Berberine and its Role in Diabetes Care
In the last five years, Berberine has come to the forefront of the treatment for chronic diseases such as diabetes. Berberine is an herbal nutraceutical noted for its multisystem effects, primarily in lipid and glucose reduction. What is Berberine? Berberine is a chemical extract from herbs containing a complex of vitamins, antioxidants, and other synergistic chemicals that form a compound called Berberine, a bitter crystalline yellow alkaloid. It is a compound obtained from the parts of various plants (such as barberry) and used in medicine specifically for its antimicrobial, hypoglycemic, and hypolipidemic properties. Berberine has its roots in Chinese and Ayurvedic medicine. It can be isolated from various traditional herbs such as goldenseal, tree Tumeric (not spice Tumeric), barber, Oregon grape, Phellodendron, and golden thread herbs. The compound is found in all parts of the with the roots containing the highest concentration of the alkaloid. How does Berberine act to control blood sugar? The downfall of studying potential mechanisms for Berberine is that many of the studies have been conducted in animal models or, at best, in human' cellular tissues. Actual clinical trials are sparse and need to be performed on a widespread basis. What we know are the following: Berberine stimulates AMPK, or 5' adenosine monophosphate-activated protein kinase, is a crucial energy-regulating enzyme in the human system. The key roles of this enzyme are:
Berberine reduces insulin resistance Insulin resistance is a primary finding in diabetes type II. Exercise, calorie restriction, low glycemic load diets all reduce insulin resistance. We are finding that Berberine, through multiple metabolic pathways, reduces insulin resistance through multiple mechanisms. Insulin resistance is reduced by upregulating insulin receptors, so there are more receptors for insulin to bind to.This is a unique way around the resistance of the existing receptors – make new ones. Berberine stimulates this process. Although AMPK mediates this process, it deserves mentioning on its own. Clinical Role of Berberine.
500 mg of Berberine t.i.d. (three times daily) A study published in 2010 replicated the increase in humans' insulin receptors, concluding that a 500 mg. berberine supplement taken twice per day lowered serum insulin in the patient group by 28% and fasting glucose by 26%, similar to the drug intervention group receiving Metformin and rosiglitazone. Berberine reduces insulin resistance by inhibiting the uptake of free fatty acids as well. Berberine also stimulates the insulin-signaling cascade, or the way insulin talks to the cells. Action on Glut1 Glut1 is a transport protein that carries glucose across cell membranes without the requirement of insulin. Recent data has shown that Berberine facilitates the glucose transport mechanism of Glut1, which is another potential explanation for Berberine’s positive blood-glucose-lowering role in diabetes. A study published in 2011 demonstrated for the first time that Berberine acutely activates the transport activity of GLUT1 in mouse fibroblast cells. Action on branched-chain amino acids Obesity and insulin resistance have been associated with a high circulating blood level of the branched-chain amino acids (BCAAs), leucine, valine, and isoleucine. A recent 2019 study in mice demonstrated that Berberine reduces these amino acids, thus reducing insulin resistance. Of course, whether this study can be extrapolated to humans remains to be seen in well-designed clinical trials. Stimulation of glycolysis Glycolysis is the breakdown of glucose for energy. Berberine is known to stimulate this function. What does the research say about type 2 diabetes and berberine treatment? Berberine has become well known as a nutraceutical similar in effectiveness to Metformin or Glucophage without the serious gastrointestinal side-effects Metformin is so well known for. Through identified mechanisms such as stimulating AMPK, and glycolysis, as well as other identified actions, Berberine may very well be a suitable adjunctive therapy for prediabetes or diabetes in conjunction with diet and exercise. Studies back in 2008 showed significant drops in HbA1C and fasting glucose in hyperglycemic patients given 500 mg berberine three times per day compared to traditional Metformin treatment. Fasting plasma insulin and insulin resistance were reduced by 28.1 and 44.7%, respectively, in this study. A 2019 review revealed more extensive studies of Berberine relative to its hypoglycemic effects and positive relationship in diabetes management. Used in a traditional dosage of 500 mg two to three times a day, Berberine can be a successful adjunctive treatment to medical nutrition therapy in the management of diabetes. Safety Profile of Berberine Treatment for Diabetes Berberine has been used safely for thousands of years. However, recent studies have shown interaction with drug detoxifying enzymes and thus a potential for drug-drug interactions. As with any nutraceutical treatment, always check with your health care provider before adding a nutraceutical to your care plan regimen. ConclusionThe use of Berberine in the control of blood sugar is well supported by the literature and historically in treatment regimens. It has proven to be a safe alternative to Metformin and may be preferable, or certainly, an alternative given the side-effects associated with this medication.
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Weight Plateaus are frightful, bothersome states of metabolic stagnation that occur smack dab in the middle of a successful weight loss plan. Even if expected, plateaus can cause discouragement, feelings of failure, and a desire to “give up.”
No, no need to give up. Let’s look at some game changers for those plateaus. At the bottom of this physiological storm is that of survival. In a plateau, the body is fighting to stay alive, lowering its metabolism to match the calories given to it. Yes, it defeats the purpose but the body is just trying to save its own life by this metabolic shift. The question(s) then become the following:
Plateau Interventions, What Should be in Your Toolbox???? Meal Plan Manipulations Keep the Food/Symptom Diary again if you are not still doing it. Sometimes, as the same old regimen is repeated, boredom slips in. Calories begin to creep back in, portion sizes aren’t watched like they used to be. Go back to the basics: weigh, measure and revisit portion sizes and food choices. Intermittent-Fasting Routine: For this plateau buster, the weight loss is facilitated by moving calories. For 2-3 days either a very low calorie diet (800 calories) or a fast can be chosen to throw the body’s expectations off. Do this for two days then go back on your meal plan for 3 days and then fast or follow a very low calorie diet on an every- other- day basis. There are various renditions of this manipulation. Now, hunger is still a problem with this type of plan unless your fasting days take you into ketosis. Not appropriate for diabetes. Fasting is associated with increased ghrelin and decreased obestatin in the blood circulation. Specifically these naughty hormones are ghrelin and obestatin. Both hormones play intricate roles in playing with our regulation of diet induced thermogenesis. Alternatively, one can increase calories while at the same time kicking up exercise intensity to 70-75% Maximum Heart Rate for one to two days and then drop down to 800 calories and then return to caloric weight loss plan. The idea is to fool your body’s metabolism to break the cycle. Calorie-Restricted Adequate Nutrition (CRAN): This meal plan, originally developed in life- extension research, was found to be effective at keeping the body lean and mean, but it is not practical to live on such small amounts of food with supplementation for extended periods of time. These human studies continue, but now the rage is to look for CRAN mimetics that make life more livable. However, short term use can blast a hole in a plateau! Macronutrient Manipulation: Take your meal plan and flip flop it. For example, low carbohydrate high protein for one month may be different than the high fiber low fat meal plan you may have been following. Some meals will be turned from a meat based to a vegetarian based or from a regular carbohydrate diet to a low glycemic carbohydrate, high protein diet. Again, your body is fooled for a bit. Then, don’t forget the little plateau “busters”: a) drink 8 oz. glass of water or sugar free beverage prior to a meal; b) achieve adequate hydration, but not too much – 1 ml per kcal or 8 glasses per day and consume high water foods such as melons, hot cereals; c) keep your sodium to the recommended level of 2,300 mg. sodium/day or higher if exercise requires it. Exercise and Lifestyle Change Your Workout Routine: Keep your metabolism guessing! Here are some guidelines creating new work-outs for your toolbox. Have fun with the following ideas! Redesign your old work -out program by changing one or more variables – frequency, intensity, duration. FREQUENCY: Change the number of times you do a work out per week. DURATION: Change the length of time you do a specific workout. INTENSITY: Increase your target heart rate for 20 minutes of the cardio portion of the routine. Use Video exercise programs to increase compliance. Try to get fresh air and walk daily! Remember to adjust your fluid and meal intake to the type of sports you are in – professional athlete vs. weekend warrior. Get in touch with your hunger signals again and what that feeling is like. Plan ahead for parties and social events. Thermogenic Aides or Where's The Pill? A pill is not our long-term answer. Short-term like in Breaking a Plateau, it is reasonable. And, our top contenders for Thermogenic Aides are: Green Tea: This herb has been used medicinally for a very long time. Studies have shown that green tea can help reduce obesity when consumed on a daily basis. I seems to work by increasing metabolism after eating. Green tea may also reduce appetite, fat absorption, and storage. To break a plateau, drink 6 0z of caffeinated green tea 3x per day until weight loss is established again. The chemicals responsible for green tea's effect on weight are primarily ECGC, catechins , and polyphenols. Green Tea should be respected as a known adjunct to reducing BMI, body weight, and body fat, reducing overall fat cell generation, decreased fat absorption, and suppressed appetite. Hot, Spicy Foods: Incorporate the use of hot chili peppers and turmeric in meals. These spices cause a slight sweating reaction and a greater response to the food, thus elevating thermogenesis. Resveratrol: Resveratrol has been on the market for many years and has been used medicinally for generations. Controversial human trials continue, but studies have shown that 150 mg of trans-resveratrol will cause weight loss in obese but not normal weight humans. Vitamin D/Calcium: Approximately 90% of our world’s population is deficient in vitamin D. Vitamin D is actually a hormone, and recent reports suggest that our rise in obesity is related, in part, to our lack of Vitamin D and calcium. Bitter Orange, p-Synephrine, Caffeine, Kola Nut: These nutrients/foods- all thermogenic teas-can be used alone or in combination to break the plateau. While controversy exists regarding the use of these products, used judiciously they are safer than weight loss drugs in general and pose few side effects when used as indicated. Vitamin C: Vitamin C is inversely related to body mass. Individuals replete vitamin C and oxidize 30% more fat during moderate exercise than those who are depleted. The dosage should be approximately 100 mg by food (preferably) or supplement. If you smoke, add 35 mg daily to this value. Transformation of our Mindset
In taking an Integrative and Functional Medicine Approach, we must look at our toolbox holistically. Approaching problems from many angles means utilizing the most neglected tools to meet our goals at all levels of the problem. Sources Al-salafi R, Irshad M, Abdulghani. Does green tea help to fight against obesity? An overview of the epidemiological reports. Austin Journal of Clinical Medicine. April, 2014. http://www.researchgate.net/profile/Md_Irshad2/publication/262201112_Does_Green_Tea_Help_to_Fight_against_Obesity_An_Overview_of_the_Epidemiological_Reports/links/54367faa0cf2dc341db352c7.pdf. Accessed 5/21/15. Bradford PG. Curcumin and obesity. Biofactors. 2013; 39 (1):78-87. http://onlinelibrary.wiley.com/enhanced/doi/10.1002/biof.1074 . Accessed 5/22/15. Johnstone A. Fasting for weight loss: an effective strategy or latest dieting trend? International Journal of Obesity. http://www.nature.com/ijo/journal/v39/n5/full/ijo2014214a.html Accessed 5/21/15. Lin L, Lee JH, Bongmba OYN . . . The suppression of ghrelin signaling mitigates age-associated thermogenic impairment. 2014. Aging.6 (12):1019 http://www.impactaging.com/papers/v6/n12/pdf/100706.pdf Assessed 5/21/15. Muceherjee A, Mukherjee S, Biswas J. Phytochemicals in obesity control. International Journal of Current Microbiology and Applied Sciences, 2015 4(4): 558-567 http://www.impactaging.com/papers/v6/n12/pdf/100706.pdf Accessed 5/22/15. Singh R. Significant improvement in obese, grade three male individual with nutrient dense low calorie, moderate to high protein diet. Advances in Obesity, Weight Management and Control2015. 2(2) http://medcraveonline.com/AOWMC/AOWMC-02-00013.pdf Accessed 5/22/15. Stohs SJ, Preuss HG, and Mohd Shara. A review of the human clinical studies involving citrus aurantium (Bitter Orange) Extract and its primary protoalkaloid p-synephrine. International Journal of Medical Sciences 9(7): 527-528. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3444973/ Accessed 5/22/15. Timmers S, Konings E, Bilet L, . . .Calorie restriction-like effects of 30 days of resveratrol supplementation on energy metabolism and metabolic profile in obese humans. Cell Metabolism. 14:612-622 http://www.sciencedirect.com/science/article/pii/S155041311100386X Accessed 5/21/15. Wang S, Moustaid-Moussa NM, Chen L.. Novel insights of dietary polyphenols and obesity. J of Nutr Biochemistry. (25): 1 http://www.sciencedirect.com/science/article/pii/S0955286313001617 Accessed 5/21/15. Adapted from the Weight-Loss Program, “Synergetics,” by Kathryn J. Shattler, M.S., RDN Unlock the secrets to enhanced well-being with our guide to the best functional nutrition supplements for optimal health.
Understanding Functional Nutrition and Its Importance Functional nutrition is an approach to health that considers an individual's unique nutritional needs. It emphasizes using whole, minimally processed foods and targeted supplements to support the body's natural functions and promote overall well-being. Functional nutrition aims to optimize health and prevent disease by focusing on personalized nutrition and addressing the root causes of health issues. This holistic approach considers genetics, stress levels, and lifestyle choices, making it a comprehensive strategy for achieving and maintaining optimal health. Critical Supplements for Boosting Immunity A robust immune system is essential for defending against infections and illnesses. Several supplements, including vitamin C, vitamin D, and zinc, can play a crucial role in enhancing immune function. These nutrients are known for their ability to strengthen the immune response, reduce inflammation, and support the production of immune cells. Probiotics are another essential supplement for immunity, as they help maintain a healthy gut microbiome, which is closely linked to immune health. Additionally, herbs such as echinacea and elderberry have been shown to boost immune function and reduce the severity of colds and flu. Enhancing Digestive Health Through Supplements Digestive health is a cornerstone of overall well-being, affecting nutrient absorption, energy levels, and immune function. Supplements such as probiotics and digestive enzymes can significantly improve gut health by supporting the balance of beneficial bacteria and aiding in the breakdown of food. Fiber supplements, like psyllium husk, can also enhance digestive health by promoting regular bowel movements and preventing constipation. Additionally, supplements like glutamine and licorice root extract can help heal the gut lining and reduce symptoms of digestive disorders such as leaky gut syndrome and irritable bowel syndrome (IBS). Supplements to Support Mental Clarity and Mood Various factors influence mental clarity and mood, including nutrition. Certain supplements can help enhance cognitive function and emotional well-being. Omega-3 fatty acids, found in fish oil supplements, are known to support brain health and improve mood by reducing inflammation and promoting neurotransmitter function. Adaptogenic herbs such as ashwagandha and rhodiola can help manage stress and improve mental clarity by balancing cortisol levels and enhancing resilience to stress. Additionally, supplements like magnesium, B vitamins, and GABA can support relaxation, reduce anxiety, and improve overall mood. Choosing the Right Supplements: Safety and Quality Considerations When choosing supplements, it's essential to prioritize safety and quality. Look for products that have been third-party tested for purity and potency, and opt for supplements made from high-quality, natural ingredients. Avoid supplements with artificial additives, fillers, or preservatives. Consulting with a healthcare professional before starting any new supplement regimen is also crucial. They can provide personalized recommendations based on your specific health needs and conditions. By taking these precautions, you can ensure that you're selecting the most effective and safe supplements to support your health and well-being. Check out the Fullscript Dispensary under the Supplements tab for a 15% discount and more information on top selling supplements. Disclaimer: This page may have affiliate links that I make a commission off of. I strive to make products available that I would use myself at a discounted price to my visitors. What is a lectin? A lectin is a type of protein that is attracted to certain types of sugars or carbohydrates in our diets. It binds to cell membranes in a sticky manner and becomes the “glyco” of glycoproteins. Lectins offer a way for molecules to stick together without involving the immune system, which can influence cell-cell interaction. However, lectins are involved in the immune response.
Where are lectins found? Lectins are found mostly in starchy foods, except for seeds, dairy and nightshade vegetables. They are high in foods such as the following:
Lectins serve as a natural pesticide for plants. They ward off bugs, diseases, fungi, and microorganisms. It has even been hypothesized that lectins allow a plant to evolve and seeds to pass through a gastrointestinal tract unchanged and, thus, subject to further propagation. The curious part is that they end up in the bloodstream of humans unchanged since they are resistant to our digestive process. Lectins are thought to play a role in immune function, cell growth, cell death, and body fat regulation. They can also be powerful allergens. Are there any benefits to lectin use? Surprisingly, lectins and their application in medicine have benefits. In general, a wide range of biological applications has been attributed to plant lectins, such as mediators of inflammatory and immune response, antiviral, antibacterial, antifungal, and anthelminthic agents, healing effect, drug delivery, histochemical markers, biosensing of diseases, and antitumoral activities. One of the most well-documented uses of lectins is in anticancer activities. In addition, lectins may interact with receptors and other molecules present in the cell surface and/or cytosol to reduce cell proliferation, activating cell death pathways. A recent 2022 study linked lectins to antiviral uses, including COVID. Anti-viral lectins bind to glycans on the viral surface and interfere with the binding of the virus to an infected cell. What are the dangers of lectins? Although lectins do play a role in human physiology, care in the selection and cooking process of many lectin-containing foods can render the dangers harmless. In other cases, lectins may need to be avoided. Systemically, they can disrupt lipid, carbohydrate, and protein metabolism, promote enlargement and/or atrophy of key internal organs and tissues, and alter the hormonal and immunological status of the body. Lectin-free diets exist; some integrative physicians use them with their patients to alleviate systemic complaints. Lectins and the intestinal wall: Despite popular literature, not all lectins are bad, as we discussed in our discussion of their applications in medicine. It is essential to take a balanced view of the topic of lectins and realize that while lectins may cause some problems when used correctly and for the right therapeutic reasons, they can also be a medicinal aid. Final thought Lectin-free diets have again become popular since Dr. Gundry published his book The Plant Paradox in 2017. Remember that a lectin-free diet is very restrictive and fosters an unhealthy relationship with food. It may make getting all your nutrients from the food groups difficult. It may not be accessible or affordable. Despite being on the NY Times bestseller list, this book has problems. His views on lectins may just be one of them. Does Your Food Look Like and Taste Like Plastic? Here’s the Reason Why
Have you noticed that your meat is unnaturally rubbery, and your vegetables seem to bend, not break? This is a sign of a serious issue-they're contaminated with phthalates, a problem that's now at epidemic levels. The concerning part? Government regulations are lagging behind the mounting evidence of the health risks these phthalates pose. What Are Phthalates? Named the “forever chemical,” phthalates are plasticizers used to create durability, flexibility, transparency, and longevity in products that contaminate our foods. They are used in canned foods, infant foods, packaging, and sealants; they are everywhere. The government regulates a “safe” level, but that safe level does not seem to be consistent with current research on the levels that cause adverse health impacts. Where Are Phthalates Found? Foods highest in phthalates are:
What Are the Health Problems Associated with Phthalates? These eight plasticizers are all endocrine disruptors that have ill effects on reproductive health, childhood development, insulin resistance, the development of high blood pressure, obesity, breast cancer, allergy, asthma, and diabetes. The FDA has continually denied petitions from other groups to change the levels of plasticizers allowed in food products, even being sued once. However, despite years of protests, petitions, and lawsuits, the FDA refuses to change the levels they have deemed safe despite proof that such levels cause human harm. Reducing Your Exposure to Plasticizers Here are some action tips to reduce your level of contamination from forever chemicals.
It looks like plasticizers are here to stay, so just try to avoid them as much as you can. It is sad that we cannot depend on the FDA to protect us from known contaminants that cause human harm. After all, isn’t that one of their roles? Comment from Reader Per- and polyfluoroalkyl substances also known as "Forever Chemicals" are used in many chemical and manufacturing processes. Humans can be exposed to PFAS in the air, food, water, dust, soil, food wrappers, cosmetics and personal care products. PFAS have been associated with serious health effects including cancer, organ damage and endocrine disruption. Various common foods, including meat, seafood, dairy, grains, and produce, can contain PFAS. Tests on several brands' food packaging have shown elevated PFAS levels. Consuming contaminated foods exposes individuals to potentially harmful levels of these chemicals. Cooking with contaminated water can also be a significant source of exposure to PFAS in food. Both tap water and some bottled waters have been found to contain potentially dangerous levels of forever chemicals Find out more on: https://www.consumernotice.org/environmental/water-contamination/pfas/food/ https://www.consumernotice.org/environmental/water-contamination/pfas/products/ Thank you for reading my blog and I encourage more of my readers to interact with my blogs. Functional medicine focuses on global health by emphasizing the personalized and systems-oriented approach found in the functional medicine matrix. At the heart of this is the consideration of everyone as a “biochemically individual” patient. Just what does this mean? Definition of “Biochemical Individuality” This term represents the concept that the human body is a composite of each individual's physiological structure, nutritional, and chemical makeup as influenced by their environment, lifestyle, and genes. Some geneticists say we control 80% – 97% of our genetic expressions. Genes are turned on and off by nutrition and the environment. The term was coined in 1956 by Dr. Roger Williams, so it is not a new concept, just a newly used concept. It is a familiar concept in integrative medicine, but not so much in allopathic approaches such as obtained with traditional medical doctors who have had no osteopathic or integrative experience. Functions of Biochemical Individuality in Functional Medicine This term explains how the body individually reacts to stimuli such as:
The most accurate test to determine the nutritional status of the blood is not always a blood test. A “challenge” test or other more specific tests are often needed to determine individuality. For example, a simple blood test of B12 levels may show values in a normal range, but testing for antibodies to vitamin B12 may uncover a problem that otherwise would not be seen. Antibodies against B12 mean you may have adequate B12 levels in the blood, but you also have substances causing the B12 not to work. In addition, folate and B12 should be measured at the same time because deficiencies of both can cause similar symptoms. The Schillings test tells the practitioner if you are absorbing that average level of B12 properly. The methylmalonic test detects early B12 deficiency that a regular blood test would not pick up. These are tests that an MD is unfamiliar with, but that shed light on the intricacies of precise deficiencies and how to fix them. Gene-Nutrient Interactions Each of us may have a unique “barcode” that separates us as individuals buried in our genes. The mind, emotions, behavior, and physiological functioning are all determined to a great extent by the interaction of this “barcode” with nutrition. For example, metabolic syndrome progression largely depends on gene/nutrition/environment interactions. The importance of nutrition cannot be overstated. Studies have shown that personalized dietary instruction improves insulin sensitivity in those with metabolic syndrome, a disease for which no one treatment is entirely adequate. This raises questions about the adequacy of the Recommended Dietary Intake (RDI) levels established by the government and based on “normal” people. The RDI levels did not consider biochemical individuality. Genetotrophic Disease These diseases result from genetically determined metabolic needs not being met through diet and supplements. Medications, the environment, or other nutritional factors may have altered the genes. Nevertheless, the disease will develop if the nutrient in question is not provided. Remember, your doctor does not usually test the vitamin status of your blood, yet these tests are available and are often ordered by dietitians or integrative medicine practitioners. Insurance may cover these tests if properly coded and ordered by a licensed professional such as a Physician's Assistant or Doctor of Osteopathic Medicine. Companies such as Labcorp, or Ulta Labs perform micronutrient tests. *Note: RDs may be able to order reimbursable labs once our licensure is in place next year in 2025. We can already order clinical diets in hospitals and long-term care. Application Consideration of each person's biochemical individuality is integral to a comprehensive functional medicine assessment. Implementing patient-specific treatment plans based on biochemical individuality is essential to the success of patient outcomes. Clinical nutrition used within the contextual framework of Functional Medicine (FM) is similar in structure, but not theory, to Medical Nutrition Therapy (MNT) practiced by registered dietitians as commissioned by the Academy of Nutrition and Dietetics (AND). The difference lies in the theory and how the framework is applied to the individual, where MNT is expanded to operate out of the Functional Medicine Matrix of assessment and treatment.
What is Medical Nutrition Therapy in Functional Medicine? MNT is a clinically focused approach with a defined system of assessment charting and intervention, evaluation, and follow-up considerations. The acronym for this system is ADIME, assessment, diagnosis, intervention, monitoring, and evaluation, and often forms the basis for charting notes. Assessment In functional medicine, the assessment phase differs for clinical nutrition from that of a traditional dietitian or practitioner. In the assessment phase, the probing for information and the tests are clinically specific, and the information is globally pertinent in the areas of environment, society, culture, relationships, stress, sleep, anxiety, eating disorders, food/medication interactions, and work. All this information is considered in the nutrition assessment phase of the FM practitioner as opposed to a pure nutrition assessment of calorie intake, food preferences, and medical history. While the traditional dietitian asks for general labs, the FM practitioner may ask for more biochemical absorption and metabolism tests, such as the Shillings test for B12 absorption or a urinary iodine test for thyroid function. Diagnosis Clinical nutrition diagnoses are biochemically individual based on specific laboratory tests and the functional medicine matrix assessment. Intervention The interventions for an FM clinical nutrition patient may contain elements gathered from the FM matrix and may often include stress interventions to lower cortisol, which affects carbohydrate metabolism, or sleep interventions that affect appetite control during the day. Monitoring After an intervention, one of the most frequent problems is the loss of patients to follow-up. Nutritional therapies must be monitored as many are short-term, and lab reassessments are needed to determine progress and future treatment. For example, a person with high cholesterol/triglycerides may be placed on a low-fat, low-carbohydrate diet with Berberine 500 mg 3x/day for six weeks. Then, a total cholesterol \triglyceride redraw is done to see if progress is being made to determine if berberine needs to be continued or the diet tweaked. Follow-up Follow-up is similar to monitoring, but you are making specific scheduled visits to obtain monitoring data, so the patient expects to come back to see the practitioner on a given date and time. It stresses accountability for the intervention. Goals of Clinical Nutrition in Functional Medicine The goals of clinical nutrition are to use the MNT model in such a manner that:
Clinical nutrition is essentially MNT applied within the Functional Medicine Matrix, which customizes all assessments and interventions to personalize the individual's care. It is a comprehensive approach to nutritional intervention that goes deeper yet is more expansive than traditional medicine. Nootropic adaptogens enhance the “state of nonspecific resistance” to stress, a physiological condition linked with various disorders of the neuroendocrine-immune system. Adaptogens exhibit neuroprotective, anti-fatigue, antidepressive, anxiolytic, nootropic, and CNS-stimulating active properties. Notice nootropic effects. Nootropic specifically refers to the actions of the adaptogens that stimulate memory, learning, and overall cognition.
How does one “bio-hack” with nootropic adaptogens? Bio-hacking refers to hacking into the body’s neuro-immune system with those adaptogens known most for their nootropic effects. This creates a sharper memory, bigger brainpower, and maybe even a reversal of mild cognitive impairment or MCI, affecting over 20% of the population. Furthermore, chronic stress is known to compromise brain function in those already suffering from MCI and to be a risk factor for its development. About 284 million people suffer from anxiety disorders worldwide. Given the need for stress relief, scientists have begun studying adaptogens more acutely. Nootropics are of specific interest, given the need for sharper brain power and ammunition against MCI. Most Commonly Used Herbal Nootropic Adaptogens
The most widely studied effect of nootropic adaptogens has been their notorious stabilizing effect on the cortisol hormones, raising them or lowering them as needed. Since cortisol plays a vital role in cognition, keeping the levels regular is important in maintaining a good memory. Other than this effect, numerous other effects can be attributed to this class of plant medicinal, such as:
This is a very new field in conventional medicine, and studies on the use of these agents in the field of mental health are evolving. Ginseng, for example, has been recently proven to enhance cognition in Alzheimer’s disease. However, the widespread use of nootropics for general mental acuity has been utilized for centuries in both Chinese and Ayurvedic medicines. Theoretically, nootropics can prevent or reverse MCI. Since adaptogens also act as nootropics, using an adaptogen to facilitate optimal cognition or reverse MCI is a strategic approach to decreasing stress-related changes that facilitate MCI and optimize existing cognition. Conclusions may be that nootropics be regarded as a novel pharmacological category of anti-fatigue drugs that:
If you feel you need a cognitive bio-hack, choose one of the most commonly used nootropic adaptogens and, with the help of your clinician, design a mental health improvement plan. Dosages for each nootropic differ according to the herbal type (root, powder, tincture) and classification. The inflammatory process is designed to help us with the function and repair of injury. However, inflammation that is out of control and chronic can lead to diseases such as metabolic syndrome or arthritis. Acute inflammation can be downright painful. It is no wonder we have developed anti-inflammatory medications to control these effects and have now turned to a more natural relief, cannabidiol.
What is Inflammation? nflammation is the body’s response to injury. It is the body’s way of telling the immune system that it needs to heal itself, repair damaged tissue, and defend against pathological invaders such as bacteria and viruses. For example, in acute injury, inflammation is usually short, and it is designed to remove the harmful agent. This is a positive inflammatory response. Our job is to prevent the inflammation from getting out of control by taking anti-inflammatory measures. Short-term measures for acute inflammation might include rest, ice, compression, elevation, and topical CBD. When inflammation is prolonged past the critical stage and becomes chronic, tissue damage can occur, and pain can become relentless. What happens when inflammation sets in? Your body increases its production of white blood cells and cytokines to help fight infection. Cytokines are small messenger proteins that can stimulate inflammation. Cytokines can be pro-inflammatory and cause swelling and heat in the tissues as an inflammatory response. Cytokines are also involved in the sensation of pain. CBD has been shown to downregulate cytokines. The primary problem with inflammation is the increased production of free radicals, causing oxidative stress. Oxidative stress is the balance between the production of free radicals and the presence of antioxidants. When there are more free radicals than antioxidants, the body becomes stressed and out of balance, and tissue damage occurs in general. When oxidative stress operates, total speed damage occurs to proteins, fats, and genetic material, specifically. CBD has been shown to have potent antioxidant activity. Signs of inflammation include:
If inflammation is necessary for our body to heal, what types of inflammation do we need to control to feel well and still be in balance and healthy? Acute inflammation Inflammation can be divided into acute and chronic. There is local vasodilation, increased capillary perfusion, accumulation of fluid, and pain from increased cytokine production in acute inflammation.” If these processes are not halted, such as by the use of CBD, and whatever caused the inflammation is not removed, progression to chronic inflammation will occur, which is characterized by a maladaptive immune system and the overexpression of pro-inflammatory genes, the dysregulation of cellular signaling and the loss of barrier function. Examples of acute inflammation:
A reaction to an acute injury will begin within two hours of the injury, and anti-inflammatory measures are generally begun to prevent the inflammation from causing tissue damage or pain from the resulting swelling. Acute inflammation can serve a positive role if it stops an infection from causing tissue damage or cushions an injured joint from further harm. Chronic inflammation is a maladapted immune system response of the immune, nervous, endocrine, and reproductive systems to a perceived threat or injury. This maladaptation leads to such diseases as:
Can CBD be Used for Inflammation? Some of these chronic conditions do not have acceptable treatments for the pain associated with them, such as osteoarthritis. Opioids and non-steroidal anti-inflammatories often do not adequately control the pain and/or are not acceptable as a treatment option. In a landscape of opioid addiction, other viable pain relievers must be found. This is where CBD can be safely used topically or orally to control the pain from the inflammatory process. CBD as a Safe Alternative Anti-inflammatory Current therapies for inflammation involve pharmaceutical drugs with well-known and mostly adverse side-effect risk profiles not only on the cardiovascular system but also on the gastrointestinal tract. Drugs such as diclofenac sodium or ibuprofen are common pharmaceutical answers to inflammation, but they come at a price that may put your heart or gut at risk. CBD has few to no adverse side effects making it a perfect alternative to more dangerous therapies. Does CBD Help With Inflammation? CBD is well known for its anti-inflammatory effects, and CBD limits the formation of free radicals and modulates the function of the immune system. How does it do this? CBD is known to: ● Increase cellular apoptosis (cellular death). Cell death refers to leakage of cell contents into the adjacent tissues, resulting in the transfer of white blood cells to the injured tissue. The accumulation of white blood cells and enzymes and oxygen radicals release enhances the inflammatory reaction. ● Inhibit cell proliferation. The cellular division increases rapidly during the inflammatory process, and CBD slows down the growth of unruly cells. ● Inhibit cytokine production. Cytokines are signaling molecules released from immune cells that cause inflammation. ● Stimulates induction of T-regulatory cells. T-regulatory cells prevent auto-immune disease, are immunosuppressive, and promote wound healing. ● IL-6 suppression IL-6 has pro-inflammatory characteristics and plays a pathological role in autoimmunity and chronic inflammation. CBD amplifies CB2 receptor signaling, which regulates inflammation and immune cell activity. It does this without actually binding to the CB2 receptor, and CBD can down-regulate the CB1 receptor while up-regulating the CB2 receptor. It does this through a myriad of parallel metabolic pathways involving other receptor sites and enzymatic actions. Its actions are often termed the “entourage effect” since CBD works in concert with terpenes, flavonoids and other synergistic molecules to achieve its anti-inflammatory effect. CBD is also known to inhibit a specific enzyme (FAAH) that breaks down the body’s own endocannabinoid, Anandamide, causing these levels to be elevated exerting another synergistic anti-inflammatory effect. CBD Dosage for Inflammation Clinical trials are fervently underway to answer the myriad of questions the new legal status of CBD has ushered in. With CBD status now primarily legal in the US and Europe and the rest of the world taking a renewed interest in it pharmacologically, studies that can accurately answer CBD dosage questions are underway. For now, we have a plethora of animal studies that cannot be extrapolated to humans and small, poorly designed human trials from which to glean some information on dosages for inflammation. Topical doses of CBD for inflammation Animal studies have shown us that low doses of CBD do not exert an anti-inflammatory effect that we must turn to higher doses to achieve local effects. This could be because CBD will interact with cannabinoid receptors in the epidermis (the outer layer of skin tissue) but not enter the endocannabinoid system itself. The epidermis has cannabinoid receptors, but the effect is local, not systemic, which is why topicals can be used without the CBD getting into the bloodstream and, thus, the entire endocannabinoid system. Transdermal applications have shown a dose-dependent response, with the higher doses giving greater pain relief. Animal studies showed a wide range of effective doses from 6.2 – 62 mg/day. Transdermal applications enter the endocannabinoid system. Oral doses of CBD for inflammation Oral bioavailability is quite low – about 13%-19% of the ingested amount. According to one study, suggested oral amounts are 5-25 mg/kg/day. To get an idea how much CBD oil this would be for anti-inflammation for this woman, calculate: for a 60 kg woman, take 60 kg and multiply by 5mg = 300 mg of CBD. The low oral bioavailability is due to the excretion of metabolites via the kidneys and the multiple metabolic pathways CBD undergoes in the transition from the gastrointestinal tract through the liver and then undergoing elimination. Oral CBD bioavailability can be increased if taken sublingually and held under the tongue putting the oil in direct contact with the blood vessel located on the underside of the tongue. Hold the oil there for 60-90 seconds. CBD doses based on weight Other resources based on body weight suggest a dose range of 1-6 mg of CBD per 10 lbs. Of body weight. The weight guideline is unclear on whether these dosage recommendations are for inhaled or oil-based products. For example, starting at the lowest dose of 1 mg per 10 lbs., a 100 lb. woman would need 100 lbs. divided by 10 = 10 x 1 mg = 10 mg to start. Dosages will vary according to several variables, including sex, genetics, environment, presence of food, the form of CBD, age, and others. A scientific basis for the weight guidelines is not found and varies from website to website. What about CBD vaping for inflammation? Doses by inhalation would theoretically be lower as you don’t have to deal with the first pass metabolism associated with digestion and the CBD would pass into the bloodstream within minutes. Clinical data on inhalation doses for inflammation are currently lacking, although a proposal for an aerosol delivery system of 4 mg -200 mg of CBD has been proposed. Is CBD legal for athletes to take for their injuries? All cannabinoids except for CBD are prohibited from the World Anti-Doping Agency (WADA), so CBD is in the clear for using topically or orally to treat inflammatory conditions resulting from sports trauma or injuries. Topical ointments and creams packed with CBD are widely available in doses up to 3500 mg for application on injured areas to subdue pain and reduce swelling in the injured athlete. These may be used in conjunction with CBD oils for a synergistic effect. Application We know CBD works for inflammation, and it offers a safer alternative than opioids or NSAIDs. Many products for CBD treatment exist, and more are being put on the patent market every day. The literature supports using both topical and oral CBD for inflammation, with dosages yet to be determined. Acute inflammation would benefit from topical use of the creams and lotions with supportive oral use as prevention for a few days. More chronic conditions might want to consider oral or aerosol/inhalation devices for use every day to prevent the persistent discomfort prevalent with the pain these inflammatory dysfunctions often bring. And, always, if in doubt, consult your physician or health provider for guidance. Many patients with chronic diseases ask themselves and their doctors this question. The truth is, it is all individual. With some people and some diseases, cures do exist, and with others, they are only managed until a cure can be found or the right therapy implemented.
What is the Difference Between a Cure and Management? A cure entails that all aspects of the disease process are gone, and they aren’t expected to return. Management of a disease is the mainstay of medicine, and its primary function is to control symptoms while the original disease continues to ravage the body. Allopathic medicine, or traditional medicine, uses prescription drugs, topicals, and treatments to help manage bothersome symptoms while often looking for a cure. An example of a typical cure would be athlete’s foot, where the use of topical antifungal creams can get rid of the fungus, and the foot is cured of the infection. Other diseases have no cure, such as pancreatic deficiencies that cause diabetes. While treatments exist to control the blood sugar and ravages of the disease, there is no viable cure for this type of diabetes yet. When is Cure and Management at a Point of Disagreement in Medicine?Philosophies in medicine vary. Allopathic medicine is compartmentalized into a vast array of specialties, making it difficult for a practitioner to see the whole picture and how one system may relate to another when planning a treatment regimen. This also makes it more difficult to find a cure as opposed to symptom management. How often have you gone to the doctor for a simple problem only to be referred to a specialist who never asks you about other dimensions in your life that may be affecting your condition? After all, the doctor is a specialist and only focuses on his specialty. Thus, a specialist manages care but rarely cures the problem. Take hypothyroidism, for example. An endocrinologist will more than likely do a thyroid panel and, if awry, prescribe the appropriate medications to manage the symptoms. There will be no inquiry into whether the hypothyroidism is caused by iodine or selenium deficiency or both. Either deficiency, when treated, may cure hypothyroidism, but a focus on management means the origin of the problem is missed, and the patient continues to be a silent sufferer of a chronic condition that could have easily been cured. Grammar Often Leads to Confusion Cure implies there is a certainty that a medical condition will not be present after a medical intervention. However, many medical conditions have no cure, such as HIV, and management is the only option. Treatment involves examining the processes underlying the risks contributing to the medical condition. Cure involves certainty, and treatment is a process. A process can lead to a cure, but management does not lead to a cure. It only leads to managing symptoms with the underlying cause unidentified. So, when looking for a cure, you aren’t looking to manage your disease; you are looking for a practitioner, of whatever philosophy, be it allopathic, functional, or integrative, that will look at you as a whole person. A person that will not just manage your care but will get to know you as an individual and the variables that might contribute to your chronic illness. Thus, a comprehensive treatment plan is needed to get to the root cause of the problem and promote healing. Take Home Know when your care is only being managed and when you should look for someone who can cure your condition. Too many people settle for managed care when it is within the powers of the individual and the medical practitioner to guide the individual patient to a cure for their illness. Whether it is lifestyle change, taking supplements, or researching the literature, answers to healing many diseases are often within our reach, we just need to cooperate with and seek out those practitioners who look at a condition holistically and keep up to date with the scientific literature. With other conditions, we need to settle for management of symptoms. As with arthritis and heart disease, these chronic conditions have no cure yet, only symptom management and we need to recognize the difference. Even symptom management should be done holistically with a comprehensive treatment plan done by a practitioner who considers the whole picture. |
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