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Nutrition Rikki Keen, MS, RD, CSCS, CSSD

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Disclosures & Affiliations UAA Adjunct Faculty Athletic Dept/Sports Medicine Human Performance Lab ESPN WWOS, Training Facility Columbus Crew MLS Florida Hospital, Orlando Alyeska Pipeline Co. FRS Healthy Performance, Scientific Advisor 2

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Goals Educate on Diet & Metabolism & Genes & YOU Understand Not all calories are created equal Reduce risk of chronic diseases; CVD, DM, Hypertension, Cancer, Enhance Immune system Better Engine, Better Energy Track Health Markers blood work, measurements Promote Healthy Lifestyle 24/7

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4 You are what you eat!

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Wise words! "Let your food be your medicine, and your medicine be your food." Hippocrates

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Diet & Genetics

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Its a Journey

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Genetics & Nutrients Genes are turned on and off by regulatory genes, and regulatory genes are controlled mainly by nutrients, there are no drugs anywhere that can regulate genetic expression better or more powerful than diet.

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Act as Vasodilators relaxes the tone of blood vessels Less sticky platelets Foods: Beets, spinach, Butterhead Lettuce Dose: 2 cups/day. 300 mg Nitrate peak 1 hr (blood), Nitrite 2.5-3 hr Avg intake US 60-120 mg 9 Nitrates Nitrites Nitric Oxide

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Oleic acid Reduce joint pain inflammation 4 tsp/d. 12 weeks. EVO; oleocanthol. Blocks COX1, 2. (Nature 2005) Extra virgin oil (not refined) + Fish oilMediterranean diet Add spices, pressed garlic 1 TB = 126 cal, 14 gm fat 10 Olive Oil

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Real Food = Real Health 11

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Dark Chocolate - study, 2014 40 grams (1 bar), 85% cocoa Within 2 hrs, walk test Subjects; atherosclerosis Walked +15% further How? Nitric oxide effect No claim in US, Claim in Europe (200 mg flavanols) = CocoVia. 250 mg. ~$1.25 or Tb Navitas Nibs. = Hersheys Special Dark Choc bar (45%). 142 mg flavanols. 225 cal. 1.5 bars.

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Keep it real! Sugar, honey Avoid/limit artificial sweeteners Whole milk vs creamers Real cheese/aged vs cheese food, low fat cheese slices Butter (+olive oil) vs Margarine Use spices, seasonings for flavor Raw to roasted, saut; add olive oil, blend foods

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My Breakfast Breakfast: 1c coffee/milk/sugar/whey protein. 1 egg, c shredded cheese, ckd sauted spinach (olive oil), 1 slice Daves Killer Bread, smear butter, drizzle honey 30 gm carb, 30 gm protein, 20 gm fat 400-425 calories. Your Turn?

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Mindful eating Do you know when you are full? Do you know when you are hungry?

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Biggie Size Society 16

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Portion Sizes 17 Eat off of a 9-inch plate for your largest meal of the day for one month. 19852005 2010 Sports Cardiovascular and Wellness Nutrition (SCAN)

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Real vs. Recommended

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Same calories = same nutrients? Vitamin C 8.4 mg Beta Carotene 1688 mcg Lutein/Zeaxanthin 1087 mcg Vitamin C 1.5 mg Beta Carotene 164 mcg Lutein/Zeaxanthin 152 mcg

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Sugar Type Matter? Fructose: 100 gm/day, 400 cal 1 20 oz soda = 35 gm fructose 1 apple = ~10 gm Fruit - saved by the fiber content, slows absorption. Excess of all sugars = overweight, inflammation, higher lipid profile (cholesterol, TG, LDL), poor mood/brain health.

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Liquid calories 21

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Sneaky Calories Soda125-190 calories (12 oz) Sweet tea 130-145 calories (12 oz) Juices160-200 calories (12 oz) Beer 100-150 calories (12 oz) Rockstar 280 calories (16 oz) Mocha 300 cal (Tall, 12 oz)

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Occupational Hazards Busy Stations; Large Portions, Late night eating, On the go (Prov, ARH) Slower Stations; Snacking when your not hungry, Portion Control Dinner Clubs healthy menus, portions Tradition - portions Irregular schedule/sleep pattern Night time eating..plan for meal #7, #8 Large meals between calls/limited time

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Hormone Levels Effected Leptin, Ghrelin Musculoskeletal system Inflammatory arthritis, Osteoporosis Respiratory system Sleep apnea, asthma risk, less lung volume Digestive System Acid reflux occurs more frequently putting an individual at risk for esophageal cancer

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Typical Office Job

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Perform as a Tactical Athlete: Train & Eat like one Work under strenuous and physically demanding conditions. Gear and SCBA can weigh up to ~75 lbs+ Expected to lift, carry, or pull objects weighing 80 to 135+ lbs Study, 2008 (Orange County Fire Dept) Initial alarm call increased HR (avg) ~170 bpm While dressing in PPE, HR (avg) increased more than 50 bpm over resting rate.

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Is your HEART ready? FF climbing stairs w/ gear and equipment for 5 min. ~ 95% of max HR effort during the climb Study, 1996 40 min Rescue Drill. Average max HR to 182 bpm. Example; 50 yo, 170 bpm, est HR max Plus add + Heat? Mental Stress? Confined Space?

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High CVD Risk CDC (2006) on fatalities among volunteer and career firefighter: 610 Volunteer, 368 Career - LODD 50% Volunteer, 39% Career Heart Attacks, #1 cause FF increased potential for MI working at ~90-95% HR max Low cardiorespiratory fitness, inactive Overweight Sub-clinical or Dx: high lipids, HTN, DM Stress/Pressure on Arteries..plaque?....MI or Stroke

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Hypertension Monitor blood pressure FF 12x more likely to die of CV event FF at higher risk than DM, smoking, or high cholesterol NFPA. 2011: 31 MI. 22 known medical hx. 59% HTN 2012: 27 MI. 70% HTN. + other risk factors (obesity, smoking, DM, high cholesterol, hx CVD)

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HTN Triggers Obesity accounts for ~78% risk Age..I disagree, counter w/ exercise, healthy weight & diet. Stress (work, home, etc) Sleep apnea High salt diet.salt sensitive?

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Energy Drinks & Health Tachycardia ( Heart Rate), arrhythmia, MI* Blood Pressure Platelet aggregation, endo function (Worthley 2010) Seizures, Anxiety, Sleep issues + Strenuous Activity + Heat + Dehydration Increased Emergency Room visits (2007 to 2011) 60% adverse effect 27% + Rx drugs 13% + Alcohol

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Best HTN Treatment: Lifestyle Changes Weight loss; ~2 lbs loss = ~2 mmHG systolic drop Exercise; lowering effect lasts up to 24 hrs. Nutrition Calcium Potassium bananas, sweet potato, dried apricots, tomatoes Magnesium avocado, seeds, beans, bran DASH Diet: High Fruits/Veg, nuts, seeds, beans. Low animal meat, dairy and saturated fats

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Beyond Sodium Moderate Weight loss (10-20 lbs)5-20 mmHg lower BP Exercise, 30-40 min, most days5-10 mmHg lower BP DASH Diet8-14 mmHg lower BP Reduce salt (< 2400 mg/d = 1 tsp)2-8 mmHg lower BP Limit alcohol2-4 mmHg lower BP

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Measurements Body: waist/hip ratio, body composition Blood work simple screen to complex (VAP, Calcium score, CRP hs ) Blood Pressure Blood Glucose levels

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New Heart Healthy Guidelines Statins Use 15% now, 30% projected - Americans on statins MDs to focus on diet & exercise Are statins for you? 1. Prior MI 2. DM, 40-75 yr old 3. >7.5% risk over next 10 years 4. > 190 mg LDL

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The Lyon Diet Heart Study (1999) American Heart Association (step 1) vs. Mediterranean (MED) Followed over 4 years, n= 605 prior MI (heart attack) patients Subjects: same blood pressure, BMI, smoking status, lipid profile. < 70 yr Objective: Measure the rate of cardiovascular complications after 1st heart attack Results: Same lipids; total cholesterol, LDL, HDL. TG levels.bwtn both groups

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More Results Mediterranean group had 70% fewer CV events (fatal & non fatal heart attacks) 56% fewer deaths 61% fewer cancers Why? Less red meat, Higher antioxidants, Higher omega 3s.lower INFLAMMATION

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Carb or Not to Carb?

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Better Balance Cut back on red meat Cut back on sugar/processed starchy foods & DRINKS Increase fiber: vegetables, fruit, bran, beans Increase healthy fats: salmon, tuna, nuts/seeds, avocado, olive oil Portion Control Higher Meal Freq stimulate metabolic rate

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Power of Nutrients Go Anti-Inflammatory Team!! Dark Cocoa Green tea EGCG Omega 3s salmon, tuna, sardines, herring, flax, chia Antioxidants colorful fruits & vegetables

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Eat Smart, Be Smart Neuroscience. 2002;112(4):803-14. A high-fat, refined sugar diet reduces hippocampal brain-derived neurotrophic factor, neuronal plasticity, and learning. Neuroscience. Alters brain cells (neurons) & communication The raw material for building new and pruning old brain connections comes from the food we eat. (stiff cells vs. flexible cells)

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Anti-inflammatory : muscle, joints, heart, brain Vasodilator & blood thinning properties (safe) Exercise Induced Asthma, rheumatoid arthritis 1-2 grams (EPA/DHA) Salmon, tuna, flaxseed, walnuts Nordic Naturals, GNC, Costco Omega 6 (arachidonic acid): processed foods w/ corn, safflower, soybean veg oils. Mayo, salad dressings, margarine. 46 Omega 3s

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Meal Frequency & Body Comp Mixed data obese, non obese. Not favorable if sedentary. What about active individuals or athletes? Boxers; 2 vs 6 meals. 1200 calories. 2 weeks. Wt loss same. More fat loss/less LBM loss w/ 6 meals

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Meal Frequency & Health N=5, men & women. 14 days Ck Lipids, glucose levels 1 large meal vs. 3 meals std Results: 1 meal/day = higher lipids levels 3 meals = Better cholesterol/LDL N=~14,000, meal freq = lipids

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Sarcopenia

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Protein Age - Muscle Post - Strength Training, whey protein 20 gm, 20 yr old = muscle gain/maintain 20 or 40 gm, 60 yr old = muscle gain/maintain Key: higher level Leucine required

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Protein Timing

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Double Dipping

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Animal vs. Plant Protein

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Hydrate

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Body Composition BodPod Skinfold (sum of 7, ISAK) BIA Ultrasound Metabolic Testing (VO2 max, Exercise Metabolic Rate, Resting Metabolic Rate) Waist: females > 35 in, males > 40 in = CVD risk 55 Know what you are made of

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March 1343 cal: 74% CHO, 26% Fat

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December 1448 cal: 33% CHO, 67% Fat

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58 Pre: Runner, 51 yr, trained

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59 Post: Runner, 51 yr, trained

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The Honest Chia Seed (2 TB) 8x Omega 3? 5000 mg ALA, 0 EPA, 0 DHA 6x calcium? 177 mg calcium 3x iron? 2.4 mg iron 3.5 oz Salmon; 0 ALA, 830 mg DHA, 545 mg EPA (1375 mg) 1 c milk; 300 mg calcium c ckd spinach; 2.7 mg iron

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Kale vs. Spinach 49 calories 9 gm carbs Vitamin C Copper Calcium 23 calories 3.5 gm carbs Vitamin E Folate Choline Iron Magnesium Lutein & Zeazanthin

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Omega 3s & Prostate Cancer Media/Study: stop taking omega 3s/eating salmon Linked to 71% increase risk of advanced prostate cancerreally? 4.66% (cancer) vs. 4.48% (control).0.2% diff Side study of old study diet? supplements? Blood marker? Smokers & Drinkers risk of cancer

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Buy Organic Annual list 12 fruits/vegs pesticides content exposure by 80%

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Seasonal Vitamin D 65 Cannell JJ, Vieth R, Umhau JC,et al. Epidemiol Infect. 2006

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Healthy Tools Track/Log food, exercise Make a Plan Fitbit, Jawbone Apps; myfitnesspal, loseit, fastfood/nutrition facts Crew, Spouse, your kids, your dog On Line programs; trainingpeaks, Jeff Galloway (walk/run) Local groups/classes

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Sleep

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Thank You! Questions? Rikki Keen Registered Dietitian/Exercise Physiologist sportsrd1@gmail.com