TAKE CHARGE OF YOUR HEART Nicole Derse, B.Scs. Med, C.N.C. Preventative, Functional & Nutritional Medicine Center for Optimal Health www.DCOptimalHealth.net Functional Medicine Functional Medicine is a science based system of personalized medicine that focuses on the root cause of chronic illness and correction of these underlying dysfunctions rather that treating the symptoms The Iceberg Analogy Seeking Causes Heart Disease Today • • • • Heart Disease is the leading cause of death for men and women. 600,000 Americans die from heart disease each. Every 34 seconds some in America has a heart attack According to the American Heart Association, 1 in 3 adults has some form of cardiovascular disease Coronary heart disease cost America 109 billion dollars annually. Traditional Risk Factors Hypertension, obesity, cigarette smoking, diabetes, physical inactivity, family history of premature CAD, age (men >44 yrs; women >54 yrs), and abnormal serum lipids. These traditional risk factors do not fully account for the individual risk for the development of cardiovascular disease. Over 50% of heart attack victims and 80% of patients with CAD have normal cholesterol levels. The 17 ‘Daggers’ to the Heart 1. Hypertension Damage to your arteries Healthy arteries are flexible, strong and elastic. Their inner lining is smooth so that blood flows freely, supplying vital organs and tissues with adequate nutrients and oxygen. If you have high blood pressure, the increased pressure of blood flowing through your arteries gradually can cause a variety of problems, including: Coronary artery disease Coronary artery disease affects the arteries that supply blood to your heart muscle. Arteries narrowed don't allow blood to flow freely through your arteries. Results in chest pain, a heart attack or irregular heart rhythms (arrhythmias). Enlarged left heart High blood pressure forces your heart to work harder than necessary in order to pump blood to the rest of your body. This causes the left ventricle to thicken or stiffen. This can limit the ventricle's ability to pump blood to your body. This condition increases your risk of heart attack, heart failure and sudden cardiac death. Heart failure Over time, the strain on your heart caused by high blood pressure can cause your heart muscle to weaken and work less efficiently. Eventually, your overwhelmed heart simply begins to wear out and fail. Damage from heart attacks adds to this problem. Causes of Hypertension Magnesium Deficiency Taurine Deficiency Toxin Exposure Detoxification compromise Fatty Acids Imbalance Antioxidant Deficiencies Low Testosterone Stress Response Supplemental Support COq10 (Ubiquinol form) 100mg daily Magnesium Potassium Omega 3 Fatty Acids Garlic Hawthorn Berry 2. Excess Cholesterol Cholesterol is not BAD! Soft, waxy substance found not only in your bloodstream, but also in every cell in your body, where it helps to produce cell membranes, hormones, vitamin D and bile acids that help you to digest fat. Cholesterol also helps in the formation of your memories and is vital for neurological function. Your liver makes about 75 percent of your body's cholesterol The Diet-Heart Hypothesis If you eat too much food containing cholesterol and saturated fat, the levels of cholesterol in your blood will rise. The excess cholesterol will be deposited in your artery walls, causing them to thicken and narrow. In time this will block blood supply to the heart (and other organs) causing a heart attack or stroke. Cholesterol’s Bad Rap “THE SINGULAR FOCUS on treating cholesterol as a means to prevent heart attacks is leading to the deaths of millions of people because the real underlying cause of the majority of heart disease is not being diagnosed or treated by most physicians.” Mark Hyman, MD Cholesterol is a Band-Aid Cholesterol is a response to damage in the arteries. Atherosclerosis is an attempt for the body to send a band-aid (plaque and cholesterol) to an injury sight where an artery has developed a tiny crack. Body is trying to heal itself. This attempt often causes inflammation and swelling of the coronary artery affected, leading to a partial or complete blockage of blood flow. Cholesterol is the patch, not the cause. 3. Excess LDL Particles Particle Sizes Better Predictor Instead of looking just at the cholesterol numbers, we need to look at the cholesterol particle size. The real question is: Do you have small or large HDL or LDL particles? Small, dense particles are more atherogenic (more likely to cause the plaque in the arteries that leads to heart attacks), than large buoyant, fluffy cholesterol particles. Size Does Matter… Diabetes Predictor Small particles are associated with pre-diabetes (or metabolic syndrome) and diabetes and are caused by insulin resistance. Recent research indicates that statins may actually increase diabetes. 4. Oxidative LDL It’s not just normal cholesterol that is forming plaques in the artery walls but oxidized cholesterol. Oxidation is said to damage cholesterol and then oxidized cholesterol in turn damages artery walls. Cholesterol is oxidized when exposed to sunlight, heat and oxygen. It’s cholesterol that has gone rancid, such as that from overcooked, scrambled eggs Present day food processing methods—like the manufacturing of many commercial oils. It could also include animal products that have been heated or foods fried in oils such as corn oil. Anti-Oxidants Vitamin E Beta-Carotene Vitamin C Green Tea Avoid processed oils liquid at room temp besides olive oil. Avoid overcooked eggs, animal products, and fried foods. 5. Low HDL What does HDL do? 1/4 to 1/3 of blood cholesterol is carried by HDL. HDL cholesterol is known as "good" cholesterol because high levels seem to protect against heart attack. Low levels of HDL (less than 40 mg/dL) also increase the risk of heart disease. HDL tends to carry cholesterol away from the arteries and back to the liver, where it's passed from the body. HDL removes excess cholesterol from arterial plaque, slowing its buildup. Sizes & Numbers Smaller, dense HDL particles are less efficient at clearing cholesterol. A smaller HDL particle size has been associated with oxidative stress, hyperglycemia, and high TGs. A low number of HDLL particles is associated with metabolic syndrome and increased risk of CHD. Factors of Low LDL’s Smoking, Overweight, Sedentary Lifestyle, & Poor Diet, and Hypothyroidism Dietary Support Increase fiber intake by eating more fresh fruits, vegetables and whole grains, while reducing intake of saturated and trans fats. At least twice per week, consume fish high in omega-3 fatty acids, such as salmon, herring, trout, mackerel, water-packed albacore tuna and water-packed sardines or use vegetarian sources such as flaxseed. Niacin (Nicotinic Acid) up to 3,000mg daily Garlic, 6grams raw or in capsule form 6. Excess Triglycerides What are they? TG’s play a major role in transporting fats and providing energy. In excess, TGs represent an independent risk factor for heart attack, heart disease, & CV related death, as well as for insulin resistance and metabolic syndrome. High TGs directly impact LDL density and size and contribute to lower levels of HDL-C, all of which promote atherogenesis. These get elevated when eating to many grains sugars, not exercising, smoking, or consuming alcohol, or being overweight. 7. Insufficient Vitamin D Vitamin D Low levels of Vitamin D have been linked to higher levels of Heart Disease and early death Optimal levels of Vitamin D (>50 nm/l lowers risk of early death by as much as 80%. ‘ Vitamin D is actually a hormone and is important in blood in immune/inflammation regulation as well as blood sugar regulation. Get your levels checked. Most people do not take enough. 25 (OH) Vitamin D3-most accurate test Increasing Vitamin D Absorption It is also important to take your Vitamin D with food because it is fat soluble and make sure you take it with Vitamin K to enhance absorption. Especially if you are taking Calcium and Vitamin D and not Vitamin K you could actually be putting yourself at higher risk of HA. 8. Low Vitamin K Vitamin K1 Vitamin K1 (phylloquinone): Found in green vegetables Goes directly to your liver and helps you maintain a healthy blood clotting system. It is also vitamin K1 that keeps your own blood vessels from calcifying, and helps your bones retain calcium and develop the right crystalline structure. Vitamin K2 Vitamin K2 (menaquinone, MK: Bacteria produce this type of vitamin K. K2 goes straight to vessel walls, bones, and tissues other than your liver. Studies found K2 is better and preventing calcification of arteries than K1 It is present in fermented foods, particularly cheese and the Japanese food natto, the richest source of K2. 9. High Glucose Hemoglobin A1C Lowering blood sugar levels could reduce the risk of coronary heart disease according to researchers at the Johns Hopkins. The researchers found that HbA1c predicts heart disease risk in both diabetics and non-diabetics. An elevated blood glucose level is the defining feature of diabetes, but until now it was unclear whether elevated glucose levels contributed independently to increasing heart-disease risk.. HbA1c: Hemoglobin A1C HbA1c levels were taken from a study of 16,000 participants. Researchers tracked study participants for 10-12 years to acquire coronary heart disease events, hospitalizations and deaths. In participants with diabetes, the researchers found a graded association between HbA1c and increasing coronary heart disease risk. Each 1percentage-point increase in HbA1c level was associated with a 14 percent increase in heart disease risk They found that those study participants without diabetes but who had “high normal” HbA1c were at an increased heart disease risk, even after accounting for other factors such as age, cholesterol level, blood pressure, BMI and smoking. 10) Excess Insulin How does this happen?? When you eat too much sugar, flour and white rice, your insulin levels spike. When this happens, your cells become resistant to its effects. So you pump out more and more insulin, become even MORE resistant to its effects, and end up in the vicious cycle of insulin resistance. Statins and Insulin… Patients who lowered their cholesterol with statins had higher levels of insulin, while those who lowered their cholesterol through diet had lower insulin levels. Elevated insulin levels are the first step on the road to diabetes — they make you gain weight around the middle, cause high blood pressure, increase inflammation, and promote stickiness of the blood. Each of these conditions, in turn, contributes to heart attacks and heart disease. 11. Nitric Oxide Deficit NO More Heart Disease NO is one of the most significant molecules in the human body. It has an influence of every organ. It relaxes the blood vessels, reduces blood pressure, lowering your risk of HA or stroke. We become deficient in this when our tissues get damages by age, an unhealthy lifestyle, illness, a toxic environment, sometimes genetics. THE HEART OF THE MATTER •The endothelial cells manufacturing the NO that guards against many common diseases. By controlling blood flow, they can help regulate blood pressure. •Once plaque forms in the arteries, it is difficult to undo the damage. Thus, prevention is key, and NO can play and important role in keeping plaques at bay. •By interfering with platelet aggregation, NO minimizes the risk of strokes. How to Increase NO Test to assess ADMA: Asymetric Di-Methyl Arginine L-Ariginine: Amino Acid that get converted to NO in the body. Antioxidants to help support stress on cells Vitamin C 12. Low Blood EPA/DHA Natures Anti-Inflammatory Omega-3 FA reduce inflammation throughout the body. May decrease triglycerides lower blood pressure, reduce blood clotting, boost immunity and improve arthritis symptoms. Eating one to two servings a week of fish, particularly fish that's rich in omega-3 fatty acids, appears to reduce the risk of heart disease, particularly sudden cardiac death. 13. Excess Estrogen Roles of Estrogen • Estrogen is a group of hormones that are essential to sexual and reproductive systems in females. • Help the body to retain fluids and salts, and helping to prevent certain diseases. • Negative effects of estrogen can occur when the body contains too little or too much. • Examples of these include increased weight gain, increased chances of heart disease, and increased chances of breast cancer. Estrogen has 400 functions It increases your metabolic rate, enhances energy, improves insulin sensitivity, and regulates body temperature In the cardiovascular system Maintain the elasticity of your arteries Dilates your small arteries Increases blood flow Inhibits platelet stickiness, Decreases the accumulation of plaque on your arteries Decreases blood pressure, decreases LDL (bad cholesterol) and prevents its oxidation Estrogen Dominance… Too much of a good thing… Excess estrogen promotes abnormal blood clots Excess estrogen in men is also common and can lead to heart attacks and atherosclerosis, which is the thickening of the arteries. Get hormone levels check Always chose bio-identical hormone replacement therapy over HRT. 14. Low Free Testosterone Benefits of Testosterone Fights Depression Decreases Body Fat Increases muscle mass Strengthens the heart and bones Increase libido and erections Overweight men tend to have lower rates of testosterone and higher levels of estrogen Testosterone Imbalance Aging bodies produce less testosterone while more of their beneficial testosterone is converted into estradiol. The pathological result is an altering of the ratio of testosterone to estrogen, creating estrogen dominance. This imbalance of estrogen overload and testosterone insufficiency is an often overlooked cause of cardiovascular disease. Hormones and the Heart A study published last year compared blood levels of testosterone and estradiol in men suffering from acute HA with those who had previously suffered a HA. The results showed significantly higher levels of estrogen in both groups of heart attack patients compared with those without coronary disease. Heart attack victims also had decreased testosterone levels. 15. Excess Fibrinogen Too Much of a good thing… Fibrinogen is a protein that helps your blood clot . Fibrinogen making blood thick and sticky Studies published in the American Heart Association’s journal Circulation found that people with high levels of fibrinogen were more than twice as likely to die of a heart attack as those with low levels. Toss the aspirin… Aspirin will help reduce levels of fibrinogen but at what cost??? Natural alternatives to Aspirin, like Nattokinase, from fermented soybeans, can safely lower levels of fibrinogen through its anti-clotting and anti-inflammatory activity. Omega 3 Fatty Acids help to reduce fibrinogen levels Excessive Fatigue, irritability, and hopelessness increases fibrinogen. 16. Elevated C-Reactive Protein CRP is a protein produced within the liver and atherosclerotic arteries. CRP is an independent risk marker for coronary events in individuals without overt hyperlipidemia. Increased levels of CRP are associated with increased risk of cardiac death in patients with previous MI, CAD, peripheral artery disease, and diabetes, suggesting a key role for inflammation in the development of these conditions. Levels of CRP tend to be higher in hypertension, metabolic syndrome, and aging. Interventions Mediterranean diet, high in fruits and vegetables and low in saturated fats Fiber Omega 3 FA Vitamin A, C, D, E Antioxidants Chocolate 17. Excess Homocysteine Homocysteine Amino acid found in the blood that we get usually from eating meat. High levels of this can lead to early development of HD and blood level disease. Everyone should have this test done. Some doc will say this is more of a predictor than cholesterol. High levels of Hcy are independently associated with risk of atherosclerosis and cardiac events and stroke. Hcy is directly capable of injuring endothelial cells. Functional Biomarker for Folate and B12 levels in the blood. Dietary Considerations Minimize coffee intake Avoid processed foods and trans fats. Emphasize Mediterranean-type diet; foods rich in choline, whole grains, spinach, beets & other vegetables Note: B12 deficiency is possible with low stomach acid or vegan diet. Supplemental Support… Folic acid (or 5-MTHF, 2-5 mg/d) vitamins B12, B6, riboflavin, magnesium Consider CoQ10 L-carnitine N-acetylcysteine (NAC) may displace Hcy from binding to arterial walls Heart Healthy Diet… Food is by far the most powerful clinical intervention in chronic disease. Motto to live by: If it is made from a plant it is ok, if it made in a plant its not. Nutrigenomics Plant based diet: a whole, unprocessed predominately plant based • Low Glycemic Load – the overall balance of the meal • Proper Fatty Acid Composition – high level of healthy omega-3 fats vs. omega-6 fats, low in saturated fats and no trans fats. • High Phytonutrient Density – high level of phytonutrients and antioxidants • Healthy Protein – lean, healthy predominately plant based proteins, or pasture raised animal products Nutrigenomics continued • Low Allergenic Burden – low in foods that are highly allergenic (gluten, dairy and others based on personalized prescription) • Low Toxic Burden – minimizes toxic burden of food, e.g. no/low added hormones,pesticides, antibiotics or any other artificial additives • Healthy pH Balance – provides proper balance between acidity and alkalinity • Healthy Salt-Potassium Ratio – low in salt and high in potassium • High Fiber Content – high in fiber to help slow the insulin response and optimize digestive health Top 25 Foods for the Heart Salmon Flaxseed (ground) Oatmeal Black or Kidney Beans Almonds Walnuts Red wine Tuna Organic Tofu Brown rice Organic Soy milk Blueberries Carrots Spinach Broccoli. Sweet potato Red bell peppers Asparagus Oranges Tomatoes Acorn squash Cantaloupe Papaya Dark chocolate Tea Drug Induced Deficiencies Aspirin Diuretics Vitamin C Magnesium Folic Acid Potassium Glycine Sodium Histidine Zinc Potassium Increase in blood sugar Zinc Statins Coenzyme Q10 Vitamin K Cardiovascular Testing CV Health Profile Cardio Ion Panel CV Health Profile LIPID MARKERS Traditional Markers LDL-cholesterol HDL-cholesterol Triglycerides Total cholesterol Lipid Particles LDL-Particle # (LDL-P) HDL-Particle # (HDL-P) LDL particle size Lipoprotein (a) INDEPENDENT RISK FACTORS High-Sensitivity C-Reactive Protein (hsCRP) Lp-Phospholipase A2 (Lp-PLA2) Fibrinogen Homocysteine INSULIN RESISTANCE RISK MARKERS Lipid Particle Number Lipid Particle Size HDLL HDL Size LDLS LDL Size VLDLL VLDL Size Insulin Resistance Score Combination of analyses of organic acids, fatty acids, vitamins, minerals, and antioxidants, with a specific focus on amino acid absorption and imbalances. • Vitamin D & K • Fibrinogen • Homocysteine • Coenzyme Q10 • Fasting Insulin • C-reactive protein Prevent a Broken Heart Take Charge of Your Heart, Your Health, & Your Life!