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