croton-harmon septa 2010 nutrition, vitamins and cognition stephen cowan md, faap

Croton-HarmonSEPTA2010

Nutrition, Vitaminsand

Cognition

Stephen Cowan MD, FAAP

Basic Sanity

Living in synch with the cycles and seasons of nature

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Sympathetic“Fight or Flight”

Parasympathetic“Rest and Digest”

Yang

Yin

Effects of Poor Nutrition on our Children

Cardiovascular

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Learning and BehaviorObesity



DiabetesCancer



“You can’t just keep writing out script after script after script of new medications when diet is just as important as drugs or any other treatment a patient may be using.”

Katherine Chauncey RD, Texas Tech Medical SchoolNY Times Article Sept 16, 2010

Current diet studies suggest that:

Eating Habits in Childhood

“Many children do not eat breakfast and get at least 1/3 of calories from snacks”.

“Sweetened beverage intakes contribute significantly to total caloric intake.”

“Sweetened snacks contribute to deficiencies in the intake of

foods containing essential nutrients”



Adolescence is a “nutritionally vulnerable” age

Increased appetite + Sedentary life = Obesity

Peer pressure + Media promotion = Over-eating as “natural”

Increased “junk food” = Decreased “healthy foods”

Consumption of excess

saturated fat, trans fats, and added sugars

=Insufficient consumptionof micronutrients(calcium,iron, zinc, and potassium, vitamins A, D, and C, Folic acid and

Omega-3 fatty acids)

Adolescent Eating Habits

Taking inthe world

Break it downSort it

Integrate it

Eliminate it

Food is Information

In-sanity

Taking inthe world

Break it downSort it

Integrate it

Eliminate it

“unfinished business”

Fast Food!

Accumulation

Distraction

Stagnation

Boredom

Agitation

Dissatisfaction

“phlegm mists the mind”

Hostility

No Time!

Organic Food



Cooking togetherEating together

The Physiology of Appetite

Ghrelin “I’m Hungry”

Leptin“I’m Full!”

Gastric motilityVagal nerve stimulationHypothalamus sensation of hunger

Produced in fatProduced in stomach

Maintain body fat stores

Loss of fat = lowers Leptin = “I’m hunger”

Obesity increases Ghrelin= I’m hungry



Eating in the Absence of Hunger

American Journal of Clinical Nutrition, Vol. 76, No. 1, 226-231, July 2002

Eating in the absence of hunger and overweight in girls from 5 to 7 y of ageJennifer Orlet Fisher and Leann L Birch

The girls who ate large amounts of snack foods in the absence of hunger at 5 and 7 y of age were 4.6 times as likely to be overweight at both ages.

Parents' reports of restricting their daughter's access to foods at age 5 y predicted girls' eating in the absence of hunger at age 7 y

Developing Habits of Self-regulation of Energy-intake

Control - Children can self-regulate in Non-controlling, non-coercive conditions Birch et al

Use of External cues: prompts- clocks, “clean your plate”, rewards for finishingleads to LACK OF SELF REGULATION

Self Reflection - Effect of parental beliefs, worries and role modeling

Use of Internal cues: Aware of when hungry, when fullleads to improved self regulation

Susan Johnson PhD Pediatrics 2000;106;1429-1435

LESS IS MORE !

The Hormetic Effect of Food

1. Low energy intake stimulates cellular stress resistancethereby protecting various tissues against disease and increasing lifespan

2. Specific phytochemicals exhibit biphasic does responseon cells with low doses activating signaling pathways that result in expression of genes encoding cytoprotective proteins



1. Low energy intake stimulates cellular stress resistancethereby protecting various tissues against disease and increasing biologic function and lifespan

High energy intake increases the risk of : 1. Cardiovascular disease2. Type 2 diabetes3. Stroke4. Cancers 5. Neurodegenerative disorders

and Low Energy Intake reduces the risk!



How Hormesis Works

Energy restriction

Protect against cell damage

Increases cytoprotective molecules

Heat-shock proteinsAnitoxidants, vit E, co Q10Plasma redox enzyme actovoty

Up-regulation of protein production involved in mitochondrial oxidative phosphorylation

Increased adaptive stress

Improved energy efficiency

Growth factorsEndothelial cells in heartBDNF in brain



Plant defense:During evolution plants develop specific biosynthetic pathwaysfor the production of toxins that prevent microorganisms and insects from eating them

Sub-toxic (hormetic) doses induce adaptive stress responses in humans

2. Specific Phytochemicals Hormetic effects



Sulphoraphane in broccoli- increase expression of cell protective proteins in liver, intestinal and stomach cells

Examples of hormetic phytochemical protection

Curcumin induce adaptive stress response genesCell Protective proteins in animal models of cataractPulmonary toxicity, MD and Alzheimer's disease

Resevratrol activates stress response pathwaysCell prtoective to heart (MI and stroke)

Allicin in garlic induces gene expression of cell protectiveproteins involved in immune system



Dietary Supplementation

The child growing up in the U.S. in the 1940's got:

The child growing up in the U.S. today gets:

White toothpaste Multi-colored toothpaste, perhaps with sparkles

Oatmeal Sea Treasures Instant Oatmeal (turns milk blue)

Corn flakes Fruity Pebbles

Toast & butter, jam Pop Tarts

Cocoa made with natural ingredients Cocoa made with artificial flavoring, & some with dyes.

Whipped cream Cool Whip

No vitamins (or perhaps cod liver oil) Flintstone vitamins

White powder or bad-tasting liquid medicine

Bright pink, bubble-gum flavored chewable or liquid medicine

Sample school lunch:Meat loaf, freshly made mashed potatoes, vegetable. Milk, cupcake made from scratch.

Sample school lunch: Highly processed foods loaded with synthetic additives, no vegetable. Chocolate milk with artificial flavor.

Sample school beverage: Water from the drinking fountain

Sample school beverage: Soft drink with artificial color, flavor, caffeine, aspartame, etc.

Candy in the classroom a few times a year at class parties.

Candy (with synthetic additives) given frequently.

The Feingold Programeliminates these additives: SalicylatesArtificial (synthetic) coloring Artificial (synthetic) flavoring Aspartame (Nutrasweet, an artificial sweetener) Artificial (synthetic) preservatives BHA, BHT, TBHQ

The Impact of a Low Food Additive and Sucrose Diet on Academic Performance in 803 New York City Public Schools,Schoenthaler S et al; Int J Biosocial Res, 1986;8(2):185-195

The introduction of a diet policy which lowered sucrose, synthetic food color/flavors and two preservatives (BHA and BHT) over 4 years in 803 schools was followed by a 15.7% increase in mean academic percentile ranking above the rest of the nation’s schoolswho used the same standardized tests.

Each school’s academic performance ranking was negatively correlated with the percent Of children who ate school food prior to diet policy changes. However, after policy transitions,The percent of students who ate school lunches and breakfasts within each school became Positively correlated with the school’s rate of gain (r = .28, p< .0001)

“Fish oil dramatically improved the symptoms of Attention Deficit Disorder (ADHD) as effectively as stimulant medications like Ritalin and Concerta without the serious adverse side effects”

University of Adelaide Australia Journal of Developmental and Behavioral Pediatrics 2006

Effect of Supplementation with Polyunsaturated Fatty Acids and Micronutrients on Learning and Behavior Problems Associated with Child ADHD.Natalie Sinn, PhD; Janet Bryan, PhD

Journal of Developmental and Behavioral Pediatrics March, 2007

Omega 3 Fatty acids

Omega 3 Fatty Acids

Studies confirm that breast-fed babies have an IQ advantage over babies fed on formula lacking DHA.



sources of DHA:

salmon, sardines and trout Krill oilomega-3 fortified eggs

green leafy vegetables,soybeans, walnuts, flaxseed oil



The Importance of Micronutrients in Cognition

Important Micronutrients in Cognition

The role of micronutrients in psychomotor and cognitive development

S M Grantham-McGregor and C C AniCentre for International Child Health, Institute of Child Health,

University College London London, UK

British Medical Bulletin 55:511-527 (1999)

http://bmb.oxfordjournals.org/cgi/reprint/55/3/511

Essential for myelination, dopaminergic and serotonergic neurotransmission, stress response, arousal and attention

Iron Deficiency- Most vulnerable during periods of rapid growth

Causes reduced work-capacity and productivityin children and adults

Behavior problems, attention, motor and cognitive function, school achievement, lower IQ

IRON

Sources of Iron

HEME :Beef, Liver, Chicken, Fish, Pork, Turkey

NON-HEME: Beans, Spinach, Tofu, Oatmeal (fortified)

Low maternal intakes of zinc during pregnancy and lactation were found to be associated with:

1. less focused attention in neonates 2. decreased motor functions at 6 months of age.

British Journal of Nutrition (2001), 85:S139-S145

Zinc

Zinc supplementation resulted in: 1. better motor development and more playfulness in low birth weight infants 2. increased vigorous and functional activity in infants and toddlers.

In older school going children the data is controversial but there is some evidence of:improved neuropsychological functions with zinc supplementation.

Sources of Zinc

It has been found that increasing intake of vitamins such as Vitamin C, E and B6 and minerals such as magnesium can increase zinc absorption in the body.

Proteins (meat, fish, eggs, milk)

It has been reported that intake of more than 50 milligrams of zinc (both from diet and from supplements) can lead to improper copper metabolism, altered iron function, reduction of HDL's and reduced immune function.

Peanuts, beans, and wholegrain cereals, brown rice, whole wheat bread,

*Pumpkin Seeds offer one of the most concentrated non-meat food sources of zinc.

Iodine

Iodine deficiency remains a significant public health problemin many countries and is estimated to be responsible for 5.7 million cases of cretinism and 43 million cases of less severe cognitive impairment.

Many observational studies have compared children in iodine sufficient and iodine deficient areas and nearly all have found:poorer psychomotor and cognitive development in childrenliving in iodine deficient areas.

The controversy over conditions of borderline thyroid function

Iodine sources

Salt (iodized)Sea vegetables Yogurt, cow's milk, eggs, mozzarella cheese.strawberries

Fish and shellfish - extremely variable

Upper limit RDA 1000 mcg

Multivitamins and cognitive function in children

Six clinical trials examined the effect of multivitamin supplementation on young peoples' cognitive function.

• Two reported significant improvements in the intelligence of school children treated. British Medical Bulletin 1999; 55 (No. 3)

• The third reported gains only in females.

• The fourth found gains only in children given 100% of the RDA with no gains among those who received 50% and 200% of the RDA.

Vitamin D

The study in the Archives of Internal Medicine, found those deficient in vitamin D were 60 percent more likely to have substantial decline in overall cognition and 31 percent more likely to have declines in executive functionthan those with sufficient vitamin D.

B12

In elderly: two proposed mechanisms

1. The role of vitamin B12 and folic acid in reducing homocysteine levels. Elevated homocysteine level has been linked with atherosclerosis which is a mediator of vascular dementia.

2. The role of B12 in neutralizing free radicals linked to the pathogenesis of normal brain ageing and Alzheimer's disease

In autism: Methyl B12

Metabolic biomarkers of increased oxidative stress and impaired methylation capacity in children with autism

Jill James et al American Journal of Clinical Nutrition, Vol. 80, No. 6, 1611-1617, December 2004

1 Raskin LA, Shaywitz SE, Shaywitz BA, Anderson GM, Cohen DJ. Neurochemical correlates of attention deficit disorder. Pediatr Clin North Am 1984;31(2):387-96.2 Malone MA, Kershner JR, Swanson JM. Hemispheric processing and methylpehidate effects in attention-deficit hyperactivity disorder J Child Neurol 1994;9(2):181-9.3 Hunt RD, Cohen DJ, Shaywitz SE, Shaywitz BA. Strategies for study of the neurochemistry of attention deficit disorder in children. Schizophr Bull 1982;8(2):236-52.4 Irwin M, Belendiuk K, McCloskey K, Freedman DX. Tryptophan metabolism in children with attentional deficit disorder. Am J Psychiatry 1981;138(8):1082-5.5 Comings DE. Serotonin and the biochemical genetics of alcoholism: lessons from studies of ADHD and Tourette syndrome. Alcohol Alchol Suppl 1993;2:237-41.6 Comings DE. Blood serotonin and tryptophan in Tourette syndrome. Am J Med Genet 1990;36(4):418-30.7 McConnell H. Catecholamine metabolism in the attention deficit disorder: implications for the use of amino acid precursor therapy. Med Hypotheses 1985;17(4):305-11.8 Bornstein RA, Baker GB, Carroll A, King G, Wong JT, Douglass AB. Plasma amino acids in attention deficit disorder. Psychiatry Res 1990;33(3):301-6.9 Zeisel SH. Dietary influences on neurotransmission. Adv Pediatr 1986;33:23-47.10 Sun Y, Wan Y, Qu X, Wang J, Fang J, Zhang L. Clinical observation and treatment of hyperkinesia in children by traditional Chinese medicine. J Tradit Chin Med 1994;14(2):105-9.

Amino acid Metabolism and Cognition

Taurine

Neuro-inhibitory neurotransmitter involved in neuromodulatory and neuroprotective actions.

Support GABA function

Neuro-protective

Found in Cheese, Granola, Milk,

L-Theanine

Theanine is an amino acid naturally found in green tea and has been widely studied for its calming effects. The ability of theanine to reduce over-stimulation is thought to be due to its function as a glutamate receptor antagonist

Theanine has been found to prevent the death of neurons exposed to oxidative stress or glutamate over-stimulation.

N-acetyl-tyrosineN-acetyl-tyrosine is readily converted to L-tyrosine in the body, which serves as the amino acid precursor to the Catecholamines: dopamine, norepinephrine and epinephrine

Neuro-stimulant

L-Tyrosine

Food sources- proteins

WHAT WE EAT

WHEN WE EAT

WHERE WE EAT

HOW WE EAT

WHY WE EAT

croton-harmon septa 2010 nutrition, vitamins and cognition stephen cowan md, faap

Documents

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im hungry slide

immune system slide

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dietary supplementation

low energy intake