C212                  DIET TO PROMOTE HEALTH, PREVENT DISEASE                  WARREN KARP, PHD, DMD                  FRID...
Chicago Dental Society                                                     MWM & REGIONAL MEETING COURSE EVALUATIONSpeaker...
Please Note                                                                       In order to have the most complete and u...
So, here’s what’s real when it                                                  Nutrition is a SCIENCE thatcomes to nutrit...
Guess what!                                      You don’t work by simple                                      diffusion! ...
Reflexive                                    Reflective               Reflexive                         ReflectiveIs muscl...
Protein                                            Protein                                                      Most guide...
Not all proteins are created equal! Biological Value of Proteins                       Biological Value of Proteins       ...
Complementary Proteins                                               Vegetarians                                          ...
Smoked and Charcoal-broiled           Foods  It is prudent to minimize these.                                           Th...
Fiber is not a molecule!   High Fiber Carb Advantage                                                       It is a family ...
Vitamins and Minerals                                              There are no recommendations from any major health     ...
What about this idea that vitamins                                                                          Free Radical T...
Tocopherol Acetate                                       The form in vitamins.                          Free Radical Theor...
Beta Carotene Supplements and Lung Cancer                 Total Fat   Smokers who take beta-carotene   supplements have hi...
Saturated Fat                                             Lean Bacon?No more than 6-10% of total calories                 ...
Monounsaturated Fat               Is eating chocolate really healthy?                                           The main f...
American Heart AssociationRecommendations for Omega-3 Fatty Acids                                                         ...
Total CarbohydratesWhat’s all the fuss about carbs?          Complex carbohydrates                                        ...
Carbohydrates                                                          CaloriesCarbohydrates are not considered essential ...
MacronutrientsCaloric Distributions/Total Amount                                         THE DIETTotal Fat                ...
THE DIET                                                                  IN A NUTSHELL                                   ...
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  1. 1. C212 DIET TO PROMOTE HEALTH, PREVENT DISEASE WARREN KARP, PHD, DMD FRIDAY, FEBRUARY 22DISCLAIMER: This work, audio recordings and the accompanying handout, are the intellectual property of the clinician, and permission hasbeen granted to the Chicago Dental Society, its members, successors and assigns, for the unrestricted, absolute, perpetual, worldwide rightto distribute solely as an educational material at the scientific program being presented at the 2011 Midwinter Meeting. Permission has beengranted for this work to be shared for non-commercial education purposes only. No other use, including reproduction, retransmission in anyform or by any means or editing of the information may be made without the written permission of the author. The Chicago Dental Societydoes not assume any responsibility or liability for the content, accuracy, or compliance with applicable laws, and the Chicago Dental Societyshall not be sued for any claim involving the distribution of this work.
  2. 2. Chicago Dental Society MWM & REGIONAL MEETING COURSE EVALUATIONSpeaker: Date:Subject: Number of attendees:PLEASE RATE YOUR SPEAKER AS TO: Excellent Good Fair Poor N/A • Subject selected................................. 4 3 2 1 0 • Timeliness of subject ......................... 4 3 2 1 0 • Comprehensiveness........................... 4 3 2 1 0 • Meeting your expectations ................ 4 3 2 1 0 • Content level...................................... 4 3 2 1 0 • Delivery .............................................. 4 3 2 1 0 • Voice quality....................................... 4 3 2 1 0 • Holding your interest ......................... 4 3 2 1 0 • Appropriate audiovisuals ................... 4 3 2 1 0 • Effective audiovisuals ........................ 4 3 2 1 0 • Overall evaluation of speaker ............ 4 3 2 1 0 • Overall evaluation of program........... 4 3 2 1 0Should this speaker be invited for future meetings? Yes q No qWhat topics of interest would you like to see covered in the future?Comments (use reverse if you need additional space):Name (requested but not required—please print):RETURN EVALUATION CARD TO: DO NOT FOLD CARD. FOR CDS PERMANENT FILES.Chicago Dental SocietyAloysius F. Kleszynski, DDS401 N. Michigan Ave., Suite 200, Chicago, IL 60611-5585
  3. 3. Please Note In order to have the most complete and up-to-date version of this handout, you need to go to the website that I created for the 2013 Chicago The Diet to Promote Health Midwinter Dental Meeting: and Prevent Disease https://sites.google.com/site/2013chicagomidwinter/ On this website, you will find the updated versions of all my lectures, in powerpoint format. In addition, you will find links to some of my other websites and to my Facebook page. Warren B. Karp, Ph.D., D.M.D. Thanks, WBK Professor Emeritus Georgia Health Sciences University wkarp@georgiahealth.edu Malnutrition MalnutritionOvernutrition Undernutrition Overnutrition Undernutrition Industrialized 3rd World Signs Signs Too Much, Too Much Too Few, Too Few Obesity Sore mouths, skin Calories Macronutrients CV Disease Anemias Fat Vitamins High Blood Pressure Lab Tests Salt Minerals Lab Tests Serum Albumin Sugar Diseases LDL, HDL, TG Nitrogen Balance Cholesterol Scurvy Diet Immunity Tests Diseases Pellegra Restrict Fat Diet Heart Disease Beriberi Restrict Calories More Vitamins Stroke Specific patients Restrict Salt More Protein Diabetes Cancer Restrict Sugar More Fat ICU 1
  4. 4. So, here’s what’s real when it Nutrition is a SCIENCE thatcomes to nutrition. studies the nature and Heart Disease distribution of nutrients in food, Stroke/Alzheimer’s Disease their metabolic effects, and the Peripheral Vascular Disease effect of the diet on changes in Diabetes Hypertension the organism. Obesity Cancer Nutrition Science Evolves Too much fat is unhealthy. Starches are healthy Too much fat is unhealthy. Saturated fats are unhealthy. Polyunsaturated fats are healthy. Starches with fiber are healthy Too much fat is unhealthy. Saturated fats are unhealthy. Olive oil and other monounsaturated fats are healthy. Fish oil and other polyunsaturated fats are healthy. 2
  5. 5. Guess what! You don’t work by simple diffusion! You’d be dead if you An Example did. Homeostasis, which is a characteristic of living Protein Builds Big Muscles tissues, is a steady-state away from equilibrium. ExampleIf you want bigger muscles, all you Reflexive Thinkinghave to do is eat more protein??? Muscles are made out of protein. If I exercise, I tear some muscle fibers. If I am weightlifting to build bulk, I need extra protein in my diet. If I take protein supplements, I can build muscle better and repair muscle better. 3
  6. 6. Reflexive Reflective Reflexive ReflectiveIs muscle wasting a sign of protein In a normo-nourished person, is dietmalnutrition? directly responsible for muscle bulk andDoes supplementing an undernourished composition?person with protein increase muscle How is protein digested and absorbed?mass? What controls protein synthesis insideDoes supplementing a normo-nourished muscle cells? Is it what I eat?or overnourished person with protein What is the point at which “studies”increase muscle mass? translate into clinical action? Muscle Cell Glutamate Glucosamine/Chondrotin Sulphate? Dehydrogenase Glutamine Effects of glucosamine, chondroitin, or placebo Blood SynthetaseGI Tract in patients with osteoarthritis of hip or knee: META-ANALYSIS. BMJ 2010;341:c4675 Albumin 10 trials in 3803 patients were included Tryptophan Binding Glutamine Conclusions Sites Urea Compared with placebo, glucosamine, Saturated? NH4+ Cycle chondroitin, and their combination do not Saturated? reduce joint pain or have an impact on Urea, NH4+ narrowing of joint space. Health authorities and health insurers should not cover the costs of these preparations, and new prescriptions Poop to patients who have not received treatment should be discouraged. 4
  7. 7. Protein Protein Most guidelines do not focus on protein QUANTITATIVELY. 10 - 15% of total calories Usually, guidelines focus on protein QUALITATIVELY; i.e, the majority of protein should come from low fat dairy, vegetables, fish, lean meat (occasionally), etc. What are Americans doing? Just the opposite!American Heart Association Position Function of Amino Acids Statement on High Protein Diets Body Fuel Stores? American Heart Association High Protein Diets Fat Carbs Proteins as triglycerides as glycogen *non-storageEating large amounts of high-fat foods for a Calories 140,000 2000 30,000-40,000sustained period raises the risk of coronary % Calories 80-85% 0% 15-20%heart disease, diabetes, stroke and severaltypes of cancer. People who cant useexcess protein effectively may be at higher Amino acids are not used asrisk of kidney and liver disorders, and an energy source, unless you are starving. Normally, onlyosteoporosis. about 10% of your ATP comes from amino acids. 5
  8. 8. Not all proteins are created equal! Biological Value of Proteins Biological Value of Proteins A protein that possesses a perfectThe relative nutritional value of individual balance of amino acids and absorbedproteins. 100% has a biological value of 100. The protein of an egg, egg white (albumin),Biological value is related to the aminoacid composition of proteins and the has the highest value and is considereddigestibility of proteins. a standard protein of reference.Biological Value of Proteins You can combine protein sources to produce a meal with “complete protein”. Egg Albumin 100.0 Whole egg 93.7 Generally, plant proteins have a lower Milk 84.5 biological value due to the presence of Fish 76.0 certain limiting amino acids. Beef 74.3 Soybeans 72.8 Plant Limiting Amino Acid Rice, polished 64.0 Corn Tryptophan, lysine Wheat, whole 64.0 Wheat Lysine Corn 60.0 Beans Methionine Beans, dry 58.0 6
  9. 9. Complementary Proteins Vegetarians Ovolactovegetarians are healthier Milk and cereal than most. Beans and rice Vegans are, generally, not as Corn and lima beans healthy and require supplements. – Vegan diets are particularly unhealthy for children. They lack calories, calcium, iron, B12. Red Beans and Rice – Children on vegan diets may be shorter than their peers. Succotash Relationship of Cancer to AnimalDietary Protein Recommendations Protein With respect to cancer, the major The recommended dietary allowance (RDA) for problem with animal protein is the protein decreases from 2.2 g/kg in 3-mo-old amount of total fat and the way the infants to 1.2 g/kg in 5-yr-old children and to protein is cooked. By cooking meat at 0.8 g/kg in adults. high temperatures (grilling, broiling), you create carcinogens in the food. Plants For an adult, this is very little protein! are generally cooked at lower temperatures under less extreme cooking conditions. 7
  10. 10. Smoked and Charcoal-broiled Foods It is prudent to minimize these. The Fiber Bandwagon Fiber 25 - 30 grams per day Do not exceed 35 grams per day.Fiber in one, medium apple = 4 gramsCalories in one, medium apple = 53Fat grams in one, medium apple = 0Cost of one apple = $.40 8
  11. 11. Fiber is not a molecule! High Fiber Carb Advantage It is a family of carbs. 1. Cellulose-beta glucosidic 1,4 linkages 2. Hemi-cellulose contains mainly xylose One big advantage of eating high fiber 3. Lignin-complex fiber polymer 4. Pectin-apples, cranberries and cherries foods, is that they fill you up and are 5. Gums and Mucilages-oatmeal and legumes often high in protein, too, like beans. 6. Algal Polysaccharides – kelp (seaweeds) 7. Indigestible oligosaccharides – legumes Fibers and Disease Metabolism of FibersSoluble fibers may form gels and sols Fibers cannot be digested by human enzymes.in the intestine and may absorbmolecules like cholesterol, bile acids However, bacteria can metabolize fiber andand salts, and carbohydrates (for produce short chain fatty acids (besides gases)blood glucose control) which may be absorbed in the distal part of the intestine.Insoluble fibers provide bulk and maystretch the GI tract and increase This adds a small amount of calories and mayperistalsis. This may decrease GI have metabolic affects.cancer by eliminating the naturalcarcinogens in food more quickly. 9
  12. 12. Vitamins and Minerals There are no recommendations from any major health organization for a normal, healthy population to routinely take a specific vitamin or mineral or a multivitamin/mineral supplements, especially ones which contain more than 100%The Vitamin and Antioxidant Hyphe the RDA for that vitamin or mineral. There are sub-populations which might benefit. Examples are: – Women of childbearing age, specifically for folic acid (CDC, March of Dimes recommendations) – Children who are not getting enough Ca++ and Vitamin D – For undernourished individuals. – For people who have specific diseases or are critically ill. – For postmenopausal women not getting enough calcium and Vitamin D. National Institutes of Health State-of-the-Science Conference Vitamins and Cancer Statement Multivitamin/Mineral Supplements and Chronic Disease Prevention Most recommendations for cancer- In systematically evaluating the effectiveness and preventing diets stress staying away safety of MVMs in relation to chronic disease from excessive vitamin consumption. prevention, we found few rigorous studies on which to base clear conclusions and recommendations. Most of the studies we examined do not provide strong I am not talking about meeting RDA’s. I evidence for beneficial health-related effects of am talking about taking megadoses of supplements taken singly, in pairs, or in combinations vitamins in the misguided attempt to of 3 or more. prevent or cure or treat cancer. 10
  13. 13. What about this idea that vitamins Free Radical Theory scavenge free radicals? The free radical “grabs” a electron from any molecule it its vicinity. A free radical is a molecule with an unpaired, highly reactive electron. It does this because electrons like to exist in pairs. When it “grabs” an electron from another molecule, it damages the other molecule. Free Radical Theory Free Radical TheorySome of the molecules that may be damaged by free radicalsare fats, proteins, and DNA (both in the nucleus and in Free radicals do not go unchecked. Themitochondria). body has a multi-layed defense system that reacts and detoxifies the damagingIf membrane fats are attacked, then you get the breakdown of radicals.the cell membrane. If it is a red blood cell membrane, you gethemolysis. Defenses include:If proteins are attacked, you get the breakdown of proteins, – Natural antioxidants in the body, such as BILIRUBIN.which may result in the loss of biological function and the – Enzymes such as superoxide dismutase (SOD),accumulation of “catastrophic” compounds. catalase, & glutathione peroxidase.If DNA is attacked, you will get a mutation that may cause aging – Dietary antioxidants such as beta carotene, and theor cancer. vitamins C and E (when present in food). 11
  14. 14. Tocopherol Acetate The form in vitamins. Free Radical Theory For example, when Vitamin E “scavenges” free radicals, it becomes a free radical and may be more carcinogenic than the original free radical. This is the reason why taking high doses of vitamin E SUPPLEMENTS or other free radical scavengers, like beta carotene, appears to INCREASE cancer risk in a person, not decrease cancer risk.Many times, vitamin E free radical is a more SELECT Vit E/Selenium powerful pro-oxidant than the original free radical. Prostate Cancer TrialMeta-analysis: high-dosage vitamin E supplementation may increase SELECT participants are being told to STOP taking theirall-cause mortality. Ann Intern Med. 2005 Jan 4;142(1) study supplements but will continue to have their health monitored by study staff for about three more years.135,967 participants in 19 clinical trials. The independent Data and Safety Monitoring Committee (DSMC) forOf these trials, 9 tested vitamin E alone and 10 tested vitamin E the trial found that selenium and vitamin E, taken alone or together forcombined with other vitamins or minerals. The dosages of vitamin E an average of five years, did not prevent prostate cancer.ranged from 16.5 to 2000 IU/d (median, 400 IU/d. The data also showed two concerning trends: there wereA dose-response analysis showed a statistically significant relationship slightly more cases of prostate cancer in men taking onlybetween vitamin E dosage and all-cause mortality. vitamin E and slightly more cases of diabetes in men taking only selenium.CONCLUSION: High-dosage (> or =400 IU/d) vitamin E supplementsmay increase all-cause mortality and should be avoided. http://www.cancer.gov/newscenter/pressreleases/SELECTQandA 12
  15. 15. Beta Carotene Supplements and Lung Cancer Total Fat Smokers who take beta-carotene supplements have higher lung cancer rates than smokers not taking these 25-35% or less of total calories supplements. However, smokers who eat 5 or more fruits and vegetables a day have a decreased risk of lung cancer. Ironically, smokers are more likely to take supplements than to eat tomatoes! I hate broccoli! Fat is very calorie-dense. Obesity > 60% dietary calories from fat results in Calories/gram obesity in all animals. One major Fat 9 kcal/gram problem with the American diet today Alcohol 7 kcal/gram is that it has too much fat...40-42%. The Carbs 4 kcal/gram more you approach this >60% figure, Protein 4 kcal/gram the more prevalent obesity will be in the population. 13
  16. 16. Saturated Fat Lean Bacon?No more than 6-10% of total calories Oscar Mayer proudly presents our Center Cut Bacon premium slices, carefully selected and hand trimmed from our meatiest cuts to give you 30% Lower Fat. When you want to treat your family to the very best, OSCAR MAYER® Center Cut Bacon consistently delivers great tasting bacon with the famous naturally hardwood smoked flavor youve come to expect from Oscar Mayer. Oscar Mayer... nothing but the best®! Lean Bacon? Fat and Blood Cholesterol Type of Fat LDL HDL Serving Size 12g Servings per package 10 Monounsaturated lowers raises olive oil, canola oil Amount Per Serving Saturated raises raises Total Calories 50 butter Calories from Fat 35 (70% Total Calories) Trans fat raises lowers Total Fat 4g Polyunsaturated lowers no effect Saturated Fat 2g (50% Total Fat Calories) fish oil 14
  17. 17. Monounsaturated Fat Is eating chocolate really healthy? The main fat in chocolate is stearic acid. Stearic acid (C18:0) is the only saturated fatty acid that Up to 15-20% of total calories does not raise LDL cholesterol. The reason is that after absorption, stearic acid is desaturated to C18:1; hence, the action of stearic acid in the liver is that of the monounsaturated fatty acid, oleic acid. Substitute monounsaturated fats for saturated fats and trans fatty acids However, chocolate is loaded with fat and sugar and has a huge amount of calories, so WATCH IT! It is not a health food! What about the antioxidants (procyanidins) in chocolate? There is very little relationship between the studies on unpurified and unprocessed raw chocolate and a candy bar! A Word About Trans Fat Polyunsaturated FatHydrogenation is a chemicalprocess used to addhydrogen atoms to theunsaturated fatty acids. The Up to 10 % of total caloriesaddition of hydrogenreduces the development ofoff-flavors in oil products.During hydrogenation,hydrogen bonds inunsaturated fat may changefrom the cis form to the transform. 15
  18. 18. American Heart AssociationRecommendations for Omega-3 Fatty Acids CholesterolPatients without documented coronary heart disease (CHD) – Eat a variety of (preferably fatty) fish at least twice a week. Include oils and foods rich in alpha-linolenic acid (flaxseed, canola and soybean oils; flaxseed and walnuts).Patients with documented CHD No more than 300mg/day – Consume about 1 g of EPA+DHA per day, preferably from fatty fish. EPA+DHA supplements could be considered in consultation with the physician.Patients who need to lower triglycerides – 2 to 4 grams of EPA+DHA per day provided as capsules under a physician’s care.Patients taking more than 3 grams of omega-3 fatty acids fromsupplements should do so only under a physician’s care. Highintakes could cause excessive bleeding in some people.NOTE: Vitamin E is also an anti-coagulant. Are eggs healthy, again??? They always have been and they always will be healthy. It’s the yolk (for most people) that’s the problem, but even that is not a poison! It’s too many eggs that’s the problem, how they are cooked, and the bacon that comes with them. 16
  19. 19. Total CarbohydratesWhat’s all the fuss about carbs? Complex carbohydrates 50% of total calories Sugars 10% or less of total calories Carbs? Whole Grain Carbs! Microwave in the husk for 3 minutes, then husk This is corn, fat, and carcinogens corn and shake in a bag with olive-oil margarine, some salt (if you want) and we add Cajun spices yum, yum! or curry. Delicious and healthy! 17
  20. 20. Carbohydrates CaloriesCarbohydrates are not considered essential to the diet Non-essentialfrom a biochemical point of view, since they can be Amino Acidssynthesized from glycogenic amino acids. Fats Ketogenic Carbohydrates are a cheap source of calories Carbohydrates will "spare" fat metabolism in your body. – sufficient carbohydrates are needed in your diet to prevent excess fat breakdown or ketosis. Low carb diets promote ketosis. Ketone Bodies – 50-100 gms carbohydrate/day alleviates ketosis Carbohydrates Some organs and the fetus use glucose as a sole source of energy. Ketosis The Diet to Promote Health Ketosis is an abnormal state and is and unhealthy. It occurs during starvation DELAY Disease and during illnesses (such as diabetes). It is not an end-point titration for healthy dieting! 18
  21. 21. MacronutrientsCaloric Distributions/Total Amount THE DIETTotal Fat 25-35% Total Calories – Saturated Fat no more than 6-10% – Monounsaturated FatUp to 15-20% Eat less sugar and the sugar you eat should – Polyunsaturated Fat Up to 10% come from fruits and dairy products. – Cholesterol not more than 300 mg/day Eat better quality starchs. Eat more whole grain foods.Carbohydrates 50-60% Eat more high fiber foods. – Sugars no more than 10% Eat food, not supplements – Starches 50% Eat less salt.Total Fiber 20-30 gms/day, not Drink less alcohol, but a little is probably ok. more than 35 Eat less red meat. – Soluble Fiber 10-25 gm/day Eat more fish, especially oily fish.Protein Up to 15%, mostly as vegetable protein. THE DIET THE DIETEat less smoked and charcoal-broiled foods. Overall, eat less fatEat more nuts. – Eat less saturated fatAvoid high doses of vitamin supplements – Eat less trans fatty acidsDon’t be fat. – Eat more monounsaturated fatExercise more. – Eat fewer high-cholesterol foods.Avoid moldy foods.Don’t eat burnt food.Increase your amount of soy products.Eat more variety of foods.Drink fluoridated water and eat iodized salt.Breastfeed your babies. 19
  22. 22. THE DIET IN A NUTSHELL Eat a varied plant-based diet with moderate amounts of meat, fat, sugar, and salt and exercise everyEnjoy what you are eating and stopbeing such a food phobic and bore day.about your diet! Great Nutrition Websites About the Speakerhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi Warren B. Karp, Ph.D., D.M.D. is Professor Emeritus of Pediatrics, Biochemistry and Molecular Biology, Oral Biology(public access site to Medline) and Oral Diagnosis at the Georgia Health Scienceswww.americanheart.org University, in Augusta, GA. He has a Ph.D. in nutritionalwww.diabetes.org biochemistry from The Ohio State University and a Doctorate in Dental Medicine from the Georgia Health Scienceswww.eatright.org University. He is an elected member of The Americanwww.usda.gov Institute of Nutrition (Federation of Societies of Experimentalwww.guidelines.gov Biology) and is past president of the Georgia Nutrition Council. He has served as Director of the Nutrition Consultwww.cancer.org Service at the College of Dental Medicine for over twentywww.nih.gov years, and has served as Vice Chair of the Board of Healthhttp://www.nhlbi.nih.gov/health/public/heart/hbp in Augusta (Columbia County)./dash/ 20

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