Integrative Cardiology
By Drs. Mao Shing Ni, D.O.M. & Yu-Ming Ni, M.D.
February is Heart Health month so at least once a year the focus of National public relations is on the heart and the cardiovascular system, however, given that heart disease remains the number one killer in the U.S.—claiming about 655,000 Americans each year, the focus on heart health should be year-round and not just merely once a year. To the horror of family members of 18.6 million victims in 2019, heart disease is also the world’s number one killer.
Technology Intervention
While technology and innovations have saved lives—more than 600,000 angioplasty are performed each year in the U.S., where balloons are sent into the coronary arteries to reopen plaque-blocked arteries and stents installed to keep them open have stopped heart attacks, or to relieve severe chest pain, it is now generally agreed that some cases angioplasty aren’t absolutely necessary, or necessarily the right thing to do.
Angioplasty
Angioplasty offers an easy alternative to bypass surgery and the recovery is a few days versus weeks compared to surgery. In fact, angioplasty is easy enough to do that it is sometimes done too often. After all, it is a symptomatic treatment and what it doesn’t do is to stop atherosclerosis, the disease that caused the blockage in the first place. It won’t increase your lifespan or protect you from a heart attack—for that, you’ll need to address the underlying cause.
In fact, the use of angioplasty for opening partially blocked arteries in asymptomatic patients has been questioned for some time. Many studies published in peer-reviewed, professional journals have concluded that comparing angioplasty and standard medical therapy—taking medication and lifestyle modification -- found no difference in the outcome of rates of heart attack and death.
Integrative Medicine
Today, the open-minded approach to applying knowledge in other fields for the best outcome of disease care and prevention forms the basis of integrative medicine. Integrative medicine is a combination of conventional medicine and other healing modalities not commonly taught in Western medical schools. In addition to incorporating all of the incredible advances of medication and technology, integrative medicine emphasizes nutrition, lifestyle and the all-too-often ignored mind-body factors.
Integrative Cardiology
Integrated Cardiology represents a new, cutting edge, evidence-based approach in the treatment strategy of cardiovascular disease. It focuses attention on nutrition, herbal medicine, acupuncture, anti-inflammation through the intervention of gut microbiome, and low dose medication therapy. Integrative cardiology also emphasizes the mind-body connection with techniques like meditation, tai chi, and qi gong, and the evidence that depression, anxiety, and stress are not only risk factors for the development of a cardiovascular disease, but lead to adverse outcomes, including cardiac death and disease progression.
Diet & Nutrition
The old adage, “You are what you eat” is a truism when it comes to heart disease. If you pile on your dinner plate with a typical American diet—a steak or a double cheeseburger, potato or French fries and chase it down with a soda and finish off with a slice of apple pie ala mode—full of saturated fat, sugar, and processed ingredients you’ll soon enough experience the results in your clogged arteries.
Plant-Based Diet
Diet has the power to modify your genetic expression—meaning if you happen to have a family history of heart disease, eating the right foods can lower the risk of developing heart disease but eating the wrong foods may hasten the onset of it. In the case of heart disease, the definitive diet proven in studies to reverse atherosclerosis or plaque in arteries is a plant-based one. In comparison to other diets, a plant-based diet free of animal products and fats is even more effective than the Mediterranean Diet.
The China Study
The China Study is the most comprehensive study of health and nutrition ever conducted—the culmination of a 20-year partnership of Cornell University, Oxford University, and the Chinese Academy of Preventive Medicine. The author Dr. Campbell showed the undisputed connection between diet, obesity, and long-term health outcome especially with heart disease, diabetes, and cancer.
The common diet of the Chinese in the 1970s and 80s consisted of vegetables, whole grains, beans and legumes, nuts and seeds, and an occasional animal product during festivities and celebrations. As a result, the vast Chinese population avoided being victims of modern diseases that America was at war with—mainly heart disease and cancer.
Epigenetic
The study of ways that modifies genetic expression is called epigenetic. Many factors, besides diet, may modify gene expressions such as lifestyle, gut microbiome, and even emotions. The good news is that even if your genetic test results such as from 23andme showed that you have a relatively high chance of developing various diseases including heart disease that, due to discoveries in epigenetic, you now hold the power to greatly reduce the development of that disease and change your genetic destiny.
Clinically, Chinese Nutrition has always emphasized a personalized approach to eating based on one’s constitution and diagnosis. At Tao of Wellness, we offer our patients comprehensive nutrition consultation and diet planning at our offices for those serious about using diet to modify their genetic expression and to achieve optimum health.
Herbal Medicine
With a long history of documented and evidence-based use, Chinese herbal therapy has proven to be a potent complement to medication for heart disease treatment and prevention. Chinese herbs such as hawthorn berry, eyebright seed, and water plantain root, have been shown in studies to both lower blood pressure and reduce cholesterol safely without any side effects or adverse interaction with drugs.
Acupuncture
When it comes to heart disease, blood pressure control is key to reducing stress on the heart. Acupuncture has been found to exert immediate action on relaxing blood vessels thereby lowering pressure and delivering more blood flow—oxygen and nutrients to the heart muscles. The mechanism underlying this phenomenon is due to acupuncture’s action on increasing production of nitric oxide which dilates arteries, as well as rebalancing the sympathetic and parasympathetic systems, and the decrease of cortisol that ultimately lowers inflammation.
Lifestyle—Long Walks Begets Long Life
A sedentary lifestyle is a time bomb waiting to go off. Many studies have confirmed the essential nature of cardiovascular exercise as a requisite for heart health. In my years of studying and interviewing centenarians around the world—culminating in the publication of my best-selling Secrets of Longevity, the one common denominator that every 102 or 105-year-old I’ve met is daily walks of between one to two hours. Forget the gym and exercise classes, as for these folks there weren’t any when they were growing up. In addition, most did not own a car which forced them to walk or bike to their daily destination.
Tai Chi & Qi Gong
For the Chinese population, besides daily walks, the preferred exercise is the practice of Tai Chi and the lesser-known Qi Gong at the parks. Studies on tai chi and qi gong showed benefits such as a reduction in blood pressure, increased circulation and oxygenation of the heart muscle, and lowered stress hormone cortisol. Moreover, the group gathering at the park afforded socialization that is a bonus for heart health.
Inflammation
The bad cholesterol or low-density lipoprotein (LDL) especially the micro-particle ones called lipoprotein or LP(a) are the ingredients of plaque. As they circulate throughout your arteries they are looking for inflamed areas of the walls of your blood vessels to stick to, forming plaque. If your arteries are free of inflammation then despite the presence of LP(a), no plaque is formed. This is why the presence of inflammation is key to atherosclerosis.
Foods rich in Omega 3 fatty acids such as flax, hemp and chia seeds, walnut, soy, seaweed, and fatty fish as well as supplemental Omega 3 help to fight and reduce inflammation.
Gut Microbiome & Inflammation
The biggest cause of inflammation, besides injury, is imbalanced gut flora or microbiota due to poor dietary choices. Highly processed foods, deep-fried foods, preservatives, additives, cow dairy, gluten, and sugar all contribute to inflammation by creating an intestinal environment unfriendly to beneficial bacteria leading to overgrowth of bad bacteria.
Probiotic-rich foods such as kimchi, miso, sauerkraut, coconut kefir, and goat milk yogurt (avoid cow dairy) are helpful to restore gut microbiome as well as supplemental probiotics.
The Mind-Body Connection
The link between emotional stress and physical disease has been well documented. This is especially true when it comes to heart disease. Studies published in the journal Circulation showed that people with high levels of anxiety and depression were more likely to have a heart attack or stroke than people without those symptoms. There’s even a condition called “broken heart syndrome”, also called stress-induced cardiomyopathy that is brought on by stressful situations and extreme emotions when there’s a sudden malfunction of the left ventricle of the heart accompanied by symptoms resembling those of a heart attack. Broken heart syndrome almost exclusively affects women.
Understanding the mind-body connection is the first step to creating a positive action to prevent heart disease with evidence-based practices such as meditation, hypnosis, and other stress management techniques.
In summary, prevention is the cornerstone of integrative cardiology. With a whole person approach to disease care and prevention through diet, herbal and nutritional therapies, acupuncture, lifestyle changes, combined with conservative use of medication when necessary, regular monitoring with diagnostic tests together, patients and doctors can work together to steadily lower the unnecessary deaths claimed by heart disease which, for the most part, is preventable.
About Yu-Ming Ni, M.D.
Dr. Yu-Ming Ni is the eldest son of Dr. Daoshing Ni who is currently completing an Integrative Cardiology Fellowship at Scripps Medical Center in La Jolla, California. He did his undergraduate at UC Berkeley and received his medical degree from New York Medical College and completed his residency at Cedar Sinai Hospital, Los Angeles.