Initiating the First Steps to a Lifetime of Change

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

Enrique Saguil, MD

• “The best use of a physicians knowledge is to teach people to heal themselves…”

-David Simon, 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, LCPCJennifer Green, NDJoe Musolino, DCAmy Iaquinta, DCNick Nowicki, DC

Emery Paredes, PTCourtney Day, EPYu Zhu, MD China

Mike Blumberg, LCPCAimee Weber, EP

You

grounding

nutrition

movemen

tWe 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

Enrique Saguil, MD

• Family Medicine West Suburban• Sports Medicine St Joseph• Medical Acupuncture UCLA• Integrative Medicine AZCIM• Yoga Teacher The Chopra Center• No affiliations with REI or Whole Foods Market• In Private Practice in Arlington Heights, IL• Author of Running Behind (release date 8/2012)

What’s the “End Game” in change:

• Longevity• No medicines• Mobility• Love/companionship/passion• Community• Family • Fulfillment

Current methods

• Diet• Group challenge• Surgery• Retirement (early)• Job change • Down-sizing economic expectations

The usual roadblocks

• Cravings• Damaged Relationships• Overstepped Financial Obligations (live-in divorce)

• Aggressive Fad Diets• Side effects (chemical effects) of food• Unaddressed Stress Response/no RR• Limited free time• Frustration with usual coping skills• Risky Behavior during Anger (DABDAR)

• Food Insecurity• Information overload

STRESS!!!

Why do we crave?

What is stress eating?

Why is there guilt?

Is it the food industry?

Are these food allergies?

Am I depressed?Am I sleepy?

MOVIE TRIVIA!!!

?3 min preview:

1966 Oscar for Special Visual Effects

Tobacco?

out of control in ear fluid

Strangled by antibodies

Lazering the blood clot

White Corpuscles Attack the “Foreign Bodies”

White Corpuscle Digests the Ship Helm

The End

Movie Synopsis:

• Stressor occurs to the body (-blood clot)• Body needs help in healing (-team)• Western medicine has treatment but dangerous side

effects (-brain surgery 1966)• Team travels inside to “target” the problem • Journey dangerous in avoiding body defenses• Every cell along the way had its function but all

together played a role in sustained survival• Human’s natural healing/defenses win in the end with

the assistance of medical science!!!!Back to teaching

All Cells Different but the Same

The Nucleus (DNA)

The blob

DNA – stored messages for 80 years

• Your DNA will only replicate properly when given the proper environment!

• Old-school: traits & character controlled by genes• New-school: environment controls genetic activity

and even the rewriting of genetic code

Richie Davidson, PhD Harvard/U of WIEsther Sternberg, MD NIHJeff Ducek, PhD Mass Gen Hosp/U of MNHerb Benson, MD HarvardBruce Lipton, PhD ….

•Epigenetics•Neuroplasticity…..

…..next time.

Teaser!!!

Reference books

Love your genes!!

• JAMA. 2010 Jan 20;303(3):250-7. Association of marine omega-3 fatty acid levels with telomeric aging in patients with coronary heart disease.

Or Face Mutation

Genetic Expression?

Genetic Expression

ASTHMA

IBS DEPRESSION HEART DISEASE

THYROID

Genetic Expression?

I don’t have any stress in my life doc!

• The study of social aggression in baboons• Lower strata males had higher stress and….• ….with increased brain stress hormone level; HBP, high heart rate, poor

reproductive capacity.

• Later TB wiped out the aggressive males • The resulting troop lived longer with multiple heiarchies and important duties

within each heiarchy• Less aggressive male combat, less “dumping” on a female, more grooming, no

intimidation of younger, no biting of mother

• New troop -Low aggression, high social affiliation, less disease

Scientist Robert Sopolsky

Love is the Answer!• Telomeres shorten with age normally• Stress speeds up shortening Biologist Elizabeth Blackburn• For every year of care for a chronically ill child ….add on 6 years of aging to the mom• Compassion and caring may add to increasing telomerase and

healing (at the DNA level) Psychologist Elissa Epel, PhD UCLA• Mind-body interventions affect gene expression and disease

vulnerability by improving response to oxidative stress and associated cellular damage, and inflammation.

Ducek Harvard 2008

New School Ways to Love your Cells

• Mind body modalities:• Hypnotherapy• Yoga/guided imagery • MBSR/CBT• Increase serotonin/relaxation response • Reinforce good food/cell environment• Meditation/biofeedback

Old School ways to “Love your cells” :)• Eat your vegetables• Take your vitamins• Listen to your elders• Do your chores• Do your homework• Get to bed early• Say your prayers

4-7-8 Breath Work for Stress Relief

You can go to http://www.herbal411.com/the_library and catch a 2 minute demo

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

done

• “Let food be thy medicine and medicine be thy food….” -Hippocrates

Looks good, feels good-do you indulge?

Looks good, feels good-do you indulge?

Diets • Atkins: induction-premaintenance-maintenance, low fiber fruits veg, multiple returns to

induction phase can lead to prob with TC, LDL, BP, osteop, kidney stones• Zone (Sears): 3meal+2 snacks, may be low in fiber some vits, rigid planning• Eat Right for your Type (D’Adamo): O-hunter diet/A-gather diet/B-varied + dairy/AB-little

of all, O’s could have same prob as Aktins• Sugar Busters: 3 balanced meals/d, nothing after 8pm, may be low in fiber and some vits, • Body for Life (Phillips): 6 small fit meals with one day for crave, protein supplements

expensive, rigorous exercise scd• Volumetrics (Rolls): no structured pattern but no skipping and no snacks, water/foods

high in water content/ caloric restriction• Eat More Weigh Less (Ornish): eat when hungry and get satisfd, comlex CHO, vegtarian,

low in B and Zinc, fat intake falls 10% (watch fatty acid cut)• South Beach (Agaston): 3 phases/ low CHO,reintroduce,maintenance, phase 1 low in fiber

and potentially calcium, may be high in sat fat• Raw Foods: 80% raw, not over 118*, using dehydrator to hot air sprout, blend,juice,chop,

watch B12 and Vit D

Diet Wars

A Review found more weight loss at 12 months with Atkins than Ornish, Zone or LEARN• Gardner, et al 20075.9 kg in 6 months regardless of WeightWatchers, Atkins Slim Fast• Truby, et al 2006At any given time, 45% women and 30% men on a diet• Serdula, et al Jama 1999

Carb-Monosaccarides

• Glucose• Glycogen• Fructose• Galactose

Polysaccarides

• Maltose glu + glu• Sucrose glu + fru• Lactose glu + galact

• Amylose (starch)• Amylopectin (starch)

Carb-Disaccarides

Carb-Fiber

• Soluble -pectins, gums, mucilage• Insoluble –cellulose:whole wheat flour,

vegetables, bran -- hemicellulose: bran, whole grain -- lignins: vegetables, wheat, fruit, edible seeds

Proteins

• Its not just beef that gives muscle• Plant based proteins can total same with less

side effects (antibiotic traces, hormones, sat fat)

• Care with protein supplements!

• Ocean and fresh water fish (uncontaminated sources)

• Veggie burgers• Egg whites, (organic if possible)

• Whey protein (micro-filtered, lactose-free)

• Occasional shell fish, omega 3 whole eggs, veggie meat subs, tuna (canned but check ewg for amount/week), swordfish (high Hg), mackerel (high Hg)

• None or Rare Non O3 whole eggs, Lean game (venison, ostrich buffalo), Textured veg protein, naturally smoked fish, skinless free-range white meat free range poultry, grass-fed beef

Protein examples Keith Block, MD

Fats 30% of your daily intake

Lyon Heart Study (good fats)

• Some had 40% of daily calories from fat• (vs 20% from fat with the AHA diet)• 70% reduction in cardiovascular mortality and

morbidity• Quality not the quantity of fats…..discuss!

“Get” your Physiology

• Break down carb-get into bloodstream• Insulin secreted• Carb initially goes to remake liver and muscle

glycogen stores (70kg stores about 300gm)• Excess floats for a “second”, > glycolysis, >ATP,

>acetyl CoA,>fatty acid synthesis,>fat deposition I get it!!

Hormonal action with eating

• Insulin release stimulates glycolysis and causes glycogen formation

• Glucagon/epinephrine stimulate glycogenolysis

• When blood glucose is high, glycation of protein occurs esp in the glom.bas.memb, vascul.enoth, eye lens (glycation causes malfunction of the organ it attacks)

Side effects with food

• Very subtle• Very powerful• Play on hormonal responses• Powerful technology for research• Started as innocent money making for the

food industry-now with evidence for damage not so innocent anymore

Why bother with the side effects?

• $294 million targeted at kids fast food indust

Processed Food Side Effects:Faster spike of sugar “high”

Lower drop “crash”

With the fast peak and abrupt drop, “markers” of inflammation are released into the blood

Spaghetti

White Bread

Slow and steady release

Fast and persistent release

Whole Foods Market -ANDI scores

A mostly plant based diet gives more than just fiber

Nutrients & Phytochemicals with National Cancer Institute Clinical Development Plans

Calcium18?-glycyrrhetinic

Vitamin ACarotenoids

Indole-3-carbinolVitamin D analogs

CurcuminPerillylic acid

Vitamin EFolic acid

9-cis-retinoic acidGenistein

Tea polyphenols

Is “rabbit food” worth it?

• Esselstyn’s subjects had 70% reversal of 3v ds• Ornish’s subjects had stopped or reversed

severe coronary artery disease in 1y (+in 5y)• Ornish’s beneficial gene expression in 3mth prostate ca slowed/stopped/reversed• Effective January 1, 2011, Medicare Part B will

cover "Dr. Ornish's Program for Reversing Heart Disease" We eat “rabbit food “ too!

Information = Empowerment

• Sift through the SH_T• Attend lectures WholeFoodsMarket.com• Visit your library (lectures and DVD’s)• See a registered dietician -RD

• Challenge your doc –MD• See a naturopathic doctor -ND

http://www.eatright.org

http://www.naturopathic.org

My Take on Vitamins

• Standard American Diet is lacking in nutrient• In all cases of disease, poor nutrition

exacerbates symptoms• In many cases of performance plateau,

nutritional depletion is a contribution• Good but don’t go overboard-(invest in food)

DrRic Rules!

• Multivitamin• Omega 3 Fish Oil Everyone• Vitamin D3• Vitamins/Botanicals -Personal deficiencies

• Mostly plant based diet (51% at least!)• “Inject daily 5-7fruits and veggies, your grains,

your organic produce into your food stream”

www.ewg.org

grounding

nutrition

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

done

• “What in the morning was true, will at evening have become a lie….”

-Carl Jung

• “I felt like I was in a concrete suit” LL Graduate

• Not everyone likes running• Knee joints become arthritic with disease• Joining a gym – only good if you get there• Act your age? – Andy Weil, MD

• Some diseases are selective due to meds• Bound for glory or failure?

Move It or Lose It!

Small changes are ok• Daily routine (parking, stairs)• Building exercise aerobic strength and flexibility training

small tangible 5-10min in group of three• Reflect after 24hours on side effects • Increase duration • Strength 8-12 rep• Flexibility tr good comp to aerobic and strength tr

The following are DrRic’s opinions:

Resistance Training

Old school but very availableEasy to sit in a machine and follow the instructions

Get a “burn” and big musclesTendinitis

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 help “green living”Watch back/neck

Watch wallet and the roadWatch speed/coasting

Running

Long developed community activityCan be done by any age

Addictive (positively-chi running)Watch the lower extremities

(Shoes!)

SAD

http://www.cararuns.org

Yoga!

Ancient artPopularity high, lots of places

Low injury riskExcellent at cultivating relaxation response

Excellent flexibility/power/balance Detoxing

Still Growing with multiple styles

http://www.yogachicago.com/

Hiking

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

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

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

Watch animals

http://www.rei.com/stores/118

No Membership Required!

Loop Trail

One Way

Elk GroveSchaumburg

Argonne Lab/Waterfall Glen

Spring Valley Nature Sanctuary

Starved Rock

Devils Lake

Walking Stats and “gettin sweaty”

MET’s (cal/kg/hr):Sitting for this lecture= 1 METHiking= 6-7 MET Jogging 12min/mile 8 METBike 10-16 mph 6-10 METSwimming fast 6-10 MET

4 min mile=15mph5 min mile=12mph10min mile=6mph12min mile=5mph15min mile=4mph20min mile=3mph25min mile=2.5m/h

Adapted from Compendium of Physical Activities. Ainsworth, BE et al. Medicine and Science in Sports and Exercise. Vol 25, Pg 713 (1993) and Vol 32, S498 (2000).

Advanced trainingto break your barrier <2hours

• Increase in speed or resistance• Cross training (endurance and altitude work)• Flexibility is a universal improvement any

sport

Invest in an Exercise Physiologist- it pays off!

EP’s Rule!!!

+OT/PT’s Rock the Joint!!What works for Sean, doesn’t work for me;what works for me, doesn’t work for Liz….

My “Eyes” in the field:

Listen to the cues

grounding

nutrition

movemen

tWe 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

done

Keeping Healthy = Think outside the BOX

• Cultivating the Relaxation Response Ѱ LC • Mind Body Modalities MD/ Ѱ

Community/group tx (Dean Ornish says it helps)• Sleeping 6-8 hours MD/ND • Eating properly (Read and ask) MD/RD• Personal Diet Design RD• Exercise EP• Maintaining low BMI RD

….if you need help with the above, just ask my team at FHA!

First Health Associates

• Protection (long-term) is ultimately making a lifestyle change with education/guidance in

………..diet/movement/neutralizing stress.• Not one size fits all, sometimes “Steps” are necessary to

improve outcome while under the care of a qualified team.

We pride ourselves on developing a personal program with a multidisciplinary approach

to a sustainable lifestyle change.

FHA’s Steps of “Kaizen”

In making a change, everyone starts and ends at a different step…..

….make it sustainable by increasing your chances of success!

Starved Rock

Stress is a Distraction

Kathy204#

Cholesterol: 245

Kathy141# (in the 120s today)

Cholesterol: 191

Weeks 1-4: 3 Pounds Lost (0.75# per week)INTERVENTION: counseling to address stressWeeks 5-28: 48 Pounds Lost (2# per week)

Protein and Fiber for Satiety

Bill254#

Triglycerides: 338

Bill189#

Triglycerides: 68

Bill’s Meal PlanB: High Fiber OatmealSn: Cottage CheeseL: Turkey Sandwich + Carrot SticksSn: 2 String CheeseD: 4oz Protein, 1c Carb, 2-3c Veggies

Balancing Blood Sugars w/ Small Snacks

Pillars of Blood Sugar Management1) Nutrition2) Physical Activity3) Weight Control4) Stress Management5) Medical Monitoring

Mary292#

Fasting

Blood Sugar: 107

Mary227#

Fasting

Blood Sugar: 93

The Satiety King

Paul191#

“Eat until I’m stuffed” (FULLNESS)

Paul173#

“Eat Until I’m Satisfied”

Ric Saguil-life before

10/1/11 2013

Don’t wait for the catastrophe….make the change now.

Life now as a pesco/ovo vegitarian

Thanks for listeningQ&A

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

Next Lecture:October 29th Sat 3:00p

Pre-Diabetes...a Scary Diagnosis!Whole Foods Market Schaumburg

www.FirstHealthAssociates.com

QUESTIONS?

COMMENTS?CONCERNS?