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Women’s Functional & Integrative Medicine Professional Training

Metabolism and Cardiovascular II: Diet and Lifestyle Support

MODULE 17

What Can We Do?

Disrupt /counterbalance the mechanisms leading to modifiable HLD and HTN - particularly insulin resistance and inflammation.

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Mediterranean Diet§ Shown to reduce BP between 8 and 14 mmHg systolic in hypertensives, improve lipid levels,

improve insulin sensitivity, reduce inflammation, and weight, increase dietary phytoestrogen intake, and improve microbiome to increase estrogen metabolism and absorption.

§ 45.4% of CMD deaths in the United States in 2012 were associated with 10 dietary factors deemed to have “probable or convincing evidence” for causality with heart disease, stroke, diabetes, or systolic blood pressure. The highest proportion was related to excess sodium intake (9.5% of CMD deaths); the other 9 factors were low intake of nuts and seeds (8.5%), high intake of processed meats (8.2%), low seafood omega-3 fats (7.8%), low vegetables (7.6%), low fruits (7.5%), high sugar-sweetened beverages (7.4%), low whole grains (5.9%), low polyunsaturated fats (2.3%), and high unprocessed red meats (0.4%).

§ In the Lyon Diet Heart Study, eating a Mediterranean diet compared to a low fat diet resulted in a 70% (12 % reduction vs. a 4%) reduction of heart events in those with documented heart disease. This is three times more effective than statin drugs in preventing a secondary cardiac event. JAMA. 2017;317(9):908-909.

JAMA. 2017 Mar 7;317(9):912-924. • Public Health Nutr. 2006;9(1A):118-123.

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Balancing Energy Needs

• Protein balance at each meal: keeps blood sugar steady, reduces reliance on ‘fast’ (but empty) energy sources. Diets with a higher amount of protein have been shown to reduce blood pressure and atherogenic cholesterol compared to diets high in carbohydrates.

• Good quality fats: Randomized trials have demonstrated that replacement of saturated fat with polyunsaturated vegetable oil reduced cardiovascular disease events by 18% to 41%.

• Adequate carbohydrate (including legumes) intake (needs vary per woman)

• Eliminate ‘fast carbs’ which transform into triglycerides that require increased LDLs for transport.

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The Portfolio DietA Mediterranean eating plan that has been found to reduce LDL cholesterol by about 30% (similar to 20 mg of lovastatin), when the foods were provided and by 13% when only the dietary recommendations were provided.

Daily amounts for 2000 cal/day:

JAMA. 2003;290(4):502-510. • Am J Clin Nutr. 2005;81(2):380- 387. • JAMA. 2011;306(8):831-839.

• 30 grams of almonds – about 23 almonds. Walnuts, cashews, Brazil nuts and macadamia nuts are also beneficial.

• 20 grams of viscous fiber from foods such as oats, barley, psyllium, and certain fruits and vegetables. (< 1 ounce)

• 50 grams of soy protein from foods such as tofu

• 2 grams (.064 ounces) of plant sterols from foods such as Benecol® or Take Control® spreads (one Tbsp. = 1gm). (Or beta-sitosterol for a more ‘natural’ option).

• Other food sources include: avocado, legumes, olive oil and green leafy vegetables.

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Exercise/Movement

Exercise:

• Improves insulin sensitivity

• Reduces stress

• Reduces weight

• Improves muscle mass

• Increases mitochondrial amount and function

• Reduces inflammation

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Yoga and Metabolism• Regular yoga may be an important nonpharmacological method of improving serum

lipid concentrations and reducing adipose tissue and metabolic syndrome.

• Sixteen healthy postmenopausal (Korean) women aged 54.50 ± 2.75 years with more than 36% body fat were randomly assigned to either a yoga exercise group (n = 8) or to a "no exercise" control group (n = 8).

• The variables of body composition, visceral fat, serum adiponectin, and metabolic syndrome factors were measured in all the participants before and after the 16 week study.

o Body weight, percentage of body fat, lean body mass, body mass index, waist circumference, and visceral fat area significantly decreased.

o HDL and adiponectin had significantly increased, but total cholesterol, triglyceride, LDL, BP, insulin, glucose, and HOMA-IR had significantly decreased.

o Serum adiponectin concentrations were significantly correlated with waist circumference, HDL, diastolic BP, and HOMA-IR in the post-yoga exercise group.

Menopause. 2012 Apr;19(4):486.

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HPA Axis Support

• The hypothalamus controls food intake, energy expenditure, and body weight homeostasis vis a vis central actions and via the HPA Axis. HPA Axis support benefits from being nurtured as we age. For example, ten years after menopause the circulating levels of DHEA are approximately 70% less and the DHEA sulfate is approximately 74% less compared to younger ages.

o Work on stress levels, sleep, address life satisfaction and loneliness.

o Adaptogens can play an important role here.

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Detoxification & Oxidative Stress Prevention/Repair

• Phase 1 and 2 Detox Support (remember, cumulative effects of environmental exposures as we enter our 40s on.)

• Oxidative stress à chronic inflammation à disease; address with diet, appropriate supplementation (GSH upregulation: Curcumin, NAC, Resveratrol, etc.).

• In a limited study from the University of Minnesota, low GSH was associated with significant increased mortality in individuals with low GSH and low HDL, while several large prospective studies have found that cardiac tissue health may partly depend on adequate GSH-p activity and low levels may increase risk of cardiovascular disease.

• Mitochondrial Support: exercise is an important factor in mitochondrial amounts and muscle mass; important for general health and CV function; also oxidative stress àmitochondrial damage. Also use Co-Q-10, d-ribose, L-carnitine, etc.

Nature. 2006;444(7117):337-342 • Nat Rev Drug Discov. 2006;5(6):493-506.Free Radic Biol Med. 2002;32(4):314-318 • PLoS One. 2012; 7(6): e38901.

N Engl J Med. 2003 Oct 23;349(17):1605-13. • Am J Cardiol. 2007 Mar 15;99(6):808-12.

Address thyroid function. Boom!

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Medicinal Foods

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Fiber, Yes, Again!

Water soluble or viscous fiber does three things well in promoting health. It:

1) Reduces the absorption of cholesterol

2) Reduces the speed of absorption of carbohydrates or sugars (lowers glycemic index),

3) And if taken before meals, promotes weight loss by absorbing water and giving the sense of being full (satiety).

Good sources of water-soluble fiber include pectin, oat bran, ground flaxseed, barley

Nutritional fiber supplements include flax seed and psyllium seed which can be included in the daily ‘diet.’ (1-2 TBS/day)

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Soy

• The daily dose of soy protein for lowering cholesterol is between 20-50 g.

• Approximately 10 g. of soy can be obtained from 1 to 2 cups of soy milk, 4 oz. of tofu, or 1 oz. of soy flour.

• Eating the whole food is more beneficial than taking a soy supplement unless it consists of whole soy protein.

• Soy supplements often only include isoflavones (such as genistein and daidzein) and do not include the fiber or the plant sterols, which limit their effectiveness in lowering cholesterol.

• Other sources, for example, garbanzo beans, also contain isoflavones.

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Plant Sterols and Stanols

• Sterols and stanols are types of cholesterol found in plants such as fruits, vegetables, nuts, seeds, cereals, legumes, vegetable oils (particularly soybean oil).

• They inhibit cholesterol absorption through the gut by approximately 50%.

• Eating a Mediterranean diet that is rich in plants provides a rich source of plant sterols and stanols and is the best way to lower cholesterol.

• If a change in diet is difficult, beta-sitosterol can be used as a supplement. The most effective dose is 700 mg to 1 g. 30 minutes before each meal.

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Legumes • Peas, beans, lentils, soy, and peanuts

• A 2011 study found that along with a low calorie diet, and in some cases independent of the diet, 4 servings of legumes per week resulted in a specific reduction in proinflammatory markers, such as CRP and C3 and a clinically significant improvement of some metabolic features (lipid profile and BP) in overweight/ obese subjects, which were in some cases independent from weight loss.

• A recent meta-analysis identified 26 RCTs (n = 1037) that satisfied the inclusion criteria. Diets emphasizing dietary pulse intake at a median dose of 130 g/d (about 1 serving daily) significantly lowered LDL cholesterol levels compared with the control diets (mean difference −0.17 mmol/L, 95% confidence interval −0.25 to −0.09 mmol/L). Treatment effects on apolipoprotein B and non-HDL cholesterol were not observed.

Eur J Nutr. 2011 Feb;50(1):61-9.CMAJ. 2014 May 13; 186(8): E252–E262.

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Tree Nuts

• Nuts are an excellent source of omega-3 polyunsaturated fat, fiber, plant sterols and flavonoids. These are all beneficial for cholesterol and heart health.

• Nuts are also high in calories so the dose should remain less than ¼ cup or about a handful a day (1 oz.) unless weight gain is needed (‘handful not canful’, avoid dry roasted w/salt or oil-roasted).

• Increasing nut consumption works best at lowering cholesterol if they are consumed in place of saturated fat in the diet.

• After combining the results from 4 major epidemiological trials on nutrition and the risk of heart disease, regular nut consumption reduced the risk by an average of 37%.

Am J Clin Nutr. 2009;89(5):1643S-1648S.

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Vitamin K2, for example...

• Vitamin K1 plays a large role in blood clotting, while K2 is responsible for calcium regulation. During arterial calcification, calcium adheres to the artery wall, increasing its stiffness. Arterial stiffness and flexibility are very reliable biomarkers of mortality from cardiovascular diseases.

• Vitamin K2, found in egg yolks and some fermented foods, is one of the few dietary supplements that may be able to reduce arterial calcification and stiffness.

• While most can get adequate K1 from eating green leafy vegetables, K2 supplementation may be necessary to reap some of K2 cardiovascular benefits.

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