Turning Point Acupuncture
Email Newsletter: Cardiac Protection -The East and West View
Volume 4 Number 5
Dear Friends and Colleagues,
This issue of the newsletter addresses one of the most serious medical issues in this country today, high blood pressure (HBP). Often called the silent killer, this problem has now reached massive proportions. Below we will examine the problem from both the Western and Traditional Chinese Medicine (TCM) perspectives, explore the role of high cholesterol in this epidemic, present some holistic options and offer some cautions about mixing herbs and medications.
Much of this newsletter was prepared by Amanda Silver, L.Ac., one of our staff acupuncturists. I am pleased that she has tackled this difficult area and presented the issues so cogently.
You can read more about her and the other staff here:
http://www.nycacupuncture.com/docbios.html
TABLE OF CONTENTS
1. Western Medical Perspective
2. Traditional Chinese Medicine (TCM) View
3. Combining East and West
4. Adding Holistic Treatments
5. Alternative Treatment of High Cholesterol
6. Mixing Herbs & Medications
7. Turning Point News
You can read an extended version of this newsletter online at:
http://www.nycacupuncture.com/bp.html
1. Western Medical Perspective
Heart disease is the leading cause of death in this country. It is widely acknowledged that there are four major risk factors in its development: high blood pressure, high cholesterol, diabetes and cigarette smoking. This newsletter will focus on the first two.
Fifty million Americans suffer from high blood pressure (hypertension), and yet nearly one third are unaware of their condition. In May of 2003, the National Heart, Lung, and Blood Institute (NHLBI) issued new guidelines redefining acceptable blood pressure levels. Levels once thought to be within the realm of normal (above 120/80 but below 140/90) are now considered to be pre-hypertensive. Normal and optimal blood pressure is now below 120/80. Under the new definition, the population thought to be at risk of developing hypertension (and the complications associated with it) increased by 45 million, bringing the total number up to ninety five million - a staggering number, by any standards!
Blood pressure is determined by measuring the pressure in the blood vessels using a compression cuff. The top number (systolic) is the amount of pressure when the heart is contracted. The lower number (diastolic) is the amount of pressure in the blood vessels/heart when the heart is relaxed between beats.
While the exact cause is usually unknown, there are many factors that increase one's risk of developing hypertension. Some of these factors include aging, weight gain, smoking, diabetes, heavy drinking and diet. A number of medications including birth control pills, steroids, nasal decongestants, non-steroidal anti-inflammatory drugs and diet pills can also cause high blood pressure.
Increasingly there is concern that high cholesterol levels, particularly the LDL (low density lipoproteins) levels, correlate with plaque formation in the arteries and are thus prognosticators for HBP. Total cholesterol levels above 200 mg/dL, LDL above 130 and HDL less than 40 are cause for concern. It is likely that these levels, like the blood pressure readings described above, will be reevaluated. Already doctors are treating middle aged people with total cholesterol in the 180-200 range with medication. (Note that a lot of the research on cholesterol is supported by the drug companies). It is important to remember that cholesterol is a substance vital to the body in the formation of hormones and the production of cell membranes. Normal levels must be maintained for good health.
Generally, high blood pressure, like high cholesterol, has no obvious symptoms. It can increase the risk of stroke, heart attack, heart failure and kidney failure, without any outward manifestations.
Western Medical Treatments:
Anti-Hypertensive Medication
Western hypertensive medications typically fall into one of five categories: diuretics, ACE inhibitors, beta-blockers, vasodilators, and calcium channel blockers. Their modes of action are as follows:
Diuretics cause the body to excrete water and salt.
ACE inhibitors block an enzyme that indirectly causes blood vessels to constrict.
Beta-blockers block the effects of adrenaline, causing the blood vessels to widen and the heart to relax.
Vasodilators expand the blood vessels for easier flow.
Calcium channel blockers help decrease contractions of the heart and widen the blood vessels.
Unfortunately, all of these medications have side effects. Symptoms may include loss of sex-drive, incontinence, cold hands and feet, fatigue, depression, memory loss, and heart arrhythmias.
If your blood pressure is dangerously high (160/100 and higher), treatment with pharmaceutical drugs is essential, at least for the short term.
Anti-cholesterol Medication
The most commonly prescribed medication for controlling cholesterol levels is Lipitor (atorvastatin). Lipitor belongs to the class of medicines called statins. All statins are inhibitors of HMG-CoA reductase, an enzyme involved in the synthesis of cholesterol in the body. The brand names of these drugs are Zocor, Mevacor, Pravachol, Lescol and Baycol. All these drugs can hurt the liver and blood testing to monitor ones liver function must be done before and during the treatment. Of greater concern is the incidence, albeit rare, of a serious muscle wasting disease called Rhabdomyolysis. This side effect presents as muscle tenderness, soreness or weakness and can lead to death via kidney damage if not identified. 100 such deaths have been attributed to Baycol, which was recalled by the FDA in August 2001. Milder forms of this muscle toxicity do exist and some researchers think that up to 1 in 10 people taking statins may manifest this as mild fatigue, or simply having trouble getting out of a low chair. One possible explanation of this muscle damage is that the statins, as they reduce HMG-CoA reductase, also cause CoQ10 deficiency in the tissue mitochondria (the energy factories of the cells). At Turning Point Acupuncture we encourage all patients on statins and natural anti-cholesterol regimes to take Coenzyme Q 10 supplements.
Since cholesterol is important in the formation of cell membranes, another alarming side effect is the observation reported in a large Danish study that long-term statin users had a 4 to 14 times higher risk of developing peripheral neuropathy. Peripheral neuropathy is nerve damage that can cause weakness, numbness, tingling and pain in the hands and feet. The incidence of this side effect increases with prolonged use.
2. Traditional Chinese Medical View
Hypertension is not a TCM diagnosis, rather it is noted as a consequence of other underlying patterns of disharmony that are causing the pressure to rise. The Chinese medical approach to HBP is to determine what that pattern is. The TCM practitioner examines three main organ systems that are commonly involved in HBP: the heart, liver and spleen organ systems. (Note that the TCM organ systems discussed here do not refer to the actual anatomical organ.) We also look for 3 patterns of energy imbalances: liver fire rising, phlegm dampness and blood stagnation, to identify the root of the problem.
The 3 Main Organ Systems
The Heart
In Chinese medicine, the heart is responsible for moving the blood around the body and is the seat of consciousness (spirit) and mental state. Diseases of the heart can manifest as heart palpitations, heart pain, oppression in the chest and shortness of breath. And if the imbalance affects the spirit, there may be symptoms such as, forgetfulness, insomnia, profuse dreaming, anxiety and being easily frightened.
The Liver
The liver stores the blood and governs the free coursing of Qi throughout the body, and controls the sinews and tendons. Storing the blood refers to the liver retaining and regulating the amount of blood in the body when the body is at rest or in activity. The liver's free coursing function means that it causes Qi to course freely around the body, ensuring normal emotional activity.
Stress commonly hurts the liver. This is the reason that most health professionals include stress reduction as part of a cardiovascular protection program. Diseases of the liver can manifest as flank pain, bitter taste in the mouth, irritability, anger, menstrual irregularity, and blurred vision.
The Spleen
The spleen extracts the nutrients from food in the stomach and transports them throughout the body for nourishment for all of the tissues and organs. Fatty, sweet and rich foods can damage the spleen and stomach. Thus diet is another important factor in cardiovascular protection. The result of poor dietary choices is an accumulation of phlegm and dampness that impedes the free flow of energy around the body. Diseases of the spleen can manifest as poor appetite, diarrhea or constipation, obesity and fatigue
The 3 Energetic Imbalances Involved With HBP
Every individual that comes for treatment has his or her own particular energetic imbalance. Here are some possible imbalances that can be found in Chinese medicine that are responsible for high blood pressure.
Liver fire rising
This pattern is commonly seen in patients with a high stress lifestyle. In this condition, excessive stress causes the Qi to stagnate. When the Qi stagnates, fire is generated and rises upwards. This excess of yang energy creates symptoms like red eyes, dry mouth, irritability, headache and insomnia.
Phlegm dampness
This condition can be found in people who are overweight and have a diet high in animal fat and salt. The spleen and stomach are responsible for transforming and transporting the nutrients from the food we eat. When the spleen and stomach do not function properly, fluids accumulate and stagnate and become pathological dampness. Phlegm dampness symptoms include digestive disturbances, obesity, and shortness of breath.
Blood stagnation
Blood stasis occurs when there is impairment of the normal free flow of blood. When blood stagnates, tissues do not get properly nourished and pain can result. The symptoms from this stagnation can manifest as a dusky complexion, chest pain, and headaches.
TCM Treatment
In summary we can see that to treat HBP from a TCM viewpoint we must address the organ systems and energy imbalance patterns described above. As opposed to treating the symptoms as we do in western medicine, the object here is to address the underlying disharmony in an attempt to eliminate the problem.
We use the age old proven tools of TCM, specifically acupuncture to balance Qi and to remove stagnation, and Chinese herbal formulas to correct the organ system problems.
For example, to treat HBP that is caused by liver fire rising, we might use an herbal formula which contained Gastrodia to calm liver wind, and do regular acupuncture treatments.
3. Combining Western Medicine and TCM
It is a good idea to start TCM treatment of the underlying causes of HBP without making changes to ones medication regime. This is especially true for the individual with severe HBP. However, careful BP monitoring must be done regularly throughout the treatment course to insure that the medications don't then lower the pressure too much!
4. Adding Holistic Treatments
From the TCM perspective it is easy to see why weight loss and diet (for the spleen), exercise (for the heart) and stress-reduction (for the liver) are so important in a cardiovascular protection.
For a review of a wide range of holistic options (diet, supplements, etc.) read the expanded version of this article on our website:
http://www.nycacupuncture.com/bp.html
5. Herbal Treatment of High Cholesterol
There are natural alternatives to pharmaceutical statins for the treatment of high cholesterol, most prominently Policosanol. Most commonly derived from sugar cane, Policosanol is a long chain fatty acid compound that is thought to inhibit cholesterol synthesis in the liver. There are also numerous herbs, known to the Chinese herbalist for centuries, that can be applied to this contemporary issue. The noted herbalist, Andrew Gaeddert, recently reviewed many of these in an article for TCM practitioners. We think his Health Concern formulations are attractive alternatives to statins and we stock both Polilipid and Astra Garlic.
Read a reprint of his article Anti-Cholesterol Herbs:
http://www.nycacupuncture.com/chol.html
Another interesting alternative to pharmaceutical statins is Red Yeast Rice Extract, which has a potent natural inhibitor of HMG-CoA reductase. At Turning Point we like Choleast from Thorne Research which contains Red Yeast Rice Extract (600 mg) and Coenzyme Q10 (10 mg). When using red yeast rice extract we like to combine it with Metagenics' Cholarest sc, which contains 10 mg of Policosanol. Finally we add Hawthorne, an herb that opens up blood vessels.
(Thanks to Richard Kowal, DC, nutritionist, suggesting this treatment protocol.)
Read more about the efficacy and safety of red yeast rice on our website:
http://www.nycacupuncture.com/bp.html
6. Herbs & Medications: Caution when mixing!
See the expanded web page version of this newsletter for warnings about combining cardiac medications and herbs:
http://www.nycacupuncture.com/bp.html
7. Turning Point News
Appointments are now available 6 days a week including early morning and late evenings. To learn more visit:
http://www.nycacupuncture.com/patientinfo.html
To schedule an appointment with one of our practitioners call (212) 489-5038
Yours in Peace,
Amanda Silver, Licensed Acupuncturist
Naomi Rabinowitz, MD Medical Director
9 October 2003
Turning Point Acupuncture
1841 Broadway, Suite 509
New York City, NY 10023
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copyright 2003 Naomi Rabinowitz. All Rights Reserved. This newsletter may be reproduced or transmitted in its entirety only, including this copyright line.
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