By Dr. Mercola
Dr. Stephen Sinatra is a board certified cardiologist, and a prominent expert in the field of natural cardiology.
His newsletter helps educate large numbers of people about the importance of maintaining a heart-healthy lifestyle.
He also addresses the psycho-emotional component of the heart.
Dr. Sinatra explains:
"I was working in the cardiac catheterization laboratory and was seeing an alarming number of young patients with sudden cardiac death… men in their 30s, women in their 40s…
[S]ome of these cases, I ended up writing up in my book Heartbreak and Heart Disease.
What I realized back then was that emotions… led to them to develop heart disease and cardiac arrhythmia, and then sudden death.
I needed to learn more about the mind-body connection."
Gestalt Psychotherapy and Heart Health
As a result, Dr. Sinatra entered a two-year Gestalt psychotherapy training program, followed by a seven-year Bioenergetics training program at Cambridge, in Boston.
In 1989, he was certified as a bioenergetics psychotherapist.
"[T]here was no drug training in these aspects," Dr. Sinatra says. "Basically, I realized after spending 10 years in psychotherapy that heartbreak was one of the major causes of heart disease."
Having gone through these two separate training tracks professionally, Dr. Sinatra offers intriguing insight into what really helps keep your heart ticking. In his former practice, he successfully integrated bioenergetics with his conventional cardiology training.
"[A] good bioenergetics therapist can look at a person and track the energy in the eyes, follow the voice, look at the breathing pattern in the diaphragm, look at how [the patient] holds his shoulders and get a sense of who that person really is, and get a sense of their struggle, or their search," he explains.
Cholesterol—Found at the Scene of the Crime. But is it a Culprit?
Dr. Sinatra, like so many doctors who have taken the time to study cholesterol and heart disease at greater depth rather than relying on information from the pharmaceutical industry, believes that cholesterol is not the main perpetrator causing heart disease.
"Let's face it, cholesterol is something your body needs," he says. "If you look at the MRFIT study [Multiple Risk Factor Intervention Trial] where they looked at 180,000 men over a period of… 13 years (1973-80); men with cholesterol of 330 had less hemorrhagic stroke than men with cholesterol less than 180. If you look at cholesterol numbers, the higher cholesterol number would give you protection from hemorrhagic stroke. (I'm not talking about ischemic stroke now but hemorrhagic stroke.)
… [W]e need cholesterol in our skin to activate vitamin D3 from sunlight. We need cholesterol to make our sex hormones… to make our adrenal hormones.
We need it for lubrication.
We need it for neurotransmitter function in the brain.
When LDL is driven too low, it's no wonder that a lot of patients develop memory problems or pre-Alzheimer's, or even total global amnesia, which is really losing one's memory. It's very frightful and I have seen several cases.… There are so many other aspects that in my mind play a much bigger role that I put cholesterol down at the low end of the spectrum."
Dr. Sinatra's Take on Cholesterol-Lowering Drugs
Some researchers like Dr. Seneff do not believe it is appropriate for anyone to take statins, and while Dr. Sinatra believes that a statin drug may be suitable for some people, he agrees that the risks are very high, and side effects grossly underreported.
"I feel that the best indication for a statin drug is a middle-aged male with coronary heart disease and a low HDL," he says. "To me this person has the greatest to gain and the least to lose. The problem I have with cholesterol lowering drugs is that they have horrific side effects… If you treat a woman in her 30s just for "high cholesterol," and treating numbers, I think we're doing a disservice… We really shouldn't use them in elderly people. We shouldn't use them in young people, or in women. I have been very disappointed as a clinical cardiologist in the efficacy of statins in women, even with advanced coronary disease."
Modern Tests More Accurately Define Individual Heart Disease Risk
Dr. Sinatra points out that today there are far more sophisticated tests that can differentiate different kinds of cholesterol to determine your heart disease risk based on your individual cholesterol makeup, as opposed to trying to squeeze everyone into a specific total cholesterol range.
He urges every clinician to use a cholesterol fractionation test these days, along with a subfractionated lipid panel. The first measures total cholesterol, LDL cholesterol, HDL cholesterol and triglycerides. The subfractionated lipid panel further differentiates the various subclasses of Low Density Lipoprotein Cholesterol (LDL), meaning it measures your mean particle size, and that can make all the difference in the world.
If you fractionate the LDL, and discover that you have what Dr. Sinatra refers to as "fluffy" LDL, in other words, large buoyant LDL particles that are not oxidized, and therefore not inflammatory, then having a high LDL level is not a concern in terms of heart disease risk. These LDL's, while conventionally thought of as "bad" cholesterol, are actually harmless. Small-particle LDL's on the other hand, are more inflammatory, and because of their tiny size can get stuck and cause problems in your arteries.
"I still wouldn't treat small particle LDL in the absence of any documented coronary disease," Dr. Sinatra says. "I would use niacin for example. Niacin can change small particle LDL and make it fluffy. Certainly, the tocotrienols—I've had good luck with delta tocotrienol. Even nattokinase. I have seen it not only thinning the blood but [also]… LDL becoming more buoyant.
I would reserve statin drugs for, again, documented cases of coronary artery disease and again particularly middle-aged males. If I did have cholesterol problems or inflammatory cholesterol subtypes, I would try to treat the patient with weight loss and exercise and nutraceutical support first, before I would consider a statin drug."
Two Ratios that are Potent Indicators of Heart Disease
Additionally, the following two ratios are far better indicators of heart disease risk than total cholesterol alone:
- Your HDL/Cholesterol ratio-- HDL percentage is a very potent heart disease risk factor. Just divide your HDL level by your cholesterol. This percentage should ideally be above 24 percent. Below 10 percent, it's a significant indicator of risk for heart disease.
- Your Triglyceride/HDL ratios—Divide your triglycerides by your HDL level. This percentage should ideally be below 2.
Diet and Triglycerides
In my experience, high triglycerides specifically, and elevated cholesterol in general, is typically related to excessive consumption of grains and sugars. A high-fructose, high-grain carb diet contributes to insulin resistance, which will cause your liver to produce more cholesterol and more inflammatory LDL particles, raise your triglycerides, and increase your risk of metabolic syndrome.
Dr. Sinatra agrees.
In fact, he discusses the dangers of sugar in his book Sugar Shock, coauthored by Connie Bennett.
"If you look at the most horrific inflammatory hormone, it's insulin," he says. "It causes inflammation of the basement membrane of the vessels… which is the endothelial cell membrane. Insulin is the most endothelial unfriendly component around. If you don't want to get inflammation of your coronaries, or any blood vessels for that matter, you need to restrict sugar in your diet."
Important Precaution for Those Who Take a Statin Drug
One in four Americans over the age of 45 are currently taking a statin drug. Unfortunately, few are aware of the need to take coenzyme Q10 along with it, to buffer against some of the most devastating side effects of the drug.
"[S]tatins block several biochemical pathways in the production of cholesterol. In other words, statins are great cholesterol killers but in the same process they knock out other biochemical pathways. One of the pathways is squalene, which I think is really essential in preventing breast cancer in women.
The other major pathway is a CoQ10 pathway.
Anybody taking a statin drug has to be concerned about immune system dysfunction because of the squalene reduction. But more importantly, we have to be concerned about the CoQ10 reduction because CoQ10 is one of the most important nutraceutical or natural vitamin-like enzymes that is produced in your body that supports your immune system. If CoQ10 levels go down, you can get immune system dysfunction and… inflammation."
One of the major problems with statin drugs is that they diminish your CoQ10 levels. So if you're taking a statin drug, you MUST take Coenzyme Q10 as a supplement. Dr. Sinatra recommends taking at least 100 milligrams (mg), but preferably 200 mg, of high-quality CoQ10 or ubiquinol daily. You cannot get enough of it through your diet.
"Even if you ate five pounds of wild salmon a day, you're not going to get near enough the amount of CoQ10 to protect your immune system and your vascular system," Dr. Sinatra warns.
Why Virtually Everyone Can Benefit from CoQ10
CoQ10 may also benefit those who are not taking a statin drug. Dr. Sinatra has personally taken it for 30 years, simply because "it is the most important antioxidant membrane stabilizer around." He goes on to discuss its use for mitochondrial toxicity—a severe case of which would be the Gulf War syndrome. (The mitochondria are little organelles—found in the cytoplasm of the cell—inside of which energy is formed.
This energy is called adenosine triphosphate or ATP.
Without ATP, the cell dies. Toxic exposure can cause mitochondrial dysfunction, and once the mitochondria dies, you get tissue impairment, followed by pathology.)
While most of us have never set foot on a burning oil field, most people today are still exposed to a number of mitochondrial toxins, such as insecticides, pesticides, mercury and other heavy metals, radiation and EMF. All of these vaccines and some pharmaceutical drugs contribute to mitochondrial instability and vulnerability. Interestingly, Dr. Beatrice Golomb has shown that when Gulf War veterans are given CoQ10, they improve and in some cases even thrive. And while the Gulf War syndrome is on the extreme high end, general fatigue is on the lower end, and fatigue is rampant in modern society.
According to Dr. Sinatra, this feeling of being chronically tired is a generalized symptom of mitochondrial toxicity. He suggests that most people need to take CoQ10 for the simple reason that we live in such a toxic world.
"I believe everybody should take CoQ10," he says. "I just feel that it's such a powerful and unique and extraordinary nutraceutical. You need it to turn over your mitochondrial enzymes for mitochondrial support. Alone, CoQ10 is great, but when we give CoQ10 in combination with the carnitine and magnesium and ribose, then you get the perfect combination for mitochondrial support. That's why people on metabolic cardiology approach absolutely thrive. I just feel it's a great combination. But for starters let's start with CoQ10, because that's the leader of the pack in general at this time."
CoQ10 may also help slow down the aging process itself, in large part due to its membrane stabilizing activity.
"I believe that CoQ10 absolutely supports aging and delays aging at the same time. By supporting it, I mean by giving people a better quality of life and delaying symptoms of the aging process itself," Dr. Sinatra says.
Potential Side Effects
In terms of side effects, you can't get a whole lot safer than CoQ10. No adverse effects have been reported at the doses Dr. Sinatra recommends.
"The one side effect that I want to caution people about is that if your heart is very starved for CoQ10, in other words, if the serum level is very low, then you want to start taking very low levels, like 10 mg once a day, or even twice a day, and just go very slowly," he says.
"Very rarely you'll see somebody with some diarrhea or GI complaints. Maybe in 1 in 500 patients might see a slight rise in liver enzymes. I have [also] used CoQ10 with Coumadin in lots of my patients. Remember CoQ10 structurally, metabolically looks a lot like vitamin K2. I suspect in somebody's body, if they're on Coumadin or warfarin, the body may turn around and look at CoQ10 as an antagonist but I haven't seen it.
Three cases were reported in The Lancet back 15-20 years ago, but again, I had not seen a contraindication with warfarin and CoQ10. Would I be a little cautious with CoQ10 and warfarin? Just draw your INRs. If the INR is stable certainly the CoQ10 is not contributing to any blood thinning or blood clotting. CoQ10, like carnitine, is a very safe nutrient to take. The reason being is [because] your body makes it… The side effect profile so far is basically nil."
Again, if you're on a statin drug, you MUST take at least 100-200 mg of ubiquinol or CoQ10 per day. If you're not on a statin drug, the amount of CoQ10 or ubiquinol you might need depends on how sick you are. The sicker you are, the more you need. As a general guideline if you're not ill, Dr. Sinatra suggests taking 50-100 mg per day. If you're over the age of 70, double that dose, or up to 200 mg per day. This is because your natural CoQ10 levels begin to drop after the age of 40, and by the age of 70, levels begin to precipitously drop.
Ideally, you'll want to split the dose up to two or three times a day, rather than taking it all at once, as this will result in higher blood levels. Other dosing guidelines include:
✓ Hypertension 200 mg/day
✓ World class athletes who need extra ATP turnover, 300-600 mg/day
✓ Heart transplant or severe CHF, 300-600 mg/day in divided doses
✓ Arrhythmia 200 mg/day
✓ Typical athlete 100-300 mg/day
✓ Mitral valve prolapse, a combination of 400 mg magnesium and 100-200 mg of CoQ10
For more information on CoQ10, please see Dr. Sinatra's website at www.DrSinatra.com.