2010 Metabolic Syndrome

7/31/2019 2010 Metabolic Syndrome

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METABOLIC SYNDROME

Nature, Nurture, NutritionGenomics, Proteomics,

Metabolomics


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Janice Werbinski, M.D., FACOG

Gynecologist -Borgess Womens Health

Former Medical Director -BMH Womens Center

Associate Clinical Professor - MSU / CHM

Author, Curriculum, Womens Health Track,

Internal Medicine Residency, MSU/KCMS

Founding President, ACWHPConsultant/Metabolic Syndrome Program

Borgess Integrative Medicine


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CLASSIC DEFINITIONSyndrome X (Dr. G. Reaven)

High Blood Pressure (>130/85)

High Blood Fats (Triglyceride) (>150)

Low HDL (Good) Cholesterol (110 mg/dl)

Increased Waist to Hip Ratio (>35 waist)

Central Obesity-Inability to Lose Weight

Family History of DM, HTN, CVD,Obesity


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FUNCTIONAL MEDICINEDEFINITION

Metabolic Syndrome

An age-related functional disorder of

glucose metabolism, mediated byaltered genetic expression at the cell

membrane level, and manifested under

particular environmental conditions.

-Dan Lukaczer, ND

Institute for Functional Medicine


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Alternative Labels

Syndrome X

Metabolic SyndromeInsulin Resistance

Pre-Diabetes

Glucose Intolerance


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INCIDENCE

Up to 25% of Americans (47,000,000 in US)

50% May not be Obese

Increasing in Children and AdolescentsIncreasing in Industrialized Nations

Very Close Association with:

-Diabetes-Cardiovascular Disease

-PCOS

-Preeclampsia / Eclampsia


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LABORATORY

PARAMETERSFasting Glucose & Insulin

2 hour Glucose & Insulin after 75gm glucola

Lipid panel

Homocysteine

Thyroid panelCRP

Euglycemic Clamp Studies (Research)


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CAUSES

1. GENETIC PREDISPOSITION (Genomics)

2. STANDARD AMERICAN DIET (SAD) Processed Foods, Preservatives, Additives

Low-and No-Fat Foods (High Carb) The Food Pyramid (High Carb)

Trans- and Saturated Fats

Low in Essential Nutrients and Fiber

High Fructose Corn Syrup and Soda3. SEDENTARY LIFESTYLE

4. GLUTEN AND DAIRY INTOLERANCE common


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Does Nutrigenomics Play a Role?


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RESULTING SYNDROMES

Classic presentation

CAD

CVA

HyperlipidemiaHypertension

DM

Obesity

Cancer

PCOS


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CLASSIC APPROACH(KNEE-JERK)

Missing the Forest for theTrees


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Traditional Allopathic Approach

Abnormal Parameter, Symptom, or LaboratoryBlood Values: GTT, or 2 hr Postprandial Glucose

LDL Cholesterol

Blood Pressure

High BMI

Mood Disorders

GERD

Fibromyalgia/ Chronic Fatigue Syndrome

Signs of PCOS

IBS


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Knee-Jerk Reaction

Diabetic Meds

Antihypertensives

Statins

AnalgesicsOCs/Progestins

Antidepressants

Proton pump inhibitors

Anorexics

Bariatric Surgery


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WHY TRADITIONAL

APPROACH FAILSPatient has intense CHO cravings diet &medications alone do not lessen the cravings

Patients worry about the multiple symptoms, thinking

their body is becoming alien - need emotional support& education of this multidimensional condition

Medications are prescribed to treat a prevalentsymptom or disease, not the global assimilation ofsymptoms

Poly-pharmacy increases drug interaction, cost, sideeffects, & non-compliance

Patients ask for a holistic model due to multiplesymptoms

Patients want to be FUNCTIONAL again


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NUTRITIONAL APPROACH

Kalamazoo Heart Center of

Excellence:Metabolic Syndrome

Program


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THE CASE FOR NUTRITIONALTHERAPIES

This disorder does not result from a lack of

prescription drugs

There is no magic bullet

Many end up taking 4 or more drugs then

dealing with an array of side effects

Drugs merely treat a symptom or lab valuewhile allowing the underlying disease

process to continue


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TREATMENT PLANOnce diagnosis is made:

Assess any medical problems

Psychophysiological assessment: meet the patient in

theirmoment with all of their symptomsSet up Primary and Secondary goals together withthe patient

Nutritional Supplement Recommendations

40-30-30 Macronutrient PlanLifestyle Modification Discussion

F/U at 3 wks, 8 wks, 3 mos, 6 mos, 9 mos, 12 mos

Group Classes for Health Education


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PROGRAM GOALS

Appropriate Calories to Ideal Weight

Increase Omega-3 Oils

Increase MonoUnsaturated (Mediterranean) Fat

Low Saturated and Trans Fatty Acids

Low Glycemic Index Foods

High Fiber

Low simple CHO (increase complex CHO)

Moderate Protein


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NUTRICEUTICAL

TREATMENTDIET IN GENERAL:

Mediterranean

30% Protein

30% Good Fats (monounsaturated)

40% Low Glycemic Index Carbs

Soy

High in Soluble Fiber

Micronutrients


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NUTRICEUTICAL

MODE OF ACTIONOMEGA - 3 FATS (EPA/DHA)-Cell Wall and

Receptor Function

a LIPOIC ACID -Mimics InsulinMG -Needed for release of Insulin

CHROMIUM -Increases function of insulin

VANADIUM -Mimics insulin (>100mg toxic)gamma LINOLEIC ACID-Restores insulin

function. Restores nerve function

FIBER -Slows Glu absorption in GI Tract


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MODE OF ACTION

Pharmaceutical vs. Nutriceutical

ENHANCEDINSULINSECRETION

SLOWED

GLUCOSE

ABSORPTION

REDUCEDGLUCOSEPRODUCTION

PERIPHERAL

GLUCOSEDISPOSAL

IMPROVEDRECEPTORFUNCTION

PHARMA

CEUTICAL

Sulfonylurea

(Micronase)

Meglitinides

(Prandin)

Alpha-

Glycosidase

Inhibitors

(Acarbose)

Biguanides

(Metformin)

Thiazolidine-

diones

(Actos)

Thiazolidine-

diones

(Actos)

NUTRI

CEUTICAL

Magnesium

Vanadium

SolubleFiber

Complex

Carbs

Protein

Complex

Carbs

Protein

Fiber

PUFA

Lipoic Acid

Linoleic Acid

PUFA

Omega-3

Vanadium


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Recommended Nutrients

EPA 1500-4000 MG

DHA 1000-2000MG

Mg 200-400 mg

Cr 400-1000 ugVd 15-50 mg

CLA 1000-3000 mg

Vit E 400-800 U

Vit C 2-6 gm

aLA 50-200 mg

Arg 2 gm


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GOOD CARBS

GLYCEMIC INDEX

Volunteers blood sugar response to a test food

containing 50 gm carbohydrate, as compared to

50 gm pure glucose (3 Tbs)

HIGH >70%

MODERATE 55-66%LOW 40-54%

VERY LOW


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Foods that Lower I.R.

Rice (esp. high amylose starch)

Soluble Fiber (slows glucose absorption)

Vegetable Protein (modulate GLUT-4transport)

Complex CHO (slowly digested, prevents

rapid change in glucose and insulin)


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Foods to Avoid

Refined CHO (Glycemic Index)

Simple Sugars -High Fructose Corn Syrup

White bread and flourJuices

Sugar-containing Soda

Processed FoodsTrans Fats

Saturated Fats


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GOOD FATS

Monounsaturated, Mediterranean (olive)

Omega-3 Fatty Acids (Fish Oils, Flaxseed)Conjugated Linoleic Acid (PPAR agonist,

acts like TZDs)

Alpha Lipoic Acid (Antioxidant)


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FATS AND HEART DISEASE

Saturated Fat Diet

Finland

US

Monounsaturated Fat

Italy Greece

Low Total Fat

Japan


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Shopping Tips

AVOID THE CENTER AISLES AT THE

SUPERMARKET

SHOP MAINLY IN THE PERIMETER

AREAS:

Fresh Produce

Fruits and Vegetables

Meats and Eggs

+/- Frozen Foods


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UNHEALTHY DIET

Refined CHO is absorbed rapidly and

triggers release of excess insulin

Diminished insulin signal impedes fusion of

transport channel vesicles with cell

membrane

Insulin signal is diminished by

Phosphotyrosine, TNF alpha, cytokines,NF-kappa, inflammatory substances


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HEALTHY DIET ANDMICRONUTRIENTS

Complex CHO more slowly absorbed inintestine appropriate insulin released

(Soy, Amylose Starch, fiber)

Insulin signal supported by: Vn, Cr, CLA,Lipoate, Inositol, Mg, Vit E

Strong insulin signal directs sugar transport

vesicle to fuse with cell wallCLA binds to nucleus to support gene

expression


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GOALS

Work closely with PCP

Approach chronicdiseases by addressingunderlying functional problems

Formulate a viable program for the

prevention of disease


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CONCLUSIONCorrection of lab values does not

constitute wellness

Lifestyle intervention REQUIRESimmediate positive effects & education

for optimal change and management.

The healing process needs: support,love, hope & humor


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END


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CASE PRESENTATIONS

Metabolic Syndrome

Insulin ResistanceSyndrome X

C St d PCOS


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Case Study - PCOS

(Rebecca)31 y.o. Woman with:

Anxiety

PMS and MoodinessFatigue

Amenorrhea

Sleep Disorder


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PCOS (Rebecca)

October 31Glucose

FBS 93

2 hr 112

Insulin

Fasting 12

2 hr 108

Cholesterol 271

HDL 39LDL 178

Triglyceride 269

Weight 165

Menses absent

December 21Glucose

FBS 91

2 hr 83

Insulin

Fasting 9

2 hr 17

Cholesterol 200

HDL 45LDL 141

Triglyceride 71

Weight 153

Menses regular

C St d PMS F ti


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Case Study PMS, Fatigue

(Martha)54 y.o. Woman with:

Anxiety

Irritable Bowel SymptomsAdrenal Fatigue

Fibromyalgia

No weight loss with low fat diet, exercise


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Fatigue, FMA (Martha)

November 8

Glucose

FBS 114

2 hr 209

Insulin

Fasting 9

2 hr 87

Cholesterol 204

HDL 77LDL 111

Triglyceride 78

Weight 189

TSH 3.94 (2/13/02)

February 21

Glucose

FBS 104

2 hr 92

Insulin

Fasting 7

2 hr 25

Cholesterol

HDL 70LDL 97

Triglyceride 84

Weight 169


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PHARMACEUTICAL

SIDE EFFECTSSU - hypoglycemia, weight gain,

hyperinsulinemia

Non-SU Secretagogues - same, plus3/day dosing

Biguanides - GI upset, lactic acidosis

a-Glucosidase Inhib - GI upset, 3/daydose

Thiazolidinediones - LFT, weight gain,

edema, slow onset of action


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METABOLIC SYMPTOMS

AND SYNDROMESSymptoms:Weakness/Fatigue

Muscle Pain

Diarrhea/ConstipationStomach Irritation

Sleep Problems

Allergy Symptoms

Inability to Lose Wt

Immune Problems

Hypoglycemia

Syndromes:

Chronic Fatigue

FibromyalgiaIrritable Bowel

Syndrome

SomatizationPMS/PCOS

Mood Disorders

Chronic Yeast

2010 Metabolic Syndrome

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