chest pain, and headaches.
In summary we can see that to treat HBP from a TCM viewpoint we must address the organ systems and energy imbalance patterns described above. As opposed to treating the symptoms as we do in western medicine, the object here is to address the underlying disharmony in an attempt to eliminate the problem.
We use the age old proven tools of TCM, specifically acupuncture to balance Qi and to remove stagnation, and Chinese herbal formulas to correct the organ system problems.
For example, to treat HBP that is caused by liver fire rising, we might use the Health Concerns herbal formula, Gastrodia Relieve Wind, and do regular acupuncture treatments.
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3. Combining Western Medicine and TCM
It is a good idea to start TCM treatment of the underlying causes of HBP without making changes to ones medication regime. This is especially true for the individual with severe HBP. However, careful BP monitoring must be done regularly throughout the treatment course to insure that the medications don't then lower the pressure too much!
4. Adding Holistic treatments
From the TCM perspective is easy to see why weight loss and diet (for the spleen), exercise (for the heart) and stress-reduction (for the liver) are so important for cardiovascular protection.
Many patients with hypertension are overweight. Blood pressure dramatically decreases with weight loss, as the heart has less tissue to perfuse. TCM can help people to lose weight, especially when caused by spleen dampness from overeating. Acupuncture can help by treating anxiety eating, as well as addressing water retention.
See this webpage for more.
Western health professionals recommend the DASH Diet (Dietary Approaches to Stop Hypertension); A diet high in fruits, whole grains and vegetables and low in animal fats and salt, while avoiding saturated fats and refined carbohydrates such as white flour and sugars. Vegetables and fruits are high in potassium, magnesium and calcium, which help to reduce blood pressure. Salt causes water retention, which increases blood volume and blood pressure. Limiting daily dietary sodium intake to less than 2,400 mg of sodium (about 1 teaspoon of salt) per day helps lower or control blood pressure. Read the labels and watch out for fast food and prepackaged foods - they are notorious for high salt content!
This diet can lower 5.5 to 11.4 points off systolic and 3 to 5.5 points off diastolic pressure.
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Other dietary recommendations include:
Fish oils are found in coldwater fish like salmon, sea bass, tuna, trout, and mackerel. These oils have a high concentration of polyunsaturated fats, known as Omega-3 fatty acids. Of these, EPA (eicosapentaenoic acid) and DHA (docosahexaenoic acid) are the most healthful. Omega 3s discourage platelets from clumping together, ease strain on the heart, keep arteries flexible, control inflammation in artery walls, lower LDL (the bad cholesterol), and prevent heart rhythm abnormalities. These oils can intensify blood thinning medications like aspirin and warfain, so take with caution if you are using a blood thinner.
To read about how to avoid mercury toxicity in fish, see this link:
Fish oils can be taken encapsulated:1,000 mg 3 times a day taken with meals. Look for EPA/DHA content.
Flaxseed oil is rich in essential fatty acids (EFA) including omega 3 fatty acids. One of the EFA in flaxseed oil is alpha linolenic acid, which inhibits inflammatory reactions that cause artery-hardening plaque and poor circulation. Be sure to buy products with an expiration date, and in opaque bottles, to prevent the oil from becoming rancid.
Note: Heating flaxseed oil can destroy therapeutic compounds Recommended dose = 1- 3 tablespoons (14 grams) daily
Garlic makes blood platelets less likely to clump and stick to artery walls, so the blood can circulate more freely in the vessels. Garlic also lowers LDL (bad cholesterol) and raises HDL (good cholesterol), and enables flexibility of the aorta (which can stiffen with age).
Garlic Rx 1 clove or 400 to 600 mg once or twice a day. Odorless garlic is available.
Arginine is an amino acid that is found in many foods, including meat, poultry, fish, dairy products, and nuts. The body makes arginine by digesting the proteins in foods. Arginine appears to reduce mildly elevated blood pressure by enhancing the synthesis of nitric oxide in the cells that line the blood vessels, which causes the vessel walls to dilate, improving the blood flow around heart. These amino acids may also reduce cholesterol and inhibit the buildup of plaque that hardens the blood vessels. If you use arginine for longer than a month, be sure to take an amino acid complex supplement, so you get a proper balance.
Note: Herpes sufferers should avoid Arginine, as it may cause additional outbreaks.
Arginine - 1.00 mg of L-arginine taken twice a day without food.
The American Journal of Hypertension found that even modest increases in activity, in once sedentary people, results in significant reduction in high blood pressure. The benefits are 3 fold. Exercise reduces stress, promotes weight loss, and improves blood vessel elasticity.
Keeping relaxed and calm prevents the stagnation of Qi and helps to lower blood pressure.
From a western perspective, stress activates the body's fight or flight response which increases the heart rate and constricts blood vessels thus elevating blood pressure.
Meditation Qi Gong, breath work, yoga, can all be helpful.
Of course, acupuncture is great for stress-reduction!
Change Lifestyle Habits:
Stop smoking and limit alcohol consumption!
Smoking raises blood pressure and injures blood vessel walls. Excessive drinking not only increases blood pressure, it can make the blood pressure resistant to treatment. Alcohol also injures the liver.
Note: Acupuncture has been shown to be highly effective in helping people to overcome their addiction to smoking and drinking, and to lessen the symptoms of withdrawal that accompany quitting.
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Two of the most important supplements are:
Coenzyme Q 10
Co Q 10 is fat-soluble and is absorbed best with foods that contain some fat. Look for oil based soft gel capsules. The body naturally produces coenzyme Q 10; it is found in every human cell and living organism, as well as in small amounts in certain foods. Co Q10 works with other enzymes in chemical reactions throughout the body. Large amounts are found in high energy cells like those in the heart. Studies have shown that people with low levels of Co Q 10 have weaker heart muscle function and their hearts are less efficient at pumping blood. Medications such as statins for high cholesterol or beta blockers for high blood pressure have been clinically shown to decrease the body's naturally occurring Co Q10.
Rx: 50 - 100 mg twice a day with food.
Hawthorne (Crataegus oxyacantha)
Hawthorne is an herb known to block an enzyme known as ACE (angiotensin-converting enzyme) that constricts blood vessels. Hawthorne opens up blood vessels that feed the heart, thus increasing energy supply and enhancing the heart's contractions. Hawthorne may be helpful in the treatment of angina and arrhythmia, and in the prevention of congestive heart failure. The herb's primary active ingredient is called vitexin.
There are numerous other supplements, minerals, food products and western herbs that can help lower blood pressure.
Note: As cautioned in section #3, Combining Western Medicine and TCM, here again be sure to check your blood pressure daily while taking any of these supplements. Dosages of prescription medications may need to be lowered or altered in some other way. When changes are needed, consult your doctor.
5. Herbal Treatment of High Cholesterol
There are natural alternatives to pharmaceutical statins in the treatment of high cholesterol, most prominently Policosanol, a long chain fatty acid compound most commonly derived from sugar cane that may inhibit cholesterol synthesis in the liver. There are also numerous herbs, known to the Chinese herbalist for centuries, that can be applied to this contemporary issue.
The noted herbalist, Andrew Gaeddert, recently reviewed many of these in an article for TCM practitioners. We are fortunate to have his permission to post his article here. We think his Health Concerns formulations are attractive alternatives to statins and we stock both Polilipid and Astra Garlic.
Another interesting alternative to pharmaceutical statins is Red Yeast Rice Extract (RYR).
RYR has been used in Traditional Chinese Medicine for over 1000 years to stimulate digestion and to promote blood circulation, but only recently has its cholesterol lowering ability been identified. Like the prescription statins RYR contains a potent natural inhibitor of HMG-CoA reductase. It also contains nine other active ingredients, such as sterols. It is thought that these naturally occurring ingredients, by acting together, make using it safer than the pharmaceutical formulation.
In a double blind, three month UCLA study published in the American Journal of Clinical Nutrition in 1999, RYR was compared to lovastatin (Mevacor). In this study the amount of active ingredient required for therapeutic effect was much less compared to the prescription drug. The liver tests of people taking the supplement remained normal. A five year study is now underway to determine long term safety.
Heber D, Yip I, Ashley JM, et al. Cholesterol-lowering effects of a proprietary Chinese red-yeast-rice dietary supplement. Am J Clin Nutr 1999;69:231-6.
Despite the apparent safety of the red rice yeast extracts, because of its mode of action it is important to watch for muscle tenderness or weakness and to monitor the blood for liver dysfunction. Like other statins it must be taken with Coenzyme Q 10.
A product Dr. Rabinowitz suggests is Choleast from Thorne Research, which contains Red Yeast Rice Extract (600 mg) and Coenzyme Q10 (10 mg). Take twice daily with food (equals 5mg of statin medication). It is recommended to supplement the amount of Coenzyme Q10 to a daily total of 60mg -100 mg.
In some studies red yeast rice extract lowered cholesterol but did not increase HDL (the good cholesterol), thus we like to combine it with Policosanol. A good choice is Metagenic's Cholarest scTM, which contains 10 mg of Policosanol.
Finally we suggest adding Hawthorne, an herb that opens up blood vessels.
Avoid alcohol and grapefruit juice.
(Thanks to Richard Kowal, DC, nutritionist, for suggesting this treatment protocol.)
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6. Herbs & Medications: Caution when mixing!
Radix glycyrrhizae (gan cao), licorice and Radix Panacis Ginseng (Ren Shen) may raise blood pressure.
Patients taking anticoagulants such as warfain (coumadin) or even regular aspirin must be cautious when talking garlic, ginger, gingko, feverfew, and bromelain. If these herbs are taken together excessive bleeding may result.
Natural stimulants such as ma huang (ephedra), yohimbe, guarana, yerba mate, Asian ginseng (ren shen), caffeine and pseudoephedrine (found in decongestants) may interfere with blood pressure lowing medications, and increase blood pressure.
Hawthorne may dangerously increase the effects of : anti-hypertensives; calcium channel blockers (including amlodipine, diltiazem, verapamil); beta blockers (including atenolol, metoprolol, propranolol); ACE inhibitors (including benazepril, enalapril, fosinopril); digitalis drugs and cardiac glycosides (including digitoxin, digoxin); and nitrates (including amyl nitrate, nitroglycerin, sildenafil citrate, isosorbide mononitrate, and dinitrate).
Contributing Researcher for this page was Amanda Silver, L.Ac.
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