This ppt covers the role of diet in various diseases and the effects of excessive stress and gives an overview of the optimal diet in various non-communicable diseases. Dr B Ravinder Reddy Care Hospital, Hyderabad, India

1. Dr B Ravinder Reddy MBBS, MS, FRCS (Edinburgh), FRCS (Glasgow) Consultant Gastrointestinal & General Surgeon Chief – Division of Clinical Nutrition Care Hospitals Hyderabad bravinderreddy@doctor.com

2. Dept. of Surgical Gastroenterology & Division of Clinical Nutrition Greetings From Care Hospital, Hyderabad www.carehospitals.com

3. Diet & Disease Nutrition is of interest to Everyone! Impoverished Scientists Community Worker Over Nourished Under Nourished Pts Food Industry (FF&N) Aesthetic & Cosmesis Clinicians & Nutritionists

4. 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

5. Diabesity

6. Front Cover

7. 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

8. Diet Will Not Keep The Stress Away!

9. Diet Helps To CopeWith Stress = + Lifestyle Dietary Factors

10. Diet & Disease A wrong diet can be a major cofactor in causing various diseases and aggravating the various stressors!

11. Diet & Disease After eating a calorie dense diet ↑Saturated Fats ↑ Refined CH ↑ Fibre Is Very Common!

12. Stress, Diet & Disease This diet is associated with Hyperglycemia Hypertriglyceridemia Increase in free radicals (pro-oxidant state) Increase in cytokines (pro-inflammatory state)

13. Stress, Diet & Disease This in turn is associated with: Endothelial dysfunction Increase in free radicals Increase in inflammation

14. Stress & Wrong Diet Insulin Resistance Inflammation  ROS, TNF, IL6, IL18 Obesity Visceral Metabolic Syndrome Type 2 Diabetes Atherosclerosis

15. Stress, Diet & Disease High Fat, Refined Carbohydrate Diet Insulin Resistance / Hyperinsulinemia

16. Diet & Disease High Fat, Refined Carbohydrate Diet Blood Insulin Resistance / Hyperinsulinemia   IGF  Free IGF  Testosterone  Estradiol  Estradiol

17. Diet & Disease High Fat, Refined Carbohydrate Diet Blood Insulin Resistance / Hyperinsulinemia   IGF  Free IGF  Testosterone  Estradiol  Estradiol Tumor Promotion

18. Correct Diet & Stress Management Can Prevent: Metabolic Syndrome Diabetes Mellitus Cardiovascular Disease Cancer Obesity Dyslipidemia

19. Diet & Disease: Preventive Diabetes Mellitus: 91% reduction* Cardiovascular Disease: 83% reduction* Cancer: 71% reduction (colon cancer)*

20. Stress, Diet & Disease: Therapeutic Roles Acute illness (critically ill, pancreatitis, MOF) Chronic diseases (MS, DM, HBP, CVD,) Inflammatory bowel diseases (UC & CD) Irritable bowel syndrome Autoimmune diseases Congenital & metabolic diseases (lactose intolerance, cystic fibrosis etc) HIV

21. Stress, Diet & Disease Can Appropriate Diet Prevent or Treat All Diseases? NO!

22. Diet & Disease A select few types of diets have shown to be effective as per their respective claim* *By scientific investigations & clinical trails

23. Diet & Disease Fibre (25 – 50 gms) Reduces Cardiovascular Diseases* Reduces LDL Cholesterol Provides SCFA Avoids Constipation *The first health claim allowed by US Government FDA, US Department of Health and Human Services FDA proposes health claim for oatmeal & oat bran. Jan 11, 1999

24. Diet & Disease Soy Protein(35 – 45 gms) Reduces Cardiovascular Diseases* Reduces LDL Cholesterol & Triglycerides Antioxidant, Antiproliferative, Antimigratory Reduces Atherosclerosis Phytoestrogens *Due to its amino acid profile which differs from animal protein FDA, US Department of Health and Human Services FDA proposes health claim for soy protein & hear disease. Oct 26, 1999

25. Diet & Disease Omega - 3 Fatty Acids 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

26. Diet & Disease Omega - 3 Fatty Acids Reduces inflammation by inhibiting cytokines Inhibits mitogens Inhibits thrombosis Inhibits antherosclerosis Reduces TG Increases NO production Is beneficial in autoimmune diseases, IBD, RA Forms important aspect of nervous system 1 to 2 gms

27. Diet & Disease Without Omega - 3 Fatty Acids

28. Diet & Disease Omega - 3 Fatty Acids Connor WE. Importance of n-3 fatty acids in health & disease. Am J Clin Nutr 2000;71

29. Diet & Disease Synbiotics 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

30. Diet & Disease Synbiotics Immunity of the gut largely depends on type of micro-organisms Alter the gut bacterial colonies Reduce permeability of harmful micro-organisms

31. Diet & Disease Synbiotics Strengthen intestinal immunity through IgA & inflammatory responses Decrease levels of enzymes, mutagens & 20 bile salts, thereby reducing the incidence of colon cancer

32. Diet & Disease Synbiotics 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

33. Diet & Disease Synbiotics 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 *SCFA, Short Bioactive Peptides (cleaved from milk & other proteins)

34. Alcohol

35. Alcohol Beneficial effects within 2 weeks! “Moderate alcohol”: Men - 2 drinks per day Women – 1 drink per day

36. Alcohol One Drink?

37. Alcohol “One Drink*” *1 ounce = 30 mls 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.

38. 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

39. Nutrigenomics “Personalised Nutrition” 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

40. Nutrigenomics “Personalised Nutrition” 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!

41. Till nutrigenomics is available…

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

43. Physical Activity, High Fibre, Low Fat Stress Reduction Methods

44. Diet & Disease 9 to 11 servings per day 25 gms dietary fibre Substituting soy for animal protein

45. Diet & Disease Fish 2 times a week Nuts 1 ounce / day Moderate alcohol 1-2 drinks / day Regular Physical Activity Lifestyle Changes

46. Stress, Diet & DiseaseStress Reduction Methods

47. Only Medicines Without Nutrition & Stress Reduction

48. “Futulis” Attempt of Danaides We Will Also Be Confronted With Such Futile Situations

49. “Futulis” Attempt of Danaides If We Do Not Control Our Stress & Supplement Our Diet With Correct Nutrients!

50. Stress Is the price we pay for becoming more civilised and sophisticated!! It is inevitable!!

51. PrescriptionsLifestyle, Stress ↓ & Diet

52. References www.teachhealth.com www.residentassistant.com

53. Many Many Thanks ? bravinderreddy@doctor.com