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

Welcome to

Lifestyle Intervention Program

Kay Theyerl, MD, MS, FACP, ABIHM

TonightOverview of Lifestyle MedicineLifestyle Intervention Program – from a medical perspective

Group visit to review labs/biometrics

Questions

3

Crisis of Chronic Diseases80% 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

Partnership to Fight Chronic Disease: “The Growing Crisis of Chronic Disease in the United States”, 2009Willett WC: Science 296: 695-698, 2002; Ford ES et al: Arch Intern Med, 169:1355-1362, 2009

Disease management continuum

4

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

5

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

LifestyleLifestyle is more important than:

GeneticsAgeGender

Percentage of common diseases that are likely preventableColon cancer 71%Stroke 70%Heart Disease 82%Diabetes 91%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Percentage of Deaths from Heart Disease and CancerPercentage of Calories from Unrefined Plant Foods

Health/Healing = Whole

• Healthy diet– “Let Food be thy

Medicine”• Physical activity• Healthy emotions

• response to stressorshttp://classics.mit.edu/Browse/browse-Hippocrates.htmlSternberg EM: The Balance Within, 2000

Origins of Lifestyle Medicine

What Can We Do?Eat Healthy FoodsMove!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…

Timeless Knowledge A merry heart

does good medicine makeProverbs 17;22

Can I just take a Pill?Medicine may help and may be necessary in some

patientsBut – we can “overeat” our medicinesMedicines have side effectsMedicine can be expensiveWith 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!

ResultsWeight lossMedication decreased and/or discontinuedCholesterol decreasedBP decreasedOff CPAPBlood sugar normalizedPrediabetes to normalDecreased inflammation

Knowing is not enough; we must apply.

Willing is not enough; we must do.

Johann Wolfgang von Goethe 

ThedaCare Lifestyle ProgramsLifestyle (Pilot)

1-year program/ 24 sessionsOver 250 participants

Thedacare employees and spouses/domestic partners (NC)

Employers Community members

Lifestyle Intervention ProgramEnables 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

VisionaryThe 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 TeamCongratulations!!!Fortunate to be part of the teamLeading 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 ProgramGroup Visit # 1

Group Visit: Biometrics and Labs

Teammates Concept

We are all on this journey together!

Biometrics and LabsHAT Lifestyle ToolGroup Visit to review results (tonight)

Medical DirectorGroup dataIndividual dataMay request to opt out of group visit

Communication with PCPParticipant and Medical DirectorLabs/biometricsMedical Director will not treat, change medication,

or recommend individual treatment

Biometrics and LabsTiming

Baseline6 weeks6 months1 year

18 months2 years

LabsThe baseline labs :

Lipid panel GlucoseLiver panel Hgb A1c TSH level (thyroid) Vitamin DHigh sensitivity C-reactive Protein (hs-CRP)Insulin Assay

.

Group VisitPersonal Health Assessment (PHA) Tool!

Lifestyle HabitsBiometrics

Biometric (HAT) scoreMeasurements

Height (baseline only)WeightWaistBP

Lab Results

RemindersCommunicate with your PCPYour PCP will:

Manage your chronic diseasesWork with you to manage your medicationsGive specific recommendations

Lifestyle Medical Director will:Make general recommendationsCommunicate with your PCP if needed

Biometrics and LabsDefinitions – what does it measure?

Implications – what does it mean?

Expectations – how will the Lifestyle Intervention Program affect it?

Personal Health Assessment (PHA) Tool

SummaryLifestyle HabitsBiometrics

MeasurementsLab Results

Results At-A-Glance (page 3)Lifestyle Habits

NutritionPhysical ActivityStress and DepressionAlcohol Consumption

Need to Work OnKeep Up the Good Work

Results At-A-GlanceBiometrics for HAT

LabsBMITobacco

Health Trends – HAT (page 4)Measurements

WeightBMILifestyle: waist measurementBP

Labs (usual HAT labs)Lifestyle Biometrics (HAT) Score

Lifestyle Lab Trends - page 22Lifestyle Labs for comparison

HAT(Pages 5-9)NutritionPhysical ActivityStress and DepressionAlcohol ConsumptionTobacco Use

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!

WeightGoals/expectationsBody composition

Decrease in fatIncrease in muscle

How will program affect weight and BMI?Healthy weight loss?

Blood PressureHigh Blood Pressure increases your risk of:

Heart DiseaseStroke

Ideal: <120/80PreHypertension: 120-139/80-89Hypertension - 1: 140-159/90-99Hypertension - 2: over 160/100

Blood PressureHow does the program affect BP?Goals/expectationsWhat 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 feelingBlurry visionConfusionWeaknessSleepinessNausea

HypotensionWhat to do:

Immediately sit or lie down until symptoms resolveChange positions slowlyDrink plenty of water especially as we embark on an

exercise programContact 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)

LDLHDLTotal Cholesterol/HDL RatioTriglyceridesTotal CholesterolGlucose

LipidsTotal Cholesterol <200 mg/dlLDL <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

LipidsHow does the program affect lipids?Goals/expectationsWhat 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 100Increased Risk: 100 – 125 (Prediabetes)

High Risk: 126 and greater* (Diabetes)

*diagnosis requires 2 readings >125

Diabetes and Pre-DiabetesHow will the program affect these?Goals/expectationsWhat 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 weeks15 more at 6 months17 more at 1 year

Diabetes – groups 1-732 participants with DiabetesAt 6 months:

A1C dropped by an average of .8585% were at goal (A1C<7)

At 1 year:A1C dropped by an average of 1.5685% were at goal (A1C<7)

Hypoglycemia (low blood sugar)Symptoms:

Shaking Blurry vision Confusion

Rapid heartbeat Weakness Anxiety

Dizziness Hunger Headache

Pale skin Sweating irritability

HypoglycemiaWhat to do?

Check your blood sugar or notify staffEat if past mealtime and if BG is less than 80Fruit juice/glucose tabsRest/Repeat/Recheck glucoseEat light snackContact 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 circumferenceMen - 40 inches or moreWomen - 35 inches or more

Low HDL cholesterol:

Men - under 40 mg/dLWomen - under 50 mg/dL

Triglycerides ≥ 150 mg/dL

Hemoglobin A1C (HgBA1C)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 RangeLow 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 = IllnessBroad PerspectiveAcute Inflammation/Acute Disease

InjuryTraumaInfectionToxinsImmune reaction/allergies

TreatmentModern Model of Medicine

Very effective

Chronic Diseases Atherosclerosis

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

TreatmentCurrent model

Just give a pill, perform a procedure, right?If we do not address underlying cause it =

bandaidExpensiveIneffective in the long run

Chronic Disease

InflammationGone awry

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

InsulinThis 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 Range2.6 - 24.9 mcIU/mL

> 25 mcIU/mL = PREDIABETES

Group 11 Data - 30Vitamin D deficiency <25: 15 (5 on low end)

Contact PCP to discuss planPrediabetes : 11hs-CRP: Only 4 were in low risk category

High lipids: 23

I Have Control?

Questions