|
Education CAUSES,
TREATMENT (OPTIONS), AND TREATMENT OF COMPLICATIONS
Slimmer Success Founder
Cary
Fechter, M.D.
( taken from National PTA Convention
of 3500 attendees)
*
National Keynote speaker on Adult and Childhood Obesity since
2001
*Cardiopulmonary
Medicine, Internist and Metabolic Specialist, Sleep Disorder
Specialist
*
Behavioral Modification Clinics since 1983
*Research Physician since 1981
*Founder
of the National Student Body Challenge – A broad
approach to the many factors that lead to childhood obesity
*
American Diabetic Association advocate for a multi-factorial
approach to reversing the obesity and diabetic epidemic
There
are weight-related conditions so serious that you are too sick, have to much joint pain, or
are too
depressed
to exercise at all or sustain a diet. The depression alone gives
the patient the wrong impression that they have "passed a point
of no return." Some heart conditions, or stages of cancer are
that way, but obesity should always have solutions if patient
desire is combined with medical professional training.
You may feel that you have already passed
"that point of no return." GOOD
NEWS we have had over 1000 patients who have changed their lives
by re-focusing on the best that life still offers. So many obese
patients are depressed, in fact as the charts below indicate it
is the NUMBER ONE association or cause of obesity. So much of
our approach starts with perceptions and is guided by medical
safety.
For those of you who are modestly
overweight and fatigued or have other symptoms, it's our goal to
identify the reasons (etiology) of
your weight gain. Usually it's as simple as time-management to
get out and exercise, lack of a "weight loss buddy" who wants to
be part of your success. We refer to this buddy often, he, she,
or the group will "be there" to help you eat right, exercise,
and even laugh-away the many daily stresses that lead to
comfort-food consumption.
We link to the USDA's
EXCELLENT DAILY RECORDING AND CHARTS, which visually reinforces your
efforts.
go to
www.choosemyplate/tools.html
We're all are seeking SUCCESS!!! We and the USDA and other
reputable sources will be your
INTERNET
"Progress Buddies".
But with all the enormous number of on-line articles and tools
for weight loss, Americans are still enlarging.
It's been hard to do it alone, so PLEASE, PLEASE, PLEASE
FIND
YOUR REAL-LIFE, CAREFULLY SELECTED, "PROGRESS BUDDY."
IT WORKS AND CAN BE FOREVER!!!
What should buddies do? Start off
as friends and just get out and find pleasurable things to
do...it starts that simply.
Then find ACTIVITIES that expend a little energy and calories, then
you'll find simple movement an "expression of freedom". Maybe
its freedom from the
embarrassment of your weight or maybe its a freedom to rise above
whatever has chained your physical confidence to snacks, a sofa,
or the dinner table. But once you start
enjoying movement and freedom, both your confidence and your
food selection will change.
NOW we have conquered the two essentials
of weight loss: diet and exercise.
Athletes, one of which this author was once
considered, take it another step: they make exercise a
competition. Initially, a competition within themselves, but at
least in my case, there was a great pleasure, reinforcement, and
CONFIDENCE that came in beating expectations. This is why, in my
observations, so many athletes excel in business, relationships,
and so many facets of life. I find them typically more
spiritual, thankful, and helpful-they expect more of themselves.
At least in my case, I now see obstacles are really just
"accomplishments-soon-to-be-attained" that needed to re-emerge
after some real hardships. Those previous victories and friends'
encouragement is what made me watch my meals carefully the last
month, and will make me go swim as hard and long as I can when I
finish this section! It's Saturday and the water's warm. NOW,
THERE'S NO REASON WHY YOU CAN'T BE THE SAME!!!
You may still be at the stage of finding a
reliable buddy, going through the lifestyle contract,
identifying the many stressors we all have or "take-on" instead
of prioritizing our health. My buddy and I laugh about how many
of the stressors have no possible solutions (we call them
"eye-rollers") and we just accept them or try to minimize their
negative effects. But there are a lot of stressors that can be
fully erased, without any repercussions. Go to the lifestyle
section which is the key.
Testimonial: For 2 decades, I have given too
much to medical rounds and, while my family expected me to
manage time and my physical care, priorities were askew and,
from a purely body image perspective, I have a lot more
than "love handles" and fatigue issues. But, this is a
challenge, less difficult than previous ones, which will make my
family and myself quite proud. So, I'm already in my yellow non-speedo®
swim trunks and will even giggle about today's writings while
flipping back and forth up and down the pool.
Our doctors and testing regimen is
carefully designed to recognize medical conditions which have
lead to your weight gain. The great thing is that once they are
identified, you have changed your lifestyle and/or priorities,
and committed yourself to change, then you will NEVER need us
again.
However,
that mistaken "point of no return" does at times require
physician intervention that can range from simple counseling, to
sleep condition repair, to typical 6 month courses of appetite
suppressants, to either gastric surgery or orthopedic surgery.
All these get you up and able to once again enjoy a more
mobile-energy expending nature. We promise your family will be
proud and pleased, a few creeps might be jealous of your
success, and some may even undermine your efforts (misery can
enjoy company). You'll also socialize more frequently, and for
those without medical conditions...your sex life should be much
better with an enhanced self-image, self confidence, and the
rejuvenation that comes with healthiness.
Disclaimer:
The following information, while updated frequently, is not
intended to replace physician visits, knowledge or experience.
Questions about sections could be further researched by
physicians or yourself. These sections provide basic and
detailed relationships between weight gain and medical
conditions which will help you recognize conditions and
potential interventions.
THE FOLLOWING
ARE GENERAL, BUT VERY IMPORTANT FACTS OR REFERENCE MATERIALS
WHICH
WILL HELP YOU OR YOUR DOCTOR GUIDE YOU TO A LONGER,
HEALTHIER, AND SLIMMER FUTURE
SECTION ONE
CAUSES OF
WEIGHT GAIN:
OBESITY-RELATED CONDITIONS
BY FREQUENCY IN THE USA
THE BASIC
CAUSES OF WEIGHT GAIN
MAJOR
MEDICATIONS THAT ARE ASSOCIATED WITH WEIGHT GAIN- BY CLASSES AND
ALPHABETICALLY
DIABETIC
MEDICATIONS THAT OFTEN WORSEN WEIGHT GAIN
SECTION TWO
DIAGNOSIS AND
TREATMENT OF THE SERIOUSLY OBESE PATIENT
SECTION THREE
MEDICATION
MANAGEMENT:
SUMMARY OF THE ORAL DIABETIC MEDICATIONS
SUMMARY OF THE
INSULIN PREPARATIONS
SUMMARY OF LIPID MEDICATIONS AND MANAGEMENT
HEART SMART DIET
EXCELLENT FREE
HEALTH SUPPORT FROM THE GOVERNMENT/OTHERS
SECTION FOUR
GENERAL
EDUCATION:
THE METABOLIC SYNDROME (Insulin Resistance Syndrome)
OBESITY HYPOVENTILATION AND PULMONARY HYPERTENTION
OUR FAVORITE FREE ON-LINE HEALTH CALCULATORS
____________________________________________________________________________________________________________________
ALL ABOUT US
SECTION ONE
CAUSES OF OBESITY-
BY FREQUENCY
Medical Conditions
that Cause Obesity that are Very Common
The following causes of
Obesity are diseases or medical conditions that affect
more than 10
million people in the USA:
Medical Conditions
that cause Obesity that are common
The following causes of Obesity are diseases or conditions
that affect
more than 1
million people in the USA:
Causes of Obesity
that are less common The following causes of Obesity are
diseases or conditions that affect
more than 200,000 people, but less than 1 million people in the
USA:
Causes of
Weight Gain by Category
Eating more
o Overeating
Pregnancy
o Recent
childbirth - retaining weight after giving birth
o Aging –
often due to changes in activity and metabolism.
o Appetite
changes
o High-fat
diet High-carbohydrate diet Excessive snacking
o
Page 3
o Sedentary
lifestyle
o Reduced
exercise or activity level
o Quitting
smoking - or other type of tobacco withdrawal
o Rebound
after prior dieting Comfort eating Stress eating
Depressive
disorders -
some people eat more (some eat less)
Several mental
illnesses- such
as bi-polar disease with excessive appetite,
when in the manic phase
o Compulsive
eating
o Genetic
tendency to obesity - Familial
obesity
· Water
retention -
retaining fluid rather than true weight gain.
o Premenstrual
bloating
Edema -
o Congestive
heart failure Kidney
failure Nephrosis
o Cirrhosis
of the liver
Lymphatic
obstruction
Hormonal
conditions
o Hypothyroidism Growth
hormone excess
AND Growth hormone failure
· PCOS-Poly
cystic ovarian syndrome
· Hypopituitarism
Excessive Androgens
Postmenopause Orchidectomy
Hypogonadotrophic hypogonadism
Non-pathological conditions
Medications or
Substances That Cause Weight Gain
(by
class-with examples)
PSYCHOLOGICAL
· Depression
and Anti-Depresants-Wellbutrin appears to have the least weight
gain
· Mania
· Sedatives
such as Clonazepam
NEUROLOGICAL ANXIETY
/DEPRESSION
Gabapentim Ambilify
Dilantin
ANTI-HYPERTENTIVES
Calcium blockers
DIABETIC MEDS
In general, most oral diabetic medications , except Metformin
and Januvia, cause weight gain.
·
Byetta, Victoza, and Januvia are our favorite
weight-related medications. These originally were
recommended en AFTER oral diabetics have failed.
They are associated with WEIGHT LOSS-but are more
expensive (however, managed care plans typically
cover the cost)
ALL INSULINS are generally associated with weight
gain
MEDICATIONS ASSOCIATED WITH WEIGHT GAIN 
Oral
Diabetic Medications
Obese patients frequently have diabetes. Several
diabetic medications CAUSE FURTHER WEIGHT GAIN. Metformin is
generally considered the
first choice to avoid weight gain and still control blood
sugars. Metformin has other side effects
such as a very rare, but very serious acidosis reaction.
So medication choices require a knowledgeable physician.
|
Generic Name |
Action |
Brand Name |
Comments |
WEIGHT EFFECTS |
|
Chlorpropamide
(older drug) |
Stimulates the pancreas to secrete or make
more Insulin |
Diabinese |
Generally
taken one to two times daily, before meals;
can have interactions with other drugs. |
Weight NEUTRAL |
| Glipizide |
same |
Glucotrol |
|
Weight NEUTRAL |
| Glyburide |
same |
DiaBeta/
Micronase/Glynase |
|
Weight NEUTRAL |
| Glimepiride |
same |
Amaryl |
|
Cardiac side effects…to be likely totally
removed from the market |
| Meglitinide |
Works with
similar action to sulfonylureas |
Repaglinide |
Prandin Novo
Nordisk |
Taken before
each of three meals
WEIGHT GAIN |
| Nateglinide |
Works with
similar action to sulfonylureas |
Nateglinide |
Starlix |
Taken before
each of three meals WEIGHT
GAIN |
| Metformin |
Glucophage |
|
|
Many believe the best oral sulfonalurea for
weight control-NEUTRAL |
| Metformin
(long lasting) |
Glucophage
XR |
|
|
NEUTRAL |
| Metformin
with glyburide |
Glucovance |
|
|
Combination medication |
|
Rosiglitazone |
Avandia |
|
|
NEUTRAL |
| Pioglitazone |
Actos |
|
|
MAJOR FLUID AND WEIGHT GAIN |
|
Byetta, and
Victoza are our
favorite weight-related type II medication. They are not
insulin. They typically should be given AFTER oral diabetics
have failed, but before beginning insulin (according AACE
guidelines). Byetta is associated with WEIGHT LOSS as opposed to
weight gain (managed care plans typically cover the increased
cost). They use a much smaller injectable needle, but are NOT
insulins.
Januvia is
an oral member of the same class of medications. There is weight
loss, but some initial reports sugest a lesser weight loss
effect.
Insulin
Preparations
Which
insulin to choose is based on an patient's lifestyle, your
medical preferences and experience, and the patient's blood
sugar levels. Among the
criteria considered in choosing insulin are:
Since 1982, most
of the newly approved insulin preparations have been produced by
inserting portions of DNA ("recombinant DNA").. The following
table lists some of the more common insulin preparations
available today. Onset, peak, and duration of action are
approximate for each insulin product, as there may be
variability depending on each individual, the injection site,
and the individual's exercise program.
| Type of
Insulin |
Examples |
Onset of
Action |
Peak of
Action |
Duration
of Action |
fast-acting insulin
|
Humalog (lispro) |
15 minutes |
30-90
minutes |
3-5 hours |
| fast-acting insulin |
NovoLog (aspart)
Novo Nordisk |
15 minutes |
40-50
minutes |
3-5 hours |
|
Short-acting (Regular) |
Humulin R
Eli Lilly Novolin R
Novo Nordisk |
30-60
minutes |
50-120
minutes |
5-8 hours |
| Intermediate to Long-acting Insulins |
Humulin N
Novolin N
Novo Nordisk |
1-3 hours |
8 hours |
20 hours |
| |
Humulin L
Novolin L
Novo Nordisk |
1-2.5 hours |
7-15 hours |
18-24 hours |
|
Intermediate- and short-acting mixtures |
Humulin
50/50
and 70/30 Humalog Mix 75/25 and 50/50
Novolin70/30
Novolog Mix 70/30
Novo Nordisk |
The onset, peak, and duration of action of
these mixtures would reflect a composite of
the intermediate and short- or rapid-acting
components, with one peak of action. |
| Long Acting Insulins |
Ultralente
|
4-8 hours |
8-12 hours |
36 hours |
|
Lantus (glargine) |
1 hour |
none |
24 hours |
| |
|
|
|
|
|
Benefit:
Lantus Insulin
Marketed by
Sanofi-Aventis is a long-acting basal
insulin analogue, given once daily to help control the
blood sugar level of those with
diabetes.
When standard NPH is administered at night, its peak of
action can coincide with the lower serum glucose levels
associated with nocturnal metabolism potentially setting the
stage for nocturnal
hypoglycaemia. Lantus is associated with a lower risk of
nocturnal hypoglycaemia.
This insulin glargine to forms a precipitate (hexamer) when
injected subcutaneously into the patient. It can achieve a
peakless level for at least 24 hours.
A Synopsis of
Lipid Management-
Critical
Treatment Common in Both Diabetes and Obesity
Treatment Options High
Cholesterol *Further
comparisons and study is suggested, however the following is a
time-saving physician’s tool. It is taken from the ADA, AHA, and
other creditable sources intended to be a quick, smart guide to
a challenging science which is now America’s foremost clinical
problem in morbidity and mortality.
Why be
aggressive?
Decreasing
total cholesterol by 10% can result in a 30% reduction in
coronary heart disease incidence. For
every 1% decrease in LDL (bad cholesterol levels), heart disease
rates drop 2%. On the other hand, for every 1% decrease in HDL,
there is a 2 to 3% increase in the risk of heart disease.
Patients with established cardiac disease and multiple risk
factors (metabolic syndrome, diabetes, or smoking and COMPLIANCE
ISSUES) are sometimes given more intense lifestyle changes. Diet
and exercise are basic interventions, Healthier
Choices’ goal is
to summarize medication choices
The decision to
start a patient with dietary therapy or drug therapy is usually
based on a patient's LDL cholesterol levels, presence of heart
disease, and risk factors. Your
doctor should calculate your "10-year
risk" (also known as a Framingham Risks) for developing
heart disease and use that risk estimation to decide if and when
to start cholesterol-lowering therapy either through dietary
modifications or medications.
First think LDL not
total cholesterol, though relative risks for each are reviewed
above. Goal
LDL level will also depend on the below listed factors. The
following table illustrates guidelines
|
LDL LEVEL-
"The Bad Cholesterol"
LDL Goal:
Without heart disease and with less than 2 risk
factors:
LDL greater than 160 mg/dL start
diet therapy+ exercise
LDL greater than 190 mg/dL start
drug therapy (160 to 189 mg/dL: LDL-lowering drug
optional)
LDL less than 160 mg/Dl Without
heart disease and with 2 or more risk factors with a
10- year risk less than 10%*
LDL greater than 130 mg/dL start
diet therapy + exercise
LDL greater than 160 mg/dL start
drug therapy
LDL less than 130 mg/dL Without
heart disease and with 2 or more risk factors with a
10- year risk 10 to 20%*
LDL greater than 130 mg/dL start
diet therapy + exercise
LDL greater than 130 mg/dL start
drug therapy
(LDL 100 to 129 mg/dL: drug
therapy optional)
LDL less than 130 mg/dL (optional
goal: less than 100 mg/dL)
With heart disease:
LDL greater than 100 mg/dL
start diet therapy + exercise
LDL less than 100 mg/dL:
drug therapy optional
With Type 2 Diabetes Mellitus
LDL greater than 100
mg/dL start diet therapy + exercise
(LDL less than 100 mg/dL:
drug therapy optional)
LDL less than 100 mg/dL
(optional goal: less than 70mg/dL**)
*10-year
risk calculators are available at on DrugDigest
under the ?Interactive Tools? tab.
**In patients that are ?very high risk? (those with
established heart disease and multiple major risk
factors including diabetes, metabolic syndrome, and
current smokers), a more aggressive LDL goal of less
than 70 mg/dL may be encouraged |
| |
Detailed Discussion
For
the initial drug treatment of hypercholesterolemia,
HMG-CoA reductase inhibitors, "statins", are often
used because of their effectiveness and lower
incidence of side effects.
Currently, six statin drug classes are available.
The choice of which to use will depend on how much
cholesterol reduction is needed, your preferences
(read below for help), and prescription insurance
benefits
Cholesterol
absorption inhibitors are a new class of cholesterol
lowering agents and work together with statins to
lower cholesterol. This class of drugs works to
lower blood cholesterol levels by absorbing excess
cholesterol (from foods) in the intestines and thus
blocking cholesterol's entry into the bloodstream.
In a study published by the Mayo Clinic in May 2005,
it was found that the addition of Zetia (a
cholesterol absorption inhibitor) to statin therapy
may cause a further reduction in a patient’s
cholesterol levels. It is thought that this
reduction may be the result of the two drugs working
together but at different areas of the cholesterol
production pathway. In fact, one pharmacy
manufacturer combined Zetia with a commonly used
statin known as Zocor. This combination product is
called Vytorin. However, as with any medications,
there can be conflicting data. A study released this
year (2008) said that objective control of plaque
formation in the carotids was NOT seen with Zetia.
Beyond the basics:
Cholesterol Subclasses –taken
from Berkeley Heart Labs
We now know that cholesterol can be broken down beyond just
LDL and HDL. Within both LDL and HDL, there exist particles
that vary in their characteristics and therefore in their
risk (in the case of LDL) and protective (in the case of HDL)
factors for CAD. A much better assessment of CAD risk is
achieved by enlarging the spectrum of testing to
includeadditional disorders, such as a predominance of small
particles within the LDL family (small LDL trait), and low
levels of HDL2b, the most heart-protective type of HDL.
This more comprehensive approach can point to treatment that
differs from traditional therapy and is more effective in
slowing, halting, or reversing the progression of CAD.
LDL particles contribute to the harmful buildup of fat
inside artery walls, a process called atherosclerosis. The
LDL particles contribute to atherosclerosis partly by
slipping through the spaces between the cells of the
artery0-wall lining and unloading their cargoes of
cholesterol inside the wall. LDL particles floating in the
blood of the same person vary in size and small particles
penetrate the artery wall with relative ease! Making matters
worse, they are also more susceptible to oxidation, a
chemical process that intensifies the atherosclerotic
activity of LDL.
People with a predominance of small LDL particles have an
increased risk of developing CAD and suffering a heart
attack. The small LDL trait is found in 50% of men and
postmenopausal women, and in 30% of pre-menopausal women
with CAD. The small LDL trait is also present in 50% of
their first-degree relatives, who may or may not have CAD
symptoms.
HDL particles, on the other hand, inhibit atherosclerosis in
part by carrying cholesterol out of the arterial wall and,
the liver, via the circulation, which can dispose of it. The
process is called reverse cholesterol transport. HDL2b is
the most active of all the HDL particles in such transport.
The more HDL2b you have the better.
HMG-CoA Reductase
is a chemical made in our bodies that helps the liver
produce cholesterol. HMG CoA reductase inhibitors get in the
way of that process, reducing the amount and frequency of
cholesterol being produced. These medications cause the
greatest reduction in cholesterol at the lowest doses and
are used in many individuals at high risk of heart disease,
or to help prevent those that have had a heart attack or
stroke from having another one.
Drugs in the class
Atorvastatin (Lipitor) Lovastatin (Mevacor) Fluvastatin
Extended-Release (Lescol XL) Fluvastatin (Lescol)
Rosuvastatin (Crestor) Simvastatin (Zocor) Lovastatin
Extended Release (Altocor, Altoprev) Pravastatin (Pravachol)
Crestor (upda
Cerivastatin -
Withdrawn From The Market (Baycol - Withdrawn From The
Market) Cholesterol
Absorption Inhibitors
Drugs in this class work to lower blood cholesterol levels
by absorbing excess cholesterol (from foods) in the
intestines and thus blocking cholesterol entry into the
bloodstream.
Drugs in the class
Ezetimibe
(Zetia)- see
carotid study results discussed above-this drug has a
generally very low side-effect profile and continues to be
prescribed by cardiologists and other physicians.
Page 9
Anti-lipidemic Agents How
niacin lowers cholesterol levels is not well understood, but
it seems to inhibit production of VLDL, and significantly
lowers levels of triglycerides (primary indication) as well
as LDLs. Niacin can also raise levels of HDL, the good
cholesterol. Fibric acid derivatives affect the breakdown of
body fats and reduce the amountof triglyceride manufactured
by the liver. A very common side effect called ?flushing?
(redness, burning,
and tingling of the skin) causes may individuals to stop
using this medication.
Drugs in the class
Niacin (Niacor, Nicolar, Nicotinic Acid)
Bile
Acid Resins Particles
made up of bile and fat are reabsorbed by the small
intestine, go into the blood, and travel directly to the
liver where the bile is recycled. Bile acid resins absorb
bile acid in the intestinal tract rather than let it be
reabsorbed and reused by the body. This decrease in bile
causes the liver to produce more bile. Since the liver uses
cholesterol to produce bile, bile acid resins reduce
cholesterol levels in the blood stream. Use of bile acid
resins is a conservative approach to treating high
cholesterol because the drug's action is limited to the
intestinal tract. However, because they are known to be safe
and have few side-effects, they are used to treat patients
with moderately elevated LDL- cholesterol, in people who do
not already have heart disease, and when drug therapy is
necessary in young adult men and premenopausal women. They
are also used in combination with other drugs (such as
statins) to treat more severe forms of
hypercholesterolemia.
Drugs in the class
Colesevelam (Welchol)
Colestipol (Colestid)
Cholestyramine Powder for Suspension (Prevalite, Questran, Questran
Light)
Combination HMG-CoA Reductase and Cholesterol Absorption
Inhibitors
This class combines
the most potent cholesterol reducers (HMG-CoA reductase
inhibitors statins) with another cholesterol lowering
medication (Cholesterol Absorption Inhibitors) in one tablet
to give those who take it that extra decrease in cholesterol
they may not be able to achieve with one of the medications
alone.
HMG-CoA reductase is a chemical made in our bodies that
helps the liver produce cholesterol. HMG-CoA reductase
inhibitors get in the way of that process, reducing the
amount and frequency of cholesterol being
produced.Cholesterol Absorption Inhibitors block cholesterol
found in food from being absorbed into the blood stream from
the intestinesThe combination works by blocking cholesterol
production by the body and well as blocking absorption of
cholesterol from the food we eat.
Drugs in the class
Ezetimibe
and Simvastatin (Vytorin)
Treatment Options Elevated Triglyceride Levels
Fibric acid derivative or niacin may be most effective. Both
medications work by decreasing the liver's production of
triglycerides.
Additionally, fibric acid derivatives (or "fibrates") such
as gemfibrozil also increase HDL-C production.Clofibrate
(No Longer Available) (Atromid-S (No Longer Available))
Fenofibrate (Micronized) Capsules (Antara, Lofibra)
Gemfibrozil (Lopid)
Fenofibrate Tablets (Tricor, Triglide)
"RE-CROSSING THE LINE"-losing
enough weight to physically exercise and have the resolve
to change habits permanently
SUGGESTED TESTING FOR THE SERIOUSLY OVERWEIGHT PATIENT
- CARDIO-PULMONARY
STRESS TESTING
FOR EXERCISE
CAPABILITY ,
EXERCISE AND DIET PRESCRIPTIONS-
- SLEEP-RELATED
DISORDERS/LAB- AASM
certified sleep lab-with typical symptoms such
as excessive daytime sleepiness, snoring, witnessed apnea
and preferably with physical findings most common of which
are LARGE NECK SIZE (over 17.5 men) , small oral airway
passage, retracted chin, usually obese BUT NOT NECESSARILY
OBESE!!!
- PFT’S AND
ECHOCARDIOGRAMS FOR
PULMONARY HTN, OBESITY- INDUCED ASTHMA- if indicated
- VASCULAR STUDIES- if
indicated ( hypercholesterolemia, OR symptoms)
- LIPID, DIABETIC,
AND THYROID TESTING your
lab if requested-if not done within 6 months
Stressing
lifestyle changes, exercise, reduced intake, and motivation
-
MATERIALS:
Web-site support Lifestyle contracts
-
Fractional cost meal replacements via direct pick-up in
Charleston or through internet sales
-
Our favorite diet plans: South Beach, Adkins, Nutri-systems,
and Healthy Choice
-
Contracted discounts to local fitness centers
Heart-Healthy
Diet and Information for the High Cholesterol Patient
Learn how to eat a
heart-healthy diet and reduce your risk of heart disease.
By paying close
attention to what you eat, you can reduce your chance of
developing atherosclerosis, the blocked arteries that cause
heart disease. If the artery-clogging process has already begun,
you can slow the rate at which it progresses. With very careful
lifestyle modifications, you can even stop or reverse the
narrowing of arteries.
While this is very important for
everyone at risk for heart disease, it is even more important if
you have had a heart attack and/or procedure to restore blood
flow to your heart or other areas of your body, such as
angioplasty, bypass surgery or carotid surgery. Following
prevention advice can protect against re-stenosis (re-blockage),
or the re-narrowing of your arteries.
Feed Your Heart Well
Feeding your heart well is a
powerful way to reduce or even eliminate some risk factors.
Adopting a heart-healthy diet can help reduce total and LDL
cholesterol (the "bad" cholesterol), lower blood pressure, lower
blood sugars, and reduce body weight. While most dietary plans
just tell you what you CAN'T eat (usually your favorite foods!),
the most powerful nutrition strategy helps you focus on what you
CAN eat. In fact, heart disease research has shown that adding
heart-saving foods is just as important as cutting back on
others.
These are 5 nutrition
strategies to lower your cholesterol and reduce your risk of
heart disease:
1. Eat
more vegetables, fruits, whole grains and legumes. These
wonders of nature may be one of the most powerful strategies in
fighting heart disease.
2. Choose fat calories wisely. Keep
these goals in mind: Limit total fat grams; Eat a bare minimum
of saturated fats and trans-fatty acids (for example, fats found
in butter, salad dressing, sweets and desserts); When you use
added fat, use fats high in monounsaturated fats (for example,
fats found in olive and peanut oil).
3. Eat
a variety -- and just the right amount -- of protein foods. Commonly
eaten protein foods (meat, dairy products) are among the main
culprits in increasing heart disease risk. Reduce this
nutritional risk factor by balancing animal, fish and vegetable
sources of protein.
4. Limit
cholesterol consumption. Dietary
cholesterol can raise blood cholesterol levels, especially in
high-risk people. Limiting dietary cholesterol has an added
bonus: You'll also cut out saturated fat, as cholesterol and
saturated fat are usually found in the same foods. Get energy by
eating complex carbohydrates (whole wheat pasta, brown or wild
rice, whole-grain breads) and limit simple carbohydrates
(regular soft drinks, sugar, sweets). If you have high
cholesterol, these simple carbohydrates exacerbate the condition
and may increase your risk for heart disease.
5. Feed
your body regularly. Skipping
meals often leads to overeating. For some, eating five to six
mini-meals may help keep cravings in check, help control blood
sugars and regulatemetabolism.
This approach may not be as effective for those who are tempted
to overeat every time they are exposed to food. For these
individuals, three balanced meals a day may be a better
approach.
Other
Heart-Healthy Strategies:
Reduce salt intake. This
will help control your blood pressure.
Exercise. The
human body was meant to be active. Exercise strengthens the
heart muscle, improves blood flow, reduces high blood pressure,
raises HDL cholesterol ("good" cholesterol), and helps
control blood sugars and body weight.
Hydrate. Water
is vital to life. Staying hydrated makes you feel energetic and
eat less. Drink 32 to 64 ounces (one to two liters) of water
daily (unless you are fluid restricted).
Enjoy every bite. Your
motto should be dietary enhancement, not deprivation. When you
enjoy what you eat, you feel more positive about life, which
helps you feel better and less likely to overindulge.
EXCELLENT FREE
HEALTH SUPPORT FROM THE GOVERNMENT/OTHERS
http://www.health.gov/ A
great free US government website for general health issue…use
the healthfindrer to learn what IS RECOMMENDED for American by
age, sex and if pregnant
http://www.healthfinder.gov/ a
very good search engine with supportive links
GENERAL
EDUCATION:
SERIOUS CONDITIONS ASSOCIATED WITH SEVERE OBESITY WHICH YOUR MD
MUST BE AWARE AND ADDRESS
The Metabolic Syndrome
(Insulin Resistance Syndrome)
http://www.americanheart.org/presenter.jhtml?identifier=4756 Characteristics
according to The
American Heart Association
Central obesity (excessive
fat tissue in and around the abdomen)- Elevated
waist circumference: Men: Equal to or greater than 40 inches
(102 cm) Women : Equal to or greater than 35 inches (88 cm)
· Dyslipidemia (blood
fat disorders — mainly high triglycerides (Equal
to or greater than 150 mg/dL) and Reduced
HDL ("good")
cholesterol: Men — Less than 40 mg/dL Women — Less than 50 mg/dL Insulin
resistance or glucose intolerance (the
body can’t properly use insulin for blood sugar) Elevated
fasting glucose: Equal to or greater than 100
mg/dL (5.6 mmol/L) or use of medication for hyperglycemia Hypertension (130/85
mm Hg or higher)
Some studies include:
Prothrombotic state (e.g.,
high fibrinogen or plasminogen activator inhibitor)Proinflammatory state
(e.g., elevated C-reactive protein)
CAUSES overweight/obesity physical inactivity genetic factors
RESULTS coronary
heart disease type 2 diabetes stroke and peripheral vascular
disease
Obesity is now more serious than smoking and is very treatable.
Management should NOW be a major goal for every great physician.
Obesity Hypoventilation
Syndrome
The obesity
hypoventilation syndrome, also known as Pickwickian syndrome, is
the combination of obesity ,
falling oxygen levels
in blood (hypoxia) during sleep and increasing carbon
dioxide levels (hypercapnia);
this is the result of hypoventilation (excessively
slow or shallow breathing) during sleep. Obstructive
sleep apnea is
often but not necessarily present. Pulmonary hypertension is
common and later causes cardiac arrhythmias.
SIGNS AND SYMPTOMS
Most people with
obesity hypoventilation syndrome have concurrent obstructive
sleep apnea, a condition characterized by snoring, brief
episodes of apnea (cessation of breathing) during the night,
interrupted sleep and excessive daytime sleepiness. In OHS,
sleepiness may be worsened by elevated blood levels of carbon
dioxide, which causes drowsiness ("CO2 narcosis").
Other symptoms present in both conditions are depression,
hypertension (high blood pressure) that is difficult to control
with medication and headaches occurring in the morning. Blurring
of vision and visual changes may result from papilledema
(swelling of the optic disc) in response to the raised carbon
dioxide levels.
Diagnosis
If OHS is suspected,
various tests are required for its confirmation. Arterial
blood gas levels
are determined to measure oxygen and carbon dioxide levels; this
requires a blood sample from an artery,
usually the radial
Page 14
artery. To
distinguish various subtypes, polysomnography is
required. To distinguish between OHS and various other lung
diseases that can cause similar symptoms, CT scan, PFT’s and echocardiography may
be performed. Criteria
Formal criteria for
diagnosis of Obesity Hypoventilation Syndrome are:
Body mass index over
30 kg/m2 ,
Arterial carbon dioxide level over 45 mmHg , No alternative
explanation for hypoventilation-such as use of narcotics
Treatment
Reduction in weight,
either through a regimen of diet and exercise, medication or
sometimes through bariatric surgery, has been shown to improve
the symptoms of OHS and resolution of the high carbon dioxide
levels. Weight loss may take a long time and is not always
successful.
Overnight mask
ventilation with positive airway pressure may lead to an
improvement in most symptoms of OHS.
Our Favorite On-line
FREE Weight Loss calculators: tools are also available
through the USDA website
www.choosemyplate.gov
Measure Your Metabolism
http://health.msn.com/weight-loss/measure-your-metabolism.aspx
Calculate your daily
caloric needs. You will find by comparing light activity to
moderate activity…that increased activity will greatly reduce
weight if done regularly!!!!
This chart is taken
from the web page: there is about 700 calories per day
difference between a very light and moderate activity level
(that’s one pound a week!!! Activity
Level:
Choose an activity
level below to determine how many calories you burn a day.
| |
Very Light |
Seated and
standing activities, painting, driving, laboratory
work, typing, sewing, ironing, cooking, playing
cards, playing a musical instrument |
| |
Light |
Walking on
a level surface at two-and-a-half to three mph,
garage work, electrical trades, carpentry,
restaurant trades, housecleaning, child care,
golfing, sailing, table tennis |
| |
Moderate |
Walking
three-and-a-half to four mph, weeding and hoeing,
carrying a load, cycling, skiing, tennis, dancing |
| |
Heavy |
Carrying a
load uphill, felling a tree, heavy manual digging,
basketball, climbing, football, soccer |
Typically a higher activity
category will burn on average about 550 additional calories per
day!
Weight Loss
Calculator
http://health.msn.com/weight-loss/weight-loss-calculator.aspx
Find out how long it
will take to reach your healthy
weight loss goal,
and how many calories you should consume each day.
We use this
calculator to also show how many days it would take to lose to a
target (or desired) weight—given that you burn or exercise
different calories each day
FOR MORE OF OUR
FAVORITE GREAT CALCULATORS ..... http://health.msn.com/tools-and-resources
OUR LOCATIONS:
MOUNT
PLEASANT
EDUCATIONAL MATERIALS, DIETARY SUPPORT,
MEAL PLAN REPLACEMENTS, TESTING AND
MEDICATION PRESCRIPTION DISTRIBUTION
1060 Cliffwood Dr
BEHIND THE FIRST CITIZEN'S BANK NEXT TO ANDOLINI'S PIZZA ON
COLEMAN BLVD.
TURN RIGHT AFTER THE BANK IF HEADING TOWARD THE BEACH,
THE
STREET
SIGN WILL READ “GROVES OFFICE BUILDING”
JAMES
ISLAND LOCATION
EDUCATIONAL MATERIALS, DIETARY SUPPORT,
MEAL PLAN REPLACEMENTS, TESTING AND
MEDICATION PRESCRIPTION DISTRIBUTION
NEXT TO
THE
WACHOVIA BANK, NEAR THE FOLLY AND MAYBANK INTERSECTIONS
If you have any questions about Slimmer
Success email:
info@slimmersuccess.com or call
843-795-1025
Website questions or comments may be directed to:
webmaster@slimmersuccess.com
Copyright 2006. Slimmer Success, Inc. All rights reserved |
DISCLAIMER: ALL
ADVICE MUST BE REVIEWED BY YOUR LOCAL MEDICAL PROVIDER. THIS WEBSITE IS INTENDED TO GUIDE
THE READER TOWARD A HEALTHIER FUTURE
AND DOES NOT
REPLACE DIRECT MEDICAL SUPERVISION. ENROLLMENT AT THE
SLIMMER SUCCESS WEIGHT
CENTERS WILL
ESTABLISH A PHYSICIAN-PATIENT RELATIONSHIP. DIRECT PHONE :843-795-1025 |
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