Can Food Really Be Medicine?

1. Can Food Really Be Medicine? Patricia B. Brevard, PhD, RD, FADA Department of Health Sciences James Madison University

2. Nutrition and Disease Prevention: Can Specific Nutrients Help to Prevent Cancer and Other Chronic Diseases?

3. Preview of Presentation: • Nutrient content of foods • Prevalence and causes of dz • Other chem found in fd • Vit/min/antiox and how they prevent dz • AHA prevention diet, CA prevention diet • Fds most likely to be used as preventive mechanisms: Top Ten Food Lists • CA, CVD < risk with good nutr

4. Essential Nutrients Found in Foods (Required for Good Health) Macronutrients (energy nutrients) Proteins Carbohydrates Fats Water Vitamins 8 B vitamins (thiamine niacin, riboflavin, folic acid, Vitamin B 12, Vitamin B6, pantothenic acid, biotin) Vitamin C Vitamins A, D, E, K Minerals Ca, Fe, Mg, Mn, Se, Na, K, V, Bo, I, S, Cl, P, Cr, Cu, F, Mo, Zn

5. The Ten Leading Causes of Death in the United States Heart disease Cancers Strokes Chronic lung diseases Accidents Diabetes mellitus Key: Pneumonia and influenza Diet related Alzheimer’s disease Alcohol related Kidney diseases Other causes Blood infections Deaths per 100,000 population

6. Free Radicals Cause Many Diseases, Antioxidants Quench Free Radicals (cont’d)

7. The Actions of Free Radicals and Antioxidants (cont’d)

8. Phytochemicals and Antioxidants • Important chemicals found in foods • Not currently known if they are required • Play an important role in prevention of dz • May be up to 10,000 in a single food • Over 600 currently identified • Like nutrients, also found in foods • Many different methods of identifying, many foods not yet tested for their content • Numbers currently reported not yet complete

9. Immune system: • Cells and chemicals synthesized in the blood, tissues (antibodies, white blood cells, etc.) • Designed to destroy anything detected as “not self”, any foreign substance that can harm the body • Lines of defense: skin, tears, GI tract, blood, tissues, cells, and chemicals • A healthy immune system helps resist disease

10. What is MI? • Initial damage to blood vessel walls, chemical or physical stress may contribute to damage • Begins as fatty streak, then develops into fibrous plaque, fat, cholesterol deposited • Platelets in blood aggregate, clot forms, plaque occludes arteries • Blood flow to part of body is restricted • Extent of damage determined by location of plaque • Oxidized LDL and elevated serum LDL are key factors • Elevated HC and CRP also increase risk • All are related to nutrients and phytochemicals • What you eat at each feeding may be critical in causing or preventing platelet aggregation and MI occurrence

11. What is CA? • Loss of control of division mechanism of cells • Lack of differentiation of cells • Many surface constituents lost on cell • Cell fools IS into thinking it’s “self” • Different set of rules, different surface enzymes, charges, antibodies • Often DNA damage begins the process of carcinogenesis or development of cancer

12. Metastasis…spreading • Normal cells know their boundaries, divide as genetically programmed, die as programmed • CA cells “immortal”, don’t have time clock telling when to die • CA cells metastasize: break off and grow in another part of the body, spread, still maintain cell characteristics where originated, ie, colon type metastasized cells growing in liver, breast type cells growing in lung, etc.

13. Figure 18-6Page 637 Benign Normal cells Tumor Formation Tumor formation Carcinogen Initiation Promotion Noncancerous (benign) tumor Malignant Normal cells Normal cells Initiators begin the process of changing the DNA in some of the cells. Promoters enhance the development of abnormal cells. Cancerous (malignant) tumor releases cells into the bloodstream (metastasis)

14. ©2003 Wadsworth, a division of Thomson Learning, Inc. Thomson Learning™ is a trademark used herein under license. For the best heart attack and cancer fighter, visit your local produce center and look for different colors!

15. In-text Figure Page 619 Vegetables rich in fiber, phytochemicals, and the antioxidant nutrients (beta-carotene, vitamin C, and vitamin E) help to protect against chronic diseases.

16. Nutrition recommendations change as science changes… new research every day, but we don’t change recommendations based on one study BE CAREFUL!!

17. Case study: Beta-carotene Hundreds of studies show diets high in beta-carotene... ….decrease risk of cancer.

18. But how did we really know it was the beta-carotene? We Didn’t!!!

19. beta-carotene* alpha-carotene cryptoxanthin* lycopene lutein zeaxanthin neoxanthin canthaxanthin violaxanthin phytoluene phytoene astaxanthin *indicates VA activity Common Carotenoids

20. Controversial clinical trials: • CARET Study, NEJM 1996;Omen et al • Physician’s Health Study, NEJM 1996, Hennekens et al. • ATBC Study, NEJM 1996 • Chinese Study, AJCN 1995, Blot et al.

21. Increased CA risk in smokers • stronger effect if > 20 cigarettes/d • stronger effect if EtOH around 1 drink/d • smoking + drinking lowers serum beta-carotene • smokers should avoid supplements, especially high doses

22. Nutrients function metabolically at optimal physiological doses... …in proper combinations.

23. American Heart Association’s Eating Plan for Healthy Americans (Oct 2000) • Eat a variety of fruits and vegetables, 5+ svgs/d • Eat a variety of grains, include whole grains, 6+ svgs/d, include fat-free and low-fat milk products, fish, legumes (beans), skinless poultry, lean meats • Choose fats and oils with 2 grams or less saturated fat/T, ie. liquid and tub margarines, canola oil, olive oil • Balance the number of calories you eat with the number you use daily. (To find that number, multiply the number of pounds you weigh now by 15 calories. This represents the average number of calories used in one day if you're moderately active. If you get very little exercise, multiply your weight by 13 instead of 15. Less-active people burn fewer calories.)

24. Maintain a physical activity level to keep you fit and match the number of calories you eat: salk or do other activities at least 30 minutes most days; to lose weight, do enough activity to use up more calories than you eat daily Limit intake of foods high in calories/low in nutrition, ie. soft drinks, candy, foods with a lot of sugar Limit foods high in saturated fat, trans fat and/or cholesterol, such as full-fat milk products, fatty meats, tropical oils, partially hydrogenated vegetable oils and egg yolks; choose foods low in saturated fat, trans fat and cholesterol Eat less than 6 grams of salt (sodium chloride) per day (2,400 milligrams of sodium) Have no more than one alcoholic drink per day if you're a woman and no more than two if you're a man; with one drink defined as no more than 1/2 ounce of pure alcohol, ie 12 oz. beer, 4 oz. wine, 1-1/2 oz. 80-proof spirits, or 1 oz. 100-proof spirits

25. Cancer Guidelines July 1997 World Cancer Research Fund American Institute for Cancer Research Other observer groups: Internat’l Agency for Res. on CA FAO of UN WHO, NCI, NIH

26. CA Prevention Guidelines • 1. Variety: consume varied diet based primarily on plant foods with a wide variety of vegetables and fruits, pulses (legumes) • 2. Maintaining Weight: keep BMI in range of 18.5 – 25, avoid underweight or overweight; limit weight gain during adulthood to less than 5 kg (11 #) • 3. Maintain Physical Activity via an active lifestyle throughout life, take and hour’s brisk walk or other exercise daily, exercise vigorously for a total of at least 1 hr/wk • 4. Year-round consume 7%+ of total energy from fruits and vegetables, eat 15 - 30 oz or 5 + servings daily of a variety of fruits and veggies • 5. Other plants: eat variety of starchy plants, minimally processed, 45-60% of kcals from starches, <10% from sugars, eat 20-30 oz or 7+ svgs/d of cereals, grains, pulses, roots, tubers, plantains • 6. Consumption of EtOH is not recommended; excessive consumption is discouraged, if it is used, restrict to < 5% total energy men and 2.5% for women which is the equivalent of 2/d for M and 1/d for F

27. If eaten at all, red meat should provide < 10% of kcals or less than 3 oz/d, preferable to choose fish, poultry, or meat from non-domesticated animals in place of red meat • Total fats and oils should provide 15% to 30% of total energy, limit fatty foods, esp those of animal origin, use modest amounts of appropriate veggie oils • 9. Salt from all sources should amount to < 6 g/d or .25 oz for adults, limit salted foods, limit use of cooking oil and table salt, season foods with herbs and spices • 10. Store perishable foods to minimize fungal contamination, do not eat food with liability to contamination with mycotoxins • 11. Preservation: freeze or chill foods not consumed right away, use refrigeration or other appropriate methods to preserve perishable food as purchased and at home • 12. Monitor enforcement of safety limits of food additives, pesticides, and their residues; when carefully monitored, residues of additives are not present in food and drink at levels known to be harmful; unregulated or improper use can be a health hazard, esp in developing countries • 13. Do not eat charred meats, avoid burning meat juices, cook meats at low temperatures; consume these only occasionally: meat and fish grilled or broiled in direct flame, cured and smoked meats • 14. Dietary patterns should be consistent with reducing cancer risk without use of dietary supplements, supplements are probably unnecessary, and possibly unhelpful, for reducing cancer risk • 15. Discourage production, promotion, use of tobacco in any form, do not smoke or chew tobacco, it is especially dangerous combined with alcohol

28. Changes AICR Conference 2003 • “Double action”: either too much or too little of some nutrients/chemicals may cause cancer, they protect if adequate, but increase risk if too low or too high • EtOH less than 1 drink/d or < 15 g/d • Many specific foods appear to have protective chemicals, but may work in combination with other foods/chemicals • Phytochemicals and nutrients may interact to protect if adequate, or harm if too high or too low • Varied diet with lots of different foods will insure that you get all of the chemicals/nutrients in proper combinations

29. ©2003 Wadsworth, a division of Thomson Learning, Inc. Thomson Learning™ is a trademark used herein under license. The Antioxidant Theory of Disease Prevention

30. Phytochemicals in many foods may help prevent diseases

31. In-text Figure Page 467 Functional foods provide us with many health benefits.

32. An Array of Phytochemicals in a Variety of Fruits and Vegetables Broccoli and broccoli sprouts contain an abundance of the cancer-fighting phytochemical sulforaphane. The phytochemical resveratrol found in grapes (and nuts) protects against cancer by inhibiting cell growth and against heart disease by limiting clot formation and inflammation. The flavonoids in cocoa and chocolate defend against oxidation and reduce the tendency of blood to clot.

33. An Array of Phytochemicals in a Variety of Fruits and Vegetables (cont’d) An apple a day—rich in flavonoids—may protect against lung cancer. The ellagic acid of strawberries may inhibit certain types of cancer. Tomatoes, with their abundant lycopene, may defend against cancer by protecting DNA from oxidative damage. Spinach and other colorful vegetables contain the carotenoids lutein and zeaxanthin, which help protect the eyes against macular degeneration.

34. An Array of Phytochemicals in a Variety of Fruits and Vegetables (cont’d) The phytoestrogens of soybeans seem to starve cancer cells and inhibit tumor growth; the phytosterols may lower blood cholesterol and protect cardiac arteries. The monoterpenes of citrus fruits (and cherries) may inhibit cancer growth. Flaxseed, the richest source of lignans, may prevent the spread of cancer.

35. An Array of Phytochemicals in a Variety of Fruits and Vegetables (cont’d) Garlic, with its abundant organosulfur compounds, may lower blood cholesterol and protect against stomach cancer. Chives, leeks, and onions also contain these compounds. The flavonoids in black tea may protect against heart disease, whereas those in green tea may defend against cancer. Blueberries, a rich source of flavonoids, improve memory in animals.

36. Cruciferous vegetables, such as cauliflower, broccoli, brussels sprouts, cabbage, horseradish, and mustard greens contain nutrients and the phytochemicals indoles and isothiocyanates that may inhibit cancer development. Black-eyed peas, grapes, lentils, red and white wine, tea contain antioxidants which inhibit cancer promotion. Green vegetables, tomatoes, potatoes, alfalfa sprouts, and other sprouts contain saponins which inhibit cancer Growth and stimulate the immune system.

37. Figure 18-7Page 641 Fats, Oils & Sweets • Limit salt to < 6 grams. • Reduce energy-rich foods high in sat. fat & sugar. • Use unsaturated fats instead of sat. or trans fats. • Drink alcohol in moderation, if at all. Maintain a healthy weight. be physically active. Don’t smoke. Milk, Yogurt & Cheese Group Meat, Poultry, Fish, Dry Beans, Eggs & Nuts Group • Eat < 4 eggs per week. • Eat red meat sparingly. • Eat fish frequently. • Eat nuts and legumes often. • Eat low-fat or fat- free milk products. Vegetable Group • Eat vegetables in abundance. Fruit Group • Eat fruit in abundance. Bread, Cereal, Rice & Pasta Group • Eat whole-grain breads, cereals, rice, and pastas instead of refined products. Food Guide Pyramid for Disease Prevention

38. Red/blue berries (grapes, blueberries, strawberries, cranberries, blackberries, etc) Soy foods Beans (pinto, garbanzo, lentils, kidney) Oats and grains (oatmeal, whole grain breads & cereals) Stanols/sterols (Take Control, Benecol) Nuts (almonds, cashews, pecans, walnuts, peanuts, hazelnuts) Garlic, onions Red wine (2 glasses/d max) Green and black teas Tomatoes, oranges Salmon and fish in general Spinach, green leafy veggies in general Olives, olive oil Sweet potatoes Lowfat milk Apples Fruits and veggies in general Flaxseed Hot chocolate/chocolate/cocoa Cruciferous veggies: broccoli, Brussels sprouts, cauliflower, cabbage, kale, kohlrabi Total calcium intake Many“Top 10”/“Power Food” Lists (cancer, CHD, disease prevention)…eat often but don’t overdo it! These are not magic foods!

39. It’s All About Balance! • Antioxidant load vs. pro-oxidant load • Anti-aggregation factors vs. pro-aggregation factors • Factors that ↓ LDL and ↑ HDL vs. factors that ↑ LDL and ↓ HDL • Your diet provides all of these, it’s up to you to get the right balance!

40. Healthy Foods: the best medicine you’ll ever take!