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“Attacking the Driver of Increased
     Stroke, Heart Disease, and Diabetes”

                         Invited Talk
       Right Care Rotating University of Best Practices
                            UCSD
                     November 5, 2012


                             Dr. Larry Smarr
Director, California Institute for Telecommunications and Information
                                Technology
                       Harry E. Gruber Professor,
             Dept. of Computer Science and Engineering
                                                                        1
                 Jacobs School of Engineering, UCSD
During the Last 15 Years, the Fraction of the Population
         That is Obese Has Greatly Increased
                    Source: Behavioral Risk Factor Surveillance System, CDC




    (Obese is
  BMI ≥30, or
     ~ 30 lbs.
  overweight
for 5’ 4” person)
Over 1/3 of American Adults are Obese:
    This is the Driver of Increased Disease




 Obesity-related conditions include heart disease,
stroke, type 2 diabetes and certain types of cancer,
 some of the leading causes of preventable death.
                          --CDC




             www.cdc.gov/obesity/data/adult.html
I Arrived in La Jolla in 2000 After 20 Years in the Midwest
      and Decided to Move Against the Obesity Trend


                       1999                      2010
                        2000



 Age                                                    Age
  51                                                     61




              I Reversed My Body’s Decline By
              Altering Nutrition and Exercise
The Body’s Glucose-Insulin Cycle
Is at the Heart of Why We Get Fat




           “Carbohydrate is
            driving insulin is
              driving fat,”
        the late George Cahill,
          formerly at Harvard
            Medical School.
Is Government and Medical Advice
   Driving the Obesity Epidemic?

                        The Low-Carb Alternative




  Avoid High Glycemic Carbs Which
  Spike Your Glucose-Insulin Cycle
Intermediate Moments
    On the Path to Public Health
    2012                       1982




Glycemic Index:
•Potato 126
•Table Sugar 97
Reversing the Consumption of High Glycemic
Sweeteners is Key to Reducing Public Health Risks
I Modified My Diet to Reduce Calories, Sugar,
     and Sodium, While Increasing Fiber
Statins Do Change Your Cholesterol Levels
By Lowering LDL, Thus Lowering Total Cholesterol




                                  Began Statin




           I am Currently on 5mg Crestor Daily
But What About Fat? Inflammation Is Driven
By Consuming Excess Omega-6 Essential Fatty Acids




                     2004
I Lowered My Body’s Inflammation Driven by Food
 By Increasing Omega-3s and Reducing Omega-6s


                              “Silent Inflammation”

         Chronically Ill                            I take 6 Fish Oil
          American
                                                      Pills Per Day


                           Average “Healthy”
                               American


      Blood Ratio of
    Omega 6 to Omega 3                         Ideal Range
                                                             My Range



                  Range Source: Barry Sears
             My Tests by www.yourfuturehealth.com
Goal: Increase My Omega-3 Scores By Diet Changes
         To Protect Against Future Heart Disease
                          Graphics from www.anne-marie.ca/ratiokits/

If your Omega-3 Score

is at least 7.2 and your
     DHA Score is
  at least 4.5, you are
   32% less likely to
develop heart disease



   If your EPA+DHA
 Score is at least 4.6,
   you are 70% less
likely of dying from a
      heart attack.                           = My Values Tested by yourfuturehealth.com

            Ref: Based on Lemaitre et al., n-3 Polyunsaturated fatty acids, fatal ischemic
            heart disease, and nonfatal myocardial infarction in older adults: the
            Cardiovascular Health Study. Am. J. Clin. Nutr. 77:319-325 (2003).
Lower Triglycerides by Increasing Omega-3 Intake
    and by Reducing Foods High in Refined Carbs
• TG
  – High Risk 200-500
  – Best <150
  – My TG Dropped from 62 (2001) to 37 (2012)
• TG/HDL
  – Ratio >4 Are Pre-Diabetic or Have Type 2 Diabetes
  – Average American Has a Ratio of ~3.3
  – My Ratio 0.6 Is Half What is Was in 2001

                “The Ratio of Triglycerides to
              HDL Cholesterol (TG/HDL-C) is the
                    Single Most Powerful
                      Lipid Predictor of
                Extensive Coronary Disease.”
                 [Clinics 63, 427-432 (2008)]
New Meta-Analysis Shows Why
             Low-Carb Diets Lower Heart Disease Risk




     Tian Hu, et al., Tulane University School of Public Health and Tropical Medicine
     Am J Epidemiol. 2012;176(Suppl):S44–S54


“Compared with participants on low-fat diets, persons on low-carbohydrate diets experienced
     a slightly but statistically significantly lower reduction in total cholesterol, and LDL,
            but a greater increase in HDL and a greater decrease in triglycerides.”




                 TG Down, HDL Up  TG/HDL Much Lower
mobile   social




SMART             Social Mobile Approach to Reduce Weight

                  Source: Kevin Patrick, UCSD SOM & Calit2
PURPOSE
To leverage social networks, social media, mobile phones, and the
web for weight loss among 18-35 year old young adults.
Funded with a 5-year grant from NHLBI/NIH
Exercise Lowers Risk of Heart Disease and Diabetes




     “Weight training was associated with
 a significantly lower risk of Type 2 Diabetes,
       independent of aerobic exercise.
Combined weight training and aerobic exercise
          conferred a greater benefit.”
The Biofeedback of Monitoring Enables Me
             To Increase My Daily Caloric Burn
www.bodymedia.com



                    Elliptical Gardening   Up and Down House Steps




                               25 Week Average:
                           2473 Calories Burned/Day
                     1:19 hr Physical Activity/Day (>3 METs)
                           6887 Steps/Day (~3.4 Miles)



                            Now Using Fitbit
                         Average 8000 Steps/Day
FitBit Compares Your Steps
to Population of Your Age and Sex
Goal: Use Strength Training
to Raise My Rest Metabolic Rate




                                        3x




     Source: Terry Martin, LS Trainer
LS Resting Heart Rate



Year                  Resting Heart Rate

2000                           60



2005                           50



2010                           45



2012                           40
Another Example of the Efficacy of Aerobic Exercise
            on Lowering Heart Rate




            Data from Rajesh Gupta, Chair CSE, UCSD
Blood Pressure Home Monitoring Problem:
    Wide Scatter in Results Over Time




             LS Feb-March 2010
             40mg Benicar Daily
Change in LS Blood Pressure
 Under Different Blood Pressure Medications

Year       Blood         Average      Average
          Pressure       Systolic     Diastolic
            Drug
2010        Benecar        134            73
             20mg


2012        Losartan       143            82
             100mg


2012          Lotrel       125            70
          5/10mg combo
Quantifying My Sleep Pattern Using a Zeo -
 Increased My Average to 8 Hours/Night




          Stroke risk increased by sleeping less than six hours a night
                              -M. Ruiter, Sleep 2012




      REM is Normally 20% of Sleep        An Infant Typically
     Mine is Between 45-65% of Sleep        Has 50% REM
Challenge-Coupling Personal Sensor Data
         With Social Networks Across Private Clouds
                                                    Withing/iPhone-
                                                    Blood Pressure




                     Body Media-
                    Calories Burned
     Lose It-
Calories Ingested



                                      EM Wave PC-
                                         Stress

                                                    Azumio-Heart Rate


                         Zeo-Sleep
Invited Paper for Focus Issue of Biotechnology Journal,
    Edited by Profs. Leroy Hood and Charles Auffray.




       Download Pdfs from my Portal:
http://lsmarr.calit2.net/repository/Biotech_J.
_LS_published_article.pdf
http://lsmarr.calit2.net/repository/Biotech_J.
_Supporting_Info_published.pdf

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Attacking the Driver of Increased Stroke, Heart Disease, and Diabetes

  • 1. “Attacking the Driver of Increased Stroke, Heart Disease, and Diabetes” Invited Talk Right Care Rotating University of Best Practices UCSD November 5, 2012 Dr. Larry Smarr Director, California Institute for Telecommunications and Information Technology Harry E. Gruber Professor, Dept. of Computer Science and Engineering 1 Jacobs School of Engineering, UCSD
  • 2. During the Last 15 Years, the Fraction of the Population That is Obese Has Greatly Increased Source: Behavioral Risk Factor Surveillance System, CDC (Obese is BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
  • 3. Over 1/3 of American Adults are Obese: This is the Driver of Increased Disease Obesity-related conditions include heart disease, stroke, type 2 diabetes and certain types of cancer, some of the leading causes of preventable death. --CDC www.cdc.gov/obesity/data/adult.html
  • 4. I Arrived in La Jolla in 2000 After 20 Years in the Midwest and Decided to Move Against the Obesity Trend 1999 2010 2000 Age Age 51 61 I Reversed My Body’s Decline By Altering Nutrition and Exercise
  • 5. The Body’s Glucose-Insulin Cycle Is at the Heart of Why We Get Fat “Carbohydrate is driving insulin is driving fat,” the late George Cahill, formerly at Harvard Medical School.
  • 6. Is Government and Medical Advice Driving the Obesity Epidemic? The Low-Carb Alternative Avoid High Glycemic Carbs Which Spike Your Glucose-Insulin Cycle
  • 7. Intermediate Moments On the Path to Public Health 2012 1982 Glycemic Index: •Potato 126 •Table Sugar 97
  • 8. Reversing the Consumption of High Glycemic Sweeteners is Key to Reducing Public Health Risks
  • 9. I Modified My Diet to Reduce Calories, Sugar, and Sodium, While Increasing Fiber
  • 10. Statins Do Change Your Cholesterol Levels By Lowering LDL, Thus Lowering Total Cholesterol Began Statin I am Currently on 5mg Crestor Daily
  • 11. But What About Fat? Inflammation Is Driven By Consuming Excess Omega-6 Essential Fatty Acids 2004
  • 12. I Lowered My Body’s Inflammation Driven by Food By Increasing Omega-3s and Reducing Omega-6s “Silent Inflammation” Chronically Ill I take 6 Fish Oil American Pills Per Day Average “Healthy” American Blood Ratio of Omega 6 to Omega 3 Ideal Range My Range Range Source: Barry Sears My Tests by www.yourfuturehealth.com
  • 13. Goal: Increase My Omega-3 Scores By Diet Changes To Protect Against Future Heart Disease Graphics from www.anne-marie.ca/ratiokits/ If your Omega-3 Score is at least 7.2 and your DHA Score is at least 4.5, you are 32% less likely to develop heart disease If your EPA+DHA Score is at least 4.6, you are 70% less likely of dying from a heart attack. = My Values Tested by yourfuturehealth.com Ref: Based on Lemaitre et al., n-3 Polyunsaturated fatty acids, fatal ischemic heart disease, and nonfatal myocardial infarction in older adults: the Cardiovascular Health Study. Am. J. Clin. Nutr. 77:319-325 (2003).
  • 14. Lower Triglycerides by Increasing Omega-3 Intake and by Reducing Foods High in Refined Carbs • TG – High Risk 200-500 – Best <150 – My TG Dropped from 62 (2001) to 37 (2012) • TG/HDL – Ratio >4 Are Pre-Diabetic or Have Type 2 Diabetes – Average American Has a Ratio of ~3.3 – My Ratio 0.6 Is Half What is Was in 2001 “The Ratio of Triglycerides to HDL Cholesterol (TG/HDL-C) is the Single Most Powerful Lipid Predictor of Extensive Coronary Disease.” [Clinics 63, 427-432 (2008)]
  • 15. New Meta-Analysis Shows Why Low-Carb Diets Lower Heart Disease Risk Tian Hu, et al., Tulane University School of Public Health and Tropical Medicine Am J Epidemiol. 2012;176(Suppl):S44–S54 “Compared with participants on low-fat diets, persons on low-carbohydrate diets experienced a slightly but statistically significantly lower reduction in total cholesterol, and LDL, but a greater increase in HDL and a greater decrease in triglycerides.” TG Down, HDL Up  TG/HDL Much Lower
  • 16. mobile social SMART Social Mobile Approach to Reduce Weight Source: Kevin Patrick, UCSD SOM & Calit2 PURPOSE To leverage social networks, social media, mobile phones, and the web for weight loss among 18-35 year old young adults. Funded with a 5-year grant from NHLBI/NIH
  • 17. Exercise Lowers Risk of Heart Disease and Diabetes “Weight training was associated with a significantly lower risk of Type 2 Diabetes, independent of aerobic exercise. Combined weight training and aerobic exercise conferred a greater benefit.”
  • 18. The Biofeedback of Monitoring Enables Me To Increase My Daily Caloric Burn www.bodymedia.com Elliptical Gardening Up and Down House Steps 25 Week Average: 2473 Calories Burned/Day 1:19 hr Physical Activity/Day (>3 METs) 6887 Steps/Day (~3.4 Miles) Now Using Fitbit Average 8000 Steps/Day
  • 19. FitBit Compares Your Steps to Population of Your Age and Sex
  • 20. Goal: Use Strength Training to Raise My Rest Metabolic Rate 3x Source: Terry Martin, LS Trainer
  • 21. LS Resting Heart Rate Year Resting Heart Rate 2000 60 2005 50 2010 45 2012 40
  • 22. Another Example of the Efficacy of Aerobic Exercise on Lowering Heart Rate Data from Rajesh Gupta, Chair CSE, UCSD
  • 23. Blood Pressure Home Monitoring Problem: Wide Scatter in Results Over Time LS Feb-March 2010 40mg Benicar Daily
  • 24. Change in LS Blood Pressure Under Different Blood Pressure Medications Year Blood Average Average Pressure Systolic Diastolic Drug 2010 Benecar 134 73 20mg 2012 Losartan 143 82 100mg 2012 Lotrel 125 70 5/10mg combo
  • 25. Quantifying My Sleep Pattern Using a Zeo - Increased My Average to 8 Hours/Night Stroke risk increased by sleeping less than six hours a night -M. Ruiter, Sleep 2012 REM is Normally 20% of Sleep An Infant Typically Mine is Between 45-65% of Sleep Has 50% REM
  • 26. Challenge-Coupling Personal Sensor Data With Social Networks Across Private Clouds Withing/iPhone- Blood Pressure Body Media- Calories Burned Lose It- Calories Ingested EM Wave PC- Stress Azumio-Heart Rate Zeo-Sleep
  • 27. Invited Paper for Focus Issue of Biotechnology Journal, Edited by Profs. Leroy Hood and Charles Auffray. Download Pdfs from my Portal: http://lsmarr.calit2.net/repository/Biotech_J. _LS_published_article.pdf http://lsmarr.calit2.net/repository/Biotech_J. _Supporting_Info_published.pdf