What does a personalized approach look like when working with an integrative functional medicine practitioner to prevent or treat cardiovascular disease? With the aim of reducing the risk of heart attack, strokes, and other vascular disease, we consider the person's history, their nutritional status, their environment, their gut health, and more in order to create a personalized protocol.
Diet is always the key part of any health protocol, mainly because 90% of your immune system is in your GI tract. What you eat becomes the building blocks and structure that your body uses to build and heal. Food also communicates important messages to the body and modulates your metabolism. And our diet is also one of the major sources of toxins and inflammation in the body.
“The food you eat can be either the safest and most powerful form of medicine or the slowest form of poison.”
For more help on increasing the quality of your diet, please refer to the nutrition section of our website or check out our posts on social media.
Fat reduction can be important as well. This is not simply weight loss, but reducing fat around your organs (visceral fat) and reducing total body fat. What we've learned over the last 20 years is that fat accumulation in and around the internal organs including the liver and even your heart is more damaging than the fat under the skin (subcutaneous). This is where we get the term "skinny fat" - people who are a normal weight but actually have fat accumulated around their organs. We can address this by increasing lean muscle mass using both aerobic and anaerobic exercise. Interval fasting (also known as time-restricted eating), and High-Intensity Interval Training (HIIT) can be very helpful with fat loss as well.
Nutritional Supplements and Foods that Can Reduce Cardiovascular Disease Risk
On top of the foundation of a quality diet and healthy lifestyle, scientifically-proven nutrition and nutraceuticals can have a powerful effect on cardiovascular health and healing. We use food as medicine and nutrients like drugs.
Ideally, you would work with a practitioner who understands how to use lab testing to determine which nutrients would be most helpful to you, how to source them, and how to use them appropriately. Using nutraceuticals can actually be way more complicated than medications and drugs as there are more options, more interactions, and more data, to be honest, with nutrition than medications. This is a striking statement to make since our primary treatment currently is medications, not nutrition.
The most important nutrients for reducing your risk for cardiovascular disease are:
- Red rice yeast
- Plant sterols (phytosterols)
- Green tea (EGCG)
- Omega-3s (especially Alpha-linolenic acid or ALA)
- Flax seeds
- Monounsaturated fatty acids (MUFAs)
Niacin (Vitamin B3)
Niacin is an important nutrient in cardiovascular disease prevention for its role in various benefits. It has been shown to lower total cholesterol, lower triglycerides, and reduce LDL particle numbers.
A typical dose is between 500 milligrams up to four grams daily. Interestingly, lower doses of vitamin B3 have a more profound effect on elevating HDL, which is your healthy cholesterol. Higher doses have a more profound effect on lowering LDL. So the dose should depend on whether your goal is to increase HDL or lower LDL.
Mass trials such as the Coronary Drug Project (CDP), the HDL-Atherosclerosis Treatment Study (HATS), the ARBITER 2 trial, the Oxford Niaspan Study, and the Familial Atherosclerosis Treatment Study (FATS), have shown a reduction in heart events and coronary plaque build-up with niacin. There is even a prescription version called Niaspan, so the FDA even acknowledges that niacin is an effective treatment and preventative for cardiovascular disease.
Red Rice Yeast
Red rice yeast is the next heavy hitter. A fermented rice product, red rice yeast contains over 13 natural statin-like properties, as well as amino acids, flavonoids, trace elements sterols, monounsaturated fatty acids, and a whole host of anti-inflammatory molecules.
Combined with berberine and other plant sterols, red rice yeast has been shown to lower cholesterol anywhere from 20 to 30%. In a Chinese study of over 4000 patients over almost five years, red rice yeast lowered the risk of heart disease death by 30%!
One caveat with red rice yeast is that, if it's not packaged appropriately, it can become contaminated with mold toxins, since it is a fermented product. So if you have used red rice yeast in the past and have experienced muscle aches and pains, it's likely that it was caused by contamination of a mold-related mycotoxin and not from the red rice yeast itself. This is one of the many reasons we recommend high-quality nutrient products and not some of the cheaper over-the-counter brands.
Plant Sterols (Phytosterols)
Plants sterols are typically sourced from maritime pine trees. Some less lesser-quality products do come from soybeans, so definitely avoid those. Plant sterols work by decreasing the reabsorption of cholesterol in the GI tract, and they also lower inflammation. They reduce hs-CRP, interleukin 6, TNF alpha, and fibrinogen levels. Fibrinogen is especially associated with tiny blood clots (microclots) and small arterial disease.
In combination with berberine and niacin, the phytosterols can support cardiovascular health and healing. Studies have shown a total cholesterol reduction from 8 to 10% and an LDL reduction from 6 to 15%. A typical dose is between 500 to 1000 milligrams. Higher doses of this nutrient don't necessarily give a better result.
One side note is that, because plant sterols do affect lipid metabolism, they can potentially reduce levels of vitamins D, E, K, and alpha-carotene. Either supplementing with these or testing these nutrients to make sure they are not lowered is appropriate.
Green Tea (EGCG)
EGCG is another great nutraceutical for lowering cholesterol. It's been shown to reduce oxidized LDL, upregulate LDL receptors, and lower inflammation. The pharmaceutical dosing is four to six cups of green tea a day, or 500 to 1000 milligrams daily of EGCG. This is such a simple add-on with a slew of benefits, including improving insulin sensitivity and improving hormone detoxification just to name two in addition to the cholesterol-lowering effects.
Omega-3 Fatty Acids
Omega-3s are a powerful nutraceutical with so many positive effects on health, including cardiovascular health. They have become one of the top recommendations for heart attack and stroke reduction as well as for lowering cholesterol and triglycerides. Data has shown that omega-3 fatty acids can lower the risk for coronary events by about 20%, strokes by about 22 to 25%, and sudden cardiac death by up to 45% to 50%.
Omega-3s also have anti-inflammatory, blood-thinning, and cholesterol-lowering properties. They are one of the few nutrients that reduce a molecule called Lp-LPA2, which is a very inflammatory molecule associated with acute stroke and heart attack. Typical doses range from 1000 to 3000 milligrams.
Be sure to balance your omega-3s with GLA (Gamma-linolenic acid) as well as vitamin E, since excessive amounts of fish oil can sometimes induce insulin resistance and make your sugars go up slightly.
Flax seeds are another of my favorites. Note that the effects of flax seeds do not apply to flax oil. Flax seeds are a much more comprehensive and traditional type of pharmaceutical. The fiber, lignans, phytoestrogens, and plant sterols have a multitude of effects that the oil by itself does not provide. Flax seeds promote anti-inflammatory effects, lower hs-CRP, reduce triglycerides, increase HDL (good cholesterol), and improve insulin sensitivity. For women, flax seeds help modulate hormones and lower the risk for both heart disease and breast cancer by about 25%.
Monounsaturated Fatty Acids (MUFAs)
Finally, I'd like to talk about monounsaturated fatty acids (MUFAs), the best source of which is extra virgin olive oil. Olive oil has been shown to lower total cholesterol by 10 to 15%, LDL and triglycerides by 10%, and increase HDL by about 5%. Olive oil lowers oxidized LDL, one of the major causes of artery disease, better than almost any other substance. It's also an anti-inflammatory, helps modulate the bacteria in your gut (your microbiome), and helps with weight maintenance.
Typical dosing is between 30 and 40 grams a day or three to four tablespoons if you're using it pharmacologically. According to some of the research from Dr. Gundry, author of The Plant Paradox, up to nine tablespoons of olive oil a day will give you a strong cardiovascular-protective effect. I find that four tablespoons per day are a dose that most people are more likely to stick to.
There are many other nutraceuticals or nutritional substances that have drug-like strengths that we haven't talked about. We have not talked about tocotrienols, pantethine, resveratrol, garlic, curcumin, vitamin C, citrus bergamot, lycopene, flavonoids, or berberine.
The point here is that there are many simple foods and food concentrates that have medicinal-type strengths and usages. It's important to understand that all these things should be an add-on to the foundations of health: diet, lifestyle, exercise, sleep, and stress reduction. This is a strong combination that can have a powerful impact on your cardiovascular health and longevity.
If you'd like to learn more about this kind of medicine and how we practice, please check out the rest of our blogs or jump over to social and say hi!
Take care and be well.
Since 2010, Richmond Integrative and Functional Medicine has been helping people to restore their health and hope with an integrative approach to conventional and alternative medicine that’s entirely science-backed. We at RIFM believe everyone is made for health. We offer a comprehensive, in-person patient membership program to ensure you get access to the care you need to thrive.
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