This document provides an overview of obesity, energy balance, inflammation, and other factors related to metabolic health. It discusses how factors like stress, poor diet, lack of activity, and environmental toxins can disrupt metabolic processes and gene expression, leading to issues like insulin resistance, obesity, and disease. The document recommends addressing the root causes of metabolic imbalance through a Mediterranean-style diet high in nutrients and low in inflammation-promoting foods. Regular physical activity and lifestyle factors are also important to maintain metabolic health and gene expression. The goal is to take an integrative, upstream approach to metabolic disorders through nutrition and lifestyle interventions before relying on downstream medical treatments.
The presentation has three parts: UNITE for Diabetes Philippines CPG recommendations on medical nutrition therapy (MNT), improving adherence to MNT and use of SMS.
Carbohydrate Counting for insulin dose adjustmentltejas86
Carbohydrate counting is the method of estimating carbohydrates from your meal and adjusting insulin dose to keep blood sugar levels under control. It is easy and very effective specially for children with type 1 diabetes. It offers variety and flexibility in the diet at the same time improves blood sugar profile.
Are you Struggling to Control of your Diabetes and Weight?
People who are overweight or obese are more prone to developing Type 2 diabetes. Those who have Type 1 and Type 2 diabetes with weight problems struggle to control their blood sugar levels. Research shows that people with diabetes find it more difficult to lose weight than those without diabetes.
Weight loss significantly improves blood sugar control and also reduces the risk of getting complications from diabetes. However, whilst attempting to lose weight, people with diabetes find it hard to restrict their intake of food since eating less may trigger hypoglycaemia (low blood sugar). All these facts explain the need for specialist input in management of weight in people with diabetes.
This Slideshow gives you insight to Diabesity
For more information please visit
http://www.simplyweight.co.uk
Articles
http://www.simplyweight.co.uk/articles/
Videos
http://www.simplyweight.co.uk/video/
Blogs
http://simplyweight.co.uk/blogs/
Forum
http://www.simplyweight.co.uk/forum/forum.php
Contact Us
http://www.simplyweight.co.uk/how-to-contact-us/
The presentation has three parts: UNITE for Diabetes Philippines CPG recommendations on medical nutrition therapy (MNT), improving adherence to MNT and use of SMS.
Carbohydrate Counting for insulin dose adjustmentltejas86
Carbohydrate counting is the method of estimating carbohydrates from your meal and adjusting insulin dose to keep blood sugar levels under control. It is easy and very effective specially for children with type 1 diabetes. It offers variety and flexibility in the diet at the same time improves blood sugar profile.
Are you Struggling to Control of your Diabetes and Weight?
People who are overweight or obese are more prone to developing Type 2 diabetes. Those who have Type 1 and Type 2 diabetes with weight problems struggle to control their blood sugar levels. Research shows that people with diabetes find it more difficult to lose weight than those without diabetes.
Weight loss significantly improves blood sugar control and also reduces the risk of getting complications from diabetes. However, whilst attempting to lose weight, people with diabetes find it hard to restrict their intake of food since eating less may trigger hypoglycaemia (low blood sugar). All these facts explain the need for specialist input in management of weight in people with diabetes.
This Slideshow gives you insight to Diabesity
For more information please visit
http://www.simplyweight.co.uk
Articles
http://www.simplyweight.co.uk/articles/
Videos
http://www.simplyweight.co.uk/video/
Blogs
http://simplyweight.co.uk/blogs/
Forum
http://www.simplyweight.co.uk/forum/forum.php
Contact Us
http://www.simplyweight.co.uk/how-to-contact-us/
Managment of Diabesity (Obesity in diabetes mellitus) Tarek Al 3reeny
This presentation summaries state of the art management of obesity in diabetes mellitus (diabesity) including definition and classifications of both obesity and diabetes. Multidisciplinary approach , pharmacotherapy & bariatric surgery
The presentation in detail covers the Glycemic index and glycemic load of various kinds of food. The standard calculation of Glycemic index and GLycemic load.
Moreover, it covers the food processing effects that can alter the glycemic load and glycemic index like gelatinization, retrogradation, cooking, annealing, etc.
Anti-Obesity Pharmacotherapy: Where are we now? Where are we going?InsideScientific
Obesity is a treatable chronic disease. With nearly 2 billion individuals worldwide classified as being overweight and 650 million as having obesity, it is critical to optimize implementation of existing treatment interventions and develop novel therapies to mitigate the obesity pandemic. Anti-obesity medications are one of the essential tools in our medical toolbox to help patients achieve their health and weight goals.
In this webinar, Dr. Jastreboff discusses current use of anti-obesity pharmacotherapy, mechanisms involved, and agents in various stages of development with considerations for next steps. The presentation aims to inspire development of innovative therapeutics while optimizing use of existing agents to address the urgent need to effectively and sustainably treat millions of individuals with obesity around the world.
Key Topics Include:
- Understand the role of anti-obesity pharmacotherapy in the treatment of obesity
- Describe current anti-obesity pharmacotherapy
- Discuss anti-obesity medications under development
Managment of Diabesity (Obesity in diabetes mellitus) Tarek Al 3reeny
This presentation summaries state of the art management of obesity in diabetes mellitus (diabesity) including definition and classifications of both obesity and diabetes. Multidisciplinary approach , pharmacotherapy & bariatric surgery
The presentation in detail covers the Glycemic index and glycemic load of various kinds of food. The standard calculation of Glycemic index and GLycemic load.
Moreover, it covers the food processing effects that can alter the glycemic load and glycemic index like gelatinization, retrogradation, cooking, annealing, etc.
Anti-Obesity Pharmacotherapy: Where are we now? Where are we going?InsideScientific
Obesity is a treatable chronic disease. With nearly 2 billion individuals worldwide classified as being overweight and 650 million as having obesity, it is critical to optimize implementation of existing treatment interventions and develop novel therapies to mitigate the obesity pandemic. Anti-obesity medications are one of the essential tools in our medical toolbox to help patients achieve their health and weight goals.
In this webinar, Dr. Jastreboff discusses current use of anti-obesity pharmacotherapy, mechanisms involved, and agents in various stages of development with considerations for next steps. The presentation aims to inspire development of innovative therapeutics while optimizing use of existing agents to address the urgent need to effectively and sustainably treat millions of individuals with obesity around the world.
Key Topics Include:
- Understand the role of anti-obesity pharmacotherapy in the treatment of obesity
- Describe current anti-obesity pharmacotherapy
- Discuss anti-obesity medications under development
to download this presentation from this link
https://mohmmed-ink.blogspot.com/2020/12/obesity.html
obesity, causes, diagnosis, complications, treatment, prevention.
Nutrigenomics is the science that examines the response of individuals to food compounds using post-genomic and related technologies (e.g. genomics, transcriptomics, proteomics, metabol/nomic etc.). The long-term aim of nutrigenomics is to understand how the whole body responds to real foods using an integrated approach termed 'systems biology'. The huge advantage in this approach is that the studies can examine people (i.e. populations, sub-populations - based on genes or disease - and individuals), food, life-stage and life-style without preconceived ideas.
With a growing number of conditions being grouped under the ‘umbrella’ of autoimmune disease, supporting clients who are, increasingly, presenting with various, and often multiple, autoimmune conditions, can appear complex at first glance.
In this webinar, Dr Danielle Crida outlines a clinical protocol that can support most autoimmune conditions, and takes a deep dive into the role of the immune system and key inflammatory processes at play.
My recent introduction talk for the Nutrigenomics Masterclass 2011in Wageningen (The Netherlands):
How to use Nutrigenomics & molecular nutrition? From challenges to solutions
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
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Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
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This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
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The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
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3. Overview:
Obesity
Energy – what can go wrong
Inflammation- what does it mean
Other factors
Current trends- do diets work?
Looking to the future...
4. Obesity
Implicated as a risk factor for many different
disorders including:
CVD
Diabetes type II
Some Cancers
BPH
Female infertility & uterine fibroids
Gallstones
Pregnancy disorders such as pre-eclampsia
5. Relieving the economic burden of
disease
“coronary heart disease, prostate and breast
cancer, diabetes and obesity account for 75% of
health-care costs, yet the progression of these
diseases can be stopped or even reversed with
intensive lifestyle changes.”
Ornish D. Lancet Oncol. 2009 Jul;10(7):638-9
7. Functional Medicine:
Functional medicine involves understanding
the origins, prevention, and treatment of
complex, chronic disease.
8.
9. Clinical psychoneuroimmunology and
nutritional medicine (CPNI)
Interactions between the
nervous system and the
immune system, and the mutual
relationship between behaviour
and health.
The main disciplines that are
brought together are
psychology, neurology,
immunology, endocrinology,
evolutionary biology and
epigenetics.
Research has revealed that
human physiology and the
external environment interact
dynamically.
10. Considerations:
Epigenetics: concerned with how our
environment changes gene expression
Proteomics: concerned with proteins
expressed by a genome.
Nutrigenomics: the science of how food
substances alter gene expression within
human cells.
11. Food is information for our
epigenome (gene expression)
Food provides signals for cellular
function to programme for health and
disease.
13. An environmental mismatch:
“through nearly all human evolution genetic adaptation
was closely coupled with environmental alterations.
Now, however, cultural change comes too rapidly for
genetic accommodation to keep pace.”
Prev Med. 2002 Feb; 34(2): 109-18
14. Our environment is changing the way
our genes are expressed
“ ...recent studies indicate that environmental factors &
diet can perturb the way genes are controlled by DNA
methylation & covalent histone modifications.
Unexpectedly, and not unlike genetic mutations, aberrant
epigenetic alterations and their phenotypic effects can
sometimes be passed on to the next generation.”
Mutat. Res. 2006 Aug 30;6001-2):46-57
16. Factors influencing glycaemic control
Traditional model:
Regulation of blood sugar- insulin and glucagon
Functional model:
Metabolic Intelligence:
Balancing act, the adrenals, pituitary gland, intestines
and pancreas work in synchrony to achieve blood
glucose balance.
18. Losing equilibrium:
T3 & T4 Sex hormones
Corticosteroids Growth
hormones
Normal Normal insulin
catabolism
CATABOLISM ANABOLISM
19. How do we confuse the metabolic system?
Erratic eating patterns and fad diets may confuse the
metabolic system
Poor blood sugar regulation will lead to reduced
response to insulin
Breakdowns occur in signalling
Hypothalamus develops a resistance to leptin signals
(Halle & Persson, 2003) Primary role is to coordinate metabolic, endocrine
and behvioural responses to starvation.
22. How do we confuse the metabolic system?
Chronic stress and adrenal function-- stress elevated
cortisol induces insulin resistance and inflammation
Symptoms of high cortisol: intermittent fatigue,
irritability, dysglycaemia, sleep disturbances, central
obesity
23. The motion picture of Diabetes
Central cortisol resistance precedes peripheral
insulin resistance.
Garcia-Prieto et al.; Cortisol secretary pattern and glucocorticoid feedback
sensitivity in women from a Mediterranean area: relationship with anthropometric
characteristics, dietary intake and plasma fatty acid profile. Clin Endocrinol
(Oxf)). 2007 Feb;66(2):185-91.
Higher expression of glucocorticoid receptors on the
liver precede insulin resistance.
24. Clinical PNI – Metamodel 1
Causes
(nutrition, inactivity, lack of sunshine,
tabaco)
Cortisol
Resistance
Insulin
resistance
LGI
Proximate
medicine
The symptom
25. The result:
T3 & T4
Sex hormones
Abnormal
insulin
Corticosteroids
Growth
hormones
Normal
catabolism
CATABOLISM ANABOLISM
26. Other factors:
Thyroid function- sets metabolic rate and responsible
for energy release
Psychological factors- serotonin, dopamine
Immune Dysfunction- it is now widely accepted that
obesity is associated with a level of chronic
inflammation in the body.
27. Toxicity and its impact on mitochondrial function
Chemical known as obesogens are known to induce
obesity
Loss of circadian rhythm- studies have demonstrated that
melatonin can reduce diet-induced obesity in rats (Prunet-
Marcassus, 2003)
Imbalance of gut flora- function of ghrelin and leptin;
Experiments performed on mice colonized with human
gut microbes showed that changes in diet that resulted in
the mice becoming obese (high carb to Western diet)
allowed a rapid switch in microbial community.... when
this modified gut flora was transferred to germ free mice,
the obese phenotype was also passed on. (Turnbaugh P J et
al, 2009)
29. Current trends: do DIEts work?
Insulin resistance is affected by the factors
mentioned earlier, what‟s also interesting is that
erratic eating patterns and fad diets may confuse the
metabolic system, a breakdown occurs in the
signalling, the hypothalamus develops a resistance
to leptin signals (Halle and Persson, 2003)
Evidence now clearly demonstrates that the body
gets “stingier” in its use of calories after each diet
(Muls E et al, 1995)
30. What is our aim:
Control dysglycaemia:
Minimise the effect of the
inflammation response
Improve anti-oxidant status
31. MEDITERRANEAN diet:
Neopolitan researchers found that participants
assigned to a Mediterranean diet:
• Lost more weight
• Experienced greater improvements in glycaemic
control
• Showed improvements in coronary risk measures
(Esposito K, 2009)
32. Med-style diet for type 2 diabetes
(Eposito et al 2009):
“compared with a low-fat diet, a low carbohydrate,
Mediterranean-style diet led to more favourable changes
in glycaemic control and coronary risk factors and
delayed the need for anti-hyperglycaemic drug therapy in
overweight patients with newly diagnosed type 2
diabetes.”
Ann Intern med. 2009 sep 1; 151(5): 306-14
33. REVIEW OF 35 STUDIES ON THE
MED DIET
“The MED diet showed favourable effects on lipoprotein
levels, endothelium vasodilation, insulin resistance
metabolic syndrome, antioxidant capacity, myocardial
and cardiovascular mortality, and cancer incidence in
obese patients and those with previous myocardial
infarction.”
Serra-Majem et al.; Nutrition Reviews 64(2): S27-S47
34. MED diet reduces inflammation
“compared with patients consuming the control diet,
patients consuming the intervention diet had significantly
reduced serum concentrations of hs-CRP, IL-6, IL-7 & IL-
18, as well as decreased insulin resistance.”
Eposito et al., JAMA 2004;292:1440-1446
35. Mediterranean Diet:
• Rich in cereals, fruit, nuts, legumes, whole
grains, fish, olive oil
• Low in dairy, meat, junk food, fat
• High in beta-carotene, vitamin C, tocopherols,
polyphenols, minerals, soluble fibre.
36. What about fat??
“Consumption of mono-unsaturated fatty acids is
thought to increase insulin sensitivity, and this
component of the diet may explain the favourable
effect of the MED diet.”
Esposito K, 2009
37. Good fat is better than low fat:
The Medl-RIVAGE study: reduction of CVR disease risk
factors after a 3-mo intervention with a MED-type diet or
a low fat diet.
“our data predicted a 9%reduction in cardiovascular
disease risk with the low-fat diet and 15% reduction with
this particular MED diet”
Vincent-Baudry et al.; Am J Clin Nutrition 2005; 82:964-71
38. Inflammation: immune dysfunction
Morbid obesity is now known to be associated with low-
grade systemic inflammation & immune activation
Pro-inflammatory cytokines are synthesized and released
in human adipose tissue :
TNF-alpha,
IL-1,
IL-6,
IFN-gamma
39. The anti-inflammatory diet
“the MED diet ensures adequate intake of whole grains,
fruits, vegetables, nuts, fish, cereals, legumes and olive
oil; all this together with moderate consumption of
alcohol, predominantly wine, leads to high ingestion of
dietary fibre, antioxidants, magnesium and unsaturated
fatty acids. Therefore, the MED diet could serve as an
anti-inflammatory dietary pattern, which could protect
from or even treat diseases that are related to chronic
inflammation, including visceral obesity, type 2 diabetes
and the metabolic syndrome.”
Giugliano D, Esposito K. MED diet & Metabolic diseases. Curr Opin Lipidol.
2008 Feb; 19(1):63-8
40. Benefits of the MED diet
Improved glycaemic control
Reduction in Cardiovascular risk
Reduction in inflammation
41. Micronutrients for genomic stability....
A new paradigm for RDAs
“current recommended dietary allowances for
vitamins & minerals are based largely on the
prevention of disease of deficiency, eg scurvy in the
case of vitamin C. Because diseases of
development, degenerative disease and aging itself
are partly caused by damage to DNA it seems logical
that we should focus better our attention on defining
optimal requirements of key minerals and vitamins
for preventing damage to both nuclear and
mitochondrial DNA.”
Food and Chemical Toxicology 40(2002)1113-1117
42. Nutrients & compounds researched
Chromium Gymnema Sylvestre
Magnesium Bitter Melon
Alpha Lipoic Acid Fenugreek
Omega 3 EFAs Bilberry
Manganese Gingko Biloba
Zinc Ginseng,
Vitamin D Garlic
Vitamin E Cinammon
B vitamins Results, are mixed and vary
according to the aims of the
Vitamin C trial
43. Metabolic Foods
Medical foods: “super-nutrition” containing nutrients
needed for specific clinical conditions.
Trial using these with MED diet, vs MED diet alone
Low GI (doesn‟t cause insulin spike)
Soy protein (for body composition & lipids)
2 g plant sterols(healthy cholesterol levels)
Targetted phytonutrients (cellular signal improvement)
46. To move or not to move?? That is the
question.
• More frequent television viewing in adolescence and
early adulthood is associated with greater BMI gains
through to mid-adulthood and with central adiposity in
mid-life.
(Ashcroft, J 2008)
47. Activity
„Our results strongly suggest that the increased risk of
obesity owing to genetic susceptibility can be blunted
through physical activity.
These findings suggest the important role of physical
activity in public health efforts to combat obesity,
particularly in genetically susceptible individuals.‟
Rampersaud E et al. Physical activity may help offset genetic risk for
obesity” Archives of Internal Medicine, 2008; 168:1791-1797
50. Nutrition is/as Medicine
Nutritional intervention is the upstream intervention
in people with metabolic disorders in Diabetes
.... In contrast medical intervention is approximate
downstream intervention for people suffering with
metabolic disorders.
The proximate intervention should be used to gain
time for repairing the motion picture.