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A Breakthrough in the Treatment of Heart Disease: Re-fueling the Energy-Starved Heart

Dear Reader, When a hospital attorney paid a home visit to former heart patient Mary, two things happened: she served him home-baked cookies... and he broke down and cried. Youll read Marys remarkable story in just a moment because it exemplifies an exciting breakthrough in modern heart health care. And it has nothing to do with expensive drugs or invasive surgery. Its all about getting to the real cause of a failing heart. Dr. Stephen T. Sinatra, who has been practicing cardiology for more than 35 years, has discovered nutritional missing links in the treatment of cardiovascular disease. Without these nutritional building blocks, even sophisticated procedures like angioplasty and coronary artery bypass surgery do not fully restore normal heart function. The result is that the same patients return again and again in a cycle of revolving door medicine. The patient is treated for one type of heart problem and sent home with a handful of prescriptions, only to return in a year or two with another complication. If the problem was fixed, why did overall heart function not return to normal? Thats the question that plagued Dr. Sinatra. In spite of the incredible advances in modern cardiology, he found that his patients were still suffering while he looked for more options. Even more frustrating was the fact that the first symptom for half of all people with heart disease is sudden cardiac death. Dr. Sinatra decided to study the basic function of heart cells and what makes them work. Over many years, he uncovered the biochemical secrets of heart health. And he learned how to restore heart function at the cellular level. He calls his approach metabolic cardiology. It is the future of the treatment of heart disease. Back to Marys Story... 79-year-old Mary was admitted to a community hospital in Connecticut in October 1996 with congestive heart failure and pneumonia. Except for childbirth, it was her first time as a hospital patient. She had always been a healthy, vibrant woman. Now here she was, comatose and dependant on a respirator to breathe. The prognosis was not good. But Marys son Bob, a PhD biochemist, wanted to start Mary
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on nutritional supplementation. He provided reams of research for the doctors, but they wouldnt even consider it. Bob tried to have his mother moved to another hospital, but the community hospital enlisted lawyers to block the transfer. The physicians on the case advised the family to discontinue life support. Marys family refused. Bob was frantic and began to call other cardiologists. When he reached Dr. Stephen Sinatra, who agreed to dispense the supplement, he hit another roadblock. He was advised that his mother might be too ill to transfer to another treatment facility. But Bob was willing to take the chance. The current hospital would not approve the supplement even though they were willing to let Mary die. Moving her was the only chance she had. The final decision was left to the hospital attorney, who reluctantly agreed to let Mary make the transfer. Mary survived the trip to Connecticuts Manchester Memorial Hospital where she was put back on full respiratory support with the same ventilator settings. The only change was the addition of the nutritional supplement, delivered each day by a feeding tube. On the third day, Mary began to come out of the coma. Within ten days, she had been weaned off the ventilator. In another four days she was sitting up in a wheelchair and using only supplemental oxygen. She was released from the hospital to an extended care facility. Mary was eventually able to go home and resume a normal life. One of her major projects was to reorganize a library of about 3,000 books which she did by herself! So she was glad to welcome the hospital attorney to her home. She even baked him cookies when he came to visit. This professional man, so many years younger than Mary, was overcome with emotion. He admitted that he almost refused her hospital transfer because he thought she was a hopeless case. In truth, Mary lived another six years and died of natural causes at age 85. All because her son knew that her heart was not worn out it just needed refueling. And that was possible with entirely natural supplements.1 The Energy Currency of Life Your heart is an electrical pump that needs a constant source of energy to function well. A healthy heart beats about 100,000 times per day and pumps about 5 quarts

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A Breakthrough in the Treatment of Heart Disease: Re-fueling the Energy-Starved Heart

Dr. Stephen Sinatra is a Fellow of the American College of Cardiology and former Chief of Cardiology at Manchester Memorial Hospital From 1977 through 2007, Dr. Sinatra was an attending

physician at Manchester Memorial Hospital (Eastern

Connecticut Health Network), where he performed both invasive and noninvasive cardiac procedures. His career at ECHN included nine years as chief of cardiology,18 years as director of medical education, seven years as director of echocardiography and three years as director of cardiac rehabilitation. His New England Heart & Longevity Center in Manchester, Conn., integrates conventional medical treatments for heart disease with complementary nutritional, anti-aging and psychological therapies that help heal the heart.
Source: drsinatra.com

An energy-starved heart is like a dying battery. When your car battery is low, the car will still run. But the headlights will be dim and there isnt enough power to run the heater and the radio at the same time. The same is true of the heart. It can keep going, but only at a reduced level. There is no energy reserve to bring the heart back to full function. And what is the source of the hearts energy? Its the same as every other cell of the body. Its a compound called adenosine triphosphate (ATP). Biologists call it the energy currency of life.3 ATP - the Miracle Energy Source ATP is a molecule that stores energy like a rechargeable battery. It is literally your cellular and your lifes energy supply. But the thing about energy is that it is not a compound. Its a force. It happens as a result of a chemical reaction. When the ATP molecule is broken down, it releases its energy and turns into adenosine diphosphate (ADP). All that means is that the molecule went from having three phosphates to two. It is the breaking off of the third phosphate that releases the energy force. Fortunately, the body can recycle ADP back into ATP by adding that third phosphate back. It does this by rebuilding the molecule with nutrients and oxygen delivered by the blood stream. Its a constant process that needs to stay in balance. If production and recycling of ATP slows down, the energy level of the cell drops, much like a battery losing its charge. Since energy is a force, you cant put it in a pill or a drink. You have to supply the raw materials the body needs to make and re-charge ATP. So ATP is not a vitamin or a mineral you can take with breakfast. Its constantly made and recycled in all your cells. And what Dr. Sinatra discovered was how to enhance and restore the ATP energy process. Most cardiologists worry about restoring the supply of oxygenated blood to the heart. And while thats important, oxygen is really just one stepping stone to ATP. Oxygen is vital, but its not the energy of life... ATP is. ATP drives the processes that use oxygen. When energy is depleted, even oxygen does no good just like gasoline in a car with a dead battery wont make it run. Oxygen is vital, but its not the energy of life... ATP is.

of blood every minute. Keeping the blood circulating through the body is what carries oxygen and nutrients to all your cells.2 Its important to keep the arteries open so blood flows freely through them. When arteries become narrow due to buildup of plaque, less oxygen and fewer nutrients reach the bodys cells. This condition is called arteriosclerosis or hardening of the arteries and is the underlying cause of heart attack and stroke. As the heart works harder to pump blood, pressure increases inside the arteries and can result in high blood pressure. This in turn leads to more artery damage. Its a destructive cycle that can go on for decades with no symptoms, which is why hypertension is known as the silent killer. But even when blood pressure is controlled, and even after arteries are opened with angioplasty or a stent, heart disease often continues to progress. As mentioned earlier, that was what bothered Dr. Stephen Sinatra. He felt like he was merely patching up his patients with drugs and therapies that worked in the short term, but never got to the real underlying problem. Dr. Sinatra began to look beyond traditional medicine for an answer. He became a certified psychoanalyst to explore the heart/mind connection and spent years studying nutrition. Gradually, the pieces of the puzzle began to fall into place and his patients not only got better, they experienced a better quality of life. He even had patients who were on a waiting list for a heart transplant, not only come off the list, but resume a normal lifestyle. What Dr. Sinatra discovered is this: sick hearts are starved for energy.
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A Breakthrough in the Treatment of Heart Disease: Re-fueling the Energy-Starved Heart

For instance, heart patients who undergo a stress test on a treadmill are pushed to exercise until the hearts demand for oxygen is exceeded. At that point the test is stopped and the demand for oxygen returns to normal. Once oxygen is restored, heart function should normalize, too, but patients often experience fatigue, weakness, and shortness of breath for several days after a stress test. Why does that happen when theres plenty of oxygen? Dr. Sinatra found that it was due to energy depletion - the fact that ATP was not restored as fast as it was used up. People with cardiovascular disease have impaired ATP production in the heart cells. Supply doesnt keep up with demand and the heart is always leaking ATP. Without adequate ATP, the cardiac cells cannot perform their usual processes and activities. The cells are just like a dying battery still alive, but not able to fully function. Dr. James Roberts, board-certified cardiologist, confirmed this with his patients as well. He discovered that cardiac wall motion remains abnormal for days to weeks after angioplasty or stent placement. It would seem that it should return to normal as soon as the oxygen supply is restored, but it doesnt. Why the delay? Because it doesnt return to normal until ATP function is restored, a process that can take days or weeks. So Dr. Roberts delays follow up tests for several weeks so that arteries that were successfully opened dont show a false positive of still being blocked when theyre not.4 The bottom line is that heart health is not just about oxygen its all about ATP. The Awesome Foursome ATP is synthesized in the mitochondria, the tiny energy factories in your cells. When ATP is broken down, it releases its energy and becomes adenosine diphosphate, or ADP. But because it is rechargeable, it can be recycled back into ATP as long as the cell has the proper food and oxygen supply. When the right amount of food and oxygen is not present, the ATP recharging process cant keep up with the energy demand of the cell. The amount of energy charge in the cell goes down. Your cells can also make ATP from scratch, but thats a process that takes days or weeks. Recycling and recharging is much more efficient. Either way, a lack of oxygen or the raw materials that form ATP will cause a deficit and a low energy situation. Cells require large amounts of ATP to keep the heart healthy. So what are the raw materials that help form ATPin the cells? Dr. Sinatra calls them the awesome foursome, and they each play a vital role in providing cellular energy. They are:

Coenzyme Q10 L-carnitine D-ribose Magnesium The mitochondria require a good supply of each one of these compounds to generate ATP. Lets take a closer look at how each one works. CoQ10 - Providing the Spark CoQ10 is a fat-soluble, vitamin-like compound found in all of your bodys cells. You can get it from foods like broccoli, cabbage, ocean fish, meats, and nuts, but mostly your body makes it internally. But like a lot of other nutrients, the body slows down in making
One study using CoQ10 for congestive heart failure followed 2,664 patients. After taking 100 mg of CoQ10 daily for three months, fluid retention was reduced by79%. Lung congestion was reduced by 78%, heart palpitations were reduced by 75% and shortness of breath was reduced by 53%. Source: Baggio E, et al. Italia multicenter study on safety and efficacy of coenzyme Q10, Mol Aspects Med 1994;15:S287-S294

CoQ10 around age forty. CoQ10 is an energy booster. It is what provides the spark in the mitochondria that sets off the release of energy by ATP. And since the heart is the pump that keeps the body going, it has a tremendous need for CoQ10 to circulate the blood. In fact, tissue levels of CoQ10 are up to ten times higher in a healthy heart than any other organ of the body. People with congestive heart failure (CHF) are often low in CoQ10. CHF occurs when the heart doesnt pump the blood very well. This causes blood to pool in parts of the body like the lungs and the legs. Studies have shown that CoQ10 can reduce leg swelling and reduce fluid in the lungs by energizing the heart to pump stronger.5

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A Breakthrough in the Treatment of Heart Disease: Re-fueling the Energy-Starved Heart

CoQ10 not only improves energy production in cells, it inhibits blood clot formation. People who take daily CoQ10 supplements within three days of a heart attack are less likely to have chest pain or another heart attack. They are also less likely to die of heart disease than those who do not get the supplement.6 CoQ10 is also a powerful antioxidant. Taking CoQ10 prior to heart surgery reduces damage caused by free radicals. It strengthens the heart and helps regulate the heart beat during recovery.7 Medications that deplete CoQ10 in the body include statin drugs (used to lower cholesterol) and beta blockers. Taking supplements can correct the deficiency and can also decrease the muscle pain often caused by statin treatment.8 Production of CoQ10 in the body really drops after age 80, which correlates with a higher incidence of congestive heart failure. The older heart is very vulnerable to stress and lack of oxygen, but one study showed that CoQ10 could increase the workload an older heart can sustain by 28%.9 And by the way, CoQ10 is the nutrient that was the turning point in Marys story in the beginning of this article. Once Mary was transferred to the hospital where she could receive the supplement, 450 mg of CoQ10 was administered to her each day through her feeding tube. L-carnitine - Turning Fat into Fuel L-carnitine is a vitamin-type nutrient you can get from foods like red meat and dairy products. It is also produced naturally by the body, although that production tends to decrease with age. L-carnitine helps the body produce energy by transporting fatty acids into the mitochondria to be burned for fuel. For the heart to keep beating 60 to 100 times every minute of every day, it needs a constant supply of fuel, so this energy transport is critical. On the way back out of the cell, L-carnitine removes toxic by-products that interfere with energy production. Its like a bus that carries vital compounds into and out of the cell. Its a critical process since, for these compounds, its the only way in or out. L-carnitine is also a vasodilator that helps keep blood vessels open. With better blood flow, oxygen gets delivered to the heart and all other parts of the body. needed to make the ATP reaction happen. But D-ribose is an actual ingredient. That means it is a building block that helps rebuild energy within the cell. Ribose is found naturally in the body, but it cannot be stored in cells. Cells actually have to make ribose every time it is needed. And because it is a sugar, it is metabolized quickly. About 97% of supplemental ribose will be absorbed into the blood within 30 to 120 minutes. From there, it is easily transferred to tissue for energy.12 Because of this fast processing, ribose is quick fuel for the heart. Ischemia (lack of oxygen) due to heart disease can cause a loss of 50% of the ATP energy pool in heart cells. Even when blood flow and oxygen are restored to a damaged heart, it can take up to ten days for the heart to rebuild its basic cellular energy. But when ribose is supplemented, the same process of energy recovery can happen in just one to two days.13 And a good oxygen supply allows the heart to work more efficiently. Because of the way L-carnitine improves cellular energy production, athletes often use it to enhance stamina and endurance. The added benefit is that Lcarnitine also helps clear excess lactic acid from the body. This aids in recovery since lactic acid contributes to muscle pain and fatigue. Reducing lactic acid levels can relieve fatigue in heart patients as well. D-Ribose - Sweetness in Action D-ribose is a kind of sugar produced by the body. It is found in every cell and is often used as a medicine because it boosts muscle energy. It also helps prevents cramping, pain and stiffness after exercise.11 Unlike the other compounds of the awesome foursome, D-ribose is a structural component of ATP. The other three compounds are precursors - elements L-carnitine and Heart Attack
160 patients hospitalized with a heart attack were divided into two groups. 80 received 4 g of L-carnitine a day for 12 months. 80 received a placebo. This was in addition to standard treatment. All subjects had improvements in blood pressure, cholesterol and heart rhythm. However,the mortality rate in the L-carnitine group was 1.2% compared to 12.5% in the placebo group.10

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A Breakthrough in the Treatment of Heart Disease: Re-fueling the Energy-Starved Heart

Researchers tested ribose in a study of twenty men with chronic coronary artery disease and angina. All of the men took a treadmill stress test. For the next three days, half of the men took ribose while the other half were given a glucose placebo. When the stress test was repeated, the ribose group stayed on the treadmill much longer. The onset of angina in the ribose group was delayed longer as well.14 Ribose also helps restore energy to the heart after surgery. Surgical procedures put great stress on the heart and patients often have a drop in cardiac function following the surgery. In one study, patients were given ribose intravenously for seven days after aortic valve repair. Only 20% of the ribose group showed a drop in cardiac performance (measured by a fall in ejection fraction of at least 15%). In the group receiving glucose alone, 85% had a drop in cardiac function. Ribose gave the heart more energy to pump easier.15 Ejection The thing to remember is Fraction that ribose is not stored in
The amount of blood volume pumped from the heart with each beat is called Ejection Fraction (EF). Normal EF is50 - 70%, which means the left ventricle ejects 50-70% of the blood with each heartbeat and the rest refills the ventricle.

Magnesium is found in green vegetables like spinach and whole grains, but most people dont get enough magnesium from food. Excess caffeine and alcohol washes magnesium out of the body, as do diuretics. People with congestive heart failure are often deficient in magnesium due to using diuretics to control fluid retention. This can lead to irregular heartbeat unless magnesium is replenished.18 1 + 1 + 1 + 1 = A whole lot more than four! The four pillars of heart health CoQ10, L-carnitine, D-ribose, and magnesium are vital elements in the production of ATP (the source of energy) in every cell. They are particularly important in fueling the heart. So its not surprising to find that people with heart problems are deficient in these nutrients. But if each of these nutrients is a powerhouse on its own, its amazing what happens when they all work together. They can literally refuel and recharge an energy-starved heart. None of the nutrients work alone. Each one depends on some function of another one to create a process that releases energy. It takes a constant supply of energy for the heart to pump. Energy is life. Dr. James Roberts credits the four nutrients with keeping his patients out of the hospital. At one time, Dr. Roberts felt that nutritional medicine was unproven. But after observing improvements in a friend who used CoQ10, he began to give it to his own patients. In combination with L-carnitine, his patients began showing remarkable improvements and he got fewer calls in the middle of the night. Eventually Dr. Roberts added D-ribose to his patients treatment regimens and saw even more improvement. In fact, he went from being the number one cardiology emergency room admitter in his primary hospital, to rarely even having a patient in the hospital at all! His heart failure readmission rate is almost zero and he seldom has to get out of bed in the middle of the night to see a sick patient.19 Dr. Sinatra comments that he doesnt know how he ever practiced cardiovascular medicine without these four vital nutrients. They make such a difference in the quality of life for his patients that he would feel like he was withholding vital information if he didnt use nutritional therapies. One of Dr. Sinatras patients, Joe, was almost sixty when he first treated him in 1977. Joe had severe angina but was not a good candidate for bypass surgery at the
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The thing to remember is that ribose is not stored in the cells. If you decide to supplement, you will need to take ribose every single day. It can increase cellular energy, but it is quickly used up. You cant take ribose just until you feel better and then stop, because as soon as you stop, theres no supplemental ribose left in your system. Magnesium - the Rescue Mineral Magnesium is the fourth most abundant mineral in your body. It is most concentrated in the mitochondria and plays a vital role in ATP production. It also helps keep blood vessels open by relaxing the artery walls. Because of the relaxation effect, magnesium can help lower blood pressure. A study where participants took 300mg of magnesium a day for three months confirmed this. The systolic/diastolic pressure in those who took the magnesium fell 17.1/6.7 mmHg compared to 3.4/0.8 in the placebo group.16 Adequate intake of magnesium also lowers risk of sudden cardiac death. Researchers at Brigham and Womens Hospital of Harvard Medical School reviewed 26 years of data from The Nurses Health Study. They found that those with the highest blood levels of magnesium had a 37% lower incidence of sudden cardiac death.17
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A Breakthrough in the Treatment of Heart Disease: Re-fueling the Energy-Starved Heart

time. Dr. Sinatra prescribed beta blockers and a pacemaker. Then in the mid-80s, he put Joe on a multivitamin and CoQ10. When Joe had a follow up angiogram in 1987, it showed that he wasnt any worse than he had been ten years before. One artery was actually improved. As Dr. Sinatra learned more about neutraceuticals, he added them to Joes treatment plan. Joe started on L-carnitine in the late 90s and D-ribose in 2004. As a result, Joe is now in his 90s and his overall quality of life has gotten better with age. He eats a healthy diet and walks two miles a day. He sometimes has shortness of breath, but is in better shape than most of his colleagues.20 Re-Energizing the Heart at the Cellular Level The four vital nutrients of energy production, CoQ10, L-carnitine, D-ribose, and magnesium, have held up under intense study. They have proven to re-energize the heart in numerous research projects. Together, they can nurture, fortify, and strengthen the cellular structure of the heart. CoQ10 is the spark that initiates energy metabolism. L-carnitine escorts fat into the cell to be used as fuel and eliminates toxins.

300 - 360 mg per day for mild or moderate congestive heart failure. 360 - 600 mg per day for more severe heart disease.

Once improvement is achieved, the dose may be lowered. You should work with your physician to find a therapeutic dose so that improvement is maintained. L-carnitine L-carnitine is not very bioavailable. You will absorb it best if you take it in smaller doses, three times a day, on an empty stomach. Some companies combine CoQ10 and l-carnitine in one supplement. General doses are: 400-800 mg daily to prevent deficiency (especially for vegetarians). 500-1,000 mg two to three times per day if you have heart disease. 1-2 grams per day for arrhythmia. 2-4 grams per day for congestive heart failure or following a heart attack.

D-ribose D-ribose is a building block for ATP and helps restore energy reserves quickly. Magnesium is the energy mineral and is crucial for any reaction involving ATP. Each compound alone is valuable, but together, their effect on heart health is exponential. Here are some general guidelines for adding them to your supplement regimen... CoQ10 Water and fat-soluble forms of this compound are better than dry forms because more of the nutrient will get to the bloodstream. Suggested doses are: 90- 150 mg per day to prevent cardiovascular disease. 180 - 360 mg per day for heart patients who suffer angina, high blood pressure, or arrhythmia are taking statin drugs. Any amount of ribose you supply to energy starved cells will give them a boost. How much you need depends on what you want to accomplish. Athletes wanting to offset fatigue from strenuous workouts can benefit from a dose of 1 teaspoon (5 grams) before and after the workout. Patients with heart disease or circulatory problems need much more since ribose gets used up very quickly often in about 30 minutes. A higher dose is needed if the ribose has to work its way through clogged arteries to get to tissue. Ribose is water-soluble and can be added to any beverage. General doses are: 5-7 grams per day for people engaged in strenuous activity. 7-10 grams per day for those with congestive heart failure or angina, or those who are recovering from heart attack or heart surgery.

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A Breakthrough in the Treatment of Heart Disease: Re-fueling the Energy-Starved Heart

10-15 grams per day for patients with advanced heart disease and those waiting for a heart transplant. Note: split doses into 5 gram portions throughout the day rather than taking it all at once. Magnesium D-ribose: 7-10 grams per day A great majority of people are deficient in magnesium regardless of dietary intake. If your diet doesnt include a lot of green leafy vegetables and fresh fruit, then you may be low in magnesium. A good baseline is to supplement with 400 mg per day. Try magnesium citrate since it is very inexpensive and is easily absorbed in the body. Heres a Quick Guide for Using the Four Pillars of Heart Health... General Protocol: CoQ10: 90-150 mg per day L-carnitine: 250-750 mg per day D-ribose: 5 grams per day Magnesium: 400 mg per day High Blood Pressure: CoQ10: 180-360 mg per day L-carnitine: 500-1000 mg per day D-ribose: 5-10 grams per day And making sure your heart has a steady energy supply cannot be underestimated. The most fundamental process that fuels your heart is the release of energy when ATP breaks down in the cell. Anything you do to support that process will make your heart beat stronger and more efficiently. You cant take ATP in a pill, but you can give your cells what they need to make it happen. Even surgical procedures like coronary artery bypass and angioplasty do not cure heart disease. Its important to look at your lifestyle to see if youre doing all you can to take care of your heart. Diet and exercise are always factors within your control. So is stress management. Magnesium: 400-800 mg per day Note: you should work with your personal physician if you have any sort of heart disease and take medication for it. Generally, nutritional supplements are safe taken in appropriate doses, but they may have an interaction with some medications. A Steady Energy Supply Heart disease remains the number one cause of death for both men and women in the United States. Magnesium: 400-800 mg per day Diagnosed Heart Disease: CoQ10: 180-360 mg per day L-carnitine: 1000-2000 mg per day

Sources: http://hyperphysics.phy-astr.gsu.edu/hbase/biology/atp.html Sinatra S, The Sinatra Solution, Basic Health Publications, Inc., 2005 1. Sinatra S, The Sinatra Solution, Basic Health Publications, Inc., 2005 2. Heart and Circulatory System - How They Work, MayoClinic.com, Aug 7, 2009 3. http://hyperphysics.phy-astr.gsu.edu/hbase/biology/atp.html 4. Sinatra S, The Sinatra Solution, Basic Health Publications, Inc., 2005 5. 6. 7. 8. Ehrlich S, CoEnzyme Q10, University of Maryland Medical Center, 3/20/09 9. Rosenfeldt F, F Miller, P Nagley, et al. Response of the senescent heart to stress: Clinical therapeutic strategies and quest for mitochondrial predictors of biological age, Ann NY Acad Sci. 2004;1019:78-84 10. Sethi R, et al. Improvement of cardiac function and beta-adrenergic signal transduction by propionyl L-carnitine in congestive heart failure due to myocardial infarction. Coron Atery Dis, 2004. 15(1):p 65-71 11. Ribose, WebMD.com, http://www.webmd.com/vitamins-supplements/

ingredientmono-827-RIBOSE.aspx?activeIngredientId=827& activeIngredientName=RIBOSE 12. Sinatra S, The Sinatra Solution, Basic Health Publications, Inc., 2005 13. Sinatra S, The Sinatra Solution, Basic Health Publications, Inc., 2005 14. Pliml W, T von Arnim, C Hammer, Effects of ribose on exerciseinduced ischaemia in stable coronary artery disease, Lancet 1992;340:507-510 15. Vance R, S Einzig, K Kreisler, et al. D-Ribose maintains ejection fraction following aortic valve surgery, FASEBJ 2000;14(4):A419 16. Fedich J, Magnesium and Heart Health, examinor.com, Sep 4, 2009 17. Daniells S, Magnesium reduces sudden heart failure risk for women: Harvard study, Nutraingredients.com, Nov 29, 2010 18. Iezhitsa IN, Potassium and magnesium depletions in congestive heart failure--pathophysiology, consequences and replenishment, Clin Calcium. 2005 Nov;15(11):123-33 19. Sinatra S, The Sinatra Solution, Basic Health Publications, Inc., 2005 20. Sinatra S, The Sinatra Solution, Basic Health Publications, Inc., 2005

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