final slide set with vu slides - villanova university › ... › aggarwal_3slides.pdf · 5/17/2019...

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COPE WEBINAR SERIES FOR HEALTH PROFESSIONALS

May 17, 2019

The Role of Inflammation and Diet in Chronic Disease

Moderator: Rebecca Shenkman, MPH, RD, LDNProgram DirectorMacDonald Center for Obesity Prevention and EducationM. Louise Fitzpatrick College of Nursing

Nursing Education Continuing Education Programming Research

FINDING SLIDES FOR TODAY’S WEBINAR

www.villanova.edu/COPEClick on Monica Aggarwal M.D.

webinar description page


DID YOU USE YOUR PHONE TO ACCESS THE WEBINAR?

If you are calling in today rather than using your computer to log on, and need CE credit, please email [email protected] and provide your name so we can send your certificate.


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OBJECTIVES

1. Describe the roles of stress and diet in triggering inflammation and chronic illness.

2. Explain the role of diet on the microbiome and inflammatory process.

3. Discuss facets of the optimal diet to reduce inflammation.


CE DETAILS

• Villanova University College of Nursing is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center Commission on Accreditation

• Villanova University College of Nursing Continuing Education/COPE is a Continuing Professional Education (CPE) Accredited Provider with the Commission on Dietetic Registration


CE CREDITS

• This webinar awards 1 contact hour for nurses and 1 CPEU for dietitians

• Suggested CDR Learning Need Codes: 2000, 4040, 5160, 5370

• Level 2

• CDR Performance Indicators: 6.2.5, 8.1.2, 8.1.5, 8.6.6


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THE ROLE OF INFLAMMATION AND DIET IN CHRONIC DISEASE

Monica Aggarwal, M.D.

Director, Integrative Cardiology and Prevention

University of Florida

DISCLOSURE

Neither the planners or presenter have any conflicts of interest to disclose.

Accredited status does not imply endorsement by Villanova University, COPE or the American Nurses Credentialing Center of any commercial products or medical/nutrition advice displayed inconjunction with an activity.

• Look for an email containing a link to an evaluation. The email will be sent to the email address that you used to register for the webinar.

• Complete the evaluation soon after receiving it. It will expire after 3 weeks.

• You will be emailed a certificate within 2-3 business days.

• Remember: If you used your phone to call in, and want CE credit for attending, please send an email with your name to [email protected] so you receive your certificate.

TO RECEIVE YOUR CE CERTIFICATE

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HOW MY DAUGHTER SAVED ME

MY JOURNEY TO BETTER HEALTH

MONICA AGGARWAL, MD

DIRECTOR OF INTEGRATIVE CARDIOLOGY AND PREVENTION

UNIVERSITY OF FLORIDA, GAINESVILLE, FL

DRMONICAAGGARWAL.COM

FB/INSTAGRAM: @DRMONICAAGGARWAL

TWITTER:DRMAGGARWAL

WHY I AM HERE

DAUGHTERWIFE

MOTHERATHLETEPATIENT

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4 MONTHS AFTER BABY 3 WAS BORN

THE MOMENT WHEN I KNEW I HAD A REAL PROBLEM

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LYME? LET THE TREATMENT BEGIN

LABS

• ESR 30 (0-22 MM/HR)

• RF >50 (NORMAL <15 IU/ML)

• ANTI-CCP ANTIBODY (ANTI-CYCLIC CITRULLINATED PEPTIDE) >250 U/ML (NORMAL: LESS THAN

20 U/ML)

• WENT TO THE BEST RHEUMATOLOGIST IN TOWN

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COMMON side effects

If experienced, these tend to have a Severe expression•Azotemia•Bleeding Of The Stomach Or Intestines•Canker Sore•Decreased Blood Platelets•Hole In The Intestine•Infection Caused By Bacteria•Inflammation Of The Gums And Mouth•Inflammation Of The Lining Of The Stomach And Intestines•Sepsis Caused By Bacteria•Stomach Or Intestinal Ulcer•Sun‐Sensitive Skin If experienced, these tend to have a Less Severe expression•Dizzy •Feel Like Throwing Up •Loss Of Appetite •Low Energy•Not Feeling Well•Throwing Up

If experienced, these tend to have a Severe expression•Anemia •Arachnoid Membrane Inflammation Caused By Chemicals•Decreased White Blood Cells•Disease In The White Matter Area Of The Brain•Hardening Of The Liver•Hepatitis Caused By Drugs•Interstitial Pneumonitis•Liver Tissue Death•Lung FibrosisIf experienced, these tend to have a Less Severe expression•Abnormal Liver Function Tests•Acne•Chills•Diarrhea•Fever•Hair Loss •Itching•Presence Of Boils On The Skin•Rash

HOW I FELT

• SCARED ALL OF THE TIME

• EMOTIONAL

• FRAGILE

• UNABLE TO UNDERSTAND HOW THIS HAD HAPPENED

• NOT IN CONTROL

• ANGRY AT MY DAUGHTER

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WHAT DO YOU HAVE TO LOSE?

THOUGHTS…

Do I SLEEP enough?

Is my DIET affecting my health? I am already vegetarian.

What part of my day is about ME?

Am I ready for a Leap of faith?

Am I making the wrong choices?

Hope

Empowerment

Can I ever get off of these medications?

ANGER at my daughter

THE FORK IN THE ROAD

• WHAT AM I WILLING TO DO TO GET BETTER?

• WHAT IF IT DOESN’T WORK?

• WHAT IF I GET WORSE?

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PLAN OF ATTACK

• ALREADY VEGETARIAN.

• ELIMINATION

• ADD BACK

• SLEEP

• YOGA

MY ROAD TO RECOVERY

• HOW DID I FEEL?

• HOW SOON?

• WHAT HAPPENED?

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TODAY

• 7 YEARS AFTER DIAGNOSIS

• 5 YEARS WITH LIFESTYLE CHANGES

• 4 YEARS OFF MEDICATIONS

• NOT LOOKING BACK

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CHANGED MY COURSE

• LIFESTYLE ACTUALLY WORKS

• DIET CAN CHANGE YOUR BODY

• MOVED FROM PRIVATE PRACTICE

• WROTE A BOOK TO HONOR MY

DAUGHTER

• CAREER SHIFT

MY MISSION

• 1. BRING LIFESTYLE PRACTICES INTO MY PRACTICE OF MEDICINE.

• YOGA ROOM

• DIET INTO THE CLINIC

• STRESS REDUCTION

• 2. EDUCATE THE NEW DOCTORS/ALLIED PROFESSIONALS ABOUT LIFESTYLE

• 3. RESEARCH: UNDERSTAND WHY DOES DIET WORK AND WHAT DO WE DO TO OUR BODIES TO

TRIGGER ILLNESS?

• 4. VALIDATE: PUBLISH EDUCATION/STANDARDS TO MOVE LIFESTYLE MEDICINE INTO THE

MAINSTREAM

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United States Cancer Rates

http://www.drmonicaaggarwal.com

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STATS

• AUTOIMMUNE DISEASES AFFECT APPROXIMATELY 5%–8% OF THE POPULATION OR 14–22

MILLION PERSONS

• 78% OF AFFECTED ARE WOMEN

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WHAT IS INFLAMMATION?

TRADITIONAL THOUGHT

INFLAMMATIONILLNESS

Genetic Predisposition

Second Hit ??

ANOTHER WAY TO LOOK AT IT

INFLAMMATION ILLNESS

LIFESTYLE

Gene Activation

Genetic Predisposition

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LIFESTYLE FACTORSIMBALANCE=INFLAMMATION

Aggarwal M, Rao J. Finding Balance

WHY DID I GET RA?

• GENES>>INFLAMMATION>>ILLNESS

• GENES ALWAYS THERE

• LIFESTYLE TRIGGERS INFLAMMATION AND ACTIVATES GENES EXPRESSION

• MY LIFESTYLE TRIGGERS:

• LACK OF SLEEP

• STRESS

• DAIRY

INFLAMMATION THROUGH DIET

DIET GUT FLORA INFLAMMATION ILLNESS

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MICROBIOTA/MICROBIOME

MICROBIOTA/MICROBIOME

• ALL SURFACES ON BODY ARE EXPOSED TO OUTSIDE ARE COVERED IN BACTERIA

• IT IS ESTIMATED THAT 90% OF CELLS (APPROXIMATED 100 TRILLION CELLS) FOUND IN OUR BODIES ARE NOT HUMAN

• ONLY 10% HUMAN AND THE REMAINDER IS MICROBIAL.

• MICROBIOME: EACH OF THESE BACTERIA IN OUR BODY CARRIES GENETIC MATERIAL.

• SOME PEOPLE CALL THIS MICROBIOME, OUR “SECOND GENOME” OR OUR SECOND BRAIN

• GUT BUGS CAN AFFECT HOW YOU FEEL

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MICROBIOTA AFFECTED BY CHANGES FROM BIRTH

• TWENTY MINUTES AFTER BIRTH, THE MICROBIOTA OF VAGINALLY DELIVERED INFANTS RESEMBLES THE MICROBIOTA OF THEIR MOTHER'S VAGINA

• WHILE INFANTS DELIVERED VIA CESAREAN SECTION HARBOR MICROBIAL COMMUNITIES TYPICALLY FOUND ON HUMAN SKIN

• SIGNIFICANT CHANGES IN GUT NOTED

• STARTING A DIET OF BREAST MILK,

• DEVELOPMENT OF FEVER AT DAY 92,

• INTRODUCTION OF RICE CEREAL AT DAY 134,

• INTRODUCTION OF FORMULA AND TABLE FOODS AT DAY 161,

• AND ANTIBIOTIC TREATMENT AND ADULT DIET AT DAY 371

Ursell et al., Defining the Human Microbiome, Nutr Rev, 2013

BACTERIAL COMPOSITION IS AFFECTED BY WHAT YOU EAT

ALL BACTERIA PRODUCE SHORT CHAIN FATTY ACIDS (SCFA).

BUTYRATE SCFA IS ANTI-INFLAMMATORY AND ANTI-NEOPLASTIC

AGRARIAN SOCIETIES PRODUCE MORE BUTYRATE SCFA

Bacteroides=More common in

Western diet

Prevotella=More common in the non-Western, agrarian

diet

Ou et al., Diet, microbiota, and microbial metabolites in colon cancer risk in rural Africans and African Americans, Am J Cl Nutrition, 2013

DIET AFFECTS GUT FLORA, EXAMPLE 112 Africans 12 African Americans

More fiber, plant based, whole grains Less fiber, animal based, refined foods2-3 times more animal protein and fat than African cohort

More Bacteria, Prevotella predominance Less Bacteria, Bacteroides predominance

More fermentation Less fermentation

More Butyrate Less Butyrate

Minimal colon cancer rates High rates of colon cancer

Ou et al., Diet, microbiota, and microbial metabolites in colon cancer risk in rural Africans and African Americans, Am J Cl Nutrition, 2013

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From: Diet, microbiota, and microbial metabolites in colon cancer risk in rural Africans and African AmericansAm J Clin Nutr. 2013;98(1):111-120. doi:10.3945/ajcn.112.056689Am J Clin Nutr | © 2013 American Society for Nutrition

NA=Native AfricansAA=African Americans

THE GREAT DIET SWITCH

• PRIOR TO STARTING: THIS INSPECTION OF THE

LARGE INTESTINE (THE COLON) SHOWED THAT NINE

OF THE 20 AMERICANS HAD POLYPS. NO POLYPS

WERE FOUND IN ANY OF THE 20 SOUTH AFRICANS.

• TWO-WEEK FOOD EXCHANGES

O’ Keefe et al., Fat, Fiber and Cancer Risk in African Americans and Rural Africans, Nat Communications, 2015

RESULTS

• MOVING TO AFRICAN DIET:

• SIGNIFICANT REDUCTIONS IN COLON INFLAMMATION AND OTHER CHEMICAL SIGNALS THAT HAVE BEEN LINKED TO COLON CANCER RISK.

• MICROBIOMES GENERATED MORE BUTYRATE, A BYPRODUCT OF FIBER METABOLISM THAT CAN HELP PREVENT CANCER.

• MOVING TO THE WESTERN DIET

• INCREASE IN INFLAMMATION

• A DECREASE IN BUTYRATE GENERATION, AND OTHER CHANGES THAT COULD LEAD TO COLON CANCER.

• IN 2 WEEKS!!!

O’ Keefe et al., Fat, Fiber and Cancer Risk in African Americans and Rural Africans, Nat Communications, 2015

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EXAMPLE 2: INTESTINAL METABOLITE- TMAO

Tang WW, Wang Z, Levison BS, Koeth RA, Britt EB, Fu X, Wu Y, Hazen SL. Intestinal microbial metabolism of phosphatidylcholine and cardiovascular risk. New England Journal of Medicine. 2013 Apr 25;368(17):1575-84.

Dietary choline and L-carnitine are metabolized into TMA in the gut and an enzyme in the liver converts it to TMAO (trimethylamine-N-oxide)

Effects of TMAO in the bloodstream:

Cholesterol metabolismVascular inflammation Plaque formation in the

arterial walls

Participants who had major adverse cardiovascular events also had higher baseline levels of TMAO, as compared with those who did not have cardiovascular events independent of traditional risk factors

Tang WW, Wang Z, Levison BS, Koeth RA, Britt EB, Fu X, Wu Y, Hazen SL. Intestinal microbial metabolism of phosphatidylcholine and cardiovascular risk. New England Journal of Medicine. 2013 Apr 25;368(17):1575-84.

• DIETARY CARNITINE ACCELERATES ATHEROSCLEROSIS BY 1.8 FOLD

• ANTIBIOTICS INHIBIT THIS EFFECT….GUT FLORA?!

ANIMAL MODELS WITH CARNITINE

Koeth RA Hazen S. Nature Medicine 2013

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DIFFERENT RESPONSES WITH DIFFERENT GUT BIOMES

• VEGAN=NO CAPACITY TO

PRODUCE TMAO AFTER

CHALLENGE

Koeth RA Hazen S. Nature Medicine 2013

EXAMPLE 3:GUT METABOLITES

• ENDOTOXIN (LIPOPOLYSACCHARIDE): RELEASED FROM BACTERIA WHEN THEY DIE

• TRANSLOCATE TO BLOODSTREAM

• ELEVATED LEVELS ARE ASSOCIATED WITH INFLAMMATION, INCREASED INTESTINAL PERMEABILITY

• ASSOCIATED WITH NASH, ATHEROSCLEROSIS (FORMATION OF CHYLOMICRONS), RHEUMATOID ARTHRITIS, OBESITY, TYPE II DM

Ahola, Nature, 2017Cani et al., Metabolic Endotoxemia Initiates Obesity and Insulin Resistanc, Diabetes, 2007

ENDOTOXIN

• INGESTION OF HIGH-FAT AND HIGH-CARBOHYDRATE WESTERN-STYLE MEALS FOUND TO

PRODUCE POSTPRANDIAL “METABOLIC ENDOTOXEMIA”: AN INCREASE IN CIRCULATING LPS

LEVELS AND OTHER INFLAMMATORY CHANGES

• AFTER SUCCESSFUL ROUX-EN-Y GASTRIC BYPASS SURGERY, THE REDUCTIONS IN WEIGHT AND

INSULIN RESISTANCE ARE ASSOCIATED WITH REDUCTIONS IN CIRCULATING LPS AND

INFLAMMATION

• INCREASED FRUIT AND VEGETABLE EXTRACTS DECREASE LPS LEVELS

• HIGH FIBER MAY DECREASE LPS

Spreadbury, Comparison with ancestral diets suggests dense acellular carbohydrates promote an inflammatory microbiota, and may be the primary dietary cause of leptin resistance and obesity, 2012

Ahola, Nature, 2017Cani et al., Metabolic Endotoxemia Initiates Obesity and Insulin Resistanc, Diabetes, 2007

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EXAMPLE 4=C DIFF COLITIS

RECAP

• BUGS ALL OVER YOU. YOU ARE MADE OF LOADS OF BUGS

• CHANGE FROM BIRTH

• CHANGE FROM DIET, ANTIBIOTICS

• DIFFERENT FOODS AFFECT GUT BIOME AND DIFFERENT BIOMES ARE ASSOCIATED WITH

DIFFERENT RISKS OF ILLNESSES

• BUT WHAT IS THE MECHANISM?

HOW THE GUT FUNCTIONS


Gut bugs=Microbiota

Good bugs, bad bugs

What you eat determines your bugs


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THE SICK GUT:

INTESTINAL PERMEABILITY

How does this happen?Change of bugsIncrease LPS

Leaky gut


Guo et al., Lipopolysaccharide Regulation of Intestinal Tight Junction Permeability Is Mediated by TLR4 Signal Transduction Pathway Activation of FAK and MyD88., J Immunol, 2015Thank you to Alessio Fasano, MD-Harvard Medical School

ZONULIN

EXAMPLE 5: CELIAC DISEASE


WHAT YOU PUT INTO

YOUR BODY MATTERS

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CLINICAL OUTCOMES

TARAHUMARA INDIANS

McMurray, NEJM, 2001

LIFESTYLE HEART TRIAL

• 48 PATIENTS WITH MODERATE-SEVERE CAD WERE RANDOMIZED TO INTENSIVE LIFESTYLE

CHANGES (10% FAT WHOLE FOODS VEGETARIAN DIET, AEROBIC EXERCISE, STRESS

MANAGEMENT TRAINING, SMOKING CESSATION, GROUP PSYCHOSOCIAL SUPPORT) FOR 5

YEARS VERSUS CONTROL

• 35 COMPLETED THE STUDY

Ornish et al., JAMA 1998

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LIFESTYLE GROUP HAD 3% REDUCTION IN ABSOLUTE DIAMETER STENOSIS AND

CONTROL GROUP HAD 12% PROGRESSION

FRUITS AND VEGETABLES: DASH DIET

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30% RRREnd point driven by reduction in strokes

PREDIMED

Estruch et al., Primary Prevention of Cardiovascular Disease with a Mediterranean Diet Supplemented with Extra-Virgin Olive Oil or Nuts, NEJM, 2013

Date of download: 1/14/2018Copyright © 2012 American Medical

Association. All rights reserved.

From: Effect of Legumes as Part of a Low Glycemic Index Diet on Glycemic Control and Cardiovascular Risk Factors in Type 2 Diabetes MellitusA Randomized Controlled Trial

Arch Intern Med. 2012;172(21):1653-1660. doi:10.1001/2013.jamainternmed.70

High fiber diet:Relative CVD risk reduction1.3----1.2

LegumesRelative CVD risk reduction1.5----1.4

EFFECTS OF VEGETARIAN DIET IN ENDOTHELIAL FUNCTION

Dod HS, et al. Am J Cardiol 2010;105:362–367

Flow Mediated Dilatation Normalized by Shear Rate

Flow Mediated Dilation

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WHAT ABOUT VEGAN DIET SPECIFICALLY?

Barnard ND, Diabetes Care 29:1777–1783, 2006

•Body weight decreased 6.5 kg in the vegan group and 3.1 kg in the ADA group (p =0.001)

•LDL cholesterol fell 21.2% vegans and 10.7% in the ADA group (p = 0.02).

•Urinary albumin reductions were greater in the vegan group (15.9 mg/24h) than in the ADA group (10.9 mg/24 h) (p = 0.013)

•A1C fell 1.23 points in the vegan group compared wit h 0.38 points in the ADA group (P 0.01).

Esselstyn et al. J Fam Practice

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Dod HS, et al. Am J Cardiol 2010;105:362–367Szeto YT, Ornish D. Nutrition 20:863–866, 2004

Vegetarian diet and inflammatory markers

Inflammatory markers only measured in intervention group

ALL COMES BACK TO INFLAMMATION

100 patientsCAD8 weeks plant based diet versus AHA recommended dietVegan diet lowers inflammation in people with heart disease, heart healthy diet does not.4x reduction in CRP than control group

RA STUDY

• 7-10 DAY FAST, FOLLOWED BY 3.5 MONTHS VEGAN, THEN TRANSITION TO OVO-LACTO

VEGETARIAN VERSUS CONTROL

• SIGNIFICANT IMPROVEMENT IN NUMBER OF TENDER JOINTS, NUMBER OF SWOLLEN JOINTS,

PAIN SCORE, DURATION OF MORNING STIFFNESS, GRIP STRENGTH, ERYTHROCYTE

SEDIMENTATION RATE, C-REACTIVE PROTEIN, WHITE BLOOD CELL COUNT, AND A HEALTH

ASSESSMENT QUESTIONNAIRE SCORE.

• IN THE CONTROL GROUP, ONLY PAIN SCORE IMPROVED SCORE.

• AT 4 WEEKS, LASTING UP TO ONE YEAR

Kjeldsen-Kragh J, Controlled trial of fasting and one-year vegetarian diet in rheumatoid arthritis. Lancet, 1991

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RA STUDIES

• CHANGES IN FECAL FLORA WITH RAW, VEGAN DIET AND CHANGES IN SYMPTOMS

Peltonen, Faecal microbial flora and disease activity in rheumatoid arthritis during a vegan diet, Br J Rheumatol, 1997

IT’S THE FOOD

SOTOS-PRIETO M ET AL. N ENGL J MED 2017;377:143-153.

Risk of Death from Any Cause per 20-Percentile Increase in Diet-Quality Scores.

CONCLUSIONS: 20-percentile increase in diet-quality scores was associated with a reduction of 8 to 17% in the risk of death from any cause

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Date of download: 1/14/2018Copyright © 2013 American Medical

Association. All rights reserved.

From: The State of US Health, 1990-2010Burden of Diseases, Injuries, and Risk Factors

JAMA. 2013;310(6):591-606. doi:10.1001/jama.2013.13805

STANDARD AMERICAN DIET (SAD)=STANDARD WESTERN DIET

• THIS DIETARY PATTERN IS CHARACTERIZED BY A HIGH CONSUMPTION OF

• RED MEAT

• REFINED GRAINS

• PROCESSED MEAT

• HIGH-FAT DAIRY PRODUCTS

• DESSERTS

• HIGH-SUGAR DRINKS

• EGGS

• FRENCH FRIES

Halton et al. Am J Clin Nutr February 2006, vol. 83 no. 2 284-290

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• ALMOST 75% OF PACKAGED FOODS IN THE U.S. NOW CONTAIN ADDED SUGARS,

AND MUCH ALSO COMES FROM CONSUMPTION OF SUGAR-SWEETENED

BEVERAGE (SSBS)

Bray, GA and Popkin, BM (2014) Dietary sugars and body weight: Have we reached a crisis in the epidemic of obesity and diabetes. Diabetes Care 37:950-56.

WHAT ABOUT FRUITS AND VEGETABLES?

• IN 2005, APPROXIMATELY 32.6% OF

THE U.S. ADULT POPULATION SURVEYED

CONSUMED FRUIT TWO OR MORE

TIMES PER DAY

• 27.2% ATE VEGETABLES THREE OR

MORE TIMES PER DAY.

• GOAL: 5-7-10 SERVINGS OF

FRUITS/VEGETABLES PER DAY

World Health Organization

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Devries S, Agatson A, Aggarwal, M et al. Am J Medicine, 2017

HOW SHOULD WE ADVISE OUR PATIENTS?

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GOALS

Eliminate red meat>>CHICKEN>>fish

Eliminate dairy-All dairy (whey, casein)

Eliminate simple sugars and simple carbs

Eliminate processed foods• Preservatives• Artificial sweeteners

Watch your omega 6:3 ratio• Eat nuts and seeds• Job of omega 6• Job of omega 3: full of DHA

and EPA

Avoid trans fats

Add in lots and lots of fruits and vegetables • 5-7 servings per day Eat complex

carbohydratesAnti-inflammatory

spices

1 serving= 1 cup uncooked, 1 cup cooked

THERE IS NO TIME FOR JUNK

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WHAT ABOUT THE

KIDS?

WHY ARE WE, AS PHYSICIANS, SO BAD AT TEACHING THIS?

• 57% of cardiologists received no nutrition training

• 33% of cardiologists received minimal nutrition training

• 59% cardiologists recall no nutrition talks in their internal medicine residency

• 57% cardiologists recall no nutrition talks in their cardiology fellowships

• No trend towards improvement as 56% of fellows in training state they receive no nutrition education

• 59% of cardiologists spend less than 3 minutes counseling patients on nutrition

Devries S, Agatson A, Aggarwal, M et al. AM J Medicine, 2017

90% of cardiologists receive minimal to no

nutrition training

WHAT WE ARE DOING AT UNIVERSITY OF FLORIDA

Medical Education Changing the Hospital Paradigm

Changing the Clinic Paradigm RESEARCH

Areas

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MEDICAL EDUCATION:

ACCOMPLISHMENTS

• MEDICAL STUDENTS

• ONE-WEEK NUTRITION INTENSIVE IN FIRST YEAR MEDICAL SCHOOL NUTRITION INTENSIVE

• HANDS-ON EXPOSURE THROUGH GENERAL CARDIOLOGY AND PREVENTION CLINICS

• RESIDENTS

• DELIVER NUTRITION-FOCUSED NOON CONFERENCES

• HANDS-ON EXPOSURE THROUGH PREVENTION CLINIC

• MENTOR RESIDENTS ON LIFESTYLE-RELATED RESEARCH PROJECTS

• DIVISION OF CARDIOLOGY MEDICAL EDUCATOR, INFLUENCING MEDICAL CURRICULUM

• FELLOWS/FACULTY

• ESTABLISHED CME CERTIFIED PREVENTION CONFERENCE

• MEDICAL GRAND ROUNDS

PREVENTION CLINIC

BUILD A PREVENTION CLINIC AND EMPOWER

PATIENTS TO TAKE CONTROL OF THEIR

HEALTH USING LIFESTYLE AND DIET TOOLS

INTEGRATIVE AND PREVENTATIVE MODEL

Prevention Clinic with one-hour long visits. A Yoga Room Meditation

Extensive nutrition education.

RESULTS:

Improved Quality of life

Decrease in Anthropomorphic measurements

Reduction in medications

Reduction in serum lipid profiles

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HOSPITAL PARADIGM

• DISCHARGE EDUCATION

PACKET

• NURSING INVOLVEMENT IN

EDUCATION

• REQUIRED DIETICIAN VISIT PRE

DISCHARGE

• REQUIRED DOCUMENTARIES

TO BE WATCHED ON

TELEVISION

• PLANT BASED MENU

RESEARCH

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WHAT I TELL MY PATIENTS

• “WHEN WE LOSE OUR MAP, OUR REAL KNOWLEDGE OF THE PATH BEGINS...ONCE WE ADMIT THAT WE'RE NOT SURE WHERE LIFE IS TAKING US, THEN WE ARE RIPE FOR TRANSFORMATION.”—MARK NEPO

• “IT TAKES TIME”

• “ACCEPT WHAT YOUR BODY HAS TO GIVE, AND PUSH IT FURTHER.”

• “FORGIVE YOURSELF”

• “BE EMPOWERED TO CHANGE”

• “I WOULD EAT DIRT IF I THOUGHT IT WAS GOOD FOR ME”

• “WHAT DO YOU HAVE TO LOSE BY TRYING AND WHAT DO YOU HAVE TO GAIN”

FUTURE GOALS:MORE RESEARCH!!!

• 7 YEARS LATER SINCE

DIAGNOSIS

• 5 YEARS OFF

MEDICATION

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MY HOPES FOR THE

FUTURE=THIS IS WHERE WE NEED

YOUR HELP

• MORE EDUCATION OF PHYSICIANS.

• CULINARY WORKSHOP AT UF FOR PHYSICIANS AND

ALLIED PROFESSIONALS

• MORE CLINICS CROPPING UP AROUND THE COUNTRY

THAT FOCUS ON WELLNESS:

• BE STAY ON THE RIGHT SIDE OF THE LINE

• WRITE MORE PAPERS

• CHF AND LIFESTYLE PAPER COMING OUT IN JACC 11/7

• RESEARCH.

• NEED TO MAKE THE LINKS MORE CLEAR BETWEEN

FOOD, MICROBIOME, INFLAMMATION AND ILLNESS

• CAN DIET SUPPRESS GENE EXPRESSION?

• COUPLE OF RESEARCH PROTOCOLS AND GRANTS

PENDING

Stay tuned for the date!

THIS IS AN EXCITING TIME

• HAVE HOPE THAT CHANGE IS POSSIBLE

• THERE IS A VERY REAL CONNECTION BETWEEN THE FOOD WE EAT AND WHAT HAPPENS IN OUR

GUT AND HOW THAT TRIGGERS INFLAMMATION AND EVENTUALLY CHRONIC ILLNESS

• BE EMPOWERED AND KNOW THAT YOU CAN DO THIS AND YOU CAN BE PART OF THE CHANGE

IMBALANCE=INFLAMMATION


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CONTACT INFORMATION

• DRMONICAAGGARWAL.COM

• FACEBOOK/INSTAGRAM: @DRMONICAAGGARWAL

• TWITTER: @DRMAGGARWAL

• [email protected]

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UPCOMING EVENTS

To register: villanova.edu/cope

UPCOMING EVENTS

July 9, 2019: Hot Topics in Nutrition and Research Half Day Conference4 CPEUs/ 4 Contact Hours

September 25, 2019 Free CE Webinar 12‐1 PM ESTMeghan Butryn, PhDRole of Executive Function in Predicting Weight Loss and Physical Activity Outcomes

To Register: villanova.edu/cope

QUESTIONS & ANSWERS

Moderator: Rebecca Shenkman MPH, RDN, LDNEmail: [email protected]: www.willanova.edu/COPE

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