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The Ambulatory Reversal Program

The Ambulatory Reversal Program. Overview.

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The Ambulatory Reversal Program

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  1. The Ambulatory Reversal Program

  2. Overview In today’s society, where inactive lifestyles and obesity are becoming increasingly common, the incidence of diabetes is growing rapidly. Recent economic data shows soaring numbers of money spent and lost to fight diabetes both in the United States and Worldwide. www.themegallery.com Diabetes Wellness Clinics of America

  3. Pedro J Martinez, M.D., C.M.C.M. • Board Certified Internal Medicine • Board Certified in Managed Care Medicine • Board eligible Geriatrics • Health Ministries Director, Arizona Conference • Office Director, Apologetics, Arizona Conference • Commissioned Minister, Arizona Conference • Medical Evangelist, Arizona Conference • Guatemala • Mexico • Chairman – Health Advisory Committee, NAD • Hope Medical Institute, Medical Director • Hope Diabetes Center Medical Director • PM Ministries [Internet Ministries], Director • License Minister • Doctor in Practical Ministries –Candidate • Master of Art in Biblical Counseling - Candidate www.themegallery.com Diabetes Wellness Clinics of America

  4. Diabetes Mellitus

  5. Diabetes is a serious disease with far-reaching consequences. • In 2007, the disease and its complications cost the United States about $174 billion. Direct costs had doubled since 2000 and costs are expected to continue to increase. • Type 1 and type 2 diabetes currently affect over 24 million Americans, or 8% of the population. • Additionally, an estimated 5.2 million people remain undiagnosed, and more than 60 million Americans have pre-diabetes, a precursor condition characterized by plasma glucose levels that are above normal but below the values diagnostic of diabetes www.themegallery.com Diabetes Wellness Clinics of America

  6. Diabetes – an Unfolding Epidemic WHO estimates that the number of diabetics world wide will reach 300 million by 2025 World Health Organisation, September 1998 220 150 2000 2010 Increase in the number of people with diabetes from 150 million to 220 million – 10 years from now – yearly growth of 3.9%. The cost of treating people with diabetes is expected to amount to about USD 1 trillion annually – in the US in 2025 Dr G Bernstein, former president of ADA Source: Amos A.., McCarty DJ, Zimmet P: Diabet. Med. 1997; 14 www.themegallery.com

  7. www.themegallery.com

  8. 2.5 mn years 50 years The evolution of mankind www.themegallery.com Diabetes Wellness Clinics of America

  9. Diabetes Mean Body Weight 7.5 7.0 6.5 Prevalence (%) 6.0 kg 5.5 5.0 4.5 4.0 1990 1992 1994 1996 1998 2000 Year The Prevalence of Diabetes and Obesity • Prevalence of obesity increased by 61% since 1991 • More than 50% of US adults are overweight • Body mass index (BMI) and weight gain are major risk factors for diabetes: • BMI 25-30 is overweight • BMI >30 is obese Mokdad AH, et al. Diabetes Care. 2000;23:1278-1283. Mokdad AH, et al. JAMA. 1999;282:1519-1522. Mokdad AH, et al. JAMA. 2001;286:1195-1200. www.themegallery.com Diabetes Wellness Clinics of America

  10. Visceral Fat Distribution:Normal vs Type 2 Diabetes Type 2 Diabetes Normal Courtesy of Wilfred Y. Fujimoto, MD.

  11. Total Prevalence of Diabetes in Americans Aged =20 Years by Age Group (2005) www.themegallery.com

  12. Current Treatment Goalsfor Glycemic Control www.themegallery.com

  13. Diabetic Metabolic, Macrovascular, andMicrovascular Complications • Metabolic Complications Ketoacidosis Hyperosmolar nonketotic syndrome Hypoglycemia • Macrovascular Complications Cardiovascular disease Cerebrovascular disease Peripheral vascular disease • Microvascular Complications Diabetic neuropathy Diabetic retinopathy Diabetic nephropathy Abbott KC, et al. BMC Endocr Disord. 2003;3:1. Reusch JEB. J Clin Invest. 2003;112:986-988. Sheetz MJ, King GL. JAMA. 2002;288:2579-2588. Williams R, et al. Diabetologia. 2002;45:S13-S17. www.themegallery.com Diabetes Wellness Clinics of America

  14. The Defect Pancreas Dysfunction Insulin Resistance Liver Dysfunction Small Bowel Hormonal Imbalance www.themegallery.com Diabetes Wellness Clinics of America

  15. Unmet Therapeutic Needsin Type 2 Diabetes www.themegallery.com

  16. b-Cell Function Declines Regardless of Intervention in Type 2 Diabetes Ambulatory Reversal Program www.themegallery.com

  17. The Ambulatory Reversal Program Hope Medical Institute ARP

  18. Overview • The Ambulatory Reversal Program[ARP] is the most cost effective non-residential [out-patient], functional lifestyle and health maintenance program of its kind. • Based on the Genesis Agenda with the ARP protocols • It is a broad base, scientifically sounded, evidence based, affordable comprehensive and easy to follow lifestyle program • Facilitate the transition from a live-in [Residential] to the “real life” • Culturally sensitive • Enhances the replication, preservation, and regeneration [neogenesis] of the beta cell Diabetes Wellness Clinics of America

  19. Overview • Naturally control the appetite, facilitating a significant amount of weight loss • Reduce or eliminate the insulin resistance • Is fast, fun, motivating with a high degree of compliance • Our programs emphasize a non-new age progressive functional lifestyle, exercise and stress reduction program. • Although it is not a requirement to be a vegetarian. • Our goal is to guide our patient in that direction by a gradual, cultural based well balanced process. Diabetes Wellness Clinics of America

  20. Overview • Offers Freedom of Choice Relaxing atmosphere Quick Satisfaction Warranty Fullness Diabetes Wellness Clinics of America

  21. Phases of ARP Stabilize Preserve Damage Control [Restore] Reversibility Diabetes Wellness Clinics of America

  22. 1.Stabilize: the first immediate goal is to stabilize the patient [safety is always our main concern] in order to prevent those conditions that can and will put the patient life in jeopardy. Results can be seen within days, not weeks, months or years • 2.Preserve. Our intensive program is designed to preservebeta cells that remain in your pancreas by slowing and/or eliminating the destruction of it

  23. 3.Restore: Beta cell regeneration is not Science Fiction. Since 1998 evidence has been accumulated pointing in that direction. • The patient will be empowered with all the tools necessary to actively participate in the healing process that will prevent and/or reverse diabetes • 4.Rebuild: Quality of life is essential to us. • Physically:A well balance exercise program will be tailor to every patient needs. • Mentally: Patient will be able to enjoy the true understanding of the positive thinking [based on evidence not on theory]

  24. The Deadly Quartet • Abdominal Obesity • Men: > 102 cm [>40 in] • Female: >88 cm [35 in] • Dyslipidemia • Triglycerides > 150 • HDL <40 in men, < 50 in female • Fasting glucose >110 • High blood pressure >130/85

  25. Our Goal A normal glycated hemoglobin (HbA1c), the same as a person without diabetes

  26. Mission To improvethe quality of lives and to reduce or eliminate diabetes complications through a new community outreach, evidence and scientifically based program. ARP is based on an innovative and new treatment paradigm, education and research, leading to the prevention and/or reversal of Diabetes Mellitus

  27. Our Philosophy“One of the mantras of diabetes care is that the patient should be in charge”Patient-Centered Care

  28. Synchronized Secuence of Event Diabetes Wellness Clinics of America

  29. The Issues Diabetes • Diagnosis • Type I • Type II • Production • Apoptosis • Neo-genesis • Stress • Gluco-toxicity • Lipo-toxicity • Utilization • Insulin resistance • Visceral Obesity • Hormonal Balance • Glucagon • GLP-1 • Adrenal system

  30. 1 2 3 4 5 6 7 Reduce Apoptosis Increase Beta Cell Replication Increase GLP-1 Reduce Glucagon Decrease Free Fatty Acids Decrease Insulin Resistance Reduce Hyperinsulinemia New Treatment Paradigm Woerle H, et al., Diabetes 2003;52”[Suppl 1]:A351

  31. Synchronized Sequence Reversibility Psychological /Spirit Regenerator Complementary Med Damage control ARP Protocol Stabilization DiaFiber Plus

  32. 7 days Clinical Flow First visit 4» Visit 2nd Visit 3rd Visit 21 days 14 days Stabilization Stabilization Stabilization Damage Control Initiate Level 1 Collect Information Focus on Physiology Monitor Progress

  33. Diabetes Wellness Clinics of America Services and Programs

  34. Fundamental Defect Glucagon Abnormalities • Insulin Resistance • Acquired • Obesity • Unhealthy lifestyle • Medication • Glucose toxicities • Lipo-toxicities • Impaired Insulin Release • Genetics • Glucose toxicities • Lipo-toxicities Increased PP Overprod Glu High Elev SPM Pre & Post Hyperglycemia Woerle H, et al., Diabetes 2003;52”[Suppl 1]:A351

  35. Pancreatic Dysfunction Decreased Insulin Secretion DIS Impaired Early Release of Insulin Decreased Beta Cell Mass IERI CBCM Pancreas Decreased Sensitivity to Glucose DSG ACA Decreased secretion of Amylin

  36. 1 2 3 • Apoptosis [program death of cell] • Prevention • Fiber • Post-prandial walk • Beta Cell Replication • Prevention • Fiber • GLP-1 • Neogenesis • Prevention • Fiber • GLP-1 • Altern. Med. Beta Cell function Butler AE, et al. Diabetes. 2003,52:102-110

  37. Postprandial Abnormalities in People with Type 2 Diabetes • Reduced early insulin release, increased glucagon secretion • Increased glucose release • From meal -- reduced hepatic sequestration • Endogenously produced • Liver -- increased glycogenolysis and gluconeogenesis • Kidney -- increased gluconeogenesis • Abnormal routes of glucose disposal • Decreased oxidation • Increased nonoxidative glycolysis • Increased hepatic glycogen cycling • Decreased muscle glucose uptake • Increased glucose uptake in other tissues (eg, kidney)

  38. Real Issues Portion Education Methods Calories Compliance Appetite Satisfaction How are we doing this?

  39. Type 1 Insulin therapy 1900 1950 2000 1920 Type 2 Diet 1900 1950 2000 1920 A Century of Diabetes Care Insulin analogs Human insulin Pump therapy DCCT Meglitinides Glitazones Alpha-glucosidase Inhibitors Biguanide Sulfonylureas Insulin therapy UKPDS

  40. Diabetes Wellness Clinics of America The Cost

  41. The Cost

  42. Diabetes Mellitus • Production [Homa B] • Absolute deficiency of insulin • Relative deficiency of insulin • Utilization [Homa R] • Insulin resistance

  43. “Ticking Clock” Hypothesis For Microvascular complications Macrovascular complications The “clock starts ticking” At onset of hyperglycemia Before the diagnosis of hyperglycemia WHO. Diabetologia 1985;28:615-640; Haffner SM et al. JAMA 1990;263:2893-2898.

  44. 1st Structured –office based Provider oriented provider to intervene on time Evidence based Scientifically grounded Clinically tested Help Helps to target the root of the problems, no just the numbers Empower physician Financially attractive Fast Glycemic control Weight control ARP -Physician

  45. Facilitate gradual lifestyle changes Eliminate craving and food addiction Helps patient to feel free of counting calories Empower patient Helps to eliminate in a safe and timely fashion, unnecessary drugs Culturally sensitive High compliance Fast Simple and affordable Improve self-esteem Always full and satisfied Appetite control without drugs = weight loss ARP -Patient

  46. Diabetes Wellness Clinics of America The Toxic Effect of Sugar

  47. Metabolic Pathways Leading to Diabetic Microvascular Complications

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