Explore topics related to the Cardiometabolic Advanced Practice Module:


Reducing Cardiometabolic Risk, With Shilpa Saxena, MD


Shilpa_Saxena

By IFM Educator Shilpa Saxena, MD

The current recommended model of care for managing patients at risk for cardiovascular disease is far short of ideal. Like many, I practiced family medicine as I was trained in medical school and residency until I realized that there was actually more I could be doing for my patients’ long-term trajectory toward health or disease. Truthfully speaking, the disheartening morbidity and mortality statistics obligated me to find better options for my many patients at risk for cardiometabolic disease (e.g., hypertension, metabolic syndrome, diabetes, hyperlipidemia, etc.).

Study and training through The Institute for Functional Medicine allowed me to transcend the fatalistic myth I had accepted and, worse, passed onto my patients: that cardiovascular risk factors are mostly genetically predetermined. IFM educators at the Cardiometabolic Advanced Practice Module (APM) emphasized the fascinating and emerging science of epigenetics. We learned to rethink the basic science tenet stating that genes have not changed for thousands of years as evidence clearly underscores the clinical impact of poor lifestyle choices and cultural norms over the last century. 

Blood_Cells_Arteries_Blocked

Practically, while cholesterol plays a role in screening for the general population, it falls short of identifying and adequately assessing many individuals who are at risk. This lack of emphasis on personalized medicine, the foundation of epigenetics, is why nearly 50% of all heart attacks and strokes occur in patients with ‘normal’ cholesterol levels. IFM’s Cardiometabolic APM expands on the unique impacts of cholesterol, lipoproteins, insulin dysfunction, inflammation, and oxidative stress, which enables clinicians like me to now provide my patients the added security of knowing how their decisions (lifestyle and/or pharmaceutical) are impacting their global cardiometabolic risk score. 

With almost a decade of advanced lipoprotein testing under my belt, I am reassured that I can provide either a sense of security on the current therapeutic plan or an opportunity to address otherwise undetected risk that could put my patients in the 50/50 gamble that the general population faces without this vital clinical information.

Join me for IFM's Cardiometabolic APM, this February 2-4, in Austin, TX, and come away with new tools for helping patients understand their true cardiometabolic risk.

Shilpa Saxena, MD






Beyond Glycemic Control

Many patients with cardiometabolic syndrome or diabetes want to know what they can do to preserve their vision, preserve renal function, and reduce both foot and dental disease. How do you advise these patients? The current standard of care often highlights glycemic control, but recent research indicates that this metric may not be delivering the health outcomes that patients need.

doctor-optometry-looking-at-eye

A recent analysis found that diabetic retinopathy and associated blindness and vision impairment have been increasing steadily around the world, despite a focus on glycemic control.1 Renal failure and neuropathy also showed no improvements,1 despite the increasing focus on glycemic control, which has been supported by a variety of clinical guidelines.2 What can you do to help these patients with the outcomes that matter to them most?

IFM’s Cardiometabolic Advanced Practice Module (APM) gives you the tools to successfully improve patient compliance with their treatment plans, beyond just controlling their glucose. Treatment plans that are easily personalized and supported by patient education handouts will allow you to help your cardiometabolic patients improve multiple aspects of their health, helping to prevent complications. Expert physician-educators will teach you how to provide targeted interventions that can reduce risk factors, improve biomarkers, and help prevent the development or progression of cardiometabolic disease.

Join us via live stream or in Austin, Texas from February 2-4 to get new tools and strategies for assessing and treating patients with cardiometabolic dysfunction. An ever-increasing number of your patients will benefit from your knowledge and personalized treatment.

 

References
  1. Leasher JL, Bourne RR, Flaxman SR, et al. Global estimates on the number of people blind or visually impaired by diabetic retinopathy: a meta-analysis from 1990 to 2010. Diabetes Care. 2016 Sep;39(9):1643-49. doi: 10.2337/dc15-2171.
  2. Rodríguez-Gutiérrez R, Montori VM. Glycemic control for patients with type 2 diabetes mellitus: our evolving faith in the face of evidence. Circ Cardiovasc Qual Outcomes. 2016 Aug 23 [Epub ahead of print]. doi: 10.1161/CIRCOUTCOMES.116.002901.



Adipose Tissue and Evaluating Cardiometabolic Patients

Assessing the risk factors for cardiometabolic patients continues to be a crucial topic. In this video, Kristi Hughes, ND, explains how visceral adipose tissue is one key modifiable risk factor.








Tailor Lifestyle Interventions for High-Risk Patients

Several years ago, the Diabetes Prevention Program (DPP) Outcomes Study revealed the power of lifestyle change to reduce the rate of progression to diabetes in those at high risk.1 In that study of 3234 overweight or obese subjects with impaired glucose tolerance, a diet and exercise program with a goal of losing at least 7% of body weight reduced the three-year incidence of diabetes by 58% — nearly twice as much as metformin.1

The DPP Outcomes Study1 and more recent, similar studies such as E-LITE led the US Preventive Services Task Force to recommend that healthcare providers offer obese adults intensive lifestyle interventions with multiple components.2 Enriching a low-calorie diet with phytonutrient-rich fruits and vegetables, particularly those high in cardioprotective polyphenols, can enhance the cardiovascular benefits.

For example, a recent study found that a high-polyphenol diet improved endothelial function and decreased cardiovascular risk in 92 hypertensive subjects in just eight weeks.4 After acetylcholine infusion, forearm blood flow increased nine times more in the group eating six daily servings of fruits and vegetables, including polyphenol-rich dark chocolate and berries, than it did in the low-control group (P = 0.02).4

Lifestyle interventions are most effective when tailored to individuals and their life circumstances.2 IFM’s Cardiometabolic Advanced Practice Module (APM) provides patient education and assessment materials to easily personalize nutrition plans. IFM educator Michael Stone, MD, provides an overview of the takeaways from the Cardiometabolic APM:



The Cardiometabolic APM features the latest evidence-based guidance on using specific micro-, macro-, and phytonutrients as well as botanicals and stress reduction techniques to prevent or reverse the progression of metabolic syndrome, type 2 diabetes, and cardiovascular disease in your high-risk patients. Join us via live stream or in person at Austin, Texas, this February, 2-4.



References
  1. Goldberg, RB, Mather, K. Targeting the consequences of the metabolic syndrome in the Diabetes Prevention Program. Arterioscler Thromb Vasc Biol. 2012;32(9):2077-90. doi: 10.1161/ATVBAHA.111.241893.
  2. Rosas LG, Lv N, Azar K, Xiao L, Yank V, Ma J. Applying the Pragmatic-Explanatory Continuum Indicator Summary model in a primary care-based lifestyle intervention trial. Am J Prev Med. 2015;49(3 Suppl 2):S208-14. doi: 10.1016/m.amepre.2015.05.011.
  3. Lien LF, Brown AJ, Ard JD, et al. Effects of PREMIER lifestyle modifications on participants with and without the metabolic syndrome. Hypertension. 2007;50(4):609-16. doi: 10.1161/HYPERTENSIONAHA.107.089458.
  4. Noad RL, Rooney C, McCall D, et al. Beneficial effect of a polyphenol-rich diet on cardiovascular risk: a randomised control trial. Heart. 2016;102(17):1371-79. doi: 10.1136/heartjnl-2015-309218.



What Drives Hyperlipidemia?

Michael Stone, MD, discusses key takeaways for measuring lipids, assessing interventions, and cholesterol measurements.



Learn more at IFM's Cardiometabolic APM taking place February 2-4, 2017.





NAFLD, Diabetes, and Metabolic Syndrome

By Shilpa Saxena, MD
Educator at the Cardiometabolic APM

Non-alcoholic fatty liver disease (NAFLD) is predicted to replace hepatitis C as the most frequent indication for liver transplantation in the next 10-15 years.1 While hepatitis C rates decline with effective pharmaceutical therapy, no similar drug option exists for NAFLD. Making matters worse, it is evident that NAFLD additionally increases risks for extrahepatic diseases such as type 2 diabetes mellitus (T2DM), cardiovascular and cardiometabolic conditions, chronic kidney disease, and more.1 Fortunately, research has also revealed NAFLD and its associated diseases stem from metabolic dysfunction, a modifiable mechanism.

Functional Medicine helps practitioners utilize a systems biology approach to link these seemingly disconnected organ systems (i.e., liver, pancreas, arteries, adipose) through a common underlying cause: chronic inflammation.

Distinct from the short-term protective effects of acute inflammation, chronic inflammation is harmful and disease promoting. At IFM’s Cardiometabolic Advanced Practice Module (APM), we review modifiable drivers of chronic inflammation through advanced training in nutritional biochemistry and exercise physiology. In addition to showing you how to help patients optimize these lifestyle choices, we also elaborate on underdiagnosed yet prevalent etiologies of prolonged inflammation. For example, dysbiosis has a key role in T2DM,1 and genetics are known to play a role in NAFLD independently of T2DM.2 When treatment is personalized, these novel strategies can reduce liver transplantation and extrahepatic disease risks for those with NAFLD.

The Cardiometabolic APM provides a logical method to identify the unique drivers of each patient’s cardiometabolic disease using common lab markers and genetic principles. Join me for the Cardiometabolic APM to learn about the discrete mechanisms that underpin these diseases and how to implement personalized care plans, which may include such interventions as an anti-inflammatory food plan, a personalized exercise prescription, or probiotics. Functional Medicine can help you implement evidence-based interventions to ultimately reverse NAFLD and improve patient outcomes.



References
  1. Scorletti E, Byrne CD. Extrahepatic diseases and NAFLD: the triangular relationship between NAFLD, type 2-diabetes and dysbiosis. Dig Dis. 2016;34(Suppl 1):11-18. doi: 10.1159/000447276.
  2. Lallukka S, Yki-Järvinen H. Non-alcoholic fatty liver disease and risk of type 2 diabetes. Best Pract Res Clin Endocrinol Metab. 2016;30(3):385-95. doi: 10.1016/j.beem.2016.06.006.



Cardiovascular Risk and Physical Activity

By Shilpa Saxena, MD
Educator at the Cardiometabolic APM

Current evidence suggests we need an update on exercise prescriptions for cardiovascular disease (CVD) reduction or prevention. Our emphasis up until now has primarily centered on motivating patients to initiate and maintain regular exercise, specifically 30-60 minutes of moderate to vigorous daily physical activity. However, in narrowing our focus to this recommendation, we might have neglected a concurrent cultural shift in our daily behaviors. In 1960, about 15% of all U.S. jobs were sedentary; by 2008, more than 20% of U.S. jobs were sedentary, and average amount of time spent sedentary has increased from 26 hours to 38 hours per week in 2009.1 Moreover, U.S. adults spend an average of 6-8 hours in sedentary behaviors and less than 30 minutes on average per day in moderate-to-vigorous physical activity.1 High amounts of sedentary time and low physical activity are each independently strong predictors of early death.2

Not only are we more sedentary as a people, but we have also created a new exercise archetype: the exercising couch potato. This humorous, although apt, phrase describes the individual who exercises most every day yet spends a majority of his/her day sitting, whether for work or for leisure. The dangerous assumption made by this individual, and perhaps the managing healthcare provider, has been that the daily exercise offsets the risks of the daily sedentary behavior. Unfortunately, this has not been supported by recent data. Increasing research supports that sedentary behavior should be viewed as a separate and additional risk factor for chronic disease development, specifically the development of coronary artery disease and type 2 diabetes.1 So even though daily exercise should be commended, we must inquire further to ensure the risks of the office chair do not unknowingly fuel vascular and metabolic risks long term.

At IFM’s Cardiometabolic APM, you will learn how to effectively motivate patients to view exercise as a comprehensive systems biology benefit, and not just a means for weight loss. Whether structured, as in exercise programs, or unstructured, as brief interruptions of sedentary behavior,3 we need to examine how to engage and empower patients to leverage movement as powerful medicine. Join us this February 2-4, either via live stream or in person in Austin, TX, to learn the multifocal mechanisms by which movement can reverse the major underlying causes of cardiovascular disease, and how to effectively motivate your patients to move well for their health.



References
  1. Young DR, Hivert MF, Alhassan S, et al. Sedentary behavior and cardiovascular morbidity and mortality: a science advisory from the American Heart Association. Circulation. 2016;134(13):e262-79. doi: 10.1161/CIR.0000000000000440.
  2. Schmid D, Ricci C, Leitzmann MF. Associations of objectively assessed physical activity and sedentary time with all-cause mortality in US adults: the NHANES study. PLoS One. 2015;10(3):e0119591. doi: 10.1371/journal.pone.0119591.
  3. Dempsey PC, Larsen RN, Sethi P, et al. Benefits for type 2 diabetes of interrupting prolonged sitting with brief bouts of light walking or simple resistance activities. Diabetes Care. 2016;39(6):964-72. doi: 10.2337/dc15-2336.



Cardiometabolic Syndrome and Sustainable Lifestyle Change

Cardiometabolic syndrome is on the rise, and many of these patients also have comorbid obesity. Lifestyle change may be the most successful intervention for their overall health, yet knowing where to start with these interventions isn't always easy. You want them to focus on an aspect of their lifestyle (nutrition, exercise, sleep, stress management, etc.) where small changes will make a big difference in order to encourage them to continue on the path to better health.

Experienced Functional Medicine practitioners utilize a range of tools to assess the key factors contributing to each patient's condition, organize these factors, and prioritize interventions to increase the chances of success. At the Cardiometabolic Advanced Practice Module (APM), educators present the common underlying causes, key modifiable lifestyle factors, and how to use that information to personalize treatments for improved outcomes.

Kara-Fitzgerald
Kara Fitzgerald, ND

IFM educator Kara Fitzgerald, ND, often treats patients with comorbid obesity and metabolic syndrome. In this case example, she found that dietary change led to a marked improvement in a range of symptoms—including weight and cardiometabolic function.1 Over the course of a year, Dr. Fitzgerald reports that the patient, “has profoundly altered the course of her health, and feels very empowered.”

Many practitioners find that Functional Medicine offers the framework to individualize treatment for successful lifestyle change. When you see patients with cardiometabolic issues, you need the tools and information to help them change in ways that motivate and invigorate them. Join your colleagues for the Cardiometabolic APM this February 2-4, 2017, either via live stream or in person in Austin, TX, and walk out the door ready to prioritize interventions that help patients reverse cardiometabolic syndrome.



References
  1. Fitzgerald K. Recovering from morbid obesity, depression and metabolic syndrome using functional medicine. Dr. Kara Fitzgerald, Functional Medicine. http://www.drkarafitzgerald.com/2016/01/18/recovering-from-morbid-obesity-depression-and-metabolic-syndrome-using-functional-medicine-one-womans-inspiring-journey-to-wellness/. Published January 8, 2016. Accessed October 21, 2016.



Detect Signs and Cues of Metabolic Dysfunction

Given the widespread and increasing prevalence of metabolic dysfunction,1 being able to rapidly assess patient risk during a short encounter has become increasingly important. The physical exam offers numerous ways to zero in on nutritional and metabolic concerns—and IFM’s Cardiometabolic Advanced Practice Module (APM) teaches you how to see these signs.

Shilpa Saxena, MD, an educator at the Cardiometabolic APM, discusses the many ways to detect, assess, and evaluate metabolic function:

Join us this February, 2-4, 2017, to refresh your technique in the physical exam, update your clinical knowledge on metabolic risk factors, and gain tools to help improve patient outcomes. You can intervene early and help your patients improve their metabolic function. Attend in person in Austin, TX, or online via live stream and become an expert at the cardio-focused physical exam.



References
  1. Kelli HM, Kassas I, Lattouf OM. Cardio Metabolic Syndrome: A Global Epidemic. J Diabetes Metab. 2015;6(3):513. doi: 10.4172/2155-6156.1000513.



Reversing the Diabetes Epidemic

Arthritic_hands_pain

A 2016 analysis estimated that 46% of Californians have prediabetes, with disproportionately higher rates among young adults of color.1 California is not alone; in the US as a whole, blood glucose and metabolic disorders are on the rise.2 As clinicians, should we consider screening everyone for metabolic syndrome? At IFM’s Cardiometabolic Advanced Practice Module (APM), expert educators present on expanded definitions and assessment techniques to identify and work with at-risk patients.

Knowing how to identify higher risk patients streamlines your office visit. A recent study suggests that individuals with certain conditions or characteristics may be at higher risk of metabolic syndrome. In patients with rheumatoid arthritis, researchers found significantly higher rates of undiagnosed diabetes when compared with age- and sex-matched controls.3 Chronic inflammation may be the underlying factor, perhaps contributed to by the increased visceral fat often found in patients with rheumatoid arthritis.3

Cardio_BMI_Indicator

The latest anthropometric evaluations go far beyond BMI—in fact, measures of visceral adiposity may supersede BMI for assessing cardiometabolic risks.4,5 Join us for IFM’s Cardiometabolic APM on February 2-4, 2017, either via live stream or onsite in Austin, TX, to update your knowledge on screening tools to identify patients at risk. Using sophisticated risk analysis methods, as well as cutting-edge research, expert presenters will help you help the growing number of patients with cardiometabolic conditions.



References
  1. Babey SH, Wolstein J, Diamant AL, Goldstein H. Prediabetes in California: nearly half of California adults on path to diabetes. Policy Brief UCLA Cent Health Policy Res. 2016 Mar;(PB2016-1):1-8.
  2. Guo F, Garvey WT. Trends in cardiovascular health metrics in obese adults: National Health and Nutrition Examination Survey (NHANES), 1988-2014. J Am Heart Assoc. 2016;5(7). pii:e003619. doi: 10.1161/JAHA.116.003619.
  3. Ursini F, Russo E, D’Angelo S, et al. Prevalence of undiagnosed diabetes in rheumatoid arthritis: an OGTT study. Palazon-Bru A, ed. Medicine (Baltimore). 2016;95(7):e2552. doi: 10.1097/MD.0000000000002552.
  4. Weber DR, Moore RH, Leonard MB, Zemel BS. Fat and lean BMI reference curves in children and adolescents and their utility in identifying excess adiposity compared with BMI and percentage body fat. Am J Clin Nutr. 2013;98(1):49-56. doi: 10.3945/ajcn.112.053611.
  5. Lee JJ, Beretvas SN, Freeland-Graves JH. Abdominal adiposity distribution in diabetic/prediabetic and nondiabetic populations: a meta-analysis. J Obes. 2014;2014:697264. doi: 10.1155/2014/697264.



Cardiometabolic Conditions and the Microbiome

 

As clinicians, we recognize that cardiometabolic dysfunction is a leading cause of illness among our patients. But the commonly used risk factors are only part of the story. Understanding the biochemical and systems-biology interactions that underlie the health of the arterial walls, the lipid components in the blood, and the blood glucose balance is critical to helping patients prevent serious adverse events. IFM’s Cardiometabolic Advanced Practice Module (APM) will update your clinical toolkit to help you address all the known underlying causes of cardiometabolic dysfunction.

One example of a nontraditional factor that can impact cardiometabolic health is the gut microbiome. Recently, the microbiome’s role in cardiometabolic health has become a topic of much interest. One large-scale study (n=893) provides evidence that certain families of gastrointestinal bacteria can either positively or negatively affect cardiovascular health.1 Different compositions in the gut microbiome were correlated to both BMI and lipid levels, independent of genetics, age, and gender.1 Lower levels of bacterial families Christensenellaceae and Rikenellaceae, class Mollicutes, genus Dehalobacterium, and kingdom Archaea correlated with high BMI.1 The researchers estimate that 4.5-6% of BMI, triglycerides, and HDL variations could be explained by these variations in the microbiome, independent of other risk factors.1 Another study has connected insulin sensitivity to the gut microbiome, suggesting that some bacteria may even induce insulin resistance.2 Treating the gut using diet, probiotics, prebiotics, and other therapies may be effective for many cardiometabolic patients.

Join IFM for the Cardiometabolic APM via live stream or in Austin, Texas, on February 2-4, 2017, and learn how a systems-biology approach can help you identify and address the expanded set of risk factors that impact cardiometabolic health. You will leave with an expanded outlook on assessment, prevention, and treatment of chronic metabolic and cardiovascular disorders.



References
  1. Fu J, Bonder MJ, Cenit MC, et al. The gut microbiome contributes to a substantial proportion of the variation in blood lipids. Circ Res. 2015;117(9):817-24. doi: 10.1161/CIRCRESAHA.115.306807.
  2. Pedersen HK, Gudmundsdottir V, Nielsen HB, et al. Human gut microbes impact host serum metabolome and insulin sensitivity. Nature. 2016;535(7612):376-81. doi: 10.1038/nature18646.

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