Kronisk Inflammasjon Kosthold og livsstil som slukker brannen

1. Kronisk InflammasjonKosthold og livsstil som slukker brannen Fedon Alexander LindbergSpes.i indremedisin-Dr. Lindbergs Klinikk

2. Livsstilsykdommer: Verdens største helseproblem • Hjerte- og karsykdom(nr.1 årsak til prematur død) • Kreft(nr.2 årsak til prematur død) • Metabolsk SyndromOvervekt -diabetes type 2 • Muskel-, skjelett- og Leddlidelser • Psykiske plager

3. Kr. 3790 Kr.1559 Vi tygger piller som aldri før Medikamentforbruket har økt fra 6,6 mrd i 1990 til godt over 18,6 mrd i 2011 (i 2002-kroner) Medisinbruk pr. innbygger

5. Kolesterolsenkende midler i NorgePå midten av 1990-tallet kom det første kolesterol- eller lipidsenkende midlene på markedet. Siden har flere midler kommet til, og salget har økt voldsomt. Figuren viser salget av lipidsenkende midler, oppgitt i form av såkalt definerte døgndoser (DDD) per 1000 innbyggere per døgn.

6. Blodtrykksmedisiner - forbruk i NorgeSalget av blodtrykksmedisiner økte for alvor fra slutten av 1980-tallet. Det viser den øverste kurven i samlefiguren nedenfor.

7. Polymåltid vs Polypille • The Polypill. A strategy to reduce cardiovascular disease by more than 80%. Wald NJ, Law MR. BMJ. 2003 Jun 28;326(7404):1419. • The Polymeal: a more natural, safer, and probably tastier (than the Polypill) strategy to reduce cardiovascular disease by more than 75%. Franco OH, Bonneux L, de Laet C, Peeters A, Steyerberg EW, Mackenbach JP. BMJ. 2004 Dec 18;329(7480):1447-50.

8. The Polymeal • 1 glass of wine daily (150cc) • 400gram (~1lb) assorted fruits and vegetables daily • 110gram (~4oz) fish 4 times a week • 60gram (~2oz) of almonds daily • 100gram (~3oz) dark chocolate daily • 2,8 gram (1 clove) of garlic daily

9. Hippokrates of Kos Medisinens Far 460-370 f.Kr. • ”…Du er hva du spiser……La Mat være din Medisin…” • ”…Det som er bra for hjertet er bra for hjernen…”

10. Nåtidens kosthold – mye feil mat • Altfor mye junk food (bearbeidede produkter) • Altfor mye raske karbohydrater • Poteter, fint hvetemel, finere brød • Altfor mye sukker • Altfor mye salt • Altfor mye feil fett (billige planteoljer og margariner) • For mye transfett (herdet vegetabilsk fett) i f.eks. kjeks, brød, wienerbrød • …og altfor lite grønnsaker, fisk

11. Hvilket kosthold er vi programmert til? Menneskets evolusjon… Genene våre har gjennomgått en 7 mill år lang evolusjonsutvikling Historisk sett er vi programmert til lite, men naturlig mat og mye slit

12. SteinalderenSankingJaktSesongtilgang LandbruksrevolusjonenKornHusdyrKjøtt & melkMindre fysisk aktivitet IndustrirevolusjonenPoteterSukkerRaffinert hvetemelEnda mindre fysisk aktivitet McDonaldiseringLettvint / tilgjengelig Bearbeidede produkterMaskiner / bilKontorarbeide Våre gener er i steinalderen –98% av dem er identisk med sjipansens

13. Hva styrer vårt kosthold • Lettvinthet • Tilgjengelighet • Pris • Media • Smak • Næringsverdi

14. Hvilken livsstil er vi programmert til? Menneskets evolusjon… Genene våre har gjennomgått en 7 mill år lang evolusjonsutvikling Historisk sett er vi programmert til lite, men naturlig mat og mye slit

16. Hva er viktig for oss? • MAT • VANN • LUFT • SOLLYSDisse elementers kvalitet er avgjørende for vår helse Vi kan klare oss uten alt annet unntatt:

17. 1.2% skiller oss, men hvem er klokest?

18. Lavkarbo, Høykarbo eller Smartkarbo? Hvilket kosthold kan sørge for bedre helse og lengre liv?

19. Kostholdsforvirret??Da er du en av 73% nordmenn Høykarbo eller lavkarbo? Sunt med masse brød og poteter eller egg og bacon hver morgen? Pøse på med fløte og smør eller «kolesterolsenkende-hjertevennlige» margariner? Hvem skal man tro og hvorfor?

20. Tre enkle prinsipper:1. Velg oftest naturlig ubearbeidet mat 2. Mest mat fra planter 3. Helst ikke for mye om gangen

21. Inflammation, AGING AND CHRONIC DISEASE Chronic systemic inflammation is an underlying cause of many seemingly unrelated, age-related diseases. As humans grow older, systemic inflammation can inflict devastating degenerative effects throughout the body (Ward 1995; McCarty 1999; Brod 2000). Correcting a chronic inflammatory disorder will enable many of the health problems of aging to be prevented or reversed.

22. Inflammasjon:Fellesnevner bak de fleste kroniske sykdommer • Oksidasjon • Glykosylering • Metylering • Eikosanoidbalanse Følgendemekanismererinvolvert

23. The Causes of Age-Related Inflammation • Aging results in an increase of inflammatory cytokines that contribute to the progression of many degenerative diseases (Van der Meide et al. 1996; Licinio et al. 1999). • Rheumatoid arthritis is a classic autoimmune disorder in which excess levels of cytokines such as TNF-a, IL-6, IL-1(b), and/or IL-8 are known to cause or contribute to the inflammatory syndrome (Deon et al. 2001). • Chronic inflammation is also involved in diseases as diverse as atherosclerosis, cancer, heart valve dysfunction, obesity, diabetes, congestive heart failure, digestive system diseases, and Alzheimer's disease (Brouqui et al. 1994; Devaux et al. 1997; De Keyser et al. 1998).

30. The Causes of Age-Related Inflammation (2) • In aged people with multiple degenerative diseases, the inflammatory marker, C-reactive protein, is often sharply elevated, indicating the presence of an underlying inflammatory disorder (Invitti 2002; Lee et al. 2002; Santoro et al. 2002; Sitzer et al. 2002). • When a cytokine blood profile is conducted on people in a weakened condition, an excess level of one or more of the inflammatory cytokines, e.g., TNF-a, IL-6, IL-1(b), or IL-8, is usually found (Santoro et al. 2002).

31. The Causes of Age-Related Inflammation (2) • In aged people with multiple degenerative diseases, the inflammatory marker, C-reactive protein, is often sharply elevated, indicating the presence of an underlying inflammatory disorder (Invitti 2002; Lee et al. 2002; Santoro et al. 2002; Sitzer et al. 2002). • When a cytokine blood profile is conducted on people in a weakened condition, an excess level of one or more of the inflammatory cytokines, e.g., TNF-a, IL-6, IL-1(b), or IL-8, is usually found (Santoro et al. 2002).

32. Elevated TNF-a in well treated hypertension • TNF-a levels were measured in a group of people with high blood pressure and a group with normal blood pressure (Verdecchia et al. 2002). The hypertensive subjects taking anti-hypertensive medications had about the same blood pressure as the healthy test subjects. • Arterial flow medicated dilation, however, was significantly impaired in the hypertensives and this group also showed higher levels of TNF-a, indicating persistent inflammation despite blood pressure control. • This study showed that even when blood pressure is under control, hypertensives still suffer endothelial dysfunction caused by a chronic inflammatory insult.

33. Elevated C-Reactive Protein and Interleukin-6 Predict Type II Diabetes • Baseline levels of C-reactive protein and interleukin-6 (IL-6) were significantly higher among those who subsequently developed diabetes compared to those who did not. (Pradhan et al. 2001). • Women with the higher IL-6 levels were 7.5 times more likely to develop diabetes while those in the higher C-reactive protein ranges were 15.7 times more likely to become diabetic. • After adjusting for all other known risk factors, women with the highest IL-6 levels were 2.3 times at greater risk, while those with the highest C-reactive protein levels were 4.2 times more likely to become diabetic. • These other diabetic risk factors (such as obesity, estrogen replacement therapy and smoking) all sharply increase inflammatory markers in the blood. These data support a possible role for inflammation in diabetogenesis.

34. C-Reactive Protein and IL-6 Predict Death • Elevated C-reactive protein, IL-6 and other inflammatory cytokines indicate significantly greater risks of contracting or dying from specific diseases (heart attack, stroke, Alzheimer's disease, etc.). • 1,293 healthy elderly people were followed for a period of 4.6 years (Harris et al. 1999). • Higher IL-6 levels were associated with a twofold greater risk of death. • Higher C-reactive protein was also associated with a greater risk of death, but to a lesser extent than elevated IL-6. • Subjects with both high C-reactive protein and IL-6 were 2.6 times more likely to die during follow up than those with low levels of both of these inflammation markers. • These results were independent of all other mortality risk factors.

35. Diet and chronic inflammation • Foods can potentially cause or reduce inflammation • Some foods cause more inflammation than others • Inflammation is mediated through chemical substances called cytokines, which all cells produce - eicosanoids/cytokines • Eicosanoids are made of essential fatty acids (omega 3 and 6) • Eicosanoid balance is affected by - hormones (among others insulin, cortisol)- type of fat we eat- several micro nutrients (vitamins-minerals)

36. Oxidation and inflammation affect all organs, not least the brain, because of its high fat content • Everything that contributes to less oxidation and inflammation will have a universall positive health effect

37. Oksidasjon og Inflammasjon • Oksidasjon står sentralt • Oksygen er livsviktig men fører til gradvis oksidasjon i kroppen • Prooksidanter:- mat, økt blodsukker, (flere)umettet fett, stress, røyking, miljøgifter, jern med mer • Antioksidanter: Viktigst er vårt endogene antioksidantsystem (Glutathion, Liponsyre, Superoxid dismutase, Urinsyre, Melatonin)- vitaminer (for eksempel vit E, C, beta karoten), noen mineraler (for eksempel selen), fytokjemikalier (polyfenoler med mer), stressmestring, god og nok søvn, ren luft, unngå miljøgifter med mer). • Antioxidant status kan testes i blodprøve

39. Add colour to your diet for antioxidant protection

40. Foods with Antioxidant Power Avocado 782 Orange 750 Grape, red 739 Pepper, red 731 Cherry 670 Kiwifruit 602 Beans, baked 503 Grapefruit, pink 483 Beans, kidney 460 Onion 449 Corn 402 Peas, frozen 364 Potatoes, sweet 301 Cantaloupe 252 Apple 281 Carrots 207 • Per 100grams • Chocolate, cloves, allspice, cinnamon, saffron, coffee, oregano, sage, thyme • Blueberries 2234 • Blackberries 2036 • Kale 1770 • Strawberries 1536 • Spinach, raw 1210 • Raspberries 1227 • Plums 949 • Alfalfa sprouts 931 • Spinach, steamed 909 • Broccoli 888 • Beetroot 841

41. Glycation'sRole in InflammationCooking and Aging have similar Biological Properties • Glycation can be described as the binding of a protein molecule to a glucose molecule resulting in the formation of damaged protein structures- AGE or Advanced Glycation Endproducts. (Maillard-Amidori reaction). • Many age-related diseases such as arterial stiffening, cataract and neurological impairment are at least partially attributable to glycation. • AGE render proteins in the body cross-linked and barely functional. As AGE accumulate, they cause cells to emit signals that induce the production of inflammatory cytokines.

42. Glycation IN VIVO • Glycation occurs in vivo when blood glucose reacts with body proteins. • AGE production is much higher in diabetes • Consuming low glycemic foods prevents excessive glycation. The higher the glycemic load (GL) of the diet, the more AGE are produced. • The insulin surge that contributes to chronic inflammatory processes. • It is also important to avoid over consumption of foods high in omega 6 arachidonic acid (beef, egg yolk, dairy, etc.).

43. Cooking, glycation and inflammation • Glycation occurs ex vivo during cooking in high temperatures (browning effect) and little or no water (frying, high temp.oven baking, grilling). • Approximately 10-20% of AGE in food gets absorbed by the gut. • AGE form in the skin, arteries, eye lenses, joints, cartilage, etc. • Consuming foods high in AGE might be responsible for the induction of a low-grade, but chronic state of inflammation.

44. JUNK FOOD, glycation and inflammation • Since most "junk" foods are cooked at extremely high temperatures, it makes sense to avoid French fries, hamburgers, potato chips, fried food and other snacks. These foods not only contain lots of glycotoxins, they also create other metabolic disorders that can induce degenerative disease.

45. Methylation • Chemical reactions that go on in every cell in your body by which methyl groups (one atom of carbon and three atoms of hydrogen) are transferred into another molecule. • When this does not happen in a complete manner, intermediary molecules are created, which create free radicals and damage DNA. One of the best examples of this is the creation of homocysteine, which can damage arteries and cause heart disease. Cancer is another possible outcome of this process. • To address this, you need to ensure that your diet contains precursors for methylated DNA. These are called methyl donors and can help ensure proper methylation reactions necessary for gene expression take place in your body.

46. Methylation, the Homocystein Connection and Inflammation Homocysteine is a toxic byproduct of normal protein metabolism- Enough Vitamin B6, B12 and folate keep it low

47. Homocysteine predicts risk for.. • Heart attacks, strokes and blood clots • Pregnancy problems and birth defects • Memory deficit and Alzheimer’s disease • Depression (especially in women) • Schizophrenia (especially in young men) • School grades • Possibly autism • … and is easily reversible with optimum nutrition

48. Optimal‘Homocysteine’ Scoreis below 7-9 (“normal” is up to 15)Around 8-10% of the population has a gene variation (MTHFR) causing excessive homocysteine and need supplementation

49. 8 Ways to Lower Your ‘Homocysteine’ Scorebelow 7-9 • Eat enough animal protein (less meat, more fish and vegetable protein, eggs, dairy)- for B12 • Eat your greens • Have a clove of garlic a day • Cut back on coffee and black tea • Limit your alcohol • Reduce your stress • Stop smoking • Consider supplementing homocysteine lowering nutrients daily (Vitamin B12, B6 and folate)

50. OMEGA FATS, EICOSANOIDS AND INFLAMMATION • Omega-3 fatty acids found in fish oil help to suppress the formation of undesirable prostaglandin E2 and promote synthesis of beneficial prostaglandin E3 (Kelley et al. 1985; Watanabe et al. 2000). • Similar mechanism as NSAID/COX inhibitors. • Gamma - linolenic acid (GLA) induces production of the anti-inflammatory prostaglandin E1 (Das et al. 1989; Fan et al. 1997). What you eat can significantly affect whether you have more of the beneficial prostaglandins (E1 and E3) as opposed to the pro-inflammatory prostaglandin E2. • Reducing the consumption of foods that are high in omega-6 fatty acids and increasing the consumption of omega-3 rich foods, such as salmon and other fish, can be beneficial.