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18 Cards in this Set
- Front
- Back
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CHOLESTEROL
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-Most common lifestyle cause of low HDL are low fat diets (due to decreased APO-A-I production) and smoking. -Most common reversible cause of high triglycerides are obesity, smoking, very high carb/low fat diet, excess alcohol intake. -HS CRP less than 1 has low CVD risk and greater than 3 is higher risk. -Non-HDL cholesterol is total cholesterol minus HDL. Evidence is increasing that non-HDL cholesterol may be superior to LDL in predicting cardiovascular events. -HDL less than 50 increases risk in women and less than 40 increases risk in men. -Saturated fats raise both LDL and HDL whereas mono and polyunsaturated fats decrease LDL and raise HDL. -Trans fats raise LDL and lower HDL. -Corn oil is good. -Diet low in total and saturaged fat can decrease LDL AND HDL. -Co-Q 10 reduces myopathy from statins. Some clinicians will give 420mg of milk thistle if liver function tests are elevated -Red yeast rice is essentially lovastatin. 1200mg BID. Most common side effects headaches and GI discomfort. Check lipids and liver tests 8 weeks after starting. -Niacin increases HDL. -DASH diet lowers HDL and LDL without effect on triglycerides. -Mediterranean diet increases HDL without effect on LDL and reduces systolic blood pressure -Tai Chi reduces blood pressure, triglycerides, total cholesterol and crp. -Meditation and yoga improves cholesterol. -Alcohol raises triglycerides. -Tea decreases LDL oxidative susceptibility. - |
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METABOLIC SYNDROME
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-Vinegar will delay gastric empyting and carb absortption. Add vinegar to olive oil with bread and it will decrease glycemic index of bread. -Nuts and olive oil decrease hyperglycemia, hyperlipidemia and inflammation. -Cinnamon reduces glucose and works in synergy with meds. -Alpha lipoic acid prevents diabetic neuropathy and increases HDL. -Vitamin D has an inverse relationship with metabolic syndrome -Soy(Diadzen)/s-equal. No recommended at this time. -DASH diet lowers HDL and LDL without effect on triglycerides. -Mediterranean diet increases HDL without effect on LDL and reduces systolic blood pressure -Tai Chi reduces blood pressure, triglycerides, total cholesterol and crp. -Meditation and yoga improves cholesterol. -Acupuncture lowers total cholesterol, LDL and triglycerides but can not be recommended for cholesterol control. -Phytosterol decreases cholesterol absorption. -Guggul is an aryuvedic medicine and studies show it is not effective for cholesterol. -Fiber. 5-10 grams per day recommended. Oat bran, psyllium, guar. -Artichoke leafe decreases cholesterol. -Green tea lowers CVD risk. -Garlic improves blood pressure and lowers cholesterol -Nuts improve lipids -Alcohol. 1-2 drinks per day lowers heart attack, stroke, CHF, PVD, and increases HDL. -Fish oil. Adds omega-3 to statin. Decreases triglycerides. Lovaza (3-acid ethyl ester) is approved for people with elevated triglycerides (take 500mg per day) |
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HYPERTENSION
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-DASH diet -Aerobic exercise -Grapefruit juice inhibits CYP3A4 and interacts with calcium channel blockers increasing serum levels of the drug. Grapefruit juice may also impair uptake of beta blockers thus reducing serum concentration. Grapefruit juice does not interfere with thiazides or ace inhibitors. -Magnesium 230-460mg per day enhances BP lowering effects of anti-hypertensives in stage 1 hypertension. -Low levels of vitamin D can increase risk of hypertension and diabetes. -Omega 3 fatty acids show a small but significant reduction in blood pressure. -Several botanicals can be used as duiretics. They can all also lower potassium. 1. Hibiscus acts like a calcium channel blocker and diuretic. It increases HDL. It's as effective as captopril when take as standardized extract of 9.6mg anthocyanins. 1000mg of dried hibiscus per day. 2. Parsley. Seeds have more effect than leaves. Enhances sodium and water excretion. 1000mg parsley leaf 2-3 times a day. 3. Fennel. Diuretic and breath freshener. Use as tea. 4. Dandelion. 1000mg 2-3 times a day. 5. Grape seed extract. 150-300mg. May potentiate warfarin effect. 6. Hawthorn leaf and flower has shown decreased BP in humans. 7. Licorice is contraindicated in hypertension. |
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CARDIOVASCULAR DISEASE
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-Lyon heart study. People with MI started on mediterranean diet and had fewer cardiovascular events and deaths as well as reduced cancer. -Do not use folate and B12 in cardiovascular disease. Folate associated with higher rates of stent restenosis and both are associated with an increase in cardiovascular events. -Vitamin D shows reduction in cardiovascular disease and all cause mortality. -Acetyl L-carnitine. 500-3000mg may be effective in improving exercise in patients with unstable angina. -Vitamin E beneficial in people over 65 years old. -Omega 3 reduces sudden death. -Beta Carotene is bad. It increases lung cancers in male smokers and is associated with increased angina. -L-Arginin is bad. It increases cardiovascular death. -The FDA now supports the claim that 25 grams of soy protein per day as part of a diet low in saturated fat and cholesterol reduces the risk of heart disease. -Black tea causes flow mediated vasodilation. -Grape juice contains flavanoids. It prevents blood clotting and acts as an antioxidant. Whole grapes do not have the same effect. Both wine and grape juice have flavonoids. -Chocolate lowers BP, increases insulin sensitivity and lowers LDL. -Potassium lowers BP. Potassium rich foods include sweet potatoes, oranges, milk, beans, spinach, bananas, and tomatoes. -Calcium decreases menstrual syndrome, stroke, and lowers BP. -Magnesium is a natural calcium channel blocker that causes vasodilation. Foods rich in magnesium like nuts, seeds, leafy greens and whole grains increase the effectiveness of antihypertensives. -Vitamin D deficiency increases BP and CVD. -Sodium. 2,400mg per day recommended. If hypertension, 1,500 mg per day. -Hibiscus is a diuretic and mild laxative. -Parsley is a diruetic |
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HEART FAILURE
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-In heart failure there are documented deficiencies of L-carnitine, CoQ10, Taurine, Thiamine, and other B vitamins. -L-carnitine. serum levels do not reflect deficiency. LV remodeling improvement after MI in one study. -CoQ10. Deficiency caused by statins. 60-300mg can improve LV function. -Thiamine. Severe deficiency leads to wet beriber with severe vasodilation and fluid retention. It is depleted by loop diuretics. -Omega 3 fatty acids reduce sudden death after MI, suppress arrhythmias and display anti-thrombotic, anti depressant and anti-inflammatory effects. -D Ribose can improve diastolic and systolic function. Powder dose 5 grams TID for one month then BID. No saftey issues up to 15 mg per day. -Foxglove = digitalis. Not used today. -Hawthorn is cardiotonic. Use for mild CHF. |
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ARRHYTHMIAS
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-Magnesium used for V-Tach - Omega-3 Fatty acids reduce sudden death mortality in patients with CAD. It improves outcomes in atrial fib, can reduce heart rate, increase heart rate variability, reduce PVCs and prevents recurrent arrhythmias in patients with ICDs. -Motherwort is used in German for rapid or irregular heartbeat due to anxiety and stress. 3-5 grams per day of dried herb. |
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STROKE
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-Use lowest effective dose of estrogen. -Use transdermal estrogen in obese women since this form is associated with less clots compared to oral therapy. -micronized progesterone or dydrogesterone may have a better risk profile with respect to breast cancer. -Combined oral contraceptives are safe for simple migraine unless there are other risk factors for stroke like smoking, high blood pressure, obesity, etc, especially if over age 35. -For migraine with aura use progestin only pills or mirena. -Flavanols (coffeed) decreased stroke by 0.8 relative risk. Healthy lifestyle reduces risk by 80%, exercise by 20-30%. Acupuncture listed as treatment for stroke. |
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CELIAC DISEASE
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-First do serologic testing .-If testing is negative and you have a high suspicion do intestinal biopsy.-You can see iron deficiency anemia and foalte deficiency in celiac.-You can also see nutrtient deficiencies of fat soluble vitamins (A, D, E, K) , B12, and calcium.-Anti-tissue transglutaminase and Anti-endomysial antibodies are thebest to use.-Serological testing can be negative if patient has been following a gluen free diet.-Eliminate wheat, barly and rye.-Grains that should be avoided: 1.wheat including spelt, kamut, semolina, triticale.2. Rye.3. Barley, inluding malt.-Gluten free grains include: oats, rice, amaranth, buckwheat, corn, millet, quinoa, sorghum,teff, polenta, montina (indian rice grass).-Osteoporosis is more prevalent in celiac.-Oats that are pure and uncontaminated with other gluten containing grains, if taken in limited quantities, are safe for those with celiac.- In celiac, there is an increased incidenceof non-Hodgekins lymphoma, esophageal adenocarcinoma, cancer of the small intestines, colon cancer, hepatobilliary and pancreatic cancer.
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IBS
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-Avoid sugary foods, while flour, dairy. -Caffeine can irritate the stomach and cause motility (good for constipation, bad for diarrhea). -One approach to IBS is to try elimination diet. -Here is an approach for constipation type IBS: 1. carminatives (they are good for bloating and gas): Basil, anise, caraway, catmint, cinnamon, dill, fennel, ginger, lemon blam. sage, thyme. 2. Non-carminatives: ginger, psyllium, triphala, flax, magnesium. -For IBS diarrhea type try peppermint oil, chamomile, and licorice. -Peppermint oil works by calcium channel blockage. It slows gut motility and helps with diarrhea. Meta-analysis confirms response in IBS. Side effect is anal burning. Use 0.2 ml peppermint oil taken before meals. - Probiotics restore mobility and rebalance flora. Sacchromyces boulardi 5 billion CFU (colony forming units), VSL-3. -Artichoke leaf promotes bile flow, is anti-emetic and anti-nauseas. Use 400-600 mg twice a day. -German chamomile relaxes gut smooth muscle and calms mind. Use one heaping tablespoon in hot infusion three times a day. -Ginger is prokinetic and antiemetic. Use 500mg three times a day of dried ginger. -Melatonin is anxiolytic. use 0.3-6mg per day -Tannins. Anti-motility and antimicrobial. Drink black or green tea to get tannins. -Acupuncture showed inconclusive studies for IBS. Although studies for abdominal pain shows acupuncture is helpful. -Recommended: yoga, meditation, hyponotherapy, CBT. |
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IBD - Inflammatory Bowel Disease
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- Meta-analysis showed positive association for both ulcerative colitis and crohns with oral contraceptive use. -Some studies show positive association between crohns and antibiotic use. - Breast feeding is protective. -An increased incidence of relapse with crohns is seen with brassica (ie cruciferous) vegetables like broccoli, cabbage, cauliflower, collards, kale, kohlrabi. Also alcohol, red meat, eggs, fat, sufur, trans-fat. -Pro-iotics, prebiotics and fish oil help maintain remission in ulcerative colitis. Glutamine does not. Glutamine is good in crohns not ulcerative colitis. -Aloe Vera is good for IBD and GERD. -Boswellia is good for IBD. -Demulcents like slippery elm and marshmellow help with IBD and gerd. Ginger is also useful for IBD and gerd. -Good for IBD in general: aloe vera, demulcents, ginger, pre-biotics, pro-biotics, vitamin D, zinc, boswellia. -For crohns specifically use glutamine. -Saccharomycess boulardi reduces frequency of diarrhea in patients with stable and active chrons. -For ulcerative colitis specifically use short chain fatty acid enema, omega-3 fatty acids may decrease dose of steroids needed. -A well designed study shows that VSL-3 used along with 5-ASA produced faster remission in ulcerative colitis. -For GERD use aloe vera, demulcents, and ginger. -It is unclear as to whether fish oil supplements can maintain remission of crohns while in ulcerative colitis, the data supports its use for maintenence of disease. -Check people with IBD for folate and vitamin D deficiency. -Avoid probiotics in immunocomprised patients. It can cause fungemia or bacteremia. -Here are some other useful botanicals in IBD: 1. Tumeric inhibits pro-inflammatory genes 2. Boswellia seratita (indian frankincense) 3.Aloe vera 4. Ashwaganda (adaptogen meaning it promotes homeostasis). calming the git, and anxiolytics 4. Marshmellow ( a demulcent, soothes esophagus) 5. Oregano 6. Wild tam which is anti-spasmodic 7. Slippery elm |
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LIVER DISEASE
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-Most commonly used herb for hepatitis c is milk thistle. -Milk thistle (or silymarin) is hepatoprotective against a diverse range of toxins. It is a lactogogue and is also used in chemo liver. -Look for zinc deficiency in liver disease. -Zinc inhibits the absorption of copper. Muscle cramps are an under recognized common complication of cirrhosis that may respond to zinc or oral magnesium. -Liver disease decreases SAM-e -Avoid licorice root in liver disease because the glycyrrhizin can cause fluid retention and hypokalemia.b -Here are some herbs that can cause liver toxicity: 1. Mistletoe can cause chronic hepatitis 2. Kava kava can cause acute and chronic hepatitis or fulminant hepatitis 3. Saw Palmetto can cause mild hepatitis. 4. Valerian can cause mild hepatitis. -Data is emerging that pre-biotics and pro-biotics may have a in treating liver disease. |
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GERD
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-PPI's have side effects including two-fold increased rates of C.Diff, bacterial colonization with resistant microbes, community acquired pneumonia, acute interstitial nephritis, hip fracture, malabsorption of calcium/iron/B12, baterial gastroenteritis. All of the following are depleted by PPIs: calcium, magnesium, zinc, B12, B1, folic acid, iron, sodium, beta-carotene. Copper is not depleted. |
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COLORECTAL CANCER
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-Biggest risk factor: advancing age. -25% associated with family history. -Intake of processed meat is a risk factor. -Heterocyclic amines are carcinogens created in process of cooking meat at high temperatures. Avoid charred meats. -There is no consistent relationship between alcohol and colorectal cancer. -To prevent colorectal cancer, avoid charred meats, eat 7 fruits/veges per day, get 25-30 grams of fiber per day, take calcium and vitamin D. -To prevent recurrence get in some linoleic acid (which is found in oils like safflower, grapeseed, poppyseed, sunflower) -No evidence that not use folate or other supplements except calcium and D will lower risk of colorectal cancer. Vitamin E may increase the risk of colorectal cancer. -Fat intake can increase the risk of colorectal cancer. |
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CHEMOTHERAPY SIDE EFFECTS
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-Neuropathy. Gluatmine supplementation is effective but may be unsafe. It appears to activate growth pathways in cancer. Do not give glutamine in cancer unless you have studies showing the cancer will not respond to glutamine. -Nausea. Use ginger. Dried root 500-1000 mg per day. |
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DIABETIC PERIPHERAL NEUROPAHTY
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-Alpha-lipoic acid may help. 600-1800ng. More evidence for IV administration. |
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HOT FLASHES
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-Be familiar with treatment approaches for menopause and men with hot flashes secondary to prostate cancer treatment. -HRT. Use lowest dose for shortest duration. -Transdermal estrogen has lower risk of thromboembolism. -Several studies show that progestin, not estrogen increase the risk of breast cancer. -Some evidence that micronized or natural progesterone is safer for breast cancer risk than others. Also oral micronized progesterone has a more favorable cardiovascular risk profile. -In WHI study, oral equine estrogen + Progesterone increases incident breast cancers. This was not found in the estrogen only arm. -Women may benefit from estrogen + Testosterone especially if low libido. Conjugated equine estrogen plus methyltestosterone is available as a prescription using 5mg of testosterone. -NAMS stated that postmenopausal women with decreased sexual desire who have no cause other than being postmenopausal may be candidates for T treatment. Check T level before and during therapy. Contraindicated with history of breast or uterine cancer, cardiovascular disease or liver disease. Use lowest does for shortest duration. -Avoid caffeine, alcohol, spicy food, heat. -Soy has mixed data. NAMS says there is insufficient data to evaluate effect of isoflavone on breast cancer, bone mass and vagainal dryiness but there is data that isoflavones reduce LDL and triglycerides while increasing HDL. Choose fermented soy like miso and tempeh. -Black Cohosh. Mixed data. Better if combined with St. John's Wort. Rare but possible liver damage. 40-160mg divided BID. -Chaste Berry. German health authority for irregular menses and PMS. Useful for dysfunctional uterine bleeding. A study showed that with St John's Wort, it relieved PMS type symptoms, hot flashes and night sweats. Take 500mg per day taken continously. -Dong Quia. Not effective for hot flashes. Can increase menstrual flow and interacts with warfain. Can be used to prevent clots. -Kava. Studies support use for reduction of anxiety and menopausal women. 100-210 mg per day of kava extract standardized to 60-70% kavalactones. Avoid in patients with liver disease or meds that increase risk of liver toxicity. -Maca. Studies support use. A study showed it reversed SSRI induced sexual dysfunction. 2-4 grams taken per day in two divieded doses can significantly improve depression, anxiety, and sexual dysfunction. Has been used for centuries in the Andies as an aphrodisiac. -Red Clover. Studies show mixed results. 3 studies show benefit and 3 do not. -St. John's Wort. Studies support use. 900mg of extract improved psychological and psychosomatic symptoms and enhanced sexual well being. Combination of SJW and black cohosh reduced menopause scores. -Acupuncture reduces the number and severity of hot flashes. -Men with hot flashes can be given transdermal estrogen for moderate to severe hot flashes. Venlafaxine, paxil, gabapentin can be used. Preliminary studies on acupuncture show benefit. No studies on men with black cohosh, SJW. Soy not beneficial. Flaxseed does not help with hot flashes but 30 grams per day slows proliferation rate of prostate tumors when given prior to prostatecomy. Hypnosis decreases hot flashes in women with breast cancer. |
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PCOS/INFERTILITY
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-Some evidence shows that pregnant women who practice yoga, relaxation exercise or meditation for one hour a day have lower rates of prematurity and gestational diabetes. -Diet, exercise, weight loss. -OCPs, metformin. If unable to use estrogen due to risk use medroxyprogesterone to reestablish menses. |
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DIABETES
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-barley is a high protein, high fiber grain and will decrease hepatic glucose production by up to 30%. -Mushrooms: Reishi and Mitake mushrooms lower blood sugar and increase insulin levels. -A big no no for button mushrooms. They may push your cancer buttons. -No reason to recommend seaweed for diabetes management although it did lower post prandial glucose in animals. -Stevia is a safe sweetener for diabetes. -Alpha lipoic acid can be used for diabetic neuropathy. IV and PO. 600-1200mg per day. May cause hypoglycemia. At higher doses can cause nausea, vomiting, vertigo. Allergies reported. -Magnesium. Mag citrate and oxide are laxative. Mag glycinate, lactate and aspartate are better tolerated. Careful in renal disease. Dose is about 400mg for men and 300mg for women. -Chromium picolinated 600-1000mcg per day. Deficiency impairs glucose metabolism. Careful in renal or hepatic dysfunction. -Co-Q-10. Use for statin induced myopaty. 50-200mg in divided doses. -Spirulina has early data that is promising. It's well tolerated. Cases of contamination with cyanobacteria leading to hepatotoxicity. -Thiamine for diabetic retinopathy and nephropathy. Take a multivitamin with 25-50mg of B1. -Vanadium. May interfere with heparin. Do not take if on anti-coagulation. -Vitamin D. -Vitamin E. RDA for adults is 15mg. May increase bleeding. High dose E related to increased mortality. -Zinc. RDA dosing 11mg. Treatment is 30mg of glysine chelated zinc. High dose zinc supplementation can result in copper deficiency. |
