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CV Select - More about our New, Innovative Cardiovascular Support Formula!

06/01/2016 - Product Newsletter #291

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Introduction

Last month, we introduced 3 new products. This month, I will delve into more detail about CV SELECT; sharing with you the reasons why we are excited about this new product that many of you have been requesting from us for quite some time - a cardiac support formula that addresses many aspects of cardiac support, including optimization of homocysteine metabolism.  As you will see from the enclosed technical bulletin, CV SELECT has many of the ingredients you might expect in a formula such as this, including the B vitamins that are involved in homocysteine optimization, vitamins B6, B12, and folate.  Furthermore, to maximize its impact on homocysteine, CV SELECT contains what are widely considered to be the most bioavailable forms of these B vitamins:

  • Vitamin B6 is provided as pyridoxal-5'-phosphate
  • Vitamin B12 is provided as methylcobalamin
  • Folate is provided as 6S-5-methyltetrahydrofolic acid (MTHF)

INGREDIENTS FOUND IN CV SELECT THAT ARE RARELY FOUND IN CARDIOVASCULAR SUPPORT PRODUCTS

Of course, what really excites me about CV SELECT is not the usual constituents that are the same as found in many other cardiovascular support products but the unusual, unique and very clinically significant constituents.  To me, the two ingredients that best fit this description in CV SELECT are L-leucine and Meriva® curcumin.  Therefore, in the remainder of this this newsletter I would like to discuss in some detail why L-leucine and Meriva® can provide significant benefit to those patients for whom you feel would qualify for CV SELECT supplementation. 

SARCOPENIA (LOSS OF MUSCLE MASS) AND CARDIOVASCULAR DISEASE (CVD) RISK

To truly understand why L-leucine and Meriva® are so crucial to the clinical benefit derived from CV SELECT intake, the all-too-often ignored relationship between optimal muscle health and CVD risk must be understood.  This important relationship was highlighted in the paper "Relationship between sarcopenic obesity and cardiovascular disease risk as estimated by the Framingham Risk Score" by Kim et al (Kim JH et al, J Korean Med Sci, Vol. 30, pp. 264-271, 2015).  To begin this discussion, first consider this overview statement on the relationship between sarcopenia and various ailments, including CVD:

"Sarcopenia leads to physical disability and functional impairment (i.e., impaired activities of daily living, falls, and gait disturbance).  Moreover, sarcopenia is known to be associated with cardiovascular disease (CVD) risk factors, such as glucose intolerance and metabolic syndrome."

Of course, as we very often see in our patients with loss of muscle mass, they also tend to be overweight.  In turn, loss of muscle mass is most often accompanied by increases in fat mass - hence the term "sarcopenic obesity."  Kim et al state:

"Similar to sarcopenia, obesity is known to be related to diabetes mellitus and CVD (i.e., ischemic heart disease and stroke), which can lead to functional impairment and physical disability.  Therefore, sarcopenia and obesity might synergistically increase their effects on physical disability, metabolic disorders, and CVD.  The concept of sarcopenic obesity was proposed to describe the relationship between sarcopenia and obesity."

When comparing the two risk factors for CVD, which is more important - sarcopenia or obesity?  It is my guess that most in our society would suggest obesity.  Actually, according to Kim et al, just the opposite is true - sarcopenia is a much more powerful risk factor.  The authors point out:

"In the representative sample of the Korean population in this study, we found that both men and women with sarcopenic obesity had a higher risk of CVD than those with a normal BMI and muscle mass.  Furthermore, participants who were obese and non-sarcopenic were not significantly associated with increased CVD risk."

From a metabolic standpoint, why is sarcopenia such an important risk factor for CVD?  Kim et al suggest:

"Several mechanisms could explain the significant relationships between sarcopenic obesity and increased CVD risk.  Skeletal muscle is a primary site for glucose uptake and deposition and myokine secretion, which plays a protective role against insulin resistance.  Therefore, sarcopenia promotes insulin resistance, leading to the development of several metabolic abnormalities (i.e., diabetes and related CVDs).  In other studies, an increase in skeletal muscle mass through training enhances the protection against arterial stiffness and hypertension.  To summarize, it is believed that skeletal muscle acts as a defense against CVD."

Before continuing, please note again the last sentence in the above quote: "...it is believed that skeletal muscle acts as a defense against CVD."  As you will see shortly, both L-leucine and Meriva® curcumin are excellent agents to promote optimal muscle mass and function.  Hopefully, you are now getting a good idea of why I am so excited about their inclusion in CV SELECT.

Of course, even with this emphasis on sarcopenia and CVD, obesity is still an important part of the equation, as noted by Kim et al:

"In addition to the close relationship between obesity and CVD, adipocytokines (i.e. interleukin-6 and tumor necrosis factor-alpha) secreted from the fat mass, which increase during obesity, raise the incidence of insulin resistance and CVD, and worsen sarcopenia by exerting catabolic effects on muscles.  Furthermore, muscle loss is not isolated, but is strongly associated with a parallel increase in fat mass.  This mechanism leads to a vicious cycle between increased fat mass and muscle loss, and may act synergistically to increase CVD risks.  Therefore, it is important to examine sarcopenic obesity by measuring muscle mass, which can be useful for assessing public health care."

CURCUMIN, INFLAMMATION, AND CVD

With the above in mind, interventions that reduce inflammation and/or increase muscle mass and strength will have a positive impact on CVD.  Curcumin, interestingly, can do both.  First, consider the impact of curcumin on inflammation as discussed in the paper "Curcumin and health" by Pulido-Moran et al (Pulido-Moran M et al, Molecules, Vol. 21, No. 264, 2016).  The authors state:

"The inflammatory cascade plays an important role in the development of chronic illnesses such as autoimmune, cardiovascular, endocrine, neurodegenerative and neoplastic diseases.  Curcumin is able to decrease inflammation by interacting with many inflammatory processes."

The next quote discusses curcumin in relation to a leading cause of inflammation, oxidative stress:

"Oxidative stress can lead to chronic inflammation, causing chronic diseases.  ROS production modulates the expression of the nuclear factor -kappaβ (NF-kappaβ) and tumour necrosis factor alpha (TNF-α) pathways which play a role in the inflammatory response.  Curcumin could downregulate oxidative stress and the subsequent inflammation through the Nrf2 pathway."

The final quote I would like to feature from this paper discusses other ways that curcumin inhibits inflammation:

"Curcumin also inhibits inflammatory cytokines such as interleukins (ILs), chemokines, as well as inflammatory enzymes, such as cyclooxygenase-2 (COX-2), inducible nitric oxide synthase (iNOS) and other molecules as cyclinD1."

CURCUMIN AND SARCOPENIA

Given all that has been stated above about curcumin, it should be expected that curcumin will have a positive impact on sarcopenia.  This suspicion was confirmed in the study "A novel phospholipid delivery system of curcumin (Meriva®) preserves muscular mass in healthy aging subjects" by Franceschi et al (Franceschi F et al, Eur Rev Med Pharmacol Sci, Vol. 20, pp. 762-766, 2016).  As the title of the study suggests, the form of curcumin used in this study is the exact same form that is used in CV SELECT.  Concerning Meriva® and sarcopenia the authors note:

"Our registry study shows that the addition of Meriva® -either or not combined with other nutritional supplements - to a standardized diet and exercise plan contributes to improved strength and physical performance in elderly subjects, potentially preventing the onset of sarcopenia."

LEUCINE AND SARCOPENIA

As was mentioned above, one method to address sarcopenia and the CVD that can potentially follow is the reduction of inflammation via the use of curcumin.  However, another way to address sarcopenia is employing interventions that have a direct muscle building impact.  One of the best is supplemental leucine, another key ingredient in CV SELECTIn the paper "Nutritional supplements in support of resistance exercise to counter age-related sarcopenia" by Phillips (Phillips SM.  Adv Nutr, Vol. 6, pp. 452-60, 2015) the following is stated about leucine when used in conjunction dietary protein, even when the protein intake is suboptimal:

"Although all of the essential amino acids (EAA) would be needed to allow muscle protein synthesis (MPS) to occur with protein ingestion, Leu is the key amino acid that triggers the stimulation of key regulatory proteins and the initiation of MPS from a state of negative protein balance.  The potency of Leu was shown when subjects consumed a lower dose of protein (6 g), which had previously been shown to be less effective in stimulating MPS, with added Leu, which effectively elicited the same MPS response as an optimal dose (25 g) of protein, in young individuals."

It has also been shown that when leucine supplementation is added to the diet along with resistance exercise, leucine will provide added stimulus for MPS.  Phillips notes:

"Similarly, after a session of resistance exercise, the addition of Leu to a protein/carbohydrate beverage increased MPS to a greater extent than the protein/carbohydrate beverage alone.  These findings indicate that proteins with a higher Leu content would be more effective that those with lower Leu content at stimulating MPS and this may be particularly true in the elderly in whom it appears there is a reduced sensitivity to Leu."

SOME FINAL THOUGHTS ON CV SELECT

As I mentioned above, CV SELECT was formulated with the idea that it would contain virtually all of the cardiac support nutrients you might usually expect in a product such as this.  However, we did not want to stop there.  As I have often mentioned over the years, we feel strongly that the often ignored issue of loss of muscle mass is a core, foundational concern with all chronic illness.  To us, the research overwhelmingly suggests that cardiovascular disease is no exception.  Therefore, CV SELECT was designed to address all the cardiac risk issues typically addressed by cardiac support product plus one very important issue that is rarely addressed - sarcopenia.

CV Select- Moss Nutrition

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