Back Clinic Diets. The sum of food consumed by any living organism. The word diet is the use of specific intake of nutrition for health or weight management. Food provides people with the necessary energy and nutrients to be healthy. By eating various healthy foods, including good quality vegetables, fruits, whole-grain products, and lean meats, the body can replenish itself with the essential proteins, carbohydrates, fats, vitamins, and minerals to function effectively.
Having a healthy diet is one of the best things to prevent and control various health problems, i.e., types of cancers, heart disease, high blood pressure, and type 2 diabetes. Dr. Alex Jimenez offers nutritional examples and describes the importance of balanced nutrition throughout this series of articles. In addition, Dr. Jimenez emphasizes how a proper diet combined with physical activity can help individuals reach and maintain a healthy weight, reduce their risk of developing chronic diseases like heart disease, and ultimately promote overall health and wellness.
For individuals with peanut allergies, can finding a peanut alternative be as satisfying as a real creamy or crunchy peanut butter sandwich?
Peanut Butter Sandwich Alternatives
For individuals who are unable to have a peanut butter sandwich due to an allergy, there are healthy satisfying alternatives. Tree nut butter, seed butter, and deli meats can all satisfy sandwich cravings and provide nutrition. Here are a few healthy, nutritious alternatives to try out:
Sunflower Seed Butter and Jam, Jelly, or Preserves
It can be substituted for a PBJ with jam, jelly, and preserves.
Ham and Cheese, Grainy Mustard on Rye Bread
Getting ham and cheese from the deli can potentially have cross-contamination with allergens during slicing and packaging.
Prepackaged and sliced ham and cheese is a safer bet in terms of allergens.
It is recommended to read the ingredient label for potential allergens, as processing in facilities can have cross-contamination issues. (William J. Sheehan, et al., 2018)
Turkey, Tomato, Lettuce, and Hummus on Whole Grain Bread
The same is true for turkey and is recommended to buy prepackaged and sliced.
Check the ingredients for possible allergens.
Hummus is made from chickpeas/garbanzo beans and tahini/ground sesame seeds.
Hummus comes in a variety of flavors that can be used as a dip or spread.
Although chick peas’ are a member of the legume family, hummus can be tolerated with peanut allergies. (Mathias Cousin, et al., 2017)
Check with a healthcare provider if unsure.
Pita Pocket with Salad and Hummus
Pita pockets are great with hummus stuffed with vegetables.
This is a delicious crunchy pocket sandwich loaded with protein, fiber vitamins, and minerals.
Cashew butter on a hot English muffin with raisins on top for a boost of iron is reminiscent of a cinnamon roll.
Pumpkin Seed Butter and Honey Sandwich
Pumpkin butter is made from the orange flesh of the pumpkin.
Pumpkin seed butter is made by roasting pumpkin seeds and grinding them to a butter consistency.
The seed butter can be spread on bread and drizzled with some honey on top for a nutritious and delicious snack.
There are tasty healthy peanut butter alternatives that can be mixed, matched, and reinvented into various satisfying sandwiches. Individuals are recommended to consult their healthcare provider or a dietician or nutritionist to find what works for them.
Smart Choices, Better Health
References
Lavine, E., & Ben-Shoshan, M. (2015). Allergy to sunflower seed and sunflower butter as a proposed vehicle for sensitization. Allergy, asthma, and clinical immunology: Official Journal of the Canadian Society of Allergy and Clinical Immunology, 11(1), 2. doi.org/10.1186/s13223-014-0065-6
U.S. Department of Agriculture: FoodData Central. Seeds, sunflower seed butter, with salt added (Includes foods for USDA’s Food Distribution Program).
Sheehan, W. J., Taylor, S. L., Phipatanakul, W., & Brough, H. A. (2018). Environmental Food Exposure: What Is the Risk of Clinical Reactivity From Cross-Contact and What Is the Risk of Sensitization. The journal of allergy and clinical immunology. In practice, 6(6), 1825–1832. doi.org/10.1016/j.jaip.2018.08.001
Gorrepati, K., Balasubramanian, S., & Chandra, P. (2015). Plant-based butters. Journal of food science and technology, 52(7), 3965–3976. doi.org/10.1007/s13197-014-1572-7
Cousin, M., Verdun, S., Seynave, M., Vilain, A. C., Lansiaux, A., Decoster, A., & Sauvage, C. (2017). Phenotypical characterization of peanut-allergic children with differences in cross-allergy to tree nuts and other legumes. Pediatric allergy and immunology: Official publication of the European Society of Pediatric Allergy and Immunology, 28(3), 245–250. doi.org/10.1111/pai.12698
Almond Board of California. Nutrient comparison chart for tree nuts.
American Academy of Allergy, Asthma and Immunology. Everything you need to know about a tree nut allergy.
The brain and body need macronutrients that include carbohydrates, fats, and protein in the right amounts to energize the body. About half of the calories should come from carbohydrates, 30% from fat, and 20% from protein. Food energy density is the amount of energy, represented by the number of calories, in a specific weight measurement.
Food Energy Density
Energy density is determined by the proportion of macronutrients – protein, fat, carbohydrates, fiber, and water.
Energy-dense foods are high in calories per serving.
Foods with large amounts of fiber and water have a lower density.
Foods high in fat have an increased energy density.
An example of a high-energy-density food is a donut because of the high-calorie count from the sugar, fat, and small serving size.
An example of a low-energy-density food is spinach because it only has a few calories in a whole plate of raw spinach leaves.
Energy Dense Foods
Energy-dense foods contain a high number of calories/energy per gram. They are typically higher in fat and lower in water. Examples of energy-dense foods include:
Full-fat dairy
Butter
Cheese
Nut butter
Fatty cuts of meat
Starchy vegetables
Thick sauces
Nuts
Seeds
Less nutrient-dense foods include:
Sweets
Deep-fried foods
French fries
Pasta
Crackers
Chips
Foods like soups and beverages can be either high or low energy density depending on the ingredients. Broth-based soups with vegetables usually have low density while creamed soups are energy-dense. Non-fat milk is less dense than regular milk, and diet soda is less dense than regular soda.
Low Energy Dense Foods
Foods with low energy density include high-fiber green and colorful vegetables.
Foods with low energy density are often nutrient-dense, which means they have plenty of nutrients per serving size.
Many fruits, berries, and vegetables are low in calories, high in fiber, and packed with vitamins and minerals.
Foods high in water content like citrus fruits and melons are usually less energy-dense.
Low-calorie foods often have a low energy density, but not always.
It’s important to read nutrition labels to know how many calories are being provided daily.
Weight Management
Weight management is about watching how many calories are taken in and how many calories are burned.
Filling up on foods with low energy density will cause the body to feel satisfied while eating fewer high-density calories.
Plan all meals so they include foods with a low energy density and high in nutrients.
However, the opposite can happen if individuals eat mostly low-energy-dense foods, will need a larger volume of food to fill up, and as a result, will take in more calories.
This is not ideal for losing weight, but it could be helpful if trying to gain weight.
High-energy-dense foods that are nutritious include avocados, nuts, and seeds.
Adjustment Recommendations
Add More Fruits and Vegetables To The Plate
At least half of a plate should be covered with low-calorie fruits and vegetables.
Berries are sweet and delicious and provide antioxidants
Leave a quarter of the plate for the protein, and the remaining quarter can hold a serving of starchy foods like pasta, potatoes, or rice.
Eating more fruits and vegetables will partially fill the body leading to eating less high-energy-dense foods.
Picky eaters should try various recipes, sooner or later, they will discover something they enjoy.
Start With Salad or a Bowl of Clear Broth Soup
Soups and salads will fill the body before the main energy-dense course like pasta, pizza, or another high-calorie food.
Avoid heavy cream-based salad dressings and creamed soups.
Water has zero calories and drinking a few glasses can help suppress the hunger until the next meal, or a low-density snack.
Fernandez, Melissa Anne, and André Marette. “Potential Health Benefits of Combining Yogurt and Fruits Based on Their Probiotic and Prebiotic Properties.” Advances in nutrition (Bethesda, Md.) vol. 8,1 155S-164S. 17 Jan. 2017, doi:10.3945/an.115.011114
Horgan, Graham W et al. “Effect of different food groups on energy intake within and between individuals.” European Journal of Nutrition vol. 61,7 (2022): 3559-3570. doi:10.1007/s00394-022-02903-1
Hubbard, Gary P et al. “A systematic review of compliance to oral nutritional supplements.” Clinical nutrition (Edinburgh, Scotland) vol. 31,3 (2012): 293-312. doi:10.1016/j.clnu.2011.11.020
Prentice, A M. “Manipulation of dietary fat and energy density and subsequent effects on substrate flux and food intake.” The American Journal of clinical nutrition vol. 67,3 Suppl (1998): 535S-541S. doi:10.1093/ajcn/67.3.535S
Slesser, M. “Energy and food.” Basic life sciences vol. 7 (1976): 171-8. doi:10.1007/978-1-4684-2883-4_15
Specter, S E et al. “Reducing ice cream energy density does not condition decreased acceptance or engender compensation following repeated exposure.” European Journal of clinical nutrition vol. 52,10 (1998): 703-10. doi:10.1038/sj.ejcn.1600627
Westerterp-Plantenga, M S. “Effects of the energy density of daily food intake on long-term energy intake.” Physiology & behavior vol. 81,5 (2004): 765-71. doi:10.1016/j.physbeh.2004.04.030
A satisfying salad is a great way to get more fruits and vegetables high in vitamins, minerals, and fiber. A salad using the right ingredients can be a filling meal. With the summer heat kicking in, making a quick, satisfying salad using your favorite ingredients can help cool off, rehydrate, and refuel the body.
Making A Satisfying Salad
Leafy Greens
Start with leafy greens.
They’re low in calories and a healthy source of fiber.
Different varieties include iceberg lettuce, leaf lettuce, spinach, escarole, romaine, kale, and butter lettuce.
Starchy vegetables like roasted sweet potatoes or cooked butternut squash.
These provide fiber, complex carbohydrates, vitamins, and minerals.
Fruit
Fruits or berries, blueberries, raspberries, blackberries, pomegranate seeds, apple slices, oranges, dates, and raisins can add vitamins, fiber, and antioxidants.
One-half cup of apple slices has 30 calories.
One-half cup of berries has about 40 calories.
Protein
A hard-boiled egg is an excellent source of protein.
A serving of lean beef, cooked shrimp, tuna, chicken breast, cheese strips, beans or legumes, hummus, tofu, or cottage cheese.
Be mindful of portion size.
A quarter cup of chopped chicken meat or one egg will add 75 calories.
Half a can of tuna adds about 80 calories.
Depending if it is low fat, two ounces of cubed or shredded mozzarella or cheddar cheese can add 200 calories.
Nuts or Seeds
Almonds, cashews, walnuts, pecans, sunflower, pumpkin, or chia seeds are great for added crunch.
All nuts add protein and heart-healthy polyunsaturated and monounsaturated fatty acids.
One-eighth cup of nuts adds around 90 calories.
Walnuts contain omega-3 fatty acids.
Salad Dressing
Add salad dressing.
One tablespoon of regular commercial salad dressing adds 50 to 80 calories.
Low-fat and reduced-calorie dressings are available.
Adding beans will increase fiber, protein, and total carbohydrates.
Body Signals Decoded
References
Chambers L, McCrickerd K, Yeomans MR. Optimizing foods for satiety. Trends in Food Science & Technology. 2015;41(2):149-160. doi:10.1016/j.tifs.2014.10.007
Cox, B D et al. “Seasonal consumption of salad vegetables and fresh fruit in relation to the development of cardiovascular disease and cancer.” Public health nutrition vol. 3,1 (2000): 19-29. doi:10.1017/s1368980000000045
Dreher ML, Davenport AJ. Hass avocado composition and potential health effects. Crit Rev Food Sci Nutr. 2013;53(7):738-750. doi:10.1080/10408398.2011.556759
Roe, Liane S et al. “Salad and satiety. The effect of timing of salad consumption on meal energy intake.” Appetite vol. 58,1 (2012): 242-8. doi:10.1016/j.appet.2011.10.003
Sebastian, Rhonda S., et al. “Salad Consumption in the U.S. What We Eat in America, NHANES 2011-2014.” FSRG Dietary Data Briefs, United States Department of Agriculture (USDA), February 2018.
Yen, P K. “Nutrition: salad sense.” Geriatric nursing (New York, N.Y.) vol. 6,4 (1985): 227-8. doi:10.1016/s0197-4572(85)80093-8
Dr. Jimenez, D.C., presents how to find the right diet for cardiometabolic syndrome in this 2-part series. Many environmental factors often play a role in our health and wellness. In today’s presentation, we continue discussing how genes play with the cardiometabolic diet. Part 1 looked at how every body type is different and how the cardiometabolic diet plays its role. We mention our patients to certified medical providers that provide available therapy treatments for individuals suffering from chronic conditions associated with metabolic connections. We encourage each patient when it is appropriate by referring them to associated medical providers based on their diagnosis or needs. We understand and accept that education is a marvelous way when asking our providers’ crucial questions at the patient’s request and acknowledgment. Dr. Alex Jimenez, D.C., uses this information as an educational service. Disclaimer
Omega-3s & Genes
Dr. Alex Jimenez, D.C., presents: We’ve found that fish oils or omega-3s can lower triglycerides, small-density LDL, and sometimes lower LDL and keep HDL regulated. But these studies were back when they were supplementing with more of an even DHA/EPA ratio. But that’s something to be observant of; the study showed that giving them fish oil lowers their small density LDL and triglycerides. They also found that if they gave them a lower fat food plan, and a lower fat diet, they found it lowered their LDL and small density LDL. A moderate fat diet reduced their LDL, but it increased their small density LDL. And they found that average alcohol consumption lowered their HDL and increased their LDL. So that’s not a good sign when that happens. So the opposite of what you want to occur with a moderate alcohol consumption diet or food plan.
So going back to APO-E4 in the body, how would this gene be affected when dealing with viral infections like herpes or cold sores? So research studies have revealed that APO-E4 and herpes simplex one viruses can affect the brain’s cerebral tissues. So the research also indicates that patients with APO-E4 are more susceptible to getting the herpes virus. And remember, herpes simplex one virus is what causes cold sores. What about HSV and dementia? How would that correlate with the body? The research indicates that HSV increases the risk of dementia. And what the thought is is that just like the herpes virus can come out and cause cold sores, it can internally manifest, and you can get these episodes where HSV becomes active in the brain, which can cause some of the pathogenesis of dementia or Alzheimer’s disease.
APO-E & Finding The Right Diet
Dr. Alex Jimenez, D.C., presents: And there was a study that showed that if you gave patients with dementia antivirals, it decreased the risk of getting dementia. So what do we do with the APO-E genotype? If you have APO-E2, APO-E3, or APO-E4, you can start them on the cardiometabolic food plan. If they’re on the SAD diet, the standard American diet, then putting them on the cardiometabolic food plan is just a good idea. It’s going to start shifting them in the right direction. What about additional consideration if they have APO-E3/4 and APO-E4/4? There are a couple of reasons you should jump in on this. They like it more when you customize a diet to a patient’s genetics. So if you can say, listen, we have your genes, and we know that you would do better if you had lower saturated fat, or if you don’t do so well on alcohol X, Y, or Z, it makes them pay attention more.
Because now it’s personalized. It’s not like, “Hey, everybody, just eat healthily.” It’s more personalized to your genetics. So, that would be a reason to start this from the get-go. But get them on the cardiometabolic food plan, and they should begin to feel better. But we would start by putting the whole thing in perspective that this APO-E3/4 and APO-E4/4 is not a death sentence. It’s a clue of how you respond to your environment and what we need to watch out for. It does not mean that you are going to get Alzheimer’s. The majority of people with Alzheimer’s do not have APO-E4. You have a higher risk of getting Alzheimer’s if you have APO-E4. And that’s where functional medicine comes in to risk-stratify them.
Finding The Right Diet For You
Dr. Alex Jimenez, D.C., presents: We recommend a lower simple carbohydrate diet or a higher glycemic index diet. And diet and food plan interchangeably, but patients call it a food plan because diet has negative connotations. So we avoid the word diet because when people hear or speak it, some people are triggered by it. You have people with food disorders and people with bad experiences with diets. A lower fat and a lower saturated fat food plan or recommendation is something to consider and be more aggressive with omega-3s. And if you start giving omega-3s to the patients, it is best to check their omega-3 levels and see if they begin to fluctuate. If they start shifting for the better, then we strongly advise against alcohol and monitor these patients for cognitive decline; there are different tools that you can use.
When it comes to omega-3s, it is best to do a cognitive test to keep an eye on their mentation. So if it starts to decline, you’re jumping in way before you have a major problem. And because of the issue of them not being able to deal with viral infections like herpes. And because the herpes virus may play a role in getting dementia, you may consider lysine supplementation. Arginine can deplete lysine. So if you end up eating a lot of pumpkin seeds and a lot of almonds and whatnot that have higher amounts of arginine, you can counteract that with lysine. And the research suggested that you need about two grams of lysine daily. But remember, every patient is different, so don’t just throw everybody on lysine if they have APO-E3/4, APO-E4, or APO-E44 3 but just something to consider.
So final thoughts on APO-E and nutrition. There are many pieces to the puzzle. Do not be dogmatic and say you have these genes, so you must do this. Just realize there are so many different genes, so many other variabilities, and recognize that it’s not that race can have something to do with how APO-E is affected. For example, they did a study that found that people in Nigeria had higher amounts of APO-E4, and the APO-E4 four did not increase their risk of dementia. So there are other pieces of the puzzle, monitor biomarkers and continue to adjust the plan. Next, we will discuss dealing with people with high triglycerides and high LDL.
What To Do With Abnormal Lipids?
Dr. Alex Jimenez, D.C., presents: So how do you take the abnormal lipid findings that you see on your profiles of your patients, those biomarkers, as all of us check? And how do you adjust the cardiometabolic food plan? What of the highlights of a cardiometabolic food plan that you will do for your patient in response to their lipids? Let’s first review a few things we know about how to modulate the diet’s lipids. First, we know that if you go from a standard American diet to the cardiometabolic food plan. You remove the trans fatty acids, and if you remove the trans fatty acids, then you will see a decrease in LDL cholesterol triglycerides. You’ll get an improvement in HDL; to say it another way, if your diet is high in trans fatty acids, you’ll have a higher LDL you have, you’ll have more elevated triglycerides, and you’ll have lower HDL.
How To Modulate Your Diet
Dr. Alex Jimenez, D.C., presents: What else about modulating the diet? If you have longer chain fatty acids that are not polyunsaturated, you’ll have an increase in your LDL and triglycerides and an increase or no change in your HDL cholesterol. On the other hand, we focus a lot on the shorter chain fatty acids and functional medicine. So if you have shorter chain fatty acids that are less than ten carbons, you’ll have lower LDL cholesterol triglycerides and increased HDL. So you can see with the cardiometabolic food plan, by addressing with the patient, their fat source, you can begin to impact LDL cholesterol without anti-triglycerides, without any other modulation other than dietary habit. And then finally, we know the data early and some of the most recent meta-analyses of changing simple sugars in the diet.
We know that that can, in its own right, increase LDL cholesterol triglycerides, and you get a lowering of HDL. So let’s put this all in context. What do we want to do for our patients to decrease the risk of coronary artery disease or atherosclerosis fat disease? We want their LDL cholesterol to be in a lower range. We do not wish for that LDL to be oxidized. We want the HDL to be higher. And if we can get triglycerides down through dietary change, then that gives us a clue that they might not be dysfunctional in the insulin metabolism. Then finally, with omega-3 fatty acids or adding omega-3 fatty acids or mono-concentrated fatty acids, we’ll lower LDL cholesterol triglycerides, and we’ll get an increase in HDL cholesterol. This is associated with a reduction in cardiovascular risk independent of lipid levels.
Conclusion
Dr. Alex Jimenez, D.C., presents: How is that affecting the body? It is because you have inflammatory drivers independent of your serum lipids that will increase your risk of atherosclerosis disease. It comes to saturated fat and fat content. Balancing the proteins, and the fat, you don’t have as much oxidative stress associated with inflammation after a meal. Thus, even if you have an elevated LDL level, you have less chance of having an increased oxidized LDL. Incorporating fibrous foods, antioxidants, lean meats, dark leafy greens, and supplements into a healthy diet can help lower LDL and fatty acids in the body and reduce all these comorbidities causing issues to your health and wellness.
So, those are just some tips and tricks for diet prescription to reduce cardiometabolic syndrome. And we encourage your patients to add more greens, legumes, nuts, and seeds, making the plant-based diet a mainstay for their heart health.
Dr. Jimenez, D.C., presents how to find the best diet approach to hypertension and cardiometabolic risk factors in this 2-part series. Many factors often play a role in our health and wellness. In today’s presentation, we will look at how a cardiometabolic diet is personalized for every body type and how genes play with the cardiometabolic diet. Part 2 will continue with how genes play their role in a cardiometabolic diet. We mention our patients to certified medical providers that provide available therapy treatments for individuals suffering from chronic conditions associated with metabolic connections. We encourage each patient when it is appropriate by referring them to associated medical providers based on their diagnosis or needs. We understand and accept that education is a marvelous way when asking our providers’ crucial questions at the patient’s request and acknowledgment. Dr. Alex Jimenez, D.C., uses this information as an educational service. Disclaimer
What Is A Cardiometabolic Diet?
Dr. Alex Jimenez, D.C., presents: Regarding cardiovascular disorders, some terms we look for are: actual heart disease or stroke risk, or they’re on the metabolic side. Insulin, blood sugar, metabolic dysfunction. These words capture the themes we’ve been talking about lipids, glucose, inflammation, and insulin. Those are the people that you’re thinking about for this plan. And what you’re doing is building a lifestyle prescription. And for our patients who have cardiometabolic issues, we’re going to really take advantage of those features of our cardiometabolic food plan and then take them a step further to not only give a low glycemic impact, anti-inflammatory, plant-based kind of nutrient source but then how can we tailor it according to other parameters of this patient and then how can we help this patient implement it when they step outside your office and have to enter into their environment, which may or may not be set up for success.
So first things first. There is a practitioner guide that you must take advantage of, and this is like the scriptures of nutrition, and it has so many resources in here, but of course, they are of use to you once you know about them. So this is going to give you the how-to. So in case you miss something or want more detail, please refer to this practitioner guide for the cardiometabolic food plan. Now, let’s say you want to do the first entry-level use of this food plan. Well, we would grab the one that tells a cardiometabolic food plan. You’ll notice that all these specialized foods are selected to help with cardiometabolic conditions.
Personalizing A Plan
Dr. Alex Jimenez, D.C., presents: And it’s much better than saying, “Hey, eat fewer carbs, eat more plants. You know, eat healthier and exercise more.” That needs to be more specific. So taking it a step further, give them a blank food plan. It doesn’t have to be personalized to another level. Handing them a food plan and telling them to start eating from this list is only sometimes going to work. Sometimes we have to take it a step further to give them food choices in terms of quality and quantity. To that point, you have the ability right now with your patient to guesstimate size and caloric targets.
We can estimate size and weight and put small, medium, and large portions on food consumption. An example will be if we look at the different sizes of body types. For a petite adult body, it is best to ensure they consume about 1200-1400 calories. A medium adult body must consume about 1400-1800 calories, and a large adult body must consume about 1800-2200 calories. That might be the first kind of personalization.
Let’s give you some caloric-guided, quantity-guided food plan options. So what’s beautiful is that we have those already built out, and if you look closely at them, it tells you how many servings of each category should be in each specific small, medium, and large food plan. So you don’t have to do that calculation. Now if you want to take it to the next level and you have a BIA or a bioimpedance analysis machine, you can understand specifically their caloric burn rate and then if you want to modify it. An example would be a 40-year-old male who is unhappy with his weight and has been dealing with issues causing him ankle pain. So let’s see how we can change these things.
As we look at his body index, he is about 245 pounds and has been dealing with some cardiometabolic issues. Now when we look at his numbers and data from the BIA machine, we would develop a food plan that can help dampen the cardiometabolic issues effects that can help him. We would start to calculate come caloric recommendations and have a personalized diet and exercise plan to reduce the symptoms affecting his body and help promote muscle gain and weight loss. This customized plan allows him to keep track of his progress to see what works that is helping him lose weight or what needs improvement. Making these small changes can be beneficial in the long hall, as it will take some time to develop healthy habits.
How To Cater a Cardiometabolic Diet?
Dr. Alex Jimenez, D.C., presents: Now, what do you do with that information and cater it to become a diet for cardiometabolic disorders? Well, you would work with a health coach and other associated medical providers like a nutritionist to pull out a personalized food plan to help your patients understand what’s in each category and how to personalize the servings per day if you decide to get a bit more personalized with the caloric targets. And remember that some MVPs are the most valuable players with super nutrient powers within this food plan. It is also important to make time with the patient to discuss foods that benefit their health and wellness. Remember that this cardiometabolic food plan’s goal is to be able to personalize for unique clinical cases and unique patients. However, it still serves the general need for cardiometabolic food signals for our patients with these issues.
There’s something in here for everybody; remember, you must get started on something. So please consider how you can make this available to your patients so that they have it to a couple of recipes; it’s got menu plans, shopping guides, and recipe indexes. It’s chalked full of the things that slow us down in getting nitty gritty about the cardiometabolic food plan or nutrition in general. Something is always better than nothing. So by starting with the cardiometabolic food plan for your patients, you will start seeing the science be beautifully put into action. We will talk about how to use genetics with diet prescription.
Cardiometabolic Diet & Genes
Dr. Alex Jimenez, D.C., presents: Going a bit deeper, we will discuss how we tailor the cardiometabolic food plan in patients based on their APO-E genotypes. How do we customize it a little bit further? So what is APO-E? APO-E is a class of APO lipoproteins produced in the liver macrophages in astrocytes. It is required for the chylomicrons and IDLs while mediating cholesterol metabolism and is the principal cholesterol carrier in the brain. Now, there are three possible genotypes. There’s APO-E2, APO-E3, and APO-E4. And what happens is you’re going to get one from each parent. So you’re going to end up with a combination at the end. So you’ll be either APO-E3 with APO-E4 or APO-E2 with APO-E3. So based on what you got from your mother and what you got from your father, you’re going to have that combination.
APO-E Explained
Dr. Alex Jimenez, D.C., presents: So APO-E2 two and APO-E3, there’s a lot of information online, but there’s not good evidence on making specific dietary changes in these particular genotypes. So unfortunately, we don’t have the data to confidently say how to modulate, change or customize the food plan based on these genotypes. The best we can tell you is to follow the biomarkers; every patient is an individual. But what about APO-E4? Around 20% of Americans have at least one APO-E4 allele, and if you have APO-E4, you have an increased risk of mild cognitive impairment, Alzheimer’s, hyperlipidemia, diabetes, and coronary heart disease. And if you smoke or drink, you have a worse outcome with this genotype. Interestingly, being relevant to the times increases the risk of infections that can affect your body.
So usually, something helps one thing, but it will, and it can hurt others. So with your patients that you already have their genetics on, this might be a nice way to look at if you know their APO-E4 risk stratified them even more when protecting them. So this was independent of whether they had dementia, underlying cardiovascular disease, or diabetes.
If you have APO-E4, it may be protective against malaria, and who knows what other benefits it would have? An interesting fact about APO-E4 is that, in a study where they tried to give them DHA supplementation, they found it harder to get the DHA in the brain higher with APO-E4. They could elevate it, but not as well as if you had APO-E2 or APO-E3. And this was like supplementing with DHA. Other studies showed that the levels did not respond well if you did DHA and EPA together. So you didn’t get as high of a response of the omega-3s with APO-E4 versus if you had APO-E2 or APO-E3.
How Omega-3 Play Their Role?
Dr. Alex Jimenez, D.C., presents: So the interesting thing, though, is that the study looked at the omegas in the brain that was supplemented with DHA. We have all kinds of new research on the benefit of EPA-only omega-3s; there’s even a main name brand product that is EPA-only. If you look at, if you look to the right, you see that EPA ends up becoming DHA. So if you start increasing, both EPA and DHA will go up. What about APO-E in your diet or the food that you’re consuming? When they looked at genetically modified mice where they took APO-E out, they found extreme hypercholesterolemia with a high-fat food plan.
So when the mice were fed higher fat diets, they had this extreme rise in high cholesterol. Why is this relevant? Because APO-E4 does not function as well as APO-E3 and APO-E2. That hinted that this could affect us if we consumed a higher-fat food plan. So in a U.K. study, they found out that if they gave patients APO-E4 and switched it from saturated fats, they decreased their saturated fats while increasing their lower glycemic index carbohydrates; they found that it lowered their LDL and APO-B. This is a clue that we may want to decrease saturated fats, even healthier saturated fats, in these patients.
So the Berkeley Heart Study from the Berkeley Heart Lab was bought by Quest. It’s now called Cardio iq. It’s one of the original advanced lipid testing labs. And they had an observational study where they saw different effects in these patients with APO-E4 and other products based on various dietary modifications. So what did they find? They found that giving them fish oil lowered their triglycerides, reduced their small density LDL and HDL, and increased their LDL. So their HDL decreased, but the small density LDL went down, and their triglycerides went down.
Around 60% of individuals have a condition caused by or complicated by chronic inflammation. The body reacts with acute inflammation, which is beneficial as the immune system fights off bacteria that could infect the injury. Examples could be getting a cut on the finger that swells for a day or so to repair the wound or catching a cold and coughing up mucus to expel the germs. However, acute inflammation only lasts as long as necessary; chronic inflammation can last for weeks, months, and years. Individuals can have chronic inflammation and not know the damage being done to arteries and organs until pain or other issues begin to present. There are a few anti-inflammatory diets, which are nutrition plans that can help reduce inflammation.
Anti-Inflammatory Diets
Health-promoting substances include vitamins, minerals, fiber, omega-3 fatty acids, flavan-3-ols in tea and cocoa, and anthocyanins in blueberries, strawberries, raspberries, and other red and purple plant foods. Certain chemicals in the body cause inflammation, and naturally-occurring chemicals in foods, can prevent and combat inflammation by providing essential nutrients.
Nordic Diet
This includes Denmark, Sweden, and Finland, which each have different cuisines, but traditionally, they share healthy foods that provide anti-inflammatory benefits, including:
Rye is a grain shown to help reduce blood sugar, the inflammatory marker C-reactive protein. Individuals that follow this way of eating have lower blood levels of C-reactive protein and other inflammation markers. A randomized study was done in various Nordic countries and lasted six to 24 weeks. One group was assigned a healthy Nordic diet while the other stayed on the country’s modern, less healthy diet. The studies found that individuals that practiced a healthy Nordic diet even for a short while improved inflammatory markers and lost weight.
Mexican Diet
Research has linked a traditional Mexican diet to lower inflammation. Staple foods of a traditional Mexican diet include:
Cheese
Corn tortillas
Fruits and vegetables, including hot peppers
Rice – brown and white
Legumes/Beans
Legumes/beans are linked to protection from inflammatory-related conditions that include:
Obesity
High blood pressure
High blood cholesterol
Type 2 diabetes
Cardiovascular disease
Legumes are high in fiber, which helps:
Reduce inflammation
Reduce unhealthy cholesterol
Reduce blood sugar spikes after a meal, which helps prevent type 2 diabetes and inflammation.
A National Cancer Institute study of post-menopausal women of Mexican descent living in the U.S. found that those following a more traditional Mexican diet averaged 23% lower C-reactive protein levels.
Nutritionist Health Coach and Chiropractic
In some instances, chronic inflammation can come from acute inflammation that does not turn off, which can happen when the body does not make enough chemical substances responsible for turning off the immune response. Blood tests for inflammation can include tests that detect the C-reactive protein and the erythrocyte sedimentation rate, which measures the speed red blood cells settle in a test tube that shows if more inflammatory compounds are present. A combined approach and team of medical professionals, including chiropractic, massage therapy, health coaching, and nutrition, can help relieve and prevent inflammation.
Nutritionist
Consulting a nutritionist is recommended to figure out and determine the best diet/nutrition plan for the individual.
A nutritionist may also suggest supplementation like vitamin D, magnesium, and fish oil supplements.
Body composition analysis breaks down the body elements of water, protein, minerals, and fat that can also discover inflammation markers.
Chiropractic
Chiropractic adjustments help reduce the production of cytokines or proteins that regulate the cells of the immune system. Overproduction of cytokines can cause a severe inflammatory response. Chiropractic’s purpose is to rebalance the body by realigning the vertebrae to reduce pressure on the nerves and promote a healthy nervous system. When the spine and other joints are correctly aligned, the nerves function correctly, returning the body’s biomechanics to normal.
InBody Results
References
Galbete C, Kröger J, Jannasch F, et al. Nordic diet, Mediterranean diet, and the risk of chronic diseases: the EPIC-Potsdam study. BMC Med. 2018;16(1):99.
Lankinen M, Uusitupa M, Schwab U. Nordic Diet and Inflammation-A Review of Observational and Intervention Studies. Nutrients. 2019;11(6):1369.
Ricker MA, Haas WC. Anti-Inflammatory Diet in Clinical Practice: A Review. Nutrition in Clinical Practice. 2017;32(3):318-325.
Santiago-Torres M, Tinker LF, Allison MA, et al. Development and Use of a Traditional Mexican Diet Score in Relation to Systemic Inflammation and Insulin Resistance among Women of Mexican Descent. J Nutr. 2015;145(12):2732-2740.
Valerino-Perea, Selene, et al. “Definition of the Traditional Mexican Diet and Its Role in Health: A Systematic Review.” Nutrients vol. 11,11 2803. 17 Nov. 2019, doi:10.3390/nu11112803
Yang, Yoon Jung, et al. “Dietary flavan-3-ols intake and metabolic syndrome risk in Korean adults.” Nutrition research and practice vol. 6,1 (2012): 68-77. doi:10.4162/nrp.2012.6.1.68
Nutrition is how the body utilizes consumed food. Nutrition plays a role in chronic pain; lifestyle behaviors can influence how food contributes to illness/diseases. A common cause of chronic pain is chronic systemic inflammation. Inflammation plays a role in many chronic disease conditions, including diabetes, heart disease, and cancer. Reducing inflammation can be achieved by adjusting diet to get individuals back to feeling better quickly and to aid them in maintaining and improving their overall health. Injury Medical Chiropractic and Functional Medicine Clinic offer diet and nutritional supplements guidance as part of a personalized treatment plan.
Inflammation
The purpose of the inflammatory response includes:
Isolate the dangerous bacteria, viruses, or damaged cells.
Flush out the dead cells and other damaging substances.
Reductions of comorbidities like obesity and cardiovascular disease.
Reducing healthcare costs.
Vitamin and Mineral Supplements
Diet and nutritional supplements provide added essential nutrients to a damaged, inflamed, or injured body. Dietary supplements improve overall health and wellness.
Vitamin D and calcium tablets help maintain optimal bone health, as low vitamin D levels can lead to back pain.
Vitamins E and C, combined with copper, help with blood production, tissue repair, and brain and skin health.
Folic acidcan help with joint pain and myofascial pain.
B Vitamins can help with pain and prevent liver dysfunction.
Nutritional supplements support the body until the body and/or organs have correctly healed. Recovery from an injury could cause body stress that can interfere with the healing process. Diet and nutritional supplements expedite the healing and recovery process by:
Helping overcome dietary deficiencies.
Improving immune system function.
Detoxifying toxins.
Contain antioxidants that help the body stay toxin-free.
Chiropractic restores and realigns the body by incorporating supplements to nourish the body tissues and recover optimally from injury.
InBody Nutrition
References
Dragan, Simona, et al. “Dietary Patterns and Interventions to Alleviate Chronic Pain.” Nutrients vol. 12,9 2510. 19 Aug. 2020, doi:10.3390/nu12092510
Lee, Mi Kyung, et al. “The use of nutritional guidance within chiropractic patient management: a survey of 333 chiropractors from the ACORN practice-based research network.” Chiropractic & manual therapies vol. 26 7. 20 Feb. 2018, doi:10.1186/s12998-018-0175-1
Li, Chuan, et al. “Macrophage polarization and meta-inflammation.” Translational research: the journal of laboratory and clinical medicine vol. 191 (2018): 29-44. doi:10.1016/j.trsl.2017.10.004
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