Posted on Natural Practitioner Magazine on Jan 2019
Achieving cardiovascular health is possible through diet, exercise and supplementation.
As a working heart is pretty much the main thing upon which life depends, it is no wonder that heart health is uppermost in the minds of consumers.
Achieving healthy heart status depends on many factors, and conversely, there are a number of conditions that can negatively impact one’s cardiovascular state, such as blood pressure, obesity, cholesterol and diabetes.
Many lifestyle choices also impact heart health, such as smoking, excessive alcohol use, diet and exercise levels.
The Centers for Disease Control and Prevention (CDC) reported in 2008 that 610,000 people die of heart disease every year, which represents one in four of all deaths, and it affects men and women equally. Another staggering figure by the CDC is that someone in the U.S. has a heart attack every 40 seconds. And high blood pressure affects 78 million people in the U.S., while 68 percent of adults are overweight, and there are eight million cases of undiagnosed diabetes.
Another scary statistic is how frequently women are affected. “The number one cause of death in women is heart disease—in this day and age with all that we know—this is astonishing. Clearly women still think that heart disease is for men and clearly doctors are not getting the message through to women about their risks and how to comprehensively support heart health with lifestyle, nutrition and supplementation,” said Amy McKelvey, integrative herbalist, natural products consultant and chief engineering officer of her vital way, a manufacturer based in California.
“Eighty percent of the time, the main causes of cardiovascular problems are due to modifiable risk factors. Those risk factors include high blood pressure, high cholesterol, elevated sugars, overweight or obesity, poor diet, not exercising and stress,” said Suzanne Steinbaum, DO, director of women’s cardiovascular prevention, health and wellness at Mt. Sinai Hospital in New York. Dr. Steinbaum is also a founding member of the Global Nutrition and Health Alliance; her practice is focused on women and heart disease and prevention.
The primary causative factors for such cardiovascular problems as atherosclerosis and high blood pressure is inflammation and oxidation, said Cheryl Myers, chief of scientific affairs and education for EuroMedica, a manufacturer based in Wisconsin. “Cholesterol isn’t an issue until inflammation and oxidation enter the picture. The body uses cholesterol as a Band-Aid on damaged arterial linings. Blaming cholesterol for heart disease is like blaming the cast for the broken arm,” she said.
Anne Trias, MS, product director for American River Nutrition, LLC, a manufacturer headquartered in Massachusetts, agreed that chronic inflammation plays a causative role in cardiovascular disease, as well as elevated lipid levels. “Another growing trend in cardiovascular disease is metabolic syndrome, an umbrella term for a cluster of distinct abnormal cardiovascular measurements.”
“One of the areas gaining recognition as a cardiovascular risk marker is atherosclerosis, which is a disease in which plaque builds up inside the arteries. Over time, plaque (primarily made up of calcium) hardens and narrows the arteries. This limits the flow of oxygen-rich blood to your organs and other parts of the body,” said Chris Speed, senior vice president of global sales and marketing with NattoPharma, based in Oslo, Norway and New Jersey.
Jared Paulson, sales and education coordinator with Ayush Herbs, a Washington State-based manufacturer added, “Cardiovascular problems rarely stem from one particular cause, but a constellation of issues that build on each other.” These include a perfect storm of the high carb/high fat American diet and lack of exercise.
Lowering cholesterol and blood pressure numbers goes a long way toward preventing heart disease, and there are many prescription drugs that are doled out each year to patients. For example, statins, which are prescribed to slow cholesterol production and remove LDL (low-density, liproprotein, i.e., “bad” cholesterol) from the blood stream.
While they often do what they are intended to do, there can be a down side to them.
“While prescription medications certainly have their place and are commonly used, they do have side effects and interactions with other drugs and even some foods,” said Lisa Wang, general manager of Nutri-Rich, a manufacturer based in California.
Most everyone in the medical profession can agree that dietary and lifestyle changes factor heavily into the prevention of cardiovascular disease.
“While we believe in the effectiveness of prescription drugs for cardiovascular diseases, we do also believe that lifestyle changes such as getting more exercise and eating a heart-healthy diet would go a long way towards addressing underlying causes of such diseases, and a multifaceted treatment plan teaches life-long healthy habits that go above and beyond the effects of any one medication,” said Wang.
In fact, Dr. Steinbaum’s mantra is that exercise is the best medicine. “The American Heart Association has clear recommendations that state the ideal amount of exercise is 150 minutes of moderate-intensity exercise every week, or 75 minutes of high-intensity exercise. Even brisk walking counts if it’s a tough workout for you. And the 150 minutes can be broken up into 30-minute sessions five days a week or even in 10-minute chunks throughout the day,” she said. “Getting your heart rate up can improve vitality, decrease the incidence of heart disease and stroke, prevent obesity, diabetes, osteoporosis and improve mood,” she added.
Dr. Steinbaum also recommends that her patients consume a diet high in fruits, vegetables, whole grains, legumes, nuts and olive oil.
Paulson pointed out the benefits of Ashtanga and Hatha yoga. “Not only is yoga used for prevention, a person who has never done yoga and has CVD (cardiovascular disease) can participate and improve their health. The reason this is profound is because yoga and breathing practice can meet patients at their skill level and evolve. One can do yoga while in bed until they are able to sit, then stand. When combined with herbal therapies, yoga and breathing practice can assist in the treatment of CVDs,” he said.
Other natural approaches being studied, said McKelvey, include research on removing lectins from the diet to reverse heart disease, as well as studies on plant based diets, addressing hormone imbalances, and keeping inflammation at bay.
Consumer Demand for Cardiovascular Products
Even though CVD and heart issues more typically affect the older population at a greater rater than younger people, younger consumers are beginning to be aware that preventative measures are important to ward off future heart-related issues.
“I think that may be one of the biggest challenges going forward—how to intervene wisely for the health of the next generations who are at risk as a result of dramatic changes to our food, toxic exposure and lifestyle,” said Myers.
Still, the primary demographic for natural supplements related to heart health is the over 50 population. “In addition to adhering to a healthy lifestyle, there is an increasing demand for dietary supplements that will maintain optimal heart health and prevent cardiovascular events, without having to endure the negative side effects of prescription drugs,” said Hank Cheatham, the vice president of marketing and sales for Daiwa Health Development, Inc., a manufacturer based in California.
Natural products should not be a replacement for traditional medically-based treatments and lifestyle changes but can be used to supplement other treatments as part of a holistic approach. For example, said Wang, whose company, Nutri-Rich, manufactures Ultra EPA + DHA, an Omega-3 product that is sustainably sourced from wild Norwegian fish, “We know that it’s hard to consistently eat a well-rounded diet that’s full of omega-3s because many people don’t like to eat fish or cannot afford to eat healthy foods all the time. The key ingredients of EPA and DHA in omega-3 supplements have been shown to help promote healthy cholesterol levels and protect your cognitive and vascular function.”
Another Nutri-Rich product is Essentials Multi, a multivitamin that also contains omega-3 fish oil. “It’s a great way for younger generations to get a jump start on cardiovascular health protection,” said Wang. Dr. Steinbaum concurred regarding the efficacy of omega-3s. “While I encourage people to get as much of their omega-3 fats from foods, the reality is, it is difficult to consume enough of these nutrients through food alone. Being educated on the supplements one might take is extremely important and, in many cases, overlooked,” she said. She added that she would consider advising patients to take a high-quality product that contains omega-3s if they are not getting enough through diet alone.
EuroMedica has a suite of supplements often recommended by practitioners, including EurOmega-3 Plus with phospholipids and peptides; Mesoglycan to support artery strength and healthy circulation; and Clinical OPC, a tannin-free French grape seed extract to support cardiovascular health.
“We’re seeing a real uptick in the way that omega-3s are delivered moving into phospholipid, versus oil, delivery. That’s fine for us, because EurOmega-3 feature a phospholipid delivery,” said Myers.
While NattoPharma does not make a finished product, the company’s branded MenaQ7 Vitamin K2 as MK-7 is available exclusively in the renowned practitioner-specific brand OrthoMolecular Products.
American River Nutrition manufactures DeltaGold, which is comprised of annatto-derived tocotrienols, a type of vitamin E which has been studied for its heart health benefits and its lipid-lowering properties. “Tocotrienols, although not able to achieve the same drastic effects as statins, have been shown to safely lower cholesterol and triglyceride levels by 15 to 20 percent, and concurrently reducing C-reactive protein—a measure of inflammation—by up to 40 percent percent,” said Trias.
Daiwa offers several products to support heart health. Plasmanex1 contains Bacillopeptidase F Proprietary Blend, an enzyme isolated from natto to form a unique molecule that supports healthy blood circulation and prevents blood clots. Other products, Daiwa Krill Oil and Daiwa Super Krill Oil are both antioxidant dietary supplements composed of pure oil derived from Antarctic krill.
“Krill oil is the only marine oil that includes a combination of three key substances the human body needs to function properly: omega-3 essential fatty acids (EPA and DHA), phospholipids (an important component of the cell membranes) and antioxidants including astaxanthin (a potent carotenoid that gives krill its red-orange color). Research studies show that krill oil can significantly decrease both diastolic and systolic blood pressure, thereby, enhancing cardiovascular health,” said Cheatham.
Ayush manufactures Carditone, a capsule that contains Rauwolfia serpentina, Boerhaavia diffuse, Terminalia arjuna, Convolvulus pluriacaulis, Rosa vinca and magnesium aspartate. “This herbal supplement helps to stabilize blood pressure, promotes healing of cardiovascular stress, soothes the nervous system into more parasympathetic patterns, and helps to facilitate proper fluid balance between the cardiovascular system and renal system,” said Paulson, adding that this product addresses the whole body, not just the cardiovascular system, and ingredients are grown at organic, sustainable farms.
NattoPharma contends that atherosclerosis is the product of a vitamin deficiency. “Matrix Gla Protein (MGP) is the most potent known inhibitor of vascular calcification to date. MGP is a K-dependent protein already present in the body, but it needs adequate vitamin K2 in order to be activated to perform its function,” said Speed. To that end, the company manufactures a branded vitamin K2 as MK-7 ingredient called MenaQy, which Speed noted is clinically proven to deliver cardiovascular benefits. This ingredient is featured in many brands across the globe, but specific to the practitioner market, the company has formed an exclusive partnership with OrthoMolecular Products as its vitamin K supplier.
“Ideally, we would obtain all of our nutrients from food, but today that is just not realistic. Supplementation offers practitioners an opportunity to ensure their patients are able to obtain the vital nutrients, like vitamin K2, so they can achieve optimal health,” said Speed.
Other significant heart-healthy ingredients are in some products made by her vital way. McKelvey explained of TumerZing, “We combine our turmeric with the activator herb ginger that creates a very synergistically powerful anti-inflammatory that women love—they’re replacing their pain meds with it and feeling more energy from the inflammation subsiding.” Another product, L-Theanine, supports healthy blood pressure. Additionally, a newly launched product called Organic Sea Buckthorn Oil contains omega-7 and palmitoleic acid. “Sea buckthorn oil is clinically proven to support healthy cholesterol levels,” she said.
Wang said that the market has been stagnant for a while with little major innovation in ingredients, perhaps in part because that EPA and DHA have long been established in the cardiovascular supplement market However, she added, “The FDA (U.S. Food and Drug Administration) recently approved a prescription EPA fish oil product used to reduce the risk of heart disease. That’s an exciting and validating breakthrough for us. The formulation is a prescription drug but does not contain any other drugs, so it would be easy for us to make a super high EPA product in the supplements market that would have the same benefits.”
Still, Cheatham posited that the increasing cases of mortality rate due to cardiovascular diseases have actually raised the demand for heart health products globally.
“The shift of food preferences and choice of healthy lifestyle amongst the wide population of people is fueling up the market demand for such healthy products. The health benefits obtained from the heart health products is considered one of the major drives of the product’s market,” he said.
“Heart health remains one of the top reasons that consumers first seek supplementation,” added Speed, referring to a survey sponsored by the company.
How to Help Patients
Taking a holistic approach to cardio wellness is the best way to make sure that all bases are covered, especially since multiple factors can contribute to heart disease. Practitioners should make sure that patients understand the causal relationship between heart disease and daily lifestyle habits, a message that can be challenging to get across.
There are many steps that practitioners can take to prevent and treat heart disease, and it starts with education—practitioners educating their patients and suggesting lifestyle changes at every appointment, said McKelvey. These include regular lab work for liprpotein panel, discussing blood pressure, stress reducation, toxins in the environment, etc. “The goal is to systematically remove as many ‘stressors’ from a woman’s body as possible,” she said.
“The goal is always to stay ahead of a condition before it progresses [to] the point of requiring drugs and/or surgery. To that end, sound counsel about diet and lifestyle remains an important aspect of a natural practitioner’s role when it comes to patients with or seeking to stave off heart disease,” said Speed.
Myers agreed, stating, “Reminding patients that diet is where everything should start is the beginning of any heart-related regimen, but many patients are overwhelmed if told they must make drastic changes. I prefer small changes that eventually add up to a healthier diet for heart health.” She said she would encourage patients to cut back on inflammatory foods such as sugars and refined grains, while simultaneously promoting consumption of healthy fats, such as the type found in avocados, nuts and omega-3s.
“Any kind of sensible, actionable exercise—something that is realistically within reach of a patient and is enjoyable enough to do as a habit—is a great adjunct to a treatment protocol, too,” said Myers.
Sometimes, however, prescription drugs are necessary for such conditions as high blood pressure or high cholesterol, but often, they can work in conjunction with supplements, along with lifestyle management.
“Evaluating the risk factors for heart disease is the first step. From there, practitioners must work with patients to manage each individual risk factor,” said Dr. Steinbaum.
Some natural practitioners sell products in their office, which can be mutually beneficial to both practitioner and manufacturer alike. “By offering them at a great price to their patients or making concrete recommendations and monitoring the patient’s response to the supplements, practitioners can forge deeper relationships with supplement brands whose products fit their needs and adhere to high quality standards,” said Wang.
However, practitioners need to understand the ingredients contained within the products that they offer for sale.
Most manufacturers will make studies available to practitioners who sell heart-related natural products in their offices. And companies like American Nutrition, an ingredient manufacturer, collaborate with brand partners that work specifically with health practitioners. They also provide technical support, webinars, podcasts and the like for practitioners who supply their products. Similarly, Daiwa provides practitioners with research studies and literature to share with patients as well as offers promotional price discounts on orders.
Transparency is important to companies such as Ayush, which makes their studies available to practitioners. “We encourage practitioners to contact us with questions and frequently provide webinars and other education events,” said Paulson.
McKelvey said that samples are a compelling way to get patients to feel comfortable with an ingredient. “The reality is that most people need someone to compel them into action—and practitioners are wonderful at that. They are part coach, advisor and even friend. This is how change happens. Ask a lot of questions and empower patients to talk more and share what they think is going on. Discuss prevention constantly. Increase awareness and start the conversation, even with the least likely candidates. One caring, informed conversation at a time. Being honest with patients and looking them in the eye and sharing the truth about what’s at stake and how they can reverse it. This is when healing happens.”
Healthy Take Aways:
• Heart disease and the risk factors for heart disease are at an all-time high in this country.
• Preventing cardiovascular disease should start at a young age with a healthy lifestyle habits that include regular exercise and a balanced diet.
• Supplements have their place in a heart-healthy regimen but should not replace necessary prescription medications.