Naturopathic Approaches to Cardiovascular Heath

1. Naturopathic Approaches to Cardiovascular Heath Dr. Jeanny S. Kim, ND October 20, 2011

2. Talk Outline Cardiovascular Disease What is Naturopathic Medicine? Philosophy, Education, Modalities What is the Naturopathic Doctor�s role in cardiac patient health? Individual � Assessment & Treatment Group � As part of the health care team Society � Research & Education Question & Answer Period

3. Cardiovascular Disease One of the leading causes of death in North America (Statistics Canada, 2007) Includes the heart and all blood vessels E.g. Arteriosclerosis, Atherosclerosis, Coronary Heart Disease (CHD), Congestive Heart Failure (CHF), Angina, Myocardial Infarction (MI) Metabolic Syndrome: Hypertension + Dyslipidemia + Insulin Resistance + Central Obesity The other leading cause: Cancers (3rd = strokes) One heart attack every 7 minutes. Every 7 minutes in Canada, someone dies from heart disease or stroke Proportion of deaths d/t heart disease increased steadily as population aged. It surpassed the proportion of deaths d/t cancer at the age of�85�and older. Heart dz & stroke = leading cause of hospitalization � accounting for 16.9 % of total hospitalizations (19.8% for men and 14.0% for women). High BP = 130/85 mmHg Dyslipidemia (�abN lipid levels�) = low HDL, high TGThe other leading cause: Cancers (3rd = strokes) One heart attack every 7 minutes. Every 7 minutes in Canada, someone dies from heart disease or stroke Proportion of deaths d/t heart disease increased steadily as population aged. It surpassed the proportion of deaths d/t cancer at the age of�85�and older. Heart dz & stroke = leading cause of hospitalization � accounting for 16.9 % of total hospitalizations (19.8% for men and 14.0% for women). High BP = 130/85 mmHg Dyslipidemia (�abN lipid levels�) = low HDL, high TG

4. �The Other Guys� CAM: Complementary and Alternative Medicine Naturopathic Doctors (NDs) Homeopathic Doctors (HDs) Traditional Chinese Medicine (TCM) Doctors Chiropractors (DCs) Osteopaths (DOs) Talk about education process for NDs (VS the other practitioners) Mention: RMTs, Registered Holistic Nutritionists (RHN), Energy practitioners (Reiki), Reflexology, Craniosacral Therapy�etc.!Talk about education process for NDs (VS the other practitioners) Mention: RMTs, Registered Holistic Nutritionists (RHN), Energy practitioners (Reiki), Reflexology, Craniosacral Therapy�etc.!

5. What is Naturopathic Medicine? Individualized treatment that addresses the whole person Naturopathic doctors are highly educated primary care providers who integrate standard medical diagnostics with a broad range of natural therapies

6. Naturopathic Principles First do no harm Find and treat the cause Support the healing power of nature Treat the whole person Doctor as teacher Docere: includes patient education AND research + education of general public We have a responsibilityDocere: includes patient education AND research + education of general public We have a responsibility

7. The Naturopathic Doctor�s Toolbox Nutrition Counseling Botanical Medicine Traditional Chinese Medicine and Acupuncture Homeopathy Hydrotherapy Physical Medicine Lifestyle Counseling

8. A Natural Approach to Heart Health PREVENTION is key! Regular check-ups (MD & ND) Know your health history Diet & lifestyle The superior doctor prevents sickness; The mediocre doctor attends to impending sickness; The inferior doctor treats actual sickness. - Chinese Proverb What happens when �prevention� isn�t enough?

9. Assessment & Diagnosis Physical exam Lab tests Complete Blood Count (CBC) Urinalysis (U/A) Complete Lipid Profile Fasting Plasma Glucose (FPG) & Oral Glucose Tolerance Test (OGTT) Electrocardiogram (ECG) Generally: Screening for all adults 20+ yoa with fasting lipoprotein profile, every 5 years Canadian Diabetes Association: yearly screening with full lipoprotein profile for all adults with diabetesGenerally: Screening for all adults 20+ yoa with fasting lipoprotein profile, every 5 years Canadian Diabetes Association: yearly screening with full lipoprotein profile for all adults with diabetes

10. Naturopathic Treatments for Cardiovascular Disease

11. Diet & Lifestyle Modifications Reduce sodium and caffeine intake Decrease weight Reduce saturated fat Consume: low-fat dairy, high-fiber whole foods, fruits & veggies, nuts, coldwater fish Monounsaturated fatty acids: olive oil, avocado, almonds 4-year Hypertension Control Program trial (Stamler et al, 1987): 39% successfully discontinued their meds when they followed basic nutritional interventions, i.e. weight loss, salt restriction, alcohol avoidance. Further improvement with: DASH diet, physical exercise program, stress reduction measures NOT ONLY reducing saturated fat � need to also keep CARBS in mind! Fiber: oat bran, oat meal, konjac root glucomannan have best cholesterol lowering effect � then psyllium and flax (Rispin et al, 1992; Gore et al, 1994) *With fiber � drink plenty of water! Fish: at least 2x/week MUFAs: lower total cholesterol and LDL cholesterol, while increasing HDL cholesterol. Also helps in reducing body fat. EVOO: add 2tbsp/d4-year Hypertension Control Program trial (Stamler et al, 1987): 39% successfully discontinued their meds when they followed basic nutritional interventions, i.e. weight loss, salt restriction, alcohol avoidance. Further improvement with: DASH diet, physical exercise program, stress reduction measures NOT ONLY reducing saturated fat � need to also keep CARBS in mind! Fiber: oat bran, oat meal, konjac root glucomannan have best cholesterol lowering effect � then psyllium and flax (Rispin et al, 1992; Gore et al, 1994) *With fiber � drink plenty of water! Fish: at least 2x/week MUFAs: lower total cholesterol and LDL cholesterol, while increasing HDL cholesterol. Also helps in reducing body fat. EVOO: add 2tbsp/d

12. Diet & Lifestyle Modifications cont�d Limit alcohol consumption Smoking cessation Increase physical activity 30-40 min at 70% max heart rate, at least 3x/week Lipid-lowering effect: 50-60% max heart rate, 4-7x/week *Stress reduction* Effects of stress on CV system (SNS activation ? damage) Stress reduction is one of the most difficult things to do Important to find source/triggers for stress reaction - & appropriate stress-relieving techniques May also have co-morbid mood disorders � i.e. depression. Therefore, must address this too!Effects of stress on CV system (SNS activation ? damage) Stress reduction is one of the most difficult things to do Important to find source/triggers for stress reaction - & appropriate stress-relieving techniques May also have co-morbid mood disorders � i.e. depression. Therefore, must address this too!

13. Nutritional Supplements Coenzyme Q10 (100-300mg/d) Depleted in patients taking statin drugs Antioxidant for the heart Fish oil (1-2g EPA/d) Inflammation mediator Decreases platelet aggregation Magnesium (300-800mg/d) Muscle relaxant B vitamins B3, B5, folic acid, B6, B12 Plant sterols (1.5-2g/d) CoQ10: statistically sig BP reduction of 10.6-19.5mmHg after 4-12 weeks use (Digiesi et al, 1992); improved overall heart function Fish oil: lowers resting heart rate & systemic vascular resistance; improves filling Magnesium: calcium-channel blocker; cofactor in stabilizing heart function; may be depleted d/t medications B vitamins: helps convert homocysteine, which can cause heart disease B3 = need niacin (the �flushing� type) and NOT slow-release! *UP to 3000mg/day! B5 = inhibits HMG CoA reductase (therefore, stops production of cholesterol). Plant sterols: mimic cholesterol � lower TC and LDL by inhibiting absorption. Take with meals and carotenoids.CoQ10: statistically sig BP reduction of 10.6-19.5mmHg after 4-12 weeks use (Digiesi et al, 1992); improved overall heart function Fish oil: lowers resting heart rate & systemic vascular resistance; improves filling Magnesium: calcium-channel blocker; cofactor in stabilizing heart function; may be depleted d/t medications B vitamins: helps convert homocysteine, which can cause heart disease B3 = need niacin (the �flushing� type) and NOT slow-release! *UP to 3000mg/day! B5 = inhibits HMG CoA reductase (therefore, stops production of cholesterol). Plant sterols: mimic cholesterol � lower TC and LDL by inhibiting absorption. Take with meals and carotenoids.

14. Nutritional Supplements cont�d Vitamin E (400-1200IU/d) Antioxidant Decreases platelet aggregation Inflammation mediator Blocks the cycling of catecholamines Controversy? Controversy: studies in 2001, 2005, 2006 � no significant improvements, even increased risk of developing CHF in pxts with L ventricular dysfunction BUT studies = duration too short, inadequate therapeutic dosages, poor pxt compliance, lack of monitoring Vit E levels, not noting that D-alpha depletes gamma Vitamin E: use a mixed tocopherol blend, with equal amounts of D-alpha tocopherol and gamma-tocopherol D-alpha may deplete gamma (and gamma has greater benefit!!) Works better when taken with other micronutrients, e.g. Ca, Mg, Zn, Cu, Se, A, Bs, C, D, CoQ10Controversy: studies in 2001, 2005, 2006 � no significant improvements, even increased risk of developing CHF in pxts with L ventricular dysfunction BUT studies = duration too short, inadequate therapeutic dosages, poor pxt compliance, lack of monitoring Vit E levels, not noting that D-alpha depletes gamma Vitamin E: use a mixed tocopherol blend, with equal amounts of D-alpha tocopherol and gamma-tocopherol D-alpha may deplete gamma (and gamma has greater benefit!!) Works better when taken with other micronutrients, e.g. Ca, Mg, Zn, Cu, Se, A, Bs, C, D, CoQ10

15. Botanicals Crataegus spp. (Hawthorn) Cardiac tonic � improves coronary circulation, cardioprotective Allium sativum (Garlic): 300mg, 3x/d Reduces elevated cholesterol Antiplatelet activity Allium cepa (Onion) Zingiber officinale (Ginger) Limits cholesterol absorption Improves circulation, inflammation modulator With ALL botanicals, must be aware of contraindications and interactions � e.g. pregnancy, pharmaceutical medications � ALWAYS check with ND Forms of botanicals = liquid tincture, capsules, tablets, teas Hawthorn: may interact with other cardiac stimulants, BUT research says it�s safe to use altogether (may even reduce need for other meds) Garlic: though antimicrobial effects are lost during cooking, its BP- & cholesterol-lowering actions appear to be unaffectedWith ALL botanicals, must be aware of contraindications and interactions � e.g. pregnancy, pharmaceutical medications � ALWAYS check with ND Forms of botanicals = liquid tincture, capsules, tablets, teas Hawthorn: may interact with other cardiac stimulants, BUT research says it�s safe to use altogether (may even reduce need for other meds) Garlic: though antimicrobial effects are lost during cooking, its BP- & cholesterol-lowering actions appear to be unaffected

16. Botanicals cont�d Monascus purpureas (Red yeast rice): 1.2g, 2x/d Reduces total cholesterol (16%) and LDL (21%), elevates HDL (15%) Similar to statins Cynara scolymus (Artichoke) Reduces cholesterol Coleus forskohlii Helps reduce weight Reduces blood pressure Coleus forskohlii: also helps with healthy digestion and normal thyroid function Coleus forskohlii: also helps with healthy digestion and normal thyroid function

17. TCM Liver Fire Liver Yang Rising from Yin Deficiency Phlegm-Damp stagnation of the Middle Warmer Yin and Yang imbalance There are more possible diagnoses than these listed � must get individual TCM case taken for more specific diagnosis & treatment There are more possible diagnoses than these listed � must get individual TCM case taken for more specific diagnosis & treatment

18. Homeopathy Constitutional remedy: to return the body to its normal state of balance Then, the body can heal itself Colubrina (Nux vomica) Natrum muriaticum Kali phosphorium Phosphoricum acidum HOM rems are very specific � modalities (better/worse), mental/emotional, physical, etc. Different doses � 6, 30, 200CH, 1M Again, must get your individual case taken in order to find a specific remedyHOM rems are very specific � modalities (better/worse), mental/emotional, physical, etc. Different doses � 6, 30, 200CH, 1M Again, must get your individual case taken in order to find a specific remedy

19. Post-MI Health Diet & lifestyle, including exercise Niacin (Vitamin B3) Fish oil Plant sterols Fiber Vitamin D3 D3: Research is showing it to be beneficial for cardiovascular, immune, mood health We don�t get enough, especially in Canada 2000-4000IU/day A lot of what we covered can be applied to post-MI health � e.g. TCM & HOM for adjunct stress-relief Always check with the appropriate health care providerD3: Research is showing it to be beneficial for cardiovascular, immune, mood health We don�t get enough, especially in Canada 2000-4000IU/day A lot of what we covered can be applied to post-MI health � e.g. TCM & HOM for adjunct stress-relief Always check with the appropriate health care provider

20. Angioplasty Pre-procedure health Preparation for good recovery May need to stop certain supplements several days before Homeopathics are generally safe to take Post-procedure health Back on the heart-healing supplements Always check with your health care provider Before any kind of surgery or procedure � want to be as healthy as possible to help with recovery Can wait a few days after procedure to start up supplements againBefore any kind of surgery or procedure � want to be as healthy as possible to help with recovery Can wait a few days after procedure to start up supplements again

21. Diabetes Develop heart disease 10-12 years earlier than individuals without Diabetes (Canadian Diabetes Association, 2011) Typically have cardiovascular risk factors: obesity, hypertension, atherosclerosis Lab test: Hemoglobin A1c - Mortality rate due to heart disease is higher among diabetic population (3x higher for men and 5x higher for women).- Mortality rate due to heart disease is higher among diabetic population (3x higher for men and 5x higher for women).

22. Naturopathic Treatment for Diabetes Dietary Eliminate simple sugars, processed carbs, saturated fats High-fiber foods, legumes, vegetables, lean proteins Nutrition Chromium picolinate: 500mcg, 2x/d Alpha-lipoic acid: 300-600mg/d B vitamins In severe cases, need to seriously limit amount of fruit � at least until blood sugar levels have normalized Chromium: increases cell sensitivity to insulin ALA: antioxidant for diabetes � protective and reduces long-term effects of diabetes A lot of the heart-healthy supplements will also apply to Diabetes � e.g. EFAs, CoQ10, MgIn severe cases, need to seriously limit amount of fruit � at least until blood sugar levels have normalized Chromium: increases cell sensitivity to insulin ALA: antioxidant for diabetes � protective and reduces long-term effects of diabetes A lot of the heart-healthy supplements will also apply to Diabetes � e.g. EFAs, CoQ10, Mg

23. Naturopathic Treatment for Diabetes cont�d Botanicals Mamordica charantia (Bitter melon): 100-200mg, 3x/d Gymnema sylvestre: 400-600mcg/d Vaccinum myrtillus (Blueberry leaf): 80-160mg, 3x/d Ginkgo biloba: 40mg, 3x/d Panax ginseng: 100mg, 3x/d Allium sativum (Garlic) and Allium cepa (Onion) Cinnamomum spp. (Cinnamon) Morus alba (Mulberry leaf) Bitter melon and Gymnema: lowers fasting p-glucose and HbA1c Gymnema: may stimulate regeneration of pancreatic insulin-secreting cells AND Gymnema: suppresses the taste receptors for sugar � take in a liquid tincture form or �taste� the tablet before swallowing (e.g. of what happens when eat straight sugar, or cheesecake) Blueberry: diabetic retinopathy Ginkgo: improves CNS manifestations d/t peripheral vascular disease Panax: reduces fasting glucose levels, helps reduce body weightBitter melon and Gymnema: lowers fasting p-glucose and HbA1c Gymnema: may stimulate regeneration of pancreatic insulin-secreting cells AND Gymnema: suppresses the taste receptors for sugar � take in a liquid tincture form or �taste� the tablet before swallowing (e.g. of what happens when eat straight sugar, or cheesecake) Blueberry: diabetic retinopathy Ginkgo: improves CNS manifestations d/t peripheral vascular disease Panax: reduces fasting glucose levels, helps reduce body weight

24. Naturopathic Treatment for Diabetes cont�d Exercise Even a 10lb reduction in weight significantly improves metabolic control, and induces a remission of diabetes 60-70% max heart rate for 30min, 3-4x/week Avoid exercise-induced hypoglycemia Complex carb snacks after exercise

25. MDs, NDs, Cardiologists, Pharmacists� �How do I know WHO to see, and WHEN? A team-based approach to health & wellness Comprehensive view of patient health Knowledgeable Look for reputable resources � Internet, T.V. hosts? Where to find an ND: www.cand.org www.oand.ca www.ccnm.edu; www.rsnc.ca Frontline: MDs and NDs � but you can see us all when need be (when referred to specialists � cardiologists, etc.) Remember who is trained in what � that will guide what sort of questions to ask, and answers to expect Here, talk about the �Group� role of the ND �Shopping� for an ND � ask about specialties (though we are all trained in all conditions)Frontline: MDs and NDs � but you can see us all when need be (when referred to specialists � cardiologists, etc.) Remember who is trained in what � that will guide what sort of questions to ask, and answers to expect Here, talk about the �Group� role of the ND �Shopping� for an ND � ask about specialties (though we are all trained in all conditions)

26. A Happy Heart =A Happy Soul One sees clearly only with the heart. - Antoine De Saint-Exupery, The Little Prince Re-iterate how important it is to put health as first priorityRe-iterate how important it is to put health as first priority

27. Thank you! Question & Answer Contact Info: jeanny.kim.nd@gmail.com First Step Pain Relief & Wellness Inc. (King City) www.firststepking.ca, 905.833.5800 Labalaba Wellness Centre (Markham) www.labalaba.ca, 905.305.1411

28. References Brill, J.B. Heal Your Heart With Food: 8 Foods That Help Prevent a Second Heart Attack. Better Nutrition. 73:2 (pg. 38-42). 2011. El-Hashemy, S. Naturopathic Standards of Primary Care. Toronto, ON: CCNM Press Inc. 2007. Heart and Stroke Foundation. www.heartandstroke.com. 2011. Hoffman, D. Medical Herbalism: The Science and Practice of Herbal Medicine. Rochester, VT: Healing Arts Press. 2003. MD Consult. Heart Disease. Elsevier Inc. www.mdconsult.com. 2010. Prousky, J. Principles & Practices of Naturopathic Clinical Nutrition. Toronto, ON: CCNM Press Inc. 2008. Statistics Canada. www.statcan.gc.ca. 2011.