A man grabbing his chest during an agina episode.

Angina, which is chest pain caused by decreased blood flow to the heart muscle, was rare until about 100 years ago. Changes in our diet and lifestyle started to catch up with us and cause the arteries that feed the heart muscle to start blocking up. These blockages cause heart attacks and angina. When they block the arteries going to the brain they can cause a stroke. These problems are now the most common cause of death in the US and Europe.

Symptoms of Angina

Many benign things can also cause chest pain, and these are more common causes of chest pain in those under 45 years of age. These include chest wall (muscle and cartilage) pain, which is also called costochondritis. If the pain is reproduced or affected by pushing over the ribs and muscle in the area of the pain, it is likely chest wall pain and not dangerous (ribs are thick, and pushing on them won't cause pain in the heart or lungs below). Though this may also cause benign chest pain on taking a deep breath, if this is occurring (especially with a lung infection or cough) see your doctor to check for pneumonia or pleurisy. If the chest pain is relieved by drinking an ounce or 2 of antacid (e.g., Maalox or Mylanta), it is likely stomach or acid reflux related.

If the pain is worse with exertion, and/or associated with shortness of breath or chest tightness, the risk of it being angina is increased. If this is new and occurring now, call 911, chew up an aspirin and sit back and rest. If it is a chronic and ongoing problem, see your physician.

Either way, if you have chest pain, see your doctor (or go to the emergency room if new or sudden onset). Most often it will be nothing and you'll be reassured, but if it is a heart attack or blood clot to the lungs and you miss it, you may be dead. With chest pain, better safe than sorry.

Angina Treatment

If you suspect you have angina, you should be followed by a physician who can diagnose and treat it. If angina is proven, use the chest pain medications and even the cholesterol-lowering medications (which in my opinion are NOT needed or helpful in most cases where they are prescribed when no heart disease is present). Some doctors are quick to recommend heart bypass surgery in cases where the research suggests it is not helpful. In such cases, using heart stints is preferable (minor surgery and pretty safe). If bypass surgery is recommended, get a second opinion. If they feel it is OK to wait on surgery, try these options:

Diet, Lifestyle, and Supplements for Angina

Eat a high fiber, high vegetable, low red meat diet. Eat at least 3-4 portions a week of salmon and tuna. Avoid sugars (Stevia is OK). Consume grains that are only whole grains.

Exercise as OK'd by your physician. This helps your heart and body to heal.

Many nutrients are important for heart health. Consider taking ribose, coenzyme Q10, B complex vitamins, acetyl L-carnitine, and magnesium orotate. Pomegranate extract was associated with a remarkable 35 percent improvement in blood vessel size after 1 year (vs a 9 percent worsening in the placebo group).

Learn how to lower an elevated cholesterol. If on cholesterol-lowering medications, be sure to take coenzyme Q10 (at least 200 milligrams a day). These medications deplete this nutrient, and the CoQ10 deficiency can cause fatigue and muscle pain followed by heart failure — which the doctor will blame on your heart disease. Your doctor means well, but no one is paying to be sure they learn about this. Though I consider the cholesterol medications (statins) to be a bad idea — the word scam comes to mind — if no heart disease is already present, once someone has been diagnosed with angina or if you have diabetes, these statin medications can be life-saving and, in this situation, a very good treatment to use. A MUCH healthier way to lower cholesterol is with red rice yeast and by optimizing thyroid function, and in men optimizing testosterone.

Angina & Chest Wall/Muscle Pain

Willow bark and boswellia may be very helpful for most kinds of muscle pain. They increase in effectiveness over the first week of use and then even more over 6 weeks. Though often helpful with the first dose, they are more effective over time. Also, look for an herbal mix containing boswellia, curcumin, DLPA, and natto.

A special topical comfrey is also wonderful for muscle pain.

Medications for Chest Wall Pain

  • Tylenol is OK to use for the pain, but aspirin-related medications like Ibuprofen can cause stomach irritation or ulcers and actually worsen the chest pain over time.
  • Lidoderm patches (like Novocaine in a patch) by prescription may be helpful but pricey. Put the patch(es) over the painful area for 16 hours a day (though the box says 12 hours). They may start to work in 1/2 hour, but give them 2 weeks to become optimally effective.
  • Other Therapies & Advice for Chest Wall/Muscle Pain
  • Hot compress: If the pain is chest wall tenderness, a hot compress for up to 20 minutes 4x times a day can help the muscle relax.
  • Relax your chest muscles. Learning to relax your chest muscles (we may keep them tight during stress) can be very helpful.
  • A hot bath also helps. Better still is to add 2 cups of Epsom Salts to the bath water.
  • The indigestion/reflux pain can trigger chest wall muscle pain and vice versa in a reflex arc.

Remedies for Angina Pain

Follow your physician's advice for this important problem. A natural option to consider that may help heal the problem is external counterpulsation. This safe and simple technique helps your heart to grow new blood vessels to bypass the old blocked ones naturally (visit the American Heart Association website for more on external counterpulsation). The economics didn't work (invasive cardiology like surgery is one of the biggest revenue centers in most hospitals) and it has been slow to catch on. Fortunately, many health insurers will pay for the treatment.

Intravenous chelation is a series of intravenous treatments that markedly decreased angina in studies in the 1950s, and was used without going through the usual placebo-controlled studies. Because of this, it became very controversial, with many natural physicians using it and standard practitioners attacking them for this. It is very safe (safer than aspirin) but costs over $5,000 for the series of injections (not covered by insurance). A recent placebo-controlled trial has now proved it to be helpful, and many people have had wonderful results with it. So it should be considered before having non-emergency heart bypass surgery performed. I would begin with the external counterpulsation, and consider using both together.

Angina & Bypass surgery

Sometimes bypass surgery will be required. But if it is not an emergency situation, a second opinion from a cardiologist is a good idea.

A key risk is the possibility of stunning brain cells during surgery, though much of this can be prevented by antioxidants (which can often be found in a good vitamin powder) plus lipoic acid 300 mg a day. I prefer to begin these at least a week before surgery (but even a day before helps) and continue for a month after.

In one study, taking ribose was associated with a dramatic drop in heart bypass mortality. I recommend that you take 5 gm 3x day for as long as you can before surgery (and even 1 day before helps) and for 6 weeks after.


Dr. Jacob Teitelbaum, MD

Jacob Teitelbaum, M.D. is a board certified internist and author of the popular free iPhone application “Cures A-Z,” which was ranked in the top 10 of all health/wellness downloads on iTunes.

Dr. Teitelbaum is the author of the perennial bestseller From Fatigued to Fantastic! (Avery Penguin), which has sold over half a million copies; Pain Free 1-2-3 (McGraw-Hill); Three Steps to Happiness: Healing Through Joy (Deva Press); the Beat Sugar Addiction Now! series (Fair Winds Press);  Real Cause, Real Cure (Rodale Press); The Fatigue and Fibromyalgia Solution (Penguin/Avery); and his latest, The Complete Guide to Beating Sugar Addiction (Fair Winds Press, 2015).