1. C212
DIET TO PROMOTE HEALTH, PREVENT DISEASE
WARREN KARP, PHD, DMD
FRIDAY, FEBRUARY 22
DISCLAIMER: This work, audio recordings and the accompanying handout, are the intellectual property of the clinician, and permission has
been granted to the Chicago Dental Society, its members, successors and assigns, for the unrestricted, absolute, perpetual, worldwide right
to distribute solely as an educational material at the scientific program being presented at the 2011 Midwinter Meeting. Permission has been
granted for this work to be shared for non-commercial education purposes only. No other use, including reproduction, retransmission in any
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3. Please Note
In order to have the most complete and up-to-date version of this handout,
you need to go to the website that I created for the 2013 Chicago
The Diet to Promote Health Midwinter Dental Meeting:
and Prevent Disease https://sites.google.com/site/2013chicagomidwinter/
On this website, you will find the updated versions of all my lectures, in
powerpoint format. In addition, you will find links to some of my other
websites and to my Facebook page.
Warren B. Karp, Ph.D., D.M.D.
Thanks, WBK
Professor Emeritus
Georgia Health Sciences University
wkarp@georgiahealth.edu
Malnutrition Malnutrition
Overnutrition Undernutrition Overnutrition Undernutrition
Industrialized 3rd World Signs Signs
Too Much, Too Much Too Few, Too Few Obesity Sore mouths, skin
Calories Macronutrients CV Disease Anemias
Fat Vitamins High Blood Pressure Lab Tests
Salt Minerals Lab Tests Serum Albumin
Sugar Diseases LDL, HDL, TG Nitrogen Balance
Cholesterol Scurvy Diet Immunity Tests
Diseases Pellegra Restrict Fat Diet
Heart Disease Beriberi Restrict Calories More Vitamins
Stroke Specific patients Restrict Salt More Protein
Diabetes Cancer Restrict Sugar More Fat
ICU
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4. So, here’s what’s real when it
Nutrition is a SCIENCE that
comes to nutrition.
studies the nature and
Heart Disease distribution of nutrients in food,
Stroke/Alzheimer’s Disease their metabolic effects, and the
Peripheral Vascular Disease
effect of the diet on changes in
Diabetes
Hypertension the organism.
Obesity
Cancer
Nutrition Science Evolves
Too much fat is unhealthy.
Starches are healthy Too much fat is unhealthy.
Saturated fats are unhealthy.
Polyunsaturated fats are healthy.
Starches with fiber are healthy
Too much fat is unhealthy.
Saturated fats are unhealthy.
Olive oil and other monounsaturated fats are healthy.
Fish oil and other polyunsaturated fats are healthy.
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5. Guess what!
You don’t work by simple
diffusion! You’d be dead if you
An Example did.
Homeostasis, which is a characteristic of living
Protein Builds Big Muscles tissues, is a steady-state away from equilibrium.
Example
If you want bigger muscles, all you Reflexive Thinking
have to do is eat more protein???
Muscles are made out of protein.
If I exercise, I tear some muscle fibers.
If I am weightlifting to build bulk, I need
extra protein in my diet.
If I take protein supplements, I can build
muscle better and repair muscle better.
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6. Reflexive Reflective Reflexive Reflective
Is muscle wasting a sign of protein In a normo-nourished person, is diet
malnutrition? directly responsible for muscle bulk and
Does supplementing an undernourished composition?
person with protein increase muscle How is protein digested and absorbed?
mass? What controls protein synthesis inside
Does supplementing a normo-nourished muscle cells? Is it what I eat?
or overnourished person with protein What is the point at which “studies”
increase muscle mass? translate into clinical action?
Muscle Cell
Glutamate Glucosamine/Chondrotin Sulphate?
Dehydrogenase
Glutamine Effects of glucosamine, chondroitin, or placebo
Blood Synthetase
GI Tract in patients with osteoarthritis of hip or knee:
META-ANALYSIS. BMJ 2010;341:c4675
Albumin 10 trials in 3803 patients were included
Tryptophan
Binding
Glutamine Conclusions
Sites Urea Compared with placebo, glucosamine,
Saturated?
NH4+ Cycle chondroitin, and their combination do not
Saturated? reduce joint pain or have an impact on
Urea, NH4+ narrowing of joint space. Health authorities
and health insurers should not cover the costs
of these preparations, and new prescriptions
Poop to patients who have not received treatment
should be discouraged.
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7. Protein Protein
Most guidelines do not focus on protein
QUANTITATIVELY.
10 - 15% of total calories
Usually, guidelines focus on protein
QUALITATIVELY; i.e, the majority of protein
should come from low fat dairy, vegetables,
fish, lean meat (occasionally), etc.
What are Americans doing? Just the opposite!
American Heart Association Position Function of Amino Acids
Statement on High Protein Diets Body Fuel Stores?
American Heart Association High Protein Diets
Fat Carbs Proteins
as triglycerides as glycogen *non-storage
Eating large amounts of high-fat foods for a Calories 140,000 2000 30,000-40,000
sustained period raises the risk of coronary % Calories 80-85% 0% 15-20%
heart disease, diabetes, stroke and several
types of cancer. People who can't use
excess protein effectively may be at higher Amino acids are not used as
risk of kidney and liver disorders, and an energy source, unless you
are starving. Normally, only
osteoporosis. about 10% of your ATP comes
from amino acids.
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8. Not all proteins are created equal!
Biological Value of Proteins Biological Value of Proteins
A protein that possesses a perfect
The relative nutritional value of individual
balance of amino acids and absorbed
proteins.
100% has a biological value of 100. The
protein of an egg, egg white (albumin),
Biological value is related to the amino
acid composition of proteins and the has the highest value and is considered
digestibility of proteins. a standard protein of reference.
Biological Value of Proteins You can combine protein sources to produce a
meal with “complete protein”.
Egg Albumin 100.0
Whole egg 93.7
Generally, plant proteins have a lower
Milk 84.5 biological value due to the presence of
Fish 76.0 certain limiting amino acids.
Beef 74.3
Soybeans 72.8 Plant Limiting Amino Acid
Rice, polished 64.0 Corn Tryptophan, lysine
Wheat, whole 64.0 Wheat Lysine
Corn 60.0 Beans Methionine
Beans, dry 58.0
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9. Complementary Proteins Vegetarians
Ovolactovegetarians are healthier
Milk and cereal than most.
Beans and rice Vegans are, generally, not as
Corn and lima beans healthy and require supplements.
– Vegan diets are particularly unhealthy for children. They lack
calories, calcium, iron, B12.
Red Beans and Rice
– Children on vegan diets may be shorter than their peers.
Succotash
Relationship of Cancer to Animal
Dietary Protein Recommendations
Protein
With respect to cancer, the major
The recommended dietary allowance (RDA) for problem with animal protein is the
protein decreases from 2.2 g/kg in 3-mo-old amount of total fat and the way the
infants to 1.2 g/kg in 5-yr-old children and to protein is cooked. By cooking meat at
0.8 g/kg in adults. high temperatures (grilling, broiling), you
create carcinogens in the food. Plants
For an adult, this is very little protein! are generally cooked at lower
temperatures under less extreme
cooking conditions.
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10. Smoked and Charcoal-broiled
Foods
It is prudent to minimize these.
The Fiber Bandwagon
Fiber
25 - 30 grams per day
Do not exceed 35 grams per day.
Fiber in one, medium apple = 4 grams
Calories in one, medium apple = 53
Fat grams in one, medium apple = 0
Cost of one apple = $.40
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11. Fiber is not a molecule!
High Fiber Carb Advantage
It is a family of carbs.
1. Cellulose-beta glucosidic 1,4 linkages
2. Hemi-cellulose contains mainly xylose
One big advantage of eating high fiber 3. Lignin-complex fiber polymer
4. Pectin-apples, cranberries and cherries
foods, is that they fill you up and are
5. Gums and Mucilages-oatmeal and legumes
often high in protein, too, like beans. 6. Algal Polysaccharides – kelp (seaweeds)
7. Indigestible oligosaccharides – legumes
Fibers and Disease Metabolism of Fibers
Soluble fibers may form gels and sols Fibers cannot be digested by human enzymes.
in the intestine and may absorb
molecules like cholesterol, bile acids However, bacteria can metabolize fiber and
and salts, and carbohydrates (for produce short chain fatty acids (besides gases)
blood glucose control) which may be absorbed in the distal part of the
intestine.
Insoluble fibers provide bulk and may
stretch the GI tract and increase This adds a small amount of calories and may
peristalsis. This may decrease GI have metabolic affects.
cancer by eliminating the natural
carcinogens in food more quickly.
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12. Vitamins and Minerals
There are no recommendations from any major health
organization for a normal, healthy population to routinely take
a specific vitamin or mineral or a multivitamin/mineral
supplements, especially ones which contain more than 100%
The Vitamin and Antioxidant Hyphe the RDA for that vitamin or mineral.
There are sub-populations which might benefit. Examples
are:
– Women of childbearing age, specifically for folic acid (CDC, March of
Dimes recommendations)
– Children who are not getting enough Ca++ and Vitamin D
– For undernourished individuals.
– For people who have specific diseases or are critically ill.
– For postmenopausal women not getting enough calcium and Vitamin D.
National Institutes of Health State-of-the-Science Conference
Vitamins and Cancer Statement Multivitamin/Mineral Supplements and Chronic
Disease Prevention
Most recommendations for cancer-
In systematically evaluating the effectiveness and
preventing diets stress staying away safety of MVMs in relation to chronic disease
from excessive vitamin consumption. prevention, we found few rigorous studies on which to
base clear conclusions and recommendations. Most of
the studies we examined do not provide strong
I am not talking about meeting RDA’s. I evidence for beneficial health-related effects of
am talking about taking megadoses of supplements taken singly, in pairs, or in combinations
vitamins in the misguided attempt to of 3 or more.
prevent or cure or treat cancer.
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13. What about this idea that vitamins
Free Radical Theory
scavenge free radicals?
The free radical “grabs” a electron from
any molecule it its vicinity.
A free radical is a molecule with an
unpaired, highly reactive electron. It does this because electrons like to
exist in pairs.
When it “grabs” an electron from
another molecule, it damages the other
molecule.
Free Radical Theory Free Radical Theory
Some of the molecules that may be damaged by free radicals
are fats, proteins, and DNA (both in the nucleus and in Free radicals do not go unchecked. The
mitochondria). body has a multi-layed defense system
that reacts and detoxifies the damaging
If membrane fats are attacked, then you get the breakdown of radicals.
the cell membrane. If it is a red blood cell membrane, you get
hemolysis. Defenses include:
If proteins are attacked, you get the breakdown of proteins, – Natural antioxidants in the body, such as BILIRUBIN.
which may result in the loss of biological function and the – Enzymes such as superoxide dismutase (SOD),
accumulation of “catastrophic” compounds. catalase, & glutathione peroxidase.
If DNA is attacked, you will get a mutation that may cause aging
– Dietary antioxidants such as beta carotene, and the
or cancer.
vitamins C and E (when present in food).
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14. Tocopherol Acetate
The form in vitamins. Free Radical Theory
For example, when Vitamin E “scavenges” free
radicals, it becomes a free radical and may be
more carcinogenic than the original free
radical.
This is the reason why taking high doses of
vitamin E SUPPLEMENTS or other free radical
scavengers, like beta carotene, appears to
INCREASE cancer risk in a person, not
decrease cancer risk.
Many times, vitamin E free radical is a more SELECT Vit E/Selenium
powerful pro-oxidant than the original free
radical.
Prostate Cancer Trial
Meta-analysis: high-dosage vitamin E supplementation may increase SELECT participants are being told to STOP taking their
all-cause mortality. Ann Intern Med. 2005 Jan 4;142(1) study supplements but will continue to have their health
monitored by study staff for about three more years.
135,967 participants in 19 clinical trials. The independent Data and Safety Monitoring Committee (DSMC) for
Of these trials, 9 tested vitamin E alone and 10 tested vitamin E the trial found that selenium and vitamin E, taken alone or together for
combined with other vitamins or minerals. The dosages of vitamin E an average of five years, did not prevent prostate cancer.
ranged from 16.5 to 2000 IU/d (median, 400 IU/d. The data also showed two concerning trends: there were
A dose-response analysis showed a statistically significant relationship slightly more cases of prostate cancer in men taking only
between vitamin E dosage and all-cause mortality. vitamin E and slightly more cases of diabetes in men
taking only selenium.
CONCLUSION: High-dosage (> or =400 IU/d) vitamin E supplements
may increase all-cause mortality and should be avoided.
http://www.cancer.gov/newscenter/pressreleases/SELECTQandA
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15. Beta Carotene Supplements and Lung Cancer Total Fat
Smokers who take beta-carotene
supplements have higher lung cancer
rates than smokers not taking these 25-35% or less of total calories
supplements. However, smokers who
eat 5 or more fruits and vegetables a
day have a decreased risk of lung
cancer. Ironically, smokers are more
likely to take supplements than to eat
tomatoes!
I hate
broccoli!
Fat is very calorie-dense. Obesity
> 60% dietary calories from fat results in
Calories/gram obesity in all animals. One major
Fat 9 kcal/gram problem with the American diet today
Alcohol 7 kcal/gram is that it has too much fat...40-42%. The
Carbs 4 kcal/gram more you approach this >60% figure,
Protein 4 kcal/gram the more prevalent obesity will be in the
population.
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16. Saturated Fat Lean Bacon?
No more than 6-10% of total calories
Oscar Mayer proudly presents our Center Cut Bacon premium
slices, carefully selected and hand trimmed from our meatiest
cuts to give you 30% Lower Fat. When you want to treat your
family to the very best, OSCAR MAYER® Center Cut Bacon
consistently delivers great tasting bacon with the famous
naturally hardwood smoked flavor you've come to expect from
Oscar Mayer. Oscar Mayer... nothing but the best®!
Lean Bacon? Fat and Blood Cholesterol
Type of Fat LDL HDL
Serving Size 12g
Servings per package 10 Monounsaturated lowers raises
olive oil, canola oil
Amount Per Serving Saturated raises raises
Total Calories 50
butter
Calories from Fat 35 (70% Total Calories)
Trans fat raises lowers
Total Fat 4g
Polyunsaturated lowers no effect
Saturated Fat 2g (50% Total Fat Calories)
fish oil
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17. Monounsaturated Fat Is eating chocolate really healthy?
The main fat in chocolate is stearic acid.
Stearic acid (C18:0) is the only saturated fatty acid that
Up to 15-20% of total calories does not raise LDL cholesterol. The reason is that after
absorption, stearic acid is desaturated to C18:1; hence,
the action of stearic acid in the liver is that of the
monounsaturated fatty acid, oleic acid.
Substitute monounsaturated fats for
saturated fats and trans fatty acids However, chocolate is loaded with fat and sugar and has
a huge amount of calories, so WATCH IT! It is not a
health food!
What about the antioxidants (procyanidins) in chocolate?
There is very little relationship between the studies on
unpurified and unprocessed raw chocolate and a candy
bar!
A Word About Trans Fat Polyunsaturated Fat
Hydrogenation is a chemical
process used to add
hydrogen atoms to the
unsaturated fatty acids. The Up to 10 % of total calories
addition of hydrogen
reduces the development of
off-flavors in oil products.
During hydrogenation,
hydrogen bonds in
unsaturated fat may change
from the cis form to the trans
form.
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18. American Heart Association
Recommendations for Omega-3 Fatty Acids
Cholesterol
Patients without documented coronary heart disease (CHD)
– Eat a variety of (preferably fatty) fish at least twice a week. Include oils
and foods rich in alpha-linolenic acid (flaxseed, canola and soybean oils;
flaxseed and walnuts).
Patients with documented CHD No more than 300mg/day
– Consume about 1 g of EPA+DHA per day, preferably from fatty
fish. EPA+DHA supplements could be considered in consultation with
the physician.
Patients who need to lower triglycerides
– 2 to 4 grams of EPA+DHA per day provided as capsules under a
physician’s care.
Patients taking more than 3 grams of omega-3 fatty acids from
supplements should do so only under a physician’s care. High
intakes could cause excessive bleeding in some people.
NOTE: Vitamin E is also an anti-coagulant.
Are eggs healthy, again???
They always have been and they always will
be healthy. It’s the yolk (for most people)
that’s the problem, but even that is not a
poison! It’s too many eggs that’s the
problem, how they are cooked, and the
bacon that comes with them.
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19. Total Carbohydrates
What’s all the fuss about carbs? Complex carbohydrates
50% of total calories
Sugars
10% or less of total calories
Carbs? Whole Grain Carbs!
Microwave in the husk for 3 minutes, then husk
This is corn, fat, and carcinogens corn and shake in a bag with olive-oil margarine,
some salt (if you want) and we add Cajun spices
yum, yum! or curry. Delicious and healthy!
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20. Carbohydrates Calories
Carbohydrates are not considered essential to the diet Non-essential
from a biochemical point of view, since they can be Amino Acids
synthesized from glycogenic amino acids.
Fats
Ketogenic
Carbohydrates are a cheap source of calories
Carbohydrates will "spare" fat metabolism in your
body.
– sufficient carbohydrates are needed in your diet to prevent excess fat
breakdown or ketosis. Low carb diets promote ketosis. Ketone Bodies
– 50-100 gms carbohydrate/day alleviates ketosis Carbohydrates
Some organs and the fetus use glucose as a sole
source of energy.
Ketosis
The Diet to Promote Health
Ketosis is an abnormal state and is and
unhealthy. It occurs during starvation DELAY Disease
and during illnesses (such as diabetes).
It is not an end-point titration for healthy
dieting!
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21. Macronutrients
Caloric Distributions/Total Amount THE DIET
Total Fat 25-35% Total Calories
– Saturated Fat no more than 6-10%
– Monounsaturated FatUp to 15-20% Eat less sugar and the sugar you eat should
– Polyunsaturated Fat Up to 10% come from fruits and dairy products.
– Cholesterol not more than 300 mg/day Eat better quality starchs.
Eat more whole grain foods.
Carbohydrates 50-60% Eat more high fiber foods.
– Sugars no more than 10%
Eat food, not supplements
– Starches 50%
Eat less salt.
Total Fiber 20-30 gms/day, not Drink less alcohol, but a little is probably ok.
more than 35 Eat less red meat.
– Soluble Fiber 10-25 gm/day
Eat more fish, especially oily fish.
Protein Up to 15%, mostly as
vegetable protein.
THE DIET THE DIET
Eat less smoked and charcoal-broiled foods. Overall, eat less fat
Eat more nuts. – Eat less saturated fat
Avoid high doses of vitamin supplements
– Eat less trans fatty acids
Don’t be fat.
– Eat more monounsaturated fat
Exercise more.
– Eat fewer high-cholesterol foods.
Avoid moldy foods.
Don’t eat burnt food.
Increase your amount of soy products.
Eat more variety of foods.
Drink fluoridated water and eat iodized salt.
Breastfeed your babies.
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22. THE DIET
IN A NUTSHELL
Eat a varied plant-based diet with
moderate amounts of meat, fat,
sugar, and salt and exercise every
Enjoy what you are eating and stop
being such a food phobic and bore
day.
about your diet!
Great Nutrition Websites About the Speaker
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi Warren B. Karp, Ph.D., D.M.D. is Professor Emeritus of
Pediatrics, Biochemistry and Molecular Biology, Oral Biology
(public access site to Medline) and Oral Diagnosis at the Georgia Health Sciences
www.americanheart.org University, in Augusta, GA. He has a Ph.D. in nutritional
www.diabetes.org biochemistry from The Ohio State University and a Doctorate
in Dental Medicine from the Georgia Health Sciences
www.eatright.org University. He is an elected member of The American
www.usda.gov Institute of Nutrition (Federation of Societies of Experimental
www.guidelines.gov Biology) and is past president of the Georgia Nutrition
Council. He has served as Director of the Nutrition Consult
www.cancer.org Service at the College of Dental Medicine for over twenty
www.nih.gov years, and has served as Vice Chair of the Board of Health
http://www.nhlbi.nih.gov/health/public/heart/hbp in Augusta (Columbia County).
/dash/
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