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The Biology of Aging Week 3 PRESENTED BY DR. SARAH VADEBONCOEUR, NATUROPATHIC DOCTOR Lecture Overview Heart Health & Blood Pressure Age related changes in the cardiovascular system Risk factors for heart disease Hormonal Changes Sexual Health Overview of Cardiovascular System Consists of: the heart, arteries, veins, capillaries Overview of Cardiovascular System HEART Approximately the size of your fist Consists of 4 chambers 2 Atria: superior chambers Receiving chambers Receive blood from veins 2 Ventricles: inferior chambers Pumping chambers Send blood through the body via arteries Overview of Cardiovascular System BLOOD VESSELS 1. Arteries: carry oxygenated blood away from the heart 2. Veins: carry unoxygenated blood towards the heart 3. Capillaries : link between arteries and veins Transport materials (oxygen, nutrients) to and from the cells Flow of Blood through the Body Blood arrives to the heart from veins Right atrium Right ventricle Lungs Lungs add oxygen, remove CO2 Lungs Left atrium Left ventricle Left ventricle Aorta systemic circulation Heart Circulation Coronary circulation is the functional blood supply to the heart muscle itself Collateral routes ensure blood delivery to heart even if major vessels are occluded Blood 1. Plasma Liquid portion of the blood Contains clotting factors, hormones, antibodies, dissolved gases, nutrients and waste 2. Red Blood Cells Carry hemoglobin and oxygen Live only about 120 days Can not repair themselves Blood 3. White Blood cells Fight infection Formed in the bone marrow Five types – neutrophils, lymphocytes, eosinophils, basophils, and monocytes 4. Platelets. Formed in the bone marrow Clot Blood by sticking together What makes our heart beat? Heart muscle: Is stimulated by nerves and is self-excitable Calcium plays important role in contracting heart muscle Heart is stimulated by the sympathetic nervous system cardioacceleratory center Heart is inhibited by the parasympathetic cardioinhibitory center Heart Rate/Pulse Ideal resting heart rate: 60-100 beats per minute Fast heart rate = 100 + Caffeine Stress, anxiety, excitement, or exercise Excessive thyroid medications/Hyperthyroidism Warmer temperatures Cortisol, epinephrine and thyroxine Slow heart rate = < 60 Athletes Hypothyroidism Beta-blocker medication (blocks adrenaline) Sedatives (e.g. alcohol) Parasympathetic nervous system activity Vagus nerve Blood Pressure Top number = systolic blood pressure Pressure when the heart contracts Bottom number = diastolic blood pressure Pressure when the heart is relaxed 122/78 Blood pressure: what’s normal? Ideal blood pressure = less than 120/80 What causes high blood pressure? High Stress levels Cortisol increases potassium loss while retaining sodium in the cell Kidney disease Nutrient deficiencies Low magnesium, low potassium, high sodium High cholesterol / Atherosclerosis Tumours Overweight / Obesity Hyperthyroid Dehydration (constricts blood vessels) Genetics Blood pressure: what’s normal? Is low blood pressure dangerous? Generally safer than high blood pressure Low blood pressure = < 90/60 May be associated with dizziness and fainting Causes of low blood pressure Low cortisol/stage 3 stress Excessive blood pressure medication Hypothyroidism Aging Effects on the Heart The heart has a natural pacemaker system that controls the heartbeat This system may develop fibrous tissue and fat deposits Pacemaker loses some of its cells Can result in a slightly slower heart rate Increase in the size of the heart (especially the left ventricle) Heart wall thickens Amount of blood that the chamber can hold may decrease despite the increased overall heart size The heart may fill more slowly Aging Effects on the Heart Abnormal rhythms (arrhythmias) are more common in older people They may be caused by heart disease Heart muscle cells degenerate slightly The valves inside the heart can thicken and become stiffer Heart murmur caused by valve stiffness is fairly common in the elderly Aging Effects on Blood Vessels Baroreceptors: monitor and change blood pressure Become less sensitive with aging May explain why many older people have orthostatic hypotension Causes dizziness because there is less blood flow to the brain The capillary walls thicken slightly May cause a slightly slower rate of exchange of nutrients and wastes Aorta becomes thicker, stiffer, and less flexible Raises blood pressure & makes the heart work harder May lead to thickening of the heart muscle (hypertrophy) Most elderly people have a moderate increase in blood pressure Aging Effects on the Blood Blood itself changes slightly Reduction in total body water -> blood volume decreases Production of red blood cells is slower Slower response to blood loss and anemia White blood cells stay at the same levels Reduced neutrophils = decreased immunity again bacterial infections Cardiovascular Disease Heart Attack (Myocardial Infarction) Most often caused by a blood clot Blocks one of the coronary arteries Coronary arteries bring blood and oxygen to the heart Blood flow is blocked -> the heart is starved of oxygen and heart cells die Cardiovascular Disease Symptoms of Heart Attack #1: Chest pain The pain can be severe or mild. A tight band around the chest Bad indigestion Something heavy sitting on your chest Squeezing or heavy pressure Cardiovascular Disease Symptoms of Heart Attack Other symptoms of a heart attack can include: Anxiety Cough Fainting Light-headedness, dizziness Nausea or vomiting Palpitations (feeling like your heart is beating too fast or irregularly) Shortness of breath Sweating, which may be very heavy Cardiovascular Disease Symptoms of Heart Attack Women may experience different symptoms Can present as abdominal pain vs chest pain Women who appeared anxious upon admittance to the hospital tended to have delays in crucial care Women who appeared anxious upon admittance to the hospital tended to have delays in crucial care “Men underwent electrocardiograms (ECGs) within 15 minutes and clot-dissolving therapy within 21 minutes, compared with 28 minutes and 36 minutes, respectively, for women” Cardiovascular Disease STROKE Blood flow to your brain stops Within minutes -> brain cells begin to die 2 Types of stroke: Ischemic Stroke More common Caused by a blood clot that blocks a blood vessel in the brain Hemorrhagic stroke Caused by a blood vessel that breaks and bleeds into the brain "Mini-strokes" or transient ischemic attacks (TIAs), occur when the blood supply to the brain is briefly interrupted Cardiovascular Disease Symptoms of stroke are: Sudden numbness or weakness of the face, arm or leg (especially on one side of the body) Sudden confusion, trouble speaking or understanding speech Sudden trouble seeing in one or both eyes Sudden trouble walking, dizziness, loss of balance or coordination Sudden severe headache with no known cause STROKE = medical emergency! Blood Disorders Anemia - lack of iron in the blood, low RBC count Can be causes by chronic disease and blood loss Hemophilia - bleeder’s disease, due to lack of fibrinogen in thrombocytes Atherosclerosis Hardening of the arteries Occurs when fat, cholesterol, and other substances build up in the walls of arteries -> plaques Plaques calcify vessels hard & brittle Risk factors: cigarette smoking, high fat/cholesterol diet, hypertension Coronary Artery Disease (CAD) Most common type of heart disease CAD -> arteries that supply blood to heart muscle become hardened and narrowed Due to the buildup of cholesterol and other material, called plaque, on their inner walls (atherosclerosis) Increased plaque -> decreased blood flow through the arteries Heart muscle can't get the blood or oxygen it needs. Leads to chest pain (angina) or a heart attack. Most heart attacks happen when a blood clot suddenly cuts off the hearts' blood supply, causing permanent heart damage. Over time, CAD can also weaken the heart muscle and contribute to heart failure and arrhythmias. Congestive Heart Failure Heart can't pump enough blood to meet the body's needs Does not mean that your heart has stopped or is about to stop working Causes of CHF: Coronary artery disease High blood pressure Multiple myocardial infarcts (heart attack) Diabetes Risk factors: 65 years + African Americans Overweight Men > Women Congestive Heart Failure Left side heart failure Less effective pump so more blood remains in ventricle Heart is overstretched & even more blood remains Blood backs up into lungs as pulmonary edema Suffocation & lack of oxygen to the tissues Right side failure Fluid builds up in tissues as peripheral edema Heart Disease Stats According to Heart & Stroke Foundation: Good News: Since 1952: Cardiovascular death rate in Canada has declined by more than 75 per Nearly 40 per cent in the last decade Largely due to research advances in surgical procedures, drug therapies and prevention efforts Bad News: Every 7 minutes in Canada, someone dies from heart disease or stroke Heart Disease Stats Heart disease and stroke are two of the three leading causes of death in Canada In 2008 cardiovascular disease accounted for 29% of all deaths in Canada In 2008, of all cardiovascular deaths 54% were due to ischemic heart disease 20% to stroke 23% to heart attack Risk Factors for Heart Disease Non-modifiable risk factors include: Male sex Older age Family history of heart disease Post-menopausal Race (African Americans, American Indians, and Mexican Americans are more likely to have heart disease than Caucasians) Risk factors for cardiovascular disease Nine in 10 Canadians (90%) have at least one modifiable risk factor for heart disease or stroke Smoking High LDL, or "bad" cholesterol and low HDL, or "good" cholesterol Uncontrolled hypertension (high blood pressure) Physical inactivity Obesity (more than 20% over one's ideal body weight) Uncontrolled diabetes High C-reactive protein Uncontrolled stress and anger What is cholesterol? Waxy, fat substance Found in all cells in the body Helps to heal damage in the body Backbone for hormones (estrogen, progesterone, testosterone) Involved in the production of vitamin D Helps to make bile (important for digestion of fats) Cholesterol: what’s optimal? Total cholesterol = < 5.2 Triglycerides < 1.7 HDL cholesterol > 1.3 LDL cholesterol: depends on risk level Calculated based on other values so can be inaccurate How to Measure Overall Risk Framingham Risk Calculates overall risk of developing cardiovascular disease over next 10 years < 10 % = low risk > 20% = high risk Takes several risk factors into account: Age Gender Total cholesterol HDL cholesterol Smoking status Diabetes Systolic blood pressure Treatment for high blood pressure Risk doubles if 1st degree relative with heart disease < 60 yrs How to Measure Overall Risk My cholesterol is high, is my risk increased? LDL on its own is a very poor estimator of cardiovascular risk Doesn’t take into account different types of LDL Large LDL molecules = safer Small LDL molecules = dangerous Total cholesterol : HDL ratio better predictor How to Measure Overall Risk Causes for elevated small particle LDL High triglycerides Poor thyroid function Affects liver production and clearance from body Infections H. Pylori Herpes virus Digestive issues Genetics The Cholesterol Myth Most researchers now believe the primary causes of heart disease are inflammation and oxidative stress “The cholesterol factor is of minor importance as a risk factor in CVD. Of far more importance are smoking, hypertension, obesity, diabetes, insufficient physical activity, and stress.” ~Frederick Stare, American Heart Association Where does Cholesterol Come From? MYTH: High Cholesterol is due to eating too much cholesterol Framingham Heart Study: demonstrated that intake of cholesterol in the diet had absolutely no correlation with heart disease. Where does cholesterol come from? Liver makes ~70% of cholesterol in the body! 75% of population = no relation between cholesterol intake and blood cholesterol 25% are “hyper responders” Dietary fats Cholesterol: doesn’t raise blood levels of cholesterol Saturated fats & trans fats: can increase liver production of cholesterol What does cause high cholesterol? Smoking Physical Inactivity Genetics Diabetes Abdominal Obesity Statin Medications Statins block LDL production in the liver Lowering LDL may have little to no benefit in reducing risk (especially for women) Low cholesterol can increase the risk of death, especially in women and the elderly Statin medications have side-effects and long-term consequences Muscle pain and damage Liver damage Increase blood sugar levels and risk for Type 2 Diabetes (48% increase in women) Cognitive (brain-related) impairment, such as memory loss, forgetfulness and confusion Statin Medications Only group with significant benefit = men with history of heart attack Reduces risk of 2nd heart attack by 1/3 In other groups: NNT = 83-1000 Need to treat 83-1000 people with statins for 1 year in order to save 1 life Is Aspirin a better choice? Aspirin Doesn’t prevent cardiovascular event in those with no history of heart attack. NNT = 120 120 people have to take aspirin to prevent one case of cardiovascular disease However, there is one “bleeding event” for every 73 people No significant difference in mortality Cochrane Collaboration found that anti-hypertensive drugs used to treat mild hypertension (140–159 / 90–99 mm/Hg) did not reduce disease complications or the risk of death Strategies for Preventing Cardiovascular Disease Preventing Heart Disease Quit Smoking Limit alcohol intake Men: no more than 3 drinks per day, 15 per week Women: no more than 2 drinks per day, 10 per week Preventing Heart Disease Maintain a healthy weight/waist Men: < 40 inches Women: < 35 inches Asian descent: subtract 5 inches Waist-to-Hip Ratio Men: > 1 Women > 0.8 Consume a Heart Healthy Diet The Mediterranean diet Can help to prevent ~ 30 percent of heart attacks, strokes and deaths from heart disease in high risk individuals Benefits are conferred even if: No weight loss Currently using statins, blood pressure or diabetes drugs Low-fat diets have not been shown in any rigorous way to be helpful, and they are also very hard for patients to maintain Consume a Heart Healthy Diet The Mediterranean diet emphasizes: Eating primarily plant-based foods, such as fruits and vegetables, whole grains, legumes and nuts Replacing butter with healthy fats, such as olive oil Using herbs and spices instead of salt to flavor foods Limiting red meat to no more than a few times a month Eating fish and poultry at least twice a week Drinking red wine in moderation (optional) Load Up on Healthy Fats Don’t eat a low-fat diet! Needed for satiety Important for weight loss Contribute to health They taste good! Help us to absorb fat-soluble vitamins and nutrients E.g. vitamins A, D, E, K, lycopene Important for brain function Provide backbone for hormones Fats 3 Types of fat Unsaturated (mono- and poly-unsaturated) Saturated Trans fat Fats Unsaturated fats Monounsaturated: avocado, olive oil, nuts/seeds Associated with lower cardiovascular risk Polyunsaturated: Omega 3: salmon, sardines, herring, mackerel, flax, walnuts Essential fatty acids: body can’t produce them Omega 6: vegetable oils (corn, canola, soybean) Low intake of omega-3 and high intake of omega-6 fats can increase heart disease risk Fats Saturated fat: not all bad! Found in: Animal protein Dairy products Coconut oil Good: coconut oil, organic butter Not so good: animal fats (unless organic, grass fed) Health Effects: Raises HDL Changes LDL from small to larger (safer) molecules Fats Trans Fat: as close to zero as possible Worst! Margarine, processed foods (e.g. Muffins, crackers, chips) Small amounts found in animal milk Result of hydrogenation of oils Beware of nutrition labels! “No trans fat” and “Zero trans fat” Can contain up to 1 gram trans fat per serving Health Effects: Decrease HDL Increase LDL Increase TG Butter or margarine? Butter Margarine Saturated Fat PUFA (omega-6) Naturally occurring fat Chemical process Made by: cows Made by: chemists Ingredients: milk fat Ingredients: vegetable oil along with emulsifiers, colorants and various artificial ingredients. WINNER! How does food affect cholesterol? LDL Saturated fats (in excessive amounts and in high risk individuals) Trans fat HDL Omega-3 MUFA Saturated fats Triglycerides Alcohol High sugar intake Refined carbohydrates (bread, pasta, pastries) Foods to help lower cholesterol Almonds/walnuts: small handful or ¼ cup Raw, unsalted Beta-glucan (oats) Steel cut preferred to instant/quick oats Soluble fiber: helps with cholesterol elimination Aim for 25-30 grams of fiber per day Beans Yam/sweet potatoes (with skin) Brussel spouts Fruit (e.g. oranges) Seeds: chia seeds, flaxseeds Foods to help lower cholesterol Olive oil: 1-4 Tbsp. daily Soy lecithin: 1 Tbsp. daily Soy (50 grams/day) Reduced Total cholesterol by 4-10% Reduced LDL by 3-6% Reduced TG by 10% Choose organic soy (ideally fermented like tempeh or miso) Foods to Help Lower Blood Pressure Foods rich in magnesium: 350-500 mg daily Nuts, seeds, spinach, beet greens, and chocolate Foods rich in potassium: 4,700 mg daily Swiss chard, lima beans, potatoes (especially skins), yams, soybeans, spinach, papaya, pinto beans, lentils, kidney beans Celery Pomegranate juice Foods to Help Lower Blood Pressure Herbal Teas: Linden tea, Hibiscus tea, Hawthorne Consume cold water fish: rich source of omega-3 Salmon, herring, mackerel, sardines Beets/beet juice Rich source of nitric oxide Nitric oxide = vasodilator = relaxes blood vessels SALT: friend or foe? Evidence supporting a connection between salt intake and cardiovascular disease is weak at best Some evidence suggests that restricting salt too much may be harmful to our health Body requires salt Blood pressure regulation Production of stomach acid Nerve signalling Low blood sodium is dangerous and can be life threatening Daily recommended intake ~1500 mg Lifestyle habits for Heart Health Weight loss Exercise Reduces blood pressure Lowers bad cholesterol and raises good cholesterol Sleep Reduces risk of high blood pressure Sunlight Increases the production of nitric oxide Meditation Calms nervous system -> lowers blood pressure Deep breathing. 3-4 fifteen-minute sessions per week of deep breathing can lower blood pressure long-term What are hormones? Hormones are messengers! Made in one part of the body Effect on another part of the body Where do hormones come from? Hormones & Aging Response to hypothalamus hormones decreases Metabolism slows over time, beginning at around age 20 Parathyroid hormone levels rise PTH raises blood calcium levels by releasing calcium from your bones and increasing the amount of calcium absorbed from your small intestine May contribute to osteoporosis Hormones & Aging Fasting blood sugar levels increase up to 1 point for each 10 years after age 50. Cells become less sensitive to the effects of insulin Aldosterone release decreases with age Aldosterone regulates fluid and electrolyte balance. Can contribute to light-headedness and a drop in blood pressure with sudden position changes Cortisol release also decreases with aging, but the blood level of this hormone stays about the same Keep in mind stress levels will impact cortisol levels Hormonal Changes in Women Decreasing levels of estrogen & progesterone Causes the ovaries and uterus to shrink Tissues of the vagina become thinner, drier, and less elastic Severe cases can lead to itching, bleeding, pain during intercourse, and a need to urinate immediately Breasts become less firm and more fibrous, and they tend to sag Lower estrogen levels can also increase risk for: Osteoporosis Heart disease Hormonal Changes in Men Hormonal changes are more gradual in men Decreases testosterone results in: Fewer sperm Decreased sex drive (libido) Although blood flow to the penis tends to decrease, most men can have erections and orgasms throughout life Erectile dysfunction can be a sign of vascular disease or diabetes Increase estrogen activity Can contribute to prostate enlargement Sexual Health Good indicator of overall health Although sexual intercourse appeared to become significantly less frequent with increasing age, age did not seem to have an influence on men’s satisfaction Women: proportion satisfied with the frequency of sexual intercourse increased with age. Among respondents aged 60 years + 58% of men and 41% of women attached the same level of importance to Sex (“very important “or “absolutely essential”) Sexual satisfaction positively linked to satisfaction with overall physical health, family life and financial wellbeing Hormone Balancing Tips for Men & Women Liver friendly foods Cruciferous vegetables: broccoli, cauliflower, cabbage, Brussel spouts Lemon (add to water) Grapefruit: caution if taking medications Load up on fiber-rich foods Chia seeds, fruit, vegetables, beans/legumes, whole grains Fiber feeds healthy bacteria that are important for hormone health Consume healthy fats every day Get enough sleep Avoid exposure to hormone disrupting chemicals BPA, pthalates, parabens Hormone Balancing Tips for Women Ground flaxseeds: 2 Tbsp. daily Organic soy products Contain phytoestrogens Caution if history of breast cancer Keep stress levels under control Cortisol steal Choose personal care products that are free of hormone disrupting chemicals Average women uses more than 12 products every day Hormone Balancing Tips for Men Increase intake of foods rich in zinc: Zinc important for testosterone production Oysters, pumpkin seeds Other nutrients important for testosterone production: Selenium: Brazil nuts (2-3/day) Beta-carotene: all yellow-orange fruit and vegetables Vitamins C: citrus fruit, strawberries, papaya, broccoli, bell peppers Vitamin E: Sunflower seeds, almonds, spinach, Swiss chard Exercise regularly Weight/strength training can help raise testosterone levels Next Week The digestive system Nutrition Changes over the adult lifespan Immune System Nutrient Deficiencies References National Institute of Health (2012) Aging changes in the heart and blood vessels. Retrieved from: http://www.nlm.nih.gov/medlineplus/ency/article/004006.h tm Robert Preidt (March 27, 2014) Women Face Delays in Heart Attack Care: Study. Retrieved from WebMD: http://www.webmd.com/women/news/20140317/womenface-delays-in-heart-attack-care-compared-to-men-study http://www.heartandstroke.com Mayo Clinic ChrisKresser.com http://www.nytimes.com/2013/02/26/health/mediterranean -diet-can-cut-heart-disease-study-finds.html?pagewanted=all References Dean J. (2013) Sexual Health and Overall Wellness (SHOW) survey in men and women in selected European and Middle Eastern countries. Journal of International Medical Research 41(2) 482–492