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"The Works" Detailed Assessment, Discussion of Results and Optimal Health Plan

INSIDE OUTSIDE WELLNESS CENTER

OPTIMAL HEALTH PROGRAM FOR

Mr. John Doe

Prepared 31 Jan 2006

Dear Mr. Doe

Thank you for participating in the Inside Outside Comprehensive Health Evaluation, “The Works”. Remember, Optimal Health yields Optimal Function and Peak Mental and Physical Performance and sets the stage for Successful Aging. Although the evaluation performed was quite extensive, it was by purpose limited in scope and should be viewed only as a partial evaluation of your present health status.

FINAL ASSESSMENT:

1. Healthy appearing Caucasian Male.

2. Normal physical exam except for central obesity, left femoral bruit and photodamaged skin.

3. Personal History diverticulitis.

4. Family History of Lung Cancer, Type II Diabetes

5. Increased risk for Atherosclerosis based on Male Sex, Age and presence of Metabolic Syndrome due to abnormal Lipid Pattern, elevated Homocysteine, elevated fasting Insulin, low Testosterone, elevated Body Fat % (BMI Overweight Category with central obesity), Slightly elevated Fasting Glucose tolerance and genetic Polymorphisms of CETP, METHFR, GNB3, AGTR1 and CYBA.

See Section 2 and Section 9 CardioGenomic Profile.

6. Lowered levels of Multiple Hormones, probably related to age and stress.

See Section 3.

Sub Optimal IGF1 level at 164. Optimal 250-320.

Hypogonadism, probably of Pituitary Origin with

Sub Optimal Total Testosterone of 198. Optimal 700-900.

Sub Optimal Free Testosterone of 46.5. Optimal 130-190.

Sub Optimal Dihydrotestosterone of 16. Optimal 25-75.

Border Line Low Luteinizing Hormone (LH) of 1.6. Optimal 1.5-9.3.

Sub Optimal DHEA Level of 170. Optimal Range 350-500.

Mild Sub clinical Hypothyroidism with TSH 4.53, Optimal <3.0. Normal T3 and T4.

7. Normal AM Cortisol level.

8. Normal Estradiol.

9. Normal PSA Level.

10. Mildly Elevated Plasma AA/EPA ratio of 3.65, Optimal Range 1.5-3.0. Indication of Mild pro-inflammatory state.

11. Normal Blood Chemistry, Liver function, U/A, Kidney Function. See attached Raw Data Sheets from Cenegenics.

12. Normal Complete Blood Count except for slightly low Platelet Count of 135K, Normal 140K-400K.

13. Mild Glucose Intolerance. See Section 4

Slightly elevated Fasting Glucose of 100. Optimal 65-95.

Elevated Fasting Insulin of 12. Optimal <6.0

Slightly elevated Hemoglobin A1C of 5.3. Optimal 4.5-5.1

14. Abnormal Lipid Profile with: See Section 2

Elevated Total Cholesterol 228. Optimal 140-200

Elevated LDL Cholesterol of 153. Optimal <130 with Small, Dense LDL Pattern

Low HDL Cholesterol of 35. Optimal 50-110.

Elevated Triglyceride of 216, Optimal 50-100.

Normal Lp(a)

15. Elevated Homocysteine of 10.9. Optimal <9. Also MTHFR SNP Present.

16. Elevated body fat of 23.6% (Optimal 16% for Male) with central obesity. BMI of 27.8, Overweight Category. See Section 5.

17. Inadequate Antioxidant Function of 38%, Optimal >75%. See Section 6.

18. Severe Osteopenia of Both Forearms. Normal overall bone density of both Hips but Femoral Necks meet criteria for Osteopenia. Normal bone density of L1-L4 Spine.

At increased risk for decreased bone density due to Genomic profiles revealing Homozygous + SNP’s of COL1A1 and CALCR and Heterozygous + for TNF-alpha. See Section 8 and Section 9 OsteoGenomic Profile.

19. Increased risk for Inflammatory responses due to SNPs of TNF-alpha, IL-10. See Section 9 ImmunoGenomic Profile.

20. Several SNPs indicating decreased detoxification capability of the liver and increased risk for Oxidative Stress. See Section 9 DetoxiGenomic Profile.

21. History of Surgery for appendectomy, tonsillectomy, open reduction/fixation of a left clavicular fracture and sigmoidectomy for diverticulitis.

SPECIFIC RECOMMENDATIONS: Based on your Age, Medical History, Physical Exam and the Lab Work and Scans we performed.

1. ROUTINE CHECKUPS/FOLLOWUPS:

Your Age, Evaluation and Medical History indicate a number of areas that need attention at this time. Although you do not presently have any serious symptoms of chronic diseases, the evaluation has discovered a number of “silent” abnormalities which have the potential to lead to the early onset of a number of chronic problems. In addition the DXA Scanning has revealed significant osteopenia and loss of bone density. These items will be discussed in detail in this report.

GENERAL RECOMMENDATIONS FOR ROUTINE CHECKUPS:

1. Yearly Physical Exam. Your evaluations with your personal physician.

2. Yearly Routine Lab Work.

3. Yearly Eye checks for Glaucoma, Cataracts and refraction

4. Dermatology examination every year.

5. Annual Prostate Exam and PSA testing

6. Colonoscopy this year.

7. Dental Prophylaxis yearly.

8. Annual DXA bone density scan for followup of osteopenia.

9. Cardiac Stress Testing and Vascular Surgery Baseline Evaluation.

2. ATHEROSCLEROSIS SCREENING:

There is a no family history of heart disease. You have no symptoms of heart disease and Treadmill testing done in 1995 was normal according to your history. Your Comprehensive Cardiovascular Assessment performed at the Great Smokies Laboratory is enclosed. Please review it and the Lipid Charting enclosed.

The Testing has shown that you are at increased risk for the development of atherosclerosis. The traditional lipid profile consisting of Total Cholesterol, LDL Cholesterol, HDL Cholesterol are all abnormal and the Cholesterol/HDL ratio is quite elevated at 6.5, Normal <4.5. We now realize that these measurements don’t give us a complete assessment of your risk of Atherosclerosis however and the Assessment included tests for LDL and HDL particle size and other newer markers of risk. The “Bad” LDL cholesterol level is elevated at 153, Optimal 80-100, and there is a predominance of the small LDL particles which increase your risk. One of the LDL fractions, The Lp(a) is Normal which is good. The “Good” HDL cholesterol at 35 is low, Optimal 50-110, and the HDL fractions show a low number for the HDL2 which is most protective. You have a SNP of the CETP gene which tends to make HDL lower. The C-Reactive protein and Fibrinogin are fine. These are indexes of inflammation and a tendency for the blood to be hypercoagulable. The Homocysteine is elevated at 10.90, Optimal 5-9, and you have a SNP for MTHFR gene which often elevates the homocysteine. In addition, the SNP of the gene AGTR1 and the GNB3 increases your risk for hypertension. Other risk factors for accelerated atherosclerosis are the elevated Triglycerides at 216, Optimal <100, Mild Glucose intolerance and an elevated fasting Insulin level of 12, Optimal 3-6. Your physical exam reveals central obesity, a sign of increased visceral fat which has been shown to be a risk factor for atherosclerosis. In addition, the left femoral bruit may be an indication of some degree of peripheral vascular disease and you should have a baseline evaluation by a vascular surgeon.

RECOMMENDATIONS:

1. You are at increased risk for atherosclerosis due to the factors discussed above. The combination of these risk factors is diagnostic of the “Metabolic Syndrome” which is a well recognized syndrome which increases risk of atherosclerosis. It is also recognized that low Testosterone causes elevations of Cholesterol and increased risk of atherosclerosis.

2. The importance of antioxidant protection for further protection against atherosclerosis needs to be emphasized. Please review Section 6 and continue your commitment to a comprehensive micronutrition program to include a wide range of antioxidants such as Vitamins C, E, Beta Carotine, Selenium, CoEnzyme Q10 and others. We will have you take more Vitamin E including all the Isoforms of the tocopherols and tocotreinols.

3. Adhere to the OmegaRx Zone program. It promotes low fat protein choices with most of the fat calories coming from Omega 9 sources such as extra virgin olive oil and almonds and this will keep the Total Cholesterol down. Try to limit saturated animal or dairy fat and stay away from the Trans Fatty acids (Partially Hydrogenated Fat) we talked about as these will elevate the total Cholesterol and LDL Cholesterol. Soluble fiber like the Colon Health product product will also help with the cholesterol. Please avoid the High Glycemic (Unfavorable) Carbohydrates as these elevate the Triglycerides.

4. A small dose of a Statin such as Lipitor is indicated.

5. Your AA/EPA ratio of 3.65 is only slightly higher than the 1.0-3.0 range which is Optimal. You Should take about 6gm daily, this is 2 teaspoons of Dr. Sears’ Fish Oil or 8 of his capsules for 1 month and then 1 teaspoon or 4 capsules daily thereafter. Fish oil will increase the large beneficial LDL particles as well as elevate the HDL.

6. You should also take a 81mg Baby Aspirin daily.

7. You should have a repeat evaluation with a Cardiologist with Stress Testing and a baseline evaluation with a vascular surgeon for possible early peripheral vascular disease.

3. HORMONE OPTIMIZATION:

Please review the Hormone Graphic charts. There are several abnormalities which indicate lowered function of your endocrine, hormone producing, system. The IGF1 at 164 is lower than our Optimal Level of 250-320. The Total and Free Testosterone are also quite low at 198, Optimal 700-900,and 46.5, Optimal 130-190, respectively. The LH, Luteinizing Hormone, from the Pituitary gland is in the low normal range at 1.6. It should be higher based on your low Testosterone levels suggesting there is lowered function of the Pituitary Gland which cannot increase the LH which stimulates the testicles to make Testosterone. The Dihydrotestosterone, which is converted from Testosterone is also low at 16, Optimal 25-75. The Estradiol is in a normal range for a male. The DHEA is low at 170, Optimal 350-500, indicating lowered Adrenal function. The AM fasting Cortisol is also on the low normal side, a little suggestive of lowered adrenal function. Finally, the thyroid studies consisting of a slightly elevated TSH of 4.53 suggest a mild subclinical hypothyroid state. The T-3 and T-4 are in a normal range however. The PSA is normal. As discussed above your AA/EPA ratio of 3.65 is only slightly higher than the 1.0-3.0 range which is Optimal. This is a much better range than we usually see. The average American has a level of about 11.

RECOMENDATIONS:

1. There are multiple abnormalities suggesting hypofunction of your endocrine system. This is a normal process with aging but the very low levels of the Testosterone are especially concerning. I would like to have a serum Prolactin level measured. Elevated Prolactin can cause low Testosterone levels. We know that Stress can dramatically affect the levels of all the hormones we have tested and no doubt your high stress lifestyle has contributed to these abnormalities.

2. There is no question that Cenegenics would recommend a comprehensive hormone supplementation program for you to increase your levels to those of a 35 year old male. There is considerable synergy between a combination of small doses of Growth Hormone, Testosterone, Thyroid and DHEA on increasing muscle mass and allowing for improved fat mobilization. There might also be improvements in mood, concentration, libido, sexual function, sleep and other subtle mental symptoms.

3. For the reduced IGF1, the treatment is Human Growth Hormone .25cc Sub Cu daily 6 days a week.

4. For Hypogonadism with low Testosterone, we should initially try Novartel, given as 2500Units Sub Cu twice a week. Novartel is Human Chorionic Gonadotropin and identical to LH. This would hopefully stimulate your testicles to make more Testosterone. If this did not work, you would need to start weekly IM Injections of Depo Testosterone.

5. For Decreased DHEA, start DHEA 25mg daily.

6. For Mild Subclinical Hypothyroidism, Start Armour Thyroid ½ gr daily.

7. In addition start Melatonin 1mg each night.

8. As discussed above you need a little more Omega3 to normalize your AA/EPA ratio. You should take about 6gm daily, this is 2 teaspoons of Dr. Sears’ Fish Oil or 8 of his capsules for 1 month and then 1 teaspoon or 4 capsules daily thereafter.

4. DIABETES SCREENING:

Please review the Glucose Graphic charts. Your measures of glucose/insulin metabolism are indicative of mild glucose intolerance. The fasting Glucose of 100 is slightly elevated, Optimal 65-95 and the Hemoglobin A1C, a measure of glucose levels over the past 90 days is slightly elevated at 5.3, Optimal 4.0-5.1. The Fasting insulin level at 12 is elevated, Optimal 3-6. These all could be interpreted as very early signs of Type II Diabetes and insulin resistance. The Insulin is elevated to try to keep the glucose levels down.

RECOMMENDATIONS:

1. Please continue to follow the OmegaRx Zone Program as outlined for you with strict emphasis on the favorable carbohydrates only and including low fat protein and Omega 9 fats with each meal and snack.

2. Normalizing your AA/EPA ratio with more Omega 3 fish oil should also improve insulin sensitivity.

5. EXERCISE AND WEIGHT MANAGEMENT:

Your Zone prescription and DXA body composition data enclosed. Your weight of 180.2lbs gives you a Body Mass Index of 27.8 placing you in a Overweight Category. Your Body Fat % is 23.6% with the ideal male at 16%. Your Lean Body Mass is 138lbs. You desire to get to 16% body fat and we can achieve this by having you add about 4lbs of muscle and lose about 16 lbs of fat over the next 4-6 months. I have calculated a daily calorie count for you of about 1500 Calories. Please see the enclosed Zone Prescription. You should end up with a body fat % of 16% and your weight would be 168lbs.

RECOMMENDATIONS:

1. Stick to the OmegaRx Zone prescription with the extra protein we have prescribed.

2. Continue your SuperSlow program.

3. Repeat Body Composition Scan in Jan 2004 to check your progress.

6. MICRONUTRITION PROGRAM:

Micronutrients are important for Free Radical Control and to get the full benefit of your exercise program and slow the aging process. Your Spectracell Analysis showed a Total Antioxidant Function of 38.1%. The ideal level is >75% and this indicates probably inadequate antioxidant function and increased risk of damage from free radicals. Your present micronutrition program appears to be deficient in antioxidants. There are also mild deficiencies of Vitamin B-12, Folate and Zinc.

RECOMMENDATIONS:

1. We can discuss your present MicroNutrition Program.

2. An excellent program consists of the Life Extension Mix, Life Extension Booster, Dr. Sears Fish Oil, CoQ10 100mg and Bone Up as your Calcium/Magnesium supplement and Extra Vitamin D 1000mg daily.

3. To lower the AA/EPA ratio you need to increase your intake of the Omega 3 Fatty Acids a little bit. Aim for about 6 grams per day of DHA and EPA

(2 Teaspoons or 8 Capsules of Dr. Sears product) for 2 months and then 1 teaspoon or 4 capsules thereafter.

4. You can continue to take the Garlic and Palmeto Plus.

5. A probiotic should be taken anytime you take a course of Antibiotics.

7. MACRONUTRION PROGRAM:

See your OmegaRx Zone Prescription and review your Zone book and video. Your OmegaRx Zone Program has been discussed in the above sections and at the Seminar. I would only emphasize the importance of at least 64oz of water and 30 grams of fiber daily. A good soluble fiber product is the Colon Health product or Metamucil. Soluble fiber promotes the production of the short chain fatty acids needed for colon health. Also remember to stay away from the Trans Fatty acids and the Partially Hydrogenated Fat!! Think about the OmegaRx Zone Brain Shake discussed for Breakfast.

8. OSTEOPOROSIS SCREENING:

See attached DXA printouts. Severe Osteopenia of both Forearms was found with the Right T-Score of –2.3 and a Left T-Score of –2.0. These findings indicate you have 82% and 84% of the Bone density of a young man in your right and left forearms respectively. The Right and Left Hip Overall T-Scores are in the normal range at –0.8 and –0.9 respectively, both close to the osteopenia level of –1.0. Each hip shows that the femoral necks meet criteria for Osteopenia however. The L1-L4 Lumbar Spine has a Overall T-Score of –0.7 and the L3 vertebra meets criteria for Osteopenia with a T-Score of –1.1. These findings are not surprising in view of your low Testosterone and IGF1 levels. Both of these hormones are important for bone metabolism. In addition you have several SNPs which increase your risk for loss of bone mass density and two of these, the COL1A1 and the CALCR are Homozygous + for the SNP. In addition the presence of a SNP of the TNF-alpha gene increases risk for bone loss due to its inflammatory effect. Attention to nutrients known to diminish the effect of these SNPs is important and you will be taking extra protein, Calcium, Vitamin D and Omega 3 Fats.

RECOMMENDATIONS:

1. The Life Extension Bone Up is an excellent product. You should take 8 capsules a day. In addition take the Life Extension Vitamin D 1000mg daily.

2. Testosterone and Growth Hormone will both help restore bone density.

3. I would consider adding Miacalcin, a nasal spray due to the homozygous +SNP of the CALCR gene

4. Continue SuperSlow Strength training. Pressing movements should improve forearm bone density.

5. We should repeat a DXA Bone Scan in 1 year.

9. GENOVATIONS GENOMIC SCREENING:

See the enclosed reports from Genovations. We will discuss these separately

+ Means SNP Present on Gene - Means Gene is Normal

CardioGenomics

APO E		3	3	Average risk for Alzheimer's Disease and Heart Disease. This is the most common form of this gene in the population.
CETP	Taq1B	+	-	HDL tends to be lower in with this SNP. Your HDL at 35 is indeed low.	Exercise, Red Rice Yeast, LEF #20238 or a small dose of a Statin such as Altocor.
	Rsa I	-	-	OK
	D422G	-	-	OK
SELE	98G-T	-	-	OK
	128R	-	-	OK
MTHFR	677C-T	+	-	May have elevated Homocysteine. Yours is indeed elevated at 10.9.	Vit B-12, B-6, Folic Acid
GNB3	825C-T	+	-	Increased risk for Hypertension, Depression and Bipolar Disorder.
AGT	M235T	-	-	OK
AGTR1	1166A-C	+	-	Increased risk for Hypertension.
FACTOR 2	G20210A	-	-	OK
FACTOR 5	R506Q	-	-	OK
*CYBA8**	H72Y	+	-	Increased Oxidative Stress, Increased risk of athereosclerosis.	Lots of Antioxidants, Red Rice Yeast, CO Q10, small Dose of a Statin, Altocor.

ImmunoGenomics

TNF-alpha	308G-A	+	-	Increased activation of the inflammatory cascade with this SNP.	Fruits and Vegetables and lots of Omega 3 Fish Oil.
IL-6	174G-C	+	+	Lowered inflammatory response in most situations. This is good!!
IL-10	627C-A	+	+	Increased risk of chronic inflammation.	Omgea 3 Fats
IL-13	R130Q	-	-	OK

DetoxiGenomics

Detoxi				COMMENT	TREATMENT
CYP1A1		+		Detox of burning organic things, car exhause and cigarette smoke and charbroiled foods.	Do Not Smoke, Avoid Charbroiled or well done meats. Avoid second hand smoke. More antioxidants.
CYP1B1		+		Detox of burning organic things, car exhaust, cigarette smoke and charbroiled foods.	Do Not Smoke, Avoid Charbroiled or well done meats. Avoid second hand smoke. More antioxidants. DHEA, Omega 3 Fish Oil and Red Wine help
CYP2A6		-		OK, Detox of Nicotine
CYP2C9		+		Metabolizes many drugs. You may need lower doses of certain drugs like coumadin, Viagra, Aspirin
CYP2C19		-		OK, Detox of drugs
CYP2D6		-		OK, Detox of drugs
CYP2E1		-		OK, Detox of alcohol
CYP3A4		-		OK, Detox of 50% of Drugs
COMT		+	-	Increased risk of bi polar disorder, late onset alcoholism.
NAT1	R64W	-	-	OK
NAT1	R187Q	-	-	OK
NAT2	I114T	+	-	Some increased risk of environmental toxins, smoke etc	Don't smoke, limit exposure to exhaust, second hand smoke. More Cruciferous Vegetables.
NAT2	R197Q	+	-	Some increased risk of environmental toxins, smoke etc	Don't smoke, limit exposure to exhaust, second hand smoke. More Cruciferous Vegetables.
NAT2	G286E	-	-	OK
NAT2	R64Q	-	-	OK
NAT2	K286R	+	-	Some increased risk of environmental toxins, smoke etc	Don't smoke, limit exposure to exhaust, fried foods and red meat. More Cruciferous Vegetables.
GSTM1	1p13.3	Null	Null	You are missing this gene. This affects your ability to produce Glutathione, an important antioxidant.	You should take extra antioxidants and also extra NAC N-Acetylcysteine and Milk thistle to raise Glutathione levels. Avoid solvents, herbbicides, fungicides, insect sprays.
GSTP1	I104V	-	-	OK
GSTP1	A113V	-	-	OK
SOD1	G93A	-	-	OK
SOD1	A4V	-	-	OK
SOD2	A16V	-	-	Increased risk of Oxidative stress may lead to increased Parkisons, ALS.	Lots of Antioxidants! Increase Glutathione levels.

Osteo Genomics

COL1A1	2046G-T	+	+	Increased risk of loss of bone density.	Extra Calcium and Vitamin D
CALCR	P463L	+	+	Increased risk of loss of bone density.	Extra Calcium and Vitamin D. Consider Calcitonin Spray.
VDR	RFLP	-	-	OK	You still need extra Vitamin D and Calcium.
IL-6	174G-C	+	+	This is good for Bones!!
TNF-alpha	308G-A	+	-	Increased Inflammatory response leading to more bone density loss.	Omega 3 Fish Oil, N Acetylcysteine, Green Tea.

Your partner in Health,

Charles B. Christian, Jr. M.D.

Medical Director

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