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Functional Medicine:

  Illness to Wellness Continuum  

What is Functional Medicine?

Functional medicine addresses the underlying causes of disease, using a systems-oriented approach and engaging both patient and practitioner in a therapeutic partnership. It is an evolution in the practice of medicine that better addresses the healthcare needs of the 21st century. By shifting the traditional disease-centered focus of medical practice to a more patient-centered approach, functional medicine addresses the whole person, not just an isolated set of symptoms.

Check your score on the Functional Medicine Health Profile Questionaire

What is First Line Therapy?

Helping You Make Lifestyle Changes to Improve Health.

Everyone knows that eating right and staying in shape are important for overall health. But life's everyday pressures•hectic schedules, work deadlines, family issues, etc.•can make it difficult to find the time for good nutrition, exercise, and adequate rest.

Whether you suffer from a lifestyle-related chronic disease, or have been advised by your doctor to eat right and exercise more, the FirstLine Therapy lifestyle medicine program can help.

Change Your Life and Change Your Health With Lifestyle Medicine:

FirstLine Therapy is a therapeutic lifestyle change, or lifestyle modification, program. Designed by health care professionals, FirstLine Therapy has been shown remarkably successful in helping individuals like you return to a path of extended health.

This is not a weight reduction program•it's a disease reduction program. While weight loss often occurs, it's only secondary to the primary goal helping you achieve and maintain a healthy body composition (lean-muscle-to-fat ratio) to improve health, manage disease, feel better, and reduce your risk to more serious conditions.

The Support You Need to Succeed:

In truth, most doctors don't have the time, skills, or resources to provide you with effective lifestyle counseling. And so their patients•even those at high risk of disease - are often left to "figure it out" by themselves.

FirstLine Therapy Is different. It's structured with professional supervision to help you:
   •   Establish realistic, personalized goals to improve health,
   •   Monitor your progress and help you stay on track,
   •   Learn how to eat and shop for healthy, nutritious foods that manage (not increase) cravings,
   •   Exercise in a way that builds muscle and gets rid of unwanted fat,
   •   Relax and manage unhealthy stress,
   •   Feel better and do more!

Know Your Numbers !!!!
   •   BMI

   •   Waist circumference
   •   Body Fat percentage
   •   Blood glucose
   •   Insulin
   •   Metabolic Syndrome

   •   What is prediabetes
   •   Cholesterol
   •   What are HDL and LDL cholesterol?
   •   Lipoprotein (a)?
   •   Homocysteine?
   •   Vitamin D3

Body Mass Index (BMI):

Is the best proxy for body fat percentage among ratios of weight and height. It does have shortfalls but is a good start to see if you are at your correct weight according to your height.

Waist Circumference:
Abdominal obesity is commonly assessed using waist circumference, and common measurement protocols include the midpoint between the last rib and the iliac crest. (men < 102 cm, women < 88 cm)

A high waist circumference predicts a later decline in insulin sensitivity and increased risk of chronic disease.

Association Between Waist Circumference and Intra-abdominal Fat:
Increases in abdominal fat are largely responsible for increases in waist circumference. Abdominal fat can be divided into two major components: subcutaneous fat and intra-abdominal fat. Subcutaneous fat lies just below the skin and is outside the abdominal muscle wall, whereas intra-abdominal (visceral) fat is located inside the abdominal muscular wall and lies in between the organs or viscera. Intra abdominal fat is metabolically active fat, producing its own set of hormones and chemicals that can contribute to chronic disease. Waist circumference is a good correlate of both total abdominal fat and its sub-compartments. However, the importance of waist circumference in predicting health risk is more commonly thought to be due to the relationship between waist circumference and intra-abdominal fat. Indeed, waist circumference is a stronger predictor of intra-abdominal fat than BMI

Waist Hip Ratio, Health Risk, and Intra-abdominal Fat:
Waist-to-hip ratio (WHR) is an estimate of the relative amount of abdominal fat: the higher your waist girth compared to your hip girth, the greater your proportion of abdominal fat. WHR is a significant predictor of type 2 diabetes, (1) coronary heart disease, (2) and death.
Body fat percentage:
A person's body fat percentage is the total weight of the person's fat divided by the person's weight and consists of essential body fat and storage body fat

A number of methods are available for determining body fat percentage, such as measurement with calipers or through the use of bioelectrical impedance analysis (BIA).

Some regard the body fat percentage as the best measure of an individual's fitness level since it is the only body measurement which directly calculates the particular individual's body composition without regard to the individual's height or weight. The widely used body mass index (BMI) provides a measure that allows for the comparison of individuals of different heights in terms of their weight. Due to differences in body composition, the BMI is not necessarily an accurate indicator of body fat; for example, individuals with greater muscle mass will have higher BMIs. The thresholds between "normal" and "overweight" and between "overweight" and "obese" are sometimes disputed for this reason. You can also get the •skinny fat person• who is in the recommended BMI level but has a body fat of greater than 30%.

Different cultures value different body compositions differently at different times, and some are related to health or different athletic performance. Levels of body fat are epidemiologically dependent on different gender and age. Different authorities have developed different recommendations for ideal body fat percentages. The table below from the American Council on Exercise (not an official government agency) recommends the following percentages:

  Blood Glucose:
The blood sugar concentration or blood glucose level is the amount of glucose (sugar) present in the blood of a human or animal. Normally in mammals, the body maintains the blood glucose level at a reference range between about 3.6 and 5.8 mM (mmol/L, i.e., millimoles/liter),

Glucose is the primary source of energy for the body's cells, and blood lipids (in the form of fats and oils) are primarily a compact energy store. Glucose is transported from the intestines or liver to body cells via the bloodstream, and is made available for cell absorption via the hormone insulin, produced by the body primarily in the pancreas.

The mean normal blood glucose level in humans is about 4 mM (4 mmol/L or 72 mg/dL, i.e. milligrams/deciliter);[2]however, this level fluctuates throughout the day. Glucose levels are usually lowest in the morning, before the first meal of the day (termed "the fasting level"), and rise after meals for an hour or two by a few millimolar.

Hyperglycemia, or high blood sugar, is a condition in which an excessive amount of glucose circulates in the blood plasma. This is generally a glucose level higher than are 6 mmol/l, but symptoms may not start to become noticeable until even higher values such as 15•20 mmol/l. A subject with a consistent range above 7 mmol/l is generally held to have hyperglycemia. Chronic levels exceeding 7 mmol/l (125 mg/dl) can produce organ damage

Signs and symptoms:
Temporary hyperglycemia is often benign and asymptomatic. Blood glucose levels can rise well above normal for significant periods without producing any permanent effects or symptoms. However, chronic hyperglycemia at levels more than slightly above normal can produce a very wide variety of serious complications over a period of years, including kidney damage, neurological damage, cardiovascular damage, damage to the retina or damage to feet and legs. Diabetic neuropathy may be a result of long-term hyperglycemia.

What is insulin resistance?
Insulin resistance is a condition in which the body produces insulin but does not use it properly. Insulin, a hormone made by the pancreas, helps the body use glucose for energy.

The body's digestive system breaks food down into glucose, which then travels in the bloodstream to cells throughout the body. Glucose in the blood is called blood glucose, also known as blood sugar. As the blood glucose level rises after a meal, the pancreas releases insulin to help cells take in and use the glucose.

When people are insulin resistant, their muscle, fat, and liver cells do not respond properly to insulin. As a result, their bodies need more insulin to help glucose enter cells. The pancreas tries to keep up with this increased demand for insulin by producing more. Eventually, the pancreas fails to keep up with the body's need for insulin. Excess glucose builds up in the bloodstream, setting the stage for diabetes. Many people with insulin resistance have high levels of both glucose and insulin circulating in their blood at the same time.
Insulin resistance increases the chance of developing type 2 diabetes and heart disease. Learning about insulin resistance is the first step toward making lifestyle changes that can help prevent diabetes and other health problems.
  What causes insulin resistance?
   •   specific genes
   •   excess weight
   •   lack of physical activity
   •   eating high GI and GL foods

Many people with insulin resistance and high blood glucose have other conditions that increase the risk of developing type 2 diabetes and damage to the heart and blood vessels, also called cardiovascular disease. These conditions include having:
   •   excess weight around the waist,

   •   high blood pressure, and
   •   abnormal levels of cholesterol
   •   abnormal triglycerides in the blood.

Having several of these problems is called metabolic syndrome or insulin resistance syndrome, formerly called syndrome X.

Metabolic Syndrome:
Metabolic syndrome is defined as the presence of any three of the following conditions:
   •   waist measurement of 102cm or more for men and 88cm or more for women,
   •   triglyceride levels of 1.0 (mg/dL) or above,
   •   HDL, or "good," cholesterol level below 1.05 for men and below 1.3 for women,
   •   blood pressure levels of 130/85 or above,
   •   fasting blood glucose levels of 6 or above.

What is prediabetes?
Prediabetes is a condition in which:
   •   blood glucose levels are higher than normal,
   •   but not high enough for a diagnosis of diabetes,
   •   impaired fasting glucose (IFG) or impaired glucose tolerance (IGT),
   •   increased risk of developing type 2 diabetes.

Studies have shown that most people with prediabetes develop type 2 diabetes within 10 years, unless they lose 5 to 7 percent of their body weight by making changes in their diet and level of physical activity. People with prediabetes also are at increased risk of developing cardiovascular disease.
  What are LDL and HDL cholesterol?
LDL cholesterol is called "bad" cholesterol, because elevated levels of LDL cholesterol are associated with an increased risk of coronary heart disease, stroke, and peripheral artery disease. LDL lipoprotein deposits cholesterol along the inside of artery walls, causing the formation of a hard, thick substance called cholesterol plaque. Over time, cholesterol plaque causes thickening of the artery walls and narrowing of the arteries, a process called atherosclerosis, which decreases blood flow through the narrowed area.

HDL cholesterol is called the "good cholesterol" because HDL cholesterol particles prevent atherosclerosis by extracting cholesterol from the artery walls and disposing of them through the liver. Thus, high levels of LDL cholesterol and low levels of HDL cholesterol (high LDL/HDL ratios) are risk factors for atherosclerosis, while low levels of LDL cholesterol and high levels of HDL cholesterol (low LDL/HDL ratios) are desirable and protect against heart disease and stroke.

Total cholesterol is the sum of LDL (low density) cholesterol, HDL (high density) cholesterol, VLDL (very low density) cholesterol, and IDL (intermediate density) cholesterol.

Diets that are high in saturated fats and cholesterol raise the levels of LDL cholesterol in the blood. Fats are classified as saturated or unsaturated (according to their chemical structure). Saturated fats are derived primarily from meat and dairy products and can raise blood cholesterol levels. Some vegetable oils made from coconut, palm, and cocoa are also high in saturated fats.
  Does lowering LDL cholesterol prevent heart attacks and strokes?
Lowering LDL cholesterol is currently one of the primary public health initiatives preventing atherosclerosis and heart attacks. The benefits of lowering LDL cholesterol are:
   •   Reducing or stopping the formation of new cholesterol plaques on the artery walls
   •   Reducing existing cholesterol plaques on the artery walls and widening the arteries
   •   Preventing the rupture of cholesterol plaques, which initiates blood clot formation and blocks blood vessels
   •   Decreasing the risk of heart attacks
   •   Decreasing the risk of strokes
   •   Decreasing the risk of peripheral artery disease

The same measures that decrease narrowing in coronary arteries also may benefit the carotid and cerebral arteries (arteries that deliver blood to the brain) as well as the femoral arteries that supplies blood to the legs.

What is Lipoprotein (a)
   •   High lipoprotein (a) (Lp(a)) in blood is a risk factor for coronary heart disease (CHD), cerebrovascular disease (CVD),
       atherosclerosis, thrombosis, and stroke.

   •   Most commonly prescribed lipid-reducing drugs have little or no effect on Lp(a) concentration.
   •   Niacin (nicotinic acid) easily available and inexpensive known to significantly reduce the levels of Lp(a) in some individuals
       with high Lp(a);

   •   High Lp(a) predicts risk of early atherosclerosis independently of other cardiac risk factors, including LDL. In patients with
        advanced cardiovascular disease, Lp(a)indicates a coagulant risk of plaque thrombosis.
  What is homocysteine?
Ideal 5 - 7
Homocysteine is an amino acid that is produced by the body, usually as a byproduct of consuming meat. It is produced in a metabolic process called methylation. This is the process that creates glutathione which helps keep you young. Glutathione is the strongest anti oxidant produced by the body. When homocysteine accumulates above the ideal levels it is an indication that this process is sluggish and not producing enough anti oxidant.

Elevated levels of homocysteine (>10 micromoles/liter) in the blood may be associated with atherosclerosis (hardening and narrowing of the arteries) as well as an increased risk of heart attacks, strokes, blood clot formation, mental disorders.

Vitamin D:
Ideal >60
If you shun the sun you may be at risk for vitamin D deficiency. Known as the sunshine vitamin,vitamin D is produced by the body in response to sunlight.

Vitamin D is essential for strong bones because it helps the body use calcium from the diet. Traditionally, vitamin D deficiency has been associated with rickets, a disease in which the bone tissue doesn't properly mineralize, leading to soft bones and skeletal deformities. But increasingly, research is revealing the importance of vitamin D in protecting against a host of health problems.

Symptoms and Health Risks of Vitamin D Deficiency:
Symptoms of bone pain and muscle weakness can mean you have a vitamin D deficiency. However, for many people, the symptoms are subtle. Yet even without symptoms, too little vitamin D can pose health risks. Low blood levels of the vitamin have been associated with the following:
   •   Increased risk of death from cardiovascular disease
   •   Cognitive impairment in older adults
   •   Severe asthma in children
   •   Cancer

Research suggests that vitamin D could play a role in the prevention and treatment of a number of different conditions, including type1 and type 2 diabetes,hypertension, glucose intolerance, and multiple sclerosis.

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