MME AND THE EVOLUTION OF CARDIOVASCULAR MEDICINE
When I began my training in Cardiology, hypertension was defined as a diastolic pressure above110, high cholesterol began at 300 mg/dl, and in the discipline of Cardiology, anatomy was king. We didn't know anything about electron spin, physiology was left in the textbooks, but I did learn about coronary anatomy and how to evaluate it with coronary angiography, and I did a lot of angiograms. Back then, the classic teaching was that all phenomena of coronary disease, the patient's current symptoms, and their risk of future adverse events, was related directly, and related solely, to the degree of arterial blockage seen on the coronary angiogram. We wanted to know the all important percent stenosis (the degree of narrowing in comparison to a normal segment of the vessel) in the three arteries serving your heart. Based upon this "Gold Standard" we would make recommendations as to treatment.
ANATOMY IS KING
In a sense, we did pay attention to physics, as the laws of physics tell us that flow through a tube becomes impaired only when the tube has been narrowed to half its original diameter. The law of physics do apply to coronary flow. Narrowings involving less than 50% of a vessel's diameter due not retard blood flow to the heart muscle, and will not show up as abnormal on a stress study. If you had a 50-70% narrowing, your stress study would return abnormal, and we would consider your symptoms to be heart related. Medications aiming to decrease your heart's need for oxygenated blood (drugs to lower your BP, HR, and the vigor of cardiac contraction) would be prescribed - the idea here was to compensate for the reduction in oxygen supply by decreasing the heart's need for oxygen. If the narrowing was >70%, you might be experiencing symptoms with minimal effort, and we would recommend a revascularization procedure, to "protect you" from the heart attack that your angiogram predicted. Angioplasty would be utilized in the situation of single vessel blockage, direct bypass surgery in the setting of multivessel disease, and if your heart was too far gone for these conventional methods, then we would offer you a cardiac transplantation (why not, Medicare paid for it).
If you had a <50% narrowing, your stress studies would return normal; we would tell you that your chest pain could not be coming from the heart, and that your outlook was good. This "anatomy is king" approach made sense when it was taught to me 25 years ago, but this concept has since been abandoned, based on the science that has come out since then - maybe even early on I had a sense that anatomy was a king with no clothes.
"CROCKS" WITH A HEART ATTACK
Funny thing, some of these people with 30-40% narrowings ("unimportant" to us back then) were experiencing classic anginal, an effort related, rest or nitroglycerin responsive chest pressure. Of course, the laws of physics and the counsel of our professors told us that this chest pain could not be coronary related, so we told them that their pain must be musculoskeletal, or GI in nature, while privately we considered many of these patients to be crocks.
Funny thing, actually not really a funny thing, sometimes these crocks would have a heart attack and die. Their family would not buy my "laws of physics" explanation, as to how their "insignificant" coronary narrowing could not be the culprit, so we would hypothesize "viral attack" - but this didn't sound right and it didn't feel right. Regarding the patients with severe anatomic narrowings, here we could "fix" their anatomy with a balloon angioplasty, or bypass the blockage with vein grafts. Here again, dealing with the "anatomy problem" didn't always work. While many patients did great (don't get the idea that I think bypass surgery and angioplasty are bad ideas - hundreds of my patients have benefited from these procedures), we saw that 40% of balloon angioplasty patients renarrowed within 6 months, and we observed that 1 in 3 vein grafts would close down the first year. If anatomy was king, and revascularization our ace, then why were these patients falling out of the deck? Dealing with anatomy alone was not solving the problem in many of our patients, because the key problem is not anatomy, but an abnormality in physiology. It is an abnormality in physiology that caused the coronary anatomy to be abnormal in the first place, and which causes the narrowings to progress. It is an abnormality in physiology, arterial biochemistry, that allows vasospasm to occur, bringing out symptoms, and which causes platelet aggregation and clot formation to occur, precipitating the inevitable heart attack - we began to learn and we began to see more clearly.
CAN THE ANGIOGRAM BE NEAR-SIGHTED AND STUPID?
We began to see that coronary anatomy was not the king, and that the coronary angiogram could be "near-sighted" and "stupid". I was taught that atherosclerotic narrowings (also known as plaque) built up slowly and narrowed your arteries in a concentric fashion, such that interpretation of the angiogram would gave an accurate measure of plaque size and functional significance. In trying to understand why patients with 30% coronary narrowings were actually experiencing angina and developing heart attacks, we learned that plaques could grow eccentrically and erode into the vessel wall, such that a large, 70% plaque, might appear on the angiogram as only a 30% narrowing (the coronary angiogram is thus near-sighted). If we looked at coronary angiograms obtained on patients who three years later sustained a heart attack, we learned that it was the 30-50% narrowings, as opposed to the 70-90% plaques, that closed off to cause the majority of the heart attacks, especially the large heart attacks (high-grade narrowings typically lead to collateral formation, so when they close off, little damage occurs - this is discussed further in the EECP section). The "smart" IVUS (IntraVascular UltraSound) catheter was devised, allowing a direct measurement of plaque volume. The IVUS determined plaque volume correlated better with a patient's symptoms and future outcome than did the angiographic percent stenosis. But IVUS technology, still an anatomic measurement, could not explain why one patient with a 70% narrowing was experiencing angina at rest while another patient with an anatomically similar 70% narrowing could play singles tennis without difficulty. Anatomy as king could not explain why some patients with low-grade plaques, even low-grade plaques by IVUS, had angina, and it didn't explain how moderate narrowings suddenly destabilized and closed down (the angiogram, even the IVUS angiogram, does not think, it only measures anatomy) - these moderate but still pre-lethal narrowings were given the name "vulnerable plaque", not an anatomic description. Also, the therapies that typically improve outcome the most, such as antioxidant vitamins, fish oil, and statin lipid-lowering agents, have little effect on your anatomy, but still they keep you out of trouble. The anatomy is king paradigm can not explain vulnerable plaque any better than it can explain how Vitamin E decreases the coronary patient's 2-year heart attack rate by 57% and how Vitamin C decreases your 10-year death rate by 46% - So anatomy is no longer the king and the angiogram's status as the gold standard has been called into question. But if anatomy is no longer king, who is the king?
PHYSIOLOGY IS KING - HAIL THE ENDOTHELIUM
Anatomy has been deposed and physiology has risen to the throne, and the endothelium is physiology's messenger and marker. Dysfunction of the endothelium is what puts the "vulnerable" into "vulnerable plaque" - it is the functional status of the endothelium that determines whether you live or die from cardiovascular disease. The endothelium refers to the single layer of cells that line the arteries, veins, and capillaries of your body. If you scrape the endothelial lining off your vasculature, you would have a mass of tissue the size of the liver. Think of the endothelium as a hormone producing factory. Multiple vasoactive molecules are made, also known as angiochemicals, but the most important is Nitric Oxide (NO). NO tells the muscular wall of your arteries to relax, leading to wide open arteries that resist spasm. NO also functions as a vascular antioxidant; it prevents the initiation and build up of plaque, and it is NO that prevents blood platelets from aggregating and clotting off your coronary arteries. It is Nitric Oxide that provides the "teflon coating" of the healthy arterial wall. The nitroglycerine (NTG) tablet that angina patients take simply provides them with a jolt of exogenous NO. Those of us who can manufacture NO don't need to take NTG. Those of us who can manufacture NO, as Mother Nature intended, will never get heart disease. If we cannot make NO, if we have endothelial dysfunction, then we are doomed. A man with 80% narrowings in all three arteries but preserved endothelial function may do well for years, while his colleague with three 50% narrowings and a shot endothelium is not as well fated. EECP, actually a biochemical cardiology device, doubles your NO level; this is one of the mechanisms by which EECP resolves your pain.
BIOCHEMICAL CARDIOLOGY
So anatomy is out, physiology is in, and the key is to support the endothelium. Better stated, the key is to support the biochemistry of the endothelium, and while were at it, why not support the biochemistry of the heart muscle (myocardial) cells, as well as every cell in your body. This makes sense. This makes more sense than addressing an abnormality in your physiology with repetitive procedures designed to change your recurrent abnormal anatomy. If I could, I would biopsy your endothelium and your heart muscle, and ask - what vitamins, minerals, fatty acids, and co-factor substances that are supposed to be in the cell are not in the cell? - then I would give you these agents, aiming to restore your physiology to normal. Of course, I'd also have to ask - what toxic substances that aren't supposed to be in the cell have made their way into the cell, poisoning the enzyme systems that govern your physiology - then I'd begin a program to remove these toxins from your cells. If I could do this, take out the poisons and fill your cells with the good stuff, then I could stabilize or reverse any non-genetic cardiovascular disease state, or any disease state for that matter, that you could throw at me - that, of course, is what we try to do in this medical practice.
ANATOMY ALTERATION ALONE IS A FAILED POLICY
I trained until I was 30 to get good at coronary angiography, and I've done a lot of them. During my "anatomy was king" years, I admitted lots of patients to the hospital, did lots of procedures on them, and then handed them on to other doctors for other anatomy altering procedures "that they deserved". If their kidneys clogged up from the X-ray dye that we used, I would call in a nephrologist, if the blood thinners made their ulcers bleed, then we would consult a gastroenterologist, and if their bypass surgery was complicated by a stroke, then a neurologist would get involved. These consultants might need to do procedures of their own, to evaluate for anatomic abnormalities in "their" organ systems. The patients would usually recover, as we are good at this anatomy altering stuff, but more often than not, we'd see them again, typically via the emergency room. We were following a policy of anatomy alteration, without any attention to fixing their physiology, so our fixes didn't last - the patients would come back with restenosis, graft failure, or a new artery would block up - this approach to cardiovascular disease, the "standard of care", was really revolving door cardiovascular medicine. We were applying sophisticated band aids but we weren't actually trying to heal the physiologic wound - it was always a matter of time until the band aids would fall off.
THE REVOLVING DOOR BEGAN TO SLOW DOWN
I didn't want to learn about biochemical cardiology or preventive measures (I was busy doing procedures) but a patient who would not take no for an answer basically forced me to read three papers - one on antioxidant vitamins, one on fish oil, and one on Co-enzymeQ10. These papers talked about dealing with anatomic heart disease by dealing with the physiologic abnormalities that caused it in the first place. This approach, which I will term the paradigm of biochemical cardiology, leads to treatment regimens that resolve the patient's symptoms, and decrease the likelihood that the patient will return with a new or recurrent problem. I tried some of these treatments (with great apprehension I might add) and what do you know - they worked. All of a sudden I was admitting fewer and fewer patients, patients were not returning with new problems, and I was getting fewer phone calls at night - hooray! (15 years ago I was tied with two older MDs as the cardiology admitting leader at my primary hospital - these days my patients are much sicker but hospital admits are few and far between - double hooray!). My practice changed as I got more and more involved in biochemical medicine, in dealing with the causes, not just the anatomic consequences, of my patients' abnormal cardiovascular biochemistry. Patients who had not done well with standard, anatomy based cardiology, whose bypass grafts had closed down prematurely or whose angioplasty sites had renarrowed, would ask to be seen - they needed "something more". My practice began to focus on the patient with recurrent or inoperable coronary artery disease. We got involved with EECP seven years ago, as the 22nd center in the US. To ensure the best outcome for my patients, and to help those too-far-gone for EECP, I learned about other approaches to biochemical medicine. I joined a number of complementary medicine professional societies (ICIM, IAOMT, IOMA, and ACAM), took their courses, and over the years had the opportunity to present at their meetings. Open minds catch ideas, and I've caught a lot from some of the brightest minds in medicine. I learned about chelation therapy, phosphatidylcholine to promote reverse cholesterol transport, nanobiotic therapy, mercury toxicity - the list goes on and on - all these techniques reverse the disordered biochemistry that made you ill in the first place. Your symptoms improve or resolve, and as we actually addressed the underlying biochemical cause of your misery, we decrease the likelihood that your misery will return. My patients are doing better, much better in fact, then during the reign of anatomy.
BIOCHEMICAL CARDIOLOGY ALONE HAS ITS LIMITS
OK - so now I'm practicing biochemical cardiology, giving you biochemicals that you lack (antioxidants, metabolic co-factors, etc.), and giving you biochemicals designed to remove the harmful biochemicals that you have but shouldn't have (e.g.. removing mercury with DMSA). A goal of biochemical cardiology is to assist your heart cells in the production of energy - the ability of the heart cells to convert the caloric energy of dietary fatty acids and glucose into the ATP energy packets that the cell uses to contract, relax, and carry out its useful biochemical functions. Most patients respond well to this approach, but some don't. Some are to far gone. Some have lost too much heart muscle, from one or more heart attacks. Some are too toxic to assimilate the biochemicals that we give them. Some are too toxic to detoxify; their detoxification pathways are terminally toxified (is this a medical alliteration?). Some patients just don't respond to the best combinations of biochemical support and EECP that I can construct for them - and remember, revascularization didn't work for them and their cardiac drugs are already maxed out. Why aren't these patients getting better? What do they need that I am not providing them? Dr. Bonlie gave me the answer - its energy, energy at the molecular level.
BIOCHEMICAL CARDIOLOGY MEETS MAGNETIC MEDICINE
I'd heard about Dr. Bonlie; some guy with a magnetic device that stimulated intracellular energy production and stem cell proliferation. This sounded a little far-fetched to me. After all, what does magnetism have to do with cardiovascular biochemistry. I met Dr. Bonlie in September 2003 at a meeting in Phoenix. We were both speaking, Dr. Bonlie on MME while my topic was Ribose, a key co-factor in cellular ATP regeneration. Dr. Bonlie spoke before me, and I was thinking more about giving my talk that listening to his, and I didn't understand everything he said, but it was sure intriguing. The next weekend we were both speaking at another meeting, this one in St. Louis. My topic was reverse cholesterol transport with phosphatidylcholine, another biochemical approach. This time I spoke first, so when Dr. Bonlie presented, I was all ears. I grabbed Dr. Bonlie at the break and that afternoon we spoke for an hour. I learned a lot in that hour, and I continue to learn a lot from Dr. Bonlie (I call the poor man every other day. I think his receptionist is getting frustrated with me but he always takes my calls). This guy with a magnetic device will be invited to Stockholm within the next 10 years - I'll bet my electrons on it.
A NEGATIVE MAGNETIC FIELD CREATES BIOCHEMICAL CARDIOLOGY
Just how MME works is discussed in more detail elsewhere on this site, but suffice it to say, while I am giving you good and taking away bad biochemicals, aiming to help your cells generate more energy, often struggling to do so, and sometimes without success, Dr. Bonlie can use his MME machine to generate energy from scratch. Dr. Bonlie explained to me that biochemistry is not an entity unto itself, but rather an entity that is determined by, and influenced by, physics. Biochemistry only occurs when molecules interact. Molecules interact only when the atoms that make them up interact, and atoms interact only when their orbiting electrons collide and combine. The negative magnetic field of MME speeds up the velocity of electron spin, increasing the rate at which the electrons of one atom will collide with and then bind to the electrons of another atom. As the interaction of atoms is increased, so is the interaction of the molecules that contains them, and this interaction of molecules is simply biochemistry, what I do. During MME, useful biochemical reactions in the cell are sped up, including the reactions that generate intracellular energy. This energy can be used to carry out useful work, to repair the cell, and to rid the cell of toxins. By improving physics, MME improves biochemistry. In a sense, I could abandon biochemical cardiology and treat you with MME as a monotherapy, but that's not our plan.
IS THIS THE END OF BIOCHEMICAL CARDIOLOGY?
No - When something new comes out, we don't throw out what's worked for 10 years just because it is old. No, we integrate new techniques, even new paradigms, into what has worked well in the past. The care we offer our patients doesn't change. A better characterization is that the best care that we can offer to our patients evolves. With MME alone, wonderful things can happen. MME is not FDA approved, and thus we should not and do not make claims, but as you can see from the case studies presented on this site and those corresponding to the other MME centers, wonderful things are happening. Broken bones heal in one third the expected time. Pain from arthritis may abate without the use of anti-inflammatory medications (a timely advance, with all the studies coming out linking these drugs with increased cardiovascular risk). Cirrhotic livers may regenerate. Kids with cerebral palsy may regain neurological function. These things aren't supposed to be possible, and they weren't possible when all we had to offer was anatomic and biochemical medicine. But now we can intervene with MME at the molecular level, and what was once impossible is now another day at the office.
MME will generate energy, but the oxygen starved cell will regain its normal energy charge a lot faster if we increase its oxygen supply with EECP, and provide it with the metabolic co-factors that make up its biochemical energy assembly line. MME will detoxify the cell, but the cell will detoxify a whole lot faster, and the patient will get better a whole lot faster, is we combine MME with biochemical detoxification maneuvers. MME can stimulate stem cells, but these cells will need essential fatty acids to compose their cell membranes, antioxidants to fend of free radical attack, and arginine to convert into nitric oxide. By combining MME with all that that biochemical cardiology and EECP have to offer, we move closer to the point at which there will be no patients "too far gone" for treatment. Take a look at our outcomes, and see how well we are achieving this goal. doing. And if there are conditions that do not respond to MME on top of our best biochemical and anatomic efforts, simply wait, because in five years there will another breakthrough, and when it is available we will offer it to you, in conjunction with MME, EECP, and our current best therapies.
James C. Roberts MD FACC - last updated 12/23/04
AMRI of NW Ohio provides MME treatment under the guidelines of an Investigational Review Board, consistent with FDA regulations.
Please note that MME treatment is considered to be experimental by the FDA. Although many patients have improved, no guarantee of success is implied.