1. Get a Pedometer

You’d be amazed to see how many extra steps you can take in one day — grab a pedometer and watch the numbers roll as you make simple changes for your health and take the stairs, walk to work, or stroll around the neighborhood to increase your physical activity for better heart health. Tracking your progress throughout the day can be great inspiration to keep going, and walking is a simple and easy type of exercise to help lower cholesterol.

2. Find an Exercise Buddy

A healthy lifestyle requires motivation, encouragement, and a friend to lean on. Grab an exercise buddy and support each other in the challenge to lower your cholesterol. Take long walks together and encourage each other to try new types of physical activity to get the heart pumping and to keep cholesterol levels down. Enjoy each other’s company and laugh — reduced levels of stress will help your heart, too.

3. Steer Clear of Hidden Fats and Sugars

Be an informed eater. Get to know your ingredients and read the nutrition labels thoroughly. Hidden sugars and unhealthy ingredients can increase your weight, which can lead to high cholesterol. Stay away from foods that contain high levels of saturated fat, cholesterol, and hidden sources of sugar such as high fructose corn syrup, some dextrins, or evaporated cane juice.

4. Say Psyllium, Please

One of the simplest tips is to get more fiber in your diet. Viscous soluble fiber like psyllium fiber, the natural dietary fiber found in Metamucil, is proven to help lower total and “lousy” LDL cholesterol because it forms a thick gel that traps and helps remove some cholesterol, bile acids, and waste in the gut. Most Americans only get 10 to 15 grams of fiber per day through their normal diet, versus the recommended 20 to 35 grams. This is why I recommend my patients supplement low fat, low cholesterol diets with 7 grams of soluble fiber from psyllium daily, as in Metamucil.

5. Add Healthy Fat, Too

DHA is short for docosahexaenoic acid, a polyunsaturated fatty acid. Regular intake of DHA can aid in proper heart function, help lower LDL, and raise HDL, or the “healthy” cholesterol. Popular sources of DHA are salmon, sardines, tuna — but if you aren’t a seafood fan, try fish oil supplements. Don’t like fishy taste? Get the healthy fat from vegetarian supplements made with algal DHA.

Heart Healthy Living The Saturday Evening Post

I came through the stroke fine because I went to the hospital right away and have been on warfarin ever since. My question is: If there’s no shunt, is the hole present?

A: The heart defect (or hole) responsible for a stroke is usually located in the top chambers of the heart, or atria. Diagnostic tests may detect an atrial septal defect (ASD) or a patent foramen ovale (PFO), both of which are “holes” in the tissue separating the right and left atria. A “shunt” is the term used to describe blood flow across such a defect. In your case, the concern is a right-to-left shunt, meaning that a blood clot could travel from the right to the left side of the heart, and then on to the brain and cause a stroke. Even if testing did not show a right-to-left shunt, it could still happen on occasion, such as after coughing or sneezing. Ask your cardiologist whether you indeed do or do not have a shunt. Treatments include closing the shunt via a device implanted during a heart catheterization (rather than open-heart surgery) or lifelong anti-coagulation with warfarin.

Heart Defect Often Causes No Symptoms The Saturday Evening Post

M. H.

Watertown, Massachusetts

Small studies in lab animals suggested that vitamin E supplements helped prevent heart disease and cancer. Although these health claims were widely reported, they 
just didn’t hold up after more testing.

But don’t give up on vitamin E. The nutrient is a family of eight antioxidants that prevent cell damage. The research mentioned above focused solely on one of its forms (alpha tocopherol). Today, researchers are exploring natural and synthetic versions of E for eye diseases, diabetes, arthritis, and cancers. Until we know more, experts generally recommend getting E from foods such as spinach, almonds, oils, and fortified cereals. Supplements with “mixed tocopherols” most closely match the E in foods.

Vitamin E Update The Saturday Evening Post

Millions of Americans are living with an overactive or underactive thyroid, according to the American Association of Clinical Endocrinologists (AACE). Unfortunately, many go undiagnosed until something goes terrible awry, at times wreaking havoc on one’s quality of life. In this Web exclusive interview, we offer information about diagnosing and treating thyroid disease from Dr. Jeffrey R. Garber, immediate past president of the AACE, chief of endocrinology at Harvard Vanguard Medical Associates, and associate professor of medicine at Harvard Medical School to accompany the Jul/Aug 2010 Post Investigates feature: “Thyroid: A Secret Culprit,” by Dr. Mehmet Oz.

Dr. Jeffrey GarberCourtesy AACE

Post: Who should be tested? Should it be part of a routine annual physical?
Dr. Garber: Thyroid testing was not part of President Bush Sr.’s annual physical. If you remember, his hyperthyroidism was diagnosed after he had problems breathing while jogging. Today, the American Thyroid Association recommends screening every five years, starting at age 35. Universal screening is not felt to be cost effective, but most experts would recommend testing women over 60, those with symptoms, and then targeted subgroups such as smokers or those with a personal or family history that includes autoimmune conditions.

Having symptoms of thyroid disease does not mean one has it. Making a diagnosis solely based on symptoms can be inordinately difficult. However, the diagnosis becomes straightforward by testing for it. People should target themselves based on symptoms. If you are aware of thyroid conditions and believe you are experiencing enough symptoms, it is easy for a doctor to justify testing.

In addition, doctors should target patients on the basis of other risk factors. For example, I would check someone who comes to my office saying “I feel perfectly well” if I felt a lump in their thyroid or there was a compelling history. Thyroid disease is very easy to overlook.

Post: Hypothyroidism seems to be frequently in the headlines. Any reason why?
Dr. Garber: I think we live in an era in which people are seeking holistic approaches—sometimes in a good sense, and sometimes in a way that they can get exploited, in my view. Thyroid disease lends itself to an approach by some practitioners that is generally symptom-based. The idea that a constellation of symptoms dictates a diagnosis, despite the lack of conventional proof, is where the tension comes in.

“What Your Doctor Won’t Tell You” is a great headline. What people don’t read about is the downside of taking thyroid hormone products. It is not a free ride. My major concern is the risk of over-treatment. The second concern is that by treating symptoms without a certain diagnosis, a doctor will overlook another important fact or condition. Hypothyroidism can masquerade as depression, but depression can masquerade as hypothyroidism, for example.

Then there is the cost of medicine and the cost of testing. I would never argue with someone who says they feel a certain way, but the data doesn’t support that treating marginal disease necessarily leads to benefit. If a person has borderline thyroid stimulating hormone (TSH) levels and no symptoms or compelling medical reason, such as planning a pregnancy, treatment may not be called for. If people are borderline and symptomatic, of course, try to treat it. But give it a limited time. Don’t just commit people to medicine and put them at risk for being over-medicated or being subject to costs and missing other possible reasons for what they are feeling. Fatigue is the 21st century complaint. We’ve got a lot of reasons to be tired besides our thyroid.

Thyroid drug analogs, or copies of thyroid hormone, are also being mentioned in the press. As recently as March 11, 2010, the New England Journal of Medicine featured a follow-up article on the subject. The concept is to design a thyroid hormone analog that has the benefits of, say, inducing weight loss or lowering cholesterol, but not the drawback of stimulating the heart.

Post: How far away is this concept from actual reality?
Dr. Garber: It was pretty far away until March 11. These researchers demonstrated that one particular analog did not affect the heart, and did lower cholesterol.

Another drug analog was studied in heart disease patients. Many lost weight, but 60 percent to 70 percent of the patients dropped out of the study because they felt lousy. Since the study was not designed to analyze weight loss, researchers couldn’t do a good job of finding out whether people ate less because they had a lousy appetite, which is a terrible way to lose weight, as opposed to eating less because their appetite isn’t as high.

Post: Is there a better test for thyroid hormone levels on the horizon?
Dr. Garber: Not at present. The current discussion is whether we need to take a new look at what is considered the normal range for TSH levels, depending on the situation. Data show that some TSH levels we now consider elevated—in the elderly—may not represent hypothyroidism. And, on the other hand, new guidelines are definitely going to set a lower TSH of approximately 2.5 as the upper normal in the first trimester of pregnancy.

Post: What is the link between thyroid hormone and heart attack and heart disease?
Dr. Garber: If you are profoundly hypothyroid, you often become hypertensive and hypercholesterolemic. As a result, your vessels become constricted as well. Hyperthyroidism affects the heart mostly through rhythm disturbances characterized by fast heart rates including atrial fibrillation and sinus tachycardia.

Post: Are there other new developments you would like to mention?
Dr. Garber: A recent discovery suggests there is a subgroup of people with a certain genotype that are more likely to feel better on a T3-T4 combination therapy. We are not at the point that we are going to start doing genetic testing on people, but the study found that certain people with a certain genotype were more likely to feel better on combination therapy. From a hot, new, and conceptual point of view, the discovery may provide yet another role for genetic testing.

Resources:

Click here for more information from the American Association of Clinical Endocrinologists and to find an endocrinologist near you.

Click here for an excerpt from “The Harvard Medical School Guide to Overcoming Thyroid Problems” by Dr. Jeffrey R. Garber, published by McGraw-Hill.

Thyroid Disease: A Post Web Exclusive The Saturday Evening Post

Preventing Sudden Cardiac Arrest

Every two minutes, someone collapses and dies from a malfunction in the heart’s electrical system—a condition called sudden cardiac arrest or SCA—and most of the victims have no idea they are at risk for the tragic event.

“That’s absolutely true,” says Dr. Richard Page, immediate past president of the Heart Rhythm Society and chair of the Department of Medicine at the University of Wisconsin School of Medicine and Public Health. “While a single individual’s chance of dying suddenly is quite small, there are so many people out on the street with some risk that the overwhelming majority of SCA victims have not ever demonstrated cardiac disease.”

The challenge for SCA researchers is two-fold, according to Dr. Page, who recently took time to discuss with us the latest findings on SCA risk factors and symptoms, as well as advances in preventing the heart emergency and saving lives.

“It comes down to two questions,” explains the heart rhythm specialist. “How can we better identify those at risk? And, given the fact we can’t identify all (or even most) of the potential patients: How do we address sudden cardiac arrest when it does happen?

Post: About 250,000 Americans die of sudden cardiac arrest every year. Who is at most at risk?

Dr. Page: Ongoing research confirms that heart structure is an important risk factor. People with an enlarged heart, or heart damage from a prior heart attack, are at higher risk for SCA than those with normal heart structure.

Remember, a heart attack isn’t a sudden cardiac arrest; a heart attack is death of heart tissue due to a blockage in an artery. A person who has a heart attack doesn’t lose consciousness, unless they have a cardiac arrest on top of that.

But it is clear from large, multi-center, randomized studies that many patients with prior injury to the heart or enlargement of the heart are better off with an implanted cardioverter defibrillator (ICD) than without one.

More recently, we have identified certain families who are at higher risk because of cardiomyopathy (a condition in which the heart is enlarged or thickened) or an electrical abnormality called long Q-T syndrome that can be seen on the EKG test. In addition, investigators are identifying the genetic abnormalities that underlie these conditions, as well as some genetic traits that may put one at higher risk of sudden cardiac arrest that are less subtle than abnormal heart structure or function.

Post: Is genetic screening for SCA risk available yet?

Dr. Page: Genetic tests for the general population are not ready for primetime because the genes don’t predict risk adequately. An abnormal EKG, for example, may or may not represent a significant risk to the individual. But we may have genetic tests for general screening five or ten years from now.

Likewise, there continues to be some debate as to the proper way to screen athletes. In Europe (particularly in Italy) everyone who participates in sports is screened with an electrocardiogram. The American Heart Association doesn’t yet recommend that. But they do advise that people be examined and asked about personal and family history. If someone has family members who died suddenly, he or she is clearly at higher risk for SCA and should be evaluated further.

Post: You mentioned that Italy recommends EKGs. Don’t we use echocardiograms (Echos) to screen U.S. athletes?

Dr. Page: We do both in some cases—but according to the risk. The most aggressive method of screening athletes is an exam, a history, an EKG, and an Echo. The echocardiogram defines heart structure. It provides a two-dimensional moving picture that shows chamber size and wall thickness. An EKG provides indirect evidence of structure. For example, alterations in electrical activity may suggest hypertrophy, or a prior heart attack. It doesn’t necessarily tell you if the heart is enlarged or damaged the way an Echo does, but it’s a simple and less expensive test.

Another point about universal screening: Some might say, “Well, let’s just screen everybody.” Well, the problem is that the tests aren’t perfect. If you screen a low-risk population, there will be some false positive results. I am concerned that the Italian protocols have excluded too many athletes. So universal screening of athletes might cause undue concern, and even cause some athletes at low risk to stop competing. Universal screening of low-risk individuals is a double-edged sword.

Are there any symptoms or warning signs of SCA?

Dr. Page: There may be symptoms in some cases. An important warning is passing out, or fainting. Most episodes of passing out are not a cause for alarm. But people should get checked out if they pass out while exercising, or if they experience palpitations and feel close to passing out. In addition, those with a history of heart attack or heart failure need to know their ejection fraction—a number that reflects the percentage of blood that is pumped from the left ventricle with each heartbeat. A good, efficient heartbeat pumps out more than half the blood in that chamber. When the heart is enlarged or scarred, however, the ejection fraction can drop below 35 percent or less. These people are at higher risk of SCA, and may be candidates for an ICD. A patient ought to be able to ask a doctor, “Is my heart enlarged, and if so, is there a number that would suggest I should have a defibrillator implanted?”

Post: What type of test is used to determine the patient’s ejection fraction?

Dr. Page: The most common test used to determine the ejection fraction is the echocardiogram. As I mentioned earlier, this test is basically a two-dimensional movie. Geometric calculations of the chamber volume just before and after the left ventricle squeezes suggest how much blood is pumped from the heart. For example, if the volume was a hundred before it squeezes and 50 after it squeezes, that’s an ejection fraction of 50 percent, which is good. But if the volume was 100 squeezing down to 75, that’s an ejection fraction of 25 percent, which is bad, and adds risk for sudden cardiac arrest.

Post: What should people do to lower their risk of SCA?

Dr. Page: If you have a personal or family history of recurrent pass-out spells, see a doctor. But all of us (whether or not we have heart disease) should care of our hearts. Discuss your cardiovascular risk factors with your doctor. Then, stop smoking, eat properly, exercise, control diabetes, and keep blood pressure and cholesterol in check to protect your heart and blood vessels.

Minimizing the risk of developing heart disease lowers the risk of heart damage and sudden cardiac arrest. Every day, I tell patients they ought to exercise. I don’t want to be a hypocrite, so I work out between 4:30 and 5:30 each morning, and then go to the office. I wish I ate a perfect diet, but I am trying!

Click here for more on SCA and an animation of the life-threatening emergency from The Heart Rhythm Society.

Watch for more from Dr. Page about saving lives with automated external defibrillators (AEDs) in a future Medical Update posting.

Preventing Sudden Cardiac Arrest The Saturday Evening Post

A: The Maze procedure is open heart surgery to eliminate rapid heartbeats. It involves making a series of incisions in the top portion of the heart, the atria. In experienced hands, the procedure is successful in more than 90 percent of patients. A far less invasive option, ablation, utilizes heart catheterization for the same purpose. While its success rates are somewhat lower (60 percent to 75 percent), catheter ablation is often recommended unless the patient is scheduled for surgery to bypass a clogged vessel or correct a valve during which the Maze procedure can also be performed.
To find an expert near you, visit hrsonline.org.

Surgery Corrects Heart Rhythm The Saturday Evening Post

A: It is safe for your pacemaker—but it may not be safe for your wallet!

Pacemaker Safety The Saturday Evening Post

A: Bypass vessels, particularly when veins are used in contrast to arteries, can clog or narrow (note President Bill Clinton’s recent incident), but it usually occurs years after the surgery. Damage to the bypass vessel during surgery sometimes triggers early scarring. In any event, an obstructed bypass vessel can often be propped open with a heart stent, a wire mesh tunnel that is inserted with a catheter, as Clinton had done.

Heart Scars The Saturday Evening Post

Psoriasis, an autoimmune disorder that triggers inflammation and overgrowth of skin cells, affects about 7.5 million Americans. Its symptoms include red, raised patches of skin that may itch, burn, and crack.

Having the chronic condition also increases the risk of developing heart disease, according to experts who explain that both are inflammatory conditions.

Fitness expert Jackie Warner remembers her grandmother’s struggle with psoriasis.

“My grandmother lived with psoriasis for many years,” Warner tells the Post, “and she was very embarrassed by it—especially during flare-ups. This led to a sedentary lifestyle, and resulted in significant weight gain. Her struggle motivated me to become a part of a comprehensive wellness program designed with psoriasis sufferers in mind.”

Warner developed a new fitenss program to help psoriasis sufferers.

The new online program and DVD, Fit in Your Skin http://www.fitinyourskin.com/, offers tips on fitness, nutrition, and reducing stress.

People without the skin disease can also benefit from the wellness plan.

“Fit in Your Skin offers fitness and nutrition guidance to help people get healthy and enjoy a more active lifestyle—whether or not they have the disease,” explains Warner.

Psoriasis, Exercise, and Heart Health The Saturday Evening Post

A: Severe blockages in coronary arteries can certainly cause a heart attack. Often, such blockages can be propped open with stents, which can relieve the angina. When people have good collateral circulation (new blood vessels bypassing the blocked ones and supplying the heart with blood), then nothing further may need to be done. Imdur (isosorbide mononitrate) helps relieve angina, Taking aspirin, a statin, an ACE inhibitor, and a beta blocker may be recommended, too.

Heart Attack Risk The Saturday Evening Post

A: It is always a good idea to get another opinion, especially when 
it comes to surgery. After all, it is 
your body, and you want to be sure the decisions made are the absolute best for you. Ask your doctor for another recommended cardiologist 
or visit the American College of Cardiology Web site (acc.org) to find someone near you. 

Blood Pressure Boosters

Get Second Opinion About Surgery The Saturday Evening Post

1. Monounsaturated fats in olive oil are associated with lower rates of heart disease and colon cancer, and reduced risk of diabetes and osteoporosis.

2. Quercetin in onions is one of the most powerful flavonoids (natural plant antioxidants). Studies show it helps prevent cancer.

3. Rich in carotenoids, carrots may help lower cholesterol, regulate blood sugar levels, and protect against coronary heart disease and certain cancers.

4. An excellent source of potassium and manganese, zucchini provides your body with vitamins C, B1, and B6.

5. Several population studies associate an increased intake of garlic with a reduced risk of cancers, including stomach, colon, esophagus, pancreas, and breast.

6. Processing makes the cancer-fighting compounds in tomato paste more available to your body because heat breaks down the plant’s cell walls.

7. The type of soluble, cholesterol-lowering fiber found in chickpeas is not only heart-healthy, but helps stabilize blood sugars—particularly important for people living with diabetes.

8. Fresh basil boasts a healthy dose of blood-clotting vitamin K, and its oils and extracts are said to possess antibacterial and antioxidant properties.

9. Omega-3 fatty acids found in salmon promote heart, skin, and joint health. A study in the British Journal of Ophthalmology suggests omega-3s could also protect against age-related macular degeneration (AMD).

10. Data from a study published in Diabetes Care reported that a dietary pattern incorporating more low-fat dairy products may lower the risk of type 2 diabetes in middle-aged or older women.

11. According to a USDA Human Nutrition Research Center on Aging in Boston report, blueberries may improve motor skills and reverse the short-term memory loss that comes with aging.

12. A limited study at the University of Memphis Exercise and Sports Nutrition Laboratory found honey to be one of the most effective forms of carbohydrate gels to ingest prior to exercise, also functioning well in post-workout recuperation.

Salmon with Chickpea Ragu

Salmon with Chickpea Ragu

(Makes 4 servings)

• 1 tablespoon olive oil
• 1 small onion, chopped
• 1 large carrot, peeled and diced
• 1 large zucchini, diced
• 2 cloves garlic, minced
• 2 tablespoons tomato paste
• 4 cups low-sodium chicken broth
• 1 (15.5-ounce) can low-sodium chickpeas, drained and rinsed
• 1 cup basil leaves, sliced into ribbons, plus more for garnish
• ½ teaspoon salt (optional)
• ½ teaspoon freshly ground black pepper
• 4 (6-ounce) skinless salmon fillets

Heat oil in large skillet over medium-high heat. Add onion and cook until soft, about 3 minutes. Add carrot, zucchini, and garlic and cook, stirring, until carrots are firm-tender, about 4 to 5 minutes. Add tomato paste and stir. Add chicken broth and chickpeas and bring to boil. Reduce heat to low and cook, covered, until liquid thickens, about 10 minutes. Remove skillet from heat, add 1 cup basil and ¼ teaspoon each of salt and pepper. Stir and cover to keep warm.

To cook salmon: preheat broiler. Season with remaining salt and pepper. Broil fillets for 8 to 10 minutes per inch thickness, turning once. Serve with 1 ½ cups chickpea ragu in shallow bowl. Garnish with basil.

Nutrition Facts

Per serving: 1 salmon fillet and 1 1/2 cups chickpea ragu

calories: 460

fat: 17 g (saturated: 2.5 g; monounsaturated: 7 g; polyunsaturated: 5 g)

protein: 46 g

carbohydrate: 30 g

fiber: 6 g

cholesterol: 95 mg

sodium: 550 mg

Ellie’s Blueberry Blast Smoothie

Blueberry Blast Smoothie

(Makes 1 smoothie)

• ½ cup nonfat milk
• ½ cup plain nonfat yogurt
• 1 cup frozen unsweetened blueberries
• 1 teaspoon honey

Put all ingredients into blender and process until smooth.

Nutrition Facts

Per serving: 1 smoothie
calories: 195
fat: 1 g (saturated: 0 g; monounsaturated: 0 g; polyunsaturated: 0 g)
protein: 10g
carbohydrate: 40 g
fiber: 4 g
cholesterol: 5 mg
sodium: 134 mg

Spice Things Up!

Krieger says spices such as turmeric (found in curry) and ginger provide anti-inflammatory effects—an observation especially important for anyone suffering from rheumatoid arthritis or inflammation-related ailments.

Healthier by the Dozen The Saturday Evening Post

“I was always a very active person,”

Narracci says. “But all of a sudden, my energy level started waning. The simplest physical activity—showering—wore me out.”

A battery of tests confirmed that the then 67-year-old was living with cardiomyopathy, or heart failure—a condition affecting about 5 million Americans—which leaves the heart weakened and unable to pump blood efficiently. One clinical tool used to assess heart function is the ejection fraction—a measurement of how well the heart is pumping. Normal ejection fraction is greater than 50 percent. However, if the heart is damaged, it can be significantly lower.

“I had an ejection fraction of 20,” the former teacher says. “My heart was not pumping enough blood or oxygen. I couldn’t do anything and lived like that for four years.”

Narracci was at a crossroad.

“I was in such a state of depression that I felt life just wasn’t worth living anymore,” he recalls. “I told my wife that I had to find a better way to live—if one even existed.”

The road to recovery began on the Internet, where he discovered that scientists were utilizing adult stem cells to treat heart failure, and that this promising approach was under way close to his Florida home. Moreover, the lead researcher—Zannos Grekos, M.D.—was delivering a seminar in nearby Naples. Narracci eagerly attended the presentation, spoke with former patients, then called that same day to schedule an appointment.

Adult Stem Cells: A Primer

More than a decade ago, Dr. James Thomson, director of regenerative biology at the Morgridge Institute for Research of the University of Wisconsin, derived the first stem cells from human embryos. At the time, scientists said the cells could be induced to turn into any type of tissue in the human body, and the medical world was abuzz with talk of a “human spare-parts kit.” Futurists predicted that repairing hearts and regenerating withered brain regions would be as easy as snapping LEGO bricks into place.

But because the extraction of those cells destroyed the embryos, an ethical and political firestorm arose. Since then, researchers like Dr. Grekos have worked to develop regenerative therapies from adult stem cells harvested from mature human tissue—no embryo required. What’s more, patients can often be treated with their own adult stem cells so there is little danger that their immune systems will reject the cells. If adult stem cells live up to their potential, that vision of snapping new body parts into place might not be so farfetched after all.

There’s a lot of high-profile back-and-forth between proponents of different types of stem cells. But where do various lines of stem cells come from, and what distinguishes them from one another?

Embryonic stem cells. Regenerative science’s basic building blocks, embryonic stem cells are extracted from a cluster of cells which gives rise to an embryo. Some think the cells will revive dying brain cells, repair damaged heart tissue, and mend damaged spinal cords. Critics say mining a developing embryo for stem cells is equivalent to murder.

Cord blood stem cells. Originally touted as a way to bypass ethical concerns associated with embryonic stem cells, stem cells extracted from babies’ umbilical cords haven’t panned out as researchers hoped. In part, that’s because the cells can’t be used in as many therapies as other types. But cord blood stem cell transplants can be a welcome alternative when doctors can’t find a bone marrow donor match for patients who suffer from leukemia.

Induced pluripotent stem (iPS) cells. Though not naturally occurring stem cells, these cells are proof that time travel is possible—at least in a biological sense. Here, scientists train regular adult cells to behave like stem cells. The recipe: Take a culture of normal adult cells (skin or blood cells, for example) and use a modified virus to insert one of several pluripotency genes that are active in embryonic stem cells, turning the developmental clock back to zero. When these modified adult cells are cultured, they can—like embryonic and adult stem cells—turn into other kinds of tissue, including cardiac cells.

Nonembryonic stem cells (adult stem cells). Our body produces these cells for use in everyday processes—fracture healing, tissue regeneration, and new skin growth. Researchers are finding ways to harvest these cells from patients, multiply them in culture, and use them to induce targeted regrowth of failing body tissues.

It was Leonard Narracci’s hope that research in this area could help his weakened heart.

Renewed Hope

In November 2008, Narracci met Dr. Grekos, associate clinical professor at Nova Southeastern University and director of the cardiology and vascular disease branch at Regenocyte—an independent biotechnology firm exploring the potential of adult stem cells. By treating the patient’s stem cells with specific growth factors that the body already uses, the research team was creating a new cell population “educated” to target the damaged area.

“In the past 10 years, we realized that the body’s stem cells possess the ability to regenerate damaged

tissue,” Dr. Grekos explains. “We’ve applied this technology to patients with heart damage.”

The procedure, which is international in scope, takes about one week. “We do the blood draw,” explains Dr. Grekos, who has performed more than 400 of these procedures. Five days after a blood draw, the transplant team reintroduces the stem cells back into the patient’s heart.

In December 2008, Dr. Grekos released findings from a small trial on the potential of adult stem cells in heart failure. “Before treatment, the average ejection fraction in participants was roughly 28 percent,” Dr. Grekos says. “After treatment, ejection fraction reached 40 percent or more. I should add that we have found that patients treated in the early course of their disease fare better.”

Some patients may require additional treatment, but to date, no harmful side effects have been noted.

Quality of life also improved.

“Patients now can walk to the beach, go grocery shopping, and play with grandkids,” Dr. Grekos reports. “We also reduced hospitalization due to congestive heart failure in treated patients by more than 80 percent.”

As with any new radically different approach, reaction from professionals in the field is mixed.

“At first, patients sought us out because they had no other options and nothing to lose,” Dr. Grekos says. “More recently, we’re getting referrals from cardiologists and pulmonologists. It’s becoming more mainstream.”

Because the procedure remains experimental, patients must pay out of pocket for the procedure, which can cost about $64,500—and there’s no guarantee of results.

Delivering on the Promise?

While some specialists talk of adult stem cells as a biological and moral holy grail—able to perform regenerative feats without the ethical baggage that drags down embryonic stem cell research—others disagree. They argue that adult stem cells are less “programmable” than embryonic stem cells, for instance—less conducive to being transformed into a variety of different tissue types.

Scientific results, as always, will tell the story. In the next few years, expect to see large-scale human trials of adult stem cell therapies. Those trials will be the ultimate acid tests, determining whether adult stem cells will go down in history as a failed experiment or as the foundation for a golden age of regenerative medicine.

But Leonard Narracci isn’t waiting for the next few years to tell the tale. For him, the future has already begun.

“One week after the procedure, I was absolutely astounded,” he says. “I felt my energy coming back. At my one-year follow up, my ejection fraction was 52 percent. Now, I trim palm trees, do yard work, and exert myself without getting tired. Life is worth living again.”

To learn more about the promise of adult stem cells in treating Crohn’s disease and reconstructive surgeries, as well as Dr. Grekos’ research, visit saturdayeveningpost.com/stemcell..

Post Investigates: Adult Stem Cells The Saturday Evening Post

1. “For Dr. Craig Venter, Discovery Can’t Wait!” [PDF]

Sequencing the human genome signals one of the greatest biological accomplishments of our time.

2. “Tobacco: Making a Killing” [PDF]

Anti-tobacco forces wage war against the powerful tobacco lobby and the rising pandemic of cardiovascular and other smoking-related diseases in the world.

3. “An Emergency Room in Your Chest” [PDF]

Dick Cheney is protected by one, as are thousands of other Americans. Implantable cardioverter defibrillators reduce the risk of having sudden cardiac death to almost zero.

4. “The Other Stem Cells” (See the Jan/Feb 2010 issue on newsstands) and “Breakthroughs on the Brink: Turning the Tide on MS”

Adult stem cells may represent the future of regenerative medicine—minus the controversy.

5. “The Post Investigates Cancer Vaccines”

Cancer researchers are working on “personalized” vaccines that prime the body’s immune system to go after a unique biological tag found only on tumor cells.

6. “Women at Risk” [PDF]

Findings on hormone replacement therapy bring clarity to a longstanding debate, but for the millions of women on hormone therapy, questions remain.

7. “A Cutting-Edge Surgery for Prostate Cancer” [PDF]

Robotic procedures are revolutionizing surgery and rapidly becoming the gold standard for minimally invasive surgery.

Top Medical News Stories of the 2000s The Saturday Evening Post

Regenocyte—an independent biotechnology firm—is exploring the potential of adult stem cells for cardiovascular and severe lung disease. For more about the experimental process from lead researcher Dr. Zannos Grekos and for patient stories, visit Regenocyte – Adult Stem Cell Therapy or call The Heart and Vascular Institute in Naples, Florida, at 866-216-5710.

News Worth Knowing

With so much adult stem cell research underway, it can be tough to keep track of it all. Here are more breakthroughs that are worth keeping an eye on.

Crohn’s Disease: Resetting the Immune System

For sufferers of Crohn’s disease, everyday life can feel like a never-ending bout of food poisoning. The disease arises when the immune system attacks the stomach and intestines, causing abdominal pain, diarrhea, and vomiting. No cure for the condition has yet been found, but Julian Panes, a gastroenterologist at the Hospital Clinic in Barcelona, Spain, thinks he may have hit on the most effective treatment yet: giving chronic Crohn’s patients an infusion of their own adult stem cells to “reset” their immune systems, ending the body’s misguided efforts to attack the digestive system.

The procedure Dr. Panes uses is a straightforward but grueling one. First, patients receive a round of chemotherapy to depress their immune systems, then blood is drawn to obtain a critical mass of adult stem cells. “We check that there is a sufficient number of cells to complete two procedures, just to make sure we are on the safe side,” Dr. Panes says. “After another round of chemotherapy, we infuse the cells into the patient, and the cells populate the bone marrow.” So far, he adds, the treatment seems to result in quick and effective healing of patients’ damaged digestive tissue. “We already have four patients that have been transplanted for more than a year, and three of them are completely without any symptoms. The disease made them miserable, and now they have a normal life.” Dr. Panes plans to begin large-scale clinical trials of the treatment within the next few years.

Reconstructive Surgery: The Next Level

Jeremy Mao, director of the Tissue Engineering and Regenerative Medicine Laboratory at Columbia University’s College of Dental Medicine, thinks he’ll someday be able to do lasting reconstructions of the breast and skin using soft-tissue implants studded with adult stem cells.

In a 2007 animal study, Dr. Mao demonstrated the viability of his technique. First, he inserted adult stem cells that generate fatty tissue into minuscule channels etched in hydrogel implants. He added a growth factor known to promote the development of blood-vessel tissue. Then he transplanted the hydrogel cylinders into mice. He observed that fatty tissue grew in the region of each cylinder—and that it stayed healthy because networks of blood vessels formed to support the new tissue. “When you put micro-channels in the hydrogel, they become a conduit for the blood vessels,” he says.

If Dr. Mao’s technique works in humans, surgeons may be able to perform successful breast reconstructions without silicone and design facial soft-tissue implants that actually hold their shape. Dr. Mao also thinks his method of engineering tissue with its own blood vessel supply will eventually help researchers who use stem cells to build replacement kidneys and livers. “The work we are doing could be informative for more complex organs.”

For more, read “The Post Investigates: The Other Stem Cells,” in the Jan/Feb 2010 issue of The Saturday Evening Post, on newsstands through February.  Subscribe online or purchase the issue at ShopThePost.com.

Adult Stem Cells: Web Extra The Saturday Evening Post