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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 - PowerPoint PPT Presentation
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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.