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METABOLIC SYNDROME Nature, Nurture, Nutrition

Explore the classic and functional definitions of metabolic syndrome, its causes, and the limitations of traditional approaches. Discover the importance of nutrition in treating metabolic syndrome and learn about the Nutritional Treatment Plan offered by the Kalamazoo Heart Center of Excellence.

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METABOLIC SYNDROME Nature, Nurture, Nutrition

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  1. METABOLIC SYNDROMENature, Nurture, Nutrition Genomics, Proteomics, Metabolomics

  2. Janice Werbinski, M.D., FACOG • Gynecologist -Borgess Women’s Health • Former Medical Director -BMH Women’s Center • Associate Clinical Professor - MSU / CHM • Author, Curriculum, Women’s Health Track, Internal Medicine Residency, MSU/KCMS • Founding President, ACWHP • Consultant/Metabolic Syndrome Program – Borgess Integrative Medicine

  3. CLASSIC DEFINITIONSyndrome X (Dr. G. Reaven) • High Blood Pressure (>130/85) • High Blood Fats (Triglyceride) (>150) • Low HDL (Good) Cholesterol (<50 mg/dl) • Borderline Diabetes (FBS>110 mg/dl) • Increased Waist to Hip Ratio (>35” waist) • Central Obesity-Inability to Lose Weight • Family History of DM, HTN, CVD,Obesity

  4. FUNCTIONAL MEDICINE DEFINITIONMetabolic Syndrome “An age-related functional disorder of glucose metabolism, mediated by altered genetic expression at the cell membrane level, and manifested under particular environmental conditions.” -Dan Lukaczer, ND Institute for Functional Medicine

  5. Alternative Labels • Syndrome “X” • Metabolic Syndrome • Insulin Resistance • Pre-Diabetes • Glucose Intolerance

  6. INCIDENCE Up to 25% of Americans (47,000,000 in US) • 50% May not be Obese • Increasing in Children and Adolescents • Increasing in Industrialized Nations • Very Close Association with: -Diabetes -Cardiovascular Disease -PCOS -Preeclampsia / Eclampsia

  7. LABORATORY PARAMETERS • Fasting Glucose & Insulin • 2 hour Glucose & Insulin after 75gm glucola • Lipid panel • Homocysteine • Thyroid panel • CRP • Euglycemic Clamp Studies (Research)

  8. 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 Soda 3. SEDENTARY LIFESTYLE 4. GLUTEN AND DAIRY INTOLERANCE common

  9. Does Nutrigenomics Play a Role?

  10. RESULTING SYNDROMES Classic presentation • CAD • CVA • Hyperlipidemia • Hypertension • DM • Obesity • Cancer • PCOS

  11. CLASSIC APPROACH(KNEE-JERK) Missing the Forest for the Trees

  12. Traditional Allopathic Approach • Abnormal Parameter, Symptom, or Laboratory Blood Values: • GTT, or 2 hr Postprandial Glucose • LDL Cholesterol • Blood Pressure • High BMI • Mood Disorders • GERD • Fibromyalgia/ Chronic Fatigue Syndrome • Signs of PCOS • IBS

  13. Knee-Jerk Reaction • Diabetic Meds • Antihypertensives • Statins • Analgesics • OC’s/Progestins • Antidepressants • Proton pump inhibitors • Anorexics • Bariatric Surgery

  14. WHY TRADITIONAL APPROACH FAILS • Patient 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 prevalent symptom or disease, not the global assimilation of symptoms • Poly-pharmacy increases drug interaction, cost, side effects, & non-compliance • Patients ask for a holistic model due to multiple symptoms • Patients want to be FUNCTIONAL again

  15. NUTRITIONAL APPROACH Kalamazoo Heart Center of Excellence: Metabolic Syndrome Program

  16. THE CASE FOR NUTRITIONAL THERAPIES 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 value while allowing the underlying disease process to continue

  17. TREATMENT PLAN Once diagnosis is made: • Assess any medical problems • Psychophysiological assessment: meet the patient in theirmoment with all of their symptoms • Set up Primary and Secondary goals together with the patient • Nutritional Supplement Recommendations • 40-30-30 Macronutrient Plan • Lifestyle Modification Discussion • F/U at 3 wks, 8 wks, 3 mos, 6 mos, 9 mos, 12 mos • Group Classes for Health Education

  18. 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

  19. NUTRICEUTICAL TREATMENT DIET IN GENERAL: • “Mediterranean” • 30% Protein • 30% Good Fats (monounsaturated) • 40% Low Glycemic Index Carbs • Soy • High in Soluble Fiber • Micronutrients

  20. NUTRICEUTICAL MODE OF ACTION • OMEGA - 3 FATS (EPA/DHA)-Cell Wall and Receptor Function • a LIPOIC ACID -Mimics Insulin • MG -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

  21. MODE OF ACTION Pharmaceutical vs. Nutriceutical

  22. Recommended Nutrients • EPA 1500-4000 MG • DHA 1000-2000MG • Mg 200-400 mg • Cr 400-1000 ug • Vd 15-50 mg • CLA 1000-3000 mg • Vit E 400-800 U • Vit C 2-6 gm • aLA 50-200 mg • Arg 2 gm

  23. 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 <39%

  24. Glycemic Load of Various Foods • White bread 70 • Potato 85 • Carrots 71 • Rice 88 • Oat Grain Bread 47 • Pasta 45 • All-Bran 42 • Corn Flakes 84 • Corn Chips 73 • Pretzels 80 • Peanuts 14

  25. Foods that Lower I.R. • Rice (esp. high amylose starch) • Soluble Fiber (slows glucose absorption) • Vegetable Protein (modulate GLUT-4 transport) • Complex CHO (slowly digested, prevents rapid change in glucose and insulin)

  26. Foods to Avoid • Refined CHO (Glycemic Index) • Simple Sugars -High Fructose Corn Syrup • White bread and flour • Juices • Sugar-containing Soda • Processed Foods • Trans Fats • Saturated Fats

  27. GOOD FATS • Monounsaturated, “Mediterranean” (olive) • Omega-3 Fatty Acids (Fish Oils, Flaxseed) • Conjugated Linoleic Acid (PPAR agonist, acts like TZD’s) • Alpha Lipoic Acid (Antioxidant)

  28. FATS AND HEART DISEASE Saturated Fat Diet • Finland • US Monounsaturated Fat • Italy • Greece Low Total Fat • Japan

  29. 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

  30. 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

  31. HEALTHY DIET AND MICRONUTRIENTS Complex CHO more slowly absorbed in intestine – 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 wall CLA binds to nucleus to support gene expression

  32. GOALS • Work closely with PCP • Approach chronic“diseases” by addressing underlying functional problems • Formulate a viable program for the prevention of disease

  33. CONCLUSION • Correction of lab values does not constitute wellness • Lifestyle intervention REQUIRES immediate positive effects & education for optimal change and management. • The healing process needs: support, love, hope & humor

  34. END

  35. CASE PRESENTATIONS Metabolic Syndrome Insulin Resistance Syndrome X

  36. Case Study - PCOS(Rebecca) 31 y.o. Woman with: • Anxiety • PMS and Moodiness • Fatigue • Amenorrhea • Sleep Disorder

  37. October 31 Glucose FBS 93 2 hr 112 Insulin Fasting 12 2 hr 108 Cholesterol 271 HDL 39 LDL 178 Triglyceride 269 Weight 165 Menses absent December 21 Glucose FBS 91 2 hr 83 Insulin Fasting 9 2 hr 17 Cholesterol 200 HDL 45 LDL 141 Triglyceride 71 Weight 153 Menses regular PCOS (Rebecca)

  38. Case Study – PMS, Fatigue(Martha) 54 y.o. Woman with: • Anxiety • Irritable Bowel Symptoms • Adrenal Fatigue • Fibromyalgia • No weight loss with low fat diet, exercise

  39. November 8 Glucose FBS 114 2 hr 209 Insulin Fasting 9 2 hr 87 Cholesterol 204 HDL 77 LDL 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 70 LDL 97 Triglyceride 84 Weight 169 Fatigue, FMA (Martha)

  40. PHARMACEUTICAL SIDE EFFECTS • SU - hypoglycemia, weight gain, hyperinsulinemia • Non-SU Secretagogues - same, plus 3/day dosing • Biguanides - GI upset, lactic acidosis • a-Glucosidase Inhib - GI upset, 3/day dose • Thiazolidinediones - LFT, weight gain, edema, slow onset of action

  41. METABOLIC SYMPTOMS AND SYNDROMES Symptoms: • Weakness/Fatigue • Muscle Pain • Diarrhea/Constipation • Stomach Irritation • Sleep Problems • Allergy Symptoms • Inability to Lose Wt • Immune Problems • Hypoglycemia Syndromes: • Chronic Fatigue • Fibromyalgia • Irritable Bowel Syndrome • Somatization • PMS/PCOS • Mood Disorders • Chronic Yeast

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