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1/14/09
Nutrition 2 (exam1)
Clinical Nutrition
Why? Who? How?
-Philosophical considerations for nutrition practice
The Scourge of Chronic Illnesses
Seventy million American suffer from arthritis—or one in every three adults. That’s twice as many arthritis sufferers as there were twenty years ago.
More than 20 million Americans have asthma today. It is the sixth most common chronic disease.
More than 50 million Americans suffer every year from allergies, a number that has doubled in the past two decades.
There has been a 100 percent increase in the prevalence of hay fever in developed countries in each of the last three decades. Allergic dermatitis affects us at triple the rate in 1960. Ten percent of young children are affected by allergic dermatitis.
There were 18.2 million people in the United States with diabetes in 2002, almost a 50 percent increase from a decade ago--contributing to about two hundred thousand deaths in the United States each year.
Cardiovascular disease is the number one killer of Americans. Almost 64 million Americans have it in some form, and it killed close to a million people in 2001.
Eczema is the most common skin condition in children under eleven;
an estimated 15 million Americans have inflammatory bowel disease.
Almost one in two Americans(150 million) suffer from an inflammatory disease.
Source: Inflammation Nation, Floyd Chilton
Chronic Diseases: Cause Unknown
How many of you think that there is a major health care crisis in the US today? For some reason unknown to the medical industry that there are so many of us decided to get all kinds of chronic illnesses these last twenty years or so. All they have to offer is symptomatic relief that comes with side effects that are worse than the problems in the first place.
The Cause of Chronic Illnesses
A major driving force of these diseases is our diet—the “toxic-waste spill”--leads to chronic inflammation
The food industry is worth $1.4 trillion and we spent 1.6 trillion dollars in 2003 in “health” care
Who is at risk? Every single one of us!
There are no safe medical interventions or surgical procedures that will save us. The only way out is a fundamental change in the way we produce, deliver and consume our food.
Diabetes Out of Control
1/3 US , ½ Hispanic children born since 2000 is expected to have diabetes
It is fastest growing disease in the US, China, Japan and India
Expected to grow from 20 million today to 50 million in 2025 in the US
50% of children Dx with diabetes today is type 2, age as young as 7
It causes more suffering and disability than heart disease and cancer and cost more to treat
It is considered a health time bomb that threaten to destroy our economy
1/16/09
Nutritional Deficiency is Common
It is estimated that our hunter-gatherer ancestors consumed about 7,778-11,083 mg/day of potassium.
We are consumming 75% less today
On average, we consume about 2500 mg of K per day
RDA for K is 3500 mg/day
BMJ 2001;323:497-501
Potassium Deficiency
Increased risk of high blood pressure and stroke
Increased risk of diabetes, fatigue, muscle weakness and heart conditions
Increased PGE-2 and inflammation
In severe cases, rhabdomyolysis
Magnesium Deficiency
Minerals work together
Mg depletion affects K homeostasis—hypokalemia
Kidney fails to conserve K during Mg deficiency
Both minerals are severely lacking in our overly processed diet
Fruits, vegetables, nuts, seeds and healthy animal protein and dairy
Vitamin D Deficiency
-rickets (children)
-osteomalacia (adults)
-elevated serum PTH
-decr serum phosphorus
-elevated serum alkaline phosphatase
-osteoporosis
-epidemiological evidence of increased risk of colon, breast, and prostate cancer
-increase rate of autoimmune, CV, endocrine problems
Micronutrient Deficiency
Linked to DNA damage, cancer risk
Depressed immune system
Impaired cognitive and mental functions
Free-radical damages
Developmental defacts
Semin Arthritis Rheum 1997;27:180-85
Mutat Res 2001 Apr 18;475(1-2):7-20
Int J Vitam Res 1995;65(2):117-21
Nutrition 2001;17(9):709-12
Toxical Enviorn Health 2001;63(8):583-98
Pottenger’s Cat Study
Diet can alter body physiology
Improper diet can lead to physical degeneration that negative traits can pass onto the next generations
These effects are cumulative upon the next generation unless the natural diet is restored
Altering both physical and emotional wellbeing
Culminate in infertility--extinction
We have drifted into this deplorable position of national Malnutrition quite inadvertently. …It is the result of scientific research with the objective of Finding the best way to create foods that are non-perishable, that can be made by mass production methods in central factories, …and distributed so cheaply that they can sweep all local competition from the market… Then, after there develops a suspicion that these “foods” are inadequate to support life, modern advertising steps in to propagandize the people into believing that there is nothing wrong with them. That they are products of scientific research…intended to afford a food that is the last word in nutritive value …and the confused public is totally unable to arrive at any conclusion of fact, …and continues to blindly buy the rubbish that is killing them Years ahead of their time.
--Royal Lee, DDS, June 1943
A Wonder bread culture
With the advent of industrialized roller milling and mass refining of grains in about 1880, worldwide epidemics of pellagra and beriberi began because of loss of B vitamins during processing of grain to remove the bran and the germ for longer shelf life. -Am J Clin nutr 2003;78(suppl):508S-13S.
-The grain passes through more than forty processes before it emerges as flour and bran.
Sifters consist of a dozen large sieves, one below the other-just like the floors of a tall building. The top sieve has the coarsest mesh, the next not quite so coarse, and so on. These sieves are all made to swing briskly by machinery - in fact they swing continuously with a motion very like that of the ordinary sieve at home. The broken wheat comes first onto the top sieve, and then through the others in turn, each sieve helping to separate the material.
Purifiers not only separate the broken parts of the wheat by sieving, that is, according to size, but it also separate those parts which are of the same size but of different weight. This is done by using currents of air. The skins are much lighter in weight than the inner white floury parts, and a current of air is drawn upwards through the mixture on the sieve, lifting up and 'floating' the skins, but allowing the heavier white parts to remain on the sieve and be separated by the sieving motion.
A “WONDER BREAD” CULTURE OF INSTITUTIONALIZED SUPPLEMENTATION
In 1937 scientists showed that nicotinic acid was the specific micronutrient deficiency for pellagra and thiamine for beriberi.
These discoveries were so fundamental and startling that some believed that little remained to be investigated in the field of nutrition. One obvious solution, protecting health and satisfying the needs of industry, was to re-supply the deficient nutrients. There seemed to be no need to modify food production, because the only problem was a shortage of a few important vitamins.
The net result of all these forces was over-reliance on several nutrients and food enrichment, what might be called a "Wonder Bread" culture of institutionalized supplementation.
It is now clear that today’s chronic diseases, such as atherosclerosis, ischemic heart disease, and cancers, are complex diseases with multiple etiologies and not simple deficiency diseases. For example, findings of the strongly reduced risk of ischemic heart disease, diabetes, and some cancers among habitual consumers of whole-grain foods support the idea that food synergies play an important role in chronic disease prevention. Nevertheless, the over-processing of grains and other foods has worsened since the early 1900s....”
-Am J Clin nutr 2003;78(suppl):508S-13S.
Pasteurization of Milk
The Lancet, page 1142, May 8, 1937 states that resistance to tuberculosis increased in children fed raw milk instead of pasteurized to the point that, in five years, only one case of pulmonary TB had developed, whereas in the previous five years, when children had been given pasteurized milk, 14 cases of pulmonary TB had developed.
The Lancet, page 1142, May 8, 1937 says that in children the teeth are less likely to decay on diet supplemented with raw milk than with pasteurized milk.
-Vitamin News, by Dr. Royal Lee, DDS, ifnh.org
“…the response in height to raw milk was significantly greater than that to pasteurized milk. Their interpretation of the data led to the assertion that the pasteurized milk was only 66 percent as effective as the raw milk in the case of boys and 91.1 percent as effective in the case of girls in inducing increases in weight, and 50 percent as effective in boys and 70 percent in girls in bringing about height increases.” Milk protein is destroyed by heat. Therefore milk calcium cannot be assimilated.
-Krauss, W.E, Erb, J.H. and Washburn, R.G., Studies on the Nutritive Value of Milk. Ohio Agricultural Experiment Station Bulletin 518, page 7, January 1933
-Soil to Supplements, op.cit.
Standard American Diet
80% processed refined carbohydrate foods
Commercial factory farm meats
Chemical farming
Genetically Modified Organism
Fast-super-sized foods
30% calories come from sugar
Man-made fat instead of traditional fats
GM Soy Kills Rats
55.6% Mortality in Rats Whose MothersWere Fed GM Soy
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Why nutrition?
Chiropractors are in a responsible position to make a fundamental difference in people’s lives
Clinical experience, epidemiological data and research support the need to change the ways we eat to halt the growth of chronic illness and suffering
More teachers are needed
To improve treatment outcome
Mission Control
The ongoing discovery of how we express our gifts to add life enriching value to the world.
Nutrition and dietary counseling is an added value in our practice and patient’s treatment outcome
Disease is a dynamic event in the life of an individual. Determined by disharmonies, imbalances, and pernicious influences. The goal of diagnosis is not to identify the disease entity, which has no independent reality, but to characterize the disharmonies of the particular case, so that they can be corrected.
--Leo Galland, MD
Cookbook Vs. Patient-Centered
Symptoms relief
Removing the causes
Functional Health Care
Functional Healthcare
Health oriented
Patient oriented
Biochemical individuality
Cost effective
Holistic
Look for true cause
High touch high tech
True prevention
The Nutrition Care Process
Assess nutrition status
Analyze assessment data to determine nutrient requirements
Develop a plan of action for meeting nutrition needs, include education
Implement the care plan
Evaluate the effectiveness of care plan through ongoing assessment and make changes as needed.
Total Load
Food allergies
Mold allergies
Structural lesion
Intestinal pathogens
Leaky gut
Compromised detox
Environmental toxins
Hormone imbalance
Polypharmacy
Nutritional deficiencies
Repressed emotion
Functional disturbance and physical symptoms
The Health Detective
Get the whole picture
Elucidate the underlying causes by first line and second line testing
Respect biochemical individuality
Focus on restoring normal functions
Cause no harm to the patient
Critical Questions
What is the patient’s full story?
Where does the symptoms come from?
What does the symptoms mean?
What keep the condition going?
What is the major point of leverage?
The Functional Health Care Workup
Chief complaint
History of present illness OPQRST
Past medical history
Review of organ systems
Family history
Dietary history
Medication and dietary supplement history
Social, lifestyle and exercise habits
Physical exam
Lab findings
Radiology
Assessment and diagnosis
Fundamental clinical imbalances that underlie the diagnosis
Who should I teach?
Everyone is affected by the modern deficient diet and polluted environment.
Patients with chronic pain
Trauma, acute injuries
Young athletes
Children with learning problems, allergies
Women in all stages of life
Man in all stages of life
Students under loads of stress
We all need help in eating better
How to practice nutrition?
Technique: AK (CRA, MRT, Lebowitz’s Protocol), CMRT, BEST (pH balance), evidence based (Janet Lang, Datis Kharrazian)
Philosophical: Weston A. Price Whole Food, Natural Hygiene, Macrobiotic, Vegan, lacto oval vegetarianism
Macronutrients: Atkin’s, SouthBeach, Protein Power, USDA Food Guide, Zone
Biochemical: using lab tests, symptoms surveys, and physical exam to guide and replace deficient nutrients, pH/acid-base balancing
Supplements: mega-dose isolated, whole-food extracts, herbs, homeopathic, flower remedies
What do I do?
Start somewhere
Using some supplements
Experiment with different natural, organic foods
Try a diet
Detox program
Nutrition classes and seminars
Learn about special lab tests
Saliva test, hair analysis, functional tests
Dangerous Rx, FDA Inaction
Rosiglitazone is taken by about seven million people worldwide and brings in sales of more than $3 billion for GlaxoSmithKline. Analysts have warned that these new safety concerns could cut sales by 50%, and shares in GlaxoSmithKline have plummeted
Was the NEJM right to publish?
FDA: No action recommended at this time
Nutrition Assessment
History
Physical exam
Symptoms surveys: paper or computer
pH: saliva, urine
Lab tests
Blood, Urine, stool, Hair Analysis, Saliva
AK
Others
Nutrition Companies
Standard Process
Thorne Research
Biotic Research
Design For Health
Apex Energetics
Orthomolecular
Nordic Natural fish oils
Premier Research Labs
Healthforce Nutritionals
Pure Encapsulations
Tropical Tradition Coconut oil
Many others, call and get info, catalogs, sponsored seminars, newsletter, freebies
Discount for Chiropractic students
Websites
Great Smokies:
health section
Diet For Optimal Health
1/20/09
Nutrition and health among people on traditional diets in the 1930s
14 human groups
From isolated Irish and Swiss, to Eskimos and Africans
Almost every member enjoyed superb health
Free of chronic diseases
Free of dental decay
Free of mental illness
Strong, sturdy and attractive
Produced healthy children with ease
”Civilized” humans in comparison groups
Members of the same racial/ethnic groups who had become ”civilized” who ate the food products of commerce:
Refined grains
Canned foods
Pasturized milk
Sugar
Infectious disease
Degenerative illness
Infertility
Tooth decay
Children with
Crowded an crooked teeth
Narrow faces
Deformities of bone structure
Susceptibility to many medical problems
Malnutrition affects all human groups in similar ways
Historical experience of indigenous/traditional peoples
No cancer, cardiovascular diseases, type 2 diabetes or dental caries
Independent observations of anthropologists, physicians, missionaries, explorers, etc.
E.g. !Kung San people in the Kalahari desert
Chronic diseases appear as soon as such humans change environment and lifestyle, particularly diet
Characteristics of Traditional Diets
1. The diet of healthy, nonindustrialized peoples contain no refined or denatured foods such as refined sugar or corn syrup; white flour; canned foods; pasteurized, homogenized, skim or low fat milk; refined or hydrogenated vegetable oils, protein powders; artificial vitamins; or toxic additives and colorings
Modern American Diet
The fattest nation on earth
64.5% of Americans are overweight or obese. Source: JAMA, 2002;28:1723-1727
Obesity is now the number 1 preventable cause of death in the US. Source: JAMA, 1996;276:1907-1950
“Low fat” foods often high in sugar and low in nutrients
Convenience foods usually high in refined carbs, highly processed, and super-size portions
Trans fats are found in most processed foods and may disrupt fat and cholesterol metabolism.
80% supermarket offerings are carbohydrate foods, Increased carbs lead to:
Increased blood glucose and insulin output
Decreased glucose and increased food cravings, especially more carbs and sweets
Excessive calories lead to fat storage and obesity
Fortunately there seems to be a reverse of this trend due to the success of Atkin’s and other high protein diets.
2. All traditional cultures consume some sort of animal food, such as fish and other seafood; land and water fowl; land and sea mammals; eggs; milk and milk products; reptiles; and insects. The whole animals is consumed—muscle, organs, bone and fat.
The Importance of Meat
Two important parts of human evolution
The progressive incorporation of more meat into the early human diet
Going from scavenging to hunting
Meat provides easy access to the full complement of nutrients our body needs
More closely adapted to a meat based than a plant based diet
3. The diets of healthy, indigenous peoples contained at least four times the calcium and other minerals and ten times the fat-soluble vitamins found in animal fats (vitamin A, vitamin D and activator X) as the average American diet.
Modern American Diet
Low-fat diet consists of processed low-fat food.
Avoid sunshine lead to lack of vitamin D synthesis
Avoid animal fat—the only source of vitamin A and vitamin D
Wide-spread deficiency of fat-soluble nutrients
Protein deficiency
Mineral deficiency
4. In all traditional cultures, some animal foods are eaten raw:
Meats and organ tissues
Seafood
Dairy products
Eggs
5. Primitive and traditional diets have a high food enzyme content from raw dairy products, raw meat and fish, raw honey; tropical fruits; cold-pressed oils; wine and un-pasteurized beer; and naturally preserved, lacto-fermented vegetables, fruits, beverages, diary products, meats, and condiments.
6. Seeds, grains and nuts are soaked, sprouted, fermented or naturally leavened to neutralize naturally occurring anti-nutrients such as enzyme inhibitors, tannins and phytic-acid.