Doctor’s Tip: For heart month, take care of your endothelium |

Doctor’s Tip: For heart month, take care of your endothelium

Dr. Greg Feinsinger
Doctor’s Tip
Dr. Greg Feinsinger
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Today is Valentine’s Day, and because it falls in February, February is called “heart month.” If you don’t already do this, you should consider being kind to your endothelium and encourage your loved ones to do the same.

The endothelium is an organ, one cell thick, that lines our arteries. It is the largest organ in our body and if spread out it would cover the area of six tennis courts. In their book “Beat the Heart Attack Gene,” Bradley Bale and Amy Doneen state that “some doctors call the endothelium the ‘brain’ of the arteries because it plays a vital role in regulating blood pressure and other vessel activities.”

Doctors used to think that damaged endothelium was an inevitable result of aging, but now we know that if people lead an optimal lifestyle, their endothelium remains “pristine” into their 90s and beyond, irrespective of their genetics. People who mistreat their endothelium end up with stiff, hardened arteries that have lost their elasticity. These people are prone to high blood pressure; heart attacks and strokes; peripheral vascular disease that affects their legs; kidney failure; erectile dysfunction; and dementia.

The endothelium makes nitric oxide, which causes arteries to dilate and keeps them healthy. Researchers can determine which factors damage endothelium and which ones support endothelial health by putting monitors on subjects’ brachial arteries (upper arm), feeding them different foods and seeing if the arteries dilate (good) or constrict (bad). Coronary (heart) arteries can be studied during open heart surgery.

Here are some things that increase production of endothelial nitric oxide, resulting in arterial dilation:

• Moderate exercise.

• Plant-based foods, particularly arugula, rhubarb, cilantro, butter leaf lettuce, mesclun greens, basil, beet greens, oak leaf lettuce, Swiss chard and beets (per Dr. Michael Greger in his book “How Not to Die”).

• Turmeric, walnuts, potassium, decaf coffee, green tea (if you put milk or creamer in your coffee or tea the benefit is negated).

• Alcohol-free red wine.

• Vinegar.

• ACE (angiotensin converting enzyme) inhibitors such as lisinopril and ramipril, and to a lesser extent ARBs (angiotensin receptor blockers) such as losartan, both of which are used to treat high blood pressure.

Here are a few of the things that have been shown to damage endothelium, causing arteries to stiffen and constrict:

• Sedentary lifestyle.

• Prolonged sitting. Even if you exercise, endothelial health is dependent on the increase in blood flow associated with moving about throughout the day.

• Too much exercise, such as running marathons and ultramarathons.

• Smoking.

• Animal products, including meat, fish, dairy and eggs. (Don’t believe it? Go to Dr. Greger’s well-referenced book “How Not to Die” or his website

• All added oils, including olive and coconut.

• Salt (sodium).

• Caffeinated coffee (it’s not the caffeine that makes this unhealthy per Dr. Greger, but some undetermined compound that is removed in the decaf process).

• Alcohol (sorry, I’m just the messenger).

• Sugar.

• Inflammation, such as rheumatoid arthritis and dental/gum issues.

Since today is Valentine’s Day, chocolate deserves special mention. Unfortunately, chocolate is usually combined with milk and sugar, which harm the endothelium, and milk chocolate has lots of calories. But dark chocolate and pure, unprocessed chocolate in the form of cacao powder (which is minimally processed) and nibs improve endothelial function. Bale and Doneen recommend 1 or 2 squares (7-10 grams) of at least 72 percent dark chocolate a day. The healthiest way to get the benefits of chocolate is to eat a teaspoon of cacao powder a day, which I put it in my tea in the morning. Eating a few cacao nibs a day is another healthy option. The powder and the nibs are more bitter than what you’re used to when you eat or drink chocolate, but you quickly get used to the taste.

The bottom line is this: Being kind to your endothelium has many health benefits, including preventing the main cause of death and disability in countries on a Western diet: heart attacks and strokes respectively. You can find many tasty healthy recipes in cookbooks such as “Oh She Glows,” “Isa Does It” and “Thug Kitchen,” (this one has some off-color language). Sure, you’ll miss salt, sugar and fat at first, but after 10-14 days you will lose your taste for them. Ardis Hoffman does plant-based cooking classes and can be reached at

Dr. Feinsinger, who retired from Glenwood Medical Associates after 42 years as a family physician, now has a nonprofit Center For Prevention and Treatment of Disease Through Nutrition. He is available for free consultations about heart attack prevention and any other medical concerns. Call 970-379-5718 for an appointment. For questions about his columns, email him at

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