Cardiovascular Wellness

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1 Cardiovascular Wellness By: Dr. Jonathan Ritz, N.D. Dr. Jon Ritz, N.D. Naturopathic Approach, Page 1

Function of the Endothelia Endothelial cells are involved in many aspects of vascular biology, including: Atherosclerosis Barrier function - the endothelium acts as a selective barrier between the

2 Function of the Endothelia Endothelial cells are involved in many aspects of vascular biology, including: Atherosclerosis Barrier function - the endothelium acts as a selective barrier between the vessel lumen and surrounding tissue, controlling the passage of materials and the transit of white blood cells into and out of the bloodstream. Excessive or prolonged increases in permeability of the endothelial monolayer, as in cases of chronic inflammation, may lead to tissue oedema/swelling. Blood clotting (thrombosis & fibrinolysis) Inflammation Formation of new blood vessels (angiogenesis) Vasoconstriction and vasodilation, and hence the control of blood pressure In some organs, there are highly differentiated endothelial cells to perform specialized 'filtering' functions. Examples of such unique endothelial structures include the renal glomerulus and the blood-brain barrier. Pathology Endothelial dysfunction, or the loss of proper endothelial function, is a hallmark for vascular diseases, and is often regarded as a key early event in the development of atherosclerosis. Impaired endothelial function is often seen in patients with coronary artery disease, diabetes mellitus, hypertension, hypercholesterolemia, as well as in smokers. Endothelial dysfunction has also been shown to be predictive of future adverse cardiovascular events. One of the main mechanisms of endothelial dysfunction is the diminishing of nitric oxide, often due to high levels of asymmetric dimethylarginine, which interfere with the normal L-arginine-stimulated nitric oxide synthesis. The most prevailing mechanism of endothelial dysfunction is an increase in reactive oxygen species, which can impair nitric oxide production and activity via several mechanisms.[3] The signalling protein MAPK7is essential for maintaining normal endothelial cell function.[4] (from: Dr. Jon Ritz, N.D. Naturopathic Approach, Page 2

Simple Concepts Cholesterol is not the enemy. Oxidized fat

repair tool. a.k.a.: Free Radical Damage Macrophage Response Oxidized Cholesterol stimulates an immune response Monocytes convert to macrophages Macrophages gobble up rancid fats becoming Foam Cells

This is called transendothelial migration There is a conflict of strategies Reduce Cholesterol Block Inflammation Both 2004 WHO Data of 100+ countries shows all cause mortality (blue curve) is lowest

3 Simple Concepts Cholesterol is not the enemy. Oxidized fat is. It s the idea repair tool. a.k.a.: Free Radical Damage Macrophage Response Oxidized Cholesterol stimulates an immune response Monocytes convert to macrophages Macrophages gobble up rancid fats becoming Foam Cells Foam Cells change the permeability of the intima layer or inflammatory molecules create more permeability or both Foam Cells migrate across the membrane and seat between the intima and media layers This is called transendothelial migration There is a conflict of strategies Reduce Cholesterol Block Inflammation Both 2004 WHO Data of 100+ countries shows all cause mortality (blue curve) is lowest at total cholesterol of 224. Cardiovascular mortaility (red curve) is lowest right above 200. Common Statins: Lipitor, Mevocor, Zocor, Pravacor, Lescol, Crestor: $20bb in sales in 2004: and they re pushing for OTC status. Statins deplete CoQ10 Serum CoQ10 levels can decrease up to 40% in people taking statin drugs Serum CoQ10 levels are a better marker of cardiovascular fitness than cholesterol! A petition requesting that the labels of prescription statin drugs recommends mg of supplemental CoQ10 per day was presented to the FDA The FDA has taken no action on the petition at this time Not sure that Statins are the answer Cholesterol Transendothelial Migration Dr. Jon Ritz, N.D. Naturopathic Approach, Page 3

5 million Americans have Congestive Heart Failure (CHF) 500,000 new cases each year Hospitalizations have increased 402,000 in 1979 1,101,000 in 2004 Half of the patients diagnosed with CHF will be

4 5 million Americans have Congestive Heart Failure (CHF) 500,000 new cases each year Hospitalizations have increased 402,000 in ,101,000 in 2004 Half of the patients diagnosed with CHF will be dead within 5 years. At the same time, statin drug sales have increased to $20 billion market $14.3 billion 2009 Statin sales 211,000,000 prescriptions written in US in 2009 Lipitor: #1 Drug $7.5 billion in 2009 sales $6 billion in drug eluting stents Naturopathic Approach Labs: Lipid Fractions (Berkeley Heart Lab); ESR, CRP(HS); Homocysteine Diet: this is our primary pharmacy. Eat Food, mostly plants, just a little. Reduce incoming oxidation when possible metals, petrochemicals, trans-fats, processed foods Fat Soluble antioxidants tocopherols/tocotrienols; carotenoids; ALA, CoQ10/Ubiquinone, Curcumin Water Soluble Antioxidants VitC, EGCG (from green tea) Recycling agents such as (r-) Alpha Lipoic Acid Craetagus (Hawthorn) Solid Extract helps improve the circulation of the blood to the heart by dilating the blood vessels and relieving spasms of the arterial walls helps regulate the tone of the blood vessel walls helps in maintenance of healthy blood pressure antioxidant helps in restoring normal heart beat helps relieve angina pain increases the strength of heart contraction increases coronary blood flow Biochemical pathway leads to cholesterol AND CoQ10, a vitally important anti-oxidant molecule required for proper aerobic respiration in every cell! We don t want to block this with a statin drug, do we? Dr. Jon Ritz, N.D. Naturopathic Approach, Page 4

5 this tonic herb works slowly in the body, over periods of months and years, not hours and days. Detoxing of the liver to clear oxidized cholesterol Silybum Marinarum (Milk Thistle) Seed Cholesterol tends to oxidize in the bile, be reabsorbed back into circulation, and used in the arterial repair process. Milk Thistle enhances this, as does Schisandra (Schisandra), and Turmeric (Curcuma) Manage constipation, promote normal, regular bowel movements Constipation leads to increased cholesterol reabsorbtion as well as increased blood pressure and vascular back-pressure through the liver (a main source of blood-return to the heart) Hydrate with revitalized or fresh spring water Digestive support like Freshly ground Flax (Linneum) or Chia Probiotics Increase aerobic capacity This doesn t just mean going on more long runs and doing aerobics. It means giving your cells what they need to burn oxygen and fuel efficiently. Think of the carburetor on your car: you need it to mix air and fuel efficiently, and effectively, or you get smoke in the exhaust! Adaptogens: Schisandra, Siberian Ginseng (Eleuthero), Ashwaganda (Withania), Chinese (Panax) Ginseng, Salvia, Gotu Kola (Centella), Licorice (Glycyrrhiza). To name a few. Antioxidants: from fresh whole plant sources Hydration: as mentioned above, with revitalized or spring water. I recommend Kangen (Enagic) water. CHOLESTEROL GOALS MEN LDL 40+ HDL 125 or below TG WOMEN LDL 55+ HDL 125 or below TG Total Cholesterol is not necessarily the best measure. A direct LDL/lipid fraction is best for differentiating genetic issues. ADDITIONAL PARTICLES Dr. Jon Ritz, N.D. Naturopathic Approach, Page 5

6 Lpa (viscosity assesment) ApoB, ApoE RLP IDL HDLII Therapies: Numerous therapies exist to naturally normalize lipids. Namely: exercise, nutrition/diet, herbs BLOOD PRESSURE GOALS 120/80 HYDRATE, 1/4tsp unrefined sea salt, anti-hypertensive herbs (Hawthorne, Rawolfiia) Bottom Line: The greater the inflammation, the greater the activity of the immune system The greater the immune system activity, the potentially greater the severity of heart disease Immune system is not specific. It senses inflammation and releases cytokines and inflammatory chemical signals. Dr. Jon Ritz, N.D. Naturopathic Approach, Page 6

JUICE PLUS 9 Fruits and 10 Vegetables, 9 Berries 18 published studies show: bioavailable, reduces inflammation, protects CV, improves immune function My Cardiovascular favorites: Raises folate and

7 JUICE PLUS 9 Fruits and 10 Vegetables, 9 Berries 18 published studies show: bioavailable, reduces inflammation, protects CV, improves immune function My Cardiovascular favorites: Raises folate and lowers homocysteine considerably (premiere marker of inflammation) after only 6 weeks. Dramatically improves large artery compliance after a high fat meal (protecting from a heart attack or stroke) after only 4 weeks. 6 Weeks: JP+ raises folate almost 80% 6 Weeks:JP+ lowers homocysteine almost 13% 4 Weeks:JP+ improves large artery compliance over 65%, and over 90% when combined with Vineyard (berry) blend. JP+ is bioavailable. It doesn t look like the mega-doses we are used to. The thousands other phytonutrients make the difference. Dr. Jon Ritz, N.D. Naturopathic Approach, Page 7

Chapter 18. Diet and Health

Chapter 18. Diet and Health Chapter 18 Diet and Health Risk Factors and Chronic Diseases Interrelationships among Chronic Diseases Chronic Disease Heart Disease and Stroke Hypertension Cancer Diabetes The Formation of Plaques in