5/1/2013 - aao david -- normal vs...5/1/2013 1 normal vs. optimal health the new paradigm of choice...

5/1/2013

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Normal vs. Optimal Health

The New Paradigm of Choice David Leonardi, M.D.

American Association of Orthodontists

Philadelphia, PA

May 5, 2013

5/1/2013 225 Union Blvd. Ste 400, Lakewood, CO 80228 1

A B

The Science is Here

• Disease biochemical pathways have been mapped.

• We now have biomarkers to measure disease pathways.

• Much of what promotes disease, we do to ourselves.

• We now have the technology…

Degenerative Diseases

• Heart Disease

• Cancer

• Dementia – Alzheimer’s

– Vascular

• Stroke

• Parkinson’s

• Diabetes

• Osteoporosis

• Osteoarthritis

How We Age

• Oxidative Stress

• Glycation

• Inflammation

• Declining levels of vital hormones

• Dyslipoproteinemia

• Acidic Nutrition

• Cruise Ship Buffets

Oxidative Stress

• Electron Transfers – Systems

– Organs

– Tissue

– Cells

– Molecules

– Atoms: Nucleus + electrons

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Electron Transfers

• Structural Change

• Unimportant to critical

• Cancer, heart disease, dementia

Glycation

5/1/2013 225 Union Blvd. Ste 400, Lakewood, CO 80228 9 225 Union Blvd. Ste 400, Lakewood, CO 80228 10

Glycation: The bonding of glucose to protein

Cell Membrane

225 Union Blvd. Ste 400, Lakewood, CO 80228 11

AGE Formation

Cell Membrane


AGE Inflammation

Lymphocyte

AGE

Cytokines

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Inflammation

• Brain cell death – Alzheimer’s disease

– Parkinson’s Disease

• Plaque formation – Coronary Heart Disease

– Stroke

• Cancer risk


Aging

Glycation

Oxidative Stress Degenerative

Disease

Inflammation

AGEs

Air Pollution

Use Recirc Button

Water Pollution

Good: Carbon filtration Best: Reverse Osmosis or Distilled (supplement minerals – Ca, Mg, K)

Produce Pollution

Avoid Pesticides Organic Produce

Limiting Oxidative Stress

• Avoid pollution – Air, water, pesticides

• Eat lots of fruits and vegetables

• Take antioxidants – Beta carotene, vitamins C&E, selenium, alpha lipoic acid, CoQ10, N-

Acetyl Cysteine

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Blood Glucose and Glycation

Blood glucose

HbA1C


Glycemic Load Comparison

• ½ cup mashed potato

• GI = 70

• AC = 24

• GL = 16.80

• ½ cup broccoli

• GI = 32

• AC = 2.8g

• GL = 0.9

½ cup of mashed potato has the same GL

as 9 1/3 cups of broccoli

225 Union Blvd. Ste 400, Lakewood, CO 80228 21 225 Union Blvd. Ste 400, Lakewood, CO 80228 22

“Complex Carbs” vs. Table Sugar

Carb Glycemic index

French baguette 95

White bread 71

Whole wheat bread 72

White potato 85

Sweet potato 61

White rice 64

Brown rice 50

Table Sugar (Sucrose) 64


Low GL

• Low GI

• Low density – Non-starch vegetables


Moderate GL

• Low GI • High carb density

– Legumes – Pasta – Oatmeal – Brown Rice

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High GL

• High GI

• High density

– Sweets

– Starches

– Bananas, kiwi, mango, papaya

– All fruit juice

– Carrot and beet juice


How To Keep Blood Sugar Low

Eliminate:

• Bread • Rice

• Potatoes • Cereal

• Chips, Crackers

• Sweets (exceptions: sucralose, stevia, sugar alcohols)

• Corn, Beets, Peas • Watermelon, Bananas,

Kiwi, Mango, Papaya

Limit:

• Pasta • Legumes

• Oatmeal

• Brown rice

Consume:

• Non-starch vegetables as a sole source of carbohydrate – preferably organic

Glucose and Insulin vs. Time

Blood

Glucose

and

Insulin

Time of Day meal


Sugar, Starch and Obesity

• Dr. Alemzadeh, U Tenn.

• 24 obese patients

• Low cal diet + exercise

• Half the insulin Double the fat loss!


Sugar, Starch and Cancer

• 89,000 women studied for approx. 15 years

• Overweight + high glycemic foods

• 2 ½ X pancreatic cancer

Charles Fuchs, M.D., Dana Farber Cancer Inst. + Harvard School of Public Health.

Journal of the National Cancer Inst. Sept. 4, 2002


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FATS

• Good – n 3 – Fish Oil

• Flax seed oil not recommended – n 9 – Olive oil, avocado, almonds

• Bad – Saturated (meat & dairy) – n 6 – Sunflower, safflower, corn, soybean

• Ugly

– Trans (hydrogenated oil) • Margarine, fried foods, baked goods

• candy bars, chips, crackers

• Ingredients label (hydrogenated)

Hormones and Aging

Testosterone

Breakfast of Champions Testosterone Decline

• Decreased muscle mass

• Increased body fat

– Especially visceral fat

• Decline in scores of mood

• Increased irritability

• Declining cognitive skills: memory and concentration

• Increase likelihood of dementia

• Increased risk of coronary disease and diabetes

• Decreased libido

• Erectile dysfunction

• Decreased aerobic capacity

LI Goals of Therapy

Goal:

• Men and Women – 66th percentile for age 40.

– Upper normal range

Benefits of Testosterone

• Reduced Heart Risk – Waist/Hip Ratio – Cholesterol – Triglycerides – Blood sugar – Insulin – Blood Pressure

• Elevated mood and reduced anxiety

• Improved memory and cognition

• Increased bone density • Increased libido • Improved sexual

performance • Increased M. mass • Decreased body fat

– Especially visceral

• Reduced diabetes risk • CHD:

– Greater exertion – Less chest pain

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Benefits of Testosterone

• After menopause: Women on Estrogen alone lost memory building; those on Estrogen + testosterone did not.

• Testosterone decreases beta amyloid formation (Alzheimer’s Disease).

Risks of Testosterone

• MEN: – Existing prostate cancer can be fueled

• MEN and Women – Unmonitored: Elevated level could lower HDL cholesterol

Doctor Awareness?


Menopause

• Ovaries retire

• Production of estradiol, progesterone and testosterone plummet

• Menstrual cycle stops

Menopause

• Vaginal dryness

• Incontinence

• Hot flashes

• Atherosclerosis accelerates

• Blood becomes hypercoagulable

• Bone loss occurs

• Mood swings (depression)

• Thinning and drying of skin

Menopause

• Premarin and Provera

• 20 years of research: These drugs are good

• 2002: WHI: These drugs are bad – Slightly higher incidence of:

• Heart attack

• Stroke

• DVT

• Pulmonary Emboli

• Breast Cancer

• Dementia

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Premarin: Not a hormone, but a drug

• Conjugated Equine Estrogen – Horse Estrogen – 23 estrogens, 2 natural – Taken orally

• Oral administration of any estrogen – Increases clot risk

• Stroke • Heart Attack • DVT • Pulmonary Embolus • Dementia

Tendency to Clot

Women after menopause

Current oral ERT users were 3.5 times more likely to develop VTE than non- ERT users. Transdermal ERT use, however, was actually tied to a 10% reduction in the VTE risk compared with non-use. Lancet 2003;362:428-432.

Another drug

Provera, a synthetic progestin (another drug) – Not progesterone

– Foreign to the human body

– Carcinogenic in animal studies

– Promotes human breast cell division (growth)

The Good Hormones

• Bioidentical

• Estradiol (never orally)

• Estriol

• Progesterone

Bioidentical Progesterone

• Protects the uterus

• Builds bone

• Balances Mood

• Anti-proliferative for human breast cells – Testosterone

– DHEA

DIM: Di-indolyl methane

Estradiol

16 alpha-OH Estrone (Ca)

4-OH Estrone (Ca)

2-OH Estrone (B)

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DIM: 100 mg daily

Estradiol

16 alpha-OH Estrone (Ca)

4-OH Estrone (Ca)

2-OH Estrone (B)

Melatonin 1-3 mg bedtime

• Peaks age 13

• Natural deep sleep

• Immune stimulator

• Antioxidant

• Potent cancer inhibitor

Reversing Osteoporosis

• Don’t smoke (direct effect on bone density)

• Avoid cola and Dr. Pepper (phosphoric acid)

• Alkalinize your diet

• Weight-bearing exercise

• Nutrient intake – Calcium, Vit D, Boron, Manganese, Zinc, Copper, Silica, Vit K

• Hormone replacement – Testosterone, DHEA

– Estradiol, Progesterone

– Growth hormone for a select few


Alkaline Nutrition

Acidic Foods • Animal Protein (limit)

– meat, fish, eggs, dairy

• Grains (eliminate)

– wheat, corn, rice, barley, rye, oats, quinoa, etc.

• Potato (eliminate)

Alkaline Foods

Non-Starch Veggies Fruit Plant Protein

- Soy

Edamame Tofu


Protein 20%

Non-Starch Vegetables

80%


Famous Last Words:

“My cholesterol is great!”

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Grim Statistics

Coronary heart disease (CHD) still

kills 28% Americans

• men and women

Women have decreased risk until age 60

when their risk equals that of men


Reversing Heart Disease

Bulletin:

The disease that kills 28% of us…

…is now REVERSIBLE!


Interventional Approach

Wait until the disease manifests and undergo: Sudden Death (25%),

or

Recovery with disability (75%) • Angioplasty

• Bypass Surgery

Or….


Proactive Approach

Make use of: Biomarkers to detect disease several decades before symptoms begin.

Technology to alter the disease process in this pre-symptom phase.


Preventing Heart Attack

Traditional risk biomarkers: Family History

Smoking

High Blood Pressure

Diabetes

Dyslipidemia (High Ratio of TC:HDL-C)

Overweight

Stress

Sedentary Lifestyle


Cholesterol: How Valid?

100% of statin users drop their LDL-C

Only a 21-40% reduction in heart attacks

Yet plaque proven to be reversible

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Cholesterol: How Valid?

Scandinavian Simvastatin Survival Study

31%

Heart Protection Study

21%


Here’s Why

LDL Cholesterol is only a surrogate marker.

Drives the getaway car.

Not the trigger man.

The direct offending agents are:in particles

• Lipoprotein particles that carry LDL-C

• Oxidative stress

• Glycation

• Inflammation


The Hard Truth About CHD.

Plaque Formation

Weissburg PL, Rudd JHF. In: Topol EJ, ed. Textbook Cardiovasc Med 2nd Ed 2002.

Inflammation

Penetration

Low-density lipoproteins (LDL) are the known causal agents in atherosclerosis.

Oxidation

Glycation


The classic concept of plaque progression from normal to a critical lesion.


Most common mechanism of heart attack:

• Inflammation erodes the protective cap

• Causing a clot / heart attack even with a small amount of plaque.


Impact of LDL Size

100 mg/dl 100 mg/dl

Large LDL Particles

Small LDL Particles

Up to 70%

more particles

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Risk of Small Dense LDL

• Quebec Cardiovascular Study

– 2057 subjects

LDL Cholesterol Relative Risk

Large LDL

Upper 1/3 2.8

Middle 1/3 1.3

Lower 1/3 1

Relative Risk

Small LDL

4

3.4

1.5



More Non-Traditional Yet Critical Risk Factors


Indicator

Normal Optimal Treatment

Lipoprotein (a) < 30 < 30

Niacin

C-reactive protein 2-3 < 1 Optimize other risk factors (Lipoprotiens, BP, BS)

Homocysteine 5-11 < 7 B6, B12, Folic Acid, TMG, NAC

Fasting Insulin 0-22 < 6 Low Gly Nutrition/ Exercise

Ferritin 20-380 < 100 Donate Blood


Getting from 30% to 100%

Measure and modify: • LDL-P • LDL,HDL particle size • Large HDL-P • Large VLDL-P • Lp(a) • CRP • Homocysteine • HbA1C • Insulin • Ferritin • Free testosterone in men • Bioidentical HRT in women • Body fat %


Reversing Plaque

CIMT Mean Change from Previous

% Change Comp Age Age Diff

07/07 .717 07/07 -.147 07/07 -17% 07/07 57 07/07 +12

04/06 .864 04/06 N/A 04/06 N/A 04/06 70 04/06 +26

CIMT Max Change % Change Plaque R Plaque L

07/07 .822

07/07 -.209

07/07 -20% 07/07 (1)

1.145

07/07 (3)

1.382

04/06 1.031 N/A N/A 04/06 (2) 1.297

04/06 (3)

1.705

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How We Can Engineer This Information to

Deliver to Real People


Measure Baseline Biomarkers

MEDSTART (MEDical STatus And Risk Targeting)

Blood drawn at home 2 weeks prior

Medical history questionnaire

All day visit:

DXA Scan

Cognitive Stability Index

Strength and Flexibility

Resting Energy Expenditure

Complete physical


LI Procedure

Our tools:

• Education

• Optimal nutrition

• Nutritional supplementation

- Targeted at specific disease risk markers

- Demonstrated to be preventive for:

Cancer, cardiovascular disease, dementia

• Optimal hormone balancing

• Exercise program: aerobic and anaerobic

• Prescription medication when advantageous


Ongoing Program:

• Limited to 300 patients per physician

• Unlimited professional contact

• Prescheduled testing every 13 weeks

• Scheduled visit after each test module

- Review results and alter program

• Quarterly Newsletter with updates

LI Procedure


J.D. Charlotte, NC

Date Total Cholesterol

(<200)

LDL

(<100)

HDL

(>50)

CRR

(<3.0)

Triglycerides

(<100)

2-5-05 141 74 52 2.7 75

1-5-05 257 187 50 5.1 99


J.D. Charlotte, NC

Date LDL P#

(<1000)

LDL P Size

(>20.5)

Small LDL

(<600)

Large HDL

(>30)

Large VLDL (<7)

2-5-05 913 21 463 23 9

1-5-05 1834 21 857 8 20

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Date Lp(a) (<30) CRP (<1) Homocysteine (<7)

2-5-05 27 0.4 7.4

1-5-05 55 5.9 18.7

J.D. Charlotte, NC


Date DHEAS T. Tes F. Tes

2-5-05 204 787 127

1-5-05 129 393 63

J.D. Charlotte, NC


Putting it all together…

Slow, arrest or reverse: Oxidative Stress

Glycation

Inflammation

Declining levels of vital hormones

Dyslipoproteinemia

Acidification


Goals:

Enhance vitality

Prevent degenerative disease Coronary Heart Disease

Diabetes

Cancer

Alzheimer’s Disease

Parkinson’s Disease

Osteoporosis

Osteoarthritis

Autoimmune Disease


Final Message

The processes underlying degenerative disease are invisible.

The majority of people will pour 10 times the resources into life issues that are more visible than protecting their health… until

the illness is visible.

5/1/2013 - aao david -- normal vs...5/1/2013 1 normal vs. optimal health the new paradigm of choice...

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