Quality

Company

Quantity

Context

Nutrigenomic IndexWhole, unprocessed predominantly plant-based diet

• Low glycemic load • Proper fatty acid composition (omega 3:6 ratio)• High phytonutrient density• Healthy protein (plant or grass-fed)• High micronutrient density• Low allergenic burden (gluten, dairy, etc.)• Low toxic burden (pesticides, hormones, GMO, etc.)• Healthy pH balance• Healthy salt-potassium ratio• High fiber content

MacronutrientsWhat to Eat

• Low glycemic index and glycemic load diet

• High fiber – 50 g.

• Increase omega-3 fatty acids, monounsaturated fats

• Colorful diversity of low glycemic vegetables and fruits

• Increase intake of nuts, seeds and legumes

• Non-GMO traditional soy foods

• Lean animal protein (wild?)

• Whole grains (minimal flours)

MacronutrientsWhat and When Not to Eat

• Minimize or eliminate refined flours and sugars

• Minimize caffeine and artificial sweeteners

• Eliminate trans fats and minimize saturated fats

• Combine protein, fat and carbohydrates to reduce glycemic load

• Increase meal frequency and decrease meal quantity

• Eat breakfast and don’t eat 2-3 hours before bed

Among individuals aged 70 to 90 years,

adherence to a Mediterranean diet

and healthful lifestyle is associated with a

more than 50% lower rate of all-causes and

cause-specific mortality.

JAMA. 2004;292:1433-1439 article

Adherence to the Mediterranean diet, long-term weight change, and incident overweight or obesity: the Seguimiento Universidad de Navarra (SUN) cohort

Conclusion: adherence to the Mediterranean diet pattern is significantly associated with reduced weight gain. This dietary pattern can be recommended to slow down age-related weight gain

Am J Clin Nutr 2010;92:1484-93

“….one third of what we eat keeps us alive.

Two thirds of what we eat keeps doctors alive”

Unknown

Genetically engineered salmon approved for consumption

Federal regulators approved genetically engineered salmon as fit for consumption, making it the first genetically altered animal to be

cleared for American supermarkets and dinner tables

NYTimes, Nov 19, 2015

A genetically engineered salmon from AquaBountyTechnologies, rear, with a conventionally raised sibling roughly the same age.Credit Paul Darrow for The New York Times

New study finds organic diet for one week drops pesticide levels by 90 percent in adults

• RMIT University study published in Environmental Research: organic diet for just one week significantly reduced pesticide exposure in adults

• Study found – urinary dialkylphosphates (DAPs) measurements 89% lower when they ate an organic diet for seven days compared to conventional diet for the same amount of time

New study finds organic diet for one week drops pesticide levels by 90 percent in adults (cont’d)

“A lot of these agents were initially developed as nerve gases for chemical warfare, so we do know that they have toxic effects on the nervous system at high doses. Conventional food production commonly uses organophosphate pesticides, which are neurotoxins that act on the nervous system of humans by blocking an important enzyme. Recent studies have raised concerns for health effects of these chemicals even at relatively low levels. This study is an important first step in expanding our understanding about the impact of an organic diet.” – Dr. Liza Oates

Lifestyle Changes Could Significantly Decrease Chronic Disease

“More than one billion adults worldwide are overweight, and at least 300 million of these are clinically obese. Up to 80% of cases of coronary heart disease, 90% of type-2 diabetes cases, and one-third of cancers can be avoided by changing to a healthier diet, increasing physical activity and stopping smoking.”

WHO.com

Exercise “can be as good as pills”

• For people with conditions such as heart disease

• Physical activity rivaled some heart drugs and outperformed stroke medicine

• Finding suggest exercise should be added to prescriptions

BMJ – BBC News, Oct. 1, 2013

Why runners get slower with age (and how strength training may help)• Young runners use certain leg muscles quite differently than runners past age 50

do

• With each passing decade, the runners’ stride length and preferred speed dropped by about 20 percent

• Runners older than 40 displayed much less activation of and power in the muscles of their lower legs, especially those around the ankle and in the calf

• Older runners pushed off more weakly with each stride and did not rise as high into the air as younger runners, a change in form that accelerated as runners reached their 50s

• Evidence that those muscles age earlier than other muscles in the body do, with connections between cells in those muscles and the nervous system faltering and the muscles’ repair systSports &ems weakening earlier than in other muscles

Medicine & Science in Exercise, Aug 2015

What’s Your Fitness Age?

• New study of fitness and lifespan suggests - person’s fitness age – determined primarily by a measure of cardiovascular endurance – is a better predictor of longevity than chronological age

• Good news – unlike actual age, fitness age can decrease

• Fitness age – determined primarily by VO2max – a measure of body’s ability to take in and utilize oxygen

• VO2max indicates current cardiovascular endurance

The New York Times, Oct. 15 2014

How Exercise Changes our DNA

• Volunteers exercised one leg

• Muscle biopsies revealed:1) Exercised leg more powerful

2) Changes within exercised muscle cells DNA

3) New methylation patterns had taken place in 7,000 genes

• Genes in question known to play role in energy metabolism insulin response and inflammation with muscles

Karolinska Institutet in Stockholm. NY Times Dec. 14, 2014

Op-Ed: Weight loss through exercise alone is

a myth

Malhotra A. et al. British Journal of Sports Medicine 2015

Dr. Rob’s 2016 Wellness Protocol

• Nutrition assessment• Repair the gut• Detox with body composition program• Low glycemic index/load foods• Small, frequent meals

• Medical Food:• To increase intake of targeted quality nutrients • Management of dyslipidemia • Central obesity/Metabolic syndrome

• Quality EFAs, esp. omega-3 (EPA, DHA)• Exercise – progressively increase intensity

• Aerobic, strength, flexibility

• Additional supplementation as needed:• CLA• Alpha-lipoic acid

Management of Dyslipidemia is Critical for at Risk Patient Groups

Powdered medical food is designed to help manage distinctive nutritional requirements of patients with dyslipidemia

Powdered medical food can be used by individuals with:• Cardiovascular disease• Metabolic syndrome• Obesity and/or central adiposity

Prevalence of Dyslipidemia in the US Today

Cardiovascular Disease (35%)

CDC National Center for Health Statistics http://www.cdc.gov/nchs/NHANES

Raised Triglycerides (30%)

Reduced HDL Cholesterol (23%)

Increased LDL Cholesterol (27% US Adults)

Metabolic Syndrome (30%)

Elevated Cholesterol Is An Important Risk Factor For Heart Disease And Stroke

Prevalence Data Available at: http://www.cdc.gov/nchs/fastats/cholesterol.htm. Date accessed: 12/21/2015 http://www.nhlbi.nih.gov/health/educational/hearttruth/downloads/html/infographic-riskfactors/infographic-5.htm. Date accessed 1.3.2016

Raised total cholesterol is highly prevalent, affecting 13.4% of US adults2

The prevalence of high cholesterol increases with age

Managing Dyslipidemia and Other CVD Risk Markers is Critical for Metabolic Syndrome Patients

The National Cholesterol Education Program’s Adult Treatment Panel III: Criteria for Metabolic Syndrome

3 of 5 Criteria Needed to Qualify for Metabolic Syndrome Diagnosis

• Waist circumference greater than or equal to 40” (102 cm) in men or 35” (88 cm) in women

• Plasma triglycerides greater than or equal to 150 mg/dl

• HDL cholesterol less than 40 mg/dl in men or less than 50 mg/dl in women

• Blood pressure greater than or equal to 130/85 mmhg

• Glucose greater than 110 mg/dl (includes diabetes) per ATP III, 2001

Hydration

Excretion and Elimination

Mitochondrial Function (Phytonutrient)

Liver

Body Composition

5 Steps to Anti-Aging

Dr. Rob’s Fab 5Micronutrients for Anti-Aging

1) Multivitamin/multimineral

2) Omega-3 fatty acids

3) Vitamin D

4) Probiotics

5) Phytonutrient supplements

Why we need to take supplements….

Patients are like…

….we can take it to the next level

What Distinguishes a Quality Nutritional Product?

1) GMP-certified manufacturing:i. NPA

ii. NSF international

iii. TGA

2) Comprehensive scientific evaluation of ingredients – how do you verify the quality of ingredients (i.e. raw material selection)

3) Comprehensive safety reviews

4) Human clinical evaluations

5) Scientific staff and facilities

Howzabout you get involved all up in here

Skin (fascia)E.C. Matrix

Mechano Receptors

Nerves

Dr. Rob’s Concussion Protocol

Concussion Nutrition ProtocolFeed the concussionInitially After Injury – within 1 day

1) Protein: helps heal the injury. Take 1g/kg of body weight

2) Creatine: gives the brain an intense/immediate energy to heal cells

3) Reduce inflammatory damage to brain DHA, bromelain, quercetin, ginger, turmeric, resveratrol, grapeseed extract

4) Antioxidants: alpha-lipoic acid

5) Choline: critical for brain development

6) Vitamin D: neuroprotective

7) Zinc: enzyme for CNS

8) Magnesium: great weapon against delayed brain injury

If You Give a Mouse a Concussion

• Using glutathione after a concussion reduced brain tissue damage by an average of 70%

Sports Illustrated, April 17, 2014

Brain-Derived Neurotrophic factor(BDNF)

Supports Branching Network of Neurons

Helps Nerves Grow

Reduces Neurodegeneration

Risk

Makes Neuronal Synapses and Communication More Efficient

Improves Neuron Synapses

Concussion Nutrition ProtocolFeed the concussion (cont’d)

Symptoms persist

• Ratio of substance P to BDNF is excessive

Decrease substance P – natural anti-inflammatories plus magnesium and L-carnitine

Build-up BDNF – DHA, zinc, turmeric, alpha-lipoic acid

Long-chain omega-3 fatty acids (LC-n3-FA) improve brain function and structure in older adults

• LC-n3-FA exert positive effects on brain functions

• They exerted beneficial effects on:• White matter integrity

• Grey matter volume in frontal temporal, parietal and limbic areas

• Increased BDNF

• Decreased peripheral fasting insulin

Witte AV, Kerti L, et al. Cereb Cortex, 2014 Nov;24(11):3059-68

Concussion increases odds of sustaining a lower extremity musculoskeletal injury after return to play among collegiate athletes

Conclusion: Concussed athletes have increased odds of sustaining an acute lower extremity musculoskeletal injury after return to play than their non-concussed teammates. Study results suggest further investigation of neurocognitive and motor control deficits may be warranted beyond the acute injury phase to decrease risk for subsequent injury

A single concussion may triple the long-term risk of suicide

• New study of mild concussions in Canadian adults suggests risks are even higher for recreational activities

• Published in the Canadian Medical Association Journal

• For weekend concussion – suicide risk increased to 4X the norm

Scientific American. Feb. 8, 2016

Women’s Brains May Have Tougher Time Recovering From Concussion• Research shows female athletes suffer concussions at higher rate than

male athletes playing similar sports

• One theory – women have weaker muscles in the neck that are a factor in how head injures affect them

Broglio, S., Ellemberg, D. Apr 28, 2015, Radiology online

Menstrual cycle influences concussion outcomes• Women injured during the 2 weeks leading up to their period

(premenstrual stage) had slower recovery and poorer health 1 month after injury compared to women injured during the 2 weeks directly after their period or women taking birth control pills

• Progesterone is known to have a calming effect on the brain and on mood

Journal of Head Trauma Rehabilitation Dec. 2010, p.2255-60

Menstrual cycle influences concussion outcomes (cont’d)• “Withdrawal hypothesis”: If a woman suffers a concussion in the

premenstrual phase when progesterone levels are naturally high, an abrupt drop in progesterone after injury produces a kind of withdrawal which either contributes to or worsens post concussive symptoms like headache, nausea, dizziness and trouble concentrating

Journal of Head Trauma Rehabilitation Dec. 2010, p.2255-60

Concussion

• Any stressful event, like a hit to the head, can shut down pituitary gland in the brain, which is the body’s hormone generator

• Pituitary doesn’t work – estrogen + progesterone decline

J of Head Trauma Rehab Nov. 13, 2013

Why increased concussion?

• Diminished brain resilience syndrome: a modern-day neurological pathology of increased susceptibility to mild brain trauma, concussion, and downstream neurodegeneration

Surgical Neurology International 2014, June 14

Food for Thought

• Traumatic brain injury leads to intestinal dysfunction and breakdown

Surprising answer

• Vagus nerve – the great wanderer

Traumatic brain injury and intestinal dysfunction: Uncovering the neuro-enteric-axis

Conclusion:

1) An increase in intestinal permeability and marked changes in intestinal histology 6 hr. following TBI

2) Expression of tight junction proteins-Zonulin and occludin decrease following TBI compared to sham animals

Journal of Neurotrauma, 28:1353-1359, Aug 2009

Diabetes takes a toll on the brain

• Type-2 diabetes associated with greater impairment of blood flow to the brain and sharper decline in mental acuity compared with nondiabetic people of similar age and health status – even over a 2-year period

• At end of 2 years – people with diabetes had greater decline in:• Gray matter volume

• Composite scores on mental tests

• Rates of blood flow to the brain than those in control group

• Also had greater increases in blood measures of inflammation

Neurology, July 8, 2015

Hemoglobin A1c

• Those who live the longest have A1c values <5.2%

• Elevated HgA1c levels start to shrink the brain

Neurology May 24, 2005;64:1704-11

Sugar triggers memory problems and neuroinflammation

Brain and Mental Performance Neurology Nov. 27, 2015

Research discovers that depression is an allergic reaction to inflammation

FeelGuide, January 6, 2015

Air Pollution Tied to Brain Aging

• Air pollution known to increase risk for stroke and other cerebrovascular disorders

• Now researchers also found it is linked to premature aging of the brain

Stroke, May 2015

Excess Weight at Age 50 Tied to Earlier Alzheimer’s Onset

Molecular Psychiatry, Sept. 2015

Two Key Nutrients Help Stave Off Alzheimer’s Disease• Omega-3 supplements and antioxidants improve clearance of amyloid

beta protein and reduce inflammation of brain tissue, in people with early stages of Alzheimer’s

World Health Net, July 28, 2015

Dr. Dale Bredesen – Alzheimer’s Protocol

• Eliminate:• Simple carbs• Gluten• Processed foods• Increase vegetables and fruits• Increase wild salmon

• Decrease stress and increase sleep

• Supplements:• Melatonin: 2 mg• B-vitamins – methylated• D3: 2,000 IU• Omega 3: 2,000 mg• Co Q10: 200 mg

• Good quality oral hygiene

• Exercise: 30 mins. 4-6 days a week

• Fast 12 hours between dinner and breakfast

• Minimum 3 hours between meals

Buck Institute

Which type of exercise is best for the brain

• Jogging – steady state - most neurogenesis:• The greater the distance, the more new cells produced

• HIIT – higher than sedentary

• Weight training – no neurogenesis

• Distance running releases BDNF

Optimal brain diet

• Depression-prevention study at University of Pittsburgh:• 50% received 5 hours of problem-solving therapy (cope with life stressors); or

• Dietary counselling

• Results: Surprise! Both groups significantly reduced the risk of depression – by same amount

Scientific American Mind, March/April 2016;p.27-34

Optimal brain diet (cont’d)

• A study of more than 12,000 healthy Spaniards found – those who closely followed a Mediterranean Diet had a 30 percent reduced risk of depression

• Central feature – low in sugar, processed foods and fatty meats

Scientific American Mind, March/April 2016;p.27-34

Optimal brain diet (cont’d)

• In both animal and human studies, typical unhealthy Western diets appear to cause damage to the hippocampus

• Participants consumed poor quality diets over 4 years

Scientific American Mind, March/April 2016;p.27-34

PREDIMED

• 7500 participants

• Mediterranean Diet plus nuts protects against CVD

• PREDIMED participants – testing depression

• Results:• Lower risk for depression

• 40% drop in risk for diabetics

Mind Diet

• Hybrid of Mediterranean and Dash diets

• Mind diet rich in vegetables, berries, whole grains, nuts

• Diet helps slow cognitive decline

• Diet may help prevent Alzheimer’s

• Results: those who followed Mind diet for 5 years – achieved cognitive scores of people 7.5 years younger

March 19, 2015 Rush University Medical Center. Journal Alzheimer’s and Dementia, The Journal of the Alzheimer’s Association

Multidimensional Support for Brain Function

• Ingredients: thiamin, riboflavin, niacin, vit. B6, L-5-MTHF, vit. B12, NAC, Acetyl-L-carnitine, grapeseed extract – 3 caps daily

• Protects blood-brain barrier and supports mitochondrial function

• NAC and L-5-MTHF can cross blood-brain barrier

• Formulation protects against oxidative stress

• Neuroprotection

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Inside-Out Health: A Revolutionary Approach to Your Body

Intro: A new view

Chap. 1: It’s all about your gut

Chap. 2: Your knee bone’s connected to…

Chap. 3: The new frontier

Chap. 4: Toxins, toxins, toxins

Chap. 5: Inflammation nation

Chap. 6: Weight…Don’t tell me!

Chap. 7: Life in motion

Chap. 8: Let there be light

Chap. 9: Inside-out treatments

Conclusion: An inside-out life

Q & A

Artificial sweeteners disrupt body blood sugar controls

• Sweeteners alter microbiome

• The different mix of microbiomes changes the metabolism of glucose causing levels to rise higher after eating and to decline more slowly than otherwise

• Big 3:• Saccaharine

• Sucralose

• Aspartame

Journal Nature, Sept. 2014

Artificial sweeteners induce glucose intolerance by altering the gut microbiota• Recent study of mice and people suggest that saccharin interferes

with gut’s microbial community, initiating metabolic changes associated with obesity and diabetes

• Saccharin-fed mice on a high-fat diet – resulted in impaired glucose metabolism in five weeks

• Mice fed glucose-laced water – normal metabolism

• Researchers compared 40 people who ate artificial sweeteners and 236 who did not – those consumed artificial sweeteners more likely to have impaired glucose metabolism

J. Suez et al. Nature. Published online Sept. 17, 2014

Metabolic effects of non-nutritive sweeteners (NNSs) (cont’d)• NNSs interfere with learned responses that contribute to control

glucose and energy homeostasis

• NNSs interfere with gut microbiota and induce glucose intolerance

• NNSs interact with sweet-taste receptors expressed throughout the digestive system that play a role in glucose absorption and trigger insulin secretion

Pepino MY. Physiol Behav 2015