Cardiology, Weight & Lipids Lecture Notes PDF (2023)

CARDIOLOGY, WEIGHT & LIPIDS AUTHOR: D R. M A R YA M YAVA R I , M D , P H. D. , N D NMT150 2023 LEARNING OBJECTIVES Considerations for providing nutritional guidance as it relates to this week’s case presentation: Diet Review on fiber, types, applications and its role in lipid management,...

CARDIOLOGY, WEIGHT & LIPIDS AUTHOR: D R. M A R YA M YAVA R I , M D , P H. D. , N D NMT150 2023 LEARNING OBJECTIVES Considerations for providing nutritional guidance as it relates to this week’s case presentation: Diet Review on fiber, types, applications and its role in lipid management, weight management and CVD prevention TREATMENT GOALS Address presenting symptoms and improve patient comfort Support full and speedy recovery to return to regular activities Patient education Monitor and Prevent sequelae FIBERS FIBER & FIBER-RELATED COMPOUNDS Gums Cellulose Mucilage Hemicellulose b-glucans Lignins & lignans Fructans Pectins CELLULOSE Cellulose is a polysaccharide molecule, consisting of carbon, hydrogen and oxygen atoms. (Unbranched polymer of long chains) helping plants to remain stiff and upright Insoluble in water Humans cannot digest cellulose, Increases fecal volume Sources: bran, legumes, root veg, seeds HEMICELLULOSE Mixture of linear & highly branched polymers containing various sugars (short chains) Digested better than cellulose Most are insoluble but some are soluble Sources: Bran, whole grains, nuts, legumes, some fruits and vegetables PECTIN Complex group of polysaccharides called galacturonoglycans Found between plant cell walls & the intracellular layers and acts like a “glue” holding cells together Completely digested through microbial action Forms a viscous gel when mixed with water, used in marmalades, jams, and jellies Sources: Apples, pears, strawberries, and citrus fruit LIGNINS Highly-branched polymer composed of phenol units with strong bonding cell walls, especially in wood and bark (rigidity) Structural components of plants found in stems, seeds, and bran layer Antioxidant & phytoestrogenic properties Sources: Flax and other seeds, wheat, root veg, legumes  CLINICAL NOTE: FLAX SEED Linum usitatissimum § Contains 35–45 % of fiber: two-third is insoluble (cellulose, hemicellulose and lignin) and one third is soluble fiber (mucilage of seed coat). § Highest natural source of lignins (contains phytoestrogen) § One of the richest plant sources of the ω-3 fatty acid alpha-linolenic acid (ALA, C18:3 ω-3) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4375225/#:~:text=It%20contains%2035%E2%80%9345%20%25%20of,the%20mucilage%20of %20seed%20coat. High ALA content  CLINICAL NOTE: FLAX SEED Clinical Application Chronic constipation May help inhibit growth & metastasis of breast & prostate cancers & melanoma Symptoms associated with menopause Therapeutic Dosage: 2-3 tablespoons of the ground seeds daily https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4375225/#:~:text=It%20contains%2035%E2%80%9345%20%25%20of,the%20mucilage%20of%20seed%20coat.%20High%20ALA%20content GUMS Group of substances secreted at site of plant injury e.g. tree exudate - gum arabic Composed of sugars & derivatives Sources: Oats, barley, legumes MUCILAGES & ALGAL POLYSACCHARIDES Thick glutinous substances, secreted by seed covers such as psyllium, flax, and certain seaweeds Storage of water and food, seed germination, and thickening membranes Water soluble Food additive to give foods a firmer texture: guar, carageenan, agar CLINICAL NOTE: PSYLLIUM High in soluble fiber & mucilage Derived from the husk of psyllium seeds Clinical Applications: Constipation or diarrhea Hypercholesterolemia Therapeutic Dosage: 1-2 tablespoons bid  b -GLUCANS Soluble fibers in the cell walls of bacteria, fungi, yeasts, and some plants. Might lower the CVD risk, BP and Cholesterol Immune stimulating (caution with immunosuppressant) or immune modulating Highly fermentable Sources: barley fiber, oats and whole grains, brewers yeast, reishi, maitake and shiitake mushrooms, seaweed, algae. https://pubmed.ncbi.nlm.nih.gov/27724985/ FRUCTANS A molecule consisting of a chain of fructose molecules joined together, and with a glucose molecule at the end. Are included in the FODMAP group of carbohydrates Fructan intolerance: gas, bloating, belching, constipation or diarrhea Function: prebiotics, immunomodulatory Sources: Chicory, onions, artichokes, asparagus, garlic, bananas PROPERTIES & PHYSIOLOGICAL EFFECTS OF FIBER Important properties of fiber include: Solubility in water Water-holding capacity & viscosity Adsorption or binding ability Fermentability  WATER SOLUBILITY Water Soluble Fiber Water Insoluble fiber Dissolves in hot water Mostly pectin & gums Does not dissolve in hot water Delays gastric emptying Cellulose, lignin, & most hemicelluloses Increases intestinal transit Decreases intestinal transit time time Decreases nutrient Increase fecal bulk absorption Higher hydration capacity Lower hydration capacity Higher adsorption capacity Lower adsorption capacity Higher fermentability Lower fermentability Fruits, oats, barley, legumes Vegetables & most grains CLINICAL INDICATIONS Soluble fibers Hyperglycemia Hyperlipidemia Diarrhea or constipation Insoluble fibers Constipation Maintaining bowel regularity in certain GI diseases Immunomodulation REQUIREMENTS Adequate Intakes Men 19-50: 38 g >50: 31 g Women 19-50: 25 g >50: 21 g DISEASES ASSOCIATED WITH A LOW-FIBER DIET GI diseases Diverticular diseases IBS Ulcerative colitis Hemorrhoids Colon cancer? Cardiovascular disease Obesity Type 2 diabetes TOXICITY Most common adverse effects: Increased gas & bloating Constipation Serious adverse effects: Intestinal or esophageal obstruction NUTRIENT INTERACTIONS Minerals Fiber may bind minerals & decrease their absorption especially iron, calcium, magnesium, zinc Vitamins Children given 10 g of supplemental fiber daily developed a vitamin A deficiency Long-term psyllium supplementation has been shown to decrease serum B12 levels over time in the elderly  DIETARY FIBER: AN OPPORTUNITY FOR A GLOBAL CONTROL OF HYPERLIPIDEMIA There are five primary mechanisms that are thought to contribute to the antihyperlipidemic advantages of dietary fibers (DFs). These mechanisms include the low-energy content of DFs, their bulking effect, their ability to increase viscosity, their capacity to bind, and their potential to ferment, all of which can help alleviate hyperlipidemia symptoms. From the molecular level, DFs could possibly affect the activities of HMG-CoA reductase, LDL receptors, CYP7A1, and MAPK signaling pathway as well as other lipid metabolism-related target genes. Nie Y, Luo F. Dietary fiber: An opportunity for a global control of hyperlipidemia. Oxidative Medicine and Cellular Longevity. 2021 Oct;2021.  FIBER AND WEIGHT MANAGEMENT Findings from 62 trials (n = 3877): Viscous fiber reduced mean body weight, BMI, and waist circumference, with no change in body fat. Greater reductions in body weight in overweight individuals and those with diabetes and metabolic syndrome. Dietary viscous fiber modestly yet significantly improved body weight and other parameters of adiposity independently of calorie restriction Jovanovski E, Mazhar N, Komishon A, Khayyat R, Li D, Blanco Mejia S, Khan T, L Jenkins A, Smircic-Duvnjak L, L Sievenpiper J, Vuksan V. Can dietary viscous fiber affect body weight independently of an energy-restrictive diet? A systematic review and meta-analysis of randomized controlled trials. The American journal of clinical nutrition. 2020 Feb 1;111(2):471-85.  FIBER AND CARDIOMETABOLIC SYNDROME 52 meta-analyses involving 47,197 subjects: Higher dietary fiber intake was significantly associated with reductions in parameters involving glycemic control, including fasting plasma glucose, fasting plasma insulin, homeostasis model assessment of insulin resistance (HOMA-IR) and glycosylated hemoglobin (HbA1c). Soliman GA. Dietary fiber, atherosclerosis, and cardiovascular disease. Nutrients. 2019 May 23;11(5):1155. Iversen KN. High fiber rye foods decrease body weight and body fat and affect metabolic risk markers. Chalmers Tekniska Hogskola (Sweden); 2021. Fu L, Zhang G, Qian S, Zhang Q, Tan M. Associations between dietary fiber intake and cardiovascular risk factors: An umbrella review of meta-analyses of randomized controlled trials. Frontiers in Nutrition. 2022 Sep 12;9:2153.  FIBER AND CARDIOMETABOLIC SYNDROME Higher dietary fiber intake was associated with significant reductions in the serum level of total cholesterol and low-density lipoprotein cholesterol but not triglycerides and high-density lipoprotein cholesterol. Soliman GA. Dietary fiber, atherosclerosis, and cardiovascular disease. Nutrients. 2019 May 23;11(5):1155. Iversen KN. High fiber rye foods decrease body weight and body fat and affect metabolic risk markers. Chalmers Tekniska Hogskola (Sweden); 2021. Fu L, Zhang G, Qian S, Zhang Q, Tan M. Associations between dietary fiber intake and cardiovascular risk factors: An umbrella review of meta-analyses of randomized controlled trials. Frontiers in Nutrition. 2022 Sep 12;9:2153.  FIBER AND CARDIOMETABOLIC SYNDROME Higher dietary fiber intake was significantly associated with improved tumor necrosis factor-alpha serum levels while no significant effect was observed for C-reactive protein. Blood pressure was significantly improved following higher dietary fiber intake. Soliman GA. Dietary fiber, atherosclerosis, and cardiovascular disease. Nutrients. 2019 May 23;11(5):1155. Iversen KN. High fiber rye foods decrease body weight and body fat and affect metabolic risk markers. Chalmers Tekniska Hogskola (Sweden); 2021. Fu L, Zhang G, Qian S, Zhang Q, Tan M. Associations between dietary fiber intake and cardiovascular risk factors: An umbrella review of meta-analyses of randomized controlled trials. Frontiers in Nutrition. 2022 Sep 12;9:2153. QUESTION Tina is a 58-year-old obese patient with a high cholesterol level and strong family history of CVD. Which one of the following options can help Tina improve her health status? Adding psyllium because it can reduce cholesterol levels. Taking beta-glucans as it may reduce heart disease risk. Taking fish oil to reduce triglyceride levels. All options are correct. REFERENCES CDC: https://www.cdc.gov/ Online source Center for Disease Control and Prevention Updates 2022 Prousky J. Textbook of Integrative Clinical Nutrition. CCNM Press Inc.; 2012. Katz D. Nutrition in Clinical Practice. 2nd Edition. Lippincott Williams & Wilkins; 2008. Katsilambros N. Clinical Nutrition in Practice. WileyBlackwell; 2010. Pizzorno J and Katzinger J. Clinical Pathophysiology. Mind Publishing; 2012. Marz RB. Medical Nutrition from Marz. 2nd edition. Quiet Lion Press; 1999. Murray MT. Encyclopedia of Nutritional Supplements. Prima Health; 1996. Gropper S, Smith J. Advanced Nutrition and Human Metabolism. 7th Ed. Cengage Learning; 2018. Gaby A. Nutritional Medicine.; Perlberg Publishing 2011. Hoffer A, Prousky J. Naturopathic Nutrition: A Guide to Nutrient-Rich Food & Nutritional Supplements for Optimal Health. CCNM Press; 2006. Gropper S, Smith J. Advanced Nutrition and Human Metabolism. 7th Ed. Cengage Learning; 2018. Gaby A. 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Pereira MA, O’Reilly E, Augustsson K, Fraser GE, Goldbourt U, Heitmann BL, Hallmans G, Knekt P, Liu S, Pietinen P, Spiegelman D. Dietary fiber and risk of coronary heart disease: a pooled analysis of cohort studies. Archives of internal medicine. 2004 Feb 23;164(4):370-6. Jesch ED, Carr TP. Food ingredients that inhibit cholesterol absorption. Preventive nutrition and food science. 2017 Jun;22(2):67. Rimm EB, Ascherio A, Giovannucci E, Spiegelman D, Stampfer MJ, Willett WC. Vegetable, fruit, and cereal fiber intake and risk of coronary heart disease among men. JAMA. 1996 Feb 14;275(6):447-51. Brown L, Rosner B, Willett WW, Sacks FM. Cholesterol-lowering effects of dietary fiber: a meta-analysis. The American journal of clinical nutrition. 1999 Jan 1;69(1):30-42. Institute of Medicine 2005. Dietary Reference Intakes for Energy, Carbohydrate, Fiber, Fat, Fatty Acids, Cholesterol, Protein, and Amino Acids. Washington, DC: The National Academies Press. https://doi.org/10.17226/10490. THANK YOU!