Safeguarding musculoskeletal structures

from food technologies’ untoward metabolic effects

Ingrid Kohlstadt MD, MPH, FACN, FACPM

April 19, 2018

American Academy of Orthopedic Medicine Clearwater, Florida

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Food technologies are less known among the external environment “saboteurs.”

Rappaport, SM. Perspectives: Environment and disease risks. Science. 22 October 2010; Vol. 330. p.461.

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Which of our patients are most at risk?

Thought provocateur 1

What dairy products are ultra-pasteurized? How does this relatively new technology work How is ultrapasteurization thought to affect metabolism?

Traditional people groups use milking sacks containing Lactobacilli which digest lactose.

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Ultra-pasteurization and aseptic (Ultra-high temperature) methods

Parameters Pasteurization Ultra-pasteurization

Ultra-high Temperature

Heat treatment 161F for 15

seconds

280 F for 2

seconds

280 F for 2

seconds+

Bacterial kill Some survival Nearly “sterile” Nearly “sterile”

Package treatment

Untreated Treated with

H2O2

Sterilized

Product storage Refrigerated Refrigerated Shelf-stable

Shelf-life 10-21 days 30-90 days 6 months+

Cornell University Department of Food Science. Dairy Foods Science Notes. October 10, 20076

Ultrapasteurized milk doesn’t make yogurt

Study demonstrates homemade yogurt treats irritable bowel syndrome. The live active bacterial cultures can not grow in ultrapasteurized milk

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Intolerance of food tech could be misdiagnosed as IBS or

lactose intolerance

Findings presented by Drs. Chandran and Heizer at the World Congress of Gastroenterology October 16, 2017 demonstrated it is feasible and effective for patients with IBS to prepare and consume their own yogurt. Restored gut microbiome is the biologic mechanism. 8

Thought provocateur 2

Synthetic trans fats are used less often. What has replaced them?

Interesterification

• Shuffles the fatty acids on the glycerol backbone. The type of fatty acids and the position of the fatty acids on the triglycerides can be selected.

• Allows industry to pay less for oil, adjust the consistency of the food, and extend shelf life.

• Does not appear on nutrition labels at this time.

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Metabolic impact of interesterification

• Fats are stripped of the antioxidant nutrients which chaperone fatty acid oxidation

• The position of the fatty acid on the glycerol backbone is not random to metabolic processes, although the impact of switching this around is not clear at this time. 11

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Interesterification removes fat-soluble nutrients

Fat-soluble nutrients chaperone the beta oxidation to prevent free radical formation.

Colorful phytonutrients i.e.

lycopene, resveratrol, oleuropein, carotenoids have anti-inflammatory and other immune effects likely to be beneficial although not yet studied in tropical infections.

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Dietary fats become..

Free (often released from membrane by phospholipase A2) fatty acids which are beta oxidized

Phospholipids (2 fatty acids) incorporated into membranes

Triglycerides (3 fatty acids) Cardiolipin (4 fatty acids)

incorporated into inner mitochondrial membranes for ATP synthesis

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Dietary fats and the metabolic engine

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Oleic acid structure Fatty portion

Oleic acid has a single

double bond and a melting point 55°F

differentiating it from stearic acid which is fully saturated and has a melting point of 157°F

Acid portion

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The fatty tails composing the membranes confer structure and function

Reproduced with permission from Olmstead, S. and Meiss, D. Cardiac Arrhythmias in Kohlstadt, I (ed.) Food and Nutrients in Disease Management. CRC Press, Boca Raton, FL Jan 2009, Chapter 7.

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Plant and animal species in cold environments have more fats with double bonds

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Plants and animals living in tropical climates have more saturated fat and

fewer double bonds.” Tropical oils include coconut, shea, macademia, and red palm. Even the fish swimming in tropical waters have few polyunsaturated fats

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Thought provocateur 3

Metabolism depends on bilipid membranes. Emulsifiers enable oil and water to stay in solution. Adding emulsifiers to food stands to change the effectiveness of bilipid membranes in the lumen of the intestinal tract.

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Bilipid membranes are dynamic • 4.5nm diameter is

preserved across organelles and across species.

• The fatty tails of the lipids vibrate at the double bonds and the phospholipids are in constant motion.

• Lipids influence function of transmembrane protein.

22 -Albert Einstein

Make everything as simple as possible, but not simpler.

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Membranes = MOVEMENT

Michael Flatley leading Riverdance

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Membrane properties alter protein function

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Aquaporin protein (discovered by Johns Hopkins’ Nobel Laureate Peter Agre) function is altered by

membrane fatty acids

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Emulsifiers in nut milk

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Emulsifiers in mouthwash

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Example of membrane stabilizing diet • Protein at each meal- organic meat, poultry, eggs, fish (wild salmon,

sardines) • Organic Raw Seeds and Nuts (may use in place of flour) • Organic 4:1 omega 6 / omega 3 rich oils / 4 – 6 Tablespoons daily • Free range, organic eggs • Organic butter, ghee, cream, sour cream, full fat organic or yogurt,

homemade kefir • Organic 4:1 omega 6 / omega 3 oil, Grape seed oil mayonnaise, coconut

butter (to fry foods), homemade salad dressing, cold pressed / organic oils and dressing (no canola or peanut oil)

• Green/ low carbohydrate vegetables – organic cucumber, chives, chard, cauliflower, cabbage, sprouts, celery, onion, leeks, zucchini, broccoli, asparagus, snow peas, bok choy, eggplant, green beans, kale, collard greens, Chinese cabbage, Brussels sprouts

• Salads daily withhomemade dressing of pure oils, vinegar (Eden Plum), • Fresh herbs / spices, natural flavoring to flavor foods • Lemonade or limeade made with fresh lemon/ lime with H20 + dry stevia to

sweeten drinks • Organic unsweetened berries/fresh whipped cream or organic yogurt • Tofu spaghetti or fettuccine (drain, rinse, boil on high 30 minutes); Soy chips

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Lipids Dosage

Balanced 4:1 omega 6 to omega 3 oil 1 to 2 tablespoons bid

Evening primrose oil 1 to 2 tablespoons bid

Phosphatidylcholine (PC) p.o. 1 to 2 tablespoons bid i.v. Lipostabil sol inj. i.v. 250mg 5 amp 5ml (D)

Nattermann/Aventis

GlycerylPhosphorylCholine (GPC) 300-1,200mg qd

Sodium phenylbutyrate (Buphenyl) Rx only Sodium butyrate dietary supplement

Prescription dosing of 500mg tablets 1 to 2, 600mg tablets bid

Medium chain triglycerides as tropical oils

1 teaspoon to 1 tablespoon bid

Fish or algal sources of EPA and DHA Disease and lab-test specific dosing

Essential oils including peppermint, tamanu, sage, clove oils

Topical applications, apply to affected areas as needed

Examples of lipid therapies

Thought provocateur 4

Is “gluten-free” a trend or a treatment?

What has changed in 2,000 years?

Not the wine and the olive oil, but the barley and the wheat. The use of GMO for glyphosate resistance (misuse of great technology) has direct and indirect effects on musculoskeletal structures.

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Thought provocateur 5

In pop culture titanium means inner strength, but what does exposure to titanium nanoparticles mean in biologic terms?

Safety concern about additive E171 TiO2 nanoparticle fraction

“Health effects due to exposure to titanium dioxide nanoparticles via food, food supplements and toothpaste cannot be excluded,” according to the Dutch National Institute for Public Health and the Environment (RIVM). “Because it has become clear that nanoparticles can behave differently as compared to larger particles or soluble substances.”

36 https://www.rivm.nl/en/Documents_and_publications/Common_and_Present/Newsmessages/2016/Health_effects_due_to_titanium_nanoparticles_in_food

d t th t t b l d d

Many routes of entry for unstudied TiO2 nanoparticles

• TiO2 nanoparticles penetrate skin when lathered and lung tissue when aerosolized and the gi tract when ingested.

• TiO2 sunscreen penetrates more deeply and impairs vitamin D synthesis.

• TiO2 toothpaste effects on oral musculoskeletal structures remain unstudied.

• Titanium sensitivity is a recognized cause of orthopedic implant failures

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Thought provocateur 6

What patients benefit most from nixing noncaloric artificial sweeteners (NAS)?

First in human study links artificial sweeteners to diabetes

Sucralose and acesulfame-K reduced the glucose reaching the distal intestine where the incretin hormone glucagon-like peptide 1 (GLP-1) is released.

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Artificial sweeteners have the opposite metabolic effect of Byetta (exenatide), reducing GLP-1 instead of increasing it.

Young, RL. et al. Impact of artificial sweeteners on glycaemic control in healthy humans. Abstract # 193 Session: Gastro-entero-pancreatic interactions EASD Lisbon 2017.

Artificial sweeteners impair rehydration

Oral rehydration solution (ORS) research demonstrates NAS are not a substitute for glucose. Only glucose can increase intestinal sodium uptake, with minimal osmotic effect.

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• Bariatric and gastrointestinal surgery increase risk of dehydration lifelong.

Remembering Dr. Fereydoon Batmanghelidj

Chronic dehydration causes mechanical stress on joints.

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Genomic discovery links sour taste perception and sense of balance

Yu-Hsiang Tu, et al. An evolutionarily conserved gene family encodes proton-selective ion channels, Science. 2018. What could this tell us about NAS safety?

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Thought Provocateur 7

The Radura symbol resembles the EPA logo, more than the radiation tri-foil. Should we feel reassured about irradiated food?

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Why irradiate food?

• Prevention of Foodborne Illness • Preservation • Control of Insects • Delay of Sprouting and Ripening • Sterilization

44 Source: FDA.gov

Reasons to not be reassured

• No radiation is retained, however there is minimal safety data on the breakdown products of the irradiation and these are retained in food.

• Loss of absorbable minerals • Affects on the digestibility of food and the

human microbiome are not yet addressed • Extended farm-to-fork time due to

diversion to facilities where food can be irradiated. 45

A special thanks to the authors

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