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The Relationship of Obesity – Cholesterol – Triglycerides
to Metabolic Syndrome: Assessment and Interventions
Presented by Graham Simpson, MD
Institute Physician, Cenegenics® Medical Institute
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The Relationship of Obesity-Cholesterol-Triglycerides to Metabolic Syndrome
Accumulating scientific research has shown that adipose tissue is an active endocrine and metabolic organ that plays a critical role in the development of cardiometabolic risk factors, diabetes and cardiovascular disease.
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The Relationship of Obesity-Cholesterol-Triglycerides to Metabolic Syndrome
Adipose tissue plays an important role in the development of low-grade systemic inflammation. Adipose tissue secretes a number of cytokines TNF2, IL1, IL6, adiponectin, leptin, plasminogen activator-1 – these stimulate inflammatory protein production in the liver through activation of NFKB.
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The Relationship of Obesity-Cholesterol-Triglycerides to Metabolic Syndrome
Macrophage accumulation in adipose tissue also promotes obesity associated inflammation and its sequelae, including endothelial dysfunction, insulin resistance, dyslipidemia, hypertension, impaired thrombolysis, diabetes and atherosclerosis.
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The Relationship of Obesity-Cholesterol-Triglycerides to Metabolic Syndrome
Liposuction of abdominal subcutaneous adipose tissue has been shown not to improve cardiometabolic risk factors, whereas experimental studies report that reduction of visceral fat improved glucose levels and insulin sensitivity.
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The Relationship of Obesity-Cholesterol-Triglycerides to Metabolic Syndrome
ASSESSMENT
1. Blood tests
2. Tape measure
3. Dexa scan
4. IMT
5. Vascular reactivity (FMD)
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Patient Overview
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AVERAGE MIN MAX
Age 51.8 28 73
Married 139 total
Children 2.4 0 15
Ht 70.8 60.4 78.8
Wt 212.7 134 344.5
% body fat 30.3 9.2 44.2
Densitometer none = 95 Penia = 83 Porosis = 20
Depression 8.3 0 32
QLI 6.6 0 22
Glucose 95.3 65 245
A1C 5.6 4.6 11.2
M Gluc 123.2 86 321
F Insulin 7.6 1 59
Uric Acid 6.6 1.6 11.8
Homo 9.9 3.8 20.5
CRP 3.0 0.1 37.8
Chol 197.5 109 331
TG 151.4 39 975
HDL 49.7 31 99
LDL 121.3 40 235
Total Test 428.6 29 966
Free Test 67.2 5.6 936
DHT 37.8 2 182
E2 23.7 1 158
IGF 159.8 66 315
PSA 1.2 0.1 5.3
DHEA 163.5 2.5 1210
TSH 2.42 0.7 12.66
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What is IMT?
IMT measured the Intima-Media Thickness (IMT) of the common carotid Determines the presence and severity of atherosclerosis
IMT of the carotid artery has been conclusively demonstrated as a surrogate endpoint for cardiovascular disease (CVD)
IMT evaluates CVD itself instead of the risk factors for the disease
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The Relationship of Obesity-Cholesterol-Triglycerides to Metabolic Syndrome
INTERVENTION
Lifestyle
Paleo-Nutrition
Nutraceuticals
Exercise
Detoxification
Mind-Body Rx Hormone Restoration Pharmaceuticals
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Paleolithic NutritionA Consideration of Its Nature and Current Implications
S. Boyd Eaton, MD, and Melvin Konner, PhD
NEJM 31Jan85 Vol 312 No.5
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The Relationship of Obesity-Cholesterol-Triglycerides to Metabolic Syndrome
PHARMACEUTICALS
1. Metformin
2. Orlistat
3. Niacin
4. Statins
5. Omega 3 fatty acids
6. Fibrates
• Gemfibrozil
• Fenofibrate
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The Relationship of Obesity-Cholesterol-Triglycerides to Metabolic Syndrome
PHARMACEUTICALS, cont’d
7. Cholesteryl Ester Transfer Protein Inhibitor (CETP)• Torcetrapib (discontinued)
• JTT-705
8. Endocannabinoid Receptor Antagonism• Rimonabant (first CB1 antagonist)
9. Thiazolidinediones• Pioglitazone
10. Obesity Drugs• Sibutramine (Meridia)