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 Nutritional Programs: Nutritional Program for Cardiovascular Disease Prevention 

Other fats contained in foods that have beneficial effects on cholesterol are the omega-3 fatty acids, EPA and DHA, found in coldwater fish such as salmon, mackerel, and sardines. This fairly recent important discovery, as well as other essential nutrients, especially magnesium and pyridoxine, are discussed in more detail below.

Smoking is another crucial factor and an instigator of not only our number one killer, cardiovascular disease, but also our number two life destroyer, cancer. Day-to-day smoking sensitizes our vascular system and heart. Nicotine damages the vascular lining, increases heart rate, and decreases oxygen delivery, with further carbon monoxide intoxication. Smoking also increases LDL cholesterol levels and possibly poses an additional risk of increased levels of beta-VLDL (currently under research). Cadmium, which is a blood pressure elevator, and other toxic minerals are also found in cigarette smoke. Nicotine also increases arterial constriction, which further limits oxygen and nutrient delivery to the cells and tissues. And chronic cigarette smoking clearly increases our chances of having atherosclerosis and hypertension with all of their complications. Thus, cigarette smoking by itself includes all three primary risk factors for CVD.

Hypertension is not only another major risk factor, but also occurs as a result of atherosclerosis itself. High blood pressure is defined as one over 140/90 mm Hg (millimeters of mercury, a pressure reading). Normal blood pressure (BP) should range from 100/70 to 120/80. The higher number represents the systolic BP, the BP while the heart pumps; while the lower number represents the diastolic BP during the rest between beats. The blood pressure itself is basically the pressure that the blood exerts on the arterial walls. An elevated diastolic pressure has a worse affect on the genesis of atherosclerosis than does a high systolic pressure. Even a diastolic pressure between 80 and 90 is associated with an increased risk. High blood pressure puts strain on the blood vessels, the heart, and the kidneys (especially important in controlling the BP).

Many doctors consider a BP in the range from 140/90 to 160/95 to be only mildly elevated, though it definitely increases risk. This is the area of "borderline" hypertension that we can do most about. Hypertension, like CVD in general, is affected by a number of risk factors. Weight, diet, family history, gender, race, stress, smoking, and lack of exercise are some of the main ones; there are many more. Suffice it to say here that it is a major disease, limiting and shortening the lives of nearly 50 million people in the United States and many more times that in the entire world. And it is a disease we can do something to prevent. The CVD prevention program applies to high blood pressure as well, and clearly, lowering elevated blood pressure by whatever means possible reduces the risk of heart disease, heart attacks, and strokes.

Obesity is another major risk factor in CVD, contributing to both atherosclerosis and hypertension. Being overweight raises blood pressure, increases blood fats, reduces HDL, and usually minimizes exercise, as well as increasing diabetes incidence. This all speeds up the atherosclerotic process and the occurrence of coronary artery disease. By decreasing obesity, we can decrease many of the above-mentioned CVD risk factors at one time.

Stress factors also contribute to CVD. The type A personality has an increased risk, more indirectly, through poor diet, caffeine use, and increased adrenaline output, which raises blood pressure. The hard-driven, ambitious type A person is constantly creating his or her life under the pressure of time, with the attitude that there is never enough time to do all there is to do, or that it should be done faster. Some authorities further attribute to this personality a low awareness of spiritual or philosophical values, or a low religious orientation, with a perspective basically geared toward work and running around the world. These type A people could benefit from stress reduction to help them in relaxation, and from exercise, especially with a sense of fun, to aid in letting go of the ever-riding tensions.

Lack of exercise is also a problem in CVD. The heart and circulation need regular, even vigorous exercise to keep them strong. Remember, the heart is a muscle that needs to work out. We will look more at exercise as a positive preventive to cardiovascular disease in the discussion below.

Drinking "soft" water is definitely a risk. It replaces the minerals calcium and magnesium in normally CVD-protective water with sodium mainly, which has a tendency to increase blood pressure and worsen atherosclerosis. Areas where people drink "soft" water have higher incidences of CVD and heart attacks. It is best to drink spring or well water for its beneficial minerals as well as to prevent chemical exposure. And water is definitely better for us than caffeine and alcohol. Caffeine increases heart rate and blood pressure and adds the risk of cardiac arrhythmia. Alcohol is a suppressant but also an irritant and is a minor risk factor itself in CVD.

Family history is not something we can do much about, but our knowledge of it can motivate us to take extra special care of ourselves and more diligently apply the program outlined here. Certain genetic traits may influence cholesterol metabolism and levels of production of cholesterol and other fats. It appears that some people actually make more cholesterol (or perhaps clear less or use less) than others. This increases their risk of vascular problems. Specific genetic (familial) problems of fat levels are described in medicine. These are termed "hyperlipidemias," the lipid disorders, and include five types. Types II and IV, the most common, cause high cholesterol and high triglyceride levels, respectively. Type IV is the most common and is thought to result more from familial eating patterns than from genetics. It also can proceed to problems in sugar metabolism. These disorders can be revealed by a blood test.

A history of hyperlipidemia disorder or a family history of coronary heart disease, high blood pressure, diabetes, or obesity put us at increased risk for developing some type of CVD. This means we need to enhance our prevention efforts, which may require many changes, depending on our current lifestyle. Cardiovascular disease really needs to be prevented in childhood. Atherosclerosis often starts in children, as can hypertension. Avoiding the typical high-fat, high-sugar, and high-salt foods and snacks and fried oils can make a big difference. Keeping the weight normal and getting plenty of exercise is the way to go. In some manner, television is a cardiovascular disease risk as it encourages a sedentary life and poor food choices are highly advertised. Dietary suggestions for children with CVD risk and obesity will be discussed later in this section.

It is important to remember that effects of risk factors are cumulative. Just being overweight is not a big problem if our cholesterol and diet are okay or if we do not smoke, but if we are an overweight, sedentary smoker with high blood pressure and a poor diet, we will not be living on that path very long.

I would like to discuss the process of atherosclerosis so that we have a clearer picture of this basic degenerative disease affecting the lives of millions. Atherosclerosis is the hardening of the inner arterial walls with lipids (mainly cholesterol), smooth muscle cells from the blood vessel walls themselves, and calcium. This process, which is stimulated and added to by platelets and white blood cells, forms the plaque, or atheromas. Atherosclerosis can begin early with these fatty streaks in the blood vessel walls. Many teenagers with high-fat diets have plaque in their arteries. The fries, shakes, burgers, and hot dogs that are so prevalent in our culture?s diet, along with the deficiencies that arise from high intake of sugar and refined foods (there often is not much room left for many nutrient-rich foods), predispose our youth to this early hardening of the arteries.

The basic process of atherosclerosis is thought to begin with minor microinjuries to the vascular linings. These tiny wounds stimulate the overgrowth of muscle cells and attract and attach the fat/cholesterol and platelet aggregation along with calcium precipitation to eventually form a small fibrous scar that begins to narrow the opening of the artery. (Cholesterol is a waxy fat/sterol that is attempting to heal the irritated or injured tissues; it?s really trying to help!) This arterial plaque reduces the blood flow and also decreases the strength and elasticity of the vessel wall. This can predispose us to increased blood pressure and aneurysms (ballooning of the artery), which can then lead to bleeding, strokes, or other, milder consequences.

These tiny injuries to the blood vessels involve many contributors, but the mechanism by which they occur is via free-radical pathology, not dissimilar to most inflammatory and cellular changes. We discussed the formation of these irritating molecules in the Anti-Aging and Anti-Stress programs, and the development of diseases such as arthritis and cancer.

Free-radical formation and the process of atherosclerosis involve many factors, most of which we have discussed. Saturated and hydrogenated fats in diet, elevated fats and cholesterol in the blood, hypertension, smoking, carbon monoxide, and deficiencies of nutrients such as vitamins C and E, chromium and selenium, are some of the main ones. Other contributing factors include infection, allergy, particularly from antigen-antibody complexes formed from food proteins, and abnormal platelet activity. Platelet function is important; it helps our blood to clot when this is needed. However, an increased adhesiveness can be a big problem, especially in those with already thicker, fatty blood or with irritated tissue linings (saturated fats thicken the blood). Platelets produce a substance called thromboxane A2, which increases platelet stickiness and stimulates clot formation. It also stimulates increased productivity of the smooth muscle cells in the blood vessel walls. Contributors to increased platelet adhesiveness are smoke, excess fats, especially LDL cholesterol, diabetes (high blood sugar), and many nutritional deficiencies, such as vitamins A, C, E, B3, and B6 and the minerals calcium, magnesium, zinc, and manganese. This overfunction of platelets is thought to increase the progress of certain diseases, mainly cardiovascular in nature, and especially atherosclerosis, but also arthritis, diabetes, and cancer.

Atherosclerosis can be a slow process. The disease may not cause problems for many years and then the symptoms can begin and progress rapidly, as a blood vessel usually must be more than half (more like 70?80 percent closed before it creates difficulty. A full clot?that is, a thrombosis?will lead to blocked circulation and often death of the tissues to which the blood vessel leads, unless there is existing collateral circulation to that area. This is how a heart attack develops, with atherosclerosis in the significant coronary arteries. In coronary artery disease, 70?80 percent closure will more likely lead to chest pain, the symptom of angina pectoris. If an atheroma or clot breaks off from its blood vessel attachment, it will move through the blood until it reaches a vessel that it is too large to pass through and then clog up that vessel, which can be disastrous. Clots in the blood vessels also can stimulate arterial spasm, which often worsens symptoms.

Atherosclerosis affects the vascular, mainly the arterial, system and commonly leads to problems in the heart, kidneys, brain, ears, and sexual organs. The heart, or coronary, blood vessels are the biggest area of concern. The effect on the kidney (renal) circulation can lead to hypertension. Carotid artery disease directly influences brain circulation, which can lead to memory problems, hearing loss, perhaps dizziness or vertigo, senility, and strokes. Transient ischemic attacks (TIAs) affect the state of consciousness with intermittent loss of blood flow. Poor circulation is the biggest cause of decreased sexual function and impotence in middle-aged or older men.

(Excerpted from Staying Healthy with Nutrition ISBN: 1587611791)
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 About The Author
Elson Haas MDElson M. Haas, MD is founder & Director of the Preventive Medical Center of Marin (since 1984), an Integrated Health Care Facility in San Rafael, CA and author of many books on Health and Nutrition, including ...more
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