Stroke and Heart Attack: The Whole Picture of Prevention
Paul Reller, L.Ac.
Cardiovascular risk of stroke and heart attack is one of the chief health concerns of the U.S. population, and a majority of people are now looking to some form of Complementary Medicine and integrated medical approach to decrease risk of occurrence or recurrence, and avoid some of the side effects of their pharmaceutical medicines. It is always good to discuss cardiovascular issues with a cardiologist, especially if standard tests reveal significant risk, or if you fall into a high risk demographic. On the other hand, the latest findings in Complementary Medicine present an array of health issues that the cardiologist may not have sufficient expertise with which to guide the patient, and instead may be relying on information given to him by the pharmaceutical industry. This is where a Complementary Medicine physician, such as a knowledgeable Licensed Acupuncturist, can help make sense of the wide array of health research on reducing cardiovascular risk, and tailor a program specific to the individual patient. As you will see from this article, there are a wide variety of herbs, nutrient therapies, dietary changes, and techniques that are proven helpful in prevention of cardiovascular risk. Integrative medical care is the best approach when trying to prevent or reverse cardiovascular problems, and may be the key to a safe effective treatment protocol for any of the related pathologies, such as atherosclerosis, hypertension, high cholesterol, etc.
Unlike standard care in cardiovascular medicine, Complementary Medicine offers the patient the goal of restoring the health of the system, not just blocking the highest risk factors
Just below iatrogenic deaths, death from heart attack and stroke is the second most common statistical cause of death in the United States, at 768,755 per year in 2005. How do we actually determine if we are at high risk of cardiovascular health problems? Atherosclerosis usually develops slowly, and there are no symptoms until the artery becomes highly atherosclerotic, or small emboli break off and cause such problems as chest pain or neurological episodes. Chest pain is not the only symptom of mild heart attacks, though. Recent research by the National Institutes of Health has found that women suffer different symptoms before heart attacks than men, with 70% reporting severe fatique, 48% reporting sleep disturbances, and about half reporting anxiety, indigestion and shortness of breath. These symptoms correlated with reports of symptoms experienced during the heart attacks for about half of the women studied, along with profuse cold sweat and dizziness. These common health problems could be a sign that cardiovascular stress is increasing, and attention to the whole cardiovascular health picture that is started early may be important to prevent future cardiovascular problems.
An alarming statistic that points to the need for early prevention, and may also indicate a failing of standard pharmacological therapy, is the high incidence of recurrence of stroke and heart attack within three years of a serious event. The Northwestern University Feinberg School of Medicine reported in 2009 that when following over 32,000 patients with atherothrombosis, patients who reached a symptomatic state with vascular disease had a 14.4% average rate of recurrence one year after having a heart attack or stroke, and a 18.4% average rate of recurrence within 3 years of that first stroke or heart attack. Patients with atherosclerosis in multiple sites had a 40.5% average rate of recurrence within 3 years, despite being on standard pharmaceutical drugs. Data from the REACH Registry (Reduction of Atherothrombosis for Continued Health), also showed that almost all strokes were preceded by mild transitory ischemic attacks (TIAs), often mild enough to go unreported. Ischemia is a term meaning local decrease in blood oxygen and nutrients to tissues, and a transitory ischemic attack, or TIA, is usually short, and the lack of blood flow to parts of the brain often creates a period of confusion and poor judgement due to the mild injury to the brain tissue. The mild temporary confusion occurring with TIAs contributes to the lack of alarm and recognition of the seriousness of these events. Data on the recurrence of stroke and heart attack can be accessed by clicking here: http://www.feinberg.northwestern.edu/news/2009E-August/alberts-paper.html
Many patients are turning to healthy alternatives rather than waiting until the cardiovascular problems arise and harsh drug therapy becomes necessary. Both effectiveness and degree of risk are concerns with standard pharmacological therapy. Some of the latest findings on standard cardiovascular treatment are disturbing. The new drug touted to reduce arterial plaque, torcetrapib, created to compete with Complementary Medicine’s goal of improving cardiovascular health by raising HDL (high density lipoproteins) has been pulled from the market because large studies on the human population showed that it caused more deaths than it saved. This drug, like the popularly prescribed statins, which lower LDL, works by blocking genetic expression of a key protein in lipid metabolism. Modern research now confirms that the problems with atherosclerosis and cardiovascular degeneration are more complicated than just the levels of cholesterol in your body. Inflammory regulation, accumulation of harmful oxidants, and a host of specific metabolic concerns, especially the accumulation of advanced glycation endproducts (AGEs), are now known to be the cause of the buildup of atherosclerotic plaques that contain cholesterol carried lipoproteins, but are not caused by them. The ability of your body to clean up atherosclerotic plaque is also of prime importance and is overlooked in standard therapy to a large extent. Not just prevention, but also reversal of atherosclerosis is important. Allopathic drugs may not be enough to reverse this complex degeneration of your blood vessels and reverse atherosclerosis. Even if you are happy with standard drug therapy, and the chronic side effects are still mild, Complementary Medicine offers not an alternative, but a partnering, or integrating, with standard medicine to achieve greater health goals.
The prime drug emphasis with atherosclerosis is still the blocking of production of cholesterol and cholesterol carrying lipoproteins with statin drugs. The problem with these allopathic drugs are that, while they do statistically raise HDL and lower LDL, the chemical manipulation involved produces altered proteins and poor quality HDL and LDL. In other words, quantity rather than quality is altered. Since HDL and LDL, lipoproteins mistakenly called cholesterol because these molecules transport cholesterol steroid hormones, are essential to the healthy function of the human body, it is vitally important that the quality and function of these molecules is healthy, as well as the quantities. Misformed or genetically altered lipoproteins (HDL and LDL) cause the serious side effects associated with statin drugs, mainly the accumulation of broken proteins in the tissues that cause much muscle and joint pain and inhibit organ function, especially in the kidney, over time. Other important side effects come from the inhibition of other important chemicals in the body related to cholesterol production, such as CoQ10, or ubuquitone, an important cellular antioxidant, and Vitamin D3 hormone. As you may see from reading this article, depending on cholesterol lowering drugs and hypotensives alone may not be a smart and effective protocol for decreasing risk of stroke, heart attack and atherosclerosis.
What do we mean when we refer to the quality of cholesterol and lipoproteins? For many years, researchers have been puzzled at the low incidence of cardiovascular disease in targeted populations in Europe, despite the standard high dietary intake of fats. Research in Spain in 2010 (cited below) found that low rates of strokes and heart attacks, and a low incidence of death attributed to cardiovascular disease, occurs in Spain despite a high prevalence of standard cardiovascular risk factors, including a high consumption of unsaturated fatty acid rich foods. The researchers found that the fats generally consumed were still of high quality, with high proportions of healthy essential fatty acids, such as DHA (docosahexaenoic acid), alpha-linolenic acid, and oleic acid. The research showed that high intake of healthy fats had a strong correlation in individuals studied with low rates of cardiovascular disease. These quality fatty acids were found in phospholipids in the body, and were carried in serum phosphatidylcholine (a lecithin metabolite). High quality phospholipids had a strong relationship to decreased incidence of carotid artery atherosclerosis.
Has our medical community led us to believe that simply taking cholesterol inhibiting statin drugs and hypertension medications with limited benefits would protects us from cardiovascular injury? Has this advice and treatment protocol led millions of Americans to a false reality and contributed to the avoidance of a real preventive medicine protocol? Serious questions are being raised about the standard medical protocol to reduce cardiovascular deaths, accounting for more than 40 percent of all deaths in the United States, and to prevent and treat the myriad ill effects of poor cardiovascular health.
Cholesterol itself is not a lipoprotein, but rather is a steroid hormone carried by lipoproteins. Cholesterol is primarily made in the liver, but is also produced by cells in the lining of the small intestine, as well as individual fat cells in the body. The molecule Acetyl coenzyme A is the building block to cholesterol, as well as the building block of an important neurotransmitter, acetylcholine, the most important neurotransmitter in the autonomic nervous system. Acetyl coenzyme A is derived from healthy fatty acids, many from the diet, and in the production of cholesterol is turned into mevalonic acid. Statin drugs block the production of the enzyme that controls the rate of production of mevalonic acid, thus reducing the endproduct cholesterol steroid hormone. Unfortunately, a number of other important molecules are also blocked downstream from mevalonic acid, including the precursors to the Vitamin D hormone, and the important antioxidant Coenzyme Q10, both of which more recent research has revealed are essential to cardiovascular health.
There are also a variety of reasons why each individual may have a higher level of circulating chlesterol or lipoprotein. Allopathic medicine tries to find a single treatment that works for a majority of paients, but with this approach comes an attitude that tends to treat each patient the same, ignoring individuality in the health profile to a great extent. Increased circulating cholesterol may be a sign of increased need for this hormone in the body, and a growing number of medical doctors and researchers are questioning the need to reduce, or block, cholesterol production, in a great number of patients. With any molecule in the body, there is a tendency to express variants that do not work well in the body. This is why the body may express large amounts of certain valuable molecules. Cholesterol is certainly an important molecule in the body, playing a host of vital roles, such as the daily precursor to other steroid hormones, such as progesterone, estrogen etc. There is now some concern that the number of poor quality cholesterol molecules in the body could be hurting our health, and a host of factors may be causing the difficulties with quality cholesterol production. Certainly, fatty acid imbalance is a factor, but poor liver function, metabolic stress, and the chemical blocking of the pathway of cholesterol production, may all play a part in poor quality cholesterol. Fatty acids are long chain hydrocarbons that are the backbone of triglycerides and phospholipids, whose degradation products form the sterol base of cholesterol. Many fatty acids are essential fatty acids, meaning that it is essential that we obtain them from our food. Building a holistic basis for healthy cholesterol and lipoproteins requires quality natural foods and oils, daily essential fatty acid balance in the diet, good liver function and health, decrease in metabolic stress, and overall hormonal balance.
While high cholesterol has some oblique association with atherosclerotic plaque, we now know that it is certainly not responsible for the buildup of arterial plaques. High cholesterol itself produces no symptoms, and is not a disease mechanism. There is an association between persons with a high total cholesterol in circulation and cardiovascular disease, but many experts question whether this association points to a shared underlying disease mechanism rather than high cholesterol as a cause of cardiovascular disease. Low cholesterol, on the other hand, may be a disease mechanism. Children born with a genetic defect that prevents adequate mevalonic acid metabolism and results in low cholesterol, have many related health problems, including mental handicaps, poor growth, anemia, acidosis, immune problems, and cataracts.
Cholesterol is the most abundant steroid hormone in our bodies. Cholesterol, as a steroid hormone, plays many important roles in the body, including maintenance of brain function. Besides being a precursor to the sexual steroid hormones, cholesterol is also a precursor to all of the adrenal glucocorticoid hormones, which include cortisol, and important mediator of stress and inflammation, as well as a precursor to Vitamin D3, cholecalciferol, the prohormone precursor to the Vitamin D3 hormone that so many people are now deficient in. In addition, statin drug inhibition of the mevalonic acid pathway of cholesterol also inhibits the production of prenylated proteins, which include G-proteins, a subject of much research in recent years related to neurodegenerative disease, mood disorders, subclinical hypothyroid conditions, and immune disorders. Finally, an important antioxidant chemical found in all cells, ubiquitone, or Coenzyme Q10, is also inhibited when the mevalonic acid pathway is inhibited by statin drugs. The reasons for a reconsideration of cholesterol lowering as the main, or only, therapy to counter atherosclerosis and cardiovascular disease are mounting. Large groups of medical doctors and researchers around the world are now heavily questioning a cholesterol emphasis in cardiovascular health.
In 2011, researchers at the University of Texas Southwestern Medical School, and the Cooper Institute in Dallas, Texas, released data from long term studies that shows that cardiovascular maintenance, not cholesterol levels, is the key factor in assessing future cardiovascular risk. Two reports, published in the medical journals Circulation and the Journal of the American College of Cardiology, found that the level of aerobic cardiovascular fitness maintained between the ages of 40 and 50, was the greatest indicator of cardiovascular risk. A person in the higher realm of cardiovascular fitness during this phase of life had a 10 percent lifetime risk, while those that fell into the lower realm of cardiovascular fitness had a 30 percent lifetime risk. Those persons in the higher realm of fitness were not always high level athletes, as any man that could run a 8 or 9 minute mile was in the moderate to high level of cardiovascular fitness, and this was mainly maintained by increased walking and stair climbing, and general activity. The recommendations were not to start running miles as fast as you can, the lead researchers stated, which could lead to strain and injury, but to increase the daily aerobic activities, get up from the desk and the couch, use the stairs, walk to work, and start a weekly routine of modest exercise. This may be the reason why populations, such as those mentioned in Spain, had such a lower incidence of cardiovascular disease. In addition to these lifestyle changes, dietary improvements, especially concerning healthier fats, whole grains and beans, and a more plant-based diet, as well as the utilization of health maintenance in the form of herbal and nutrient medicine, acupuncture and physiotherapy, are the keys to a simple but dramatic decrease in overall cardiovascular risk.
While the many potential adverse effects of chronic statin drug use are not dramatic, and occur slowly over time, with chronic use, they still are a large concern for many patients, once these effects are studied. Statin drugs not only affect the pathway of expression of cholesterol in the liver, but exert cellular effects as well. While these peripheral cellular effects have generated interest in statin drugs to treat peripheral diseases, as always, there are two sides to this subject, the good and the bad. Statin drugs have been shown to induce changes in cell shape and actin/myosin cytoskeletal organization in peripheral cells (Song et al, Duke University School of Medicine). While this is touted as a potential treatment for such diseases as glaucoma, the implications for statin drugs affecting musculoskeletal function and cell health imply that the chronic side effects of musculoskeletal pain may be tied to more than just accumulation of protein fragments in tissues. To see a recent analysis of the doubts of benefits of widespread statin prescription, click on this link: http://healthjournalclub.blogspot.com/2010/06/statins-and-myoglobin-how-muscle-pain.html. Of course, research on statins is producing both support for increased use of the drugs as more physiological mechanisms are found, as well as a healthy skepticism of the use or need for the drugs for most patients. In the end, the choice is an individual one that each patient makes.
Cardiovascular Risk: A Reality Check
The questions concerning the effectiveness and benefits, as well as the long adverse effects, or risks, associated with cholesterol lowering statin drugs are legitimate. As the long-term studies on hypertensive drug protocol have revealed, such as the ALLHAT study of the NIH’s National Heart, Lung and Blood Institute, the benefits and effectiveness of hypertensive drugs may also be limited, and the adverse effects in the long term with multiple drug regimens may be greater than the benefits (see the article on High Blood Pressure on this website). Intelligent patients, as well as an increasing number of medical doctors, are finally taking a serious look at the reality of our present standard protocol to reduce cardiovascular risk, and finding that we are not doing enough to decrease risk and improve the cardiovascular health. The false sense of security that is promoted with the standard drug protocol is not real.
Another aspect of the standard cardiovascular protocol that is widely overlooked, both by patients and prescribing doctors, is the increased risks of cardiovascular ill health from other commonly prescribed medications. Assessment of individual cardiovascular risk and avoidance of medications that increase this risk is not being performed. Instead, patients are being led to believe that when they are taking drugs that increase cardiovascular risk, they are safe as long as they take cholesterol and hypertensive medications with these drugs. The scientific data does not support this attitude.
Which drugs do we take that may increase the risk of cardiovascular disease and poor maintenance of cardiovascular health? Most people do not realize that the most commonly prescribed medications dramatically increase cardiovascular risk. Non-steroidal anti-inflammatory drugs for chronic pain (NSAIDs), synthetic hormonal drugs in the form of contraceptives and hormone replacement regimens, and even some of the newer drugs to treat diabetes are all linked to a higher risk of cardiovascular death and disease. FDA warnings have been issued concerning the high cardiovascular risks of the sulfonylurea drugs to treat diabetes, including Glyburide, Glipizide, Tolazamide, Diabinase and Orinase. Actos, or pioglitazone, was withdrawn from the market or banned in Europe due to concerns of cardiovascular risk, and its competitor Avandia has faced similar criticisms and warnings, with updated FDA warnings on 11/4/2011 requiring healthcare providers to enroll in a medicines access program if they wish to prescribe these rosiglitazone medications to outpatients or nursing homes, because of the high cardiovascular risk. Large studies by the NIH and the Women’s Health Initiative found that a greater than one year use of progestin estrogen combination drugs increased cardiovascular risk by 29 percent, and the NIH halted a large study in 2002 because of the concerns of high cardiovascular risk. Newer forms of synthetic hormonal contraceptives were touted as carrying less cardiovascular risk, and instead, long term studies prompted an FDA warning that the risk of embolisms and thromboses from greater than one year of use of these drugs was almost double that of the prior class of hormonal contraceptives, increasing risk increases of as much as 79 percent! A large study by Hull York Medical School in the UK, released in 2011 (PMID: 21980265), prompted by the large number of randomised studies highlighting cardiovascular risks of NSAIDs, used a systematic analysis of all published studies to determine which of these pain relievers had the lowest and highest risk of cardiovascular death. The results revealed that the highest risks were seen with rofecoxib (Vioxx), diclofenac (Cambia, Cataflam, Voltaren, Voltarol, Zipsor), celecoxib (Celebrex), and the lowest with Naproxen. Of course, Vioxx was removed from the American market due to high incidence of cardiovascular deaths, and the ensuing study of NSAIDs prompted warnings on all of these medications. Studies find that the risk of cardiovascular disease and injury is associated with higher dosage and prolonged use.
Besides these very commonly prescribed medications, a number of other medications come with cardiovascular risks as well. The combination of drugs with cardiovascular risk needs to be considered in the overall assessment of risk versus benefit as well. Concurrant prescription of medications is very high today, especically in the aging population, with many patients prescribed 5 to 10 medications concurrently. This aging population is also at a higher risk of cardiovascular disease, events and death. Is the treatment protocol designed to achieve the healthiest outcomes for these patients, or is it driven by a medical system where monetary rewards are tied to increased drug prescription? If true healthcare reform occurred in the form of rewarding outcomes of therapy rather than the amount of expensive drugs and other protocols prescribed and performed, this practice might be changed, and more attention might be paid to the risk versus benefit assessment overall.
Medications with less cardiovascular risk include antidepressants, where ventricular arrhythmias and sudden cardiac deaths have drawn attention, and numerous studies have produced varied results evaluating overall risk of ischemic disorders due to inhibition of platelet function. Some studies have shown increased overall risk of stroke and heart attack, while others have shown modest decrease in risk with antidepressant use. The findings of inhibition of platelet activity by SSRI antidepressant medications has been used as a potential reason for increased prescription to patients with cardiovascular disease. Patients are beginning to question such logic.
One of the most popularly prescribed drugs in the world today is the type 5 phosphodiesterase inhibitors for erectile dysfunction (ED), and after a large study (SSRC-PM) found that nearly 93 percent of men diagnosed with ischemic heart disease were diagnosed with erectile dysfunction, alarms went off at the offices of the European Society of Urology, and warnings were issued that changes in life style and other health corrections needed to be made before prescription of drugs to treat erectile dysfunction. The cardiovascular ramifications for these drugs involves sudden drops in blood pressure and heart function, exemplified by severe warnings for concurrent use of nitrate drugs for angina. Other studies have now explored the role in common hypertension medications that come with a significant percentage of patients experiencing erectile dysfunction as a side effect, particularly beta-adrenergic blockers and angiotensin converting enzyme inhibitors (ACE inhibitors). The response in standard medicine has not been what you would expect, and not what is recommended by leading health researchers. The Mount Sinai School of Medicine showed that there was a clear and indisuputable connection between erectile dysfunction and atherosclerosis, and recommended an evaluation of inflammatory markers, endothelial function, and cardiac stress testing before prescribing any erectile dysfunction drugs. Instead, standard medicine has recommended prescribing erectile dysfunction drugs more often to men with ischemic heart disease, marketed under the guise that ED is highly associated with heart disease. The fact that treatment with the ED drugs does not address the underlying inflammatory and oxidative stresses, or the endothelial health considerations and calcifications causing these pathologies is not made clear. Prescibing protocols run counter to the patient welfare and only mask the health problems and treat superficial symptoms. This appears to be standard practice.
Evaluating standard medical protocols in prevention of cardiovascular disease
In 2011, serious questions are being raised concerning the standard treatment guidelines in cardiovascular medicine. A study published in the Archives of Internal Medicine and reviewed in the March 29, 2011 issue of the New York Times found that 56 percent of medical experts writing the clinical practice guidelines for the Amercican College of Cardiology and the American Heart Association reported a financial conflict of interest concerning the pharmaceutical, medical equipment, or other company with financial interest in these practice guidelines used to guide the advice and prescription of drugs and interventions for patients with cardiovascular problems. Payment concerning consultant fees or membership on an advisory board were the most common types of conflict of interest. A call for serious health care reform in this area of clinical practice guidelines was made by the authors and the institutions that sponsored this large study, including the Harvard Medical School, Mongan Institute for Health Policy, the University of Pennsylvania Center for Bioethics, and Thomas Jefferson University. Consultant fees in medicine have been the subject of a number of New York Times investigative articles in recent years. In 2010, a study published on the web site of The Archives of Internal Medicine found that of 32 medical doctors and doctoral researchers who were paid at least $1 million in 2007 and published one or more professional articles in medical journals the following year, that 25 of these experts did not disclose financial connections to companies affected by these articles. Dr. Marcia Angell, a former editor of the prestigious New England Journal of Medicine, was quoted in the New York Times, stating “it is one more indicaton of the widespread corruption of the medical profession by industry money.” With both research and guidelines affected by financial conflicts of interest, the public is responding with a sense of personal skepticism concerning the best way to reduce cardiovascular risk.
Medical doctors, especially cardiologists, are compelled to follow standard practice guidelines. The threat of malpractice lawsuit has created an entity that today we call “defensive medicine”. Ignoring standard clinical practice guidelines in cardiovascular care leaves the medical doctor open to malpractice accusation if the patient experiences cardiovascular harm. Since cardiovascular harm is the most prevalent threat to our health in the United States today, this is a serious consideration. The intelligent patient realizes this scenario, and takes a proactive approach in deciding the individual guidelines for their cardiovascular care. As patients are becoming more proactive and informed, the growth in utilization of Complementary Medicine, integrated into standard care, is growing exponentially. With increasing manipulation of medical research, published medical articles, and medical guidelines, there are a large number of conflicting sources of information. Today, most medical doctors are employed by corporations or companies, and fewer and fewer medical doctors are in private practice in the United States. What this means to the patient is that corporations and large companies are determining what treatment guidelines and which research is to be utilized in practice. Patients are choosing their health care based on cost of the insurance, often based on the cost of the copay, and ignoring the implications concerning their care. The prevalent attitude is that there is no variance in standard medical care and practice, but this is a false assumption.
In 2010, the American Academy of Cardiology presented its study findings on the current array of drugs prescribed to reduce cardiovascular risk in patients with metabolic syndrome (still commonly called type 2 diabetes or pre-diabetic state, for some reason), and the study found that this array of drugs actually increases cardiovascular risk for most patients (see the article cited below in additional information). Metabolic syndrome describes most of the classic high risk factors in cardiovascular disease, such as high LDL, low HDL, high triglycerides, high blood pressure, insulin resistance, obesity, and high transient blood sugar, and about one third of heart attack patients suffer from metabolic syndrome. Currently, medical doctors, due to failure of past drug regimens, prescribe on average 3.4 drugs just to lower the blood pressure for patients with metabolic syndrome, and many patients are now prescribed 5 or more drugs to lower the cardiovascular risk. The current studies showed that lowering of systolic blood pressure did not reduce risk. Maintaining a lower diastolic blood pressure, or the pressure in the arteries when the heart is at rest, has long been the focus in hypertension. Studies also showed that enhancing insulin secretion to reduce post-prandial (after eating) blood sugars did not reduce cardiovascular risk. Now that a number of current studies show that this intensive drug regimen is not healthy for most patients, where do the medical doctors and patients turn? The answer lies in restoring natural healthy balance in the body, or homeostasis, and utilizing Complementary Medicine and patient education to help with this complex task.
The other major medical treatment touted in recent years, the use of a stent to surgically open the arteries, has also been shown to be ineffective. The first large-scale study showed that patients with the stent did not do any better than those treated just with statins after 5 years. Although the stents increased blood flow to the heart, they didn’t reduce symptoms or deaths in the long run better than drugs, and were found to actually cause harmful blood clots in many patients. A high percentage of patients experience chronic symptoms such as episodic shortness of breath after insertion of a stent. A New York Times Health article from Dec. 5, 2010, revealed that insertion of unnecessary stents is a very large problem, with economic incentives resulting in 585 stents inserted that were medically unnecessary by just one cardiologist in Maryland from 2007 to 2009, and Dr. Steven Nissen, chief of cardiovascular medicine at the reknowned Cleveland Clinic stating “What was going on in Baltimore is going on right now in every city in America.” The costs of unnecessary stents do not only impact the individual patients, with negative health consequences and risks, but add billions of dollars to America's health care costs unnecessarily, with the bulk of these costs usually passed on to Medicare and the taxpayer, increasing our federal deficit. Senate investigation into this one hospital found that Medicare had paid $3.8 million for medically unnecessary stents over two years. To read this article, click on this link: http://www.nytimes.com/2010/12/06/health/06stent.html?ref=health.
Often, chronic use of blood thinning drugs is also used. Some studies have shown that the standard blood thinner, coumadin, is no more effective than low dose aspirin, has chronic side effects, and has been shown to be contaminated in production. One problem with coumadin/warfarin is that common foods that are rich in potassium may alter the effective circulating dose, causing overdose complications. Since many types of healthy foods common in the diet are rich in potassium, this is problematic. Many doctors now prescribe the alternative blood thinning drug, plavix, because of these inherent problems with coumadin, but in 2006, the American College of Cardiology concluded that the costs and risks of Plavix are too great to recommend its use. A study by the Cleveland Clinic of over 15,000 patients found that Plavix did not reduce the risks of heart attacks or strokes in most groups compared to aspirin. In 2005, the New England Journal of Medicine reported that Plavix users had 12 times the incidence of stomach and intestinal ulcers than patients taking aspirin with a heartburn medication. These studies should be discussed with the prescribing M.D., and patients should be careful when deciding issues of starting or stopping these medications. If you and your doctor decide that these medications are necessary, Complementary Medicine may help you to prevent or alleviate side effects. Even in the U.S. many medical doctors are now turning to Complementary Medicine as an effective alternative or complement to standard drug therapy.
So what sort of prevention and treatment strategy can the patient depend on? Obviously, the pharmaceutical and surgical approaches often have limited benefits and serious side effects. The quantity of cardiovascular medicines and procedures have increased dramatically in the last few decades, but the incidence and mortality from cardiovascular problems have not been significantly reduced. Why are the benefits limited? One reason is that these procedures and drugs are narrowly focused to solve a single problem without looking at the big picture. This is where Complementary Medicine and an integrated approach comes into play. Intelligent Complementary Medicine can improve the whole health picture, play a significant role in the overall protocol to reduce cardiovascular risk, and help reduce the side effects of surgical and pharmaceutical treatments as well. Improving one’s health with an array of simple protocols, including dietary changes, a little increased exercise, and integration of acupuncture, herbal medicine and nutrient medicine, not only will decrease cardiovascular risk, but will result in a more productive and higher quality life, with less dependence on drug therapies and less chance of resorting to surgical intervention. Effective Complementary Medicine should be managed by a professional. Many Complementary therapies outside of standard care are being touted in the press, though, and the patients are seeing lots of advertised claims and articles. Be aware that the FDA does not regulate herbs and nutrient medicines, and quality of product is often a big problem, as well as misleading claims in advertising. Let the professional Complementary Medicine physician guide you through this array of information as you seek to utilize it to improve overall cardiovascular health. Most of the certified professional herbalists in this country are either Licensed Acpuncturists or Naturopathic doctors.
Utilizing Complementary Medicine and Integrative Medical Approaches Effectively to Reduce Cardiovascular Risk and Treat Atherosclerosis and Recurrence of Stroke and Heart Attack
The goal for many cardiovascular patients is to reduce risk of thrombosis, or formation of a blood clot, that is the leading cause of strokes. Atherosclerotic plaque on the inside of major arteries is highly associated with thrombosis, as well as stenosis, or narrowing of the artery. An emobolism is an obstruction or occlusion of an artery by a detached thrombus. When an atheroembolism, or large blood clot composed of atherosclerotic plaque, breaks off in the Aorta, or large central artery, or in the carotid artery, the obstruction, or occlusion of blood flow, to parts of the brain, causes destruction of some of the brain tissue. This is called a stroke, or if mild, a transitory ischemic attack (TIA). Much research has been accomplished to elucidate the exact mechanisms of formation of these atheroembolisms in the last 10 to 20 years. These modern findings are vitally important for the patient that tries to find the best way to reduce risk of stroke. We have come a long way from early assumptions that atherosclerotic plaque is composed mainly of cholesterol, and that lowering cholesterol will prevent atherosclerosis and stroke.
There are two main assumptions driving the standard treatment of atherosclerosis and atherembolism. One, that atherosclerotic plaque is caused by a simple high amount of cholesterol in the circulating blood. We have come a long way from this simplistic explanation. Two, that recurrence of atheroembolism in the distal aorta, which is the leading mechanism of strokes, is treatable by simply staying on anticoagulation and antiplatelet drugs. This also may not be true. When considering the need for more comprehensive complementary therapy to reduce risk of stroke and atherosclerosis, the patient needs to understand these two health mechanisms and make objective decisions on the best course of overall care. To repeat, the goals of therapy are, one, to reduce, reverse, or prevent atherosclerotic plaque, and two, to prevent the formation of embolism. These are the main causes of both strokes and heart attacks. Some patients may also need to explore other cardiovascular problems, such as sustained high blood pressure, weak or thin areas of the arteries, or problems with the heart muscle and valve tissues. Today, many progressive M.D.s, such as Dr. Andrew Weil, state that the scientific evidence and clinical data may show that herbal and nutrient medication will produce a better long-term outcome than the pharmaceuticals, and have none of the side effects and risks associated with treatment.
We now know that atherosclerotic plaque is formed by inflammatory injury to the inside of the artery. A new standard of risk assessment is the C-reactive protein (CRP), which indicates levels of arterial blood heat and inflammation. When chronic inflammation continues in the body, the system of repair of the arterial walls, via the inflammatory system, is not working properly. The body is not able to achieve the goal of the inflammatory process, which is to repair and replace old or injured tissue with healthy new tissue. Instead, inflammatory mediating chemicals and clotting agents build up on the artery wall and calcium deposits gather, causing further irritation. Behind this accumulation of inflammatory mediating immune cells, or macrophages, and collected calcium deposits, cholesterol that is being transported in the blood may accumulate. Around this accumulation is scar tissue, or fibrosis, and collagens. The most problematic portion of this accumulated plaque is the macrophages, which release nitric oxide and other toxins that contibute to tissue necrosis and debris. A number of factors play a role in this immune dysfunction.
One of these factors, or dysfunctions, that contribute to atherosclerotic plaque, are advanced glycosylation endproducts, or AGEs. While the term given to these metabolites sounds complicated, the dysfunction is actually rather simple. When our bodies process sugar, or carbohydrates, these sugar metabolites of course combine with other molecules, such as fats (lipids) and proteins (amino acid combinations). This is called glycosylation. Our diets are now composed of simple sugars, or carbohydrates, to a large extent. This is a rather modern phenomenon, and our bodies are still adapting to these processed simple sugars, or carbohydrates. The main type of these AGEs is called A1C, which is a sugar metabolite that is attached to hemoglobin protein in your red blood cells. Too much of this hemoglobin A1C is highly associated with diabetes, and this test is now an important test that the M.D. runs to check for diabetes. AGEs, or advanced glycosylation endproducts, are also highly associated with atherosclerosis, for three reasons. One, these sugar metabolites link with arterial lining cells, or lipoproteins, and what we call cholesterol, or LDL, and harden these cells. Hardening of the arteries occurs. Two, the AGEs react with receptors on the immune cells, and they produce too many inflammatory mediators and oxidants, or free radicals, which are highly associated with atherosclerosis. Three, AGEs also inhibit nitric oxide, a cellular chemical that is important in vasodilation, lowering blood pressure, and maintaining a healthy arterial lining. High AGE levels in your body, such as A1C, create atherosclerotic plaques independantly from diabetic states, according to recent scientific study.
Imbalances in the AGE receptor (RAGE) metabolism are highly associated with atherosclerosis. A number of factors create this imbalance. When there are excess AGEs over time, when there is insulin resistance, when there is chronic inflammatory dysfunction, and when there is high circulating glucose, even episodically, there may be too few circulating AGE receptors open (esRAGE), and an excess of total AGE receptors (sRAGE). This creates a thickening of the arterial lining over time, called hardening of the arteries, which is almost synonymous with atherosclerosis. Atherosclerosis does not cause symptoms, and goes unnoticed, until it becomes severe. The smart patient starts early in life and prevents this severe atherosclerotic plaque from becoming severe enough to cause stroke or heart attack. A comprehensive treatment protocol with Complementary Medicine will balance the AGE metabolism, control chronic inflammation, help the antioxidant metabolism, decrease arterial plaque accumulation, lower blood pressure, and help your body achieve improved health of the arterial linings and tissues of the heart.
Scientific study has found that a number of healthy nutritional supplements and herbal chemicals help to reduce AGE (advanced glycoylation endproducts). P5P, the active form of Vitamin B6, helps inhibit AGE formation and platelet clumping. Vitamin B1 thiamine, and the metabolite of thiamine, benfotiamine, both protect cells from excess AGE, and inhibit superoxide radicals and excess inflammatory mediators called nuclear factors (NFKbeta). There are many different antioxidants, and some of them are particularly effective in inhibiting AGE formation and accumulation. These include L-Carnosine, N-acetyl cysteine, and alpha-lipoic acid (ALA). Of course, dietary changes, such as eating less simple carbohydrates, or refined foods, and more real whole grains, fresh vegetables and whole beans and legumes, will also help. Herbs have been well studied and various medicinal herbs have been shown to reduce AGE and arterial plaque accumulation, aid healthy sugar metabolism, improve inflammatory function, lower blood pressure, and provide antioxidant chemicals. Unlike pharmaceutical medications, herbal formulas contain many chemicals that work synergistically to provide a complete and holistic treatment.
Atherosclerotic plaque begins to build up on the endothelial lining of arteries when pro-inflammatory mediators create adhesion molecules that adhere monocytes to the arterial wall. A number of factors stress the arterial wall and stimulate inflammatory mediators, including sustained high blood pressure, stress, and modified low density lipoproteins (LDL). A number of Chinese herbs have now been proven effective in decreasing atherosclerotic plaque by inhibiting specific pro-inflammatory mediators, such as tumor necrosis factor alpha. The most studied in this regard is the herb Huang lian (Coptis chinensis), which contains berberine, and a number of formulas that contain this herb have now undergone clinical trials and have been proven effective. TNFalpha also increases reactive oxygen species, which is a major cause of vascular inflammation, and the reason that antioxidants are important in the reversal of atherosclerosis. As research progresses, professional herbal formulas are modified to deliver the most proven combination of herbal chemicals to achieve the goal of preventing and reducing atheroscleritic plaque and promoting healthy arterial linings. Drugs in standard medicine do not achieve these goals, and thus integration of professional herbal formulas, specific nutrient medicines, and acupuncture are important if your goal is actual restoration of healthy arteries to decrease cardiovascular risk. In time, these regimens may create arterial health, normalize blood pressure, reduce stress, stimulate healthier immune response, and promote better metabolic balance, reducing the need for long term use of pharmaceuticals.
Understanding the physiology of atherosclerosis and reversing this process over time
It is estimated that one in four Americans are affected by atherosclerosis, and this causes approximately 42% of all deaths. About half of these deaths are due to atherosclerotic plaque affecting the heart and coronary arteries. Many other deaths related to atherosclerosis affect the brain, where strokes occur when arterial plaque breaks off, or when arteries in the brain become unhealthy. Atherosclerois is the hardening of arterial walls and decrease of the potential flow of arterial blood through both inflexiblity of the vessels and stenosis, or narrowing due to plaque accumulation. Consequences of atherosclerotic plaque accumulation include obstruction of small arteries, formation of thrombi on roughened arterial plaque, hemorrhage of the artery under the atherosclerotic plaque, breaking off of the plaque deposit and creating an obstruction of blood flow downstream, and encroachment of the plaque into the arterial wall, causing a weak spot, and aneurysm. The goal of therapy should not be just to block cholesterol production and lower blood pressure, but to actually decrease atherosclerotic plaque and repair and maintain healthy blood vessels.
A sensible approach by the patient involves restoring healthy tissue to these arteries, as well as the muscles and valves of the heart. As stated, one way that our poor diets have contributed to this hardening of the arteries is through advanced glycosylation endproducts (AGEs), which gradually accumulate when circulating sugars and high oxidative stress combine. Another way is when red meat consumption becomes too much a part of our diet, producing an excess of unhealthy essential fatty acids, namely arachidonic acids, which are not offset by healthy omega-3 and omega-6 fatty acids. While we are led to believe that all of our omega-3 fatty acids are gotten from fish oil capsules, the truth is that many foods contain these healthy essential fatty acids, and supplements, as their name implies, are only meant to supplement our normal intake via a healthy diet. Currently, the subject of omega-3 fatty acids is not being made clear to the patient, though, and a profit driven approach is contributing to fatty acid imbalance in many patients. The important aspect of essential fatty acid balance in our bodies is the word balance. When there is a chronic imbalance of excess omega-6 arachidonic acid, increased omega-3 acids, especially EPA and DHA, may be needed, but many patient concurrently minimize red meat consumption and take omega-3 supplement, which may throw the balance in the other direction. This too may create problems with inflammatory regulation. A more extensive article on omega-3 fatty acid metabolism is found on this website. Our diet should also contain healthy and effective antioxidants, of which there are a wide variety. Deficient consumption of antioxidant chemicals also plays a part in formation of atherosclerotic plaque, particularly when poor health, overwork, tissue injury, or emotional problems cause an excess of harmful oxidants, or free radicals. These free radical, or oxidant, producing factors are called stress.
One result of these physical stressors, besides formation of excess free radical oxidants, is a chronic adrenal stress syndrome. The adrenal glands are part of the kidneys and constantly respond with hormonal regulators to protect and restore metabolic balance. When chronic stress produces adrenal dysfunction, one of these hormonal regulators, cortisol, is not produced efficiently to maintain the health. The slow adrenal responses mean that not enough cortisol is produced at one time of the day, and subsequently, an excess is produced later. Excess cortisol accelerates atherosclerosis by increasing high blood pressure, insulin resistance, and increasing fatty accumulation in the organs, especially the liver, which controls both inflammatory mediators and cholesterol regulation. Cortisol imbalance may also contribute to thyroid deficiency, hypothalamic deficiency, and overall hormone imbalance. When estrogen and progesterone deficiency occurs, the lack of estrogens, and the estrogen progesterone imbalance, reduces the ability of your body to decrease atherosclerotic plaque accumulation. Estrogen has been shown to contribute a potent antioxidant effect in cardiovascular tissue, as well as the liver and uterus. Progesterone has been shown to present a significant antioxidant effect in brain tissue. Relative excess of testosterone has been shown to decrease antioxidant effects of superoxide dismutase, leading to increased lipid peroxidation. To protect yourself and restore all of the factors that contribute to atherosclerosis, holistic approach to hormonal and metabolic balance is necessary. There is no simple solution.
How does the body try to decrease this accumulated atherosclerotic plaque? Phagocytosis is the term used to describe the body's attempt to clear the atherosclerotic plaque. This phagocytosis is impaired by oxidative stress. The low density lipoproteins (LDL) that accumulate are oxidized LDL. Oxidized blood cells need to be reduced, including oxysterols, and antioxidants are created by your body to reduce them. There are so many types of antioxidant chemicals in the body that we are still discovering new ones. Not only antioxidant chemicals in your diet, but also your ability to produce antioxidants is important. A number of effective antioxidants and antioxidant building blocks are now used in nutrient medicine. Alpha-lipoic acid, N-acetyl-cysteine, and L-carnosine have been mentioned and proven effective in scientific study. Co-Q10 is a powerful antioxidant that is often deficient in our body and proven effective to decrease atherosclerosis with antioxidant activity. Atherosclerotic plaque also contains certain proteins and peptides that increase irritating nitric oxide and other irritants. Some of these proteins are even associated with the cellular plaque deposits noted with Alzheimers, namely amyloid precursor protein and beta-amyloid peptide. These unhealthy protein accumulations need to be cleared just like the free radicals, or excess oxidants. The body uses proteolytic enzymes to clear these problematic proteins and parts of proteins, which are called peptides. Nutrient medicine also utilizes effective proteolytic enzymes in therapy, and high quality antioxidants and proteolytic enzymes are a key part of the overall treatment protocol. Nattokinase and serratiopeptidase are two proteolytic enzymes discovered that are especially effective.
In addition of antioxidants and proteolytic enzymes, a number of herbs have been thoroughly studied and proven to benefit the reduction of atherosclerotic plaque accumulation. Well known herbs, such as aged garlic, are widely used by the public now, but Chinese research has found evidence to support the use of a number of herbs to reduce atherosclerotic plaque. Not only choice of the herbs, but also quality and professional production methods are important. In an unregulated industry, many companies fail to process and select the herbs properly, reducing or nullifying their effects. A professional herbalist looks into quality and selection to insure success. Besides herbal formulas and tinctures, and antioxidants and proteolytic enzymes, key essential fatty acids help the body to regulate inflammatory processes better and are highly recommended in the treatment protocols around the world. The essential fatty acids EPA and DHA were discovered when researchers found that people native to the arctic regions had almost no incidence of cardiovascular disease. They found that these essential fatty acids were a big part of their diet, consumed in fresh ocean fish. Vegans may increase the EPA and DHA by taking dried powders of the blue-green algaes, such as chlorella and spirulina.
In addition, high levels of homocysteine in the body are now known to be an important key, or marker, to formation of large atheroembolisms, and herbal and nutrient therapy is effective to control this hyperhomocysteinemia, which indicates an imabalance of the glutathione metabolism of cellular detoxification and antioxidant clearing. Use of just one type of supplement may have limited benefit. A combination of these herbs and nutrients individually tailored to the patient may have a profound effect.
While none of us wants to take a large number of nutrient supplements, it is important to keep in mind that a proper course of therapy will produce the results we need, and then we won't need these supplement pills and herbs. Health maintenance after correction of the problem will involve healthy dietary and exercise habits. Maintenance with Complementary Medicine may involve a periodic checkup and therapy, with advice to keep you on course. Compare this with the allopathic approach of staying on pharmaceutical medicines forever with increasing side effects, and potentially decreasing overall health. The decision for many is to utilize Complementary Medicine and work with your medical doctor to decrease chemical dependancy and improve overall health to achieve a preventative state.
Quality of herbs and nutrients is essential to effective therapy, and this cannot be emphasized enough. For example, researchers found that certain types of aged garlic, such as Moascus pilosus, that was properly fermented in aging, was potently effective in inhibiting atherosclerotic plaque, while standard commercial powders were often ineffective. This quality aged garlic had a number of beneficial effects, reducing triglycerides and LDL-C, antioxidant effects, inhibiting free radicals and glycation endproducts, and significant reduction of thrombocyte and erythgrocyte aggregation. While raw garlic had beneficial effects on artery dilation, it showed no effects on reducing LDL-C. The professional herbalist utilizes quality professional products and often does the research to insure that proven herbal remedies with quality herbs and nutrients are used in your care. This type of research evidence is now widespread as the popularity and proof of Complementary Medicine expands exponentially. This area of scientific research may be confusing to the lay person, and when one reads that a study found that garlic is ineffective in reducing cardiovascular risk, few people look to see whether they were testing raw garlic or aged Moascus pilosus variety. To be certain of the health facts, consult with a knowledgeable professional.
The Problems with Standard Therapy and the Need for a Comprehensive Approach with Integrative Medicine to fully address the causes of cardiovascular risk
The second assumption in standard medicine, that anticoagulation agents and antiplatelet drugs are useful, has been problematic in long-term study. In 2002, researchers at John Hopkins University School of Medicine (Sen, Oppenheimer, Lima, and Cohen), concluded that “anticoagulation and antiplatelet agents are frequently used to treat stroke patients with aortic atheroma without any definitive evidence of beneficial effect in prevention of distal embolization.” They concluded that there were too few studies that tried to identify the cause of these atheroembolisms, and that what we saw in available studies was evidence that there was both progression and regression of atherosclerotic embolisms. They noted that therapies were needed to reduce aortic atheromas larger than 4 millimeters. Their finding suggested that high homocysteine levels were associated heavily with atherosclerotic progression. Their conclusion was that: “Stroke and transient ischemic attack patients with aortic atheroma should undergo assessment of homocysteine levels, which, if elevated, may be treated with vitamins in an effort to arrest atheroma progression.” Research has found that supplementation with Vitamin B6 and sublingual B12, and with folic acid, is effective. Niacin, Vitamin E, and various herbs have also been found effective, as have choline and betaine.
Another aspect of high homocysteine levels and the correlation with stroke risk must also be considered. It is now generally accepted that high homocysteine is a marker for disease, not a cause. The high homocysteine is a marker that the glutathione metabolism is not balanced, and this metabolism is the chief antioxidant and cellular detoxification mechanism in our bodies. Perhaps we need to take a holistic approach to this problem. You may go to the article on this website entitled glutathione balance to better understand this important aspect to cardiovascular health. The reasons behind the high homocysteine levels, as well as the high CRP, triglycerides, low HDL etc. need to be addressed. These underlying problems may be more pertinent than the actual levels in your blood. A complete assessment of all of the pertinent aspects of your health that could reduce the risk of stroke, atherosclerois or recurrence of stroke or TIA should be performed by a competent holistic physician, such as a Licensed Acupuncturist.
The reason why homocysteine is associated with cardiovascular risk is that the homocysteine derivative, homocysteine thiolactone, inhibits antithrombin activity. Antithrombin is one of the most important inhibitors of blood coagulation in your body. Acrolein is another important inhibitor and is a component of cigarette smoke, other environmental chemicals, and is generated in your body by lipid peroxidation and phagocyte metabolism. Acrolein inactivates an enzyme (paraoxonase) in HDL that protects against oxidative damage. This enzyme is calcium-dependant. Since calcium regulation is dependant on hormonal balance, this could be an underlying factor. Other systems in the body, such as liver function, are also key aspects of the whole picture, since the liver system regulates lipids, triglycerides, protein enzymes etc. A comprehensive approach would involve incorporation of many of these key elements in your therapeutic protocol, including antioxidants, essential fatty acids, proteolytic enzymes, key vitamins, herbs, other nutrients, and acupuncture.
Some facts to discuss with your cardiologist and/or Complementary Medicine physician
- European health organizations now strongly recommend the use of fish oil, with inflammatory regulating essential fatty acids, to prevent future cardiovascular problems. The best fish oil is krill oil, high in EPA and DHA (omega 2 fatty acids), and containing a natural preservative to prevent the oxidative deterioration that occurs easily in other fish oils. A balance of omega 3 and 6 fatty acids is the important factor, though, for each individual, and a knowledgeable Complementary Medicine physician may help you to understand how to best create a better essential fatty acid balance geared to your individual diet and health profile. Studies have also demonstrated that with utilization of herbal products high in a variety of beneficial fatty acids, such as sea cucumber, a type of sea animal, plasma levels of total cholesterol, LDL-cholesterol, and atherogenic index were significantly decreased, while HDL-cholesterol was significantly increased, and excess liver production of triglycerides and phospholipids were prevented. A variety of treatment options is available in Complementary Medicine, and the experienced Licensed Acupuncturist and herbalist, as well as the experienced Naturopathic doctor, can individually tailor a protocol that is most effective.
- European studies in 2005 found that pomegranate juice, with true OPCs and other essential chemicals, lowered the incidence of angina and chest pain following a heart attack by 50%. This was a dramatic finding. Now, pomegranate juice is acidic and may contain a high amount of fructose, and the taste is not to the liking of many patients. The highest concentration of these OPCs and antioxidants in pomegranate is found in the seed, rind and calix of the fruit, and a quality extract delivers these beneficial chemicals in a concentrated pill form. Pomegranex, a tablet form of pomegranate that avoids the sugars and acids, and includes the beneficial chemicals of the rind and calyx. These European studies also found that aspects of the diet may increase the incidence of angina and chest pain following a heart attack, and sound advice, individualized for each patient, concerning diet, may be very important in these circumstances.
- Studies also confirm that aged garlic is very effective in decreasing plaque buildup that clogs arteries. Herbal products and formulas, such as AstraGarlic formula by Health Concerns, which combines beneficial herbs for the heart and cardiovascular health, as well as the immune response, with quality aged garlic, and dependable professional quality herbs, is an example of the type of utilization of this research one sees from the professional Licensed Acupuncturist and herbalist.
- Numerous studies have found extreme differences in quality and quantity of ingredient chemicals in commercial herbal and nutrient supplements because of the lack of FDA oversight in this business. I guarantee that the products that I provide for you are of the highest quality and rigorously tested. The FDA is still being swayed by big money in the supplement industry to allow complete freedom to swindle you with commercial products. Use professional herbal and supplement products, and depend on me to keep track of this field.
- Coumadin, or Warfarin, is the drug of choice to prevent future strokes and heart attacks. How does it work and what are the negative considerations? None of my patients seem to have this discussion with their cardiologist. It works by inhibiting Vitamin K, an important chemical in the body. It has numerous problems with drug interactions, and numerous conditions may alter its response in the body, leading to unwanted ill effects and fluctuations in the levels of platelets and clotting factors in the blood. Drug interactions that are harmful mainly occur because various drugs compete for the same enzyme actions in the liver that control the rate of the chemical entering the bloodstream. Various foods and a few herbs may also compete for these liver enzymes, but this danger is still largely theoretical, whereas drug interactions have been proven to alter the effects of coumadin in a dangerous way. Unwanted clotting responses from Coumadin/Warfarin may occur if the patient has elevated temperature, diarrhea, poor fat digestion, poor nutrition, congestive heart disorder, poor liver function, hepatitis, cancer, or vitamin K deficiency, or has a vascular collagen disease or a blood dyscrasia (low production of red blood cells). A list of drugs, foods and herbs that may negatively interact with Coumadin/Warfarin can be found at the end of this document. A 2006 study has confirmed that the decrease in risk is equal with taking of aspirin or coumadin, so you may want to discuss this safer option with your cardiologist.
- Angioplasty: a rigorous 7 country study was completed in 2006, showing that patients receiving angioplasty fared worse than patients who took the drug regimen only. The National Heart, Lung and Blood Institute found that 17% of angioplasty patients had a recurrence of serious heart attack within 4 years, compared to 16% that relied only on drugs. The institute recommended that angioplasty only be used in the first 12 hours following heart attack.
- Studies of coumadin/warfarin use by doctors, such as those at the Washington University School of Medicine in St. Louis, Missouri, (published in Archives of Internal Medicine vol. 166, 2006), concluded that Alternative Medicine should be strongly recommended or considered in the treatment and prevention of irregular heartbeat and other heart and cardiovascular problems. A study of 1200 patients confirmed that risks and side effects from Coumadin/Warfarin long-term use were significant and that use of aspirin and other supplemental medicines were nearly as effective and had few side effects. The study found that long term use of warfarin was associated with osteoporotic fractures and other serious risks. These experts, like many across the world, recommended that anticoagulant medication be used only for short courses when needed.
- Coumadin/Warfarin acts by inhibiting the Vitamin K in the body. Vitamin K is essential to activate clotting factors and bone proteins to maintain a healthy system of arterial repair and bone health. Coumadin/Warfarin levels may fluctuate with use, depending on diet and stress of the liver function, individual Vitamin K levels, and concurrent use of other drugs. Excess levels of Coumadin/Warfarin may cause serious problems. One of these potential problems in the aging population would be an increase in the risk of arterial bleeding in the brain. Head trauma from falls is a serious problem with the aging population, and deficient Vitamin K and clotting factors could increase the risk of subdural hematoma. Many patients also are shown now to have an intrinsic deficiency of Vitamin K, making coumadin therapy ineffective for these patients. By assuming that all patients are alike, standard cardiology is ignoring the potential problems in the individual, and creating a false sense of security.
- Research has revealed a number of healthy herbs and supplements that help dissolve blood clots and thrombi. Nattokinase is a proteolytic enzyme derived from fermented soy (natto) that is proven to help dissolve blood clots and thrombi before they break off and contribute to a stroke (2006 study at the University of Michigan College of Pharmacy). Studies at the Hamamatsu University School of Medicine in Japan in 2003 showed that nattokinase suppressed arterial wall thickening (atherosclerosis) produced by arterial injury in laboratory animals, and enhanced thrombolysis, or the dissolution of thrombi, as well. Professional prescription suited to each individual insures safe and effective use of such nutrient and herbal medicines. Improper use and self-prescription of these potent herbs and supplements is not recommended for patients at risk. Licensed Acupuncturists and herbalists now have access to a growing amount of sound research presented by the U.S. NIH PubMed medical database with which to guide the use of evidence-based herbal therapy to both reduce the threat of clot and thrombus, and improve the health of the vascular lining, or endothelium. Some of these studies are presented below with links.
- Study by such groups as the Erasmus University Medical Center Inspectorate of Health Care in the Netherlands (Archives of Internal Medicine, vol. 166, 2006), concluded that patients receiving corticosteroid medications had a significant increase in incidence of atrial fibrillation, or heart irregularity, which can be fatal, and is often the cause of a heart attack. Corticosteroids are used as asthma and respiratory medications, injections for pain, treatment for autoimmune and skin disorders, and other problems.
- Aspirin works by binding to platelets and inhibiting their accumulation as unwanted clots and thromboses in the arteries. Unfortunately, long term use of aspirin has some serious ill effects on the stomach and intestinal linings and with inflammatory regulation. When the patient discontinues the aspirin, the risk of platelet aggregation may increase suddenly. It may be best to regulate the platelet and clotting factors in the body by helping the body to become healthier in this regard rather than to use synthetic or drug chemical blocking methods. Short term use of aspirin or other drugs while you improve your health is generally recommended to assure decreased risk. Long-term strategy may involve a comprehensive holistic treatment protocol. It is best to rely on a knowledgeable Complementary Medicine practitioner rather than to follow the advice of advertisements when trying to do what is best.
- Studies such as those at McGill University in Quebec, Canada, and numerous studies at European Universities and medical schools, conclude that oxidative stress plays and important role in the development of cardiovascular disease, and recommended antioxidant compounds. Alpha-Lipoic Acid (ALA) has been found to be most effective in this regard. N-acetyl-cystein, L-Carnosine, and Co-Q10 are also proven effective. The R isomer of this nutrient chemical, R-lipoic acid, has been found to be the form utilized by human cells, and thus a more bioactive version of ALA. Low doses of ALA are also found in spinach, broccoli, tomato, garden peas, brussel sprouts, and rice bran (highest to lowest concentrations). Taking ALA with these foods will increase its effectiveness and absorption. Green tea was also found to be effective as a preventative antioxidant in a large study on women’s health and cardiovascular disease. Green teas contain catechins that suppress high triacyl and homocysteine conditions that are a significant risk factor for coronary heart disease, especially in the female population. Leantain, a formula with green tea extract and hoodia, is safe and effective, also helping to reduce excess appetite when taken properly, for those women wishing to reduce weight at well as reduce cardiovascular risk.
- Studies such as those conducted by the University of Milan, Italy (Journal of Nutrition, vol. 134, 2004), showed that a diet containing soy proteins (tempeh and miso are recommended), nuts (walnuts and soaked almonds are recommended), plant sterols (beta-sitosterol and stigmasterol was found to decrease cholesterol absorption by over 40%, exerting a modulatory effect), and plant fibers (whole grains or fiber supplements etc.), with avoidance of trans-fats and reduction of excess saturated fats (red meat), was as effective in lowering cholesterol and C-reactive protein marker as was a statin-drug regimen. The American Heart Association and the USA National Cholesterol Education Program recommended this protocol. (Journal of Nutrition, vol. 134, 2004). Statin drugs have a high incidence of serious side effects that almost precluded their allowance on the market by the FDA when they were introduced, and an early form of statin, Baycol, was removed from the market due to these concerns. The most serious consideration is the accumulation of protein fragments in tissues that leads to chronic inflammatory painful conditions because of the inhibition of protein expression by the statins. While acute protein fragment accumulation (rhabdimylosis) is rarely seen, gradual accumulation with chronic use of statins is believed to be very common, and explains a gradual increase in muscle and joint pain. If you have this condition, new research has uncovered powerfully effective proteolytic enzymes to help the body clear this protein accumulation and decrease inflammatory problems (nattokinase and serratiopeptidase for example). Protein fragment inflammatory conditions may occur in the blood vessels and heart tissues as well as the joints and muscles. For most patients, this effect is gradual, and goes unnoticed and undiagnosed. Another potential problem is the blocking of healthy cholesterol production at the genetic level, which is one mechanism of statin drugs. Since cholesterol is the building block for a number of essential chemicals in the body, including bile, steroid hormones, and Vitamin D3 prohormone, the potential problems in degrading this healthy cholesterol metabolism are many. Other proven effective herbs and supplements to correct cholesterol and lipid imbalances are available, with niacin, gugulipid, omega 3 fatty acids, aerobic exercise, and weight loss all proving effective in dramatically boosting levels of healthy HDL. The most dramatic of these herbs and nutrients in research is the Red Rice Yeast extract (the original natural statin), but certain palm and citrus extracts (sytrinol) are also proven effective, as well as a variety of herbs and supplements, to achieve lowering of excess cholesterol and normalizing of the triglyceride metabolism. Your recent blood test analyses should be brought to the Complementary Medicine physician to create the right individualized treatment protocol. Other health problems common with statin use include peripheral neuropathy and other nerve pathology (published in the medical journal Neurology, May 14, 2002, vol. 58, by Dr. D. Gaist et al). ALSO: the Center for Clinical Cardiology and Research, Sartori Memorial Hospital, concluded from studies that drug therapies to lower total cholesterol and triglycerides did not have significant success without improving the diet, and diet control alone appears to significantly reduce these lipid levels, resulting in reduced need for medications (PMID: 8810649). The number of studies in standard medicine devoted to the subject of potential problems with utilizing standard cholesterol lowering drug regimens, and depending upon these protocols alone, indicates that this is not just a concern of so-called alternative medicine.
- Research into the real and specific dangers of thrombi, or blood clots, which break off and cause strokes, found that spontaneous platelet aggregration, or quick qrowing blood clots, presented the most dangerous type of thrombi. These fast growth thrombi may more easily break off and cause a stroke. A 1994 British study at The Manchester Metropolitan University published in Atherosclerosis, Vol 112, Issue 1, stated that “increased spontaneous aggregation appeared to be independent of serum cholesterol and triglyceride concentrations, as well as age and sex per se.” The study found that women, but not men, with fluctuating levels of lipids in the blood, or dyslipidemia, and patients with non-insulin dependant diabetes, now called metabolic syndrome, were more at risk for developing increased spontaneous platelet aggregation, or thrombi that might break off easily. This study 14 years ago showed us that we need to pay attention to all of these other factors mentioned above, rather than just high cholesterol and triglycerides when assessing stroke risk. We also need to pay special attention to the hormonal imbalances that lead to metabolic syndrome and insulin resistance, as well as the chronic inflammatory dysfunction in our population. Acupuncture and Complimentary Medicine addresses this issue of holistic approaches to better liver function and hormonal balance.
- Vitamin B6 deficiency and homocysteine imbalance have been found to be significant possible causes of increased stroke and heart attack risk. High homocysteine levels are associated with B6, folic acid and B12 deficiencies. This is because high homocysteine is a marker for a deficient glutathione metabolism (refer to the article on glutathione balance on this website). Taking a B vitamin complex may not correct these problems. It is advisable to supplement with injections or sublingual B12, and take a folic acid and B6. Since vitamins store in the body as part of a healthy liver function, herbal formulas to aid liver function, along with acupuncture, could be very helpful to correct these deficiencies. Studies that lowered homocysteine levels did not succeed in lowering risk, but the HOPE-2 study showed a 25% reduction in stroke incidence with the taking of the above 3 vitamins. Since B12 absorption may be problematic, oral supplements may not have significant benefit. Taking this combination of supplements, and ensuring the quality of product, within a comprehensive course of therapy, assures benefits.
- Research by the University of Kentucky found that long term use of anti-depressant drugs may result in compromised cardiac function. (Reported at the FASEB conference, Experimental Biology, 1999, Washington, D.C.) If you are taking a variety of common pharmaceutical drugs, your risk of cardiovascular problems may be increased. If this is the case, the need for addition of a Complementary Medicine protocol is increased to insure success in prevention of stroke, heart attack, TIA, atherosclerosis, or to insure less risk of recurrence.
- The common use of CT or CAT scans with strokes is now being heavily questioned. A CT or CAT scan is a computerized tomography that utilizes hundreds of x-rays to scan the body. The 2009 President's Council on Cancer stated that the increased use of radiology in medicine was now responsible for a high percentage of cancers in this country. A series of articles subsequently by the New York Times found that there was a high incidence of overradiating and damage to patients, sometime deadly, with CAT scans (see article links below). While most patients do not experience acute overdosage of radiation with these scans, the amount of radiation in normal use is very high, and the recommendation by the President's Council on Cancer is to curb the use of CT or CAT scans considerably. In the past, a simple X-ray with contrast dye injected into the blood produced a highly explicit picture of the cardiovascular problems in the brain with stroke. This procedure is cheaper, safer, and perhaps more detailed. CT or CAT scans are more profitable, quicker to analyze, and may benefit the bottom line more than the patient. Patient awareness may be the key in decision making when choosing the safest testing with cardiovascular problems.
The LIST: from WebMD and confirmed by other sources
When using a anti-coagulant drug, commonly referred to as a blood thinner, there is a growing concern of improper blood concentration and dosage. Excess blood concentration may occur when other drugs, foods, and herbs are consumed. The potential for altered blood concentrations with concurrent use of other medications, or drugs, is the area of most concern, but even such common foods as kale, spinach, and other green leafy vegetables, green tea, grapefruit, and cranberry may alter the drug concentration and inhibit the ability of the body to use clotting factors to repair weak areas of the arteries. In addition, each individual may have differing levels of the natural pro-coagulant Vitamin K, altering the effects of coumadin. These drugs and foods pose potential negative interactions with Coumadin/Warfarin:
- catecholamines (ephedrine diet pills or allergy/asthma pills, or dopamine effectors, such as antidepressants or anti-anxiety agents that inhibit dopamine reuptake), anti-depressants or anti-anxiety drugs that are reuptake inhibitors or MOA inhibitors, beta-adrenergic blockers (hypertension meds or asthma/allergy medications), diuretics, cholesterol lowering drugs such as statins or dietary cholesterol inhibitors (Zetia), antibiotics, steroids, diabetic medications, antacid medications, aspirin, thyroid medications, anti-fungal agents, 5-lipoxygenase inhibitors that treat COPD, allergy, asthma et al, such as Zileuton, like corticosteroids, and many others. The list includes acetaminophen, aspirin, alcohol, celebrex, vioxx, cortisone, erythromycin, neomycin, lovastatin, simvastatin, fluvastatin, pravastatin, atorvastatin, clozapine, flu vaccine, ibuprofen, prednisone, Dilantin, phenobarbital, tamoxifen, atenolol, propranolol/Inderol/Dociton/Blocadren, and more. Ask me to review your medication list or look in my physicians desk reference if your M.D. doesn’t make clear which of your medications may be included in this list.
- Foods, supplements and herbs that may potentially interact with coumadin to alter the effects (although no actual incidents of injury have been proven or documented yet, and rxlist.com states that few adequate well-controlled studies exist that evaluate the potential metabolic or pharmacologic interactions between botanicals and Coumadin) include: high dose vitamin C, alcohol, St. Johns wort, danshen, gingko biloba, ginseng, feverfew, yarrow, willow, goldenseal, danggui, juemingzi, shengma/black cohosh, coenzyme Q10, arnica, nettle, parsley, celery, chamomile, anise, fennel, clove, licorice, dandelion, horseradish, asa foetida, cayenne, passion flower, pau’d’arco, garlic, onion, cocoa, tamarind, sarsaparilla, aloe, sweet clover, boldo, buchu. While these herb and drug negative interactions remain unproven, there is a general agreement that foods rich in potasssium may alter the circulating levels of coumadin. Potassium-rich foods include a wide variety of common healthy foods, as well as some popular snacks. Since effectiveness and safety of coumadin are so widely questioned, many patients are discussing whether it would be better to eat healthy foods and take herbs instead. Discuss this with your medical doctor.
- SIDE EFFECTS THAT ARE COMMON WITH USE OF COUMADIN ARE: headache, numbness and tingling, muscle or joint pain, dizziness, shortness of breath, low blood pressure, easy bleeding, and poor tissue health leading to chronic inflammatory conditions. Infrequent side effects include: poor liver function, allergic reactions, cold sensitivity, diarrhea, itch and rash, fatigue, and balding. If you are experiencing these side effects, discuss them with your M.D. and discuss the possibility of discontinuing Coumadin use and the actual risk if other alternative health regimens are used and you maintain optimum health.
NOTE: the few studies that deal with herb drug interactions have produced questionable data. For instance, the main herb studied, St. Johns Wort, was found to compete with the liver enzyme that broke down digoxin, increasing blood levels acutely, but with use greater than 2 weeks induced greater amounts and efficiency of this liver enzyme, bringing the digoxin levels to normal. A 2005 statement published in Fundamentals of Clinical Pharmacology stated: “the majority of interactions are theoretical and based on case reports, in vitro assays, animal studies, and/or speculation.” The actual cases reported that confirm such negative herb drug interactions is zero. Also, the dosage of herbal chemicals in normal professional use is low, and this may also contribute to the lack of clinical problems recorded.
The Real Evidence
Coumadin/Warfarin has been used for many years, as have herbs and common foods. A MEDLINE and TOXLINE review of all databases from 1966 to 1993 revealed only 43 instances reported of highly probable interactions in the English speaking world. These interactions occurred with:
- 6 antibiotics: erythromycin, cotromoxazole, fluconazole, isoniazid, metronidazole and micoonazole increased the anticoagulant or ‘blood-thinning’ effect
- 5 cardiac drugs: propranolol, clofibrate, amiodarone, propafenone and sulfinpyrazone increased the anticoagulant effect
- alcohol increased the anticoagulant effect only if there was liver dysfunction
- cimetadine
- omeprazole
- phenylbutazone
- piroxicam
- 3 antibiotics: rifampin, nafcillin, griseofulvin inhibited the anticoagulant effects
- 3 central nervous system drugs: barbiturates, carbamazepine, and chlordiazepoxide inhibited the anticoagulant effect
- cholestyramine
- sucralfate
- foods high in vitamin K is eaten in excess: asparagus, broccoli, blackstrap molasses, Brussel sprouts, dark leafy greens, cabbage, cauliflower, egg yolk, oatmeal, oats, rye, safflower oil, soybeans, wheat, alfalfa, green tea, blueberry, nettle, and kelp.
- large amounts of avocado
There is no vitamin K in ginseng, aged garlic, parsley, danshen, danggui, yarrow, or the other substances with warnings or potential interactions. If these foods and herbs had caused problems in the past they would have been cited in the above review of 17 years of worldwide English interactions.
A 2006 study proved that there was no discernable negative interaction between aged garlic and coumadin. (PMID: 16484565)
A 2003 study in Britain found that of 631 coumadin users, 99 were taking an herb or supplement that was potentially able to negatively interact with coumadin. None of these patients reported any problems. (PMID: 16115136)
Additional Information and information resources
- A July 31, 2010 article in the New York Times outlines recent findings of the dangers of CT or CAT scans commonly used to evaluate the patients with strokes. This is an ongoing series in the New York Times that explores the dangers and harm from excess routine radiation in radiology tests in the U.S. that was initiated after the 2009 President's Councel on Cancer found that radilogy radiation was now a very significant cause of cancer in the U.S.: http://www.nytimes.com/2010/08/01/health/01radiation.html?_r=2&th=&emc=th&pagewanted=all
Much evidence is accumulating to help guide the modern herbalist in the best course of therapy for the patient with cardiovascular risk. Use of a double boil water extract of Dang gui, Astragalus, Rhodiola and American Ginseng has been proven highly beneficial, as has the alcohol extract of European olive leaf, Gingko biloba, Gotu Kola and Siberian Ginseng. Red Rice Yeast extract and sytrinol and tocotrienols are also supported by much research to improve cholesterol and lipid metabolism.
- Cardioprotective effects of common Chinese herbs, Dang gui and Huang qi, or Astragalus were confirmed with research in 2006: http://www.ncbi.nlm.nih.gov/pubmed/16619337
- Further information on cardioprotective effects of common Chinese herbs, Dang gui and Huang qi, or Astragalus were confirmed with research in 2007, which showed an increase in glutathione metabolism: http://www.ncbi.nlm.nih.gov/pubmed/17325989
- Cardioprotective effects of European Olive leaf tincture were identified in 2003, preventing high blood pressure and atherosclerosis, while also improving insulin metabolism and providing antioxidant clearing of arteries: http://www.ncbi.nlm.nih.gov/pubmed/12648829?
- Cardioprotective effects of the unique Chinese herb, Rhodiola rosea, or Hong Jin Tian, were reviewed in 2007: http://www.ncbi.nlm.nih.gov/pubmed/18074810
- Cardioprotective effects of Omega-3 fatty acids, EPA and DHA, were reviewed in Europe in 1999, and have become standard therapy following a stroke or myocardial infarction (heart attack). Krill oil presents the high quality and most concentrated type of this supplement, with a natural preservative, unlike fish oils: http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(99)07072-5/abstract
- Scientific study in Spain in 2010 found that the quality of fats in the diet explained the low incidence of cardiovascular disease in the population, which consumes a high amount of natural fatty foods with high content of the essential fatty acids DHA, alpha-linolenic, and oleic acid: http://www.ncbi.nlm.nih.gov/pubmed/20463042
- A growing group of medical doctors, researchers, and scientists from around the world are urging a new direction in cardiovascular treatment, with growing evidence that the focus on cholesterol is not producing cardiovascular health or significantly effecting disease, but instead creating ill health by decreasing healthy fats in the diet and prescribing statin drugs with many long-term side effects and widespread deficiencies in CoQ10, steroid hormone precursors, Vitamin D3 hormone, and other beneficial terpenoids: http://www.thincs.org/
- Herbal research in China has focused on the effects of herbal chemicals on the expression of many genes involved in the ischemic process of stroke, with herbal chemicals proven to reduce the genetic expression of genes that were altered in the hippocampus of laboratory animals with induced ischemic stroke. The effects of the herbal preparations were also found to be modulatory, upregulating genetic expression that were beneficial to brain tissue repair, while downregulating genetic expression that produced negative effects: http://www.sciencedirect.com/
- Studies in 2010 at Beijing University found that a common Chinese herbal formula used to reduce inflammation, Huang lian Jie Du Tang, could remarkably inhibit cellular calcium overload after an ischemic stroke to decrease injury to brain neurons: http://www.ncbi.nlm.nih.gov/pubmed/21046754
- Studies in 2010 presented by the American College of Cardiology showed that the array of medications commonly prescribed to reduce risk for patients with metabolic syndrome are not only ineffective, but actually increased cardiovascular risk for most patients: http://www.nytimes.com/2010/03/15/health/research/15heart.html
- Studies have shown significant benefit in correcting the mechanisms of atherosclerotic plaque formation with Chinese herbal formulas. This study, published in the Oxford Journal in 2009 discusses the physiology of atherosclerotic plaque formation and explains how specific Chinese herbs, including Coptis chinensis with berberine, reverse this pathology: http://ecam.oxfordjournals.org/cgi/content/full/nep126v1
- A study in 2010 of a specific Chinese herbal formula used in cardiovascular medicine found that this array of phytochemicals exerted significant effects modulating the inflammatory cytokine TNF-alpha that promotes the inflammation central to the formation of atherosclerotic plaque. This study at Dongguk University in South Korea details the study and findings. The herbal formula HMC05, comprised of Pinelliae ternate Ten. Ex Breitenb. (Ban xia), Atractylodes macrocephala Koidz. (Bai zhu), Gastrodia elata Blume (Tian ma), Citrus unshiu Marcow. (Zhi ke), Poria cocos Wolf (Fu ling), Crataegus pinnatifida Bunge var. typica C. K. Schneider (Shan zha), Siegesbeckia pubescens Makio. (Xi xian cao), and Coptidis japonica Makino (Huang lian), is comprised of herbs commonly used in TCM. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3130524/?tool=pmcentrez
- Studies in 2009 in Turkey found that the Chinese herb Bai ji li (Tribulus terrestris) was effective both in lowering high lipids as well as reducing atherosclerotic plaque and protecting the endothelial lining of blood vessels: http://www.ncbi.nlm.nih.gov/pubmed/19269683
- Studies in 2009 in Turkey also found that St. John's Wort, or Hypericum, alcoahol extract, was effective in lowering high lipids and improving the lipid balance and profile, while also exerting significant beneficial antioxidant effect: http://wwww.ncbi.nlm.nih.gov/pubmed/16901489
- An overview of recent scientific studies of Red Rice Yeast extract by UCLA found that it was surprisingly effective in lowering high cholesterol and triglycerides, without side effects, and with a balancing or modulating action: http://www.cellinteractive.com/ucla/natural_remedies/chinese_red_rice.html
- A 2001 study at the Loma Linda University School of Medicine in Loma Linda, California, found that aged garlic extract is able to clear oxidized LDL (low-density lipoprotein), a major component of atherosclerotic plaque: http://jn.nutrition.org/cgi/content/full/131/3/1020S
- A 2010 study at Henan College in China found that an herbal extract from wild rhubarb root (Da huang), aglycone, when combined with thrombolytic therapy following a stroke, exerted significant protective effects on brain microvascular membranes, reducing the risk of intercranial hemmorrhage recurrence (ICHR) and mortality, when taken after a cerebral ischemic stroke: http://www.ncbi.nlm.nih.gov/pubmed/21322957
- A 2002 study at the Beijing College of TCM showed that a common Chinese herb prescribed to promote blood circulation and inhibit blood stasis worked by inhibiting thrombus formation and platelet aggregation in arteries. The herb Paeonia lactiflora (Chi shao) prolonged the prothrombin time (PTT) and exerted significant antithrombin effects, showing how traditional Chinese herbs are scientifically proven in medical efficacy: http://www.ncbi.nlm.nih.gov/pubmed/2364461
The information on this website is not intended to be used as a specific medical advice or cure. Please consult with the practitioner or an appropriate physician, such as a licensed acupuncturist, naturopath, or medical doctor, to discuss the proper application of the information contained on this website.