How To Be Healthy Without Killing Yourself B Bottenberg, D.O., FNLA, FACOI
Feb 22, 2016
How To Be Healthy Without Killing Yourself
B Bottenberg, D.O., FNLA, FACOI
Topics For Today
• Major Risk Factors For Disease• Disease Prevention• Diet and Exercise• Think About The Big Picture
Cardiovascular Disease
• Cardiovascular Disease Remains the Biggest Killer of Adult Americans
• 500,000 Deaths Annually• One Third of Cardiovascular Deaths Are In • Those Under 55 Years of Age• Accounts For More Deaths Than All Cancers
Combined
Major Cardiovascular Risk Factors
• Age/Gender : >= 45 male, >= 55 female• HDL < 40 mg/dl (male) HDL < 50 mg/d
(female)• HTN or on Tx• Tobacco use• Family History premature events in first
degree relative (male < 55) (female < 65)• If >1 Risk Factor Then Perform Framingham
Risk Scoring
ATP III Risk Categories
• CHD, PAD, carotid disease, diabetes, 2+ RF (10-year risk >20%)– LDL-C goal
<100 mg/dL
High Risk Moderately High Risk
Moderate Risk Lower Risk
2+ RF (10-yr risk 10–20%)– LDL-C goal
<130 mg/dL
2+ RF (10-yr risk <10%)– LDL-C goal
<130 mg/dL
0–1 RF – LDL-C goal
<160 mg/dL
Ruptured Atheroma
-40
-20
0
Reduction in Major Coronary Events in Major Statin Trials
SecondaryPrimary
* p<0.001; †p=0.0005; ‡p<0.0001; §p=0.002.LaRosa J et al. JAMA. 1999;282:2340-2346; HPS Collaborative Group. Lancet. 2002;360:7-22; Sever PS et al. Lancet. 2003;361:1149-1158.
-38* -38*
High Risk
4S 4444 -36%
AF/TexCAPS
6605 -27%
LIPID 9014 -25%
CARE4159 -28%
WOSCOPS 6595 -26%
Trial N
LDL-C
-25* -25§
-31*-27‡
HPS20,536 -29%
Risk
Red
uctio
n, %
ASCOT 10,305 -28%
-36†
Major coronary events defined as: fatal or nonfatal myocardial infarction (MI), unstable angina, sudden cardiac death in AF/TexCAPS; nonfatal MI or coronary death in WOSCOPS, ASCOT, HPS, LIPID, CARE; coronary death, nonfatal MI, silent MI, resuscitated cardiac arrest in 4S.
Heart Attacks
50%% 50%%
LDL. LDL.
LDL20mg/dL
Size Matters!
LDL100mg/dL
LDL20mg/dL
LDL20mg/dL
LDL20mg/dL
Triglycerides
Triglycerides
ALDL
20mg/dL
Insulin Is Secreted To Control Sugar
Insulin
Glucose
Insulin
Glucose
As You Gain Weight, It Takes More Insulin…
Insulin
Insulin
Glucose
And More Insulin…
Insulin
Insulin
Glucose
Until the Pancreas Fails
Insulin
Insulin
Glucose
80% Loss Of Pancreatic Function
Insulin
Insulin
Glucose
Risk Factor Defining LevelAbdominal obesity Waist circumference
Men >102 cm (>40 in)Women >88 cm (>35 in)
Triglycerides 150 mg/dLHDL-CMen <40 mg/dL
Women <50 mg/dLBlood pressure 130/85 mm HgFasting glucose 100 mg/dL
Reprinted with permission from NCEP ATP III. JAMA. 2001;285:2486-2497.
Risk Factors and Defining Levels of Metabolic Syndrome
HDL-C = high-density lipoprotein cholesterol.
RISK FACTORS FOR ALZHEIMERS
• Hypertension• Large Waist• Low HDL• High Triglycerides• Borderline High Blood Sugar
(Neurology: Feb. 2011. Vol 76. 518-525)
Obesity in the United States
• Adults… 1 in 3• Children… 1 in 4
(Source: CDC 2010)
Diabetes in the United States
• Diabetes… 1 in 10 !• Prediabetes… 1 in 3 !
(Source: CDC 2011)
OVEREATING vs. “BUNCH EATING”
• YOUR BODY BURNS FUEL• YOUR TANK ONLY HOLDS SO MUCH• NO MORE “BUNCH” EATING• “BUT DOC, I’M NOT HUNGRY”
We “Bunch” Eat
5 510
Triglyceride
Adipose Cells Getting Plump
Triglyceride
Adipose Cells Hypertrophy
So… How To Eat?
• 1500 – 2000 Calories Per Day• 500 – 600 Calories Per Meal• 3 Servings Per Meal• 1 Protein 15-25 gms. Per Meal (7 gms. / 20 lbs.) • 2 Healthy Carbohydrates (colored,crunchy,fruit,grains)
• Fat Fills In…(MUFA, PUFA)
Exercise
• Good For Mood• Great For Bones• Excellent For Circulation• Reduces Insulin Resistance (Diabetes)• Reduces Vascular Disease Problems• Fit People Have 50% Less Mortality !• Probably Doesn’t Affect Your Weight
Exercise
• 30 Minutes- 5 Times Per Week• 2 ½ Hours Per Week• Moderate Intensity Walking… Easy Biking… Light Swimming… Gardening… Housework… Softball… Golf…
• Heavier Intensity Counts Double
Drugs To Reduce Heart Disease
• Aspirin Reduces Heart Attacks By 18% • Niacin Reduces Heart Attacks By 25%• Statins Reduces Heart Attacks By 40%
WALKING TWO MILES DAILYREDUCES HEART DISEASE
BY 45%
Women’s Health Study: JAMA, 2001
3 OR MORE FRUITS AND VEGETABLES DAILY
42% FEWER STROKE DEATHS27% LESS HEART DISEASE DEATHS
15% OVERALL LESS DEATHNHANES: AJCN. 2002
EATING FISH TWICE WEEKLY (SALMON, TROUT, HERRING, HALIBUT)
31% REDUCTION IN HEART DISEASENurses Heart Study: JAMA, 2002
81% REDUCTION IN SUDDEN DEATHPhysician’s Health study: NEJM, 2002
LOSING 5-7% BODY WEIGHT BY EATING BETTER
58% LESS CHANCE OF BECOMING DIABETICDiabetes Prevention Program: NEJM, 2002
STAY FIT
HIGHLY FIT MEN HAVE 50% LOWERDEATH RATES THAN LOWER FIT MEN
Circulation: 2008
ADDRESS LIFE
Preventing Disease• Get a Flu Shot Annually (for the rest of us)• Pneumovax Every 10 Years• Zostavax (Shingles)• 1-2 Alcoholic Beverages Daily (not more)• Colonoscopy at Age 50 *• Stop Smoking (are you kidding me?)• Check Blood Pressure, Glucose and Cholesterol• Annual Physicals, Pap, Mammograms, DEXA• Eat Better, Move Around Some, Lose Weight