Recent health and nutrition information from Douglas Laboratories                                       March/April 2002  ...
flow, which may or may not have total                   Table 2 – Vasodilationobstruction associated with it. Ischemia can...
B6, B12 and folic acid deficiency. Even    Table 3 – Lipid Modulation                                                     ...
GAMMA-TOCOPHEROL: ITS IMPORTANCE                                                     AND        UNIQUE PROPERTIES   When t...
dioprotective     property.       Some   have    Table 5 – Insulin Resistance Reduction                                   ...
disease, they significantly contribute to a       sequent increase in epinephrine/norepi-          seems to reduce the hea...
Abnormal tests would be noted andrepeated after an appropriate length oftreatment and adjustment of the treat-            ...
ReferencesArsenio, L., et al. Effectiveness of Long-Term Treatment with Pantethine       Langsjoen, H., et al. Usefulness ...
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March April 2002 NutriNews

  1. 1. Recent health and nutrition information from Douglas Laboratories March/April 2002 NUTRACEUTICAL APPROACHES TO CORONARY ARTERY DISEASEMitchell J. Ghen, D.O., Ph.D. Outside of the medical/surgical neously. It is this concerted effort that focusing on supplemental issues, there ismodel for heart disease, modern practi- should prove to have maximum impact a marked importance in appropriatetioners should consider complementary on quality and quantity of life issues for dietary intervention as well.approaches to assist their patients. The the coronary artery disease patient. Anticoagulantsstand-out difference between the two Therefore, we will consider the issues ofapproaches is that the complementary inflammation, infection, hormones, lipids, One of the primary treatments appliedstrategy attempts to break the underlying platelet aggregation, vasodilation, for patients with coronary artery diseasepathology perpetuating the disease. The antioxidants, sympathetic tone, stress, are anticoagulants. The aging processbest example is arteriosclerotic cardio- insulin resistance and homocysteine. You lends itself to increased coagulability. Thevascular disease, an epidemic malady of may note that several nutrients may be obvious consequence of hypercoagula-the industrialized nations. With so many mentioned or noted twice due to their bility is clot formation and subsequentproducts available today, it is best to multiple types of action. It is best that you artery occlusion. Increase in blood vis-approach the discussion by grouping choose at least one from each of these cosity can create a hemodymamic statenutraceuticals by their physiologic categories, utilize the proper dose, eval- of ischemia, with its own set of circum-actions. Our nutritional knowledge base uate the efficacy and then add or sub- stances. Ischemia is defined as low blood continued on page 2today helps us to recognize key areas of tract substances depending on yourconcern that must be addressed simulta- patient’s response. Though this article is INSIDE THIS ISSUE • Nutraceutical Approaches to Table 1 – Anticoagulant Activity Coronary Artery Disease • Anticoagulants . . . . . . . . . . .page 1 Alpha-tocopherol . . . . . . . . . . . . . . . . .400-1600 I.U./day • Vasodilation . . . . . . . . . . . . .page 2 Arginine . . . . . . . . . . . . . . . . . . . . . .2000-6000 mg/day • Lipid Modulation . . . . . . . . .page 2 Ascorbic acid . . . . . . . . . . . . . . . . . . .1000-4000 mg/day • Homocysteine Reduction . . . .page 3 Bromelain . . . . . . . . . . . . . . . . . . . . .500-3000 mg/day • Antioxidants and Curcuma longa . . . . . . . . . . . . . . . . . .200-1200 mg/day Biological Enzymes . . . . . . . .page 5 E.D.T.A.-Oral or rectal suppository . . . . .Dose varies depending on renal fx • Inflammation and Infection . .page 5 Essential Fatty Acids (EFAs) . . . . . . . . . .5000-10,000 mg/day • Sympathetic Tone . . . . . . . . .page 6 Ginger (powdered) . . . . . . . . . . . . . . .1/2 to 1 tspn/3 times a day • Ionotropic and Chronotropic Augmentation . . . . . . . . . . .page 6 Ginkgo biloba . . . . . . . . . . . . . . . . . .40-120 mg/day Inositol hexanicotinate . . . . . . . . . . . . .400-3000 mg/day • Gamma-Tocopherol . . . . . . . . .page 4 Magnesium . . . . . . . . . . . . . . . . . . . .300-1600 mg/day N-acetyl cysteine . . . . . . . . . . . . . . . . .500-3000 mg/day • Coenzyme Q10: Pancreatin . . . . . . . . . . . . . . . . . . . . .300 mg/day A Brief Description . . . . . . . . . .page 7
  2. 2. flow, which may or may not have total Table 2 – Vasodilationobstruction associated with it. Ischemia can Arginine . . . . . . . . . . . . .3000-6000 mg/daylead to apoptosis and inflammation. Garlic . . . . . . . . . . . . . . .400-600 mg/dayEvaluation of ischemic potential can be Hawthorne . . . . . . . . . . . .160-250 mg of the flower (standardized)approached with a functional coagulation Horse chestnut . . . . . . . . . .600-700 mg (standardized to aecins)panel. This composite of tests includes the Capsicum (cayenne) . . . . . .40,000-100,000 heat units 1-6 capsules/daytypical PT, PTT tests and also the more aspirin still have clot formation. In con- or by vasospasm. The natural substance,comprehensive combination of fibrino- trast EDTA (ethylene diaminetetracetic arginine, for example, is said to increasegen, prothrombin fragments one and acid), inhibits aggregation to all of the nitric oxide, a free radical (part of atwo, thrombin-anti-thrombin complexes, substances above with the exception of group of compounds known as endothe-soluble fibrin monomers and platelet collagen. Acute phase reaction, particu- lial releasing factor, EDRF) that functionsCD62P (Selectin) receptors. A valuable larly a high c-reactive protein, is related to as a vasodilator. Nitric oxide has a sec-test for evaluation of clotting is platelet vascular inflammation and or infection. ondary effect to potentially reduce theaggregation testing. Platelet aggregation Substances, such as coumadin affect pro- damage created by homocysteine. It hasoccurs with the presence of adenosine, thrombin/thrombin activation. Natural been hypothesized that EDTA’s benefitepinephrine, collagen and thrombin. products like vitamin E and magnesium can, to a large degree, be attributed to itsMost anti-platelet aggregation medica- have similar properties. Platelet hyperac- release of nitric oxide. Of course, EDTA istions work only in the presence of adeno- tivity is minimized by aspirin and similarly an excellent anti-coagulant.sine (aspirin for example). This may by other natural products like ginkgo andexplain why type A personalities using Also worthy of note, cayenne pepper ginger. Fibrinogen/fibrin monomers can has excellent effects on blood lipids, be addressed with enzymatic therapy like platelet activity, and vasodilatory action. bromelain and pancreatin. Natural sub- As a wonderful first aid remedy, one tea- stances, that have similar reaction toPublisher ...................... Peter W. Hefele spoon of cayenne in a glass of water can heparin, are arginine, niacin, bromelainEditor In Chief .... Andrew D. Halpner, Ph.D. quickly relieve the discomfort of acute and papain. I have found clinically thatAssistant Editor ........ Michael Traficante chest pain caused by angina. increased fibrinogen levels of greater thanAssistant Editor 400 mg respond quickly and effectively to Lipid Modulation & Research .......... Natalie Shamitko Curcuma longa.Technical Advisors/Contributors: There are many products that effec- Nita Bishop, Clinical Herbalist tively control dyslipidemia without the Vasodilation Martin P. Gallagher, M.S., D.C. side effects often associated with conven- Mitchell J. Ghen, D.O., Ph.D. An important component to coronary tional medical drugs. For elevated cho- Brad Lichtenstein, N.D. artery disease treatment is vasodilation. lesterol, a combination of pantethine and Derek DeSilva Jr., M.D. The consequence of vasodilation is inositol hexacotinate can demonstrate James Wilson, Ph.D. improved blood flow and subsequent profound improvements in one month.Contact Us: increase in tissue oxygenation. TheNutriNews For those patients with elevated triglyc- object of nitrates or nitrate therapy, a600 Boyce Road eride levels, L-Carnitine, as well as EFAs,Pittsburgh, PA 15205 mainstay of both acute and chronic coro-Phone: (412) 494-0122 can often solve the problem. I prefer the nary arterial disease care is to increaseFax: (412) 278-6804 inositol hexanicotinate form of niacin dueInternet: nutrinews@douglaslabs.com blood flow to constricted blood vessels, to its absence of the troublesome side whether this stricture is created by plaque 2
  3. 3. B6, B12 and folic acid deficiency. Even Table 3 – Lipid Modulation Raloxefen’s benefit as seen in the Ruth Pantethine . . . . . . . . . . . . . . . . . . . . . . . . .500-1,000 mg/day Study “Raloxefen use for heart study” Inositol hexanicotinate . . . . . . . . . . . . . . . .3000 mg/day Garlic . . . . . . . . . . . . . . . . . . . . . . . . . . .400-600 mg/day suggested this drug’s action on coronary L-Carnitine . . . . . . . . . . . . . . . . . . . . . . . . .1000-3000 mg/day artery disease, may in part be due to its Essential Fatty Acids (EFAs) . . . . . . . . . . . . . 5000-10,000 mg/day homocysteine-lowering qualities. Regular MIC (methionine-inositol choline) . . . . . . . . . .200-400 mg/day of each supplementation with the three B vitamins Lpa (lipoprotein a) — decreasing agents (B6, B12 and folate) will control a great Inositol hexanicotinate . . . . . . . . . . . . . . . . . 3000 mg/day majority of elevated homocysteine levels. CoQ10 . . . . . . . . . . . . . . . . . . . . . . . . . .200-400 mg/day A simple blood test confirming the Vitamin C . . . . . . . . . . . . . . . . . . . . . . . . .1000-2000 mg/day patient’s level of homocysteine should be L-Lysine . . . . . . . . . . . . . . . . . . . . . . . . . . .1000-2000 mg/day performed with their annual routineeffects of flush and liver irritation. Its gation used omega-6 fatty acids as well. In exam. Although laboratories suggest thatmechanism of action is similar to all refractory cases of elevated lipids, which a level below 15 is normal, a level of lessniacin compounds to reduce plasma have failed to respond to the above regi- than 10 is ideal and less than 7 is con-triglycerides, VLDL, LDL synthesis and men, consider the combination of methion- sidered optimal.total cholesterol. Pantethine is the active ine, inositol and choline in doses of 200-hormone of pantethenic acid. It is consid- 400 mg of each taken 3 times daily. Insulin Resistance Reductionered to be one of the most important Lipoprotein a (Lpa) is an apolipoprotein, Receptor sensitivity for insulinparts of coenzyme A (CoA) that trans- i.e. an LDL particle, to which an additional decreases and the body compensates byports fats to and from the cells. It has a protein is attached. Because of Lpa’s simi- secreting increased amounts of insulin.potent effect on cholesterol as well as larity with plasminogen, it interferes with This is known as ‘insulin resistance’.triglycerides. L-Carnitine is synthesized fibrinolysis, and of course ultimately speeds Increased insulin levels promote lipogen-from lysine with the help of methionine. It up clot formation. Several substances as esis, increased thrombosis from increaseimproves triglyceride levels, total choles- shown Table 3 can be helpful. Coenzyme in plaminogen activator/inhibitor, andterol and increases HDL. The n-3-polyun- Q10 for example, can inhibit the Lpa decreases through a hepatic mechanism,saturated acids in large enough doses receptor expression. which will decrease HDL while increasinghave been shown to be helpful in many Table 4 – Homocysteine Reductionstudies. The DART study and most recent- B6 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10-50 mg/dayly the GISSI study (published in The B12 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1000-5000 mcg/dayLancet) are good examples. The role of Folate (folic acid) . . . . . . . . . . . . . . . . . . . . . . .800 mcg-5 mg/dayomega-3 fatty acids are several, but TMG (trimethylglycine) . . . . . . . . . . . . . . . . . . . .250-1000 mg/dayrecent studies report that their most pro- Choline . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .200-1000 mg/dayfound effects may be on arrhythmogene- Also helpful are: Serine, Glycine, and NAC (n-acetyl cysteine)sis as well as inflammation. The GISSI Homocysteine Reduction triglyceride production. One of the moststudy reported a substantial decrease incardiovascular events as a result of fish There are many published studies devastating effects is the glycosylationoil supplementation. I believe the study supporting homocysteine as a risk factor process, whereby circulating glucoseresults, although impressive, would have for vascular disease. Homocysteine has attaches to proteins. Eventually this leadsbeen even more dramatic had the investi- also been considered a good marker for continued on page 5 3
  4. 4. GAMMA-TOCOPHEROL: ITS IMPORTANCE AND UNIQUE PROPERTIES When the term “vitamin E” is used, alpha-tocopherol is Alpha-tocopherol is generally thought of as the most pow-generally what comes to mind. However, vitamin E is actually erful antioxidant of the various tocopherols, and due to itsa collective term that encompasses 3 other tocopherols (beta, structure it can more readily donate electrons compared withgamma, and delta) in addition to alpha-tocopherol. These gamma-tocopherol. Gamma-tocopherol, however, can bettermolecules are differentiated by the number and placement of quench certain dangerous reactive nitrogen species such asmethyl groups on their structure (see figure). Recent research peroxynitrate and nitrogen dioxide, both of which have beenhas been revealing that gamma-tocopherol possesses some associated with a number of degenerative diseases. In fact, inunique properties that allow it to function independently from relation to alpha-tocopherol it has been reported that gamma-as well as synergistically with alpha-tocopherol. tocopherol is superior in detoxifying nitrogen dioxide to less harmful compounds. In addition to its antioxidant properties, Alpha-tocopherol is the major form of vitamin E that gamma-tocopherol has also been shown to possess anti-can be found in blood as well as many tissues in humans. Due inflammatory properties and can inhibit the activity ofto its abundance in the body research has generally focused cyclooxygenase-2 (COX-2) and production of prostaglandinon alpha-tocopherol, with less emphasis on the other isomers. E2. Given the role that inflammation plays in the pathology ofHowever, gamma-tocopherol is the major form of vitamin E cardiovascular disease this finding is particularly important.consumed in the diet and is found in many plant seeds and the Some researchers have also reported that gamma but notoils made from them. It has been estimated that gamma- alpha-tocopherol levels are lower in those with cardiovasculartocopherol represents 70% of the vitamin E consumed in the disease compared with control subjects. Recent work has alsotypical US diet. Once in the body, the metabolism of alpha brought to light a relationship between gamma-tocopheroland gamma-tocopherol differs signifi- and prostate cancer. In a case-control study, thecantly. Alpha and gamma-tocopherol are correlation between alpha-tocopherol, gamma-absorbed similarly from the gastrointestinal tocopherol, selenium intake and prostate cancertract and secreted into chylomicron Alpha-Tocopherol was examined. The researchers found a signifi-particles without selective discrimination. cant inverse correlation between the intake ofHowever, when the chylomicron remnant gamma-tocopherol and the incidence ofparticles are taken up by the liver, alpha- Beta-Tocopherol prostate cancer (i.e., the greater the intake oftocopherol is preferentially incorporated gamma-tocopherol, the lower the risk of dis-into very low-density lipoprotein (VLDL) ease). Most intriguing was that alpha-toco-cholesterol particles. This preferential Gamma-Tocopherol pherol and selenium intake was only protectiveplacement of alpha compared with when gamma-tocopherol intake was also high.gamma-tocopherol into VLDL particles is aresult of the presence of a protein in the These interesting scientific findings, coupledliver called alpha-tocopherol transfer pro- Delta-Tocopherol with the fact that gamma-tocopherol, but nottein. This protein is able to recognize the alpha-tocopherol levels have been shown tostereochemistry of the various tocopherols and has the great- decline with age in humans give further credibility to theest affinity for the d-alpha form. Consequently, alpha-toco- importance of supplementing with a well-rounded mixed toco-pherol becomes selectively located in VLDL particles, which pherol supplement that contains significant amounts ofafter circulation and metabolism are transformed in to low- gamma-tocopherol.density lipoprotein (LDL) particles. An interesting note is that Helzlsouer KJ., Huang HY., Alberg AJ., et al. Association between alpha-tocopherol,supplementation with alpha-tocopherol in the absence of gamma-tocopherol, selenium, and subsequent prostate cancer. J Natl Cancer Inst 2000;92:2018-2023.gamma-tocopherol leads to a reduction of both tissue and Jiang Q., Christen S., Shigenaga MK., Ames BN. γ-Tocopherol, the major form ofplasma levels of gamma-tocopherol. Nonetheless, given its vitamin E in the US diet, deserves more attention. Am J Clin Nutr 2001;74:714-722.presence in chylomicrons, and presence in other lipopro- Jiang Q., Elson-Schwab I., Courtemanche C., Ames BN. γ-Tocopherol and its major metabolite, in contrast to αtocopherol, inhibit cyclooxygenase activity in macrophagestein particles (albeit it at levels less than alpha-tocopherol) and epithelial cells. Proc Natl Acad Sci 2000;97:11494-11499.gamma-tocopherol does reach the circulation and plays an McLaughlin PJ., Weihrauch JL., Vitamin E content of foods. J Am Diet Association 1979;647-665.important role. 4
  5. 5. dioprotective property. Some have Table 5 – Insulin Resistance Reduction claimed that bromelain can not be effec- Soluble fibers . . . . . . . . . . . . . . . . . . . . . . . . . . 35-45 g/day tive orally, but this has since been refuted. Chromium . . . . . . . . . . . . . . . . . . . . . . . . . . . . 200-1000 mcg day Vanadium . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-2 mg/day Researchers report that soluble fibers (higher doses often used for short periods of time) have a positive effect on hypertension as Cinnamon . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1/2 tspn 3 times/day C.L.A. (conjugated linoleic acid) . . . . . . . . . . . . . 1-3 gm/day well as serum-fasting insulin. Patients EFAs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-3 gm/day should be regularly tested for glycosylat- Magnesium . . . . . . . . . . . . . . . . . . . . . . . . . . . 800-2000 mg/day ed hemoglobin, fasting blood sugar and Zinc . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15-60 mg/day fasting insulin levels.to advanced glycosylation end products apy. Grapeseed extract alone has been Inflammation and Infection(AGE), which can be a precursor to shown to reduce plaque size. Since mostmicrovascular disease. The abnormal diets have poor consumption of antioxi- Presently, most recognize that thereglucose/insulin metabolism augments dants and flavanoids, supplementation are several infectious agents that areformation of free radicals. Of course, with larger doses than usual for coronary associated with coronary vascular dis-oxidative stress is often responsible for artery disease (C.A.D.) patients may ease. Human herpes virus 6, nanobacte-many of the factors contributing to coro- be helpful. ria, chlamydia and cytomegalo virus allnary artery disease. Other than the sub- have been implicated as part of the epi- Bromelain has been shown to have genesis of heart disease. Studies havestances noted in Table 5, caloric restric- numerous therapeutic benefits, including even shown 89% of patients havetion is an excellent way to decrease free effects on cytokines such as TNF-alpha, chlamydia in their hearts at the time ofradical formation and improve insulin IL-1beta, IL-6 and IL-8. Studies also give bypass surgery. Most investigators agreesensitivity. Equally as important is a reg- evidence that bromelain may inhibit that, although these infectious organismsular exercise program given that insulin platelet aggregation, an important car- may not be the primary cause of heartreceptors are located within muscle tissue.In addition, repletion with antioxidants is Table 6 – Antioxidants & Biological Enzymesalso imperative (see Table 6). Antioxidants Vitamin A . . . . . . . . . . . . . . . . . . . . . . . . . . .5000-10000 I.U./dayAntioxidants and Biological Enzymes Vitamin C (buffered preferred) . . . . . . . . . . . . .1000-4000 mg/day There are many studies that support Vitamin E (unesterified, natural alpha-tocopherol with mixed tocopherols and tocotrienols) . . . . . .800-1600 I.U./daythe importance of adequate antioxidant Selenium . . . . . . . . . . . . . . . . . . . . . . . . . . .200-1000 mcg/daylevels and the occurrence of coronary Biological enzymesartery disease. In several instances, it has SOD (superoxide dismutase) . . . . . . . . . . . . . .2000-3000 MF/unitsbeen postulated that antioxidant use is Catalase . . . . . . . . . . . . . . . . . . . . . . . . . . . .2000-3000 MF/unitsmore important than the control of lipid Table 7 – Inflammation and Infectionlevels. It is well known that cholesterol in Bromelain (acid stable) . . . . . . . . . . . . . . . . . . .500-2000 mg/dayitself is not problematic, but the exposure Papain . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .100-200 mg/dayof cholesterol to the oxidation process cer- Pancreatin . . . . . . . . . . . . . . . . . . . . . . . . . . . .300 mg/daytainly can generate plaque. Grapeseed Central fatty acids (EFAs) . . . . . . . . . . . . . . . . . .5000-10000 mg/dayextract, vitamin E and vitamin C are Curcuma longa . . . . . . . . . . . . . . . . . . . . . . . . .200-1200 mg/day Vitamin C (buffered) . . . . . . . . . . . . . . . . . . . . .1000-4000 mg/dayimportant components of antioxidant ther- 5
  6. 6. disease, they significantly contribute to a sequent increase in epinephrine/norepi- seems to reduce the heart failure associ-hypercoagulable state. The use of low- nephrine. Also, melatonin levels could ated with low coenzyme Q10. Anotherdose broad-spectrum antibiotics such as possibly explain why the majority of study on the usefulness on coenzymetetracycline has been suggested along heart attacks occur in the early morning Q10 in clinical cardiology demonstratedwith aggressive enzyme usage. It seems hours. Melatonin has also been found to large doses over time will reduce overallthat this combination affords the best inhibit platelet aggregation. Saliva mela- cardiac medication requirements signifi-result of reducing infection and inflam- tonin sampling can be obtained from sev- cantly. (See insert on this page “Co-mation. Several studies have shown the eral laboratories throughout the country. enzyme Q10) Taurine, an amino acidoverall effectiveness of enzyme use is has likewise been shown to have positive Table 9 depicts several substancesgreater than the non-steroidal anti- cardiac effects and diuretic properties. with either ionotropic (increase heartinflammatories. Hawthorne berry has been used for Table 8 – Sympathetic Tone years by western herbologists as a good Melatonin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .0.5-10 mg/night ionotropic natural agent.Sympathetic Tone contractibility) or chronotropic (rhythm Summary The sympathetic nervous system heart stabilizing) effects on the heart. A multiangle assertive approach(flight or fight) plays an important role in Regular use of these substances can often seems to be appropriate when treatingC.A.D. Greater than usual sympathetic augment typical conventional medica- the coronary artery disease patient.tone will increase heart rate and elevate tions of similar nature, i.e., digitalis and Hormonal issues should also be exam-blood pressure. Increased sympathetic antiarrythmics. Several studies have ined and a saliva profile may prove effi-activity has often been demonstrated in shown magnesium to be an excellent pre- cacious in determining DHEA, estrogen,patients with C.A.D. Increased levels of ventative of dysrythmias and can be progesterone, and testosterone levels.adrenal medulla hormones, i.e., norepi- especially useful in intravenous doses of Recently, much has been written aboutnephrine and epinephrine damage the 2-3 gm in the early stages of heart attack hormones and their inverse relationshiparterial lining, increase platelet aggrega- and for several days thereafter. Its use with coronary artery disease. By routine-tion and increase oxidized cholesterol, can prevent the serious rhythm distur- ly screening with these saliva and bloodall which lead to a faster generation of bances that often accompany myocardial tests, you will be able to note lipid levels,arthrogenesis. Remember, calcium stimu- infarction. Long-term use is also suggest- coagulability, glucose/insulin levels,lates sympathetic discharge, whereas, ed since most patients are magnesium melatonin level, hormone levels, inflam-magnesium has antagonistic properties. deficient. Other studies have determined matory status, and homocysteine levels.Therefore, appropriate levels of magne- that the use of coenzyme Q10 in dosages A practitioner could then choose, fromsium and melatonin help to control an of 300 mg/day one week prior to car- the tables provided, those nutritional sup-imbalanced sympathetic nervous system. diac surgery improves three-fold the plements that would address areas of serum levels and tissue levels in the heart concern revealed by the test results. Researchers have demonstrated that of this nutraceutical. This improvementpatients with C.A.D. have nighttime Table 9 – Ionotropic and Chronotropic Augmentationmelatonin levels that are 1/5 lower than Magnesium . . . . . . . . . . . . . . . . . . . . . . . . . . . .1600-3000 mg/dayhealthy controls. Explanatory physiology Taurine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2000-4000 mg/dayis likely to be related to increased night- Hawthorne Berry . . . . . . . . . . . . . . . . . . . . . . . . .250-500 mg/daytime sympathetic discharge and the sub- Coenzyme Q10 . . . . . . . . . . . . . . . . . . . . . . . . .200-400 mg/day 6
  7. 7. Abnormal tests would be noted andrepeated after an appropriate length oftreatment and adjustment of the treat- COENZYME Q10:ment plan, by either increasing doses of A BRIEF DESCRIPTIONalready-prescribed nutraceuticals, withor without the addition of new agents. Coenzyme Q10, (CoQ10) also known as ubiquinone has been receivingFurther adjustment in the program would an increasing amount of attention over the past 5 years for its cardioprotec-be necessary when the patient is takingconcurrent medicine(s). Drugs that have tive abilities. CoQ10 is a fat-soluble molecule synthesized from cholesterolsimilar properties to those nutraceuticals, and located predominantly in mitochondria (the cell’s powerhouse) where itthat your patient is already taking, would plays a vital role in energy production. Specifically CoQ10 is crucial for therequire appropriate adjustment. Forexample, patients taking anti-coagulants proper transfer of electrons through the mitochondrial respiratory chain.would require lower doses of those sup- Given that heart muscle requires a tremendous amount of energy to functionplements mentioned in Table 1. However, properly, it is not unusual that significant levels of CoQ10 can be found inother patients, taking lipid-loweringdrugs, may require increased doses of heart muscle. Since CoQ10 levels have been found to be lower under cer-CoQ10. Remember, many coronary- tain circumstances, researchers have been investigating the effect that sup-related medications cause other nutrition- plemental CoQ10 can have on heart function. Not surprisingly, numerousal deficiencies and I suggest that yourefer to a text describing drug-herbal clinical studies have demonstrated improvements in functional parameters ofand drug-nutrient interactions. the heart in patients with congestive heart failure after supplementation withFinal thoughts: CoQ10. CoQ10 treatment prior to bypass procedures has also yielded The use of EDTA, although it is con- more positive outcomes when compared with patients who did not receivesidered by the conventional medical supplementation. CoQ10 levels have also been shown to be reduced incommunity as controversial, has revealedin many studies to have a significant patients taking statin drugs, as cholesterol is required for the synthesis ofplace in the treatment of coronary artery CoQ10 in the body. CoQ10 has been shown to be an effective antioxidant,disease along side the nutraceuticals pre- protecting against lipid peroxidation, DNA and protein oxidation and is alsosented in this paper. Heavy metals doplay a role in artherogenesis and should capable of functioning synergistically to help regenerate other antioxidants.be studied further. Don’t forget, in the The research community continues to find strong data indicating the benefitsmidst of this complex array of nutraceuti- from supplementation with CoQ10, especially in the area of cardiovascularcals, water itself may improve the out-comes of coronary events. Simply drink- health as it relates to congestive heart failure.ing 4 or more glasses of pure water eachday, can decrease myocardial infarctionby more than 50%. 7
  8. 8. ReferencesArsenio, L., et al. Effectiveness of Long-Term Treatment with Pantethine Langsjoen, H., et al. Usefulness of Coenzyme-Q-10 in Clinicalin Patients with Dyslipidemias. Clin Ther, 1986; 8: 537-545. Cardiology: A Long Term Study. Mol Aspects Med, 1994; 15 Suppl: s165-175.Baggio, E., et al. Italian Multicenter Study on the Safety and Efficacyof Coenzyme-Q-10 as Adjunctive Therapy in Heart Failure. Co-Q-10 Lipson, S.F., Ellison, P.T. Development of Protocols for the ApplicationDrug Surveillance Investigators. Mol Aspects Med, 1994; 15 Suppl: of Salivary Steroid Analysis to Field Conditions. American Journal ofs287-294. Human Biology, 1989; 1:249-255.Broughton, D.L., Taylor, R.L. Review: Deterioration of Glucose Lukaczer, Dan. Nutritional Support for Insulin Resistance. AppliedTolerance with Age: The Role of Insulin Resistance: Age and Aging, Nutritional Science Reports, July 2001; pp. 1-6.1991; 20: 221-225. Maurer HR. Bromelain: biochemistry, pharmacology and medical use.Brugger, P., et al. Impaired Nocturnal Secretion of Melatonin in Cell Mol Life Sci 2001;58:1234-45.Coronary Artery Disease. Lancet, 1995; 345: 1408. Merghioli, Robert, et al. Dietary Supplementation with N-3Cantin, B., et al. Lipoprotein (a) An Independent Risk Factor for Polyunsaturated Fatty Acids and Vitamin E After MyocardialIschemic Heart Disease in Men? The Quebec Cardiovascular Study. J Infarction: Results of the GISSI-PREVENZIONE Trial. The Lancet,Am Cardiol, 1998; 31:519-525. Volume 234, Aug 7, 1999; pp 447-495.Cardinali, D.P., Del Zar, M.M., Vacas, M.I. The Effects of Melatonin in Mori, T.A., et al. Interactions Between Dietary Fat, Fish, and Fish OilsHuman Platelets. Acta Physiol Pharmacol Ther Latinoam, 1993; 43: and their Effects on Platelet Function Men at Risk with Cardiovascular1-13. Disease. Arterioscler Throm Vasc Biol, 1997; 17:279-286.Chappell, L.T., Stahl, J.P. The Correlation Between EDTA Chelation Phillips, R., Lemon, F., Kuzma, J. Coronary Heart Disease, MortalityTherapy and Improvement in Cardiovascular Function: A Meta- Among Seventh Day Adventists with Differing Dietary Habits. Am JAnalysis. J Adv Med, 1993; 6: 139-160. Clin Nutr, 1978 Oct 31;(10 Suppl): 5191-5198.Dabbs, J.M. Savory Testosterone Measurements: Collecting, Storing Rosenfeldt, Franklin, et al. Experience with Coenzyme-Q-10 inand Mailing Saliva Samples. Physiology and Behavior, 1991; 49: Cardiac Surgery Patients. 2nd Conference of the International Co-Q-815-817. 10 Association. Frankfurt, Germany, December 1-3, 2000.El-Enein Ama, et al. The Role of Nicotinic Acid and Inositol Watson, P.S., Scalia, G.M., et al. Lack of effect of Coenzyme-Q-10Hexanicotinate as Anti-Cholesterolemic and Anti-lipemic Agents. Nutr on Left Ventricular Function in Patients with Congestive Heart Failure.Rep Intl, 1983; 28: 899-911. J Am Coll Cardiol, 1999, May; 33(6):1549-1552.Folsom, A. Homocysteine: Not a Risk Factor. Circulation 98, 1998; Weiss, Decker. Part One: Cardiovascular Disease Risk Factors and196-199, 204-210. Fundamental Nutrition. Applied Nutritional Science Reports, Feb 2000, pp. 1-6.Fox, M. More Evidence that Infections Cause Heart Disease. ScienceNews, Sept 18, 2000. Welsh, A.L, Edede, M. Inositol Hexanicotinate for Improved Nicotinic Acid Therapy. Int Record Med, 1961; 174:9-15.Fukagawa, N.K., Anderson, J.W., et al. High-Carbohydrate, HighFiver Diets Increase Peripheral Insulin Sensitivity in Healthy Young and Weiss, Decker. Part Two: Cardiovascular Disease NutrtionalOld Adults. Am J Clin Nutr, 1990; 52: 524-528. Management of Clinical Markers. Applied Nutritional Science Reports, Feb 2000, pp. 1-6.Ghen, M.J., et al. The Advanced Guide to Longevity Medicine. 2001,Landrum, South Carolina, pp. 193-201, 239-246.Graham, I.M., et al. Plasma Homocysteine as a Risk Factor forVascular Disease: The European Concerted Action Project. JAMA,1997; 277; 1775-1781.Hancke, C., Flytlie, K. Benefits of EDTA Chelation Therapy inArteriosclerosis: A Retrospective Study of 47- Patients. Journal ofAdvancement in Medicine, 1993; 6(3); 161-172. © 2002 Douglas Laboratories. All Rights Reserved. 8

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