Lecture from 9/24/11 on Initiating a Sustainable Lifestyle Change given at Whole Foods Market Schaumburg Dr Ric Saguil

1. Initiating the First Steps to a Lifetime of Change Enrique Saguil, MD We didn’t invent the practice of medicine…. we’re just changing the way it’s provided.

2. “The best use of a physicians knowledge is to teach people to heal themselves…” -David Simon, MD

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

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

5. First Health Associates 2010 S. Arlington Heights Rd LL Suites Arlington Heights, IL grounding nutrition movement RicSaguil, MD We didn’t invent the practice of medicine…. we’re just changing the way it’s provided.

6. Enrique Saguil, MD Family Medicine West Suburban Sports Medicine St Joseph Medical Acupuncture UCLA Integrative Medicine AZCIM Yoga Teacher The Chopra Center No affiliations with REI or Whole Foods Market In Private Practice in Arlington Heights, IL Author of Running Behind (release date 8/2012)

7. What’s the “End Game” in change: Longevity No medicines Mobility Love/companionship/passion Community Family Fulfillment

8. Current methods Diet Group challenge Surgery Retirement (early) Job change Down-sizing economic expectations

9. The usual roadblocks Cravings Damaged Relationships Overstepped FinancialObligations (live-in divorce) Aggressive Fad Diets Side effects (chemical effects) of food Unaddressed Stress Response/no RR Limited free time Frustration with usual coping skills Risky Behavior during Anger(DABDAR) Food Insecurity Information overload

10. STRESS!!! Am I depressed? Am I sleepy? Why do we crave? Why is there guilt? Are these food allergies? Is it the food industry? What is stress eating?

11. MOVIE TRIVIA!!! ? 3 min preview:

12. 1966 Oscar for Special Visual Effects

18. Tobacco?

20. out of control in ear fluid

21. Strangled by antibodies

22. Lazering the blood clot

23. White Corpuscles Attack the “Foreign Bodies”

24. White Corpuscle Digests the Ship Helm

25. The End

26. Movie Synopsis: Stressor occurs to the body (-blood clot) Body needs help in healing (-team) Western medicine has treatment but dangerous side effects (-brain surgery 1966) Team travels inside to “target” the problem Journey dangerous in avoiding body defenses Every cell along the way had its function but all together played a role in sustained survival Human’s natural healing/defenses win in the end with the assistance of medical science!!!! Back to teaching

27. All Cells Different but the Same The Nucleus (DNA) The blob

28. DNA – stored messages for 80 years Your DNA will only replicate properly when given the proper environment! Old-school: traits & character controlled by genes New-school: environment controls genetic activity and even the rewriting of genetic code Richie Davidson, PhD Harvard/U of WI Esther Sternberg, MD NIH Jeff Ducek, PhD Mass Gen Hosp/U of MN Herb Benson, MD Harvard Bruce Lipton, PhD ….

29. Epigenetics Neuroplasticity….. …..next time. Teaser!!!

30. Reference books

31. Love your genes!! JAMA. 2010 Jan 20;303(3):250-7. Association of marine omega-3 fatty acid levels with telomeric aging in patients with coronary heart disease. Or Face Mutation

32. Genetic Expression?

33. ASTHMA THYROID Genetic Expression? Genetic Expression HEART DISEASE IBS DEPRESSION

34. I don’t have any stress in my life doc! The study of social aggression in baboons Lower strata males had higher stress and…. ….with increased brain stress hormone level; HBP, high heart rate, poor reproductive capacity. Later TB wiped out the aggressive males The resulting troop lived longer with multiple heiarchies and important duties within each heiarchy Less aggressive male combat, less “dumping” on a female, more grooming, no intimidation of younger, no biting of mother New troop -Low aggression, high social affiliation, less disease Scientist Robert Sopolsky

35. Love is the Answer! Telomeres shorten with age normally Stress speeds up shortening Biologist Elizabeth Blackburn For every year of care for a chronically ill child ….add on 6 years of aging to the mom Compassion and caring may add to increasing telomerase and healing (at the DNA level) Psychologist ElissaEpel, PhD UCLA Mind-body interventions affect gene expression and disease vulnerability by improving response to oxidative stress and associated cellular damage, and inflammation. Ducek Harvard 2008

36. New School Ways to Love your Cells Mind body modalities: Hypnotherapy Yoga/guided imagery MBSR/CBT Increase serotonin/relaxation response Reinforce good food/cell environment Meditation/biofeedback

37. Old School ways to “Love your cells” :) Eat your vegetables Take your vitamins Listen to your elders Do your chores Do your homework Get to bed early Say your prayers

38. 4-7-8 Breath Work for Stress Relief You can go to http://www.herbal411.com/the_library and catch a 2 minute demo

39. First Health Associates 2010 S. Arlington Heights Rd LL Suites Arlington Heights, IL grounding done RicSaguil, MD We didn’t invent the practice of medicine…. we’re just changing the way it’s provided.

40. “Let food be thy medicine and medicine be thy food….” -Hippocrates

41. Looks good, feels good-do you indulge?

42. Looks good, feels good-do you indulge?

43. Diets Atkins: induction-premaintenance-maintenance, low fiber fruits veg, multiple returns to induction phase can lead to prob with TC, LDL, BP, osteop, kidney stones Zone (Sears): 3meal+2 snacks, may be low in fiber some vits, rigid planning Eat Right for your Type (D’Adamo): O-hunter diet/A-gather diet/B-varied + dairy/AB-little of all, O’s could have same prob as Aktins Sugar Busters: 3 balanced meals/d, nothing after 8pm, may be low in fiber and some vits, Body for Life (Phillips): 6 small fit meals with one day for crave, protein supplements expensive, rigorous exercise scd Volumetrics(Rolls): no structured pattern but no skipping and no snacks, water/foods high in water content/ caloric restriction Eat More Weigh Less (Ornish): eat when hungry and get satisfd, comlex CHO, vegtarian, low in B and Zinc, fat intake falls 10% (watch fatty acid cut) South Beach (Agaston): 3 phases/ low CHO,reintroduce,maintenance, phase 1 low in fiber and potentially calcium, may be high in sat fat Raw Foods: 80% raw, not over 118*, using dehydrator to hot air sprout, blend,juice,chop, watch B12 and Vit D

44. Diet Wars A Review found more weight loss at 12 months with Atkins than Ornish, Zone or LEARN Gardner, et al 2007 5.9 kg in 6 months regardless of WeightWatchers, Atkins Slim Fast Truby, et al 2006 At any given time, 45% women and 30% men on a diet Serdula, et al Jama 1999

45. Carb-Monosaccarides Glucose Glycogen Fructose Galactose

46. Polysaccarides Maltose glu + glu Sucrose glu + fru Lactose glu + galact Amylose (starch) Amylopectin (starch) Carb-Disaccarides

47. Carb-Fiber Soluble -pectins, gums, mucilage Insoluble –cellulose:whole wheat flour, vegetables, bran -- hemicellulose: bran, whole grain -- lignins: vegetables, wheat, fruit, edible seeds

48. Proteins Its not just beef that gives muscle Plant based proteins can total same with less side effects (antibiotic traces, hormones, sat fat) Care with protein supplements!

49. Ocean and fresh water fish (uncontaminated sources) Veggie burgers Egg whites, (organic if possible) Whey protein (micro-filtered, lactose-free) Occasional shell fish, omega 3 whole eggs, veggie meat subs, tuna (canned but check ewg for amount/week), swordfish (high Hg), mackerel (high Hg) None or Rare Non O3 whole eggs, Lean game (venison, ostrich buffalo), Textured veg protein, naturally smoked fish, skinless free-range white meat free range poultry, grass-fed beef Protein examplesKeith Block, MD

50. Fats30% of your daily intake

51. Lyon Heart Study (good fats) Some had 40% of daily calories from fat (vs 20% from fat with the AHA diet) 70% reduction in cardiovascular mortality and morbidity Quality not the quantity of fats…..discuss!

52. “Get” your Physiology Break down carb-get into bloodstream Insulin secreted Carb initially goes to remake liver and muscle glycogen stores (70kg stores about 300gm) Excess floats for a “second”, > glycolysis, >ATP, >acetyl CoA,>fatty acid synthesis,>fat deposition I get it!!

53. Hormonal action with eating Insulin release stimulates glycolysis and causes glycogen formation Glucagon/epinephrine stimulate glycogenolysis When blood glucose is high, glycation of protein occurs esp in the glom.bas.memb, vascul.enoth, eye lens (glycation causes malfunction of the organ it attacks)

54. Side effects with food Very subtle Very powerful Play on hormonal responses Powerful technology for research Started as innocent money making for the food industry-now with evidence for damage not so innocent anymore

55. Why bother with the side effects? $294 million targeted at kids fast food indust

56. Processed Food Side Effects: Faster spike of sugar “high” Lower drop “crash” With the fast peak and abrupt drop, “markers” of inflammation are released into the blood

57. Spaghetti Slow and steady release White Bread Fast and persistent release

59. Whole Foods Market -ANDIscores

60. A mostly plant based diet gives more than just fiber

61. Nutrients & Phytochemicals withNational Cancer Institute Clinical Development Plans

62. Is “rabbit food” worth it? Esselstyn’s subjects had 70% reversal of 3v ds Ornish’s subjects had stopped or reversed severe coronary artery disease in 1y (+in 5y) Ornish’s beneficial gene expression in 3mth prostate ca slowed/stopped/reversed Effective January 1, 2011, Medicare Part B will cover "Dr. Ornish's Program for Reversing Heart Disease" We eat “rabbit food “ too!

63. Information = Empowerment Sift through the SH_T Attend lectures WholeFoodsMarket.com Visit your library (lectures and DVD’s) See a registered dietician -RD Challenge your doc –MD See a naturopathic doctor -ND http://www.eatright.org http://www.naturopathic.org

64. My Take on Vitamins Standard American Diet is lacking in nutrient In all cases of disease, poor nutrition exacerbates symptoms In many cases of performance plateau, nutritional depletion is a contribution Good but don’t go overboard-(invest in food)

65. DrRic Rules! Multivitamin Omega 3 Fish Oil Everyone Vitamin D3 Vitamins/Botanicals -Personal deficiencies Mostly plant based diet (51% at least!) “Inject daily 5-7fruits and veggies, your grains, your organic produce into your food stream” www.ewg.org

67. First Health Associates 2010 S. Arlington Heights Rd LL Suites Arlington Heights, IL grounding nutrition done RicSaguil, MD We didn’t invent the practice of medicine…. we’re just changing the way it’s provided.

68. “What in the morning was true, will at evening have become a lie….” -Carl Jung

69. “I felt like I was in a concrete suit” LL Graduate Not everyone likes running Knee joints become arthritic with disease Joining a gym – only good if you get there Act your age? – Andy Weil, MD Some diseases are selective due to meds Bound for glory or failure? Move It or Lose It!

70. Small changes are ok Daily routine (parking, stairs) Building exercise aerobic strength and flexibility training small tangible 5-10min in group of three Reflect after 24hours on side effects Increase duration Strength 8-12 rep Flexibility tr good comp to aerobic and strength tr The following are DrRic’s opinions:

71. Resistance Training Old school but very available Easy to sit in a machine and follow the instructions Get a “burn” and big muscles Tendinitis

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

73. Biking Good for joints Good nature contact Good to help “green living” Watch back/neck Watch wallet and the road Watch speed/coasting

74. Running SAD http://www.cararuns.org Long developed community activity Can be done by any age Addictive (positively-chi running) Watch the lower extremities (Shoes!)

75. Yoga! http://www.yogachicago.com/ Ancient art Popularity high, lots of places Low injury risk Excellent at cultivating relaxation response Excellent flexibility/power/balance Detoxing Still Growing with multiple styles

76. Hiking http://www.rei.com/stores/118 Forest Preserves are tax supported The fastest hikers burn as much as the slowest joggers Slowing down can bring awareness to the rhythm of nature Moving away from technology cultivates the relaxation response (kids!) Less chances for strain and overuse injury Watch solitude (injury, dehydration, disorientation) Watch animals

77. No Membership Required!

78. One Way Loop Trail

79. Elk Grove Schaumburg

80. Argonne Lab/Waterfall Glen

81. Spring Valley Nature Sanctuary

82. Starved Rock

83. Devils Lake

84. Walking Stats and “gettin sweaty” MET’s (cal/kg/hr): Sitting for this lecture=1 MET Hiking= 6-7 MET Jogging 12min/mile 8 MET Bike 10-16 mph 6-10 MET Swimming fast 6-10 MET 4 min mile=15mph 5 min mile=12mph 10min mile=6mph 12min mile=5mph 15min mile=4mph 20min mile=3mph 25min mile=2.5m/h Adapted from Compendium of Physical Activities. Ainsworth, BE et al. Medicine and Science in Sports and Exercise. Vol 25, Pg 713 (1993) and Vol 32, S498 (2000).

85. Advanced trainingto break your barrier <2hours Increase in speed or resistance Cross training (endurance and altitude work) Flexibility is a universal improvement any sport

86. Invest in an Exercise Physiologist- it pays off! EP’s Rule!!! What works for Sean, doesn’t work for me; what works for me, doesn’t work for Liz…. +OT/PT’s Rock the Joint!!

87. My “Eyes” in the field:

88. Listen to the cues

89. First Health Associates 2010 S. Arlington Heights Rd LL Suites Arlington Heights, IL grounding nutrition movement done RicSaguil, MD We didn’t invent the practice of medicine…. we’re just changing the way it’s provided.

90. Keeping Healthy = Think outside the BOX Cultivating the Relaxation Response ѰLC Mind Body Modalities MD/ ѰCommunity/group tx (Dean Ornish says it helps) Sleeping 6-8 hours MD/ND Eating properly (Read and ask) MD/RD Personal Diet Design RD Exercise EP Maintaining low BMI RD ….if you need help with the above, just ask my team at FHA!

91. First Health Associates Protection (long-term) is ultimately making a lifestyle change with education/guidance in ………..diet/movement/neutralizing stress. Not one size fits all, sometimes “Steps” are necessary to improve outcome while under the care of a qualifiedteam. We pride ourselves on developing a personal program with a multidisciplinary approach to a sustainable lifestyle change.

92. FHA’s Steps of “Kaizen” In making a change, everyone starts and ends at a different step….. ….make it sustainable by increasing your chances of success! Starved Rock

93. Stress is a Distraction Kathy 204# Cholesterol: 245 Kathy 141# (in the 120s today) Cholesterol:191 Weeks 1-4: 3 Pounds Lost (0.75# per week) INTERVENTION: counseling to address stress Weeks 5-28: 48 Pounds Lost (2# per week)

94. Protein and Fiber for Satiety Bill 254# Triglycerides: 338 Bill 189# Triglycerides:68 Bill’s Meal PlanB: High FiberOatmeal Sn: Cottage Cheese L: TurkeySandwich + Carrot Sticks Sn: 2 String Cheese D: 4oz Protein, 1c Carb, 2-3c Veggies

95. Balancing Blood Sugars w/ Small Snacks Pillars of Blood Sugar Management Nutrition Physical Activity Weight Control Stress Management Medical Monitoring Mary 292# Fasting Blood Sugar: 107 Mary 227# Fasting Blood Sugar:93

96. The Satiety King Paul 191# “Eat until I’m stuffed” (FULLNESS) Paul 173# “Eat Until I’m Satisfied”

97. RicSaguil-life before

98. Life now as a pesco/ovovegitarian 2013 10/1/11 Don’t wait for the catastrophe….make the change now.

99. QUESTIONS? Thanks for listeningQ&A COMMENTS? CONCERNS? Next Lecture: October 29th Sat 3:00p Pre-Diabetes...a Scary Diagnosis! Whole Foods Market Schaumburg www.FirstHealthAssociates.com We didn’t invent the practice of medicine…. we’re just changing the way it’s provided.