AMEN 2015: CrossTraining

Breakout Sessions A

Tim Arakawa

Adventist Medical Evangelism Network (AMEN)

Lifestyle Intervention and Its Impact on Diabetes Treatment & Outcomes

All right, we gave you just a little time to finish lunch and then come in so I think it worked out okay but we do have a lot to cover so Just by way of an introduction though, we're going to be talking a little bit about diabetes Lifestyle intervention how many of you?

Well, you watched the beginning part, or I don't know, maybe it was partly in the middle.

I found it interesting that it was the non-physicians that actually brought up the fact that if we really want to address the health care crisis in this country, we need to address the health crisis that we're facing.

We're going to be talking about that today.

But I missed a little bit of an introduction here, so I haven't been here for a couple years to amen, so some of you may not know me as well.

I'm currently an endocrinologist working on the island of Guam There's an STA mission clinic there and I practice there.

I would say 70 80% of my practice is diabetes type 2 There's very little type 1 actually in Guam Because that's a lot of it is in a Caucasian demographic.

But we also have a wellness center there.

We have lifestyle classes and the whole bit there.

You may have seen my wife and kids running around here.

He was 3 years old at the time of this picture.

You can stop them if you see them in the hall and say hi.

Before we go into learning objectives, let's bow our heads for a word of prayer.

Dear Father in heaven, we thank you for the privilege we have of knowing so much about healthy living, and we pray that as we now go over the evidence in the medical literature and as we apply it to our situation as Adventists, May you give us a special portion of your spirit to both understand and to learn how we can be a part of spreading this important message.

Alright, so today we're going to have 3 main objectives.

The first 1 is to look at some of the recent medical literature that really has proven that diabetes can be prevented and treated and that can be done through lifestyle intervention.

And then the second part of it is going to be looking at how lifestyle intervention works or potentially how it could work and how it affects the progression of diabetes.

And then the final part, we're going to touch briefly on some things perhaps that we can do to help people sustain their healthy lifestyle choices, and that is a big dilemma nowadays.

So before we begin that, you probably are aware of the current diabetes epidemic.

But just to review and to reinforce in our minds where we're at now, the most current statistics as of 2015 show that over 50% of the American public either has prediabetes or diabetes.

That's 12% to 14% with diabetes and about 40% with prediabetes.

So you walk out on the street, 1 out of 2 people has pre-diabetes or diabetes, and I include pre-diabetes because that's almost as important as diabetes, especially when we talk about lifestyle intervention.

115 million people in the United States with diabetes and 387 million currently worldwide.

And just to underscore how quickly this is growing, realize that in 1985 there were only 30 million diagnosed cases of diabetes at that time.

Since then, of course, we know we're in the 300s, 300 millions currently.

And it's projected that by 2030, we'll have about 552 million people diagnosed with diabetes.

The latest number that I've seen is a projection for 2035, and they're estimating almost 600 million people with diabetes.

That's a tremendous amount of morbidity and mortality, as well as health care costs.

However, a lot of the medical societies now are recommending lifestyle intervention for prediabetes and diabetes.

And in fact, just 3 days ago, the United States Preventive Services Task Force recommended diabetes screening for certain groups of people.

And you can see here, this just came out a few days ago, that it says that they recommend screening for abnormal blood glucose as part of a cardiovascular risk assessment in adults between 40 to 70 years who are overweight or obese.

As an endocrinologist and as a diabetologist, I would say we probably aren't going far enough with this.

You're missing a lot of potential diabetes cases by not going lower than 40, by not paying attention to high-risk populations and women with gestational diabetes and all these type of other categories.

It says, clinicians should offer or refer patients with abnormal blood glucose to intensive behavioral counseling interventions to promote a healthful diet and physical activity.

So this is the most recent recommendations out there.

And if you look at the other medical societies, you'll see a similar recommendation.

So here's the American Diabetes Association, 1 of the preeminent medical societies for diabetes.

And in their guidelines, this is what they say.

Patients with impaired glucose tolerance, impaired fasting glucose, or an A1c between 5.7 and 6.4, All of those groups would be considered pre-diabetes, correct?

Should be referred to an intensive diet and physical activity behavioral counseling program targeting loss of 7% of body weight and increasing moderate intensity physical activity, brisk walking, to at least 150 minutes per week.

So that is the current guidelines from the American Diabetes Association.

And then, of course, there's the American Association of Clinical Endocrinologists, which is the society that I belong to, and they also have the recommendations for prediabetes and diabetes.

This is the algorithm for prediabetes, and you can see here that lifestyle modification is the first line treatment.

And if you look at the algorithm for diabetes treatment, again, we all know this.

Lifestyle modification is the first thing that we should recommend to our patients.

There were 3 landmark clinical trials that were done around the turn of the millennium that really proved eloquently and convincingly that lifestyle intervention is very important in the progression of diabetes.

And we're going to go through each 1 of those now.

It was called the Daqing IGT and Diabetes Study.

The second 1 was published about 4 years later in 2001, and it was called the Finnish Diabetes Prevention Study.

And the last 1 that we're going to talk about was published just a year later in 2002, called the Diabetes Prevention Program.

It's maybe the most famous 1, and it was done in the United States.

This study looked at 110, 660 adults from 33 clinics in Dacheng, China.

This is back in 1986, probably before China was as westernized as it is now.

But they were looking for individuals with IGT, or impaired glucose tolerance, or diabetes type 2.

And of those 110, 000 people, they were only able to find 577 people with prediabetes.

That's pretty amazing actually, isn't it?

If you were to do that same screening process in the United States right now, okay, with the known rates of prediabetes, you'd probably find about 44, 000 people with prediabetes.

That just gives you a little idea of where China was and maybe that demographic at that time in 1986.

That was prior to the boom in diabetes, at least on the early stages of it, especially in China.

Anyway, they randomized these 577 people to either control or 3 different intervention arms.

1 was a diet only arm, 1 was an exercise only, and then 1 was combined together.

And I'll show you what they did for each of those in a moment.

They followed these individuals at two-year intervals for 6 years, and they were trying to identify those who developed diabetes.

Here's what the different interventions were.

Of course, control was just general advice, brochures, things of that nature that you would normally give in a primary care setting.

They had dieticians that helped advise patients on a diet that was supposed to consist of 55-65% carbs, 10-15% protein, and 25-30% fat.

And if you kind of know these proportions, it wasn't that aggressive, okay?

You know, the fat levels are pretty high, and there's a lot of things that we could do probably to make this stricter But that's what they chose to use for their study.

They were encouraged to eat more vegetables drink less alcohol and Less simple sugars There was a calorie restriction for those who were overweight or obese and that was to encourage them to lose weight.

And then in terms of the actual counseling, there was individual counseling with physicians as well as small group sessions that continued throughout the active intervention.

With the exercise only arm, it's a little bit more complicated, but they basically were asked to increase their exercise level from whatever they were at baseline up by 1 or 2 levels or so.

And so it wasn't specifically, there wasn't a goal for a certain amount of minutes or a certain level of intensity.

The results of this study did show a decreased incidence of diabetes in the intervention arms, whether it was diet, exercise, or the combined diet and exercise, you can see that the cumulative incidence of diabetes dropped from about 68% down to the 40s.

And that correlated to a risk reduction, especially for the combined arm, of about 42%.

Breakout Sessions B

Dona Cooper-Dockery

Reversing Diabetes & Other Chronic Diseases

I am from Texas, do you know where Texas is?

I have been practicing internal medicine for the last maybe 24 years and This is my third year here at Amen, but every year that I've been here, I have taken something back to my practice.

And I was asked to talk to you a little bit about what I do to help my patient reverse their diseases.

So most of the talk will be focused on what I'm actually doing, not on the pathophysiology of diabetes or hypertension, I'll go over some some of that.

I love medicine obviously, however I spent many years trying to manage symptoms and manage diseases without placing emphasis on how to get the root causes of these diseases.

In order for us to significantly impact life we must get to the root causes and it is quite difficult and we can only do that when we go to the cross.

So at this time before I continue, why don't we go to the cross and ask the Lord to lead us in this discussion.

Heavenly Father we thank you so much for this opportunity in which we can come to learn how to lead our patient to the cross and help them attain abundant life.

As we discuss a little bit about chronic diseases, I pray Lord that you will be in our midst and help us Lord to go home and learn and do and change the lives of our patient.

Now you know a little bit about me, let me see if I could know a little bit about you.

Let me say all the doctors in the audience.

So my emphasis really is to help you become medical missionaries.

Diabetes is a disease in which we can help patients to reverse.

You know, God wants us to have abundant life.

Why don't we read 3 John 1, 2, we all know it.

Beloved, I wish above all that you prosper and be in good health, even as your soul prospereth.

That is what God wants for us and that is what we should also want for our patients.

Diabetes is a significant problem here in this country.

It is believed that about 30 million people in this country are diagnosed with diabetes, but another 86 million might be pre-diabetic or undiagnosed.

That is a significant portion of our population.

We are 300 million in this country so about 10% or so have diabetes or are pre-diabetic.

It is believed that there are certain areas in this country in which the incidence of diabetes is higher than the national average.

Those areas are called diabetes belt and in those areas we also have a high incidence of obesity and sedentary lifestyle.

As a matter of fact in South Texas where I'm from 39% of the population is overweight.

39% and therefore we have a very high incidence of diabetes.

Maybe 1 in every 3 patients, 1 in every 3 persons really have diabetes there in South Texas.

What are we doing to help these patients with diabetes.

It is believed that worldwide there are about 300 million diabetics and the incidence is rising.

If this trend continues then we're going to have 1 in 3 people with diabetes by 2020 and maybe more in this country.

So it is very important that we teach the patient how to prevent, improve, or reverse diabetes and other chronic diseases.

It is very alarming that we are now seeing type 2 diabetes in children.

A couple months ago I had a young child age 12 in my office with diabetes.

Now I'm an internist but because I emphasize lifestyle medicine I sometimes see children.

Age 12, last week I had 1 age 17 with diabetes.

Of course I did not prescribe another pill because that will not solve the problem.

We are 70 Advantage Physicians and we do have the health message But what are we actually doing with the message that we have?

If this trend continues, then the lifespan of our children will be much less than us, the parents.

So it is urgent that we do something about diabetes.

Let us look at some of the complications of diabetes.

Now we all know that 1 of the main causes of chronic renal failure is diabetes.

44% of all new cases of renal failure per year is attributed to diabetes and we have almost 50, 000 Americans each year on dialysis as a result of diabetes.

It is believed that diabetes kills more people per year than breast cancer and AIDS combined.

It is also believed that a diabetic has a shorter lifespan that someone same age without diabetes.

Diabetes and heart disease, We know the correlation there and therefore as primary care physician, if a patient has diabetes, how do we treat the patient?

We treat the patient as if that patient also had heart disease.

We start the statin, we start the aspirin, and we treat the patient as if the patient has heart disease, because of the significant risk factor for heart disease.

So if we treat Diabetes, we tend to reverse diabetes, we're also treating or reversing or preventing other chronic diseases.

Over 230, 000 deaths per year is attributed to diabetes in this country.

So diabetes is a disease that we need to stop.

Let's look at the effects that diabetes has on our economy.

It is believed that 322000000000 dollars spend yearly on diabetes in direct cost as well as indirect costs.

It is also believed that someone who has diabetes, it costs the government 2.3 times to care for this patient than other patients without diabetes.

1 in every 5 of our healthcare dollars is spent on patients with diabetes.

And of course the Medicare dollars, 1 in 3.

So a lot of our healthcare spending is spent on the treatment of diabetes, caring for the patient with diabetes.

So therefore it is very urgent, very important that we as healthcare providers, we as 70 Adventists, doctors, nurses, do something in reversing this disease.

You know obesity, there is a crisis for obesity and as you saw in the prior slide that in the areas in which there is a high incidence of obesity, we also had a high incidence of what?

We need to do something then about obesity.

You know the excessive fat, especially the abdominal fat, lead to changes in the body and the cell that inhibits the proper functioning of insulin.

There is insulin resistance and that's 1 of the reasons why we have obese patients that are also diabetic.

It is believed that if we were to attack obesity, we can actually reverse or treat 90% of patients who are diabetic.

So obesity and diabetes, they tend to go along hand in hand and if we can put a stop to obesity then we'll do the same with diabetes.

So as Christian health care providers what can we do?

You know our approach should not be to treat the physical problem but as we know how health is defined.

Health is defined that it's not merely the absence of physical ailment but mental, social and spiritual well-being as well.

We need to reach out to the whole man and we know how to do so and if we were to do so we will be positively helping our patients.

Let's look at some some of the main factors for diabetes and obesity.

1, overeating, poor food choices, lack of physical activity, genetics and pregnancy.

We all know why overeating leads to diabetes.

Overeating leads to obesity, obesity leads to insulin resistance, insulin resistance leads to diabetes.

You know studies have shown that the most common risk factor for chronic diseases in this country and in the world is poor food choices and it is now believed that exercise is medicine and doctors are now prescribing exercise in order to prevent many chronic diseases.

Genetics, I had a patient who walked into my office, he was overweight, a family history of diabetes, heart disease.

I began to speak to him about changing his lifestyle.

Breakout Sessions C

Joe Kretschmar

CrossTraining With the Latest in GI

My name is Joe Kretschmar, as you can see.

I thought I'd start with some disclosures.

I'm a gastroenterologist in Greenville, Tennessee with Tacoma Medical Associates, but most importantly, and this is something that's very important to me, I'm actually a servant of Jesus Christ and want to be, have that clear to all my patients when they come to me that that is very important to me.

So before we start any further, let's bow our heads for prayer.

Father in heaven, we pray that at this time, you may be lifted up, that everything that is said here may be to your honor and glory.

So I thought I'd start with a patient encounter.

This is a 60-year-old lady who was overweight, which is not uncommon in where I'm coming from.

Very nice looking lady, very pleasant, very intelligent, but she had abdominal pain.

That's something I see a lot as a gastroenterologist.

She had abnormal liver enzymes, which is fairly common.

She was over 50 and she had not had a screening colonoscopy.

She had aches and pains and constipation and no energy and she didn't have the energy to finish her day at work every day and that really distressed her and She just had multiple complaints along those lines.

So being a gastroenterologist, we discussed what to do about this.

We ordered some tests to find out what's going on with her liver.

I thought it was probably gonna be fatty liver, but we needed to make sure it wasn't some other issues.

Decided to look in her stomach and a colon to an ultrasound.

Then we discussed what to do for her symptoms.

I said, would you like to hear some things you can do in the meantime while we set these things up, things you can do to try to minimize these symptoms and so you can get some help with what's bothering you.

So I presented to her something that I've been presenting to many of my patients.

And so I told her right up front, I said, you know, I'm going to try to persuade you or convince you.

They look at me and they kind of look strange.

I said, I'm going to try to convince you.

So I may or may not succeed, but let me see if I can try.

OK, would you agree with me that every machine you can think of runs on fuel?

Would you agree that it's going to run best if it runs on the fuel it's designed to run on rather than you decide you're going to put whatever you jolly well want to in there?

I had 1 patient tell me, you know, in my chainsaw I'm supposed to have gas and oil mixture.

I just put straight gas in it and burn the thing up.

Next question I asked them, would you agree with me that when you swallow, once you swallow, whatever you eat or drink for your body at that time, that's going to be your fuel.

So I say, okay, so what's the best fuel for humans?

I said, you can read 10 different books and probably get 12 different answers.

I said, you know, I came across a simple concept.

I told Mike, he tended to like simple ideas.

The concept was, the way to know if a food is good for you is whatever food has the most nutrition in it and the fewest harmful substances in it per calorie, that's the best food.

It's all been studied and published in medical literature.

The most nutritious food turns out to be the foods that grew from the earth.

Greens and vegetables, fruits, beans, whole grains, nuts and seeds, unless, I told them it's a very big Unless, unless you take that very food and you put it through a factory.

Once it comes out the other end, they've been processing it, so they've been taking out nutrition, putting additives in which aren't good for you, as you know the rule.

So when it comes out the other end, it's not good for you anymore, it's good for the factory owner.

And they said, well, I said, and then there is another concept, the same principle applies.

If you take foods that grew from the earth and you feed it to an animal, by the time you eat the animal, you've lost nutrition compared to where you started from.

Plus, if you think about it, That animal, as it's living, gets exposed to who knows what.

It could be heavy metals, pesticides, radiation, fungus, bacteria, viruses, antibody.

I mean, and she's nodding her head by this time.

Back to Menu

All Teachings

Lifestyle Intervention and Its Impact on Diabetes Treatment & Outcomes

52m

Reversing Diabetes & Other Chronic Diseases

55m

CrossTraining With the Latest in GI

1h

AMEN Orientation

36m

Surveying the Cross: The Impact

47m

The Cross Connection: How Love Flowing From the Cross Changes Us and Our Patients

45m

Crossfit: Training for Eternity

37m

Great Is Thy Faithfulness: My Journey into Medicine

1h

Surveying the Cross: The Power

49m

The Message of the Cross

38m

The Cross: It’s Prophetic & Healing Significance

45m

Learning to Carry the Cross

55m

Sound Doctrine