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The Sinatra Solution, Metabolic Cardiology (I) |
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The Sinatra Solution,
Metabolic Cardiology |
illustration by Jeff Ham |
Editor's Note:
This is the first in a series of articles drawn from The Sinatra Solution, Metabolic Cardiology by Stephen Sinatra, M.D. In his introduction to this landmark work, James C. Roberts, M.D., FACC states the following: “Nutritional science provides answers to many lingering questions in medicine. It's the difference between natural science and the man-made science of drug therapy.
Pharmaceuticals do play an important role in medicine and Dr. Sinatra and I study their use, but more drugs are not the only answer. A better answer is for physicians and patients to learn more about the biology of disease and the biochemical keys to energy production. This knowledge provides the insight needed to support the heart and the recovery of our health, well beyond what drug and surgical therapies can provide. That is why I'm so passionate about metabolic cardiology and that's what you will learn about in this important book.”
Whether you are a practicing cardiologist, afflicted with a heart disease or simply the responsible owner of an adult body, we are confident you will find The Sinatra Solution an invaluable asset to achieving and maintaining optimum health. |
My journey as an integrative cardiologist
has been an exciting period in my life,
and it has brought me endless
moments of satisfaction and joy. Yes, it
is joyful when you can reduce human
suffering and improve the quality of life
for someone else. l have shared many
moments of sublime satisfaction with
my patients and their families, after
their life has been improved or spared
through the many alternative, pharmaceutical
and technical tools of modern
cardiology. But the specialty I hold so
close to my own heart still has considerable
limitations.
Pharmaceutical drugs, bypass surgery,
angioplasty, stent emplacements,
pacemakers and implantable defibrillators
all have their place, and many lives
would be lost without these high-tech
interventions. Cardiologists face a daily
dilemma concerning the best diagnostic
procedures to refer for their
patients and then, based on those test
results, which surgical and/or pharmaceutical
interventions to select. To
complicate the choice, the evaluations
we order and the treatments we select
may actually create unnecessary risks
for patients.risks that are out of
proportion to the benefits they will
experience. Continuing technological
advances, although necessary, add to
the complexity of the decision-making
process.
Cardiologists have grown reliant
upon these sophisticated medical
processes. But somewhere along the
way, something has gone amiss. There
has been much mistrust of the conventional
medical model among the public
recently. Starving for new information,
massive numbers of patients are consulting
alternative therapy practitioners
and are visiting book and health food
stores in record numbers, creating a
multibillion dollar industry outside of
the mainstream medical community.
What is driving even our most
conservative patients to look at other
forms of therapies? There are many
reasons for the increased popularity of
alternative medicine, including patient
dissatisfaction with ineffective conventional
treatments, pharmacologic drug
side effects and the high price of
medications. Perhaps most important
is the fact that traditional medicine has
become too impersonal with the
involvement of high-tech modalities
and time-limited office visits.
Obviously, the medical consumer is
searching for less invasive, safer and
lower cost interventions. Some of this
comes out of necessity; managed care
plans have driven our patients into
seeking cost-effective medical care
delivery, as more of their health care
dollars are coming out of their own
pockets.
Many patients are now questioning
the need for potentially life threatening
drugs and invasive interventions that
carry considerable risk of side effects,
complications and even mortality.
Recent research has suggested that
2 million lives are lost each year
as a result of complications from
"standard-of-care" interventions, medical
errors and complications. When we
consider that the fourth leading cause
of death in the United States is properly
prescribed medications in a hospital
setting, something's gotta give!
Even in 2005, coronary artery bypass
surgeries (CABS) are performed on the
basis of clogged arteries alone with no
regard to quality of life issues. This is
not smart medicine. Rates of complications
from CABS—such as heart attack,
infection, stroke, and central nervous
system (CNS) dysfunction—are disturbing.
It is important to note that
CNS dysfunction was observed in an alarming 61 percent of patients six
months after CABS. People are naturally
looking for less risky and fewer surgical
alternatives in lieu of such downsides.
During my 30 years of practicing
cardiology I have seen a slow paradigm
shift regarding the perceived availability
of effective, natural alternatives for the
treatment of a wide range of cardiovascular
disorders—problems like angina,
arrhythmia, high blood pressure and
congestive heart failure (CHF). More
physicians have expanded their
approach to heart disease and accept
and recommend complementary therapies
as equally judicious treatment interventions.
However, invasive CABS is a
sound approach to improve quality of
life and possibly advance longevity when
alternative or medical therapy fails to correct
a patient’s symptoms of refractory
angina (chest pain, shortness of breath
and so on).
An integrative cardiologist is one who
brings conventional methodologies to
the table and also offers complementary
and alternative interventions that can
boost patients to an even better quality of
life. Integrative cardiologists are as comfortable
prescribing diet and lifestyle
changes, a vast array of nutritional therapies
and mind/body approaches as they
are scheduling a treadmill stress test,
recommending angioplasty and handing
out a medication. They integrate the best
of both worlds when caring for their
patients.
For example, I have encountered an endless
number of patients awaiting heart
transplants—those with the most seriously
compromised heart function—who
have been literally “cured” by nutritional
therapies. Those who want to improve
the quality of their lives through both
conventional and alternative approaches.
Getting well requires that the physician
and the patient share in the
healing process. I believe that we
physicians don’t really “cure” anyone. We
merely coach, care for and support our
patients . . . only nature heals.
A good physician assists patients in
finding and stimulating their own healing
capabilities. Over the years I’ve learned
that real healing takes place when the
intention of the healer matches the intention
of the patient.
The real essence of “doctoring”
employs elements from physical, emotional
and spiritual realms to reduce
human suffering and enhance quality of
life. Integrative physicians who use whatever
it takes to help heal the patient, are
practicing good medicine, as well as
what I refer to as smart medicine. And
physicians who listen to “the messengers”
around them are open enough, and
wise enough, to understand that not only
can they can learn from their teachers
and colleagues, but also from their own
patients as well.
I know that many of my own patients
are interested in how I became involved
in nutritional and other nonconventional
therapies. Most tell me how hard it is to
find a physician comfortable with what
(I’m sorry to say) we still call “alternative”
approaches, and ask how I “fell into it.” First of all, many of the practices we
now call alternative are actually mainstream
healing methods that we’ve abandoned in our age of technology.
Indigenous and advanced cultures alike
still use these therapies appropriately
and with good results.
I didn’t “fall” into practicing and
endorsing complementary forms of
healing at all. I truly believe that I was led
here. Within a year after passing my
cardiovascular boards and becoming a
credentialed invasive cardiologist, I
began to realize something was missing.
For instance, I started asking myself why
I saw the same patients coming back into
the emergency room with the exact same
problems that had brought them there
just months earlier—after we thought
we’d “fixed” them. Too many times I
would take care of a medical crisis, patch
the patient up and send him back out,
only to see them return again. Surely
something was amiss.
I didn’t quite get it. I sincerely thought
that I was doing the right things, but I
wasn’t really helping anyone’s body heal
itself. Instead, I was performing in the
hospital like that proverbial boy desperately
sticking his finger in a hole to patch
up a dike doomed to break down. I was
prescribing drugs and different therapies
aimed at directly “fixing the problem,”
and they did—in the short term. Then I
realized what I was failing to see was the
bigger picture: I was doing nothing to
actually help prevent or even cure the
real, complex, underlying problems.
MY JOURNEY
At that juncture, I decided I needed to
enter a psychotherapy training program
to become more open to other modalities
of healing, including mind-body
medicine. Over the next decade I studied
mind-body interactions, became a certified
psychoanalyst and read all I could
about nutritional medicine. I spent nine
years studying bioenergetic psychotherapy,
an approach that confirmed
my experience and belief that stress in
the psyche can translate into physiological
processes that create "dis"-ease in
the body. Eventually, I coupled this
approach with learning all I could about
providing better care for the psyche and
the body. The latter brought me into the
field of nutritional approaches as well as
to cellular healing.
It was at this point that I had my first
encounter with coenzyme Q10. It seems
no accident that I came across an article
in the Annals of Thoracic Surgery reporting
how patients taking coenzyme Q10 were
able to be weaned more quickly from the
heart-lung bypass machine we use
during open heart surgeries. I'd recently
lost a dear patient after a successful
mitral valve replacement operation
because he had failed over and over to
come off that same pump—a nightmare
scenario that happens on extremely rare
occasions. So that article really grabbed
me and made a strong impression. What
regrets! What if I had known about coenzyme
Q10 before I'd sent that kind man to
a surgeon? His death had been a real
heartbreak for me and one that still strays
into my thoughts.
I couldn't bring that one gentleman
back, but from then on I could, and did,
tell patients awaiting open heart surgeries
to start taking a daily dose of 30
milligrams (mg) of coenzyme Q10 two
weeks in advance. Thanks to the lessons
from one patient, they all came off the
heart-lung bypass machine without a
problem.
All through the 1980s I found myself
driven to learn all I could about mindbody
and nutritional medicine. It consumed
most of my spare time. By 1986, I
was convinced enough to start using
coenzyme Q10 for more cardiac situations,
like arrhythmias, hypertension,
coronary artery disease, CHF and angina.
In 1990 I actually began to develop my
own vitamin and mineral formulas using
coenzyme Q10, B vitamins, vitamins C, E,
and D, carotenoids, flavonoids, calcium,
fish oil, green tea and so on, and I believe
that they all have merit in the treatment
and prevention of heart disease.
I read reams of research, and even
authored several books and journal articles
to share the success stories I was
observing with my own patients, many of
whom were transcending the kind of
improvements I had only hoped and
prayed for. As I watched those tears of joy
and enjoyed hugs from my patients and
their family members, it was obvious that
we were onto something . . . something
big! I didn't realize it, but in the future I
would become a metabolic cardiologist.
A few years later I started using L-carnitine
and was truly amazed at how this combination
of two nutraceuticals (coenzyme
Q10 and L-carnitine) provided an even
bigger quality of life boost for people.
Frankly, when I look back I don't know
how I ever practiced cardiovascular medicine
without them. Now it's unthinkable
not to recommend them to my patients
with heart failure, arrhythmia, angina and
hypertension. Knowing what I know now,
withholding information about these
nutraceuticals would be tantamount to
malpractice for me.
It was a new beginning in my practice
of medicine to be able to offer my
patients alternative therapies that were
safe and efficient—and that truly worked.
Because nutrition had not been a part of
the curriculum when I went to medical
school, I had to make time to study it at
great length, but my physician colleagues
were often skeptical that I knew what I
was talking about. So to be sure that I
was qualified, I dug in, learned more and
took the board examination given by the
American College of Nutrition (ACN). I
studied for two years, passed the exam
and added CNS (Certified Nutrition
Specialist) to my credentials.
MITOCHONDRIAL DEFENSE
In the 1990s I was recommending
nutraceuticals to support the mitochondrial
defense system in the cell. You may
recall from high school biology that the
mitochondria is nicknamed the "powerhouse
of the cell" because it's primary
function is to generate ATP, that complex
energy substrate generated by the Krebs
cycle (a long chemical process I hope you
never had to memorize for a test question.)
I serendipitously came to learn that
preserving the mitochondrial adenosine
triphosphate in our precious heart cells
was really the answer in sustaining the
pulsation of cells and life itself.
I learned that pulsation in the body is
the key to vibrancy and life itself in my
bioenergetic training for certification.
Even prehistoric man knew that life
depended upon the pulsating heart.
Another light bulb went off! I realized
that the health of the heart cell's mitochondria
was the key to pulsation and
contraction. I became driven to devote
my energies to studying the relationships
among mitochondria, the heart and cardiological
diseases. This complex relationship
is the essence of metabolic
cardiology.
In 2002 I met Dr. James Roberts at a
conference in Las Vegas and listened to
his research on the utilization of D-ribose
in the cardiac patient. D-ribose is a fivesided
sugar that is the missing link in
energy transformation. I was truly
amazed by Dr. Roberts' presentation and
we have become colleagues over the past
few years. I have such a genuine respect
for Dr. Roberts that I asked him to write
the introduction to my book. A well-credentialed
integrative cardiologist
himself, Dr. Roberts knows the vital
importance of D-ribose in providing and
sustaining energy, particularly in hearts
that are compromised.
After using D-ribose dozens and
dozens of times and becoming convinced
of its efficacy, I wrote a newsletter
article about it in my "Sinatra Health
Report." I wanted to give this new and
vital information to my 50,000-plus subscribers
describing the emerging field I
call "Metabolic Cardiology."
As my knowledge and experience
evolved, I came to realize that when you
treat the mitochondria and nurture the
heart on a cellular level, then you can
improve the health of the whole
organism. The study of mitochondrial
energy and pharmacokinetics became
such a passion that I wanted to write this
book to get this life-saving information
out to more and more people.
Part two of the series from the Sinatra
Solution, Metabolic Cardiology will appear
in the next issue of totalhealth.
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