Can your diet save your life?


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  • Risk factors for heart disease are divided into two groups: modifiable and non-modifiable. All of the risk factors shown are modifiable except for age, menopause and heredity. The risk factors highlighted in yellow are specific to women or a greater risk for women than men.
  • These are the goals for total cholesterol, LDL, HDL and Triglycerides. It is important that people ask their healthcare providers for their actual numbers and not accept a general “your cholesterol is good.” Everyone should “Know Their Numbers” and work to get them to the above goal levels.
  • AS with cholesterol numbers, patients should ask their healthcare providers for their blood pressure numbers when they get their blood pressure checked. It is recommended that everyone have a blood pressure under 120/80 mmHg, even those taking antihypertensive medications.
  • The Metabolic Syndrome (MS) is also known as “pre-diabetes.” If a person has 3 or more of these risk factors, they are classified as having the MS. This increases a persons risk of developing diabetes and heart disease in the future. The good news is that all of these risk factors are modifiable through healthy lifestyle changes.
  • High protein diet, initially no carbs, then low carb- to force the body into ketosis-burning fat as the major energy source. All fats/protein are allowed-no restriction on saturated fats. Proved to promote weight loss, other claims not scientifically proven. O long term data as far as safety of this diet and long term effects of high fat diet.
  • Even one high fat meal can have a negative effect on CV risk factors. 2 hours after the high fat meal, blood pressure elevates.
  • Other effects of a high saturated fat meal. In addition to detrimental effects on CV risk factors, there is an effect on endothelial and HDL function.
  • A low carb diet that allows the “healthy or good” carbs-fruits, vegetables, whole grains. Fat intake is restricted to “good fats” which are the lean proteins-fish, poultry, etc. The South Beach Diet has been proven to decrease the MS.
  • The Ornish diet is strictly vegetarian so it is therefore high in carbohydrates. This diet does include regular exercise and stress management which are very important features of an overall healthy lifestyle. There is no scientific data supporting the claim of reversing heart disease and plaque regression even though there has been data showing decreased angina in people with heart disease. This diet will decrease LDL.
  • A very heart healthy diet. It includes smaller more frequent high quality meals-lean proteins, fish, fruits and vegetables. It also includes a glass og wine daily and exercise. It has been proven that this diet decreases LDL,BP,FBS,Weight and also prevents re-current cardiovascular events.
  • 2 studies of the Mediterranean diet-both very positive results. Lyon Heart Study showed that this diet decreased cardiovascular events from 50-70%. Lifestyle is a very powerful “medicine.” There aren’t any prescription medications that decrease CV risk by that amount.
  • DASH (Dietary Approaches to Stop Hypertension) diet has been proven to effectively lower BP. It is a low-fat and low sodium diet.
  • Many people follow advice from television and magazine articles. The Dr. Oz and Best Life Diet became very popular from the Oprah show. They are similar to the Mediterranean Diet with high fiber, small, frequent meals and lifestyle changes. These diets do promote weight loss, but there isn’t any scientific data confirming a decreased risk of CAD or DM.
  • The American Heart Association Diet stresses a low fat diet, high in fruits and vegetables and whole grains. It also recommends limiting salt and sugars. It is a heart healthy diet plan.
  • A diet high in whole grains has been shown to decrease abdominal fat, CRP and riak of CVA. Many products now have whole grain varieties such as breads, pastas and rice. Especially in people with high triglycerides, whole grains should be chosen over white flour products. The ingredient list should have the whole grain as the first or second item listed and it should not be listed as “enriched” whole wheat.
  • A high fiber diet decreases the absorption of cholesterol in the intestines and can be as effective as a low dose statin medication at lowering cholesterol. Diabetics should choose carbohydrates that have a higher fiber content to help prevent sudden increases in blood sugar that occurs when low fiber carbohydrates are ingested. Fiber also gives you a full feeling which helps with weight loss.
  • Unhealthy lifestyles/diet can greatly increase your risk for MI, CVA, and Diabetes.
  • Serving sizes today are much larger than they were 20 years ago. The following slides compare portion sizes, the difference in the number of calories people are consuming today, and the amount of activity required to burn it off.
  • In the day of specialty coffees with artificial flavors and whipped toppings, people do not realize that they may be taking in the amount of calories in a small meal with every “coffee.” Liquid calories add up too!
  • Visualization of a “Healthy Plate.” The majority of your plate should be fruits and vegetables (50%). The other 50% should be divided between the protein and carb/starch sources.
  • There is no nutritional value in salt and many people add salt to their food. Some also believe that Sea Salt is a better alternative. Sea Salt still contains sodium and by adding it to foods, it can increase blood pressure. Some good alternatives are Potassium Salt, Mrs. Dash, or other spices.
  • The majority of sodium intake comes from food processing (which is why these foods should be avoided by hypertensive patients). There is also an inherent amount of sodium in most foods. The smallest amount of sodium intake is from adding salt during cooking and at the table, but this is the only amount that can be controlled.
  • Recent research has indicated that adding potassium to the diets of patients with hypertension can help lower blood pressure. When potassium intake is increased, the body tends to excrete more sodium. There are many good food sources of potassium or another option would be to use potassium salt instead of regular salt (sodium).
  • Added free sugars should be limited to 12 tsp. per day-this is the amount of sugar added to 1 soda! Added free sugars do not include naturally occurring sugars in fruits/vegetables/milk products.
  • Tea has a lot of heart healthy benefits – white, green and black tea but there is not enough data to support the benefits of tea supplements. Also the research shows that fresh tea made with tea leaves is beneficial. There is no data to support the benefit from commercial processed teas.
  • The research on black tea heart health benefits.
  • Research summary of green tea benefits.
  • Research does support some heart healthy benefits with daily coffee consumption, but not more than 3 cups of coffee.
  • Alcohol does provide some heart healthy benefits when consumed in moderation (one drink per day for women and not more than two drinks per day for men). There are adverse effects that occur with higher amounts of alcohol (hypertension, cardiomyopathy) – so patients who do not drink alcohol should not be encouraged to start.
  • Dark chocolate in moderation is heart healthy. For some reason when milk is added or consumed at the same time as chocolate the heart healthy benefits are diminished.
  • There is presently no standardized garlic dose.
  • Garlic research studies have reported inconsistent results.
  • There is a lot of good scientific data to support the heart health benefits of omega 3 fatty acids.
  • AHA recommends obtaining omega 3 fatty acids from food: fish, soy, nuts. For some reason it is believed the heart health benefits are diminished when fish is fried.
  • Nuts are a good source of omega 3 fatty acids (especially almonds, walnuts, peanuts, pistachios). One ounce of nuts (handful) five times per week was reported to decrease the risk of heart disease by 25 to 39%. Nuts do have a lot of calories so moderation is key.
  • These are the current AHA recommendations for omega 3 intake.
  • Flaxseed (seeds not oil) has high fiber content. Flaxseed (seeds and oil) are good source of ligans and omega 3 fatty acids.
  • Red Yeast Rice acts just like a HMG-CoA (statin) and should never be taken with a statin. Patients who take red yeast rice should be closely monitored by a healthcare provider because adverse effects like myopathies and elevated liver enzyme can occur with red yeast rice.
  • Two grams a day of a plant stanol/sterol can help lower LDL cholesterol by 9 to 20%.
  • Antioxidant vitamin supplements should NOT be used for heart health prevention. This is a list of primary and secondary heart disease prevention studies that found NO benefit with antioxidant supplements.
  • Obtain b complex vitamins from food sources NOT supplements.
  • Two large studies that reported NO heart health benefit with b complex vitamins.
  • There is a lot of recent data that reports an increased heart disease risk when vitamin D levels are low.
  • Coenzyme Q10 is a free radical scavenger and generates ATP. CoQ10 is a naturally occurring substance. People with heart failure, people taking statins have been reported to have lower levels of CoQ10. Also as we get older our body makes less CoQ10.
  • People with heart failure may benefit from CoQ10 supplements. Also patients taking statins who develop myopathic pain may experience relief of pain when treated with CoQ10 supplements.
  • Soy products are everywhere!!
  • Soy research studies have been inconclusive and most experts agree that presently there is no reliable data to support the claims that soy can reduce cholesterol levels or lower heart disease risk.
  • Patients taking prescription medications should not start taking any herbal supplements without first discussing the potential adverse interactions with their healthcare provider or pharmacist.
  • Can your diet save your life?

    1. 1. Presented by: Margie Latrella, Cardiac APN and Carolyn Strimike, Cardiac APN Heartstrong, LLC
    2. 2. •Increased Age (Menopause) •Heredity •Overweight/Obesity •Physical Inactivity •Smoking •Emotional Stress •Gum Disease •Inflammation •Sleep Apnea •High Blood Pressure (Pregnancy Induced) •High Cholesterol (HDL, Triglycerides) •Diabetes/Metabolic Syndrome •Depression (Broken Heart Syndrome) •Thyroid disease
    3. 3.  Total CholesterolTotal Cholesterol < 200< 200  LDLLDL (Bad “Lousy” Cholesterol) < 100(Bad “Lousy” Cholesterol) < 100  HDLHDL (Good “Healthy” Cholesterol)(Good “Healthy” Cholesterol) > 60 in women> 60 in women >50 in men>50 in men  TriglyceridesTriglycerides < 150< 150
    4. 4. SystolicSystolic DiastolicDiastolic NORMALNORMAL < 120< 120 < 80< 80 HIGH NORMALHIGH NORMAL 120-139120-139 81-8981-89 HYPERTENSIONHYPERTENSION >> 140140 >> 9090
    5. 5. NCEP-ATP III definitionNCEP-ATP III definition:: Waist circumference >35” inWaist circumference >35” in women, >40” in menwomen, >40” in men  HDL <50 mg/dl in women,HDL <50 mg/dl in women, <40 mg/dl in men<40 mg/dl in men  TriglyceridesTriglycerides >>150 mg/dl150 mg/dl Glucose > 100Glucose > 100 Blood pressureBlood pressure >>130/85 mmHg130/85 mmHg
    6. 6. Atkin’s Diet (Low Carb)  Eat Protein, Fats (all fats)Eat Protein, Fats (all fats)  Causes Ketosis – burns fatCauses Ketosis – burns fat  Promotes Weight LossPromotes Weight Loss, Lowers TG, Improves, Lowers TG, Improves HDL, Lowers BP (No effect LDL)HDL, Lowers BP (No effect LDL)  ? Questionable Long Term Effects/Safety ?? Questionable Long Term Effects/Safety ?  Increases Urinary Excretion Calcium =Increases Urinary Excretion Calcium = Increased RiskIncreased Risk Osteoporosis, Kidney StonesOsteoporosis, Kidney Stones
    7. 7. Single Fatty Meal Stresses the Heart Sausage McMuffin Hash Browns (42 Grams Fat) OR Cereal, Skim Milk Yogurt Orange Juice (1 Gram Fat) 2 Hours Later – Blood Pressure Higher After High Fat Meal Journal of Nutrition (137) 2007
    8. 8.  3 Hours Later – arteries unable dilate3 Hours Later – arteries unable dilate  6 Hours Later – anti-inflammatory6 Hours Later – anti-inflammatory properties HDL diminishedproperties HDL diminished “Effects of ONE Saturated Fat Meal”
    9. 9. South Beach Diet (Low Carb)  Allows “good” carbs, Low Glycemic Index,Allows “good” carbs, Low Glycemic Index, “good” fats“good” fats  Fruits, Vegetables, Whole Grains, LeanFruits, Vegetables, Whole Grains, Lean ProteinProtein  Decreased Metabolic SyndromeDecreased Metabolic Syndrome Hayes, J of Nutrition 2007
    10. 10. Ornish Diet (Vegetarian, EXTREMELY Low Fat, High Fiber)  No Meat/Fish/NutsNo Meat/Fish/Nuts  Promotes Complex Carbohydrates (70%)Promotes Complex Carbohydrates (70%)  Regular Exercise/Stress ManagementRegular Exercise/Stress Management  ? Reverses Heart Disease – Plaque Regression ?? Reverses Heart Disease – Plaque Regression ? Decreases AnginaDecreases Angina  Decreases LDLDecreases LDL, Small amount weight loss, Small amount weight loss
    11. 11. Mediterranean Diet (Low Fat)  Small portions “high quality food”Small portions “high quality food”  Fruits/VegetablesFruits/Vegetables (7-10/day),(7-10/day), Olive oil, Nuts,Olive oil, Nuts, Red wine, FishRed wine, Fish  Exercise (Lifestyle)Exercise (Lifestyle)  Decreases LDL, BP, Blood Sugar, WeightDecreases LDL, BP, Blood Sugar, Weight  Prevents re-current CV eventsPrevents re-current CV events
    12. 12. Mediterranean Diet  PREDIMED StudyPREDIMED Study (ongoing)(ongoing)  Lowers LDL better than “routine” lowLowers LDL better than “routine” low fat diet – Adds “good” fats (olive oil,fat diet – Adds “good” fats (olive oil, nuts)nuts)  LYON Heart StudyLYON Heart Study  Secondary preventionSecondary prevention  Decreased CV events 50-70%Decreased CV events 50-70% JAMA 2004 Circ (103) 2001
    13. 13. DASH Diet (Low Fat, Low Salt)  Fruits/Vegetables, Whole grain, Fish, Poultry,Fruits/Vegetables, Whole grain, Fish, Poultry, NutsNuts  Lowers BPLowers BP, Weight Loss, Decreases LDL, Weight Loss, Decreases LDL  Lower Risk CVA/MILower Risk CVA/MI (Women)(Women) Arch Intern Med (168) 2008
    14. 14. Dr Oz’s Diet  High Fiber, Small Frequent MealsHigh Fiber, Small Frequent Meals  Low Fat, Fruits/VegetablesLow Fat, Fruits/Vegetables  Exercise, LifestyleExercise, Lifestyle  Weight LossWeight Loss, Slim Waist, Slim Waist  Claims: Decrease RiskClaims: Decrease Risk Heart Disease, Diabetes ?Heart Disease, Diabetes ? Best Life Diet
    15. 15. AHA Dietary Guidelines  Low FatLow Fat  Fruits/Vegetables (4 to 9/day)Fruits/Vegetables (4 to 9/day)  Whole Grains (6 to 8/day)Whole Grains (6 to 8/day)  Fish, Poultry, Lean Meats (< 6 oz/day)Fish, Poultry, Lean Meats (< 6 oz/day)  Legumes, NutsLegumes, Nuts  Limit added salt/sugarLimit added salt/sugar
    16. 16. Lose Belly Fat with Whole Grains  Whole GrainsWhole Grains (Oatmeal, Whole wheat pasta,(Oatmeal, Whole wheat pasta, Granola)Granola)  Weight Loss (Abdominal Fat)Weight Loss (Abdominal Fat)  Decreases CRPDecreases CRP  Stabilizes Blood SugarStabilizes Blood Sugar  Decreases Risk CVADecreases Risk CVA ““Everyone Needs at least 3 servings ofEveryone Needs at least 3 servings of Whole Grains Every Day”Whole Grains Every Day” www.wholegrainscouncil.orgJAMA (284) 2000
    17. 17.  Soluble Fiber (psyllium, beans, legumes, fruits,Soluble Fiber (psyllium, beans, legumes, fruits, oats)oats)  Lowers cholesterol, Controls blood sugarLowers cholesterol, Controls blood sugar  Psyllium (5 Gm TID) + Simvastatin 10 mg = Simvastatin 20Psyllium (5 Gm TID) + Simvastatin 10 mg = Simvastatin 20 mgmg  Reduces risk CV disease, DiabetesReduces risk CV disease, Diabetes  Decrease inflammation (CRP)Decrease inflammation (CRP)  Weight managementWeight management  Women 25 to 30 grams/dayWomen 25 to 30 grams/day  Men 30 to 35 grams/dayMen 30 to 35 grams/day Circulation (95) 1997
    18. 18. “More Americans Die By the Fork than any Other Weapon.”
    19. 19.
    20. 20. Calorie Difference: 525 calories 1,025 calories 20 Years Ago Today 500 calories SPAGHETTI AND MEATBALLS
    21. 21. *Based on 130-pound person If you do aerobic dance for 1 hour and 20 minutes you will burn approximately 525 calories.* Calories In = Calories Out
    22. 22. Chocolate chip cookie 220 calories! 20 Years Ago Today 55 calories 275 calories
    23. 23. *Based on 160-pound person If you ride a bike for 50 minutes you will burn approximately 220 calories.* Calories In = Calories Out
    24. 24. COFFEE 20 Years Ago Coffee (with whole milk and sugar) Today Mocha Coffee (with steamed whole milk and mocha syrup) 45 calories 8 ounces 350 calories 16 ounces Calorie Difference: 305 calories
    25. 25. If you walk 1 hour and 20 minutes, you will burn approximately 305 calories.* *Based on 130-pound person Calories In = Calories Out
    26. 26. ¼ of Plate Grains, Starches ¼ of Plate Beans, Meat, Poultry or Fish ½ of Plate Fruits and Vegetables
    27. 27. “Salt is NOT a Food”  No Vitamins/NutrientsNo Vitamins/Nutrients Most Americans consume more salt than they need
    28. 28. Sources of Dietary Sodium (Salt) Food Processing At the Table During Cooking Inherent Food Processing 77% 6% 5% 12%
    29. 29. Adding Potassium to Your Diet can Help Lower BP Daily recommended amount PotassiumDaily recommended amount Potassium 4,700 mg/day4,700 mg/day
    30. 30. WHO Recommendations on Sugar Intake Added free sugars include:Added free sugars include:  Table, refined, processed,Table, refined, processed, added sucroseadded sucrose  Corn sugar(glucose), cornCorn sugar(glucose), corn syrup (high fructose)syrup (high fructose)  HoneyHoney  SyrupsSyrups  Sugars added to fruit juicesSugars added to fruit juices Added free sugars doAdded free sugars do NOT include:NOT include:  Fresh fruit sugars-Fresh fruit sugars- natural fructose andnatural fructose and sucrosesucrose  Milk – lactoseMilk – lactose  VegetablesVegetables Limit “added free sugars” to 48 grams or 12 tsp. per day One 12 ounce soda averages 12 teaspoons of sugar!!!
    31. 31. WHITE TEA GREEN TEA BLACK TEA (Not Supplements) Polyphenols (Antioxidant)
    32. 32. Black Tea  Decreases LDL /TriglyceridesDecreases LDL /Triglycerides  Improves endothelial functionImproves endothelial function  VasodilationVasodilation  Lowers blood pressureLowers blood pressure  Decreases risk MI/CVADecreases risk MI/CVA (1 - 3 cups/day)(1 - 3 cups/day)  Helps regulate blood sugarHelps regulate blood sugar
    33. 33. Green Tea (3 to 5 cups/day) (More Antioxidants)  Lowers Total Cholesterol/LDL/TGLowers Total Cholesterol/LDL/TG  Improves HDLImproves HDL  Lowers Blood PressureLowers Blood Pressure  Anti-inflammatoryAnti-inflammatory  Reverses Endothelial DysfunctionReverses Endothelial Dysfunction  Decreases Risk MI/CVADecreases Risk MI/CVA  Decreases MortalityDecreases Mortality  Reduces Blood Sugar LevelsReduces Blood Sugar Levels  Very Low Caffeine ConcentrationVery Low Caffeine ConcentrationInt J Card (108) 2006 J Nutr Bichem (18) 2007 JAMA (296) 2006
    34. 34.  Caffeinated CoffeeCaffeinated Coffee::  1 to 3 cups decrease CV risk1 to 3 cups decrease CV risk ( in women)( in women)  S/P MI – no increased risk with espressoS/P MI – no increased risk with espresso (GISSI(GISSI – Prev Study)– Prev Study)  Increased risk HTNIncreased risk HTN  Decreased FMD/Endothelial functionDecreased FMD/Endothelial function  Decaffeinated CoffeeDecaffeinated Coffee::  Increases cholesterolIncreases cholesterol (ApoB)(ApoB)  Overweight – Increased HDLOverweight – Increased HDL Am J Clin Nut (83) 2006 Am J Clin Nut (86) 2007 Circ (107) 2007 AHA 2005 Scient Session 2005 (abstract 3852)
    35. 35.  Increases HDL, Lowers BPIncreases HDL, Lowers BP  Decreases blood clotsDecreases blood clots  Reduce risk CVA, MI, DiabetesReduce risk CVA, MI, Diabetes  Decrease mortality after MIDecrease mortality after MI  Women – one drink/dayWomen – one drink/day  Men – two drinks/dayMen – two drinks/day If You Don’t Drink, Don’t Start Adverse Effects: HTN, Alcoholic Cardiomyopathy
    36. 36. “Take 2 Hershey Kisses or BonBons to Lower Your Blood Pressure ??”
    37. 37.  Potent Antioxidant/Plant Phenols/FlavonoidsPotent Antioxidant/Plant Phenols/Flavonoids  Decreases Arterial Stiffness/Dilates VesselsDecreases Arterial Stiffness/Dilates Vessels  Lowers Blood Pressure (2 to 5 mmHg)Lowers Blood Pressure (2 to 5 mmHg) Similar BPSimilar BP med effectmed effect  Inhibits Platelet ActivationInhibits Platelet Activation  ““Hold the Milk” – Benefits lost ifHold the Milk” – Benefits lost if drink milk with chocolate ??drink milk with chocolate ?? Arch Intern Med (167) 2007
    38. 38. Lowers Total Cholesterol, LDL, Triglycerides Lowers Blood Pressure Prevents Platelet Aggregation
    39. 39.  Garlic Dose ???Garlic Dose ???  1 to 2 cloves raw garlic1 to 2 cloves raw garlic (chopped, wait 15 minutes then use, do(chopped, wait 15 minutes then use, do not cook at high temperatures)not cook at high temperatures)  300 mg freeze dried powder 2 – 3 x’s/day,300 mg freeze dried powder 2 – 3 x’s/day, must be enteric coated avoid breakdown inmust be enteric coated avoid breakdown in stomachstomach  7.2 grams aged extract7.2 grams aged extract  Side effects – bad breath, body odor, GI upset,Side effects – bad breath, body odor, GI upset, antiplatelet effect (D/C high doses beforeantiplatelet effect (D/C high doses before surgery – increases bleeding risk)surgery – increases bleeding risk)
    40. 40. Garlic Trials = Inconsistent Results  May haveMay have short-termshort-term effect on loweringeffect on lowering cholesterol ???cholesterol ???  May lower BP 3 to 5% ???May lower BP 3 to 5% ???  Mild antiplatelet effectMild antiplatelet effect Arch Intern Med. 2007;167:346-353 Amer Fam Physician. July 1, 2005 Journ Agric & Food Chemistry June 2006
    41. 41. (Contains Tilapia, Sardines, Anchovies)
    42. 42.  Decreases Risk SCD/MIDecreases Risk SCD/MI (re-infarction)(re-infarction)  Decreases TriglyceridesDecreases Triglycerides (20-40%)(20-40%)  Decreases Growth AtheroscleroticDecreases Growth Atherosclerotic Plaque (Decreases Inflammation)Plaque (Decreases Inflammation)  Lowers Blood PressureLowers Blood Pressure (2-5 mmHg)(2-5 mmHg)  Prevents Platelet AggregationPrevents Platelet Aggregation  Decreases Stroke RiskDecreases Stroke Risk AHA Scientific Statement, Circulation 2002
    43. 43.  AHA recommendsAHA recommends eatingeating omega 3 fattyomega 3 fatty acids from fish and plant sourcesacids from fish and plant sources NOT FRIED
    44. 44. DART Trial (Diet & Reinfarction Trial)  Secondary Prevention TrialSecondary Prevention Trial  People ate 2 servings fatty fish/weekPeople ate 2 servings fatty fish/week  Decreased 2 year totalDecreased 2 year total && CV mortality 30%CV mortality 30% BMJ 1998
    45. 45.  1 ounce nuts 5 X’s/week decreases risk CV1 ounce nuts 5 X’s/week decreases risk CV disease 25-39%disease 25-39%  Lower LDL cholesterolLower LDL cholesterol  Omega 3 fatty acidsOmega 3 fatty acids (Protect against arrhythmias)(Protect against arrhythmias)  Precursor nitric acidPrecursor nitric acid (vasodilator)(vasodilator)  High in fiberHigh in fiber  Handful = 150 caloriesHandful = 150 calories Am J Clin Nutrition (70)1999 Nutr Metab CV Dis (11) 2001
    46. 46. Omega 3 Intake Recommendations:  No CHDNo CHD:: Fish twice/week and oils/foodsFish twice/week and oils/foods rich alpha-linolenic acidrich alpha-linolenic acid (flaxseed, walnuts)(flaxseed, walnuts)  Patients with CHDPatients with CHD:: 1 Gm EPA+DHA1 Gm EPA+DHA per dayper day (preferably from fish: 2- 4 ounces salmon, 4-(preferably from fish: 2- 4 ounces salmon, 4- 12 ounces canned tuna, 7 ounces flounder/sole)12 ounces canned tuna, 7 ounces flounder/sole)  Patients with High TriglyceridesPatients with High Triglycerides:: 2 to 42 to 4 Gm EPA+DHA per dayGm EPA+DHA per day (High Doses May Cause(High Doses May Cause Bleeding)Bleeding) AHA Scientific Statement, Circulation 2002
    47. 47.  High Fiber ContentHigh Fiber Content (2 tablespoons 4.5 Gm Fiber, 3 Gm Omega(2 tablespoons 4.5 Gm Fiber, 3 Gm Omega 3)3)  Ligans (phytoestrogen)Ligans (phytoestrogen) (Menopausal symtpoms)(Menopausal symtpoms)  Omega 3 fatty acidsOmega 3 fatty acids
    48. 48.  Lowers CholesterolLowers Cholesterol  9% drop Total Cholesterol, 18% drop LDL (Seeds NOT Oil)9% drop Total Cholesterol, 18% drop LDL (Seeds NOT Oil)  Reduces Platelet AggregationReduces Platelet Aggregation  Reduces Inflammatory MarkersReduces Inflammatory Markers  Improves Glucose ToleranceImproves Glucose Tolerance J Clin Endo & Metab, 90 2005
    49. 49. Acts like HMG-CoA (Statin - Lovastatin), Contains Sterols/Isoflavones • Reduces Total Cholesterol 15-20%, LDL 20-30%, Triglycerides 20-30%, Increases HDL 15 to 20% •Dose 600 mg BID = 10mg HMG-CoA reductase inhibitor daily •Contraindications – same as Statins, DO NOT TAKE WITH STATIN, •Can cause myopathies
    50. 50. (2 Grams/Day Lower LDL 9 to 20%) Competes with Cholesterol for Absorption in Intestines
    51. 51.  Vitamin E, C, Beta CaroteneVitamin E, C, Beta Carotene  Negative Primary Prevention StudiesNegative Primary Prevention Studies:: ATBC, Health Professionals F/U Study, NursesATBC, Health Professionals F/U Study, Nurses Health Study, Iowa Women’s Health Study,Health Study, Iowa Women’s Health Study, PPP, CARET, HPSPPP, CARET, HPS  Negative Secondary Prevention StudiesNegative Secondary Prevention Studies:: HOPE, GISSI-Prevension Trial, VEAPS,HOPE, GISSI-Prevension Trial, VEAPS, WACS, WAVE, HATSWACS, WAVE, HATS (?May Increase Mortality?)(?May Increase Mortality?) JAMA. 2005;293:1338- 1347 JAMA 2007; 297:842-857 JACC 2005;46(1):184
    52. 52. “Get antioxidants from food, not supplements” At this time, there is little reason to adviseAt this time, there is little reason to advise that individuals take antioxidantthat individuals take antioxidant supplements to reduce their risk ofsupplements to reduce their risk of cardiovascular disease.cardiovascular disease. AHA Scientific Advisory 08/02/2004
    53. 53. So far,So far, no study has shown that folic acidno study has shown that folic acid supplements reduce the risk of CADsupplements reduce the risk of CAD or that takingor that taking these vitamins affects the development orthese vitamins affects the development or recurrence of cardiovascular disease.recurrence of cardiovascular disease. Food SourcesFood Sources:: Fortified cereals, Dark Leafy Green VegetablesFortified cereals, Dark Leafy Green Vegetables
    54. 54.  Lowers Homocysteine Levels But May NotLowers Homocysteine Levels But May Not Decrease Risk CV Disease ??Decrease Risk CV Disease ?? HOPE – 2 Trial Shows NO HOPE for High Dose B Complex Vitamins in Decreasing Heart Disease Risk •Over 5,000 High Risk Patients •No Benefit NORVIT Trial Demonstrated Possible Harm •Over 3,700 Post MI Patients •Decreased Homocysteine Levels BUT Increased Adverse CV Events N Engl J Med 2006
    55. 55.  Framingham Heart StudyFramingham Heart Study  62% Higher Risk Heart Disease events62% Higher Risk Heart Disease events (especially in people with HTN)(especially in people with HTN)  Recommended Daily DoseRecommended Daily Dose 800 and 1,000 IU of800 and 1,000 IU of Vitamin D3 (cholecalciferol)Vitamin D3 (cholecalciferol)  AHA recommends getting Vitamin D from foodAHA recommends getting Vitamin D from food sources (milk, salmon, mackerel, sardines, fortifiedsources (milk, salmon, mackerel, sardines, fortified cereals)cereals) Science Daily March 2008 Am J HTN (20) 2007
    56. 56. (Generates ATP, Free Radical Scavenger) • Produced naturally in body ubiquinone • Food Sources: Organ Meats, Beef, Sardines, Mackerel, Nuts
    57. 57.  Improves QOL, Decreases Heart FailureImproves QOL, Decreases Heart Failure HospitalizationsHospitalizations (CHF patients may have lower(CHF patients may have lower CoQ10 levels?)CoQ10 levels?)  Improves myopathic pain in StatinImproves myopathic pain in Statin Treated PatientsTreated Patients (Statins may decrease CoQ10(Statins may decrease CoQ10 production?)production?)
    58. 58.  Take supplements with fatty meal (toTake supplements with fatty meal (to improve absorption)improve absorption)  Recommended dose 50 to 200 mg/dayRecommended dose 50 to 200 mg/day  Possible interaction with CoumadinPossible interaction with Coumadin
    59. 59.  Improves CholesterolImproves Cholesterol  Lowers T.C. (9%) LDL (3%)Lowers T.C. (9%) LDL (3%) Triglycerides (10%)Triglycerides (10%)  Increases HDL (2.5%)Increases HDL (2.5%)  INCONCLUSIVE STUDIESINCONCLUSIVE STUDIES Circulation Feb 2006
    60. 60. Eating foods that contain soy protein instead of food high in animal fats may be beneficial ??
    61. 61. Medication & Herbal/Supplement Interactions
    62. 62. “Healthy living is the most powerful medicine of all. It requires no prescription, and all of the side effects are beneficial.” Dr Katz, director Prev. Research Ctr, Yale
    63. 63. Heart Health Blog