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?

www.EvelynTribole.com
Attunement
Internal External
http://www.gse.buffalo.edu/cap/satsanga/healthyself.asp

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


Omega-6
Polyunsaturated Fats
• Most Commonly Eaten Fat
• Soybean oil
• Cottonseed oil
• Corn oil
• Margarines, spreads,
dressing

Anti-Inflammation Medications
Block
Effects of Omega-6 Fat
• NSAIDS
• COX-2 Inhibitors
• Statins
• Inhalers
• Acne medication
• Mood Stabilizers

FirstLine Colitis Medications
Block Omega6 Effects
DoseDependent
5aminosalicylic acid
(Mesalamine)

5-ASA Trade Names
Apriso, Asacol, Canasa
Lialda, Pentasa, Rowasa

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
• 1 Tb soybean oil=6.9 grams
1 Tb soybean oil= grams linoleic acid
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

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.

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.

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.

Omega-Fats
Omega-3 Omega-6 Omega-9
Olive oil
Avocado
Nuts
algae oil

Fats in Olive Oil
Monunsaturated RATIO
73% VS
CONTENT
Saturated 14%
Polyunsaturated 11%

Fats in Soybean Oil
Monunsaturated 23%
Saturated 16%
Polyunsaturated 58%

Different Omega-
3s
Marine Plant
Foods
Foods
EPA
ALA
DHA

Omega-3 Fat: Basics
Originally classified as a
vitamin
Required in every cell
Different types with

different jobs

Recommended
Omega-3 Intake
Omega-3 Fatty Acid Milligrams/day
ALA [1] (from plants) 2220 *
DHA + EPA [1]

650 *
(marine)
Rx: IBD Fish Oil [2] 2700-5600
*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.

USA Diet Compared to
Recommendations
Milligrams/da USA Diet=
Fatty Acid y
Deficient
1300
ALA 2200
(60%)
DHA +
650 85 (13%)
EPA

2Fish Servings/Week
Fish (6-oz
EPA + DHA (mg)
cooked)
Anchovies 3500
Wild Salmon 2960
Halibut 2000
Rainbow
1960
Trout
Sardines 1660
Sea Bass 1300

What if You Won’t Eat
Fish?
EPA
&DHA
•Fish
•Algae oils
•Fortified

Foods
Fortified Foods
Read the Label
• Which omega-
3?
• What Amount?
– DHA 32 mg/serving
(Horizon milk)

Supplements
How to Choose
No standard
formula
Amount of:
DHA
EPA
No need for
added:
Omega-6

Omega-9
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.


Mediterranean Diet

Silo Effect
• Pharmaceutical:
Blocking the excessive omega-6
eicosanoid signals
• Cardiology
• Oncology
• IBD

Conclusion
Type of Omega-
3 DHA + EPA
Right Amount
650
milligrams/day
Limit Omega-6


Tribole - Inflammatory Bowel DZ Nutrition.n6.Aug.09

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Nutrition Management

Omega-3 Omega-6 Omega-9

Required in every cell

Different types with

ALA [1] (from plants) 2220 *

DHA + EPA [1]

Top Omega-6 Sources=Vegetable oils

Lowest Omega-6 Vegetable oils

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