Hypothetical Case Study #1 Obesity and Metabolic Syndrome

Hypothetical Case Study #1: An Approach to Obesity and Metabolic Syndrome

By Laura Sheehan

I am going to discuss my hypothetical client Marilyn. Marilyn has come to me for nutritional help, with the goal of making dietary modifications to get off her medications. She is 65 years old and obese.

Multiple definitions for Metabolic Syndrome (MetS) have evolved over the past two decades 1. The most recent and applicable definition to my clinical practice is the NCEP ATP III (2005 revision). In order to be diagnosed with MetS, my imaginary client Marilyn would need to meet three of the following five criteria: abdominal obesity (waist circumference >35 inches in women), high triglycerides (≥ 150 mg/dl), low HDL cholesterol (< 50 mg/dl in women), high blood pressure (≥ 130/≥ 85 mmHg), and high fasting glucose (≥ 110 mg/dl). According to these criteria, Marilyn fits all the criteria for MetS. She has obesity, type II diabetes with a fasting glucose of 190 mg/dl, hypertension (180/90 mmHg), high triglycerides (202 mg/dl), and low HDL cholesterol (40 mg/dl).

Insulin resistance has been proposed as the common thread linking the symptoms of MetS 2. In response to diminished sensitivity to circulating insulin, the pancreas produces more and more of this necessary hormone, and the result is high levels of glucose and insulin in the blood. These elevated levels of insulin and glucose are damaging to the body and are associated with a myriad of negative health effects, especially cardiovascular disease and diabetes mellitus, with its complications of increased susceptibility to infection, diabetic retinopathy, cataracts, and chronic renal disease3. To help Marilyn, I will need to focus on reversing her insulin resistance and MetS. I will need to provide guidelines to make her body more insulin sensitive.

Several metrics will help me to monitor Marilyn’s progress towards her goals of increasing her insulin sensitivity and getting off her medications. I will try to regulate Marilyn’s measurements toward normal. Her waist circumference should be progressively decreasing to below 35 inches, her fasting glucose toward normal (80-100 mg/100ml), her triglycerides toward normal (70-110 mg/dl), HDL cholesterol increasing toward ≥ 55 mg/dl4, and blood pressure toward normal (120/80 mmHg).

Although there is quite a bit of debate in the literature, simple biochemistry indicates that MetS and insulin resistance are effects of too much sugar in the diet. It makes sense that I would consider recommending changes to Marilyn’s carbohydrate consumption. Lowering the overall glycemic index of carbohydrates in Marilyn’s diet could be successful5, but It would be simpler in practice to reduce Marilyn’s total carbohydrate intake6. Both approaches could be successful in reducing waist circumference and hyperlipidemia. A carbohydrate restricted diet combined with added soluble fiber could increase HDL and decrease LDL levels78.

Within Marilyn’s carbohydrate-restricted diet, I will emphasize that she avoid processed sugars and focus on complex carbohydrates in their whole form. Processed sugars, especially high-fructose corn syrup, have been shown to contribute to MetS by increasing the deposition of fat in the liver9. I will also stress increasing soluble fiber as the literature suggests a benefit to lipid profiles7. After implementing these changes, provided Marilyn can stick to her diet long enough, she should see improvements in her MetS criteria and be able to visit her family doctor for a medication review.

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1. Huang PL. A comprehensive definition for metabolic syndrome. Disease Models & Mechanisms. 2009;2(5-6):231-237. doi:10.1242/dmm.001180.

2. Reaven G. 1988 Banting Lecture: role of insulin resistance in human disease. Diabetes 1988; 37: 1595-1607.

3. Hall J. Insulin, Glucagon, and Diabetes Mellitus. In: Hall J. Guyton and Hall Textbook of Medical Physiology. Philadelphia, PA: Saunders Elsevier, 2011: 939-954.

4. Weatherby D, Ferguson S. Blood Chemistry and CBC Analysis: Clinical Laboratory Testing from a Functional Perspective. Jacksonville, OR: Bear Mountain Publishing, 2002.

5. Finley CE, Barlow CE. Glycemic Index, Glycemic Load, and Prevalence of the Metabolic Syndrome in the Cooper Center Longitudinal Study. Journal of the American Dietetic Association. 2010;110(12):1820-1829. doi:10.1016/j.jada.2010.09.016.

6. Volek JS, Phinney SD. Carbohydrate Restriction has a More Favorable Impact on the Metabolic Syndrome than a Low Fat Diet. Lipids. 2008;44(4):297-309. doi:10.1007/s11745-008-3274-2.

7. Wood RJ, Fernandez ML. Effects of a carbohydrate-restricted diet with and without supplemental soluble fiber on plasma low-density lipoprotein cholesterol and other clinical markers of cardiovascular risk. Metabolism. 2007;56(1):58-67. doi:10.1016/j.metabol.2006.08.021.

8. Yancy WS, Westman EC. A Randomized Trial of a Low-Carbohydrate Diet vs Orlistat Plus a Low-Fat Diet for Weight Loss. Archives of Internal Medicine. 2010;170(2):136. doi:10.1001/archinternmed.2009.492.

9. Havel P. Dietary Fructose: Implications for Dysregulation of Energy Homeostasis and Lipid/Carbohydrate Metabolism. Nutrition Reviews 2005; 63(5): 133-157.

5 Things You Can Do to Improve (or in most cases, reverse!) Diabetes

If you’ve been diagnosed with diabetes, you might be wondering what you can do to help it.  Personally, in our office, when we have put a patient with Type II diabetes on a personalized diet and supplementation program, we’ve seen people dramatically reduce their fasting glucose, H1AC, triglyceride, and cholesterol numbers.  I’m happy to say I’ve heard this sentence many times: “My doctor says I’m not diabetic anymore, and I don’t need meds!”

Here’s a quick summary of what you can do to help yourself if you’ve been diagnosed with type II diabetes (or been told that you’re pre-diabetic).

  1. Cut down the carbs, especially refined carbohydrates such as grains, sugar, and other junk food, but also high carb fruit such as bananas, mangoes, and pineapples. When you’ve been diagnosed as being a type II diabetic, or pre-diabetic, foods such as these will cause your blood sugar to skyrocket, further beating up your blood sugar regulation.  Better to eat low carb fruit such as berries, low carb veggies such as greens, tomatoes, cucumbers, pepper, etc (basically avoid high carb veggies such as potatoes and corn), as well as meats, nuts, seeds, and low carb dairy such as cheese, cream, butter, and cottage cheese.  Most of my patients either use a carb counting app on their phones, or keep track of their carbs using a pen and paper (we call it a diet log in our office).  See the link below for a partial list of good foods for type II diabetics. Keep in mind, you should cut down your carbs, but increase your veggies!  Veggies help to regenerate your liver’s function, which is key to blood sugar stabilization.
  2. Eat more fat and protein. Fat causes very little insulin to be released when you eat, protein (especially higher fat protein sources) causes your body to release more more insulin, but not as much as carbohydrates. A good rule of thumb is that at least 70% of your calories should come from fat and protein for optimum blood sugar control.
  3. Cut down the snacking. Every time you eat, you stimulate the release of insulin. Therefore, cutting down the number of times you eat per day will give your pancreas and insulin receptors on your cells rest, so that they can heal.
  4. Get moving, especially in the morning on an empty stomach. Exercising first thing in the morning helps to re-sensitize insulin, which is of utmost importance when fighting type 2 diabetes. I like to go for a slow jog of 1-1 ½ miles, but if you have more time, you can walk, do yoga, ride a bike, whatever.  Just get moving, preferably in the morning!
  5. Take your blood sugar at least every day. Usually on a program like this, people’s blood sugar, cholesterol, and triglycerides will plummet, so make sure you’re keeping tabs on this, and communicating with your MD.
  6. Take supplements.  There’s lots of supplements that will help with blood sugar stabilization, so this is not a complete list. These are just the ones that I’ve successfully used in my office:
    1. Glyc-Aide-This is my go-to product from Ulan Nutritional Systems.
    2. Gymnema-This has a long history of helping blood sugar issues. I like the one from MediHerb.
    3. Zinc, chromium and magnesium-All of these have been shown to be deficient in the majority of patients with diabetes type II, so supplementing them helps. I like Standard Process for these supplements.
    4. Other supplements for the liver, gallbladder, pancreas, and adrenals-as determined by Nutrition Response Testing.

Honestly, I like to get the 1st 5 steps in place before I recommend supplements.  You can’t “out supplement” the wrong diet, or make up for lack of exercise with supplements.

Give this program a try, and see how you do.  As always, please feel free to leave feedback, or ask questions below.  Thanks for watching.

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11 Ways to Lower Insulin

So by now you’ve probably watched a number of my videos, and/or read my articles, and know that we mainly focus on cutting down refined carbohydrates and sugars in the diet, to cut down the body’s secretion of insulin, to help return your health.  You know high insulin and carbohydrate levels are linked to inflammation, tumor growth, increased cholesterol, triglycerides, heart disease, strokes, cancer, arthritis, diabetes, blood pressure, anxiety, depression, hormonal imbalances, and so on.

Basically, almost all of the chronic diseases we suffer from in this country today can be at least partially linked to high insulin and carbohydrate intake.

So how do we cut down our insulin production and blood sugar swings?

Here are eleven steps:

  1. Cut carbs.

    The quickest way to cut down your secretion of insulin and balance blood sugar is to cut carbs. Start with the cakes, cookies, pies, breads, chips, baked good, candy, soft drinks, and fruit juices, and then move on to starches like potatoes. If you’re still having health symptoms, problems with blood sugar, altered lab tests, or trouble losing weight,  then cut out fruit.

    Start with the high sugar fruits, like bananas, pineapples, and mangoes, and move on to cut out the other fruits.  Low carb fruits, such as raspberries, strawberries, and blackberries, and non-starchy vegetables almost never have to be cut out. In fact, veggies should never be cut out as they help your liver balance blood sugar and blood fats.  On the other hand, high carbohydrate dairy, like milk,  should usually be cut out in the beginning steps of counting carbs.

  2. Eat a moderate amount of protein

    Protein, also causes your body to secrete insulin, although not as much as carbohydrates. However, it’s hard to eat too much protein, and in our society, it’s not as common as overeating carbs. That’s why we don’t concentrate on it.  Our bodies need protein to make enzymes and rebuild muscle, hair, skin, and nails. Protein is needed by our bodies to make enzymes and rebuild tissues such as muscle, hair, skin and nails. So don’t skimp on it!                                                                                                                                                                                                                                                                                        Keep this in mind:  the lower the fat content of the protein source, the more insulin you will produce.  That’s why I recommend full-fat meat, eggs, fattier fish and chicken and so on. Eating your protein with fat such as avocados, nuts, seeds, coconut oil, low carb cheese and butter will lessen insulin secretion.  Stick to protein servings the size of the palm of your hand three times per day, and you’ll be fine.

  3. Eat moderate to high amounts of fat

    Fat slows down sugar absorption, to blunt blood sugar and insulin spikes. Fat is the only macronutrient that does not cause insulin secretion. Most fat sources, such as nuts, seeds, low carb dairy, oils, and butter, create a small insulin surge because they almost always naturally occur with small amounts of proteins and carbohydrate.  In fact, the more protein and carbohydrate they have in them, the more they secrete insulin (but it’s still a small amount).  Include a little extra fat at each meal.  Good fat sources are low carb dairy, butter, seeds, nuts, avocado, coconut oil, and nut butters.

  4. Increase veggies

    Besides being high in fiber (helping you to feel full), veggies slow down sugar absorption, and keep your bowel healthy (and therefore aids in liver detoxification) In addition, non-starchy vegetables are low in carbohydrates, and high in the vitamins and minerals that your body needs. Vegetables are especially important in detoxing the body. They also help you body to break down fats (i.e. they help to lower cholesterol, and triglycerides, while raising HDL cholesterol).                                                                                                                                                                                                                                                      One of the common complaints of  older ketogenic diets was that they did not contain vegetables, which puts you at risk for fatty liver syndrome (and other problems) if you don’t eat plenty of them while you diet.  I speak from experience: I’ve followed a low carb lifestyle for many years, but did not incorporate enough veggies into my diet. I ended up suffering from liver toxicity.  Broccoli, kale, cauliflower, and brussel sprouts are especically good for minimizing blood sugar spikes and resensitizing your body to insulin, since they powerfully detox the liver. For an easy way to get in your veggies, see my Kale shake video).

  5. Proper sleep

    Sleep helps lower stress hormones like cortisol, and bolsters feel-good hormones like serotonin. Since you are not eating while you sleep, your pancreas and liver also get a break, allowing them to regenerate helping to resensitize your  cells to insulin for better blood sugar control.  Sleep deprivation has been shown to decrease insulin sensitivity to levels seen in people who are diabetic, and/or obese.  Bottom line: If you want to have healthy blood sugar control, sleep enough.  People need plenty of sleep, 7-9 hours minimum. If health is your goal, try getting more like 9 hours per night.

  6. Decrease stress

    Stress causes the release of cortisol, which tanks your body’s sensitivity to insulin (bad!), and causes blood sugar spikes. Good ways to decrease stress include low intensity exercise (like walking, qi Gong, tai chi, and yoga), mindful meditation, adopting the dietary changes I talk about above (a low carb, medium fat, medium protein, high vegetable diet prevents blood sugar swings and lowers stress hormones, like cortisol), getting on the proper nutritional supplement program, and handling any stress you have in your life (wow is that a whole topic in itself-see my video on that).

  7. Don’t snack

    Every time you eat, your body secretes insulin to counteract the blood sugar spikes. One of the best ways to decrease insulin production and blood sugar spikes is just to cut down the number of times you eat per day.  You could even skip a meal (whichever meal is easiest to skip for you), and do an intermittent fast.  I have one patient that comes into my office, a 13 year old young man, who was pre-diabetic.  We had him cut carbs, while increasing fat, and he started exercising more. He also confided in me that he felt like lunch was too much for him, so he started skipping it.  I made sure that he was eating enough, as he was still growing, and he was, just skipping lunch.  He stopped gaining weight, and is now at a healthy weight for his height (he “grew in to” his weight).  What’s more, it’s something he came up with that he likes, and works for him.  I myself was snacking a lot during the day, and stopping that was one of the things that helped me recently drop 20 pounds of belly fat (along with increasing my intake of kale, cutting milk, and doing just a little fasted cardiovascular exercise in the morning-like 15 minutes).

  8. Exercise

    Exercise resensitizes insulin receptors, and stabilizes blood sugar, but only in the muscles exercised. That’s why weight lifting works better.  Also, for every pound of muscle you gain, your insulin receptors will work better further stabilizing blood sugar.  For maximum benefits, combine weight training and cardiovascular training.

  9. Fasted cardio

    Performing fasted cardio, aka doing cardio first thing in the morning, really sensitizes your cells to insulin and raises fat burning hormones, adding to long term blood sugar stabilization. The key is, don’t do it too hard, in other words, not over 60% of your maximum heart rate.  To find your maximum heart rate, subtract your age from 220.  Take this number, multiply by .6, and this is where you should keep your pulse while performing fasted cardio.  For example, I’m 45, so (220-45) x.6 is 105.  When I perform fasted cardio, I keep my pulse around 105.  Good activities for morning fasted cardio are walking, jogging, biking, and yoga.

  10. Avoid Sitting

    My wife always says, “Sitting is the new smoking!” Studies have shown that sitting a lot is just as detrimental to your health as smoking!  What defines as “sitting a lot”?  Having a desk job where you sit all day qualifies.  If you have a desk job, think about getting a standing desk, or even a treadmill desk, or getting up every hour our half hour for 5 minutes of walking or stretching, or even calisthenics.

  11. Supplements

    Ah yes, the part that everyone wants to hear, what pill can I take to make me feel better! First, get in the 8 steps above, because I always say, diet and lifestyle first!  That being said, here’s what will help to lower blood sugar and resensitize your cells to insulin, safely and effectively:

    1. Glyc-Aide-This is my go-to product from Ulan Nutritional Systems. I’ve seen it work time and time again.
    2. Gymnema-This has a long history of helping blood sugar issues. I like the one from MediHerb because of its high quality.  In a lot of other herbal products, you can’t always tell how much they contain of the actual herb.
    3. Zinc, chromium and Magnesium-The majority of patients with Type 2 Diabetes and blood sugar issues have been shown to be deficient in these three minerals. Supplementing with them helps. I like to use Standard Process for these supplements.
    4. Other supplements for the liver, gallbladder, pancreas, and adrenals-as determined by Nutrition Response Testing.  If you’re interested in a Nutrition Response Testing consultation, go here or give us a call at 717-392-6606 to schedule!





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Natural Help for Type 2 Diabetes

Dr. Sheehan’s Natural Help for Type 2 Diabetes

Do you, or a loved one either have Type 2 diabetes, or what is called Pre-Diabetes, aka Syndrome X?

I have a lot of patients coming in with these two disorders, so before I talk about it, I decided to look into exactly what the American Diabetes Association is saying about it.

I’m very happy that the American Diabetes Association is starting to talk about food’s relationship to diabetes, I think if they were a little clearer cut, they would encourage more people to take control of their diabetes to the best of their ability. In my office, I’ve helped at least 90 percent of cases reverse Type 2 diabetes!

In their post, the ADA attempts to answer a few so-called myths about diabetes. I found some of their information confusing.

They answer this “myth,” eating too much sugar causes diabetes, with the following answer:

 “The answer is not so simple. Type 1 diabetes is caused by genetics and unknown factors that trigger the onset of the disease; type 2 diabetes is caused by genetics and lifestyle factors.

Being overweight does increase your risk of developing type 2 diabetes, and a diet high in calories from any source contributes to weight gain. Research has shown that drinking sugary drinks is linked to type 2 diabetes.

The American Diabetes Association recommends that people should avoid intake of sugar-sweetened beverages to help prevent diabetes…These will raise blood glucose and can provide several hundred calories in just one serving!”

After reading this, I’m left wondering, are they saying sugar causes diabetes or not? In my work with diabetics, I’ve found it works best if they cut sugar 100 percent. Why? Let’s illustrate this with another example: It’s also true alcohol alone doesn’t cause alcoholism, but shouldn’t alcoholics avoid it 100 percent?

Here’s a second “myth” the ADA attempts to address: “If you have diabetes, you should only eat small amounts of starchy foods, such as bread, potatoes and pasta.”

What’s their answer?  “Starchy foods can be part of a healthy meal plan, but portion size is key. Whole grain breads, cereals, pasta, rice and starchy vegetables like potatoes, yams, peas and corn can be included in your meals and snacks. In addition to these starchy foods, fruits, beans, milk, yogurt, and sweets are also sources of carbohydrate that count in your meal plan.

Wondering how much carbohydrates you can have? The amount of carbohydrates you need will vary based on many factors. You and your healthcare team can figure out the right amount for you. Once you know how much carbs to eat at a meal, choose your food and the portion size to match.”

Soooo…sounds to me like they’re saying you should only have a small amount of starchy foods.  Why do they start off saying it’s a myth, and then say the opposite?

Starchy foods break down into sugar- plain and simple. Doesn’t the fact that you have diabetes indicate you should only be eating very small servings of starches, if at all?

For the record, I do agree with greatly reducing or eliminating starchy foods while you work on reversing Type 2 diabetes.

That brings me to a major point on their website I don’t agree with, and that’s this one: “There’s no cure for diabetes.”  While this is true for a small minority of people, a good many people can reverse Type 2 diabetes with proper diet, exercise, supplementation, and intermittent fasting.

In the next few paragraphs, I’m going to suggest a diet designed to minimize blood sugar fluctuations, cut down insulin secretions, and re-sensitize your body to insulin.  This diet helps support most, if not all, hormone imbalances that accompany Type 2 Diabetes. It decreases stress hormones such as cortisol by minimizing blood sugar swings.  It also helps balance testosterone, estrogen, and progesterone by minimizing estrogen production.

This is a low carb, high veggie, moderately low protein diet that helps to support weakened blood sugar controlling organs.  We have seen people reverse their diabetes by cutting sugar and carbohydrates and supporting the digestive organs as determined by a Nutrition Response Testing® program. For example, there may be a deficiency of enzymes or B vitamins in diabetes, and these deficiencies are caused by eating TOO MUCH SUGAR!

For cases of borderline Type 2 diabetes, or newly diagnosed Type 2 diabetes, switching to a diet of protein, veggies, nuts, seeds, oils, and a little fruit, along with the correct supplement regiment as determined by Nutrition Response Testing rolls back diabetes over 90% of the time.

So what does a meal and exercise plan look like?

  1. Minimize the times you eat to 2-3x/day. Every time you eat, you secrete insulin. Seems like the intermittent fasters got it right!  A lot of my patients will skip breakfast or lunch to minimize insulin surges.
  2. Considering sugars and carbohydrates cause the secretion of insulin, keep carbs low. You don’t want to eliminate them though because carbs from non-starchy vegetables help to cleanse your liver, colon, kidneys, and skin.  They also provide you with lots of vitamins and minerals.  So eat lots of non-starchy vegetables at each meal, such as kale, all types of lettuce, peppers, broccoli, you get the idea.  About 3 cups of non-starchy veggies for each and every meal is right for most people.  I tell my diabetic patients to just stay away from grain and starches (even a little bit is often too much for them), and to stick with berries other than cherries if they want to eat fruit, such as blueberries, raspberries, and strawberries.
  3. Eat enough protein, but don’t go overboard. Protein also causes the secretion of insulin, but you need this to stoke your metabolism (protein intake increases calories burned to a certain degree), retain muscle mass, and satisfy your hunger.  About four to six ounces per meal seems to work best for my patients, depending on their size, metabolism, and activity level.  Any kind of protein seems to work well, such as fish, chicken, beef, or even eggs.  I don’t usually recommend dairy as a main source of protein as it can be a food sensitivity for some people. I do tell people that if they add a little cheese or cottage cheese to what they eat, it will not spike their insulin levels, and will add a little variety to their food.  I’m not totally overbearing!
  4. Eat plenty of fat. Fat does not cause the release of insulin, so enjoy nuts, seeds, and oils with each meal. I usually recommend at least one fat per meal, but you could try more if it tickles your fancy.  Good ones to try are avocado, coconut oil, and all kinds of nuts, seeds, butters, and so forth.  Butter, cream, and cheese also have plenty of fat, so these are fine too.
  5. Get a calorie counting app, but not specifically to count calories. Calorie counting apps, such as My Fitness Pal will tell you how many grams of protein, fat, and carbohydrates you are eating.  It also tells you other important data, like how much potassium, vitamin C, and fiber you are eating.  Just make sure to adjust the macronutrient settings to something like 30% carbohydrate, 30% protein, and 40% fat.  You can go higher on the fat and protein, and lower on the carbs, but I find that these are pretty safe numbers.  If you can achieve these numbers each day while adhering to the above 4 steps, you’re definitely seeing improvement in your blood sugar, triglycerides, cholesterol, and blood pressure.
  6. Start moving! People who have  Type 2 diabetes, or are prediabetic always have inflammation and high-stress hormonal levels.  Walking is the perfect exercise for them.  It decreases stress hormones, sensitizes insulin, and burns calories.  It also gets your body used to exercise, more “in shape” so that you can exercise more vigorously later if you feel like it.  I recommend one hour per day for my clients.  It’s even better done 1st thing in the morning on an empty stomach, as it will increase your insulin sensitivity, and really increase your body’s output of growth hormone (the master healing hormone of the body).

Other good choices for decreasing stress hormones are yoga, qi gong, and tai chi.  If relaxation is not your style, you can lift weights, run, swim, play sports or whatever floats your boat.  Just remember, the harder you exercise, the less you should do of that exercise (You can always mix difficult levels of exercise-I lift 3 days per week, and walk about 3-5 hours per week).  The rule of thumb is this (you can mix and match these):

  1.      5 hours per week of gentle exercises, such as walking, yoga, tai chi, etc.
  2.      3 hours per week of moderate exercises, such as jogging, swimming, weightlifting, etc.
  3.      ½ hour (or less!) of high-intensity interval training.

There you have it, the exact diet and exercise plan I use every day in my office with my Diabetes patients.  Feel free to leave comments down below. And as always, go here to see how you can get your very own personalized Nutrition Response Testing®  evaluation!

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