Helping the Population Find Cardiovascular Health Through Chiropractors
Dr. Jeffrey Tucker- Apr 21
- 8 min read
If you are like me and many other doctors, you have seen the profession put lots of attention on helping expose the opioid epidemic and offer non-drug therapy for chronic pain. What do you think as a profession we could set our sights on next as far as prevention and reversal of disease? So many choices await us, osteoarthritis, osteoporosis, headaches, balance, posture, etc.
I’m going to suggest that the medical community needs our help with preventing coronary artery heart disease, including hypertension. Cardiovascular disease is the leading killer of women and men in Western civilization.
Stats: Somebody in this country is dying of cardiovascular disease about every 30 seconds. Every 3 minutes and 14 seconds a stroke happens. (1) We have work to do!
Standard medicine uses drugs, stents, and bypass operations, none of which have anything whatsoever to do with the cause of the illness. I think we can turn our attention to early detection of risk and get more aggressive about treating patients at risk for cardiovascular disease.
Since the late 1940s the American Heart Association (AHA) has supported almost $6 billion dollars’ worth of cardiovascular and stroke related research and after the NIH the American Heart Association is the largest supporter of cardiovascular and cerebrovascular research in the country. Imagine what we could have done with a billion dollars worth of that since 1940. (1)
We are as much stakeholders interested in the health of the country as the AMA.
I’m going to give the American Heart Association this. We have seen marked improvements from 1950 to 2021 but we're starting to see a reversal in the progress that they made across the landscape whether we look at heart failure or coronary artery disease. Things are getting worse. Keep in mind that the progress that's been made has largely been made from two perspectives, one of which was the public health implementation of the Surgeon General report in the early 1960s around the dangers of smoking. A large focus of the American Heart Association has been on tobacco control since the 1960s. But with the vaping epidemic and a switch from vaping to combustible cigarettes, there's been a reversal particularly amongst young people. We as a profession can be messaging in helping here.
The second big Public Health implementation is around blood pressure control and the AHA has worked to control population level blood pressure. But since about 2020 in the pandemic, blood pressure control in this country has gotten considerably worse.
MDs and the public need our help. I use these important talking points to educate patients. If patients can understand that the reason they have their heart disease is because they had sufficiently trashed, injured, and compromised the endothelial capacity to make nitric oxide, or they realize they may be short on nitric oxide, they've lost their protection, and that it wasn't done by their genes or by stress alone. It was done by their food and lifestyle choices.
Tuckers Talking Points - Taking care of the endothelium and not injuring it.
What to recommend to improve circulation and vessel health
Hydration. I talk about how I front load my water in the morning. I strive for 90 ounces within 90 minutes of being awake. Then I continue drinking what I have always consumed throughout the day. I typically stop drinking water around 7 PM which translated into less nighttime urination.
Eat dark green, leafy veggies multiple times a day because they help turn the body into a nitric oxide factory; Spinach, Rucola, Radish, Lettuce, Beet root, Beet Greens, Beets, Bok Choy, Celery, Swiss Chard, Kale, Collards, Collard Greens, Mustard Greens, Turnip Greens, Napa Cabbage, Brussel Sprouts, Broccoli, Cauliflower, Cilantro, Parsley, and Asparagus. Garlic activates nitric oxide synthase and helps maximize nitric oxide absorption. Citrus fruits are high in vitamin C, which enhances nitric oxide bioavailability. Pomegranate contains antioxidants that protect and preserve nitric oxide. When in season watermelon is okay because it’s rich in citrulline, an amino acid that converts to nitric oxide. Nuts and seeds are high in arginine, which is involved in nitric oxide production.
It helps to dab vegetables with balsamic or rice vinegar. Why? The acetic acid in those vinegars can restore the nitric oxide synthase enzyme contained within the endothelial cells. I’m suggesting eating vegetables alongside their breakfast, again as a mid-morning snack, with their lunch, mid-afternoon snack and going big at dinnertime. When you need an evening snack, try pumpkin (good for prostate health) or sunflower seeds.
Green leafy vegetable also help restore the capacity of your bone marrow to once again make the endothelial progenitor cell, which will replace our senescent, injured, worn-out endothelial cells.
Eating green leafy vegetables increases nitric oxide in your body through a simple process. Here’s how:
1. Green leafy vegetables contain high levels of nitrates. Chew well.
2. When you chew these vegetables, the nitrates mix with anaerobic bacteria that reside in the crypts and grooves of your tongue.
3. These bacteria are going to reduce/convert the nitrates that you've been chewing to a nitrite.
4. When you swallow the nitrates and nitrites they travel to your stomach and become part of the gastric acid, which is going to further reduce the nitrate to more nitric oxide, which can enter your nitric oxide pools.
5. In your blood vessels, the nitrites are further converted into nitric oxide. This process begins in your mouth and continues as the nitrates are absorbed into your bloodstream. The nitric oxide then helps relax and dilate your blood vessels, improving blood flow and reducing blood pressure [2].
Protein. I want people to get their protein amounts dialed in. I still use body composition analysis measurement to guide my protein recommendations. At least 1 gram of protein per pound of lean body mass. Depending on diet preferences (Keto, Mediterranean, Vegetarian, Paleo, etc.), age, current health status, and health goals we discuss meat, fish, chicken, fowl, turkey, eggs, etc. I find many patients need help in understanding how much protein they need and what they are actually getting. Meat, poultry, and seafood are excellent sources of coenzyme Q10, which may help preserve nitric oxide (2)(3).
Some people need to eliminate dairy milk, cream, cheese, ice cream, and yogurt. Why? Because those foods injure endothelial cells and take away your nitric oxide. Regarding diet I think this is where knowing your genetics is helpful. Understanding what your ancestors ate does give you a clue as to what you should eat.
Anti-inflammatory diet. I am a BIG proponent of anti-inflammatory foods, using curcuminoids as supplements, and a plant-based forward diet for nutrition. Getting people to accept an anti-inflammatory diet can absolutely destroy diabetes, hypertension, vascular issues, dementia, Crohn's disease, ulcerative colitis, rheumatoid and immune arthritis, lupus, multiple sclerosis, allergies, and asthma. The list goes on.
Sleep. Deep sleep is the most restorative and rejuvenating sleep stage. Adults spend on average 1-1.5 hours of their total sleep time in deep sleep. When we are in deep sleep, blood pressure drops, heart and breathing rates are steady, arm and leg muscles relax, and the brain flushes out toxins. These patterns affect our cardiovascular health whether we exercise and what kind of diet we eat (4).
Oils. This can get really confusing because several oils have been shown to damage or impair endothelial function. Olive oil seems to have the most support for nitric oxide production, particularly extra virgin olive oil (EVOO) which contains polyphenols like hydroxytyrosol and oleuropein, which have been shown to increase nitric oxide production.
Flaxseed Oil, Walnut Oil, Hemp Seed Oil and Pumpkin Seed Oil can also protect nitric oxide.
Olive oil obviously gets the most attention because consuming olive oil instead of animal fats may lower the risk of premature death from CVD. The PREDIMED trial showed a Mediterranean diet supplemented with EVOO reduced CVD risk by 31%. Extra Virgin Olive Oil (EVOO) consumption may improve glucose metabolism and prevent diabetes from onset. Olive oil intake is linked to improvements in lipid profiles, including increased HDL and reduced LDL oxidation. EVOO may help manage components of metabolic syndrome, including blood pressure and insulin sensitivity.
Higher olive oil consumption (more than half a tablespoon daily) is associated with a lower risk of premature death from various causes. A dose-response relationship was observed, with benefits seen at intakes up to 20 g/day. (5) (6) (7)
Currently some functional nutritionists and health influencers advise against consuming seed oils, often referred to as "vegetable oils." They make the point that there is a higher Omega-6 to Omega-3 ratio. Seed oils like soybean, corn, sunflower, safflower, and cottonseed oil are high in omega-6 fatty acids. While omega-6s are essential, an imbalance where they significantly outnumber omega-3 fatty acids can promote inflammation in the body. No one disputes that chronic inflammation is linked to various health issues, including cardiovascular disease, diabetes, and autoimmune conditions.
Further, seed oils are often highly refined, which involves high heat, solvents, and bleaching agents. This process can make the oils more prone to oxidation, especially when exposed to heat, light, or air. Oxidized fats can produce free radicals, which contribute to oxidative stress and cellular damage.
During the refining process, some seed oils can form trans fats, even if they are not intentionally hydrogenated. Trans fats are known to increase bad LDL cholesterol, decrease good HDL cholesterol, and increase the risk of heart disease. Even small amounts of trans fats can have a detrimental effect on health. The recommendation is to eliminate fried foods. It’s going to be tough for Americans to eliminate French fries, but you get the point.
Here's where I currently stand. While seed oils are not inherently "bad," the concerns stem from their processing methods, potential for oxidation, high omega-6 content, and their role in displacing more nutrient-dense fats in the diet. I encourage a return to traditional fats like olive oil, coconut oil, butter from grass-fed cows, or animal fats like lard or tallow for those who tolerate them well. We still must advocate for individual health goals and conditions.
Nuts & Seeds. I don't like peanuts and peanut butter, because they contain toxins and too much saturated fat. Walnuts, flaxseed and meal, pumpkin and chia seeds are okay because they have omega-three, and they don’t seem to have as much saturated fat.
Eliminate sugar. Do this as much as possible. Drinks like Cola, Pepsi, Coke, cakes, pies, cookies, stevia, agaves, maple syrup, and molasses. Even diet cola is off the list.
Remove processed foods, period. Patients need a lot of help here.
Nasal breathing. It is one of the most overlooked fitness and wellness practices to recommend. Nasal breathing triggers receptors in the body that affect hormones, HR, body temp, blood pressure and acidity.
Toothpaste. Brushing with fluoride, public drinking water with fluoride, and mouthwash will injure the beneficial bacteria in your mouth.
Antacids. This will reduce your gastric acidity, and you will be unable to reduce the nitrate and more nitric oxide.
Get a water filter. I encourage all patients, regardless of where they live, to filter their water.
Supplements: Along with the above, I’m pushing Red Ginseng and Red Sage (EuroMedica), a supplement called Healthy Circulation.
Overall recommendations need to improve nitric oxide production for healthy blood flow & circulation, strong, flexible blood vessels & arteries, energy for muscles, especially the heart, healthy blood pressure levels & cholesterol balance. You're doing all this all day long, morning to night, you're restoring nitric oxide, the very molecule, the deficiency of which is giving you this disease in the first place.
Are you with me helping people prevent cardiovascular disease? Nobody ever says, “When I had my first low back attack, that was exciting? I think I'll destroy some more disc space and herniate a little more?” We are good at talking about posture and biomechanics, but people don’t even know about endothelial cells.
If you look at the risk of having a heart attack it's not in your genes that's predicting that, it's in how you respond to a variety of behavioral aspects of your life; diet, sleep, whether you use tobacco, controlling your blood pressure, controlling your blood sugar, how much exercise do you get, what’s your weight, this explains about 90% of the risk of having a heart attack at the population level. (1)
Talk about prevention of coronary artery disease. It is preventable. Is it completely preventable? Probably not, but if we had perfect adherence to suggestions, we would have a lot less global burden of coronary artery disease and by extension other cardiovascular diseases.
In part two I will discuss my step-by-step approach for exercise recommendations in a case example to help boost cardiovascular health, vessel health, and maintain sufficient levels of nitric oxide in blood and tissues.
References
(7) Curr Opin Lipidol. 2021 Feb 1;32(1):62-69. doi: 10.1097/MOL.0000000000000731.PMID: 33315620
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