1. The document discusses using food choices to control inflammation in the body and reduce the risk of chronic diseases like heart disease and cancer. 2. It recommends following an anti-inflammatory diet like the Mediterranean diet, which is high in vegetables, fruits, whole grains, fish and healthy fats. 3. Research studies have shown that following a Mediterranean diet is associated with reduced risk of death from all causes as well as specific diseases.

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

2. First Health Associates2010 S. Arlington Heights RdLL SuitesArlington Heights, ILMy Doctor:Listens to my concerns

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 ApproachWe didn’t invent the practice of medicine…. we’re just changing the way it’s provided.

7. Your Community of CareRic Saguil, MDJason Gruss, MDTom Jordan, RDKatrina Christie, LCPCJennifer Green, NDJoe Musolino, DCAmy Iaquinta, DCNick Nowicki, DCEmery Paredes, PTCourtney Day, EPYu Zhu, MD ChinaMike Blumberg, LCPCYou

8. Japanese death toll9700 dead 16,501 missing

9. Heart disease233,000 women die annually19416.7 women will die this month4854.2 women will die this week1.5 million heart attacks annually500,000 die annuallyCardiac event every 26 seconds1 Death every minute

10. Cancer death rateAmerican cancer society says 1,527,560 new cancer cases 2010569,490 deaths 201047,457.5 deaths per month 201011,764.4 deaths per week 2010Prostate, lung and colorectal = ½ menBreast, lung and colorectal = ½ womenLifetime 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 inflammationHow its involved with injury, heart, cancerHow 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 responseActivation of the inflammatory cascadeFirst lets talk about inflammation in easy terms……

13. Muscle injury:A twist, roll, bend or fall occurs with immediate painStiffness and spasm set in by one dayOther areas start to spasm in a weekSoft 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 prevailCompensating areas start to fail when they can’t do the work of the originally injured part

14. Electron microscope

15. Inflammatory phase starts day 0-5BleedingPMN’sMacrophages and platelets stimulates GFProliferative phase from day 5-21GF stimulates endothelial cells, fibroblasts and myofibroblastsMacrophages continueMaturation phase from day 21-wheneverFibroblastsIncreased collagen and tensil strengthThe ProblemWhen tissue is torn or stretched:

16. When tissue damage occurs, the “cascade” startsNormal tissues*stomach*kidneys*platlets*endotheliumInflammatory sites*macrophages*synoviocytes*fibroblasts

17. Nonselective cox2Normal tissues*stomach*kidneys*platlets*endotheliumInflammatory sites*macrophages*synoviocytes*fibroblastsRegular NSAIDs block here

18. corticosteroidsNormal tissues*stomach*kidneys*platlets*endotheliumInflammatory sites*macrophages*synoviocytes*fibroblastsSteroids block here

19. Cox-2Normal tissues*stomach*kidneys*platlets*endotheliumInflammatory sites*macrophages*synoviocytes*fibroblastsCox 2 used to block here

20. Non standard prescription supplements by doctorsLimbrel (flavocoxid) Severe OALovaza (omega 3 acid ethyl esters)Severe HypertriglyceridemiaSynvisc-One (hylan G-F 20) Severe OA “-prescription foods”

21. Standard Anti-inflammatory prescriptions by doctorsNSAIDsSteroids (oral or injectable)DMARDs

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

23. RestIceCompressionElevationTherapy (my next lecture)NSAIDsSteroids(injection or pills)Muscle relaxers and narcotics (“pills 4 pills”)Standard approach always works:

24. The Saguil approach to an injured patient:Turmeric 400mg tidMagnesium 100mg tidVitamin D 3 2000IUHold on dairyHold processed meats (processed anything)Increase fluidsIncrease plant based products (f&v)Do no further harm, but keep active

25. Once injured, stop the injury?Skeletal muscleBone and/or TendonCardiac Muscle?Soft tissue (pancreas)?Abnormal tissue (cancer)?

26. Antiinflammatory EatingIt is a Lifestyle not a DietFood can killFood can healMedicines are a temporary fixThe concept of marketing food/concept of marketing pillsThe science of nutrition

27. Mediterranean dietTraditional foods 1950’s-60’s around the medTunesia morocco turkey franceitalygreeceOOMore mono less room for sat fatWhole grainsWineFish 2xweekF&V (yes….plants)

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

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

30. OOArbicana grassyMoreola hot…..First pressed extra virgin olive oil usually not green and blandUsed like wine depending on meal in the mediterranean77% 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 1yrJ 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 cognitionSo 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 TrialIntensive 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 arteriesRegression in 5 years of coronary plaques vs progression and 2x as many events 28 people 5 years

35. NIH-AARPWatched 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 monthsA coronary artery bypass surgeryCurrent stable angina pectorisHeart valve repair or replacementPercutaneous transluminal coronary angioplasty or coronary stentingA heart or heart-lung transplantPaid 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 weeksOrnish research has been out for 16 yearsHow many died waiting for approval?

38. First symptom of heart disease:60% of men is massive MI or death50% of women is massive MI or death…who should run to get a physical next week?

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

40. Framingham StudyOngoing study with generation repeatsHas shown the relationship of heart disease to DM, HBP, Cholesterol, GenesAbout 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 cannonHerbals = smart bomb

43. PharmaceuticalsCame on scene in the late 80’sThey do work!You are on them “for life!?!”

44. Meet your meds:Advicor

45. Questran

46. Welchol

47. Zetia

48. Crestor

49. Lipitor

50. Zocor

51. Pravachol

52. Niaspan

53. Lopid

54. Tricor

55. VytorinTesting 1,2,3Standard bloodFractionated cholesterolUltra fast CTStress TestingAngiography with transluminal ultrasound

56. The Saguil approach to High CholesterolGet a doc that listens to historySee a registered dietician that walks the walkLook for a Naturopath (NU Lombard)Commit to lifestyle change (do it with or for)Join a communityDon’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/pHPaleolithicVegetarian/Vegan/RawMany are great but in the end, can it be sustained for life?

58. Raw Foodhttp://worldpeacefood.blogspot.com/

59. macronutrientsCarbohydratesProteinsFats

60. CarbohydratesOld rating = simple and complexNew = glycemic index and load

61. Glycemic IndexFood absorption is compared to glucose absorbed in the blood stream over timeGroups of volunteers the amount of food that will give 50 grams of carbohydrateCompare the tested carb to glucose absorption and give a number higher/lower www.glycemicindex.com

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

66. When high is indulgedThe gut stress response is turned onCatecholamine, glucagon, cortisol, growth hormoneBlood sugar below baseline occurs “reactive hypoglycemia”Craving starts instinctively for starchy foods, feel ravenously hungry=out of control eatingAthletes go for high GI post workout +/_

67. Food studiesPam: please eat something for breakfastBryan: 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-NutrigenomicsGenes 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 DMHigh GI up regulated 62 diff genes many related to inflammation and oxidative stress

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

70. Other food rating systems ONQI (unhealthy/healthy=number)NuValAggregate Nutrient Density Index Dr. Joel FuhrmanCalcium, 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 evaluatedChicken 39 less than Turkey 48Goldfish crackers 20, pickled beets 8NuValhttp://www.nuval.com/Scores/List/

73. ProteinsIts not just beef that gives musclePlant 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 containsGetting better fats-ie soy with O3fa10-20% 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, MD1 cup rice, soy or oat beverage3 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 regularly2 tbsp brown rice syrupFruit for flavor (optional; if used, count as 1 fruit serving)Put all ingredients in a blender, blend and chillThe 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, MDLegumesAduki beansAnasazi beansBlack beansBrown beansChickpeas (garbanzo)Fava beansLentilsLima beansMung beansPeasPinto beansSplit peas (green yellow)White beans (canellini, great northern, navy)TempehTofuSoybeansedamameCook with kombueas per Wendy Kohatsu

77. Ocean and fresh water fish (uncontaminated sources)Veggie burgersEgg 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 beefProtein examplesKeith Block, MD

78. FatsLimit Sat Fat (as Andy says, sat fat budget)Say yes to mono or unsat fatMake Expeller Rressed Extra Virgin Olive Oil your go to oil good ratio, polyphenols fraction of aoConsider 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 morbidityQuality not the quantity of fats…..discuss!

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

82. Honorable mention: Whole grainsWild riceBarleyQuinoaMilletWheat berriesVisible pieces of grainDense pumpernicle (denture wearers beware!)

83. Real Grains

84. breads