Mark Swanson, ND
Dr Sinatra, thank you for taking the time from your busy schedule to share some clinical pearls from your vast reservoir of functional-integrative expertise in cardiology with the naturopathic community. Many of our ND readers follow your advice and would appreciate any examination room insight you can share. I’d like to focus our brief interview on several important clinical challenges facing cardiology that NDs often encounter.
Dr Sinatra, what is your educational background and current position?
Dr Sinatra: After graduation from Albany Medical School [Albany, New York] in 1972, I did a 3-year medical residency, followed by a 2-year fellowship in cardiovascular disease. I spent 10 years in getting a certification in bioenergetic psychotherapy, as I needed a more in-depth experience in looking into how character analysis impacts the mind-body interactions of illness. During this time, I realized that I needed more training in nutritional medicine and took the CNS [certified nutrition specialist] certification examination given by the American College of Nutrition. The preparation to take the exam included 2 years of intensive study regarding nutritional and metabolic considerations in health and wellness. I received a certification in antiaging medicine around the same time. In 2005, I wrote the first edition of The Sinatra Solution: Metabolic Cardiology [Laguna Beach, CA: Basic Health Publications, Inc; 2005], which studies the concept of energy substrates and the heart, as heart failure is literally an “energy-starved heart.” It was the understanding of how adenosine triphosphate (ATP) participates in metabolic pathways that led me into looking deeper into the concepts of energy medicine. The concept of metabolic cardiology launched me into vibrational medicine, which is an extension of the energetic concepts of disease. Since every living thing has frequencies, vibrational medicine is really the future of medicine and currently where my passion resides. I lecture about vibrational medicine, as well as metabolic cardiology, throughout the USA and incorporate grounding and earthing into these discussions. I discuss all these concepts in my monthly newsletter, Heart, Health & Nutrition [www.drsinatra.com], which I’ve been doing for the last 15 years. My latest Web site, www.heartmdinstitute.com, is an informational noncommercial site devoted to educating and empowering people to help themselves in overcoming cardiovascular disease.
Let’s start with laboratory evaluation. What are the best initial screening tests to order for a new patient with suspected risks as part of a cardiovascular workup?
Dr Sinatra: I consider metabolic syndrome a highly inflammatory disorder and follow glucose, hemoglobin A1c [glycated hemoglobin], and triglycerides as indicators of impending inflammation. In addition, I look at homocysteine, Lp(a) [lipoprotein(a)] (the real cholesterol story), fibrinogen, ferritin, and C-reactive protein as markers of inflammation. Whenever I check a cholesterol, it must be fractionated to assess for dysfunctional HDL [high-density lipoprotein], as well as determine the amount and number of small-particle inflammatory LDL [low-density lipoprotein]. I use the VAP [Vertical Auto Profile; Atherotech Diagnostics Lab, Birmingham, AL] or the LPP [Lipoprotein Particle Profile; SpectraCell Laboratories, Houston, TX] profiles.
What’s more important for heart attack prevention: lowering LDL cholesterol to 70 mg/dL or below or increasing omega-3 levels in cardiac cells to at least 8% or higher? Or both? Or is there another best option?
Dr Sinatra: Honestly, I don’t consider high LDL a serious risk factor in heart disease, as we remember the cholesterol theory is a hypothesis to begin with. LDL cholesterol may be at the scene of the crime, but it’s not the perpetrator in cardiovascular illness. Inflammation and blood viscosity are the real culprits behind cardiovascular illness, so I would say without a doubt that the omega-3 level is much more important in heart attack prevention, as it addresses both viscosity and inflammation. Lowering LDL cholesterol to 70 or below in my opinion is not smart medicine, as serious ramifications can result in both cognition and memory, as well as making us more susceptible to MRSA [methicillin-resistant Staphylococcus aureus] and “weakening of blood vessels,” etc.
With hypertension, new studies suggest aggressive therapy to achieve targets below 130/80 mm Hg may not necessarily improve outcomes on stroke prevention and cardiovascular disease, especially in patients with type 2 diabetes. What are your recommendations?
Dr Sinatra: Although it is desirable to get blood pressure lower, in type 2 diabetes the inflammation index must also be lower. This is why lowering blood pressure numbers may not be the key to success. Weight reduction, loss of excess fat, and improvement of inflammatory mediators, as well as a good walking or exercise program, must be instituted in the treatment and prevention of insulin resistance and type 2 diabetes.
What are your natural alternatives to antihypertensive drugs?
Dr Sinatra: I use natural alternatives to antihypertensive drugs in situations of mild hypertension and when there is no renal impairment or renal insufficiency. I really like a metabolic cardiology approach, including CoQ10 [coenzyme Q10], broad-spectrum carnitine, magnesium, and ribose as a way of improving energy substrates, while repairing cells at the same time. Many of my patients on this metabolic approach also had significant lowering of blood pressure. In other cases, I had to use nattokinase (50-100 mg a day), garlic (1000 mg), hawthorn [Crataegus] (1500 mg), and fish/squid oil (1-2 g daily). Adding foods to the diet—such as the peptides of sardines, the alginates of wakame seaweed, and the essential fatty acids of oatmeal—are also a few dietary considerations that can be utilized in lowering blood pressure. Obviously, weight loss and exercise are key ingredients.
What natural agents do you recommend for lipid management for LDL, HDL, and triglycerides?
Dr Sinatra: For triglyceride lowering, certainly restriction of carbohydrates and weight reduction will work. I also add 1 to 3 g of essential fatty acids to the mix. For HDL, short-acting niacin is crucial in helping to raise HDL. Carnitine and CoQ10 have also been helpful, as well as broad-spectrum vitamin E and tocotrienols. If I’m treating small inflammatory particle LDL or LP(a) for that matter, I like a combination of niacin, fish oil or squid oil, nattokinase, and d-tocotrienol. Remember, you want to counteract the thrombotic and inflammatory effects of small-particle LDL, as well as LP(a), and this is where nattokinase and omega-3 essential fatty acids have their “magic.”
We are seeing many more patients with atrial fibrillation. There’s almost an epidemic of this rhythm disturbance. What’s the best way to “treat the beat?”
Dr Sinatra: You are right. Atrial fibrillation is on the rise, and my intuition tells me it’s probably related to the toxic environment we live in. In addition to insecticides, pesticides, high mercury, and other metals, wireless technologies are “everywhere,” which can disturb heart rate variability. For these reasons, I believe “prevention is easier than cure,” and whenever we can neutralize mitochondrial toxins or attenuate the autonomic nervous system, we can lessen the likelihood of atrial fibrillation. For example, recent research—such as yoga and multiple anecdotal cases of preventing atrial fibrillation with grounding or earthing—has demonstrated the favorable outcomes of improved sympathetic tone on the heart. So when it comes to atrial fibrillation, again prevention is easier than cure. In patients who are prone to atrial fibrillation, cessation or restriction of alcohol, sugars, and caffeine is recommended. Once the patient is in atrial fibrillation, the response to natural therapies is not very desirable. However, natural therapies (including metabolic cardiology), as well as reduction in toxins (including EMF [electromagnetic field]), will help keep a person out of atrial fibrillation once they are in sinus rhythm.
Peripheral artery disease (PAD) is also a cardiology challenge. What insight can you share about improving lower limb circulation?
Dr Sinatra: The best insight I can give you about PAD is the use of GPLC (glycine propionyl), which not only helps to take toxic metabolites out of mitochondria, but GPLC also releases nitric oxide (NO) at the same time. Such a combination offers a perfect solution in preventing spasm of smaller blood vessels when in an ischemic situation. Two to four grams of GPLC in combination with 100 to 200 mg of CoQ10, 200 to 400 mg of magnesium citrate or glycinate, and 5 g of ribose twice a day and especially after exercise is a Sinatra solution for PAD.
What are the latest advances in the Sinatra solution to congestive heart failure?
Dr Sinatra: The metabolic cardiology approach to congestive heart failure absolutely works: the sicker the patient, the more nutritional support you need. For example, in mild heart failure, you may need only 100 to 300 mg of CoQ10 but 300 to 600 mg in patients with severe cardiomyopathy or in patients awaiting heart transplantation. In addition to CoQ10, 5 g of ribose 3 times daily and 1 to 3 g of broad-spectrum carnitine and 200 to 400 mg of broad-spectrum magnesium are extremely helpful in addressing the energy-starved heart. If this approach does not offer a significant improvement in quality of life after 4 weeks, the addition of 500 mg of hawthorn berry 3 times daily and 1000 mg of taurine 3 times daily has also improved the suffering of these patients. Grounding and earthing has also helped by improving blood viscosity, thus enhancing blood flow.
Is it possible to reverse high coronary calcium scores naturally?
Dr Sinatra: Yes. I’ve seen plaque reversal in some of my patients when they include a metabolic cardiology program with at least 300 µg of vitamin K2 (menaquinone-7) on a daily basis. Pomegranate juice and green tea, as well as omega-3 fats in the diet as well as the supplemental form, are definitely helpful in plaque stabilization and even reversal as well.
Can nattokinase or some of the other natural kinases be used with confidence in clot or thrombosis prevention vs warfarin? Do you ever take patients off warfarin and use nattokinase instead or combine it with other antiplatelet or antithrombotic drugs or aspirin?
Dr Sinatra: This is a difficult question. No natural therapy can be used in patients with metallic or plastic heart valves, as warfarin is the only efficacious agent. However, more and more patients with atrial fibrillation who do not have significant enlargement of the left atrium, as well as significant mitral regurgitation, can be treated with nattokinase, omega-3 essential fatty acids, or with aspirin in combination. Patients who can’t tolerate Coumadin [warfarin sodium] have taken a combination of nattokinase, Plavix [clopidogrel bisulfate], or aspirin and omega-3s with much success as well. Every patient must be individualized. Grounding can also thin the blood, and we don’t recommend grounding in patients taking Coumadin, as this combination also increases the INR [international normalized ratio]. In patients who wish to come off Coumadin or cannot take it, grounding with nutriceutical therapies that I’ve outlined above are beneficial in combination for lowering blood viscosity.
I’ll leave this last question open for any other clinical pearls and wisdom that come to mind. Please share any final thoughts.
Dr Sinatra: Many people ask me if heart disease is reversible. After discovering the power of metabolic cardiology, I can look people in the eye and relay the positive intention that heart disease can be reversible. I’ll tell you why. I have seen dozens and dozens of patients with severely diminished ejection fraction live decades. How is this possible, when the average survival for heart failure was 5 years (less than cancer) when I was in medical school? This concept is discussed in my revised author’s preface in my latest book, The Sinatra Solution: Metabolic Cardiology, April 2011. In my opinion, metabolic cardiology not only repairs and restores heart cells over time, but it literally “buys” the desirable time it takes for the natural healing wisdom of the body to take over. In Science in 2009, groundbreaking research has revealed that the body-intrinsic stem cells and particularly heart cells can regenerate themselves over time [Yu J, et al. Science. 2009;324:797-801 and Bergmann O, et al. Science. 2009;324:98-102]. So, I believe that metabolic cardiology gives people the necessary time to allow the stem cells to help heal their heart naturally.
Dr Swanson’s Comments
Thank you for a quick peek into “The Heart of the Matter” by sharing your expertise and insight in integrative-functional cardiology. You managed to fill the clinical pearl vase full of “cardio-gems” in this issue of the Expert Report. In addition to recommending your latest edition of The Sinatra Solution: Metabolic Cardiology, I also want to remind our readers to visit your new Web site at www.heartmdinstitute.com and your excellent videos on YouTube.
Mark Swanson, ND, writes “The Expert Report” column, which is featured in NDNR. Dr. Swanson has over 25 years experience as chief medical advisor, research and technical consultant, and products formulations expert to leading practitioner brand supplement manufacturers. He is a former associate editor for the American Journal of Naturopathic Medicine, national product director, and published researcher. He is a pioneer graduate of Bastyr University, 1984. Dr. Swanson has his private practice specializing in Preventics Care and Functional Medicine, in Sequim, Washington. Contact: [email protected]
