By Stephen T. Sinatra, M.D., F.A.C.C., F.A.C.N., C.N.S., C.B.T.
Recently, NGVC’s nutrition writer sat down with integrative cardiologist, Dr. Stephen Sinatra to discuss his holistic approach to cardiovascular health. Here is what he had to say…
LW: You are a board certified cardiologist, but your approach to cardiovascular health is not entirely conventional. You practice something you call “metabolic cardiology.” Can you explain what that is?
SS: Metabolic cardiology describes the biochemical interventions used to improve energy metabolism in the heart. The heart uses a large amount of energy, in the form of adenosine triphosphate (ATP), to function. The body is continuously making ATP, but when people have any form of heart disease—whether it’s a diabetic heart, an alcoholic heart, someone who has had a bypass or a heart attack or even an otherwise healthy person with hypertension, any sick heart—their hearts’ cells are losing ATP and overtime, the body can’t make it fast enough to refill the tank. What metabolic cardiology is all about is preserving the heart’s cells with the substrates it needs to make ATP. If you give it what it needs—CoQ10, L-carnitine, D-ribose and magnesium—the heart has an incredible innate intelligence to repair itself. When you give it the right nutraceutical support, the heart’s energy machinery, the mitochondria, can produce more ATP. The heart needs ATP for systole and diastole (contraction and relaxation) but the heart also needs ATP to repair and rejuvenate itself. When you give a cell ATP, the cell is able to repair itself.
When you increase ATP to any cell, you’re increasing the pulsatile activity of the cell, allowing the cell to function better, allowing more nutrients in, more toxins out. When you do that, you really invigorate, regenerate and revitalize the cell—that’s what metabolic cardiology is all about.
LW: CoQ10, L-carnitine, D-ribose and magnesium make up the foundation of your nutraceutical protocol to treat a sick heart. Why these four nutrients?
SS: If you add ribose to CoQ10 and carnitine and magnesium—I call it the “awesome foursome”—you literally create a rocket fuel supply for the heart. Ribose forms the sugar in the ATP molecule. CoQ10 and carnitine increase the turnover of ATP in the mitochondria, and magnesium is the glue that holds this whole reaction together. Even though I’ve had enormous successes with CoQ10 alone—I’ve had people come off heart transplant lists—and even though I’ve had incredible success with a combination of CoQ10, carnitine and magnesium, about 10 to 15 percent of my patients didn’t get better. But when I added ribose to the combination, then I was literally getting 99.9 percent of patients improving.
LW: Can everyone benefit from taking the “awesome foursome” or only those with a sick heart?
SS: I use the awesome foursome in cases of metabolic syndrome, type-2 diabetes, hypertension and in athletes. I think any illness would respond to the awesome foursome because when you fortify the ATP (energy) supply, you’re going to rescue tissues in need.
LW: The focus on risk for heart disease has primarily been on cholesterol and blood lipids. Are these reliable markers, or should we be looking at other risk factors?
SS: These are dinosaurs. First of all you have to believe in the theory that cholesterol causes heart disease, and that theory has been beaten to death. There’s a lot of doubt about cholesterol causing heart disease. Half of the people that I have treated with heart disease had normal levels of cholesterol so I don’t really believe in this theory. Cholesterol is found at the scene of a heart attack, but it’s not the perpetrator. Instead, we should look for inflammatory markers like C-reactive protein, interleukin-6, homocysteine, lipoprotein lipase and fibrinogen—especially in postmenopausal women who smoke. These are the blood markers that I worry about a lot more than cholesterol. C-reactive protein has been shown in the literature of the Women’s Health Study to be a far more significant risk factor than native LDL cholesterol. You see, when cholesterol is native, and it is not oxidized, it is harmless in the body. It forms your sex hormones, it forms your neurotransmitters, it reacts with vitamin D in your skin to form the active form of vitamin D, it lubricates the skin and it is one of the most important things in response to injury, as well. We need cholesterol.
LW: Can you talk about the roles sugar and refined carbohydrates play in cardiovascular health?
SS: People with type-2 diabetes, metabolic syndrome and insulin resistance get heart disease at an alarming rate and it’s because they have problems with sugar metabolism. I believe sugar gives you heart disease, not cholesterol. Sugar is useless in the body—it’s full of dead calories. Whenever we eat sugar and refined carbohydrates, we get an insulin response. We know now that insulin is a pro-inflammatory hormone. People are drinking sugary sodas, adding sugar to their tea and coffee, eating breads, and pasta, and bagels, and donuts and cookies—we’re a sugar society. And then there’s high fructose corn syrup, which is even worse than sugar. These sugars and refined carbs turn on an insulin response and insulin causes inflammation of blood vessels. If you have surging insulin levels going back and forth with high sugar, insulin, high sugar, insulin, etc. (i.e. the blood sugar rollercoaster) it causes the cells to become inflamed and sets the process for inflammatory atherosclerosis. Even as a medical student, we were told that the average diabetic ages 15 years quicker than the average non-diabetic. But it makes sense—if you have problems with sugar metabolism, you’re going to age quicker, and we know now that it’s because the sugar and proteins create glycolated proteins in the body, and these cause accelerated aging. I worry about people who are overweight and who eat a lot of sugar—those are the risk factors for heart disease, not cholesterol.
LW: The American Heart Association recommends a low-fat, high-carbohydrate diet for reducing the risk of cardiovascular disease. Do you agree with this recommendation?
SS: Another dinosaur. That was created back in the 1970s, when the AHA came down on saturated fat, but nothing’s further from the truth. A low fat, high-carbohydrate diet is a ticket for developing insulin resistance. The Heart Association is wrong here. They should be preaching a low carbohydrate, moderate healthy fat, moderate protein diet. When you eat healthy, high-quality proteins, especially organic proteins like wild fish, or bison or range-fed beef, for example, you are eating non-inflammatory foods. And healthy fats like those found in nuts, or omega-3s and monounsaturated fats, do not set off an insulin response. The more healthy fats and healthy proteins you eat, you get a lower insulin response, and therefore a lower risk for developing heart disease. The diet for America should not be low fat, high carbohydrate; it should be moderate fat, lower carbohydrate. This is one of the reasons we have so many people with type-2 diabetes in this country—we are eating too many sugars. Sugars are disguised in a lot of foods, and a lot of those sugars are in the form of high fructose corn syrup, which has its own baggage.
LW: You’re familiar with the JUPITER study, in which statin drugs were shown to lower C-reactive protein levels (inflammation) and were thus recommended for use as preventatives for heart disease in healthy people. What are your thoughts on this?
SS: It’s another ploy by the drug companies to increase their market. It’s true that statins will lower C-reactive protein, and I’ve used them, but I would not use a statin to lower inflammation. First of all, many of the subjects who were placed on statins developed metabolic syndrome and they stopped the study early. Basically the drug companies are trying to corner another market, but there are so many natural ways to combat inflammation. You could take fish oils, for example; CoQ10 and vitamin E will lower C-reactive protein; losing weight can lower C-reactive protein; exercise lowers it; nattokinase lowers it nicely. There’s a whole host of lifestyle or nutraceutical interventions you can use to lower inflammation. Why use a drug that can increase a woman’s risk of breast cancer, give people polyneuropathy (a neurological disorder) or cause problems with memory? Furthermore, statins inhibit the pathway the body requires to synthesize CoQ10.
LW: You mention in your book, The Sinatra Solution, that there is quite a bit of information about these nutrients in the medical literature, yet most cardiologists don’t know much, if anything, about the use of nutrients in healing the heart. Do you see that changing in the future?
SS: Absolutely. At least once a week, I get a call from a board-certified cardiologist, or a pediatric cardiovascular surgeon or a cardiovascular physiologist and they say, “This (metabolic cardiology) makes so much sense…” Metabolic cardiology is more of a system of biochemistry, and conventional doctors can relate to that—they can’t relate to a vitamin-like substance like CoQ10. I think there’s a whole new era of medicine emerging, and we’re going to call it metabolic medicine and I think it’s all going to come out of metabolic cardiology.
This interview was originally published in Health Hotline, a free monthly nutrition newsletter by Natural Grocers Vitamin Cottage. HMDI has reprinted it with permission.