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Nutrition for Cardiovascular Disease


GENERAL COURSE NOTES FIRST, CV TX NOTES FARTHER DOWN
he's ranting already from behind the podium
wearing a red tie, grey vest, grey suit, and a businessman's hat
glasses half down his nose
gesticulating

Richard Heinberg will be a guest lecturer for this class
http://www.richardheinberg.com/Home.html

Marz says we're in the "right profession"
and that the "other profession" won't exist not far into the future

The Silence of the Bees
important movie
Albert Einstien said when the bees go we have four years to live
because they are main pollenators
geneticaly modified crops as a reason why bees are going
cell phone theory debunked

clip from good will hunting
Matt Damon applying to NSA
he response as to why he not should join
humorous perspective on world

ASSIGNMENT
project to do
cookbook compilation project
he has 14 years of recipes
tasty and life extending (decr CV dz and DM2)
on ersvs there's an example
be creative with your dishes

midterm and final

waffle party
attendance requirement
no eggs or gluten
recipe in book under allergies

there's a proposal to Whole foods to build kitchen
in building adjacent to NCNM clinic

powerpoint is up now, lecture keeps getting longer, he'll make short cuts
*******************************************************************************

CARDIOVASCULAR DISEASE: ATHEROSCLEROSIS PART 1
all dz related to cv function which is in turn related to nutrition
Dr Oster, cardiologist, turn of the century "you are only as old as your BVs"

CIMT
CAROTID INTIMAL MEDIAL THICKENING
DrM uses this test
US of carotids gives biological vs chronological age
can get it done in Clackamas at a place called "bodyview" run by Mike and Tony
says Dr Marz sent you and you might get it for free "professional courtesy"
http://www.bodyviewscanning.com/
cost is aobut $150

EARTH MONTH
earth hour, goal is to turn off everything
he was in Toronto lights went out
didn't happen here in PDX

I'm not typing the notes that are on the screen
just what he says

pretty much everyone has some form of CV dz
1st step: complete hx
stroke or heart attack before age of 60 esp relevant

book: the Great Cholesterol Con
a little bit sensationalized
but good info and references in there
hemochromatosis info

Kellogg report 1984
**98% of 7-12 year olds showed at least one major risk factor for heart dz
54% had 3+ risk factors
abn high chol recorded in 42% of kids

test for Lp-PLA2
lipoprotein PLA2 is best new indicator for atherosclerosis
on LDL which when oxidized
PLAC test measures Lp-PLA2 in blood
enzyme highly specific to vascular inflam and implicated in formation of rupture-prone plaque
more in circ-->more MI and stroke risk

VAP testing is vertical somethingorother
differentiates between LDL and oxidized LDL??

prevent LDL from being oxidized
prevent LDL from penetrating ECs
by reducing inflam, decr free radicals, allergens, high iron, heavy metals, parasites, AGEs, HTN
avoid alc (incr perm), avoid NSAIDS, chlorinated water
**track inflam via CRP, want values under 1.0, correlates with inflam in coronary vessels
Okinawans have flavonoids in blood to protect ECs (green tea)
book: the French Paradox, French have flavonoids too (wine)
avoid NSAIDS = new sorts of aspirin in disguise

small dense LDL penetrates and oxidizes more easily
"Lp-PLA2 hydrolyzes oxidized LDL to generate pro-inflam mediators"
Lyso-PC and OxFA trigger inflam and atherogenesis, upreg of adhesion, recruits monocytes
they go to intima, become macrophages, eat ox-fa, become foam cells
this is measurable thickening of intima and media
CIMT measures intimal thickening within 1/1000 of a mmm
foam cells aggregate into fatty streak
plaque is covered by fibrous cap
cap is thinned and prone to rupture
protect CT in ECs
PDX has soft water 1.2
hard water has more minerals, Mg, Si, Mn, these things strengthen ECs and reduce rupture

clotting
can measure PLT stickiness, platelet aggregometer, need fresh specimen
and also PLT activation time, activity, and one thing he can't remember
perfect thing for monitoring health

he got in trouble for not supporting mammography in western states lecture

no attendance sheet today

Kurt Oster
homogenized milk -->higher xanthine oxidase in blood, toxic to BVs
atherosclerosis directly related to consuming homogenized cow milk products

homocysteine elevation
folic is #1 def, get from green leafies
high homoc related to alzheimers, dementia, osteoporosis

lead-->HTN
bisphenol A-->breast, uterus, colon, prostate CA

mirador store on division
pressure cookers
http://www.miradorcommunitystore.com/

some who die of MI have clean vessels
mbdt Mg def

S/Sx of atherosclerosis:
insidious, usu ASx
stress EKG mb false negative "Bill Clinton effect"
silver wire changes in retinal aa (advanced)
atrophic change in skin, loss of hair on legs and dorsum of feet, toes
violaceous mottling of skin of lower legs
poor circ esp in extremities
diagonal earlobe creases esp in males whites 12% false pos rate
dry skin and ear canals (EFA def) also excessive dark earwax
ringing in ears (decr blood flow)
waist: hip ratio too big: over 1.2 is big risk for DM etc

VAP TESTING
vertical auto profile
most accurate and comprehensive chol test
reports 15 separate components (4 on standard test)
most insurance companies will cover it
http://thevaptest.com/
total HDL is types 2 and HDL3 together
HDL2 optimal is greater than 20
LDL is fluffy pattern A and small dense pattern B for BAD (2 types)
if bad: incr antioxidants

CHEM SCREEN
HDL, LDL, TGs
apolipoproteins AI, AII, B (LDL subfraction, toxic to BVs)
LpA is not same as apolipoprotein A
high LpA levels correl with incr risk of CHD
(over 10 is too high per Marz, ref range is 30-70 for total)
apolipoprotein A is protective
homocysteine, fibrinogen

chol Marz ideal 150-170
220 chol mb OK for some individuals
chol alone doesn't give whole picutre
chol 300 or so must have a lot of LDL and be bad

chol under 150 hardly under heart dz
if SAD diet and chol under 120 then be nervouse
cancer risk
Jeff Bland lecture

Okinawans centenarians averagechol 152
elders 65-72 avg chol 212 HDL 57m, ration 3.7
avg homoceystine 8mmoles/L, flavonoids/day 100.9, vit E 16.7
US elders avg chol 221, avg HDL 37, ratio 6.0
12.9mg/day flavonoids (not enough colored foods)

10% of world pop heterozygous for hemochromatosis
**if 2 or more Fe saturations values over 40% then get genetic testing

stress EKG
thalium stress test using treadmill or toponine
more sensitive rel to stationary EKG
noninvasive, good info
angiography is most invasive
EKGs notorious for negative findings even with severe atherosclerosis

IONIC MAGNESIUM LEVELS
most accurate way to measure intracellular levels of Mg
not commercially available
more accurate than WBC or RBC levels
imp link to CV risk and atherogenesis

EXATEST
sublingual swab for cells, fix them, do xray analysis

HOMOCYSTEINE
he wants levels under 9
decr prot intake to lower, less methionine

GARLIC AS HYPOLIPIDEMIC
http://www.naturalmedicinejournal.com/pdf/NMJ_APR10_BP.pdf
(not from Marz lecture)

SONOCLOT ANALYZER
3 steps:
time until initial clot formation
rate of fibrin gel formation
clot retraction of the fibrin gel

VIT D levels
he says most people here in the 20-30 range
ng/ml or another measure
numbers not always same, be careful
surfers and outdoor workers 50-70 levels common
hx of cancer go for levels of 90
mb protective vs bisphenol A induced cancers (his theory)
mushrooms good source of ergocalciferol, shitakes irradiated
too high-->calcification of soft tissues, kidney stones
take vit D with fat, not alone
if elevated chol or TG get false elevation of Vit D level readings

EBCT
electron beam computed tomography
Marz likes low tech better

NUTRITIONAL TREATMENT

water soluble fibers: pectin, guar gum, oat bran, Konjac, rice, bran
want 40-50 grams/day, most people get about 2
(konjac: grown in India, China, Japan and Korea for large starchy corms, used to create a flour and jelly of the same name, vegan substitute for gelatin, in Japanese cuisine, konnyaku is noodle-like strips in dishes ie oden, typically mottled grey and firmer in consistency than most gelatins, has little taste; the common variety tastes vaguely like salt, valued for its texture

soy and vegetable protein, 40g goal
oats reduce chol

incr complex carbs

decr fats to 12-25% of total calories depending on activity and glucose metabolism

cook rice al dente to keep glycemic index low

avoid sucrose and high fructose corn syrup
avoid Maillard rxn, glycosylation

avoid hydrogenated oils and trans fatty acids
avoid oxidized fats, fast food, deep fried, beef jerky, egg beaters, sprayed eggs
*ghee was in list but he's removed that restriction, used as carrier for medicinal herbs, tumeric etc, contains butyrate which is good for GI

eat cold water fish, colder water-->higher EPA and DHA, less in farmed fish. salmon, mackeral, sardines are best. source: vitalchoice.com has less toxic fish
http://www.vitalchoice.com/index.cfm WHERE TO BUY FISH
sustainable fishing
he recommends the sardines
need more EPA for schizo
one study: fish once a week has better effect than taking a statin

fish oil
pharmax has finest
may incr HDL, lowers TGs

flavonoids
antioxidants to protect ECs from LDL damage
quercetin, proanthocyanidins, (PCO = procyanidolic oligomers), catechin (in green tea)
eating good chocolate once a day has sig effect in lowering heart dz

legumes
decr chol, have low glycemic index
contain soluble fiber
sulfur containing aa's, NAC
also contain methionine
fermented tofu??

yogurt
Metchnikoff in early 1900's, bact cultures and bowel flora
M proposed that lactic acid microbes are antagonistic to putrefying microbes of gut
populations that eat yog regularly live long time (Bulgaria)

**xanthine oxidase is toxin to BVs
found in homogenized milk, micelles suspend fats and xanthine oxidase
http://en.wikipedia.org/wiki/Xanthine_oxidase
in humanx xo normally found in liver not in blood
when liver is damaged xo released into blood: blood assay for ox is way to detect dmg
on path to forming uric acid
allopurinol is a xanthine oxidase inhibitor used in tx of gout
also involved in the metabolism of 6-mercaptopurine
caution in administering allopurinol and 6-mercaptopurine, or its prodrug azathioprine
Xanthinuria = rare genetic disorder:
lack of xanthine oxidase-->high xanthine-->renal failure
sufferers advised to avoid foods high in purine and drink plenty of H2O
*inhibition of xanthine oxidase proposed as a mechanism for improving CV health
xanthine oxidase and xanthine oxidoreductase also present in corneal epi & endothelium
mb involved in oxidative eye injury

garlic and onions
inhibit plt agg by blocking thromboxane syn for several hours

alfalfa sprouts (Medicago sativa)
large amounts antag B6-->high homocysteine
5cups+/day may increase HDL
sprouts in general known as health foods
high in protein, calcium, minerals, B vitamins, C, E, K
Dr M says they have omega 3 fatty acids

COFFEE
decrease coffee intake
more than 1.5 cups/day incr chol
one study shows over 5 cups/day incr risk of heart dz by 50%
method of brewing is important
paper filtering is better than boiling, percolating, other filters
use unbleached paper to avoid dioxin
phenols protective vs cancer and cv dz
DrM says a couple of cups a day are probably health promoting
paper filter removes oily diterpenes (kahweol and cafestol) which incr LDL-->incr cvdz

ALCOHOL
mostly stims production of HDL3
alc is angiotoxin
small amounts mb protective vs atherosclerosis BUT
studies on drinkers biased dt presence of former heavy drinkers in non-drinker pool

NIACIN
schizophrenics don't flush: a test for schizo!!
for smoking cessation
caution: some time-release niacin-->fulminant hepatitis
use hexannicotinate because it doesn't flus and is much less toxic
effect is not as strong as regular "flushing" niacin
blocks synthesis of cholesterol in liver
gram amounts used (high doses)
http://en.wikipedia.org/wiki/Niacin#Lipid-modifying_effects
decr: total chol, TGs, VLDL, LDL, incr HDL
). It has been proposed that niacin has the ability to lower lipoprotein(a), which is beneficial at reducing thrombotic tendency.[15]
doses: 1000-2000mg, 2-3x/day
blocks breakdown of fats in adipose esp VLDL

two to three times daily,[16] blocks the breakdown of fats in adipose tissue, more specifically the very-low-density lipoprotein (VLDL), precursor of low-density lipoprotein (LDL) or "bad" cholesterol. Because niacin blocks breakdown of fats, it causes a decrease in free fatty acids in the blood and, as a consequence, decreased secretion of VLDL and cholesterol by the liver.[17]

By lowering VLDL levels, niacin also increases the level of high-density lipoprotein (HDL) or "good" cholesterol in blood, and therefore it is sometimes prescribed for patients with low HDL, who are also at high risk of a heart attack.[18][19]

The ARBITER 6-HALTS study, reported at the 2009 annual meeting of the American Heart Association and in the New England Journal of Medicine[20] concluded that, when added to statins, 2000 mg/day slow-release niacin was more effective than ezetimibe (Zetia) in reducing carotid intima-media thickness, a marker of atherosclerosis.[21]

As of August 2008[update], a combination of niacin with laropiprant is tested in a clinical trial. Laropiprant reduces facial flushes induced by niacin. [22] Taking 650 mg of aspirin 20–30 minutes prior to taking niacin has also been proven to prevent flushing in 90% of patients, presumably by suppressing prostaglandin synthesis,[2] and while this regimen also increases the risk of gastrointestinal bleeding,[3] the increased risk is less than 1 percent. [4]

PYRIDOXINE 40MG FOLATE 5-10MG B12 1/5MG-3MG
folate lowers homocysteine most
b12 helsp
pyridoxine promosed conversion of homocysteine to cystathionine
pts with early cv dz have genetic defect 30% of the time: lack cystathionine synthase

VIT C
protects vs oxidation of LDL
protects collagen in capillaries, prevent stroke, aneurism
copper

VIT E
Wilfred Shutes: Vit E and the Ailing Heart, little paperback pretty impressive
unesterified vit E was used
synthetic DL alpha tocopherol commonly used
1600 IUs or more have sig effects at reducing plt stickiness
if combine with fish oil, ginger, might bleed

MAGNESIUM
500-800mg/day
he uses sustained release Cardio Mag-lo-plex (Omnivite Nutrition 150mg/tab)
helped formulate this product
others: Mag SR from Niche, Slow Mag from Searle
concentrated in heart 18x more than in blood (in mito)
promotes efficient fx of heart muscle, helps generate ATP
pts with cardiomyopathy have 1/3 the mg level of pts who do not
incr HDL slightly
fibrinolytic activity like drug streptokinase
is a good calcium channel blocker (comparable to verapamil)
decr plt agg
prevents smooth muscle spasm
IV Mg at onset of MI or stroke limits damage, dilates bvs
don't put it in too quickly
works for migraines, menstrual cramps
**if blood sugar high and pee out sugar, also peeing out Mg and Ca+
depleted by stress (noise, sleep deprivation, type A personality)
def agg neg effects of stress (HTN, PUD, MI, noise induced hearing loss)
**cofactor in what enzyme: delta 6 desaturase, if def then low PGE1-->depression
cytotec is drug that is analog of PGE1, used for pts on NSAIDS to protect stomach
book: Immunity and Mental Health, by bates
sx of def: fatigue, anxiety, weakness, chest pain, dyspnea, mm cramps, palpitat, memory loss, intestinal probs, headache, lightheaded, poor stress tolerance, insomnia, lump in throat
60% of pts with mitral valve prolapse have low Mg
Bella and Burton Altura
Burton Silver EXATEST

GITTLEMAN'S SYNDROME
inborn error of metab
Mg and K wasting dt mutat of thiazide sensitive Na?Cl cotransporter (TSC) gene)
autosomal recessive
NEJM article

SELENIUM
200-300mcg/day
more CVD where soil is depleted
potent antioxidant, protects ECs
Keshan dz is se def resulting in cardiomyopathy, common in parts of China
Se and glutathione peroxidase changes inflam LKs to another form (changes HPETES)

BROMELAINE
to decr plt agg and break down arteriosclerotic plaques
use for murmurs
nattokinase
lumbrikinase
decr activation time for PLTs
also used to break down clots (enzymatically)

**diagram page 53: PHOTOCOPY and carry around

MOLYBDENUM
he doesn't use for CV but studies show CT protective effect
protects vs environmental toxins
**used IV to tx sulfite sensitivity asthma, decreases sensitivity

CHROMIUM
200-1500mcg/day
in brewer's yeast
hard to get toxic dose, doesn't compete
most studies use chromic chloride which isn't well absorbed
Alan Gaby rec chromium aspartate
he uses Biotics

ZINC
too much competes with copper-->decr HDL incr total chol
copper is essential for chol metabolism
ZINC DEF CONDITION that will be on boards
**acrodermatitis enteropathica
will be on boards

COPPER
2mg/day
aneurisms??

PANTETHINE
600-1200mg/day
use in pts who don't respond to niacin
metabolic intermediate, precursor of coenzyme A
raises HDL 10-30%, decr chold 10-20%, decr TGs 30-60^

L-CARNITINE
for pts with very low HDL
rate limiting step for beta oxidation
3gm/day incr exercise tolerance
may incr HDL in pts with normal chol and low HDL

PHOSPHATIDYL ETHANOLAMINE
a form of lecithin
found in soybean oil
2T of 12-20 caps/day mostly incr HDL
phosphatidyl choline has better effects on brain fx

HYPOTHYROID?
TX it
TSH over 3
"end organ for environmental toxins"
if HTN with hypo and get thyroid level up to normal: BP may come down

VANADIUM
uses sulfate
.5-1 mg/day lowers chol
used for diabetics with low/normal insulin

SSKI from Sci Bot
saturated solution of potassium iodine
6-8 drops daily solublizes chol esp in small vessels
tx for atherosclerosis! if def only:
**more than 300mg/day inhibits thyroid
can tx thyroiditis with iodine
pt with 330 chol wasn't worried until did VAT test and found superhigh LDL

REMOVE CHLORINE FROM DRINKING WATER
lowest heart dz where chlorination of water not done

HARD WATER
silicon and magnesium
minerals protective vs cv dz
not all hard water is the same
water in PDX is very soft, 1.5 on 10 scale

GINGER
may decr PLT agg and lower chol
he uses lots of ginger
prescribes tincture during flu season
freeze a chunk of it then you can grate it for tea or put in stir fry

HORMONES

ESTROGEN
triple est formula best for avoiding neg effects
3% estrone, 7% estradiol, 90% estriol
est incr HDL and lowers chol, prevents ox of LDL

TESTOSTERONE
Dr M prescribed for young male patient with HTN since age 14
T was low tested 3x
did OGTT and sugar went over 230

DHEA
esp for the elderly
Okinawans have 3x higher levels than American elders
want to do it naturally but how?
do ASI to check levels

CHONDROITIN POLYSULFATE
for CT
indic: petechia, taking coumadin

SNAKE OIL AND SNAKE VENOM
both found to have therapeutic value in tx of cv conditions
both make plts less sticky
decr strokes
http://www.encyclopedia.com/doc/1P3-35377276.html

CASE STUDY
chol 345
TGS in case study: 1820, blood like half and half, causes roulleaux formation
ferritin 287, need to check % saturation, could be incr dt inflam
fibrinogen 390, best under 250
total lipoprotein A 69nmol/L ideal under 20
(subfraction best under 10)
fasting gluc 81
liver enzymes all OK
creat 1.1 a little higher than e likes
dx fatty liver dz via US, tell tech looking for fatty infiltration
TX: 5-6 grams of EPA, DHA, fish oil high dose (mainstay of tx)
diet homework: eat 40 grams of fiber daily
monitor fibrinogen to make sure he doesn't clot excessively
aerobic physical activity

VIETNAM ERA SOLDIERS
high incidence of atherosclerosis
mbdt stress and highly chlorinated water

AEROBIC EXERCISE INCREASES HDL
if HDL is in 30's, too low
mb because exercise is not very aerobic
aerobic exercise will increase it

book: fit or fat, a little dated but he recommends it to pts
how to get heart rate elevated

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