DIETS, NUTRITION AND

LIVING LONGER

Charlene LePane DO, MSPH FASGE FACG FACOI

Site Director AdventHealth GI Fellowship

Asst Professor Internal Medicine NSUCOM, KCUMB, LECOM

AdventHealth Medical Group

TOPICS TO DISCUSS

• Nutrients:

– (macro=carbohydrates, protein and fat)

– (micro=vitamins and minerals)

• Elements

• Diets: keto, vegan, gluten-free, paleo

• How to live longer

VITAMIN A BENEFITS

• Keeps tissues and skin healthy (tretinoin topical Retin-A reduce appearance of fine wrinkles and treat acne)

• Plays an important role in bone growth and in the immune system

• Diets rich seems to lower lung and prostate cancer risk

• Carotenoids act as antioxidants

• Foods rich may protect against cataracts

• Retinoids and Carotene

• Includes retinol, retinal, retinyl esters, and retinoic acid referred to as “preformed” vitamin A (lipid soluble vitamin found in animal fat sources)

• Beta carotene (vegetable sources) can easily be converted to vitamin A as needed

VITAMIN A RDA

• 900 mcg (3,000 IU) (upper limit 3000mcg or 10,000 IU)

• Sources of retinoids:

– beef liver, eggs, shrimp, fish, fortified milk, butter, cheddar cheese, Swiss cheese

• Sources of beta carotene:

– sweet potatoes, carrots, pumpkins, squash, spinach, mangoes, turnip greens

VITAMIN A DEFICIENCY *

• It is the world's leading cause of preventable blindness in children

• Increases the risk of disease and death

• In pregnant women night blindness and increase risk of maternal mortality

THIAMINE (VITAMIN B1)

• Needed for healthy skin, hair, muscles, and brain and nerve function

• M 1.2 mg, W 1.1 mg

• Pork chops, brown rice, ham, soymilk, watermelons, acorn squash

THIAMINE (VITAMIN B1) :

• Thiamin (vitamin B1) convert carbohydrates into energy (nervous system)

• Helps muscle contraction and conduction of nerve signals

• Deficiency called beriberi and can cause weakness, fatigue, psychosis and nerve damage

• Alcoholics are at high risk

THIAMINE (VITAMIN B1)

• Fatigue and anorexia

• Indigestion or constipation d/t improper muscle tone in the GI tract

• Muscle tenderness

• Numbness in the arms and legs d/t improper nerve function

• Beriberi-a chronic neurological and cardiovascular disease

• Wenicke-Korsakoff syndrome-causes brain abnormalities, opthalmoplegia

RIBOFLAVIN (VIT B2) SOURCES

• M 1.3 mg, W 1.1 mg

• Helps convert food into energy

• Needed for healthy skin, hair, blood, and brain

• Milk, Eggs, Yogurt, Cheese, Meats

• Green leafy vegetables

• Whole and enriched grains and cereals

RIBOFLAVIN (VIT B2) DEFICIENCY

• cheilosis (lesions on the lips)

• angular stomatitis (cheleitis) (lesions on the angles of the mouth typically caused by yeast)

• glossitis (fissured and magenta-colored tongue)

• corneal vascularization

• dyssebacia (red, scaly, greasy patches on the nose, eyelids, scrotum, and labia)

• normocytic, normochromic anemia

NIACIN (VIT B3) *

• Helps convert food into energy

• Essential for healthy skin, blood cells, brain, and nervous system

• Lowers LDL ,increase HDL and lower triglycerides

• Taking too much niacin causes flushing, (especially with ETOH)

– Aspirin reduces this flushing

• M: 16 mg, W: 14 mg

• Meat, Poultry, Fish, fortified and whole grains, Mushrooms, Potatoes, Peanut butter

NIACIN (VIT B3) DEFICIENCY

• PELLAGRA

• Dermatitis

• Dementia

• Diarrhea

• Death

PANTOTHENIC ACID (VIT B5)

• Helps convert food into energy

• Helps make: – Lipids

– Neurotransmitters

– steroid hormones

– hemoglobin

• Helps create CoA along with cysteine, adenosine and triphosphate – CoA involved in synthesis and

oxidation of FA and oxidation of pyruvate in Krebs cycle

• M: 5 mg, W: 5 mg

• Chicken

• egg yolk

• whole grains

• Broccoli

• Mushrooms

• Avocados

• tomato products

PANTOTHENIC ACID (VIT B5) DEFICIENCY

• Burning feet

• Fatigue

• Headaches

• Tingling in hands and feet

• Nausea

• Irritability

• Insomnia

PYRIDOXINE (VIT B6)

• Aids in lowering homocysteine is a non-proteinogenic α-amino acid and is biosynthesized from methionine (essential AA) by the removal of its terminal methyl group

• May reduce the risk of heart disease (high levels of homocysteine associated with heart disease)

• Studies show an extra dose B6 helps relieve morning sickness

• Helps convert tryptophan to serotonin neurotransmitter that plays key roles in sleep, appetite, and moods

PYRIDOXINE (VIT B6)

• Helps make norepinephrine

• Influences cognitive abilities and immune function

• Allows the body to use and store energy from protein and carbohydrates to form hemoglobin

• Without this vitamin the thyroid cannot utilize its iodine raw material efficiently to make the hormones

• Studies show individuals with a deficiency in Vit B6 are 3.5 times more likely to have a cognitive decline in adulthood

• Skin inflammation, scaly dermatitis, anemia, depression, dizziness, nausea and sores in mouth

• COMMON DEFICIENCY

PYRIDOXINE (VIT B6)

• Long term high doses of vitamin B6 can be toxic and may result in nerve damage loosing control of body movements

• 31–50 years old: M: 1.3 mg, W: 1.3 mg

• 51+ years old: M: 1.7 mg, W: 1.5 mg

• Meat

• Fish

• Poultry

• Legumes

• Tofu and soy products

• Potatoes

• Non-citrus fruits such as bananas and watermelons

COBALAMIN (VIT B12)

• Aids in lowering homocysteine levels and may lower the risk of heart disease

• Assists in making new cells and break down fatty acids and amino acids

• Protects nerve cells and encourages growth

• Helps make RBCs and DNA

• M: 2.4 mcg, W: 2.4 mcg

• Meat, Poultry, Fish, Milk, Cheese, Eggs, Fortified cereals, Fortified soymilk

CAUSES OF B12 DEFICIENCY

• Pernicious anemia(parietal cells IF and acid)

• Dietary deficiency (vegan)

• Malabsorption

– Crohns disease

– Chronic pancreatitis

– Whipple’s disease

– Parasite

• Post surgical malabsorption

– Gastrectomy

– Terminal ileum resection

• Atrophic gastritis

• Chronic H pylori infection

• Chronic antacid use>12 mo

• Chronic alcoholism (malnutrition)

• Use of metformin >4 mo (interferes with Ca-dependent membrane for B12-IF absorption)

COBALAMIN (VIT B12) DEFICIENCY *

• Pernicious anemia is the most common cause of B12 deficiency:

– Autoimmune; attack against parietal cells (IF)

– extreme lack of energy

– pins and needles (paresthesia)

– sore and red tongue

– muscle weakness

– depression

– problems with memory, understanding, and judgement

BIOTIN (VITAMIN B7)

• Helps convert food into energy and synthesize glucose

• Helps make and break down some fatty acids

• Needed for healthy bones and hair

• Biotin is essential for the metabolism of fat and only a tiny amount is required

• Some is made by bacteria in the GI tract

• Not clear how much of this the body absorbs

• M: 30 mcg, W: 30 mcg

• Whole grains, Organic meats, Egg yolks, Soybeans, Fish

BIOTIN

• Taking a biotin supplement could cause falsely elevated or suppressed thyroid levels

– avoid taking any biotin supplements at least a day or two before blood test to ensure accurate results

• May be a helpful adjunct in the treatment of multiple sclerosis (MS) by improving myelin repair and facilitating cellular energy production

• Biotin plays a role in energy production

• Commonly used to remediate neurological problems, alopecia and skin conditions (acne, eczema)

BIOTIN DEFICIENCY

• Alopecia

• Conjunctivitis

• Dermatitis with scaly, red rash around the eyes, nose, mouth, genitals

• Neurological symptoms such as depression, lethargy, hallucination and paresthesia

ASCORBIC ACID (VIT C)

• Foods rich in vitamin C may lower the risk for some cancers, including those of the mouth, esophagus, stomach, and breast

• Long-term use of supplemental vitamin C may protect against cataracts

• Helps make collagen; connective tissue that binds wounds and supports blood vessel walls

• Helps make the neurotransmitters serotonin and norepinephrine

• Acts as an antioxidant, neutralizing unstable molecules that can damage cells

• Bolsters the immune system

• M: 90 mg, W: 75 mg Smokers: Add 35 mg (to counteract the damage that smoking causes to cells)

ASCORBIC ACID (VIT C) DEFICIENCY

• Deficiency disease is called scurvy

• Deficiency symptoms:

– Anemia

– Atherosclerotic plaques and pinpoint hemorrhages

– Bone fragility and joint pain

– Poor wound healing and frequent infections

– Bleeding gums and loosened teeth

– Muscle degeneration and pain, hysteria and depression

– Rough skin and blotchy bruises

• Evidence that vitamin C helps with colds not convincing

• fruits and fruit juices (especially citrus)

• potatoes

• broccoli

• bell peppers

• Spinach

• Strawberries

• Tomatoes

• brussels sprouts

CALCIFEROL (VIT D)

• Helps maintain normal blood levels of calcium and phosphorus, which strengthen bones

– Calcium cannot be absorbed without vitamin D

• Helps form teeth and bones

• Supplements can reduce the number of non-spinal fractures

• Some reports suggest as much as 42% of the US population has a Vitamin D deficiency

• Fortified milk, margarine, fortified cereals, fatty fish

CALCIFEROL (VIT D) DEFICIENCY

• Rickets in children

– Imperfect calcification, softening and distortion of the bonesbowed legs

• Weakness, aches, and pains in adults where bones don't have enough calcium, called osteomalacia in adults

ALPHA-TOCOPHEROL (VIT E) • Acts as an antioxidant, neutralizing unstable molecules that can

damage cells

• Protects Vitamin A and certain lipids from damage

• Does not prevent wrinkles or slow aging processes

• Deficiency unlikely; stored in body

• Helps maintain healthy skin and eyes, while also strengthening the immune system

• Current research finding vitamin E may help slow the growth of dementia, particularly Alzheimers

• Studies demonstrate Vit E decreases risk for prostate, lung, colon cancer

• Vegetable oils, wheat germ, leafy green vegetables, whole grains, nuts

FOLIC ACID (VIT B9, FOLATE)

• Vital for new cell creation

• Helps prevent brain and spine birth defects when taken early in pregnancy; should be taken regularly by all women of child-bearing age since women may not know they are pregnant in the first weeks of pregnancy

• Can lower levels of homocysteine and may reduce heart disease risk

• May reduce risk for colon cancer

• Offsets breast cancer risk among women who consume alcohol

• Sickle Cell Anemia (d/t hemolysis) needs folic acid

• M: 400 mcg, W: 400 mcg

FOLIC ACID (VIT B9, FOLATE) SOURCES

• Fortified grains and cereals

• Asparagus

• Okra

• Spinach

• turnip greens

• Broccoli

• legumes like black-eyed peas and chickpeas

• orange juice

• tomato juice

FOLIC ACID (VIT B9, FOLATE) DEFICIENCY

• Anemia(MACROCYTIC), fatigue, weakness, diarrhea, loss of appetite and weight loss

• heart palpitations

• sore tongue

• behavioral disorders

• B12: MMA elevated and homocysteine elevated

• Folate: MMA normal, homocysteine elevated

• Common deficiency

• Occasionally, folic acid masks a B12 deficiency, which can lead to severe neurological complications (check MMA)

FOLIC ACID (VIT B9, FOLATE) DEFICIENCY: CAUSES

• Phenytoin (Dilantin)

• Trimethoprim-sulfamethoxazole

• Methotrexate

• Sulfasalazine

• Antacids/PPI

• Bile acid sequestrants

• Crohns disease

• Celiac disease

• Hemodialysis

• Genetic mutation that hinders conversion of folate to methylfolate

PHYLLOQUINONE, MENADIONE (VIT K)

• Activates proteins and calcium essential to blood clotting

• May prevent hip fractures and keep bones healthy

• M: 120 mcg, W: 90 mcg

• Intestinal bacteria make a form of vitamin K that accounts for half your requirements, deficiency rare

• If you take an anticoagulant, keep your vitamin K intake consistent

• Cabbage, liver, eggs, milk, spinach, broccoli, sprouts, kale, collards, and other green vegetables

MINERALS

CALCIUM 1000mg <50, 1200 mg>50

• Builds and protects bones and teeth

• Muscle contractions and relaxation, blood clotting, and nerve impulse transmission

• Hormone secretion, enzyme activation, maintains healthy blood pressure

CHROMIUM(TRIVALENT)

50-200 ug

• Enhances the activity of insulin

• Helps maintain normal blood glucose levels (pre-diabetics and diabetics)

• Needed to free energy from glucose

• Weight loss supplement

MINERALS

COPPER 900 ug

• Iron metabolism and immune system

• Helps make RBCs

FLUORIDE few mg daily (water, toothpaste)

• Encourages strong bone formation

• Keeps dental cavities from starting or worsening

MINERALS

IODINE 150 ug

• Part of thyroid hormone

• Helps set body temperature

• Influences nerve and muscle function, reproduction, and growth

• Prevents goiter and a congenital thyroid disorder

IRON (17-19 mg women and 19-20.5 mg men)

• Helps hemoglobin in red blood cells and myoglobin in muscle cells carry oxygen throughout the body

• Helps make amino acids, collagen, neurotransmitters, and hormones

MINERALS

MAGNESIUM 350-360 mg

• Needed for many chemical reactions in the body

• Works with calcium in muscle contraction, blood clotting, and regulation of blood pressure

• Build bones and teeth

MANGANESE 9 mg

• Helps form bones

• Helps metabolize amino acids, cholesterol, and carbohydrates

MINERALS

MOLYBDENUM 45 ug

• Helps ward off a form of severe neurological damage in infants that can lead to early death

PHOSPHORUS 2.5-4.5 mg/dl

• Helps build and protect bones and teeth

• Part of DNA and RNA

• Helps convert food into energy

• Part of phospholipids

MINERALS

POTASSIUM

• Balances fluids in the body

• Helps maintain regular heartbeat and propagate nerve impulses

• Needed for muscle contractions

• A diet rich in potassium seems to lower blood pressure

SELENIUM

• Acts as an antioxidant, neutralizing unstable molecules that can damage cells

• Helps regulate thyroid hormone activity

MINERALS

SODIUM <2300 mg

• Balances fluids in the body

• Helps send nerve impulses

• Needed for muscle contractions

• Impacts blood pressure; even modest reductions in salt consumption can lower blood pressure

SULFER no RDA

• Helps form bridges that shape and stabilize some protein structures

• Needed for healthy hair, skin, and nails

MINERALS

• Helps form many enzymes and proteins and create new cells

• Frees vitamin A from storage in the liver

• Needed for immune system, taste, smell, and wound healing

• When taken with certain antioxidants, zinc may delay the progression of age-related macular degeneration

ZINC 8 W 11 M

10 tips for healthy eating Harvard School of Public Health

• Choose good carbs, not no carbs. Whole grains are your best bet.

• Pay attention to the protein package. Fish, poultry, nuts, and beans are the best choices.

• Choose foods with healthy fats, limit foods high in saturated fat, and avoid foods with trans fat. Plant oils, nuts, and fish are the healthiest sources.

• Choose a fiber-filled diet, rich in whole grains, vegetables, and fruits.

10 tips for healthy eating Harvard School of Public Health

• Eat more vegetables and fruits. Go for color and variety—dark green, yellow, orange, and red.

• Calcium is important. But milk isn’t the only, or even best, source.

• Water is best to quench your thirst. Skip the sugary drinks, and go easy on the milk and juice.

• Eating less salt is good for everyone’s health. Choose more fresh foods and fewer processed foods.

• Moderate drinking can be healthy—but not for everyone. You must weigh the benefits and risks.

• A daily multivitamin is a great nutrition insurance policy. Some extra vitamin D may add an extra health boost.

KETO DIET

Minimizing your carbs to have body use fat for energy

60-75% of your calories from fat

15-30% of your calories from protein

5-10% of your calories from carbs

PALEO DIET

Foods that in the past~10,000 years ago could be obtained by hunting and gathering

VEGAN DIET

A vegan diet excludes all animal products

Many people choose to eat this way for ethical, environmental or health reasons

GLUTEN FREE

MAKE A DIFFERENCE?

• Organic foods cost upwards of > 60 % than conventional alternatives

• Eating organic makes a difference in your chemical exposure; less pesticide and other chemical residues

HOW TO LIVE LONGER

1. Don't smoke

2. Enjoy physical and mental activities every day

3. Eat a healthy diet rich in whole grains, vegetables, and fruits, and substitute healthier monounsaturated and poly-unsaturated fats for unhealthy saturated fats and trans fats

Mediterranean Diet is well-known as one of the world's healthiest

4. Take a daily multivitamin, and be sure to get enough calcium and vitamin D

5. Maintain a healthy weight and body shape

HOW TO LIVE LONGER

6. Challenge your mind, keep learning and trying new activities

7. Build a strong social network

8. Follow preventive care and screening guidelines

9. Floss, brush, and see a dentist regularly

10. Ask your doctor if medication can help you control the potential long-term side effects of chronic conditions such as high blood pressure, osteoporosis, or high cholesterol

11. Napping for 30 minutes per day could cut your risk of heart disease by up to 30%, according to research from Harvard School of Public Health

Scientists suspect a daily nap reduces stress hormones in the body

THANK YOU clepane@Hotmail.com