January 24, 2021

New study demonstrates the role of fiber in rheumatoid arthritis

Most individuals have a less-than-perfect diet, which is high in calories, short on nutrients, and the majority are not getting enough fiber in their diet. Over the past several decades Americans have lost much of the diversity in their diet which plays an essential role in the gut microbiome and a contributing factor in the epidemic of autoimmune disorders. Only about 10 percent of Americans meet their daily fiber requirements. More and more research demonstrates that the food one eats affects what bacteria populations are in their gut.

 A significant environmental trigger in autoimmune disease is the diet. Dietary approaches provide the most effective means to returning balance and dysfunction with the gastrointestinal system. According to a new study published Monday in Nutrients, researchers demonstrated the role of dietary fiber in rheumatoid arthritis.

 This study included 36 patients with rheumatoid arthritis (RA) in clinical remission. All of the patients continued their current medication throughout the study. They consumed either a high-fiber bar or cereal for a 28-day period. Laboratory assessment included biomarkers of intestinal inflammation, intestinal permeability, and adaptive T cell-related immunity taken at baseline and at the end of the study. In addition, measurements of disease activity, physical function, and quality of life were assessed. As a result, researchers noted an increase in T regulatory cell numbers, a positive Th1/TH17 ratio, and decreased bone erosion demonstrated by a significant reduction in serum collagen fragments (CTX-1). In addition, IgM rheumatoid factor and IgG anti-citrullinated protein antibodies slightly decreased and the anti-citrullinated vimentin p18 peptide antibody levels significantly decreased after the high-fiber supplementation. Also, serum calprotectin and zonulin were significantly reduced after treatment.

 The gut plays an essential role in immune function as well as digesting and absorbing one’s food. The intestinal barrier provides an effective barrier from pathogenic bacteria as well a healthy environment for beneficial bacteria.

A high fiber diet leads to the production of short chain fatty acids (SCFAs) in the gastrointestinal tract. These play an essential role in T regulatory cell activation, which regulates the intestinal immune system. If there is dysregulation in the immune system, there can be increase inflammation increasing disease severity.

In addition to increasing fiber and following a strict gluten-free diet, other nutrients to consider include vitamin D, fish oil, resveratrol, curcumin, and probiotics.

Autoimmunity can occur a few different ways. It is also important to look at any environmental triggers such as food sensitivities, nutrient status, toxins, and gut health. Each person’s biochemical individuality exerts a major influence on his or her health. The level of nutrient intake, lifestyle choices and environmental exposures filtered through genetic predisposition are major factors in the expression of disease, and a successful treatment approach must investigate these factors.

By Michael Jurgelewicz, DC, DACBN, DCBCN, CNS

Source: Hager J, Bang H, et al. The Role of Dietary Fiber in Rheumatoid Arthritis Patients: A Feasibility Study. Nutrients. 2019. Oct 7;11(10).





New study demonstrates the association of EPA and DHA blood concentrations and 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 last Wednesday in the European Journal of Nutrition, researchers demonstrated that higher red blood cell concentrations of EPA and DHA are associated with decrease in depressive treatment.

This study was a double-blinded, randomized, controlled trial including 112 individuals. Each participant took a combination product including 1 gram of EPA and 656 mg of DHA along with other nutrients including SAMe, zinc, 5-HTP, folinic acid, and co-factors or placebo for an 8-week period. Brain-derived neurotropic factor (BDNF) and omega 3 fatty acid concentrations were significantly higher in the nutraceutical group. There was also a decrease in omega-6 fatty acid levels and arachidonic acid to EPA ratio. In addition, there was significant improvement in the Montgomery–Asberg Depression Rating Scale (MADRS) score from baseline to week 8. As a result, greater increases in EPA and DHA concentration were associated with a greater improvement in depressive symptoms.

There are potentially several mechanisms of essential fatty acids in depression. EPA and DHA both influence cell membrane fluidity. In addition, they mitigate oxidative stress and inflammation which has been linked to depression. The study demonstrated that EPA had the strongest antidepressant effect from fish oil, which has been consistent with previous research.

EPA and DHA have similar effects as compared to previous meta-analyses of those taking antidepressants. This effect is greater in studies where participants were supplementing with higher doses of EPA. The research suggests that it is not the ratio of EPA vs DHA that is important, but the higher EPA dose. It is interesting that EPA seems to be responsible for the beneficial effects of omega fatty acid supplementation while DHA concentrations appear to vary more between patients and controls. We must consider that the beneficial effects of EFA supplementation are not because the supplementation corrects a membrane DHA insufficiency, but due to the anti-inflammatory properties of EPA.

Essential fatty acids should be consumed in everyone’s diets for overall health, but most individuals are often deficient. Fish oils are essential for one’s overall health and reduce inflammation. 

Also, one should consider natural alternatives to anti-depressants such as 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.

By Michael Jurgelewicz, DC, DACBN, DCBCN, CNS Source: Van der Burg KP, Cribb L, et al. EPA and DHA as markers of nutraceutical treatment response in major depressive disorder. Eur J Nutr. 2019 Sept 25.

New research links amount of gluten in early life and risk of 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.

There has been increasing evidence of the correlation between the gut and Type I diabetes. Alessio Fasano, MD brought this to everyone’s attention in “Surprises from Celiac Disease” published in Scientific American August 2009. In this article he discusses the role of zonulin and intestinal permeability and its role in many autoimmune diseases such as celiac disease, type I diabetes, MS, and rheumatoid arthritis.

According to new research just published in Diabetologia and presented at the Annual Meeting of the European Association for the Study of Diabetes (EASD) in Barcelona, Spain September 16 to 20th demonstrated that a child’s intake of gluten at 18 months of age is associated with a 46% increased risk of developing type 1 diabetes for each extra 10 grams of gluten consumed per day. There was no association between the maternal intake of gluten during pregnancy and type 1 diabetes.

The new study included 86,306 children in The Norwegian Mother and Child Cohort Study born from 1999 to 2009 and followed up until April 2018. The study investigated the association between the maternal gluten intake during pregnancy, child’s gluten intake at age 18 months, and the risk of type 1 diabetes. The clinical outcome was the diagnosis of type 1 diabetes based upon a nationwide childhood diabetes registry. An Increased risk was calculated using statistical modelling for maternal gluten intake during pregnancy and child’s gluten intake at 18 months. The research team estimated the amount of gluten intake from a food frequency questionnaire at week 22 of pregnancy and from a questionnaire completed when the child was 18 months of age.

As a result, 346 children (0.4%) developed type 1 diabetes. The average gluten intake was 13.6 grams per day for mothers during pregnancy and 8.8 grams per day for the child at 18 months of age. Maternal gluten intake during pregnancy was not associated with the development of type 1 diabetes, however, the child’s gluten intake at 18 months of age demonstrated an increased risk of later developing type 1 diabetes. This risk increased by 46% for each 10g per day increase in gluten intake.

There is some evidence that gluten intake may influence the gut microbiota and induce inflammation and contribute to intestinal hyper-permeability. Since these results demonstrate the highest risk of developing T1D is in the group with the highest gluten consumption, simply reducing gluten intake may be enough to reduce risk and complete avoidance may not be necessary.

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.

It has not been determined if Type 1 diabetes’ signature effect on the gut is caused by or the result of the body’s own attacks on the pancreas but It is essential to investigate into these factors for all patients with autoimmunity.

By Michael Jurgelewicz, DC, DACBN, DCBCN, CNS Source: N.A. Lund-Blix, G. Tapia, et al. Amount of gluten in early life and risk of type 1 diabetes. Diabetologia. September 2019, Volume 62, Supplement 1, pp S184-185.

New review examines the effect of B vitamin supplementation on mood, depression, anxiety, and stress.

B vitamins are essential nutrients involved in numerous metabolic processes that play a significant role in brain health. Due to the increasing number of individuals with mental health issues, researchers are looking more and more at nutrients to prevent or reduce this incidence.

According to a new review published Monday in Nutrients, researchers investigated the effects of B vitamin supplementation on mood, depression, anxiety, and stress.

This review consisted of 18 studies including over 2000 participants over the age of 18 involving a B vitamin supplement containing at least 3 B vitamins with a minimum study duration of 4 weeks. The rationale is that multiple vitamins would be more efficacious than single nutrients. Studies published after 1999 were only accepted. All of the studies used supplements containing B6 and B12, with all but one study including folate. Vitamins B1, B2, B3, and B5 were included in 16 of the 18 included studies. Biotin was the least included and was only in 10 of the studies. Most of the supplements contained twice the recommended daily value of B vitamins and some exceeded the intake by 10 to 300 times. Eleven of these studies demonstrated a positive effect of B vitamins for overall mood. Eight of these studies were in an ‘at-risk’ population and five were found to have a significant benefit on mood. Total well-being and mood was assessed by either a General Health Questionnaire (GHQ) or Profile of Mood States (POMS) B vitamin supplementation was also shown to benefit stress, which was assessed utilizing the Perceived Stress Scale (PSS).

The research team also investigated B vitamin supplementation and its effects on depression and anxiety. As a result, a benefit on depressive symptoms did not reach clinical significance and there was no effect on anxiety. This review demonstrates the benefit of B vitamin supplementation in healthy and at-risk populations on mood and stress, but not for depression or anxiety.

Previous research has reported that up to 30% of patients that suffer from depression have elevated homocysteine, therefore, B vitamin supplementation would support lowering these levels and improving mood.

There was an interesting study published January 6, 2016 in the Journal of Alzheimer’s Disease. Previous studies have already established that B vitamins can slow cognitive. The research team initially found that there was a link between Omega-3 levels, homocysteine, and brain atrophy rates. There have been links between homocysteine and omega-3 fatty acids. Homocysteine plays a role in regulating phospholipid metabolism and omega-3 distribution by the methionine cycle. As a result, B vitamins are essential for the synthesis of phospholipids.  In this study researchers investigated whether omega-3 fatty acid status had an effect on the treatment of B vitamins in mild cognitive impairment (MCI).

This study demonstrated that B vitamins had no effect on cognitive decline in MCI when omega-3 levels are low. However, when omega-3 levels are in an upper normal range, B vitamins slow cognitive decline and brain atrophy. These findings suggest that a combination of fish oil supplements and B vitamins may help to improve cognition and the importance of synergy as dysfunction and symptoms are often due to multifactorial causes.

Also, we should consider natural alternatives to anti-depressants such as 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 mild clinical depression and has gone head to head with SSRIs and tricyclic antidepressants demonstrating the same efficacy.

Previous research has also demonstrated that probiotics, specifically multispecies formulations, can have beneficial effects on mood and cognition. There is definitely a gut-brain relationship between nutrition and the gut microbiome and how they support brain health and function. The gut and brain communicate through the nervous system, immune system, and hormones. The microbiome can also release neurotransmitters.

By Michael Jurgelewicz, DC, DACBN, DCBCN, CNS Source: Lauren M Young, Andrew Pipingas, et al. A Systemic Review and Meta-Analysis of B Vitamin Supplementation on Depressive Symptoms, Anxiety, and Stress: Effects on Healthy and ‘At-Risk’ Individuals. Nutrients. 16 September 2019, 11(9), 2232.

New review demonstrates the role of probiotics in Irritable Bowel Syndrome

Irritable bowel syndrome (IBS) can be debilitating condition consisting of cramping, abdominal pain, bloating, gas, diarrhea and constipation. IBS can affect and one’s work, sleep and relationships.

The gastrointestinal tract is considered to be 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.

A variety of factors have been associated with IBS such as genetic susceptibility, infections, small bowel intestinal overgrowth, deficiencies in tight junction proteins, intestinal abnormalities with bile acid metabolism, changes in GI motility, visceral hypersensitivity, dysregulation of the interaction between the CNS and enteric nervous system, as well as psychosocial factors.

According to a new published this week, researchers investigated the effects of probiotic supplements on irritable bowel syndrome symptoms.

Previous animal studies have demonstrated effects of gut microbiome on brain function and behavior as well as the influence of the brain on the composition of microbes in the gut.

This review included 11 random controlled trials within the last 5 years evaluating the effects of probiotic supplementation on IBS symptoms. As a result, seven studies demonstrated a significant improvement in IBS symptoms compared to the placebo and the other four studies did not. It is important to note that three of the studies used only a supplement containing only one strain compared to the other eight that used a multi-strain probiotic. In conclusion, the clinical benefits in IBS were seen in multi-species probiotics give over an 8-week period.

The two most common genus studied were Lactobacillus and Bifidobacterium. Previous studies have reported both increased or decreased amount of Lactobacillus and reduced amounts of Bifodobacterium in IBS patients.

One may need a combination of botanicals, enzymes, fiber, and probiotics to optimize the gastrointestinal environment. Specific diets like the low-FODMAP diet should be considered. Certain diagnostic tests may also be beneficial, including stool testing as well as food antibody testing as certain diets and probiotics can be personalized based on an individual’s gut microbial profile.

By Michael Jurgelewicz, DC, DACBN, DCBCN, CNS Source: Dale HF, Rasmussen SH, et al. Probiotics in Irritable Bowel Syndrome: An Up-to-Date Systematic Review. Sept 2, 2019. Nutrients 2019, 11(9), 2048.

CoQ10’s effects on inflammatory markers in chronic inflammatory states

CoQ10 is a powerful antioxidant and vitamin-like nutrient that provides protective properties against oxidative stress. It is naturally found in the diet and is also an endogenous compound. Previous research of CoQ10 supplementation on biomarkers of glucose metabolism, lipids, inflammation, and oxidative stress have been inconsistent.

According to a review published recently in Pharmacological Research, CoQ10 was investigated as an anti-inflammatory agent, which would be beneficial in chronic disease states.

This systematic literature review consisted of 9 randomized, placebo controlled trials including at total of 509 patients. There were 269 patients in the CoQ10 group and 240 patients in the control group. Laboratory assessment included tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6) levels. Elevation of these levels have been correlated with several chronic conditions such as obesity, type II diabetes, metabolic syndrome, cardiovascular disease, non-alcoholic fatty liver disease, cancer, and others. As a result, CoQ10 supplementation was shown to significantly reduce TNF-α and IL-6 levels. The studies ranged from a two to three-month period and dosing ranged 60 mg up to 500 mg per day.

After 40 years of age the body’s cells are typically less able to produce antioxidants and soak up free radicals making them more susceptible to damage and death. In addition, CoQ10 synthesis may decline due to the aging process, stress, chronic disease, or increased demand.

This meta-analysis of randomized, placebo controlled trials demonstrates that CoQ10 can have a significant effect among patients in a chronic inflammatory state.

Other dietary supplements that have been shown to be effective for mitigating chronic low-grade inflammation in aging include tocotrienols, geranylgeraniol, fish oil, and high dose probiotics. There are eight vitamin E isomers, however, delta and gamma-tocotrienols have the most potent antioxidant properties.

Geranylgeraniol (GG) is also an endogenous compound naturally found in foods that plays an important role in biological processes. Since GG is part of the structure of CoQ10, having low CoQ10 levels is a marker of low GG status as well.

The studies on omega-3 fatty acid supplementation had dosing ranges of 1-4 grams per day over a duration of 4 to 48 weeks.

Probiotics at higher doses influence immunity and decrease influence ways lower dose probiotic cannot. There is evidence that age-related changes in the gut microbiome may be related to elevated inflammatory makers and other geriatric conditions such as sarcopenia, frailty, cognitive decline secondary to reduced short chain fatty acid production. In addition, the immune system has a tendency to decline with age which makes us more susceptible to infections as well as increasing our risk of other diseases. Probiotics have the potential to rebalance gut microbiota and modulate gut immune response inhibiting the NF-κB pathway.

Previous research has demonstrated how the gastrointestinal tract changes with aging and how this impacts overall health. As one ages, the gut has an increase in interleukin 6 (IL-6) which causes the immune system to release IL-6 and trigger inflammation.

Increased levels of IL-6 directly lead to increased intestinal permeability with no physical differences seen in its structure. They also showed there was an association with a decreased immune response to microbes with aging, which may contribute to an increased susceptibility to infection.

By Michael Jurgelewicz, DC, DACBN, DCBCN, CNS Source: Vafa M. Can coenzyme Q10 supplementation effectively reduce human tumor necrosis factor-α and interleukin-6 levels in chronic inflammatory diseases? A systematic review and meta-analysis of randomized controlled trials. Pharmacol Res. 2019 Jun 8; 104290.

New study demonstrates the effect of hesperidin in nonalcoholic fatty liver disease

Fatty liver disease and Non-alcoholic steatohepatitis (NASH) are an increasing epidemic in the U.S. and the rest of the world. It is the leading cause of abnormal liver enzymes and is associated with diabetes and obesity. Long term hyperglycemia causes an increase in the synthesis of fatty acids and triglycerides in the liver leading to fatty liver.

At this time there are few guidelines for diagnostic and follow up methods and limited proven treatment options. Previous research of pharmacological agents to treat nonalcoholic fatty liver disease (NAFLD) were performed with poor results.

According to a new study published this month in Phytotherapy Research, researchers investigated the effects of hesperidin in hepatic steatosis, liver enzymes, and inflammatory and metabolic biomarkers in patients with nonalcoholic fatty liver disease (NALFD).

This randomized, double-blind, controlled clinical trial included 50 patients with NAFLD. Each patient supplemented with either 1 gram of hesperidin or placebo for 12 weeks. During the treatment each group was advised to follow healthy lifestyle habits including dietary and physical activity recommendations. At the end of the study, the patients in the hesperidin group demonstrated a significant reduction in alanine aminotransferase (ALT), γ-glutamyltransferase (GGT), total cholesterol, triglyceride, hepatic steatosis, high-sensitivity C-reactive protein, tumor necrosis factor-α, and nuclear factor-κB (NF-κB).

As a result, this study demonstrates that hesperidin supplementation along with lifestyle modification is superior to lifestyle modification alone in management of NAFLD and improving lipid parameters. 

Insulin resistance, diabetes, obesity, and metabolic syndrome are all major key factors in the development of NAFLD, primarily driven by the excess intake of sugar.

Previous research has demonstrated that patients with diabetes and metabolic syndrome due to increased metabolic and nutrient demands have vitamin C insufficiency. Hesperidin is the most active bioflavinoid in citrus based fruits such as oranges, lemons, and grapefruit, and facilitates the formation of vitamin C complex.

Other nutrients to consider include fish oil, tocotrienols, and probiotics. Numerous studies have demonstrated low polyunsaturated fat and the development of pathogenesis of NAFLD. In addition, supplementation with fish oil was associated with mitigating the disease process and improving lipid markers and insulin resistance in patients with NAFLD. Fish oil supplementation restores insulin sensitivity and exerts anti-inflammatory actions. In addition, fish oil significantly reduces liver enzymes. Dosing ranges have been studied between 1 to 4 grams per day.

Tocotrienol supplementation has also been demonstrated to reduce liver enzymes as well as improve both inflammatory and oxidative stress markers in patients with NALFD. Dosing used has been 300 mg twice daily.

Probiotics also play a role in improving NAFLD. They restore the gastrointestinal barrier function, modulate the immune system, and inhibit the proliferation of harmful bacteria. Probiotics have been shown to reduce liver fat and improve liver enzymes. Probiotics are likely most effective by preventing bacterial translocation and reducing the effects of the intestinal microbiota on the liver.

It is essential to encourage a restricted carbohydrate diet and exercise to support weight loss in these individuals. They have established disease and increased demands then what could be obtained from the diet alone and therefore, dietary supplements should be considered to mitigate to help reduce the progression and improve liver function in patients with NAFLD.

By Michael Jurgelewicz, DC, DACBN, DCBCN, CNS Source: Cheraghpour M, Imani H, et al. Hesperidin improves hepatic steatosis, hepatic enzymes, and metabolic and inflammatory parameters in patients with nonalcoholic fatty liver disease: A randomized, placebo-controlled, double-blind clinical trial. Phyother Res. 2019 Aug;33(8):2118-2125.

Researchers demonstrate the efficacy of omega-3 fatty acid supplementation in patients with asthma

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

According to a new study published earlier this year, researchers demonstrated the efficacy of omega-3 fatty acid supplementation in patients with bronchial asthma.

In this study researchers compared the efficacy of omega-3 fatty acids and sublingual immunotherapy in patients with bronchial asthma. Assessments included the asthma control test (ACT), peak expiratory flow rate (PEFR), forced expiratory volume in the first second (FEV1) and serum interleukin 17A (IL17A) in patients with mild to moderate persistent asthma. Serum 17A levels are used as a marker to demonstrate the efficacy of treatment.

This study included 48 patients divided into two groups. One group of 24 patients was treated with sublingual immunotherapy for 6 months and the second group was given omega-3 fatty acid supplementation for a 3-month period. As a result, there was a significant difference in each parameter between before and after treatment. Also, the omega-3 fatty acid group was shown to be more effective than sublingual immunotherapy in decreasing IL17A, however, both were effective in decreasing PEFR, FEV1 and ACT.

Since the pathophysiology of asthma is multifactorial as with many chronic diseases, there are several other nutrients that can support and modulate the underlying dysfunction and immune response.

Previous research has demonstrated Lactobacillus supplementation improves asthma severity. Individuals receiving Lactobacillus containing probiotics all had lower asthma severity and higher ACT scores. In addition, the group that received both Lactobacillus strains demonstrated increased peak expiratory flow rates and lower IgE levels.

Low serum vitamin D levels have also been linked to an increased risk of asthma. There was a previous study from the journal Allergy which demonstrated that Vitamin D could help manage asthma attacks. Asthma patients with a Vitamin D deficiency were 25% more likely than other asthmatics to have had at least one flare-up in the recent past.

We know vitamin D has significant immunomodulatory effects and it has been shown to have an effect on asthma. Vitamin D has been shown to promote T regulatory cells and has been proposed as one of the causes of the increased prevalence of asthma.

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

By Michael Jurgelewicz, DC, DACBN, DCBCN, CNS Source: Abdo-Sultan MK, Abd-El-Lateef RS, et al. Efficacy of Omega-3 Fatty Acids Supplementation versus Sublingual Immunotherapy in Patients with Bronchia Asthma. Egypt J Immunol. 2019 Jan;26(10):79-89.

New study demonstrates the effect of vitamin D supplementation on insulin sensitivity and secretion

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 associated with an increased risk of developing diabetes, however, some studies have shown no effect on metabolic function. These studies had few participants or often included individuals with normal levels of vitamin D or had long standing disease.

According to a new study published in July, researchers demonstrated that vitamin D supplementation may slow the progression of diabetes by increasing peripheral insulin sensitivity and β-cell function in newly diagnosed diabetes patients.

This randomized, placebo controlled trial included individuals at high risk of type II diabetes or newly diagnosed with diabetes. Vitamin D supplementation was given at 5,000 IU daily for six months. Markers of insulin function and glucose metabolism including an oral glucose tolerance test, HbA1c, and anthropometry were taking at baseline and at six months.

Although only 46% of the individuals had low vitamin D levels at the beginning of the study, vitamin D supplementation significantly improved the action of insulin in muscle tissue of participants after six months.

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 and tocotrienols. 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: Lemieux P, Weisnagel JS, et al. Effects of 6-month vitamin D supplementation on insulin sensitivity and secretion: a randomized, placebo controlled trial.





New review investigates the potential benefits of probiotics in metabolic disorders

According to a new study published last week in Nutrients, researchers investigated the potential benefits of probiotics in metabolic diseases including obesity, type 2 diabetes, hypertension, and dyslipidemia. Previous research has demonstrated the association of the gut microbiome with metabolic markers and type II diabetes.

In this study, researchers designed a cross-sectional study using data from the National Health and Nutrition Examination Survey (NHANES) from 1999 to 2014. Probiotic consumption was considered when an individual reported eating yogurt or a probiotic supplement during the 24-hour recall or the Dietary Supplement Use 30-Day questionnaire. This study included 38,802 individuals and 13.1% reported consuming probiotics. As a result, the incidence of obesity and hypertension was lower in the probiotic group. Body mass index (BMI), systolic and diastolic pressure, and triglycerides were all lower and HDL was higher in the probiotic group.

Previous research has shown that it is not the body fat alone but the increased low grade inflammation and metabolic dysfunction causing disease. This promotes insulin resistance in the liver and the release of inflammatory mediators from the adipose tissue. In addition, increased intestinal permeability allows translocation of proinflammatory lipopolysaccharides.

There is evidence that age-related changes in the gut microbiome may be related to elevated inflammatory makers. As one ages, the gut has an increase in interleukin 6 (IL-6) which causes the immune system to release IL-6 and trigger inflammation. Increased levels of IL-6 directly lead to increased intestinal permeability with no physical differences seen in its structure. Probiotics have the potential to rebalance gut microbiota and modulate gut immune response inhibiting the NF-κB pathway.

Other research has indicated that obesity has a microbial component that alters the caloric extraction from ingested food. For example, if one has more Bacteroidetes bacteria, the individual tends to be leaner. High Firmicutes:Bacteroidetes ratios have been known to increase the caloric extraction from food and these individuals tend to be more obese. This also ties together the importance of dietary fiber, prebiotics, and weight loss.

I remember when I was at a probiotic workshop a few years ago at Yale, Max Nueuwdrop, MD, PHD, an internist and endocrinologist, from Amsterdam presented on this topic. He went into detail on the microbiota and metabolism.  He described how butyrate, a SCFA, improved insulin resistance and brown fat activation. In general, low short chain fatty acids (SCFAs) are associated with low diversity and abundance of the commensal bacteria. When patients introduce probiotics and increase their dietary fiber intake by consuming fruits and vegetables, the beneficial bacteria butyrate, and SCFAs increase.

Probiotics help encourage microbial diversity, especially if the probiotic supplement is of mixed species. In ecological terms, it is more stable to have diverse populations in any ecosystem. The same is true for the gastrointestinal microbiome. This large scale study demonstrates the potential benefits of probiotic supplementation in patients with obesity and hypertension.

By Michael Jurgelewicz, DC, DACBN, DCBCN, CNS

Source: Lau E, Neves JS, et al. DIM, Probiotic Ingestion, Obesity, and Metabolic-Related Disorders: Results from NHANES, 1999–2014. Nutrients 2019, 11(7), 1482.