Selected Portions Chap 11 Cardiovascular Disease and Caffeine

Selected Portions Chap 11: Cardiovascular Disease and Caffeine (starts pg 410) VALERIE SCHULZ, MMSC, RD, LD/N, CDE

Causes of premature death �On the following slide, strokes and heart disease are split into separate bars, but we usually discuss them together as cardiovascular disease (CVD) �So CVD is the number one cause of premature death, and cancer is number two. �Both of them, along with diabetes, are diet related (and most likely preventable).

Ten leading causes of premature death in US

Risk Factors �When studying nutrients, we can say, ‘deficiency of nutrient X causes disease Y’ �When studying chronic diseases, the causes are not as clear… �Discussions center on risk factors and research that illuminates current thinking �Risk factors show a correlation with a disease – that is, they occur together with the disease.

Risk Factors �In the chart on the following slide, focus on: HTN, atherosclerosis and stroke Notice they all share: � Diet high in saturated & trans fat � Excessive alcohol intake � (and non-diet factors of smoking, sedentary lifestyle and stress)

The Concept of Risk Factors

Atherosclerosis �At the root of most forms of cardiovascular disease (CVD) is atherosclerosis, the common form of hardening of the arteries. �We ALL have some accumulation of soft, fatty streaks along the inner walls of the arteries, especially at branch points. �These gradually enlarge and harden, damaging artery walls, making them become inelastic �Most people have well-developed plaques by the time they reach age 30.

Atherosclerosis

How Plaques Form �What causes plaques to form? A diet high in saturated fat is a major contributor Inflammation of the artery is also involved; it comes from different factors such as: � High LDL cholesterol � Hypertension � Toxins from cigarette smoking � High blood levels of homocysteine (needs folate, B 6 and B 12 to reduce) 2011 data, omega-3 helps lower homocysteine) Tao Huang, Jusheng Zheng, Ying Chen, Bin Yang, Mark L Wahlqvist, Duo Li. High consumption of omega-3 polyunsaturated fatty acids decrease plasma homocysteine: A meta -analysis of randomized, placebo-controlled trials. Nutrition. 2011 Apr 16. [Epub ahead of print]. DOI: 10. 1016/j. nut. 2010. 12. 011 � Low levels of omega-3 fats in the diet � Certain viral or bacterial infections

Plaques and Blood Pressure �Arteries hardened and narrowed by plaques cannot expand as blood flows through, which raises blood pressure. �This further damages the artery walls. �If the pressure causes the wall to weaken and balloon out, it is called an aneurysm. Can be fatal if occurs in the aorta.

Plaques and Blood Clots �Abnormal blood clotting also threatens life. Platelets are involved in blood clotting under normal circumstances. In atherosclerosis, platelets clot the blood in an injured, hardened artery. �A stationary clot = thrombus � If thrombus closes off a blood vessel = thrombosis � If the clot breaks loose = embolus � If the embolus becomes stuck = embolism which can lodge in a heart artery and cause a heart attack; if embolism is in brain = stroke (I will not be testing you on these terms, they are not strictly nutrition related; presented here because you will hear them in your normal work day. )

Omega-3 action �Opposing the clot-forming actions of platelets is one of the eicosanoids (EPA) �active product of an omega-3 fatty acid in fish oils. Recall from 2002 that if we do not eat the actual animal form (EPA/DHA), that we humans CAN make these longer chain animal forms (EPA is 20 carbons, DHA is 22) but ONLY if we have consumed the plant form of ALA (alpha linolenic acid, the 18 carbon form) Why is this? (you will know the answer if you remember why ALA is an essential fatty acid…)

Omega-3 fats Not because I want you to know the structures, but because I thought it might help you visualize that EPA is longer that ALA, and DHA is longer than EPA. One more time: ALA is the plant form, and both EPA and DHA are animal forms.

Modifiable related risk factors for CVD �Diet related High blood LDL Low blood HDL HTN (hypertension, or less commonly HBP) Diabetes Obesity “Atherogenic “diet �Non-diet Cigarette smoking Physical inactivity

High LDL and Low HDL Cholesterol

Controlling Dietary Lipids �Lowering intakes of saturated fat and trans fat lowers blood LDL cholesterol and this reduces heart disease. �Dietary Guidelines for Americans recommend: � No more than 10% of calories from saturated and trans fat combined � No more than 35% of calories from total fat � Less than 300 mg a day of cholesterol � (how many mg of cholesterol in one egg yolk? )

Effects of Fiber, Nutrients, and Phytochemicals �A heart-healthy diet provides abundant complex carbohydrates in the form of whole grains, vegetables, and fruit. Soluble fiber helps improve blood lipids. Foods rich in fiber also provide minerals (Mg++, K+, Ca++) to help control blood pressure, antioxidants to help protect against LDL oxidation, phytochemicals, and vitamins and minerals. Supplements of nutrients or phytochemicals have failed to provide benefits. So should we be eating whole foods, or trying to get phytochemicals from supplements?

Other Dietary Factors �Fortified foods: Sterol and stanol esters (also called phytosterols) that are added to certain kinds of margarines, orange juice, and other foods help lower blood cholesterol levels about 7 to 10 percent. �A meal of fish twice a week can help favor the right balance of fatty acids so that clot formation is less likely.

Hypertension (HTN) �HTN is silent, progressively worsens atherosclerosis, and makes heart attacks and strokes more likely. �All adults should know their blood pressure. Blood pressure is vital to life; when the pressure is right, the cells receive a constant supply of nutrients and oxygen and can release their wastes. Kidneys: blood pressure has to be high enough to force the blood’s fluid out of the capillaries into the kidney’s filtering networks, so waste can get into urine. High enough, but not too high.

How Does Nutrition Affect Hypertension? �To prevent hypertension: � Lower salt intake � Lose weight if needed � Use alcohol in moderation � Replace sources of saturated and trans fats with fruits, vegetables, fish, and low-fat dairy products � Reduce intakes of fat � Calcium, potassium, magnesium, and other nutrients seem to also play a role, as does physical activity (recall food sources of calcium, potassium, magnesium) � DASH diet (Dietary Approaches to Stop Hypertension)

Weight Control and Physical Activity �For people who have hypertension and are overweight, a weight loss of as little as 10 pounds can significantly lower blood pressure. �Moderate physical activity can lower almost everyone’s blood pressure, even people without hypertension.

How Does Nutrition Affect Hypertension? (pg E-3) 8 – 10 servings per DAY of fruits and or vegetables. This is about 3 servings or ~1. 5 – 2 cups per meal.

Caffeine � Caffeine (1, 3, 7 -trimethylxanthine) is widely consumed (don’t need to know chemical name) Beverages: coffee, tea, or cola soft drinks, energy drinks over-the-counter anorectic, stimulant, diuretic, and analgesic drugs � Mechanism of action: Adenosine, chemical created in brain important roles in multiple biochemical processes within the body. Adenosine is also an inhibitory neurotransmitter, believed to play a role in promoting sleep and suppressing arousal, with levels increasing with each hour we are awake. Adenosine causes the brain's blood vessels to dilate, most likely to let more oxygen into that organ during sleep To a nerve cell, caffeine looks like adenosine; caffeine binds to all the adenosine receptors. Caffeine doesn't slow down the cell's activity like adenosine would; the firing of the brain increases. The pituitary gland senses this activity, releases hormone that tell the adrenal glands to produce adrenaline (epinephrine) � Pharmacologically active dose is defined as 200 milligrams

Effects from caffeine � Your pupils dilate � The airway opens up � Your heart beats faster � Blood vessels on the surface constrict to slow blood flow from cuts and increase blood flow to muscles � Blood pressure rises � Blood flow to the stomach slows � The liver releases sugar into the bloodstream for extra energy. � Muscles tighten up � � Caffeine also causes the brain's blood vessels to constrict, because it blocks adenosine's ability to open them up. (This effect is why some headache medicines like Anacin contain caffeine -- constricting blood vessels in the brain can help stop a vascular headache. )

Adverse cardiovascular effects from caffeine �Palpitations �Extrasystoles (a premature cardiac contraction that is independent of the normal rhythm) �Supraventricular tachycardia (any rapid heart rhythm originating above the ventricular tissue) �Premature ventricular contractions (PVCs) �Bigeminy (a descriptor for a heart arrhythmia in which abnormal heart beats occur every other concurrent beat) (I am not expecting you to remember these rhythm names, they are listed so that you understand the issue. ) �So persons with rhythm issues should avoid caffeine

How much caffeine is in …? �Monster energy drinks: ~160 mg for a 16 oz can �Red Bull: ~80 mg (for the original 8 oz can size) �Coffee, brew: 8 oz (1 measuring cup) – 95 -100 mg �Blk tea: 8 oz -47 mg �Cola: 12 oz -30 -35 mg �Grn tea: 8 oz- 30 mg Be aware of these amounts �Here is a site to look up your favorite: http: //www. energyfiend. com/the-caffeine-database

Health Benefits (? ) of Coffee �http: //articles. mercola. com/sites/articles/archive/2 012/09/16/coffee-healthbenefits. aspx? e_cid=20120916_SNL_Art. New_1 �Watch all three of the videos embedded in this link above the chart. Scan the chart to notice how many diseases have data showing benefits of coffee.