DIETS, NUTRITION AND LIVING LONGER

C. LePane DO MSPH FASGE FACG FACOI Central Florida Hepatology and Gastroenterology Florida Hospital Medical Group TOPICS TO DISCUSS

• : – (macro=carbohydrates, protein and fat) – (micro= and minerals) • Elements • Diets: keto, vegan, gluten-free, paleo • How to live longer • How to look younger A • 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 • Essential for vision Lycopene may lower prostate cancer risk VITAMIN 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 in the carotenoids alpha carotene and lycopene seem to lower lung and prostate cancer risk • Carotenoids act as antioxidants • Foods rich in the carotenoids lutein may protect against cataracts 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 • A serious problem in more of half of all countries, though it mainly affects poorer regions • In pregnant women, vitamin A deficiency can cause night blindness and increase risk of maternal mortality (VITAMIN B1) • Helps convert food into energy • Needed for healthy skin, hair, muscles, and brain and is critical for 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) • Thiamin also plays a role in muscle contraction and conduction of nerve signals • A lack of thiamin is called beriberi and can cause weakness, , psychosis and nerve damage • While it is not very common, alcoholics are most at risk of thiamin deficiency THIAMINE (VITAMIN B1) • Loss of appetite • Fatigue • 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 • Keeps skin, eyes, and the nervous system healthy, helping the body release energy from the food we eat • Milk • Eggs • • Cheese • • Green leafy vegetables • Whole and enriched grains and cereals RIBOFLAVIN (VIT B2) DEFICIENCY • A deficiency of riboflavin – sore throat – 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 (VIT B3) * • Helps convert food into energy • Essential for healthy skin, blood cells, brain, and nervous system • Lowers LDL (since 1950), increase HDL and lower triglycerides • Niacin is also known as vitamin B3 • Taking too much niacin causes flushing, (especially with ETOH) – Aspirin reduces this flushing • M: 16 mg, W: 14 mg NIACIN (VIT B3) SOURCES * • • Poultry • Fish • fortified and whole grains • • Potatoes • NIACIN (VIT B3) DEFICIENCY • • • Dementia • Diarrhea • Death (VIT B5) • Helps convert food into energy • Helps make: – Lipids – Neurotransmitters – steroid hormones – • Helps create CoA along with cysteine, adenosine and triphosphate – CoA involved in synthesis and oxidation of FA and oxidation of pyruvate in Krebs cycle • M: 5 mg, W: 5 mg PANTOTHENIC ACID (VIT B5) SOURCES • Chicken • egg yolk • whole grains • Broccoli • Mushrooms • Avocados • tomato products PANTOTHENIC ACID (VIT B5) DEFICIENCY • Burning feet • Fatigue • Headaches • Tingling in hands and feet • Nausea • Irritability • Insomnia (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 PYRIDOXINE (VIT B6) • Helps make norepinephrine • Influences cognitive abilities and immune function • Allows the body to use and store energy from protein and carbohydrates to form hemoglobin • Without this vitamin the 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 of • Poultry 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 PYRIDOXINE (VIT B6) DEFICIENCY • Studies show individuals with a deficiency in Vit B6 are 3.5 times more likely to have a cognitive decline in adulthood • Skin inflammation, scaly dermatitis, anemia, , dizziness, nausea and sores in mouth • COMMON DEFICIENCY COBALAMIN (VIT B12) • Aids in lowering homocysteine levels and may lower the risk of heart disease • Assists in making new cells and breaking down some fatty acids and amino acids • Protects nerve cells and encourages their normal growth • Helps make red blood cells and DNA • M: 2.4 mcg, W: 2.4 mcg COBALAMIN (VIT B12) SOURCES * • Meat • Poultry • Fish • Milk • Cheese • Eggs • Fortified cereals • Fortified soymilk COBALAMIN (VIT B12) CAUSES OF B12 DEFICIENCY • Pernicious anemia • Food b12 malabsorption (inability to release b12 from • Dietary deficiency (lack of IF; food or intestinal transport needed for B12 absorption at TI) proteins) • Malabsorption • Atrophic gastritis – Crohns disease • Chronic H pylori infection – Chronic pancreatitis – Whipple’s disease • Chronic antacid use>12 mo – Parasite • Chronic • Post surgical malabsorption • Use of metformin >4 mo (interferes with Ca- – Gastrectomy dependent membrane for B12- – Terminal ileum resection IF absorption) COBALAMIN (VIT B12) DEFICIENCY • Older adults have trouble absorbing this vitamin from food • Those on a vegan or vegetarian diet often don't get enough B12 as it's mostly found in animal products 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 () – sore and red tongue – muscle weakness – depression – problems with memory, understanding, and judgement COBALAMIN (VIT B12) DEFICIENCY (VITAMIN B7) • Helps convert food into energy and synthesize glucose • Helps make and break down some fatty acids • Needed for healthy bones and hair • Biotin 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 BIOTIN SOURCES

• 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 around the eyes, nose, mouth, genitals • Neurological symptoms such as depression, lethargy, 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) SOURCES • fruits and fruit juices (especially citrus) • potatoes • broccoli • bell peppers • Spinach • Strawberries • Tomatoes • brussels sprouts ASCORBIC ACID (VIT C) DEFICIENCY Evidence that vit C • Deficiency disease is called helps with colds not • Deficiency symptoms: convincing – Anemia – Atherosclerotic plaques and pinpoint hemorrhages – Bone fragility and joint pain – Poor wound healing and frequent infections – Bleeding gums and loosened teeth – Muscle degeneration and pain, hysteria and depression – 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 vit D • 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 deficiency • While the body uses sunlight to make vitamin D, it cannot make enough if you live in northern climates or don't spend much time in the sun • Fortified milk CALCIFEROL (VIT D) SOURCES * • margarine • fortified cereals • fatty fish CALCIFEROL (VIT D) DEFICIENCY • A lack of vitamin D can lead to 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

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 other aging processes • You are unlikely to have a deficiency of vitamin E, as any excess is stored in your body naturally • However, it is important to have because it is an antioxidant and helps maintain healthy skin and eyes, while also strengthening the immune system • Current research finding vitamin E may help slow the growth of dementia, particularly Alzheimers • Studies demonstrate Vit E decreases risk for prostate, lung, colon cancer ALPHA-TOCOPHEROL (VIT E) SOURCES • vegetable oils • salad dressings and margarines made with vegetable oils • germ • leafy green vegetables • whole grains, nuts ALPHA-TOCOPHEROL (VIT E) DEFICIENCY 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 • A lack of folate can lead to • Many people don't get – anemia(MACROCYTIC), which enough of this causes fatigue, weakness, diarrhea, loss of appetite and • Occasionally, folic acid masks a B12 deficiency, – heart palpitations which can lead to severe – a sore tongue neurological complications – behavioral disorders (check MMA) – **B12: MMA elevated and homocysteine elevated – **Folate: MMA normal, homocysteine elevated FOLIC ACID (VIT B9, FOLATE) DEFICIENCY: CAUSES • (Dilantin) • Crohns disease • Trimethoprim- • Celiac disease sulfamethoxazole • Hemodialysis • Methotrexate • Genetic mutation that • Sulfasalazine hinders the conversion of dietary or supplemental • Antacids/PPI folate to its usable form • Bile acid sequestrants methylfolate PHYLLOQUINONE, (VIT K) • Activates proteins and calcium essential to blood clotting • May help prevent hip fractures • M: 120 mcg, W: 90 mcg • There is also some evidence to suggest it helps keep bones healthy • Not very much is needed, so deficiencies are rare • Intestinal bacteria make a form of vitamin K that accounts for half your requirements • If you take an anticoagulant, keep your vitamin K intake consistent PHYLLOQUINONE, MENADIONE (VIT K) SOURCES • 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 and • Enhances the activity of teeth insulin • Helps with muscle • Helps maintain normal blood contractions and relaxation, glucose levels (pre-diabetics blood clotting, and nerve and diabetics) impulse transmission • Needed to free energy from • Plays a role in hormone glucose secretion and enzyme activation • Used as a weight loss • Helps maintain healthy blood supplement pressure MINERALS FLUORIDE few mg daily COPPER 900 ug (water, toothpaste) • Plays an important role in • Encourages strong bone iron metabolism and formation immune system • Keeps dental cavities from • Helps make red blood cells 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 blood cells and myoglobin • Helps set body temperature in muscle cells carry oxygen • Influences nerve and muscle throughout the body function, reproduction, and • Needed for chemical reactions growth in the body and for making • Prevents goiter and a amino acids, collagen, congenital thyroid disorder neurotransmitters, and hormones 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 • Helps build bones and teeth MINERALS

MOLYBDENUM 45 ug PHOSPHORUS 2.5-4.5 mg/dl

• Part of several enzymes: • Helps build and protect – one of which helps ward off bones and teeth a form of severe • Part of DNA and RNA neurological damage in infants that can lead to • Helps convert food into early death energy • Part of phospholipids, which carry lipids in blood and help shuttle nutrients into and out of cells MINERALS

POTASSIUM SELENIUM

• Balances fluids in the body • Acts as an antioxidant, neutralizing unstable molecules • Helps maintain regular that can damage cells heartbeat and propagate nerve impulses • Helps regulate thyroid hormone activity • Needed for muscle contractions • A diet rich in potassium seems to lower blood pressure • Getting enough potassium from your diet may benefit bones 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 ZINC8 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 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 • Don't smoke • Enjoy physical and mental activities every day • 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 • Take a daily , and be sure to get enough calcium and vitamin D • Maintain a healthy weight and body shape HOW TO LIVE LONGER • Challenge your mind, keep learning and trying new activities • Build a strong social network • Follow preventive care and screening guidelines • Floss, brush, and see a dentist regularly • 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 HOW TO LIVE LONGER • 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

• MAKE INTIMACY A PRIORITY – Studies suggest that having sex more frequently may extend your life – University of the West of Scotland at Paisley found that couples that committed to having more sex for two weeks logged lower blood pressure levels during stressful situations (such as public speaking) compared to couples who abstained from sex How to Look Younger • Ask your colorist for warm tones • Fake fuller lips • Wear sunscreen on your face and neck • Use an acid peel 1-2 times a week – “Hyaluronic acid (a naturally occurring substance in skin that keeps it hydrated and youthful) absorbs 1000 X its weight in water and expands, helping to blur fine lines and wrinkles – Or try hyaluronic acid fillers • Embrace thick brows • Use castor oil on your brows How to Look Younger • Keep cuticles hydrated and go for neutral nails • Try a soft shadowed liner on your lower lash line • Rinse your hair with cold water • Change your mindset about aging • Pair a creamy stick highlighter with a powder illuminator • Use products that color correct – Green helps areas with redness such as cheeks, under eyes, and nasal folds – Apricot cancels the blue-ish color found within the dark circles underneath eye areas How to Look Younger • Avoid matte formula foundations • Prep under eyes before applying concealer • Take collagen supplements – Our collagen production decreases by 1% each year after the age of 20, which essentially means your skin is getting thinner and more fragile – Oral supplements can help to support the body’s natural collagen production How to Look Younger • Try a laser treatment on hands (Fraxel) • Give your hair the same type of care you give to your skin • When applying blush, use the “smile and swoosh” technique • Make working out a priority • Swap out your liquid liner and jet black eye pencils • Consider undereye filler – Restylane gives immediate, painless results that can last up to a year How to Look Younger • Deep condition your strands • Start drinking green juice • Avoid dark shadows and liquid liners • Use white eyeliner on your water line • Layer your mascara • Choose a pink or peachy blush with golden shimmer • Don’t skimp on skincare products • Use vitamin A on your skin THANK YOU