Integrative Approach To Metabolic Disease And Diabetes

Question 1

Non traditional risks for DM/metabolic syndrome

Answer 1

1) poor sleep or lack of sleep or excess sleep
- 48% higher risk if less than 5 hrs of sleep
- 36% higher risk if >9hrs of sleep
- **goal is 6-8 hrs a night
- 100% higher risk if sleep apnea is present

2) stress and psychoneuroimmunology
- childhood neglect increases risk of DM2
- high levels of stress = 60% increased DM2
- emotional stress = high levels of inflammation (increases cortisol, epinephrine, norepinephrine and dopamine)

3) higher intake of meat and poultry increases risk of developing diabetes type 2
- **no increased risk in fish/seafood
- reinforced by the Singapore Chinese health study

4) RA, psoriatic diseases, periodontitis, all chronic inflammation diseases, HIV, hepatitis
- NHANES study*
- significantly increase risk for both DM types and metabolic syndrome
- excessive TNF-a, IL-6 contribute to this

5) environmental pollutants
- arsenic = 3.5x increase in DM2 risk if urine excretion is in 80th percentile
- organochlorine pesticides = 7.5x increase risk of DM2
- tobacco = 44% increase of DM2
- BPA = 40% increase in DM type 2
- PCB (PolyChlorinated Biphenyls)high levels = 2x increased risk

6) microbiota impacts
- species that are needed to ferment SCFAs and complex carbs are needed to control systemic inflammation. If you dont feed them then other species move in that increase inflammation
- this is common in urbanization (1st world)

Question 2

Fructose effects on the body

Answer 2

Is the primary source of sugar in the US since it is cheap to get
- also sweetest sugar

Is metabolized by the liver into TG, uric acid and some glycogen
-high fructose diet causes high levels a of these

it doesnt impact plasma glucose and doesn’t stimulate release of insulin, however it also DOENST stimulate leptin until later in metabolism which means there is no appetite control initially = eat more than normal

Increases in fructose consumption results in inital-hyper leptin release = leptin resistance
- overtime it leads to hyperinsulinemia though Also

Question 3

What are direct effects of fructose metabolism

Answer 3

Fructose uses GLUT5 receptors to get inside peripheral cells and GLUT 2/8 to get inside liver cells

1) increases uric acid and methyglyoxal levels as well as decreases ATP level all of which antagonizes Nitric oxide levels
- ends in increases in BP

methylglyoxal also forms “advanced glycation endproducts” AGE’s which increase oxidative stress (ROS and RNS) and inflammation on top of HTN

2) generates lipid droplets and increases FFAs in blood
3) produces skeletal muscle Insulin resistance
4) produces excess Triglycerides which leads to obesity

5) also increases sympathetic nerve activity which leads to increase RAAS activation via hyperinsulinemia, hyperleptinemia, and stimulation of the ventromedial hypothalamus
- also results in HTN

Question 4

Dietary and lifestyle ways to combat DM2 and metabolic syndrome

Answer 4

1) limit sugar intake
- <10% kcal/day recommended
- avoid HFCS
- American heart associations are even stricter saying males shouldnt get more than 150 kcal/day and females shouldnt get more than 100 kcal/day

2) exercise
- both anaerobic and aerobic combined = can decrease A1C by up to 1%
- exercise increases GLUT4 transporters in cells which lowers need for insulin and fights insulin resistance

3) get good sleep
- cognitive behavioral therapy is very good at getting good amounts of sleep
- avoid sedative and sedating antihistamines in elderly

4) be intentional with quality of food you eat
- avoid plastics and BPA
- grow own food if possible

5) avoid artificial sweeteners
6) treat high levels of stress and treat past stressful incidences

Question 5

Glycemic index vs glycemic load

Answer 5

Index:

• a number that is assigned to food based on how much it makes your blood sugar rise directly after eating.
• 100 = pure glucose/sugar
• the lower the index = the lower your blood sugar will rise after eating the food (high index spikes quicker than low index)
• high GI foods have a higher correlation with T2DM
• low = <55
• moderate = 56-69
• high = >70

Load:

• measures the carbohydrate quantity and quality of a food.
• obtained by multiplying the quality of a carb (GI value) by the quantity of the carb in a Serving of that food and then divide by 100
• more importiant in determine how detrimental a food source can be to glucose levels
• High GL has a higher adverse health effects all around the highGI foods (although ideally you eat both low)
• high GL = >20
• moderate GL = 11-19
• mild = <10
• *currently no evidence that low GI/GL diets are any better than moderate GI/GL. However high GI./GL diets are associated with gallbladder disease, cardiac disease and DM probability**
• low GI/GL diets decrease CRP and fasting insulin levels, but no effect on blood lipids, HbA1C and fasting glucose**

Question 6

What are the effects of EVOOC olive oil, kombucha and viscous fiber?

Answer 6

EVOO
- induce NO and endothelin-1 mediated relaxation in most arteries which helps HTN

Kombucha

• converts the majority of sucrose in the body to beneficial SCFAs which lowers dietary carcinogens in stomach
• also stabilizes blood sugars in diabetics but the how is unknown

Viscous fiber intake
- slows absorption of CHO by forming a gel with water

Question 7

Coffee and vinegar effects on health

Answer 7

> 1 cup/day of coffee is considered to be protective against diabetes

• decreases risk by 11%
• can also slightly raise glucose levels in current diabetics, but not to dangerous levels
• contains protective multiple polyphonols against diabetics
• avoid excess sugar and cream

Vinegar decreases postprandial rise in serum (especially after CHO-rich meal (carbohydrates))
- contains acetic acid and appears to act similarly to acarbose and metformin by decreasing disaccharides activity in brush border And decreases GI absorption and also increases glucose-6-phosphylation in skeletal muscles (improves insulin sensitivity)

Question 8

Red wine effects on diabetes

Answer 8

In moderation = good

• contains phenolic acids, bioactive flavonoids and trihydroxystilbene
• improves glucose handling in moderation

Higher intake = increases risk of DM2

Moderate ETOH intake

• < 2 drinks a day or <15 drinks a week for male
• < 1 drinks a day or < 8 drinks a week for female

Question 9

What supplements decrease risk of DM2/metabolic syndrome

Answer 9

1) trivalent chromium
- is an insulin sensitizer at 200-1,000 mcg/day
- variable patient response though

2) cinnamon
- is an insulin sensitizer to 500mg PO BID
- lowers A1C by 1% roughly
- aqueous extract is more potent than dried cinnamon

3) biotin (Vit. B7)
- reduces hepatic glucose production with doses between 9mg-16mg
- enhances glucokinase activity and decreases liver output of glucose form gluconeogenesis

4) HCA from garcinia Cambodia
- may decrease hepatic conversion of glucose to fat and lower insulin levels
- HOWEVER, need more studies since there are cases of rhabdomyolysis, hepatotoxicty, nephropathy