DrRic lecture at Whole Foods Market Schaumburg for Diabetes month. Topic=Pre-Diabetes.

1. “Pre-Diabetes….
…a scary diagnosis!
Enrique Saguil, MD
We didn’t invent the practice of medicine….
we’re just changing the way it’s provided.

2. The First Health Approach
We didn’t invent the practice of medicine….
we’re just changing the way it’s provided.

3. Your Team
Ric Saguil, MD
Jason Gruss, MD
Tom Jordan, RD
Katrina Christie, LCPC
Mike Blumberg, LCPC
Jennifer Green, ND
Joe Musolino, DC
Amy Iaquinta, DC
Nick Nowicki, DC
Emery Paredes, PT
Courtney Day, EP
Aimee Weber, EP
Yu Zhu, MD China
You

4. Ric Saguil, MD
We didn’t invent the practice of medicine….
we’re just changing the way it’s provided.

5. This concept of “Pre-Anything”
• NOT COVERED ON INSURANCE
• Your on your own (run/bike/swim)
• Most of us -“school knowledge” of
exercise, (which could be dangerous)
….“leagues?”
• If it was so good, why didn’t we stick with it
last new years resolution?
• No place that’s close enough, cheap
enough, new enough or fast enough….but
what about your neighborhood?....or
backyard!!

7. Started with the “5-O” mentality
• You are driving along, 5-10 mph over the
speed limit (like everyone else) and suddenly a
police car on the side of the road. Then
everyone slows down and behaves
themselves.
• You are not feeling any symptoms, 10-20
pounds overweight (like everyone else) and
suddenly you have a physical. Then you eat
right and plan to exercise more to make the
change to be healthy.

8. Facts:
• Coronary heart disease (CHD) caused about 1
of every 5 deaths in the United States in 2005.
• It is estimated that 195, 000 silent first
myocardial infarctions occur each year.
• About every 25 seconds, an American will
have a coronary event, and about every
minute someone will die from one. (8th
slide, 60 seconds per slide-8 americans just
died)

9. Wait…isn’t this a pre-diabetes talk?
Normal physical Overweight-Gradeschool Obese-HS Heart Attack College

10. Graphic Scale BMI

11. Visual Scale BMI

38. Another 20 years?
•1 in 2 will be obese

39. YOU?

40. Diabetes trend 2004

41. Diabetes trend 2005

42. Diabetes trend 2006

43. Diabetes trend 2007

44. Diabetes trend 2008

45. 2004

46. 2005

47. 2006

48. 2007

49. Physical Inactivity 2008

50. Diabetes
Inactivity
Diabetes = Physical Inactivity

51. Pre-Diabetics…should we act now?
• Aka-Impaired glucose tolerance, impaired
fasting glucose.
• People with pre-diabetes have a 1.5-fold risk
of cardiovascular disease compared to people
with normal blood glucose. (vs 2-4 fold DM)
• Damage to end organs suspected to already
occur with pre-diabetes
• With ignorance, move onto diabetes in 10y

52. Testing….Testing!!!

53. Who gets tested?
• Overweight and 45 or older
• Normal weight and 45 or older (ask)
• Overweight and younger than 45 +(ask)
+ = HBP, Low HDL, High Tri, Fam Hx DM
Gest DM, Birth of > 9lb baby,

54. Who benefits from testing
• Doctor - no…I can fill your spot with another
• Drug company – yes (muuuhaha)
• Family - yes…observed habits rub off
• Patient - yes…a chance to change
…knowledge is power
…eventually gonna need it!

55. Test Awareness
• HA1C awareness = 14.8% to 27%
• BP awareness =20.7% to 26.6%
• LDL awareness =3.5% to 5.6%
Joslin Center 2009

56. “Pre” or “Full Blown”
Endocrinologist/CDE
Family Medicine/Internist/Ob/Peds
Underserved/
Undiagnosed

57. • www.diabetes.org
Diabetes Risk Test
Local Events
November is DM month!

58. What not to do = Heart Attack Grill

59. Treatment ADA (for DM)
• Blood glucose control
• Medications
• Organ transplant
• Dental health
• Diabetes 24/7 (blood glu, aic, bp, chol, physical act, weight, meds)

60. Trip down “digestive lane”

61. Stomach acid breaks down food

62. Insulin from the pancreas

63. Body “puts away” the glucose
(But may overcorrect)

64. Absorption of the carbohydrate

65. Spaghetti
White Bread

66. Confused? Follow ANDI….
Aggregate Nutrient Density Index…Dr Joe Furhman

67. Largest Losers FHA
Mary Mary
292# 227#
Fasting Fasting
Blood Sugar: Blood Sugar:
107 93

68. Largest Losers FHA
Kathy Kathy
204# 141# (in the
120s today)
Cholesterol:
245 Cholesterol:
191

69. Largest Losers FHA
Bill Bill
254# 189#
Triglycerides: Triglycerides:
338 68

70. First Health Associates
Pillars of Blood Sugar Management
1) Weight Status
2) Fitness
3) Labs
4) HRA
5) Mental Fitness
6) Nutrition
Motion, heat, galvanic change, temp

71. Doing it on your own?!
Weight
Control

72. A Quicky with DrRic
• Strategic locations (arms reach when tired)
• Plan ahead (pick shop day and load up)
• Shop full, meals for the week
• Always have a “go to” reward– (food/snack/meal)
• Water! (tea or warm water to start the day)
• Must have a F/V/G in sight
• Prep a “Go-Bag”
• Set a deadline for success/help

73. My “go bag” (or get help)

74. Inject your kitchen (or get help!)
Your proving ground!

75. The exercise part….

76. Swimming
Excellent for joints,
Good for lung capacity
Limited by place and climate
Watch skin conditions
Watch asthma
Watch shoulder injury

77. Biking
Good for joints
Good nature contact
Good to include in work
Watch back
Watch wallet
Watch speed/coasting

78. Running
Long developed community activity
Can be done by any age
Addictive (positively-chi running)
Watch exposure (newcomers)
Watch the lower extremities
Shoes!

79. Hiking
Forest Preserves are tax supported
The fastest hikers burn as much as the slowest jogger
Slowing down can bring awareness of nature
Moving away technology cultivates the relaxation response (think kids!)
Less chances for strain and overuse injury
Watch solitude (injury, dehydration, disorientation)
Watch animals

80. Walking Stats and “gettin sweaty”
MET’s (cal/kg/hr):
Sitting for this lecture
0.0 mph - 1
Walking
2.0 mph - 91 1 min mile=60mph
2.5 mph - 87
3.0 mph - 85 2 min mile=30mph
3.5 mph - 83 3 min mile=20mph
4.0 mph - 91 4 min mile=15mph
4.5 mph - 102 5 min mile=12mph
5.0 mph – 116
10min mile=6mph
Running 12min mile=5mph
5.0 mph - 116 15min mile=4mph
6.0 mph - 121 20min mile=3mph
7.0 mph - 119 25min mile=2.5m/h
8.0 mph - 123
9.0 mph - 121
10.0 mph - 131
Bottom line….fastest walker burns like the slowest jogger…but less knee pain

81. Timing of hikes
• Weather.com
• Weather.gov
• Sunrise/sunset
• 1-3 times a week for 30-60 minutes
(30+minutes to achieve RR)
• Or add resistance to burn more calories
(depending on your indivi resting metabol rate)
• Diabetics can increase to 5x week for glucose
control
• Hypertensives can use breathwork twice a day

83. Yoga!
Ancient art
Popularity high
Low injury risk
Excellent at cultivating relaxation response
Excellent flexibility/power/balance
Detoxing
Still Growing with multiple styles

84. Or….get…help!!!
Physical therapists
Exercise physiologists
Personal trainers
Life coaches
Yoga instructors
Dieticians (RD)
Has to be sustainable!!!

85. Not that I’m biased but….yoga has
hidden prizes!!!

86. Not that I’m biased but….yoga has
hidden prizes!!!
Pancreas massage Balance/Strength
Cultivation of Relaxation Response

87. Hidden prize-controlling Stress eating

88. Godzilla VS Ghandi
Control these hormones!!! Cultivate these !!!

89. RR and breath
IN IN OUT OUT- 1st 2nd 3rd 4th

90. A Quicky with DrRic
IN
IN
OUT
OUT
Intructions: Thumb to index then middle with inhale, ring then pinky with exhale, repeat.
Slow, concentrate on matching breath to thumb movement….continue for 5-10 mnutes.

91. Herbal supplements
100-400mg/d? 1-3gm/d?
90-120mg/d? 1000mcg/d?
Gurmar for appetite?
Please ask a Naturopath first.

92. Halloween Treats:
• Avoid giving out any candy combination of milk or
white chocolate with nuts or peanut butter - they rank
highest in calories.
• Chocolate with mint or marshmallows has fewer
calories, as do caramels and non-chocolate candy such
as licorice, taffy, lollipops and flavored fruit candies.
However, these are cavity-makers and not very
nutritious.
• Consider giving out small squares of dark chocolate
with at least 70 percent cocoa, little boxes of organic
raisins, organic granola bars, organic fruit wraps or
snack-size bags of air-popped popcorn.
www.DrWeil.com

93. In summary: Pre-Diabetes Checklist:
• Maintaining low BMI
• Eating properly (Or Get Some Help!!!)
• Exercising
• Cultivating the Relaxation Response
• Sleeping 6-8 hours
• Community/group activity
• Go outside insurance (outside the box)

94. One size never fits all…
Make changes that not only work
your heart but come from the
heart….
Starved Rock…..Thanks for Listening!!!

95. In the end, follow your “gut feeling”
Disease
Pre-Diabetes
If something feels wrong about life….take the steps to change

96. Live Healthy!!!
Next Lecture:
Whole Foods Market Schaumburg
The “Yoga” of Eating Right
January TBA
We didn’t invent the practice of medicine….
we’re just changing the way it’s provided.

97. Bibliography
• Molecular aspects of lipoic acid in the prevention of diabetes complications
Lester Packer PhD , a, , Klaus Kraemer PhDb, Gerald Rimbach PhDc
• Advanced glycation end product-induced activation of NF-kappaB is suppressed by alpha-lipoic
acid in cultured endothelial cells.
-A Bierhaus, S Chevion, M Chevion, M Hofmann, P Quehenberger, T Illmer, T Luther,
-E erentshtein, H Tritschler, M Müller, P Wahl, R Ziegler and P P Nawroth
• Enhancement of glucose disposal in patients with type 2 diabetes by alpha-lipoic acid.
-Jacob S, Henriksen EJ, Schiemann AL, Simon I, Clancy DE, Tritschler HJ, Jung WI, Augustin HJ,
• alpha-Lipoic acid treatment decreases serum lactate and pyruvate concentrations and improves
glucose effectiveness in lean and obese patients with type 2 diabetes.
-T Konrad, P Vicini, K Kusterer, A Höflich, A Assadkhani, H J Böhles, A Sewell, H J Tritschler,
• Cinnamon Improves Glucose and Lipids of People With Type 2 Diabetes
-Alam Khan, MS, PHD123, Mahpara Safdar, MS12, Mohammad Muzaffar Ali Khan, MS,
HD12, Khan Nawaz Khattak, MS12 and Richard A. Anderson, PHD3
• Effects of a cinnamon extract on plasma glucose, HbA1c, and serum lipids in diabetes mellitus type
2
B. Mang1, M. Wolters1, B. Schmitt1, K. Kelb1, R. Lichtinghagen2, D. O. Stichtenoth2, A. Hahn1

98. • Chromium, Glucose Intolerance and Diabetes
-Richard A. Anderson, PhD, FACN
• Elevated intakes of supplemental chromium improve glucose and insulin
variables in individuals with type 2 diabetes.
-R A Anderson, N Cheng, N A Bryden, M M Polansky, N Cheng, J Chi and J Feng
Antidiabetic effect of a leaf extract from Gymnema sylvestre in non-insulin-
dependent diabetes mellitus patients
K. Baskaran, B.Kizar Ahamath, K.Radha Shanmugasundaram , E.R.B.
• Antidiabetic effect of Gymnema montanum leaves: effect on lipid peroxidation
induced oxidative stress in experimental diabetes
R. Ananthana, , , C. Baskara, V. NarmathaBaia, L. Parib, M. Lathab, K.M. Ramkumarb
• Systematic Review of Herbs and Dietary Supplements for Glycemic Control in
Diabetes
-Gloria Y. Yeh, MD, MPH12, David M. Eisenberg, MD1, ed J. Kaptchuk, OMD1 and
Russell S. Phillips, MD12