The IFM Cardiometabolic Food Plan; Using a Food First Approach to Supporting Metabolic Syndrome, Hypertension, and Dyslipidemia within the Functional Medicine Model Kristi Hughes, ND February 2016 Learning Objectives • .-$/#$(+/****)-$*4.3'- $..)(/*'$.7)-*( • ++'7/#-+30**$)/-4)0*)./* (/*'$.7)-*()-.+04'$)$' *)$0*)..3#.#7+-/).$*)) 7.'$+$($ • (+'()/+-.*)'$8**+')*- -$*(/*'$*)$0*)./*/#+0)/ Does food matter when it comes to heart health? ©2012 The Institute for Functional Medicine Functional Nutrition ©2012 The Institute for Functional Medicine )) 5.,#0)( #-.),9 6&50)(6&50)( A A ..5-..5- 5.,#0)( ----'(. ©2012 The Institute for Functional Medicine -$*4.3'-3)0*)'3/-$0*)4'30*)-$*4.3'-3)0*)'3/-$0*)4'30*) B-),!(#:9A CB-),!(#:9A C #& #-.),9 #& #-.),9 5-0)((#,-5-0)((#,- (.",)*)'.,#-(.",)*)'.,#- #)',%,-#)',%,- &#(#& (#.),-&#(#& (#.),- • $('$)$('$) • *3-)' *3-)' • ;L ;L • • *3/#6(*3/#6( • 4$5*7./(.4$5*7./(. • • C*7/ C*7/ • $+$ $+$ • 6(6( • $./7'4$5 $./7'4$5 • #7-*$#7-*$ • L3'.;Q;L3'.;Q; • -0'.$8-0'.$8 • &$)6(&$)6( • ($'$'2-)($'$'2-) • '+'+ • ; ; • .D .D • -$+#-')-46(-$+#-')-46( • )0.)0.. • • 4/-$.4 /-$.. • L$).3'$) L $).3'$) .3'- ((3) )!((0*) 6$04/-.. )*/#'$' /*'$ 7.3)0*) 7.3)0*) 7.3)0*). 3)0*)'$$)E7./(.$*'*"7-$(-73.. ). )-"7 *((3)$0*) /-3/3- -).+*-/ ..$($'0*) /*6 )07)-'7$)"*)/-$30*)./*-$(-73.. '+ *4()/ 3/-$0*) /-.. '0*).#$+. 4$5*$)$)".; )$0/$0*)'4'30*).L "$) )/-4)0*) ©2012 The Institute for Functional Medicine )) 5.,#0)( #-.),9 6&50)(6&50)( A A ..5-..5- 5.,#0)( ",*50 ----'(. (.,6(0)( ©2012 The Institute for Functional Medicine Food Is… ©2012 The Institute for Functional Medicine Food is information, Food is medicine. “…we are witnessing food being redefined as “information” that alters cellular function in the post- prandial state…” '); >#/-*'#.)3/-$0*))+'7$)"$)*3-#'/#:# 6)*#*-(.$.*))0*)> UGRH< 3)C 3'QOOV> ©2012 The Institute for Functional Medicine Poly-pills vs. Poly-meals for the Poly-ills Statin Three different anti-hypertensives Aspirin Folic acid Fruits & vegetables Almonds Chocolate Wine Fish Wald et al., British Medical J 2003; 525: 1-6. Garlic Franco et al. Horm Metab Res. 2007 Sep;39(9):627-31. ©2012 The Institute for Functional Medicine Food is medicine. “Let food be your medicine and medicine be your food.” - Hippocrates ©2012 The Institute for Functional Medicine Food is Medicine for the Heart ©2012 The Institute for Functional Medicine The Impact of Food on CVD Prevention “Broader adherence to recommendations for daily intake of fruit, vegetables, fish and fatty acid composition may take away as much as 20-30% of the burden of cardiovascular disease and result in approximately 1 extra life year for a 40-year-old individual. Promotion of a healthy diet should be given more emphasis in the prevention of cardiovascular disease.” 3- -$*4.-4#$'>QOPO<PVGPH=TODT> ©2012 The Institute for Functional Medicine )) 5.,#0)( #-.),9 6&50)(6&50)( A A ..5-..5- 5.,#0)( ",*50 ----'(. (.,6(0)( ©2012 The Institute for Functional Medicine Choosing an IFM Food Plan ©2012 The Institute for Functional Medicine Considerations for Personalizing the Food Plans • Choose Food List Based on Features • Provide Tailored Food List – Consider Macronutrient Percentages – Targeted Calories when Appropriate – Provide Serving Allowances – Remove Triggering Foods • Discuss Therapeutic Foods • Provide Practical Tools such as Weekly Menu Plan, Recipes, and Shopping List ©2012 The Institute for Functional Medicine Considerations for Personalizing the Food Plans • Choose Food List Based on Features • Provide Tailored Food List – Consider Macronutrient Percentages – Targeted Calories when Appropriate – Provide Serving Allowances – Remove Triggering Foods • Discuss Therapeutic Foods • Provide Practical Tools such as Weekly Menu Plan, Recipes, and Shopping List ©2012 The Institute for Functional Medicine ©2012 The Institute for Functional Medicine Foundational and First Step Intervention Considerations ),))&( &#'#(0)(#. ,#)'.)&# $"#/$)C$"#/'*.. .6.D'*0)";$)$".0*) '4/'**3"- 0"3 *$)/+$) )-.'**-..3- "#)'*&#(.( 3.'#. )-.$./ $) #& #-.),9 ((3)7.-"3'0*) 0"3 0"3 *)D.+$ ./-*$)/.0)' .$/7 • --$/'*5'7)-*( /*'$7)-*( • )/.0)'-($'$/7 7+Q$/. ((3)C )!((0*) ..)0' 7+-/).$*) • 3/*D$((3)$... 7.'$+$($ )(#0)(- • ./#( • /*+7L&$) )!((0*) • 7'"$.)-/#-'"$. **$.*--. • +-..$*) ©2012 The Institute for Functional Medicine Functional Nutrition Patterns ),))&( &#'#(0)(#. ,#)'.)&# Food Nutrition History Seeking Healthy Diet, All Ages, Allergies, Atopy, Asthma, GI Metabolic Syndrome, Type 2 Athletic, Pregnancy, Overweight, Distress, Pain and Fatigue, AI Diabetes, Hypertension, Overweight, Underweight. Diseases. Dyslipidemia, Obesity Timeline Seeking Healthy Diet, All Ages, Allergies, Atopy, Asthma, GI Metabolic Syndrome, Type 2 Athletic, Pregnancy, Overweight, Distress, Pain and Fatigue, AI Diabetes, Hypertension, Overweight, Underweight. Diseases. Dyslipidemia, Obesity Anthropometrics Non-specific Increased BMI, Increased ECW/ICW Incr: BMI, WC, WHR, Fat, Blood Pressure Biomarkers & Labs Normal screening values Incr. IgG or IgE food reactions, Incr: HgbA1C, FBS, insulin, hs-CRP, Celiac, Autoantibodies, Dysbiosis. Trigs Decr: HDL Clinical Indicators from Non-specific Dry Skin, thin eyebrows, Fluid Incr: WC and WHR Nutrition Physical Exam retention, and skin inflammation. Skin tags, acanthosis nigricans, peripheral neuropathy. Diet and Lifestyle Inadequate nutrients Food Triggers, Allergy Exposures. Excess simple sugar Prepared food Excess reliance on one food. High CHO intake, GI foods, low protein, excess alcohol, elevated trans fats. Functional Nutrition Status ©2012 The Institute for Functional Medicine Functional Medicine Patterns ),))&( &#'#(0)(#. ,#)'.)&# Medical History Seeking Healthy Diet, All Ages, Allergies, Atopy, Asthma, GI Metabolic Syndrome, Type 2 Athletic, Pregnancy, Overweight, Distress, Pain and Fatigue, AI Diabetes, Hypertension, Overweight, Underweight. Diseases. Dyslipidemia, Obesity ATMs Antibiotics, Multiple infections, Family History, T2DM, CVD, HTN, (Antecedents, Triggers, and Trauma, Stress, Familial allergies, Obesity, Sedentary Lifestyle, Sleep Mother with Group B strep, Acid Disorder (inadequate sleep and Mediators) Blocking Medication, Maternal use of Sleep apnea) PPI during pregnancy Matrix Patterns Non-specific Assimilation Structural Integrity Biotransformation Transport Communication/Defense and Repair Defend and Repair/Communication ©2012 The Institute for Functional Medicine Common Dietary Approaches Utilized in Addressing and Preventing Cardiovascular Disease ©2012 The Institute for Functional Medicine Plant-Based Diets: Cardiovascular Health Benefits for the Individual, Sustainable Nourishment for the Planet ©2012 The Institute for Functional Medicine 0(! 5**),0(! -*)(-#&9 5-.#(#&#.9 ©2012 The Institute for Functional Medicine The evidence for plant- based eating • Convincing body of evidence to suggest that a plant-based dietary pattern beneficially impacts cardiovascular health • Fruits & vegetables (F&V) are low in energy, sodium and fatty acids and high in nutrient density, providing significant amounts of fiber and micronutrients 3--/#-*.'-+>QOPP<PRGUH=SXXDTOV>#.,95#&#(-),',#(-FDED> #'*&#0)(-),,#)6-5&,#--?'*&; -$.D/#-/*)> ©2012 The Institute for Functional Medicine The evidence for plant- based eating • Fruit & vegetable intake > 5 servings/d is associated with the lowest risk of CVD • Highest risk with an intake <3 servings/d. 3--/#-*.'-+>QOPP<PRGUH=SXXDTOV>#.,95#&#(-),',#(-FDED> #'*&#0)(-),,#)6-5&,#--?'*&; -$.D/#-/*)> ©2012 The Institute for Functional Medicine Plant-Based Eating and Blood Pressure • F&V intake is associated with lower BP • Greater BP effect is due to higher potassium content • Limited evidence for an inverse trend between FV consumption and LDL levels • Greater LDL lowering effect is due to soluble fiber and plant-based sterols 3--/#-*.'-+>QOPP<PRGUH=SXXDTOV>#.,95#&#(-),',#(-FDED> #'*&#0)(-),,#)6-5&,#--?'*&; -$.D/#-/*)> ©2012 The Institute for Functional Medicine The Mediterranean Diet ©2012 The Institute for Functional Medicine Mediterranean-Style Diet • A collection of dietary habits followed by countries bordering the Mediterranean Sea • High olive oil, vegetables, legumes, whole grains, fruit, nuts, spices, herbs • Moderate fish and poultry • Low red meat and dairy • Low to moderate alcohol (e.g., red wine) ©2012 The Institute for Functional Medicine Where did it originate from? • Mediterranean Diet is best described as the dietary patterns adopted in the olive growing areas during the 1950-60s. • Diet reflects the post WWII era before fast food. ©2012 The Institute for Functional Medicine There is no “one” Mediterranean Diet • 16 countries in the Mediterranean region • Italy 30% total lipid intake • Greece 40% ©2012 The Institute for Functional Medicine How is the Mediterranean Diet assessed in research studies? Modified Mediterranean Diet Score and Cardiovascular Risk in a North American Working Population. PLoS One. 2014;9(2):e87539. ©2012 The Institute for Functional Medicine Prospective Design Studies on Mediterranean Diet and DM • GISSI-Prevenzione Trial • SUN study • Health professionals follow-up study • EPIC • NHS II “reveal a 12-83% reduced risk of DM with highest adherence to the MD” ©2012 The Institute for Functional Medicine Lyon Diet Heart Study: Survival Without MI 72% Risk Reduction P = 0.0001 Mediterranean Diet: ↑ Fruits / Veggies, Nuts, Olive Oil, Canola Oil, Fish Prudent / AHA Step 1 ↓ Fats, Saturated Fat & Cholesterol; AHA Step 1 Circulation. 1999; 779-785 ©2012 The Institute for Functional