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  1. 1.
  2. 2. Sam Young, MD<br />Family Physician<br />Community Health Advocate<br />Former US Army Medical Corps Colonel<br />Born and raised in Savannah, Georgia<br />30 years of combined clinical experience in <br />Traditional & Complementary Medicine<br />
  3. 3. The Impact of Obesity on the Local Community <br /><br />
  4. 4. Understanding Low Glycemic Nutrition concepts will help us fight our common enemies… <br />versus<br />
  5. 5. My personal story as well,… Me before…<br />212 lbs<br />05/29/2001<br />200 lbs<br />June 2009<br />212<br />162 lbs<br />Sept 2009<br />197 lbs<br />
  6. 6. Me 12 weeks later, and since…<br />212 lbs<br />05/29/2001<br />200 lbs<br />June 2009<br />212<br />162 lbs<br />Sept 2009<br />197 lbs<br />
  7. 7. My Four Objectives Today(using recent medical evidence)<br />1. Demonstrate Obesity as the Major Community Health Crisis<br />2. Identify the Primary Cause…. Insulin Resistance<br />Show how simple lifestyle changes can actually<br />Reverse Insulin Resistance and Obesity through<br />- Low Glycemic Food Choices<br /> - Moderate Consistent Exercise<br /> - Community Awareness<br />4. Relate these to The Metropolitan Planning Commission’s Strategic Plans, which will play an extremely critical role in our community’s success, …or failure <br />
  8. 8. My two KEY Individuals in Obesity, Insulin Resistance Low Glycemic NutritionResearch<br /> Dr. David Jenkins & Dr. David Ludwig<br />
  9. 9. David J.A. Jenkins, M.D., Ph.D., D.Sc. Developed the Concept of The Glycemic Index<br />
  10. 10. David Ludwig, MD, PhD<br />Pediatric Endocrinologist<br />International expert on Childhood Obesity<br />Principle Author of over 40 research studies on Adult and Childhood Obesity, Insulin Resistance, Chronic Disease, and Nutrition<br />Director, Optimal Weight for Life (OWL) Program at Children's Hospital Boston<br />
  11. 11. Obesity, the #1 Health Threat in the USA<br />33% of US adults are obese, & another33% are overweight<br /> By the year 2020<br />45% will be obese, & another >33% will be overweight<br />
  12. 12. Recent CDC reports “Diabetes Belt” Tightens Around the South<br />The same CDC reportalso found higher levels of<br /> Obesity in the South as well<br />March, 2011<br /> American Journal of Preventive Medicine <br />
  13. 13. Obesity dramatically increases risk of Diabetes, <br /> Heart Disease, and many other Chronic Diseases<br />Obesity significantly decreases the length and quality of an individual’s life<br />andInsulin Resistanceleads to Obesity<br />
  14. 14. 33%of US children are either overweight or obese<br />This dramatically increases their lifelong risk of Diabetes, Heart Disease, and other Chronic Diseases<br />Despite living in the most developed nation on earth and for the first time in our history, the life expectancy of children in the USA today is less than it is for their parents<br />Insulin Resistancealso leads to Childhood Obesity<br />
  15. 15. The#1 Health Threatfacing Savannah <br />& Chatham County is Obesity<br />Childhood and Adult Obesity are most commonly the result of Insulin Resistance<br />
  16. 16. Insulin, a hormone made in the pancreas Lowers Blood Sugar<br /> The “Insulin” Funnel<br />Think of insulin as a funnel to help move sugar from the blood into the cell<br />
  17. 17. Some foods elevate the blood sugar slowly and gently<br />These are called Low Glycemic Foods<br />or “Real Foods”<br />Nuts, berries, vegetables, fruits, beans, whole grains <br />
  18. 18. Th<br />and little insulin then required<br /> to control the blood sugar<br /> This is Desired and Good <br />Blood Glucose <br />meal<br />meal<br />Time <br />Low Glycemicfoods gently increase blood sugar levels <br />
  19. 19. Some foods elevated blood sugar too fast and too high <br />High Glycemic Foods or Fake Foods*<br />Dr. Ludwig<br />*Highly processed foods made in factories, such as sweetened cereals, sugary drinks, chips, cookies, candy, white bread and fast food<br />
  20. 20. High Blood Sugar <br />more insulin is required to lower the blood sugar,<br /> which is bad because overtime, it leads to insulin resistance<br />Blood Glucose <br />meal<br />meal<br />Time<br />High Glycemic Foods Spike Blood Sugars<br />Stress Hormones released due to too much insulin release<br />Over Hungry<br />
  21. 21. Normal Blood Sugars <br /> & <br />Low Insulin Need<br />
  22. 22. To Control Ongoing Blood Sugar Spikes <br />Insulin Production Rises <br />And Insulin<br />Resistance<br />Begins<br />
  23. 23. Insulin Resistance and Ongoing High Insulin Demand<br /> Eventually Exhaust the Pancreas<br />Insulin Production Falls<br />Fasting Sugar Elevates<br />Type II Diabetes Results<br />
  24. 24. Carbohydrates<br />All carbohydrates are composed of sugars<br />Short chains of sugar, simple carbohydrates(glucose, sucrose, lactose and fructose)<br />were traditionally thought to be digested very quickly<br /> Long chains of sugars called starches or complex carbohydrates<br /> were thought to be digested more slowly than simple sugars<br />But is this actually True?<br />
  25. 25. David J.A. Jenkins, M.D., Ph.D., D.Sc.<br />Dr. Jenkins began testing the actual effectsof carbohydrate containing foods on blood sugar and insulin levels in the 1970’s, and developed the concept of the Glycemic Index<br />Dr. Jenkins’ findings were reported in the <br />American Journal of Clinical Nutrition in 1981 1984, 1985, and 1987 <br /> As well as the NEJM 1989, Diabetes 1990, and British Medical Journal in 1998 <br />
  26. 26. The Glycemic Index<br />Dr. Jenkins measured the area under the blood sugar curve after Glucose was given.<br />He used Glucose as the standard and assigned it a Glycemic Index value of 100 units.<br />He then compared other carbohydrate foods to glucose’s Glycemic Index of 100 units. <br />Blood sugar curve for glucose<br /> Area <br />under blood sugar curve<br />Test Food Given<br />
  27. 27. Examples ofGlycemic Index (GI) <br />Low Glycemic Foods<br />High Glycemic Foods<br /> GI<br />Apple 36<br />Low fat yogurt 31 <br />Lentil beans 29<br />Chickpeas 28<br />Sweet Cherries 22<br />Black Beans 20<br />Peanut 14<br />Almonds 0 <br />Avocado 0<br /> GI<br />Baked Potato (no skin) 98 <br />Instant White Rice 91<br />Corn Flakes 84 <br />White Bagel 72 <br /> Jelly Beans 78 <br />Pretzels 83 <br />Table Sugar (sucrose) 61 <br />Glucose 100<br />
  28. 28. Spiking Blood Sugar Promotes Insulin Overproduction<br />Highly processedbreads, rices, cereals, and baked potatoes are high glycemic foods and spike blood sugarfasterthan table sugar <br />85 to 90% of the carbohydrates in the USA are highly processed and high-glycemic, and promote<br />overproduction of Insulin,<br /> Insulin Resistance, and <br /> Obesity<br />
  29. 29. Insulin Resistance<br />Increases Risk for<br />Metabolic Syndrome<br />Pre - Diabetes<br />Heart Disease<br />Obesity<br />Stroke<br />Diabetes<br /> Sleep Apnea<br />Premature death<br />Related Clinical Findings<br />Central Obesity<br />High Blood Pressure<br />Cholesterol Problems<br />High Blood Sugar<br />Trouble Losing Weight<br />Food Cravings<br />
  30. 30. High Glycemic foods are everywhere<br />The major reason for skyrocketing rates of obesity is that we are surrounded by high glycemic foods<br />The fast food and beverage industries target children, and adults<br />If we were taken back to the 1960’s most obesity would disappear<br />Never before have so many kids been so heavy so early in life <br /> Dr. David Ludwig<br />
  31. 31. The Fake Food versus“Stone Age Food”Game<br />"Fake food is a concept that kids can get in a few minutes, and once they get it, it can guide them to make some dramatic changesin their eating habits“ Dr. David Ludwig<br />Write down foods normally eaten now<br /> Circle foods not present in “Stone Age”<br /> Call these “Fake Foods” (usually 70%)<br /> Eat more “Stone Age Foods”<br />
  32. 32. Simple Low-Glycemic Food Pyramid<br />limit refined grains, breads, pasta and potatoes <br />Lots of <br />non-starchy vegetables<br />
  33. 33. Selecting Low Glycemic Foods<br />Typically whole foods, eaten in their natural state.<br />Examples include most fruits, non-starchy vegetables, beans, nuts, berries and whole grains.<br />Requires a commitment to simple lifestyle changes which are clearly supported by medical evidence<br />
  34. 34. American Association of Endocrinologists <br />In response to obesity, metabolic syndrome and diabetes epidemics in the United States, the Fall 2008 AACE/ACE Consensus Report Recommended the First Step should be …..<br />Intensive Lifestyle Changes<br />
  35. 35. Just How Effective is Lifestyle Change?VERY EFFECTIVE!!!<br />In this Clinical Study, Four Simple Lifestyle Changes were used for 12 weeks<br />August 2009 <br /> Holly R. Wyatt, MD <br /> Center for Human Nutrition<br /> University of Colorado<br />
  36. 36. Obesity and Weight Management Journal<br />August 2009, pages 167-173, peer reviewed<br />Overweight Patients age 20-60 years<br /> Pre-Diabetes, (Metabolic Syndrome) <br /> Not on cholesterol or diabetes medications<br /> 12 week program<br />Low Glycemic Nutrition<br />2. A Moderate Exercise Program <br />3. High Quality Multiple Vitamins<br />4. Internet Coaching Program <br />The study results are shown next…<br />
  37. 37. Significant Weight Loss<br />220<br />215<br />210<br />205<br />200<br />215<br />Weight (lbs)<br />205<br />202<br />Baseline<br />Week 6<br />Week 12<br />
  38. 38. Improved Total Cholesterol<br />220<br />210<br />200<br />190<br />180<br />170<br />160<br />206<br />Total Cholesterol mg.dl<br />180<br />176<br />Baseline<br />Week 6<br />Week 12<br />
  39. 39. Improved LDL Cholesterol<br />150.0<br />132.5<br />115.0<br />97.5<br />80.0<br />134<br />LDI Cholesterol mg.dl<br />114<br />111<br />Baseline<br />Week 6<br />Week 12<br />
  40. 40. Improved Triglycerides<br />160<br />140<br />120<br />100<br />80<br />141<br />Triglycerides (mg/dl)<br />111<br />106<br />Baseline<br />Week 6<br />Week 12<br />
  41. 41. Lower Systolic Blood Pressure<br />135<br />130<br />125<br />120<br />115<br />110<br />131<br />Systolic BP (mm Hg)<br />123<br />121<br />Baseline<br />Week 6<br />Week 12<br />
  42. 42. Lower Diastolic Blood Pressure<br />90<br />85<br />80<br />75<br />86<br />Diastolic BP (mm Hg)<br />83<br />80<br />Baseline<br />Week 6<br />Week 12<br />
  43. 43. Improved Insulin Sensitivity<br />140<br />130<br />120<br />110<br />100<br />90<br />127<br />121<br />ISI Units<br />111<br />Baseline<br />Week 6<br />Week 12<br />
  44. 44. Reduced Insulin Levels<br />40.000<br />33.125<br />26.250<br />19.375<br />12.500<br />Blood Insulin (120 min)<br />34<br />Blood Insulin (mU/l)<br />23<br />19<br />Baseline<br />Week 6<br />Week 12<br />
  45. 45.
  46. 46. Savannah is a community committed to supporting healthy lifestyles<br />The Healthy Savannah Initiative is dedicated to making Savannah a healthier place to live by…<br /> 1. Promoting Health Awareness through Education<br /> 2. Increasing Access to Quality Nutrition<br /> 3. Encouraging Safe Consistent Physical Activity<br />And each of these three help reduce insulin resistance and obesity<br />
  47. 47. Parental Lifestyle Modeling Critical<br />Families should rid their homes of most “fake foods” and increase “real foods”<br />Everybody in the family wins if the food environment at home is better<br />Adults should also be models for safe consistent moderate physical activity also known to prevent insulin resistance<br />
  48. 48. “Community” Lifestyle Modeling also Critical to Combat Insulin Resistance and Obesity<br />Communities should significantly increase access to “real foods”<br /> and help “Make the Healthy Choice the Easy Choice”<br />Everybodywins if the food environment in the community is better <br />GROUNDBREAKING FOR SAVANNAH’s SHUMAN MIDDLE SCHOOL GARDEN PROJECT<br />23 March 2011<br />
  49. 49. Physical Activity reduces Insulin Resistance and Obesity<br />Civic leaders and planners should also encourage safe consistent moderate physical activity to promote community wellness<br />
  50. 50. Overview of Key points<br />Insulin Resistance is a Major cause of Childhood and Adult Obesity<br />Insulin Resistance and Obesity can be PREVENTED and REVERSED through appropriate Lifestyle Changes<br />Civic leaders & planners are in a very unique positionto positively influence the health of entire communities for decades to come<br />