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Stephen Sinatra Md, Hawthorn Berries
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Dr. Thank you, Sinatra, for taking time out of your busy schedule to share some clinical pearls from your vast repertoire of functional-integrated expertise in cardiology with the naturopathic community. Many of our ND readers follow your advice and would appreciate any exam room insights you can share. I would like to focus in our brief interview on some of the important clinical challenges facing cardiology that NDs often face.
Dr. Sinatra: After graduating 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 getting certified in bioenergetic psychotherapy, because I needed more in-depth experience to see how character analysis affects the mind-body interactions of illness. During this time, I realized I needed more training in nutritional medicine and took the CNS [Certified Nutrition Specialist] certification exam offered by the American College of Nutrition. Preparation for taking the exam includes 2 years of intensive study in nutrition and metabolism in health and wellness. I got certified in antiaging medicine at the same time. In 2005, I wrote the first edition of
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[Laguna Beach, CA: Basic Health Publications, Inc; 2005], which studies energy substrates and the concept of the heart, as heart failure is literally an “energy-starved heart”. It was this understanding of how adenosine triphosphate (ATP) participates in metabolic pathways that led me to look deeper into the concepts of energy medicine. The concept of metabolic cardiology drew me to vibrational medicine, an extension of energetic concepts of disease. Since every living thing has frequency, vibrational medicine is truly the future of medicine and currently where my passion resides. I lecture throughout the USA on vibrational medicine, as well as metabolic cardiology, and incorporate grounding and earthing into these discussions. I discuss all these concepts in my monthly newsletter,
[www.drsinatra.com], which I have been doing for the past 15 years. My latest web site, www.heartmdinstitute.com, is an informative non-commercial site dedicated to educating and empowering people to help overcome cardiovascular disease.
Let’s start with the laboratory evaluation. What are the best initial screening tests to order for a new patient with suspected risks as part of a cardiovascular workup?
[glycated hemoglobin], and triglycerides as indicators of impending inflammation. Additionally, 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 cholesterol, it must be separated to assess for inactive HDL [high-density lipoprotein], as well as to determine the amount and number of small-particle inflammatory LDL [low-density lipoprotein]. I VAP [Vertical Auto Profile; Atherotech Diagnostics Lab, Birmingham, AL] or LPP [lipoprotein particle profile; SpectraCell Laboratories, Houston, TX] profiles.
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What is more important for heart attack prevention: lowering LDL cholesterol to 70 mg/dL or less or increasing omega-3 levels in cardiac cells by at least 8% or more? or both? Or is there another best option?
Dr. Sinatra: Honestly, I don’t think high LDL is a serious risk factor in heart disease, because we remember that the cholesterol theory is a hypothesis. LDL cholesterol may be at the scene of the crime, but it is not the culprit in cardiovascular disease. Inflammation and blood viscosity are the real culprits behind cardiovascular disease, so I would say without a doubt that omega-3 levels are more important in heart attack prevention, because they address both viscosity and inflammation. In my opinion lowering LDL cholesterol to 70 or below is not a smart drug, as severe effects can result in both cognition and memory, as well as making us more susceptible to MRSA [methicillin-resistant”.
With hypertension, new studies suggest that aggressive therapy to achieve goals below 130/80 mm Hg may not improve stroke prevention and cardiovascular disease outcomes, particularly in patients with type 2 diabetes. What are your recommendations?
Dr. Sinatra: Although lowering blood pressure is desirable, the inflammatory index should also be low in type 2 diabetes. This is why lowering blood pressure numbers may not be the key to success. Treatment and prevention of insulin resistance and type 2 diabetes must include weight loss, loss of excess fat, and improvement of inflammatory mediators, as well as establishing a good walking or exercise program.
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Dr. Sinatra: I use natural alternatives to antihypertensive drugs in cases of mild hypertension and when there is no renal impairment or renal insufficiency. I really like the metabolic cardiology approach, in which CoQ10 [coenzyme Q
], broad-spectrum carnitine, magnesium, and ribose as a way to improve energy substrates while simultaneously repairing cells. Many of my patients on this metabolic approach also had significant reductions in blood pressure. In other cases, I had to use nattokinase (50-100 mg per day), garlic (1000 mg), hawthorn.
] (1500 mg), and fish/squid oil (1–2 g daily). Adding foods to the diet — such as peptides from sardines, alginates from wackeme seaweed, and essential fatty acids from oatmeal — are also some dietary factors that can be used to lower blood pressure. Obviously, weight loss and exercise are key components.
Dr. Sinatra: To lower triglycerides, certainly restriction of carbohydrates and weight loss will work. I also add 1 to 3 grams of essential fatty acids to the mix. For HDL, short-acting niacin is crucial to help raise HDL. Carnitine and CoQ10 have also been helpful, as well as broad-spectrum vitamin E and tocotrienols. If I’m treating small inflammatory 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 the “magic” of nattokinase and omega-3 essential fatty acids is.
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We are seeing many more patients with atrial fibrillation. There is almost an epidemic of rhythm disturbances. What is the best way to “treat a bite”?
Dr. Sinatra: You’re right. Atrial fibrillation is increasing, and my intuition tells me it’s probably related to the toxic environment we live in. In addition to pesticides, insecticides, high mercury and other metals, wireless technologies are “everywhere”, which can disrupt heart rate variability. . For this reason, I believe that “prevention is easier than cure,” and whenever we can neutralize mitochondrial toxins or lower the autonomic nervous system, we can reduce the likelihood of atrial fibrillation. For example, recent research—such as multiple cases of prevention of atrial fibrillation with yoga and grounding or earthing—has shown favorable results of improved sympathetic tone on the heart. So when it comes to atrial fibrillation, again prevention is easier than cure. In patients prone to atrial fibrillation, stopping or restricting alcohol, sugars and caffeine is recommended. Once a patient is in atrial fibrillation, the response to natural remedies is not very desirable. However, natural therapies (including metabolic cardiology), as well as toxin reduction (including EMF [electromagnetic field]), will help keep a person out of atrial fibrillation once they get into sinus rhythm.
Peripheral artery disease (PAD) is also a challenge in cardiology. What insight can you share about improving lower limb circulation?
Dr. Sinatra: The best understanding I can give you about PAD is the use of GPLC (glycine propionyl), which not only helps remove toxic metabolites from the mitochondria, but GPLC also releases nitric oxide (NO) at the same time. Such combination offers a perfect solution to prevent spasm of small blood vessels when in ischemic condition.