Atherosclerosis

Question 1

Atherosclerosis Aetiology

Answer 1

Endothelial dysfunction
Inflammation
Dyslipidaemia

Question 2

Atherosclerosis: Natural Approach

Answer 2

• Promote a healthy lipid profile
• Increase dietary fibre (30–35 g / day)
• Support endothelial health and vasodilation
• Hawthorn berries, bilberry, blueberries and blackcurrants are antioxidant and support blood vessel integrity and tone.
  -Lower ET-1 levels: Enhance citrus flavonoids, quercetin, epicatechins, garlic, olive oil, ginkgo, folate, blackcurrant.
• Beetroot contains inorganic nitrates that convert to NO in the body. Also ↓ homocysteine― contains betaine which is utilised by the enzyme BHMT that re-methylates homocysteine to methionine.
• L-theanine ↑ NO production in ED cells through eNOS phosphorylation (green tea is a key source).
• Reduce homocysteine
• Lower fibrinogen levels
• Mediterranean style diet
• Exercise
• Promote and support liver detox

Question 3

Atherosclerosis: Schisandra fruit

Answer 3

Supports liver function and is a powerful activator of phase I detoxification without increasing harmful bioactivation (antioxidant and hepatoprotective effects). Enhances phase II detoxification.

Dose: 2–3 dried fruit infused twice daily. Dried berries can be eaten as a ‘superfood’.

Question 4

Atherosclerosis: Nutrients

Answer 4

L-citrulline
Pantothenic acid (B5)
Niacin (B3)
Omega 3
Pomegranate
Pycogenol
Lycopene
Citrus Bergamia
Globe artichoke

Question 5

Atherosclerosis: L-citruline

Answer 5

500–3000 mg / day

• NO is synthesised from L-arginine by eNOS.
• Arginase in intestinal enterocytes andfirst-pass metabolism (FPM) in the liver ↓the availability of oral L-arginine supplementation. L-citrulline is not affected by arginase and skips FPM before conversion to arginine by argininosuccinate lyase in the kidneys, so is preferrable to enhance both arginine and NO bioavailability.
• Renal arginine regulates BP, blocks formation of endothelin, ↓renal sodium reabsorption and is a potent antioxidant.

Question 6

Atherosclerosis: Pantothenic Acid (B5)

Answer 6

300 mg x 3 daily

• Metabolised to cystamine-SH. Reduces TC, LDL, Apo-B, TG and increases HDL over 4 months with a peak effect at 6 months.
• Reduces lipid deposition, oxidation and fatty streak formation. Appears to be especially useful in lowering lipids in diabetic patients.

Question 7

Atherosclerosis: Niacin (B3)

Answer 7

500–3000 mg daily

• Niacin reduces TC, LDL, Apo-B, LDL-P, TGs and VLDL.
• Also shown to decrease fibrinogen.
• Note: Can cause niacin flush, GI disturbance.

Question 8

Atherosclerosis: Omega - 3

Answer 8

3000–5000 mg / day

• Reduces TG, VLDL, LDL-P and chylomicron remnants. Uniquely reduces Lp-PLA 2.
• Anti-inflammatory, anti-thrombotic, lowers BP, heart rate and IR.PPAR-α agonist.
• Reduces CVD progression and stabilises plaques.

Question 9

Atherosclerosis: Pomegranate

Answer 9

250 ml of juice (pure) per day
or 1–2 cups of seeds per day

• Improves HDL function, ↑reverse cholesterol transport.
• Potent antioxidant, ↓oxLDL and macrophage LDL uptake.
• Decreases progression of carotid artery IMT (marker of atherosclerosis).
• Reduces BP mostly in those with high oxidative stress.

Question 10

Atherosclerosis: Pycogenol (pine bark extract)

Answer 10

100–200 mg / day

• Flavonoid, antioxidant, anti-inflammatory,anti-thrombotic.
• Enhances NO and ED function, reduces BP and Hs-CRP.
• ↓myeloperoxidase― an enzyme secreted from macrophages that ↑ oxidation of lipoproteins in atheroma.
• Appears to reduce foam cell formation in atherosclerosis.

Question 11

Atherosclerosis: Lycopene

Answer 11

25 mg/day

• Anti-oxidant. Suppresses intestinal cholesterol absorption. Lowers TC, LDL-C, inflammation and increases HDL-C.
• Activates PPAR-γ.
• Studies show reduction in carotid atherosclerosis.

Question 12

Atherosclerosis: Citrus Bergamia

Answer 12

500 - 1000 mg/day

• Bergamot (citrus fruit): Natural source of flavonoids, e.g., naringin, hesperidin, neohesperidin and neoeriocitrin.
• Lowers LDL and TGs. Increases PPAR activation.
• Reduces ROS, oxidised LDL, balances blood glucose and reduces weight.
• Improves serum glucose via AMPK and GLUT 4 receptor.

Question 13

Atherosclerosis: Globe Artichoke

Answer 13

Dietary + 1-2g/day powdered

• Reduces serum LDL, TC and TGs.
• Regulates lipid metabolism, increasesbile production, is antioxidant and hepatoprotective.