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.

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• 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.

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• 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.

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Dr. Tuckers Therapeutic Lifestyle Program

• Diet
• Exercise
• Supplement
• Rest

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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

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Charting Office VisitsSOAP Note Format

• Subjective
• Objective
• Assessment/Diagnosis
• Functional abnormalities
• Plan (diet modifications, exercise program,
  supplementation recommendations, relaxation
  techniques)

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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

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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

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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

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Charging for Programs

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

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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.

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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

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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.

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BIA may be used

• To assess
• Body composition (estimate)
• Fluid balance
• Cellular performance (cellular health analysis)

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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.

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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.

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Trunkal Obesity/Central Adiposity

• Waist Circumference
• Waist to Hip Ratio

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Vital Signs

• BP
• Pulse
• Temp

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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

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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

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Lab Cardiovascular

• Lipids, fractionated lipid profile
• Hs-CRP
• Fibrinogen
• Homocysteine

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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.

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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

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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

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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

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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

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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

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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.

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Lab Metabolic Syndrome/DMII

• Glucose-fasting and two hour
• Insulin-fasting and two hour
• HgbA1C

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Lab Altered Endocrinology

• Adrenal Stress Profile salivary cortisol
• Thyroid

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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

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American Cholesterol education program expert
panels current policy on fasting blood
triglyceride levels in adults
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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

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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.

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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

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The Initial Health Consultation

• Objective Data Collection
• BIA and vitals
• Review of Findings
• Begin Education and Health Coaching

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Lifestyle Change How?

• It takes 45 days to change a habit or incorporate
  a new one.

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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)

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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.

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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

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Inflammatory Related Chronic Disorders

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

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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
  

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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

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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.

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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.

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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.

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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

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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.

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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

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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

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Metabolic Syndrome Patients

• Increased blood fat
• Increased body fat
• Increased muscle fat
• Increased liver fat
• Increased pancreatic fat

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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

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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.

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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

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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.

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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

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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

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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.

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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

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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

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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

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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