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Home , Riboflavin

DIETS, NUTRITION AND LIVING LONGER

Charlene LePane DO, MSPH FASGE FACG FACOI Site Director AdventHealth GI Fellowship Asst Professor Internal Medicine NSUCOM, KCUMB, LECOM AdventHealth Medical Group TOPICS TO DISCUSS

• : – (macro=carbohydrates, protein and fat) – (micro= and minerals) • Elements • Diets: keto, vegan, gluten-free, paleo • How to live longer A BENEFITS • Keeps tissues and skin healthy ( topical Retin-A reduce appearance of fine wrinkles and treat acne) • Plays an important role in bone growth and in the immune system • Diets rich seems to lower lung and prostate cancer risk • Carotenoids act as antioxidants • Foods rich may protect against cataracts • Retinoids and Carotene • Includes , retinal, retinyl esters, and retinoic acid referred to as “preformed” (lipid soluble vitamin found in animal fat sources) • Beta carotene (vegetable sources) can easily be converted to vitamin A as needed

VITAMIN A RDA • 900 mcg (3,000 IU) (upper limit 3000mcg or 10,000 IU) • Sources of retinoids: – beef , eggs, shrimp, fish, fortified , butter, cheddar , Swiss cheese • Sources of beta carotene: – sweet potatoes, carrots, pumpkins, squash, , mangoes, turnip greens * • It is the world's leading cause of preventable blindness in children • Increases the risk of disease and death • In pregnant women night blindness and increase risk of maternal mortality (VITAMIN B1) • Needed for healthy skin, hair, muscles, and brain and nerve function • M 1.2 mg, W 1.1 mg • Pork chops, brown , ham, soymilk, watermelons, acorn squash THIAMINE (VITAMIN B1) : • Thiamin (vitamin B1) convert carbohydrates into energy (nervous system) • Helps muscle contraction and conduction of nerve signals • Deficiency called beriberi and can cause weakness, fatigue, psychosis and nerve damage • Alcoholics are at high risk THIAMINE (VITAMIN B1) • Fatigue and • Indigestion or constipation d/t improper muscle tone in the GI tract • Muscle tenderness • Numbness in the arms and legs d/t improper nerve function • Beriberi-a chronic neurological and • Wenicke--causes brain abnormalities, opthalmoplegia (VIT B2) SOURCES • M 1.3 mg, W 1.1 mg • Helps convert food into energy • Needed for healthy skin, hair, blood, and brain • Milk, Eggs, , Cheese, • Green leafy vegetables • Whole and enriched grains and cereals

RIBOFLAVIN (VIT B2) DEFICIENCY • cheilosis (lesions on the lips) • angular (cheleitis) (lesions on the angles of the mouth typically caused by yeast) • (fissured and magenta-colored tongue) • corneal vascularization • dyssebacia (red, scaly, greasy patches on the nose, eyelids, scrotum, and labia) • normocytic, normochromic

NIACIN (VIT B3) * • Helps convert food into energy • Essential for healthy skin, blood cells, brain, and nervous system • Lowers LDL ,increase HDL and lower triglycerides • Taking too much causes flushing, (especially with ETOH) – Aspirin reduces this flushing • M: 16 mg, W: 14 mg • , Poultry, Fish, fortified and whole grains, , Potatoes,

NIACIN (VIT B3) DEFICIENCY • • Dermatitis • Dementia • Diarrhea • Death

PANTOTHENIC ACID (VIT B5) • Helps convert food into energy • M: 5 mg, W: 5 mg • Helps make: – Lipids • Chicken – Neurotransmitters • egg yolk – steroid hormones – • whole grains • Helps create CoA along with • Broccoli cysteine, adenosine and triphosphate • Mushrooms – CoA involved in synthesis and • Avocados oxidation of FA and oxidation of pyruvate in Krebs cycle • tomato products

PANTOTHENIC ACID (VIT B5) DEFICIENCY • Burning feet • Fatigue • Headaches • Tingling in hands and feet • Nausea • Irritability • Insomnia

PYRIDOXINE (VIT B6) • Aids in lowering homocysteine is a non-proteinogenic α- amino acid and is biosynthesized from methionine (essential AA) by the removal of its terminal methyl group • May reduce the risk of heart disease (high levels of homocysteine associated with heart disease) • Studies show an extra dose B6 helps relieve morning sickness • Helps convert to serotonin neurotransmitter that plays key roles in sleep, appetite, and moods (VIT B6) • Helps make norepinephrine • Studies show individuals with a deficiency in Vit B6 are 3.5 • Influences cognitive times more likely to have a abilities and immune cognitive decline in function adulthood • Allows the body to use and • Skin inflammation, scaly store energy from protein and dermatitis, anemia, carbohydrates to form depression, dizziness, nausea hemoglobin and sores in mouth • Without this vitamin the • COMMON DEFICIENCY thyroid cannot utilize its iodine raw material efficiently to make the hormones

PYRIDOXINE (VIT B6) • Long term high doses of • Meat can be toxic and may result in nerve • Fish damage loosing control • Poultry of body movements • • 31–50 years old: M: 1.3 mg, W: 1.3 mg • Tofu and soy products • 51+ years old: M: 1.7 mg, W: • Potatoes 1.5 mg • Non-citrus fruits such as bananas and watermelons

COBALAMIN (VIT B12) • Aids in lowering homocysteine levels and may lower the risk of heart disease • Assists in making new cells and break down fatty acids and amino acids • Protects nerve cells and encourages growth • Helps make RBCs and DNA • M: 2.4 mcg, W: 2.4 mcg • Meat, Poultry, Fish, Milk, Cheese, Eggs, Fortified cereals, Fortified soymilk

CAUSES OF B12 DEFICIENCY • Pernicious anemia(parietal • Atrophic gastritis cells IF and acid) • Chronic H pylori infection • Dietary deficiency (vegan) • Chronic antacid use>12 mo • Malabsorption • Chronic – Crohns disease () – Chronic pancreatitis • Use of metformin >4 mo – Whipple’s disease (interferes with Ca- – Parasite dependent membrane for B12-IF absorption) • Post surgical malabsorption – Gastrectomy – Terminal ileum resection COBALAMIN (VIT B12) DEFICIENCY *

• Pernicious anemia is the most common cause of B12 deficiency: – Autoimmune; attack against parietal cells (IF) – extreme lack of energy – pins and needles (paresthesia) – sore and red tongue – muscle weakness – depression – problems with memory, understanding, and judgement

BIOTIN (VITAMIN B7) • Helps convert food into energy and synthesize glucose • Helps make and break down some fatty acids • Needed for healthy bones and hair • is essential for the of fat and only a tiny amount is required • Some is made by in the GI tract • Not clear how much of this the body absorbs • M: 30 mcg, W: 30 mcg • Whole grains, Organic meats, Egg yolks, , Fish BIOTIN • Taking a biotin supplement could cause falsely elevated or suppressed thyroid levels – avoid taking any biotin supplements at least a day or two before blood test to ensure accurate results • May be a helpful adjunct in the treatment of multiple sclerosis (MS) by improving myelin repair and facilitating cellular energy production • Biotin plays a role in energy production • Commonly used to remediate neurological problems, alopecia and skin conditions (acne, eczema) • Alopecia • Conjunctivitis • Dermatitis with scaly, red rash around the eyes, nose, mouth, genitals • Neurological symptoms such as depression, lethargy, hallucination and paresthesia ASCORBIC ACID (VIT C) • Foods rich in may lower the risk for some cancers, including those of the mouth, esophagus, stomach, and breast • Long-term use of supplemental vitamin C may protect against cataracts • Helps make collagen; connective tissue that binds wounds and supports blood vessel walls • Helps make the neurotransmitters serotonin and norepinephrine • Acts as an antioxidant, neutralizing unstable molecules that can damage cells • Bolsters the immune system • M: 90 mg, W: 75 mg Smokers: Add 35 mg (to counteract the damage that smoking causes to cells)

ASCORBIC ACID (VIT C) DEFICIENCY

• Deficiency disease is called • Evidence that vitamin C helps with colds not convincing • Deficiency symptoms: • fruits and fruit juices (especially – Anemia citrus) – Atherosclerotic plaques and • potatoes pinpoint hemorrhages • broccoli – Bone fragility and joint pain • bell peppers – Poor wound healing and frequent infections • Spinach – Bleeding gums and loosened teeth • Strawberries – Muscle degeneration and pain, • Tomatoes hysteria and depression • brussels sprouts – Rough skin and blotchy bruises

CALCIFEROL (VIT D) • Helps maintain normal blood levels of calcium and phosphorus, which strengthen bones – Calcium cannot be absorbed without • Helps form teeth and bones • Supplements can reduce the number of non-spinal fractures • Some reports suggest as much as 42% of the US population has a • Fortified milk, margarine, fortified cereals, fatty fish

CALCIFEROL (VIT D) DEFICIENCY • in children – Imperfect calcification, softening and distortion of the bonesbowed legs • Weakness, aches, and pains in adults where bones don't have enough calcium, called in adults

ALPHA- (VIT E) • Acts as an antioxidant, neutralizing unstable molecules that can damage cells • Protects Vitamin A and certain lipids from damage • Does not prevent wrinkles or slow aging processes • Deficiency unlikely; stored in body • Helps maintain healthy skin and eyes, while also strengthening the immune system • Current research finding may help slow the growth of dementia, particularly Alzheimers • Studies demonstrate Vit E decreases risk for prostate, lung, colon cancer • Vegetable oils, germ, leafy green vegetables, whole grains, nuts

FOLIC ACID (VIT B9, ) • Vital for new cell creation • Helps prevent brain and spine birth defects when taken early in ; should be taken regularly by all women of child- bearing age since women may not know they are pregnant in the first weeks of pregnancy • Can lower levels of homocysteine and may reduce heart disease risk • May reduce risk for colon cancer • Offsets breast cancer risk among women who consume alcohol • Sickle Cell Anemia (d/t hemolysis) needs folic acid • M: 400 mcg, W: 400 mcg FOLIC ACID (VIT B9, FOLATE) SOURCES • Fortified grains and cereals • Asparagus • Okra • Spinach • turnip greens • Broccoli • legumes like black-eyed peas and chickpeas • orange juice • tomato juice

FOLIC ACID (VIT B9, FOLATE) DEFICIENCY • Anemia(MACROCYTIC), • Common deficiency fatigue, weakness, diarrhea, loss of appetite and weight • Occasionally, folic acid masks loss a B12 deficiency, which can lead to severe neurological • heart palpitations complications (check MMA) • sore tongue • behavioral disorders • B12: MMA elevated and homocysteine elevated • Folate: MMA normal, homocysteine elevated FOLIC ACID (VIT B9, FOLATE) DEFICIENCY: CAUSES

• Phenytoin (Dilantin) • Crohns disease • Trimethoprim- • Celiac disease sulfamethoxazole • Hemodialysis • Methotrexate • Genetic mutation that • Sulfasalazine hinders conversion of folate • Antacids/PPI to methylfolate • Bile acid sequestrants PHYLLOQUINONE, (VIT K) • Activates proteins and calcium essential to blood clotting • May prevent hip fractures and keep bones healthy • M: 120 mcg, W: 90 mcg • Intestinal bacteria make a form of that accounts for half your requirements, deficiency rare • If you take an anticoagulant, keep your vitamin K intake consistent • Cabbage, liver, eggs, milk, spinach, broccoli, sprouts, , collards, and other green vegetables

MINERALS CHROMIUM(TRIVALENT) CALCIUM 1000mg <50, 1200 mg>50 50-200 ug

• Builds and protects bones • Enhances the activity of and teeth insulin • Muscle contractions and • Helps maintain normal relaxation, blood clotting, blood glucose levels (pre- and nerve impulse diabetics and diabetics) transmission • Needed to free energy from • Hormone secretion, enzyme glucose activation, maintains healthy blood pressure • supplement MINERALS FLUORIDE few mg daily COPPER 900 ug (water, toothpaste) • Iron metabolism and • Encourages strong bone immune system formation • Helps make RBCs • Keeps dental cavities from starting or worsening MINERALS IRON (17-19 mg women and IODINE 150 ug 19-20.5 mg men)

• Part of thyroid hormone • Helps hemoglobin in red • Helps set body temperature blood cells and myoglobin in muscle cells carry oxygen • Influences nerve and muscle throughout the body function, reproduction, and growth • Helps make amino acids, collagen, neurotransmitters, • Prevents goiter and a and hormones congenital thyroid disorder MINERALS

MAGNESIUM 350-360 mg MANGANESE 9 mg

• Needed for many chemical • Helps form bones reactions in the body • Helps metabolize amino • Works with calcium in acids, cholesterol, and muscle contraction, carbohydrates blood clotting, and regulation of blood pressure • Build bones and teeth MINERALS

MOLYBDENUM 45 ug PHOSPHORUS 2.5-4.5 mg/dl

• Helps ward off a form of • Helps build and protect severe neurological damage bones and teeth in infants that can lead to early death • Part of DNA and RNA • Helps convert food into energy • Part of phospholipids MINERALS

POTASSIUM SELENIUM

• Balances fluids in the body • Acts as an antioxidant, neutralizing unstable • Helps maintain regular molecules that can damage heartbeat and propagate cells nerve impulses • Helps regulate thyroid • Needed for muscle hormone activity contractions • A diet rich in potassium seems to lower blood pressure MINERALS

SODIUM <2300 mg SULFER no RDA • Balances fluids in the body • Helps form bridges that shape and stabilize some • Helps send nerve impulses protein structures • Needed for muscle • Needed for healthy hair, contractions skin, and nails • Impacts blood pressure; even modest reductions in salt consumption can lower blood pressure MINERALS • Helps form many enzymes and ZINC 8 W 11 M proteins and create new cells

• Frees vitamin A from storage in the liver • Needed for immune system, taste, smell, and wound healing • When taken with certain antioxidants, zinc may delay the progression of age-related macular degeneration

10 tips for healthy eating Harvard School of Public Health • Choose good carbs, not no carbs. Whole grains are your best bet. • Pay attention to the protein package. Fish, poultry, nuts, and beans are the best choices. • Choose foods with healthy fats, limit foods high in saturated fat, and avoid foods with trans fat. Plant oils, nuts, and fish are the healthiest sources. • Choose a fiber-filled diet, rich in whole grains, vegetables, and fruits. 10 tips for healthy eating Harvard School of Public Health • Eat more vegetables and fruits. Go for color and variety—dark green, yellow, orange, and red. • Calcium is important. But milk isn’t the only, or even best, source. • Water is best to quench your thirst. Skip the sugary drinks, and go easy on the milk and juice. • Eating less salt is good for everyone’s health. Choose more fresh foods and fewer processed foods. • Moderate drinking can be healthy—but not for everyone. You must weigh the benefits and risks. • A daily is a great nutrition insurance policy. Some extra vitamin D may add an extra health boost. KETO DIET Minimizing your carbs to have body use fat for energy 60-75% of your calories from fat 15-30% of your calories from protein 5-10% of your calories from carbs PALEO DIET Foods that in the past~10,000 years ago could be obtained by hunting and gathering VEGAN DIET A vegan diet excludes all animal products Many people choose to eat this way for ethical, environmental or health reasons GLUTEN FREE MAKE A DIFFERENCE? • Organic foods cost upwards of > 60 % than conventional alternatives • Eating organic makes a difference in your chemical exposure; less pesticide and other chemical residues HOW TO LIVE LONGER 1. Don't smoke 2. Enjoy physical and mental activities every day 3. Eat a healthy diet rich in whole grains, vegetables, and fruits, and substitute healthier monounsaturated and poly- unsaturated fats for unhealthy saturated fats and trans fats Mediterranean Diet is well-known as one of the world's healthiest 4. Take a daily multivitamin, and be sure to get enough calcium and vitamin D 5. Maintain a healthy weight and body shape HOW TO LIVE LONGER

6. Challenge your mind, keep learning and trying new activities 7. Build a strong social network 8. Follow preventive care and screening guidelines 9. Floss, brush, and see a dentist regularly 10. Ask your doctor if medication can help you control the potential long-term side effects of chronic conditions such as high blood pressure, osteoporosis, or high cholesterol 11. Napping for 30 minutes per day could cut your risk of heart disease by up to 30%, according to research from Harvard School of Public Health Scientists suspect a daily nap reduces stress hormones in the body

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