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Transcript
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]