Module 11: Cardiovascular Health
2/10/2017
MODULE 11
Cardiovascular Health
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MODULE 11 OBJECTIVES 1
State the Big Ideas for Cardiovascular Health
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Describe how each of the Foundations support the Cardiovascular System
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List some underlying causes of high blood pressure
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Distinguish between the “B” and “G” type vitamin complexes and provide two characteristics of the type of person that would benefit from each
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Describe and perform the Functional Evaluation for the Cardiovascular System
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Explain the relationship between cardiovascular health and inflammation 2
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THE BIG IDEAS 1. Heart disease results from over‐consumption of processed foods 2. The health of the heart reflects the health of the body, ALWAYS address The Foundations first 3. Inflammation is a significant cause of the most common form of heart disease Copyright © 2016 Nutritional Therapy Association, Inc.
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HISTORICAL LOOK AT HEART DISEASE
CAD Deaths Vitamin Sales
350
$1.2
300
$1.0
250
$0.8
200
$0.6
150
$0.4
100 50
$0.2
0
$0.0
$ Billions of Vitamins sold
Vitamin sales went up 4.4 times while the death rate from CAD fell by 35%
Deaths per 100,000 population
Deaths from Coronary Artery Disease and Vitamin Sales
YEAR Source: US Dept. of Commerce and the National Center for Health Statistics Copyright © 2016 Nutritional Therapy Association, Inc.
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Overview: The Cardiovascular System Copyright © 2016 Nutritional Therapy Association, Inc.
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THE CARDIOVASCULAR SYSTEM There are three components to the Cardiovascular System: The Blood Blood Vessels The Heart
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THE HEART The heart is the “pump” of the cardiovascular system The left side of the heart pumps blood through 60,000 miles of blood vessels (Systemic Circulation)
The right side pumps blood through the lungs, enabling the blood to unload carbon dioxide and pick up oxygen (Pulmonary Circulation)
The heart pumps more than 3,600 gallons of blood each day (2.6 million gallons/year) Copyright © 2016 Nutritional Therapy Association, Inc.
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THE CIRCULATORY PATHWAYS Blood is confined to a closed system of blood vessels and the four chambers of the heart
Oxygenated blood leaves the heart Arteries Arterioles Capillaries Venules Veins
Deoxygenated blood returns to the heart Copyright © 2016 Nutritional Therapy Association, Inc.
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RED BLOOD CELLS • RBCs have a concave shape to maximize surface area for the exchange of oxygen and carbon dioxide • The shape also provides the flexibility needed to pass through the narrow capillaries • The average lifespan of RBCs is 120 days
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THE MIRACLE OF IT ALL However, there’s so much more to the vitality of the cardiovascular system. It’s an electrical miracle.
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The Foundations and Cardiovascular Health Copyright © 2016 Nutritional Therapy Association, Inc.
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FIRST LINE OF SUPPORT The health of the heart reflects the health of the body, Always address The Foundations first
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DIET • As we mentioned in the Big Ideas, heart disease is a processed food disease • A diet of properly‐prepared, nutrient‐dense foods is fundamental for a healthy heart ─ It’s in whole grains that we get the naturally‐occurring B1 vitamins and B4 ─ It’s in cold‐pressed oils, raw nuts, and raw seeds that we get our essential fatty acids
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DIGESTION • Good protein digestion is critical to make the amino acids needed by the heart available (like taurine and carnitine)
• Proper stomach pH is needed to absorb calcium and digest the B vitamins • Proper liver/gallbladder function enables you to digest healthy fats and the fat‐soluble vitamins • Proper bowel flora is needed to produce vitamins B1, B2, B12, and K2
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BLOOD SUGAR BALANCE • Blood sugar imbalances lead to an overproduction of cortisol during the “fight or flight” response (Remember the cortisol cascade from the Endocrine Module?)
• This can lead to insulin resistance, which compromises mineral uptake by the cells • High insulin also blocks the PG1 pathway for prostaglandin anti‐inflammatory production
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INSULIN RESISTANCE Elevated Cortisol
Insulin Resistance
Increased Testosterone in Women
Increased Estrogen in Men
Inflammation Issues (Excess Insulin Blocks PG1 Pathway)
Elevated Blood Pressure and Cholesterol
Poor Mineral Absorption by Cells Copyright © 2016 Nutritional Therapy Association, Inc.
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BLOOD SUGAR AND HEART HEALTH
DR. MERCOLA’S COMMENT: Insulin resistance is probably the single most important dietary factor to consider. It is the one that is most frequently ignored, even in many natural dietary approaches.
Controlling your insulin levels is one of the most powerful anti‐aging strategies you could possibly implement.
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FATS AND HEART HEALTH From breast cancer to heart disease… Blame it on the FAT!
Excess or deficiency? ─
Highly toxic oils (hydrogenated) ─
Low essential fatty acids
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TYPES OF DIETARY FAT AND RISK OF CORONARY HEART DISEASE: A CRITICAL REVIEW During the past several decades, reduction in fat intake has been the main focus of national dietary recommendations. In the public’s mind, the word “dietary fat” has become synonymous with obesity and heart disease, whereas the words “low‐fat” and “fat‐free” have become synonymous with heart health. In response to the low‐fat campaign, the food industry has produced numerous commercial products labeled as “low‐fat” or “fat‐free,” but with high amounts of refined carbohydrates and sugar. Ironically, while dietary fat intake as percentage of energy intake has declined in the U.S. over the years, total caloric intake has not declined, and the prevalence of obesity and type 2 diabetes has grown dramatically. Reference: Journal of American College of Nutrition, Vol 20, No. 1, 5‐19 (2001), “Types of Dietary Fat and Risk of Coronary Heart Disease: A Critical Review” by Frank B. Hu, MD, Phd, JoAnn E. Manson, MD, DrPh, and Walter C. Willett, MD, DrPh, Department of Nutrition, Harvard School of Public Health
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TYPES OF DIETARY FAT AND RISK OF CORONARY HEART DISEASE: A CRITICAL REVIEW • It is now increasingly recognized that the low‐fat campaign has been based on little scientific evidence and may have caused unintended health consequences. • Indeed, the regions with the highest coronary heart disease (CHD) rate (Finland) and the lowest rate (Crete) had the same amount of total fat intake, at about 40% of energy. Reference: Journal of American College of Nutrition, Vol 20, No. 1, 5‐19 (2001), “Types of Dietary Fat and Risk of Coronary Heart Disease: A Critical Review” by Frank B. Hu, MD, Phd, JoAnn E. Manson, MD, DrPh, and Walter C. Willett, MD, DrPh, Department of Nutrition, Harvard School of Public Health
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TYPES OF DIETARY FAT AND RISK OF CORONARY HEART DISEASE: A CRITICAL REVIEW • Despite the long‐standing interest in the diet‐heart hypothesis, the number of cohort studies that have directly addressed associations between dietary fat intake and risk of CHD is surprisingly small and the results are not consistent. • Using 14‐year follow‐up data from the Nurses’ Health Study, Hu and colleagues conducted detailed prospective analyses of dietary fat and CHD among 80,082 women aged 34 to 59. The study was particularly powerful because of large sample sizes and repeated assessments of diet. Hu et al. found a weak positive association between saturated fat intake and risk of CHD, but a significant and strong positive association with intake of trans fatty acids. Reference: Journal of American College of Nutrition, Vol 20, No. 1, 5‐19 (2001), “Types of Dietary Fat and Risk of Coronary Heart Disease: A Critical Review” by Frank B. Hu, MD, Phd, JoAnn E. Manson, MD, DrPh, and Walter C. Willett, MD, DrPh, Department of Nutrition, Harvard School of Public Health Copyright © 2016 Nutritional Therapy Association, Inc.
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TYPES OF DIETARY FAT AND RISK OF CORONARY HEART DISEASE: A CRITICAL REVIEW • The association between saturated fat and CHD observed in the Nurses’ Health Study was much weaker than that predicted by international comparisons, but is consistent with the possibility that the proportional increase in plasma HDL concentration produced by saturated fat somewhat compensates for its adverse effect on LDL level. • In a recent analysis of the Nurses’ Health Study, Hu and colleagues found that dietary intake of short to medium chain saturated fatty acids (4:0 – 10:0) was not significantly associated with risk of CHD. Reference: Journal of American College of Nutrition, Vol 20, No. 1, 5‐19 (2001), “Types of Dietary Fat and Risk of Coronary Heart Disease: A Critical Review” by Frank B. Hu, MD, Phd, JoAnn E. Manson, MD, DrPh, and Walter C. Willett, MD, DrPh, Department of Nutrition, Harvard School of Public Health
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TYPES OF DIETARY FAT AND RISK OF CORONARY HEART DISEASE: A CRITICAL REVIEW A higher intake of trans fat can contribute to increased risk of CHD through multiple mechanisms. • First, trans fatty acids raise LDL cholesterol levels and lower HDL cholesterol relative to cis unsaturated fatty acids. • Second, trans fat increases lipoprotein levels, which are positively associated with risk of CHD. • Third, trans fat raises plasma triglyceride levels, and increased triglycerides are independently associated with increased risk of CHD. • Fourth, trans fatty acids can adversely affect essential fatty acid metabolism and prostaglandin balance by inhibiting the enzyme delta‐6‐desaturase and, as a result, may promote thrombogenesis. • Finally, recent data have suggested that high intake of trans fat may promote insulin resistance in humans. Reference: Journal of American College of Nutrition, Vol 20, No. 1, 5‐19 (2001), “Types of Dietary Fat and Risk of Coronary Heart Disease: A Critical Review” by Frank B. Hu, MD, Phd, JoAnn E. Manson, MD, DrPh, and Walter C. Willett, MD, DrPh, Department of Nutrition, Harvard School of Public Health
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TYPES OF DIETARY FAT AND RISK OF CORONARY HEART DISEASE: A CRITICAL REVIEW • Compelling evidence indicates the greater importance of types of fat than total amount of fat with respect to risk of CHD, although the optimal mixture of different fatty acids remains unsettled. • Secondary prevention trials have demonstrated that adding n‐3 fatty acids from fish and plant sources to the diet without altering total amount of fat substantially reduces coronary and total mortality among post‐MI patients. Reference: Journal of American College of Nutrition, Vol 20, No. 1, 5‐19 (2001), “Types of Dietary Fat and Risk of Coronary Heart Disease: A Critical Review” by Frank B. Hu, MD, Phd, JoAnn E. Manson, MD, DrPh, and Walter C. Willett, MD, DrPh, Department of Nutrition, Harvard School of Public Health
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PALEOLITHIC DIET VS. TODAY’S WESTERN DIET Nutrient
Paleolithic Diet
Western Diet
(Range: grams/day)
(Range grams/day)
9.0 – 54.3
24.5
Omega‐6 (n6)
5.2 – 20.6
22.5
Omega‐3 (n3)
3.5 – 25.2
1.2
n6:n3 Ratio
0.004 – 2.8
16.7
Total Polyunsaturated Fat
Eaton et al., 1998, 12‐23
Pottenger’s Prophecy, page 118, Gray Graham, Deborah Kesten, Larry Scherwitz, 2011
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FATS: EXCESS OR DEFICIENCY? Framingham Heart Study: • The Framingham Heart Study is often cited as proof of the cholesterol‐ animal fat theory of heart disease. • In 1992, after 40 years of the study, the director of the study was quoted as saying: “In Framingham, Mass., the more saturated fat one ate, the more cholesterol one ate, the more calories one ate, the lower the person’s serum cholesterol. We found that people who ate the most cholesterol, ate the most saturated fat, ate the most calories, weighed the least and were the most physically active.”
• This study did show that those who weighed more and had high blood cholesterol levels were more at risk for future coronary heart disease. • Weight gain and cholesterol levels had an inverse correlation with fat and cholesterol intake. Copyright © 2016 Nutritional Therapy Association, Inc.
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FATS: EXCESS OR DEFICIENCY? (CONTINUED) JAMA, September 24, 1982 • JAMA reported on an intervention trial that compared mortality rates and eating habits of over 12,000 men. • Those with “good” eating habits (reduced cholesterol and saturated fats, reduced smoking, etc.) showed a marginal decrease in total coronary heart disease rates, but their overall mortality was higher. • Other studies that indicate a correlation between fat reduction and a decrease in coronary heart disease also document a concurrent increase in deaths from cancer, brain hemorrhage, suicide, and violent death. Copyright © 2016 Nutritional Therapy Association, Inc.
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FATS: EXCESS OR DEFICIENCY? (CONTINUED) Pharmacological Effects of Lipids, 1986 • A multi‐year study involving several thousand men had half of the group reduce saturated fat and cholesterol in their diets, stop smoking, and increase the amounts of unsaturated oils such as margarine and vegetable oils. • After one year, those on the “good” diet had 100% more deaths than those on the “bad” diet in spite of the fact that those men on the “bad” diet continued to smoke!
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FATS AND HEART HEALTH
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A Harvard Study of nearly 90,000 women showed margarine caused a 50% (up to 70 % with over 4 teaspoons!) increase in heart disease.
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Butter, beef, pork and lamb consumption did not increase risk. Cookies and white bread did.
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High consumption of hydrogenated vegetable oils raised cholesterol.
Source: Lancet March 6, 1993
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FATS AND HEART HEALTH (CONTINUED)
EFAs are very important to health. Most of us eat way too many grains. The increase in high glycemic grains causes us to produce an excess of insulin, a potent inhibitor of delta-6-desaturase. This is an important enzyme that converts Linolenic Acid into GLA or Gamma Linolenic Acid, and Alpha Linoleic Acid into EPA and DHA once a person reduces their grain intake. Copyright © 2016 Nutritional Therapy Association, Inc.
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FATS AND HEART HEALTH (CONTINUED)
Further documentation that consumption of nutrient dense foods like nuts and seeds, which are high in essential fatty acids, should be part of some regular foods consumed.
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FATTY ACID BALANCE • The truth is that good fats are the best source of energy for the heart ─ Fish oil is especially good
• The appropriate mix of fatty acids is critical for the management of inflammation ─ Inflammation is now considered to be a major factor contributing to heart disease
• Remember that fatty acids are an essential part of the cell membranes that make up the tissues of the heart and the coronary arteries Copyright © 2016 Nutritional Therapy Association, Inc.
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MINERAL BALANCE • Magnesium and calcium are essential for a healthy heart ─ Calcium triggers the contraction and relaxation of the heart (as well as all muscles) ─ Magnesium is also important, because without the appropriate calcium‐magnesium ratio, the calcium will not work (Irregular heartbeats are often a sign of magnesium deficiencies)
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LOW‐SALT DIET INEFFECTIVE, STUDY FINDS. DISAGREEMENT ABOUNDS A new study found that low‐salt diets increase the risk of death from heart attacks and strokes and do not prevent high blood pressure. The investigators found that the less salt people ate, the more likely they were to die of heart disease — 50 people in the lowest third of salt consumption (2.5 grams of sodium per day) died during the study as compared with 24 in the medium group (3.9 grams of sodium per day) and 10 in the highest salt consumption group (6.0 grams of sodium per day). And while those eating the most salt had, on average, a slight increase in systolic blood pressure — a 1.71‐millimeter increase in pressure for each 2.5‐gram increase in sodium per day — they were no more likely to develop hypertension.
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LOW‐SALT DIET INEFFECTIVE, STUDY FINDS. DISAGREEMENT ABOUNDS (CONTINUED) “If the goal is to prevent hypertension” with lower sodium consumption, said the lead author, Dr. Jan A. Staessen, a professor of medicine at the University of Leuven, in Belgium, “this study shows it does not work.” Lowering salt consumption, Dr. Alderman said, has consequences beyond blood pressure. It also, for example, increases insulin resistance, which can increase the risk of heart disease. Reference: The New York Times, 5/3/2011 by Gina Kolata, http://www.nytimes.com
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THE POWER OF MASS MEDIA
A major medical study on the use of aspirin to prevent heart disease was reported inaccurately by the press. It was concluded that those that took aspirin suffered more strokes and the public should not start taking aspirin to prevent heart disease. But that was not what was reported in the nation’s five largest newspapers.
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MINERALS AND HEART HEALTH
Once the grain carbohydrate and the sugar content of the diet are controlled, the vast majority of patients will experience dramatic normalization of their blood pressure. Once this aspect of the diet is controlled, therapeutic mineral application (calcium) will be more beneficial. Calcium supplementation significantly reduces the risk of heart attacks.
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VITAMIN K‐2 (ACTIVATOR X) The Calcium Paradox Why do some individuals have both a deficiency disease (osteopenia, osteoporosis) and an excess disease (atherosclerosis, calcification) of the carotid arteries, bursitis, spurs, etc.) at the same time?
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HYDRATION • Good hydration supports good lymphatic flow and proper blood viscosity • Dehydration causes the vascular system to selectively close some of its vessels, which leads to hypertension • Hydration impacts how efficiently proteins and enzymes function within the body Copyright © 2016 Nutritional Therapy Association, Inc.
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Cardiovascular Issues: Hypertension Copyright © 2016 Nutritional Therapy Association, Inc.
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BLOOD PRESSURE: HYPERTENSION Optimal BP
Systolic: less than 120 mm Hg Diastolic: less than 80 mm Hg
Normal BP
Systolic: less than 130 mm Hg Diastolic: less than 85 mm Hg
High Normal
Systolic: 130 mm Hg to 139 mm Hg Diastolic: 85 mm Hg to 89 mm Hg
Hypertension
Systolic: 140 mm Hg or greater Diastolic: 90 mm Hg or greater
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HYPERTENSION: UNDERLYING CAUSES Kidney Function/Hydration
Fatty Acid Imbalance (poor Omega 3‐6 ratio)
Liver/Biliary Stasis
Allergies and Food Sensitivities
Adrenal ─ Hyper or Hypo
Sugar Handling Imbalances ─ Dysinsulinism ─ Diabetes
Thyroid Circulatory ─ Arteriosclerosis ─ Atherosclerosis
─ Reactive hypoglycemia
Mineral Imbalances
Emotional Structural
─ Sodium/Potassium ─ Calcium/Phosphorous/ Magnesium
Obesity Lack of Exercise
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PROCEDURE To identify the cause of hypertension: • Take the client’s blood pressure • Look at the presentation of the person • Start working down the “causes” list, beginning with the Foundations • Look at the results of the Functional Evaluation/LNT to find out what supplement(s) worked • Have the client chew up 2 – 3 tablets and wait 5 minutes • Have the client chew up 2 – 3 more and wait 5 minutes • Put 1 tablet in their mouth to LNT • Take the client’s blood pressure ─ If the blood pressure goes down, it was part of the problem ─ If the blood pressure does not change, keep trying Copyright © 2016 Nutritional Therapy Association, Inc.
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HYPOTENSION Hypotension
Systolic: 90 mm Hg or lower Diastolic: 60 mm Hg or lower
Even though hypotension is not as dangerous a conditions as hypertension, generally people who are hypotensive do not feel well. Common complaints are feeling run down, low energy or depression. Thiamine and associated B vitamins are the recommended support. Copyright © 2016 Nutritional Therapy Association, Inc.
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Cardiovascular Issues: Vascular Disease Copyright © 2016 Nutritional Therapy Association, Inc.
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VASCULAR DISEASE
Is vascular disease the PROBLEM? or Is vascular disease the SOLUTION? Copyright © 2016 Nutritional Therapy Association, Inc.
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ARTERIES AND VEINS
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VASCULAR PROBLEMS
Healthy Tissue Mineralized Tissue
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VASCULAR IRRITANTS AND SUPPORT IRRITANTS IRRITANTS Anything leading to inflammation, including:
SUPPORT •
– – – –
• Homocysteine • High Insulin • Smoking
Nutrients that metabolize homocysteine: B6 B12 Folic Acid Betaine
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Nutrients that support blood sugar balance
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Chondroitin Sulfate
• Chlorine
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Antioxidants
• Oxidative Stress
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Vitamins C and E
• Chemical Stress
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EFAs
• Emotional Stress
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Bioflavonoids
•
Proteolytic Enzymes
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CHOLESTEROL It is an ERROR to think of Lipoproteins and Cholesterol as either good or bad. It is really about balance and quality.
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CHOLESTEROL Cholesterol is required to: • Build and maintain membranes • Modulate membrane fluidity • Converted in the liver to bile • Precursor to vitamin D • Precursor to steroid hormones: ─ ─ ─ ─ ─
Cortisol Aldosterone Progesterone Estrogens Testosterone Copyright © 2016 Nutritional Therapy Association, Inc.
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CHOLESTEROL TRANSPORTED • Cholesterol is transported in the blood by lipoproteins • Lipoproteins have cell targeting signals that direct the lipids then carry to certain tissues • For this reason, there are several types of lipoproteins (listed in order of increasing density): ─ Chylomicrons ─ Very‐Low Density Lipoprotein (VLDL) ─ Intermediate‐Density Lipoprotein (IDL) ─ Low‐Density Lipoproteins (LDL) ─ High‐Density Lipoproteins (HDL)
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TYPES OF DIETARY FAT AND RISK OF CORONARY HEART DISEASE: A CRITICAL REVIEW The Nurses’ Health Study found a weak and nonsignificant positive association between dietary cholesterol and risk of CHD (relative risk for each increase of 200 mg/1000 kcal = 1.12, 95% confidence interval 0.91‐1.40. Reference: Journal of American College of Nutrition, Vol 20, No. 1, 5‐19 (2001), “Types of Dietary Fat and Risk of Coronary Heart Disease: A Critical Review” by Frank B. Hu, MD, Phd, JoAnn E. Manson, MD, DrPh, and Walter C. Willett, MD, DrPh, Department of Nutrition, Harvard School of Public Health.
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TYPES OF DIETARY FAT AND RISK OF CORONARY HEART DISEASE: A CRITICAL REVIEW There is little direct evidence linking higher egg consumption and increased risk of CHD. In the Framingham study, Dawber and colleagues found no significant association between egg consumption and incidence of CHD despite a wide range of egg intake. In an earlier analysis of the Seventh‐Day Adventists study, higher egg consumption appeared to be associated with increased risk of fatal CHD, but this association was not present in a more recent analysis with a longer follow‐up. In a case‐control study conducted in Italy, the frequency of egg consumption was not significantly associated with the risk of CHD in women. In a detailed analysis of egg consumption and incidence of CHD among 117,933 apparently healthy subjects in the Nurses’ Health Study and Health Professionals’ Follow‐up Study, Hu and colleagues found no evidence of an overall positive association between egg consumption and risk of CHD in either men or women.
Reference: Journal of American College of Nutrition, Vol 20, No. 1, 5‐19 (2001), “Types of Dietary Fat and Risk of Coronary Heart Disease: A Critical Review” by Frank B. Hu, MD, Phd, JoAnn E. Manson, MD, DrPh, and Walter C. Willett, MD, DrPh, Department of Nutrition, Harvard School of Public Health.
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TYPES OF DIETARY FAT AND RISK OF CORONARY HEART DISEASE: A CRITICAL REVIEW The null association between egg consumption and risk of CHD observed in these studies may be somewhat surprising, considering the widespread belief that eggs are a major cause of heart disease. One egg contains about 200 mg cholesterol, but also appreciable amounts of protein, unsaturated fats, folate, B vitamins and minerals. Reference: Journal of American College of Nutrition, Vol 20, No. 1, 5‐19 (2001), “Types of Dietary Fat and Risk of Coronary Heart Disease: A Critical Review” by Frank B. Hu, MD, Phd, JoAnn E. Manson, MD, DrPh, and Walter C. Willett, MD, DrPh, Department of Nutrition, Harvard School of Public Health.
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HYPERCHOLESTEROLEMIA PARADOX Hypercholesterolemia paradox in relation to mortality in acute coronary syndrome. We explored this paradox in 84,429 patients. A history of hypercholesterolemia was associated with lower in‐hospital mortality. This protective association persisted after adjusting for baseline characteristics. Among 22,711 patients with no history of hypercholesterolemia, 12,809 has a new in‐hospital diagnosis of hypercholesterolemia. Unadjusted mortality in these patients was lower than among those with normal LDL levels. The association of hypercholesterolemia with better outcomes highlights a major challenge in observational analyses. Reference: NCBI, PubMed Abstract, 2009 by Wang TY, Newby LK, Chen AY, Mulgund J, Roe MT, Sonel AF, Bhatt DL, DeLong ER, Ohman EM, Gigler WB, Peterson ED, Division of Cardiology, Duke Clinical Research Institute. http://www.ncbi.nlm.nih.gov/pubmed/19645040
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CHOLESTEROL
Study Findings 1. People with cholesterol of more than 280 were twice as likely as those with cholesterol at 230 to have an occlusive stroke. 2. People with cholesterol less than 180 had double the risk of those at 230 for a hemorrhagic stroke. 3. High cholesterol probably accounts for 10‐15% of occlusive (clot) strokes. 4. Low cholesterol is probably the cause of perhaps 7% of hemorrhagic strokes. Copyright © 2016 Nutritional Therapy Association, Inc.
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CHOLESTEROL
Another nail in the coffin of the low fat diet myth. Eating low fat means eating high grains, as there really are no other options. This will increase insulin and cause significant disruption in the finely tuned hormone balance of the body.
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VAP CHOLESTEROL TEST DEFINITIONS VAP Cholesterol Test is an expanded lipid panel that directly measures lipids HDL Cholesterol
The protective or “Good” cholesterol
LDL Cholesterol
The “Bad” cholesterol
VLDL Cholesterol
The main carrier for Triglycerides and if out of range can be an independent risk factor for heart disease
Total Cholesterol
The total amount of cholesterol circulating throughout your body
Triglycerides
Energy rich molecules needed for normal functions throughout the body. Elevated levels are associated with cardiovascular disease
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VAP CHOLESTEROL TEST DEFINITIONS Large buoyant and the most protective form of HDL cholesterol (Low HDL2 is risk factor for heart
HDL2
disease in patient with normal cholesterol values)
HDL3
Small dense and is the least protective HDL
Total HDL
Total Non‐HDL Non‐HDL/HDL Ratio
The sum of HDL2 and HDL3
LDL‐C + VLDC‐C Shown to be a better predictor for CAD risk than LDL cholesterol alone
Should be less than 4.0 mg/dL
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VAP CHOLESTEROL TEST DEFINITIONS LDL‐R‐Cholesterol
The real LDL cholesterol circulating in your body. High levels of LDL‐R are usually associated with bad eating habits
Lp(a)‐Cholesterol
A highly inherited independent risk factor and is also considered the “Heart Attack” cholesterol
IDL‐Cholesterol
Total LDL Cholesterol
Strongly inherited independent risk factor for CHD
The sum of LDL‐R‐C + Lp(a) + IDL‐C
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VAP CHOLESTEROL TEST DEFINITIONS LDL‐R Subclass Pattern Large buoyant LDL‐R that can cause blockage Ideal risk
Pattern A
Intermediate density LDL‐R that can cause blockage Moderate risk
Pattern A/B Pattern B small, dense
LDL‐R that can cause blockage
High risk
VLDL1,2 (Buoyant)
VLDL3 (Dense)
Main carrier for Triglycerides and when elevated is an independent risk factor for heart disease
The most dense sub fraction of VLDL and constitutes a greater risk for heart disease than VLDL1,2.
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VAP CHOLESTEROL TEST DEFINITIONS LDL‐R Subclass Pattern Homocysteine
hsCRP
Not related to cholesterol. High levels are associated with greater risk for plaque buildup in arteries
Not related to cholesterol. High levels are associated with cardiovascular disease
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C‐REACTIVE PROTEIN (CRP) C‐Reactive Protein is an inflammatory marker that is used to indicate systemic inflammation on blood chemistries.
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HOMOCYSTEINE • Homocysteine is a caustic amino acid formed from the incomplete metabolism of the amino acid, methionine ─ First found in 1962 ─ 1:200,000 had a genetic defect of methionine metabolism
• Increased levels of homocysteine increase the risk of cardiovascular disease (Australia, 1976) • More than 1,000 articles on homocysteine have been published in the last five years Copyright © 2016 Nutritional Therapy Association, Inc.
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MECHANISM OF ACTION Homocysteine raises peroxide levels, which cause oxidative damage to LDL cholesterol and the vascular linings
This damage raises collagen instability and causes a breakdown of the artery
This also lowers the sulfate detox pathway, which causes increased toxins (including steroids) Copyright © 2016 Nutritional Therapy Association, Inc.
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CAUSES • Elevations of homocysteine are often thought to be due to errors of metabolism • Increasing levels are made worse by several enzyme deficiencies: Methionine synthase:
Transulfuration enzyme:
Requires B12, folate, and betaine as a methyl donor to process homocysteine
Requires B6
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HOMOCYSTEINE ASSESSMENT Blood levels of homocysteine are available from many labs. The best results are obtained following a methionine load challenge. This will actively test for homocysteine metabolism. 100 mg/Kg (of body weight) of methionine is given 6 hours before a fasting blood draw
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Cardiovascular Issues: Two Types of Heart Disease Copyright © 2016 Nutritional Therapy Association, Inc.
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TWO TYPES OF HEART DISEASE
Congestive Heart Failure A weakening and enlarging of the pump…the heart muscle loses its tone
Myocardial Infarction A seizing up of the pump
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THE “B” AND “G” COMPLEXES
The “B” Type
The “G” Type
• • • • • •
• Hypertensive
Hypotensive Craves sugar Feels bad/run down Sick often Tends toward CHF Need B1 (the “B” factor) NATURALLY OCCURING THIAMINE
• Craves alcohol • Feels good/pumped up • Does not get sick • Tends toward MI • Need B2 (the “G” factor) RIBOFLAVIN AND ASSOCIATED B VITAMINS
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THE “B” AND “G” COMPLEXES (CONT.) Many nutritional pioneers believed the B complex is really two distinct vitamin complexes. Although related, these two vitamin complexes have some very different properties. By combining them, these unique individual properties were lost.
The Vitamin “B” complex is thiamine (B1) based, and contains other B vitamins that are soluble in alcohol:
B12, B6, and B4
The Vitamin “G” complex is riboflavin (B2) based, and contains other B vitamins that are not soluble in alcohol:
B3, PABA, folic acid, the lipotropic factors, choline, inositol, and betaine
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B AND G DIFFERENCES The Differences Between the “B” and “G” Complexes
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SYMPTOMS OF EACH TYPE
NAQ: 297‐303
NAQ: 304‐306
Congestive Heart Failure •
Heavy and/or irregular breathing
•
Discomfort at high altitudes
•
“Air Hunger” and/or yawns frequently
•
Compelled to open windows in a closed room
•
Shortness of breath with moderate exertion
•
Ankles swell, especially at the end of the day
•
Cough at night
Myocardial Infarction • Blush or face turns red for no reason • Dull pain or tightness in chest and/or radiate into right arm…worse with exertion • Muscle cramps with exertion
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ALWAYS REFER TO SPECIALIST
If a client marks any of the symptoms on the NAQ for Cardiovascular, ALWAYS refer the client to a cardiologist for a traditional cardiac assessment. (This is an area where nutrition and medicine need to work together)
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Cardiovascular System: Functional Evaluation Copyright © 2016 Nutritional Therapy Association, Inc.
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THYROID/HEART Chapman Reflex Heart (2nd L/R) Bilateral Second intercostal spaces, next to the sternum. Palpate A>P, for tenderness. Record R and L indicators. * There is theory that the point on the right is more of a Thyroid indicator and the left side, Heart. This is NOT absolute.
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LEFT THENAR PAD Left Thenar Pad tenderness Draw an imaginary circle around the Left Thenar Pad. Directly in the middle of the circle there should be a slight “hole.” Go into the depth of the tissue palpating for tenderness. Often the indicator is a sharp pain. Same as pancreas palpation, opposite side.
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LNT: THYROID/HEART MULTIPLE NUTRIENTS SUPPORTING CARDIOVASCULAR HEALTH HEART GLANDULAR L‐CARNITINE BROAD SPECTRUM NUTRITIONAL SUPPORT FOR VASCULAR HEALTH W/ RESVERATROL RESVERATROL EMULISIFIED COENZYME Q‐10
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WORKSHOP 11A Using your Workshop 11a pages work with a partner to complete the Functional Evaluation/LNT for the Cardiovascular System.
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Cardiovascular: Solutions Copyright © 2016 Nutritional Therapy Association, Inc.
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YOUR STRATEGY The Foundations
• 2‐3 months on The Foundations, emphasizing Blood Sugar, Minerals, and EFAs
Practitioner Decisions
• Refer client to a Cardiologist • Add the appropriate “B” or “G” complex to your protocol • Add Coenzyme Q10 in your protocol • Consider general supplement for the cardiovascular system
Re‐evaluate as needed Copyright © 2016 Nutritional Therapy Association, Inc.
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CARDIOVASCULAR PROTOCOLS • Congestive Heart Failure • Cardiac Support and Maintenance • Arrhythmia • Angina • Oral Chelation for Arteriosclerosis or Atherosclerosis • Peripheral Vascular Disease • Hypertension
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MODULE 11 SUMMARY 1
State the Big Ideas for Cardiovascular Health
2
Describe how each of the Foundations support the Cardiovascular System
3
List some underlying causes of high blood pressure
4
Distinguish between the “B” and “G” type vitamin complexes and provide two characteristics of the type of person that would benefit from each
5
Describe and perform the Functional Evaluation for the Cardiovascular System
6
Explain the relationship between cardiovascular health and inflammation 86
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