“Pre-Diabetes….

We didn’t invent the practice of medicine…. we’re just changing the way it’s provided.

…a scary diagnosis!

Enrique Saguil, MD

The First Health Approach

We didn’t invent the practice of medicine…. we’re just changing the way it’s provided.

Your TeamRic Saguil, MD

Jason Gruss, MDTom Jordan, RD

Katrina Christie, LCPCMike Blumberg, LCPC

Jennifer Green, NDJoe Musolino, DCAmy Iaquinta, DCNick Nowicki, DC

Emery Paredes, PTCourtney Day, EPAimee Weber, EPYu Zhu, MD China

You

nutrition

movemen

t grounding

We didn’t invent the practice of medicine…. we’re just changing the way it’s provided.

First Health Associates

2010 S. Arlington Heights RdLL Suites

Arlington Heights, IL

Ric Saguil, MD

This concept of “Pre-Anything”

• NOT COVERED ON INSURANCE• Your on your own (run/bike/swim)• Most of us -“school knowledge” of exercise,

(which could be dangerous) ….“leagues?”• If it was so good, why didn’t we stick with it last

new years resolution?• No place that’s close enough, cheap enough,

new enough or fast enough….but what about your neighborhood?....or backyard!!

Started with the “5-O” mentality• You are driving along, 5-10 mph over the

speed limit (like everyone else) and suddenly a police car on the side of the road. Then everyone slows down and behaves themselves.

• You are not feeling any symptoms, 10-20 pounds overweight (like everyone else) and suddenly you have a physical. Then you eat right and plan to exercise more to make the change to be healthy.

Facts:

• Coronary heart disease (CHD) caused about 1 of every 5 deaths in the United States in 2005.

• It is estimated that 195, 000 silent first myocardial infarctions occur each year.

• About every 25 seconds, an American will have a coronary event, and about every minute someone will die from one. (8th slide, 60 seconds per slide-8 americans just died)

Wait…isn’t this a pre-diabetes talk?

Normal physical Overweight-Gradeschool Obese-HS Heart Attack College

Graphic Scale BMI

Visual Scale BMI

Another 20 years?

•1 in 2 will be obese

YOU?

Diabetes trend 2004

Diabetes trend 2005

Diabetes trend 2006

Diabetes trend 2007

Diabetes trend 2008

2004

2005

2006

2007

Physical Inactivity 2008

Diabetes = Physical Inactivity

Diabetes

Inactivity

Pre-Diabetics…should we act now?

• Aka-Impaired glucose tolerance, impaired fasting glucose.

• People with pre-diabetes have a 1.5-fold risk of cardiovascular disease compared to people with normal blood glucose. (vs 2-4 fold DM)

• Damage to end organs suspected to already occur with pre-diabetes

• With ignorance, move onto diabetes in 10y

Testing….Testing!!!

Who gets tested?

• Overweight and 45 or older• Normal weight and 45 or older (ask)• Overweight and younger than 45 +(ask) + = HBP, Low HDL, High Tri, Fam Hx DM Gest DM, Birth of > 9lb baby,

Who benefits from testing

• Doctor - no…I can fill your spot with another• Drug company – yes (muuuhaha) • Family - yes…observed habits rub off• Patient - yes…a chance to change …knowledge is power …eventually gonna need it!

Test Awareness

• HA1C awareness = 14.8% to 27%• BP awareness =20.7% to 26.6%• LDL awareness =3.5% to 5.6%

Joslin Center 2009

“Pre” or “Full Blown”

Underserved/Undiagnosed

Endocrinologist/CDE

Family Medicine/Internist/Ob/Peds

• www.diabetes.org Diabetes Risk Test Local Events November is DM month!

What not to do = Heart Attack Grill

Treatment ADA (for DM)

• Blood glucose control• Medications• Organ transplant• Dental health• Diabetes 24/7 (blood glu, aic, bp, chol, physical act, weight, meds)

Trip down “digestive lane”

Stomach acid breaks down food

Insulin from the pancreas

Body “puts away” the glucose

(But may overcorrect)

Absorption of the carbohydrate

Spaghetti

White Bread

Confused? Follow ANDI….

Aggregate Nutrient Density Index…Dr Joe Furhman

Largest Losers FHA

Mary292#

Fasting Blood Sugar: 107

Mary227#

Fasting Blood Sugar: 93

Largest Losers FHA

Kathy204#

Cholesterol: 245

Kathy141# (in the 120s today)

Cholesterol: 191

Largest Losers FHA

Bill254#

Triglycerides: 338

Bill189#

Triglycerides: 68

First Health Associates

Pillars of Blood Sugar Management 1) Weight Status

2) Fitness3) Labs4) HRA5) Mental Fitness6) Nutrition

Motion, heat, galvanic change, temp

Doing it on your own?!

Weight Control

• Strategic locations (arms reach when tired)

• Plan ahead (pick shop day and load up)

• Shop full, meals for the week • Always have a “go to” reward– (food/snack/meal)

• Water! (tea or warm water to start the day)

• Must have a F/V/G in sight• Prep a “Go-Bag”• Set a deadline for success/help

A Quicky with DrRic

My “go bag” (or get help)

Inject your kitchen (or get help!)

Your proving ground!

The exercise part….

Swimming

Excellent for joints,Good for lung capacity

Limited by place and climateWatch skin conditions

Watch asthmaWatch shoulder injury

Biking

Good for jointsGood nature contact

Good to include in workWatch back

Watch walletWatch speed/coasting

Running

Long developed community activityCan be done by any age

Addictive (positively-chi running)Watch exposure (newcomers)Watch the lower extremities

Shoes!

Hiking

Forest Preserves are tax supportedThe fastest hikers burn as much as the slowest jogger

Slowing down can bring awareness of natureMoving away technology cultivates the relaxation response (think kids!)

Less chances for strain and overuse injuryWatch solitude (injury, dehydration, disorientation)

Watch animals

Walking Stats and “gettin sweaty” MET’s (cal/kg/hr):Sitting for this lecture0.0 mph - 1Walking2.0 mph - 912.5 mph - 873.0 mph - 853.5 mph - 834.0 mph - 914.5 mph - 1025.0 mph – 116

Running5.0 mph - 1166.0 mph - 1217.0 mph - 1198.0 mph - 1239.0 mph - 12110.0 mph - 131

1 min mile=60mph2 min mile=30mph3 min mile=20mph4 min mile=15mph5 min mile=12mph10min mile=6mph12min mile=5mph15min mile=4mph20min mile=3mph25min mile=2.5m/h

Bottom line….fastest walker burns like the slowest jogger…but less knee pain

Timing of hikes

• Weather.com• Weather.gov• Sunrise/sunset• 1-3 times a week for 30-60 minutes (30+minutes to achieve RR)• Or add resistance to burn more calories (depending

on your indivi resting metabol rate)• Diabetics can increase to 5x week for glucose control• Hypertensives can use breathwork twice a day

Yoga!

Ancient artPopularity highLow injury risk

Excellent at cultivating relaxation responseExcellent flexibility/power/balance

Detoxing Still Growing with multiple styles

Or….get…help!!!

Physical therapistsExercise physiologists

Personal trainersLife coaches

Yoga instructorsDieticians (RD)

Has to be sustainable!!!

Not that I’m biased but….yoga has hidden prizes!!!

Not that I’m biased but….yoga has hidden prizes!!!

Pancreas massage Balance/Strength

Cultivation of Relaxation Response

Hidden prize-controlling Stress eating

Godzilla VS Ghandi

Control these hormones!!! Cultivate these !!!

RR and breath

IN IN OUT OUT- 1st 2nd 3rd 4th

A Quicky with DrRic

IN

IN

OUT

OUTIntructions: Thumb to index then middle with inhale, ring then pinky with exhale, repeat. Slow, concentrate on matching breath to thumb movement….continue for 5-10 mnutes.

Herbal supplements

100-400mg/d?

1000mcg/d?90-120mg/d?

1-3gm/d?

Gurmar for appetite?

Please ask a Naturopath first.

Halloween Treats:• Avoid giving out any candy combination of milk or white

chocolate with nuts or peanut butter - they rank highest in calories.

• Chocolate with mint or marshmallows has fewer calories, as do caramels and non-chocolate candy such as licorice, taffy, lollipops and flavored fruit candies. However, these are cavity-makers and not very nutritious.

• Consider giving out small squares of dark chocolate with at least 70 percent cocoa, little boxes of organic raisins, organic granola bars, organic fruit wraps or snack-size bags of air-popped popcorn.

www.DrWeil.com

In summary: Pre-Diabetes Checklist:

• Maintaining low BMI • Eating properly (Or Get Some Help!!!)

• Exercising• Cultivating the Relaxation Response• Sleeping 6-8 hours • Community/group activity • Go outside insurance (outside the box)

One size never fits all…

Make changes that not only work your heart but come from the heart…. …..Thanks for Listening!!!

Starved Rock

In the end, follow your “gut feeling”

If something feels wrong about life….take the steps to change

Disease

Pre-Diabetes

Live Healthy!!!

We didn’t invent the practice of medicine…. we’re just changing the way it’s provided.

Next Lecture:Whole Foods Market Schaumburg

The “Yoga” of Eating RightJanuary TBA

QUESTIONS?

COMMENTS?CONCERNS?

Bibliography• Molecular aspects of lipoic acid in the prevention of diabetes complications Lester Packer PhD , a, , Klaus Kraemer PhDb, Gerald Rimbach PhDc

• Advanced glycation end product-induced activation of NF-kappaB is suppressed by alpha-lipoic acid in cultured endothelial cells.

-A Bierhaus, S Chevion, M Chevion, M Hofmann, P Quehenberger, T Illmer, T Luther, -E erentshtein, H Tritschler, M Müller, P Wahl, R Ziegler and P P Nawroth• Enhancement of glucose disposal in patients with type 2 diabetes by alpha-lipoic acid. -Jacob S, Henriksen EJ, Schiemann AL, Simon I, Clancy DE, Tritschler HJ, Jung WI, Augustin HJ,• alpha-Lipoic acid treatment decreases serum lactate and pyruvate concentrations and

improves glucose effectiveness in lean and obese patients with type 2 diabetes. -T Konrad, P Vicini, K Kusterer, A Höflich, A Assadkhani, H J Böhles, A Sewell, H J Tritschler, • Cinnamon Improves Glucose and Lipids of People With Type 2 Diabetes -Alam Khan, MS, PHD123, Mahpara Safdar, MS12, Mohammad Muzaffar Ali Khan, MS, HD12, Khan Nawaz Khattak, MS12 and Richard A. Anderson, PHD3• Effects of a cinnamon extract on plasma glucose, HbA1c, and serum lipids in diabetes mellitus

type 2 B. Mang1, M. Wolters1, B. Schmitt1, K. Kelb1, R. Lichtinghagen2, D. O. Stichtenoth2, A. Hahn1

• Chromium, Glucose Intolerance and Diabetes -Richard A. Anderson, PhD, FACN• Elevated intakes of supplemental chromium improve glucose and insulin

variables in individuals with type 2 diabetes. -R A Anderson, N Cheng, N A Bryden, M M Polansky, N Cheng, J Chi and J Feng Antidiabetic effect of a leaf extract from Gymnema sylvestre in non-insulin- dependent diabetes mellitus patients K. Baskaran, B.Kizar Ahamath, K.Radha Shanmugasundaram , E.R.B. • Antidiabetic effect of Gymnema montanum leaves: effect on lipid peroxidation

induced oxidative stress in experimental diabetes R. Ananthana, , , C. Baskara, V. NarmathaBaia, L. Parib, M. Lathab, K.M. Ramkumarb

• Systematic Review of Herbs and Dietary Supplements for Glycemic Control in Diabetes

-Gloria Y. Yeh, MD, MPH12, David M. Eisenberg, MD1, ed J. Kaptchuk, OMD1 and Russell S. Phillips, MD12