The part 5 and the 4 other parts are being updated so as to better account for the evidence of infective agents in the cardiovascular disease process. It will be completed by December of 2014.  For the evidence in support of infection in the artery walls,  for an evaluation of the cholesterol myth

Part 5:  Healthful Lifestyle, Diet, Supplements, & Drugs   id5.html

Lifestyle makes a difference. The greatest lifestyle gains are from weight control, low-sucrose/fructose diet, cessation of smoking, and vigorous exercise.  Rapping the heart in a layer of fat and making the heart pump harder through miles of blood vessels that are consequences of obesity.  Moreover with obesity, fat adversely affects the feedback mechanism that regulates insulin; thus the risk of type-2 diabetes increases 30 fold.  Diabetes causes a higher level of blood borne sugars thus increases the amount of glycation.  Diabetes causes red blood cells to leak out of capillaries which cause an immune response by macrophages thereby accelerating AS.  Death from CVD increased between 200 to 400% in the last 120 years.  Diabetes shortens life an average of 5 years and with obesity more.  Carbon monoxide--a reactive chemical that damages LDL-- from tobacco doubles the rate MI.  A pack-a-day smoker shortens their life on an average 7-12 years and has a 2.04 fold risk of death from MI.  More smokers diet from tobacco induced CVD than cancer.  Carbon monoxide promotes the production of unstable young plaque, thus with cessation, the risk for MI dramatically drops over the next 5 years. Vigorous exercise strengthens the heart, improves vascularization, and has an anti-inflammatory affects upon the epithelium cell (walls) of arties.  Also exercise and physical excursion lower risk of insulin intolerance by utilizing excess glucose and fructose & reduces glycation.  Senior runners average age 75, extended life 8.7 years to an average of 89 years; & it improves quality of life.    “Exercise capacity is a more powerful predictor among men than other established risk factors for cardiovascular disease.” NEJM, 2002.  Diet and taking the 3 supplements and drugs below make a major difference.

Three very effective supplements & drugs:  besides lowering CVD and AS risk, they have major additional health benefits—all well supported in the journals.  Pharma has done mountains of marketing studies to sell hypercholesterolemia and the use of statins.  Similarly pharma has done studies to dissuade doctors and public from the usage of hormone replacement therapy (HRT), either estrogen and of late testosterone, and aspirin by claiming their benefits aren’t worth the risks.  See Aspirin, Natural HRT, and testosterone for an exposure of the junk science on risks; and also for a list of their many benefits.   Since there are no side effects from Q10, pharma ignores Q10 and does junk science to deny its benefits.  Their effectiveness at preventing CVD and AS is proof of the role oxidative damage to LDL and the immune response.  (Yes, besides MI reduces the risk AS.)   With these 3 and healthful lifestyle, the benefit from other drugs & supplements is small.     

Tobacco ethics:  Think back on how the tobacco corporations fought tooth and nail to suppress the health consequences.  In 1970 the consensus was that smoking shortened life 7 years and caused yearly 450,000 to die early.  Congress wouldn’t regulate a product which killed more American in one year than died in the entire Second World War.  The effects of tobacco were well demonstrated in scientific studies by 1900.  Dr. Kellogg (the cereal manufacturer) in 1922 wrote a book going over the extensive and varied evidence.  Please review this book, for it illustrates the extent of research on tobacco; how little effect this knowledge had; and  the state of since by 1920.  Tobacco industry is very effective selling their poison (so too is pharma and the food industries).  It took until 1964 for the Surgeon General in a report to warn the public that smoking causes lung cancer and bronchitis; and until 1970 for Congress to mandate a warning on all cigarette packages (Wiki).  Think how successful they were with their tobacco science at denying the consequences, how the media would not offend a major advertiser, or Congress corporations.  Tobaccos corporations aren’t a mutant form of capitalism.   Think about how the auto industry opposed seat belts and pollution regulations. Think about how chemical companies, mines, and paper mills who dumped waste in our streams and pollute the air.  Effective regulation of corporations in the public’s interest occurred only in a period of strong unions during starting with Roosevelt in 1933 and lasted until the 70s, those regulation have been dismantled and/or ignored.  Now think how much more power a world-wide $800 billion industry is at protecting its profits and controlling the beliefs of the public and doctors.  We have returned to the pre-regulatory form of government.  I could write a book on how the FDA pretends to protect the public, but is in bed with pharma.  Fortunately Dr. Ben Goldacre, Prof, has.  See chapter 3 “Bad Regulators” in Bad Pharma; his examples expose the many ways in which the FDA & EMA (European Medical Agency) functions to benefit pharma.  Read Marketing Science, for 2 page outline of what pharma is doing to market their drugs.  I have dedicated  in the “recommended” pages of the healthfully website to exposing pharma’s the junk science and finding out what really is healthful.  Below are products of that effort that are relevant to CVD and AS.    

NSAIDs risk of MI:  There are grave risks associated with immunosuppressant drugs.  The most popular group of drugs is the NSAIDs (non-steroidal anti-inflammatory drugs); they reduce an immune response and through reduced inflammation reduce pain.  But through this anti-inflammatory action of inhibition of the COX-2 (cyclooxygenase, a prostaglandin hormone) they all increase very significantly the risk for ischemic events, but for aspirin[1].   In a news release:  “Many doctors should change the way they prescribe pain relievers for chronic pain in patients with or at risk for heart disease based on accumulated evidence that nonsteroidal anti-inflammatory drugs (NSAIDs), with the exception of aspirin, increase risk for heart attack and stroke”, advice issued by the American Heart Association..  Vioxx and several others NSAIDs have been pulled from the market for this reason.  Long-term Vioxx use increased the risk of MI over 300%, long term Celebrex 340%[2], and naproxen (Alive) by at least 50%; yet Celebrex is still a blockbuster in the US, but banned in Canada and Europe.  In spite of the greatly increased risk of death NSAIDs are used long term for arthritic pain.    Studies have been done to promote the off label use of Celebrex for intestinal polyps,[3] anther requiring daily use.   Acetaminophen (Tylenol) causes triples the risk of asthma in children and is the leading cause of drug induced liver failure.   A Danish pregnancy cohort study of 64,322 consisting of 3 interviews followed by one at 6 months after child birth:  “Research data suggest that acetaminophen is a hormone disruptor, and abnormal hormonal exposures in pregnancy may influence fetal brain development.”   In a Norwegian study (Oct 2013) of 2.919 Norwegian mothers which same-sex sibling pairs who were used to adjust for familial and genetic factors, they found “substantially adverse development outcomes at 3 years of age.”  Yet doctors think it safe.  COX-2 inhibitors perceived superior efficacy at relieving pain was exposed as fabricated in 2009.[4]  Doctors are general silent about NSAIDs life ending CVD effect, and the FDA’s black-box warning on all NSAID--but aspirin--of this risk is clearly ineffective--a pseudo fix. 

Aspirin:  In the 1950s, when I was growing up, aspirin was the dominant over-the-counter drug for mild pain, arthritis, anti-inflammatory, and colds.  It came in 500 mgs, and the initial dose was 2, followed by 1 every 3 hours, or as needed.  The standard daily usage for arthritic and joint pain, and chronic lower back pain was 2.5 grams per day, with 7.5 grams as the upper limit—this continued to be recommended by doctors until the 1990s.  Annual production reached a peak in the U.S. of 20,000 tons in 1958.  Nothing has changed since the 1960s as to its risk factors; and several major benefits were since discovered including those from the prevention of blood clots which causes kidney, heart attacks, strokes, and other organ damage.  Aspirin reduces the risk for pulmonary embolism, cancer, atherosclerosis, Alzheimer’s disease, Parkinson’s disease, arthritis, macular degeneration, and increases cancer survival.  This is why pharma is against aspirin and promotes for heart attack prevention the, ineffective low-dose of under 100 mg—tolerance develops to its antiplatelet effect within 1 year.  The above listed benefits are for higher-dose aspirin taken long-term.  Being 8^th in sales is proof that pharma’s tobacco ethics and their control of drug usage.  Only higher dose aspirin reduces significantly the top three killers.  Because of its anti-inflammatory action, “It is the standard against which all rheumatoid arthritis medication should be measured” Goodman & Gilman 11^th Ed, 2006 textbook.  Aspirin is the drug of choice for osteoarthritis, Merck Manuel 15^th Ed. p 973.  Aspirin’s anti-inflammatory action prevents hardening of the arteries, which is essentially an inflammatory process that oxidizes LDL.  Aspirin stimulates the body’s mechanism for destruction of abnormal cells (necrosis factor) including from trauma, precancerous, and cancerous cells.  By doing so it both prevents most cancers and promotes survival.   For example, with breast cancer the rate is reduced over 40% and survival of stages I, II & III is increased over 60% (doesn’t affect metastatic cancers).  Yet the FDA gives it the lowest approval rating for cancer prevention.  Pharma attacks the usage aspirin because it would drastically reduce the sales of nearly half their blockbusters.  Besides ignoring aspirin’s benefits, pharma has blown out of proportion its health risks.   Doctors automatically blame aspirin for all major & minor bleeding episodes, though scientific studies shown an increases the risk of ulcer 4% over 5 years—comparable to most other drugs. This occurs because of pylori bacteria in their stomach that has penetrated the protective mucus membrane, thereby permitting aspirin to increase irritation to the unprotected areas of the stomach.  Goodman and Gilman pharmacology supra, comment that “many clinicians favor the use of other NSAIDs perceived to have better gastrointestinal tolerability, even though this perception remains unproven by convincing clinical trial”.  And to prevent the next generation from taking aspirin, pharma and the FDA warn about Reyes Syndrome.  Once diagnosed based on symptom with 555 cases in 1980; now with the advent of genetic testing for the metabolic syndrome it dropped to two cases in 1994.   This drop in frequency is ignored by pharma and the FDA.  Finally on dosage:  pharma reduced aspirin from 500 to 325 mg, and initial dose from 1 gram to 325 mg, which is too low to be effective for pain and inflammation.   Effective dose for pain and arthritis is 2.5 g m daily.  For prevention of blood clot (thrombosis) cancer, atherosclerosis, and Alzheimer’s disease 325 mg once or twice daily, and twice that amount as chemotherapy for cancer.  For over 50 years 2.5 grams or more taken by millions for arthritis--the 1987 Merck Manual recommends 3.5 grams daily.  The increased ulcer risk was known for over a century, but it took pharma’s unwarranted assault to change doctors’ opinion.  Tens of millions have died early from cancer, ischemic heart attacks & strokes, and Alzheimer’s disease because the marketplace has no conscience

Q10 (CoQ10):   recognized as the most effective antioxidant.[5]  A number of major health conditions are caused by oxidative damage.   Q10 is found in every cell in the body because it is used by the mitochondria in the production of ATP from glucose.  ATP accounts for 95% of the body’s energy.   “The antioxidant effect of Q₁₀ derives from its energy carrier function in the production of ATP.   As an energy carrier, the Q₁₀ molecule is continually going through an oxidation-reduction cycle” Wiki.  It is the best anti-oxidants because it is in every cell of the body.  It is found in LDL and thus reduces oxidative damage to LDL.  For the same reason Q10 reduces the risk for Alzheimer’s & Parkinson’s diseases, CVD, diabetes, hypertensions, and macular degeneration.  Q10 also function to protection the mitochondria from damage from the reactive chemicals produced in the metabolism of glucose & fatty acids.  Decline in endurance & peak performance with age is a result of oxidative damage to the mitochondria for which Q10 slows that process.  Age related decline of immune system, liver functions, etc. is in part a result of the decline in production of ATP by the mitochondria.  Q10 counteracts the effect of Statins, bisphosphonates, & beta blockers (for hypertension) which partially block the mevalonate pathway .  Statins reduce the production of Q10 by 40%.   The very poor compliance among the elderly results from the reduction of Q10 and thus ATP.[6]   Q10 is not toxic:  a study found that daily dose of 3600 mg was well tolerated by both the healthy and unhealthy patients.  Recommendation:  100 mg for children, being gradually increased to 300 mg by the age of 40--yearly cost from Costco is under $70.   

Natural HRT (estradiol with progesterone):  What every woman should be taking because of the numerous, major health benefits, benefits that would slash pharma’s profits.  As Dr. Ben Goldacre says, “the devil is in the details.”  Of the 4 natural estrogens, only estradiol (E2, 17β-estradiol) has major benefits.  Two (estriol (E3) and estetrol (E4)) are found in pregnant women and should not be used in HRT because they block estradiol’s action.  Big pharma being against hormone replacement therapy (HRT) markets ineffective products at too low a dose or with E3 and E4.  Prempro, the best-selling HRT, is the worse.  Based on marketing science, especially the WHI (Women’s Health Initiative) 2001 clinical trial by the FDA that knowingly used Prempro, an estrogen derived from pregnant mare’s urine and the progestin MPA.[7]  The biological effects of mare’s estrogens are different than human estrogen and MPA blocks most of the benefits of estrogen.  The results from WHI apply only to Prempro;[8] thus cannot be validly applied to other formulation of HRT--though pharma and the FDA did.  The FDA warns that hormone replacement therapy has only one valid medical use, to manage hot flashes, and it should be used at the lowest dose for the shortest time.  Earlier trials and epidemiological studies found that HRT lowers  Alzheimer’s 83%, heart attacks 32%, coronary heart disease 50%, colorectal cancer 46%, breast cancer 73%, thrombosis 8%, osteoporosis fractures 90%, macular degeneration 65%, reduces & prevents arthritic join destruction, firmer breasts, healthier skin (less wrinkles, thicker, 48% more collagen), reduces hair loss, improved cognitive function, less depression and mental illness, and a general feeling of well-being with increased libido.  Estradiol is the most effective treatment to prevent fractures from osteoporosis—bisphosphonates the worse.  Estradiol’s methods of cardiovascular protection are well documented.  The lack of estradiol is the reason for the precipitous decline in health of women.  The brouhaha over estrogen receptors and breast cancer is based on marketing science[9].  Life extension with long-term natural HRT is at least 4 years.  Because of an  increase in a low incident cancer (uterine), a progestin (synthetic orally active hormone with some progesterone properties) is added to hormone replacement therapy rather than the natural progesterone which isn’t orally active—except when micronized and suspended in oil, a recent development.  The best method of application is a lotion obtained from a compounding pharmacy in a dose of 4 mgs estradiol plus 100 mg of progesterone per application--absorption rate is about 15%.  Apply widely as possible over the torso, back, shoulders, underarms, and face using water and rubbing it in to promote better absorption. Recently progesterone has been micronized in oil and available as a pill.  Ideal free-serum estradiol level is 7-9 pg/mL.   A compounding pharmacy can prepare a pill consisting of 2 mg of estradiol with 50 mg of progesterone.[10]  The lotion form is better for the skin.  Plant sources of estrogens are not very effective.  Doctors who follow the Wiley Protocol are other methods of hormone balancing for post-menopausal women are milking the insurance and patient.  A prescription of phasic estradiol shouldn’t require extensive testing and frequent visits.  Unfortunately triphasic estrdiol and noresthisterone is only available in Europe—see results of Danish study­­[11]._­      

Niacin family and other natural cholesterol lowering drugs and cardiovascular disease (CVD):  Some of you will as a matter of insurance want to lower your TC a natural way; and hopefully by now will if on statins, not fill the next prescription.  Pharma recommends 1,500 to 3000 mgs of niacin (nicotinic acid) taken with meal; however insulin produced with meals blocks niacin’s cholesterol lowering affect.  High dose causes the unpleasant flushing effect and thus low compliance.  The only long-term study (usage 6 years, followed 15 years) was of high dose niacin.  It produced a reduction in deaths from cardiovascular disease of 11%; this compares favorable to statins once the tobacco science trials are eliminated from consideration (see Statin, Braunwald table).  However, a study based on blood work showed that 250 mgs of niacin at bed is just as effective, and without flushing.  In the same experiment similar results were obtained with inositol hexanicotinate, a source of niacin.  Both sources of niacin also possesses anti-inflammatory and antioxidant benefits, and thus inhibits atherogenesis.  For lowering the bad cholesterol use 250 to 500 mgs at bedtime of either inositol form or niacin.  Note, there is miniscule value of lowering TC that is below 350 for those without major risk factors.  But marketing studies and pharma manipulated guidelines on cholesterol to promote statins for those above 240, or a 10 year risk of 7.5% for an acute ischemic event—that would put 85% of those over the age of 65 on statins.

Other healthful drugs and supplements: There is a number of other that substances shown of value based on laboratory experiments.  Resveratrol a natural phenol is an anti-oxidant from in red wine; so too of value is nutritional yeast, red yeast extract, and omega-3 fatty acids (concentrated from fish oil and sold as pills).  However, aspirin and Q10, along with estrogen for postmenopausal women offers are best.  Testosterone once blood level is below 350 lowers risk of MI, heart failure, and metabolic syndrome.  Change in lifestyle is very effective.  A gram of fish oil per day counteracts the western diet unhealthful ration of N-6 to N-3 of 16:1 and thus is recommended.    Following the advice of lifestyle change, Q10, aspirin, estradiol, testosterone and fish oil are sufficient to reduce the value of other options.  Nevertheless some people will take more than is advisable.  For their sake and for completeness additional options are listed.    D-ribose is a building block for ATP, L-carnitine aids in the production of Q10 and is an effective antioxidant, and vitamin C is an antioxidant that lowers risk for AS (not recommended for those with hemochromatosis).  Vitamin E should not be used over 1,000 mg if taking aspirin or anticoagulants, and benefits are questioned Wiki.     Vitamin D3 plus calcium has become popular, evidence for it value is mixed (possible more marketing science by pharma)   Magnesium 1 gm daily is recommended for those with the issue of high blood pressure and a significant load of arterial calcium. Coronary artery calcification is a major risk factor for heart disease and magnesium lowers that load (Bowden 136).  Berberine, a Chinese herbal product has a positive effect upon TC, reduces superoxide levels in LPS-stimulated macrophages, and is “useful for patients with congestive heart failure…suppresses the growth of a wide variety of tumor cells[1]” Wiki, and it lowers blood sugars in treating diabetes, etc.  Glutathione is an organic chemical found in plants and animals.  “It is the major endogenous antioxidant produced by the cells, participating directly in the neutralization of free radicals and reactive oxygen compounds, as well as maintaining exogenous antioxidants such as vitamins C and E in their reduced (active) forms.  Glutathione is also needed for the detoxification ofmethylglyoxal, a toxin produced as a by-product of metabolism.” Wiki.  Extensive research on animals has shown that glutathione exerts protective action in the liver.  Pantethine is considered the more biologically active form of vitamin B₅, but it is less stable, decomposing over time if it is not kept refrigerated.  Pantethine serves as the precursor for synthesis of coenzyme A.  In multiple clinical trials using 600 to 1200 mg/day of patients with elevated cholesterol and triglycerides, total and LDL cholesterol were decreased by 12%, triglycerides decreased by 18%, and HDL cholesterol was increased by 9%.  Although pantethine can serve as a precursor for generation of vitamin B₅, this is not thought to be the mechanism of action.   In time JK will devote more time to assess the merit of these supplements and herbs; however, following the recommended course of diet, exercise, weight control, and the recommended 3 (aspirin, Q10, and hormones) entails a much lower benefit from additional intervention, with the possibility of competing modes of cellular action reducing their  benefits.   Other supplements mention in Bowden (supra) are Curcumin an extract from the Indian spice turmeric which is highly anti-inflammatory; and cocoa flavanois derived from cocoa that promotes the synthesis of nitric oxide which has a number of bodily functions and has several clinical uses because it causes vasodilation. 

Polypharmacy a major cause of death under reported.  Polypharmacy is defined as the taking of 5 or more prescription drugs.[2]   Risk looms greater with each additional chemical added. Seniors because of chronic conditions and higher risk fact are the most vulnerable.  A UK study of 715 consecutive hospital admissions, age range of 72 to 82, found an average of 6 prescription medications.  One study of 130 assisted living residents mean age of 86 found an average of 13 medications.  Given that the elderly have major reduction in liver and kidney function, this number of drugs is clearly milking the system and harming patients.   For those with CVD, pharma’s drugs are neither safe nor effective.  Asking your doctor about treatment choices is equivalent to asking his thought leader or sales rep who provides his continuing medical education.  The compliant patient with CVD pays dearly for his faith.  For example those with what pharma considers a high level of cholesterol are given statin and probably 3 drugs for hypertension—two of these drugs reduce significantly cognitive function.   A much better choice is following the recommendations in the prior sections.  We have a long way to go before the potential of medical science is unleashed from its corporate master. 

Other possible factors:  Among the possible likely contributing causes for the prevalence of obesity the estrogen & testosterone mimic loom large.  Main sources would be soy products and plastics which have bisphenols. Circumstantial evidence is that in the western countries Caucasians menarche come about 2 years earlier than it did in 1800, the average height of people has increased 6 inches, obesity increased from under 5% to over 30%, and decline in testosterone levels for mature men of about 30% from 1974 until 2004 (period of measurement in Boston study).    Estrogens lower the production of testosterone.  IQ has increased.[3]  While all these might not have the same types of causes, for obesity, decline in testosterone, and menarche there are hormone causal mechanisms  in place. Moreover, there is a feedback system where estrogen lowers the level of testosterone.  Estrogen was once widely used to slow the growth of stage-4 prostate cancer until pharma made patented alternatives.[4]

1871 census UK and longevity:  More evidence of the consequences of the western diet and our over medication:  the 1871 census in the UK (the first of its kind) found the average male life expectancy as being 44, but if infant mortality is subtracted, “males who lived to adulthood averaged 75 years.   The present male life expectancy in the UK is 77 years for males [the United States averages 74 for males]” Wiki.  In spite of the improved medical procedures[5] for cancer, heart attacks, strokes, contagious diseases, and infections,[6] and also a safer work environment, these benefits have been undone as to life extension by CVD, cancer, osteoporosis, Alzheimer’s disease, for which western diet and lifestyle is the major cause.  We are enduring the effects of corporate tobacco ethics. 

What to eat and not to eat:  The food pyramid of the FDA is fundamentally sound with its vegetables meats and fish and dairy products with overall adjustments of lower the amount of carbs and increase animal fats while lowering vegetable oils.  Replace as source of protein chicken and meats with fish because of the GMO corn feeding, use of antibiotics, etc. in the factory type system used in the industry.   Sugar sources are well handled by the body following extensive physical excursion or prior to it.  Seniors are far more sensitive to the effect of sugar upon insulin level.     

A summary of this will soon be posted at http://healthfully.org/rh/id8.html.  The diet changes just outlined, along with the healthful lifestyle, is the path to a long and healthful life, gods willing.  A careful review of the evidence was need prior to issuing recommendations based upon an analysis of the scientific evidence. 

The fix:  a whack at the perverse system.  We simply can’t expect our government to put a bandage on or to clean up the mess in our health care.  Every enacted change has been for the benefit of pharma (see Goldacre’s and Angell’s books for proof).  That corporations can use tobacco science in matters of health is a sign of a much deeper illness:  the global corporations as shadow government have dismantled the New-Deal constraints and voices for the people.  From this power shift came the dismantling of our liberal-education system and media (liberal in the sense of promoting reasoning skills and a sound factual basis).  World finance forces governments to promote their agenda for globalization.  NATO and the US military are tools to force globalization (open markets) upon resistant nations, currently focused on oil rich nations.  As Napoleon said:  “The hand that gives is above the hand that takes.”  They have established world wide a debt-based currencies for which only through loans the currency expands, and thus there is an every growing amount of interest payments.  Right now it is after the military that does the globalizer’s bidding; the second largest item in the federal budget is payment on debt.  If the federal government issued its debt free currency, and was the loan system, there would be no debt payments.  Currently the financial sector consumes 44% of GDP.  Is this a service or product of value?  This sucking of resource entails that we have lost the right for everyone who works to earn a living wage.  And their media blames unemployment, government debt payments on our elected government rather than on the shadow government and its media.  Change won’t happen to make pharma serve people first until we recreate the financial system and set up managed capitalism as we did with Keynesian economic (or more utopian alternatives).  Bad pharma is a product of a perverse system.  We must first fix the system. 

One last though, a quote from Thomas Alva Edison:  If our nation can issue a dollar bond, it can issue a dollar bill. The element that makes the bond good, makes the bill good, also. The difference between the bond and the bill is the bond lets money brokers collect twice the amount of the bond and an additional 20%, whereas the currency pays nobody but those who contribute directly in some useful way.  It is absurd to say that our country can issue $30 million in bonds and not $30 million in currency. Both are promises to pay, but one promise fattens the usurers and the other helps the people.