Transcript 3rd Age Nutrition - Jessica

Optimal Nutrition in The Third Age
© Burrell Education 2014. Do not copy, duplicate or transmit electronically without full permission from the author(s).
Optimal Nutrition Strategies
• In the third age, optimal nutrition comes from supporting
your clients systems…
• Detoxification
• Digestion (Both maintaining the healthy barrier/
immunity and nutrient absorption)
• Hormone Balance
© Burrell Education 2014. Do not copy, duplicate or transmit electronically without full permission from the author(s).
Detoxification
• Lower the toxic load.
• Support the liver and other detox organs.
© Burrell Education 2014. Do not copy, duplicate or transmit electronically without full permission from the author(s).
Less Exposure to Toxic Chemicals
• “... postnatal exposure to some pesticides can interfere
with all developmental stages of reproductive function in
adult females, including puberty, menstruation and
ovulation, fertility and fecundity, and menopause.” -ACOG
• “The evidence that links exposure to toxic environmental
agents and adverse reproductive and developmental
health outcomes is sufficiently robust, and the American
College of Obstetricians and Gynecologists and the
American Society for Reproductive Medicine join leading
scientists and other clinical practitioners in calling for
timely action to identify and reduce exposure to toxic
environmental agents while addressing the consequences
of such exposure.” - ACOG
• 1996 - 2011 Pesticide use increased 404 million pounds
(7%) in the US
© Burrell Education 2014. Do not copy, duplicate or transmit electronically without full permission from the author(s).
Cadmium
• Cadmium - mild effects on kidney and bone at present
levels of environmental exposure.
• Women may be at greater risk than men of cadmium
toxicity because cadmium uptake is increased at lower
iron levels (common in women in childbearing age.)
• Iron status in women tends to improve at menopause and
cadmium exposure/ uptake improves. But, cadmium
accumulates in the kidneys (half life 10 -30 years) and
peaks around menopause when the effects appear.
• Based in work done by looking at the very painful disease
called Itai-itai, which is a combination of osteoporosis,
osteomalacia and renal damage caused by consumption of
cadmium-polluted rice.
© Burrell Education 2014. Do not copy, duplicate or transmit electronically without full permission from the author(s).
Lead
• 90% of lead is stored in the bones.
• The menopausal release of bone may cause issues
associated with lead exposure.
© Burrell Education 2014. Do not copy, duplicate or transmit electronically without full permission from the author(s).
© Burrell Education 2014. Do not copy, duplicate or transmit electronically without full permission from the author(s).
Coriander (Cilantro/ Chinese Parsley)
and Heavy Metal Chelation
• Cilantro is a known heavy metal chelator.
• In a recent mouse study (a study done on mice with lead
induced testicular toxicity)...
• C. sativum (Coriander) significantly protects against lead induced oxidative stress.
• Has also been used preventatively in mouse studies to
prevent the deposition of lead into bones and kidneys to
mouse who are over exposed to lead in the lab.
© Burrell Education 2014. Do not copy, duplicate or transmit electronically without full permission from the author(s).
Bentonite Clay for Heavy Metal
Detoxification
• Bentonite Clay - small amounts of food grade ingested
daily (colon) or made into a facial mask (skin) to detoxify
heavy metals and other toxic chemicals.
• A strong negative charge attracts the positive charge in
many toxins.
• A few reported cases of hypokalemia in a child and
pregnant woman who consumed large quantities of clay.
May also cause intestinal blockages.
© Burrell Education 2014. Do not copy, duplicate or transmit electronically without full permission from the author(s).
Soy
• How common is a soy sensitivity? Eight foods account for
90 percent of all food allergic reactions: milk, eggs,
peanuts, tree nuts, soy, wheat, fish and shellfish.
• Top food sensitivities: gluten, dairy, corn, eggs, soy, nuts,
nightshades (tomatoes, bell peppers, potatoes and
eggplant), citrus and yeast (baker's, brewer's yeast and
fermented products like vinegar).
• Soy and GMO’s - 90 percent of soy grown in the US is
genetically modified.
• More than three millions tonnes of soy is imported into the
UK every year, a large proportion of which is GM. - The
Telegraph
• Unless organic, most animal feed contains GM soy.
© Burrell Education 2014. Do not copy, duplicate or transmit electronically without full permission from the author(s).
Gluten
• Zonulin - a protein in gluten is one cause of leaky gut.
• Wide disagreement on the numbers of people affected with
gluten sensitivity (non-celiac.) Experts estimate from 6 -7%
up to 50% of people are sensitive to gluten
© Burrell Education 2014. Do not copy, duplicate or transmit electronically without full permission from the author(s).
Detoxification
• Lower the toxic load.
• Support the liver and other detox organs.
© Burrell Education 2014. Do not copy, duplicate or transmit electronically without full permission from the author(s).
Dairy
• Eating more low-fat dairy may delay menopause (it
also affects fertility - adding to the hypothesis that
diary foods are hormonally active)
• Data from The Nurses Health Study: the estimated mean
age at natural menopause was 51.5 y for women who
consumed no low-fat dairy and 51.5, 51.6, 51.7, and 51.8
y for women who consumed 0.1-1.0, 1.1-2.0, 2.1-3.0, and
>3 servings of low-fat dairy daily, respectively.
• Interestingly this did not hold true for high fat dairy. While
in the data looking at fertility (from the same Nurses
Health Study), high fat dairy did have an influence.
© Burrell Education 2014. Do not copy, duplicate or transmit electronically without full permission from the author(s).
Dairy
• Dairy - reducing telomere length (a sign of aging/ life
expectancy)
• Data from the Women’s Health Initiative, 4029 healthy
postmenopausal women were studied. Looking at the
relationship of their telomere length correlated with their
intake of dietary fats.
© Burrell Education 2014. Do not copy, duplicate or transmit electronically without full permission from the author(s).
Food Sensitivity Testing
• To find out if your client/ patient has specific food
sensitivities.
• Testing - IgG antibodies, inflammatory markers - helpful,
but not 100% accurate
• Cyrex testing for gluten sensitivity
• Elimination Diet (the gold standard).
© Burrell Education 2014. Do not copy, duplicate or transmit electronically without full permission from the author(s).
Elimination Diet
• Eliminate the most common foods that cause sensitivities • Gluten, dairy, soy, eggs, peanuts, sugar/ sweeteners,
corn, nightshades (pain/ bones), yeasts (nuts, red meat,
fish, shellfish, citrus (pelvic pain))
• Remove from the diet for 3 weeks - 3 months
• Challenge
• Add each food back into the diet, one at a time, for 4 days.
The last 3 days of the week, remove the food again but
look for symptoms all week.
• Symptoms: digestive, skin irritation, headaches,
congestion, pain, fatigue, etc.
© Burrell Education 2014. Do not copy, duplicate or transmit electronically without full permission from the author(s).
What Organs/ Glands Are Involved in
Detox?
• Liver
• Skin/ Sweat Glands
• Lungs
• Colon
• Kidneys
© Burrell Education 2014. Do not copy, duplicate or transmit electronically without full permission from the author(s).
Skin
• Dry Brushing (similar to lymph massage, but also sloughs
off dry skin cells. No published research.) Improves
circulation and bloating.
• Sweat - Exercise is the best option. .
© Burrell Education 2014. Do not copy, duplicate or transmit electronically without full permission from the author(s).
Colon and Kidneys
• The basics - Don’t forget fiber and water!
• Fiber 14 grams/ day is average, 20-35 g/ day studied, 3545 g/ day recommended by some experts for optimal sex
hormone detoxification. (See next slides for potential
fertility risks of high fiber diets.)
• It is healthier in postmenopausal women for estrogen not
to be reabsorbed in the colon to lower breast cancer risk.
• Water - no specific data- thirst is likely a good indicator,
1/2 the body weight per day in ounces is a good guideline.
(Start where they are and progress slowly.)
© Burrell Education 2014. Do not copy, duplicate or transmit electronically without full permission from the author(s).
© Burrell Education 2014. Do not copy, duplicate or transmit electronically without full permission from the author(s).
Fiber Matters
• Dietary fiber was stratified into insoluble and soluble
components.
• Soluble fiber had a stronger inverse relation with estradiol
concentrations (b = 20.222, P = 0.01) than did insoluble
fiber(b = 20.057, P = 0.02).
• Of the 3 sources of fiber, fruit fiber had the strongest
association with concentrations of estradiol (b =20.104, P
= 0.03), followed by grain fiber (b = 20.073, P =0.03),
whereas vegetable fiber was not associated (b =
20.027,P = 0.40) with estradiol concentration.
• Fruit and grain fiber were also associated with
statistically significant decreases in concentrations of
progesterone (b = 20.242, P = 0.02, for fruit fiber, and b =
20.163, P = 0.02, for grain fiber)
© Burrell Education 2014. Do not copy, duplicate or transmit electronically without full permission from the author(s).
Fiber Matters
• A 5-g/d increase in fruit fiber had the strongest
association with probability of anovulation (aOR: 3.05;
95% CI: 1.07, 8.71). Grain and vegetable fiber were not
significantly associated with anovulation.
• In this study, it could be that these women are over exercising, low BMI, calorie restriction in addition to high
fiber. But, some of these factors (like BMI) were looked at
in this study and not found to be an issue.
© Burrell Education 2014. Do not copy, duplicate or transmit electronically without full permission from the author(s).
Good vs. Bad Estrogen
• Shifting estrogen metabolism to 2OHE1 may help to better
detox the system of estrogen.
• May decrease estrogen sensitive cancer risk, and
eliminate painful cysts and fibroids.
• In a small clinical trial, increasing cruciferous vegetable
intake of healthy postmenopausal women for four
weeks increased urinary 2OHE1:16αOHE1 ratios,
suggesting that high intakes of cruciferous vegetables can
shift estrogen metabolism.
© Burrell Education 2014. Do not copy, duplicate or transmit electronically without full permission from the author(s).
Supporting Liver Detox
• Cruciferous Vegetables... Let’s name some!
• Genetics may matter.
• Some genetic variations allow for the good, cancer
fighting, estrogen metabolizing compounds
(isothiocyanates and indoles) to be eliminated more
slowly.
• A better relationship was found between eating cruciferous
veggies and lowered cancer risk in people with more
favorable genetics
© Burrell Education 2014. Do not copy, duplicate or transmit electronically without full permission from the author(s).
Raw is (Sometimes) Better Than Cooked
• Cooking – high heat and using a lot of water can decrease
the bioavailability of the isothiocyanates.
• Be cautious with high volumes of raw cruciferous veggies
if your client/ patient has hypothyroidism. The goitrogens
can suppress thyroid function. But, they are inactivated
by cooking.
© Burrell Education 2014. Do not copy, duplicate or transmit electronically without full permission from the author(s).
Postmenpausal Fatty Liver Disease
• Non-alcoholic fatty liver disease - a liver manifestation of
metabolic syndrome and the most common liver disease.
• Fat tends to increasingly accumulate in the liver in postmenopausal women.
• Non-alcoholic fatty liver disease is more common in post menopausal women who are not on HRT - 26.4% in the
group with hormone replacement therapy and 39.9%
without hormone replacement therapy
© Burrell Education 2014. Do not copy, duplicate or transmit electronically without full permission from the author(s).
Postmenopausal Fatty Liver Disease
• Gamma-glutamyl transpeptidase and alanine transaminase
(two liver enzymes that are associated with fatty liver),
ferritin, and insulin resistance were higher in the group of
women with NAFLD diagnosis who did not use hormone
replacement therapy.
• Metabolic syndrome was also more frequent in women
with NAFLD, who did not use hormone replacement
therapy.
© Burrell Education 2014. Do not copy, duplicate or transmit electronically without full permission from the author(s).
Soy + Exercise for Fatty Liver Disease
• Caucasian, overweight (body mass index (BMI) between
28 and 40 kg/m 2 and waist circumference >88 cm),
postmenopausal, sedentary, no soy allergy
• Pre-intervention: baseline metabolic testing, 12h fasting
blood sample, & measurements of body composition.
• Two groups: exercise + soy (44 mg daidzein, 16 mg
glycitein and 10 mg genistein extracted from natural soy
daily - this is considered just over a high dose of 40 -50 mg
isoflavones daily) or exercise + placebo
• Exercise was 6 months of 3x per week 30mins of aerobics
+ 30 mins of resistance ex.
© Burrell Education 2014. Do not copy, duplicate or transmit electronically without full permission from the author(s).
Soy + Exercise for Fatty Liver Disease
• Results: Body weight and BMI remained unchanged in
both groups.
• Fat mass and waist circumference decreased in both
groups, and lean body mass increased in both groups.
• Fasting plasma insulin levels did not change, fasting
glucose concentrations increased in both groups.
• Plasma triglyceride levels were significantly decreased in
the exercise + soy group.
© Burrell Education 2014. Do not copy, duplicate or transmit electronically without full permission from the author(s).
© Burrell Education 2014. Do not copy, duplicate or transmit electronically without full permission from the author(s).
© Burrell Education 2014. Do not copy, duplicate or transmit electronically without full permission from the author(s).
The Paleo Diet and Fatty Liver
• Ectopic lipid deposition = lipid accumulation outside of
adipose tissue (in the liver and skeletal muscles.)
• 10 healthy, overweight (BMI 28-35), postmenopausal
Swedish women - ate a paleo diet x 5 weeks. (They could
eat as much as they wanted by actually lowered their
overall intake.)
• The diet included lean meat, fish, fruit, vegetables
(including root vegetables), eggs and nuts. (Dairy
products, cereals, beans, refined fats and sugar, added
salt, bakery products and soft drinks were excluded.)
© Burrell Education 2014. Do not copy, duplicate or transmit electronically without full permission from the author(s).
The Paleo Diet
and Fatty Liver/ Weight Loss
• Lower the toxic load.
• Support the liver and other detox organs.
© Burrell Education 2014. Do not copy, duplicate or transmit electronically without full permission from the author(s).
Fatty Liver Disease and
Menopausal Women
• Take home message on macronutrient composition for
postmenopausal women to reduce risk of fatty liver (and
other negative general health markers)...
• Increase MUFA’s - avocados, nuts, nut butters, olives,
olive oils
• Reduce SFA’s (consider the composition - coconut and
palm kernel oil vs. dairy??)
• Increase PUFA’s - especially omega-3’s - fish, walnuts,
flaxseeds (may reduce hot flashes, and/or further lower
estrogen levels due to high levels of fiber?)
© Burrell Education 2014. Do not copy, duplicate or transmit electronically without full permission from the author(s).
Summary: Optimal Detox for the 3rd Age
• Lower the toxic load: Chemicals, heavy metals, and food
sensitivities
• Skin brush, sweat, and water.
• Fiber? Too much can lower estrogen levels further. But,
flaxseeds may(??) reduce hot flashes.
• Optimally detox estrogen with cruciferous veggies (cook
them if hypothyroid.)
• Enhance glutathione and methylation.
• Exercise + Soy and/or Paleo (the jury is still out)
© Burrell Education 2014. Do not copy, duplicate or transmit electronically without full permission from the author(s).
“You are what you absorb.”
• Menopausal women with nutrient deficiencies are more
susceptible to:
• Fracture Risk
• Thyroid Problems
• Cognitive Decline
• Inflammation
• Toxicity
• Hormonal Imbalances due to Physical Stressors
© Burrell Education 2014. Do not copy, duplicate or transmit electronically without full permission from the author(s).
Studies on Dietary Patterns
• Unhealthy dietary patterns (refined sugar/ cereals, red/
processed meat, processed food)
• Multiple studies showing impact on bone density.
• Mixed results on fracture risk.
• Singapore Chinese Health Study (63,257 men and
women), interviews, 24 hour recalls, 165 food item
questionnaire. Less than 8% of women on supplements,
4.1% on HRT.
• Large population, few dropouts, prospective study
• VFS (Vegetable-Fruit-Soy) pattern reduced fracture risk,
MDS (Meat-Dim-Sum) raised fracture risk (dose
dependent)
© Burrell Education 2014. Do not copy, duplicate or transmit electronically without full permission from the author(s).
Diet + Exercise
• Also, in the Singapore Chinese Health Study –
• the women with higher VFS scores and lower fracture risk
also exercised more.
© Burrell Education 2014. Do not copy, duplicate or transmit electronically without full permission from the author(s).
Studies on Dietary Patterns
• In a retrospective Canadian cohort, 2 dietary patterns, a
nutrient dense
• diet with higher intakes of fruit, vegetables, and whole
grains and an energy-dense (aka calorie dense) diet with
a high consumption of soft drinks, potato chips, French
fries, meats, and desserts, were identified. The nutrientdense diet was inversely associated with lower
fracture risk in women, whereas the energy-dense diet
was not related to fracture risk
• In a European population of men and women, a
Mediterranean diet lowered hip fracture risk.
© Burrell Education 2014. Do not copy, duplicate or transmit electronically without full permission from the author(s).
Studies on Dietary Patterns
• 213 postmenopausal Iranian women (average age of 60)
• Found 3 dietary nutrient patterns.
• Pattern 1 - correlate positively with BMD at the lumbar
spine (but not at the femoral neck)
• Pattern 1 - Abundant in folate, total fiber, vitamin B6 ,
potassium, vitamin A as RAE, vitamin C, b -carotene,
vitamin K, magnesium, copper, and manganese, which was
associated with high intakes of fruits and vegetables
and low intakes of cereals
• Surprisingly... Pattern 2 (high intakes of protein, calcium,
phosphorus, zinc, and vitamin D) did not correlate with
bone density. - acidic and low in vitamin E
• Pattern 3 -low nutrient and no correlation.
© Burrell Education 2014. Do not copy, duplicate or transmit electronically without full permission from the author(s).
Consistencies to Reduce Fracture Risk
• Vegetables
• Fruits
• Healthy Fats
• Nutrient Dense
• Soy & Whole Grains may depend on population
(genetics?)
© Burrell Education 2014. Do not copy, duplicate or transmit electronically without full permission from the author(s).
What is “Leaky Gut”
(intestinal permeability)
© Burrell Education 2014. Do not copy, duplicate or transmit electronically without full permission from the author(s).
Common Causes of Leaky Gut for
Third Age Women
• Food Sensitivities/ Lack of chewing/ Weak digestive
enzymes
• Medications - The average American age 45 and older is
on 4 prescription medications daily. (2002 data)
• Physical Stress (chronic gut/ systemic inflammation, lack
of physical activity, surgery, chronic illness)
• Emotional Stress - What are some of the top emotional
stressors that your clients/ patients are dealing with?
© Burrell Education 2014. Do not copy, duplicate or transmit electronically without full permission from the author(s).
Gut Microbiome
• 10 13 -10 14 microorganisms in the GI tract.
• 10x the amount of human cells.
• 150x the amount of human genes.
• Thousands of species and strains. Wide variety of
organisms
© Burrell Education 2014. Do not copy, duplicate or transmit electronically without full permission from the author(s).
Functions of The Gut Microbiome
• Healthy microbiome is essential for the repair of the gut
epithelium when injured.
• Microbiota is key to gut associated lymphoid tissue (GALT)
and other GI immune system development.
• Digestion
• Prevention of infection
• Produces nutrients, and activates isoflavones (and other
ingested molecules)
© Burrell Education 2014. Do not copy, duplicate or transmit electronically without full permission from the author(s).
Detoxification
• Lower the toxic load.
• Support the liver and other detox organs.
© Burrell Education 2014. Do not copy, duplicate or transmit electronically without full permission from the author(s).
Understanding the Gut Microbiome
• The gut of the fetus is effectively sterile until birth.
This idea is now being challenged and bacterial
colonization of membranes may contribute to premature
rupture. (Fortner, et al. 2014)
• Gut colonization begins at birth:
• With vaginal delivery - microbiota of moms’ vagina
(Lactobacillus, Pevotella, or Sneathia)
• With C-Section delivery - microbiota of mom’s skin
(Staphylococcus, Corynebacterium, and
Propionibacterium)
• Firmicutes and Bacteriodetes (dominate the adult
microbiome) - delayed acquision in C -Section babies.
© Burrell Education 2014. Do not copy, duplicate or transmit electronically without full permission from the author(s).
Maturation of the Gut Microbiome
• Preterm babies lack two of the main bacterial genera in
healthy term infants: Bifidobacterium and Lactobacillus,
instead that have lots of Proteobacteria.
• These species of bacteria can be very, very different:
• Kingdom, Phylum, Class, Order, Family, Genus (Genera is
plural), Species
• Exclusive breastfeeding leads to more Bifidobacterium.
• In elderly, microbiome is related to residence location and
diet.
© Burrell Education 2014. Do not copy, duplicate or transmit electronically without full permission from the author(s).
Factors that Disturb a Healthy Microbiome
• Antibiotics
• Western Diet: n-6 PUFA’s can enhance inflammatory
factors in mice with colitis. n -3 PUFA’s reduce
inflammation, but leave the host open to increased risk of
sepsis if a systemic infection takes over because the
inflammatory response has been dampened.
• Yeast overgrowth
• Infectious bacterial overgrowth
© Burrell Education 2014. Do not copy, duplicate or transmit electronically without full permission from the author(s).
How to Heal a Leaky Gut
• Remove the factors that are causing the leaks
• Soothe, feed, and rebuild the cells that line the gut
• Restore better balance in the gut microbiome
© Burrell Education 2014. Do not copy, duplicate or transmit electronically without full permission from the author(s).
Remove the Causes of The Leaks
• Elimination Diet
• Medication weaning (with physician supervision)
• Lower toxic load
• Lower physical and emotional stress
© Burrell Education 2014. Do not copy, duplicate or transmit electronically without full permission from the author(s).
Soothe, Feed, and Rebuild The Cells
That Line The Gut
• Bone Broth
• L-glutamine powder supplement (3000 mg/day up to
5000mg 3x/day)
• Zinc (has been shown to improve the intestinal
permeability caused by heat stress in pigs.)
© Burrell Education 2014. Do not copy, duplicate or transmit electronically without full permission from the author(s).
Restore Better Balance in the
Gut Microbiome
• Prebiotics: raw chicory root, raw J erusalem artichoke, raw
dandelion greens, raw garlic, raw leek, raw onion, cooked
onion, raw asparagus, raw banana
• Probiotics: lactobacilli and bifidobacteria (VSL #3 - the
brand most studied)
• Fermented Foods
© Burrell Education 2014. Do not copy, duplicate or transmit electronically without full permission from the author(s).
Nutrient Deficiencies: Calcium
• “...based on the currently available evidence, it would be
unwise to advocate avoidance of or ceasing consumption
of calcium supplements at recommended levels when
adequate dietary calcium cannot be achieved.”
• Very high intakes of calcium (levels above 2,000–2,500
mg/d) may increase risk of progression of vascular
calcification.
• Also, calcium supplements in elderly people with kidney
disease may pose a higher risk of cardiovascular
problems.
© Burrell Education 2014. Do not copy, duplicate or transmit electronically without full permission from the author(s).
Nutrient Deficiencies: Calcium
• The consensus of research is now recommending simply
eating more calcium containing foods (vs. trying to create
safer, more absorbable calcium supplements.)
• In ovariectomized rats, smaller particle calcium
supplements did not improve calcium levels. What did
improve them was eating a diet higher in calcium.
© Burrell Education 2014. Do not copy, duplicate or transmit electronically without full permission from the author(s).
Nutrient Deficiencies: Vitamin K2
• Significant deficits in vitamin K are found in patients with
Chronic Kidney Disease (CKD)
• Patients with CKD requiring dialysis have a 4 -fold
increased risk of hip fracture compared with the general
population.
• Supplementing with K1 and K2 can improve biomarkers for
the proteins and enzymes dependent on these vitamins in
the CKD population.
• Risks of sub-clinical vitamin K deficiency include
cardiovascular disease and bone fracture.
© Burrell Education 2014. Do not copy, duplicate or transmit electronically without full permission from the author(s).
Nutrient Deficiencies: Vitamin K2
• Randomized clinical intervention study of 325
postmenopausal women receiving either placebo or 45
mg/day of vitamin K2 (MK-4, menatetrenone) for three
years
• Bone mineral content (BMC) and the Femoral neck width
(FNW) had increased in the K2 group relative to placebo.
• In the K2-treated group hip bone strength remained
unchanged during the 3-year intervention period, whereas
in the placebo group bone strength decreased
significantly.
• High dose with minor side effects that were no different
than placebo.
• The women in this study were not already diagnosed with
osteoporosis.
© Burrell Education 2014. Do not copy, duplicate or transmit electronically without full permission from the author(s).
Nutrient Deficiencies: Vitamin K2
• Double blind, randomized, placebo controlled trial of 63
postmenopausal Indonesian women with osteoporosis.
• The vitamin K2 group (n = 33) received 45 mg
menatetrenone and 1500 mg calcium carbonate per day
and the control group (n = 30) received placebo and 1500
mg calcium carbonate per day for 48 weeks.
© Burrell Education 2014. Do not copy, duplicate or transmit electronically without full permission from the author(s).
Nutrient Deficiencies: Vitamin K2
© Burrell Education 2014. Do not copy, duplicate or transmit electronically without full permission from the author(s).
Nutrient Deficiencies: Vitamin K2
• In non-osteoporetic, postmenopausal North American
women, K1 or K2 supplementation was not significant for
improvements in Bone Mineral Density.
• These subjects were also given calcium and Vitamin D3
supplementation: 315 mg/200 IU; Citracal + D, twice daily
© Burrell Education 2014. Do not copy, duplicate or transmit electronically without full permission from the author(s).
Nutrient Deficiencies: Vitamin K2
© Burrell Education 2014. Do not copy, duplicate or transmit electronically without full permission from the author(s).
Healthy Diet Composition:
Fats
• High intake of short -> medium chain saturated fatty acids
(SMSFAs) inversely associated with telomere length.
• “Telomeres are highly conserved regions of repetitive
nucleotide sequences (TTAGGG) that protect the ends of
chromosomes. Telomere length (TL) decreases over time
due to cell division and may serve as a biomarker for the
aging process and some age-related complex diseases.”
• 4029 participants from a subset of the WHI Observational
Study (WHI-OS) - participants estimated dietary intake
over the last 3 months using a standard questionnaire.
• Correlation of shorter telomere length with increased
SMSFA intake - specifically whole milk, full fat cheese,
and butter.
© Burrell Education 2014. Do not copy, duplicate or transmit electronically without full permission from the author(s).
Healthy Diet Composition:
Fats
• Correlation of shorter telomere length with increased
SMSFA intake - specifically whole milk, full fat cheese,
and butter.
• Lauric acid was not found to be associated with shorter
telomere length.
• 50% of the fat in coconut oil is lauric acid
• Palm kernel oil is also nearly 50% lauric acid
© Burrell Education 2014. Do not copy, duplicate or transmit electronically without full permission from the author(s).
Healthy Diet Composition:
Iron
• Ferritin is a key protein regulating iron uptake, storage,
and release, and its concentration is a marker of iron
stores.
• Iron supplementation has been shown to be of cognitive
benefit for iron deficient mothers and in reproductive -age
women in general.
• The participants in this study were taken from a group that
were given antioxidant vitamin and mineral
supplementation in a randomized, double-blind, placebocontrolled primary prevention trial (the original trial looked
at cardiovascular disease and cancer incidence.) Women
in the trail were aged 35-60 years old.
© Burrell Education 2014. Do not copy, duplicate or transmit electronically without full permission from the author(s).
Healthy Diet Composition:
Iron
• Ferritin is also nonspecifically elevated in many
inflammatory conditions (like acute infection, RA, and
cancer.
• In this study, it was found that lower lower serum ferritin at
midlife and smaller ferritin increase over time correlated
with better cognition (particularly short-term and episodic
memory) for those women who were 46 an older (and pre /perimenopausal) at baseline.
• There was no association found in hemoglobin levels and
cognition postmenopausally.
• Thus, adding iron supplementation in peri- and
postmenopause may contribute to chronic inflammation
and cognitive decline.
© Burrell Education 2014. Do not copy, duplicate or transmit electronically without full permission from the author(s).
Importance of Healthy Dietary Composition
and Digestion in The Third Age
• Reduce causes of leaky gut/ heal leaky gut/ improve
nutrient density of the diet
• Improves nutrient absorption
• Minimizes chronic, low grade inflammation
• Reduces risk of fracture, cognitive decline, mood
disorders, and aging associated telomere shortening.
© Burrell Education 2014. Do not copy, duplicate or transmit electronically without full permission from the author(s).
Hormone Balance and Sex Drive
• Keep your clients off of the Stress-Sugar Roller Coaster
• For adrenal health
• Raw materials to build sex hormones vs. stress hormones
• Thyroid Health for optimal metabolism
© Burrell Education 2014. Do not copy, duplicate or transmit electronically without full permission from the author(s).
Stay off of the Stress-Sugar
Roller Coaster!
© Burrell Education 2014. Do not copy, duplicate or transmit electronically without full permission from the author(s).
Stress = Survival
(Sex is the icing on the cake)
© Burrell Education 2014. Do not copy, duplicate or transmit electronically without full permission from the author(s).
High Fat and High Sugar Diet
• Increases the risk of hot flashes and night sweats.
• Australian Longitudinal Study on Women's Health - 6040
women, followed over 9 years at 3 year intervals
• Mediterranean diet - lower risk of hot flashes and night
sweats
• High Fat and High Sugar diet - higher risk of hot flashes
and night sweats
© Burrell Education 2014. Do not copy, duplicate or transmit electronically without full permission from the author(s).
Dairy is a Hormonally Active Food in
Menopause
• What is the ideal age to transition into menopause?
• Average in the US is between 50 and 51 years old.
• Later menopause is protective against cardiovascular
disease and osteoporosis.
• Later menopause = higher risk of breast and endometrial
cancer.
• Entering menopause earlier is positively associated with
all cause mortality.
© Burrell Education 2014. Do not copy, duplicate or transmit electronically without full permission from the author(s).
Should Menopausal Women Eat Dairy Foods?
• Data from the Nurses Health Study - a long term,
epidemiologic study of nurses age 30-55 with up to 20
year follow up.
• Among women <51 y of age more frequent consumption
of low-fat dairy and skim milk , but not high-fat dairy or
whole milk, predicted a later age at natural menopause
(i.e., a lower rate of natural menopause). Specifically,
premenopausal women who consumed >3 servings/d of
low-fat dairy were 18% less likely to report natural
menopause in the next month relative to those consuming
0.1–1 servings/d of low -fat dairy.
• Estrone sulfate and other conjugated estrogens (most
biologically active) are hydrophilic (unlike lipophilic free
estrogens) and might therefore be expected to be present
in the highest concentrations in low-fat dairy.
© Burrell Education 2014. Do not copy, duplicate or transmit electronically without full permission from the author(s).
Dairy and Menopause
• Thus, if women are not dairy sensitive. The bio -active
hormones in low fat milk may be beneficial due to their
ability to delay menopause by a few months on average.
© Burrell Education 2014. Do not copy, duplicate or transmit electronically without full permission from the author(s).
Soy
• 2010 - The Soy Summit - Insights gained from 20 years
of soy research
• Soy
• High in protein, high in antioxidants, low in soluble fiber,
high in omega-6 fats (with some omega-3 fat), modest in
zinc, high in ferritin (iron)
• Contains both phytate and oxalate (inhibits mineral
absorption, but the calcium absorption in calcium fortified
soymilk is similar to that of cow milk)
© Burrell Education 2014. Do not copy, duplicate or transmit electronically without full permission from the author(s).
Soy
• 2010 - The Soy Summit - Insights gained from 20 years
of soy research
• Soy isoflavones: genistein, daidzein, and glycitein
• Isoflavones bind to estrogen receptors
• Genistein can inhibit (in vitro) the activity of tyrosine
protein kinase, an enzyme often over expressed in cancer
cells
• Soy found to be protective of breast cancer in
epidemiologic studies, but the soy consumption had to
have happened in childhood/ adolescence (1 serving/ day
of soy in Asian culture epidemiologic studies.)
© Burrell Education 2014. Do not copy, duplicate or transmit electronically without full permission from the author(s).
Soy and Fat Loss in Menopause
•
2006 Study on ovariectomized female rats.
•
Removing a rats ovaries increases body fat and estrogen
replacement reverses that increase. Similarly
postmenopausal women have increased body fat, and
estrogen replacement therapy has been shown to decrease
body fat in postmenopausal women.
•
Genistein (a soy isoflavone) at high doses 1500mg in rats
(equating to a soy based meal - like a soy supplement shake
in humans) was also shown to reduce the rats’ body weight
by 9%.
•
And, there is evidence that at least part of that body fat
reduction is due to fat cell apoptosis. Additional mechanism
is likely through estrogen pathways, which as other studies
have shown likely depend on the ability of gut bacteria to
metabolize the isoflavones into an active form.
© Burrell Education 2014. Do not copy, duplicate or transmit electronically without full permission from the author(s).
Soy and Bone Health
• Because of soy’s estrogenic effects, soy has been
studied as a therapy to improve BMD.
• With high doses of soy (4 servings or 80-120mg/day
depending on the study) - long term 1-3 year dosing and
measurement
• BMD improved (but just modestly in one study) in the soy
group and worsened in the placebo group. No data
collected on absolute fracture risk in these studies.
• Epidemiologic studies in Asia (Shanghai and Singapore) lower fracture risk in the group that ate the highest amount
of soy for their culture. That absolute amount differed in
the different culture cohorts.
• Lifelong soy intake? Generally healthier Asian health
behaviors?
© Burrell Education 2014. Do not copy, duplicate or transmit electronically without full permission from the author(s).
Soy and Menopause Symptoms
•
1992 it w as noticed that there w as a low prevalence of
hot flashes in Japanese w omen. Is this because the
estrogenic effects of soy mitigate the estrogen drop that
naturally occurs in menopause?
•
More than 50 hot flash trials evaluating the efficacy of
isoflavone-containing products have been conducted. Most
analyses have found suggestive evidence supporting the
efficacy of isoflavones, but did not reach definitive
conclusions because of the conflicting data.
•
The overall benefit (including placebo response) tends to be
around 50% and the effects tend to show up within a few
weeks.
•
Why not try a soy supplement (how much?) and see if it
helps your specific client? (There are some reasons NOT to
add soy. Stay tuned...)
© Burrell Education 2014. Do not copy, duplicate or transmit electronically without full permission from the author(s).
Soy and Menopause Symptoms
• Is your client equol producing?
• For soy supplementation to have any influence it must be
metabolized into equol by a woman’s gut bacteria.
• In a 6-month, parallel group, double -blind, placebo
controlled trial of 270 equol- producing, prehypertensive,
postmenopausal Chinese women...
•
40 g of soy flour (whole soy group), 40 g of low -fat milk
powder + 63 mg of daidzein (daidzein - a soy isoflavone group), or 40 g of low-fat milk powder (placebo group)
daily, each given as a solid beverage for 6 months
• No significant change in menopause symptoms. (But,
these women already had high soy intake - they were
asked to reduce it for the study to twice weekly, and they
did not test for severity of hot flashes.)
© Burrell Education 2014. Do not copy, duplicate or transmit electronically without full permission from the author(s).
Soy and Menopause Symptoms
• Adverse Effects of using soy as a treatment for
menopause symptoms
• There were 182 reports of adverse effects (equally divided
among all 3 groups - soy, daidzein, and milk)
• Gastrointestinal discomfort
• Weight gain
• Sore throat
• Vaginal bleeding
© Burrell Education 2014. Do not copy, duplicate or transmit electronically without full permission from the author(s).
Soy and Menopause Symptoms
• Japanese women and an equol supplement
• A supplement containing equol (natural S-equol developed
by Otsuka Pharmaceutical)
• 3 randomized clinical trials were conducted. The studies
indicated that a daily dose of 10 mg of natural S -equol
improved menopausal symptoms.
• In the confirmation study, menopausal women who were
equol nonproducers who consumed 10 mg/d of natural
S-equol for 12 wk had significantly reduced severity
and frequency of hot flashes as well as a significant
reduction in the severity of neck or shoulder stiffness.
The equol-ingesting group also showed trends of
improvement in sweating and irritability and a significant
improvement in the somatic category symptoms.
© Burrell Education 2014. Do not copy, duplicate or transmit electronically without full permission from the author(s).
Soy and Menopause Symptoms
© Burrell Education 2014. Do not copy, duplicate or transmit electronically without full permission from the author(s).
Soy and Menopause Symptoms
• 160 Japanese, postmenopausal women with normal BMI
and hot flashes at least once daily.
• Placebo x 4weeks (those who showed at least a 50%
reduction in symptoms were excluded.)
• Ingestion period x 12 weeks - placebo and equol
supplement groups (The supplement contained: 5mg
equol, 1.2mg diadzien, and 1.4mg genistein) - orally
ingested morning and evening, daily
• Equol group had significant reductions in hot flashes and
neck/ shoulder stiffness compared with placebo.
• After 6 week wash out period rebound of symptom
occurred. (No serious adverse events.)
© Burrell Education 2014. Do not copy, duplicate or transmit electronically without full permission from the author(s).
Soy and Thyroid Function
• Two groups of monkeys - randomized to soy protein (n=41)
or casein-lactalbumin (n=44) diets (to approximate about
140mg/d of isoflavone)
• All monkeys were ovariectomized after 34 months.
• Half of the monkeys from each treatment group continued
their diets for an additional 34 months (the others were not
followed.)
• Dietary soy increased triiodothyronine (T3) in
preovariectomized monkeys and prevented a decline in
thyroxine (T4) after surgical menopause.
• Mean progesterone concentrations were positively
correlated with triiodothyronine at baseline in
preovariectomized monkeys (P G 0.01).
© Burrell Education 2014. Do not copy, duplicate or transmit electronically without full permission from the author(s).
Soy and Oxidative Stress
• 182 Indonesian postmenopausal women
• 100mg per day of soy isoflavone supplementation (100 mg
soy isoflavones + calcium carbonate 500 mg)
• The control group receiving 500 mg calcium carbonate
(*note: Calcium supplements are now shown to be an
issue of potential risk to the vascular system.)
• After 6 and 12 months of supplementation - markers of
oxidative stress reduced (significantly lower in the soy
group), but no improvement in vascular endothelial
function.
• Adverse effects: Similar complaints of joint pain,
headache, and increased appetite in both groups
© Burrell Education 2014. Do not copy, duplicate or transmit electronically without full permission from the author(s).
Soy Risks
• Breast Cancer? Clinical data does not show an increased
risk of recurrence or worsening prognosis with amounts of
soy typical in the Asian diet (~ 1 serving per day of
traditional soy foods.)
• Soy isoflavones can worsen thyroid function in populations
with iodine deficiency.
• Soy foods inhibit thyroid drug absorption.
• Soy foods have not been evaluated on those with
subclinical hypothyroidism (4-8.5% of the US Adult
population - could be nearly 20 million people in the US nearly 3 times the population of London)
• A few Asian studies correlated high tofu consumption with
cognitive/ memory decline. Tempeh showed cognitive
improvement.
© Burrell Education 2014. Do not copy, duplicate or transmit electronically without full permission from the author(s).
Evidence-Based Soy Recommendations
•
Asian amounts (1-2 servings per day) of traditional soy
foods.
•
Be cautious if patient/ client presents with hypothyroidism or
subclinical hypothyroidism (especially if they are low in
iodine - this is usually not the case in Western autoimmune
hypothyroidism)
•
Supplements may have different effects than traditional soy
foods. (Be wary of large amounts of isoflavones in
supplements. The daily Asian amount is about 40 mg/ day)
•
Fermented soy foods may be more beneficial (especially +
pre and pro biotics)
•
If using for menopause symptoms - try supplementing with
foods or supplements for a few weeks, and notice changes.
•
Check for sensitivity first!
© Burrell Education 2014. Do not copy, duplicate or transmit electronically without full permission from the author(s).
Summary – Optimal Nutrition for
Hormone Balance in the Third Age
• Balancing the endocrine system is essential for energy,
libido, bone health, and menopause symptoms in the 3rd
age.
• Adrenal resilience - start early! - cut the sugar/ stress,
orgasm, laptop curfew, extreme self-care.
• Dairy - if not sensitive - may be beneficial to delay
menopause a few months. (But, dairy fat associated with
shorter telomere length in third age women.)
• Soy - lots of pros and cons. Check sensitivity first, avoid
if low thyroid + low iodine, consider adding for bone
health, hot flashes, and oxidative stress. Best in
traditional Asian diet amounts of organic (non-GMO)
fermented soy. Women must be equol producers to
experience benefit.
© Burrell Education 2014. Do not copy, duplicate or transmit electronically without full permission from the author(s).