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3rd Annual Medical Conference & Community Outreach Program June 10, 11 & 12, 2016 Grenada, W.I. Nutrition in Sports and Orthopedics Kenneth Cintron, MD, FAAOS, ABoIM, MBA Southeast Orthopedic Specialists Jacksonville, Florida, USA Popular Thinking “The problem with popular thinking is that it does not require you to think at all.” Kevin Meyers Agenda Essential Concepts: Nutrigenomics, Epigenetics Current Strategies in Sports Nutrition Obesity, Inflammation and Nutrition in Orthopedics Conclusion Nutrigenomics Is the study of how foods affect our genes and how individual genetic differences can affect the way we respond to nutrients (and other naturally occurring compounds) in the foods we eat. Epigenetics Refers to heritable changes in gene expression (active versus inactive genes) that does not involve changes to the underlying DNA sequence; a change in phenotype without a change in genotype. In simplified terms, epigenetics is the study of biological mechanisms that will switch genes on and off. Strategies Nutrition Periodization SUPPORT the body’s energy needs associated with the different training VOLUME and INTENSITY stressors throughout the training year to elicit positive physiological responses. “Eat to train, don’t train to eat.” Nutrition Periodization* *Physical goals are athlete specific. Metabolic Efficiency • Improving the body’s efficiency of utilizing endogenous stores of carbohydrate and fat throughout different durations of exercise and at rest. • Mobilize a higher amount of almost unlimited fat stores while preserving very limited carbohydrate stores. Why Metabolic Efficiency? 1. Decreases/eliminates risk of gastrointestinal (GI) distress. 2. Improves nutrient partitioning for energy use. 3. Improves body weight and composition. 4. Improves health markers and risk of chronic disease states. 5. Creates a healthy relationship with food. Metabolic Efficiency Testing • Assesses the nutrition status of individual • Validates and offers more accurate daily and training nutrition education/ implementation strategies • Can provide proper exercise recovery intervals to maximize fat adaptation • Provides custom hourly energy intake/hour during exercise Genes and Nutrition COMT Cravings/Eating Behaviors-Genes related to homocysteine-B vitamins FTO-1 Increased risk of food cravings-Increased disease risk in certain populations-Distracted eating LEP Lower leptin (may increase sense of hunger)-Increased disease risk in certain populations Mindful eating LEPR sugar MC4R-1 Increased risk of food cravings-Increased disease risk in certain populations-Decrease sugar intake, optimize blood sugar; Rhodiola, L-theanine Decreased sense of satiety-Increased disease risk in certain populations-Optimize blood Genes and Nutrition COMT Cravings/Eating Behaviors - Genes related to homocysteine - B vitamins MC4R-1 Increased risk of food cravings - Increased disease risk in certain populations Decrease sugar intake, optimize blood sugar; Rhodiola, L-theanine Genes and Nutrition CAT Formation of free radicals-Oxidative stress-Antioxidants GPx Reduced neutralization of hydrogen peroxide-Oxidative stress-Selenium, glutamic acid, Nacetyl cysteine GSTP1 Increase ROS-Oxidative stress-Fruits, vegetables; antioxidants GSTT1 Increase ROS-Oxidative stress-Fruits, vegetables; antioxidants HMOX1 Increase ROS-Oxidative stress-Fruits, vegetables; antioxidants, turmeric, Omega 3, quercetin NQO1 NRF2L2-2 Increase ROS-Oxidative stress-Fruits, vegetables, cruciferous vegetables, green tea, turmeric, quercitin, Omega 3 SOD2 Reduced enzymatic mitochondrial activity-Oxidative stress-Fruits, vegetables; antioxidants Increase ROS-Oxidative stress-Ubiquinone Genes and Nutrition GPx Reduced neutralization of hydrogen peroxide - Oxidative stress - Selenium, glutamic acid, Nacetyl cysteine HMOX1 Increase ROS - Oxidative stress - Fruits, vegetables; antioxidants, turmeric, Omega 3, quercetin NQO1 Increase ROS - Oxidative stress - Ubiquinone Genes and Nutrition IL-6 Increased production of IL6 and CRP-May increase inflammation and fatigue; lengthen recoveryEPA/DHA, curcumin, betasitosterol SOD2 Inflammation and oxidative stress-Increased fatigue with prolonged exercise-Fruits/vegetables, Antioxidants BHMT Lower enzyme activity and poor recycling of homocysteine-Increase risk for CVD-Folate, Vitamin B6 MTFR Lower enzyme activity and higher homocysteine levels-Increase risk for CVD B vitamins MTHFR-1 and -2 Disruption of methylation, homocysteine, CoQ-10 and DNA repair-Increase risk for diseases-Methylfolate BOMO1-1 and -2 Risk for Vitamin A deficiency-Increased risk for health conditions-Retinol containing foods (animal products); reduce alcohol MMAB Elevated homocysteine; higher LDL; lower HDL with High CHO diet-Increased risk for health conditions-Vitamin B12 foods TON2 Increased risk for B12 deficiency-Increased risk for health conditions-Vitamin B12 foods NBPP3 Increased risk for B6 deficiency-Increased risk for health conditions-Vitamin B6 foods Genes and Nutrition SOD2 Inflammation and oxidative stress - Increased fatigue with prolonged exercise Fruits/vegetables, Antioxidants TON2 Increased risk for B12 deficiency - Increased risk for health conditions - Vitamin B12 foods Genes and Nutrition CYP1A2 Sensitivity to caffeine-Increased disease risk in certain populationsReduce caffeine DHCR7, GC, VDRBsml, VDRTaq1 Vitamin D deficiency-Increased risk for health conditions-Vitamin D foods TTPa Lower levels of Vitamin E-Increased risk for health conditions-Vitamin E rich foods BEST SPORT NUTRITION STRATEGIES NUTRITION PERIODIZATION NUTRITION RX FOR HEALTHPERFORMANCE METABOLIC EFFICIENCY GENETIC TESTING Obesity, Inflammation and Nutrition in Orthopedics US Healthcare USA spend more money than any other industrialized country. Worst ranking on years of life lost from preventable medical conditions and infant mortality. 200,000 deaths from preventable errors. $77 billion in preventable drug-related illness and mortality. US Healthcare 80% of all healthcare expenditures are related to chronic diseases. 85% of these chronic diseases are preventable. We are clearly in need of a pervasive paradigm shift in both patient management and physician training in order to improve the cost-effectiveness of care. ORTHOENDOCRINOLOGY Decreased Increased Testosterone Estrogen DHEA Prolactin Cortisol Progesterone Thyroid Progesterone “Evidence suggests that mitochondrial metabolism might be a target to stop the progression of cell death matrix deterioration and the development of OA.” “Many of the PPACA initiatives aim to reduce long-term costs by redirecting resources from treating illness to preventing disease, thus improving health care for broad segments of the population. This paradigm shift from treatment and intervention to prevention also affects TJR surgery.” “Given the emerging fiscal and societal pressure on the American health-care system, delay (of the surgical procedure) with the goal of risk mitigation for high-risk TJR seems not only moral but also morally obligatory.” Conclusion Nutrigenomics and epigenetics are emerging sciences that will transform the way we practice medicine. The addition of these concepts are the base for the optimization of athletes in the field of sports medicine. Based on the definition of value = outcomes/costs, our current sickcare system is… The status quo is not an option. We (you and me) have the fiscal, societal and moral obligation to execute this paradigm shift from treatment and intervention to prevention and health. Thinking for a change “The difficulty lies not so much in developing new ideas as in escaping the old ones.” [email protected]
