Transcript Power Point presentation - Gordon Medical Associates

By Elizabeth Large, ND
Gordon
Medical associates
3471 Regional Parkway
Santa Rosa, CA 95403
707.575.5180
[email protected]
www.gordonmedical.com
Metabolic Syndrome
 Metabolic syndrome is called a syndrome rather than a
disease because it refers to a group of risk factors that
occur together and increase the risk for coronary artery
disease, peripheral artery disease, type 2 diabetes and
stroke.
 It is believed to effect approximately 25% of the
population.
Risk Factors
 Genetics
 Hypertension Insulin Resistance
 Hyperlipidemia
 Obesity especially increased abdominal girth**
 Sleep Apnea
Metabolic Syndrome
Criteria
 3 + of the following
Central or abdominal obesity (waist): Men - Greater than 40
inches and Women - Greater than 35 inches,
Triglycerides greater than or equal to 150
Blood HDL - Men - Less than 40 Women - Less than 50
Blood pressure greater than or equal to 130/85
Fasting glucose greater than or equal to 100
Truncal Obesity
Genetics
 The Thrifty Gene proposed by geneticist James Neel in
1962. Historically advantageous in times of famine, but
then became detrimental in the modern world.
 Thrifty genes are genes which enable individuals to
efficiently collect and process food to deposit fat during
periods of food abundance.
 Those carrying the thrifty gene survived when food
was scarce.
Thrifty Gene
 Research shows that those with this gene have a slowed
metabolic rate. The mitochondria produce 70% less
ATP than controls.
 Ethnic Groups commonly effected were stressed
populations:
 African Americans (50%), Pima Indians (nearly 100%),
Polynesians, Mexican Americans (50%)
 Genetic theories are unproven at this point
Insulin and Glucose
 When food is eaten, carbohydrates are broken down to the
end product of glucose.
 This stimulates the release of Insulin which the body needs
to absorb glucose into fat, heart, liver and muscle cells
which act as a sponge.
 Overtime, the cells began to ignore the insulin messenger.
When that signal is ignored, the body’s insulin producers—
beta cells—have to work harder and harder, overproducing
insulin to get the job done causing insulin resistance.
Insulin promotes fat storage
 Excess glucose can also be converted to fatty acids, which
are the immediate precursors of fats (triglycerides)
 In addition to facilitating the transport of fatty acids into
cells that need them as fuel, insulin promotes their
conversion to fat for storage in adipocytes (fat cells). if we
overeat and don’t exercise enough, the supply of fat will
exceed the demand for energy. That can lead to obesity,
the main cause of insulin resistance, which can lead to
diabetes.
Insulin in Excess
 Signals the body to store fat causing obesity
 Inflammation
 Oxidative stress
 Increases vagal nerve gastric acid production
 Alters sex hormone production (PCOS, low testosterone in
men, high in women, increased estrogen in men)
Virulization of women and feminization in men
 Fatty liver disease
Obesity/Inflammation
Connection
 Obesity is a state of chronic low-grade
inflammation that is initiated by changes in the
adipose tissue.
 Research suggest that as fat cells increase in size,
the composition of their lipid membrane
composition changes in a manner that may make
these cells more prone to triggering inflammation.
Inflammation/IR
 Increased plasma levels of pro-inflammatory markers
including cytokines and C-reactive protein (CRP) in
obese individuals Many of the inflammatory markers
found in plasma of obese individuals appear to
originate from adipose
 In chronic inflammation, chemicals released such as
TNF and IL6 directly interfere with insulin signaling
pathways making cells more insulin resistant.
Vicious Cycle of Obesity
 "Now we know that fat cells are little hotbeds of
inflammation. Therefore excess belly fat is a great
source of inflammation.
 Therefore being obese can cause insulin resistance and
insulin resistance can cause obesity.
Cardiovascular Effects
 Insulin resistance significantly increases the risk of
ischemic stroke in nondiabetic adults, independent of
traditional vascular risk factors or metabolic syndrome
, “October 2010 issue of Archives of Neurology”
 Individuals in the top quarter of insulin resistance had
a 45 percent greater risk of any type of vascular event.
Cardiovascular Effects
 Insulin stimulates the sympathetic nervous system,
increasing nor-epinephrine release contributing to high
blood pressure
 Insulin increases triglycerides and cholesterol. Eat eggs
not sugar!
Cardiovascular Effects
 Insulin damages the endothelium or cells lining our
blood vessels. Endothelin dysfunction reduces nitric
oxide production needed for healthy blood vessels. It
also reduces blood flow by causing vascular smooth
muscle contraction and the growth of vascular smooth
muscle cells. As a result, the blood vessels are thicker
with a smaller lumen; blood flow is slower and there is
increased risk of clotting inside the vessels
(thrombosis) and stroke.
Stroke
 Insulin resistance significantly increases the risk of
ischemic stroke in non-diabetic adults.
October 2010 issue of Archives of Neurology
Hormonal activation
 Aromatization -Testosterone is chemically converted to
estrogen.
 In people with excess fat and especially abdominal fat
with higher aromatase so greater conversion of
testosterone to estrogen.
 Insulin increases LH blocking testosterone production.
 Testosterone: lower in men and higher in women.
Hormonal Activation –
PCOS
 Polycystic Ovarian Syndrome
 Production of multiple small cysts beneath the ovarian
capsule. These insulin-damaged ovaries act like
testicles; they make excessive androgens, from DHEA
to testosterone
 Increased Luteinizing hormone.
 Anovulation
PCOS
 A woman’s body converts these androgens to estrogens
as and levels of both testosterone and estrogens can
significantly exceed that of progesterone
 Symptoms: excess facial hair, lack of ovulation, heavy
periods, painful periods, irregular or absent periods,
acne or oily skin, depression or mood swings
Fatty Liver
 Fatty liver, also known as fatty liver disease (FLD), is
a reversible condition where fat accumulates in liver
cells
 Despite the strong association between insulin
resistance and dyslipidemia/fatty liver, the precise
mechanism linking these conditions is unclear.
 Signs: Decreased (HDL) cholesterol and increased
(VLDL) and possible elevated liver enzymes. Dx:
Ultrasound or a non-contrast CT scan of the abdomen
Cortisol/Adrenaline
 Those with Metabolic syndrome has been shown to
have higher cortisol levels.
 High sugar causes cortisol to spike.
 A New York Times article on a study showing when
children eat sugar, their adrenaline levels rise far higher
than those of adults – up to 15x higher than baseline.
Another vicious cycle..
 Cortisol effects worsen insulin resistance and its
consequences include weight gain, especially with
increased abdominal fat; elevated blood pressure;
higher blood sugar; insomnia and reduced activation
of thyroid hormone.
 Insulin resistance increases cortisol production, which
in turn worsens insulin resistance.
Inflammation
 Chronic inflammation and its cytokine messengers,
especially TNFa and IL-6 increase energy demands in
an already-challenged system; they worsen insulin
resistance, and add to sympathetic nervous system
activation.
 The effect of insulin on oxidative load: depletes our
glutathione, vitamin C, vitamin E and other
antioxidants
IR and Type 2 Diabetes
 Diabetes mellitus type 2 – or adult-onset diabetes
 a metabolic disorder characterized by high blood
glucose in the context of insulin resistance and relative
insulin deficiency.
IR and Type 2 diabetes
 Pre-diabetes :Elevated insulin and borderline glucose
levels precede onset of type 2 diabetes.
 In time elevated insulin will stress the beta cells, which
wear out over time. When most are diagnosed with
type 2 diabetes, they have already lost some of their
ability to make insulin.
Insulin’s Dermatological
effects
 Acne
 Skin tags
 Acne rosacea
Testing
 Glucose/Insulin Tolerance Test: Insulin resistance - insulin
levels rise above 200
 Lipids (Cholesterol, HDL, LDL, TRIG) VAP
 Fasting glucose and hA1c
 CRP - independent biomarker for the development of CVD
which emphasizes the connection between inflammation,
obesity, and CVD.
 Homocysteine, Free and Total Testosterone, Estrogen, Liver
Enzyems.
Food as Medicine
 Dietary Goals – Reduce obesity and improve insulin
sensitivity.
 “Hunter Gatherer”Diet. It reflects what our Paleolithic
ancestors (i.e., before agriculture) evolved eating over a
million years and, as such, has the highest potential of
supporting healing and preventing disease.
 Examples: The Zone, Paleo Diet, Diet Cure,
Schwarzbein Principle, South Beach Diet, Candida
Diet.
Food as Medicine
 Avoid: White Foods with a low glycemic index and fast
foods. Complex carbohydrates in moderation.
 Non-Starch Vegetables –should be the majority of
carbohydrates.
 Protein - Beans, Legumes, Fish, Free Range Animal
Protein. Grass fed beef. Protein at each meal preferred.
 Healthy fats – avocado, organic butter, olive oil, coconut.
Avoid hydrogenated oils and fried foods. Nuts in
moderation.
Food as Medicine
 Fruit – moderate consumption. Only in season.
· Small amounts of fruit are OK but eat it with
protein meals and not alone. Berries are best. No dried
fruit.
 Reduction or elimination of sweeteners (including
artificial and stevia)
 Dairy - whole milk is best. But the best is no milk, as it
raises the blood sugar.
Lifestyle Changes
 Exercise may be the single most important factor for
reversing insulin resistance. Exercise improves insulin
sensitivity, lowers fasting glucose, lowers fat mass, and
improves fat metabolism.
 Sleep - Sleep deficiency significantly worsens insulin
resistance, with a nearly 40% decrease in glucose
tolerance
Supplements
 R-Lipoic Acid: Taking 600 mg orally daily improves insulinsensitivity in diabetics; stimulates glucose uptake by GLUT4 receptors
 Carnosine: Antioxidant. Helps prevent damage caused by
too much sugar in the body, “glycosylation,”
 Antioxidants in general to protective from oxidative stress of
high insulin.
 Cinnamon:decreases blood glucose and improves insulin
sensitivity – 1-6 G for 4 months.
Supplements
 Berberine - 1500 mg per day improves insulin
sensitivity
 Fiber - slows down release of glucose into the blood.
Guar gum, glucomannan, oat fiber.
 Vanadium – Research slows activates GLUT 4
transporters.
 Chromium improves glucose metabolism. 300-1000
mcg per day
Berberine Study
 “Compared with metformin, berberine exhibited an
identical effect in the regulation of glucose metabolism,
such as HbA1c, FBG [fasting blood glucose], PBG [blood
sugar after eating], fasting insulin and postprandial insulin
[insulin level after eating]. In the regulation of lipid
metabolism, berberine activity is better than metformin. By
week 13, triglycerides and total cholesterol in the berberine
group had decreased and were significantly lower than in
the metformin group (P<0.05).”
 http://tahomaclinicblog.com/berberine-diabetes/
Drug Therapy
 Metformin: commonly used for type 2 diabetes and to treat
young women with infertility due to PCOS
 Improves insulin sensitivity, with “increased peripheral
uptake and utilization”
 Decreases intestinal absorption of glucose. The reduced
absorption of glucose from the gut means less sugar gets
into the blood stream to stimulate pancreatic insulin release.
 Patients with larger body-mass index (BMI) respond better
to metformin treatment than do the more slender
Metformin
 Reduced the amount of insulin released in response to
drinking sugar (46% less)
 Reduced blood levels of LH (67% lower),
 Reduced free testosterone (44% less)
 SHBG (which rose nearly three times higher than the
untreated baseline.)
 Reduces Total-cholesterol, LDL-cholesterol and TG
Tests
 VAP panel (an expanded lipid profile), CRP, hA1c, 2-4
hour Glucose and Insulin Tolerance Test,
homocysteine, LH, Free and total testosterone,
Estrogen, Liver enzymes and fasting glucose.
 Adiponectin: A hormone e secreted by fat cells.
Improves insulin sensitivity, reduces insulin resistance
and may protect pancreatic b cells. High levels are
associated with normal insulin sensitivity. Low levels
correlate with metabolic syndrom and diabetes.
The road to health
 Remember metabolic syndrome is an outcome
of our sedentary, fast-food oriented modern
lifestyle. With commitment to healthy eating,
daily exercise and your doctors support,
metabolic syndrome can be reversed.
 Thank you
Contact Dr. Large
Elizabeth Large N.D.
Gordon
Medical associates
3471 Regional Parkway
Santa Rosa, CA 95403
707.575.5180
[email protected]
www.gordonmedical.com