By Jack Challem
Copyright © 1997 by Jack Challem, The Nutrition Reporter™.
All rights reserved.
Imagine the unimaginable.
You're having a heart attack or stroke, or you're being wheeled into the operating room for heart surgery. You fear that you're about to meet your maker - but you don't want to. At least, not yet.
If you've been taking vitamin supplements, or if your doctor has been smart enough to recommend them, you're more likely to survive.
The message here is simple: it's never too late to start taking your vitamins.
Heart Patients Low on Vitamins
Many vitamins, of course, are well documented for their ability to prevent heart disease. For example, last year a team of British researchers reported in the journal Lancet that natural vitamin E supplements reduced the incidence of heart attacks among high-risk patients by 77 percent.1
But not everyone takes vitamins. Or enough of them. In fact, a recent study conducted at a major hospital in Manchester, England, found that patients scheduled for coronary bypass surgery had abnormally low levels of vitamins E and C, beta-carotene, and glutathione.2 Low intake of these nutrients undoubtedly increased the patients' risk of heart disease. In the operating room, such deficiencies will increase the risk of surgical complications and death.
Recognizing the dismal state of their patients' nutrition, some doctors have begun using vitamins to minimize post-operative complications and reduce the risk of death from heart surgery. On average, 3 percent of coronary bypass patients die during or immediately after heart procedures, but the percentage is much higher at some hospitals.
Vitamins help improve the outcome of heart surgery for many of the same reasons they help prevent heart disease: they essential for the normal functioning of the body. Some vitamins, called antioxidants, control the production of free radicals, harmful molecules that oxidize and damage cells.
Ischemia-Reperfusion Injury
Especially large numbers of dangerous free radicals are generated during a sequence of events, called ischemia-reperfusion, which occurs during a heart attack or stroke.
Ischemia describes a serious decrease or interruption in blood flow, which prevents oxygen-rich blood from reaching heart cells. One consequence is the increased production of free radicals, which rapidly deplete antioxidants and interfere with the ability of the heart to continue beating.
To survive, blood flow must be restored, or reperfused. Ironically, the rush of oxygen-rich blood to heart cells creates still more free radicals, which depress heart function (a phenomenon called myocardial stunning) or by triggering erratic heart beats (arrhythmias).
The same ischemia-reperfusion process - and resultant free-radical damage - also occurs during coronary artery bypass surgery, angioplasty, and heart and other organ transplants. The free radicals can overwhelm the body's natural antioxidant defenses, especially if a patient already happens to be short on vitamins.
In a recent issue of the journal Transplantation, Hans-Anton Lehr, M.D., of Johannes Gutenberg University, Germany, described the rationale for using antioxidant vitamins before and after organ transplants, which may very well generate more free radicals than any other surgical procedure. "While ischemia temporarily deprives the organ of oxygen...and prevents the removal of harmful metabolic by-products," he explained, "reperfusion of oxygenated blood initiates a complex series of events that have the potential to exacerbate the ischemic tissue damage."
But, added Lehr, "boosting the antioxidant defense system by pretreatment with antioxidants...significantly attenuated ischemia/reperfusion injury in transplanted organs, resulting in extended graft and host survival."3
Vitamins Reduce Surgical Risk
Several antioxidant vitamins and other micronutrients reduce ischemia-reperfusion injury. If you or someone you know is scheduled for heart surgery, these nutrients can improve your chances of having a successful surgery. Ask your doctor to look at the research.
Vitamin E. Several years ago, doctors at Harefield Hospital, England, reported that free radical levels increased and vitamin E levels in the heart dropped within five minutes of surgical reperfusion. Patients with higher baseline, or initial, vitamin E levels were less likely to suffer free-radical injury to heart cells.
Another study found that vitamin E supplements improved the success of balloon angioplasty. During this surgery-like procedure, doctors insert a spaghetti-thin tube, called a catheter, into blocked arteries. Once in place, they inflate a tiny balloon at the end of the catheter, which widens the diameter of the blood vessel.
However, as many as half of all balloon angioplasties fail within a few months because of restenosis, or reclogging of the arteries. When Samuel J. DeMaio, M.D., of the Emory University School of Medicine, Atlanta, gave 1,200 IU of vitamin E daily to angioplasty patients, only 35 percent of them subsequently developed restenosis. By comparison, 50 percent of DeMaio's angioplasty patients not getting vitamin E developed restenosis.4
Coenzyme Q10. This vitamin-like nutrient also reduces ischemia-reperfusion injury. It works in two ways, by stimulating natural energy production in heart cells and by quenching free radicals.
Several years ago, Massimo Chello, M.D., of the Medical School of Catanzaro, Italy, compared the recoveries of 40 bypass patients, some of whom were given 150 mg daily of CoQ10. Patients receiving CoQ10 had significantly fewer erratic heartbeats, called ventricular arrhythmias, compared with patients not given the nutrient. Patients receiving CoQ10 also needed fewer blood pressure drugs after surgery.5
In a more recent study, reported in the Journal of Cardiovascular Surgery, Chello gave 150 mg of CoQ10 or a placebo daily to patients for seven days before surgery. He found that patients getting CoQ10 had significantly lower free radical levels during the surgical clamping (which induces ischemia) and declamping (reperfusion) of arteries.6
Vitamin C. Modest amounts of vitamin C can greatly reduce the risk restenosis, according to Haruo Tomoda, M.D., and his colleagues at Tokai University, Japan. In an article published last December in the American Journal of Cardiology, Tomoda described how he began giving 500 mg of vitamin C daily to 59 patients immediately after angioplasty. Sixty other patients not given vitamin C were used as a control group for comparison.
Of the patients getting vitamin C, only 12 (or 20 percent) developed restenosis. In contrast, arteries reclogged in 22 of the patients (or 37 percent) not getting vitamin C. "The present study suggested the effectiveness of ascorbic acid in attenuating...restenosis," Tomoda wrote. "Ascorbic acid is inexpensive and without significant side effects, and thus, an increased dosage of ascorbic acid up to 1,000 mg/day starting before [the procedure] may bring better results."7
Alpha-lipoic acid. This vitamin-like nutrient holds particular promise for the treatment of ischemia-reperfusion injury in stroke, according to Lester Packer, Ph.D., a leading antioxidant researcher at the University of California, Berkeley.
"Very few neuropharmacological intervention strategies are currently available for the treatment of stroke and numerous other brain disorders involving free radical injury," he wrote in the January/February 1997 issue of Free Radical Biology & Medicine.8
Alpha-lipoic acid looks especially promising because it is a powerful antioxidant. It also can pass through the blood-brain barrier and thus protect brain cells from free radical damage. That's consistent with numerous animal studies showing that alpha-lipoic acid reduces cerebral ischemia-reperfusion injury from stroke.
Magnesium. A study of 148 patients at the Tel-Aviv Medical Center, Israel, found that intravenous magnesium and magnesium supplements greatly reduced the risk of restenosis in patients who had undergone angioplasty. Only 25 percent of patients getting magnesium developed restenosis, compared with 38 percent of those who did not receive the mineral.
"Magnesium lowers system vascular resistance, decreases platelet aggregation, improves myocardial metabolism and decreases mortality in acute myocardial infarction," wrote lead researcher Arie Roth, M.D. It is also associated with lower prevalence of cardiovascular disease and sudden death"9
Fish oils. The omega-3 fatty acids, found in salmon and "fish oil" capsules, can also reduce the risk of restenosis after balloon angioplasty. James P. Gapinski, M.D., of the Medical College of Wisconsin, Milwaukee, analyzed seven studies on the use of fish oil capsules after angioplasty. He found that the benefits of fish oil capsules were related directly to their dose, with 4 to 5 grams daily of the omega-3 fatty acids having the greatest benefits. The fish oils help because they prevent blood clots. They also retard the growth of smooth-muscle cells in the heart, which are associated with cardiovascular disease risk, according to Gapinski's article in Archives of Internal Medicine.10
Flavonoids. In a recent animal experiment, researchers found that the flavonoids found in grape seed reduced many of the complications from ischemia-reperfusion injury, including arrhythmias. The flavonoids neutralized several major types of free radicals that cause ischemia-reperfusion damage to heart cells.11
Multiple Antioxidants May Be Key
Although most of these studies focused on the use of single nutrients in preventing ischemia-reperfusion injury, there's compelling evidence that multiple vitamins and minerals can have more dramatic benefits. For example, Packer has reported that alpha-lipoic acid recycles and boosts levels of other antioxidants in the body. And Al L. Tappel, Ph.D., of the University of California, Davis, has shown that a variety of antioxidants work better than single antioxidants in neutralizing free radicals.
The use of multiple vitamins during heart surgery was recently put in practice by a team of physicians at the University of Graz, Austria. Doctors gave a combination of vitamins E, C, and A to 57 patients undergoing surgery on the carotid artery, which feeds blood to the brain. Patients receiving the vitamin combination had significantly lower levels of free radicals after reperfusion than did patients getting a placebo. Furthermore, only 13 percent of the vitamin-treated patients developed headaches after surgery, an indicator of reperfusion injury. In contrast, 67 percent of the other patients got headaches.12
Vitamins, of course, are best used preventively. However, most people don't take supplements. With more than 300,000 patients receiving coronary artery bypasses and more than 400,000 getting angioplasties each year in the United States, there's a clear need to minimize life-threatening surgical complications and death. Taking vitamins before heading into the operating room seem be a little late but, as the adage reminds us, it's better late than not at all.
1 Stephens NG, et al., Lancet, 1996;347:781-6
2 Gu M, et al., Clinica Chimica Acta, 1996;252:181-95.
3 Lehr H-A and Messmer K, Transplantation, 1996;62:1197-9.
4 DeMaio SJ, et al., Journal of the American College of Nutrition, 1992;11:68-73.
5 Chello M, et al., Annals of Thoracic Surgery, 1994;58:1427-32.
6 Chello M, et al., Journal of Cardiovascular Surgery, 1996;37:229-35.
7 Tomoda H, et al., American Journal of Cardiology, 1996;78:1284-6.
8 Packer L, et al., Free Radical Biology & Medicine, 1997;22:359-78.
9 Roth A, et al., European Heart Journal, 1994;15:1164-73.
10 Gapinski JP, Archives of Internal Medicine, 1993;153:1595-1601.
11 Facino RM, et al., Planta Medica, 1996;62:495-502.
12 Rabl H, et al., Medical Science Research, 1996;24:777-780.
13 Lelli JL, et al., Circulatory Shock, 1993;39:178-187.
This article originally appeared in Let's Live magazine. The information provided by Jack Challem and The Nutrition Reporter™ newsletter is strictly educational and not intended as medical advice. For diagnosis and treatment, consult your physician.