Tribole.inflammatory Bowel Dz Nutrition.n6.aug.09

Nutrition Management Inflammatory Bowel Disease Evelyn Tribole, MS, RD Author, Ultimate Omega-3 Diet August 19, 2009 Orange County CCFA www.EvelynTribole.com

Beyond Symptom Management • New Research • Implications • So What Do I Eat?

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Attunement Internal

External

http://www.gse.buffalo.edu/cap/satsanga/healthyself.asp 

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Linoleic Acid Doubles Risk for  Ulcerative Colitis Why • • •

Dramatic rise in dietary omega­6 fats “heart healthy” First­line medications block omega­6 fat compounds  Tissue levels of omega­6 inflammatory compounds  rise with the amount of intestine damage.

WHO & Where • • •

200,000 people 10 Countries Prospective study

Hart AR. Linoleic Acid, a Dietary N­6 Polyunsaturated Fatty Acid, and the Aetiology of Ulcerative Colitis ­ A European  Prospective Cohort Study.Gut 2009. Gut. Published Online First: 23 July 2009. doi:10.1136/gut.2008.169078

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Omega-6 Polyunsaturated Fats • • • • •

Most Commonly Eaten Fat Soybean oil Cottonseed oil Corn oil Margarines, spreads, dressing

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Anti-Inflammation Medications Block Effects of Omega-6 Fat • • • • • • 

NSAIDS COX-2 Inhibitors Statins Inhalers Acne medication Mood Stabilizers

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First­Line Colitis Medications Block Omega­6 Effects Dose­Dependent 5­aminosalicylic acid  (Mesalamine)

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5-ASA Trade Names Apriso, Asacol, Canasa Lialda, Pentasa, Rowasa

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Linoleic Acid Doubles Risk for  Ulcerative Colitis Findings

• Dietary Omega­6 Fat Ups Risk 2­fold • Accounted for 30% of cases

Diet Details

• Risk for Women: > 6.1 grams linoleic acid • Risk for Men: > 7.8 grams linoleic acid

Perspective

• USA Diet averages 13.0 grams linoleic acid • Top Sources: soybean oil, corn oil, cottonseed oil grams linoleic acid • 1 Tb soybean oil=6.9 grams  1 Tb soybean oil= Hart AR. Linoleic Acid, a Dietary N­6 Polyunsaturated Fatty Acid, and the Aetiology of Ulcerative Colitis ­ A European  Prospective Cohort Study.Gut 2009. Gut. Published Online First: 23 July 2009. doi:10.1136/gut.2008.169078 

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Dietary Omega­6 Fat Ups Risk  for Colorectal Cancer Why

• Omega­6 compound (PGE2), is associated with a high risk of  colorectal cancer. • Balance of dietary omega­6 and omega­3 effect eicosanoids

WHO & Where • 75,000 Women • China

Murff HJ et al.A Prospective Study of Dietary Polyunsaturated Fatty Acids and Colorectal Cancer Risk in Chinese Women. Cancer Biomarkers Prev. 2009 18: 2283-2291. Chan AT et al.Aspirin Use and Survival After Diagnosis of Colorectal Cancer.JAMA. 2009;302(6):649-658. 

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Dietary Omega­6 Fat Ups Risk  for Colorectal Cancer Findings

 Omega­6 compound (PGE2), with low dietary omega­6:3  Cancer risk  Cancer risk: • Dietary arachidonic acid  • High dietary ratio of omega­6 to omega­3 fats

Murff HJ et al.A Prospective Study of Dietary Polyunsaturated Fatty Acids and Colorectal Cancer Risk in Chinese Women. Cancer Biomarkers Prev. 2009 18: 2283-2291. Chan AT et al.Aspirin Use and Survival After Diagnosis of Colorectal Cancer.JAMA. 2009;302(6):649-658. 

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Arachidonic Acid Found in meats, poultry, eggs Higher in farmed fish Lower in pasture­raised (grass­fed) cattle

Murff HJ et al.A Prospective Study of Dietary Polyunsaturated Fatty Acids and Colorectal Cancer Risk in Chinese Women. Cancer Biomarkers Prev. 2009 18: 2283-2291. Chan AT et al.Aspirin Use and Survival After Diagnosis of Colorectal Cancer.JAMA. 2009;302(6):649-658.

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Omega-Fats Omega-3

Omega-6

Omega-9 Olive oil Avocado Nuts

algae oil

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Fats in Olive Oil RATIO VS CONTENT

Monunsaturated 73%

Saturated 14% Polyunsaturated 11%

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Fats in Soybean Oil Monunsaturated 23%

Saturated 16% Polyunsaturated 58%

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Different Omega3s

Marine Foods

EPA DHA 

Plant Foods

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ALA

Omega-3 Fat: Basics Originally classified as a vitamin Required in every cell Different types with different jobs 

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Recommended Omega-3 Intake Omega-3 Fatty Acid

Milligrams/day

ALA [1] (from plants) DHA + EPA [1] (marine)

2220

Rx: IBD Fish Oil

2700-5600

[2]

*

650 *

*based on 2,000 kcal/day [1] Simopoulos, AP et al.. Workshop on the Essentiality of and Recommended Dietary Intakes for Omega­6 and Omega­3 Fatty Acids. J Am Coll Nutr  (1999) 18: 487. [1] Simopoulos, AP et al.. Workshop on the Essentiality of and Recommended Dietary Intakes for Omega­6 and Omega­3 Fatty Acids. J Am Coll Nutr (1999) 18: 487. [2] Calder P. Recommendations for Therapeutics and Prevention: n-3 Polyunsaturated fatty acids, inflammation, and inflammatory diseases. Am. J Clinical Nutr. 2006; 2006; 83(6):S1505-1519S. 

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USA Diet Compared to Recommendations Milligrams/da USA Diet= Fatty Acid y Deficient

ALA

2200

1300 (60%)

DHA + EPA

650

85 (13%)

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2­Fish Servings/Week Fish (6-oz cooked) Anchovies Wild Salmon Halibut Rainbow Trout Sardines Sea Bass 

EPA + DHA (mg)

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3500 2960 2000 1960 1660 1300

What if You Won’t Eat Fish?

EPA &DHA •Fish •Algae oils •Fortified Foods www.EvelynTribole.com 

Fortified Foods Read the Label • Which omega3? • What Amount? – DHA 32 mg/serving (Horizon milk)

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Supplements How to Choose No standard formula Amount of: DHA EPA

No need for added: Omega-6 Omega-9 www.EvelynTribole.com

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Special Concerns: Omega-6 Fats Excess Interferes with Omega-3s Top Omega-6 Sources=Vegetable oils Soybean oil Corn oil Cottonseed oil  Margarines

Lowest Omega-6 Vegetable oils Olive oil  Canola oil  Flax oil Brenna JT, et al. Prostaglandins, Leukotrienes & Essential Fatty Acids.2009;80: 285-91. 

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Mediterranean Diet

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Silo Effect • Pharmaceutical:

Blocking the excessive omega-6 eicosanoid signals

• Cardiology • Oncology • IBD

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Conclusion Type of Omega3 DHA + EPA Right Amount 650 milligrams/day

Limit Omega-6 

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