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An attack of angina, especially the first one, is a terrifying and life-changing experience. You’ve raced up the stairs or you’ve run to catch a train; suddenly an elephant is standing on your chest or a huge hand is squeezing your heart. Then you’re sweaty, lightheaded, and nauseated. You stop in your tracks; you wait; you pray you’re not having a heart attack. At last the elephant lifts his foot or the fist opens, the world slowly brightens, and slowly, carefully, you go home. (You really SHOULD go to an emergency room.

Angina pectoris is Latin for “pain in the chest.” It’s caused by a blockage in any of the arteries that nourish your heart. And there aren’t any home treatments for it. However, once you’ve found a reassuring cardiologist, and your angina’s been controlled with medication or surgery, lifestyle changes and a good supplement program can really make a difference. Good solid research is showing us the beneficial effects of antioxidants, herbs, the mineral magnesium, and the amino acid arginine.

Let’s see how our WholeHealth Chicago suggestions can help.

What is Angina?
Angina (or angina pectoris, to give the disorder its full medical name) is the intense crushing or squeezing chest pain that results when the heart receives an insufficient amount of blood and oxygen. Also characterized as a tightness, heaviness, or aching in the chest, the pain of angina is usually located under the breastbone and may radiate to the shoulders, neck, arms (often the left one), or jaw. Lasting anywhere from 30 seconds to 15 minutes, an attack is generally triggered by physical exertion or stress, which increases the heart’s need for oxygen, and is relieved by rest. The pain generally builds in intensity, hits a plateau, and then subsides. Angina is a primary symptom of coronary artery disease, the gradual narrowing of the arteries that supply heart muscles with oxygenated blood. Coronary artery disease develops slowly, often with no symptoms at first. In time, and especially if the disease is not controlled through lifestyle changes and medications, angina attacks may increase in frequency, intensity, or duration, or they may be triggered by less exertion. Such changes in the pattern of angina attacks may signal an impending heart attack.

The traditional treatment for angina pain is nitroglycerin, a prescription drug that helps dilate blood vessels. Cardiologists use other medications as well to reduce the work load of the heart. All angina medications treat basically the symptom, not the cause of the problem. Dietary and lifestyle changes, combined, if necessary, with drugs to lower cholesterol and blood pressure, are the keys to slowing or halting the arterial damage that causes angina. Supplements can also play a role in the treatment of angina by helping to improve arterial health and heart function.

Key Symptoms

An intense crushing or squeezing pain in the chest, generally triggered by exertion and relieved by rest. Pain may also radiate to the shoulders, arms (usually the left one), neck, and jaw.
Shortness of breath
General weakness and lightheadedness

What Causes Angina?
Angina is a result of the narrowing of the coronary arteries caused by atherosclerosis–the buildup of cholesterol-rich fatty deposits, or plaques, on the inside of arterial walls. As plaques develop, the coronary arteries thicken and narrow over time, impeding the flow of oxygenated blood to the heart muscles. During rest, the narrowed arteries may still be wide enough to supply the heart with the oxygen it requires. But when physical activity, such as running or climbing stairs, increases the heart’s need for oxygen, the narrowed arteries now fail to meet the demand, and angina results.

In some cases, angina attacks are not triggered by physical activity, but occur instead when a small blood clot forms on plaque-damaged arterial walls, temporarily blocking a coronary artery. Arterial wall spasms, possibly induced by smoking, extreme emotional stress, or exposure to cold air, may also produce angina.

High blood cholesterol is the primary cause of atherosclerosis, the medical term for the development of arterial plaque within and along the wall of the artery. Other factors that promote plaque formation include high blood pressure, smoking, obesity, lack of exercise, family history, diabetes, and stress.

Treatment and Prevention
Angina can be relieved with nitroglycerin and other nitrate drugs that help dilate blood vessels throughout the body and immediately reduce the workload of the heart. Placing a nitroglycerin tablet under the tongue at the start of an attack usually eases pain within minutes. Because the activities that trigger angina soon become predictable, a patient can also take nitroglycerin before engaging in such activities to ward off an attack.

Other medications used for angina are beta-blockers and calcium channel blockers. By separate mechanisms, each of these medications prevents angina attacks by reducing the work performed by the heart muscle. When the load is reduced, so is the heart’s oxygen requirement. These drugs also reduce high blood pressure (a cause of atherosclerosis and angina) because the rate and force that the heart pumps is lowered.

To slow, halt, or even begin to reverse the coronary artery disease that causes angina, patients need to make fundamental dietary and lifestyle changes–stop smoking, lose weight, eat a healthy diet, start exercising–and be vigilant about taking any medications prescribed to lower cholesterol and blood pressure. In addition, supplements that benefit the heart and help keep arteries in good repair can be used (in combination or singly, but always under a doctor’s supervision) to complement angina and other cardiovascular medications.

The same dietary and lifestyle changes recommended for the treatment of coronary artery disease are recommended for its prevention, along with regular monitoring of cholesterol and blood pressure levels.

Just a reminder: If you have a serious medical condition, it’s always a good idea to check with your doctor before beginning a supplement program.

How Supplements Can Help
Vitamins C and E are both antioxidants that can help prevent cell damage. Vitamin E keeps LDL (“bad”) cholesterol from oxidizing, which is the first step in the development of arterial plaque. Take vitamin C to help repair plaque-damaged arteries.

Add magnesium to your regimen to help prevent the coronary artery spasms responsible for some angina attacks.

Take one or more of the following amino acids, all of which have beneficial effects on the heart. Arginine is involved in the formation of nitric oxide, an arterial wall relaxer. Carnitine is an amino acid-like substance that improves the energy efficiency of heart muscle cells. The amino acid taurine helps regulate abnormal heart rhythm.

Consider taking as well the nutritional supplement coenzyme Q10, which helps improve heart function, and the herb hawthorn, which helps improve blood flow to the heart.

The essential fatty acids in flaxseed oil and fish oils promote arterial health and flexibility, and may help raise HDL (“good”) cholesterol and reduce blood triglyceride levels, a risk factor for heart disease. In addition, fish oils reduce the risk of developing cardiac arrhythmias, which can occur when the circulation to the heart is threatened, as is the case with angina.

Self-Care Remedies
Stop smoking immediately. Avoid smoke-filled places.

Watch what you eat. Stick with a diet that’s low in saturated fat, cholesterol, and salt, and high in fiber. Use flaxseed, canola or olive oil instead of butter. And if you drink alcohol, do it in moderation. Try to eat fish, especially an oily fish, such as salmon, mackerel, tuna, or sardines, at least two or three times a week.

If you are overweight, lose the excess pounds.

Exercise regularly. At least 30 minutes a day of aerobic exercise three times a week is the usual recommendation. If you haven’t been exercising or are over 50, check with your doctor before starting an exercise program.

Promote relaxation and relieve stress. Mind/body techniques such as meditation, tai chi, and yoga may help control angina.

When to Call a Doctor

If you experience any of the symptoms of angina for the first time
If you notice a change in the usual pattern of your angina attacks–for example, if they last longer or become more frequent or intense, or if they are triggered by less exertion or new activities
If an angina attack lasts more than 15 minutes. (You may be having a heart attack. Call an ambulance immediately.)

Supplement Recommendations

From David Edelberg, M.D. at WholeHealth Chicago: All the supplements listed here can be helpful if you have angina and want to try some nutritional supplements and herbs that have definite benefits for the heart. Just remember that although these supplements go well with any prescription drugs you’re taking, they’re not, under any circumstances, meant to replace your prescribed drugs.
By improving your nutritional and lifestyle habits and by regular use of supplements, you may find that you are taking fewer tablets of nitroglycerin. That’s fine. But your maintenance prescription drugs–namely, your nitroglycerin patch, your beta-blocker, or your calcium channel blocker–should not be tampered with.

In short, don’t stop your prescription medications without talking with your doctor about it.

How to take the supplements
In addition to a basic daily high-potency multivitamin and an antioxidant complex, you will benefit from the extra doses of vitamin C and vitamin E shown in our chart. These two antioxidants directly prevent the kind of cell damage that eventually causes angina attacks: C also helps fix arteries damaged by plaque, while E blocks the oxidation of “bad” LDL cholesterol, the precursor to plaque formation.

Taking magnesium may help prevent or minimize spasms of the coronary arteries. Magnesium has also been shown to help other conditions where a part of the body goes into spasm, including asthma (bronchial tubes), muscle cramps, and migraine headaches (blood vessels in the brain).

Amino acids are another heart-friendly substance. Arginine aids in the manufacture of nitric oxide, which helps relax arterial walls, an action similar to that of nitroglycerin. One study showed that regular use of arginine increased the amount of time people could exercise before angina forced them to stop. The amino acid carnitine benefits the heart muscle, while taurine calms abnormalities in heart rhythm.

Coenzyme Q10 also acts to strengthen the heart muscle and reduce its workload. With angina, your heart isn’t getting enough blood, and the herb hawthorn helps enhance blood flow to the heart.

Take fish oil supplements if you don’t eat fish twice a week, and add to it the dose of flaxseed oil. These essential fatty acids may help lower levels of triglycerides, the body’s main fat, which are strongly linked with heart disease; essential fatty acids also seem to keep arteries flexible.

We at WholeHealth Chicago strongly recommend that everyone take a high-potency multivitamin/mineral and well-balanced antioxidant complex every day. It may be necessary to adjust the dosages outlined below to account for your own daily vitamin regimen. All of our supplement recommendations also assume you are eating a healthful diet.

Be aware that certain cautions are associated with taking individual supplements, especially if you have other medical conditions and/or you’re taking medications. Key cautions are given in the listing below, but you need to see the WholeHealth Chicago Reference Library for a comprehensive discussion of each supplement’s cautions and drug/nutrient interactions.

For product recommendations and orders click here for the Natural Apothecary or call 773-296-6700, ext. 2001.

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The Next Lyme Academy Begins
Tuesday, October 4, 5:30-7 pm
Here’s a special invitation for patients of Dr. Kelley who are currently being treated for Lyme disease. Dr. Kelley’s new, four-week Lyme Academy starts on October 4, continuing over the following three Tuesdays.


Awakened Body, Quiet Mind
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Thursdays from 6:00-8:00pm; beginning October 20th

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