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Dr. Jeffrey Tucker Presents

Dr. Jeffrey Tucker Presents. The Program For Total Health. The gold standard is health span. Of American women ages 45 – 54 33% suffer from hypertension 32% have lower back pain 20% have elevated blood pressure 22% have knee pain 21% have neck pain 12% have shoulder pain

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Dr. Jeffrey Tucker Presents

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  1. Dr. Jeffrey TuckerPresents The Program For Total Health

  2. The gold standard is health span Of American women ages 45 – 54 • 33% suffer from hypertension • 32% have lower back pain • 20% have elevated blood pressure • 22% have knee pain • 21% have neck pain • 12% have shoulder pain • 11% have finger pain

  3. The gold standard is health span Of American men ages 45 – 54: • 30% suffer from hypertension • 27% have lower back pain • 20% have elevated blood pressure • 19% have knee pain • 15% have neck pain • 13% have shoulder pain • 7% have finger pain

  4. American diet: about 72% of the calories in the average American's diet come from foods that were not consumed by our recent hunter-gatherer ancestors. Consider that 23% come from grains (20.4% from refined grains), 18.6% from refined sugars, 17.6% from refined omega-6 seed oils (corn, soybean, sunflower, cottonseed, safflower, peanut, etc.), 10.6% from dairy, and about 1.4% from alcohol.  • Cordain L, Eaton SB, Sebastian A, et al. Origins and evolution of the Western diet: health implications for the 21st century. Am J Clin Nutr, 2005;81(2):341-54.

  5. The remaining 28% come from a marginal intake of fruits, vegetables, nuts and legumes, and a substantial intake of domestic, feedlot, grain-fed meat. We know wild game is about 2% to 4% fat by weight, while modern feed-lot meat is 20% to 24% fat by weight. Essentially, this means we are eating unhealthy, obese animals. • Seaman DR. The diet-induced pro-inflammatory state: a couse of chronic pain and other degenerative diseases. J Manip Physiol Ther, 2002;25:168-79.

  6. In short, our diet in America today consists of grains, sugars, omega-6 fatty acids, trans fats, and obese meat, and is substantially deficient in fruits and vegetables. The outcome of this pattern of eating is the typical inflamed, swollen-looking, overweight American, who is prone to osteoporosis, osteoarthritis, chronic pain, and other chronic diseases.

  7. Dr. Tucker’s Therapeutic Lifestyle Program • Diet • Exercise • Supplement • Rest

  8. The Program Will Address • Making healthy food choices • Preventing chronic disease formation • Improving body composition • Reducing body fat storage • Increasing lean muscle mass • Reducing inflammation • Improving blood sugar management • Reducing hyperinsulinemia and hyperglycemia • Increasing exercise & physical activity = gentle movement therapy & strength training

  9. Charting Office VisitsSOAP Note Format • Subjective • Objective • Assessment/Diagnosis • Functional abnormalities • Plan (diet modifications, exercise program, supplementation recommendations, relaxation techniques)

  10. Office Flow Algorithm • The doctor prescribes the program to the patient • Patient assessment (BIA, blood, FMS) • Patient consultation (ROF, establish goals, individualize the program) • Follow up visits • Retest BIA = Bioelectrical impedance analysis FMS = Functional Movement Screen ROF = report of findings

  11. Program goals are achieved Prescribe maintenance program Send re-evaluation reminder card in 6-12 months Program goals are not achieved Return to step 3 previous slide Retest

  12. Medical Doctor (weeks) Forms/Assessment (blood, etc.) Consultation/Refer to Tucker for Total Health program Tucker Tucker/Follow up visit MD Tucker Tucker Tucker Tucker/MD Tucker Tucker Tucker Re-evaluation MD Tucker (weeks) Forms/Assessment/BIA Diet/meal plan/supplements Functional Movement Screen Education/exercise Education/exercise/BIA Education/exercise Exercise Exercsie Retest FMS/BIA Exercise Retest FMS/BIA Re-evaluate Tucker/MD FMS = Functional Movement Screen BIA = Bioimpedance Analysis Timing of Return Visits Recommended Follow Up

  13. Charging for Programs • Determine what method of payment will work best for patients. • Determine cost of services. • Supplements are charged for separately.

  14. Counseling For Patients With NO Medical Illness or Symptoms Insurance codes: • 99401 15 Minutes • 99402 30 Minutes • 99403 45 Minutes • 99404 60 Minutes • Patients can call there own insurance company and ask them how much they will reimburse for these services.

  15. Individual and Group Counseling WITH Medical Illness or Symptoms • For counseling GROUPS of patients 99078 • For counseling INDIVIDUALS • 99213 Consultation 15 min ____ • 99214 25 min ____ • 99215 40 min ____ • 99244 60 min ____ • 99245 90 min ____ • 99354 Prolonged Care $150

  16. Bioimpedance Analysis (BIA) • A4556 BIA Electrodes (2 sets @ 15 each) • $30 • Provides: Body composition, fluid distribution, phase angle • This test can be performed as often as necessary to document changes in body fat and lean muscle mass.

  17. BIA may be used To assess: • Body composition (estimate) • Fluid balance • Cellular performance (cellular health analysis)

  18. Body composition - BCM • Loss of BCM (sarcopenia) is associated with a reduced quality of life, poor immune response, increased biological age, osteoporosis, and impaired healing.

  19. Body Composition - BCM • It takes three times longer to accumulate BCM as to deplete it. • To increase BCM you must remove catabolic factors (stress, anxiety, sedentary behaviors, insulin resistance, etc.), increase protein calories, and introduce resistance training.

  20. Trunkal Obesity/Central Adiposity • Waist Circumference • Waist to Hip Ratio

  21. Vital Signs • BP • Pulse • Temp

  22. Hypertension Staging • Pre-hypertension • Systolic BP: 120-139 mm Hg; diastolic BP: 80-89 mm Hg • Stage I • Systolic BP: 140-159 mm HG; diastolic BP: 90-99 mm Hg • Stage II • Systolic BP: 160-179 mm HG; diastolic BP: 100-109 mm Hg • Stage III • Systolic BP: 180+ mm HG; diastolic BP: 110+ mm Hg

  23. Hypertension • Stress – Adrenal hyper/hypo function i.e: addison/cushings or other adrenal tumor. Test with urine cortisol or 24 hour urine test for vanillylmandelic acid and catecholamines (severe HTN) • Renal function (U/A) • Congestive heart failure/atherosclerosis • Hyperinsulinemia • Hypothyroid • Lymphatic congestion • Drug interaction/reaction • Especially contraceptive pills, steroids, decongestants, appetite suppressants • Lifestyle • Alcohol, obesity, smoking, high sodium, lead toxicity (soft water), caffeine

  24. Lab: Cardiovascular • Lipids, fractionated lipid profile • Hs-CRP • Fibrinogen • Homocysteine

  25. Highly Sensitive C-reactive Protein • C-reactive protein – is an important independent marker for inflammation. • High levels reflect over activity of inflammatory cytokines linked to coagulation and vascular endothelium damage. • Evidence suggests that previous infection with pathogens such as Chlamydia pneumoniae or Helicobactor pylori may act as an initiating trigger for this chronic inflammation.

  26. C-Reactive Protein • Marker of inflammation, infection and cell injury • Aspirin’s reduction of MI risk appears to be related to CRP levels • CRP activates complement which injures the inner layer of blood vessels leading to constriction of vessels, arrhythmia • Strong predictor of the risk of future MI • Study of 2,037 healthy middle-aged men from the Quebec Cardiovascular Study: • 105 first cardiac events during 5 years of follow-up lead to 1.8 fold increased risk of ischemic heart disease when CRP was at least 1.77 mg/L

  27. hs-CRP • Is helpful in assessing risk for unstable plaque, myocardial infarction, and diabetes. • Elevated levels of CRP and IL-6 predict the development of type 2 DM. these data support a possible role for inflamation in diabetogenesis. • JAMA, 2001, Vol 286: 327-334

  28. Diseases Associated With Defective Methylation Capacity • Atheroscelosis, coronary artery disease, deep vein thrombosis, stroke • Neural tube defects, spontaneous abortion, placental abruption • Cervical dysplasia, cervical cancer • Colon cancer • Cognitive impairment, depression, senility, Alzheimer’s disease • Osteoporosis, RA, diabetes

  29. MTHFRMethylenetetrahydrofolate reductase • MTHFR is involved in the conversion of homocysteine to methionine via the remethylation pathway • Polymorphism associated with increased levels of homocysteine and defective methylation

  30. MTHFR – Intervention • Folic acid/5-MTHFR • Vitamin B12/Methylcobalamin • Vitamin B6 • Roboflavin: precursor for FMN (flavin mononucleotide) (B6 to p-5-p), precursor for FADH2 (flavin dinuceotide), coenzyme for MTHFR • Betaine/TMG

  31. Fibrinogen • Plays a key role in arterial occlusion by promoting thrombus formation, endothelial injury, and hyperviscosity. • Increased fibrinogen levels are seen with: smoking, oral contraceptive use, obesity, stress, inflammation, insulin resistance, and aging. • Higher risk: elevated fibrinogen with high total cholesterol or elevated LDL; elevated fibrinogen with high CRP.

  32. Lab: Metabolic Syndrome/DMII • Glucose-fasting and two hour • Insulin-fasting and two hour • HgbA1C

  33. Lab: Altered Endocrinology • Adrenal Stress Profile – salivary cortisol • Thyroid

  34. Lab: Objective Goals • Total cholesterol – under 200 • Triglyerides – under 150 • HDL – over 50 (male) and over 60 (female) • LDL – under 130 (under 100 if blood risks are present) • Trig/HDL ratio – under 3.0 Adults 3+ screen for IR Children 2+ screen for IR • Lipoproteins A1 and B

  35. American Cholesterol education program expert panel’s current policy on fasting blood triglyceride levels in adults:

  36. How to Make the Program Flow • Where I begin with a new patient: • Initial consultation • Charting the Subjective Intake • Establishing the patient’s health goals to start their Lifestyle Change Program • Objective findings: ordering or collecting data • Review of findings (first or second visit) • Developing their unique program • Follow up appointments

  37. Complete the Health Profile Questionnaire (HPQ) • Anyone scoring over 50 points total or 10 or more in any one section would benefit from a detoxification program. • Even individuals scoring as low as 25-30 will experience greater energy, clarity, vitality and find that nagging symptoms of unknown origin often get better. • Go to www.DrJeffreyTucker.com to complete this form.

  38. The Initial Health Consultation • Subjective interview • HCP Prescription • Health History • Health Profile Questionnaire (HPQ) • Diet/Exercise/Sleep/Stress Diary • Client’s Health Goals • Assessing Readiness to Change

  39. The Initial Health Consultation • Objective Data Collection • BIA and vitals • Review of Findings • Begin Education and Health Coaching

  40. Lifestyle Change – How? • It takes 45 days to change a habit or incorporate a new one.

  41. Diet Diary/Exercise log • Are you filling yours out daily? • Keep track of: • Everything you eat • Everything you drink • Your Activity/Exercise • People who self-monitor both eating and exercise behaviors, are more successful at reaching and maintaining their ideal weight. • The American College of Sports Medicine. (Med Sci Sports Exerc 2001 Dec;33(12):2145-56)

  42. Portion sizes & eating frequency • Don’t skip meals • Skipping meals leads to increased production of glucagon & gluconeogenesis resulting in muscle loss • Eat frequently • 3 small meals and 2-3 snacks daily • To maintain stable blood sugar and insulin levels • Use high quality meal replacement to: Achieve frequency goals Increase nutrient intake while decreasing calorie intake Do the body composition analysis to find out your body fat percent and lean muscle mass.

  43. Identifying the clients that will benefit from this program: • Altered Body Composition • Sacropenic obesity • Weakness and Fatigue • Inflammatory Conditions • Abnormal Blood Sugar Regulation • Insulin Resistance/Hyperinsulinemia • Metabolic Syndrome • Type II Diabetes • Cardiovascular Risks • Hypertension • Hyperlipidemia

  44. Inflammatory Related Chronic Disorders • Obesity (Adipocyte) • Sarcopenia (Muscular) • Atherosclerosis (Cardiovascular) • Type II Diabetes (Endocrine) • Osteo- and Rheumatoid Arthritis (Skeletal) • Inflammatory Bowel Disease (Gastrointestinal)

  45. Lifestyle Modifications and Preventing Disease • 3,234 non-diabetic subjects with elevated fasting and post-load plasma glucose concentrations were randomized to placebo, Metformin (850 mg twice daily), or lifestyle-modification program. Program goals of at least a 7 percent weight loss and at least 150 minutes of physical activity per week. Initial average BMI = 34. • At average follow up of 2.8 years, the lifestyle intervention reduced the incidence of progression to diabetes by 58 percent vs. the Metformin reduction of 31 percent (as compared with placebo). • Knowler, W.C. et al., Reduction in the incidence of Type 2 Diabetes with lifestyle intervention or Metformin. N Engl J Med. 2002. 346(6): p. 393-403

  46. The goals of the diet are • Decrease insulin stimulation via dietary changes which decrease insulin release • ‘Good’ (vs ‘bad’) carbohydrates • Fiber • Moderate protein • ‘Good’ (vs ‘bad’) fat • Portion size & meal frequency • Increase cellular responsiveness to insulin: Chromium Green tea Lipoic acid Cinnamon Magnesium

  47. Definition of Glycemic Index • Glycemic Index (GI) is defined as the incremental area under the blood glucose curve in response to a standardized carbohydrate load. It is therefore an index of the blood glucose raising potential of the available carbohydrate in a food.

  48. Obesity as an Inflammatory Disorder • Obesity reduces a lifespan by 8 to 20 years. • One of the most interesting discoveries of the past decade has been the recognition that the adipocytes produces inflammatory cytokines. • Obesity, therefore, may be viewed as a low grade systemic inflammatory disease.

  49. What does the Adipocyte secrete? • Resistin is an adipose tissue-specific factor inducing insulin resistance linking DM to obesity. • Adiponectin is an anti-inflammatory, insulin sensitizing adipocytokine. • Adiposity is a form of chronic, low-grade inflammation.

  50. Mid-line trunkal obesity (VAT deposition) • Cushingoid appearance –increased deposition in the visceral adipose tissue enhanced by increased levels of • Insulin • Glucocorticoids (cortisol) • VAT contributes to: - Production of the release of TNFa, IL-1, IL-6 - Altered insulin sensitivity and glucose tolerance -Thyroid hormone activity alterations

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