4/15/16  

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WHOLE  HEALTH:      

Change  the  Conversa5on  

Food  &  Drink:  Meals  before  Pills  

VETERANS  HEALTH  ADMINISTRATION  

Food & Drink – Health for Life Video Office of Patient Centered Care & Cultural Transformation

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êRed Meat êDairy êSugar

VETERANS  HEALTH  ADMINISTRATION  

Med Diet Grows Your Brain

Gu,  et  al.  Mediterranean  diet  and  brain  structure  in  a  mulKethnic  elderly  cohort.  Neurology®  2015;85:1–8  

Lowest Score Medium Score

High Score

1.  Vegetables 2.  Legumes 3.  High fiber cereal 4.  Fish 5.  Nuts/fruits 6.  Monounsaturated

fats (olive oil) 7.  Low to moderate

ETOH 8.  Low Meat 9.  Low Dairy

Low Score = Few of the these 9 foods

High Fish

High Red Meat

VETERANS  HEALTH  ADMINISTRATION  

Reduc5on  in  the  incidence  of  type  2  diabetes  with  the  Mediterranean  diet:  results  of  the  PREDIMED-­‐Reus  nutri5on  interven5on  randomized  trial.  Diabetes  Care.  2011  Jan;34(1):14-­‐9.  2010    

52%  reducKon  in  diabetes  in  those  with  3  risk  factors.  

418  subjects  in  3  groups  (Age:  55-­‐80)  

No  calorie  restricKon  

No  weight  loss  

No  increase  in  exercise  

Benefits  remain!!  

a)Med  Diet  (Olive  Oil)  

b)Med  Diet  (Nuts)  

c)Control  (Low  fat)  

4/15/16  

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VETERANS  HEALTH  ADMINISTRATION  

CV Events with Mediterranean Diet

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30% Reduction in those at high risk

Estruch,  R.,  et  al.,  Primary  Preven+on  of  Cardiovascular  Disease  with  a  Mediterranean  Diet.  N  Engl  J  Med,  2013.  VETERANS  HEALTH  ADMINISTRATION  

Nuts: A handful, Not a Canful

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Bao,  Y.,  et  al.,  Associa+on  of  nut  consump+on  with  total  and  cause-­‐specific  mortality.  N  Engl  J  Med,  2013.  369(21):  p.  2001-­‐11.  

4 oz. of nuts, 7 days a week = •  20% reduction in death from all

causes •  29% reduction in death from

heart disease •  39% reduction in death from

kidney disease

Beet Juice for Blood Pressure

•  250  mL  of  Beet  Root  Juice  (n-­‐36)  Vs  •  250  mL  of  Nitrate-­‐Free  Beet  Root  Juice  (n-­‐36)  

Kapil,  V.,  et  al.,  Dietary  Nitrate  Provides  Sustained  Blood  Pressure  Lowering  in  Hypertensive  Pa+ents:  A  Randomized,  Phase  2,  Double-­‐Blind,  Placebo-­‐Controlled  Study.  Hypertension,  2014.  

Systolic ê8.1 mm Hg w/ 250 ml of Beet Juice

Diastolic ê3.8 mm Hg w/ 250 ml of Beet Juice

VETERANS  HEALTH  ADMINISTRATION  

Relevance

Beet Root Juice = 8.1/3.8 mm Hg, a reduction similar to the reduction seen with one anti-hypertensive pharmaceutical agent = 9.1/5.5 mm Hg

4/15/16  

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↑Gastrin  ↑  Acid

↓NeuropepKde  Y

↑Enzymes (pepsin), GLP-1

↑Mucous

Fiber + Bacteria = SCFA (Butyrate)

PPI, GLP-1 Agonists

Steroids, NSAIDS

Antibiotics

Hernandez-­‐Alonso  P,  et  al.  Beneficial  effect  of  pistachio  consumpKon  on  glucose  metabolism,  insulin  resistance,  inflammaKon,  and  related  metabolic  risk  markers:  a  randomized  clinical  trial.  Diabetes  Care.  2014  

VETERANS  HEALTH  ADMINISTRATION  

Chronic PPI Use

Shah,  N.H.,  et  al.,  Proton  Pump  Inhibitor  Usage  and  the  Risk  of  Myocardial  Infarc+on  in  the  General  Popula+on.  PLoS  One,  2015.  10(6).    

1.8 million patients, a trillion bits of data! 1.2 x risk of MI 2.0 x risk of cardiac mortality

MOA: Blocks enzymes (DDAH, ADMA) needed to produce nitric oxide

VETERANS  HEALTH  ADMINISTRATION  

Are Nitrates in Meat Good For You?

VETERANS  HEALTH  ADMINISTRATION  

WHO Perspective

• 86%  of  lung  cancers  are  from  Tobacco  

• 21%  of  bowel  cancers  are  from  processed  and  red  meat  

Or  

• 19%  of  all  cancers  caused  by  Tobacco  

• 3%  of  all  cancers  caused  by  processed  and  red  meat.    

Bae,  S.  and  Y.C.  Hong,  Exposure  to  bisphenol  A  from  drinking  canned  beverages  increases  blood  pressure:  randomized  crossover  trial.  Hypertension,  2015.  65(2):  p.  313-­‐9.  

4/15/16  

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VETERANS  HEALTH  ADMINISTRATION  

Higher the BPA = Higher SBP

Urine BPA levels increased 1600% two hours after drinking 2 cans of soymilk.

SBP increased by ~ 5 mm HG.

(Proanthocyandines)

VETERANS  HEALTH  ADMINISTRATION  

Gepner,  et  al.  Effects  of  Ini+a+ng  Moderate  Alcohol  Intake  on  Cardiometabolic  Risk  in  Adults  with  Type  2  Diabetes.  Ann  Int  Med.  Oct.  2015.    

Is it the Grape or the ETOH? 5 oz Nightly

Mineral Water White Wine Red Wine

éHDL  Improvement  in  metabolic  syndrome  

Better Sleep

VETERANS  HEALTH  ADMINISTRATION  O’Keefe, et al. J of Am Coll of Card. 51(3);2008

Wine=most reduction in post-prandial blood sugar

VETERANS  HEALTH  ADMINISTRATION  

Water with Soluble Fiber! (psyllium, guar gum, ground flax, etc.)

1.  Reduces absorption of cholesterol

2.  Slows absorption of sugar, lowering glycemic index.

3.  Absorbs water and slows digestion stimulating satiety (wt. loss)

Parrel  et  al.  Efficacy  of  water  preloading  before  main  meals  as  a  strategy  for  weight  loss  in  primary  care  paKents  with  obesity:  RCT.  Obesity  2015;23:1785-­‐91.     Taubert  D,  Roesen  R,  Schomig  E.  Effect  of  

cocoa  and  tea  intake  on  blood  pressure.  Arch  Intern  Med  2007;  167(7):626-­‐34  

¼ of Chocolate Bar/Day ↓  Systolic  ~5  mmhg  ↓  Diastolic  ~3  mmhg

4/15/16  

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VETERANS  HEALTH  ADMINISTRATION  

Pearls •  Eat  a  Medi-­‐Diet  with  people  you  love  •  Eat  your  root  vegetables  and  avoid  chronic  PPIs  if  able  

•  Drink  red  wine  out  of  glasses,  not  cans  •  Eat  a  handful,  not  a  canful  of  nuts  daily  •  Eat  more  fish  than  red  meat  and  don’t  burn  it  •  Drink  water  with  soluble  fiber  before  meals  •  Enjoy  ¼  of  a  70%  Cocoa  Chocolate  Bar  Daily