Evaluation of the Impact of a Paleolithic Diet on

Cardiovascular Risk Factors and Lipoproteins in a Law

Enforcement PopulationScott Hall, MDRobb Wolf, BS

Cardiovascular (CV) disease is the leading cause of death for both women and men in the United States1

It is estimated that about 47% of cardiac deaths occur before emergency services or transport to a hospital2

“In principle, all people can take steps to lower their personal risk of heart disease and heart attack by addressing their risk factors.” www.cdc.gov

Cardiovascular disease

Smoking High cholesterol hypertension Diabetes Overweight and obesity Poor diet Physical inactivity Excessive alcohol use

Cardiovascular disease risk factors

Law enforcement is a high-stress occupation with increasing prevalence and incidence of cardiovascular disease.

Epidemiological studies suggest that police officers and related public safety personnel have an increased risk of cardiovascular morbidity and mortality.

Currently employed police personnel have a high prevalence of traditional risk factors, including hypertension, hyperlipidemia, metabolic syndrome, cigarette smoking, and a sedentary lifestyle.

Law enforcement and cardiovascular disease

Zimmerman F. Cardiovascular Disease and Risk Factors in Law Enforcement Personnel: A Comprehensive Review. Cardiol Rev 2012; 20 (4): 159-166.

occupation-specific risk factors◦ sudden physical exertion◦ acute and chronic psychological stress◦ shift work

“Workplace programs to promote the health and fitness of police officers are commonly lacking, but can be an effective means for reducing cardiovascular risk.”

Law enforcement and CV disease

Zimmerman F. Cardiovascular Disease and Risk Factors in Law Enforcement Personnel: A Comprehensive Review. Cardiol Rev 2012; 20 (4): 159-166.

“Police officers have one of the poorest cardiovascular disease (CVD) health profiles of any occupation.”

Compared to general population

obese (40.5% vs. 32.1%) metabolic syndrome (26.7% vs. 18 total cholesterol levels (200.8 mg/dL vs.

193.2 mg/dL).7%)

Hartley TA, Fekedulegn D, Burchfiel M, et al. Health disparities in police officers: comparisons to the U.S. general population. Int J Emerg Mental Health. 2011 Oct; 13(4):211-220 .

“It was determined the average age at death for members assigned to law enforcement and corrections duties was 62.4 years, while the average age of death for Florida's general population was almost 12 years longer at 74.2 years (approximately 19% longer life spans).”

Florida mortality study

http://www.floridastatefop.org/pdf_files/floridamortalitystudy.pdf

“Experience has shown that workplace wellness programs are an important strategy to prevent the major shared risk factors for cardiovascular disease and stroke, including cigarette smoking, obesity, hypertension, dyslipidemia, physical inactivity, and diabetes.”

American Heart Association

AHA Policy Statement: Worksite Wellness Programs for Cardiovascular Disease Prevention. Accessed at: http://circ.ahajournals.org/content/120/17/1725.full

City of Reno Chief of Police Steve Pitts Drs. Greenwald and Hall with

SpecialtyHealth Reno City Council Labor Union Rob Wolf, Author and Editor

Collaboration

Grant obtained from the Reno City Council 15 Officers chosen and consented to

participate by City of Reno Police Leadership All 15 were high or moderate risk for

cardiovascular disease by ATP III guidelines from their most recent annual examination

Design

Health risk assessment Biometrics

◦ Height ◦ Weight◦ Body fat◦ Blood pressure

Laboratory evaluation including lipoprofile Informed by the “Big 5” chart

Individual assessment

33

2231

73

Physician evaluation◦ One officer found to have familial hyperlipidemia

Informed of individual results and risk Exercise assessment and fitness prescription Nutrition assessment and dietary counseling

◦ Paleo/low carbohydrate Follow-up assessment at 4-6 months Average age of participants was 45 years old

Intervention

Resiliency as a path to Wellness

Results published by Steve Pitts, City of Reno Chief of Police

The costs associated with an MI for medical retirement benefits and medical care is estimated at $1.2 million in the State of Nevada for a total cost of $10.8 million for 9 “high risk” officers

The preventative costs for all 15 officers over 20 years is $505,560 or $33,704 per officer prorated over a 20 year period

The ROI applied to this initial program for the Reno Police Department is 20 to 1.

http://www.policechiefmagazine.org/magazine/index.cfm?fuseaction=display_arch&article_id=2822&issue_id=122012

B/P WEIGHT BMI

INTIAL 126/80 207 29.14

AFTER 122/79 196 27.59

RESULTS -4 -11 -1.55

BIOMETRICS

LDL-P LDL-C HDL-C TRIG.TOTAL CHOL.

INITIAL 1735 118 44 179 197

AFTER 1357 94 48 101 163

RESULTS -378 -24 4 -78 -34

Lipoprotien and cholesterol results

TG/HDL Ratio LP-IR GLUCOSE

INITIAL 4.61 65 91

AFTER 1.58 47 81

RESULTS -3.03 -18 -10

Insulin resistance markers

“As useful as the standard lipid profile has been, it has shortcomings that prevent clinicians from doing an optimal job with assessing baseline or on-treatment atherosclerosis risk, especially in patients with insulin resistance.”

“Multiple trials … have demonstrated that CV events are more related to atherogenic lipoprotein concentration than to cholesterol estimates … such as LDL-C.”

Lipoprotiens

Dayspring T, Dall T, and Abuhajir M. Moving beyond LDL-C: incorporating lipoprotein particle numbers and geometric parameters to improve clinical outcomes. Res Report Clin Cardiol 2010:1, 1-10.

Lipoprotein Cross-Section (It’s not the passengers, It’s the cars)

AFTER WELLNESS PROGRAM

33

1026

57

33 year old high risk officer with a family history of cardiovascular disease.

2/1/11BEFORE

6/6/11AFTER

4 MONTH RESULT

WEIGHT 219 207 5.4%

LDL-P 2231 1026 1205

HDL-P 23.6 28.7 5.1

LDL-C 117 61 56

HDL-C 31 35 4

TRYGLICERIDES 362 119 243

INSULIN RESISTANCE SCORE 73 57 16

Examples of officers who have been involved with the program for more than five years

Each is seen currently on an annual basis More details on their stories can be found at

specialtyhealth.com

Are the results sustainable??

BEFORE WELLNESS PROGRAM

This high risk officer came to us at age 31. He had an incredible 10 year treatment success:

The results were reached using a Low Carb Diet, Exercise and inexpensive medications.

*Non HDL 197 - Calculations based on Table 4. Page 8 of the American Association for Clinical Chemistry article: Apolipoprotein B and Cardiovascular Disease Risk: Position Statement from the AACC Lipoproteins and Vascular Diseases Division Working Group on Best Practices; Dr. Contols JH, Dr. McConnel, JP, et. al.

Clin Chem. 2009 Mar;55(3):407-19. doi: 10.1373/clinchem.2008.118356. Epub 2009 Jan 23.

 

DOES IT WORK?

Case Study 4

5/24/02BEFORE

3/5/12AFTER

10 YEAR RESULT

LDL-C 152 70 82HDL-C 31 40 9TRYGLICERIDES 226 72 154INSULIN RESISTANCE RATIO

7.3 1.8 5.5

HIGH RISK – RED LIGHTS 4 0 4LDL-P (At goal under 1000)

2010* 845 1165

BEFORE PROGRAM 2006

AFTER PROGRAM 2012

2/1/06 BEFORE

2/10/12AFTER

6 YEAR RESULT

WEIGHT 235 195 40WAIST 43 38 5LDL-P 1820* 1096 724LDL-C 106 83 23HDL-C 38 55 17TRYGLICERIDES 270 38 232INSULIN RESISTANCE RATIO 7.1 .7 6.4METABOLIC SYNDROME MARKERS

5/5 1/5 4

52 year old officer in real trouble in 2006. In 2012, no more “dead man walking.”

1. Kochanek KD, Xu JQ, Murphy SL, Miniño AM, Kung HC. Deaths: final data for 2009.  [PDF-2M] National vital statistics reports. 2011; 60 (3).

2. Zheng ZJ, Croft JB, Giles WH, Ayala C, Greenlund K, Keenan NL, Neff L, Wattigney WA, Mensah GA. State specific mortality from sudden cardiac death: United States. MMWR. 2002; 51:123–126.

3. Zimmerman F. Cardiovascular Disease and Risk Factors in Law Enforcement Personnel: A Comprehensive Review. Cardiol Rev. 2012;20 (4): 159-166.

4. Hartley TA, Fekedulegn D, Burchfiel M, et al. Health disparities in police officers: comparisons to the U.S. general population. Int J Emerg Mental Health. 2011; 13(4):211-220 .

5. Parker JR. The Florida Mortality Study: Florida Law Enforcement and Corrections Officerscompared to Florida General Population. Accessed 7/30/13 at: http://www.floridastatefop.org/pdf_files/floridamortalitystudy.pdf.

6. AHA Policy Statement: Worksite Wellness Programs for Cardiovascular Disease Prevention. Accessed at: http://circ.ahajournals.org/content/120/17/1725.full.

7. Dayspring T, Dall T, and Abuhajir M. Moving beyond LDL-C: incorporating lipoprotein particle numbers and geometric parameters to improve clinical outcomes. Res Report Clin Cardiol 2010; 1: 1-10.

8. Pitts S. Resiliency as a Path to Wellness. Accessed at: http://www.policechiefmagazine.org/magazine/index.cfm?fuseaction=display_arch&article_id=2822&issue_id=122012.

References