Transcript Anti-Inflammatory Cooking: Everyday Foods Can Reduce Risk of

Cooking with Heart: Anti-inflammatory
Cooking
Richard E. Collins, MD, FACC
THE COOKING CARDIOLOGIST®
Outline of Today’s Talk
• What is inflammation?
• The important role of inflammation in the
development of coronary artery disease.
• What foods are considered anti-inflammatory?
• Are supplements protective?
• How does cooking affect foods?
• Cooking methods to reduce inflammation
• Cooking demonstration…chocolate blueberries
and guiltless potato chips.
Inflammation
• Part of a healthy immune system response
• Low-level, chronic inflammation is an
excessive, inappropriate inflammatory
response
• Linked to heart disease, cancer, diabetes,
osteoporosis, Alzheimer’s disease and
even depression and mood disorders
Models for the Role of
Inflammatory Markers
Risk Factor Model:
Inflammation is causative
Traditional risk factors
Atherosclerosis
CVD
Inflammatory marker
Risk Marker Model:
Inflammation is not causative
Inflammatory marker
Traditional risk factors
Inflammatory marker
Atherosclerosis
CVD
CVD = cardiovascular disease.
Adapted from Pearson TA et al. Circulation. 2003;107:499 511, with permission from Lippincott Williams
and Wilkins.
Relationship Between Atherogenic
Lipoproteins and Inflammation
• A high plasma LDL-C level is a major risk factor and causes the
development of atherosclerosis. Beyond LDL, other lipids are
pro-inflammatory including elevated triglycerides, VLDL
remnants, small particle size LDL.1
• Inflammation plays a role in all stages of atherogenesis.2,3
• Increased circulating levels of inflammatory markers may
indicate the presence of atherosclerotic disease.3
– May provide independent predictive risk beyond established lipid
risk factors.
1. Grundy SM et al. Circulation. 2004;110:227 239. 2. Ross R. N Engl J Med.
1999;340:115 126. 3. Hansson GK. N Engl J Med. 2005;352:1685 1695.
Markers of Inflammation
Most researched markers of inflammation1–4
 MPO
 LpPLA2
 CRP
 SAA
Other inflammatory markers5
•
 Adhesion proteins
Inflammatory signaling
molecules
–
–
–
–
– IL-1
– IL-6
– TNF-a
 Chemokines
– IL-18
–
– CD40L
•
ICAM-1
VCAM-1
E-selectin
Fibronectin
MCP-1
Soluble cytokine receptors
– TNFR
– IL-1R
1.Clin Chem. 2000;46:461─468. 2. Uhlar CM et al. Eur J Biochem.
1999;265:501 523. 3. Zhang R et al. JAMA. 2001;286:2136 2142. 4. Packard CJ et al. N
Engl J Med. 2000;343:1148 1155. 5. Ridker PM et al. Circulation. 2004;109(suppl
IV):IV6 V19.
─
─
─
─
7
Post Prandial State is Toxic
8
The Effect of Post Prandial Hyperglycemia
(Dysmetabolism) on the Vascular System
•
•
•
•
•
•
Endothelial dysfunction
Triggering of acute inflammation
Oxidant stress
Hypercoagulability
Sympathetic hyperactivity
Post meal increases in triglycerides, VLDL
remnants, HDL clearance and production
of small dense LDL particles
Postprandial change in plasma
lipid levels
mg/dL
mg/dL
Postprandial Lipemia: Increased
Levels of TG and RLPs
*P<0.01 vs hr 0.
†P<0.05
620
Triglycerides
531
443
*
354
266
177
0
2
*
*
*
4
6
39 Cholesterol in RLPs
35
*
31
†
27
23
19
15
0
2
4
*
6
8
N= 15
*
8
Hours following ingestion of oral fat load
vs hr 0.
TG = triglyceride; RLP = remnant lipoprotein.
10
Maggi FM, Raselli S, Grigore L, Redaelli, Fantapple S, Catapano AL. Lipoprotein remnants and endothelial dysfunction in the
postprandial phase. J Clin Endocrinol Metab. 2004;89:2946─2950, Copyright 2004, The Endocrine Society.
Fat Is Toxic
11
12
Foods that promote inflammatory
disease
• Foods with high saturated fat content, such
as animal products and dairy products
• Foods with high omega-6 fatty acid content
and low omega-3 fatty acids such as
partially hydrogenated oils, margarine, oils
from corn, cottonseed, safflower, sesame
and sunflower
• Foods with high glycemic load, such as
bagels, instant rice, white pasta
Foods that promote inflammatory
disease
• Food with high allergy potential, such as
dairy products, wheat and eggs
• These inflammatory foods can increase
production of inflammatory mediators
• Foods with high allergy potential may also
increase intestinal permeability, triggering
immune response and potential increase in
inflammatory disease
Anti-Inflammatory Foods
• Foods with high omega-3 fatty acids, such
as cold water fish, flaxseeds, walnuts
• Foods with high levels of antioxidants, such
as vegetables, citrus fruits, cherries, garlic,
onion and tea
• Spices, in particular, ginger, garlic,
rosemary, turmeric, oregano,
cayenne, clove and nutmeg
Anti-Inflammatory Foods
• Low glycemic index/load foods
• Mediterranean diet foods rich in omega-3
fatty acids, fruits/vegetables,
nuts
Polyunsaturated fatty acids in
inflammation
• Coronary heart disease, major depression,
aging and cancer are characterized by an
increased level of interleukin 1 (IL-1), a proinflammatory cytokine.
• Arthritis, Crohn’s disease, ulcerative colitis
and lupus erythematosis are autoimmune
diseases characterized by a high level of
IL-1 and the pro-inflammatory leukotriene
LTB(4) produced by omega-6 fatty acids.
Omega-3 fatty acids in
inflammation
• Among the fats, omega-3 PUFA from fish
oil – eicosapentaenoic acid (EPA) and
docosahexaenoic acid (DHA) – has some
of the most potent anti-inflammatory
properties
• Clinical trials assessing benefits of fish oils
in inflammatory and autoimmune diseases
including rheumatoid arthritis, Crohn’s
disease, ulcerative colitis, psoriasis, lupus,
multiple sclerosis and migraine headaches
reveal significant benefit, including
decreased disease activity and a lowered
use of anti-inflammatory drugs
Omega 3s and Plant Sterols
• Dietary intervention with omega-3 PUFA
(1.4 g/d) plus plant sterols (2g/d) reduced
several markers of systemic inflammation
in hyperlipidemic individuals
• C-Reactive protein was reduced by 39%
• Tumor necrosis factor-alpha reduced by
10%
• Interleukin-6 reduced by 10.7%
• Overall cardiovascular disease risk by
22.6%
Omega-3 fatty acids in
inflammation
• EPA and DHA from fish oils are more
biologically potent than alpha-linolenic acid
(ALA) from flaxseeds and walnuts
Balanced Omega 6/Omega 3
• A balanced intake of omega-6 and omega3 fatty acids is anti-inflammatory
• Overconsumption of omega-6 fats in
relation to omega-3 fats leads to
inflammation
• Most appropriate ratio of omega-6 to
omega-3 fatty acids is approximately 4:1.
This requires increasing the intake of
omega-3s and decreasing intake of omega6s
Anti-Inflammatory
Fruit/Vegetables
• A high fruit and vegetable intake has been
shown to be associated with a low level of
inflammation
• Fruit and vegetable intake has been shown
to be inversely related to oxidative stress
and inflammation in type 2 diabetics
Cherries
• Cherries contain compounds that inhibit
enzymes cyclooxygenase-1 and -2 (COX),
the targets of anti-inflammatory drugs
• Studies on healthy men/women consuming
280 g/d of Bing cherries for 28 days
showed reduced serum CRP by 25% and
Nitric oxide by 18%
Garlic
• Garlic has been used as a medicinal plant
since ancient times
• Researchers have shown that garlic may
promote an anti-inflammatory environment
by cytokine modulation that leads to overall
inhibition of NF-(kappa)B activity (9)
• NF-(kappa)B is a central transcription factor
in adaptive immunity and a central
regulator of pro-inflammatory gene
expression
Spices: Turmeric
• Turmeric, sometimes called curcumin, is a
mustard-yellow spice from Asia.
• Main ingredient in curry
• Laboratory and animal research has
demonstrated anti-inflammatory,
antioxidant, and anti-cancer properties of
turmeric and its constituent curcumin.
www.nlm.nih.gov/medlineplus/.../patientturmeric.html
Spices: Turmeric
• Researchers tested turmeric extracts in
animal models and found evidence of antiarthritic efficacy
• They found that curcuminoid extract inhibits
a transcription factor, NF-KB, from being
activated in the joint
• Typical dose used therapeutically 400 mg
twice a day
Spices: Turmeric
• Inflammation in Alzheimer’s disease
patients is characterized by increased
cytokines and activated microglia
• Researchers found that both low and high
doses of curcumin significantly lowered
oxidized proteins and interleukin-1beta, a
proinflammatory cytokine elevated in the
brains of Alzheimer transgenic mice
Spices: Ginger
• Ginger belongs to the same botanical
family as turmeric and cardamon
• Has been used as an anti-inflammatory
agent for centuries
• Researchers have found that ginger inhibits
prostaglandin biosynthesis – similar to
NSAIDs
Spices: Ginger
• Ginger extract also inhibits the induction of several genes
involved in the inflammatory response
• In a study of 261 people with osteoarthritis (OA) of the
knee, those who received a ginger extract twice daily
experienced less pain and required fewer pain-killing
medications compared to those who received placebo. (14)
• For analgesic purposes, 2 to 4 grams fresh ginger juice or
extract taken daily is recommended
Salicylic Acid
• Salicylic acid is the active component of
willow-bark, long used as a folk remedy for
pain
• Aspirin is a synthetic derivative of willow
bark
• Foods high in salicylic acid: berries, grapes,
broccoli, spinach, chili peppers, cinnamon,
ginger, rosemary, nutmeg, sage, basil,
strawberries
Low-glycemic foods
• Plasma levels of high-sensitivity C-reactive
protein, a sensitive marker of systemic
inflammation, were found to be positively
associated with both Glycemic Index and
Glycemic Load in 244 women from the
Nurses’ Health Study, aged 45-82 years,
with a stronger relationship in overweight
women than in normal-weight women
Brown Rice Associated with
Improved Heart Health
• Researchers at Temple University in
Philadelphia recently reported a component
in brown rice that blocks the effect of
Angiotension II, a precursor of high blood
pressure and inflammation.
• This layer is striped away when brown rice
is converted to white rice. Partially mulled
rice (Haigamai) and (Kinmemai), both
popular in Japan, are also protective.
Data presented at Exp. Biology Conference, Anaheim, Ca, April 24-28,
2010
Grapes Could reduce
Diabetes and Heart Disease
• Phytochemicals in grapes (green, red and black)
have been found to reduce risk for metabolic
syndrome, high blood pressure and inflammation
at least according to research on rats fed daily
added grapes in comparison to a base diet high
in fat.
• At three months, those with added grapes had
lower triglycerides, BP and inflammation.
• Dr Bolling, researcher, commented that more
studies are needed to extrapolate data to
humans.
Data presented at Exp. Biology, Anahiem, Ca, April 2010
Mediterranean Diet
• Studies have found that the Mediterranean
diet can produce beneficial changes on
markers of inflammation, including
reduction in C-reactive protein and proinflammatory cytokines, as well as reduced
platelet aggregation and improved
endothelial function
Mediterranean Diet - Nuts
• Frequent consumption of nuts, containing
omega-3 fatty acids, dietary fiber,
magnesium, L-arginine and antioxidants,
was shown to be inversely related to
peripheral concentrations of CRP, IL-6 and
fibrinogen
So forget about anti-oxidant foods,
why not just take supplements?
• Vitamin A: Not effective for CV protection.
• Vitamin B: Recent study in diabetics with
renal disease, worsening of function and
increase in vascular events.*
• Vitamin C: Variable results for protection.
• Vitamin D: Real and effective.
• Vitamin E: Multiple studies ineffective and
may interfere with statin effectiveness.
*JAMA, April 28, 2010;202:16,1603-1609
Let’s Go Cooking !
Cooking Can Be Hazardous
To Your Health
Going beyond the smoke point of oils can create free
radicals.
Cancinogens are created when fat and animal proteins
hit the hot coals producing heterocyclamines.
Foods subjected to high heat create
acylamides…starches and sugars convert to
carcinogens.
Aromatic compounds…flour, dust, oil sprays harmful to
the lungs when inhaled.
Teflon compounds in the kitchen.
A knife and a bagel…the most dangerous combination.
The worse combination…beer, hot oil, a deep fat fryer,
a turkey and propane.
Time For An Oil Change!
• Know your oils
• Date when purchased
• Store away from heat,
moisture and light
• Know the smoking
point
• Monitor temperatures
of the sauté pan
• Be careful of aerosols
sprays
Cooking Oils
• Different oils have different uses,
and each performs best within a
certain range of temperatures.
• Every oil has a smoke point, the
temperature at which it begins to smoke.
• Oil should never be allowed to smoke as it
compromises nutritional value and releases
carcinogenic free radicals.
Olive Oil
• As an unrefined oil, extra virgin olive oil
should not be exposed to heat higher than
325°F, its smoke point
• Most of its characteristic flavor dissipates
under sustained heat
• Extra virgin olive oil is more suitable for use
as a condiment than in most cooking
applications.
Smoke points of oils
•
•
•
•
•
•
•
•
Avocado
Tea seed
Almond
Sesame
Canola
Walnut
Olive
Flax
510 degrees F
485
495
445
425
400
325
225
http://www.spectrumorganics.com/images/uploads/496241e
655274.pdf
Avoid Dangerous
Equipment
Grilling
• The American
Grill…the most
dangerous cooking
apparatus in America
• Avoid flaming heat
and smoke
• Keep food moist
• Indirect heat best
• Hand technique
• Have a thermometer
Go Get a Free Grill
• A free grill…yes absolutely FREE
• Pick one up today at Costco, Bloor Super Save,
Loblaws or Pusateri’s
Cooking With a Teflon Pan
• Follow manufacturer directions.
• Avoid high heat or medium heat on an
empty pan.
• Use approved non-stick cooking utensils.
• Never use an abrasive cleaner or pad.
• If the Teflon surface is cracking, discard.
• Teflon compounds used in manufacture
have been found in the majority of
American people even in the blood of
newborns.
Teflon
Top 10 Ways To Ruin A Nonstick
Pan
•
•
•
•
•
•
•
•
•
•
Cutting portions on a nonstick pan.
Storing pans improperly
Drastic water temperature changes
Using metal utensils
Cleaning with a scouring pad
Cleaning in a dishwasher
Cooking on high heat
Storing foods in your nonstick pan
Pizza pan nonstick, do not use a pizza cutter
A bread pan is a bread pan, non-meats, acid free
Water Sautéing or Pan
Steaming
•
•
•
•
Shorter time.
Vegetables can be sliced into larger pieces.
Process is steeping with flavors in the pan.
Start by creating flavor…garlic, onions in
large sauté pan.
• Add liquid to create steam. Never let the
pan dry. Add chopped vegetables or if
caramelizing, add veggies first with sugar.
• Cover with a tight fitting lid.
Steaming
•
•
•
•
•
•
•
•
Adds moisture to the food.
Maintains nutrients.
Is rather quick.
Avoid tap water…chlorine
gases.
Flavors enhanced without
oil.
Not all vegetables
steamed equally.
Avoid over cooking.
A variety of utensils
available.
Steaming Vegetables
• Vegetables have variable
steaming times.
• Cook to al dente.
• Artichokes, potatoes,
sweet potatoes, beets
require 30-40 minutes.
• Carrots 6-8 minutes.
• Asparagus, broccoli
same.
• Beans, corn on the cob
about 5 minutes.
• Peas are quick, 2 minutes
Steaming Techniques
• Add aromatics to the steaming
liquid…herbs, citrus.
• Cut vegetables to shorten steam time.
• Ice water blanch to stop cooking process
and maintain color.
• 1 teaspoon vinegar in bath helps to
maintain color in vegetables.
• Season after steaming.
Cooking with Ice
 Freezing can hold
certain flavors and
preserve
ingredients, but can
dehydrate foods.
 Freezing will
change texture.
 Avoid freezer.
burn…keep airtight.
 Perfect for
herbs…the ice cube
secret.
Tagine
• Definition: A tagine is like a casserole
dish used in north African cooking, most
commonly in Morocco. It consists of two
pieces - a plate like bottom and a conical
shaped lid. The bottom doubles as a
serving dish. Le Creuset Moroccan Tagine
• Can purchase in cooking stores or online.
Which is the healthiest cooking method
to maintain vitamins?
1.
2.
3.
4.
5.
Boiling
Steaming
Roasting
Microwaving
Grilling
Which is the healthiest cooking method
to maintain vitamins?
1.
2.
3.
4.
5.
Boiling
Steaming
Roasting
Microwaving
Grilling
Which statements are
true?
1. More than 80% of people feel
well informed about heart health
2. Less than 50% of people chose
healthy foods when dinning or
shopping for groceries
3. Orange juice is one of the
leading sources of Vitamin C for
consumers
4. All of the above
Which statements are
true?
1. More than 80% of people feel
well informed about heart health
2. Less than 50% of people chose
healthy foods when dinning or
shopping for groceries
3. Orange juice is one of the
leading sources of Vitamin C for
consumers
4. All of the above
Which of the following can
reduce Vitamin C levels?
1. Heating to greater than
70 degrees F.
2. Freezing
3. Prolonged storage
4. Light
5. Fat
6. Adding acidity
Which of the following can
reduce Vitamin C levels?
1. Heating to greater than
70 degrees F.
2. Freezing
3. Prolonged storage
4. Light
5. Fat
6. Adding acidity
Heart-Healthy Diets
• Heart Healthy Diets can help reduce risk for other
diseases or conditions (cancer, diabetes, obesity)
– Vegetables, fruits, whole-grains, fat-free or low-fat
dairy
– Lean meats and poultry
– Omega-3 rich fish at least twice a week (for example,
salmon, trout, and herring)
– Cut back on foods high in cholesterol, saturated fats,
trans fats, sodium, added sugars
– Moderate alcohol intake
– Watch portion sizes
– Balance physical activity with caloric intake
Source: American Heart Association website: http://www.americanheart.org/presenter.jhtml?identifier=851
What the Doctor Recommends!
• Vitamin C and Vitamin D for heart
health…two of the most studied vitamins
in heart related literature
• Get vitamin C from foods rather than
supplements
– Other benefits of vitamin C-rich foods
•
•
•
•
•
Benefits of fruits and vegetables
Other vitamins and minerals
Fiber
Phytonutrients
Additive effects of vitamin interaction
Keeping the “C”
• Minimize losses of vitamin C during
food preparation and storage
– Cut fruits and vegetables just before
cooking or serving
– Serve fruits and vegetables raw when
possible
– Don’t soak or store fruits or
vegetables in water
– Store cut, raw fruits or vegetables in
airtight containers and refrigerate
– Don’t open juices until ready to use
and cover or close containers tightly
when storing
Keeping the “C”
• Cooking
– Use a small amount of water for cooking
– Avoid high heat
– Microwave or steam foods to retain the most vitamin
C and pre-heat water to bring to temperature quickly
– Reuse cooking water in soups or stews
– Adding lemon juice or vinegar slows down Vitamin C
loss
– Serve foods immediately. Vitamin C loss in warmed
foods is 4-17% first hour and 7-34% in second hour
These techniques will also help retain other
vitamins and minerals in foods!
Keeping the “C”
• Add fresh fruits, vegetables, or their juices to
dishes after cooking
–
–
–
–
Edible garnishes
Fresh fruit or vegetable salsas
Add fresh fruit to cakes or other desserts
Citrus juice or other fruit juice used for
vinaigrettes or marinades
• Smoothies with fresh fruit and/or 100% juice
• Ingredient substitutions: use nutrient rich
ingredients
Cooking Requires Proper
Attitude
• An hurried meal prepared in anger imparts
stressful flavors and chaotic thoughts.
• A restricted recipe can lead to deprivation,
loneliness and isolation.
• If the cook feels rejected, so will be the
meal.
• Cooking is a time of self-reflection.
• If cooking is a chore, then move on.
• Food is art and an expression of self.
In summary
• Inflammation plays an important role in
heart disease.
• Fact: how we cook foods rather than what
we eat may be just as important as the
type of foods.
• Your kitchen could become the pharmacy
of the future.
Remember: “When you see the
Golden Arches, the pearly gates
are not far behind”.
Cooking demonstration
• For more recipes:
Cooking with heart
Guiltless Potato Chips
Blueberry Chocolate Almond Clusters
Guiltless Potato Chips
Preparation and ingredients:
Wash and slice unpeeled potatoes. A mandoline works the best. There
are a number of different types, ranging in price from $30 to $200.
Save your money, an inexpensive model works well. The key is to get
a uniform cut in order to brown the potatoes evenly.
The best potatoes for chips are russet potatoes.
Place sliced potatoes on a microwave-safe sheet. Flavor with favorite
seasonings...no salt, Mrs. Dash’s, rosemary, or dry ranch dressing.
Microwave on high until brown, 4-8 minutes. Cool and store in an airtight
bag.
Nutritional analysis:
Fried potato chips have 150 calories per ounce verses 30 calories in this
healthier version. Enjoy.
Blueberry Almond Clusters
Ingredients and preparation:
4 ounces bittersweet dark chocolate
1 cup fresh blueberries, sorted, washed and dried
¼ cup slivered almonds
Melt chocolate in a double boiler or micro-wave. Mix berries into warm
chocolate, stirring gently to coat them.
Cover a baking sheet with wax paper. Mound several slivered almonds
on the sheet. Using two spoons, lift 6-8 berries in chocolate and place
on top of the almonds. Shape each cluster. Repeat to create
approximately 24 clusters. Chill for about 45 minutes.
Makes 24. Serving size: 1 cluster.
Nutritional analysis: Calories 35, fat 2g, carbohydrates 4g, protein 1g.
For more information and
recipes
•
•
•
•
•
www.southdenver.com
Google: the Cooking Cardiologist
www.floridajuice.com
www.thecookingcardiologist.com
www.tatteredcover.com. Search for the
cookbook, Cooking with Heart