Heart Health Center
In my Heart Health Center, learn all about:

• Heart Disease Can Start In Your Mouth
• Power Healing for Surgery
• Antioxidants for Exercise
• Cold, Clammy Hands & Hot Reactivity 
• Top 15 Tips for Keeping a Healthy Heart 
• Dr. Sinatra's Healthy Heart Program
  - Step One: The Healthiest Diet of All
  - Step Two: Supplements for the Heart
  - Step Three: Exercise — Just Do It!
  - Step Four: Reduce Your Emotional Risk Factors
  
• For the Love of Chocolate 
• Which Fat is the Right Fat?
  - Part I: Your Optimal Omega-3 Option
  - Part II: Fabulous Flax Oil
  - Part III: Fats 101 
• Reduce Blood Clotting and Inflammation 
• Antioxidants for Optimal Vascular Health 

Dr. Sinatra's Top Recommendation for Heart Health

Power Healing for Surgery

Power Healing is my term for a nutritional supplement program aimed at fortifying patients before surgery and accelerating their recovery after surgery. I recommend it whenever a patient faces a surgical procedure. Since most of my patients are already taking supplements, they may only have to make some minor adjustments in their program.

Although there are some caveats to keep in mind, the right supplements can make a big difference in your recovery, so before I tell you what supplements to take and when to take them as part of the Power Healing preparation and recuperation for surgery, I want to first cover three important requirements about these and all supplements.

Inform Your Doctor

Most supplements are not only safe for surgical patients but will actually help the healing process. However, some may not be appropriate. Thus, regardless of whether your surgery is major or minor, always tell your doctor what you’re taking well in advance of the day of the surgery. Incredibly, 70 percent of patients don’t disclose all the supplements they use.

A prime example comes from Joe, one of my longtime patients. Years ago, Joe needed to have an aortic valve replacement and bypass surgery. He was a keen supplement advocate and took a number of things that even I didn’t know about—including a great deal of garlic, volumes of vitamin E, and a fair amount of fish oil.

Those supplements were good for him as natural anticoagulants. However, when you go in for surgery, you need your blood to clot—so the incisions won’t bleed after they’re sutured, and so you can heal.

Joe didn’t tell me (or his surgeon) everything he was taking, so he experienced complications from excess bleeding and ended up needing an additional procedure to address the problem. He eventually recovered, but the lesson was learned. What he should have done is told me all the supplements he was using, so I could advise him when to stop taking certain ones.

Before Surgery: Stop Using Certain Supplements

In addition to the garlic, vitamin E, and fish oil that Joe was taking, ginkgo biloba and aspirin should also be stopped because of their blood thinning effects. However, unwanted bleeding isn’t the only concern. Some supplements can also interfere with anesthesia.

For instance, St. John’s wort may increase sedation when narcotics are administered. Further herbs singled out by anesthesiologists include ephedra (also called Ma Huang), feverfew, goldenseal, garlic, ginseng, ginger, licorice, and valerian.

Because of possible problems, some physicians suggest stopping all supplements a week before surgery. I’m a bit more lenient. In my experience, you’re okay to stop three days before, and then start up again three days after. Additionally, you might choose to consult with a nutrition-oriented physician who can customize a program for you before your surgery. Whatever you do, though, be sure to inform your doctors.

Other Things to Avoid: Alcohol and Certain Painkillers

I always tell my patients who are going in for major surgery involving general anesthesia to stop drinking alcohol a month before the operation. You need your liver operating optimally and, as you no doubt know, alcohol is toxic to the liver.

I also suggest staying away from acetaminophen (Tylenol), which has a toxic effect on the liver. In clinical studies, this over-the-counter painkiller has been associated with unexplained liver failure. If you rely on painkillers, check with your doctor for any pre-operation advice.

My Power Healing Program

My recommended Power Healing supplements can be found at most health food stores. Remember, though, to stop taking the supplements about three days before surgery because of the potential for certain nutrients, particularly herbs, to interact with anesthesia and medication. Except where noted below, start your supplements again three days after surgery.

Before and After Surgery:

• Take a high-quality multinutrient as part of your daily routine before and after surgery. Choose one that contains 25 to 50 mg of the B complex vitamins.
  
  
• Surgical trauma (particularly from cardiac surgery) causes an increase in free radicals, which disrupt and damage cellular function. For this reason alone, you should take at least 50 mg of CoQ10 as part of your daily routine before surgery, and 100-200 mg per day for at least four weeks after.
  
  
• Because surgery depletes your body of vitamin C, take 500-1,000 mg as part of your daily routine before surgery, and 1,000 mg three times a day after surgery. Return to your usual dosage after two weeks.
  
  Numerous studies indicate that vitamin C helps prevent surgical shock and post-surgical bed sores, and that it significantly speeds healing time. It’s also necessary for the production of collagen—a basic structural protein used in wound repair.
  
  
• Begin taking milk thistle a month before surgery, and then continue for a month after (follow label instructions for dosage). This wonderful herb protects, rejuvenates, and repairs the liver. General anesthesia and other medications used during and after surgery are exceptionally hard on the liver, so anything you can do to protect this vital organ will be a big plus.
  
  
• Increase your zinc intake to 30-50 mg for two weeks before and two weeks after surgery, using zinc picolinate. Zinc is critical to wound healing, and surgery or trauma can decrease the level of zinc in your body.
  
  
• Start taking a probiotic supplement two weeks before surgery, and continue using it for at least a month afterward—or, better yet, indefinitely. Choose a strain that contains acidophilus and bifida bacteria (follow label instructions for dosage). Surgical patients often receive oral or intravenous antibiotics in the hospital, which creates the potential for fungal disorders (including yeast infections), digestive disturbances, and diarrhea. A probiotic can help counteract these problems.

Also After Surgery:

• Take 250 mg of vitamin B6 twice a day for a week, starting three days after surgery. This nutrient helps reduce post-surgical fluid retention, such as swelling of the face, hands, feet, or legs. The swelling usually takes two to four weeks to go down. With B6, you can experience substantial reduction within 24 to 48 hours.
  
  
• MSM, a highly bioavailable form of sulfur, can reduce post-operative pain and inflammation. Start taking 1,000 mg of MSM a few days after surgery and slowly increase your dosage to obtain desired relief. Take it for at least two weeks.
  
  Dr. Stanley Jacob, surgical professor at Oregon Health Sciences University, has found that MSM also reduces scarring and generates energy. To further reduce scar formation, apply a topical MSM lotion or gel to an incision site once the wound has closed.
  
  
• To reduce inflammation, take 2,000-3,000 mg of omega-3 fish oil per day for two weeks after surgery. You can then go to a maintenance dosage of 500-1,000 mg per day. If fish oil is already part of your daily routine, be sure to stop taking it five days before surgery, since it can promote blood thinning and increase bleeding during surgery.
  
  
• Take bromelain on an empty stomach for two weeks after surgery (follow label instructions for dosage). This formidable pineapple enzyme supplement helps prevent blood clots, aids the liver and digestion, and decreases inflammation and pain after surgery. It also helps to remove protein debris that form at trauma sites.
  
  
• Another supplement to relieve pain and inflammation is the homeopathic remedy Arnica 30C. Take one pellet four or five times a day for up to two weeks after surgery.
  

I highly recommend following this Power Healing program. Not only will you be able to recuperate faster, so you can get back to the enjoyable task of living each day to your full capability, you’ll also be able to make it through your surgery more easily.

One last thing: Whenever I make extensive supplement recommendations such as this, people always ask for my top three choices if they couldn’t—or didn’t want to—take everything. In this case, here’s what I recommend at a minimum:

• Multinutrient formula
• Vitamin C
• CoQ10

References:

Cheraskin, E, et al. The Vitamin C Connection New York: Bantam Books (1984): 53-65.

Hallbook, T, et al. Zinc metabolism and surgical traumas. Br J Surg 1977; 64: 271-273.

Norred, C. Herbs and anesthesia. Alternative Therapies in Women’s Health 2001; 3(4): 26-30.

Rosenfeldt, F, et al. Coenzyme Q10 therapy before cardiac surgery improves mitochondrial function and in vitro contractility of myocardial tissue. J Thorac Cardiovasc Surg 2005; 129(1): 25-32.

Seymour, DG, et al. A prospective study of elderly general surgical patients: II. Post-operative complications. Age Ageing 1989; 18(5): 316-326.

Taussig, SJ, et al. Bromelain, the enzyme complex of pineapple and its clinical application. An update. J Ethnopharmacol 1988; 22: 191-203.

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Antioxidants for Exercise

A few years ago, as part of a research study, I performed exercise stress tests on middle-aged male runners. I was impressed with their conditioning, but I noticed that most them looked older than their ages—with wrinkles on their faces and premature baldness. This disturbed me.

These men were living proof that intense exercise ages, stresses and injures your body's tissues because it creates free radicals. Free radicals are highly reactive molecules produced in your body during normal metabolism. They damage your cells by causing oxidation, like the browning of the flesh of a cut apple exposed to the air.

Normally, your body compensates for this oxidation and repairs its cells. However, intense exercise breaks down muscular tissue and cellular membranes to the point where it can overwhelm your body's natural antioxidant system.

Exercise Always Creates Free Radicals

I'm sure some of you are wondering why I'm telling you this, because most of you are not fanatical runners. However, many of you do jog, bicycle, roller skate, walk, and dance for exercise. I want to caution you that the elevated metabolic rate associated with even these moderate types of exercise also causes elevated levels of free radicals.

Of course, I still highly recommend exercise to protect your heart and overall health. However, since exercise increases the production of free radicals, you need to be aware of what is happening and which antioxidants you should take as supplements so that you can get all the benefits of exercise with none of the drawbacks. The risks of not exercising or of exercising too little are far greater than the risks of free radical damage.

Here Are the Simple Steps to Protect Yourself

If you exercise more than 30 minutes a day (which you definitely should), I want you to take at least 10-30 mg of CoQ10, 200-400 IU of vitamin E, 300-600 mg of vitamin C, 12,500-25,000 IU of beta carotene, 7.5-15 mg of glutathione, and 125-250 mg of magnesium every day.

You can buy these supplements individually, but it's less expensive to find a high-quality multivitamin and mineral combination that contains them. Please remember that you need adequate amounts of these nutrients as “health insurance” if you’re regularly subjecting yourself to the accelerated metabolism and free radical damage that occurs through exercise.

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Cold, Clammy Hands & Hot Reactivity

Have you ever had the experience of shaking someone’s hand only to find it ice cold and clammy? If that person had a reason to be nervous (such as a young man meeting his future in-laws for the first time), then there wouldn’t necessarily be any reason to be concerned—but what if that person wasn’t in a situation that might make him nervous?

Cold, clammy hands are the result of what cardiologists call “total peripheral resistance.” In most cases, peripheral resistance is nothing to be alarmed about. When your heart contracts, it sends blood into your arteries. Peripheral resistance occurs when the blood moves from the arteries into the arterioles (small blood vessels branching off from arteries) and then into the capillaries where the oxygen and nutrients are transferred from the blood to your body’s tissues. That normal resistance of blood moving from a large vessel into smaller vessels results in normal blood pressure.

When a person is nervous or under stress, the heart beats faster, which sends much more blood into the arteries. Additionally, one of your body’s normal stress responses is the contraction of the peripheral circulation (the smaller vessels) and the expansion of core circulation (the larger vessels).

The diminished circulation is accompanied by increased sweating—particularly of the palms of your hands and soles of your feet. Thus, you get cold, clammy hands when you’re nervous or under severe stress.

Everyone has occasion to be nervous from time to time. However, when a person’s anxiety is constantly disproportionate to the situation, the total peripheral resistance is constant and it becomes a problem because of chronic wear and tear on the cardiovascular system, which is obviously accompanied by a chronic increase in blood pressure.

Such a person is known as a “hot reactor.” These are ordinary people who are out of touch with the messages their bodies are trying to send to them. A hot reactor’s cardiovascular system is literally taking a beating. The effect is like driving your car with one foot pushing the accelerator while the other is on the brakes.

Approximately 20 percent of the population are true hot reactors.

Are You a “Hot Reactor”?

Dr. Robert Eliot, M.D., considered the father of psychoneurocardiology, defined a hot reactor as someone who demonstrates “extreme cardiovascular reactions to standardized stress tests.” Eliot observed that hot reactors exhibit disproportionately high heart rate and blood pressure responses in exercise testing situations.

Back in 1982, I was a young, driven, ambitious, and aggressive cardiologist. I wondered if I might be a hot reactor. I wanted to make sure I was behaving constructively rather than self-destructively, so I signed up at the Life Stress Simulation Laboratory in Omaha, Nebraska where cardiologists were using technology originally developed by NASA to measure the effects of emotional stress on the body.

They tested me like they did the astronauts. My hands were plunged into ice water and I was asked left and right brain questions in an effort to trigger a physical response. I “passed” with flying colors—cool as ice on the inside, and my blood pressure didn’t budge. I was not a hot reactor.

Intrigued by the procedure, I went home and set up my own hot reactivity lab, where I did 200 tests from 1985 to 1989. Here’s how this noninvasive procedure works:

Tracking your heart rate beat by beat, computers tap directly into your emotional and physiological state by using a technique called “impedance cardiography”—which measures cardiac output, blood pressure, and systemic resistance. You are taken from quiet, restful periods through a series of increasingly challenging mental tasks that include math calculations, quizzes, and video games that demand keen visual perception and manual dexterity—all simulating controlled competition.

It’s likely that your reactivity profile generated in this lab setting reflects your response to stress in the real world. Armed with the knowledge that a poor profile could indicate a risk of developing cardiovascular disease, you could then take steps to correct hot reactions to stress. Generally, however, a simple treadmill stress test will give you the information you need.

The normal response to a treadmill, step, or bicycle stress test is for both the heart rate and systolic blood pressure to rise proportionately and incrementally as each workload is introduced. This response indicates your body’s ability to generate the extra energy that is needed to meet the increased workload. The diastolic pressure (the lower number) is expected to stay the same or lower.

During a normal treadmill evaluation, the heart rate rises in the first minute of each two- to three-minute stage and then levels off. A high-sustained heart rate may simply indicate a poor level of physical conditioning (in other words, you’re out of shape).

However, in hot reactors, the elevated heart rate is associated with a disproportionately high blood pressure response in the first stage of exercise. In other words, an exaggerated response to the first stage of exercise stress testing may be a sign of hot reactivity.

You may be sufficiently in touch with your body to recognize a sudden heat flush, headache, anxiety, or cold sweaty palms as exaggerated nervous system responses. However, some people are completely out of touch with their bodies and may not realize they are having hot reaction responses. Here are some strategies you can use to help tone down your reactions to stress, especially if you’re a hot reactor but even if you just suffer from an occasional peripheral resistance.

Take These Steps to “Turn Down the Heat”

Boost your fitness level through an exercise program, such as walking daily. You don’t have to train like an athlete. Just maintain a regular 15-to-30-minute walking program three to five times a week. If you’d like to include sports or recreational activities, that’s great, too. Tennis, golf, skiing, swimming and similar activities enhance your cardiovascular fitness and temper your reaction to stress. Remember, almost any type of aerobic exercise will help relieve depression, tension, and anxiety while increasing your sense of self-control.

If you’re one of the people who is aware of your body’s distress signals, try this “body scan” technique. Starting at the top of your head, observe areas of tension or tightening as you move your focus down your body. Are your shoulders raised up around your neck like you’re poised for a fight, or are they slumped forward under the load of your concerns? Close your eyes and form a mental picture of your body as you slowly scan from head to toe.

Use mental imagery or meditation to induce states of relaxation. When you recognize stress in your body, focus on your breathing, and imagine a relaxing, pleasant experience. One of my patients, for example, combats stress by visualizing herself lying in a meadow of flowers. Sometimes she can even “smell the flowers.” Through instant visualization, she actually creates a meditative state and, thus, a calming response.

If you suspect you’re a hot reactor, you need to take responsibility for your body. Remember, by learning to identify your body’s distress signals, you can reduce stress and maximize your heart’s health.

Other Ways to Cool a Hot Reactor

• If you’re fatigued, take a nap or a break.
• Learn to say “no” when you mean no.
• Take vacations and honor your leisure time.
• If you have an emotion, experience it, but don’t editorialize on it. For example, if you are sad, be sad, but don’t get angry at yourself for feeling sad.
• Beware of your negative self-talk. If you are being negative, turn it around into some form of optimism. Almost all stressors can be “re-worded.”
• When you confront stressful situations that you can’t change, try to just “go with the flow.”
• Don’t make mountains out of mole hills—and remember, they’re all mole hills in the end anyway.

To learn more about Dr. Sinatra's top recommendation for heart health, click here.

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Top 15 Tips for Keeping a Healthy Heart

1. Get on the modified Mediterranean diet. I love this diet because it offers a combination of healthy fats, moderate protein and fewer carbohydrates — the optimal recipe for heart health. The diet is also rich in alpha-linolenic acid and omega-3 oils, which help prevent blood clotting, reduce blood pressure and prevent cholesterol buildup.
2. Raise your fitness level. The best exercise is the one you will stick with. Walking and dancing are both great. You don't have to work up a sweat or push yourself until you're out of breath. Find your rhythm — go with the flow. Exercise supports your heart and circulatory system. It also bolsters your state of mind.
3. Join a cardiac rehabilitation program. Supervised exercise, nutritional counseling and peer support — key components of a rehab program — can help you get back on track and feel good again. See if your local hospital has one.
4. Reduce your stress. There are many effective stress-reduction techniques, such as, yoga, massage, prayer, visualization, deep breathing exercises, qigong, positive affirmations, listening to classical music and sitting quietly for 15 minutes a day.
5. Take a multivitamin that has carotenoids, flavonoids, vitamins C, E and B, selenium and cardiac-supporting herbs.
6. Coenzyme Q10 is another must. It's one of the best nutrients for promoting heart health. I can't imagine practicing medicine without it. I prefer the water-soluble form of CoQ10 over other brands.
7. L-carnitine, a nutrient that helps preserve heart health, is also great for promoting healthy weight. Take 500 mg to 2 grams daily. 
8. Magnesium and calcium promote healthy blood pressure and help regulate heart health. Calcium, which has a synergistic relationship with magnesium, promotes healthy blood vessels. Take 500 mg daily of magnesium and 1,000 mg daily of calcium. 
9. Fish oil sounds bad, but it is one of the best sources of healthy fat around. You can eat cold-water fish like salmon and mackerel at least twice a week and/or take daily fish oil supplements. I'm so impressed with the research on fish oil that I include it in my core heart-health program.
10. Smoking: Stop it! Research shows that smokers are twice as likely to have serious heart problems as non-smokers.
11. L-arginine, an amino acid that improves blood flow to the heart by stimulating endothelial cell releasing factor, thereby inhibiting a chain of complex reactions that might otherwise cause plaque to form in the arteries and stifle blood flow to the heart. Take 2 to 4 grams before bedtime. May experience gastrointestinal upset in high doses.
12. Taurine has been shown to boost the electrical activity within the heart and promote the heart's contractile strength. Take 3 grams daily if you have congestive heart failure.
13. Nattokinase is very effective in breaking down fibrin which in turn helps keep blood free-flowing.
14. If your response to CoQ10 is insufficient and you have congestive heart failure, add hawthorn berry, a treatment I've used extensively, particularly in patients sensitive to digoxin. Hawthorn berry can make it possible to decrease the dose of digoxin, thereby avoiding or lessening digoxin-related side effects. The berry promotes the heart's ability to metabolize energy and use oxygen. It also helps maintain regular heartbeats and healthy blood pressure and circulation. Take 500 to 1500 mg daily, or take as a tincture in water 3 times daily. For prevention, I recommend drinking hawthorn berry tea, which you can make by pouring boiling water over a cup of berries and letting them steep for 15 minutes.
15. Alcohol: Limit it! Some studies suggest that moderate alcohol consumption can reduce risk for poor heart health, but more than one drink a day for women could have negative consequences. One glass of beer or wine daily is fine. Hard alcohol is out.

To learn more about Dr. Sinatra's top recommendation for heart health, click here.

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Dr. Sinatra's Healthy Heart Program
Step One: The Healthiest Diet of All

After a great deal of research, I've concluded that the best overall diet is the Pan Asian Modified Mediterranean (PAMM) Diet. There's a remarkable amount of research to back up this healthy and delicious approach to nutrition. It's good for your heart and will help protect you against breast cancer and osteoporosis. And best of all, it's not really a "diet" — it's a lifestyle choice.

Moderate Carbohydrates, More Protein and Healthy Fats 

What is a PAMM diet? In a nutshell, it encourages eating cold-water fish such as salmon and halibut; "healthy fats" such as olive oil and low-glycemic carbohydrates such as garlic and onions, plus plenty of fruits, vegetables, soy, and nuts.

The overall percentage of each lines up something like this: 25-30% protein; 25-30% healthy fats; and 45-50% carbohydrates. This is a moderate-carbohydrate diet with slightly more protein than is often recommended.

Note: Like many cardiologists, I used to recommend low-fat, high-carbohydrate foods to my cardiac patients. I was caught up in the low-fat, high-carbohydrate craze that swept across the country ten years ago. Boy, was I off the mark! In fact, I was so wrong that I wrote a book, Lower Your Blood Pressure in Eight Weeks, in which I highlighted the PAMM diet.

Instead of eating large chunks of meat, Mediterranean people flavor their sauces with meat. And at most meals, they eat fiber-rich fruits and vegetables teeming with phytonutrients and packed with vitamins, carotenoids, flavonoids, polyphenols and monounsaturated fats crucial to well-being and cardiac health. Their diets are naturally rich in omega-3 fatty acids, coenzyme Q10 and the minerals potassium, calcium and magnesium. The same holds true for Pan Asian people, who eat lots of fish, soy, vegetables, and nuts.

Lose Weight, Gain Energy, Fight Disease 

The PAMM diet can support more even blood sugar and insulin levels while giving you more energy and helping find your ideal weight or body mass. My patients report that they consistently feel better, experience a better quality of life and, according to the literature, enhance their resistance to diseases such as coronary heart disease and cancer.

Take a look at these important benefits of the PAMM diet:

1. Cold-water fish such as salmon and halibut contain an abundance of beneficial essential fatty acids, omega-3 oils that reduce arterial clotting and inflammation. They are also excellent sources of coenzyme Q10, an energy-boosting nutrient.
2. High in low-glycemic legumes such as lentils and chickpeas. These foods slow the release of sugars into the bloodstream, helping to prevent excess insulin release leading to hyperinsulinemia and its related health concerns, including poor heart health, obesity, high blood pressure and high LDL "bad" cholesterol.
3. Offers a cornucopia of fresh fruits and vegetables teeming with phytonutrients — carotenoids, flavonoids and polyphenols — associated with a lower incidence of heart health problems, vision problems and more
4. Lower in dairy and excessive quantities of meat, thus less methionine, an amino acid precursor to homocysteine, which is formed without adequate B-vitamin support.
5. Rich in root vegetables such as garlic and onions, two terrific heart healers noted for their blood-pressure-lowering and antioxidant effects.
6. High in vitamin C, vitamin E, magnesium, zinc and L-glutathione — key antioxidants necessary to control free-radicals; vitamin E is especially important for cardiovascular health.
7. Low in saturated fat, creating less arterial plaque.
8. High in fiber, further helping to stabilize blood sugar by slowing the absorption of carbohydrates and supporting a healthy lower bowel.
9. High in olive oil, far healthier than margarine, which contains trans fatty acids.
10. Soy products such as soy milk, soybeans, and tofu are rich in antioxidants that can reduce cancer risk.
11. May include small amounts of red wine, a rich source of quercetin, which prevents the deposit of arterial plaque.

Now that you're aware of the multiple benefits of my PAMM diet, here's how to apply it:

Decrease your intake of:

• Processed foods containing refined white flour and sugar, such as breads, cereals (Corn Flakes, Frosted Flakes, Puffed Wheat and sweetened granola), flour-based pastas, bagels and pastries
• Foods containing hydrogenated or partially hydrogenated oils (which become trans fatty acids in the bloodstream), such as most crackers, chips, cakes, candies, cookies, doughnuts, and processed cheese
• Starchy, high-glycemic cooked vegetables, such as potatoes, corn and carrots
• Processed canned vegetables (usually very high in sodium)
• Processed fruit juices, which are often loaded with sugars. (Try juicing your own carrots, celery and beets instead, or other fruit and vegetable combinations)
• Red meats and organ meats
• Oils such as corn, safflower, sunflower, peanut and canola
• Dairy products such as whole milk, high-fat cheese and whole-milk yogurt.

Increase your intake of:

• Oatmeal and higher-fiber pastas made with spelt or Jerusalem artichokes instead of semolina flour pasta. Go to my Pasta á La Sinatra recipe.
  
• Slow-burning low-glycemic vegetables such as asparagus, broccoli, kale, spinach, cabbage, Brussels sprouts and legumes such as lentils, soybeans and chickpeas. Go to my Essential Fatty-Acid Salad Dressing recipe.
• Onions and garlic
• Herbs such as rosemary, ginger and turmeric
• Grapefruit, cherries, peaches, plums, dried apricots, rhubarb, pears and apples; cantaloupes, grapes and kiwifruit are suitable; however, they contain more sugar Note: if you take any medications, do not consume grapefruit products.
• Protein such as fish, especially fatty, cold-water fish like salmon, mackerel and sardines; shellfish. You may flavor your sauces with small amounts of lamb, lean beef, chicken or turkey. And eat up to six eggs a week
• Soy products like tofu, soybeans, tempeh and soy milk
• Extra-virgin olive oil and sesame oil on salads or for cooking
• Nuts and seeds, including raw walnuts, almonds and flax
• Low-fat cottage cheese, feta cheese and small amounts of grated Parmesan

To learn more about Dr. Sinatra's top recommendation for heart health, click here.

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Dr. Sinatra's Healthy Heart Program
Step Two: Supplements for the Heart 

While books have been written about the following nutritional supplements and more, here are some of your key nutritional allies to promote a healthy heart and cardiovascular system. I encourage you to expand your horizons when it comes to nutritional supplements, and read and learn all you can in this rapidly evolving field.

Vitamin E: One of Your Heart's Best Friends

Study after study has confirmed my long-held conviction that vitamin E acts like a loyal bodyguard as it promotes healthy cell membranes.

Recommended dose: For women, take 200 IU of vitamin E a day. Men need 400 IU per day. In addition, women with hot flashes or night sweats can increase the dose to 400 to 600 IU a day.

When you're out shopping for vitamin E, look for one of the newer generation of products that contain mixed tocopherols, including alpha and gamma fractions, and tocotrienols, a group of related compounds. These do an even better job than standard vitamin E products of promoting healthy cells and healthy cholesterol levels.

Note: If you take the blood thinner Coumadin, don't take more than 200 units vitamin E per day because a combination of the two could promote excess blood thinning and the remote possibility of bleeding.

Tocotrienols: New Kids on the Block

These compounds have demonstrated vitamin E-like activity, with added benefits in protection from serious heart problems: they help lower cholesterol (standard d-alpha-tocopherol does not), and there's evidence that tocotrienols provide greater antioxidant protection against lipid peroxidation than standard vitamin E.

Tocotrienols can be purchased in health food stores as a single supplement or as part of a mixed-tocopherol vitamin E product.

Recommended dose: 40 - 80 mg per day

Colorful Carotenoids

Consumption of fresh fruits and vegetables has long been associated with promoting heart and eye health. But it can be a challenge to consume the five to nine recommended servings per day. That's why it makes sense to take out the additional "insurance" in supplements.

Look for a special supplement or read the label to find a mixed carotenoid complex within your multivitamin, including alpha carotene, beta carotene, gamma carotene, xeaxanthin, cryptoxanthin, lycopene and lutein.

Recommended dose: Strive for a carotenoid complex total of up to 10,000 IU per day.

A Word About Beta Carotene

Beta carotene is an extremely important player in promoting heart health. More than 200 studies have confirmed that foods rich in flavonoids, carotenoids and other antioxidants can reduce risk of numerous health conditions, including heart health and a stronger immune system.

I do not recommend that you take high-dose supplemental beta carotene alone, but get it in combination with your diet. In fact, it's best to combine a good diet with some supplements, like my basic antioxidant formula [link to DNP product page].

Lutein: The French Paradox Explained

When news broke a few years back that red wine seemed to protect the French from heart health problems, some of you may have stocked up on Cabernet or Beaujolais. But there's a healthier and less expensive way to protect your heart and your eyes, and that is found in a carotenoid called lutein. This antioxidant nutrient is found in most fruits and vegetables, most abundantly in spinach, kale, and collard greens. Scientists believe that it promotes healthy cholesterol levels and ultimately heart health.

Recommended dose: Take at least 6 mg a day. Lutein supplements are available in health-food stores, pharmacies and grocery stores.

Magnesium: Unsung Hero of Cardiovascular Health

Magnesium is essential for healthy heart function. It is crucial to produce the high-energy bonds that drive the energy machinery of your cells.

More specifically, magnesium:
helps maintain proper smooth muscle function in your blood vessels.

• Helps shuttle potassium and sodium into and out of cells, maintaining proper membrane balance (homeostasis).
  
• Acts like a calcium channel blocker to stabilize cardiac conduction, heart muscle and vascular membranes.
• Magnesium deficiencies can lead to muscle weakness and tremors (spasm) and a host of cardiovascular problems ranging from high blood pressure to arrhythmias

Calcium: The Other Half of the Dynamic Duo

Calcium is important, too, because of its synergistic relationship with magnesium. Although most people associate calcium deficits with poor bone health, low levels can also increase your vulnerability to high blood pressure. But you must be careful about the amount of calcium you take. More than 2,000 mg of calcium per day can cause your kidneys to excrete magnesium!

Recommended dose: Take 1,000 mg daily of calcium in conjunction with 500 mg daily of magnesium. Postmenopausal women are often advised to take 1,500 mg of calcium, which is fine, but most of you will be able to make up the difference in your diet with 1,000 mg.

I like calcium in softgel form because of its rapid disintegration time (six minutes or less) and better bioavailability. In people with poor digestion, solid calcium tablets may pass through the digestive tract intact and out of the body. Choose a calcium formula that contains mixed compounds such as citrate, carbonate, aspartate and gluconate in combination with a similar magnesium complex. For more on my recommendation, click here.

B-Vitamins & Folic Acid: Starring Roles for Your Heart

Recently, a national survey showed that only 45% of women between the ages of 20 to 29 have a folate intake that achieves 100% of the RDA. This means that slightly more than half of women in this age group have low intakes of folic acid, which in turn increases their risk of having a child with serious — and fully preventable — birth defects.

• Here's what else researchers at the Harvard School of Public Health in Boston found:
  An intake of folic acid and B6 above the current RDA (180 mcg of folic acid; 1.6 mg B-6) could significantly lower a woman's risk of serious heart problems.
• Women who typically consumed 400 mcg folic acid and 3 mg of B6 daily — significantly above the current RDA — were half again as likely to suffer from serious heart problems than those who consumed the lower levels.

Most of the women in the study received the bulk of their folic acid and B6 from multivitamins and fortified cereals.

Recommended dose: Although you can get folic acid and B6 from food, including green leafy vegetables, beans, legumes, oranges and orange juice, diet may not give you all that you need. I've always believed that a higher dose of folic acid, as well as other B vitamins, is the antidote for reducing high homocysteine. Make sure you're getting what you need in your multivitamin [link to DNP product page].

Vitamin C: Still the All-Around Antioxidant Champ

Vitamin C, also known as ascorbic acid, is one of the best-known antioxidants. Vitamin C promotes heart, immune, bone, and joint health as well as healthy mood.

Recommended dose: Take 500 mg daily. In addition, eat foods rich in vitamin C, such as broccoli, tomatoes, strawberries and citrus fruits such as pink grapefruit and oranges.

Note: If you have high iron (ferritin) levels, be careful about megadosing with vitamin C. Vitamin C enhances the absorption of iron, and too much iron (which can be determined by a blood test) is a risk factor for heart disease.

Coenzyme Q10: Energy on Call

More than 100 clinical studies at major universities and hospitals have documented the actions of coenzyme Q10. I have long considered CoQ10 a wonder nutrient because of its ability to support heart health.

The heart is one of the few organs in the body to function continuously without resting; therefore, the heart muscle (myocardium) requires the highest level of energetic support. And any condition that causes a decrease in CoQ10 could impair the energetic capacity of the heart, thus leaving the tissues more susceptible to free radical attack.

Dietary sources of CoQ10 come mainly from beef heart, pork, chicken livers, fish (especially salmon, mackerel and sardines).

Recommended dose: 30-120 mg of water soluble
Q-Gel per day.

L-Carnitine: Fuel for the Heart

While CoQ10 sparks the energy within the cells, L-carnitine is like a shuttle, bringing fuel into heart cells to be burned as energy. I've observed some dramatic effects in my patients teaming up these two nutritionals; in fact, they have changed the way I treat heart health.

Recommended dose: Take 250 - 500 mg L-carnitine fumarate two to four times daily. Start at the low end of the dosage scale and work up until you achieve the effect desired. Both L-carnitine and coenzyme Q10 may require fine-tuning to obtain the optimal therapeutic blood level and symptom relief, especially if you have a compromised heart.

Alpha Lipoic Acid: Antioxidant with a Twist

Alpha lipoic acid is considered a universal antioxidant because of its ability to promote healthy stress levels and conserve other important antioxidants such as vitamins C and E and coenzyme Q10.

And because it's fat and water soluble, alpha lipoic acid is readily dissolved and distributed throughout all the tissues and cells of your body, including the brain, where it readily crosses the blood/brain barrier to protect neural tissues.

As you age, your stores of lipoic acid decline. Sure, you can get some of what you need from food, but, unfortunately, the best dietary source of lipoic acid is red meat, which often contains high levels of saturated fats, hormones, insecticides, pesticides and radiation. As a result, it's far better and safer to get this antioxidant in supplement form.

Recommended dose: 50 - 100 mg of alpha lipoic acid daily.

N-acetylcysteine (NAC): Free-Radical Fighter

N-acetylcysteine (NAC) also helps raise levels of L-glutathione, one of the most potent free radical scavengers around. Teaming up with vitamin C to form glutathione peroxidase, glutathione supports red blood cell function. This sulfur-containing compound has been shown to promote healthy endothelial cells that line your coronary arteries and keep blood flowing smoothly by producing various chemical substances, which cause blood vessels to relax.

Recommended dose: Take at least 100 mg daily and up to 600 mg.

Oligomeric Proanthocyanidins (OPCs): Bioflavonoids With Clout

You've probably heard about the benefits of red wine, green tea and grape juice. All are in the family of oligomeric proanthocyanidins (OPCs). These free radical scavengers are quickly absorbed into the bloodstream where they cross the blood/brain barrier. They show great promise in supporting healthy circulation, including blood vessel elasticity, blood stickiness, clotting, plaque buildup, blood pressure and vein integrity. In addition, they may promote eye health.

Recommended dose: 30 - 60 mg daily.

L-arginine: Supercharged Amino Acid

The amino acid L-arginine is gaining favor as an essential nutrient to promote heart health. It is thought to be the primary source for the production of nitrogen molecules involved in maintaining the elasticity of blood vessels. Research has also shown that L-arginine may be helpful for people with high cholesterol and for men who suffer from impotence.

Good sources of L-arginine include nuts, especially almonds and peanuts. You can also find L-arginine in meat and, to a lesser degree, in dairy products, but since I'd rather see you limit your intake of these foods, L-arginine capsules can be purchased in health food stores as an amino acid supplement.

Recommended dose: 2 - 3 grams at bedtime.

How to Pick a Good Multivitamin

When shopping for a "multi" here are the overall ranges of "the basics" that I recommend. Please note that I'm not a proponent of mega-dosing.

To learn more about Dr. Sinatra's top multi-nutrient recommendation, click here.

The following superantioxidant nutritionals can further promote heart health. These include:

Coenzyme Q10
L-carnitine
lutein
alpha lipoic acid
proanthocyanidins
N-acetylcysteine (NAC)
L-arginine

To learn more about Dr. Sinatra's top recommendation for heart health, click here.

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Dr. Sinatra's Healthy Heart Program
Step Three: Exercise - Just Do It!

Exercise. I can't think of another lifestyle modification with such immediate and long-lasting benefits for your health and well being. Even simple exercises strengthen your heart and circulatory system, build stamina and improve your state of mind.

Top ten reasons to exercise

1. Your heart will love you for it. Your heart will become more efficient, maintaining the same level of output with fewer beats per minute.
2. Your blood pressure will go down.
3. You'll minimize your risk for stroke.
4. You'll increase your muscle strength and restore your range of motion (flexibility).
5. You'll rev up your metabolism and burn calories, thereby losing weight.
6. You'll beat depression. Exercise releases endorphins and triggers release of the neurotransmitter serotonin, which lifts your mood.
7. Your blood sugar will go down, improving your body's regulation of insulin.
8. You'll age more gracefully and look and act younger than your years.
9. You'll fall asleep more quickly and sleep more deeply, improving your concentration and your memory.
10. You'll feel more amorous. Exercise not only increases your growth hormones, it improves your self-image, making you feel better about yourself.

Aerobic Movement: The Foundation

Did you know that 30 minutes of exercise will keep your metabolic rate up for another hour? So the longer you exercise, the greater the benefits.

You don't need a lot of fancy equipment. Nor do you need to join a health club. Just put on a pair of comfortable lace-up shoes and start walking.

If you haven't been active for a while, start out easy — just 10 minutes a day. (Please consult with your doctor before you initiate any exercise program.)

Your goal should be to add five minutes a week to your walking regimen, building up to 30 minutes total, five days a week. If you can devote more time to exercise, 45 to 60 minutes a day, so much the better!

Walk with friends to make it fun. If the weather is bad, head over to your local mall and get moving!

I'm a big fan of dancing. It's great exercise and reduces stress at the same time. You don't have to work up a sweat or push yourself until you're out of breath. Find your own rhythm and "go with the flow." Dynamic exercise enhances well being and puts a spring in your step. Add a bit of stretching and yoga and spice it up with a bit of weight training to create a great exercise session.

Here's one way to get started: put on your favorite music, warm up with a good stretch and some deep-breathing, then walk for 10 to 15 minutes. Mix it up with some free weights, finish with a little yoga and stretching and cool-down.

Weight Training: Tone and Strengthen

I wholeheartedly endorse adding weights to your exercise regimen to promote a healthy heart and bones.

Not only does strength training increase endurance, it can promote healthy blood pressure and cholesterol levels and enhance your sense of well being.

Some researchers believe that strength training may also reduce subsequent cardiac events and the risk of sudden death.
And for those who are frustrated with the limitations heart disease has imposed upon their active lifestyle, strength training is a way to fight back. Many of my cardiac patients have discovered that they don't have to sit in the rocking chair for the rest of their lives!

Exercise Safely

Be alert to warning signs that you may be doing too much exercise. If you experience any of the following, stop immediately:

• Lightheadedness or dizziness
• Palpitations
• Shortness of breath (unable to carry on a conversation)
• Jaw pain
• Arm tingling or numbness
• Tight feeling in the lungs (bronchospasm)

Whatever form of exercise you choose, learn to listen to your body and be aware of any symptoms that come up during exercise or up to an hour afterward. If you feel ill, stop exercising and rest. If symptoms persist after three to five minutes of rest, seek medical attention immediately.

Thinking About Running?

I'm often asked about the health benefits of jogging. I advise against strenuous exercise like jogging or running, especially if you're just starting an exercise program. Studies have shown a connection between heart attacks and sudden exertion.

Conversely, moderate exercise has been shown to reduce the long-term risk of coronary artery disease. The Nurses Health Study found that women who walked briskly at least three hours a week achieved results equivalent to jogging or aerobic dancing.

To learn more about Dr. Sinatra's top recommendation for heart health, click here.

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Dr. Sinatra's Healthy Heart Program
Step Four: Reduce Your Emotional Risk Factors

Withheld and denied emotions, social inhibition and lack of social support were identified as predictors of coronary heart disease in a study published in The Lancet of Feb. 17, 1996. The findings confirmed some of my own research in the area of negative emotions.

Through years of conducting Healing the Heart workshops, I observed that sadness and a negative outlook on life, along with an inability to cry or express anger, correlates strongly with an increased risk of developing heart disease.

And because they withhold their emotions more than women do, men are particularly at risk. These observations led me to explore alternative methods of addressing — and even shifting — these personality factors.

How to Unlock Armored Emotions

• To increase energy flow, you must first learn how to breathe fully. Do this by taking deep breaths in through your nose, and feeling the air fill your lungs. Then, slowly exhale through your mouth, allowing yourself to sigh. Breathing deeply can put you back in touch with your body, bringing emotions to the surface. Your body becomes more alive, increasing your energy, vitality and passion for living.
• When deep breathing is first stimulated, don't be surprised if it triggers crying, the body's way of discharging sadness and hurt. Deep sobs allow energy bound by stress to be released from the thoracic cavity, freeing the grip of muscular tension on your heart. A good cry also enhances oxygen to the cells and stimulates the release of biochemicals to the brain that encourage relaxation.
• Learn to say "No" and mean it. Sometimes, I encourage patients to kick and shout to release long-suppressed hurts and anger. Using your voice and expressing negativity, jutting out the jaw and making a fist, and even using upper arm motions such as striking out or hitting pillows can loosen tension in the body, particularly the upper back and neck.
• Laughter is potent medicine for the heart. When you laugh with your whole heart, the depth of your breathing increases, releasing trapped energy from your chest, diaphragm and even your groin muscles. Laughter releases endorphins and DHEA, hormonal markers of health and well being. Let yourself go every now and then, and feel free to be silly and uninhibited.

Begin Shifting Your Attitude

With the support of a psychotherapist or other skilled coach or trainer, you can learn to bring up suppressed emotions such as anger and fear without a sense of abandonment or humiliation. When you're "in touch" with yourself, you're in touch with your body and your emotions. You can gain insight into how persistent beliefs that long ago shaped your personality may no longer serve you.

The good news: Your "personality" is not carved in stone. Therapies such as Bioenergetic Therapy can unlock long-held emotions and defenses, especially if you are prone to bouts of hostility or rage.

Your health, and especially your heart health, is directly related to your capacity for emotional growth, self-expression and willingness to be supported with a vibrant social network. Without these crucial "life support" systems in place, as life goes on, you'll be more vulnerable to isolation, alienation, heartbreak and serious health risks.

Tap Into These Powerful Emotional Healers

1. Spirituality and prayer. More physicians and healthcare providers are discovering that spirituality can be a healing tool. In a conference at Harvard Medical School, research showed that people who attend church or pray regularly have lower rates of heart disease, hypertension and suicide.
2. Scientific evidence suggests that faith, religion and/or belief in God lowers death rates and increases health, specifically reducing anxiety, depression, anger and blood pressure. Double-blind studies worldwide have shown that people who are prayed for by others have higher survival rates and fewer complications from heart surgery.
3. Meditation and relaxation. Relaxation is characterized by an absence of physical, mental and emotional tension. Researchers have identified relaxation as the vehicle with the highest potential for "opening the door to change" by reconnecting the body, mind and spirit.
4. Bioenergetic therapy uses the language of the body to heal the problems of the mind. Alexander Lowen, MD, the founder of Bioenergetic Therapy who taught me for three years, offers a body-mind approach that has a liberating and positive effect on emotional, physical and psychic health. Bioenergetic therapy goes beyond "talk." The therapist may use specific body positions to first encourage deep, free breathing to release emotional expression. For example, men and women with heart disease often have a high, inflated chest that rarely moves freely, even with conversation.
5. Other types of therapy such as gestalt, which strives for an understanding of conscious, "here and now" behavior, and cognitive behavioral therapy (CBT), which looks at your beliefs and expectations, are also excellent interventions for the cardiac patient.

Anger: Self-Quiz

When you're in touch with your anger, you'll be able to release it more effectively and move on. How do you know if you have some anger that you need to look at? The following quiz will help you. Answer yes or no to each question candidly.

• Do I ever become hostile and impatient to the point of interrupting others?
• Do I have "looks that could kill"?
• Do I ever strike out verbally or physically?
• Do I sometimes flare my nostrils or hold my breath when I am upset?
• Do I "stuff" my negative feelings, blame myself or become depressed
• (for women) Do I feel that it would be unfeminine to show my anger?
• (for men) Do I feel that "real men" show their anger?

If you responded "yes" to one or more questions, you probably have some unresolved issues surrounding anger, hostility or rage. If you have uncontrolled, suppressed anger in the form of rage, beware: This can be hazardous to yourself and others. Most of us are reluctant to give in to our rage out of fear that we may loose control and hurt someone. This is where one-on-one supportive psychotherapy is not only helpful, but therapeutic.

To learn more about Dr. Sinatra's top recommendation for heart health, click here.

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For the Love of Chocolate

The recent press on chocolate warms my heart and validates what I've been saying for years — it's good for you! Well, certain kinds of chocolate are.

Over the last two years, the body of research on cocoa and dark chocolate has been building, and the latest studies have shown that the darkest confections can help regulate blood pressure, reduce blood platelet stickiness, and reduce both total and LDL cholesterol levels.

Dark chocolate is chock-full of flavonoids — naturally occurring components of plant-based foods that act as antioxidants and modulators of hormone-like compounds in the body. The flavonoids abundant in cocoa and dark chocolate are especially interesting because they're large, complex molecules not commonly found in other foods. That's why some researchers believe chocolate provides even more health benefits than red wine or green tea.

Dark chocolate is also rich in oleic acid, a fatty acid that helps reduce total cholesterol and LDL cholesterol concentrations. Furthermore, chocolate's flavonoids have been shown to be instrumental in preventing the oxidation of LDL cholesterol and inhibiting blood platelet clumping.

The Darker the Better

Chocolate has a light and a dark side — literally. White and milk chocolate, for example, have none of the benefits mentioned. They're just pure sugar and fat, or empty calories. What you need to look for are high-quality semisweet or bittersweet bars or pure cocoa powder.

My favorite brand is Chocolove, a premium Belgian chocolate sold via the Internet and in selected health food stores, including Whole Foods markets and Wild Oats. All Chocolove products have a high cocoa content, but their "strong dark" bar with 70 percent cocoa provides the best balance between taste and health benefits, in my estimation.

I eat dark chocolate at least once a week, no more than 1 oz. at a time, savored slowly. Chocolate morsels are also delicious mixed with dried, organic cranberries or added to the trail mix I developed and shared with you newsletter subscribers (to learn more about the Dr. Sinatra's Heart, Health & Nutrition, click here.

Don't Go Overboard

While I frequently enjoy chocolate, I don't eat it every day because that's where addiction starts. Even cardiac patients can enjoy dark chocolate regularly in moderation. Although chocolate does contain some caffeine, this downside is almost always outweighed by chocolate's many benefits. The two groups that need to be careful are people with atrial fibrillation or arrhythmia. They may be sensitive to the small amounts of caffeine in chocolate and should avoid it if it aggravates their condition.

To learn more about Dr. Sinatra's top recommendation for heart health, click here.

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Which Fat is the Right Fat?
Part I: Your Optimal Omega-3 Option

The diets of Pan Asian and Mediterranean people, which I believe are two of the healthiest, are naturally rich in omega-3 fatty acids. These are also known as essential fatty acids (EFAs), because it is essential that you consume these fats; your body can't make them, and they are vital for a healthy life.

Meanwhile, most of us in the U.S. have been cutting omega-3s from our diet. Today, we get roughly 20 times more omega-6 fats than omega-3s, and what we need is closer to a 1:1 ratio. (Omega-6 fats are abundant in conventional oils such as safflower, corn, and soybean.) In fact, I believe that one of the reasons we have so many serious health problems today is because processed omega-6s in excess can be harmful to health.

The trick is to supplement your diet with omega-3s. Omega-3 EFAs are found primarily in fish and certain plant foods. The best source of these EFAs, bar none, is cold-water fish such as Atlantic salmon [link to salmon product page] and mackerel. Fish contain higher amounts of docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA) than plant sources. Both substances are key building blocks of tissue, and both can be readily converted into "good" prostaglandins — hormone-like compounds that reduce platelet stickiness and inflammation. You'd need to consume about 12 times as much flax oil as fish oil to get the same benefits.

Fishing for Sources of Fish Oil

I realize, however, that it's not possible for most people to eat fish every day. That's why I recommend that you take fish oil supplements. Make sure the oil is from a reputable supplier and is harvested from fish that swim in deep, cold ocean waters. There's far too much contamination in the bulk of the fish supply these days for me to be comfortable with anything caught or raised near land.

To learn more about Dr. Sinatra's top recommendation for heart health, click here.

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Which Fat is the Right Fat?
Part II: Fabulous Flax Oil

Pure flax oil is the world's most abundant source of omega-3 fatty acids, containing an amazing 55 percent by weight. As such, flax oil offers incredible health benefits that should not be discounted. The reason I prefer fish oil is simply that flax does not contain EPA and DHA, two key nutrients that go straight to your head and your heart, literally, to promote health in both areas and throughout your body.

Instead, flax oil contains alpha linolenic acid (LNA), which your liver must break down to form EPA and DHA. There has been debate about whether LNA effectively converts to EPA and DHA. Research is showing that it does, though blood levels of these nutrients are still much lower than with fish oil.

I like to get flax oil as part of my Essential Fatty Acid Salad Dressing. I developed this dressing because I'm not wild about the taste of flax oil. If you're among those whose palates favor flax, however, have a tablespoon or two of it each day — straight from the bottle or on a salad.

Flaxseed: Nearly Perfect Food

A better way I like to incorporate flax into my diet is by eating ground flaxseed. And yes, you must grind the seeds to release the oil. Otherwise, they'll pass through you, undigested.

I recommend getting a coffee grinder and dedicating it to flaxseed, because you don't want to mix ground coffee and flax. It's not a taste sensation! Also, you must use the flax within hours of grinding it. Once exposed to air, the oil in ground flax goes rancid quickly (which is why flax oil must be refrigerated).

You can sprinkle ground flax on just about anything - soups, stews, ice cream, you name it. One of my patients, Joe, makes a shake with it. You can also cook with flaxseed at lower temperatures. Baking it into breads is fine, too. To see my collection of flax recipes, click here.

The beauty of flaxseed is that you get significant amounts of protein and fiber in a tiny package. A typical 2 oz. serving (1/4 cup) contains approximately 11 grams of fiber and 10 grams of protein.

The exact amounts will vary with the quality of the flaxseed and how it's grown. That's why I particularly like golden flax grown in Canada: The nutrient content of the soil tends to be richer and better suited to growing pesticide-free flax. Analysis shows that it contains:

• 28 mg calcium
• 32 mg magnesium
• 166 mg phosphorous
• 68 mg potassium (all figures are per serving, according to testing by an independent lab).

Whether you go with fish, flax, or both, you can't go wrong.

To learn more about Dr. Sinatra's top recommendation for heart health, click here.

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Which Fat is the Right Fat?
Part III: Fats 101

Fat is a chemical combination of carbon, hydrogen, and oxygen atoms. Saturated fats, found in all animal products and in tropical oils like palm and coconut, contain a high proportion of hydrogen atoms. In fact, these fats are saturated with hydrogen, hence the name.

As you probably know, saturated fats threaten your cardiovascular system because they're converted to cholesterol in the body. They'll raise cholesterol levels significantly if you eat them in excess.

But the ones I'm most concerned about these days are trans-, or hydrogenated, fats. These are vegetable oils with an extra hydrogen molecule artificially added. This addition makes them solid at room temperature and, most important to manufacturers, extends the shelf life of any food containing them.

Although trans-fatty acids aren't saturated, they act even worse than saturated fats when consumed, making them killers in the blood stream. They raise blood levels of LDL ("bad") cholesterol and lipoprotein(a), a toxic blood factor.

Remember, total cholesterol is not your biggest cardiovascular enemy; oxidized LDL, Lp(a) and other members of the toxic blood syndrome gang are. (If you've also been reading my print newsletter, you know exactly what I'm talking about.)

Trans-Fatty Acids Lurk Literally Everywhere

Most of the foods in boxes and bags on grocery store shelves contain trans-fats. They're in packaged cookies, crackers, microwave popcorn, frozen foods like French fries and fish sticks, and commercial baked goods. Many margarine products, non-dairy creamers, and egg substitutes also contain trans-fats, yet you won't see them listed on ingredient labels.

The Food and Drug Administration is working to change that, but the issue has bogged down in bureaucracy. Until trans-fats are exposed for the villains they are, you need to look for words like "partially hydrogenated" or "vegetable shortening" on ingredient lists. If you see either of these phrases listed on the label of a food product you want to buy, look for another product. I avoid these like the plague.

By the way, I'm not a big fan of polyunsaturated fats either. These are found primarily in canola oil and soft-tub margarine. The paradox is that polyunsaturated fats will indeed lower LDL levels when substituted for saturated fats, but they can lower HDL levels, too (i.e., your "good cholesterol"). In addition, polyunsaturated fats are easily oxidized, making your body more vulnerable to degenerative disease — cataracts, Alzheimer's, atherosclerosis, even cancer.

So when my patients ask me whether they should use butter, margarine, or canola oil, I advise them to forget them all; use olive, almond, or flax oil instead. But if you must choose between butter, margarine, and canola oil, a little butter is better.

To learn more about Dr. Sinatra's top recommendation for heart health, click here.

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Reduce Blood Clotting and Inflammation

Here are some natural solutions if you want to reduce blood clotting and inflammation, and enhance circulation:

• Garlic is a basic component of my modified Mediterranean diet and an important medicinal herb in supporting cardiovascular health. It reduces blood platelet "stickiness," and promotes healthy blood pressure, cholesterol, and triglyceride levels. Dosage: 2 cloves of fresh garlic per day. If this is difficult or you don't like the "breath effects" of fresh garlic, look for odorless garlic supplements and take 600-900 mg of high allicin garlic, 2 or 3 times daily. Allicin is an active constituent of garlic; aim for 6,000 mcg of allicin "potential" or "yield" per day.
  
  
• Ginkgo is an excellent herb for promoting blood circulation to the brain and all parts of the body. Bioflavonoids known as gingko-flavone glycosides are primarily responsible for ginkgo's inhibition of platelet aggregation and antioxidant power. I use this ancient herb to support patients with heart concerns, age-related memory loss, ringing in the ears (tinnitus), impotence, and depression. Dosage: 40-80 mg of extract standardized to contain 24% ginkgo-flavone glycosides, 2 or 3 times daily. Do not take ginkgo with aspirin.
  
  
• Fish oil is another super nutrient for promoting circulation and overall heart health. Omega-3 fatty acids (EPA and DHA) enhance blood "slipperiness," preventing it from clotting too quickly, keep triglycerides in check, and support healthy blood pressure. They also have anti-inflammatory activity. Anchovies, mackerel, salmon, and sardines are particularly high in omega-3s. If it's impractical for you to eat fish a couple of times a week, consider a high quality fish oil capsule. Dosage: 500-1,000 mg of fish oil (containing both EPA and DHA) daily.
  
  
• Turmeric (curcumin is the active constituent) reduces platelets from clumping together, which in turn improves circulation. Curcumin is also a powerful antioxidant. Dosage: extract standardized to contain 400-600 mg curcumin, 2 or 3 times daily.
  
  
• Ginger has a mild blood-thinning effect and can enhance your program to promote healthy blood consistency and flow. Dosage: 1 or 2 cups of ginger tea daily. You can also use fresh or dried ginger in your cooking, or take ginger in supplement form. New Chapter makes ginger capsules, tinctures, and syrups that are available in health food stores (follow directions on the label.)
  
  
• Bromelain is known primarily as a proteolytic enzyme (capable of digesting protein) and anti-inflammatory. It is also a natural blood thinner that reduces excessive platelet stickiness. Dosage: 500 mg, 2 or 3 times daily, between meals (for blood-thinning and inflammation). Bromelain products come in different strengths or "levels of activity". Look for bromelain from Country Life or Source Naturals.
  
  
• Vitamin E is a natural blood thinner, promotes healthy circulation, and protects lipid-containing parts of the body-such as cell membranes and vascular walls-from free-radical damage. For these reasons, it earns my vote for elite antioxidant status. I recommend taking a blend of d-alpha tocopherol and mixed tocopherol vitamin E. Better yet, combine tocopherols with tocotrienols- more recently-studied forms of vitamin E with significantly greater antioxidant capability than the "regular" tocopherol forms. Tocotrienols also lower LDL cholesterol (something tocopherols do not do). Dosage for tocopherol vitamin E: Women should take 200 IU daily and men can take 200-400 IU per day. High-risk individuals should consider taking more. Dosage for tocotrienols: 50-100 mg daily. Carlson and Twin Labs ("MaxiLIFE" line) make tocotrienols products.
  
• Nattokinase is an enzyme that breaks down fibrin, keeping you blood free-flowing. Take 100 mg daily for prevention.

Interactions you should know about 

• Garlic, gingko, and fish oil should not be taken with blood-thinning medications such as Coumadin (warfarin), heparin, Plavix (clopidogrel), or Trental (pentoxifylline). There is some theoretical concern about ginger, turmeric, and bromelain as well, so exercise caution if you are already taking a prescription blood-thinner.
• People on blood-thinning medication should limit their vitamin E intake to 200 IU/day of tocopherols, and 50 mg of tocotrienols.
• I don't recommend ginkgo for patients on long-term aspirin therapy because of some isolated case reports of bleeding.
• Taking garlic together with ginkgo or high-dose vitamin E can cause a risk of bleeding problems.
• Taking fish oil by itself does not seem to cause bleeding problems.
• Fish oil may temporarily raise LDL, but this effect is short-lived.
• Some people may experience mild gastrointestinal upset and occasional, mild headache when taking ginkgo.
• Individuals with bleeding disorders such as hemophilia, and those about to undergo surgery, or labor and delivery should approach use of natural blood thinners with caution, and advise your doctor or surgeon if you have been taking any of these nutrients.
• And remember, anyone can be allergic to any herb.

To learn more about Dr. Sinatra's top recommendation for heart health, click here.

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Antioxidants for Optimal Vascular Health

In the June issue of my newsletter, I commented on the recent study that showed angioplasties are no more beneficial than drug therapy for most patients who have the procedure. That got me thinking about vascular health in general, and what you can do to help support yours—no matter how old you are, or whether you’ve undergone a vascular procedure.

It Starts with Free Radicals

If you read much about preventive medicine, you know that I think the “Free Radical Theory” is a key health concern. As your body uses oxygen to produce adenosine triphosphate (ATP) for vital energy, free radicals, or oxidants, are released as a byproduct. Free radicals are atoms that lack an electron (a negatively charged particle). They’re molecular bullies, too, because they take electrons away from vital body cells—impeding the ability of those cells to function optimally. This thievery is called “oxidation.”

Fortunately, your body produces antioxidant molecules to help stop oxidation. You may recognize the names of some of the players in these defense systems—glutathione, catalase, and superoxide dismutase. However, even with all these defenses, we still can lose the battle against oxidation. As a result, free radicals can cause problems with vital tissues and, if left unchecked, create oxidative stress. When oxidative stress persists, tissues can start to break down.

Zeroing In on Free Radicals

The protective nature of antioxidants gives physicians some amazing opportunities. For instance, cardiologists frequently cite the process of “lipid peroxidation” (when free radicals steal electrons from fats, causing cell damage) as a focal point for vascular health.

Since many antioxidants actively block the oxidation of LDL, a cardiologist can identify the specific antioxidants that are useful for this purpose. That’s how I first started my probe into the world of supplements. I was looking for antioxidants that would help support the optimal condition of blood vessels.

The Key Supplements for Vascular Health

Research shows that supplementing your body’s natural supply of antioxidants can help to minimize oxidative stress. These five ingredients get inside the inner mitochondrial membrane where they can help support vital cell functions:

Coenzyme Q10 (100-200 mg daily in divided doses)

Carnitine (1000 mg daily of a full-spectrum carnitine supplement with at least 250 mg of acetyl l-carnitine)

Alpha Lipoic Acid (50-150 mg daily)

Vitamin C (a minimum of 400 mg daily)

Vitamin E (200–400 IU of a natural full-spectrum vitamin E daily—see the “Key Supplements” section below for more on the benefits of full-spectrum vitamin E)

I recommend full-spectrum vitamin E because tocotrienols are a form of vitamin E not commonly found in basic vitamin E supplements. However, they have potent antioxidant activity that can greatly help support your overall health.

Like carnitine and Coenzyme Q10, a full-spectrum vitamin E gets into the inner mitochondrial membrane. And like flavonoids (mentioned below), a full-spectrum vitamin E helps to prevent the oxidation of LDL. I recommend a full-spectrum natural vitamin E supplement that gives you at least 50 mg of tocotrienols daily.

You can get more mileage out of the vitamin E by taking alpha lipoic acid (which I mentioned above) at the same time. When vitamin E and tocotrienols become oxidized, alpha lipoic acid helps to regenerate them so they can continue to fight free radicals.

Additionally, supplementing with N-acetylcysteine (NAC) helps raise glutathione, which is one of the body’s most potent antioxidants. I discourage taking most forms of affordable glutathione supplements, though, since they are difficult to absorb. Instead, based on research, I recommend 1,200 mg of NAC daily in divided doses.

Along with antioxidants, I also recommend the following nutrients to help support your vascular health:

Lutein—In my research, I found that there are studies documenting the powerful antioxidant value of lutein. This substance is a carotenoid found naturally and abundantly in both kale and spinach. Lutein lessens oxidative stress in blood vessels. In addition to a high-quality multivitamin with lutein, I recommend 2-6 mg daily in supplement form along with a diet high in the most lutein-rich foods—such as spinach, mustard greens, and kale.

Lycopene—Another carotenoid worthy of mention is lycopene (found in tomatoes), which not only helps support normal prostate function in men but also fights oxidative stress in blood vessels for men and women. Like lutein, lycopene helps prevent the oxidation of LDL. Preliminary research also shows that lycopene is mildly associated with improving lung function among elderly people. I recommend 60 mg of lycopene daily to help support vascular health,

Flavonoids—These compounds are found in many fruits and vegetables. They are vitally important in preventing LDL oxidation. Green tea, grape seeds, grape skins, the polyphenols in red wine, curcumin, and pine bark are all potent flavonoids that help to interrupt the oxidation of LDL. I recommend 30-60 mg daily each of grapeseed extract and pinebark extract (under the patented brand name Pycnogenol). Both of these extract products should be available in local health supplement stores and through the Internet.

Vitamins—And let’s not forget that vitamins B6, B12, and folic acid also help to promote healthy homocysteine levels. A high quality daily multinutrient should provide you with at least 40 mg of B6, 200 mcg of B12, and 800 mcg of folic acid.

If you’re interested in maintaining your overall health (and who's not?), remember how important your vascular health is. Toward that end, I hope most of you exercise regularly and engage in a healthy diet. On top of that, remember to supplement your healthy lifestyle program with the targeted nutritionals that I’ve outlined above and you’ll be on the right track to obtain optimum health.

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