Leading Causes of Death. Nutrition Matters. Dietary Facts for Treating and Preventing Disease. Obesity by country. Debra G. Bell, M.D.

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1 Nutrition Matters Dietary Facts for Treating and Preventing Disease Debra G. Bell, M.D. Obesity by country Leading Causes of Death Four of 10 are diet related Heart Disease, Cancer, Stroke and Diabetes 1

2 Health Consequences of Obesity For BMI and >30 the risks for the following conditions increases: Coronary heart disease Type 2 diabetes Cancers (endometrial, breast, and colon) Hypertension Dyslipidemia Stroke Liver and Gallbladder disease Sleep apnea and respiratory problems Osteoarthritis Gynecological problems (abnormal menses, infertility) NUTRITION MATTERS Contributing Factors to Obesity Increased consumption of energy-dense, nutrient-poor foods with high levels of sugar and saturated fats More sedentary Genes are important in terms of susceptibility to weight gain and we may be making that worse! Energy balance is determined by calorie intake and physical activity. 2

3 Standard American Diet S.A.D. Why we have become more obese Percentage of calories coming from sugars has increased to 20%. Eating about 25% more calories/day than in 1970 This starts early. Childhood obesity tripled in past 30 years. Industrialization Packaged, processed, fast foods-many of which is NOT REAL FOOD! Cost of Obesity Obesity-related conditions now account for 9.1 percent of all medical spending, up from 6.5 percent in Obesity-related diseases currently account for a large portion of health care expenditure - $117-$147 billion/year, double what it was nearly a decade ago. Americans spent around 24% of their expenses on food in 1960/1961 compared to only 12.4% in Conversely, in 1970 the US spent 7.2% of its GDP on healthcare vs. 17.6% (projected) in Food Politics Direct effect of food industry and American dietary trends Can t look at S.A.D. without considering food politics Many changes have been fueled by agribusiness. Food Bill, Farm Bill marketing - grains and dairy Wheat Soy and Corn in everything Commodity foods are hence artificially cheap. Cost to taxpayers $19billion/year. NOT REAL FOOD = NOT REALLY CHEAP 3

4 Impact of Weight Loss Weight loss results in lower blood pressure, lower blood sugar, and improved lipid levels. The Surgeon General's Call To Action To Prevent and Decrease Overweight and Obesity Weight loss may improve survival in those who have an obesity related disease, especially type 2 diabetes Weight loss of 10% or less can improve the complications most commonly associated with obesity. What to eat? Review of basic nutrition Sounds basic but has become complicated because of all the unhealthy choices in our culture Must individualize depending on age, individual metabolism and underlying health. Types of foods PROTEINS CARBOHYDRATES FATS Copyright 2008 dgbell 4

5 Types of food Three major classes used for energy: Carbohydrates, Fats, Proteins Protein differs from other 2 structurally because it contains nitrogen. Energy storage 1. Fat 2. Protein 3.Carbohydrates (stored as glycogen - short term energy - a few hours) Carbohydrates An important source of energy for the body Important in the regulation of blood sugar Prevent the breakdown of the bodies protein for use of energy Important source of fiber and nutrients (vitamins, antioxidants and phytonutrients). Carbohydrates are necessary but what kinds? ALL CARBS ARE NOT CREATED EQUAL Simple Carbohydrates: starches and sugars. Complex Carbohydrates: whole grains vegetables and fruits 5

6 Glycemic index Highly sweet or very starchy foods - HIGH on the Index: break down quickly and cause the release of extra insulin, burdening our metabolism. More likely to metabolize to fat. Low Index (below 55)- metabolized slower and provide a steadier stream of glucose and other nutrients. As a result, they're less work and stress for the body, and the energy can be better utilized. Tend to conserve insulin and hormones. Glycemic Load High glycemic load can lead to large insulin release and can worsen insulin resistance The release of this large load if insulin can be rapid which can ultimately lead to rebound hypoglycemia - lead to fatigue. Low foods - Body puts out less insulin, creates less stress on pancreas and other glands. May decrease risk of diabetes, heart disease and obesity. It s the blast of insulin from high glycemic foods that drives hunger cravings. Most Common Carbohydrates eaten in US #1 potatoes #2 white bread #3 Cold breakfast Cereal #4 Dark Bread #5 Orange Juice #6 Bananas #7 White Rice #8 Pizza #9 Pasta #10 Muffins #11 Fruit Punch #12 Coca-cola #13 Apples #14 Skim Milk #15 Pancakes #16 Table Sugar #17 Jam #18 Cranberry Juice #19 French Fries #20 Candy 6

7 Heart Disease and Carbs Harvard research - tracked role of starches and sugars in heart disease over 10-year period, monitoring the diet and health of over 75,000 women, ages 38 to 63 with no history of diabetes, stroke, or heart disease. The risk of heart disease was found to be "directly associated" with high carbohydrate foods. Over the course of the study, 761 cases of heart disease developed. Of those at risk for heart disease, eating a high carbohydrate diet was found to double the risk of heart attack in the top 40%, with even greater risk among the top 20%. Heart Disease and Carbs Obesity also was part of this picture. The researchers reported that the link between high glycemic load and coronary heart disease risk was most often seen in subjects with "body weights above average." They concluded that a diet high in refined carbohydrates increases the risk of coronary heart disease. Proteins Amino acids from dietary proteins are 1. Oxidized for energy 2. Incorporated into body proteins (muscle) 3. Used for other nitrogen containing compounds in the body. 7

8 Importance of Proteins Support proper metabolism Essential for creation of hormones Building blocks for the immune system Needed for growth and repair of all cells Preserve and build muscle mass Energy source when carbohydrates not available Stabilize blood sugars and helps feel full PROTEINS Non- animal proteins: Legumes, beans, nuts and seeds. Whole grains have some protein. Animal proteins: Fish, poultry, red meats, eggs, dairy website for fish safety information We Need Fats For skin, nails, hair and cell development For hormone development Involved in our neurological systems (brain and mood) Needed to keep cell membranes healthy so messages between cells can take place 8

9 FATS Different from other macronutrients - not water soluble so require different processes of digestion, absorption, transport and utilization. Most common dietary lipid - Triglycerides Cholesterol only found in foods of animal origin Plant sterols=phytosterols FAT Saturated Fats Monounsaturated fats Polyunsaturated fats Trans Fats = Partially Hydrogenated Oils 9

10 Fats Good fats olive oil, nuts, avocado, fish Bad fats trans fatty acids, saturated fats (animal fats -including dairy )in excess, overheated polyunsaturated fats. Low Fat Low fat craze of the 70s proved to be bad for our health. Substituted carbs for fat The low fat craze caused some to replace real food with invented substances and processed foods Low ratio of total cholesterol to HDL is important for heart health. Substitution of carbohydrate for saturated fat reduces HDL as well as total chol and LDL so does not change the ratio Many low fat items have high sugar to add flavor. Many low fat dairy products have additives to preserve texture. 10

11 High Fructose Corn Syrup Not only high glycemic index but because it is has been chemically altered, it may cause even more strain on insulin and metabolism than even sugar. More carbohydrate and food cravings. Stimulates neuropeptides (brain messengers) which causes hunger and cravings. Increases triglycerides and LDL. DO NOT TELL PATIENTS TO EAT A LOW FAT DIET!!! Essential Fatty Acids Essential means we can not synthesize this from other things in our body and need to get it from the outside - our nutrition Omega-3 Flaxseed oil, walnut oil, Salmon, tuna, mackerel, sardines Omega-6 canola oil, eggs, chicken, safflower oil, sunflower oil, wheat germ oil, poultry 11

12 Omega Fatty Acids Ratio of Omega 3, 6, 9 important. Omega 6: Omega 3 fat intake ratio estimated as 1:1 in prehistoric man and as 4:1 in 1900, and 20:1 in S.A.D. Poor ratio is result of corn and soy added to packaged food and baked goods and agricultural practices for raising meat, poultry and fish. Increase omega 3. Decrease omega 6 in diet. Omega Fatty Acids Omega 3 - anti inflammatory Too much omega 6 - pro inflammatory Diabetes and Heart Disease Monounsaturated fats (compared to carbs) reduces blood sugar and triglycerides in type 2 DM. Fish consumption twice /week reduces risk of sudden death Trans Fats increase risk of type 2 DM and heart disease. Red meat may be associated with increase risk of colon and prostate cancer. 12

13 A word or about DAIRY Dairy foods are not a nutritional requirement. Marion Nestle, What To Eat. Source of calcium and protein. Healthful highly absorbable calcium sources: Beans and Greens, the calcium they contain is absorbed nearly twice as well as the calcium in cow's milk. Americans may require more calcium only because of high animal protein and salt in diet. Many intolerances and problems for some consuming dairy such as constipation, irritable bowel syndrome, lactose intolerance, allergies. Dairy and Bone Health Bone Health? NO data to suggest that consuming dairy is related to bone health or that calcium in dairy is bio-available to bone after adolescence. Population studies show that countries with minimal or no dairy in diet have less osteoporosis and fewer bone fractures. Animal proteins (dairy, meat) have negative impact on bone. Fruits and vegetables also good for bones ACTIVITY, NO SMOKING OR SECOND HAND SMOKE, Dairy and Bone Health In a 12-year Harvard study of 78,000 women, those who got the most calcium from dairy products received no benefit and actually broke more bones than the women who got little or no calcium from dairy 1994 study of elderly men and women in Sydney, Australia, showed that those who consumed the most dairy products had double the hip fracture rate of those who consumed the least. Several studies of teenagers have found that their adult bone health is related to their physical activity level earlier in life, but not to the amount of milk or calcium they consumed 13

14 Whole Foods Diet A well-balanced whole-foods diet consists of vegetables, fruits, whole grains and legumes, nuts/seeds, with smaller amounts of dairy, meat/poultry/fish/eggs. REAL FOOD! Foods that are eaten in close to their natural state Example: a chicken breast instead of a chicken nugget Foods that are not processed or refined Brown rice instead of Uncle Ben s Minute Rice Foods that do not contain: synthetic chemicals, additives, preservatives or artificial colors Mediterranean Diet Balanced diet of high-nutrient and low-calorie foods=vegetables and fruits, whole grains, legumes. olive oil is principal fat. Positive impact on health: weight management, heart health, diabetes Research showed 33% reduction in risk of heart disease, 24% lower death rate from cancer. Research showed worked better that low fat diet in treating metabolic syndrome 14

15 Taking a Diet History Imperative component - must individualize. No judgment How often, how much, what time of day? Must also know approximate energy expenditure - activity level. FOCUS ON HEALTH not on weight. DIET DIARY Please write down EVERYTHING you have to eat or drink (including water) for 3 days. If your weekends are very different from weekdays then record for 1 week. DAY 1 Breakfast Morning snack Lunch Afternoon snack Supper Evening snack DAY 2 DAY 3 Nutrition Counseling 4 W s: what, when, why and aware Read labels, eat real food. Paying attention to what one is putting in mouth, hunger and satiety Positive attitude (you deserve to be healthy) vs. guilt, shame (should, bad food ) 15

16 Case #4 56yo male, hypothyroid, dyslipidemia 6/10: Wt lb Chol 213 HDL 36 TG 497 (no LDL can t calc) Diet: bagel for breakfast, school lunch, snack foods cheetos, meat, veg at supper, ice cream in evening. No exercise. 8/10: No bagel or ice cream, less bread, more whole grains and veggies. Exercising 4-6 days/week. Wt. 188lb Chol 148 HDL 48 LDLL 76 TG 133 Summary Take a diet history Individualize- One size does NOT fit all Be positive and realistic Encourage to read labels EAT REAL FOOD 16