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Super Immunity

Lesson 6: Making the Right Choices

Copyright 2011 Joel Fuhrman, M.D.

Correct information empowers good decisions


Misinformation has led to a health crisis
There is a great deal of nutritional
misinformation floating around
We need correct information to make our
daily nutritional choices
Diet change doesnt happen overnight
questions will come up as you transition

Copyright 2011 Joel Fuhrman, M.D.

High Fruit and Vegetable Intake, Low


Saturated Fat Intake, and Longevity
Baltimore Study of Aging 18-year follow-up:
High fruit and vegetable intake - 19% reduced risk
of death
Low saturated fat intake - 15%
Both - 21%

Copyright 2011 Joel Fuhrman, M.D.

Disease Risk in Vegans and Non-vegans


Lower heart attack and cancer rates compared
to general population
However, these same benefits are seen in
people who consume animal products
occasionally
More than occasional (1-2 servings/week) use
of animal products is associated with greater
prevalence of heart disease and cancers
Copyright 2011 Joel Fuhrman, M.D.

Vegans have a lower risk of death from


heart disease and cancer
pooled results from 5 prospective studies

# of deaths

Regular meat
eaters

Occasional
meat eaters
(less than
once/week)

Vegetarians

Vegans

Colorectal
cancer

78

30

71

Breast cancer

61

19

41

Prostate cancer 51

18

33

Heart disease

912

251

521

17

Stroke

267

92

234

4
Copyright 2011 Joel Fuhrman, M.D.

Vegans have a lower risk of death from


cardiovascular disease and cancer
pooled results from 5 prospective studies

# of
deaths/1000

Regular meat
eaters

Occasional
meat eaters
(less than
once/week)

Vegetarians

Vegans

Colorectal
cancer

2.5

3.7

1.3

Breast cancer

1.9

2.3

1.8

Prostate cancer 1.6

2.2

1.4

Heart disease

28.7

30.8

22.4

22.6

Stroke

8.4

11.3

10

5.3

Longest-lived societies ate only small


amounts of animal products

Hunzas
Abkhazians
Vilcabambans
Okinawans
California Adventists

Copyright 2011 Joel Fuhrman, M.D.

Most long-lived modern society:


Seventh-Day Adventists

Extensively studied population in California


Healthy eating and living is emphasized
Avoid tobacco and alcohol
About half are vegetarian, many are near
vegetarian

Copyright 2011 Joel Fuhrman, M.D.

Average Life Expectancy of Modern


Populations
Population

Men

Women

Vegetarian California
Adventists (1980-88)
California (1985)

83.3

85.7

73.8

79.6

Japan (1990)

75.9

81.8

Australia (1990)

73.9

80.0

United States (1990)

73.0

79.7

United Kingdom (1985-87)

71.9

77.6
Copyright 2011 Joel Fuhrman, M.D.

Characteristics of the longest-lived


Adventists

Vegetarian status
Vigorous exercise
Healthy weight
Nut consumption 5 days/week

Copyright 2011 Joel Fuhrman, M.D.

Is it necessary to eat a completely


vegan diet?
Is a diet completely free of animal products
more health-promoting than a diet that
contains a small amount of animal products?
The short answer: nobody knows for sure, but
animal products AND processed foods must
be minimized for excellent health.

Copyright 2011 Joel Fuhrman, M.D.

Nutrients of Concern on a Vegan Diet


All can be easily supplemented and adequacy
confirmed with blood test:
Vitamin B12
EPA and DHA
Iodine
Zinc
Vitamin D

Copyright 2011 Joel Fuhrman, M.D.

Im tired. I must need more protein.


Many people believe that they need animal
products to feel good and perform well.
Usually, this is the result of a diet change
followed by temporary withdrawal symptoms
(such as fatigue). People assume that there is
a lack of protein in their new diet, and return
to their old diet.
Protein deficiency does not cause long-term
fatigue.
Copyright 2011 Joel Fuhrman, M.D.

Feeling well doesnt always mean


getting well
Animal products stress the bodys
detoxification systems
Withdrawal symptoms may occur, but in most
cases resolve within 2 weeks
Fatigue
Headache
GI discomfort (from abundant and different fibers)

Copyright 2011 Joel Fuhrman, M.D.

Certain people have greater


requirements for protein and/or fat
Athletes, thin individuals, those with certain
GI conditions
Sunflower seeds, hemp seeds, Mediterranean
pine nuts, soybeans high-protein plant foods
Walnuts and flaxseeds high-EFA plant foods
Raw nuts and nut butters, avocados high-fat
plant foods
Taurine supplement
Copyright 2011 Joel Fuhrman, M.D.

Exercise and Immunity


Compared to sedentary individuals, those who
exercised at least 5 days/week experienced
46% fewer upper respiratory infections.
Severity and duration of infection were also
decreased in exercisers.

Copyright 2011 Joel Fuhrman, M.D.

Vigorous Exercise and Longevity:


Survival of the Fittest
Harvard Alumni Health Study: men followed
for up to 26 years, starting at average age 46
More vigorous exercise associated with longer
life
No association between non-vigorous exercise
(e.g. walking) and lifespan
Guidelines: exercise at least 3 days/week,
using vigorous activities like jogging, jumping
Copyright 2011 Joel Fuhrman, M.D.

Extreme Exercise Stresses the Body


High-performance athletes often have mildly
suppressed immune function
Intense training diminishes neutrophil function,
potentially increasing susceptibility to infection
Adequate micronutrients can limit these effects
Extreme exercise also produces free radicals, and
the damaging effects of this stress may outweigh
any benefits of the exercise.
Marathons, triathlons, and other extended-length
competitive events are likely not lifespanenhancing
Copyright 2011 Joel Fuhrman, M.D.

What You Need to Know About


Vitamins and Nutritional Supplements

Supplements are not substitutes for a healthy diet.

Copyright 2011 Joel Fuhrman, M.D.

Nutrients Appropriate to Supplement


Vitamin D: sunshine vitamin, inadequate
levels in food
Vitamin B12: not present in plant foods
Zinc: abundant in plant foods but not highly
absorbable
Iodine: chief source is table salt
Long-chain omega-3 fatty acids: scarce in plant
foods, individual differences in elongation
Copyright 2011 Joel Fuhrman, M.D.

Vitamin and Mineral Use: Biphasic


Dose-Response Curve
.

2008 by American Society for Nutrition

Copyright 2011 Joel Fuhrman, M.D.

Caution: Some Supplements May be


Harmful

Vitamin A
Beta-carotene
Vitamin E
Folic acid
Copper
Iron
Vitamin A and folic acid are the two riskiest
ingredients in typical multivitamins.
Copyright 2011 Joel Fuhrman, M.D.

Multivitamins and longevity


Multivitamins (without vitamin A and folic
acid) have the potential to enhance lifespan
Multivitamin use associated with greater
telomere length
Telomeres are regions of DNA at the ends of
chromosomes they shorten during each cell
division as DNA is replicated
Shorter telomeres are an indicator of aging
Copyright 2011 Joel Fuhrman, M.D.

Beta-carotene
Populations with high blood beta-carotene
levels had very low rates of cancer
Scientists didnt understand at the time that
beta-carotene was simply a marker for a high
fruit and vegetable diet, rich in hundreds of
additional carotenoids and phytochemicals
Beta-carotene supplement trials:
28% higher rate of death from lung cancer
17% higher rate of death from heart disease
Copyright 2011 Joel Fuhrman, M.D.

Vitamin A
Beta-carotene is abundant in fruits and
vegetables, is converted to vitamin A in the
body no need for a supplement
Even more risky than beta-carotene
Cochrane review of 68 trials: vitamin A
supplementation associated with 16%
increased risk of death
Typical amounts used in multivitamins
associated with hip fractures
Copyright 2011 Joel Fuhrman, M.D.

Folic Acid
Folate is a B vitamin found in green vegetables
and other plant foods
Important for DNA replication and methylation
important role in fetal development and cancer
Inadequate folate early in pregnancy neural
tube defects
Folic acid is the synthetic form used in
multivitamins and enriched foods; folic acid is
NOT folate
Copyright 2011 Joel Fuhrman, M.D.

Folic Acid Supplements Associated


with Several Cancers
Folic acid during pregnancy associated with
breast cancer 30 years later
10-year study of women: multivitamins with folic
acid increased breast cancer risk 20-30%
Increased risk of prostate and colorectal cancers
Six-year study in Norway: folic acid supplements
increased risk of death from cancer by 43%
In contrast, food-derived folate intake decreases
risk of breast and prostate cancer
Copyright 2011 Joel Fuhrman, M.D.

Emphasis on Folic Acid During


Pregnancy The Wrong Approach
Folic Acid during Pregnancy associated with poor
health outcomes in child:
Cardiac birth defects
Asthma
Respiratory tract infections

More food folate associated with less likelihood


of ADHD
Poor nutrition during pregnancy, in particular
processed meats, increase risk of childhood
cancers
Copyright 2011 Joel Fuhrman, M.D.

Guidelines for Folate During Pregnancy


Regularly consume a high-folate diet rich in
green vegetables
Folate blood test to confirm adequacy before
contemplating pregnancy
Prenatal multivitamin without folic acid

Copyright 2011 Joel Fuhrman, M.D.

Copper and Iron


Copper excess associated with reduced
immune function, lower antioxidant status,
accelerated mental decline
Iron is an oxidant, can contribute to infection
and increase heart attack risk
Iron should only be supplemented in the case
of deficiency or increased need (e.g.
pregnancy)
Copyright 2011 Joel Fuhrman, M.D.

Review: Healthy Bacteria


Probiotics can mean healthy bacteria in the GI
tract or live bacteria supplements
95% of the cells in the human body
Perform vital functions:

Produce vitamins, SCFA


Process fiber
Protect against overgrowth of pathogenic microbes
Protect against allergies and immune disorders

Healthful diet is key to maintaining healthy flora


Antibiotics kill bacteria indiscriminately
Copyright 2011 Joel Fuhrman, M.D.

Healthful Diet Maintains Gut Flora


Limited numbers and species of bacteria in
supplements and fermented foods compared to
gut flora
Usually beneficial only when native flora has
been harmed by poor diet or antibiotic use
It can take months to replenish gut flora
Healthful diet is the most important factor in
maintaining flora
It is not necessary to consume fermented foods
Copyright 2011 Joel Fuhrman, M.D.

When to use Probiotic Supplements


For at least 3 months after using antibiotics
Most healthy people eating a healthy diet
should never need an antibiotic
Certain medical conditions: IBS, autoimmune
diseases, allergies, headaches, excessive yeast
in the gut
Should be avoided in immune-compromised
patients with HIV or advanced cancer, people
undergoing chemotherapy
Copyright 2011 Joel Fuhrman, M.D.

Salt Intake
U.S. average daily sodium intake 3,500 mg
80% of sodium comes from processed and
restaurant foods
A diet of natural plant foods provides 600-800
mg sodium/day
For millions of years, the human diet did not
contain any added salt

Copyright 2011 Joel Fuhrman, M.D.

Salt Elevates Blood Pressure


Americans have a 90% lifetime probability of
developing high blood pressure (BP)
Elevated BP accounts for 62% of strokes and
49% of coronary heart disease
Risk of heart attack and stroke begins to rise
with systolic pressures above 115 (normal)
Poses risk of hemorrhagic stroke in those who
eat an otherwise healthy diet
Elevated BP is a risk factor for kidney disease
Copyright 2011 Joel Fuhrman, M.D.

Other Harmful Effects of Salt


Excessive cell growth leading to thickening of vessel
walls, even in the absence of high BP
Altered production of structural proteins leading to
stiffening of vessels
Promotes urinary calcium loss, contributing to
osteoporosis; may prevent young girls from building
optimal bone mass
Strongest dietary factor associated with stomach
cancer
Promotes growth of H. Pylori
High sodium intake correlates with death from all
causes
Copyright 2011 Joel Fuhrman, M.D.

Guidelines for Sodium Intake


Upper limit: 1,000 mg/day; no more than 200-400 mg
added sodium
Exotic sea salts are still salt still over 98% sodium
chloride; trace mineral content insignificant
Salt deadens taste buds
Easy to avoid most added sodium by avoiding
processed foods
Purchase salt-free canned goods and soups
Beware of salty condiments
Flavor food with garlic, onion, lemon/lime, and spices
Copyright 2011 Joel Fuhrman, M.D.

The Coffee Question:


Can a healthy diet include coffee?
Does coffee have health-promoting
effects?

Copyright 2011 Joel Fuhrman, M.D.

Mysterious Protective Effects of Coffee


Against Diabetes
Meta-analysis found that each cup of coffee/day was
associated with a 7% reduced risk of diabetes
However, coffee (regular and decaf) raises glucose
levels after a meal
Likely that antioxidants and other phytochemicals in
the coffee bean are responsible
Those eating the SAD are starved for phytochemicals,
and coffee may be their richest source!
Chlorogenic acid and trigonelline may increase insulin
sensitivity (but also found in plant foods)
Doubtful that coffee would offer additional protection
on top of a nutrient-dense diet
Copyright 2011 Joel Fuhrman, M.D.

Caffeine is a Drug
Caffeine is a stimulant
Increases blood pressure
Provides a false sense of increased energy,
allowing you to function on inadequate sleep
Reduces depth of sleep
Produces withdrawal symptoms often mistaken
for hunger
Note: it takes 4-5 days for caffeine withdrawal
headaches to resolve

Prevents getting in touch with true hunger signals


Copyright 2011 Joel Fuhrman, M.D.

What About Decaf?


The chemicals used to remove the caffeine
may be hazardous
Decaffeinated coffee is associated with risk of
rheumatoid arthritis, possibly due to these
additives
Probably safer to choose water-processed
decaf

Copyright 2011 Joel Fuhrman, M.D.

Recommendations on Coffee

Coffee is a drug, not a food


Powerful addictive qualities
Coffee may have some benefits
Risks likely outweigh the benefits
If you do drink coffee, stick to waterprocessed decaf

Copyright 2011 Joel Fuhrman, M.D.

The Soy Debate

Copyright 2011 Joel Fuhrman, M.D.

Soy Contains Phytoestrogens Called


Isoflavones
Phytoestrogens are plant substances similar to
estrogens
Higher estrogen levels promote breast cancer
Some people predicted that phytoestrogens
would have the same effect
Phytoestrogens actually block the effects of
estrogen

Copyright 2011 Joel Fuhrman, M.D.

Early Soy Intake and Breast Cancer


Asian populations (who consume high
amounts of soy) have lower rates of hormonal
cancers
Soy intake during adolescence when breast
tissue is most sensitive to environmental
stimuli reduces the risk of breast cancer
later in life by up to 60%

Copyright 2011 Joel Fuhrman, M.D.

Evidence that Soy is Protective


Two recent meta-analyses compiling data
from a total of 26 studies concluded that soy
consumption decreases breast cancer risk
Soy consumption reduces risk of recurrence in
breast cancer survivors
Soy consumption also protects against
prostate, endometrial, and ovarian cancers

Copyright 2011 Joel Fuhrman, M.D.

Choose Minimally Processed Soy


Foods
In the U.S., the majority of soy intake is from soybased additives or isolated soy protein in lownutrient processed foods and meat substitutes
The most healthful foods are minimally
processed:

Edamame
Tofu
Unsweetened soy milk
Tempeh

A healthy diet contains a variety of beans not


just soybeans.
Copyright 2011 Joel Fuhrman, M.D.

Omega-3 Fatty Acids

Copyright 2011 Joel Fuhrman, M.D.

Review: Omega-3 Fatty Acids


The body cannot make omega-3 fatty acids
The American diet is too low in omega-3 and
too high in omega-6
Sources of ALA (basic building block of omega3s): flax, walnuts, chia, hemp, leafy greens,
edamame
ALA is elongated to DHA and EPA
Long-chain omega-3s also found in fish and
algae
Copyright 2011 Joel Fuhrman, M.D.

Low Levels of DHA and EPA Associated


With:

Heart disease
Depression
Cancer
Anxiety/panic
Alzheimers disease
Hyperactivity

Attention Deficit
Disorder
Allergies
Autoimmune illnesses
Dermatologic disorders
Inflammatory bowel
disease

Copyright 2011 Joel Fuhrman, M.D.

Sufficient Elongation Without


Consuming Fish?
Individual differences in efficiency of
elongation from ALA to EPA and DHA
Men elongate less efficiently than women
Ability to elongate declines with age
A source of long-chain omega-3 is
recommended

Copyright 2011 Joel Fuhrman, M.D.

Fish, Fish Oil, or Algae-based


Supplements?
Fish is concentrated animal protein,
accumulates environmental pollutants
Mercury is a neurotoxin
PCBs, chlordane, and dioxins (which
accumulate in fish) in human body fat are
associated with increased risk of cancer
Fish consumption also associated with modest
increase in risk of diabetes, prostate cancer,
breast cancer
Copyright 2011 Joel Fuhrman, M.D.

Fish, Fish Oil, or Algae-based


Supplements? (2)
Fish oil is often rancid when you buy it
Capsules can hide the smell and taste of
rancid oil
Rancid fish oil can stress the liver
If you do take fish oil, make sure it is purified
and certified to be free of mercury
Cut open a capsule to make sure that it
doesnt taste rotten
Copyright 2011 Joel Fuhrman, M.D.

Fish, Fish Oil, or Algae-based


Supplements? (3)
Most people can assure adequate EPA and DHA
levels by taking a vegan algae-based supplement
Lab-grown algae is free of mercury and other
pollutants
More may not be better be cautious with
supplementation
Recommendations:
100-200 mg DHA daily
1 tablespoon of ground flaxseed daily for ALA
Copyright 2011 Joel Fuhrman, M.D.

Organic Fruits and Vegetables and the


Dangers of Pesticides

Copyright 2011 Joel Fuhrman, M.D.

Dangers of Agricultural Pesticide


Exposure
EPA reports that the majority of pesticides in
use are probable or possible cancer causes
Studies of farmworkers suggest a link between
pesticide exposure and brain cancer,
Parkinsons disease, multiple myeloma,
leukemia, lymphoma, stomach and prostate
cancers

Copyright 2011 Joel Fuhrman, M.D.

Does the low level of pesticides remaining


on produce after harvest present a risk?
However, pesticide exposure from food has
been linked to certain diseases
Organophospates (used on corn, apples, pears,
grapes, berries, peaches) associated with AHD,
behavior problems, neurodevelopmental deficits
in children
Rotenone, paraquat (used on a variety of crops),
organochlorines (primarily from accumulation in
animal fat) contribute to Parkinsons Disease
Copyright 2011 Joel Fuhrman, M.D.

Plant foods have the lowest


concentration of pesticides
When animals eat pesticide-treated feed,
pesticide residues accumulate in their fatty
tissues
Meat, dairy, and fish have higher
concentrations of pesticides than produce

Copyright 2011 Joel Fuhrman, M.D.

Which Crops Are Highest and Lowest


in Pesticides?
It is better to eat vegetables and fruits grown
using pesticides than to not eat them at all; but it
is also wise to minimize pesticide exposure
Buying organic minimizes pesticide exposure;
often greater nutrient content especially
minerals and antioxidants
Supporting organic produce also decreases the
percentage of farmland (and farmworkers)
exposed to potentially harmful pesticides
Copyright 2011 Joel Fuhrman, M.D.

Most Important to eat organic

Celery
Spinach
Kale
Lettuce
Collards
Strawberries
Blueberries
Copyright 2011 Joel Fuhrman, M.D.

Concluding Remarks
No matter where your health is today, you can
improve it
Do not be complacent with taking medications
for the rest of your life.
In the process of striving toward superior
health, you will look better, feel better, and
live longer

Copyright 2011 Joel Fuhrman, M.D.

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