Hypothetical Case Study #1 Obesity and Metabolic Syndrome

Laura SheehanDiabetes, Nutrition, Our Blog, Wellness Library, , , , , , , , ,

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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References

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

Laura SheehanDiabetes, Nutrition, Our Blog, Video Transcripts, Wellness Library, , ,

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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Types of Carbohydrates (from a blood sugar point of view)

Laura SheehanNutrition, Our Blog, Video Transcripts, Wellness Library, , , ,

When people come in to my office, and we start talking about diet, and we start talking about carbs, they invariably say “are all carbs bad for you?”  This is a difficult question to answer, because it’s not about bad or good, it’s about what carbs your body need and can handle, and how much of each.  Every person is different, but there’s some good rules to follow.  Now keep in mind, this is not the article about simple vs complex carbs, or refined vs unrefined, or something else like that.  It’s literally what myself and other nutritional specialists have observed after treating thousands upon thousands of new patients.  It’s more about how to practically apply knowledge of carbohydrates vs theoretical what they’re made of, and how they work in the body (although there’s a place for that, most people just want to know what they should and shouldn’t eat.  So here it is).

  1. White Trash, or White Death, as Arnold Schwarzenegger would call it. Yup, the worst of the worst, white sugar, and white flour and all of its family. I would include in this any refined sugar, and any refined flour, and all its family, cousins, and extended family.  Here you’ll find candy, cakes, soft drinks, juice drinks and fruit juices (even though fruit juices are from fruit, they are still concentrated sugars. I’ve seen them be responsible for serious health problems like high cholesterol, high triglycerides, weight gain, obesity, high blood pressure, suppressed immune function, etc.), cookies, pies, bagels, bread, pasta, doughnuts, rice, rice cakes, pastries, I think you get the point.  These are bad.  No one does well with them.  They might get away with them for a while, but eat enough of them, and they will catch up to you.  Remember the insulin surge caused by these foods may not cause weight gain, high blood sugar, and or triglycerides, it might just cause high cholesterol, blood pressure, or they may just be causing hormonal problems or tumor growth.  Avoid them at all costs.
  2. Whole grains. People are often surprised that I tell most of my patients to avoid them. Why would I do that?  Aren’t they supposed to be “good carbs?”  Don’t they have B vitamins and fiber?  Well, here’s the rub.  A lot of people have digestive sensitivities to them, and they aggravate any health condition they have.  You get more B vitamins from certain veggies, and definitely meat.  You can get plenty of fiber once again from veggies.  Also, it’s very easy to overdo it with these. Take for instance brown rice.  One cup has 45 carbs (ok, so only 41.5 net carbs, since it has 3.5 grams of fiber)!  Considering that most people can only handle 70-100 grams of carbs per day for optimum sugar balancing, having whole grains once per day can severely limit the amount of vitamins and minerals you can get from other carbs, like fibrous veggies.  In this category I’d put brown rice, whole wheat (although I’d avoid this altogether because almost all of my patients with symptoms are sensitive to it, some severely), quinoa (although it’s not as high in carbs as other grains), corn, barley, spelt, and other grains.  The low down on grains is that you are not looking to lose weight, and that you don’t have health problems, you can eat them sparingly. If you’re looking to lose weight, balance blood sugars, inflammation, or reverse an illness, avoid them.  They have a sneaky way of getting in to your diet.
  3. High carb veggies-In here are things like potatoes, sweet potatoes, beans, certain squashes, beets, and some others. They are packed with vitamins, minerals, and fiber, and some are especially high in potassium (extremely important for liver health, especially in how it processes sugars and fats).  They are good for you, but depending on how well you handle carbs, you may need to limit these.  For example, for someone with diabetes or pre-diabetes, or some kind of inflammatory condition, I’d only eat them sparingly.  Basically, this is a grey area, and you’ll have to use some judgement.
  4. High carb fruits-In here are bananas, pineapple, mango, and of course dried fruit. Once again, it’s not that they are bad for you, they are actually good for you if you can handle sugar.  For someone with diabetes or prediabetes, or some kind of inflammatory condition, I’d only eat them sparingly.
  5. Medium carb fruits-In here you’ll find apples, oranges, pears, cherries, blueberries, grapefruit, etc. You can eat more of these, even if you’re a little carb sensitive.  But not too much, or you’ll blow your carb count, and aggravate any condition you have.
  6. Low carb fruits-In here are strawberries, raspberries, and blackberries. You can eat almost as much of these as you want.  Eating a little here and these won’t even bring someone out of ketosis if they are in a ketogenic diet usually!  I put them in my shakes if I’m trying to lose weight, I love fruit.
  7. Low carb, or fibrous veggies-There are a huge number of fibrous, low-carb veggies. There loaded with fiber, vitamins, and minerals.  You can, and should eat a ton of these.  I try and eat at least 10 cups of leafy greens per day (yup, 10 cups).  You need a lot to support liver detoxification, and balance blood sugar.  Some favorites (but I’m not listing them all) are broccoli, cauliflower, kale, Brussel sprouts, spinach, salad greens, peppers, squash, zucchini, onions (a little on the high side of carbs, but not bad), and the list goes on and on.  Unless you’re on a strict ketogenic diet, you can eat pretty much as much of these as you can handle.

Here’s a pictorial representation of the carbs.  As you can see, we should eat plenty of the ones on the bottom.  The ones at the top, everyone should avoid.  In the middle is the “grey” area.  The better your blood sugar metabolism is, the more you can eat. Hope this helps.

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Natural Help for Type 2 Diabetes

Dr. Sheehan’s Natural Help for Type 2 Diabetes

Laura SheehanDiabetes, Nutrition, Our Blog, Wellness Library, , , , , ,

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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Mommy Needs Whole Food Nutrition

Laura SheehanNutrition, Our Blog, Wellness Library, , , , , , , , ,

Mommy needs whole food nutrition and the exact right supplement program (as determined by Nutrition Response Testing(R)). These are important for everyone’s health, but most importantly for hopeful, or expecting mothers. Getting onto a nutrition plan should begin well in advance of trying to conceive. This will ensure that mom (and dad!) have the best chance of an easy pregnancy and a healthy, well-nourished child. It makes sense! It’s because the proper development of the growing child depends on the nutrients available to the child from preconception through childhood.

Here are some important points for mommy and daddy to consider when baby-having is on their mind:

  1. Both mom and dad should be on a nutrition program at least three months before trying to conceive. This will improve their nutritional profile and ensure the baby has enough good vitamins and minerals to grow a healthy body.
  2. Whole food vitamins are perfectly safe and very effective for mommy and baby because they are made from food! Whole food vitamins are also great to help with milk production when breast-feeding.
  3. During pregnancy, as much as possible, eat foods in their whole form. Pasture-raised, organic, local–get the best quality you can. You’re growing another human body, in all of its wondrous complexity. This is not a time to skimp!
  4. Here is a great resource for feeding the family: http://www.westonaprice.org/childrens-health/

And now here is the featured diet log of our client T.  who had high blood sugar and now he has brought his blood sugar down to normal (and avoided having to take meds! Go!) and lost 15 lbs so far and is still losing. He is following a “ketogenic diet” which is very low in carbohydrates, and very high in fat. He says he does not even crave sugar or sweets on this high-fat diet.

Tues

Breakfast 3egg omelette, diced tomatoes, jalapenos, one spicy italian sausage, guacamole cooked in avocado oil with avocado oil poured onto it

Lunch 2 organic gluten free and dairy free hotdogs, goat cheese crumbles, poured avocado oil on them

Snack 2tbsp of Almond butter

Dinner 1 doz wings with broasted hotsauce, celery, dipped in guacamole

Snack 2tbsp of almond Butter

Wednesday

Breakfast 8 gluten free meatballs, goat cheese crumbles, sirracha sauce, covered in olive oil

Snack 2tbsp almond butter

Lunch pulled pork, guacamole, avocado oil

Dinner Chicken smothered in guacamole, broccoli

Snack 2tbsp almond butter

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