~Cardiovascular Disease Comprehensive 10 - Therapeutic F-G

Fiber-- is a hypolipidemic and antidiabetic agent, aids in weight loss, and blocks iron absorption

The intake of dietary fiber among people living in Western countries is low (about 17 grams a day in the United States), according to the Third National Health and Nutrition Examination Survey (NHANES). This is unfortunate, for soluble fiber offers significant protection against a number of risk factors associated with cardiovascular disease. For example, mucilages, guar gum, psyllium powder, oat bran, and pectin reduce cholesterol levels. Guar gum (5 grams with meals), psyllium powder (5 grams before meals), or pectin (10 grams with meals) reduce fasting and postprandial blood glucose, as well as insulin levels, in both healthy and diabetic subjects. If taken with meals, soluble fibers (6-10 grams a day) reduce iron absorption from foods, important to those with hemochromatosis or iron overload (Monnier et al. 1980) (to read about hemochromatosis as a contributor to cardiovascular disease, turn to Iron Overload in the section devoted to Traditional Risk Factors).

Illustrative of the value of fiber, researchers from the Veterans Affairs Medical Center, the University of Kentucky (Lexington), and the Procter & Gamble Company (Cincinnati, OH) evaluated the effectiveness of psyllium as a hypocholesterolemic and blood glucose modulator. Thirty-four men with Type II diabetes and mild-to-moderate hypercholesterolemia were randomly assigned to receive 5.1 grams of psyllium or a cellulose placebo twice daily for 8 weeks. The psyllium group showed significant improvements in glucose and lipid values compared with the placebo group. Serum total and LDL-cholesterol concentrations were 8.9% and 13.0% lower, respectively, in the psyllium group compared to the placebo group. All-day and postlunch postprandial glucose concentrations were 11.0% and 19.2% lower in the psyllium group (Anderson et al. 1999). These impressive results occur as fiber binds bile acids, cholesterol, and fats, preventing their absorption. Short-chain fatty acids, products of fiber fermentation in the colon, further inhibit cholesterol synthesis by the liver.

Studies in the New England Journal of Medicine confirmed the value of a high fiber diet in improving glycemic control and reducing hyperinsulinemia and plasma lipid levels in patients with Type II diabetes (Chandalia et al. 2000). In a randomized, 6-week crossover study, 13 patients with Type II diabetes were given diets containing either moderate or high amounts of fiber. The moderate fiber allowance was 24 grams (8 grams of soluble and 16 grams of insoluble), an amount compliant with guidelines established by the ADA. The high-fiber diet consisted of 50 grams of fiber (25 grams soluble and 25 grams insoluble).

During the sixth week of the high-fiber diet (as compared with the sixth week of the ADA diet) the diet supplying 50 grams a day of fiber lowered plasma glucose 10%, insulin concentrations 12%, total cholesterol 6.7%, triglyceride levels 10.2%, VLDL 12.5%, and LDL cholesterol 6.3%. It is speculated that the decrease in triglycerides and VLDL may be due more to improved glycemic control than to a direct relationship with the fiber. There was no significant difference between the two diets in terms of HDL cholesterol levels. Note: The fiber-rich foods included in the study were cantaloupe, grapefruit, raisins, oranges, papayas, lima beans, okra, sweet potatoes, winter squash, zucchini, oat bran, and oatmeal.

Fiber is also of advantage to individuals who wish to lose weight. Bulk tends to render a feeling of fullness, negating the desire to overeat. An overweight individual should consider using bulk fibers stirred into an 8-oz glass of water; drink the mixture about 20 minutes before meals.

Diabetics and those not accustomed to higher levels of fiber should initially use the material cautiously. Fiber can significantly alter insulin or sulfonylurea requirements and some individuals experience gastrointestinal distress until the GI tract becomes better acquainted with the new material. A suggested initial dosage is 1 tsp daily; gradually increase to 1 tsp 3 times daily.

Reader's guide to foods high in fiber: Grains are excellent sources of fiber, but many individuals find the addition of cereal grains problematic due to food sensitivities. Vegetables and fruits (raw and with peel intact) are pleasant fibrous additions to the diet.

Garlic-- acts as a hypotensive, decreases fibrinogen, inhibits platelet aggregation, thins the blood, protects against LDL oxidation and arterial wall damage, reduces the incidence of arrhythmias, modestly reduces blood glucose levels, protects against iron overload, and is vasodilating

The consensus surrounding the benefits of garlic as a hypolipidemic is not unified. The Archives of Internal Medicine found garlic powder (900 mg a day for 12 weeks) to be ineffective in lowering blood lipids (Isaacsohn et al. 1998). Researchers concede that variations in preparations could be distorting results as well as gender. For example, women showed favorable effects in terms of coronary heart disease risk factors (i.e., increases in HDL-C and reductions in total cholesterol) using garlic oil, whereas men had small adverse effects. There was a significant difference in the garlic oil effect for glucose, with a reduction seen for men and an increase for women (Zhang et al. 2001).

Interestingly, the American Journal of Natural Medicine reported that 4000 mg of fresh garlic (guaranteeing an allicin content of at least 10,000 mcg or a total allicin yield of 4000 mcg) typically lowers total cholesterol levels 10-12%, triglycerides by about 15%, and LDL 15%, while increasing HDL cholesterol levels 10% (Murray 1995a). Healthy human volunteers given 600 mg a day of a garlic preparation (providing 7.8 mg of allicin for 2 weeks) reduced lipoprotein oxidation 34% compared to controls. It should be noted that garlic could cause a transient elevation in blood lipids, as garlic unseats fats deposited in tissues. With continued garlic supplementation, lipid stores complete the breakdown process and blood cholesterol levels modulate.

While much of the research has focused on improving lipid levels, researchers have isolated hypotensive factors in garlic as well. An analysis of published and unpublished randomized, controlled trials (415 patients) showed that 600-900 mg a day of dried garlic powder may be of clinical value in subjects with mild hypertension (Silagy et al. 1994). Other researchers have noted a 5.5% decrease in systolic blood pressure and a modest reduction in diastolic blood pressure in response to aged garlic extract (Steiner 1996).

Garlic, a sulfur-rich plant from the lily family, exerts its hypotensive nature through the following pathways:
    * Supplementation with aged garlic significantly reduced epinephrine, a vasoconstricting hormone released from the adrenal medulla (Steiner et al. 1998).
  • Garlic moderately inhibited (both in vivo and in vitro) the activity of ACE, an enzyme that increases blood pressure by catalyzing the conversion of angiotensin I to angiotensin II. This sequence constricts blood vessels, conserves water and sodium ions, and, unless interrupted, results in an increase in blood pressure (Rietz et al. 1993).
  • Garlic increases the activity of nitric oxide synthase, an enzyme essential for nitric oxide synthesis (Morihara et al. 2002). Nitric oxide, a relaxing factor, not only reduces blood pressure by acting as a vasodilator, but also lessens platelet aggregation, suppresses smooth muscle proliferation, reduces leukocyte adherence to vessel walls, and has antianginal and antispasmodic activity.
  • Garlic contains chemicals that act as calcium antagonists, reducing blood pressure and lessening the incidence of arrhythmias (Duke Database 1992).
Garlic exhibits additional cardiovascular protection by thinning the blood and acting as a fibrinolytic. German researchers reported successes in treating ventricular tachycardia and fibrillation with garlic, as well as the duration of arrhythmias (Isensee et al. 1993). Garlic also modestly reduces blood glucose levels, while EDTA-garlic combinations appear to decrease iron stores. Dosage suggestions are 1-2 Kyolic caplets (1000 mg) twice daily with meals or 2-8 capsules of Pure-Gar Caps (900 mg) daily with food. (One Pure-Gar Cap contains 900 mg of garlic bulb powder extract standardized to supply 9 mg of allicin, the highest potency available.)

Ginger-- reduces cholesterol, prevents blood clots, is an anti-inflammatory, and has chemical components that are calcium antagonists, vasodilators, and ACE inhibitors

Ginger (Zingiber officinale) is reliable in treating a wide variety of cardiovascular complaints. Among ginger's protective properties is its ability to reduce cholesterol by promoting cholesterol excretion, impairing cholesterol absorption, and encouraging bile secretion and bile acid production. (Bile acid is a steroid acid of bile, produced during the metabolism of cholesterol.) Ginger exerts some of its hypolipidemic effects by stimulating cholesterol-7-alpha-hydroxylase, a rate-limiting enzyme of bile acid synthesis (Srinivasan et al. 1991).

Researchers reported the effects of administering ginger (200 mg/kg orally) to 61 cholesterol-fed rabbits (Bhandari et al. 1998). The marked rise in cholesterol, triglycerides, lipoproteins, and phospholipids (which normally follows 10 weeks of cholesterol feeding) was significantly reduced by ginger. The favorable results obtained from ginger were comparable to the hypolipidemic effects of the drug Lopid, known generically as gemfibrozil.

Various chemicals contained in ginger are calcium antagonists, vasodilators, ACE inhibitors, and diuretics, suggesting additional value in reducing blood pressure and the incidence of arrhythmias (Duke Database 1992).

Ginger reduces the likelihood of a blood clot through the following mechanisms:
  • Ginger, ginkgo, olive leaf, and garlic each contain chemicals that inhibit platelet-activating factor, PAF (Duke Database 1992). Adequate amounts of PAF are essential to coagulation and inflammatory processes; excesses are associated with blood clot formation, stroke, and heart disease.
  • Thromboxane A-2, a platelet-aggregating factor, is inhibited more by ginger than by either garlic or onions (Srivastava 1984).
  • Prostacylin, an inhibitor of platelet aggregation, is pressed into service by ginger, a process that further reduces the likelihood of blood clot formation (Backon 1986).
Although all of these effects are similar (blood clot reduction), a study involving healthy volunteers showed no irregularities in blood coagulation among participants receiving 2 grams of ginger a day (McCaleb et al. 2000). Nonetheless, caution is indicated for those individuals with baseline disturbances in platelet numbers or prothrombin time. Furthermore, the activity of prescribed blood thinners may be heightened if used in concert with ginger.

Ginger also appears to protect the heart during periods of inflammation. (Recall that inflammation is considered a trigger in heart disease.) Ginger's anti-inflammatory properties are due to interruption of the prostaglandin-leukotriene cascade, blocking damaging prostaglandins but leaving beneficial prostaglandins unaffected. Ginger root (gingerols) has been shown to inhibit cyclooxygenase pathways, sharing anti-inflammatory traits with other popular COX-2 inhibitors (Newmark et al. 2000; Faloon 2001).

A preventive dose of ginger is one to two 300-mg capsules 1-3 times a day. Interestingly, a researcher recently recommended 10 grams (approximately 1 tsp a day) to reduce platelet aggregation (Bordia et al. 1997). A qualified healthcare practitioner must monitor this dosage. JAMA published an article raising a cautionary flag concerning the risk of cardiovascular events among users of COX-2 inhibitors (such as Celebrex and Vioxx) (Mukherjee et al. 2001). The FDA has also objected to claims and promotional activities by Pharmacia Corporation minimizing the potentially serious risk of bleeding associated with Celebrex (Fort 2001). It is hoped further prospective evaluations will characterize and determine the magnitude of the risks. In the interim, natural COX-2 inhibitors (including ginger) loom as welcome alternatives.

Ginkgo Biloba-- improves circulation and memory; reduces platelet aggregation and excesses of fibrinogen; has antioxidant and anti-inflammatory activity; prevents capillary fragility; lessens angina attacks, dyspnea, and intermittent claudication; limits brain damage following stroke; increases insulin secretion; and is a vasodilator

Ginkgo biloba is one of the oldest surviving species on earth. But this ancient herb, renowned for its ability to retard aging, has survived the test of time and is yielding remarkable benefits for millions of Americans and Europeans. Heart, circulatory, and cognitive disorders are the principal reasons individuals rely upon ginkgo. More than 300 clinical and experimental studies have supported the worth of Ginkgo biloba.
  • Ginkgo has won favor among the Chinese as a heart tonic by lessening coronary demands for oxygen, thus reducing shortness of breath and chest pain (Duke 1997).
  • Ginkgo's antioxidant properties, particularly the flavones, assist in strengthening blood vessel walls and improving tone and elasticity (Joyeuz et al. 1995).
  • Ginkgo is a vasodilator, making it useful in lowering blood pressure and treating many forms of heart disease (120 mg a day at bedtime for 3 months reduced systolic blood pressure from 125 mmHg to 118 mmHg and diastolic from 86 mmHg to 68 mmHg) (Kudolo 2000). Some of the chemicals contained in ginkgo are ACE inhibitors, further explaining its hypotensive nature (Duke Database 1992).
  • Ginkgo is also an anti-inflammatory, adding additional merit to its cardiac profile (Hopes 2000). Consult the section entitled Link Between Infections and Inflammation in Heart Disease (in this protocol) to understand the value of anti-inflammatories in a comprehensive cardiovascular program.
  • Ginkgolide B infusions are comparable to standard antiarrhythmic drugs in controlling irregular heartbeats (Koltai et al. 1989).
  • Patients with chronic cerebral vascular insufficiency typically respond well to ginkgo biloba extract (GBE), reporting improvement in vertigo, headache, ringing in the ears, and memory (Murray 1995c).
  • GBE also significantly improves the supply of blood to the limbs. As resting blood flow and peripheral circulation improve, intermittent claudication, a cramp-like pain in the calves, diminishes. In fact, 40 mg of GBE twice a day is from 10-45% more effective at controlling intermittent claudication than pentoxifylline (Trental) (Duke 1997).
Varro Tyler, Ph.D. (dean and professor emeritus at Purdue University), profiles ginkgo in his book Herbs of Choice as a treatment for peripheral vascular disease and cerebral circulatory disturbances (Robbers 2000). Ginkgo can, in fact, act as a prophylaxis against strokes by reducing fragility of capillaries and counteracting erythrocyte and platelet hyperaggregability. The nature of platelets is strongly influenced by platelet-activating factor (PAF), which ginkgo inhibits.

The American Academy of Neurology reported that ginkgo reduced the extent of brain damage caused by artificially induced strokes in mice (June-July 2000 edition). Mice receiving low-dose GBE 1 week prior to stroke reduced the area in the brain that was affected by 30%. The journal Stroke concurred that GBE reduced stroke infarct volume but noted the beneficial effect appears to be dose related. In fact, researchers found that higher doses had the potential for increasing the risk of intracerebral hemorrhage. The combined clinical use of GBE with antiplatelet, anticoagulant, and thrombolytic agents could potentially further increase the risk (Clark et al. 2001).

Researchers recently reported a function of ginkgo biloba not frequently credited to the herb, that is, an ability to increase insulin secretion. A study was undertaken to determine the effect of GBE on glucose-stimulated pancreatic beta-cell function in normal glucose-tolerant individuals: 20 participants (14 females and six males, ages 21-57) underwent a 2-hour, 75-gram oral glucose tolerance test before and after ingestion of GBE (120 mg a day at bedtime). During the 3-month evaluation, both fasting plasma insulin and C peptide (a biologically inactive residue of insulin formation) increased. Dr. G.B. Kudolo (principal researcher) believes the changes in the insulin-C peptide response curves are due to increased production and secretion of insulin (Kudolo 2000).

Note: Herbals that influence glycemic control by increasing insulin secretion would be contraindicated in cases of existing hyperinsulinemia. If insulin production declines to the point that hypoinsulinemia exists, herbs that encourage insulin release would then be appropriate.

High quality GBE is typically standardized to contain a minimum of 24% ginkgo flavone glycosides and 6% terpene lactones. Side effects are rare when using the standardized extract; however, concomitant use with an anticoagulant medication or administering GBE to individuals with prolonged prothrombin time may make ginkgo inappropriate. (Ginkgo is not recommended for pregnant or lactating women.) A dosing suggestion is 120-240 mg a day. (A dose of 120 mg a day assists in reducing excessive fibrinogen levels, i.e., levels greater than 300 mg/dL).

Grapefruit Pectin-- is hypocholesterolemic

Grapefruit pectin and other food sources rich in soluble fibers are useful adjuvants in the treatment of hypercholesterolemia. In fact, grapefruit pectin, a stringy white fiber, appears equal to or more effective than most popularly prescribed drugs for lowering cholesterol. Since grapefruit pectin is highly soluble, the pectin is broken down in the small intestine so that 100% of the fiber is utilized.

Illustrative of its potential, guinea pigs administered grapefruit pectin reduced their cholesterol by greater than 40% over a 6-week period (Cerda 1994b). No side effects were noted, a vast departure from the potential risks associated with many prescription drugs.

In addition, researchers found citrus pectin effective in reducing atheromatous plaque. Substantiating its worth, an atherogenic diet was fed to a group of microswine to induce hypercholesterolemia. Plasma cholesterol levels rose rapidly and for 360 days were sustained at levels 6-12 times the norm. Half of the microswine were then fed a diet containing 3% grapefruit pectin; the remaining animals received the original diet. Animals were slaughtered 270 days later, and the extent of atherosclerosis determined. The mean surface area covered by plaque in the aorta was 13.6% in the group not receiving pectin compared to 5.3% in the group receiving pectin. Mean coronary artery narrowing was 45% without pectin and 24% with pectin (Cerda et al. 1994a).

Human trials have also been gratifying. Hypercholesterolemic subjects using no other cholesterol lowering agents and without lifestyle modification significantly lowered total cholesterol and LDL while increasing HDL levels (Cerda et al. 1988). Begin with less than 1 scoop of grapefruit pectin (with meals) and gradually increase until 2-3 scoops are used daily. If using grapefruit pectin tablets, use 1000 mg with meals.

Gugulipid-- lowers total cholesterol, LDL, and triglycerides; increases HDL cholesterol; regresses plaque formation; opposes platelet aggregation; and has fibrinolytic activity

Numerous studies have demonstrated that gugulipid is beneficial to about 70% of individuals with disorganized lipid profiles, that is, elevations in LDL and total cholesterol or triglycerides. Human clinical trials showed gugulipid dropped total cholesterol levels by 14-27% in a 4- to 12-week period and reduced triglycerides 22-30%. HDL cholesterol increased in 60% of cases considered gugulipid-responsive. In addition, gugulipid regressed plaque formation, opposed platelet aggregation, and encouraged fibrinolysis. Gugulipid is regarded as nontoxic, with liver and kidney function, blood sugar control, and hematological parameters unaffected during clinical trials (Agarwal et al. 1986; Nityanand et al. 1989; Murray 1995c).

Comparing gugulipid to clofibrate, hypercholesterolemic patients appeared more responsive to gugulipid therapy, while patients with hypertriglyceridemia responded better to clofibrate (Nityanand et al. 1989). A suggested dosage is 500 mg (5% guggulsterone content) 3 times a day.

Continued . . .


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