Heart Health and Naturopathic Medicine ©Dr. Kevin Passero 2005 Dr. Kevin Passero, N.D. 203 Ridgely Ave

Review of Major Risk Factors Elevated Cholesterol High Blood Pressure SmokingDiabetesInactivity

The Blood Vessel 4 Layers the endothelium the Intima the Media the Adventitia

Cycle of Damage Chronic endothelial injury –Hyperlipidemia –Hypertension –Smoking –Homocysteine –Toxins –Viruses –Immune reactions

Cycle of Damage Endothelial dysfunction –Increased permeability –Platelet adhesion –Monocyte adhesion and emigration –LDL emigration

Causes of Endothelial Injury Hemodynamic disturbance –High blood pressure Homocysteine Cigarette Smoke Hyperlipidema

Cycle of Damage Further Damage –Smooth muscle migration –Foam cell production –Collagen proliferation –Feeds the cycle

Cholesterol HDL “the good one” –Carries fat from the periphery back to the liver for excretion through the bile LDL “the bad one” –Carries fat from the liver to the periphery for deposition and storage

Other forms of Lipids Apolipoprotein B (ApoB) –These proteins transport VLDL (the precursor to LDL) throughout the blood stream. –ApoB contributes to peripheral uptake of LDL by receptor recognition. –Recent research has shown that levels of APOB can be more important in determining cardiovascular risk factors than just HDL and LDL.

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

Cholesterol Precursor to many hormones in the body 80% produced by the body 20% from the diet

Cholesterol Lowering

Exercise One of the most important factors in changing the ratio of HDL to LDL levels. Both cardiovascular and weight training programs are important to achieve adequate results

Diet Avoid saturated and trans/hydrogenated fats –Increase oxidation and potentiate endothelial damage –Very rigid structures that do not act appropriately when incorporated into cellular structure

Foods that contain hydrogenated oils Virtually all refined and processed foods Margarine Cakes Cookies Candies Doughnuts Bread Canned soups Crackers Processed cheese Canned foods Cereals Snack foods Salad oils Grocery store oils Virtually all refined and processed foods Margarine Cakes Cookies Candies Doughnuts Bread Canned soups Crackers Processed cheese Canned foods Cereals Snack foods Salad oils Grocery store oils

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

Fats The Omega 3 vs Omega 6 –Reduce arrythmias –Reduce MI risk –Slow growth of plaques –Reduce liproprotein and triglyceride levels –Enhance endothelial function –Induce slight drop in BP –Lower CV risk by reducing inflammation

Fiber Enhances cholesterol excretion by absorption Enhanced absorption in the GI equals greater excretion via the feces.

Sources of Fiber Psyllium Husk Fruits and Vegetables Flax seed

Supplements Guggul Gum –Clinical trials have demonstrated a 10%-25% reduction in cholesterol using 75 mg of guggulipid per day.[i] [i] – [ i]Gavagan, T MD, MPH. Cardiovascular Disease. Primary Care; Clinics in Office Practice June;29 (2) [ i] [ i]

Supplements Niacin –Numerous trials have shown IHN to be virtually free of the side effects associated with conventional niacin therapy, and extensive research has proven it’s efficacy in treating hyperlipidemia.[i] Effective doses of IHN for treatment of hypercholesterolemia range from 500 mg- 1g TID. [i] – [i] Head, K. Inositol Hexaniacinate: A Safer Alternative to Niacin. Alt Med Review Sep;1 (3): [i]

Supplements Fish Oil –Shown to lower LDL levels and raise HDL levels –Have strong anti-inflammatory properties –Can have mild effects on blood vessels

Supplements Red yeast rice –Works via the same mechanism as traditional statin therapy.

Drugs Main class is the statins –Lipator, Lescol, Mevacor, Pravachol, Zocor –These act by inhibiting the HMG-CoA reductase enzyme, a rate limiting enzyme in the production of cholesterol in the liver –HMG-CoA reductase also vital enzyme in the production of CoQ10 (ubiquitone)

Statins Often very effective at lowering cholesterol without dietary changes but easily deplete CoQ10 levels Results in muscle cramps, aches and fatigue. Very important to supplement with CoQ10 when taking statins

The Rest of the Story InflammationToxicityCarbohydratesHomocysteine

Inflammation Chronic inflammation can contribute significantly to heart disease and CAD Measuring C-reactive protein can serve as an important marker for identifying cardiovascular risk factors.

Reduce Inflammation Eating a diet limited in trans fats, hydrogenated fats, sugar, dairy products, red meat, coffee and alcohol will help reduce systemic inflammation Omega 3 fatty acids (EPA) is one of the strongest anti-inflammatory substances in our bodies.

Toxicity Cholesterol can often serve as buffer for the bodies level of toxicity. Production can increase as a defense mechanism Toxicity can also disturb negative feedback pathways in the liver

Carbohydrates Stimulate a quick rise in blood sugar which often results in rapid and extensive insulin response Insulin is the bodies hormone that signals the storage of fat

Homocysteine Naturally occurring byproduct of the bodies metabolism Can significantly increase inflammation, platelet aggregation, and plaque formation Very easy to reduce levels by eating foods rich in folate and by supplementing folate, B6 and B12

Overview Important Dietary Considerations –High Fiber Foods –Fruits, vegetables, flax seeds, pysillium powder

Overview Avoid high inflammatory foods –Trans fats, hydrogenated fats, sugar, red meat (unless grass fed), coffee, dairy products, refined carbohydrates and highly processed foods

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

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

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

Overview Get the proper tests along with the regular ones for HDL/LDL and triglycerides –Homocysteine levels –C-reactive protein –LpA

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