Food Therapy

1. Food Therapy • Dr. Alex Alexander • Week 4

2. FOOD QUALITY AND FAD DIETS • Is this true?

3. Weight Loss • Hee Hee

4. Needs a diet plan? • Before

5. What the Heck? • After fad diet

6. No Words for This One.

7. Surgery • Silence of the Lambs?

8. Post - Op • Healing

9. Finished for Now • Worth it?

10. FOOD QUALITY • Food processing • Glycation of proteins during food processing has been linked to some of the changes associated with aging (Mt Sinai J Med. 2003 Sep;70(4):232-41) • glycated protein has a sugar attached to it • glycated amino acids don’t do what normal aa’s do→glycosylated tryptophan doesn’t enter brain as does non-glycosylated tryptophan. • glycated aa are implicated w/ carcinogenic risk

11. More on Glycation • Advanced Glycation end-products [AGEs] occur when glucose reacts to proteins causing cross-linking of these proteins resulting in irreversible damage to sensitive proteins such as collagen, haemoglobin, receptors [RAGE] and cell structures. • The best known AGE is HbA1c which is glycated haemoglobin [US hemoglobin] used to assess if diabetic control is adequate. • Glycation of proteins is a big danger for diabetics. In fact, aging occurs at an accelerated rate in type 2 diabetics.   • Glycation is also an important process in aging that causes wrinkling of our skin. • Pyridoxamine (a form of B6) is a potent inhibitor of both advanced glycation end-products [AGEs] and advanced lipoxidation end products [ALEs]. • Pyridoxamine in particular has shown potential in the treatment of diabetes and atherosclerosis. • Glycation of proteins [AGEs] and lipids [ALEs] occur in the aging process and pyridoxamine may have a role here. (alzheimer’s and peripheral neuropathy)

12. FOOD QUALITY • Precocious puberty has been associated with estrogenic compound leeched from baby bottles (sorry, can’t find reference. It was in Environmental Health Perspectives around 1998 or 1999) • babies bottle fed enter puberty earlier. 68% of girls who entered puberty by age 8 had high thalate levels compared to 0% of those entering puberty at normal age. Thalates are found in soft plastics. Good book on estrogen disruptors in diet by Dr. Lindsey Berksen.

13. Organic Production • Organic production • Nine times as many pesticide residues found in Seattle children eating conventional diet compared to organic (Environ Health Perspect. 2003 Mar;111(3):377-82) • Amounts of beneficial constituents higher in organically grown foods compared to conventional (J Agric Food Chem. 2003 Feb 26;51(5):1237-41, Altern Ther Health Med. 1998 Jan;4(1):58-69, J Agric Food Chem. 2002 Sep 11;50(19):5458-62)

14. Genetic Modification • Genetic modification • Who knows?→ experiment being conducted w/out a control (similar to fluoride experiment) • Most of the problems to date have been ecological instead of nutritional • Conventional sources believe that risk of allergy to new antigens is overstated (Ann Allergy Asthma Immunol. 2003 Jun;90(6 Suppl 3):90-8) • allergenic proteins may be introduced into food via genetic modification process

15. Contamination • Heavy metal / pesticide contamination • Water is an underrated source of contamination • Like with many environmental issues, the risks involved with these exposures are not well quantified • Some pesticides are known mitochondrial poisons, and can even trigger symptoms of Parkinson’s Disease (Neuroscientist. 2002 Jun;8(3):192-) • some pesticides (organochlorine) are mitochondrial poisons. 4 times greater rates of Parkinson’s dz among farmers (also higher rates of Hodgkins dz) • Top 3 environmental contaminants: arsenic, lead, mercury

16. FAD DIETS • Standard American Diet. SAD. Really sad. • If you were to list the factors that increase the risk of cancer, heart disease, stroke, intestinal disorders – just about any illness – the standard American diet has them all: • High in animal fats • High in unhealthy fats: saturated, hydrogenated • Low in fiber • High in processed foods • Low in complex carbohydrates • Low in plant-based foods • The striking fact is that cultures that eat the reverse of the standard American diet – low fat, high in complex carbohydrates, plant-based, and high in fiber – have a lower incidence of cancer and coronary artery disease (CAD). What's even more sad is that countries whose populations can afford to eat the healthiest disease-preventing foods don't. The United States has spent more money on cancer research than any country in the world, yet the American diet contributes to the very diseases we are spending money to prevent.

17. Blood Type Diet • Blood type diet • popularity has fallen off • this one antigen on RBC has been chosen as representative- large evolutionary component • this is in vitro research being applied to in vivo situation • all 4 diets are nutritious and raise consciousness about food • no objective research in literature • skeptical that this will hold up when looking at it critically

18. High Protein Diets • High-protein diets (e.g. Zone, Atkins, Heller) • 30% protein (don’t need to ↑protein for ave. American diet to get this), 40% carbs, 30% fat (need to ↓fat for ave. American diet to get this) • #1 recommendation seeing in clinic for people w/ blood sugar irregularities is to ↑protein- recall research showing protein stabilizes glucose levels is weak • Lancet recently ran a review of research on these diets, outcome not good

19. A look at ATKINS • By restricting carbohydrates drastically to a mere fraction of that found in the typical American diet, the body goes into a state of ketosis, which means it burns its own fat for fuel. • A person in ketosis is getting energy from ketones, little carbon fragments that are the fuel created by the breakdown of fat stores. • When the body is in ketosis, you tend to feel less hungry, and thus you're likely to eat less than you might otherwise. • However, ketosis can also cause a variety of unpleasant effects (such as unusual breath odor and constipation in a small number of people.

20. Atkins • As a result, your body changes from a carbohydrate-burning engine into a fat-burning engine. • So instead of relying on the carbohydrate-rich items you might typically consume for energy, and leaving your fat stores just where they were before (alas, the hips, belly, and thunder thighs are popular fat-gathering spots), your fat stores become a primary energy source. • The purported result: weight loss.

21. Atkins • In slightly more detail, consider what happens when you eat a high-carbohydrate meal. • Sugar from the carbohydrate quickly enters the bloodstream. To keep the blood sugar from rising too high, the body secretes insulin. • Insulin allows the extra sugar to be stored in the liver and muscle as glycogen, but these stores are rapidly filled to capacity. • The insulin then converts any extra sugar to fat -- the stuff we're trying so hard to get rid of.

22. Atkins • According to the Atkins theory, if the body keeps on making "too much" insulin -- as it tries to deal with the "excess" sugar -- it may become less responsive to insulin and eventually may develop the metabolic disorder diabetes. • The Atkins theory states that this should properly be called "unstable blood sugar" since the blood sugar level rises and then drops quickly.

23. Atkins • This "first step in an unhealthy metabolic path" leads to "the early stages of diabetes." However, a body in ketosis burns up excess fat, and in time -- according to the Atkins theory -- returns to normal metabolic function. • Though all the fat in this diet may temporarily spike someone's cholesterol level, this is usually short lived and soon rights itself with a lower cholesterol and triglyceride level as weight loss occurs -- at least, that's the theory. • For most people, the carb consumption must be no more than 40 grams a day for this biochemical mechanism to occur. Although exercise isn't stressed, the Atkins theory holds that some people will need to add physical activity for ketosis to kick in. • People are urged to supplement with vitamins, since they won't be getting them from sources such as vegetables and fruits.

24. Atkins • The Atkins diet at a glance: • Sets few limits on the amount of food you eat but instead severely restricts the kinds of food allowed on your plate: no refined sugar, milk, white rice, or white flour • Allows you to eat foods traditionally regarded as "rich": meat, eggs, cheese, and more • Claims to reduce your appetite in the process. • On the Atkins diet, you're eating almost pure protein and fat. You can consume red meat, fish (including shellfish), fowl, and regular cheese (not "diet" cheese, cheese spreads, or whey cheeses). You can cook with butter, have mayo with your tuna, and put olive oil on your salads.

25. Atkins • On the other hand, carbs are restricted (about 20 grams of net carbs per day, meaning total carbs minus fiber) in the first two weeks, which translates to three cups of loosely packed salad or two cups of salad with two-thirds cup of certain cooked vegetables each day. • There are no exceptions to these rules during the first two weeks because low-carb consumption (no fruits and only a few leafy green vegetables) is supposed to jump-start the weight-loss biochemical activity of the diet. You're not counting calories (in fact, you may be eating more calories than you were before). • Later, the carb allowance is increased in the form of fiber-rich foods, but you do not return to eating refined sugar (by the teaspoonful or in desserts), milk, white rice, white bread, white potatoes or pasta made with the dreaded white flour. • The diet does allow for adding fruits, vegetables, and whole-grain foods after the two-week induction period.

26. Atkins • An Atkins spokesperson points out that a number of studies since 2002, including those funded by the American Heart Association, the National Institutes of Health, and the Philadelphia Veterans Administration, demonstrate some benefits of a low-carbohydrate diet -- especially when weight-loss results achieved with a diet like the Atkins plan are compared to weight-loss results on other diet plans. • But many health experts remain wary. "The Atkins diet is a viable option that requires more testing," Gary D. Foster, PhD, clinical director of the weight and eating disorders program at the University of Pennsylvania says. "The Atkins diet works at producing weight loss. If you are looking for weight loss, yes, it works. If you are looking for improvement in triglycerides and HDL Cholesterol, yes, it works." • But Foster, like other experts, remains concerned about the long-term safety of the diet.

27. Atkins • Robert H. Eckel, MD, director of the general clinical research center at the University of Colorado Health Sciences Center in Denver, agrees. "Our worries over the Atkins diet go way past the question of whether it is effective for losing weight or even for keeping weight off. We worry that the diet promotes heart disease...We have concerns over whether this is a healthy diet for preventing heart disease, stroke and cancer. There is also potential loss of bone, and the potential for people with liver and kidney problems to have trouble with the high amounts of protein in these diets."

28. Atkins • The American Dietetic Association also has concerns about the Atkins diet. Gail Frank, PhD, former spokeswoman for the organization and professor of nutrition at California State University in Long Beach, says, "The body needs a minimum of carbohydrates for efficient and healthy functioning -- about 150 grams daily." Below that, normal metabolic activity is disrupted. • "The brain needs glucose to function efficiently, and it takes a long time to break down fat and protein to get to the brain," says Frank. Carbohydrates, especially in the form of vegetables, grains, and fruits, are more efficiently converted to glucose. And this more efficient use of glucose has developed over a long period of time, according to Frank. "Fruits and berries are much more indicative of early man's eating pattern than eating only protein, and we haven't changed all that much physiologically."

29. Atkins conclusion? • The Atkins theories remain unproven, and most experts are concerned that a high-protein, high-fat diet can cause a host of problems, particularly for the large segment of the population that is at risk for heart disease. What's more, the plan doesn't permit a high intake of fruits and vegetables recommended by most nutrition experts because of the numerous documented health benefits from these foods.

30. Vegan Diet • Vegan diet • Concerns • ↓B12 • ↓iron • ↓essential fa (only 5% of flax seed is converted to longer chain fa)

31. Vegan Diet • The simplest definition of veganism is broad. There are lacto-ovo vegetarians who avoid animal flesh but eat eggs and milk products. At the other end are pure vegans, who forego eating (and often wearing) all animal-based products, honey included. Raw foodists are vegans who eat mainly raw fruits, vegetables, legumes, sprouts, and nuts.

32. The Good News for Vegans? • A vegan diet may do a better job of reducing cardiovascular disease in diabetic patients than a diet recommended by the American Diabetes Association (ADA), according to a new study. • Two out of three people with diabetes die of a heart attack or stroke, so reducing cardiovascular disease is a priority. The study was in part funded by the Physicians Committee for Responsible Medicine, which promotes a vegan diet.

33. The Study • For 22 weeks, participants followed either a low-fat, low-glycemic vegan diet or guidelines prescribed by the ADA. All 99 participants had type 2 diabetes. Both men and women participated and were recruited through a newspaper ad in the Washington, D.C., area.

34. The Results of Vegan Diet Study • The vegan group improved significantly in every category, including increased intake of vegetables, fruits, nut and soy protein, and cereal fiber, and a decrease in trans fat intake. • Both groups were able to reduce their weight and their hemoglobin A1c, a measure of blood sugar levels over a prolonged period of time. However, the vegan group experienced more significant reductions in both categories. • "The results of this study suggest that, if followed for the long-term, a low-fat vegan diet may be associated with a reduced risk of major chronic diseases, particularly cardiovascular disease," the study concludes. • Neither diet resulted in adequate intake of vitamins D or E, or of calcium. Patients attempting to follow either eating plan should consult with their doctor and make sure they are getting adequate amounts of these nutrients.

35. Macrobiotics • Macrobiotics • popular w/ CA pts • from TCM and acid base balance theories • vegan diet w/ fish and fermented foods • concern→rigid enough that people on this diet restrict food intake→CA pts can crash in burn since they have ↑metabolic needs. Not recommended for CA pts or those w/ eating disorders

36. Macrobiotic Diet • A macrobiotic diet isn't simply a diet plan. It's a way of life. It’s an organic, plant-based diet (with a little fish) and embraces a Zen-like spirituality in both your life and food selections. • Originally from Japan, the principle behind the macrobiotic diet combines tenets of Zen Buddhism with a Western-style vegetarian diet. • Much more than a list of recommended foods, it is all about a spiritualism that transcends lifestyle, attitude, and diet practices. • The word "macrobiotic" comes from the Greek and essentially means "long life" or "great life." 

37. The Eastern Philosophy? • Yin Foods? Yang Foods? You tell me...

38. What you can eat... • Here's a breakdown of a typical macrobiotic diet: • Whole grains, especially brown rice: 50%-60% • Vegetables (and seaweed): 25%-30% • Beans: 5%-10% • Fish, nuts, seeds, fruits, miso soup: 5%-20% • Soup (made from ingredients above): 1-2 cups/day

39. What Do Experts Say? • A well-managed macrobiotic diet can be nutritionally sound. The ADA approves of carefully planned and monitored vegetarian diets for all stages of the life cycle, including pregnancy, breastfeeding, childhood, and adolescence. • The macrobiotic diet is low in fat and high in fiber. Because of all the soy products, it is also rich in phytoestrogens, which may reduce the risk of estrogen-related cancers, such as breast cancer. There is no scientific evidence that a macrobiotic diet will reduce breast cancer, however eating a diet low in fat, high in fiber, and rich in plant foods containing phytochemicals may offer disease protection. • Experts say focus on healthy foods that are low in fat and high in fiber, but recognize the potential nutritional deficiencies. Nutrients of concern are vitamins D and B12, iron, protein, and calcium if you are not careful. • Whenever you eliminate food groups, it can create deficiencies and affect your health. Advice? Good nutrition should be considered first before balancing for yin and yang. 

40. Paleolithic Diet - Caveman • Paleolithic diet • Hunter gatherer • Eliminates processed foods and grains • ↑nuts, seeds, fruits and veggies • concern→low in fiber if not done right

41. The Proponents say... • The Paleo diet is a very healthy diet, says Loren Cordain, PhD, Colorado State University professor and author of The Paleo Diet. • “Clinical trials have shown that the Paleo Diet is the optimum diet that can lower the risk of cardiovascular disease, blood pressure, markers of inflammation, help with weight loss, reduce acne, promote optimum health and athletic performance," Cordain says. • Supporters of this nutritional approach have published papers and books, and created web sites, to promote it. They argue that today's typical Western diet is responsible for the epidemic levels of obesity, heart disease, diabetes, and more.

42. The Controversy • The Paleo or Caveman diet is not without controversy. Some nutrition experts assert that humans have adapted to a broader diet including whole grains, dairy, and legumes. Others question the evidence for the diet’s evolutionary logic. • And even though grains and dairy seem healthful, Cordain says our "genome has not really adapted to these foods, which can cause inflammation at the cellular level and promote disease.”

43. What You Eat? • The diet is based on the foods that could be hunted, fished, and gathered during the Paleolithic era -- meat, fish, shellfish, eggs, tree nuts, vegetables, roots, fruits, and berries. • But a true paleolithic diet is impossible to mimic because wild game is not readily available, most modern plant food is cultivated rather than wild, and meats are domesticated. • Modified version of the original diet that's gluten-free and includes lean meat, organ meats, fish, poultry, eggs, vegetables, fruit, and nuts. It's a wide variety of foods. NO dairy, grains, sugar, legumes, potatoes, processed oils, and any foods that were grown after agriculture started. • On this diet, you'd skip salt and any drinks other than water, coconut water, or organic green tea.

44. What you eat, continued... • You can satisfy your sweet tooth with raw honey or coconut palm sugar, but only in limited quantities. • Some versions of the plan encourage fasting, eating raw foods, and eliminating nightshade vegetables (tomatoes, eggplant). • Some plans allow a little flexibility, like adding some processed oils from fruits and nuts, such as olive and flaxseed oil. • Supporters suggest eating organic plant foods, wild-caught fish, and grass-fed meats because they're closer to the nutritional quality of the foods of our ancestor

45. What Do Experts Say? • Nutrition experts have been clamoring for years for a cleaner diet based on whole foods, lean meats, fruits, vegetables and less sugar, sodium, and processed foods, but they also typically include low-fat dairy, legumes, and whole grains based on the wealth of research that supports the role of these foods in a healthy, well-balanced diet. • “People who eat diets high in whole grains, beans, and low-fat dairy tend to be healthier because these foods are nutrient-rich and there are mountains of research about the health benefits of diets that include, not exclude, these foods,” says Keith Ayoob, EDd, RD, an assistant professor at New York's Albert Einstien School of Medicine. • American Dietetic Association spokeswoman Heather Mangieri, MS, RD, says, "This diet has some great aspects, but the limitations make it another diet that people go on but can’t sustain for a number of reasons, including a lack of variety, [cost], and potential

46. Finally • A diet that includes whole, unprocessed foods is the basis of most all healthy diet recommendations. But so are whole grains, low-fat dairy, and legumes. • If the Paleo or Caveman diet appeals to you, be sure to supplement the plan with calcium and vitamin D. • Eliminating all grains, dairy, processed foods, sugar, and more will most likely lead to weight loss. But it may be tough to follow this plan long-term due to the diet's strict nature.

47. How Do You Make Dietary Recommendations Succeed? • Best of luck to you on this one. It is very difficult. • Reiterate. Repeat. Say it again. • Build it slowly – try not to overwhelm with dramatic immediate changes • If you take something away, replace it→have handouts for food replacements • Meet patient where they are – not everyone will become granola-eating, organic dieted, health food addicts. • Try to avoid food-phobia • Focus on the positive aspects of dietary change, rather than the restrictive • Be willing to bargain a little • Be as specific and practical as possible • Have a referral nutritionist who can help implement your recommendations into real-life dietary strategies

48. Reading and Interpreting The Research • Research interpretation→ most research accompanying a product is flawed in someway. • Study quality (in increasing order of persuasiveness) • Hypothesis • Animal / in vitro work • Case report • Case series (or a bunch of case reports) • Case-control study • Prospective epidemiological trial • Uncontrolled clinical trial • Open-label, controlled trial • Double-blind clinical trial • Limitations of a double blind controlled trial • controlling variables is not representative of how people live • people are not all the same • size • ethics • cost • debate over whole practice vs double control trial • Questions to ask in interpretation • Does the conclusion follow from the findings • Is the study large/well-designed/adequately performed enough to support conclusion • Does the result make sense clinically (be careful here, sometimes results of studies can be surprising) • Has the safety of the intervention been adequately demonstrated

49. Discussion • Food Quality • FAD Diets