1. Minnesota Sleep Society 4 th Annual Meeting Jeffrey Kotulski, D.O.

3. CarbohydratesObesityInsomnia

4. Functional Medicine/Orthomolecular Medicine Abram Hoffer Linus Pauling

5. Functional Medicine Matrix

6. Obesity “Diabesity” – Mark Hyman, M.D. Obesity: Why are men getting pregnant? Author: Alexander Schauss, Ph. D Wheat Belly Author: William Davis, M.D.

8. Economics 1960 - $0.25 of every dollar earned spent on food 2010 - $0.08 of every dollar earned spent on food 1960 - $0.05 of every dollar earned spent on health care 2010 - $0.22 of every dollar earned spent on health care

9. Insulin Dysregulation ->Inflammation

10. HPA Axis Issues Cortisol DHEA Cortisol 5 HTP Melatonin Insomnia Depression Cortisol Muscle Mass (Sarcopenia) Glucose Insulin Resistance

11. HPA Axis Increased cortisol leads to increased consumption of carbohydrates – This leads to insulin resistance & cortisol resistance

12. HPA Axis Cortisol Resistance – A phenomena of the last decade. The anti- inflammatory properties are negated, however, the catabolic changes persist. – Stress = Inflammation

13. “Direct inhibitory effects of melatonin upon several ACTH responses in the human adrenal gland.” Hormone Metabolism Res., 2011, May, 43 (5): 337-42.

14. What is the Skinny on High Fructose Corn Syrup? There is no skinny, it’s all FAT!

15. Insomnia Nocturnal melatonin production is significantly diminished in insomnia patients. - Psychology Res. 2002, Dec. 12; 113 (1-2): 17 - 27

16. Where does hyperinsulinemia come from? 1. Genetics – insulin gene expression 2. Epigenetics 3. Social environment, cortisol 4. Exercise environment 5. Food environment – High fructose, low fiber

17. Fructose Is Not Glucose Fructose is 7 x more likely to form advanced glycation end-products (AGES) Acute fructose does not stimulate insulin Fructose does not suppress grehlin Chronic fructose exposure promotes metabolic syndrome Fructose: “It’s alcohol without the buzz.” -Gaby, Alterative Medicine Reviews, 2005 - Lustig, OrthoMolecular conference, 2013

18. Fructose Of the 600,000 items in the American food supply, 80% have added sugar (sucrose, HFCS). Our food environment is “fructosified.”

19. What About Gluten? (another day) Wheat is a very unusual carbohydrate Amylopectin A – – Spikes blood sugars after consumption more so than consuming table sugar.

20. Examples from the Farm Cows: THEN lifespan of 10 – 12 years NOW lifespan of 5 years Chickens: THEN standing NOW siting The answer is…. it’s the grains.

21. What Can We Do? Doctors Food Project - Robert Lustig, M.D.

22. Therapeutic Lifestyle Changes Sleep & Relaxation Exercise & Movement Nutrition & Hydration Stress & Resilience Relationships & Networks

24. Biochemical Individuality Roger J. Williams, Ph.D.

25. Fit By Design Genetic testing using the following genes: – FABP2 – ADRB2 – ADRB3 – PPARG Outcome of genetic analysis allows a personalized plan for long-term health.

26. Genetics The GeneRole of the Gene FABP2-54How much dietary fat is absorbed into your bloodstream. ADRB2-16Where you store fat. Your most efficient exercise. ADRB2-27How fat is used for energy and how high carb diets influence weight gain. ADRB3-64How much exercise stimulus you need weekly to maintain or lose weight. PPARG-7A nuclear receptor involved with metabolism pathways at the cellular level

27. Jeffrey Kotulski, D.O. 45 Teton Lane Mankato, MN 56001 (507) 388-7488