FREQUENTLY ASKED QUESTONS

Frequently Asked Questions
<Back to FAQs index page>

Presented in part with the support of Novartis Pharmaceuticals and Boston Scientific / Guidant

Vitamins and the Heart

Introduction

Since ancient times, certain herbs, minerals, and other nutrients have been cloaked in mystery, revered religiously, or, in some cases, anointed with near supernatural status because of the tremendous healing and health-giving potential.

Even physicians, who have often been reluctant to hop on the nutritional therapy bandwagon, now acknowledging in ever growing numbers that, yes, there really maybe something to this nutrition business.

OBJECTIVES

This is an overview of nutritional concepts as it relates to cardiovascular disease with emphasis in some newer theories that should be considered for most patients using scientific data (medical publications and research) to support the discussion.

Demystify some of the controversial advanced nutritional therapies.

Increase awareness of nutrition in the prevention of disease.

Nutrition

Definitions

Nutrition is the process by which a living organism assimilates food and uses it for growth and for replacement of tissues.

Essential nutrients include dietary fats, proteins, carbohydrates, minerals, vitamins.

Vitamin: Organic compound required in the diet of animals, including humans, for normal growth and maintenance of life. Vitamins provide the only source of certain coenzymes necessary for metabolism, the biochemical processes that support life.

Since vitamins differ widely in chemical structure, there is no common grouping. they were originally classified as fat soluble or water soluble, but as more were discovered, they were also classified alphabetically.

The fat soluble vitamins are stored in body fat and may, therefore, accumulate in quantities that can be toxic. Vitamins A, D, E, and K, are fat soluble. Most water soluble vitamins are rapidly excreted in the urine and those rarely cause toxicity, even when ingested in excessive amounts: the B Complex Vitamins and Vitamin C are water soluble.

Minerals: A dietary mineral is an organic element found in the earth's crust that is an essential nutrient; vital to normal body function. Minerals are those elements for which the body requirements is at least 100 mg per day. Trace minerals are those that are needed in smaller amounts. Major dietary minerals include calcium and phosphorous (for bone and teeth), magnesium (for cellular metabolism), sodium (for fluid balance and muscle function), potassium (for fluid-electrolyte and acid-based balance), chloride (for water balance digestion), sulfur (for protein structure and enzyme activity).

Antioxidants: Substances that fight the destructive effects of free radicals (unstable oxygen molecules) in the body.These neutralize the oxidation of certain molecules like "bad" LDL cholesterol.(Oxidized LDL cholesterol is the primary factor in buildup of plaque in the blood vessels).

A Healthy Diet and an Unhealthy Diet

A well-balanced diet--including sufficient amounts of fruit and vegetable as well as eggs, meat, fish, or fowl (that is, a good source of protein)--usually satisfies the minimum vitamin requirement of human beings.

An inadequate vitamin intake can lead to deficiency diseases, but there is growing evidence that vitamins have roles in health beyond the prevention of deficiency diseases. Vitamin C and E act as antioxidants and may prevent LDL cholesterol from clogging arteries, and Vitamin K inhibits loss of bone calcium in post-menopausal women.

So, what's the problem? Heart disease is the nation’s #1 killer. It claims Ѕ million lives every year.

Although we all know that high cholesterol is a well-established risk, most heart attack victims have cholesterol levels that would qualify as normal.

Moreover, America's heart attack rate has fallen by half in recent decades, while average cholesterol levels have declined only slightly.

What Else Should We Worry About?

Smoking, obesity, high blood pressure, and diabetes all pose well-known hazards, yet roughly one-fourth of all heart attacks occur in people with no known risk factors.

An avalanche of new studies suggest that there are other nutritional factors linked to heart disease.

Homocysteine, is this the Culprit?

There are some reports claiming that no one has ever demonstrated that circulating cholesterol is what first injures the arterial wall.

According to pathologist Dr. Kilmer McCully (VA Medical Center, Providence, Rhode Island) the initial injury is not cholesterol but homocysteine.

Research suggests that homocysteine, an amino acid derived from dietary protein, plays a critical role in destroying our arteries.

Like cholesterol, homocysteine can be useful but elevated levels may pose a health problem.

Our bodies derive it from methionine, an amino acid that abounds in animal protein, and use it to build and maintain tissues.

During normal metabolism, any excess homocysteine is quickly swept away.

With the help of Vitamin B6, B12, and Folic Acid, the liver converts it back to methionine or breaks it down for excretion.

When the metabolism of homocysteine is disrupted, the consequences can be fatal.

McCully discovered the negative relationship back in 1968.

Children born with homocystinuria lack proper liver enzymes to process homocysteine, which then accumulates in the blood. If untreated, these children die of premature heart attacks and strokes.

THE BIG QUESTION! If severe homocysteine overload can destroy a child's arteries, could milder but more chronic elevation--the kind that anyone might develop from a diet low in vitamin rich plant foods--foster cardiovascular disease in adults?

THERE IS HOPE. Almost anyone can control homocysteine levels by getting enough B Vitamins.

Many studies have consistently linked low levels of Folic Acid to high levels of homocysteine.

A recent European study found that people who reported taking B Vitamin supplements had just half the heart disease rate of those who didn't.

GOOD AND BAD LEVELS: As we all know, the desirable total cholesterol should be less than 200. Obviously there are other factors besides total cholesterol like HDL and LDL cholesterol that fit into the equation. What is important to remember is that normal homocysteine levels in men should be less than 12 and in women, less than 10. The danger zone occurs with levels greater than 14.

COST ANALYSIS: Until the evidence is definitive, your annual physical is unlikely to include lab tests for homocysteine or B Vitamins.

Consider, that there is nothing to lose, and much to gain, by paying attention to the vitamins in your diet.

Therefore, the recommended Folic Acid supplementation dose should be between 0.4 and 1.0 mg per day. For Vitamin B6, 50 mg per day and for Vitamin B12, 0.5 mg per day.

Niacin (Vitamin B3, Nicotinic Acid)

Do not confuse nicotinic acid with nicotine.

Important in promoting a healthy nervous system, skin, gastrointestinal functioning.

Megadoses (1500 to 3000 mg. per day) may help reduce total cholesterol and increase the good "HDL cholesterol".

COST ANALYSIS: May be toxic to the liver (with as little as 500 mg per day), sustained release may be more toxic to liver than regular dose. May cause flushing, rash, nausea, liver damage. As far as recommendations, consult with physician and do not treat yourself.

Vitamin C (Ascorbic Acid)

Enhances the action of Vitamin E in the body. Vit C is an antioxidant.

May reduce the risk of heart disease, certain cancers and cataracts.

May increase immunity to infectious diseases.

Possible lowering of total cholesterol and raises HDL cholesterol.

May lower high blood pressure.

May promote the healing of wounds and tissue repair.

Vitamin C is shown to help reduce risk of cardiovascular disease but results are less consistent than with Vitamin E (Annals of Internal Medicine, December 1995).

Men and women who consume two to three times the RDA for Vitamin C (the RDA is 60 mg per day) have lower heart disease risk.

HDL cholesterol increased with greater intake of Vitamin C (American Journal of Clinical Nutrition, July, 1994).

Although Vitamin C does not prevent calls, 1000 to 3000 mg. per day reduced the duration from 6 to 4.5 days (Health Confidentials, August, 1996).

COST ANALYSIS: Relatively abundant in citrus fruits. To get just 500 mg per day, you would need to consume a total of one cup of strawberries, one papaya, and one eight ounce glass of orange juice or cranberry juice. The recommended dose of Vitamin C 500 to 1000 mg per day.

Vitamin E (Alpha Tocopherol)

Anticoagulant properties (blood thinner).

Powerful antioxidant (neutralize free radicals which initiate the injury to blood vessels).

Full benefit obtained through high doses only.

Recommended dose of Vitamin E is 400 to 1200 units per day.

Vitamin A (Retinol)

Vitamin A helps maintain health of your eyesight, skin, teeth, bones, and mucous membranes.

Vitamin A relatives include carotenoids such as beta-carotene.

Too much Vitamin A can be toxic (blurred vision, hair loss, nausea, liver damage, spleen enlargement).

Beta-Carotene

Beta-carotene is an antioxidant that may reduce lung cancer in some patients but somewhat controversial:

Two studies, one involving Finnish smokers (New England Journal of Medicine, April, 1994) and a second reported at a press conference by the National Cancer Institute (January, 1996), suggests that an increased risk of death from lung cancer and heart disease for smokers on mega-doses of beta-carotene.

In 1996, the Physicians Health Study (22,000 doctors) show that it is neither harmful nor beneficial with beta-carotene at doses of 50 mg. every other day.

COST ANALYSIS: Vitamin A sources: dairy products, liver, to mention a few. Beta-carotene sources: oranges, green vegetables and fruits. Cautionary fact: be wary of the food additive OLESTRA (fat substitute), since it may reduce absorption of carotenoids. Recommended doses for Vitamin A - essentially none, unless prescribed by your doctor. For beta-carotene, it would be 25,000 units per day if you must.

Thiamine (Vitamin B1)

Helps maintain the nervous system, metabolism of carbohydrates, overall growth and skin health.

Beriberi--severe Vitamin B1 deficiency which can produce weakness, muscle pain, upset stomach, neuritis (degeneration of nerves), and congestive heart failure (due to cardiomyopathy).

Usually not advisable to supplement unless patient is a heavy drinker.

Coenzyme Q10 (Ubiquinone)

Potential as an antioxidant, but it's primary job is to help convert the food we eat into energy.

Possible cardiac benefits: improvement of congestive heart failure, reduction of irregular heart beats, improvement of hypertension, protection against free radical damage to heart tissue.

Large, well-designed, double blind scientific sites are hard to find.

What About Alcohol?

The Nurses Health Study (New England Journal of Medicine, May, 1995), light drinking in women (one to three mixed drinks per week) had a 17% lower death rate than nondrinkers.

WARNING! Those same nurses that consumed two or more drinks per day had a 19% higher risk of death.

The Danish Epidemiology Science Centre, in Copenhagen, showed that low to moderate intake of wine was associated with lower mortality from cardiovascular and cerebrovascular diseases (British Medical Journal, May, 1995). In contrast, a similar intake of hard liquor was associated with an increased risk of these diseases. Beer drinking did not have an effect on mortality.

"The French Paradox"--researchers noted a relative immunity of the French to coronary disease attributed to their high alcohol consumption, despite the fact that saturated fat intakes, serum cholesterol, blood pressure, and smoking habits were not ideal (Journal of Research and Social Health, August, 1995).

Small study on healthy Israeli males compared to health effects of red and white wine. The red wine, but not the white wine, resulted in 11% increase in triglycerides and 26% increase in HDL cholesterol. There was no change in LDL or total cholesterol.

Conclusion: red wine may contribute to the reduced risk for cardiovascular disease observed in red wine drinkers (Annals Nutritional Metabolism, 1994).

COST ANALYSIS: Possible benefits of alcohol include antioxidant activity, anticoagulant activity, increase the good HDL cholesterol. Recommendations if you must, would be the following: For men, no more than 10 glasses of wine per week. For women, no more than 6 glasses of wine per week.

Garlic

Evidence not convincing but various studies have revealed some health benefits, which include: Lowering of LDL cholesterol and raising HDL cholesterol, may act as an antioxidant, may be a potent inhibitor of blood platelet aggregation (aspirin-like), lowering blood pressure, may strengthen the immune system, may ward you off against vampires (just kidding!).

Grapefruit

Constituents of grapefruit juice are known to interfere with cytochrome P450 isozymes lowering the biotransformation of drugs in the liver and increasing their bioavailability.

The predominant mechanism for enhanced bioavailability is presumably the inhibition of oxidative drug metabolism in the small intestine.

Examples: some calcium antagonists, tranquilizers (like Versed), antihistamines, cyclosporine, coumadin, 17 beta-estradiol.

Miscellaneous with Potential Benefits

Lecithin - lowers LDL, raises HDL, helps process fats in liver

Pantothenic acid - lowers TGs, total chol., & LDL (600-900 mg/day)

Magnesium - anti-arrhythmic, anti-HTN, improves K+ balance, constricted blood vessels relax, ? reduces angina, raises HDL, lowers LDL

Arginine - increases nitric oxide levels, reduces chol. & LDL, ? anti-CHF

Carnitine - fat burner, 50% reduction in post-MI complications, good for cardiomyopathies, energy booster (500-1500 mg/day).

Essential fatty acids (Omega-3, Omega-6, Omega-9) - at least 2 gm/day, reduces platelet aggregation, reduces plaque, ? 50% reduction fatal MI, lowers TGs, reduces angina by 41% (high doses of 10 gm/day), 50% reduction sudden cardiac death (high doses), anti-HTN.

Herbs

There is the mistaken belief that herbs are healthier and safer than over-the-counter drugs.

No safety monitoring, not regulated by FDA. Most packages bear no indications for use. In general, the literature is used to sell the product, not to provide sound information based on scientific evidence. Various types of toxins are found in herbs.

EXAMPLES:

Ginkgo Biloba - world’s oldest living species of tree. Increases blood flow to various organs (brain, liver, eyes, circulatory system), anti-arrhythmic, ? for claudication, ? for impotence.

Ginseng - root, stabilizes diabetes, increases physical endurance & stamina, for colds.

Echinacea - infection fighter

Hawthorn - “wise man’s digitalis”, may potentiate some cardiac meds.

St. John’s wort - antidepressant, fights some viruses.

Conclusion

Vitamins are no substitute for healthy eating and exercise.

There is a lot of “garbage” and bad information out there: consider only the reputable research data and act accordingly.

| Home | About Us | Prestigious Accreditations | Physicians | Services | FAQs | Links | Directions | Disclaimer | Contact Us |

Cardiology Associates of Fort Lauderdale, P.A.
4725 N. Federal Hwy, Suite #401
The Jim Moran Heart and Vascular Center
Fort Lauderdale, FL 33308
Phone: (954) 772-2136
Fax: (954) 772-7156

©2010, Cardiology Associates of Fort Lauderdale, P.A. All rights reserved.
Web site by Ticsay Internet.