girlfriend’s guide to a better you...angela lasalle md 11/15/2012 go red for women luncheon 9...

Angela LaSalle MD 11/15/2012

Go Red for Women Luncheon 1

Girlfriend’s Guide To A Better YouAngela LaSalle, MD

Medical DirectorIntegrative Medicine and

Parkview Women’s Health Center

Michele Helfgott, MD, FACOG

Not for profit, all for you.

Board certified OB/GYN20 years experienceFellowship in Anti-Aging and Regenerative Medicine

Committed to finding the root cause of disease, Dr. Helfgott treats issues associated with:

Menopause, perimenopause, Autoimmune diseaseGastrointestinal issues. Bio-identical hormone replacementAssists with nutritional counseling and exercise

INTEGRATIVE MEDICINEfocused on you



Objectives Understand the role of insulin in the

development of heart disease

Discuss dietary and exercise strategies to reduce insulin and improve risk factors for heart disease

Understand the role of stress in increasing inflammation

Review talking points for you and your doctor

Heart Attack Survival DifferencesBetween men and women following a heart attack:

42 percent of women who have heart attacks die within 1 year compared with 24 percent of men.

Women may not be diagnosed or treated as aggressively as men.

Their symptoms may be very different from those of men who are having a heart attack.



Postmenopausal WomenWith Metabolic Syndrome are at increased risk for a cardiovascular event.

Metabolic syndrome — a combination of high blood pressure, elevated blood glucose, abnormal lipid levels, and increased waist size — is known to be associated with elevated risk for heart attack and stroke.

Source: Brown, Vaidya, Rogers, et al., J Womens Health 17(5):841-847, 2008 (AHRQ grant HS13852).

Management of Chest PainDiffers by sex and race.

More men than women received definitive diagnoses of angina, while more women than men were diagnosed with vague chest pain.

Women and blacks received fewer cardiovascular medications than men and whites.

Source: Hendrix, Mayhan, Lackland, and Egan, Am J Hypertens 18(8):1026-1032, 2005 (AHRQ grant HS10871).



Treatment for Heart Attack and CHFWomen continue to fare worse than men in treatment for heart attack and congestive heart failure.

Study of gender disparities among adults age 65 and older, women with acute myocardial infarction (AMI) or congestive heart failure (CHF) do not receive the same care as men.

Source: Correa-de-Araujo, Stevens, Moy, et al., Women's Health Issues 16(2):44-55, 2006 (AHRQ Publication No. 06-R042).

Delays In Emergency CareWomen are more likely than men to experience delays in emergency care for cardiac symptoms.

On average, women arrived at the hospital 2.3 minutes slower than men.

Factors increasing delay included evening rush hour travel, bypassing a local hospital, and living in a densely populated neighborhood.

Source: Concannon, Griffith, Kent, et al., Circ Cardiovasc Qual Outcomes 2:9-15, 2009 (AHRQ grants HS10282, T32 HS00060).



The Role of InsulinIn Heart Disease



How does Insulin Work?

The results of insulin dysfunctionIt isn’t just about the blood sugar.

Higher insulin results in inflammationhigh blood pressureweight gainlipid disordersincrease in risk of heart attack, stroke, canceretc.

Abdominal Fat is a biochemical problem!



Diabetes: What causes it?Type 2 diabetes is a miscommunication between multiple organs:

IntestinesPancreasLiverBrainCells

It is not just a high blood sugar, but rather multiple biochemical abnormalities.

Insulin and Altered Lipid MetabolismElevated insulin alters the clearance of fats and sugars from the blood after meals.

Increases the release of inflammatory chemicals from the fat tissue.



Recommendations to Reduce Insulin



Table Sugar

Table SugarSugar:

The Bitter Truth by Dr. Robert Lustig Pediatric EndocrinologistYouTube

DVD: Sweet Suicide, A Documentary by Nancy Appleton, PhD

Sweet Suicide is a 60-minute documentary produced in 2009 by Nancy Appleton, PhD, about the health dangers of sugar. Appleton is America's most well known anti-sugar expert and author of Lick the Sugar Habit, which is still selling strong after 30 years in print.



Sugar Makes FatStudy:

Healthy med students were given a high fructose diet for 6 days

• Triglycerides doubled

• Free fatty acids in the blood doubled

• Insulin levels increased

• 5x more fat cells

Sugar Makes You OldSugar is implicated in all of the degenerative disease processes:

Heart DiseaseDiabetesAuto Immune DiseaseArthritisCancerImpotenceHormone disruptionsand…. Wrinkles



Watch Your FluidsRecent studies have shown that drinking one soda a day increases your risk of heart disease by 20%

Did you know that 4 grams of sugar equals approximately one teaspoon?



Nutrition Label – Coca Cola

Sober Thought

Some brands of baby formula contain up to 43% corn syrup and 10.3% sucrose

Coca Cola contains 10.5% sucrose



Sweeteners

Nutrition Label – Diet Nestea



Diet Soda and Weight GainUniversity of Texas Health Science Center in San Antonio San Antonio Longitudinal Study of Aging (SALSA)

70% greater increase in waistline (9.5 yrs later)

2 or more sodas a day resulted in 500% more weight gain than non soda drinkers

Results adjusted for diabetes status, physical activity and age.

Artificial SweetenersHundreds of times more sweet than sugar

Body preps for sweets and releases excess insulin

Blunts the neurotransmitters in brain that help you feel full

Result is you feel less satisfied, take in more calories and the body stores more fat due to higher insulin levels.

Implicated in inflammatory symptoms in some people



Overhaul Your Fluids Eliminate all soda

Look for any artificial sweeteners in your beverages

Increase your water intake

Limit coffee to no more than 2 cups a day

Eliminate juices…eat the fruit instead



Eliminate the Sweets Remember that flour also breaks down to

sugar…decrease the baked goods

Try keeping a food diary to learn your habits

Evaluate what you put in your beverages…creamers, flavors and look for sugars and sweeteners.

Start reading food labels for hidden sugars/sweeteners

Remember 4 grams of sugar equals a teaspoon

Balance any sugar intake with protein or fiber

Increase Your Vegetables Good source of nutritients: antioxidants,

phytonutrients, minerals

Good source of fiber

Helps hydration

Good source of carbs without high insulin response

Balance your plate with lean proteins (fish, chicken, lean cuts beef)



Watch Your Grains

Definition of “Whole Grains”

Consider eating non gluten grains

Avoid Processed flour

Exercise



Exercise 30 minutes daily

Decreases insulin resistance in skeletal muscle

Decreases inflammation

Rehearses the neurovascular connections of the body

All disease preventative

There is no substitute for the benefits of exercise!

Women and ExerciseOregon State University, April 2012

Women averaged 18 minutes of exercise

VS

Men averaged 30 minutes exercise daily

Best exercise Interval Training for aerobics with resistance training



Stress and Heart DiseaseStress causes increase in inflammatory chemicals

Affects on clotting

Constricts blood vessels

Increases heart rate and blood pressure

Job Stress Lack of control and low sense of reward

associated with two fold increase in new coronary events.

High stress, high reward/purpose less problematic.

Bosma et al. “Two alternative job stress models and risk of coronary heart disease.” American Journal of Public Health. Jan 1998, Vol 88, no 1.



Stress Management Breathing

Positive internal dialogue

Journaling

Defined sense of purpose

Social connections

Important to make stress management a regular habit

Talking Points with Your DoctorMeasurements:

WeightBlood PressureBMIWaist to hip ratio

0.8 or below, is normal



Talking Points with Your DoctorAsk for Testing:

25-OH Vitamin DFasting Glucose

< 95 is normal> 110, then glucose intolerant> 126 Diabetes

Fasting InsulinFasting Lipids

Talking Points with Your DoctorTesting considerations: EKG Stress testing Coronary imaging (HeartSmart

Scan or CCTA)



There is in every true woman's heart, a spark of heavenly fire, which lies dormant in the broad daylight of prosperity, but which kindles up and beams and blazes in the dark hour of adversity.

Angela LaSalle, MDAngela LaSalle is board certified in Family Medicine with a

fellowship in Integrative Medicine. She is a guest and keynotespeaker on a variety of medical topics and women’s health issuesand provides interviews for radio and print media.

A graduate of Indiana University School of Medicine, she received herfellowship in Integrative Medicine through the University ofArizona, a program founded by Andrew Weil, M.D.

Her practice includes assessment of thyroid, adrenals, treatment ofmetabolic syndrome, bioidentical hormone replacement as well ascomprehensive nutritional assessments. She provides integrativehealth care services for patients with thyroid, diabetes, metabolicand menopausal issues. A strong believer that inflammation is theunderlying cause of many diseases, she also incorporates nutritionand stress management into her treatment arsenal.

Dr. Angela LaSalle is Medical Director of Parkview Physician’sGroup Integrative Medicine clinical division and Medical Directorof the Parkview Women's Health Center located at the newParkview Regional Medical Center on its Parkview NorthCampus.

www.angelalasallemd.com

Visit her web site:

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