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Cooking with Heart: Anti-inflammatory Cooking Richard E. Collins, MD, FACC THE COOKING CARDIOLOGIST®

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Presentation on theme: "Cooking with Heart: Anti-inflammatory Cooking Richard E. Collins, MD, FACC THE COOKING CARDIOLOGIST®"— Presentation transcript:

1 Cooking with Heart: Anti-inflammatory Cooking Richard E. Collins, MD, FACC THE COOKING CARDIOLOGIST®

2 Outline of Today’s Talk What is inflammation? The important role of inflammation in the development of coronary artery disease. What foods are considered anti-inflammatory? Are supplements protective? How does cooking affect foods? Cooking methods to reduce inflammation Cooking demonstration…chocolate blueberries and guiltless potato chips.

3 Inflammation Part of a healthy immune system response Low-level, chronic inflammation is an excessive, inappropriate inflammatory response Linked to heart disease, cancer, diabetes, osteoporosis, Alzheimer’s disease and even depression and mood disorders

4 Risk Factor Model: Inflammation is causative Models for the Role of Inflammatory Markers CVD = cardiovascular disease. Adapted from Pearson TA et al. Circulation. 2003;107:499511, with permission from Lippincott Williams and Wilkins. Risk Marker Model: Inflammation is not causative Traditional risk factors Inflammatory marker AtherosclerosisAtherosclerosisCVDCVD CVDCVD Traditional risk factors Inflammatory marker AtherosclerosisAtherosclerosis

5 Relationship Between Atherogenic Lipoproteins and Inflammation A high plasma LDL-C level is a major risk factor and causes the development of atherosclerosis. Beyond LDL, other lipids are pro-inflammatory including elevated triglycerides, VLDL remnants, small particle size LDL. 1 Inflammation plays a role in all stages of atherogenesis. 2,3 Increased circulating levels of inflammatory markers may indicate the presence of atherosclerotic disease. 3 –May provide independent predictive risk beyond established lipid risk factors. 1. Grundy SM et al. Circulation. 2004;110:227239. 2. Ross R. N Engl J Med. 1999;340:115126. 3. Hansson GK. N Engl J Med. 2005;352:16851695.

6 Markers of Inflammation Inflammatory signaling molecules –IL-1 –IL-6 –TNF-  –IL-18 –CD40L Soluble cytokine receptors –TNFR –IL-1R  Adhesion proteins –ICAM-1 –VCAM-1 –E-selectin –Fibronectin  Chemokines –MCP-1 1.Clin Chem. 2000;46:461 ─ 468. 2. Uhlar CM et al. Eur J Biochem. 1999;265:501 ─ 523. 3. Zhang R et al. JAMA. 2001;286:2136 ─ 2142. 4. Packard CJ et al. N Engl J Med. 2000;343:1148 ─ 1155. 5. Ridker PM et al. Circulation. 2004;109(suppl IV):IV6 ─ V19.  CRP  SAA  MPO  LpPLA 2 Most researched markers of inflammation 1–4 Other inflammatory markers 5

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8 Post Prandial State is Toxic 8

9 The Effect of Post Prandial Hyperglycemia (Dysmetabolism) on the Vascular System Endothelial dysfunction Triggering of acute inflammation Oxidant stress Hypercoagulability Sympathetic hyperactivity Post meal increases in triglycerides, VLDL remnants, HDL clearance and production of small dense LDL particles

10 10 Postprandial Lipemia: Increased Levels of TG and RLPs * P<0.01 vs hr 0. † P<0.05 vs hr 0. TG = triglyceride; RLP = remnant lipoprotein. Maggi FM, Raselli S, Grigore L, Redaelli, Fantapple S, Catapano AL. Lipoprotein remnants and endothelial dysfunction in the postprandial phase. J Clin Endocrinol Metab. 2004;89:2946─2950, Copyright 2004, The Endocrine Society. Hours following ingestion of oral fat load 620 531 443 354 266 177 * * * * 02468 39 35 31 27 23 19 15 02468 * * * † Postprandial change in plasma lipid levels mg/dL Triglycerides Cholesterol in RLPs N= 15

11 11 Fat Is Toxic

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14 Foods that promote inflammatory disease Foods with high saturated fat content, such as animal products and dairy products Foods with high omega-6 fatty acid content and low omega-3 fatty acids such as partially hydrogenated oils, margarine, oils from corn, cottonseed, safflower, sesame and sunflower Foods with high glycemic load, such as bagels, instant rice, white pasta

15 Foods that promote inflammatory disease Food with high allergy potential, such as dairy products, wheat and eggs These inflammatory foods can increase production of inflammatory mediators Foods with high allergy potential may also increase intestinal permeability, triggering immune response and potential increase in inflammatory disease

16 Anti-Inflammatory Foods Foods with high omega-3 fatty acids, such as cold water fish, flaxseeds, walnuts Foods with high levels of antioxidants, such as vegetables, citrus fruits, cherries, garlic, onion and tea Spices, in particular, ginger, garlic, rosemary, turmeric, oregano, cayenne, clove and nutmeg

17 Anti-Inflammatory Foods Low glycemic index/load foods Mediterranean diet foods rich in omega-3 fatty acids, fruits/vegetables, nuts

18 Polyunsaturated fatty acids in inflammation Coronary heart disease, major depression, aging and cancer are characterized by an increased level of interleukin 1 (IL-1), a pro- inflammatory cytokine. Arthritis, Crohn’s disease, ulcerative colitis and lupus erythematosis are autoimmune diseases characterized by a high level of IL-1 and the pro-inflammatory leukotriene LTB(4) produced by omega-6 fatty acids.

19 Omega-3 fatty acids in inflammation Among the fats, omega-3 PUFA from fish oil – eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) – has some of the most potent anti-inflammatory properties Clinical trials assessing benefits of fish oils in inflammatory and autoimmune diseases including rheumatoid arthritis, Crohn’s disease, ulcerative colitis, psoriasis, lupus, multiple sclerosis and migraine headaches reveal significant benefit, including decreased disease activity and a lowered use of anti-inflammatory drugs

20 Omega 3s and Plant Sterols Dietary intervention with omega-3 PUFA (1.4 g/d) plus plant sterols (2g/d) reduced several markers of systemic inflammation in hyperlipidemic individuals C-Reactive protein was reduced by 39% Tumor necrosis factor-alpha reduced by 10% Interleukin-6 reduced by 10.7% Overall cardiovascular disease risk by 22.6%

21 Omega-3 fatty acids in inflammation EPA and DHA from fish oils are more biologically potent than alpha-linolenic acid (ALA) from flaxseeds and walnuts

22 Balanced Omega 6/Omega 3 A balanced intake of omega-6 and omega- 3 fatty acids is anti-inflammatory Overconsumption of omega-6 fats in relation to omega-3 fats leads to inflammation Most appropriate ratio of omega-6 to omega-3 fatty acids is approximately 4:1. This requires increasing the intake of omega-3s and decreasing intake of omega- 6s

23 Anti-Inflammatory Fruit/Vegetables A high fruit and vegetable intake has been shown to be associated with a low level of inflammation Fruit and vegetable intake has been shown to be inversely related to oxidative stress and inflammation in type 2 diabetics

24 Cherries Cherries contain compounds that inhibit enzymes cyclooxygenase-1 and -2 (COX), the targets of anti-inflammatory drugs Studies on healthy men/women consuming 280 g/d of Bing cherries for 28 days showed reduced serum CRP by 25% and Nitric oxide by 18%

25 Garlic Garlic has been used as a medicinal plant since ancient times Researchers have shown that garlic may promote an anti-inflammatory environment by cytokine modulation that leads to overall inhibition of NF-(kappa)B activity (9) NF-(kappa)B is a central transcription factor in adaptive immunity and a central regulator of pro-inflammatory gene expression

26 Spices: Turmeric Turmeric, sometimes called curcumin, is a mustard-yellow spice from Asia. Main ingredient in curry Laboratory and animal research has demonstrated anti-inflammatory, antioxidant, and anti-cancer properties of turmeric and its constituent curcumin. www.nlm.nih.gov/medlineplus/.../patient- turmeric.html

27 Spices: Turmeric Researchers tested turmeric extracts in animal models and found evidence of anti- arthritic efficacy They found that curcuminoid extract inhibits a transcription factor, NF-KB, from being activated in the joint Typical dose used therapeutically 400 mg twice a day

28 Spices: Turmeric Inflammation in Alzheimer’s disease patients is characterized by increased cytokines and activated microglia Researchers found that both low and high doses of curcumin significantly lowered oxidized proteins and interleukin-1beta, a proinflammatory cytokine elevated in the brains of Alzheimer transgenic mice

29 Spices: Ginger Ginger belongs to the same botanical family as turmeric and cardamon Has been used as an anti-inflammatory agent for centuries Researchers have found that ginger inhibits prostaglandin biosynthesis – similar to NSAIDs

30 Spices: Ginger Ginger extract also inhibits the induction of several genes involved in the inflammatory response In a study of 261 people with osteoarthritis (OA) of the knee, those who received a ginger extract twice daily experienced less pain and required fewer pain-killing medications compared to those who received placebo. (14) For analgesic purposes, 2 to 4 grams fresh ginger juice or extract taken daily is recommended

31 Salicylic Acid Salicylic acid is the active component of willow-bark, long used as a folk remedy for pain Aspirin is a synthetic derivative of willow bark Foods high in salicylic acid: berries, grapes, broccoli, spinach, chili peppers, cinnamon, ginger, rosemary, nutmeg, sage, basil, strawberries

32 Low-glycemic foods Plasma levels of high-sensitivity C-reactive protein, a sensitive marker of systemic inflammation, were found to be positively associated with both Glycemic Index and Glycemic Load in 244 women from the Nurses’ Health Study, aged 45-82 years, with a stronger relationship in overweight women than in normal-weight women

33 Brown Rice Associated with Improved Heart Health Researchers at Temple University in Philadelphia recently reported a component in brown rice that blocks the effect of Angiotension II, a precursor of high blood pressure and inflammation. This layer is striped away when brown rice is converted to white rice. Partially mulled rice (Haigamai) and (Kinmemai), both popular in Japan, are also protective. Data presented at Exp. Biology Conference, Anaheim, Ca, April 24-28, 2010

34 Grapes Could reduce Diabetes and Heart Disease Phytochemicals in grapes (green, red and black) have been found to reduce risk for metabolic syndrome, high blood pressure and inflammation at least according to research on rats fed daily added grapes in comparison to a base diet high in fat. At three months, those with added grapes had lower triglycerides, BP and inflammation. Dr Bolling, researcher, commented that more studies are needed to extrapolate data to humans. Data presented at Exp. Biology, Anahiem, Ca, April 2010

35 Mediterranean Diet Studies have found that the Mediterranean diet can produce beneficial changes on markers of inflammation, including reduction in C-reactive protein and pro- inflammatory cytokines, as well as reduced platelet aggregation and improved endothelial function

36 Mediterranean Diet - Nuts Frequent consumption of nuts, containing omega-3 fatty acids, dietary fiber, magnesium, L-arginine and antioxidants, was shown to be inversely related to peripheral concentrations of CRP, IL-6 and fibrinogen

37 So forget about anti-oxidant foods, why not just take supplements? Vitamin A: Not effective for CV protection. Vitamin B: Recent study in diabetics with renal disease, worsening of function and increase in vascular events.* Vitamin C: Variable results for protection. Vitamin D: Real and effective. Vitamin E: Multiple studies ineffective and may interfere with statin effectiveness. * JAMA, April 28, 2010;202:16,1603-1609

38 Let’s Go Cooking !

39 Cooking Can Be Hazardous To Your Health Going beyond the smoke point of oils can create free radicals. Cancinogens are created when fat and animal proteins hit the hot coals producing heterocyclamines. Foods subjected to high heat create acylamides…starches and sugars convert to carcinogens. Aromatic compounds…flour, dust, oil sprays harmful to the lungs when inhaled. Teflon compounds in the kitchen. A knife and a bagel…the most dangerous combination. The worse combination…beer, hot oil, a deep fat fryer, a turkey and propane.

40 Time For An Oil Change! Know your oils Date when purchased Store away from heat, moisture and light Know the smoking point Monitor temperatures of the sauté pan Be careful of aerosols sprays

41 Cooking Oils Different oils have different uses, and each performs best within a certain range of temperatures. Every oil has a smoke point, the temperature at which it begins to smoke. Oil should never be allowed to smoke as it compromises nutritional value and releases carcinogenic free radicals.

42 Olive Oil As an unrefined oil, extra virgin olive oil should not be exposed to heat higher than 325°F, its smoke point Most of its characteristic flavor dissipates under sustained heat Extra virgin olive oil is more suitable for use as a condiment than in most cooking applications.

43 Smoke points of oils Avocado 510 degrees F Tea seed 485 Almond 495 Sesame 445 Canola 425 Walnut 400 Olive 325 Flax 225 http://www.spectrumorganics.com/images/uploads/496241e 655274.pdf

44 Avoid Dangerous Equipment

45 Grilling The American Grill…the most dangerous cooking apparatus in America Avoid flaming heat and smoke Keep food moist Indirect heat best Hand technique Have a thermometer

46 Go Get a Free Grill A free grill…yes absolutely FREE Pick one up today at Costco, Bloor Super Save, Loblaws or Pusateri’s

47 Cooking With a Teflon Pan Follow manufacturer directions. Avoid high heat or medium heat on an empty pan. Use approved non-stick cooking utensils. Never use an abrasive cleaner or pad. If the Teflon surface is cracking, discard. Teflon compounds used in manufacture have been found in the majority of American people even in the blood of newborns.

48 Teflon

49 Top 10 Ways To Ruin A Nonstick Pan Cutting portions on a nonstick pan. Storing pans improperly Drastic water temperature changes Using metal utensils Cleaning with a scouring pad Cleaning in a dishwasher Cooking on high heat Storing foods in your nonstick pan Pizza pan nonstick, do not use a pizza cutter A bread pan is a bread pan, non-meats, acid free

50 Water Sautéing or Pan Steaming Shorter time. Vegetables can be sliced into larger pieces. Process is steeping with flavors in the pan. Start by creating flavor…garlic, onions in large sauté pan. Add liquid to create steam. Never let the pan dry. Add chopped vegetables or if caramelizing, add veggies first with sugar. Cover with a tight fitting lid.

51 Steaming Adds moisture to the food. Maintains nutrients. Is rather quick. Avoid tap water…chlorine gases. Flavors enhanced without oil. Not all vegetables steamed equally. Avoid over cooking. A variety of utensils available.

52 Steaming Vegetables Vegetables have variable steaming times. Cook to al dente. Artichokes, potatoes, sweet potatoes, beets require 30-40 minutes. Carrots 6-8 minutes. Asparagus, broccoli same. Beans, corn on the cob about 5 minutes. Peas are quick, 2 minutes

53 Steaming Techniques Add aromatics to the steaming liquid…herbs, citrus. Cut vegetables to shorten steam time. Ice water blanch to stop cooking process and maintain color. 1 teaspoon vinegar in bath helps to maintain color in vegetables. Season after steaming.

54 Cooking with Ice Freezing can hold certain flavors and preserve ingredients, but can dehydrate foods. Freezing will change texture. Avoid freezer. burn…keep airtight. Perfect for herbs…the ice cube secret.

55 Tagine Definition: A tagine is like a casserole dish used in north African cooking, most commonly in Morocco. It consists of two pieces - a plate like bottom and a conical shaped lid. The bottom doubles as a serving dish. Can purchase in cooking stores or online. Le Creuset Moroccan Tagine

56 Which is the healthiest cooking method to maintain vitamins? 1. Boiling 2. Steaming 3. Roasting 4. Microwaving 5. Grilling

57 Which is the healthiest cooking method to maintain vitamins? 1. Boiling 2. Steaming 3. Roasting 4. Microwaving 5. Grilling

58 Which statements are true? 1.More than 80% of people feel well informed about heart health 2.Less than 50% of people chose healthy foods when dinning or shopping for groceries 3.Orange juice is one of the leading sources of Vitamin C for consumers 4.All of the above

59 Which statements are true? 1.More than 80% of people feel well informed about heart health 2.Less than 50% of people chose healthy foods when dinning or shopping for groceries 3.Orange juice is one of the leading sources of Vitamin C for consumers 4.All of the above

60 Which of the following can reduce Vitamin C levels? 1.Heating to greater than 70 degrees F. 2.Freezing 3.Prolonged storage 4.Light 5.Fat 6.Adding acidity

61 Which of the following can reduce Vitamin C levels? 1.Heating to greater than 70 degrees F. 2.Freezing 3.Prolonged storage 4.Light 5.Fat 6.Adding acidity

62 Heart-Healthy Diets Heart Healthy Diets can help reduce risk for other diseases or conditions (cancer, diabetes, obesity) –Vegetables, fruits, whole-grains, fat-free or low-fat dairy –Lean meats and poultry –Omega-3 rich fish at least twice a week (for example, salmon, trout, and herring) –Cut back on foods high in cholesterol, saturated fats, trans fats, sodium, added sugars –Moderate alcohol intake –Watch portion sizes –Balance physical activity with caloric intake Source: American Heart Association website: http://www.americanheart.org/presenter.jhtml?identifier=851

63 What the Doctor Recommends! Vitamin C and Vitamin D for heart health…two of the most studied vitamins in heart related literature Get vitamin C from foods rather than supplements –Other benefits of vitamin C-rich foods Benefits of fruits and vegetables Other vitamins and minerals Fiber Phytonutrients Additive effects of vitamin interaction

64 Keeping the “C” Minimize losses of vitamin C during food preparation and storage –Cut fruits and vegetables just before cooking or serving –Serve fruits and vegetables raw when possible –Don’t soak or store fruits or vegetables in water –Store cut, raw fruits or vegetables in airtight containers and refrigerate –Don’t open juices until ready to use and cover or close containers tightly when storing

65 Keeping the “C” Cooking –Use a small amount of water for cooking –Avoid high heat –Microwave or steam foods to retain the most vitamin C and pre-heat water to bring to temperature quickly –Reuse cooking water in soups or stews –Adding lemon juice or vinegar slows down Vitamin C loss –Serve foods immediately. Vitamin C loss in warmed foods is 4-17% first hour and 7-34% in second hour These techniques will also help retain other vitamins and minerals in foods!

66 Keeping the “C” Add fresh fruits, vegetables, or their juices to dishes after cooking –Edible garnishes –Fresh fruit or vegetable salsas –Add fresh fruit to cakes or other desserts –Citrus juice or other fruit juice used for vinaigrettes or marinades Smoothies with fresh fruit and/or 100% juice Ingredient substitutions: use nutrient rich ingredients

67 Cooking Requires Proper Attitude An hurried meal prepared in anger imparts stressful flavors and chaotic thoughts. A restricted recipe can lead to deprivation, loneliness and isolation. If the cook feels rejected, so will be the meal. Cooking is a time of self-reflection. If cooking is a chore, then move on. Food is art and an expression of self.

68 In summary Inflammation plays an important role in heart disease. Fact: how we cook foods rather than what we eat may be just as important as the type of foods. Your kitchen could become the pharmacy of the future.

69 Remember: “When you see the Golden Arches, the pearly gates are not far behind”.

70 Cooking demonstration For more recipes: Cooking with heart Guiltless Potato Chips Blueberry Chocolate Almond Clusters

71 Guiltless Potato Chips Preparation and ingredients:Preparation and ingredients: Wash and slice unpeeled potatoes.A mandoline works the best. There are a number of different types, ranging in price from $30 to $200. Save your money, an inexpensive model works well. The key is to get a uniform cut in order to brown the potatoes evenly. Wash and slice unpeeled potatoes. A mandoline works the best. There are a number of different types, ranging in price from $30 to $200. Save your money, an inexpensive model works well. The key is to get a uniform cut in order to brown the potatoes evenly. The best potatoes for chips are russet potatoes.The best potatoes for chips are russet potatoes. Place sliced potatoes on a microwave-safe sheet. Flavor with favorite seasonings...no salt, Mrs. Dash’s, rosemary, or dry ranch dressing. Microwave on high until brown, 4-8 minutes. Cool and store in an airtight bag. Nutritional analysis:Nutritional analysis: Fried potato chips have 150 calories per ounce verses 30 calories in this healthier version. Enjoy. Fried potato chips have 150 calories per ounce verses 30 calories in this healthier version. Enjoy.

72 Blueberry Almond Clusters Ingredients and preparation: 4 ounces bittersweet dark chocolate 1 cup fresh blueberries, sorted, washed and dried ¼ cup slivered almonds Melt chocolate in a double boiler or micro-wave. Mix berries into warm chocolate, stirring gently to coat them. Cover a baking sheet with wax paper. Mound several slivered almonds on the sheet. Using two spoons, lift 6-8 berries in chocolate and place on top of the almonds. Shape each cluster. Repeat to create approximately 24 clusters. Chill for about 45 minutes. Makes 24. Serving size: 1 cluster. Nutritional analysis: Calories 35, fat 2g, carbohydrates 4g, protein 1g.

73 For more information and recipes www.southdenver.com Google: the Cooking Cardiologist www.floridajuice.com www.thecookingcardiologist.com www.tatteredcover.com. Search for the cookbook, Cooking with Heartwww.tatteredcover.com


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