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.