Whole Foods Market Lecture March 2011

1. Using Food Choices to Control Inflammation Enrique Saguil, M.D. We didn’t invent the practice of medicine…. we’re just changing the way it’s provided.

3. Cares what I have to say

4. Doesn’t Keep Me Waiting

5. Gives Me OptionsWe didn’t invent the practice of medicine…. we’re just changing the way it’s provided.

6. The First Health Approach We didn’t invent the practice of medicine…. we’re just changing the way it’s provided.

7. Your Community of Care Ric Saguil, MD Jason Gruss, MD Tom Jordan, RD Katrina Christie, LCPC Jennifer Green, ND Joe Musolino, DC Amy Iaquinta, DC Nick Nowicki, DC Emery Paredes, PT Courtney Day, EP Yu Zhu, MD China Mike Blumberg, LCPC You

8. Japanese death toll 9700 dead 16,501 missing

9. Heart disease 233,000 women die annually 19416.7 women will die this month 4854.2 women will die this week 1.5 million heart attacks annually 500,000 die annually Cardiac event every 26 seconds 1 Death every minute

10. Cancer death rate American cancer society says 1,527,560 new cancer cases 2010 569,490 deaths 2010 47,457.5 deaths per month 2010 11,764.4 deaths per week 2010 Prostate, lung and colorectal = ½ men Breast, lung and colorectal = ½ women Lifetime risk = 40.77% born today will be diagnosis with some form of cancer at some point in their life National Cancer Institute

11. Take home points for today: Basics concept of inflammation How its involved with injury, heart, cancer How to control it with pharmacy (your inner pharmacy) How food works as an anti-inflammatory

12. What happens chemically? Hormones Imbalances in stress response/relaxation response Activation of the inflammatory cascade First lets talk about inflammation in easy terms……

13. Muscle injury: A twist, roll, bend or fall occurs with immediate pain Stiffness and spasm set in by one day Other areas start to spasm in a week Soft tissue (ligament, tendon and muscle) gets over stretched and torn off its connecting points to bone. The tissue reacts by sending more blood to the area and heat/redness prevail Compensating areas start to fail when they can’t do the work of the originally injured part

14. Electron microscope

15. Inflammatory phase starts day 0-5 Bleeding PMN’s Macrophages and platelets stimulates GF Proliferative phase from day 5-21 GF stimulates endothelial cells, fibroblasts and myofibroblasts Macrophages continue Maturation phase from day 21-whenever Fibroblasts Increased collagen and tensil strength The Problem When tissue is torn or stretched:

16. When tissue damage occurs, the “cascade” starts Normal tissues *stomach *kidneys *platlets *endothelium Inflammatory sites *macrophages *synoviocytes *fibroblasts

17. Nonselective cox2 Normal tissues *stomach *kidneys *platlets *endothelium Inflammatory sites *macrophages *synoviocytes *fibroblasts Regular NSAIDs block here

18. corticosteroids Normal tissues *stomach *kidneys *platlets *endothelium Inflammatory sites *macrophages *synoviocytes *fibroblasts Steroids block here

19. Cox-2 Normal tissues *stomach *kidneys *platlets *endothelium Inflammatory sites *macrophages *synoviocytes *fibroblasts Cox 2 used to block here

20. Non standard prescription supplements by doctors Limbrel (flavocoxid) Severe OA Lovaza (omega 3 acid ethyl esters) Severe Hypertriglyceridemia Synvisc-One (hylan G-F 20) Severe OA “-prescription foods”

21. Standard Anti-inflammatory prescriptions by doctors NSAIDs Steroids (oral or injectable) DMARDs

22. NonSteroidalAntiInflammatoryDrugs The non prescription nsaids-Advil, ibuprofen,motrin Aleve, naprosyn, naproxen aspirin The prescription nsaids-Relafen, Voltaren, Lodine, Naprelan, Cataflam, Indocin, Nuprin….. The “non prescription” foods……..coming up!

23. Rest Ice Compression Elevation Therapy (my next lecture) NSAIDs Steroids(injection or pills) Muscle relaxers and narcotics (“pills 4 pills”) Standard approach always works:

24. The Saguil approach to an injured patient: Turmeric 400mg tid Magnesium 100mg tid Vitamin D 3 2000IU Hold on dairy Hold processed meats (processed anything) Increase fluids Increase plant based products (f&v) Do no further harm, but keep active

25. Once injured, stop the injury? Skeletal muscle Bone and/or Tendon Cardiac Muscle? Soft tissue (pancreas)? Abnormal tissue (cancer)?

26. Antiinflammatory Eating It is a Lifestyle not a Diet Food can kill Food can heal Medicines are a temporary fix The concept of marketing food/concept of marketing pills The science of nutrition

27. Mediterranean diet Traditional foods 1950’s-60’s around the med Tunesia morocco turkey franceitalygreece OO More mono less room for sat fat Whole grains Wine Fish 2xweek F&V (yes….plants)

28. Book note: What is the color of your diet? Omnivore’s Dilemma

29. Documentaries: Food Inc. The Killer at Large The Hidden Epidemic

30. OO Arbicana grassy Moreola hot….. First pressed extra virgin olive oil usually not green and bland Used like wine depending on meal in the mediterranean 77% monounsaturated fat, +polyphenols (antiox/bitter), +sterols (prevents choabsorpt) Wendy Kohatsu, MD

31. Organic when you can

32. Attica study (chemical markers in blood tests) OBJECTIVES: We studied the effect of the Mediterranean diet on plasma levelsof: C-reactive protein (CRP), White blood cell counts, Interleukin(IL)-6, Tumor necrosis factor (TNF)-alpha, Amyloid A, Fibrinogen Homocysteine 3000 people 1yr J Am CollCardiol, 2004; 44:152-158, doi:10.1016/j.jacc.2004.03.039

33. Side bar: Increased total homocysteine levels in the blood can be reduced with B12, folic acid and pyridium supplementation but most studies say no great improvement in movement or cognition So perhaps an overall diet change is necessary?....... Reduction of plasma homocysteine and serum methylmalonate concentrations in apparently healthy elderly subjects after treatment with folic acid, vitamin B12 and vitamin B6: a randomised trial

34. Lifestyle Heart Trial Intensive lifestyle changes (10% fat whole foods vegetarian diet, aerobic exercise, stress management training, smoking cessation, group psychosocial support) for 5 years. Measured stenosis of the arteries Regression in 5 years of coronary plaques vs progression and 2x as many events 28 people 5 years

35. NIH-AARP Watched population over 5 years and determined if survival was related to adherance with portions of the mediterranean diet. Points were given to every point related to veg, legumes, fruits, nuts, whole grains, fish, mufa/sfa ratio, alcohol and meatThe Mediterranean diet was associated with reduced all-cause and cause-specific mortality. 214 284 men and 166 012 women 5 years

36. Ornish Program for reversing Heart Disease Prerequisites: An acute myocardial infarction within the preceding 12 months A coronary artery bypass surgery Current stable angina pectoris Heart valve repair or replacement Percutaneous transluminal coronary angioplasty or coronary stenting A heart or heart-lung transplant Paid for by Medicare!!!!!......

37. Reversal of artery blockage! ICR sessions are limited to 72 1-hour sessions, up to 6 sessions per day, over a period of up to 18 weeks Ornish research has been out for 16 years How many died waiting for approval?

38. First symptom of heart disease: 60% of men is massive MI or death 50% of women is massive MI or death …who should run to get a physical next week?

39. Major risk factors for heart attack Smoking F ‘61 High blood pressureF ‘61 High blood cholesterolF ‘61 Overweight and obesity Physical inactivity Diabetes (high blood sugar) NHLBI * F = Framingham Study NHLBI = National Heart Lung Blood Institute

40. Framingham Study Ongoing study with generation repeats Has shown the relationship of heart disease to DM, HBP, Cholesterol, Genes About the time of the first Framingham…cholesterol meds were discovered! Yay???...

41. Stargate Video Game 1981

42. Cholesterol and the Stargate game: Prescription meds = nose cannon Herbals = smart bomb

43. Pharmaceuticals Came on scene in the late 80’s They do work! You are on them “for life!?!”

45. Questran

46. Welchol

47. Zetia

48. Crestor

49. Lipitor

50. Zocor

51. Pravachol

52. Niaspan

53. Lopid

54. Tricor

56. The Saguil approach to High Cholesterol Get a doc that listens to history See a registered dietician that walks the walk Look for a Naturopath (NU Lombard) Commit to lifestyle change (do it with or for) Join a community Don’t be afraid of meds or herbals (but also plan on getting off the day you start) Make friends with your kitchen

57. The class reunion diets: Low fat (people got heavier) Low carb (Atkins made us aware) Blood Type/pH Paleolithic Vegetarian/Vegan/Raw Many are great but in the end, can it be sustained for life?

58. Raw Food http://worldpeacefood.blogspot.com/

59. macronutrients Carbohydrates Proteins Fats

60. Carbohydrates Old rating = simple and complex New = glycemic index and load

61. Glycemic Index Food absorption is compared to glucose absorbed in the blood stream over time Groups of volunteers the amount of food that will give 50 grams of carbohydrate Compare the tested carb to glucose absorption and give a number higher/lower www.glycemicindex.com

65. Low is good Note on the chart the range with the typical breads, noodles ….the tighter the solid, the slower the digestion

66. When high is indulged The gut stress response is turned on Catecholamine, glucagon, cortisol, growth hormone Blood sugar below baseline occurs “reactive hypoglycemia” Craving starts instinctively for starchy foods, feel ravenously hungry=out of control eating Athletes go for high GI post workout +/_

67. Food studies Pam: please eat something for breakfast Bryan: Mom, I’m not waking up early just to eat “breakfast” Tell your teens: “Second meal effect” with low glycemic index meals vs 81% more calories by end of day with high GI breakfast (just from hunting the remainder of the day) The gut stress response is turned on: Catecholamine, glucagon, cortisol, growth hormone hormone. Blood sugar below baseline occurs “reactive hypoglycemia” Craving starts instinctively for starchy foods, feel ravenously hungry= out of control eating

68. Gene involvement in eating-Nutrigenomics Genes respond to how we eat (esp carbs) Low GI eaters down regulate 71 different genes to translate into lower insulin levels and risk for obesity and T2 DM High GI up regulated 62 diff genes many related to inflammation and oxidative stress

69. Just to leave you with another idea today: Glycemic load The combination of several items on a plate or in a meal “..vinegar or lemon juice”

70. Other food rating systems ONQI (unhealthy/healthy=number) NuVal Aggregate Nutrient Density Index Dr. Joel Fuhrman Calcium, Carotenoids: Beta Carotene, Alpha Carotene, Lutein & Zeaxanthin, Lycopene, Fiber, Folate, Glucosinolates, Iron, Magnesium, Niacin, Selenium, Vitamin B1 (Thiamin) Vitamin B2 (Riboflavin), Vitamin B6, Vitamin B12, Vitamin C, Vitamin E, Zinc, plus ORAC score X 2 (Oxygen Radical Absorbance Capacity is a method of measuring the antioxidant or radical scavenging capacity of foods).

71. ANDI scores

72. ONQI (Overall Nutritional Quality Index) Bad nutrient / good nutrient All ingredients have been evaluated Chicken 39 less than Turkey 48 Goldfish crackers 20, pickled beets 8 NuVal http://www.nuval.com/Scores/List/

73. Proteins Its not just beef that gives muscle Plant based proteins can total same with less side effects (antibiotic traces, hormones, sat fat) Care with protein supplements!

74. Proteins (plant, yes plants) Sources of amino acids, bacteria in GI and the cells that are sloughed off (villi) Veggie protein is less dense with the fiber it contains Getting better fats-ie soy with O3fa 10-20% calories should be proteinvs the low carb diet when people ate more protein, amino acid residues-urea from liver and kidney and calcium lost=osteopenia and osteoporosis (*unless eating disorder- FAT)

75. Protein boosting drink Keith Block, MD 1 cup rice, soy or oat beverage 3 tbsp protein powder (cold-processed whey, egg white powder, glutamine, or soy protein isolate; breast cancer patients may choose to substitute more whey). Be sure to include the glutamine regularly 2 tbsp brown rice syrup Fruit for flavor (optional; if used, count as 1 fruit serving) Put all ingredients in a blender, blend and chill The protein-boosting shake has 310 calories, 22 grams of protein, and replaces 1 dairy serving, 11/2 protein servings, and 2 fruit servings (the brown rice syrup in the recipe substitutes for fruit)

76. Protein examplesKeith Block, MD Legumes Aduki beans Anasazi beans Black beans Brown beans Chickpeas (garbanzo) Fava beans Lentils Lima beans Mung beans Peas Pinto beans Split peas (green yellow) White beans (canellini, great northern, navy) Tempeh Tofu Soybeans edamame Cook with kombueas per Wendy Kohatsu

77. Ocean and fresh water fish (uncontaminated sources) Veggie burgers Egg whites, (organic if possible) Whey protein (micro-filtered, lactose-free) Occasional shell fish, omega 3 whole eggs, veggie meat subs, tuna (canned but check ewg for amount/week), swordfish (high Hg), mackerel (high Hg) None or Rare Non O3 whole eggs, Lean game (venison, ostrich buffalo), Textured veg protein, naturally smoked fish, skinless free-range white meat free range poultry, grass-fed beef Protein examplesKeith Block, MD

78. Fats Limit Sat Fat (as Andy says, sat fat budget) Say yes to mono or unsat fat Make Expeller Rressed Extra Virgin Olive Oil your go to oil good ratio, polyphenols fraction of ao Consider expeller pressed organic Canola for other cooking (neutral tasting) Fruit and veggie oils good (Palm, Tree nuts)

79. Fats 30% of your daily intake

80. Lyon Heart Study (good fats) Some had 40% of daily calories from fat (vs 20% from fat with the AHA diet) 70% reduction in cardiovascular mortality and morbidity Quality not the quantity of fats…..discuss!

81. DrSaguil’s take on low fat: Only other options are carbs or protein Going to foods that were labeled as low fat, they had to taste good so carbs were pushed and thus started the insulin resistance epidemic High protein diets aren’t good either (gout, kidney failure in bb) http://www.meatlessmonday.com/articles/

82. Honorable mention: Whole grains Wild rice Barley Quinoa Millet Wheat berries Visible pieces of grain Dense pumpernicle (denture wearers beware!)

83. Real Grains

84. breads

85. Environmental Working Group www.ewg.org The Dirty Dozen The Clean 15

86. Piggy back products in/on your food Bacteria Pesticides Mercury Antibiotics Hormones Genetic contaminants (GMO)

87. Nod to mindful eating Slow down, turn off the noise, enjoy and secrete serotonin

88. Controlling the stress response allows every cell to function better Remember from carbs, high GI foods will trigger the stress response

89. The body has an innate healing that is very powerful -AW

90. WHEL study Studied carotenoids in cancer survivors Juicing helped those that had low levels Low body weight found significant

91. HALE study Among individuals aged 70 to 90 years, adherence to a Mediterranean diet and healthful lifestyle is associated with a more than 50% lower rate of all-causes and cause-specific mortality. 1507 men 832 women 12 years

92. Another Ornish study! Increased telomerase activity and comprehensive lifestyle changes: a pilot study. Small group of men (30) with bxdxd low risk prostate ca found increase telomerase activity in 3 months

93. Hippocrates First do no harm Revere the healing power of nature Use food as medicine Everyone is stressed so don’t blame and just change!

94. Be your own advocate! Information searches http://scholar.google.com/ Yoga teachers/healers https://yogaalliance.org/content/what-we-do AyurvedicDoctors http://www.ayurveda-nama.org/index.php Acupuncturists http://www.ilaaom.org/practicioners http://www.medicalacupuncture.org Cancer Care http://www.blockmd.com/ Physicians http://integrativemedicine.arizona.edu/alumni.html

95. Using Food Choices to Control InflammationRicSaguil, MD QUESTIONS? COMMENTS? CONCERNS? 2010 South Arlington Heights Road Arlington Heights, IL Phone: 847-593-3330www.FirstHealthAssociates.com

96. Call for Pilot Participants First Health Pilot Program: 30 subjects April 2011 The First Health Comprehensive Wellness Profile YOU GET: Medical Exam Blood Work Health Risk Assessment Body Composition & Fitness Testing Comprehensive (CWP) Report of Findings FOR: Medical Exam

97. GOAL: multicenter, open-label, post-marketing study of flavocoxid, a novel pathway inhibitor anti-inflammatory agent of botanical origin. May 2010, Vol, 26, No. 5 Pages 1055-1063 Pillai, Burnett, Levy Therapeutic potential of curcumin in human prostate cancer-I. Curcumin induces apoptosis in both androgen –dependant and androgen –independent prostate cancer cells Dorai,T, Gehani N, Katz A Prostate Cancer Prostatic Dis, 2000 Aug; 3(2):84-93 Efficacy and mechanism of action of turmeric supplements in the treatment of experimental arthritis Funk, Frye, Oyarzo, Kuscuoglu, Wilson, McCaffrey, Stafford, Chen, Lantz, Jolad, Solyom, Kiela, Timmermann Arthritis Rheum, 2006, Nov;54(11):3452-64 High Glycemic Index Foods and Obesity Ludwig, Majzoub, Alzahrani PEDIATRICS Vol. 103 No. 3 March 1999, p. e26 WHEL study Journal of the American Medical Association, July 18, 2007 (see the journal abstract) (JAMA 2007 Jul 18;298(3):289-98) Complementary and Alternative Medicine Secrets, published in 2002 Wendy Kohatsu, MD Adherence to the Mediterranean diet attenuates inflammation and coagulation process in healthy adults The Attica study J Am CollCardiol, 2004; 44:152-158, doi:10.1016/j.jacc.2004.03.039 Intensive Lifestyle Changes for Reversal of Coronary Heart Disease JAMA. 1998;280(23):2001-2007. doi: 10.1001/jama.280.23.2001 Increased telomerase activity and comprehensive lifestyle changes: a pilot study Lancet Oncol. 2008 Nov;9(11):1048-57. Epub 2008 Sep 15. Mediterranean Dietary Pattern and Prediction of All-Cause Mortality in a US Population Arch Intern Med. 2007;167(22):2461-2468 Mediterranean Diet, Lifestyle Factors, and 10-Year Mortality in Elderly European Men and WomenThe HALE Project JAMA. 2004;292(12):1433-1439. doi: 10.1001/jama.292.12.1433 Reduction of plasma homocysteine and serum methylmalonate concentrations in apparently healthy elderly subjects after treatment with folic acid, vitamin B12 and vitamin B6: a randomised trial European Journal of Clinical Nutrition (2003) 57, 1426–1436. doi:10.1038/sj.ejcn.1601707