Heart health has developed into somewhat of a circus—with Big Pharma companies as the ringleaders. Some of the pharmaceuticals and methods used to sell them are high-flying acts that are not suitable for the faint of heart, literally.

However, long-standing perceptions about heart health are changing. For example, heart disease has often been referred to as a “man’s disease.” But the staggering statistic that heart disease is the number one killer of women in the United States has been the impetus for major change. Sunil Kohli, chief operating officer for Health Plus, Inc., Chino, CA, says, “So many more young people and women are now aware that taking care of their hearts is a great idea to prevent heart attacks in the future.”

In general, people are reevaluating the information they receive about heart health, questioning authority and rejecting the colossus of pharma-influenced media. “Consumer confidence in the pharmaceutical industry and drug safety has severely eroded over the past several years. The major cause is due to large failures in drug safety and the omission of adverse event information from drug trials performed by some of the major pharmaceutical companies,” says Steve Holtby, president and CEO of Soft Gel Technologies, Inc., Los Angeles, CA, says. This has created a tremendous opportunity for the natural products industry to bring cardiovascular health back down to earth, where caring for your heart doesn’t have to be a death-defying act of courage.

Inflammation Nation
Inflammation is now recognized as a major contributing factor to cardiovascular disease, perhaps even more so than cholesterol, which will be discussed later in this article. Fried foods, hydrogenated oils, diets high in sugar and diets with an imbalance of omega-3 fatty acids to omega-6 fatty acids (otherwise known as American favorites), smoking, pollution and stress are all some of the factors that can contribute to inflammation.

Although inflammation is a good thing when appropriately defending the body from infection, chronic inflammation can be devastating to the entire body. Inflammation can trigger a variety of biochemical reactions that stress the body and, thereby, the cardiovascular system, including blood vessel dilation, immune system over activity, increased pathway signaling, pain sensor firing, serous fluid release and so on. It makes the heart susceptible to damage, which is then mainly repaired by vitamin C, amino acids and cholesterol. But, as cholesterol begins to repair more of these injuries, the plaque builds up and atherosclerosis begins to develop.

One means of assessing inflammation is by measuring levels of C-reactive protein in the bloodstream. Holtby says, “While high levels of C-reactive protein can also correlate to obesity, infection, injury and other pathologies, its prolonged, elevated presence accelerates the degradation of the circulatory system.”

In addition, nutrient deficiencies, such as vitamins B12, B6 and folic acid allow for the amino acid homocysteine to become elevated, creating more inflammation. According to the American Heart Association (AHA), too much homocysteine in the blood (plasma) is related to a higher risk of coronary heart disease, stroke and peripheral vascular disease (1). Richard Passwater, Ph.D., vice president of research and development for Solgar, Inc., Leonia, NJ, suggests that folic acid and vitamins B6 and B12 can help keep homocysteine levels in check.

Blood clots, like those that can be seen in peripheral artery disease (PAD), can also be attributed to inflammatory events. Dennis Goodman, M.D., consultant to Enzymatic Therapy and Paula Hanek, heart health brand manager for the Green Bay, WI-based company say, “It’s the inflammation that brings macrophages and other white blood cells into the plaque, making it grow, narrowing the passageway and restricting the amount of blood the vessel can carry.” The macrophages and inflammatory process make the plaque more fragile and likely to burst, leading to blood clots.

Trisha Sugarek, national educator and research and development specialist for Bluebonnet Nutrition Corporation, Sugar Land, TX, adds, “Virtually every step in angiogenesis is believed to involve substances involved in the inflammatory response and cells that are characteristic of inflammation.”
The obvious way to address inflammation is to reduce the intake of processed, packaged and fried foods—something on which many people get stuck because of their attachment to convenience.

In addition to dietary improvements, says Bradley West, N.D., research advisor at Nordic Naturals, Watsonville, CA, “EPA [eicosapentaenoic acid] and DHA [docosahexaenoic acid] from fish oil can improve lipid profiles, reduce inflammation and arrythmias, improve arterial elasticity and improve blood pressure.” Three large, controlled trials of 32,000 participants randomized to receive omega-3 fatty acid supplements containing DHA and EPA showed reductions in cardiovascular events of 19% to 45% (2).

Michael T. Murray, N.D., director of product development and education for Natural Factors, Everett, WA, says in addition to essential fatty acids, “The antioxidant system in the human body is a beautifulorchestra that requires all of the interrelated instruments. Vitamins C and E, zinc, selenium and flavonoids are particularly important against inflammation.”

Digestive health is also very closely linked with inflammation, and thus, heart health. If the digestive system is unhappy with a certain type of food, it will trigger the immune system as it rejects certain food particles, keeping the body in a vulnerable state of activity and spurring inflammation. Therefore, eating wholesome, unprocessed foods is essential. Jason Mitchell, vice president of research and product development and education for County Life Vitamins, Hauppauge, NY, recommends his “Big Five” to all people to build a foundation for heart health through healthy immunity and digestion: 1) a high-quality multivitamin, 2) essential fatty acids (borage and fish oil), 3) probiotics, 4) fiber and 5) CoQ10. He calls this an “ultimate combination” for cleansing the body of impurities, driving down triglycerides and keeping cholesterol in the right ratio.

Cholesterol Calamities
Cholesterol has dominated the heart health category as it can be one indicator of cardiovascular disease—but, it’s not an absolute.

Holtby says, “It is important to note that many individuals with heart disease do not have elevated cholesterol or other common markers for heart disease risk. Also important is that some individuals with elevated markers for disease have no disease present.”

No consensus about cholesterol has been reached, but it is recognized that more important than cholesterol level is the type. As the size of cholesterol particles decreases, cardiovascular risks may increase. For example, the small, dense particles in low-density lipoprotein (LDL) cholesterol can more easily penetrate arterial walls to cause damage.

West says, “The real issue is whether cholesterol being used in the body is becoming damaged by diet and lifestyle choices and whether it is being used for repair in the heart from inflammatory conditions. Checking blood levels of C-reactive protein, homocysteine, triglyceride levels and hemoglobin A1C are more accurate markers of health and are a reflection of how healthy one’s diet has been over time.”

Studies are also showing that dietary cholesterol may not be linked to blood cholesterol at all. In a recent WholeFoods Vitamin Connection two-part article, Passwater interviewed Sheldon Zerdon, author of the new book, The Cholesterol Paradigm: The Greatest Health Scam of the Century. The interview refutes the long-standing conviction that food cholesterol results in arterial deposits of cholesterol, and implies that such beliefs were based upon imperfect pharmaceutical clinical trials (see WholeFoods Dec. 2009, pp. 30 and Jan. 2010, pp. 42) that have affected the entire heart health industry ever since.

West agrees: “Cholesterol does repair injuries and tears in the heart’s vasculature, and can build up, but eating less of it does not prevent this from happening.”

Statin controversy. While some maintain that statin drugs are still appropriate in extreme cases, there is a growing belief that statin drugs are over-prescribed. There is speculation that the gradually decreasing LDL level required to begin statin treatment has been triggered by concern for wealth, not health. Ron Udell, president of Optipure Brand/Kenko International, Inc., Los Angeles, CA, says, “Exercise and eating right are always the most effective bastions for heart health, but the pharmaceutical industry’s push to market drugs that specifically target certain symptoms has proven more lucrative and thus takes precedence in most advertising.”

While the controversy and speculation will undoubtedly continue, the side effects associated with statins are real. West says, “Lipitor and Mevacor are taken by over 13 million Americans today. The side effects associated with these drugs are liver damage, muscle pain, weakness and fatigue. Even heart failure itself can result with long-term use. Repeated use of statins over time can deplete CoQ10, resulting in a weakened heart muscle and leaving one vulnerable to damage.”

Another side effect, says Murray is that statins can reduce the amounts of dolichols (compounds that help direct proteins to targeted cells) in blood, which can produce significant chaos in our body processes. The effect, he says, would be comparable to “a large city with no street signs or addresses; mail would never be delivered.”

Additionally, many people are up in arms about a 2008 AHA and American Pediatric Association guideline suggesting that children as young as eight with high LDL levels be given statin drugs. The effects of long-term statin use in children are not known, and many believe more emphasis should be placed on nutrition and exercise, rather than a quick fix for medical problems or lax parenting. Imagine the results of this faux safety net: kids could have their cake and eat it too; parents could take the whole family on a one-stop trip through the drive-through straight to the couch.

Sugarek notes that cholesterol is required as a precursor to five major classes of sterol hormones: progesterone, glucocorticoids, mineralocorticoids, androgens and estrogens. It is also used with vitamin D3 and bile salts that aid in digestion—all pretty important elements for growing bodies, on which statins’ effects in children are not known.

Adding to this, Udell says, “There is a higher risk of dependence with pharmaceutical heart medications because they tend to be more effective at masking the symptoms and thus lull the consumer into contentment with the status quo, rather than providing an impetus to make valuable and lasting changes to one’s lifestyle that can improve heart health.” And, that is dangerous to people of all ages.

Natural answers. Natural products offer a different pathway to heart health by addressing the root of the problem, rather than just masking symptoms. For example, red yeast rice and/or fish oil may be an answer to pharmaceutical statins. A Mayo Clinic study (3) involving 74 patients with hypercholesterolemia were randomized to receive the drug simvastatin or be part of the alternative treatment group (AG), which included therapeutic lifestyle changes, ingestion of red yeast rice and fish oil supplements for 12 weeks. Results showed a statistically significant reduction in LDL cholesterol levels in both the AG (–42.4% ± 15%) (P<.001) and the simvastatin group (–39.6% ± 20%) (P<.001). In addition, the AG demonstrated significant reductions in triglycerides (–29% vs –9.3%; 95% confidence interval, –61 to –11.7; P=.003) and weight (-5.5% vs -0.4%; –5.5 to –3.4; P<.001) compared with the simvastatin group. The study concluded that “lifestyle changes combined with ingestion of red yeast rice and fish oil reduced LDL cholesterol in proportions similar to standard therapy with simvastatin.”

If statins are still recommended by a doctor, omegas may still help (with doctor’s approval). According to another Mayo Clinic study, “Combination therapy with omega-3 fatty acids and a statin is a safe and effective way to improve lipid levels and cardiovascular prognosis beyond the benefits provided by statin therapy alone” (2).

Flaxseed may also be helpful for supporting healthy cholesterol. According to Herb Joiner-Bey, N.D., scientific advisor to Barlean’s Organic Oils, Ferndale, WA, flaxseed mucilages (indigestible, water-soluble fiber compounds) help lower undesirable fats, including LDL-cholesterol in blood and body tissues and can reduce the amount of LDL released by the liver. Also, flaxseed lignans, specifically secoisolariciresinol diglycoside (SDG), were shown in rabbit studies to reduce total cholesterol by 33%, decrease undesirable LDL cholesterol by 35% and increase desirable HDL cholesterol by 140% (4).

Also, vitamin E, in its various tocopherol and tocotrienol forms, is said to inhibit LDL oxidation and blood clotting.

Gene Bruno, M.S., MHS, consultant for Jarrow Formulas, Los Angeles, CA and dean of academics at Huntington College of Health Sciences, suggests the following natural remedies to support healthy cholesterol levels: pantethine (vitamin B5), artichoke extract and theaflavin, which can be found in green tea extract. Other herbal remedies include guggul and hawthorne extract.

In the Spotlight: Resveratrol
Resveratrol is a natural substance found in grapes, peanuts and Japanese knotwood and has become exceedingly popular in recent years. It is believed to be a large part of the explanation for the “French paradox” (eating fatty foods without resulting in poor health). Resveratrol supplements gain their appeal from offering the benefits of red wine without the alcohol content, sulfites, hangovers or excess calories.

A specific form of resveratrol, trans-resveratrol, is touted to offer the most benefits. Trans-resveratrol has been shown to activate the SIRT1 longevity gene and enhance cellular productivity. Trans-resveratrol has also been shown to inhibit pro-inflammatory enzymes such as COX-1 and COX-2, and exhibits cardioprotective effects and caloric restrictive behavior (5).

There has been some debate regarding resveratrol products and the source of the resveratrol contained within them, although there is no consensus as to whether or not there are any nutritional differences between sources. Most agree that the molecule is the same, but there is a possibility that co-nutrients, known and unknown, from various sources may be significant.

For example, says, James C. Perin, M.D., scientific advisor for ReserveAge Organics, Gainesville, FL, “Resveratrol derived from grapes has many important phytochemicals like quercetin that enhance and improve the ability of resveratrol to provide benefits as well as these other phytochemcials to benefit the health of individuals.”

One of these benefits includes its effect on plaque formation in arteries. Perin says, “Resveratrol has been shown to inhibit thromboxane that is found within the immune system. In vitro studies have shown that resveratrol inhibits blood platelets with a similar biochemical pathway as aspirin to reduce their response to clumping (forming clots) and reacting to tears in the blood vessel to form occlusions.”

Bruno also references a study showing that resveratrol can promote vasodilation (a relaxed and expanded state of the artery that accommodates increased blood flow) by increasing the production of nitric oxide that naturally occurs in the body (6).

Stress = A Cardiovascular Mess
We typically think of stress as the rush out the door, spilling our coffee, rush hour traffic and so on. Moreover, we are so desensitized to stress that we often forget constant anxiety wreaks havoc on our cardiovascular system. Rarely do we acknowledge that stress in our bodies begins at the cellular level. When our bodies don’t have proper amounts of certain nutrients in the correct balance, they begin to experience dysfunction, straining to work like rusty gears, rather than smoothly functioning like well-oiled machines.

Chronic stress overworks the immune system; Mitchell even calls stress the “silent killer.” Levels of the hormone cortisol are at their highest when you first wake; as you go through your day, cortisol levels are supposed to fall. But, because of our hectic lifestyles, cortisol continues to rise throughout the day, sometimes hitting its peak in the afternoon. This affects norepinephrine and dopamine levels, and the body is almost in a state of fight or flight all day long. Being in this phase all day, everyday punishes the body, which is constantly robbed of nutrition to feed an unnecessary deficiency. “So, if you’re not eating correctly and getting the vitamins and minerals you need to feed this stressful reality, your body is becoming depleted,” says Mitchell.

A petite, but important balance. Tiny micronutrients are probably the last thing we want to think of when faced with life-sized drama and stress. But one, magnesium, should be paid more attention, experts say.

“Magnesium plays important roles in electrolyte balance and is a component in hundreds of enzymes required for healthy biochemistry of all cells, including heart and artery cells,” says Passwater. Because of this, when one thing is out of whack, the entire system can become disturbed.

For example, says magnesium expert Carolyn Dean, M.D., N.D., the mineral is essential for healthy mood and mental clarity and can stave away depression. She writes: “People do not get anxiety, panic attacks or depression because they have a deficiency of Valium or Prozac. However, we can develop a myriad of psychological symptoms because of a deficiency of magnesium” (7). And, as Mitchell noted previously, the mental health has an extreme impact on the cardiovascular system. Thus, adding magnesium may be a simple way to begin addressing heart health in our frenzied lives.

Ken Whitman, president of Peter Gillham’s Natural Vitality, Burbank, CA, says, “As a result of factory farming and mineral-depleted soils, we are not getting enough magnesium from what we eat. So, for most of us, if we’re not taking a bioavailable magnesium supplement, we’re out of balance with calcium.” Simply put, without enough magnesium, calcium cannot function properly in the body.

Whitman suggests that many people may have too much calcium in their systems from diet or supplementation. This can be devastating to cellular and muscular function—and also to arteries.

Eric Anderson, brand manager at PL Thomas, based in Morristown, NJ, says, “Calcium is called the ‘ion of death’ because when a cell or tissue is injured, calcium will accumulate and finish the job. This is really an issue when considering hardening arteries—the process of calcium accumulation in the wall of the artery causing it to become rigid, inflexible and can lead to death.”

Retailers should be careful when recommending calcium supplements. Whitman says, “Most people think they should be taking 1,200–1,500 mg of supplemental calcium daily. They need to factor in what they are getting from their diets. Also, a lot of products (orange juice, for example) may include supplemental calcium. Most people won’t need more than 500 mg of supplemental calcium.” This should be discussed with customers, as well as which kind of calcium is taken, as not all kinds are equally absorbed. Whitman says that calcium carbonate, the most common kind, is the least absorbed, not to mention that pills and capsules are not as easily digested. Water-soluble powders and liquids are immediately bioavailable and easier on the digestive system.

The goal is to keep calcium out of arteries and in bones, where it belongs. Whitman says, “A heart supplement should contain more magnesium that calcium and no less that a 1:1 ratio. Vitamins D and K are also important.”

A vitamin K2-dependent protein called MGP (matrix GLA protein) is a potent inhibitor of vascular calcification. MGP circulates within the blood where it binds with calcium, preventing it from accumulating in vessel walls and thus removing it from arteries, keeping them clean and flexible. Simply put, says Anderson, “Without adequate vitamin K2 in the diet, MGP is inactive and cannot inhibit the calcification resulting in the increased risk of heart attack and negative outcomes.”

Warfarin and coumarin are commonly prescribed blood thinners. These drugs, says Anderson, slow coagulation and block vitamin K activity inside and outside of the liver, leading to increased cardiovascular calcification. Two studies show that patients on warfarin/coumarin have twice the cardiovascular calcification as control patients in as little as three years (8, 9). However, patients on blood-thinning medications should always consult their physician before starting a vitamin K regimen.

Adequate levels of vitamin K2 and vitamin D will keep bones functioning properly, putting calcium where it is needed. According to West, “Vitamin D deficiency is associated with increased risk of cardiovascular disease, including hypertension, heart failure and ischemic heart disease.”

But in addition to proper calcium absorption, vitamin D may be linked to heart health genetically. A 2009 study shows that patients with high blood pressure who possess a gene variant that affects an enzyme critical to normal vitamin D activation are twice as likely as those without the variant to have congestive heart failure (10).

Also, those with higher vitamin D levels may tend to spend more time outdoors in the sunshine, which can boost mood and decrease anxiety levels, leading to a happier heart.

Feeling the pressure. We’ve all felt our blood boil when under stress or feeling angry. What we really might be feeling is a temporary increase in blood pressure; but for some people, high blood pressure is a chronic condition related to stress, poor diet or the wrong combination of drugs.

Joiner-Bey says, “High blood pressure is an insidious risk factor for cardiovascular problems because high blood pressure is not associated with any specific symptoms of its own. In fact, hypertension is not a disease in itself; it is a sign indicative of other problems that lead to sustained elevated blood pressure. High blood pressure damages heart muscle, blood vessels and kidneys. It is the leading risk factor for stroke.”

Passwater says, “Often a reduction in salt (sodium) and an increase in potassium and magnesium are very helpful.” Others, he says, may respond well to nitric oxide-inducing nutrients such as carnitines, l-arginine and French maritime pine bark (Pycnogenol from Natural Health Science). A double-blind, placebo-controlled study demonstrated that 58 participants taking high blood pressure medication were able to cut their dosage of prescribed medication in half when they supplemented with the French maritime pine tree bark extract (11).

Holtby agrees that, “Nitric oxide (NO) plays a vital role in the health of the arteries and heart. It is primarily produced in the blood vessels’ endothelium where it increases blood flow, prevents fatty deposits from sticking to blood vessel walls, keeps walls from getting too thick and stiff, and prevents the arteries from narrowing. Certain nutritional supplements, like arginine (from which NO is produced), restore endothelial health.”

Other approaches include flaxseed oil (rich in alph-linolenic acid) and fish oil (source of omega-3s EPA and DHA), which can help normalize tension in the smooth muscle tissue of artery walls, allowing them to relax and allowing blood pressure to decline, says Joiner-Bey.

The other types omegas should not be forgotten, however. Gamma-linolenic acid (omega-6 GLA) found in borage oil and evening primrose oil have also demonstrated the ability to reduce elevated blood pressure (12, 13). Olive oil, rich in oleic acid (omega-9), can increase levels of the monounsaturated fatty acid in membranes, thus regulating the membrane lipid structure in such a way as to control G protein-mediated signaling, causing a reduction in blood pressure (14).
Bruno recommends that in addition to dietary modification (reduced sodium and calories and foods lower on the glycemic index), CoQ10 can be used as a first line of defense against high blood pressure.

SIDEBAR: Need Some Ideas for Resuscitating Your Heart Health Section?
Trisha Sugarek, national educator and research and development specialist for Bluebonnet Nutrition Corporation, Sugar Land, TX, says, “There is not a one-size-fits-all approach to maintaining the health of the heart, making it a difficult condition to tackle, because it is such a complex issue.”

Traditional herbal remedies for heart health include plant sterols and garlic.

Exercise some power over stress. It makes us feel and look good, but exercise certainly stresses us physically—from the tiniest cells keeping us moving, to the anguish felt while pushing to the limit. Athletes need to be sure their hearts are up for the challenge.

Gabe Herrick, sales manager of the Ribose Ingredient Division at Bioenergy Life Science, Inc., Minneapolis, MN, says, “ATP is necessary to ensure cellular integrity. Free radical formation takes place when adequate amounts of ATP are not available. Strenuous exercise, especially endurance exercise, can significantly deplete the heart’s healthy level of ATP.” Ribose allows the “heart to relax more, and become a more efficient pump,” he says. It may also reduce recover time, including stiffness and soreness, which increases the likelihood of sticking to a heart-healthy exercise routine.
L-carnitine and CoQ10 may also help improve tolerance to higher workloads. Kohli of Health Plus says, “The heart relies on CoQ10 to produce energy—the heart utilizes more cellular energy than any other organ.” CoQ10 may improve oxygen uptake in the mitochondria of the heart.

In addition, for athletes on high-protein diets, says Kohli, “Psyllium helps counteract the constipation effects of too much protein, which do strain and stress the heart.”

A Change of Heart
The population with pre-diabetic metabolic syndrome is estimated to be over 50 million Americans (1). Metabolic syndrome, also known as Syndrome X, is characterized by a group of metabolic risk factors including:

• Abdominal obesity (excessive fat tissue in and around the abdomen)

• Atherogenic dyslipidemia (blood fat disorders such as high triglycerides, low HDL and high LDL cholesterol)
• Elevated blood pressure

• Insulin resistance or glucose intolerance (the body can’t properly use insulin or blood sugar)

• Proinflammatory state (e.g., elevated C-reactive protein in the blood)

Diabetes is considered to be a strong indicator of cardiovascular disease risk and the above pathophysiology associated with it is known to be a causative factor. The educated consumer, however, is increasingly becoming aware of this link, says Paul Dijkstra, C.E.O. of InterHealth Nutraceuticals, Benicia, CA. “It is therefore no surprise that the market for heart health supplements alone grew by nearly 16% in 2007 to $1.5 billion, whereas the one for diabetes supplements increased by 6.6%, reaching an unprecedented $666 million in 2007,” he feels.

Despite this, many Americans still have trouble revamping their lifestyles. Mitchell says, “It’s almost the definition of insanity. People are doing the same thing everyday, but expecting different results.” At least 65% of people with diabetes die of some form of heart disease or stroke (1). This is because, Holtby says, “The free radical damage and glycation of tissue associated with diabetes damages the circulatory system and can damage organs such as the kidneys, eyes, brain and heart.”

Because of these dangers, Americans need to start improving their lifestyles to maintain a healthy body weight and Body Mass Index (BMI) through diet and exercise.

Everyone has body fat; fat is required for survival. But what most people have not yet recognized, is that the type of fat affects health, not just the amount. In fact, says Holtby, “Reducing the fat you can’t see, called visceral fat, may be more important than overall lean body mass for reducing the risk of certain chronic health conditions. Where fat gets deposited, particularly around our abdomen (central obesity) and our internal organs (visceral fat), can lead to an increased secretion of many important hormones and chemicals, including pro-inflammatory cytokines.” As a result, there can be an increase of oxidative stress and inflammation in the body, causing an avalanche of problems. Increased insulin production is just one of these problems, which leads to insulin resistance, which causes even more inflammation and stress—a highly destructive cycle.

“White” and “brown” fat are other ways of distinguishing types of body fat. White fat is where energy is stored and is easily visible on the body; brown fat is made up of more blood vessels, giving it its darker color. Brown fat, however, is not as visible or easy to get rid of, as it is usually located near the organs (viscera). “When it begins to accumulate in and around the viscera, it can potentially impede healthy organ function the way cancer does,” says Udell. “The best way to inhibit the accumulation of brown fat is the same as inhibiting the accumulation of white fat: healthy diet and exercise. The results may not change a person’s clothing size, but having healthy organs makes for a longer and higher quality of life.”

In addition to diet and exercise, a new, patented ingredient (Viscerol AI from OptiPure) derived from lemon balm, mulberry extract and Artemisia is an anti-angiogenic compound that specifically targets visceral fat. It works by inhibiting the formation of new blood vessels that are necessary for the addition of visceral fat cells. A randomized, placebo-controlled double-blind human clinical study showed that subjects taking 300 mg of the compound three times daily experienced a statistically significant reduction in visceral fat of 20%, which was more than double that of the placebo group. Results were achieved in 12 weeks when combined with a regimen of slightly reduced caloric intake and moderate exercise to produce a calorie deficit of ~500 K/cal per day (15).

Goodman confirms, “Eating a low-fat, low-sugar diet and finding ways to exercise and manage stress are essential to a heart healthy lifestyle.” WF

References
1. The American Heart Association, www.americanheart.org.
2. J. Lee, et al., “Omega-3 Fatty Acids for Cardioprotection” Mayo Clinic Proceedings 83 (3), 324–332 (2008).
3. D. Becker, et al., “Simvastatin vs Therapeutic Lifestyle Changes and Supplements: Randomized Primary Prevention Trial,” Mayo Clinic Proceedings 83 (7), 758–764 (2008).
4. K. Prasad, “Reduction of Serum Cholesterol and Hypercholesterolemic Atherosclerosis in Rabbits by Secoisolariciresinol Diglucoside Isolated From Flaxseed,” Circulation 99 (10), 1355–1362 (1999).
5. ReserveAge Organics, www.reserveage.com/faqs-pg-9.html, accessed January 6, 2010.
6. T. Wallerath, et al., “Resveratrol, A Polyphenolic Phytoalexin Present In Red Wine, Enhances Expression And Activity Of Endothelial Nitric Oxide Synthase,” Circulation 106 (13), 1652–1658 (2002).
7. C. Dean, The Magnesium Miracle (Ballantine Books, New York, NY, 2007).
8. L. Schurgers, et al., “Oral Anticoagulant Treatment: Friend or Foe in Cardiovascular Disease?” Blood (104) 10, 3231–3232 (2004).
9. R. Koos, et al., “Relation of Oral Anticoagulation to Cardiac Valvular and Coronary Calcium Assessed by Multislice Spiral Computed Tomography,” Am. J. Cardio. (96) 6, 747–749 (2005).
10. R. Simpson, et al., “Heart Failure Linked to Gene Variant Affecting Vitamin D Activation,”
Pharmacogenomics 10 (11), 1789–97 (2009).
11. X. Liu, et al., “Pycnogenol, French Maritime Pine Bark Extract, Improves Endothelial Function of Hypertensive Patients,” Life Sci. 74 (7), 855-62 (2004).
12. M.M. Engler, “Dietary Borage Oil Alters Plasma, Hepatic and Vascular Tissue Fatty Acid Composition in Spontaneously Hypertensive Rats,” Prostaglandins, Leukot. Essent. Fatty Acids 59 (1), 11–15 (1998).
13. M.M. Engler, “Comparative Study Of Diets Enriched With Evening Primrose, Black Currant, Borage Or Fungal Oils On Blood Pressure And Pressor Responses In Spontaneously Hypertensive Rats,” Prostaglandins, Leukot. Essent. Fatty Acids 49 (4), 809–814 (1993).
14. S. Teres, et al., “Oleic Acid Content Is Responsible For The Reduction In Blood Pressure Induced By Olive Oil,” Proceedings of the National Academy of Sciences of the United States of America 105 (37) 13811–13816 (2008).
15. Product Brochure, Kenko International, Inc./Optipure Brands, 2009.

Published in WholeFoods Magazine, Feb. 2010