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The Role of Nutrition in Human Health, Disease, and Aging – A Practical Approach
Christopher B. Heward, Ph.D.President – Kronos Science Laboratories, Inc.
IABG 10th Congress - September 2003
Physician: “We think you ate something that triggered some primitive genes?”Patient: “But Doc, what do I do?”
Physician: “Stop eating so much sh__ …garbage!”
Sound Nutritional Advice
The Current Scientific Consensus About Nutrition
USDA Dietary Guidelines
THE USDA FOOD PYRAMIDTHE USDA FOOD PYRAMID
Promotes a grain-basedPromotes a grain-basedlow fat / high carbohydrate diet.low fat / high carbohydrate diet.
1955 1962 1969 1976 1983 1990
34
42
32
36
38
40% Dietary Calories as Fat
% o
f C
alo
ries
fro
m F
at
from Amer Dietetic Assoc 95 417-420(1995)
Year
Dietary Fat Intake and Obesity (US 1955-1990)
% Dietary Calories as Fat
35
32
29
26
23
20
1955 1962 1969 1976 1983 1990
34
42
32
36
38
40
% O
verw
eig
ht
% o
f C
alo
ries
fro
m F
at
from Amer Dietetic Assoc 95 417-420(1995)
Year
Dietary Fat Intake and Obesity (US 1955-1990)
% Overweight
% Dietary Calories as Fat
Actual Causes of Death – United States (1990)
Tobacco 400,000 19%
Diet/Activity Patterns 300,000 14%
Alcohol 100,000 5%
Microbial Agents 90,000 4%
Toxic Agents 60,000 3%
Firearms 35,000 2%
Sexual Behavior 30,000 1%
Motor Vehicles 25,000 1%
Illicit Use of Drugs 20,000 <1%
Cause Estimated Number % of Cause Estimated Number % of TotalTotal
McGinnis et al. - JAMA, November 10, McGinnis et al. - JAMA, November 10, 19931993
Actual Causes of Death – United States (1990)
Tobacco 400,000 19%
Diet/Activity Patterns 300,000 14%
Alcohol 100,000 5%
Microbial Agents 90,000 4%
Toxic Agents 60,000 3%
Firearms 35,000 2%
Sexual Behavior 30,000 1%
Motor Vehicles 25,000 1%
Illicit Use of Drugs 20,000 <1%
Cause Estimated Number % of Cause Estimated Number % of TotalTotal
McGinnis et al. - JAMA, November 10, McGinnis et al. - JAMA, November 10, 19931993
Major Causes of Death in the US
29.6
23
7
5.1
4.1
2.9
2.72.1
1.5 1.3 1.2 1.1 0.8
Cardiovascular Disease
Cancer
Cerebrovascular Disease
Chronic Pulmonary Disease
Accidents
Diabetes Mellitus
Influenza & PneumoniaAlzheimers
KidneySepticemia
Suicide Chronic Liver Disease/Cirrhosis
Hypertension & Hypertensive Renal Disease
Not Shown: 17.6 - Other Source: Minino, AM, Arias, E, Kochanek, et al., Summary National Vital Statistics 2000
The Problem
Visceral FatVisceral Fat
Subcutaneous FatSubcutaneous Fat
Obesity Trends* Among U.S. AdultsBRFSS, 1990
Source: Mokdad A H, et al. J Am Med Assoc 1999;282:16, 2001;286:10.
Height (meters)Height (meters)BMI = BMI =
[Weight (kilograms)][Weight (kilograms)]22
[Height (Inches) / 39.54][Height (Inches) / 39.54]BMI = BMI =
[Weight (Pounds) / 2.2][Weight (Pounds) / 2.2]22
Body Mass Index (BMI)
Body Type BMI RangeUnderweight < 18.5Healthy Weight 18.5 - 24.9Overweight 25.0 - 29.9Obese 30.0 - 39.9Extremely Obese > 40.0
Weight Ranges For Different BMI Scores
Obesity Trends* Among U.S. AdultsBRFSS, 1991
Source: Mokdad A H, et al. J Am Med Assoc 1999;282:16, 2001;286:10.
Obesity Trends* Among U.S. AdultsBRFSS, 1992
Source: Mokdad A H, et al. J Am Med Assoc 1999;282:16, 2001;286:10.
Obesity Trends* Among U.S. AdultsBRFSS, 1993
Source: Mokdad A H, et al. J Am Med Assoc 1999;282:16, 2001;286:10.
Obesity Trends* Among U.S. AdultsBRFSS, 1994
Source: Mokdad A H, et al. J Am Med Assoc 1999;282:16, 2001;286:10.
Obesity Trends* Among U.S. AdultsBRFSS, 1995
Source: Mokdad A H, et al. J Am Med Assoc 1999;282:16, 2001;286:10.
Obesity Trends* Among U.S. AdultsBRFSS, 1996
Source: Mokdad A H, et al. J Am Med Assoc 1999;282:16, 2001;286:10.
Obesity Trends* Among U.S. AdultsBRFSS, 1997
Source: Mokdad A H, et al. J Am Med Assoc 1999;282:16, 2001;286:10.
Obesity Trends* Among U.S. AdultsBRFSS, 1998
Source: Mokdad A H, et al. J Am Med Assoc 1999;282:16, 2001;286:10.
Obesity Trends* Among U.S. AdultsBRFSS, 1999
Source: Mokdad A H, et al. J Am Med Assoc 1999;282:16, 2001;286:10.
Obesity Trends* Among U.S. AdultsBRFSS, 2000
Source: Mokdad A H, et al. J Am Med Assoc 1999;282:16, 2001;286:10.
Obesity Trends* Among U.S. AdultsBRFSS, 2001
Source: Mokdad A H, et al. J Am Med Assoc 1999;282:16, 2001;286:10.
What Do The Experts Say?
• Dr. Atkins’ New Diet Revolution - Atkins
• Protein Power - Eades
• Sugar Busters - Steward
• The Zone - Sears
• Dieting With The Duchess - Sarah
• Volumetrics - Rolls
• The Pritikin Principle - Pritikin
• Choose To Lose - Goor
• Eat More, Weigh Less - Ornish
Comparison of Popular Diets - Macronutrients
Atkins Eades USDA Sears Sarah Pritikin OrnishTotal Fat (g) 110 105 66 30 30 15 10% Total Fat (by weight) 31.3% 31.0% 14.3% 12.3% 8.7% 3.6% 2.5%Total Fat (Calories) 990 945 594 270 270 135 90% Total Fat Calories 55.9% 56.8% 29.7% 26.7% 19.4% 8.6% 6.0%Sat. Fat (g) 36 34 22 8 10 3 2% Sta. Fat (by weight) 10.3% 10.0% 4.8% 3.3% 2.9% 0.7% 0.5%Sat. Fat (Calories) 324 306 198 72 90 27 18% Sat. Fat Calories 18.3% 18.4% 9.9% 7.1% 6.5% 1.7% 1.2%Protein (g) 135 110 62 70 90 95 60% Protein (by weight) 38.5% 32.4% 13.5% 28.8% 26.1% 22.7% 14.9%Protein (Calories) 540 440 248 280 360 380 240% Protein Calories 30.5% 26.4% 12.4% 27.7% 25.9% 24.1% 16.1%Carbs. (g) 60 70 290 115 190 265 290% Carbs (by weight) 17.1% 20.6% 63.0% 47.3% 55.1% 63.4% 72.1%Carbs. (Calroies) 240 280 1160 460 760 1060 1160% Carbs Calories 13.6% 16.8% 57.9% 45.5% 54.7% 67.3% 77.9%Fiber (g) 10 20 20 20 25 40 40% Fiber (by weight) 2.8% 5.9% 4.3% 8.2% 7.2% 9.6% 10.0%Total Intake (g) 351 339 460 243 345 418 402Total Calc. Intake (Calories) 1770 1665 2002 1010 1390 1575 1490
Comparison of Popular Diets - Macronutrients
Atkins Eades USDA Sears Sarah Pritikin OrnishTotal Fat (g) 110 105 66 30 30 15 10% Total Fat (by weight) 31.3% 31.0% 14.3% 12.3% 8.7% 3.6% 2.5%Total Fat (Calories) 990 945 594 270 270 135 90% Total Fat Calories 55.9% 56.8% 29.7% 26.7% 19.4% 8.6% 6.0%Sat. Fat (g) 36 34 22 8 10 3 2% Sta. Fat (by weight) 10.3% 10.0% 4.8% 3.3% 2.9% 0.7% 0.5%Sat. Fat (Calories) 324 306 198 72 90 27 18% Sat. Fat Calories 18.3% 18.4% 9.9% 7.1% 6.5% 1.7% 1.2%Protein (g) 135 110 62 70 90 95 60% Protein (by weight) 38.5% 32.4% 13.5% 28.8% 26.1% 22.7% 14.9%Protein (Calories) 540 440 248 280 360 380 240% Protein Calories 30.5% 26.4% 12.4% 27.7% 25.9% 24.1% 16.1%Carbs. (g) 60 70 290 115 190 265 290% Carbs (by weight) 17.1% 20.6% 63.0% 47.3% 55.1% 63.4% 72.1%Carbs. (Calroies) 240 280 1160 460 760 1060 1160% Carbs Calories 13.6% 16.8% 57.9% 45.5% 54.7% 67.3% 77.9%Fiber (g) 10 20 20 20 25 40 40% Fiber (by weight) 2.8% 5.9% 4.3% 8.2% 7.2% 9.6% 10.0%Total Intake (g) 351 339 460 243 345 418 402Total Calc. Intake (Calories) 1770 1665 2002 1010 1390 1575 1490
Comparison of Popular Diets - Macronutrients
Atkins Eades USDA Sears Sarah Pritikin OrnishTotal Fat (g) 110 105 66 30 30 15 10% Total Fat (by weight) 31.3% 31.0% 14.3% 12.3% 8.7% 3.6% 2.5%Total Fat (Calories) 990 945 594 270 270 135 90% Total Fat Calories 55.9% 56.8% 29.7% 26.7% 19.4% 8.6% 6.0%Sat. Fat (g) 36 34 22 8 10 3 2% Sta. Fat (by weight) 10.3% 10.0% 4.8% 3.3% 2.9% 0.7% 0.5%Sat. Fat (Calories) 324 306 198 72 90 27 18% Sat. Fat Calories 18.3% 18.4% 9.9% 7.1% 6.5% 1.7% 1.2%Protein (g) 135 110 62 70 90 95 60% Protein (by weight) 38.5% 32.4% 13.5% 28.8% 26.1% 22.7% 14.9%Protein (Calories) 540 440 248 280 360 380 240% Protein Calories 30.5% 26.4% 12.4% 27.7% 25.9% 24.1% 16.1%Carbs. (g) 60 70 290 115 190 265 290% Carbs (by weight) 17.1% 20.6% 63.0% 47.3% 55.1% 63.4% 72.1%Carbs. (Calroies) 240 280 1160 460 760 1060 1160% Carbs Calories 13.6% 16.8% 57.9% 45.5% 54.7% 67.3% 77.9%Fiber (g) 10 20 20 20 25 40 40% Fiber (by weight) 2.8% 5.9% 4.3% 8.2% 7.2% 9.6% 10.0%Total Intake (g) 351 339 460 243 345 418 402Total Calc. Intake (Calories) 1770 1665 2002 1010 1390 1575 1490
Comparison of Popular Diets - Macronutrients
Atkins Eades USDA Sears Sarah Pritikin OrnishTotal Fat (g) 110 105 66 30 30 15 10% Total Fat (by weight) 31.3% 31.0% 14.3% 12.3% 8.7% 3.6% 2.5%Total Fat (Calories) 990 945 594 270 270 135 90% Total Fat Calories 55.9% 56.8% 29.7% 26.7% 19.4% 8.6% 6.0%Sat. Fat (g) 36 34 22 8 10 3 2% Sta. Fat (by weight) 10.3% 10.0% 4.8% 3.3% 2.9% 0.7% 0.5%Sat. Fat (Calories) 324 306 198 72 90 27 18% Sat. Fat Calories 18.3% 18.4% 9.9% 7.1% 6.5% 1.7% 1.2%Protein (g) 135 110 62 70 90 95 60% Protein (by weight) 38.5% 32.4% 13.5% 28.8% 26.1% 22.7% 14.9%Protein (Calories) 540 440 248 280 360 380 240% Protein Calories 30.5% 26.4% 12.4% 27.7% 25.9% 24.1% 16.1%Carbs. (g) 60 70 290 115 190 265 290% Carbs (by weight) 17.1% 20.6% 63.0% 47.3% 55.1% 63.4% 72.1%Carbs. (Calroies) 240 280 1160 460 760 1060 1160% Carbs Calories 13.6% 16.8% 57.9% 45.5% 54.7% 67.3% 77.9%Fiber (g) 10 20 20 20 25 40 40% Fiber (by weight) 2.8% 5.9% 4.3% 8.2% 7.2% 9.6% 10.0%Total Intake (g) 351 339 460 243 345 418 402Total Calc. Intake (Calories) 1770 1665 2002 1010 1390 1575 1490
Comparison of Popular Diets - Macronutrients
Atkins Eades USDA Sears Sarah Pritikin OrnishTotal Fat (g) 110 105 66 30 30 15 10% Total Fat (by weight) 31.3% 31.0% 14.3% 12.3% 8.7% 3.6% 2.5%Total Fat (Calories) 990 945 594 270 270 135 90% Total Fat Calories 55.9% 56.8% 29.7% 26.7% 19.4% 8.6% 6.0%Sat. Fat (g) 36 34 22 8 10 3 2% Sta. Fat (by weight) 10.3% 10.0% 4.8% 3.3% 2.9% 0.7% 0.5%Sat. Fat (Calories) 324 306 198 72 90 27 18% Sat. Fat Calories 18.3% 18.4% 9.9% 7.1% 6.5% 1.7% 1.2%Protein (g) 135 110 62 70 90 95 60% Protein (by weight) 38.5% 32.4% 13.5% 28.8% 26.1% 22.7% 14.9%Protein (Calories) 540 440 248 280 360 380 240% Protein Calories 30.5% 26.4% 12.4% 27.7% 25.9% 24.1% 16.1%Carbs. (g) 60 70 290 115 190 265 290% Carbs (by weight) 17.1% 20.6% 63.0% 47.3% 55.1% 63.4% 72.1%Carbs. (Calroies) 240 280 1160 460 760 1060 1160% Carbs Calories 13.6% 16.8% 57.9% 45.5% 54.7% 67.3% 77.9%Fiber (g) 10 20 20 20 25 40 40% Fiber (by weight) 2.8% 5.9% 4.3% 8.2% 7.2% 9.6% 10.0%Total Intake (g) 351 339 460 243 345 418 402Total Calc. Intake (Calories) 1770 1665 2002 1010 1390 1575 1490
Comparison of Popular Diets - Macronutrients
Atkins Eades USDA Sears Sarah Pritikin OrnishTotal Fat (g) 110 105 66 30 30 15 10% Total Fat (by weight) 31.3% 31.0% 14.3% 12.3% 8.7% 3.6% 2.5%Total Fat (Calories) 990 945 594 270 270 135 90% Total Fat Calories 55.9% 56.8% 29.7% 26.7% 19.4% 8.6% 6.0%Sat. Fat (g) 36 34 22 8 10 3 2% Sta. Fat (by weight) 10.3% 10.0% 4.8% 3.3% 2.9% 0.7% 0.5%Sat. Fat (Calories) 324 306 198 72 90 27 18% Sat. Fat Calories 18.3% 18.4% 9.9% 7.1% 6.5% 1.7% 1.2%Protein (g) 135 110 62 70 90 95 60% Protein (by weight) 38.5% 32.4% 13.5% 28.8% 26.1% 22.7% 14.9%Protein (Calories) 540 440 248 280 360 380 240% Protein Calories 30.5% 26.4% 12.4% 27.7% 25.9% 24.1% 16.1%Carbs. (g) 60 70 290 115 190 265 290% Carbs (by weight) 17.1% 20.6% 63.0% 47.3% 55.1% 63.4% 72.1%Carbs. (Calroies) 240 280 1160 460 760 1060 1160% Carbs Calories 13.6% 16.8% 57.9% 45.5% 54.7% 67.3% 77.9%Fiber (g) 10 20 20 20 25 40 40% Fiber (by weight) 2.8% 5.9% 4.3% 8.2% 7.2% 9.6% 10.0%Total Intake (g) 351 339 460 243 345 418 402Total Calc. Intake (Calories) 1770 1665 2002 1010 1390 1575 1490
The Metabolic Imperative
EnergyEnergyIntakeIntake
EnergyEnergyExpendedExpended==
The Metabolic Imperative
EnergyEnergyExpendedExpended
EnergyEnergyIntakeIntake
>>
The Metabolic Imperative
EnergyEnergyIntakeIntake
EnergyEnergyExpendedExpended
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NO!NO!
Does That Mean You Should Go On A Diet?
Rx For Healthy Nutrition and Weight Control
Diet
• Carbohydrates - 35% (Fruits & Vegetables)
• Proteins - 30% of Calories (Fish, Poultry, Eggs)
• Fats - 35% of Calories (Fish, Meat, Nuts, Oils)
1/3 - Saturated
1/3 - Monounsaturated
1/3 - Polyunsaturated
• Colorful Fruits and Vegetables
Supplements
• Vitamins & Minerals (RDA)
• Omega-3 FA’s (fish oil)
0
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<200 >200
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(A
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In the 88,000 Nurses Study, Dietary Vitamin E greater than 200 IU per In the 88,000 Nurses Study, Dietary Vitamin E greater than 200 IU per day was associated with a 41% Decreased Risk for Major Coronary day was associated with a 41% Decreased Risk for Major Coronary Heart Diseases.Heart Diseases.
Vitamin E and Heart Disease
Health Benefits:Health Benefits:• Reduces Risk of Sudden Cardiac DeathReduces Risk of Sudden Cardiac Death• Anti-inflammatory PropertiesAnti-inflammatory Properties• Improves Membrane FluidityImproves Membrane Fluidity• Increases HDL (good) CholesterolIncreases HDL (good) Cholesterol• Reduces Blood PressureReduces Blood Pressure• Reduces Risk of Blood ClotsReduces Risk of Blood Clots• Lowers LP(a) Lowers LP(a)
Eicosapentaenoic Acid (EPA, 20:5w3)Docosahexaenoic Acid (DHA, 22:6w3)
Omega-3 Fatty Acids (fish oil)
Consume ONLY those foods with a nutritional payoff -
NO EMPTY CALORIES!NO EMPTY CALORIES!Consume ONLY those foods with a nutritional payoff -
NO EMPTY CALORIES!NO EMPTY CALORIES!
• VitaminsVitamins
• MineralsMinerals
• WaterWater
• Amino AcidsAmino Acids
• Fatty AcidsFatty Acids
• PhytochemicalsPhytochemicals
X
X
X
X
XXX
Focus On Essentials - Eat Mostly Nutrient-Dense Foods
Avoid Avoid ““Trans” Fats!Trans” Fats!
Avoid Avoid ““Trans” Fats!Trans” Fats!
USDA Revising The Food Pyramid?
What About Caloric Restriction and Aging?
0
20
40
60
80
100
0 10 20 30 40 50 60
Age (months)
Perc
ent
Surv
ival
Adapted From: R. Weindruch et al. , J. of Nutrition, 116:641, 1986
Fully Fed
50% Calorie Restriction
10% Calorie Restriction
60% Calorie Restriction
Typical Survival Curves For Mice On CR Diets
Caloric Restriction In Adult Mice
0
6 12
Age (months)
12991177941Group 4
1040918808Group 3
129612261057Group 2
941822701Group 1
Maximum10th %ileMedian
Length Of Life In Days
ad libidum
60% of ad libidum intake
0 6 120 6 12 Age (months)Age (months)
Data from Yu et al. (1985) Figure from Masoro (1989)Data from Yu et al. (1985) Figure from Masoro (1989)
Caloric Restriction In Adult Mice
0
6 12
Group 4 Lifespan Increase: ~40%Age (months)
12991177941Group 4
1040918808Group 3
129612261057Group 2
941822701Group 1
Maximum10th %ileMedian
Length Of Life In Days
ad libidum
60% of ad libidum intake
0 6 120 6 12 Age (months)Age (months)
Data from Yu et al. (1985) Figure from Masoro (1989)Data from Yu et al. (1985) Figure from Masoro (1989)
Studies of Late-Onset Caloric Restriction
Adapted From Walford & Weindruch (1989)Adapted From Walford & Weindruch (1989)
5%13%4135393112M50%Rat5
10%8%4539413614M50%Mouse4
18%30%3330282312M50%Hamster3
15%24%3026262112M50%Mouse2
0%44%3026301812M50%Rat1
MaxAveMaxAveMaxAveOnsetCRAnimalStudy
Ad libidumAd libidum RestrictedRestricted % Increase% Increase
Length Of Life In Months
Studies of Late-Onset Caloric Restriction
Adapted From Walford & Weindruch (1989)Adapted From Walford & Weindruch (1989)
5%13%4135393112M50%Rat5
10%8%4539413614M50%Mouse4
18%30%3330282312M50%Hamster3
15%24%3026262112M50%Mouse2
0%44%3026301812M50%Rat1
MaxAveMaxAveMaxAveOnsetCRAnimalStudy
Ad libidumAd libidum RestrictedRestricted % Increase% Increase
Length Of Life In Months
The Payoff From A Successful Caloric Restriction Diet
• Constant Hunger• Abnormal Focus On Food (24hrs./day)• Loss of Libido (reproductive function)• Increased Life Expectancy
Payoff:– If, starting at age 50, you do CR successfully
for 30 years, then when you are 80 years old, you will function as though you were only 70.
~33% Retardation of Aging Rate
This is just NOT enough for most people!
Adapted From: British Medical Journal, 1997; 314: 1311-1317 Adapted From: British Medical Journal, 1997; 314: 1311-1317
0
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Body Mass Index
Death
s/1
000/y
ear
All Cause Mortality
Height (meters)Height (meters)BMI = BMI =
[Weight (kilograms)][Weight (kilograms)]22
BMI and All Cause Mortality
Lee CD et al. Am J Clin Nutr 1999.
0
0.5
1
1.5
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2.5
Lean Normal Obese
Ris
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eath
Unfit Fit
<16% 16-25% 25%
Ris
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eath
Fit-Fat & Mortality In Men
% Body Fat% Body Fat
• 173 Sedentary, overweight, post-menopausal women• Exercise group: 45 minutes, 5 day/day X 1 year• 3 months 3 d/week supervised & 2 days
unsupervised • 9 months 1 d/week supervised & 4 days
unsupervised-2.86
-8.5
0.22 0.1
-9-8-7-6-5-4-3-2-101
Weight (lbs) Visceral Fat(g/cm2)
Exercise Control
(1.6%)
(5.7%)
p< 0.05 for change in weight and VF JAMA- Jan 15, 2003: Vol 289(3)
Effect of Exercise On Total and Visceral Body Fat
Conclusions
• Americans are too fat – and getting fatter.• The best diet is to reduce caloric intake without reducing
nutritional intake.• Take high quality dietary supplements that include:
– Vitamins and Minerals (RDA)
– Fish Oil
– Vitamin E
• The benefits (if any) of serious CR diets are not worth the effort for most people.
• Exercise may help compensate for some of the negative health affects of obesity.