CARDIOVASCULAR
By Jim Duke
ANECDOTE: As the drug companies bought up the vitamin companies,
the FDA and fizzicians concertedly denounced vitamin supplementation. Naturopath Steve Austin has summed it up nicely for us. Following the publication of two studies in the distinguished New England Journal of Medicine suggesting that vitamin E supplements dramatically lowered the risk of heart disease, leading cardiologists still advised their cardiovascular patients not to supplement antioxidants. But when asked if they took antioxidants to prevent heart disease, nearly 2/3rds of some 700 cardiologists said that they did. It's fine that these doctors are following the Biblical dictum, ‘physician heal thyself’ (St. Luke 4:23) but why not heal patients, too?
Especially with the big killers, cancer, cardiopathy and stroke, perhaps more so than the lesser killers, prevention is the better part of valorous wisdom. Even our National Institutes of Health paid lip service to that nearly a decade ago when coronary artery disease was affecting approximately 7 million Americans and causing about 1.5 million heart attacks and 500,000 deaths a year. Approximately 300,000 coronary artery bypass graft operations were being performed in the United States each year at a cost of about $30,000 each, or $9 billion total. (NIH 1994) But coronary bypass surgery saves few lives, only the most serious cases. If this 9 billion went instead into preventive medicines, the US health system would be better off, but I'll admit that a few coronary patients who avoided preventive medicine, would be worse off. “Thus, for health care reform truly to succeed at reducing costs and increasing access, disease prevention must be the ultimate focus of the primary health care system rather than disease treatment.” (NIH, 1994) Dietary modification, exercise, and blood pressure monitoring all tend to give the patient a sense of self control that in itself may be beneficial. Still, the pharmaceutical industry may not encourage life-style changes, which might cut into the US antihypertensive market, pegged at $2.5 billion a year in 1987. (CMR Aug. 31, 1987)
Consumer Reports (1995) indicates that modest (not all-tiring) exercise, i.e., biking, dancing, swimming, walking (no mention of sexercise, the real fountain of youth) reduces coronary deaths, raises “good” cholesterol, lowers blood pressure, and helps control weight, (not to mention strengthens the immune system, lowers cancer risks, alleviates stress, e.g. psychological stress, that wears on the adrenal and immune system, strengthens bones, and cuts diabetic risks). The biggest improvements in immunity come when previously inactive people exercise moderately, not when moderate exercisers overexert (CRH 7(4):39-39.1995). On the cholesterol side, their August issue says cholesterol-lowering drugs should be reserved for those who don’t respond to at least six months of diet and exercise, who have coronary disease or several risk factors for the disease, and who can expect to live many more years if they manage to avert a heart attack. (Aug. 1995. p. 91) Then in September of 1999, all the major TV and radio newscasts broadcast that moderate exercise (2-3 hours per week) lowered a ladyÕs chance for a gall-bladder operation some 30%.
If it made medical headlines in 1999, it must be important! Implication: drugs with both hypocholesterolemic and anti-inflammatory activity can reduce a person’s risk of heart disease, and that’s according to the Journal of the American Heart Association. Well, if itÕs important enough to them to trigger headlines, I think it could be even more important in the world of safer evolutionary phy-tochemicals. We have our herbs for lowering cholesterol (like garlic) and our herbal COX-2-inhibitory anti-inflammatory drugs (like the curcumin and turmeric).
NEW BIOLOGICAL TARGET
IDENTIFIED FOR
CHOLESTEROL-LOWERING DRUGS
Jan 22, 1999, all the radio and TV health columnists were blurting out a bigger 4-prong approach to weak hearts, and all four prongs could be derived from natural or from synthetic compounds, depending on our phytomedical persuasion or lack thereof. The four prongs were (slightly re-titled here to give me an A,B,C,D memory device):
1. ACE-Inhibitors (e.g. pycnogenol, a widely occurring, if not ubiquitous, constituent or mix of constituents in plants) exhibits a weak ACE-inhibition (Angiotensin-Converting Enzyme) activity. Procyanidins in hawthorn are
also said to be as effective as some of
the synthetics, and safer. A high molecular weight procyanidin fraction, derived from Areca catechu L. seeds, administered orally to spontaneously hypertensive rats produced an antihypertensive response equal to that of the ACE-Inhibitor, captopril, at equivalent doses.
2. Beta-Blockers (JAMA: July 14, 1999) had one article (p. 113) and one abstract (p. 116) praising their effectiveness. The article, prescribing for seniors, suggested that seniors, having suffered one myocardial infarction (MI) had a 43% reduction in mortality if given beta-blockers. They are still underprescribed, 20 years after being proven effective. “Underuse of beneficial drug therapy by seniors has been associated with increased morbidity, mortality, and reduced quality of life.” (Rochon and Gurwitz, 1999) (Sounds like the pharmaceutical party line to me). The abstract concluded that for patients having had a MI, aspirin, beta-blockers and lipid-lowering agents reduce risk of a second MI and death. In both accounts naive readers may miss the point that beta-blockers are not or should not be routinely recommended for hypertension, just for patients after the first MI. Messerli et al. (1998) say that beta-blockers “have been used for the treatment of hypertension for more than 3 decades. . .(N)o study shows that their use as a single hypertensive therapy in the elderly reduces mortality...beta-blockers do not reduce coronary heart disease (CHD) morbidity and cardiovascular and all-cause mortality.” In one case control study, risk of sudden cardiac death was higher in elderly patients receiving either a beta-blocker as monotherapy or in combination with thiazide diuretic compared with patients receiving other anti-hypertensive therapy (calcium-antagonists, angi-otensin converting enzyme inhibiting or potassium sparing diuretics. I (JAD) think that all doctors prescribing beta-blockers for seniors should read, understand and pass a quiz on all these articles before prescribing beta-blockers.
3. Calcium Channel Blockers and Cardioactive Digitalics. Do we believe JAMA in 1998 (Messeril et al.) or 1997 when Larson and Sheffield say: “...Lowering cholesterol level in middle-aged men with hypercholesterolemia reduced all-cause mortality by 22% after 5 years. Until randomized trials demonstrate that calcium channel blockers improve mortality, diuretics and beta-blockers should remain front-line agents in the treatment of hypertension.”
4. Diuretics: I’m a little afraid of some of the pharmaceutical diuretics, even though Mrs. Duke is taking one. I’d rather go with some of the herbal or phytochemical diuretics like birch, butcher’s broom, my celery seed, dandelion, goldenrod, nettles and string beans, or better yet natriuretics like aescin (in horse chestnut), alisol (in mud plantain), and kaempferol (in green tea). THE HOLISTIC HEART HEALTHY HAWTHORN has all these ABCDÕs for heart health. ACE-Inhibitor: procyanidins. Beta Blocker: catechin, epicatechin, procyanidins. Calcium-Antagonist: magnesium. Diuretic: adenine, apigenin, ascorbic-acid, caffeic-acid, chlorogenic-acid, epinephrine, esculin, hyperoside, luteolin, quercitrin, sorbitol, ursolic-acid. And that is in addition to the cholesterol lowering compounds (ascorbic-acid, beta-sitosterol 5,100-7,800 ppm, calcium, catechin, chromium, fiber, linoleic-acid, magnesium, pectin, rutin), anti-inflammatory (amygdalin, ascorbic acid, caffeic-acid, chlorogenic acid, epicatechin, huperoside, linoleic-acid, magnesium, sitosterol, ursolic acid, vitexin) and antioxidant compounds ((+)-catechin, apigenin, ascorbic-acid, beta-carotene, caffeic-acid, catechin, chlorogenic-acid, esculin, hyperoside, lupeol, luteolin, quercetin, quercitrin, rutin, selenium, sucrose, ursolic-acid). And there are more, but we’ll not bore you with all of them. The hawthorn presents a whole menu of potentially useful heart-healthy compounds from which your homeostatic human body can select judiciously (without you having to even think about it). According to He et al., (1998) aspirin therapy increases the risk of hemorrhagic stoke. However, its overall benefit on myocardial infarction and ischemic stroke may outweigh the increased risk for hemorrhagic stroke in most populations. Aspirin was introduced as an analgesic and antipyretic agent nearly a century ago. More recently (past 2 decades) we focused on aspirin’s effect on cardiovascular disease. Clearly, aspirin can reduce the risk of subsequent myocardial infarction and ischemic stroke among patients with a wide range of preexisting cardiovascular diseases. It is now widely used for primary and secondary prevention of cardiovascular disease in the general population. In one study of 15,735 middle-aged men and women, 30% of whites and 11% of African Americans were regularly using aspirin for prevention of cardiopathy.
My genes dictate that celery seed, echinacea and garlic be tops in my herbal hit parade, the celery seed to prevent the crisis of gout which all of us Duke boys have, and the echinacea and garlic to prevent and ameliorate the colds and flus that we all get once in a while, and to prevent the colon cancer that killed my father and two of his brothers in their 65th year. But there’s no history of heart disease in my dad’s or mom’s family. Peggy’s (my wife) family, yes; both her mother and father suffered heart problems. So in a sense, the hawthorn, for the prevention of heart disease belongs more in her herbal medicine chest than mine. But last year I thought it over and realized that the hawthorn should be added to my top dozen. No one, except me, in my immediate family smoked, but Peggy’s father, like me, smoked like a chimney, three packs a day. I have the tar of 30 3-pack-a-day years coating my lungs. So a heart attack just might be on the horizon for me, since I smoked and drank, while my father did neither. And even in retirement I am under the stress of 200 lectures a year, and more than 400 writing deadlines, including this one. Yes, racing to the airport, to the hotel, to the lecture hall, to the hotel, to the airport takes a toll on the heart. My physician has never seemed concerned. EKG’s have never raised any eyebrows. But an ounce of hawthorn is worth a pound of nitro.
But here I am reading more into the literature than some leading British and German scientists. Note that Newall, Anderson and Philipson in their Herbal Medicines for Health-Care Professionals (1996) say “In view of the nature of the actions documented for hawthorn, it is not suitable for self medication.” True! No one should self medicate a serious heart condition. Does that mean that one should not attempt to prevent a serious heart condition by food pharmacy? Yes, the hawthorn is a food. I ate hawthorn fruits of many species last year: one at the colonial garden at Plymouth, Mass., and another, much tastier, in the Coker Arboretum (with permission) at the University of North Carolina, my alma mater. Tanaka’s Ency-clopedia of Edible Plants lists dozens of edible species of Crataegus. Of the major medicinal species, Crataegus oxyacantha, he says: “Fruits are edible; leaves are used as a tea substitute.” Of the Chinese species, Crataegus pinnatifida, equally medicinal methinks, he says: “Fruit is consumed when candied, preserved, stewed, in sweetmeat or as jelly.”
Prospective trials at UCLA school of Public Health showed that as little as 500 mg vitamin C/day can decrease cardiovascular mortality up to 45%. It is critical in regenerating vitamin E (since it is cleared by the kidney, it must be watched in kidney patients). CoQ10 (ubiquinol) protects LDL cholesterol from oxidation, decreases LDL while raising HDL, and improves electron transport within the cell. Since this strengthens cardiac contraction, CoQ10 is good in congestive heart failure and cardiomyopathy. It is anti-hypertensive and reduces episodes of angina and nitroglycerine use in Coronary Heart Disease (CHD). Goldstrich prescribes CoQ10 for CHD patients still suffering angina pain despite full doses of anti-anginal drugs. Like vitamin E, fat soluble, it is better taken with fat in the meals. Since most patients on reductase inhibitors will feel better on CoQ10, Goldstrich prescribes it to reductase patients. Finally he moves from the nutrients to the botanicals. Goldstrich (1999) finds proanthocyanidins (from certain berries, grapeseed, hawthorn and pine bark [actually in most woody plants JAD]) very exciting. They appear to prevent plaque buildup in the endothelium, possibly preventing myocardial infarction if lesions are already substantial. For grapeseed extracts he suggests 100 mg standardized extract (StX), 300 mg as an upper limit. He cautions here that with other anticoagulants, like vitamin E, garlic, ginger, and ginkgo, bleeding times must be checked before such patients undergo surgery. He recommends Hawthorn StX, as a cardiotropic, in hypertension, and in some cases of arrhythmia. He cautions to watch grapeseed and hawthorn when taking other anticoagulants, apparently making this a caution for any high proanthocyanidin herb. He advises against mixing hawthorn with digoxin, “because their synergistic effect may increase the risk of digitalis toxicity.” Goldstrich recommends ginkgo, whose vasodilation improves blood flow. And he closes with a sour note for those of you elated by all the studies pushing red wine for cardiopathy prevention: “Despite clear preventive value, red wine may actually be harmful if pathology has begun. Some hypertensive patients and some with elevated triglycerides experienced a worsening of their conditions.”
According to Gaby (1998), olive oil, long a constituent of the so-called Mediterranean diet, is believed to be a cardioprotective factor, perhaps because it is rich in the MUFA oleic acid, which inhibits the oxidation of LDL cholesterol. There is at least one other compound in olive oil (and another substance in whole olives) that might prevent cardiopathy through a different mechanism. Gaby speculates that it is unlikely that the cardioprotective effect of olive oil could be duplicated by
other high-oleic-acid foods.” Actually some of the palm oil from Amazonian palms have more MUFA’s and are also rich in cardio-protective carotenoids and tocotrienols. Matter of fact, the palm oil may be our richest source of tocotrienols. I might as well push my Amazonian Heartwise Salad. Down in Peru we have the worlds best source of ascorbic acid, the great equalizer, said to add 7 years to a man’s life, 1 to a woman’s. That is the delicious fruits of the camu-camu, which will provide 400 mg ascorbic acid. Other ingredients in the salad include palm oil for the carotenoids, MUFA’s and tocotrienols, and brazilnut for the selenium.
Coming back again from the heartwise Amazon, I was surprised to see Food Farmacy all but recommended in American Medical News. ÒTo our knowledge, there are no single pharmaceutical interventions capable of inducing simultaneous improvements in these cardiovascular risk factors. (McCarron, DM et al., Jan 27, 1997) A nutritionally balanced diet, i.e., 17% fat, 62% carbohydrate, and 21% protein; meeting daily nutritional guidelines for the intake of sodium, fat, cholesterol, refined sugars, fiber and complex carbohydrates, fortified to meet at least 100% of the recommended dietary allowances for adults for most nutrients except vitamin D (77%) and copper (91%), benefits people at risk for cardiovascular disease (hypertension, dyslipidemia, or NIDM diabetes) and also improves quality of life. (American Medical News, Feb 10, 1997. p. 10)
HERBAL SUGGESTIONS FOR CARDIOPATHY
Angelica (Angelica archangelica): Some authors liken papaverine, a natural beta-blocker, to verapamil. Verapamil is effective in the treatment of angina, alone or in combination therapy. Verapamil hydrochloride is given orally at a rate of 80 to 120 mg, thrice daily, far exceeding anything we could find in the way of papaverine in poppyseed. In a surprising tribute to nature, Hollman (s.d.), Emeritus Consulting Cardiologist at University College Hospital in London, tells us that verapamil “is a derivative of papaverine which constitutes about 1% of the alkaloids in crude opium, largely if not completely absent in poppyseed.” Perhaps there’s more anti-anginal potential in Angelica, which contains 15 calcium antagonists, one more potent than verapamil. Perhaps we should chase our angelade with tonic water and poppyseed. Angelade consists of juiced angelica, carrot, celery, fennel, parsley, and parsnip juice. Could it conceivably be as safe, efficacious and cheap as verapamil as a calcium blocker? Angelica, of the carrot family, contains some 15 calcium blockers, possibly if not probably synergic, including one that is reportedly as strong as verapamil. Might that thereby partially explain the lower incidence of cardiopathy in vegetarians who indulge in angelica and/or other members of the carrot family?
Celery (Apium graveolens): Of rats fed a high fat diet for eight weeks to induce hyperlipidemia, those given a celery juice supplement had significantly lower total cholesterol, LDL-cholesterol and triglycerides. Interestingly the celery juice lacked the known lipolytic n-butylphthalide (Tsi et al., 1995). Four celery sticks alone have lowered hypertension in some subjects. Tsi et al., (1995) note that celery has long been recommended in Traditional Chinese Medicine (TCM) orally for dizziness, headache and high blood pressure.
Intraperitioneal infusion of aqueous celery extract significantly lowers the systolic blood pressure. 3-n-Butyl-phthalide is significantly hypotensive and hypocholesterolemic in experimental rats. With the 1999 push on anti-inflammatories for cardiopathy, especially in concert with hypocholesterolemic herbs, it is noteworthy that celery contains more than 2 dozen anti-inflammatory compounds.
Chicory (Cichorium intybus): This beautiful weed is our best source of the cholesterol-lowering phytochemical inulin. Inulin is also reportedly lipolytic
and may thereby decrease obesity, one of the contributors to cardiopathy. Egyptian researchers found that chicory slows a rapid heartbeat. Compounds in the roots (dried and roasted) have a weak digitalis-like effect, but in doses low enough to make it safe for anyone to use. Several commercial coffee substitutes contain roasted chicory. In France and Italy, the roots not only are consumed as a drink, but are considered a vegetable.
Digitalis (Digitalis spp): Hollman (s.d.) recounts the story of the discovery of digitalis. “William Withering wrote a British Botany Book in 1776 and stated categorically about a secret dropsy recipe, containing over 20 plants: “that the active herb would be none other than foxglove.” He studied the pharmacology of foxglove 10 years before publishing his Account of the Foxglove in 1785. Foxglove was said to have a power over the motion of the heart to
a degree not observed in any other medicine. Still, it became almost obsolete for nearly a century when James Mackenzie identified atrial fibrillation and demonstrated the unique activity of the purple foxglove in controlling the ventricular rate. The wooly foxglove was later found to be especially effective and digoxin was isolated by Wellcome Laboratories in 1935. Though there are at least 38 genera belonging to 13 families which yield cardiac glycosides, some of which like digitoxin, digoxin, oubain, and strophanthin, are well known, others have barely been investigated. Perhap’s Withering’s brilliant work has inhibited a thorough evaluation of other cardiac glycosides.”
Evening Primrose (Oenothera biennis): Gamma linolenic acid (GLA), the major active ingredient in the oil (also in borage, currant and hempseed oil) inhibits platelet aggregation, reduces blood pressure, and restores the motility of red blood cells (all useful attributes at preventing cardiopathy). Reviewing the literature, Fan, Chaplkin and Ramos (1996) note that gamma-linoleic-acid (GLA) may inhibit a number of cardiovascular pathologies, including cardiac arrhythmia, hypertensive responses, platelet aggregation and hyperlipidemia. Interestingly, though the GLA content of borage oil (BO) is twice that of evening primrose oil (EPO), GLA-related effects, e.g. formation of prostaglandin (PGE1) and blood pressure lowering effects are comparable for both sources. In what could be synergy or additivity, dietary combos of GLA and fish-oil Poly unsaturated Fatty Acids (PUFA) preferentially enhance macrophage biosynthesis of PGE1 relative to PGE2, significantly decreases smooth muscle cell (SMC) proliferation, and “is capable of exerting a potent antithrombotic effect. . . .The combination of fish oil and EPO, but not BO, synergistically down-regulated SMC DNA synthesis. These data
suggest that EPO may have superior anti-atherogenic value in comparison
to BO, especially when combined with an (n-3) PUFA source. . .BO and EPO alone or in combination with fish oil influence macrophage/smooth muscle cell interactions in a manner consistent with favorable modulation of the atherogenic process.”
Garlic (Allium sativum): I had hoped that the American Association of Retired Persons (AARP) would come around to take a more pro-herbal stance, since the elderly are being priced out of the pharmaceutical market. We heard on TV in November of 1999 their drug prices have gone up more than twice the national average. Nowhere more than chronic diseases like cardiopathy, cancer and diabetes. Do diet (including our herbal supplements) and exercise hold more promise, so much safer and cheaper than the pharmaceuticals? But regarding garlic, Baker (1999) seems to listen more to JAMA with its questioning of the hypocholesterolemic activity of garlic, than with the excellent summary book on garlic by Koch and Lawson, tabulating much more dramatic hypocholesterolemic studies. “Evidence from studies so far is inconclusive.” says AARP writer Baker. Sad! Too bad!!! If garlic is one of the best studied herbs (it is) and the data are still inconclusive (as Baker says; I say its conclusive), then that puts into more serious question the less studied herbs. My conclusion, garlic is better than Zocor. I wish I could find an unbiased statistician, to study all the garlic studies and all the Zocor studies, and the sources of funding for same, and conclude which is safer. More efficacious? We are sure which is cheaper. Baker quotes studies by O’Hara who reviewed 7 trials, 4 neutral (no change in cholesterol), and three showing reductions of 6-11%. (Baker, 1999) Koch and Lawson reviewed many more, much more positive studies. Many of the so-called negative studies did not study herbal garlic at all but deodorized and coated pills (some of which pass
thru undigested). It’s time for me to
mix up an anti-cancer, anti-coronary, anti-gout, hypocholesterolemic and hypotensive juice of the real McCoy: fresh garlic juiced with celery and carrots, and the antiprostatic tomato, with some pink grapefruit as a chaser, perhaps potentiating the herbal medicines like it potentiates one third of pharmaceuticals.
I quite agree with Baker’s recommendations to buyers. US and European botanicals are usually the best quality. FDA requires labeling with the plants common or scientific name and plant parts involved. Buy from reputable dealers whose label includes the company’s address, the batch or lot number, the expiration date and dosage guidelines. I’d add that the label should indicate if it is standardized and on what chemical(s) it is standardized and how much per capsule: there should be an 800 number for inquiries. Anderson quotes the American Botanical Council (ABC; of which I have been a trustee from its
outset) and its not-so-conservative estimate that “one third of all adults...have turned to herbal pills and powders, teas and tonics, in the search for cheaper, gentler, natural alternatives to mainstream medicine.” I like, but am not sure I believe, Baker when she says “Roughly half of the drugs sold in the United States are derived from plants.’ I do believe her when she says, “Some 80 percent of the world’s people still use herbs - leaves, roots, berries or extracts - as their primary source of medicine.” (Baker, 1999)
JAMA tells us that garlic oil doesn’t lower cholesterol. But the oil with which they toiled contained no allicin at all. Recently CNN approached me about
a JAMA article which they said showed that garlic was useless for lowering cholesterol. The article by Berthold only showed that the poor brand of garlic oil they used did not lower cholesterol. (Berthold, 1998) (I’ll bet my wild garlics and ramps would do better than their expensive coated (and poorly absorbed) product). You see their product not only was poorly absorbed, it was also devoid of the most important active ingredients. First let me chastise the writers and reviewers of the Berthold article for (1) not recommending diet (except for tending to drive people away from one of the best dietary approaches to high cholesterol, whole garlic or garlic powder) and (2) not recommending exercise, and more importantly (3) not telling what the hypercholesterolemics should take, if not garlic. Berthold et al. were negative on one good thing, and omitted reference to the other good things. They should have compared whole garlic and standardized garlic powder against the pharmaceutical hypochoelsterolemic pharmaceuticals, not garlic oil (devoid of alliin, allicin and diallyl sulfide, the major active ingredients, well known to all).
My letter to JAMA following their harshly critical article on garlic was unpublished. HereÕs my note to CNN who failed to air the criticisms I accurately leveled at the Berthold paper when they interviewed me in the backyard and filmed me blending garlic and carrots in the kitchen.
“(CNN) Reckon I bombed. Please ask your supporters of Berthold if the product studied in the JAMA study contained any alliin, allicin, or diallyl sulfide (if it did, it was not reported). And then ask any garlic researcher what are the major active ingredients of garlic. Their study did not recommend diet and exercise to my recollection. Those intelligent alternatives are more often made by the “quacks” than by the AMA. Berthold et al. (1998) concluded, and I quote exactly BECAUSE THEIR FINAL CLAUSE WAS MISQUOTED WIDELY, dropping as did I the qualifying clause “based on the results of the present study”. But here’s what the allopathic world was quoting, the second half “there is no evidence
to recommend garlic therapy for lowering serum lipid levels.” Theirs was a 12-week study of 25 patients dosed twice daily with enteric coated “Tegra” containing 5 mg of steam-distilled garlic oil bound to a matrix of beta cyclodextrin or matching placebos whose coatings tasted like garlic. The authors equate this 10 mg garlic oil with 4 g to 5 g of fresh garlic cloves or 4000 units of allicin equivalents per day. “The active ingredients are the stable compounds diallyl disulfide (30%) and diallyl trisulfide (25%) which are formed from alliin and allicin upsteam.” ‘There was a slight increase in all lipoprotein fractions during active drug (garlic) treatment compared with placebo, none statistically significant.”
If we can believe the authors, all three studies (including this one) that showed no influence of garlic on cholesterol were well designed, while they seemed to think they have trashed, as poorly designed, the 2 meta-analyses (including one that included 1365 individuals) and a recent study that showed small but significant effects on serum lipoprotein levels. Strangely, Berthold et al. (1998) admit that “few studies have used steam-distilled garlic oils or oil-macerated garlic.” Still they say, “Based on comparison of the content of active ingredients, the dosage of our study medication would be relatively high.” But they as MDs and pharmacists will know better than this botanist how many of the above hypochoelsterolemic compounds were eliminated in steam distillation. I read their article and interpret them as saying that their steam distilled oil did not contain the most important ingredients, alliin, allicin, ajoene, and diallyl sulfide. The following are the only compounds they name as suspected actives. “In vitro data in rat hepatocytes suggest that allicin and ajoene inhibit cholesterol synthesis at various steps or inhibit acetate uptake into liver cells respectively.” Having reread their paper a second time, I’d like to restate their conclusions in their words.
“Absorption of cholesterol was not affected by garlic,” i.e., “10 mg (Tegra’s) steam-distilled oil” which “contain(s) only polysulfides and other volatile thioallyls.”
MY CONCLUSION
“Cholesterol metabolism at multiple metabolic sites is not influenced by “10 mg (Tegra’s) steam-distilled oil” which “contain(s) only polysulfides and other volatile thioallyls.”
THEIR CONCLUSION
That’s not exactly how they conclude: “(T)here is no evidence to recommend garlic therapy for lowering serum lipid levels.” What they should have concluded is that, under their 12 week study of 25 moderately hypercholesterolemic people Ò10 mg/day (Tegra’s) steam-distilled garlic oil (minus many of garlic’s active ingredients) did not lower serum lipid levels.” I’ll go with that rephrased conclusion. Tegra ain’t garlic! Garlic lowers cholesterol, at least that’s my heartfelt opinion!!
Hawthorn (Crataegus spp.): As I was writing this on Nov. 6, 1999, I for the first time enjoyed (or feigned pleasure) my ripe hawthorn fruits, mostly hard osseous seeds with a little sweet red pulp around them, no doubt containing some carotenoids and ascorbic acids. Not very good food, the fruit of the hawthorn, but probably healthier than most. Reminds me of that paleolithic diet that is supposed to prevent cancer and cardiopathy. Those paleolithic goodies werenÕt very good, that is pre-agricultrual beans and berries, fruits and roots and shoots, seeds and weeds.
Schulz et al. (1998) note that there are only a few cardiovascular herbal applications whose safety and efficacy have been adequately proven, including hawthorn for coronary insufficiency and heart failure, garlic for atherosclerosis, ginkgo extract for arterial occlusive disease and horsechestnut for chronic venous insufficiency. With hawthorn, 4 to 8 weeks may be needed for significant improvement in subjective complaints and exercise tolerance. There’s a suggested daily dose of 160-900 mg hawthorn extract with known content of 4-30 mg flavonoids or 30-160 mg oligomeric procyanidins (OPC’s). In vivo and in vitro studies show an increased amplitude of myocardial contractions and increased stroke volume. Coronary flow and heart rate was increased in isolated guinea pig heart, but the heart rate is decreased in various anesthetized animals. Extracts are clearly anti-arrhythmic, with decrease in ventricular fibrillations (0.5 - 5 mg/kg). Though hawthorn is positively inotropic, it appears “to stabilize the heart rhythm.” Almost all clinical trials showed improvement, even at doses below 300 mg/kg. Hawthorn significantly increases exercise tolerance. As a positive inotropic agent and a peripheral vasodilator, hawthorn is a double whammy. In early heart disease, hawthorn seems better than digitalis for its broader therapeutic window, little danger, no arrhythmogenic potential, and little or no renal impairment, increased tolerance to oxygen deficit. Diuretics and laxatives can be safely used with the hawthorn but require potassium monitoring with digitalis. “The hawthorn preparation offers better tolerance than the ACE inhibitor captopril while providing equal therapeutic efficacy...There are no known risks, contraindications, or drug-drug interactions.” No deaths resulted from oral or intraperitoneal doses of up to 3,000 mg/kg. Above 3,000, there was dyspnea, sedation and tremors. Rats and dogs given doses of 30, 90, and 300 mg/kg/day for 26 weeks exhibited no toxic effects.
Grapes (Vitis vinifera): Red wine is well endowed with bioflavonoids. Cardiac fatalities in older gentlemen were inversely related to the consumption of flavonoids. Flavonoids in red wine, especially quercetin, are said to be far more effective than vitamin E in preventing the oxidation of LDL cholesterol. Flavonoids do benefit the heart apparently, but according to John D. Folts, Univ. of Wisconsin, it takes a lot of wine - 3 times the legal limit for driving - to help the heart by reducing platelet aggregation. Working with monkeys, Folts studied the effects of encapsulated flavonoids on their blocked arteries. They work as well as or better than aspirin at slowing
platelet aggregation and thus unblocking the monkey’s arteries. He notes one important advantage to flavonoids: “Adrenaline can completely wipe out aspirin’s beneficial effects. But adrenaline doesn’t affect the flavonoids.” Whether due to alcohol or flavonoids, or both, synergetically, a drink a day may protect the heart. Remember that more than moderate drinking (not defined here) damages the heart. (Science News Dec. 2, 1995. p. 380) Proanthocyanins in red wine are both radical scavengers and xanthine-oxidase inhibitors. The vasorelaxing activity of wine is believed to be due to quercetin and tannic acid. Polyphenols range from 735 to 2,860 ppms in red wine, 260-720 in white wine. Superoxide radical scavenging activity of red wine was 5-10 times higher than that of white wine, the redder the wine the more the scavenging. In vivo lipid peroxidation has been implicated in many coronary malfunctions and ailments, like atherosclerosis, in aging and cancer. Phenolic constituents also inhibit cyclooxygenase and lipoxygenase of platelets and macrophages, thereby reducing thrombotic tendencies (Sato et al., 1996). Some 30 long-term studies suggest that the moderate drinker (1-2 drinks a day) reduces their heart attack risk 25-40%. Finnish researchers found that men who had up to 12 drinks a week
had only half the risk of clot-related strokes as teetotalers. (Men’s Health, Jan/Feb/1996. p 94). Phenolic compounds from red wine inhibit LDL oxidation even better than alpha-tocopherol. Phenolic antioxidants in red wine include anthocyanins, catechins, flavonols and tannins, “suggesting that red wine could decrease oxidation-induced atherosclerosis.” The same could be said for many fruits and vegetables without the heavy baggage of ethanol.
Motherwort (Leonurus cardiaca): Schulz, Hansel and Tyler (1998) note that Commission E’s 1986 monograph recommends extracts of motherwort for nervous heart conditions, at daily doses of 4.5 g crude drug. Motherwort is found in many “patent” cardiovascular teas in Germany, some in combination with hawthorn.
Purslane (Portulaca oleracea): Probably overdosed with propaganda for the health benefits attributed to the so-called omega-3 fatty acids, vegetarians have been actively seeking vegetable sources of these health-promoting acids. Writing in the prestigious New England Journal of Medicine, NIH scientists Artemis P. Simopoulos and Norman Salem (1986) say, “Purslane is the richest source of omega-3 fatty acids of any vegetable yet examined.” Let me insert the word leafy before the word vegetable to make the above sentence more accurate. Oils of wild walnuts and
butternuts are magnitudes higher than purslane, the wild vegetable, in omega-3 fatty acids, recently suggested to lower our risks for heart diseases, perhaps even cancer. While Rudin’s book The Omega-3 Phenomenon hints at more than 50 ailments alleviated by omega-3’s. Our FDA states, “In summary, there is no general recognition of the therapeutic role of omega-3 fatty acids in human nutrition and health at this time.” I’m more inclined to believe Rudin. Elsewhere, after a cursory study of the claims for omega-3’s, I concluded: “As with most other compounds, too little or too much of a given fatty acid can probably be harmful. Be modest...consuming a variety of wholesome oils, or better yet, the seeds from which they are expressed. Variety is the spice of life, perhaps the fountain of youth, with the wide array of antioxidants in a varied unprocessed diet of natural seeds. (Organica, 1989) “While not outstanding as an omega-3 source when compared to seeds, the wild vegetable purslane is a forager’s treasure in the dead heat of summer, and can be dried, pickled, or canned for later use in winter. I dry it like I do my culinary herbs, slowly, out of direct sunlight; then, I crumple the dried herb into my winter dried bean soups. The mucilaginous purslane is almost as good as okra or “file” (dried sassafras leaf) as a soup thickener. In her book, The Omega Plan, Artemis Simopoulos, indicates that Americans normally get 14-20 times more omega-6 than omega-3 fats. That’s way out of line with our paleolithic ratios, which she estimates at closer to 1:1. She suggests that getting closer to our paleolithic omega3:omega6 ratio might eliminate many of the diseases that have increased dramatically in Japan, since their traditionally high omega-3 intake was supplanted by high-omega-6 veggie oils. These diseases include: ADHD, Alzheimer’s, arthritis, asthma, depressions, diabetes, heart attack, insulin resistance, lupus, obesity, postpartum depression, schizophrenia, and stroke. If you read this fascinating book, you’ll get her feeling, perhaps overoptimistic, that these ailments might often be helped by eating more fish and alpha-linolenic-acid (ALA), a chemical generously provided by one of the weeds our ancestors ate. Dr. Simopoulos found that purslane she collected near her NIH office contained 4,000 ppm ALA, such that a 100 gram serving provided 400 mg ALA. Artemis also noted that purslane seeds, Greek in derivation, were found in a cave in Greece that was inhabited 16,000 years ago. Historically, she says, early humans got their omega-3Õs in seafoods, sea vegetables, nuts, seeds, and green plant leaves. She says the omega-6Õs are concentrated in grains and seeds which didn’t increase in our diet until the development of agriculture about 10 millennia ago. Artemis, like me, has come to the conclusion that one serving of purslane fulfills the daily requirement for vitamin E (usually difficult to do dietarily), while providing significant quantities of ascorbic acid, beta-carotenes, and glutathione. According to Dr. Simopoulos, Theophrastus (372-287 BC), the father of botany, recommended purslane for heart failure. His recommendations for heart patients may have been better than the American Heart Association’s. Some 600 French patients recovering from heart attacks were put on the AHA “prudent diet” high in omega-6 diet, or on a modified Cretan diet, with canola oil as a major source of omega-3 ALA. Dietary ALA was clearly diverted into cardioprotective EPA and DHA. Four months into the trial, there were already significantly fewer side deaths in those on the Cretan diet than on the AHA diet. (NO OTHER HEART DIET OR DRUG HAS SHOWN A LIFE-SAVING EFFECT EARLIER THAN 6 MONTHS). Two years into the study, it was discontinued because it seemed unethical to expose patients to the AHA recommended diet when the Cretan diet was so much better. The Cretan diet resulted in a 76% lower risk of dying from cardiovascular disease or suffering heart failure, heart attack or stroke. The new diet was more effective at saving lives than anything ever studied.
And there’s a sequel worth repeating in this book on disease prevention, life extension, and youth preservation. The Cretan men with the winning diet never had their cholesterol in the AHA desirable levels (under 180 mg/dL) even at their best (age 40-59 in 1960). It averaged closer to 200. Now that they are 70-90, it’s gone up, averaging 220. They have grown on to be active healthy seniors. That’s why you’ll hear me harping on chiso, flaxseed, purslane and walnuts, especially for those who don’t, can’t or won’t eat fish, a better source of omega3s, hoping to help you get back closer to those youth-preserving paleolithic omega3;omega6 ratios.
Spinach (Spinacia oleracea): I lead off this folic acid paragraph with spinach, only because its better known to most of my readers than edible jute (jew’s mallow, mulakiya). But with some of the other better sources of folate, we could cook up a FOLK FOLIC FOLLY: Folacin (folic acid), not plentiful in plants, is highest in edible jute (Corchorus olitorus) at 32 ppm (Zero Moisture Basis) (among reliable entries in my database), spinach at 27, endive at 25, asparagus at 18, parsley at 18, okra at 10, pigweed at 10, and cabbage at 9 ppm’s, on a calculated zero moisture basis. Nine parts per million converts to 900 micrograms (ug) per 100 g (1/2 cup), but to convert to dry weight you need to divide by 10 if the water content was 90%. According to Consumer Reports on Health 7 (CRH7): p. 63, 1995, on a fresh weight basis, 1/2 cup black eyed peas will provide 45% of the RDA of 400 micrograms of folic acid, or 180 micrograms (ug); 1/2 cup lentils 180, one avocado 164 ug, 1/2 cup sunflower seed 160, 1/2 cup pinto beans 148, 1/2 cup garbanzos 140, 1/2 cup lima beans 136, 1/2 cup spinach 132 ug, 1/2 cup lima beans 128, 1/2 cup kidney beans 116, 1/2 cup asparagus 96, 1/2 cup peanuts 88, 1 cup orange juice 76, one cup lettuce 76, one cup escarole 72, 1/2 cup peas 52, 1/2 cup broccoli 48, and 1/2 cup Brussels sprouts 48 micrograms on an as purchased basis. (CRH7: 61.1995) Folic acid can reduce homocysteine levels, converting it back to methionine, which does not foster arterial damage. Hence Werbach (1993) suggests 5 mg folic acid a day, under medical supervision. We could however get this much from lentil or other bean soups. It took a long time for the FDA and fizzicians to admit that some of us might be helped by folic acid. All of a sudden it’s legal and fashionable. Finally it’s legal not only to fortify with folate, it’s recommended, and it’s legal to make health claims about it. In JAMA, University of Washington researchers (Boushey et al. 1995), using various assumptions, estimate that 13,500 to 50,000 deaths could be avoided annually by folate supplementation. “The deaths of more than 30,000 men and 19,000 women might be prevented with the 350 ug fortification scheme.” How many lives would have been saved had the FDA moved a bit faster on folic acid? By lowering levels of homocysteine and its related moeities, higher folic acid intake “promises to prevent atherosclerotic disease.” Increasing folic acid intake by only 200 ug/day significantly lowers homocysteine.
Stampfer and Rimm (1996) lament about folate like I’ve been lamenting about my orphan herbs, they urge immediate randomized trials of homocysteine reduction with folate. ÒBecause there is little commercial interest and incentive to test such an inexpensive and nonpatentable intervention as folate (in contrast to cholesterol-lowering medication), the National Institutes of Health must step in to serve the public’s interest to fund such trials. Further delays cannot be justified... If proven effective, lowering the homocysteine level could prevent tens of thousands of cases of cardiovascular disease each year at very low cost and with few (if any) adverse effects.Ó (Stampfer and Rimm, 1996