1 / 50

Food as Medicine

Food as Medicine. Integrative Medicine Curriculum 2014 Marc Engfield MD FRCP Internal Medicine & Acupuncture. Music: Mark Knopfler , “Classical Gas”. Objectives. Describe the main features and benefits of the mediterranean diet

kolya
Download Presentation

Food as Medicine

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. Food as Medicine Integrative Medicine Curriculum 2014 Marc Engfield MD FRCP Internal Medicine & Acupuncture

  2. Music: Mark Knopfler, “Classical Gas”

  3. Objectives • Describe the main features and benefits of the mediterranean diet • Explain glycemic index and load and understand the benefits of a low-GL diet • Name five specific food choices associated with increased risk of chronic disease • Describe the main differences between organic and conventionally-grown foods • Reflect on your own diet and the changes you could make to improve your health

  4. Canada Food Guide

  5. Problems with Canada’s Food Guide • Too many grains • Too much dairy • Nuts are considered a ‘protein’ rather than a food in themselves • How about water? • …and healthy oils?

  6. Nutrition for Dummies • Eat less • Eat more plants

  7. What to eat?

  8. Mediterranean Diet

  9. Mediterranean Diet

  10. Key Features • Raw and cooked vegetables at every meal • More fish and seafood • Nuts, seeds and legumes • Fruit for dessert • Spices and herbs • Olive oil • Wine with meals • Less red or processed meat • Fresh, seasonal, varied diet • Relaxed, social meals

  11. Mediterranean EBM • First recognized in Seven Countries Study in 1950s • Total mortality 0.90 • CVD incidence/mort 0.92 • Caincidence/mort 0.94 • Neurodegenerative incidence/mort 0.87 PMID: 20810976

  12. Caloric Restriction

  13. Caloric Restriction • Increased lifespan up to 40% in animals Mice, dogs and fish Primate studies ongoing • Human CALERIE study Comprehensive Assessment of Long-term Effects of Reducing Intake of Energy HDL  LDL, TG  Fasting insulin and glucose BP, CRP, carotid IMT Memory in the elderly PMID: 16595757 • Phase II CALERIE study ongoing

  14. Caloric Restriction • Mechanisms stress-induced conservation Less insulin, less glycation Sir2 longevity genes •  calories - NOT nutrients • Nutrient density of Food Nutrients = Nutrient Density Calories Vegetables are the primary food CHO 4 kcal/g protein 4 kcal/g fat 9 kcal/g

  15. Different than Mediterranean Diet! Nutrient Density Of Different Foods

  16. Why Vegetables • Old - Vitamins and minerals Ca, Mg, K instead of Na • New - Phytochemicals Too many to mention Science is just beginning Raw vs cooked – it depends

  17. Vegetables • Leafy greens Bok choy, Broccoli, Cabbage, Chard, Collard greens, Endive, Kale, Lettuce, Mustard green, Radicchio, Spinach, Turnip • Fruits and flowers Artichoke, Avocado, Broccoli, Cauliflower, Cucumber, Eggplant, Peppers, Pumpkin, Squash, Tomato, Zucchini • Bulbs and Stems Asparagus, Celery, Garlic, Leek, Onion, Shallot • Roots and tubers Beet, Carrot, Cassava, Ginger, Parsnip, Potato, Radish, Sweet potato, Turnip, Yam

  18. Fruits How-to • Eat berries raspberries – Ellagic acid and CAD blueberries – anthocyanins and dementia cranberries – acidity, quercetin and UTI Indian gooseberry – many diseases • Mix colors • The peel is most nutrient-dense • Eat them instead of dessert

  19. Why eat organic? • More phytochemicals Nature’s medicines Developed as defense system Drought, lack of nutrients Oxidative stress Fungal infection Herbivores and insects • Less harmful chemicals Pesticides and fertilizer No stress – no response Fewer phytochemicals Lower vitamin and mineral content

  20. Organic evidence? • More polyphenols and fewer pesticides 24436145 • More Campylobacter in organic chicken 16863067 • Reduced risk of cancer? Only non-Hodgkins lymphoma 24675385

  21. Glycemic Index

  22. Reduce Glycemic index • Simple vs complex CHO Based on CHO structure obsolete • Glycemic index Based on blood glucose response Reflects metabolic burden of food

  23. Impact of glycemic index • Increased risk of Diabetes More insulin required Shanghai Women’s Health Study Black Women’s Health Study • New era of research Prevents heart disease 23804161 May reduce inflammation 24552752 No apparent DM2 risk 24265366 Lowers LDL cholesterol 23804161

  24. Glycemic load • GI x CHO (grams) = GL Incorporates serving size CHO burden of an amount of food • Better measure of a food’s impact on the body

  25. Practical choices

  26. Reduce carbohydrates • CHO restriction Initial <20g/d run-in phase Prolonged <60g/d • Benefits in short-term studies Weight loss Decreased fasting insulin and glucose TG reduction BP decreased Long-term studies needed PMID: 23035144

  27. Limit Fruit Juice • The body cannot use fructose Liver metabolism like EtOH High intake raised uric acid 22457397 • Preliminary link to obesity PMID: 20524996 • May promote diabetes Inflammationand lipogenesis insulin resistance and satiety No long-term studies yet

  28. Avoid High-fructose corn syrup • Has replaced glucose to save $ Isomil 43% HFCS gatorade, chocolate milk • YouTube “Sugar:The Bitter Truth” Robert Lustig, Pediatrician, UCSF • Conflicting meta-analyses • 23630060

  29. Diet soda is not OK • Artificial sweeteners Sucralose Aspartame Acesulfame Stevia • Chemical toxicity Leukemia PMID: 23097267 Preterm PMID: 22854404 • Triggers CNS insulin mechanisms

  30. Avoid Sweetened Beverages • Ischemic Stroke OR 1.83 39,786 Japanese for 18y Higher risk in women PMID: 23076619 • DM2, metabolic syndrome 20% increased risk of each Meta-analysis of 11 studies PMID: 20693348

  31. Gluten allergy • Wheat, rye, barley, spelt • Celiac disease affects 1% • Biopsy-negative allergy 30%? Anxiety, insomnia IBS, Crohn’s, abdo pain Rashes Anemia NYD • Try it yourself for 1 month • The next tobacco?

  32. Protein

  33. Avoid Processed Meat • Ham, Salami, Bacon, Sausage • All-cause mortality OR 1.18 per 50g/d in EPIC PMID: 23497300 • Several cancers OR 1.38 nitrosamines in the GI tract 11 studies in >4700 pts J NCI 2006;98:1078 • CVD risk

  34. Grass-fed beef • Cows are made to eat grass • Agribusiness uses grain (corn) Changes stomach pH Changes bacterial flora Liver abscesses ABx • Omega-3 fats Omega 6:3 ratio 20 vs 0.16 • Conjugated Linoleic Acid • Avoids E coli

  35. Avoid ALL meat? • Vegetarians are healthier All-cause mortality 0.91 Ischemic heart disease 0.71 CVD mortality 0.84 Cancer incidence 0.82 PMID: 22677895

  36. Meat and Global Hunger • Every kg of beef 4.8 kg of grain 2200 L of water 2.2 L of gasoline • We eat more meat 50% more than in 1960 China and India 2.2bn • Global food shortages Rising food prices 33 countries at risk Many ban exports • Be green … go Vegan

  37. Choose your Fish • Wild vs Farmed Salmon More omega-3 More astaxanthin • Sardines 80% cheaper than salmon The benefits of bones Lower on the food chain • Choose low-mercury fish Do not eat tuna Eat wild, small fish Add garlic and onions for -SH

  38. Plant protein • Beans, lentils, flax, soy • Very nutrient-dense K, Ca, Mg, B vitamins Phytochemicals Many antioxidants • Alkaline Less renal acid load ?prevent end-stage renal failure PMID: 20872351 • More sustainable than meat

  39. Nuts • Improves LDL and lipid profile 25 trials in 483 pts With or without lipid disorders About 10% improvement PMID: 20458092 • Cardiovascular risk 5 epidemiologic studies 45% reduction vs saturated fat PMID: 19321572

  40. Eat chocolate • Flavan-3-ols considered the key phytomedicine • Improve insulin sensitivity • Lower BP • Reduce LDL improve lipids • Reduce CV risk • PMID: 22301923

  41. Fat

  42. Good fats • Omega-3 fats Seafood Flax, nuts, grass-fed beef EPA and DHA better than ALA • Monounsaturates From olives or nuts Vs PUFAs in vegetable or seeds • Medium-chain saturated fats Coconut and palm oil Digested without bile, not stored Appear anti-inflammatory

  43. Bad Fats • Trans fats Hydrogenated industrially Prevents rancidity for shelf life Grain-fed beef and dairy • Pro-inflammatory CAD 2x risk per 2% caloric intake Ca, DM2, obesity, Alzheimer’s • Legislation Banned in Denmark, Switzerland Banned in NYC restaurants No legislation in Canada

  44. Avoid Heated oils • Time-dependent damage • Creates trans fats, AGEs and other toxins • One serving equivalent to a pack of cigarettes • Higher smoke point Coconut oil or butter/ghee PMID: 20886885

  45. Let food be thy medicine, and medicine be thy foodHippocrates

More Related