The Mito Food Plan

Optimizing Cellular Energy Production: The Mito Food Plan

ELIZABETH BOHAM, MD, RD

Integrative Health Symposium February 21st, 2020 New York City ©2019 The Institute for Functional Medicine Following this activity, successful participants will beable to… Performance Objectives 1. 4. 3. 2. ketogenic friendly. Explain how to adapt Mito Food Plan to become mitochondria function. Explain different fasting strategies to improve Identify the top 12mitochondrial therapeutic foods. mitochondrial health and support healthy aging. Implement the Mito Food Plan to improve ©2019 The Institute for Functional Medicine Fueling Healthy Mitochondria The Mito Food Plan: ©2019 The Institute for Functional Medicine Evaluation Nutrition ©2019 The Institute for Functional Medicine Functional Nutrition ©2019 The Institute for Functional Medicine Food Is… ©2019 The Institute for Functional Medicine Food Is… ©2019 The Institute for Functional Medicine Protein Macronutrient Metabolism ATP Pool β TCA Cycle - Fat oxidation ETC Carbs ©2019 The Institute for Functional Medicine ©2019 The Institute for Functional Medicine ©2019 The Institute for Functional Medicine Introducing the IFM MITO FOOD PLAN ©2019 The Institute for Functional Medicine High in FatHigh ProtectiveAntioxidant Anti Low RestrictionCaloric IntermittentFasting and KetogenicOptions Reducedwith Calories Low Glycemic - - Grainand Gluten InflammatoryNutrients - Free ©2019 The Institute for Functional Medicine ©2019 The Institute for Functional Medicine The Mito Food Plan ©2019 The Institute for Functional Medicine Mito Food Plan Comprehensive Guide, Weekly Menu, Recipes, and Shopping List ©2019 The Institute for Functional Medicine

Therapeutic Foods ©2019 The Institute for Functional Medicine • • • • category you ate yesterday. many sizesserving in each Write on the left side how sizesserving (front back).and Review the categories and Takea pen. out Takeyour out Mito Food Plan. Getting to Know Your Mito Plan ©2019 The Institute for Functional Medicine 5 0 2 4 5 ©2019 The Institute for Functional Medicine Phytonutrient Spectrum ©2019 The Institute for Functional Medicine ©2019 The Institute for Functional Medicine Phytonutrient Spectrum Checklist for Kids ©2019 The Institute for Functional Medicine Phytonutrient Spectrum Foods ©2019 The Institute for Functional Medicine ©2019 The Institute for Functional Medicine ©2019 The Institute for Functional Medicine The Mito FoodPlan ©2019 The Institute for Functional Medicine Cardiovascular Alzheimer's Insulin Resistance disease Neurodegeneration N.A.S.H. Epilepsy Many more Huntington’s inflammation Fatigue Vascular … ©2019 The Institute for Functional Medicine calories enhances the production of BDNF carbohydrates and supplementing with fat “ Decreasing calories specifically from David Perlmutter, MD ” ©2019 The Institute for Functional Medicine or extremist diet by managing the amount be achieved without apurposeful ketosis “ Appropriate rhythmic bioenergetics can of calories andspacing of meals Jeff Bland,PhD ” ©2019 The Institute for Functional Medicine “ The low The grade inflammaging that happened with aging canaging with be neutralized by our food choices cookingand our methods Deanna Minich, PhD, CNS ” ©2019 The Institute for Functional Medicine Mitochondrial Therapeutic Foods ©2019 The Institute for Functional Medicine Antioxidants Protective ©2019 The Institute for Functional Medicine

Protective Anti-oxidants ©2019 The Institute for Functional Medicine Nutr Metab. 2015;2015:760689. Nutr Metab. doi:10.1155/2015/760689 2015;2015:760689. Components: A Scientific Review with Clinical Application. J Detoxification Pathways Using Foods and Food Hodges RE, Minich DM. Modulation of Metabolic • • • • • • • DHA Garlic(allicin) Sulforaphane Resveratrol Greentea extract Curcumin Mild Oxidative stress - Derived Caloric Restriction Carbohydrate Restriction Fasting Anti Anti De - inflammatory - toxifying enzymes - stress NRF2 Activation Keap Nrf2 Nrf2 Antioxidants Signal Signal Transduction ©2017 The Institute for Functional Medicine Differential responses to risingoxidative stress 19;6(9):3777 Stefanson AL, Bakovic M. Dietary regulation of Keap1/Nrf2/ARE pathway: focus on plant

- 801. doi: 10.3390/nu6093777. 801. doi: 10.3390/nu6093777. Priming Oxidativestress Mildto Moderate Nrf2 - derived compounds and trace minerals. Nutr Inflammation NF High κ B ients. Sep2014 Apoptosis Extreme AP

1 Oxidative Stress Stress Oxidative ©2019 The Institute for Functional Medicine Anti (phyto)nutrients - inflammatory ©2019 The Institute for Functional Medicine Phytonutrient Diversity ©2019 women dueto high vegetable and fruit intake. J Nutr. Aug;136(8):2207 2006 Thompson HJ, et al. Dietary botanical diversity affects the reduction of oxidative biomarkers in The Institute for Functional Medicine determiningbioactivitythe of high beneficialeffects larger than amounts phytochemicalsmay have greater (Vegetabledietsthatand &Fruit) botanicaldiversity plays rolea in “These findings indicatefindings that “These of fewer phytochemicals.” smalleramountsof many - 12. 12. - VF Women due to High Vegetable Dietary Botanical Diversity Affectsthe Reduction of OxidativeBiomarkers in and and Fruit Intake ©2019 The Institute for Functional Medicine Feb;23(1):20 Vincent HK,Bourguignon CM, Taylor AG. Relationship of the dietary phytochemical index to weight gain, oxidative stress and i Phytochemical Inflammatory - 9. 9. doi: 10.1111/j.1365 Cytokines Index The & - 277X.2009.00987.x. 277X.2009.00987.x. nfl ammation in overweight young adults. J Hum Nutr Diet. 2010 ©2019 The Institute for Functional Medicine High inQuality Dietary Fats ©2019 The Institute for Functional Medicine

High Quality Fats ©2019 The Institute for Functional Medicine • • • • Carnitine deficiencyCarnitine to leads toinability oxidize fats as fuel. mitochondrialmembrane. and CPT1transports the conjugated fatty acrossacid the Fatty acidsconjugate to Carnitineoutside themitochondria Healthy fats regenerate the membraneassist and fluidity.with Mitochondrialmembrane bilayer as a lipid Fatty Acids ©2019 The Institute for Functional Medicine Schönfeld P, Wojtczak L. Short 10.1016/j.neuint.2017.01.008. Nafar F,Clarke JP, Mearow KM. Coconut oil protects cortical neurons from amyloid beta toxicity by enhancing signaling of cel Coconut Oil - and medium - chain fatty acids in energy metabolism: the cellular perspective. J Lipid Res. 2016;5 Medium ChainTriglycerides • • • Suggestions: Serving • • • as water high in minerals Shred onsalads and yogurt/drink high heat Use in stir Should bebothvirgin and organic on cortical neurons Attenuates effects of amyloid Increases beta oxidation offats High in beta HBA l s - urvival pathways. Neurochem Int. May;105:64 2017 7(6):943 frying – 954. 954. doi:10.1194/jlr.R067629 – no oxidationat - - 79. 79. doi: beta ©2019 The Institute for Functional Medicine Schönfeld • • • formation. transiently into This more rapid absorption of MCFA enter in a more regulated manner. while other types of fatty acids must mitochondrialinner membrane In the liver, lauric acid (C12:0). acid (C8:0), capric acid (C10:0), and including caproic acid (C6:0), caprylic MCTs contain 6to 12 carbonatoms P, P, Wojtczak themitochondrialinner space Medium Chain Triglycerides (MCT) L. L. Short - and medium increases ketone body MCFA can freelycross the - chain fatty acids in energy metabolism: the cellular perspective. J Lipid Res. 2016;57(6):943 , , Adapted from: ACBach Babyan & VK The American Journal of Clinical Nutrition 36(5):950 1982; MCFA = medium medium chain = fatty acids, MCFA Mitochondria Acetyl – - 954. 954. doi:10. CoA OM LIVER CELL LIVER = outer = membrane, MCFA 1194/jlr.R067629 Bodies Ketone IM OM = inner membrane Energy IM - 62. ©2019 The Institute for Functional Medicine Low Glycemic Impact ©2019 The Institute for Functional Medicine

Low Glycemic Impact

BLOOD GLUCOSE LEVELS TIME/HOURS HIGH GI 1 LOW GI 2 ©2019 The Institute for Functional Medicine “High Glycemic Index/Load” • Decreases insulin Decreasesstimulation • Anti Stream orTrickle? - Low GlycemicLow Index/Load: inflammatory Glycemic Index • • Improvessatiety Increases insulinIncreases sensitivity “Low Glycemic Index/Load” ©2019 The Institute for Functional Medicine doi:10.1161/ATVBAHA.111.241919 vascular biology. 2012;32(9):2052 Arteriosclerosis, thrombosis, and and cardiovascular disease. insulin signaling, metabolic syndrome Rask - Madsen C, Kahn CR. Tissue - specific - 2059. 2059. Dysfunction Beta Fatty Liver - cell cell Osteoporosis Lipotoxicity Obesity Diabetes Type3 Cardiovascular Disease Dysfunction Dysfunction Endothelial Immune ©2019 The Institute for Functional Medicine Ahmed S, Mahmood Z, Zahid S. Linking insulin with Alzheimer's disease: emergence as type III diabetes. Neurol Sci. Oct;3 2015 WecouldconcludeAD referred be that to ‘type as “ Strikingevidence attributed has owing tocommonpathophysiology with …Oxidativestress, tau hyper impairedglucosemetabolism energy and all beenlinked have to to precedeor accompany stageinitial Disease.Alzheimer’s of regimes couldeffectiveregimes be forpatients AD perturbation ininsulin/IGFperturbation signaling. Type 3Diabetes - phosphorylation, APP phosphorylation, loss of insulin receptor loss of diabetes, 6(1 0):1763 - 9. 9. doi: 10.1007/s10072 3 commontherapeutic - diabetes’ deposition, and Aβ - bearing neurons bearing .” - 015 - . Moreover,. 2352 - 5. ©2019 The Institute for Functional Medicine Bahniwal M, Little JP, Klegeris A. High Glucose Enhances Neurotoxicity and Inflammatory Cytokine Secretion by Stimulated Huma High Glucose Enhances Neurotoxicity and neuro factors contributing to the observedincreased risk ADby of exacerbating astrocyte “ …hyperglycemia inT2DM may be the one of - inflammation andneuronal caused injury by disease Inflammatory Cytokines - associated agents. n A strocytes. AlzheimerCurr Res. Jan2017 16 - mediated ” ©2019 The Institute for Functional Medicine type type diabetes.2 Ann Y AcadN Sci. Jul;1201:157 2010 Wang CH, Wang CC, Wei YH. Mitochondrial dysfunction in insulin insensitivity: implication of mitochondrial role in Mitochondrial Dysfunction mitochondrial dysfunctionplays a role in mitochondrial toxins are involved in the environmental factors, pollutants, and “… “… it has been elucidated that some pathogenesis of type 2diabetes. Taken together, we suggest that the pathophysiologyof insulin And Diabetes insensitivity - 65. 65. doi: 10.1111/j.1749 ….” - 6632.2010.05625.x. 6632.2010.05625.x. Russell). Used with permission. (credit: modification of work byMatthew Britton; scale mitochondrial matrix. ATP synthesis takes place on the inner membrane. intermembrane space, and the space inside the inner membrane is called the increase its surface area. The space between the two membranes is called the an inner membrane. innerThe membrane contains folds, called cristae, which transmission electron microscope. This organelle has an outer membrane and Figure This 1. electron micrograph shows a mitochondrion as viewed with a - bar data from Matt ©2019 The Institute for Functional Medicine Reduced Carbs with Ketogenic Option ©2019 The Institute for Functional Medicine carbohydrates. which worries which I don’t know terrorists or me moreme - ©2019 The Institute for Functional Medicine

Reduced Carbs and Ketogenic Options ©2019 The Institute for Functional Medicine ✓ ✓ ✓ ✓ ✓ ✓ ✓ Clients with Clients with increased bellyfat) Clients with Clients with Clients with Clients with and Neurodegenerative Dz) Clients with “Weight lossResistance” Cognitive decline Neurological issues T2D PCOS Metabolic Syndrome Fatigue and Fibromyalgia When to Usethis Plan (includesfamily of Dementia Hx (includes high bloodsugar, ©2019 The Institute for Functional Medicine • • • • • Sharma S, Jain P. The ketogenic diet and other dietary treatments for refractory epilepsy in children. Ann Indian Acad Neurol glycolysis, and mitochondrialmetabolism Mechanismof actionunclear attributed but to ketone bodies, Efficacy appearsto be independent of seizure type fatHigh adolescentsand Clinically metabolism of ketones Mimicsfasting state – - used treatmentused for intractable seizures in children low carbohydrate (4:1) The Ketogenic Diet(KD) – switches from metabolism of glucose to . 2 014;17(3):253 – 258. 258. doi:10.4103/0972 - 2327.138471 ©2019 The Institute for Functional Medicine 10.1016/j.cell.2018.04.027. Olson CA, Vuong HE, Yano JM, Liang QY, Nusbaum DJ, Hsiao EY. The Gut Microbiota Mediates the Anti • • • Microbiota andKetogenic Diet hippocampalGABA/glutamate. acid g KD microbiota regulate amino seizure effects ofthe KD. mediateconfer and the anti Specific KD seizure effects theKD. of are required forthe anti Changes in the gut microbiota - glutamylationand - associated bacteria - - - Seizure Effects of the Ketogen The Gut Microbiota Mediatesthe Anti - ic Diet. Cell. May 2018 24. pii: S0092 SeizureEffects ofthe Ketogenic Diet - 8674(18)30520 - 8. doi: ©2019 The Institute for Functional Medicine Krilanovich Benefits NJ. of ketogenic diets. Am J Clin Nutr. Jan;85(1):238 2007 Ketosis: • • • • • metabolismof ketone bodies. Ketosis isglucose a erythrocytes. Gluconeogenesis isvital tomeet needs and of CNS zero in 12 If onlywater is ingested, hepatic stores of glycogen decrease to Everyone approaches ketosissleepthe normalcycle. during allowsIt for survivalduringbrief periods ofnaturalstarvation. an evolutionary adaptation - 24 hours.24 - sparing strategy resultingin the - 9; 9; author reply 239 - 40. ©2019 The Institute for Functional Medicine and hormonal responses to a carbohydrate Volek JS, Sharman MJ, Love DM, Gómez Avery NG, AL, Scheett TP, Kraemer WJ. Body composition Ketones • • • Anxiety decreases. more stable and hunger is calmed. As aresult, sugar blood becomes insulinand stress hormones. Ketones inhibit the release of liver kidney.and are broken down for energyin the by compoundsthat are produced as Ketones are water - products when fats (fatty acids) - restricted diet. Metabolism. Jul;51(7):864 2002 - soluble - 70. Low Carbohydrate, ©2019 The Institute for Functional Medicine LIVER β - hydroxybutyrate fattyacids H igher ketones F at fat ©2019 The Institute for Functional Medicine Cahill GF Jr,Veech RL. Ketoacids? Good medicine? Trans Am Clin Climatol Assoc. 2003;114:149 β “ketone,” justis not a fuel, a but sapiens β - “ hydroxybutyrate, the principal Without this adaptation,this Without producingATP energy than superfuel - hydroxybutyrate glucose orfatty acid. such alarge brain. could not have evolved ,” more efficiently H. - 61; 61; discussion 162 - 3. 3. Ketoacids? Good Medicine? ©2019 The Institute for Functional Medicine Paoli Paoli A, Bianco A, Damiani E, Bosco G. Ketogenic diet in neuromuscular and neurodegenerative diseases. Biomed Res Int. 2014;2 KetoNeurodegenerative Diet& Diseases types of neurodegenerative diseases characterized by It may provide an efficient energy source for certain mitochondrialbiogenesis ketones to It may also implicatedin someneurological diseases. focal brain hypometabolism. bypass thedefect incomplex Iactivity decrease oxidative damage, increase , and and , provide capacity for 014 :474296. doi: 10.1155/2014/474296. ©2019 The Institute for Functional Medicine • Ketogenic diet • • The MetabolicAdaptation (keto Adequate protein High fat Low carbohydrate insulin dueto carbohydrate glucose and circulating Reduced reduced dietary intake Increaseliver in fattyacid acetone)in circulation and utilizationbybrain as fuel Increasedketone bodies (bHB, acetoacetate, oxidation source. β HB, HB, beta - adaptation) - hydroxybutyrate; FFA,free fatty acids hydroxybutyrate; FFA/Glycerol adipose tissue) foradipose ketone body Increased production ketoneof bodies using using bodies FFA(from dietary FFA preservation glycogenof energy source in skeletal source and released from Increased FFAof use as production within liver muscle with with muscle mitochondria stores ©2019 The Institute for Functional Medicine Ketone bodies O OH O O O Acetone OH OH Beta Acetoaceticacid - Measuring Ketones hydroxybutyric acid • • • most accurate measuring circulating Blood results followingketo test, it may provide the easiest and most common of Urine: Breath acetoacetate : : measuresexcretion urinary finger stick /serum measures - although thisis acetone falsenegative - β adaptation HB levelsHB - ©2019 The Institute for Functional Medicine Adapted Volek from: JS Phinney & SD et al. Carbohydrate Performance Measuring Ketones The Art and Science of Low 2012. ➢ ➢ Dangerous Levels: Optimal Levels of Ketosis: • • • Ketoacidosis: >10mM 0.5 Nutritional Ketosis 0.2 Overnight fasting - - 3.0mM 0.5mM : (KD): (KD): ©2019 The Institute for Functional Medicine Branco AF, et al. Ketogenic diets: from cancer to mitochondrial diseases and beyond. Eur J Clin Invest. Mar;46(3):285 2016 Effects ofKetogenic Diet • • • • • • Increases leptinsensitivity Increases sensitivityinsulin Reduces ROSproduction ATPEnhances production Enhancesmitochondrial biogenesis Reduces inflammation(NF k B) - 98. 98. d oi: oi: 10.1111/eci.12591. ©2019 The Institute for Functional Medicine Emerging Science mental clarity KD and KD Headlines KD improvesKD increasesKD KD induces cognition longevity mood humans f whereas Preclinical studies haveshown anecdotally whereas researchKD has historically focusedon diseases of neurodegenerative outcomes in models memory and learning Preclinical mortality Preclinical cognitive outcomes healthyin havesubjects been ewcasehavereports published been studies rodentsmale that on show that studies miceshowmale KD on reported Study anxiolytic effects findings neurological disorders disorders neurological KD improvesKD reduced midlifereduced showing benefits showing in associated KD with Bostock ECSBostock etal. 57(6):724 El 9:137 Cet Ari al. W Zhao etal. DYKim et al. Reger M et al. KashiwayaY W Zhao etal. DYKim et al. Reger M et al. Kashiwaya Roberts MN etal. al. Newman JC et - Mallakh Mallakh RS& Paskitti ME - 26 Frontiers in Y et Y al. et al. PloS ONE PloS ONE PLoS ONE PLoS ONE Neurobiology of Aging Neurobiology of Aging References Cell MetabCell Cell MetabolismCell Frontiers inPsychology Neurobiology of Aging Neurobiology of Aging , 2012; 7(5):e35476 7(5):e35476 2012; , Molecular Neuroscience 2012; 7(5):e35476 2012; 2012; 7(11):49191 2012; 7(11):49191 2012; Medical Hypothesis o lism 2017; 26:547 2017; 2017; 26:539 2017; 2004; 25:311 2004; 25:311 2004; 2012; 1 2012; 1 2012; 2017; 8:43 2017; 2016; 2016; - - 2001; 2001; 57 - - 46 10 10 - - 14 14 ©2019 The Institute for Functional Medicine Intermittent Fasting Caloric RestrictionCaloric and ©2019 The Institute for Functional Medicine “The best of allmedicines are “The resting and fasting” Fasting Benjamin Benjamin Franklin ©2019 The Institute for Functional Medicine Intermittent Fasting & CaloricRestriction ©2019 The Institute for Functional Medicine ➢ ➢ IntermittentFasting: Caloric Caloric Restriction • • • • • • 12 hour fast12 hour every daily fast24 hour monthly 16 or 600 cal/day or 600 20 5:2 foodplan - - 30% less30% BMR 18 hourfast weekly or monthly Caloric Restriction Types ofFasting : ©2019 The Institute for Functional Medicine 2. 1. neurons. Wang R, Li Xu Y Y, et al. Curcumin produces neuroprotective effects via activating brain doi:10.1602/neurorx.1.1.111. Mattson M, Duan W, Wan R, Guo Z. Prophylactic activation of neuroprotective stress response pathways by dietary and behaviora The gene that turns on BDNF isactivated by: Progress in Neuro • • • • • • • Curcumin Meditation DHA Exercise Ketosis from lower carbohydrates Intermittentfasting Caloric Restriction(20 - Psychopharmacology and Biological Psychiatry BDNF Activation . 2010;34(1):147 - 30%) - derived neurotrophic factor/TrkB - 153. 153. doi:10.1016/j.pnpbp.2009.10.016. - depend chemical called BDNF. day for mice50% had Fastingevery other increase a brainin ent MAPK and PI l m anipulations. www.newscientist.com - NeuroRX 3K 3K cascades in rodent cortical . 2004;1(1):111 - 116. 116. ©2019 The Institute for Functional Medicine Nutr Metab. 2015;2015:760689. Nutr Metab. doi:10.1155/2015/760689. 2015;2015:760689. Components: A Scientific Review with Clinical Application. J Detoxification Pathways Using Foods and Food Hodges RE, Minich DM. Modulation of Metabolic • • • • • • • DHA Garlic(allicin) Sulforaphane Resveratrol Greentea extract Curcumin Mild Oxidative stress - Derived Caloric Restriction Carbohydrate Restriction Fasting Activation NRF2 ©2019 The Institute for Functional Medicine Mitochondrial Dysfunction and Activation of Nrf2. Cell Physiol Biochem. 2017;41(6):2255 Zhang M, Pan H, Y Xu et al. Allicin Decreases Lipopolysaccharide OxidativeStress and Inflammation in HumanVein Endothelial Cells Mitochondrial Dysfunction and - Induced Oxidative Stress and Inflammation in Human Umbilical Ve Lipopolysaccharide through Suppression of Activation ofNrf2 Allicin DecreasesAllicin - 2267. 2267. doi: 10.1159/000475640. - Induced Induced in Endothelial Cells through Suppression of ©2019 The Institute for Functional Medicine • • • monthly 24 hour fast weekly or lunch 1 16 hours from dinner to breakfast every day 12 hours from dinner to Intermittent Fasting - 2x weekor month ©2018 The Institute for Functional Medicine Mattson M, Allison D, Fontana L et al. Meal frequency and timing in health and disease. Circadian Rhythm Eating of Proceedings of the National Academy of S ciences. 2014;111(47):16647 - 16653. 16653. doi:10.1073/pnas.1413965111. ©2019 The Institute for Functional Medicine Mattson M, Allison D, Fontana L et al. Meal frequency and timing in health and disease. “ diet such as one moderate size meal every other day ….switching from eating 3 full meals per day to an IER Intermittent Energy Restriction ✓ ✓ ✓ ✓ ✓ Increased BDNF Elevated B Increased mobilization of fatty acids R I ncreased insulin sensitivity (500 educed levels of insulin and leptin - 600 calories2d/wk)” - hydroxybutyrate Proceedings of the National Academy of S ciences. 2014;111(47):16647 - 16653. 16653. doi:10.1073/pnas.1413965111. ©2019 The Institute for Functional Medicine • • Key to Success withcomplex conditions. Slowly lengthen evening andwant to snack. so youdinnerlater willnotbehungry in the Eat enough protein, fats and veggies the time between meals at ©2019 The Institute for Functional Medicine • • (assuming moderate(assuming activity) is generally 1400 FEMALES: calories1800 per day. reduction ofcalories wouldbe arange ofapproximately 1400 moderate activity) is generally2000 MALES: 1000 20 – 30% reduction30% ofcalories wouldbe arange ofapproximately – 1400 calories1400 perday. Average calories consumed per day for males (assuming Average calories consumed per dayfor females 20 Caloric Restriction - 30% Reduction – 2400 calories,2400 so – 1800 calories,1800 so a 20 – 30% – a ©2019 The Institute for Functional Medicine balsamic vinegar ½ cupcherry tomatoes, cup ½ thinly sliced redcabbage, ½ Ttossed with olive oiland Dinner: tossed with T ½ oliveoil and your favorite vinegar, and aroasted seaweed snack cups of salad greens (or a mixture of kale and greens) plus 2 cups ofraw veggies, Lunch blueberries Breakfast: 600 calorie menu plan : 2 ounces grass 2 ounces wildsalmon with 1 cup cooked broccoli and salad of 1½ cups greens, spinach omelet (two with eggs) 1 cup spinach cooked in water, and cup ½ - fedbeefor buffalo burgeror an organic turkey burger with 2 Caloric Restriction 600calories ©2019 The Institute for Functional Medicine Taormina Taormina G, Mirisola M. Longevity: epigenetic and biomolecular aspects. but alsoarecapableof regulation geneexpression…the restrictions not onlyhaveadirect effect onmetabolism “ amount andqualityofnutrients inthediet influence [Caloric Restriction] thelifespanincreases in a wide longevity the by epigenetic modifying pattern array of organismsincluding humans…thesearray CR, IF, &Longevity Biomolecular Concepts . 2015;6(2). doi:10.1515/bmc . 2015;6(2). - 2014 - 0038. . ” ©2019 The Institute for Functional Medicine Low Gluten - Grain and - Free ©2019 The Institute for Functional Medicine

Low-Grain and Gluten-Free ©2019 The Institute for Functional Medicine 20P/60F/20CMacronutrient Distribution ©2019 The Institute for Functional Medicine Food Distribution for20P/60F/20C by Plan Caloric Ranges Mito Food Plan: Ketogenic Option Customizing Macronutrients ©2019 The Institute for Functional Medicine Food Distribution for20P/60F/20C by Plan Caloric Ranges Mito Food Plan: Ketogenic Option Customizing Macronutrients ©2019 The Institute for Functional Medicine Food Distribution for20P/60F/20C by Plan Caloric Ranges Mito Food Plan: Ketogenic Option Customizing Macronutrients ©2019 The Institute for Functional Medicine Within Within Certain Categories, the client can choose how they want • Example:2200 to “spend” size.their serving They can choose any 2 • • • Example:starchyand 1 fruit 1 vegetable, fruits 2 or Fruits StarchyVegetables Mito Food PlanFlexibility - 2500 has 2 serving of carbs from2 serving has 2500 category: this ©2019 The Institute for Functional Medicine (Exclusively forUse with the Mito Food Plan) Food Distribution for Customizing Macronutrients Mito FoodPlan: 15P/70F/15C Ketogenic Adaptation Plan Plan by Caloric Ranges • • • • option: Mito and Mito withketo Differences between servings. non increased number of M ranges. week toservings M products entirely. M protein. reliance on animal M - - - - K has increased an K limits GF grain K omits dairy K hasslightly less - starchy vegetable at higher calorie 1 - 2 per ©2019 The Institute for Functional Medicine Mito FoodPlan Flexibility Customizing Macronutrients UtilizingIFM Food Plans ©2019 The Institute for Functional Medicine Customizing Macronutrients Mito Food Plan Flexibility ©2019 The Institute for Functional Medicine Customizing Your Plan The Mito Food Plan ©2019 The Institute for Functional Medicine Clients donotcountcalories. Transfer ServingSizes They count sizes.serving Onto Mito Food Plan ©2019 The Institute for Functional Medicine 1 9 0 8 12 ©2019 The Institute for Functional Medicine 13 1 1 0 ©2019 The Institute for Functional Medicine Customizing Macronutrients/ Servings Mito FoodPlan: Ketogenic Adaptation ©2019 The Institute for Functional Medicine 7 0 - 8 Customizing Macronutrients/ Servings Mito FoodPlan: 8 1 13 - 16 Ketogenic Adaptation 10 - 11 0 - 0 1 - 1 ©2019 The Institute for Functional Medicine Ranges Food Distribution for (Exclusively for Use with the Mito Food Plan) Customizing your Mito Food Plan 15P/70F/15C Plan Plan by Caloric Food Distribution for 20P/60F/20C Plan Plan by Caloric Ranges ©2019 The Institute for Functional Medicine • • • • • Transition out of Move towards 3 hours of fasting before bed. first meal. Slowly lengthen the fasting time between dinner and before starting. Consider doingElimination diet for personalization first with IRand DM. Stabilize bloods sugarson Cardiometabolic Food Plan Clinical Pearls Ketosis slowly. ©2019 The Institute for Functional Medicine Principles ofIFM Mito the Food Principles Plan: 7. 6. 5. 4. 3. 2. 1. OrganicFoodClean and Fasting;and/orCalorie RestrictionCarb Impact Cooking FatsOils and Anti LowGlycemic Impact PhytonutrientDensity Summary & TakeawaysSummary & - inflammatoryand Anti - oxidant ©2017 The Institute for Functional Medicine Weekly Menu, Recipes, andShopping List Mito Food Plan Comprehensive Guide, ©2019 The Institute for Functional Medicine