Carnitine

Oct

2013

Pulmonary Arterial Hypertension

Late last week the FDA approved a new drug to treat Pulmonary Arterial Hypertension (PAH). The medication, called macitentan (Opsumit, Actelion) is the second drug approved this month to treat the debilitating disease. Earlier, the regulatory body approved a medication called riociguat (Adempas).

Micrograph showing a plexiform lesion of the lung, as seen in irreversible pulmonary hypertension. Image contributed by Bulent Celasun, MD, via Wikimedia Commons.

Pulmonary Arterial Hypertension is a condition that affects the blood circulation in the pulmonary system, which is medical term referring to respiratory mechanics and the lungs. Although no one knows exactly how many people have PAH, according to the American Thoracic Society (ATS), it may affect as many as hundreds of thousands of Americans. It can best be thought of as high blood pressure of the lung arteries and can lead to all kinds of unpleasant bodily symptoms including bluish lips, hands or feet, dizziness, fatigue and lethargy, shortness of breath, fainting and swelling in the lower extremities. PAH has no surgical cure, progresses rapidly and is marked by progressive degeneration and breakdown of the blood vessels that travel from the heart to the lungs. In a normal healthy body, blood is carried from the heart, then to the lungs, where it picks up oxygen, which is then in turn delivered back to the heart and then to the rest of the organs and tissues of the body. Under conditions of Pulmonary Arterial Hypertension however, pulmonary arterial constriction, i.e. a tightening of the blood vessels in the lungs, restricts flow resulting in a sluggish circulation to the heart as well as a decrease in the amount of blood and oxygen that is ultimately delivered to the rest of the body. In addition, long term hypertension in the pulmonary arteries can lead to vascular changes including thickening of vessel walls, inflammation and the formation of plaques, all of which can further impair circulation and blood flow. Most significantly as the condition progresses, the heart, which is forced to work harder and faster to compensate for the vascular changes, becomes weakened. This can result in heart failure which is the most common cause of death in cases of PAH.

PAH can be associated with various other disease states including connective tissue disease, hypothyroidism, liver disease and heart disease, HIV infection and stimulant drug intake. However the vast majority of cases, according to ATS literature are said to be idiopathic, meaning they are associated with no known cause.

Although there is no medical cure for Pulmonary Arterial Hypertension, drug treatments have traditionally focused on vasodilators, which open up the blood vessels. However these kinds of drugs can create potential problems via lowering blood pressure in the rest of the body and ultimately decreasing the flow of blood to the lungs. Although the recently approved drugs, macitentan and riociguat, operate via novel mechanisms they are still vasodilators and can result in the same kind of problems as the more conventional PAH medications.

As with other circulatory health challenges there are many nutritional and dietary strategies that may help improve PAH. According to researchers writing in the European Respiratory Journal in April 2013, there is an increased prevalence of insulin resistance in PAH patients. Thus, restoring insulin sensitivity by reducing the intake of sugars and refined carbs may have a beneficial effect. Additionally there are nutritional supplements that can be used that improve insulin response. Niacin, thiamin, chromium and vanadium can all increase insulin sensitivity. So can the mineral magnesium, which can the potentize effects of insulin, and can provide lung and circulatory benefits. Magnesium has also been used as a medical treatment for PAH in newborns. In a 2004 study of 12 newborn babies with pulmonary hypertension published in the Journal of Tropical Pediatrics, magnesium was found to be “a safe and effective pulmonary vasodilator”, which is medical talk for “a safe substance for opening up blood vessels in the lungs”.

Finally, according to the University of Maryland Medical Center, while not specifically associated with treating pulmonary arterial hypertension, there are several nutritional supplements that can be used to improve heart health function in general. These include carnitine (500mg, three times a day), CoQ10 (200-600mg a day), Vitamin E (400 IU a day), potassium (20mg and day) and taurine (1000mg twice a day).

May

2013

Eggs, Lecithin, Choline & TMAO

By Ben Fuchs | Pharmacist Ben

Summary:
1) Gut bacteria can convert eggs and lecithin into chemicals that are associated with heart disease.
2) These chemicals are also produced by the body they have a long and proven reputation for NON toxicity and perform many vital functions especially for the heart.
3) While elevated blood levels of these substances are associated with heart disease, the body has very efficient mechanisms for clearing them out.
4) If your blood levels of this chemicals are elevated, don’t blame the foods which can very helpful, healthy and nutritionally valuable.
5) If your blood levels of these chemicals are elevated you probably are dealing with a digestive health issue or a detoxification issue and not a food issue.

Earlier this week a study was published in the New England Journal of Medline that has raised quite an internet ruckus. According to the article, gut bacteria can metabolize substances found in eggs like lecithin, and choline into precursor of something called TMAO which again supposedly is linked to heart disease. And now the mainstream media, as they tend to do, are making the leap to “eggs and lecithin consumption is associated with heart disease”.

The NEJM study follows fast on the heels of another study, this one released by the Cleveland Clinic that implicated carnitine, an amino acid found in red meat in the production of TMAO. As with the egg and lecithin study researchers as well as the media again the hastily linked the carnitine derived TMAO with heart disease.

Here’s the problem with drawing these types of conclusions. First of all, they leave out the important and relevant fact that these substances, (e.g. carnitine, lecithin, choline) that are supposedly so dangerous for the health of your heart in addition to being found in foods, ARE MADE BY YOUR BODY! And , researchers advocating abstinence seem to be unaware of the fact that there is voluminous literature published over the course of at least 50 years that lend credence to these biochemicals as not only being gentle and benign, but really being very, very important. They perform numerous vital functions in the body and are beneficial for overall health as well as cardiovascular health.

Is it conceivable, even likely that blood levels of chemicals like TMAO are increased by the ingestion of certain foods and perhaps supplements like choline and carnitine? Yes. And no one disputes the possibility, based on their chemistry, that when these chemicals build up in the blood, toxicity, especially heart toxicity, can result (remember however: possible does NOT mean proven!)

The link between the offending cardiotoxic chemical TMAO and eggs and lecithin and choline and meat are bacteria that live in our large intestine. The critters, generically referred to as “probiotics” feed on these types of foods and readily convert them into precursors which the body then metabolizes into TMAO precursors

Bacteria like fatty nutrients as much as we do! And bacteria produce waste materials as a function of their digestion of foods just like we do. Our gut bacteria eat the food we eat and then they poop! Bacteria poop! This makes all food is a potential problem. Eating and digesting can, even under normal healthy circumstances result in the production of these kinds of wastes. This is why we want to be careful about what and how we eat. But we do need to eat.

We have trillions of bacterial cells that live with us. And they are our friends! They make vitamins and purify our blood and help us digest our food. They make good fats for our digestive tract and the fight yeast and other bacteria and cancer. And, they need to eat too. And, they eat what we eat. In other words, anything we eat is likely to feed these little critters. And one of the things bacteria produce as a result processing and digesting eggs and other foods are TMAO precursors. They’re the bacterial version of feces. And like all waste, it’s not supposed to hanging around. That’s why the body has mechanisms for dealing with these types of chemicals. The liver has enzymes for processing it and most of it is eliminated very effectively through urine.

The bottom line is if blood levels of TMAO are elevated, eggs are not the issue. Nor is lecithin or choline or carnitine or any other vitamin or nutrient biochemical. The issue is bad blood chemistry following a breakdown in digestive tract health that leads to an accumulation of food derived WASTE; it’s not the fault of the food. If your metabolic and detoxification systems are whacked out and you are accumulating TMAO in the blood, solving the problem by avoiding eggs and lecithin and choline is simplistic and silly. These supposed bad guys like lecithin and eggs, are not only innocent bystanders, they are motherlodes of nutrients that make your heart strong and health. Substances like Vitamin A and D and Zinc, the b-complex, choline, essential fats and precious phospholipids. And meat carnitine is one of the most important, heart- strengthening amino acids you can ingest. Please, don’t blame these healthy foods. It’s not their fault. What we need to be doing instead of staying away from these powerful and important foods and supplements is fixing our guts, fixing our digestive systems.

Is elevated TMAO problematic? Perhaps. The chemistry is right for it. These kinds of chemicals are unstable and need to be eliminated from the body. That’s why you have a liver and that’s why you should be careful about how you eat. But this is a far cry from the claim that eggs or lecithin cause or are even associated with heart disease.

Jan

2012

Top 12 Heart Nutrients Part 2

By Ben Fuchs | Pharmacist Ben

According to the U.S Department of Health and Human Services, nearly one in 5 Americans is dealing with some form of heart disease. Much of this is needless suffering and can be alleviated with appropriate life style strategies.

Exercise is important. So is making good food choices and being a non-smoker. But there is nothing more important than getting on a good nutritional supplement program. Last post we listed the first part of the top 12 supplements for cardiovascular health.

We conclude with Top 12 Heart Nutrients Part 2 below. For more detailed information make sure to listen to The Bright Side on the Genesis Communication Network, daily 8 to 9 PST, 11-12 EST (The Bright Side).

Omega 3s –thin the blood and relax blood vessels allowing for more blood flow and oxygen to the heart. Provide well-researched and dramatic protection against cardiovascular disease and fatal heart attacks. Reduces inflammation and may improve blood fats and cholesterol too. Fish oil works but Krill Oil may be
even better.

CoQ10 –super vita-nutrient for the heart. Used by cardiac cells to produce energy and as a defense against rogue oxygen “sparks”. Thousands of studies show protection against all forms of heart disease.May help lower blood pressure too. Look for oil-soluble gel caps.

B Vitamins –protection from cardio-toxic homocysteine. Intimate involvement in energy production chemistry make these nutrient absolutely indispensable for protection against all forms of heart disease. Vitamin B3 helps lower triglycerides and cholesterol too. Water-soluble format leads to rapid excretion and potential deficiencies.Dissolve in liquid and drink them all day long for maximum benefits.

Carnitine – take as L-Carnitine or for maximum cardiac benefits as Propionyl L-Carnitine. A must-have supplement for all form of heart disease.Critical for the production of energy from fat (fat-burning) by cardiac cells.Numerous studies demonstrate benefits for coronary artery disease as well as myocardial ischemia (lack of blood flow to the heart).

Vitamin E – provides vital cardiac protection from oxidized (rancid) cholesterol plaques.Thins blood and helps maintain heart oxygenation.Reduces free radical activity in heart.Take as both tocopherols and tocotrienols (mixed tocopherols and mixed tocotrienols) in mixed format for best results.Especially important for smokers and as protection from a second heart attack.

Chromium – low levels associated with increased risk of heart attacks.Chromium deficient diabetics especially at risk for heart attacks.Critical role in sugar metabolism provides benefits for the cardiovascular system.May improve high blood pressure too.Niacin bound form (chromium polynicotinate) most effective for protection from heart disease.