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Normal vs. Optimal Health
The New Paradigm of Choice David Leonardi, M.D.
American Association of Orthodontists
Philadelphia, PA
May 5, 2013
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A B
The Science is Here
• Disease biochemical pathways have been mapped.
• We now have biomarkers to measure disease pathways.
• Much of what promotes disease, we do to ourselves.
• We now have the technology…
Degenerative Diseases
• Heart Disease
• Cancer
• Dementia – Alzheimer’s
– Vascular
• Stroke
• Parkinson’s
• Diabetes
• Osteoporosis
• Osteoarthritis
How We Age
• Oxidative Stress
• Glycation
• Inflammation
• Declining levels of vital hormones
• Dyslipoproteinemia
• Acidic Nutrition
• Cruise Ship Buffets
Oxidative Stress
• Electron Transfers – Systems
– Organs
– Tissue
– Cells
– Molecules
– Atoms: Nucleus + electrons
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Electron Transfers
• Structural Change
• Unimportant to critical
• Cancer, heart disease, dementia
Glycation
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Glycation: The bonding of glucose to protein
Cell Membrane
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AGE Formation
Cell Membrane
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AGE Inflammation
Lymphocyte
AGE
Cytokines
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Inflammation
• Brain cell death – Alzheimer’s disease
– Parkinson’s Disease
• Plaque formation – Coronary Heart Disease
– Stroke
• Cancer risk
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Aging
Glycation
Oxidative Stress Degenerative
Disease
Inflammation
AGEs
Air Pollution
Use Recirc Button
Water Pollution
Good: Carbon filtration Best: Reverse Osmosis or Distilled (supplement minerals – Ca, Mg, K)
Produce Pollution
Avoid Pesticides Organic Produce
Limiting Oxidative Stress
• Avoid pollution – Air, water, pesticides
• Eat lots of fruits and vegetables
• Take antioxidants – Beta carotene, vitamins C&E, selenium, alpha lipoic acid, CoQ10, N-
Acetyl Cysteine
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Blood Glucose and Glycation
Blood glucose
HbA1C
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Glycemic Load Comparison
• ½ cup mashed potato
• GI = 70
• AC = 24
• GL = 16.80
• ½ cup broccoli
• GI = 32
• AC = 2.8g
• GL = 0.9
½ cup of mashed potato has the same GL
as 9 1/3 cups of broccoli
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“Complex Carbs” vs. Table Sugar
Carb Glycemic index
French baguette 95
White bread 71
Whole wheat bread 72
White potato 85
Sweet potato 61
White rice 64
Brown rice 50
Table Sugar (Sucrose) 64
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Low GL
• Low GI
• Low density – Non-starch vegetables
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Moderate GL
• Low GI • High carb density
– Legumes – Pasta – Oatmeal – Brown Rice
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High GL
• High GI
• High density
– Sweets
– Starches
– Bananas, kiwi, mango, papaya
– All fruit juice
– Carrot and beet juice
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How To Keep Blood Sugar Low
Eliminate:
• Bread • Rice
• Potatoes • Cereal
• Chips, Crackers
• Sweets (exceptions: sucralose, stevia, sugar alcohols)
• Corn, Beets, Peas • Watermelon, Bananas,
Kiwi, Mango, Papaya
Limit:
• Pasta • Legumes
• Oatmeal
• Brown rice
Consume:
• Non-starch vegetables as a sole source of carbohydrate – preferably organic
Glucose and Insulin vs. Time
Blood
Glucose
and
Insulin
Time of Day meal
225 Union Blvd. Ste 400, Lakewood, CO 80228 28
Sugar, Starch and Obesity
• Dr. Alemzadeh, U Tenn.
• 24 obese patients
• Low cal diet + exercise
• Half the insulin Double the fat loss!
225 Union Blvd. Ste 400, Lakewood, CO 80228 29
Sugar, Starch and Cancer
• 89,000 women studied for approx. 15 years
• Overweight + high glycemic foods
• 2 ½ X pancreatic cancer
Charles Fuchs, M.D., Dana Farber Cancer Inst. + Harvard School of Public Health.
Journal of the National Cancer Inst. Sept. 4, 2002
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FATS
• Good – n 3 – Fish Oil
• Flax seed oil not recommended – n 9 – Olive oil, avocado, almonds
• Bad – Saturated (meat & dairy) – n 6 – Sunflower, safflower, corn, soybean
• Ugly
– Trans (hydrogenated oil) • Margarine, fried foods, baked goods
• candy bars, chips, crackers
• Ingredients label (hydrogenated)
Hormones and Aging
Testosterone
Breakfast of Champions Testosterone Decline
• Decreased muscle mass
• Increased body fat
– Especially visceral fat
• Decline in scores of mood
• Increased irritability
• Declining cognitive skills: memory and concentration
• Increase likelihood of dementia
• Increased risk of coronary disease and diabetes
• Decreased libido
• Erectile dysfunction
• Decreased aerobic capacity
LI Goals of Therapy
Goal:
• Men and Women – 66th percentile for age 40.
– Upper normal range
Benefits of Testosterone
• Reduced Heart Risk – Waist/Hip Ratio – Cholesterol – Triglycerides – Blood sugar – Insulin – Blood Pressure
• Elevated mood and reduced anxiety
• Improved memory and cognition
• Increased bone density • Increased libido • Improved sexual
performance • Increased M. mass • Decreased body fat
– Especially visceral
• Reduced diabetes risk • CHD:
– Greater exertion – Less chest pain
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Benefits of Testosterone
• After menopause: Women on Estrogen alone lost memory building; those on Estrogen + testosterone did not.
• Testosterone decreases beta amyloid formation (Alzheimer’s Disease).
Risks of Testosterone
• MEN: – Existing prostate cancer can be fueled
• MEN and Women – Unmonitored: Elevated level could lower HDL cholesterol
Doctor Awareness?
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Menopause
• Ovaries retire
• Production of estradiol, progesterone and testosterone plummet
• Menstrual cycle stops
Menopause
• Vaginal dryness
• Incontinence
• Hot flashes
• Atherosclerosis accelerates
• Blood becomes hypercoagulable
• Bone loss occurs
• Mood swings (depression)
• Thinning and drying of skin
Menopause
• Premarin and Provera
• 20 years of research: These drugs are good
• 2002: WHI: These drugs are bad – Slightly higher incidence of:
• Heart attack
• Stroke
• DVT
• Pulmonary Emboli
• Breast Cancer
• Dementia
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Premarin: Not a hormone, but a drug
• Conjugated Equine Estrogen – Horse Estrogen – 23 estrogens, 2 natural – Taken orally
• Oral administration of any estrogen – Increases clot risk
• Stroke • Heart Attack • DVT • Pulmonary Embolus • Dementia
Tendency to Clot
Women after menopause
Current oral ERT users were 3.5 times more likely to develop VTE than non- ERT users. Transdermal ERT use, however, was actually tied to a 10% reduction in the VTE risk compared with non-use. Lancet 2003;362:428-432.
Another drug
Provera, a synthetic progestin (another drug) – Not progesterone
– Foreign to the human body
– Carcinogenic in animal studies
– Promotes human breast cell division (growth)
The Good Hormones
• Bioidentical
• Estradiol (never orally)
• Estriol
• Progesterone
Bioidentical Progesterone
• Protects the uterus
• Builds bone
• Balances Mood
• Anti-proliferative for human breast cells – Testosterone
– DHEA
DIM: Di-indolyl methane
Estradiol
16 alpha-OH Estrone (Ca)
4-OH Estrone (Ca)
2-OH Estrone (B)
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DIM: 100 mg daily
Estradiol
16 alpha-OH Estrone (Ca)
4-OH Estrone (Ca)
2-OH Estrone (B)
Melatonin 1-3 mg bedtime
• Peaks age 13
• Natural deep sleep
• Immune stimulator
• Antioxidant
• Potent cancer inhibitor
Reversing Osteoporosis
• Don’t smoke (direct effect on bone density)
• Avoid cola and Dr. Pepper (phosphoric acid)
• Alkalinize your diet
• Weight-bearing exercise
• Nutrient intake – Calcium, Vit D, Boron, Manganese, Zinc, Copper, Silica, Vit K
• Hormone replacement – Testosterone, DHEA
– Estradiol, Progesterone
– Growth hormone for a select few
225 Union Blvd. Ste 400, Lakewood, CO 80228 52
Alkaline Nutrition
Acidic Foods • Animal Protein (limit)
– meat, fish, eggs, dairy
• Grains (eliminate)
– wheat, corn, rice, barley, rye, oats, quinoa, etc.
• Potato (eliminate)
Alkaline Foods
Non-Starch Veggies Fruit Plant Protein
- Soy
Edamame Tofu
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Protein 20%
Non-Starch Vegetables
80%
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Famous Last Words:
“My cholesterol is great!”
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Grim Statistics
Coronary heart disease (CHD) still
kills 28% Americans
• men and women
Women have decreased risk until age 60
when their risk equals that of men
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Reversing Heart Disease
Bulletin:
The disease that kills 28% of us…
…is now REVERSIBLE!
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Interventional Approach
Wait until the disease manifests and undergo: Sudden Death (25%),
or
Recovery with disability (75%) • Angioplasty
• Bypass Surgery
Or….
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Proactive Approach
Make use of: Biomarkers to detect disease several decades before symptoms begin.
Technology to alter the disease process in this pre-symptom phase.
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Preventing Heart Attack
Traditional risk biomarkers: Family History
Smoking
High Blood Pressure
Diabetes
Dyslipidemia (High Ratio of TC:HDL-C)
Overweight
Stress
Sedentary Lifestyle
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Cholesterol: How Valid?
100% of statin users drop their LDL-C
Only a 21-40% reduction in heart attacks
Yet plaque proven to be reversible
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Cholesterol: How Valid?
Scandinavian Simvastatin Survival Study
31%
Heart Protection Study
21%
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Here’s Why
LDL Cholesterol is only a surrogate marker.
Drives the getaway car.
Not the trigger man.
The direct offending agents are:in particles
• Lipoprotein particles that carry LDL-C
• Oxidative stress
• Glycation
• Inflammation
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The Hard Truth About CHD.
Plaque Formation
Weissburg PL, Rudd JHF. In: Topol EJ, ed. Textbook Cardiovasc Med 2nd Ed 2002.
Inflammation
Penetration
Low-density lipoproteins (LDL) are the known causal agents in atherosclerosis.
Oxidation
Glycation
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The classic concept of plaque progression from normal to a critical lesion.
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Most common mechanism of heart attack:
• Inflammation erodes the protective cap
• Causing a clot / heart attack even with a small amount of plaque.
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Impact of LDL Size
100 mg/dl 100 mg/dl
Large LDL Particles
Small LDL Particles
Up to 70%
more particles
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Risk of Small Dense LDL
• Quebec Cardiovascular Study
– 2057 subjects
LDL Cholesterol Relative Risk
Large LDL
Upper 1/3 2.8
Middle 1/3 1.3
Lower 1/3 1
Relative Risk
Small LDL
4
3.4
1.5
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More Non-Traditional Yet Critical Risk Factors
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Indicator
Normal Optimal Treatment
Lipoprotein (a) < 30 < 30
Niacin
C-reactive protein 2-3 < 1 Optimize other risk factors (Lipoprotiens, BP, BS)
Homocysteine 5-11 < 7 B6, B12, Folic Acid, TMG, NAC
Fasting Insulin 0-22 < 6 Low Gly Nutrition/ Exercise
Ferritin 20-380 < 100 Donate Blood
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Getting from 30% to 100%
Measure and modify: • LDL-P • LDL,HDL particle size • Large HDL-P • Large VLDL-P • Lp(a) • CRP • Homocysteine • HbA1C • Insulin • Ferritin • Free testosterone in men • Bioidentical HRT in women • Body fat %
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Reversing Plaque
CIMT Mean Change from Previous
% Change Comp Age Age Diff
07/07 .717 07/07 -.147 07/07 -17% 07/07 57 07/07 +12
04/06 .864 04/06 N/A 04/06 N/A 04/06 70 04/06 +26
CIMT Max Change % Change Plaque R Plaque L
07/07 .822
07/07 -.209
07/07 -20% 07/07 (1)
1.145
07/07 (3)
1.382
04/06 1.031 N/A N/A 04/06 (2) 1.297
04/06 (3)
1.705
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How We Can Engineer This Information to
Deliver to Real People
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Measure Baseline Biomarkers
MEDSTART (MEDical STatus And Risk Targeting)
Blood drawn at home 2 weeks prior
Medical history questionnaire
All day visit:
DXA Scan
Cognitive Stability Index
Strength and Flexibility
Resting Energy Expenditure
Complete physical
225 Union Blvd. Ste 400, Lakewood, CO 80228 75
LI Procedure
Our tools:
• Education
• Optimal nutrition
• Nutritional supplementation
- Targeted at specific disease risk markers
- Demonstrated to be preventive for:
Cancer, cardiovascular disease, dementia
• Optimal hormone balancing
• Exercise program: aerobic and anaerobic
• Prescription medication when advantageous
225 Union Blvd. Ste 400, Lakewood, CO 80228 76
Ongoing Program:
• Limited to 300 patients per physician
• Unlimited professional contact
• Prescheduled testing every 13 weeks
• Scheduled visit after each test module
- Review results and alter program
• Quarterly Newsletter with updates
LI Procedure
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J.D. Charlotte, NC
Date Total Cholesterol
(<200)
LDL
(<100)
HDL
(>50)
CRR
(<3.0)
Triglycerides
(<100)
2-5-05 141 74 52 2.7 75
1-5-05 257 187 50 5.1 99
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J.D. Charlotte, NC
Date LDL P#
(<1000)
LDL P Size
(>20.5)
Small LDL
(<600)
Large HDL
(>30)
Large VLDL (<7)
2-5-05 913 21 463 23 9
1-5-05 1834 21 857 8 20
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Date Lp(a) (<30) CRP (<1) Homocysteine (<7)
2-5-05 27 0.4 7.4
1-5-05 55 5.9 18.7
J.D. Charlotte, NC
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Date DHEAS T. Tes F. Tes
2-5-05 204 787 127
1-5-05 129 393 63
J.D. Charlotte, NC
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Putting it all together…
Slow, arrest or reverse: Oxidative Stress
Glycation
Inflammation
Declining levels of vital hormones
Dyslipoproteinemia
Acidification
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Goals:
Enhance vitality
Prevent degenerative disease Coronary Heart Disease
Diabetes
Cancer
Alzheimer’s Disease
Parkinson’s Disease
Osteoporosis
Osteoarthritis
Autoimmune Disease
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Final Message
The processes underlying degenerative disease are invisible.
The majority of people will pour 10 times the resources into life issues that are more visible than protecting their health… until
the illness is visible.