The Role of Nutrition in Human Health, Disease, and Aging

1
The Role of Nutrition in Human Health, Disease,
and Aging A Practical Approach Christopher B.
Heward, Ph.D. President Kronos Science
Laboratories, Inc. IABG 10th Congress -
September 2003
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Sound Nutritional Advice
Physician We think you ate something that
triggered some primitive genes?
Patient But Doc, what do I do?
Physician Stop eating so much sh__ garbage!
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The Current Scientific Consensus About Nutrition
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USDA Dietary Guidelines
THE USDA FOOD PYRAMID
Promotes a grain-based low fat / high
carbohydrate diet.
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Dietary Fat Intake and Obesity (US 1955-1990)
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Dietary Calories as Fat
Dietary Calories as Fat
40
38
of Calories from Fat
36
34
32
1955
1962
1969
1976
1983
1990
Year
from Amer Dietetic Assoc 95 417-420(1995)
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Dietary Fat Intake and Obesity (US 1955-1990)
35
42
32
40
29
38
Overweight
of Calories from Fat
26
36
23
34
20
32
1955
1962
1969
1976
1983
1990
Year
from Amer Dietetic Assoc 95 417-420(1995)
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Actual Causes of Death United States (1990)
Cause Estimated Number of
Total
Tobacco 400,000 19
Diet/Activity Patterns 300,000 14
Alcohol 100,000 5
Microbial Agents 90,000 4
Toxic Agents 60,000 3
Firearms 35,000 2
Sexual Behavior 30,000 1
Motor Vehicles 25,000 1
Illicit Use of Drugs 20,000 lt1
McGinnis et al. - JAMA, November 10, 1993
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Actual Causes of Death United States (1990)
Cause Estimated Number of
Total
Tobacco 400,000 19
Diet/Activity Patterns 300,000 14
Alcohol 100,000 5
Microbial Agents 90,000 4
Toxic Agents 60,000 3
Firearms 35,000 2
Sexual Behavior 30,000 1
Motor Vehicles 25,000 1
Illicit Use of Drugs 20,000 lt1
McGinnis et al. - JAMA, November 10, 1993
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Major Causes of Death in the US
Suicide
Chronic Liver Disease/Cirrhosis
Septicemia
Hypertension Hypertensive Renal Disease
Kidney
Alzheimers
Influenza Pneumonia
Cardiovascular Disease
Diabetes Mellitus
Accidents
Chronic Pulmonary Disease
Cerebrovascular Disease
Cancer
Source Minino, AM, Arias, E, Kochanek, et al.,
Summary National Vital Statistics 2000
Not Shown 17.6 - Other
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The Problem
Subcutaneous Fat
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Obesity Trends Among U.S. AdultsBRFSS, 1990
Source Mokdad A H, et al. J Am Med Assoc
199928216, 200128610.
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Body Mass Index (BMI)
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Weight Ranges For Different BMI Scores
Body Type
BMI Range
Underweight
lt 18.5
Healthy Weight
18.5 - 24.9
Overweight
25.0 - 29.9
Obese
30.0 - 39.9
Extremely Obese
gt 40.0
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Obesity Trends Among U.S. AdultsBRFSS, 1991
Source Mokdad A H, et al. J Am Med Assoc
199928216, 200128610.
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Obesity Trends Among U.S. AdultsBRFSS, 1992
Source Mokdad A H, et al. J Am Med Assoc
199928216, 200128610.
16
Obesity Trends Among U.S. AdultsBRFSS, 1993
Source Mokdad A H, et al. J Am Med Assoc
199928216, 200128610.
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Obesity Trends Among U.S. AdultsBRFSS, 1994
Source Mokdad A H, et al. J Am Med Assoc
199928216, 200128610.
18
Obesity Trends Among U.S. AdultsBRFSS, 1995
Source Mokdad A H, et al. J Am Med Assoc
199928216, 200128610.
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Obesity Trends Among U.S. AdultsBRFSS, 1996
Source Mokdad A H, et al. J Am Med Assoc
199928216, 200128610.
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Obesity Trends Among U.S. AdultsBRFSS, 1997
Source Mokdad A H, et al. J Am Med Assoc
199928216, 200128610.
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Obesity Trends Among U.S. AdultsBRFSS, 1998
Source Mokdad A H, et al. J Am Med Assoc
199928216, 200128610.
22
Obesity Trends Among U.S. AdultsBRFSS, 1999
Source Mokdad A H, et al. J Am Med Assoc
199928216, 200128610.
23
Obesity Trends Among U.S. AdultsBRFSS, 2000
Source Mokdad A H, et al. J Am Med Assoc
199928216, 200128610.
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Obesity Trends Among U.S. AdultsBRFSS, 2001
Source Mokdad A H, et al. J Am Med Assoc
199928216, 200128610.
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What Do The Experts Say?

• Dr. Atkins New Diet Revolution - Atkins
• Protein Power - Eades
• Sugar Busters - Steward
• The Zone - Sears
• Dieting With The Duchess - Sarah
• Volumetrics - Rolls
• The Pritikin Principle - Pritikin
• Choose To Lose - Goor
• Eat More, Weigh Less - Ornish

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Comparison of Popular Diets - Macronutrients
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Comparison of Popular Diets - Macronutrients
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Comparison of Popular Diets - Macronutrients
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Comparison of Popular Diets - Macronutrients
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Comparison of Popular Diets - Macronutrients
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Comparison of Popular Diets - Macronutrients
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The Metabolic Imperative
Weight Stability
Energy Intake
Energy Expended

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The Metabolic Imperative
Weight Gain
Energy Expended
gt
Energy Intake
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The Metabolic Imperative
Weight Loss
Energy Intake
lt
Energy Expended
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Does That Mean You Should Go On A Diet?
NO!
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Rx For Healthy Nutrition and Weight Control

• Diet
• Carbohydrates - 35 (Fruits Vegetables)
• Proteins - 30 of Calories (Fish, Poultry, Eggs)
• Fats - 35 of Calories (Fish, Meat, Nuts, Oils)
• 1/3 - Saturated
• 1/3 - Monounsaturated
• 1/3 - Polyunsaturated
• Colorful Fruits and Vegetables
• Supplements
• Vitamins Minerals (RDA)
• Omega-3 FAs (fish oil)

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Vitamin E and Heart Disease
Relative Risk (Age Adjusted)
In the 88,000 Nurses Study, Dietary Vitamin E
greater than 200 IU per day was associated with a
41 Decreased Risk for Major Coronary Heart
Diseases.
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Omega-3 Fatty Acids (fish oil)
Eicosapentaenoic Acid (EPA, 205w3) Docosahexaenoi
c Acid (DHA, 226w3)
Health Benefits

• Reduces Risk of Sudden Cardiac Death
• Anti-inflammatory Properties
• Improves Membrane Fluidity
• Increases HDL (good) Cholesterol
• Reduces Blood Pressure
• Reduces Risk of Blood Clots
• Lowers LP(a)

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Focus On Essentials - Eat Mostly Nutrient-Dense
Foods
Avoid Trans Fats!
X
X
X
Consume ONLY those foods with a nutritional
payoff - NO EMPTY CALORIES!
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USDA Revising The Food Pyramid?
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What About Caloric Restriction and Aging?
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Typical Survival Curves For Mice On CR Diets
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Caloric Restriction In Adult Mice
 
 
Length Of Life In Days
ad libidum
Maximum
10th ile
Median
60 of ad libidum intake
941
822
701
Group 1
1296
1226
1057
Group 2
1040
918
808
Group 3
1299
1177
941
Group 4
0 6 12 Age (months)
0
6
12
Age (months)
Data from Yu et al. (1985) Figure from Masoro
(1989)
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Caloric Restriction In Adult Mice
 
 
Length Of Life In Days
ad libidum
Maximum
10th ile
Median
60 of ad libidum intake
941
822
701
Group 1
1296
1226
1057
Group 2
1040
918
808
Group 3
1299
1177
941
Group 4
0 6 12 Age (months)
0
6
12
Group 4 Lifespan Increase 40
Age (months)
Data from Yu et al. (1985) Figure from Masoro
(1989)
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Studies of Late-Onset Caloric Restriction
Adapted From Walford Weindruch (1989)
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Studies of Late-Onset Caloric Restriction
Adapted From Walford Weindruch (1989)
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The Payoff From A Successful Caloric Restriction
Diet
33 Retardation of Aging Rate

• Constant Hunger
• Abnormal Focus On Food (24hrs./day)
• Loss of Libido (reproductive function)
• Increased Life Expectancy
• Payoff
• If, starting at age 50, you do CR successfully
  for 30 years, then when you are 80 years old, you
  will function as though you were only 70.

This is just NOT enough for most people!
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BMI and All Cause Mortality
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All Cause Mortality
20
15
Deaths/1000/year
10
5
0
lt20
20
22
24
26
28
30
Body Mass Index

• Adapted From British Medical Journal, 1997 314
  1311-1317

• Adapted From British Medical Journal, 1997 314
  1311-1317

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Fit-Fat Mortality In Men
Body Fat
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Effect of Exercise On Total and Visceral Body Fat

• 173 Sedentary, overweight, post-menopausal women
• Exercise group 45 minutes, 5 day/day X 1 year
• 3 months 3 d/week supervised 2 days
  unsupervised
• 9 months 1 d/week supervised 4 days unsupervised

JAMA- Jan 15, 2003 Vol 289(3)
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Conclusions

• Americans are too fat and getting fatter.
• The best diet is to reduce caloric intake without
  reducing nutritional intake.
• Take high quality dietary supplements that
  include
• Vitamins and Minerals (RDA)
• Fish Oil
• Vitamin E
• The benefits (if any) of serious CR diets are not
  worth the effort for most people.
• Exercise may help compensate for some of the
  negative health affects of obesity.

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