The Cardiovascular Cure: How to Strengthen Your Self Defense Against Heart Attack and Stroke

The Cardiovascular Cure offers a groundbreaking approach to preventing heart attack and stroke by enhancing your body’s own natural defenses. Dr. John Cooke, head of Stanford Medical School’s vascular unit, has devised a powerful new method for fighting cardiovascular disease without bypass surgery or angioplasty. Drawing on his own investigations, as well as Nobel Prize-winning research from a team of American scientists, Dr. Cooke provides heart patients with a diet, supplement, and exercise program that will help them feel better in as little as two weeks. His program also works to prevent heart disease in those at risk.

In 1998, the Nobel Prize in Physiology or Medicine was awarded for the discovery of EDRF (endothelium-derived relaxing factor), a chemical produced in the lining of the blood vessels, which keeps them free of plaque. Dr. Cooke and other investigators have found that specific nutrients can enhance EDRF production and improve blood flow in people with high cholesterol, high blood pressure, diabetes, or other risk factors for heart disease.

This potentially life-saving book shows how anyone can achieve healthier blood vessels (the key to preventing heart disease). A two-week menu plan contains recipes that emphasize EDRF-enhancing foods, and there is detailed information on supplemental nutrients and vitamins that are useful in strengthening the cardiovascular system. Recipes from breakfast (Banana Date-Nut Bread; Blueberry Oat Pancakes; Pineapple Ginger or Tropical Smoothies; Pumpkin Muffins) to dinner (Moroccan Red Snapper; Chicken Wrap with Refried Beans; Soy-Glazed Salmon; Turkey Meatloaf) feature healthy fats found in fish, nuts, and olive oil. There is also welcome news that red wine and chocolate can be good for you (there are recipes for Double Chocolate Cake and Chocolate Raspberry Surprise).

The exercise program consists of the same therapeutic plans Dr. Cooke has prescribed for even his most severely ill patients, many of whom begin to walk and even exercise more vigorously without pain after two weeks. In addition, there are aerobic workouts designed for more active patients. Dr. Cooke also provides state-of-the-art information (pro and con) on conventional drugs–from aspirin to beta blockers–and medical tests and procedures to further combat cardiovascular disease.

With an introduction by Sir John Vane, a Nobel Prize-winning cardiovascular scientist, this book will provide anyone concerned about his or her cardiovascular health with new hope for a pain-free, disease-free life.

“In The Cardiovascular Cure, Dr. Cooke has translated the research of our field into life-saving information that we can all use. If you really care about your cardiovascular health, you must read this book!”
--Louis J. Ignarro, Ph.D., 1998 Nobel Laureate in Physiology or Medicine for the discovery of Nitric Oxide

“This authoritative book appropriately points out why everyone should worry about the health of their endothelium and, better still, do something to protect it if it shows signs of damage. Early identification and treatment of reduced nitric oxide release should be the preventive agenda for the new millenium.”
--Jay N. Cohn, M.D., Professor of Medicine, University of Minnesota Medical School

“This book should be read by all patients with heart disease as well as anyone at increased risk for a heart attack or stroke. The comprehensive risk reduction program recommended by Dr. Cooke uses the most advanced research to help everyone improve the health of their blood vessels.”
--William L. Haskell, Ph.D., Stanford Center for Research in Disease Prevention

“The Cardiovascular Cure is a lucidly written description of EDRF and endothelial dysfunction. Treatment with exercise and a diet rich in arginine, vitamins, and anti-oxidants is important to the many patients prone to develop heart attacks or stroke.”
--Dr. Ferid Murad, M.D., Ph.D., Director of the Institute of Molecular Medicine at the University of Texas, 1998 Nobel Laureate in Physiology or Medicine

“Helping yourself prevent a heart attack means knowing more than your ‘cholesterol count.’ In this clearly written book, Dr. Cooke introduces you to the important role played by the endothelium (the lining of your blood vessels) in this process, and what you can do to keep this vital organ as healthy as possible.”
--Gerald Reaven, Professor of Medicine, Stanford University School of Medicine

The Cardiovascular Cure offers a groundbreaking approach to preventing heart attack and stroke by enhancing your body’s own natural defenses. Dr. John Cooke, head of Stanford Medical School’s vascular unit, has devised a powerful new method for fighting cardiovascular disease without bypass surgery or angioplasty. Drawing on his own investigations, as well as Nobel Prize-winning research from a team of American scientists, Dr. Cooke provides heart patients with a diet, supplement, and exercise program that will help them feel better in as little as two weeks. His program also works to prevent heart disease in those at risk.

In 1998, the Nobel Prize in Physiology or Medicine was awarded for the discovery of EDRF (endothelium-derived relaxing factor), a chemical produced in the lining of the blood vessels, which keeps them free of plaque. Dr. Cooke and other investigators have found that specific nutrients can enhance EDRF production and improve blood flow in people with high cholesterol, high blood pressure, diabetes, or other risk factors for heart disease.

This potentially life-saving book shows how anyone can achieve healthier blood vessels (the key to preventing heart disease). A two-week menu plan contains recipes that emphasize EDRF-enhancing foods, and there is detailed information on supplemental nutrients and vitamins that are useful in strengthening the cardiovascular system. Recipes from breakfast (Banana Date-Nut Bread; Blueberry Oat Pancakes; Pineapple Ginger or Tropical Smoothies; Pumpkin Muffins) to dinner (Moroccan Red Snapper; Chicken Wrap with Refried Beans; Soy-Glazed Salmon; Turkey Meatloaf) feature healthy fats found in fish, nuts, and olive oil. There is also welcome news that red wine and chocolate can be good for you (there are recipes for Double Chocolate Cake and Chocolate Raspberry Surprise).

The exercise program consists of the same therapeutic plans Dr. Cooke has prescribed for even his most severely ill patients, many of whom begin to walk and even exercise more vigorously without pain after two weeks. In addition, there are aerobic workouts designed for more active patients. Dr. Cooke also provides state-of-the-art information (pro and con) on conventional drugs–from aspirin to beta blockers–and medical tests and procedures to further combat cardiovascular disease.

With an introduction by Sir John Vane, a Nobel Prize-winning cardiovascular scientist, this book will provide anyone concerned about his or her cardiovascular health with new hope for a pain-free, disease-free life.

“In The Cardiovascular Cure, Dr. Cooke has translated the research of our field into life-saving information that we can all use. If you really care about your cardiovascular health, you must read this book!”
--Louis J. Ignarro, Ph.D., 1998 Nobel Laureate in Physiology or Medicine for the discovery of Nitric Oxide

“This authoritative book appropriately points out why everyone should worry about the health of their endothelium and, better still, do something to protect it if it shows signs of damage. Early identification and treatment of reduced nitric oxide release should be the preventive agenda for the new millenium.”
--Jay N. Cohn, M.D., Professor of Medicine, University of Minnesota Medical School

“This book should be read by all patients with heart disease as well as anyone at increased risk for a heart attack or stroke. The comprehensive risk reduction program recommended by Dr. Cooke uses the most advanced research to help everyone improve the health of their blood vessels.”
--William L. Haskell, Ph.D., Stanford Center for Research in Disease Prevention

“The Cardiovascular Cure is a lucidly written description of EDRF and endothelial dysfunction. Treatment with exercise and a diet rich in arginine, vitamins, and anti-oxidants is important to the many patients prone to develop heart attacks or stroke.”
--Dr. Ferid Murad, M.D., Ph.D., Director of the Institute of Molecular Medicine at the University of Texas, 1998 Nobel Laureate in Physiology or Medicine

“Helping yourself prevent a heart attack means knowing more than your ‘cholesterol count.’ In this clearly written book, Dr. Cooke introduces you to the important role played by the endothelium (the lining of your blood vessels) in this process, and what you can do to keep this vital organ as healthy as possible.”
--Gerald Reaven, Professor of Medicine, Stanford University School of Medicine

JOHN P. COOKE, M.D., Ph.D., is Associate Professor of Medicine and Director of the Section of Vascular Medicine at Stanford University’s Medical School. He trained at the Mayo Clinic, earning a Ph.D. in physiology there, and he was on the faculty of Harvard Medical School before he was recruited to Stanford to spearhead the program in Vascular Biology and Medicine. He is a sought-after consultant and has served on numerous national and international committees dealing with cardiovascular diseases, including those of the American Heart Association and the National Heart, Lung and Blood Institute. JUDITH ZIMMER has been a medical journalist for more than fifteen years. She has contributed to such publications as the New York Times, and Self and Fitness magazines, and she currently writes for academic medical centers in New York City.

Chapter 1

Your Blood Vessels and NO (and Why You Need to Know about Them)

This is a story about the health of your blood vessels. If you are like most people, you have probably given some thought to the health of your heart, but not the 100,000 miles of blood vessels that run throughout your body. Wherever blood flows in your body, it flows through blood vessels.

Blood vessels have been given short shrift mainly because people think that they are nothing more than passive pipes. But we now know that they are much more important than anyone ever realized.

Your blood vessels are dynamic, living tissue just like any other organ in your body. And just like every other organ, they perform a vital function: in this case, controlling blood flow from one moment to the next. Every 60 seconds, your vessels are responsible for distributing five quarts of life-sustaining blood to your body. Just think, five quarts every minute, 1,800 gallons every day, a virtual river of life.

Composed of living cells, blood is alive. And like all living things, blood has its own complex functions. It carries the oxygen and nutrients your tissues need to survive. It removes the waste products of cellular metabolism, distributing these to the liver or kidney where the waste products can be excreted. Blood carries hormones from the brain and other glands to distant parts of the body where these hormones are needed for the growth and function of each organ. When you cut yourself, blood has the ability to clot and stop the bleeding. And when you lose blood, your body has the ability to make new blood, replacing what's been lost. Blood carries white blood cells, your body's major defense against infection. White blood cells course through all of the blood vessels, constantly patrolling for foreign invaders. If you think about it, blood is the unifying force within the body, both a link between distant parts and an intricate system of transportation that provides fuel, disposes of waste, and carries disease-fighting cells.

And all of this happens within the blood vessels.

As the conduit, blood vessels play a role in the ability of the blood to do its job. Blood vessels can control their own diameter and control the flow of blood from one moment to the next. They can open up to increase the flow of blood to where it is needed (such as to the muscles during exercise or to the pelvis during sexual intercourse). Blood vessels can also reduce the flow of blood to an area of the body. The blood vessels to the skin constrict or shut down completely when blood must be diverted (which is why a person may become pale with fear when blood is diverted from the skin to the muscles, heart, and brain where it is needed for fight or flight). Blood vessels can do this because their walls are made of muscle, similar to that of the heart muscle. This muscle responds to nervous impulses from the brain, to changes in pressure within the vessel, and to substances made by the endothelium, the inner lining of the blood vessel.

Blood vessels are always active and constantly in motion as they respond to the rhythms of the body: the heart, the flow of blood, signals from the brain, and signals from tissues of the body that need more blood. Like so many other parts of the body, blood vessels do their job without our conscious knowledge.

The small and large blood vessels perform different roles. The smaller vessels contract to restrict blood flow and dilate to increase it. They direct the flow of blood where it is needed. On the other hand, the larger vessels do not contract or dilate very much on their own, but instead respond to the beat of the heart. They expand with each beat, much as the inner tube of a tire expands when it is filled with air. When the heart relaxes between beats, the walls of the great vessels (the aorta, which carries blood from the heart to the rest of the body, and the pulmonary artery, which carries blood to the lungs) rebound, giving the blood an extra push forward, maintaining blood flow until the heart pumps again. (When you take your pulse, you are actually measuring the wave of energy that passes through the blood from the beating heart, expanding the vessels as the wave passes through.)

It is this dance between the heart and the great vessels that makes a smooth and efficient circulation system. To do their job properly--keeping pace with the heart, expanding and rebounding--vessels need to be pliable and elastic. You want your vessels to be as resilient as possible.

The problem is that--due to many factors, such as aging, genetics, poor diet, smoking, and sedentary lifestyle--the elasticity and flexibility of your vessels can become compromised. When vessels are the opposite of pliable and elastic, they are stiff and fixed in place like a pipe. When vessels are stiff, they can't comply with the beat of the heart and the waves of life-giving energy. When the heart pumps blood into stiff arteries, the heart must work harder. It takes more energy to pump blood through stiff vessels.

Although the smaller vessels do not harden like the larger ones, they can also become damaged and function poorly. Poor diet, lack of exercise, and risk factors such as aging, high blood pressure, high blood sugar, high cholesterol, and smoking all impair the ability of the smaller vessels to relax. The vessel wall becomes thicker and the bore of the vessels becomes smaller. The vessels tend to constrict rather than dilate and it is more difficult for blood to flow through them. Accordingly, to get the same amount of blood flow through these vessels, the heart has to pump harder. As a result, blood pressure rises.

For hundreds of years, we've known that blood pressure is a measure of the blood circulating through the body. It is determined by the amount of blood flow and the blood vessels' resistance to that blood flow. The pumping of the heart establishes the amount of blood flow. When the heart beats faster or contracts more vigorously, blood flow increases. The health of the blood vessels determines the resistance. When the vessels are relaxed and flexible, resistance is low. In about 90 percent of people with high blood pressure, blood pressure increases because the vessels are not relaxed or have thickened.

You are probably familiar with the way blood pressure is measured. The measurement is represented by two numbers, top and bottom. The top number is the systolic pressure, the pressure in the vessels at the time the heart beats and pumps blood into the arteries. The bottom number, or diastolic pressure, is a measurement taken when the heart is resting in between beats. The normal blood pressure reading for an adult is 140/80; anything over these numbers is considered elevated.

In my opinion, the lower your blood pressure, the better. Obviously, if your blood pressure is too low, you will faint. But I tell my patients that their blood pressure should be just high enough to keep them from falling over. Even if your blood pressure is as low as 90/60 but you can stand without trouble, this is healthy and, in the long run, better for your heart and vessels.

To understand the difference between arteries that are stiff and those that are compliant, think about the difference between a thick and thin balloon. It is difficult to blow air into a thick-walled balloon. Expanding a thick-walled balloon takes much more effort than expanding a thin one, and the thick-walled balloon doesn't recoil very far once it is stretched. Like the thick-walled balloon, arteries that have hardened take much more effort to expand--and that makes it more difficult for the heart to pump blood into them. When blood is pumped into vessels that are not compliant, blood pressure rises faster and higher. The vessels can't expand to accommodate the rush of blood. On the other hand, the thin-walled balloon expands, stretches, and recoils with ease. It should be obvious then that, to maintain cardiovascular health, we want our vessels to be pliable like the thin-walled balloon. As you'll find out, it is possible to return your blood vessels to their youthful state.

The Lining of the Blood Vessel--the Endothelium

if you were to look at the outside of a blood vessel, it would appear enmeshed and attached to surrounding tissue, almost as though it had a myriad of threads circling it. The inside of a blood vessel is different, made up of smooth tissue, the easier to facilitate the flow of blood.

A closer look inside a blood vessel takes us to the endothelium, the innermost layer of tissue that lines the blood vessel. If you were to look at a cross section of an artery, the endothelium would be the inner surface. It would be similar to looking into a garden hose: the inside of the hose is lined by a smooth surface that is like the endothelium.

All blood vessels are lined with a carpet of endothelial cells. The blood vessels in your skin, brain, heart, and all of your organs are lined with this film of tissue. Only one cell layer thick, the endothelium seems almost immaterial, so thin that it cannot be seen by the naked eye. Yet it is a fascinating, versatile, and vital part of our anatomy. It could even be considered the largest organ in our body. Because this almost invisible veil of tissue lines all blood vessels, and because we have about 100,000 miles of blood vessels, the endothelium has the surface area of eight tennis courts. Incredibly, if all of the endothelial cells in the body were lumped together, they would weigh as much as the liver.

For many years, researchers believed that the endothelium was nothing more than an inert layer of cells, a simple barrier between blood and the smooth muscle wall of the vessel. Nevertheless, the process through which this "barrier" worked fascinated physiologists for many years--ever since it was found that certain substances seemed to pass through it, whereas others could not. It acted as a selective filter for the vessel wall. Eventually, scientists suspected that the endothelium was more than just "wallpaper," as it had bee...