Scott Hall, MD
Robb Wolf, BS
 Cardiovascular (CV) disease is the leading
cause of death for both women and men in
the United States1
 It is estimated...
 Smoking
 High cholesterol
 hypertension
 Diabetes
 Overweight and obesity
 Poor diet
 Physical inactivity
 Excess...
 Law enforcement is a high-stress occupation
with increasing prevalence and incidence of
cardiovascular disease.
 Epidem...
 occupation-specific risk factors
◦ sudden physical exertion
◦ acute and chronic psychological stress
◦ shift work
 “Wor...
Compared to general population
 obese (40.5% vs. 32.1%)
 metabolic syndrome (26.7% vs. 18
 total cholesterol levels (20...
 “It was determined the average age at death
for members assigned to law enforcement
and corrections duties was 62.4 year...
 “Experience has shown that workplace
wellness programs are an important
strategy to prevent the major shared risk
factor...
 City of Reno Chief of Police Steve Pitts
 Drs. Greenwald and Hall with SpecialtyHealth
 Reno City Council
 Labor Unio...
 Grant obtained from the Reno City Council
 15 Officers chosen and consented to
participate by City of Reno Police Leade...
 Health risk assessment
 Biometrics
◦ Height
◦ Weight
◦ Body fat
◦ Blood pressure
 Laboratory evaluation including lipo...
33
2231
73
 Physician evaluation
◦ One officer found to have familial hyperlipidemia
 Informed of individual results and risk
 Exe...
 Results published by Steve
Pitts, City of Reno Chief of
Police
 The costs associated with an
MI for medical retirement
...
B/P WEIGHT BMI
INTIAL 126/80 207 29.14
AFTER 122/79 196 27.59
RESULTS -4 -11 -1.55
LDL-P LDL-C HDL-C TRIG.
TOTAL
CHOL.
INITIAL 1735 118 44 179 197
AFTER 1357 94 48 101 163
RESULTS -378 -24 4 -78 -34
TG/HDL Ratio LP-IR GLUCOSE
INITIAL 4.61 65 91
AFTER 1.58 47 81
RESULTS -3.03 -18 -10
 “As useful as the standard lipid profile has
been, it has shortcomings that prevent
clinicians from doing an optimal job...
Lipoprotein Cross-Section
(It’s not the passengers, It’s the cars)
AFTER WELLNESS PROGRAM
33
1026
57
2/1/11
BEFORE
6/6/11
AFTER
4 MONTH
RESULT
WEIGHT 219 207 5.4%
LDL-P 2231 1026 1205
HDL-P 23.6 28.7 5.1
LDL-C 117 61 56
HDL...
 Examples of officers who have been involved
with the program for more than five years
 Each is seen currently on an ann...
BEFORE WELLNESS
PROGRAM
This high risk officer came to us at age 31. He had an incredible 10 year treatment success:
The results were reached usin...
BEFORE PROGRAM 2006
AFTER PROGRAM 2012
2/1/06
BEFORE
2/10/12
AFTER
6 YEAR
RESULT
WEIGHT 235 195 40
WAIST 43 38 5
LDL-P 1820* 1096 724
LDL-C 106 83 23
HDL-C 38 55...
1. Kochanek KD, Xu JQ, Murphy SL, Miniño AM, Kung HC. Deaths: final data for 2009. [PDF-2M] National vital statistics repo...
ASH13 Scott Hall and Robb Wolf — Evaluation of the Impact of a Paleolithic Diet on Cardiovascular Risk Factors  and Lipopr...
ASH13 Scott Hall and Robb Wolf — Evaluation of the Impact of a Paleolithic Diet on Cardiovascular Risk Factors  and Lipopr...
ASH13 Scott Hall and Robb Wolf — Evaluation of the Impact of a Paleolithic Diet on Cardiovascular Risk Factors  and Lipopr...
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ASH13 Scott Hall and Robb Wolf — Evaluation of the Impact of a Paleolithic Diet on Cardiovascular Risk Factors and Lipoproteins in a Law Enforcement Population (AHS13)

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Traditional cardiovascular risk factors including cholesterol may not provide the best tools for predicting individuals at risk for future cardiovascular disease and current insulin resistance. Novel and emerging evaluations of lipoproteins may provide a more accurate assessment of future cardiovascular risk. In an observational study of a small group of law enforcement officers, we studied the changes in both traditional and nontraditional risk factors when instructed in a “paleo” diet over 6 months. Overall, we found an encouraging impact on both traditional and nontraditional risk factors over the course of the study. It is proposed that a “paleo” diet supplemented with exercise has a positive effect on cardiovascular risk factors and may be a treatment recommendation for individuals at risk.

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ASH13 Scott Hall and Robb Wolf — Evaluation of the Impact of a Paleolithic Diet on Cardiovascular Risk Factors and Lipoproteins in a Law Enforcement Population (AHS13)

  1. 1. Scott Hall, MD Robb Wolf, BS
  2. 2.  Cardiovascular (CV) disease is the leading cause of death for both women and men in the United States1  It is estimated that about 47% of cardiac deaths occur before emergency services or transport to a hospital2  “In principle, all people can take steps to lower their personal risk of heart disease and heart attack by addressing their risk factors.” www.cdc.gov
  3. 3.  Smoking  High cholesterol  hypertension  Diabetes  Overweight and obesity  Poor diet  Physical inactivity  Excessive alcohol use
  4. 4.  Law enforcement is a high-stress occupation with increasing prevalence and incidence of cardiovascular disease.  Epidemiological studies suggest that police officers and related public safety personnel have an increased risk of cardiovascular morbidity and mortality.  Currently employed police personnel have a high prevalence of traditional risk factors, including hypertension, hyperlipidemia, metabolic syndrome, cigarette smoking, and a sedentary lifestyle. Zimmerman F. Cardiovascular Disease and Risk Factors in Law Enforcement Personnel: A Comprehensive Review. Cardiol Rev 2012; 20 (4): 159-166.
  5. 5.  occupation-specific risk factors ◦ sudden physical exertion ◦ acute and chronic psychological stress ◦ shift work  “Workplace programs to promote the health and fitness of police officers are commonly lacking, but can be an effective means for reducing cardiovascular risk.” Zimmerman F. Cardiovascular Disease and Risk Factors in Law Enforcement Personnel: A Comprehensive Review. Cardiol Rev 2012; 20 (4): 159-166.
  6. 6. Compared to general population  obese (40.5% vs. 32.1%)  metabolic syndrome (26.7% vs. 18  total cholesterol levels (200.8 mg/dL vs. 193.2 mg/dL).7%) Hartley TA, Fekedulegn D, Burchfiel M, et al. Health disparities in police officers: comparisons to the U.S. general population. Int J Emerg Mental Health. 2011 Oct; 13(4):211-220 .
  7. 7.  “It was determined the average age at death for members assigned to law enforcement and corrections duties was 62.4 years, while the average age of death for Florida's general population was almost 12 years longer at 74.2 years (approximately 19% longer life spans).” http://www.floridastatefop.org/pdf_files/floridamortalitystudy.pdf
  8. 8.  “Experience has shown that workplace wellness programs are an important strategy to prevent the major shared risk factors for cardiovascular disease and stroke, including cigarette smoking, obesity, hypertension, dyslipidemia, physical inactivity, and diabetes.” AHA Policy Statement: Worksite Wellness Programs for Cardiovascular Disease Prevention. Accessed at: http://circ.ahajournals.org/content/120/17/1725.full
  9. 9.  City of Reno Chief of Police Steve Pitts  Drs. Greenwald and Hall with SpecialtyHealth  Reno City Council  Labor Union  Rob Wolf, Author and Editor
  10. 10.  Grant obtained from the Reno City Council  15 Officers chosen and consented to participate by City of Reno Police Leadership  All 15 were high or moderate risk for cardiovascular disease by ATP III guidelines from their most recent annual examination
  11. 11.  Health risk assessment  Biometrics ◦ Height ◦ Weight ◦ Body fat ◦ Blood pressure  Laboratory evaluation including lipoprofile  Informed by the “Big 5” chart
  12. 12. 33
  13. 13. 2231
  14. 14. 73
  15. 15.  Physician evaluation ◦ One officer found to have familial hyperlipidemia  Informed of individual results and risk  Exercise assessment and fitness prescription  Nutrition assessment and dietary counseling ◦ Paleo/low carbohydrate  Follow-up assessment at 4-6 months  Average age of participants was 45 years old
  16. 16.  Results published by Steve Pitts, City of Reno Chief of Police  The costs associated with an MI for medical retirement benefits and medical care is estimated at $1.2 million in the State of Nevada for a total cost of $10.8 million for 9 “high risk” officers  The preventative costs for all 15 officers over 20 years is $505,560 or $33,704 per officer prorated over a 20 year period  The ROI applied to this initial program for the Reno Police Department is 20 to 1. http://www.policechiefmagazine.org/magazine/index.cfm?fuseaction=display_arch&article_id=2822&issue_id =122012
  17. 17. B/P WEIGHT BMI INTIAL 126/80 207 29.14 AFTER 122/79 196 27.59 RESULTS -4 -11 -1.55
  18. 18. LDL-P LDL-C HDL-C TRIG. TOTAL CHOL. INITIAL 1735 118 44 179 197 AFTER 1357 94 48 101 163 RESULTS -378 -24 4 -78 -34
  19. 19. TG/HDL Ratio LP-IR GLUCOSE INITIAL 4.61 65 91 AFTER 1.58 47 81 RESULTS -3.03 -18 -10
  20. 20.  “As useful as the standard lipid profile has been, it has shortcomings that prevent clinicians from doing an optimal job with assessing baseline or on-treatment atherosclerosis risk, especially in patients with insulin resistance.”  “Multiple trials … have demonstrated that CV events are more related to atherogenic lipoprotein concentration than to cholesterol estimates … such as LDL-C.” Dayspring T, Dall T, and Abuhajir M. Moving beyond LDL-C: incorporating lipoprotein particle numbers and geometric parameters to improve clinical outcomes. Res Report Clin Cardiol 2010:1, 1-10.
  21. 21. Lipoprotein Cross-Section (It’s not the passengers, It’s the cars)
  22. 22. AFTER WELLNESS PROGRAM 33
  23. 23. 1026
  24. 24. 57
  25. 25. 2/1/11 BEFORE 6/6/11 AFTER 4 MONTH RESULT WEIGHT 219 207 5.4% LDL-P 2231 1026 1205 HDL-P 23.6 28.7 5.1 LDL-C 117 61 56 HDL-C 31 35 4 TRYGLICERIDES 362 119 243 INSULIN RESISTANCE SCORE 73 57 16
  26. 26.  Examples of officers who have been involved with the program for more than five years  Each is seen currently on an annual basis  More details on their stories can be found at specialtyhealth.com
  27. 27. BEFORE WELLNESS PROGRAM
  28. 28. This high risk officer came to us at age 31. He had an incredible 10 year treatment success: The results were reached using a Low Carb Diet, Exercise and inexpensive medications. *Non HDL 197 - Calculations based on Table 4. Page 8 of the American Association for Clinical Chemistry article: Apolipoprotein B and Cardiovascular Disease Risk: Position Statement from the AACC Lipoproteins and Vascular Diseases Division Working Group on Best Practices; Dr. Contols JH, Dr. McConnel, JP, et. al. Clin Chem. 2009 Mar;55(3):407-19. doi: 10.1373/clinchem.2008.118356. Epub 2009 Jan 23. 5/24/02 BEFORE 3/5/12 AFTER 10 YEAR RESULT LDL-C 152 70 82 HDL-C 31 40 9 TRYGLICERIDES 226 72 154 INSULIN RESISTANCE RATIO 7.3 1.8 5.5 HIGH RISK – RED LIGHTS 4 0 4 LDL-P (At goal under 1000) 2010* 845 1165
  29. 29. BEFORE PROGRAM 2006
  30. 30. AFTER PROGRAM 2012
  31. 31. 2/1/06 BEFORE 2/10/12 AFTER 6 YEAR RESULT WEIGHT 235 195 40 WAIST 43 38 5 LDL-P 1820* 1096 724 LDL-C 106 83 23 HDL-C 38 55 17 TRYGLICERIDES 270 38 232 INSULIN RESISTANCE RATIO 7.1 .7 6.4 METABOLIC SYNDROME MARKERS 5/5 1/5 4
  32. 32. 1. Kochanek KD, Xu JQ, Murphy SL, Miniño AM, Kung HC. Deaths: final data for 2009. [PDF-2M] National vital statistics reports. 2011; 60 (3). 2. Zheng ZJ, Croft JB, Giles WH, Ayala C, Greenlund K, Keenan NL, Neff L, Wattigney WA, Mensah GA. State specific mortality from sudden cardiac death: United States. MMWR. 2002; 51:123–126. 3. Zimmerman F. Cardiovascular Disease and Risk Factors in Law Enforcement Personnel: A Comprehensive Review. Cardiol Rev. 2012;20 (4): 159-166. 4. Hartley TA, Fekedulegn D, Burchfiel M, et al. Health disparities in police officers: comparisons to the U.S. general population. Int J Emerg Mental Health. 2011; 13(4):211-220 . 5. Parker JR. The Florida Mortality Study: Florida Law Enforcement and Corrections Officerscompared to Florida General Population. Accessed 7/30/13 at: http://www.floridastatefop.org/pdf_files/floridamortalitystudy.pdf. 6. AHA Policy Statement: Worksite Wellness Programs for Cardiovascular Disease Prevention. Accessed at: http://circ.ahajournals.org/content/120/17/1725.full. 7. Dayspring T, Dall T, and Abuhajir M. Moving beyond LDL-C: incorporating lipoprotein particle numbers and geometric parameters to improve clinical outcomes. Res Report Clin Cardiol 2010; 1: 1-10. 8. Pitts S. Resiliency as a Path to Wellness. Accessed at: http://www.policechiefmagazine.org/magazine/index.cfm?fuseaction=display_arch&article_id=2822&issue_id=122012.

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