Episode Description – Filomena Trindade, MD, MPH

dr-filominaBlood sugar stabilization is essential as each blood glucose spike and dip can cause brain damage. Diabetes increases the risk of heart disease and dementia four fold. Yet persons with normal blood glucose can have the same increased risks because the process towards diabetes starts long before it can be measured in the doctor’s office. The risks for diabetes start when the fasting morning glucose levels are 81: the risk for heart disease starts when the the fasting glucose levels are 84. We cannot rely on normal medical laboratory values to be sure that we are healthy. Typically, lab values that are based on 95 % of the population most of whom have chronic diseases. Also, lab values do not typically appear abnormal until a person is 75 % along the path toward the chronic disease. Learn how to “look under the hood.” to assess the status your metabolic status and risks for diabetes and cardiovascular disease.

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Background

I. DEFINITIONS
A. Diabetes
A disease in which the body’s ability to produce or
respond to the hormone insulin is impaired, resulting in
abnormal metabolism of carbohydrates and elevated
levels of glucose in the blood and urine
B. Insulin
  • A hormone produced in the pancreas that regulates the amount of glucose in the blood. The lack of insulin causes a form of diabetes.
  • It regulates the metabolism of carbohydrates and fats by facilitating sugar getting into the fat, liver and muscle cells so it can be transferred into other substances.
C. Insulin Resistance
The body does not use insulin properly. The pancreas
makes extra insulin to make up for it. Over time the
pancreas is not able to make enough insulin to keep
blood glucose at normal levels.
  • As a result, glucose cannot get into the cell and blood glucose levels increase
  • It is the root cause for diabetes
  • Process begins in beta cells of the pancreas dysfunctional insulin leads to the production of too much insulin
  • Etiology for each person is different
D. Diabetes I
The type of diabetes where there is insufficient insulin
and the person has to take insulin shots
E. Diabetes II
The type of diabetes where the body does not use insulin
properly.
  • Diabetics have four times the risk for a stroke
  • Diabetics have three times the risk for a heart attack
  • There is a continuum, where patients pass through irregular blood sugar levels, then insulin resistance, prediabetes and diabetes.
II. HEALTH RISKS OCCUR BEFORE DIABETES OCCURS
  • Persons on the continuum towards diabetes suffer the same consequences / risks as persons diagnosed with diabetes
  • They have four times the risk for a stroke
  • They have three times the risk for a heart attack
  • They can have normal fasting blood sugar levels of 75 and still have insulin resistance and its adverse consequences.
  • 30 % of people with normal weight are diabetic
III. HEALTH RISKS OF UNSTABLE BLOOD SUGARS
  • It is important to keep blood levels stable.
  • The body likes balance and equilibrium
  • Sugar spikes and dips can affect health.
    • Insults the brain and sets off a cascade causing brain damage
    • nervous system and causes inflammation
    • Leads to advanced glycated end products (AGE) which are involved in eye problem kidney problem and loss of limb associated with diabetes
    • Excess sugar becomes free radical and tries to become stabilized causing damage to fats and proteins inflammation
IV. HEALTH RISKS OF INSULIN RESISTANCE
  • Prediabetes and people with erratic increases in blood sugars have the same risk.
  • Increase thickness of blood vessels
  • Is associated with sleep apnea and polycystic ovary syndrome
  • Most cancer patients have insulin resistance
  • Is associated with a fatty liver although liver lab test may not detect this
V. CAUSES OF INSULIN RESISTANCE
A. TOXINS
  • Persistent organic pollutants
Italian study showed exposure to dioxin increased the
risk for insulin resistance and diabetes
  • Heavy metals such as mercury in fillings
  • Mercury treated as toxin, banned in the EU for persons under the age 15, yet routinely put in teeth in the US
  • Arsenic used as a fumigant to protect rice from mold The arsenic in ½ cup white rice has arsenic over daily EPA limit
  • PCBs likely to cause insulin resistance
  • Toxins found in detergents, skin cream products,
B. FOODS
  • Processed foods
  • Food additives (added to preserve shelf life
  • High fructose corn syrup
  • skin creams air
  • fresheners
  • Sugar substitutes
  • Gluten
  • Genetically modified foods (GMO)
  • Nutrient deficiencies
  • Food sensitivities
C. LIFESTYLE
  • Lack of sleep. Sleeping six hours per nigh can lead to insulin resistance
  • Stress
D. CHANGES IN MICROBIOME – A BIG CONTRIBUTOR
  • Prescription drugs
    • Statins can lead to heart attacks. They decrease adiponectin and deplete co Q 10.
    • Protein pump inhibitors
  • Poor chewing, digestion, and poor intestinal absorption
  • Three ways bad gut bugs lead to inflammation
1. lipopolysaccharide (called LPS – the cell wall of gram negative bacteria). These are proinflammatory and are constantly breaking down. Normally the body gets rid of them, but a diet that is high in fat and sugar impedes the ability to breakdown LPS resulting in an increase in the toxins released from these bacteria leading to inflammation and subsequent insulin resistance.
2. Gut bacteria break fiber down into short-chained fatty acids (SCFA) which feed the good bacteria in the colon and help absorb nutrition from food. In a diet low in fiber, there is an insufficient amount of SFCA produced which creates more inflammation
3. The good gut bugs conjugate bile acid to make secondary protective bile acids which decrease inflammation
VI. TESTS FOR THOSE ON PATH TO DIABETES
  • People can have a disease and current tests will not show it
  • People can have the same risks as people with diabetes, and current tests will not show it.
  • There is a need for earlier measures because if it is determined early enough, the process can be reversed.
A. HbA1c precise better indicator of heart disease than cholesterol
B. Insulin and Sugar Levels after a meal
  • Abnormalities in these levels are part of the first step leading to insulin resistance.
  • This measures blood glucose irregularities and insulin resistance before the current test of fasting blood sugar levels
  • Postprandial (after a meal ) insulin after eating 75 g of sugar (equivalent to a bagel and a glass of orange juice)
C. Adiponectin
  • Abnormalities show insulin resistance
in its earliest stage.
  • Adiponectin falls as insulin levels increase.
D. Proinsulin
A precursor to insulin: assesses pancreas’ ability to
make insulin.
E. Fasting insulin
VII. WHY DOCTORS DON’T MEASURE EARLY MEASURES
  • 15 – 25 years for discovery to be implemented in practice.
  • Medical education is typically 15 – 25 years behind studies.
  • Labs not change norms which includes 95 % of the people within the normal range.
  • Labs are set up to detect disease not function
  • The disease show up when 25 % of normal
VIII. HOW TO DECREASE INSULIN RESISTANCE /INCREASE INSULIN SENSITIVITY
A. STABILIZE BLOOD SUGAR LEVELS
  • Minimize glycemic load. That is if a concentrated sweet is eaten, add fiber and healthy fats to minimize the sugar impact.
B. DIET
  • E.g. the Mediterranean diet
  • Rich in fish, olive oil,
  • Vegetables
    • colourful vegetables
    • 10 – 12 portions fruit, vegetables per day
    • if insulin resistant, then eat low glycemic fruits such as berries, apples, oranges and pears
  • Fiber at least 35 grams per day (flax seeds, chia, coconut flour, all vegetables, nuts)
  • A change in diet can change the gut microbiota in 24 hours
  • Caloric Restriction
  • Don’t eat from dinner until at least 12 hours later
  • Nutriceutical supplements and antioxidants help feed the body and eliminate toxins
  • Probiotics decrease gut inflammation and bring balance to the gut.
  • Prebiotics to feed good bacteria
C. AVOID
  • Toxins
  • Gluten, wheat
  • food preservatives
  • high fructose corn syrup
  • non caloric sweeteners
  • prepackaged foods
  • toxins
  • detergent use
  • skin cream products
  • air fresheners
D. LIFE STYLE
  • Exercise
  • Lower stress (change reaction to stress)
  • Our thoughts
  • Connect with spiritual source
E. DETOXIFICATION
Specific for each toxin
IX. TAKE AWAY POINTS
  • Thin people may have diabetes
  • Fat people may not have diabetes
  • Like with cardiovascular disease there is a continuum of risk factors.
  • The risk for diabetes and heart disease begins when fasting blood sugars are in the low 80’s
  • People with all normal current lab tests can have the same increased risk factors as those who have diabetes
  • These conditions may be reversed if found early enough
  • Studies show that life style changes can be more effective that the diabetic medication, metformin.