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Exercise Hyperthyroidism Malabsorption Insufficient dietary intake of taurine ( an amino acid found in brewers yeast, eggs, fish, meat, seafood A Bioflavonoid in wine, grapes, peanuts and mulberries

1 Exercise Hyperthyroidism Malabsorption Insufficient dietary intake of taurine ( an amino acid found in brewers yeast, eggs, fish, meat, seafood A Bioflavonoid in wine, grapes, peanuts and mulberries Anti-oxidant, anti- inflammatory, decreases platelet stickiness, prevents LDL cholesterol oxidation, stops the proliferation of cells that narrow your arteries, helps prevent Alzheimer s disease, opens arteries by increasing nitric oxide, helps with detoxification in the liver. Resveratrol is found in Grapes (only in skin) Wine Grape Juice Peanuts Blueberries Bilberries Cranberries Healthy Platelet Activity Study reported a dose-dependent inhibition of platelet aggregation (blood clottin by resveratrol. Clin Chim Acta. 235: , Rodent study demonstrated that resveratrol protects the heart and improves heart functions after diminished blood flow, affecting developed pressure and arterial flow. Journal of Cardiovascular Pharmacology. 35(2 ): , Shown to inhibit platelet aggregation both in vitro and in vivo International Journal of Molecular Medicine. 9: 77-9, Platelet aggregation is one of the first steps in the formation of a blood clot that can occlude a coronary or cerebral artery, resulting in myocardial infarction or stroke. Resveratrol has been found to inhibit platelet aggregation in vitro. Blood Cells Mol Dis. 2000; 26(2 ): Clin Chim Acta. 1995; 235(2 ): enos is an enzyme that catalyzes the formation of nitric oxide (NO) by vascular endothelial cells. NO is needed to maintain arterial relaxation (vasodilation), and impaired NO- dependent vasodilation is associated with increased risk of cardiovascular d isease. Resveratrol has been found to stimulate e NOS activity in cultured endothelial cells. Circulation. 2002; 106( 13) : ٧

Total Resveratrol Content of Selected Foods Food S erving Total resveratrol (m Peanuts (raw) 1 c ( 146 0. 01-0. 26 Peanuts (boiled) 1 c ( 180 0. 32-1. 28 Peanut butter 1 c ( 258 0. 04-0.

(said several centuries ago) Let Food be Your Medicine The Philosophy behind is: Focus on Prevention Nutraceutical can be defined as A food or part of food or nutrient, that provides health benefits,

Functional Foods Foods that provide benefits beyond basic nutrition n Phytonutrient s Prebiotics/probiotic s F atty fish/omega 3 s Soy protei n O ats (hear t- healthy ) Flaxsee d EXAMPLES OF

2 Total Resveratrol Content of Selected Foods Food S erving Total resveratrol (m Peanuts (raw) 1 c ( Peanuts (boiled) 1 c ( Peanut butter 1 c ( Red grapes 1 c ( Greek Physician Hippocrates, Known as father of Medicine. (said several centuries ago) Let Food be Your Medicine The Philosophy behind is: Focus on Prevention Nutraceutical can be defined as A food or part of food or nutrient, that provides health benefits, including the prevention and t reatment of a disease. Functional Foods Foods that provide benefits beyond basic nutrition n Phytonutrient s Prebiotics/probiotic s F atty fish/omega 3 s Soy protei n O ats (hear t- healthy ) Flaxsee d EXAMPLES OF FUNCTIONAL COMPONENTS Class / components n-3 FA(DHA, EPA) S ource Fish oils, berseem & maize fodder,mustard,linseed, rapeseed Potential benefit Reduce CVD & improve mental, visual function Recommendations for Diet (ATP III) Polyunsaturated fats 10% of total calories Monounsaturated fats 20% of total calories Total fats 25-35% of total calories* Carbohydrates 50-60% of total calories Fibre g/day Protein 15% of total calories * I ncreased from 30 % per da y 48 ٨

Phytochemicals could provide health benefits as: Substrate for biochemical reactions Cofactors of

ϕ Inhibitors of enzymatic reactions Absorbents that bind to & eliminate undesirable constituent in the

і 49 Enhance the absorption and / or stability of essential nutrients Selective growth factor for

levels (up to -30 to 35% ), H arris WS et al. J Cardiovasc Risk. 1997;4: 385-391.

3 Phytochemicals could provide health benefits as: Substrate for biochemical reactions Cofactors of enzymatic reactions.ϔ.ϕ Inhibitors of enzymatic reactions Absorbents that bind to & eliminate undesirable constituent in the intestine.ϖ.ѕ Scavengers of reactive or toxic chemicals.і 49 Enhance the absorption and / or stability of essential nutrients Selective growth factor for beneficial bacteria Fermentation substrate for beneficial bacteria Selective inhibitors of deleterious intestinal bacteria.ї.ϡ.ϯ.ϯ Polysaturated FA (n3) Soybeans, canola oils, fish oils, nuts, seeds Decreases VLDL and triglyceride levels (up to -30 to 35% ), H arris WS et al. J Cardiovasc Risk. 1997;4: Evidence to reduce CHD is weak but encouraging Am J Med 2002 Mar; 112(4 ): Cochrane Database Syst Rev. 2004(4) CD The Family of Dietary Fats Dietary Fat Saturated Fat Unsaturated Fat 3 Fats Monounsaturated Fat Polyunsaturated Fat 6 Fats 3 Fats Alpha-linolenic acid (ALA) Eicosapentaenoic acid (EPA) Docosahexaonoic acid (DHA) ٩

ALA Flaxseed oil Canola oil Soybean oil Wheat germ Walnuts EPA and DHA Mackerel Salmon Anchovy Herring Sardines Tuna Other coldwater fish

nuggets, ham, processed meats Fruit juice, energy drinks Microwaveable meals, pizza, energy bars 58 Makes it possible for substances in

constricts blood vessels in the stomach, intestines, uterus and bronchial tree Decreases blood pressure Decreases arrhythmias Enhance

4 ALA Flaxseed oil Canola oil Soybean oil Wheat germ Walnuts EPA and DHA Mackerel Salmon Anchovy Herring Sardines Tuna Other coldwater fish 55 In 2006 approximately 250 products with omega 3 s were introduced to the market Milk, yogurt, cheese Cereals, breads, cakes Chicken nuggets, ham, processed meats Fruit juice, energy drinks Microwaveable meals, pizza, energy bars 58 Makes it possible for substances in the blood to pass through the cell wall Decreases inflammation Lowers triglycerides, raises HDL Makes blood less sticky Dilates or constricts blood vessels in the stomach, intestines, uterus and bronchial tree Decreases blood pressure Decreases arrhythmias Enhance insulin action Needed for normal function of the brain, eyes, inner ear, adrenal glands and reproductive tract Important for mitochondrial function ١٠

Capsules Low Potency - 300 mg EPA+DHA/ g (Typical drug store capsules) High Potency

$agent to diet in the treatment of refractory very high TGs (> 500 mg/dl) 4 caps qd$ or 2 caps bid 1 gram soft-gelatin capsule % Change TG (mg/dl ) 0% - 20% - 40% - 60%

treatment Nutritional supplement therapy Chapter 1, page 8: SUPPLEMENT Red yeast

grains) 3 fatty acids ( fish oils, certain plants/nuts) Green tea c atechins and

5 Capsules Low Potency mg EPA+DHA/ g (Typical drug store capsules) High Potency mg EPA+DHA/ g (CardioTabs, Triomega, Rx) P harmaceutical 850 mg EPA+DHA/ g ( Omacor, Reliant Pharmaceuticals) 62 Omacor (omega-3- acid ethyl esters) Adjunct agent to diet in the treatment of refractory very high TGs (> 500 mg/dl) 4 caps qd or 2 caps bid 1 gram soft-gelatin capsule % Change TG (mg/dl ) 0% - 20% - 40% - 60% Dose of O3AEEs Placebo 2 g/d 4 g/d 8 g/d - 8.2% % % % Source: Data on TG mg/dl at baseline; 8- week file at Pronova/Reliant. treatment Nutritional supplement therapy Chapter 1, page 8: SUPPLEMENT Red yeast rice, Plantp hytosterols and phytostanols ( vegetable oil, nuts, legumes, whole grains) 3 fatty acids ( fish oils, certain plants/nuts) Green tea c atechins and black tea theaflavins G uggulipids, p olicosanol, cinnamon, garlic Reduce LDL EFFECT R educe T G, possibly raise HDL, possibly reduce CV event rates Possibly lower LDL No effect ١١

6 Dietary/Lifestyle Prevention/Intervention Disease of Heart Maintain Endothelial Function High Blood Pressure Homocystein e B6, B1 2, Folic Acid Phytochemicals Platelet Activity ω-3 PUFAs ω -6 PUFA Phytochemicals Decrease LDL I ncrease HDL Saturated Fat MUFA/ PUFA Cholesterol ω-3 PUFAs (fish) Increase Antioxidants MUFA/ ω -6 PUFA Vegetable s Aspirin ω-3 oils (fish) Exercise Fruits Stop smoking Fiber Stop smoking Stop smoking Garlic Decreases metabolism of acetaminophen & other drugs metabolized by the enzyme CYP 2E1 Garlic along with anticoagulants, NSAIDs, & prostacyclin may increase bleeding time Blood glucose level may further decreased with usage of antidiabetic drugs Trans Fats Body weight if overweight Fiber Type of Fat Trans S aturated Polyunsaturated ( omega-3) Mono-unsaturated Adapted from Béliveau, R., Fats and Cholesterol Main Sources P rocessed foods and commercial baked goods, shortening, deep fried foods, fast foods Whole milk, butter, cheese, red m eat, coconut and palm oils, lard C anola oil, flaxseed, c hia seeds, fatty fish (salmon, sardines, mackerel, tuna), walnuts O livesand olive oil, canola oil, cashews, almonds, peanuts, avocadoes and Gingras, LDL Levels HDL Levels D. Eating Well, Living Well: An Everyday Guide for Optimum Health. McClelland & Stewart Ltd., Toronto, You can live to be a hundred if you give up all the things that make you want to live to be a hundred ~ Woody Allen ١٢

3% 2% 3% 2%2% 1% 4% 5% 6% 22%

3% 2% 3% 2%2% 1% 4% 5% 6% 22% LEADING CAUSES OF DEATH Cardiovascular supplements Fariborz Farsad Pharm D/BCPS 3% 2% 3% 2%2% 1% Malignant neoplasms Diseases of heart 4% 5% 6% 21% 22% 29% Other causes of death Cerebrovascular diseases