Transcript Title here - Iowa Academy of Nutrition and Dietetics

High Performance Health
Being healthy is more than
not being sick
James Rippe, MD,
Rippe Lifestyle Institute
Dec 5, 2008
What is health?
For many—it’s the passive absence of disease.
About 90% of Americans rate
their health as good or excellent.
Statistics tell a different story
 In the U.S., more than 66% of adults are
overweight or obese.1
 More than 20 million people have diabetes and
54 million have pre-diabetes2
 More than 70% of adults do not exercise enough
to achieve health benefits; 40% are truly
sedentary. 3
 Only 10% of grains consumed are whole
grains. 4
 Adults consume about 50% of recommended
fiber. 4
 Fewer than 25% of adults regularly eat
recommended servings of fruits and vegetables.5
1. Prevalence Statistics Related to Overweight and
Obesity, NIDDK
2. American Diabetes Association stats.
3. Healthy People 2010
4. Nutrition Insight 32 Analysis of NHANES Data.
5. Behavioral Risk Factor Surveillance System (CDC),
www.taday.org
More Stats…
 In the Nurses Health Study, only 3.1% of this educated
population followed all five practices that put them at low
risk of heart disease. 7.1% followed four practices.
5
 Not smoking
 BMI under 25
 Moderate to brisk physical activity 30 minutes daily
 Ate healthy diet rich in cereal fiber, folate, marine n3 fatty acids, high
ratio of polyunsaturated to saturated fat, low in trans fats and glycemic
load
 On average consumed half a drink of an alcoholic beverage daily.
5 Stampher et al, NEJM July 6, 2000.
Health is more . . .
. . . than the passive absence of disease
 Health is a positive value, a valuable asset.
 High performance health is:
— a tool for living more fully
— a springboard for a higher quality of life
Nutrition: a pillar for high performance
health
1987 Seven of the 10 leading causes of mortality have an alcohol, nutrition or lifestyle
component
1. Heart diseases
2. Cancers
3. Strokes
4. Unintentional injuries [alcohol]
5. Chronic obstructive lung diseases
6. Pneumonia and influenza
7. Diabetes mellitus
8. Suicide [alcohol]
9. Chronic liver disease and cirrhosis [alcohol & nutrition]
10. Atherosclerosis [now counted as part of heart diseases]
2004 These seven are still in the top 12 leading causes of mortality
1987: Surgeon General;s Report on Health and Nutrition, 1988.
2004 National Vaital Statistics Reports 2006
Health Problems with a Dietary Component
“Poor diet and a sedentary lifestyle
contribute to about 400,000 of the
2 million or so annual deaths in the
United States.”
Report of the 2005 Dietary Guidelines Advisory Committee
Why seek High Performance Health?
 It redefines health—and
takes it to a new level
 It is about getting the most
out of life—mentally,
physically, spiritually—for
you and your clients
 The way you start the day
is very important
Blueprint for optimal health and wellness:
Your clients need to be the architects
of their own health—you provide the plan
and the tools
#1 Assess Your Health, Set Goals
and Track Them
 “If you don’t know where you are going, you will
probably end up somewhere else.”
 Need to set goals with your clients—jointly agree to
them—and then track them. Have markers to measure
success/progress.
#2 Connect with Your Body and Mind
Examine Your Three Ages:
 Chronological age
 Physical age
 Spiritual age
 Good health is not just your
chronological age or even your
physical age—need to connect
with yourself
#3 Engage in 30 Minutes of
Physical Exercise Daily
• Commit to 30 minutes at least
-- Walk like you are late or in a hurry
#4 Establish a Third Place
 A “place” (sport, interest, hobby)
outside of home and work
 Connecting with like-minded people
(readers, travelers)
#5 Use Active Rest Principles
 Active rest is not laziness—it is
re-charging
 This is an active not passive
process:
—Good night’s sleep
—Day breaks
—Weekly rest
—Personal retreat
#6 Connect with Others
 Health is benefited when you
connect with others
#7 Eat to Fuel Performance
Regular breakfast consumption is key to performance
Many Potential Benefits of Breakfast
Research suggests that
regular consumption of
breakfast* in a diet
consistent with the Dietary
Guidelines is associated
with potential health
benefits.
Weight
Control
Heart
Health
Nutrient
Intake
Breakfast
Diet Quality
Satiety
Energy
*low in saturated fat and
cholesterol, high in fiber
Cognition
But There May be a Breakfast Gap
U.S. Breakfast Consumption by Age Group
100
90
80
70
60
50
40
30
20
10
0
Male
Female
2 - 5 6 - 11 12 - 20 - 30 - 40 - 50 - 60 yr
yr
19 yr 29 yr 39 yr 49 yr 59 yr 69 yr
NHANES 2001-2002
70+
yr
Trends in Breakfast Consumption
Breakfast Consumption by U.S. Adults
100
90
89 88 90
88 87 88
82 80 84
82 80 84
80
All Adults
Men
70
Women
60
50
NHANES I
1971-75
NHANES II
1976-1980
Forty years of data from NHANES
Kant & Graubard, AJCN 2006; 84:1215-23
NHANES III
1988-1994
NHANES
1999-2002
Trends in Breakfast Consumption
Breakfast Consumption among U.S. Adults
100
90
85.7
89
88
82
80
75.9
82
74.8
NHANES
70
NFCS/CSFII
60
50
40
1965
197175
197778
197680
198991
198894
19992002
Comparing NFCS/CSFII and NHANES Data Longitudinally
Nutrient Contribution of Breakfast
Total U.S. Population over age 2
Sodium
15
Zinc
20
Potassium
20
Fe
27
Mg
19
Nutrients
Phos
20
Fiber
17
Ca
23
Folate
30
B 6`
25
Vit E
17
Vit C
24
Vit A
28
KCal
16
0
5
10
15
20
Percentage of Daily Intake
Source: What we Eat in America 2001-2002.
25
30
35
Breakfast Skipping and Nutrient Intake
in Adolescents
Adolescents who skip breakfast tend
to have:
1Nicklas

lower energy intake

lower calcium intake

lower iron intake
1,2,6

lower zinc intake
1,2,5

lower intake of many vitamins
(e.g. A,C, D and folate)1,5,7

lower intake of fiber
et al. J Adoles Health 2000;27:314-321
et al. Eur J Clin Nutr 2003; 57:1569-1578
3 Dwyer et al. J Am Diet Assoc 2001; 101:798-802
4 Affenito et al. J Am Diet Assoc 2005; 105:938-945
5 Barton et al. J Am Diet Assoc 2005; 105:1383-1389
6 Stockmanet al. Prev Med 2005; 41:203-210
7 Ramersaud et a. J Am Diet Assoc 2005; 105:743-760
8 Gleason et al. USDA /FNS 2001
2Sjoberg
1-3
1,2,4,5
2, 4, 5
Breakfast And Nutrition Throughout The Day
 Energy density (cal/gm) predicts energy density throughout
the day1
 Energy density is strongly associated with body weight
 Energy density at breakfast is associated with dietary
quality and meeting shortfall nutrients
1. Kant et al AJCN 2008; 88 [page #s TK]
Breakfast and Adult Nutrient Intake
 Adult breakfast consumption is
associated with:
 Diets that are higher in grains, fruit,
fiber, calcium and overall variety 1-2
 Success in maintaining weight loss
3
 Breakfast skippers had the lowest
intakes of all micronutrients except
sodium (analysis of NHANES III data2)
 More research is needed on
contribution of breakfast to nutrient
intake in adults
1.Nicklas et al. JADA 1998;98:1432-1438.
2. Kerver. JADA 2006; 106:46-53
Breakfast: An Opportunity for Meeting
Dietary Guidelines
What Foods?
Key 2005 Dietary Guidelines
Recommendations:
 Consume a sufficient amount of fruits and
vegetables while staying within energy
needs.
 Choose a variety of fruits and vegetables
each day.
 Consume 3 or more ounce-equivalents of
whole-grain products per day, with the rest
of the recommended grains coming from
enriched or whole-grain products. In
general, at least half the grains should
come from whole grains.
 Consume 3 cups per day of fat-free
or low-fat milk or equivalent
milk products.
Whole Grain Breakfast Consumption
Brunch
1%
 Breakfast is a popular time to eat
whole grains.
 A variety of cereals and breads
available are whole grain.
 Only 4.1 percent of all Americans
get enough whole grains
Dinner
15%
Breakfast
36%
Snack
33%
Lunch
15%
NHANES 1999-2001 Data
Source: Carlson A et al Nutrition Insights 32, 2005.
What about Fruit and 100% Fruit Juice?
Mean fruit servings (Adults 18+)
3
2.5
2
1.5
1.08
0.99
1.07
1
0.5
NHANESII 1976-80
NHANESIII 1988-94 NHANES 1999-2002
“Approximately 62% did not consume any whole fruit servings
and 75 percent did not consume any fruit juice servings; about
half of the participants reported no fruit and no fruit juice
servings in both surveys [1988-94 and 1999-2002].”
Source: Casagrande et al, Am J Prev Med 2007; 32-257-263.
Low Fruit Consumption in All Age Groups
Mean Servings of Fruit*, NHANES 1999-2000
2.5
2.2
1.8
2
1.3
1.5
1.4
1.3
1.3
1.9
1.7
1.2
1.4
1.3
1.1
1
0.5
14 yr
-1
8
yr
19
-3
0
yr
31
-5
0
51 yr
-7
0
yr
>7
0
yr
M
al
es
913
14 yr
-1
8
yr
19
30
y
31 r
-5
0
51 yr
-7
0
yr
>7
0
yr
13
9-
Fe
m
al
es
0
*Fruit includes fruit juice.
Source: Guenther et al. JADA 2006;106:1371
Breakfast and Risk Factors for Disease
Can eating breakfast on a regular basis
affect any of these modifiable health risk
factors?
 Overweight and obesity
 Coronary Heart Disease
 Hypertension
 Elevated cholesterol or triglycerides
Type 2 Diabetes
Some Cancers (endometrial, breast and colon)
The scientific evidence suggests that the
answer may be yes . . .
Epidemic of Obesity
Overweight and Obesity in the U.S.
Source: Centers for Disease Control and Prevention, National Center for Health Statistics, Health, U.S. 2005, figure 15
Health Risks Associated with
Overweight and Obesity
 Hypertension
 Dyslipidemia (for example, elevated cholesterol or triglycerides)
 Type 2 Diabetes
 Coronary Heart Disease
 Stroke
 Gallbladder Disease
 Osteoarthritis
 Sleep Apnea and Respiratory Problems
 Some Cancers (endometrial, breast, and colon)
Breakfast Consumption and BMI
 Significant associations between breakfast consumption and BMI
in adults and in children and adolescents?1,2,4
Yes: 9 studies
No: 3 studies
 Two 2007 and one 2008 prospective studies found an inverse
association between breakfast consumption and long-term weight
gain.2,3,4
 Potential mechanisms for beneficial effects of breakfast: appetite
control (satiety), thermic effect of food, glucose and lipid
metabolism.5
A caution: Different definitions of breakfast, research methodologies, length of studies,
potential confounding factors, and lack of longer, randomized clinical trials contribute to
observed inconsistencies in findings.
1. BRI Review “Are Breakfast Consumption Patterns Associated with Body Mass Index? Sept 2006
2. Purslow, et al. , Am J Epidemiology, epub Dec 2007
3. van der Heijden et al. Obesity, 2007; 15:2463-2469
4.Timlin et al. Pediatrics 2008; 121; e638-3645
5 Timlin and Pereira. Nutrition Reviews 2007; 65:268-281
Eating Breakfast Important for Successful
Long-Term Weight Loss
Frequency of breakfast consumption by individuals
successful at long-term weight loss.
% participants successful
at weight loss maintenance
BREAKFAST EATING BEHAVIOR
100
Other observed
behaviors with
weight-loss
maintainers:
80
60
 Low fat, high
carbohydrate diet
 Frequent weight
monitoring
 Physically active
40
20
0
Usually Eat
N = 2,959 men and women from the National Weight Control Registry
Kept weight off (30 lbs) for at least one year
Source: Wyatt H et al. Obesity Res 2002; 10:78-82.
Never Eat
Satiety Index of Breakfast Foods
“Oats produced the highest satiety rating within the cereal category. (Dieting)
strategies which focus on making more satiating food choices (such as
oatmeal) would appear to be a logical measure in controlling energy intake.”
(white bread as reference = 100; all foods consumed with 220 ml water)
250.0
200.0
150.0
100.0
50.0
0.0
Croissant
Yogurt –
Strawberry
White
Bread
Granola – Special K
Oats,
Fruits,
Nuts
Source: European Journal Clinical Nutrition 1995, 49:675-690.
Corn
Flakes
Bananas
Eggs –
Poached
Wheat
Bran
Cereal
(14g Fiber)
Oatmeal
Epidemic of Cardiovascular Disease
 CVD as an underlying or contributing cause of death
accounted for about 57 percent of deaths in 2004.
 CVD claims more lives each year than the next four leading
causes of death combined (cancer, chronic lower respiratory
diseases, accidents and diabetes).
Source: Heart Disease and Stroke Statistics – 2008 Update, American Heart Association
Modifiable Risk Factors for
Coronary Artery Disease
 Tobacco use (including tobacco smoke)
 Body Weight (obesity/overweight)
 Hypertension (high blood pressure)
 Dyslipidemia (high LDL cholesterol, low HDL cholesterol, etc)
 Diabetes
 Sedentary Lifestyle
Potential Effects of Breakfast on
Risk Factors for Heart Disease
Epidemiologic evidence suggests
that some foods frequently
consumed at breakfast may be
related to reduced risk of chronic
diseases including CVD:
— Whole grains
— Higher fiber foods
— Fruits/juices
Whole-Grain Breakfast Cereals
Are Associated with Reducing the
Risk of Cardiovascular-Specific Mortality
Breakfast Cereal (whole grain vs. refined grain) Intake
and Risk of Cardiovascular-Specific Mortality*
1.15
1.00
relative risk
1.00
Rarely
0.88
1 Serving
per Week
0.85
2-6 Servings
per Week
Whole-Grain Breakfast Cereal Intake (Whole Grains: P for Trend < 0.001)
Refined-Grain Breakfast Cereal Intake (Refined Grains: P for Trend = 0.07)
Prospective study approx 86,000 male physicians.
*Risk adjusted for age, smoking, alcohol intake, physical activity, BMI, history of type 2 diabetes, high
cholesterol, hypertension, and use of multivitamins.
Source: Liu S et al. American Journal Clinical Nutrition 2003; 77:594-9.
1.09
1.08
0.83
> 1 Serving
per Day
Diets Rich in Fiber Are Associated with Helping
Reduce the risk of CHD Death
Relative risk of death from coronary heart disease (CHD) by category of total dietary fiber intake. Error bars indicate
95% confidence intervals.
Source: Pereira et al. Archives of Internal Medicine 2004;164:370-376
Other Potential Health Benefits Of
Whole Grain Consumption
Whole grains, including oatmeal, may contribute to
an overall healthful diet which is consistent with:
 healthy weight management
 improving dietary risk profile for type 2
diabetes
 an overall dietary pattern shown to
reduce the risk for elevated blood
pressure
Source: Cho et al. J Am Coll Nutr. 2003; 22:296-302.
Pereira et al. Am J Clin Nutr. 2002; 75:848-855.
Lin et al. J Am Diet Assoc. 2003; 488-496.
Am Diabetes Association. Diabetes Care. 2006. 29;2140-2157.
Real life Goldilocks story
Oatmeal-Cholesterol Connection:
10 Years Later
• New research paper shows science
on linking oatmeal to reducing the risk
of heart disease is stronger than ever.
AJLM, 2008, Vol 2, Number 1: 51-57
Example: Oatmeal-Cholesterol Connection
1997 FDA approved claim: Three grams of soluble fiber from oatmeal
daily in a diet low in saturated fat may reduce the risk of heart disease.
2007 Scientific evidence continues to support the claim.
Chronology of Formal Literature Reviews for Whole-Oat Products and Cholesterol
Lowering
Was
Conclusion
Positive?
Yes
Year
Type of Review
Group Conducting Review
1992
Meta-analysis
Faculty from University of
Minnesota
1997
Health Claim Petition
US Food and Drug
Administration
Yes
1999
Meta-analysis
Faculty from Harvard University
Yes
2002
Evidence-based review
National Cholesterol Education
Program Expert Panel, NIH
Yes
2004
Evidence-based review
Joint Health Claims Initiative
Expert Panel, UK
Yes
2006
Functional claim petition
Ministry of Health, Malaysia
Yes
2007
Systematic review including a
meta-analysis
The Cochrane Collaboration
Yes
Source: Andon and Anderson. American Journal of Lifestyle Medicine, 2008; 2:51-57
More Good Reasons to Eat Oats
Formal reviews have consistently concluded that oat consumption
Reduces total and LDL cholesterol without adverse impact on HDL
cholesterol or TG
Emerging data demonstrate oat consumption:
 may favorably alter LDL cholesterol subclass composition
 provides unique phenolic compounds for which a molecular
mechanism has been identified related to reducing early
atherogenic events.
As a whole grain, oat consumption is consistent with a dietary pattern
that may:
 decrease weight gain
 reduce risk for type 2 diabetes
 lower blood pressure.
To expand and promote the practice of
daily breakfast as part of a healthy lifestyle.
www.BreakfastResearchInstitute.org
The Breakfast Calculator – Client Concepts
 Calories –
— Discuss energy balance concept
— Consider food choices and satiety
— Review breakfast as a weight control
strategy
 MyPyramid –
— Illustrate breakfast contribution to
meeting whole grains; fruits and
vegetables recommendations
— Compare calories in breakfast choices
— Discuss portion size
— Review variety and food choices
 Dietary Guidelines –
— Highlight shortfall nutrients (A, C, E,
calcium, potassium, fiber, magnesium)
— Illustrate impact of whole grains, lower
fat dairy on % DV for fiber, fat and
saturated fat
High Performance Health
1) Assess Your Health and Set Goals
2) Connect with Your Body and Mind
3) Engage in 30 Minutes of Physical Activity Daily
4) Establish a Third Place
5) Use Active Rest Principles
6) Connect with Others
7) Eat to Fuel Performance
What do sumo wrestlers
have to do with breakfast?
Rumor has it they skip breakfast!