michele helfgott, md, facog · 2012-11-14 · fellowship in anti-aging and regenerative medicine...

Parkview Women's Health Center Seminar Series

11/13/2012

Angela LaSalle MD 1

www.angelalasallemd.com

Not for profit, all about you.

Protecting Your Waistline:

The Skinny on Vitamin Dand the Insulin Connection

Angela LaSalle, MDMedical Director

Integrative Medicine andParkview Women’s Health Center

Michele Helfgott, MD, FACOG


Not for profit, all for you.

Board certified OB/GYN20 years experienceFellowship in Anti-Aging and Regenerative Medicine

Committed to finding the root cause of disease, Dr. Helfgott treats issues associated with:

Menopause, perimenopause, Autoimmune diseaseGastrointestinal issues. Bio-identical hormone replacementAssists with nutritional counseling and exercise

• .INTEGRATIVE MEDICINEfocused on you


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Angela LaSalle MD 2

Workshop Goals


Role of Vitamin D as a preventative strategy in the fight against obesity, diabetes and chronic disease.

Understand screening tests for Vitamin D deficiency

Risks and benefits of Vitamin D supplementation

Role of insulin in obesity and diabetes

Review basic recommendations to reduce insulin levels.

Obesity: How Big is the Problem?


Allen County

2004: 24.7%

2012: 33%

Overweight is BMI > 25%

Obesity is BMI > 30%


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Angela LaSalle MD 3

Diabetes: How Bad is the problem?


The CDC estimates that by 2050, the incidence of Type 2 DM may be as high as 33%

Vitamin D Deficiency: Who has it?


75% of Americans have low levels(Archives of Int. Med 3/09)

12.1% of infants and toddlers

Higher incidence in dark skinned individuals:African Americans, Hispanics, Indian


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Angela LaSalle MD 4

Causes of Vitamin D deficiency


• Lack of sunlight

• Ethnicity – Melanin in dark skin blocks light stimulation

• Aging

• Renal Disease

• Obesity

• Genetic Variance in Vitamin D receptors

Common Denominator


Insulin


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Angela LaSalle MD 5

How does Insulin Work?



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Angela LaSalle MD 6

Diabetes: What causes it?


Type 2 diabetes is a miscommunication between multiple organs:

IntestinesPancreasLiverBrainCells

It is not just a high blood sugar, but rather multiple biochemical abnormalities.


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Angela LaSalle MD 7

The results of insulin dysfunction


It isn’t just about the blood sugar.Higher insulin results in

inflammationhigh blood pressureweight gainlipid disordersincrease in risk of heart attack, stroke, canceretc.

Abdominal Fat is a biochemical problem!

Role of Vitamin D in Insulin Release


Key word is CALCIUM

Vitamin D is responsible for the Calcium balance in the body.

Release of Insulin requires the action of Calcium in the Beta Cell of the Pancreas.

Action on other Vitamin D receptors in the cells of the body still under investigation.


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Angela LaSalle MD 8

Vitamin D Sources


• Fortified foods: most common ergocalciferol or vitamin D2

• Vitamin D3 or Cholecalciferol is 66% better absorbed than D2


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Angela LaSalle MD 9

Vitamin D Sources


Sunlight is best source.– UVB light 270-300nm

– Body makes 10,000 iu with 20-30 min sunlight

– Toxicity from sun not possible• After body makes 20,000 iu same

light begins degradation of vitamin D


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Angela LaSalle MD 10

Symptoms of Deficiency


• Depression

• Fatigue

• Increased infections

• Muscle aches

• Loss of bone density

Diseases with Vitamin D deficiency


• Rickets

• Osteomalacia, Osteopenia, Osteoporosis

• Psoriasis

• Peripheral Vascular Diease (80% may be deficient)

• Diabetes (both type 1 and type 2)

• Cancer


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Diseases Under Investigation


• Multiple Sclerosis

• Rheumatoid Arthritis

• Parkinson’s

• Alzheimer's

Metabolic Functions of Vitamin D


• Affects insulin signaling

• Affects activation of enzymes

• Affects neurotransmitter production

• Affects function of macrophages

• Affects ability to fight infections

• Affects inflammatory cascades

• Affects cell growth


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Vitamin D and Cancer


• 1000 IU (D3) decreased cancer:– Colon by 50%

– Breast and ovarian by 30%

– Pancreatic by 43%


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Medication Effects on Vitamin D

Vitamin D Toxicity


• Signs consistent with high calcium levels– Muscle Aches

– Loss of appetite, nausea

– Protein in urine

– Kidney stones

– Increased thirst and urination


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Caveats


• Have Vitamin D levels checked

• Rule out magnesium deficiency

• Supplementation more than 1000iu daily should be followed by physician

• Monitor Vitamin D, parathyroid levels on therapy.

• Report any side effect of supplementation to physician.

Recommendations to Reduce Insulin



11/13/2012


Table Sugar


Table Sugar


Sugar:

The Bitter Truth by Dr. Robert Lustig Pediatric EndocrinologistYouTube

DVD: Sweet Suicide, A Documentary by Nancy Appleton, PhDSweet Suicide is a 60-minute documentary produced in 2009 by Nancy Appleton, PhD, about the health dangers of sugar. Appleton is America's most well known anti-sugar expert and author of Lick the Sugar Habit, which is still selling strong after 30 years in print.


11/13/2012


Sugar Makes Fat


Study:Healthy med students were given a high fructose diet for 6 days

• Triglycerides doubled

• Free fatty acids in the blood doubled

• Insulin levels increased

• 5x more fat cells

Sugar Makes You Old


Sugar is implicated in all of the degenerative disease processes:

Heart DiseaseDiabetesAuto Immune DiseaseArthritisCancerImpotenceHormone disruptionsand….

Wrinkles


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Watch Your Fluids


Recent studies have shown that drinking one soda a day increases your risk of heart disease by 20%

Did you know that 4 grams of sugar equals approximately one teaspoon?

Nutrition Label – Coca Cola



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Sober Thought


Some brands of baby formula contain up to 43% corn syrup and 10.3% sucrose

Coca Cola contains 10.5% sucrose

Sweeteners



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Nutrition Label – Diet Nestea


Diet Soda and Weight Gain


University of Texas Health Science Center in San AntonioSan Antonio Longitudinal Study of Aging (SALSA)

70% greater increase in waistline (9.5 yrs later)

2 or more sodas a day resulted in 500% more weight gain than non soda drinkers

Results adjusted for diabetes status, physical activity and age.


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Artificial Sweeteners


Hundreds of times more sweet than sugar

Body preps for sweets and releases excess insulin

Blunts the neurotransmitters in brain that help you feel full

Result is you feel less satisfied, take in more calories and the body stores more fat due to higher insulin levels.

Implicated in inflammatory symptoms in some people

Overhaul Your Fluids


Eliminate all soda

Look for any artificial sweeteners in your beverages

Increase your water intake

Limit coffee to no more than 2 cups a day

Eliminate juices…eat the fruit instead


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Eliminate the Sweets


Remember that flour also breaks down to sugar…decrease the baked goods

Try keeping a food diary to learn your habits

Evaluate what you put in your beverages…creamers, flavors and look for sugars and sweeteners.

Start reading food labels for hidden sugars/sweeteners

Remember 4 grams of sugar equals a teaspoon

Balance any sugar intake with protein or fiber

Increase Your Vegetables


Good source of nutritients: antioxidants, phytonutrients, minerals

Good source of fiber

Helps hydration

Good source of carbs without high insulin response

Balance your plate with lean proteins (fish, chicken, lean cuts beef)


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Exercise


30 minutes daily

Decreases insulin resistance in skeletal muscle

Decreases inflammation

Rehearses the neurovascular connections of the body

All disease preventative

There is no substitute for the benefits of exercise!

Talking Points with Your Doctor


Ask for Testing:25-OH Vitamin DFasting Glucose

< 95 is normal> 110, then glucose intolerant> 126 Diabetes

Fasting InsulinFasting Lipids


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Talking Points with Your Doctor


Measurements:WeightBlood PressureBMIWaist to hip ratio

0.8 or below, is normal

Supplementation and Monitoring

Q & A



11/13/2012


Angela LaSalle, MDAngela LaSalle is board certified in Family Medicine with a

fellowship in Integrative Medicine. She is a guest and keynotespeaker on a variety of medical topics and women’s health issuesand provides interviews for radio and print media.

A graduate of Indiana University School of Medicine, she received herfellowship in Integrative Medicine through the University ofArizona, a program founded by Andrew Weil, M.D.

Her practice includes assessment of thyroid, adrenals, treatment ofmetabolic syndrome, bioidentical hormone replacement as well ascomprehensive nutritional assessments. She provides integrativehealth care services for patients with thyroid, diabetes, metabolicand menopausal issues. A strong believer that inflammation is theunderlying cause of many diseases, she also incorporates nutritionand stress management into her treatment arsenal.

Dr. Angela LaSalle is Medical Director of Parkview Physician’sGroup Integrative Medicine clinical division and Medical Directorof the Parkview Women's Health Center located at the newParkview Regional Medical Center on its Parkview NorthCampus.

www.angelalasallemd.comVisit her web site:

michele helfgott, md, facog · 2012-11-14 · fellowship in anti-aging and regenerative medicine...

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