Meer dan 95% van onze ziektes worden veroorzaakt door de

Terugkeer naar de leefstijl van de oermens
conform de cultuur van de 21ste eeuw
Frits A.J. Muskiet
5000 generations
400 generations
5 generations
In NL: onze levensverwachting, onze
levensverwachting zonder fysieke limitaties en
onze levensverwachting in door onszelf ervaren
gezondheid stijgt, maar onze levensverwachting
zonder chronische ziekte daalt!
Men
Women
48!
Common ancestor chimpanzee
Out of Africa
First homo sapiens
Agricultural revolution
Industrial revolution
Current homo sapiens
Cumulative rates of major depression for
USA birth cohorts as a function of age
42!
Bruggink J-W, Lodder B, Kardal M, CBS webmagazine 12 februari 2009
Meer dan 95% van onze
ziektes worden veroorzaakt
door de omgeving
Ons genetisch materiaal
speelt hooguit een secundaire
rol
(‘disease susceptibility genes’)
Klerman, JAMA 1989
Environmental influences on major diseases
PARs for lifestyle (here: specific aspects of diet, overweight, inactivity, smoking)
Hier de #1 op de lijst van de
10 ongezondste drankjes in de USA van 2009:
Baskin and Robbins Large Chocolate Oreo Shake
>90%
>80%
>70%
>70%
• 2,600 kilocalories
• 135 g fat (59 g saturated
fat, 2.5 g trans fat)
• 263 g sugars
• 1,700 mg sodium
This drink packs more sugar than 29 Fudgsicles, as much fat as a
stick and a half of butter, more calories than 48 actual Oreos, three
days' worth of saturated fat, and as much salt as you'll find in 9 bags
of Lay's Classic potato chips.
Willett, Science 2002
1
8 oz soda, regular hamburger and
small fries = 590 kcal
vs.
850 kcal difference =
2 h leisure walking for 70 kg
person to burn extra calories
Marathon = 42 km
Weight = 60 kg
Total: 2,610 kcal
Metabolic
syndrome
kcal = kilometers x kg x 1.036
When super sized = 1440 kcal
Metabool syndroom
Inhoud
Het dodelijke kwartet
- Metabool syndroom
- Evolutionaire geneeskunde/veranderende omgeving
- Waar komen we vandaan?
- Valse signalen van ontsteking
* Fysieke activiteit
* Voeding
Macronutriënten, CHO, eiwit
Vetzuren, visolie
Vitamine D
- 21ste eeuw jager-verzamelaar
- Conclusies
Whole-body images
demonstrating the
TOFI (thin-outside fat-inside)
phenomenon.
The male individuals shown in
this figure are of similar
age, BMI and percentage body
fat but have different levels of
visceral fat and
therefore different disease risks.
Subject (a) is a TOFI (BMI 25·8
kg/m2; 3·3 litres of visceral fat);
Subjects (b) is a healthy
volunteer (BMI 26·5 kg/m2;
2·2 litres of visceral fat).
Thomas, Nutr Res Rev 2012
1. Te zwaar
2. Gestoorde bloedglucose
3. Te hoge bloedvetten
4. Te hoge bloeddruk
Clinical syndromes associated with the metabolic
syndrome/insulin resistance syndrome
Preeclampsia (late onset)
Reaven, Ann Rev Nutr 2005
World Cancer Research Fund 2007
2
Evolutionary
Medicine and
changing
environment
Inhoud
- Metabool syndroom
- Evolutionaire geneeskunde/veranderende omgeving
- Waar komen we vandaan?
- Valse signalen van ontsteking
* Fysieke activiteit
* Voeding
Macronutriënten, CHO, eiwit
Vetzuren, visolie
Vitamine D
- 21ste eeuw jager-verzamelaar
- Conclusies
Evolutionary Medicine, or Neo-Darwinian Evolution
A composite of Darwin and Mendel
"Nothing in biology
makes sense except
in the light of
evolution"
"Nothing in medicine
makes sense without
biology"
Theodosius Dobzhansky
1900 - 1975
Charles Robert Darwin, (1809-1882)
Gregor Mendel (1822-1884)
On the Origin of Species, 1859
Experiments on Plant Hybridization, 1865
Adaptation to the
conditions of
existence
By natural selection
(and by epigenetics)
Charles Robert Darwin, (1809-1882)
On the Origin of Species, 1859
Genetics and the Origin of Species,
published 1937
Er is iets
vreselijk fout
gegaan:
We zijn
tegenwoordig
slecht
aangepast aan
onze omgeving
3
We hebben een conflict
veroorzaakt tussen de
door onszelf gecreëerde
omgeving en ons
miljoenen jaar oud
genetisch materiaal
Waar komen we
vandaan?
Inhoud
- Metabool syndroom
- Evolutionaire geneeskunde/veranderende omgeving
- Waar komen we vandaan?
- Valse signalen van ontsteking
* Fysieke activiteit
* Voeding
Macronutriënten, CHO, eiwit
Vetzuren, visolie
Vitamine D
- 21ste eeuw jager-verzamelaar
- Conclusies
gibbon
orangutan
gorilla
chimpanzee
bonobo
5.9 Myr
homo sapiens
160,000 yr
7.2 Myr
17.9 Myr
13.9 Myr
Hacia. Trends in Genetics 2001
Based on β -globulin region
From vegetarian to omnivore,
predominantly meat (fish) eater
Australopithecus
africanus
Australopithecus
afarensis
Homo habilis
vegetarian
Homo erectus
Neanderthal
Homo sapiens sapiens
2.5 Mya: cut-marks on
mammalian bones
Australopithecus
(- 2.6-3.2 Mya “Lucy” from Ethiopia)
Meat eater: 100,000 years
bp sophisticated tools for
hunting and butchering
4
160,000 years old H. sapiens idaltu
We are of East African ancestry: 3rd Out of Africa wave
from Herto, Middle Awash, Ethiopia
Genetic
diversity
highest
among
Africans
White, Nature 2003; Gibbons, Science 2003
Reconstruction:
www.dienekes.com/blog/archives/cat_physical_
anthropology.html
‘Race’ is biologically meaningless.
‘Out of Africa’ predicts more genetic homogeneity in the
geographic region of origin of a person’s ancestry
Genetic variation:
sub-Sahara Africa>Eurasia>
East Asia>Oceania>America
Adaptation to local
conditions
– Mutation.
– Gene flow (no
admixture).
– Genetic drift
/bottle necks
(small populations
72,000 BC Toba Vulcano,
6 y temp 5-10 degrees down
Migration speed: no more than one mile every eight years
“Cultureel zijn we mensen van de
21ste eeuw. Maar genetisch bevinden
we ons nog in de Paleolithische tijd’’
O’Keefe and Cordain, Mayo Clin Proc 2004
Black/African
White/Caucasian
Asian
Pacific
Islander/
Hawai
American Indian/Alaska
Microsatellite clustering of 52 world-wide populations Zhivotovsky Am J Hum Genet 2003
Tattersall 2003, update of 2000
The savanna hypothesis is in error, we lived at the interface of water
and land and ate a water-shore diet from those rich ecosystems
Our ancestors
found an ecological
niche in the landwater interface
5
Fossils of our 6-2.5
Mya ancestors are
mainly found at
present and former
interfaces of
(fresh) water and
land
s
Food for brain: AA and DHA in fish
available to hominids in Rift Valley Lake
Nyasa (Tanzania) and Lake Turkana
(Kenya)
Gibbons Science 2002
Broadhurst, CBP 2002
Mbelele (catfish)
Perch
Njenu (carp)
Tilapia species
Kambale (local sp)
Mfui (local sp)
Number of
identifiable
specimens
fat
g/100 g
10,3
2,6
4,9
2,3
1,8
1,1
AA
mg/100 g
421
190
270
184
99
84
DHA
mg/100 g
842
447
363
343
227
200
Faunal remains
associated with the
excavation at the
FwJj20 locality
Hominins, predating Homo erectus, 1.95 Mya enjoyed
access to carcasses of terrestrial and aquatic animals that
they butchered in a well watered habitat
Koobi Fora Formation
in northern Kenya
(Turkana Basin): a well
watered environment
Earliest definitive
evidence of the
incorporation into the
hominin diet of various
aquatic animals
including turtles,
crocodiles, and fish,
which are rich sources
of specific nutrients
needed in human brain
growth
Braun, PNAS 2010
The aquatic ape: Elaine Morgan-Floyd
(Koobi Fora
Formation in
northern Kenya;
Turkana Basin)
Bony fish
Catfish
Crocodile
Turtle
224=30%
7=27%
Braun, PNAS 2010
13C
Collagen shows sharp shift in diet from marine-based to
terrestrial-based in Britain at onset of Neolitic (-4,000 y)
Marine-based diet
Bone collagen from coastal site dweller
Bone collagen from inland dweller
Terrestrial-based diet
Neolitic period
Mesolitic period
Restanten van onze
land-water voeding
(‘voeding voor de hersenen’)
jodium, selenium
vitamine D
vitamine A
visolie-vetzuren
Richards, Nature 2003
6
Contributions (in 2005) of marine and fresh water products
(finfish and shellfish, seafood, wild and farmed) to the French
dietary intakes of vitamins D and B12, selenium, iodine and
docosahexaenoic acid
Seafood provides (% of RDA)
23% of selenium
25% of vitamin D
28% of iodine
56% of vitamin B12
203% of DHA (French RDA)
Global Prevalence of Micronutrient
Malnutrition: 2 million at risk
The beneficial effect
of fish intake on
cerebrovascular risk
might be mediated
through a complex
interplay among a
wide range of
nutrients commonly
found in fish.
Chowdhury,
BMJ 2012
Ramakrishnan,
Nutr Rev 2002
Bourre, Int J Sci Food Nutr 2008
VCP 2007-2010, children and adults
Selenium intake in The Netherlands
Dutch people still consume insufficient fruit, vegetables, fish and fibre.
The proportion of saturated fatty acids in the diet is still high and
overweight is common.
Some people have intakes below the recommended amounts for some
vitamins and minerals, such as vitamin A, B1, C, E, magnesium,
potassium and zinc.
GR vs. IOM:
recommended that a re-evaluation
of the dietary reference value for
selenium is made
Age groups with specific higher intake requirements often do not meet
these, i.e. concerning folate (for women with a pregnancy wish),
vitamin D (people above 50), iron (women of childbearing age) and
calcium (adolescents).
Dutch National Food Consumption Survey 2007-10, Van Rossum 2011
Dutch National Food Consumption Survey 2007-10, Van Rossum 2011
Jodiuminname in NL,
VCP 2007-2010
=gejodeerd zout toegevoegd bij bereiding maaltijd
=gejodeerd zout toegevoegd door voedingsmiddelenproducenten
60%
uit nietnatuurlijke
bron
Dutch Health Council, Naar behoud van een optimale jodiuminname 2008
Salehy, VoedingNu 2012
7
Whole brain volume across
the life span between 4 and
88 years of age
Longitudinal magnetic resonance
brain imaging studies measuring
whole brain volume change with
age in humans
Whole brain volume across
the life span between 4 and
88 years of age
60 y,
0.5%
per y
35 y,
0.2%
per y
Longitudinal magnetic resonance
brain imaging studies measuring
whole brain volume change with
age in humans
60 y,
0.5%
per y
>60 y,
>0.5%
per y
35 y,
0.2%
per y
Hedman, Hum Brain Mapp 2011
>60 y,
>0.5%
per y
Hedman, Hum Brain Mapp 2011
False triggers of
inflammation
Inhoud
- Metabool syndroom
- Evolutionaire geneeskunde/veranderende omgeving
- Waar komen we vandaan?
- Valse signalen van ontsteking
* Fysieke activiteit
* Voeding
Macronutriënten, CHO, eiwit
Vetzuren, visolie
Vitamine D
- 21ste eeuw jager-verzamelaar
- Conclusies
We bevinden ons in een
pro-inflammatoire toestand
8
Factoren in onze leefstijl die ons in een proinflammatoire toestand hebben gebracht of antiinflammatoire responsen verhinderen
1.
2.
3.
4.
5.
6.
Lifestyle factors exhibit interaction
abnormale voedingssamenstelling
abnormale microbiële flora
onvoldoende fysieke activiteit
chronische stress
slaaptekort
milieu verontreiniging (b.v. roken)
Inflammation
and
metabolism
are
intimately related
Physical activity
Hotamisligil, Nat Rev Immunol 2008
Inhoud
- Metabool syndroom
- Evolutionaire geneeskunde/veranderende omgeving
- Waar komen we vandaan?
- Valse signalen van ontsteking
* Fysieke activiteit
* Voeding
Macronutriënten, CHO, eiwit
Vetzuren, visolie
Vitamine D
- 21ste eeuw jager-verzamelaar
- Conclusies
Recalled physical activity at 15, 30, and 50 years in a large
sample of Swedish men (n= 33,466) from 1932-1997
The decline in activity
was especially
marked at 15 years of
age from the 1940s
through the 1960s
which was due to a
reduction in work or
occupational activity.
At the three ages, the
decrease in physical
activity over time was
due in large part to a
reduction in
occupational and
leisure time activities
Malina, Am J Hum Biol 2008
9
Relative Risk of CVD Mortality
Fatness, Fitness and Cardiovascular Disease
Mortality
8
7
6
5
4
3
2
1
0
Among individuals with MDD, exercise therapy is feasible and is
associated with significant therapeutic benefit, especially if exercise
is continued over time
Aerobically fit
Unfit
lean
unfit
Lean
<16.7%
Clinical status at 10 months (6 mo after treatment) among patients
who were remitted (N = 83) after 4 months of treatment in Exercise
(N = 25), Medication (N = 29), and Combination (N = 29) groups
156 patients Major Depressive Disorders;
50+ years; HRSD of at least 13 (max 17) at
entry; 1) 4 months aerobic exercise 7085% of heart rate reserve, 3 times/week:
10 min warm up, 30 min cycle or brisk
walk/jogging, 5 min cool down; 2)
sertrialine (SSRI); 3) Combination;
Hamilton Rating Scale, Beck Depression
Inventory, at 4 mo and 6 mo after
treatment stop (10 mo total)
fat
fit
Normal
16.7%-24.9%
Compared with participants in the other
conditions, those in the Exercise
condition were more likely to be partially
or fully recovered and were less likely to
have relapsed
Obese
>25%
Body Fat Category (% Weight as Fat)
Lee et al. Am J Clin Nutr 1999;69:373.
Babyak, Psychosom Med 2000
Slide Source:
www.obesityonline.org
Our exploratory analyses suggest that exercise
may be particularly beneficial for depressed
participants with elevated levels of anxiety
Although aerobic exercise has been shown to be an effective
short-term treatment for MDD in patient volunteers, the
beneficial effects of exercise, like those of antidepressant
medications, may dissipate after the intervention is discontinued.
However, regardless of the initial treatment strategy (i.e.,
exercise or medication), it is possible that depressed patients
may be able to benefit from ongoing exercise participation
Association between self-reported exercise during follow-up and depression at
1 year (4 months intervention, then 1 year no treatment)
Regular exercise during the follow-up period predicted both Hamilton Depression
Rating scores and MDD diagnosis at 1 year
The expected difference in HAM-D score
between a person reporting 180 minutes/week
of exercise and a person reporting 0 minute of
exercise was a decrement of 3.1 points
The adjusted odds of being in an
improved category of depressive
status for a person reporting
exercising 180 minutes per week
are about three times greater
compared with a person reporting
0 minute of exercise.
180 minutes
Hoffman, Psychosom Med 2011
Hoffman, Psychosom Med 2011
Cognitively normal sedentary APOEε4-positive
individuals may be at augmented risk for cerebral
amyloid deposition
MCBP value is a
measure of amyloid
deposition
established by
binding of the
amyloid imaging
agent carbon 11–
labeled Pittsburgh
Compound B
([11C]PiB)
APOE4 is associated with increased risk of
cognitive decline and elevated amyloid
deposition.
201 cognitively normal adults (135 women)
aged 45-88 years recruited from the Knight
Alzheimer’s Disease Research Center.
Diet
Head, Arch Neurol 2012
10
Macronutriënt
samenstelling
Inhoud
- Metabool syndroom
- Evolutionaire geneeskunde/veranderende omgeving
- Waar komen we vandaan?
- Valse signalen van ontsteking
* Fysieke activiteit
* Voeding
Macronutriënten, CHO, eiwit
Vetzuren, visolie
Vitamine D
- 21ste eeuw jager-verzamelaar
- Conclusies
Vetzuur
samenstelling
Glycemische
lading
Voedingskarakteristieken die we
veranderd hebben
sinds de landbouw en
de industriële revolutie
Micronutriënt
gehalte
Vezel
gehalte
Zuur-base
balans
Na-K
ratio
Cordain
AJCN 2005
VCP 2007-2010, children and adults
Dutch people still consume insufficient fruit, vegetables, fish and fibre.
Food products
The proportion of saturated fatty acids in the diet is still high and
overweight is common.
Some people have intakes below the recommended amounts for some
vitamins and minerals, such as vitamin A, B1, C, E, magnesium,
potassium and zinc.
Age groups with specific higher intake requirements often do not meet
these, i.e. concerning folate (for women with a pregnancy wish), vitamin
D (people above 50), iron (women of childbearing age) and
calcium (adolescents).
Dutch National Food Consumption Survey 2007-10, Van Rossum 2011
aantal gevallen van ziekte (incidentie) of sterfte
Gezondheidverlies (incidentie van ziekte, sterfte) veroorzaakt omdat
5 voedingsfactoren (SAFA, transvetzuren, vis, fruit en groente) en
lichaamsgewicht (BMI) niet voldoen aan de aanbevelingen
2.700
38.000
2.200
16.000
22.000
Wat u doet
en
wat u denkt dat u doet
De meeste Nederlanders denken dat ze niet alleen
lekker maar ook goed eten
Groente: 10% denkt te weinig groente eten;
in werkelijkheid is dat 80%
Fruit: 33% denkt onvoldoende fruit te eten;
in werkelijkheid is dat 60%
Van alle sterfgevallen
10%
5%
Ons eten gemeten, RIVM 2004
NHS; Eten naar hartelust, januari 2010
11
Increased
consumption of fruit
and vegetables is
related
to a reduced
<3 vs. >5 servings/day
risk of coronary
relates to
17%
heart
disease: metaanalysis
of 12
reduction in CHD risk
cohort studies
(278,459 subjects,
9,143 events)
He, J Hum Hypertens 2007
Meta
analysis
3-5 and >5
servings
fruits/vegetables and
stroke
(ischemic
and hemorrhagic)
<3 vs. 3-5
servings/day: 11%
reduction in stroke risk
<3 vs. >5: 26%
reduction
Prospective
studies
He, Lancet 2006
Fiber intake in The Netherlands
About 2/3 of recommendation in g/MJ/day
Representative natural
dietary bioactive
compounds and their
sources
Pan, J Agric Food Chem 2009
Dutch National Food Consumption Survey 2007-10, Van Rossum 2011
Inhoud
Macronutrients
- Metabool syndroom
- Evolutionaire geneeskunde/veranderende omgeving
- Waar komen we vandaan?
- Valse signalen van ontsteking
* Fysieke activiteit
* Voeding
Macronutriënten, CHO, eiwit
Vetzuren, visolie
Vitamine D
- 21ste eeuw jager-verzamelaar
- Conclusies
12
De inname van koolhydraten is in korte
tijd sterk gestegen (USA data) Mediane Paleolithische
Voeding,
Kuipers, Br J Nutr 2010
51
40 en%
33
35 en%
Carbohydrates
25 en%
16
CHO intake in The Netherlands
Dutch National Food Consumption Survey 2007-10, Van Rossum 2011
UK/US jaarlijkse suikerconsumptie
1815-2000
Voor een 70
kg/persoon
is dat: 200 g/dag
<10 kg/
persoon
WO1
Comparison of blood sugar responses to low– and
high– glycemic-index foods
hyperinsulinemia
has been implicated
as a mediator in
heart disease
development
WO2
Vóór de in industriële revolutie werden geraffineerde suikers en
granen door de doorsnee bevolking nagenoeg niet gegeten
reactive hypoglycemia
can stimulate the
appetite and lead to
increased caloric intake
Keefe, Cordain. Mayo Clin Proc 2004
Last, Am J Fam Phys 2006
13
18 months RCT 250 mL sugar-free or sugar-containing
drink (104 kcal) per day to 641 normal-weight children
4y/10mo to 11y/11mo of age
Weight
increased by
6.35 kg in the
sugar-free
group as
compared with
7.37 kg in the
sugar group
De Ruyter, Katan, NEJM 2012
Sugar consumption and number of identified
people with mental illness 1800–1914
National dietary patterns in relation to international
variations in 2 year schizophrenia outcome and
depression prevalence
Schizophrenia outcome
+ meat
+ eggs
+ dairy
+ sugar
+ alcohol
- pulses
Depression prevalence
+ sugar
+ dairy
- starchy roots
- fish
Multivariate
- fish and seafood
Multivariate
+ sugar
Peet, Br J Psychiatry 2004
Consumption of burgers, oily fish and full sugar
carbonated drinks in relation to age groups
Sucrose
SAFA vs. LCPω
ω3
Peak onset of
schizophrenia
UK National Diet and
Nutritional Survey
2002
10-25 y males 25-35 y females
Peak onset of schizophrenia
Peet, PLEFA 2004
Peet, PLEFA 2004
Association between consumption of fast food
(hamburgers, sausages, pizza) and depression
Association between consumption of commercial baked goods
(muffins, doughnuts, croissants and other similar) and depression*;
SUN Project (Seguimiento Universidad de Navarra–University of
Navarra Follow-up, Spain)
Protein
Sanchez-Villegas Public Health Nutr 2012
14
Why do people have difficulty maintaining
clinically significant weight loss over long time?
Among overweight and obese young adults
compared with pre-weight loss energy expenditure,
isocaloric feeding following 10-15% weight loss
resulted in decreases in REE and TEE that were:
Motivation to adhere to restrictive regimens
typically diminishes with time.
Biological adaptations-specifically a decline in
energy expenditure (adaptive thermogenesis) and
an increase in hunger- that promote weight regain
- Greatest with the low-fat diet
- Intermediate with the low-glycemic index diet
- Least with the very low-carbohydrate diet
Ebbeling, JAMA 2012
Ebbeling, JAMA 2012
Fat intake of hominids and homo sapiens
Fatty acid
composition
Common ancestor with chimpanzee
Switch from vegetarian to hunting-gathering
omnivore -160,000 years: homo sapiens
Paleolithic diet
Agricultural revolution
Industrial revolution
Simopoulos, AJCN 1999
Visolievetzuren spelen een rol in:
LCPω
ω3
- (Hersen)ontwikkeling
- Zwangerschapscomplicaties
- Hart en vaatziekte
- (Neuro)psychiatrische ziektes
- Andere
15
EPA and DHA per 100 g fish
Reported frequency of fish consumption by the Dutch
population aged 7-69 years (DNFCS 2007-2010), weighted
for socio-demographic factors and season
6-28%
28-65%
5-18%
Fedacko Pathophysiology 2007
Dutch National Food Consumption Survey 2007-10, Van Rossum 2011
Fish is high in EPA and DHA
Richtlijnen Goede Voeding 2006: 450 mg/dag
NL, VCP-2007-2010:
P50 for EPA+DHA:
CAD
F+M: 75-110 mg/day
GISSI: secondary prevention trial
11,324 MI patients; 1 g n-3/day; 3.5 y NNT at low risk (2.6% annual mortality)=164 patients
Marchioli et al. Circulation 2002
Lavie, J Am Coll Cardiol 2009
ORIGIN trial, 2012
12,536 patients at high risk for CAD events, with impaired fasting glucose,
impaired glucose tolerance, or diabetes, 6.2 years at least 900 mg ethyl
esters of n–3 fatty acids or placebo
ORIGIN
investigators,
Bosch,
NEJM 2012
16
Meta analysis negative:
EPA and DHA per 100 g fish
Omega 3 Fatty Acids and Cardiovascular Outcomes
20 studies including 63 030 participants
Effect of ω-3 fatty acids on composite cardiovascular outcomes
Kotwal, Circ Cardiovasc Qual Outcomes 2012
Fedacko Pathophysiology 2007
American Heart Association Recommendations 2002
Depression
Kris-Etherton, Circulation 2002
Should depressive syndromes be
reclassified as Metabolic Syndrome type II?
While major depression is often a prelude to dementia in later life.
dementia
depression
Low grade inflammation
Mood disorders and impaired insulin sensitivity:
overlapping pathophysiology.
Leonard, Neurochem Res 2007
McIntyre, Ann Clin Psychiatr 2007
17
EPA >60% is effective in depression
EPA >60% is effective in depression
A ≥60%
ing EP ange
in
ta
n
o
r
c
a dose
ments
Supple PA+DHA, in of EPA in
lE
of tota to 2,200 mg/d effective
, were
of 200
ssion.
of DHA
excess primary depre
t
s
again
Sublette, J Clin Psychiatry 2011
Hamilton Depression Rating Scale (HDRS) total scores over time in the
modified intention-to-treat population (adjusted on type of antidepressant
medication and baseline HDRS score)
(1 g/d) of EPA or DHA or
placebo (pure coconut oil)
as adjuvants to
maintenance
antidepressant medications
for 12 weeks.
81 mild-tomoderately
depressed
outpatients:
1 g/d EPA, 1 g/d
DHA, or placebo
(coconut oil),
12 weeks
EPA may be more
efficacious than DHA or
placebo as an adjuvant to
antidepressant medications
for the treatment of mild-tomoderate depression.
Mozaffari-Khosravi, Eur Neuropsychopharmacol. 2012
Sublette, J Clin Psychiatry 2011
American Psychiatric Association
Estimation of optimal DHA intake required for
treating affective disorders: 1,000 mg/d EPA+DHA.
This value is in line with the daily dose
recommended by the American Heart Association
for patients with established coronary heart disease.
Freeman, J Clin Psychiatry 2006; McNamara, PLEFA 2009
Attention to risk factors, such as hypertension, coronary artery disease, hyperlipidemia
and smoking could reduce or delay the incidence of dementia,
both vascular dementia and Alzheimer’s disease (also named type 3 diabetes)
Neurodegenerative
Korczyn, J Neurol Sci 2007
Kroner, Altern Med Rev 2009 (AD=DM3)
18
US
Esposito, J Nucl Med 2008
ADHD
Meta-analysis EPA+DHA in ADHD
- 10 RCTs, 699 children
- Small but significant effect
- EPA might be more efficient
Vitamin D
- Relative efficacy modest compared with
pharmacotherapy
- Might be reasonable to use because of relatively
benign side effects
Bloch J Am Acad Child Adol Psych 2011
Inhoud
Rachitis, osteomalacie, osteoporose
- Metabool syndroom
- Evolutionaire geneeskunde/veranderende omgeving
- Waar komen we vandaan?
- Valse signalen van ontsteking
* Fysieke activiteit
* Voeding
Macronutriënten, CHO, eiwit
Vetzuren, visolie
Vitamine D
- 21ste eeuw jager-verzamelaar
- Conclusies
19
Vitamin D and disease
US
Vitamin D is a neuroactive nutrient
Gestational vitamin D deficiency causes permanent changes in
the developing rat brain.
There is ample biological evidence to suggest an important role
for vitamin D in brain development and function
Deficiency alters brain gene and protein expression
Deficiency disrupts the balance between neuronal stem cell
proliferation and programmed cell death in the offspring
Deficiency has been associated with impaired cognition,
depression, bipolar disorder, and schizophrenia
Tuohimaa, Psychoneuroendocrinology 2009
Age/gender adjusted RR of first contact for schizophrenic
disorders for ethnic minorities in The Hague 1997-1999
1st + 2nd
generation
15-54 years
1st
generation
15-54 years
Natives
1.0
1.0
1.0
3.7
3.2
5.5
Netherlands Antilles
2.2
2.9
NA
Turkish
0.6
0.8
NA
Moroccans
5.0
4.5
8.0
1.1/2.4
Serum 25(OH)D, vitamin D deficiency and percentage
undetectable 25(OH)D in pregnant women of several
ethnic backgrounds living in The Hague, NL
2nd
generation
15-29 years
Surinamese
Others (West/non West) 2.0
Kiraly, ScientificWorldJournal 2006; McCann, FASEB J 2008; Levenson, Nutr Rev 2008;
Cherniack Curr Psychiatry Rep 2009
1.7
Selten, Br J Psychiatr 2001
Van der Meer, AJCN 2006
Associations of low maternal or early postnatal
vitamin D status with adverse offspring health
outcomes at later life
Mother and child
Almost equal sharing of 25(OH)D
Low vitamin D
prevents children
from attaining
their genetically
programmed
peak bone mass.
Other
consequences:
e.g.
schizophrenia
risk?
Nicolaidou, Calcif Tissue Int 2006
•
•
•
•
Intrauterine growth restriction (Morley, JCEM 2006)
Reduced bone mineral accrual: low bone mass 9 y (Javaid Lancet 2006)
Recurrent wheeze at 3 y (Camargo: AJCN 2007 and Pediatrics 2011)
Increased risk of respiratory syncytial virus (RSV) respiratory tract
infections (LRTI) during infancy (Belderbos, Pediatrics 2011)
• Multiple sclerosis (Schwalfenberg J Environ Public Health 2012)
• Diabetes mellitus type 1 (Zipitis, Arch Dis Child 2008; Schwalfenberg J Environ Public
Health 2012)
•
•
•
•
No association behavior and IQ at 9 y (but study was imperfect)
Schizophrenia (McGrath: J Steroid Biochem Mol Biol 2004; Schizophr Bull 2010 and 2001)
Higher change MTCT of HIV and death (Mehta, J Infect Dis 2009)
Mild or moderate-severe language impairment at 5 and 10 y (Whitehouse,
Pediatrics 2012)
Whitehouse, Pediatrics 2012
20
119±26 (58-167)
Dutch adequate 25(OH)D levels
109±28 (71-171)
<70 years: ≥30
nmol/L
≥70 years: ≥50
nmol/L
Dutch Health Council 26 09 2012
Traditionally living
populations in East
Africa have a
mean serum
25(OHD)
concentration of
115 nmol/L
Luxwolda, Br J Nutr 2012
Inhoud
21st
Century
Hunter gatherer
- Metabool syndroom
- Evolutionaire geneeskunde/veranderende omgeving
- Waar komen we vandaan?
- Valse signalen van ontsteking
* Fysieke activiteit
* Voeding
Macronutriënten, CHO, eiwit
Vetzuren, visolie
Vitamine D
- 21ste eeuw jager-verzamelaar
- Conclusies
Huidige leefstijl
Chronische systemische lage graad
ontsteking
Insuline resistentie
tijd
Metabool syndroom
tijd
Metabool syndroom
gerelateerde ziektes
De trigger en het aanhouden
hiervan is abnormaal
NIET de respons
21
Yakky!
Moet ik
dit dan
weer
gaan
doen?
Conventional vs. lifestyle medicine approaches
Conventional
Lifestyle
Foto: Remko Kuipers en
Martine Luxwolda
Egger, Med J Aust 2009
Moet ik weer knollen gaan graven?
Moderne jager-verzamelaars
US
jagen in de Supermarkt
English
AB19
Die voedings
pyramide moet
op zijn kop
Dit is dus okay!
Wat overblijft is
groente/fruit and
dierlijke
producten
AB19
22
Eet meer
groente en
pluk de
vruchten
van het
leven
EPA and DHA per 100 g fish
Fedacko Pathophysiology 2007
Dit is NIET okay
Dit is het
alternatief
Sometimes it is better to go fishing!
23