CHRONIC DISEASE A "Side Effect" of Food?

Delali Hevi, MD

Board Certified- Obesity Medicine

Board Certified- Internal Medicine

Member- Obesity Medicine Association

No conflicts to declare

Common "Side Effects" of Food 1 Allergy

2 Food-Drug Interactions

3 Bad Breath

4 Body Odor

5 Diarrhea

6 Constipation

7 Gas, Flatulence, Abdominal Bloating, Frequent Urination

9 Edema, Swelling, Water Retention

10 Heartburn & Acid Reflux

11 Stress

Common "Side Effects" of Food

12 Insomnia

13 Sleepiness

14 Gastritis, Peptic Ulcers

15 High Blood Pressure

16 High Cholesterol (Hyperlipidemia)

17 Kidney Stones

18 Migraine & Headache

19 Arthritis, Gout

20 Acne

21 Candidiasis

Common "Side Effects" of Food 22 Memory & Cognition Impairment

23 Tooth Decay (Dental Caries)

24 Tooth Staining

25 Nausea

26 Photosensitivity

27 Tears

28 Thirst

29 Yellow Skin Pigmentation (Carotenemia)

30 Fertility Problems in Men

31 Weight Gain

For todays talk our main concern is with chronic

diseases

One cannot talk about chronic disease without

talking about....

OBESITY-The Mother of all Chronic

Diseases

Obesity is directly linked to almost all NCD's

It has been demonstrated that weight loss leads to an improvement and/or

even reversal of many NCD's

Courtesy of nairaland

.com

Obesity-Definition

“Obesity is defined as a chronic, relapsing, multi-factorial, neurobehavioral disease, wherein an increase in body fat promotes adipose tissue dysfunction and abnormal fat mass physical forces, resulting in adverse metabolic, biomechanical, and psychosocial health consequences.”

-Obesity Medicine Association

Obesity is a disease when...

•Excessive body fat is caused by genetic factors, developmental errors,

infections, hypothalamic injury, adverse reactions to medications, nutritional

imbalance, or unfavorable environmental factors

•Multiple adipose tissue endocrine and immune dysfunctions contribute to

metabolic disease (a.k.a. “sick fat” disease)

•Multiple pathogenic physical forces from excessive body fat cause stress

damage to other body tissues (fat mass disease)

Big advantage of the recognition of obesity as a

disease-Removal of stigma

Up until recently people with excess weight were generally thought to be...

Lazy

Lacking in self control/morals

Greedy

Dirty

Unattractive

Unhealthy

Depressed

"Check your Statistacs"

1 in 2 Americans has a chronic disease, and one in four has multiple chronic

diseases

27 percent of kids now have a chronic disease, up from just 13 percent in 1994

Chronic disease is responsible for seven out of every ten deaths

Spending on chronic disease worldwide will reach $47 trillion by 2030.

This is equivalent to the GDP of the six largest economies in the world.

This generation is the first in which kids are expected to live shorter

lifespans than their parents.

1 in 5 Americans struggles to pay medical bills, and three in five

bankruptcies are due to medical expenses.

50 million Americans (approximately 1 in 6) have an autoimmune disease

(more than cancer and heart disease combined)

Nearly 1 in 3 Americans have either prediabetes or diabetes. (100 Million)

At any given moment, roughly half of the adults in the U.S., including 9 out of 10 adults over age 60, are taking at least one prescription drug

Almost a third of adults take two or more drugs.

Almost 30 percent of all teens are now on a prescription drug, as are 20 percent of young children.

America spent just under $310 billion on pharmaceutical drugs in 2015 (IMS Health 2016)

Chronic disease will generate $47 trillion in

healthcare costs globally by 2030 if the epidemic is

unchecked (Duff-Brown, 2017).

That is more than the annual GDP of the six

largest economies in the world.

Overweight and obesity epidemic in Ghana—a systematic review

and meta-analysis. Richard Ofori-Asenso et al. BMC Public

Health (2016)

Forty-three (43) studies involving a total population of 48,966 sampled

across all the ten (10) regions of Ghana were selected for the review.

Findings Nearly 43% of Ghanaian adults are either overweight or obese.

Overweight=25.4%

Obese=17.1%

Urban obesity= 16.7%

Rural obesity= 8.0%

Female obesity=21.8%

Male obesity= 6.0%

At the regional level...

Greater Accra= 55.2%

Ashanti= 43.4%

Central=36.9%

Northern= 32.4%

These patterns generally mimic the levels of urbanization.

About 45.6% of adult diabetes patients in Ghana are either overweight or obese.

What is the link between diet, obesity and

consequently chronic disease?

Mismatch between genetics and

environment

Human beings have evolved over millions of years; our genes

and biology have adapted to allow us to survive and thrive in a

particular environment.

When the environment changes faster than our genes can

adapt, a mismatch occurs which can lead to ill health.

Timeline of Man's Existence On Earth

99.5 yards represents the time we were

hunter-gatherers

Plant-animal subsistence ratios and macronutrient energy estimations in

worldwide hunter-gatherer diets. Cordain et al. The American Journal of

Clinical Nutrition, Volume 71, Issue 3, 1 March 2000

Group of Anthropologists from USA and Australia

Sought to study the diets of our ancestors

Studied/analyzed the economic subsistence data for 229 hunter-gatherer

societies from all around the world using all 3 subsistence categories

(gathered plant foods, hunted animal foods, and fished animal foods)

Findings Whenever and wherever it was ecologically possible, hunter-

gatherers consumed high amounts (45–65% of energy) of animal food.

Most (73%) of the worldwide hunter-gatherer societies derived >50% of their subsistence from animal foods

Only 14% of these societies derived >50% of their subsistence from gathered plant foods.

0.0% of the societies studied were 100%

Vegetarian!

Comparison of the two diets Hunter/Gatherer

Meat

Fish

Wild fruits and vegetables

Nuts and seeds

A few starchy plants and tubers

All of the above were organic

Modern

Bread

Grain based desserts

Sugar sweetened beverages

Pizza

Alcohol

Chicken

Comparison of the two diets Hunter/Gatherer

Naturally anti-inflammatory

Low in calories

High in nutrients

Modern

Pro-inflammatory

High in calories

Low in nutrients

Human beings evolved to seek calorie dense foods because food was

seasonal and scarce; our bodies efficiently stored food as fat in times of

plenty, and then burned those fat stores for energy when food was scarce

Fast forward to today...

In modern times... Food is available in abundance

Can be delivered to your door... No effort or activity required

Food is geared towards convenience and cost effectiveness at the expense of nutritional value

Our soils have been so depleted of nutrients that even 'healthy' fruits and vege's may be nutritionally suboptimal

The CARDIA study Fast-food habits, weight gain, and insulin resistance; 15-year

prospective analysis.

Published in the Lancet, 2005

INTERPRETATION/CONCLUSION: Fast-food consumption has strong positive associations with weight gain and insulin resistance, suggesting that fast food increases the risk of obesity and type 2 diabetes.

Food Quality

70% to 80% of the processed and manufactured foods available in a

conventional grocery store contain one or more ingredients derived from

genetically engineered (GMO) organisms Grocery Manufacturers’ Association position on GMOs

What is GMO? A GMO (genetically modified organism) is a plant, animal, microorganism

or other organism whose genetic makeup has been modified in a

laboratory using genetic engineering or transgenic technology.

This creates combinations of plant, animal, bacterial and virus genes that

do not occur in nature or through traditional crossbreeding methods.

Most common GMO's Corn

Soybean and canola cooking oils

High-fructose corn syrup

A variety of meals and flours

Factory farm raised meat, fish, or eggs

Added ingredients designed to increase protein content, alter cooking and

baking properties, or add other attributes to a given food product.

Factory Farm Raised Meat Genetically modified to grow rapidly

Fed with GMO grain

Given growth hormone

Prophylactic antibiotics-given to all

Lower in omega-3 fatty-acids, vitamin E, beta-carotene, antioxidants and

conjugated linoleic acid, or CLA.

Food & The Gut Microbiome Estimated over 100 trillion bacteria in the intestinal tract (10X the number of

human cells)

Gut flora (bacteria, fungi, viruses, and parasites) play a very prominent role in human immunity, digestion, vitamin production, absorption, hunger, and neurologic processes

Gut flora can send impulses through the vagus nerve to the brain and influence behavior, hunger, mood. E.g. candidal overgrowth can send impulses to the brain that cause carbohydrate and sugar cravings...contributing to obesity

What Factors Can Alter the Gut Flora? Genetically modified foods

Meats raised with antibiotics

Antibiotics

High carb/high sugar diets

Artificial sweeteners

Stress

What can be done? Limit antibiotic use to when it is absolutely necessary

Avoid the factors mentioned in the previous slide

Intake of prebiotics, probiotics, fermented foods

Misguided Food Policy/ Guidelines There has been a war on fat that many obesity specialists believe has

actually spearheaded the obesity epidemic

This war is not based on actual science, but on "common sense" and

"consensus"

The origin of the 'fat phobia' lies in an experiment conducted in Russia in

1910 in which they fed rabbits high fat/cholesterol diets and noticed that

there was an increase in atherosclerosis over the controls

FLAW?- rabbits are herbivores!!!

My only take-home from this study is that if you feed any animal (including

humans) a diet that they are not genetically adapted to, there will be

problems

Ancel Keys, PhD-Physiologist in the

1950's Heavily promoted his theory that dietary fat led to hyperlipidemia which led to

heart disease

Had strong influence among the politicians of the day

Viciously discredited/maligned anyone who disagreed with him

His theory contributed in large part to the drafting of the low fat food policy that was adopted worldwide

The problem with Ancel Keys Theory Not based on solid scientific evidence

Based on his "7 Countries Study"… he actually studied 22 countries!

The fact is that dietary cholesterol has very little influence on serum cholesterol levels

The fact is that dietary fat is NOT the primary driver of obesity

Courtesy of the Journal of Food and Nutrition Research 2016. Food consumption and the actual statistics of

cardiovascular diseases: an epidemiological comparison of 42 European countries

Courtesy of the Journal of Food and Nutrition Research 2016. Food consumption and the actual statistics of

cardiovascular diseases: an epidemiological comparison of 42 European countries

Ghana's Burden of Chronic Non-Communicable Diseases: Future

Directions in Research, Practice and Policy. GMJ.

A de-Graft Aikins et. al

Chronic NCDs contribute significantly to the nation's disease burden. They

constitute both a public health and a developmental issue that should be of

urgent concern not only for the Ministry of Health, but also for the Government of

Ghana.

The government needs to give high priority to policies and funded programs for

the prevention and control of chronic diseases.

Public-private partnerships with the pharmaceutical industry should aim to

ensure availability, affordability and accessibility of low-cost generic drugs for the

management of chronic diseases. Researchers need to focus efforts on

implementation research questions relevant to Ghana.

Thank You!