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by Lyle Hurd, editor
Illustration Jeff Ham
Stephen T. Sinatra, M.D. bridging allopathic and integrative medicine in Cardiology Health Care
Editor’s notes-:
The following interview with noted cardiologist Stephen T. Sinatra, MD is the second in a series featuring heath care practitioners who are at the forefront of pioneering nutrition based medicine as the solution to America’s health care crisis. Persons who are committed to reducing human suffering and improving quality of life by making their patients healthier and keeping them out of hospitals. Many of these individuals are highly respected medical doctors who have been certified in their individual medical specialties; however, when asked to describe their practice would respond, “Nutrition or wellness based medicine.”
While the success of these modern health care pioneers in changing both the quality of life of their patients as well as the economics of treatment has been significant, it has not seemed to cause an epiphany among either the pharmaceutical oriented government agencies or HMOs. Although it certainly has to be a factor in the growing incidence of integrative medicine programs in numerous prestigious medical schools across the country. Many of whom access these same practitioners as their instructors or lecturers.
Dr. Sinatra, is a fellow of the American College of Cardiology, fellow of the American College of Nutrition he is board-certified in internal medicine and cardiology, and certified in anti-aging medicine, clinical nutrition and bioenergetics analysis. He authors the popular newsletter “The Sinatra Health Report”—an insider’s guide to smart medicine and longevity, and has written numerous books including The CoQ10 Phenomenon, Heart Sense for Women, The Sinatra Solution: Metabolic Cardiology the New Hope for Preventing and Treating Health Disease and Reverse Heart Disease Now.
I first met Dr. Sinatra in December 1996 at the annual American Academy of Anti-aging (A4M) conference where he was a keynote speaker and involved with administrating the continuing medical education programs. He was familiar with totalhealth magazine, supportive of our editorial commitment, and agreed to consider contributing an article on his work. Over the past 10 years he has contributed over twenty articles, acted as a friendly advisor, allowed us to excerpt from his excellent newsletter and introduced us to numerous other individuals who have been assets to our publication.
The following excerpt from his landmark book, The Sinatra Solution, introducing the concept of Metabolic Cardiology is both an excellent introduction to Dr. Sinatra as a physician and compelling statement for incorporating an integrative mode as the standard of contemporary medicine.
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 today, 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 learn from their teachers and colleagues, but also from their own patients as well.
TH: Dr. Sinatra your new book, Reverse Heart Disease Now, coauthored with James C. Roberts, M.D. and Martin Zucker, states the following sobering statistics: The American Heart Association estimates that in 2002 approximately 70 million Americans had one or more forms of cardiovascular disease (CVD). In that year, CVD took 927,?448 lives in the United States—that is one out of every 2.6 deaths.
Also that most of us with serious cardiovascular disease probably have no idea we are afflicted by this insidious threat to our health and mortality. Particularly when according to the book “Cardiovascular disease kills in an instant by heart attack or stroke. Fifty percent of the time the very first symptom is cardiac arrest. Without warning, half of all the people who have the disease die without every knowing they had it.
“CVD can also silently and slowly strangle the vitality of the most important muscle in your body—the heart muscle—which pumps life-sustaining blood and nutrient through 60,000 miles of blood vessels. The lining of those blood vessels becomes inflamed and can even be destroyed. Blockages develop and the blood can’t flow.”
TH: It is really frightening, recently a friend of mine with no history of heart disease died from a sudden heart attack within a period of twenty minutes.
SS: Did he have and MI or dissection?
TH: I’m not sure. He and his wife were driving home in a snowstorm, got into a little town, he was not feeling well and he died shortly after arriving at the hospital.
SS: Unfortunately, I’ve seen that scenario many times.
TH: Are there warning signals, or precautions people should be aware of relative to this potential problem?
SS: Unfortunately, there are not. Sometimes a day before people will get some discomfort in the chest, they get a little shortness of breath and think it’s nothing. Patients who have survived sudden death tell me; they thought they had the flu, because they felt weak. They had difficulty breathing, profound fatigue, and vital exhaustion, and then “bang”.
TH: Does this mean I could have had a complete physical yesterday and it could happen to me today?
SS: Yes, you could even drop dead leaving your doctor’s office. That’s the problem with contemporary cardiology, up to 50 percent of the time; sudden death is the first symptom of heart disease. The first symptom, and 90 percent of it is asymptomatic. That’s the dilemma cardiologists are faced with. That’s why I’m a big proponent of fish oil, because of its impact on heart rate variably. Fish oil gets inside the soft plaque and hard plaque of blood vessels and makes them more resistant to rupture. I think one of the best ways to protect yourself from this syndrome of sudden cardiac death is to use fish oil on a daily basis. That’s why I added fish oil to the CoQ10 formula I put together for DPI the organization that publishes “Heart, Health & Nutrition” my newsletter, it contains fish oil, carnitine and CoQ10. CoQ10 is vital, however a lot of people are resistant to taking too many pills, so I just added a gram of fish oil to protect them from sudden death.
TH: Dr. Sinatra, how would you best describe the approach to cardiology practiced by you and Dr. James Roberts, your coauthor of Reverse Heart Disease Now?
SS: We consider ourselves a new breed of cardiologists—making our patients healthier and keeping them out of hospitals. We were once “typical” board-certified cardiologists. We did thousands of angiograms and performed emergency cardiac procedures. We rolled up our sleeves at all hours of the day and night. We did what we were trained to do and thought we did the very best for our patients. We saw ourselves as saviors.
In the beginning, we didn’t know there were other ways to practice cardiology other than what we had been taught. Then we learned differently. We learned we could stabilize killer arterial plaque—stop it in its tracks—and maybe even reverse it. And what we learned changed our lives and the lives of our patients.
Independently, something big happened to us both on our journey as cardiologists. Medically speaking, we became born-again doctors with an enlarged vision that transformed the way we practice. We refer to it as New Cardiology or integrative cardiology, and it gives us dynamic tools to raise patients to the highest level of their health potential. It brings together conventional care with complementary care. In this new format, we are as comfortable recommending nutritional supplements and mind/body approaches as we are prescribing bypass surgery or a heart drug. We integrate what works the best.
Over the years, I have seen a slow but growing acceptance within the medical profession regarding the effectiveness of natural alternatives for a wide range of cardiovascular disorders such as angina, arrhythmias, high blood pressure, and heart failure. This is the way it should be integrating the best of conventional medicine with natural healing.
We believe this is smart medicine that can save countless lives and make a huge dent in the continuing epidemic of cardiovascular disease. Usually, with a combined program of nutritional medicine, medications, or reverse lifestyle changes, and, if necessary, surgery, we can stabilize or reverse existing disease. Many of our sickest patients make remarkable recoveries.
We have written this book as a guide for the medical consumer. It is an effort to explain and demonstrate the benefits of an integrated cardiology approach based on our medical research and our combined 50-year clinical cardiology practice. The information will help the reader understand how arteries become enveloped in inflammation and plaque, which may lead to heart attack, stroke, and heart failure.
We also want to show how patients and doctors can work together to promote health and vitality. There are wonderful options—medications and scientifically proven supplements and lifestyle changes—with which to extinguish the flames of disease and promote good blood flow, even for the most compromised cases. This book and the practice are about integrating those options to restore and maintain the best possible arterial function and a vigorously pumping heart. It is a guide to improving and saving lives.
TH: Are you optimistic concerning the future of this evolution in the prevention and treatment of heart disease?
SS: We see an exciting time ahead for cardiology because so many new tools and so much new information are constantly emerging. The day is coming when no one will have to die from arterial disease.
But even today we can put out the flames of arterial disease with the best that alternative and conventional medicine has to offer. We can now determine the presence of nasty constituents within the blood—such as toxic metals—that poison the arteries. We can determine with new imaging technology the?extent of a patient’s calcification and whether hard plaque or soft plaque is building up.
We are beginning to utilize genetics to hone in on a patient’s specific weaknesses then map out individualized remedies. One day soon, we will be able to genetically test babies shortly after birth and determine enzyme deficiencies that may set them up for heart disease 40 years later. The genetic age in medicine is coming.
Soon we expect to be able to monitor endothelial function and check on the status of this critical one-cell layer that lines the arterial walls of the body. In the not-too-distant future, we may even have vaccines against atherosclerosis.
We see metabolic cardiology, electromagnetic frequency devices, and other forms of energy medicine getting noninvasively to the heart of the matter, raising ATP and rejuvenating failing hearts.
The future of cardiology isn’t just about applying high-tech gadgetry and research. Arterial and cardiac health still requires that patients do their share, applying the low-tech (and low-cost) healing power of diet, nutritional supplements, and lifestyle changes. These are the basics that benefit not only the cardiovascular system but the body as a whole. We are often amazed at how, in the shadow of high-tech medicine, we consistently achieve powerful healing effects with our patients by using simple, standard nutrients like vitamins E and niacin and CoQ10 and fish oil. Now we are excited by the promise shown recently by vitamin K-2 for plaque reversal. Soon we both will participate in a multicenter international research project to help clarify further the potential of K-2.
Fortunately, the bitterness and bad-mouthing seem to be receding. We give lectures at alternative medicine meetings on how alternative patients can benefit from angioplasty and bypass surgery when and if it is appropriate for them. And our mainstream cardiology journals have opened their pages to nutritional interventions.
For the sake of our patients and the economics of medicine, the future must bring about a union in which there will be no separate alternative medicine and conventional medicine. Instead, we must have smart medicine in which physicians consider combinations of nutrition, lifestyle, pharmacology, and surgery to prevent or treat CVD. Hopefully, this union will occur in time to help you and your family, and before our expensive disease management approach bankrupts the Medicare and Medicaid programs.
TH: You have stated and evidenced through your work that you feel a doctor really needs to have a responsibility to the medical community as well as to the general public. Is that correct?
SS: A doctor has to do the right thing. Which in my opinion means a doctor has to extend himself/herself to both the medical community and the people she/he treats. It is vitally important for a doctor to think out of the box because what is the standard of care in medicine for one doctor may be malpractice and another it may be the golden rule so to speak. It’s very hard, take drugs for example, most doctors have become “drug salespeople”, you look at the teaching of pharmacology in this country, sure it becomes taught as part of the medical school curriculum. But, as soon as the doctor becomes a medical student, intern, resident, or fellow, he/she is constantly bombarded by pharmaceutical reps who buy them watches and take them out to dinner and offer them double-blind placebo controlled trials in hopes to convince these doctors drugs will fix the problem. That is a major flaw in our medical system. Because, once a doctor becomes “married” to that form of education, I believe he is doing himself a disservice because he or she is only hearing one side of the story. Also as you really look at the doctor patient relationship, lots of patients are becoming savvy to the side effects of drugs and in many instances its a serious friction between doctors and patients. In working with two other cardiologists I see this even in my own practice. One of them is like me, the other is very traditional. Many patients don’t want to take all these drugs, because they know they have side effects. Today there are some very savvy patients, like my newsletter subscribers, or people that read Dr. Whitaker’s “Health and Healing” or other newsletters know that properly prescribed drugs, and the key world here is “properly”, are the fourth leading cause of death in America today.
If you look at drugs, what they do is cause nutrient depletion, which is one of the major flaws of pharmaceutical drugs. Let’s just take the classic ones. Any diuretic will deplete potassium and magnesium. Aspirin, a wonderful pharmaceutical drug depletes folic acid. Birth control pills deplete B vitamins across the board. Statins deplete CoQ10. Anti-hypertensive like beta-blockers deplete CoQ10 and ace inhibitors can have an affect on zinc. The list goes on and on. What I feel in over 30 years of practicing medicine is this, if you have nutrient depletion on one side and emotional and or environmental toxicity on the other side this is the perfect substrate for disease…for developing cancer, Alzheimer’s, Parkinson’s, heart disease, hypertension you name it. If you look at our society, there are environmental toxicities all over the place, people are full of rage, anger, resentment, etc. that also has a major impact on the body. Then you are taking pharmaceutical drugs or have nutrient depletion caused by diet or aging, because when we age we can’t absorb nutrients like we should, then you get sick.
I write about H2 blockers in my newsletter. They block the formation of acid in the gut and help to treat the syndrome, however they block calcium, and people are getting hip fractures. I don’t want to sound biased against conventional medicine. Because you can go the other way and say if you take too much beta carotene over years you might be susceptible to hip fracture. If you take as a male over a gram and a half a day, you have twice the incidence of prostrate cancer. Also as a male if you take over 100 mg of zinc a day then you get immune system dysfunction. What the doctor has to do is constantly educate himself to the point where he or she is reading on a daily basis because this nutra/pharmaceutial field is so vast and so comprehensive, that if they don’t put it into their daily routine like brushing their teeth they’ll be overwhelmed. I think the doctor of the future will be combination of the ND/MD degree.
TH: That is a profound observation. After 12 years of being involved with totalhealth I wholeheartedly agree with you.
SS: I am working toward that goal with my medical school now. I also teach at Bastyr University, the University of Connecticut and the Albany Medical Center. And offer scholarships to first, second and third year medical students who want to participate in the summer internal medicine program at Bastyr.
I am sincerely convinced today’s patients want to see a practitioner who integrate detoxification, diet, nutraceuticals, immunoceuticals, and herbal products into their practice as does the naturopathic doctor. However the ND’s Achilles heel is they don’t take care of sick patients. It’s hard to be a really good doctor unless you’ve taken care of a lot of sick people. Now a MD is brilliant at taking care of sick people, treating cancer, heart disease, emergencies, accidents, pediatrics emergencies, obstetrics, the M.D.’s treat all these emergencies and are very erudite and very comfortable on sick people, but what do they do? They prescribe pharmaceutical drugs; they don’t really offer the lifestyle changes, detoxification procedures, the dietary therapies, and the anti-inflammatory diets.
Consequently I’m working to help structure a six-year MD/ND program. Where as today if an MD goes to medical school and then decides to earn an ND degree they are required to go through five years more of naturopathic school. This new program would reduce the total commitment by three years.
Learn more about Dr. Sinatra’s simple, at-home solutions for cardiovascular wellness and other common health problems in his monthly newsletter, “Heart, Health & Nutrition.” Each issue features step-by-step recommendations on how you can use foods, nutritional supplements, and other natural substances to feel better and live longer, as well as Dr. Sinatra’s expert opinion on trends in both conventional and alternative medicine. Call 800-784-0867 to subscribe. Additional health advice and a registration form for a free monthly e-letter are available at www.drsinatra.com
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