BY Samuel Mathis MD, MBA
Studies have found that the holiday time and winter season are the most likely times for heart attacks. This can be due to many reasons. The cold weather causing vasoconstriction, the stress of the holiday, late nights, and increased physical activity from normal sedentary lifestyles all increase the risk of a myocardial infarction. Our diets also don’t help with this risk. With the holiday season upon us, many Americans allow their diet and healthy eating habits to slide. These high-calorie, proinflammatory foods can contribute to coronary artery disease and increased blood pressure. What are some integrative therapies we can recommend to our patients to protect their heart health during the holiday season?
The first and best recommendation for heart health is prevention. The best prevention for heart disease and cholesterol deposits is to work on healthy eating and diet. For 2024, the best diet recommendation continues to be the Mediterranean diet. This diet promotes plenty of fruits, vegetables, whole grains, nuts, seeds, healthy oils (olive), seasoning with herbs and spices, and consumption of lean meats like fish, turkey, or chicken with limited red meat. This diet is also low in processed sugars and saturated fats. One of the best aspects of this diet is the ease with which individuals can incorporate this eating style into their lifestyles as had previous generations of individuals who live in Spain, Italy, Greece, and the northern countries of Africa.
For those with significant CAD or who are very concerned about their health, the Ornish Diet from the Lifestyle Heart Trial may be beneficial in halting or regressing coronary atherosclerosis (1). This lifestyle recommendation, initially published in 1999, requires a significant lifestyle and dietary adjustment. The diet is primarily vegetarian with low fat content, regular exercise, stress management, and group support therapy. The original study required participants to follow the regimen for 5 years, but some more recent studies have found positive benefits even as quickly as 15 weeks. Like the Mediterranean diet, the Ornish diet discourages highly processed foods or refined sugars.
However, let’s face it, dietary compliance is low for most patient populations. Many patients desire supplements or other complementary therapies. The use of herbal supplements for heart disease can be split into three categories: Hypertension management, cholesterol control, and other heart conditions such as arrhythmias and heart failure. In managing hypertension herbs such as Hawthorn or Aged Garlic have some studies that show benefits in blood pressure control (2). The dose for Hawthorn should be 600-1800mg of whole leaf/flower or 160mg of concentrated extract. Studies using Aged Garlic Extract used 1200mg per day with some benefit. Of note, chocolate or cocoa has been shown to lower blood pressure due to Nitric Oxide production. However, these results are significantly reduced if ingested with milk or as milk chocolate (2).
In terms of cholesterol control, red yeast rice has shown some benefits in lowering cholesterol levels. Regular intake of red yeast rice led to lower total cholesterol, LDL, and triglycerides compared to placebo. It is estimated that red yeast rice may lower cholesterol levels between 15-25%. One caveat of red yeast rice is ensuring a high-quality supplement. This supplement is not regulated by the FDA, so it is recommended to get a supplement that has been third-party tested to ensure quality. I typically recommend 1,800mg a day in divided doses if patients are prone to myalgias from statin use.
Some studies have found that fish oil supplementation may help reduce cardiovascular risk (2). However, it is important to note that recent studies have found that increased consumption of fish oil may increase cardiovascular risk in patients with good cardiovascular health (3). Conversely, fish oil supplementation in patients with cardiovascular disease or a history of atrial fibrillation and stroke decreases the risk of major cardiovascular events (3). The standard recommendation for fish oil supplementation is 2,000-3,000mg a day in high-quality fish oil. Alternatively, I recommend patients try to consume healthy cold-water fish 2-3 times a week for maximum benefit.
Finally, all these diet changes and supplements should be accompanied with exercise recommendations. Patients should engage in regular aerobic exercise with weight training 2-3 times per week. My typical recommendation is 20 minutes a day of exercise such as a brisk walk or swim. While these recommendations are not comprehensive, they can be helpful for many patients looking to improve their heart health or prevent cardiovascular disease or complications during the holidays or for the new year.
References
- Ornish D, Scherwitz LW, Billings JH, Brown SE, Gould KL, Merritt TA, Sparler S, Armstrong WT, Ports TA, Kirkeeide RL, Hogeboom C, Brand RJ. Intensive lifestyle changes for reversal of coronary heart disease. JAMA. 1998 Dec 16;280(23):2001-7. doi: 10.1001/jama.280.23.2001. Erratum in: JAMA 1999 Apr 21;281(15):1380. PMID: 9863851.
- Aggarwal M, Aggarwal B, Rao J. Integrative Medicine for Cardiovascular Disease and Prevention. Med Clin North Am. 2017 Sep;101(5):895-923. doi: 10.1016/j.mcna.2017.04.007. PMID: 28802470.
- Ge Chen, Zhengmin (Min) Qian, Junguo Zhang, Shiyu Zhang, Zilong Zhang, Michael G Vaughn, Hannah E Aaron, Chuangshi Wang, Gregory YH Lip, Hualiang Lin, Linda Gough – Regular use of fish oil supplements and course of cardiovascular diseases: prospective cohort study: BMJ Medicine 2024;3:e000451.