Supporting Diabetics Who Have an Autoimmune Response in a ...€¦ · primary care provider. –...

Supporting Diabetics who have an

Autoimmune Response in a Functional Model

Copyright 2013 -- Functional Medicine Masters -- All Rights Reserved -- Not for Distribution

Autoimmune Responses and Diabetes

• “Type II Diabetic” with the following findings: – Positive Insulin Antibodies – Positive GAD-65 Autoantibody – Positive Beta Cell Antibodies – Low (below lab range) C-peptide

• Type I Diabetic (Insulin Dependent) • Type 1.5 Diabetic (AI and IR mechanisms) • Hashimotos • RA, Lupus, Psoriasis, MS, Celiac Ds., Eczema

etc. Copyright 2013 -- Functional Medicine Masters -- All Rights Reserved -- Not for Distribution

Glutamic Acid Decarboxylase-65 Auto-Antibody

• Positive GAD-65 test can be a marker for multiple tissues being attacked. – Pancreas – Cerebellum – Basal Ganglis

• It is however thought to be an early marker for beta-cell destruction. Can be positive before a beta cell test.

• It is a pretty safe hypothesis that a positive GAD-65 test in a diabetic refers to pancreatic destruction.

• Positive GAD-65 test can also reflect attack on multiple tissue simultaneously.

• It is advisable to stay away from supplements that support the Nitric Oxide System (Nitric Balance, Arginine) when a positive GAD-65 tests exists.


When to Screen for Hashimotos

• You diagnose Primary Hypothyroidism. – High TSH (above functional or lab range)

• Patient’s history indicates Primary Hypothyroidism – Patient is taking thyroid hormones – Patient has a history of taking thyroid hormones

• Patient history is significant for: – Thyroidectomy – Graves – Radiation of the Thyroid – Heart palpitations, anxiety, inability to gain weight or keep wgt. On – Family history of Hashimotos


When to screen for Graves

• Patient has a hyperthyroid pattern – Low TSH – High T4 – High T3 – Symptoms consistent with hyperthyroid

• Always consider Screening for both Hashimotos

and Graves in a hyperthyroid situation. Hashimotos can at times create hyperthyroid state. Copyright 2013 -- Functional Medicine Masters -- All Rights Reserved -- Not for Distribution

When to refer a thyroid patient • Anytime you see a hyperthyroid pattern (or diagnose

Graves) it is important to refer the patient back to the primary care provider. – Hyperthyroid can be life threatening…medical management may

be necessary • You diagnose primary hypothyroid (high TSH)

– Technically patients with a high TSH need to be on thyroid hormone replacement therapy.

• You find TPO and/or antithyroglobulin ab.s above 4,000. – This could indicate thyroid cancer – You can also refer the patient to an imaging center for thyroid

ultrasound – It is a good practice in these cases to clear the patient of thyroid

cancer before admitting and treating


Diabetes/Insulin/Low C-peptide

• Patient history is significant for: – Type II Diabetes – Insulin usage – Low C-peptide

• It is a good practice to reset expectations with the patient. Many of these patients will never get off of insulin.

• Instead the patient must be informed of the full scope of their health care problem. This is much more significant and clinically difficult when a positive insulin ab. test exists.


Potential Antagonists to Patients with Auto-Immune Responses

• Genetic Polymorphisms at the Vitamin D receptor site.

• Insulin Surges (PCOS, Diabetes, Drug induced, Dysglycemias)

• Estrogen Surges/Estrogen Dominance

• Intestinal Permeability (“Leaky Gut”)

• Blood-Brain Barrier Permeability (“Leaky Brain”)

• Heavy Metal Toxicity with Immune Response

• Environmental Toxicity • GI Infections

• Infections in general • Food intolerances • Gluten allergy • Iodine Exposure • Pregnancy • Stress (physical, mental,

emotional, trauma) • TH1/TH2 imbalance • Cytokine Elevations • Inflammation • Gene Susceptibility

(Epigenetics)


Estrogen Surges/Estrogen Dominance and Autoimmune Responses

• Estrogen Surges have been suggested in the literature to be a potential trigger for Auto-immune diseases.

• Estrogen Surges have been suggested in the literature to be a potential antagonist for patients suffering from an AI disease.

• Perimenopause can be a time where autoimmune conditions are triggered or exacerbated.

• Estrogen surges and estrogen dominant situations can be driven by drug therapy (ie. Estrogen hormone replacement therapy)


Vitamin D Deficiency/Genetic Polymorphisms

• Vitamin D Deficiency is rampant in the patient population. – Lack of exposure to sunlight – Not eating foods rich in Vit. D (oily fish) – GI inflammatory disorders which can create poor

absorption (celiac, leaky gut, IBD, dysbiosis, etc.) – Inability to convert 1,25 Vit. D to 25 Vit. D – Cortisol elevations or use of Cortisone – Magnesium deficiency (or any other deficiency in the co-

factors needed for absorption) – Improper supplementation

• Dose not therapeutic • Vit. D is not emulsified (which enhances digestion)


Vitamin D Deficiency/Genetic Polymorphisms

• Many autoimmune patients have a genetic defect at the vit. D receptor site. – This can prohibit a therapeutic response even in

the face of normal Vit. D labs. – Often it can be useful to push the Vit. D levels

above 100 to find a therapeutic benefit. (Pay attention to signs of Vit. D toxicity…skin peeling, hair falling out, excessive urination, kidney strain)


Vitamin D

• Vitamin D has been shown to have many health benefits…particularly with immune dysfunction/AI conditions.

• It is known to have a positive impact on T-regulatory cells which in turn benefit T-helper expression and supporting a balanced TH1/TH2 system


Vitamin D Deficiency • 1.) The flu - In a study published in the Cambridge Journals, it was

discovered that vitamin D deficiency predisposes children to respiratory diseases. An intervention study conducted showed that vitamin D reduces the incidence of respiratory infections in children. 2.) Muscle weakness - According to Michael F. Holick, a leading vitamin D expert, muscle weakness is usually caused by vitamin D deficiency because for skeletal muscles to function properly, their vitamin D receptors must be sustained by vitamin D. 3.) Psoriasis - In a study published by the UK PubMed central, it was discovered that synthetic vitamin D analogues were found useful in the treatment of psoriasis.


Vitamin D Deficiency • 4.) Chronic kidney disease - According to Holick, patients with advanced

chronic kidney diseases (especially those requiring dialysis) are unable to make the active form of vitamin D. These individuals need to take 1,25-dihydroxyvitamin D3 or one of its calcemic analogues to support calcium metabolism, decrease the risk of renal bone disease and regulate parathyroid hormone levels. 5.) Diabetes - A study conducted in Finland was featured in Lancet.com in which 10,366 children were given 2000 international units (IU)/day of vitamin D3 per day during their first day of life. The children were monitored for 31 years and in all of them, the risk of type 1 diabetes was reduced by 80 percent. 6.) Asthma - Vitamin D may reduce the severity of asthma attacks. Research conducted in Japan revealed that asthma attacks in school children were significantly lowered in those subjects taking a daily vitamin D supplement of 1200 IU a day.


http://www.naturalnews.com/disease.html

http://www.naturalnews.com/Vitamin_D.html

Vitamin D Deficiency

• 7.) Periodontal disease - Those suffering from this chronic gum disease that causes swelling and bleeding gums should consider raising their vitamin D levels to produce defensins and cathelicidin, compounds that contain microbial properties and lower the number of bacteria in the mouth. 8.) Cardiovascular disease - Congestive heart failure is associated with vitamin D deficiency. Research conducted at Harvard University among nurses found that women with low vitamin D levels (17 ng/m [42 nmol/L]) had a 67 percent increased risk of developing hypertension.


Vitamin D Deficiency • 9.) Schizophrenia and Depression - These disorders have been linked to

vitamin D deficiency. In a study, it was discovered that maintaining sufficient vitamin D among pregnant women and during childhood was necessary to satisfy the vitamin D receptor in the brain integral for brain development and mental function maintenance in later life. 10.) Cancer - Researchers at Georgetown University Medical Center in Washington DC discovered a connection between high vitamin D intake and reduced risk of breast cancer. These findings, presented at the American Association for Cancer Research, revealed that increased doses of the sunshine vitamin were linked to a 75 percent reduction in overall cancer growth and 50 percent reduction in tumor cases among those already having the disease. Of interest was the capacity of vitamin supplementation to help control the development and growth of breast cancer specially estrogen-sensitive breast cancer.


Insulin Surges and Autoimmune Responses

• PCOS (females taking testosterone) • Diabetes • Dysglycemic patterns of any kind • Drug induced • Diet induced


Insulin Surges and Autoimmune Responses

• Two primary mechanisms that can produce insulin surges.

• 1. Insulin Resistance – Fatigue after meals – Difficulty falling asleep – Crave sugar after meals

• 2. Low Blood Sugar – Energy increases after a meal – Craves sugar before meals – Can’t stay asleep – Craves sweets between 3-5 pm.


Intestinal Permeability (“Leaky Gut”)

• Cyrex testing: Array 2 – You should always test and retest

• Intestinal Permeability issues can antagonize autoimmune responses.

• Intestinal Permeability issues can increase inflammatory responses.


Intestinal Permeability Clinical Protocols to Consider

• Repairvite et. al. program • Apex will send you a brochure • Repairvite et. al. consists of:

– Repairvite powder – Repairvite diet – GI Synergy (3-4 packs daily)

• This may need to be continued after repairvite program if you are supporting an infection pattern

– Strengtia (2 capsules daily) • This may need to be continued after repairvite program if you are supporting an infection

pattern or dysbiosis. • You can always add other supplements to this regimen where needed. • Repairvite et. al. should be done for as long as the patient can tolerate. • Consider following the Repairvite et. al. program up with the clearvite et.

al. program (2 weeks)


“Leaky Brain”

• Compromise of the Blood Brain Barrier • GABA Challenge • Same clinical approach as Leaky Gut. • Make sure to recheck the GABA challenge

after treatment.


Gluten Allergy and other Food Intolerances

• It has shown to be clinically prudent to follow a gluten free diet when autoimmune responses are apparent or suspected.

• For clinical validation of gluten issues consider Cyrex’s Array 3.

• Also consider Array 4 if patient is eating gluten free items and other foods that might be problematic.

• Ideal scene is to eat protein and vegetables. NO dairy, wheat, corn, or soy.


GI Infections

• Consider Metametrix test no. 2105

• Make sure to treat infections and retest.

• You can always refer out for Rx. • Also consider GI Synergy


Date post:	27-Jun-2020
Category:	Documents
Upload:	others
View:	0 times
Download:	0 times

Supporting Diabetics Who Have an Autoimmune Response in a ...€¦ · primary care provider. –...

Documents