Take
This To Heart....
One of the issues we face with large
and giant breeds is the problem of DCM or Dilated Cardiomyopathy and
other heart diseases. It is my opinion much of this has do to low
levels of Taurine and L-Carnitine amino acids, although there can
be some genetic component to this problem as well. The problem is
some dogs get enough L-Carnitine and Taurine in their diets, but their
body is not able to utilize it. Nonetheless, if you have a dog diagnosed
with DCM, it is well worth trying to use supplement support, based
on the human research discussed in Dr. Sinatra's articles below. Dr.
Sinatra is an eminent cardiologist and a nutritionist. The information
at his site is the most through or any I have read.
To date, only a handful of recent
studies have been done dealing with the use of supplements
in canines, as a way to improve or potentially prevent diseased heart.
On the other hand, there has been considerable research in humans,
as to the benefits of using nutritional substances in conjunction
with traditional medications. I recently was part of an online seminar
discussing the benefits of L-Carnitine supplementation in canines
and I personally would not hesitate to use it not only a daily maintenance
level but also at therapeutic levels for dog's diagnosed with heart
disease.
I would like to share with you two articles that pertain to Congestive
Heart Failure in humans. You will find this very interesting indeed.
I know I am more than willing to apply the same principles to the
heart health of my Great Danes.
What I am about to suggest is not research, only my opinion based
on numerous conversations with nutritionists in the dog food industry.
I feel the advent of the cereal based kibbles, over the past 40 years,
has been a major contributing factor in the issue of heart disease
in canines,... even more than genetics, in my opinion.
The lack of high quality, multiple protein(meat) sources in pet foods,
coupled with the fact that the foods are cooked, destroying important
nutrients (dietary
enzymes), and the fact that many companies
do not pay a great deal of attention to Taurine and L-Carnitine levels,
points to these being a major contributing factor in heart disease
in dogs and cats.
Many of us are aware
of the earlier problems of the lack of Taurine in cat diets, and after
numerous deaths, manufacturers started paying more
attention to Taurine levels in cat
foods. Many even state on the bag, with
added Taurine! Now it is time for the dog food industry as
a whole to pay even closer attention to the L-Carnitine levels in
their dog foods.
I feel it is very important to use a high quality human
grade, multiple protein based kibble - if feeding a commercial
food, one that is between 23 - 25% protein. My preference is using
a food like Eagle Pack
dog food, a food that can be used with a raw meat component
to the diet, if you want to. If you are interested in feeding
a totally raw
diet - use this link for information
.Eagle
Pack foods can be used with 10-15% balanced commercial
raw meat diet such as Honest
Kitchen, which I reference in all my feed programs.
And if using raw from the grocery store, the use of OxEDrops
to keep pathogens at a minimum. (See Puppy
Feed Program or Adult
Feed Program
for instructions).
Another way to handle getting more Taurine
and Carnitine is to supplement. If you are using Eagle foods the Taurine
levels are fine, as well as the L-Carnitine, but my preference is
to supplement with more L-Carnitine if your dog has been diagnoised
with DCM
Here are some suggested for canines based on the textbook Small
Animal Clinical Nutrition. Discuss this with your holistic veterinarian.
For maintenance dose on puppies 12 weeks - adult, with no known
heart problems
- Taurine - 100 - 250 mg daily
- L- Carnitine - 200 - 500 mg daily
- Co-Q-10 - 30 mg - 60 mg daily - (optional
on young dogs)
For therapeutic doses when a pet has been diagnosed with DCM on
adult large/giant breeds like danes, dobes etc.
- Taurine: 500 - 2000mg - a day
- L-Carnitine: 2000 mg -6000 mg - a day.
- Co-enzyme-Q-10 - 120 mg - 300 mg a day
Unfortunately L- Carnitine and Co-Q-10 can
be very costly - even in pill form for 6000 mg a day it could run
$600 alone. As of 2008, Dr. Wagner carries a very high quality liquid
L-Carnitine supplement that is very usable by the body and not cost
prohibitive. It is from the Lonza Corporation, the best L-Carnitine
in the world. He also carries Co-Q-10 from Japan (not China), because
the best Co-Q10 has always been grown by the Japanese. Dr. Wagner
and I have designed a Cardio
Support Kit #21 that he offers to assist pet owners in trying
to provide supplements that will be effective and yet not require
a second mortgage to obtain them
.
For more information on the Cardio
Support Supplement Kit #21, call 765-287-8288 or toll free
- 765-287-8288. it will not be posted on their website until Feb 22,
2008 for ordering. but you can get it by calling them.
Other supplements that research has shown to be beneficial are Colostrum
and ionic trace minerals (Spark
of Life), both of which are included in the Cardio Support
Kit #21.
RESEARCH INFORMATION:
Lonza corporation, the worlds largest manufacturer of Carnitine has
done some interesting studies on piglets and the muscle mass obtained
when supplementing 100 mg of Carnitine daily. It was a significant
increase in muscle, not fat. It was suggested we can supplement our
puppies at 10 weeks with 50 mg daily of L-Carnitine and move up to
100 mg at 16 weeks, and by 6 months 100mg. At 12 months 100 - 200
mg daily will be the adult dose they can remain on for their life.
Increase if old or if they have heart problems. Frankly, to be on
the safe side in this breed and if there is a family history, I would
have my adults on on at least 500 mg daily as maintenance of L-Carnitine.
Make sure you discuss this with your vet.
If you have the stomach for it...another
thing you can do is purchase "heart" meat. NO LIVER OR OTHER
ORGAN MEAT - due to high levels of vitamin A in them. Grind up and
use RAW!!,
Print out and discuss this with your veterinarian before you start.
Below you will find some very interesting research information for
humans - please take it to heart.
is another supplement
that needs to be discussed when dealing with cardiovascular issues
in humans or pets. This article by Dr. Eugene Wagner, biochemist and
researcher in the field of Co-Q-10 clarifies the question, what
is Co-Q-10.
These articles are the property of Dr.
Sinatra see his website for further valuable information.
This is one of my favorite websites for human nutritional information.
Dr. Sinatra is a practicing cardiologist in Connecticut and combines
traditional medicine with nutrition to solve health issues.
L-Carnitine Helps Reduce Death From Congestive
Heart Failure
September 1999, Vol. V No.9 - Author: Dr.
Sinatra
While the number of heart attacks in the United States has dropped
in the last 20 years?largely due to positive lifestyle changes?deaths
from congestive heart failure (CHF)?an energy-starved heart?have more
than doubled during the same period.
Why? We don't really know why. But I believe it's because we're not
giving people the nutritional support they need to feed their starving
hearts. Currently, the typical treatment for CHF is: Digitalis (Lanoxin,
Digoxin), which increases the strength of the heart's contractions
and also helps slow the heart so it can fill and empty better.
Diuretics (Lasix, Bumex, Aldactone, etc.), which help the body eliminate
excess salt and water. Aldactone, which has been around for more than
30 years, has received a fair amount of news coverage recently because
of its ability to preserve potassium and improve the survival rate
of people with CHF. This low-cost diuretic should be used more often.
Other commonly prescribed drugs are ACE inhibitors or beta-blockers,
which relax arteries and lower blood pressure, thereby reducing stress
on the heart and allowing it to pump more effectively. I've written
much about both in the past (see HeartSense, March 1999, p.6).
Patients and doctors applaud these conventional treatments because
they offer immediate relief of common symptoms like shortness of breath,
swelling of the ankles, chest pressure or discomfort and even water
in the lungs.
Unfortunately, these drugs are now given like aspirin for a headache.
Yes, the pain is gone, but do we know what caused the headache so
we can prevent another one from occurring?
Certainly, it's wonderful to alleviate a patient's symptoms, but these
remedies don't get to the heart of the problem. While many people
feel better when they take these agents, their underlying heart problems
rarely improve?and may even get worse.
What's missing from the equation? Nutrients. Chief among them is L-carnitine.
I've just finished doing a massive amount of research on L-carnitine
for a book that I'm writing. I've found many studies that show how
L-carnitine improves the survival rate of CHF patients. This is great
news! This nutrient, like coenzyme Q10, is often lacking in CHF patients.
It not only reduces or eliminates symptoms, but also fuels the "energy"
houses of the heart's cells (the mitochondria) so the heart can pump
better. This is what I call a total frontal attack of the problem!
All of my CHF patients take L-carnitine in conjunction with conventional
therapies. It has helped me lessen heart failure and keep many patients
out of the hospital. In fact, it should come as no surprise, given
that I'm a cardiologist, that I encourage 80% of my patient population
to take L-carnitine. I'll never forget when I lost five patients in
one week to CHF. That was in the early part of the decade?before I
started using L-carnitine. Now that I employ it widely, I have much
more hope for a better quality of life for my CHF patients, as well
as an improved survival rate. Indeed, the high mortality rate for
CHF patients is a major problem. Often these patients have so much
scar tissue from multiple heart attacks that the amount of healthy,
functioning muscle is limited. And that frequently sets these patients
up for heart failure. There is absolutely no downside to L-carnitine,
which is even more effective when coupled with CoQ10 (see HeartSense,
March 1999, p.7).
Let's take a look at the research. L-carnitine Reduces Mortality,
Study Shows
In one controlled study of 160 patients hospitalized for heart attack,
80 received 4 grams of L-carnitine daily for 12 months. The other
half received placebos. Both groups, meanwhile, continued to take
conventional drugs during the study. The upshot? Blood pressure and
cholesterol levels improved and rhythm disorders and CHF symptoms
lessened or abated. The most significant finding was a tremendous
reduction in mortality among those taking carnitine supplements: 1.2%
compared to 12.5% for the controls.
More recently, in a double-blind, placebo-controlled study, 100 patients
with heart attack symptoms received 2 grams of L-carnitine a day for
28 days. Arrhythmia, angina, heart failure and muscle damage all improved.
There also was a significant reduction in cardiac death and non-fatal
heart attack in the L-carnitine group: 15.6% compared to 26% in the
placebo group. Although a larger study is needed to confirm this research,
the fact remains that L-carnitine improved arrhythmias, the rate of
recurring heart attack and even death from heart attack.
In a European study published in 1995 in the Journal of the American
College of Cardiology, 472 patients received intravenous doses of
9 grams of carnitine a day for five days, followed by 6 grams daily
(orally) for the next year.
The incidence of CHF death was 6% in the L-carnitine group versus
9.6% in placebo group ?a reduction of more than one third. Again,
this data further confirms that L-carnitine prolongs life in these
vulnerable patients. Researchers also validated previous studies by
demonstrating an improvement in the heart's ejection fraction (EF)
rate (the proportion of blood that's pumped out of the heart on each
heartbeat. In CHF, the EF is often as low as 10?15%; a good rate is
over 50%), as well as a reduction in the size of the left ventricle.
The smaller the heart size, the better the survival rate.
Cardiomyopathy
Numerous studies also show that patients with cardiomyopathy, another
common cardiac condition, have L-carnitine deficiencies. This condition
(characterized by heart tissue that's damaged, diseased, scarred and
a heart chamber that's enlarged, stretched or dilated) is often caused
by a history of chronic high blood pressure or long-standing alcohol
abuse, valve problems, viruses that attack the heart or even atherosclerosis.
In animal studies, researchers concluded that an L-carnitine deficiency
causes biochemical changes that impair the function of the heart.
In the case of the Syrian hamster, researchers gave the rodent L-carnitine
in the early stages of cardiomyopathy and successfully prevented further
damage to the animal's heart. In a study of very young children with
cardiomyopathy, researchers found that the children responded favorably
to prolonged administration of L-carnitine.
Given the research on L-carnitine, I wouldn't hesitate to give it
to anyone?whether that person was having an acute heart attack or
had a history of heart disease and/or CHF. L-carnitine is a must for
anyone with any form of heart disease. It is also a great preventive
as well as an anti-aging nutrient. I take L-carnitine myself and I
plan to add it to my coenzyme Q10 Q-gel formula in the future (it's
patented by Sigma-Tau.) Please stay tuned.
References: Davini P, Bigalli A, Lamanna F, Boem A. "A controlled
study on L-carnitine therapeutic efficacy in post-infarction,"
Drugs Exp Clin Res., 1992;18:355?365. Singh RB, Niaz MA, Agarwal P,
et al. "A randomized, double-blind, placebo-controlled trial
of L-carnitine in suspected acute myocardial infarction," Postgrad
Med J, 1996;72:45?50. Iliceto S, Scrutinio D, Bruzzi P, et al. "Effects
of L-carnitine administration on left ventricular remodeling after
acute anterior myocardial infarction: the L-carnitine ecocardiografia
digitalizzata infarto miocardioco (CEDIM) trial," JACC, 1995;26(2):380?7.
Kobayashi A, Yoshinori M, Yamazaki N. "L-carnitine treatment
for congestive heart failure: experimental and clinical study,"
Jpn Circ J, 1992;56:86?94. Bashore TM, Magorien DJ, Letterio J, et
al. "Histologic and biochemical correlates of left ventricular
chamber dynamics in man," J Mol Cell Cardiol, 1987;9:734.
© Copyright 1999, All rights reserved. Photocopying, reproduction
or quotation is strictly prohibited without permission from the publisher.
For subscription information, please call 800-211-7643. HeartSense
is dedicated to the prevention and treatment of disease. HeartSense
cannot offer medical services; Dr.
Sinatra encourages his readers to seek advice from competent medical
professionals for their personal health needs. Dr. Sinatra will respond
in the newsletter to questions of general interest, and urges you
to write him at Phillips Publishing, Inc. The recommendations in this
newsletter should not be viewed as a substitute for personal medical
care.
Congestive Heart Failure: You
May Have Options to Strengthen Your Heart - June 1996, Vol.
II, No. 6 - author Dr. Sinatra
Let me tell you about my patient Hugh, a 66-year-old once fond of
daily three-mile walks. He thought his recent wheezing, mild cough
and shortness of breath were simply a prelude to a pesky "cold."
His physician heard fluid in Hugh's chest and suspected it was more
serious. His tentative diagnosis: pneumonia. He sent Hugh home with
inhalers and a powerful antibiotic.
But Hugh's condition worsened. Over the next couple of days his cough
became incessant. It was a struggle to breathe, and when he tried
to lay down, the sensation was one he described with panic: "I
thought I was drowning." Exhausted and fearful after a miserable
night, Hugh went to the emergency room at dawn and was immediately
admitted into the hospital. The diagnosis: congestive heart failure
(CHF).
What's Going On During Congestive Heart Failure?
In essence, CHF results from a tired, weak, energy-starved heart that
is losing its ability to pump blood efficiently. Sadly, it results
in approximately 30,000 deaths annually. In this article, I want to
discuss how you and your physician can improve your condition, strengthen
your heart, relieve or even eliminate your symptoms, and not only
prolong the length but also boost the quality of your life.
What Causes CHF?
First, I want you to understand that CHF is only a symptom of an underlying
problem. In other words, the heart doesn't simply "fail"
on its own, even though the underlying cause might not easily be figured
out. Why is this important? Because the treatment that's right for
you will take into account many factors unique to your situation?the
stage of your disease, the nature and severity of your symptoms, your
sensitivity to traditional cardiac drugs, your tolerance for side
effects as well as other factors and circumstances that might be contributing
to (and possibly be the primary cause of) your heart's weakened state.
These might include high blood pressure, cigarette smoking, diabetes,
alcoholism, damaged heart valves, previous heart attacks, deficiencies
of vital nutrients, stress, anger....The list goes on.
How Is CHF Treated?
The medical community has come a long way in the treatment of CHF,
and for many patients traditional medicine is effective. Prescription
medication, in particular, can be dramatically helpful in alleviating
symptoms. However, as with all strong drugs, the side effects can
be almost as problematic as the initial symptoms. In other cases,
the drugs simply aren't providing enough relief?you feel better, but
not "in the pink."
It is for these kind of patients that I usually prescribe a course
of complementary natural therapies to improve their prognosis. In
some cases, natural therapies, which have few or no side effects,
can reduce the need for conventional medicines. In many cases, alternative
therapies can augment traditional medicines (see
sidebar at right) and provide the final measure of relief that
was lacking with drug therapy alone. Many patients benefit greatly
from blending conventional and alternative therapies?a strategy I
recommend to you if you are dissatisfied with your current treatment
plan for CHF.
What follows is a description of the alternative therapies I use in
my practice, most often as an adjunct to conventional medicine, sometimes
in place of it. Most of these therapies are readily available without
a prescription at health food stores. I'll describe how to use them,
how they work and the dosages that I prescribe for my patients. Expect
to spend between $10-15 for a 30-day supply of each of these treatments.
The listing is in the order in which these therapies should be tried.
You often need a four-to-six-week trial to determine whether they
are doing any good. It is a good idea to tell your physician what
you are up to. Remember, it's safe to use natural remedies with medication
but not as an immediate substitute for a medication. Eventually, you
may be able to cut back on your prescription drugs by as much as 50%.
Alternative Therapies For Treating Congestive Heart Failure
Coenzyme Q10 (CoQ10) is prescribed by many highly trained, board-certified
cardiologists across this country as well as in Western Europe and
Japan. Unfortunately, there are still too many cardiologists who not
only fail to recommend it but actually scoff at the idea, perhaps
because they've been trained to believe that anything natural can't
be as potent and effective as a highly engineered drug. Nonetheless,
my own experience with patients and the enormous body of science supporting
CoQ10 have convinced me that CoQ10 is the greatest addition to the
treatment of congestive heart failure in this century. Its primary
role?the production of energy at the cellular level?fuels the heart's
essential function: pumping blood. Since all cellular functions are
dependent upon energy, CoQ10 is essential for the health and normal
functioning of all human tissues and organs. Normally, the amount
of CoQ10 within the heart muscle is 10 times greater than in any other
organ, but in CHF the heart cells are CoQ10-deficient, and the heart
literally is not strong enough to pump blood from its own chambers.
Clinical studies show that 87% of patients with congestive heart failure
and hypertensive cardiovascular disease improved after taking CoQ10
for six months, and for some, the gentle, natural boost to their energy-starved
hearts brought dramatic improvement. Take one CoQ10 softgel daily
with meals (three per day). For CHF, start with 180 mg daily and increase
to 360 mg over three weeks. Significant relief from symptoms may take
a few weeks to months. If you are generally healthy and are interested
in preventive health, take 30-60 mg daily. (For references, see the
insert listing over 100 CoQ10 studies included with your April issue.
If you don't have a copy, send a self-addressed, stamped envelope
to Customer Service, HeartSense, Phillips Publishing, 7811 Montrose
Rd., Potomac, MD 20854.) Side effects: none reported.
If your response to CoQ10 is insufficient, the next step is
to add hawthorn berry (Crataegus spp.), a treatment I've used extensively,
particularly in patients sensitive to digoxin. According to clinical
research, hawthorn berry can increase the action of digoxin, making
it possible to decrease the dose of digoxin, thereby avoiding or lessening
digoxin-related side effects. In fact, some patients with mild CHF
get significant relief with hawthorn berry alone, an effect supported
by double-blind studies in Europe. It's interesting to note that hawthorn
berries are recognized by the German government as an approved heart
medicine.
How does hawthorn work? It is believed to improve the heart's ability
to metabolize energy and utilize oxygen, and the berry's extracts
contain flavonoids that increase the heart muscle's force of contraction.
Hawthorn berries also normalize irregular heartbeats, help
lower blood pressure and enhance circulation by dilating the arteries.
Dose: 500-1500 mg daily or take as a tincture in water three times
daily. For prevention, I recommend drinking hawthorn berry tea, which
you can make by pouring boiling water over a cup of berries and letting
them steep for 15 minutes. Side effects: none reported.
L-carnitine, an amino acid reportedly taken by marathon runners
to enhance athletic performance, may increase energy available to
the heart muscle cells by supporting free fatty acid metabolism. Dose:
500 mg twice daily. Side effects: none reported.
Also available at health food stores, L-arginine is an amino
acid that improves blood flow to the heart by stimulating endothelial
cell releasing factor (ECRF), thereby inhibiting a chain of complex
reactions that might otherwise cause plaque to form in the arteries
and stifle blood flow to the heart. Dose: 2-4 grams before bedtime.
Side effects: none reported.
Taurine has been shown to stabilize the electrical activity
within the heart and improve the heart's contractile strength. You'll
find it at health food stores. Dose: 3 grams daily. Side effects:
none reported.
In stubborn, severe cases of congestive heart failure, I turn to Levodopa
(L-dopa). It's the natural counterpart of an intravenous drug
called Dobutamine. When CHF approaches terminal stages, cardiologists
sometimes opt to administer Dobutamine, although they must hospitalize
the patient for half a day in order to closely monitor the individual
for dose-related adverse reactions. Many patients experience an increase
in heart muscle strength with this once-weekly treatment, improving
the effectiveness of their heart's pumping action.
Like Dobutamine, Levodopa is converted to dopamine in the body and
can have similar beneficial effects on the weakened heart, but it
can be taken orally. Vitamin B-6 promotes the conversion of
L-dopa to dopamine and should therefore be taken along with the L-dopa
to maximize the beneficial heart effects. Dose: must be determined
and carefully adjusted for each patient. Side effects: rhythmic muscular
twitches, heart palpitations, lightheadedness, nausea, vomiting.
The whole point here is to give your heart, and your quality of life,
the best possible chance for improvement. For this to happen, it's
critical that you and your physician respect the uniqueness of your
body and of your particular heart condition?every patient is different.
For your best shot at good quality of life, you should have a cardiologist
who is willing to try complementary options.
If you have CHF and are unhappy with your response to traditional
treatment, take heart: the alternative therapies I've outlined here,
along with eating the Mediterranean
way, regular activity and opening your heart emotionally, could make
the difference you've been searching for.
Standard Medical Treatments: A Brief Overview
Digoxin. Used in this country for over six decades, digoxin
is used in CHF to increase the force of heart muscle contraction.
By improving the "pump's" performance, digoxin can help
clear the body of the excess fluid that accumulates in the lungs of
CHF patients. Side effects: nausea, vomiting, diarrhea, blurred vision,
headaches, psychosis.
Diuretics. Diuretics increase urine output, thereby clearing
the body of excess fluid and, as a fortunate secondary effect, lowering
the blood pressure. Side effects: dehydration, electrolyte imbalance.
ACE inhibitors (ACE stands for Angiotensin Converting Enzymes).ACE
inhibitors lower the blood pressure by inhibiting the body's production
of specific chemicals that cause arteries to constrict. The arteries
relax, and the heart's job (pumping blood through them) becomes easier.
Side effects: dizziness, headache, fatigue, severe coughing.
Beta blockers. A typical bodily response to a failing heart
is the secretion of the hormone adrenaline, causing an increase in
heart rate?a useful response when you're in a threatening situation,
but one that is supposed to last only long enough to get you out of
trouble. Bathe your system in adrenaline over the long haul, as happens
in the patient with CHF, and the chronic pounding will cause problems
for your already weak heart. Beta blockers interfere with the "adrenaline
effect," thereby protecting the heart.
Side effects: fatigue, dizziness, depression, diarrhea, low heart
rate, wheezing, impotence.
Nitrates. Nitroglycerin and its relatives are potent dilators
of the coronary arteries, enhancing blood flow to otherwise blocked
segments of the heart muscle. The most common and important role of
nitroglycerin is to provide relief from angina and shortness of breath.
Side effects: headache, dizziness, lightheadedness.
References
Barron J, Parrillo J. "Dilated cardiomyopathy: management strategy."
Choices in Cardiology 6:205-208, 1995. Koifman B, Wollman Y, Bogomolny
N, et al. "Improvement of cardiac performance by intravenous
infusion of L-arginine in patients with moderate congestive heart
failure." JACC 36(5):1251-56, 1995. Azuma J, Sawamura A, Awata
N, et al. "Therapeutic effect of taurine in congestive heart
failure: a double-blind crossover trial." Clin Cardiol 8:276-282,
1985. Ioannis K, Rizos, Aristoteles N, et al. "Haemodynamical
effects of L-carnitine on patients with congestive heart failure due
to dilated cardiomyopathy." JACC Abstract 339a, 1996. Barron
J, Parrillo J. "Dilated cardiomyopathy: management strategy."
Choices in Cardiology 6:205-208, 1995. Koifman B, Wollman Y, Bogomolny
N, et al. "Improvement of cardiac performance by intravenous
infusion of L-arginine in patients with moderate congestive heart
failure." JACC 36(5):1251-56, 1995. Azuma J, Sawamura A, Awata
N, et al. "Therapeutic effect of taurine in congestive heart
failure: a double-blind crossover trial." Clin Cardiol 8:276-282,
1985. Ioannis K, Rizos, Aristoteles N, et al. "Haemodynamical
effects of L-carnitine on patients with congestive heart failure due
to dilated cardiomyopathy." JACC Abstract 339a, 1996.
© Copyright 1996, All rights reserved. Photocopying, reproduction
or quotation is strictly prohibited without permission from the publisher.
For subscription information, please call 800-211-7643. HeartSense
is dedicated to the prevention and treatment of disease. HeartSense
cannot offer medical services; Dr.
Sinatra encourages his readers to seek advice from competent
medical professionals for their personal health needs. Dr. Sinatra
will respond in the newsletter to questions of general interest, and
urges you to write him at Phillips Publishing, Inc. The recommendations
in this newsletter should not be viewed as a substitute for personal
medical care.
