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TAKE CHARGE OF YOUR HEART
Nicole Derse, B.Scs. Med, C.N.C.
Preventative, Functional & Nutritional Medicine
Center for Optimal Health
www.DCOptimalHealth.net
Functional Medicine
Functional Medicine is a science based system
of personalized medicine that focuses on the
root cause of chronic illness and correction of
these underlying dysfunctions rather that
treating the symptoms
The Iceberg Analogy
Seeking Causes
Heart Disease Today
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Heart Disease is the leading cause
of death for men and women.
600,000 Americans die from heart
disease each.
Every 34 seconds some in America
has a heart attack
According to the American Heart
Association, 1 in 3 adults has some
form of cardiovascular disease
Coronary heart disease cost
America 109 billion dollars
annually.
Traditional Risk Factors
Hypertension, obesity, cigarette smoking, diabetes, physical
inactivity, family history of premature CAD, age (men >44 yrs;
women >54 yrs), and abnormal serum lipids.
These traditional risk factors do not fully account for the individual
risk for the development of cardiovascular disease.
Over 50% of heart attack victims
and 80% of patients with CAD
have normal cholesterol levels.
The 17 ‘Daggers’ to the Heart
1. Hypertension
Damage to your arteries
 Healthy arteries are flexible, strong and
elastic.
 Their inner lining is smooth so that blood
flows freely, supplying vital organs and
tissues with adequate nutrients and oxygen.
 If you have high blood pressure, the increased
pressure of blood flowing through your
arteries gradually can cause a variety of
problems, including:
Coronary artery disease
 Coronary artery disease affects
the arteries that supply blood to
your heart muscle.
 Arteries narrowed don't allow
blood to flow freely through
your arteries.
 Results in chest pain, a heart
attack or irregular heart
rhythms (arrhythmias).
Enlarged left heart
 High blood pressure forces your heart to work harder than
necessary in order to pump blood to the rest of your body.
 This causes the left ventricle to thicken or stiffen. This can
limit the ventricle's ability to pump blood to your body.
 This condition increases your risk of heart attack, heart
failure and sudden cardiac death.
Heart failure
 Over time, the strain on your
heart caused by high blood
pressure can cause your heart
muscle to weaken and work less
efficiently.
 Eventually, your overwhelmed
heart simply begins to wear out
and fail.
 Damage from heart attacks
adds to this problem.
Causes of Hypertension
 Magnesium Deficiency
 Taurine Deficiency
 Toxin Exposure
 Detoxification compromise
 Fatty Acids Imbalance
 Antioxidant Deficiencies
 Low Testosterone
 Stress Response
Supplemental Support
 COq10 (Ubiquinol form) 100mg daily
 Magnesium
 Potassium
 Omega 3 Fatty Acids
 Garlic
 Hawthorn Berry
2. Excess Cholesterol
Cholesterol is not BAD!
 Soft, waxy substance found not only in your
bloodstream, but also in every cell in your
body, where it helps to produce cell
membranes, hormones, vitamin D and bile
acids that help you to digest fat.
 Cholesterol also helps in the formation of
your memories and is vital for neurological
function.
 Your liver makes about 75 percent of your
body's cholesterol
The Diet-Heart Hypothesis
 If you eat too much food
containing cholesterol and
saturated fat, the levels of
cholesterol in your blood will rise.
 The excess cholesterol will be
deposited in your artery walls,
causing them to thicken and
narrow. In time this will block
blood supply to the heart (and
other organs) causing a heart
attack or stroke.
Cholesterol’s Bad Rap
 “THE SINGULAR FOCUS on treating
cholesterol as a means to prevent heart
attacks is leading to the deaths of millions of
people because the real underlying cause of the
majority of heart disease is not being
diagnosed or treated by most physicians.”
Mark Hyman, MD
Cholesterol is a Band-Aid
 Cholesterol is a response to damage in the
arteries.
 Atherosclerosis is an attempt for the body to
send a band-aid (plaque and cholesterol) to an
injury sight where an artery has developed a tiny
crack.
 Body is trying to heal itself. This attempt often
causes inflammation and swelling of the
coronary artery affected, leading to a partial or
complete blockage of blood flow.
 Cholesterol is the patch, not the cause.
3. Excess LDL Particles
Particle Sizes Better Predictor
 Instead of looking just at the
cholesterol numbers, we
need to look at
the cholesterol particle size.
 The real question is: Do you
have small or large HDL or
LDL particles?
 Small, dense particles are
more atherogenic (more
likely to cause the plaque in
the arteries that leads to
heart attacks), than large
buoyant, fluffy cholesterol
particles.
Size Does Matter…
Diabetes Predictor
 Small particles are
associated with pre-diabetes
(or metabolic syndrome)
and diabetes and are caused
by insulin resistance.
 Recent research indicates
that statins may actually
increase diabetes.
4. Oxidative LDL
It’s not just normal cholesterol that is forming plaques in
the artery walls but oxidized cholesterol.
Oxidation is said to damage cholesterol and then oxidized
cholesterol in turn damages artery walls.
 Cholesterol is oxidized when exposed to
sunlight, heat and oxygen.
 It’s cholesterol that has gone rancid, such as that
from overcooked, scrambled eggs
 Present day food processing methods—like the
manufacturing of many commercial oils.
 It could also include animal products that have
been heated or foods fried in oils such as corn oil.
Anti-Oxidants
 Vitamin E
 Beta-Carotene
 Vitamin C
 Green Tea
 Avoid processed oils liquid at room temp
besides olive oil.
 Avoid overcooked eggs, animal products, and
fried foods.
5. Low HDL
What does HDL do?
 1/4 to 1/3 of blood cholesterol is carried by HDL.
HDL cholesterol is known as "good" cholesterol
because high levels seem to protect against
heart attack.
 Low levels of HDL (less than 40 mg/dL) also
increase the risk of heart disease.
 HDL tends to carry cholesterol away from the
arteries and back to the liver, where it's passed
from the body.
 HDL removes excess cholesterol from arterial
plaque, slowing its buildup.
Sizes & Numbers
 Smaller, dense HDL particles are less efficient
at clearing cholesterol. A smaller HDL particle
size has been associated with oxidative
stress, hyperglycemia, and high TGs.
 A low number of HDLL particles is associated
with metabolic syndrome and increased risk
of CHD.
Factors of Low LDL’s
 Smoking, Overweight, Sedentary Lifestyle, &
Poor Diet, and Hypothyroidism
Dietary Support
 Increase fiber intake by eating more fresh
fruits, vegetables and whole grains, while
reducing intake of saturated and trans fats.
 At least twice per week, consume fish high in
omega-3 fatty acids, such as salmon, herring,
trout, mackerel, water-packed albacore tuna
and water-packed sardines or use vegetarian
sources such as flaxseed.
 Niacin (Nicotinic Acid) up to 3,000mg daily
 Garlic, 6grams raw or in capsule form
6. Excess Triglycerides
What are they?
 TG’s play a major role in transporting fats and
providing energy.
 In excess, TGs represent an independent risk
factor for heart attack, heart disease, & CV
related death, as well as for insulin resistance
and metabolic syndrome.
 High TGs directly impact LDL density and size
and contribute to lower levels of HDL-C, all of
which promote atherogenesis.
 These get elevated when eating to many
grains sugars, not exercising, smoking, or
consuming alcohol, or being overweight.
7. Insufficient Vitamin D
Vitamin D
 Low levels of Vitamin D have been linked to
higher levels of Heart Disease and early death
 Optimal levels of Vitamin D (>50 nm/l lowers risk
of early death by as much as 80%. ‘
 Vitamin D is actually a hormone and is
important in blood in immune/inflammation
regulation as well as blood sugar regulation.
 Get your levels checked. Most people do not take
enough.
 25 (OH) Vitamin D3-most accurate test
Increasing Vitamin D
Absorption
 It is also important to take your Vitamin D
with food because it is fat soluble and make
sure you take it with Vitamin K to enhance
absorption.
 Especially if you are taking Calcium and
Vitamin D and not Vitamin K you could
actually be putting yourself at higher risk of
HA.
8. Low Vitamin K
Vitamin K1
 Vitamin K1 (phylloquinone):
 Found in green vegetables
 Goes directly to your liver and helps you
maintain a healthy blood clotting system.
 It is also vitamin K1 that keeps your own
blood vessels from calcifying, and helps your
bones retain calcium and develop the right
crystalline structure.
Vitamin K2
 Vitamin K2 (menaquinone, MK:
 Bacteria produce this type of
vitamin K.
 K2 goes straight to vessel walls,
bones, and tissues other than your
liver.
 Studies found K2 is better and
preventing calcification of arteries
than K1
 It is present in fermented foods,
particularly cheese and the
Japanese food natto, the
richest source of K2.
9. High Glucose
Hemoglobin A1C
 Lowering blood sugar levels could reduce the risk
of coronary heart disease according to
researchers at the Johns Hopkins.
 The researchers found that HbA1c predicts heart
disease risk in both diabetics and non-diabetics.
 An elevated blood glucose level is the defining
feature of diabetes, but until now it was unclear
whether elevated glucose levels contributed
independently to increasing heart-disease risk..
HbA1c: Hemoglobin A1C
 HbA1c levels were taken from a study of 16,000
participants. Researchers tracked study
participants for 10-12 years to acquire coronary
heart disease events, hospitalizations and
deaths.
 In participants with diabetes, the researchers
found a graded association between HbA1c and
increasing coronary heart disease risk. Each 1percentage-point increase in HbA1c level was
associated with a 14 percent increase in heart
disease risk
 They found that those study participants without
diabetes but who had “high normal” HbA1c were
at an increased heart disease risk, even after
accounting for other factors such as age,
cholesterol level, blood pressure, BMI and
smoking.
10) Excess Insulin
How does this happen??
 When you eat too much
sugar, flour and white rice,
your insulin levels spike.
 When this happens, your cells
become resistant to its
effects. So you pump out
more and more insulin,
become even MORE resistant
to its effects, and end up in
the vicious cycle of insulin
resistance.
Statins and Insulin…
 Patients who lowered their cholesterol with statins had
higher levels of insulin, while those who lowered their
cholesterol through diet had lower insulin levels.
 Elevated insulin levels are the first step on the road to
diabetes — they make you gain weight around the middle,
cause high blood pressure, increase inflammation, and
promote stickiness of the blood.
 Each of these conditions, in turn, contributes to heart
attacks and heart disease.
11. Nitric Oxide Deficit
NO More Heart Disease
 NO is one of the most significant molecules in
the human body.
 It has an influence of every organ. It relaxes
the blood vessels, reduces blood pressure,
lowering your risk of HA or stroke.
 We become deficient in this when our tissues
get damages by age, an unhealthy lifestyle,
illness, a toxic environment, sometimes
genetics.
THE HEART OF THE MATTER
•The endothelial cells manufacturing the NO
that guards against many common diseases. By
controlling blood flow, they can help regulate
blood pressure.
•Once plaque forms in the arteries, it is difficult
to undo the damage. Thus, prevention is key,
and NO can play and important role in keeping
plaques at bay.
•By interfering with platelet aggregation, NO
minimizes the risk of strokes.
How to Increase
NO
 Test to assess
 ADMA: Asymetric Di-Methyl Arginine
 L-Ariginine: Amino Acid that get converted to
NO in the body.
 Antioxidants to help support stress on cells
 Vitamin C
12. Low Blood EPA/DHA
Natures Anti-Inflammatory
 Omega-3 FA reduce inflammation throughout
the body.
 May decrease triglycerides lower blood
pressure, reduce blood clotting, boost
immunity and improve arthritis symptoms.
 Eating one to two servings a week of fish,
particularly fish that's rich in omega-3 fatty
acids, appears to reduce the risk of heart
disease, particularly sudden cardiac death.
13. Excess Estrogen
Roles of Estrogen
• Estrogen is a group of hormones that are
essential to sexual and reproductive
systems in females.
• Help the body to retain fluids and salts, and
helping to prevent certain diseases.
• Negative effects of estrogen can occur
when the body contains too little or too
much.
• Examples of these include increased
weight gain, increased chances of heart
disease, and increased chances of breast
cancer.
Estrogen has 400 functions
 It increases your metabolic rate, enhances
energy, improves insulin sensitivity, and
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regulates body temperature In the
cardiovascular system
Maintain the elasticity of your arteries
Dilates your small arteries
Increases blood flow
Inhibits platelet stickiness,
Decreases the accumulation of plaque on your
arteries
Decreases blood pressure, decreases LDL (bad
cholesterol) and prevents its oxidation
Estrogen Dominance…
Too much of a good thing…
 Excess estrogen promotes abnormal blood
clots
 Excess estrogen in men is also common and
can lead to heart attacks and atherosclerosis,
which is the thickening of the arteries.
 Get hormone levels check
 Always chose bio-identical hormone
replacement therapy over HRT.
14. Low Free Testosterone
Benefits of Testosterone
 Fights Depression
 Decreases Body Fat
 Increases muscle mass
 Strengthens the heart and bones
 Increase libido and erections
 Overweight men tend to have
lower rates of testosterone and higher levels
of estrogen
Testosterone Imbalance
 Aging bodies produce less testosterone while
more of their beneficial testosterone is
converted into estradiol.
 The pathological result is an altering of the
ratio of testosterone to estrogen, creating
estrogen dominance.
 This imbalance of estrogen overload and
testosterone insufficiency is an often
overlooked cause of cardiovascular disease.
Hormones and the Heart
 A study published last year compared blood
levels of testosterone and estradiol in men
suffering from acute HA with those who had
previously suffered a HA.
 The results showed significantly higher levels
of estrogen in both groups of heart attack
patients compared with those without
coronary disease.
 Heart attack victims also had
decreased testosterone levels.
15. Excess Fibrinogen
Too Much of a good thing…
 Fibrinogen is a protein that helps your blood
clot .
 Fibrinogen making blood thick and sticky
 Studies published in the American Heart
Association’s journal Circulation found that
people with high levels of fibrinogen were
more than twice as likely to die of a heart
attack as those with low levels.
Toss the aspirin…
 Aspirin will help reduce levels of fibrinogen
but at what cost???
 Natural alternatives to Aspirin, like
Nattokinase, from fermented soybeans, can
safely lower levels of fibrinogen through its
anti-clotting and anti-inflammatory activity.
 Omega 3 Fatty Acids help to reduce
fibrinogen levels
 Excessive Fatigue, irritability, and
hopelessness increases fibrinogen.
16. Elevated C-Reactive Protein
 CRP is a protein produced within the liver and
atherosclerotic arteries.
 CRP is an independent risk marker for coronary
events in individuals without overt
hyperlipidemia.
 Increased levels of CRP are associated with
increased risk of cardiac death in patients with
previous MI, CAD, peripheral artery disease, and
diabetes, suggesting a key role for inflammation
in the development of these conditions.
 Levels of CRP tend to be higher in hypertension,
metabolic syndrome, and aging.
Interventions
 Mediterranean diet, high in fruits and
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vegetables and low in saturated fats
Fiber
Omega 3 FA
Vitamin A, C, D, E
Antioxidants
Chocolate
17. Excess Homocysteine
Homocysteine
 Amino acid found in the blood that we get usually
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from eating meat.
High levels of this can lead to early development of
HD and blood level disease.
Everyone should have this test done. Some doc will
say this is more of a predictor than cholesterol.
High levels of Hcy are independently associated with
risk of atherosclerosis and cardiac events and stroke.
Hcy is directly capable of injuring endothelial cells.
Functional Biomarker for Folate and B12 levels in the
blood.
Dietary Considerations
 Minimize coffee intake
 Avoid processed foods and trans fats.
 Emphasize Mediterranean-type diet; foods
rich in choline, whole grains, spinach, beets &
other vegetables
 Note: B12 deficiency is possible with low
stomach acid or vegan diet.
Supplemental Support…
 Folic acid (or 5-MTHF, 2-5 mg/d) vitamins
B12, B6, riboflavin, magnesium
 Consider CoQ10
 L-carnitine
 N-acetylcysteine (NAC) may displace Hcy
from binding to arterial walls
Heart Healthy Diet…
Food is by far the most powerful clinical intervention
in chronic disease.
Motto to live by: If it is made from a plant it is ok, if it
made in a plant its not.
Nutrigenomics
Plant based diet: a whole, unprocessed predominately
plant based
• Low Glycemic Load – the overall balance of the meal
• Proper Fatty Acid Composition – high level of healthy
omega-3 fats vs. omega-6 fats, low in saturated fats and
no trans fats.
• High Phytonutrient Density – high level of
phytonutrients and antioxidants
• Healthy Protein – lean, healthy predominately plant
based proteins, or pasture raised animal products
Nutrigenomics continued
• Low Allergenic Burden – low in foods that are highly
allergenic (gluten, dairy and others based on
personalized prescription)
• Low Toxic Burden – minimizes toxic burden of food,
e.g. no/low added hormones,pesticides, antibiotics or
any other artificial additives
• Healthy pH Balance – provides proper balance
between acidity and alkalinity
• Healthy Salt-Potassium Ratio – low in salt and high in
potassium
• High Fiber Content – high in fiber to help slow the
insulin response and optimize digestive health
Top 25 Foods for the Heart
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Salmon
Flaxseed (ground)
Oatmeal
Black or Kidney Beans
Almonds
Walnuts
Red wine
Tuna
Organic Tofu
Brown rice
Organic Soy milk
Blueberries
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Carrots
Spinach
Broccoli.
Sweet potato
Red bell peppers
Asparagus
Oranges
Tomatoes
Acorn squash
Cantaloupe
Papaya
Dark chocolate
Tea
Drug Induced Deficiencies
Aspirin
Diuretics
 Vitamin C
 Magnesium
 Folic Acid
 Potassium
 Glycine
 Sodium
 Histidine
 Zinc
 Potassium
 Increase in blood sugar
 Zinc
Statins
 Coenzyme Q10
 Vitamin K
Cardiovascular Testing
CV Health Profile
Cardio Ion Panel
CV Health Profile
LIPID MARKERS
Traditional Markers
LDL-cholesterol
HDL-cholesterol
Triglycerides
Total cholesterol
Lipid Particles
LDL-Particle # (LDL-P)
HDL-Particle # (HDL-P)
LDL particle size
Lipoprotein (a)
INDEPENDENT RISK FACTORS
High-Sensitivity C-Reactive Protein
(hsCRP)
Lp-Phospholipase A2 (Lp-PLA2)
Fibrinogen
Homocysteine
INSULIN RESISTANCE RISK MARKERS
Lipid Particle Number Lipid Particle Size
HDLL
HDL Size
LDLS
LDL Size
VLDLL
VLDL Size
Insulin Resistance Score
 Combination of analyses of organic acids, fatty
acids, vitamins, minerals, and antioxidants, with
a specific focus on amino acid absorption and
imbalances.
• Vitamin D & K
• Fibrinogen
• Homocysteine
• Coenzyme Q10
• Fasting Insulin
• C-reactive protein
Prevent a Broken Heart
Take Charge of Your Heart, Your Health, & Your Life!