Download Coping With Change Conference - Alumni Groups

The Ohio State University Retirees' Association
Alternative Approaches to Medicine:
Living Well Beyond 100 Years of Age
______________________
Coping With Change Conference
Glen Aukerman, MD
Medical Director
The Ohio State University
Center for Integrative Medicine
Objectives
• Participants will have greater understanding of
– Complementary and Alternative Medicine
(CAM) Use Among Older Adults
– Important to Communicate with your doctors
about herbs, nutrition, nutritional supplements
– Credible information about supplements and
herbal products, their safety and effectiveness
– Nutritional needs for increased functioning and
reduced effects of aging
– How other Systems of Health-Care, Ayurveda
Complementary and Alternative Medicine
(CAM) Use Among Older Adults
Older adults increasingly use complementary and alternative medicine
• 2000 Health and Retirement Study showed:
– 88% of respondents 65 years and older used CAM
• Dietary supplements = 65%
• Chiropractic = 46%
– Age correlated with use of dietary supplements and personal practices
• inversely correlated with alternative practitioners
– Men reported less CAM use than women
– Men use more chiropractic and personal practices
– Blacks and Hispanics used fewer dietary supplements, less chiropractic
• more personal practices than Whites
– Advanced education correlated with fewer chiropractic visits
• more dietary and herbal supplement and personal practices use
– More alternative practitioner use
• Higher income, functional impairment, alcohol use and frequent physician visits
correlated
– No association between CAM use and number of chronic diseases
Ness J, Cirillo DJ, et al. Use of Complementary Medicine in Older Americans: results from the Health and Retirement Study. The Gerontologist. 45:516524 (2005)
CAM Use Among Rural Older Adults
• CAM use, older rural white and black adults;
– 41%-75% of older adults were using some form of
CAM
– Most common CAM used by this population were
• prayer
• vitamins
• exercise
85%
83%
64%
– Other forms of CAM reported were: meditation, herbs,
chiropractic, glucosamine, and music therapy
– Money was spent on CAM;
• 45% of respondents reported spending < $100/year on CAM
• Note: may be due to limited income, lack of insurance
coverage for CAM, and limited availability of CAM in rural
areas
Cuellar N, Aycock T, Cahill B, Ford J. Complementary and Alternative Medicine Use by African American and Caucasian
American Older Adults in a Rural Setting. BMC Complementary and Alternative Medicine 2003, 3:8
CAM Use Among Urban Older Adults
• Cross-sectional analysis of medical charts 65 years of age,
urban academic hospital geriatrics
practice
• Elements measured included:
– a) CAM use Prevalence = 64%
– b) proportion of CAM supplements and herbs (CAMsh) reported by
patients and documented in patients’ charts = 35%
– c) 46% of patients reporting taking CAMsh with anticoagulant
activity (ginger, gingko, garlic, vitamin E) while concomitantly taking
prescribed anticoagulant medications
• 52% took a prescribed anticoagulant (per chart)
• 48% took CAM but not prescribed anticoagulants
– d) 46% of patients for whom the CAM anticoagulant was not
documented in the chart
Cohen RJ, Ek K, Pan CX. Complementary and Alternative Medicine Use by Older Adults. The Journals of Gerontology Series A: Biological
Sciences and Medical Sciences 57:M223-M227 (2002) Ther Gerontological Society of America
CAM Use Among Older Adults
• Conclusions
– CAM use is prevalent among older adults
– Health care professionals should recognize that CAM may be used
very differently among a variety of racial and ethnic backgrounds
– Patients often do not report or under-report CAM use
– CAM frequently not documented in the patient’s chart if
reported
– Health care professionals should encourage patients to discuss
CAM activity, particularly vitamin/herb supplements, as these may
cause potentially harmful drug-supplement interactions
Increased Life Expectancy Last Century
• 30 years added to ave. US life expectancy
–
–
–
–
–
100 years ave American life span expected this century
Decreases in early-life mortality
Decreases in mid-life mortality from medical advances
Curative medicine will play a lesser role
Nutrition and Supplements will play larger role
• Aging population has increased health care costs
– Costs will increase more as we have even longer lives
• Unless we become more healthy through Nutrigenetics
– Establishing and safeguarding optimal health from
early life must become increasingly important
• Concerns for governments and health care providers
– Allocate resources wisely
– Ensure and maintain a high quality of life in the population
through better nutrition and fitness
The Future of Living Well to 100
• Healthy aging presents an enormous challenge
• Advances in biological sciences provide the knowledge
and tools needed to
• understand nutrition at genetic and molecular levels and
• elevate the scientific basis underlying nutritional recommendations
• Understanding roles requires interdisciplinary
cooperation of:
» nutrition
» genetics,
» inflammation
• Developing partnerships among specialties to promote
the goal of healthy aging
– come together as a science community
– generate the evidence base to influence recommendations
• Value of nutrition and genetics in achieving healthy aging
Am. J. Clinical Nutrition, Feb 2006; 83: 488s - 490s. Gordon W Duff, Peter Libby, José M Ordovas, and Philip R Reilly
The Different Paths to 100
• Most centenarians do not have significant disability
– 90% of centenarians functionally independent @ ave. age of 92 years
• A more enabling point of view emerges to achieve extreme old age :
– The older an individual gets, the healthier he or she has been
– Centenarians show
• Relative resistance to age-related diseases
• Slower aging
– Where are we heading
• 1 centenarian per 10,000 persons in the United States NOW
• 1 centenarian per 5,000 persons for industrialized nations SOON
•
Ability to survive to extreme old age appears to be the result of:
– Complex combination of
• Genetics,
• Environment
• Lifestyle (Diet, Exercise,Social Activities), and Luck
•
The Future Path lies in:
–
–
–
–
–
Better Perinatal Nutrition = Omega-3, Nutrients
Genetics of the Very Old
Identifying the molecular drivers of longevity or mortality = omega 3/6 ratio
Discovering and targeting the pathways mediating aging and disease susceptibility
Developing preventive and therapeutic agents that will allow aging in good health
Thomas T Perls,am. J. Clinical Nutrition, Feb 2006; 83: 484s - 487s
Starting Down the Right Path:
Nutrition Connections With Chronic Diseases of Later Life
• Prevention-oriented life cycle approach is critical to
– Establishing and maintaining health throughout life
– Delay and compress morbidity (sickness) and
– Decrease the social toll associated with chronic disease and disability
for as long as possible into old age
• Good evidence that early nutrition affects key risk factors for:
– Chronic degenerative diseases of middle and later life, such as
• Osteoporosis and
• Cardiovascular disease
• Influence of nutrition on health status and morbidity supports
primary, secondary, and tertiary prevention of disease and
intervention strategies at each point in the process
– Enable people to live well, longer
– Minimize chronic disability
Johanna Dwyer, Am. J. Clinical Nutrition, Feb 2006; 83: 415S - 420S
Genetics of Aging:
Implications for Drug Discovery
• Aging is not a passive activity,
– But an actively regulated metabolic process
• Specific genes identified that regulate aging,
– Aging and Longevity are only partially under genetic influence
– Rest of Gain is from Nutrition
• It is possible to increase life span by environmental
modification;
– caloric restriction can increase life span
– dysregulation of glucose homeostasis is a hallmark of aging in
humans
– type 2 diabetes, a disease of glucose homeostasis, is a form of
accelerated aging
– Aging and Diabetes are both common risk factors for a wide range of
diseases
– Aging and Diabetes are related at a molecular level
Andrew S Greenberg and Martin S ObinAm. J. Clinical Nutrition, Feb 2006; 83: 461s - 465s
Bard J Geesaman, Am. J. Clinical Nutrition, Feb 2006; 83: 466S - 469S
Influence of Human Genetic Variation
on Nutritional Requirements
•
Genetic variation is known to affect food tolerances among human
subpopulations and may also influence dietary requirements, giving rise to
the new field of nutritional genomics and raising the possibility of individualizing
nutritional intake for optimal health and disease prevention on the basis of an
individual's genome
•
Gene-diet interactions are complex and poorly understood, the use of
genomic knowledge to adjust population-based dietary recommendations is not
without risk
•
Current recommendations target most of the population to prevent
nutritional deficiencies, inclusion of genomic criteria may indicate
subpopulations that may incur differential benefit or risk from generalized
recommendations and fortification policies
•
Current efforts to identify gene alleles that affect nutrient utilization have
been enhanced by the identification of genetic variations that have expanded
as a consequence of selection under extreme conditions
Patrick J Stover, Am. J. Clinical Nutrition, Feb 2006; 83: 436S - 442S
Evidence for Genetic Variation
A Factor in Maintaining Health
•
•
•
Influence of Genetics subtle, complex, not conforming to simple Mendelian
patterns of inheritance as is seen with single-gene disorders
Genetic Variation can influence the propensity for the initiating event, the
progression to a clinical disease state, and the trajectory of disease
Interleukin 1: example genetic variations affecting complex diseases is
provided by the interleukin 1 family of cytokines
–
Key role in mediating inflammation = central component of many chronic diseases
– Coronary artery disease
– Rheumatoid arthritis
•
Research has identified many sequence variations in regulatory DNA of
the genes coding for important members of the interleukin 1 family, and these
variations are associated with differential effects on the inflammatory response
– These in turn alter the risk of some diseases in which inflammation plays a
role and also affect physiologic responses, such as the inflammatory
response to exercise. As this new genetic knowledge is developed and
extended, it may be possible to make health care interventions at an
earlier stage, before clinical disease is established, rather than after
tissues have been permanently damaged
Gordon W Duff, Am. J. Clinical Nutrition, Feb 2006; 83: 431S - 435S
Chronic Illnesses & Diet-Related Health Problems
Are the Most Serious Threat to Public Health
•
Sixty-five percent of US adults aged >20 years = overweight or obese:
– 280,184 deaths per year attributable to obesity
•
> 64,000,000 Americans have cardiovascular disease (CVD) = 38.5% deaths
–
–
–
–
•
Leading cause of mortality in the United States.
50,000,000 Americans are hypertensive
11,000,000 Americans have type 2 diabetes, and
37,000,000 adults have high-risk total cholesterol (>240 mg/dL)
Postmenopausal women aged >50 years
– 7.2% have osteoporosis and
– 39.6% have Osteopenia
– Osteoporotic hip fractures = 20% excess mortality in the year after fracture
•
Cancer = 25% of all deaths in the United States,
– is the second leading cause of death
– one-third of all cancer deaths are due to nutritional factors, including obesity
Nutrients Restore The Immune System
• Changes in USDA Food Composition Data for 43 Garden Crops,
1950 to 1999, Protein, Ca, P, Fe, Pyridoxine, and Vit C all decreased
• The Fundamentally Altered 7 Crucial Nutritional Characteristics of
Modern Diets and the Impact of Health in The 21st Century
• Associations of Mortality With Ocular Disorders and an Intervention
of High-Dose Antioxidants and Zinc, Age-Related Eye Disease Study
• Relation Between Dietary N–3 and N–6 Fatty Acids and Clinically
Diagnosed Dry Eye Syndrome in Women when om 6: om 3 > 6:1
• The Western Diet Frequently Contains Excessive Saturated and
Trans Fatty Acids, Too Little N–3 PUFAs versus excess N–6 PUFAs
• Western Diet Yields a Net Acid Load = Renal Failure
• Latex Exposure comes from inhaled auto tires but Immune system
is depressed when we eat foods laden with naturally occurring latex
• Role of Thiamine and B Complex in High Calorie Malnutrition
Inflammation and
Neurodegenerative Diseases
• Mental Fitness Decline in Alzheimer Disease accompanies:
– Physical changes in the brain, including the development of
• characteristic plaques and
• Neurofibrillary tangles
– Pathogenesis of those changes is not clear
•
Activation of microglia in response to injury, illness, aging, or other causes
begins a cascade of events characterized as an inflammatory process
– Cascade is mediated at first by the proinflammatory cytokine interleukin 1,
which is over expressed by the activated microglia
– Interleukin 1 causes neuronal death, which activates more microglia,
which in turn release more interleukin 1 in a self-sustaining and
self-amplifying fashion
– Over a period of years, this slow smoldering inflammation
in the brain destroys sufficient neurons
to cause clinical signs of Alzheimer disease
W Sue T Griffin,Am. J. Clinical Nutrition, Feb 2006; 83: 470S - 474S
The Fundamentally Altered 7 Crucial
Nutritional Characteristics of Modern Diets
Food staples and food-processing procedures
introduced during the Neolithic and Industrial
Periods have fundamentally altered 7 crucial
nutritional characteristics of ancestral hominin
diets:
1) glycemic load
2) fatty acid composition = omega 6:3 ratio
3) macronutrient composition
4) micronutrient density
5) acid-base balance
6) sodium-potassium ratio, and
=
7) fiber content
Changes in USDA Food Composition Data
From1950 to 1999 for 43 Garden Crops
All 43 fruits and vegetables tested show statistically reliable declines (R <
1) for 6 nutrients:
•
•
•
•
•
•
Protein, 6%
Calcium,
Phosphorus,
Iron,
Riboflavin 38%
Vitamin C
Conclusions:
– Declines are generally changes in cultivated varieties between 1950 and 1999, in
which there may be trade-offs between yield and nutrient content
Observations:
– Need to replace those nutrients not available in current Western Food Supply
Donald R. Davis, PhD, FACN, Melvin D. s, PhD and Hugh D. Riordan, MD
Nutritional Needs As We Age
• Nutritional Needs for Increased Functioning and
Reduced Effects of Aging in the Elderly
– Avoid Latex in Foods,
– Decrease Gluten and Omega-6 as much as possible
– Replace Nutrients no longer in our Food Supply
Western Diet Yields a Net Acid Load
• Western net acid load estimated to be 50 mEq/d
– Adults on the standard US diet sustain a chronic low-grade pathogenic
metabolic acidosis that worsens with age as kidney function declines
– Virtually all preagricultural diets were net base yielding because of the
absence of cereals and energy-dense, nutrient-poor foods
• introduced during the Neolithic and Industrial Eras
• displaced base-yielding fruit and vegetables
• base-producing diet, the norm throughout most of hominin evolution
• Health benefits of a net base-yielding diet include
preventing and treating:
–
–
–
–
–
–
Osteoporosis
Age-related muscle wasting
Calcium kidney stones
Hypertension
Exercise-induced asthma
Slow progression of age / disease-related
chronic renal insufficiency
Thiamine Deficiency
•
Modern Western diet is loaded with simple carbohydrates
– B-Vitamin deficiency is extremely widespread
– Thiamine is very high in this deficiency because
of its biochemical association with glucose metabolism
•
•
•
•
Because of vitamin fortification of many foods and the relative affluence of our
present culture we have no considered that obscure symptoms, particularly
those that are generally termed functional, are of dietary origin
Deficiency is direct result of years of high calorie diet and treatment with
large doses of the appropriate vitamin/mineral supplementation is
mandatory
Physiological doses have no effect since the enzyme/cofactor bonding appears
to be damaged or partially atrophied. (Need High Dose, not Mega Dose)
Physicians become disenchanted when they treat a patient with low-dose
supplementation and see no benefit
– The RDA of thiamine is 1–1.5 mg per day, but only in a biochemically healthy
individual, and many physicians are under the impression that this kind of vitamin
deficiency, if it occurs at all, is easily and quickly treated
– In the treatment of beriberi, it took very large doses of thiamine for months
and there was often only partial recovery and sometimes none at all
Clinical Features Now Emerge
•
•
•
•
•
Clinical features of beriberi have been forgotten in modern medicine since it has been
assumed that the classic deficiency diseases do not occur in developed societies
Dysfunction in the autonomic system was a prominent part of the clinical expression of beriberi (21)
and reversible autonomic dysfunction, associated with evidence of high calorie malnutrition, has been
reported in recent times in the United States (22,23)
– Sweating, tachycardia, dermographia, wide unstable pulse pressure, attention deficit and other
symptoms of autonomic dysfunction in children have been reported as functional dysautonomia
(24)
Relation between thiamine requirements and the intake of carbohydrates
– The influence of stepwise increases of carbohydrate intake on the status of thiamine in healthy
volunteers under isocaloric conditions (25) An increase of dietary carbohydrate intake caused a
decrease of plasma and urine levels of thiamine without affecting enzyme activities
Thiamine Deficiency has been reported in refractory heart failure (36) and has occurred in epidemic
form in Cuba involving 50,862 (461.4 per 100 000) people
– Lesions included peripheral neuropathy, retrobulbar optic neuropathy, sensory and dysautonomic
peripheral neuropathy, sensorineural deafness, dysphonia, dysphagia and spastic paraparesis
(37,38). TD ataxia (39), post-gastrectomy polyneuropathy (40) and reversible autonomic
neuropathy involving bladder dysfunction (41) have been described
Natural Sources and Modern Antagonists to Thiamine
– Thiamine is present in lean pork and other meats, wheat germ, liver and other organ meats,
poultry, eggs, fish, beans and peas, nuts, and whole grains
– Dairy products, fruit and vegetables are not good sources
– The RDA is 0.5 mg per 1000 kcal, adequate for a healthy individual consuming a healthy diet
– Considerable losses occur during cooking or other heat-processing of food
– Polyphenolic compounds in coffee and tea can inactivate thiamine so that heavy use of these
beverages could compromise thiamine nutrition
B-complex Vitamins’ Biochemical Roles,
Physiologic Roles of Co-enzyme Forms, and
Brief Description of Clinical Deficiency Symptoms
Vitamin
Physiologic Roles
Co-substrate,Coenzyme Functions
Thiamin (B1)
Metabolism of carbohydrates,
branched-chain amino acids
Riboflavin (B2)
Niacin (nicotinic
acid, nicotinamide)
Oxidation and reduction
reactions
Hydrogen transfer with
Deficiency Signs
Symptoms
Beri-beri, polyneuritis, and
Wernicke-Korsakoff syndrome
Growth, cheilosis, angular
stomatitis, and dermatitis
Pellagra with diarrhoea,
dermatitis, and dementia
Vitamin B6
numerous dehydrogenases
Metabolism of amino acids,
Pantothenic acid
glycogen, sphingoid bases
Constituent of co-enzyme A,
Fatigue, sleep disturbances,
phosphopantetheine FA met
Bicarbonate-dependent
impaired coordination,nausea
Fatigue, depression, nausea,
carboxylations
dermatitis, muscular pains
(pyridoxine,pyridoxamine,
and pyridoxal)
Biotin
Naso-lateral seborrhoea,
glossitis, peripheral neuropathy
Various Eye Disorders Predict Survival
•
Various ocular disorders (eg, visual impairment and cataract and those in persons with
diabetes mellitus, severe retinopathy, or visual impairment)reported to be significant
predictors of a decreased life span, after extensive adjustment for potential confounders
– Cataract surgery has been associated with decreased survival in many studies
– Nuclear opacities associated with decreased survival
– Age-related macular degeneration (AMD) has not been found to be related to
decreased survival in the few studies that have examined the relationship
• Ability to find an association is limited because few participants in these studies had
advanced disease (neovascular AMD or geographic atrophy)
•
Age or underlying disease related to the ocular conditions and mortality could explain
the findings why ocular factors could be associated with decreased survival
– Loss of vision could have a direct effect on mortality if it results in a susceptibility to
accidents such as fatal falls or in depression reported to increase mortality
– Cataracts may be markers of systemic processes that are associated with
accelerated physiologic aging and earlier death
– Generalized oxidative damage play a role in cataract development, aging process
Nutrients found helpful:
• Centrum Silver
– Reverses Cataracts
•
Omega-3 Fish Oil
•
– Reverses Dry Eyes Syndrome
Zinc oxide 80 mg
– had lower mortality
Associations of Mortality With Ocular Disorders and
an Intervention of High-dose Antioxidants and Zinc
•
•
•
•
Objective To assess the association of ocular disorders and high doses of antioxidants
or zinc with mortality in the Age-Related Eye Disease Study (AREDS)
Methods AREDS is an ongoing, multicenter study of the clinical course of cataract and
AMD. The study included a randomized clinical trial that evaluated the effect of high daily
doses of selected oral supplements (vitamin C, 500 mg; vitamin E, 400 IU; beta carotene,
15 mg; and zinc, 80 mg as zinc oxide with 2 mg of cupric oxide) on the incidence and
progression of the 2 conditions. A total of 4757 persons aged 55 to 81 years at enrollment
were entered into the study at 11 clinical centers between November 13, 1992, and Januar
15, 1998
Results During median follow-up of 6.5 years, 534 (11%) of 4753 AREDS participants died
–
Advanced age-related macular degeneration (AMD) compared with participants with few, druse
had increased mortality (relative risk [RR], 1.41; 95% confidence interval [CI], 1.08-1.86)
–
Advanced AMD was associated with cardiovascular deaths
–
Visual acuity worse than 20/40 in one eye had increased mortality (RR, 1.36; 95% CI, 1.12-1.65)
–
Nuclear opacity (RR, 1.40; 95% CI, 1.12-1.75) and cataract surgery (RR, 1.55; 95% CI, 1.182.05) were associated with increased all-cause mortality and with cancer deaths
–
Zinc participants had lower mortality than those not taking zinc (RR, 0.73; 95% CI, 0.61-0.89)
Conclusions
– The decreased survival of AREDS participants with AMD and cataract suggests that
these conditions may reflect systemic rather than only local processes
Improved survival in individuals randomly assigned to receive zinc requires further study
Relation Between Dietary Omega–3
and Omega–6 Fatty Acids and
Clinically Diagnosed
Dry Eye Syndrome in Women
32,470 women aged 45–84 y were assessed Fatty Acid intakes using a validated
food-frequency questionnaire and assessed Dry Eye Syndrome by using selfreports of diagnosed cases
Results: A
> 6:1 ratio of omega–6 to omega–3 Fatty Acid (Fish Oil) consumption
was associated with a significantly increased risk of DES
Conclusions:
These results suggest that a higher dietary intake of Omega–3 Fatty Acids is
associated with a decreased incidence of Dry Eye Syndrome in women
Observations:
Added Omega –3 fish oil reduces and prevents dry eyes resulting from excess
Omega-6 Plant oils in the diet
Biljana Miljanovi , Komal A Trivedi, M Reza Dana, Jeffery P Gilbard, Julie E Buring and Debra A Schaumberg
Brigham and Women’s Hospital, Massachusetts Eye and Ear Infirmary Harvard Medical School, Boston, MA;
Western Diet Contains
Excessive Saturated and Trans Fatty Acids and
Fewer Omega–3 PUFAs than Omega–6 PUFAs
•
•
•
High dietary intakes of Saturated Fatty Acids and trans fatty acids
increase the risk of Heart Disease by elevating blood total and LDL cholesterol
Omega-3 fish oil PUFAs reduce the risk of CVD via many mechanisms,
including reductions in ventricular arrhythmias, blood clotting, serum
triacylglycerol concentrations, growth of atherosclerotic plaques, and blood
pressure
After 3.5 years of takings 850 mg omega–3 fatty acids, +/- vitamin E
subjects with preexisting CVD reported:
– 20% reduction in mortality
– 45% reduction in sudden death
– Preventing or ameliorating many inflammatory and autoimmune diseases
•
No difference total or LDL cholesterol after a 50-d trial on Low and High
fat diets that had identical ratios of PUFAs to SFAs, n–6 PUFAs to n–3 PUFAs,
and MUFAs to total fat
– Low- (22% energy)
– High- (39% energy)
•
Fat quality is more important than fat quantity in regard to CVD risk
Latex Chemical Sensitivity
• Exposure comes from inhaled auto tires
• Immune system becomes depressed when we eat
foods laden with naturally occurring latex
– Fruits and Vegetables make latex bittering agent to prevent animal
damage
– Latex is converted protein and carbohydrate when fruits and
vegetable ripens on the plant naturally
– Latex is trapped in the plant when picked green to ship
– Latex becomes injury protein when treated with ethylene gas
in ALL grocery warehouses, such as;
Whole Foods, Wild Oats, Kroger, Giant Eagle, etc
– Symptoms are stiffness, fatigue, aches, redness on
chin, cheeks, ears, and forehead, burning eyes
• Dried, frozen or canned foods have less latex
Nutrient Replacement List
Omega 3 Fish Oil (1000 mg cap), 1-2 caps before meals and at bedtime
Good Start = 1000-2000 mg of combine EPA and DHA daily
High Potency B Complex (B-50 or B100), 1 tablet before meals
Multivitamin (for age and gender), 1/2 tablet twice daily
Magnesium Oxide 250 mg tabs, 1 tab before meals and at bedtime
Calcium 500 mg with Vit D, 1 tablet up to three time daily
Do not take calcium at same time as thyroid dose
Vitamin C 1000 mg, 1 tablet before meals
Vitamin E 400 IU, 1 cap twice a day
Cinnamon caps 500mg, 2 caps before meals and at bedtime for
Cholesterol, metabolic syndrome, diabetes, weight control, fatigue
Check with your Doctors before trying any of these !!!
Credible Resources and Information About
Supplements, Herbal Products, Their Safety and
Effectiveness
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http://efaeducation.nih.gov for immune omega balance in diet
www.nih.gov for basic answers to supplements
www.ajcn.org for nutritional frontiers
www.nutritiondata.com/facts for individual food omega-3:6 facts
www.jacn.com for nutrition policies
www.nci.gov for cancer supplements
http://lpi.oregonstate.edu/ for new science in Nutrients
www.consumerlab.com Products / Nutrients reports (subscription)
http://medicalcenter.osu.edu/patientcare/hospitalsandservices/primary
care/im/?CFID=228520&CFTOKEN=20456422 for updates and
Classes on Integrative Medicine
• www.naturalstandard.com for evidence-base CAM (subscription)
– Free Trial Logon for NaturalStandard for October is
October
– Password for October is
tomorrow
Chicken Breast Roasted
Nutritional Facts for Chicken, 1 unit breast
broilers / fryers, breast, meat and skin, cooked, roasted:
• Total omega-3 fats (est)
63.8 mg
• Total omega-6 fats (est) 818 mg
– Omega 6:3 ratio
–
–
–
–
–
–
13:1
Total Fat
4.5 grams
Saturated Fat
1.3 grams
Fat Calories
= 607
Carbohydrate Calories
= 127
Protein Calories
= 120
Carb
0.0%, Fats
40.7%, Protein 73.5%
• Healthy Foods approach 6:3 ration of 2:1
http://www.nutritiondata.com
Peanuts
Nutritional Facts for Peanuts,
all types, dry-roasted, without salt, 1 cup:
• Total omega-3 fats (est)
•
Total omega-6 fats (est)
44 mg
22,910 mg
– Omega 6:3 ratio
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–
–
–
–
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Total Fat
Saturated Fat
Fat Calories
Carbohydrate Calories
Protein Calories
Carb
15%, Fats
520:1
218 grams
25.2 grams
= 607
= 127
= 120
71%, Protein 14%
• Healthy Foods approach 6:3 ration of 2:1
http://www.nutritiondata.com
Potato Chips With Olestra
Nutritional Facts for Potato Chips:
• Total omega-3 fats (est)
•
Total omega-6 fats (est)
With
mg
818 mg
without Olestra
– Omega 6:3 ratio
–
–
–
–
–
–
Total Fat
Saturated Fat
Fat Calories
Carbohydrate Calories
Protein Calories
Carb
0.0%, Fats
13:1
4.5 grams
1.3 grams
= 607
= 127
= 120
40.7%, Protein 73.5%
• Healthy Foods approach 6:3 ration of 2:1
http://www.nutritiondata.com
Avocado, Pureed
Nutritional Facts, 1 cup avocado pureed:
• Total omega-3 fats (est) 221 mg
•
Total omega-6 fats (est) 3,396 mg
– Omega 6:3 ratio
–
–
–
–
–
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Total Fat
Saturated Fat
Fat Calories
Carbohydrate Calories
Protein Calories
Carb
6%, Fats
15:1
29.5 grams
4.3 grams
= 247
= 61.5
= 13.5
45%, Protein 8 %
• Healthy Foods approach 6:3 ration of 2:1
http://www.nutritiondata.com
Food Choices to Balance Omega 3:6
Worse Choices
Omega-3 Fish Oil
Better Choices
Best Choices
Foods loaded Omega-6
Needed to Fix Each Choice
Less Omega-6
Least Omega-6
safer foods
safest foods
Foods High in n-6 Plant Oil
EPA/DHA fish oil needed to balance
No extra EPA/DHA required
Provides EPA/DHA
Chicken
Turkey
Farm-fed Fish, Atlantic Salmon
Peanuts ( per 12 peanuts )
Peanut Butter ( per 1 tsp )
capsule equals 300 mg EPA/DHA
900 mg of EPA/DHA
900 mg of EPA/DHA
900 mg of EPA/DHA
900 mg of EPA/DHA
900 mg of EPA/DHA
Pork
Beef
White fish
Nut Butters, Lard
Nut Butters, Lard
Lamb
Omega-3 Eggs
Pacific Wild Salmon
Butter
Butter
All Chips ( per 7 oz bag )
Potato
Veggie
Extruded
Nachos
Baked Chips
1800
1800
1800
1800
1800
1800
mg
mg
mg
mg
mg
mg
of EPA/DHA
of EPA/DHA
of EPA/DHA
of EPA/DHA
of EPA/DHA
of EPA/DHA
Popcorn
Popcorn
Popcorn
Popcorn
Popcorn
Popcorn
Fruits
Fruits
Fruits
Fruits
Fruits
Fruits
&
&
&
&
&
&
Veggies
Veggies
Veggies
Veggies
Veggies
Veggies
Taco Shells ( per taco shell )
900 mg of EPA/DHA
Wraps
without Covering or Shell
Granola ( per ounce of plain )
Granola bar ( for each plain bar )
Trail Mix w/o nuts ( per ounce )
900 mg of EPA/DHA
900 mg of EPA/DHA
900 mg of EPA/DHA
Corn cereals
Corn snacks
Corn, Rice, Nuts-Dry Roasted
Rice products
Rice products
Fruits & Veggies
Problem Foods
Why The Concerns
Alternatives
Better Alternatives
Avoid all Flax products
Flax = 0.2% conversion to EPA
Thus, 99.8% leads to disease
Magnesium Oxide
Magnesium Oxide
Limit Soy
If using as a Protein Source
If using as a Phytoestrogen
May Cause Infertility
Breast & Prostate Cancers
Nuts- dry roasted
Natural Estrogen
Omega-3 Eggs
Omega-3 Eggs
www.nutritiondata.com/facts
For Individual Food Choices
http://efaeducation.nih.gov
For Daily Diet Analysis
www.naturalstandard.com
Evidence Based CAM Reviews
October / tomorrow
Just the Beginning of Opportunities
Ayurveda
Roles of Inflammation
Nuclear Factor-kappa B
CURCUMIN (Turmeric: Curcuma longa)
Ashwagandha (Withania somnifera)
Slides From Hari Sharma, MD
Ayurveda Practitioner
The Ohio State University
Center for Integrative Medicine
CURCUMIN (Turmeric: Curcuma longa)
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Prevents breast cancer spread in mice xenograft model.
Interferes with proliferation of skin melanoma cells.
Sensitizes cells to radiation and chemotherapy.
Suppresses proliferation of wide variety of tumor cells – Down regulates:
– Transcription factor.
– Expression of COX-2, LOX, cell surface adhesion molecules, protein
kinase, etc.
• Anti-mutagenic effect.
• Suppresses nuclear factor kappa beta (regulates inflamm. & immune
response).
• Blocks estrogen-mimicking chemical.
• Anti-inflammatory – Inhibits cyclooxygenase-2 (COX-2), lipoxygenase
(LOX), thromboxane, leukotrienes, interleukin-12, hyaluronidase.
• Potent antioxidant (prevents damage to DNA and genes).
• Promotes normal cell cycle.
References: Clin Cancer Res 2005;11(20):7490-7498
• Inhibits angiogenesis.
Anticancer Res 2003;23:363-398
J Ethnopharmacol 1993;38(2-3):113-119
• Anti-thrombotic.
Indian J Med Res 1971;59(8):1289-1295
• Hepatoprotective.
Blood 2003;101:1053-1062
J Cell Biochem 2003;89:1-5
Mol Cancer Ther 2003;2:95-103
Pharmacol Res 2003;47:113-140
Anticancer Res 2001;21:873-878
Oncogene 2004;26:1599-1607
ASHWAGANDHA (Withania somnifera)
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Anti-tumor and radiosensitizing properties
Adaptogenic
Rasayana – General and Medhya
Increases quality and quantity of Ojas
Clears Ama from channels
Immune-enhancer
Anti-cancer
Prevents angiogenesis
References: •Food and Chem Toxicol 2004;42:2015-2020
•Indian J Expt Biol 1992;30:169-172, 1996;34:927-932, 1993;31:607-611
•Med Sci Res 1987;15:515-516
•Cancer Lett 1995;95:189-193
•Acta Oncol 1996;35:95-100
•Angiogenesis 2004;7:115-122
•J Ethnopharmacol 2001;75:165-168