Dysglycemia: A Nutrition Detective Story From Hypoglycemia to Diabetes

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Dysglycemia A Nutrition Detective Story From
Hypoglycemia to Diabetes

• Ed Bauman, M.Ed., Ph.D.
• IET Nutrition Culinary Arts Programs
• Partners In Health Rejuvenation Retreats
• iet_at_sonic.net www.iet.org

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Outline

• Insulin resistance scope and prevalence of the
  problem, risk factors and associated health
  challenges.
• Physiology of cellular blood sugar control
  mechanisms.
• Scientific validation for nutritional support
  strategy.

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Insulin resistance...results when normal insulin
action is impaired and the cell does not hear
the message of the insulin molecule. To overcome
this impairment, and to maintain glucose
homeostasis, the pancreas will attempt to secrete
larger and larger amounts of insulin. Lukaczer,
D. Nutritional support for insulin resistance.
ANSR, July 1, 2001
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Insulin Resistance Increases Risk of

• Type 2 Diabetes
• Coronary artery disease
• Hypertension
• Stroke
• Inflammation
• AGE proteins
• Polycystic ovary syndrome
• Cancer

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Proposed Stages of Dysglycemia

• (Reactive) Hypoglycemia
• Insulin Resistance with Hyperinsulinemia
  (Syndrome-X)
• Hyperglycemia
• Diabetes

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Insulin, Cell Receptors and Blood Sugar
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• Converting carbohydrate from food into energy
  involves many different processes.
• The macronutrient makeup of the diet can have a
  profound influence on the outcome--vitality or
  fatigue and disease.
• Each step of this dance requires specific
  vitamins and minerals in adequate quantities.

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Stimuli for Insulin Release

• Elevated plasma glucose levels
• diet
• insulin resistance
• Chronic exposure to
• GI hormones (gastrin, secretin, etc.)
• growth hormone
• estrogens
• cortisol
• progestins
• Islet tumors

Guyton. Textbook of Medical Physiology 8th
Edition. LondonW.B. Saunders CO.1991
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The insulin signal on the membranes surface
stimulates production and mobilization of
vesicles containing specialized GLUT 4 molecules,
responsible for membrane uptake of sugar.
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These vesicles fuse to the membrane surface and
provide transport for sugar into the cells to be
utilized for the production of energy by the
mitochondria.
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Receptors on the nuclear membrane (PPAR Alpha and
Gamma), activated by certain fatty acids,
regulate gene expression that contributes to
proper glucose homeostasis and energy production
in the mitochondria.
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Lipoic acid and vitamin E support the strength of
the insulin signal directly, as well as through
reduction of NF-KappaB, TNF alpha, cytokines and
other inflammatory mediators.
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A healthy diet consisting of complex, unrefined
carbohydrates from whole foods are absorbed more
slowly from the intestine, leading to a more
controlled and slower elevation of blood sugar.
Insulin production (and associated serum level)
is therefore lower.
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Make time for health Eat great foods Hang out
in the places we love.
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Low glycemic index foods such as soy protein and
high-amylose starch also contribute to a slower
absorption of sugar and a reduced insulin
response.
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An unhealthy diet, high in refined carbohydrates,
causes rapid elevation of blood sugar. The
pancreas responds by increasing insulin output.
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Assessment of the Insulin Resistant Patient
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When Should Insulin Resistance Be Suspected?

• Apple-shaped obesity
• Family history of type II diabetes
• History of gestational diabetes
• Hypertension
• Dyslipidemia
• Left ventricular hypertrophy
• Polycystic ovaries
• Acanthosis nigricans
• (velvety, mossy hyperpigmented skin often found
  in the nape of the neck, axillae, and beneath the
  breasts)
• Granberry MC. Insulin resistance syndromeoptions
  for treatment. S Med J 199992(1)2-14 Bell DSH.
  Insulin resistance. Postgrad Med 199393(7)99-106

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AssessmentProfile History and Physical

• BMI gt29
• Waist/hip
• Men gt1.0
• Women gt.9
• Family history of obesity
• Sugar cravings
• Cold hands and feet
• Menstrual difficulties (female)

• High stress and/or difficulty handling stress
• Smoking
• Poor exercise tolerance
• Inflammation prone
• Low energy/fatigue
• Mood swings
• Poor appetite control

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AssessmentProfile Lab Findings

• OGTT aberrations
• (Adrenergic type)
• Low sulfation/glucuron
• Oxidative stress markers
• Dysbiosis indicators
• Elevated C-16/C-2 hydroxylated estradiol ratio
  (female)
• Low estrogen/androgen ratio (female)

• Elevated triglycerides
• Elevated trigs/HDL ratio
• gt5/1
• Elevated BP
• Elevated cholesterol
• (as dense LDL)
• Altered T3/T4
• Elevated HgB AGE

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Treatment Strategies

• Diet and Lifestyle
• Medical Food
• Adjunctive Nutrients

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Calm the mind by attuning to nature. Then, the
nourish the body Ed Bauman, Ph.D.
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DysglycemiaTreatment

• Weight loss
• Improves insulin sensitivity
• Exercise
• Improves energy production
• Mobilizes GLUT-4 vesicles
• Eating for Health Diet
• Seafood and Soy proteins
• Essential Fatty Acids
• Antioxidants and Minerals
• Pancreatic Supporting Herbs

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Treatment continued

• Fiber
• 1 scoop, BID
• Insulin Receptor Mineral Support
• 1 cap, TID
• Alpha Lipoic Acid
• 200 mg., BID

• Congugated Linoleic Acid
• 1000 mg, BID
• Fenugreek Plus
• 2 caps, BID
• Omega 3 Fatty Acids
• 1000 mg, TID
• Vitamin E
• 200 iu, TID

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Remember to Breathe
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Increased participation in nonvigorous as well
as overall and vigorous physical activity was
associated with significantly higher S1. JAMA.
279(9)669-674 (1998)
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• Soy Protein
• Dietary protein adequacy and nitrogen balance are
  important in insulin resistance.
• Amylose Starch
• The proper starch is important to a low glycemic
  index dietary program.
• Amylose, as opposed to the more common
  amylopectin, has a significant positive impact on
  insulin response.

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Fiber

• The high-fiber diet induced lower fasting blood
  glucose levels and decreased the ratio of
  low-density lipoproteins to high-density
  lipoproteins. The results suggest a beneficial
  effect of dietary fiber in the metabolic control
  of NIDDM.
• AM J Clin Nutr 198847(5)852-8

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Locust-bean (Ceratonia siliqua) gum
significantly decreased the glucose response to,
and glycaemic index of, melawach in these
diabetic subjects. It also tended to decrease
their insulinaemic response and insulinaemic
indexThe results indicate that foods containing
the same nutrients in almost the same amounts,
but differing in added dietary fibre, lead to
different physiological responses in diabetic
subjects. Feldman N, et al. Brit J Nutr
199574681-88
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• Oxidative stress, antioxidants, and the
  antioxidant network can be relevant to diabetes
  because diabetes appears to involve antioxidant
  stress. One antioxidant that may have particular
  relevance to diabetes is lipoic acid.
• Two mechanisms are proposed
• Reducing competition for glucose uptake.
• Directly stimulating GLUT-transporter glucose
  uptake.
• Packer, L. Oxidative stress and antioxidants The
  antioxidant network, ?-lipoic acid, and diabetes.
  InAntioxidants in Diabetes Management, Packer et
  al, ed. New York Marcel Dekker, 2000

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Food Mix for Insulin Resistance

• Micronutrients
• Vanadium
• Chromium
• Magnesium
• Lipoic acid
• Vitamins A and E
• Beta carotene
• Minerals zinc, selenium, copper and manganese

• Macronutrients
• AmyloSTAR
• Mixture of resistant starch and special soluble
  fibers.
• Soy Protein Isolate
• Isoflavones believed to help support healthy
  blood sugar levels.
• Soluble Fiber

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Nutrients to Support Insulin Receptor Activity

• Chromium (as nicotinate glycinate)..200 mcg
• Vandadium (as sulfate)....... 5 mg
• Magnesium (as taurinate)....... 70 mg
• Thiamin 25 mg
• Riboflavin.. 10 mg
• Niacinamide...25 mg
• Zinc (as taurinate)........ 5 mg
• Dosage 1 tablet three times daily with meals

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?-Lipoic Acid Supplement

• Two Capsules Supplies (60 tablet bottle)
• Alpha-lipoic acid .200 mg
• Features
• ALA has been called the perfect antioxidant,
  providing protection in both aqueous and fatty
  tissues.
• Pharmaceutical grade, epilipoic-free ?-lipoic
  acid
• Some ALA products may contain up to 4 epilipoic
  acid, a potentially harmful sulfr complex.
• Packaged in amber-colored glass bottles to
  protect from destabilizing influences of light
  and oxygen.
• Recommended Dosage
• Take two or more tablets one to three times daily
  with food.

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Pancreatic Support Herbs

• Fenugreek seed 151 extract . . .. . . . . . . .
  . . . . . . . 300 mg (Trigonella
  foenum-graecum)
• Bitter gourd fruit extract . . . . .. . . . . . .
  . . . . . . . . . . 150 mg
• (Momordica charantia)standardized
• to contain 2.5 bitter principles
  
• Gymnema leaf extract . . . .. . . . . . . . . . .
  . . . . . . . . 100 mg
• (Gymnema sylvestre)standardized
• to contain 25 gymnemic acids
• 41 Solidified Aqueous Concentrate (SAC) . . .
  . 750 mg
• Fenugreek seed (Trigonella foenum-graecum)
• Rosemary leaf (Rosmarinus officinalis)
• Equivalent to 3 grams raw, unprocessed herbs
• Dosage one to two tablets twice daily following
  meals

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Vitamin E

• Even at a modest dosage (100 IU/d), a
  statistically significant decrease in glycated
  hemoglobin and triglycerides levels in vitamin
  E-supplemented diabetics was observed.
• Jain SK, et al. Effect of modest vitamin E
  supplementation on blood glycated hemoglobin and
  triglyceride levels and red cell indices in type
  I diabetic patients. J Am Coll Nutr
  199615(5)458-61

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