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COMPLEMENTARY AND ALTERNATIVE TREATMENT IN CV DISEASE. DEFINITIONS • Complementary: Enhances treatments currently used • Alternative: Replaces treatment currently used. OBJECTIVES • Explain what works, or might work • Explain what does not work and may harm • Have the courage to explain the difference 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. DIET AS AN HERBAL THERAPY • • • • • • • Grains Vegetables Fruits Oils, Olive, Canola, Peanut, Soy etc. Milk and cheese Meat and beans Discretionary SUPLEMENTS FOR HIGH CHOLESTEROL • • • • • • Fish Oil Red Rice Yeast Artichoke Leaf Niacin Garlic Fiber 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. RED YEAST RICE • Ferment rice with yeast-Monascus purpureus • Asian digestive tonic • Monacolin K=Lovastatin • Highly variable levels of Monacolin and potential muscle injury. PLANT STEROLS • • • • • Sterols and Stanols=Phytochemicals Lower LDL 10% reduction in LDL Very effective when added to a statin. Block intestinal absorption 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. GARLIC • Little evidence for significant cholesterol lowering • Small reduction in TC. • Increased risk of bleeding with coumadin. 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. ARTICHOKE LEAF • Plant, Cynara scolymus contains antioxidants • Very Small effect on cholesterol • Not recommended. 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. 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) 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 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 VITAMIN E • Nuts, vegetable oils, whole grains • Antioxidant • Ask MD if you are taking aspirin or coumadin 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. 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. RIBOFLAVIN (B2) • • • • • • Dairy products, red meat Helps convert carbohydrates into energy Red cell production Women 1.1mg Men 1.3 Supplements are not necessary 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. 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 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 VITAMIN B12 • • • • • • Cobalamin Liver, Beef, poultry Essential to RBC development Maintains the nervous system Adults 2.4 mcg No benefits from megadoses. PANOTHENIC ACID • • • • Whole grains, beans, milk Vital for metabolism. Adults 5 mg Supplements are not necessary BIOTIN • • • • Peanuts, eggs, milk Important in metabolism Adults 30 mcg Supplements not recommended • If you are concerned take a good multivitamin. 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 DRUGS TO AVOID • • • • Yohimbine-hypertension, kidney disease Licorice-hypertension, dig toxicity Black cohosh BOTTOM LINE-check with you doctor before trying any herbal product. 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 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. 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. 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.