The document discusses the current medical paradigm that focuses on disease treatment rather than prevention. It notes America's declining health outcomes and rising rates of chronic diseases like cancer and cardiovascular disease. The new medical paradigm emphasizes healthy lifestyle choices, nutrition, supplementation and exercise to prevent disease. It provides examples of supplements and nutrients that can reduce risks of cancer and heart disease, such as omega-3 fish oil, vitamin E, CoQ10, grape seed extract and indole-3-carbinol. The document also discusses the obesity epidemic and metabolic syndrome/type 2 diabetes, highlighting the role of high glycemic diets and carbohydrate addiction. It compares different nutritional supplement products and ranks USANA Essentials as the highest scoring option

1. Health, Nutrition and
Disease Prevention Update
John J. Koehler, M.D., FACEP
Board Certified
American Board of Preventive
Medicine
Occupational Medicine

2. The CURRENT Medical Paradigm
• Focuses on disease diagnosis and
management
• Emphasizes pharmaceuticals and
technology
• De-emphasizes patient empowerment
and involvement
• Supports the
Pharmaceutical/Medical/Insurance
System

3. America’s Health is Declining
In 1950 the United States ranked seventh in
life expectancy.
In 1990 our nation ranked eighteenth!
No progress on Cancer or Cardiovascular
Incidence since the 70’s.
For the first time in American history our life
expectancy has dropped.

4. The NEW Medical Paradigm
• Focuses on disease prevention
• Emphasizes healthy lifestyles
– proper nutrition
– proper supplementation
– exercise
• De-emphasizes dependency on
pharmaceuticals and technological solutions

5. Current
Medical
Paradigm
The Continuum
Of Disease
SYMPTOMS
Underlying
Disease
Process

6. CARDIOVASCULAR DISEASE
#1 KILLER
• Current Paradigm takes action with
manifestations of the disease and provides
revascularization as the primary solution.
• New Paradigm addresses the root cause to
prevent and reverse the disease process.

7. Occluded
Artery
Non-Occluded
Artery
Atherosclerosis: Narrowing or blockage of arteries caused by a
build-up of fat (cholesterol) within the artery wall. This build-up is
sometimes referred to as plaque.

8. Atherosclerotic Plaque
Large lipid-core
Inflammation thin cap
remodeling
Vulnerable Plaque
Inflammatory cells
Reduced number/function
of smooth muscle cells
Inflammatory
cells
Increased matrix
breakdown
Reduced matrix synthesis
Plaque Cap Thinning
Plaque Disruption
Inflammatory
cells
Circulating Tissue
Factor
Tissue factor
in Plaque
Inflammatory
cells
Systemic
Thrombotic-Fibrinolytic Balance
Local shear rate
Thrombosis
Triggers
REFERENCE: Vol. 2 No. 2 2001 Reviews in Cardiovascular Medicine

9. Multiple Inflammatory Agents
Interleukin 6,8
Cytokines
Tumor Necrosis Factor
C-Reactive Protein
Homocysteine
Oxidized LDL
Free Radicals
Fibrinogen
Circulation 2003; 108:1917
Study points to Heart Disease Marker’s Dark Side, HealthDay News, Jun 24, 2005.
Researchers find a new enemy of the heart, CNN.com News, Aug 4, 2002: Libby P. et al.
Circulation, 2002 Mar 5;105(9):1135-43.
Ridker PM, et al. Circulation, 2000 Apr 18;101(15):1767-72.

10. Omega 3 Fish Oil VS Statin Drugs
35%
30%
25%
20%
15%
10%
5%
0%
Reduction of Overall
Mortality
Reduction of Cardiac
Mortality
statins omega-3 fish oil
Archives of Internal Medicine/Vol. 615, April 11, 2005

11. Vitamin E Supports
Heart Health in Women
• 40,000 healthy women
• To date, this is the largest and longest trial conducted on
vitamin E
• a 24% reduction in cardiovascular deaths among the
20,000 women in the group
• Women 65+ received a greater benefit
• Reduced risk of heart attack incidence by 34%
• Reduced risk of heart attack death by 49%
Journal of the American Medical Association, July 6, 2005

12. DR. KOEHLER’S RESULTS
140
120
100
80
60
40
20
0
8/1/99 5/24/02 9/7/04 10/3/06
Percentage Increase in Calcium Volume
RCA
LAD

13. DR. KOEHLER’S LATEST
HEART SCAN RESULTS!!!
140
120
100
80
60
40
20
0
RCA
8/1/99 5/24/02 9/7/04 10/3/06
Percentage Increase in Calcium Volume
Diet, Exercise,
Supplements, & Lipitor
Started USANA Health Sciences;
Stopped Lipitor
LAD
+24%
-10%
+104%
+24%
+23%
- 47%

14. CANCER #2 KILLER
• Current Paradigm:
Early diagnosis at best
No plan for prevention
• New Paradigm:
Lifestyle change to address risk factors
Proper Nutrition – low saturated fat diet/high fiber
Proper Supplementation
Exercise

15. BREAST CANCER
One out of 8 women
NO plan for prevention!!

16. Indole – 3 – Carbinol (I3C)
Cruciferous Extract
Actions:
• Soy and cruciferous vegetables reduce cancer risk by
enhancing DNA repair
• Converts Estradiol to Estriol
• Promotes tumor suppressing gene (p53)
• Blocks new blood vessel formation in tumors
• Inhibits expression of MUC 1, associated with aggressive
tumors and metastasis
• Induces cancer cells to “self destruct” by up to 90%
• Blocks breast cancer cell growth by up to 90% compared to 50%
by Tamoxiphen
Reference: 1. British Journal of Cancer (2006) 94407-426. 2. Breast Cancer – The Role of
Nutritional Supplements in the Prevention & Treatment of Breast Cancer by Ladd R.
McNamara, M.D.

17. Bioflavinoids
Grape Seed Extract
Effects:
• Anti-estrogenic
• Reduces breast cancer cell growth and propagation
• Works synergystically with chemotherapy
Reference: Breast Cancer – The Role of Nutritional Supplements in the Prevention & Treatment of
Breast Cancer by Ladd R. McNamara, M.D.; Ref 20. Kim H, et al. Chemoprevention by grape seed extract and
genistein in carcinogen-induced mammary cancer in rats is diet dependent. J Nutr. 2004 Dec; 134(12 Suppl):3445S-
3452S. Ref 21. Eng ET, et al. Suppression of estrogen biosynthesis by procyanidin dimers in red wine and grape
seeds. Cancer Res. 2003 Dec 1; 63(23):8516-22. Ref 22. Sharma G, et al. Synergistic anti-cancer effects of grape seed
extract and conventional cytotoxic agent doxorubicin against human breast carcinoma cells. Breast Cancer Res
Treat. 2004 May; 85(1):1-12. Ref 23. Olsson ME, et al. Inhibition of cancer cell proliferation in vitro by fruit and berry
extracts and correlations with antioxidant levels. J Agric Food Chem. 2004 Dec 1; 52(24):7264-71.

18. Omega 3 Fish Oil
Key Points:
• Influences the fat composition of the breast, reduces
oxidation potential
• Decreased risk of breast cancer
• Apoptosis
Reference: Breast Cancer – The Role of Nutritional Supplements in the Prevention & Treatment of
Breast Cancer by Ladd R. McNamara, M.D.; Ref 59. Wu M, et al. Omega-3 polyunsaturated fatty acids
attenuate breast cancer growth through activation of a neutral sphingomyelinase-mediated pathway. Int J Cancer.
2005 May 17; [Epub ahead of print]. Ref 60. Sun H, et al. Omega-3 polyunsaturated fatty acids regulate syndecan-1
expression in human breast cancer cells. Cancer Res. 2005 May 15; 65(10)4442-7. Ref 61. Chiu LC, Docosahexaenoic
acid from a cultured microalga inhibits cell growth and induces apoptosis by upregulating Bax/Bc1-2 ratio in human
breast carcinoma MCF-7 cells. Ann N Y Acad Sci. 2004 Dec; 1030:361-8. Ref 62. Heller AR, et al. Omega-3 fatty acids
improve liver and pancreas function in postoperative cancer patients. Int J Cancer. 2004 Sep 10; 111(4):611-6.

19. CoEnzyme Q10 – Powerful cell
membrane based anti-oxidant
Key Points:
• Decreased risk of multiple types of cancers
• Blocks initiation of cancer cells as well as
propagation and metastasis
• Promotes apoptosis
• Deficiency raised risk of breast cancer by 50%. Most
women with breast cancer are found to be deficient.
• Reduced tumor size and increased outcome in
animal models
• Statin drugs reduce it
• Chronic diseases deplete it
Reference: Breast Cancer – The Role of Nutritional Supplements in the Prevention &
Treatment of Breast Cancer by Ladd R. McNamara, M.D.; Ref 24. Siemieniuk E, et al. Coenzyme Q10:
its biosynthesis and biological significance in animal organisms and in humans. Postepy Hig Med Dosw
(Online.) 2005 Apr 18; 59:150-9.
References continued on next slide.

20. Reference: Breast Cancer – The Role of Nutritional Supplements in the Prevention & Treatment
of Breast Cancer by Ladd R. McNamara, M.D.; Ref 25. Shekelle P, et al. Effect of the supplemental use of
antioxidants vitamin C, vitamin E, and coenzyme Q10 for the prevention and treatment of cancer. Evid Rep
Technol Assess (Summ). 2003 Oct;(75):1-3. Ref 26. Hodges S, et al. Co-Q10: could it have a role in cancer
management? Biofactors. 1999; 9(2-4):365-70. Ref 27. Rerumal SS, et al. Augmented efficacy of tamoxifen in rat
breast tumorigenesis when gavaged along with riboflavin, niacin, and Co-Q10: effects on lipid peroxidation and
antioxidants in mitochondria. Chem Biol Interact. 2005 Feb 28; 152(1):49-58. Ref 28. Roffe L,l Efficacy of
coenzyme Q10 for improved tolerability of cancer treatments: a systematic review. J Clin Oncol. 2004 Nov 1;
22(21):4418-24. Ref 29. Fleischauer AT, et al. Antioxidant supplements and risk of breast cancer recurrence and
breast cancer-related mortality among postmenopausal women. Nutr Cancer. 2003; 46(1):15-22. Ref 30. Sinatra
ST, The Co-Q10 Phenomenon. Keats Publishing, New Canaan, 1998. Ref 31. Borek C. Dietary antioxidants and
human cancer. Integr Cancer Ther. 2004 Dec; 3(4):333-41. Ref 32. Lockwood K, et al. Progress on therapy of
breast cancer with vitamin Q10 and the regression of metastasis. Biochem Biophys Res Commun. 1995 Jul 6;
212(1):172-7. Ref 33. Lockwood K, et al. Partial and complete regression of breast cancer in patients in relation
to dosage of coenzyme Q10. Biochem Biophys Res Commun. 1994 Mar 30; 199(3):1504-8. Ref 34. Lockwood K,
et al. Apparent partial remission of breast cancer in ‘high risk’ patients supplemented with nutritional
antioxidants, essential fatty acids and coenzyme Q10. Mol Aspects Med. 1994; 15 Suppl:231-40. Ref 35. Crane
FL. Biochemical functions of coenzyme Q10. J Am Coll Nutr. 2001 Dec; 20(6):591-8. Ref 36. Portakal O, et al.
Coenzyme Q10 concentrations and antioxidant status in tissues of breast cancer patients. Clin Biochem. 2000
Jun; 33(4):279-84. Ref 37. Folkers K, et al. Lovastatin decreases coenzyme Q levels in humans. Proc Natl Acad
Sci U S A. 1990 Nov; 87(22):8931-4. Ref 38. Rundek T, et al. Atorvastatin decreases the coenzyme Q10 level in
the blood of patients at risk for cardiovascular disease and stroke. Arch Neurol. 2004 Jun; 61(6):889-92. Ref 39.
Sacks FM, et al. The effect of pravastatin on coronary events after myocardial infaction in patients with average
cholesterol levels. Cholesterol and Recurrent Events Trial investigators. N Engl J Med. 1996 Oct 3; 335(14):1001-
9. Ref 40. Sinatra ST. “Care,” cancer and coenzyme Q10. J Am Coll Cardiol. 1999 Mar; 33(3):897-9.

21. METABOLIC SYNDROME
TYPE II DIABETES
• 47 Million Americans have Metabolic
Syndrome
• 30% of us are obese
• Type II Diabetes is now afflicting teenagers!!

22. Overweight Trend for Men
40.0%
30.0%
20.0%
10.0%
0.0%
1971-1974 1976-1980 1988-1994 1999-2000
Ages 20-39 10.2% 9.8% 14.9% 23.7%
Ages 40-59 14.7% 15.4% 25.4% 28.8%
Ages 60-74 10.5% 13.5% 23.8% 35.8%
In 1970 Americans spent about $6 billion on fast food; in 2000 they spent more than $110 billion.

23. Overweight Trend for Women
40.0%
30.0%
20.0%
10.0%
0.0%
1971-1974 1976-1980 1988-1994 1999-2000
Ages 20-39 11.2% 12.3% 20.6% 28.4%
Ages 40-59 19.7% 20.4% 30.4% 37.8%
Ages 60-74 23.4% 21.3% 28.6% 39.6%
In 1970 Americans spent about $6 billion on fast food; in 2000 they spent more than $110 billion.

24. Overweight Trend for Adolescents
20.0%
15.0%
10.0%
5.0%
0.0%
1971-1974 1976-1980 1988-1994 1999-2000
Boys 6.1% 4.8% 11.3% 15.5%
Girls 6.2% 5.3% 9.7% 15.5%
In 1970 Americans spent about $6 billion on fast food; in 2000 they spent more than $110 billion.

25. CARBOHYDRATE
ADDICTION CYCLE
80
High Glycemic
Carbs Intake
Release of Epinephrine,
Glucagon, Cortisol
Carb Craving
More Carb
Intake
TIME
Glucose
Insulin
Glucose
Insulin

26. ENERGY
FAT
100 Caloric
Units
100 Caloric
Units
ENERGY
High Glycemic Diet
Lower Glycemic
Diet
FAT
High Insulin
Low Insulin

27. Comparative Guide to
Nutritional Supplements
by Lyle MacWilliam, BSc, MSc, FP
Northern Dimensions Publishing
2003
3rd Edition
A compendium of over 500 products
available in the United States and Canada.

28. Evaluation Criteria
•Bioavailability
•Completeness
•Potency
•Antioxidant Triad
•Gluthathione Support
•Metabolic Support
•Cardiac Health Triad
•Homocysteine Reduction Triad
•Bone Health
•Phenolic Compound Profile
•Bioflavonoid Profile
•Lipotropic Factors
•Potential Toxicities Penalty

29. Scoring Table
Usana Essentials
Shaklee
Nutralite (Amway) Double X
Unicity Network Cardio-Basics
Herbalife
Reliv Classic
Reliv Now
Melaleuca
Nutrilite (Amway)
Centrum
96.1
30.5
30.0
30.0
14.8
10.4
9.0
6.2
3.4
3.2
Fewer than 0.8 percent of the 1000+ products initially reviewed
were able to surpass the benchmark of 80 percent or above.

30. Usana Essentials Centrum
Bioflavonoid Complex (Rutin, Quercetin, Hesperidin
[Citrus SSP. L., Fruit] Green Tea Extract-Decaffeinated
[Camellia Sinensis Hunt, Leaves], Bilberry Extract [Vaccinium
Myrtillus L., Fruit])
Coenzyme Q10
193 mg 0
12mg 0
Broccoli Concentrate (Brassica Oleracae V. Botryis L., 15mg 0
Flower)
Olivol (Olive Extract, Olea Europae L., Fruit) 30 mg 0
Inositol 150 mg 0
Choline Bitartrate 100 mg 0
N-Acetyl L-Cysteine 65 mg 0
Bromelain 50 mg 0
Alpha Lipoic Acid 15 mg 0
Glutathione 10 mg 0
Turmeric Extract (Curcuma Longa L., Root) 15 mg 0
Lutein (Tagetes Erecta L., Flower) 600 mcg 0
Lycopene 1 mg 0

31. ESSENTIALS - Mega Antioxidant
Vitamin A (As Beta Carotene) 15000.0 IU
Vitamin C (As Calcium, Potassium, Magnesium, & Zinc Ascorbates) 1300.0 mg
Vitamin D (As Cholecalciferol) 450.0 IU
Vitamin E (As D-Alpha Tocopheryl Succinate) 450.0 IU
Vitamin K (As Phylloquinone) 60.0 mcg
Vitamin B1 (As Thiamine HCL) 27.0 mg
Riboflavin 27.0 mg
Niacin (As Niacin and Niacinimide) 40.0 mg
Vitamin B6 (As Pyridoxine HCL) 27.0 mg
Folate (As Folic Acid) 1000.0 mcg
Vitamin B12 (As Cyanocobalamin) 60.0 mcg
Biotin 300.0 mcg
Pantothenic Acid (As D-Calcium Pantothenate) 90.0 mg
Bromelain 50.0 mg
Olivol (Olive Extract, Olea Europaea L., Fruit) 30.0 mg
Bioflavonoid Complex (Rutin, Quercetin, Hesperidin [Citrus Spp. L., Fruit], Green Tea Extract-Decaffeinated [Camillia
Sinensis Hunt, Leaves], Billberry Extract [Vaccinium Myrtillus L., Fruit])
193.0mg
Inositol 150.0 mg
Choline Bitartrate 100.0 mg
N-Acetyl-L-Cysteine 65.0 mg
Alpha Lipoic Acid 15.0 mg
 Coenzyme Q10 12.0 mg
Glutathione 10.0 mg
Curcumin Extract (Curcuma Longa L., Root) 15.0 mg
Lutein (Tagetes Erecta L., Flower) 600.0 mcg
Lycopene 1.0 mg
 Broccoli Concentrate (Brassica Oleracea V. Botrytis L., Flower) 15.0 mg










32. Essentials – Chelated Mineral
Calcium (As Calcium Citrate) 270.0 mg
Magnesium (As Magnesium Citrate, Amino Acid Chelate and Oxide) 300.0 mg
Iodine (As Potassium Iodide) 225.0 mcg
Zinc (As Zinc Citrate) 20.0 mg
 Selenium (As L-Selenomethionine and Amino Acid Complex) 200.0 mcg
Copper (As Copper Gluconate) 3.0 mg
Manganese (As Manganese Gluconate) 5.1 mg
Chromium (As Chromium Picolinate** and Polynicotinate) 300.0 ug
Molybdenum (As Molybdenum Citrate) 50.0 mcg
Boron (As Boron Citrate) 3.0 mg
Silicon (As Amino Acid Complex) 3.0 mg
Vanadium (As Vanadyl Sulfate) 30.0 mcg
Ultra Trace Minerals 3.0 mg
**Licensed under U.S. Patent 4,315,927.

33. Usana Shakes
Usana Nutrimeal
Serving Size: 3 Scoops (61g)
Servings Per Container: 9
Amount Per 3 Scoops
Cholesterol 0 mg
Total Fiber 8 g
Insoluble Fiber 6 g
Soluble Fiber 2 g
Protein 15 g
Saturated Fat 1 g
Sugars 18 g
Total Carbohydrate 32 g
Total Fat 7 g
Calories 230

34. Usana Shakes
ADVANTAGES
Breaks Carbohydrate Addiction
Assists in Releasing Fat
Perfect Nutrition
-- High Protein
-- High Fiber
-- Low Glycemic
Convenient
-- Prepare in Advance
-- Quick to Take

35. Cost Comparison Slide
Big Mac, Fries & Coke $4.38
Starbucks Regular Coffee $1.75
Starbucks Latte $2.65
Starbucks Mocha $2.95
Usana Shake $2.22

36. Why USANA Health Sciences?
• Myron Wentz, Ph.D.
• Independent Verification – Comparative Guide
Number 1 Ranking
• GMP/USP In House Manufacturing

37. Universal Recommendations
Optimal Nutrition
- Reduce High Glycemic Carbs
- Increase Protein
- Reduce Saturated Fats
High Quality Supplementation
- Antioxidants
- Free Radical Scavengers
- Omega 3,6,9 Oils
- Minerals
Exercise More
- 20 Minutes Per Day