The Role of Nutrition in Integrative Medicine

Rebecca Lee Campos, MD ABFM, ABIHM

March 2015

Objectives○ Recognize role of Nutrition in Traditional

and Conventional Medicine ○ Identify the areas within of Integrative

Medicine that have a foundation in Nutrition

○ Identify various dietary trends in IM○ Current trends in consumer knowledge ○ Be able to engage with patients on

nutritional therapy for various chronic conditions

Role of Nutrition in Modern Medicine: Hypertension & Hyperlipidemia

Diagnosis Medication

Lifestyle Changes• Diet• Exercise• Weight Loss

“Ill To the Pill”

PillHeartburn

Osteoporosis

Diabetes

PCOS

Hyperlipidemia

Rheumatoid Arthritis

IBS

Dr. Mimi Guarneri, MD

American Heart Assoc, 2013 LDL(Grade A)

Emphasis of veg, fruit, whole grains Lower fat diary, poultry, fish, legumes Aim: 5-6% calories from saturated fat Reduce trans fat

BP (A) Emphasis on veg, fruit, whole grains Lower fat diary, poultry, fish, legumes Lower sodium intake (A) Na(<2400mg/day) (B) Combine DASH with lower sodium (A)

Physical activity (B) 3-4 sessions/wk, avg 40min / session with moderate-

to-vigorous – both BP and lipids.http://circ.ahajournals.org/content/early/2013/11/11/01.cir.0000437740.48606.d1.long

Role of Nutrition Modern Medicine:Diabetes

Diagnosis: Diabetes

Begin Medication

Diabetic Education• Diet

Weight Loss

ADA, 2014 Recommendations

Mediterranean Plan foods, Fresh foods, olive oil(dietary lipids), Dairy

products(low-mod), <4eggs/week Vegetarian/Vegan

Ovo-, lacto- Lower saturated fat and cholesterol High fruits, veg, whole grains, nuts, soy, fiber, phytochemicals

Low fat More veg, fruit, starches, lean protein, low fat diary

Low Carbohydrate High protein intake, fats, veg that are low in carb.

DASH Emphasizes fruits, veg, low fat dairy, whole grains, poultry fish,

nuts; Reduced sodium

http://professional.diabetes.org/admin/UserFiles/0%20-%20Sean/dc132042%20FINAL.pdf

During 2007–2010, adults consumed, on average, 11.3% of their total daily calories from fast food.

Non-Hispanic black adults consumed a higher percentage of calories from fast food compared with non-Hispanic white and Hispanic adults.

The percentage of total daily calories from fast food increased as weight status increased.

More than one-third of U.S. adults are obese

NCHS Data Brief http://www.cdc.gov/nchs/data/databriefs/db113.pdf http://www.cdc.gov/nchs/data/databriefs/db114.pdf

The percentage of calories from protein, carbohydrate, and fat were within the ranges recommended for these macronutrients for this age group (3), but the percentage of calories from saturated fat was above the 10% recommended in the Dietary Guidelines for Americans, 2010

During 2007–2010, adults consumed, on average, 11.3% of their total daily calories from fast food.

Non-Hispanic black adults consumed a higher percentage of calories from fast food compared with non-Hispanic white and Hispanic adults.

The percentage of total daily calories from fast food increased as weight status increased.

More than one-third of U.S. adults are obese

NCHS Data Brief http://www.cdc.gov/nchs/data/databriefs/db113.pdf http://www.cdc.gov/nchs/data/databriefs/db114.pdf

The percentage of calories from protein, carbohydrate, and fat were within the ranges recommended for these macronutrients for this age group (3), but the percentage of calories from saturated fat was above the 10% recommended in the Dietary Guidelines for Americans, 2010

“Ill To the Pill”

PillHeartburn

PCOS

Diabetes Hyperlipidemia

Rheumatoid Arthritis

Psychiatric dx

Dr. Mimi Guarneri, MD

It is more important to know what sort of patient has a disease than what sort of disease a patient hasSir William Osler

Role of Nutrition Within Integrative Medicine

Food Is Medicine

Food

Meal Replacement

Dietary Supplement

Nutraceutical

OTC Drug

Prescription Drug

New Perspective on Old Ways Practitioners are seeing a need Patients are seeing a need

Patients are becoming consumers Searching for holistic care

Alternative & integrative Culture – herbal, ointment

National Health Interview Survey, 2012

34,525 Adults; 10,218 children

How many providers do nutritional referrals during preventive care visits?

Principle: Food, Body, Environment & Epigenetics

Nutritional Medicine

Functional Medicine

Herbal Medicine

Specific areas: Ayuveda

Nutritional Medicine Individualized

Reactive hypoglycemia Ex. Refined Sugars

Chinese Food Syndrome MSG(monosodium glutamate)

Identify lifestyle deficits vs excess

Nutritional Medicine “Nutritional Medicine is based on the principle

that nutrients, including essential micronutrients, are required for the proper functioning of all the biochemical processes on which our bodies depend. Therefore, when treating symptoms or diseases, we look for the underlying causes which, although often partly genetic, are usually very much tied up with nutritional and environmental factors. This is in contrast to the tendency in the conventional medical approach to treat symptoms by means of drugs or surgery”

Meldrum JM1 What is nutritional medicine? Nutr Health. 1993;9(2):135-50.

themicrogardener.com

Functional Medicine

• A methodology of approaching individualized patient centered medical care looking at risk factors (genetic, environmental, lifestyle), triggers, symptoms and presentation.

• Goal to prevent illness and maintain a healthy life.

https://www.functionalmedicine.org/getstarted/resources/IFMTools/

“If we could give every individual the right amount of nourishment and exercise, not too little and not too much, we would have found the safest way to health.” ― Hippocrates

themicrogardener.com

Herbal Medicine Maximizing function of the body to

improve status or recover health through the use of plant derivatives.

ManzanillaGerman Chamomile

GI: colic, spasms, ulcers, nervous diarrhea, acute diarrhea

Rheumatic: fibromyalgia Topical: pressure ulcer, mastitis, leg

ulcers, atopic dermatitis, oral mucosal inflammation

Psychiatric: anixiety

Local

Yerba buena – spearmint Heartburn, colic, GI upset

Estafiate Tea for GI symptoms, glucose Topical for anti-inflammatory

Ayuveda Over 3,000 year old practice Meaning:

Aur means life Veda means science or knowledge

Both culture and belief system Balance of the body and environment BODY

Spirit – dosha Physical body - prakriti

https://nccih.nih.gov/health/ayurveda http://www.pbs.org/frontlineworld/stories/india701/interviews/ayurveda101.html

Ayuveda Composed of 3 Doshas:

Pitta Vata Kapha

Treatment: Use of food, herbs, herbal teas, essential

oil

Caution: metals in treatment and contamination

Specific Dietary Protocols

Guided Diets

Allergies• Food Intolerance

Autoimmune• Anti-inflammatory

Chronic Disease• Glycemic• DASH• Mediterraean• Vegetarian

Specific Diet plans• Paleo • SCD

Elimination Diet 2-3 weeks completely avoid common allergens Complete Resolution symptoms before

reintroduction NO Food:

Diary, Corn, Wheat, Eggs, refined sugars Additives

YES Food: Cereals, grains, legumes, vegetables (no corn),

olive oil, flaxseed oil. Journal record Withdrawal effect

Guided Diets

Allergies• Food Intolerance

Autoimmune• Anti-inflammatory

Chronic Disease• Glycemic• DASH• Mediterranean• Vegetarian

Specific Diet plans • SCD

Anti-Inflammatory Diet

Less processed foods Whole, fresh foods: fruits and vegetables Certain cooking herbs and spices Healthy fats as well: nuts and legumes Focus on omega 3, fiber, phytonutrient

Patient panel: Rheumatic, Diabetic, autoimmune

Guided Diets

Allergies• Food Intolerance

Autoimmune• Anti-inflammatory

Chronic Disease• Glycemic• DASH• Mediterraean• Vegetarian

Specific Diet plans • SCD

Mediterranean Diet High in monounsaturated fats

Olive oil, avocado, olives, peanut oil High in whole foods; less processed

Associated decrease in Cardiovascular disease Cognitive impairment

http://oldwayspt.org/resources/heritage-pyramids/mediterranean-diet-pyramid

Guided Diets

Allergies• Food Intolerance

Autoimmune• Anti-inflammatory

Chronic Disease• Glycemic• DASH• Mediterraean• Vegetarian

Specific Diet plans• SCD

Specific Carbohydrate Diet (SCD) Entirely anecdotal Focused for Celiac, IBD, IBS Based on GI flora balance:

restriction of carbohydrates that promote proliferation of bacteria that may produce toxins inflaming intestinal lining.

SIBO: Small Bowel Intestinal Overgrowth Concept of gastrointestinal flora imbalances Opportunistic bacteria flourish Spectrum of disease process

Irritable Bowel Syndrome

http://fnic.nal.usda.gov/dietary-guidance/myplate-and-historical-food-pyramid-resources/past-food-pyramid-materials

How do we treat our food?Consumer Trends

We No Longer… “Eat to Live, but Live to Eat” Processed foods

Increased shelf life.. Apocalyptic Twinkie

Larger the Fish Bigger the apples

Enticing the eye of the stomach

Chemicals &Food Genetics

Genetically Engineered Food From NIH directly • Potential benefits of genetically engineered food

include:– Increased nutrition– Improved taste– Disease- and drought-resistant

• Less water need– Decreased use of pesticides– Increased supply of food with reduced cost and

longer shelf life– Faster growing plants and animals– Food with more desirable traits

• such as potatoes that absorb less fat when fried– Medicinal foods

Genetically Engineered FoodRisks

1. pathogenic microorganisms,

2. nutrient imbalances,

3. naturally occurring toxicants,

4. environmental and industrial chemicals, including pesticides,

5. food and feed additives,

6. food alterations associated with genetic modification.

Safety of Genetically Engineered Foods: Approaches to Assessing Unintended Health Effects http://www.nap.edu/catalog/10977.html http://www.nlm.nih.gov/medlineplus/ency/article/002432.htm

Not All Bad… For example, Kiwi

China – very poor tasting berry New Zealand – breeding produced kiwi

Actinidia deliciosa 1900s advertised in US

No record of safety evaluation Allergic reactions to naïve

Identified actinidin protein

http://www.nap.edu/catalog/10977.html

THURSDAY, JULY 14, 2005

BODY BURDEN: THE POLLUTION IN NEWBORNSThe Pollution in NewbornsA BENCHMARK INVESTIGATION OF INDUSTRIAL CHEMICALS, POLLUTANTS AND PESTICIDES IN UMBILICAL CORD BLOODEnvironmental Working Group, July 14, 2005

“In a study spearheaded by the Environmental Working Group (EWG) in collaboration with Commonweal, researchers at two major laboratories found an average of 200 industrial chemicals and pollutants in umbilical cord blood from 10 babies born in August and September of 2004 in U.S. hospitals. Tests revealed a total of 287 chemicals in the group. The umbilical cord blood of these 10 children, collected by Red Cross after the cord was cut, harbored pesticides, consumer product ingredients, and wastes from burning coal, gasoline, and garbage.”

http://www.ewg.org/research/body-burden-pollution-newborns

Consumer Knowledge

Consumer Trends Choosing pesticide free Choosing against genetically engineered

Limitations: Cost Availability/ Selection

Dirty Dozen?

Clean Fifteen?

Shopper’s Guide, 2015

Dirty Dozen• positive for at least one pesticide residue

– 99 percent of apple samples, – 98 percent of peaches, and – 97 percent of nectarines tested

• The average potato had more pesticides by weight than any other produce.

• A single grape sample and a sweet bell pepper sample contained 15 pesticides.

• Single samples of cherry tomatoes, nectarines, peaches, imported snap peas and strawberries showed 13 different pesticides apiece.

Clean Fifteen• Avocados were the cleanest: only 1 percent of avocado samples showed any

detectable pesticides.• no residues

– Some 89 percent of pineapples, – 82 percent of kiwi, – 80 percent of papayas, – 88 percent of mango and – 61 percent of cantaloupe had.

• No single fruit sample from the Clean Fifteen™ tested positive for more than 4 types of pesticides.

• Multiple pesticide residues are extremely rare on Clean Fifteen™ vegetables. Only 5.5 percent of Clean Fifteen samples had two or more pesticides.

https://www.aace.com/files/nutraceuticals-2003.pdf

Centers for Disease Control and Prevention. State Indicator Report on Fruits and Vegetables, 2013. Atlanta, GA: http://www.cdc.gov/nutrition/downloads/State-Indicator-Report-Fruits-Vegetables-2013.pdf http://www.cdc.gov/nchs/data/nhis/brochure2010January.pdf http://www.cdc.gov/nchs/fastats/diet.htm

Ervin RB, Ogden CL. Trends in intake of energy and macronutrients in children and adolescents from 1999–2000 through 2009–2010. NCHS data brief, no 113. Hyattsville, MD: National Center for Health Statistics. 2013 http://www.cdc.gov/nchs/data/databriefs/db113.pdf

Environmental Working Group, www.ewg.org

Fryar CD, Ervin RB. Caloric intake from fast food among adults: United States, 2007–2010. NCHS data brief, no 114. Hyattsville, MD: National Center for Health Statistics. 2013 http://www.cdc.gov/nchs/data/databriefs/db114.pdf

Gaby MD, Alan. Nutritional Medicine, 2011 p 1-28, 1525-30 Institute of Functional Medicine, https://www.functionalmedicine.org/getstarted/resources/IFMTools/

National Center of Complementary and Integrative Health (NCCIH), https://nccih.nih.gov/

Safety of Genetically Engineered Foods: Approaches to Assessing Unintended Health Effectshttp://www.nap.edu/catalog/10977.html