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Inflammation and The AntiInflammatory Diet Through ACancer LensTODAY’S AGENDA:Become an OrgainAmbassador Today!Request an Orgain Ambassadoraccount today to get access to our online sampling portal so you can shareOrgain products and coupons withyour patients or clients. Introduction & HousekeepingSpeaker IntroductionPresentationQ&AClosingWEBINAR HOST:Keith Hine MS, RDSr. Director of Healthcare & SportsOrgainhealthcare.orgain.comWEBINAR PRESENTER:Jean La Mantia, RDRegistered Dietitian, Private Practice

Jean LaMantiaDietitian Survivor SpeakerDisclosuresTHECOMPLETELYMPHEDEMAMANAGEMENT ANDNUTRITION GUIDEEmpoweringStrategies,Supporting Recipes& TherapeuticExercisesJEAN LAMANTIA, RDANN DIMENNA , PT, CDTANDWith foreword by EWASZUMACHER, MD, FRCP(C), MEdwww.jeanlamantia.com

Agenda Helping your clients understand inflammation Inflammation through a cancer lens Inflammation, cancer and;– Arthritis– COPD– GERD– Others Blood tests for inflammation Anti-inflammatory foods Inflammatory foods Anti-inflammatory meal pattern Practical tools PDF downloadwww.jeanlamantia.com

Feb23,Inflammation– A Hot Topic2004

Understanding Inflammationwww.jeanlamantia.com

The 5 Pillars of Inflammationwww.jeanlamantia.com

Why Does Inflammation Become Chronic?Associated with: Exposure to irritants– in the environment– in our bodies e.g. bile acid Lack of physical activity Obesity Poor dietwww.jeanlamantia.com

ADD INFLAMMATION AND AND IMMUNE SYSTEM IS COMPROMISEDwww.JeanLamantia.com

“Persistent inflammation gives rise toincreased release of pro-inflammatorymediators including cytokines,chemokines, prostaglandins and reactiveoxygen/nitrogen species. Many suchmediators are found to promote cellgrowth and invasion, to inducemutagenesis and to increaseangiogenicity”-Mohammed Abdel-Latif et alDepartment of Clinical MedicineSt James Hospital, IrelandAbdel-Latif M. Inflammation and Esophageal Carcinogenesis. Current Opinion in Pharm. 2009. 9:396-404.

Chronic Disease,Inflammation andCancer

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ArthritisRheumatoid Arthritis (RA) Chronic inflammatory disorder Affects joints and other body systems Autoimmune diseasewww.jeanlamantia.com

Arthritis and Cancer2008 Literature ReviewSmitten, A. A metaanalysis of the incidenceof malignancy in adultpatients withrheumatoid arthritis.Arthritis Res Ther 10,R45 2008 21 Publications Rheumatoid Arthritis and risk of: Overall malignancy Lymphoma Lung Colorectal Breast Standardized Incidence Ratio (SIR) Divide observed number of cases by theexpected numberwww.jeanlamantia.com

Arthritis and Cancer RiskLymphomaCompared to general population: 2 x risk of lymphoma More Hodgkin’s than non-Hodgkin’sLung Cancer 1.63 x risk of lung cancerwww.jeanlamantia.com

Arthritis and Cancer RiskResultsCompared to general population: 0.77 colorectal cancer 0.84 breast cancerwww.jeanlamantia.com

Conclusions about RA, Inflammation and CancerRA and Lymphoma Inflammation is believed to play a key role in lymphoma Higher inflammatory activity is a major risk for lymphomaRA and Lung Cancer A 10 year observational cohort study reported that CRP was significantlyassociated with lung cancer, independent of smoking RA has been shown to affect the lungsRA and Colorectal Cancer The reduced risk is most likely due to use of non-steroidal antiinflammatoriesRA and Breast Cancer No Discussionwww.jeanlamantia.com

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COPD Progressive airflow obstruction Abnormal chronic inflammatoryresponse to particles and gaseswww.jeanlamantia.com

Lung CancerLung Cancer The most commonly diagnosed form of cancer Responsible for the most cancer deaths Small cell Non small cell (NSCLC) 80-85% Can occur in non-smokersImageby truthseeker08 from Pixabaywww.jeanlamantia.com

Lung Cancer“Chronic obstructive lung disease (COPD), aBozinovski, S et al.COPD andsquamous cell lungcancer: aberrantinflammation andimmunity is thecommon link.British J of Pharm.2016. 173;635-648.lung disease with long-standinginflammation, is a risk factor for lungcancer and inflammation in the lungscontributes to both the susceptibility andprogression to lung cancer”-Bozinovski et al, 2016www.jeanlamantia.com

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GERD Erosion of the esophagus by: Acid reflux Bile refluxAbdel-LatifM.Inflammation andEsophagealCarcinogenesis. CurrentOpinion in Pharm. 2009.9:396-404.www.jeanlamantia.com

Esophageal CancerAbdel-LatifM.Inflammation andEsophagealCarcinogenesis.Current Opinion inPharm. 2009. 9:396404. 10-20% of people with GERD developBarrett’s esophagus The squamous epithelium of thedistal esophagus are replaced bycolumnar epithelium and mucussecreting goblet cells Incidence of esophageal cancer withBarrett’s esophagus is 30-125 x that ofthe general populationwww.jeanlamantia.com

GERD and Esophageal Cancer Bile acids are important in thedevelopment of Barrett’s esophagus Bile acid exposure esophagealmucosal damage High fat diet more bile acid Bile salt, bile acid or gastric acidexposure esophageal injury andchronic inflammationAbdel-LatifM.Inflammation andEsophagealCarcinogenesis. CurrentOpinion in Pharm. 2009.9:396-404.www.jeanlamantia.com

Abdel-LatifM.Inflammation andEsophagealCarcinogenesis.Current Opinion inPharm. 2009. 9:396404.“It is clear thatchronic inflammationplays a key role in the initialdevelopment of Barrett’sesophagus.Inflammatory signaling is alsoinvolved in the promotion oftumorigenesis from the epithelialand immune cell sources.”- Abdel-Latif et al. 2009www.jeanlamantia.com

Other Conditions Linked to Cancer viaInflammation ObesityMetabolic syndromeInflammatory bowel diseaseHepatitisGallbladder stonesPancreatitisPsoriasis

Measuring Inflammationwww.jeanlamantia.com

How Do I Measure Inflammation?Shivappa N, et al.Designing anddeveloping aliterature-derived,population-baseddietary inflammatoryindex. Public HealthNutr. 2014Aug;17(8):1689-96. High sensitivity C-Reactive Protein (hs-CRP)C-Reactive Protein (CRP)Erythrocyte sedimentation rate (ESR)Plasma viscosity (PV)TNF- (tumor necrosis factor-alpha)Interleukin biomarkers; IL-1β IL-4 IL-6 IL-10

Diet and Inflammationwww.jeanlamantia.com

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Dietary Inflammatory IndexCavicchia PP, Steck SE,Hurley TG, et al. A newdietary inflammatory indexpredicts interval changes inserum high-sensitivity Creactive protein. J Nutr.2009;139(12):2365-2372.Goals:1. To define and validate a DietaryInflammatory Index2. Determine how well the DII predicts changesin hs-CRPHow the DII was developed Examined peer-reviewed research from1950-2007 that identified the role of specificfoods and constituents on 6 inflammatorymarkers: IL-1β, IL-4, IL-6, IL-10, TNF and CRP A score was given to the food andconstituent The scores were combined into an index,“The DII”

InflammatoryAnti-InflammatoryCavicchia PP, Steck SE,Hurley TG, et al. A newdietary inflammatory indexpredicts interval changes inserum high-sensitivity Creactive protein. J Nutr.2009;139(12):2365-2372.

Validation of the DII 2015 FFQ from 2567postmenopausalwomen The DII wassignificantlyassociated withinflammatorybiomarkers

DII and Colorectal Cancer Incidence 2015 DII calculatedfrom foodfrequencyquestionnaires 152, 536 women Moreinflammatory DIIscores associatedwith increasedrisk of colorectalcancer

DII and Postmenopausal Breast Cancer 2018 2150postmenopausalwomen FFQ 1.5 years afterdx of breast cancer 13.3 years Anti-inflammatorydiets associatedwith lower risk ofCVD but not withbreast cancermortality

DII and Metabolic Syndrome 2019 3733overweight andobese adults 24 hour recalls DII associatedwith all causemortality inadults withmetabolicsyndrome

DII and Colorectal CancerSurvival 2020 463 women withcolorectal cancer 11.6 years Lowest tertile ofDII associated withsignificantly lowerall cause mortality

Healthy Dietary Patterns

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Meta-Analysis: Can a Dietary PatternReduce Inflammation?Neale EP, et al.Consumption of ahealthy dietarypattern results insignificantreductions in Creactive proteinlevels in adults: ameta-analysis. NutrRes. 2016May;36(5):391-401.17 Clinical Trails examining, if a healthy dietary pattern canhave an effect on: Biomarkers of adiposity Insulin resistance Inflammation C-reactive protein Total adiponectin Retinol binding protein 4 Tumor necrosis factor – alpha Leptin ResistinDietary Patterns: Mediterranean diet Nordic diet Tibetan diet DASH

ResultsDietary Pattern and InflammationNeale EP, et al.Consumption of ahealthy dietarypattern results insignificantreductions in Creactive proteinlevels in adults: ameta-analysis. NutrRes. 2016May;36(5):391-401. 18 articles, describing 17 studies CRP was the only biomarker with substantial evidencefor a relationship with healthy dietary patterns Healthy dietary patterns reduced CRP compared tocontrol diets Mediterranean diet demonstrated improvementswith interventions of 3 months or more Consumption of a dietary patterns rich in fruits,vegetables, wholegrains and with reduced intakes ofred meat resulted in decreases in levels of CRP

What Foods Are Anti-Inflammatory?Shivappa N,Designing anddeveloping aliterature-derived,population-baseddietary inflammatoryindex. Public HealthNutr. 2014Aug;17(8):1689-96Ricker MA, et al.Anti-InflammatoryDiet in ClinicalPractice: A Review.Nutr Clin Pract. 2017Jun;32(3):318-325. Antioxidant rich fruits and vegetables; Berries Melon Citrus Carrots Squash Sweet potato Green leafy vegetables Fibre Fruits, vegetables Legumes Whole grains

SpicesShivappa N,Designing anddeveloping aliterature-derived,population-baseddietary inflammatoryindex. Public HealthNutr. 2014Aug;17(8):1689-96Ricker MA, et al.Anti-InflammatoryDiet in ClinicalPractice: A Review.Nutr Clin Pract. 2017Jun;32(3):318-325. emaryOnionGreen and black tea

What Else?Shivappa N,Designing anddeveloping aliterature-derived,population-baseddietary inflammatoryindex. Public HealthNutr. 2014Aug;17(8):1689-96Ricker MA, et al.Anti-InflammatoryDiet in ClinicalPractice: A Review.Nutr Clin Pract. 2017Jun;32(3):318-325. Vitamins A, C, D and ENiacin and RiboflavinZinc and MagnesiumLow Glycemic Index (GI)Low Glycemic Load (GL)Exercise Whole foodsPlant-based foodsRich in healthy fatsRich in phytonutrients

Omega-3, 6 and 9Omega 3 and 6 are both ESSENTIALRicker MA, et al AntiInflammatory Diet inClinical Practice: AReview. Nutr ClinPract. 2017Jun;32(3):318-325.Sales-Campos H, etal. An overview of themodulatory effects ofoleic acid in healthand disease. Mini RevMed Chem. 2013Feb;13(2):201-10.PMID: 23278117. Omega-3 is considered ANTI-inflammatory Omega-6 is considered PRO-inflammatory It is the RATIO that likely determines inflammationlevels Omega-6: Omega3: 10:1 is PRO-inflammatory Positive results in cardiovascular disease, rheumatoidarthritis and asthma are achieved with a ratio ofOmega-6: Omega 3 of 5:1Omega-9 Non-essential Oleic acid Anti-inflammatory

Seed Oil Variants

OilOleic Acid (Omega-9)SUNFLOWERSeed OilVariantsPEANUT1. Regular 50%2. High oleicUp to 80%1. High linoleic21%2. Mid-Oleic “NuSun”65%3. High Oleic82%4. High Stearic/High Oleic72% (18% stearic)SAFFLOWER1. High linoleic17%2. High oleic70%CANOLA1. Commodity/classic61%2. High oleic70%Foodservice OnlySOYBEAN1. Conventional23%2. Vistive Gold (GM)72%3. Plenish high oleic (GM)75%Foodservice Only

“The U.S. Food and Drug Administration has determined that THERE IS CREDIBLEEVIDENCE TO SUPPORT A QUALIFIED HEALTH CLAIM that consuming OLEIC ACID inedible oils, such as olive oil, sunflower oil, or canola oil, may reduce the risk ofcoronary heart disease.After conducting a systematic review of the available scientific evidence, the FDAnow intends to exercise enforcement discretion over the use of two qualified healthclaims characterizing the relationship between consumption of OLEIC ACID inedible oils (containing at least 70% OLEIC ACID PER SERVING) and reduced risk ofcoronary heart disease. Oleic acid is a monounsaturated fat which, whensubstituted for fats and is higher in saturated fat, may reduce the risk of coronaryheart disease.https://www.fda.gov/Nov 19, 2018www.jeanlamantia.com

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