We start by acknowledging that you are not alone, falling instead in the growing ranks of the Great North American Bulge. Oversized waistlines are as much a hallmark of the 21st century as the sedentary, wired, prepackaged, convenience-driven relentless lifestyles that cause them.

But that’s where our sympathy ends.

Current research suggests that when you take in more nutrients than your body needs, it changes the way cells process these nutrients. Mitochondria (the energy stations in the cell) become sluggish and start actively accumulating fat stores rather than producing energy. Altered metabolism results in the production of highly reactive molecules called “free radicals”.

Free radicals set off inflammation throughout the body. Inflammation, we are now learning, is the starting point for most chronic disease.

For instance, it blocks the action of the hormone insulin (which controls blood sugar levels) resulting in “insulin resistance” in the body, which then leads to “adult onset” Type 2 diabetes.

Inflammation in the lining of blood vessels inhibits production of nitric oxide, which causes arterial narrowing. In the long run, continued inflammation leads to high blood pressure, heart disease, stroke, several cancers, arthritis, and a host of other immune disorders.

Inflammation is notoriously silent in its early stages. It lurks and grows in your body, as you go about carrying that excess weight with no apparent effects on your health. It is easy to fall into the trap of complacency, only to discover a few pounds later that it is too late.

The much talked about November 2007 study in the Journal of American Medical Association reported that being overweight was not associated with increased heart disease or cancer related deaths. In interpreting this information, we must remember that they were only looking at causes of mortality, and not the occurrence of heart disease or cancer, in various weight categories. The media also failed to highlight the higher rates of deaths from diabetes and kidney disease in the overweight category.

Being slightly overweight may have one advantage, in that the higher fat stores do assist in better recovery from adverse events such as infections or surgical procedures due to higher nutritional reserves.

That is poor consolation given the overriding and devastating long term complications of inflammation that are triggered by those few extra pounds.

1. Body Mass Index (BMI) is calculated by dividing height (in inches) over weight (in pounds). A BMI of 18.5-24.9 is defined as “normal” weight; BMI of 25-29.9 = “overweight”; BMI of 30 or more = “obese”.

Parneet Pal, MD
Manager, Health Programs

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It’s because the traditional diagnostic tests we use are decades behind today’s science. Why? Three reasons – the necessary tests are not covered by insurance; many physicians are unfamiliar with today’s science, and certain test equipment is just not available in many areas (read Ontario).

What’s the “standard practice”?

If you have a family physician, it’s likely to be “incremental medicine” – check your LDL. If it’s “normal” (benchmarks vary) and you are symptom-free, not over-weight and have a healthy lifestyle, that’s where it stops. If your LDL is high, you may be sent for a Stress Test, and ECG or even an Echo-Cardiogram or Nuclear Stress Test.

If you enroll in a “good” executive health assessment, these procedures may all be included as standard practice.

What’s missing from this picture?

None of these tests provides an adequate view or measurement of the common killer, growing plaque in your cardiac arteries. The Stress Test will only register “positive” when a blood vessel has “high-grade stenosis” i.e. when it’s approximately 75% or more blocked, which could mean imminent disaster.

Anything less is a “pass”. This type of testing is simply outdated and inadequate.
Nor do these tests report on the root cause of plaque formation – inflammation of the artery walls. Inflammation produces red, raw and sticky tissue. As a result, even normal levels of cholesterol stick to these damaged artery walls and add to the build up of plaque.

Inflammation results from several causes:

• Diet - an excess of pro-inflammatory foods high in arachidonic acid (red meat, acidic vegetables) and/or inadequate intake of foods rich in essential fatty acids (EFA’s such as Omega’s found in fish and certain nuts) which stimulate healing and recovery and protect against inflammation
• Stress, lack of sleep or exercise, all contributing to impaired immune and bodily healing functions
• Genetics – some of us are simply more prone to inflammation and plaque formation
• High blood sugar, as in diabetes
  

How should you be tested?

First, your genetic predisposition can be determined. It’s no longer a hit-or-miss guess about which parent’s genes you inherited. If you are at risk, you should seriously consider further screening, regardless of your cholesterol levels.

Second, LDL levels alone can be very misleading. You should have the inflammation levels in your blood tested (which most executive check-up’s fail to do).

Risk indications from genetics and abnormal inflammatory markers give sufficient grounds to consider further screening, no matter how “normal” your cholesterol levels.

What’s the next step?

A Cardiac CT (computer tomography) can detect and score calcified plaque. Add to that the CT (“virtual”) Angiography, you will get a vivid 3-D picture of all plaque – calcified or otherwise – and be able to identify any points where arterial occlusion is a risk. This CT procedure is non-intrusive and takes no more than one hour. It should be part of the effective cardiac health assessment for anyone determined to be at risk.

We at Scienta know of far too many instances in which near-fatal heart attacks could and should have been prevented in people who have had regular executive-type check-ups.

Of course, the most current testing would be the use of a Cardiac MRI scan which emits very little radiation, and provides your physician and radiologist the functionality of both the CT (to detect arterial disease) and the nuclear echo testing (to screen for structural or cardiac function abnormalities). Unfortunately, this procedure is still expensive in the US and, in Canada, is almost unavailable.

You can and should go beyond yesterday’s medical science to insure that your risk of a heart attack is clearly identified and effectively managed.

Elaine Chin, MD Chief Medical Officer

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The company’s shareholders have handed you and your co-directors fiduciary responsibility for safeguarding their interests. In today’s knowledge-based economy those interests are not just the numbers on the balance sheet. Rather, they go up and down in the elevator each day.

The fact is, while we say our “people are our most important assets”; neither the Board nor top management fully walks that talk.

Imagine your fit, hard-charging CEO suddenly felled by an unexpected heart attack … or, being diagnosed with an incurable form of cancer. The day after the company discloses this information the stock plunges 20%.

Who is responsible?

Well, the HR Committee did approve an executive health program and the CEO mentioned to you that he/she had recently been given a “clean bill of health”.

Did anyone check to make certain that the program incorporated an adequate risk assessment and early disease detection? Or did you simply sign off on it because it was some big-name clinic or because the price was right? Or you accepted the company Medical Director’s expert view … which too often is based on “old school thinking”?

Suddenly, a large hedge fund that owns 5% of the company sues the Directors for negligence.

Far-fetched?

Here is the reason it isn’t. Today we have the medical science and diagnostic techniques – readily available and in use – to identify risks of heart attack, cancer and other devastating diseases. We can detect them before they become irreversible or fatal.

Why are these techniques not being used by the “big-name” executive clinics?

For several reasons. Most physicians have a traditional “evidence-based” approach which argues that, until the symptoms are evident, certain testing is unnecessary. It can also be that the physicians have not remained current with science and are unfamiliar with the latest tests. It could also be that your insurer will not cover these tests until they’re “medically necessary” (read “too late”).

You should be aware that tests conducted in even the most leading-edge “executive check-up’s” have hardly changed in almost 20 years. The gap between science and practice has never been wider! Unfortunately, medical training and peer pressure against innovation are exacerbating this.

Does that exonerate you as a Board member in today’s Sarbannes-Oxley-driven world?

Indeed, your responsibility as a Director extends well beyond this enormously important Risk Management role. Should you not be ensuring that the CEO and management enjoy the best possible health in order to remain highly energized, creative and productive?

Think about it next time the cost or content of executive health programs become a discussion topic (if they indeed ever reach the agenda of the Board or the HR Committee). The highest-value executives represent highest individual risk to the company. The cost of the demise of any one of them through death or debilitating disease is enormous and dwarfs the cost of a true prevention-driven health screen that uses today’s science.

Health Risks affecting the CEO and other key executives should be right at the center of the Board’s Risk Management thinking and oversight.

Peter Cooper President & CEO

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The best food sources of B-12?

• Meats, fish, shellfish, dairy products
• Cereals fortified with B-12
• Certain green leafy vegetables (providing only limited amounts of B-12, although high in folic acid, which functions synergistically)

If it’s so readily available in the diet, why would someone become deficient?

Absorption of Vitamin B-12 is a multi-step process, with the following factors involved:

• Stomach acid
• Intrinsic Factor (vital protein secreted in stomach)
• Upper part of intestine (B-12 in food combines with Intrinsic Factor here)
• Lower part of intestine (actual absorption of B-12 occurs here)

Deficiency occurs when the body is unable to absorb the vitamin properly, at one or more of the levels above.

Who is the most vulnerable to a deficiency?

• Those aged 50 or over (production of stomach acid declines significantly with age, and up to 30% of the population over 50 is Vitamin B-12 deficient)
• Vegans or strict vegetarians
• Those who have had surgical resection of the intestine
• Those with increased requirements e.g. pregnant women; cancer, liver or kidney disease

What are the symptoms of a B-12 deficiency?

The nervous system begins to get affected even at smaller levels of deficiency:

• Tingling numbness in hands and feet
• Dizziness and Unsteady gait
• Muscle weakness
• Mood disturbances
• Confusion and disorientation

With larger deficiencies, other symptoms show up:

• Lack of energy
• Anemia
• Bleeding gums

Prolonged deficiency can lead to potentially severe and irreversible damage, especially to the nervous system.

So how much Vitamin B-12 should one strive to get in the diet?

Though the Recommended Daily Allowance (RDA) is 2.4 mcg, recent research suggests that much higher levels (in the vicinity of 6 mcg) are necessary to avoid the risk of deficiency.

Amazingly, the body can store from 3-5 years of the vitamin in the liver.

Is a deficiency easily corrected?

Yes, low B-12 levels can typically be corrected with oral supplementation, usually with doses of 1000-1500 mcg per day. Though this dose may sound dramatically high compared to the RDA, these high levels ensure that enough B12 is absorbed into the blood to make up for long standing deficiency and to build up stores. For those with severe absorption abnormalities, intramuscular or intranasal supplementation is an alternate option.

Shelley Burns, ND

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All cereals have a significant amount of fiber

For a 1 cup serving of each type, compare the differences in the fiber content of some common cereals:

Cereal	Fiber (g)	Carbs (g)	Fat (g)	Protein (g)	Calories
Raisin Bran	7	45	1.5	5	190
Cheerios	2	21	2	3	110
Kashi Go Lean	10	30	1	13	140
All Bran	12	27	1	4	180
Post Muslix	4	40	3	5	200

Caesar salad is a healthy lunch choice

An analysis of the caloric and nutrient content reveals that being a salad doesn’t equal “healthy”.

	Caesar salad	Spinach salad
Contents	Romaine lettuce, chicken breast, croutons, bacon, Caesar salad dressing	Spinach, mushrooms, sweet peppers, balsamic vinaigrette, chicken breast
Calories	295	174
Fat (grams)	11	2
Protein (grams)	16	9
Carbohydrates	31	29

Shelley Burns, ND

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What are the benefits?

• Improved balance – a key attribute overlooked in most workout plans
• Enhanced core and trunk muscles, especially the erector spinae (muscles around the spine) which are difficult to develop safely and are critical to protecting you against spinal injury and degradation
• Develops multiple muscles simultaneously in a coordinated manner
• Enhances safe and essential stretching of muscles that contract while seated in meetings, commuting or air travel

Most hotel and other fitness centers now offer a range of stability balls.

Get started with these 4 exercises on the ball:

1. PUSH-UPS
   • Prone Position (face down), neutral spine, shins or thighs resting on ball
   • Hands on floor with wrists stacked under shoulders and slightly wider
   • Do 2 sets x of 8-12 push-ups, keeping your balance on the ball
   
2. “PLANK POSITION” CORE STRENGTHENING
   • Prone position (face down), forearms on ball, toes on floor
   • Straighten your spine into a "plank" position, head in line with spine looking down, hold abs in; full weight on forearms and toes
   • Hold 15 - 30 seconds x 3 sets
   • If you find this too difficult, start with the Modified version on the knees
   
3. HAMSTRINGS CURLS
   • Supine position (on your back), palms flat on floor, and heels on ball,
   • Lift hips off floor, roll the ball in and out with heels, keeping hips elevated
   • Do 2 sets x 8 reps
   
4. AB CURLS / OBLIQUE CROSS OVERS
   • Supine position (on your back), knees at 90 degree angle, calves resting on ball
   • Clasp hands behind head, elbows back
   • Raise head, neck and shoulder blades off floor, lifting chest toward ceiling, keeping a large space under chin – hold briefly and relax
   • Change to oblique cross-overs, turning elbow to point at opposite knee and alternate (oblique exercise)
   • Do 4 sets x 8 reps of each type
   

 

Heidi Dreimuller, BA
Health Concierge & Certified Personal Trainer

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