Dr.

Stephen Sinatras

A Cardiologists Guide to Total Wellness

Dear Reader, The dictionary definition of mania is excessive or unreasonable enthusiasm, and it perfectly describes what has been going on for years in the medical community when it comes to lowering cholesterol with statins. The fact is that about a third of cardiologists take statin drugs themselves, many for preventive reasons, believStephen Sinatra, MD ing that cholesterol is the cause of heart disease. I even saw a recent paper suggesting that all men over 50 whether they have heart disease or notshould take a statin drug. This is insanity, particularly since some of my medical colleagues who are also concerned about the overuse of statins are beginning to see evidence that these drugs can lead to heart failure when used long term. As you know, I dont believe that statins should ever be used for prevention. Only men with diagnosed heart disease stand to benefit from taking these drugs. So is there something anythingthat all of us doctors can actually agree on, including those of us in the integrative camp who dont believe in the exaggerated cholesterol theory? There is, I believe. I am often asked what I think is the single most important cardiovascular blood test. While it is, of course, important to get a comprehensive blood screening, my choice is to pay particular attention to the level of triglycerides, and how it equates to HDL level. This is the real story. Triglycerides are a type of fat found in the blood. Too much of it contributes to inflammation, metabolic syndrome, diabetes, and arterial disease. Lets say, for instance, you have a triglyceride level of 100, which is borderline elevated, and an HDL of 50, which is good. That equals a ratio of 2, which is fine. The lower the ratio, the lower the incidence of heart disease. Everybody agrees on this. Unfortunately, many people dont have such a sweet ratio. They may have a triglyceride level of 200 (or higher) and HDL of 40 (or lower). Divide HDL into the triglycerides and youre in the danger zone with a ratio of 5. And there is a mountain of data showing that if your triglycerides are high and your HDL is low, you are headed for trouble. For those with high triglycerides and low HDL, there isnt a magical pill to pop. But the best treatment options are natural, cheap, and very effective. First you need to lose weight. You also need to cut down on sugar and refined carbohydrates. Finally, you need to exercise regularly. All simple solutions with no side effectsexcept for positive ones.

July 2012

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Stephen Sinatra, MD, FACC, FACN, CNS is a board-certified cardiologist and certified bioenergetic analyst with more than 30 years of experience in helping patients prevent and reverse heart disease. Dr. Sinatra integrates the best conventional medical treatments with complementary nutritional and psychological therapies. Dr. Sinatra is an Assistant Clinical Professor at the University of Connecticut School of Medicine and is author of numerous books including Lower Your Blood Pressure in Eight Weeks, Heart Sense for Women, Reverse Heart Disease Now, and Earthing. He is a Fellow of the American College of Cardiology; Fellow of the American College of Nutrition; board certified in internal medicine and cardiology; and certified in anti-aging medicine, clinical nutrition, and bioenergetic analysis.

Tips From
eriodically I like to get on the phone with a handful of other integrative cardiology physicians whom I greatly respectcall them my heart-health dream teamfor updates on new treatments and tests or just to hear what recommendations are continuing to work well for their patients. What follows are the highlights from my most recent round of cardio communications. Peter Langsjoen, M.D., has more clinical experience with CoQ10 than any other physician in the United States. He has written more than 25 published studies on CoQ10. CoQ10 powerfully improves cardiac function in my heart patients, said Dr Langsjoen. It has been a fundamental part of my practice ever since my father (also a cardiologist) and I first studied the effect of CoQ10 in heart failure. We published our initial findings in 1985. At that time we used 33 mg of CoQ10 three times daily with meals. Today, I recommend 200 to 600 mg daily in divided doses to my heart failure patients. Because of individual absorption differences, the lower dosage works for some people, while others need a higher dosage in order to reach a therapeutic blood level of 4 to 5mcg/mL. Dr. Langsjoen also reported on CoQ10s effect on cholesterol. High cholesterol, as we all know, is regarded by mainstream medicine as a primary cause of heart disease. Although I believe that this theory is false, there may be validity to the potential for oxidized cholesterol to create harm to our blood vessels. Cholesterol becomes oxidized from excess free radicals generated by things like air pollution, smoking, emotional stress, and heavy metal toxicity. CoQ10 and cholesterol travel together in lipoproteins, and supplemental CoQ10 has been shown to protect cholesterol from oxidation. This antioxidant role of CoQ10 may be useful in the prevention of atherosclerosis.
Heart, Health & Nutrition (ISSN# 1554-2467) is published monthly by Healthy Directions, LLC 7811 Montrose Road, Potomac, MD 20854-3394. Telephone: (800) 211-7643. Please call or write to P.O. Box 3264, Lancaster, PA 17604-9915 if you have any questions regarding your subscription. Postmaster: Send address changes to Heart, Health & Nutrition, P.O. Box 3264, Lancaster, PA 17604-9915. Periodicals postage at Rockville, MD, and at additional mailing offices. Author: Stephen Sinatra, MD, FACC, FACN, CNS Managing Editor: Jane Hahn Research Editors: Martin Zucker and Jan DeMarco-Sinatra, MSN, CNS, APRN.

the

Top

The Sinatra Spin: I first became excited about CoQ10 after reading the landmark studies the Langsjoens wrote back in the 1980s. Since then Ihave had consistently great results with CoQ10 and made it a keystone in my metabolic cardiology strategy. If mainstream cardiologists were to put their biases against nutritional supplements aside and give CoQ10 a chance, they would be doing a great service for their patients. Stephen Devries, M.D., Executive Director, The Gaples Institute for Integrative Cardiology, and Associate Professor at Northwestern University, weighed in on the crucial importance of diet when it comes to heart health. As a foundational strategy, there is no intervention in cardiology as potent as the time-tested Mediterranean diet. Studies show it can reduce the risk of heart attack by 70percent, he explained. The basics are simple: 5 daily servings of vegetables; 2 servings of fruit; whole grains over refined; 2 fish meals/week; minimizing red meat; and a predominant use of olive oil. If you dont like fish, a fish oil supplement can be helpful for prevention. Exercise is also critical for Dr. Devries. As a second foundational strategy, physical activity is a must. Unfortunately, most people dont want to hear about it, let alone do it. But this is the real fountain of youth. It is as simple as 30 minutes of daily recreational walking. The Sinatra Spin: It is imperative to remember that while supplements and medications are important, diet and exercise are truly foundational to health. I also recommend adding traditional Asian dishes to the diet. A Pan Asian Mediterranean diet, as I call it, gives patients an expanded variety of great anti-inflammatory foods to choose from. James Roberts, Jr., M.D., coauthored Reverse Heart Disease Now (Wiley) with me in 2008. He is a relentless clinical investigator, constantly searching for new research and techniques to help his
PA 17604-9915, or send e-mail to feedback@drsinatra. com. He maintains a website with additional information and services at www.drsinatra.com. Dr. Sinatrais compensated on the sales of the supplements heformulates for Healthy Directions. Heis not compensated for other companies products thathe recommends in this newsletter.

Annual subscription $69.99. 2012 by Healthy Directions, LLC. Photocopying, reproduction, or quotation strictly prohibited without written permission of the publisher. Bulk rates available upon request. Heart, Health & Nutrition is dedicated to the prevention and treatment of disease. Heart, Health & Nutrition cannot offer medical services; Dr. Sinatra encourages his readers to seek advice from competent medical professionals for their personal health needs. Dr. Sinatra will respond in the newsletter to questions of general interest, and urges you to write him at P.O. Box 3264, Lancaster,

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patients. I have been impressed with 2 to 4 g of L-arginine three times daily for my heart patients, said Dr.Roberts, not so much as an immediate remedy but as a good idea to reduce further trouble. L-arginine improves endothelial function and the ability of the arterial wall to generate nitric oxide and keep the lining of the blood vessels healthy. Thats a valuable contribution for dealing with all forms of cardiovascular disease. Dr. Roberts also discussed a new urine test that measures organic pollutants, such as phthalates, benzene, and toluene, commonly found in food, air, and water. These substances can potentially cause endocrine disruption and contribute to weight problems, diabetes, inflammation, and hypothyroidism. They accumulate in belly fat and seem to impair the ability to lose weight. I also have a suspicion they may play a role in the growing epidemic of atrial fibrillation. US BioTek, a Seattle company, offers the test to doctors (http://www.usbiotek.com/Services_ Environmental-Pollutants-Panel.php). It measures seven key pollutants. At a cost of about $125 to a patient, your doctor can get a good handle on what is a widespread and underdiagnosed toxicity problem. Im finding my sick patients are loaded with these pollutants. I detoxify them with various treatments and they get better. The Sinatra Spin: I frequently used L-arginine as a way to improve endothelial health, and, at the dose levels that Dr. Roberts suggests, it can be also be used to address erectile dysfunction. I also applaud his emphasis on detoxification, which is so overlooked yet critical for health in our modern polluted environment. If you have any stubborn health issues, I suggest seeing an integrative physician who has a detoxification program. Or consult with a naturopathic physician who typically uses detoxification techniques as a main therapeutic tool. Howard Elkin, M.D., practices in Whittier, CA, just east of Los Angeles, and brings an emphasis on fitness and nutrition into his integrative practice. D-ribose is an unsung supplement for getting energy levels up quickly and feeding heart cells starving for energy, he said. This natural sugar compound is a main energy substrate for cells. Ivehad many patients with cardiomyopathies and other types of heart dysfunction who have responded superbly. I recommend 5 g twice daily, a dosage that often boosts patients with low energy to feel good enough to start exercising, which, of course, is so important for the heart.

Using magnesium to calm premature ventricular contractions (PVCs) is another tip Dr. Elkin passed along, recommending 500 mg of magnesium glycinate daily. And a fish oil supplement works wonders on so many things, not just for the heart, blood, and blood vessels, but for the brain, memory, eyesight, inflammation, and for balancing neurotransmitters. I recommend 1 to 2 g daily, but will go up to as much as 6 g for individuals with high triglycerides. The Sinatra Spin: As much as CoQ10, magnesium, and fish oil are central supplements for health, Dr. Elkin has smartly picked up on the generally overlooked nutrient D-ribose. I discovered the importance of D-ribose about seven years ago and added it as one of my main metabolic cardiology therapeutic nutrients. Richard Delany, M.D., is board-certified in internal medicine, cardiology, critical care, and geriatrics. My goal is to individualize supplements to the patients needs and illness, he explained. However, my main goal, before I choose any supplement, is to try to understand the inflammatory cause of the disease process. I then implement a four-step process that requires different supplements at different times coupled with some supplements all of the time. Patients typically end up with five to six supplements when it is all finished. Niacin is key to Dr. Delanys program. I use niacin to strategically raise the beneficial large subfraction of HDL, to lower triglycerides, and to shift small dense LDL to large LDL. I recommend starting with 500 mg and then increasing by the same amount after three weeks. Most patients take 1,000 to 1,500 mg, usually with a snack like an apple in the evening to help further reduce the possibility of an uncomfortable niacin flush. An aspirin a half-hour before the niacin can also help reduce any possible flushing. Its a good idea to check liver function from time to time if you routinely take higher doses of niacin, since the vitamin is known to elevate liver enzymes and stress the liver in some people. The Sinatra Spin: Dr. Delany gets to the real point of the cholesterol theory, and that is to effectively use the influence of a nutrient, in this case niacin, to help reshape LDL cholesterol particles from a more potentially invasive and inflammatory form to a larger, more fluffy form. Just be sure, as he suggests, to check your liver function periodically.

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Fighting Heart DiseaseOne Recipe at a Time

rganic, free-range chicken is packed with quality protein to help keep your strength up and your hunger down, both of which are key to staying fit and lean. And tucked inside the chicken breasts featured in this delicious recipe is one of my favorite Super Foods: spinach. (You can go to drsinatra. com for a complete list of Sinatras Super Foods.) This leafy green nutritional powerhouse is an excellent source of bone-building and blood pressurelowering calcium. Its also brimming with the important antioxidants vitamin C and vitamin E, which reduce the oxidative stress in your body and benefit the cardiovascular and pulmonary systems. So make this satiating chicken/spinach combo regularly to benefit your waistline, muscles, bones, lungsand your heart.
Parmesan Chicken Breasts Stuffed with Spinach Two 4-oz. chicken breasts 2 Tbsp. extra-virgin olive oil 1/2 cup grated or julienned carrots 1 cup spinach, thawed or fresh 1 tsp. dried or fresh basil leaves, chopped, to taste 4 Tbsp. grated Parmesan or Romano cheese Black pepper to taste

Cardiologist

in the

Kitchen

Preheat the oven to 400 degrees. Slice the chicken breasts halfway through the center lengthwise, forming a pocket. Heat the oil in a skillet over medium-low heat. Stir in the carrots and heat until softened, about 5 minutes. Add the spinach and basil. Cook about 3 minutes, or until wilted. Remove from heat. Add the cheese and stir to combine. Divide the mixture and stuff into the chicken pockets. Soak toothpicks in water or oil and use them to secure the chicken pockets. Lightly brush the top of the chicken with oil and sprinkle liberally with pepper. Bake for about 20 minutes, or until the chicken juices run clear. Remove toothpicks and serve. Makes 2 servings. Nutrition Facts (per serving): Calories 360, Fat 21 g, Sodium 268 mg, Carbs 4 g, Fiber 3 g, Protein 40g For more heart-healthy recipes go to drsinatra.com.

For more heart-healthy recipes go to drsinatra.com Nutrient Science Grape

ack in the 1990s I became quite enthusiastic about grape seed extract and have recommended it and used it myself ever since. As I first learned from the research literature and then confirmed in my cardiology practice, grape seed extract can definitely help lower blood pressure. Grape seed extract has a high concentration of proanthocyanidin, a plant-based compound with substantial antioxidant potency. So it helps protect the sensitive endothelial lining of the arteries against oxidative stress. And research has also shown that grape seed extract increases the nitric oxide level that relaxes vascular tissue and helps facilitate blood flow and maintain healthy blood pressure. In addition to all these impressive findings, grape seed extract can be much less expensive than another highly touted proanthocyanidin product, pycnogenol. Both are definitely stars in this antioxidant class, but Ive more often opted for grape seed extract since it was more affordable for my patients. I often used grape seed extract with garlic and
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Seed Extract

hawthorn berry, a combination that worked well to frequently drop blood pressure as much as 5 to 10 points. And I recently found a new source of grape seed, extracted from white varietal and other grapes, that has been found to have a particularly potent antioxidant effect and reduce blood pressure in patients with prediabetic metabolic syndrome. In27subjects, this proprietary extract reduced systolic blood pressure by 11 points on average and diastolic by 6 points after four weeks. I am constantly combing the nutritional research in order to update and upgrade the nutritional supplements I formulate. So the new evidence about the advanced grape seed extract led me to include it in my new and improved Advanced BP Support formulamaking a good product even better.
References
Sivaprakasapillai B, et al. Effect of grape seed extract on blood pressure in subjects with the metabolic syndrome. Metabolism. 2009;58(12):17431746. Lu B, et al. Effect of a grape seed extract in subjects with pre-hypertension. 13th World Congress on Heart Disease. Vancouver, B.C., Canada, July 2831, 2007. Fitzpatrick DF, et al. Isolation and characterization of endothelium-dependent vasorelaxing compounds from grape seeds. J Agric Food Chem. 2000;48(12):63846390.

Sinatras Super Foods: Blueberries

elieve it or not, beautiful blueberries are beneficial for your blood pressure, your brain, and your baby blues! And all of these health-enhancing effects appear to stem from the berries high flavonoid content and powerful antioxidant properties. In particular, blueberries are extraordinarily rich in anthocyanins, which are flavonoid pigments that provide color to many fruits and vegetables and have been shown to reduce the risk of cardiovascular disease. In one study, British researchers found that those with the highest intake of anthocyanins (predominantly from blueberries and strawberries) had an 8 percent lower blood pressure than those with the lowest intake. Researchers think that the anthocyanins protect against high blood pressure by promoting the release of nitric oxide, the chemical in arterial walls that keeps the blood vessels relaxed and dilated. Those blood pressurefriendly flavonoids also appear to protect your aging eyes and brain. At one anti-aging conference I attended, a research ophthalmologist proclaimed that, when it comes to protecting your retina, blueberry pigments have even more antioxidant potential than the more common resourcemarigold flower (lutein)used

to prevent macular degeneration. And other research on aging rats showed that those consuming blueberries in their feed had a lower rate of memory decline. The blueberry diet also reversed memory loss. It was speculated that the flavonoids in the blueberries probably helped brain cells communicate better.

Blueberry Basics
Eating blueberries several times a week is simple to do, since you can work them into just about any meal. Take breakfast, for instance. Try a morning shake of blueberries with organic yogurt and crushed flax. Throw a heaping handful of blueberries into your cereal bowl. Eat them alongside your omelet. Or include them in your waffles or pancakes as in the recipe below. Organic wild blueberries are best because they are cultivated without toxic chemicals, so try to get them whenever you can. And dont discount dried blueberries in a pinchespecially for a snack. Dried fruit, in general, is an excellent source of fiber, minerals, antioxidants, and complex carbohydrates.

Buckwheat Blueberry Pancakes 1 cup buckwheat flour 2 cups soy milk or water 1 cup other whole-grain flour 2 egg whites 1 tsp. baking powder 1 Tbsp. light olive oil

1 Tbsp. honey cup blueberries

Stir the dry ingredients together. Add the soy milk, egg whites, oil, and honey. Mix briefly. Add the blueberries and stir gently. Cook on a hot griddle, lightly oiled with olive oil. Makes 14 servings Nutrition Facts (per serving): Calories 90, Total Fat 2 g, Sodium 30 mg, Carbs 14 g, Fiber 2 g, Protein 4 g

For more Sinatras Super Foods go to drsinatra.com

Heart Beat: Whats Good, Whats Not,

Cut Down on Meatand HeartHealth Risks
Epidemiological studies indicate that a meat-heavy diet, and particularly red meat, raises your risk of coronary heart disease, stroke, colorectal cancer, and diabetes. Researchers from Harvard have now published an analysis of two health databases with more than 110,000 men and women showing that

in

Cardiology

red meat actually increases the risk of dying from cardiovascular causes by 16 percent and cancer by 10 percent. The analysis, published in the Archives of Internal Medicine, found that nearly one in 10 deaths in men and one in 7.6 deaths in women could be prevented if people ate fewer than 0.5 servings of red meat per day. The researchers estimated that substitutions of
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one serving a day of other foods, including fish, poultry, nuts, legumes, low-fat dairy, and whole grains, for one daily serving of red meat could reduce the mortality rate anywhere from 7 to 19 percent. I follow the 80/20 diet rule where only 20 percent of the diet is from animal sources, including fish, chicken, lamb, and even buffalo. The best diets in the world, eaten in Asia and the Mediterranean, simply dont include big chunks of meat.
Reference
Pan A, et al. Red meat consumption and mortality: results from 2 prospective cohort studies. Arch Intern Med.2012;172(7):555563.

The cause of gout is an overload of uric acid that leads to the deposition of crystals in the joints and other tissues. Contemporary research says the problem is often related to a genetic inability to properly process uric acid, a breakdown product of purines, compounds found in many foods, most notably red meat, game meats (pheasant, rabbit, venison), seafoods like shellfish, anchovies, herring, and sardines, mushrooms, asparagus, soy, and yeastcontaining foods and beer. The reason I bring all of this up is that for decades, high uric acid has also been associated with an increased incidence of cardiovascular disease, and recently several studies presented at the European Society of Hypertension in London further incriminated uric acids involvement with hypertension, diabetes, and other cardiovascular risk factors. One of the studies, based on an analysis of a large Israeli database of more than 100,000 individuals, suggests that even a so-called normal level of uric acid poses an almost twofold risk of diabetes and kidney disease over a decade of follow-up compared to a low level. A normal level is considered to be 3.1 to 6.8 mg/dL and low is less than 3. Another study, this one from Japan, linked a uric acid level over 8 to hypertrophy, which is a thickening of the left ventricular section of the heart muscle, and a significant symptom of weakening cardiac function. Other studies reported an elevated uric acid level was associated with metabolic syndrome as well as arterial stiffness and fatty deposits in the carotid arteries. These reports suggest to me that elevated uric acid may be related to dysfunctional metabolism of adenosine triphosphate, the basic cellular fuel in the body. I strongly recommend that you have your doctor pay attention to your uric acid level the next time you get a blood test. While it is part of regular blood tests, doctors may not pay much attention to it if it shows up in the normal range. The normal range could mean youre off the hook for gout but may still be at an increased risk for cardiovascular problems.
References
Culleton BF, et al. Serum uric acid and risk for cardiovascular disease and death: the Framingham Heart Study. Ann Intern Med. 1999;131(1):713. Leiba A, et al. Healthy subjects with low uric acid levels followed up for 10 years, have a decreased incidence of diabetes and hypertension. J Hypertens. 2012. [Epub ahead of print.] Yoshimura A, et al. Serum uric acid is strongly associated with the left ventricular mass index in the general population. J Hypertens. 2012. [Epub ahead of print.] Papavasileiou MV, et al. Uric acid blood levels and relationship with components of metabolic syndrome of hypertensive patients. J Hypertens. 2012. [Epub ahead of print.]

Another Reason to Take Magnesium

As you know, magnesium is one of my awesome foursome supplements, which are so vital for enhancing cellular energy production. Thus, a recent review on magnesium in the European Journal of Clinical Nutrition caught my attention. It was conducted by British medical statisticians who combed through previous published studies to assess how much of an effect magnesium supplementation exerts on lowering blood pressure. Based on 22 trials involving 1,173 subjects with 3 to 24 weeks of follow-up, they found a small, but clinically significant average drop of 3 to 4 mmHg systolic and 2 to 3 mmHg diastolic. Magnesium dosage in these studies ranged from 120 to 973 mg (mean dose 410 mg), with the largest reductions in blood pressure generated by an intake over 370 mg a day. One of the explanations for this effect is that magnesium protects the sensitive endothelial linings of blood vessels and acts like a vasodilator, which is important for relaxed arterial function. Magnesium is one of my must-take supplements. It contributes to hundreds of enzymatic reactions in the body and promotes healthy bowel movements. I generally recommend 200 to 400 mg daily. Just be cautious with magnesium if you have kidney disease, which can impair the bodys ability to clear magnesium from the body.
Reference
Kass L, et al. Effect of magnesium supplementation on blood pressure: a metaanalysis. Eur J Clin Nutr. 2012;66(4):411418.

Check Your Uric Acid Level

Youve no doubt heard the term gout in reference to a hot, tender, and painful big toe. Although this arthritic-like condition most commonly affects the base of the big toe, it can also involve the ankle, knee, wrist, finger, and elbow joints.
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Carotid StentingA Safe Option

The carotid arteries in the neck are the critical channels through which blood flows up into the brain. A stroke can occur when they become significantly blocked. For decades, vascular surgeons have cleaned up blocked carotids with surgical carotid endarterectomies. They open the affected vessel, scrape the lining to remove plaque and debris, and sometimes put in a graft. Carotid artery stenting is an alternative to endarterectomies. In this procedure, a stent (a small wire mesh tube) is maneuvered into the carotid artery via a catheter inserted through an incision in the groin. When the site is reached, a balloon is inflated to widen the artery, then the stent is laid in place to keep the artery open. In a yet-to-be-published study, researchers at Thomas Jefferson University Hospital in Philadelphia, along with investigators from several other medical centers, found that carotid artery stenting is safe and effective for patients over 70. There is an increased risk of stroke and heart attack with age, they said, but the overall risk remains extremely low at 6 percent, even in those over 85. Their conclusion was based on a review of 5,000 high-risk patients who had undergone stenting. The researchers said they were encouraged by their findings. Iam as well. Both endarterectomies and stenting are potentially life-saving procedures. The results here add to the confidence with which surgeons can pursue these options for patients at risk.
Reference
www.jeffersonhospital.org/News/2012/March/carotidartery-stenting-found-to-be-safe-in-the-elderly.aspx. Accessed June 8, 2012.

Dr. Sinatras
have written about the power of positive thinking for years because Ive long subscribed to the theory that our emotions have a profound impact on our health. Thats why I recently blogged about a study that confirmed my heartfelt belief: I wasnt surprised to read new findings from a team of Harvard researchers who found that optimism and joy can protect your heart actually lowering the risk of strokes and heart attacks. In this study, the researchers reviewed the outcomes of more than 200 previous studies. What they found is that in those studies, people with the most optimistic attitudes had a 50% reduced risk of having a cardiac event than those who were less optimistic.

Healthy Heart Blog

things you are most grateful for and internalize how each makes your life better.

Reframe your frustrations. Whenever things dont go your way, reevaluate the situation in a light that casts it in a positive perspective. For instance, if you step on the scale only to find out that your diet has not produced any weight loss, reframe your thoughts to focus on the fact that you did not gain any weight. Remember a happier time. When you feel your pulse begin to rise in the face of a stressor, shortcircuit the stress response by concentrating on a past moment of intense joy, like the birth of a child, an engagement or marriage, or being recognized for an accomplishment. Focus only on what you can change. Dont encourage pessimism by wrestling with problems that are beyond your control or that you cant change in any constructive way. Instead, focus your positive energy on issues that you can actually do something about.

Additional Thoughts
To harness the healing power of optimism and cultivate a happier, healthier attitude, I suggest the following strategies:

Begin the day grateful. When you first get up, perhaps as you take your morning walk, make a mental list of some of the

Join the Conversation

You and your fellow readers are a never-ending source of inspiration to me and to each other. I encourage you to read more of my blogs, ask me a question, or post your thoughts at drsinatra.com.
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Dr. Stephen Sinatras

P.O. Box 3264 Lancaster, PA 17604-9915
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Heres your July issue!

Volume 18, Number 7

Q & A Session
Keep those questions coming! Send an email to feedback@drsinatra.com, or write to me at Dr.Sinatra Feedback, P.O. Box 3264, Lancaster, PA 17604-9915.

Inside this issue:

Dear Reader: Managing

Triglycerides Is a Must. . . 1
Tips From the Top. . . . . . . 2 Cardiologist in the

Diuretics for High Blood Pressure

My doctor wants to prescribe a diuretic for me to help lower my blood pressure. I am a 70-year-old woman. Are diuretics a good option? Dr. Sinatra replies: In my newsletter series on cardiology drugs last year, I dedicated a whole article to diuretics (August 2011). I am very wary of diuretics, particularly for long-term use, because they can deplete the body of many key minerals, such as potassium, magnesium, calcium, and zinc, along with the fluid loss that is promoted. Its kind of like throwing the baby out with the bath water. High blood pressure is a significant heart-health risk factor for both men and women. A diuretic may help in the short term. You could ask your doctor specifically about thiazide diuretics, which may decrease the risk of hip fracture. If you do start on a diuretic, be sure to take a good multinutrient supplement as well to help offset any possible loss of key nutrients. It is also possible, however, that by supplementing with the awesome foursome (CoQ10, L-carnitine, magnesium, and D-ribose) and omega-3 fatty acids, you may be able to bypass the need for a diuretic at all. Talk to your doctor to see if your situation allows you to try these natural options.

Kitchen: Parmesan Chicken Breasts Stuffed with Spinach . . . . . . . . . . . . . . . . . 4

Nutrient ScienceGrape

Seed Extract. . . . . . . . . . . . . 4
Sinatras Super Foods:

Blueberries. . . . . . . . . . . . . . 5
Heart Beat: Cut Down

on Meat; Magnificent Magnesium; Uric Acid Levels; Carotid Stenting. . 5

Dr. Sinatras Healthy Heart

Blog: The Healing Power of Positive Thinking. . . . . . . . 7

reat the patient, not the X-ray.

James M. Hunter

See more Q & As online at drsinatra.com in the Q & A Archive.

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