SALT LAKE CITY—When talking to your patients about heart disease, offer them the choice between a Path or a Pathology, and help them identify their own obstacles to a healthier lifestyle, said S. A. Decker Weiss, NMD, at the annual meeting of the American Association of Naturopathic Physicians.
It may seem like a word game, but how you frame your dialog with patients makes a tremendous difference in their responsiveness, said Dr. Weiss, of the Arizona Heart Institute, Phoenix. Harping on cardiovascular risk factors and major lifestyle changes is not going to motivate the Big Mac n’ Marlboro crowd.
Dr. Weiss believes preventing CVD is not so much about reducing risk factors as identifying a patient’s individual obstacles to good health and then helping to clear them. Risk factors happen in a context, and that’s what you need to try and address. The key is to identify pivot factors—small changes a patient just might be willing to make—which could gradually move them in the right direction.
Forget statins for a minute. Given the fact that ingested fats reach the heart in roughly 12 minutes, helping a patient to stop eating french fries—even if they still eat the cheeseburger—can have an immediate impact. You might not get Captain Coldcuts to go macrobiotic, but you could potentially get him to add some niacin, folate, and fiber to his diet and cut some refined carbohydrates.
“You need to explain to patients that health and disease are part of a continuum, not separate “states” or “moments.”
Healthy Gut = Healthy Heart
It is easy, when evaluating heart disease, to get overly focused on the heart and vessels, forgetting that atherosclerosis and hypertension are whole systems disorders that manifest in the cardiovascular system. While most physicians recognize the importance of good nutrition, Dr. Weiss believes too few are paying enough attention to digestive health. The digestive system has profound influence on the cardiovascular system beyond the obvious dietary link.
“Anybody who is constipated will have a 10%–15% increase in blood pressure. If you can get them passing stools regularly, you will have an immediate effect on their blood pressure,” said Dr. Weiss.
Folate, B6 and Magnesium
Total dietary overhauls are very difficult for most patients. But there are a few heart-threatening nutrient deficiencies that are easy to rectify. Concentrate on increasing folate, B vitamins, and magnesium, and you’ll be doing your patients a big favor. “Approximately 75% of all Americans don’t get enough magnesium. You’re not even in the game if you’re not getting your patients on magnesium.”
But simply putting patients on supplements or getting them to eat healthier foods won’ t do much if they’re not absorbing what they ingest. Poor digestion and impaired nutrient absorption are very common, said Dr. Weiss.
Many factors—most of them reversible—contribute to poor nutrient absorption. These include: sympathetic nervous system overactivity, high caffeine intake (especially coffee) which exacerbates the sympathetic overdrive, high consumption of refined carbohydrates, low stomach acid production, insufficient digestive enzyme production, and pH dysregulation throughout the digestive tract (see related story).
Refined Carbs Not Sweet to Heart
For many people, refined carbohydrates are the most common obstacle to good health, said Dr. Weiss. “The genetic predisposition to Type II diabetes may not be so much for diabetes per se, but for an inability to handle refined carbohydrates.”
Hyperinsulinemia actually reflects a delayed insulin response to sugar loads. Up to 75% of the US population shows delayed insulin response. In these individuals, refined carbs are particularly destructive. In real time, the insulin release lags behind the rise in blood sugar in a way that ultimately creates the hyperglycemic-to-hypoglycemic swings many patients experience.
Refined carbs rapidly dump glucose into the blood, creating a hyperglycemic state to which the pancreas is slow to respond. When insulin release finally does peak, glucose levels are already dropping; the insulin surge drives levels into the hypoglycemic zone. At this point, the patient experiences the ravenous cookie craving, starting the cycle all over again.
The adverse CV effects of both hyperglycemia and hyperinsulinemia are well documented. Dr. Weiss stressed that anything a patient can do to replace refined with unrefined carbohydrates is ultimately to their benefit. Chromium supplements can be a real ally in managing hyperinsulinemia. Dr. Weiss noted that in a low-chromium state, an individual requires 10 times the amount of insulin to process a given amount of sugar as he would if chromium levels were adequate. Though the mechanisms are not entirely clear, chromium seems to increase the ability of insulin to metabolize glucose.
Drug-Free BP Reduction
Natural products can be used effectively both alone and in combination with prescription drugs to control blood pressure, provided one understands their value and limitations.
“If the hypertension is stress-related and there is concurrent angina, conventional drugs like beta blockers, ACE inhibitors and angiotensin receptor blockers simply won’t work. If the pressure is moderately high in this context, I go with natural therapeutics like Rauwolfia.” He added that he seldom uses calcium channel blockers unless the patient also has an elevated heart rate.
Vitamin B6, delivered intravenously, can go a long way in reducing diastolic pressure. “I see a lot of B6 deficiency, particularly in perimenopausal women. I give them B6 shots, they diurese and lose a lot of water, and the bottom number comes down quite a bit.”
He added that mind-body strategies aimed at balancing parasympathetic-sympathetic nervous system activity is also extremely helpful in controlling blood pressure. Without controlling the autonomic driver of hypertension, pressure-lowering drugs and botanicals are little more than “putting a lid on a pot that is boiling over.”
