1. Note
Exam
Monday, 7 March at 12:50 in class
65 minutes, bring a calculator and answer in pen
-50 multiple choice questions-50 points
-1 short answer question-10 points
-all Nutrition 263 material to and inclusive of 14 February 2011-strong emphasis on notes

2. Lecture 6a 14 Feb
Hypertension
Pathology
Nutritional Intervention
Nutraceutical Approaches

3. Group activity
Better to manage blood pressure with diet or drugs?

4. PATHOLOGY
Water volume
Water viscosity
Vasodilation
Vasoconstriction

5. Pathology-Water volume
-kidney function
-salt load-osmosis

6. Pathology- Water viscosity
-salt load-osmosis
-fat load-cells are more difficult to shove through tiny spaces if loaded with saturated fat and cholesterol
-saturated fat makes the cells less pliable
- as the cholesterol to phospholipid ratio goes up in cells they are less pliable

7. Pathology- Vasodilation- ability of artery to expand
-important to overcome volume to space ratio
-saturated fat makes walls stiffer and vasodilation more difficult
-cholesterol influx makes vasodilation even more important since cholesterol can reduce lumen size

8. Pathology- Vasoconstriction
-occurs when cholesterol and other lipids infiltrate the arterial wall
-calcium follows causing stiffening of the arteries

9. What can be done nutritionally ?
Group discussion- what are the food groups that affect blood pressure- how?

10. What are the nutritional interventions ?
Water volume
Reduce salt intake to 1500 mg Na (or x milligrammes of NaCl) –why the difference (ie not 50/50) particularly in salt sensitive persons
Reduces osmotic pressure
Reducing blood pressure can keep kidney able to regulate water volume

11. Nutritional interventions -Water viscosity
-reduce salt load- overcomes the osmosis factor discussed above.
-fat load-reduce saturated fat and cholesterol to encourage cell pliability via decreased saturated fat in the cell walls combined with a decreased cholesterol:phospholipid ratio in the cell walls
-fat load reductions accomplished by table 6

13. Nutritional interventions -Vasodilation- ability of artery to expand
-important to overcome volume to space ratio
-reduce saturated fat and cholesterol and increase monounsaturated and polyunsaturated fat -makes walls less stiff and vasodilation easier
-also diets rich in fruits, vegetables and low fat dairy products helps in this regard

14. Nutritional interventions -Vasodilation-
-monounsaturated and polyunsaturated fats also displace saturated fats and reduce cholesterol synthesis in the body
-cholesterol influx makes vasodilation even more important since cholesterol can reduce lumen size
-increase potassium intake

15. Nutritional interventions -Vasoconstriction
-nutritional interventions as above

16. Nutraceuticals
Class activity-better to use nutraceuticals
or drugs to combat blood pressure

17. Nutraceuticals-Water volume
To improve kidney function reduce blood pressure -less chance of renal failure

18. Nutraceuticals -Water viscosity
Gamma-linolenic and dihomogammalinolenic and alpha-linolenic and eicosapentaenoic acids are all polyunsaturated fatty acids and they displace saturated fatty acids in the cell membranes thus increasing cell membrane fluidity
Increases in cell membrane fluidity-reduced resistance posed by cells as they squeeze through tiny spaces

19. Nutraceuticals-Vasodilation- ability of artery to expand
Gamma linolenic acid produces dihomogammalinolenic acid (DGLA) and DGLA produces prostaglandin I1 (PGI1)and prostaglandin E1(PGE1)
Alpha-linolenic acid produces eicosapentanenoic acid (EPA) and EPA produces prostaglandin I3 (PGI3)
PGI1 and PGE1 and PGI3 are all vasodilatory eicosanoids

20. Nutraceuticals-Vasodilation- ability of artery to expand
Any of these fatty acids reduce the production of vasoconstrictory thromboxane A2 which is derived from arachidonic acid
Such a reduction in TxA2 results from decreased availability of arachidonic acid
Garlic capsules increases vasodilatory nitric oxide

21. Concept of reverse nutraceutical-avoid excessive alcohol
-excessive alcohol can raise triglycerides