By Hunter Yost M.D.

Previous medical studies showed that lifestyle and dietary changes could provide long lasting protection against Type II or Adult Onset Diabetes but doctors weren’t sure for how long. Now a new just published in the journal Lancet, the longest follow up of patients from the Diabetes Prevention Program Research Group provides the answer. This study followed 3,234 non-diabetic patients with elevated fasting glucose and impaired glucose tolerance. The rate of new diabetes fell by 58% with intensive lifestyle intervention and by only 31% in those patients taking metformin (a common drug for diabetes) compared to placebo over 2.8 years. Over the next 5.7 years the original lifestyle intervention group maintained their low diabetes onset rate. When researchers combines the two time periods to cover 10 years, the rate of new diabetes fell by 34% in the lifestyle intervention group and by 18% in the metformin group. The authors concluded, “a carefully followed diet-exercise combination seemed to be superior in preventing or delaying the development of diabetes compared to the effect of anti-hyperglycemic drugs (metformin)…”

For those who would prefer to rely on medicine such as metformin, Avandia or Actos to treat their diabetes there is bad news. In 2008 in the New England Journal of Medicine, a study of 10,000 people showed that people who took medicines only to lower their blood sugar had a higher risk of death. YES, A HIGHER RISK OF DEATH. Why, because the medicines don’t treat the underlying cause of the diabetes which in insulin resistance when the cells of the body don’t respond to the insulin signal to lower blood sugar. The drugs make the problem worse by elevating insulin levels.

Contrary to the television commercials saying, “when diet and exercise aren’t enough” medical studies now show diet and exercise are not only effective but long lasting for preventing diabetes. The low technology approaches of lifestyle changes are not advertised since there is no profit to be made. Yet the improved quality of life and prevention of the serious consequences of diabetes is priceless to those who want to take charge of their health. The Mediterranean diet is the one used in most of these studies ands is in fact the most widely studied diet in all of medical literature for heart disease, diabetes, high blood pressure and arthritis. It can also help to reverse the problem of insulin resistance.

Hunter Yost M.D. has a private practice in northwest Tucson. www.hunteryostmd.com

Please visit our therapeutic lifestyles program.

By Hunter Yost M.D.

According to the American Journal of Clinical Nutrition, non-alcoholic fatty liver disease (NAFLD) affects about 70 million adults in the U.S. or 30% of the adult population. About 20 % of these individuals have the more severe form called non-alcoholic steatohepatitis or NASH. NAFLD is emerging as a major cause of chronic liver disease and is associated with the increasing prevalence of type II diabetes and obesity. It is the most common reason for the need for a liver transplant.

NAFLD is the most frequent explanation for abnormal liver test results and accounts for elevation of liver enzymes in up to 90 % of cases. Specific patterns of liver enzymes can be markers of insulin resistance, the primary cause of type II or adult diabetes.

Fatty liver is strongly associated with the Metabolic Syndrome. This is a pre-diabetic condition defined by 3 out of 5 of the following: blood pressure greater than 130/85, blood sugar greater than 100 mg/dl, triglycerides greater than 150 mg/dl, waist circumference greater than 40 inches for men and 35 inches for women and HDL (good cholesterol) less than 50 for women and 40 for men. People with Metabolic Syndrome have five times greater risked for diabetes, two times greater risk for heart disease, and significantly greater risk for stroke and gout. 64 million Americans are estimated to have Metabolic Syndrome.

The good news is that recently many studies show that the Mediterranean Diet can improve and prevent this fatty liver condition. This is the most researched diet in all of medical literature for heart disease, diabetes, cancer and arthritis. It consists of legumes, fruits and vegetables, nuts and seeds, fish, poultry, lamb, whole grains and minimal dairy. This diet decreases inflammation in all tissues of the body including the liver and improves insulin sensitivity so that adult diabetes can also be reversed. The standard American diet consisting of packaged and processed foods, soda drinks, fast foods, snack foods, refined sugars, and white flour based products is the primary cause of fatty liver, insulin resistance and expanding waistlines.

These dietary and lifestyle changes are a good example of effective low technology, low cost approaches to complex medical problems and are well documented in the medical literature.

Hunter Yost M.D. is in private practice in northwest Tucson. www.hunteryosymd.com

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“Ask your doctor if lifestyle changes are right for you”? You probably didn’t hear this on TV. However, according to the National Cholesterol Program of National Institute of Health in 2001, called the Adult Treatment Panel III (ATP III), study authors concluded, ”Everyone with elevated LDL cholesterol should be treated with lifestyle changes that are effective in lowering LDL. Lifestyle changes are the most cost effective means for reducing risk for cardiovascular heart disease. This approach is designated therapeutic lifestyle change (TLC)”. The ATP III guidelines recommended that physicians should begin to incorporate “medical nutrition therapy” in patients in need of lowering LDL before medications.

The American Journal of Cardiology in 2004 said “many patients with conventional risk factors for cardiovascular heart disease can experience lowered risk without medications within 12 weeks of starting a therapeutic lifestyle program, refuting the notion that lifestyle modification is not worth the effort.” These recommendations apply to high blood pressure, pre-diabetes, elevated triglycerides and low HDL (the “good cholesterol”). Many people with one or more of these factors also have elevated waist circumferences. Above 40 inches in men and 33 inches in women is considered to be a major risk factor for heart disease and diabetes.

In the 2008 Journal of the American College of Cardiology researchers found that eating a common American meal (e.g. steak, baked potato with sour cream or butter and desert) would immediatly elevate triglycerides, blood sugar, damaging free radicals. This causes a response in the body consisting of unnecessary stress chemicals triggering plaque deposition in arteries within hours after the meal. However a Mediterranean diet consisting of fish or poultry, vegetables, nuts and seeds, fruits and legumes has the opposite effect in the body. They called the Mediterranean diet an anti-inflammatory diet and should be considered for the primary (1st heart attack) and secondary (2nd heart attack) prevention of heart disease and diabetes.

“Ask your doctor if the Mediterranean diet is right for you”? Again, you probably didn’t hear this on TV. If these recommendations were actually followed the cost savings to our health care system would be tremendous through decreased medication usage and a decreased need for medical services for the most costly chronic illnesses.

Tucson Arizona

Please see our therapeutic lifestyles program.

We may get either good news or bad news when we stand on the scale and conclude that either the diet is working or it’s not working. Some people avoid using a scale altogether so as not to get depressed. These people have essentially given up and resigned themselves to weighing more than they want to by reasoning that it’s due to genetics or hormonal changes or past pregnancies or a wide assortment of other factors. But what if the scale is not giving all the information that is important regarding the composition of fat and muscle in the body? A scale can only determine pounds. What would be much more helpful to know is how much muscle mass we have, fat mass and water distribution both inside and outside the cells. These measurements are possible with a device known as a bioimpedance analyzer. A mild current, as weak as a household battery, is passed through the body from hand to foot traveling through the compartments of fat, muscle, water and bone. This takes a few seconds and a print out indicates both the pounds of muscle and fat as well as percentage of fat and muscle. It also indicates the water distribution inside and outside of cells for unhealthy water retention. Measurements are to the tenth of a point. Each of these markers is very sensitive to dietary and lifestyle changes. The goal is to build muscle, reduce fat and promote a healthy shift of water to inside muscle cells.

Your bathroom scale cannot give you this information. How do you know if your weight gain is due to gaining fat or muscle? How do you know if your weight loss is due to loosing fat or loosing muscle? Anyone can go on a diet and loose 20-30 pounds but unless they were following a specific program to build muscle through diet and exercise, much of that weight loss would be due to loosing muscle and they would be likely to gain back most of the weight. It is quite encouraging for people to learn that their muscle mass has increased even by a few tenths of a point while their fat mass has decreased by a few tenths of a point or more. Some healthcare practitioners are beginning to use the bioimpedance analyzer in their practices for individuals who want to know more than what their scales can tell them.

Tucson Arizona

Recent estimates from the Center for Disease Control say almost two thirds of the population of the U.S. is either overweight or obese. Multiple chronic health issues related to being overweight include diabetes, high blood pressure, heart disease, degenerative changes in back and knees, and cancer. People with weight issues often want quick solutions. Rapid weight loss claims like losing 40 pounds in four weeks ignore established medical research recommending a one-pound weight loss per week for women, and 1-2 pounds per week for men. With rapid weight loss, muscle mass (one of the most important biomarkers of aging) is also lost. Many highly advertised weight loss programs fail to offer a specific plan to maintain muscle mass while losing fat - in other words, how to maintain a healthy body composition. In studies, there is increasing focus on healthy body composition instead of just weight loss since it is well known that aging, sedentary lifestyle, weight gain, chronic disease, and poor nutrition can lead to unhealthy changes in body composition.

Body composition can be measured through a simple, non-invasive device called a bioimpedance analyzer. A mild current, which cannot be felt, is passed through electrodes attached to the foot and hand. The current passes through the different body compartments: intracellular water, extracellular water, fat mass, and free fat mass (everything other than fat). If the current passes slowly, there is more fat mass and extracellular water. If it passes through more quickly, there is more intracellular water and muscle tissue. The analyzer is also programmed to calculate the amount of stored energy in the cells and cell membranes, called phase angle and body capacitance. Not surprisingly, healthy people have more stored energy than unhealthy people. Bioimpedance correlates quite well with the DEXA scan, which is considered the gold standard for measuring fat, muscle, and bone mass, but uses radiation so it cannot be used for regular assessment of body composition.

Traditional markers of total body weight, body mass index (BMI), and waist circumference are helpful for baseline information but cannot tell whether a person is gaining or losing muscle mass, or shifting from unhealthy extracellular water to healthier intracellular water. By measuring these latter biomarkers, along with the phase angle marker, we can track nutritional and lifestyle changes, and minimize the otherwise inevitable consequences of aging and disease.

A new term called ‘sarcopenic obesity’ is appearing in the medical literature. Simply put, it means loss of muscle mass while fat mass increases. Reduction in muscle mass can be caused by previous bouts of crash dieting, inadequate protein intake and inactivity. Sarcopenic obese people may even have a normal or low BMI measurement and look thin, but have a relatively high fat ratio – lending the term “skinny fat people”. Research from UCLA Center for Human Nutrition showing bioelectrical impedance measurements made of young women at increased risk of breast cancer demonstrated sarcopenic obesity in 38 out of 40 women. In these women, body fat is best reduced by encouraging heavy resistance exercise rather than simply restricting calories. Increasing their muscle mass will help increase their basal metabolic rates and burn more fat.

Incorporated into a comprehensive therapeutic lifestyle management program, bioimpedance analysis, performed every few weeks, can be a powerful tool to monitor body composition changes. It is also a great motivator as people see the results of the lifestyle and dietary changes they have made. With weight loss, slower is healthier, and energy usually improves quickly. Medical studies agree that maintaining muscle mass and minimizing fat mass is one of the best indicators of healthy aging.

Tucson, Arizona

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According to recent reports, there are definite signs of an economic recovery starting as soon as this summer. This is hopeful news for both your wallet and your waistline. Looking at this economic downturn from the perspective of diet and nutrition and the effect on general public health, we see that it is much different from the downturn of the Great Depression. Back then most people could not afford high fat meats and dairy products and turned to less expensive homegrown vegetables and beans. The rates of heart disease dropped dramatically. Then, during the growing prosperity of the 1950’s, the rates of heart disease climbed back to their pre-depression levels.

How many people today are turning to homegrown vegetables to cope with the current downturn? Hardly anyone I know. Why, because coinciding with the post-war economic boom was the rise of the fast food industry and the introduction of convenience foods (remember Swanson’s TV dinners) that did not exist in the 1930’s, providing inexpensive, high fat, high salt and sugar, low nutrition foods. In fact, the fast food industry is doing quite well right now with McDonald’s Corp. announced a first-quarter profit of $980 million, up 4% from last year and Burger King 1st quarter profits up 1.6% over last year. So this time instead of a decrease in heart disease and related problems there may be an increase. People’s waistlines are expanding as their wallets have been shrinking.

Our relatives of not so long ago had it right. They switched by necessity to healthier foods. Fresh produce, beans and legumes and poultry are relatively inexpensive today. Spending about one hour a week making a bean and vegetable soup can provide leftovers to last the rest of the week for a lot less money than eating out. Our parents, grandparents and great-grandparents also walked a lot more by necessity in those days than we do now. Unless we learn these important lessons from them, we may emerge from this recession much less healthy than they did when economic times were even worse.

Tucson, Arizona

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We are proud to announce the start of our therapeutic lifestyle change program called First Line Therapy to address the most important problem in our health care delivery system today – the lack of medically proven preventive programs for the most common chronic diseases in the U.S.

How many people do you know have high blood pressure, high cholesterol and triglycerides, borderline diabetes, and extra inches around the waist? The combination of these indicators is called The Metabolic Syndrome. All of these factors have a common cause – elevated insulin levels in the blood, which comes from a diet high in refined carbohydrates and bad fats and low in protein, fiber, vegetables and fruits, i.e. the Standard American Diet or SAD.

About 65 million Americans are now either overweight or obese many of who have the Metabolic Syndrome, which can progress to adult diabetes, heart disease, cancer and other ailments. Instead of treating the separate elements with cholesterol medicines, blood pressure and blood sugar medicines medicines, it makes much more sense to treat the root of the problem through dietary and lifestyle changes. In fact this is recommended by many organizations including:

National Institutes of Health
Am. Heart, Blood & Lung Institute
Am. Diabetes Association
Am. Heart Association
Am. Association Clinical Endocrinologists
Arthritis Foundation
North American Menopause Society

The American Journal of Cardiology said in 2004:“

…The findings clearly show that many patients who have conventional risk factors for coronary heart disease can achieve goal levels without medications within 12 weeks of initiating therapeutic lifestyle changes…”

“Moreover, therapeutic lifestyle changes can generally be implemented less expensively than most medications and, unlike single drug therapy, favorably impacts multiple cardiovascular disease risk factors.”

Other conditions shown to be improved by therapeutic lifestyle changes include:

Fatigue
Osteoarthritis
Osteoporosis
Menopausal symptoms
Back pain and widespread pain
Improved memory and cognition

The program consists of an initial medical evaluation with Hunter Yost M.D. to assess the primary health concerns and document basic information including blood work, waist and hip measurements, blood pressure, weight and eventually body composition. Then regular visits are scheduled with Casey Wilson LE (Certified Lifestyle Educator), who helps to design an individualized food and lifestyle plan to decrease multiple risk factors. Blood work and other data will be rechecked at regular intervals.

The program places great emphasis on health body composition rather than just weight loss. Muscle mass is one of the most important biomarkers of aging. Improving and maintaining muscle mass is essential for improved health and longevity.

The visits with the doctor and the Lifestyle Educator can be covered through many insurance companies. Even without insurance, the cost is well below many commercially advertised “weight loss” programs and certainly a worthwhile investment for your good health.

Our therapeutic lifestyles program, First Line Therapy, is an example of personalized medicine which is the new medical paradigm of the 21st century. It is the only medically based preventative program of its kind in Tucson. It does not replace your relationship with your primary care physician.

Tucson, Arizona

We are available to give presentations to your organization, group, or company about First Line Therapy. Please contact Casey @ 520-219-5060 to make arrangements.

This program is all about improving the quality of your life! Please tell your family and friends.

Please visit our Therapeutic Lifestyles page

Medical Studies Say Lifestyle Changes Before Drugs

Have you ever heard a TV commercial say, “Ask your doctor if lifestyle changes are right for you”? Probably not, since they can’t be patented and sold. However, according to the National Cholesterol Program of National Institute of Health in 2001, called the Adult Treatment Panel III (ATP III), study authors concluded, ”Everyone with elevated LDL cholesterol should be treated with lifestyle changes that are effective in lowering LDL. Lifestyle changes are the most cost effective means for reducing risk for cardiovascular heart disease. This approach is designated therapeutic lifestyle change (TLC)”. The ATP III guidelines recommended that physicians should begin to incorporate “medical nutrition therapy” in patients in need of lowering LDL before medications.

The American Journal of Cardiology in 2004 said “many patients with conventional risk factors for cardiovascular heart disease can experience lowered risk without medications within 12 weeks of starting a therapeutic lifestyle program, refuting the notion that lifestyle modification is not worth the effort.” These recommendations apply to high blood pressure, pre-diabetes, elevated triglycerides and low HDL (the “good cholesterol”). Many people with one or more of these factors also have elevated waist circumferences. Above 40 inches in men and 33 inches in women is considered to be a major risk factor for heart disease and diabetes.

In the 2008 Journal of the American College of Cardiology researchers found that eating a common American meal (e.g. steak, baked potato with sour cream or butter and flan for desert) would significantly elevate triglycerides and blood sugar, damaging free radicals and a stress response in the body consisting of unnecessary stress chemicals triggering immediate plaque deposition in arteries. However a Mediterranean diet consisting of fish or poultry, vegetables, nuts and seeds, fruits and legumes has the opposite effect in the body. They called the Mediterranean diet an anti-inflammatory diet and should be considered for the primary (1st heart attack) and secondary (2nd heart attack) prevention of heart disease and diabetes.

Tucson, Arizona

Visit our Therapeutic Lifestyles page

The causes of low energy can fill a medical textbook. Almost every chronic illness is associated with low energy. There are some easily fixable causes such as anemia and low thyroid. Severe fatigue not related to a diagnosable illness may be an illness in itself called Chronic Fatigue Syndrome in the U.S. or Myalgic Encephalomylitis in England, Canada and Australia. There may be deficiencies of vitamins, minerals and amino acids which can be assessed through blood and urine tests. Correcting these deficiences can improve energy for many people. There may be impairments of the immune system from viruses, bacteria or toxic metals or chemicals which can be evaluated and treated. The course of recovery is highly individual and is based on many environmental and genetic factors. The CDC has recently established the validity of Chronic Fatigue as a specific illness through extensive genetic studies.

Functional Medicine is a branch of medical science based on a biological systems approach to healthcare especially chronic complex illness. There are special functional medicine tests which evaluate how the body works as opposed to just what is grossly wrong. The Functional Medicine web or matrix includes gastrointestional and liver functioning, mediators of inflammation and the immune system, insulin and glucose regulation, cellular and mitochondrial functioning including oxidative stress, hormones, structural issues, the nervous system and neurodegenerative disorders and emotional health. All areas need to be addressed in conditions like fibromyalgia and chronic wideapread pain.