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Transcript
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, B6 and B12 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: 8oz (1 measuring cup) – 95-100mg
 Blk tea: 8oz -47mg
 Cola: 12oz -30-35mg
 Grn tea: 8oz- 30mg
 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_ArtNew_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.