The Pharmacy in Your Kitchen: An Overview of Medical and Medicinal ... · PDF fileThe Pharmacy in Your Kitchen: An Overview of Medical and Medicinal Foods Michael Lara, MD Diplomate,

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The Pharmacy in Your Kitchen: An Overview of Medical and Medicinal Foods

Michael Lara, MD

Diplomate, American Board of Psychiatry and Neurology

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Medical Disclaimer

The medical information contained herein is provided as an information resource only, and is not to be used or relied on for any diagnostic or treatment purposes. This information is not intended to be patient education, does not create any patient-physician relationship, and should not be used as a substitute for professional diagnosis and treatment.

Please consult your health care provider before making any healthcare decisions or for guidance about a specific medical condition.

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Logistical Issues ‣ Breaks: ‣ 10:30-10:45 am ‣ Noon-1:00 pm ‣ 2:30-2:45 pm

‣ Questions: ‣ Due to medical-legal reasons, I cannot answer

questions about personal medical problems

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www.Facebook.com/BrainMD

www.drmikelara.com

Up to a two line subtitle, generally used to describe the takeaway for the slide

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Click on the “Resources”

tab

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“Let food be thy medicine and medicine be thy food”

~Hippocrates

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Medical Foods that Alter Neurotransmitter Levels How Serotonin, Dopamine, GABA and other NTs are Affected by Nutrients

Medical Foods that Target Inflammation Nutritional Strategies for Reducing Chronic Inflammation

Medical Foods that Affect Nutrient Metabolism Medium-Chain Triglycerides and Folate Metabolism

Practical Strategies for Using Foods that Heal

Food or Medicine? Understanding Medical Foods in the Context of the Food-Drug Spectrum 1

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Practical Strategies for Using Foods That Heal


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512

87%

Source: 2011 IFIC Functional Foods/Foods for Health Consumer Trending Survey

Percentage of Americans who believe that certain foods have health benefits that go beyond basic nutrition.

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FDA Definition of Medical Food

A food which is formulated to be consumed or administered enterally through the supervision of a physician and which is intended for the specific dietary management of a disease or condition for which distinctive nutritional requirements, based

on recognized scientific principles, are established by medical evaluation.

Food or Drugs?

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Medical Foods

‣ Medical foods aren’t regular foods • Dietary products formulated for the management of diseases for which

specific nutritional requirements have been established

‣ Medical foods aren’t drugs or dietary supplements and are monitored separately by the FDA

‣ All efficacy claims for medical foods must be based on recognized scientific principles and clinical data

‣ Medical foods may be used only under medical supervision

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Supplement Medical Food Drug

Governing Regulation

Premarket Scientific Testing

Ingredients

Claims

Intended Target Population

Safety and Pharmacovigilance

Physician Supervision

Federal Food, Drug andCosmetic Act

Orphan Drug ActDietary Supplements, HealthEducation Act

NoMedical evaluation in

patients withthe specific disease

being targeted

Preclinical and Clinical Studies

Mostly synthetic; can be nutritionalNutritional

Nutritional; not inordinary diet

Support HealthyFuntion

Dietary managementof a specific disease

Negotiated with FDA anddependent on pivotal clinical

trial data

Normal, healthyadults

Diseased-for nutritionalrequirements of a specific disease

Diseased-for patients witha specific indication or

symptoms

General expectation ofsafety and through monitoring

of consumer complaints

GRAS and post marketsurveillance

Need to establish through clinical trials and post market

surveillance

None Required Required, if prescription drug

Conditions for which Medical Foods are UsedMedical Foods: Therapeutic Areas

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PKU

Metabolic Syndrome

Osteoporosis

Chronic Pain

B-vitamins, soy fiber, plant sterols, EPA/DHA

Vitamin D, zinc, genestein, calcium

Choline, tryptophan, arginine, glutamine, and histidine; GABA; antioxidants (gingko biloba, grape seed extract, and cinnamon)

Soluble fibers, probiotics, vitamins, minerals, amino acids, and/or hydrolyzed protein; ginger, rosemary, turmeric; MCTsGastrointestinal

Protein formulas with reduced phenylalanine; increased amounts of large neutral amino acids (e.g., tyrosine, tryptophan)

MCTs; B-12, folic acid (L-methlylfolate); DHA/EPA; Vit C, ENeuropsych

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Medical Food DiseaseTargeted Key Ingredients Presumed Mechanism of Action

Juven Diseases that cause weight loss HMB, L-leucine, L-glutamine Inhibition of protein breakdown,

stimulation of mTOR pathway

Axona Alzheimer’s Disease Medium chain triglyceride (Caprylic Acid)

Caprylic acid increases production of ketone bodies, an alternative energy

source for neurons.

Deplin Depression L-methylfolate Increase in neurotransmitters affected by MTHFR polymorphism

Limbrel Osteoarthritis Polyphenol flavonoids Inhibition of pro-inflammatory COX-2 and 5-LOX pathways

Cerefolin NAC Cognitive Impairment B12, L-methylfolate, NACReduction of homocysteine levels,

increase in neurotransmitters affected by MTHFR polymorphism

App Trim Insulin resistance and

other forms of metabolic dysfunction

Whey protein, amino acids, Griffonia seed extract,

cocoa, caffeineIncrease in amino acids involved in

appetite regulation, increase in lipolysis.

Trepadone Pain and inflammation syndromes, arthritis

Whey protein, GABA, L-histidine, glucosamine/

chondroitin, omega-3 fatty acids, polyhenols

“Supports the synthesis and physiologic activities of neurotransmitters involved

in joint disease”

Sentra PMSleep disorders associated with

DepressionNeurotransmitter

precursors, polyphenolsSupports neurotransmitters involved in

regulation of sleep

Benefits of Combining Medical Foods with Prescription Drugs

‣ Reduction in medication side effects

‣ May lower overall medical costs

‣ Enhances patient adherence

‣ Empowers patients to take active role in meal planning and overall nutrition

‣ Combination therapy perceived as a “natural” treatment regimen

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Medical Foods: Major Mechanisms of Action

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Mechanism Of Action

Neurotransmitters Inflammation

Nutrient Metabolism

‣ Medical foods that alter neurotransmitter levels (e.g. Theramine)

‣ Medical foods that reduce acute and chronic inflammation (e.g. Vascazen)

‣ Medical foods that affect nutrient metabolism (e.g. Axona)

Mechanism

Theramine

Gabadone

App Trim

Vascazen

Limbrel

Pulmona

AxonaDeplin

CerefolinNAC

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Essential Amino Acids and Neurotransmitters

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Tryptophan Methionine Phenylalanine Threonine ValineLeucine IsoleucineLysine

Serotonin

Melatonin

Cysteine

Glutathione

Tyrosine

Dopamine

Norepinephrine

Epinephrine

Glycine AspartaticAcid

Glutamate

Glutamine

GABA

Arginine

Histadine

Histamine

Nitric Oxide

Therapeutic Roles of Amino Acids‣ Neurotransmitter Precursors

• Tyrosine is precursor for dopamine

• Tryptophan is a precursor for serotonin

‣ Branched-Chain Amino Acids • Leucine, isoleucine, and valine

‣ Leucine • Regulates protein synthesis

‣ Glutamine • Conditionally-essential amino acid that promotes gut health and assists in wound

healing.

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Dietary Precursor Neurotransmitter Function

Tryptophan

Phenylalanine

Histidine

Arginine

Glutamine

Choline

Serotonin

Dopamine

Nitric Oxide

Histamine

Glutamate GABA

Acetylcholine

Norepinephrine

Mood, sleep, appetite

Reward, motivation,

concentration

Vasodilation

Regulation of immune

response

Major regulatory neurotransmitters

Learning, memory, arousal

GABAdone™

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Indication

Primary Ingredients

Mechanism of Action

For the nutritional management of the metabolic processes associated with sleep disorders

Choline bitartrate, GABA, cocoa extract, l-glutamine, whey protein isolate (milk), Griffonia extract, valerian root, acetyl l-carnitine, ginkgo biloba, and grape seed extract

Supports neurotransmitters that regulate sleep: serotonin, GABA, and acetylcholine.

A visual record of the stages of sleepSleep Hypnogram

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Midnight 0130 0300 0500 0630

Awakening

REM Sleep

Stage 1

Stage 2

Stage 3

Stage 4

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Active Placebo

Gabadone Reduces Time to Fall AsleepMedical food for the management of chronic and acute pain, fibromyalgia, and neuropathic pain

Theramine™

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Indication

Primary Ingredients

Mechanism of Action

For the dietary management of the metabolic processes associated with pain disorders and inflammatory conditions

GABA, choline, whey protein isolate, arginine, histidine, glutamine, theobromine, Griffonia seed, grape seed, serine, cinnamon

Stimulates production of neurotransmitters involved in regulation of pain signals: GABA, serotonin, norepinephrine.

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Medical food that supports muscle protein synthesisJuven®

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Indication

Primary Ingredients

Mechanism of Action

For the dietary management of cachexia associated with cancer and age-related muscle loss (sarcopenia)

HMB (a leucine metabolite), glutamine, and arginine.

Activates metabolic pathways involved in protein anabolism, including mTOR pathway.

Leucine Enhances Protein Synthesis in Older Adults

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Video #1 Leucine Recipe

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Medical food for patients with treatment-resistant depressionDeplin® (L-Methylfolate)

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Indication

Primary Ingredients

Mechanism of Action

For the distinct nutritional requirements of individuals who have suboptimal L-methylfolate levels in the cerebrospinal fluid, plasma, and/or red blood cells and have major depressive disorder (MDD) with particular emphasis as adjunctive support for individuals who are on an antidepressant.

L-methylfolate

Supports synthesis of monoamine neurotransmitters

Folate in Neurotransmitter Synthesis

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Folic Acid(Synthetic folate)

Dihydrofolate(Dietary sources)

Tetrahydrofolate

L-methylfolate L-methylfolate

BH4

Serotonin Dopamine

Norepinephrine

CH

HH

H H

HH

HH

H H

HH

H H

CH2

3

Tryptophan hydroxylase Tyrosine hydroxylase

+

MTHFRBBB

5,10 methylene THF

Liver Brain

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L-Methylfolate Improves Depression and Reduces Markers of Inflammation

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http://ndb.nal.usda.gov/National Nutrient Database

‣ Comprehensive database of more than 8,000 foods ‣ Foods can be searched and sorted according by content

of specific nutrients (e.g., omega-3, magnesium, folate)

‣ Includes common restaurant foods

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Diseases Associated with Chronic Inflammation

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Chronic Inflammation

Cancer

Cardiovascular Disease

Alzheimer’s Disease

Pulmonary Disease

Arthritis

AutoimmuneDisease

NeurologicDisease

Diabetes

Lifestyle Factors Contributing to Chronic Inflammation

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Exercise Exercising too much or to little has been associated with increases in inflammatory cytokines

Nutrition Standard American Diet: high in trans-fatty acids, high in omega-6s, and high GI foods; low in fiber, plant-based foods

Obesity Obesity is associated with increases in pro-inflammatory cytokines and smaller brain volume

Sleep Deprivation

Chronic and acute changes in sleep lead to increases in pro-inflammatory cytokines and disruption of leptin/grehlin

Smoking Chronic elevations of CRP, pro-inflammatory cytokines, and disruption of blood-brain barrier

Stress Acute and chronic stress leads production of pro-inflammatory cytokines

Omega-3 Fatty Acids

‣ Essential fatty acids are required for normal metabolism

‣ EPA (eicosapentaenoic acid) and ALA (alpha-linolenic acid) are essential; DHA is synthesized from EPA

‣ Sources • EPA: Wild fish, seaweed, algae

• ALA: Nuts, seeds, vegetable oil

‣ Ideal ratio of omega-6:omega-3 is 1:1, but in Western diets ratio is closer to 16:1

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Essential Fats Derived from Plant and Marine SourcesHealth Benefits of Omega-3s

Improve heart health

Reduce risk of stroke and heart attack

Improve Brain Function

Decrease inflammation

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The Major Omega-3 Fatty Acids

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O

HO

O

HO

O

HO

Alpha-linolenic acid (ALA)18:3n-3

Eicosapentaenoic acid (EPA)20:5n-3

Docasahexaenoic acid (DHA)22:6n-3

ω-3

ω-3

ω-3

Medical food for patients with cardiovascular diseaseVascazen®

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Indication

Primary Ingredients

Mechanism of Action

For the dietary management of omega-3 deficiency in patients with cardiovascular disease

EPA and DHA in a patented 6:1 ratio

-Inhibition of pro-inflammatory eicosanoids

-Increased production of anti-inflammatory eicosanoids

-Downregulation of pro-inflammatory NFκΒ pathway

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Potent anti-inflammatory compounds derived from plant sources

Polyphenols

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Polyphenols Food Sources

Catechins

Flavanones

Flavanols

Anthocyanins

Reservatrol

Curcumin

Green and white tea, grapes, cocoa, lentils, berries

Oranges, grapefruit, lemon

Berries, red grapes, wine

Grape skin, red wine, nuts

Licorice, strawberries, apricots, cherries, cinnamon

Walnuts, strawberries, cranberries, blackberries, guava, grapes

Tea, mango, strawberries, rhubarb, soy

Blueberries, kiwi, plums, cherries, apples

Coumarin

Ellagic acid

Tannic acid

Gallic acid

Caffeic acid

Phen

olic

Aci

dsN

on-F

lavo

noid

sFl

avon

oids

Cocoa, green vegetables, apples, berries, onions

Tumeric, mustard

Nettles, tea, berries

Curcumin

‣ Anti-inflammatory via inhibition of cytokine production

‣ Anti-cancer effects via induction of apoptosis

‣ Anti-depressant effects via MAO inhibition

‣ Inhibits formation of β-amyloid

‣ For inflammatory disorders, 2-8 grams curcumin/day

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Derived from turmeric, a member of the ginger family, curcurmin has multiple medicinal properties

Health Benefits of Curcumin

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Curcumin

Cancer prevention

Cardiac Protection Anti-Arthritic Effects

Neuroprotective Effects

Anti-diabetetic Effects

HO

CH O3

O

OH

OCH3

O

Curcumin Dosing Considerations

‣ Curcumin undergoes rapid biotransformation during and after GI absorption • 40-85% of an oral dose of curcumin passes thru GI tract unchanged; often

combined with black pepper for increased absorption

‣ Preparations: dried root; liquid extract, or capsules.

‣ Powdered rhizome provided at a heaped teaspoon (about 4 grams) mixed with water to a slurry and drank 1-2 times/day. A teaspoon of lecithin can be added to improve absorption.

‣ 1:1 liquid extract using 45% ethanol or higher recommended at 5-14 ml/day taken in 4 equal doses throughout the day

‣ Encapsulated 500 mg 4 times daily

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Derived from the seeds of the tree theobroma cacao, “drink of the gods”, cocoa is rich in anti-oxidants

Cocoa

‣ Improves cardiovascular health by reducing blood pressure, inhibiting platelet aggregation, and reducing insulin resistance

‣ Contains range of bioactive compounds, including theobromine (similar to caffeine), phenylethylamine (a psychostimulant), and flavanols

‣ Dark, unsweetened 70% cacao

‣ Optimal dose: 10 g/day55

Health Benefits of Cocoa Flavanols

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OH

O

Cocoa Flavanols

Improve Glucose Tolerance

Reduce Blood Pressure Improve Endothelial Function

Reduce Cholesterol

Improve Platelet Activity

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Medical food for the management of lung diseasePulmona™

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Indication

Primary Ingredients

Mechanism of Action

For the dietary management of the metabolic processes associated with pulmonary hypertension and bronchospasm

L-arginine, l-glutamine, l-histidine, l-leucine, l-cysteine, choline bitartrate, whey protein hydrolysate, cinnamon, ginkgo biloba, grape seed extract, caffeine, cocoa extract

Improves endothelial function and reduces hypertension via production of nitric oxide

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Made from leaves of the plant Camellia SinensisGreen Tea

‣ Rich in polyphenol flavonoids ‣ Multiple purported health benefits but very few clinical

studies in human subjects

‣ Studies suggest optimal anti-oxidant benefits by consuming 3-4 cups/day

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Health Benefits of Green Tea Catechins

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HO

OH

OH

OH

OH

O

Green TeaCatechins

Cancer prevention

Cardiac Protection Weight Loss

Neuroprotective Effects

Anti-diabetetic Effects

Medical food for patients with osteoarthritisLimbrel (Flavocoxid)

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Indication

Primary Ingredients

Mechanism of Action

For the dietary management of the metabolic processes associated with osteoarthritis

Scutellaria baicalensis (Chinese skullcap)

Acacia Catechu (catechin)

-Inhibition of COX-2 and 5-LOX pathways

-Downregulation of pro-inflammatory NFκΒ pathway

Flavocoxid is as Effective as Naproxen in The Treatment of Osteoarthritis

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Phospholipase A2

Pro-InflammatoryLeukotrienes

Pro-InflammatoryProstaglandinsThromboxanes

5-LOXCOX-1

COX-2

LipoxygenasePathway

CyclooxygenasePathway

Vitamin EQuercetin

EPADHA

EPAVitamin EQuercetin

LicoriceCurcumin

GinsengCurcumin

Black WillowWintergreen

CurcuminOnionGarlic

Boswellia

NSAIDs-Indomethacin

-Aspirin-Ibuprofen

-SulfasalazineAcetaminophen (weak)

Sulfasalazine

Corticosteroids

ArachadonicAcid

Free Arachadonic Acid

FlavocoxidGreen Tea

Green TeaGreen Tea

CocoaCocoa

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Saturated fatty acids containing 6-12 carbon atoms

Medium-Chain Triglycerides

‣ MCTs are used by the brain as an alternative energy source to glucose

‣ MCTs are metabolized to ketone bodies, which improve cognition in patients with memory impairment

‣ Axona, a medical food product containing MCTs, improves cognitive function in patients with MCI or AD

‣ Dose of MCTs: 5-40 grams/day

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Metabolism of Ketone Bodies

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MCTs

Acetyl CoA Acetoacetate

B-hydroxybutyrate

Acetoacetate

B-hydroxybutyrate

Acetyl CoA

TCA

TCA

Glucose Glucose Pyruvate

⬆ATP

Pyruvate

BBB

Liver Brain

Macronutrient Ratios on a Typical Ketogenic Diet

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5%

20%

75%

FatProteinCarbohydrate

keto-calculator.ankerl.com72

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What Level of Ketosis is Optimal? Strategies for Monitoring Ketosis

‣ Ketostix • Measures levels of acetoacetate in urine

‣ Blood ketone monitor • Measures levels of beta-hydroxybutyrate

in blood

‣ Ketonix • Measures acetone in breath

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Medical food for patients with Alzheimer’sAxona®

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Indication

Primary Ingredients

Mechanism of Action

For the dietary management of the metabolic processes associated with mild to moderate Alzheimer’s disease

Caprylic triglycerides (MCTs)

MCTs are metabolized by the liver to form ketone bodies (acetoacetate and β-hydroxybutryrate). In neurons, ketone bodies are converted to ATP, acetyl-coA, and acetylcholine.

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Capryrlic Acid, a MCT, Improves Cognition

Smart Coffee

‣ 1 cup of caffeinated black coffee

‣ 2 tablespoons MCT oil

‣ 2 tablespoons organic salted butter

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A biomarker linked to heart disease, stroke, and cognitive decline

Homocysteine

‣ Elevated homocysteine levels are a risk factor for brain atrophy, cognitive impairment, and dementia.

‣ B-vitamins serve as co-factors for enzymes that convert homocysteine into methionine

‣ B-vitamin therapy may slow progression of MCI to AD by reducing homocysteine levels

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Accelerated rate of atrophy in elderly with MCI can be slowed by treatment with homocysteine-lowering B vitamins

B-Vitamins Lower Homocysteine

‣ Randomized, double-blind trial of high dose folic acid, vitamins B6 and B12 in 271 individuals with MCI

‣ Treatment group received folic acid (0.8 mg/d), vitamin B12 (0.5 mg/d), and vitamin B6 (20 mg/day) for 24 months

‣ Outcome measure: rate of whole brain atrophy assessed by MRI scans

‣ Results: Mean rate of brain atrophy was 0.76% in treatment group and 1.08% in placebo group

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Smith, A. D., Smith, S. M., de Jager, C. A., Whitbread, P., Johnston, C., Agacinski, G., ... & Refsum, H. (2010). Homocysteine-lowering by B vitamins slows the rate of accelerated brain atrophy in mild cognitive impairment: a randomized controlled trial. PloS one, 5(9), e12244.

Homocysteine levels are correlated with rate of brain atrophyB-Vitamin Therapy Reduces Brain Atrophy

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Better Outcome

Worse Outcome

Cerefolin Reduces Homocysteine Levels

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Folic Acid(Synthetic folate)

Dihydrofolate(Dietary sources)

Tetrahydrofolate

L-methylfolate

BH4

Methionine

Homocysteine

CH

HH

H H

HH

HH

H H

HH

H H

CH2

3

+

MTHFR

5,10 methylene THF

SAM

SAH

B12

Methylation CH3

Cerefolin NAC®

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Indication

Primary Ingredients

Mechanism of Action

For the distinct nutritional requirements of individuals under treatment for early memory loss with particular emphasis for those individuals diagnosed with or at risk for neurovascular oxidative stress and/or hyperhomocysteinemia; mild to moderate cognitive impairment with or without vitamin B12 deficiency, vascular dementia or Alzheimer’s disease

Cobalamin (Vitamin B12)

L-methlyfolate

N-acetylcysteine Supports neurotransmitter synthesis; reduces homocysteine; and increase production of antioxidant glutathione

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Gut contains more than 10 trillion microorganismsProbiotics

‣ Human gut contains 10x more bacteria than all the human cells in the entire body

‣ Composition of gut flora differs from people who are obese and diabetic, and people who are normal weight

‣ Changes in the gut flora can increase the rate at which we absorb fatty acids and carbohydrates, and increase the storage of calories as fat

‣ Disturbances of gut flora may lead to symptoms associated with irritable bowel and ulcerative colitis

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VSL#3

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Indication

Primary Ingredients

Mechanism of Action

For the dietary management of patients with ulcerative colitis or irritable bowel syndrome

8 strains of live bacteria namely Bifidobacterium breve, Bifidobacterium longum, Bifidobacterium infantis, Lactobacillus acidophilus, Lactobacillus plantarum, Lactobacillus paracasei, Lactobacillus bulgaricus and Streptococcus thermophilus.

Supports healthy gut flora; may involve increases in anti-inflammatory IL-10.

Fermented foods are the preferred form of probiotic supplementationSources of Probiotics

‣ Kefir ‣ Sauerkraut

‣ Kimchee

‣ Yogurt

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Practical Strategies for Using Foods That Heal


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Where To Find Reliable Information on Nutritional Supplements

‣ National Nutrient Database • Comprehensive database that ranks common foods by nutrient content

‣ Examine.com • Evidence tables for commonly used supplements

‣ ConsumerLab.com • Independent, consumer-oriented rankings of major supplements by

brand

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Where to Find Medical Foods ‣ Although medical foods should be used only under a physician’s

supervision, the FDA website points out that medical foods can be purchased online through qualified pharmacies

• Look for VIPPS accreditation: Verified Internet Pharmacy Practice Sites

‣ An updated list of VIPPS accredited pharmacies is available at the National Association of Boards of Pharmacy website

• http://www.nabp.net/programs/accreditation/vipps

‣ ConsumerLab.com • Independent, consumer-oriented rankings of major supplements by

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Recommended Clinical Lab Studies

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Neurotransmitters Inflammation

Nutrient Metabolism

‣ Neurotransmitters: B12 and folate levels are indirect markers of levels of brain neurotransmitters

‣ Inflammation: High-sensitivity C-reactive protein and homocysteine levels are good indicators of overall inflammatory status

‣ Nutrient Metabolism: Elevated fasting glucose and insulin may suggest presence of metabolic syndrome

Rationale

B12 Folate

HS-CRP Homocysteine

Fasting Glucose Fasting Insulin

Optimal Lab Levels

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Labs Conventional Range Optimal Levels

B12 200-900 picograms/mL >550 picograms/mL

Folate 2.0-20 nanograms/mL Not established

Hs-CRP 1.0-3.0 mg/L <1.0 mg/L

Homocysteine 6.1-15 micromol/L <7 micromol/L

Fasting Glucose 65-99 mg/dL 65-85 mg/dL

Fasting Insulin 2.6-24.9 micro IU/mL 2-6 micro IU/mL

Neurotransmitter Status

Inflammatory Status

Metabolic Status

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Nutritional/Metabolic Analyses

‣ Several commercial labs offer comprehensive nutritional analyses based on samples of hair, saliva, urine, and blood

‣ Genova Diagnostics • https://www.gdx.net/patients

• NutrEval®

• ONE (Optimal Nutritional Evaluation)

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Alternative Strategies

‣ In addition to manipulating macronutrient composition (e.g. ketogenic diets), other clinically-evaluated strategies include manipulations of meal timing

‣ Fasting • Caloric Restriction

• Alternate Day Fasting

• Intermittent Fasting

‣ Some programs include combinations of strategies that combine manipulations of macronutrients AND meal timing.

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Cellular and molecular effects of CR and IF are similar to those of regular physical exercise

CR and IF Mimic Effects of Exercise

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Decrease of 30% to 60% of ad libitum feeding without malnutritionCaloric Restriction

‣ Increases lifespan across a range of animal species ‣ CR improves memory, cognitive function and overall

health in humans

‣ Little or no evidence that CR extends life in humans

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20% increase in verbal memory after only 3 months of CRCaloric Restriction Improves Memory

105Witte, A. V., Fobker, M., Gellner, R., Knecht, S., & Flöel, A. (2009). Caloric restriction improves memory in elderly humans. Proceedings of the National Academy of Sciences, 106(4), 1255-1260.

n=50

An alternative to daily CRIntermittent Fasting

‣ Nutrient strategy that alternatives brief periods (<24 hours) of fasting with non-fasting

‣ Improves blood glucose, lipid profiles and cognitive function ‣ CR and IF reduce inflammation, increase BDNF, improve insulin

signaling, and inhibit mTOR

‣ These physiologic changes are similar to those seen with aerobic exercise

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Intermittent Fasting Improves Markers Associated with Obesity

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Eat food. Not too much. Mostly plants. ~Michael Pollan

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The Pharmacy in Your Kitchen: An Overview of Medical and Medicinal ... · PDF fileThe Pharmacy in Your Kitchen: An Overview of Medical and Medicinal Foods Michael Lara, MD Diplomate,