The Impact of Vitamins and Supplements Presented by Georgia Tetlow, MD March 13, 2013

2Georgia Tetlow, MD - Philadelphia Integrative Medicine – The Impact of Vitamins and Supplements

Disclosure/Disclaimer Disclaimer Information is intended for educational purposes only, not as medical or psychological advice or treatment Nothing that isnt disclosed –I have an online store that benefits educational programs –Monthly educational webinars 3Georgia Tetlow, MD - Philadelphia Integrative Medicine – The Impact of Vitamins and Supplements

Integrative Medicine Key research pearls Vitamin D Omega 3s Dairy Soy Lifestyle choices –Smoking –Weight –Alcohol –Green tea –Emotional/spiritual health, social connection, mindfulness Georgia Tetlow, MD - Philadelphia Integrative Medicine – Agenda The Impact of Vitamins and Supplements

Integrative Medicine Combines best of conventional medicine –Cancer fighting drugs, therapies, surgery With additional safe, effective approaches, treatments Evidence-based = standard for medicine JUST GOOD MEDICINE –Need provider who is open to all the evidence and who is trained 5Georgia Tetlow, MD - Philadelphia Integrative Medicine – The Impact of Vitamins and Supplements

Integrative Medicine continued… Biological interventions –Vitamins and Supplements –Whole Food diet Mind-Body Medicine Alternative Medical Systems –Traditional Chinese Medicine, Ayurveda, Homeopathy Energy Medicine –Acupuncture Hands-On medicine 6Georgia Tetlow, MD - Philadelphia Integrative Medicine – The Impact of Vitamins and Supplements

Integrative medicine honors the innate ability of the body to heal, values the relationship between patient and physician, and integrates complementary and alternative medicine to support the organism and facilitate healing. ---Victoria Maizes, MD, Executive Director University of Arizona Center for Integrative Medicine Integrative Medicine 7Georgia Tetlow, MD - Philadelphia Integrative Medicine – The Impact of Vitamins and Supplements

Why Integrative Medicine? Patient at the center Addresses the full range of physical, emotional, mental, social, spiritual and environmental influences Personalized strategy that considers the patients unique conditions, needs and circumstances Health as a state of complete physical, mental and social wellbeing and not merely the absence of disease or infirmity.* *Constitution of the World Health Organization Basic Documents, Forty-fifth edition, Supplement, October Georgia Tetlow, MD - Philadelphia Integrative Medicine – The Impact of Vitamins and Supplements

About Georgia Tetlow, MD Graduate Fellow, University of Arizona Center for Integrative Medicine CEO, Founder of Philadelphia Integrative Medicine Clinical Assistant Professor of Rehabilitation Medicine Thomas Jefferson Medical College Yoga Teacher for 20 years Mindfulness teacher 9Georgia Tetlow, MD - Philadelphia Integrative Medicine – The Impact of Vitamins and Supplements

Georgia Tetlow, MD - Philadelphia Integrative Medicine – The Impact of Vitamins and Supplements

Your Plate 11Georgia Tetlow, MD - Philadelphia Integrative Medicine – The Impact of Vitamins and Supplements

Your Plate No one food ingredient –Eat from the rainbow –Broccoli/cabbage family Indole-3-carbinol –Supports immune system, reduces cellular damage balances hormones –Collards, mustard greens, turnips, cabbage, broccoli, kale, cabbage, cauliflower and Brussels sprouts Food choices for healthy weight 5 or more servings of vegetables and fruit daily 12Georgia Tetlow, MD - Philadelphia Integrative Medicine – The Impact of Vitamins and Supplements

Antioxidants Reduce inflammatory and toxic cell mediators –NFkB, Il-6, Il-8 Donate electrons to electron-deficient free radicals –Neutralize them! –Cells and DNA protected, help prevent cancer 13Georgia Tetlow, MD - Philadelphia Integrative Medicine – The Impact of Vitamins and Supplements

Why Supplements, Anyway? –Strengthen the immune system –Reduce inflammation –Reduce free radicals –Reduce DNA damage that leads to cancer 14Georgia Tetlow, MD - Philadelphia Integrative Medicine – The Impact of Vitamins and Supplements

Pearl 1 Whole foods and healthy diets should be the primary approach in designing studies to test nutrition-cancer associations Experts believe components in many foods, especially fruits and vegetables, act synergistically to reduce cancer risk 15Georgia Tetlow, MD - Philadelphia Integrative Medicine – The Impact of Vitamins and Supplements

Pearl 2 Seek products that most closely mimic the forms that nutrients naturally take in food, such as vitamin E in the form of mixed tocopherols and tocotrienols or vitamin A in the form of mixed carotenoids (vs. β-carotene alone or vitamin A palmitate) Dosage, duration and quality matter 16Georgia Tetlow, MD - Philadelphia Integrative Medicine – The Impact of Vitamins and Supplements

Pearl 3 The greatest benefit from taking supplements of any kind seems to be for those who are deficient in a particular nutrient "Diet, anthropometric measures and prostate cancer risk: a review of prospective cohort and intervention studies." Dagnelie PC, et al. BJU international 93(8): May, Georgia Tetlow, MD - Philadelphia Integrative Medicine – The Impact of Vitamins and Supplements

Pearl 4 Genetic differences contribute to individual variation in response to foods and nutrients Genetics influence the rates of absorption, metabolism and sites of action of individual constituents Unmeasured, uncharacterized gene variation likely explains inconsistent findings across studies and across different populations Milner, JA. "Incorporating basic nutrition science into health interventions for cancer prevention. The Journal of nutrition 133(11 Suppl 1):3820S-3826S Nov, Georgia Tetlow, MD - Philadelphia Integrative Medicine – The Impact of Vitamins and Supplements

Vitamin D3 (Cholecalciferol) Hormone Controls phosphorus, calcium and bone metabolism and neuromuscular function The only vitamin the body can manufacture from sunlight More and more people deficient due to indoor living, heliophobia and sunscreen use 19Georgia Tetlow, MD - Philadelphia Integrative Medicine – The Impact of Vitamins and Supplements

Approx. 1 billion* may be Vitamin D3 deficient Dark skin, obesity, heredity may hinder production Elderly may need more D3 (decreased skin, renal synthesis) Test: 25 (OH) Vitamin D –<30 ng/mL insufficient –45 ng/mL adequate –60-80 ng/mL more optimal *world wide 20Georgia Tetlow, MD - Philadelphia Integrative Medicine – Vitamin D3 (Cholecalciferol) continued… The Impact of Vitamins and Supplements

Vitamin D3 continued… 21Georgia Tetlow, MD - Philadelphia Integrative Medicine – The Impact of Vitamins and Supplements

Fats, Omega 3s Cook with Olive Oil FISH OIL (Omega 3s fatty acids) –modulate estrogen metabolism, estrogen receptors –Must be triglyceride –1-3 grams daily, with food, discuss with doctor –mercury/toxin free –many benefits –thins the blood 22Georgia Tetlow, MD - Philadelphia Integrative Medicine – The Impact of Vitamins and Supplements

Fish Oil Slows Tumor Growth Hardman, J. Nutr. 132:3508S-3512S, Georgia Tetlow, MD - Philadelphia Integrative Medicine – The Impact of Vitamins and Supplements

Dairy Over 36 case-control plus 10 prospective cohort studies showed inconsistent findings Recent pooled analysis of American and European cohort studies found no association with dairy and postmenopausal breast cancer Moorman PG, et al. "Consumption of dairy products and the risk of breast cancer: a review of the literature." Moorman PG, et al. The American journal of clinical nutrition 80(1):5-14 Jul, 2004 Missmer SA, et al. "Meat and dairy food consumption and breast cancer: a pooled analysis of cohort studies." International journal of epidemiology 31(1):78-85 Feb, Georgia Tetlow, MD - Philadelphia Integrative Medicine – The Impact of Vitamins and Supplements

Dairy continued… Dietary calcium and low-fat dairy products associated with a moderately lower risk of postmenopausal breast cancer compared with women with lowest intake levels Supplemental calcium or higher levels of total calcium (diet plus supplements) were not related to overall breast cancer risk Moorman PG, et al. "Consumption of dairy products and the risk of breast cancer: a review of the literature." Moorman PG, et al. The American journal of clinical nutrition 80(1):5-14 Jul, 2004 Missmer SA, et al. "Meat and dairy food consumption and breast cancer: a pooled analysis of cohort studies." International journal of epidemiology 31(1):78-85 Feb, Georgia Tetlow, MD - Philadelphia Integrative Medicine – The Impact of Vitamins and Supplements

Soy Soy beans and fermented soy bean products such as tofu, tempeh and soymilk Case-control studies support a protective effect of soy in the breast –case-control study among Korean women stratified by menopausal and hormone receptor status of the tumors significant 64% reduction in breast cancer risk (95% CI 0.20, 0.64) with higher soy consumption Cho YA, et al. "Effect of dietary soy intake on breast cancer risk according to menopause and hormone receptor status." European journal of clinical nutrition 64(9): Sep, Georgia Tetlow, MD - Philadelphia Integrative Medicine – The Impact of Vitamins and Supplements

Soy continued… This association may not only result from higher intake of soy but also in utero and early exposure and pre- pubertal and adolescent exposure during mammary gland development In addition, soy intake among Asian women is strongly correlated with increased consumption of fruit and vegetables Butler LM, et al. "A vegetable-fruit-soy dietary pattern protects against breast cancer among postmenopausal Singapore Chinese women." The American journal of clinical nutrition 91(4): Apr, Georgia Tetlow, MD - Philadelphia Integrative Medicine – The Impact of Vitamins and Supplements

Soy Conclusions Moderate amounts in diet are safe and likely protective Half serving a day servings per day May not be advisable in advanced stage breast cancer as early evidence from cell culture studies suggest possible proliferative effect in the setting of metastatic carcinoma Messina M, et al. Can clinicians now assure their breast cancer patients that soy foods are safe? Women's health (London, England) 6(3):335-8 May, 2010 Martínez-Montemayor, et al. "Individual and combined soy isoflavones exert differential effects on metastatic cancer progression." Clinical & experimental metastasis 27(7): Oct, Georgia Tetlow, MD - Philadelphia Integrative Medicine – The Impact of Vitamins and Supplements

Cancer: Factors Within Your Control Smoking Weight control/Exercise Diet –Alcohol –(Fruits/vegetables, best fats, certain cancers: hormones in beef and milk) –Green tea Omega 3 Fatty Acids Vitamin Dget tested! Healthy immune systememotional and spiritual health, social connection 29Georgia Tetlow, MD - Philadelphia Integrative Medicine – The Impact of Vitamins and Supplements

Breast cancer prevention: 1 drink daily or less Georgia Tetlow, MD - Philadelphia Integrative Medicine – The Impact of Vitamins and Supplements

Mind-Body Interventions -Mindfulness 31Georgia Tetlow, MD - Philadelphia Integrative Medicine – The Impact of Vitamins and Supplements

Mindfulness Literature Witek-Janusek, et al (2008). Effect of mindfulness based stress reduction on immune function, quality of life and coping in women newly diagnosed with early stage breast cancer. Brain, Behavior, and Immunity, 22(6), Carlson, et al (2007). One year pre-post intervention follow-up of psychological, immune, endocrine and blood pressure outcomes of mindfulness-based stress reduction (MBSR) in breast and prostate cancer outpatients. Brain, Behavior, and Immunity, 21(8), Georgia Tetlow, MD - Philadelphia Integrative Medicine – The Impact of Vitamins and Supplements

Integrative medicine addresses the root causes of illness and suffering. These root causes involve many aspects of a persons life, including the physical, but also the psychosocial, emotional, and spiritual dimensions as well. --Dean Ornish, MD Founder and Director of the Preventive Medicine Research Center 33Georgia Tetlow, MD - Philadelphia Integrative Medicine – The Impact of Vitamins and Supplements

Return to Art of Medicine Mind, Body and Spirit Fight cancer, but focus is on health and returning to health Power of life style choices! –Understand root causes 34Georgia Tetlow, MD - Philadelphia Integrative Medicine – The Impact of Vitamins and Supplements

Philadelphia Integrative Medicine offers a comprehensive approach to health and healing which recognizes the whole person, and champions self-care for health, illness recovery and prevention through education, inspiration and empowerment. Mission 35Georgia Tetlow, MD - Philadelphia Integrative Medicine – The Impact of Vitamins and Supplements

4wholeness.com An online community and resource for women with breast cancer who want information about how to integrate natural and holistic therapies with allopathic cancer treatment. If the HPERLINK above doesnt work, copy and paste this link into your Internet browser:

Upcoming Webinar Detoxify Mind & Body – Today! Friday, April 5, 2013 (12-1pm) –Detoxify your mind Focus on your purpose Address emotional blocks that undermine energy and reduce hope –Detoxify your body Learn how the elimination diet profoundly detoxifies and potentially addresses hardest-to-treat symptoms Webinars: less than $20 37Georgia Tetlow, MD - Philadelphia Integrative Medicine – The Impact of Vitamins and Supplements

Thank you! Georgia Tetlow, MD - Philadelphia Integrative Medicine –