Heart Health and Heart Health and Naturopathic MedicineNaturopathic Medicine

©©Dr. Kevin Passero 2005Dr. Kevin Passero 2005

Dr. Kevin Passero, N.D.Dr. Kevin Passero, N.D.

203 Ridgely Ave203 Ridgely Ave

443-433-5540443-433-5540

Review of Major Risk FactorsReview of Major Risk Factors

Elevated CholesterolElevated Cholesterol

High Blood PressureHigh Blood Pressure

Smoking Smoking

DiabetesDiabetes

InactivityInactivity

The Blood VesselThe Blood Vessel

4 Layers4 Layers

the endotheliumthe endothelium

the Intimathe Intima

the Mediathe Media

the Adventitiathe Adventitia

Cycle of DamageCycle of Damage

Chronic endothelial injuryChronic endothelial injury– HyperlipidemiaHyperlipidemia– HypertensionHypertension– SmokingSmoking– HomocysteineHomocysteine– ToxinsToxins– VirusesViruses– Immune reactionsImmune reactions

Cycle of DamageCycle of Damage

Endothelial dysfunctionEndothelial dysfunction– Increased permeability Increased permeability – Platelet adhesionPlatelet adhesion– Monocyte adhesion and emigrationMonocyte adhesion and emigration– LDL emigrationLDL emigration

Causes of Endothelial InjuryCauses of Endothelial Injury

Hemodynamic disturbanceHemodynamic disturbance– High blood pressureHigh blood pressure

HomocysteineHomocysteine

Cigarette SmokeCigarette Smoke

HyperlipidemaHyperlipidema

Cycle of DamageCycle of Damage

Further DamageFurther Damage– Smooth muscle migrationSmooth muscle migration– Foam cell productionFoam cell production– Collagen proliferationCollagen proliferation– Feeds the cycle Feeds the cycle

CholesterolCholesterol

HDL “the good one”HDL “the good one”– Carries fat from the periphery back to the liver Carries fat from the periphery back to the liver

for excretion through the bilefor excretion through the bile

LDL “the bad one”LDL “the bad one”– Carries fat from the liver to the periphery for Carries fat from the liver to the periphery for

deposition and storagedeposition and storage

Other forms of LipidsOther forms of Lipids

Apolipoprotein B (ApoB)Apolipoprotein B (ApoB)– These proteins transport VLDL (the precursor These proteins transport VLDL (the precursor

to LDL) throughout the blood stream.to LDL) throughout the blood stream.– ApoB contributes to peripheral uptake of LDL ApoB contributes to peripheral uptake of LDL

by receptor recognition.by receptor recognition.– Recent research has shown that levels of Recent research has shown that levels of

APOB can be more important in determining APOB can be more important in determining cardiovascular risk factors than just HDL and cardiovascular risk factors than just HDL and LDL.LDL.

Apolipoprotein BApolipoprotein B

Levels of ApoB can be directly tested or Levels of ApoB can be directly tested or measured through Lipoprotein Lp(a) measured through Lipoprotein Lp(a) levels.levels.

CholesterolCholesterol

Precursor to many hormones in the bodyPrecursor to many hormones in the body

80% produced by the body80% produced by the body

20% from the diet20% from the diet

Cholesterol LoweringCholesterol Lowering

ExerciseExercise

One of the most important factors in One of the most important factors in changing the ratio of HDL to LDL levels.changing the ratio of HDL to LDL levels.

Both cardiovascular and weight training Both cardiovascular and weight training programs are important to achieve programs are important to achieve adequate resultsadequate results

Diet Diet

Avoid saturated and trans/hydrogenated Avoid saturated and trans/hydrogenated fatsfats– Increase oxidation and potentiate endothelial Increase oxidation and potentiate endothelial

damagedamage– Very rigid structures that do not act Very rigid structures that do not act

appropriately when incorporated into cellular appropriately when incorporated into cellular structurestructure

Foods that contain hydrogenated Foods that contain hydrogenated oilsoils

• • Virtually all refined and processed foods• Virtually all refined and processed foods• Margarine• Cakes• Cookies• Candies• Margarine• Cakes• Cookies• Candies• Doughnuts• Bread• Canned soups• Doughnuts• Bread• Canned soups• Crackers• Processed cheese• Canned Crackers• Processed cheese• Canned foods• Cereals• Snack foods• Salad oils• foods• Cereals• Snack foods• Salad oils• Grocery store oilsGrocery store oils

DietDiet

Avoid animal products high in fatAvoid animal products high in fat– Red meatRed meat– Processed meats (hot dogs)Processed meats (hot dogs)– High fat dairy productsHigh fat dairy products

FatsFats

The Omega 3 vs Omega 6The Omega 3 vs Omega 6– Reduce arrythmiasReduce arrythmias– Reduce MI riskReduce MI risk– Slow growth of plaquesSlow growth of plaques– Reduce liproprotein and triglyceride levelsReduce liproprotein and triglyceride levels– Enhance endothelial functionEnhance endothelial function– Induce slight drop in BPInduce slight drop in BP– Lower CV risk by reducing inflammationLower CV risk by reducing inflammation

FiberFiber

Enhances cholesterol excretion by Enhances cholesterol excretion by absorptionabsorption

Enhanced absorption in the GI equals Enhanced absorption in the GI equals greater excretion via the feces.greater excretion via the feces.

Sources of FiberSources of Fiber

Psyllium HuskPsyllium Husk

Fruits and VegetablesFruits and Vegetables

Flax seedFlax seed

SupplementsSupplements

Guggul GumGuggul Gum– Clinical trials have demonstrated a 10%-25% Clinical trials have demonstrated a 10%-25%

reduction in cholesterol using reduction in cholesterol using 75 mg75 mg of of guggulipid per day.guggulipid per day.[i[i]]

–[[i]i]Gavagan, T MD, MPH. Cardiovascular Disease. Gavagan, T MD, MPH. Cardiovascular Disease. Primary Care; Primary Care; Clinics in Office PracticeClinics in Office Practice- 2002 June;29 (2) - 2002 June;29 (2)

SupplementsSupplements

NiacinNiacin– Numerous trials have shown IHN to be virtually free of the side effects Numerous trials have shown IHN to be virtually free of the side effects

associated with conventional niacin therapy, and extensive research has associated with conventional niacin therapy, and extensive research has proven it’s efficacy in treating hyperlipidemia.proven it’s efficacy in treating hyperlipidemia.[i[i]] Effective doses of IHN Effective doses of IHN for treatment of hypercholesterolemia range from for treatment of hypercholesterolemia range from 500 mg- 1g TID500 mg- 1g TID..

–[i][i] Head, K. Inositol Hexaniacinate: A Safer Alternative to Niacin. Head, K. Inositol Hexaniacinate: A Safer Alternative to Niacin. Alt Alt Med Review-Med Review- 1996 Sep;1 (3):176-84 1996 Sep;1 (3):176-84

SupplementsSupplements

Fish OilFish Oil– Shown to lower LDL levels and raise HDL Shown to lower LDL levels and raise HDL

levelslevels– Have strong anti-inflammatory propertiesHave strong anti-inflammatory properties– Can have mild effects on blood vesselsCan have mild effects on blood vessels

SupplementsSupplements

Red yeast riceRed yeast rice– Works via the same mechanism as traditional Works via the same mechanism as traditional

statin therapy.statin therapy.

DrugsDrugs

Main class is the statinsMain class is the statins– Lipator, Lescol, Mevacor, Pravachol, ZocorLipator, Lescol, Mevacor, Pravachol, Zocor– These act by inhibiting the HMG-CoA These act by inhibiting the HMG-CoA

reductase enzyme, a rate limiting enzyme in reductase enzyme, a rate limiting enzyme in the production of cholesterol in the liverthe production of cholesterol in the liver

– HMG-CoA reductase also vital enzyme in the HMG-CoA reductase also vital enzyme in the production of CoQ10 (ubiquitone)production of CoQ10 (ubiquitone)

StatinsStatins

Often very effective at lowering cholesterol Often very effective at lowering cholesterol without dietary changes but easily deplete without dietary changes but easily deplete CoQ10 levelsCoQ10 levels

Results in muscle cramps, aches and Results in muscle cramps, aches and fatigue. fatigue.

Very important to supplement with CoQ10 Very important to supplement with CoQ10 when taking statinswhen taking statins

The Rest of the StoryThe Rest of the Story

InflammationInflammation

ToxicityToxicity

CarbohydratesCarbohydrates

Homocysteine Homocysteine

InflammationInflammation

Chronic inflammation can contribute Chronic inflammation can contribute significantly to heart disease and CADsignificantly to heart disease and CAD

Measuring C-reactive protein can serve as Measuring C-reactive protein can serve as an important marker for identifying an important marker for identifying cardiovascular risk factors.cardiovascular risk factors.

Reduce InflammationReduce Inflammation

Eating a diet limited in trans fats, Eating a diet limited in trans fats, hydrogenated fats, sugar, dairy products, hydrogenated fats, sugar, dairy products, red meat, coffee and alcohol will help red meat, coffee and alcohol will help reduce systemic inflammationreduce systemic inflammation

Omega 3 fatty acids (EPA) is one of the Omega 3 fatty acids (EPA) is one of the strongest anti-inflammatory substances in strongest anti-inflammatory substances in our bodies.our bodies.

ToxicityToxicity

Cholesterol can often serve as buffer for Cholesterol can often serve as buffer for the bodies level of toxicity. Production can the bodies level of toxicity. Production can increase as a defense mechanismincrease as a defense mechanism

Toxicity can also disturb negative Toxicity can also disturb negative feedback pathways in the liverfeedback pathways in the liver

CarbohydratesCarbohydrates

Stimulate a quick rise in blood sugar which Stimulate a quick rise in blood sugar which often results in rapid and extensive insulin often results in rapid and extensive insulin responseresponse

Insulin is the bodies hormone that signals Insulin is the bodies hormone that signals the storage of fatthe storage of fat

HomocysteineHomocysteine

Naturally occurring byproduct of the Naturally occurring byproduct of the bodies metabolismbodies metabolism

Can significantly increase inflammation, Can significantly increase inflammation, platelet aggregation, and plaque formationplatelet aggregation, and plaque formation

Very easy to reduce levels by eating foods Very easy to reduce levels by eating foods rich in folate and by supplementing folate, rich in folate and by supplementing folate, B6 and B12B6 and B12

OverviewOverview

Important Dietary ConsiderationsImportant Dietary Considerations– High Fiber FoodsHigh Fiber Foods

– Fruits, vegetables, flax seeds, pysillium powderFruits, vegetables, flax seeds, pysillium powder

OverviewOverview

Avoid high inflammatory foodsAvoid high inflammatory foods– Trans fats, hydrogenated fats, sugar, red Trans fats, hydrogenated fats, sugar, red

meat (unless grass fed), coffee, dairy meat (unless grass fed), coffee, dairy products, refined carbohydrates and highly products, refined carbohydrates and highly processed foodsprocessed foods

OverviewOverview

Eat foods rich in folic acid and vitaminsEat foods rich in folic acid and vitamins– Dark leafy greens, like collards, spinach, kale, Dark leafy greens, like collards, spinach, kale,

beet greens beet greens

OverviewOverview

Include plenty of high quality fats from wild Include plenty of high quality fats from wild fish like salmon, game meats and grass fish like salmon, game meats and grass fed beeffed beef

OverviewOverview

If diet and exercise are not enough, add If diet and exercise are not enough, add appropriate supplementsappropriate supplements

OverviewOverview

Get the proper tests along with the regular Get the proper tests along with the regular ones for HDL/LDL and triglyceridesones for HDL/LDL and triglycerides– Homocysteine levelsHomocysteine levels– C-reactive proteinC-reactive protein– LpALpA

ALWAYS WORK IN CONJUNCTION ALWAYS WORK IN CONJUNCTION WITH A QUALIFIED HEALTH CARE WITH A QUALIFIED HEALTH CARE PROVIDER WHO CAN SAFELY PROVIDER WHO CAN SAFELY MONITOR AND DIRECT YOUR CARE.MONITOR AND DIRECT YOUR CARE.