“nutrition for the dental team” you and foodcuring, salting or adding other chemical...

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Copyright © Integrative Medicine Concept, LLC. All Rights Reserved.

“Nutrition for the Dental Team”Tieraona Low Dog, MD

Chair: US Pharmacopeia Dietary Supplements

Admissions Joint Standard Setting Sub-Committee

Author of National Geographic’s “Fortify Your Life” “Healthy At Home” and “Life Is

Your Best Medicine”

www.DrLowDog.comCopyright © Integrative Medicine Concept, LLC.

All Rights Reserved.

You and Food

•What is your first “food” memory?•What is your favorite food?•How mindful are you when you eat? •Who makes the food choices at home?•Do you shop the perimeter of the store?•Do you consciously choose ”healthy” food?



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Diet and Obesity in US


Do Not Focus on Weight

•Focus on:•Healthy food•Healthy movement•Healthy rest•Healthy relationships


Nutrition in the 21st Century

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Is it any wonder that people are confused?


CDC results show that <18% of adults consumed the recommended amount of fruit and <14% consumed the recommended amount of vegetables.

www.cdc.gov/mmwr/preview/mmwrhtml/mm6426a1.htm Accessed December 20, 2016



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This equals 32 pounds of sugar per year simply from one can of soda per day


Glycemic Index and Load

•Glycemic Index: ranks carbohydrates based upon the impact of 50 grams of carbohydrate food on blood glucose response.

•Glycemic Load: helps predict blood glucose response to more typical serving size of a specific carbohydrate food.


Low(<=55)

Low(<=10) 11-19

56-69 High(>=70)

High(>=20)

Glycemic Index (GI)

Glycemic Load (GL)

0

0

20

10 20 30 40 50 60

6040 80 100

Glycemic Index & Glycemic Load Rating Chart

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Which One Would You Choose?

BananaGlycemic Index = 52Available Carbs = 24 gramsGlycemic Load = 14

WatermelonGlycemic Index = 72Available Carbs = 10 gramsGlycemic Load = 8


Influences on Glycemic Load of Foods

• Amount of processing (increases surface area)

• Fiber content (decreases GL)• Fat content and protein slow

stomach emptying and lower the glycemic load

• Many “fat-free” foods are high GL and contribute to obesity


Health Benefits of Low Glycemic Load Diet

•Numerous studies in both adults and teens have found that low glycemic load diets are associated with:•Better weight control• Improvement in blood sugar•Reduction in triglycerides• Improved ovulation in obese women with infertility•Lower risk of depression•Lower risk of heart disease, particularly in women


Glycemic Load and Mood

• 82 healthy weight and healthy overweight or obese, adults enrolled in randomized, crossover controlled feeding study.• Compared to a low GL diet, consumption

of high GL diet resulted in:• 38% higher score for depressive

symptoms (P = 0.002)• 55% higher score for total mood

disorder (P = 0.05)• 26% higher score for fatigue/inertia

(P = 0.04), compared to low GL diet. Breymeyer KL, et al. Appetite 2016; Dec 1;107:253-259.

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Glycemic Load

Individual Food Portion

Low 0-10

Moderate 11-19

High 20+

Whole Day

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


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


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

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Low/High GI Meals

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


Low/High GI Meals

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


Some Resources

Low GI Diet Tracker

App $3.99


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Tips on Whole Grains

• 100% Whole Wheat (first ingredient!)• Oats (skip the instant)• Brown Rice (white has bran/germ removed, LOW in nutrients)• Whole Rye (four times the fiber of whole wheat, most nutritious)• Whole Grain Barley (not pearled: bran and germ have been removed)• Buckwheat (loaded in magnesium, gluten-free)• Quinoa (not a grain, it’s a seed loaded in protein and omega 3)• Whole Wheat Couscous (delicious and high in fiber)• Corn (organic, non-GMO – increases healthy gut flora)


Gluten•Autoimmune condition celiac disease, where immune system

interacts negatively with gluten, a storage protein in cereal grains. ONLY treatment is complete avoidance of gluten. •Celiac symptom checklist: (celiac.org/celiac-

disease/resources/checklist/)•Other individuals may be allergic to wheat, not all grains.

Symptoms can include GI (indigestion, cramps, diarrhea, nausea), respiratory (stuffy/runny nose) and/or skin (hives or rash). Necessary to AVOID wheat.•And still others appear to have a gluten sensitivity, where

“symptoms” improve when they eliminate gluten from their diet. This is less clear…..

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www.celiac.org

Lots of info. Recipes provided for 7 day meal plan.

Get an app!

The Gluten-Free Scanner (free, more than 500,000 products)


Some of My Favorite Cookbooks


What is the Low FODMAP Diet?

• FODMAP are highly fermentable but poorly absorbed short-chain carbohydrates and polyols. Studies have shown that in some people, they can be a big cause of irritable bowel syndrome (IBS).•Gas, cramping, diarrhea

• Studies show that by eliminating wheat derivatives, lactose-containing dairy products, many vegetables and beans, and several types of fruits can improve IBS.

Barrett JS. Journal of Gastroenterology Hepatology 2017; Mar;32 Suppl 1:8-10.


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Useful ResourcesUse an App


Sugar Substitutes/Non-Caloric Sweeteners

•Aspartame (Equal & Nutrasweet)•Sucralose (Splenda)•Saccharin (Sweet ‘N Low, Sweet Twin)•Acesulfame K (Sunett, Sweet One)•Stevia (Truvia, Pure Via, Sun Crystals)•From Stevia rebaudiana leaves

•Monk Fruit (Nectresse)


Sugar Alcohols (Polyols)

•Erythritol•Hydrogenated starch hydrolysate• Isomalt•Lactitol•Maltitol•Mannitol•Sorbitol

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Natural Sweeteners

• Agave nectar•Date sugar• Fruit juice concentrates•Honey •Maple syrup•Molasses



• Eating an organic diet for one week significantly reduced pesticide exposure in adults. Mean total organophosphate metabolites were 89% lower than when participants were eating conventional foods.

• Similar results have been shown in children.

Oates L, et al. Environ Res 2014; 132:105-11Bradman A, et al. Environ Health Perspect2015; 123(10):1086-93


www.ewg.org/foodnews/

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FAT

• Most concentrated source of energy, more than twice carbohydrates or proteins. • Acts as messengers in reactions that help

control growth, immune function, reproduction and basic metabolism.• Help absorb fat soluble vitamins (A, D, E, K).• Certain fats, like linoleic acid and alpha linolenic

acid (ALA), are “essential” because our bodies cannot produce them, we must get in diet.• Makes foods taste flavorful and help us feel

full.


SATURATED FAT

• Meat, dairy products, eggs• Coconut and palm oil• Solid at room temperature• Increases LDL and HDL

UNSATURATED FAT

• Vegetable oils• Liquid at room temperature• Increases HDL, lowers LDL• Includes monounsaturated • Olive oil, avocados, peanuts,

almonds• Polyunsaturated • Omega 3• EPA/DHA: fish/shellfish• ALA: flax, walnut, soy, canola

• Omega 6• Corn oil, safflower oil,

sunflower oil


Does Eating Fat Give You Heart Disease?


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Saturated Fat Debate

• Three large meta analyses (21 studies, 12 studies, and 76 studies) have all failed to show any significant evidence that saturated fat increases the risk for heart disease. • It also has failed to find any significant

evidence that increasing polyunsaturated fats and decreasing saturated fats lowers your heart risk.• Consume a variety of fats in diet.

Siri-Tarino, Amer J Clin Nutr 2010; 91 (3): 535–46.Schwingshacki L, et al. BMJ Open 2014; 4(4):e004487.Chowdhury R, et al. Ann Intern Med 2014; 160(6):398-406.



Red Meat and Cancer

• Poultry and fish have neutral or beneficial effects regarding cancer/health.• The American Institute for Cancer Research has made the

following recommendations regarding red meats (beef, lamb, pork) based upon the data that links them to an increased risk of colon cancer:• Limit red meats to < 18 ounces per week.• Avoid processed red meats.


• Red meat refers to beef, pork and lamb – foods like hamburgers, steak, pork chops and roast lamb.

• Processed meat is red meat that is preserved by smoking, curing, salting or adding other chemical preservatives. Sausage, bacon, ham and lunch meats (such as bologna, salami and corned beef) are processed meats.

• The evidence is convincing that processed meats raise your risk of colorectal cancer, but the risk is considerably greater. For every ounce and half of processed meat eaten per day, risk rises by 21 percent.

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Grass-Fed/Pasture-Raised or Grain Fed

• Ethical and humane treatment of farm animals is an important consideration. Many reasons to support organic and grass fed/finished animals. •Grass fed fat higher in conjugated linoleic acid (CLA), stearic acid,

vitamins A and E, as well as antioxidants.•Organic pastured dairy and meats are up to ~50% higher in

omega 3 fatty acids•Organic meat and dairy: animals given organic feed and no growth

hormones or antibiotics.



Full or Low Fat Dairy?

• Full fat dairy products MAY help reduce weight gain and protect against type 2 diabetes. Fat slows absorption of milk sugar, causing slower rise in blood sugar, and lower/slower release of insulin. Fatty acids in dairy may also be protective against diabetes. No evidence that full fat dairy increases risk of heart disease. • Full fat dairy recommended for women trying to get pregnant as it

reduces anovulatory infertility. • Full fat dairy improves acne, low fat dairy aggravates it. • Full fat dairy lower in lactose, better tolerated by lactose intolerant

individuals.

Chavarro JE, et al. Hum Reprod 2007; 22(5):1340-7.Alexander DD, et al. Br J Nutr 2016; 115(4):737-50


Dairy Products

• Lactase produced by intestinal cells allows lactose to be digested/absorbed. Enzyme activity is highest after birth.• 30% of global population produces enough

lactase to digest/absorb lactose in adult life (*Scandinavian/northern Europeans).• The vast majority, lactase declines to 5-10% of

what was produced in infancy.• When more lactose is consumed than can be

digested, bloating, gas and diarrhea occur.• Protein: 1 ounce cheese ~ 8grams

8 ounces yogurt ~11grams8 ounces milk ~ 8grams

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What About Eggs?

• Provide essential fatty acids, proteins, choline, vitamins A and B12; selenium, and other critical nutrients.• Egg consumption (dietary

cholesterol) not associated with an increased risk of heart disease in the general population. • Look for organic eggs and omega

3 enriched whenever possible. •One egg provides ~ 6grams

proteinShin JY, et al. Am J Clin Nutr 2013; 98(1):146-59


Choline in Foods: http://naldc.nal.usda.gov/download/47335/PDF



Fish and Seafood

• Fish and seafood are low fat protein and high in omega 3 fatty acids, are a significant source of vitamin D and contribute valuable mineral nutrients to the diet such as selenium, iodine, magnesium, iron and copper.• Fish and seafood consumption are heart healthy. • Most governmental bodies recommend eating at least two servings of fish

per week that are high in omega 3 fatty acids and low in mercury. • Sustainability issues, as well as risks of toxicity for both children and adults,

make fish consumption a complex topic.

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Choosing Seafood

Low in contaminants high in omega-3s

No more than one serving per month

Highest in contaminants—avoid/limit

• European anchovy

• Oysters (farmed)

• Sablefish/black cod

• Salmon (canned)

• Salmon (wild)

• Pacific sardines

• Rainbow trout (farmed)

• Albacore tuna (US or Canada)* limitschildren/pregnantwomen

• Mahi mahi

• Blue mussel

• Eastern oyster

• Cod

• Pollock

• Blue crab

• Channel catfish (wild)

• Lake whitefish

• Grouper

• Orange roughy

• Rockfish

• Sea bass

• Atlantic salmon

• Shark

• Atlantic sturgeon

• Swordfish

• Tilefish

• Bluefin tuna


Coconut Oil• From coconut tree (Cocos nucifera), extensively

used in tropics/subtropics. Was widely consumed in US (behind animal and dairy fats) prior to production of edible oils.• Rich in medium chain saturated fatty acids (e.g.,

lauric acid), directly absorbed from intestine to the liver to be used for energy production. • Compared to long chain fatty acids, less likely

to be stored as adipose tissue and may be less likely to promote insulin resistance and inflammation. It raises both LDL and HDL. • Active against a variety of viruses and

possesses antibacterial and antifungal activity (great for topical use).

McCarty MF, et al. Open Heart 2016; 3(2):e000467.Eyres L, et al, Nut Rev 2016; 74(4):267-80


What’s In a Name? Virgin versus Refined

• Refined coconut oil is derived from dried coconut meat (copra). High heat and bleaching clays often used to deodorize the oil. If using refined coconut oil use ORGANIC only: no chemical solvents. • Unrefined coconut oil, "virgin" coconut oil, is

obtained from the fresh and mature kernel of coconut by mechanical or natural means with or without the application of heat, which does not lead to alteration of the oil. Smoke point is lower than refined: 350 degrees F. • Cold pressed coconut oil has a stronger coconut

flavor and tiny traces of the soluble constituents extracted from the dried coconut meat.


Olive Oil

• Cornerstone of Mediterranean diet.• Rich in monounsaturated fat oleic

acid (73%), antioxidants, and modest levels of vitamin E and K. • Oleocanthal mimics effect of

ibuprofen in reducing inflammation. • Protects against heart disease and

stroke; lowers total blood cholesterol, LDL-C, triglycerides; improves HDL, has a mild blood pressure lowering effect.• May offer additional protection

against Alzheimer’s disease, diabetes and cancer as part of a healthy diet.

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

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• Extra virgin olive oil made simply by crushing olives. Only cooking oil made without the use of chemicals and industrial refining.• Must be produced entirely by mechanical means without the use of any

solvents, and under temperatures that will not degrade the oil.• Olive oil should be kept refrigerated for optimal shelf life. • To find top olive oils that meet rigorous quality standards:

www.bestoliveoils.com


Avocado

• Only fruit that contains significant amount of monounsaturated fat; also oleic acid (like olive oil). • Contains twice the potassium than bananas,

low in sodium, high in fiber and very low in sugar, incredibly healthy addition to diet.• Powerhouse for heart health, significantly

lowering total cholesterol, triglycerides and LDL cholesterol, particularly small dense type that is particularly dangerous for the heart.• I add avocados to smoothies, use it as a spread

on whole grain bread instead of butter, or just slice one open and eat it for breakfast with a little lemon.

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


Fats to Generally Avoid

•Margarine and vegetable shortening •Regular (non-organic) sunflower and safflower oils•Corn oil, cottonseed oil, and mixed vegetable oils•Products made with refined soybean oil•All products made with any partially hydrogenated oils•NO trans fats!!!


Protein

• From Greek protos, “first.” • Build new cells, maintain tissues (e.g., muscles, inner bone, hair, nails),

create enzymes, make hemoglobin, lipoproteins to transport cholesterol; present in membrane of every living cell. • Sources include meat, poultry, seafood, eggs, soy products, nuts, nut butters,

beans, peas, and seeds. You need ~8 grams protein per 20 pounds body weight for adults.• Choose seafood two times weekly (low in mercury, high in omega 3s,

sustainable)• Include beans and peas often in your diet, as a side or main dish• Avoid processed red meats, include modest amounts of other meats

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Protein Rich Foods


Protein and Fracture Risk

• Framingham Osteoporosis Study found higher protein intakes (60-83g/d versus 46g/d) in elder men and women (mean 75 years) were associated with a 37% decreased risk of hip fracture.• Women's Health Initiative found 20% increase in protein intake (15-18%

of energy intake) improved bone mineral density maintenance and marginally lowered forearm fracture risk. • No clinical data support the hypothesis of a detrimental effect of high

protein diet on bone health, except in the context of inadequate calcium supply.

Misra D, et al. Osteoporosis Int 2011; 22(1):345-349. Beasley JM, et al. Am J Clin Nutr 2014; 99(4):934-940.

Calvez J, et al. Eur J Clin Nutr. 2012;66(3):281-295.


Protein Intake and Fracture in Men

• As part of the Osteoporotic Fractures in Men Research, higher protein intake was associated with an 8% decreased risk of major osteoporotic fracture.• Increased dairy protein and non-dairy animal protein associated

with a 20% and 16% decreased risk of hip fracture, respectively.• Plant protein not associated with decreased risk of hip fracture. • Total protein was associated with a 16% decreased risk of hip

fracture but not clinical spine fracture. • Caution with high protein in those with severe kidney disease.

Langsetmo L, et al. J Bone Miner Res 2017; Mar;32(3):592-600


• All models adjusted for age, height, TEI, center, education, smoking, alcohol intake, physical activity, sedentary hours, calcium and vitamin D supplement use, hormone therapy (women 50+ y), bisphosphonate use (50+ y), and diagnosis of osteoporosis (50+ y).

Langsetmo L, et al. J Nutr Health Aging 2015 Oct; 19(8): 861–868

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Legumes Are Awesome!

• Soak larger dried legumes (kidney, chickpeas, black & red beans) for 4-24 hours in cold water before cooking, Change water 1-2 times to reduce gas.• Use 3 cups water per cup of legumes in

cooking.• Use ladle to occasionally remove foam on top

when cooking legumes• Rinse canned beans before use to remove

sodium• Lentils are quick and easy to prepare - rinse till

clear and remove any small stones/grit. • Prepare large bag of lentils and then freeze half

for future use. • Add vinegar, salt, etc. at end of cooking time.


Soy Milk• Highest in protein of dairy alternatives• A good source of B-vitamins and soy has

been shown to be heart healthy.• It is also the least processed of most

commercially available dairy alternatives.• High in phytic acid, however, which can

impair absorption of nutrients such as calcium, iron and zinc. (Fermented soy: no phytic acid: miso, tempeh)• Purchase organic, non-GMO soy and look

for unsweetened products to avoid high sugar. • 1 cup soy milk ~ 8grams protein


Almond Milk

• Only 90 calories per 8 ounces• No saturated fats or cholesterol• 25% of the daily value for vitamin D and

almost half of the vitamin E and also provides some magnesium, zinc, calcium and other minerals. • Lovely nutty flavor• Very little protein (1 gram per cup)• Easy to make at home (you can save your

almond meal by drying it in oven on very low heat for 3 hours. Freeze and use.)

• 1 cup raw almonds (soaked overnight)• 2-4 cups water• 1 Medjool date• 1/8 tsp vanilla extract

• Soak the almonds in bowl of water for 12-24 hours. Longer the soak, the creamier your milk.• Strain almonds. Put almonds in blender,

add water (less makes it creamier), and blend for 2 minutes. Strain through muslin cloth or nut milk bag. You can stop here OR• Put strained milk into blender and add

date and vanilla. Blend well. Refrigerate for up to 3 days.


• Studies show dairy products are beneficial for building muscles and preserving lean muscle mass, lowering blood pressure, preventing tooth decay, diabetes, colorectal cancer, and obesity.• In those with mild lactose deficiency, full fat dairy, yogurt with live bacteria and

kefir (fermented foods) are not only generally well tolerated. Hard cheeses are low in lactose. If purchasing milk, ONLY organic and grass fed.

Tunick MH, et al. J Agric Food Chem 2014; Nov 19

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“nutrition for the dental team” you and foodcuring, salting or adding other chemical...

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