1. The Anti-Inflammatory Diet and Cardiovascular Disease

5. Inflammation: A common final pathway
Cardiovascular disease
Cancer
Neurodegenerative disease
Autoimmune disease DM
Obesity

6. What is Inflammation?
Complex orchestration of pro-inflammatory and anti-inflammatory events
Mediated by eicosanoids
Prostaglandins, thromboxanes, leukotrienes,
Hydroxylated fatty acids, lipoxins, prostamides, isoprostanoids
Silent inflammation vs. painful inflammation

7. Phases of inflammation
Initiating event-
Pro-inflammatory attack response/cellular destruction
Anti-inflammatory healing response/Cellular rejuvenation

8. Δ6-Desaturase Omega 6 Fatty Acid Omega 3 Fatty Acids
(Linoleic Acid)
Omega 3 Fatty Acids
(alpha-linolenic acid)
Δ6-Desaturase
Gamma-linolenic acid
(GLA)
Evening Primrose Oil
Borage Oil
Black Current Oil
Eicosapentaenoic Acid
(EPA)
COX
Lipoxygenase
Δ5-Desaturase
Arachidonic Acid
Prostaglandins
PGE1, PGE3
(Favorable)
Less Inflammatory
Leukotrienes
Cyclo-oxygenase
(COX)
Lipoxygenase
Docosahexaenoic acid
(DHA)
Prostaglandins (PGE2)
(Inflammatory)
Leukotrienes

9. Leukotriene Inhibitors: COX II Inhibitors:
Arachidonic Acid
(in cell membrane)
Phospholipase A-2
Steroids
Free AA
Colchicine
Aspirin
Cyclo-oxygenase
Pathway
Lipoxygenase
Pathway
Sulfasalazine
NSAIDs
Leukotriene Inhibitors:
Accolate, Singulair, Zyflo
COX II Inhibitors:
Celebrex, Vioxx, Mobic
Prostaglandins
&
Thromboxanes
Leukotrienes

10. FAT IS GOOD!! Depending on what kind….
Omega 3 fatty acids (fish oils-EPA, DHA; plant sources -ALA)
Mono-unsaturated fats (canola and olive oils)
Decreased fat consumption since the 1960’s associated with obesity epidemic—CHO intake has increased dramatically
Glycemic index/glycemic load

11. Types of fats Saturated: beef and other animal fats, dairy
Monounsaturated (omega-9):
olive and canola oils

12. Polyunsaturated fats (essential FA’s):
Omega-6: Linoleic acid (LA)--vegetable oils, seeds, nuts
Gamma Linolenic Acid (GLA)--borage and primrose oil
Arachidonic Acid(AA)--meat products
— Omega-3: Alpha Linolenic Acid (ALA)--legumes, leafy vegetables, flax, flaxseed and canola oils) Eicosopentanoic acid (EPA)-fish oil Docosahexanoic acid (DHA)--fish oil, breast milk

13. Avoid or Reduce Trans-fatty acids BAD! Omega-6 fatty acids Margarine
Corn oil, cottonseed oil, grapeseed oil, peanut oil, safflower oil, sesame oil, soybean oil, sunflower oil, partially hydrogenated oils
Any product with long shelf life (crackers, pastries, chips)

17. How much Omega-3 fats do you need?
Strive for Omega 6: Omega-3 ratio of 4:1 (usual SAD (Standard American Diet) 16:1
Maintenance 2.5 g/d
Improve hear function 5 g/d
Treat chronic pain 7.5 g/d
Treat neurological disease >10g/d
Sears, The Anti-Inflammation Zone, 2005

18. Types of Fish Oil Fish Contamination with PCB, dioxin, and Hg
Higher in AA than fish oil
Crude fish oil
High contamination
Health food grade
Still some contamination with PCB’s and dioxins
Ultra-Refined EPA/DHA Concentrates
Removal of PCB’s and other toxins
Can be used in high doses (“weapons grade”)

19. Requirements for an Ultra-refined EPA/DHA concentrate
Total long-Chain Omega-3 >60%
Dioxins< 1 ppt
Mercury <10 ppb
PCB’s<30 ppb

20. What is an anti-inflammatory diet?
Lose fat
Eat small meals
Have some protein at every meal but reduce red meat and dairy (Avoid charred, overcooked foods)
Cold water fish (salmon, mackerel, sardines, herring)
Eat primarily fruits and vegetables
Leafy green vegetables, nuts, flaxseeds or oil
Take your fish oil

21. Anti-inflammatory Lifestyle
Exercise
Quit smoking
Weight loss
Stress management
Vagal nerve stimulation via abdominal breath work
Treatment of depression
Social support

22. Onions/ Apples Quercetin
Arachidonic Acid
(in cell membrane)
Phospholipase A-2
Onions/ Apples Quercetin
Turmeric Curcumin
Rosemary Ursolic acid
Red Pepper Capsaicin
Ginger
Onions/Apples Quercetin Turmeric Curcumin, Feverfew Perthenolides
Free AA
Onions/Apples Quercitin
Cyclo-oxygenase
Pathway
Lipoxygenase
Pathway
Boswellia Bosellic Acid
Rosemary Carnosol
Prostaglandins
&
Thromboxanes
Leukotrienes

23. Mediterranean Diet
More tolerable than low fat diets and associated with improved long term weight loss (McManus 2001)
Risk reduction of death from CAD = 0.67 compared to usual AHA diet (Trichopoulou et al, 2003)

25. Something fishy?

26. American Heart Association Recommendations
·   Healthy individuals should take two servings of fish(salmon, sardines, tuna, mackerel, trout) weekly along with flaxseed, canola, and soybean oil
·  Patients with CHD should consume higher doses, 1 g/d of EPA + DHA, which may require fish oil supplementation
Utilize complex carbohydrates, higher in fiber and lower in glycemic load to reduce risk of CHD
AHA Recommendations: Intake of omega-3 fatty acids. Women’s Health in Primary Care (1): (Consensus opinion)
Hu F, Willett W.Optimal diets for prevention of coronary heart disease. JAMA. 2002;288: {Systematic review}
       

27. Indications from other studies
Eating fish as little as once a week reduces the risk of sudden death in men
Eating fish twice a week reduces CHD risk in women
Fish intake reduces Alzheimer’s risk
Harper, Beyond the Mediterranean Diet: the Role of Omega-3 Fatty Acids in the Prevention of CAD, Prev Cardiol, 2003
Morris, Consumption of fish and n-3 fatty acids and risk of Alzheimer dz,. Arch Neurol, 2003

28. How intake of Omega-3 Fatty Acids is helpful
Stabilization of atherosclerotic plaques
Reduction of inflammation by mediation prostaglandin synthesis pathway
Improved ratio of omega-3 to omega 6 FA reduces arachidonic acid and pro-inflammatory, pro-platelet aggregatory cytokines
Enhances PGE1 and PGE 3 and less inflammatory leukotrienes(see diagram)
Thies F, et al. Association of n-3 polyunsaturated fatty acids with stability of atherosclerotic plaque: RCT, Lancet, 2003;361:477-85
Harper, Beyond the Mediterranean Diet: the Role of Omega-3 Fatty Acids in the Prevention of CAD, Prev Cardiol, 2003;6(3):134-46

29. Fish Oil for secondary prevention
240 pts with suspected Acute MI
2 gms fish oil vs. placebo
After 1 year, 54% reduction in serious ventricular arrhythmia, 30% total reduction in cardiac events
Singh, Cardiovasc Drugs Ther 1997

30. GISSI More than 11,000 patients on 1 gm fish oil/d < 3mos post MI
20% reduction in total mortality
10% reduction in recurrent MI
40% reduction in sudden death
Lancet 1999;354

32. A word about… Glycemic Index (rate of absorption of glucose)
Glycemic Load (ratio between GI and CHO content)

33. High Glycemic/Load Foods Increase:
Inflammation
Risks of heart disease, diabetes
Examples include:
White bread, glucose (GI= 100)
Potatoes, white rice
Pastries, white flour
Sweets, carbonated soft drinks

34. Lower GI/GL reduces risk
Whole grains
Fruits
Vegetables
Legumes
Or…mixing high GI/GL foods with those with lower GI/GL

38. Superfoods to decrease inflammation
BEANS
Pinto, navy, Great Northern, lima, garbanzo(chickpeas), black beans, lentils, green beans, sugar snap peas, and green peas
BLUEBERRIES
Purple grapes, cranberries, boysenberries, raspberries, strawberries, currants, blackberries, cherries, and all other varieties of fresh, frozen, or dried berries
BROCCOLI
Brussel sprouts, cabbage, kale, turnips, cauliflower, collards, bok choy, mustard green, Swiss chard
OATS
Wheat germ, ground flaxseed, brown rice, barley, wheat, buckwheat, rye, millet, bulgur, wheat, amaranth, quinoa, triticale, kamut, yellow corn, wild rice, spelt, couscous
ORANGES
Lemons, white, and pink grapefruit, kumquats, tangerines, limes
PUMPKIN
Carrots, butternut squash, sweet potatoes, orange bell peppers

39. Superfoods to decrease inflammation
TOMATOES
Red watermelon, pink grapefruit, Japanese persimmons, red-fleshed papaya, strawberry, guava
TURKEY
Skinless chicken breast
WALNUTS
Almonds, pistachios, sesame seeds, peanuts, pumpkin, and sunflower seeds, macadamia nuts, pecans, hazelnuts cashews
YOGURT
Kefir
SALMON
Alaskan halibut, canned albacore tuna, sardines, herring, trout, sea bass, oysters, and clams
SOY
Tofu, soymilk, soy nuts, edamame, tempeh, miso
SPINACH
Kale, collard, Swiss chard, mustard greens, turnip greens, bok choy, romaine lettuce, orange bell peppers
TEA – GREEN OR BLACK

40. SUPERFOOD #7: WILD SALMON
Lowers the risk of heart disease and cancer.
The more omega-3 fish oils you eat; the lower your blood pressure
In one study eating the oil in fish cut cancer incidence by over 60%
4x weekly  risk for and progression of AMD
Studies suggest that fish consumption is associated with a lower risk for depression, violent behavior, Alzheimer’s disease, Attention Deficit Disorder, Atrial fibrillation.
SPF nutrients
TRY TO EAT Wild salmon, halibut, sardines, etc.  2 to 4 times per week

41.   SUPERFOOD #13: WALNUTS
A handful a day can cut your risk of cardiovascular event by as much as 51%
Two tablespoons of peanut butter 5 times/week cuts risk of type II diabetes by 20%
Along with tea, the easiest way to improve your heath
 Risk/progression of AMD
SPF nutrients
TRY TO EAT a handful of nuts, five times a week
* Skip the salt and added oils

42. WALNUT SIDEKICKS Almonds Pistachios Sesame Seeds Peanuts
Pumpkin and Sunflower Seeds
Macadamia Nuts
Pecans
Hazelnuts
Cashews

43. 10 Foods to Avoid Donuts White Bread
Bread with < 3 grams fiber/ slice
Soda
Stick Margarines
White Pasta
Full Fat Dairy
Movie Theatre Popcorn
Luncheon Meats
Sugar Coated Cereal