Eating Strategies to Improve Your Health

Transcription

1 Eating Strategies to Improve Your Health

2 Canada s Population is Aging Canada s Aging Population, Health Canada 2002

3 Mortality is Due Primarily to Chronic Disease Canada s Aging Population, Health Canada 2002

4 Causes of Chronic Disease In summary: where we live + who we are + how we live = diseases we get WHO (2005). Preventing Chronic Diseases: A Vital Investment Although your age cannot be reversed, it is still worth asking whether certain strategies can be employed to reduce the impact of aging on the development of chronic disease

5 Managing Chronic Disease Management Strategies Lifestyle Lifestyle & Drugs Drugs Preventing and Managing Chronic Disease: Ontario s Framework (2007)

6 Promoting a Healthy Lifestyle for Disease Management Reduce smoking and drinking Encourage more physical activity Maintain a healthy diet (these 3 items require changes in behavior) Get regular check-ups (enhances the chance of detecting disease early) It is generally recognized that lifestyle can influence disease onset, but is it useful for disease treatment? A key factor in addressing this question is whether the disease can be detected early enough to be controlled by lifestyle changes.

7 Primary Cause of Mortality and Morbidity [V]ascular diseases are the principal causes of death and disability in people with diabetes. The macrovascular manifestations include atherosclerosis and medial calcification. The microvascular consequences, retinopathy and nephropathy, are major causes of blindness and end-stage renal failure. from Diabetes and Vascular Disease Pathophysiology, Clinical Consequences, and Medical Therapy: Part I Circulation 2003; 108: Mark A. Creager, MD; Thomas F. Lüscher, MD, FRCP It is now known that the same vascular defects occur in obesity and that they become more prevalent with age It is thus reasonable to conclude that atherosclerotic disease is the primary cause of death in older Canadians except in the case of cancer

8 A major issue with cardiovascular disease is that early detection is not promoted in the Canadian healthcare system. Rather, treatment is initiated once symptoms arise chest pain, heart attack, stroke, etc. This contrasts with cancer where numerous screening tests are available. For this reason, we have focused our efforts on identifying and acquiring novel non-invasive instruments capable of diagnosing early changes in blood vessel function due to atherosclerosis.

9 Manifestations of Systemic Atherosclerosis Cerebrovascular Coronary Artery Peripheral Arteries from Viles-Gonzalez et al. Eur Heart J 25:1197, 2004

10 Our Model: Peripheral Artery Disease 10 million with known disease (2005 statistics - US) 25 million undiagnosed 1 million with symptoms (claudication) 20,000 amputations per year 5 year survival = 50% (worse than colon cancer) Evidence of systemic vascular disease 5-10 fold higher incidence of heart attack and stroke Associated costs = $21 billion annually

11 Symptoms of PAD Claudication cramps due to poor blood flow Poor wound healing Decreased leg temperature Reduced nail and hair growth Colour changes in feet

12 How are PAD and Atherosclerosis Diagnosed? Ankle-Brachial Index (ABI) Limb Perfusion Pulse Wave Analysis/Pulse Wave Velocity Arterial Stiffness PAD = ABI<

13 So how have we used these novel diagnostic capabilities to determine whether lifestyle modification is applicable to the treatment of chronic disease, such as PAD? We undertook a study to test the hypothesis: Eating at least one serving of pulses per day improves cardiovascular health

14 What are Pulses? Pea Bean Lentil Chickpea Yellow Pinto Large green Kabuli Green Navy (White) Small green Desi Marrowfat Black Red Austrian Winter Kidney Maple Romano Small Red

15 Pulses are Good for Us! Lower blood cholesterol due to dietary fibre Better metabolic control because of their low glycemic index Reported to improve blood vessel function Soybean phytosterols reduce cholesterol levels (Matvienko et al 2002) Isoflavones from greengram and other pulses have a similar effect (Sharma 1979, Sumner et al 1996) Anthocyanins, isoflavones present at high levels in beans, stimulate the production of adiponectin, a naturally produced hormone that protects against vascular disease (Hosfield 2003) Compounds present in pulses can improve arterial stiffness (He et al 1998) Pulse flavonoids can block specific cellular processes that promote atherosclerosis (Dzau et al 2002) But clinical trials investigating the beneficial actions of pulses on cardiovascular health, particularly with clinical endpoints, are lacking 15

16 Stage 1: Design the Study Baseline Cohort = 26 individuals with PAD Daily ½ cup serving* locally grown lentils (green, red), beans (pinto, kidney, navy, black), peas (whole green, yellow), or chickpeas 8 weeks Food Frequency Questionnaire 3 Day food records Anthropometric Blood samples Clinical assessments *¼ cup serving during week 1 Typical consumption before study was <⅓ cup per week

17 Stage 2: Prepare the Foods Recipes available online at ccarm.ca

18 Stage 3: Recruit Participants n =26 Average Age = 70 Male = 50%, Female = 50% Hyperlipidemia = 20 Hypertension = 22 Heart Disease = 17 Type 2 Diabetes = 12 Kidney disease = 0 If you are interested in joining our studies please visit ccarm.ca and click the clinical trials button 18

19 Stage 4: Consumption Analysis Baseline & during week 7-8 of study 2 week days, 1 weekend day Participant records all food and beverage consumption (food type, amount, preparation method) Enter into a nutrient analysis computer program

20 Nutrient Intakes 3 day total Nutrient Baseline 8 weeks Energy (kcal) 5095 ± ± 258 Carbohydrate (g) 621 ± ± 40 Protein (g) 220 ± ± 13 * Fat (g) 187 ± ± 14 Total dietary fibre (g) 55 ± 5 68 ± 4 * * P<0.05

21 Nutrient Intakes 3 day total Nutrient Baseline 8 weeks Vitamin B 6 (mg) 4.64 ± ± 0.25 * Folate (ug) 1078 ± ± 56 * Vitamin C (mg) 207 ± ± 33 * Potassium (mg) 8270 ± ± 412 * Iron (mg) 36.0 ± ± 1.7 Zinc (mg) 28.1 ± ± 1.8 Iron, P=0.07; Zinc, P=0.09

22 Nutrient Intakes: % of recommended intake for age & gender Nutrient Baseline 8 weeks Dietary Fibre 70 ± 8 86 ± 7 * Protein 127 ± ± 10 Vitamin B 6 98 ± ± 6 * Folate 90 ± ± 5 * Vitamin C 87 ± ± 14 * Potassium 59 ± 4 68 ± 3 * Iron 147 ± ± 8 Protein, P=0.08; Iron, P=0.08

23 Stage 5: Analyze the Clinical Data - 1 Anthropometrics Weight no change Blood lipids Triglycerides no change HDL Cholesterol no change Lp(a) no change Indices of Diabetes Serum glucose levels no change Serum insulin no change Glycated hemoglobin no change

24 Stage 5: Analyze the Clinical Data - 2 Vascular Function ABI improved Arterial stiffness decreased Blood lipids Total cholesterol declined LDL Cholesterol was reduced Lp(a) no change Anthropometrics BMI decreased Vascular improvements were not due to the decline in cholesterol

25 Summary Eating pulses positively affects functional endpoints of cardiovascular health Improvements in arterial stiffness and blood flow are not linked to reductions in lipid levels or better glycemic control Pulses can impact on quality of life due to improvements in physiological measures of this disease, particularly in diabetes Because atherosclerosis is a systemic disease, affecting blood vessels of the heart, brain and kidneys in addition to other organs, the ability to stop or reverse PAD suggests pulses could be used to treat or prevent atherosclerotic disease, including heart disease and stroke. 25

26 Conclusions Pulses may be considered a Medicinal Food since their consumption can be used to treat a serious chronic disease As well, our results indicate food-based interventions are a viable option for the treatment of human disease 26

27 So how can we implement this information? Get Canadians to eat more pulses! see our Mr Bean video at ccarm.ca

28 But Canadians Do Not Eat Pulses

29 How Can We Overcome the Obstacles? Disseminate the results of this and similar studies Provide tasty recipes that contain pulses Healthcare facilities should increase the number of foods that contain pulses Encourage food companies to develop new pulserich foods These need to have the right amount so that the beneficial effects are obtained The foods should fit our lifestyle Continue to research how pulses work Determine which pulse varieties are best Can we identify the active ingredient(s) and incorporate them into other foods for ease of consumption?

30 Advancing Medicine Through Agriculture

31 CCARM s Mandate Develop reliable, evidence-based information concerning functional foods & nutraceuticals Conduct human studies to explore the health benefits of functional food & nutraceutical interventions Manage clinical trials to validate safety and efficacy of novel food intervention formulations suitable for prevention and treatment of disease

32 The integration of agriculture & food production with medical research provides a unique niche for CCARM investigators. As this presentation demonstrates, the investigative approach we employ is able to enhance our ability to discover new interventions that do not rely on pharmacological agents for treating the afflictions associated with aging.

33 Clinical Studies Completed Pulse: n=26, endpoint = vascular function (PAD) Barley: n=24, endpoint = glycemic control (healthy) Buckwheat: n=24, endpoint = glycemic control (diabetes) Ongoing Eggs: n=60, LDL-cholesterol & vascular function (PAD) Reference Population: n=120, endpoint = vascular function (healthy) Pulse: n=160, endpoint = potency of different varieties (PAD) Canola: n=70, endpoint = vascular function & cognition (PAD) Funded (*multisite trial) Lentil: n=90, endpoint = glycemic control & vascular function (diabetes)* Pulse: n=160, endpoint = vascular function & cognition (obesity)* Pea & Bean: n=150, endpoint = cholesterol reduction (for health claim)* Canola: n=100, endpoint = lipids & vascular function (metabolic syndrome) Please go to ccarm.ca/ and click the Clinical Trials button to view the details of these studies

34 Why Is This Research Important? Have you been told by your health-care professional you have high blood pressure, high cholesterol or Type 2 diabetes and you need to do something to improve your "numbers"? If so, it is likely their recommendations were based on national clinical practice guidelines written by experts in cardiovascular health. On the face of it, following guidelines seems a very reasonable approach. What could be the problem? Well, a recent evaluation of cardiovascular patient guidelines reveals only 12 per cent of the recommendations are based on randomized controlled trials (the highest level of evidence). In contrast, 54 per cent of the recommendations are based purely on opinion and consensus. James McCormack, Winnipeg Free Press May 5, 2012 If these statistics for prescription medications are correct, then how much of the information we hear about the beneficial effects of foods and nutritional supplements can we believe?

35 Acknowledgements Co-investigators Carla Taylor, PhD Randy Guzman, MD Trainees Heather Blewett, PhD Danielle Stringer, MSc Clinical Team Delphin Rodriguez, MD Wendy Weighell, RN Alanna Baldwin, RN, MSc Angela Wilson, RN Technical Assistants Brenda Wright, BSc Leslee Tworek, RT And of course we thank the study participants for their willingness to assist with our investigation

36 Taylor/Zahradka Labs Summer 2010