Eradicating Heart Disease

On May 4, 2002, Matthias Rath, M.D. world renowned scientist and physician gave a landmark scientific presentation at Stanford Medical School in Palo Alto, California, on the possibility to eradicate cardiovascular disease. Dr. Rath is the scientist who discovered the close connection between cardiovascular disease and the sailor’s disease scurvy: The common denominator of both health conditions is the instability of the blood vessel wall due to impaired supply of micronutrients to millions of cells of the vascular wall.10 years after Dr. Rath had first published his landmark discovery it is recognized as the key discovery towards the control of cardiovascular disease. The invitation of Stanford University for Dr. Rath reflects the fact that the world’s leading medical institutions can no longer ignore this medical breakthrough.Following is the landmark speech of Dr. Rath at Stanford University on May 4, 2002: The Scurvy – Heart Disease Connection Solution to the Puzzle of Cardiovascular Disease I would like to congratulate Stanford University for addressing the need for preventive and natural answers to the number one cause of death in the industrialized world. I will present to you the facts that atherosclerosis, heart attacks and strokes are not diseases but the direct result of long-term vitamin deficiency. And therefore they can be prevented by natural means, without pharmaceutical drugs or surgical intervention.
	Heart Disease is an early form of the sailor’s disease scurvy. In my presentation I can only focus on the most compelling evidence.
	All existing hypotheses of atherogenesis have one problem in common – they defy human logic. The theory that high cholesterol levels, oxidized LDL or bacteria damage the vascular wall would lead to the formation of atherosclerotic plaques along theentire vascular pipeline. Inevitably, peripheral vascular disease would be the primary manifestation of cardiovascular disease. This is clearly not the case.
	It doesn’t require a degree from Stanford or any other medical school – any lay person can solve the Plumber’s riddle. The arteries, veins and capillaries in our body are a pipeline that is 60,000 miles long. But this pipeline fails in 90% of the cases at one specific spot: The coronary arteries, with the length of only one billionth of the total vascular pipeline. If bad water quality – e.g. high cholesterol – would cause damage to this pipeline, it would clog everywhere, not just at one spot. Obviously, elevated cholesterol can not be the cause of coronary artery disease.
	The solution to the puzzle of cardiovascular disease, therefore, must lie in the explanation of coronary artery plaques as the predominant manifestation of cardiovascular disease.
	To solve this puzzle we need to refocus our attention away from the blood stream and its constituents towards the one and only relevant target: the stability of the vascular wall.
	As opposed to animals, the human body cannot synthesize vitamin C. Ascorbate deficiency results in two distinct morphological changes of the vascular wall: Impaired vascular stability due to decreased collagen synthesis and loss of the endothelial barrier function.
	The sailors of earlier centuries died within a few months from hemorrhagic blood loss due to lack of endogenous ascorbate synthesis combined with a vitamin deficient diet aboard. When the Indians gave those sailors tea from tree barks and other vitamin rich nutrition, blood loss was stopped and the vascular wall healed naturally.
Today, everyone gets some vitamin C and open scurvy is rare. But almost everyone suffers from chronic vitamin deficiency. Over decades, micro lesions develop in the vascular wall, especially in areas of high mechanical stress such as the coronary arteries.Just as in the sailor’s disease scurvy, so does vitamin C induce the natural repair of the blood vessel wall in cardiovascular disease leading to a halt in progression and even to natural regression of vascular lesions. In contrast to current models of atherogenesis, the Scurvy / Heart Disease Connection can answer all key questions in clinical cardiology today.
	Why do we get infarctions of the heart and not the nose or ears? The answer can be reduced to two factors: Structural impairment of the vascular wall due to vitamin deficiency combined with the mechanical stress from pulsatile blood flow in the coronary arteries. It is at this unique spot where the underlying structural impairment is exposed first.
	Why do we get arteriosclerosis, but not venosclerosis? The cholesterol and the infection theory would inevitably lead to clogging of veins and capillaries. The scurvy heart disease connection provides the only logical answer to this phenomenon.
	Why animals donÆt get heart attacks, but people do? Why do bears and other hibernators with cholesterol levels of 600 mg/dl are not extinct from an epidemic of heart attacks? The answer: Animals produce their own vitamin C in amounts between 1 gram and 20 grams each day, compared to the human body weight. These amounts of ascorbate are obviously sufficient to optimize the stability of their vascular walls û without any necessity for Statins.
	Why are all important risk factors for CVD closely connected to ascorbate deficiency, including, diabetes, hyperlipdemia, homocysteinuria and others. The common denominator of these metabolic disorders is to provide compensatory stability for the vitamin deficient vascular wall. This is also the reason, why ascorbate deficiency increases fibrinogen and thromboxane levels while decreasing endothelial derived relaxing factor (NO) and prostacyclin.
	Lets turn to key evidence for the scurvy / heart disease connection. The guinea pig, like man, cannot synthesize ascorbate endogenously. In our published research we demonstrated that, when guinea pigs are fed vitamin C only at the level of the human RDA they develop atherosclerosis. These vascular lesions are histologically indistinguishable from human atherosclerotic plaques. In contrast, the control animals receiving Vitamin C levels of one teaspoon vitamin C per day have clean arteries.
	These experiments were confirmed by Meade et al. in an ascorbate “knock out” animal model. The first manifestation in these animals was the deterioration of the vascular wall, resembling early atherosclerosis in man.
	We confirmed these results in a clinical study in patients with preexisting coronary artery deposits measured by Ultrafast Computed Tomography. Following a defined vitamin program, the progression of calcification significantly decreased and in some cases the disappearance of lesions was documented, as you can see in this X-ray CT pictures. Copies of the publication of this clinical study are available at this meeting or online.
	The scurvy heart disease connection means a paradigm shift in medicine from symptom-orientation to the only relevant preventive and therapeutic target: The stability of the vascular wall. With the discovery of the scurvy / heart disease connection, the “world of heart disease” has ceased to be a plate and has become a globe.
	Now that we have identified the true nature of cardiovascular disease, its eradication is only a question of time. Already in ten years from now the headlines of the leading newspapers may read: “WHO proclaims heart disease as eradicated / The pharmaceutical market of statins and other symptom-oriented drugs have collapsed on Wall Street / and the cardiology departments at Stanford and other Medical Schools are closing”.
On behalf of millions of patients with heart diseases I call upon Stanford University and other medical institutions to accept their responsibility and join us in the eradication of cardiovascular disease.

What Is Integrative Medicine?

Experts explore new ways to treat the mind, body, and spirit — all at the same time.

At age 68, Martha McInnis has had her share of health woes: breast cancer, high cholesterol, clogged arteries, osteoporosis, and scoliosis — curvature of the spine. Once a year she journeys from her home in Alabama to the Duke University Medical Center in North Carolina where an internist, endocrinologist, and other specialists monitor her with blood tests, X-rays, bone scans, and other tests.

But McInnis knows that she’s more than the sum of her illnesses. When her checkup ends, she heads for the Duke Center for Integrative Medicine, where she has learned about nutrition, fitness, yoga, tai chi, meditation, and other practices she says have helped her to live better. “I became an avid tai chi person,” she says. “I’m a type A personality. I knew I had to do something about my lifestyle. I had to bring myself down to a type B.”

Many Americans have never heard of integrative medicine, but this holistic movement has left its imprint on many of the nation’s hospitals, universities, and medical schools.

Treating the Whole Person

Both doctors and patients alike are bonding with the philosophy of integrative medicine and its whole-person approach — designed to treat the person, not just the disease.

IM, as it’s often called, depends on a partnership between the patient and the doctor, where the goal is to treat the mind, body, and spirit, all at the same time.

While some of the therapies used may be nonconventional, a guiding principle within integrative medicine is to use therapies that have some high-quality evidence to support them.

Conventional and Alternative Approaches

The Duke Center for Integrative Medicine is a classic model of integrative care. It combines conventional Western medicine with alternative or complementary treatments, such as herbal medicine, acupuncture, massage, biofeedback, yoga, and stress reduction techniques — all in the effort to treat the whole person. Proponents prefer the term “complementary” to emphasize that such treatments are used with mainstream medicine, not as replacements or alternatives.

Integrative medicine got a boost of greater public awareness — and funding — after a landmark 1993 study. That study showed that one in three Americans had used an alternative therapy, often under the medical radar.

In the past decade, integrative medicine centers have opened across the country. According to the American Hospital Association, the percentage of U.S. hospitals that offer complementary therapies has more than doubled in less than a decade, from 8.6% in 1998 to almost 20% in 2004. Another 24% of hospitals said they planned to add complementary therapies in the future. Patients usually pay out of pocket, although some services — such as nutritional counseling, chiropractic treatments, and biofeedback — are more likely to be reimbursed by insurance.

The Appeal of Integrative Medicine

What makes integrative medicine appealing? Advocates point to deep dissatisfaction with a health care system that often leaves doctors feeling rushed and overwhelmed and patients feeling as if they’re nothing more than diseased livers or damaged joints. Integrative medicine seems to promise more time, more attention, and a broader approach to healing — one that is not based solely on the Western biomedical model, but also draws from other cultures.

“Patients want to be considered whole human beings in the context of their world,” says Esther Sternberg, MD, a National Institutes of Health senior scientist and author of The Balance Within: The Science Connecting Health and Emotions.

The Mind-Body Connection

Sternberg, a researcher who has done groundbreaking work on interactions between the brain and the immune system, says technological breakthroughs in science during the past decade have convinced even skeptics that the mind-body connection is real.

“Physicians and academic researchers finally have the science to understand the connection between the brain and the immune system, emotions and disease,” she says. “All of that we can now finally understand in terms of sophisticated biology.”

That newfound knowledge may help doctors to see why an integrative approach is important, she says.

“It’s no longer considered fringe,” Sternberg says. “Medical students are being taught to think in an integrated way about the patient, and ultimately, that will improve the management of illness at all levels.”

The Osher Center for Integrative Medicine at the University of California, San Francisco, takes a similarly broad view of health and disease. The center, which includes a patient clinic, says on its web site: “Integrative medicine seeks to incorporate treatment options from conventional and alternative approaches, taking into account not only physical symptoms, but also psychological, social and spiritual aspects of health and illness.”

To promote integrative medicine at the national level, the Osher Center and Duke have joined with 42 other academic medical centers — including those at Harvard, Columbia, Georgetown, and the University of Pennsylvania — to form the Consortium of Academic Health Centers for Integrative Medicine.

Medical Schools and Integrative Medicine

Even medical schools have added courses on nontraditional therapies, although doing so can sometimes be a point of contention among faculty.

At the University of California, San Francisco, medical students can augment their coursework in infectious disease and immunology with electives, such as “Herbs and Dietary Supplements” or “Massage and Meditation.” They can even opt to study as exchange students at the American College of Traditional Chinese Medicine. In the world of integrative medicine, it’s not unusual to see a Western-trained MD who also has credentials in acupuncture or hypnosis, or a registered nurse who is also a yoga teacher and massage therapist.

Opposing Views

Not all doctors are jumping onboard, though. Some critics have charged that integrative medicine is driven largely by market forces, as well as public fascination and demand for alternative treatments.

“This is a very faddish country,” says Tom Delbanco, MD, a Harvard Medical School professor and doctor at Beth Israel Deaconess Medical Center in Boston. In one national survey of hospitals that offer complementary therapies, 44% listed “physician resistance” as one of the top three hurdles in implementing programs, along with “budgetary constraints” (65%) and “lack of evidence-based research” (39%).

Delbanco says he’s concerned that there’s not enough scientific evidence to justify the amount of resources spent on integrative medicine and complementary therapies. “I worry that people are making claims in the context of scientific medicine that they cannot really justify. I think there have been few rigorously controlled, scientifically sound studies in the area, and when they have been done, the vast majority have shown these medicines to be no different from placebo.”

“I have no trouble with offering hope,” he adds. “I think people need hope and optimism. Where I have trouble is when we promise things to people that aren’t real.”

Finding the Evidence

The search for solid evidence is key: which therapies help and which don’t? “There’s a clamoring for understanding the biology of this,” Sternberg says. Many proponents of integrative care say that it’s crucial to hold alternative therapies up to scientific scrutiny, rather than dismissing them outright, because doctors and patients alike need answers. For example, a patient may be taking an herb that is harmful or may interfere with prescription drugs.

As a result, researchers across the country are studying complementary and alternative therapies for safety and effectiveness. Duke is studying whether stress-reduction techniques, such as meditation and writing in a journal, can help prevent preterm labor, which can be precipitated by stress-related hormones. In other clinical trials, researchers are trying to determine, among other things, how acupuncture affects brain activity, how biofeedback can better treat incontinence, and whether the medicinal herb valerian improves sleep in patients with Parkinson’s disease.

With the large numbers of people using nontraditional therapies, even finding out what doesn’t work can be valuable. For example, researchers affiliated with the Osher Center at the University of California, San Francisco, completed a study that showed that saw palmetto did not improve benign prostate hyperplasia, a noncancerous enlargement of the prostate gland. More than 2 million men in the U.S. take saw palmetto as an alternative to drugs. The results were published in The New England Journal of Medicine.

Tracy Gaudet, MD, director of the Duke Center for Integrative Medicine, says she encounters little resistance once fellow doctors understand that integrative medicine doesn’t entail “blindly advocating for alternative approaches and rejecting conventional ones.”

“That’s not what we’re about,” she says. “There’s a lot of quackery out there and a lot of dangerous therapies. Our first priority is to guide people away from them.”

“We all want the same thing: the best care for patients,” Gaudet says.

Sex and the Mind’s Decline

All you have to do is visit a nursing home to see that Father Time is not as good to women as it might seem: Women may live longer than men, but they are more likely to face Alzheimer’s disease. If the recent report in the journal Neurology from the French medical research institute INSERM bears out, Mother Nature may have stepped in by offering up the gift of coffee to protect her daughters’ ability to think, remember, and communicate into old age. If its protective effect endures further study, coffee holds a promise of saving aging brains from the onslaught of dementia.

To be precise, over a four-year period, coffee use in excess of three cups a day in patients age 65 and older slowed down cognitive decline. People with mild cognitive impairment—a medical state halfway between normal brain functioning and Alzheimer’s disease—have memory difficulties but show none of the deterioration in reasoning, mood, movement, and consciousness that defines life-destroying dementia. Once mild cognitive impairment emerges, however, the odds of Alzheimer’s following within four years are at least 40 percent. Notably, many beat those odds, suggesting there’s a window of opportunity for stopping or slowing down the pace of mental deterioration.

Cognition can be measured with a variety of tests of verbal recall, fluency, and visual retention. Once performance scores begin to fall, decline moves fastest in older patients and in women. Coffee seems to benefit both groups. In the French study, women over 80 who drank lots of coffee showed 70 percent less cognitive decline than their peers who imbibed a cup or less daily. The reduction was a more modest 27 percent for the younger women, and absent in men.

A shield. It is not the first study to show that coffee is good for some brains. As any aficionado knows, one cup is often enough to bring on a burst of energy and mental focus. But to generate an age-defying benefit in memory or thinking, it takes regular use over many years. This may be explained in part by lab studies showing caffeine can shield certain memory-forming neurons from destruction caused by the toxic amyloid deposits, which are known to accumulate in older brains long before dementia is evident.

What has researchers scratching their heads is why at least some studies show the gender difference. In a 2002 report, performance on a battery of memory and reasoning tests among elderly residents of Rancho Bernardo, Calif., was better among women—but not men—who had the highest lifelong intake of caffeinated coffee. Some researchers surmised that men and women may metabolize coffee differently. Others, that biological sex differences in cognitive decline make women more sensitive to coffee’s protection. In the French study, men tended to have more advanced education—but they also scored higher on baseline mental testing than did the women, a fact the researchers tried to take into account. Still, the men may have been less prone to cognitive deterioration from the outset, coffee or no coffee.

This should remind us that using one’s brain is a health food in and of itself. It’s been long known that dropping out of school early is a risk factor for Alzheimer’s later in life. And there is new evidence that regardless of formal schooling, cognitive activity in older individuals exerts its own benefit on brain health, while mental sluggards are more than twice as susceptible to cognitive decline. To be sure, keeping your brain active takes more effort than sipping a Starbucks. But it has none of coffee’s side effects, like palpitations or trouble sleeping. So for those who like coffee, why not do both? Enjoy a good book and a cup of joe, or a lively kaffeeklatsch brimming with brainteasing discussion.

As for men, don’t give up. The French study continues and just may turn up positive for them, too. Not long ago, researchers from Finland, Italy, and the Netherlands reported that elderly coffee-drinking European men, when followed for a full 10 years, behaved just like women: They had less mental decline with greater coffee consumption. And three cups a day seemed to be the magic number.

So it’s quite possible that la difference will vanish with further study. After all, most other health benefits gleaned from a coffee habit—such as a lower incidence of gout, type 2 diabetes, and Parkinson’s disease—serve men and women equally. I’d suggest for now that it’s only prudent and fair to invite men to the kaffeeklatsch as well.

This story appears in the August 27, 2007 print edition of U.S. News & World Report.

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