1. The Anti-Inflammatory Diet and Disease

2. Evolution in the United States

5. Alternative Food Pyramid

6. New US Food Advice

7. Food Business Intensive chicken and cow farming
Relies on cheap raw materials such as corn, soy, wheat, sugar, palm oil
antibiotics
fertilizers
GMOs
Pesticides
Preservatives

8. Changing Food

11. Inflammation: A common final pathway
Cardiovascular disease
Cancer
Neurodegenerative disease
Autoimmune disease DM
Obesity

12. What is Inflammation?
Complex orchestration of pro-inflammatory and anti-inflammatory events
Mediated by eicosanoids
Prostaglandins, thromboxanes, leukotrienes,
Hydroxylated fatty acids, lipoxins, prostamides, isoprostanoids
Silent inflammation vs. painful inflammation

13. Phases of inflammation
Initiating event-
Pro-inflammatory attack response/cellular destruction
Anti-inflammatory healing response/Cellular rejuvenation

20. Δ6-Desaturase Omega 6 Fatty Acid Omega 3 Fatty Acids
(Linoleic Acid)
Omega 3 Fatty Acids
(alpha-linolenic acid)
Δ6-Desaturase
Gamma-linolenic acid
(GLA)
Evening Primrose Oil
Borage Oil
Black Current Oil
Eicosapentaenoic Acid
(EPA)
COX
Lipoxygenase
Δ5-Desaturase
Arachidonic Acid
Prostaglandins
PGE1, PGE3
(Favorable)
Less Inflammatory
Leukotrienes
Cyclo-oxygenase
(COX)
Lipoxygenase
Docosahexaenoic acid
(DHA)
Prostaglandins (PGE2)
(Inflammatory)
Leukotrienes

21. Leukotriene Inhibitors: COX II Inhibitors:
Arachidonic Acid
(in cell membrane)
Phospholipase A-2
Steroids
Free AA
Colchicine
Aspirin
Cyclo-oxygenase
Pathway
Lipoxygenase
Pathway
Sulfasalazine
NSAIDs
Leukotriene Inhibitors:
Accolate, Singulair, Zyflo
COX II Inhibitors:
Celebrex, Vioxx, Mobic
Prostaglandins
&
Thromboxanes
Leukotrienes

22. FAT IS GOOD!! Depending on what kind….
Omega 3 fatty acids (fish oils-EPA, DHA; plant sources -ALA)
Mono-unsaturated fats (canola and olive oils)
Decreased fat consumption since the 1960’s associated with obesity epidemic—CHO intake has increased dramatically
Glycemic index/glycemic load

23. Types of fats Saturated: beef and other animal fats, dairy
Monounsaturated (omega-9):
olive and canola oils

24. Polyunsaturated fats (essential FA’s):
Omega-6: Linoleic acid (LA)--vegetable oils, seeds, nuts
Gamma Linolenic Acid (GLA)--borage and primrose oil
Arachidonic Acid(AA)--meat products
— Omega-3: Alpha Linolenic Acid (ALA)--legumes, leafy vegetables, flax, flaxseed and canola oils) Eicosopentanoic acid (EPA)-fish oil Docosahexanoic acid (DHA)--fish oil, breast milk

25. Avoid or Reduce Trans-fatty acids BAD! Omega-6 fatty acids Margarine
Corn oil, cottonseed oil, grapeseed oil, peanut oil, safflower oil, sesame oil, soybean oil, sunflower oil, partially hydrogenated oils
Any product with long shelf life (crackers, pastries, chips)

29. How much Omega-3 fats do you need?
Strive for Omega 6: Omega-3 ratio of 4:1 (usual SAD (Standard American Diet) 16:1
Maintenance 2.5 g/d
Improve hear function 5 g/d
Treat chronic pain 7.5 g/d
Treat neurological disease >10g/d
Sears, The Anti-Inflammation Zone, 2005

30. Types of Fish Oil Fish Contamination with PCB, dioxin, and Hg
Higher in AA than fish oil
Crude fish oil
High contamination
Health food grade
Still some contamination with PCB’s and dioxins
Ultra-Refined EPA/DHA Concentrates
Removal of PCB’s and other toxins
Can be used in high doses (“weapons grade”)

31. Requirements for an Ultra-refined EPA/DHA concentrate
Total long-Chain Omega-3 >60%
Dioxins< 1 ppt
Mercury <10 ppb
PCB’s<30 ppb

32. What is an anti-inflammatory diet?
Lose fat
Eat small meals
Have some protein at every meal but reduce red meat and dairy (Avoid charred, overcooked foods)
Cold water fish (salmon, mackerel, sardines, herring)
Eat primarily fruits and vegetables
Leafy green vegetables, nuts, flaxseeds or oil
Take your fish oil

33. Anti-inflammatory Lifestyle
Exercise
Quit smoking
Weight loss
Stress management
Vagal nerve stimulation via abdominal breath work
Treatment of depression
Social support

34. Onions/ Apples Quercetin
Arachidonic Acid
(in cell membrane)
Phospholipase A-2
Onions/ Apples Quercetin
Turmeric Curcumin
Rosemary Ursolic acid
Red Pepper Capsaicin
Ginger
Onions/Apples Quercetin Turmeric Curcumin, Feverfew Perthenolides
Free AA
Onions/Apples Quercitin
Cyclo-oxygenase
Pathway
Lipoxygenase
Pathway
Boswellia Bosellic Acid
Rosemary Carnosol
Prostaglandins
&
Thromboxanes
Leukotrienes

35. Mediterranean Diet
More tolerable than low fat diets and associated with improved long term weight loss (McManus 2001)
Risk reduction of death from CAD = 0.67 compared to usual AHA diet (Trichopoulou et al, 2003)

37. Something fishy?

38. American Heart Association Recommendations
·   Healthy individuals should take two servings of fish(salmon, sardines, tuna, mackerel, trout) weekly along with flaxseed, canola, and soybean oil
·  Patients with CHD should consume higher doses, 1 g/d of EPA + DHA, which may require fish oil supplementation
Utilize complex carbohydrates, higher in fiber and lower in glycemic load to reduce risk of CHD
AHA Recommendations: Intake of omega-3 fatty acids. Women’s Health in Primary Care (1): (Consensus opinion)
Hu F, Willett W.Optimal diets for prevention of coronary heart disease. JAMA. 2002;288: {Systematic review}
       

39. How intake of Omega-3 Fatty Acids is helpful
Stabilization of atherosclerotic plaques
Reduction of inflammation by mediation prostaglandin synthesis pathway
Improved ratio of omega-3 to omega 6 FA reduces arachidonic acid and pro-inflammatory, pro-platelet aggregatory cytokines
Enhances PGE1 and PGE 3 and less inflammatory leukotrienes(see diagram)
Thies F, et al. Association of n-3 polyunsaturated fatty acids with stability of atherosclerotic plaque: RCT, Lancet, 2003;361:477-85
Harper, Beyond the Mediterranean Diet: the Role of Omega-3 Fatty Acids in the Prevention of CAD, Prev Cardiol, 2003;6(3):134-46

40. A word about… Glycemic Index (rate of absorption of glucose)
Glycemic Load (ratio between GI and CHO content)

41. High Glycemic/Load Foods Increase:
Inflammation
Risks of heart disease, diabetes
Examples include:
White bread, glucose (GI= 100)
Potatoes, white rice
Pastries, white flour
Sweets, carbonated soft drinks

43. Lower GI/GL reduces risk
Whole grains
Fruits
Vegetables
Legumes
Or…mixing high GI/GL foods with those with lower GI/GL

46. Superfoods to decrease inflammation
BEANS
Pinto, navy, Great Northern, lima, garbanzo(chickpeas), black beans, lentils, green beans, sugar snap peas, and green peas
BLUEBERRIES
Purple grapes, cranberries, boysenberries, raspberries, strawberries, currants, blackberries, cherries, and all other varieties of fresh, frozen, or dried berries
BROCCOLI
Brussel sprouts, cabbage, kale, turnips, cauliflower, collards, bok choy, mustard green, Swiss chard
OATS
Wheat germ, ground flaxseed, brown rice, barley, wheat, buckwheat, rye, millet, bulgur, wheat, amaranth, quinoa, triticale, kamut, yellow corn, wild rice, spelt, couscous
ORANGES
Lemons, white, and pink grapefruit, kumquats, tangerines, limes
PUMPKIN
Carrots, butternut squash, sweet potatoes, orange bell peppers

47. Superfoods to decrease inflammation
TOMATOES
Red watermelon, pink grapefruit, Japanese persimmons, red-fleshed papaya, strawberry, guava
TURKEY
Skinless chicken breast
WALNUTS
Almonds, pistachios, sesame seeds, peanuts, pumpkin, and sunflower seeds, macadamia nuts, pecans, hazelnuts cashews
YOGURT
Kefir
SALMON
Alaskan halibut, canned albacore tuna, sardines, herring, trout, sea bass, oysters, and clams
SOY
Tofu, soymilk, soy nuts, edamame, tempeh, miso
SPINACH
Kale, collard, Swiss chard, mustard greens, turnip greens, bok choy, romaine lettuce, orange bell peppers
TEA – GREEN OR BLACK

51. Healthy Food from Lidl/Aldi
Tinned wild salmon
Tinned cooked beans
Tinned Tuna
Organic potatoes
Organic/Free Range Eggs
Sweet Potatoes
Large natural live yoghurt
Organic cheddar cheese
Mussels , cod, smoked makerel
Sundried tomatoes (though have preservative)
Avocados, bag €2
Organic minced beef
Brown Rice
Whole wheat pasta
Almonds, other nuts
Brown pitta bread
Nuts in shell
Free range chicken
Organic apples, oranges
Tinned tomatoes, passata
Fair trade organic bananas
Olives
Organic porridge oats
Range fruit and veg

52. Shopper’s Guide to Pesticides in Produce
The Dirty Dozen list
1. Apples (98% had pesticide residue) Celery 3. Strawberries 4. Peaches 5. Spinach 6. Nectarines (imported) Grapes (imported) Sweet bell peppers 9. Potatoes 10. Blueberries 11. Lettuce 12. Kale/collard greens
The Clean 15 list
1. Onions 2. Corn 3. Pineapples 4. Avocado 5. Asparagus 6. Sweet peas 7. Mangoes 8. Eggplant 9. Cantaloupe (domestic) 10. Kiwi 11. Cabbage 12. Watermelon 13. Sweet potatoes 14. Grapefruit 15. Mushrooms
Researchers at the Environmental Working Group gathered data from the USDA and FDA (Food and Drug Administration) from 2000 to They ranked fruit and vegetables according to a composite score, which weighed six factors equally.
These factors reflect how many pesticides were detected in testing, and at what levels. The majority of samples were washed and peeled before testing, reflecting what chemicals people might be ingesting when they eat them.
The Apple was found to be the most contaminated product, jumping from third to first place, knocking celery back into second. In over 700 samples tested, 98% of the apples were found to have pesticide residues in them. Thirty-three unapproved pesticides were detected on 44% of cilantro samples tested; the highest percentage of unapproved pesticides in any tested produce since Coriander refers to the seeds (fruits) while cilantro refers to the leaves of the Coriandrum sativum plant.
Ref: Article 13 Jun-11: The report notes: You should not avoid eating fruit and vegetables, the authors of the report stress. The health benefits of eating five servings of fruit and vegetables each day far outweigh any health risks posed by their pesticide content. US health authorities insist that all pesticide contents in the fruit and vegetables tested were within recommended limits.

53. SUPERFOOD #7: WILD SALMON
Lowers the risk of heart disease and cancer.
The more omega-3 fish oils you eat; the lower your blood pressure
In one study eating the oil in fish cut cancer incidence by over 60%
4x weekly  risk for and progression of AMD
Studies suggest that fish consumption is associated with a lower risk for depression, violent behavior, Alzheimer’s disease, Attention Deficit Disorder, Atrial fibrillation.
SPF nutrients
TRY TO EAT Wild salmon, halibut, sardines, etc.  2 to 4 times per week

54.   SUPERFOOD #13: WALNUTS
A handful a day can cut your risk of cardiovascular event by as much as 51%
Two tablespoons of peanut butter 5 times/week cuts risk of type II diabetes by 20%
Along with tea, the easiest way to improve your heath
 Risk/progression of AMD
SPF nutrients
TRY TO EAT a handful of nuts, five times a week
* Skip the salt and added oils

55. WALNUT SIDEKICKS Almonds Pistachios Sesame Seeds Peanuts
Pumpkin and Sunflower Seeds
Macadamia Nuts
Pecans
Hazelnuts
Cashews

56. 10 Foods to Avoid Donuts White Bread
Bread with < 3 grams fiber/ slice
Soda
Stick Margarines
White Pasta
Full Fat Dairy
Movie Theatre Popcorn
Luncheon Meats
Sugar Coated Cereal