Flt Public Pres

Achieve Vibrant Health & Well-Being With

Therapeutic Lifestyle Changes

Presented by: Dr. Sarah Corcoran, DC, FLT cpRebecca Sauer, FLT Certified Practioner & featuring Chris from Metagenics

Back To Health Chiropractic 450 Chauncy St., Mansfield

From: ACS / ADA / AHA Scientific StatementPreventing Cancer, Cardiovascular Disease, and Diabetes

A common Agenda for the American Cancer Society, the American Diabetes Association, and the American Heart Association

Circulation 2004;109:3244-3255

Cardiovascular disease, cancer, and diabetes account for nearly 2 of every 3 deaths in the US

At a cost of $700 billion “While healthcare costs skyrocket, the

national investment in prevention was estimated at less than 3% of the total annual healthcare expenditures.”

From: ACS / ADA / AHA Scientific StatementPreventing Cancer, Cardiovascular Disease, and Diabetes

A common Agenda for the American Cancer Society, the American Diabetes Association, and the American Heart Association”

Circulation 2004;109:3244-3255

“In spite of hundreds of medical studies, media reports and advice from health officials, Americans still have not got the message that they can prevent most cases of chronic disease.” – John Seffrin, American Cancer Society CEO

From:

“Effectiveness of Therapeutic Lifestyle Changes in Patients With Hypertension, Hyperlipidemia, and/or Hyperglycemia”

American Journal of Cardiology 2004;94:1558-1561

“National clinical guidelines recommend therapeutic lifestyle changes as a standard of care in the management of conventional risk factors (for coronary heart disease).”

From:



“…the findings clearly show that many patients who have conventional risk factors for coronary heart disease can achieve goal levels without medications within 12 weeks of initiating therapeutic lifestyle changes…”

From:



“Moreover, therapeutic lifestyle changes can generally be implemented less expensively than most medications and, unlike single drug therapy, favorably impacts multiple cardiovascular disease risk factors.”

FOOD FUN FACT!

EAT A RAINBOW EVERYDAY!!!

Colorful fruits & vegetables deliver healthful doses of vitamins, minerals, and disease fighting

phytochemicals.

The darker the color of the fruit or vegetable, the more nutrients it contains…

National Health Organizations recommended Therapeutic Lifestyle Changes (TLC)

as a “first line” treatment

National Health Orgs. National Institutes of Health Am. Heart, Blood & Lung

Institute Am. Diabetes Association Am. Heart Association Am. Association Clinical

Endocrinologists Arthritis Foundation North American Menopause

Society Many others

Conditions High Cholesterol High Blood Pressure High Blood Sugar and/or

Diabetes Heart Disease Osteoarthritis Osteoporosis Metabolic Syndrome Menopausal symptoms Many others

From: ACS / ADA / AHA Scientific Statement Preventing Cancer, Cardiovascular Disease, and Diabetes

A common Agenda for the American Cancer Society, the American Diabetes Association, and the American Heart Association

Circulation 2004;109:3244-3255

“At present, preventive health receives only sporadic attention, in the context of office visits for acute and chronic medical problems. Health care providers and medical organizations must transform this model into systems that provide preventive care and early detection as an integral part of standard medical practice.”

Presentation Objective

Review the system we use to provide Therapeutic Lifestyle Changes (TLC’s)

Our system is:

Supported by research Clinically effective Realistic and manageableFulfilling for us & our patients

From: AHA / NHLBI Scientific Statement

“Diagnosis and Management of the Metabolic Syndrome” An American Heart Association /

National Heart, Lung, Blood Institute Scientific Statement

Metabolic Syndrome confers:

A 2-fold increase in relative risk for ASCVD events. A 5-fold increase in risk for developing DM-II in

individuals without established diabetes.

“This finding implies that the metabolic syndrome imparts a relatively high long-term risk for both ASCVD and diabetes.”

Circulation 2005;112:000-000 @www.circulationaha.org

From:

“Prevalence of the Metabolic Syndrome Defined by the International Diabetes Federation Among Adults in the U.S.”

Diabetes Care 2005;28:2745-2749

“…almost 40% of U.S. adults were classified as having the metabolic syndrome...”

FOOD FUN FACT!

Regular Family Meals

encourage healthy eating habits &

reduce the risk of eating disorders

according to results

of a new study.

From:

“Metabolic Syndrome in Normal-Weight Americans New definition of the metabolically obese, normal weight individual

Diabetes Care 2004;27:2222-2228

“Individuals in the upper normal-weight and slightly overweight BMI range have a relatively high prevalence and are at increased risk of having the metabolic syndrome. Therefore, screening in individuals with normal or slightly elevated BMI is important in the prevention of diabetes and cardiovascular disease.”

From:

“Metabolic Syndrome: Time for Action”

Am Fam Physician 2004;69:2875-82, 2887-8

“Soon metabolic syndrome will overtake cigarette smoking as the number one risk factor for heart disease among the U.S. population. The NCEP ATPIII has identified metabolic syndrome as an indication for vigorous lifestyle intervention.”

From:

“Metabolic Syndrome: Time for Action”

Am Fam Physician 2004;69:2875-82, 2887-8

“All patients diagnosed with metabolic syndrome should be encouraged to change their diet and exercise habits as primary therapy.”

Case History: Metabolic Syndrome and efficacy of TLC’s

Complaints:-Occasional fatigue,

lethargy, apathy-Dizziness-Restlessness-Rapid heartbeat-Shortness of breath-Heartburn-Overweight - 195 lbs

Lifestyle Factors:-Significant stress levels-Eating poor quality food & fast food -Skip meals, only two meals per day-Crave Stimulants such as caffeine,

soft drinks (4-5 cups of coffee, 1 soda per day)-Smoking 1 pack per day-Occasional alcohol-Exercises 1-2 times per week

E.C. - 50 year old male, 5’10’, 197.5 lbs, 0 meds, unremarkable family and medical history

E.C. - Lab data and body composition:

Glucose 143

Cholesterol 267

Triglycerides 523

HDL Cholesterol 35

LDL Cholesterol N/Aval

Chol / HDL Ratio 7.6

HS CRP 9.7

PSA, Total 4.4

Blood Pressure 130/80

BMI 28.0

Fat Mass 25.9%

Lean Body Mass 74.1%


-Metabolic Syndrome (Elevated glucose, triglycerides, blood

pressure, low HDL)-High risk to diabetes -High risk to CVD (hyperlipidemia, high HS CRP)-BPH-Sub-optimal over-all health and well-being

E.C. - Conclusions:


Initial:-Occasional fatigue,

lethargy, apathy-Dizziness-Restlessness-Rapid heartbeat-Shortness of breath-Heartburn-Overweight - 195 lbs

Final (12 weeks):

-resolved, has high energy-resolved-resolved-resolved-resolved-resolved-currently 177 lbs

E.C. - 50 year old maleFinal Results


Initial:-Significant stress levels-Eating poor quality, fast food -Skip meals - two meals per day-Crave Stimulants such as

caffeine, soft drinks (4-5 cups of coffee, 1 soda per day)-Smoking 1 pack per day-Drinks occasionally-Exercises 1-2 times per week

E.C. - 50 year old maleFinal Results

Final (12 weeks):-Stress well controlled-Eating high quality, healthy food -6 small, low GI meals per day-Eliminated coffee & soda (healthy menu plan

eliminated cravings for coffee & soda)

-Smoking 1-2 cigarettes per day-Occasional alcohol (wine)-Exercises daily


E.C. - 50 year old male

Glucose 143

Cholesterol 267

Triglycerides 523

HDL Cholesterol 35

LDL Cholesterol N/Aval

Chol / HDL Ratio 7.6

HS CRP 9.7

PSA, Total 4.4

Blood Pressure 130/80

BMI 28.0

Fat Mass 25.9%

Lean Body Mass 74.1%

93

149

141

51

70

2.9

1.2

2.2

120/78

25.2

17.7%

82.3%

Lab Data: Initial Final* Body Comp: Initial Final*

*after 12 weeks


FOOD FUN FACT!

Inadequate intake of B-12 is more common than previously thought…

A new study showed that most people are 40% deficient in the vitamin

Low amounts of B-12 damages the nervous system, resulting in loss of feeling &

balance.It can also lead to dementia

FOOD FUN FACT! Back to Back

Omega-3 Fatty Acids:

Help protect the brain against plaque build-up

that can lead to cognitive decline and Alzheimer’s disease.

*Also, Omega-3 fatty acids also protect CV health by decreasing the risk of a heart

attack.

From:“Effect of a low glycemic index diet with soy protein and phytosterols on CVD risk factors in postmenopausal women ”

Nutrition, Feb 2006;22:104-113

This study compared a low glycemic index diet combined with a medical food to the AHA Step I diet in obese, postmenopausal women.

Before After Change % Change

Triglycerides 212 mg/dl 117 mg/dl -95 mg/dl -45%

Total Cholesterol 274 mg/dl 231 mg/dl -43 mg/dl -16%

LDL-C 185 mg/dl 158 mg/dl -27 mg/dl -15%

HDL-C 48 mg/dl 51 mg/dl +3 mg/dl +6%

tChol/HDL-C 5.8 4.6 1.2 -21%

TG/HDL-C 4.6 2.4 2.2 -48%

hs-CRP 5.0 mg/l 3.3 mg/l -1.7 mg/l -34 %

Fasting insulin 8.3 mcIU/ml 6.2 mcIU/ml 2.1 mcIU/ml -25%

Blood Pressure 130/84 mmHG 124/77 mmHG -6/-7 mmHG -5%/-8%

Weight 186 lbs 171 lbs 15 lbs -8%

% lean body mass 61.1% 63.2% +2.1% +3%



Triglyceride / HDL Ratio



Before After Change % Change

4.6 2.4 -2.2 -48%

High triglycerides and low HDL are features of Metabolic Syndrome

TG/HDL ratio of 3 or higher suggests individual has Metabolic Syndrome

Comparing Arms

LGI diet with medical food

AHA Step 1 Diet

Triglycerides -95 mg/dL -49 mg/dL

T-Chol -43 mg/dL -2.6 mg/dL

LDL-C -28 mg/dL +3.2 mg/dL

HDL-C +2.8 mg/dL -.5mg/dL

Weight -14.8 lbs -7.8 lbs



From:

“Putting It Together: Finding Success in Behavior Change Through Integration of Services” Robert Wood Johnson Foundation initiative - $9 million, 5-year program

Ann Fam Med, 2005;Vol. 3, Supp 2: p.S20-S27

Implementing behavior change via the 5 A’s model. 1. Assess: identify behaviors & health conditions 2. Advise: brief advise 3. Agree: goal setting 4. Assist: information, counseling, self-management 5. Arrange: reinforcement / follow-up

The 5 A’s:1. Assess (PCP)

Identify unhealthy behaviors & health conditions

Vitals and weight Complete medical history Health history (lifestyle oriented) Health risk appraisals In-office & out-sourced testing

blood chemistry analysis body composition assessment (BIA) others

firstline therapy

Bioimpedance Analysis (BIA)

The 5 A’s:2. Advise (PCP)

Offer brief advise

Brief, general advise Brief motivational interviewing Behavior prescription

Prescribe TLC programSchedule patient visit for TLC counseling with selected staff member

From:



“…these first steps can be leveraged into more effective interventions if they (PCP’s) connect patients with professionals (staff) and programs - within or outside the office - that can provide more extensive follow-up.”

From:



“…these resources should work in concert with primary care professionals in a team approach, reporting to and consulting with clinicians as counseling progresses, and integrating follow-up into ongoing health care.”

The 5 A’s:3. Agree (Staff)

Set collaborative goals and action plans

Collaborate with patient to establish an action plan

Create and document weekly written goals Review Dr’s prescription and intake

data as basis for collaboration Use individual program plan or personal contract to create action plan

The 5 A’s:4. Assist (Staff)

Provide more information, counseling, self help tools

Menu plan Food diary Handouts TLC guidebook Activity log In office

coaches/counselors

The 5 A’s:5. Arrange (Staff)

Arrange follow-up and reinforcement

Follow-up visits Email & telephone follow-up Wellness concierge Group sessions & support,

when requested

Benefits of a System for TLC’s

Meets patient demand, is cost effective Many of our patients don’t want to take meds

Applies national guidelines Allows us to do what we already know we should be doing

Produces superior clinical outcomes Addresses underlying cause of problem Addresses broad range of health problems unlike single

drugs Provides the needed tools & information Saves practitioners time

Utilizes integration of PCP and staff

firstline therapy

Serving Sizes

FirstLine Therapy

Schedule your “new, healthier you” today…

Back to Health

450 Chauncy Street, Suite 2

Mansfield, MA

(508) 339 - 7788

Health & Medicine

Flt Public Pres