THE SCIENCE OF LIFESTYLE MEDICINE Corey Howard, MD, FACP, FMNM Internal Medicine, Gastroenterology, Anti-Aging, Functional and Regenerative Medicine, Lifestyle Medicine
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THE SCIENCE OF LIFESTYLE MEDICINE
Corey Howard, MD, FACP, FMNM
Internal Medicine, Gastroenterology, Anti-Aging, Functional and Regenerative Medicine, Lifestyle Medicine
ABOUT: COREY HOWARD, MD, FACP, FMNM
• Internship, Psychiatry, Einstein Campus at Long Island Jewish Medical Center
• Residency, Internal Medicine, University of South Florida
• Chief Resident, Internal Medicine
• Fellowship, Digestive Diseases and Nutrition
• Private Practice Gastroenterology (Board Certified)
• Private Practice Internal Medicine (Board Certified)
• Board Certified Anti-Aging and Regenerative Medicine
• Professional Certification, Plant Based Cooking
• Past Chair, Department of Internal Medicine NCH Healthcare
• Past President, Collier County Medical Society
• Speaker, Florida Medical Association
• Community Involvement
• Ironman Triathlete
• Musician
• Writer
• Public Speaker
• Dad, Husband, Friend
80% of Chronic Disease Can Be Attributed to
Lifestyle Choices
Each lifestyle factor was associated with
a reduction in risk.
The more factors you had the lower
the risk.
Diet/Nutrients
Physical Activity
Stress Response
Sleep
Environmental Factors
Community and Purpose
ADAPTED FROM THE ORIGINAL PRESCRIPTION BY THOMAS GUILLIAMS PHD
HEALTH
OBESITY FACTS
• 34.9% (78.6 million) US adults are obese
• Increases risks of diseases
• Leading cause of preventable death
• $147 billion annual medical cost of obesity
• Obesity rate in black population 47.8%
• Rate highest in middle age (39.5%)
2000
Obesity Trends* Among U.S. AdultsBRFSS, 1990, 2000, 2010
(*BMI 30, or about 30 lbs. overweight for 5’4” person)
2010
1990
No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%
15%–<20% 20%–<25% 25%–<30% 30%–<35% ≥35%
Prevalence* of Self-Reported Obesity Among U.S. Adults by State and Territory, BRFSS, 2013
*Prevalence estimates reflect BRFSS methodological changes started in 2011. These estimates should not be compared to prevalence estimates before 2011.
CA
MT
ID
NV
UT
AZNM
WY
WA
OR
CO
NE
ND
SD
TX
OK
KS
IA
MN
AR
MO
LA
MI
IN
KY
ILOH
TN
MS AL
WI
PA
WV
SC
VA
NC
GA
FL
NY
VT
ME
HI
AK
NH
MA
RI
CTNJ
DE
MD
DC
PRGUAM
HEALTH CONSEQUENCES OF OBESITY
• Coronary heart disease
• Stroke
• High blood pressure
• Type 2 diabetes
• Elevated lipids
• Sleep apnea
• Osteoarthritis
• Reproductive issues
• Mental health issues
• Cancer (uterus, cervix, endometrium, liver breast, ovaries, colon, prostate…)
POTENTIAL CANCER CAUSING FOODS YOU MAY EAT RIGHT NOW
• Microwave popcorn
• Non-organic fruits
• Processed meats
• Farmed salmon
• Potato chips (fried foods) acrylamides
• Hydrogenated oils
• White flour
• GMO
• Sugars (HFCS)
• Artificial sweeteners
• Red meats
• Soda
GOOGLE: DIET COMPARISON
136,000,000 RESULTS IN 0.27 SECONDS!
DASH
TLC DIET
MAYO CLINIC DIET
MEDITERRANEAN DIET
WEIGHT WATCHERS DIET
FLEXITARIAN DIET
VOLUMETRICS
JENNY CRAIG
BIGGEST LOSER DIET
ORNISH DIET
TRADITIONAL ASIAN DIET
VEGETARIAN DIET
ANTI-INFLAMMATORY DIET
SLIM FAST DIET
SPARK SOLUTION DIET
FLAT BELLY DIET
HMR DIET
NUTRISYSTEMS
ABS DIET
ENGINE 2 DIET
SOUTH BEACH DIET
VEGAN DIET
ZONE DIET
GLYCEMIC INDEX DIET
MACROBIOTIC DIET
MEDIFAST
SUPERCHARGED HORMONE DIET
BODY RESET DIET
THE FAST DIET
ATKINS
RAW FOOD DIET
DUKAN DIET
PALEO DIET
3-HOUR DIET
8-MINUTES DIET
BECK DIET SOLUTION
THE BEST LIFE DIET
THE BLOOD TYPE DIET
BODY FOR LIFE DIET
CABBAGE SOUP DIET
CURVES
DR. PHIL
E-DIETS
EAT CLEAN DIET
FAT FLUSH PLAN
FAT SMASH DIET
FLAT BELLY DIET
THE FLAVOR POINT DIET
FRENCH WOMEN DON’T GET FAT DIET
THE GI DIET
GRAPEFRUIT DIET
THE PERFECT BODY DIET
PICTURE PERFECT DIET
PRITIKIN DIET
SCARSDALE DIET
SKINNY BITCH DIET
SNACK FACTOR DIET
THE STEP DIET
STRUCTURE HOUSE DIET
SUGAR BUSTERS DIET
SUZANNE SOMERS DIET
THE SOLUTION
TEN YEARS THINNER
THE THRIVE DIET
YOU ON A DIET
US per capita red meat, poultry, and fish availability (kg/y).
Barnard N D Am J Clin Nutr 2010;91:1530S-1536S
©2010 by American Society for Nutrition
US per capita use of added fats and oils (kg/y).
Barnard N D Am J Clin Nutr 2010;91:1530S-1536S
©2010 by American Society for Nutrition
US per capita cheese consumption(kg/y).
Barnard N D Am J Clin Nutr 2010;91:1530S-1536S
©2010 by American Society for Nutrition
Vitamin C
Vitamin A Anti Cancer
Carotenoids,
Vitamin C,
Manganese and
Selenium (SOD)
Copper, nasunin,
Lycopene
Anthocyanins
Polyphenols/Lignans
Vitamin C
Lycopene
Vitamin K, Folate,
antioxidants
Sulforaphanes
Zeaxanthin, polyphenols,
Potassium, floride, iron,
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Men Women
Fruits Veg
CDC MMWR 59(35);2010.
% OF ADULTS ACHIEVING THE RECOMMENDED DIETARY
INTAKES OF FRUITS AND VEGETABLES
Diet/Nutrients
Physical Activity
Stress Response
Sleep
Environmental Factors
Community and Purpose
ADAPTED FROM THE ORIGINAL PRESCRIPTION BY THOMAS GUILLIAMS
PHD
HEALTH
WHY IS EXERCISE IMPORTANT?
80% of all chronic illness is
related to lifestyle behaviors
SITTING VERSUS EVERYTHING ELSE
• Sleeping 48 calories
• Sitting 55 calories
• Standing 65 calories
• Walking 138 calories
• Cooking 138 calories
• Sex 221 calories
• Jogging 524 calories
• Based on 60 minutes of activity in a woman (5’5, 115 lbs)
I-Min Lee et. al. Lancet Vol 380 July 21, 2012
Inactivity causes 9% (range 5.1–12.5)
of premature mortality, or more than 5.3 million of the 57 million
deaths that occurred worldwide in 2008.
If inactivity were not eliminated, but decreased instead by 10% or 25%,
more than 533 000 and more than 1.3 million deaths, respectively, could
be averted every year. We estimated that elimination of physical
inactivity would increase the life expectancy of the world’s population
by 0.68 (range 0.41–0.95) years
Effect of physical inactivity on major non-communicable
diseases worldwide: an analysis of burden of disease
and life expectancy
Copyright © The American College of Cardiology.
All rights reserved.
From: Low-Risk Diet and Lifestyle Habits in the Primary Prevention of Myocardial Infarction in Men: A
Population-Based Prospective Cohort Study
J Am Coll Cardiol. 2014;64(13):1299-1306. doi:10.1016/j.jacc.2014.06.1190
The combination of healthy behaviors (found in only 1%) could prevent 79% of MI
events on the basis of the study population
Photo credit: Flicker.com/photos/compfight
What is mindfulness?
The skill of being deliberately attentive to one’s
experience as it unfolds-without the superimposition of
our usual commentary and conceptualizing.
*Practicing Mindfulness: An Introduction to Meditation
Professor Mark W. Muesse
Rhodes College
Photo Credit: <a href="https://www.flickr.com/photos/70140013@N07/7416282758/">ShotHotspot.com</a> via <a href="http://compfight.com">Compfight</a> <a href="https://creativecommons.org/licenses/by/2.0/">cc</a>
November
2014
Scientific American
November 2014
Conclusion: There is emerging evidence that certain areas of the brain actually grow more connections in those who meditate compared to those who do not.
HEALTHY LIFESTYLES ARE ASSOCIATED WITH HIGHER NATURAL KILLER CELL ACTIVITY
• Kusaka et al.
• Looked at: smoking, alcohol, sleep, exercise, breakfast, balanced nutrition, hours of work, and mental stress
• Conclusion: Higher NK activity with healthy lifestyle practices may reflect an increase in the cytolytic potential of NK cell activity within the CD16 and CD57 subset
• CD16-Fc receptor of IgG Ab activates Ab dependent cell mediated toxicity
• CD57-distinct mature NK cell=more potent lytic activity
Preventive medicine: volume 21, issue 5, september1992, pages 602-615
GREATEST DISCOVERY OF OUR TIME
The new science of epigenetics reveals how the choices you make can change your genes …
by John Cloud
NUTRIGENOMICS
• How nutrients in your diet affect the expression of your genes
FOOD CHOICES AFFECT YOUR LIFE
DNA METHYLATION• One way to control gene expression
METHYLATION REVIEW
• Addition of CH3 (methyl) group to DNA/RNA, neurotransmitters, hormones, immune cells, nerves, environmental toxins
• This modification in DNA alters gene expression
• Methylation of DNA helps to “lock” genes in an off position
• Methylation cycle involved with: detoxification, immune function, Maintaining DNA, energy production, mood balancing, controlling inflammation
• Basic nutrients needed: B12, glycine, serine, B6, selenium, cysteine, methionine and folic acid
HOW FOODS INTERACT WITH YOUR DNA
FOODS AND HABITS THAT DEPLETE METHYLATION
• Tobacco
• Caffeine
• Alcohol
• Sugar
• Processed and canned foods
• Animal protein increases homocysteine
• Saturated fats
• Metal toxicity
WHAT CAN LIFESTYLE CHANGE?
• Reduce and reverse coronary disease
• Reduce prostate cancer: Ornish D et al. Journal of Urology. 2005;174:1065
• Affects gene expression in a short time
• Down regulate different oncogenes that promote prostate and breast cancer
• Decrease aging process through telomeres
Conclusions.— More regression of coronary atherosclerosis
occurred after 5 years than after 1 year in the experimental
group. In contrast, in the control group, coronary
atherosclerosis continued to progress and more than twice as
many cardiac events occurred.
DIABETES
• 29.1 million people or 9.3% of the population
• Cost in 2014 is $245 billion
• 43% hospital inpatient care
• Costs expected to rise exponentially
• Lifestyle trumps medications:
• NEJM 2002;346:393-403
DIETS HIGH IN ANIMAL PROTEINS
• 75% increase mortality
• 400% increase in cancer risk
• 500% increase in diabetes
• Higher levels of IGF-1 (some cancers grow more easily)
Levine ME et al. Cell Metabolism 19, 407-417, March 2014
Winter 2014
Food is information for our genes.
Bland, J. What role has nutrition been playing in our health?
The xenohormesis connection. Integrative Medicine 6(3);
Jun/Jul 2007.
Surh Y-J, (2003) Nature Reviews Cancer. 2003;3:768-780.
Bioactive
Phytochemicals
• Indole-3 carbinol
reduced
cervical
neoplasia in
women
• Other foods
containing
isoflavones may
improve
outcomes as
well
EFFECTS OF HERBS AND SPICES
• Healing properties
• Anti-inflammatory
• Antioxidants
• Antimicrobial
• Antifungal
• Aid in digestion
• Ginger
• Peppermint
• Turmeric
• Black pepper
The Atlantic
March 24, 2014
Adherence to a
Mediterranean diet and
healthful lifestyle is
associated with a more
than 50% lower rate of all-
cause mortality and cause-
specific mortality.
CONCLUSION OF ALL DIETS REVIEWED
“A diet of minimally processed foods close to nature,
predominately plants, is decisively associated with health
promotion and disease prevention”
Katz and Meller. Annu Rev. Public Health 2014. 35:83-103
INHIBITORS
Busy Practice OBAMACARE AND REGULATIONS
Meaningful Use
Requirements Time
Training/Education
Limited Referral Sources
Treatments:MedicalSurgical, Alternative
Disease/Illness
Toxic exposures
Lifestyle behaviors
Fitness
Nutrition
Avoid
This
By
Improving
This
SUMMARY
• Only able to scratch the surface
• Obesity can cause many chronic diseases-PREVENTABLE
• Inactivity can cause many chronic diseases-PREVENTABLE
• We need to rethink our definition of health
• We need to emphasize nutrition as a health habit
• Empower patients to help themselves
THANK YOU
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