HEART MATTERS YOUR
The Integrative Solution to Cardiovascular Care
HEART MATTERS YOUR
CopyrightŠPlatinum Naturals Ltd 2015 Published by: Platinum Naturals Ltd. 11 Sims Crescent, Unit 2 Richmond Hill, ON L4B 1C9 Canada Toll Free Phone: 1-800-668-5028 Toll Free Fax: 1-800-565-4586 Website: www.platinumnaturals.com Book and Cover Design: Cindy Quach Copy Editing: Bert Vandermoer All rights reserved. No part of this book may be reproduced, distributed or transmitted in any form or by any means, including photocopying, recording or other electronic or mechanical methods, or by any information storage and retrieval system without prior written permission from the author, except for the inclusion of brief quotations embodied in critical reviews and certain other noncommercial uses permitted by copyright law. For permission requests, write to the publisher at the address above. WARNING This book is not intended to diagnose disease, nor to provide specific medical advice nor to promote the sale of any product. Its intention is solely to inform and to educate. For the diagnosis of any disease, please consult a physician. The author and publisher cannot accept responsibility for illness arising out of the failure to seek medical advice from a physician. ii
Table of Contents Foreword
iv
About the Authors
v
Did you know?
1
The Heart
2
What is Cardiovascular Disease?
3
Risk Factors
5
The Calcium Paradox
6
Vitamin K2 Synergy: Bone and Cardiovascular Health
7
Prevention and Management Primary Prevention Secondary Prevention Pharmaceutical Therapy Statins Statins and Coenzyme Q10
8
Cardiovascular Protective Supplements Vitamins and Minerals Nutraceuticals Resveratrol Coenzyme Q10 (CoQ10) Omega-3 Oils Adaptogens Cordyceps Sinensis Eucommia Ulmoides Herbs Chinese Hawthorn Cayenne
11
The Power of Synergy
17
Tables of Cardiovascular Protective Supplements Anti-Inflammation Blood Lipids Hemodynamic (Blood Flow) Anti-Clotting
18
List of Abbreviations
22
The Future of Promoting Heart Health
23
References
24 iii
Foreword “Knowledge is power.� Knowledge gives people the power to transform their lives. This guide was written to empower you with the knowledge to transform your life by improving your cardiovascular health. I have witnessed too many people suffer or pass away from heart disease. No one should have to suffer when nature has given us everything we need to slow, stop, or even reverse heart disease. Yes, medical intervention is at times necessary and it is an important first step when heart disease has progressed to a dangerous state. However, our body has an incredible ability to heal itself, provided that it is given the vitamins, minerals, healthy oils, and phytonutrients it needs. A balanced and healthy diet is the foundation of good health. Beyond that, when faced with heart disease or any other disease, adding key quality supplements that are well absorbed by the body is absolutely essential to allow the body to heal itself. This book will take a look at both pharmaceutical medicines and natural approaches so that you, with the supervision of your healthcare provider, can decide what is best for you. I am very grateful to Dr. Mary Nagai and Dr. Jeanny Kim for writing this book, for it will surely touch many people. It presents information that can truly help you transform your life and experience your full vitality.
David Khang R.H.N.
Founder of Platinum Naturals iv
About the Authors Mary Nagai, MD PhD, is the Director of Medical and Scientific Affairs at Platinum Naturals and a Clinician-Scientist at the Rehabilitation Engineering Laboratory (REL) at the University Health Network, Toronto Rehabilitation Institute (Lyndhurst). Her research is focused on using functional electrical stimulation and brain machine interface to improve the quality of life for patients following a spinal cord injury or stroke. She is a graduate of the University of Toronto, Faculty of Medicine. Through her passion for health and education, Dr. Nagai hopes to empower others to make knowledgeable lifestyle choices that will improve their quality of life and longevity. Dr. Nagai is a sought-after lecturer and guest speaker. She has been a teaching professor and guest speaker in Europe, the USA and Canada, and has published many peer-reviewed journal articles and invited book chapters.
Jeanny Kim, ND, received her Doctor of Naturopathic Medicine from the Canadian College of Naturopathic Medicine. Her commitment to a holistic view of health – in how we eat, think, and live – extends to helping her patients benefit from the phenomenal power of preventive medicine. She has additional training in acupuncture (Traditional, Cosmetic, and Sports Medicine), and is a frequent guest lecturer on Naturopathic Medicine, Nutrition, Sports Injuries, Digestive Pathologies, and Cardiovascular Health. As the resident Naturopathic Doctor with the Continuing Education Institute, Dr. Kim provides education seminars to healthcare professionals. Dr. Kim is a member of the Canadian and Ontario Associations of Naturopathic Doctors (CAND and OAND), and licensed to practise in Ontario through the Board of Drugless TherapyNaturopathy (BDT-N).
Did you know? Did you know that 14% of the Canadian population is over 65 years old? Canadians are living longer and the prevalence of chronic diseases is rising (Figure 1). In 2014, the Canadian Centre for Chronic Disease Prevention reported that chronic disease rates are increasing at a rate of 14% per year.1 Today, 9 out of 10 Canadians have at least one risk factor for heart disease or stroke.2
Age-adjusted prevalence (%)
0.8
0.6
0.4
0.2
0 2001
2010
Cardiovascular Disease
2020
2030
Diabetes
2040 Hypertension
Figure 1: Prevalence of Chronic Diseases in Canada 1
The Heart The cardiovascular system is remarkable! At first glance it appears to be a very basic structure with a simple task. It has its own electrical system, 4 hollow muscular chambers, 4 valves that direct the flow of blood, and veins and arteries to carry the blood. Looks can be deceiving. The heart is one of the most dynamic and physiologically complex organ systems in the body. The heart pumps blood to the lungs, clearing it of carbon dioxide and bringing oxygenated blood to the organs and extremities (Figure 2). How well the heart is able to move blood around the body is dependent upon two things: the coupling of the electrical activity to trigger the mechanical contraction of the heart (heartbeat), and the freedom of blood flow (patency) in the arteries and veins.
Superior Vena Cava (from the body)
Pulmonary Artery (to right lung) Pulmonary Veins (from right lung)
Aorta (to the body)
Pulmonary Artery (to left lung)
Pulmonary Veins (from left lung) Left Atrium
Pulmonary Valve Right Atrium
Aortic Valve Mitral Valve Left Ventricle
Tricuspid Valve
Right Ventricle Septum
Inferior Vena Cava
Descending Aorta
Figure 2: Anatomy of the heart. The right side of the heart pumps oxygenpoor blood to the lungs. The left side of the heart receives oxygen-rich blood from the lungs and pumps it out of the heart to the rest of our body. The heart is constantly making macro and micro adjustments to meet the always-changing demands placed on it (for example: exercise, stress and sleeping), to maintain balance (homeostasis). 2
What is Cardiovascular Disease? Cardiovascular disease (CVD) represents a cluster of disorders, including heart valve problems, arrhythmias, heart attack, and stroke. It may involve the heart and/or the blood vessels. CVD commonly arises from complex interactions between multiple risk factors. The most common cause of cardiovascular disease is atherosclerosis. Atherosclerosis literally means ‘hardening of the arteries’. It is a chronic, progressive, systemic low-grade inflammatory process that is strongly influenced by diet, lifestyle and aging. Aging is a biological process characterized by a systemic state of low-grade chronic inflammation and progressive deterioration of metabolic function.3 Inflammation is part of the body’s innate or non-specific immune response to injury. Inflammation is a critical step in the body’s self-healing process. It is beneficial to control the amount of inflammation but not to completely eliminate it. The cells lining the inner surface of all blood vessels, endothelial cells, are constantly sustaining damage from collisions with circulating low-density lipoprotein cholesterol (LDL), excessive carbohydrates and other toxic substances like nicotine (Figure 3). The injury sustained by the endothelial cells is similar to when you repetitively rub the skin on your arm with your finger. Your skin becomes irritated and may sustain a minor superficial injury (redness). Eventually new skin cells will replace the injured skin cells. Similarly, the body attempts to repair the damage to the endothelial cells. However, these focal areas of injury may become sites of systemic chronic inflammation and the development of atherosclerosis (Figure 3).
Atherosclerosis
The basic lesion of atherosclerosis is an atheroma or ‘fibrofatty’ plaque (Figure 3). A plaque is composed of LDL, calcium and other blood-borne substances. Over time circulating calcium may deposit in the plaque, resulting in arterial stiffening and loss of elasticity—hence ‘hardening’.4 When the plaque becomes large enough it may obstruct blood flow and a blood clot may form, preventing the delivery of oxygen and nutrients to the cells. Tissue and organ damage may ensue, including heart attack or stroke.5 Atherosclerosis may obstruct the flow of blood in any artery in the body, including arteries in the heart (coronary heart disease), brain (stroke), or lower extremities (peripheral vascular disease). Arteries carry oxygen-rich blood from the heart to the rest of the body. Over time atherosclerosis can reduce the delivery of oxygen and other nutrients to cells throughout the body. It may secondarily lead to the development of serious health problems, including heart attack, stroke or even death.6
3
Figure 3: The development of a ‘fibrofatty’ plaque. (1) A healthy blood vessel. (2) Specific sites of the arterial tree are susceptible to injury from turbulent collision with blood-borne particles. LDL particles and other circulating debris and toxins are able to infiltrate the injured blood vessel wall. (3) The injured blood vessel wall becomes a focal area of chronic inflammation populated with macrophages. (4) The macrophages ingest the LDL particles and other debris in an attempt to prepare the injured blood vessel wall to begin the healing phase by reducing the inflammation and clearing the injured site of debris. (5) Macrophages are very powerful defensive cells that consume the circulating oxidized LDL (and other circulating irritants) to become fat-laden ‘foam cells’. The accumulation of foam cells is responsible for the expansion of the plaque. (6) Sometimes the plaque is so large that it interferes with the flow of blood in the artery. The blood is unable to pass by the plaque and a blood clot forms. If the blockage is significant and occurs in a coronary artery, a heart attack may ensue. If a piece of the blood clot breaks off, it may lodge itself in a coronary artery and a heart attack may ensue or it may lodge itself in an artery in the brain and a stroke may develop.
4
1
2
LDL
3
Macrophage
4 Atheroma
5
6
Foam Cells
Thrombus
Plaque
Risk Factors Poor Diet Stress
Inactive Lifestyle
Diabetes
AGING FAMILY HISTORY GENDER ETHNICITY GENETICS
Body Weight
Smoking & Alcohol
Blood Pressure
Figure 4: Intrinsic and modifiable risk factors. Developing symptoms of CVD is determined not only by intrinsic risk factors but more importantly personal diet and lifestyle choices. Isn’t it wonderful that life expectancy continues to rise? The average life expectancy for a Canadian male is 80 years and for a Canadian female 84 years.7 Our longer lifespan is a testament to improvements in occupational health and safety, food supply and nutrition, and healthcare. Living longer has introduced a new set of health challenges. Atherosclerosis is one of those challenges. Atherosclerosis is a chronic silent inflammatory process that may begin in the arteries during infancy. It can remain silent for a lifetime or become symptomatic, typically around middle age. Whether or not symptoms of atherosclerosis develop depends on the interaction between the intrinsic risk factors (risk factors we are born with) and personal diet and lifestyle decisions (Figure 4).3,4 Some risk factors for atherosclerosis are beyond our control (intrinsic risk factors) and include aging, gender, genetic makeup, ethnicity, and family medical history.8,9 Many more risk factors are controlled by personal decisions and actions and are modifiable.8,10 These may include high blood cholesterol levels, poor diet, body weight, inactive lifestyle, smoking, excessive alcohol consumption, and living in a high-stress environment.10 5
The Calcium Paradox Calcium is an essential mineral. It is the most abundant nutrient in the body. Ninety-nine percent of the body’s calcium is stored in bones and teeth.11,12 For decades, dietary and supplemental calcium intake has been promoted because of its benefits for bone health and for the prevention of osteoporosis.12,13 It is also an essential requirement for numerous other physiological functions9 (Table 1). Unfortunately, too much of a ‘good thing’ can be bad too, as scientific and clinical trials have recently discovered.14 Table 1: The Physiological Importance of Calcium
Calcium is required for:
• • • • • •
Structure and hardness of bones and teeth Skeletal, Smooth & Cardiac Muscle contraction Nerve signal conduction Blood vessel constriction and relaxation Protein function Hormone regulation
An increasing number of clinical trials have discovered that calcium supplementation may be strengthening our bones at the expense of cardiovascular health.15,16 Calcium supplementation (1000 mg per day) may be associated with kidney stones, cardiovascular problems, prostate cancer, constipation and digestive problems.17 The National Institutes of Health, USA clinical trial is currently the largest reported study.18 They recruited 200,000 men and 169,000 women between 50-71 years of age over a period of more than 12 years. The study found that high intake of supplemental calcium is associated with 20% higher risk of CVD death in men but not in women. Calcium supplementation with or without vitamin D (400 IU) significantly increased the risk of myocardial infarction (heart attack) by 31% in 5 trials involving 8,151 participants and by 27% in 11 trials involving 11,921 participants regardless of gender.19,20 The message is very clear: high-dose calcium supplementation (1000 mg per day) increases the risk of myocardial infarction or stroke. Why? The calcification of atherosclerotic plaques is responsible for arterial ‘blockages and hardening’ and increases the risk of a heart attack or stroke. Given these concerns, should anyone be taking calcium supplements? YES! Adequate calcium levels are essential for normal physiological function (Table 1). Osteoporosis Canada and Health Canada21 recommend that calcium be obtained from the diet whenever possible. However, when dietary calcium is lacking, a calcium supplement may bridge the gap. The ideal calcium supplement is one that is formulated not only with a low dose of calcium, but includes all of the complementary cofactors necessary for maintaining bone health and reducing the risk of osteoporosis. These cofactors include vitamins (such as D and K2) and minerals (such as magnesium and boron); and omega oils. Vitamin K2 is particularly important because it helps to protect the heart from the dangers of calcification. 6
Vitamin K2, Synergy: Bone and Cardiovascular Health Vitamin K2 is important for bone and heart health. It also plays a critical role in maintaining the integrity of the blood vessel wall. Vitamin K2 helps the hormone, osteocalcin, encourage circulating calcium to bind to bone.22 It prevents calcium from depositing in arteries, thereby reducing calcification of atherosclerotic plaques and hardening of the arteries.22,23 In 2004, the Rotterdam Study (n=4,807 participants) reported that long-term (7-10 years) dietary intake of vitamin K2 (45 mcg/day) significantly reduced the risk of arterial calcification. Mortality related to CVD was reduced by 50%. The strong protective effect on heart health was similar for men and women above age 55.24 The cardiovascular and bone health benefits of low-dose vitamin K2 were confirmed in 2015 by Knapen et al. Healthy post-menopausal women (n=244) received 180 mcg of vitamin K2 daily for 3 years.25,26 Vitamin K2 intake significantly reduced the rate of bone mineral density loss in their lumbar spine and decreased the loss of mid-thoracic vertebral height.25 The elasticity of their arteries improved significantly, thereby improving blood flow throughout their bodies (Figure 5).26 Placebo
Stiffness Index β
15
180 mcg/day Vitamin K2
14
13
12
11
0
1
2
3
Treatment Period (Years)
Figure 5: 3-year vitamin K2 supplementation decreased arterial stiffness index β in healthy post-menopausal women. Data presented are mean values with corresponding standard error. The results are significant with p<0.05.26 Therefore, when taking a low-dose calcium multi-supplement, it is essential to ensure that it includes vitamin K2. If not, there is a risk of losing the benefits of calcium for bone health and increasing the risk of CVD.
7
Prevention and Management Atherosclerosis progresses slowly and may take decades to become symptomatic. This is good news because it gives us the opportunity to be proactive and take steps to reduce the risk of developing symptomatic CVD regardless of individual inborn risk factors. Healthy Weight
Cardiovascular Protective Supplements
Active Lifestyle
AGING FAMILY HISTORY GENDER ETHNICITY GENETICS
Sleep
Healthy Diet Reduced Stress
Figure 6: Adopting a rigorous integrated CVD prevention strategy that is focused on a healthier diet and smart lifestyle decisions can significantly improve your general health but more specifically your cardiovascular health.
Primary Prevention focuses on delaying or preventing the onset of
symptomatic CVD. It requires that we be proactive and make healthy lifestyle choices. Conscious healthy lifestyle choices may include reducing stress, being mindful of blood pressure, sugar and cholesterol levels, maintaining a healthy bodyweight, refraining from smoking and excessive use of alcohol, being physically active, and developing heart-healthy eating habits (Figure 6). In 2007, a Cochrane meta-analysis of 55 international clinical trials showed that after adopting heart-healthy eating habits such as reducing total and saturated fats, sugar and salt intake, eating more fresh fruits and vegetables, together with healthy lifestyle modifications (Figure 6), an 84% reduction in the risk of developing CVD can occur in as little as 6 months.10,27,28 Strong peerreviewed studies support the efficacy and safety of integrating cardiovascular protective natural supplements into your primary heart-healthy strategy to correct nutritional deficiencies that may exist.29,30
Secondary Prevention focuses on the early detection of CVD so
that intervention(s) can be undertaken to reduce the risk of developing complications of CVD including heart attack and stroke. The primary prevention strategies discussed above also apply here (Figure 6).27-30 Pharmaceutical therapy(ies) are more likely to be used as part of a secondary prevention strategy.27-28,31,32 8
Pharmaceutical Therapy
Pharmaceutical drugs may be prescribed as part of a primary or secondary CVD prevention or intervention program. Common pharmaceutical therapy programs may include a baby aspirin (80 mg), a statin class drug, a betablocker, an angiotensin converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB). These therapies work by addressing the major modifiable risk factors such as high blood pressure, elevated cholesterol (TC) and/or triglycerides (TG), and diabetes.
Statins
Statins are the most widely prescribed class of medications. Studies have shown that they may reduce the risk of heart attack, stroke and even death from CVD by 25-35% and the chance of recurrent strokes or heart attacks by about 40%.32 Commonly prescribed statin medications include atorvastatin (Lipitor速), simvastatin (Zocor速), lovastatin (Mevacor速), pravastatin, rosuvastatin (Crestor速) and others. They can be used effectively for the primary and secondary prevention or intervention of CVD.28 Statins are HMG-CoA reductase inhibitors that block the synthesis of cholesterol by the liver. Greater reductions in LDL and TC levels occur when statins are taken at night rather than in the morning.33 HMG-CoA HMG-CoA Reductase
Statins
h
Mevalonate
h
h h
Cholesterol
Coenzyme Q10 (Ubiquinone) Circulating LDL Cholesterol
h
h
LDL Receptors
h h
Figure 7: Biosynthesis of cholesterol and coenzyme Q (CoQ10) from the common precursor HMG-CoA. Statins inhibit HMGCoA reductase and effectively reduce the synthesis of both cholesterol and CoQ10. Reducing intrinsic synthesis of cholesterol stimulates cells to increase their uptake of dietary cholesterol or LDL, effectively reducing the amount of cholesterol in blood.
Physiological Upregulation of LDL Receptors
h
Cellular Cholesterol
The cells themselves manufacture almost all of the cholesterol in blood. The liver synthesizes 70% of the cholesterol. Cholesterol is an essential structural component of cell membranes. It maintains the integrity and fluidity of cell membranes and is the precursor for the biosynthesis of all steroid hormones, bile acids, and vitamin D. By reducing the intrinsic synthesis of cholesterol, statins stimulate cells to increase their uptake or removal of dietary cholesterol from the circulatory system to satisfy their cholesterol requirements (Figure 7).34 9
Lovastatin is a commonly prescribed statin medication that is also naturally synthesized by oyster mushrooms and red yeast rice.32 Randomized controlled trials have shown that dietary consumption of red yeast rice reduces circulating cholesterol and improves circulating levels of markers of systemic inflammation.35-39 Consuming naturally synthesized lovastatin (found in red yeast rice) for 10 weeks did not interfere with the synthesis of coenzyme Q10 (CoQ10).39 More important was the lack of adverse events associated with the dietary consumption of naturally synthesized lovastatin in red yeast rice. No reports of liver dysfunction, acute kidney failure, muscle pain or cataracts were reported after 10 weeks of red yeast rice supplementation.39 In contrast numerous randomized controlled trials have shown that several adverse events may be associated with pharmaceutical statin medication usage.40 These adverse events include muscle pain, a modestly increased risk of new-onset diabetes mellitus41, liver dysfunction, acute kidney failure, cataracts, cognitive loss, and neuropathy.42 Rhabdomyolysis is a rare but the most feared adverse reaction. It is a medical condition in which skeletal muscle is damaged and breaks down. The breakdown products, including myoglobin, are released into the bloodstream and are harmful to the kidneys.
10%
T C ot ho al le st er ol Tr ig ly ce H C D rid ho L es le s LD ter C L o ho l le st er ol V ita m in C V ita m i C n (U oQ E bi 10 qu R ino G BC ne lu ) ta th io ne
Figure 8: Nineteen participants received 10 mg atorvastatin/ day for 5 months. Atorvastatin improved the participantsâ&#x20AC;&#x2122; lipid profile (total cholesterol (TC), LDL, and triglycerides (TG). The metabolic and antioxidant profile was negatively affected (vitamin C, E, CoQ10 and glutathione (GSH).44
% Change from Baseline (Before Dosing)
Statins and Coenzyme Q10
0%
4%
-10%
6% -14%
-20% -30% -34%
-40% -50%
-44% -44%
-60% -70% -80%
-75%
-68%
Statins not only decrease the synthesis of cholesterol but they also reduce the synthesis of coenzyme Q10 (CoQ10).36 Aging, independent of statin use, also causes a gradual decrease in the intracellular synthesis of CoQ10.52 The inhibition of HMG-CoA reductase by statins interferes with the production of mevalonic acid, which is the shared precursor in the synthesis of both cholesterol and coenzyme Q10 (Figure 8).34 Statin usage is associated with a deficiency in CoQ10116 and other important antioxidants such as glutathione (GSH)43,44 (Figure 8). It is recommended that anyone taking a statin medication should also be taking CoQ10 supplements.43,45 10
Cardiovascular Protective Supplements It is important that we do our best to eat a healthy, balanced diet. However, despite our best efforts nutritional deficiencies may exist. Cardiovascular protective supplements can help address these nutritional deficiencies (refer to the Tables of Cardiovascular Protective Supplements on the beginning of page 18) and reduce the risk of developing CVD. They can help maintain and improve not only general health but more specifically cardiovascular health.
Vitamins and Minerals
Consuming the recommended daily intake of vitamins and minerals is the foundation of good overall health. Vitamins A, C and E and the minerals selenium and zinc are very important in countering the effects of free radicals. Free radicals are formed when oxygen interacts with cellular components such as DNA, proteins and cell membranes. Free radicals can cause irreversible cell and tissue damage.46,47 Free radicals initiate and promote the development of atherosclerosis.46,47 Deficiencies in the B vitamins have been linked to cognitive decline, heart disease, and general nervous system dysfunction.48,49
Nutraceuticals
The word nutraceutical comes from the words ‘nutrition’ and ‘pharmaceutical’. It is a food, vitamin, mineral or herb that, when consumed may improve our health. CoQ10 and resveratrol are two nutraceuticals that have been scientifically and clinically shown to be cardiovascular protective. Resveratrol is a naturally occurring polyphenol antioxidant found in grapes and grape products. It is a free radical scavenger and significantly reduces the oxidation of LDL.50 A double-blind, placebo-controlled trial showed that resveratrol supplementation post-heart attack effectively reduced the ‘hardening’ and patency of the aorta, thereby improving blood flow (Figure 9).51 Figure 9: Forty postheart attack participants received 10 mg resveratrol/day for 3 months. TC, TG and the size and density of atherosclerotic plaques in the aorta were all significantly reduced. The end result was a statistically significant improvement in vascular patency and blood flow, *p<0.05%.51
% Improvement in Blood Flow
6
*
5 4 3 2 1 0
Placebo Resveratrol Baseline
Placebo Resveratrol 3 months 11
Coenzyme Q10 (CoQ10) is an essential cofactor in mitochondrial production of energy (ATP) and water; and is an important intracellular antioxidant. Ninetyfive percent of the human body’s energy production requires CoQ10.52-55 Deficiencies in CoQ10 may cause cells to burn energy inefficiently, eventually producing increased oxidative stress and cell/tissue damage.53 CoQ10 works synergistically with vitamins C and E to control oxidative stress and thereby reduce the oxidation of LDL and the development of atherosclerotic plaque(s). When the availability of antioxidants like CoQ10 and vitamins C and E are reduced, there is an increased risk of developing cardiovascular, neurological and muscular health problems. Intrinsic CoQ10 synthesis is reduced with aging. Some pharmaceutical drugs, like statins, inhibit the cells from making CoQ10 (Figure 10).45,53 Statin medications lower CoQ10 levels in serum and skeletal muscle tissue. This may account for statininduced muscle pain (myopathies) and general fatigue.53,55 LOO . LOOH
Vitamin E Vitamin E.
Vitamin C. GSSG CoQ10 Vitamin C GSH CoQ10H2
Dihydrolipoic Acid
α -Lipoic
Acid
NAD(P)+ NAD(P)H
A. Cell Membrane Antioxidant Activity Oxygen
CoQ10 CoQ10H2
MITOCHONDRIAL RESPIRATION CoQ10 delivers electrons that help convert ADP to ATP.
ADP
Water CO2
ATP
B. Mitochondrial Energy (ATP) and Water Generation
Figure 10: CoQ10 is an important cofactor in maintaining heart health. A. CoQ10 is an important factor in mitochondrial respiration and its production of energy (ATP) and water in all cells. Deficiencies in CoQ10 result in a number of neurological, cardiovascular and musculoskeletal health problems. B. CoQ10, glutathione (GSH and GSSG) and vitamins C and E are important antioxidants that work in synergy to protect cell membranes from free radical damage. The Q-SYMBIO study is the first comprehensive, double-blind, multicentre study demonstrating the dramatic, life-saving impact of CoQ10 supplementation in patients with chronic heart failure (Table 2).54 The Q-SYMBIO study found that patients who did not receive CoQ10 had twice the risk of experiencing a major cardiac event (unplanned hospitalization for worsening heart failure, death from a cardiovascular cause, urgent heart transplantation, or artificial mechanical heart support).54 Why? Chronic oxidative stress is one of the main contributing factors in the formation of atherosclerosis and ‘hardening of the arteries’ (endothelial dysfunction). Endothelial dysfunction is a major precursor to high blood pressure and CVD. 12
2
The Q-SYMBIO study found that 300 mg/day of CoQ10 significantly improved the participants’ natural endothelial antioxidant levels, blood vessel relaxation/elasticity, and the oxygenation of their tissues. CoQ10 supplementation restored CoQ10 levels to a healthy level. More importantly, in some cases, CoQ10 altered the progression of heart failure, extending survival time and improved quality of life.54 Table 2: Cardiovascular Benefits of Supplemental CoQ10 10-Year Q-Symbio Study: (CoQ10 300 mg once per day) • • •
Significantly less likely to die from heart failure Less than half as likely to die from any cause at all Half as likely to have a major adverse cardiac event compared to those not taking CoQ10
CoQ10 can significantly help to maintain and improve general health, but more specifically cardiovascular health. In 2010 Shargorodsky designed a clinical trial (n=70 participants) to examine the benefits that participants with multiple CVD risk factors might receive from taking one multi-antioxidant supplement per day.55 The multi-antioxidant multi-supplement contained 500 mg vitamin C, 200IU vitamin E, 100 mcg selenium and 60 mg CoQ10. The multi-antioxidant supplement significantly helped the participants reduce their risk of developing CVD. It improved their lipid profile (HbA1C, TC, TG, HDL, LDL), decreased systemic inflammation (C-reactive protein (CRP), a marker of systemic inflammation), and improved their hemodynamic profile (arterial elasticity and systolic blood pressure (SBP)), compared to those receiving a placebo (Figure 11).55 50
Artery Elasticity
% Change from Baseline
30
HDL
10 -10
SBP
HbA1C
TC
TG
LDL
-30 -50 -70 -90
CRP Placebo
Antioxidants
Figure 11: All participants who received the multi-antioxidant supplement experienced a significant improvement in their lipid and hemodynamic profiles and a reduction in systemic inflammation compared to those who received the placebo. The data is expressed as a percent difference from the placebo, p>0.001.55 13
Omega-3 Oils The human body cannot produce omega-3 oils. Omega-3 oils must be consumed through diet and supplements. Fish and krill oil are excellent sources of the essential omega-3 fatty acids, eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA).56 Clinical studies have shown that dietary supplementation of EPA and DHA yields a multitude of cardiovascular benefits (Table 3). Omega-3 fatty acids may reduce the development and progression of atherosclerotic plaques.52 Omega-3 fatty acids help to decrease platelet aggregation (‘sticky blood’) and the risk of thrombosis (a blood clot) that can lead to myocardial infarction (heart attack) and stroke.57,58 Omega-3 fatty acids may also reduce serum TG levels, blood pressure, and the incidence of arrhythmias and sudden cardiac death in patients with existing heart disease.57,58 It is recommended that primary CVD prevention strategies include the combined daily consumption of a minimum of 500 mg of EPA and DHA. Secondary prevention programs should include 1000 mg of EPA and DHA daily. If you have been diagnosed with high TG, the recommended combined intake of EPA and DHA is 3-4 g/day. This may lower TG levels by 20-50% and optimize the anti-clotting and anti-inflammatory benefits of omega-3 fatty acids.58 Table 3: The Cardiovascular Benefits of Omega-3 Fatty Acids
Dyslipidemia • • •
Reduces triglycerides Reduces LDL Reduces VLDL
Atherosclerosis • • •
•
14
Reduces the risk of developing blood clots Reduces inflammation Reduces the development & progression of atherosclerosis Improves vasodilation of blood vessels
Cardiac • •
•
Reduces blood pressure Reduces the risk of major cardiovascular events (heart attack, stroke, coronary artery disease, atrial fibrillation, heart failure) May reduce size of repeat heart attack
Adaptogens
Figure 12: Cordyceps Sinensis improved the aerobic capacity of 20 healthy elderly participants. Their metabolic threshold increased by 10% and their ventilation threshold improved by 8.5%.59
Change in Threshold from Baseline (%)
Adaptogens are a group of unique herbs that are used in Chinese, African, Tibetan and Ayurvedic medicine to restore balance in the body. They are used to support the health of the adrenal system and manage the bodyâ&#x20AC;&#x2122;s hormonal response to stress (physical, environmental, or emotional). 14 12 10 8 6 4 2 0
Metabolic Threshold
Ventilatory Threshold
Cordyceps Sinensis (C. sinensis) is one of the most important adaptogens that support heart health. Traditional Chinese Medicine uses C. sinensis as a tonic for longevity, endurance, energy, and vitality.59,60 Its powerful antioxidant activities may reduce the oxidation of LDL, thereby delaying the expansion of the atherosclerotic plaques. This may help to improve arterial blood flow. Improving the delivery of blood to organs and tissues will improve aerobic capacity and ultimately increase physical activity endurance. Aerobic capacity is defined as the maximal amount of physiological work that the body can do. It is determined by a combination of aging and cardiovascular health and conditioning: (i) the size and strength of the heart, (ii) the concentration of oxygen-carriers in the blood (hemoglobin) and (iii) the delivery of oxygen to tissues and organs (i.e. blood flow). In 2011, the benefits of taking 333 mg of C. sinensis 3 times a day for 12 weeks was studied in 20 healthy elderly men and women (50-75 years old).59 All of the participants experienced an increase in their aerobic capacity. It took longer for them to develop muscle fatigue (metabolic threshold) and the need to increase their rate of breathing (ventilation threshold) (Figure 12). Eucommia Ulmoides (E. ulmoides) is commonly used in Traditional Chinese Medicine to manage blood pressure, TC and TG, obesity, sexual dysfunction, osteoporosis and diabetes.61,62 Studies suggest that E. ulmoidesâ&#x20AC;&#x2122; ability to block the beta-adrenergic pathway and increase nitric oxide is responsible for its ability to manage blood pressure and alleviate the effects of stress on the heart.62 15
Herbs Herbs have always been used in both western and natural medicine to detoxify, cleanse, and nourish the body. A few of the herbs that have been scientifically shown to enhance heart health include Chinese hawthorn63, grape seed extract64, E. ulmoides61,62, garlic65, cayenne66 and citrus bioflavonoids.68-71 Chinese Hawthorn (Crataegus pinnatifida) has shown clinical promise as a hypolipidemic agent. In 2011, 29 male and female participants with diabetes and chronic coronary heart disease participated in a randomized double-blind placebo-controlled clinical trial that examined the cardiovascular benefits of hawthorn.63 Hawthorn improved lipid metabolism and reduced the risk of CVD by 11% (as indicated by a reduction in non-HDL-C by 11%) (Figure 13). Non-HDL-C is an important marker that is used as an indicator for the risk for CVD.63 Hawthorn also reduced the level of systemic chronic inflammation (measured by CRP) by 65% (Figure 13). This suggests that atherosclerosis activity may have been significantly reduced by supplemental hawthorn.62 10
HDL
% Difference Hawthorn vs. Placebo
0 -10
Total Cholesterol
LDL
Non-HDL-C
-20 -30 -40
Triglycerides
-50 -60 -70
CRP
Figure 13: Twenty-nine participants received 400 mg of hawthorn 3 times per day for 6 months. The data is expressed as a percent difference between those who received hawthorn compared to the placebo group. Lipid metabolism and chronic inflammation statistically improved. p<0.00163 Cayenne (a.k.a. capsaicin) promotes cardiovascular health through its antiinflammatory, anticoagulant and antioxidant properties.67,72 Its antioxidant property has been clinically shown to reduce the oxidation of LDL in men and women.63 Oxidation of LDL is believed to initiate the development and progression of atherosclerosis. Therefore, cayenne may prevent or reduce the risk of CVD such as atherosclerosis and coronary heart disease. 16
The Power of Synergy 0
Figure 14: A 9-ingredient multisupplement taken for 30 days significantly improved the lipid profile of all 19 participants. The results are expressed as a percent change from the baseline value. p<0.00137
% Change from Baseline
-2 -4 -6 -8 -10 -12 -14
Total Cholesterol
Triglycerides
-16 -18
LDL
A comprehensive description of the evidence-based health benefits of individual cardiovascular protective natural supplements can be found at the end of this booklet. What is not obvious from this information is the augmented health benefits of natural supplements when they are combined together into a multi-supplement or when a number of single natural supplements are taken together. This is the power of synergy. A well-formulated single multi-supplement should always be the foundation of a health promotion program. Why? A single multi-supplement is typically formulated to address common nutritional deficiencies. A multi-supplement may combine vitamins and minerals, herbs, nutraceuticals and adaptogens together into one product. They are designed to help maintain and improve our general health and/or that of a specific organ system or health concern (such as womenâ&#x20AC;&#x2122;s health, heart health etc). Additional single-ingredient supplements may be taken in addition to a single multi-supplement to address specific health concerns. Formulating an effective multi-supplement is dependent upon not only combining the correct ingredients together but achieving the correct balance among the ingredients. A single supplement may have a minor effect; but when combined with other supplements in a balanced formula, the benefits may be amplified by the synergism between supplements. A clinical study in 2014 demonstrated just how powerful a well-formulated multi-supplement can be.37 A multi-supplement containing 9 known cardiovascular protective ingredients: red yeast rice, bioflavonoids, polycosanol, omega-3 fatty acids, resveratrol, CoQ10, folic acid, vitamin B3 (niacin) B6, B12 and black pepper significantly improved the lipid profile (decreased TC, LDL and TG levels) of all 19 participants (with known elevated TC but no evidence of CVD) (Figure 14). 17
Cardiovascular Protective Supplements Cardiovascular protective supplements include a variety of vitamins, minerals, nutraceuticals, adaptogens and herbs. Each natural supplement has been placed into a Table according to its reported cardiovascular benefit. Many natural supplements have multiple benefits and are found in multiple Tables. Only peer-reviewed human studies and meta-analyses were reviewed and evaluated to determine the ‘Quality of Evidence’ supporting the cardiovascular benefits of each natural supplement and the potential effect or change that it may have on the given parameter. Not all nutraceuticals, adaptogens and herbs are used to support cardiovascular health have been included. The exclusion of these natural supplements does not imply that they do not possess cardiovascular benefits. Their exclusion may have occurred because: (i) no peer-reviewed human studies were available for evaluation. (ii) the available peer-reviewed human studies were single case studies or very small pilot studies. The study populations were too small to permit conclusions to be formulated. (iii) the cardiovascular effects were studied in animals or in vitro (the study was performed with cells outside of the human body). The GRADE (Grading Recommendations Assessment, Development and Evaluation (A, B, C) system was used to evaluate and categorize the quality of the supporting clinical documentation for the cardiovascular benefits of each natural supplement.72 The GRADE system and the Human Effects Matrix system were used to establish the strength of the physiological change (Minor, Moderate, Strong) imparted by the natural supplement.73
18
Grade
Quality of Evidence
A
High
B
Moderate
Further research is likely to have an impact on the confidence of the effect. • Multiple studies where at least two are double-blind and placebo-controlled • Several studies with some limitations • One high-quality study
C
Low
Further research is very likely to have an impact on the confidence of the effect. • Single double-blind study or multiple-cohort studies
Level of Evidence Further research is very unlikely to have an impact on the confidence of the effect. • Several high-quality, robust studies with repeated double-blind clinical trials • One large, high-quality multi-centre trial
Effect
Comments
i or h
A change was noted but will not be discernible.
(Minor)
ii or hh
A change was noted and will be felt.
(Moderate)
iii or hhh (Strong)
The change is very strong. This is reserved for pharmaceutical-grade effects.
Anti-Inflammation These supplements have been clinically shown to decrease or reduce the severity of chronic inflammation experienced by injured tissues. Atherosclerosis is a chronic inflammatory condition. Supplement
Quality of Effect Evidence
Bromelain75,85,87
A
ii
Capsaicin67,72
B
ii
A
ii
Cat’s Claw
112-116
Chymotrypsin
ii
86
Comments • A mixture of digestion enzymes found in pineapple that helps to remove cellular debris and accelerate the healing process
• Digestion enzyme that helps remove cellular debris and accelerate the healing process
Curcumin89-91
B
ii
Eucommia
A
ii
Grape Seed Extract64
B
i
Hawthorn63
B
i
Resveratrol80-82,84
A
ii
Serratiopeptidase88
A
ii
• Reduces swelling
Trypsin86
A
ii
• Digestion enzyme that helps remove cellular debris and accelerate the healing process
61,92-94
• Significantly reduces LDL oxidation, thereby reducing the development of atherosclerotic plaques
19
Blood Lipids Supplement
Quality of Evidence
Capsaicin72
B
Citrus Bioflavonoids
B
Curcumin95-98
B
Fish Oil56-58
A
Garlic
A
Hawthorn63
B
Lipid TC
LDL
TG
HDL
Comments
ii ii
68-71
65,66,77,111
i
h
ii
ii
iii
hh
• 15-30% reduction in TG
ii
ii
i
hh
• 10-15% increase in HDL • 10-20% reduction in LDL
ii
i
i
i
h
• Increase in circulating HDL in women • Decrease in TG in women
hh
• May contain lovastatin/ monacolin K • In Canada red yeast rice supplements may contain up to 1 mg per daily dose of lovastatin • If you have had an adverse event while taking a statin pharmaceutical medication, consult a healthcare practitioner prior to use
• Inhibits HMG-CoA reductase • Reduces lipid oxidation • Decreases absorption of TG from the intestines
A
20
• Some benefits but further research is needed
i
Inositol99
B
Red Yeast Rice32,34-36
A
ii
ii
ii
Resveratrol51,81-84
A
ii
ii
i
Vitamin B3 (Niacin)101-109
B
ii
ii
ii
hhh
Hemodynamic (Blood Flow) Blood flow determines how well oxygen is delivered to the cells and tissues and how well carbon dioxide is removed from the cells and tissues. Several physical factors govern how blood flows throughout the body including resistance to blood flow (determined by the elasticity and size of the lumen (internal diameter) of blood that the left side of the heart is able to pump out each time it contracts (left ventricular ejection fraction, LVEF). Effect Effect Quality on on Supplement of Blood Blood Evidence Flow Pressure Coenzyme Q1053-55,110
B
h
i
Eucommia Ulmoides62
A
hh
ii
Fish Oil56-58 (Omega Oils)
A
hh
i
Garlic111
B
hh
ii
Grape Seed Extract64
B
h
Inositol99
B
i
i
Resveratrol
A
hh
ii
51,81-84
Comments
• Appears to improve vasodilation or blood vessel relaxation • May decrease blood pressure in persons with high blood pressure • Improves the blood vessels’ response to changing needs of the cells and tissues • May reduce blood pressure 8-10% in persons with high blood pressure • Improves blood flow and indirectly reduces leg swelling • Interacts with nitric oxide to improve blood flow • 10 mg resveratrol appears to improve LVEF • May reduce blood pressure in persons with high blood pressure
21
Anti-Clotting These supplements have been clinically shown to decrease the ‘stickiness’ or clotting ability of platelets. If you are taking a blood thinner or protease inhibitor or have a history of stomach ulcers, consult a healthcare practitioner prior to use.
Supplement
Blood Quality of Clotting Evidence Effect
Bromelain75
A
i
Capsaicin72
B
i
Curcumin76
B
i
Fish Oil57,58
B
i
C
i
A
i
Garlic77 Resveratrol
78-81,84
Comments • Inhibits clot formation and improves blood flow
• May help to reduce the formation of atherosclerotic plaque(s)
• May reduce clot formation
List of Abbreviations ACE
Angiotensin converting enzyme
ARB
Angiotensin receptor blockers
CoQ10
Coenzyme Q10 (oxidized)
CoQ10H2
Coenzyme Q10 (reduced)
CRP
C-reactive protein
CVD
Cardiovascular disease
DHA
Docosahexaenoic acid
EPA
Eicosapentaenoic acid
GSSG
Glutathione (oxidized)
GSH
Glutathione (reduced)
HDL
High-density lipoprotein cholesterol
LDL
Low-density lipoprotein cholesterol
VLDL
Very low-density lipoprotein cholesterol
LVEF
Left ventricular ejection fraction
Non-HDL-C SBP
22
Non-high-density lipoprotein cholesterol Systolic blood pressure
TC
Total cholesterol
TG
Triglyceride(s)
The Future of Promoting Heart Health Sometimes the body is unable to successfully address the physiological stresses (such as heart disease) it is faced with and pharmaceutical, medical and/or surgical intervention(s) are necessary. However, the body usually lets us know well in advance when its resources are deficient, giving us ample opportunity to take the necessary steps to improve our health. A wellbalanced and healthy diet and lifestyle not only prepare the body to better cope with these challenges but also improve its tolerance to pharmaceutical, medical or surgical intervention(s). Looking forward, embracing and learning how to integrate the benefits of both natural and pharmaceutical therapies will empower you to transform your life by improving your health and quality of life. The foundation of â&#x20AC;&#x2DC;goodâ&#x20AC;&#x2122; health requires first and foremost that you do your best to provide the dietary nourishment (vitamins, minerals, healthy oils, and phytonutrients) that the body needs to not only support its daily activities but also respond to everyday stresses. Including a comprehensive well-formulated natural multi-supplement (containing vitamins, minerals, healthy oils, nutraceuticals, adaptogens and herbs) as part of your daily dietary plan will help address any dietary deficiencies that may exist. Sometimes the body may require additional nutritional support when faced with specific health concerns such as heart disease. Adding quality, well-absorbed natural supplements that address specific health concerns is essential to maintaining and improving your health and to re-establishing a healthy, balanced (homeostasis) internal milieu. The bodyâ&#x20AC;&#x2122;s ability to respond to daily physiological challenges and to heal itself, is a reflection of the strength of its nutritional health. The body has an incredible ability to heal itself, provided that it has the essential nutrients. Appreciating the benefits of adopting an integrative medicine approach to promote not only your general health but more specifically your heart health can truly transform your life.
23
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