Alternative Approaches to Medicine: Living Well Beyond 100 Years of Age

1. The Ohio State University Retirees' Association Alternative Approaches to Medicine: Living Well Beyond 100 Years of Age______________________Coping With Change Conference Glen Aukerman, MD Medical Director The Ohio State University Center for Integrative Medicine

2. Objectives • Participants will have greater understanding of • Complementary and Alternative Medicine (CAM) Use Among Older Adults • Important to Communicate with your doctors about herbs, nutrition, nutritional supplements • Credible information about supplements and herbal products, their safety and effectiveness • Nutritional needs for increased functioning and reduced effects of aging • How other Systems of Health-Care, Ayurveda

3. Complementary and Alternative Medicine (CAM) Use Among Older Adults Older adults increasingly use complementary and alternative medicine • 2000 Health and Retirement Study showed: • 88% of respondents 65 years and older used CAM • Dietary supplements = 65% • Chiropractic = 46% • Age correlated with use of dietary supplements and personal practices • inversely correlated with alternative practitioners • Men reported less CAM use than women • Men use more chiropractic and personal practices • Blacks and Hispanics used fewer dietary supplements, less chiropractic • more personal practices than Whites • Advanced education correlated with fewer chiropractic visits • more dietary and herbal supplement and personal practices use • More alternative practitioner use • Higher income, functional impairment, alcohol use and frequent physician visits correlated • No association between CAM use and number of chronic diseases Ness J, Cirillo DJ, et al. Use of Complementary Medicine in Older Americans: results from the Health and Retirement Study. The Gerontologist. 45:516-524 (2005)

4. CAM Use Among Rural Older Adults • CAM use, older rural white and black adults; • 41%-75% of older adults were using some form of CAM • Most common CAM used by this population were • prayer 85% • vitamins 83% • exercise 64% • Other forms of CAM reported were: meditation, herbs, chiropractic, glucosamine, and music therapy • Money was spent on CAM; • 45% of respondents reported spending < $100/year on CAM • Note: may be due to limited income, lack of insurance coverage for CAM, and limited availability of CAM in rural areas Cuellar N, Aycock T, Cahill B, Ford J. Complementary and Alternative Medicine Use by African American and Caucasian American Older Adults in a Rural Setting. BMC Complementary and Alternative Medicine 2003, 3:8

5. CAM Use Among Urban Older Adults • Cross-sectional analysis of medical charts 65 years of age, urban academic hospital geriatrics practice • Elements measured included: • a) CAM use Prevalence = 64% • b) proportion of CAM supplements and herbs (CAMsh) reported by patients and documented in patients’ charts = 35% • c) 46% of patients reporting taking CAMsh with anticoagulant activity (ginger, gingko, garlic, vitamin E) while concomitantly taking prescribed anticoagulant medications • 52% took a prescribed anticoagulant (per chart) • 48% took CAM but not prescribed anticoagulants • d) 46% of patients for whom the CAM anticoagulant was not documented in the chart Cohen RJ, Ek K, Pan CX. Complementary and Alternative Medicine Use by Older Adults. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences 57:M223-M227 (2002) Ther Gerontological Society of America

6. CAM Use Among Older Adults • Conclusions • CAM use is prevalent among older adults • Health care professionals should recognize that CAM may be used very differently among a variety of racial and ethnic backgrounds • Patients often do not report or under-report CAM use • CAM frequently not documented in the patient’s chart if reported • Health care professionals should encourage patients to discuss CAM activity, particularly vitamin/herb supplements, as these may cause potentially harmful drug-supplement interactions

8. Increased Life Expectancy Last Century • 30 years added to ave. US life expectancy • 100 years ave American life span expected this century • Decreases in early-life mortality • Decreases in mid-life mortality from medical advances • Curative medicine will play a lesser role • Nutrition and Supplements will play larger role • Aging population has increased health care costs • Costs will increase more as we have even longer lives • Unless we become more healthy through Nutrigenetics • Establishing and safeguarding optimal health from early life must become increasingly important • Concerns for governments and health care providers • Allocate resources wisely • Ensure and maintain a high quality of life in the population through better nutrition and fitness

9. The Future of Living Well to 100 • Healthy aging presents an enormous challenge • Advances in biological sciences provide the knowledge and tools needed to • understand nutrition at genetic and molecular levels and • elevate the scientific basis underlying nutritional recommendations • Understanding roles requires interdisciplinary cooperation of: • nutrition • genetics, • inflammation • Developing partnerships among specialties to promote the goal of healthy aging • come together as a science community • generate the evidence base to influence recommendations • Value of nutrition and genetics in achieving healthy aging Am. J. Clinical Nutrition, Feb 2006; 83: 488s - 490s. Gordon W Duff, Peter Libby, José M Ordovas, and Philip R Reilly

10. The Different Paths to 100 • Most centenarians do not have significant disability • 90% of centenarians functionally independent @ ave. age of 92 years • A more enabling point of view emerges to achieve extreme old age : • The older an individual gets, the healthier he or she has been • Centenarians show • Relative resistance to age-related diseases • Slower aging • Where are we heading • 1 centenarian per 10,000 persons in the United States NOW • 1 centenarian per 5,000 persons for industrialized nationsSOON • Ability to survive to extreme old age appears to be the result of: • Complex combination of • Genetics, • Environment • Lifestyle (Diet, Exercise,Social Activities), and Luck • The Future Path lies in: • Better Perinatal Nutrition = Omega-3, Nutrients • Genetics of the Very Old • Identifying the molecular drivers of longevity or mortality = omega 3/6 ratio • Discovering and targeting the pathways mediating aging and disease susceptibility • Developing preventive and therapeutic agents that will allow aging in good health Thomas T Perls,am. J. Clinical Nutrition, Feb 2006; 83: 484s - 487s

11. Starting Down the Right Path:Nutrition Connections With Chronic Diseases of Later Life • Prevention-oriented life cycle approach is critical to • Establishing and maintaining health throughout life • Delay and compress morbidity (sickness) and • Decrease the social toll associated with chronic disease and disability for as long as possible into old age • Good evidence that early nutrition affects key risk factors for: • Chronic degenerative diseases of middle and later life, such as • Osteoporosis and • Cardiovascular disease • Influence of nutrition on health status and morbidity supports primary, secondary, and tertiary prevention of disease and intervention strategies at each point in the process • Enable people to live well, longer • Minimize chronic disability Johanna Dwyer, Am. J. Clinical Nutrition, Feb 2006; 83: 415S - 420S

12. Genetics of Aging: Implications for Drug Discovery • Aging is not a passive activity, • But an actively regulated metabolic process • Specific genes identified that regulate aging, • Aging and Longevity are only partially under genetic influence • Rest of Gain is from Nutrition • It is possible to increase life span by environmental modification; • caloric restriction can increase life span • dysregulation of glucose homeostasis is a hallmark of aging in humans • type 2 diabetes, a disease of glucose homeostasis, is a form of accelerated aging • Aging and Diabetes are both common risk factors for a wide range of diseases • Aging and Diabetes are related at a molecular level Andrew S Greenberg and Martin S ObinAm. J. Clinical Nutrition, Feb 2006; 83: 461s - 465s Bard J Geesaman, Am. J. Clinical Nutrition, Feb 2006; 83: 466S - 469S

13. Influence of Human Genetic Variation on Nutritional Requirements • Genetic variation is known to affect food tolerances among human subpopulations and may also influence dietary requirements, giving rise to the new field of nutritional genomics and raising the possibility of individualizing nutritional intake for optimal health and disease prevention on the basis of an individual's genome • Gene-diet interactions are complex and poorly understood, the use of genomic knowledge to adjust population-based dietary recommendations is not without risk • Current recommendations target most of the population to prevent nutritional deficiencies, inclusion of genomic criteria may indicate subpopulations that may incur differential benefit or risk from generalized recommendations and fortification policies • Current efforts to identify gene alleles that affect nutrient utilization have been enhanced by the identification of genetic variations that have expanded as a consequence of selection under extreme conditions Patrick J Stover, Am. J. Clinical Nutrition, Feb 2006; 83: 436S - 442S

14. Evidence for Genetic Variation A Factor in Maintaining Health • Influence of Genetics subtle, complex, not conforming to simple Mendelian patterns of inheritance as is seen with single-gene disorders • Genetic Variation can influence the propensity for the initiating event, the progression to a clinical disease state, and the trajectory of disease • Interleukin 1: example genetic variations affecting complex diseases is provided by the interleukin 1 family of cytokines • Key role in mediating inflammation = central component of many chronic diseases • Coronary artery disease • Rheumatoid arthritis • Research has identified many sequence variations in regulatory DNA of the genes coding for important members of the interleukin 1 family, and these variations are associated with differential effects on the inflammatory response • These in turn alter the risk of some diseases in which inflammation plays a role and also affect physiologic responses, such as the inflammatory response to exercise. As this new genetic knowledge is developed and extended, it may be possible to make health care interventions at an earlier stage, before clinical disease is established, rather than after tissues have been permanently damaged Gordon W Duff, Am. J. Clinical Nutrition, Feb 2006; 83: 431S - 435S

16. Chronic Illnesses & Diet-Related Health ProblemsAre the Most Serious Threat to Public Health • Sixty-five percentof US adults aged >20 years= overweightor obese: • 280,184 deaths per year attributableto obesity • > 64,000,000 Americanshave cardiovascular disease (CVD) = 38.5% deaths • Leading cause of mortality in the United States. • 50,000,000 Americans are hypertensive • 11,000,000 Americans have type 2 diabetes, and • 37,000,000 adults havehigh-risk total cholesterol (>240 mg/dL) • Postmenopausal women aged >50 years • 7.2% have osteoporosis and • 39.6% have Osteopenia • Osteoporotic hip fractures = 20% excess mortality in the year after fracture • Cancer = 25% of all deathsin the United States, • is the second leading cause of death • one-third of all cancerdeaths are due to nutritional factors, including obesity

17. Nutrients Restore The Immune System • Changes in USDA Food Composition Data for 43 Garden Crops, 1950 to 1999, Protein, Ca, P, Fe, Pyridoxine, and Vit C all decreased • The Fundamentally Altered 7 Crucial Nutritional Characteristics of Modern Diets and the Impact of Health in The 21st Century • Associations of Mortality With Ocular Disorders and an Intervention of High-Dose Antioxidants and Zinc, Age-Related Eye Disease Study • Relation Between Dietary N–3 and N–6 Fatty Acids and Clinically Diagnosed Dry Eye Syndrome in Women when om 6: om 3 > 6:1 • The Western Diet Frequently Contains Excessive Saturated andTrans Fatty Acids, Too Little N–3 PUFAs versus excess N–6PUFAs • Western Diet Yields a Net Acid Load = Renal Failure • Latex Exposure comes from inhaled auto tires but Immune system is depressed when we eat foods laden with naturally occurring latex • Role of Thiamine and B Complex in High Calorie Malnutrition

18. Inflammation and Neurodegenerative Diseases • Mental Fitness Decline in Alzheimer Disease accompanies: • Physical changes in the brain, including the development of • characteristic plaques and • Neurofibrillary tangles • Pathogenesis of those changes is not clear • Activation of microglia in response to injury, illness, aging, or other causes begins a cascade of events characterized as an inflammatory process • Cascade is mediated at first by the proinflammatory cytokine interleukin 1, which is over expressed by the activated microglia • Interleukin 1 causes neuronal death, which activates more microglia, which in turn release more interleukin 1 in a self-sustaining and self-amplifying fashion • Over a period of years, this slow smoldering inflammation in the brain destroys sufficient neurons to cause clinical signs of Alzheimer disease W Sue T Griffin,Am. J. Clinical Nutrition, Feb 2006; 83: 470S - 474S

20. The Fundamentally Altered 7 Crucial Nutritional Characteristics of Modern Diets Food staples and food-processingprocedures introduced during the Neolithic and Industrial Periodshave fundamentally altered 7 crucial nutritional characteristicsof ancestral hominin diets: 1) glycemic load 2) fatty acidcomposition = omega 6:3 ratio 3) macronutrient composition 4) micronutrientdensity 5) acid-base balance 6) sodium-potassium ratio, and = 7) fiber content

21. Changes in USDA Food Composition Data From1950 to 1999for 43 Garden Crops All 43 fruits and vegetables tested show statisticallyreliable declines (R < 1) for 6 nutrients: • Protein, 6% • Calcium, • Phosphorus, • Iron, • Riboflavin 38% • Vitamin C Conclusions: • Declines are generallychanges in cultivated varieties between1950 and 1999, in which there may be trade-offs between yieldand nutrient content Observations: • Need to replace those nutrients not available in current Western Food Supply Donald R. Davis, PhD, FACN, Melvin D. s, PhD and Hugh D. Riordan, MD

22. Nutritional Needs As We Age • Nutritional Needs for Increased Functioning and Reduced Effects of Aging in the Elderly • Avoid Latex in Foods, • Decrease Gluten and Omega-6 as much as possible • Replace Nutrients no longer in our Food Supply

23. Western Diet Yields a Net Acid Load • Western net acid load estimated tobe 50 mEq/d • Adults on thestandard US diet sustain a chronic low-grade pathogenic metabolicacidosis that worsens with age as kidney function declines • Virtually all preagricultural diets were net base yieldingbecause of the absence of cereals and energy-dense, nutrient-poorfoods • introduced during the Neolithicand Industrial Eras • displaced base-yielding fruit andvegetables • base-producing diet, the norm throughout most of hominin evolution • Health benefits of a net base-yielding diet include preventingand treating: • Osteoporosis • Age-related muscle wasting • Calcium kidney stones • Hypertension • Exercise-induced asthma • Slow progressionof age / disease-related chronic renal insufficiency

24. Thiamine Deficiency • Modern Western diet is loaded with simple carbohydrates • B-Vitamin deficiency is extremely widespread • Thiamine is very high in this deficiency because of its biochemical association with glucose metabolism • Because of vitamin fortification of many foods and the relative affluence of our present culture we have no considered that obscure symptoms, particularly those that are generally termed functional, are of dietary origin • Deficiency is direct result of years of high calorie diet and treatment with large doses of the appropriate vitamin/mineral supplementation is mandatory • Physiological doses have no effect since the enzyme/cofactor bonding appears to be damaged or partially atrophied. (Need High Dose, not Mega Dose) • Physicians become disenchanted when they treat a patient with low-dose supplementation and see no benefit • The RDA of thiamine is 1–1.5 mg per day, but only in a biochemically healthy individual, and many physicians are under the impression that this kind of vitamin deficiency, if it occurs at all, is easily and quickly treated • In the treatment of beriberi, it took very large doses of thiamine for months and there was often only partial recovery and sometimes none at all

25. Clinical Features Now Emerge • Clinical features of beriberi have been forgotten in modern medicine since it has been assumed that the classic deficiency diseases do not occur in developed societies • Dysfunction in the autonomic system was a prominent part of the clinical expression of beriberi (21) and reversible autonomic dysfunction, associated with evidence of high calorie malnutrition, has been reported in recent times in the United States (22,23) • Sweating, tachycardia, dermographia, wide unstable pulse pressure, attention deficit and other symptoms of autonomic dysfunction in children have been reported as functional dysautonomia (24) • Relation between thiamine requirements and the intake of carbohydrates • The influence of stepwise increases of carbohydrate intake on the status of thiamine in healthy volunteers under isocaloric conditions (25) An increase of dietary carbohydrate intake caused a decrease of plasma and urine levels of thiamine without affecting enzyme activities • Thiamine Deficiency has been reported in refractory heart failure (36) and has occurred in epidemic form in Cuba involving 50,862 (461.4 per 100 000) people • Lesions included peripheral neuropathy, retrobulbar optic neuropathy, sensory and dysautonomic peripheral neuropathy, sensorineural deafness, dysphonia, dysphagia and spastic paraparesis (37,38). TD ataxia (39), post-gastrectomy polyneuropathy (40) and reversible autonomic neuropathy involving bladder dysfunction (41) have been described • Natural Sources and Modern Antagonists to Thiamine • Thiamine is present in lean pork and other meats, wheat germ, liver and other organ meats, poultry, eggs, fish, beans and peas, nuts, and whole grains • Dairy products, fruit and vegetables are not good sources • The RDA is 0.5 mg per 1000 kcal, adequate for a healthy individual consuming a healthy diet • Considerable losses occur during cooking or other heat-processing of food • Polyphenolic compounds in coffee and tea can inactivate thiamine so that heavy use of these beverages could compromise thiamine nutrition

26. Vitamin Physiologic Roles Co-substrate,Coenzyme Functions Deficiency Signs Symptoms Thiamin (B1) Metabolism of carbohydrates, branched-chain amino acids Beri-beri, polyneuritis, and Wernicke-Korsakoff syndrome Riboflavin (B2) Oxidation and reduction reactions Growth, cheilosis, angular stomatitis, and dermatitis Niacin (nicotinic acid, nicotinamide) Hydrogen transfer with numerous dehydrogenases Pellagra with diarrhoea, dermatitis, and dementia Vitamin B6(pyridoxine,pyridoxamine, and pyridoxal) Metabolism of amino acids, glycogen, sphingoid bases Naso-lateral seborrhoea, glossitis, peripheral neuropathy Pantothenic acid Constituent of co-enzyme A, phosphopantetheine FA met Fatigue, sleep disturbances, impaired coordination,nausea Biotin Bicarbonate-dependent carboxylations Fatigue, depression, nausea, dermatitis, muscular pains B-complex Vitamins’ Biochemical Roles,Physiologic Roles of Co-enzyme Forms, and Brief Description of Clinical Deficiency Symptoms

27. Various Eye Disorders Predict Survival • Various ocular disorders (eg, visual impairment and cataract and those in persons with diabetes mellitus, severe retinopathy, or visual impairment)reported to be significant predictors of a decreased life span, after extensive adjustment for potential confounders • Cataract surgery has been associated with decreased survival in many studies • Nuclear opacities associated with decreased survival • Age-related macular degeneration (AMD) has not been found to be related to decreased survival in the few studies that have examined the relationship • Ability to find an association is limited because few participants in these studies had advanced disease (neovascular AMD or geographic atrophy) • Age or underlying disease related to the ocular conditions and mortality could explain the findings why ocular factors could be associated with decreased survival • Loss of vision could have a direct effect on mortality if it results in a susceptibility to accidents such as fatal falls or in depression reported to increase mortality • Cataracts may be markers of systemic processes that are associated with accelerated physiologic aging and earlier death • Generalized oxidative damage play a role in cataract development, aging process Nutrients found helpful: • Centrum Silver • Reverses Cataracts • Omega-3 Fish Oil • Reverses Dry Eyes Syndrome • Zinc oxide 80 mg • had lower mortality

28. Associations of Mortality With Ocular Disorders and an Intervention of High-dose Antioxidants and Zinc • Objective  To assess the association of ocular disorders and high doses of antioxidantsor zinc with mortality in the Age-Related Eye Disease Study (AREDS) • Methods  AREDS is an ongoing, multicenter study of the clinical course of cataract and AMD. The study included a randomized clinical trial that evaluated the effect of high daily doses of selected oral supplements (vitamin C, 500 mg; vitamin E, 400 IU; beta carotene, 15 mg; and zinc, 80 mg as zinc oxide with 2 mg of cupric oxide) on the incidence and progression of the 2 conditions. A total of 4757 persons aged 55 to 81 years at enrollment were entered into the study at 11 clinical centers between November 13, 1992, and January 15, 1998 • Results  During median follow-up of 6.5 years, 534 (11%) of 4753 AREDS participants died • Advanced age-related macular degeneration (AMD) compared with participants with few, drusen had increased mortality (relative risk [RR], 1.41; 95% confidence interval [CI], 1.08-1.86) • Advanced AMD was associated with cardiovascular deaths • Visual acuity worse than 20/40 in one eye had increased mortality (RR, 1.36; 95% CI, 1.12-1.65) • Nuclear opacity (RR, 1.40; 95% CI, 1.12-1.75) and cataract surgery (RR, 1.55; 95% CI, 1.18-2.05) were associated with increased all-cause mortality and with cancer deaths • Zinc participants had lower mortality than those not taking zinc (RR, 0.73; 95% CI, 0.61-0.89) • Conclusions  • The decreased survival of AREDS participants with AMD and cataract suggests that these conditions may reflect systemic rather than only local processes Improved survival in individuals randomly assigned to receive zinc requires further study

29. Relation Between Dietary Omega–3 and Omega–6 Fatty Acids and Clinically Diagnosed Dry Eye Syndrome in Women 32,470 women aged 45–84 y were assessed Fatty Acid intakes using a validated food-frequency questionnaireand assessed Dry Eye Syndrome by using self-reports of diagnosedcases Results: A > 6:1 ratio of omega–6 to omega–3 Fatty Acid (Fish Oil) consumptionwas associated with a significantly increased risk of DES Conclusions:These results suggest that a higher dietary intakeof Omega–3 Fatty Acids is associated with a decreased incidence ofDry Eye Syndrome in women Observations: Added Omega –3 fish oil reduces and prevents dry eyes resulting from excess Omega-6 Plant oils in the diet Biljana Miljanovi , Komal A Trivedi, M Reza Dana, Jeffery P Gilbard, Julie E Buring and Debra A Schaumberg Brigham and Women’s Hospital, Massachusetts Eye and Ear Infirmary Harvard Medical School, Boston, MA;

30. Western Diet Contains Excessive Saturated and TransFatty Acids and Fewer Omega–3 PUFAs than Omega–6PUFAs • High dietary intakes of Saturated Fatty Acids and trans fattyacids increase the risk of Heart Disease by elevating blood total and LDL cholesterol • Omega-3 fish oil PUFAs reduce the risk of CVD via many mechanisms, including reductionsin ventricular arrhythmias, blood clotting, serum triacylglycerolconcentrations, growth of atherosclerotic plaques, and bloodpressure • After 3.5 years of takings 850 mg omega–3 fatty acids, +/- vitamin Esubjectswith preexisting CVD reported: • 20% reduction in mortality • 45%reduction in sudden death • Preventingor ameliorating many inflammatory and autoimmune diseases • No difference total or LDL cholesterol after a 50-d trial on Low and High fat diets that hadidentical ratios of PUFAs to SFAs, n–6 PUFAs to n–3PUFAs, and MUFAs to total fat • Low- (22% energy) • High- (39% energy) • Fat quality is more important thanfat quantity in regard to CVD risk

31. Latex Chemical Sensitivity • Exposure comes from inhaled auto tires • Immune system becomes depressed when we eat foods laden with naturally occurring latex • Fruits and Vegetables make latex bittering agent to prevent animal damage • Latex is converted protein and carbohydrate when fruits and vegetable ripens on the plant naturally • Latex is trapped in the plant when picked green to ship • Latex becomes injury protein when treated with ethylene gas in ALL grocery warehouses, such as; Whole Foods, Wild Oats, Kroger, Giant Eagle, etc • Symptoms are stiffness, fatigue, aches, redness on chin, cheeks, ears, and forehead, burning eyes • Dried, frozen or canned foods have less latex

32. Nutrient Replacement List Omega 3 Fish Oil (1000 mg cap), 1-2 caps before meals and at bedtime Good Start = 1000-2000 mg of combine EPA and DHA daily High Potency B Complex(B-50 or B100), 1 tablet before meals Multivitamin(for age and gender), 1/2 tablet twice daily Magnesium Oxide 250 mg tabs, 1 tab before meals and at bedtime Calcium 500 mg with Vit D, 1 tablet up to three time daily Do not take calcium at same time as thyroid dose Vitamin C 1000 mg, 1 tablet before meals Vitamin E 400 IU, 1 cap twice a day Cinnamon caps 500mg, 2 caps before meals and at bedtime for Cholesterol, metabolic syndrome, diabetes, weight control, fatigue Check with your Doctors before trying any of these !!!

33. Credible Resources and Information About Supplements, Herbal Products, Their Safety and Effectiveness • http://efaeducation.nih.gov for immune omega balance in diet • www.nih.gov for basic answers to supplements • www.ajcn.org for nutritional frontiers • www.nutritiondata.com/facts for individual food omega-3:6 facts • www.jacn.com for nutrition policies • www.nci.gov for cancer supplements • http://lpi.oregonstate.edu/ for new science in Nutrients • www.consumerlab.com Products / Nutrients reports (subscription) • http://medicalcenter.osu.edu/patientcare/hospitalsandservices/primarycare/im/?CFID=228520&CFTOKEN=20456422 for updates and Classes on Integrative Medicine • www.naturalstandard.com for evidence-base CAM (subscription) • Free Trial Logon for NaturalStandard for October is October • Password for October is tomorrow

34. Chicken Breast Roasted Nutritional Facts for Chicken, 1 unit breast broilers / fryers, breast, meat and skin, cooked, roasted: • Total omega-3 fats (est) 63.8 mg •   Total omega-6 fats (est) 818 mg • Omega 6:3 ratio 13:1 • Total Fat 4.5 grams • Saturated Fat 1.3 grams • Fat Calories = 607 • Carbohydrate Calories = 127 • Protein Calories = 120 • Carb 0.0%, Fats 40.7%, Protein 73.5% • Healthy Foods approach 6:3 ration of 2:1 http://www.nutritiondata.com

35. Peanuts Nutritional Facts for Peanuts, all types, dry-roasted, without salt, 1 cup: • Total omega-3 fats (est) 44 mg •   Total omega-6 fats (est) 22,910 mg • Omega 6:3 ratio 520:1 • Total Fat 218 grams • Saturated Fat 25.2 grams • Fat Calories = 607 • Carbohydrate Calories = 127 • Protein Calories = 120 • Carb 15%, Fats 71%, Protein 14% • Healthy Foods approach 6:3 ration of 2:1 http://www.nutritiondata.com

36. Potato Chips With Olestra Nutritional Facts for Potato Chips: With without Olestra • Total omega-3 fats (est) mg •   Total omega-6 fats (est) 818 mg • Omega 6:3 ratio 13:1 • Total Fat 4.5 grams • Saturated Fat 1.3 grams • Fat Calories = 607 • Carbohydrate Calories = 127 • Protein Calories = 120 • Carb 0.0%, Fats 40.7%, Protein 73.5% • Healthy Foods approach 6:3 ration of 2:1 http://www.nutritiondata.com

37. Avocado, Pureed Nutritional Facts, 1 cup avocado pureed: •  Total omega-3 fats (est) 221 mg •   Total omega-6 fats (est) 3,396 mg • Omega 6:3 ratio 15:1 • Total Fat 29.5 grams • Saturated Fat 4.3 grams • Fat Calories = 247 • Carbohydrate Calories = 61.5 • Protein Calories = 13.5 • Carb 6%, Fats 45%, Protein 8 % • Healthy Foods approach 6:3 ration of 2:1 http://www.nutritiondata.com

39. Food Choices to Balance Omega 3:6

40. Just the Beginning of Opportunities

41. Ayurveda Roles of InflammationNuclear Factor-kappa BCURCUMIN (Turmeric: Curcuma longa)Ashwagandha (Withania somnifera) Slides From Hari Sharma, MD Ayurveda Practitioner The Ohio State University Center for Integrative Medicine

46. CURCUMIN (Turmeric: Curcuma longa) • Prevents breast cancer spread in mice xenograft model. • Interferes with proliferation of skin melanoma cells. • Sensitizes cells to radiation and chemotherapy. • Suppresses proliferation of wide variety of tumor cells – Down regulates: • Transcription factor. • Expression of COX-2, LOX, cell surface adhesion molecules, protein kinase, etc. • Anti-mutagenic effect. • Suppresses nuclear factor kappa beta (regulates inflamm. & immune response). • Blocks estrogen-mimicking chemical. • Anti-inflammatory – Inhibits cyclooxygenase-2 (COX-2), lipoxygenase (LOX), thromboxane, leukotrienes, interleukin-12, hyaluronidase. • Potent antioxidant (prevents damage to DNA and genes). • Promotes normal cell cycle. • Inhibits angiogenesis. • Anti-thrombotic. • Hepatoprotective. References: Clin Cancer Res 2005;11(20):7490-7498 Anticancer Res 2003;23:363-398 J Ethnopharmacol 1993;38(2-3):113-119 Indian J Med Res 1971;59(8):1289-1295 Blood 2003;101:1053-1062 J Cell Biochem 2003;89:1-5 Mol Cancer Ther 2003;2:95-103 Pharmacol Res 2003;47:113-140 Anticancer Res 2001;21:873-878 Oncogene 2004;26:1599-1607

48. ASHWAGANDHA(Withania somnifera) • Anti-tumor and radiosensitizing properties • Adaptogenic • Rasayana – General and Medhya • Increases quality and quantity of Ojas • Clears Ama from channels • Immune-enhancer • Anti-cancer • Prevents angiogenesis References: • Food and Chem Toxicol 2004;42:2015-2020 • Indian J Expt Biol 1992;30:169-172, 1996;34:927-932, 1993;31:607-611 • Med Sci Res 1987;15:515-516 • Cancer Lett 1995;95:189-193 • Acta Oncol 1996;35:95-100 • Angiogenesis 2004;7:115-122 • J Ethnopharmacol 2001;75:165-168