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Waging a War Against Obesity with Fasting Protocols and Nutraceuticals

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Waging a War Against Obesity with Fasting Protocols and Nutraceuticals Waging A War Against Obesity with Fasting Protocols and Nutraceuticals Dr. Tim Schroeder, PharmD, FAARFM, ABAAHP, MS, MBA Executive Leadership / Vice President / General Manager / Compounding & BHRT Expert / Private Pilot Disclosure Statements: • No financial disclosures to report at this time. • This material is provided for educational and informational purposes only to licensed health care professionals. This information is obtained from sources believed to be reliable, but its accuracy cannot be guaranteed. Herbs and other natural substances are very powerful and can occasionally cause dangerous allergic reactions in a small percentage of the population. • Patients undertaking a weight-loss program should be under the care of a health care professional at all times. • The use of any specific product should be in accordance with the manufacturer’s directions. My Journey in Functional Medicine Paradox!!! Learning Objectives: • Discuss weight loss as a multi-factorial problem • Review metabolic targets and labs in weight loss management • Define autophagy • Outline the physiology, phases and types of fasting • Summarize compounding and nutraceuticals options for weight loss Pre-Assessment Questions • Which of the following supplement (mineral) has over 300 biochemical reactions in the body: Hint – minerals in the human body include calcium, potassium, magnesium, sodium, o A. Ashwagandha and phosphorus. o B. Potassium o C. Magnesium o D. L-theanine • 8-OHdG (deoxyguanosine) is a reliable marker for oxidative stress? o True or False? Billboard Signs: Weight-Loss Highway https://www.d4creative.com/soza http://visualfunhouse.com/billboards/weight-loss-billboard-optical- illusion.html Obesity Epidemic • Obesity is one of the greatest public health challenges of the 21st century • There are 1.6 billion adults currently classified as being overweight and 500 million as obese worldwide. • Obesity is the leading cause of DM2 and DM2 is the leading cause of: o Renal failure requiring transplant or dialysis o Blindness (in western world) o Cardiac disease o Amputations Karra, E., et al., “The role of peptide YY in appetite regulation and obesity,” Jour Physiol 2009; 587(Pt 1): 19-25 Cawley J, et al., “The medical care costs of obesity: an instrumental variables approach.” J Health Econ 2012;31:219-230. Obesity Epidemic continued • Economic cost of diabetes - 2012 versus 2017 (in USA) o 2012 – estimated cost of diagnosed $245 billion ($176 billion direct costs and $69 billion in reduced productivity) o 2017 – estimated cost of diagnosed $327 billion ($237 billion direct costs and $90 billion in reduced productivity) An Increase of $82 Billion! Economic Costs of Diabetes in the U.S. in 2012 & 2017. Diabetes Association annual report 2017 Obesity Epidemic continued • Obesity is associated with a constellation of metabolic abnormalities o Insulin resistance o B-cell failure o Dyslipidemia o Low HDL o Increased LDL particles o Increases free radical production (ROS) What else should be on this list? Phillips CM. Metabolically health obesity: definitions, determinants, and clinical implications. Rev Endocr Metab Discord 2013;14:219-227 Obesity Epidemic continued • Being overweight or obese increases the patient’s risk of developing the following cancers: o Postmenopausal breast cancer o Endometrial o Esophageal o Gallbladder o Kidney o Pancreatic o Thyroid https://www.sunstar.com.ph/article/1777390 http://www.pompanodialysis.com/what-kidney-dialysis-can-cant-do/ Obesity Epidemic continued • Historical view of Obesity o Lifestyle choice o Character flaw • Lack of willpower • Psychological issue • Current perspective o Not simply a problem of eating too much o Inflammation closely associated • Adipose tissue o Probably several dozen or more clinically meaningful types o Multi-factorial disorder Adipose Tissue • Once considered storage depots for energy, adipocytes are now recognized as active endocrine cells that have several roles: o Regulation of metabolism o Energy intake o Fat storage Halberg, N. et al., “The adipocytes as an endocrine cell.” Endorinol Metab Clin North Am 2008;37:753-768. Greenberg, AS. et al., “Obesity and the role of adipose tissue in inflammation and metabolism. Am J Clin Nutr 2006;83(suppl.):461S-465S. Endocrine Effects of Adipose Tissue • Fat cells secrete Adipokines – impacts appetite, balance, immunity via TNF- alpha and IL – 6, blood pressure, lipid metabolism, insulin sensitivity • Bottom Line – weight gain leads to dysinsulinemia and can lead to inflammation, elevated lipids and blood pressure Forsythe LK, Wallace JM, Livingston MB. Obesity and inflammation; the effects of weight loss. Nutr Res Rev. 2008 Dec; 21(2):117-33. Review. Adipose Tissue Alternative Macrophage Activation and Metabolism - Scientific Figure on ResearchGate. Available from: https://www.researchgate.net/figure/Functional-differences-between-lean- and-obese-adipose-tissue_fig4_47632963 [accessed 25 Nov, 2019] Adipose Tissue Jung UJ, et al. Obesity and its metabolic complications: the role of adipokins and the relationship between obesity, inflammation, Insulin resistance, dyslipidemia and nonalcoholic fatty liver. Int J Mol Sci. 2014; 15(4);6184-6223 Weight Loss as a Multi-Factorial Problem It’s not just about calories in vs. calories out. Weight Loss as a Multi-Factorial Problem • Detoxification • Inflammation • Sleep deprivation • Gut Microbiome • Yeast • Fiber • Water • Exercise • Hormones • Food o Artificial sweeteners o Food addictions o High fructose corn syrup Smith, P. Why you can’t lose weight: Why its so hard to shed pounds and what you can do about it. Garden City Park, NY. Square One Publishers. 2011. Weight Loss as a Multi-Factorial Problem • Neurotransmitters o Epinephrine o Norepinephrine o Serotonin Hedonic o Dopamine Reward-based o GABA o Glutamate o Histamine • Neural pathways involved in regulating food intake and energy control o Gut Hormones • Ghrelin • Cholecystokinin • Peptide YY Hardy OT, et al., “What causes the insulin resistance underlying obesity?” Curr Opin Endorinol Diabeets Obes 2012;19:81-87. Sweeney, TE. et al., “The human gut microbiome: a review of the effect of obesity and surgically induced weight loss. JAMA Surg 2013;148:563-569. Luther M, et al., “Homeostatic and hedonic signals interact in the regulation of food intake. J Nutr 2009;139:629-632 Billboard Signs: Weight-Loss Highway Types of Bariatric Surgery • Restrictive o Adjustable gastric Banding (Lap Band), Gastric Sleeve • Malabsorptive o Bilopancreatic diversion with or without duodenal switch • Combination o Gastric Bypass (Roux-en-Y), Doudenal switch • 1992 ~16,000; 2003 ~103,000; 2009 ~ 220,000 • Average cost $17,000 to $28,000 • Recidivism after Bariatric Procedures is a problem Bariatric Surgery Complications • Deficiencies in certain micronutrients • Dumping • Osteoporosis • Skin wrinkles • Weight gain • Psychological problems • Increased suicidality Labs for Weight-Loss Testing Labs for Weight-Loss Testing • Due to time constraints, if you would like my entire slide deck on Labs for Weight-Loss testing please email me. Labs for Weight-Loss Testing https://southjordanwellness.com/functional-medicine/ Labs for Weight-Loss Testing • Cost of Lab Testing o Cash pay versus insurance o Most insurances will not pay for functional-type lab testing • Core testing – CMP and CBC o Helps determine basic foundation of health and looks at: • Blood parameters • Organs of detoxification • Blood sugar and insulin regulation • Electrolyte balance • Functional Medicine tests + standard PCP labs Labs for Weight-Loss Testing Labs for Weight-Loss Testing • Lab values (ranges) can be improved by o Dietary and lifestyle changes o Exercise regimen o Dietary supplements o Rx medications/surgery when necessary • Factors affecting lab values o Sex o Age o Race o Medical history o Sleep and stress levels o Not following testing requirements Labs for Weight-Loss Testing • CBC • Vitamin D • CMP • RBC Chromium • Urinary pH • RBC Magnesium • Salivary pH • NMR lipoprofile • Gamma glutamyl transferase • 8-deoxygaunasine (8-OHDG) (GGT) • Adiponectin • Fasting glucose • Leptin • Insulin • CRP • Hemoglobin A1c • Hormones (Testosterone, • 2 hour post prandial Estrogens, Progesterone, • Thyroid panel DHEA) • Stress/Cortisol salivary and serum Insulin Resistance… Labs for Weight-Loss Testing • Urinary and Salivary pH o pH critical in determining biochemical balance o Optimal salivary pH = 7-7.2 (trending low 6.1-6.9, trending high 7.3-7.8) o Optimal urinary pH = 6.5-7 (trending low 6 -6.49, trending high 7.1-7.2) o The more acidic (lower pH) = more inflammation • Mitochondria less efficient • Joints and tissues stressed o More lactic acid produced at lower pH o A trending high or high pH means body too alkaline • Digestive issues (hypochlorhydria) • Detoxification and drainage problems (liver, lymph, kidney) Labs for Weight-Loss Testing • Cortisol and Weight Gain o Chronic stress directly related to weight gain • “Stress eating” o Imbalances in hypothalamic-pituitary-adrenal (HPA) axis leads to: • Increased cortisol output • Insulin resistance • Inflammation • Sleep problems • Hormonal imbalances • Weight gain o Increased visceral “belly” fat Labs for Weight-Loss Testing • Cortisol Level: Triggers o Wired and Tired o Tired and flat o Poor sleep o Poor performance o Weight gain around the abdomen o Mind racing “chatter” o Immune problems • Allergies and Asthma • Inflamed joints • Poor exercise recovery Labs for Weight-Loss Testing • Serum cortisol Ranges o 8 am serum cortisol
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