Karon Rzad of Sylvester Comprehensive Cancer Center presented "Eat Right, Feel Right" at the 2011 WellBeingWell Conference in Miami.

1. Energy Balance:Banking Currency in the Body Karon Rzad RD LDN CDE CPT Lic. Stress Management Coach Integrated Medicine Practitioner

2. Disclaimer: RD/Clinical Nutritionist The Registered Dietitian/Clinical Nutritionist is a trained expert in human nutrition and nutrition science. RD’s utilize health promotion, for disease prevention and treatment strategies that support communities and individuals to make healthy eating and active living choices. These strategies are well recognized as important in reducing the incidence of chronic illness and reducing health care costs. Their primary focus is to prevent and correct nutrient deficiency symptoms. Ref. ADA position paper.

3. References Americana Dietetic Association, position papers. Shils, M. E. et al, “Modern Nutrition in Health & Disease” 3rd ed., ISBN: 0 7817 4133 5; 2006 Lippincott Wms & Walker. Quillin, P., PhD, RD CNS, Beating Cancer with Nutrition, Nutrition Times Press, Inc., 2002. pgs. 71, Hirsch, Julie B., Ph.D., Wellgen, Inc., Communication Structure-function: Why not call ‘antioxidants’ ‘anti inflammatories’ if that is what they do?Nutr. In Complementary Care, winter, 2007, Vol. 9. Issue 3, page 37. World Cancer Research Fund/American Institute of Cancer Research, Food, Nutrition, Physical Activity, and the Prevention of Cancer: A Global Perspective, Washington, DC: AIRC, 2007. Silva, O., MD-Onc, spec. BrCa-UM/SCCC, Conversations in CA-:What’s Next”. 10/08. Rzad, K. M., RD LDN CDE LSMC CAM, “Know Your Numbers”, 2002 – 2003, Florida Keys. Silver. J Am Geriatr Soc. 1988. Kotler, Ann Intern Med. 2000. Tisdale, Langenbecks Arch Surg. 2004 Acharya et al. J Clin Invest. 2004 Inui, CA Cancer J Clin. 2002. Ref. :MEGACE ES625mg/5ml (Strativa Pharm. Formerly PAR) Heber, D., L. O. Byerley & N. S. Tchekmedyian, “Hormonal & Metabolic Abnormalities in the Malnourished Cancer Patient: Effects on Host-Tumor Interaction”, JPEN J Parenter Enteral Nutr 1992 16:60S, DOI: 10:1177/014860719201600605. Dempsey, DT, et al, “Energy expenditure in malnourished gastrointestinal CA patients.” Cancer 53:1265-1273, 1984 www.aicr.org , Foods That fight Cancer. www.herbal-supplements-guide.com, Herbs for Cancer www.cancer.gov, Cancer Prevention. www.medterms.com http://www.answers.com/topic/green-marketing#ixzz1JDTzsSb4

4. Objectives Participants will: Verbalize the energy balance equation Define the difference faces of malnutrition Define Energy Balance Identify Foods to use Identify Activities that enhance the wellness experience

5. Definitions Under nutrition: Over nutrition: Malnutrition: Cachexia Sarcopenia or unexplained weight loss, Wasting Functional Foods: Going Green

6. Presence of Obesity 65% of Americans are overweight to obese, & of that, >65% of Females are overweight to obese Ref. “Know Your Numbers” campaign., 2003 Florida Keys.

7. Nutrition and Disease

8. The Presence of Malnutrition Ref. Quillin, P., PhD, RD CNS, Beating Cancer with Nutrition, ; Heber, et. al.,JPEN J Parenter Enteral Nutr 1992 >40% CA patients die from malnutrition NOT Cancer; “The overall incidence ranges between 30% and 87%” data from different populations studied.

9. Malnutrition - What is it? It is a state of starvation – a physical condition Caused from inadequate “CAR” : Consumption, Absorption & Retention Protein for building & repairing Carbs & Fats for energy & metabolism Or both called PCM = Protein Calorie Malnutrition. Ref. Shils, M.E. et. Al., “Modern Nutrition in Health & Disease”, 10th Ed., ISBN: 0 7817-4133-5, 2006. ppgs. 730-747.

10. Some Nutrient Deficiencies Happen Over Time. Go unnoticed until it is too late! Weight loss or poor diet is not recognized as a problem. Macronutrients imbalance: Protein, Carbohydrates, Fat Micronutrients: Minerals, Vitamins Phytochemicals, Antioxidants.

11. Definitions Anorexia: Side effect of therapies resulting in poor oral intake of foods (PEG, PEJ,) Cachexia: Pure Malnutrition = 25% to 67% of all CA patients Protein-Calorie Malnutrition = 80% have reduced levels of serum albumin. Sarcopenia: Age related wasting: poor nutrient intake and utilization

12. The Many Faces of Malnutrition

13. Potential Causes of Malnutrition Inattentive caregivers Alcoholism Inappropriate tablemate Anorexia nervosa Poor lighting Dementia Unpleasant odors Depression Excessive noise Late-life paranoia Insufficient time to eat Pacing & wandering Cancer Decline in usual activities Diabetes Embarrassment diarrhea, Renal Failure vomiting….. Difficulty Breathing Loneliness Digestive Issues Temperature of food + - Tires easily Silver. J Am Geriatr Soc. 1988. Environment Psychological Medical Social A Life Change

14. Activity: Energy Balance Issues of Aging and Disease Inactivity, No exercising or moving!

15. Cachexia Population Statistics Ref. :MEGACE ES625mg/5ml (Strativa Pharm. Formerly PAR)

16. Consequences of Malnutrition Body composition changes Metabolic process changes Impaired immunity Decreased wellness & Quality of Life Nutrient deficiencies: Macronutrient: protein, carbohydrates, fat Micronutrient: minerals, vitamins, phytochemicals (antioxidants) Ref. Shils, M.E. et. Al., “Modern Nutrition in Health & Disease”, 10th Ed., ISBN: 0 7817-4133-5, 2006. ppgs. 730-747.

17. Taking a Look at Malnutrition Loss of appetite, Anorexia; Cachexia = involuntary weight loss; There are ↑cytokines; Metabolism is accelerated; Muscle & fat mass become quickly depleted; Blood sugars may be ↑ and/or go Out-of-Control. Ref: 1. Kotler, Ann Intern Med. 2000. 3. Tisdale, Langenbecks Arch Surg. 2004 2. Acharya et al. J Clin Invest. 2004 4. Inui, CA Cancer J Clin. 2002.

18. “Eat Whatever You Want To..” Beware: A clinical statement made to someone with no clinical knowledge.

19. Dirty Dozen & Clean Fifteen

21. Can include foods like cereals, breads and beverages which are fortified with vitamins, herbs and Nutraceutical.

22. The healing power of foods focuses on how "super foods" can have health protecting properties.

24. Natural Foods Work Best Organic Less Processed Eating Like a Cave Man! It is not just twigs, bark, and twine! It is colors!

25. The Super Foods

26. Super Foods 2

27. Nutraceutical A Nutraceutical may be a food or part of a food with a nutrient-rich or medicinally active component such as garlic or soybeans, or it may be a specific component of a food, such as the omega-3 fish oil that can be derived from salmon and other cold-water fish.www.medterms.com

28. Going Green with Food A Marketing Idea: These are products and services based on environmental factors or awareness. Companies involved in green marketing make decisions relating to the entire process of the company’s products, such as methods of processing, packaging and distribution. http://www.answers.com/topic/green-marketing#ixzz1JDTzsSb4

29. Feeding to Fight Cancer Beans-Legumes Flaxseed Green Tea Berries Garlic Soy Cruciferous Grapes/Jc Tomatoes Dark Leafy Herbs Whole Grain Green Ref. www.aicr.org

30. The Warrior Foods & Herbswww.herbal-supplements-guide.com, Herbs for Cancer

31. Pleasure for the Palate Herbs Mint Basil Mint Garlic Rosemary Tumeric

32. Size DOES MatterNo One Size Fits All Here! During starvation: A decrease in glucose production, protein synthesis and protein catabolism. Fat derived fuels, ketone bodies, are used for energy. Of the 54,000 kcal of protein stored in the body cell mass only 50% is available for energy production. Metabolically active muscle is preserved. Ref.Heber, et.al., JPEN, 1992.

33. How Can You Eat and Lose Weight? Some truth about food: 4 small meals are better than 1 - 2 large meals! Nibbling just means calories are out-of-control! Drinking juices is not low calories! Eat your carbs before sundown! Exercising on an empty stomach can ↑ appetite. Foods eaten while standing or on the run Count as Kcals! Keep active AFTER eating.

34. Solutions: Energy Balance as a Lifestyle

35. What is the Difference? Lean Body Mass vs. Fat Mass? Hypothesis: The malnourished cancer patient may be hypermetabolic relative to the amount of lean body mass. Conclusion: This difference was due to both a decrease in body cell mass and Increased REE before the onset of the weight loss. Ref.Heber, et.al., JPEN, 1992.

36. What About Exercise? What is it? Walk after each meal Conduct an orchestra using upper body movement Rock in a rocking chair “toes to nose” technique If bedridden: Move by rolling from side to side every 2-4 hours Roll to one side; sit up slowly; swing legs to the side; slowly stand No scooting or sliding to get out of bed

37. Non-CA, Normal: Talk & Walk Exercise: 60 to 90 Minutes Daily ↓Obesity ↓Insulin Resistance ↑Oxygenation to cells & Wellness Walking continuously gives the greatest benefit. Ref. Silva

39. For males walking 5hr/wk ↓Prostate Ca by 25%

40. And, generally, 90 minutes of walking daily ↓colon Ca by 30%!

42. Summary: Strategies Should be Taught & Used to Enhance Survival We are a nation that can rescue, once someone has fallen off the cliff. We now need to put up stop signs that say: Eat Right and Stay Active America!