The primary prevention and treatment of coronary artery disease is not limited to low cholesterol, low salt, low fat diets.  Nutrients reverse atherosclerosis: they should be ranked first, ahead of all other treatments for coronary atherosclerosis, which is responsible for at least half of all deaths in our time.

Orthomolecular therapy, putting nutrients first, i.e. antioxidants, anticoagulants, and trace minerals, especially copper.  But so entrenched has the cholesterol theory become in the public mind, that Americans are still in the dark as to the real power of nutrition and nutrient therapy against perils coronary artery disease.  In part this is due to a smoke screen of propaganda.  The Public Health Service, a government agency, has been allocated several billions of dollars to educate the American public about the virtues of a low fat, low cholesterol diet to prevent coronary artery disease--even though there is no proof that this actually rewards us with a drop in over-all mortality.  Heart attacks do drop but at the expense of depression, suicide and accidents--and possibly cancer and stroke as well.

In the broadest sense, cholesterol has played a role analogous to a germ; and the various drugs are analogous to antiseptics or antibiotics that kill the germs, or cholesterol deposits.  That idea has prevailed for half a century, so it will probably continue to dominate physicians and patients alike for some time to come.  New “truth” is not always welcome when an old theory has taken hold and fits in with the established belief systems of the people.  After 50 years of anti-cholesterol propaganda most people are afraid of eggs, butter, cream, liver, beef and even lobster, because they are told these foods contain cholesterol or saturated fat, which somehow increases blood  cholesterol.  We have become a nation of cholesterol-phobics.

On the other hand, orthomolecular theories, long subject to disbelief and derision, are finally gaining respect.  The antioxidant theory is the most popular of the new theories about coronary artery disease,.but it turns out that the antioxidant vitamins C and E are effective ONLY at levels 5 to 10 times greater than the recommended daily allowance (RDA).  And carotene is effective even at usual doses.  One reason for this acceptance of antioxidant megavitamins is that antioxidant theory does not contradict cholesterol theory.  A minor revision will suffice: cholesterol is now recognized as harmless, but oxidized cholesterol is bad.  Why?  Because it is carried by macrophages, white blood cells, to the blood vessel wall. There it induces free-radical formation, formation of superoxide and hydroxyl ions, which cause damage to the cells there.  Antioxidants prevent this damage.  

This view of the mechanism is based on the observation that oxidized cholesterol attaches to receptors in the blood vessel wall, then attracts white blood cells that release chemical mediators of inflammation and spasm, ultimately leading to plaque, calcification and thickening of the blood vessel and setting the stage for clotting.  Other explanations are also possible but the main thing is that treatment with antioxidants, particularly vitamin E, can prevent oxidation of cholesterol and inhibit platelet aggregation, an early step in clot formation as well.  Thus, a recent large research study in which over 80,000 nurses were followed for 4 to 8 years in separate studies, found 150 mg doses of vitamin E, over 10 times the RDA, reduced the mortality from heart attack by almost 50 percent.  Five years earlier a similar benefit was reported after a ten year study of 22,000 physicians who volunteered to take carotene supplements.  

One would think that these research results would assure antioxidant therapy a starring role in treating coronary artery disease.  Such is not yet the case.  Orthodox physicians continue to cavil and debate the fine points with such fervor that even the experts who run the research still advise against vitamin therapy.  Privately, however, they take large doses of vitamins C and E along with fresh fruits and vegetables.  Publicly they call for more controlled, double-blind clinical studies.  Orthomolecular physicians, on the other hand, believe “if it might help and won’t hurt, go ahead-now.”  To an ordinary mind this is simple common sense.  To a physician or medical ethicist, however, it remains profoundly controversial and so the orthodox path relies heavily on angiograms and by-pass surgery.

Eating habits and cholesterol.  Family Practice, 1996, 26(12):33
“ in Nutrition Week, 1996; 26(31):7.
In a study of 300 people aged 35-55, those eating 4.5 times per day (meals and snacks combined) had high HDL, lower LDL and insulin and lower body mass than those who ate fewer meals per day.  This study, small though it is, confirms an opinion that snacking is a healthier mode of eating than binging.  Eating 3 square meals can be construed as binging.  In my Listen to Your Body Diet a meal is defined as any combination of 3 foods; a snack is less than that, just one or two items at a time.  And when eating more than 3 foods at a time, isn’t that a feast?  The benefits of increased frequency of eating probably  applies to meals and snacks, not feasts.  Our custom of 3 square meals a day is actually 3 feasts a day, 3 binges if you please, and unless you are a physically very active person that is probably too much.  The essence of this research is that under-eating is not an advantage; and we already know that over-eating is a health hazard.  The idea of 4.5 meals a day is probably a lucky estimate of what is optimal.  The optimal frequency remains to be seen; but it probably varies with the individual and his day to day conditions of living.

Rodriguez BL, et al.  Fish intake may limit the increase in risk of coronary heart disease morbidity and mortality among heavy smokers: The Honolulu Heart Program. 1996; Circulation 94(5):9529-956.
The Honolulu Heart Study followed the lives of 8000 Hawaiian -Japanese-American men, between 45 and 65 years of age in 1965.  Over 3000 were smokers at the beginning of the study and if they ate fish less than twice a week they had an increased risk of death due to heart attack.  Heavy smokers who also ate a lot of fish had half the risk of those with low fish intake. Current smokers who ate fish more often than twice a week had no relationship between coronary mortality and cigarettes smoked. In other words, eating fish was a stronger influence than smoking cigarettes!

This verifies in humans the same results as Bonnie Weiner found in her study of pigs on a high fat diet.  Even though these animals had a high cholesterol, over 400 mg per 100 ml of blood, they didn’t have heart attacks so long as they were fed fish oil in addition.

Simons LA, et al; What dose of vitamin E is required to reduce susceptibility of LDL to oxidation. Australian-New Zealand Journal of Medicine, 1996;26:496-503.
Vitamin E is also protective against heart attack mortality, a fact that has been known since the 1940’s due to the brilliant clinical observation and personal integrity and courage of the Schute brothers in Canada.  Now we have a study which evaluated 42 individuals in a placebo-controlled trial, in which vitamin E was provided at doses of either 500 iu, 1000 iu, or 1500 iu per day.  The oxidation of LDL was measured and found related to the dose of vitamin E: the higher the dose, the longer it took to oxidize the LDL.  This means protection of the blood vessel wall is greater at higher doses than at lower ones.  That is an important fact.  Doses of vitamin E in the 1000 to 2000 iu per day range are no longer to be abhorred.  Side effects are nil.  Benefits may be life-saving.

Hans Selye, pioneer researcher into the hormonal basis of the Stress Response performed an experiment that showed the combined effects of rancid oils and the Stress hormone to cause heart attacks in laboratory rats within a matter of hours.
Selye’s experiment reproduced real-life conditions:  he fed his laboratory rats a diet high in corn oil, full of peroxides.  He then gave them calcium supplements and an injection of a natural stress hormone, DOCA (deoxy corticosterone), which is known to cause sodium retention and potassium loss.  That was sufficient to kill most of his animals within an hour.  At autopsy the hearts of his animals were found to have well-defined infarcts.  They had heart attacks!  

This experiment is in my opinion one of the all-time great demonstrations of the biology of heart attacks.  It strikes close to home because so many Americans take calcium supplements, use corn oil margarine or corn oil, either of which is oxidized, and produce adrenal cortex hormones under the stress of everyday life.  The wonder is why we don’t have more heart attacks than we do.  

That question is the more relevant in the light of environmental pollution, which provides irritants that accumulate in the lining of our blood vessels.  Pesticide residues actually accumulate within the plaque that causes heart attacks, good reason to suspect that they may contribute to the irritation that causes thickening of the blood vessel wall, narrowing of the lumen and clumping of platelets that generates clot.  Is it a coincidence that the rate of heart attacks has dropped sharply since DDT was banned in 1972?  

Water pollution is also suspect, for the beginnings of our heart attack epidemic coincide with large-scale chlorination of public water supplies at the turn of the Century.  Could this be due to depletion of antioxidant reserves.  Could there be a water borne chlorine product that acts as an irritant once absorbed into circulation?  The questions are not answered; they have hardly been asked.  

The effect of fluoridation on heart attack is even more suspect.  Dean Burk and John Yiamouyiannis found a 12 percent increase in heart attack mortality in the 10 largest fluoridated cities compared to the 10 largest non-fluoridated cities in America between 1950 and 1972.  Dr. Burk was head of research at the National Cancer Institute and Dr. Yiamouyiannis is a research trained biochemist.  Their analysis could not be dismissed lightly, especially since the data was procured from government sources.  Finally a “sophisticated” re-analysis of the data erased the excess mortality from heart attack by modifying the data in relation to population density and education level of the communities.  This did not erase excess mortality from high blood pressure however; and in my opinion, the issue is far from settled. Millions are exposed to the cumulative effects of lifelong fluoride exposure.  

Is it possible that negatively charged fluoride, which we consume in our food and water in the amount of about 5 mg per day, might form insoluble salts with positively charged essential minerals, such as chromium (200 mcg per day), selenium (50 mcg per day), molybdenum (50 mcg per day), copper and boron (1 to 2 mg per day)?  Would this deprive us of adequate trace minerals?  The numbers make sense enough to me to want to have the question answered by a serious research effort.  At the time fluoridation was introduced, in the 1940s and 1950s, these trace minerals were not recognized as essential.  Now we know that boron prevents osteoporosis; molybdenum and selenium protect against cancer; and chromium not only enhances regulation of blood sugar, it also protects our blood vessels from glycosylation damage.  This is especially relevant because chromium therapy reverses arterioslcerotic plaque in animal research studies.  This single mineral has some of the impact of a total Dean Ornish diet-meditation program!  In addition, copper deficiency causes high cholesterol, which is intriguing, but it also causes fatal heart rhythm disturbance, which is absolutely convincing that it plays a role in cardiac mortality statistics.

One more man-made pollutant: Iron.  You may be surprised to think of this as a pollutant because you have been propagandized to believe that this mineral needs to be supplemented.  Wrong.  With the exception of women with heavy menstrual bleeding and children with poor diets and patients with chronic bowel malabsorption, iron supplementation is a mistake, one that can aggravate all inflammatory disorders and possibly cause heart attacks.  If you take vitamin pills, eat pastry or breakfast cereals or eat meat regularly, iron can accumulate in your body to a dangerous level--without you or your doctor suspecting a thing--until your arthritis or heart disease gives a warning signal to check your blood iron or ferritin levels.  Don’t ignore the warning.

These risk factors are amenable to orthomolecular treatment today.  Research studies verify benefits greater than any ever reported in relation to the cholesterol theory.  And we have just begun to assess vitamins in relation to the full spectrum of their health effects, which are so powerful that already they are known as “anti-aging nutrients.”  It is because they are more effective than low fat diets or surgical by-pass grafts that you have a choice in how you take your medicine.  Surgery may seem quicker; but orthomolecular therapies are better.

©2014 Richard A. Kunin, M.D.


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