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From the Townsend Letter
May 2015

Managing Cardiovascular Diseases
Ramblings of a Maniacal Frenetic: Pragmatic Reflections on Helping Patients Understand Their Illnesses and Treatments
by John Parks Trowbridge, MD, FACAM
Diplomate, American Board of Clinical Metal Toxicology
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Coronary calcium scans ("heart scans," coronary artery CT calcium scoring, also called EBCT for "electron beam") are noninvasive and useful predictive monitors for coronary events. Their value is enhanced when a sequentially rising calcium count is documented, particularly in a patient who has been asymptomatic. An exciting development is the markedly improved sensitivity of coronary MRA, magnetic resonance angiogram (imaging of heart blood vessels) without (or especially with) use of peripheral intravenous contrast. Among the most accurate "predictive" clinical tests are the carotid neck artery and abdominal aorta ultrasounds (or even CT scans), along with the noninvasive vascular lab tests for leg (peripheral) artery disease. These usually allow tracking of credible blockage and flow patterns, but they don't reflect the entire range of pathologies hidden inside the vessel walls.
The ideal predictive tests would be those that disclose unsuspected "tendencies" to develop more aggressive diseases. When a particular patient has a number of such genetic or epigenetic (variable gene expression, depending on environment and other factors) proclivities, he or she warrants more attention. Here is your "likely candidate" for more extensive and earlier blockage disease to progress. Since "pipe" problems can be imaged and measured, tests should be proposed as indicated by history, clinical exam findings, and abnormal laboratory patterns. (A simple example serves well: history of visual changes, ophthalmic exam showing blood vessel or retinal changes, with elevated blood sugars – clearly carotid artery studies are appropriate, perhaps even a brain SPECT scan, maybe others.) Unfortunately, the data are unclear regarding how best to predict the development of non-"pipe" pathologies – those of the pump or its performance. Cardiac muscle biopsy is not something to consider!
One predictive parameter that is grossly underemphasized is that of oxygen saturations. Numbers of studies have shown that decreasing nocturnal saturations – which reflect lowering oxygen tension in the blood and, hence, in the tissues and especially inside the mitochondria energy factories of the cells – are directly related to impaired pump function and performance issues. The critical continuous generation of ATP to power cellular processes is absolutely dependent on sufficient oxygen to receive and remove electrons stripped during oxidative phosphorylation in the mitochondria. Energy production is perilously degraded when the anaerobic fermentation pathway is employed. When oxygen saturations are raised toward normal, improvements in tissue functions in all organs can be expected, including retarding of "aging" degeneration and even deferred initiation/promotion of neoplastic patterns. Otto Heinrich Warburg, MD, nominated 47 times for the Nobel prize, finally received the unshared award in physiology in 1931 for discovery of the "nature and mode of action of the respiratory enzyme." Concluding that cancer (and other deterioration diseases) should be interpreted as a mitochondrial dysfunction, Warburg proclaimed that "the prime cause of cancer is the replacement of the respiration of oxygen in normal body cells by a fermentation of sugar." As noted in Wikipedia, "When frustrated by the lack of acceptance of his ideas, Warburg was known to quote an aphorism he attributed to Max Planck: "Science progresses not because scientists change their minds, but rather because scientists attached to erroneous views die, and are replaced." Sound familiar?
Though autoimmune issues are not the main topic for this review, practitioners should remain alert to the prospect that they might be aggravating heart and blood vessel problems. The defense system, just like all others, works optimally when oxygen tensions are sufficient, nutritional status is replete, and toxic metal and chemical exposures are minimal. When conditions are not ideal, aberrated responses are more likely and any tissue can be targeted. Since endothelial blood vessel linings are present throughout the circulatory system, any immune attack on their components can alter function – and subsequent changes can be induced in end-organ tissues anywhere. Autoimmune heart problems occur classically after untreated streptococcal infections ("strep throat"), wherein any heart tissue or the surrounding sac can suffer severe damage. Recent reports have documented antiendothelial cell antibodies as associated with accelerated artery disease in patients with rheumatoid arthritis (RA), systemic lupus (SLE), and "spondyloarthropathies" (systemic sclerosis found with inflammatory joint diseases of the vertebral column – which can include psoriatic arthritis, inflammatory bowel disease, and so on). More autoimmune interactions will be identified in the future.
Unnoticed or misdiagnosed parasitic infections might be at the root of many diseases appearing to be autoimmune. While most people think of "worms" or "flukes," since they are most commonly diagnosed in humans, the vast majority of parasites are single-cell organisms, extremely easy to "get," astonishingly difficult to document or diagnose, and particularly difficult to treat. And, of course, most physicians disregard or dismiss the idea that parasites contribute that much to degenerative diseases – this oversight might be fatal to thousands of patients each year. Parasitic infections are no longer classifiable as just "diseases of the third world." "Montezuma's Revenge," traveler's diarrhea sometimes acquired in Mexico, is due to a single-cell amoeba, which (like almost all tiny parasites) is readily shared through water exposure. How many other cases of diarrhea or digestive disorders are related to unsuspected organisms? Malaria is the classic case to document endothelial blood vessel damage associated with infection. Virtually all of the world's oceans, lakes, and rivers are teeming with parasites of some sort, found mostly in the first 9 feet below the surface. Genomic testing might become the ideal way to document some of these unwelcome residents, but many of them reside deep in tissues, where they wreak havoc. Their "stealth mode" keeps them from being "seen" until damage is profound, such as abscesses in the brain and even multiple sclerosis.
Recent discoveries of biofilms – aggregates of microorganisms within a secreted slime or protective matrix and present on virtually all moist surfaces "outside and inside" human beings (such as plaque on the teeth) – suggest that all infectious agents can be shielded from access to the immune system or antibiotics and thus could persist for years, repeatedly seeding infection that could provoke or amplify inflammation, degenerative diseases, and autoimmune responses. Complex infection patterns linked to biofilms could be more than a passing fancy, and might indeed hold critical clues on prevention and treatment of most cardiovascular diseases. Bacterial biofilms have been found within fatty deposits of damaged arteries. Perturbations of the gut microflora are clearly related to inflammation and dysfunction of the intestinal lining. Periodontal disease (progressive gingivitis, gum inflammation) has long been associated with heart attacks and strokes. Effective dental hygiene can reduce these risks, especially important in compromised patients such as diabetics. An excellent review of how oral disease correlates with systemic health is presented in Mouth Matters; How Your Mouth Ages Your Body and What YOU Can Do About It (2013), by Carol Vander Stoep, RDH. Keep in mind that all these departures from normal structure and function are associated with inflammation … and that this poses special challenges to maintenance of all cell activities.
Incidentally, as mitochondria become "sick" – such as having their chemical pathways poisoned by toxic metals – they swell with increasing calcium concentration, disrupting their shelflike cristae fold structures, dramatically interrupting the electron transport chain. Chelation therapy has been shown to repair such injured organelles, restoring more normal energy generation. So here arises the charge that chelation can be criticized for claiming that it "fixes everythin', jus' like some kinda snake-oil!" But … patients claim (and dozens of studies by Edward McDonagh, DO, and Charles J Rudolph, DO, PhD, as well as others have documented) that chelation does "fix mos' everythin'!"
All toxic metals are, to some extent, accumulating in endothelial linings and throughout heart and blood vessel cells as well – mercury, lead, cadmium, arsenic, and so on. Each has a separate contribution to amplify free radical production leading to functional impairment. Rodent studies suggest a marked intensification of damage when two or more heavy metals are present, even in trivial concentrations. But toxic heavy metals are not the only culprits. Iron is an essential element that can be present in excess (iron "storage" disorders, even mild polycythemia?), where it also stimulates the generation of free radicals that are especially toxic in metabolically active tissues such as liver and heart, even more so in compromised patients such as diabetics. Neurodegenerative disorders such as Alzheimer's and Parkinson's have been conclusively linked to excess iron accumulation in brain tissues. Elevated cancer rates are seen in patients with iron overload. These clinical observations confirm Warburg's contention that mitochondrial decay, mediated through amplified free radical attacks, is the root of disparate and disastrous disease patterns that steal our comfort and, ultimately, our life.
Jukka T. Salonen, MD, PhD, MPH, of Finland, reported in 1992 a prospective study of 1931 men with no symptoms of heart disease. Over the next three years from entry, the lifetime total of cigarettes smoked was determined to be the primary risk factor in those 51 patients who experienced acute myocardial infarction (heart attack). The second factor was (not cholesterol or blood sugar or blood pressure or obesity!) an elevated blood ferritin level (possibly correlated with a shift toward tissue acidosis). Beyond an accurate smoking history, this realization provides an easy laboratory test to identify those at higher risk. Ferritin levels rising ever higher above 100 ng/ml are directly associated with an alarming increasing incidence of coronary events. The iron story is, however, complicated because adequate pools of iron are essential for life. Ferritin only slowly declines after dozens of EDTA chelation treatments – correction of other metabolic perturbations is essential. Even mild iron-excess patterns might be clinically more significant than earlier appreciated.
A toxic metal side issue is now coming to the forefront: the expanding use of injectable MRI diagnostic imaging contrast agents, such as gadolinium, iron (Feridex), and manganese (Teslascan). Urinary challenge tests with D-penicillamine in some patients have shown very high excretion levels of gadolinium. The clinical significance of these findings is variable, but chelation in patients who have had repeated contrast studies might prove very valuable. Gadolinium use has been linked to onset of rare but often crippling nephrogenic systemic fibrosis, especially in patients with reduced kidney function.

Oversaturated with Facts?
So-called sleep apnea is associated with magnified rates and more injurious cardiac events. Sadly, most physicians have only a passing exposure at best to the parameters of at-rest oxygenation. (The awake-in-the-exam-room-chair saturation level obtained in some offices is almost useless for prediction, unless the patient is in clinical distress.) "Obstructive" events are routinely blamed for desaturation events, but my experience shows that accusation is misplaced in the vast majority. Thus, patients are subjected to "scuba-torture" (CPAP pressure mask worn during the night), usually disrupting sleep patterns for many. Further, CPAP is notorious as a failing therapy within a year of two of starting, due to minimal results (of simply blowing room air) and frustrating discomfort.
Pause to consider: if you use an "obstructive" treatment (CPAP) for a "central" problem (as interpreted from "low sats"), how likely is it to succeed? Obstructive sleep apnea is routinely "diagnosed" by sleep labs – but my observations and clinical results over the past 22 years clearly show that central apnea is far more common … and easily controlled by nasal cannula oxygen from a home concentrator during sleep. Medicare and insurance companies concede that saturations below 89 qualify for "lifetime" oxygen support. In sharp contrast, patients with "sats" from the mid-90s on down show improvements with virtually all heart and circulation problems, mentation, arthritis, digestive disorders, strength and vitality, and so on. Recall that robust oxygen availability is essential for mitochondria to meet the metabolic demand for ATP. My testing of nocturnal oxygen saturations over the past 22-plus years has proved that the vast majority of desaturation patterns can be related to central causes. This central "respiratory disconnect" appears associated with past head injuries of any kind and/or toxic insults (heavy metals, organic and inorganic chemicals). Presumably hypoxic/anoxic shock and severe infections (especially meningitis and encephalitis patterns) would qualify, but my experience is too limited to offer those conclusions.
These desaturation issues present a glaring example of "the Missing Diagnosis." When "modern" medicine doesn't have (or doesn't accept) a specific treatment program, then its regimented practitioners routinely miss the accurate diagnosis for one very simple reason … they don't look for or don't actually see the problem.
Another worthwhile topic to explore would be EECP (enhanced external counterpulsation), compression therapy wherein air pressure cuffs squeeze on the legs during the relaxation phase of the heart beat (diastole). In a surprising number of cases, augmented boluses of recently oxygenated blood surging through the coronary arteries and vital organs appear to produce a significant improvement in underlying pathology. At present, the cost and complexity of such strategies are prohibitive for many – and, again, the added benefit of supplemental oxygen during EECP treatments is likely overlooked by conventional practitioners.

A major change in our food processing has occurred in just the past 40-some years: the introduction of HFCS, high-fructose corn syrup, as a flavoring. Actually, more as a "sweetener." But it's not really "all natural," as we think of foods (such as glucose or sucrose [table sugar]). And it doesn't taste just exactly like sugar – but it is close enough to substitute in an astonishing number of "sweet" foods and drinks … and even in ketchup, mayonnaise, hamburger and hotdog buns, and the like. The worst part is that it acts more like a drug than the historical sweeteners such as cane or beet sugar or honey, encouraging you to "seek more" of the HFCS-supplemented foods. You probably avoid such foods … certainly you would recognize the chemical name. But would you tag as the same … "corn syrup solids"? "Natural sweeteners"? "Fructose" (fruit sugar) or "fructose syrup"? "Crystalline fructose"? HFCS intake (often quickly, in soda pop, candies, cookies, "treats," cereals and baked goods, and junk foods) spikes insulin release and triggers production of triglycerides and cholesterol, let alone aggravating or actually causing intestinal permeability syndrome ("leaky gut"). Elevated insulin levels contribute to all the pathologic damage of metabolic syndrome, the preliminary to adult-onset diabetes, now epidemic in America.

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