Food as Medicine “Let food be thy medicine and medicine be thy food.” -Hippocrates

1. Food as Medicine“Let food be thy medicine and medicine be thy food.” -Hippocrates Andrea Ogden, RD

2. Food as Medicine He that takes medicine and neglects diet, wastes the skill of the physician.- Chinese Proverb Goiter: Iodine Scurvy: Vitamin C Rickets: Vitamin D, Calcium, and/or Phosphate Beriberi: Thiamin (Vitamin B1) Pellagra: Niacin (Vitamin B3) Anemia: Iron, Vitamin B12 Neural Tube Defect: Folic acid

3. Objectives • Relationship between food & Inflammation • Phytonutrients help the body fight disease & manage symptoms. • Educate patients; food in the disease management process.

4. Inflammation and Disease Coronary Artery Disease Inflammatory Bowel Disease Autoimmune diseases Obesity Alzheimer’s disease Rheumatoid Arthritis Colon Cancer

5. The Western Diet Promotes Inflammation • animal based foods • limited vegetables • high glycemic • processed foods containing omega-6 & trans fats • high volume consumption

6. Focus on what you NEED “Eat food. Not too much. Mostly plants.” -Michael Pollan Consistent meal pattern Take time to enjoy your food “Food is the most primitive form of comfort.” - Sheilah Graham (1904-1988) 1,2,3

7. Anti-Inflammatory Diet 1. Eliminate trans fats • The breakdown of trans fatty acids  free radical formation, which can lead to damaged blood vessels  more inflammatory agents • Fast foods, chips, crackers, breads, soups, pastries, processed peanut butter, margarine, and Crisco 2. Reduce intake of saturated fats • Animal fat in the form of butter, cream, and lard 3. Reduce intake of omega-6 fatty acids 4. Increase intake of omega-3 fatty acids • Hypolipidemic, Anti-hypertensive, Antidepressant • More fish and less corn, safflower, sunflower and cottonseed oils 4, 5, 6, 7,8

8. “A Therapeutic Trial of a Raw • Vegetable Diet in Chronic Rheumatic Conditions” • Proc Royal Soc Med 1936;20:1-10 5. Consume a diet rich in antioxidants from plant foods • Association between Inflammatory Bowel Disease and Arthritis with low antioxidant levels 6. Eat a diet high in fiber 7. Include probiotics 8. Include spices • ginger, turmeric, garlic, rosemary 9. Avoid high glycemic carbohydrates 10. Maintain a healthy weight 11. Avoid food sensitivities/allergies/intolerances 12. Include moderate amounts of soy products 9, 10, 11, 12

9. Drink to Your Health Water Green & Black Tea Polyphenols Flavonoids Make your own decaf Wine & Beer Polyphenols 13

10. Too much of a good thing… Limit alcohol to 1 serving or less/day Avoid High Fructose Corn Syrup 14

11. Dairy Organic PLEASE Non-fat will reduce saturated fat by nearly 8 grams Probiotics -Yogurt & Kefir Soy, almond, rice, & hemp substitutes 15

12. Protein Plant Based • Provides fiber Organic or Non-Genetically Modified Soy • Vitamin E, Isoflavones, Plant Sterols, and some Omega-3 • Lower levels of inflammatory mediators • Complete protein Cold Water Fish • Salmon, sardines, herring, light tuna Limited Organic Poultry Egg Whites

13. Nutrition Content of Beans

14. Phytonutrients “Phytochemicals are chemical compounds that occur naturally in plants. The term is generally used to refer to those chemicals that may affect health.” • > 5000 phytochemicals identified in foods • Polyphenols, Flavonoids • Red, blue, purple pigments • Flavonols like quercetin (red and yellow onions, tea, wine, apples, cranberries, buckwheat, beans) • Isoflavones (primarily soy) • Terpenes like Carotenoids • Alpha & beta carotene, lycopene, lutein • Lipids are another terpene. Tocopherols (vitamin E) • Omega-3,6,9 fatty acids – dark-green leafy vegetables, grains, legumes, nuts. 16, 17

15. Make ½ the Plate Vegetables Vitamin C – citrus fruits, papaya, kiwi, strawberries, cantaloupe, mango, tomatoes, red and yellow peppers Vitamin E – asparagus, corn, avocado Trace minerals (zinc, copper, & selenium) legumes, pumpkinseeds Carotenoids – carrots, sweet potatoes, pumpkin, yams, mango, broccoli, spinach, kale Flavonoids –berries, apples, citrus fruits, tomatoes, greens, beans Plant sterols-legumes Pre-biotics, fiber, and Omega-3’s

16. Whole Grains As close to their natural state as possible Vitamin E Trace minerals Prebiotics Fiber

17. Fat IS Good for You Monounsaturated fat • olive oil, almonds, hazelnuts, avocado, & canola oil. Omega-3 Fats • walnuts, pepitas Limit Omega-6 • corn, sunflower, safflower, soybean, cottonseed, grapeseed, & peanut oils Avoid partially- Hydrogenated oils

18. Herbs and Spices Herbs come from the leaves of plants. Spices come from the bark, stem and seeds of plants.

19. Anti-Inflammatory Spices &Healing Herbs Ginger Fennel ParsleyOregano Cinnamon Garlic Rosemary Turmeric

20. Focus on What You Need Eliminate trans fats Reduce intake of saturated fats Reduce intake of omega-6 fatty acids Increase intake of omega-3 fatty acids Consume a diet rich in antioxidants from plant foods Include moderate amounts of soy products Eat a diet high in fiber Include probiotics Include spices and herbs Avoid high glycemic carbohydrates Maintain a healthy weight Avoid foods we are sensitive/allergic/intolerant to.

21. Andrea Ogden, RD Scripps Center for Integrative Medicine ogden.andrea@scrippshealth.org 858.554.3378

22. Resources The Cook’s Thesaurus http://www.foodsubs.com/ San Diego Farm Bureau http://www.sdfarmbureau.org/ Herb & Spice Chart http://homecooking.about.com/library/archive/blmisc2.htm Sustainable Fishery http://www.oceansalive.org/home.cfm http://www.mbayaq.org/cr/SeafoodWatch.asp Chef MD: Big Book of Culinary Medicine, John La Puma Eating Well for Optimum Health, Weil MD Superfoods Rx, Pratt MD How to Cook Everything Vegetarian, Bittman