Most people have heard of type I and type II diabetes, but what about the other three types? Prediabetes, Type 1.5, and Type 3 Diabetes are all common metabolic abnormalities, but little reference is made to them in the clinical setting. So, let us take a peek at these mysterious “lurkers” behind the metabolic curtains!
While many people look at this diagnosis as just a warning sign of an impending problem, it is actually far more serious than that. If you are at the prediabetes stage, the insulin resistance that got you there has been going on far too long, and the longer it has been rampant in your body, the more damage it may have done.
Prediabetes is diagnosed when your blood sugar is ≥100-125 or the HbA1C is 5.7-6.4%. There may or may not be symptoms at this point. Treatment usually consists of weight management and lifestyle medicine. Occasionally a patient is started on metformin to decrease the chances of progression to type 2 diabetes.
Functional medicines used in place of conventional medications include the herbal extract berberine at 500 mg three times a day or a combination of Banaba, fenugreek, cinnamon, Gymnema, magnesium, ginseng, or white mulberry.
The best thing to do if you find yourself prediabetic is to find a functional medicine doctor who can probe into the why’s and how the insulin resistance got started in the first place. Once the source of the problem can be found and treated, the symptoms will disappear.
This form of diabetes is thought to be autoimmune in nature and is a combination of type 1 and type 2 in its features. Latent autoimmune diabetes (LADA) is a type of slowly progressing type 1 diabetes with the body slowly losing its ability to produce insulin and not requiring it pharmacologically for several months to years after diagnosis.
People with LADA are often over 30, and since their body is still producing some insulin, they are frequently misdiagnosed as diabetes type 2. According to a journal article from Diabetic Medicine, “around 4-14 % of patients classified with type 2 diabetes have DAA” (diabetes-associated antibodies characteristic of LADA). Diagnosis can be confirmed by the presence of one of two autoantibodies in the blood of the patient and a low to normal C-peptide level and a progressive loss of pancreatic beta-cell activity.
Initially, LADA can be controlled with diet and exercise, but eventually, insulin shots will be necessary. Patients with LADA should be treated with insulin as the first choice as opposed to oral hypoglycemics when diet and exercise fail to control the blood sugar. Sulfonylureas should not be used as they will increase the rate of C-peptide degradation. Treatments that may preserve beta-cell function include dipeptidyl peptidase-4 (DPP-4) inhibitors and glucagon-like peptide 1 (GLP-1) receptor agonists.
Diabetes Type 3
Currently, there is a rapid growth in the literature pointing toward insulin deficiency and insulin resistance as mediators of Alzheimer's Disease (AD)-type neurodegeneration, but this surge of new information is riddled with conflicting and unresolved concepts about the relationship between diabetes type 2, obesity and metabolic syndrome.
Type 2 diabetes causes brain insulin resistance, oxidative stress, and cognitive impairment, but its aggregate effects fall far short of mimicking AD; AD represents a form of diabetes that selectively involves the brain and has molecular and biochemical features that overlap with both type 1 diabetes mellitus and type 2 diabetes
Type 2 diabetes may not be sufficient to cause AD, although it could serve as a cofactor in its pathogenesis or progression. However, data referring to AD as type 3 diabetes is justified because the fundamental molecular and biochemical abnormalities overlap with type 1 diabetes and type 2 diabetes rather than mimic the effects of either one.
The field of diabetology is growing as we understand more about the molecular and biochemical nature of diabetes.
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#Alzheimer'sDisease #Diabetes #Prediabetes
Fatty liver disease affects 25.2% of the population worldwide. Nonalcoholic fatty liver disease or NAFLD is often a precursor to colon cancer, making it a common practice now to screen all fatty liver diagnosis for bowel cancer.
What is NAFLD?
Fatty liver is just that. The normal cells of the liver have been replaced with fat cells that cannot do the job of a liver cell. Thus, the total mass of the liver is decreased, which impacts the quality of the job a liver can do, which is to filter the blood coming from the gastrointestinal tract and to detoxify toxins from food, the environment, and from oxidative stress within the body.
Weighing in at three lbs., the liver is the workhorse of the digestive system and performs over 500 functions to keep the body healthy.
What Causes NAFLD?
Lifestyle choices affect most chronic diseases, and NAFLD is no exception. The primary aggravators of fatty liver disease are:
· Being overweight or obese
· Being insulin resistant
· Having abnormally high levels of blood fats, especially triglycerides
· Having metabolic syndrome or symptoms of such
· Being diagnosed with Type 2 diabetes
Understanding the causes and contributors to fatty liver disease assist practitioners in individualizing a comprehensive care plan to reverse the disorder. Although no established treatment protocol exists for NAFLD, several treatments have been shown to reverse the damage and restore healthy liver functioning. Specifically, there are ten different approaches to restoring the liver to a healthy metabolic balance.
1. Losing weight
Excess weight causes inflammation and insulin resistance, both contributors to fatty liver disease. Studies show that a weight loss of just 10% can dramatically improve NAFLD indicators and function. Even losing 3-5% of one’s body weight can improve liver function and insulin sensitivity.
With exercise, there is an increase in fatty acid oxidation (thus taking it out of the liver), improved insulin sensitivity in the cells, decreased fatty acid synthesis, and a reduction in liver and mitochondrial damage. Mitochondria are the powerhouses of the cell and the primary determinant of our metabolic rate (in conjunction with the thyroid). Physical exercise remains a powerful keyway to reversing fatty liver disease.
The American Heart Association recommends 150 minutes of cardiovascular exercise per week. Or, 75 minutes of vigorous physical activity per week will produce the same beneficial results. Even handicapped and elderly individuals can participate in low impact exercises such as sitting exercises, walking, aqua therapy, Tai Chi, or other creative forms of movement.
Berberine is a herbal supplement frequently used to replace pharmaceutical drugs in lowering cholesterol and glucose. Recent studies have shown it to be beneficial in NAFLD, although more research is needed to determine effective dosage.
Berberine promotes fatty acid oxidation, inhibits fat generation and positively alters gut microbes. It has been used as a pharmacological replacement for Metformin ( a standard glucose-lowering drug) and for statin medications (used for cholesterol reduction) with excellent outcomes.
Berberine is safe with few if any, side- effects aside from some mild gastrointestinal discomfort occasionally reported.
The dosage of Berberine most effective is 500 mg three times daily.
4. Omega-3 fatty acids
Studies have shown the administration of omega-3 fatty acids to improve liver enzyme levels, normalize blood triglycerides, lowers the enzyme GGT, increases HDLs, and decreases fat in the liver. These are all positive changes indicative of liver regeneration. Recent studies suggest that treatment with omega-3 fatty acids may be a new pharmacological approach due to their positive impact on liver inflammation, fibrosis, and liver injury.
Studies using omega 3 supplements have achieved positive results with 450 mg – 4 gms/day. Most studies use 1 gram twice per day of omega-3 fatty acids to achieve effects while avoiding fishy aftertastes or unpleasant gastrointestinal upset.
Foods high in omega 3 fatty acids include salmon, sardines, flaxseeds and walnuts.
5. Milk Thistle
In a recent study, the obtained results indicated that silymarin (milk thistle) appears to be effective in reducing the biochemical, inflammatory, and ultrasonic indices of hepatic steatosis. Some parameters indicative of an early stage of atherosclerosis were also lowered.
Milk thistle also decreased insulin resistance.
The most effective dose to achieve a liver improvement is 420 mg/day.
Beetroot is effective due to its betaine content, which is known to control the inflammation and fibrotic changes within the liver. Beetroot is also super high in antioxidants and nutrients, aside from the betaine content.
Beets can be enjoyed as food or purchased as a food supplement. It comes as a powder to make beet juice or in capsules in the root form. Beetroot juice 80-140 ml daily or 200 grams baked or simmered beets can be used for therapy.
Increasing nutritional fiber has been shown to reduce liver enzymes and improve fatty liver infiltration. Increasing vegetables and complex carbohydrates should help, but if on a weight loss program, and especially if constipation is a problem, a fiber supplement may be in order.
PGX is a water-soluble fiber that can be taken before or with meals to increase satiety, decrease blood sugars and fats, and positively affect the liver. If FODMAPS are a problem, taking Benefiber might be a better choice, and two servings a day provide only 6 grams of fiber – not enough to cause the common side effects of adding a fiber supplement of bloating and gas.
The fiber recommendations for NALFD are at least 21 grams per day. Dosing should start low and go slow to avoid bloating and cramps.
8. High Fructose Corn Syrup
Fructose is poorly metabolized in NAFLD. Foods high in fructose should be limited. Fresh fruits can be limited to two per day. Sugar, which is part fructose and glucose also needs to be avoided due to the fructose content. Then there is high fructose corn syrup, an additive in pop and many processed foods. Avoid at all costs. Read labels but do not consume high fructose corn syrup.
High fructose corn syrup (HFCS)-containing beverages were associated with metabolic abnormalities and contributed to the development of NAFLD in human trials. Ingested carbohydrates are a major stimulus for hepatic de novo lipogenesis (DNL) and are more likely to directly contribute to NAFLD than dietary fat.
9. Vitamin D
New evidence suggests that low serum Vitamin D may cause nonalcoholic fatty liver disease (NAFLD). Hypovitaminosis D is associated with the severity and incidence of NAFLD.
A test of vitamin D status should be run on every patient with a diagnosis of NAFLD. Furthermore, levels less than 30 should be repleted with supra-optimum doses for a period such as the repletion protocol of 10,000 IU for 5 days for 6 weeks and then retest and adjust dosage.
10. Emphasis on low glycemic index carbohydrates
A low glycemic Mediterranean type diet was found to decrease the indicators of fatty liver in a short amount of time in a recent randomized clinical trial. It was concluded that this type of intervention should be pursued as part of all lifestyle interventions for NAFLD.
Many of these changes are fairly easy but some may require some education. Don’t be afraid to reach out to your Registered Dietitian for guidance on how to make these changes.
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#NAFLD, #berberine, #fattyliver, #lowglycemic, #HFCS, #vitaminD, #beetroot, #milkthistle
Alzheimer's Disease (AD), a brain disorder that ravages your memory, robbed 5.5 million Americans of their quality of life in 2019. Two-thirds of those affected were women, the traditional caretakers of our society. African Americans are twice as likely as Caucasians to be diagnosed with this illness, and there is no cure. But there is hope.
Research is showing that diet may delay the signs and symptoms of Alzheimer's Disease, and we all know that every moment we can spend with our loved one where we don't have to wrestle with the side-effects of this disease are precious and to be treasured.
Studies from Rush University in Chicago have found that the MIND diet, a combination of the DASH diet and the Mediterranean diet, may decrease the risk of Alzheimer's by as much as 50% and can still protect the brain even when not followed rigorously.
What is the MIND Diet?
The MIND diet was born out of blending the DASH diet for hypertension, which focused on limiting sodium in the diet while increasing vegetables and low-fat dairy with the Mediterranean diet. The Mediterranean Diet, a diet focused on increasing consumption of vegetables, monounsaturated fats from olive oil, fish, whole grains, and omega-3 fatty acids- the building blocks of this meal plan.
Researchers believe that those who follow the diet for years will receive the most significant protective benefits. The time to start a MIND diet is when you find out you have Alzheimer's Disease in the family as it will lower your risk of developing it. For those who already have it, it's not too late to start the diet to delay the progression of AD.
What Does the MIND Diet Do?
The MIND diet emphasizes those foods that protect the brain and restricts those foods that affect the brain adversely. It works because it reduces inflammation of the brain and nerves; it acts as an antioxidant for the tissues it makes nerve transmission more fluid and decreases neuron loss while improving memory overall.
How Do I Follow a MIND Diet?
As with any major change, start slow. Make a few changes at a time until the MIND diet feels like your everyday routine. Soon even grocery shopping will become automatic, and you won't have to pour over lists of foods that you aren't used to eating or learning new recipes or ways of cooking because it has become a habit. It just takes a little time, one step at a time.
When introducing starchy beans into the diet, do so slowly if it is a new food to the individual. Starchy beans like chickpeas, lentils, kidney beans, fava beans, etc., are not only high in fiber, they may be gas forming and cause bloating if introduced into the diet too quickly. Always introduce increased fiber slowly with 8 glasses of water per day to avoid bloating.
Another trick to lessen gas and bloating from beans is to either soak them overnight, drain and rinse or bring to a boil and drain, rinse and then bring the beans to heat again. Draining the water gets rid of the gassy component present in beans.
Also, some healthy foods can be expensive, a real consideration for most of us. One way to save money is to buy fruits and vegetables in season and freeze them. Don't use sugar or salt, just freeze them after they've been cleaned, label and date them and freeze for later.
MIND Diet Guidelines
The Rules of the Diet Are:
The MIND diet supports vascular health and is protective against vascular dementia. Certain foods used in the MIND diet have been directly linked to improved neurological function or reduced Alzheimer's Disease biomarkers in the brain. MIND diet foods reflect nutrients that have been shown in studies to slow cognitive decline, decrease the risk of AD, scour the brain of amyloid plaque, and decrease neuron loss.
So, while a cure may not be here, hope is on the horizon for a better quality of life by following the MIND diet.
#Alzheimer's Disease #MIND diet #cognitive #dementia
We are in the dark days of a novel pandemic where any glimmer of preventive hope on the horizon is appreciated in this battle. Research has recently sounded the horns of prevention in terms of taking vitamin D to fortify the body’s immune system against influenza and the novel coronavirus. According to the most recent public health outcry, the most at-risk population should be fortifying themselves with 10,000 IU of vitamin D daily in the weeks before winter and then stabilize intake at 5,000 IU per day to maintain blood levels of 40-50 ng/ml, although, admittedly, this research is controversial and needs more study.
Vitamin D acts by three mechanisms – maintaining a physical barrier, increasing natural cellular immunity, and increasing adaptive immunity. Vitamin D helps keep tight gap junctions between cells. Several articles have suggested how viruses disturb junction integrity, increasing infection by the viruses and other microorganisms that can squeeze through the leaky membranes. This is a physical barrier function.
Innate immunity is enhanced through the induction of antimicrobial peptides, which exhibit direct antiviral and antimicrobial activities against a spectrum of microbes, including enveloped and nonenveloped viruses, fungi, and bacteria. These peptides kill the invading pathogens by invading their cell membrane and neutralizing necessary biological activities.
Cellular immunity is enhanced in part by reducing the cytokine storm induced by the innate immune system. The innate immune system generates both pro-inflammatory and anti-inflammatory cytokines in response to viral infections. Vitamin D can reduce the production of pro-inflammatory cytokines while increasing the expression of anti-inflammatory cytokines.
Vitamin D supplementation also enhances the expression of genes related to antioxidation. Increased glutathione productions spare the use of vitamin C, which has antimicrobial and antioxidant capabilities. Glutathione is a peptide involved as an antioxidant, and vitamin D affects its expression.
What is the Optimal Blood Level for Vitamin D in the Prevention of COVID-19?
Research shows that 38 ng/L was sufficient for reducing community-acquired pneumonia, although the degree of protection increased as blood level increased with the optimal range being 40-60 ng/ml. Studies show that those at risk for influenza or COVID should take vitamin D to reduce this risk. Furthermore, randomized control trials are now recommended based upon positive clinical and observational studies on the role of vitamin D in the prevention and treatment of virus related infections.
High doses of vitamin D seem to be well tolerated with doses of 60,000 IU/d found in the literature to treat asthma, rheumatoid arthritis, rickets, and tuberculosis in the 1930s and 40s. High doses of vitamin D over prolonged periods can damage the kidneys; however, we are talking about high doses for a short time. The tolerable upper limit for vitamin D is 4,000 IU/day. Research shows that doses of 25,000 IU have not caused severe side-effects. Everyone is different, and we err on the side of caution.
Obviously, the research on COVID is challenging the tolerable upper limit in its recommendations suggesting that supplementation could improve the outcome of the clinical COVID 19 condition.
Improvement of Clinical Outcomes of COVID-19 with Supplementation
Recent research results have shown that having a favorable clinical outcome rather than a critical outcome was increased approximately 19.61 times with a high vitamin D level. Vitamin D status was found to be significantly associated with clinical outcomes. Of 212 cases of COVID 19, 23.1 % were identified as mild, 27.8 % were ordinary, and 26.4 % were severe, and 22. % were critical. Mean serum vitamin D level was 23.8 ng/ml with < 20 being defined as deficient. Using multinomial logistic regression, a distinct relationship was found between the level of vitamin D and the severity of clinical outcomes between all levels of severity compared to levels of vitamin D.
As for the link with immune function, one systematic review and one met-analysis of data from 11,321 people published in the British Medical Journal found that people who took weekly or daily supplements of vitamin D were less likely to develop respiratory tract infections than those who didn't. There is despite a conflicting review in the same journal that said there was no relationship. Then, another review published in the same journal issue stated that according to the Royal Society there is a biologically plausible reason to suspect vitamin D deficiency to be involved in immune dysregulation. Clearly we see a confusion in study results. In the midst of all this mud, Dr. Fauci himself states he takes two vitamins to ward off COVID, vitamin D and vitamin C.
Public Health Call to Action
Research is showing that vitamin D deficiency is common and may contribute to increased risk of respiratory infection, particularly COVID-19. It is advised by some groups that the following be urgently supplemented with 800-1,000 IU of vitamin D to enhance their resistance to COVID-19:
While there is a slight discrepancy between the amounts of vitamin D being recommended, the fact that supplementation is being recommended should not be taken lightly. Every nursing home resident should have it in their care plan to increase vitamin D intake to 1,000-10,000 IU per day, depending on their blood levels. Deficient individuals may need to supplement with 10,000 IU 5 days per week for six weeks and then drop down to 5,000 IU per day until optimal blood levels are reached, and then maintenance may be set at 1,000 IU/d. Others who have higher blood levels of vitamin D may only need 800 IU per day.
The best thing to do is get your blood level for vitamin D measured and then consult with your health care provider for repletion and maintenance dosing recommendations.
#COVID-19 #vitaminD #coronavirus #vitamins #vitamin D deficiency
Thyroid supplements are generally taken by those who think they have sluggish thyroids, they are gaining weight for no reason or they have self-diagnosed themselves with hypothyroidism. The supplement market is eager to meet the needs of desperate consumers armed with only a handful of internet articles and a plethora of misinformation.
Here we will discuss the most common thyroid supplements and what they are designed to do and why a patient should not take these supplements without a doctor’s recommendation or upon a dietitian's recommendation.
Iodine is needed for the production of the thyroid hormone. Before the 1920’s iodine deficiency was a common problem, especially in the so-called “goiter” states where soil was especially depleted. However, the U.S. implemented a salt fortification program adding iodine to salt and thus forming iodized salt. Iodine deficiency dropped. Today, iodine deficiency in the United States is not the primary cause of hypothyroidism, but rather an autoimmune condition called Hashimoto’s is the cause of 80% of the nearly 20 million Americans who currently are hypothyroid.
In Hashimoto’s Disease (HD), iodine is often avoided. So, if someone with Hashimotos hypothyroidism supplements with iodine, the situation could be made worse as it may accelerate thyroid cell destruction. Research has shown that high doses of iodine can trigger Hashimoto’s in people who are genetically predisposed to Hashimoto’s and may perhaps have certain “vulnerabilities” like a selenium deficiency.
Selenium protects the thyroid from oxidative damage and without selenium a high iodine intake can destroy the thyroid. Iodine and selenium need to be in balance and selenium is the next most important hormone for thyroid health aside from iodine.
Taking selenium just because one thinks their thyroid is “sluggish” may not help the problem, but cover up a more serious one that need pharmacological and/or surgical intervention. Oftentimes we see patients struggle with self-perceived thyroid problems by supplementing with nutrients the thyroid needs, but giving selenium may hide an undiagnosed tumor, goiter or the synergy of nutrients needed to get the thyroid healed if it is truly sick. Both excessively high and excessively low selenium levels have proven damaging to the thyroid gland.
L-Tyrosine Most people have enough L-tyrosine in your body but occasionally a supplement is recommended if you have hypothyroidism. Be careful not to supplement on your own as too high of an L-tyrosine level can aggravate high blood pressure, manic symptoms and may interact with other medications.
Coleus Forskohlii This herb enhances the uptake of iodine into the cells and promotes the production of T3 and T4. Again the problem with this herb is the same as with supplementation with iodine.
Ashwagandha As a member of the nightshade family, those individuals with autoimmune conditions are to avoid products from this family. Grave’s Disease and Hashimoto’s Disease are both diseases of the autoimmune system and as such call for avoidance of this otherwise very beneficial herb.
Supplements should only be taken after consultation with a health professional. Seemingly wonderful products can be harmful if taken for the wrong reason or the wrong condition.
Not all supplements are safe. Supplements should be recommended by a Registered Dietitian after a complete medical nutritional assessment is done.