 Hey everybody, Dr. O here. Welcome to chapter 18 on disease prevention or what I like to call how to die of nothing. So what I mean by that is your ultimate goal should be to reach your genetic potential as far as age goes, chronological age goes and die of old age and dying peacefully in your sleep rather than dying of these diseases that take years off of our lives and they take years off of our productive lives and they harm our quality of life and they're really expensive to deal with at the end of our lives, all these kind of negative things. So basically what are the things that we are in control of? We're not in control of so non-modifiable things would be things like your age and your genetics but diet and lifestyle factors are at the top of the list of things that we can control and none of these things are guarantees. We can't guarantee that you're going to live a long and healthy life if you make all the right choices. My wife works in oncology and people that are seemingly healthy and do tons and tons of good things and don't smoke and don't do that and don't do this still get sick and still die sometimes. So we're talking about probabilities, we're talking about increasing the likelihood that you avoid these negative diseases that cost you years and quality of life at the end. All right, if you're hearing snoring in the background, my dog's asleep behind me so I guess she's not very interested in this topic. But disease prevention, chapter 18, icebreaker. Do you believe that what you eat and drink really make that much difference in how well or how long you live? Why or why not? I mean that's up to you to answer but from a probability standpoint we are talking about years of your life. So people that eat really healthy diets and are physically active live years longer than people that don't. You have the idea of the blue zones. Blue zones are areas around the globe where they have a higher percentage of centenarians or people that live to be a hundred or older than other parts of the world and they've studied these people and they've found that diet and lifestyle factors and social health, having a purpose in life, all these psychological social factors as well. All these things appear to be the reason why they live longer. You need good genetics too. There's no doubt about that. Some people live really long lives without making very many good decisions to begin with when it comes to diet and lifestyle but that's because of their genetics. So basically in spite of their diet and lifestyle they still live a long life but most people can't rely on that. We have to optimize our genetic potential with diet and lifestyle factors. So it does matter. And even if it doesn't impact how long you live, the quality of your life, notice it says how well you live or sorry, the quantity of your life, even if it doesn't make you live longer, positive diet and lifestyle factors should make you live better, right? Have an increased quality of life. One example that was one study showed that the typical person that exercises and follows the government recommendations or guidelines for exercise might live 4 or 4.7 years longer. But if you look at it, you do. You spend most of that time exercising. I exercise now. If you count my walks, we're probably looking at, I don't even know, 12, 15 hours a week. So we're looking at almost 10% of my week is spent purposely being physically active. So if those choices allow me to live 5% longer with the years I have left, then really I've spent all of that extra time exercising. And that's okay though because the quality of life is what I'm really looking for. People that exercise have a quality of life that's two or three times as good as people that don't. The difference between being able to take care of yourself until you die versus living in a long-term care facility, having lots of disabilities and problems. So you answer that. You answer that question anyway. You see fit, but that's kind of how I would answer it. What are our learning objectives this chapter? We're really trying to tie everything together. We've covered everything and I've mentioned every one of these diseases somewhere along the way. Now we're going to put a bow on this course basically by looking at how we can put these things together and decrease our risk of dying or having these chronic diseases as much as possible. So number one, identify factors that protect people from the spread of infectious diseases and describe the role of nutrition in immunity. List the leading nutrition-related causes of death in the United States. Describe how atherosclerosis or hardening of the arteries develops and strategies to lower blood cholesterol levels. Describe strategies to lower blood pressure, which is way up there on the list for me. Compare dietary strategies to manage type 1 diabetes with those to prevent and treat type 2 diabetes because they are completely different diseases. They impact your body differently. They have different causes, etc. We'll get into all that. And differentiate among cancer initiators, promoters, and anti-promoters and describe how nutrients or food play a role in each category. So we will cover all of that. All right. Let's start with nutrition and infectious diseases, obviously really important over the last few years. We've learned that with the disease, with a pandemic like COVID, there were things you could do to decrease transmission, but you were still really, really likely to get it. So that's a situation where your immune system is your best friend because if everyone is going to get a disease, the people that have the least comorbidities or underlying health problems and the people that have the best immune responses are the ones that are generally going to do the best. And that's why with COVID, you saw that a huge majority of people maybe didn't even know they had it or it was very mild, but people that are immunocompromised is a whole different story. If someone has diabetes and high blood pressure or kidney disease, these kind of things, getting COVID was a much more life-thedding situation. Look at children. COVID killed several hundred American children, but as far as I know, every one of them that I saw, every report that I saw, the child did have some underlying conditions. Maybe they were immunocompromised for genetic reasons or other reasons. So if you're making your immune system as strong as possible is one of your best weapons. And then, you know, personally, I've got COVID more than once, but I really struggled with COVID the first time I got it and it took months for me to recover. And I decided that I just had to get healthier, right? You know, I couldn't hide from COVID or other diseases. So I needed to focus on being prepared so that the next time I got it, if I got it again, my immune system would be able to handle it. And that's what I did. And that's why I've really, really gotten a lot healthier. So COVID had a very big negative impact on me, but it ended up being a blessing in disguise because I'm way healthier post COVID than I am now, but it's not because of COVID, but because of the choices I made after getting it. All right. The immune system, advances in medical science have increased average life expectancy. That's, you know, mainly we have vaccines and antibiotics have saved more humans than everything else combined, hand washings way up there too. So understanding how to stop the spread of diseases, understanding how to treat them and all the life saving treatments we have, you know, that you've got organ transplants and all the amazing things we can do. But that's really why, you know, the average American, we talked in just an earlier video about how, you know, 100 years ago, or a little more than 100 years ago, life expectancy in the United States was 47 and now it's like 78, 79. So most of those differences are way less kids dying. So it used to be if you had five kids, one or maybe two of them wasn't going to make it to their fifth birthday. So keeping really young people from dying and then these life saving things that can keep people alive for years with chronic diseases that would have usually killed them, organ transplants, you know, clot-busting drugs for heart attacks and strokes, all these kind of things. If you just go back in like the 1950s, if you went to the hospital with the heart attack, they basically just gave you, you know, they took care of you while they crossed their fingers and or prayed that you're going to survive, right? You know, now we have treatments and interventions that are just amazing. Modern medicine is really good at keeping people alive, right? But if you want to be healthy, you really can't rely on modern medicine alone. That's where the diet and lifestyle, you know, stress management, etc. all come into play. All right, immunizations and antibiotics provide anti-protection. So those, you know, on top of our own amazing immune system, these things have just like I mentioned earlier, probably the two greatest discoveries in human history are immunizations or vaccines and antibiotics because the best disease to fight is the one you never get and that's what vaccines do and then antibiotics have just saved countless, countless lives from bacterial infections. Strong immune system depends on adequate nutrition. Here's the way I like to look at it. We'll look at individual nutrients that play a really big role in the immune system, but every nutrient plays a role in your immune system, right? What I mean by that is, you know, carbs, lipids, proteins, water, and all those macro nutrients and then every vitamin and every mineral, even though, you know, the ones you don't talk about much like malibdanum and boron, if you're deficient in those neutrons, they impact the immune system. Now, being deficient in boron isn't going to impact the immune system as much as being deficient in vitamin A or zinc or something like that will, but all of it matters. So any nutrient deficiency impairs your immune system. It's just a question of how much. Poor nutrition weakens the immune system. I just said that. Parts of your immune system, again, this is all stuff. If you want information about this, let me know. I have an entire playlist on the immune system from my ANP2 course where I cover in great detail your innate immune system, your acquired immune system, all that stuff. I have a series on vaccines from a microbiology class as well. If you're interested in those kind of things, just let me know. So phagocytes, that means they're cell eaters. Those are the cells that they're especially good at fighting off bacteria because they engulf them and destroy them, but they can also can destroy virus-infected cells as well. So your neutrophils, those are your primary weapon against bacterial infections and then macrophages. Basically, this means big eaters, those cells will engulf infected cells, damaged cells, cell debris, waste products, bacteria, you name it. So they're like cleanup crew. Then we have your lymphocytes. Lymphocytes are another type of white blood cell besides the neutrophils. But again, I'm not going to go into all detail there. This is not anatomy class, but neutrophils are a kind of white blood cell. Monocytes become what's called a tissue macrophage. So one type of macrophage is in one way is a white blood cell. And then lymphocytes are a special kind of white blood cell and they have two divisions, the B cells and the T cells. So B cells, that means they develop in the bone marrow. So they're bone marrow-derived cells or B cells. And they're part of what's called your humoral immunity. So the humoral immune response or the antibody mediated immune response because B cells become a cell called plasma cells that make antibodies. So all these antibodies we've been talking about, antibody titers, antibody levels, all of that is it's the B cells that become plasma cells that make the antibodies. T cells are thymus dependent. They develop in your thymus gland in your throat, in your neck there. And so T cells are thymus dependent cells. They're involved in what's called the cellular immune response and T cells, we have a group called cytotoxic T cells. They will actually attack and destroy cells directly. So they're involved in kind of cell to cell combat, whereas the B cells, they fire off the antibodies into the plasma, into your body fluids. That's why it's called humoral immune response. So they function differently, but both are really, really needed. Like with COVID, we've been talking about antibodies all the time, but your T cell response is probably what kept you out of the hospital, those kind of things. So B cells and T cells work together. They are really important for fighting viruses, whereas neutrophils are especially important in dealing with bacteria. But we're exposed to bacteria and viruses every day all day, so we want both of them being real healthy. So nutrition in the immune system. The immune system responds to subtle changes in nutrition status. That's why I've mentioned in a few videos where when someone in my family is sick or we think we're coming down with something, we use a little cocktail of nutrients because just subtle increases in these nutrients for a few days can hopefully help your immune system fight something off that normally isn't there. The response to both over and under nutrition. So you would think that being malnourished would definitely impact your immune system, and it does. If you're deficient in vitamin D or vitamin A or vitamin C or zinc or any of these nutrients, your immune system will take a hit. But over nutrition can as well. If you're being overfed, then you have more of an inflammatory state, which inflammation is important for the immune system, but it basically responds to acute spikes in inflammation is what your immune system is used to. This chronic background baseline inflammation actually condemned the immune response a bit. Too much sugar. Sugar can impair white blood cell function. Sugar can impair immunity. So over nutrition and under nutrition can both lead to problems in the immune system. All right, the immune response requires greater nutrients. When you are sick, one of the reasons you get hot is that your metabolic rate has gone up. Let's say that your metabolic rate climbs 10% while you're fighting off an infection. That number can vary, but that means that you need 10% more calories, 10% more protein, 10% more everything. So when you're fighting off an infection, you need more nutrients, which is why it's so important. That's why, again, we use kind of a cocktail around my house and I can explain what that is in just a moment, but... So why do you need more nutrients while you're fighting off an infection? Your body is making, so synthesizing antibodies, cytokines, which are chemical messengers. Cell multiplication, you have your B cells and T cells are cloning themselves and making millions and billions of copies. So all that requires energy. Infectious diseases raise nutrient needs and decrease food intake. So that's kind of a double-edged sword, right? You need more nutrients, but maybe you're vomiting, maybe you have diarrhea, maybe you're nauseous, maybe you don't have an appetite. That can be really tricky, but thankfully your body can kind of harvest the nutrients that it needs from yourself if needed, but that's why your best bet is to be healthy before you get sick so you can rely on that, kind of like to be healthy before you're pregnant so you can rely on those nutrients that are there if your morning sickness is so bad that you're having trouble eating, those kind of things. So a synergistic downward spiral. Need more energy while you can't eat or don't feel like eating. So you're lower nutrition and less nutrients coming in, more nutrients going out, that's a recipe for disaster. All right, we'll go through these and then I'll explain that little cocktail that we use personally. Again, not medical advice, just kind of what me and my family like to do. So the roles, these are the critical nutrients, but like I mentioned before, every nutrient does play a role. Let's start with protein. Maintains healthy skin and other epithelial tissues that are barriers to infection. So you have your skin as a barrier on the outside, your mucus membranes, which are aligned with epithelial tissue, are the barrier on the inside. So you think about your respiratory tract, your gastrointestinal tract, et cetera, participates in the synthesis and function of the organs and cells of the immune system, which would be you got your bone marrow, your thymus gland, you've got your spleen, you've got all these different organs and antibody production. So antibodies are made of proteins. The antibodies are IgG, IgA, IgM, IgE and IgD, and Ig stands for immunoglobulins. These are globulin proteins. So you cannot make antibodies without proteins. The omega-3 fatty acids, so we talk about the fish oils, your EPA and DHA, they are very anti-inflammatory. So they help resolve inflammation when it is no longer needed for the immune response. So remember, inflammation is good. It is a part of when it happens acutely and when it's necessary, it is part of your immune response. Without inflammation, you wouldn't have an immune response. Without inflammation, tissues couldn't heal. Without inflammation, muscles couldn't grow, right? You see, inflammation is important, but you don't want to have chronic inflammation when you're not sick or you're not injured or you're not recovering. Okay, so helps resolve inflammation through the production of lipid mediators known as resolvins and protectins, which also play a role in enhancing host defenses. So the omega-3 fats are good for the immune system. They're also, I'll say anti-inflammatory, and they are, but they promote, they promote, well, let's say, how do you say this? They get rid of excessive inflammation or they get rid of inappropriate inflammation. They don't hurt the actual inflammation your body needs. Okay, vitamin A. When I think of, looking at the list here, vitamin A, vitamin D and zinc are the three biggest ones to me when it comes to immune health. And I've mentioned that the cocktail that we use around our house is we kind of take a high dose of vitamin A for two or three days. We take zinc pills every two, three hours for a couple of days and then we make sure we're getting plenty of vitamin D. Those are the main three things we do. On top of that, we will use some vitamin C and we will add lysine. Lysine's an amino acid that has antiviral properties. So that's kind of the cocktail that my family likes to use. All right, vitamin A maintains healthy skin and other epithelial tissues, which are barriers. Again, vitamin A, very important for your mucus membranes, participates in the cell replication and specialization that supports immune cell and antibody production and the anti-inflammatory response. So one study showed that a severe vitamin A deficiency can decrease the production of these antimicrobial compounds by up to 35%. So vitamin A, big, big impact on the immune system. Vitamin D regulates immune cell responses, your T cells, but especially what are called your regulatory T cells and they kind of modulate and control the immune system. They also, well, the helper T cells really control the immune system. With the regulatory T cells or what are called T-regs, they keep your body from having an excessive immune response. So you want to have a strong immune response, but not one that's too strong. And that's what vitamin D really appears to play a role with. Vitamin D regulates the expression of thousands of your genes and hundreds of them are in and on white blood cells. So vitamin D plays a major role in white blood cell function and then participates in antibody production as well. That would be from your B cells. Vitamin C and vitamin E, these are antioxidants. So they protect your body against oxidative damage. Vitamin C, I say especially helps with lung tissue and white blood cells. So I really like that for immune function. Vitamin E protects the lipid membrane. So the parts of your nervous system and your cholesterol, those kind of things from being oxidized. Vitamin B6 helps maintain an effective immune response, participates in antibody production. So very true, all the B vitamins are important. Vitamin B12 and folate, these two are always linked together because they both assist in cell replication and specialization that supports immune cell and antibody production. So not just immune cells, but all cells need B12 and folate when they divide. Selenium is part of what's called the glutathione peroxidase system, which is your body's most important intracellular inside your cells antioxidant system. So it protects against oxidative damage. Very, very important. And zinc helps maintain an effective immune response and participates in antibody production. Zinc's important for cell replication and division and specialization as well. Long list of things, but so genetics play a big role if your immune system, exposure plays a big role. The lots of things impact your immune system, but meeting these basic nutrient needs will give you the best immune system that you can have. All right, inflammation and chronic disease. So we mentioned before that inflammation is appropriate when your body is actively fighting infection. It is not appropriate, sorry, between infections, just like it's appropriate if you have an ankle injury. It's not appropriate just on any given Tuesday. So inflammation and chronic diseases. The immune system's response to infection or injury, that's what inflammation is, the immune system's response to infection or injury. Blood supply to the site is increased. Vessels become permeable, which is why fluid stays there and swelling occurs. Phegocytes and golf microbes, they can also clean up debris if you sprained an ankle, for example. Phegocytes release oxidative molecules like hydrogen peroxide to kill microbes and they fight off infections and promote recovery. So that's what the inflammation is supposed to do. It's to help you fight an infection in an area or clean up and recover a damaged area. It's chronic inflammation is a problem. So what causes that? Well, inflammatory diets certainly can. So diets that are too high in inflammatory fats like the Omega-6 fats while being too low in the more anti-inflammatory fats, the Omega-3 fats, that's probably a real big dietary mechanism. Insulin resistance, so if you're diabetic or pre-diabetic or having those kind of problems, that can certainly impact chronic inflammation levels. Obesity, yeah, especially central adiposity or obesity around the abdomen and visceral fat. So visceral fat, the fat that's in and around your organs is the most harmful from an inflammatory standpoint. So that's one of the things I get dexascans done to monitor my body composition and that I have found that as my, and it specifically tells you how much visceral fat you have, as my visceral fat numbers have dropped, my inflammation markers have dropped too. So a good inflammation marker is if you want a good assessment of inflammation in your body, I recommend the high sensitivity it's called, C reactive protein test and mine has been progressively dropping as my visceral fat has gone away. So chronic inflammation is bad, but we can't say inflammation is bad because inflammation is good when it's needed, when it's necessary and when it's appropriate. Too much inflammation for too long or chronic inflammation, especially systemic body-wide inflammation is bad. All right, nutrition and chronic diseases. So here you see the 10 leading causes of death in the United States and this has changed a ton, right? If you go back 1907, the two leading causes of death would have been pneumonia and tuberculosis, I believe. So, and diarrhea was way up there. So it's all, we basically now have the luxury of dying of what are called modern diseases or diseases of lifestyle, diseases of civilization. So we have the luxury of living long enough for heart disease and cancer to kill us. I know it's a weird way to look at it, but it is true. So you see heart disease and cancer are by far the two leading causes of death, accidents, chronic lung diseases, those are obviously major problems. Strokes, so you add heart disease and strokes together, you have your cardiovascular diseases. And then you have Alzheimer's, which is now rapidly increasing several percent a year. And I think there's some, it says other causes and it's true, but I think the nutrition plays a role there too, diabetes and then you have influenza and pneumonia, kidney disease and suicide way down there. But so if you look at those, the huge majority of Americans are dying from things that are preventable or at least modifiable with diet and lifestyle. All right, and pause it and see if you can answer these questions. Five of the 10 leading causes of death reflect chronic diseases that develop in response to lifestyle factors. List any five of the 10 leading causes of death. Oh, I mean these would be, I guess this is talking about the, list any of the five, I didn't read the question before, but list any five of the modifiable lifestyle factors, I think is what the question should be saying here. Diet, physical inactivity, being overweight, tobacco use, alcohol and drug abuse. So if you have a really healthy diet, you have lots of physical activity, you're not obese or overweight, you don't smoke, you don't drink and you don't do drugs. You have, that's 99% of it by far, right? People always ask about a supplement here or this little thing here, this little thing there, you know, like if these, if you handle all these big things, then the little things really just aren't that big of a deal. All right, you know, sun exposure would be a big one here too, I guess. Safe, smart sun exposure is a good thing, but excessive sun exposure, not. Each chronic disease develops in response to many risk factors. Lifestyle and genetics often work synergistically. For example, cigarette smoking increases heart disease in those that are predisposed to develop it. So some people have like genetic conditions that cause them to have high cholesterol and all sorts of things like that. But the two definitely do work together. I always like to say that genetics, your genes load the gun, your environment, which means your diet and lifestyle and those kinds of things pull the trigger. So if you have a higher risk of lung cancer than me, then you need to do more of the good things to not get lung cancer than I do. It's not a guarantee that you're gonna get lung cancer. It just means that you need to avoid smoking, avoid secondhand smoke, eat more fruits and vegetables. You need to do those kinds of things. So the more high risk you are genetically, just the harder you have to work. Or if someone has a really high risk of heart disease because they have a familial hypercholesterolemia, which is a genetic condition, or they have a lot of what's called LP little A, which puts you at real high risk for heart disease. If you're one of those people, then you don't get to just get your cholesterol down to 200. And you need to get your LDL cholesterol, your bag cholesterol pretty much as low as you can get it. So you have to be a lot more aggressive when you do things to prevent heart disease than someone else would. And some people have genetic conditions that actually make it almost impossible for them to get heart disease. So they can make a lot more mistakes than the average person like you and me. All right, risk factors and the chronic diseases that they're related to, you see how diets high in that added sugars have been linked to obesity and then obesity has been linked to all the other ones though. Atherosclerosis, stroke, hypertension, diabetes and cancer. Diets high in saltier pickled foods linked to hypertension and cancers. Salt, the salt being the cause of the hypertension and with cancers it'd be more of the actual process. All right, diets high in saturated and or trans fats linked to all of them, especially trans fats and then saturated fat didn't take above 10% of your calories. You know, nothing wrong with consuming some saturated fat, but you're not supposed to consume more than 10% of your calories and saturated fat. Diets low in fruits, vegetables and other foods rich in fiber and phytochemicals also linked to all of them. Diets low in vitamins and minerals linked to atherosclerosis, stroke, hypertension and cancer. Excessive alcohol intake linked to all of them but diabetes. But again, if you excessive alcohol intake usually leads to excessive calorie intake, et cetera, which so indirectly I would say it's related. Other risk factors, age is linked to all of them but obesity, you can be obese at any age. Environmental contaminants are primarily just linked to cancer, genetics, all of them, sedentary lifestyle, all of them. I mean, physical motion is medicine as they say. Smoking and tobacco use linked to atherosclerosis, stroke, hypertension and cancer. We know like smoking and lung cancer but smoking increases your risk of lots of other cancers like gastric cancer and then smoking damages blood vessels. That's why it's linked to hypertension and atherosclerosis and then of course strokes if you have high blood pressure and damaged blood vessels, that's where heart attacks and strokes come from. And then stress linked to all the same three there. Atherosclerosis, stroke and hypertension, stress causes blood pressure to go up, stress is inflammatory, et cetera, et cetera. All right, the interrelationship amongst chronic diseases. So you notice that a big link there is this abdominal obesity. So let's start with, so abdominal obesity is inflammatory which would increase your risk of atherosclerosis and diabetes because inflammation makes insulin resistance worse and it also makes hardening of the arteries worse. High blood pressure is gonna lead to heart attacks and strokes also making atherosclerosis worse which would lead to heart attack and stroke. You see all the arrows. You see it definitely, obesity is a link in the chain between all of them. Cancer, high blood pressure, atherosclerosis and diabetes but they all are in one way or another related to each other. Let's look at cardiovascular disease specifically here. How does atherosclerosis or hardening of the arteries develop? So we'll take a look here and then I'll kind of explain how I like to teach it. So cardiovascular disease is diseases of the heart and blood vessels. So cardiovascular disease. Coronary heart disease, CHD, is the most common form of cardiovascular disease. So the coronary arteries are the arteries that feed your heart oxygen. So the blood vessels of the heart itself are damaged by atherosclerosis and that can cause the heart to malfunction. So it usually is caused by atherosclerosis or that's why you got clogged arteries people say and you have to go in and have these coronary bypass surgeries and these kind of things. So fatty streaks, if you look at the blood vessels you'll see what are called fatty streaks which are filled with lipids, cholesterol and calcium. Those plaques that form stiffen and narrow the arteries. So less blood flowing through it and the arteries also get stiff which means that high blood pressure will make them more likely to rupture. Considered a complex inflammatory response to tissue damage, all true. So a lot of times we blame that cholesterol but what happens is there's some sort of damage to the blood vessel wall. Usually caused by oxidation or inflammation or glycation, too much glucose. So your artery walls get damaged and then cholesterol, the more cholesterol you have in the bloodstream, the more the cholesterol will be driven into the lining of your blood vessels called the endothelium. And then that cholesterol, this oxidized gross cholesterol stuff gets swallowed up by immune cells like monocytes will travel to the area and become macrophages and then they become what are called foam cells. So imagine a macrophage that's been chewing on this gross cholesterol. They become these foam cells and then you get this reaction to that that forms those fatty streaks. So you literally have chunks of fat and cholesterol and then calcium gets trapped in it. Up to 25% or so of the plaques that are in your arteries are calcium which is why you can get a calcium score to look to see how much calcium you have in your blood vessels. It's also why if you take like a chest X-ray of an elderly person, you can basically see the outline of their aorta because it's been calcified. So these plaques made of fat, cholesterol and calcium they clog up your arteries but the actual, it's usually not a clogged artery that leads to a heart attack or stroke. What usually happens is these plaques will break off and if a plaque lodges somewhere in your heart it will cause a heart attack and if it lodges somewhere in your brain it will cause a stroke. And that's why the treatment for those kind of things are clot busting drugs to break up these clots and these plaques. All right, go ahead and pause this and try to answer these. Maybe stable or unstable and may rupture, that's the plaques. And to me, the biggest thing is so stable plaques don't put you at risk. So the unstable plaques that can rupture are the ones that are the most dangerous and that's where inflammation plays a big role. I mentioned earlier that you wanna know your high sensitivity C-reactive protein levels, the higher your C-reactive protein levels the more likely these plaques are to be fragile and the more likely they are to rupture and cause a heart attack or stroke which is why if you have a high CRP your risk of heart attack or stroke is much higher, double maybe more. Platelets cover injured or damaged areas and may restrict blood vessels. That is a blood clot, not a plaque. Damage increases permeability of blood vessel walls. That's inflammation. So again, another reason not to want chronic inflammation in your blood vessels. Heart attack, stroke and angina which is chest pain. Those are the results of these problems. Composition rather than size predicts the ruptures. That's the plaques. So again, are the plaques stable or unstable? Depends on what they're made of. LDL cholesterol becomes trapped in blood vessel walls are oxidized by free radicals. So we said that cholesterol gets oxidized. I called it gross oxidized cholesterol. It gets engulfed by a macrophage. Remember the monocyte travels to the area, becomes a tissue macrophage and swallows up this cholesterol and that becomes a foam cell and that becomes part of the plaque. So that's this inflammation is what triggers all this. So you wanna create a nice low inflammation environment in your blood vessels and you wanna make sure you don't have excessive amounts of LDL cholesterol because that's diffusion, right? The more cholesterol there is in your bloodstream the more opportunities it has to plaque up in an artery. When it is high can provoke low grade inflammation that is blood pressure or hypertension. Favors the formation of blood clots is inflammation. So it's all inflammation just bad, bad, bad here. The only time you want inflammation is why you're actively fighting an infection or actively dealing with an injury. Risk factors for coronary heart disease we'll talk about both modifiable and non-modifiable risk factors. Half of the US adults have at least one major risk factor by the age of 20 already. Regular screening and early detection is good and that's why we see a downward trend since the 60s. 60s people are getting their hypertension dealt with, their high cholesterol dealt with, et cetera, et cetera. Major risk factors for coronary heart disease that are not modifiable are increasing age, the male gender and a family history of premature heart disease. So basically age, male gender, genetics those are the non-modifiable factors. The modifiable, so don't worry about those. You can't not get older, well I guess you can but like they always say aging sucks but it beats the alternative. We're gonna talk about the modifiable risk factors. So the major risk factors for coronary heart disease that are modifiable, high blood LDL cholesterol. So if you wanna lower your LDL cholesterol, what's the main thing you want to change? There's a lot of answers to these things and we could spend a week talking about each one but I'm gonna give you the big ones. If you wanna lower high blood cholesterol you need to change the ratio of saturated to polyunsaturated fats that you eat. So if you're eating like, it becomes really high risk when you're consuming more than 18% of your calories as saturated fats. Let's say that 20% of your calories are saturated fat right now. If you drop that from 20% to 10% and you make up the difference by eating more polyunsaturated fats then you've improved the ratio. And now the monoinsaturated fats like olive oil from those from nuts, those are all good for you too but they don't impact LDL cholesterol as much as the polyunsaturated fats but still they decrease heart disease risk, no doubt. So if you switch from butter to olive oil you'll see improvements but if you specifically wanna lower your LDL cholesterol you need to increase the polyunsaturated fats like myself. I've gotten rid of some saturated fats. I cut way back on my cheese intake which has a lot of saturated fat in it. I eat a lot more egg whites now than whole eggs. I love eggs, very nutrient dense. I still eat enough eggs for their nutritional quality but I don't eat excessive amounts. So that's how I lowered my saturated fat intake. I also eat leaner cuts of red meat and I eat more chicken breast now than red meat. So all those things have lowered my saturated fat intake and then increasing my polyunsaturated fat intake I've done that by eating more salmon which has the fish oils in it, the omega-3s which are polyunsaturated and also I eat, I buy them at Costco I eat shelled hemp seeds. So they have like a single serving has I believe 10 grams or 12 grams of polyunsaturated fat. So my saturated fat came down but if you really wanna lower your LDL cholesterol that would help a lot but increasing the ratio will help even more. So if while you're lowering your saturated fat intake you're increasing your intake of polyunsaturated and monoinsaturated fats your cholesterol should drop real big 20, 30% or more. Why? Saturated fat decreases LDL receptor activity meaning that the LDL receptors you have less of them and they're not as active. So you have, that means the cholesterol swimming in your blood stays in your blood because it's not, the LDL receptors aren't taking it out of your bloodstream. So if it stays in your bloodstream that's why when they draw your blood at the doctor you have high LDL cholesterol. Monoinsaturated fats increase LDL receptor activity and polyunsaturated fats greatly increase LDL receptor activity. So if the receptors are more active they're sucking that cholesterol out of your blood. So imagine taking a vacuum and sucking cholesterol out of your blood then the next time your doctor draws blood there's less LDL cholesterol in it. So that's how you modify your high cholesterol. Next one, low blood HDL. So HDLs are good cholesterol. Now modifying it, I mean consuming good healthy fats can do it. Exercise appears to be one way to do it. Genetics plays a real big role here but I would say just yeah, lowering LDL, lowering triglycerides, eating healthy fats, exercising. Those are your best bets for raising your HDL cholesterol. There are drugs that have tried to do it. The niacin, there are like treatments like niacin which uses niacin do this but the problem is the research doesn't show any improvements in your health. So like the PowerPoint we'll say in a little bit having an appropriate HDL is good but just cranking it up doesn't appear to offer much value. So just being healthy and making those healthy choices I just mentioned are your best bet there. High blood pressure. We'll talk about a lot of these separate and future slides but high blood pressure or hypertension, real big picture. Lose weight, stop smoking, increase potassium intake in your diet while decreasing sodium intake. That's the dash diet which we'll cover. Diabetes, you've got to eat an appropriate amount of carbohydrates and appropriate amount of calories, increase physical activity. Those would all be a good ideas there. Obesity, a special abdominal obesity. This would be certainly diet, right? If you wanna lose body fat, you have to be in a calorie deficit no matter what magic diet you wanna try. They all lead to a calorie deficit but if you wanna especially get rid of abdominal obesity I would say the key things here would be exercise because exercise will decrease visceral fat in your abdomen even before you see weight loss. So exercise of whatever kinds most sustainable for you but I recommend a combination of cardio and strength training, et cetera. And then another big one here would be stress management and sleep. So if you're sleeping poorly and you're stressed out you're more likely to have more visceral fat. Physical inactivity, the solution there is to be physically active. Cigarette smoking, the solution there is to not smoke or at least smoke less but try not to. An atherogenic diet which is high in saturated fats and low in vegetables, fruits and whole grains. So we talked about the saturated fat part of it but a diet that's high in vegetables and fruits and whole grains is a diet high in fiber. And the reason fiber will lower your LDL cholesterol, where'd my little thing go, yeah. So if we're trying to lower LDL cholesterol we can do so by changing how our receptors work so we get rid of what's in our bloodstream but another really cool way to do it is to eat fiber. So I will, I got my generic metamucil right here which is soluble fiber, it says premium daily fiber but it's psyllium husk. The key is a diet that's high in soluble fiber because basically what happens, so your body uses cholesterol to make bile salts and bile is needed when you digest your food to emulsify fats. So anytime you eat a meal, bile gets squirt into your gut. That bile has made a cholesterol. If there's no fiber in your gut that bile will be reabsorbed. It's called enterohepatic circulation. If you have a bunch of fiber in your gut, especially soluble fiber, it will trap that bile and it'll carry it out of your body in your fecal material which means your liver will have to take, will have to dig into its cholesterol stores which is in itself and in your blood to make new bile. So imagine if every time you need bile you had to make new bile, your body has to use more cholesterol. If it's using LDL cholesterol it is not in your bloodstream anymore. Just like if you want your blood sugar to go down you use the blood sugar by exercising and your blood sugar comes down. So basically every meal that has fiber will be removing some cholesterol from your body. So you can get rid of it. So that's another prom to the attack on high LDL cholesterol. So nothing wrong with having some LDL cholesterol. We need it, but if it's high those would be the best ways. Like I mean just that list that I gave you in the last four or five minutes, how long that's been, that will, I mean that'll have a massive impact. You're 80% of the way there for most of these diseases if you're consistent with these changes. Age, gender and family history, non-modifiable. So significant factor at 45 for men, 55 for women. So that, you know, gender. Men have an earlier onset of risk factors whether it's the effects of testosterone whether it's how we deal with stress typically males versus females, whatever. Early coronary heart disease and immediate family members that would be a genetic or family risk. A greater risk the more family members are affected which just means that your genes are more prone to heart disease. A greater risk the earlier onset, age of onset. So if you've had several family members that have died of heart attacks in their 50s you are at genetically a higher risk and you have to be more careful with the modifiable factors. You can't modify this list. It just means you gotta take the modifiable list more seriously. All right, people with high genetic risk which you might find out not because of family history but because of genetic testing. Improve the odds by living healthy lifestyle. Genes load the gun, environment pulls the trigger. So if your gun is loaded, if you're playing Russian roulette and you've got four bullets in there in the six chambers, don't pull the trigger. If you only have, if you have zero bullets in there then you don't have to worry about the pulling the trigger as much or you don't have to worry at all. You know, so maybe that rushing might sound a great example but you get what I mean anyways. So the more risk factors you have the more you need to focus on improving your odds by living a healthy lifestyle. So I've said a lot of these things so we'll kind of fly through them but high LDL and low HDL cholesterol, the total blood cholesterol, strong correlation to atherosclerosis and then yeah, so especially the higher percentage of LDL just because the more LDLs you got swimming around the more likely one of them is to get trapped in your blood vessels and start this process that leads to plaque formation. LDL is the most atherogenic lipoprotein, plaque formation and stability, inflammatory process. We talked about all that already. Adequate levels of HDL are beneficial but high HDL may or may not provide that a benefit. I would say that if you have genetically high HDL or you have high HDL because of exercise it seems to be helping you. If you take a drug or something like Niacin which is high dose Niacin that cranks up your HDL levels it doesn't seem to help. We were really hoping there are drugs that can raise your HDL quite a bit and they were very hopeful that they would help people but they don't seem to help. I'm talking like at all. All right, high blood triglycerides. They promote atherosclerosis. So to me the best way to lower your high blood triglycerides is to not be consuming too many calories because this is how your body kind of, your body turns any extra calories into fat. You would think that a high fat diet causes high blood triglycerides but a high carb diet can do so as well. If you have too many calories your body has to turn all of them whether it's carbs, protein, fat or alcohol your body turns it into fat and your liver makes lipids. It's called de novo, lipogenesis or lipogenesis. So not consuming too many calories and not consuming excessive carbohydrates and what I mean by that is just more carbs than you need that for that for you that might be 100 grams or 400 grams. I can't answer that question for you but excessive carbohydrates definitely cause triglycerides to go up. I know that people I've been on ketogenic diets I've been on low carb diets. My triglyceride levels plummet when I go on low carb diets and most of the people that I've seen on low carb diets their blood triglycerides are really low. So lowering your carbon take but lowering your total caloric intake is a really good way to get rid of high blood triglycerides. Exercise to use up the fuel you have will help as well. High blood pressure or hypertension, chronic hypertension, slightly elevated levels increase risk of heart disease. So what that means is we talk about 120 over 80 your blood pressure of 120 over 80 being normal and 140 over 90 being hypertension, high blood pressure but anything between there I call it at least pre-hypertension. So having a blood pressure of 125 over 85 slightly increases your risk of heart disease. It just goes, you see an increased risk, increased risk, 140 over 90 the risk goes way up but there is increased risk anything. So I would say hypertension at some level is any blood pressure above 120 over 80. Don't wait until your blood pressure is 140 over 90 to do something about it and that's because the best way to treat hypertension is to never get it. It's five or six times harder to bring your blood pressure down to normal than it is to keep it normal. All right, so high blood pressure injures your artery walls and this injury is what predisposes this whole process of cholesterol, immune cell, foam cell, fatty streak plaque. So it accelerates plaque formation which then increases your blood pressure further. If you have high blood pressure but clean artery walls, that's one thing. High blood pressure with artery walls full of plaque is gonna be even worse. Diabetes increases the risk of death from coronary heart disease and that's because glycation, excessive blood glucose levels also damages the artery wall. So if you have high blood pressure damaging your artery walls, high blood sugar damaging artery walls, that's a recipe for disaster. And that's why diabetes destroys blood vessels and it destroys the small ones first which is why you see vision problems, kidney problems, et cetera. What can be done to reduce the risk of cardiovascular disease? We've talked about that a lot already. When should this process start before you think it needs to start? I'm one of those people too. I really started taking care of myself. What do they say? The best time to start is 20 years ago. The second best time is now. What are some of the risk factors included by the American Heart Association? So let's go ahead and look at them. The American Heart Association has identified risk factors including age, sex, race, total cholesterol, HDL cholesterol, blood pressure, blood pressure medication use, diabetes and smoking. You see, we talked about the age, thing and sex, thing, race. People do have different genetic susceptibilities. One example of that is that one of the biggest risk factors for cardiovascular disease is something called LP-little-A. And you don't have to know what that is for this class, but let's say that 18 to 20% of the population has high LP-little-A but people of different ethnicities have different rates of risk. So if you're from African descent, you have a much higher risk of having high LP-little-A than someone, let's say Southeast Asian descent, which would be why the risk of heart disease is different or at least one of the reasons why the risk of heart disease is different. So your race and your genetics, they play a role. We've talked about cholesterol and blood pressure already. Blood pressure medication use just means that, you know, again, have you really gotten rid of all the risk? If you were 140 over 90 and you're now 130 over 85, you're still not at completely regular risk level until you get down to 120 over 80. Then we talked about diabetes and then smoking is very atherogenic, really damaged your blood vessels. To reduce the risk of cardiovascular disease, people are encouraged to increase physical activity. So I recommend the 10,000 steps a day. Exercise is great, but if you're not gonna exercise, shooting for that 10,000 step a day goal is a really good place to start. Losing weight if necessary. Oh man, if you lose like 10% of your body weight, you're gonna see a huge decrease risk of hypertension, et cetera. Most of the, so maybe you have 50 pounds. Maybe you wanna lose 50 pounds. Most of the health benefits that come from fat loss come with the first 5% to 6% of your body weight lost. So if you're 200 pounds, what would that mean? That 10 pounds would be 5% of your body weight. So maybe you wanna lose 50 pounds, but losing 10 to 12 to 13 pounds is where most of the health benefits are gonna come from. So losing weight, but especially that early weight loss seems to have a huge impact. Implement dietary changes. We just mentioned a whole bunch of them. Reduce exposure to tobacco smoke either by quitting smoking or avoiding secondhand smoke. All good ideas. All right, hypertension mentioned several times now. How does hypertension develop? Underlying causes not fully understood. About 90% of people that have hypertension have what's called primary hypertension where not exactly sure why they have high blood pressure. Now they probably have several of these risk factors we've been talking about, but like why does one person get high blood pressure and the next one doesn't? I'm not really sure. So the key is just knowing that you have it because if I can't, I can't even look at two people and guess who would have it and who wouldn't, that because it's so misunderstood, then getting your blood pressure checked, checking it on a regular basis is your best defense because if you see your blood pressure creeping up, now's the time to deal with it. Cause like I mentioned before, way easier to prevent hypertension than to treat it. Physiological factors affecting blood pressure. Your cardiac output, which is how much blood you move per minute. So contractions in the heart muscle and pumping blood. So if you have a nice, you know, strong heart, usually you have a lower heart rate because every, your stroke volume goes up, how much blood you move per beat. So your heart has, can get away with beating more slowly. But the big one to me is peripheral resistance. Like if somebody, if you have hypertension or high blood pressure, I was like, is your heart the problem? No, your heart's doing exactly what it needs to do. Your heart is going to pump, how hard is your heart going to pump? Your heart's going to pump hard enough to overcome peripheral resistance. So hypertension is caused by excessive peripheral resistance. So what causes that? Vessel length, it's like being taller, having more blood vessels because you're overweight or obese. So weight, you know, plays a big role. Atherosclerosis, which narrows your blood vessel walls. Friction because your blood is too thick, maybe because you're dehydrated or you have high homocysteine levels. All these things can impact peripheral resistance. And also the one here, diameters of your arteries or your arterioles. So stress, stimulants, drugs, things that cause vasoconstriction would make blood pressure worse. So it's a combination of all those things. So your heart isn't the problem if you have high blood pressure. Your heart is pumping as hard as it needs to to overcome the peripheral resistance. So total peripheral resistance is actually where hypertension develops. But it can also, it can be your nervous system. If you're very hard, if you're, it's type A personality, real high strung. Your nervous system could be in that fight or flight mode too much. That can certainly raise your blood pressure. Hormones, so whether it's, you know, cortisol, stress hormones like that. So again, stress can impact blood pressure. And then kidneys, if you're, if you're holding onto too much body fluid, then your blood volume would go up and now you have to pump more blood. So as the blood volume goes up, the blood pressure would also go up. Risk factors. Aging, genetics, obesity, salt sensitivity, and alcohol. So we can't control the first two, but obesity, so that's why losing weight is a great way to drop your blood pressure. Salt sensitivity, let's say 30% of Americans are salt sensitive. What that means is if you eat a high sodium diet, it will cause high blood pressure in you. People that aren't salt sensitive, when you consume excess salt, you just flush it out. A good test for this would be if you eat a salty meal, does your ring still fit? Do your ankles swell? Does your face get puffy? If those things happen, then you are definitely salt sensitive. If you, if no matter how much salt you eat, your blood pressure doesn't go up, then you are not salt sensitive. So salt, low-salt diets or salt restrictions generally are going to help more if someone is salt sensitive. And then alcohol, for multiple mechanisms, alcohol impacts blood pressure greatly. So cut back on salt, lose some fat, quit drinking alcohol, all good ideas. So treatments, weight control. You know, losing, again, lose 10% of your body weight and watch your blood pressure start to drop. Salt, sodium intake, which is half of the equation, which is why I usually talk about the dash diet. Dash diet is the dietary approaches to stop hypertension. It is not a low sodium diet. It is a low sodium, high potassium diet. Remember from earlier discussions, salt is what pulls water out of your cells. What pulls water into your cells is potassium and magnesium. So you want to be on a lower sodium diet, but not just that, but a low sodium, high potassium, high magnesium diet that will take all this excess fluid in your bloodstream, pull it into your cells where it should be and your blood pressure will drop. So the dash diet absolutely works, but it's not a low salt diet. It is a low sodium, high potassium, high magnesium diet. All right, physical activity, great for your blood pressure. Make sure you get your doctor's permission for how, you know, and determine how vigorous your exercise should be. You know, I'd start with walks and slowly work your way up from there. That's what I've done, you know? And then medications if needed. Usually they are ACE inhibitors or angiotensin converting enzyme inhibitors mixed with mild diuretics to get rid of excess fluid. Is hypertension controllable? What can you do to best manage hypertension? The single most effective step people can take against hypertension is to find out whether they have it, like I mentioned before. Treat it before it becomes a huge problem. Efforts to control blood pressure focus on weight control, the dash eating pattern which focuses on fruits, vegetables, low fat milk products, whole grains, and nuts can also help to lower blood pressure. And we're talking the dash diet or dash two diet can lower your blood pressure like 14 or 15 points. It's a big deal. So this, but look at this diet. This is a lower salt diet, but there's lots of potassium and magnesium in those fruits and vegetables and grains and nuts that you're eating. So think that we just remember the dash diet, low sodium, high potassium, high magnesium diet. Diabetes malitis, which means, diabetes means to pass through. So a passing through of sweet urine, sweet like honey basically. And that's that, that's what, you know, cause diabetes malitis used to be diagnosed by tasting patients' urine. Their urine would be sweet because of all the glucose in their urine. So that's what it means. Diabetes malitis, a passing through of sweet tasting urine or a sweet urine. There's other kinds of diabetes, like there's a diabetes encipitus, which is a passing, it doesn't matter, but it's your body doesn't have enough of the hormones that hold in excess fluid or hold in fluid. So you produce too much urine. It's called diabetes encipitus, has to do with antidiuretic hormone. But again, door diabetes just means passing through. So it's a different kind of diabetes altogether. All right, but the two we care about are type one and type two. We have also mentioned gestational diabetes that is a temporary transient type of diabetes that develops during pregnancy. All right, but how does diabetes develop? Incidence has risen dramatically. Why? People are eating too much and moving too little. It's that simple. It's not a genetic thing. It's just that, yeah, we're carrying around too much fat, we're too inflamed, we're eating too much and moving too little. All right, so the prediabetes means elevated blood glucose. So if your fasting blood sugar is below 100, then you don't have diabetes. It was between 100 and 125, you have prediabetes. If it's above 125, you have diabetes. So now 100 million Americans are either diabetic or prediabetic. Huge, huge number, right? Terrifying, if all of those people become diabetic, it will, I mean, I don't even know, it'll cripple our economy because of the impact on our healthcare system. Uncontrolled diabetes is an extremely expensive thing to deal with. All right, diabetes is the seventh among leading causes of death, but that will climb if these 100 million people continue to have diabetes or progress to it. Contributes to several other major diseases, cardiovascular disease, the leading cause of diabetes related death. Just remember that high blood sugar is really bad on your blood vessels. So it damages your arteries and your coronary arteries leading to heart attacks and strokes and those kind of things. Also damages the blood vessels to the eyes and the kidneys, I've mentioned before. So diabetes basically just accelerates the aging process if you look at it that way. Typical diabetic uncontrolled diabetes will probably cost about eight years off of your life if you don't control it. Diagnosis with fasting plasma glucose, I just told you those numbers there. The types of diabetes are type one and type two, so there I have them here I believe somewhere. But yeah, let's answer these questions and then I'll make sure you know the difference between type one and type two diabetes. So fasting plasma glucose or non-fasting hemoglobin A1C test is a diabetes diagnosis. Hemoglobin A1C is a very neat test. It's better than a fasting test because it's basically a measure of your blood sugar over the last couple of months, weeks to months. And what it does is, so the hemoglobin A1C test measures how much glycation damage or how much damage glucose has done to your hemoglobin in your red blood cells. So I think about my grandfather was a bomber pilot so they would get hit with flak and bullets and stuff while they were flying their bombing rounds and then come back. So imagine like a person back at the base when they flew back, they could look at how much damage the airplane had been through and estimate how much damage, how bad was it, how bad was this mission? Well, that's kind of what we do here. By looking at how much damage the hemoglobin has taken, you can estimate the blood glucose over time. So the fasting plasma glucose is a great screening tool but the hemoglobin A1C test is the gold standard for diagnosing and managing or monitoring diabetes. The pancreas loses the ability to produce insulin. That's type one diabetes. So type one diabetes is an autoimmune disease. It's way less common, right? Nine out of 10 people at least that have diabetes right now in the United States have type two characterized by high blood glucose concentrations or hyperglycemia. That would be diabetes mellitus. That's both, doesn't matter the cause. Insulin resistance, eventually insulin production decreases. That's type two. So type one diabetes. Oh, you see the next one less common. Autoimmune disease is type one. So, well, let me read them all and then I'll clear it up. People may have insufficient insulin, ineffective insulin or both. That's diabetes mellitus. So either not enough or ineffective insulin. The most common form hyperinsulinemia as the pancreas tries to compensate equals type two diabetes. So there's a little bit of confusion there. So diabetes mellitus is hyperglycemia. Whether it's caused by type one or type two doesn't matter. So you're going to have high blood sugar. The question is why? Type one diabetes is less common of the two by far. It's an autoimmune condition where your immune system destroys the beta cells of the pancreas and those are the cells that make insulin. So a type one diabetic isn't making enough insulin, which is why the treatment is to inject yourself with insulin using needles or pumps or whatever. Type two diabetes totally different. It's insulin resistance. The pancreas is making insulin, plenty of insulin. I've seen patients that have insulin levels like five, eight, 10 times normal. So the pancreas can make more than enough insulin. But the problem, so the problem isn't the pancreas, the problem is your cells. Your cells are insulin resistant. They've quit listening to the message of insulin. So it's like if you have kids, you whisper and that used to work and now your kids don't listen. So you got to speak up and you got to speak up and you got to yell and you got to scream. That's the pancreas. The pancreas is making more and more and more insulin. But at some point the pancreas will wear out. So at some point, so a type two diabetic, you would never want to give them insulin early because they already have too much of it. You need to make their body more sensitive to insulin or lower their blood glucose other ways. So a type one diabetic you treat them with insulin. A type two diabetic, you use oral pills or whatever, like metformin, things that lower blood glucose or in diet and exercise. So you want to lower the blood glucose so that the insulin signal can drop down to normal and then resensitize. If that doesn't work and you don't control your type two diabetes, you can reach a point where it says there eventually insulin production decreases. So at some point, a type two diabetic will have to be on insulin but that's much further in the progression of the disease. So if you gave a type one diabetic, well, you give a type one diabetic insulin. If you give a type two diabetic insulin, you're probably going to make it worse and that's why when they first discovered diabetes, then they first discovered insulin. Insulin was a life saving drug for the type one diabetics. It was killing people that had type two diabetes though and they didn't know that there was a type two diabetes at the time. All right, so what are the complications of diabetes? Chronic complications, the conversion of glucose to sugar alcohols, changes in protein, which is why you see damage on hemoglobin and with the A1C test, loss of circulation and nerve function. So you have diabetic neuropathy, so nerve damage along with atherosclerosis, infections because of impaired immunity, and excess glucose is bad for your immune system, good for pathogens. Diseases of large blood vessels, small blood vessels and nerves. So you might see someone, numbness and tingling that leads to maybe losing a limb, wounds that won't heal, definitely damage in the eyes, damage in the kidneys, real common. All right, the metabolic consequences of untreated diabetes. So you see they both lead to hyperglycemia, but with the type one diabetic, there's no insulin message, so glucose doesn't enter the cells. That's why it stays in the bloodstream. With the type two diabetic, some glucose enters the cells, but the cells aren't listening to the insulin message, so most of it stays in the bloodstream. So they both lead to hyperglycemia, which causes there to be glucose moves into the urine, which is why there's glucose in the urine. Your blood sugar has to be above 180 for there to be glucose in your urine for a typical person, but that's why a urine test can catch high blood sugar. Water moves into the bloods, there's an osmotic effect that's gonna lead to frequent urination, which is called polyuria and fluid losses. This is kind of interesting. So normally, people that drink too much fluid pee a lot, but in this situation, you pee a lot because the glucose that's in your urine is pulling water with it, so you're thirsty. So normally, you're thirsty, you drink a lot, causes you to pee a lot. A diabetic will pee a lot, which makes them thirsty and makes them drink a lot. Can definitely lead to dehydration, and then we had talked about the thirst. And then hyper, osmolar hyperglycemia, a state or a coma, which is what leads to diabetic coma and can be fatal. That's where, again, all this fluid is just, you're just sucking fluid into the wrong places and into the blood instead of into the cells, and that can be very, very serious, cause very serious problems. All right, but you see a type two diabetic, they're hungry, they'll eat a lot, and they'll gain weight, because they're, well, let's cover it more with the type one, but basically a diabetic is starving because the fuel they're eating is in their bloodstream, it's not in their cells where it's actually needed. So type one diabetic, no glucose entering the cells, which is why on the right hand side there, they're hungry, so that leads to excessive eating or polyphagia, and then we are, I didn't mention before, polyuria is excess urination, and polydipsia is excess of thirst, covered those. So since there's no glucose entering the cells, cells break down protein and fat, which leads to the breakdown of fat, leads to ketone production, which is why a diabetic will have ketones, and also lead to weight loss, cause they're burning fat and protein for fuel, again, making them hungry. So a type one diabetic is normally diagnosed with unexplained weight loss, they lose 10, 20, 30 pounds, and it's like, I'm not trying to lose weight, what's going on? You go to the doctor, maybe they do a urinalysis, whoa, you got glucose in your urine, you're losing all this weight, so you're starving, you're eating, but you're starving, right? Normally when someone is starving, what would happen if someone was starving? They'd be hungry, they'd lose weight, they'd make ketones, and they'd break down protein for fuel. So these people are starving, and the only difference is they're eating, it's just that they have a bunch of fuel, but it's trapped in their bloodstream instead, of in their cells, where it can actually be used to make energy. So the ketone production, ketosis can be fine, but ketone levels 10 times higher than that, lead to what's called diabetic ketoacidosis, which you see ketones in the breath, because an acetone breath that smells like, to me it smells like juicy fruit gum, some people say like nail polish remover. Ketones in the blood, which would be ketoneemia, and ketones in the urine would be ketoneuria, which is why diabetics use the pee on those blood ketone, or those urine ketone strips as a way to test them. There's also blood ketone meters now. And diabetic ketoacidosis can lead to diabetic coma, which can be fatal. This is caused by the ketones, ketoacidosis causing the pH to drop too low, your body becomes too acidic, and then also it causes these fluid shifts, like you see over here, that lead to serious dehydration, and can be fatal. I've had a family member die of that. All right, recommendations for diabetes. Carbohydrate intake, diet should deliver similar amounts of carbs each day. Again, that's if you're like monitoring insulin levels and those kind of things. Evenly spaced, that should, again, a type one diabetic and type two diabetics things should be different. I would say to eat the appropriate amount of carbs, like I don't believe in the recommendations that say you shouldn't decrease your carbon intake, not saying to go on a ketogenic diet or Atkins diet, nothing like that, but make sure you're eating an appropriate amount of carbs based on your activity levels. I've seen people that have been able to get off of diabetic medications by eating a more appropriate carbon intake. Maybe we're talking about going from 400 grams a day to 200 grams a day, which neither of those classify as a low carb diet. You just got to figure out the right way to fuel your body and to not be eating too much fuel. So you don't want too many calories or too many carbs. Your carb sources, high fiber foods are going to be better because they will lower the glycemic index. Remember the glycemic index is the blood sugar and then corresponding insulin response to a food. If a food has a high glycemic index, after you eat it, blood sugar climbs real high and then drops. If it has a low glycemic index, blood sugar climbs more slowly and then drops more slowly. So you want nice stable changes in blood sugar if you have diabetes, whether it's type one or type two. So yeah, high fiber foods, eating your carbs with proteins and fats, all those kind of things make a lot of sense. Eating lower glycemic index carbs or what's called lower glycemic load carbs, those are all great ideas. Recommendations for type one and type two diabetes. So type one, adjust, remember they're the ones that need insulin. It's called insulin dependent. Adjust insulin doses to accommodate meals, physical activity and health status. So just got to work with your doctor on those kind of things. But yeah, so how much insulin you're going to need depends on how much glucose you're burning and how many carbs are in the meal, et cetera. Type two diabetes, this is the solution. Moderate weight loss, eating the appropriate number of carbs, high quality carbs and physical activity. A type two diet we've known for several years now that a type two diabetic can be quote unquote cured. I never use that term. But if you catch your type two diabetes early, you can absolutely create a diet and lifestyle that puts you in remission. I like that word better because when you're in remission, it means that it can come back and your type two diabetes could certainly come back. But if you don't change your diet and lifestyle factors, it won't come back. So think about it that way. All right, cancer. How does cancer develop? We can't go into great detail here, but cancer is a second leading cause of death in the United States behind cardiovascular disease. Its development is what carcinogenesis, so basically mutations in what are called oncogenes, genes that control cell division. So the simplest way to look at it is like this. There's a mutation, you've got your car. There's a mutation that causes the accelerator to stick so you hammer the gas in your car and you can't take your foot off the gas. That's part of the equation. The other part of the equation is there's a mutation that cuts your brake lines. So you have excessive cell growth, but your body normally would stop that from happening, but the brakes get cut too. So you take your car, your accelerator gets stuck, your gas pedal gets stuck, your brake line gets cut, that you have this uncontrolled car. That's uncontrolled cell growth that is cancer. So a tumor would be where this cancer would develop and then it metastasizes when it spreads other parts of your body, usually using your blood or your lymphatic system. Caused by interaction between the genes and the environment. Absolutely. Where is a bad luck with mutations is one of the leading causes of cancer. But if you do things that accelerate the number of mutations in your body, then you're more likely to get cancer, like smoking and those kind of things. So here we see normal cells, just had a random mutation occur in this DNA. Let's say that means the accelerator was stuck. Then you see the promoters, they cut the brake lines and I have this unregulated uncontrolled cell growth and now we have a tumor. That tumor spreads in this picture to the bloodstream and that's metastasis. So you can read the rest of that there. Environmental factors, known environmental causes of cancer, radiation in the sun, so like radon exposure in your basement, radiation from excessive sun exposure, water and air pollution and smoking, those are all known causes of cancer. I mean, honestly, but the World Health Organization classifies sleep deprivation or shift work as a probable carcinogen. So stressors like that as well. Obesity and physical inactivity are risk factors. So carrying excess body weight, not moving enough. Hormones like estrogen, which is why you see the after menopause, you see breast cancer risk changes. Fat excess body fat actually increases estrogen in males and females. That's why that's one of the reasons that obesity is linked to cancer risk. Dietary factors or cancer initiators. Diet is linked to one third of all cancer cases. Head and neck cancers are strongly correlated with the use of alcohol, tobacco, like chewing tobacco, I mean all kinds of tobacco, but chewing tobacco is a real good example. And low intake of fruits and vegetables. Cooking, cooking can increase cancer risk. So high heat introduces carcinogens. A few examples here. Oh, let's see. So like when the, when you like grill, when they say when you grill, like see your grilling causes fat to splash up and introduce carcinogens. Those are called poly aromatic hydrocarbons. And then when you cook things at high heat, that creates what are called heterocyclic amines. I'm not asking you to know those, but let's say you grill a steak. So the grill marks on the steak, just like if you burn toast, the same thing would happen, but the grill marks on a steak are probably had these heterocyclic amines in them. And then the dripping of the fat into the heating elements create these poly aromatic hydrocarbons that also will get into the food. Now if you want to decrease your risk of these kinds of things, this is where marinades play a big role. So if you're going to eat like grilled meat, for example, then maybe have some tea with it or marinate the meat in a bunch of herbs and spices that have antioxidants in it or eat a big salad with it. These are all things that can protect you. So cooking at lower heat too. My wife thinks it's funny, but I used to always bake all my meat. I used to bake my steaks. We don't anymore just because grilling food tastes better, but I would bake my steaks at low heat for long periods of time because the lower the heat, the less carcinogens. Process meats are a cause of colon cancer. So if the curing process like in deli meats and sausages and those kinds of things produces what are called reactive nitrogen species that can harm your gut. Fried foods, including french fries and potato chips contain acrylamide, which is a potential carcinogen. So generally those are some examples of things that can initiate your cancer. Now, how much all up for debate still? If you have four pieces of bacon every day, does your risk of colon cancer go from four in a thousand to five in a thousand? Probably, but that's a lot of bacon over a long period of time and not a huge increase in risk. I don't know. It's up to you I guess to decide those things. Reflections, so pause and answer these questions. Defend against cancer, those are anti-promoters. Accelerate cancer development, those are promoters. And animal fats and colon cancer is an example of promoter. The ratio of dietary omega-3 and omega-6 fatty acids, total fat intake, genetics, gender and body fatness may influence the relationship between omega-3 fatty acids and cancer. So I agree with all that. I believe that we too many omega-6 fats and too few omega-3 fats. So find a way to get some more omega-3 fats in your diet. I do it with salmon and sardines and I'm shelled hemp seeds, like I mentioned earlier. And then find ways to cut out some of the omega-6 fats in your diet. Eat out less often, less processed and packaged foods. That's your best answer there. Recommendations for reducing cancer risks. Eating fruits and vegetables. They have nutrients, fiber, phytochemicals and powerful antioxidant activities. So diets high in fruits and vegetables are linked to reduced cancer risk. Same thing with nuts and seeds. Physical activity maintains body weight and reduced risk of some cancer. So we've said all that. All right, recommendations for chronic diseases. We're nearing the end here. Chronic diseases and healthy eating. I mean just the advice I've given you today is like the big stuff. The big rocks you'd move first that will give you 80, 90% of the benefit of really taking care of yourself. Not a guarantee, just decreasing the probability that you end up with these diseases. And each of these diseases increases your risk for other diseases, right? So not getting diabetes will decrease your heart disease risk. Not having high blood pressure will reduce your diabetes and heart disease risk, et cetera, et cetera. A more anti-inflammatory diet will reduce your risk of all of them. All right, dietary recommendations support each other. So for weight control, I just mentioned all that. Healthy eating, I'll show you that, the healthy eating plate based on the reviews of links between diet and health. And then individual's recommendations based on family history. To me, that's like, what's your biggest concern? Based on your family history. Are you more likely, does it appear like you're more likely to get cancer or heart disease? Well, there we can do some different, focus on different things there. But the good news is being healthy decreases your risk of both of them, right? But maybe you will want to worry a little more about this or a little less about this based on your family history or your genetics, right? We always say family history but now people are getting their genetic tests done that might even tell you what you're at more risk for. So here you see a healthy eating plate. Use healthy oils such as olive and canola oil. I'm a much bigger fan of olive oil and canola oil. Canola oil is very highly processed but I like olive oil for cooking on salads and at the table, limit butter and avoid trans fats. So keep your saturated fat intake below 10% of your calories but some is fine. Olive oil is great, macadamia nut oil is great, avocado oil is great, those are the ones I like. Eat plenty of fruits of all colors so fruits and vegetables. The more veggies and the greater the variety the better. Potatoes and french fries don't count, that's a good addition. I always say that, you know, I'm a big fan of eating animal products but I think that the 60% of the volume of food you eat should be vegetables, that's my stance. A water, drink water, tea or coffee with little or no sugar. Limit milk or dairy to one or two servings per day because of saturated fat and calories and juice to one small glass a day and avoid sugary drinks, all good advice. Eat a variety of whole grains such as brown rice, whole wheat bread and whole grain pasta. Remember half of the grains you consume should be whole grains according to the government. Limit refined grains such as white rice and white bread. And then healthy protein. Choose fish, poultry, beans and nuts. Limit red meats and cheeses. Avoid bacon, cold cuts and other processed meats. So they can be had certainly occasionally. And again, red meat to me, there's some really good healthy red meats out there too. I recommend eating organ meats, all that. But those overall really good recommendations. Discussion question number three. Review the healthy eating plate. Is there an area you need to increase your intake in? What do you do well as it relates to the healthy eating plate? What is one simple change you can work on right now to improve your nutritional efforts? So going back there, just think about that, you know? I mean, I've really, I've cut out a lot of butter. I, like I said with eggs, I do more mixture now of egg yolk and egg whites. That's been good. I have increased my whole grain intake. I'm just kind of looking at it personally. Fruit, I do a fruit smoothie every morning to make sure, because I don't eat a lot of fruit. We grow some, we have some strawberries and different things and I eat a little bit of fruit but I don't eat a lot of fruit. So I added a big serving of fruit to my smoothie in the morning and I've really been trying to crank out the vegetables. So fish, I do some salmon. Occasionally I do, I eat a lot of poultry now. So don't eat beans. Beans don't agree with me at all. But yeah, I would like to say that I'm doing pretty good here. A couple of years ago, I wouldn't be able to say that. Okay, the healthy eating plate provides a guideline for students and the discussion will help you, have a variety of areas of improvement. And again, you have to do that. So also note the stay active symbol. I mentioned shooting for that 10,000 steps a day and then meeting all the guidelines for exercise. We did it. Great chapter, right? We put everything together. This is how to not die or at least die of nothing, right? To die of old age. Identify the factors that protect people from the spread of infectious diseases and describe the role of nutrition and immunity. Did a good job of that. Next chapter we'll cover foodborne illness specifically. List the leading nutrition related causes of death in the United States. We did that. Describe how atherosclerosis develops and strategies to lower blood cholesterol levels. Check. Describe strategies to lower blood pressure. Check. Compare the dietary strategies to managing type one diabetes with those to prevent and treat type two diabetes. The similarities are you don't want high blood glucose. The differences would be the importance of your diet because with type one diabetic, it's more about managing insulin. A type two diabetic, it is more about managing insulin sensitivity and blood glucose. Differentiate among cancer initiators, promoters and anti-promoters and describe how nutrients or food play a role in each category. So we did it. Take some of the advice from this class, right? I want everyone of you to leave this class healthier forever. What are the two or three things I mentioned today that you're sure you can do for the rest of your life? Do those and you will be healthier. It's an investment in your health, right? So I really hope you do. All right, reach out if I can be of assistance. Have a wonderful day. You blessed.