HEALTH WELLNESS

PREVENTION

A. M. Donna Gordon, MD, MPH, FACP

HEALTH, WELLNESS, PREVENTION

• Primary Prevention: Promoting Health; Preventing disease

• Secondary Prevention: Preventing complications of disease

DISCLOSURES

• Distributor with Wellness International

• I am not receiving any financial benefits for this lecture

• I will discuss a few off-label use of supplements

HEALTH, WELLNESS, PREVENTION

Outline• Why Prevention / Cancer as a preventable

condition

• The New Disease – Obesity & Adiposopathy

• Consequences of Obesity

• Perspective on Obesity

• Approach to weight loss / weight management

• Medical Benefits to Weight Loss

• Supplements and Vitamins

WHY PREVENTION

Some preventable conditions:

•Hypertension

•Diabetes mellitus

•Hypercholesterolemia

•Heart disease

•Stroke

•Cancer

OUTCOME OF UNHEALTHY LIFESTYLE CHOICES

Approx. 50% of deaths in the US relate to unhealthy lifestyle choices:

•Hypertension - 1 in every 3 adults •Diabetes - 8.3% of the population •Heart Disease - leading cause of death in the US; 1 death every 33 seconds•Obesity - 1 in every 4 adults in the US•Cancer - 2nd leading cause of death in the US; 1 of every 4 deaths

LEADING CAUSES OF DEATH IN CARICOM COUNTRIES BY GENDER 2004 (Carec)

MALES FEMALES

1.Heart Disease 1. Heart Disease

2. Cancers 2. Cancers

3. Injuries & Violence 3. Diabetes

4. Stroke 4. Stroke

5. Diabetes 5. Hypertension

6. HIV & AIDS 6. HIV & AIDS

7. Hypertension 7. Influenza/Pneumonia

8.Influenza/Pneumonia

CANCER PREVALENCE (US)

• In 2015, an estimated 1,658,370 new cases of cancer will be diagnosed in the United States and 589,430 people will die from the disease

• The number of new cases of cancer (cancer incidence) is 454.8 per 100,000 men and women per year (based on 2008-2012 cases).

• The number of cancer deaths (cancer mortality) is 171.2 per 100,000 men and women per year (based on 2008-2012 deaths).

CANCER PREVALENCE (Americas)

• Overall, cancer in the Americas claim an estimated 1.3 million lives each year, according to Cancer in the report titled “Americas: Country Profiles, 2013”

• Trinidad and Tobago is among three countries with the highest cancer mortality rates in the Americas, according to a new report released by PAHO & WHO.

CANCER PREVALENCE (Americas)

• While breast cancer is the leading cancer cause of death for women in the Americas in most of the region’s countries, prostate cancer is the leading cancer cause of death for men

• The report found that obesity, another important cancer risk factor, is highest in English-speaking Caribbean countries, notably Bahamas, Belize, St. Kitts and Nevis and Trinidad and Tobago

MOST COMMON CANCERS IN 2015 (US)

• Projected to be breast cancer, lung and bronchus cancer, prostate cancer, colon and rectum cancer, bladder cancer, melanoma of the skin, non-Hodgkin lymphoma, thyroid cancer, kidney and renal pelvis cancer, endometrial cancer, leukemia, and pancreatic cancer.

MOST COMMON CANCERS IN 2015 (Caribbean)

• The incidence and mortality rates of cancers of the breast, prostate, large bowel, and lung, and, among males, bladder cancer were lower in the Caribbean countries than the United States. Caribbean countries had higher rates of cancers of the cervix, esophagus, liver, and stomach. Haiti had the highest incidence and mortality rates of cervix and liver cancers. Jamaica and Haiti had the highest rates of stomach cancer (IARC & SEER).

WHY PREVENTIONUnhealthy lifestyle

•Lack of physical exercise or sedentary lifestyle - twice the risk for heart disease; increased risk for DM; increased risk for tumors of the breast, colon and kidney

•Poor diet: Diets rich in saturated fats and cholesterol - high risk for CVD

•Tobacco - twice the risk for heart attack compared to non smokers; increased risk for cancers

OUTCOME OF UNHEALTHY LIFESTYLE CHOICES

Research has shown that being overweight or obese substantially raises a person's risk of getting endometrial (uterine), breast, prostate, and colorectal cancers.

How Can Cancer Be Prevented?

• Research shows that screening for cervical and colorectal cancers as recommended helps prevent these diseases by finding precancerous lesions so they can be treated before they become cancerous

• Screening for cervical, colorectal, and breast cancers also helps find these diseases at an early, often highly treatable stage

How Can Cancer Be Prevented?

• Vaccines also help reduce cancer risk. The human papillomavirus (HPV) vaccine helps prevent most cervical cancers and some vaginal and vulvar cancers, and the hepatitis B vaccine can help reduce liver cancer risk

• Receiving regular medical care, avoiding tobacco, limiting alcohol use, avoiding excessive exposure to ultraviolet rays from the sun, eating a diet rich in fruits and vegetables, maintaining a healthy weight, and being physically active.

PREVENTABLE CONDITION

• Obesity is a leading cause of preventable death in the United States, causing an estimated 200,000 deaths per year

• 1 in 4 adults are obese in the United States

• According to WHO 2013 Fact Sheet on "Obesity and Overweight,” obesity rates worldwide have almost doubled since 1980

• In the global population, 2012 was the first time overweight and obesity caused more deaths than malnutrition

OBESITY STATISTICS

• The United Nations’ "The State of Food and Agriculture 2013” reported as the highest rate of obesity:

• #1: Mexico - most obese populous country at 32.8%

• #2: United States of America - 31.8%

OBESITY STATISTICS

• #3: Syria - 31.6%

• #4: Venezuela - 30.8%

• #5: Libya - 30.8%

• #6: Trinidad & Tobago - 30.0%

• #18: Antigua - 25.8%

• #21: Saint Vincent - 25.1%

• #22: Dominica - 25.0%

OBESITY STATISTICS

• World Health Organization. the countries with the highest percent of overweight adults (people age 15 and over):

• #9: United States ------------- 74.1%

• #11: Dominica ----------------- 71.0%

• #12: Barbados ----------------- 69.7%

• #20: Trinidad and Tobago --- 67.9%

ADIPOSOPATHY & OBESITY – COSTS – U.S:

• In 2008 , the direct medical costs for treating obesity and obesity-related health problems was estimated at $147 billion

• Days of work lost – 52 million

• Days of restricted activity – 229 million

• Bed days – 87 million

• Psychosocial costs are additional

OBESITY GUIDELINESObesity 2 :

2013 AHA/ACC/TOS Guideline

• Based on 5-year evidence-based reviews

• 5 key recommendations operationalized via an algorithm

• Promotes addressing weight management as a pathway to better health

• Use BMI as an initial screen

• Use Waist Circumference as an indicator of risk

DEFINITION

BMI

•BMI of 25-29.9 ---------Overweight

•BMI of 30-39.9 ----------Obese

•BMI of >40 --------------Morbidly Obese

Waist Circumference (WC)

Women > 35 inches

Men > 40 inches

PERSPECTIVE ON OBESITY• Moral problem? NOT- Must not blame an individual for issues

they cannot have complete control over- i.e.: Their genes!

IT’s A DISEASE AFTER ALL• Psychological problem? Aesthetic problem?

culture based- self perception/esteem• Medical problem!- Recognized a Disease

• Public health problem! = Increased Societal Cost

Cultural Definitions Change Over Time

Obesity Is Caused by Long-Term Positive Energy Balance

Fatstores

Energyintake

Energyexpenditure

Thrifty Genes Contribute to Morbid Obesity• Genetic factors account for 80 percent of a person’s tendency to develop obesity.• These “thrifty genes” are designed to protect us from starvation by allowing us to

store large amounts of energy in the form of fat when food is abundant.• This is the first time in human history that food has been so abundant.• The age-old advantage of thrifty genes has

been influenced by our unique environment to cause disease.

Kaplan L. Body Weight Regulation and Obesity. Journal of Gastrointestinal Surgery 2003;7(4):443-451.

EnvironmentEnvironment

GenesGenes

Polygenic Monogenicdominant

MC4-R

MonogenicMonogenicrecessiverecessive LeptinLeptin-RPOMCPC-1

GENETIC APPROACH TO GENETIC APPROACH TO OBESITYOBESITY

GAD2

The “Toxic Environment”• High-Calorie Food is…

– Highly palatable

– Inexpensive

– Heavily advertised

– Near-ubiquitous

Brownell KD & Horgen KB. Food Fight. New York: McGraw-Hill; 2003.

Supersized

The “Toxic Environment”

REGULATION OF BODY WEIGHT

• Genes confer the potential for obesity.

• Environment determines whether and to what extent the potential is realized.- Diet / Exercise

RECOMMENDATIONSObesity 2 Guidelines

• Lifestyle Modification

• Pharmacotherapy

• Bariatric Surgery

ATTITUDE TOWARDS EXERCISE

Ex.er.cise (ek’ser siz), n:1. The art of converting big meals and fattening snacks into back strains and pulled muscles by lifting heavy things that don’t need to be moved, or running when no one is chasing you.

We can now prove that large numbers of Americans are dying from sitting on their

behinds.

Dr. Bruce Dan

CARNIVAL PREPARATION AROUND THE SAVANNAH

CARNIVAL PREPARATION AROUND THE SAVANNAH

TRINIDAD CARNIVAL

TRINIDAD CARNIVAL

GUIDELINES FOR BETTER HEALTH:Exercise

Recommendations by CDC and NIH:

• 30 minutes of moderate-intensity physical activity for most days of the week• Intermittent activity also confers substantial benefits• Any activity - just becoming physically active i.e. moving from fairly sedentary to active can decrease disease risk dramatically (Marcus and Bock, 1998)

GUIDELINES FOR BETTER HEALTH:Exercise

Physical Activity:• Lowers blood pressure• Increases high-density lipoprotein (HDL) cholesterol• Facilitates weight loss• Improves diabetes management• Reduces the risk of heart disease and stroke• Reduces the risk of cancers: breast, colon etc. (CDC 1996)• Reduces anxiety and stress (DHHS, 1996)• Improves mood and self esteem• Improves work performance or family interactions Jones et al, 1998)

GUIDELINES FOR BETTER HEALTH:A safe and nutritionally adequate diet

• Eat breakfast • Spice up your breakfast with fruit or

have a protein shake• Use sparingly/eliminate butter/

margarine• Use lite/low fat dairy products• Use lean meats (chicken, turkey, beef

round, sirloin)

GUIDELINES FOR BETTER HEALTH:A safe and nutritionally adequate diet

• Avoid fried foods, use oils sparingly (try olive or canola oils)

• Use healthy snacks (fruit, veg) – 5/more servings daily

• Desserts/sweets – cut down on portion size and frequency

• Reduce consumption of coffee/tea /sodas / drugs with caffeine

• Ensure adequate water intake

GUIDELINES FOR BETTER HEALTH:A safe and nutritionally adequate diet

• Low in calories

• Nutritionally sound (Nutrient rich) - colorful fruits and vegetables have more nutrients

• Adequate protein, vitamins and minerals

• Aim for 500-1000 calorie deficit per day

• Goal of 1-2 lbs. per week weight loss

DIETARY CHANGES

• REFLECT on all of your specific eating habits, both bad and good; and, your common triggers for unhealthy eating.

• REPLACE your unhealthy eating habits with healthier ones.

• REINFORCE your new, healthier eating habits.

CANCER FIGHTING FOODS

• If you balance your diet with whole grains, fruits, cruciferous vegetables, and limited portions of red meat, you can lose weight and protect yourself from developing cancer.

CANCER FIGHTING FOODS

• Lignans: Whole grains are a good source of lignans, a plant-based estrogen. Lignans may act similar to weak estrogens, sliding into estrogen receptors on cells in breast and endometrial tissues. This action may protect cells that could become damaged or cancerous when in contact with female estrogens

CANCER FIGHTING FOODS

• Saponins: These are water and fat-soluble plant compounds that function as natural antibiotics. Saponins can help lower your cholesterol, fight infections, and may help your body protect itself from cancer

CANCER FIGHTING FOODS

• Pomegranates (punica granatum) are a very healthy fruit that appears to slow down the growth of estrogen-fueled breast cancers

• Lycopene is an antioxidant that lends its color to fruits and vegetables, May help protect against some cancer

CANCER FIGHTING FOODS

• Cruciferous Vegetables are packed with phytochemicals, which are chemicals and substances found in plants. Notably, crucifers contain isothiocyanates, chemical compounds that combat carcinogens by inhibiting their activity, repairing damage made by them, and also speeding up apoptosis (cell death)

CANCER FIGHTING FOODS

• The most common cruciferous vegetables. varieties are bok choy, broccoli, Brussels sprouts, cabbage, cauliflower, collard greens, kale, mustard greens, rhutabaga, and watercress

CANCER FIGHTING FOODS

• Onions -- whether they are red, yellow or white – have antioxidants and are anti-inflammatory, antibiotic, anti-allergic and antiviral

• They contain high levels of quercetin, a potent flavonoid that may help fight or prevent cancer. An Italian study of weekly use of alliums in diet and rates of cancer found that people who ate between 14 and 22 portions of onions had the lowest rates of breast cancer

CANCER FIGHTING FOODS

• Garlic, in addition to its pungent fragrance, has the compound allicin, an antimicrobial agent that prevents the formation of nitrosamine (a carcinogen)

SUPPLEMENTS / VITAMINS

• WIN OMEGA 3

• BIOLEAN – a thermogenic agent that aids metabolism

• LIPOTRIM – a weight loss product that targets glucose control and appetite control

• PHYTOVITE - a fully loaded state of the art MVI that improves overall health, boosts immune system function and helps with hair, skin and nails

Daily LiftREAL NUTRITION | REAL FAST

INTRODUCING

MIXED BERRY

Daily LiftREAL NUTRITION | REAL FAST

INTRODUCING

COOL MINT

A COMPREHENSIVE APPROACH

• Discuss weight management with our patients

• Set realistic goals – a 10% reduction in weight can significantly improve BP/DM/Sleep Apnea; modest weight loss = dramatic health benefits

• Dietary changes can begin the process

• Increased physical activity will sustain it

• Behavior modification

• Support metabolism with daily vitamins and adequate water intake

CONCLUSION

IF YOU DO NOT MAKE TIME FOR HEALTHIER LIFESTYLE

CHOICES

YOU MUST MAKE TIME FOR ILLNESS