A Functional Medicine Approach to Weight Management

1. A Functional Medicine Approach to Weight Management Mark C. Pettus MD November 8, 2010

2. “The future ain’t what it used to be.”

3. Objectives • Explore the connection between weight (more specifically body composition), inflammation, and health. • Examine the contributors to metabolism and weight that have less to do with quantity of calories and more to do with the quality of calories. • Examine lifestyle and behavioral interventions that can reduce inflammation, improve metabolism, and enhance sustained weight loss with improved quality of life.

4. “Let food be your medicine and medicine be your food” Hippocrates, 400 BC “Motion is the lotion.” Mark Pettus 2007

5. Contributors to changes in body composition:…more fat and less lean body muscle massthat have little to do with calories • Evolutionary biology: a stone age imperative in a culture of abundant high-density caloric foods with little nutritional value. • Decreased movement • Inflammation • Stress: the cortisol response • The glycemic response • “Leaky gut” syndrome • Environmental toxins

6. Insulin and cortisol are the prime contributors to inflammation, fat production, and altered metabolic efficiency. They are, in effect, your passport to accelerated aging.

8. “The Cause of Everything” “Inflammaging” Inflammation

9. Inflammation • Increased with excess sugar, HFCS, processed foods and unhealthy fats e.g. excess of omega 6 e.g. corn oil, saturated e.g. meats, dairy, and hydrogenated and trans-fats (processed foods); low fiber intake • Stress-Cortisol “fight-flight” response • Immobility or diminished movement • GI imbalance e.g. food allergies (gluten, dairy, eggs) linked to binge eating, cravings, dysbiosis, insufficient fiber • Environmental toxins • Disrupted sleep

10. How Do You Treat Inflammation? “Eat food. Not too much. Mostly plants.” ~ Michael Pollan • Eat whole foods—plant-based diet with a low GL (glycemic load) and high PI (phytonutrient index) • Stop inflammatory foods: processed, refined foods with sugar, HFCS, and trans fats • Get an oil change—anti-inflammatory fats such as omega-3 fats from small fish like sardines, sable, herring, and wild salmon, and monounsaturated fats such as avocadoes, almonds, and olive oil.

11. Cooling Inflammation • Movement—the most powerful anti-inflammatory medicine e.g. aerobic, resistance, balance ie., yoga and tai chi • Activate the parasympathetic nervous system—the stress antidote; MBSR, HeartMath HRV biofeedback • Treat food sensitivities—gluten, dairy, yeast, eggs, soy, and corn • Restore adequate sleep • Omega-3s 2,000 mg per day EPA/DHA • Vitamin D at least 2,000 units per day (want blood levels between 50-80) • Take probiotics—cool the gut

13. Glycemic Load • The extent to which food and beverage raises blood sugar • Raises insulin levels • Excess sugar and insulin damages proteins that control bodily function from head to toe “glycation” • Enhanced by refined carbs e.g. pastries, pretzels, chips, bagels, white breads, sweetened drinks, potatoes, white rice, beer, etc. • Enhances inflammation.

14. Different carbohydrates produce unique genomic responses! High Glycemic Carbs Low Glycemic Carbs 62 genes regulating Same genes turned off; Inflammation, stress, Genes regulating insulin Immune responses turned on. Kalle et al. Am J Clin Nutr;2007:851:1417-27

15. Do you have the guts for health? • Large surface area, 1 cell thick • 70% immune system in the gut just on the other side of this cell layer (GALT) • Leaky gut syndrome • Dietary impact • Effects of medications e.g. nsaids, antibiotics, prednisone • Bacterial dysbiosis • Food allergies, sensitivities • Stress response-the brain-gut connection

16. When the barrier breaks down, disease risk increases • Small intestine surface area could cover a doubles tennis court • It is only 1 cell layer thick • Damage can lead to increased permeability of toxins, referred to as “leaky gut”

17. Balancing Hormones…the sugar-insulin-cortisol connection • Mindful eating…it takes 20 minutes for the brain to get the message that the stomach is full. • Take pleasure in meals • Eat breakfast • Remain active • Eat regularly, at least every 3-5 hours • Balance protein with healthy carbs and fats • Stress reduction techniques to reduce cortisol

18. Thyroid Balance • Many people in low end of “normal” and symptomatic • Want TSH < 2 • Free T3 and Free T4 at least 50th percentile • Do you have TPO or Thyroglobulin Antibodies? • Armour thyroid vs. synthetic T4

19. 12 Principles of Healthy Detoxification • Minimize your exposure to toxins by eating organic foods, filtering your water, avoiding large fish, and purifying your air • Liberal use of filtered water each day • Keep your bowels moving once or twice a day • Use of ground flaxseeds, probiotics, and magnesium citrate • Eat organic produce and animal products. • Eat 6-9 servings/day of colorful fruits and vegetables and include cruciferous veggies, garlic daily, watercress, green tea, cilantro, dandelion greens, pomegranate, and even chocolate • Minimize caffeine, avoid nicotine and moderate alcohol intake (3-5 glasses a week)

20. 12 Principles of Healthy Detoxification • Exercise 5 days a week with conditioning, strengthening, and stretching exercises. Yoga and tai chi • Eliminate white flour and sugar and HFCS • Sweat profusely at least 3 times a week: • Sauna, steam, detox bath • Try special detoxification supplements such as vitamin C, Zinc, • n-acetylcysteine, alpha lipoic acid, probiotics, milk thistle and green tea • Mindfulness practice

21. “Reality is an illusion, albeit a persistent one.” Albert Einstein

22. The Science of Mind…designed for adaptation at any time in life Emotions/Feelings Thoughts/Perceptions Behaviors Plasticity Teaching an old brain new tricks Body

23. Where are the greatest opportunities ?

26. Activity and Movement • Motion is the lotion • Walking 150 minutes per week can reverse diabetes and enhance cardiovascular, brain health, and mood • 10,000 steps per day…one step at a time • Aerobic, resistance, dance ( metabolic rate) •  insulin resistance,  cortisol, endorphins • Enhanced strength, resilience, balance, concentration, mood • Decreased cardiovascular, depression, diabetes, Alzheimer's, and cancer risk

27. Data from the National Weight Control Registry • 6,000 people, mostly white, “middle-aged” women followed for several years • Lose at least 30 lbs and keep it off > 1 year • Average 70 lbs for 6 years • All tried many times before ultimately succeeding • Many “pushed” by a health issues or “being at an all time high”

28. Only 10% used diet alone • Half used other resources e.g. a nutritionist or Weight Watchers • Many restricted specific foods e.g. desserts, portion control • All restrict calories, eat consistently day to day, eat breakfast, are physically active, weigh themselves frequently, watch limited TV, and do not let a small gain become bigger • Walking (ave. 60 minutes per day) most common activity • Half add other activity e.g. aerobic class, resistance trainer, biking, or swimming • Relapses most common when activity is scaled back, more TV time, more carbs

29. Supplements of Interest • Green tea extract • Glucomannan • 5HT- 5 hydroxy tryptophan • ProBiotics • Omega-3 fish oils • Vitamin D • CLA (conjugated linolenic acid) • Detox eg. N-acetyl cysteine, milk thistle, Zinc, Magnesium citrate, UltraClear medical food

30. Summary • Focus less on quantity of calories and more on quality of calories ie, food as information • Low glycemic index, anti-inflammatory nutritional program • Motion is the lotion. Exercise is crucial. Start small and build positive momentum • MBSR strategies to modify cortisol response • “Fix the Gut” e.g., fix bacterial dysbiosis, leaky gut • Check for “subclinical” hypothyroidism • Detoxification • Supplements

31. Thank you.