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Clinical Opportunities in Metabolic Dysfunction with Carrun Squires · Wellness by Designs - Practitioner Podcast

• 0:19
  Speaker 1: Music.
• 0:20
  Speaker 1: This is Wellness by Designs, and I'm your host, andrew Whitfield-Cook, and joining us today is Karen Squires, and she's a naturopath who holds a Master's in Human Nutrition and also a Grad Cert in Diabetes Education, and today we're going to be speaking about effective treatment of patients with metabolic dysfunction.
• 0:40
  Speaker 1: Welcome to Wellness by Designs, karen.
• 0:41
  Speaker 1: How are you?
• 0:42
  Speaker 1: I'm good.
• 0:42
  Speaker 1: Thank you for having me, karen it's my absolute pleasure.
• 0:43
  Speaker 2: Welcome to Wellness by Designs, Karen.
• 0:44
  Speaker 2: How are you?
• 0:44
  Speaker 2: I'm good.
• 0:44
  Speaker 1: Thank you for having me, karen, it's my absolute pleasure.
• 0:47
  Speaker 1: Just for everybody who's listening or watching in the pre-chat that Karen and I had, this lady's knowledge is extensive, so get ready.
• 0:59
  Speaker 1: This is going to be fun.
• 1:00
  Speaker 1: It's going to be really educational for you.
• 1:01
  Speaker 1: So, karen, first of all, can we go back into history?
• 1:10
  Speaker 2: Tell us a little bit about your career, because it doesn't come from naturopathy, does it?
• 1:14
  Speaker 2: No, it doesn't.
• 1:19
  Speaker 2: Prior to becoming a naturopath, I was working as an executive assistant to a senior exec at a big Australian corporate which I loved.
• 1:23
  Speaker 2: I had always been interested in medicine in health and natural medicine as well, so I took a redundancy and I used the money to study naturopathy full-time and graduated in 2006 and been in full-time practice ever since.
• 1:43
  Speaker 1: Gotcha and you're down in Victoria, right.
• 1:49
  Speaker 2: I'm, yes, down in Victoria, in the beautiful high country of Victoria, up in the hills and the mountains.
• 1:56
  Speaker 1: Yep, okay, so let's talk about metabolic dysfunction.
• 2:02
  Speaker 1: Let's dive right in.
• 2:03
  Speaker 1: How big is this topic?
• 2:07
  Speaker 1: Like, how big an issue is this in Australia?
• 2:11
  Speaker 1: We've got more than one disorder here, correct?
• 2:18
  Speaker 2: Yeah, that's right.
• 2:19
  Speaker 2: It's a really big issue.
• 2:24
  Speaker 2: In Australia.
• 2:25
  Speaker 2: I concentrate mainly on metabolic dysfunction related to blood sugar dysregulation, so usually driven by insulin resistance.
• 2:35
  Speaker 2: So in clinical it will cover things like metabolic syndrome, non-alcoholic fatty liver disease, pre-diabetes, type 2 diabetes.
• 2:45
  Speaker 2: The main driver, as I said, behind these is usually insulin resistance.
• 2:54
  Speaker 1: What's driving all of this, though, karen?
• 2:57
  Speaker 2: The main drivers is our lifestyle, current lifestyle.
• 3:01
  Speaker 2: So being sedentary or low levels of exercise, high caloric diets, being overweight or obese especially that visceral adiposity in particular that we get around the middle are the biggest drivers.
• 3:15
  Speaker 2: 90% of what we're seeing in clinic are these modifiable drivers.
• 3:22
  Speaker 2: There are non-modifiable drivers, such as aging.
• 3:25
  Speaker 2: So there are some things we can't do anything about, but most cases we actually can do something about them.
• 3:33
  Speaker 1: What about genetics?
• 3:34
  Speaker 1: We know about the you know in the olden days forgive me, it was the OB-OB gene.
• 3:41
  Speaker 1: We know about genetic predispositions for diabetes, type 2 diabetes and even carbohydrate harvesting and obesity.
• 3:51
  Speaker 1: How important are these in, a the patient presentation and B what you can control?
• 4:02
  Speaker 2: There are genetic influences in obesity and chronic disease like type 2 diabetes, but given that most of it 90% is our lifestyle and modifiable, I concentrate on that before I get to genetics.
• 4:20
  Speaker 2: It is something that I do like to look at, but it's not initially what I would start with, you know, given the presentation that I'll see in clinic.
• 4:34
  Speaker 2: So, for example, I can touch on a couple of the things that I see in clinics, such as metabolic syndrome, of the things that I see in clinics, such as metabolic syndrome.
• 4:51
  Speaker 2: So this you know more than 35% of Australians have metabolic syndrome, which is a cluster of conditions that predisposes people to type 2 diabetes, stroke and heart disease.
• 5:01
  Speaker 2: I think it's really important for us, as clinicians, to ascertain whether our client has metabolic syndrome or not, because it contributes to the risk of cardiovascular disease, chronic kidney disease and type 2 diabetes.
• 5:15
  Speaker 2: It type 2 diabetes is two to three times higher and some studies report up to five times higher than someone without metabolic syndrome.
• 5:25
  Speaker 2: And and the diagnostics for the syndrome are something that we as clinicians see daily.
• 5:34
  Speaker 2: So, for example, an elevated waist circumference, elevated triglycerides or medicated, reduced HDL or medicated, elevated blood pressure or medicated, fasting blood glucose or medicated, and you only need three of these.
• 5:51
  Speaker 2: So I see many people with metabolic syndrome that don't necessarily come in with this, but you'll pick this up with or without their pathology results.
• 6:05
  Speaker 2: So you know.
• 6:07
  Speaker 2: Think about how many people we see in clinic, for example, with an elevated waist measurement on blood pressure medication and with reduced HDR.
• 6:16
  Speaker 2: That's metabolic syndrome.
• 6:19
  Speaker 1: Yeah, yeah, yeah.
• 6:21
  Speaker 2: I think it's important for clinicians to pick up on that because it's been associated with so many other conditions like polycystic ovarian syndrome, sleep apnea, alzheimer's, some cancers as well.
• 6:34
  Speaker 2: So, while it's a condition of its own, I think you can also view it as a bit of a canary in the coal mine, alerting you to other possible health issues.
• 6:45
  Speaker 2: So that's one of the metabolic dysfunctions that I like to pick up in clinic.
• 6:54
  Speaker 1: So how often do patients come in seeing you for something totally distant to this, but something about your expertise tweaks and you go hang on for a tick.
• 7:06
  Speaker 1: We need to be, as you say, being the canary in the coal mine.
• 7:10
  Speaker 1: What are the things that you look at or notice that maybe other clinicians don't?
• 7:18
  Speaker 2: I don't know that I notice anything more than other clinicians might.
• 7:24
  Speaker 2: Perhaps they're focused on the presenting complaint which we often get on paperwork even before we see the client in clinic.
• 7:36
  Speaker 2: So we can already tell a lot about the client before we see them.
• 7:40
  Speaker 2: You know their age, what medication they might be on.
• 7:45
  Speaker 2: We may even be able to know what ethnicity they are, what family history, et cetera, so that already before we see the client in clinic can kind of, you know, just alert us.
• 7:58
  Speaker 2: They might be coming for a skin condition or a gut condition, but you know once they walk in the door if they're overweight they have that high waist measurement, certainly if they're bringing PATH results or if they're sent to you prior to an initial consultation, which happens often as well.
• 8:20
  Speaker 2: Certainly, seeing a trend in something like rising fasting blood glucose, even if it's not out of the range yet, should alert a practitioner into looking a little bit further.
• 8:34
  Speaker 1: Gotcha, gotcha.
• 8:35
  Speaker 1: So let's go further into this patient presentation, because where I'm going to go here is outliers, and the reason I say this is when I'm going to go here is outliers.
• 8:45
  Speaker 1: And the reason I say this is mature age couple, retired, quite wealthy, no stress, very positive attitude to life, healthy lifestyle, healthy eating habits.
• 9:01
  Speaker 1: The wife came in to see me not long ago and has been diagnosed with fatty liver.
• 9:07
  Speaker 1: Out of the blue there was no indication that we could see and I have no idea at this stage why, you know.
• 9:17
  Speaker 1: Let's talk about outliers Like what things tweak you to this sort of thing where you go something's weird?
• 9:23
  Speaker 1: What things tweak you to this sort of thing where you go something's weird?
• 9:29
  Speaker 2: Is it that rising glucose, as you say, it can be Also high insulin as well, so she wasn't overweight, normal weight, very healthy.
• 9:41
  Speaker 1: She was flawed.
• 9:42
  Speaker 1: She was not an alcohol drinker.
• 9:45
  Speaker 1: It was a very funny presentation and I wondered about medications passed or anything like that.
• 9:54
  Speaker 1: I don't know.
• 9:56
  Speaker 2: Yeah, or something viral perhaps, or she could just be an outlier.
• 10:00
  Speaker 2: The nomenclature for non-alcoholic fatty liver disease just changed last year, so they've actually taken the alcoholic and the fatty out of the term because they found that that was not really reflective of what was going on and also a bit stigmatising.
• 10:19
  Speaker 2: So within that new nomenclature there is some little subcategories and one of those subcategories is someone who does not fit.
• 10:33
  Speaker 2: So there could be a genetic influence there as well.
• 10:36
  Speaker 2: But if it's a diagnosis of fatty liver disease and if she has um had a you know a scan to to have a look at the extent of that, whether she's an outlier or not, you would still want to support healthy liver function.
• 10:53
  Speaker 2: You know healthy detox pathways um, any inflammatory um.
• 11:00
  Speaker 1: You know nature of, of, of what she's got going on as well yeah, yeah, with the nomenclature like it used to be non-alcoholic fatty liver disease, I thought try and find a non-alcoholic person in australia, but anyway.
• 11:13
  Speaker 1: So the nomenclature has changed and and I think it was um massiled.
• 11:20
  Speaker 1: Is that right?
• 11:20
  Speaker 1: So metabolic associated it's metabolic dysfunction.
• 11:24
  Speaker 1: Yeah, what was it sorry associated?
• 11:27
  Speaker 2: steatotic.
• 11:27
  Speaker 2: Yeah sorry, it's metabolic dysfunction associated steatotic liver disease.
• 11:33
  Speaker 2: So that's muscle d, and then there's mash as well yeah, non-alcoholic steatohepatosis, that's it, yeah, yeah.
• 11:52
  Speaker 2: Okay, sorry you were going to say something, karen.
• 11:53
  Speaker 2: It's still an issue in a person like an outlier.
• 11:57
  Speaker 2: So what's driven that?
• 12:00
  Speaker 2: May be genetic.
• 12:01
  Speaker 2: She's an outlier.
• 12:02
  Speaker 2: However, the liver fat is associated.
• 12:07
  Speaker 2: You know it is very inflammatory.
• 12:09
  Speaker 2: It's associated with impaired liver clearance of insulin.
• 12:13
  Speaker 2: The liver is actually the main organ for liver clearance.
• 12:17
  Speaker 2: So I would want to be wanting to keep an eye on blood sugar levels and insulin levels as well, given that she would have fatty liver.
• 12:26
  Speaker 2: Yeah, it's usually driven mainly by obesity, but yeah, you know, we are going to get those outliers occasionally.
• 12:38
  Speaker 1: Yeah.
• 12:38
  Speaker 1: So what about assessments?
• 12:41
  Speaker 1: Let's go into them.
• 12:42
  Speaker 1: You've spoken about fasting insulin, which is very rarely done by GPs.
• 12:49
  Speaker 1: Do you just order it yourself?
• 12:54
  Speaker 2: I do both.
• 12:55
  Speaker 2: I will ask my patient whether they have a good open relationship with their GP and whether they feel comfortable in asking the GP to do that.
• 13:05
  Speaker 2: Uh, if not, uh, I'll do it myself, but I you know, fasting blood glucose with insulin is really important to get those two together yeah, that's your homo ir right yeah, yeah, definitely.
• 13:25
  Speaker 2: so it'll give us a degree of insulin resistance.
• 13:28
  Speaker 2: But also you can see people who, like your outlier, um, have a healthy weight, uh, have a healthy diet, have a healthy lifestyle, um, and have a normal-looking, fasting blood glucose, but their insulin levels might be off the scale, holding them there, okay, oh.
• 13:54
  Speaker 2: So the reason that that's important to know is that even in a normal glycemic environment, if the insulin is too high, it's still going to drive those dyslipidemias and cardiovascular problems.
• 14:14
  Speaker 1: Yeah, yeah.
• 14:15
  Speaker 1: So other assessments.
• 14:21
  Speaker 1: So we've got that HOMA-IR, the insulin resistance test.
• 14:24
  Speaker 1: What about things like continuous glucose monitoring?
• 14:27
  Speaker 1: We're seeing that more and more used by healthy or otherwise healthy people not necessarily diagnosed diabetics and it's just amazing.
• 14:37
  Speaker 1: Like, for instance, kira Sutherland uses them quite often in athletes and is amazed at the results.
• 14:46
  Speaker 1: Yeah, so now, forgive me, I've forgotten his name, tim, I can't remember his name.
• 14:52
  Speaker 1: He was a long-distance runner, south African.
• 14:54
  Speaker 1: He got attacked by a dietician for him giving dietary advice.
• 14:59
  Speaker 1: He won that case some years ago Forgive me, sir, I can't remember your full name and he, even though being extremely fit, had type 2 diabetes, had type 2 diabetes.
• 15:15
  Speaker 1: So it's not just that robust body people who have the type 2 diabetes or that insulin resistance I should say.
• 15:26
  Speaker 1: So how much further do you go in, like your intake form, to pick up on things that are alluding to glycemic malfunction?
• 15:40
  Speaker 1: Let's say, you know, lunchtime after lunchtime, tiredness, brain fog, that sort of thing.
• 15:46
  Speaker 1: Do you look at these sort of weird vague symptoms to maybe pick up and look further?
• 15:53
  Speaker 2: I do, once I have a client in clinic, go through what signs and symptoms that they might have.
• 16:01
  Speaker 2: There's a lot that we can do in in clinic to pick up on on things like here.
• 16:07
  Speaker 2: I do use CGM continuous glucose monitors as well, not on every single person but it, you know, a fasting blood glucose is really just telling us how well our liver coped in the fasting state overnight.
• 16:24
  Speaker 2: You know, with the cgm we can really get greater insight than just fasting blood glucose, uh, an insight on in in how your body is actually responding to not just food but stress and exercise.
• 16:40
  Speaker 2: Uh, and most, most clients, I find, uh, using a cgm is extremely motivating for them, like they can actually see in real time, um, you know, the, the, the dietary and lifestyle choices that they're making.
• 16:58
  Speaker 2: And you know, tech like this is the future of health, I think, and there's several platforms out there now that are integrating other diagnostics, like Fitbits and Our Rings, and they're bringing it together with CGMs to get a really holistic view of a person's health.
• 17:20
  Speaker 2: And, you know, bringing it all together with sleep and heart rate and blood pressure and all of these kind of things with the CGM, and I think it really helps me and other practitioners who are using them to target interventions, you know, because we can start to see the trends.
• 17:39
  Speaker 2: You know we're not just seeing a fasting blood glucose and a fasting insulin, which are both important together, but that doesn't tell us what's happening during the day.
• 17:48
  Speaker 2: So starting to see where the trends are, starting to see what glucose variability there is during the day, can really help us to assess what's going on.
• 18:01
  Speaker 2: And you know, at the moment these are only subsidised for certain people, so people are buying them off the internet.
• 18:09
  Speaker 2: Otherwise, well, people, and I really think that will change, I think we'll see that change.
• 18:17
  Speaker 2: Technology really is the future of health here.
• 18:21
  Speaker 1: Yeah, I must, just as a caveat or as a warning, I must say they're not infallible.
• 18:26
  Speaker 1: I have seen probably the most common thing is that they fall off after about a week or so.
• 18:32
  Speaker 1: So particularly those people that might sweat during their work bricklayers, tradies, athletes they have to ensure that they've taped it on and continue to tape it on over the two-week period.
• 18:46
  Speaker 1: The other thing is I have noticed in a few people they're doing fingerprint glucose monitoring as well and comparing it and it may not correlate exactly.
• 18:56
  Speaker 1: I've seen sometimes a bit of a variance.
• 18:59
  Speaker 1: It's not massive but there is a variance.
• 19:07
  Speaker 2: And there should be a variance, because the continuous glucose monitor is monitoring interstitial fluid, which lags behind blood glucose by about five to ten minutes, so it will eventually catch up.
• 19:19
  Speaker 2: It will eventually catch up.
• 19:22
  Speaker 2: It'll be five to ten minutes behind.
• 19:24
  Speaker 2: So, um, if there is somebody with type 2 diabetes and the the glucose monitor is telling them that, uh, their blood sugar is currently high and there's a little arrow on the monitor that shows you if it's stabilising or if it's going higher, if they're quite concerned, they should do a blood sugar check, you know, like a glucometer, because that will give them closer to what their real current blood sugar is, whether it is actually still going up.
• 19:57
  Speaker 1: Just as a last bit on pathology, Karen, what other pathology tests are of use?
• 20:04
  Speaker 1: They show a part of the picture.
• 20:08
  Speaker 2: Just on a standard pathology test, I obviously would.
• 20:13
  Speaker 2: Still, you know, there will be the fasting blood glucose, hopefully fasting insulin, which we can use to work out insulin resistance.
• 20:21
  Speaker 2: The HOMA-IR Important to have a look at EGFR to keep an eye on kidney function If somebody does have type 2 diabetes.
• 20:35
  Speaker 2: Chronic kidney disease is a, you know, a common complication of type 2 diabetes.
• 20:41
  Speaker 2: Vitamin D even can be important.
• 20:45
  Speaker 2: Beta cells, pancreatic beta cells, have vitamin D receptors.
• 20:50
  Speaker 2: So I always make sure you know vitamin D is optimal.
• 20:59
  Speaker 2: If you have a patient on metformin, for example, whether it's for PCOS or type 2 diabetes or pre-diabetes.
• 21:04
  Speaker 2: B12 is important to keep an eye on as well, because metformin inhibits the intestinal absorption of B12.
• 21:11
  Speaker 2: Looking at some inflammatory markers like CRP looking at some inflammatory markers like crp, hba1c, to let us know how the body has been dealing with its glucose load over the last couple of months.
• 21:24
  Speaker 2: Iron studies as well can be important um very high irons, a risk factor for type 2 diabetes.
• 21:32
  Speaker 2: So there are some standard assessments on general pathology tests that can inform us also liver function, for example.
• 21:42
  Speaker 2: All of these things can give us a little bit of a picture that we can put together with the client sitting in front of us.
• 21:49
  Speaker 1: Karen, can I ask, speaking about iron studies, can I ask about ferritin?
• 21:53
  Speaker 1: Do you see a high ferritin being a risk factor?
• 21:58
  Speaker 1: And b?
• 21:59
  Speaker 1: Do you see, during therapy, ferritin decreasing to a normal level if it's elevated?
• 22:08
  Speaker 2: I I have done from In the studies.
• 22:13
  Speaker 2: It can I don't want to say cause type 2 diabetes, but it has been associated with high iron environments.
• 22:31
  Speaker 2: But ferritin can be that false positive for inflammation as well.
• 22:36
  Speaker 2: So if we start and type 2 diabetes is a very pro-oxidant and inflammatory condition so when we start to, you know, reduce some of that inflammation, we can see some ferritin, you know, can see that go down.
• 22:55
  Speaker 1: You're right, gotcha.
• 22:56
  Speaker 1: Okay, and so to therapy.
• 22:58
  Speaker 1: So now we've got so many things that we can talk about here.
• 23:03
  Speaker 1: Where do you start?
• 23:05
  Speaker 1: Obviously, it's got to be dietary driven.
• 23:06
  Speaker 1: How do you change a diet, though?
• 23:10
  Speaker 1: Because that's the probably the biggest hurdle you're ever going to encounter.
• 23:14
  Speaker 2: How do I change a diet?
• 23:17
  Speaker 2: Cgms do really help, as I said earlier, as a motivating factor.
• 23:25
  Speaker 2: And, yes, diet and lifestyle is absolutely foundational to the treatment of metabolic dysfunction.
• 23:35
  Speaker 2: Look, it can be difficult with diet, but talking somebody through the benefits of increasing their fibre intake, increasing their vegetable intake, and talking to them about the diversity of food that they, you know, rather than taking things out, I tried to crowd more in so that we can, you know, diversify, especially the plant component of their diet, given that a lot of metabolic dysfunction is driven by, you know, highly processed foods and things like that.
• 24:16
  Speaker 2: So it's more about getting things in and talking to them about the different colours in the food.
• 24:23
  Speaker 2: Actually, you know, we spoke about genetics earlier.
• 24:26
  Speaker 2: These colours in the food are very important signalling chemicals that turn on protective functions, you know, within the body yeah, yeah, sure, um, and so what about um supplements?
• 24:47
  Speaker 1: you know, um, I was speaking earlier to someone about insulin resistance and metabolic um, we were talking about the importance of myo-inositol.
• 24:57
  Speaker 1: Now, this was mainly in females they were talking about, but when you're talking about both males and females, do you have any like top five go-to supplements that you might choose?
• 25:10
  Speaker 2: Nutritionals and herbals as well.
• 25:12
  Speaker 2: So myo-inositol is really, really interesting, actually it's.
• 25:19
  Speaker 2: You know, we do produce it in our bodies and we also get some in our diet.
• 25:23
  Speaker 2: But uh, with somebody who already has type 2 diabetes there's an increased urinary loss.
• 25:29
  Speaker 2: Plus there's also decreased um absorption or penetration into the cells.
• 25:35
  Speaker 2: So kidneys and the retina.
• 25:46
  Speaker 2: I mentioned earlier about the complications of type 2 diabetes being nephropathy.
• 25:50
  Speaker 2: So kidney disease and retinopathy.
• 25:52
  Speaker 2: They're both depleted in type 2 diabetes in myo-inositol.
• 25:58
  Speaker 2: So I did see a study that showed supplementation with that may help to prevent or delay development of those microcomplications.
• 26:09
  Speaker 2: It's particularly, I think of myo-inositol, particularly for insulin resistance.
• 26:14
  Speaker 2: I think of myo-inositol particularly for insulin resistance.
• 26:18
  Speaker 2: It's particularly good in slowing glucose absorption but it improves the muscle uptake, so it really improves that insulin sensitivity.
• 26:28
  Speaker 2: So myo-inositol for insulin resistance.
• 26:30
  Speaker 2: For me, another one of my go-tos would be magnesium, especially for cardiovascular.
• 26:40
  Speaker 2: You know, cardiovascular health, nervous system health and function, muscle function, energy production, all those things, uh, especially carbohydrate metabolism, blood sugar support.
• 26:52
  Speaker 2: Yeah, magnesium is commonly deficient in people with type 2 diabetes.
• 26:59
  Speaker 2: They have increased urinary losses.
• 27:04
  Speaker 2: They have increased urinary loss of magnesium.
• 27:07
  Speaker 2: So it's often a requirement.
• 27:12
  Speaker 1: Yeah, what about the old things?
• 27:14
  Speaker 1: We used to use chromium and some of the lipotropic factors?
• 27:19
  Speaker 1: We're restricted in Australia to the good forms of chromium, as in the polynicotinate and the picolinate, to 50 micrograms per day dosing.
• 27:31
  Speaker 1: How do you get around this?
• 27:33
  Speaker 1: What do you tend to use with chromium as a dose?
• 27:37
  Speaker 2: this might not be included, andrew, but I've never actually really used chromium.
• 27:41
  Speaker 2: I've only I've never used it as a single supplement.
• 27:46
  Speaker 2: I've only ever used it as in combination.
• 27:48
  Speaker 2: You know it might already be in something that I'm prescribing.
• 27:54
  Speaker 1: Gotcha.
• 27:54
  Speaker 1: And what about herbs like berberine?
• 27:58
  Speaker 2: Oh, herbs like berberine, definitely.
• 28:01
  Speaker 2: Berberine is particularly a go-to of mine.
• 28:08
  Speaker 2: It's fantastic for increasing insulin sensitivity.
• 28:13
  Speaker 2: It's also been shown to have a positive impact on body weight.
• 28:17
  Speaker 2: Also some of those um dyslipidemias like triglycerides, for example.
• 28:23
  Speaker 2: It actually has an, even though it works different to metformin.
• 28:28
  Speaker 2: It has an insulizing, insulin sensitizing sorry action similar to metformin but, as I said, it's a different mechanism.
• 28:37
  Speaker 2: So it can actually you be used alone or in conjunction with metformin.
• 28:42
  Speaker 2: So, um, it's very safe there.
• 28:46
  Speaker 2: Um, berberine has actually been shown to be as effective as metformin in lowering fasting, blood glucose and HbA1c and some of those dyslipidemias that we see.
• 28:59
  Speaker 2: So, yeah, berberine is definitely a go-to as well.
• 29:04
  Speaker 2: I also really like turmeric as an anti-inflammatory helps that inflammatory cascade that you know it's a very inflammatory environment type 2 diabetes and turmeric works very well here, increasing insulin sensitivity.
• 29:30
  Speaker 2: It also protects the microcirculation.
• 29:31
  Speaker 2: Also protects the microcirculation so that chronic kidney disease, nephrology and the neuropathy that we see too.
• 29:44
  Speaker 1: That peripheral neuropathy.
• 29:52
  Speaker 2: Anything else that we need to discover?
• 29:58
  Speaker 2: I really like to use PEA, right.
• 29:59
  Speaker 2: So this is interesting.
• 30:02
  Speaker 2: I found PEA yeah, I really like to use PEA.
• 30:07
  Speaker 2: It's anti-inflammatory but it's analgesic, so it's really good for that neuralgic pain and I have used it in peripheral neuropathy and had good responses.
• 30:18
  Speaker 2: Uh, with that, um, you know, peripheral neuropathy in type 2 diabetes is, um, it's the what's the word?
• 30:29
  Speaker 2: It's the highest indicator of mortality, uh, once somebody has that peripheral neuropathy and that nerve damage.
• 30:38
  Speaker 2: So, uh, relieving some of that discomfort for people is is really important and it's so, pa pardon it's really painful for people.
• 30:55
  Speaker 2: It's really painful, it can affect their sleep as well, because it actually seems to be worse at night.
• 31:03
  Speaker 2: The thing that people don't realise with neuropathy in type 2 diabetes is, you know, we usually think of the peripheral neuropathy, so the hands and the feet and the toes, but it also has an autonomic effect where it can affect, um blood pressure control, which is one of the things that we're trying to to manage in um these metabolic, yeah, issues, uh also temperature control and sensation, digestion, bladder function, sexual sexual function.
• 31:35
  Speaker 2: So, people, it's not just hands and fingers and toes and, you know, as it advances, it is, you know, the highest cause of amputation.
• 31:52
  Speaker 2: Right?
• 31:53
  Speaker 1: gotcha In type 2 diabetes.
• 31:55
  Speaker 1: What about lipoic acid?
• 31:58
  Speaker 1: How often do you employ it?
• 31:59
  Speaker 1: What dose do you go to?
• 32:01
  Speaker 2: Do you know, andrew?
• 32:02
  Speaker 2: I didn't put anything for lipoic acid.
• 32:05
  Speaker 1: No, it's okay, but do you ever like forget about the notes?
• 32:09
  Speaker 1: Don't read off the notes, so do you use it in clinic?
• 32:16
  Speaker 2: I use lipoic acid in clinic for kidney support.
• 32:23
  Speaker 1: Right, okay, and do you so?
• 32:24
  Speaker 1: Are you guided by EGFR with that?
• 32:28
  Speaker 2: Yes, I am.
• 32:29
  Speaker 2: Actually.
• 32:30
  Speaker 2: I can't recall off the top of my head where that needs to be for that or what dosage I use.
• 32:36
  Speaker 2: But I remember a particular client of mine recently that I looked up some some recent research on and it was definitely indicated for chronic kidney disease.
• 32:49
  Speaker 2: Her EGFR, I think, was down to say 28 or 30, something like that.
• 32:59
  Speaker 2: So it's quite low.
• 33:00
  Speaker 2: She is very overweight.
• 33:03
  Speaker 2: She doesn't have type 2 diabetes but she is very overweight and has quite a number of different disorders going on.
• 33:12
  Speaker 2: But alpha-lipo acid has is definitely indicated for supporting healthy kidney function.
• 33:21
  Speaker 2: That filtration rate karen.
• 33:25
  Speaker 1: What other nutraceuticals or nutrients do you tend to incorporate, like for instance we haven't discussed zinc?
• 33:32
  Speaker 2: no, we haven't discussed zinc.
• 33:34
  Speaker 2: I don't usually prescribe zinc separately.
• 33:40
  Speaker 2: It's usually in a formulation.
• 33:41
  Speaker 2: Perhaps it could already be in the magnesium or another combination that I'm using.
• 33:48
  Speaker 2: Zinc is really important in type 2 diabetes.
• 33:51
  Speaker 2: It's really important for I mentioned earlier about clearance of insulin out of the body and there is an enzyme that's responsible for that.
• 34:04
  Speaker 2: That is zinc dependent, so it's important to keep zinc levels good.
• 34:08
  Speaker 2: Other nutritionals that I would use would include omegas omega-3s obviously very anti-inflammatory and very good for modulating blood fats, which is important in type 2 diabetes.
• 34:24
  Speaker 2: And we know that the DHA component is really important for eye health.
• 34:31
  Speaker 2: So most people with type 2 diabetes will actually get some degree of diabetic retinopathy once they've been diagnosed at some stage some degree.
• 34:44
  Speaker 2: So that's really protective for that as well.
• 34:48
  Speaker 2: And you know, we know, that omega-3s improve you know that cell membrane fluidity just generally, and that helps all our cells communicate uh much more efficiently really important for cardiovascular health as well karen, forgive me, I never covered this off and I should have covered this off right at the beginning exercise.
• 35:09
  Speaker 1: We haven't even covered it.
• 35:09
  Speaker 1: How do you get people to exercise?
• 35:12
  Speaker 1: What sort of exercises are most beneficial for them?
• 35:16
  Speaker 2: uh, yeah, it's true, I'll see people in clinic that often aren't doing any exercise at all.
• 35:21
  Speaker 2: So I'll start very simply.
• 35:23
  Speaker 2: Start very simply.
• 35:26
  Speaker 2: A lot of people, when they think exercise, they think that that means I've got to go out and walk for an hour or I've got to hit the gym or something like that.
• 35:34
  Speaker 2: But if it's somebody who hasn't exercised for a long time and they're quite sedentary, then I really want to make it part of their lifestyle.
• 35:45
  Speaker 2: So I want them to adopt it easily.
• 35:49
  Speaker 2: So, even if it's five minutes, it's about making it part of the routine, of of, you know, the new, the new lifestyle.
• 35:56
  Speaker 2: So, even if it's just five minutes and I'll just encourage people to do that they think it's not enough.
• 36:03
  Speaker 2: But just any level of activity is beneficial.
• 36:13
  Speaker 2: It will, you know, upregulate the glucose into the muscle cells.
• 36:17
  Speaker 2: They'll start to feel a little bit better is beneficial.
• 36:19
  Speaker 2: It will, you know, upregulate the glucose into the muscle cells.
• 36:21
  Speaker 2: Um, it'll, they'll start to feel a little bit better.
• 36:29
  Speaker 2: There's, um, once again, a study I'm a bit of a nerd.
• 36:32
  Speaker 2: I like reading studies um, that showed as little as three minutes a day of walking will show benefit.
• 36:35
  Speaker 2: Will show benefit.
• 36:37
  Speaker 2: It was as little as just three minutes on a lunch break of walking um.
• 36:42
  Speaker 2: And also very light bouts of resistance exercise, such as standing up from your desk and just doing a few squats, for example.
• 36:51
  Speaker 2: Or you don't even have to leave your office room, you can go to up to the wall and just do some you know pushes against the wall.
• 37:00
  Speaker 2: That very light intensity exercise for somebody to start off with has been shown to be of benefit as far as glucose regulation goes.
• 37:10
  Speaker 2: And then they can start to build on that.
• 37:12
  Speaker 2: And if they're wearing a CGM as well, you know, if they're wearing a CGM as well, you know if they're wearing a continuous glucose monitor as well, and they start to actually see that oh, I didn't think five minutes a day would make any difference.
• 37:25
  Speaker 2: And they can actually start to see that these choices it's not all dietary choices, it's lifestyle choices starts to have, you know, an impact and becomes very motivating for them to build on that.
• 37:42
  Speaker 1: Yeah, I couldn't agree with you more the number of times I've spoken to patients and it doesn't have to be this massive group hit therapy with everybody at the gym.
• 37:52
  Speaker 1: It doesn't have to be that, it can be.
• 37:54
  Speaker 1: Simply, these people often are out of tune and so I don't want to be placing them into a situation where they're going to be over pressurizing their, over-exerting their system and putting themselves at health risk.
• 38:06
  Speaker 1: So I often talk about exactly what you said just doing a push-up quote unquote against the kitchen bench, or holding onto the kitchen bench and doing a squat as far as they can handle with their knees, simple things like that.
• 38:19
  Speaker 1: I love what you've said about that exercise for three minutes a day because it's priming their system.
• 38:25
  Speaker 1: It's priming them for not just their system physically, but encouragingly.
• 38:33
  Speaker 1: If you're talking about the continuous glucose monitoring, I love it.
• 38:39
  Speaker 2: And we want them to be successful.
• 38:40
  Speaker 2: You know we don't want to make it hard.
• 38:42
  Speaker 2: You know we want them to achieve the small goals because when they do that they feel motivated and they feel confident in tackling the next goal, whatever that might be.
• 38:54
  Speaker 2: So you know, they may increase from walking for five minutes a day to 10 minutes a day.
• 39:00
  Speaker 2: And I often tell my clients as well don't go Dr Googling, don't listen to what your friend says or your mom says or whoever says.
• 39:09
  Speaker 2: This is your own personal journey.
• 39:12
  Speaker 2: And if 10 minutes is working for you, then you just do 10 minutes and I just tell them that I want them to be successful, I want them to achieve that goal and then you know, as I said, they will have the confidence then to tackle the next one.
• 39:27
  Speaker 1: Beautifully said.
• 39:28
  Speaker 1: Just a last point about red flags and potential medication interactions.
• 39:32
  Speaker 1: What do we have to be aware of?
• 39:36
  Speaker 2: I know that there's a lot of clinicians out there that are really concerned about prescribing nutritionals or herbal medicines with, you know, common anti-diabetic drugs.
• 39:47
  Speaker 2: But I haven't come across, I certainly haven't had the situation where I've personally experienced a negative interaction with any of my clients, and in fact a lot of the studies show, if we use metformin as an example, being one of the most common medications for metabolic dysfunction, in fact, some of our herbs, such as curcumin and nigella berberine, they've all been shown to work very strongly synergistically with metformin.
• 40:23
  Speaker 2: So yeah, you know, they work very well together.
• 40:31
  Speaker 2: In fact, I think it was actually with berberine that it can be prescribed alongside metformin.
• 40:43
  Speaker 2: But as an example of how it can potentiate the effects of metformin, if it's prescribed two hours prior to somebody taking their metformin, the metformin will actually last a little bit longer than if they didn't take the berberine.
• 41:01
  Speaker 2: So it increased the.
• 41:03
  Speaker 2: I can't remember the mechanism, but it increased the bioavailability of the metformin when it was dosed a couple of hours in advance.
• 41:14
  Speaker 2: So, yeah, yeah, it's, you know, know, like ginkgo and metformin.
• 41:20
  Speaker 2: Um, I've looked at that because I use ginkgo for, uh, kidney support, the microcirculation there, and it's been shown to work together very well with metformin in in reducing fasting, blood glucose, bmi, waist circumference, so they work very well synergistically together.
• 41:39
  Speaker 2: I've never had um an adverse uh combination effect.
• 41:46
  Speaker 2: Um, in fact it's.
• 41:48
  Speaker 2: It's it's often.
• 41:50
  Speaker 2: You know the pharmaceutical drugs that have the side effect.
• 41:53
  Speaker 2: So, talking about metformin, 30 percent of people on metformin will have gut issues with it.
• 41:58
  Speaker 2: So there'll be, nausea, diarrhea, yeah, even vomiting, um, in some people.
• 42:03
  Speaker 2: So, uh, it's, it's a, it's a.
• 42:09
  Speaker 2: It's a safe environment to prescribe our herbs and they work very, very strongly synergistically with a lot of the diabetes medications.
• 42:21
  Speaker 1: Karen, thank you so much for taking us through this today.
• 42:23
  Speaker 1: I know that we bit off way more than what we could chew.
• 42:26
  Speaker 1: This is such a huge topic and we've only covered a small part of it.
• 42:29
  Speaker 1: It's like a three podcast series, but thank you so much for taking us through your expertise today.
• 42:34
  Speaker 1: I really appreciate it.
• 42:34
  Speaker 1: You're very welcome, thank you through your expertise today.
• 42:36
  Speaker 2: I really appreciate it.
• 42:36
  Speaker 1: You're very welcome, thank you and thank you everyone for joining us today.
• 42:41
  Speaker 1: Remember you can catch up on this podcast.
• 42:43
  Speaker 1: We'll put in the show notes as much information as we can, and all the other podcasts are on the Designs for Health website.
• 42:49
  Speaker 1: I'm Andrew Whitfield-Cook.
• 42:50
  Speaker 1: This is Wellness by Designs.