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Dr. Jeffrey Tucker Presents

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Title: Dr. Jeffrey Tucker Presents


1
Dr. Jeffrey TuckerPresents
  • The Program For Total Health

2
The gold standard is health span
  • Of American women ages 45 54
  • 33 suffer from hypertension
  • 32 have lower back pain
  • 20 have elevated blood pressure
  • 22 have knee pain
  • 21 have neck pain
  • 12 have shoulder pain
  • 11 have finger pain

3
The gold standard is health span
  • Of American men ages 45 54
  • 30 suffer from hypertension
  • 27 have lower back pain
  • 20 have elevated blood pressure
  • 19 have knee pain
  • 15 have neck pain
  • 13 have shoulder pain
  • 7 have finger pain

4
  • American diet about 72 of the calories in the
    average American's diet come from foods that were
    not consumed by our recent hunter-gatherer
    ancestors. Consider that 23 come from grains
    (20.4 from refined grains), 18.6 from refined
    sugars, 17.6 from refined omega-6 seed oils
    (corn, soybean, sunflower, cottonseed, safflower,
    peanut, etc.), 10.6 from dairy, and about 1.4
    from alcohol. 
  • Cordain L, Eaton SB, Sebastian A, et al. Origins
    and evolution of the Western diet health
    implications for the 21st century. Am J Clin
    Nutr, 200581(2)341-54.

5
  • The remaining 28 come from a marginal intake of
    fruits, vegetables, nuts and legumes, and a
    substantial intake of domestic, feedlot,
    grain-fed meat. We know wild game is about 2 to
    4 fat by weight, while modern feed-lot meat is
    20 to 24 fat by weight. Essentially, this means
    we are eating unhealthy, obese animals.
  • Seaman DR. The diet-induced pro-inflammatory
    state a couse of chronic pain and other
    degenerative diseases. J Manip Physiol Ther,
    200225168-79.

6
  • In short, our diet in America today consists of
    grains, sugars, omega-6 fatty acids, trans
    fats, and obese meat, and is substantially
    deficient in fruits and vegetables. The outcome
    of this pattern of eating is the typical
    inflamed, swollen-looking, overweight American,
    who is prone to osteoporosis, osteoarthritis,
    chronic pain, and other chronic diseases.

7
Dr. Tuckers Therapeutic Lifestyle Program
  • Diet
  • Exercise
  • Supplement
  • Rest

8
The Program Will Address
  • Making healthy food choices
  • Preventing chronic disease formation
  • Improving body composition
  • Reducing body fat storage
  • Increasing lean muscle mass
  • Reducing inflammation
  • Improving blood sugar management
  • Reducing hyperinsulinemia and hyperglycemia
  • Increasing exercise physical activity gentle
    movement therapy strength training

9
Charting Office VisitsSOAP Note Format
  • Subjective
  • Objective
  • Assessment/Diagnosis
  • Functional abnormalities
  • Plan (diet modifications, exercise program,
    supplementation recommendations, relaxation
    techniques)

10
Office Flow Algorithm
  • The doctor prescribes the program to the patient
  • Patient assessment (BIA, blood, FMS)
  • Patient consultation (ROF, establish goals,
    individualize the program)
  • Follow up visits
  • Retest
  • BIA Bioelectrical impedance analysis
  • FMS Functional Movement Screen
  • ROF report of findings

11
Retest
  • Program goals are achieved
  • Prescribe maintenance program
  • Send re-evaluation reminder card in 6-12 months
  • Program goals are not achieved
  • Return to step 3 previous slide

12
Timing of Return Visits Recommended Follow Up
  • Medical Doctor (weeks)
  • Forms/Assessment (blood, etc.)
  • Consultation/Refer to Tucker for Total Health
    program
  • Tucker
  • Tucker/Follow up visit MD
  • Tucker
  • Tucker
  • Tucker
  • Tucker/MD
  • Tucker
  • Tucker
  • Tucker
  • Re-evaluation MD
  • Tucker (weeks)
  • Forms/Assessment/BIA
  • Diet/meal plan/supplements
  • Functional Movement Screen
  • Education/exercise
  • Education/exercise/BIA
  • Education/exercise
  • Exercise
  • Exercsie
  • Retest FMS/BIA
  • Exercise
  • Retest FMS/BIA
  • Re-evaluate Tucker/MD
  • FMS Functional Movement Screen
  • BIA Bioimpedance Analysis

13
Charging for Programs
  • Determine what method of payment will work best
    for patients.
  • Determine cost of services.
  • Supplements are charged for separately.

14
Counseling For Patients With NO Medical Illness
or Symptoms
  • Insurance codes
  • 99401 15 Minutes
  • 99402 30 Minutes
  • 99403 45 Minutes
  • 99404 60 Minutes
  • Patients can call there own insurance company and
    ask them how much they will reimburse for these
    services.

15
Individual and Group Counseling WITH Medical
Illness or Symptoms
  • For counseling GROUPS of patients 99078
  • For counseling INDIVIDUALS
  • 99213 Consultation 15 min
    ____
  • 99214 25 min
    ____
  • 99215 40 min
    ____
  • 99244 60 min
    ____
  • 99245 90 min
    ____
  • 99354 Prolonged Care
    150

16
Bioimpedance Analysis (BIA)
  • A4556 BIA Electrodes (2 sets _at_ 15 each)
  • 30
  • Provides Body composition, fluid distribution,
    phase angle
  • This test can be performed as often as necessary
    to document changes in body fat and lean muscle
    mass.

17
BIA may be used
  • To assess
  • Body composition (estimate)
  • Fluid balance
  • Cellular performance (cellular health analysis)

18
Body composition - BCM
  • Loss of BCM (sarcopenia) is associated with a
    reduced quality of life, poor immune response,
    increased biological age, osteoporosis, and
    impaired healing.

19
Body Composition - BCM
  • It takes three times longer to accumulate BCM as
    to deplete it.
  • To increase BCM you must remove catabolic factors
    (stress, anxiety, sedentary behaviors, insulin
    resistance, etc.), increase protein calories, and
    introduce resistance training.

20
Trunkal Obesity/Central Adiposity
  • Waist Circumference
  • Waist to Hip Ratio

21
Vital Signs
  • BP
  • Pulse
  • Temp

22
Hypertension Staging
  • Pre-hypertension
  • Systolic BP 120-139 mm Hg diastolic BP 80-89
    mm Hg
  • Stage I
  • Systolic BP 140-159 mm HG diastolic BP 90-99
    mm Hg
  • Stage II
  • Systolic BP 160-179 mm HG diastolic BP 100-109
    mm Hg
  • Stage III
  • Systolic BP 180 mm HG diastolic BP 110 mm Hg

23
Hypertension
  • Stress Adrenal hyper/hypo function
  • i.e addison/cushings or other adrenal tumor.
    Test with urine cortisol or 24 hour urine test
    for vanillylmandelic acid and catecholamines
    (severe HTN)
  • Renal function (U/A)
  • Congestive heart failure/atherosclerosis
  • Hyperinsulinemia
  • Hypothyroid
  • Lymphatic congestion
  • Drug interaction/reaction
  • Especially contraceptive pills, steroids,
    decongestants, appetite suppressants
  • Lifestyle
  • Alcohol, obesity, smoking, high sodium, lead
    toxicity (soft water), caffeine

24
Lab Cardiovascular
  • Lipids, fractionated lipid profile
  • Hs-CRP
  • Fibrinogen
  • Homocysteine

25
Highly Sensitive C-reactive Protein
  • C-reactive protein is an important independent
    marker for inflammation.
  • High levels reflect over activity of inflammatory
    cytokines linked to coagulation and vascular
    endothelium damage.
  • Evidence suggests that previous infection with
    pathogens such as Chlamydia pneumoniae or
    Helicobactor pylori may act as an initiating
    trigger for this chronic inflammation.

26
C-Reactive Protein
  • Marker of inflammation, infection and cell injury
  • Aspirins reduction of MI risk appears to be
    related to CRP levels
  • CRP activates complement which injures the inner
    layer of blood vessels leading to constriction of
    vessels, arrhythmia
  • Strong predictor of the risk of future MI
  • Study of 2,037 healthy middle-aged men from the
    Quebec Cardiovascular Study
  • 105 first cardiac events during 5 years of
    follow-up lead to 1.8 fold increased risk of
    ischemic heart disease when CRP was at least 1.77
    mg/L

27
hs-CRP
  • Is helpful in assessing risk for unstable plaque,
    myocardial infarction, and diabetes.
  • Elevated levels of CRP and IL-6 predict the
    development of type 2 DM. these data support a
    possible role for inflamation in diabetogenesis.
  • JAMA, 2001, Vol 286 327-334

28
Diseases Associated With Defective Methylation
Capacity
  • Atheroscelosis, coronary artery disease, deep
    vein thrombosis, stroke
  • Neural tube defects, spontaneous abortion,
    placental abruption
  • Cervical dysplasia, cervical cancer
  • Colon cancer
  • Cognitive impairment, depression, senility,
    Alzheimers disease
  • Osteoporosis, RA, diabetes

29
MTHFRMethylenetetrahydrofolate reductase
  • MTHFR is involved in the conversion of
    homocysteine to methionine via the remethylation
    pathway
  • Polymorphism associated with increased levels of
    homocysteine and defective methylation

30
MTHFR Intervention
  • Folic acid/5-MTHFR
  • Vitamin B12/Methylcobalamin
  • Vitamin B6
  • Roboflavin precursor for FMN (flavin
    mononucleotide) (B6 to p-5-p), precursor for
    FADH2 (flavin dinuceotide), coenzyme for MTHFR
  • Betaine/TMG

31
Fibrinogen
  • Plays a key role in arterial occlusion by
    promoting thrombus formation, endothelial injury,
    and hyperviscosity.
  • Increased fibrinogen levels are seen with
    smoking, oral contraceptive use, obesity, stress,
    inflammation, insulin resistance, and aging.
  • Higher risk elevated fibrinogen with high total
    cholesterol or elevated LDL elevated fibrinogen
    with high CRP.

32
Lab Metabolic Syndrome/DMII
  • Glucose-fasting and two hour
  • Insulin-fasting and two hour
  • HgbA1C

33
Lab Altered Endocrinology
  • Adrenal Stress Profile salivary cortisol
  • Thyroid

34
Lab Objective Goals
  • Total cholesterol under 200
  • Triglyerides under 150
  • HDL over 50 (male) and over 60 (female)
  • LDL under 130 (under 100 if blood risks are
    present)
  • Trig/HDL ratio under 3.0
  • Adults 3 screen for IR
  • Children 2 screen for IR
  • Lipoproteins
  • A1 and B

35
American Cholesterol education program expert
panels current policy on fasting blood
triglyceride levels in adults
36
How to Make the Program Flow
  • Where I begin with a new patient
  • Initial consultation
  • Charting the Subjective Intake
  • Establishing the patients health goals to start
    their Lifestyle Change Program
  • Objective findings ordering or collecting data
  • Review of findings (first or second visit)
  • Developing their unique program
  • Follow up appointments

37
Complete the Health Profile Questionnaire (HPQ)
  • Anyone scoring over 50 points total or 10 or more
    in any one section would benefit from a
    detoxification program.
  • Even individuals scoring as low as 25-30 will
    experience greater energy, clarity, vitality and
    find that nagging symptoms of unknown origin
    often get better.
  • Go to www.DrJeffreyTucker.com to complete this
    form.

38
The Initial Health Consultation
  • Subjective interview
  • HCP Prescription
  • Health History
  • Health Profile Questionnaire (HPQ)
  • Diet/Exercise/Sleep/Stress Diary
  • Clients Health Goals
  • Assessing Readiness to Change

39
The Initial Health Consultation
  • Objective Data Collection
  • BIA and vitals
  • Review of Findings
  • Begin Education and Health Coaching

40
Lifestyle Change How?
  • It takes 45 days to change a habit or incorporate
    a new one.

41
Diet Diary/Exercise log
  • Are you filling yours out daily?
  • Keep track of
  • Everything you eat
  • Everything you drink
  • Your Activity/Exercise
  • People who self-monitor both eating and exercise
    behaviors, are more successful at reaching and
    maintaining their ideal weight.
  • The American College of Sports Medicine. (Med Sci
    Sports Exerc 2001 Dec33(12)2145-56)

42
Portion sizes eating frequency
  • Dont skip meals
  • Skipping meals leads to increased production of
    glucagon gluconeogenesis resulting in muscle
    loss
  • Eat frequently
  • 3 small meals and 2-3 snacks daily
  • To maintain stable blood sugar and insulin levels
  • Use high quality meal replacement to
  • Achieve frequency goals
  • Increase nutrient intake while
    decreasing calorie
  • intake
  • Do the body composition analysis to find out your
    body fat percent and lean muscle mass.

43
Identifying the clients that will benefit from
this program
  • Altered Body Composition
  • Sacropenic obesity
  • Weakness and Fatigue
  • Inflammatory Conditions
  • Abnormal Blood Sugar Regulation
  • Insulin Resistance/Hyperinsulinemia
  • Metabolic Syndrome
  • Type II Diabetes
  • Cardiovascular Risks
  • Hypertension
  • Hyperlipidemia

44
Inflammatory Related Chronic Disorders
  • Obesity (Adipocyte)
  • Sarcopenia (Muscular)
  • Atherosclerosis (Cardiovascular)
  • Type II Diabetes (Endocrine)
  • Osteo- and Rheumatoid Arthritis (Skeletal)
  • Inflammatory Bowel Disease (Gastrointestinal)

45
Lifestyle Modifications and Preventing Disease
  • 3,234 non-diabetic subjects with elevated fasting
    and post-load plasma glucose concentrations were
    randomized to placebo, Metformin (850 mg twice
    daily), or lifestyle-modification program.
    Program goals of at least a 7 percent weight loss
    and at least 150 minutes of physical activity per
    week. Initial average BMI 34.
  • At average follow up of 2.8 years, the lifestyle
    intervention reduced the incidence of progression
    to diabetes by 58 percent vs. the Metformin
    reduction of 31 percent (as compared with
    placebo).
  • Knowler, W.C. et al., Reduction in the incidence
    of Type 2 Diabetes with lifestyle intervention or
    Metformin. N Engl J Med. 2002. 346(6) p. 393-403

46
The goals of the diet are
  • Decrease insulin stimulation via dietary changes
    which decrease insulin release
  • Good (vs bad) carbohydrates
  • Fiber
  • Moderate protein
  • Good (vs bad) fat
  • Portion size meal frequency
  • Increase cellular responsiveness to insulin
  • Chromium Green tea
  • Lipoic acid Cinnamon
  • Magnesium

47
Definition of Glycemic Index
  • Glycemic Index (GI) is defined as the incremental
    area under the blood glucose curve in response to
    a standardized carbohydrate load. It is therefore
    an index of the blood glucose raising potential
    of the available carbohydrate in a food.

48
Obesity as an Inflammatory Disorder
  • Obesity reduces a lifespan by 8 to 20 years.
  • One of the most interesting discoveries of the
    past decade has been the recognition that the
    adipocytes produces inflammatory cytokines.
  • Obesity, therefore, may be viewed as a low grade
    systemic inflammatory disease.

49
What does the Adipocyte secrete?
  • Resistin is an adipose tissue-specific factor
    inducing insulin resistance linking DM to
    obesity.
  • Adiponectin is an anti-inflammatory, insulin
    sensitizing adipocytokine.
  • Adiposity is a form of chronic, low-grade
    inflammation.

50
Mid-line trunkal obesity (VAT deposition)
  • Cushingoid appearance increased deposition in
    the visceral adipose tissue enhanced by increased
    levels of
  • Insulin
  • Glucocorticoids (cortisol)
  • VAT contributes to
  • - Production of the release of TNFa, IL-1,
    IL-6
  • - Altered insulin sensitivity and glucose
    tolerance
  • -Thyroid hormone activity alterations

51
LIPOPSUCTION
  • The New England Journal of Medicine June 17, 2004
  • Liposuction (avg of 20 lbs) did not
    significantly alter the insulin sensitivity of
    muscle, liver, or adipose tissue did not
    significantly alter plasma concentrations of CRP,
    IL-6, TNFa, and adiponectin and did not
    significantly affect other risk factors for
    coronary heart disease.

52
General Features of Metabolic Syndrome
  • Abdominal obesity
  • Men waist gt 40 inches, or waist is larger than
    hips
  • Women waist gt 35 inches, or waist is greater
    than 80 the size of hips
  • Altered blood lipids (fats)
  • High triglycerides , trig/HDL ratio
  • Small LDL cholesterol particles
  • Low HDL cholesterol
  • Raised blood pressure
  • Insulin resistance ( glucose intolerance)
  • Pro-thrombotic state (blood clotting tendency)
  • Increased fibrinogen and PAI-1
  • Pro-inflammatory state
  • - Increased IL-6 and hs-CRP

53
Clinical Identification of the Metabolic Syndrome
  • Risk Factor
  • Abdominal obesity
  • Men
  • Women
  • Triglycerides
  • HDL cholesterol
  • Men
  • Women
  • Blood pressure
  • Fasting glucose
  • Adult Dx 277.7
  • Adult Dx 277.7
  • Defining Level
  • Waist Circumference
  • gt102 cm (gt40 in)
  • gt88 cm (gt35 in)
  • gt150 mg/dl
  • lt40 mg/dl
  • lt50 mg/dl
  • gt130/gt85 mmHg
  • gt100
  • NCEP ATP III

54
Metabolic Syndrome Patients
  • Increased blood fat
  • Increased body fat
  • Increased muscle fat
  • Increased liver fat
  • Increased pancreatic fat

55
Do you know someone at risk?
  • Approximately 90 million Americans have insulin
    resistance.
  • 18.2 million Americans have diabetes.
  • Over 5 million undiagnosed diabetes.
  • Average time from onset to diagnosis is 4 to 7
    years due to insidious nature in early stages.
  • National Institutes of Health and Centers for
    Disease Control and Prevention

56
Insulin Resistance SyndromeMetabolic Syndrome
  • Overweight or a waist circum.gt40 inches for men,
    gt35 inches for women.
  • Elevated BP, blood glucose, blood lipids
    (triglycerides).
  • Sedentary lifestyle.
  • Family history of type 2 diabetes, hypertension
    or cardiovascular disease.
  • A history of glucose intolerance or gestation
    diabetes.
  • Polycystic ovary syndrome.
  • Sleep apnea.

57
Almost half of severely obese children have
metabolic syndrome
  • The overall prevalence of the metabolic syndrome
    was
  • 49.7 percent in severely obese subjects
  • N Engl J Med 20043502362-74

58
Conditions related to insulin resistance (program
candidates)
  • Cardiovascular disease
  • Type 2 diabetes
  • Hypertension
  • Hyperlipidemia
  • Polycystic Ovary Syndrome
  • Overweight/Obesity
  • Cancer (colon, breast, prostate)
  • Sarcopenia
  • Accelerated aging
  • Sleep apnea
  • Alzheimers disease

59
Inflammatory Cytokines, Hyper-insulinemia, and
Atherosclerosis
  • A number of studies have domonstarted that
    increases in inflammatory mediators like IL-6 and
    hs-CRP are associated with insulin resistance and
    metabolic syndrome.
  • Metabolic syndrome is strongly associated with
    the onset of endothelial dysfunction, which may
    explain why type-2 diabetes is a risk factor for
    atherosclerosis.

60
American College of Cardiology53rd Scientific
Sessions - March 9, 2004
  • National clinical guidelines recommend
    therapeutic lifestyle changes (TLC) as a standard
    of care in the management of CVD risk factors.
  • The value of TLC in actual practice is often
    discounted by clinicians and health insurers who
    instead frequently turn to widely available
    pharmacotherapeutic agents.
  • Emory University Health Sciences Center

61
American College of Cardiology53rd Scientific
Sessions - March 9, 2004
  • Many patients with classic cardiovascular
    disease risk factors can achieve risk reduction
    goals without medications within only three
    months of initiating therapeutic lifestyle
    changes (TLC).
  • Emory University Health Sciences Center

62
Weight loss does not always lead to better health
  • Weight and BMI do not evaluate body compartments
    and therefore do not reveal if weight changes
    result in loss of fat-free mass or gain in fat
    mass.
  • J Amer Diet Assoc 2002102(7)944-955
  • BIA is a reliable resource for assessing body
    composition and tissue differentiation.

63
Why body composition and BMI are associated with
increased risks
  • Muscle mass is the 1 Bio-Marker of aging
  • Hence, the higher the muscle mass the greater the
    longevity
  • Important for preventing
  • Sarcopenia
  • Obesity
  • Heart disease
  • Type II diabetes
  • Osteoporosis

64
Body Mass Index
  • Commonly used index of body composition
  • Not useful for measuring percentage of body fat
    or lean body mass
  • Patients with normal BMI may have sarcopenia or
    sarcopenic obesity

65
One in every six of your patients children are
now obese
  • The American Obesity Association uses a reference
    point of -85th percentile of BMI as overweight
  • -95th percentile for obesity
  • The American Obesity Association estimates that
    over 30 of Americas children can be classified
    as overweight
  • US Department of Health and Human Services

66
Developmental Origins of Health and Disease
  • As compared with members of the cohort in whom
    heart disease outcomes did not develop, those who
    were hospitalized for or died from coronary heart
    had relatively small body size during the first
    two years of life, then grew more rapidly through
    11 years of age.
  • Developmental Origins of Health and Disease, N
    Engl J Med2005353(17)1848

67
Trajectories of Growth Among Children Who Have
Coronary Events as Adults
  • On average, adults who had a coronary event had
    been small at birth and thin at two years of age
    and thereafter put on weight rapidly. This
    pattern of growth during childhood was associated
    with insulin resistance in later life. The risk
    of coronary events was more strongly related to
    the tempo of childhood gain in BMI than to the
    BMI attained at any particular age.
  • New England Journal of Medicine

68
Clinical Importance of Obesity Versus the
Metabolic Syndrome in Cardiovascular Risk in
WomenA Report From the Womens Ischemia Syndrome
Evaluation
  • The metabolic syndrome but not BMI predicts
    future cardiovascular risks in women.
  • The prevalence exceeds 20 on individuals gt 20
    years of age and 40 of the population gt 40 years
    of age.

69
Waist Circumference Predicts Metabolic Risk
  • Men with a waist circumference greater than 40
    and woman with a waist circumference greater than
    35 are at increased risk for metabolic diseases.
  • Klein S. The case of visceral fat argument for
    the defense. J Clin. Invest. 2004 113 (11)
    1530-1532.

70
Obesity Cancer
  • 14 of obese patients will go on to have cancer.
  • In 2020 1 in 26 people will get cancer.
  • 5lbs of body fat looks like a loaf of bread.

71
Essential Fatty Acids (EFAs)
  • are called essential because we MUST ingest
    them.
  • Basically two types
  • Omega-3s found in cold water fish, nuts, canola
    oil and flaxseed.
  • Omega-6s found in meat, cheese, nuts, seeds,
    grains, leafy vegetables, corn, safflower
    soybean oil.

72
Clinical importance of EFAs
  • Structural all animals cell membranes.
  • -membrane stability.
  • -membrane fluidity.
  • -membrane-bound enzyme activities.
  • -receptor action.
  • -Permeability.
  • -ion-channel modulation.
  • Eicosanoid formation.
  • Cholesterol transport and oxidation.
  • Regulation of gene expression FAs talk to our
    genes.

73
Classification of Fatty Acids
  • Saturated (SFA)
  • Monounsaturated (MUFA)
  • Polyunsaturated (PUFA)
  • Highly unsaturated fatty acids (HUFAs)
  • Trans fatty acids (TFAs)

74
Classification of Fatty Acids
  • Essential
  • -Linoleic acid (LA omega 6)
  • -Alpha-linoleic acid (ALA omega 3)
  • Non-essential
  • -SFA, MUFAs, TFAs, few PUFAs.

75
What do EFAs do?
  • Modulate the inflammatory responses.
  • Dilate or constrict blood vessels, stomach,
    intestines, bronchial tree, uterus.
  • Components of cell membranes
  • -involved in cell-to-cell communication
  • -keep cell walls rigid or fluid
  • -control the flow of nutrients in out of cells
  • Required for the production of RBCs

76
Suggested therapeutic effects of EFAs
  • Modulate autoimmune conditions.
  • Improve insulin resistance.
  • Improve lipids.
  • Reduce CAD.
  • Reduce arrhythmia.
  • CNS depression, vision, possibly ADHD.
  • Cancer-prevention, metastases control, and
    adjunct to RX.

77
Signs of EFA deficiency
  • All patients on the Standard American Diet
  • Dermatitis dry, scaly skin, follicullar
    hyperkeratosis
  • Dry hair, dandruff
  • Brittle nails
  • Decreased memory and mental abilities
  • Psychological disturbances
  • Impaired or increased immune responses
  • Neuropathy
  • Reduced visual acuity
  • Increased cholesterol/HDL ratio

78
Likely markers of EPA deficiency
  • CVD
  • Arthritis
  • Syndrome X and Insulin resistance
  • Inflammatory bowel disease
  • Irritable Bowel Disease
  • Diabetes
  • Cancer
  • Skin diseases
  • Autoimmune disease

79
In general omega 6s
  • Are derived from linoleic acid and produce
    inflammatory prostaglandins that are associated
    with heart disease, cancer and other inflammation
    associated diseases.
  • -Enhance growth of precancerous cells
  • -Initiate tumor growth
  • -Increases rates of tumor growth
  • -Promotes metastasis via PGE2 promotion
  • -PGE1 from DGLA is protective

80
In general omega-3s
  • Are derived from alpha-linolenic acid and are
    associated with anti-inflammatory properties.
  • -Smooth muscle relaxation (lower BP).
  • -Relaxation of intestines (enhances nutrient
    absorption).
  • -Enhanced ability for hormones to communicate
    with target cells, decreasing the need for total
    hormone.
  • -Enhanced cell-to-cell communication (decreases
    rate o cell growth).

81
Dietary sources of EFAs
  • FoodOmega-3 (grams per 100g)
  • Flax 20.3
  • Hemp seeds 7.0
  • Pumpkin seeds 3.2
  • Salmon 3.2
  • Walnuts 3.0
  • Rape seed 2.1
  • Herring 2.0
  • Soybeans 1.2
  • Butter 1.2
  • Olive oil 0.6
  • Wheat germ 0.5
  • Sunflower seeds 0
  • Almond 0
  • Olives 0
  • Omega-6 (grams per 100g)
  • 4.9
  • 21.0
  • 23.4
  • 0.7
  • 30.6
  • 9.0
  • 0.4
  • 8.6
  • 1.8
  • 7.9
  • 5.5
  • 30.7
  • 9.2
  • 1.6

82
Other References
  • Metabolism 199847106-112
  • Br J Nutr 200083S59-S66
  • Annu Rev Nutr 19991963-90
  • J Biol Chem 200027530749-30752
  • J Nutr 1998128923-926
  • Am J Clin Nutr 199970566-571
  • Biochimie 19987995-99
  • Int J Obes 199721637-643
  • J Nutr 19971272142-2150
  • Am J Clin Nutr 199969890-897
  • Am J Clin Nutr 199970817-825
  • J Nutr 1990120544-552
  • J Biol Chem 19982785678-5684
  • J Biol Chem 199927423577-23583
  • J Biol Chem 1999274471-477
  • J Biol Chem 199927437335-37339
  • J Biol Chem 200027532379-32282
  • Natl Acad Sci USA 1999961041-1048
  • Scand J Med Sci Sports, 7(1) 25-31, 1997

83
Omega-3 Healthy Cardiovascular Function
  • Omega 3 EFAs from fish support short- term as
    well as long-term cardiovascular health.
  • Our findings contradict the current belief in
    the medical community that increasing the intake
    of omega-3 fatty acids produces only long term
    cardiac benefits.
  • Dr. Fernando Holguin
  • Chest 127/4/April 2005

84
Omega-3s reduce the risk of heart attacks by up
to 90
  • Siscovich et al. JAMA. 19952741363-1367

85
Omega-3 and healthy body composition
  • Fish oil concentrates not only caused weight
    reduction in the mice but also appeared to stop
    the animals from gaining weight when given free
    access to food.
  • Additionally, omega-3 concentrate reduced the
    number of fat cells, especially in the abdominal
    region.
  • Researchers showed that concentrated fish oil
    increased oxidation of fat by activating genes
    that break down fat in the mitochondria and
    peroxisomes.
  • Lipids, Vol. 39, no 12 (2004)

86
EFA imbalances predispose to chronic inflammatory
conditions
  • The inflammatory based chronic diseases that are
    increasing in incidence in menopausal age women
    and are statistically most likely to kill them
  • Arthritis
  • IBD
  • Auto-immune diseases
  • Asthma
  • Atherosclerosis
  • Cardiovascular disease
  • Cancer

87
DHA Supports Mitochondrial Function Energy
Production
  • Mitochondria, have a substantial concentration of
    DHA-containing phospholipids, suggesting that
    these are essential for the functional assembly
    of the respiratory chain complexes.
  • Infante JP, Hiszagh VA, secondary carnitine
    deficiency and impaired docosahexaenoic acid
    synthesis a common demoninator in the
    pathophysiology of diseases of oxidative
    phosphorylation and beta-oxidation. FEBS Lett.
    2000 Feb 18468(1)1-5

88
Omega-3s reduce silent inflammation A primary
cause of chronic disease
  • Problem
  • 75 of Americans may have silent inflammation
  • Underlying cause of conditions such as
    Alzheimers and cardiovascular diseases
  • Solution
  • Increase EPA-DHA consumption (AA/EPA 1.5 to 3)
  • -Displace inflammatory compounds such as PGE2
  • -Increase formation of anti-inflammatory
    compounds such as PGE1
  • Reduce body fat insulin increases stored AA
    which is pro-inflammatory

89
Omega-3 and healthy brain function
  • People who eat oily fish or take fish oil
    supplements score 13 percent higher in IQ tests
    and are prone to healthier brain aging.
  • The results suggest that fish oil users have
    younger brains than non-users. The aging of the
    brain is being slowed down by a year or two.
  • Dr. Lawrence Whalley (AM J Clinic Nutrition,
    2004)
  • American J Clin Nut Vol, 80, no 6, pp 1650-1657

90
Omega-3 fatty acids and neuropsychiatry
  • Epidemiological evidence suggests that
    dietary consumption of the long chain omega-3
    fatty acids EPA and DHA, commonly found in fish
    or fish oil, may modify the risk for certain
    neuropsychiatric disorders. As evidence,
    decreased blood levels of omega-3 fatty acids
    have been associated with several
    neuropsychiatric conditions, including Attention
    Deficit (Hyperactivity) Disorder, Alzheimers
    Disease, Schizophrenia and Depression
  • Young, G et al Reprod Nutr Dev. 2005
    Jan-Feb445(1)1-28

91
Adult Attention and Focus may be aggravated by
stress
  • Effect of randomized supplementation with
    high dose olive, flax or fish oil on serum
    phospholipid fatty acid levels in adults with
    attention deficit hyperactivity disorder. Young,
    GS et al Reprod Nutr Dev. 2005 Sep-Oct45(5)549-5
    8
  • These data suggest that in order to increase
    levels of EPA and DHA in adults with ADHD, and
    decrease the AA/EPA ratio to levels seen in high
    fish consuming populations, high dose fish oil
    may be preferable to high dose flax oil. Future
    study is warranted to determine whether
    correction of low levels of long-chain omega-3
    fatty acids is of therapeutic benefit in this
    population.

92
DHA and Psychological Stress
  • DHA deficiency has been shown to-reduce
    catecholamine production
  • -lower serotonin binding affinity
  • -reduce the number of synaptic vessels
  • Administration of DHA influences behavior and
    plasma catecholamine levels at times of
    psychological stress.
  • Hamazaki T et al Lipids. 199934 SuppllS33-7
  • Anti-stress effects of DHA
  • Hamazaki T et al Biofactors. 200013(1-4)41-5.

93
Anti-Stress Effects of DHA
  • In a similar double blind two month study (study
    2), we measured plasma catecholamines and
    cortisol of students (3 females and 4 males for
    the DHA group and the same numbers for the
    control) at the start and end of the study. In
    study 2 the students were under a continuous
    stress of final exams that lasted for two months
    throughout the whole study period.
  • The plasma cortisol did not change in either
    group, but the norepinephrine concentration was
    significantly decreased in the DHA group (-31),
    whereas it stayed at the same level in the
    control group. These effects of DHA intake may be
    applied to people under psychological stress.
  • Hamazaki T et al. Biofactors 2000 13(1-4) 41-45.

94
What about depression?
  • Severity of depression correlates directly with
    the AAEPA ratio.
  • DHA deficiency has been shown to
  • -reduce catecholamine production
  • -lower serotonin binding affinity
  • -reduce the number of synaptic vessels
  • DHA supplementation dramatically increases the
    number of synaptic vessels in nerves.

95
OB/GYNs are recommending EPA/DHA
  • Promotes brain and eye development
  • Encourages fetal weight gain
  • Prevents perterm labor and preeclampsia
  • Increases the nutritional value of breast milk
  • Stabilizes mood and prevent depression during and
    after delivery baby blues

96
DHA Reduces Post-natal Depression and May Promote
Restful Sleep
  • Without sufficient dietary intake, mothers become
    depleted of DHA and may increase their risk of
    suffering major depressive symptoms in the
    postpartum period.
  • How much? 500 mg/day pre-conception, 1st 2nd
    Trimester
  • -1000 mg/day 4rd 4th Trimester
  • American journal of clinical nutrition
    200276(3)608-13

97
EPA-DHA Reduces Pediatric Asthma
  • Maternal oily-fish intake during pregnancy was
    associated with reduced asthma risk among
    children whose mothers had a history of asthma.
  • Among children of asthmatic mothers, maternal
    intake of oily-fish during pregnancy reduced
    asthma risk by 71.
  • M.T. Salam et al, Prevention Medicine USC 5/25/04

98
Change your oil, improve your health!
  • Goal to achieve minimum 8-10 cellular EPA/DHA
    level
  • Achieve by supplementing 1 gram EPA-DHA per day

99
EPA-DHA Dosing
  • Application
  • Adult Maintenance
  • Cardiovascular Health
  • Healthy Blood Fat Levels
  • Inflammation
  • Mental Function
  • Prenatal Health
  • Children
  • Adults under chronic stress
  • Blood sugar balance
  • Daily Levels
  • 1-2 grams EPA-DHA
  • 1-2 grams EPA-DHA
  • 2-4 grams EPA-DHA
  • 2-7 grams EPA-DHA
  • 2-10 grams EPA-DHA
  • 1-2 grams EPA-DHA
  • 100 mg 400 mg DHA
  • 1000 mg 2000 mg DHA
  • Individual diet plan

100
Functional Medicine
  • Functional medicine focuses on the early warning
    recognition and intervention to improve physical,
    mental and physiological function prior to the
    onset of acute disease. Gazela, KA Jeffrey S.
    Bland, PhD, FACN, CNS Functional Medicine
    Pioneer, Alternative Therapies in Health and
    Medicine, Sept/Oct 2004, VOL. 10, NO. 5.
  • Medical foods are designed to restore function
    during early phases of declining health as well
    as manage a variety of chronic conditions and
    disorders by addressing underlying causes.

101
What is a Medical Food?
  • A specific combination of whole food
    macronutrient derivatives, micronutrients and
    botanical extracts designed with a specific
    therapeutic goal in mind.

102
WHY SOY?
  • Healthy body composition
  • Insulin resistance
  • Favors Good estrogen
  • Body recognizes as safe, weak estrogen
  • Cardiovascular health
  • Bone health
  • Antioxidant protection
  • Cognitive function
  • Hot flashes, sweats, dryness, mood, etc.

103
I support the use of soy
  • Do to the large amount of reported safety and
    efficacy studies.
  • Its long history of safe consumption by Asian
    populations.
  • The FDA health claim regarding soy protein and
    its potential to reduce the risk of heart
    disease.
  • Substantial data regarding the benefits of soy in
    cardiovascular health, prostate health,
    menopausal symptom relief, and bone health as
    well as other important areas.

104
Understanding Soy
  • Soy has been consumes by Asian culture for
    thousands of years.
  • Soy is a legume that is so nutritionally complete
    that it sustained Eastern populations through
    drought and famine.
  • Composed of
  • Protein - Carbohydrates
  • Fat - Fiber
  • Phytonutrients - Isoflavones
  • Other isoflavone rich foods include garbonzo
    beans and sprouts (Red Clover).

105
The Forms of Soy
  • Soy has been used and studied in various forms
  • -Whole soybeans - raw and cooked
  • -Protein isolates - with balanced and unbalanced
    isoflavone content
  • -Balanced isoflavone isolates
  • -Single isoflavone isolates
  • The more imbalanced the isoflavones the greater
    the chance for negative affects.

106
Phytosterols and Human Lipid Metabolism
  • Plant sterols have been known for several
    decades to reduce plasma cholesterol levels.
    These plant materials have been granted a health
    claim by the FDA regarding their effects in the
    general prevention of cardiovascular disease.
  • Marie-Pierre

107
Soy Plant Sterol Research
  • At a dosage of 1.8 g/day, LDL Cholesterol
    concentrations were 11.3 lower in the plant
    sterol group, and cholesterol absorption
    efficiency was 56 lower in the plant sterol
    group.
  • Am J Clin Nutr 2002761272-78

108
Soy
  • Moreover, it has been estimatedthat
    introducing 2 g of plant sterols daily might
    reduce the risk of coronary heart disease by
    25...low dose of soy protein (8g) added in
    beta-sitosterol (2g) seems to be a practical and
    safe alternative for patients seeking reductions
    in LDL cholesterol (lt15).

109
Effects of a Dietary Portfolio of Cholesterol
Lowering Foods vs Lovastatin on Serum Lipids and
C-Reactive Protein
  • In this study, diversifying cholesterol-lowering
    components in the dietary portfolio by use of a
    soy protein-based, plant sterol fortified diet
    was as effective in lowering LDL cholesterol as
    was the use of lovastatinreductions in hsCRP
    were significant with this dietary regime.
  • JAMA 2003290502-10.

110
Is soy beneficial for breast health?
  • Research is far from conclusive on this issue and
    researchers are urging women to be cautious
  • However, a distinction should be made between the
    clear benefit of soy protein for cardiovascular
    health and the inconclusive role of isoflavones
    for breast tissue health.

111
Does soy benefit menopausal women?
  • YES. The research shows a great correlation with
    reducing hot flashes and other menopausal issues
    by consuming soy products.
  • Consumption of soy protein containing isoflavones
    decreased the intensity of hot flashes.
  • The majority of studies in menopausal women have
    shown improvement of hot flashes following soy
    consumption.

112
Do soy products compromise male reproduction?
  • NO. Studies done with balanced soy isoflavones do
    not show negative impact on male reproduction.
  • Negative studies are done with one isoflavone or
    by injecting isoflavones directly into the blood
    create much of the negative concern on soy.
  • Genistein was shown in cell cultures to
    negatively impact human sperms ability to
    fertilize the female egg.
  • Only when plant estrogens are injected, leading
    to high blood levels are adverse effects seen in
    research animals.

113
Do soy products compromise male reproduction?
  • Four published clinical trials investigating the
    effects of soy isoflavone consumption in men and
    reported that there are no adverse effects of soy
    isoflavone consumption on sperm quality.
  • Consumption of isoflavone supplements at the
    level of 40mg daily had no effect on semen
    quality.
  • There is no evidence of increased rates of
    fertility disorders among the Asian population
    due to soy consumption.
  • Medical foods with soy deliver 17mg of balanced
    isoflavones per serving.

114
Should soy be used for prostate health?
  • YES. Research shows overwhelming evidence of the
    positive benefits in supporting prostate health
    without adverse effects.
  • Nagata C, Takatsuka N, Shimizu H, Hayashi H,
    Akamatsu T, Murase K. Effect of soymilk
    consumption on serum estrogen and androgen
    concentrations in Japanese men. Cancer Epidemiol
    Biomarkers Prev 200110(3)179-84.
  • Habito RC, Montaito J, Leslie E, Ball MJ, Effects
    of replacing meat with soyabean in the diet on
    sex hormone concentrations in healthy adult
    males. Br J Nutr 200084(4)557-63.
  • Mitchell JH, Cawood E, Kinniburgh D, Provan A,
    Collins AR, Irvine DS. Effects of a phytoestrogen
    food supplement on reproductive health in normal
    males. Clin Sci 2001100(6)613-18.
  • Hussain M et al. soy isoflavones in the treatment
    of prostate cancer Nutr Cancer 200347(2)111-7.

115
Does soy inhibit thyroid function?
  • Well designed human clinical studies have
    demonstrated that soy has a minimal effect on
    overall thyroid function in healthy individuals.
  • Ultrameal Medical Food Program Containing soy
    protein (15 grams) with a comprehensive
    vitamin/mineral blend
  • Patients using the Ultrameal product had no
    change in their TSH levels after 10 weeks.
    Patients using the popular retail product showed
    a significant elevation (150 above baseline) in
    their TSH levels.

116
Does soy inhibit thyroid function?
  • Amounts greater than 200mg of isoflavones per day
    may inhibit thyroid hormone synthesis in
    susceptible people. (thyroid issues/low iodine)
  • Certain studies suggest that soy and soy
    isoflavones inhibit the production of thyroid
    hormones in individuals with thyroid issues.
  • Approximately 10 million Americans or 3 of the
    population have thyroid issues.
  • Alternatives to soy based medical foods are
    available for these individuals (rice and whey,
    etc.)

117
Is soy beneficial for bone health?
  • YES. Studies have shown that the isoflavones that
    are found in soy stimulate bone formation and
    reduce bone breakdown.
  • Soy isoflavones have been found to have a
    positive effect on bone health.
  • Isoflavones stimulate osteoblastic bone formation
    and inhibit osteoclastic bone breakdown.

118
Metagenics options to benefit every type of person
  • Thyroid issues soy allergy clients
  • UltraMeal WHEY
  • UltraMeal RICE
  • UltraClear
  • UltraClear Plus
  • UltraInflamX
  • Breast tissue health options
  • Estrium
  • UltraMeal WHEY
  • UltraMeal RICE
  • UltraClear
  • UltraClear Plus
  • UltraInflamX

119
Is soy beneficial for tissue health?
  • YES. Soy contains various beneficial agents for
    tissue health.
  • Cultures that eat soy have shown an improvement
    in colon and specific hormone-related tissue
    health issues.
  • Human trials involving post-menopausal women
    demonstrate a significant shift in healthy
    estrogen metabolism.

120
Isnt it better to use a more complete protein?
  • Early studies suggested that soy was not a
    complete protein source. These early findings
    have been shown to be inaccurate.
  • Soy has the same protein digestibility score as
    egg white and milk protein.
  • Sarwar G, McDonough FE, Evaluation of protein
    digestibility-corrected a??no??acid score method
    for assessing protein quality of foods. J Assoc
    Off Anal Chem 199073(3)347-56.

121
Isnt soy more allergenic than other proteins?
  • Soy proteins tend to be less reactive than many
    other food proteins. In fact, soy has been used
    as an alternative for infants with allergies to
    cows milk.
  • A meta-analysis of 17 studies of allergy patterns
    in high risk infants revealed soy allergy occurs
    in 3 to 4 of subjects versus 25 for cows milk.

122
Do I have to use fermented soy products to
achieve therapeutic benefits?
  • No. The majority of studies around the world show
    beneficial effects of soy.
  • Our research studies support those findings for
    areas including
  • Blood sugar
  • Body composition
  • Preserving muscle mass during weight loss
  • Cardiovascular risk reduction

123
Improve health with
  • UltraMeal
  • -Altered Body Composition
  • -Early Onset Metabolic Syndrome with Altered Body
    Composition
  • Central body obesity
  • Insulin resistance
  • Altered body composition
  • UltraMeal Plus
  • -Metabolic Syndrome with Cardiovascular Syndrome
  • Elevated Cholesterol
  • Increased Triglycerides
  • Hypertension

124
UltraMeal Plus
  • Combined with a low-glycemic-index dietary
    program and exercise regimen, provides
    nutritional support for the management of
    conditions associated with cardiovascular
    disease, including
  • Hypercholesterolemia
  • Hypertriglyeridemia
  • Metabolic Syndrome
  • Altered Body Composition

125
UltraMeal
  • Combined with a low-glycemic-index dietary
    program and exercise regimen, provides
    nutritional support for the management of
    conditions associated with altered body
    composition, including
  • Dyslipidemia
  • Metabolic Syndrome
  • Hypertension
  • Estrogen imbalance

126
UltraMeal Plus 360
  • Multi-mechanistic nutritional support for
    metabolic syndrome and CVD, with the added
    benefit of Selective Kinase Response Modulators
    (SKRMs).
  • Clinically tested results The UltraMeal Plus 360
    Medical Food Program was recently shown to
    improve important CVD risk factors in patients
    with metabolic syndrome. In this clinical study,
    patients assigned to treatment with UltraMeal
    Plus 360 Medical Food Program, exercise regimen,
    and low-gylcemic-load (GL) diet vs. the same
    low-GL diet and exercise regimen alone showed
  • Statistically greater reductions in lipid
    parameters
  • Statisitcally greater reduction in serum
    homocysteine
  • Significant increase in HDL (good) cholesterol
  • Persistent lowering effects on apoB and
    apoB/apoA1 ratio
  • ApoB may be a better indicator of CVD risk than
    total cholesterol or LDL
  • ApoB/apoA1 ratio is a newly recognized,
    increasingly significant indicator of CVD risk

127
Dynamic Combination for Overall Cardiovascular
Health
  • Patient Profile
  • Patients on statin therapy
  • Patients 35-64 under preventative care for CVD
  • Increased triglyerides
  • High C-reactive protein
  • High cholesterol
  • Increased LDL
  • Low HDL
  • UltraMeal Plus
  • 2 scoops BID along with a low glycemic diet
  • EPA/DHA
  • Recommended 1 to 3 grams daily
  • CoQ10
  • Recommended 100 300 mg daily

128
Children Young Adults(soy and whey combination)
  • Ultracare FIRST START Medical Food Program

129
UltraGlycemX Medical Food
  • Nutritional support for individuals with Type 2
    Diabetes and Hypoglycemia

130
UltraGlycemX
  • Combined with a low-glycemic-index dietary
    program and exercise regimen, provides
    nutritional support for the management of
    conditions associated with insulin insensitivity
    and elevated blood sugar levels, including
  • Type 2 diabetes
  • Insulin resistance
  • Hypoglycemia
  • Hypertension

131
Blood sugar
  • Blood sugar refers to levels of glucose in the
    blood.
  • Blood sugar concentration, or serum glucose
    level, is tightly regulated in the human body.
  • Glucose transported via the bloodstream is the
    primary source of energy for the bodys cells.

132
Fasting 2 hr postprandial glucose following a
75 gram glucose load
  • Fasting
  • 80-90 optimal
  • 105 and above DMII
  • 2 hour postprandial
  • 80-120 optimal
  • Below 80 hypoglycemia
  • 120 and above DMII

133
Glucose levels
  • 35 extremely low, danger of unconsciousness
  • 75 slightly low, first symptoms of lethargy
    etc.
  • 80-90 optimal pre-prandial in non-diabetics
  • 80-120 ooptimal 2 hour post-prandial in
    non-diabetics
  • Above 100 look for Metabolic Syndrome criteria
  • 400 max mg/dl for some meters strips
  • 600 high danger of severe electrolyte imbalance

134
Blood sugar important points
  • high fructose corn syrup, which is simply a
    Pure fructose (what we use) is NOT the same as
    replacement for table sugar. Fructose is
    natural and is the typical carbohydrate found
    in fruits and sone vegetables.
  • The fructose in UltraMeal and UltraGlycemX is
    nutritive (ie, food) and is NOT used as a
    sweetener. It is there for its therapeutic
    benefit.
  • Moderate consumption of fructose is associated
    with POSITIVE blood sugar, triglyceride, and body
    composition benefits.

135
Blood sugar important points cont
  • Data from animal studies use fructose levels far
    higher than a human would consume in a day the
    equivalent of up to 700 calories in a day from
    fructose alone.
  • We have the clinical proof in numerous studies
    that moderate fructose consumption shows health
    benefits.
  • The obvious problem is poor diet one FULL of
    empty calories from processed foods and beverages
    and NOT from a quality, balanced, meal such as
    UltraMeal or UltraGlycemX.

136
Definition of Glycemic Index
  • Glycemic index (GI) is defined as the incremental
    area under the blood glucose curve in response to
    a standardized carbohydrate load. It is therefore
    an index of the blood glucose raising potential
    of the available carbohydrate in a food.

137
Many factors affect GI of a food
  • Carbohydrate type
  • -Simple glucose, fructose, maltose
  • -Complex amylose, amylopectin
  • Fiber content and type
  • Processing (the higher the processing, the higher
    the GI load)
  • Physical nature
  • Other macronutrients in food
  • -Protein
  • -Fat

138
Glycemic Index
  • The GI for a particular food is derived by
    expressing the individual glycemic index as a
    percent of a reference food, typically white
    bread or glucose.

139
Glycemic Index and Obesity
  • Low GI foods control appetite and delay hunger.
  • Low GI diets reduce insulin levels and insulin
    resistance.
  • High-carb, low-fat diets increase postprandial
    hyperglycemia and hyperinsulinemia.
  • Several human studies found that energy
    restricted low-GI diets produced greater weight
    loss than did equivalent diets based on high GI
    foods.
  • Brand-Miller JC et al. Glycemic index and
    obesity. AM J Clin Nutr, 2002. 76(1) p. 281S-5S.

140
Glycemic Index and HDL-Cholesterol
  • Conclusion dietary GI is a stronger predictor
    than dietary fat intake of serum HDL-cholesterol
    concentration.
  • Frost G et al. Glycaemic index as a determinant
    of serum HDL-cholesterol concentration. Lancet,
    1999. 353(9158) p. 1045-8.

141
A meta-analysis of Low-GI Diets in the Management
of Diabetes
  • 14 studies that met inclusion criteria
  • Conclusions
  • -Low GI diets have a clinically useful effect on
    medium-term glycemic control in patients with
    diabetes.
  • -The benefit is similar to that offered by
    pharmacological agents that also target
    postprandial hyperglycemia.
  • Without drugs they get similar results on low
    GI diet
  • Brand-Miller et al. Low-Glycemic Index
    Diets in the Management of Diabetes A
    meta-analysis of randomized controlled trials.
    Diabetes Care, 2003 26(8) 2261-2267

142
Glycemic Index
143
Glycemic Index of Selected Foods(referenced to
glucose)
  • Watermelon 72
  • Pearled barley 25
  • White flour bread 70
  • Carrot 47
  • Cornflakes 72
  • Baked potato 85
  • Apple 38
  • Apple juice 40

144
Glycemic Load
  • The amount of carbohydrate often differs in a
    typical serving of a food.
  • A measure termed glycemic load (GL) has been
    introduced.
  • (Salmeron J, Ascherio A, et al. Dietary fiber,
    glycemic load, and risk of NIDDM in men. Diabetes
    Care, 1997. 20(4) 545-50.
  • The dietart glycemic load is defined as the
    product of a foods glycemic index and its
    carbohydrate content.

145
GL(GI divided by 100) x available carb
  • Example Watermelon (GL4)
  • Glycemic index 72. A typical serving (120 grams
    or ¾ cup) has 6 grams of available carbohydrate.
  • Glycemic load (72 / 100) x 6 4.32 (rounded to
    4).

146
Glycemic Load
147
GL(GI/100) x available carb(available
carbohydrate content of typical serving)
  • Example Carrot (GL 3)
  • - Glycemic index 47. A typical serving (80
    grams or ½ cup cooked) has 6 grams of available
    carbohydrate.
  • - Glycemic load (47/100) x 6 2.82 (rounded to
    3)

148
GI/GL Comparisons
149
GI GL values of hundreds of foods have been
determined
  • On the web
  • www.glycemicindex.com
  • www.mendosa.com

150
Effects of a Low-Glycemic Load Diet
  • Resting energy expenditure decreased less with
    the low-glycemic load diet than with the low-fat
    dietparticipants receiving the low-glycemic load
    diet reported less hunger
  • Insulin resistance, serum triglycerides,
    C-reactive protein, and blood pressure improved
    more with the low-glycemic load diet.
  • In conclusion, we found that the physiologic
    adaptations to a weight loss diet thought to
    antagonize weight loss, involving energy
    expenditure and hunger, can be modified by
    dietary composition.
  • JAMA 2004292(20)2482-2490

151
High Glycemic Index Foods, Overeating, and Obesity
  • Voluntary energy intake after the high-GI
    meal81 greater than after the low-GI meal.
  • Pediatrics 1999 103(3)E26

152
GI Meals
  • high-glycemic index meals produce an initial
    period of high blood glucose and insulin levels,
    followed in many individuals by reactive
    hypoglycemia, counter-regulatory hormone
    secretion, and elevated serum free fatty acid
    concentrations. These events may promote
    excessive food intake, beta cell dysfunction,
    dyslipidemia, and endothelia dysfunction.
  • JAMA 2002287(18)2414-2423

153
Fiber
  • Two isocalorically equal diets varying only in
    amount and type of fiber (50 g at 11
    soluble/insoluble vs 24 g at 12 soluble vs.
    insoluble) for 6 weeks in non-insulin diabetes
    patients.
  • The high-fiber diet lowered the area under the
    curve for 24-hour plasma glucose and insulin
    concentrations by 10 percent and 12 percent
    respectively.
  • Chandala, M., et al., Beneficial effects of high
    dietary fiber intake in patients with type 2
    diabetes mellitus. N Engl J Med, 2000.
    342(19)1392-8.

154
FAT
  • High-monounsaturated-fat diets reduced fasting
    triglycerides (19) and VLDL-cholesterol (22),
    and caused a modest increase in HDL-cholesterol
    concentrations with no adverse affect on
    LDL-cholesterol.
  • No evidence that high-monounsaturated fat diets
    induce weight gain in patients with diabetes
    mellitus provided that energy intake is
    controlled.
  • Garg, A., high monounsaturated fat diets for
    patients with diabetes mellitus a meta-analysis.
    AM J Clin Nutr, 1998. 67(3 Suppl) p. 577S-582S.

155
Healthy vs Unhealthy
  • Normal Metabolism
  • Healthy body composition
  • Great energy
  • Healthy attitude
  • Great mental function
  • Metabolic Syndrome
  • Mental fogginess
  • Low energy
  • Depression
  • Increased fat
  • Decreased muscle mass

156
Detoxification InflammationUltraClear
UltraClear Plus
  • Fatigue
  • Food allergies
  • Environmental toxicity
  • Liver function
  • Health maintenance

157
Elimination of Toxins
  • UltraClear Plus
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