February 2, 2023

New review investigates the effect of vitamin D supplementation in type-2 diabetes

Type II diabetes affects more than 30 million individuals and the youth account for 20% to 50% of new onset diabetes cases.

Previous research has demonstrated low levels of vitamin D are associated with an increased risk of type II diabetes. Vitamin D has been shown to play a role in reducing inflammation and inhibiting β-cell destruction. 

According to a new review this week in BMC Endocrine Disorders, researchers investigated the effect of vitamin D supplementation on the glycemic control of type 2 diabetes patients.

This review consisted of 46 randomized controlled trials (RCTs) consisting of 2,164 patients that had vitamin D supplementation and 2,149 placebo patients. The pooled analyses for HbA1c showed a significant change between the intervention and placebo group. In addition, there was a significant reduction in fasting blood glucose and significant change in HOMA-IR after vitamin D supplementation. The subgroup analyses showed the most efficacy in a higher dose (>2000 IU daily) and short intervention period (<12 weeks) and in individuals with a vitamin D deficiency.

This study demonstrates the benefits of vitamin D supplementation. It is essential to take a vitamin D supplement containing vitamin K or taking a vitamin K supplement in addition to vitamin D to optimize the level of each vitamin and prevent against arterial calcification. It is important to maintain optimal levels of all the fat-soluble vitamins as more and more research demonstrates their intricate interrelationships with other nutrients.

There is no evidence for an ideal ratio between D and K1 or K2, however, we need to optimize each vitamin. It is also important to note their no toxicity of vitamin K.

All chronic conditions are multifactorial and vitamin D is many times just a small part of the picture. It is important to look deeper and address other common deficiencies such as magnesium, vitamin C, glycine, and essential fatty acids. Other nutrients that can help therapeutically include inositol, lipoic acid, delta and gamma tocotrienols, chromium, zinc, and berberine. Many of these nutrients play a synergist role with one another and it is important to have adequate levels for optimal function.

By Michael Jurgelewicz, DC, DACBN, DCBCN, CNS

Source: Farahmand MA, Daneshzad E, et al. What is the impact of vitamin D supplementation on glycemic control in people with type-2 diabetes: a systematic review and meta-analysis of randomized controlled trails. BMC Endocr Disord. 2023 Jan 16;23(1):15.

 

 

New study demonstrates the effects of probiotic supplementation in patients with asthma

Asthma has become more prevalent over the past several decades. Many patients have managed their asthma with medication and avoiding environmental triggers.

According to a new study published last week in Allergy, Asthma & Clinical Immunology, researchers investigated the improvement of clinical asthma symptoms in patients with asthma taking probiotic supplementation.

This study was a randomized, double-blinded, placebo-controlled trial including 40 patients with asthma with a mean age of thirty-eight. Each patient was given probiotic supplementation or placebo for 8 weeks. The supplementation given was a 24 billion CFU multi-species probiotic consisting of L. acidophulus, L. rhamnosus, L. bulgaricus, B. breve, B. longum, and S. thermophilus. Assessments included pulmonary function tests, IL-4 and IFN-γ levels, and expression of microRNAs. These were obtained at baseline and after treatment.

The results demonstrated that the expression of miR-16, miR146-a and IL-4 levels after probiotic supplementation was significantly reduced and miR-133b expression was increased. In addition, the pulmonary function tests demonstrated a significant improvement in Forced Expiratory Volume in 1 s and Forced Vital Capacity after receiving probiotics.

As a result, probiotic supplementation for 8 weeks led to a reduction in Th2 cells-associated IL-4 and improved Forced Expiratory Volume and Forced Vital Capacity. Probiotics should be considered as an adjunct to traditional asthma treatment.

Probiotics exert their effects in a few different ways. They can affect the immune system providing metabolites, cell wall components and DNA. Also, probiotics can systematically affect the function of immune cells by producing short chain fatty acids (SCFAs) and modulate inflammatory responses.

This double-blind, randomized, placebo-controlled trial included 160 children ranging from 6 to 18 years of age with asthma. Each child received either a supplement of Lactobacillus paracasei, Lactobacillus fermentum, a combination of the two, or a placebo for 3 months.

Previous research has also shown a benefit of Lactobacillus probiotics in children with asthma. Compared with the placebo group, the children receiving Lactobacillus containing probiotics all had lower asthma severity and higher C-ACT scores. In addition, the group that received both Lactobacillus strains demonstrated increased peak expiratory flow rates and lower IgE levels.

Other nutrients to consider to relax the airways and provide anti-inflammatory properties include magnesium, vitamin D, vitamin C, and fish oil.

By Michael Jurgelewicz, DC, DACBN, DCBCN, CNS

Source: Sadrifar S, Abbasi-Dokht T, et al. Immunomodulatory effects of probiotic supplementation in patients with asthma: a randomized, double‑blind, placebo‑controlled trial. Allergy Asthma Clin Immunol. 2023 Jan 2;19(1):1.

New review investigates the efficacy of CoQ10 and melatonin on male infertility

Infertility effects approximately 7.3 million couples in the US. One of seven couple will experience difficulty conceiving. About 40-50% of these the cause is unknown. It may be related to toxicity, oxidative damage, poor nutritional status or nutritional deficiencies, heavy metal or environmental toxicity, systemic disorders, hormonal imbalances, xenobiotic exposure, age-related decline, or obesity.

According to a recent review published in Nutrients, researchers investigated the efficacy of CoQ10 and melatonin on male fertility.

Coenzyme Q10 is involved in mitochondrial energy production and plays a key role as

an antioxidant. In this review, CoQ10 supplementation as a monotherapy was shown to enhance sperm motility and concentration as well as improve sperm DNA fragmentation in infertile men. In addition, these results also demonstrate that CoQ10 may by itself be effective in improving conception rates. The improvement in semen parameters was followed by a higher frequency of spontaneous pregnancy and better outcomes for assisted reproductive technology (ART). The dose of CoQ10 used as monotherapy was between 200-300 mg per day.

The research team also investigated the role of melatonin in male infertility; however, the data was limited. Melatonin is a free radical scavenger demonstrating its antioxidant potential.

Animal models have shown that melatonin may contribute to gonadal physiology by modulating androgen production (both centrally and locally) by acting as an immunomodulatory compound and by influencing the progression of germ cells to spermatozoa. Clinical data in men is limited compared to the broader evidence on female fertility from ovarian aging to clinical improvement on in vitro fertilization success rate. In conclusion, preclinical data regarding melatonin show potential in the context of male infertility, but additional clinical studies are needed.

Other nutrients that may be beneficial include vitamin D, fish oil, carnitine, zinc, and inositol.

Also, one must keep in mind that exposure to endocrine-disrupting chemicals (EDCs) including Bisphenol A (BPA), Phthalates, PCBs, PBBs, PBDEs, pesticides, and heavy metals can also contribute to infertility.

It is important to minimize further exposure by eating organic produce, drink filtered water, use household products that are fragrance-free and free of phthalates and BPA, and replace non-stick pans with glass, ceramic, or cast iron.

Nutrients that can support detoxification pathways include n-acetyl-cysteine, glutathione, calcium D-glucurate, milk thistle, and sulforaphane.

By Michael Jurgelewicz, DC, DACBN, DCBCN, CNS

Source: Gianpaolo Lucignani, Letzia Maria Ippolita Jannello, et al. Coenzyme Q10 and Melatonin for the Treatment of Male Infertility: A Narrative Review. Nutrients. 2022 Nov 1;14(21):4585.

 

 

New study investigates the effects of butyrate supplementation on pediatric obesity

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.

According to a new study published earlier this month in JAMA Network, researchers investigated whether oral butyrate supplementation is effective in treating pediatric obesity.

This was a randomized, quadruple-blind, parallel-group, placebo-controlled trial including 54 patients with obesity between the ages of 5 and 17 years of age. These individuals had a body mass index (BMI) greater than the 95th percentile for sex and age. The patients in the butyrate group received sodium butyrate capsules at a dose of 20 mg/kg body weight up to a maximum dose of 800 mg per day for 6 months. The placebo group received cornstarch capsules. Children that were not able to swallow capsules, were allowed to open the capsules and dissolve them in liquid or food. Laboratory assessment included fasting glucose, insulin, and a lipid panel. HOMA-IR was calculated, and ghrelin, IL-6 levels, and gut microbiome analysis were also measured. This clinical trial took place from November 2020 through December 2021.

This was the first randomized clinical trial evaluating the effects of butyrate on pediatric obesity. As a results, the study demonstrated 6 months of supplementation with butyrate can reduce BMI and improve glucose metabolism and inflammation.

The beneficial effects of butyrate supplementation on glucose metabolism were consistent with previous data. The research team found that butyrate supplementation decreased HOMA-IR and fasting insulin levels in children with obesity. In addition, the gut microbiome analysis supported the role of butyrate in glucose metabolism, as suggested by a more positive response in children with a higher abundance of butyrate-producing bacteria at baseline.

Glutamine is also another nutrient to consider due to its benefits on modulating the microbiome and its impact on the intestinal barrier and its role in patients who are overweight or obese. Glutamine may also be altering the microbiome by decreasing the Firmicutes to Bacteroidetes ratio, which is associated with obesity.

Other nutrients that should be considered include vitamin C, fish oil, and tocotrienols.

Obesity is associated with chronic low grade inflammation, so there will be increased vitamin C and antioxidant requirements to mitigate oxidative stress.

Increasing dietary fiber or fiber supplementation should also be considered. Only about 10 percent of Americans meet their daily fiber requirements. Dietary fiber is crucial in supporting the proper microbial balance and optimizing gut health.

By Michael Jurgelewicz, DC, DACBN, DCBCN, CNS

Source: Coppola S, Nocerino R, et al. Therapeutic Effects of Butyrate on Pediatric Obesity: A Randomized Clinical Trial. JAMA Netw Open. 2022 Dec 1;5(12):e2244912.

New study demonstrates higher magnesium levels are associated with better glycemic control

Insulin resistance is preventable and reversible through lifestyle changes, proper nutrition, supplements, exercise and stress management. Weight loss and exercise are the best treatments for restoring the body’s ability to respond to insulin.

Metabolic syndrome and insulin resistance are a significant health care problem in the United States. Type 2 diabetes affects more than 300 million people. Up to 15% of patients cannot take metformin because of kidney damage risks.

There are many different cofactors that can improve dysglycemia such as zinc, alpha lipoic acid, chromium, and vanadium.

According to an observational study published last week in BMC Endocrine Disorders, researchers investigated the association between magnesium supplementation post bariatric surgery and serum magnesium levels with diabetes status after bariatric surgery.

This observational study included 403 patients with type II diabetes who underwent bariatric surgery. At baseline, 43% of the patients had a magnesium deficiency and prior to surgery these patients had poorer glycemic control (HbA1c), higher fasting glucose levels, and were taking a greater number of anti-diabetic drugs.

At the first-year post-surgery, 58% of the patients had total remission of their diabetes and 4% had partial remission. Patients that did not have a magnesium deficiency at the year mark had higher rates of total and partial remission.

Higher serum magnesium levels at baseline are an independent predictor of type II diabetes remission. The optimal cut-off level of magnesium to predict diabetes remission was 1.50 mg/dL with a sensitivity of 73% and a specificity of 58%.

As a result, patients that taking magnesium supplementation post-surgery had higher magnesium levels, better glycemic control, and higher rates of diabetes remission. The patients in the supplementation group were taking between 100 mg and 450 mg of elemental magnesium daily.

Since patients with diabetes have increased metabolic demands, they have additional micronutrient requirements for proper control of oxidant/antioxidant homeostasis.

Inositol is another nutrient that should also be considered for patients with diabetes.

Inositol acts as second messenger which regulates several hormones such as thyroid stimulating hormone and insulin.

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: Silva Mm, Neves, et al. Higher magnesium levels are associated with better glycaemic control and diabetes remission post-bariatric surgery. BMC Endocr Disord. 2022 Dec 6;22(1):303.

New study investigates low-FODMAP diet for IBS in remission of IBD

Inflammatory bowel disease (IBD) is an autoimmune condition where in most cases there are multiple triggers chronically stimulating the immune system over a long period of time in multiple ways and the immune system gets into overloaded, overwhelmed state and loses its ability to function leading to chronic inflammation causes symptoms such as diarrhea, abdominal pain, and other debilitating symptoms and anemia.

Approximately 30% with IBD have irritable bowel syndrome (IBS). Most treatments for IBS consist of medications that are often ineffective and can have numerous side effects.

According to study published six weeks ago in Nutrients, researchers investigated the effectiveness of a low-FODMAP diet in patients that meet the criteria for IBS in IBD remission.

Previous research has demonstrated the impact of diet on inflammatory bowel disease (IBD). Diets such as low FODMAP and specific carbohydrate diet (SCD) have effective in patients with IBD, whereas pro-inflammatory, western diets have been associated with IBD pathogenesis.

FODMAPs act as prebiotics and modulate the gut microbiome by stimulating the growth of beneficial bacteria and promoting the production of short-chain fatty acids, so a low-FODMAP diet might be characterized as anti-prebiotic because of its reduction in beneficial bacteria species.

This study included 59 patients that followed a low-FODMAP diet for 6 weeks. Assessments included IBS diagnostic criteria, anthropometric measurements, laboratory tests and a lactulose hydrogen breath test. After the six-week period, IBS-like symptoms were not present in 66% of the participants. This included flatulence and diarrhea. The diet had no effect on constipation or IBD activity markers of inflammation including fecal calprotectin and CRP levels. This is most likely because these individuals were in remission and not in a current disease state with their IBD. In addition, the lack of improvement of constipation makes sense as this diet was reducing their intake of dietary fiber. As a result, this study demonstrates the beneficial effects of dietary interventions for patients with IBS symptoms.

The gastrointestinal tract is the body’s ‘second brain,’ it is made up of a self-contained, complex network of neurons, neurotransmitters, and proteins embedded in the lining of the GI system. It is responsible for all aspects of the digestive process, from the esophagus to the stomach and small and large intestines and may be responsible for IBS symptoms.

There are other nutrients that can support patient with IBS. For example. Perilla frutescens is an herb native to Eastern Asia that demonstrates antispasmodic, prokinetic, and anti-inflammatory effects, which help normalize and promote health bowel function and provide relief from GI symptoms.

There remains a large disconnect between the medical research and what is experienced visiting a doctor in everyday practice. The research demonstrates the significance nutrition and nutrients and their essential role in chronic disease states.

By Michael Jurgelewicz, DC, DACBN, DCBCN, CNS

Source: Wiecek M, Panufnik P, et al. Low-FODMAP Diet for the Management of Irritable BowelSyndrome in Remission of IBD. Nutrients 2022 Oct 29;14(21):4562.

New review investigates the role of vitamin D and beta cells in type 1 diabetes

There has been a significant increase in the incidence of autoimmune disorders over the past several decades. For every 1,000 Americans, approximately one and five people have Type 1 diabetes.

Type 1 diabetes typically develops when the body’s own immune system attacks the pancreas and prevents the production of insulin.  

According to new review published last week in International Journal of Molecular Sciences, researchers investigated the role of vitamin D and beta cells in type I diabetes.

Vitamin D deficiency has been linked to many autoimmune diseases, including type 1 diabetes, systemic lupus erythematosus, multiple sclerosis, and IBD, with studies finding a higher prevalence of these diseases in those who are deficient in vitamin D.

Vitamin D receptor is one of the most highly expressed transcription factors in β-cells in mice. In general, most animal studies show that a vitamin D deficiency increases the risk of Type I diabetes and providing vitamin D treatment reduces the risk.

Human studies have demonstrated that serum vitamin D have been positively associated with higher C-peptide. In addition, most studies find that circulating vitamin D levels are lower in people with type I diabetes.

This review consisted of 13 studies that included between 15 and 72 type I diabetic patients. These patients were between 5 and 39 years of age although most were children.

Most of the results in the studies showed variable results, however, an open label RCT of 70 newly diagnosed patients showed complete preservation of baseline C-peptide as well as significantly lower insulin requirements at 3 and 6 months while vitamin D supplementation.

There are strong associations between type I diabetes and low circulating vitamin D levels as well as adequate vitamin D status early in life reducing the risk of diabetes.

This review suggests that optimizing vitamin D levels is important to reduce the risk of type I diabetes as it may have the potential in delaying the onset C-peptide deficiency. It is important to note that there is near-complete loss of β-cells by the time of clinical diagnosis, so vitamin D supplementation is much less likely to be useful at this point on impacting C-peptide.

Given the safety of vitamin D supplementation, its immunomodulation, and anti-inflammatory effects as well as its known benefits on the preservation of C-peptide on long-term complications risk, patients should consider optimizing vitamin D levels through supplementation.

Autoimmunity can occur a few different ways. First, there can be a mistaken identity and the body attacks itself. This can occur with a virus where there is tissue destruction and it appears to be foreign to the body. Second, is called molecular mimicry. This occurs when the body makes an antibody (a protein in the body that attacks objects in the body that appear to be foreign) to a specific antigen. These antigens can resemble certain proteins in the body and the antibodies attack our body’s own tissues. Third, is the development of the T cells (the immune system). This can be affected by genetics, stress, and environmental triggers.

Environmental triggers are what integrative doctors mainly work with in functional medicine. 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. Finally, there are 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.

By Michael Jurgelewicz, DC, DACBN, DCBCN, CNS

Source: Yu Josephine, Sharma P, et al. Vitamin D and Beta Cells in Type 1 Diabetes: A Systematic Review. Int J Mol Sci. 2022 Nov 20;23(22):14434.

New study investigates the effects of vitamin D supplementation on depression

Depression is a major cause of disease burden worldwide which affects approximately 350 million people. Although there are numerous medications for the treatment of depression, less than 50% of patients take medications for depression.

According to a new study published 2 weeks ago in BMC Psychiatry, researchers investigated the effects of vitamin D supplementation on depression and inflammatory biomarkers.

This study was an 8-week double blinded randomized clinical trial (RCT) including 56 patients with mild to moderate depression ranging from 18 to 60 years of age between May 2018 and June 2019. Each patient was randomly assigned to 50,000 IU of vitamin D or a placebo every two weeks over an 8-week period. Assessments included vitamin D 25-OH, intact parathyroid hormone (iPTH), interlukin (IL)- 1β, IL-6, high sensitivity C-reactive protein (Hs-CRP) and depression severity (Beck Depression-II)(BDI-II).

As a result, increased vitamin D levels following 8-weeks of vitamin D supplementation led to a significant decrease in BDI-II scores in patients with mild to moderate depression. However, vitamin D supplementation did not significantly affect the inflammatory biomarker concentrations. It is important to note that most of the patients had normal levels of vitamin D at baseline.

Vitamin D effects on the brain is due to the production of the active form of vitamin D in the brain and gene expression of VDRs in areas associated with mood and social behaviors.

Other nutrients to consider include essential fatty acids as most individuals are often deficient. Fish oils are essential for one’s overall health and reduce inflammation. 

Also, some natural alternatives to anti-depressants include Sceletium tortuosum and Saffron flower. Sceletium tortuosum has attracted increasing attention over past few decades for promoting a sense of wellbeing and treating depression andSaffron flower has had numerous studies demonstrating positive outcomes on MDD and has gone head to head with SSRIs demonstrating the same efficacy. Additional considerations include bacillus coagulans and melatonin.

By Michael Jurgelewicz, DC, DACBN, DCBCN, CNS

Source: Kaviani M, Nikooyeh B, et al. Effects of vitamin D supplementation on depression and some selected pro-inflammatory biomarkers: a double-blind randomized clinical trial. BMC Psychiatry. 2022 Nov 11;22(1):694.

New study investigates the effects of citrulline supplementation on endothelial function and blood pressure in hypertensive postmenopausal women

According to a study published this month in Nutrients, researchers investigated the effects of citrulline supplementation on endothelial function and blood pressure in hypertensive postmenopausal women.

Citrulline is an amino acid that is converted to arginine in various cells. Unlike arginine, citrulline is not metabolized in the intestine or liver and does not induce tissue arginase. It inhibits arginase, and citrulline entering peripheral tissues, specifically the kidneys and vascular endothelium and may be readily converted to arginine, thus raising arginine levels, and enhancing nitric oxide production.

Studies have shown that citrulline raises plasma arginine levels significantly higher than arginine itself and has a longer half-life in the body, so citrulline can be thought of as a potent “time-released arginine.”

Aging and menopause are associated with a reduced nitric oxide bioavailability due to reduced L-arginine levels that leads to endothelial dysfunction. This precedes arterial stiffness as well as hypertension development.

 This randomized controlled trial investigated the effects of L-citrulline supplementation on endothelial function, aortic stiffness, and blood pressures in hypertensive postmenopausal women. This study included 25 postmenopausal women between the ages of 50 to 74 years of age that were randomized to take wither 4 weeks of L-citrulline at 10 grams per day or a placebo. Assessments included serum L-arginine, brachial artery flow-mediated dilation, aortic stiffness, and blood pressure measured at baseline and 4 weeks later.

As a result, the L-citrulline supplementation group showed increased L-arginine levels and brachial artery flow-mediated dilation compared to the placebo. In addition, the resting aortic diastolic blood pressure and mean arterial pressure were significantly decreased after 4 weeks of L-citrulline supplementation compared to placebo.

In conclusion, these findings demonstrate that L-citrulline supplementation improves endothelial function and blood pressure by increasing L-arginine availability. Other nutrients to consider include magnesium, taurine, and L-arginine.

By Michael Jurgelewicz, DC, DACBN, DCBCN, CNS

Source: Maharaj A, Fischer S, et al. Effects of L-Citrulline Supplementation on Endothelial Function and Blood Pressure in Hypertensive Postmenopausal Women. Nutrients. 2022 Oct 20;14(20):4396.

New review investigates vitamin C and the management of diabetic foot ulcers

Insulin resistance is preventable and reversible through lifestyle changes, proper nutrition, supplements, exercise and stress management. Weight loss and exercise are the best treatments for restoring the body’s ability to respond to insulin.

Metabolic syndrome and insulin resistance are a significant health care problem in the United States. Type 2 diabetes affects more than 300 million people. Up to 15% of patients cannot take metformin because of kidney damage risks.

There are many different cofactors that can improve dysglycemia such as zinc, alpha lipoic acid, chromium, and vanadium.

According to a review published last month, researchers investigated the role of vitamin C and the management of diabetic foot ulcers.

This review consisted of seven studies ranging from 16 patients to 131 patients. The dosing ranged from 500 mg to 1000 mg per day or vitamin C status over an 8-to-16-week period.

Diabetic foot ulcers are complicated wounds resulting from the dysfunction of several major body systems that interfere with healing processes in which vitamin C plays an important role.

Vitamin C has been shown to improve neuropathic complications in individuals with diabetic foot ulcers. It also supports vascular function essential in wound healing and responds to oxidative stress in infections that interfere with healing.

Numerous studies have demonstrated an association between vitamin C deficiency and diabetic foot ulcer development, severity, and outcomes. Only a few clinical studies have evaluated increased vitamin C intake or supplementation for the prevention or treatment of diabetic foot ulcers.

The studies in this review between 2012 and 2021 demonstrated that vitamin C supplementation improves healing of foot ulcers and mitigate oxidative stress. There is also a high prevalence of vitamin C deficiency in these patients.

As a result, diabetic individuals have additional micronutrient requirements for proper control of oxidant/antioxidant homeostasis.

Inositol is another nutrient that should also be considered for patients with diabetes.

Inositol acts as second messenger which regulates several hormones such as thyroid stimulating hormone and insulin.

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.

Since diabetes is an increased risk factor for cognitive decline, other nutrients such as phosphatidylserine, GPC, and acetyl-l-carnitine are important. Phosphatidylserine is an essential brain nutrient that has been shown to improve the brain’s energy consumption of glucose.

By Michael Jurgelewicz, DC, DACBN, DCBCN, CNS

Source: Khanh Phuong Tong, Robert Intine, et al. Vitamin C and the management of diabetic foot ulcers: a literature review. J Wound Care. 2022 Sep 1;31(Sup):S33-S44. doi: 10.12968/jowc.2022.31.Sup9.S33.