Kay Theyerl, MD, MS, FACP, AIHM, ACLM Medical Director, ThedaCare Lifestyle Medicine

Medical Director, ThedaCare at Work Clinic Services

Be Healthy at Any Age: The Power of Lifestyle Medicine

• Define healthy • Absence of disease? • Something else?

Paradigm Shift

• Burden Of Chronic Disease • Continuum of Chronic Disease • Root Cause of Chronic Disease • Role of Lifestyle Medicine in the Treatment

of Chronic Disease – Food as Medicine • What Lifestyle Medicine can do for our

patients and our community • Challenge

Burden of Chronic Disease • Costs $ • Costs Life (Quality of Life) • Costs Lives

• Chronic disease, driven by obesity/unhealthy

lifestyle – Crippling our healthcare system – Burdening our economy – Damaging productivity

Chronic Disease Burden • $47 trillion global spend over next 20 years on

lifestyle-preventable disease – World Economic Forum

• $ 1.2 trillion US spend in 2013 on top 20 conditions – Medications – clinic/physician services

• $ 245 billion US spend alone on Diabetes in 2013 • $88 billion US spend on heart disease in 2013 • $135 billion US spend on pharmaceuticals for

hypertension and hyperlipidemia in 2013 • $3.2 trillion on healthcare in US in 2015

Crisis of Chronic Diseases

• Over 75% of health care costs are due to chronic diseases

• 60% of deaths are due to chronic diseases – Heart disease – Cancer – Diabetes

• Leading causes of death worldwide are chronic diseases

WHO 2016

More Bad News …or is it Good News?

• 80% of chronic diseases are caused by lifestyle: (Lifestyle-Related Diseases - LRDs) – Unhealthy dietary patterns (most important) – Physical inactivity – Tobacco and alcohol (excessive use) – Poor management of chronic psychological stress

• 75% of adults in Fox Valley are overweight/obese • 29% children in Fox Valley are overweight/obese

WHO 2016

The Good News • Lifestyle is more important than: Genetics Age Gender

• Chronic Diseases can be prevented by healthy lifestyle 80% + of

• Heart Disease • Stroke • Diabetes II

40% of Cancer

Disease Management continuum

Low Risk for Disease

• At goal • Healthy Lifestyle

Increased Risk for Disease

BMI Cholesterol BP Blood Sugar Tobacco Use

Emerging Disease

Cardio metabolic syndrome

Disease State

Confirmed Diabetes and/or

CAD

End Stage Disease

Complications • CHF • Renal failure

Disease can be reversed with lifestyle intervention

Low Risk for Disease

• At goal • Healthy Lifestyle

Increased Risk for Disease

BMI Cholesterol BP Blood Sugar Tobacco Use

Emerging Disease

Cardio metabolic syndrome

Disease State

Confirmed diabetes and/or

CAD

End Stage Disease

Complications • CHF • Renal failure

Inflammation = Illness Broad Perspective

• Acute Inflammation = Acute Disease – Injury – Trauma – Infection – Toxins – Immune reaction/allergies

• Modern Model of Medicine – Treatment – put out fires – Very effective

Modern Medicine

Inflammation Gone Awry - smoldering • Atherosclerosis/ Ischemic Vascular Disease

– Coronary heart disease – Stroke – Peripheral artery disease

• Cancer • Diabetes • Hypertension • Obesity • Asthma/ Sleep Apnea • Chronic Pain • Rheumatoid Arthritis • Autoimmune Disease • Alzheimer’s Disease • Acne • Systemic Lupus Erythematosus (SLE) • MS • IBD • Depression • Anxiety

Chronic Disease

Inflammation: Underlying Factor in

Chronic Disease Increase Inflammation

• Processed foods • Sugar/High Fructose Corn Syrup • Saturated Fats • Animal Products • Toxins • Smoking • Alcohol • Salt • Fried Foods • Sedentary Lifestyle • Stress

Decrease Inflammation • Fruits • Vegetables • Whole Grains • Leafy Greens • Legumes • Sleep • Water • Curcumin/Turmeric • Vitamin D/Antioxidants • Moderate Exercise • Meditation/Yoga/Mindful Living

Treatment of Chronic Disease • Current model – put out fires

– Just give a pill, perform a procedure, right? • If we apply the current model of medicine to chronic

disease and do not address the underlying, root cause, it is a bandaid

– Expensive – Ineffective in the long run – Not sustainable

What are we really doing for our patients?

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Can I just take a Pill? • Medicine may help and may be necessary in some

patients • But – we can “overeat” our medicines • Medicines have side effects • Medicine can be expensive • With proper lifestyle, patients can decrease or

eliminate the need for many medicines • …And reduce their overall health risks 85% of people who currently take medicines for high

cholesterol and Type II Diabetes could gain control with lifestyle alone!

I Have Control?

With a Healthy Lifestyle • Lifespan may increase • Illness occurs later – stay healthy longer • Reverse chronic disease • Improved quality of life

– sleep – mood – energy – memory – pain – erectile dysfunction

• Reduced chronic disease • Less medication • Less hospital time • Fewer surgical procedures • Reduced healthcare costs

What Can We Do? • Eat Healthy Foods • Move! • Manage Stress/Live Mindfully • Avoid Tobacco/Toxins

These are simple concepts and take work,

planning, commitment, practice, and support

Evolution of Obesity

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Percentage of Deaths from Heart Disease and CancerPercentage of Calories from Unrefined Plant Foods

Diet > Smoking

“Poor diet is responsible for more deaths from chronic disease at the population level than smoking…most patients know that smoking is not a good idea, but they do not have a sense of the magnitude of the importance of the food choices they make every day.”

– American College of Physicians (ACP) Internal Medicine Meeting – Michelle McMacken, MD, NYU School of Medicine

It’s Simple -- Eat Foods As Grown

Foods that provide optimal health are eaten as close to their original form as possible: fruits, vegetables, whole grains, beans, nuts, and seeds

Food Rules (Michael Pollan)

Eat Food

Not Too Much

Mostly Plants

WHOLE FOODS PLANT-BASED

What are we Feeding?

• Cells • Selves • Souls

FOOD is: • Energy

– Fuel and nourishment for Cellular Function • Information

– Turns genes on and off – Detoxification pathways

• Connection – Family/friends/tradition – Connection to the source and the greater web of life

• Medicine vs Poison – Food can make us sick or food can make us healthy!

Food and Inflammation

• Food can fan the flames of inflammation and lead to disease

OR • Food can cool the heat of inflammation

and lead to health

We decide in which direction we would like to go with every bite!

Food as Medicine

Physical Activity is needed for

Good Health Helps to prevent and/or treat:

cancers, heart disease, hypertension, diabetes, depression, fractures, stroke, obesity, pain…

Timeless Knowledge

A merry heart does good medicine make

Proverbs 17;22

Heal/Health = WHOLE • Healthy diet

– “Let Food be thy Medicine” • Physical activity • Healthy emotions

– Sleep – Music – Mindful living/Connection

http://classics.mit.edu/Browse/browse-Hippocrates.html Sternberg EM: The Balance Within, 2000

Origins of Lifestyle Medicine

Lifestyle Medicine Definition (ACLM)

Lifestyle medicine is the therapeutic use of evidence-based lifestyle interventions to treat and prevent lifestyle related diseases in a clinical setting. It empowers individuals with the knowledge and skills to make effective behavior changes that address the underlying causes of disease.

Caldwell Esselstyn Jr., MD Cleveland Clinic

• Very low fat diet shown to reverse and prevent Coronary Artery Disease (CAD)

• CAD is a food-borne illness • CAD is almost non-existent in cultures that

rely on plant-based diets – Beans – Corn – Sweet potatoes – Rice – Vegetables

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Reversal of Coronary Artery Disease by a Low-fat, Plant-based Diet

Esselstyn CB: Am J Cardiol, 84:339-341, 1999.

Lifestyle Interventions

1) Nutrition

2) Physical Activity

3) Stress Management Rest/Sleep/Meditation

4) Social supports

5) Avoid Environmental Exposures Smoking/Toxins

David Katz, MD - Yale

“Failure to use what we have known for more than two decades to prevent up to 80% of all major chronic diseases- heart disease, cancer, stroke, diabetes, dementia - is in a word, lunacy.”

Blue Zones Dan Buettner and NatGeo

• Sardinia – Italian island • Okinawa, Japan • Loma Linda, CA • Ikaria – Greek island • Costa Rica – Nicoya Peninsula

Blue Zones lifestyle can add 10-13 years to average lifespan

nutrition reductionism: We don’t eat nutrients, we eat whole foods!

“Nutrition should be recognized as the wholistic effect of countless nutrients involving countless diseases working through countless mechanisms. Nutrition must be wholistic: looking at countless nutrients and mechanisms that control many diseases.”

- T. Colin Campbell, PhD author of The China Study

Powerful ingredients in whole, plant foods

found exclusively in plant foods (animal foods contain no fiber), associated with lower rates of cancer and other chronic diseases, and facilitates healthy weight.

hydrates the body, which is crucial to proper immune, endocrine, cardiovascular, neural, gastrointestinal, muscle and skeletal function. Plant foods are rich in water!

abundant in plant foods. Slow aging, reduce inflammation in the body, and help protect against diseases — especially cancers and heart disease.

FIBER

WATER

ANTIOXIDANTS & PHYTONUTRIENTS

Myth: To get enough protein, you have to eat animal products.

Fact: a whole food, plant-based diet can supply all the

protein you need! ● More is not better! ● Excess protein is either stored as fat or excreted

along with vital minerals such as calcium. ● Studies show that the average vegetarian or

vegan meets or exceeds the recommended daily protein intake (0.8 grams per kilogram of bodyweight).

Protein Content per 100 Calories

Kale 9.46 grams

Broccoli 11.2 grams

Romaine 11.6 grams

Sirloin 5.4 grams

Myth: You can’t get enough calcium from a plant-based diet.

Fact: plants are excellent sources of calcium!

● Calcium is a mineral found in the ground, which is why plants grown in the ground are excellent sources of calcium.

● Beans and greens are rich in calcium and come packaged with countless other vitamins, minerals and phytonutrients that improve calcium absorption and utilization.

● Despite the common belief, no protective benefit between milk consumption and hip

fracture risk has been demonstrated.

● Cultures with the highest average intakes of dairy products also have the highest fracture risk!

● Milk consumption in teenage years is also not associated with better bone health in adulthood. Milk does not do a body good!

Don’t be fooled…

What is dairy designed to do? Nourish and quickly grow a calf from 90 pounds to hundreds of pounds in less than two years.

Human beings are the only species who consume other mammals’ milk — this is not something that occurs in natural habitats.

Why is it so hard to kick dairy? It may be literally addictive! Dairy contains casomorphins, substances that trigger the same “feel good” sensations as opiates. This is likely nature’s way of ensuring that baby mammals become attached to their source of nourishment.

Giving up dairy products may sound challenging, but your taste buds will adjust and you’ll no longer have this craving.

Got Milk?

Calcium Daily requirements • Children 1-3 years old: 700 milligrams (mg) • Children 4-8 years old: 1,000 mg • Children 9-18 years old: 1,300 mg • Adults 19-50: 1,000 mg • Women 51 to 70: 1,200 mg • Men 51 to 70: 1,000 mg • Women and men 71 and over: 1,200 mg

Calcium Content of Selected Vegan Foods Food Amount Calcium (mg) Blackstrap molasses 2 Tbsp 400

Plant milks, calcium-fortified 8 ounces 100-450

Tofu, processed with calcium sulfate* 4 ounces 200-434

Tofu, processed with nigari* 4 ounces 130-400

Calcium-fortified orange juice 8 ounces 350

Commercial soy yogurt, plain 6 ounces 300

Collard greens, cooked 1 cup 268 Turnip greens, cooked 1 cup 197 Tempeh 1 cup 184 Kale, cooked 1 cup 177 Soybeans, cooked 1 cup 175 Mustard greens, cooked 1 cup 165 Bok choy, cooked 1 cup 158 Tahini 2 Tbsp 128 Navy beans, cooked 1 cup 126 Okra, cooked 1 cup 124 Almond butter 2 Tbsp 111 Almonds, whole 1/4 cup 94 Broccoli, cooked 1 cup 62 Sources: USDA Nutrient Database for Standard Reference, Legacy, 2018 and manufacturers’ information.

Bone Health Factors that increase the risk of osteoporosis: • Small frame size • Female gender • Aging • Heredity • Being Caucasian or of Asian or Latino descent • Early menopause • Prolonged immobilization Lifestyle factors • Cigarette smoking • Excessive alcohol • Physical inactivity • Inadequate calcium and vitamin D • Animal protein may increase calcium loss in urine • High sodium increases calcium loss in the urine

Visionary The doctor of the future will give no medicine, but instead will interest his patients in the care of the human frame, in diet, and in the cause and prevention of disease. Thomas Edison

Lifestyle…IS the Most Powerful Medicine

• For general good health…at any age • To prevent, treat, and reverse chronic diseases

including: – diabetes, heart disease, hypertension, obesity,

cancers, autoimmune disease … • By addressing the root cause of chronic disease

… inflammation • Disease care to health care – using Food as

Medicine!

Transformation

• As Leaders in the Community, we are uniquely positioned to “be the change”

• Create a culture and maintain an environment that empowers ourselves, our families, our patients and clients, our colleagues, our organizations, our teams, our community …

…to be physically, mentally, and emotionally HEALTHY

Who wouldn’t want to be a part of it?

Thank You! Questions ???

Questions

Who Can Really Do This???

Sharon 1/16 8/16 2/17 8/17 Change

Weight 257 lbs 222 lbs 219 lbs 210 lbs - 47 lbs Waist 50.5” 44.5” 43.5” - 7” Glucose 129 102 74 (88) - 55 HgbA1C 9.0 5.8 5.7 5.3 - 3.7!!!!! Lantus insulin

62 units 38 units 32 units 26 units Huge decrease

HgbA1C decreased to well past goal even with decreased insulin! She is now OFF insulin!!!

Uncontrolled Diabetes

Diane and Paul • Paul and I joined the Lifestyle 180 program because Paul was told by his doctor

that if his numbers didn't improve he would have to go on insulin! • I really wanted to lose weight and other plans weren't working for me. • We found that doing the program together really helped both of us stay on track

and made it easier to make the changes we needed to do to reach our goals. The support and recipes we received from the staff made reaching our goals a lot easier.

• Paul has reduced his diabetic medicine, reduced his blood pressure medicine

and is down 35 pounds. • I lost 50 pounds and take less medicine for Atrial Fibrillation. We are still eating a healthy diet and we hope to lose more weight. Looking forward to warmer weather so we can exercise outside.

Paul 1/16 8/16 2/17 Change

Weight 217 lbs 184 lbs 179 lbs - 38 lbs

Waist 45” 38.5” - 6.5”

Triglycerides 229 158 - 71

Glucose 216 80 118 - 98

hsCRP 2.4 0.8 0.8 to ideal

HgbA1C 8.8 5.9 6.8 surpassed goal

Lisinopril/HCTZ 20/25 mg daily

½ dose ½ dose

Glyburide 5 mg 3x/day

5 mg 2x/day

discontinued

Diane 1/16 2/17 Change

Weight 251 lbs 201 lbs - 50 lbs

Waist 47 “ 36.5” - 10.5 “

BP 112/78 102/64 - 10/14

LDL 126 91 - 35

Metoprolol 50 mg daily 25 mg daily Off half

Sharon and Steve

• Steve joined due to a two-year history of ulcerative colitis, an autoimmune inflammatory disease of the colon – One medication caused severe joint pain – He did not want to be on meds his entire life – He had been told by multiple providers that

“we do not know the cause and food does not matter”

• Sharon joined the program to support Steve

Improvements • I have maintained my remission without the use of drugs

– through my Diet, Mindfulness and Exercise

• Side benefits for me - I have:

– lost 40 pounds – maintained the lower weight – lowered my cholesterol – more energy – completed a ½ marathon walking and numerous 5k’s, with the intention on doing more

I can honestly say, I haven’t felt this healthy at any point in my past.

Sharon and Steve

Paying it forward as mentors!

Update from Steve

• Colonoscopy results – 2014: 85% of colon with inflammation and

changes consistent with UC – 2015: 15% of colon with inflammation and

changes consistent with UC – 2017: NO INFLAMMATORY CHANGES!!!

(His MD told him that was unheard of)

Dottie 64 yo F Baseline 1 Year Change

HAT Score 66 77 11

BMI 30 25 -4.9 (28#)

Triglycerides 253 167 -86

Blood Pressure 130/64 120/60 -10/4

Medications Insulin 70/30 bid

oral meds only Off insulin!!!!

20 years on insulin!

RG 45 yo F

Baseline 6 month 1 year Change Weight/ BMI 266/44 168/29 166/27.8 -100 LDL 143 102 69 -74 Glucose 104 93 76 -28 OSA CPAP OFF CPAP! HAT 50 88 +38

No longer on CPAP! No longer Prediabetic!

Dirk • Angioplasty in 2011 • Diagnosed with MS in 2012

– Copaxone daily

• Lifestyle Intervention Program 2014 – Lost over 50 pounds – Decreased copaxone to 3x/week – MRI stable – Rare flares – Stress test in 11/16 – 12 METS!

Paying it forward as a mentor with his wife

Keith’s Story

• Age 53 • no MD appointments for many years • First HRA (Health Risk Assessment)

September 2015 – BP was 178/110!!!! – Triglycerides were 447! – Glucose was 113 (prediabetes)

Denise and Dennis

Dennis 11/18/13 7/15/14 6/25/15 Change

Age 44

HRA Score 25 76

Weight 290 291 213 - 78 lbs

Blood Pressure

144/82 106/64 -38/18

Glucose 304 270 92 -212

Triglycerides 516 74 -442

HDL 28 40 +12

HgbA1C 8.2 5.1 (4.7/5.0) -3.2

Diabetes II New Diagnosis

No Longer Diabetic!

All with NO medication! – Just a healthy lifestyle!!!!

Denise - Age 43 3/16/13 6/29/15

HRA Score 73 100!

Weight 200 143

BMI 32 24.6

Denise and Dennis embarked on the journey together!

2015: 2000 miles 2016 Goal: 3000 miles

Met goal! Now: they just keep

riding!

2014: 4 blocks (first ride)

It all began with a wart…

Tom’s Story

• Had gained weight steadily over 30+ years

By the time he saw the Clinic MD : – Obese – highest weight: 264 lbs – Metabolic Syndrome – Prediabetes – High Blood Pressure (prehypertension) – High Triglycerides and LDL – Heading for knee replacement – NSAIDs – GERD – taking his antacids like candy

• Agreed to try lifestyle change

2/15 4/15 6/15 2/16 2017 Change

HRA Score 57 76

Weight 264 199 192 - 72 lbs

BMI 38 29 - 9

Blood Pressure

142/98 112/74 - 30/24

Glucose 106 93 92 87 - 19

Triglycerides 320 193 107

LDL 144 114 102 - 42

HDL 29 50 69 + 40

hs CRP 3.8 0.5

Tom Obese – highest weight: 264 lbs Metabolic Syndrome Prediabetes High Blood Pressure (prehypertension) High Triglycerides and LDL Heading for knee replacement – NSAIDs GERD – taking his antacids like candy

WELCOA Rising Light Award

How Did They Do It?

• They ate foods as grown • They moved • They learned and applied

mindfulness strategies to effectively deal with their stressors

• They did it with the help of ThedaCare’s Lifestyle programs and services

Lifestyle Intervention Program Results

• Reductions in Medications for – Blood pressure – Lipids – Diabetes – GERD – Depression/anxiety – Pain

• Improved mobility • Improved mood and sleep • Less pain • Fewer flares of autoimmune/inflammatory diseases

Lifestyle Intervention Program 1 Year Results

• Reduced Weight: 22 pounds • Improved Health Risk Assessment (HRA) scores:

15 points • Improved Lifestyle score: 30 points • Reduced Blood Pressure: 22/11 (high risk)

• Reduced Inflammation (hsCRP): 41% (high risk)

• Reduced LDL: 39 points (22%) (high risk)

• Reduced Triglycerides: 65 points (30%) (increased risk)

• Reduced Hemoglobin A1C: to 7.0 to 6.3 /6.0 to 5.5

Complete Health Improvement Program (CHIP)

Measure Improvement % Improvement Biometric score 7 12% Lifestyle habits 24 45% BMI 1.8 5% LDL 47 25% Triglycerides 40 19% Glucose 35 22% Blood Pressure 20/13 14%

Resources • American College of Lifestyle Medicine (ACLM) • Academy of Integrative Health and Medicine (AIHM) • Institute of Functional Medicine (IFM) • Thedacare Lifestyle Medicine.com • NutritionFacts.org/ Dr. Greger’s Daily Dozen • The Plantrician Project • LifestyleFacts.org • Food Revolution • Food Matters • ForksoverKnives.com • PCRM.org • Engine2diet.com • Ornish Spectrum • CHIPhealth.com • The China Study T.Colin Campbell/ eCornell