Understanding

1

• Understanding
• Your
• Tests

2
Whats Your Wellness Score? Get a Good Grade In
Your Health
3
Body Mass Index (BMI)

• BMI Weight (in kg) Height2 (in
  meters)
• Lbs/ inches2 x 703
• A BMI of
• lt25 desirable
• 25 29.9 overweight
• gt30 obese
• Tells us if you are over weight

4
Relationship of BMI to Excess Mortality
300
Age at Issue
20-29
250
30-39
200
150
Mortality Ratio
100
High
Moderate
Low
Risk
Risk
Risk
50
0
15
20
25
30
40
35
Body Mass Index (kg/m2)
5
Waist/Hip Ratio

• Waist/Hip Ratio
• Ideal lt.80 Woman and lt.95 Man
• Tells us if you are Over-Fat. Skinny fat person
  can have normal BMI and high body fat.
• Adipose Tissue is the largest endocrine gland in
  the body and produce
• Inflammatory chemicals
• Estrogen
• Cortisol

6
Blood Pressure Resting Pulse

• Blood Pressure
• Systolic less than or equal to 110mm-Good
• Diastolic equal to or less than 70mm-Good
• Greater than 130/85mm is Mildly Hypertensive
• In Blood Pressure above 11/5/75, a 10 point jump
  in Diastolic BP (bottom number), causes a 2-fold
  increase in death from heart disease
• Medications??

7
Sugar Biomarkers

• Fasting Glucose
• 80-100 mg/dl
• If Fasting Glucose is above 100 mg/dl then
  consider HbA1C- Glycosylated Hemoglobin
• Normal range is 4-5.9 . In poorly controlled
  diabetes, its 8.0 or above, and in well
  controlled patients it's less than 7.0
• The predictive value of HbA1C for total
  mortality was stronger than that documented for
  cholesterol concentration, body mass index and
  blood pressure.
• Khaw, K-T, et al, BMJ, 2001, Vol 322 1-6
• Also consider Fasting Insulin
• Increased insulin production causes insulin
  resistance
• Sign of Insulin Resistance with levels over 15
  uU/ml

8
Lipid Biomarkers

• Lipids, fractionated lipids
• Total Cholesterol-under 200
• Triglycerides-under 150, preferably under 100
• HDL-over 50 (male) and over 60 (female)
• LDL-under 130
• Trig/HDL ratio- under 2.0
• Chol/HDL ratio- under 3.0
• Triglyceride/HDL ratio predicts a heart attack 17
  times more accurately than just Cholesterol
  numbers.

9
Consider an MSQ- Systems Evaluation

• Medical Symptoms Questionnaire (MSQ)
• Identifies symptoms in most body systems
• Quantifies patients level of symptoms
• Provides a simple metric to track patient
  improvement

10
EPIC HEALTHY LIVING STUDY

• 1. BMI Under 30
• 2. 3.5 Hours of Physical
• Activity Per Week
• 3. Following a Healthy
• Diet (fruits, vegetables,
• beans, whole grains,
• nuts, seeds, and
• limited amounts of meat)
• 4. Never Smoking

• Participants with all 4 factors to the right had
  a 78 lower risk of developing a chronic disease
  (diabetes 93 myocardial infarction 81 stroke
  50 and cancer 36 than participants without
  engaging in healthy factors.
  
• Arch Intern Med. 2009169(15)1355-1362.

11
How to Identify Patients withMetabolic Syndrome
National Cholesterol Education Program (NCEP) definition is the presence of 3 or more of the following National Cholesterol Education Program (NCEP) definition is the presence of 3 or more of the following
Waist Circumference Men gt40 in, Women gt35 in
Triglycerides 150 mg/dL
HDL Cholesterol TG/HDL Ratio 3 Men lt40 mg/dL Women lt50mg/dL
Blood Pressure 130/85 mmHg
Blood Glucose 100 mg/dL
According to the CDC if you have any two of these
symptoms you have double the risk of death from
coronary heart disease and if you have 4 of the
above you have 3.5 times the risk.
12
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

firstline therapy
13
Weight Management/NutritionWhat is Food?
14
Food is a Mixture

• 30-20-10

Protein 20 g
Fat 10 g
Carbohydrate 30 g
15
What Hormone is secreted when your eat sugar?
Understanding Glycemic Index
16
(No Transcript)
17
Understanding Food Labels
18
Use your hand as your guide
Carbohydrate- Fist Protein- Palm Fat- Thumb
19
Question?

• How many teaspoons of sugar in a 20 ounce soda?
• Bonus question what is the average pH of a soda
  (diet or regular)?

20
Are you eating like a BEAR or a DEER?
Eats Big Meals 2-3 times a day!
Eats Small Meals 5-7 times a day!
21
Eating Out

• Dont look at the menu
• The average restaurant portion size is 4-5 X a
  normal size
• The calories add up quickly
• No Starch-Double Vegetable
• Split meals and ask for the to go container
  ahead of time
• No bread before dinner!

22
Good Fat vs. Bad Fat
70 Trillion Cells in the Human Body!!
23
Power of Habits