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How To Be Healthy Without Killing Yourself

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 Remains the Biggest Killer of Adult Americans 500,000 Deaths Annually

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How To Be Healthy Without Killing Yourself

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  1. How To Be Healthy Without Killing Yourself B Bottenberg, D.O., FNLA, FACOI

  2. Topics For Today • Major Risk Factors For Disease • Disease Prevention • Diet and Exercise • Think About The Big Picture

  3. 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 Cardiovascular Disease

  4. 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

  5. ATP III Risk Categories High Risk ModeratelyHighRisk • CHD, PAD, carotid disease, diabetes, 2+ RF (10-year risk >20%) • LDL-C goal <100 mg/dL • 2+ RF (10-yr risk 10–20%) • LDL-C goal <130 mg/dL Moderate Risk Lower Risk • 2+ RF (10-yr risk <10%) • LDL-C goal <130 mg/dL • 0–1 RF • LDL-C goal <160 mg/dL

  6. Ruptured Atheroma

  7. Reduction in Major Coronary Events in Major Statin Trials Secondary Primary High Risk Trial NLDL-C AF/TexCAPS 6605 -27% WOSCOPS 6595 -26% ASCOT 10,305 -28% 4S 4444 -36% LIPID 9014 -25% CARE4159 -28% HPS20,536 -29% Risk Reduction, % -25* -25§ -27‡ -31* -36† -38* -38* 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. * 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.

  8. Heart Attacks LDL. LDL. 50%% 50%%

  9. Size Matters! LDL 20mg/dL Triglycerides LDL 100mg/dL LDL 20mg/dL LDL 20mg/dL A LDL 20mg/dL LDL 20mg/dL Triglycerides

  10. Insulin Is Secreted To Control Sugar Insulin Insulin Glucose Glucose

  11. As You Gain Weight, It Takes More Insulin… Insulin Insulin Glucose

  12. And More Insulin… Insulin Insulin Glucose

  13. Until the Pancreas Fails Insulin Insulin Glucose

  14. 80% Loss Of Pancreatic Function Glucose Insulin Insulin

  15. Risk Factors and Defining Levels of Metabolic Syndrome Risk Factor Defining Level Abdominal obesity Waist circumference Men >102 cm (>40 in) Women >88 cm (>35 in) Triglycerides150 mg/dL HDL-C Men <40 mg/dL Women <50 mg/dL Blood pressure130/85 mm Hg Fasting glucose100 mg/dL HDL-C = high-density lipoprotein cholesterol. Reprinted with permission from NCEP ATP III. JAMA. 2001;285:2486-2497.

  16. RISK FACTORS FOR ALZHEIMERS • Hypertension • Large Waist • Low HDL • High Triglycerides • Borderline High Blood Sugar (Neurology: Feb. 2011. Vol 76. 518-525)

  17. Obesity in the United States • Adults… 1 in 3 • Children… 1 in 4 (Source: CDC 2010)

  18. Diabetes in the United States • Diabetes… 1 in 10 ! • Prediabetes… 1 in 3 ! (Source: CDC 2011)

  19. OVEREATING vs. “BUNCH EATING” • YOUR BODY BURNS FUEL • YOUR TANK ONLY HOLDS SO MUCH • NO MORE “BUNCH” EATING • “BUT DOC, I’M NOT HUNGRY”

  20. We “Bunch” Eat Triglyceride 10 5 5

  21. Adipose Cells Getting Plump Triglyceride

  22. Adipose Cells Hypertrophy

  23. 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)

  24. 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

  25. 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

  26. Drugs To Reduce Heart Disease • Aspirin Reduces Heart Attacks By 18% • Niacin Reduces Heart Attacks By 25% • Statins Reduces Heart Attacks By 40%

  27. WALKING TWO MILES DAILYREDUCES HEART DISEASEBY 45%Women’s Health Study: JAMA, 2001

  28. 3 OR MORE FRUITS AND VEGETABLES DAILY 42% FEWER STROKE DEATHS 27% LESS HEART DISEASE DEATHS 15% OVERALL LESS DEATH NHANES: AJCN. 2002

  29. EATING FISH TWICE WEEKLY (SALMON, TROUT, HERRING, HALIBUT) 31% REDUCTION IN HEART DISEASE Nurses Heart Study: JAMA, 2002 81% REDUCTION IN SUDDEN DEATH Physician’s Health study: NEJM, 2002

  30. LOSING 5-7% BODY WEIGHT BY EATING BETTER 58% LESS CHANCE OF BECOMING DIABETIC Diabetes Prevention Program: NEJM, 2002

  31. STAY FIT HIGHLY FIT MEN HAVE 50% LOWER DEATH RATES THAN LOWER FIT MEN Circulation: 2008

  32. ADDRESS LIFE

  33. 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

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