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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

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Food as Medicine

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  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

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