February 20, 2020

A new review demonstrates acetyl-l-carnitine significantly decreases depressive symptoms

Acetyl L-carnitine is one of the most researched brain nutrients that has been shown to quickly enhance mental focus and energy. It has a similar structure as acetylcholine, and therefore, acetyl l-carnitine can stimulate acetylcholine receptors in the brain. The acetyl group allows it to cross the blood brain barrier, which does not occur with L-carnitine.  Acetyl-l-carnitine will support the brain as well as everything else that l-carnitine can do.

Carnitine is abundant in animal muscle tissue, including red meats. Its main function is to transport fatty acids across the mitochondrial membrane for fatty acid oxidation. Supplementation of carnitine has been studied in many areas including metabolism, cardiovascular disease, and sports enhancement.

According to a new review published last Wednesday in Psychosomatic Medicine, researchers demonstrated that acetyl-l-carnitine can significantly reduce depressive symptoms and an insufficiency of acetyl-L-carnitine can play a role in the risk of developing depression, suggesting dysregulation of fatty acids transport across the mitochondria.

In this study, researchers reviewed 12 random controlled trials (RCTs), 11 in which acetyl-l-carnitine was a monotherapy. In nine studies, there was a total 791 individuals, 231 treated with acetyl-l-carnitine, 216 people treated with placebo and 20 individuals with no intervention. As a result, the analysis showed that acetyl-l-carnitine significantly reduced depressive symptoms. The other 3 RCTs compared acetyl-l-carnitine vs. antidepressants. There were 162 individuals for each group. Acetyl-l-carnitine demonstrated similar effectiveness compared to antidepressants in decreasing depressive symptoms.

Most people associate acetyl L-carnitine with preventing age-related memory decline and slowing Alzheimer’s, however, it is also very effective for increasing mental focus, energy, and optimizing brain health. Acetyl-l-carnitine increases dopamine which enhances focus and motivation. Most individuals dose acetyl-l-carnitine between 500 mg and 3000 mg a day depending on the application. This is one of those nutrients individuals feel an increase in focus and energy within about 15 to 20 minutes. There are no side effects and only long term benefits on brain health and function.

Other brain supportive nutrients to consider are GPC, CDPcholine, gingko biloba, and phosphatidylserine, and fish oil. GPC and CDP-choline are water soluble forms of choline that can cross the blood brain barrier and support brain health. These help make more acetylcholine, neurotransmitters, as well as phosphatidylcholine in the cell membranes. In addition, phosphatidylserine is an essential nutrient for brain function and is not found in the diet. Research has demonstrated that phosphatidylserine improves depressive symptoms, memory, and behavior.

By Michael Jurgelewicz, DC, DACBN, DCBCN, CNS

Source: Veronese N, Stubbs B, et al. Acetyl-l-carnitine Supplementation and the Treatment for Depressive Symptoms: A Systemic Review and Meta-analysis. Psychosomatic Medicine. 2017 October 25.


New study demonstrates glutamine decreasing intestinal permeability in runners

There has been increased evidence on the prevalence of intestinal permeability in athletes the last year and a half. I shared previous studies on heavy exercise induced intestinal permeability in athletes.

When one thinks of nutritional supplements in athletes, they usually think of nutrients that increase enhance energy and sports performance. However, athletes commonly suffer from gut issues that are often not identifies or addressed. ‘Leaky gut’ occurs from dysfunction in the intestinal barrier.  This intestinal barrier in the gut is only one cell layer thick. It is essential for the absorption of nutrients and preventing large molecules and bacteria from getting into the blood stream.

This is a particular problem for those taking part in heavy exercise or any form of vigorous strength training, such as CrossFit athletes, strongman competitors, and powerlifters, which can lead to gut issues in athletes as well as more serious conditions like inflammatory bowel and autoimmune disorders.

In addition, gastrointestinal discomfort is a common complaint among endurance athletes who participate in marathons and triathlons as well.

In a study published last Friday in the European Journal of Applied Physiology, researchers demonstrated that acute supplementation with glutamine mitigates intestinal permeability in runners.

It makes sense to consider BCAA power with glutamine or glutamine powder prior or during exercise to prevent gastrointestinal barrier dysfunction.

Also, other studies have demonstrated that oral supplementation with colostrum decreases intestinal permeability.

These findings demonstrate the importance of colostrum and glutamine in preventing leaky gut and are important nutrients to consider for athletes. When working with athletes, there is often a disconnect between fitness and health. For those individuals that have a sensitivity to dairy and cannot use colostrum, serum-derived bovine immunoglobulin/protein isolate (SBI) is a great alternative to normalize the gut microbiota and decrease gut permeability. The other advantage of this for athletes is the addition protein content with BCAAs levels superior to whey and provides high levels of IgG which reduces inflammation decreasing mucosal damage.

I work with many of these athletes. Due to the stresses they put on their bodies and increased metabolic demands, many often have debilitating gut issues and inflammatory bowel diseases.

By Michael Jurgelewicz, DC, DACBN, DCBCN, CNS Source: Pugh JN, Sage S, et al. Glutamine supplementation reduces markers of intestinal permeability during running in the heat in a dose-dependent manner. European Journal of Applied Physiology. 2017 Oct 20.

New study demonstrates a multivitamin can improve symptoms in children with ADHD

According to a study published 2 weeks ago in The Journal of Child Psychology and Psychiatry, researchers demonstrated that supplementation with a multivitamin and mineral formula can improve aggression and emotional regulation in children with ADHD.

This was the first randomized, placebo controlled trial of children with ADHD not on medication.

In this study 93 children ages 7 to 12 years of age were given either a multivitamin/mineral formula or placebo for 10 weeks.  During this time researchers obtained data from their parents, teachers, and doctors. They measured ADHD symptoms, levels of aggression, mood, emotional regulation, general functional and impairment.

As a result, 47% of the children taking them multivitamin/mineral formula improved “much” or “very much”. This was in comparison to 28% in the placebo group. In addition, 32% of the children who received the supplement demonstrated improvements in attention, however, there were no changes in impulsivity or hyperactivity.

This study showed that a multivitamin/mineral formula can improve emotion, attention, and general functioning in children with ADHD. Twice as many children in this study had severe mood dysregulation and were randomized to the supplement group, which showed a clinically significant improvement compared to the placebo group.

Previous research has demonstrated specific nutrients and their positive impact on ADHD symptoms such, as essential fatty acids, carnitine, and phosphatidylserine. Optimal nutrition is important for brain health and this influences emotions and behavior which can impact ADHD symptoms. Gut dysfunction, food sensitivities, food dyes, processed foods, and low intake of fruits and vegetables can play a role.

The bottom line is we need optimize every child’s nutrient status based upon testing and support accordingly and we cannot forgot supporting these children with essential fatty acids. Addressing insufficiencies can optimize brain function as well as possibly prevent and alleviate some of the symptoms associated with ADHD without harmful side effects.

By Michael Jurgelewicz, DC, DACBN, DCBCN, CNS

Source: Rucklidge JJ, Eggleston MJF et al. Vitamin-mineral treatment improves aggression and emotional regulation in children with ADHD: a fully blinded, randomized, placebo-controlled trial. The Journal of Child Psychology and Psychiatry. 2017 October 2.


Resveratrol improves insulin sensitivity and glucose control in patients with diabetes

Resveratrol is a polyphenol with powerful antioxidant and anti-inflammatory properties.  It has been widely publicized for its cardiovascular, anti-carcinogenic, and anti-aging benefits.  

Resveratrol activates sirtuins, which can increase insulin sensitivity and protect against oxidative damage. Previous research with resveratrol has demonstrated improvements in dysglycemia and insulin sensitivity, however, there has been some inconsistency in results.

According to a new review published 3 weeks in Nutrition & Metabolism, researchers demonstrated that resveratrol does improve glycemic control and insulin sensitivity in individuals with type II diabetes.

This review consisted of 9 RCT studies, dosing ranges from 8 mg/d to as high as 3 g/d with a duration of 4 weeks to 12 months. The overall results demonstrated that resveratrol significantly reduces fasting glucose levels but only at a dosage of 100 mg/d or more. In addition, HOMA-IR, fasting insulin levels, and blood pressure was also reduced by resveratrol.

In addition, a previous study published earlier this year in the International Heart Journal, researchers demonstrated resveratrol’s benefits in improving arterial stiffness and reduced oxidative damage in patients with type II diabetes. This study used the same dosage of 100 mg which has been shown to reduce fasting glucose levels.

Resveratrol can act through several mechanisms, including binding and activating estrogen receptors to increase nitric oxide bioavailability and facilitate the vasodilatation. In addition, it decreases reactive oxygen species production in vascular endothelial cells. Oxidative stress is elevated in chronic disease such as obesity and diabetes. 

These results support resveratrol supplementation as a potential strategy for improving glucose control and insulin sensitivity as well as mitigating arterial stiffness and reducing blood pressure and oxidative damage with patients with type II diabetes.

By Michael Jurgelewicz, DC, DACBN, DCBCN, CNS

Source: Zhu X, Wu C et al. Effects of resveratrol on glucose control and insulin sensitivity in subjects with type 2 diabetes: systematic review and meta-analysis. Nutrition & Metabolism. 2017 Sept 22;14:60.



New study demonstrates the importance of vitamin K and cardiovascular function in teens

According to a new study published Sunday in The Journal of Nutrition, researchers demonstrated that there is a 3.3 times greater risk heart enlargement in healthy teens who consumed the least vitamin K1. This form of vitamin K is predominantly found in green leafy vegetables such as, spinach, cabbage, and lettuce.

Interestingly, approximately 10% of the teens have some degree of left ventricular hypertrophy according to the research team. This is the first study exploring associations between vitamin K, heart function, and structure in young healthy individuals. These results suggest early interventions to ensure adequate vitamin K1 in young people could improve cardiovascular development as well as reduce future cardiovascular disease risk.

This study consisted of 766 teens ages 14 to 18 years of age. They found that those who consumed the least amount of vitamin K1 had an increased overall size and thickness of the left ventricle.

In addition, only 1/4 of the teens in this study met the current adequate intake levels of the Food and Nutrition Board of the Institute of Medicine. There is also evidence that vitamin K levels are lower in obese and overweight children.

Vitamin K plays a significant role in blood clotting, cardiovascular health, and optimal bone health. It is essential for the production of osteocalcin.

The Framingham Offspring Cohort Study also found an association between higher vitamin K1 levels and lower lipid levels in the blood.

Vitamin K should be met with the intake of K1 from food sources and supplementation since some K1 will convert to K2-MK-4. There has been a lot of hype and promotion of K2 (MK-7) but keep in mind there are no proprietary forms of K1 and K2 (MK-4). Vitamin K2 (MK-7) does convert to K2 (MK-4).

There is also no evidence for an ideal ratio between D and K1 or K2. The bottom line is we need to optimize each of these based on testing.

Most people I find need anywhere form 5,000-10,000 IUs/day of vitamin D and about 1-2 mg of K1 since most people do not eat enough vegetables as we have seen in this study to get enough K. This is also the amount that carboxylates osteocalcin. This was a patient’s lab report I received back on Wednesday.

As you can see the patient has a vitamin K insufficiency. I never give vitamin D without vitamin K. About 70% of my patients have vitamin K insufficiencies. It seems to be as prevalent as magnesium deficiency. In addition, I have personally have found vitamin K1 supplementation to be much more successful at lowering undercarboxylated osteocalcin levels than K2 (MK-7).

It makes sense to supplement with all three forms of vitamin K [K1, K2(MK-4, and MK-7)] and not get hung up on the marketing hype of one proprietary form.

By Michael Jurgelewicz, DC, DACBN, DCBCN, CNS

Source: Mary K Douthit, Mary Ellen Fain, Joshua T Nguyen, Celestine F Williams, Allison H Jasti, Bernard Gutin, Norman K Pollock. Phylloquinone Intake Is Associated with Cardiac Structure and Function in Adolescents. The Journal of Nutrition, 2017; jn253666 DOI: 10.3945/jn.117.253666

New study demonstrates low vitamin C status in those with insulin resistance, obesity, and smokers

Many chronic conditions typically have increased nutrient demands than healthy individuals. These are considered conditionally essential nutrients. There is either a disruption in metabolic processes, underlying inflammation, oxidative stress, or an inability to meet the metabolic demands with the current nutrient reserves.

In a study published five days ago in Nutrients, researchers demonstrated that patients who are prediabetic, have type II diabetes, or smokers have lower plasma vitamin C levels.

This makes sense since insulin resistance is associated with chronic low grade inflammation, there will be increased vitamin C requirements to mitigate oxidative stress. There are other factors that may contribute to this as well such as, vitamin C excretion in those with microalbuminuria or competition for glucose and vitamin C into the cells.

This study included 89 patients over the age of 18 years of age who either had a normal fasting glucose, had prediabetes, or type II diabetes. There were no significant differences in macronutrient intake of dietary vitamin C between the groups. Plasma vitamin C concentrations were significantly lower in the patients with type II diabetes as well as a much higher percent with a vitamin C deficiency in the prediabetes and diabetes groups.

As a result, the researchers demonstrated that fasting glucose, BMI, smoking history, and dietary vitamin C intake to be significant independent markers of plasma vitamin C concentrations; therefore, individuals that have a history of smoking, prediabetes, diabetes, and obesity have greater vitamin C requirements. Vitamin C supplementation should be considered in these patients to prevent complications and support overall health.

Previous research has demonstrated vitamin C doses over 200 mg per day to significantly reduce glucose concentrations.

The level of nutrient intake that maintains the best possible health is highly variable from person to person. Lifestyle choices and environmental exposures filtered through genetic predisposition are fundamental factors in the expression of disease and a successful treatment approach must include investigation into these factors.

Other conditionally essential nutrients in insulin resistance are vitamin E and inositol. A study published in 2015 in the American Journal of Clinical Nutrition demonstrated that approximately one-third of Americans who have metabolic syndrome don’t absorb dietary vitamin E as effectively as healthy individuals.

Other studies have shown that an inositol deficiency is common in patients with insulin resistance. There appears to be a reduced ability to process, metabolize, and effectively use inositol from foods which is a distinctive characteristic feature of insulin resistance. As a result, the nutritional requirements of these patients may not be met by a simple change in the diet and that inositol should be viewed as a conditionally essential nutrient in these individuals.

By Michael Jurgelewicz, DC, DACBN, DCBCN, CNS

Source: Wilson R, Willis J et al. Inadequate vitamin C status in prediabetes and type 2 diabetes mellitus: associations with glycaemic control, obesity, and smoking. Nutrients. Sept 9;9(9). Doi: 10.3390/nu9090997.

New study demonstrates curcuminoids increase HDL and lower lipoprotein (a) in type 2 diabetes patients

There are only a few natural products that have demonstrated the wide range of protective properties as curcumin. Turmeric has three main bioactive components which are curcumin, desmethoxycurcumin and bisdemethoxycurcumin. These curcuminoids have many biological effects including anti-inflammatory, antioxidant, antitumor, antibacterial, and antiviral properties.

According to a new study published last month in the Complementary Therapies in Medicine, researchers demonstrated that curcuminoid supplementation can reduce lipoprotein(a) and increase HDL-C which may reduce the risk of a cardiovascular event in diabetic patients with dyslipidemia.

This study included a total of 82 patients with type II diabetes 18 to 65 years of age. Each patient took either 1000 mg of standardized curcumin or a placebo for 12 weeks. Baseline lab testing included serum triglycerides, total cholesterol, HDL-C, non-HDL-C, and lipoprotein(a). At the end of the twelve weeks there was a significant reduction of serum lipoprotein(a) and an increase in HDL-C concentrations only seen in the curcuminoid group. There were no significant changes in total cholesterol, LDL-C, and triglycerides in either group.

This is an interesting study since the ability to influence liprotein(a) is very limited. Niacin is one of the only natural agents that can significantly reduce liprotein(a), however, this is not effective for everyone.

Curcumin is used for some many applications and health benefits. This study demonstrates one other application for dyslipidemia in patients with type II diabetes.

Health care providers have many tools today to assess cardiovascular health and support the body’s physiology. It is essential to perform a thorough assessment for these patients. This may include looking at lipid fractionation profiles, chronic inflammatory markers (ferritin, hs-CRP, fibrinogen), nutrient markers (magnesium, potassium, selenium, copper, folate, B12, B6, zinc, and calcium), fat soluble vitamins (CoQ10, vitamin D, vitamin K, Vitamin A, Vitmain E), oxidative stress factors (homocysteine, insulin, and lipid peroxidases), heavy metals, and a fatty acid profiles. A successful treatment approach should include investigation into these factors.

By Michael Jurgelewicz, DC, DACBN, DCBCN, CNS

Source: Panahi Y, Khalili N et al. Curcuminoids modif lipid profile in type 2 diabetes mellitus: A randomized control trial. Complementary Therapies in Medicine. 2017 August;22:1-5. doi: 10.1016/j.ctim.2017.05.006.




New study demonstrates fat intake is associated with an overall lower mortality and a lower risk of cardiovascular disease

The association between different macronutrients and their correlation with overall mortality and cardiovascular is controversial.

Fat often gets a bad reputation in traditional medicine although all integrative functional medicine doctors and nutritionists educate their patients and clients on the benefits of consuming healthy fats. In addition, Paleo and Ketogenic diets have never been more popular.

According to a new study published in The Lancet, researchers demonstrated that high carbohydrate intake was associated with an increased risk or mortality and total fat as well as individual types of fat were associated with a lower mortality.

This is a large study that included 135,335 individuals over a span of ten years ages 35 to 70 years of age from 18 countries in 5 continents. Macronutrient intake was recorded using food frequency questionnaires. Researchers assessed the association between the consumption of total fat, each type of fat, and carbohydrate intake with total mortality and cardiovascular disease.

As a result, higher carbohydrate intake was associated with and increased risk of total mortality but not with the risk of cardiovascular disease or cardiovascular disease mortality. In addition, the total fat intake as well as each type of fat was associated with a lower risk of total mortality. Furthermore, higher saturated fat intake was associated with a reduced risk of stroke. This large study demonstrates that fats are not significantly associated with an increased risk of a heart attack or cardiovascular disease mortality.

It is important to keep in mind that in large cohort studies, dietary intake is reassessed over time and the participants can eat whatever diet they choose and then researchers obtain recent or past dietary history of the participants.

In a clinical trial the study controls the dietary intake which is more complicated in observational studies where the participants control their own diet.

There was also a review published in Circulation in which researchers demonstrated that lowering saturated fats and increasing polyunsaturated and monounsaturated fats is associated with lower rates of cardiovascular disease. This review showed similar outcomes with fat intake and a reduced risk of cardiovascular as well as carbohydrates not reducing cardiovascular disease.

Fats make up the structure of our cell membranes and fatty acid deficiencies contribute not only to cardiovascular disease but many problems such as eczema, poor concentration, immune dysfunction, and chronic inflammatory disorders.

Dietary fat, like any macronutrient, supplies energy. It important to look all of the macronutrients of each person. People who eat a lot of saturated fat eat generally eat less carbohydrates and unsaturated fat and those that eat a less saturated fat generally eat more carbohydrates or unsaturated fats. You cannot eat a lot of all the macronutrients and be healthy. The ideal amount of each macronutrient will be specific to each individual, their current state of health, condition, goals, metabolic demands, and activity level.

By Michael Jurgelewicz, DC, DACBN, DCBCN, CNS

Source: Dehghan M et al. Associations of fats and carbohydrate intake with cardiovascular disease and mortality in 18 countries from five continents (PURE): a prospective cohort study. 29 August 2017.

Inositol plus selenium restores thyroid function in Hashimoto’s patients with subclinical hypothyroidism

Hashimoto’s is one of the most common autoimmune diseases. Autoimmunity can occur a few different ways, but eventually the thyroid gland progressively becomes underactive due to antibody and cell mediated autoimmune processes.

According to a recent study published in the European Review for Medical and Pharmacological Sciences, researchers demonstrated that myo-inositol and selenium restores normal thyroid function in Hashimoto’s patients with subclinical hypothyroidism.

Environmental triggers are what integrative doctors mainly work with in functional medicine to healthy address the dysfunction in autoimmune disease. These can be food triggers such as gluten or food sensitivities that can trigger inflammation as well as anything coming in with the food such as toxins or molds. In addition, the nutrient status of the person. This can be antioxidant status, vitamins, essential fatty acids, vitamin D, etc. Also, gut health. This includes “leaky gut” and dysbiosis. There are also toxins that can be affect the status of the immune system. These are heavy metals, xenobiotics, as well as the total toxic burden in the body.

Inositol is commonly used to support sleep, female hormone health as well alleviate depression and anxiety. Inositol is also a second messenger regulating several hormones such as insulin and TSH.

In this study 168 patients ages 22 to 62 years were enrolled in a random controlled trial (RCT). These patients had a TSH level between 3-6 mIU/L, elevated TPO and/or Thyroglobulin antibodies, and normal free T4 and T3 levels. They were randomized into two groups and were given either 83 mcg of selenium or a combination of 600 mg of myo-inositol and 83 mcg of selenium and for six months.

As a result, there was a significant reduction in TSH levels in Hashimoto’s patients with subclinical hypothyroidism and increases in thyroid hormone concentrations with myo-inositol combined with selenium. In addition, there was a lower TPO antibody concentration in both groups but only a reduction in thyroglobulin antibodies in the myo-inositol with selenium group.

Since myo-inositol combined with selenium decreases TSH levels and raises T3 and T4, they may also provide indirect protection to cardiovascular complications as thyroid hormones regulate heart rate and metabolism. Decreased levels of free T3 and T4 can lead to higher blood pressure, low heart rate, and increased stiffness of the blood vessel walls.

By Michael Jurgelewicz, DC, DACBN, DCBCN, CNS

Source: Nordio M, Basciani S. Myo-inositol plus selenium supplementation restores euthyroid state in Hashimoto’s patients with subclinical hypothyroidism. European Review for Medical and Pharmacological Sciences. 2017; 21 (2 Suppl): 51-59.







Resveratrol improves arterial stiffness and reduces oxidative damage in patients with diabetes

Resveratrol is a polyphenol with powerful antioxidant and anti-inflammatory properties.  It has been widely publicized for its cardiovascular health benefits, however, there are few human studies in patients with atherosclerogenic diseases.

According to a study published last week in the International Heart Journal, researchers demonstrated improved arterial stiffness and reduced oxidative damage in patients with type II diabetes.

Resveratrol activates sirtuins, which are the same proteins activated by caloric restriction and exhibits anti-atherosclerotic effects.

This study consisted of 50 patient with type II diabetes. All participants received either a supplement containing 100 mg of resveratrol or a placebo tablet for 12 weeks.  Researchers assessed body weight, BMI, a comprehensive metabolic panel, HbA1c, lipid profile, oxidative stress markers, blood pressure, and cardio-ankle vascular index (CAVI). All patients followed the same diet and exercise routine.

After 12 weeks, the CAVI and systolic blood pressure decreased significantly in resveratrol group compared to the placebo. An increased CAVI is associated with cardiovascular disease, stroke and vascular dysfunction and predictor of a future cardiovascular event independent of other traditional risk factors. Resveratrol can act through several mechanisms, including binding and activating estrogen receptors to increase nitric oxide bioavailability and facilitate the vasodilatation.

D-ROMS, an oxidative stress marker, also decreased only in the resveratrol group. Resveratrol decreases reactive oxygen species production in vascular endothelial cells. Oxidative stress is elevated in chronic disease such as obesity and diabetes. 

These results support resveratrol supplementation as a potential strategy for mitigating arterial stiffness and reducing blood pressure and oxidative damage with patients with type II diabetes.

By Michael Jurgelewicz, DC, DACBN, DCBCN, CNS

Source: Imamura H et al. Resveratrol Ameliorates Arterial Stiffness Assessed by Cardio-Ankle Vascular Index in Patients With Type 2 Diabetes Mellitus. Int Heart J. 2017 Jul 13. doi: 10.1536/ihj.16-373.