Nourishing and Fueling a Happy Heart

The risk of dying from a broken heart is real. Takotsubo cardiomyopathy (broken heart syndrome) presents with the weakening of the left ventricle arising from severe emotional or physical stress. This concept is captured beautifully for us clinicians is the quote by Emily Dickinson, "If I can stop one heart from breaking, I shall not live in vain." 

The human heart is an amazing organ. It pumps on average 103,680 times a day, with a sustained pulse of 72 beats per minute throughout a 24-hour period of time. The heart is perfusing the trillions of cells that comprise the human frame via approximately 60,000 miles of blood vessels. This process requires monumental quantities of ATP to sustain this level of repetitive contractility.

Yet we must realize the heart is more than a mechanical wonder – its complexity and the intricacies that it shares with other organs and the mind are highly integrated. Indeed, a healthy gastrointestinal tract is essential for the assimilation of the biochemical substrates and nutritional co-factors to sustain this energetic demand. In turn, a healthy mind is critical as well to control deleterious cardiac impacts such as imbalanced sympathetic/parasympathetic pathways.

Organic Acids Profile as a Measure of Cardiac Energy Metabolism

Quantifying the metabolic energy pathways that fuel the heart and other life-sustaining functions throughout the body would seem to embody the very foundation of functional medicine testing. Any and all tissues within the body – including the heart – can only manifest their full genetic potential with optimal energy production and reserves. It is this very point that leads me as a clinician to perform Organic Acids testing on a wide variety of patients with a wide array of presenting maladies.

As we celebrate heart month in February 2022, we are fortunate to have clinical tools to test our patients’ ability to fuel their energy pathways via Organic Acid Profile testing and individualizing diet to best mitigate inflammatory responses that have a deleterious impact not only on GI function but also on cardiac health. Furthermore, it’s critical to measure vitamin D status, which is often overlooked relative to cardiac health, integrity, and mortality. In this way, we can establish a solid scientific springboard for empowered cardiac and whole body thriving.

Without continuous energy production, it is estimated that the cardiac muscles will run out of ATP in 2 to 10 seconds. So how can we measure cardiac energy metabolism? In clinical practice, employing an organic acid profile (OAP), a simple first-morning dried urine test, can offer significant clinical insights for those seeking to gain perspective into cardiac energy metabolism, including fatty acids, glucose, lactate, ketones, pyruvate, and amino acid utilization.

The adult heart harnesses energy production via mitochondrial oxidative phosphorylation (95%) and glycolysis (5%). Forty to sixty percent of mitochondrial ATP production is generated from the oxidation of fatty acids, with the remainder arising from the oxidation of pyruvate from glucose, ketone bodies, and fatty acids. Organic Acid profile analytes that may offer insights relative to cardiac energetics include beta-hydroxybutyrate, adipate, suberate, ethylmalonate, methylsuccinate, succinate, alpha-ketoisocaproate, alpha-ketoisovalerate, alpha-keto-beta-methylvalerate, and methylmalonate.

Oxygen in the Hierarchy of Therapeutics

An individual can often live weeks without food, days without proper hydration, yet merely moments without air. Ensuring that patients are well oxygenated during exercise, rest, and sleep is a foundation to proper energy production and recovery and consequently to heart health as well. Whether an individual is seeking peak exercise performance goals or generalized wellness, quantifying sufficient pulmonary function and competency is of paramount importance. Simple use of pulse oximetry, spirometry, and home sleep apnea testing can save countless lives from cardiac events.

Yet, despite the heart’s need for oxygen, screening for apnea/hypopnea often escapes even the savviest functional medicine provider. We must employ an expanded risk-determination lens in evaluating patients, such as a history of orthodontic work, mouth-breathing during early childhood, asthma, tongue to jaw ratio, soft and hard palate anatomy, and much more. The reality is that compromised energy production by myocardial tissue is a critical contributor to most forms of cardiac disease. Organic Acid Profile analytes that may point to the presence of hypoxia include lactate and the pyruvate-lactate ratio, succinate, fumarate, malate, methylmalonate, and vanilmandelate.

A Healthy Mind Is the Road to a Healthy Heart

There is a definite link between cardiac health and mental health. Worldwide 300 million individuals are affected by depression with genetic and environmental contributing factors. It is clear from the peer-reviewed literature that pro-inflammatory cytokines can alter neurotransmitter metabolism and manifest in disruption of homeostasis due to their ability to penetrate the blood-brain barrier (BBB). Our ability to process and mindfully mitigate the impact of exogenous stressors that can burden the cardiovascular system is dependent upon control of one's mindset and thoughts, which is elusive when dealing with the clinical manifestation of anxiety and depression.

Our mental health is linked to the food we eat and if the food we eat is sabotaging our mental health then our cardiovascular system will suffer as well. Often, in regards to cardiac health, we only think in terms of eating too much fat or sugar. But what about our patients’ food sensitivities?

A 2018 article in the journal Nutrients discusses the role of IgG food reactivity and depression. An inflamed brain impacts our ability to process life events but also disrupts neurotransmitter production, sympathetic tone, and inflammation of the circulatory vasculature. Exploring the contribution of food sensitivity and allergies relative to cardiac risk is paramount not only from a mental health impact but also the role of shifts in the complement pathway and innate immunity on pro-inflammatory status. Heart disease is known to be an inflammatory disorder and anything that puts our bodies in a state of inflammation can lead to harm to the vascular system. In turn, both celiac and non-celiac gluten sensitivity have been tied to alterations of inflammatory pathways within the brain and body in total.

Ensuring that the foods our patients eat are not causing an inflammatory response that can harm the cardiovascular system is critical to promoting vascular health. Testing patients for food sensitivities, food allergies, and gluten reactivity are essential as we empower our patients to eat right for their unique biochemistry and immunology.

Full Body Medicine Approach to Cardiac Health

As functional medicine providers, we grapple with matters of the heart from a mind, body, and spirit level. I share with my patients, "There is no single organ that is more tangibly physical and yet metaphysical at the very same moment." In a world of stress, sorrow, and sadness, guarding one's heart literally and figuratively serves as a prime directive for longevity and happiness. We can use Organic Acids, allergy, and sensitivity, Celiac, and vitamin D testing from US BioTek to support our patients and guard their hearts.

References:

Saddik M, Lopaschuk GD. Myocardial triglyceride turnover and contribution to energy substrate utilization in isolated working rat hearts. J Biol Chem. 1991; 266:8162–8170.   

Wisneski JA, Stanley WC, Neese RA, Gertz EW. Effects of acute hyperglycemia on myocardial glycolytic activity in humans. J Clin Invest. 1990; 85:1648–1656.  

Gary D Lopaschuk GD, Ussher JR,  Folmes CDL, Jaswal JS, Stanley WC. Myocardial fatty acid metabolism in health and disease. Physiol Rev. 2010; 90:207–258.   

Karwi QG, Uddin M, Ho KL, Lopaschuk GD. Loss of Metabolic Flexibility in the Failing Heart. Front Cardiovasc Med. 2018; 5:68. 

Neubauer S. The failing heart--an engine out of fuel. N Engl J Med. 2007; 356:1140–1151. 

Dunn EC,  Brown RC,  Dai Y, Rosand J,  Nugent NR,  Amstadter AB, Smoller JW. Genetic determinants of depression: recent findings and future directions. Harv. Rev. Psychiatry. 2015; 23:1. 

Karakula-Juchnowicz H, Gałęcka M, Rog J, Bartnicka A, Łukaszewicz Z, Krukow P, et al. The Food-Specific Serum IgG Reactivity in Major Depressive Disorder Patients, Irritable Bowel Syndrome Patients and Healthy Controls. Nutrients. 2018 May; 10(5): 548.