Paleo Diet Risk Assessment: Update Three
Sorry I have not written much of late. I have not even gotten to my massive stack of Science Bites I need to carve through. I’ll get on that stuff ASAP, but for now I wanted to let y’all know about some developments with the Risk Assessment program here in Reno. If you missed the earlier posts on this project, please check out Part 1 and Part 2.
Since December of 2011 I’ve been working with Specialty Health on this Risk Assessment program, and contributing my perspective on Evolutionary Medicine. Particularly gut health, systemic inflammation, and autoimmunity. Up until recently this has just been a friendly collaboration with no specific ties or obligations. That changed two weeks ago when I was added to the board of directors of Specialty Health, and we started talking earnestly about how we will take this program to the masses. I covered what the program is in Part 1, but I’ll provide an overview of where the program is, and where we are going:
1-The program provides a risk assessment looking at specific biomarkers to find people who are insulin resistant, inflamed, and at high risk of cardiovascular disease.
2-This program is unique in that we find folks who would otherwise pass through a screen as “healthy” but who are actually running around with serious problems, such as very high LDL-P, despite having “normal” cholesterol levels. For an exhaustive look at LDL-P, cholesterol, and the related material please see LecturePad.
3-People who flag as high risk are placed on a low-carb/paleo diet, counseled on sleep, and exercise, vit-D levels are tracked, and in some cases a very low dose statin is used to bring lipoprotein levels down. USUALLY, once the body starts to heal, folks can be titrated of the statins. Glucophage is occasionally used to address insulin resistance, but the heavy lifting is accomplished through an evolutionary approach to diet, exercise, and circadian rhythm (sleep).
The program to date has mainly been run on Police and Fire personnel with a conservative ROI of 33/1. The city of Reno now has all Police and Fire going through the program, and the conservative estimates of savings over a 30 year period are around $1.3 BILLION (yep, with a “B”).
We have been contacted by companies and municipalities around the world who are interested in the program. We have generated a ton of interest, and I think we are in a unique position to really affect remarkable change. We have faced one monumental challenge so far however:
We can order blood work for a Fire department, Law firm or Hospital system, provide the data analysis, and recommend treatment plans; but when we send this information to the affected people and release them to go work with their doctors and dieticians, the whole thing grinds to a halt. Our dietary recommendations are shifted to a high carb, low fat, grain based diet. The GP’s have no idea what LDL-P is, and cannot make heads or tails of what the hell we are recommending. We could pump millions of people through this program, save lives and money…but there are no Gate Keepers on the other end that know how to implement this stuff. Yet.
I sat down with the Specialty Health folks this weekend (after filming for about two hours as part of a documentary we are involved in…I’ll have some info up on that in a few weeks). We delineated our problems and came up with a solution:
A “soup to nuts” Evolutionary Medicine certification. This will cover much more than just the lipid based risk assessment, delving into endocrinology, immunology, and clinical medicine, all from the EM perspective. This is critical for several reasons:
1-As I mentioned above, we have no “Gate Keepers” that we can trust on the treatment side. We need to build a network of physicians, chiros, RD’s, RN’s, pharmacists, PT’s…who know this stuff front and back.
2-As solid as the lipid based risk assessment is, there are nuances that are not yet being addressed. There are multiple vectors which give rise to both insulin resistance AND systemic inflammation. Poor sleep can chronically elevate cortisol, antagonizing thyroid production, and this can lead to elevated lipoproteins due to down regulation of the LDL receptor. This condition looks quite similar to Familial Hypercholesterolemia and needs to be treated in a completely different way than elevated LDL-P from “simple” insulin resistance. This is one of the things I caught when I started looking at patient files and looking at the lab work, and that is getting integrated into the bigger treatment picture.
The pieces of the program will include the Risk Assessment program as it largely stands today, the nutrition certification we’ve been working on (should just be a couple of months on that…update to follow soon), and the EM curriculum. I’ll tell you details on all this as it rolls out.
Perhaps the most important piece of the risk assessment program has been the data analysis portion. It’s one thing to assume we are helping people, quite another to validate this statistically. Specialty Health started as an orthopedic risk assessment program/Health Management business. In that time they have amassed biometrics on ~1.3 million people. It is from this database that we can make statistical predictions on health outcomes, likelihood of occurrence of say a stroke or heart attack, and how much an individual (or group of people) is likely to consume in healthcare services. As good as that analysis has been, we have a really interesting development that will bring that part of our game to a whole new level. Dr. Jim Greenwald, the director of the Specialty Health program, is a hell of a connector. “Greenie” as he likes to be called, knows a remarkable number of people, and one of those people is pretty good at data analysis: Mohan J Kumar, one of the principals at Intel. Greenie contacted Mohan and had him look at our database, then told him what we are up to:
1-Distinguishing “signal” from noise
2-Develop algorithms to delineate treatment flow, like in the Elevated LDL-P scenario, which could be caused by a variety of issues, including systemic inflammation, gut permeability, elevated cortisol, and thyroid deregulation.
What has come from this collaboration is an algorithm for which we are seeking a patent. All I can tell you at this point is it is pretty damn slick, and will help practitioners make sense of a mass of clinical data in a time efficient, productive way. It also beef’s up our ability to calculate ROI. I’m not sure if I mentioned this above, but the risk assessment is currently “only” looking at insulin resistance, blood lipids, and markers of systemic inflammation predictive of type 2 diabetes and/or cardiovascular disease. As we graft the full EM curriculum into the program this will expand to encompass: autoimmunity, neurodegenerative disease, reproductive issues, gastrointestinal issues…anything that appears to be an outgrowth of a mismatch between genes and environment.
New team members
Specialty Health recently presented our work to a LARGE governmental entity. I was contacted via my blog by folks in this organization as they read parts 1 and 2 about the risk assessment, and were very interested in learning more. Greenie gave a whizz-bang presentation, and things look very favorable for creating a relationship with this entity. At this presentation Greenie met a number of people, but one in particular took a special interest in the program, former US Navy SEAL, Stew Smith. I’ve been a big fan of Stew’s for a long time, and I can’t tell you what a treat it was to talk to him via email and help him get up to speed on what we are up to. Stew is a really smart guy and he devoured the material we gave him. He immediately saw the importance of the program for the military at large, so he wrote a three part series which appeared on Military.com. Please check these out and pass them around to anyone you know in the Police, Fire or Military. Part 1, Part 2, Part 3
I am beyond honored to be included in this project…I think it may be the “skinny end of the wedge” that opens the door to changing how medicine is practiced.
The New Clinic
Last Friday we had the grand opening for Specialty Health’s new Integrated Medicine clinic. Up until a few days ago, Specialty Health only had clinical access for L&I and Workman’s comp type of patients. With this new clinic we have a direct access option for the people of Northern Nevada to get top-notch Evolutionary Medicine care. The plan is to take this program “everywhere.”
I’ll do my best to get some blog posts written and some Science Bite’s spit out! I am spending a lot of time on curriculum development, looking at lab work, and trying to get the wheels on this wagon. I always knew something like this would take form, I just had no idea it’d be in Reno, Nevada.