Welcome to Lifestyle Intervention Program Kay Theyerl, MD, MS, FACP, ABIHM

Tonight Overview of Lifestyle Medicine Lifestyle Intervention Program – from a medical perspective Group visit to review labs/biometrics Questions

Crisis of Chronic Diseases 80% of chronic diseases are caused by: tobacco and alcohol use unhealthy dietary choices inadequate physical activity poor management of chronic psychological stress Up to 80% of chronic diseases can be prevented by lifestyle modifications L 180 was started due to the crisis Partnership to Fight Chronic Disease: “The Growing Crisis of Chronic Disease in the United States”, 2009 Willett WC: Science 296: 695-698, 2002; Ford ES et al: Arch Intern Med, 169:1355-1362, 2009

Disease management continuum Low Risk for Disease At goal Healthy Lifestyle Increased Risk for Disease BMI Cholesterol BP Blood Sugar Tobacco Use Emerging Disease Cardio metabolic syndrome Disease State Confirmed diabetes and/or CAD End Stage Disease With Complications CHF Renal failure

Disease can be reversed with lifestyle intervention Low Risk for Disease At goal Healthy Lifestyle Increased Risk for Disease BMI Cholesterol BP Blood Sugar Tobacco Use Emerging Disease Cardio metabolic syndrome Disease State Confirmed diabetes and/or CAD End Stage Disease With Complications CHF Renal failure

Lifestyle Lifestyle is more important than: Genetics Age Gender Percentage of common diseases that are likely preventable Colon cancer 71% Stroke 70% Heart Disease 82% Diabetes 91%

Pt will say – I will never give up meat/cheese – then you can never give up cancer/heart disease

Origins of Lifestyle Medicine Health/Healing = Whole Healthy diet “Let Food be thy Medicine” Physical activity Healthy emotions response to stressors Dr Dysinger so elegantly presented the crisis of chronic disease – morbidity/cost/drain on the healthcare system. He and Dr Kelly have offered insights into the effects of lifestyle on our health and have provided the evidence supporting lifestyle medicine Does anyone feel a Paradigm shift? http://classics.mit.edu/Browse/browse-Hippocrates.html Sternberg EM: The Balance Within, 2000

What Can We Do? Eat Healthy Foods Move! Manage Stress These are simple concepts and take work, planning, commitment, and practice

It’s Simple -- Eat Foods As Grown Foods that provide optimal health are eaten as close to their original form as possible: fruits, vegetables, whole grains, and beans

Physical Activity is needed for Good Health Helps to prevent and treat: cancers, heart disease, high blood pressure, diabetes, depression, fractures, stroke, obesity, pain… If you don’t move – move! IF you do move, move more

Timeless Knowledge A merry heart does good medicine make Proverbs 17;22

Can I just take a Pill? Medicine may help and may be necessary in some patients But – we can “overeat” our medicines Medicines have side effects Medicine can be expensive With proper lifestyle, most patients can decrease or eliminate the need for many medicines …And reduce their overall health risks 85% of people who currently take medicines for high cholesterol and Type II Diabetes could gain control with lifestyle alone!

Results Weight loss Medication decreased and/or discontinued Cholesterol decreased BP decreased Off CPAP Blood sugar normalized Prediabetes to normal Decreased inflammation

Knowing is not enough; we must apply. Willing is not enough; we must do. Johann Wolfgang von Goethe  Knowledge/guidance and coaching/motivation/accountability Thedacare’s mission is to improve the health of the communities. By teaching, facilitating, and supporting our employees , they reach their goals

ThedaCare Lifestyle Programs Lifestyle (Pilot) 1-year program/ 24 sessions Over 250 participants Thedacare employees and spouses/domestic partners (NC) Employers Community members How did these folks achieve these amazing results? Through TC lifestyle medicine Programs

Lifestyle Intervention Program Enables participants to reverse their chronic disease states through a structured approach to: Nutrition Cooking Physical activity Stress management Yoga in a way that is attainable, practical, and engaging

Lifestyle…IS the Most Powerful Medicine For general good health To prevent and treat chronic diseases including: Diabetes, heart disease, hypertension, obesity, cancer, inflammatory diseases ThedaCare Lifestyle Intervention Program - designed to help you gain and sustain good health L 180 is one effective way to: Help us to turn things around and reclaim our health We feel so fortunate to be a part of the Lifestyle 180 team and we look forward to working with you as you take advantage of this lifechanging opportunity that Thedacare is making available to you

Visionary The doctor of the future will give no medicine, but instead will interest his patients in the care of the human frame, in diet, and in the cause and prevention of disease. Thomas Edison

Lifestyle Team Congratulations!!! Fortunate to be part of the team Leading this transformation at ThedaCare and at other employers in the Valley – Appvion/Galloway Look forward to walking with you as you take your first steps in this life-changing journey

Lifestyle Intervention Program Group Visit # 1

Group Visit: Biometrics and Labs Teammates Concept We are all on this journey together!

Biometrics and Labs HAT Lifestyle Tool Group Visit to review results (tonight) Medical Director Group data Individual data May request to opt out of group visit Communication with PCP Participant and Medical Director Labs/biometrics Medical Director will not treat, change medication, or recommend individual treatment

Biometrics and Labs Timing Baseline 6 weeks 6 months 1 year 18 months 2 years

Labs Lipid panel Glucose Liver panel Hgb A1c TSH level (thyroid) The baseline labs : Lipid panel Glucose Liver panel Hgb A1c TSH level (thyroid) Vitamin D High sensitivity C-reactive Protein (hs-CRP) Insulin Assay . 

Group Visit Personal Health Assessment (PHA) Tool! Lifestyle Habits Biometrics Biometric (HAT) score Measurements Height (baseline only) Weight Waist BP Lab Results

Reminders Communicate with your PCP Your PCP will: Manage your chronic diseases Work with you to manage your medications Give specific recommendations Lifestyle Medical Director will: Make general recommendations Communicate with your PCP if needed

Biometrics and Labs Definitions – what does it measure? Implications – what does it mean? Expectations – how will the Lifestyle Intervention Program affect it?

Personal Health Assessment (PHA) Tool Summary Lifestyle Habits Biometrics Measurements Lab Results

Results At-A-Glance (page 3) Lifestyle Habits Nutrition Physical Activity Stress and Depression Alcohol Consumption Need to Work On Keep Up the Good Work

Results At-A-Glance Biometrics for HAT Labs BMI Tobacco

Health Trends – HAT (page 4) Measurements Weight BMI Lifestyle: waist measurement BP Labs (usual HAT labs) Lifestyle Biometrics (HAT) Score Lifestyle 180 labs at the end of the hat

Lifestyle Lab Trends - page 22 Lifestyle Labs for comparison

HAT (Pages 5-9) Nutrition Physical Activity Stress and Depression Alcohol Consumption Tobacco Use informational

Weight Management (page 10) Height (health trends – page 4) Weight (health trends – page 4) BMI High Risk: increases risk for High Blood Pressure Heart Disease Diabetes Cancer Decreasing body weight by 5% can reduce risk – visceral fat (dangerous fat) is the first to go!

Weight Goals/expectations Body composition Decrease in fat Increase in muscle How will program affect weight and BMI? Healthy weight loss?

Blood Pressure High Blood Pressure increases your risk of: Heart Disease Stroke Ideal: <120/80 PreHypertension: 120-139/80-89 Hypertension - 1: 140-159/90-99 Hypertension - 2: over 160/100 Stay in touch with your PCP. Might see a drop quickly. Black licorice, cold meds ect.

“What do I need to do to be able to change my medications?” Blood Pressure How does the program affect BP? Goals/expectations What if I am taking medication for Blood Pressure? How will I know if my medications need to be adjusted? What do I tell my PCP? “What do I need to do to be able to change my medications?”

Hypotension (low blood pressure ) Symptoms: May occur upon change of position or after standing Dizziness/lightheaded feeling Blurry vision Confusion Weakness Sleepiness Nausea

Hypotension What to do: Immediately sit or lie down until symptoms resolve Change positions slowly Drink plenty of water especially as we embark on an exercise program Contact PCP with report of symptoms and blood pressure readings Call 911 to go to Emergency Department if Skin is cold/clammy or turns pale or blue Pulse is weak and rapid Breathing is rapid/labored

Blood Tests (page 12 - 14) LDL HDL Total Cholesterol/HDL Ratio Triglycerides Total Cholesterol Glucose

Lipids Total Cholesterol <200 mg/dl LDL <100 mg/dl “Bad” cholesterol Increases risk of cardiovascular diseases Animal products/saturated fat HDL >39 mg/dl “Good” Cholesterol Protective Exercise Triglycerides <150 mg/dl Fat Sugar Alcohol Lack of exercise

“What do I need to do to be able to change my medications?” Lipids How does the program affect lipids? Goals/expectations What if I am taking medications for lipids? How will I know if my medications could be adjusted? What do I tell my PCP? “What do I need to do to be able to change my medications?”

Glucose ( mg/dL) Low Risk: less than 100 Increased Risk: 100 – 125 (Prediabetes) High Risk: 126 and greater* (Diabetes) *diagnosis requires 2 readings >125

Diabetes and Pre-Diabetes How will the program affect these? Goals/expectations What is I am taking medication for diabetes? How will I know if my medications may need to be changed?

Prediabetes (Groups 1-9) 83 participants had Prediabetes 41 (>49%) became normal by all criteria!!! 9 at 6 weeks 15 more at 6 months 17 more at 1 year

Diabetes – groups 1-7 32 participants with Diabetes At 6 months: A1C dropped by an average of .85 85% were at goal (A1C<7) At 1 year: A1C dropped by an average of 1.56

Hypoglycemia (low blood sugar) Symptoms: Shaking Blurry vision Confusion Rapid heartbeat Weakness Anxiety Dizziness Hunger Headache Pale skin Sweating irritability

Hypoglycemia What to do? Check your blood sugar or notify staff Eat if past mealtime and if BG is less than 80 Fruit juice/glucose tabs Rest/Repeat/Recheck glucose Eat light snack Contact your PCP and report symptoms and readings Call 911 to go to Emergency Department for: Seizures/loss of consciousness/extreme weakness

Metabolic Syndrome (page 15) Metabolic Syndrome is a name for a group of risk factors that occur together and increase the risk for coronary artery disease, stroke, and type II diabetes. According to the American Heart Association and the National Heart, Lung, and Blood Institute, metabolic syndrome is present if you have three or more of the following signs: Blood pressure ≥ 130/85 mmHg   Fasting blood sugar (glucose) ≥100 mg/dL Large waist circumference Men - 40 inches or more Women - 35 inches or more Low HDL cholesterol: Men - under 40 mg/dL Women - under 50 mg/dL Triglycerides ≥ 150 mg/dL

Hemoglobin A1C (HgBA1C) High Risk (Diabetes) >6.5 This is a blood test used to look at your average blood sugar control over the past 3 months. When the blood sugar is high, the sugar attaches to the hemoglobin protein in red blood cells, forming hemoglobin A1C.    High Risk (Diabetes) >6.5 If your HgBA1C score is in the High Risk level, this confirms you have diabetes. You should consult your healthcare provider. Increased Risk (Prediabetes) 5.7-6.4 If your HgBA1C score is in the Increased Risk level, this confirms you are prediabetic. You should consult your healthcare provider. Low Risk <5.7

Thyroid Stimulating Hormone (TSH) (page 17) This is a blood test that measures how well your thyroid gland is working. The TSH test is one of several thyroid tests used to check for thyroid disease. The thyroid gland makes hormones that control your metabolism (the process of turning the food you eat into energy). The thyroid gland is critical for maintaining body temperature and controlling heart rate, appetite, and digestive tract function.   If your TSH test is Abnormal, you should consult your healthcare provider. If TSH is elevated, it may mean that thyroid function is reduced Normal Range 0.4-4.7 uIU/mL

Vitamin D (25-Hydroxyvitamin D2 & D3) Tests the level of Vitamin D in your system. For reasons yet unclear, Vitamin D is associated with insulin resistance and low levels may increase your risk of developing metabolic syndrome. If you have metabolic syndrome, you're at increased risk for diabetes, hypertension, heart disease, and stroke. Visceral fat affects metabolism of Vit D.   Low Risk 25-80 ng/mL Increased Risk 10-24 ng/mL High Risk <10 ng/mL If your Vitamin D (25-Hydroxyvitamin D2/D3) test is Abnormal, you should consult your healthcare provider. If Vit D3 < 25 – consider treating. Ideal Goal: 50 – 80 ng/mL

High Sensitivity C-Reactive Protein (HSCRP) This test is used to check the level of a substance called C-reactive protein, or HSCRP. The level of HSCRP in your blood goes up when there is inflammation in the body, specifically in the circulatory system (blood vessels). Increased HSCRP is a risk factor for coronary artery (heart) disease. An anti-inflammatory, plant-based diet reduces inflammation as well as blood glucose, blood cholesterol, and blood pressure, and helps control body weight.   Normal Range Low Risk <1.0 mg/L Your HSCRP score is in the Low Risk level, which decreases your relative risk for developing heart disease. Increased Risk 1.0-3.0 mg/L High Risk >3.0 mg/L Your HSCRP score is in the Increased/High Risk level, which increases your relative risk for developing heart disease. You should consult your healthcare provider.

Inflammation = Illness Broad Perspective Acute Inflammation/Acute Disease Injury Trauma Infection Toxins Immune reaction/allergies Treatment Modern Model of Medicine Very effective

Chronic Diseases Atherosclerosis Cancer Diabetes Hypertension Obesity Coronary heart disease Stroke Peripheral artery disease Cancer Diabetes Hypertension Obesity Asthma Chronic Pain Rheumatoid Arthritis Autoimmune Disease Alzheimer’s Disease Acne Systemic Lupus Erythematosus (SLE) MS IBD But what about chronic disease? And the list goes on

Treatment Current model Just give a pill, perform a procedure, right? If we do not address underlying cause it = bandaid Expensive Ineffective in the long run

Inflammation Chronic Disease Gone awry If we can find a common thread and address that – we could effectively prevent/treat

Inflammation: Underlying Factor in Chronic Disease Increase Inflammation Processed foods Sugar/High Fructose Corn Syrup Saturated Fats Animal Products Toxins Smoking Alcohol Salt Fried Foods Sedentary Lifestyle Stress Decrease Inflammation Fruits Vegetables Whole Grains Leafy Greens Legumes Sleep Water Curcumin/Turmeric Vitamin D/Antioxidants Moderate Exercise Meditation/Yoga Ideas re what might cause/increase inflammation How do we treat it? A pill/procedure?

Insulin This test measures the amount of insulin in the blood after a fasting period of at least eight hours. High levels are seen in people with metabolic syndrome (insulin resistance), which increases the risk of developing type II diabetes.   If your Insulin Assay Blood test is Abnormal; you should consult your healthcare provider. Normal Range 2.6 - 24.9 mcIU/mL > 25 mcIU/mL = PREDIABETES

Group 11 Data - 30 Vitamin D deficiency <25: 15 (5 on low end) Contact PCP to discuss plan Prediabetes : 11 hs-CRP: Only 4 were in low risk category High lipids: 23 Per each group facts

I Have Control?

Questions