A New Clinical Paradigm: Resolving Inflammation, Not Blocking It

like to was in the military did my training military and had 10 good years I still look upon it with a lot of fun it was a lot of good years but today I was that I currently work at the University Oregon Health Sciences University the University of Oregon's Medical School where I'm a surgeon trauma surgeon a critical care doc and I have been doing nutrition since I got my PhD in nutrition about 25 years ago 35 years ago now and you know I've really watched things going in the military we had a lot of projects going we actually had a beginner age conference 3 years ago called the nutritional support for the warfighter DoD funded but through the National Institute of Health we learned a lot we learned a lot exactly with what the general is telling us is is it you know when a troop goes out do battle every day you know in a deployed setting it has to come back in he doesn't want to go to eat MREs I mean I hate MREs for nine months when I was deployed to Iraq you know but you don't want to eat MREs you want to eat whatever it makes you feel good whether it's haagen-dazs ice cream I make sure look forward to hugging this when I come back from doing something all day long operate all day come back go out getting some ice cream you know and so I think that's what we had we got to teach the military and teach the people as I teach my young residents and young medical students got teaching they somehow make the people understand what they got to do it and because we're setting off a chronic inflammatory State and Americans today and it's across the board everybody and so really can diet changes is the question we have to ask you know we know and you know sort of relay this whole concept is we're in a chaos right now what we're doing you know we're not winning our war against inflammatory conditions you know as Napoleon said here you know the went worzic is a battlefields chaos and we're in a battlefield we're fighting what's going on in our kids and the help try to get them to eat right because look at our conditions in our health we've got diabetes obesity cancer targeting this inflammatory right now inflammatory diseases account for 86 percent of the healthcare dollar you start looking at that and say gee we have billions and Billy dollars so I think you know we've known for a long time that inflammation and it goes two ways I mean this is from a famous text book by John Hunter in 1794 showing that inflammation takes many forms the same disease process different disease process has the same inflammatory concept but look what's happened we've gone from infectious disease in this century in my lifetime you can see in 1950s I was born in 50 to look at these all coming down so we thought great science is working but look what's happened rheumatoid arthritis obesity Crohn's multiple sclerosis neurodegenerative disease Alzheimer's Parkinson's you know type 2 on diabetes asthma all going to almost exponential levels here's why it's the problem the question is getting the right diet make a change well what are we doing besides the other thing else we've changed our microbiome everything we eat alters the bacteria in your intestine that's my area of research now we're spending a lot of time in that but we know you know lifestyle changes newborns are getting by c-section is Asian domestic pets Grace studies showing you buy a dog within 48 hours the youngest child in your house gets the dogs microbiome very fast and it's all been shown very night you know all these things but really proteins fats v the additive the emulsifiers there's tremendous data now this ranch dressing we have here is full of multipliers you know most of I I have it some when I go out because my wife took it all out of our kitchen when I showed of the science articles on most of ours you know sweeteners we know now that artificial sweeteners change your metabolism increases your risk of metabolic syndrome diet coke which I used to be addicted to still has one dose think one on once in a while and our preservative refighting grain here's what the problem was the refined grain about 1920s we learned how to take the germinal center at a grain okay and we did that for a reason it made sense because now you can store your grain and a silo for three to five years you're not the mercy of selling it that year because it'll it'll go rancid in the silo so you were stuck to harvest your grain and sell it but now when you de germinate it and you leave just a carbohydrate there you no longer have to worry about really approved going rancid and destroying the whole crop so you could sell it at a better price later in the year the following year the following year so that made a difference but what happened we lost all of the good stuff in the grain basically what are we feeding our chickens and our pigs and our cows pure carbohydrate well they can't make omega-3 fats so what are they making sugars carbohydrates and fat which are all made from a pro-inflammatory eighteen carbon omega-6 fat because your body can make it from sugar we can't make the good fats they come in a germinal Center so we destroyed that we lost that so there lies the problem so if we look at all this stuff here we say these are all things in your diet we can make as anti-inflammatory the big ones of course is some of the vitamins some of the trace minerals probiotics now is a big issue omega-3 fats are probably the biggest one with the most data and the most science so let's do a case now I'm a trauma surgeon okay so this is the 63 year old male relatively healthy mild hypertension untreated okay if he gets a little dizzy in the morning and just gets up and figures he'll go downstairs not to bother his wife and is it walk going down as soon as he falls down a flight of stairs gets the hyper tape hypertensive intracranial bleed and not sure if it's from the fall or from the hypertension but he goes to trauma center and they admit him so now his right had a right-sided hemiplegia so his whole right side is out okay and he's got significant inflammation so the key here is what are we gonna do this is like the TBI is we've seen our young troops coming back we've got a big TBI project going on now we got there our place about three million dollars DoD money one minute I studied TBI that's that in coagulation in my department okay now if you look at that what do we want to do here we want to stop the inflammation because it's the inflammation it's a surrounding area where you've the cells are dead which can make this stroke become worse or better right it's called the penumbra you've got some cells which are gone they've been injured enough it's the cells surrounding that if you get more inflammation and heal damage more cells if you get less inflammation you can save those cells and save that break as a brain doesn't regenerate not like your liver so that's we're trying to save save that so we thought whoa Kay well we know we got inflammation but our whole career lots of careers in medicine have been how do we slow down inflammation how do we stop osteoarthritis how do we decrease diabetes to decrease the inflammation we forgot to talk about resolution of inflammation okay so if we look at resolution we've got these things called probe resolving mediators what you've been discovered by Charlie sir had a few years ago those in the endocannabinoids are very very big in the idea that we can slow down we can resolve it faster not only inhibit it but also resolved it faster and that's a big key so if we look at this list here pro-inflammatory versus less inflammatory fats you can see the fish oil sit over here all the way by itself olive oil is considered the neutral fat the Mediterranean diet uses mainly olive oil lots of fish okay we now know and for studies well over three million people prospective restyle trialed the Mediterranean diet works decreases heart disease cardiac I mean a cancer and other inflammatory diseases asthma type one day be type 2 diabetes you so but if we're over here you can see we got a problem and where are we intravenously we're only had this until just recently now we can get some fish oil so we know fish oils have got all kinds of stuff and I won't bore you today with biochemistry you know whether it's clinical data or biochemical data you can see lots of good stuff if we look at diseases we can we've got data now 5,000 prospective randomized clinical trials showing benefits of fish oils and all these cancer asthma you know all these psychiatry issues depression suicide is even better prospective randomized trials in Japan show us fish oils decreased suicide risk depression so major fishes well we used to think how's this work we just think epa and DHA goes down through here and stops information through their customers remember because he's a pro-inflammatory eicosanoids now we know that's a tip of the iceberg we've got all kinds of binding we show better muscle function we showed slowing of all kinds of respiratory parameters better but here's the best study here this study is a clinical study but done in healthy college students similar to our active duty guys okay so as long as so what they did here wasn't done by my you know met burger and became in a chole A's lab in Lausanne Switzerland so what they did here is they infuse fish oils or olive oils for one hour olive oil being a neutral fat okay after one hour they gave them purified ecoli endotoxin which makes you very sick okay that's what we see when people who got sepsis this is purified dose was not so bad and they looked at the metabolic response comparing if you have fish oils on board versus just having olive oil which is the nutria pet and I've been a pro-inflammatory fat like we're eating okay and what happened every metabolic parameter cortisol epinephrine il-1 i'll - you know Tia all that metabolic you know cortisol everything TNF alpha ACTH everything that would normally go up during times of stress were blunted attenuated lowered by about 25% so just having fish oils on board made the metabolic response to a stress lowered by 25% and what does that mean that means they burned less lean body tissue when you burn less lean body tissue you get out of the hospital faster you get out of bed faster you get out the ventilator faster you recover better you don't have to go to a rehab facility you can go home because you're lost lean but I didn't lose so much lean body tissue so they said everybody complained about that study this ridiculous is done in healthy college students I don't think that happens in people in the ICU well then we took people who've gone on to go on cardiac bypass identical data we could lower the response to cardiac bypass by 20% okay and then it showed it in Whipple procedure the biggest surgery I do as a general surgeon is a Whipple pancreatic cancer we take out the head of the pancreas half the stomach half the biliary tree for proximal duodenum six hours seven six or seven hour operation we saw it all back together and pray it holds okay that's a huge operation same thing we've lowered the metabolic response by lowering those people with fish oils to lower the metabolic response and there's lots of clinical studies that won't bore you this is a couple ones showing decreased infections decrease hospital stay again decrease it's our best journal for surgery decrease reported infections on this one here from from from EMA Asda and Australia same thing this is the biggest study from Japan seventy-five studies 7,000 patients now we actually show loading them with fish oils and our jinkin lower mortality this one published last week annals of Surgery 13 out of people only giving it pre up just loading the patient pre-op showed decreased infection and linked Hospital State so clearly fish oils get your body ready for a metabolic stress so if you load the patient and get their fish oils high when they do get a stress if they do get a stress they handle it better okay but it's not perfect you know in the acute lung injury and a RDS you know fibrosis we can't we don't see consistency in cardiac stabilization it will prevent new miss but does not prevent if you already have a fib you're not going to correct it prevention of fatty liver consistent every paper is pretty much across the board but really brain injury door we've got some very solid data on the fish oil but we've been lost again on trying to prevent it okay so what do we see is if we if we know what happens normally we can implement injury blood you know invading organisms injury to your vessels you can either resolve it back to normal you can form an abscess or you can get scarring or chronic inflammation obviously we want to go back to normal right okay so we look at that this guy here in 2003 had a concept he said every biological system has an on switch and an off switch so we didn't talk we've never talked about arms with off switches for fat for I Cosmo is pro-inflammatory fats well I was talking about it always turned everything on but doesn't or anything off so he said there must be an off switch long story about how he thought of that but we'll talk about that if you have a question so he discovered 1984 like boxes and then finally in early 2000s he would discover this new section of compounds that your body will make you don't have to notes cases if you have them on board your body will make them now you can take them and accentuate that but you can see what they do is they enhance that resolution basically increase killing by the bacteria by the of bacteria by your macrophages they enhance accelerate inflammatory Bri removal and so multiple things and so these are a new class of compounds your body can make now again you're not to take these if you have fish oils on board your body will make them and look they work on all your cells basically to decrease the inflammatory response and more rapidly so if you have these so-called SPM special probes are molecules we get resolution normal tissue healing as opposed to going to a chronic inflammatory state you again same thing you can't be you can't get there much in the diet but you can make them every tissue in your body can make tissue is expect to have like breast milk for example is full of SPM because we don't want the babies GI tract to be inflamed okay so they're made everywhere in the body but here's with a couple of the bigger studies showing we and we know we have better bacteria killing we increase the ability kill those bacteria and clear them an infection we know they work for viruses to SPMS were approved by the fda for injection into the eye for viral infections first thing they got approved it was mostly most rapid non orphan drug but got approved by the fda for viral infections you can see these in the animal this is flu this is the eye this is a control group and they treated group almost normal the decrease that inflammatory response what about pain post-op pain pain is inflammation right started by inflammation we lower the inflammatory response with decreased post-operative pain okay how about in sepsis we know now that people that are septic the ones who do better have a higher SPM levels when we measure that that's association not cause and effect but we've seen that association sepsis now what about cancer you know when I first started my training in nutrition and as a surgeon we were told thirty percent of cancers are from dietary change if I'm eating the bad stuff thirty percent of from environmental exposure and thirty percent are from genetics guess what now it's fifty percent from what we're eating if we have the right genes okay so now you have to have the J profile and if you've got you meet the bad diet with a certain Jerry profile you're a setup so that's completely change from peer in the past okay so we know that you know inflammation and cancers there clearly associated we know that cancer cells really can do everything a macrophage can do an inflammatory cell right basically angiogenesis continues to grow vessels unlimited replicability evasion of apoptosis means you know senescent death so all the things we have we can say what cancers are do have you know papilloma gastric cancer liver cancer cervical cancer bladder cancer colorectal cancer scar carcinoma asbestosis mesothelioma are all colonic inflammatory conditions that only after years of chronic information do we develop the cancer okay so now what can we show we know that stress PMS or have a protective role and again they decreased inflammation decrease angiogenesis but really here's the proof in the pudding here just published last year in December of 2018 they showed in human studies when you radiate the tumor we kill tumor right so inflammation is dead cells cause more inflammation if SPMS are on board we suppress the inflammatory response and clear that tissue debris faster so we clear the dead tissue which would propagate the inflammation very nice paper enhancing endogenous clearance of tumor cell debris again with SPM same thing what about obesity we know B C's inflammatory state we know that what your BMI get to about 35 to 40 we do not process spms well we have to then take more SPMS or more officials it's a dietary change how about head injury we know a lot of guys coming back from Iraq I was in Iraq I knew a lot of guys it got blast overpressure you knows near an explosion what happens they get injury in their head dai the diffuse axonal injury okay so what do we see we know that over 200 oxidation products are it noted in the brain within 24 hours of an injury the first few hours they're pro-inflammatory and then the anti-inflammatory fats start to be developed the spm start to be developing if we are loaded with fish or if we have fish oils on board okay so we know that the damage as I mentioned already is surrounding that area of damage so we have these SPMS we've got to do much better increase there by cell survival with induction with multiple pro survival proteins so I think we can say lots going on here virtually every tissue gets better okay if it's inflamed I think you know I can talk about any one of these models but this one's a very interesting model this not only shows us the the injury to the bone this family shows us that we can actually get less inflammation we can get regeneration so what they did here was they took the eye tooth out of a big pig 75 kilogram a pig they took that out and they put a silk suture through there to give it chronic osteomyelitis of the bone you know as you know when you go to the dentist oh we got it cleaned or periodontal work so you don't get bone infection because bone infection arose the bone noob of seeing older folks that lose their teeth and they lose their job so what happened here so what they did is they left that in there and it caused erosion of the bone the bone literally dissolves away with a chronic inflammatory phases you couldn't follow it by x-ray very easy to follow and then they take the suture out and they give stent control verses SPMS they get regrowth of the bone and the control group no brie growth didn't get worse now because the sutures got causing chronic inflammation but didn't get better in the spm group it grew back the high fish or group it grew back so regeneration is a whole new concept which we're looking at we know revitalization after traumatic brain injury diffuse axonal injury what happens here is you know the gray matter in your brain is heavier than the white matter so when you get out explosion or you hit the wall or a motorcycle or a car accident your brain obviously goes too well the grey matter moving heavier right force equals mass times acceleration so the gray matter moves faster the white matter being lighter doesn't move as fast and so you get stretches on those axons so you get diffuse axonal injury I see it every time I on trauma call we get a young guy car crashes car comes in maybe had a few drinks he's not awake he doesn't wake up he's got a glass shower coma the way you follow out of seven or eight and what happens next morning he starts to wake up and usually they do better because it took a while to we Milan ate those nerve those nerve fibers that got stretched and broke and some of the basically of the insulation of the nerve got broken it takes a while where the blast injury takes a little longer but you look at their CT scans and it doesn't look like it they're bad we okay the guy has Dai we gotta watch them close until they wear out to wake up the worse the injury the it's work but we now know we can regenerate even liver you know when you take out half the liver it'll grow back we now know on experimental models taking out half the liver given them SPMS it grows back about twice as fast so I think we know that SPF work so where can they work virtually everywhere in clinical medicine everywhere we see these chronic inflammatory states we've got models almost to see them almost every kind of ZZZ there's a lot more to be done but I think knowledge translation takes a while you know I work obviously in a big teaching hospital you know we have res I have 13 chief residents in general surgery it's a biggest surgical program in the country actually graduate 13 Chiefs a year they leave with an understanding of SPMS they go out to their other hospitals they call me a nice day Bob we don't have any fish oils here for our patients what are you talking about don't any fish sauce this is now approved by the FDA we've got this we've got that we can get IV fish oils you know what's going on what do you mean and so but there's a knowledge translation takes a while so it's up to us to go out and tell spread the word that we need to have understanding the science so you know again all these diseases again we know these are very tightly conserved through evolution have to be a little careful during the South you know you should live in Augusta when I was there Eisenhower couldn't talk about evolution in Georgia I guess here North Carolina better be careful Oregon we can talk about it's okay but basically they're conserved you know is right from these nematodes these are small worms we see microscopic out there humans the last thing I'll talk about is for a minute is Howard it affects our microbiome the bacteria living in our gut we need to think of those bacteria as an organ they should be thought of it we should keep take care of them because they can destroy you okay we got within one cell layer thick right there's enough endotoxin every one of our colons right now to kill everybody in this room we're not dying because that one cell layer is well protected our body does a good job as protecting us from the endotoxins of the bacteria in our colon produced okay so what they've save us they produce vitamins minerals amino acids butyrate anti-inflammatory compound lots of mechanisms again I won't bore you with all of these models crying Darius II definitely associated pneumonia all of them are benefited by probiotics the concept of giving back healthy bacteria to sick people what about prebiotics whole grains again we be germinating their grains so what are we feeding them not whole grains so feeding whole grains we know all cause mortality in many huge well-controlled studies now showing eating whole grains lowers cardiac disease cardiac death cancer cancer death again major journals like British Medical Journal circulation nutrition gas or neurology Oh major journals now have proven to us with millions of patients and prospective studies that whole grains are the way to go prebiotics also helped the bacteria they're the substrate for the bacteria to show you how important whole grains are is breast milk 15% of the sugars and breast milk are not absorbed by the baby so that doesn't make sense do you think why would the mother why would mother nature allow us to have 15% of our sugars that are in the breast milk not for the baby because they're going to make the perfect bacterial profile in her colon there's food for the bacteria remember worldwide the number one killer now for babies under six months old is diarrhea diseases if you have the right sugars feeding the right bacteria you're gonna not get infectious diarrhea you know I do a lot of work overseas it's the big issue still but to show you with exercise has to come function we have to exercise these are two studies I think that are really luster everything's to last to actually so this study here shows this we took people in the ICU we gave them a good protein diet okay with fish oil okay and then we exercised half of them every day in the unit even on a ventilator if they could walk we walked them it's very labor intensive physical therapists to nurses we walk people on a ventilator pushing the ventilator letting them walk you know we have adult ECMO with another story like being a bypass pump when your heart when your lungs are feeling okay adult ECMO we walk them on adult ECMO no longer laying in the bed sedated until they get off that stuff okay so we walked half of them and they're there I've got our standard of care and what the outcome parameter was the number who got to go home from the hospital not that had to go to a nursing home or skilled nursing facility or a long-term acute care stat place they went home 72 percent went home from their hospital stay with a key aggressive therapy 48 percent went to a subsequent acute care nursing care that's the proof that we say aggressive nutrition and goodness aggressive exercise and good nutrition and that's in 1430 look at this one 2018 now they actually got approval to biopsy the people's muscles with the tooth protocols this is what kind of exercise they did pass a crash site active cycling we have little bicycles we put in the bed ok little push things there they get in the bed if they don't want them work we turn it around and it makes them go after we strapping man ok so group this is a control group look at the size of those muscle fibers on biopsy within seven days in the ICU we lose 14 percent of the cross-sectional area so if we keep those muscles going if we give them substrate they do well and get out of the hospital sooner well let's go back to our patient this is CT that patient was me December 1st ok 2015 I had a major stroke fell down the stairs hit my head neurologist told me it'd be a year before you're walking again you know I hemiplegic completely out ok I was operating in six months now what happened well I did everything doctors had to do you know but believe me I called my friend John there and said John you know I've read the data by Charlie sir and I need some SPMS so the next day by FedEx I get a box as p.m. they weren't even out yet and we got I started taking them so I N equals one now that's N equals one but I think fish oils make a difference so I you know if I don't need fish every day we take fish shells every day I got all my family and my kids in it because I really believe this I'd say all my patients I have heart transplant patients come to my nutrition clinic because they've got chronic inflammatory conditions we switch their diet where I can get them on the anti-inflammatory diet we're just high in fish oils they cut their CRPS come down they start to get better they start to become anabolic so believe me it makes a difference getting people on the anti-inflammatory diets make a huge difference whole grains fish oils and a couple other things ok thank you very much [Applause]

Channel: WholisticMatters

Views: 5,902

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Keywords: science, nutrition, clinical nutrition, seminar, health

Id: adZyYfIWKbY

Length: 30min 19sec (1819 seconds)

Published: Thu May 23 2019