Smart Foods to Out Smart Aging PowerPoint

3/26/2016
Objectives—Smart Foods to Optimize Aging
• Clarify foods that help with weight loss
• Clarify how saturated fats impact risk for
cardiovascular disease
• Identify foods and nutrients that enhance
cognitive function
• Identify which fats are smart , neutral, and
unhealthy
• Identify which fats can tolerate higher heat
cooking
• Identify carbs and protein that are smart
Smart Foods to Optimize Aging
Steven Masley, MD, FAHA, FACN, FAAFP, CNS
President, Masley Optimal Health Center
Case Study
My Background
• A 51 year old woman with known heart disease
has struggled to follow a low fat diet for the last
decade and presents asking for an eating plan
that would help her lose weight and prevent
future cardiovascular events. She complains of
cravings on a low fat eating plan and her recent
blood work reveals elevated fasting glucose and
triglyceride levels and small LDL and HDL particle
size.
• After increasing her intake of smart fat, fiber, and
protein, she lost 20 pounds over 12 weeks and
her fasting glucose, lipid particle sizes all returned
to normal.
Why were my original
patients getting older
and sicker over time?
It isn’t from a lack of
medical care.
• I started as a regular family
physician,,,,,
• I watched my patients get older over
time
• Over time, I saw medical tragedies at
work and at home,,,,,,
• My salvation came from working
overseas as a volunteer, working in
restaurants, and devouring nutrition,
heart, and aging research
• Today, I can transform the life of my
patients
The Standard American Diet (SAD)
Was Killing My Patients
Over the last 20 years trying to follow a low-fat eating
plan, nationally we have seen that:
•
•
•
•
Weights and Waistlines are increasing
We see an epidemic in rates of diabetes & pre-diabetes
Memory loss is increasing
Heart disease remains the #1 killer for both men and
women—despite that lifestyle prevents 90% of CVD
• And for the first time in history, our children are
predicted to die younger than we are NEJM 2005.
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3/26/2016
My Clinical Transformation
Trimmer, Younger, Fitter RCT Intervention,
2006 Masley SC, Weaver W, Peri G, Phillips S. Efficacy of exercise and diet to modify
markers of fitness and wellness. Alternative Therapies in Health and Medicine, 2008;14:24-29.
• Subjects: gym members who attended < once per
week, randomized to start intervention ½ now
and ½ in 12 weeks
• Intervention:
• I discovered that if I want to
transform the lives of my
patients, I have to focus upon
life nourishing food
• Today, my typical patient is 10
years younger in only 10 weeks
time, because I’ve given them
life saving foods into their daily
lives
• This may sound too good to be
true, but I have amazing,
published, & proven results
–
–
–
–
–
–
Meet with a trainer weekly
Attend 10 weekly lectures to educate
Nutrition evaluation
Given 120 recipes to sample and try
Attend 1 shopping excursion
To ensure they followed up for data collection, we
offered 2 massage treatments as a bonus
Assessing Changes in Fat Mass
(Bioelectrical Impedance)
Assessing Changes in Lean Mass
(Strength)
Changes in Strength and Flexibility
(Intervention Group Only)
6
4.8
5
Kilograms
Fat Mass Loss (kg)
3
100
90
80
4.1
Weight Loss (kg)
4
2.3
2.6
2.5
2.5
0.4
0.4
-0.4
-0.3
0
Control
Group
-1
Control,
BMI>24
Group
Intervention
Group
Intervention, Intervention,
BMI>24
BMI>24,
Group
Active 5+
d/wk
Percent Change
10.1
Curl Ups (Abdominal
Crunches)
43.7
41.2
41.5
40.4
29.2
30
22.6
17.9
20
6.5
TC/HDL Post 10 Weeks
Intervention Group Intervention Group Intervention Group,
Active 5+d/wk
>30 gm fiber/d
Percent TC/HDL Change
10
6
5
6.7
4.2 4.6
6.3
4.5 4.1
5.5
0
Control Group
-5
-10
0
Control Group
TC/HDL At Entry
16.7
14.3
15
40
10
Total Cholesterol / HDL Ratio Changes
(from early September to mid December)
20
TC / HDL Ratio
ml/kg/min
41
Sit & Reach (cm)
50.9
48.6
50
Push Ups
Changes in TC/HDL Ratios
% Increase
52.2
30
26.2
20.1
18.1
20
10
0
VO2Max Change Over Study
Post 10 Weeks
60
Post 10 Weeks
44.7
Changes in Aerobic Fitness
At Entry
At Entry
79
70
60
50
40
30
2
1
91
85.7
-15
Control Group
TC/HDL >4.8
Intervention
Group
Intervention,
TC/HDL >4.8
-8.9
-12.7
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3/26/2016
OUTCOME DATA: Group Visits
for Type 2 Diabetics
We followed 20
•
Masley, et al. FPM 2000;June:33
•
Type 2 diabetics
HbgA1C levels and
Total Cholesterol/ HDL
ratios over time. Both
levels decreased within
90 days and remained
reduced over 20
months.
Diabetic
monitoring targets
(i.e., annual eye & foot
exams, urinary microalbumin, and blood
work screen frequency
improved from 60-70%
to >90%)
HgbA1C in Type 2 Diabetic Group Visit Cohort
10
9.1
9
7.8
8
7.2
6.8
7
7.3
6
HgbA1C level
TYPE 2 DIABETES PILOT STUDY
5
4
3
2
1
0
Oct-96
Jan-97
Cognitive Performance
Jan-98
May-98
Masley SC, Efficacy of exercise and
diet to modify markers of fitness and wellness. Alternative Therapies in Health and Medicine, 2008;14:2429.
TC/HDL ratio in Type 2 Diabetic
Group Visit Cohort
Mental
Speed
Reaction
Time*
Attention*
Control Group at Entry
171
692
8
43
Control Group post 10 Wks
(% Improvement)
176
(3%)
666
(3.7%)
8
(0%)
45
(4.6%)
4
Intervention Group at Entry
176
667
11
44
3
Intervention post 10 Wks
(% Improvement)
183
(4.6%)
637
(4.5%)
6
(45%)
50
(11%)
Intervention Group At Entry,
Activity 5+ d/wk
175
681
9.7
39.9
•Intervention Group post 10
Wks, Activity 5+ d/wk
(% Improvement)
184
(5.1%)
619
(9.1%)
5.4
(44.3%)
49.7
(24.6%)
7
6.1
Cognitive
Flexibility
6
Total Cholesterol / HDL ratio
OUTCOME
DATA: for Type
2 Diabetics
Oct-97
4.7
5
4.3
2
1
0
Oct-96
Jan-97
Oct-97
Jan-98
May-98
*A decrease in reaction time score and attention score indicates an improvement.
Effects of Exercise upon Changes in Cognition Using
Paired t Tests:
Masley SC, Roetzheim R, Gualtieri T. Aerobic Exercise Enhances Cognitive Flexibility. The Journal of Clinical Psychology
Percent Increase in Cognitive Flexibility with
Increasing Frequency of Aerobic Exercise
2009;16:186-93.
MODERATE
INTENSE
EXERCISE
EXERCISE
P
P
P
MEMORY
.359
.662
.021
PSYCHOMOTOR SPEED
.182
.007
<.001
REACTION TIME
.048
.529
.001
COGNITIVE FLEXIBILITY
.962
.048
<.001
ATTENTION
.722
.706
.001
35%
30%
Percent Increase
CONTROLS
25%
20%
15%
10%
5%
0%
Control, Minimal
Exercise
Moderately Frequent
Exercise
Highly Frequent
Exercise
Masley SC, Roetzheim R, Gualtieri T. Aerobic Exercise Enhances Cognitive Flexibility. The Journal of
Clinical Psychology 2009;16:186-93.
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3/26/2016
Younger, Trimmer, Fitter
Study Results (2006)
• 58 subjects randomized into either a control
group or the Ten Years Younger—Younger,
Trimmer, Fitter Program (YTF for short at
Carillon)
• Subjects were asked to gradually add the foods
and activities over 4 weeks, then continue them
for another 6 weeks
• Results were measured on entry and after the
ten weeks
• Now over 200 have completed the program
with the same level of success
Results: T-test assessment of various
lifestyle changes
• The mean subject increased reported weekly exercise
by 29 min, increased their intake of: fiber 4.4 gm,
protein 2.7 gm, vitamin D 828 IU, potassium 152 mg.
• Average weight loss for all subjects was 3.2 kg.
• Factors that predict weight change are:
– exercise min/wk (p<0.0001);
– intake of:
• fiber (p<0.0008),
• folate (p=0.053),
• and potassium (p=0.064).
Data for All Subjects with BMI>26 over 2.8 yrs
ANTHROPOMETRIC
• BMI:
29.3
• BP:
119/78
• Wt (lbs):
205.2
• BF(%):
29.4
FITNESS
• VO2max
33.0
• ↓HR 1 min
25.7
NUTRIENT INTAKE
• Fiber (gm/d)
18.8
• Vitamin D
534
• Potassium
2031
to
to
to
to
28.4
117/77
198.3 (↓3.2 kg)
28.0
to
to
34.4
30.7
to
to
to
24.4
1432
2271
Study Example: American College Nutrition 11/2015 Annual Mtg Abstract
Objective: This study, “lifestyle factors that
predict weight loss”. (2006-2015)
Methods:
• A prospective cross-sectional analysis of 157 subjects
with a BMI ≥ 26.0, mean BMI =30.0 and age 51.
• Subjects underwent health screening every 1-2 years at
an outpatient center and completed a 3-day food diary
at entry and on average 2.9 years later.
• Subjects received a nutritional eval with individualized
plans to correct nutrient deficiencies.
• After fitness testing, they received a customized plan
to exercise within their aerobic zone daily.
Results: A dichotomous T-test showed:
• The following factors predict weight loss:
– Exercise minutes/week (p=0.02),
– Intake of:
• Fiber (p=0.0002), (preferably from
vegetables, fruits, beans, and nuts; not
flour sources)
• vitamin D (p=0.047),
• and potassium (p=0.031).
Macronutrient Trends: 40 subjects, BMI>25, had BMI
↓2 points, and had >3 gram changes in fat and protein,
and 2 gram change in fiber. Results not statistically
valid, worthy of future study.
Fat Intake:
• When subjects ↓ fat intake by >3 grams daily, BMI ↓ 1.15
• When subjects ↑ fat intake by >3 grams daily, BMI ↓ 3.03 (>2.5x)
Protein Intake:
2 point
• When subjects ↓ protein intake by >3 grams, BMI ↓ 0.87
• When subjects ↑ protein intake by >3 grams BMI ↓2.35 (~3x)
Fiber Intake:
• When subjects ↓ fiber intake by >2 grams, BMI ↓ 0.786 BMI
• When subjects ↑ fiber intake >2 grams, BMI ↓ 1.86 (>2x)
BOTTOM LINE SUGGESTIONS:
• To ↓ more weight: consider an ↑ in fat, protein, & fiber intake
4
3/26/2016
Study Conclusion:
• An increase in exercise minutes/week and
dietary intake of fiber, folate, vitamin D, and
potassium predict sustained weight loss.
• Further study is warranted to clarify weight
loss benefits of increasing smart fat, protein,
and fiber intake
The Leading Cause of Mortality Is CVD, So
to OutSmart Aging, You Need to Assess
CVD Risk
• Cholesterol is a risk factor for CVD
• If you want to measure the progress of CVD,
you need to look at the under lying cause
– Which is arterial plaque
• You can measure arterial plaque with cardiac CT
• Even better is with carotid IMT testing—the
only way to conveniently measure soft arterial
plaque over time. Is plaque growth, shrinking,
or staying the same.
Carotid IMT
How Do You Measure Arterial Plaque?
• Stress testing: An ischemic response to ECG
stress testing identifies when your arterial plaque
is ~70% blocked. Although some patients will die
before they reach this point.
• Cardiac CT: Identifies old calcified plaque. Does
not identify new, soft plaque, which is the most
dangerous. A high score predicts futures CVD risk.
Associated with radiation exposure.
• Carotid IMT: Measures new soft plaque and can
be done serially over time.
• Outpatient
procedure using
an ultrasound
transducer, 10
minutes to
perform 10-15
images.
• 10 minutes to
interpret and
determine a score.
• Can assess current
plaque age, and
use to monitor
plaque change
over time.
What Predicts Carotid IMT Growth?
Masley SC. Emerging Risk Factors as Markers for Carotid Intima Media Thickness Scores.
Journal of the American College of Nutrition 2015; 34: 100-107
IMT plaque lining is rough and thick
before lifestyle intervention
IMT plaque lining is smoother and thinner after
18 months of lifestyle intervention
New Lifestyle Factors
• Many factors predict IMT
scores; the most powerful
included:
– Fitness (aerobic)
– Fiber intake
– Body Fat
– Fish intake
– Food nutrients
Classic Risk Factors
• Systolic blood pressure
• Total cholesterol/HDL
and TG/HDL ratios
Surprisingly, the following
don’t predict arterial plaque
scores:
• Total cholesterol
• LDL cholesterol
5
3/26/2016
Is Arterial Plaque Regression Realistic?
• Results: At the Masley Optimal Health Center,
our average patient has had a decrease in IMT
score -0.018 mm over 2.8 years, a 2.04%
reduction. (In the USA, the average increase in IMT score
is 1-1.5% per year)
• The bivariate analyses showing a significant
association with a ≥4% reduction in IMT in 62 of
288 subjects (the average reduction in this
group was 10%);
What About Your Brain?
Another Critical Marker of Aging.
Questions:
Can You Improve Cognitive Function?
How to Avoid Memory Loss?
Results: The factors associated with a
decrease in IMT score were:
– A decrease in: BMI (p=0.047) or body fat (p=0.025)
– A decrease in total cholesterol (TC) (p=0.031), LDL (p=0.028),
TC/HDL (0.002), this relationship persisted whether subjects
were Rx’d with a statin or not
– More powerful was an increase in dietary intake
of: magnesium (p=0.0001), fiber (p=0.017),
vitamin D (p=0.016), vitamin K (p=0.001),
potassium (p=0.001), & calcium (p=0.024).
– With multivariate analyses, starting a statin med (p=0.0007),
baseline IMT (p<0.0004), male gender (p=0.01), & years of
follow up (p=0.008) were also all predictive of >4% IMT
decrease; prior use of a statin med was NOT related to a
reduction in carotid IMT score
How Does Seafood Intake Impact
Cognitive Function?
Masley, Masley, Gualtieri. Effect of Mercury and Seafood Intake on Cognitive Function. Integrative
Medicine 2012;11:32-40.
• Reported cognitive benefits from long
change omega-3 fats
• Reported cognitive harm from mercury in
big mouth fish
• Epidemiologic studies have shown
decreased Alzheimer’s rates with fish
intake, and increased rates with mercury
toxicity
ALL
STUDY DESIGN, SETTING, SUBJECTS,
& MEASUREMENTS:
Masley, Masley, Gualtieri. Effect of Mercury
and Seafood Intake on Cognitive Function. Integrative Medicine 2012;11:32-40.
• A retrospective, cross-sectional analysis of 384 men and
women attending an all-day comprehensive physical
evaluation. (Database now exceeds 1000 subjects) At their
initial evaluation, measurements were made of body
composition, cardiovascular status, fitness and diet (including
specific types of seafood intake), and laboratory measures,
including whole blood mercury. Each subject was tested with
a computerized neurocognitive test battery, which is a
computerized neurocognitive test battery comprised of seven
familiar neuropsychological tests that generate ten
independent scores.
Mean
Study Demographics:
(I assume my clinic is
very similar to other
Age Management
Practices) for a “first
visit”.
SD
Number
384
Mercury level
7.2
6.5
AGE
48.2
7.4
%MALE
71.4%
%WHITE
94.5%
16.8
2.1
COMPUTER EXPERIENCE SCORE
EDUCATION YEARS
2.8
0.4
N (Men)
274
Mercury level
7.0
6.4
AGE
48.7
6.8
%WHITE
94.5%
EDUCATION
16.9
2.1
COMPUTER EXPERIENCE
2.8
0.4
N (Women)
110
Mercury level
7.8
6.7
AGE
46.9
8.7
%WHITE
94.5%
EDUCATION YEARS
16.5
2.1
COMPUTER EXPERIENCE SCORE
2.8
0.5
6
3/26/2016
COGNITIVE TEST RESULTS RELATIVE TO LONG CHAIN OMEGA-3 INTAKE
AND MERCURY (HG) INTAKE USING MANOVA ANALYSES CONTROLLING
FOR COVARIATES: AGE, RACE, GENDER, EDUCATION, COMPUTER
FAMILIARITY, AND MOTOR SPEED. Masley, Masley, Gualtieri. Effect of Mercury and
Seafood Intake on Cognitive Function. Integrative Medicine 2012;11:32-40.
Long Chain N3FA Intake
Cognitive Domain Scores:
NORMAL, ELEVATED, AND HIGH WHOLE BLOOD MERCURY LEVELS (µG/L),
COMPARED WITH COMPLEX INFORMATION PROCESSING (CIP), SHIFTING
ATTENTION TEST (SAT), SIMPLE DIGIT CODING (SDC), AND RESPONSE TIME (RT)
SCORES.
Whole Blood Hg Level
F
p Sig.
F
Memory
1.952
.001
.737
p Sig.
.971
Complex Information Processing
4.915
<.001
1.911
<.001
Effortful Attention
1.025
.432
1.256
.075
Verbal Memory
2.108
<.001
.715
.981
Visual Memory
.924
.609
.707
.984
Shifting Attention Test
2.310
<001
1.413
.015
Symbol Digit Coding
3.615
<.001
1.453
.009
Response Time
4.206
<.001
1.675
.001
Stroop Test
.802
.807
.861
.824
Choice Performance Test
.992
.489
.980
.547
Complex Reaction Time
Specifically, >4 servings/month of Large Mouth Fish Intake (grouper,
tuna, bass, snapper, swordfish, shark) is Strongly Associated with
Elevated Mercury Levels
How Do Cardiovascular Biomarkers,
Lifestyle, and Carotid IMT Scores
Predict Cognitive Function?
Masley SC, Masley LV, Gualtieri T. Cardiovascular Biomarkers and Carotid IMT scores as Predictors of Cognitive
Function. Journal of the American College of Nutrition 2014; 33: 63-69.
• Multiple cardiovascular risk factors are associated
with early cognitive decline.
• Measures of complex information processing provide
one of the earliest signs of cognitive decline and
appear related to arterial plaque growth.
• The following study will clarify how cardiovascular
risk factors, lifestyle, and carotid intima media
thickness (IMT) scores are associated with cognitive
function and complex information processing scores.
Conclusions Re Seafood & Hg Intake:
• Excessive seafood intake, particularly large mouth
fish, elevates mercury levels and causes cognitive
dysfunction, especially at a mercury ≥15 µg/L.
• Higher N3F3 intake is associated with improved
cognitive function, yet N3FA intake from fish exercises
a moderating effect that is ultimately overwhelmed
by rising mercury levels.
• You should measure whole blood or RBC mercury
levels if your patients eat ≥3 large mouth servings per
month of big mouth fish, or ≥3 servings of seafood
per week of any fish.
• I’d also encourage that you measure long chain
omega-3 levels to ensure optimal intake without
mercury toxicity.
Demographics Likely Similar to Most Age Management
Practices for the “First Visit”
N
AGE
536
EDUC
COMPUTER
FAMILIARITY (13)
Std.
Mean Deviation
47.97
7.449
16.78
2.117
2.85
MALE
389
FEMALE
147
WHITE
510
NON-WHITE
26
.384
BMI
Systolic Blood Pressure (BP)
Diastolic BP
WAIST CIRC (cm)
BODY FAT (%)
CAROTID IMT (mm)
BRUCE PROTOCOL STRESS ETT
VO2 max (ml/kg/min)
ETT DIASTOLIC BP ∆
ETT 1-MINUTE Heart Rate ↓
ETT DURATION (minutes)
NUTRITIONAL INTAKE
FIBER (gm)
SATURATED FAT (gm)
Long chain N3-fatty acid (gm)
FOLATE (mcg)
B12 (mcg)
VITAMIN D (IU)
CAFFEINE (mg)
ALCOHOL (gm)
LABORATORY VALUES
Total Cholesterol (TC) (mg/dl)
LDL Cholesterol (mg/dl)
GLUCOSE (mg/dl)
MERCURY
HOMOCYSTEINE
HS-CRP
N
536
536
536
525
536
399
Mean
27.4
117.7
75.7
93.9
28.4
0.7
SD
4.7
15.3
10.4
14.3
7.6
0.1
481
522
513
525
32.0
-0.6
23.6
12.3
7.6
8.7
9.7
2.6
518
518
531
518
518
518
518
518
18.2
21.9
0.8
487.8
32.5
239.8
170.9
13.3
8.7
10.5
2.9
325.4
93.0
238.8
242.1
19.7
431
429
530
384
499
418
204.6
129.6
98.7
7.2
10.9
2.1
38.9
33.5
15.6
6.5
3.5
2.7
7
3/26/2016
Correlation Between
Cognition and CVD
Biomarkers, 536 subjects
Index= Total Score
Mem=Memory
CIP= Complex Information
Processing
EA= Effortful Attention
Mspeed= Motor Speed
(Coefficients as Person Productmoment Correlation)
Two asterisks P < .01. One
asterisk P < 0.05.
Correlations
INDEX
MEM
AGE
.241**
.130**
RACE
.001
-.019
CIP
EA
.403** .117**
.023
-.014
MSPEED
.250**
-.023
EDUCATION
.013
.008
.037
.015
.016
GENDER
.037
-.018
.015
.024
.020
BMI
-.019
-.026
-.005
-.044
Correlation Between
Cognition and CVD
Biomarkers, 536 subjects
.026
SYSTOLIC BLOOD
PRESSURE (BP)
.023
.039
-.078
.005
-.065
DIASTOLIC BP
.036
.038
-.039
.009
.013
Index= Total Score
Mem=Memory
CIP= Complex Information
Processing
EA= Effortful Attention
Mspeed= Motor Speed
(Coefficients as Person Productmoment Correlation)
Two asterisks P < .01. One
asterisk P < 0.05.
Correlations
INDEX
MEM
CIP
EA
MSPEED
Stress Exercise Treadmill
Testing Fitness Markers
VO2max
.041
.003
.113*
.030
.151**
DIASTOLIC BP CHANGE
-.032
.026
-.063
-.031
-.081
1-MINUTE HEART RATE ↓
-.108*
-.058
-.048
-.094*
-.053
ETT DURATION (minutes)
.001
-.010
.054
-.014
.109*
-.045
-.038
-.120**
.011
-.048
Saturated fat (mg/day)
.039
-.023
.032
.058
.025
Long Chain N3FA (gram/day)
-.083
-.046
-.153**
-.047
-.042
Folate (gram/day)
-.059
-.025
-.087*
-.007
-.051
Nutritional Intake
Fiber (gm/day)
B12
-.073
-.060
-.118**
-.006
-.123**
VITAMIN D IU
-.080
-.065
-.083
.006
-.069
CAFFEINE
-.007
.010
-.008
-.003
.014
ALCOHOL
.038
.014
.058
.014
.003
TOTAL CHOLESTEROL
Fasting Laboratory Levels
WAIST
CIRCUMFERENCE (cm)
BODYFAT
PERCENTAGE
.013
-.054
.019
.001
.004
-.036
-.088
-.006
.018
-.077
LDL cholesterol
-.004
-.066
.011
.033
-.061
-.058
-.047
-.062
-.049
-.075
TC/HDL ratio
.084
.085
.047
.034
.038
CAROTID IMT SCORE
-.131**
-.090
-.169**
GLUCOSE
-.006
-.014
-.044
-.005
-.053
Homocysteine
.008
-.061
-.014
.025
-.037
HS-CRP
-.024
.007
-.014
-.046
-.021
-.200** -.056
Conclusion:
CVD Biomarkers, Lifestyle, & Cognition
• Carotid intima media thickness (IMT) scores are the most
sensitive cardiovascular biomarker associated with
overall cognitive function and with complex information
processing (CIP) and were independent of demographic
and other biometric variables
• Initial observations showed a correlation with aerobic
fitness measures and nutrient intake (fiber, long chain n-3
fatty acids, B12), yet their association dropped after
controlling for IMT
• Aim to optimize IMT scores; I hope to show you how to
do this next year
• Studies monitoring CVD outcomes with CVD biomarkers
could easily evaluate cognition as they are closely related
To Succeed with Better Health, I’ll
Suggest that there Are Four Food
Groups You Need to ADD:
• Let’s start with Food Group #1: Smart Fat.
• Here is a challenge to the conventional,
common way of thinking—I want you to eat
more fat. Yes, more fat. And for those of you
who remember the terms, Low-fat, fat-free,
bad-fat—I recall those terms too. In fact, I was
the medical director at the Pritikin Longevity
center and that is part of what we taught—eat
less fat.
What Are the Potential Benefits of
the Smart Food Eating Plan?
My Promise to My Patients Is They Will:
– Lose unwanted weight and keep it off
– Feel and look better than ever
– Control blood pressure, blood sugar,
and cholesterol profiles
– Prevent heart disease & shrink plaque
– Improve brain function
– Enhance sexual performance
– Extend quality of life for decades
What’s wrong with the low-fat message?
• First, it is hard to do. I spent years telling people to
lower their fat intake, and 95+% couldn’t do it. They
weren’t satisfied and they couldn’t stick with it.
• Second, the benefits from low fat diets (like Pritikin,
Esselstyn, and Ornish) isn’t because they took out
smart fats, but rather, they are better than the SAD
because they are high in fiber, high in nutrients, and
they got rid of unhealthy fats
• Third, getting rid of smart fats was actually pretty
dumb. Smart fats have two BIG amazing benefits. They
decrease inflammation and they improve hormone
levels. So when we cut out the Smart Fats, we became
more inflamed and lost healthy sugar, insulin-appetite
hormone balance, too
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3/26/2016
This does not mean eating more fat of any kind
is good, but only more fat if it is smart fat
• There are three general kinds of fat
– Smart fat
– Neutral fats
– Bad fats (OK, call them dumb fats)
– So let’s clarify each
More Bad Fat Controversy?
• The third group of bad fats are those that have an
excessive ratio (more than 4/1) of omega-6 fat to
omega-3 fat, because more omega-6 fatty acids
increase inflammation while omega-3 fatty acids
lower inflammation. Both are PUFA fats.
• Examples of fats with a high omega-6/omega-3 ratio
are corn, soy, and cotton seed oil, and other grain
and seed oils), which are common in feed lots
• The challenge is some studies show better CVD
outcomes with less PUFA fats and some show worse
outcomes. I think the ratio is the key, but this
remains controversial.
Critical Publications:
• Chowdhury R et al. Association of Dietary,
Circulating, and Supplement Fatty Acids with
Coronary Risk. Ann Intern Med 2014;160:398-406.
– Landmark study, reviewed 49 observational
studies and 27 randomized controlled trials
– Overall, saturated fat intake is NOT associated
with an increased risk for CVD
– Substituting polyunsaturated fat for saturated
fat does not protect against CVD
– Increased blood levels of EPA and DHA intake
(long chain omega-3 fats) are associated with
decreased CVD risk, although data from
supplement trials is mixed
What are Bad Fats?
• Bad fats have been shown to accelerate aging and
harm our health
• First are trans fats (hydrogenated fats), an perfect
example of bad fats. The are used by the food
industry to extend the shelf life of food, but shorten
your lifespan if you eat them
• What do I call hydrogenated fats?...............
• A second form of bad fats are toxic fats are loaded
with pesticides and hormones. Feed lots feed cows,
pigs, and poultry pesticide-packed grain and those
chemical accumulate in the fat.
What are Neutral Fats?
• Based upon recent published studies, neutral
fats would now include clean sources of
saturated fat
• A couple examples of neutral fats are organic
butter and cream, and fats from grass fed beef
and cage-free organic-fed poultry
• What about the idea that saturated fats are
bad?.......
Praagman J, et al. The association between dietary
saturated fatty acids and ischemia heart disease
depends on the type and source of fatty acid in
the European Prospective Am J Clin Nutr 2016;103:356-65.
– In a Dutch population eating clean animal fat,
saturated fat is not associated with CVD rates.
– Shorter chain saturated fats might be associated
with a reduced risk (dairy fats versus meat fats);
they could not control for statin use, so were only
willing to say that the impact of SFAs was neutral,
not beneficial.
– Adding more PUFAs in place of saturated fat
showed no benefit.
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3/26/2016
Siri-Tarino PW et al. Meta-analysis of prospective
cohort studies evaluating the association of
saturated fat with CVD. Am J Clin Nutr 2010;91:502-9 and 535-46.
• A review of 21 studies on MEDLINE on
prospective dietary risk associated with CVD.
• After 5-23 year follow up of 347,747 subjects,
saturated fat intake was not associated with
an increased risk for CVD.
• Controlling for age and gender did not impact
the results.
Smart Fats
• Smart Fats have clear proven
clinical benefits—showing they
improve how you age
• Great examples of Smart Fats are:
nuts, nut oils, olive oil, dark
chocolate, avocado, and cold
water seafood
• What about coconut oil? Coconut
fat is half smart and half neutral
depending upon the person and
health issues.
So if you want to benefit your
waistline, heart and brain, spend much
more time cutting out sugar and flour
intake, and less time worrying about
“clean” saturated fat.
Coconut is a good example of a beneficial
saturated fat, but with ongoing controversy
• Coconut has many benefits:
–Great energy for athletes; the MCTs in
coconut milk are great fuel.
–Has anti-microbial benefits when
eaten, fighting infections.
–Coconut fats likely protect the brain,
so people with brain injury or brain
disease should eat more coconut fat
HOWEVER; COCONUT FAT IMPACTS CVD RISK
• Eating more coconut will raise LDL and Total
Cholesterol levels, sometimes as much as 50-70
points. But HDL increases too, and the size of LDL and
HDL is bigger, so overall many of these lipid changes
with coconut intake appear beneficial
• The problem is that we don’t have any clinic studies to
prove this is a good thing, and at least one study
showing a decrease in artery function with coconut fat
intake, so honestly, there is still controversy about
asking people with heart disease to eat more coconut
oil and saturated fat
How much
smart
fat do you
need?
– Nicholls SJ et al. Consumption of saturated fat impairs the anti-inflammatory properties of
HDL lipoproteins and endothelial function. J Am Coll Cardiol. 2006; 48: 715–20.
• To be safe, if established CVD, or are being treated for high
cholesterol, I suggest avoiding coconut products and keep
saturated fat intake moderate, until we have more clinical
information, and enjoy the many other smart fats discussed
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3/26/2016
Cooking with Oils
Don’t Convert a Smart Fat into Toxic Fat
• Beyond thinking about the health issues and
flavors with cooking oils, a critical point is to
think about what temperature they can be
heated to without being damaged
• The smoke point of an oil tells you at what
temperature an oil is damaged
• Heating an oil past its smoke point converts it
from a potentially smart oil to a toxic oil
What About Grilling?
• The flame on a grill often exceeds 550 F, thus any
fat dripping from meat, poultry, and fish into the
flame is damaged fat, forming heterocyclic
amines (cancer forming compounds) that are
aerosolized on the food.
• If you marinate meat, poultry, and fish for 10-15
minutes in an acidic solution, it can decrease
heterocyclic amine formation by 70-80%, searing
the outside of the meat so fats don’t drip and it
won’t taste as dry
• Orange & lemon juice, vinegar, buttermilk, and
teriyaki sauce are good options, often improving
the flavor, too.
Food Group #2: Fabulous fiber
• Benefits of fiber (nearly endless)
• Weight loss
• Improve your cholesterol, blood pressure, blood sugar
• Support your microbiome (gut flora)
• If you only made one choice, combining fiber
and smart fat together is the #1 trick to
optimize your health
Common Oil Smoke points
OIL
SMOKE PT HEAT
Almond
430
Avocado
520
Butter
350
Coconut
350
Grapeseed 485
Lard
380
Macadamia 400
Med-high
High
Med-low
Med-low
High
Medium
Med-high
OIL SMOKE PT HEAT
Virgin olive 420 Med-high
Extra V olive 400 Medium
Pecan
470 High
Pistachio
250 Low
Sesame
350 Med-low
Walnut
320 Low
Medium High Heat Cooking (sautéing
for meat, poultry, and veggies)
• Smart Fats
– Avocado oil (OK to high heat)
– Pecan oil (OK to high heat)
– Almond and hazelnut oils
– Virgin olive oil
• Neutral Fats
– Ghee (clarified butter) (OK to high heat)
Aim for 10 Fiber serving/day = 30 gm
Examples:
• 1 cup of veggies has 3 grams of
fiber (broccoli, asparagus, peas,
kale, sweet potato
• 1 cup of fruit (berries, apples,
citrus, plums, and cherries)
• 1 ounce (1 handful) of nuts
• ¼ cup of beans (lentils, black
beans, garbanzo)
• 1 heaping Tbsp of seeds (chia,
ground flax seed)
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3/26/2016
How Glycemic Load Helps You Understand What
Carbs to Choose and What to Avoid
• Glycemic index tells you have much sugar is released from
eating 50 grams of carbohydrate foods, but the problem is that
without the quantity of food you should eat, it is deceiving
• Glycemic load tells you how much sugar is released from eating
one serving of a specific food
• Eating a high glycemic load food raises blood sugar, insulin, and
accelerates aging, especially for your heart and your brain
• Classic examples are
–
–
–
–
Carrots and beets, (HIGH GI, LOW GL)
Bread (high GI and high GL)
Cereal (high GI and high GL)
Almost any grain that is ground into flour has a high GL
• Bottom Line: The higher your glycemic load consumed, the
faster you age.
• Get to know the glycemic load of your food (gift idea)
If you can’t find clean protein, then
choose lean
• You may be in a restaurant, with limited clean protein
options
• Nearly all the toxins in meat, protein, and dairy are in
the fat. If you can’t get—grass fed, pasture raised, wild
options, then pick lean, lower fat protein, as cutting
down on the animal fat will make it cleaner
• So think lean (like chicken and turkey breast, sirloin or
tenderloin meat, and non-fat dairy) if you can’t find
totally clean options
• After all, eating lean is what doctors have been telling
you for years, so this should be a familiar message
Foods that are Double Smart
•
•
•
•
•
•
•
•
•
Beans
Edamame (organic)
Nuts
Seeds
Avocado
Olives
Salmon/Sardines
Spices/Herbs
Dark chocolate
protein + fiber
protein + fiber
fat + fiber
fat + fiber
fat + fiber
fat + fiber
fat + protein
fiber + flavor
fiber + flavor + fat!
Food Group #3: Clean Protein
• Protein intake revs BMR and
provides satiety. Examples:
• Wild seafood
• Cage-free, organic-fed poultry
and eggs
• Grass-fed beef
• Grass-fed, organic raised dairy
products
• Beans
• Fabulous protein powders
(What’s my favorite breakfast?)
• A Smart Fat Shake with clean
protein and fiber!
Food Group #4: Flavor
• If you recall, I’m a trained chef. I know
that if your food doesn’t taste delicious,
you wont eat it. The key is helping you
select food that tastes delicious, its
easy to prepare, it meets your nutrient
needs, and that your friends and family
will love it.
• The good news is that more flavor
means healthier, as spices and herbs
are packed with anti-inflammatory and
anti-aging compounds.
• And YES, in case you were wondering, as a
trained chef (Seattle Four Seasons) I have tons of
delicious recipes in my books.
The New Rules on Food and Fat Are:
1. Distinguish between smart fat, neutral fat,
and harmful fat.
2. Eat more smart fat.
3. It smarter to combine smart fat with more
low glycemic load fiber, clean protein, and
flavor from added herbs and spices.
4. Don't cook fat at the wrong temperature and
change it from smart fat to toxic fat.
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3/26/2016
Brief References: Contact me at
[email protected] if you’d like a
detailed reference list
Putting it Together. What Could Be
Easier?
• It is so easy. All you need is
5/5/10
• Every day, just add:
– Five servings of smart fat
– Five servings of clean protein
– And ten servings of fiber
– Plus spices and herbs for flavor
and health
•
•
•
•
•
•
•
•
•
•
•
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Masley SC et al. Emerging risk factors as predictors of carotid intima media thickness scores. J Am Coll
Nutr. 2015 34(2):100-7..
2.
Masley SC et al. Cardiovascular biomarkers and carotid IMT scores as predictors of cognitive function. J
Am Coll Nutr. 2014; 33(1): 63–69.
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Masley SC et al. Efficacy of exercise and diet to modify markers of fitness and wellness. Altern Ther Health
Med. 2008; 14: 24–29.
4.
Chowdhury R et al. Association of dietary, circulating, and supplement fatty acids with coronary risk: A
systematic review and meta-analysis. Ann Intern Med. 2014; 160(6): 398–406.
5.
Estruch R et al. Primary prevention of cardiovascular disease with a Mediterranean diet. N Engl J Med.
2013; 368: 1279–90.
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Bazzano LA et al. Effects of low-carb and low-fat diets. Ann Intern Med. 2014; 161: 309–18.
7.
Lawrence GD. Dietary fats and health: Dietary recommendations in the context of scientific evidence. Adv
Nutr. 2013; 4: 294–302.
8.
Yusuf S et al. Effect of potentially modifiable risk factors associated with MI in 52 countries (the
INTERHERAT study). Lancet 2004; 364:937-52.
9.
Nicholls SJ et al. Consumption of saturated fat impairs the anti-inflammatory properties of HDL
lipoproteins and endothelial function. J Am Coll Cardiol. 2006; 48: 715–20.
10.
Sacks FM et al. Effects of high vs low glycemic index of dietary carbohydrate on cardiovascular disease risk
factors and insulin sensitivity. JAMA. 2014; 312: 2531–41.
11.
Praagman J, et al. The Association between dietary saturated fatty acids and ischemic heart disease
depends on the type and source of fatty acid in the European Prospective Investigation into Cancer and Nutrition.
Am J Clin Nutr 2016;103:356-65.
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