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Interventions for Preventative Heart Health

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[edit] Main Supplements

[edit] Vitamin D3

start with 5,000 IU Recommended Value is greater than 60 and less than 80ng/mL - pay attention to the units - not all labs use the same ones... Lower blood pressure, reduce inflammation (CRP), regulation of calcification, raise HDL? (requires blood testing to get it right - see above). Carlson brand softgels

While tweaking repeat test every 2 months.. Sources

  • NOW came out with the 5000 unit gelcaps
  • Vitamin D3 5,000 IU D3 in oil gelcap
  • 5000 IU D3 has other additions..
  • Carlson brand - also recommended - only 2,000IU

[edit] Niacin

500mg without tests - over that you need liver tests - up to 2G are used.

Reduce LDL Cholesterol, Triglycerides, Lipoprotein(a), Increase HDL Cholesterol - Reduce inflammation - Niacin reduction of Lp(a) up to 75%

No anti inflammation?

anti inflammation - kidney not significant?

  • DO NOT USE -- Flush-free niacin, or inositol hexaniacinate, does indeed contain niacin, but it is not released in the human body.

Niacin has been shown to reduce intima media thickness - http://www.ncbi.nlm.nih.gov/pubmed/17935553

  • Nausea - gastrointestinal disruption.
  • High dosages can cause Abnormal heart rhythms and heart palpitations have occurred in niacin studies.
  • Niacin plus Crestor may cause rhabdomyolosis.

There are a few papers out there that suggest that quercetin and luteolin can greatly reduce the niacin flush - much better than aspirin:

[edit] IR vs SR

This graph shows a smalldifference -

but this graphShows a bigger difference.

[edit] CoQ10

Reduce muscle aches of statins, reduce blood pressure, strengthen heart muscle. Reduces Lp(a)?(perhaps weakly)


  • Possible side-effects:
  • High dosages of CoQ10 can induce restlessness and insomnia. Long term side effects of high dose CoQ10 use are not clear at this time.
  • minor CoQ10 side effects have been reported, including insomnia, dizziness, Diarrhea, loss of appetite, nausea, stomach upset.
  • - [editors note] - I've tried taking CQ10 and lost my coffee cup 4 times in a row (OK I might lose it once regularly), but I've not heard of others with having this strange effect.. On paper I want to take it.

[edit] ASA (Asprin)

Lowers Lp(a) as much as 46%.

Can cause constipation, and dangerous rebound effects. http://www.internationaljournalofcardiology.com/article/S0167-5273(00)00399-5/abstract

[edit] Fish Oil

6 G/ day of DHA + EPA (works out to 9 capsules of one brand - 3 TID ) Reduce triglycerides, VLDL, and LDL particle size; reduce risk of death from heart attack; reduce fibrinogen May reduce Lp(a) up to 48% Appears to greatly reduce inflammation.

[edit] Krill oil (containing Astaxanthin)

Not to replace fish oil - but an add on for the Astaxanthin content

[edit] Wine

10oz/day seems optimal -- may be that reveritrol is absorbed sublingaly?

Alcohol Can reduce Lp(a) up to 57%.

  • Fontana P, Mooser V, Bovet P et al. Dose-dependent inverse relationship between alcohol consumption and serum Lp(a) levels in black African males. Arterioscler Thromb Vasc Biol 1999 Apr;19(4):1075–1082.
  • Marth E, Cazzolato G, Bittolo Bon G, Avogaro P, Kostner GM. Serum concentration of Lp(a) and other lipoprotein parameters in heavy alcohol consumers. Nutr Metab 1982;26:56–62.
  • Välimeli M, Laithinen K, Ylikahri C, Ehnholm C, Jauhiainen M, Bard JM, Fruchart JC, Taskinen MR. The effect of moderate alcohol intake on serum apolipoprotein A-I-containing lipoproteins and lipoprotein(a). Metabolism 1991;40:1168–1172.

[edit] Almonds

1/4 cup per day

[edit] Coco (cocoa powder)

[edit] Magnesium

Reduce blood pressure, contribute to correction of metabolic syndrome, reduce risk of abnormal heart rhythms 400-500 mg of Mg+ (as magnesium glycinate).

[edit] Zinc

This is weird - high dose lowers HDL raises LDL but stops angina?? Perhaps 15mg is prudent for now??

No use as a marker --

I suppose someone makes a mineral capsule - with selenium, copper, zinc in it? This might apply to folks that use RO water...

[edit] Selenium

  • Selenium is a component of the enzyme that helps convert T4 to T3 peripherally
  • But - excess intake of selenium may also depress T3 levels
  • key issue - making sure to get enough, but not too much.

From wikipedia:

Iodine accounts for 65% of the molecular weight of T4 and 59% of the T3. 15-20 mg of iodine is concentrated in thyroid tissue and hormones, but 70% of the body's iodine is distributed in other tissues, including mammary glands, eyes, gastric mucosa, the cervix, and salivary glands. In the cells of these tissues iodide enters direcly by sodium-iodide symporter (NIS). Its role in mammary tissue is related to fetal and neonatal development, but its role in the other tissues is unknown.[24] It has been shown to act as an antioxidant in these tissues.[24]

Iodine may have a relationship with selenium, and iodine supplementation in selenium-deficient populations may pose risks for thyroid function.

My other impression is to wonder what role the 70% of iodine that is NOT in the thyroid is doing? Antioxidant? I'm thinking 1mg


I'm thinking it may make sense to make sure we get enough selenium.

Selenium is required for the production of

deiodinase selenoenzymes. Clinical investigators in se- lenium- and iodine-deficient populations conclude the coexisting deficiencies cause increased TSH levels and contribute to goiter development.78 One French study found an inverse relationship between selenium status and thyroid volume.79 Co-existing deficiencies become problematic in areas where iodine supplementation is promoted on a population-wide basis. Selenium sup- plementation may be necessary to prevent potential thy- roid damage from iodide supplementation in selenium- deficient individuals.

Begs the question - how common is selenium deficiency?

Again from wikipedia

Dietary selenium comes from nuts, cereals, meat, fish, and eggs. Brazil nuts are the richest ordinary dietary source (though this is soil-dependent, since the Brazil nut does not require high levels of the element for its own needs). High levels are found in kidney, tuna, crab and lobster, in that order.

Sounds like sea food is important yet again..

And from

we get this little tidbit:

Some population surveys have suggested an association between lower antioxidant intake and a greater incidence of heart disease [47]. Evidence also suggests that oxidative stress from free radicals, which are natural by-products of oxygen metabolism, may promote heart disease [48-50]. For example, it is the oxidized form of low-density lipoproteins (LDL, often called "bad" cholesterol) that promotes plaque build-up in coronary arteries [49]. Selenium is one of a group of antioxidants that may help limit the oxidation of LDL cholesterol and thereby help to prevent coronary artery disease [48-50]. Currently there is insufficient evidence available to recommend selenium supplements for the prevention of coronary heart disease.


So now what is the best amount of selenium for fighting CAD?


It appears there is a role for selenium - what happens if you drink RO water? Baseline supplementation??

[edit] Vitamin K2

Regulation of calcification in bones and arteries 100 mcg BID in the form of MK-7


[edit] Soy Protein Powder

Reduce LDL Cholesterol

  • 25 grams per day

[edit] curcumin

75 mg/kg/d ???

[edit] DHEA

DHEA is precursive to several hormones. DHEA has also been shown to reduce the amount of atherosclerotic plaque in rabbits fed a high-cholesterol diet. Possible arrhythmia at higher levels. May help lower Lp(a) up to 18%. Does not increase Testosterone long term IMHO.

  • Barnhart KT, Freeman E, Grisso JA et al. The effect of dehydroepiandrosterone supplementation to symptomatic perimenopausal women on serum endocrine profiles, lipid parameters, and health-related quality of life. J Clin Endocrinol Metab. 1999 Nov;84(11):3896–3902.

[edit] Cinnamon

Lowers blood sugar 1-2 tsps per day.. Need to figure best dosage..


[edit] l-Arginine

Lower blood pressure, inhibit inflammation and cell adhesion, possibly reduce carotid plaque. Side effects - Arginine may increase blood sugar levels - nausea may increase stomach acid by stimulating the production of gastrin,

[edit] Vitamin C

Reduce blood pressure, amplify action of l-arginine 1G/day

[edit] Pycnogenol

100 - 200mg?

[edit] L-Carnitine

Reduce lipoprotein(a) 2G


These high doses of carnitine may lead to excess energy, restlessness, perhaps insomnia?

  • Increase in blood pressure
  • Faster heartbeats
  • May lower thyroid. "was also shown to modulate thyroid hormone action in peripheral tissues, the most frequent modulation observed being inhibition."

[edit] ALA (Alpha Lipoic Acid)

Not so interested in this one:


CONCLUSIONS: Studies examining the relation between ALA and prostate cancer have produced inconsistent findings. High ALA intakes or high blood and adipose tissue concentrations of ALA may be associated with a small increased risk of prostate cancer. However, these conclusions are qualified because of the heterogeneity across studies and the likelihood of publication bias.

One should probably recheck thyroid if taking ALA (Alpha Lipoic Acid)

[edit] l-Tryptophan

3G

Could tryptophan be the link in the depression/inflammation axis of CAD?

Lancet. 1997 Mar 29;349(9056):915-9.

Abstract

Background: It is now well established that major depression is accompanied by an immune-inflammatory system response and that indicators of the latter are inversely correlated with lower availability of plasma tryptophan in depression. Inflammation and infection can alter sleep architecture, whereas sleep disturbances can impair immune functions. Aims and Methods: The aims of the present study were to examine: (i) immune-inflammatory markers, i.e. serum interleukin-6 (IL-6), IL-8, IL-6 receptor (IL-6R), IL-1R antagonist (IL-1RA), gp130, and prostaglandin E2 (PGE2) production by mitogen-stimulated whole blood and the availability of plasma tryptophan in patients with primary sleep disorders, major depression and healthy volunteers; and (ii) the relationships between the availability of tryptophan and indicators of the immune-inflammatory response system. Results: Mitogen-stimulated release of PGE2, and serum IL-6 and IL-8, were significantly increased in both depressed and sleep disordered patients compared to normal controls. Serum IL-1RA was significantly higher in depressed patients than in normal controls. Patients with depression and sleep disorders had a significantly lower availability of tryptophan than normal controls. There were significant and inverse relationships between the availability of plasma tryptophan and serum IL-1RA, IL-6 and IL-8. Conclusions: The results suggest that (i) there is an activation of the immune-inflammatory response system in primary sleep disorders and depression; and (ii) the decreased availability of plasma tryptophan may be related to the inflammatory system response.

  • Possible side-effects
  • Signs of serotonin syndrome, such as:
Confusion
Seeing or hearing things that are not really there (hallucinations)
Fast heartbeat (tachycardia)
palpitations
rebound Anxiety attacks
Feeling faint
Fever
Sweating
Muscle spasms
Difficulty walking
Diarrhea

[edit] l-glutamine

??

[edit] Vitamin E as γ-Tocopherol

γ-Tocopherol has been mentioned by Bruce Ames Vitamin E in most pills is alpha

Gamma Tocopherol is available..


[edit] B12

At least 100 mcg, up to 1000 mcg sublingual preparation is an excellent alternative to lower homocysteine.


[edit] B6 Pyridoxal phosphate

A starting dose of 50 mg usually works, to lower homocysteine

[edit] Folic acid Vitamin B9

Do not take!!

"Recent study shows 2x increase of prostate cancer with folate doses of 1 mg (1000 mcg) and higher."

[edit] TMG (Trimethylglycine) (Betaine)

[http://www.bentham.org/cdm/samples/cdm6-1/0003F.pdf Effects of Betaine Intake on Plasma Homocysteine Concentrations and Consequences for Health] Dietary and supplementary betaine: acute effects on plasma betaine and homocysteine concentrations under standard and postmethionine load conditions in healthy male subjects


Side Effects of Trimethylglycine

Trimethylglycine if taken in high dosages, such as more than 750 mg, can cause nausea, increased body temperature, restlessness and insomnia and perhaps muscle tension headache.

[edit] Luteolin

Luteolin helps reduce niacin flush

[edit] Ginseng

nih page on ginseng

[edit] L-theanine

Found in green Tea - I'm trying 600mg

[edit] Creatine

[edit] Anthocyanins

Elderberry seems to be the best source.

The CETP inhibition in the above study means that small-LDL may be reduced by this regimen of 160 mg twice per day.

LDL -13.6%
HDL +13.7%

Impressive..

It seems chokeberry juice also "decreased the activities of enzymatic markers of cytochrome P450, CYP1A1 and 1A2. NDEA treatment also decreased the activity of CYP2E1 but enhanced the activity of CYP2B." Medscape article here. As pointed on a recent thread on curcumin, this could negatively affect those taking pharmaceuticals, so caveat emptor.

ORAC = Oxygen Radical Absorbance Capacity

Acai Berry raw 100gm: with ** mono-fats, saturated fat palmitic , omega-6, phytosterol**
ORAC 18,500
Anthocyanins 320
Chokeberry raw 100gm
ORAC 15,820
Anthocyanins 1480
Blueberry raw 100gm
ORAC 6520
Anthocyanins 558
Pecans 100gm
ORAC 17,524
Anthocyanins
Blackberry raw 100gm
ORAC 5245
Anthocyanins 317
Walnuts 100gm
ORAC 13,057
Anthocyanins
Almonds 100gm
ORAC 4282
Anthocyanins
Red Wine 100gm
ORAC 3873
Anthocyanins 24 - 35

[edit] Quercetin

Helps reduce niacin flush - may reduce other niacin side effects?

Improved bone density

[edit] resveratrol

Could be that only in the form of wine sublingal absorption of dissolved - most of the studies promoting resveratrol were not oral dosages.

  • MOLECULAR PROFILING OF GENE REGULATION REVEALS A POTENTIAL LINK BETWEEN NICOTINIC ACID AND SIRTUINS
Oscar Puig, Tian-Quan Cai, Rebecca Kaplan, John Menke, Pek Lum, Gerry Waters, John Thompson, Andy Taggart.
Merck Research Laboratories, Rahway, NJ and Rosetta Inpharmatics, Seattle, WA oscar_puig@merck.com
Oral doses of 1-3 grams of nicotinic acid (NA) per day lower serum triglycerides, raise high density lipoprotein cholesterol, and reduce mortality from coronary heart disease. The molecular mechanism(s) leading to these favorable effects are currently unknown. The leading hypothesis is that NA inhibits lipolysis in adipocytes by acting through the NA receptor GPR109A, thereby reducing serum non-esterified fatty acid levels which leads to an improved lipid profile. However, other mechanisms may account for some of the beneficial effects of NA. In this study we present evidence suggesting that NA has the capacity to activate sirtuins, a class of enzymes that have been shown to extend life span and protect against different forms of cellular stress. Molecular profiling in animals treated with NA revealed gene signatures that statistically overlap with signatures from other nuclear receptors like PPARg, aryl hydrocarbon receptor, mineralocorticoid receptor or steroid receptors. A common link among all these transcription factors is that they are regulated by the acetylation/ deacetylation status through SirT1/NCoR. We therefore investigated whether resveratrol, a known SirT1 activator, and NA would have similar gene signatures. Indeed, our preliminary results suggest that resveratrol and niacin could act in a common pathway by activating sirtuins. NA activation of sirtuins would lead to general cell stress resistance and could explain, at least in part, its beneficial effects in atherosclerosis protection.

[edit] Sesamin


[edit] Lycopene

10mg/day?

From wikipedia:

After ingestion, lycopene is incorporated into lipid micelles in the small intestine. These micelles are formed from dietary fats and bile acids, and help to solubilize the hydrophobic lycopene and allow it to permeate the intestinal mucosal cells by a passive transport mechanism. Little is known about the liver metabolism of lycopene, but like other carotenoids, lycopene is incorporated into chylomicrons and released into the lymphatic system. In blood plasma, lycopene is eventually distributed into the very low and low density lipoprotein fractions.[15] Lycopene is mainly distributed to fatty tissues and organs such as the adrenal glands, liver, and testes.

[edit] Boswellia

Boswellia is an Ayurvedic plant that contains anti-inflammatory triterpenoids called boswellic acids. Boswellic acid and its derivatives have anti-carcinogenic, anti-tumor, and blood lipid lowering activities. Dried extracts of the resin of the Boswellia serrata tree have been used since antiquity in India to treat inflammatory conditions.

[edit] Ground flaxseed

[edit] Fiber

Soluble fiber that are non fermenting: methylcellulose ? others?

Salba (Salvia hispanica) Chia seeds 1/4 cup - 56g:

Total Carbohydrate 24.6g
Dietary Fiber 22.2g
Netcarbs 3.4g
Total Omega-3 fatty acids9830mg
Total Omega-6 fatty acids3240mg

Oat bran 1/4 cup - 56g:

Total Carbohydrate 15.5g
Dietary Fiber 3.6g
netcarbs 11.9g
Total Omega-3 fatty acids 28.5mg
Total Omega-6 fatty acids 621mg

Flax seed 1/4 cup - 56g:

Total Carbohydrate 16.2g
Dietary Fiber 15.2g
net carbs 1g
Total Omega-3 fatty acids 12,776mg
Total Omega-6 fatty acids 3,310mg

[edit] kaempferol

??? You can find kaempferol in many berries, including strawberry and cranberry, along with tea (Mayo Clinic is doing research on cranberry and CAD) Dosage?

[edit] Iodine

Because of salt restriction - 500-1000 mcg from kelp tablets?

Might act directly in arteries and other tissues. Antioxidant?

As inhibitors of lipid peroxidation, via 50 -monodeion dinase activity, T4 and reverse T3 were found to be more effective in this antioxidant activity than vitamin E, glutathione and ascorbic acid (17).


Lots of thyroid receptors in the heart..

Everything you want to know about iodine is here

[edit] Pyridoxamine and pyridoxal-5’-phosphate

It appears to be an anti glycation agent - prevents AGE(Advanced Glycation Endproducts)

[edit] Polyenylphosphatidylcholine

PhosChol PPC (Polyenylphosphatidylcholine ) may also lower lipids? and raise HDL Protects Liver - helps lipids a bit and reduces oxidized lipids. 2700 mg per day

But from :

However, a review of 24 such studies in 1989 suggested that, when controlled for the effect of linolenic acid (lecithin is especially rich in this fatty acid), the cholesterol-reducing effect was eliminated (Knuiman JT et al 1989).




What else? -- lots of paper showing it helps with alcohol liver problems.

Reduces oxidation of LDL???

Oxidation of LDL in baboons is increased by alcohol and attenuated by polyenylphosphatidylcholine

If I understand this right - we want to reduce oxidized LDL - , this seems to be liver protective and might be a good idea for anyone taking niacin? And if it improves lipis and oxidized LDL at the same time

This is an issue.. They found that that betaine supplementation, while effective at lowering homocysteine, also increased LDL cholesterol and triacylglycerol.

This discounts the increased triacylglycerol effect: In our study phosphatidylcholine supplementation slightly increased triacylglycerol concentrations in healthy humans. Previous studies of phosphatidylcholine and blood lipids showed no clear effect. Thus the effect of phosphatidylcholine supplementation on blood lipids remains inconclusive, but is probably not large.

[edit] phosphatidylserine

phosphatidylserine (PS) might be effective at helping to reduce the effects of cortisol

[edit] Thiazolidinediones

Reduce small-LDL and in some measures of inflammation

[edit] Things to Avoid

[edit] Avoid Carbohydrates

  • Kiortsis DN, Tzotzas T, Giral P et al. Changes in lipoprotein(a) levels and hormonal correlations during a weight reduction program. Nutr Metab Cardiovasc Dis 2001 Jun(3):153157.
  • Müller H, Lindman AS, Blomfeldt et al. A diet rich in coconut oil reduces diurnal postprandial variations in circulating tissue plasminogen activator antigen and fasting lipoprotein(a) compared with a diet rich in unsaturated fat in women. J Nutr 2003;133:3422–3427.

[edit] Avoid trans fats!

Yes, the AHA diet may be very bad if you have Lp(a)

  • Shin MJ, Blanche PJ, Rawlings RS, Fernstrom HS, Krauss RM. Increased plasma concentrations of lipoprotein(a) during a low-fat, high-carbohydrate diet are associated with increased plasma concentrations of apolipoprotein C-III bound to apolipoprotein B-containing lipoproteins. Am J Clin Nutr 2007 Jun;85(6):1527–1532.

[edit] Avoid excess Calcium

Despite the health friendly advise - taking supplemental calcium may not be good for us - I would use VitD3 to prevent osteoporosis instead - or first.

[edit] Copper

Pro-oxidant appears to make things worse

The next one seems to suggest the opposite

[edit] Avoid excess Iron

Pro-oxidant May well make things worse

[edit] N-acetylcysteine

Lp(a) reductions over 70% -- one small study. Don't use.. May be a large risk here - From:

NAC-treated mice developed pulmonary arterial hypertension (PAH) that mimicked the effects of chronic hypoxia.


[edit] Pharmaceuticals

[edit] Thyroid hormone

Lp(a) reductions of up to 50%

  • Dullaart RP, van Doormaal JJ, Hoogenberg K, Sluiter WJ. Triiodothyronine rapidly lowers plasma lipoprotein (a) in hypothyroid subjects. Neth J Med 1995 Apr;46(4):179–184.
  • Martinez-Triguero ML, Hernandez-Mijares A, Nguyen TT et al. Effect of thyroid hormone replacement on lipoprotein(a), lipids, and apolipoproteins in subjects with hypothyroidism. Mayo Clin Proc 1998 Sep;73(9):837–841.
  • Milionis HJ, Efstathiadou Z, Tselepis AD et al. Lipoprotein (a) levels and apolipoprotein (a) isoform size in patients with subclinical hypothyroidism: effect of treatment with levothyroxine. Thyroid 2003 Apr;13(4):365–369.

[edit] Testosterone

May reduce Lp(a) up to 59%

Might reduce HDL-C

  • SEX HORMONES (TESTOSTERONE, ESTRADIOL, SEX HORMONE-BINDING GLOBULIN) AND HDL-CHOLESTEROL LEVELS IN PUBERTAL SPANISH CHILDREN
...BMI was the only predictor of HDL-C in multiple linear regression analysis in both sexes. In conclusion, the important decrease in HDL-C levels observed during puberty in boys in our study seemed to be related to both the testosterone-induced reduction in apo A-I and the reduction in HDL cholesterol content related to BMI.

[edit] Pletal (cilostazol)

Raise HDL (often up to 30% or more) It also reduces small LDL quite effectively.

[edit] Zetia

Blocks the intestines ability to absorb bile cholesterol. If you eventually take Zetia, you can then safely add phytosterols (or stanols = Benecol) to further increase your LDL lowering?

[edit] Statin Drugs

statins reduce inflammation by increasing Vitamin D? Expensive way to increase D - but it appears it reduces inflammation in more ways.

It is well known that statins produce muscle damage via CQ10 depletion - but there are other side effects as well:

The above in spite of the fact it reduces depression for some people.

-- hmm from wikipedia IL-12 also has anti-angiogenic activity, which means it can block the formation of new blood vessels - so blocking would allow new blood vessels - could be good for a heart patient - bad for a cancer patient.

And promoting IL-4 induces B-cell class switching to IgE, and up-regulates MHC class II production. promoting of Interleukin-5 has long been associated with several allergic diseases including allergic rhinitis and asthma Promoting IL-10 is capable of inhibiting synthesis of pro-inflammatory cytokines like IFN-γ, IL-2, IL-3, TNFα and GM-CSF (this is a good effect.)

Statins - lowering of tryptophan availability and decreasing of serotonine levels This can be very bad for someone like me -

Methods that lower serum tryptophan are used to induce depression and has the side effect of increasing some inflammation markers. My hunch is that statins may improve mood in some people and cause problems in others. Statins appear to be a 'dirty drugs' - that is drugs that have many multiple actions - and not particularly selective in activity.

My review of the many effects leads me to think that there could be more surprises about statins down the road. My hunch is individual response may be quite varied due to the multiple actions - in other words YMMV!.


Statin drugs Seem to have little or no effect on:

Low HDL
Small LDL
High triglycerides
Postprandial abnormalities
Lipoprotein(a)

[edit] Supplement Sources


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