®

Understanding Understanding

Your Your

TestsTests

®What’s Your Wellness Score?Get a Good Grade In Your Health

®Body Mass Index (BMI)Body Mass Index (BMI)

BMI = BMI = WeightWeight (in kg)(in kg) Height Height22 (in meters)(in meters)

Lbs/ inchesLbs/ inches22 x 703 x 703

A BMI of A BMI of <25 <25 = = desirabledesirable25 – 29.9 25 – 29.9 = = overweightoverweight>30 >30 = = obeseobese

Tells us if you are over weightTells us if you are over weight

®Relationship of BMI to Relationship of BMI to

Excess MortalityExcess Mortality300

Age at Issue

Bray GA. Overweight is risking fate. Definition, classification, prevalence and risks. Ann NY Acad Sci 1987;499:14-28.

20-29250

Mort

alit

y R

ati

o

Body Mass Index (kg/[m2])

200

150

100

50

150

30-39

20 25 30

LowRisk

4035

High

Risk

ModerateRisk

® Waist/Hip RatioWaist/Hip Ratio Waist/Hip RatioWaist/Hip Ratio

Ideal: <.80 Woman and <.95 ManIdeal: <.80 Woman and <.95 Man

Tells us if you are Over-Fat. Skinny fat person can have Tells us if you are Over-Fat. Skinny fat person can have normal BMI and high body fat.normal BMI and high body fat.

Adipose Tissue is the largest endocrine gland in the body Adipose Tissue is the largest endocrine gland in the body and produce:and produce:

• Inflammatory chemicalsInflammatory chemicals• EstrogenEstrogen• CortisolCortisol

®Blood Pressure & Resting PulseBlood Pressure & Resting Pulse

Blood PressureBlood PressureSystolic less than or equal to 110mm-GoodSystolic less than or equal to 110mm-GoodDiastolic equal to or less than 70mm-GoodDiastolic equal to or less than 70mm-GoodGreater than 130/85mm is Mildly HypertensiveGreater than 130/85mm is Mildly Hypertensive

In Blood Pressure above 11/5/75, a 10 point In Blood Pressure above 11/5/75, a 10 point jump in Diastolic BP (bottom number), causes a jump in Diastolic BP (bottom number), causes a 2-fold increase in death from heart disease2-fold increase in death from heart disease

Medications??Medications??

®Sugar BiomarkersSugar Biomarkers Fasting GlucoseFasting Glucose

80-100 mg/dl80-100 mg/dl

If Fasting Glucose is above 100 mg/dl then consider If Fasting Glucose is above 100 mg/dl then consider HbA1C- Glycosylated HemoglobinHbA1C- Glycosylated HemoglobinNormal range is 4-5.9 %. In poorly controlled diabetes, its 8.0% or Normal range is 4-5.9 %. In poorly controlled diabetes, its 8.0% or above, and in well controlled patients it's less than 7.0% above, and in well controlled patients it's less than 7.0%

The predictive value of HbA1C for total mortality was stronger than The predictive value of HbA1C for total mortality was stronger than that documented for cholesterol concentration, body mass index and that documented for cholesterol concentration, body mass index and blood pressure.”blood pressure.”

Khaw, K-T, et al, BMJ, 2001, Vol 322: 1-6Khaw, K-T, et al, BMJ, 2001, Vol 322: 1-6

Also consider Fasting InsulinAlso consider Fasting InsulinIncreased insulin production causes insulin resistanceIncreased insulin production causes insulin resistanceSign of Insulin Resistance with levels over 15 uU/ml Sign of Insulin Resistance with levels over 15 uU/ml

®Lipid BiomarkersLipid Biomarkers Lipids, fractionated lipidsLipids, fractionated lipids

• Total Cholesterol-under 200Total Cholesterol-under 200• Triglycerides-under 150, preferably under 100Triglycerides-under 150, preferably under 100• HDL-over 50 (male) and over 60 (female)HDL-over 50 (male) and over 60 (female)• LDL-under 130LDL-under 130• Trig/HDL ratio- under 2.0Trig/HDL ratio- under 2.0• Chol/HDL ratio- under 3.0Chol/HDL ratio- under 3.0

Triglyceride/HDL ratio predicts a heart attack 17 Triglyceride/HDL ratio predicts a heart attack 17 times more accurately than just Cholesterol times more accurately than just Cholesterol numbers.numbers.

®

Medical Symptoms Questionnaire (MSQ)

- Identifies symptoms in most body systems

- Quantifies patient’s level of symptoms

- Provides a simple metric to track patient improvement

Consider an MSQ- Systems Evaluation

®EPIC HEALTHY LIVING STUDYEPIC HEALTHY LIVING STUDY Participants with allParticipants with all 4 4

factors to the right had a factors to the right had a 78% lower risk of 78% lower risk of developing a chronic developing a chronic disease (diabetes disease (diabetes 93%; 93%; myocardial infarction 81%; myocardial infarction 81%; stroke 50% and cancer 36% stroke 50% and cancer 36% than participants without than participants without

engaging in healthyengaging in healthy factorsfactors..

Arch Intern Med.Arch Intern Med. 2009;169(15):1355-1362 2009;169(15):1355-1362. .

1. BMI Under 301. BMI Under 30

2. 3.5 Hours of Physical 2. 3.5 Hours of Physical

Activity Per WeekActivity Per Week

3. Following a Healthy 3. Following a Healthy

Diet (fruits, vegetables,Diet (fruits, vegetables,

beans, whole grains, beans, whole grains,

nuts, seeds, and nuts, seeds, and

limited amounts of meat)limited amounts of meat)

4. Never Smoking4. Never Smoking

®How to Identify Patients withHow to Identify Patients withMetabolic SyndromeMetabolic Syndrome

National Cholesterol Education Program (NCEP) definition is the presence of 3 or more of the following:

Waist Circumference Men >40 in, Women >35 in

Triglycerides ≥150 mg/dL

HDL Cholesterol

TG/HDL Ratio ≥3

Men <40 mg/dL; Women <50mg/dL

Blood Pressure ≥130/≥85 mmHg

Blood Glucose ≥100 mg/dL

According to the CDC if you have any two of these symptoms you have double the risk of death from coronary heart disease and if

you have 4 of the above you have 3.5 times the risk.

®General Features of General Features of Metabolic SyndromeMetabolic Syndrome

Abdominal obesityAbdominal obesity Men – waist > 40 inches, or waist is larger than hipsMen – waist > 40 inches, or waist is larger than hips Women – waist > 35 inches, or waist is greater than 80% the size Women – waist > 35 inches, or waist is greater than 80% the size

of hipsof hips Altered blood lipids (fats)Altered blood lipids (fats)

High triglycerides, trig/HDL ratioHigh triglycerides, trig/HDL ratio Small LDL cholesterol particlesSmall LDL cholesterol particles Low HDL cholesterolLow HDL cholesterol

Raised blood pressureRaised blood pressure Insulin resistance (Insulin resistance ( glucose intolerance) glucose intolerance) Pro-thrombotic state Pro-thrombotic state (blood clotting tendency)(blood clotting tendency)

Increased Fibrinogen and PAI-1Increased Fibrinogen and PAI-1 Pro-inflammatory state Pro-inflammatory state

Increased IL-6 and hs-CRPIncreased IL-6 and hs-CRP

firstline

therapy

®Weight Management/NutritionWeight Management/Nutrition

What is Food?What is Food?

®Food is a MixtureFood is a Mixture

30-20-1030-20-10

Protein20 g

Carbohydrate30 g

Fat10 g

®What Hormone is secreted when your eat What Hormone is secreted when your eat sugar? Understanding sugar? Understanding Glycemic IndexGlycemic Index

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®Understanding Food LabelsUnderstanding Food Labels

®Use your hand as your guideUse your hand as your guide

Carbohydrate- Fist

Protein- Palm

Fat- Thumb

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Question?Question?

How many teaspoons of How many teaspoons of sugar in a 20 ounce soda?sugar in a 20 ounce soda?

Bonus question – what is Bonus question – what is the average pH of a soda the average pH of a soda (diet or regular)?(diet or regular)?

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Are you eating like aAre you eating like a BEAR or a DEER? BEAR or a DEER?

Eats Big Meals 2-3 times a day! Eats Small Meals 5-7 times a day!

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Eating OutEating Out

Don’t look at the menuDon’t look at the menu The average restaurant portion size is 4-5 The average restaurant portion size is 4-5

X a normal sizeX a normal size The calories add up quicklyThe calories add up quickly No Starch-Double VegetableNo Starch-Double Vegetable Split meals and ask for the “to go” Split meals and ask for the “to go”

container ahead of timecontainer ahead of time No bread before dinner!No bread before dinner!

®Good Fat vs. Bad FatGood Fat vs. Bad Fat

70 Trillion Cells in the Human Body!!

®Power of HabitsPower of Habits