New Book by Julian Whitaker Dishes Out a Recipe for Recovery

The following excerpt is a condensed reprint from Dr. Julian Whitaker, MD’s new breakthrough book, Reversing Heart Disease: A Vital New Program to Help Prevent, Treat, and Eliminate Cardiac Problems Without Surgery. Published by Warner Books, paperback, 03-2002, 492 pages. ISBN: 0446676578

Many therapies, in one way or another, increase oxygen delivery to the heart and arteries. However, there is also a dark side to oxygen. While oxygen is required for the production of energy that keeps us alive, it is also a primary source of free radicals in our bodies. Free radicals are unstable molecules that damage other molecules by stealing electrons, creating a chain reaction of destruction.

Free radicals are perpetrators of heart disease for two reasons. First, they damage the arteries, setting the stage for atherosclerosis. Second, they transform LDL cholesterol into its oxidized form, which burrows into artery walls and contributes to plaque build-up. While it is important to lower your LDL cholesterol levels, you can see that it is equally important to protect LDL from oxidation.

Nature has an ingenious system to counter oxidation: antioxidants. Antioxidants give up electrons to reactive free radicals, stabilizing them and preventing them from disrupting other molecules. High levels of antioxidants in the blood have been shown to be protective against atherosclerosis, while low levels, as you might expect, are associated with increased risk of heart disease. A 2001 study published in The Lancet found that blood levels of vitamin C were inversely related to death from heart disease — men and women with the lowest levels of this important antioxidant were twice as likely to die of heart disease as those with the highest levels.

German researchers came up with similar findings for vitamin E and beta-carotene: blood levels of these antioxidants were low in people with atherosclerosis. They concluded that measuring levels of antioxidants may be a valuable way of assessing risk of heart disease.

Your body produces antioxidants, and you also get them in your diet (provided that you eat lots of fruits and vegetables). However, the best way to ensure optimal levels of these crucial nutrients is to take supplements of the major antioxidant vitamins and minerals: vitamin E, vitamin C, vitamin A, beta-carotene, and selenium.

Researchers at the Centers for Disease Control and Prevention (CDC) in Atlanta, Georgia, recently concluded a seven-year study that included an astounding number of subjects — more than one million people — and compared death rates of those who took various combinations of multivitamin and mineral supplements. They found that individuals who took a multinutrient plus vitamin A, C, or E had a 15 percent lower risk of death from heart attack or stroke than people who did not take vitamins. Interestingly, people who took a multivitamin alone (most likely a one-a-day supplement with RDA doses) were not afforded protection. This supports my contention, that the RDAs for important nutrients are just too low.


Vitamin E is the most active antioxidant in the lipid or fatty portions of the body. It guards against the oxidation of LDL cholesterol by hitching onto LDL particles and neutralizing free radicals. Vitamin E is also highly protective of the endothelial lining of the arteries.

Vitamin E has other protective mechanisms. It improves cholesterol levels, lower levels of C-reactive protein and other inflammatory markers, and has a slight blood-thinning effect, enhancing circulation and preventing abnormal blood clots. This broad spectrum of actions is likely why vitamin E has proven so effective in protecting against heart disease.

Vitamin E also improves symptoms in patients with established cardiovascular disease. Japanese researchers found that one month of daily supplementation with 300 milligrams of vitamin E reduced angina in heart patients. They attributed this effect to the vitamin’s ability to improve endothelial function, relax the arteries, and prevent spasms that reduce blood flow. According to a 16-year study by Swedish physician Knut Haeger, MD, supplementation with vitamin E resulted in slow but significant improvements in pain and ability to exercise.


Just as vitamin E is the premier antioxidant in the lipid portions of the body, vitamin C is the most active in the aqueous, or water-based, components. Although this vitamin is best known as an immune booster and therapy for the common cold, it is also highly protective against atherosclerosis.

Higher intakes of vitamin C are associated with reductions in risk of death from heart disease in humans as well. Vitamin C’s dominant action against atherosclerosis is to protect the integrity of the arteries. It blocks free-radical damage to the endothelium and promotes healing of injuries that initiate atherosclerosis. It is also crucial for the production of collagen, an important structural material in the blood vessels and other tissues. Boosting the health of the arteries not only staves off atherosclerosis but also helps normalize blood pressure by making the arteries more responsive to signals to dilate and relax.

Vitamin C also has a role in protecting LDL cholesterol from oxidation. It is the third-string antioxidant in this particular play — if vitamin E and beta-carotene and other carotenoid stores are consumed, vitamin C comes to the rescue. Furthermore, it regenerates the oxidized vitamin E, refueling it so it can get back in the game. Other activities of this crucial antioxidant include improving blood flow by inhibiting platelet aggregation, lowering lipoprotein(a), and elevating HDL cholesterol.


Although vitamins C and E are the most active of the antioxidants in protecting the cardiovascular system, they are by no means the only ones we recommend for patients with heart disease. Vitamin A, beta-carotene and other carotenoids, and the mineral selenium each have powerful antioxidant and cardio-protective activities of their own. Coenzyme Q10 is one of the most powerful antioxidants of all, and perhaps the most therapeutic for the heart.

When vitamin E takes a hit from a free radical and stops the chain reaction of oxidative damage, it is oxidized and must be regenerated by another antioxidant such as vitamin C. Other antioxidants, such as glutathione, coenzyme Q10, and lipoic acid, can also perform this function, which is why I recommend taking a broad array of antioxidants.

My suggested doses include 5,000 international units of vitamin A and 15,000 international units of natural beta-carotene, preferably with mixed carotenoids. These two nutrients protect the arterial walls and inhibit the oxidation of cholesterol. Also make sure you take 200 micrograms of the trace mineral selenium, which has independent antioxidant activity and is required for the production of the antioxidant enzyme glutathione. The best-absorbed form of this mineral is high-yeast selenium.


Dietary changes will go a long way toward lowering cholesterol and triglyceride levels while maintaining protective HDL. Cutting out saturated fat and adding more dietary fiber — particularly in the form of oatmeal, soy and other beans, and flaxseed — takes a big bite out of cholesterol. Many of our patients have seen remarkable drops in cholesterol by adding one-quarter cup of freshly ground flaxseed to their daily diet. And eliminating white flour, sugar, and other high glycemic carbohydrates from the diet is an excellent therapy for lowering triglycerides. In addition to dietary measures, the following nutritional supplements stand out for their positive effects on blood fats.


Fish oil is one of our most potent therapies for heart disease. Research has linked consumption of fish, particularly fatty fish, with decreased risk of heart disease. These important fats cannot be produced in the body, so it is imperative that you get them from dietary or supplemental sources. Nature’s most abundant sources of omega-3s are algae, fatty cold-water fish, and marine mammals like seals and whales. Because these are not common foods on most of our dinner plates, many Americans are deficient in these important fatty acids.

While eating omega-3-rich fatty fish several times a week is highly protective against heart disease, few people do it, and experts estimate that as many as 80 percent of Americans do not get adequate essential fatty acids in their diet. So in addition to eating fish, I recommend that all my patients supplement with two 1,000 milligram fish oil capsules daily. I double, triple, or even quadruple this dose for patients with extremely elevated triglycerides.

The only other abundant source of the omega-3 fatty acids is flaxseed oil, which contains alpha-linolenic acid (ALA). ALA must be converted in the body before it is put to use. In most healthy people, this conversion is seamless; in those who are ill, however, it may be compromised. The fact that fish oil contains fatty acids in a form that is immediately useful to the body makes it my preferred source of the omega-3 fatty acids for the treatment of heart disease. Flaxseed oil, however, is a reasonable substitute — and freshly ground flaxseed has benefits of its own, particularly in lowering cholesterol. When you are taking fish oil, flaxseed oil, or any polyunsaturated oil, it is imperative that you also take potent doses of antioxidants, for these fragile oils are prone to oxidation. Vitamin E, in particular, will protect them from the ravages of free radicals.


Niacin has been around a long time as a cholesterol-lowering agent. This B-complex vitamin is listed in the Physicians’ Desk Reference as a therapy for high cholesterol levels. Niacin lowers not only LD cholesterol, but also triglycerides, lipoprotein(a), and fibrinogen, and it raises levels of protective HDL cholesterol. In fact, this neglected nutrient has been tested against several classes of newer and more dangerous cholesterol-lowering drugs and come out on top.

Many physicians are reluctant to prescribe this very effective, natural therapy because niacin, in the high doses required to lower cholesterol levels, has substantial side effects. Liver enzymes can go up, indicating chronic stress on the liver, and uric acid may rise, which can precipitate attacks of gout. Large doses may also elevate blood sugar, making it inappropriate for diabetics.

Furthermore, niacin is not very well tolerated by many patients. Because it dilates the capillaries, patients often experience an uncomfortable flushing and tingling of the skin 20 to 30 minutes after niacin is taken. To get around this common side effect, some physicians recommend time-release niacin. I do not. A few studies suggest that it is even more toxic to the liver than regular niacin.

At the Whitaker Wellness Institute, we use inositol hexaniacinate, a complex of niacin and inositol. It lowers cholesterol levels as well as regular niacin but with none of niacin’s undesirable side effects. This compound has been widely used in Europe for more than four decades not only to lower blood lipids, but also to improve circulation and reduce calf pain in patients with blockages in the arteries of the legs.

High-dose niacin, regardless of the form, should be taken under the supervision of a physician, and blood levels of liver enzymes and cholesterol should be monitored every three months or so. The usual starting dose of inositol hexaniacinate s 500 milligrams three times a day for the first two weeks, taken with meals. You can then increase your dose to 1,000 milligrams, three times per day, if needed. Stay away from time-release niacin. Diabetics and people with liver damage should avoid high-dose niacin altogether.


The most promising botanicals for treating patients with elevated cholesterol are red yeast rice and policosanol. Red yeast rice is the fermented product of red yeast cultivated on rice. In 1979, researchers discovered that this traditional Chinese remedy contained monacolin K (also called mevinlin or lovastatin), a substance that inhibits the activity of an enzyme involved in the production of cholesterol. Lovastatin was subsequently synthesized and made into the first of the statin cholesterol-lowering drugs, Mevacor. Red yeast rice, like the statin drugs, lowers LDL cholesterol and triglycerides, and raises HDL, but in a safer, gentler manner. This natural supplement does not have the sledgehammer effects of the drugs — the dose of monacolin K, or lovastatin is much lower, and red yeast rice contains other compounds such as sterols, isoflavones, and fatty acids that also have a beneficial effect on cholesterol levels. The recommended dose of red yeast rice is 1,200-2,400 milligrams per day.

Policosanol, an extract of natural plant waxes from sugar cane and wheat germ, contains a compound called octacosanol, which Cuban scientists found to have exceptional effects on cholesterol levels. This supplement has other benefits for the cardiovascular system. Like Aspirin, it decreases the stickiness of platelets in the blood and has positive effects on the lining of the arteries and the function of the heart muscle. It also improves symptoms of intermittent claudication. The suggested dose is 10 mg per day, taken with the evening meal. It has no known toxicity or adverse side effects, even when taken in very high amounts.

Because both of these natural products work on the same enzyme system as statin drugs, they could theoretically also lower CoQ10 levels. Although there is no evidence to suggest that they actually do this, I would recommend you take at least 100 mg of coenzyme Q10 daily when taking red yeast rice or policosanol, just to be safe. Do not take either of these herbs if you are taking a statin drug.

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