Grand Rounds (week 2) Body Composition Analysis
**download her notes and print body composition charts, timeline
Kristi Hughes, ND speaking, Dynamic Healing Center
1997 grad NCNM
two practices in Minneapolis area, just hired first resident, cash pracctice
her practice in her hometown was full in 6 weeks, she had to quit her job, all word of mouth
best lecture in her farmtown home 10,000 peeps, she talks about body composition
best with men over 60: belly fat and erectile dysfunction (put disease in title of talk)
assoc med dir for inst of functional medicine, international lecturer, hired at age 28 by J Bland, 11yrs
wrote first line therapy program for inst of fx med IFM
Dr David Jones here this Thurs night
she's going on the road to lecture internationally
just had her 4th child and today is her first separation from that child, talking about cortisol levels
very white-skinned woman, long red hair, black Alice heels
V neck collared short sleeved shirt and black skirt with white pattern
she was 7th ND in Minnesota, now they have 35
she thinks its remarkable how much naturopathy is expanding and new states are gaining licensing
pts with abn storage of body fat and want to lose weight
docs don't know how to monitor them and how to address
"infecto-obesity" and other extensive ddx: thyroid, etc
"sarco-penic obesity" = loss of muscle mass and increase of fat mass
weave body composition analysis into all new pt visits
"lifestyle syndromes" = emerging term in medical community for illness dt choices
apple body shape
"lifestyle medicine" is another up and coming term
read this article: ACPM Aug 25, 09, David Shih, American college of preventive medicine releases lifestyle medicine literature review
www.acpm.org/lifestylemedicine
7 fields of medicine: lifestyle, functional, mind-body, preventative, conventional, integrative, CAM
she says look at page 4
Discovery consists of looking at the same thing as everyone else does nd thinking something different.
--Albert Szent-Gyorgyi
HX
exercise
clothes fit
diet change
stress
sleep
hx of high LDL, TGs
FHx
mother's wt at birth is #1 predictor of obesity, #2 is mom's smoking during preg
Naturopathy in THE WORLD
There's a new naturopathic school in Capetown, South Africa
Australia has lots of naturopathic medicine
5-6 year undergrad degree with ND focus in Europe, Africa, Australia
GREAT WEBSITE REPRESENTS CHANGES IN GLOBAL PLATFORM ON DIABESITY
www.cardiometabolic-risk.org
http://www.myhealthywaist.org/
ND positioning as part of:
chronic care team
collaborative care team
behavioral modification, health coach
READ THIS book: SWITCH
awesome tool written by brothers, last book was Make It Stick about how to help pts remember
read both
switch is how to make difficult changes
she says avoid the word "should" =-]
it's about shaping the path
**lifestylemedicine.org (join this org???? new, raised the bar, doing good job)
TLC
Therapeutic Lifestyle Change
now standard of care of hyperlipid and dyslipidemia, offered before drug therapy
**get good at managing this and network with conventional docs
"when lifestyle and diet don't work try lipitor"
therapeutics are billable
learn it: cardiometabolic syndrome
FUNCTIONAL MEDICINE
three legs of the stool:
1) pt story with ATMs (antecendent, trigger and mediator) on matrix
**print some matrices: functional medicine matrix model---then make my own
**retelling patient story back to them--powerful, creates therapeutic bond
timeline page, preconception, prenatal, birth, life with triggers, s/sx/dz, and on far right current concerns
ask about mom's weight, smoking, etc, "never well since"
mother's wt at birth is #1 predictor of obesity, #2 is mom's smoking during preg
"metabolic imprinting" = exposures of mother while baby in utero, causing impact on baby metabolism
epigenetics
**mom's with high stress in 3rd trimester cortisol changes methylation ability in hippcampus permanently
women's brains shrink dt preg and nursing, 3 years on DHA postpartum to get cognitive abilities back
2) modifiable lifestyle factors
nutrit, exercise, sleep, self-care, relationships
3) organizing the clinical imbalances in a systems biology approach
by the underlying cause of disease
est metabolites linked to RA
BODY COMPOSITION ASSESSMENT
look at pt, how do they hold weight to frame?
five-level model (article) 1982 early article on impedance
altered body composition = belly fat?
sarcopenic obese = fatigued, achy, sore = mitochondrial dysfx
three things you want to know about each pt:
1) overweight?
2) overVAT? visceral adipose tissue?
3) overfat? too many adipocytes?
PE
vitals
height, weight
BMI (must chart! only recognized diagnostic value)
waist to hip (waist = midway btw 10th rib and iliac crest, hip = over greater trochanters)
body comp analysis
HOW TO MEASURE WAIST AND HIP
**sewing store: buy sewing tape measure with little yellow clip on the end, get six
start end at SP, have pt hold tape at side, go around and read it at the back
start at hip, have pt hold, go around pt, cinch and measure
BMI (memorize)
normal 19.5-24.9
overwt 25-29.0
obese 30-40
morbid 40-50
supermobid obesity >50
athletes are often high BMI without being overweight
many body builders don't do cardiovascular exercise and store fat inside muscle
(it's not subcu, caliper testing misses this)
CDC obesity trends charts
put these in my slide show in order by year
69% of US adults are currently either overweight or obese
she had us all flex abs and squeeze our own belly fat and back fat
better to have subcu than visceral adipose re: cv risk
pear body type
usu dt dysfx HPATG system hypothal pit adrenal thyroid gonadal hormones
"bumper" = hip fat
gynoid body type
mbdt infecto-obesity (dysbiosis), metabolic obesity (toxins, allergies, intestinal permeability)
"hot fat"
VAT, insulin resistance, CRP levels, ferritin
inflamed fat, adipose as endocrine organ
can download powerpoints from website listed above
incr arginase and IL10-->incr iNOS,TNFa, IL6, decr IL10-->incr iNOS, incr TNFa, incr IL6 in severe IR, more inflam adipo-cytokines, adipokines
insulin resistance and inflammation
adiponectin = anti-inflam, insulin sensitizer, make more with less inner belly fat
"hypoadiponectinemia" = incr inflam, occurs more during premenstrual period, sugar cravings
low adiponectin in PCOS, high risk of MI in women in 30's with apple body, high CRP
IR-->hyperinsulinemia
resistin is opposite of adiponectin, when high induces IR
adiponectin are inversely related but also independent, adiponectin changes quickly
tx: shrink inner belly fat
**IDENTIFYING VAT based on waist hip measurements
female
waist divided by hip > .08 is android obesity
if less than .8 and elevated BMI is overwt but not overVAT
young woman before puberty use 1.0
men: 1.0
when men have VAT the first subcu is usu at love handles
metabolic syndrome 277.7
cv dz, dyslipid, htn, ed, pcos, alz, osteop, nash, obes, apnea, sarcopenia, dm2
**TG/HDL, red flag ratio is 3 (memorize) general indicates IR, mb responsive to soy
2hr insulin is most sensitive indicator
in her hometown nobody else is ordering these labs and she gets referrals just because she does
she spends 30-40% of her time educating conventional docs
nobody is dxing cardiometabolic syndrome, they're txing blood sugar and htn
new to me:
osteoporosis dt fat storage in bone
stem cells become adipocytes instead of bone, due to inflammation
taking calcium and vit d, exercise, still may have this issue
apolipoproteins
B is bad; A1 good
order in pts with high inflam and LDL
B/A1 ratio: over .6 that's dangerous blood fats-->plaquing
under .6 have better quality fats, can reverse placques
bioelecrical impedance analysis
body comp
fluid distrib
phase angle
INTERESTING!
wrong fats, not enough efas and high sat fat
-->can't install thyroid and glut 4, cort, prog receptors in cell membrane
apple body
activated immune/inflam
hx of cvz, depression, dementia, cancer
triggers: sugar, inactivity, stress
pear body
infecto-obesity
detox abn
food allergies
GGT levels
not run by many
in pts who are overwt and develop dm have elevated GGT
also elevated dt environmental toxins
and I know from liver elective that isolated GGT is associated with elevated adiponectin
Est metabolites
2, 4, 16
learn them
hydoxylation and methylation to eliminate
learn urine and blood 2/16 ratios
what body did with est is more damaging than original est
joints, RA, hot flash, PMS, cancer, fibrocystic anything, fibroids, etc
GI concerns
dysbiosis, sibo, candidiasis, parasites
food sensitivities, intolerances, allergies
intestinal permeability
Kristi Hughes, ND speaking, Dynamic Healing Center
1997 grad NCNM
two practices in Minneapolis area, just hired first resident, cash pracctice
her practice in her hometown was full in 6 weeks, she had to quit her job, all word of mouth
best lecture in her farmtown home 10,000 peeps, she talks about body composition
best with men over 60: belly fat and erectile dysfunction (put disease in title of talk)
assoc med dir for inst of functional medicine, international lecturer, hired at age 28 by J Bland, 11yrs
wrote first line therapy program for inst of fx med IFM
Dr David Jones here this Thurs night
she's going on the road to lecture internationally
just had her 4th child and today is her first separation from that child, talking about cortisol levels
very white-skinned woman, long red hair, black Alice heels
V neck collared short sleeved shirt and black skirt with white pattern
she was 7th ND in Minnesota, now they have 35
she thinks its remarkable how much naturopathy is expanding and new states are gaining licensing
pts with abn storage of body fat and want to lose weight
docs don't know how to monitor them and how to address
"infecto-obesity" and other extensive ddx: thyroid, etc
"sarco-penic obesity" = loss of muscle mass and increase of fat mass
weave body composition analysis into all new pt visits
"lifestyle syndromes" = emerging term in medical community for illness dt choices
apple body shape
"lifestyle medicine" is another up and coming term
read this article: ACPM Aug 25, 09, David Shih, American college of preventive medicine releases lifestyle medicine literature review
www.acpm.org/lifestylemedicine
7 fields of medicine: lifestyle, functional, mind-body, preventative, conventional, integrative, CAM
she says look at page 4
Discovery consists of looking at the same thing as everyone else does nd thinking something different.
--Albert Szent-Gyorgyi
HX
exercise
clothes fit
diet change
stress
sleep
hx of high LDL, TGs
FHx
mother's wt at birth is #1 predictor of obesity, #2 is mom's smoking during preg
Naturopathy in THE WORLD
There's a new naturopathic school in Capetown, South Africa
Australia has lots of naturopathic medicine
5-6 year undergrad degree with ND focus in Europe, Africa, Australia
GREAT WEBSITE REPRESENTS CHANGES IN GLOBAL PLATFORM ON DIABESITY
www.cardiometabolic-risk.org
http://www.myhealthywaist.org/
ND positioning as part of:
chronic care team
collaborative care team
behavioral modification, health coach
READ THIS book: SWITCH
awesome tool written by brothers, last book was Make It Stick about how to help pts remember
read both
switch is how to make difficult changes
she says avoid the word "should" =-]
it's about shaping the path
**lifestylemedicine.org (join this org???? new, raised the bar, doing good job)
TLC
Therapeutic Lifestyle Change
now standard of care of hyperlipid and dyslipidemia, offered before drug therapy
**get good at managing this and network with conventional docs
"when lifestyle and diet don't work try lipitor"
therapeutics are billable
learn it: cardiometabolic syndrome
FUNCTIONAL MEDICINE
three legs of the stool:
1) pt story with ATMs (antecendent, trigger and mediator) on matrix
**print some matrices: functional medicine matrix model---then make my own
**retelling patient story back to them--powerful, creates therapeutic bond
timeline page, preconception, prenatal, birth, life with triggers, s/sx/dz, and on far right current concerns
ask about mom's weight, smoking, etc, "never well since"
mother's wt at birth is #1 predictor of obesity, #2 is mom's smoking during preg
"metabolic imprinting" = exposures of mother while baby in utero, causing impact on baby metabolism
epigenetics
**mom's with high stress in 3rd trimester cortisol changes methylation ability in hippcampus permanently
women's brains shrink dt preg and nursing, 3 years on DHA postpartum to get cognitive abilities back
2) modifiable lifestyle factors
nutrit, exercise, sleep, self-care, relationships
3) organizing the clinical imbalances in a systems biology approach
by the underlying cause of disease
est metabolites linked to RA
BODY COMPOSITION ASSESSMENT
look at pt, how do they hold weight to frame?
five-level model (article) 1982 early article on impedance
altered body composition = belly fat?
sarcopenic obese = fatigued, achy, sore = mitochondrial dysfx
three things you want to know about each pt:
1) overweight?
2) overVAT? visceral adipose tissue?
3) overfat? too many adipocytes?
PE
vitals
height, weight
BMI (must chart! only recognized diagnostic value)
waist to hip (waist = midway btw 10th rib and iliac crest, hip = over greater trochanters)
body comp analysis
HOW TO MEASURE WAIST AND HIP
**sewing store: buy sewing tape measure with little yellow clip on the end, get six
start end at SP, have pt hold tape at side, go around and read it at the back
start at hip, have pt hold, go around pt, cinch and measure
BMI (memorize)
normal 19.5-24.9
overwt 25-29.0
obese 30-40
morbid 40-50
supermobid obesity >50
athletes are often high BMI without being overweight
many body builders don't do cardiovascular exercise and store fat inside muscle
(it's not subcu, caliper testing misses this)
CDC obesity trends charts
put these in my slide show in order by year
69% of US adults are currently either overweight or obese
she had us all flex abs and squeeze our own belly fat and back fat
better to have subcu than visceral adipose re: cv risk
pear body type
usu dt dysfx HPATG system hypothal pit adrenal thyroid gonadal hormones
"bumper" = hip fat
gynoid body type
mbdt infecto-obesity (dysbiosis), metabolic obesity (toxins, allergies, intestinal permeability)
"hot fat"
VAT, insulin resistance, CRP levels, ferritin
inflamed fat, adipose as endocrine organ
can download powerpoints from website listed above
incr arginase and IL10-->incr iNOS,TNFa, IL6, decr IL10-->incr iNOS, incr TNFa, incr IL6 in severe IR, more inflam adipo-cytokines, adipokines
insulin resistance and inflammation
adiponectin = anti-inflam, insulin sensitizer, make more with less inner belly fat
"hypoadiponectinemia" = incr inflam, occurs more during premenstrual period, sugar cravings
low adiponectin in PCOS, high risk of MI in women in 30's with apple body, high CRP
IR-->hyperinsulinemia
resistin is opposite of adiponectin, when high induces IR
adiponectin are inversely related but also independent, adiponectin changes quickly
tx: shrink inner belly fat
**IDENTIFYING VAT based on waist hip measurements
female
waist divided by hip > .08 is android obesity
if less than .8 and elevated BMI is overwt but not overVAT
young woman before puberty use 1.0
men: 1.0
when men have VAT the first subcu is usu at love handles
metabolic syndrome 277.7
cv dz, dyslipid, htn, ed, pcos, alz, osteop, nash, obes, apnea, sarcopenia, dm2
**TG/HDL, red flag ratio is 3 (memorize) general indicates IR, mb responsive to soy
2hr insulin is most sensitive indicator
in her hometown nobody else is ordering these labs and she gets referrals just because she does
she spends 30-40% of her time educating conventional docs
nobody is dxing cardiometabolic syndrome, they're txing blood sugar and htn
new to me:
osteoporosis dt fat storage in bone
stem cells become adipocytes instead of bone, due to inflammation
taking calcium and vit d, exercise, still may have this issue
apolipoproteins
B is bad; A1 good
order in pts with high inflam and LDL
B/A1 ratio: over .6 that's dangerous blood fats-->plaquing
under .6 have better quality fats, can reverse placques
bioelecrical impedance analysis
body comp
fluid distrib
phase angle
INTERESTING!
wrong fats, not enough efas and high sat fat
-->can't install thyroid and glut 4, cort, prog receptors in cell membrane
apple body
activated immune/inflam
hx of cvz, depression, dementia, cancer
triggers: sugar, inactivity, stress
pear body
infecto-obesity
detox abn
food allergies
GGT levels
not run by many
in pts who are overwt and develop dm have elevated GGT
also elevated dt environmental toxins
and I know from liver elective that isolated GGT is associated with elevated adiponectin
Est metabolites
2, 4, 16
learn them
hydoxylation and methylation to eliminate
learn urine and blood 2/16 ratios
what body did with est is more damaging than original est
joints, RA, hot flash, PMS, cancer, fibrocystic anything, fibroids, etc
GI concerns
dysbiosis, sibo, candidiasis, parasites
food sensitivities, intolerances, allergies
intestinal permeability