KNES 337 - Unit 19 Nutrition and Heart Disease and 20 Vitamins

heart disease

• 2nd leading cause of death in Canada

• Accounts for 25% of deaths in Canada

• Strikes as many women as men

  • But women on average die 10 years later 

heart disease in women

women die 10 years later than men

• Because of estrogen - estrogen is protective against heart disease, keeps cholesterol levels in check 

• Menopause - estrogen production stops, protection lost, risk increases after menopause 

factors contributing to CVD risk

• Smoking

• Hypertension

• High LDL / low HDL

• Obesity, especially central/abdominal 

• Diabetes (2-4x higher risk than those who don’t have diabetes)

• Lack of exercise

• Heredity

• Gender - men more likely to develop earlier

• Menopause in women 

causes of CVD

• Elevated blood cholesterol and triglycerides

• Chronic inflammation

  • Conditions above increase plaque formation in the arteries 

  • Interrelated conditions and work together to increase atherosclerosis

heart attack symptoms in men

nausea or vomiting, jaw, neck, back pain, squeezing chest pressure or pain, shortness of breath

heart attack symptoms in women

nausea or vomiting, jaw, neck, upper back pain, chest pain (but not always), pain or pressure in lower chest or upper abdomen, fainting, shortness of breath, indigestion, extreme fatigue

liver

• Newly digested fats transported by chylomicron lipoproteins

• Chylomicron gives fat to tissues that need it 

• Remnants of chylomicron return to liver 

• Liver releases fats made or processed there 

lipid processing

• Packages lipids into very low density lipoprotein (VLDL)

• VLDL makes fats available to body cells via enzyme action

• LDL comes from VLDL 

• LDL carries mostly cholesterol to body cells, travels through blood vessels, is vulnerable to attack by oxygen and has affinity for linings of artery walls - contributing to plaque build up 

lipoproteins

• Chylomicron = mostly triglycerides (80%)

• VLDL = mostly triglyceride from liver (50%), also cholesterol

• LDL = mostly cholesterol (50%)

• HDL = mostly protein (50%)

chylomicron

mostly triglycerides (80%)

VLDL

mostly triglyceride from liver (50%), also cholesterol

LDL

mostly cholesterol (50%)

HDL

mostly protein (50%)

blood cholesterol

HDL helps remove cholesterol from the blood, escorts it to the liver for excretion, high HDL protects against heart disease

LDL cholesterol gets incorporated into plaque (narrows blood vessels), elevated LDL increase the chances of heart disease 

triglycerides

transported attached to VLDL cholesterol, high blood levels of triglycerides increases heart disease risk, efforts to prevent and treat heart disease should include a focus on blood triglyceride levels

to improve cholesterol and LDL

• Decrease intake of saturated fats (<10% of calories) and trans fat (0 grams/day)

• Increase intake of fiber

• Lose weight if necessary

to improve HDL cholesterol

• Increase physical activity

• Quit smoking

• Lose weight if necessary 

to improve triglycerides

• Decrease intake of sugar, alcohol, total fat (<30% of calories)

• Lose weight if necessary 

• Increase activity 

rickets

vitamin D deficiency, knocked knees, bone deformation 

• 1880-1920 - 90% of children in parts of Europe and in Boston had rickets (industrialization era)

  • Smoke from coal-burning fires absorbed much of UV portion of sunlight which was needed to produce vitamin D in the skin

  • If you exposed children to UV light, symptoms of rickets disappeared (discovered in 1921) 

beri beri

thiamin deficiency (B vitamin), fatigue, complications in cardiovascular, nervous, muscular and GI symptoms, trouble walking  

• Japanese doctor saw this in navy crew who ate only polished white rice, but not the crew who got meat, beans, and barley 

  • Polished rice with husk, bran, and germ removed = strips nutrients

pellagra

niacin deficiency disease, 3 Ds - dermatitis (itchy skin), diarrhea, dementia

• Early 1900s in southeastern USA - cotton economy failed, people ate corn as a staple, lived off of corn

• Niacin in corn is tightly bound and not very available for absorption

• 1907-1940 in USA had 3 million cases, and 100 000 deaths

vitamin A deficiency

leading cause of preventable childhood blindness and increases the risk of death from common childhood illnesses such as diarrhea, night blindness is one of the first signs

beta-carotene

precursor to vitamin A - plant foods

• Deep orange fruits and vegetables, dark green vegetables

• No upper tolerable limit but high intakes may turn skin yellow-orange

retinol

pre-formed vitamin A - animal foods 

• There is an upper limit - can develop toxicity

• In every animal product with fat (liver, fish, dairy, eggs)

• Vitamin A derivative (retinoids) used in some acne medications (e.g. accutane)

  • Retinoids dangerous for developing fetus - miscarriage, severe birth defects, death

  • Avoid getting pregnant for 4 weeks after use to eliminate risks

goiter

iodine deficiency, iodine needed for production of thyroid hormone, swelling in throat near thyroid gland 

hypothyroidism

• due to iodine deficiency, weight gain, inability to tolerate cold, fatigue 

• Can lead to intellectual disabilities in children if mother was deficient during pregnancy

• Approximately 30% of the world’s population remains at risk for iodine deficiency 

• Most iodine comes from salt in a shaker, and some seafood, eggs, and dairy

  • Sea salt - no iodine, most are very low in iodine 

  • Iodized table salt is good 

water-soluble vitamins

vitamin B and C

• they “wash out” of the body in one to several days

  • Except for B₁₂ as it can be stored up to one year in the liver

  • This does not make them safe in high doses 

    • Vitamin B₆, niacin, and C can be toxic in high doses (upper limits)

    • Megadoses stress the kidney

• Water soluble vitamins are easily destroyed during food storage and preparation

fat-soluble vitamins

vitamin A, D, E, K

folate

one of 8 B vitamins, synthetic form = folic acid

food sources of folate

• leafy green vegetables, legumes, lentils, fortified grain products

• Most common food sources is enriched or fortified food products

folic acid

synthetic form of folate, more bioavailable than naturally occurring food folate

minimizing nutrient losses

1. Refrigerate fruits and vegetables

• Banana stems taped - fruits give off ethylene gas when ripening which can ripen other fruits nearby

  • If wrap stems with plastic to prevent ethylene gas release, bananas will last longer 

• If you put a banana in the fridge, it will never ripen - if you put it in the fridge for a long time, they can get bitter

2. To minimize oxidation, reduce contact with air

3. Wash fruits and vegetables before cutting

4. To minimize cooking losses, steam or stir-fry vegetables. Avoid high temperature for a long time. 

folate and health

• Important for cancer prevention - involved in stabilizing DNA 

• Lack of folate reduces DNA stability 

  • Deficiency induces and accelerates carcinogenesis (mutation in DNA can lead to cancer)

  • Structure of cell’s genetic material becomes disrupted → accumulate abnormalities → cancer

• Heart health

  • Lack of folate causes homocysteine to accumulate in blood

  • High homocysteine → heart attacks, strokes 

• Fetal health

  • Almost complete absence of spinal cord and brain deformities (neural tube defects) in babies born to mothers consuming adequate folate 

  • 2 most common neural tube defects - spina bifida (treatable) and anencephaly (fatal - portion of brain and skull missing)

folate recommended intakes

• 400 µg for all females

• 600 µg during pregnancy

  • If a mother had a baby with a previous neural tube defect, she will need 4 mg (during her next pregnancy)

vitamin C

• Protects tissues from oxidative stress (an antioxidant) - a result of free radicals that are produced in response to normal metabolism using oxygen (UV radiation, air pollution, tobacco smoke)

  • Over time, lead to increased risk of cancer, heart disease, and arthritis

• neutralizes free radicals along with vitamin E and other phytochemicals found in fruits and vegetables

• Helps form collagen - fibrous structural protein of connective tissues (bones, teeth, blood vessels, wounds)

free radicals

missing an electron, robbers which are deficient in energy, attach and snatch an electron from other cells to satisfy themselves, thus damaging the cells membrane

• Antioxidants can donate free radicals electrons

vitamin C and collagen

• Helps form collagen - fibrous structural protein of connective tissues (bones, teeth, blood vessels, wounds)

• Assists in preventing bruising, with vitamin C deficiency, tissue hemorrhage or bleeding is a major symptom 

  • Weak connective tissue if no vitamin C

  • With vitamin C, collagen is well organized and hydroxylated

• Can take vitamin C during healing to improve connective tissue

vitamin C and stress

• Adrenal glands contain more vitamin C than any other organ

• Released with stress hormones (cortisol) during stress reaction

• Stresses: infections, burns, toxic heavy metals, chronic aspirin, barbiturates (sedatives), oral contraceptives, cigarette smoking 

  • Oral contraceptives also affects B6, B12, folate

vitamin C recommended intakes

• Males = 90 mg/day

• Females = 75 mg/day 

• Smoking

  • Need to take additional 35 mg/day 

  • Studies shown that level of vitamin C can be 7 times lower in smokers

  • Body’s ability to fight disease, including cancer, is reduced

common cold

• 1 g/day of vitamin C led to 1 day shorter cold and reduced severity of symptoms (by 23%)

• Vitamin C reduces blood histamine but at a dose of 2 g daily for 2 weeks

• Body’s need - 10 mg prevent scurvy

excess vitamin C

Excess → nausea, diarrhea, abdominal cramps, excessive gas 

vitamin D and bone growth

Raises blood concentrations of Ca and phosphorus 

• Increases absorption of calcium from the intestine

• Increases reabsorption of calcium from kidneys

• Mobilization of calcium from bones into blood 

vitamin D and cancer

Recent research - increased vitamin D intake reduces breast, prostate, and colon cancer risks 

vitamin D and multiple sclerosis and rheumatoid arthritis

• Living higher than 37 degree latitude increases multiple sclerosis risk by over 100% 

  • Canada has high incidence of MS - due to vitamin D status

• 400 IU supplement decreases risk by 40% 

vitamin D synthesis and activation

• 10-15 min of daily sunlight in the summer, with forearms and lower legs exposed produces sufficient vitamin D (double suggested for darker pigmented skin)

• Food sources - fortified dairy foods, fortified margarine, fish oils, egg yolk

• Fluid milk is most reliable source

• in the skin

  • precursor from cholesterol made in liver → + foods = vitamin D (inactive)

  • processed in the liver then the kidneys → active form

Canada

• we don’t have any vitamin D production in our skin from October to March vs. USA

  • Calgary has more sunny days than most Canadian cities 

    • But the angle that the sun is hitting us, doesn’t stimulate vitamin D production in the skin (zenith angle)

reduced vitamin D

1. 70 years and older - vitamin D production falls to 30% of younger adults

2. Institutionalized individuals at high risk

3. Sunscreen - reduce or block vitamin D synthesis, but not completely

• Can be out in the sun for 15 min, then put sunscreen on

vitamin D recommended intakes

for adults is 600 IU, for those > 70 it’s 800 IU

• Tough to get from food, therefore supplement is recommended