Diet and Obesity in US - Dr. Low Dog · Pesticide and ADHD • Pyrethroidpesticides cause...

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“TheNutritionPrescription”

Tieraona Low Dog, MDFellowship Director

Academy of IntegrativeHealth & Medicine

Author of “Fortify Your Life”“Healthy At Home” and

“Life Is Your Best Medicine”

www.DrLowDog.com

Copyright©2016IntegrativeMedicineConcepts,LLC.AllRightsReserved. Copyright © 2017 Integrative Medicine Concepts, LLC. All Rights Reserved.

“TheFoodYouEatCanBeEither:

TheSafest&

MostPowerfulFormOfMedicine

-or-

TheSlowestFormOfPoison.”

Copyright © 2017 Integrative Medicine Concepts, LLC. All Rights Reserved.

DietandObesityinUS


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Nutritioninthe21st Century


“ Let your food be your medicine and your medicine be your food.”

—Hippocrates


Copyright © 2017 Integrative Medicine Concepts, LLC. All Rights Reserved. Copyright © 2017 Integrative Medicine Concepts, LLC. All Rights Reserved.

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WHORecommendsLimitingSugarConsumptionTo25g/d


Sugarsaddedtofoods,aswellasthosefoundnaturallyinhoney,syrups,fruitjuicesandfruitconcentrates.Notinfreshproduce.


Low(<=55)

Low(<=10) 11-19

56-69 High(>=70)

High(>=20)

GlycemicIndex(GI)

GlycemicLoad(GL)

0

0

20

10 20 30 40 50 60

6040 80 100

GlycemicIndex&GlycemicLoadRatingChart

Copyright©2016IntegrativeMedicineConcepts,LLC.AllRightsReserved.

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InfluencesonGlycemicLoadofFoods

• Amountofprocessing(increasessurfacearea)

• Fibercontent(decreasesGL)• Fatcontentandproteinslow

stomachemptyingandlowertheglycemicload

• Many“fat-free” foodsarehighGLandcontributetoobesity


GlycemicLoad

IndividualFoodPortion

Low 0-10

Moderate 11-19

High 20+

WholeDay

Low <80

Moderate 80-120

High >120


Food ServingSize Glycemic Load

Grapefruit ½large 3

Apple 1medium 6

Banana 1large 14

Raisins 1smallbox 20

Watermelon 1cup 8

Carrots 1large 5

Orange 1medium 6

Sweet potato 1cup 17

Bakedpotato 1medium 28

Frenchfries 1mediumserving 26

Snickers 1bar 35

Reese’scup 1miniature 2

Whitetablewine 5ounces 1

Redtablewine 5ounces 1

Grapejuice 6ounces 12

GlycemicLoad


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Food ServingSize Glycemic Load

Asparagus ½cup 2

Broccoli 1cup 4

Greenbeans 1cup 3

Tomato 1medium 2

SubwaysandwichTurkeybreast

6inch 17

Butterpecan icecream 5.5ounces(small) 22

Vanillaicecreamcone 4.5ounces (small) 19

Potatochips,fatfree 1bag(8ounces) 49

Tortillachips,whitecorn 3.5ounces 38

Eggo oatwaffles 1serving 13

Maplesyrup 4Tbsp 39

Egg,hardboiled 1 2

Applejuice 8ounce 6

GlycemicLoad


Food Serving Size Glycemic Load

Spaghetti 1cup 38

Brown rice 1cup 23

Whiterice 1cup 33

Whitebread 1slice 10

Wholegrainbread 1slice 5

Bagel,cinnamonraisin 13.5inch 24

Pumpernickel bread 1slice 6

Macaroniandcheese 1cupprepared 31

Chocolatedoughnut 1doughnut(80g) 25

Glazeddoughnut 1doughnut(80g) 12

Kellogg’sFrostedFlakes ¾cup 20

Kellogg’sSpecial K 1cup 14

PostBranFlakes ¾cup 12

PostRaisin Bran 1cup 25

GlycemicLoad


PicturesofLow/HighGIMeals&Snacks

GI = 60 GL = 48 GI = 42 GL = 31


PicturesofLow/HighGIMeals&Snacks

GI = 80 GL = 32 GI = 61 GL = 12


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RealityCheck

• It is not practical to try to “count” glycemic load, in part because it will vary based upon portion size and other components in the meal.

• The take home message: cut back on processed, refined , sugary foods and drinks.


Resources

• The New Glucose Revolution by Jennie Brand-Miller, PhD

• The Glycemic Load Diet by Rob Thompson MD

• The Glycemic Load Diet Cookbook by R. Thompson

• The Easy GL Diet Handbook by Fedon Lindberg MD

• The 150 Healthiest 15-Minutes Recipes on Earth by Jonny Bowden, PhD


SugarSubstitutes/Non-CaloricSweeteners

• Aspartame(Equal&Nutrasweet)• Sucralose(Splenda)• Saccharin(Sweet‘NLow,SweetTwin)• Acesulfame K(Sunett,SweetOne)• Stevia(Truvia,PureVia,SunCrystals)

– FromSteviarebaudiana leaves• MonkFruit(Nectresse)


SugarAlcohols

• Erythritol• Hydrogenatedstarchhydrolysate• Isomalt• Lactitol• Maltitol• Mannitol• Sorbitol


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NaturalSweeteners

• Agavenectar• Datesugar• Fruitjuiceconcentrates• Honey• Maplesyrup• Molasses• Canesugar


GlutenandCeliac

• Glutenisthenameforthestorageproteinsfoundinwheat,barley,ryeandrelatedcerealgrains– triticale,speltandkamut.

• Inpatientswithceliacdisease,astrictgluten-freedietistheonlytreatment.

• Expertsestimatethatabout1%ofAmericanshaveceliacdisease.

• Thecondition,causedbyanabnormalimmuneresponsetogluten,candamagetheliningofthesmallintestine.


SymptomsofCeliac• Recurringbloating,gas,orabdominalpain• Chronicdiarrheaorconstipationorboth(canpresentlikeIBS)• Pale,foul-smellingstool• Unexplainedanemia• Boneorjointpain• Behaviorchanges/depression/irritability• VitaminKDeficiency• Fatigue,weaknessorlackofenergy• Delayedgrowthoronsetofpuberty• Failuretothrive(ininfants)• Missedmenstrualperiods,infertilitymale&female,miscarriage• Cankersoresinsidethemouth• Toothdiscolorationorlossofenamel


GlutenSensitivity

• Notmuchisknownaboutthisconditionexcept:– Peopledonottestpositiveforceliacdisease.– Arenotallergictogluten.– Theyreportfeelingsickaftereatingordrinkingproductsthatcontaingluten.

• Manygluten-freefoodscontainricestarch,cornstarch,tapiocastarch,potatostarchandguargumasasubstituteforflour.Inotherwords,alotofthesefoodsarenotparticularly“wholesome.”


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PesticideExposureandADHD

• UsingdatafromNHANES– childrenwithtypicallevelsofpesticideexposurefromeating pesticide-treatedfruits/vegetableshavehigherrisk ofdevelopingADHD.

• Childrenages8-15withhigherurinarylevelsofdimethylalkylphosphate (DMAP)hadtwicetheoddsofADHDwhencomparedwithchildrenwithloworundetectablelevels.

KuehnBM.JAMA.2010Jul7;304(1):27-8.Bouchard,etal.Pediatrics.2010Jun;125(6):e1270-7.


PesticideandADHD

• Pyrethroid pesticidescauseabnormalitiesindopaminesystemandproduceADHDphenotypeinanimalmodels.

• 687children(8-15yearsofage)evaluated.Thosewithurinary3-PBAabovelimitofdetectionwere2xmorelikelytohaveADHDcomparedwiththosebelowLOD.

• Hyperactive-impulsivesymptomsincreasedby50%forevery10-foldincreasein3-PBAlevels;changeininattentionwasnotsignificant.

Wagner-SchumanM,etal.EnvironHealth2015;May28;14:44.


Eatinganorganicdietforoneweeksignificantlyreducedpesticideexposureinadults.Meantotalorganophosphatemetaboliteswere89%lowerthanwhenparticipantswereeatingconventionalfoods.Similarresultshavebeenshowninchildren.

OatesL,etal.EnvironRes2014;132:105-11BradmanA,etal.EnvironHealthPerspect2015;123(10):1086-93


http://www.ewg.org/foodnews/


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Does Eating Fat Give You Heart Disease?


www.cdc.govCopyright © 2017 Integrative Medicine Concepts, LLC. All Rights Reserved.

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SaturatedFatDebate

• Threelargemetaanalyses(21studies,12studies,and76studies)haveallfailedtoshowanysignificantevidencethatsaturatedfatincreasestheriskforheartdisease.

• Italsohasfailedtofindanysignificantevidencethatincreasingpolyunsaturatedfatsanddecreasingsaturatedfatslowersheartrisk.

• Adviceforverylowfatdietsnotsupportedbyevidence.

Siri-Tarino,Amer JClin Nutr 2010;91(3):535–46.Schwingshacki L,etal.BMJOpen2014;4(4):e004487.ChowdhuryR,etal.AnnInternMed2014;160(6):398-406


Eggs

• Provide essential fatty acids, proteins, choline, vitamins A and B12 , selenium, and other critical nutrients at levels above or comparable to those found in other animal-source foods.

• Meta-analysis suggests that egg consumption is not associated with the risk of CVD and cardiac mortality in the general population.

• New dietary guidelines do not limit dietary cholesterol.

ShinJY,etal.AmJClin Nutr 2013;98(1):146-59


Choline• RelatedtoB-vitamins.Necessaryforsynthesisofcellmembranes,productionofVLDL,precursorACh

• Suboptimalintakeofcholinein95%pregnantwomeninBoston.Lowintakeé riskofNTD

• HighermaternalcholineintakealtersgenemethylationandexpressionofplacentalCRH,keyregulatorinstressresponse.Baby’sintelligence,memory,andpossiblymoodregulationmaybedamagedpermanentlyifmotherischolinedeficient

• RDA:450mg/dBreastfeeding:550mg/dJiangX,etal.FASEBJ.2012;26(8):3563–3574.Brunst KJ,etal.PublicHealthNutr 2014;17(9):1960-70.


CholineandCognition

• Prospectivestudyinvolving154healthymother-infantpairsconductedinVancouver,Canada(72%white,15%Asian).AllwomenweretakingPNV.

• Maternalbloodcollectedat16and36weeksgestationandinfantneurodevelopmentassessedat18monthsagefor154mother-infantpairs.Babieswereallsingletonsandfull-term.

• Significantpositiveassociationsfoundbetweeninfantcognitivetestscoresandmaternalplasmafreecholine(p=0.009)andastrongtrendtowardsgrossmotordevelopment.

WuBT,etal.PLoS One2012;7(8):e43448.


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CholineinFoods:http://naldc.nal.usda.gov/download/47335/PDF


• Studiesshowdairyproductsarebeneficialinmusclebuilding,loweringbloodpressure,preventingtoothdecay,diabetes,colorectalcancer,andobesity.

Tunick MH,etal.JAgric FoodChem 2014;Nov19


MilkandButter

• Formoderatemilkusers,normalmilkat4%fatisnobigdeal andcontainsfatsolublevitaminsremovedinmakinglowfatmilk.Thesaturatedfattyacidsinmilkaremostlytheshorterchainformsthatdonoteffectcholesterolmetabolism.

• Systematicreviewandmeta-analysissuggestrelativelysmallorneutraloverallassociationsofbutterwithmortality,CVD,anddiabetes.Thesefindingsdonotsupportaneedformajoremphasisindietaryguidelinesoneitherincreasingordecreasingbutterconsumption.

Pimpin L,etal.PLoS One2016;11(6):30158118LiangJ,etal.Crit RevFoodSci Nutr 2016;Dec21


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Dietary Fat and CancerSystematic Review

• No associations were found for prostate, esophageal, gastric, renal cell, bladder, lung, skin, or postmenopausal breast cancer by the total intake or types of dietary fat.

• There may be an association between total dietary fat and premenopausal breast cancer.

• Ovarian cancer there was limited-suggestive evidence for a positive association with intake of saturated fats.

SchwabU,etal.FoodNutr Res2014;10;58.doi:10.3402/fnr.v58.25145.


Omega3FattyAcidsfromPlantsandAnimals

Darkgreenvegetables,walnuts,freshlygroundflaxseedsandotherplantfoods.

ALA

Coldwaterfish,fishoil,freshseaweed,cleananimalfoodslikefreerangechicken,eggs,andgrassfedbeef.

DHA EPA

ConvertstoConvertsto

IntermediateMoleculesSuppliesSupplies


ImageFrom:FabianCJ,etal.BreastCancerRes2015;2015;17(1):6


Resolution Biology

• Inflammation always considered a passive process.• Newer research shows that resolution of self-limited acute

inflammation is an active, programmed response.• Omega 3 fatty acids produce specialized pro-resolving

mediators (SPM) – resolvins, protectins and maresins.


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Serhan CN,ChiangN.Curr Opin Pharmacol 2013;13(4):632-40.


Cardiovascular HealthOnthebasisof19cohortstudiesoffree-livingpopulationsglobally,biomarkerconcentrationsofseafoodandplant-derivedω-3fattyacidsareassociatedwithamodestlylowerincidenceoffatalCHD.

PrediMed studyfoundthatdietaryALA,suppliedmainlybywalnutsandoliveoil,relatesinverselytoall-causemortality,whereasprotectionfromcardiacmortalitywaslimitedtofish-derivedlong-chainn-3polyunsaturatedfattyacids.


DelGobbo LC,etal.JAMAInternMed2016;176(8):1155-66.

Sala-VilaA,etal.JAmHeartAssoc 2016;Jan26;5(1).pii:e002543.

KnowYour“O”

• TheOmega-3IndexindicatesthepercentageofEPA+DHAinredbloodcellfattyacids.

• CanadiangovernmentfoundthatthemeanOmega-3IndexlevelofCanadiansaged20-79was4.5%.– Levelshigherforwomen,olderadults,Asiansandothernon-whiteCanadians,omega-3

supplementusers,andfishconsumers;levelslowerforsmokersandpeoplewhowereobese.

• Fewerthan3%ofadultshadlevelsassociatedwithlowCHDrisk;43%hadlevelsassociatedwithhighrisk.

Langlois K,etal.HealthRep2015;Nov18;26(11):3-11


Omega3andHTN

• Omega-3fattyacidsdecreasetheproductionofvasoconstrictoreicosanoids,reduceACEactivityandangiotensinIIformation,andenhanceendothelialnitricoxideproductionandactivatetheparasympatheticnervoussystem.

• Metaanalysisfoundthatmarineomega3sleadstosmallbutsignificantreductioninSBPand≥2grams/dreducesDBP.

• DHA>EPAforbloodpressureloweringeffects.MillerPE,etal.AmJHypertens 2014;27(7):885-96.


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Omega 3 Fatty Acids – Bone/Muscle

• In animal studies, marine omega 3 attenuates bone loss associated with estrogen loss; EPA enhances calcium absorption, reduces calcium excretion and increases calcium deposition in bone.

• Marine omega 3 acids tend to have positive effects on bone if ingested for ≥ 18 months and given along with calcium.

• Omega-3fattyacidsstimulatemuscleproteinsynthesisinolderadultsandmaybeusefulforthepreventionandtreatmentofsarcopenia.

Fernandes G, et al. Prostaglandins Leukot Essent Fatty Acids. 2003;68(6):361-372 Orchard TS, et al. Br J Nutr. 2012;107:S253-S260

Smith GI, et al. Am J Clin Nutr 2011; 93(2):402–412


Pregnancy

• MaternalDHAintakeduringpregnancyandlactationcanprolonghighriskpregnancies,increasebirthweight,headcircumference;enhancevisualacuity,handandeyeco-ordination,attention,andinformationprocessing.

• Systematicreviewfoundriskofearlypretermdeliveryreducedby58%andanypretermdeliveryby17%withtheEPA/DHAsupplementation.

MorseNL.Nutrients2012;4(7):799-840Kar S,etal.Eur JObstet Gynecol Reprod Biol 2016;198:40-6


Omega3andProstateCancer?

• SELECTtrialraisedconcernsaboutpotentiallinkbetweenomega3sandincreasedprostatecancer/aggressivecancer.

• EuropeanFoodSafety(EFSA)concluded,“thereisnoevidenceforaroleofEPAand/orDHAintakeinthedevelopmentofprostatecancer.”

• Also,“supplementalintakeofEPAandDHAcombinedatdosesupto5g/ddoesnotgiverisetosafetyconcernsforadults.”

EFSAJournal10(7):doi:10.2903/j.efsa.2012.2815


SeafoodCalculatorwww.ewg.org/research/ewg-s-consumer-guide-seafood/seafood-calculator


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OliveOil• CornerstoneofMediterraneandiet.Richinantioxidants,particularlyvitaminE.

• Oleocanthal mimicseffectofibuprofeninreducinginflammation.

• Protectsagainstheartdisease;lowerstotalbloodcholesterol,LDL-C,triglycerides;improvesHDL.

• NursesHealthStudyfoundthatgreateradherencetoMediterraneandietwasassociatedwithlongertelomeres(healthandlongevity).

Hemaez A,etal.Arterioscler Thromb Vasc Biol 2014;34(9):2115-9.Crous-Bou M,etal.BMJ2014;349:g6674


Avocado

• Avocados second only to olives for level of monounsaturated fat.

• Randomized, crossover trial of 45 overweight/obese participants found inclusion of one avocado per day was superior to low-fat or moderate fat diet high in oleic acid for lowering cholesterol.

• Only avocado group had significantly decreased LDL particle number, small dense LDL-C and ratio of LDL/HDL.

Wang L, et al. J Am Heart Assoc 2015; 4(1). pii: e001355.


Protein

• FromtheGreekwordprotos, “first.”• Usedtobuildnewcells,maintaintissues(e.g.,muscles,innerbone,hair,nails),createenzymes,makehemoglobintocarryoxygen,lipoproteinstotransportcholesterol;presentininnerandoutermembraneofeverylivingcell.

• Sourcesincludemeat,poultry,seafood,beansandpeas,eggs,soyproducts,nuts,nutbutters,andseeds.


WCRF/AICRRecommendationstoReduceCancerRisk

• Limitconsumptionofredmeats(beef,pork,lamb)andavoidprocessedmeats.

• ThereisNOquestionthatregularconsumptionofprocessedreadmeatsincreasesriskofcolorectalcancer.

Kmietowicz Z.BMJ2015;351:h5729


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WeAren’tEatingWhatWeAteInTheStoneAge

HEALTHYPROTEINSOURCES• Soyandotherlegumes(lentils,beans,etc.)• Quinoa• Nutsandseeds• Lowmercurycoldwaterfish• Organicpoultry• Grassfedbeef,pork,lamb• Wildgame• Milkanddairywithouthormones• Omega3enrichedeggs

Roughly8gramsofproteinper20poundsofbodyweightisgenerallyrecommended


SodiumRecommendations?

• InMay2013,InstituteofMedicinefoundlimitedevidencelinkingassociationbetweenlowsodiumintake(1500-2300mg/d)andimprovedhealthoutcomesinthosewithdiabetes,kidneydisease,heartdisease,hypertensionorborderlinehypertension;those51yearsofageandolder;orAfricanAmericans(NationalResearchCouncil).

• However,averageAmericanconsumes3400mg/dsodium.Toomuch!Useiodizedsalt.

Sodium Intake in Populations: Assessment of Evidence. Washington, DC: The National Academies Press, 2013.


TraditionalAsianDiet

• LittlequestionmanypeopleinAsiancountrieshavelowratesofdiabetes,heartdiseaseandcancer.

• Thereisnoone“Asian”diet butsomegeneralizationsthatcanbemade.

• TraditionalChinesedietshavebeenexploredthroughtheChina-Cornell-Oxfordproject.Thislong-termstudyisdiscussedatlengthintherecentfilmForksoverKnives,whichpromotesbetterhealththroughaplant-baseddiet.


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Willcox DC,etal.JAmColl Nutr 2009;28(S)_500-516


OkinawanDietaryPattern

• Highconsumptionofvegetables• Highconsumptionoflegumes(mostlysoy)• Moderateconsumptionfishproducts• Lowconsumptionmeatandmeatproducts• Lowconsumptionofdairyproducts• Moderatealcoholconsumption• Lowcaloricintake• EmphasisonlowGLcarbohydrates


FlexitarianorVegetarianDiets

• Reviewof25studiesofflexitariandietsfoundemergingevidencesuggestiveofbenefitsforbodyweight,improvedmarkersofmetabolichealth,bloodpressure,andreducedriskoftype2diabetes.

• Vegetariandietshaveverybeneficialeffectsonlipids.

DerbyshireEJ.FrontNutr 2017;Jan 6;3:55WangF,etal.JAmHeartAssoc 2015;4(10):e002408

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