Lesson 4: Cardiovascular Disease 4.0 Introduction · Lesson 4: Cardiovascular Disease ... include...

Nutrition II Lesson Four: Cardiovascular Disease

©2012 by Jeananne Laing, CLH and the Wild Rose College of Natural Healing v.2012.1

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Lesson 4: Cardiovascular Disease 4.0 Introduction

The group of diseases that together are known as cardiovascular disease (CVD) include atherosclerosis, myocardial infarction (MI), stroke, arrhythmias & high blood pressure (HTN). A large percentage of Canadian adults will be touched with CVD (cardiovascular disease) in some way, so it is good clinical practice to be familiar with terms, tests and allopathic treatment for CVD, as well as understanding treatment with natural alternatives. A good overview of Heart Disease can be seen in this slide show from MedicineNet.com. http://www.medicinenet.com/heart_disease_pictures_slideshow_visual_guide/article.htm According to the Canadian Heart and Stroke Foundation, www.heartandstroke.com (information pulled Dec 1, 2012):

• Every 7 minutes a Canadian dies from Heart Disease or Stroke.

• 29% of all deaths in Canada in 2008 were related to CVD. • Of those 54% were due to ischemic heart disease, 20% to

stroke, 23% to heart attack. • CVD costs the Canadian economy more than $20.9 billion

each year due to health care costs, lost wages and lost productivity.

• Nine in 10 Canadians (90%) have at least one risk factor for heart disease or stroke (smoking, alcohol, physical inactivity, obesity, high blood pressure, high blood cholesterol, diabetes)

“Diseases of the Heart” (CVD) is the second leading cause of death in Canada. (“Malignant Neoplasms” (Cancer) is number 1.) Statistics Canada website http://www.statcan.gc.ca/pub/84-215-x/2011001/tbl/t014-eng.htm accessed December 2012. Given the numbers, it is imperative that we as health professionals recognize the signs and symptoms of these deadly, yet preventable conditions. In this lesson study hypercholesterolemia, congestive heart failure and hypertension as well as look at recent nutritional studies on cardiovascular diseases.


©2012 by Jeananne Laing, ClH and the Wild Rose College of Natural Healing v.2012.1

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Please note that although many supplements are discussed, it is NOT recommended that you place a patient on all conceivable supplements. One must look at the type of diet the person is on, what dietary and lifestyle changes they are willing to make, what medications they may currently be taking, and then recommend the needed supplements, if any, to treat their condition. This is an individualized process.

Lesson Objectives: • Understand how cardiovascular disease develops. • Know the major risk factors including nutrient deficiencies

that predispose to CVD. • Know therapeutic measures to decrease the risk and treat

CVD. • Understand the basics of helping a client to foster a stable

blood sugar. • Treatment for various CVD states

4.1 Medical Terminology

The following is a breakdown of medical terminology that will be helpful for you. Abbreviation Meaning Aa Amino acid AC After meals BID Twice daily CAD Coronary Artery Disease CHF Congestive Heart Failure CVS Cardiovascular System ETC Electron Transport Chain GTF Glucose Tolerance Factor HDL High density lipoprotein HS At bed time K Potassium LDL Low Density Lipoprotein Lp (a) Lipoprotein A MOA Mechanism of Action (ie. How it works) MI Myocardial Infarction mmHg Millimeters mercury Na Sodium OD Once daily Q Every



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qd Every day QID Four times daily TC Total cholesterol TG Triglycerides TID Three times daily VLDL Very low density lipoprotein

4.2 The Anatomy of an Artery There are 3 layers to an artery. From the external to the internal layer (which comes in contact with blood). These layers are: adventitia, media and intima.

The intima is made up of endothelial cells and glucosaminoglycans (GAG’s) that serve as a protective layer, as well as promoting repair.

In arterioscleroses, damage begins with a weakening of the GAG layer, which exposes the lining to damage by free radicals. Initial damage can be induced by immune, physical, mechanical, viral, chemical, and drug factors. Damage leads to the formation of oxidized LDL, commonly known as plaque. Sites of injury are permeable to some constituents of plasma, especially lipoproteins, which then seep through and accumulate. The binding of

lipoproteins to GAG’s causes an increased affinity for cholesterol to the site.

Over time, a fibrous cap develops over the injury site, and as deposits of fat and cholesterol continue to accumulate, the artery begins to close. Arteries are usually 90% or more blocked before any symptoms are noticed.

Figure 1: http://www.adventisthealthcare.com/



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4.3 Major Risk Factors for Cardiovascular Diseases There are several major risk factors for CVD. It is important to watch for these signs in your clients during the first assessment and history taking. The major risk factors are considered ‘modifiable’. In other words, they are life style issues that the patients has control over. These major risk factors are:

• High Blood Pressure • Smoking • High Glucose Levels/Diabetes • Physical inactivity • Unhealthy Diet • Cholesterol/Lipid levels • Overweight and Obesity

‘Unmodifiable’ risk factors are:

• Age. CVD is increasingly common with advancing age • Gender. Males are more at risk than pre-menopausal

women. After menopause, there is not difference between the genders.

• Family History of CVD, especially if family member was/is under the age of 55.

There are a number of nutritional risk factors for CVD, including:

• Low antioxidant status • Low EFA levels • Low magnesium levels • Low potassium levels • Functional B12 deficiency • Functional Folic Acid deficiency • Functional B6 deficiency

NOTE: A ‘Functional Deficiency’ can happen when there are adequate levels of the vitamin/mineral in the blood, yet symptoms of a deficiency of that vitamin/mineral persist. This can be caused when problems occur with the body’s metabolizing of the dietary source of the vitamin/mineral. A ‘functional deficiency’ can delay proper diagnosis of health problems.



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4.4 Signs and Symptoms to be aware of We know that cardiovascular diseases are preventable. Understanding the signs and symptoms will help you recognize your clients who are at risk.

Table 3.2 Signs and Symptoms of CVD

Hypertension (BP over 140/90 on 3 readings)

Shortness of Breath (SOB)

Chest Pain Pain on activity Poor circulation (check distal pulses and skin color)

Paroxysmal nocturnal dyspnea*

Swelling of the ankles Palpitations Fatigue easily on exertion Atropic skin changes** Cyanosis (blue color to skin – lips, fingers, toes)

Loss of hair on legs and dorsum of the feet

Diagonal earlobe crease *** Ringing in the ears Clubbing of fingers &/or toes (angle <180 degrees)

Abnormal lab results: Cholesterol, LDL, TG, HDL, apolipoprotein A, homocyteine.

Leg cramps (intermittent claudication)

Gradual mental deterioration

Weakness or dizziness Type “A” personality * patient may wake suddenly with SOB and coughing and must sit or stand to become comfortable. ** Due to decrease return of blood to the heart, edema develops and with it a change in skin texture and color. Skin becomes pearly in color and may discolor like a bruise. Edema leads to decreased nutrition to the skin, and skin is thin. *** does not hold true with Asians, native North Americans, and children with Beckwith’s Syndrome. Found to be the single most important predictor of all the major risk factors. It’s also possible that a client may be without any symptoms. Statistics have shown the risk of CAD in smokers is 3-5X more as compared to non-smokers. Risk increases with number of cigarettes smoked, as well as the length of time (number of years) a person has smoked. The effects of second-hand smoke are reduced by use of antioxidant nutrients such as vitamin C (500 mg/day) and vitamin E (400 IU/day).

4.5 Nutritional Risk Factors Consider the following nutritional risk factors and possible impacts on your clients.



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Homocysteine is an intermediate product in the conversion of the amino acid methionine to cysteine. (This means that methionine converts first to homocysteine, which then converts to cysteine). Homocysteinuria, is an autosomal disease (a defective gene is passed from one parent) and the second most common inborn error of amino acid metabolism. The full genetic disorder affects only one in 200 000 people, however, abnormal homocysteine metabolism is very common in adults due to enzyme dysfunction, lifestyle and/ or nutritional deficiencies. If there is a functional deficiency in folic acid, vitamin B6 , or vitamin B12 , there will be an increase in homocysteine, as these vitamins are required to convert homocysteine to cysteine (Ubbink et al, 1993). Consumption of coffee, though not caffeine, is also related to increased levels of homocysteine (Verhoef, 2002). Homocysteine has been implicated in a variety of conditions including atherosclerosis. Homocysteine is thought to promote atherosclerosis by directly damaging the artery thereby reducing the integrity of the vessel wall, and by interfering with proper collagen formation. Proper metabolism of homocysteine will result in the production of several cardio-protective substances, including cysteine, taurine & CoQ10. Magnesium and potassium are important in allowing for proper functioning of the entire cardiovascular system, and have been shown to have a role in preventing heart disease and strokes. Conditions which Mg and K+ have been shown to be helpful include: angina, arrhythmias, congestive heart failure, and high blood pressure. Potassium occurs in large amounts in all whole foods. The more refined a food is, the less potassium and more sodium you will find in the food. (When reading nutrition labels ensure that there are 2 part potassium for every 1 part sodium.) Dietary sources of Magnesium include: Tofu, legumes, nuts and seeds, and green leafy vegetables. A wide variety of cardioprotective supplement can be used. These include vitamin E, vitamin B6, vitamin B12, folic acid, selenium, copper, potassium, taurine, arginine, dimethylglycine



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(DMG), aortic GAGs, mixed carotenoids, ginkgo biloba extract, and other flavenoids. If you are unfamiliar with the indications for any of these agents, you can find out more about them in well researched texts, such as the Professional’s Handbook of Complementary & Alternative Medicines (Fetrow & Avila), or the Encyclopedia of Nutritional Supplements (Murray).

4.6 Decreasing the Risk of CVD

As wholistic practitioners, the most important thing we can do to minimize the risk of CVD among our clients is to coach them towards a healthful diet and lifestyle. The Mayo Clinic website (www.mayoclinic.com) considers “A Heart Healthy Diet: 8 Steps to Prevent Heart Disease.” See more here: http://www.mayoclinic.com/health/heart-healthy-diet/NU00196. Accessed Dec 1, 2012.

1. Control your portion size. 2. Eat more vegetables and fruit. 3. Select whole grains 4. Limit unhealthy fats and dietary cholesterol 5. Choose low-fat protein sources 6. Reduce the sodium in your food 7. Plan ahead: Create daily menus 8. Allow yourself an occasional treat

Healthful lifestyle choices in the prevention of CVD includes:

• Stay away from smoking • Daily exercise • Reduce stress • Maintain a healthy weight • Limit alcohol

How much fat? Most authorities recommend that the diet should consist of between 20 – 35% calories from fat. There are 9 calories in every gram of fat, so a 2,000 calorie per day diet would contain 44 – 78 grams of total fat. Type of fat consumed is important. Saturated fat should consist of only 7 – 10% of daily fat intake, which is 16 – 22g on a 2,000 calorie per day diet. Ingestion of trans fats should be zero. Unsaturated fats from olives, nuts and fish should make up the bulk of a day’s fat intake.



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Margarine and other hydrogenated vegetable oils raise LDL cholesterol, lower HDL cholesterol, interfere with essential fatty acid metabolism, and are suspected of being causes of certain cancers. While butter is a more healthful choice than margarine, it still needs to be restricted in a healthy diet as butter is a saturated fat.

Essential Fatty Acids are termed essential because our bodies cannot produce them. Cold water fish like salmon, sardines, mackerel, herring, and halibut are great sources of the longer chain omega-3 fatty acids eicosapentaenoic acid (EPA) and docosahexanoic acid (DHA). Hundreds of studies have shown their ability to decrease cholesterol and TG levels (Kromhout, 1985). If you intend on recommending encapsulated fish oils, it is imperative that they are high quality as 2 studies have shown a high degree of oxidative materials within fish oil capsules. If planning on getting your EFA’s from fish, it is important that the fish is wild, not farmed, and ideally periodically tested for toxin levels showing safe limits. Many people choose to rely on flaxseed oil for omega 3 EFA’s, which contains alpha-linolenic acid, an omega-3 oil which the body can convert to EPA. Omega 3 fats help to decrease platelet aggregation, whereas saturated and trans fats promote platelet aggregation, another risk factor for CVD.

Fruits & Vegetables Less than 10% of the population meet the lowest recommendation of five servings of a combination of fruits and vegetables a day, a recommendation created in an effort to reduce the risk of developing heart disease, cancer, and other chronic degenerative diseases. Encourage your clients to fill their diets with fresh fruits and vegetables, with a particular emphasis on the vegetables! Carotenes & Flavonoids Carotene-rich and flavonoid-rich (pigments) fruits and

veggies have been shown in numerous population studies to reduce the risk of heart disease and strokes. The best dietary sources of carotenes are green leafy vegetables and yellow-orange colored fruits and vegetables such as carrots, apricots, mangoes, yams, and squash. Red and purple vegetables



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and fruits such as tomatoes, red cabbage, berries, and plums contain a large portion active pigments, including flavonoids. Legumes, grains, and seeds are also significant sources of carotenoids. In a longitudinal study of 4807 healthy men & women, there was an inverse correlation between flavonoid intake and death from heart attack (Geleijnse 2002). Good dietary sources of flavonoids include citrus fruits, berries, onions, parsley, legumes, green tea, and red wine (but note: vitamin C has stronger protective action than wine).

Fiber Fiber comprises components of plant cell walls and indigestible parts of our diet. Studies have shown a dose dependent reduction in cholesterol from eating fiber, particularly soluble fiber which is found in legumes, fruit and vegetables. Many studies focused on oat bran and oatmeal consumption, and found that individuals with elevated cholesterol would see as much as a 20% reduction in total cholesterol from regular consumption of these fibers. Individuals with low or normal cholesterol levels see no change from the same consumption pattern Serum lipid response to a fat-modified, oatmeal-enhanced diet (Van Horn, 1988).

Protein Although it is imperative that people consume enough protein for optimal health, excess protein intake has been linked to several chronic diseases including cancer, osteoporosis, and heart disease. When reducing protein intake, look first to animal sources of meat and dairy. Intake of animal protein should be limited to a maximum of 4–6 ounces/day, with fish, skinless poultry, and lean cuts being preferred to fat-laden choices. Excellent alternate sources of protein include legumes, nuts, seeds & grains. To ensure vegetarian proteins are complete, follow the guidelines in the diagram below:



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Examples of meals with complete proteins are therefore: rice and beans, almonds and lentils, oatmeal with milk. There are a few grains which provide complete proteins, such as quinoa and amaranth. These grains do not need to be combined. Note: recent evidence shows that the combination does not need to occur in a single meal, but across the span of a day.

4.7 Balanced Blood Sugar

Elevated insulin levels are associated with elevations in cholesterol, triglycerides, blood pressure, and risk of death from cardiovascular disease. Remember the steps to maintaining a balanced blood sugar, including:

• Eating protein with each meal and every snack. • Focusing on complex carbohydrates as 80% or more of the

total carbohydrate intake. • Consuming lots of onions and garlic to stabilize blood

sugar. • Walking after meals (helps put sugars into the muscle

rather than allowing a high peak in the blood, thereby decreasing overall insulin release).

• Achieving and maintaining an ideal weight. Extra fat cells contribute to the development of insulin insensitivity which then results in increased insulin production.

• Eating breakfast! Don’t skip meals. • Ensuring that 60% of your diet or more comes from low

glycemic index foods. • Eating a minimum of 25gm of fiber a day. (35 gm for those

looking to decrease an already high cholesterol level). Note: there is good evidence that a diet providing as much as 100gm of fibre a day may give the best protection from major diseases (cancer, heart disease, diabetes).

4.8 Hypercholesterolemia

Hypercholesterolemia refers to high levels of cholesterol in the blood.



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Since there are several schools of thought on the cholesterol/heart disease connection, it has become an area of study that is full of controversy and continually evolving. It is important for you to stay up-to-date on the latest research and theories, and be willing to have an open mind as new information is discovered.

A great deal of good information can be found at DrMercola.com. A list of Dr. Mercola’s articles on heart disease can be found at this link: http://www.mercola.com/article/heart_disease/index.htm What is Cholesterol? Cholesterol is a soft, waxy substance found in every cell in your body. It is essential for the production of hormones, cell membranes, bile salts, and vitamin D as well as required for the digestion of fat.

Adults synthesize approximately 1 gram of cholesterol and consumes only 0.3grams of cholesterol each day. Less than 50% of dietary cholesterol is absorbed. Cholesterol and Heart Disease There is an ongoing debate over why high cholesterol levels are thought to cause heart disease. Among the popular theories, some researchers feel it is the nutritional deficiencies of Vitamin C, niacin, selenium, zinc, chromium, fibre, pyridoxine, cobalamine and folic acid which contribute to cholesterol deposition in the body (also known as the “micro-nutrient hypothesis”). Others feel it is only dietary rather than endogenous cholesterol that is deposited, and still others say we cannot use dietary cholesterol as efficiently as endogenous sources. Some theories look to lifestyle, and credit lack of exercise and obesity. A more likely theory is starting to gain ground. Simply put, cholesterol can be thought of as the body’s ‘band-aid’ that is laid down to protect damage done in the lining of the arteries. Arteries can be damaged by eating foods high in processed sugars and grains. The more damage to the arteries, the more cholesterol the body sends in to patch up the damage. These cholesterol deposits are similar to a scab that forms when we cut our skin. Once the cholesterol is laid down in the artery it is referred to as ‘plaque.’



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This theory is saying that high cholesterol is the result of the body trying to minimize the damage to the artery lining. Saying that a high blood cholesterol level is the cause of heart disease is like blaming a scab for the cut. More information about this theory can be found here: http://articles.mercola.com/sites/articles/archive/2005/05/28/cholesterol-heart.aspx The ultimate goal is not to eliminate cholesterol, as it is a vital molecule in our bodies functioning. The goal is to eliminate the foods and lifestyle habits that contribute to damage and inflammation so the body does not require so much cholesterol production. High Cholesterol Treatment Considerations It will likely be several decades before the high cholesterol fear runs its course, and you will get many clients asking how they can reduce their cholesterol levels a natural way. Below are several treatment options are available, some of which are discussed following the table.

High Cholesterol Treatment Considerations Niacin (B3) Garlic

(Allium sativum) Gugulipid (Commiphora mukul)

Pantethine (B5) HMG CoA Reductase Inhibitors (Statin Drugs)

% decrease total cholesterol: 18%

10% 24% 19% 34%

% decrease LDL : 23%

15% 30% 21% 32% (at 26 weeks maximum dose)

%increase HDL : 32%

31% 16% 23% 8% (alt study reports 7% at 26 weeks)

%decrease TG’s: 26%

13% 23% 32% 25%

Lp(a) lipoprotein A decrease: 35% at 26 weeks on 4g/day

- (no data) -(no data) -(no data) 0 at 26 weeks on max. dose.

Side Effects: Flushing of the skin, stomach irritation, ulcers, liver damage, impaired glucose tolerance, and hyperuricemia.

Non-toxic in most individuals. Can cause irritation of the GI tract.

Only use extracts of soluble portion. Clinical studies have shown no adverse affects to liver function, blood sugar control, kidney function, or blood parameters.

No significant side effects or adverse reactions have been reported.

Carcinogenicity, hepatotoxicity, elevation of creatinine kinase, rhabdomyolysis, myositis, and stomach ulcers. Main side effects are muscle pain, nausea, diarrhea, flatus, abdominal pain, headach, and skin rash.

Recommended form and daily dosing: Many side effects can be avoided if inositol hexaniacinate is used.

Dosage of commercial garlic product should provide a daily dose equal to 4gm of fresh garlic (1-2 cloves) and

Gugulipid extracts standardized to contain 25mg of guggulsterone per 500mg tablet given TID.

300mg TID. Commonly prescribed dosages (eg. 20mg/day). Periodic testing of LFT’s and cholesterol must be done (min q6mos)



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Typical dose is 1gm TID. Regardless of form used, periodic checking of LFT’s and cholesterol must be done (min. q6mos).

guarantee a minimum of at least 10’000 mcg allin or a total allicin yield of 4’000mcg.

Legend: medical nomenclature: OD = once daily, BID = twice daily, TID = three times daily, QID = 4 times daily. “q” = every (eg. q6mos = every 6 months) LFT = liver function tests (alkaline phosphatase, ALT, bilirubin)

Cholesterol Lowering Supplements There are a number of cholesterol lowering supplements which are widely available.

Studies have shown that Niacin has the ability to lower LDL cholesterol, Lp(a) (Lipoprotein A), triglyceride (TG), and fibrinogen levels while simultaneously raising HDL cholesterol levels. Niacin dosage recommendations If pure crystalline niacin is being used, start with a dose of 100 mg three times a day and carefully increase the dosage over a period of 4–6 weeks to the full therapeutic dose of 1.5–3 g daily in divided dosage. If inositol hexaniacinate is being used, begin with 500 mg TID for 2 weeks and then increase to 1000 mg TID. With either crystalline niacin or inositol hexaniacinate, it is best if they are taken with meals. Vitamin B5 Pantethine, a form of Vitamin B5, has significant lipid-lowering activity while pantothenic acid has very little (if any) effect in lowering cholesterol and triglyceride levels. Pantethine administration at a dose of 900mg/day has been shown to reduce significantly serum triglyceride by 32%, total cholesterol (TC) by 19%, and LDL cholesterol levels by 21% while increasing HDL cholesterol levels by 23%. Lipid lowering effects are even stronger in diabetics. (�� If your client is on HMG CoA Reductase inhibitors: supplement CoQ10, as the statin drugs inhibit CoQ10 synthesis. CoQ10 is an antioxidant, has a sparing effect on Vitamin E, and works with Vitamin E to prevent damage to lipid membranes and plasma lipids. It is also crucial to energy formation. Studies have shown CoQ10’s ability to reverse or prevent the degenerative lesions of the heart as well as enhance the mechanical function of a failing heart.



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Dose: 2mg per kilogram body weight. Fish Oils are beneficial in a dose of 5-10 grams per day (less in those concentrated for higher EPA and DHA content). They should be taken with Vitamin E 400-800IU (to prevent peroxidation). The benefits of fish oil supplementation include possible lowering of TG levels and variable effects on TC and LDL. There are many benefits to this treatment, including decreased vascular response to injury and decreased rate of sudden cardiac death (Kromhout, 1985; Harats, 1991).

Vitamin C Vitamin C can be given at high doses. It decreases oxidation of LDL & Vitamin E. A cohort study of 11,348 non-institutionalized US adults found that both women and men with the highest vitamin C intake and regular vitamin C supplements had a 25 and 42% decrease in cardiovascular mortality, respectively. Vitamin C supplementation may reduce the risk of cardiovascular mortality by influencing cholesterol levels, platelets, and even blood

pressure (Engstrom, 1992). Dose: 500-1000mg TID. Note: this dose can be too much in patients with a history of calcium oxalate kidney stones. Calcium Calcium Carbonate has been shown, at a dose of 2 grams daily in divided doses (500mg per dose is the maximum for efficient absorption), to decrease total cholesterol by 25% and TG’s by 35% (Gaby, 1996). The MOA (mechanism of action) may be the result of calcium’s ability to bind saturated fat or bile salts in the gut, and reduce the absorption of saturated fat in the process. More absorbable forms of calcium may be more effective.

Magnesium Magnesium citrate or Magnesium aspartate can be administered in a dose of 300 – 500 milligrams per day. While it may raise HDL, it also ensures sufficient intracellular potassium levels (it activates Na/K ATPase pump), and is a natural calcium channel blocker. (Gaby, 1996).



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L-Carnitine Studies have shown that at 4 months supplementation of 1.5 – 4grams of L-carnitine per day in divided doses, TC was lowered by 20%, TG by 28% and HDL increased by 12%. (Gaby, 1996). L-carnitine transports long chain fatty acids into the mitochondria. Supplementation improves the utilization of fat as an energy source.

Soy Soy protein given in doses of 25-50 grams per day shows significant results. LDL decreases by 12.9%, TC by 9.3%, VLDL by 2.6%, TG’s by 10.5% and there is an increase in HDL by 2.4%. Chromium All forms of Chromium have been shown to lower blood lipids at doses of 400 – 600 micrograms per day. Typical changes are small: a 10% reduction in TC and TG, and a 2% increase in HDL. Results are more pronounced in those with initial low chromium levels. Chromium is a key constituent of the Glucose Tolerance Factor (GTF), which works with insulin to facilitate uptake of glucose into cells. Niacin and glutathione (glutamic acid, cysteine and glycine) also make up GTF. Lecithin Lecithin with 90% phosphatidylcholine has been shown in several clinical studies to lower TC by 8.8-28.2%, and TG’s by an average of 25%, and increase HDL by 13.4 – 20%. Lecithin can be given in a dose of 500 – 900 mg TID. MOA increases solubility of cholesterol, removes cholesterol from tissue deposits, and inhibits platelet aggregation. These beneficial effects may come from its high linoleic content (an essential fatty acid).

4.9 Congestive Heart Failure

The inability of the heart to effectively pump enough blood is termed congestive heart failure (CHF). It is usually the result of long term hypertension, previous MI, a heart valve or heart muscle disorder, and/or chronic lung diseases. We either see left sided CHF resulting from diminished cardiac output, or a right-sided CHF which causes a damming of blood in the venous system, or both. Familiarize yourself with the flow of blood through the heart by watching some of the many animations available on the internet. Do a Google search for “blood flow through the heart.”



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To better understand the mechanisms and symptoms of CHF, a brief review of circulation can help. Oxygenated blood goes from the lungs to the left side of the heart (via the pulmonary vein), where it is dispersed to the rest of the body by the arterial system (arteries always carry blood AWAY from the heart). The venous system returns blood to the right side of the heart (veins ALWAYS return blood to the heart), where the heart pumps the blood to the lungs (via the pulmonary artery) for oxygenation. And so the cycle repeats. If the heart has a diminished cardiac output, as occurs in left heart failure, then the heart is less able to pump the oxygenated blood to the body. Blood coming into the left ventricle from the lungs may "back up," causing fluid to leak into the lungs, known as pulmonary edema, which can cause shortness of breath. The slowing of blood flow leads to excess fluid build up in the tissues, known as edema. Right-sided heart failure usually occurs as a result of left-sided failure. When the left ventricle fails, increased fluid pressure build up in the lungs, eventually affecting the hearts right side. When the right side loses pumping power, blood backs up in the body's veins. This usually causes swelling in the legs and ankles.

Nutritional Treatments for Congestive Heart Failure There are a variety of treatment considerations which health practitioners and their clients have available to them. Calcium Calcium citrate/ amino acid chelate can be given at 1 gram per day. It may aid in improving the force of contraction of the heart by increasing cytosolic calcium ion concentration in the myocardium. Magnesium Magnesium citrate/ aspartate/ amino acid chelate is given in a dosage of 500 milligrams/day. Magnesium is vital to proper functioning of Na/K ATPase pump. A patient with congestive heart failure has elevated intracellular Na and a reduction in intracellular K. A magnesium deficiency will contribute to this problem. Magnesium levels have been found to correlate directly with survival rates for patients with CHF.



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CoQ10 CoQ10 may be administered in a dose of 30-300 milligrams qd depending on the severity of the condition. Metabolically active tissues require CoQ10 to function optimally, as it is a cofactor in the ETC. Deficiency in CoQ10 can lead to heart failure. CoQ10 will increase energy production in the heart, increase cardiac output, increase stroke volume (blood ejected from left ventricle per heart beat) and increase the ejection fraction (the percent of blood ejected from the ventricle per contraction).

L-Carnitine 1500mg of L-Carnitine is taken in divided doses. Deficiency of L-Carnitine leads to a decrease in energy production, as it is needed to transport fatty acids across the mitochondrial wall. When the oxygen supply to the heart goes down (as in CHF), so do carnitine levels, and therefore energy production. Supplementation may correct this problem. L-Arginine L-arginine is taken, 2grams BID, on an empty stomach. L-arginine is a precursor to nitric oxide, which dilates blood vessels and lowers blood pressure when administered orally and intravenously. Taurine Taurine is the most important free aa in the heart. In congestive heart failure patients it improves the force of the contractions and has a hypotensive (blood pressure lowering) effect. It is taken in a dose of 2grams TID on an empty stomach).

4.10 Hypertension (High Blood Pressure

Hypertension is diagnosed when 3 or more readings on separate visits show a systolic of 140 mmHg or more and/or a diastolic of 90 mmHg or more. These reading are illustrated in the following table: Assessmen

Category Systolic And/or Diastolic Optimal <120 And <80 Normal* <130 And <85 High Normal 130-139 Or 85-89 Hypertension Stage 1 140-159 Or 90-99 Stage 2 160-179 Or 100-109 Stage 3 =>180 Or =>110



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* new parameters are being suggested (not yet widely accepted)which places anything over 120/80 as BOARDERLINE hypertension. Optimal numbers have decreased accordingly. There are a number of risk factors for hypertension which you should be aware of and watch for in your patients. These include:

• family history • obesity • alcohol • excess dietary sodium • stress • physical inactivity.

If you encounter a client with hypertension, there are a number of therapeutic considerations to use in treatment.

Treatments for Hypertension Diet Modifications The first consideration is diet. Decreasing the client’s sodium intake is useful in lowering blood pressure in about 70% of cases. Other dietary considerations include eating a diet that is low in sugar and high in fiber. Little or no caffeine or alcohol should be consumed. Finally, eliminating food allergies and sensitivities from the diet is helpful (as this will decrease overall inflammation in the body, and inflammation is a common precursor to CVD).

Exercise Participating in regular exercise shows a reduction in blood pressure of 6-7 mmHg in both systolic and diastolic measures. Thyroid A significant consideration in hypertension patients is the thyroid. One study has shown that hypertension incidence among hypothyroid patients was at 14.9% compared to 5.5% among healthy controls. The administration of thyroid hormone in hypothyroid patients showed a dramatic decrease in blood pressure.

Minerals Numerous studies have shown a decrease in BP from mineral supplementation. Minerals which are particularly helpful are potassium, calcium and magnesium.



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CoQ10 Research has shown that supplemental CoQ10 in hypertensive patients results in improvement of both diastolic and systolic blood pressure measures. Confounding factors in this research could be that were subjects on HMG CoA Reductase Inhibitors, also known as statin drugs, they would have had a functional deficiency of CoQ10, thereby increasing the need and likely the effect of supplemental CoQ10, as statin drugs inhibit its formation. Recommended dose: 50mg BID. Potential depletion problems from treatment with statin drugs include high blood pressure, congestive heart failure and low energy. Essential Fatty Acids (EFAs) Deficiencies in essential fatty acids are related to hypertension. Adequate omega 6, found in sunflower and safflower oil among other sources, and omega 3, notably present in fish or flax oil, can lower blood pressure. Single Amino Acids: L-arginine & L-taurine Finally, L-arginine and L-taurine can be beneficial in the treatment of hypertension. Arginine NO (nitric oxide) which in turn dilates blood vessels and decreases blood pressure. Taurine has a hypotensive effect on the heart.

Dosing of Therapeutic Nutrients for Hypertension

Potassium 600- 1000 mg/day if diet not high in fruits (esp. banana) and vegetables.

Calcium 800 – 2000mg/day Magnesium 300 – 500mg/day. (in low renin clients: 2:1

Cal:Mg is best, in high renin clients: 1:1 Cal:Mg is best).

CoQ10 50mg BID EFA’s 5-15mL/day with 400IU Vitamin E L-taurine 6 gm a day in divided doses L-arginine 1500mg BID away from meals

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