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The Anti-Inflammatory Diet and Cardiovascular Disease

The Anti-Inflammatory Diet and Cardiovascular Disease. Michael Brown MD, PhD. Inflammation: A common final pathway. Cardiovascular disease Cancer Neurodegenerative disease Autoimmune disease DM Obesity. What is Inflammation?.

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The Anti-Inflammatory Diet and Cardiovascular Disease

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  1. The Anti-Inflammatory Diet and Cardiovascular Disease Michael Brown MD, PhD

  2. Inflammation:A common final pathway • Cardiovascular disease • Cancer • Neurodegenerative disease • Autoimmune disease • DM • Obesity

  3. What is Inflammation? • Complex orchestration of pro-inflammatory and anti-inflammatory events • Mediated by eicosanoids • Prostaglandins, thromboxanes, leukotrienes, • Hydroxylated fatty acids, lipoxins, prostamides, isoprostanoids • Silent inflammation vs. painful inflammation

  4. Phases of inflammation • Initiating event- • Pro-inflammatory attack response/cellular destruction • Anti-inflammatory healing response/Cellular rejuvenation

  5. Omega 6 Fatty Acid (Linoleic Acid) Omega 3 Fatty Acids (alpha-linolenic acid) Δ6-Desaturase Gamma-linolenic acid (GLA) Evening Primrose Oil Borage Oil Black Current Oil Eicosapentaenoic Acid (EPA) COX Lipoxygenase Δ5-Desaturase Arachidonic Acid Prostaglandins PGE1, PGE3 (Favorable) Less Inflammatory Leukotrienes Cyclo-oxygenase (COX) Lipoxygenase Docosahexaenoic acid (DHA) Prostaglandins (PGE2) (Inflammatory) Leukotrienes

  6. Arachidonic Acid (in cell membrane) Phospholipase A-2 Steroids Free AA Colchicine Aspirin Cyclo-oxygenase Pathway Lipoxygenase Pathway Sulfasalazine NSAIDs Leukotriene Inhibitors: Accolate, Singulair, Zyflo COX II Inhibitors: Celebrex, Vioxx, Mobic Prostaglandins & Thromboxanes Leukotrienes

  7. FAT IS GOOD!! • Depending on what kind…. • Omega 3 fatty acids (fish oils-EPA, DHA; plant sources -ALA) • Mono-unsaturated fats (canola and olive oils) • Decreased fat consumption since the 1960’s associated with obesity epidemic—CHO intake has increased dramatically • Glycemic index/glycemic load

  8. Types of fats • Saturated: beef and other animal fats, dairy • Monounsaturated (omega-9): olive and canola oils

  9. Polyunsaturated fats (essential FA’s): • Omega-6: Linoleic acid (LA)--vegetable oils, seeds, nuts Gamma Linolenic Acid (GLA)--borage and primrose oil Arachidonic Acid(AA)--meat products — Omega-3: Alpha Linolenic Acid (ALA)--legumes, leafy vegetables, flax, flaxseed and canola oils) Eicosopentanoic acid (EPA)-fish oil Docosahexanoic acid (DHA)--fish oil, breast milk

  10. Avoid or Reduce • Trans-fatty acids BAD! • Omega-6 fatty acids • Margarine • Corn oil, cottonseed oil, grapeseed oil, peanut oil, safflower oil, sesame oil, soybean oil, sunflower oil, partially hydrogenated oils • Any product with long shelf life (crackers, pastries, chips)

  11. How much Omega-3 fats do you need? • Strive for Omega 6: Omega-3 ratio of 4:1 (usual SAD (Standard American Diet) 16:1 • Maintenance 2.5 g/d • Improve hear function 5 g/d • Treat chronic pain 7.5 g/d • Treat neurological disease >10g/d Sears, The Anti-Inflammation Zone, 2005

  12. Types of Fish Oil • Fish • Contamination with PCB, dioxin, and Hg • Higher in AA than fish oil • Crude fish oil • High contamination • Health food grade • Still some contamination with PCB’s and dioxins • Ultra-Refined EPA/DHA Concentrates • Removal of PCB’s and other toxins • Can be used in high doses (“weapons grade”)

  13. Requirements for an Ultra-refined EPA/DHA concentrate • Total long-Chain Omega-3 >60% • Dioxins< 1 ppt • Mercury <10 ppb • PCB’s<30 ppb

  14. What is an anti-inflammatory diet? • Lose fat • Eat small meals • Have some protein at every meal but reduce red meat and dairy (Avoid charred, overcooked foods) • Cold water fish (salmon, mackerel, sardines, herring) • Eat primarily fruits and vegetables • Leafy green vegetables, nuts, flaxseeds or oil • Take your fish oil

  15. Anti-inflammatory Lifestyle • Exercise • Quit smoking • Weight loss • Stress management • Vagal nerve stimulation via abdominal breath work • Treatment of depression • Social support

  16. Arachidonic Acid (in cell membrane) Phospholipase A-2 Onions/ Apples Quercetin Turmeric Curcumin Rosemary Ursolic acid Red Pepper Capsaicin Ginger Onions/Apples Quercetin Turmeric Curcumin, Feverfew Perthenolides Free AA Onions/Apples Quercitin Cyclo-oxygenase Pathway Lipoxygenase Pathway Boswellia Bosellic Acid Rosemary Carnosol Prostaglandins & Thromboxanes Leukotrienes

  17. Mediterranean Diet • More tolerable than low fat diets and associated with improved long term weight loss (McManus 2001) • Risk reduction of death from CAD = 0.67 compared to usual AHA diet (Trichopoulou et al, 2003)

  18. Something fishy?

  19. American Heart Association Recommendations ·Healthy individuals should take two servings of fish(salmon, sardines, tuna, mackerel, trout) weekly along with flaxseed, canola, and soybean oil ·  Patients with CHD should consume higher doses, 1 g/d of EPA + DHA, which may require fish oil supplementation • Utilize complex carbohydrates, higher in fiber and lower in glycemic load to reduce risk of CHD AHA Recommendations: Intake of omega-3 fatty acids. Women’s Health in Primary Care. 2003.6(1): 25-26 (Consensus opinion) Hu F, Willett W.Optimal diets for prevention of coronary heart disease. JAMA. 2002;288:2569-2578 {Systematic review}

  20. Indications from other studies • Eating fish as little as once a week reduces the risk of sudden death in men • Eating fish twice a week reduces CHD risk in women • Fish intake reduces Alzheimer’s risk Harper, Beyond the Mediterranean Diet: the Role of Omega-3 Fatty Acids in the Prevention of CAD, Prev Cardiol, 2003 Morris, Consumption of fish and n-3 fatty acids and risk of Alzheimer dz,. Arch Neurol, 2003

  21. How intake of Omega-3 Fatty Acids is helpful • Stabilization of atherosclerotic plaques • Reduction of inflammation by mediation prostaglandin synthesis pathway • Improved ratio of omega-3 to omega 6 FA reduces arachidonic acid and pro-inflammatory, pro-platelet aggregatory cytokines • Enhances PGE1 and PGE 3 and less inflammatory leukotrienes(see diagram) Thies F, et al. Association of n-3 polyunsaturated fatty acids with stability of atherosclerotic plaque: RCT, Lancet, 2003;361:477-85 Harper, Beyond the Mediterranean Diet: the Role of Omega-3 Fatty Acids in the Prevention of CAD, Prev Cardiol, 2003;6(3):134-46

  22. Fish Oil for secondary prevention • 240 pts with suspected Acute MI • 2 gms fish oil vs. placebo • After 1 year, 54% reduction in serious ventricular arrhythmia, 30% total reduction in cardiac events Singh, Cardiovasc Drugs Ther 1997

  23. GISSI • More than 11,000 patients on 1 gm fish oil/d < 3mos post MI • 20% reduction in total mortality • 10% reduction in recurrent MI • 40% reduction in sudden death Lancet 1999;354

  24. AHRQ report Overall, the evidence from the primary and secondary prevention studies supports the hypothesis that consumption of omega-3 fatty acids,fish, and fish oil reduces all-cause mortality. Reduction was observed in CVD outcomes such as sudden death, cardiac death (coronary or MI) and MI although the evidence is strongest for fish or fish oil.

  25. AHRQ study • Most studies show very low cardiovascular mortality in populations with high fish consumption • Strongest, most consistent effect of omega-3 fatty acids was reduction in triglycerides from 10-33%

  26. A word about… • Glycemic Index (rate of absorption of glucose) • Glycemic Load (ratio between GI and CHO content) • www.glycemicindex.com

  27. High Glycemic/Load Foods Increase: • Inflammation • Risks of heart disease, diabetes • Examples include: • White bread, glucose (GI= 100) • Potatoes, white rice • Pastries, white flour • Sweets, carbonated soft drinks

  28. Lower GI/GL reduces risk • Whole grains • Fruits • Vegetables • Legumes • Or…mixing high GI/GL foods with those with lower GI/GL

  29. Superfoods to decrease inflammation • BEANS • Pinto, navy, Great Northern, lima, garbanzo(chickpeas), black beans, lentils, green beans, sugar snap peas, and green peas • BLUEBERRIES • Purple grapes, cranberries, boysenberries, raspberries, strawberries, currants, blackberries, cherries, and all other varieties of fresh, frozen, or dried berries • BROCCOLI • Brussel sprouts, cabbage, kale, turnips, cauliflower, collards, bok choy, mustard green, Swiss chard • OATS • Wheat germ, ground flaxseed, brown rice, barley, wheat, buckwheat, rye, millet, bulgur, wheat, amaranth, quinoa, triticale, kamut, yellow corn, wild rice, spelt, couscous • ORANGES • Lemons, white, and pink grapefruit, kumquats, tangerines, limes • PUMPKIN • Carrots, butternut squash, sweet potatoes, orange bell peppers

  30. Superfoods to decrease inflammation SALMON • Alaskan halibut, canned albacore tuna, sardines, herring, trout, sea bass, oysters, and clams SOY • Tofu, soymilk, soy nuts, edamame, tempeh, miso SPINACH • Kale, collard, Swiss chard, mustard greens, turnip greens, bok choy, romaine lettuce, orange bell peppers TEA – GREEN OR BLACK TOMATOES • Red watermelon, pink grapefruit, Japanese persimmons, red-fleshed papaya, strawberry, guava TURKEY • Skinless chicken breast WALNUTS • Almonds, pistachios, sesame seeds, peanuts, pumpkin, and sunflower seeds, macadamia nuts, pecans, hazelnuts cashews YOGURT • Kefir

  31. SUPERFOOD #7:WILD SALMON • Lowers the risk of heart disease and cancer. • The more omega-3 fish oils you eat; the lower your blood pressure • In one study eating the oil in fish cut cancer incidence by over 60% • 4x weekly  risk for and progression of AMD • Studies suggest that fish consumption is associated with a lower risk for depression, violent behavior, Alzheimer’s disease, Attention Deficit Disorder, Atrial fibrillation. • SPF nutrients • TRY TO EAT Wild salmon, halibut, sardines, etc.  2 to 4 times per week

  32. SUPERFOOD #13:WALNUTS • A handful a day can cut your risk of cardiovascular event by as much as 51% • Two tablespoons of peanut butter 5 times/week cuts risk of type II diabetes by 20% • Along with tea, the easiest way to improve your heath •  Risk/progression of AMD • SPF nutrients • TRY TO EAT a handful of nuts, five times a week * Skip the salt and added oils

  33. WALNUT SIDEKICKS • Almonds • Pistachios • Sesame Seeds • Peanuts • Pumpkin and Sunflower Seeds • Macadamia Nuts • Pecans • Hazelnuts • Cashews

  34. 10 Foods to Avoid • Donuts • White Bread • Bread with < 3 grams fiber/ slice • Soda • Stick Margarines • White Pasta • Full Fat Dairy • Movie Theatre Popcorn • Luncheon Meats • Sugar Coated Cereal

  35. References • Rakel D, Rindfleisch A. Inflammation: nutritional, botanical, and mind-body influences. South Med J 2005;8(3):303-310 • Liu S, Willett W, Stampfer M, et al. A prospective study of dietary glycemic load, carbohydrate intake, and risk of coronary heart disease in US women. Am J Clin Nutr 2000;71:1455-1461 • Ascherio A, Katan, M, et al. Trans fatty acids and coronary heart disease. NEJM 1999;340;1994-1998

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