DIETS, NUTRITION AND LIVING LONGER C. LePane DO MSPH FASGE FACG FACOI Central Florida Hepatology and Gastroenterology Florida Hospital Medical Group TOPICS TO DISCUSS • Nutrients: – (macro=carbohydrates, protein and fat) – (micro=vitamins and minerals) • Elements • Diets: keto, vegan, gluten-free, paleo • How to live longer • How to look younger VITAMIN A • Retinoids and Carotene • Includes retinol, retinal, retinyl esters, and retinoic acid referred to as “preformed” vitamin A (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 (tretinointopical 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 liver, eggs, shrimp, fish, fortified milk, butter, cheddar cheese, Swiss cheese • Sources of beta carotene: – sweet potatoes, carrots, pumpkins, squash, spinach, mangoes, turnip greens VITAMIN A DEFICIENCY * • 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 THIAMINE (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 rice, 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, fatigue, 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 cardiovascular disease • Wenicke-Korsakoff syndrome- causes brain abnormalities, opthalmoplegia RIBOFLAVIN (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 • Yogurt • Cheese • Meats • 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 stomatitis (cheleitis) (lesions on the angles of the mouth typically caused by yeast) – glossitis (fissured and magenta- colored tongue) – corneal vascularization – dyssebacia (red, scaly, greasy patches on the nose, eyelids, scrotum, and labia) – normocytic, normochromic anemia NIACIN (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 * • Meat • Poultry • Fish • fortified and whole grains • Mushrooms • Potatoes • Peanut butter NIACIN (VIT B3) DEFICIENCY • PELLAGRA • Dermatitis • Dementia • Diarrhea • Death PANTOTHENIC ACID (VIT B5) • Helps convert food into energy • Helps make: – Lipids – Neurotransmitters – steroid hormones – hemoglobin • 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 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 tryptophan 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 vitamin B6 can be toxic and may result in nerve • Fish damage loosing control of • Poultry body movements • Legumes • 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, depression, 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 alcoholism • 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 (paresthesia) – sore and red tongue – muscle weakness – depression – problems with memory, understanding, and judgement COBALAMIN (VIT B12) DEFICIENCY 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 • Biotin is essential for the metabolism of fat and only a tiny amount is required • Some is made by bacteria 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 • Soybeans • 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) BIOTIN DEFICIENCY • 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 vitamin C 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 scurvy 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