Nutritional Medicine

Getting the balance

right
 Overview
 Nutritional Medicine is conceptually
mainstream
 Functional vs pathological model
 Politics, perceptions and evidence in medicine
 Inadequacy of modern diets
 Factors affecting nutrient requirements
 Digestion, anti-nutrients, nutrient losses,SNiPs
 Nutrient deficiencies: common misconceptions
 Is Nutritional and Environmental
Medicine part of main stream
medicine
 Diet Advice
 Dyslipidaemia
 NIDDM,

 Weight loss,

 Cancer Prevention

 Pregnancy

 Gout

 Osteoporosis
 Preventative Medicine
Take at least 3 times daily
 Mainstream NEM
 Specific Nutrients ( treatment and prevention)
 Osteoporosis
 Calcium Vitamin D
 Emerging (Magnesium and other Mn, boron, Vit K)
 Anaemia
 B12 Folate Iron
 Other b6 zn copper
 Pregnancy
 Folate , iron
 Emerging Vitamin D, Iodine, Fish oil, antioxidants
 Magnesium ( preeclampsia)
 Mainstream NEM
 Cardiovascular Disease
 Oxygen
 K, Na ( in hypertension CCF)
 Ca/Mg
 CoQ10, Selenium
 Depression
 B12, folate , iron,
 Zinc, Ca,B1 B2, B3, B6, Vitamin D, SAMe, Vit C
 Amino Acids ( Tryptophan, tyrosine, methionine)
 Essential Fatty acids
 Parkinsons Disease
 L Dopa
Resistance to Lifestyle Change
 Is NEM different to mainstream
medicine
 Foundation the same
 History, Examination, Provisional Diagnosis
 Investigations
 Difference Pathological model vs functional model
 Is the assymptomatic patient with no classical cardiac risk
factors healthy the day before his MI ?
 Is the teenager with mild acne consuming soft drinks, chips
and takeaway daily actually healthy?
 Does the skinny woman with the 3 dental caries and a
normal fasting BSL who craves and lives on sweets have
normal carbohydrate metabolism or is she a metabolic time
bomb?
 Are mild PMS and menopausal symptoms really normal?
 Pathological vs functional model
 Pathological
 Normal = absence of disease
 Reactive
 Assesses disease
 References ranges based on
average population and absence
of disease
 Struggles with atypical
presentation
 Functional Model
 Normal = healthy
 Predictive
 Assesses risk factors/ lifestyle
 Reference range based on optimal
function disease prevention
 Atypical presentations syndromes
dealt with systematically eg IBS,
CFS Fibromyalgia, MCS, PMS
 Heart sink patients less daunting
 NEM vs allopathic approach
 Bowel Cancer Prevention
 Allopathic: FOBT and Colonoscopy (2°prevention)
 NEM: Increase fibre, reduce red meat, reduce weight, increase fruit
and veges ( especially colourful and green leafy, folate, b12, fish oil,
licorice, probiotics, smoking cessation
 Breast Cancer
 Allopathic BSE, Mammography/ultrasound, BRACA, mastectomy,
tamoxifen
 NEM reduce weight smoking cessation, increase fibre, increase
colourful and green leafy veges, probiotics, reduce oestrogen, increase
progesterone, reduce xenoestrogens (cadmium, pesticides,
petrochemicals/ plastics), reduce aromatase in makeups nail polish etc,
Optimise folate ,b12, selenium, Vitamin D iodine; cruciferous
vegetables
 NEM vs Allopathic
Choose your Medicine
 Models of health care
Surgery
Lifestyle
modification
Drugs and herbs

Hormonal supplemention Surgery

Nutritional supplements
Vitamins Minerals

Lifestyle modification Drugs

Diet Exercise Sleep Stress management
No smoking,, Limit alcohol
Limit environmental toxins
Adequate sunlight Love Community
 Why are we not addressing the
underlying cause of disease
 Politics
 especially re environmental toxins
 Finance Funding (limited for RCTs for nutritional rx)
 Paradigm and ego
 A new scientific truth does not triumph by convincing its opponents
and making them see the light but rather because its opponents
eventually die and a new generation shows up that is familiar with it
Max Planck
 Education
 Medical Publication bias
 (we only read medical not basic science journals and nutritional/
environmental journals)
Old Habits Die Hard
 Politics and toxicology
 1000 new toxic chemicals are released into the environment
each year
 Industrial lobby is very strong
 Smoking, fast food advertising, asbestos
 Green house skeptics
 Toxicity studies
 Safety testing
 looks only at mutagenicity and carcinogenicity
 Does not consider synergism eg mercury 1% LD 50 and lead 10%
LD50 kills 100% of mice
 Delays between exposure and effects
 Eg Diethylstilboestrol causes cervical and breast cancer in offspring
 Does not consider genetic susceptibility
 Research Funding
 US National Cancer Institute
 Occupational cancer
 10% of all cancer
 < 1% of cancer research dollars

 US Govt Budget 1976

 $51.4billion on cancer research
 $1million on carcinogens
 Conflicts of interest
 Breast Cancer Awareness Month 1° sponsor
Astra Zeneca
 Manufactures
 Tamoxifen
 Herbicides and fungicides including carcinogen acetchlor

 Chemical plant in ohio is the 3rd largest source of

potential carcinogens in US
 No AWARENESS of roles of these carcinogens in
promotional material for awareness week
 Conflicts of Interest
 General Electric
 Major producer of mammogram machines
 Major producerof polychlorinated biphenyls
 PCBs
 classified by EPA as probable human carcinogens
 Linked to breast cancer in several studies
 ? Evidence Base for Mammography
 Early detection of breast cancer does not lead to improved
survivor time
 Olsen O et al ‘Cochrane Review on screening for breast cancer
with mammography’ Lancet Oct 2001
 Alexandra Barratt et al., ‘Model of outcomes of screening
mammography: Information to support informed choices’ BMJ
Apr 2005
Industry Ethics and Education
 ? Evidence Based Medicine
 The Office of Technology Assessment, a branch of the United
States Congress, 1978 " . . . only 10 to 20 percent of all procedures
currently used in medical practice have been shown to be
efficacious by controlled trial." Therefore, 80% to 90% of medical
procedures routinely performed are unproven. That report further
points out that the research which purports to prove effectiveness
of the remaining 10% to 20% of medical procedures is largely
flawed, and "many of the other procedures may not be
efficacious."

 85% of all medical therapies and surgeries are unproved BMJ Oct
1991

 WHO - 90% of all diseases today are not curable with modern
therapies
Misinformation in medical media
 Medical Observer Headline August 2007 re Cochrane
Metanalysis of Vitamin C of 11000 people/ 29 trials
 “Vitamin C won’t keep cold away”
 Small print
 “in people subject to extreme physical stress – such as
marathon runners and skiers – prophylactic vitamin C
halved the risk of contracting a cold “
 “Overall, high-dose vitamin C reduced cold duration an
average 8% for adults and 13.5% for children “
 “Trials showed consistent and statistically significant
small benefits in easing severity of symptoms for those
using regular vitamin C prophylaxis “
 Education Bias
What we can learn from vets
 Harrisons Principles of
Internal Medicine
 Entries
 Zinc deficiency 4
 Magnesium Deficiency 0
 Selenium 5
 selenium deficiency 0
 Diseases of Livestock
by Thomas Hungerford
 Entries
 Zinc Deficiency 19
 Magnesium Deficiency
11
 Selenium 50
 Selenium Deficiency 34
 Fundamentals of NEM
 Based on biochemistry and cellular physiology
 Manage Underlying Cause of illness and process driven
 Consider evolutionary background and epigenetics
 Consider biochemical individualiry and genetic polymorphism
 Aims at homeostasis balance is the key more is not better
 Considers factors effecting nutritional balance
 DIGESTION!!!!!
 Declining nutrient density of food, esp. minerals and plant chemicals
 Soil biology and chemistry
 Tissue uptake and maldistribution
 Nutrient activation and interaction
 Increased nutrient demand and losses
 Toxicology and increasing toxic burden
 Measure the right compartment and understand the meaning of tests
 Behavioral psychology
 Global Malnutrition
 Undernutrition
 Marasmus
 Kwashiokor
 Micronutrients
 Overnutrition Obesity
 Nutrition Transition
 Undernutrition
 Developing world ¼ underweight (146 million
 Unicef 2006
 Childhood malnutrition kills 6 million pa
 Black et al 2003
 Underweight < 5yo South Asia 46%
 Micronutrient Deficiency
 Vitamin A 100-140 million children
 WHO 2004
 Iodine
 Iron
 Zinc
 B12 and Folate
 Thiamine
 Vitamin D
 Mortality reduction pa < 5yo
 Breastfeeding 1.3 million (13% of deaths)
 ORS 1.5 million (15%0
 Complementary Feeding 587000 (6%)
 Zinc
 Prophylactic 459000 (5%)
 Treatment 394000 (4%)
 Vitamin A
 Prophylactic 225000 (2%)
 Treatment 8000
 Water Sanitation 403000 (4%)
 Measles vaccination 133000 (1%)
 Jones et al 2003
 Malnutrition and Hospital
Admissions
 Half of hospitalised patients have malnutrition
 Nutritional Status declines in hospital
 Catabolism
 Increase nutrient demands
 Declining nutrition increases post discharge
morbidity/mortality
 Mcwhirter & Pennington. Incidence and recognition of malnutrition
in a hopsital. BMJ 1994
 Braun et al Prevalence of malutrition in surgical patients: evaluation
of nutritional support and documentation. Clin Nutr 1999
 Braunschweig. Impact of declines in nutrititional status on
outcomes in adult patients hospitalized for more than 7 days. J Am
Diet Assic 2000
 Is our diet Adequate
 “the usual US diet provides an insufficient
amount of [many] vitamins, supplementation
is inexpensive, and the scientific evidence
shows that supplementing with certain
vitamins prevents chronic disease, specifically
cardiovascular disease, various types of cancer
and osteoporosis”
 Fairfield KM, Fletcher RH. Vitamins for Chronic Disease Prevention in Adults;
Clinical Applications. JAMA. June 19, 2002; 287,23:3127-3129
 What have we evolved for
 Consensus is that evolutionary adaptation
proceeds slowly, by random mutations
conferring positive, negative or neutral
advantage in current environment
 In humans, random genetic mutation altering
metabolism every 20,000 yrs
 Most genes concerned with cell function
 Optimal human environment
 The natural prehistoric world
 Pristine water, edible plants, healthy wild
animals and seafood, ALL RAW!
 Graze, one thing at a time, drink to full
 Active, outdoor, breathing, sunshine, daylight,
movement, rest
 Either natural food or nothing, sparing enzymes
 No chemicals, radiation, pollutants, xenobiotics
 Hunter-gatherer diets.
Analysis of dietary intake of 229 Hunter-Gatherer
populations around the world showed median animal
food intakes of
66 – 75% and plant food intakes 26 – 35% of total
energy.
Cordain L, Eaton SB et al. 2002. EJCN.56,Suppl 1:S42–S52.

Animal Plant food

Population
food (%) (%)
Ache (Paraguay) 25S 78 22
!Kung (Africa) 20S 68 32
Aborigines (Arnhem Land) 12S 77 23
Anbarra (Australia) 12S 75 25
Hiwi (Venezuela) 6N 75 25
Onge (Andaman Is) 12N 79 21
 Paleolithic diet: Modern Diet
Protein ~ 30-40% 10-20%
Carbohydrates ~ 35% 60-70%
sugars ~ 2-3% 15%
Fats ~ 30-35% 30-35%
Saturated fats ~ 7.5% 15-30%
Trans-fat < 1% 5-10% of fats
Omega-6/omega-3 ~ 2:1 10-20:1
Na/K ratio 1:4 4:1
 Paleolithic diet vs DRI
 DRI generally based on average intake in apparently
healthy and prevention of “nutritional deficiency
diseases” not optimal health
 Paleolithic diet
 Iron 8x higher, Fibre 6.5 x, Vitamin C 6x
 Riboflavin and Vitamin E 3.5x
 Zinc 3x,
 Thiamine, Calcium, B Carotene 2.5x
 Vitamin A Folate x 2
Declining nutrient density of food
 Study of 43 garden crops 1950-99
 Examined 13 nutrients
 6 decreased significantly
 Riboflavin 38%, Iron and Vitamin C 15%
 Phosphorous 9%
 Protein and potassium 6%
 Davis DR et al J Am Coll Nutr 2004
 Study 27 vegetables 10 meats 17 fruit
 Demonstrated mineral content decreased 50-70%
 Nutr Health. 2003;17(2):85-115. Links
 A study on the mineral depletion of the foods available to us as a
nation over the period 1940 to 1991.
 Thomas D
 Soil depletion
 Superphosphate fertiliser lowers soil pH
 Acidic soil inhibits uptake of Mg, Se and Mo
 Lime to balance acid but calcium decreases
absorption of Mg Se B Mn Zn Fe
 Plants do not require selenium to grow
 Animal and people do
 Deficiency associated with retained placenta,
mastitis, cancer , cardiomyopathy etc
Average loss of nutrients when fruit and
veges canned
 Tocopherols 95%  Manganese 50%
 Thiamine 80%  Zinc 50%
 Pantothenic acid B5
75%
 Selenium 35%
 Pyridoxine B6 72%
 Magnesium 30%
 Vitamin C 70%  Calcium 25%
 Folate 70%
 Riboflavin 45%
 Carotenoids 40%
 Niacin 40%
 Loss of Nutrients with cooking
 Boiling and B1
 Asparagus 20% loss
 Brussels sprout 30% loss

 Boiled Carrot
 Copper loss 65% Riboflavin 45%
 Cruciferous vegetables optimum availability of
phytonutrients after only 90s of steaming
 Optimal Digestion
 Eat slowly chew +++
 Mechanical, salivary enzymes, neurohumoral signalling eg
gastrin
 Relaxed ( digestion is parasympathetic)
 Adequate gastric acid ( requires Zinc b1 b6)
pepsinogen and intrinsic factor
 Adequate pancreatic enzymes and bile
 Normal bacterial flora
 E coli provides B2, folate, vitamin K, coenzyme q 10,
tryptophan, tyrosine
 Healthy mucosa
 Acid Suppression with PPI
 Associated with increased osteoporotic
fracture
 Hip 1yr use > 50yo OR 1.44 incresing with high
dose
 Hip wrist or vertebra OR 1.92 at 7 year in > 50 yo
 : Am J Gastroenterol. 2009 Mar;104(2 Suppl):S21-6.
:Proton pump inhibitors and bone fractures?
 Likely due to reduced calcium and magnesium
absorption
 PPI and digestion
 Reduce protein digestion
 Reduce B12 absorption
 Reduce micronutrient absorption
 zinc selenium Mn all require acid stimulus to
release picolinate
 Associated increase Gram negative pneumonia,
diarrhoea, Cl Difficile, Interstitial Nephritis
 H pylori prefer a less acidic environment
 GORD associated with hypochlorhydria
 Nutrient Blockade
 Nutrient is in blood but not in tissue
 Eg CO blocks O2 delivery
 Cadmium and mercury block Zn function
 Nutrient Activation Inhibited by oxidation
 eg Pyridoxine to pyridoxal 5 phosphate
 requires zinc and energy
 B12 to methyl B12 inhibited by oxidation
 requires B2 folate methionine)
 Can measure normal nutrient in blood and have
functional deficiency
 Need a functional marker eg methylmalonic acid for b12
 Measuring Nutrients
 Normal ranges based on Mean and 2 standard deviations not
physiolgoical
 Normal homocysteine < 15 But >10 doubles CV risk
 B 12 < 300 associated with increaser cancer risk
 Zinc < 14 associated with depression poor cognition and
behavioural disorders
 Serum levels do not reflect tissue levels
 Measure
 ferritin and transferrin not serum fe
 Red cell folate
 Serum magnesium, calcium, potassium do not reflect body stores
 Measure Red cell minerals, 24 hour urine minerals, hair, PTH
 Nutrient losses
 Diabetes
 lose Zn Mg and Cr in urine
 depletion of antioxidants
 Magnesium loss with diuretics sweating alcohol
caffeine
 ACE inhibitors change cellular distribution of zinc and
magnesium
 Paracetamol depletes glutathione
 hence use of precursor N acetyl cysteine in paracetamol
overdose
 Statins reduce production of Coenzyme Q 10
 Magnesium diuretics and
arrhythmia
 “ serious risks of potassium and magnesium depletion associated with
diuretic therapy”

“serum potassium and magnesium levels may be normal in the

presence of tissue depletion, “

. “Ventricular ectopy has also been associated with depletion of potassium

and magnesium, “

“may explain the increased risk of sudden unexpected death “

 Hollifield JW.
Am J Med. 1987 Mar 20;82(3A):30-7.
Magnesium depletion, diuretics, and arrhythmias.
 Increased Nutrient Demand
 Breast feeding
 Pregnancy
 Trauma
 Surgery
 Radiotherapy
 Chemotherapy
 Burns,
 Exercise
 Stress
Biochemical Individuality and single
nucleotide polymorphisms (SNiPs)
 M3 millions SNiPs exist in the human genome
 0.1% difference in DNA resulting in altered gene and protein
structure and functional change eg in Enzyme function
 Methyltetrahydrofolate reductase SNiP (MTHFR)
677TT
 27% anglo pop have SNiP with abnormal methylation
reduced donation methyl from folate to B12
 Increases homocysteine, risk of CVA, migraine, DVT, miscarriage,
infertility, depression
 B2 cofactor binding domain doesn’t work
 Overcome by 50-100mg of B2 cf DRI ( RDA) approx 1mg
 RCT showing decrease migraine with B2 Rx
 High dose vitamins/minerals
cofactors overcome genetically slow
enzymes
 “ our analyses of metabolic disease that affects
cofactor binding particularly as a result of
polymorphic mutations may present as a
rationale for high dose vitamin therapy
perhaps hundreds of times the normal dietary
reference intake in some cases…… Feeding
high doses if the vitamin raises tissue cofactor
concentrations and therapy increases the
activity of the defective enzyme”
 Ames B et al: High Dose vitamin therapy stimulates variant enzymes
with decreased coenzyme binding affinity relevance to Genetic disease
and polymorphisms Am J Clin Nutr 2002
 Common Deficiencies
 Zinc  Vitamin D
 Magnesium (low n in  Tocopherols/ Vit E
serum)  B12
 Iron (with normal  Folate
MCV)  B3
 Selenium  B6 (especially
 Iodine functional)
 Coenzyme Q 10  B1
 Bioflavonoids  EFA
 Protein/ amino acids
 Overview of Nutrients
 Macronutrients
 Micronutrients
 Vitamins
 Minerals

 Phytonutrients and conditional Nutrients

 Macronutrient Requirements
 Proteins 10-35% 0.8-1.5 g/kg/d
 Protein Quality
 Essential aa : Amino Acid score (digestibility
adjusted)
 Eggs/Soy/Dairy 1 Beef 0.9 Rice/Potato 0.6

 Beans/Wheat 0.6

 Issues allergy/intolerance
 Protein Function
 Structural especially BCAA
 Hormonal
 Enzymatic
 Lipoproteins, Glycoproteins
 Amino Acids
 Glutamine
 Arginine, Lysine
 Tryptophan
 Phenylalanine/Tyrosine
 BCAA (Leucine isoleucine valine)
 Cysteine, Methionine,
 Glycine
 Amino Acids and Insulin
 Arg and Leu increase insulin
 Asparagine and glycine stimulate glycogen
 Insulin increases BCAA into muscles not
tryptophan which increases across BBB
improves serotonin and reduces carb cravings
 Reduced effect in insulin resistance
Fats
 Fats
 Essential, deficiency/imbalance very common
 More efficient energy than carbs (9 cal/g vs 4)
 Contain fat-soluble vitamins
 Build/repair cell membranes with protein
 Build hormones, cytokines (cholesterol is precursor)
 Synthetic fats more damaging to burn
 Omega 3: other fats should be 1 or 2:1
 SAD about 20:1 of sat/trans/monos:omega3
 Omega 3=anti-inflam cytokines
 Inflammation essential in infection and injury
Carbohydrates
 Carbohydrates
 All starches broken down to glucose if
possible, remaining ferments or feeds
pathogens and parasites
 GI index irrelevant to total glucose burden
 Insulin resistance applies only to muscle, other
tissues become more sensitive, esp. liver, fat
cells, lymphocytes (cytokine production)
 Insulin is anabolic e.g. skin tags, acanthosis,
increased cancer and endothelial dysfunction
 Carbohydrates
 Most staple “heart foundation” carbs are inedible
in raw state. They contain NOTHING essential
for health
 High insulin part of famine early warning system
 Frequent complex carbs in NIDDM is wrong,
wrong, WRONG!!
 Remove carbs, add minerals and movement,
remove diabetes
 Water
 Not just passive carrier of solutes
 Ingredient in chemical reactions, e.g.
hydrolysis
 Provides structural support for 3d protein
structure
 Other drinks waste enzymes!!!
 Most water on an empty stomach
 Vitamin A and Carotenoids
 Animal sources = retinol (organ meats, fat)
retinyl palmitate poisonous in excess
 Plant sources = betacarotene
precursor(yellow/orange/dark green)
 Important for retinal pigment, mucosal and
skin integrity (keratin), immunity, bone
 Antioxidant
 Lutein, xeaxanthine
 B Vitamins
 Co-factors for TCA, defic = low energy
 Methyl donors, repair DNA
 Neurotansmitter and Hormones Synthesis
 Detoxify methionine to s-adenosyl methionine
(s-AME), deficiency raises homocysteine levels
 Water soluble so ongoing need
 Did cavemen eat brewers yeast and
wholegrains?!! Best sources are raw organ meats
 Vitamin C
 Beyond argument that humans designed to make
vitamin C, almost still can
 Ubiquitous in nature, except primates
 Nature’s electron donor so multiple uses
 Essential for collagen synthesis (scaffold)
 Neutrophils make H2O2 (pro-oxidant)
 Antioxidant, recycles other antioxidants
 Hormones Neurotransmitters ( with iron)
 Energy production
 Same receptor as glucose, AAs and Mg
 Vitamin D
 Hormone
 Cholesterol and UV light
 BMD – intestinal absorbtion of cal-MAG and
deposition into bone
 Deficiency widespread, implicated in asthma,
allergy, IHD, DM and syndrome X, cancers, MS.
 Activates 100s of genes that moderate the
inflammatory response, specifically reducing IL6
 Beware supplementation in autoimmune disease
 Vitamin E
 Antioxidant
 Vasodilator
 “Natural vit E” = d-alpha tocopherol
 “real” vit E = alpha, beta, gamma, delta
tocopherols and tocotrienols
 Plant foods, esp. greens, nuts, seeds, especially
sesame as in tahini
 Vitamin P (phytonutrients)
 P for Plants, Phytochemicals
 Bioflavinoids - quercetin, rutin, hesperidin,
tannins, organic acids, lycopene, resveratrol,
curcumin, pycnogenol, grape seed, ginko
biloba.
 TCM recognises 14,000 plant medicines
 Minerals
 Metallic elements from soil
 Ionic electrochemical gradients Na, K
 COFACTORS FOR ENZYMES and other
biomolecules
 Magnesium, zinc, calcium, selenium, iodine, boron,
vanadium, chromium, manganese, molybdenum,
copper, (?arsenic, cadmium)
 Magnesium – 70% of enzymes are Mg dependent
 Any sign, symptom, disease may be mineral deficiency,
one or ALL OF ‘EM
 Iron
 Haemoglobin
 Cytochromes
 Liver detoxification
 Mitochondrial Electron Transport chain

 Apoptosis

 Cofactors
 Hormones Neurotrnasmitter Synthesis
 Iodine
 Thyroid Hormones
 Oestrogen Metabolism
 Myelination
 Brain Function
 Zinc Deficiency
and function (200+ enzymes)
 Hair loss
 Weak brittle nails with white spots
 Poor memory, learning, cognition
 Anxiety/ Depression
 Poor healing stretch marks
 Recurrent infection
 Poor taste appetite prefer spicy food
 Cofactor in taste receptors
 Zinc Deficiency
 Digestive disturbance
 ( gastric acid production
 digestive enzyme cofactor{carboxypeptidase})
 prostaglandin synthesis for mucous)
 Reactive hypoglycaemia and sugar cravings (LDH and insulin
function)
 Androgen deficiency
 Dermatits (acrodematitis enteropathica)
 Phrenoderma (activation of vitamin A)
 FTT growth impairment ( DNA synthesis zinc fingers RNA/ DNA
polymerase)
 Growing pains
 Sensitivity to salicylates and heavy metals/ copper (metallothionine
also important in synaptogenesis and brain pruning)
Zinc Deficiency
 Zinc Source of 10mg
 Oysters 15g
 Fortified cereal 35g
 Wheat germ 70g
 Liver 115g
 Cheese/ nuts 185g
 Meat/ whole grain wheat 285g
 DRI 2001 8- 11mg 12-14mg in pregnancy
 Excess depletes copper
 Magnesium Deficiency
 Muscle cramps / tightness
 ( ionic imbalance required to export calcium for muscle
relaxation and calcium channel blocker)
 Fatigue ( 12/22 steps glucose→ ATP Mg
dependant /every kinase)
 Neuromuscular excitability ( twitches/startle/ brisk
reflexes restless legs uterine cramps)
 Insomnia ( prolongs action of melatonin)
 Anxiety
 Palpitations
 Magnesium and Migraine
 Migraine treatable with magenisum
 “Intravenous magnesium sulfate rapidly alleviates headaches of
various types.”
[Headache. 1996]
 Migraine associated with magnesium deficiency
 “Deficiency in serum ionized magnesium but not total magnesium in
patients with migraines. Possible role of ICa2+/IMg2+ ratio.”
Headache. 1993 Mauskop A et al
 Migraine preventable with magnesium
 “Prophylaxis of migraine with oral magnesium: results from a
prospective, multi-center, placebo-controlled and double-blind
randomized study.”
Cephalalgia. 1996 Jun Peikert A et al
Cardiovascular effects of magnesium
 Vasodilator
 Antiarrhyhthmic AF SVT VT
 Improves myocyte cellular function
 Improves outcome post CABG
 CCF and micronutrients
 Secondary hyperparathyroidism is a covariant of CHF due to
aldosteronism
 Chronic increase in Ca(2+) and Mg(2+) losses in urine and
feces and consequent secretion of parathyroid hormone.
 loop diuretic use related wasting of Ca(2+) and Mg(2+)
exacerbates
 Aberrations in micronutrient homeostasis including Ca(2+),
Mg(2+), vitamin D, zinc and selenium are an integral
component of CHF.
 Raises the prospect that dietary supplements could prove
remedial in combination with the current standard of care. :
 Congestive heart failure is a systemic illness: a role for minerals
and micronutrients. Clin Med Res. 2007 Dec;5(4):238-43
 Micronutrients in CCF
 Eur Heart J. 2005

 The effect of micronutrient supplementation on quality-of-life and

left ventricular function in elderly patients with chronic heart
failure.
 Witte KK, et al
 DBRCT ….high-dose micronutrients (calcium, magnesium, zinc,
copper, selenium, vitamin A, thiamine, riboflavin, vitamin B(6), folate,
vitamin B(12), vitamin C, vitamin E, vitamin D, and Coenzyme Q10)
for 9 months. ….. on stable optimal medical therapy for at least 3
months before enrolment
 LV volumes reduce
 LVEF increased by 5.3
 Improvement in QoL score
Coenzyme Q 10 and cardiac function
 Int Heart J. 2008
 Atorvastatin-induced changes in plasma coenzyme q10 and brain
natriuretic Peptide in patients with coronary artery disease.
 Suzuki T et al
 “The beneficial effects of statins in patients with coronary artery
disease (CAD) may be balanced by concerns that statins can depress
production of ubiquinone (CoQ10), which serves as a component of
mitochondrial energy production and an antioxidant…. There was a
linear correlation between ATO-induced changes in total cholesterol
and CoQ10 ….and an inverse correlation between ATO-induced
changes in CoQ10 and BNP ….. Multivariate analysis revealed that
ATO-induced decreases in plasma CoQ10 were significantly
associated with increasing BNP levels. “
 Co Q10 and CCF
 1: Clin Cardiol. 2004
 Coenzyme Q10 in patients with end-stage heart failure
awaiting cardiac transplantation: a randomized,
placebo-controlled study.
 Berman M, et al
 DBRCT to assess the effect of CoQ10 on patients with end-
stage heart failure and to determine if CoQ10 can improve
the pharmacological bridge to heart transplantation.
….receive either 60 mg U/day of Ultrasome--CoQ10 or
placebo for 3 months. All patients continued their regular
medication regimen. The study group showed significant
improvement in the 6-min walk test and a decrease in
dyspnea, New York Heart Association (NYHA)
classification, nocturia, and fatigue.
 Coq10 increases ex tolerance and
cardiac function in cardiomyopathy
 Heart Lung Circ. 2003
 Randomised double-blind, placebo-controlled trial of coenzyme Q,
therapy in class II and III systolic heart failure.
 Keogh A, et al
 RBDCT 150 mg/day of oral CoQ10 ….3 months of therapy,
 CoQ10. improved
 NYHF class
 Specific Activities Scale. C-min walk-test distance
 correlation between the increase in exercise time and the increase in
serum CoQ10 level
 . CONCLUSIONS: …. CoQ10 therapy improves cardiac functional
status in patients with moderately severe dilated cardiomyopathy
receiving maximal non beta-blocker therapy.
Heavy Metals
 Heavy Metals
 Metals, huge, large pos EM charge
 Strong oxidants/FR generators
 BLOCK ENZYMES by blocking minerals
 Mercury, lead, cadmium, arsenic, beryllium,
(aluminium, copper, iron)
 Dramatic compounding effect
 Amalgams, larger seafood, groundwater and
commercial fertiliser, smelting, coal, vaccines
 Conclusions
 NEM is poorly understood but evidence based
 Get on to Pubmed and explore
 Consider seeking out formal nutritional training
 Keep an open but critical mind
 Don’t throw away your basic sciences and
physiology
 Consider a systematic process of managing
syndromes that don’t fit into pathological boxes