“the nutrition prescription” the many faces of food · pesticide and adhd •...

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“TheNutritionPrescription”Tieraona Low Dog, MD

Fellowship DirectorAcademy of Integrative

Health & Medicine

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

“Life Is Your Best Medicine”

www.DrLowDog.com

Copyright©2016IntegrativeMedicineConcepts,LLC.AllRightsReserved.

TheManyFacesofFood• Culture, custom, and social meanings• Personal taste/preference• Convenience• Habit • Advertising• Availability• Budget• Health



DietandObesityinUS


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Nutritioninthe21st Century

Copyright©2016IntegrativeMedicineConcepts,LLC.AllRightsReserved. Copyright©2016IntegrativeMedicineConcepts,LLC.AllRightsReserved.

Breaking It Down:The Macronutrients


CARBOHYDRATES

• Provide majorityofcaloriesinmostdiets• Thebody�s preferred fuel source• Largestcontributor toglucosecontrol• Halfofcarbohydrates inNorthAmericandietcome from:bread, softdrinks, cakes,cookies,donuts, quick breads, sugars,syrups, jams,whitepotatoes (includingchips)andbreakfastcereals


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WHORecommends LimitingSugarConsumptionTo25g/d


Sugarsaddedtofoods,aswellasthosefoundnaturallyinhoney,syrups,fruitjuicesandfruitconcentrates.Notinfreshproduce.


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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

Glycemic Index&GlycemicLoadRatingChart


InfluencesonGlycemicLoadofFoods

• Amountofprocessing(increasessurfacearea)

• Fibercontent(decreasesGL)• Fatcontentandproteinslow

stomachemptyingandlowertheglycemicload

• Many�fat-free� foodsarehighGLandcontributetoobesity


GlycemicLoad

Individual FoodPortion

Low 0-10

Moderate 11-19

High 20+

WholeDay

Low <80

Moderate 80-120

High >120


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Food ServingSize Glycemic LoadGrapefruit ½large 3Apple 1medium 6Banana 1large 14Raisins 1smallbox 20Watermelon 1cup 8Carrots 1large 5Orange 1medium 6Sweet potato 1cup 17Bakedpotato 1medium 28Frenchfries 1mediumserving 26Snickers 1bar 35Reese’scup 1miniature 2Whitetablewine 5ounces 1Redtablewine 5ounces 1Grape juice 6ounces 12


Food ServingSize Glycemic LoadAsparagus ½cup 2Broccoli 1cup 4Green beans 1cup 3Tomato 1medium 2SubwaysandwichTurkeybreast

6inch 17

Butter pecan icecream 5.5ounces(small) 22Vanillaicecreamcone 4.5ounces (small) 19Potatochips,fatfree 1bag(8ounces) 49Tortillachips,whitecorn 3.5ounces 38Eggo oatwaffles 1serving 13Maplesyrup 4Tbsp 39Egg, hardboiled 1 2Applejuice 8ounce 6


Food Serving Size Glycemic LoadSpaghetti 1cup 38Brown rice 1cup 23Whiterice 1cup 33Whitebread 1slice 10Wholegrainbread 1slice 5Bagel,cinnamonraisin 13.5inch 24Pumpernickel bread 1slice 6Macaroniandcheese 1cupprepared 31Chocolatedoughnut 1doughnut(80g) 25Glazeddoughnut 1doughnut(80g) 12Kellogg’sFrostedFlakes ¾cup 20Kellogg’sSpecial K 1cup 14PostBranFlakes ¾cup 12PostRaisin Bran 1cup 25


PicturesofLow/HighGIMeals&Snacks

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


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PicturesofLow/HighGIMeals&Snacks

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


RealityCheck

• Itisnotpractical totry to“count” glycemicload, inpartbecause itwillvary baseduponportion sizeandothercomponents inthemeal.

• Thetakehomemessage: cutwaybackonprocessed, refined ,sugary foodsanddrinks.


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

• Monk Fruit (Nectresse)


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SugarAlcohols

• Erythritol• Hydrogenated starchhydrolysate• Isomalt• Lactitol• Maltitol• Mannitol• Sorbitol


NaturalSweeteners

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


ANoteonGluten

• Glutenisthenameforthestorageproteinsfoundinwheat,barley,ryeandrelatedcerealgrains–triticale,speltandkamut.

• Inpatientswithceliacdisease,astrictgluten-freedietistheonlytreatmentandrequireslifelongeliminationofallfoodscontainingwheat,barley,rye,relatedcerealgrainsandcommercialoats.

• Somepeoplemaybeglutenintolerantanda4weektrialeliminatingglutenmaybeappropriate.


SymptomsofCeliac(manypeoplegoundiagnosed)

• Recurringbloating,gas,orabdominalpain• Chronicdiarrheaorconstipationorboth• Unexplainedweightlossorweightgain• Pale,foul-smellingstool• Unexplainedanemia• Boneorjointpain• Behaviorchanges/depression/irritability• VitaminKDeficiency• Fatigue,weaknessorlackofenergy• Delayed growthoronsetofpuberty• Failuretothrive(ininfants)• Missedmenstrualperiods• Infertilitymale&female• Spontaneousmiscarriages• Cankersoresinsidethemouth• Toothdiscolorationorlossofenamel


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Bisphenol A

• Bisphenol A(BPA)isaknownendocrinedisruptor.• BPAassociatedwithincreasesindevelopmentaldisordersofthe

brainandnervoussysteminanimals.• Associatedwithobesity,diabetes,andCVDinadults.• RecentstudyfoundthathigherlevelsofurinaryBPAwere

associatedwithahigheroddsofobesity(BMI>95%)andabnormalwaistcircumference–to–heightratioinchildrenages6-18.

• ThereissomeevidencethatprenatalexposuretoBPAdecreasesrespiratoryfunctionandincreasespersistentwheezeinchildren.

Eng DS,etal.Pediatrics2013;132(3):e637-45.Spanier AJ,etal.JAMAPediatr 2014;168(12):1131-7McGuinn LA, et al. Environ Res 2015; 136:381-6.


DentalSealants

• Resin-based dental sealants and composites contain a BPA derivative. Researchers examined urinary BPA measurements and oral examination data for 1,001 children aged 6 to 19 years from 2003-2004 NHANES.

• Children with 7 to 42 restorations had mean BPA concentrations 20% higher than those of children with no restorations, this did not reach statistical significance.

McKinney C, et al. J Am Dent Assoc 2014 Jul;145(7):745-50.


CannedSoup

• Canned goods are significant source of BPA.• Researchers at the Harvard School of Public

Health found that volunteers consuming one serving of canned soup each day for five days had a more than 1,000% increase in urinary BPA concentrations compared with when the same individuals consumed fresh soup daily for five days.

Carwile JL, et al. JAMA 2011; 306(20):2218-20.


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• Phthalatesusedtomake plasticsmore flexible andharder tobreak.

• CDCfound84%populationhavesixormorephthalates inoursystem.

• SYNTHETIC fragrancesare asignificant sourceofexposure.

• Exposure linked toserioushealthdefects inchildren, includingearlypuberty, andlower testosteroneandspermcounts.

• Systematic review/meta-analysisfoundexposuretoEDCs, includingBPAandphthalates, increase riskoftype2diabetes

BraunJM,etal. Curr OpinPediatr 2013;25(2):247-54.SongY,etal. JDiabetes2015;doi:10.1111/1753-0407.12325.

Phthalates


PesticideExposureandADHD

• Usingdata fromNHANES – childrenwith typical levelsofpesticideexposure fromeating pesticide-treatedfruits/vegetables havehigher riskofdeveloping ADHD.

• Childrenages8-15withhigherurinary levelsofdimethylalkylphosphate (DMAP)hadtwice theoddsofADHDwhencomparedwithchildrenwith loworundetectable levels.

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


PesticideandADHD

• Pyrethroid pesticidescauseabnormalitiesindopaminesystemandproduceADHDphenotypeinanimalmodels.

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

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

Wagner-SchumanM,etal. Environ Health2015;May28;14:44.


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GlyphosateandCancer

• IARC,theworld’sleadingauthorityoncancer,determinedthatglyphosatewasaprobablehumancarcinogenwasmadebyunanimousdecisionof17qualifiedscientistsledbyDr.AaronBlair,adistinguishedepidemiologistrecentlyretiredfromtheU.S.NationalCancerInstitute.

• MassiveuseofglyphosatewithRoundupReadycropshasgeneratedanepidemicofglyphosate-resistantweeds.Moreherbicidesontheway.


UsGeologicalSurveyofGlyphosate


Eatinganorganicdietforoneweeksignificantlyreducedpesticideexposureinadults.Meantotalorganophosphatemetaboliteswere89%lowerthanwhenparticipantswereeatingconventionalfoods.Similarresultshavebeenshowninchildren.

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


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www.ewg.org/report/ewgs-water-filter-buying-guide


FAT

• Most concentrated source of energy, more than twice that of carbohydrates or proteins.

• Act 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, are “essential” because our bodies cannot produce them.

• Make foods flavorful and help us feel full.


Does Eating Fat Give You Heart Disease?


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SaturatedFatDebate

• Threelargemetaanalyses(21studies,12studies, and76studies)haveallfailedtoshowanysignificant evidencethatsaturated fatincreasestheriskforheartdisease.

• Italsohasfailedtofind anysignificantevidencethatincreasing polyunsaturated fatsanddecreasingsaturatedfatslowersyourheartrisk.

Siri-Tarino, Amer JClin Nutr 2010;91(3):535–46.SchwingshackiL,etal. BMJOpen2014;4(4):e004487.

Chowdhury R,etal. AnnInternMed2014;160(6):398-406.


Prevents:• 7nonfatal

heart attacks• 4strokes

• 2deaths


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 does not limit cholesterol. Eggs are back on the good list.

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


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Omega3FattyAcidsfromPlantsandAnimals

Dark green vegetables, walnuts,freshlygroundflaxseedsandotherplantfoods.

ALA

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

DHA EPA

Convertsto Convertsto

IntermediateMoleculesSuppliesSupplies


Conversion of ALA to EPA/DHA

• Women better able to convert ALA to DHA. Conversion associated with estrogen.

• Given importance of DHA to developing fetus, there was likely biological pressure for this to occur.

Kitson AP, et al. Lipids 2010; 5(3):209-24.


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.


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


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Mercury

• Bacteria in water can transform inorganic mercury into more bio-active, organic form, methylmercury, which can then concentrate to very high levels in fish.

• US Geological Survey of 291 freshwater streams between 1998-2005 found 100% of the larger fish tested positive for significant mercury exposure.

• Majority of mercury entering US rivers stems from emissions from coal mining. The emissions enter the air and then are precipitated back into water systems.

Scudder BC, et al. U.S. Geological Survey Scientific Investigations Report 2009–5109, 74 p.


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


Different Types of Fish Oil• Supplementation is an alternative to eating fish;

however, all supplements are not equal.• Randomized, crossover study of 35 healthy

individuals compared four popular brands/types of omega 3 fatty acids:– Concentrated triglyceride (rTG)– Ethyl ester (EE)– Phospholipid krill oil (PL)– Triglyceride salmon oil (TG)

LaidlawM, etal. LipidsHealth Dis2014;13:99


Dosing According to Manufacturer’s Recommendations


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rTG

EEE

TG

PL


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.


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WCRF/AICRRecommendations toReduceCancerRisk

• Limitconsumptionofredmeats(beef,pork,lamb)andavoidprocessedmeats.

• Striveforlessthan18ouncesperweekofredmeat.


• Redmeatreferstobeef,porkandlamb – foodslikehamburgers,steak,porkchopsandroastlamb.

• Processedmeat isredmeatthat ispreservedbysmoking,curing, saltingoraddingother chemicalpreservatives.Sausage,bacon, hamandlunchmeats(suchasbologna, salamiandcornedbeef)areprocessedmeats.

• The evidence isconvincing thatprocessed meats raiseyourriskof colorectal cancer, but theriskisconsiderably greater.Foreveryounceand half of processed meat eatenperday,riskrisesby21percent.



Eco-Label

Organization

PerConsumerUnion

AntibioticUse

Consumer�s Union Guide to Environmental Eco-labels


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Until heextendsthecircleofcompassion toallliving things,manwill not himself findpeace.

--AlbertSchweitzer

• Studies showdairy products arebeneficial inmusclebuilding, loweringblood pressure,preventing tooth decay,diabetes, colorectalcancer,andobesity.

Tunick MH,et al.JAgric FoodChem 2014;Nov19


DairyandCancer• WCRF/AICRreportconcludedthatmilkprobablydecreases

riskofcolorectalcancerbutdietshighincalciummayincreasetheriskofprostatecancer.

• AnalysesofhormonelevelshaveshownthatriskforprostatecancerishigherinmenwithrelativelyhighbloodlevelsofIGF-I (foundinmilk,especiallywithhormones).

• “ThealmostexclusivedietaryrelianceofMongoliansonmeatanddairyarguesagainstbeneficialeffectsofalow-fatdietoncirculatinghormonesexplaininginternationalbreastcancerdifferences.”

Abid Z,etal. AmJClin Nutr 2014;100(S)1:386S-93SKeyTJ. RecentResultsCancerRes2014;202:39-46Troisi R,etal. PLoS One2014;9(12):e114455.


Quinoa

• Highinprotein(8gramspercookedcup),lowincholesterol,goodsourceofironandfiber.

• Somevarietiestake20minutestocook–turnsslightlytranslucentwhendone.


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Soy

• Soy contains isoflavones (which have been studied most), saponins, phenolic acids, phytic acid, phytosterols, and protein kinase inhibitors.

• Soy inhibits the growth of prostate cancer cells and studies suggest that consuming soy in childhood and adolescence may help protect against breast cancer later in life.

• Including 1-2 servings/d of minimally processed and/or fermented soy in diet can be a healthy practice.


Soy and Breast Cancer• LACE trial saw a 60% reduction in risk of breast cancer

recurrence in women taking tamoxifen who were in the highest quintile of soy intake.

• Supplemental soy isoflavones significantly reduce hot flash frequency and severity, particularly those that provide a minimum of 18 mg/d of genistein.

Korde LA, et al. Cancer Epidemiol, Biomarkers Prev 2009; 18(4): 1050-1059. Fritz H, et al. PLoS One. 2013; 8(11): e81968Taku K, et al. Menopause 2012; 19(7):776-790


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

Roughly8gramsofproteinper20poundsofbodyweightisgenerallyrecommended


SodiumRecommendations?

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

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


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TraditionalAsianDiet

• LittlequestionmanypeopleinAsiancountrieshavelowratesofdiabetes,heartdiseaseandcancer.

• Thereisnoone“Asian”diet butsomegeneralizationsthatcanbemade.

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


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


OkinawanDietaryPattern

• Highconsumption ofvegetables• Highconsumption oflegumes (mostlysoy)• Moderate consumption fishproducts• Lowconsumption meatandmeatproducts• Lowconsumption ofdairyproducts• Moderate alcoholconsumption• Lowcaloric intake• Emphasison lowGLcarbohydrates


“the nutrition prescription” the many faces of food · pesticide and adhd •...

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