the role of nutrition in human health, disease, and aging – a practical approach christopher b....

The Role of Nutrition in Human Health, Disease, and Aging – A Practical Approach

Christopher B. Heward, Ph.D.President – Kronos Science Laboratories, Inc.

IABG 10th Congress - September 2003

Physician: “We think you ate something that triggered some primitive genes?”Patient: “But Doc, what do I do?”

Physician: “Stop eating so much sh__ …garbage!”

Sound Nutritional Advice

The Current Scientific Consensus About Nutrition

USDA Dietary Guidelines

THE USDA FOOD PYRAMIDTHE USDA FOOD PYRAMID

Promotes a grain-basedPromotes a grain-basedlow fat / high carbohydrate diet.low fat / high carbohydrate diet.

1955 1962 1969 1976 1983 1990

34

42

32

36

38

40% Dietary Calories as Fat

% o

f C

alo

ries

fro

m F

at

from Amer Dietetic Assoc 95 417-420(1995)

Year

Dietary Fat Intake and Obesity (US 1955-1990)

% Dietary Calories as Fat

35

32

29

26

23

20

1955 1962 1969 1976 1983 1990

34

42

32

36

38

40

% O

verw

eig

ht

% o

f C

alo

ries

fro

m F

at

from Amer Dietetic Assoc 95 417-420(1995)

Year

Dietary Fat Intake and Obesity (US 1955-1990)

% Overweight

% Dietary Calories as Fat

Actual Causes of Death – United States (1990)

Tobacco 400,000 19%

Diet/Activity Patterns 300,000 14%

Alcohol 100,000 5%

Microbial Agents 90,000 4%

Toxic Agents 60,000 3%

Firearms 35,000 2%

Sexual Behavior 30,000 1%

Motor Vehicles 25,000 1%

Illicit Use of Drugs 20,000 <1%

Cause Estimated Number % of Cause Estimated Number % of TotalTotal

McGinnis et al. - JAMA, November 10, McGinnis et al. - JAMA, November 10, 19931993

Actual Causes of Death – United States (1990)

Tobacco 400,000 19%

Diet/Activity Patterns 300,000 14%

Alcohol 100,000 5%

Microbial Agents 90,000 4%

Toxic Agents 60,000 3%

Firearms 35,000 2%

Sexual Behavior 30,000 1%

Motor Vehicles 25,000 1%

Illicit Use of Drugs 20,000 <1%

Cause Estimated Number % of Cause Estimated Number % of TotalTotal

McGinnis et al. - JAMA, November 10, McGinnis et al. - JAMA, November 10, 19931993

Major Causes of Death in the US

29.6

23

7

5.1

4.1

2.9

2.72.1

1.5 1.3 1.2 1.1 0.8

Cardiovascular Disease

Cancer

Cerebrovascular Disease

Chronic Pulmonary Disease

Accidents

Diabetes Mellitus

Influenza & PneumoniaAlzheimers

KidneySepticemia

Suicide Chronic Liver Disease/Cirrhosis

Hypertension & Hypertensive Renal Disease

Not Shown: 17.6 - Other Source: Minino, AM, Arias, E, Kochanek, et al., Summary National Vital Statistics 2000

The Problem

Visceral FatVisceral Fat

Subcutaneous FatSubcutaneous Fat

Obesity Trends* Among U.S. AdultsBRFSS, 1990

Source: Mokdad A H, et al. J Am Med Assoc 1999;282:16, 2001;286:10.

Height (meters)Height (meters)BMI = BMI =

[Weight (kilograms)][Weight (kilograms)]22

[Height (Inches) / 39.54][Height (Inches) / 39.54]BMI = BMI =

[Weight (Pounds) / 2.2][Weight (Pounds) / 2.2]22

Body Mass Index (BMI)

Body Type BMI RangeUnderweight < 18.5Healthy Weight 18.5 - 24.9Overweight 25.0 - 29.9Obese 30.0 - 39.9Extremely Obese > 40.0

Weight Ranges For Different BMI Scores

Obesity Trends* Among U.S. AdultsBRFSS, 1991

Source: Mokdad A H, et al. J Am Med Assoc 1999;282:16, 2001;286:10.

Obesity Trends* Among U.S. AdultsBRFSS, 1992

Source: Mokdad A H, et al. J Am Med Assoc 1999;282:16, 2001;286:10.

Obesity Trends* Among U.S. AdultsBRFSS, 1993

Source: Mokdad A H, et al. J Am Med Assoc 1999;282:16, 2001;286:10.

Obesity Trends* Among U.S. AdultsBRFSS, 1994

Source: Mokdad A H, et al. J Am Med Assoc 1999;282:16, 2001;286:10.

Obesity Trends* Among U.S. AdultsBRFSS, 1995

Source: Mokdad A H, et al. J Am Med Assoc 1999;282:16, 2001;286:10.

Obesity Trends* Among U.S. AdultsBRFSS, 1996

Source: Mokdad A H, et al. J Am Med Assoc 1999;282:16, 2001;286:10.

Obesity Trends* Among U.S. AdultsBRFSS, 1997

Source: Mokdad A H, et al. J Am Med Assoc 1999;282:16, 2001;286:10.

Obesity Trends* Among U.S. AdultsBRFSS, 1998

Source: Mokdad A H, et al. J Am Med Assoc 1999;282:16, 2001;286:10.

Obesity Trends* Among U.S. AdultsBRFSS, 1999

Source: Mokdad A H, et al. J Am Med Assoc 1999;282:16, 2001;286:10.

Obesity Trends* Among U.S. AdultsBRFSS, 2000

Source: Mokdad A H, et al. J Am Med Assoc 1999;282:16, 2001;286:10.

Obesity Trends* Among U.S. AdultsBRFSS, 2001

Source: Mokdad A H, et al. J Am Med Assoc 1999;282:16, 2001;286:10.

What Do The Experts Say?

• Dr. Atkins’ New Diet Revolution - Atkins

• Protein Power - Eades

• Sugar Busters - Steward

• The Zone - Sears

• Dieting With The Duchess - Sarah

• Volumetrics - Rolls

• The Pritikin Principle - Pritikin

• Choose To Lose - Goor

• Eat More, Weigh Less - Ornish

Comparison of Popular Diets - Macronutrients

Atkins Eades USDA Sears Sarah Pritikin OrnishTotal Fat (g) 110 105 66 30 30 15 10% Total Fat (by weight) 31.3% 31.0% 14.3% 12.3% 8.7% 3.6% 2.5%Total Fat (Calories) 990 945 594 270 270 135 90% Total Fat Calories 55.9% 56.8% 29.7% 26.7% 19.4% 8.6% 6.0%Sat. Fat (g) 36 34 22 8 10 3 2% Sta. Fat (by weight) 10.3% 10.0% 4.8% 3.3% 2.9% 0.7% 0.5%Sat. Fat (Calories) 324 306 198 72 90 27 18% Sat. Fat Calories 18.3% 18.4% 9.9% 7.1% 6.5% 1.7% 1.2%Protein (g) 135 110 62 70 90 95 60% Protein (by weight) 38.5% 32.4% 13.5% 28.8% 26.1% 22.7% 14.9%Protein (Calories) 540 440 248 280 360 380 240% Protein Calories 30.5% 26.4% 12.4% 27.7% 25.9% 24.1% 16.1%Carbs. (g) 60 70 290 115 190 265 290% Carbs (by weight) 17.1% 20.6% 63.0% 47.3% 55.1% 63.4% 72.1%Carbs. (Calroies) 240 280 1160 460 760 1060 1160% Carbs Calories 13.6% 16.8% 57.9% 45.5% 54.7% 67.3% 77.9%Fiber (g) 10 20 20 20 25 40 40% Fiber (by weight) 2.8% 5.9% 4.3% 8.2% 7.2% 9.6% 10.0%Total Intake (g) 351 339 460 243 345 418 402Total Calc. Intake (Calories) 1770 1665 2002 1010 1390 1575 1490

Comparison of Popular Diets - Macronutrients

Atkins Eades USDA Sears Sarah Pritikin OrnishTotal Fat (g) 110 105 66 30 30 15 10% Total Fat (by weight) 31.3% 31.0% 14.3% 12.3% 8.7% 3.6% 2.5%Total Fat (Calories) 990 945 594 270 270 135 90% Total Fat Calories 55.9% 56.8% 29.7% 26.7% 19.4% 8.6% 6.0%Sat. Fat (g) 36 34 22 8 10 3 2% Sta. Fat (by weight) 10.3% 10.0% 4.8% 3.3% 2.9% 0.7% 0.5%Sat. Fat (Calories) 324 306 198 72 90 27 18% Sat. Fat Calories 18.3% 18.4% 9.9% 7.1% 6.5% 1.7% 1.2%Protein (g) 135 110 62 70 90 95 60% Protein (by weight) 38.5% 32.4% 13.5% 28.8% 26.1% 22.7% 14.9%Protein (Calories) 540 440 248 280 360 380 240% Protein Calories 30.5% 26.4% 12.4% 27.7% 25.9% 24.1% 16.1%Carbs. (g) 60 70 290 115 190 265 290% Carbs (by weight) 17.1% 20.6% 63.0% 47.3% 55.1% 63.4% 72.1%Carbs. (Calroies) 240 280 1160 460 760 1060 1160% Carbs Calories 13.6% 16.8% 57.9% 45.5% 54.7% 67.3% 77.9%Fiber (g) 10 20 20 20 25 40 40% Fiber (by weight) 2.8% 5.9% 4.3% 8.2% 7.2% 9.6% 10.0%Total Intake (g) 351 339 460 243 345 418 402Total Calc. Intake (Calories) 1770 1665 2002 1010 1390 1575 1490

Comparison of Popular Diets - Macronutrients

Atkins Eades USDA Sears Sarah Pritikin OrnishTotal Fat (g) 110 105 66 30 30 15 10% Total Fat (by weight) 31.3% 31.0% 14.3% 12.3% 8.7% 3.6% 2.5%Total Fat (Calories) 990 945 594 270 270 135 90% Total Fat Calories 55.9% 56.8% 29.7% 26.7% 19.4% 8.6% 6.0%Sat. Fat (g) 36 34 22 8 10 3 2% Sta. Fat (by weight) 10.3% 10.0% 4.8% 3.3% 2.9% 0.7% 0.5%Sat. Fat (Calories) 324 306 198 72 90 27 18% Sat. Fat Calories 18.3% 18.4% 9.9% 7.1% 6.5% 1.7% 1.2%Protein (g) 135 110 62 70 90 95 60% Protein (by weight) 38.5% 32.4% 13.5% 28.8% 26.1% 22.7% 14.9%Protein (Calories) 540 440 248 280 360 380 240% Protein Calories 30.5% 26.4% 12.4% 27.7% 25.9% 24.1% 16.1%Carbs. (g) 60 70 290 115 190 265 290% Carbs (by weight) 17.1% 20.6% 63.0% 47.3% 55.1% 63.4% 72.1%Carbs. (Calroies) 240 280 1160 460 760 1060 1160% Carbs Calories 13.6% 16.8% 57.9% 45.5% 54.7% 67.3% 77.9%Fiber (g) 10 20 20 20 25 40 40% Fiber (by weight) 2.8% 5.9% 4.3% 8.2% 7.2% 9.6% 10.0%Total Intake (g) 351 339 460 243 345 418 402Total Calc. Intake (Calories) 1770 1665 2002 1010 1390 1575 1490

Comparison of Popular Diets - Macronutrients

Atkins Eades USDA Sears Sarah Pritikin OrnishTotal Fat (g) 110 105 66 30 30 15 10% Total Fat (by weight) 31.3% 31.0% 14.3% 12.3% 8.7% 3.6% 2.5%Total Fat (Calories) 990 945 594 270 270 135 90% Total Fat Calories 55.9% 56.8% 29.7% 26.7% 19.4% 8.6% 6.0%Sat. Fat (g) 36 34 22 8 10 3 2% Sta. Fat (by weight) 10.3% 10.0% 4.8% 3.3% 2.9% 0.7% 0.5%Sat. Fat (Calories) 324 306 198 72 90 27 18% Sat. Fat Calories 18.3% 18.4% 9.9% 7.1% 6.5% 1.7% 1.2%Protein (g) 135 110 62 70 90 95 60% Protein (by weight) 38.5% 32.4% 13.5% 28.8% 26.1% 22.7% 14.9%Protein (Calories) 540 440 248 280 360 380 240% Protein Calories 30.5% 26.4% 12.4% 27.7% 25.9% 24.1% 16.1%Carbs. (g) 60 70 290 115 190 265 290% Carbs (by weight) 17.1% 20.6% 63.0% 47.3% 55.1% 63.4% 72.1%Carbs. (Calroies) 240 280 1160 460 760 1060 1160% Carbs Calories 13.6% 16.8% 57.9% 45.5% 54.7% 67.3% 77.9%Fiber (g) 10 20 20 20 25 40 40% Fiber (by weight) 2.8% 5.9% 4.3% 8.2% 7.2% 9.6% 10.0%Total Intake (g) 351 339 460 243 345 418 402Total Calc. Intake (Calories) 1770 1665 2002 1010 1390 1575 1490

Comparison of Popular Diets - Macronutrients

Atkins Eades USDA Sears Sarah Pritikin OrnishTotal Fat (g) 110 105 66 30 30 15 10% Total Fat (by weight) 31.3% 31.0% 14.3% 12.3% 8.7% 3.6% 2.5%Total Fat (Calories) 990 945 594 270 270 135 90% Total Fat Calories 55.9% 56.8% 29.7% 26.7% 19.4% 8.6% 6.0%Sat. Fat (g) 36 34 22 8 10 3 2% Sta. Fat (by weight) 10.3% 10.0% 4.8% 3.3% 2.9% 0.7% 0.5%Sat. Fat (Calories) 324 306 198 72 90 27 18% Sat. Fat Calories 18.3% 18.4% 9.9% 7.1% 6.5% 1.7% 1.2%Protein (g) 135 110 62 70 90 95 60% Protein (by weight) 38.5% 32.4% 13.5% 28.8% 26.1% 22.7% 14.9%Protein (Calories) 540 440 248 280 360 380 240% Protein Calories 30.5% 26.4% 12.4% 27.7% 25.9% 24.1% 16.1%Carbs. (g) 60 70 290 115 190 265 290% Carbs (by weight) 17.1% 20.6% 63.0% 47.3% 55.1% 63.4% 72.1%Carbs. (Calroies) 240 280 1160 460 760 1060 1160% Carbs Calories 13.6% 16.8% 57.9% 45.5% 54.7% 67.3% 77.9%Fiber (g) 10 20 20 20 25 40 40% Fiber (by weight) 2.8% 5.9% 4.3% 8.2% 7.2% 9.6% 10.0%Total Intake (g) 351 339 460 243 345 418 402Total Calc. Intake (Calories) 1770 1665 2002 1010 1390 1575 1490

Comparison of Popular Diets - Macronutrients

Atkins Eades USDA Sears Sarah Pritikin OrnishTotal Fat (g) 110 105 66 30 30 15 10% Total Fat (by weight) 31.3% 31.0% 14.3% 12.3% 8.7% 3.6% 2.5%Total Fat (Calories) 990 945 594 270 270 135 90% Total Fat Calories 55.9% 56.8% 29.7% 26.7% 19.4% 8.6% 6.0%Sat. Fat (g) 36 34 22 8 10 3 2% Sta. Fat (by weight) 10.3% 10.0% 4.8% 3.3% 2.9% 0.7% 0.5%Sat. Fat (Calories) 324 306 198 72 90 27 18% Sat. Fat Calories 18.3% 18.4% 9.9% 7.1% 6.5% 1.7% 1.2%Protein (g) 135 110 62 70 90 95 60% Protein (by weight) 38.5% 32.4% 13.5% 28.8% 26.1% 22.7% 14.9%Protein (Calories) 540 440 248 280 360 380 240% Protein Calories 30.5% 26.4% 12.4% 27.7% 25.9% 24.1% 16.1%Carbs. (g) 60 70 290 115 190 265 290% Carbs (by weight) 17.1% 20.6% 63.0% 47.3% 55.1% 63.4% 72.1%Carbs. (Calroies) 240 280 1160 460 760 1060 1160% Carbs Calories 13.6% 16.8% 57.9% 45.5% 54.7% 67.3% 77.9%Fiber (g) 10 20 20 20 25 40 40% Fiber (by weight) 2.8% 5.9% 4.3% 8.2% 7.2% 9.6% 10.0%Total Intake (g) 351 339 460 243 345 418 402Total Calc. Intake (Calories) 1770 1665 2002 1010 1390 1575 1490

The Metabolic Imperative

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NO!NO!

Does That Mean You Should Go On A Diet?

Rx For Healthy Nutrition and Weight Control

Diet

• Carbohydrates - 35% (Fruits & Vegetables)

• Proteins - 30% of Calories (Fish, Poultry, Eggs)

• Fats - 35% of Calories (Fish, Meat, Nuts, Oils)

1/3 - Saturated

1/3 - Monounsaturated

1/3 - Polyunsaturated

• Colorful Fruits and Vegetables

Supplements

• Vitamins & Minerals (RDA)

• Omega-3 FA’s (fish oil)

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0.2

0.4

0.6

0.8

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<200 >200

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In the 88,000 Nurses Study, Dietary Vitamin E greater than 200 IU per In the 88,000 Nurses Study, Dietary Vitamin E greater than 200 IU per day was associated with a 41% Decreased Risk for Major Coronary day was associated with a 41% Decreased Risk for Major Coronary Heart Diseases.Heart Diseases.

Vitamin E and Heart Disease

Health Benefits:Health Benefits:• Reduces Risk of Sudden Cardiac DeathReduces Risk of Sudden Cardiac Death• Anti-inflammatory PropertiesAnti-inflammatory Properties• Improves Membrane FluidityImproves Membrane Fluidity• Increases HDL (good) CholesterolIncreases HDL (good) Cholesterol• Reduces Blood PressureReduces Blood Pressure• Reduces Risk of Blood ClotsReduces Risk of Blood Clots• Lowers LP(a) Lowers LP(a)

Eicosapentaenoic Acid (EPA, 20:5w3)Docosahexaenoic Acid (DHA, 22:6w3)

Omega-3 Fatty Acids (fish oil)

Consume ONLY those foods with a nutritional payoff -

NO EMPTY CALORIES!NO EMPTY CALORIES!Consume ONLY those foods with a nutritional payoff -

NO EMPTY CALORIES!NO EMPTY CALORIES!

• VitaminsVitamins

• MineralsMinerals

• WaterWater

• Amino AcidsAmino Acids

• Fatty AcidsFatty Acids

• PhytochemicalsPhytochemicals

X

X

X

X

XXX

Focus On Essentials - Eat Mostly Nutrient-Dense Foods

Avoid Avoid ““Trans” Fats!Trans” Fats!

Avoid Avoid ““Trans” Fats!Trans” Fats!

USDA Revising The Food Pyramid?

What About Caloric Restriction and Aging?

0

20

40

60

80

100

0 10 20 30 40 50 60

Age (months)

Perc

ent

Surv

ival

Adapted From: R. Weindruch et al. , J. of Nutrition, 116:641, 1986

Fully Fed

50% Calorie Restriction

10% Calorie Restriction

60% Calorie Restriction

Typical Survival Curves For Mice On CR Diets

Caloric Restriction In Adult Mice

0

6 12

Age (months)

12991177941Group 4

1040918808Group 3

129612261057Group 2

941822701Group 1

Maximum10th %ileMedian

 Length Of Life In Days 

ad libidum

60% of ad libidum intake

0 6 120 6 12 Age (months)Age (months)

Data from Yu et al. (1985) Figure from Masoro (1989)Data from Yu et al. (1985) Figure from Masoro (1989)

Caloric Restriction In Adult Mice

0

6 12

Group 4 Lifespan Increase: ~40%Age (months)

12991177941Group 4

1040918808Group 3

129612261057Group 2

941822701Group 1

Maximum10th %ileMedian

 Length Of Life In Days 

ad libidum

60% of ad libidum intake

0 6 120 6 12 Age (months)Age (months)

Data from Yu et al. (1985) Figure from Masoro (1989)Data from Yu et al. (1985) Figure from Masoro (1989)

Studies of Late-Onset Caloric Restriction

Adapted From Walford & Weindruch (1989)Adapted From Walford & Weindruch (1989)

5%13%4135393112M50%Rat5

10%8%4539413614M50%Mouse4

18%30%3330282312M50%Hamster3

15%24%3026262112M50%Mouse2

0%44%3026301812M50%Rat1

MaxAveMaxAveMaxAveOnsetCRAnimalStudy

Ad libidumAd libidum RestrictedRestricted % Increase% Increase

Length Of Life In Months

Studies of Late-Onset Caloric Restriction

Adapted From Walford & Weindruch (1989)Adapted From Walford & Weindruch (1989)

5%13%4135393112M50%Rat5

10%8%4539413614M50%Mouse4

18%30%3330282312M50%Hamster3

15%24%3026262112M50%Mouse2

0%44%3026301812M50%Rat1

MaxAveMaxAveMaxAveOnsetCRAnimalStudy

Ad libidumAd libidum RestrictedRestricted % Increase% Increase

Length Of Life In Months

The Payoff From A Successful Caloric Restriction Diet

• Constant Hunger• Abnormal Focus On Food (24hrs./day)• Loss of Libido (reproductive function)• Increased Life Expectancy

Payoff:– If, starting at age 50, you do CR successfully

for 30 years, then when you are 80 years old, you will function as though you were only 70.

~33% Retardation of Aging Rate

This is just NOT enough for most people!

Adapted From: British Medical Journal, 1997; 314: 1311-1317 Adapted From: British Medical Journal, 1997; 314: 1311-1317

0

5

10

15

20

25

<20 20 22 24 26 28 30

Body Mass Index

Death

s/1

000/y

ear

All Cause Mortality

Height (meters)Height (meters)BMI = BMI =

[Weight (kilograms)][Weight (kilograms)]22

BMI and All Cause Mortality

Lee CD et al. Am J Clin Nutr 1999.

0

0.5

1

1.5

2

2.5

Lean Normal Obese

Ris

k o

f D

eath

Unfit Fit

<16% 16-25% 25%

Ris

k o

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Fit-Fat & Mortality In Men

% Body Fat% Body Fat

• 173 Sedentary, overweight, post-menopausal women• Exercise group: 45 minutes, 5 day/day X 1 year• 3 months 3 d/week supervised & 2 days

unsupervised • 9 months 1 d/week supervised & 4 days

unsupervised-2.86

-8.5

0.22 0.1

-9-8-7-6-5-4-3-2-101

Weight (lbs) Visceral Fat(g/cm2)

Exercise Control

(1.6%)

(5.7%)

p< 0.05 for change in weight and VF JAMA- Jan 15, 2003: Vol 289(3)

Effect of Exercise On Total and Visceral Body Fat

Conclusions

• Americans are too fat – and getting fatter.• The best diet is to reduce caloric intake without reducing

nutritional intake.• Take high quality dietary supplements that include:

– Vitamins and Minerals (RDA)

– Fish Oil

– Vitamin E

• The benefits (if any) of serious CR diets are not worth the effort for most people.

• Exercise may help compensate for some of the negative health affects of obesity.