The Encyclopedia of Natural Medicine, 3rd Ed.

Angina

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• Squeezing or pressure-like pain in the chest occurring immediately after exertion (other precipitating factors include emotional tension, cold weather, or large meals), possibly radiating to the left shoulder blade, left arm, or jaw, and typically lasting for only 1 to 20 minutes

• Stress, anxiety, and high blood pressure typically present

• An abnormal ECG reading (transient ST segment depression) in response to light exercise (stress test)

Angina pectoris is caused by an insufficient supply of oxygen to the heart muscle, which produces a squeezing or pressure-like pain in the chest. Angina usually precedes a heart attack. Since physical exertion and stress increase the heart’s need for oxygen, they are often the triggering factors. The pain may radiate to the left shoulder blade, left arm, or jaw. The pain typically lasts for only 1 to 20 minutes.

Angina is almost always due to atherosclerosis, the buildup of cholesterol-containing plaque that progressively narrows and ultimately blocks the blood vessels supplying the heart (the coronary arteries). This blockage results in a decreased supply of blood and oxygen to the heart tissue. When the flow of oxygen to the heart muscle is substantially reduced, or when there is an increased need by the heart, it results in angina. Hypoglycemia (low blood sugar) can also cause angina.1

There is another type of angina that is not related to a buildup of plaque in the coronary arteries. It is known as Prinzmetal’s variant angina and is caused by spasm of a coronary artery. This form of angina is more apt to occur at rest, may occur at odd times during the day or night, and is more common in women under age 50. It usually responds to magnesium supplementation.

Therapeutic Considerations

Angina is a serious condition that requires careful treatment and monitoring. Prescription medications may be necessary in severe cases, as well as in the initial stages of mild to moderate angina. Eventually it should be possible to control the condition with the help of natural measures. If there is significant blockage of the coronary artery, angioplasty, coronary artery bypass, or intravenous EDTA chelation therapy (discussed below) may be appropriate.

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WARNING: An acute angina attack can be a medical emergency. If you are suffering from an acute attack, consult your physician or an emergency room immediately.

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Coronary Angiogram, Angioplasty, and Artery Bypass Surgery

An angiogram (cardiac catheterization) is an X-ray procedure in which dye is injected into the coronary arteries to locate blockages. These blockages are then most often opened with balloon angioplasty (a surgical procedure in which the diameter of the blocked artery is increased with the aid of a very small balloon attached to a flexible tube), the placement of a stent (a tiny wire mesh tube that acts as a scaffolding to maintain and support the opening of an artery), and/or coronary artery bypass surgery (a procedure in which the coronary artery is bypassed by constructing an alternative route using a portion of a vein from the patient’s leg). All of these procedures are often agreed to by patients without careful consideration of the risks and benefits.

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The Heart and Coronary Blood Vessels

Angiograms, angioplasty, and bypass surgery are big business. More than 1 million heart angiograms are performed each year, for a total annual cost of over $10 billion. But based upon extensive analysis, it appears that most of this money is wasted.

Several studies have challenged the widespread recommendation of angiograms made by most cardiologists.2 One study evaluated 168 patients who were told they needed to have an angiogram to determine the degree of blockage, followed by bypass surgery or angioplasty. Using noninvasive tests, such as the exercise stress test, the echocardiogram (an ultrasound exam that measures the size and functional status of the heart), and the Holter heart monitor (a portable heart monitor that is worn for 24 hours and measures the pulse and characterizes beats as normal or abnormal), the researchers determined that 134, or 80%, did not need the catheterization. Over a five-year period, this group of 168 patients had only a 1.1% rate of fatal heart attacks annually. This rate is much lower than the mortality rates associated with either coronary artery bypass surgery (5 to 10%) or angioplasty (1 to 2%). The researchers concluded that “in a large fraction of medically stable patients with coronary disease who are urged to undergo coronary angiography (heart catheterization), the procedure can be safely deferred.” Noninvasive testing to determine the functional state of the heart is far more important than the dangerous search for blocked arteries in determining the type of therapy that is needed. If the heart is not functioning well, then an angiogram may be needed to see if surgery should be done.

Furthermore, blockages found by an angiogram are usually not relevant to the patient’s risk of heart attack. For instance, in the most sophisticated study to date of bypass surgery, the Coronary Artery Surgery Study (CASS), it was demonstrated that heart patients with healthy hearts but with one, two, or all three of the major heart vessels blocked did surprisingly well without surgery.35 Regardless of the number or severity of the blockages, each group had the same low death rate of 1% per year.

That same year, the average death rate from bypass surgery was 10.1%, or about 1 death per 10 operations. In other words, the operation being recommended supposedly to save lives was 5 to 10 times more deadly than the disease. The best that can be said about bypass surgery and balloon angioplasty is that they are irrelevant to the course of the disease in all but the most serious cases. Patients who elect not to have the surgery live just as long as or longer than those who have the surgery.6

The severity of blockage does not necessarily correlate with reduction in blood flow in the artery. In one study, Iowa researchers measured blood flow in 44 blockages demonstrated by angiogram.7 Much to their surprise, they found no correlation between blood flow and the severity of the heart artery blockage. In other words, the angiogram did not provide clinically relevant information. The researchers found in one case that a coronary artery with a 96 percent blockage had a better blood flow than an artery with only a 40 percent blockage. The authors concluded that the blockages found by the heart catheterization simply do not correlate with blood flow restriction, and noted that these results were “profoundly disturbing . . . Information cannot be determined accurately by conventional angiographic approaches.”

The bottom line is this: when patients are advised to have a coronary angiogram, chances are 8 out of 10 that they do not need it. The critical factor in whether a patient needs coronary artery bypass surgery or angioplasty is how well the left ventricular pump is working, not the degree of blockage or the number of arteries affected. The left ventricle (chamber) of the heart is responsible for pumping oxygenated blood through the aorta (the large artery emanating from the heart) to the rest of the body. Bypass surgery is helpful only when the ejection fraction, the amount of blood pumped by the left ventricle, is less than 40% of capacity.8 Up to 90% of all bypass procedures are done when the ejection fraction is greater than 50%, which is adequate for circulatory needs. In other words, as many as 90% of all bypass procedures may be unnecessary.

Coronary artery bypass has largely been replaced by angioplasty—or, as it is known in research circles, percutaneous coronary intervention (PCI). The results from large studies with these procedures, including the use of stents that release drugs to prevent blockage (drug-eluting stents), show the same lack of benefit as bypass operations. For example, the Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation (COURAGE) trial revealed that PCI showed no significant differences over medical therapy alone in the primary end point of all-cause mortality or nonfatal heart attacks, or major secondary end points (composites of death, heart attack, and stroke; hospitalization for angina or heart attack) over a 4.6-year follow-up in 2,287 patients with stable coronary artery disease.8

When coronary artery bypass surgery or angioplasty is necessary, based on these accepted criteria, it definitely increases long-term survival and gives relief of symptoms for 85% of patients. However, the surgery is not without risk. Complications arising from coronary bypass operations are common, as this surgery represents one of the most technically difficult procedures in modern medicine. Considering the cost of the procedure, the lack of long-term survival benefit, and the high level of complications, it appears that electing to have this surgery is unwise for the majority of patients.

This is particularly true in light of the availability of effective natural alternatives to coronary bypass surgery. Numerous studies have shown that dietary and lifestyle changes can significantly reduce the risk of heart attack and other causes of death due to atherosclerosis (see the chapter “Heart and Cardiovascular Health”). Simple dietary changes—decreasing the amount of saturated fat and cholesterol in the diet; increasing the consumption of dietary fiber, complex carbohydrates, fish oils, and magnesium; eliminating alcohol consumption and cigarette smoking; and reducing high blood pressure—would greatly reduce the number of coronary bypass operations performed in westernized countries. In addition, clinical studies have shown that several nutritional supplements and botanical medicines improve heart function in even the most severe angina cases. Another important alternative is intravenous EDTA chelation therapy (discussed later in this chapter). Although this therapy is controversial, considerable clinical research has proved its efficacy.

When an Angiogram Is Unavoidable

When an angiogram or angioplasty is deemed necessary, the goal is then to prevent the damaging effects produced by this procedure. This can be accomplished with a high-potency multiple vitamin and mineral formula, along with additional vitamin C (minimum 500 mg three times per day) and CoQ10 (300 mg per day two weeks prior to surgery and for three months afterward). Note: It is generally recommended that garlic supplementation and high dosages of vitamin E (greater than 200 IU) be avoided prior to any surgery because of their ability to possibly promote excessive bleeding by inhibiting platelet aggregation, a key aspect of blood clot formation.

Vitamin C supplementation is rarely employed in hospitals, despite the fact that it may provide significant benefits; low vitamin C status is quite common in hospitalized patients. In a study analyzing the vitamin C status of patients undergoing coronary artery bypass, the plasma concentration of vitamin C was shown to plummet by 70% in the 24 hours after coronary artery bypass surgery; this level persisted in most patients for up to two weeks after surgery.9 In contrast, vitamin E and carotene levels did not change to any significant degree, presumably because these nutrients are fat-soluble and are therefore retained in the body for longer periods of time. Given the importance of vitamin C, this serious depletion may deteriorate defense mechanisms against free radicals, infection, and wound repair in these patients. Supplementation appears to be essential in patients recovering from heart surgery, or any surgery, for that matter.

Return of blood flow (reperfusion) after coronary artery bypass surgery results in oxidative damage to the vascular endothelium and myocardium and thus greatly increases the risk of subsequent coronary artery disease. Coenzyme Q10 is recommended in an attempt to prevent such oxidative damage after bypass surgery or angioplasty. In one study, 40 patients undergoing elective surgery either served in the control group or received 150 mg CoQ10each day for seven days before the surgery.10 The concentrations of lipid peroxides and the enzyme creatine kinase, which indicate myocardial damage, were significantly lower in patients who received CoQ10 than in the control group. The treatment group also showed a statistically significant lower incidence of ventricular arrhythmias during the recovery period. These results clearly demonstrate that pretreatment with CoQ10 can play a protective role during routine bypass surgery by reducing oxidative damage.

Therapeutic Considerations

Nutritional Supplements

From a natural perspective, there are two primary therapeutic goals in the treatment of angina: improving energy metabolism within the heart and improving blood supply to the heart. These goals are interrelated, as an increased blood flow means improved energy metabolism and vice versa. The heart uses fats as its major metabolic fuel. It converts free fatty acids to energy in much the same way as an automobile uses gasoline. Defects in the utilization of fats by the heart greatly increase the risk of atherosclerosis, heart attack, and angina pain. Specifically, impaired utilization of fatty acids by the heart results in accumulation of high concentrations of fatty acids within the heart muscle. This makes the heart extremely susceptible to cellular damage, which ultimately leads to a heart attack.

Carnitine, pantethine, and coenzyme Q10 are essential compounds in normal fat and energy metabolism and are of extreme benefit to sufferers of angina. These nutrients prevent the accumulation of fatty acids within the heart muscle by improving the conversion of fatty acids and other compounds into energy.

Antioxidants

Using antioxidant supplementation is important for patients with angina. In an analysis of normal controls and patients with either stable or unstable angina, the plasma level of antioxidants has been shown to be a more sensitive predictor of unstable angina than the severity of atherosclerosis.11,12 One group of researchers concluded: “These data are consistent with the hypothesis that the beneficial effects of antioxidants in coronary artery disease may result, in part, by an influence on lesion activity rather than a reduction in the overall extent of fixed disease.”11

Antioxidant nutrients are also important for patients on oral nitroglycerin therapy. Oral nitroglycerin is widely used in the conventional treatment of angina, but its continuous use can result in the development of tolerance (loss of effectiveness). Experimental findings indicate that tolerance is associated with increased vascular production of superoxide, a free radical form of oxygen. The superoxide molecules generated quickly degrade the nitric oxide formed from the administration of nitroglycerin and result in lower levels of intracellular regulators that promote relaxation of the coronary arteries. Because vitamin C is the main aqueous (water) phase antioxidant and free radical scavenger of superoxide and vitamin E is the main lipid (fat) phase antioxidant, their importance is obvious. Clinical trials have upheld this connection, showing that high-dose vitamin C and E supplementation can prevent the development of tolerance.13,14

Carnitine

Carnitine, a vitamin-like compound, stimulates the breakdown of long-chain fatty acids by the mitochondria, the energy-producing units in cells. Carnitine is essential in the transport of fatty acids into the mitochondria. A deficiency in carnitine results in a decrease in fatty acid concentrations in the mitochondria and reduced energy production.

Normal heart function is critically dependent on adequate concentrations of carnitine. Although the normal heart stores more carnitine than it needs, if the heart does not have a good supply of oxygen, carnitine levels become depleted. This leads to decreased energy production in the heart and increased risk for angina and heart disease. Since angina patients have a decreased supply of oxygen, carnitine supplementation makes good sense.

Several clinical trials have demonstrated that carnitine improves angina and heart disease.1519 Supplementation with carnitine normalizes heart carnitine levels and allows the heart muscle to use its limited oxygen supply more efficiently. This translates to an improvement in cases of angina. Improvements have been noted in exercise tolerance and heart function. The results indicate that carnitine is an effective alternative to drugs in cases of angina.

In one study of patients with stable angina, oral administration of 900 mg carnitine increased average exercise time and the time necessary for abnormalities to occur on a stress test (6.4 minutes in the placebo group compared with 8.8 minutes in the carnitine-treated group).19

These results indicate that carnitine may be an effective alternative to other anti-angina agents such as beta-blockers, calcium channel blockers, and nitrates, especially in patients with chronic stable angina pectoris.

Carnitine, by improving fatty acid utilization and energy production in the heart muscle, may also prevent the production of toxic fatty acid metabolites. These compounds are extremely damaging, as they activate various inflammatory enzymes and disrupt cellular membrane structures. The changes in the properties of cardiac cell membranes induced by fatty acid metabolites are thought to contribute to impaired heart muscle contractility, increased susceptibility to irregular beats, and eventual death of heart tissue. Supplemental carnitine increases heart carnitine levels and prevents the production of toxic fatty acid metabolites. This has been demonstrated clinically: the early administration of carnitine (40 mg/kg per day) in patients having heart attacks was found to considerably reduce heart damage.20

Pantethine

Pantethine is the stable form of pantetheine, the active form of pantothenic acid, which is the fundamental component of coenzyme A (CoA). CoA is involved in the transport of fatty acids to and from cells, as well as to the mitochondria. The synthetic pathway from pantethine to CoA is much shorter than that of pantothenic acid, making pantetheine the preferred therapeutic substance. In addition, pantetheine has significant lipid-lowering activity, while pantothenic acid has very little (if any) effect in lowering cholesterol and triglyceride levels.

The standard dose for pantethine is 900 mg per day. Like carnitine, pantethine has been shown in clinical trials to significantly reduce serum triglyceride and cholesterol levels while increasing HDL cholesterol levels.2123 Its lipid-lowering effects are most impressive when its toxicity (virtually none) is compared with that of conventional lipid-lowering drugs. Its mechanism of action is due to inhibiting cholesterol synthesis and accelerating fatty acid breakdown in the mitochondria.

Pantethine is well indicated in angina. Like carnitine levels, heart pantethine levels decrease during times of reduced oxygen supply. Demonstrated effects in animals indicate that pantethine would greatly benefit individuals with angina.24

Coenzyme Q10 (CoQ10)

CoQ10 is another essential component of the mitochondria, where it plays a major role in energy production. Like carnitine and pantethine, CoQ10 can be synthesized within the body. Nonetheless, deficiency states have been reported. Deficiency can be a result of impaired CoQ10 synthesis due to nutritional deficiencies, a genetic or acquired defect in CoQ10 synthesis (e.g., statin drugs block CoQ10 formation), or increased tissue needs.25

Cardiovascular diseases including angina, hypertension, mitral valve prolapse, and congestive heart failure are examples of diseases that require increased tissue levels of CoQ10.25 In addition, many of the elderly may have increased CoQ10 requirements: the decline of CoQ10 levels that occurs with age may be partly responsible for the age-related deterioration of the immune system.

CoQ10 deficiency is common in individuals with heart disease. Heart tissue biopsies in patients with various heart diseases show a CoQ10 deficiency in 50 to 75% of cases.25 One of the most metabolically active tissues in the body, the heart may be unusually susceptible to the effects of CoQ10 deficiency. Accordingly, CoQ10 has shown great promise in the treatment of angina. In one study 12 patients with stable angina pectoris were treated with CoQ10(150 mg per day for four weeks) in a double-blind crossover trial.26 Compared with placebo, CoQ10 reduced the frequency of angina attacks by 53%. In addition, there was a significant increase in treadmill exercise tolerance (time to onset of chest pain and time to development of ECG abnormalities) during CoQ10 treatment. The results of this study and others suggest that CoQ10 is a safe and effective treatment for angina pectoris.

Magnesium

Magnesium deficiency may play a major role in angina, including Prinzmetal’s variant. A magnesium deficiency has been shown to produce spasms of the coronary arteries and is thought to be a cause of nonocclusive heart attacks.27Furthermore, it has been observed that men who die suddenly of heart attacks have significantly lower levels of heart magnesium, as well as potassium, than matched controls.28

Making magnesium the treatment of choice for angina due to coronary artery spasm has been suggested by some researchers.2830 Magnesium administration has also been found to be helpful in the management of arrhythmias and in angina due to atherosclerosis. Its benefit in these situations is presumably via the same mechanisms responsible for its effects in an acute heart attack.

Since the mid-1980s, eight well-designed studies involving more than 4,000 patients have demonstrated that intravenous magnesium supplementation during the first hour of admission to a hospital for an acute heart attack reduces immediate and long-term complications as well as death rates.3133

The beneficial effects of magnesium in an acute heart attack relate to its ability to do the following:

• Improve energy production within the heart

• Dilate the coronary arteries, improving delivery of oxygen to the heart

• Reduce peripheral vascular resistance, reducing demand on the heart

• Inhibit platelets from aggregating and from forming blood clots

• Reduce the size of the blockage

• Improve heart rate and arrhythmias

Arginine

Arginine supplementation has been shown to be beneficial in a number of cardiovascular diseases, including angina pectoris. Its benefit is thought to occur because it increases nitric oxide levels, thereby improving blood flow and reducing blood clot formation (thrombosis). The degree of improvement offered by arginine supplementation in angina and other cardiovascular diseases can be quite significant. In double-blind studies it has been shown to be especially effective in increasing exercise tolerance. The typical dosage is 6 g per day in divided doses.3436 In a short-term study, involving 3 g per day for 15 days, arginine supplementation resulted in increased activity of free-radical-scavenging enzyme superoxide dismutase (SOD) and other antioxidant protective mechanisms.37 One caution is provided by a study in which heart attack survivors who supplemented with arginine (9 g per day for six months) had an increase in mortality compared with the placebo group (8.6% vs. 0%).38 This effect may have been an aberration or due to higher dosages of arginine being used.

Botanical Medicines

Hawthorn

Hawthorn (Crataegus species) berry and flowering top extracts are widely used in Europe for their cardiovascular activity. They exhibit a combination of effects that are of great value to patients with angina and other heart problems. Studies have demonstrated that hawthorn extracts are effective in reducing angina attacks, as well as in lowering blood pressure and serum cholesterol levels and improving heart function.3941

The beneficial effects in the treatment of angina are due to improvement in the blood and oxygen supply of the heart resulting from dilation of the coronary vessels, as well as improvement of the metabolic processes in the heart.3941

Hawthorn’s ability to dilate coronary blood vessels has been repeatedly demonstrated in experimental studies. In addition, hawthorn extracts have been shown to improve cardiac energy metabolism in human and experimental studies. This combined effect is extremely important in the treatment of angina, as it results in improved myocardial function with more efficient use of oxygen. The improvement results not only from increased blood and oxygen supply to the heart muscle but also from hawthorn flavonoids interacting with key enzymes to enhance the heart’s ability to contract properly.

Khella

Khella (Ammi visnaga) is an ancient medicinal plant native to the Mediterranean region, where it has been used in the treatment of angina and other heart ailments for thousands of years. Several of its components have demonstrated effects in dilating the coronary arteries. Its mechanism of action appears to be similar to that of the calcium-channel-blocking drugs.

Since the late 1940s, there have been numerous scientific studies on the clinical effect of khella extracts in the treatment of angina. More specifically, khellin, a derivative of the plant, was shown to be extremely effective in relieving angina symptoms, improving exercise tolerance, and normalizing ECG tests. The concluding statement in a 1952 study reads: “The high proportion of favorable results, together with the striking degree of improvement frequently observed, has led us to the conclusion that khellin, properly used, is a safe and effective drug for the treatment of angina pectoris.”42

At higher doses (120 to 150 mg per day), pure khellin was associated with mild side effects such as loss of appetite, nausea, and dizziness. Although most clinical studies used high dosages, several studies show that as little as 30 mg khellin per day appears to offer equally good results with fewer side effects.43,44

Rather than the isolated compound khellin, khella extracts standardized for khellin content (typically 12%) are the preferred form. Dose of such an extract would be 250 to 300 mg per day. Khella appears to work well with hawthorn extracts.

Other Therapies

Acupuncture

Several studies have shown acupuncture to be of benefit in improving angina, specifically in reducing nitroglycerin use, decreasing the number of angina attacks, and improving exercise tolerance and ECG readings.4548

Relaxation and Breathing Exercises

Relaxation and breathing exercises may be helpful in improving angina symptoms, especially when anxiety is a significant contributor.49 In one study in patients with cardiac syndrome X, a form of angina in people with otherwise normal coronary arteries, transcendental meditation (20 minutes twice per day of silently chanting a mantra with eyes closed) was found to reduce angina-like chest pain and to normalize ECGs.50

Intravenous Ethylenediaminetetraacetic Acid Chelation (EDTA) Therapy

EDTA chelation therapy is promoted as an alternative to coronary artery bypass surgery and angioplasty. EDTA is an amino-acid-like molecule that, when slowly infused into the bloodstream, binds with minerals such as calcium, iron, copper, and lead and carries them to the kidneys, where they are excreted. EDTA chelation has been commonly used for lead poisoning, but in the late 1950s and early 1960s it was found to help patients with atherosclerosis.

The discovery of EDTA chelation therapy in the treatment of angina and other conditions associated with atherosclerosis happened accidentally. In 1956 a battery worker whom Dr. Norman Clarke was treating with EDTA for lead poisoning noticed that his symptoms of angina disappeared. Clarke and others began using EDTA chelation therapy in patients with angina, cerebral vascular insufficiency, and occlusive peripheral vascular disease.

In a series of 283 patients treated by Clarke and his colleagues from 1956 to 1960, 87% showed improvements in their symptoms. Heart patients improved, and patients with blocked arteries in the legs, particularly those with diabetes, avoided amputation.51,52

It was originally thought that EDTA opened blocked arteries by chelating out the calcium deposits in the cholesterol plaque. However, it now seems more related to chelating out excess iron and copper, minerals that, in the presence of oxygen, stimulate free radicals. Free radicals damage the cells in the artery and are a primary reason for atherosclerosis. In a review of the progression and regression of atherosclerosis, the authors write that the process of atherosclerosis is “dependent on the presence of some metals (copper and iron) and can be completely inhibited by chelating agents such as EDTA.”53

Despite obvious benefits to heart patients, EDTA fell out of favor in the mid-1960s. Advocates believe this occurred for two reasons: (1) the lucrative surgical approach to heart and vessel disease was on the rise and (2) the patent on EDTA that was held by Abbott Laboratories expired, so there was no financial interest for drug companies to fund any research.

Fortunately, in 1972 a small group of practicing physicians using EDTA chelation therapy founded an organization now called the American College for the Advancement of Medicine to continue education and research in this important area.

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QUICK REVIEW

• Angina is a serious condition that requires careful treatment and monitoring.

• As many as 90% of all bypass procedures may be unnecessary.

• The critical factor in whether a patient needs coronary artery bypass surgery or angioplasty is how well the left ventricular pump is working, not the degree of blockage or the number of arteries affected.

• Bypass surgery is helpful only when the ejection fraction (the amount of blood pumped by the left ventricle) is less than 40% of capacity.

• The two primary therapeutic goals in the natural treatment of angina are:

  images Improving energy metabolism within the heart

  images Improving the blood supply to the heart

• Carnitine and coenzyme Q10 (CoQ10) have been shown to improve angina in well-designed double-blind clinical trials.

• Magnesium deficiency plays a major role in angina.

• Hawthorn extracts improve the supply of blood and oxygen to the heart.

• Since the late 1940s, there have been numerous scientific studies that demonstrate the clinical effectiveness of khella extracts in the treatment of angina.

• EDTA chelation therapy is an alternative to coronary artery bypass surgery and angioplasty; it may prove to be more effective, and it is definitely safer and less expensive.

In the early days of EDTA chelation therapy, several serious problems were discovered. Giving too much EDTA or giving it too fast was soon noted to be dangerous. In fact, several deaths attributed to kidney failure were caused by toxicity in reaction to EDTA. Fortunately, additional research resulted in more appropriate protocols, and EDTA chelation therapy as used now is safe. No deaths or significant adverse reactions have occurred in more than 500,000 patients who have undergone EDTA chelation therapy. Because EDTA chelation improves blood flow throughout the body, the “side effects” are usually beneficial and only a few adverse effects are noticed.

A substantial body of scientific evidence exists on the use of EDTA chelation therapy in the treatment of angina, peripheral vascular disease, and cerebral vascular disease.5458 Nonetheless, there is a lack of well-designed, placebo-controlled studies to definitively assess the efficacy of this approach. This shortcoming is unfortunate considering the early successes. The conclusion from a Cochrane review summarizes the situation well: “At present, there is insufficient evidence to decide on the effectiveness or ineffectiveness of chelation therapy in improving clinical outcomes of patients with atherosclerotic cardiovascular disease.”59

For more information, contact the American College of Advancement in Medicine (ACAM), 8001 Irvine Center DriveSte 825, Irvine, CA 92618, Phone 949-309-3520; www.acam.org.

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TREATMENT SUMMARY

The primary therapy for angina is prevention because angina is usually secondary to atherosclerosis. Once angina has developed, restoring proper blood supply to the heart and enhancing energy production within the heart are necessary. Particularly important nutrients for accomplishing these results are vitamins C and E, carnitine, pantethine, CoQ10, magnesium, and arginine. Magnesium is of additional benefit because of its ability to relax spastic coronary arteries and improve heart function.

Hawthorn berries or extracts offer a number of benefits to individuals with angina, including coronary artery dilation and improved heart muscle metabolism.

Individuals with unstable angina pectoris (characterized by a progressive increase in the frequency and severity of pain, increased sensitivity to precipitating factors, progression of symptoms over several days, and prolonged coronary pain) require immediate medical attention.

Diet

The dietary guidelines given in the chapter “A Health-Promoting Diet,” as well as in the chapter “Heart and Cardiovascular Health,” are appropriate here. In particular, an increase of soluble dietary fiber is recommended (e.g., flaxseed, oat bran, pectin). Onions and garlic (both raw and cooked), vegetables, and fish should also be increased, while the consumption of saturated fats, cholesterol, sugar, and animal proteins should be reduced. All fried foods and food allergens should be avoided. Patients with reactive hypoglycemia should eat regular meals and carefully avoid simple carbohydrates of all forms (e.g., sugar, honey, dried fruit, fruit juice). A Mediterranean-type diet is recommended.

Lifestyle

The individual with angina should not smoke or drink alcohol or coffee. Stress should be decreased by the use of stress management techniques such as progressive relaxation, meditation, and guided imagery. A carefully graded, progressive aerobic exercise program (30 minutes three times per week) is a necessity. Walking is a good exercise to start with.

Nutritional Supplements

• A high-potency multiple vitamin and mineral formula as described in the chapter “Supplementary Measures”

• Key individual nutrients:

  images Vitamin C: 500 to 1,000 mg per day

  images Vitamin E (mixed tocopherols): 200 to 400 IU per day

  images Magnesium, preferably bound to aspartate, citrate, glycinate or malate: 200 to 400 mg three times per day

• Fish oils: 3,000 mg EPA + DHA per day

• One of the following:

  images Grape seed extract (>95% procyanidolic oligomers): 100 to 300 mg per day

  images Pine bark extract (>95% procyanidolic oligomers): 100 to 300 mg per day

  images Some other flavonoid-rich extract with a similar flavonoid content, super greens formula, or another plant-based antioxidant that can provide an oxygen radical absorption capacity (ORAC) of 3,000 to 6,000 units or higher per day

• Carnitine: 500 mg three times per day

• Pantethine: 300 mg three times per day

• Coenzyme Q10: 100 mg two to three times per day

• Arginine: 1,000 to 2,000 mg three times per day

Botanical Medicines

• Hawthorn (Crataegus oxyacantha):

  images Berries or flowers (dried): 3 to 5 g or as a tea three times per day

  images Fluid extract (1:1): 1 to 2 ml (1/4 to 1/2 tsp) three times per day

  images Solid extract (10% proanthocyanidins or 1.8% vitexin-4'-rhamnoside): 150 to 250 mg three times per day

• Khella (Ammi visnaga):

  images Dried powdered extract (12% khellin content): 100 mg three times per day