Nutrition and nutraceuticals used to treat and prevent HYPERTENSION

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Nutrition and nutraceuticals used to treat and
prevent HYPERTENSION

• Presented by Dr Craige Golding
• MBChB (Cum Laude) FCP(SA)
• Specialist Physician
• ABAARM American academy board certified
  anti-aging physicianFAAFM Fellowship in
  anti-aging and functional medicine

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Dr Craige Golding MBChB (Cum Laude)
FCP(SA)Specialist PhysicianABAARM American
academy board certified anti-aging
physicianFAAFM Fellowship in anti-aging and
functional medicine

• Dr Golding is a Specialist Physician in private
  practice at the Rosebank Clinic, Johannesburg. He
  is a fellow of the SA College of Physicians. Dr
  Golding has a keen interest in preventative and
  integrative medicine and has Board Certification
  in Anti-aging Medicine from the American Board of
  Anti-aging Medicine. He has completed his
  Fellowship in Anti-aging medicine through the
  American Academy of Anti-aging Medicine. Prior to
  completing his Fellowship as a physisian, Dr
  Golding was awarded the Akromed prize for the
  best student in Pharmacology, Horrace Wells medal
  for the best Anaesthetics student the Maybaker
  prize for the best undergraduate student in
  Psychiatry.

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HYPERTENSION AND OXIDATIVE STRESS

• Oxidative stress with an imbalance between ROS
  and the antioxidant defense mechanisms may
  contribute to the etiology of hypertension, its
  initiation, maintenance, pathogenesis,
  pathophysiology, and cardiovascular complications

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HYPERTENSION AND OXIDATIVE STRESS

• Essential hypertension and salt sensitive HT
• Diabetes and hypertension
• Lead induced hypertension
• Uremic hypertension
• Cyclosporin induced hypertension
• Pre-eclampsia
• Nutritional induced (high fat and unrefined
  carbohydrates) hypertension

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HYPERTENSION AND OXIDATIVE STRESS ROS IN
HYPERTENSION

• ROS has direct action on endothelial cells with
  structural and functional damage
• Degradation of NO by ROS
• Effects of eicosanoid metabolism in endothelial
  cell
• Oxidative modification of LDL-c (oxLDL)
• Hyperglycemia, hyperinsulinaemia
• Increased fatty acid mobilization
• Increased catecholamines
• Angiotensin II increases O2- via NADPH oxidase

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IMPAIRED DEFENSE TO ROS

• Increased lipofuscin, increased lipid
  peroxidation
• Increased malondialdehyde, increased lipid
  peroxidation
• SOD decreased in erythrocytes and plasma
• Glutathione peroxidase decreased
• Decreased vit A
• Decreased Vit c

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IMPAIRED DEFENSE TO ROS CONTINUED

• Decreased vit e
• Decreased NO
• Increased O2- by PMN and increased H2O2
• Decreased PUFA in RBC membrane
• Decreased glutathione
• Decreased selenium

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Lifestyle changes and SBP metanalysis of clinical
diet trials

• Intervention reduction in SBP (mmhg)
• ---------------- ----------------------
  ---------
• Mg 0-1
• Ca 2
• K 4
• Decreasing ETOH 4
• Fish oil 6
• Lowering Na 6
• Lowering weight 8
• Exercise 10

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Lifestyle modifications and withdrawal of
antihypertensive drugs, J Hypertension
19886431-6

• Between 15 and 60 of hypertensive patients
  withdrawn from antihypertensive drugs remain
  normotensive for 9 to 36 months on strict
  lifestyle modifcations of nutrition, weight loss,
  exercise, alcohol and sodium restriction,etc

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PROTEIN, Current atherosclerosis reports
20002521-528 Jama 19962741598-1603

• Observational epidemiologic studies indicate a
  high protein intake reduces BP (non-animalgtvs
  animal protein) in numerous populations
• Daily intake recommended1-1.5g/kg/day depending
  on many factors
• Intermap study inverse relationship of BP with
  total protein intake and non-animal protein

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Protein (continued)

• Intersalt study 10020 subjects, worldwide had
  lower blood pressure (3/2.5mm hg) with dietary
  protein gt30 above mean vs those 30 below mean
  (81g vs 44g/day)
• Mechanisms ACEI, reduces SNS (Epeinephrine/NE,
  natriuresis, inhibits tyrosine kinase, reduces
  aldosterone, reduces superoxide ion

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SOY PROTEIN , Biochem Pharmacol 2000601-5

• Lowers BP and increases arterial compliance
• Lowers LDL-c (7), TC (6), LDL oxidation
• Consume 25g/day
• Contains isoflavones, amino acids, saponins,
  phytic acid, trypsin inhibitors, fiber,
  globulins, genistein/daidzen

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Whey protein, J dairy Sci 200083255-263

• Significant reduction in BP in animal and human
  studies
• 30-150mg/kg of ion exchange hydrolyzed whey
  protein isolate reduces MAP 10-18 for 24 hours
  (plt0.05)
• Must be hydrolyzed to be effective
• Act as ACEI
• 20 men given 200ml whey protein BID x 8 weeks
  decreased SBP significantly (plt0.05)

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Omega 3 PUFA circ 199288523-33
Hypertension 199832710-717

• Meta-analysis 31 studies fishoil and BP showed
  dose related effect in mild hypertension only
• lt 4g/d no change in BP
• 4-7g/d lowered BP by 1.6-2.9mm hg
• gt15g/day lowered BP by 5.8-8.1mm hg
• One percent increase in adipose tissue
  alpha-linoleic acid content reduced SBP, DBP and
  MAP by 5mm hg

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OMEGA 3 PUFA, current atherosclerosis reports
20002508-515 Hypertension 199934253-60

• Fish 3 x/week lowers BP (herring, haddock,
  atlantic salmon, trout)
• Fish or fishoil weight loss is additive to
  lower BP
• DHA better to lower BP
• Reduced ALA conversion to EPA and DHA (increased
  linoleic acid in diet omega 6, increased TSFA and
  TFA in the diet, alcohol)

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OMEGA 6 FATTY ACIDS

• LA, GLA, DGLA,AA, CLA
• GLA -gtDGLA -gt PGE1 and PGI2 cause vasodilation
• GLA blocks stress induced hypertension
• (increases PGE1, PGI2, decreases aldosterone,
  decreases adrenal AT1 receptor density /
  affinity)
• Neurohormonal regulation (SNS, RAAS)-central
  peripheral

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MUFA (olive oil), arch IM 2000160 837-842

• 23 hypertensive subjects studied for 6 months.
• Significant reduction in BP 8/6mm hg in extra
  virgin olive oil group, plt0.05 and gt0.01
• Reduces need for antihypertensive drugs in 48 vs
  4 in control group
• Reduces BP in type II DM
• No reduction of BP in normotensive, or
  non-diabetics

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MUFA (olive oil) continued

• Rich in oleic acid (w-9)
• Extra virgin5mg phenols/10 g oil
• 40g4 tablespoons full
• Increases HDL
• LDL-c rich oleate more resistant to ox LDL
• Polyphenols antiooxidants
• Replacing dietary olive oil with saturated fat
  significantly increases BP

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Garlic, Heart disease 200023-9phytochemistry
1992312389-2391

• Consisten dose dependant BP reduction
• Cultivated garlic allium sativum (not all
  garlic preparations are processed similarly and
  not comparable in antihypertensive effect)
• Wild uncultivated garlic allium urisinum

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Garlic mechanisms of action

• Garlic is a natural ace inhibitor and CCB
• ACEi due to flvanolic compounds
• Natural CCB / vasodilator (MG)
• Increases NO
• Decreases sensitivity to NE
• Increases adenosine
• Vasodilation
• Inhibits AA metabolites (TxA2)
• Reduces aortic stiffness (improves aortic
  compliance)
• Decreases ROS

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Seaweed, J Nutr biochem 200011430-4

• Wakame (undaria pinnatifida)
• Most popular edible seaweed in Japan
• Ace inhibition similar to captopril
• Lowers SBP 14-3 mmhg, DBP 5-2mm hg
• Ion exchange sodium absorbing/potassium releasing
  seaweed preparation
• Mechanisms ACEi, 771 minerals, fiber, alginate
  colloid

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Pyridoxine, vit b6 Mol cell Biochem
1998188137-148

• B6 increases cysteine synthesis from methionine
• Cysteine is precursor of glutathione
  (antioxidant)
• Cyteine nuralizes aldehydes and increases
  excretion, as does glutathione
• Decreases BP
• Blocks calcium influx, improves insulin
  sensitivity
• Reduces central sympathetic nervous system
  activity
• Decreases end organ responsiveness to
  glucocorticoids, mineralocorticoids

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LYCOPENE, paran study

• 30 subjects with HT, age 40-65
• SBP fell 9mm hg (plt0.01)
• DBP fell 7mm hg (plt0.01)
• Improvement in lipid profile

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Coenzyme q10, ubiquinone, Alternative Med Review
1996 (1),(3)171-174

• High correlation of coq10 deficiency and
  hypertension
• Coq10 reduces with age, disease, oxidative
  stress,statins, CHD, HT, Hyperlipidaemia, DM,
  aerobic exercise, atherosclerosis,
  hyperthyroidism
• Dose 100-225mg/dBP reduction occurs at 4-12
  weeks after initiation

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Coq10 continued

• Reduces total dose and frequency of
  administration of antihypertensive drugs
• Lowest serum pretreatment levels of coq10 have
  best reduction in BP
• Average BP reduction in all trials is 15/10mm hg
• Improves lipids, CHO metabolism, insulin
  sensitivity, decreases HR, decreases ROS,
  improves LV function, ischemia, angina, CHD, CHF,
  lowers NE levels

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VITAMIN C

• SBP is reduced proportionately more than DBP, but
  both are decreased
• Epidemiological, observational, cross sectional
  and controlled studies confirm improvement of
  both SBP, DBP and HR
• Lipid profile seems to be beneficial with small
  reductions in TC, TG, and LDL and oxLDL, and a
  slight increase in HDL in women
• Dose 200-1000mg/d
• Combinations with other antioxidants such as vit
  e, beta carotene or selenium provide synergistic
  anti-hypertensive effects

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N-Acetyl cysteine (NAC), J Am cell nutr
19865137-151

• SHR study normalizes BP by binding to excess
  aldehydes, reducing cytosolic ca and bp
• Thiol containing antioxidant, scavenges ROS
• Supports glutathione synthesis intracellularly
• Increases NO
• Calcium channel blocker activity
• Lowers homocysteine,lp(a) and platelet
  aggregation
• Improves ED in smokers (600mg)

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L-arginine, J clin invest 1991881559-67

• Reduces bp in humans with acute parenteral and
  chronic oral administration in normotensives,
  hypertensives, salt sensitive hypertensives, DM
  and hyperlipidemics
• In CHD it increases coronary artery bloodflow and
  decreases angina
• In peripheral arterial disease, blood flow is
  increased and claudication decreased

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Taurine

• Clinical use HT, hyperlipidaemia, arrhythmias,
  CHD, CHF
• Lowers BP, decreases proteinuria, decreases LVH,
  decreases SNS activity centrally
• Human study fujita (19 hypertensive subjects,
  6g taurine x 7 days, lowers BP 9/4.1mm hg(plt0.05)
• Mechanisms diuresis, decreases homocysteine,
  increases insulin sensitivity, aldosterone
• Dose 2-3g

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NATURAL COMPOUNDS AS ALTERNATIVES TO
DRUGSDIURETICS

• Hawthorne
• Vit b6
• Taurine
• Celery
• Gla
• Vit c
• Potassium, mg, ca
• Protein
• Fiber
• Coq10
• L-carnitine

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NATURAL ALTERNATIVES TO B BLOCKERS AND CCA

• Hawthorne
• Central alpha agonists (CCA) reduces SNS activity
• Taurine, potassium, zinc, na restriction,
  protein, fiber, vit c, vit b6, co q10, celery,
  GLA, garlic

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NATURAL DIRECT VASODILATORS

• Omega 3 FA
• MUFA (omega 9)
• K, Mg, Ca, soy, fiber
• Flavoids
• Vit c,e
• Coq10
• L-arginine
• Taurine
• Celery
• ALA

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NATURAL CALCIUM CHANNEL BLOCKERS

• Alphalipoic acid
• Vit c
• Vit b6
• Mg
• NAC
• Vit e
• Celery, hawthorne
• Omega 3, garlic
• calcium

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NATURAL ACE INHIBITORS

• Garlic
• Seaweed
• Tuna, sardines
• Pycnogenol
• Casein
• Hydrolysed whey protein
• Geletin
• Omega 3
• Egg yolks
• Zinc
• GLA

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NATURAL ANGIOTENSIN RECEPTOR BLOCKERS

• Potassium
• Fiber
• Garlic
• Vitamin c
• Vitamin b6
• Coq10
• Celery
• GLA

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FAVOURITES

• ACEI fishoil, whey protein, GLA
• DIURETICS taurine and b6
• BETA BLOCKERS hawthorne
• VASODILATORS omeg3,9, vit c also coq10
• CENTRAL ACTING vit b6
• CALCIUM CHANNEL BLOCKERS lipoic acid, mg, omega
  3

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Thank you
Dr Craige Golding Phone [phone]
011 463 0036 Fax [phone] e-mail
craigeg_at_mweb.co.za www.antiagingdoctor.co.za