By John R. Lee, M.D.

Editor’s Note: John R. Lee, M.D. was a preeminent research scientist who not only studied hormones, but also many other health issues. One of those issues was cardiovascular and heart health, where he used his talents to turn hard-to-understand scientific research into commonsense advice for his readers. Here are excerpts from Dr. Lee’s writings on cardiovascular health that are filled with his wisdom and guidance on the subject.

What is Cholesterol?

Cholesterol is a fat-soluble steroid synthesized from food by all animals. In humans, 80 to 85 percent of our cholesterol is synthesized from sugar and refined starches, and 15 to 20 percent is synthesized from fats. Cholesterol is a vital component of all cellular membranes, it is necessary for brain cell function, it is the precursor of all steroid hormone production, it is an efficient way to store sugar and starch calories, and it is a component of the myelin sheath that protects nerves and nerve impulse propagation.

There are many different types of cholesterol. Those that have been most closely studied are HDL cholesterol (so-called “good“ cholesterol) and LDL cholesterol (so-called “bad” cholesterol). High levels of HDL are protective against heart disease, while high levels of LDL are an indicator of heart disease. But it's not LDL cholesterol per se that's the culprit: it is what happens to it under certain conditions in your body. LDL-cholesterol is easily oxidized (chemically combined with oxygen) and that causes the artery damage that causes heart disease. This is why antioxidants such as vitamin E are so protective against heart disease, and why they are far more important than cholesterol-lowering drugs in preventing heart disease. Some experts estimate that if Americans took just 100 IU a day of vitamin E, we would save billions of dollars every year in health care costs. (I recommend 400 IU daily.)

Women's Symptoms Point to Spasms

It is oxidized LDL cholesterol that clogs the arteries and leads to a heart attack. However, only 50 percent of coronary artery disease (CAD) deaths are associated with clogged arteries, and the majority of those are men. Autopsies show that plaque-obstructed arteries in women are considerably less clogged than those of men, most often only 20 to 30 percent blockage, which is not sufficient to cause their deaths. Men, by contrast, tend to have more than 90 percent occlusion when they have a heart attack.

Chest pain is the most common symptom of heart disease and heart attack in both men and women, but women having a heart attack are more likely to complain of upper abdominal pain, difficulty breathing, nausea and fatigue. Syndrome X is a cluster of heart disease symptoms that almost exclusively affects menopausal women. The symptoms of women with Syndrome X include exertional angina (chest pain in response to exercise) and a positive response to diagnostic exercise testing, and yet they have clear coronary arteries.

Prior to menopause (surgical or otherwise) women may have what are considered to be heart disease risk factors such as high cholesterol and blood pressure, yet they rarely die of a heart attack. So how do women die of heart attacks after menopause? Perhaps we can take our clue from research done by Dr. Kent Hermsmeyer and others.

Provera Makes Arteries More Prone to Spasm

Hermsmeyer and his colleagues set out to study the effect of hormones on coronary artery spasm. They removed the ovaries from 12 rhesus monkeys to simulate menopause. Then six of the monkeys were put on estradiol (an estrogen) and natural progesterone, and six were put on estradiol and the synthetic progestin medroxyprogesterone acetate or MPA (Provera). Four weeks later the monkeys were injected with a combination of serotonin plus a platelet extract (thromboxane A2) known to stimulate coronary artery spasm. The monkeys that were on MPA and estrogen suffered from an unrelenting spasm that would have caused death had they not been injected with a drug that reversed the spasm. The monkeys that had been treated with estradiol and natural progesterone showed very little coronary artery spasm.

At London's National Heart and Lung institute, in a study led by Peter Collins, women on different combinations of hormone replacement therapy were put on a treadmill. Once again, those who were using natural progesterone with estrogen could exercise significantly longer than those who took medroxyprogesterone.

My hypothesis is that the increased risk of cardiovascular disease now associated with menopause may not be due to relatively minor cholesterol plaque or to hormone deficiency per se, but to increased risk of coronary vasospasm caused by synthetic progestins such as medroxyprogesterone acetate used in HRT. This does not ignore the effects of aging and the other factors listed in the box below, it points the finger at a dangerous drug.

There's absolutely no excuse for any doctor to prescribe Provera for HRT when we have this kind of data. HRT should include small, physiologic doses of transdermal natural progesterone, which will protect against coronary vasospasm, combined with very small amounts of estrogen, when needed.

An Anti-Spasm Mineral

A deficiency of the mineral magnesium can greatly increase the chance of a coronary vasospasm, and it is also implicated in mitral valve prolapse. Magnesium deficiency is common but generally unrecognized in the US, and yet cardiovascular survival correlates with magnesium concentrations, and higher cardiovascular disease mortality correlates with magnesium-depleting factors such as diuretic usage, diabetes, digoxin therapy, alcohol, age, congestive heart failure, diarrhea, and dietary deficiency.

A daily supplement of 300 to 400 mg of magnesium is good preventive medicine. It should be taken with no more than twice the amount of calcium for optimal absorption.

I hope this information on women and heart disease will create controversy and commentary, inspire research, and most of all, save lives.

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Other Factors in Heart Disease

Homocysteine: Homocysteine is a waste product of methionine that is normally converted into a safer compound for excretion in urine. If it isn't converted, it accumulates and contributes to heart disease. The B vitamins B6, B12, and folic acid play key roles in the conversion of homocysteine, and deficiency can cause high homocysteine levels. A good daily multivitamin will contain 50 mg of vitamin B6; 400 mcg of folic acid; and 1,000 mcg of vitamin B12.

Antioxidants: In the Nurse's Questionnaire Study and the Harvard Men's Study, those whose intake of vitamin E equaled at least 100 IU experienced 35 to 50 percent fewer heart attacks, and a more recent study from Great Britain showed as much as a 70 percent reduced risk. Vitamin E is especially effective because it is fat-soluble and thus more likely to supply oxidation protection to fatty compounds such as cholesterol. In considering the potential benefit of water-soluble vitamin and mineral antioxidants it is probably wise to include vitamin C and selenium, also. I recommend daily: 400 IU of vitamin E, 200 mcg of selenium, and at least 500 mg twice daily of vitamin C.

Oils: Many studies show the benefits of eating fish, nuts and seeds which contain heart-healthy oils, and olive oil. Avoid hydrogenated and unsaturated oils.

Veggies: People who eat more fresh fruits and vegetables, and more fiber, have less heart disease.

Alcohol: People who drink a moderate amount of alcohol have less heart disease.

Sugar and milk: Eat a minimum of sugar and refined carbohydrates, and stay away from milk after puberty.

Iron: Excess iron can promote oxidation reactions that increase the risk of heart disease. Unless you are anemic, find a multivitamin without iron.

Exercise: Moderate, enjoyable exercise greatly reduces heart disease risks.

Weight: While true obesity increases the risk of heart disease, the moderate weight gain most women experience around menopause is not harmful.

John R. Lee, M.D.

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Dr. Lee’s Recommended Nutritional Supplements to Support Your Cardiovascular Health

Here is a summary of the supplements that Dr. Lee recommended to support our cardiovascular and heart health. Where available, we include quotes from him on the amounts to take.

• Vitamin C – “…at least 500 mg twice daily”
• Vitamin E – “I recommend 400 IU daily.”
• Beta-carotene
• Magnesium – “A daily supplement of 300 to 400 mg of magnesium is good preventive medicine.”
• Selenium – “…200 mcg (daily)”
• B-Vitamins –- “A full complement (especially B-6 and folic acid)…A good daily multivitamin will contain 50 mg of vitamin B6; 400 mcg of folic acid; and 1,000 mcg of vitamin B12”
• Bioflavonoids – “Bioflavonoids such as quercetin, green tea and rutin, for example, enhance the action of the major antioxidant vitamins and have an antioxidant effect of their own.”
• Co-enzyme Q10 – “…also protects and strengthens the heart.”
• Bioidentical Progesterone Cream – For women who are deficient in this vital hormone.
  
  

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Now that you know the supplements Dr. Lee recommended for heart health, here’s a great way to buy them and save money on every order. If you live in the United States or have a U.S. address where you receive packages, we welcome you to visit The JohnLeeMD.com Product Shop. We have joined forces with Fullscript to create this online shop where you can buy all of the healthy heart supplements listed above, multiple bioidentical progesterone creams, and more than 20,000 other natural health products at a 20% discount from retail MSRP prices.

If you have not visited The JohnLeeMD.com Product Shop yet, we invite you to visit now and become a member. To enter the shop for the first time, please enter your email address and click on the “Submit” button. You will then be taken to a page where you will enter your first name, last name, and a password for your account. Once you have done this, click on the “Sign Up” button and you will be registered as a customer. Click here to sign up.

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