Stress, diet & disease

Dr B Ravinder Reddy

Consultant Gastrointestinal & General Surgeon

Chief – Division of Clinical Nutrition

Care Hospitals

Hyderabad

MBBS, MS, FRCS (Edinburgh), FRCS (Glasgow)

[email protected]

Greetings From Care Hospital, Hyderabadwww.carehospitals.com

Dept. of Surgical Gastroenterology & Division of Clinical Nutrition

Diet & DiseaseNutrition is of interest to Everyone!

Impoverished

Under Nourished Pts Food Industry (FF&N)

Community Worker

Aesthetic & Cosmesis

Over Nourished

Scientists

Clinicians & Nutritionists

Diet & Disease

Diet related diseases are spreading throughout the world across all age barriers, affecting many children as well as adults

Recent WHO statistics:

One Billion Adults Are Overweight!

300 Million Adults Are Obese!

Puska P et al. WHO strategy on diet, physical activity and health. Data and Statistics. Geneva: WHO; 2007

Diabesity

Front Cover

Diet & Disease

In the past two decades our understanding of food and nutrients that promote good health has grown substantially

Owing to studies of molecular mechanisms of various diseases and the effects of various nutrients

Diet

Will Not Keep The Stress Away!

Diet Helps To CopeWith Stress

Lifestyle + Dietary Factors =

Diet & Disease

A wrong diet can be a major cofactor in causing various diseases and

aggravating the various stressors!

Diet & Disease

↑ Saturated Fats

↑ Refined CH

↑ Fibre

After eating a calorie dense diet

Is Very Common!

Stress, Diet & Disease

i. Hyperglycemia

ii. Hypertriglyceridemia

iii. Increase in free radicals (pro-oxidant state)

iv. Increase in cytokines (pro-inflammatory state)

This diet is associated with

Stress, Diet & Disease

This in turn is associated with:

i. Endothelial dysfunction

ii. Increase in free radicals

iii. Increase in inflammation

Stress &Wrong Diet

Inflammation ROS, TNF, IL6, IL18

Obesity Visceral

InsulinResistance

Metabolic Syndrome Type 2 Diabetes Atherosclerosis

Stress, Diet & DiseaseHigh Fat, Refined Carbohydrate Diet

Insulin Resistance / Hyperinsulinemia

Diet & DiseaseHigh Fat, Refined Carbohydrate Diet

Insulin Resistance / Hyperinsulinemia

Blood

IGF

Testosterone Estradiol

Free IGF Estradiol

Diet & DiseaseHigh Fat, Refined Carbohydrate Diet

Insulin Resistance / Hyperinsulinemia

Blood

IGF

Testosterone Estradiol

Free IGF Estradiol

Tumor Promotion

Correct Diet & Stress Management Can Prevent:

Metabolic Syndrome

Diabetes Mellitus

Cardiovascular Disease

Cancer

Obesity

Dyslipidemia

Diet & Disease: Preventive

Diabetes Mellitus: 91% reduction*

Cardiovascular Disease: 83% reduction*

Cancer: 71% reduction (colon cancer)*

Stress, Diet & Disease: Therapeutic Roles

Acute illness (critically ill, pancreatitis, MOF)Chronic diseases (MS, DM, HBP, CVD,)Inflammatory bowel diseases (UC & CD)Irritable bowel syndromeAutoimmune diseasesCongenital & metabolic diseases (lactose

intolerance, cystic fibrosis etc)HIV

Stress, Diet & Disease

Can Appropriate Diet Prevent or Treat All Diseases?

NO!

Diet & Disease

A select few types of diets have shown

to be effective as per their respective claim*

*By scientific investigations & clinical trails

Diet & Disease

Reduces Cardiovascular Diseases*

Reduces LDL Cholesterol

Provides SCFA

Avoids Constipation

Fibre (25 – 50 gms)

*The first health claim allowed by US Government

FDA, US Department of Health and Human ServicesFDA proposes health claim for oatmeal & oat bran. Jan 11, 1999

Diet & Disease

Reduces Cardiovascular Diseases*

Reduces LDL Cholesterol & Triglycerides

Antioxidant, Antiproliferative, Antimigratory

Reduces Atherosclerosis

Phytoestrogens

Soy Protein(35 – 45 gms)

*Due to its amino acid profile which differs from animal protein

FDA, US Department of Health and Human ServicesFDA proposes health claim for soy protein & hear disease. Oct 26, 1999

Diet & Disease

The best known nutrient, has been extensively studied

Ratified by US FDA & AHA to reduce CVD and for use of supplements of FO for CHD patients

Omega - 3 Fatty Acids

Diet & Disease

Reduces inflammation by inhibiting cytokinesInhibits mitogensInhibits thrombosisInhibits antherosclerosisReduces TGIncreases NO productionIs beneficial in autoimmune diseases, IBD, RAForms important aspect of nervous system

1 to 2 gms

Omega - 3 Fatty Acids

Diet & DiseaseWithout Omega - 3 Fatty Acids

Diet & DiseaseOmega - 3 Fatty Acids

Connor WE. Importance of n-3 fatty acids in health & disease. Am J Clin Nutr 2000;71

Diet & Disease

Probiotics

Are bacteria containing foods

Alter the bacterial composition of gut by adding bacteria

Prebiotics

Act as substrate to the gut bacteria

Alter the bacterial composition by changing the substrates

Synbiotics

Diet & Disease

Immunity of the gut largely depends on type of micro-organisms

Alter the gut bacterial colonies

Reduce permeability of harmful micro-organisms

Synbiotics

Diet & Disease

Strengthen intestinal immunity through IgA & inflammatory responses

Decrease levels of enzymes, mutagens & 20 bile salts, thereby reducing the incidence of colon cancer

Synbiotics

Diet & Disease

Produce SCFA

SCFA reduce pH of colon, increase proliferation of normal epithelium, suppressing abnormal cells, thereby reducing incidence of cancer

SCFA also help in absorption of iron

Synbiotics

Diet & Disease

All these benefits are not JUST due to replacing the bacteria…

Recent evidence suggests that it is the secondary products* produced by these probiotics that are responsible for the beneficial bioactivity

Synbiotics

*SCFA, Short Bioactive Peptides (cleaved from milk & other proteins)

Alcohol

Alcohol

Beneficial effects within 2 weeks!

“Moderate alcohol”:

Men - 2 drinks per day

Women – 1 drink per day

Alcohol

One Drink?

Alcohol

Beer - 12 ounces* ( 360 mls)

Wine - 5 ounces (150 mls)

Spirits - 1.5 ounces (45 mls)

2005 Dietary Guidelines Committee report. U.S. Department of Health & Human Services. http://www.health.gov/Dietary Guidelines/dga2005/report.

“One Drink*” * 1 ounce = 30 mls

Alcohol

Benefits

Increases HDL

Reduces CVD

Anti-thrombotic (reduces fibrinogen & TPA)

Side Effects

1 gram = 7 calories

1 drink = 21 grams

30g/day Triglycerides

Cardiomyopathy, HBP

CLD, AP, GERD

Nutrigenomics

This involves application of evidence based nutrition as per the person’s genetic makeup!

Individualised nutritional intervention rather than the traditional or general approach to maintain good health appears to be more appropriate

“Personalised Nutrition”

Nutrigenomics

Nutrigenomics is promising!

Is still in the early stages

In due course of time, a more accurate and effective recommendations can be tailor made on individual basis!

“Personalised Nutrition”

Till nutrigenomics is available…

Let thy food be thy medicine…And the medicine be thy food!

Physical Activity, High Fibre, Low Fat Stress Reduction Methods

Diet & Disease9 to 11 servings per day

25 gms dietary fibre

Substituting soy for animal protein

Diet & DiseaseFish 2 times a week

Nuts 1 ounce / day

Moderate alcohol 1-2 drinks / day

Regular Physical Activity Lifestyle Changes

Stress, Diet & DiseaseStress Reduction Methods

Only

Medicines Without Nutrition & Stress Reduction

“Futulis” Attempt of Danaides

We Will Also Be Confronted With Such Futile Situations

“Futulis” Attempt of Danaides

If We Do Not Control Our Stress & Supplement Our Diet With Correct Nutrients!

StressIs the price we pay for becoming more civilised and sophisticated!!

It is inevitable!!

PrescriptionsLifestyle, Stress ↓ & Diet

References

www.teachhealth.com

www.residentassistant.com

[email protected]

Many Many Thanks

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