October 31, 2014
By Dr. Virender Sodhi, ND, MD(Ayurved) and Dr. Anuprao Mulakaluri, ND
The word ‘courage’ in the English language is derived from the latin word ‘cor’, which means heart. In our culture, we use phrases like “it takes heart” to describe the courageous quality of achieving something extraordinary. The heart is also considered central to our emotional experiences of love, generosity, compassion and sympathy. We all know the blessing of “living in someone’s heart”,the generosity of someone’s “kind heart”, the healing power of a “compassionate heart”, the ease of living with an “open heart”. All of these expressions are for real, reach far beyond the activity of the physical heart, to an emotional and spiritual understanding of the heart. This is the mythical way our ancestors viewed the heart and its power on our lives.
According to Ayurvedic medicine, the heart chakra lies at the center of the seven chakras, which governs the physical, mental, and emotional activities and experiences of the individual. The heart chakra, called Anahat Chakra, holds the emotional functions of love, confidence, trust, as well as deep connection and compassion for other people, animals and the environment. When out of balance, individuals may experience vulnerability, loss of confidence, anxiety, emotional distress, and dependency. Anahat chakra expresses self-love and unconditional love as its highest function. The heart also serves as the seat of the life-force, the Prana. Ayurveda sees the human being as a part and product of nature – thus, humans are believed to possess an inherent tendency to love, heal, and harmonize.
The functions of the physical heart are simple but very much essential for life to exist. The heart is the first organ to receive digested nutrients from the liver. It is also the first to receive the oxygenated blood from the lungs. From here, the heart distributes nutrition and oxygen-rich blood throughout the body. The heart pump also facilitates the circulation of messenger molecules, like hormones and cytokines, throughout the body. Thus, harmonizing physiological activity that sustains the body and health.
The Problem of Heart Disease:
The words “Heart disease” may represent several heart conditions that affect the cardiovascular system. Most common type is coronary artery disease, followed by stroke, heart failure, high blood pressure, and diseases of arteries. Altogether, heart disease is the leading cause of death in the United States; accounting for 600,000 deaths per year in US, that is 1 of 4 deaths every year. Every year over 700,000 Americans suffer a heart attack, of which 515,000 are first-timers. That means almost 75% people are getting heart attack for the first time. Billions dollars worth of STATIN drugs prescription have no impact on the outcome. Management of coronary heart disease also puts a burden of $108.7 billion dollars on the economy each year.
As leading cause of chronic illness and death in US, heart disease makes some poignant projections about our culture. These are revealed through looking at the causes of heart disease. High blood pressure, high LDL cholesterol, and smoking are three key risk factors of heart disease. About half of Americans (49%) have at least one of these three risk factors; high blood pressure being most prevalent of the three. Other medical conditions and lifestyles that promote heart disease include:
- Overweight and obesity
- Poor diet
- Physical inactivity
- Excessive alcohol use
All of the above, except poor diet, are diseases of excess. Diabetes represents excess blood sugar (often due to high carbohydrate intake), excessive weight is associated with excessive fat, physical inactivity with excess of lethargy and dullness, and excessive alcohol use directly damage heart. Not only general public lacks knowledge of proper nutrition, but even mainstream medical community also lack the knowledge to educate general public. Medical colleges spend two years in teaching basic sciences, two years of clinical science and average of three years in clinical residency. Out of all these years clinical nutrition teaching is only for 8 hours. Unfortunately that knowledge in nutrition is so poor that majority of medical community thinks that there is no connection between poor nutrition and diseases. Main focus is to prescribe a magic bullet to treat the disease without considering role of nutrition, exercise and stress reduction. With all the arsenal of extensive drugs and heroic surgical procedures, heart disease is still the leading cause of death even in country like USA, where we take pride in having the state of art medical facilities. If you take a close look at the statistics, you will be very much surprised to know that the leading cause death is heart disease, second leading cause is cancer and third leading cause of death is pharmaceutical drugs and hospital errors.
Ayurveda described three models that can lead to imbalance and leads to heart disease:
- Excessive consumption of food; inability to handle stress; excessive attachment; and ignorance
- Nutritional deficiencies; lack of relaxation and activity
- In-appropriate combination – of food
One pattern clearly emerges that our society is affected by pattern of excess. Look at the sizes of hamburgers, even coffee or tea. On my recent trip to Germany where I was invited to speak at International Cancer conference, the size of servings was way smaller than what we get here. Our foods are very calorie-rich but very much deficient in nutrition. This deficiency and in-appropriate combinations play significant roles in the diseases. The appearance of heart disease is usually a late sign of a long-standing imbalances. Individuals have suffered with hypertension, high cholesterol, diabetes, obesity, low grade inflammation and inactivity for a long time. Majority of these individual would have been able to prevent heart disease following preventive measurements.
Let us delve into some ideas for combating the national epidemic of heart disease with Ayurvedic understanding.
Benefits of Diet:
Natural medicine tradition of Ayurveda and Naturopathy attribute a powerful medicinal quality to food. Nutrition sustains us from the day we are born. Every tissue, organ, hormone, etc. are built from the food we eat. Our body makes antibodies to fight off any bacteria, virus, or fungus; it makes much needed hormones that help the functions of our body to synchronize with day/night (circadian) cycle and seasonal cycle; nutrition also supports our transition through different phases of life. Additionally, food is also the source of phytonutrients, antioxidants, alkaloids, vitamins, minerals that promote health on a daily basis. For any chronic disease, a clean, healthy, and wholesome diet is a foundation for healing.
In research, plant based diet appears as one of the best preventive strategies for those with heart disease or at risk of heart disease. In a study from India, researchers assess the benefit of vegetarian diet compared to non-vegetarian diet. It was found that despite eating same amount of calories as non-vegetarians, individuals on a vegetarian diet had significantly lower total cholesterol and triglycerides. Vegetarians also had lower blood pressure, while maintaining lower fasting blood sugar. This vegetarian diet included more vegetables, greens, and fruits, as opposed to heavy grain-based diet that many vegetarians eat.
A systemic review was done to study the relationship between balanced Mediterranean diet on the phenomenon of “cardiodiabecity”. Here, “Cardiodiabesity” is combination of obesity, diabetes, and heart disease. This diet pattern included “high consumption of plant foods (such as fruit, vegetables, legumes, nuts and seeds and cereals, preferably wholegrain); the seasonal choice of fresh and locally grown produce as far as possible; the presence of fruit as the main daily dessert and olive oil as the main source of dietary lipids; moderate consumption of dairy products (mainly cheese and yogurt); low to moderate amounts of fish, poultry and eggs;” In this review, 33 of 37 studies demonstrated a significant reduction in the risk of “cardiodiabesity” with adherence to Mediterranean diet pattern.
Another powerful review article looked at the effect of vegetarian diet among over 180,000 Seventh Day Adventist (SDA). This was done to observe direct reduction of specific heart diseases. This study found that SDA-diet pattern demonstrated reduction in risk of ischemic heart disease (Heart attacks) by 24%; reduction in risk of cerebrovascular disease (stroke) by 34%; reduction of death by heart disease by 35%.
It is important to note that the excellent results seen in the Seventh Day Adventist studies are not just a result of a good diet. Individuals in this group are also blessed with the support of a community and a Spiritual practice. Ayurveda philosophy “Vishwa kam, kutumb kam” which means “the whole Universe is my family” resonates with this approach of the SDA group. It teach us that community and spiritual practice are important part of the human experience, because they give us a sense of belonging and a sense of purpose. These serve as a medicine for our emotional and spiritual healing, just like food is medicine for our physical heart.
Benefits of Physical activity:
For the longest part of our evolutionary history, humans have had a close relationship with nature. We spent large spans of time working outside, migrating, hunting, gathering, etc. Our body and mind are evolved to enjoy the benefits of regular physical activity. Like diet, physical activity is one of the important foundations of health. In our society, where Cardio-Aerobics have been a popular form of workout, why is there a growing epidemic of obesity, diabetes, and heart disease? Perhaps, we are not doing the right exercise or not doing it regularly enough to meet our body’s evolutionary needs.
Researchers have wondered these questions and their studies shed some light on the truth. The physical activity report card of 2014, by National physical activity plan demonstrates the following trend among children and adolescents:
Physical activity: About 42% of 6-11 year olds and only 8% of 12-17 year olds get 60 minutes of physical activity 5 days per week
Sedentary behavior: Most children in the US have a 2+ hours in front of television or computer for every 1 instance of play/activity.
Active transportation: less than 13% of children walk or bike to school.
These trends indicate that starting as early as childhood, we are culturally geared towards very little physical activity on a daily basis. For children, play and exercise should be part of being a kid – yet, we see dismal physical activity numbers. On the other hand, regular physical activity among children has been shown to protect them against high blood pressure, high triglyceride levels, and controlled cholesterol levels. Normalizing physical activity as part of daily routine may be beneficial for protecting children in the long run. This can be done by engaging in physical activity/exercise with our children since a young age.
Regular physical activity has the direct effect of promoting adaptability of the heart, the vascular system, and the nervous system. Physical activity also promotes harmony activity between the respiratory system, cardiovascular system, nervous system, and endocrine (hormonal) system. This stimulating and harmonizing effect is enhanced by the disease preventive effect of physical activity. In one study, researchers demonstrated the effect of exercise on cardiovascular and inflammatory measures. It was shown that regular exercise resulted in reduction of various inflammatory signaling molecules; these include TNF-alpha, IL-6, INF-y. The anti-inflammatory effect was specific to protecting the cardiovascular system; this was demonstrated by reduction inflammatory markers CRP and Homocysteine.[10,11] Adhesion factors, that promote adhesion of cholesterol to blood vessels to create plaque, were also reduced. Aerobic exercise showed reduction of vascular cell adhesion molecule-1 (VCAM-1) and intercellular adhesion molecule-1 (ICAM-1); thus indicating protection from plaque formation in blood vessels.
Altogether, these studies demonstrated the protective effect of physical activity arises from its positive benefit of cardiovascular health. Doing upto 40-45 minutes of daily exercise is most beneficial. Also, interval exercise that alternates between high intensity and low intensity activity are more beneficial to burn calories and improve endurance.
Benefits of breathing exercise and yoga
Yoga is a fairly popular form of exercise that combines stretching, body-weight bearing exercise, and breathing exercises. The popularity of yoga and breathing exercises is often related to improvement of physical strength, energy, and stress relief that people experience with practice. The benefits of yoga for cardiovascular disease begin from application of Yoga as a primary prevention for heart disease. A review of studies demonstrated that yoga in healthy individuals resulted in reduction of blood pressure, total cholesterol, and LDL; while HDL level was improved. This demonstrates preventive effects on the cardiovascular system.
Furthermore, yoga intervention has demonstrated benefit of reducing cardiovascular inflammation. This action is specifically protective against development of plaque in arteries; which prevents dysfunction of blood vessels and reduces risk of heart attacks and strokes. A 12 week yoga therapy has also been shown to help patients with coronary artery disease (CAD). The 12 week yoga training, which included 2 classes per week showed improvement with cardiovascular function, cognitive function, as well as reduced symptoms of depression among CAD patients. The control group did not show any of these improvements in the absence of yoga therapy.
Rauwolfia serpentina: Commonly known as snakeroot, this herb is recognized by snake-like winding shape of its roots. Use of this herb to control hypertension has been documented as far back as 600BC in the Sushruta samhita. The long history of use attests to the legacy of successful and safe use of this herb. Native to India, rauwolfia has been tapped as a source of reserpine that acts as a parasympathomimetic. That is, reserpine promotes activity of the parasympathetic nervous system, which helps the individual and their cardiovascular system relax. In alignment with this, rauwolfia has also demonstrated graded relaxation of smooth muscles, which support the cardiovascular system and other organs. The herb also has a positive inotropic effect on cardiac muscles; improving pumping efficiency of the heart. Cochrane review of studies on the effectiveness of reserpine found that the compound has the capacity to lower blood pressure to the same degree as other first-line antihypertensive drugs.[16 ]Unfortunately, using reserpine alone has the side-effect of depression. The whole herb extract has over 40 different alkaloids, in addition to reserpine. Using the whole herb, significantly cuts down the negative side-effects of using reserpine alone.
Terminalia arjuna: This herb is commonly called Arjuna. Traditionally, it is used for a wide range of cardiac ailments. Several studies have confirmed that arjuna improves heart function among patients with congestive heart failure. Patients started out with a 2 week trial that was extended to 2 years. With the addition of Arjuna to their regular medication, patients showed improvement in signs and symptoms, exercise tolerance, quality of life, as well as reversal of severity of heart failure (NYHA class). Arjuna contains flavonoids and glycosides that improve symptoms of chest pain (angina) and generally tonify the heart tissue. In this way, the herb helps to regulate heart rate (- chronotropic) and strength of contraction (+ inotropic), as well as protects from injury. Arjuna also has effective anti-oxidant activity that is proven powerful enough to protect the heart from chemotherapy drug, doxorubicin-induced cardiotoxicity. Altogether, Arjuna is an excellent cardio-tonic when used alone or in combination with complementary herbs.
Inula racemosa: also called Pushkarmoola. It contains a variety of “lactones” that act similar to Beta-blocker drugs, reducing heart rate but increasing efficiency of the heart.[20 ]Rishi Charaka, one of the great teachers of Ayurveda, gave high regards to this herb for relieving chest pain.[21 ]A small open-label trial on patients with ischemic heart disease and chest pain was done to test this claim. Given 90 mins before exercise, inula demonstrated improvement in all cases; all patients prevented post-exercise abnormalities on ECG test of heart function. The lactone of inula seem to improve blood flow to all parts of the heart (anti-ischemic) and reduce development of arterial plaque (anti-lipid peroxidation). A clinical trial among a cohort of 200 cardiovascular patients showed that administering Inula in combination with Commiphora mukul (Guggul – lipid lowering herb) helped to achieve “a 39-percent decrease in total cholesterol, 51-percent decrease in triglycerides, and 32-percent decrease in total blood lipids.”[22 ]Added effect of inula was also seen through following results: 26% of subjects showed restoration normal ECG and 59% showed improved ECG. Also, 29% no longer experienced chest pain, while percentage of patient experiencing shortness of breath (dyspnea) dropped to 32% from 80% at the beginning of trial.
Tribulus terrestris: is traditionally used among hypertensive patients for its diuretic activity, i.e. it promotes urinary activity. A combination product with tribulus with another urinary herb, Boerhaavia had a diuretic effect comparative to the drug furosemide. Emerging research has demonstrated additional cardioprotective effects. The blood pressure supportive actions of tribulus are believed to be derived from direct relaxing effect on the arterial smooth muscles.[25 ]During the restorative phase after a heart attack, returning blood flow to the heart can cause additional injury to the heart, called reperfusion injury. The compound Tribulosin is protective from such reperfusion injury. In studies, it reduced the size of cardiac muscle injury from heart attack (infarct size), as well as had restorative effect on cardiac markers and enzymes. These included Malondialdehyde (MDA), aspartate aminotransferase (AST), and lactate dehydrogenase (LDH); superoxide dismutase (SOD) and creatine kinase (CK) activities. Tribulus extract has also been observed to restore elevated cholesterol while improving function of blood vessel walls (endothelium) in rabbits on high cholesterol diets.
When cardiovascular system is distressed, kidneys are often the next organ to become affected. Tribulus also provides protective effect on kidney function. It has shown effectiveness in tonifying kidney tissue and protecting against toxicity (nephrotoxicity) in experimental studies. Tribulus also protect kidneys from diabetes related kidney damage, owing to it ACE-inhibitor like activity on the body’s vascular tissue.[29,30]
Saxifraga Ligulata: This herb is an ideal support for the actions of Tribulus, as it combines several kidney protective actions. These actions include promoting urination, breaking down kidney stones, anti-oxidant, and anti-inflammatory.[31 ]With the combination of these activities the kidney tissue is protected from oxidative and inflammatory damage, while improving efficiency of filtration of toxins through the kidney. As further protection, Saxifraga also has anti-diabetic activity. Herbal extracts inhibit the enzyme alpha-glucosidase; which helps by preventing breakdown and absorption of sugar. In other words, saxifraga prevents starches from breaking down, thus preventing absorption and blood sugar elevation.
Omega-3 Fish oil: The effectiveness of fish oils in protecting cardiovascular function is widely recognized and accepted by conventional medicine. The supportive actions of fish oil occur by two main mechanisms 1) Controlling inflammation in the blood vessels, thus limiting cholesterol trapping (lipid peroxidation) and plaque formation. 2) Reducing thickness of blood, which lowers clotting activity of the blood and prevents damage to tissues due to loss of blood flow (ischemia). This action is especially helpful among hypertensive patients, who have 80% stroke result from ischemia.
In a study on Greenland Eskimos, 852 middle aged men were followed for 20 years. Researchers found that death related to coronary heart disease was inversely related to consumption of fatty fish. Meaning, the more fatty fish one ate, the less likely he was to die from coronary heart disease. In an Italian study, called GISSI-P, 11,324 patients with recent history heart attack (Myocardial infarction or MI) were studied. Consumption of Omega 3 PUFA (polyunsaturated fatty acids) led to 15% reduction in risk of heart disease and 30% reduction in risk of death related to cardiovascular problems. Authors of the GISSI-P study concluded, “this beneficial effect of n-3-PUFAs is in addition to their well-known anti-atherosclerotic (anti-plaque) and anti-thrombotic (anti-clotting) effect. In summary, GISSI-P showed that n-3 fatty acids cause 20% reduction in (all-cause) death, a 30% reduction in cardiovascular death, and a 45% reduction in sudden cardiac death (SCD) in patients who have recently experienced an MI.” In a follow up study on heart failure cases, GISSI-HF, authors worked with 6,975 patients. Among patients with NYHA class II-IV chronic heart failure, supplementation with n-3-PUFAs significantly reduced death rate (mortality) and hospitalizations due to cardiovascular reasons. 1 in 44 patients treated with Omega 3 Fish oils prevented “events such as death or hospitalization because of CV reasons.”
Heart disease is an alarming symptom of an unhealthy culture. Like any symptom, it is not the enemy but a warning sign to point out our mistakes. For too long, we have confused having material excess with personal success. Perhaps, this is the reason for the widespread problems of chronic disease. If we look at nature, all animals live an active life, they collect and eat the food they need, and rarely have issues with obesity or chronic disease. Our bodies have evolved in a similar living conditions as animals in nature; therefore, straying too far from our own nature leads us into existential troubles. Symptoms of this disharmony with nature are manifold and can be seen in our life and around the world.
Fortunately, nature is the most powerful and formidable ally. Adhering to nature’s laws can help us to align our body with its natural healing wisdom. Our healing journey can be simple, efficient, and powerful at once by following this wisdom.
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