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Croton-Harmon SEPTA 2010 Nutrition, Vitamins and Cognition Stephen Cowan MD, FAAP.

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Presentation on theme: "Croton-Harmon SEPTA 2010 Nutrition, Vitamins and Cognition Stephen Cowan MD, FAAP."— Presentation transcript:

1 Croton-Harmon SEPTA 2010 Nutrition, Vitamins and Cognition Stephen Cowan MD, FAAP

2 Basic Sanity Living in synch with the cycles and seasons of nature

3 Sympathetic Fight or Flight Parasympathetic Rest and Digest Yang Yin

4 Effects of Poor Nutrition on our Children Cardiovascular Learning and Behavior Obesity Diabetes Cancer

5 You can t just keep writing out script after script after script of new medications when diet is just as important as drugs or any other treatment a patient may be using. Katherine Chauncey RD, Texas Tech Medical School NY Times Article Sept 16, 2010

6 Current diet studies suggest that: Eating Habits in Childhood Many children do not eat breakfast and get at least 1/3 of calories from snacks. Sweetened beverage intakes contribute significantly to total caloric intake. Sweetened snacks contribute to deficiencies in the intake of foods containing essential nutrients

7 Adolescence is a nutritionally vulnerable age Increased appetite + Sedentary life = Obesity Peer pressure + Media promotion = Over-eating as natural Increased junk food = Decreased healthy foods Consumption of excess saturated fat, trans fats, and added sugars = Insufficient consumption of micronutrients (calcium,iron, zinc, and potassium, vitamins A, D, and C, Folic acid and Omega-3 fatty acids) Adolescent Eating Habits

8 Taking in the world Break it down Sort it Integrate it Eliminate it Food is Information

9 In-sanity Taking in the world Break it down Sort it Integrate it Eliminate it unfinished business Fast Food! Accumulation Distraction Stagnation Boredom Agitation Dissatisfaction phlegm mists the mind Hostility No Time !

10 Organic Food Cooking together Eating together

11 The Physiology of Appetite Ghrelin Im Hungry Leptin Im Full! Gastric motility Vagal nerve stimulation Hypothalamus sensation of hunger Produced in fat Produced in stomach Maintain body fat stores Loss of fat = lowers Leptin = Im hunger Obesity increases Ghrelin = Im hungry

12 Eating in the Absence of Hunger American Journal of Clinical Nutrition, Vol. 76, No. 1, 226-231, July 2002 Eating in the absence of hunger and overweight in girls from 5 to 7 y of age Jennifer Orlet Fisher and Leann L Birch The girls who ate large amounts of snack foods in the absence of hunger at 5 and 7 y of age were 4.6 times as likely to be overweight at both ages. Parents' reports of restricting their daughter's access to foods at age 5 y predicted girls' eating in the absence of hunger at age 7 y

13 Developing Habits of Self-regulation of Energy-intake Control - Children can self-regulate in Non-controlling, non-coercive conditions Birch et al Use of External cues: prompts- clocks, clean your plate, rewards for finishing leads to LACK OF SELF REGULATION Self Reflection - Effect of parental beliefs, worries and role modeling Use of Internal cues: Aware of when hungry, when full leads to improved self regulation Susan Johnson PhD Pediatrics 2000;106;1429-1435


15 The Hormetic Effect of Food 1. Low energy intake stimulates cellular stress resistance thereby protecting various tissues against disease and increasing lifespan 2. Specific phytochemicals exhibit biphasic does response on cells with low doses activating signaling pathways that result in expression of genes encoding cytoprotective proteins

16 1. Low energy intake stimulates cellular stress resistance thereby protecting various tissues against disease and increasing biologic function and lifespan High energy intake increases the risk of : 1.Cardiovascular disease 2.Type 2 diabetes 3.Stroke 4.Cancers 5.Neurodegenerative disorders and Low Energy Intake reduces the risk!

17 How Hormesis Works Energy restriction Protect against cell damage Increases cytoprotective molecules Heat-shock proteins Anitoxidants, vit E, co Q10 Plasma redox enzyme actovoty Up-regulation of protein production involved in mitochondrial oxidative phosphorylation Increased adaptive stress Improved energy efficiency Growth factors Endothelial cells in heart BDNF in brain

18 Plant defense: During evolution plants develop specific biosynthetic pathways for the production of toxins that prevent microorganisms and insects from eating them Sub-toxic (hormetic) doses induce adaptive stress responses in humans 2. Specific Phytochemicals Hormetic effects

19 Sulphoraphane in broccoli- increase expression of cell protective proteins in liver, intestinal and stomach cells Examples of hormetic phytochemical protection Curcumin induce adaptive stress response genes Cell Protective proteins in animal models of cataract Pulmonary toxicity, MD and Alzheimer's disease Resevratrol activates stress response pathways Cell prtoective to heart (MI and stroke) Allicin in garlic induces gene expression of cell protective proteins involved in immune system

20 Dietary Supplementation

21 The child growing up in the U.S. in the 1940's got: The child growing up in the U.S. today gets: White toothpaste Multi-colored toothpaste, perhaps with sparkles Oatmeal Sea Treasures Instant Oatmeal (turns milk blue) Corn flakesFruity Pebbles Toast & butter, jamPop Tarts Cocoa made with natural ingredients Cocoa made with artificial flavoring, & some with dyes. Whipped creamCool Whip No vitamins (or perhaps cod liver oil)Flintstone vitamins White powder or bad-tasting liquid medicine Bright pink, bubble-gum flavored chewable or liquid medicine Sample school lunch: Meat loaf, freshly made mashed potatoes, vegetable. Milk, cupcake made from scratch. Sample school lunch: Highly processed foods loaded with synthetic additives, no vegetable. Chocolate milk with artificial flavor. Sample school beverage: Water from the drinking fountain Sample school beverage: Soft drink with artificial color, flavor, caffeine, aspartame, etc. Candy in the classroom a few times a year at class parties. Candy (with synthetic additives) given frequently. The Feingold Program eliminates these additives: Salicylates Artificial (synthetic) coloring Artificial (synthetic) flavoring Aspartame (Nutrasweet, an artificial sweetener) Artificial (synthetic) preservatives BHA, BHT, TBHQ

22 The Impact of a Low Food Additive and Sucrose Diet on Academic Performance in 803 New York City Public Schools, Schoenthaler S et al; Int J Biosocial Res, 1986;8(2):185-195 The introduction of a diet policy which lowered sucrose, synthetic food color/flavors and two preservatives (BHA and BHT) over 4 years in 803 schools was followed by a 15.7% increase in mean academic percentile ranking above the rest of the nations schools who used the same standardized tests. Each schools academic performance ranking was negatively correlated with the percent Of children who ate school food prior to diet policy changes. However, after policy transitions, The percent of students who ate school lunches and breakfasts within each school became Positively correlated with the schools rate of gain (r =.28, p<.0001)

23 Fish oil dramatically improved the symptoms of Attention Deficit Disorder (ADHD) as effectively as stimulant medications like Ritalin and Concerta without the serious adverse side effects University of Adelaide Australia Journal of Developmental and Behavioral Pediatrics 2006 Effect of Supplementation with Polyunsaturated Fatty Acids and Micronutrients on Learning and Behavior Problems Associated with Child ADHD. Natalie Sinn, PhD; Janet Bryan, PhD Journal of Developmental and Behavioral Pediatrics March, 2007 Omega 3 Fatty acids

24 Omega 3 Fatty Acids Studies confirm that breast-fed babies have an IQ advantage over babies fed on formula lacking DHA. sources of DHA: salmon, sardines and trout Krill oil omega-3 fortified eggs green leafy vegetables, soybeans, walnuts, flaxseed oil

25 The Importance of Micronutrients in Cognition

26 Important Micronutrients in Cognition The role of micronutrients in psychomotor and cognitive development S M Grantham-McGregor and C C Ani Centre for International Child Health, Institute of Child Health, University College London London, UK British Medical Bulletin 55:511-527 (1999)

27 Essential for myelination, dopaminergic and serotonergic neurotransmission, stress response, arousal and attention Iron Deficiency- Most vulnerable during periods of rapid growth Causes reduced work-capacity and productivity in children and adults Behavior problems, attention, motor and cognitive function, school achievement, lower IQ IRON

28 Sources of Iron HEME :Beef, Liver, Chicken, Fish, Pork, Turkey NON-HEME: Beans, Spinach, Tofu, Oatmeal (fortified)

29 Low maternal intakes of zinc during pregnancy and lactation were found to be associated with: 1.less focused attention in neonates 2.decreased motor functions at 6 months of age. British Journal of Nutrition (2001), 85:S139-S145 Zinc Zinc supplementation resulted in: 1. better motor development and more playfulness in low birth weight infants 2. increased vigorous and functional activity in infants and toddlers. In older school going children the data is controversial but there is some evidence of: improved neuropsychological functions with zinc supplementation.

30 Sources of Zinc It has been found that increasing intake of vitamins such as Vitamin C, E and B6 and minerals such as magnesium can increase zinc absorption in the body. Proteins (meat, fish, eggs, milk) It has been reported that intake of more than 50 milligrams of zinc (both from diet and from supplements) can lead to improper copper metabolism, altered iron function, reduction of HDL's and reduced immune function. Peanuts, beans, and wholegrain cereals, brown rice, whole wheat bread, *Pumpkin Seeds offer one of the most concentrated non-meat food sources of zinc.

31 Iodine Iodine deficiency remains a significant public health problem in many countries and is estimated to be responsible for 5.7 million cases of cretinism and 43 million cases of less severe cognitive impairment. Many observational studies have compared children in iodine sufficient and iodine deficient areas and nearly all have found: poorer psychomotor and cognitive development in children living in iodine deficient areas. The controversy over conditions of borderline thyroid function

32 Iodine sources Salt (iodized) Sea vegetables Yogurt, cow's milk, eggs, mozzarella cheese. strawberries Fish and shellfish - extremely variable Upper limit RDA 1000 mcg

33 Multivitamins and cognitive function in children Six clinical trials examined the effect of multivitamin supplementation on young peoples' cognitive function. Two reported significant improvements in the intelligence of school children treated. British Medical Bulletin 1999; 55 (No. 3) The third reported gains only in females. The fourth found gains only in children given 100% of the RDA with no gains among those who received 50% and 200% of the RDA.

34 Vitamin D The study in the Archives of Internal Medicine, found those deficient in vitamin D were 60 percent more likely to have substantial decline in overall cognition and 31 percent more likely to have declines in executive function than those with sufficient vitamin D.

35 B12 In elderly: two proposed mechanisms 1. The role of vitamin B12 and folic acid in reducing homocysteine levels. Elevated homocysteine level has been linked with atherosclerosis which is a mediator of vascular dementia. 2. The role of B12 in neutralizing free radicals linked to the pathogenesis of normal brain ageing and Alzheimer's disease In autism: Methyl B12 Metabolic biomarkers of increased oxidative stress and impaired methylation capacity in children with autism Jill James et al American Journal of Clinical Nutrition, Vol. 80, No. 6, 1611-1617, December 2004

36 1 Raskin LA, Shaywitz SE, Shaywitz BA, Anderson GM, Cohen DJ. Neurochemical correlates of attention deficit disorder. Pediatr Clin North Am 1984;31(2):387-96. 2 Malone MA, Kershner JR, Swanson JM. Hemispheric processing and methylpehidate effects in attention-deficit hyperactivity disorder J Child Neurol 1994;9(2):181-9. 3 Hunt RD, Cohen DJ, Shaywitz SE, Shaywitz BA. Strategies for study of the neurochemistry of attention deficit disorder in children. Schizophr Bull 1982;8(2):236-52. 4 Irwin M, Belendiuk K, McCloskey K, Freedman DX. Tryptophan metabolism in children with attentional deficit disorder. Am J Psychiatry 1981;138(8):1082-5. 5 Comings DE. Serotonin and the biochemical genetics of alcoholism: lessons from studies of ADHD and Tourette syndrome. Alcohol Alchol Suppl 1993;2:237-41. 6 Comings DE. Blood serotonin and tryptophan in Tourette syndrome. Am J Med Genet 1990;36(4):418-30. 7 McConnell H. Catecholamine metabolism in the attention deficit disorder: implications for the use of amino acid precursor therapy. Med Hypotheses 1985;17(4):305-11. 8 Bornstein RA, Baker GB, Carroll A, King G, Wong JT, Douglass AB. Plasma amino acids in attention deficit disorder. Psychiatry Res 1990;33(3):301-6. 9 Zeisel SH. Dietary influences on neurotransmission. Adv Pediatr 1986;33:23-47. 10 Sun Y, Wan Y, Qu X, Wang J, Fang J, Zhang L. Clinical observation and treatment of hyperkinesia in children by traditional Chinese medicine. J Tradit Chin Med 1994;14(2):105-9. Amino acid Metabolism and Cognition

37 Taurine Neuro-inhibitory neurotransmitter involved in neuromodulatory and neuroprotective actions. Support GABA function Neuro-protective Found in Cheese, Granola, Milk,

38 L-Theanine Theanine is an amino acid naturally found in green tea and has been widely studied for its calming effects. The ability of theanine to reduce over-stimulation is thought to be due to its function as a glutamate receptor antagonist Theanine has been found to prevent the death of neurons exposed to oxidative stress or glutamate over-stimulation.

39 N-acetyl-tyrosineN-acetyl-tyrosine is readily converted to L-tyrosine in the body, which serves as the amino acid precursor to the Catecholamines: dopamine, norepinephrine and epinephrine Neuro-stimulant L-Tyrosine Food sources- proteins


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