John E. Lewis, Ph.D.Associate Professor

University of Miami Miller School of MedicineDepartment of Psychiatry & Behavioral Sciences

1120 NW 14th StreetSuite #1474 (D28)

Phone: 305-243-6227Fax: 305-243-1619

E-mail: jelewis@miami.edu

Optimizing Your Health through Proper Nutrition and Exercise

What are we doing?We have the following ongoing studies:

1. Aerobic and strengthening exercise training and nutrition education on metabolic syndrome variables in HIV

2. Vitamin D on nutrient status, QOL, and bone mineral density in the elderly

3. A broad-spectrum nutrient supplement on oxidative stress, inflammation, immune functioning, and telomeres and telomerase in healthy adults

4. Magnesium sulfate infusion in treatment-resistant depression

5. Low-level class IV laser therapy on peripheral neuropathy in type 2 diabetes

6. A polysaccharide (rice bran and Shiitake mushroom) on immunological functioning and metabolic syndrome in HIV

7. Assessment of HbA1c and blood pressure with bioelectrical impedance in healthy adults and in persons with type 2 diabetes

8. Hydroxy beta-methylbutyrate on re-hospitalization in MI, heart failure, COPD, and pneumonia

What are we doing?

Why do we have large numbers (epidemics!) of people with:

• Obesity• Cardiovascular disease• Type 2 diabetes• Cancer• Osteoporosis• Arthritis• Mental health disorders

like depression• Chronic pain

Trends in Prevalence of ObesityUnited States, 1960-2004

0%

5%

10%

15%

20%

25%

30%

35%

Men Women

Per

cent

BM

I > 3

0

1960-62

1971-74

1976-80

1988-94

2003-04

Ogden, C., Carroll, M., Curtin, L., McDowell, M., Tabak, C., and Flegal, K. (2006). Prevalence of overweight and obesity in the United States, 1999-2004. JAMA, 295, 1549-1555.

Obesity in the future...

1. Physical inactivity2. Poor nutrition

What causes chronic disease and excess fat?

U.S. Department of Health and Human Services and U.S. Department of Agriculture. (2005). Dietary Guidelines for Americans, 2005. 6th ed. Washington, DC: U.S. Government Printing Office.

So what can you do to prevent chronic disease and optimize your

health?The answer lies in a very simple approach to your dietary and physical activity behaviors.

1. Eat foods as close to the way they appear in their natural state (i.e., either in the ground or on a tree).

2. Eat a predominantly whole-food, plant-based diet.

3. If you follow the first two maxims, then do NOT count calories. It’s a waste of time.

For your nutrition, remember a few very simple maxims...

Greens have plenty of protein!Selected nutrients in a 100-calorie portion of four foods:

Broccoli Romaine Kale SirloinLettuce

Protein 11.2 g 11.6 g 9.5 g 5.4 gCalcium 182 mg 257 mg 455 mg 2.4 mgMagnesium 71.4 mg 43 mg 59 mg 5 mgIron 2.2 mg 7.9 mg 3.1 mg .7 mgFiber 10.7 g 12 g 6.7 g 0Vitamin C 143 mg 171 mg 83 mg 0Cholesterol 0 0 0 55 mgSaturated Fat 0 0 0 1.7 gWeight 357 g 714 g 333 g 24 g

Adams, C. (1986). Handbook of the nutritional value of foods in common units. New York: Dover Publications.

Don’t you need to consume cow’s milk to get calcium and protein?

Dairy industry revenue for 2012 was $34,000,000,000!

Reference: http://www.ibisworld.com/industry/default.aspx?indid=49

You drink her milk…

But would you drink their milk?

1. Cardiovascular disease and stroke2. Breast, prostate, and other forms of cancer3. Diabetes (primarily type 1)4. Allergies5. Impaired cognition

Joossens, J.V., Geboers, J., and Kesteloot, H. (1989). Nutrition and cardiovascular mortality in Belgium. Acta Cardiol., 44, 157-182.Larsson, S., Mannisto, S., Virtanen, M., Kontto, J., Albanes, D., and Virtamo, J. (2009). Dairy foods and risk of stroke. Epidemiology, 20(3), 355-360.Gerstein, H. (1994). Does cow’s milk cause type I diabetes mellitus? A critical overview of the clinical literature. Diabetes Care 17:13-19.Iacono, G., Carroccio, A., Cavataio, F., Montalto, G., Cantarero, M., and Notarbartolo, A. (1995). Chronic constipation as a symptom of cow milk allergy. J Pediatrics, 126:34-39.Hebert, J., Hurley, T., Olendzki, B., Tea, J., Ma, Y., & Hampl, J. (1998). Nutritional and socioeconomic factors in relation to prostate cancer mortality: a cross-national study. J Nat Cancer Inst, 90(21), 1637-1647.Eskelinen, M., Ngandu, T.; Helkala, E., Tuomilehto, J., Nissinen, A., Soininen, H., and Kivipelto, M. (2008). Fat intake at midlife and cognitive impairment later in life: a population-based CAIDE study. International Journal of Geriatric Psychiatry, 23(7), 741-747.

Eating cow’s milk equals a higher risk of:

Got Milk???

Got?:

1. Brucellosis and listeria: highly contagious bacteria2. Bovine leukemia3. Bovine immunodeficiency virus4. Mycobacterium paratuberculosis: causes Johne's disease, which is

related to Chrone’s disease5. Camplyobacter6. Dioxins and other chlorinated pesticides and herbicides7. Pus, blood, urine, and feces…

Yuck!

Buy a blender if you do not already have one and make smoothies…

My Smoothie Recipe

1. 1 cup of water or rice, soy, almond, or hazelnut fluid if you prefer a liquid with a taste2. A couple of servings of some fresh uncooked leafy green (collards, kale, red kale, chard, bok choi, mustard, dandelion, spinach, Romaine lettuce, etc.)3. Any combination of about 2 cups of fruit (apple, pear, banana, cherry, blueberry, blackberry strawberry, raspberry, peach, mango, pineapple, apricot, asai, or anything to your taste); definitely use some frozen fruit to give it the refreshing consistency4. A couple of ounces or handfuls of some combination of various raw nuts or seeds (flax, pumpkin, Brazil nut, pecan, walnut, cacao, chia seed, etc.)5. A shiitake mushroom

6. A handful of cauliflower, broccoli, or other Brassica plants7. ¼ of a teaspoon of dulse or kelp8. ¼ of a teaspoon of turmeric9. ¼ of a teaspoon of fenugreek10. A handful of broccoli, sunflower, or other sprouts11. 1 ounce of camu, maca, and/or pomegranate powder

This goes in the blender and makes about 1.25 liters of a smoothie. I constantly rotate the foods that I use, so I get a good mix of nutrients. Besides always tasting good, they also always taste differently each time depending on the mixture of the ingredients. I imagine it will take you a few times to get the consistency the way you want it. I do not think you will be disappointed once you do. All you need is a good blender and you are on your way. Remember to use some frozen fruit to give it that “smoothie” consistency.

An objective of Healthy People 2020 is that adults exercise for at least 30 minutes of moderate physical activity for most, if not all, days of the week.

A physically active lifestyle has been associated with health benefits that include improved control of hypertension, diabetes, obesity, hyperlipidemia, and reduced overall morbidity and mortality.

Typically, 25% of Americans did not participate in any leisure time physical activities in the previous month.

Blair, S., Kampert, J., Kohl, H., et al. (1996). Influences of cardiorespiratory fitness and other precursors on cardiovascular disease and all-cause mortality in men and women. JAMA, 276, 205-2010.Helmrich, S., Ragland, D., Leung, R., and Paffenbarger, R., (1991). Physical activity and reduced occurrence of non-insulin-dependent diabetes mellitus. N Engl J Med, 325, :147-52.United States Department of Health and Human Services. (1996). Physical Activity and Health: A Report of the Surgeon General. Atlanta, GA: United States Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion. Report No.: 017-023-00196-5.Dipietro, L., Dziura, J., and Blair, S. (2004). Estimated change in physical activity levels (PAL) and prediction of 5-yr weight change in middle-aged men: The aerobics center longitudinal study. Int J Obes and Related Met Dis, 28, 1541-1547.

What about exercise?

1 pound (2.2 kg) of fat = 3,500 calories.After age 25, people typically gain a pound (2.2 kg) of weight per year.We also lose about .25 (.5 kg) to .5 pounds (1.1 kg) per year of lean body tissue, mostly from muscle and bone.The loss of lean tissue is closely associated with reductions in physical activity.The net result is 45 pounds (20.5 kg) of extra body fat by the age of 55 years.

Weight Control

Exercise Will...

1. Be the primary method to burn calories, maintain a healthy energy balance, and lose weight.

2. Strengthen the myocardium (heart muscle) to maintain a normal pressure.

3. Increase the capacity of your lungs, i.e., your ventilation rate.

4. Raise HDL cholesterol and lower LDL and total cholesterol.

Exercise Will...

5. Improve your mood, thus making you feel good about yourself.

6. Decrease your risk or symptoms of depression and anxiety.

7. Enhance your sleeping patterns.8. Relieve stress at least partially through the release of

endorphins.9. Increase efficiency of joint action and protection from

injury.

Exercise Will...10. Increase your proportion of fat free mass.11. Increase your muscle mass (hypertrophy).12. Increase the strength of your muscles and

connective tissues.13.Improve your capacity to perform activities.14. Increase your bone mineral content.15. Assist in digestion and elimination.

Exercise Recommendations

The WHO recommends that people engage in at least 30 minutes of physical activity almost every day to prevent the

occurrence of chronic disease.

1. Activities that are liked should be picked to increase adherence.2. Exercising all muscles is very important.3. Choose moderate kinds of activity, like brisk walking.4. Work up to the goals slowly without experience in a regular exercise program.

Exercise Recommendations(American College of Sports Medicine)

Four Primary Components of Designing an Exercise Program:

1. Frequency: How many days per week?

2. Intensity: What percentage of maximal heart rate?

3. Duration: How long in a given bout?4. Mode: What type of exercise?

Exercise RecommendationsACSM and AHA recommend:

1. Moderate-intensity aerobic physical activity for a minimum of 30 minutes five days/week or vigorous intensity aerobic activity for a minimum of 20 minutes three days/week.2. 8-10 strength-training exercises be performed on two or more nonconsecutive days/week using the major muscle groups. To maximize strength development, perform 10-15 repetitions for each exercise in a progressive manner.3. Activities that maintain or increase flexibility on at least two days/week for at least 10 minutes/day.4. To reduce risk of injury from falls, community-dwelling older adults with substantial risk of falls (e.g., with frequent falls or mobility problems) should perform exercises that maintain or improve balance.Haskell, W., et al. (2007). Physical Activity and Public Health Updated Recommendation for Adults From the American College of Sports Medicine and the American Heart Association. Circulation., 116, 1081-1093.

Exercise Recommendations

Other Considerations:

1. Hydration is important to maintain homeostasis and recovery.2. Pre- and post-exercise supplementation with carbohydrates and protein maximize recovery.

The Physical Activity Bottom LineA consistent and intense exercise program will help build and maintain muscle and some level of cardiovascular fitness.

A combination of weight training, cardiovascular conditioning, and stretching are components of a complete exercise program.Intensity and Consistency are the 2 primary keys to any training program!