The Naturopathic Approach to Cardiovascular Health

Cardiovascular disease is a major burden for adults in the United States. Heart disease, a type of cardiovascular disease, is a leading cause of death. Approximately 695,000 people in the United States died from heart disease in 2021, a statistic that increases every year.₁ Fortunately, modifiable lifestyle factors can significantly reduce the risk of cardiovascular disease and improve overall cardiovascular health.

Naturopathic medicine is a model worth exploring to support overall health and ultimately prevent cardiovascular disease. It is a unique system of medicine that melds both science and tradition and allows the practitioner to explore a patient’s health through a unique lens of nutrition, education, self-healing, treatment individualization, patient empowerment, and numerous treatment modalities.  Finding the root cause of cardiovascular dysfunction is an important differentiator in this model as signs and symptoms of dysfunction generally occur well before an official diagnosis has been made.

Licensed naturopathic doctors have completed a doctorate in naturopathic medicine and uphold the six naturopathic principles. Naturopathic Doctors can support and treat patients of all ages, backgrounds, health challenges, demographics, and history.

Naturopathic medicine can be used in isolation or conjunction with other medical models depending on many factors such as patient health status and treatment goals. Complementary and integrative health has gained traction over the years, and it’s always best to find a style of medicine and medical practitioner that delivers optimal care and optimal health outcomes for all patients.

Understanding Cardiovascular Health

The cardiovascular system consists of the heart and blood vessels, which together pump and deliver blood to every corner of the body.₂ Within each of these components – the heart and blood vessels – there are many highly specialized cells that coordinate cardiovascular signaling and health.₃ Over time, internal and external factors can cause damage to the cardiovascular system, ultimately resulting in one or more cardiovascular diseases.

Cardiovascular disease is used broadly to describe any cardiovascular condition, although the most common is coronary artery disease (coronary heart disease or heart disease).₄ Coronary artery disease occurs when the coronary arteries struggle to provide enough blood, oxygen, and nutrients to the heart.₄ Oftentimes, atherosclerosis is the underlying mechanism for cardiovascular diseases. It is a serious cardiovascular condition characterized by a build-up of plaque in the arteries.₄ Other cardiovascular diseases include cerebrovascular disease and peripheral artery disease.₄

While cardiovascular diseases are very common – approximately one third of all deaths are attributed to cardiovascular diseases – several lifestyle factors can greatly improve cardiovascular health­.₅ A heart-healthy diet can prevent and even reverse heart disease in some cases.₆ Diets that are rich in fruits and vegetables, lean protein, healthy fats, and low in saturated fat, added sugar and processed foods support cardiovascular health through the inclusion of foods rich in antioxidant, inflammation-resolving compounds, and fiber.₇ Engaging in regular physical activity also provides many benefits to the cardiovascular system starting with the first workout.₈ Finally, not smoking and getting adequate sleep can also significantly improve cardiovascular health.₆

Naturopathic Methods for Cardiovascular Health

Diet and nutrition

Diet and nutrition are the cornerstone for both the naturopathic model and supporting cardiovascular disease. Depending on the cell type, cells of the human body are rapidly regenerated.  It is estimated that 330 billion cells are replaced daily which is equivalent to about one percent of all cells.₉ Cells are made from what individuals consume which certainly highlights the importance of what they choose to put into their bodies.

What constitutes a heart healthy diet? In general, a heart healthy diet places emphasis on foods that promote heart health, endothelial function, optimizes lipid parameters, and reduces inflammation. Vegetables, fruits, whole grains, lean meats, and fish high in omega-3 fatty acids are staples of this diet. Importance must also be placed on eliminating and avoiding highly processed foods such as sugar, sodium, and unhealthy fats as these have all been shown to increase the risk of heart disease.₇

The naturopathic model of medicine includes the principle Docere: Latin for “to teach.” The naturopathic physician will educate the patient of the importance of supporting the cardiovascular system including educating patients as to the “why” and “how” these food choices are effective for promoting heart health. Naturopathic doctors typically spend one or more hours with their patients during an initial consultation allowing for additional time for questions and education. This usually helps patients become more compliant and engage as an active participant in their healthcare.

For instance, naturopathic doctors may not just tell their patients to eat more vegetables, they want to teach their patients why eating vegetables is important and the benefits of doing so. Vegetables contain an important class of chemicals that are produced by plants called phytochemicals. These compounds generally have a positive effect on human health but are not classified as essential macro- or micronutrients.  Vegetables, fruits, and whole grains also contain vitamins and minerals which are important for heart health and the staple of a heart healthy diet. By providing this education to patients, naturopathic doctors hope to instill long-lasting change in their patients’ dietary habits.

Exercise and physical activity

Engaging in regular exercise and physical activity is another important aspect for optimal heart health.  The heart, a muscle, is strengthened by physical activity. Exercise improves the heart’s ability to pump blood to the lungs and other areas throughout the body, which in turn provides more oxygen to tissues and helps carry away metabolic waste.₁₀

Again, naturopathic doctors are trained to motivate and encourage their patients. While most individuals are likely aware of the importance of exercise, putting this into practice can be a completely different challenge. Naturopathic doctors can help identify exercises or activities that are relevant and of interest to patients. Doing so can help patients be more consistent and sustain exercise routines. For example, while naturopathic doctors understand the many heart-related benefits of jogging, if a patient does not enjoy this activity and is reluctant to participate, it is not the best recommendation of exercise to provide. Rather, they can suggest the patient consider alternate forms of activity such as walking, dancing, sports, hiking, skiing, paddleboarding, or playing at the park with the dog.

Stress management

Stress is another important component of cardiovascular health as it has effects on almost every other system of the body.  As it turns out, not all stress is bad, and the cardiovascular system can use acute stress to its advantage. For instance, when driving requires a quick maneuver to avoid a car accident, the body adapts by increasing heart rate and heart muscle contraction and heightening reflexes. This helps the driver respond quickly, but constant stress over an extended length of time is not healthy.  If the heart rate is increases over time, this creates long term problems for the vasculature of the heart which can increase the risk for hypertension, heart attack, and stroke.₁₁

Naturopathic doctors examine a patient’s stress level and provide techniques to manage stress. Stress management techniques include options such as breathing exercises, meditation, and counseling. Some naturopathic doctors may offer additional services including nutritional IV therapy, acupuncture, and biofeedback. Nutritional components might include taking a magnesium supplement, L-theanine, vitamin D, and other nutritional recommendations. Herbal options for stress include ashwagandha, chamomile, and rhodiola.

From a naturopathic perspective, finding the cause of stress is incredibly important to improving health and ultimately limiting cardiovascular risk factors. While nutritional supplements and herbs can be extremely helpful for management, finding and treating the cause is a primary goal of the naturopathic doctor. Realizing that each person is an individual and unique in their ability to manage stress is critical to best supporting each patient.

Naturopathic doctors are no strangers to the intricacies and uniqueness of the human body; this is why it is advised that each individual have a customized treatment approach to support heart health.  Online materials should not take the place of consultation with a licensed healthcare professional.

Natural supplements and herbs

Herbal supplements to consider for cardiovascular support

Hawthorne: A naturopathic favorite for supporting the heart. This herb is generally used over the course of months and can be consumed in many different forms including tablets or capsules, liquids, teas, or solid extracts.₁₂ The leaf, flowers, and berries are the parts of the plants that are generally used for medicine. While the exact mechanism of action on the cardiovascular system is uncertain, it is thought that the primary activity works through increasing coronary arterial blood flow. Hawthorn has been widely used in Europe as a cardiotonic and for congestive heart failure.₁₃

Garlic: Historically dates back thousands of years and one of the most heavily researched present day herbal medicines. Many trials and meta-analyses have indicated favorable effects on cardiovascular risk factors such as hypertension and hypercholesterolemia. Systolic blood pressure and diastolic blood pressure have also been shown to be reduced by 7-16 mm Hg and 5-9 mm Hg respectively.₁₄ Garlic is a standout for naturopathic use as doctors talk to patients about using garlic in food preparation (culinary use), for cardiovascular disease, and immune system support.

B vitamins: Many naturopathic doctors may recommend a multivitamin supplement which is essentially a combination of multiple vitamins, minerals, and possibly other ingredients as opposed to a single mineral or a single isolated vitamin.  While some research studies have concluded B vitamin supplementation has little to no effect on cardiovascular outcomes.₁₅ It is important that we do no overgeneralize this information as it has also been shown that certain B-vitamins including folate, vitamin B6 and B12 play an important role in the metabolism of homocysteine which has been implicated in the development of cardiovascular disease.₁₆  Some Naturopathic doctors may even run a homocysteine as part of their regular blood screening panel to help determine the best to protect their patients heart health.

Magnesium: Now considered a public health crisis, magnesium deficiency is incredibly common as approximately 50% of Americans consume less than the estimated average requirement (EAR) for magnesium. Recent literature is suggestive of magnesium deficiency being one of the leading causes of chronic diseases, including cardiovascular disease, and early mortality around the globe.₁₇  Naturopathic doctors are very aware of this trend and may suggest magnesium for many different symptoms such as headaches, muscle cramps, constipation, mood issues, brain fog, heart arrhythmias, and blood glucose dysregulation.

Bioactive compounds

Mitochondrial support such as CoQ10 is incredibly important in the human body and can play a significant role in cardiovascular disease by acting as an antioxidant, anti-inflammatory, providing protecting against reactive oxygen species (ROS), and creating energy (ATP) within the mitochondria.₁₈ These actions of CoQ10 have led to positive outcomes in clinical studies by preventing oxidized LDL in the arteries, decreasing vascular stiffness and hypertension, improving endothelial dysfunction and increasing nitric oxide levels for vasodilation.₁₉ Naturopathic doctors understand the role of this antioxidant and may recommend this as a single supplement or a combination of CoQ10 and other synergistic bioactive compounds or nutrients.

Omega 3 fatty acids: Omega 3 fatty acids are a great reminder that certain types of dietary fats are extremely heart healthy. Omega 3 fatty acids reduce the risk for sudden death caused by cardiac arrhythmias and all-cause mortality in patients with heart disease. Omega-3s have also been shown to treat hyperlipidemia and hypertension.₂₀ Naturopathic doctors generally will make recommendations for diet and lifestyle changes before adding on additional supplementation; however, as omega-3 fatty acids many times are sourced from fish, naturopathic doctors may decide it is best for their patient to take omega-3 supplementation versus consuming fish on a regular basis due to potentially elevated levels of heavy metals. A naturopathic doctor will generally make supplement recommendations they have determined to be of the highest quality and provide recommendations from companies that test for heavy metals such as lead, mercury, arsenic, and cadmium.

Naturopathic Medicine and Cardiovascular Health: Case Studies and Clinical Trials

Case Study

A 65-year-old retired male patient had his first encounter with naturopathic medicine after a referral from his son. He has a history of taking multiple medications from both his primary care physician (PCP) and cardiologist whom he sees annually for follow-up appointments. His health history includes elevated blood pressure (hypertension), triglycerides (hypertriglyceridemia), and cholesterol (hypercholesterolemia) which he reported have been well-managed with medications since he was in his 30s. The patient stands 5’10’’ and started his healthcare journey at 265 pounds presenting with fatigue, shortness of breath, exercise intolerance, and the general feeling of lethargy that had plagued him for many years. Regular home blood pressure checks showed systolic readings between 140-150 mm Hg and diastolic readings between 90—100 mm Hg.

A diet recall showed the patient had been regularly overconsuming foods with little to no nutritional value, and he was especially aware of his regular snacking in the evening hours. After necessary paperwork, physical exam, and intake were completed during his first appointment, the patient was provided with dietary counseling and education materials about diet and lifestyle medication and was instructed to follow heart healthy recipes. Being a former cook in the Navy, the patient agreed he would be most compliant if informed exactly what to eat instead of being presented with a general guide of what to eat. He was advised to continue taking all medications as directed and given only a multivitamin supplement.

The patient improved after only one week of following this regimen, including an eight-pound weight loss from the previous week. At the three-week check-in, blood pressure was the “lowest it’s ever been.” At the six-week follow-up, he was down 16 pounds from starting weight, blood pressure was stable at 118/81, and he was also able to exercise regularly, taking two walks per day. He also mentioned having to create a new hole in his belt to hold up his pants. He was advised to have a follow-up appointment with his cardiologist and PCP for possible adjustment to medications. This case study is an effective example of how this patient was able to support their cardiovascular system and overall health with the guidance of a naturopathic practitioner.

Clinical trials

Dr. Dean Ornish first published results from a clinical study evaluating the ability of lifestyle changes to positively affect coronary atherosclerosis in 1990.₂₁ He is the founder of the Ornish diet, a popular dietary pattern that can improve cardiovascular health and be customized to each patient’s goals. In a seminal study, Dr. Ornish and his team demonstrated that adoption of a low-fat vegetarian diet, smoking cessation, stress management training, and moderate exercise for one year resulted in regression of lesions of the coronary artery.₂₁ This accomplishment is even more striking considering that plaque size grew in the control group. Following these lifestyle changes allowed for regression of what is considered severe coronary atherosclerosis in some cases without the use of lipid-lowering drugs.

In a more recent clinical trial, patients received an enhanced version of the usual care for cardiovascular disease that focused on naturopathic care. After one year, naturopathic care resulted in a reduced risk of cardiovascular disease and a reduced frequency of metabolic syndrome.₂₂ This indicates that the cardiovascular and metabolic health of the participants improved beyond what was seen for patients receiving standard care for their condition.

Integrating Naturopathic Medicine into a Comprehensive Heart Health Plan

Naturopathic medicine occupies a unique space within the medicine and health realm, but it can also complement conventional cardiovascular treatments; it does not have to be a standalone option. In fact, in 2010 it was estimated that nearly 40 percent of adults in the United States were using some form of complementary and alternative medicine (CAM), which includes dietary supplements.₂₃ It is not necessary to pick just a single healthcare provider, but rather patients should consider combining naturopathic medicine into a comprehensive heart health plan.

Many naturopaths will order the same or similar bloodwork that is recommended by a PCP, with the addition of biomarkers not typically part of a ‘regular” workup.  Some naturopathic doctors even specialize in functional blood chemistry interpretation which is helpful for those patients who have bloodwork markers within normal reference ranges yet continue to report a decline in health or a worsening of symptoms. Naturopathic doctors excel at helping to optimize both blood work and body systems, objective and subjective measures, respectively.

A “regular” bloodwork panel from a PCP might include CBC (complete blood count), CMP (comprehensive metabolic panel), TSH (thyroid stimulating hormone), and Lipid Panel (checking cholesterol and triglycerides) and additional testing if medically indicted.

1. • A blood panel from a naturopathic doctor will likely contain all the biomarkers listed above and include additional blood sugar regulation labs: HbA1c (hemoglobin A1c) and fasting insulin, a more in-depth thyroid panel including (TSH, fT4, fT3, rT3, and possible thyroid antibodies), cardiovascular markers including a hsCRP (high sensitivity CRP), homocysteine, and MMA (methylmalonic acid). The panel might also include additional vitamin markers such as B12, folate, and vitamin D as well as hormone markers if indicated (free and total testosterone, estrogen, DHEA-S, progesterone). Lastly, even clotting markers are considered if medically indicated.
   • Naturopathic doctors may also suggest comanaging care with a specialist and will likely recommend routine imaging and screening exams as suggested by specific organizations.

Conclusion

The benefits of the naturopathic approach are numerous, and utilizing this approach to support cardiovascular health could be life-changing.  A naturopathic doctor employs the principles of naturopathic medicine including finding and treating the cause of disease and using the healing power of nature, all while educating the patient and helping prevent future pathology.  For cardiovascular health this could mean the implementation of a heart-healthy diet, stress management techniques, increasing physical activity, and supplement and botanical recommendations along with regular health screenings.  Emphasis must be placed on a personalized, comprehensive plan for optimized heart health.