Integrative Medicine at The Ohio State University at the Center for Integrative Medicine

Glen Aukerman, MD Medical Director The Ohio State University Center for Integrative Medicine (614) 293-9777

Research on CAM Usage Reveals Increased Consumer Demand for New Healthcare Options The medical community has become focused upon the rapidly growing phenomenon of consumers seeking alternative medical care outside their traditional physicians and specialists since the Eisenberg studies in 1990/1997 • • • •

74.6% of the population in the United States has used some form of CAM (complementary/alternative medicine) People more likely to use CAM if have a life-threatening illness, such as cancer or HIV. Studies suggest that some consumers are dissatisfied with allopathic medicine Many consumers prefer medical interventions that mirror their beliefs & value systems, want to be more involved with medical decision-making, have had a transformational life experience, and/or are more likely to suffer serious, chronic, and/or complex illnesses.

CDC Advance Data 2004, NCCAM data 2004, Eisenberg 1990, 1997

Past, Present, Future In the Past, Complementary/Alternative Medicine (CAM) • Was used as alternative to traditional western medicine – Patients seeking CAM were often required to 1. Exit the traditional healthcare system and engage CAM practitioners in storefront offices, homes, health-food stores, or 2. Start CAM modalities in conjunction with traditional medicine but without the physician’s knowledge or oversight, and 3. Communication/Collaboration between alternative providers did not occur Future began March 2005, The Ohio State University Center for Integrative Medicine • Standards emerge for training Integrative Medicine physicians with CAM modalities • Integrative Medicine programs grow and evolve as integral to their healthcare systems • Personalized Medicine is a strong initiative in the healthcare community. – – –

Integrative Medicine is the primary version of personalized medicine Research is increasing in this area, yielding better understanding of the underlying mechanism in Integrative modalities. Advances in genetic and genomic medicine are validating nutritional approaches being used at The Ohio State University Center for Integrative Medicine

10 Most Common Natural Products Used by Our Patients in 2007 http://nccam.nih.gov/news/graphics.htm

Conditions for Which Patients Frequently Used CAM -2007 http://nccam.nih.gov/news/graphics.htm

Statistics on CAM (complementary/alternative medicine) Use http://nccam.nih.gov/news/graphics.htm

Most Frequent Conditions Treated at CIM Conditions Integrative Medicine typically helps: • • • • • • • • • • • • • • • • • • •

Cancer adjunct complementary therapies Chronic Fatigue Insomnia Chronic pain Headaches Fibromyalgia Joint pain, arthritis Body sensation disturbances Tingling, numbness, tremors, tick, weakness Dizziness Tinnitis Cardiovascular, hypertension, cholesterol Diabetes Thyroid disorders Colitis, celiac disease, ulcers Weight concerns Mental health, mood Neurological problems, MS, Parkinsons Disease Immune function

The OSU Center for Integrative Medicine Definition of Integrative Medicine Integrative Medicine incorporates the art and science of caring for the whole person – body, mind and spirit—to treat and prevent disease, encouraging patients to create a condition of optimal health. The integrative approach enhances traditional medicine and technology with additional resources including: nutrigenomics, whole medical systems, mind-body medicine, biologically based practices, manipulative and body-based practices, and energy medicine.

Integrative Medicine on the Spectrum of Personalized Health Care Values

Culture

Environment

Phenotype Genotype Personalized Care Delivery

Integrative Medicine Personalized Medicine Behavioral Medicine Palliative Medicine Pharmacogenomics

Treating the Whole Person

Perspectives on Integrative Medicine CIM is NOT Alternative Medicine or Integrative CAM The National Institutes of Health (NIH) have categorized Complementary and Alternative Medicine (CAM) under five domains. At the OSU Center for Integrative Medicine only evidence-based CAM services are offered and are integrated with a foundation in Integrative Family Medicine, Internal Medicine, and Pediatrics: • • • • •

Whole Medical Systems Mind-Body Medicine Biologically-Based Practices Manipulative and Body-Based Practices Energy Medicine

Whole Medical Systems Whole medical systems are complete systems of theory and practice evolving independently from / parallel to allopathic (conventional) medicine, practiced by individual cultures throughout world as their traditional system of medicine

• Eastern whole medical systems include – (TCM) Traditional Chinese medicine (China), based on the concept that disease results from disruption in the flow of qi and imbalance in the forces of yin and yang. • Includes herbs, meditation, massage, and acupuncture to aid healing by restoring the yinyang balance and the flow of qi.

– Ayurvedic medicine (India) integrates body, mind and spirit to prevent, treat disease • Includes diet, lifestyle modifications, herbs, meditation, breathing exercises, detoxification, massage, and yoga

• Western whole medical systems include – Homeopathy originated in Europe, seeks to stimulate the body's ability to heal itself by giving very small doses of highly diluted substances that in larger doses would produce illness or symptoms (an approach called "like cures like"). – Naturopathy originated in Europe, aims to support the body's ability to heal itself through use of dietary and lifestyle changes with herbs, massage, joint manipulation.. – Other systems by Native American, African, Middle Eastern, Tibetan, Central and South American cultures. – NIH http://nccam.nih.gov/health/backgrounds/wholemed.htm –

http://clinicaltrials.gov/search/term=(NCCAM)+%5BSPONSOR%5D+(traditional+chinese+medicine)+%5BTREATMENT%5D?recruiting=false

Mind-Body Medicine Mind-body medicine focuses on the interactions among the brain, mind, body, and behavior, and powerful ways in which emotional, mental, social, spiritual, and behavioral factors can directly affect health, an approach that respects and enhances each person's capacity for self knowledge and self-care, such as; – Relaxation, – Hypnosis, – Visual imagery, – Meditation, conscious mental process using certain techniques – Yoga (Ayurvedic) combines breathing exercises, physical postures, and meditation – Biofeedback, use of electronic devices to help people learn to control body functions that are normally unconscious (such as breathing or heart rate) to promote relaxation and improve health.

– Tai chi, Qi gong, component of traditional Chinese medicine that combines movement, meditation, and controlled breathing to improve blood flow and flow of qi. – Cognitive-behavioral therapies, group support, autogenic training, and spirituality, individual's sense of purpose and meaning of life beyond material values, practiced in many ways, such as through religion

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NIH http://nccam.nih.gov/health/backgrounds/mindbody.htm

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http://clinicaltrials.gov/search/term=(NCCAM)+%5BSPONSOR%5D+(guided+imagery)+%5BTREATMENT%5D?recruiting=false http://clinicaltrials.gov/search/term=(NCCAM)+%5BSPONSOR%5D+(art+therapy)+%5BTREATMENT%5D?recruiting=false http://clinicaltrials.gov/search/term=(NCCAM)+%5BSPONSOR%5D+(yoga)+%5BTREATMENT%5D?recruiting=false

Biologically-Based Practices Biologically-based Practices is botanicals, vitamins, minerals, fatty

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acids, amino acids, proteins, prebiotics, probiotics found in foods (yogurt) or in dietary supplements, whole diets, animal-based extracts and functional foods. Natural Medicines Comprehensive Database at naturaldatabase.com NIH Web sites include nccam.nih.gov/health, ods.od.nih.gov, and cancer.gov/cam. Nutrition Labeling and Education Act of 1990 (NLEA) health claims for foods / dietary supplements vm.cfsan.fda.gov/~dms/ssaguide.html#foot1 Harvard-based www.naturalstandard.com Aetna’s CAM http://www.intelihealth.com/IH/ihtIH/WSIHW000/8513/8513.html?k=navx408x8513 NIH http://nccam.nih.gov/health/backgrounds/biobasedprac.htm Clinical trials accessed at http://nccam.nih.gov/clinicaltrials/alltrials.htm OSU Glasers http://www.stressandhealth.org/ Oregon Health and Sciences MS Alzheimer http://www.ohsu.edu/cam/for_docs/neuro.html University of Medicine Dentistry NJ, Autism http://clinicaltrials.gov/show/NCT00467818

Manipulative Body-Based Practices Chiropractic / Osteopathic Manipulation and Massage – Combined with physical therapy, instruction in proper posture, massage therapy, Tui Na, reflexology, rolfing, Bowen technique, Trager bodywork, Alexander technique, Feldenkrais method, etc. – ~ 16 % of US adults receive chiropractic manipulation in a given year – ~ 14 % of US adults receive massage therapy in a given year • Pressing, rubbing, and moving muscles and other soft tissues of the body, primarily by using the hands and fingers to increase the flow of blood and oxygen to the massaged area.

– U.S. adults in 1997 made an estimated: • 192 million visits to chiropractors • 114 million visits to massage therapists

– 50 percent of all visits to CAM practitioners = Chiro and LMT combined • Remaining manipulative and body-based practices are estimated to collectively be used by less than 7 percent of the adult population

– NIH http://nccam.nih.gov/health/backgrounds/manipulative.htm – http://clinicaltrials.gov/search/term=(NCCAM)+%5BSPONSOR%5D+(chiropractic+therapy)+%5BTREATMENT%5D?recruiting=false – The OSU, Your Plan for Health http://yourplanforhealth.com/treatments.html

Energy Medicine • Energy Medicine: dealing with two types of energy fields: – Veritable, which can be measured; • Mechanical vibrations (such as sound) • Electromagnetic forces, including visible light, magnetism, monochromatic radiation (such as laser beams), rays from electromagnetic spectrum, involving specific, measurable wavelengths and frequencies to treat patients.

– Putative, which have yet to be measured include: • Reiki and Johrei, both of Japanese origin • Qi gong, a Chinese practice • Healing touch, a therapist is purported to identify imbalances and correct a client's energy by passing their hands over the patient • Intercessory prayer, interceding through prayer on behalf of another – Keywords: biofield, ayurvedic medicine, magnetic therapy, homeopathy, light therapy

• http://nccam.nih.gov/health/backgrounds/energymed.htm • http://clinicaltrials.gov/search/term=(NCCAM)+%5BSPONSOR%5D+(reiki)+%5BTREATMENT%5D?recruiting=false

FQAs Being Asked by our Patients, the Consumers for a more Socially-Aware Provider •

What does « Organic » mean?

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http://www.ams.usda.gov/AMSv1.0/ams.fetchTemplateData.do?template=TemplateA&navID=National OrganicProgram&leftNav=NationalOrganicProgram&page=NOPNationalOrganicProgramHome&acct= nop

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Are artificial sweeteners safe?

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http://www.cancer.gov/cancertopics/factsheet/Risk/artificial-sweeteners Concern about hormones in Meat? http://www.ams.usda.gov/AMSv1.0/ams.fetchTemplateData.do?template=TemplateA&navID=National OrganicProgram&leftNav=NationalOrganicProgram&page=NOPNationalOrganicProgramHome&acct= nop

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Radiation and Electrical Wires?

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http://www.epa.sa.gov.au/powerlines.html http://www.who.int/docstore/peh-emf/publications/facts_press/efact/efs263.html

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Genetically-Modified Foods?

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http://www.ncbi.nlm.nih.gov/pubmed/18328408?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed. Pubmed_ResultsPanel.Pubmed_RVDocSum http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6T6P-4RTW3XD1&_user=3366836&_rdoc=1&_fmt=&_orig=search&_sort=d&view=c&_acct=C000058403&_version=1& _urlVersion=0&_userid=3366836&md5=e0e0769237bd7997220561f359723cf9

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Skin Products and Makeup http://www.cosmeticsdatabase.com/splash.php?URI=%2F%3Fgclid%3DCMTThJmpgJMCFUU2FQody nxzGQ

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BioIdentical Hormones? http://www.fda.gov/bbs/topics/NEWS/2008/NEW01772.html

Looking for Health In All The Right Places In 2010 and beyond Requires Using Gene-based Nutrition

to Achieve Optimal Health Glen Aukerman, MD Professor and Medical Director

The Ohio State University Center for Integrative Medicine

Nutrigenomics Be Happy, Healthy & Replace Live Deficiencies Long

Magnesium in Water Calcium in Waters Vitamin D (Sunlight) B-Complex Vitamins Reduce Excesses in Your Diet Trace Minerals SimpleAcidophilus Carbohydrates in Dairy (Complex Carbs/Cinnamon) Retinal Daylight Omega-6 Plant Oil Foods (Replace with Omega-3 Foods)

Reduce Dense Food Calories (By Starting with Soup and Salad)

Remove Toxic Foods in Your Diet and Environment Latex and Latex-like Proteins in 13 Foods Gluten and Gluten-like Substitutes in all Foods Soy and Soy Products in many Foods & Supplements Flax and Flax Products in many Foods & Supplements Artificial Flavorings or Coloring Agents in Foods and Supplements Artificial Sweeteners in Foods and Supplements

What’s Your Patient’s Genomic Pattern? Is Their Unique Problem; • Gluten, Flax, Soy, Food Latex • Magnesium / Calcium Deficits • Metabolic Syndrome, Thyroid • Obesity Habits or Genes • Lack of Sleep, Apnea • Omega-6 Foods • Overweight • Fatigue • Others • You • Me • ? ‘Quality of Life for the Rest of Your Life’

Food Components Bio-actively Influence Genetic and Genetic-related Events Associated With a Host of Disease Processes

Nutrigenomics Be Happy, Healthy & Replace Live Deficiencies Long

Magnesium in Water Calcium in Waters Vitamin D (Sunlight) B-Complex Vitamins Reduce Excesses in Your Diet Trace Minerals SimpleAcidophilus Carbohydrates in Dairy (Complex Carbs/Cinnamon) Retinal Daylight Omega-6 Plant Oil Foods (Replace with Omega-3 Foods)

Reduce Dense Food Calories (By Starting with Soup and Salad)

Remove Toxic Foods in Your Diet and Environment Latex and Latex-like Proteins in 13 Foods Gluten and Gluten-like Substitutes in all Foods Soy and Soy Products in many Foods & Supplements Flax and Flax Products in many Foods & Supplements Artificial Flavorings or Coloring Agents in Foods and Supplements Artificial Sweeteners in Foods and Supplements

Breast Cancer, as an Example

C 15-3 normal

Monocytes normal

CrProtein normal

Outline of Nutrigenomic Concepts - Review Basic Concepts We Apply: •

Balancing Omega 3/6 fatty acids = Eliminate Seeds, Nuts, Hummus, Poultry – –

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Gluten = Gluten-free is Best – –

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Sugar and honey ok? Glycemic index versus glycemic load (and what shows up on the label) Artificial sweeteners? Stevia? The cholesterol connection, diabetes, and your liver Why fat, fiber, and protein are your friends

Latex in 13 fruits/vegetables = Bananas, Kiwi, Avocados, Figs, and Celery – –

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Gluten free eating versus gluten-free products The other concepts still apply!! Oats, Corn, Rice, Potato Starch best

Carbohydrates- simple or complex = usually Need Cinnamon to Moderate – – – – –

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Continuum from positive balance to negative balance to off-the-charts! The monocyte % = inflammation rate = cancer growth rate = autism rate = ? rate

Which foods concerned us most? Who needs to worry the most?

Supplement and Nutrient Tips for getting started –

For new patients and their families

Because Cancer is not just Physical, holistic is good Identify other life domains impacted by cancer • • • • • • • •

Relationships- family, friends, coworkers, children- who are your support people and how do you discuss cancer with them? Spirituality/Faith- what do you believe in Your values- what is important to you Career- how will this impact your work, your treatment, achieving balance Mind-Body- how are you emotionally? Cognitively? What are your thoughts about cancer and how might they impact your experience of cancer Financial- medical expenses, income impacts, budgeting and prioritizing Sexual health and intimacy- has cancer changed your self-perception, partner’s perception, or intimate contact in your relationship? Stress- are you experiencing it? how are you handling it, how does it impact you?

Identify Resources • • • • • • • • • •

Via your oncologist’s office American Cancer Society (ACS), Ohio Chapter National Cancer Institute (NCI) Expressive arts (music, drama, dance/movement, visual arts, creative writing, journaling) Complementary therapies such as Massage Therapy, Reiki, Polarity, Reflexology, Meditation James Cancer Hospital Stephanie Spielman Fund Hopes Boutique Support Groups for patients and their family members Consider a therapist or other non-family member support

Balancing Omega-3:6 Ratio Essential for Cancer Patients Long 6 and Long 3 Compete for Storage

Individual Acid Proportions

80

Our ancestral balance of 1:1 became 30:1 of omega 6:3 • Deficit of Omega-3 in foods since 1950’s– – – – – –

Concentrated fruits/seeds/vegetables into highly concentrated oils Started incorporating veg/seed oils into foods in 1950’s Discouraged use of butter and lard in foods Encouraged Omega-6-rich margarines and shortenings

AA, long 6 40

20

EPA, long 3 0 20

Overabundance of Omega-6 in foods since 1950-

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% Long 6 in Total Long

CHD & Long 6 Proportions 200 y = 3.0291x - 74.675

USA

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R = 0.986

CHD Mortality

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Corn-feeding livestock changed Omega-3-rich foods to Omega-6-rich Grass-fed, organic, free-range ONLY IF not-corn-fed, too!!

60

150

Quebec All MRFIT quintiles

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Quebec Cree Quebec Inuit

50 0

Japan Greenland

Where it shows up: • Your disease or lack-of-health- Many of today’s diseases are being connected in part to overabundance of Omega-6 in the current diet; 20

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% Long 6 in Total Long

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such as heart disease, cancer, mental illness, inflammation, fibromyalgia, and many others

Your blood work tells the story– – – –

Monocyte count- the lab range for “normal” is 0-7% but ideally this should be closer to 3.5% with correct balance of Omega 3/6 (other temporary reductions can occur from chemo and/or steroids) ESR, platelet counts, RBC, CRP in part relate to Omega 3/6 balance Remember we store fat as Omega-6 so it takes some time to convert our fat and body tissues to a 1:1 balance so it’s important to get it balanced from today-on! Having the correct balance of Omegas is a foundation for other health conditions and labs to become normal

More on Balancing Omegas 60

AA, long 6 40

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EPA, long 3 0

KIM-2 at http://efaeducation.nih.gov- Do your homework!! Read Label- if has vegetable/nut/seed oils = very high in Omega-6 If it contains flax or soy oil/protein consider it very high in Omega-6 All poultry and farm-raised fish that eat corn are very high in Omega-6; But note organic, free-range, and grass-fed Do NOT Mean not-corn-fed! 20

30

40

50

60

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% Long 6 in Total Long CHD & Long 6 Proportions 200 y = 3.0291x - 74.675

USA

2

R = 0.986

CHD Mortality

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Long 6 and Long 3 Compete for Storage 80

Individual Acid Proportions

What to do about it: Avoiding Foods not easily balanced • Read the Making the Balance sheet- (+) versus (-) balances • If Not on Making the Balance sheet- why not (how bad is it?) • What to do if you must eat something high in Omega-6 • How to know if something is too high in Omega-6

150

Quebec All MRFIT quintiles

100

Quebec Cree Quebec Inuit

50 0

Japan Greenland

Supplements must Be Right Strength to equal Quality of Life • Make sure you have the right balance in fish oil supplements, capsules come in; 20

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% Long 6 in Total Long

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Since we store fat as Omega-6 (not Omega-3), we keep dosing to 4x/day. – – –

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Krill or Algae = 240 mg of EPA/DHA but 760 mg of omega-6 plant oil = 76% BAD Single strength = 300 mg of EPA/DHA but 700 mg of omega-6 plant oil = 70% BAD Double strength= 600 mg of EPA/DHA but 600 mg of omega-6 plant oil = 50% BAD Triple strength = 950 mg of EPA/DHA but 410 mg of omega-6 plant oil = 70% GOOD Patients with serious health conditions or serious diseases generally do better with triple strength capsules or liquid fish oils depending on patient’s condition, mono % Missing a dose ensures 25% of your daily red blood cells have Omega-6 loaded on them during that 4-6 hour window of a missed dose and will be there 120 days before balance is restored Miss 2 doses = 50% of your new cells that day are deficient in Omega-3, 50% with Omega-6 on them for 120 days 1 dose a day = 75% of your new cells that day are deficient in Omega-3, 75% with Omega-6 on them for 120 days

Choice is yours

The Bottom Line on Balancing Omegas If you can balance it, you can eat it • •

Become familiar with KIM-2 and other resources to determine what it would take for your food choices to balance each to a 1:1 ratio. KIM-2 is at http://efaeducation.nih.gov- Do your homework!! Take supplements as recommended based upon your labs in addition to trying to balance your foods (the program works best by reducing 6’s and supplementing 3’s)

Recipes • •

Some recipes can be adapted quite easily to balance once you know what ingredients you can substitute (i.e. yogurt-based salad dressings, olive oil mayonnaise, quick oats flours) There is not a good single-resource you can access for recipe books and/or websites that have the right information that considers the Nutrigenomic approach such as balancing carbs, gluten, and omegas. Once you understand the concepts and know what questions to ask you will find you can use the same recipe books you already have and adapt recipes based upon these concepts.

Clean out your pantry, while not healthy for you it can be food for those in need. •

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To reduce the chance of eating out-of-balance foods by accident it may help to review the items in your pantry, refrigerator, and freezer since many of us forget to look at food labels if we are familiar with a product. When grocery shopping always read labels and learn what you need to know to understand what you are reading

Attend the Workshops to learn the concepts if you do not understand them fully, it takes time re-learn nutritional messages

Gluten-free is Better for Me and You and Everyone! Who needs to be gluten-free? Anyone with these abnormal lab tests/symptoms; Consideration Based upon Labs; • • • •

HLA DQ 2,8 (+) positive for the gene (s), even if you are not obviously symptomatic Gliadin IgA, IgG (+) indicate if genes are at work on your immune system TSH >1, TPO >1, Intact PTH >14 indicate the amount of damage done to your thyroid and bones Triglycerides >100, HgbA1c >5.8 , FBS are tests pointing to simple-carbohydrate balance problems include gluten since all edible glutens are also simple-carbohydrates even if labeled “whole-grain” (see next section)

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Cr Protein, HDL Cholesterol, Anemias = Malabsorption of B-vitamins persist even with consistent supplementation of the correct products as long as gluten damage exists to prevent absorption Cholesterol (total), LDL cholesterol elevations = Malabsorption of Calcium, Magnesium, + Vit D persist with correct product supplementation as long as gluten damage exists to prevent absorption

Consideration Based upon Symptoms; • • • •

Chronic digestive issues- diarrhea, bloating, pain and discomfort, “lactose intolerance”, over-or-under active thyroid Difficulty losing weight or weight-gain Diarrhea when starting magnesium supplementation can indicate a gluten intolerance Gluten intolerance can erode health over time for people unaware they have a gluten intolerance – Linked to diabetes type 1 and other autoimmune disorders, osteoporosis, certain depressions, some cancers, some autistic behaviors – People who test negative for the HLD DQ 2, 8 may still be gluten-intolerant! – 95% of people who are gluten intolerant have other genes not identified in this test – See other symptoms relating to all simple-carbs since gluten is one – If gluten intolerant your body has a zero tolerance for gluten, meaning that a reduction in gluten consumption is often not enough to achieve better health

Gluten-Free Eating =/= Eating Gluten-Free Products Taking the Concept into an Action

“Gluten” labeling usually refers to foods containing wheat, barley, and rye, often found in breads, crackers, pastas, sauces/soups (refer to your new patient packet for other resources to determine what other words may indicate “gluten”) Common questions when considering how to be gluten-free; Q: What gluten-free products are ok to eat? • A: This depends upon your other concerns/conditions. Gluten-free products are also simple carbohydrates so may need to be reduced in the diet to stabilize blood sugar, control cholesterol, and lose weight. Some gluten-free products contain high Omega-6’s so can be counterproductive if you are trying to balance Omegas. Other products may still contain glutens even if labeled gluten-free. – High-omega-6 gluten-free flours are quinoa, millet, soy, chickpea, corn, seeds and nuts, and amaranth – Grains containing wheat even if labeled gluten-free are Ezekiel breads, spelt, some oat products – When reducing both simple carbohydrates and eliminating gluten there are ways to enjoy many of the foods you like by making simple changes and increasing consumption of complex carbohydrates (see carb section of PPT) Q: Is there something I can increase or take to counteract gluten if I eat it? • A: No, Since gluten is the problem for you there is nothing that will get you out of a gluteneffect on your health if you choose to continue to eat gluten. Some people are highly sensitive to gluten so are immediately aware when they accidentally ingest it. Others are not as aware of its impact on their health as it compounds over time. For more resources on impact of gluten on health see your new patient packet for details.

Carbohydrates- From Complex to Simple >> Consequences Glycemic Load, how it differs from Glycemic Index (Impact on blood Sugar) versus (Carbohydrate/sugar grams in a food) • • •

Glycemic load is the impact that a food has on your blood sugar - relates to how quickly or slowly it digests in your body and impacts blood sugar Glycemic index relates more to what a food contains in terms of sugar and/or carbohydrate grams (what shows on the food label) Conceptually 2 foods can contain the same grams of sugar and carbs (same glycemic index) yet the one that digests more slowly over time will have a lower glycemic load (brown rice versus white rice)

Simple Carbohydrates Concepts in NutriGenomics by Dr Aukerman? • • • •

Foods containing a Glycemic Load over 8 on your foods sheet act to impact your sugars more Often foods that are highly processed where the original form of the food may have once been complex; such as fruit and vegetable juices, cereals, breads, pastas, crackers, white rice Highly processed starches digest more quickly are converted to sugar raise your blood sugar suddenly “Whole grain-derived” pastas and breads no longer “whole grains” since the original grain was altered

Simple carbohydrates Impacts on Health? • •

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For all people frequent large amounts of simple carbohydrates causes increase work for the pancreas, For all people frequent amounts of Gluten-based carbohydrates also lead to low-HDL Cholesterol syndrome, elevated Triglycerides and LDL Cholesterol, Abnormal Liver Function tests, Fatty Liver, Weight Gain, Elevated Glucose Levels, and has been associated with some neurological disorders such as Seizure Disorders and Alzheimer's Our ancestors did well on complex carbohydrates, all that was available – No access to the quantities of sugar and refined carbohydrates – Honey would have be infrequent at best

Carbohydrates- From Complex to Simple >> Consequences What are Complex Carbohydrates? •

On your foods sheet these are foods with a glycemic load of under 5

Whole fruits, vegetables, beans, lentils have a balance in fiber, water, and carbohydrates that keep; • Consumption at a reasonable amount (versus juicing 5 lbs of carrots that you could not have eaten) • Ensures slow digestion so that it empties from your stomach over a longer period of time • Ensures Blood Sugars remain steady and does not suddenly elevate blood sugar

Fat, Fiber, and Protein are “your friends” • • • • •

Fat, fiber, and protein Take longer to digest Leave the stomach more slowly Slow the release of sugars from some foods. Full-fat ice cream has a glycemic load of under 8 and a potato has a glycemic load of 26.

What about artificial sweeteners? Stevia? • • •

Artificial sweeteners are not recommended for anyone because they require liver detoxification. Artificial sweeteners, including Stevia, are associated with weight gain and other serious health risks Artificial sweeteners are used in baked products and desserts that are already simple carbohydrates to encourage consumption of these foods which elevates blood sugar and associated health concerns

Sugar and honey are ok? • •

In reasonable amounts for many people they are fine. Our genomes can handle honey better than high glycemic foods such as sugar, breads and potatoes

Carbohydrates- From Complex to Simple >> Consequences What about Diabetics? • • • • • •

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Once diabetes has developed the body cannot handle simple carbohydrates/sugars as it once could. Some people with diabetes seek “alternate” ways to handle the foods that they enjoy Turn to artificial sweeteners and/or Take extra insulin to offset the sugars in their diets rather removing sugars and simple carbohydrates Medications and sweetening chemicals alone cannot keep a diabetic person as healthy as they could be if their lifestyle does change. In the United States, due to low magnesium, calcium and b-vitamin levels, we have palates; – Highly conditioned toward sweet foods, which is different from many other parts of the world – Highest rates of diabetes, cholesterol, obesity, liver disease (from low minerals & b vitamins) Promoting a lifelong diet of proteins, dairy, and complex carbohydrates such as whole fruits, whole vegetables, beans and lentils can help reduce the conditions that can lead to serious disease, including diabetes. Once a person is diabetic these concepts still apply.

Which supplements help manage carbohydrate effects? • •

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Cinnamon capsules- are insulin-mimetics and help regulate blood sugar if taken prior to consumption of a higher glycemic food. Cannot completely offset simple carbohydrate excess but can assist B100-time released Your body requires more B-vitamins to handle carbohydrates so if already deficient when eating higher glycemic foods you may see increased impacts of the deficiency. Making sure you take your B100 time-released as recommended for the greatest help. Magnesium- Magnesium deficiency increases the risk of cholesterol problems from carbohydrates, among other things. Taking your magnesium supplement can better protect you from cholesterolrelated problems, now we use Cal Mag D to complete the mineral protection against osteoporosis and 325 other low energy problems

The Bottom Line on Carbohydrates We need carbohydrates • •

Our bodies were designed for > 95% complex versions of these and < 5% simple carbohydrates Juicing and otherwise processing foods increases the glycemic load of a food, the reason that many grain products and juices concentrate make more available the sugars in foods with bad heal results

It’s not so simple just to categorize as Simple and Complex •

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Foods are on a continuum from not-a-carb (glycemic load “0”), to complex carbohydrates, and then to simple carbohydrates where the glycemic load can range from 8 up into the 50’s and higher. Higher glycemic loads will spike blood sugar, increase triglycerides, lower HDL cholesterol faster. A few people appear to handle more simple carbohydrates without significant health impact than others Using Nutrigenomics will watch your labs to determine your healthy carb-load based on your response to the supplements and changes in diet. Become familiar with the American Journal of Clinical Nutrition’s International Table of Glycemic Load and Glycemic Index as a peer-reviewed, published source of consistent information about foods

Who has to really watch carbohydrates? People with; • Obesity • Diabetes • Hypertension • Cancers or who have had cancer • Pre-diabetic conditions such as cholesterol problems, elevated glucose and/or hemoglobin A1c • Neurological disorders such as ALS, MS, Alzheimer's, and seizure disorders • Interest in preventing any of the above conditions

Latex Cross-Reactivity From Foods Very Important in Cancer Recovery and Chronic Pain Latex Sensitivity comes from environmental factors but not like we thought Prime Cause of this sensitivity are the tires on the roads that put latex particles into the air from friction between rubber tires and the road. • Exposed repeatedly to latex our immune systems can mount a heightened response to this substance • Latex sensitivity due to reactions from contact with latex gloves and latex in clothing items • Most have this sensitivity without a severe response to a trigger

Once we have this sensitivity • • •

It doesn’t go away, but the symptoms subside with absence or reduction of the trigger Many people who are latex-sensitive react similarly to some 13 fruits and vegetables Avoiding triggers is key to reducing the deleterious effect latex exposure can have on our immune systems and to reduce the stiffness and pain associated with latex exposure

Why a reaction to certain fruits and vegetables? • • • • •

Latex is a carbohydrate/protein compound, naturally-occurring part of the growth cycle of all plants, including fruits and vegetables when they are in their ‘green stage” In nature the plant de-natures the latex compound when the seed inside the fruit/veg was mature by emitting low-dose ethylene hormone to latex back into separate carbohydrates and proteins Produce picked before it completely ripens on the plant will always contain latex formed in the produce. When we ingest fresh fruits/vegetables that are picked early for shipping before naturally de-latexed we are ingesting intact latex, causing a cross-reaction due to our existing latex sensitivity from tire fumes Fruits and vegetables picked early “need to be forced to ripen” once separated from the plant by exposure to ethylene gas in a warehouse 7-10 days prior to being placed on the grocery store shelves (even organic) which further activates the latex causing a heightened response

Latex In Foods not On Foods Latex in fruits/vegetables Which foods are we most concerned about? • Bananas, kiwis, avocados, figs, and celery are ALWAYS high in latex even if ripened on the plant • “Stone fruits” with a pit (peaches, cherries, plums, nectarines, apricots) ripened on the tree are OK

Who needs to worry about this the most? People who have compromise to their immune functioning need to be careful about latex, as those with: • Cancer • Already-compromised immune systems such as those who are frail, ill, or have HIV/AIDS • Non-healing wounds, certain skin disorders and known allergies • Pain conditions of any kind since this reaction exacerbates pain and stiffness • Interested in preventing the above conditions

What can we eat? • • •

A good rule-of-thumb is if it is locally grown and fully ripened on the plant it is ok to eat fresh except for; Bananas, kiwis, avocados, figs, and celery If not locally grown and in-season then frozen or canned fruits/veg are more likely to be latex-free since are processed where the foods grow In the 1940’s few fresh fruits/vegetables would have been available in Ohio grocery stores in winter. What did people eat before we had the capability of shipping and forcing ripening, canned then frozen

Exceptions? • •

Lettuces, raspberries, blackberries, blueberries, pineapple generally ripen on the plant since cannot be picked early and continue to ripen so are ok fresh year-around

Tips for Getting Started and Keeping Going!! 1.

Keep it Simple – – –

2.

Get the “what”, then the “how”, then the “why” Concepts behind the recommendations are important to understand to protect yourself Develop your “decision-tree” so that you can navigate outside resources to find answers

Identify potential obstacles to getting healthier – – – – – – – – – –

3.

Budget concerns? Lack of support from family/friends? Or competing advice? Take them to a Wednesday Class Still holding on to outdated concepts that lack validation in 2005-2010 research? Distance from home interferes with attendance to Workshops? Lack of time or challenge in prioritizing your health based on others’ needs? Difficulty sticking with changes? Not “getting” how to do the program? Lack of interest in making changes? Or getting well? Condition prohibitive? Anticipating “missing” some of your favorite foods?

Plan ahead for potential “trouble spots” –

4.

The best offense is a good defense so the more you know behind what you know the better

Prioritize your goals if it feels overwhelming to take it all on at once – –

5.

Identify your most critical needs Communicate with Dr. Aukerman your need to pace yourself

If you run into problems, ask for help –

Call the office, come to a class, or email if you have any questions or problems, it’s better to ask now than to wait with questions that can impact your progress

KIM-2 Provides n-6 Plant Oil Toxicity Load of Nuts & Seeds

KIM Report by Meal Times For Snacks

Serv ing Size

78% Plan # 676 grams

kcals Serv ings Short 6 Short 3 Long 6 Long 3

Margarine, sof t, corn (hy drogenated and regular)

1 tsp

5

101

3

4272

127

0

0

Bread, rice bran

1 slice

27

66

1

447

29

0

0

Bread, oat bran

1 slice

30

71

1

477

31

0

0

Bread, oatmeal

1 slice

27

73

1

433

27

0

0

Bread, cracked-wheat

1 slice, large or thi k 1 slice, large (6" x

30

78

1

194

10

0

0

Bread, f rench or v ienna (includes sourdough)

96

263

1

634

32

0

0

Bread, italian

1 slice, large

30

81

1

387

30

0

0

Bread, mixed-grain (includes whole-grain, 7-grain)

1 slice, large

32

80

1

276

19

0

0

Bread, pita, white, enriched

1 pita, large

60

165

1

307

14

0

0

Bread, pumpernickel

1 slice (5" x 4" x 3/8") 1 slice, large

32

80

1

366

29

0

0

Bread, raisin, enriched

32

88

1

205

12

0

0

Bread, reduced-calorie, oat bran, toasted

1 slice

19

45

1

354

23

0

0

Bread, ry e

1 slice

32

83

1

236

19

0

0

Bread, wheat (includes wheat berry )

1 slice

25

65

1

216

11

0

0

Bread, white, commercially prepared (includes

1 slice, large

30

80

1

510

60

0

0

Butter, with salt

1 tbsp

14

102

1

260

168

0

0

Oil, oliv e, salad or cooking

1 tbsp

14

119

1

1067

81

0

0

Lard

1 tbsp

13

115

1

1306

128

0

0

Nuts, cashew butter, plain, without salt added

1 tbsp

16

94

1

1307

27

0

0

Nuts, almond butter, plain, without salt added

1 tbsp

16

101

1

1901

68

0

0

Margarine, regular, hard, soy bean (hy drogenated)

1 tsp

5

101

3

2735

212

0

0

Margarine, sof t, saf f lower and cottonseed

1 tsp

5

101

3

6980

0

0

0

Margarine-like spread, (approximately 40% f at),

1 tsp

5

50

3

2318

29

0

0

total mg = 22915

1058

1

0

Total Energy Choice = 2101 kcals

%Cal= 9.81%

KIM notes: Your energy allowance is

kcals

0.45% 0.00% 0.00%

These overall choices will give 76% long 6 in your body's long total

% long 6 in long total ==>>> 47% 58% 78% Heart attack deaths/100,000 ===>>> 50 90 200

Nutrigenomics Reduces Aluminum & Mercury Levels C reactive Proteins, PSA Nutrigenomics at OSU CIM

[email protected]

Calcium, Magnesium, PTH st at 1 6 to12 Week Follow-up Resolving the intact-PTH (Marker for Osteoporosis) Through Nutrigenomics at OSU CIM

Nutrigenomics Be Happy, Healthy & Replace Live Deficiencies Long

Magnesium in Water Calcium in Waters Vitamin D (Sunlight) B-Complex Vitamins Reduce Excesses in Your Diet Trace Minerals SimpleAcidophilus Carbohydrates in Dairy (Complex Carbs/Cinnamon) Retinal Daylight Omega-6 Plant Oil Foods (Replace with Omega-3 Foods)

Reduce Dense Food Calories (By Starting with Soup and Salad)

Remove Toxic Foods in Your Diet and Environment Latex and Latex-like Proteins in 13 Foods Gluten and Gluten-like Substitutes in all Foods Soy and Soy Products in many Foods & Supplements Flax and Flax Products in many Foods & Supplements Artificial Flavorings or Coloring Agents in Foods and Supplements Artificial Sweeteners in Foods and Supplements

Typical Simple Products Used by Nutrigenomic Patients Glen Aukerman, MD Laura Kunze, MAET

Creating the future of medicine to improve people's lives ….through personalized health care