COMPLEMENTARY AND ALTERNATIVE TREATMENT IN CV DISEASE.

1. COMPLEMENTARY AND ALTERNATIVE TREATMENT IN CV DISEASE.

2. DEFINITIONS • Complementary: Enhances treatments currently used • Alternative: Replaces treatment currently used.

3. OBJECTIVES • Explain what works, or might work • Explain what does not work and may harm • Have the courage to explain the difference

4. IMPORTANCE OF HERBAL MEDICATIONS • 1/3 of what we use began as herbal medications. • Digitalis from the foxglove plant • Aspirin from willow bark • Statins from red rice yeast.

5. DIET AS AN HERBAL THERAPY • Grains • Vegetables • Fruits • Oils, Olive, Canola, Peanut, Soy etc. • Milk and cheese • Meat and beans • Discretionary

6. SUPLEMENTS FOR HIGH CHOLESTEROL • Fish Oil • Red Rice Yeast • Artichoke Leaf • Niacin • Garlic • Fiber

7. FISH OIL • Omega 3 Fatty Acids • DHA and EPA • Fatty fish-Salmon, Mackerel, Lake trout • Lowers Triglycerides but not LDL or TC • Fish Burp • Lovaza • May elevate glucose.

8. RED YEAST RICE • Ferment rice with yeast-Monascus purpureus • Asian digestive tonic • Monacolin K=Lovastatin • Highly variable levels of Monacolin and potential muscle injury.

9. PLANT STEROLS • Sterols and Stanols=Phytochemicals • Lower LDL • 10% reduction in LDL • Very effective when added to a statin. • Block intestinal absorption

10. SOLUBLE FIBER • Psyllium=Metamucil • Oats, Barley,Apples, Broccoli, Beans • Binds with bile acids, removes bile acid and makes the liver convert more cholesterol into bile acids. • Use only if you cannot get enough from your diet.

11. GARLIC • Little evidence for significant cholesterol lowering • Small reduction in TC. • Increased risk of bleeding with coumadin.

12. NIACIN • Vitamin B6 • Lower triglycerides and raise HDL • May cause flushing • Hepatotoxic, especially OC varieties • Stick to Niaspan. • Take after aspirin and with a meal.

13. ARTICHOKE LEAF • Plant, Cynara scolymus contains antioxidants • Very Small effect on cholesterol • Not recommended.

14. BOTTOM LINE • Applies to all C and A treaatment • Even if its natural it still can have serious side effects-Kava Kave, Yohimbine. • Natural does not mean safe • Make sure it will not diminish or increase the effectiveness or risk of what you are on. • Tell your doctor what you are taking.

15. VITAMIN A • Liver, eggs, fortified foods, Carrots (foods that contain b carotene) • Essential for night vision, skin • Women 700 mcg • Men 900 mcg • Toxic in higher doses (3000 mcg)

16. VITAMIN C • Ascorbic acid-citrus fruits and juices • Promotes healty gums and teeth, Antioxidant • Women- 75 mg • Men-90 mg • Smokers need 35mg more • Tissue levels do not change above 250mg

17. VITAMIN D • Milk and fish and fortified foods. • Body produces in response to sunlight. • Bone density • Can be tested • Adults 19-50 200 IU • Adults 51-70 400 IU • Maine 1000 iu a day in winter

18. VITAMIN E • Nuts, vegetable oils, whole grains • Antioxidant • Ask MD if you are taking aspirin or coumadin

19. VITAMIN K Green vegetables Bacteria in the gut produce most of what we need Essential for blood clotting Women 90 mcg Men 120 mcg Suplements are not recommended.

20. THIAMIN (B1) • Whole and fortified grains, beans, wheat germ • Needed for the conversion of carbohydrates into energy • Women 1.1mg • Men 1.2 mg • Supplements are not necessary.

21. RIBOFLAVIN (B2) • Dairy products, red meat • Helps convert carbohydrates into energy • Red cell production • Women 1.1mg • Men 1.3 • Supplements are not necessary

22. NIACIN (B3) • Nuts, grains, red meat, fish • Aids in the release of energy • May be prescribed to reduce cholesterol and triglycerides. • Women 14 mg • Men-16mg • May cause flushing, gout, liver damage in high doses.

23. VITAMIN B6 • Pyridoxine • Grains, bananas, meat • Maintains reactions in proteins and amino acids. • Immune function. • Adults 1.3-1.7 mg • In large doses can cause neurological disorders

24. FOLIC ACID (B9) • Leafy greens, beans, citrus fruit • Important in the synthesis of DNA • Aids normal growth and development • Adults 400 mg • Do not exceed 1000 mg

25. VITAMIN B12 • Cobalamin • Liver, Beef, poultry • Essential to RBC development • Maintains the nervous system • Adults 2.4 mcg • No benefits from megadoses.

26. PANOTHENIC ACID • Whole grains, beans, milk • Vital for metabolism. • Adults 5 mg • Supplements are not necessary

27. BIOTIN • Peanuts, eggs, milk • Important in metabolism • Adults 30 mcg • Supplements not recommended • If you are concerned take a good multivitamin.

28. DRUGS TO AVOID • St John’s wort-hypertension • Ginseng-hypertension, reduces effect of warfarin, hypoglycemia • Ginko biloba-bleeding risk, seizures • Hawthorn berry-potentiates cardiac glycosides and nitrates • Saw palmeto-bleeding, hepatitis, floppy iris

29. DRUGS TO AVOID • Yohimbine-hypertension, kidney disease • Licorice-hypertension, dig toxicity • Black cohosh • BOTTOM LINE-check with you doctor before trying any herbal product.

30. PROBLEMS WITH HERBALS • Lack of scientific evidence and safety • Lack of regulatory oversight • Lack of quality control • Public misinformation • Lack of knowledge of the interactions by patients and providers. • Underreporting of adverse reactions

31. WHAT DO I TAKE? • I eat a healthy balanced diet • I am very active • I take my blood pressure pill • I take my multivitamin • I take fish oil • I take vitamin d and calcium • I take one aspirin.

32. I ALSO • Try to exercise regularly • Do Pilates • Do Yoga • Meditate • Bucket list-more exercise, tai-chi, more fly fishing and sailing. • More family time.

33. QUESTIONS • One at a time • No I do not support supplements with multiple components claiming to make one young, sexy, and physically vibrant • More than 5-8 bottles on the shelf is a waste of your money.